Annals of Ibadan postgraduate medicine最新文献

Background: Periodontal disease is a complex multifactorial disease resulting from the interplay amongst microbiota, host immune response (influenced by genetic make-up) and lifestyle factors. The chronic inflammatory nature of the disease results in the destruction of the component of the periodontium. The process of the disease is associated with inflammation, collagen degradation and, bone loss which correlate with clinical features of periodontal disease. The clinical diagnosis of periodontal disease entails clinical examination involving the evaluation of probing depth, bleeding on probing, and radiographic examination of alveolar bone loss but these examinations are not enough to determine the activity, progression and, evaluation of the efficacy of the periodontal disease treatment. Given the foregoing gap in the traditional method of diagnosing periodontal disease, research on the molecular disease, biomarkers became imperative. The aim of this review is to summarize the current knowledge of salivary biomarkers of periodontal disease and to evaluate their validity in predicting disease progression.

Methods: This narrative overview of 46 articles bordering on biomarkers of periodontal disease was conducted between 2000 to 2023, and assessed in Google Scholars, PubMed/Medline, Science Direct Database using keyword combined with Boolean operators. This was done following literature search; articles title, abstract evaluation and full-text reading studies.

Results: The present review comprised of 46 studies were included (observational studies; reviews articles; and experimental studies), focusing on the detection of periodontal disease using non-traditional method; saliva as a medium for detection of periodontal disease biomarkers.

Conclusion: Saliva is considered as anon-invasive and easier to collect medium for the detection of biomarkers as it contains virtually all the molecules found in other diagnostic media; serum and blood. This review highlights recent advances in salivary biomarkers as proteomics, genomics, and microbial biomarkers and potential clinical applications as well as available Point of Care (POC) diagnostics that aid easy diagnosis and prognosis.

Introduction: Trauma and trauma-related injuries are rife worldwide and constitutes part of the most common cause of hospital admission. Monocyte Chemoattractant Protein-1 is produced by several array of cells in acute traumatic injury and tissue repair.

Materials and method: This research is a prospective hospital-based study carried out at a tertiary hospital in south western Nigeria. Patients admitted through the Emergency department were categorized based on the inclusion criteria. Those eligible for inclusion were recruited and had their blood samples taken into an endotoxin free test tube at 48 +/- 2 hours after trauma. MCP-1 levels in the serum was estimated though the Human MCP-1 ELISA kit. This process was carried out using the ELISA technique based on the manufacturer's guide.

Results: The samples of 110 patients were analyzed, patient with the highest combination of injury had injuries to the Head and Neck, Face, chest, Abdomen, Extremity fractures and skin with MCP-1 value of 463pg/ml. The test of relationship using the F-test (0.299), and P-value (1.000) does not demonstrate any correlation between patterns of injury to MCP-1 values in polytrauma patients.

Conclusion: The study showed no significant relationship between the patterns of injury in polytrauma patients with serum MCP-1 levels. Therefore, injury pattern cannot be used to predict MCP-1 levels.

There is a global epidemic of obesity and hypertension. These two relatively common disorders derive from a basic underlying pathophysiologic abnormality, like 'two peas in a pod' There is a consensus that obesity predicts the future development of hypertension and that the relationship between blood pressure and body weight is linear independent of gender, age, and socioeconomic status. This brief commentary outlines the pathogenetic mechanisms for the obesity-hypertension association. These mechanisms are likely complex, multifactorial, and polygenic with possible roots in early ontogeny. A unifying hypothesis should integrate food intake and excess (resulting in weight gain) with increased sympathetic nervous activity (resulting in increased blood pressure). The adipokine, leptin, appears well suited to fill that role - its hypothalamic signaling pathways and neurovascular outcomes are therefore explored in some detail. An understanding of these relationships from the perspectives of both epidemiology and pathophysiology is crucial to the management of both disorders - obesity with hypertension - and particularly more so in developing countries that lack the resources to deal with the looming epidemic of atherosclerotic cardiovascular disease.

Background: Accessing data on the profile and pattern of people diagnosed with early onset dementia (EOD) can be challenging, especially in Low-and-Middle-Income Countries. Research focused on the epidemiology of EOD will improve early detection and diagnosis, and the understanding of its impact on individuals and society.

Objective: The study seeks to describe the sociodemographic and clinical characteristics of people diagnosed with EOD in an outpatient memory clinic.

Method: A retrospective quantitative case series to investigate the pattern and characteristics of people diagnosed with EOD attending a Psychogeriatric Clinic in Southwestern Nigeria. Data were collected manually from the medical case records of people with dementia who attended the psychogeriatric clinic.

Results: The subjects' mean ± SD age was 60.2 ± 4.2 years and 50% were females. The most common medical comorbidity was hypertension (50.0%). Depression (15.8%) was the most common behavioral symptom. Alzheimer's dementia (50.0%) was the predominant dementia type. There was a significant difference in the age (p=0.001), Boston naming test (p=0.011), based on the educational status of the participants. The neuropsychological profile of the participants showed low scores in some specific domains like memory and language.

Conclusion: Depression and hypertension are major comorbid conditions affecting persons with EOD. Such persons are impaired in some specific domains such as memory and language skills. Early detection and management of both conditions could have a positive impact on the overall management of Early-Onset Dementia.

Introduction: Introduction: Rheumatic heart disease (RHD) is a major public health issue, especially in developing countries. Globally, the largest increase in RHD incidence over 30 years was seen in sub-Saharan Africa, further contributing to the burden of cardiovascular disease in a region with high rates of hypertensive heart disease and cardiomyopathies. There are few reports describing the contemporary clinical profile of RHD in Nigeria.

Objective: The objective of the study is to describe the profile of RHD at the University College Hospital Ibadan.

Methodology: This is an analysis of data collected on adult patients aged 18 years and above attending the cardiology service of the University College Hospital, Ibadan, Nigeria between September 1, 2016, and August 31, 2021. We collected information on the bio-data, clinical features, and echocardiographic diagnoses.

Results: During this period, 92 cases of RHD were diagnosed and 24 (26.1%) were male. The mean age of the study population was 49.67 ± 17.54 years, with ages ranging from 16 to 86 years. Most participants (45.7%) were within the age group of 30-49 years. Most (70.8%) of the participants presented in NYHA Class II heart failure. The most common presentation mode was dyspnea on exertion and nocturnal cough (64.1%). Mitral regurgitation was the commonest lesion (65.4%).

Conclusion: Rheumatic heart disease is still a common cause of adult heart disease in Ibadan. There is a need for concerted efforts to tackle the burden of this disease by increasing screening among high-risk groups, improving access to healthcare, and increasing the uptake of secondary prophylaxis in those with a previous history of rheumatic fever.

[This corrects the article on p. 99 in vol. 16 PMChttps://pmc.ncbi.nlm.nih.gov/articles/PMC6580407.].

Background: In choosing Dentistry as a field of study and specialization, adequate information as well as the passion for the provision of oral health services should be taken into consideration.

Objectives: To determine the recent trend in career choices, aspirations and the reasons for choice of area of specialization among dental students in Lagos State, Nigeria.

Methodology: This was a cross sectional descriptive study that utilized a structured questionnaire to collect the demographic data, reasons for career choice, career aspirations, reasons for specialization, reasons for nonspecialization and practice preferences from dental students aged 18 to 32 years. The data was collected and analysed using SPSS version 23. Associations between categorical variables were assessed using Chi square and Fisher exact tests. P-value <0.05 was assumed to be significant at 95% CI.

Results: A total of 139 students (males 38.8%, females 61.2%) with a mean (SD) age of 23.04±2.6 years were involved in this study. Interest in Dentistry was the major reason (74.8%) for choosing the profession by the students and 2.2% of them chose Dentistry due to peer pressure influence. Oral and Maxillofacial Surgery was the specialty of choice (34.1%) followed by Orthodontics (18.7%) and Conservative Dentistry (12.1%) respectively. Dental Radiology (1.1%) was the least popular specialty. Slightly more than half of the students, 46(50.5%) intend to practice outside Nigeria.

Conclusion: Most of the students chose Dentistry based on their interest in the profession and about half of them intend to practice outside the country. The most sought after dental specialties were Oral and Maxillofacial Surgery, Orthodontics and Conservative Dentistry respectively.

Background: Total thyroidectomy is traditionally performed under general anaesthesia, which can be challenging in patients with difficult airways. This case series explores the use of ultrasound-guided bilateral intermediate cervical plexus block (US-BICPB) as an alternative anaesthetic technique for patients undergoing total thyroidectomy with potential or actual difficult intubation.

Methods: Four patients scheduled for total thyroidectomy with identified difficult airway management were included. US-BICPB was performed using a mixture of 0.5% bupivacaine and 1% lidocaine with adrenaline. Sensory block was assessed, and patients were monitored for hemodynamic stability, pain scores, and adverse events.

Results: All four patients successfully underwent total thyroidectomy under USBICPB without conversion to general anaesthesia. Patients remained hemodynamically stable throughout the procedures, with pain scores remaining at 2 or below on the Numerical Rating Scale (NRS) for several hours postoperatively. No major complications were reported. Patients expressed satisfaction with the technique and were discharged within 2-3 days post-surgery.

Conclusion: US-BICPB appears to be an effective and safe alternative anaesthetic technique for total thyroidectomy in patients with difficult airways. This approach may offer advantages in terms of airway management, postoperative pain control and patient satisfaction. Further studies with larger sample sizes are needed to confirm these findings and establish optimal protocols for patient selection and block administration.

Background: The association of Hirschsprung's disease with anorectal malformation (ARM) is both diagnostically and surgically challenging, in addition to it being a rarity. Symptoms attributable to post-repair of ARM may mask the underlying Hirschsprung's disease (HD) and become worse after closure of stoma. We aim to highlight this rare finding, the challenges associated with the management and the consequent multiple surgeries the patient underwent.

Case presentation: We report the case of a seven-year-old boy who had a diverting Devine descending colostomy for high ARM and was followed up until he had a posterior sagittal anorectoplasty (PSARP). He thereafter re-presented with complaints of intermittent constipation which was not responsive to rectal washout necessitating a levelling colostomy and subsequently an abdominal Swenson's pull-through procedure. Postoperative period was complicated with a colo-urethral fistula (Urethroscopy findings https://youtu.be/lxzyp1uHFpE?feature=shared) necessitating multiple staged surgeries. He has been followed up in clinic for over one-year post-surgery with complaints relating to frequent bowel motion, passes well-formed stool about three times daily. We report a rare case of HD associated with ARM, highlighting the delay in diagnosis, the associated morbidities requiring multiple surgeries and the challenges encountered in the management of the patient.

Conclusion: Hirschsprung's disease in a patient with anorectal malformation is a very rare occurrence, which can be fraught with delayed diagnosis and consequences as a result of the previous anorectoplasty. There is need to have a high index of suspicion and we hope this report will help raise the awareness of this association.

Haff disease is defined as unexplained rhabdomyolysis following ingestion of some sea fish and crayfish. First reported in 1926 from the Baltic region, its pathophysiologic mechanism is largely unknown, but toxins release have been implicated. Common features include generalized myalgia, brown/ dark urine, elevated serum creatine kinase and creatinine, kidney dysfunction can be severe enough to cause acute kidney injury (AKI). We present the case of a 28-year-old man who ate cooked freshwater fish and initially presented with diffuse myalgia, headache and brown-colored urine, and later fever and diarrhea. He had severely elevated serum creatine kinase and creatinine, and was managed as a case of Haff disease related AKI (HDRAKI) complicated by sepsis. He had haemodialysis and antibiotics, and recovered kidney function. A detailed history of recent diet and occupational exposure is essential in the diagnosis and management of HDR-AKI. Dialysis could be life-saving.