Nigerian medical journal : journal of the Nigeria Medical Association最新文献

Background: This research aims to find out the prevalence of depression in all types of anaemia patients of all age groups and genders by conducting a comprehensive meta-analysis of observational epidemiological studies.

Methodology: The relevant peer-reviewed literature describing primary data analysis was thoroughly evaluated using the PRISMA checklist as a reference. We searched databases, including PubMed, Scopus, Embase, and Google Scholar, to identify research publications published between 2003 and 2024. R software version 4.3.0 was utilised to perform the meta-analysis, and the JBI score was employed for quality appraisal. Heterogeneity was assessed using the Q and I2 statistics. To pool estimates, a random-effects model was employed. Publication bias was assessed using a funnel plot and Egger's regression test.

Results: After combining the results of the papers, the prevalence of depression was estimated at 36 % (CI = 95: 28-45 %) based on a random effects model. Sub-group analysis showed that the prevalence of depression was higher in patients with sickle cell anaemia (42%) followed by Thalassemia (35%) and Iron deficiency anaemia (20%). Sub-group analysis also found a higher prevalence (almost double) of depression in anaemic patients of Asia (40%) and the African continent (37%,) which is almost double as compared to America (28%) and Europe (20%). The declining trend of meta-regression analysis demonstrates that depression prevalence is higher among young anaemia patients (Children and adolescents) as compared to older ones.

Conclusion: Routine screening for depression may be required during regular follow-ups of anaemic patients, especially in resource-limited settings.

Background: Congenital heart diseases (CHD) account for 28% of birth defects in India. Treatment options and long-term outcomes have significantly improved over the past six decades. However, there is a notable delay in diagnosing CHD and initiating treatment for diagnosed patients. This study seeks to identify factors influencing the treatment timing of CHDs in paediatric patients residing in rural areas of India.

Methodology: Cross-sectional survey. The study uses descriptive statistics and chi-square tests for comparing categorical data between groups to identify factors contributing to delays.

Results: A total of 115 patients were enrolled. Ventricular septal defect was the most prevalent diagnosis (40 patients), followed by Tetralogy of Fallot (23 patients). 47 % of patients experienced delayed diagnosis, while 69% experienced delayed treatment. Notably, the severity of delayed treatment was more pronounced in acyanotic heart diseases compared to cyanotic heart diseases. Financial constraints were cited as the primary reason for delayed treatment in 27.8% of cases, while social factors were the most common reason for delayed treatment despite diagnosis in the remaining 72.2%.

Conclusion: Despite substantial government financial support for treatment and diagnosis, further delays in treatment remain significant. Social factors, other than economic factors, appear to be the primary contributors to these delays. Sample size and in-hospital study limitations are acknowledged.

Background: Ocimum tenuiflorumis an important plant in Africa with diverse medicinal properties. This study investigates the anti-diabetic effects of Ocimum tenuiflorum methanol-ethyl acetate (2:1) extract (OTE) on alloxan-induced diabetic rats.

Methodology: Thirty rats (90-100g) acclimatized for one week were grouped into 5 (n=6). Group 1 (Normal control) received distilled water. The other groups were administered a single dose of 100 mg/kg alloxan intraperitoneally and treated as follows: Group 2 (olive oil), Groups 3 and 4 (200mg/kg and 400mg/kg OTE, respectively), and Group 5 received 5mg/kg glibenclamide. After twenty-one days of treatment, the rats were fasted overnight and sacrificed. Blood and liver samples were collected for analysis. Blood glucose status was measured using a glucometer. Serum insulin concentration was measured using an Enzyme-linked immunosorbent assay. Antioxidant assays were assessed via spectrophotometry. P<0.05 was considered statistically significant.

Results: Blood glucose level increased while insulin concentration reduced in diabetic controls relative to normal rats. Conversely, a dose-dependent reduction was observed in the glucose level, while insulin concentration returned to near normal with increasing doses of OTE compared to the normal control. It was observed that GSH level, CAT, and GST activities decreased significantly in diabetic control relative to normal control. Meanwhile, treatment with doses of OTE caused a dose-related increase in these antioxidant parameters, significantly compared to the normal control. MDA showed a significant increase in the untreated group relative to the normal control. However, MDA concentration declined drastically (P<0.01) in a dose-dependent manner upon treatment with OTE relative to normal rats.

Conclusion: It could be inferred from the results above that OTE may exhibit its anti-diabetic potential via enhancing the synthesis of insulin and scavenging of free radicals. This study showed that the extract can be used in the treatment of diabetes and can be formulated into a novel drug or supplement.

Background: Professional Indemnity Insurance (PII) is an important cover for health professionals against the risks of legal and financial consequences of medical malpractice lawsuits. Nigerian medical doctors are still not adequately informed about it. This cross-sectional study evaluated PII knowledge and awareness among 300 registered physicians across different settings in Nigeria, including urban tertiary hospitals, rural clinics, and private practice.

Methodology: A self-validated questionnaire collected socio-demographic data, medical specialties, and the extent of PII knowle1dge. Descriptive and inferential statistics were used to analyse the data. Outcomes revealed that merely 32% of participants possessed sufficient knowledge about the purpose and scope of PII. Knowledge was significantly correlated with years of experience (p=0.03), with senior physicians exhibiting higher awareness, as well as practice setting (p=0.04), with doctors working in urban tertiary institutions performing better than those practising in rural clinics.

Results: In particular, 45% of urban tertiary hospital physicians expressed familiarity with PII, compared with 22% of rural clinic physicians, presumably due to greater access to professional resources. These disparities indicate a large gap in PII awareness, particularly in the countryside.

Conclusions: To address this, the integration of medico-legal modules into medical training, as implemented in South Africa, would enhance knowledge among newly qualified doctors. Targeted education interventions, such as workshops and continuing medical education courses in diverse practice settings, would be required to bridge the gap. This would empower Nigerian doctors with the knowledge needed to access PII and hence better protect themselves and patients.

Background: Urethral catheterization is a common practice during caesarean delivery. Prolonged use may lead to urinarytract infection, the duration of catheterization being critical to its development. The optimal time for its removal after caesarean delivery remains undecided. This study compared the effect of immediate, 6-hours and 24-hours removal postelective caesarean delivery on significant bacteriuria, re-catheterisation, interval to first micturition and maternal discomfort.

Methodology: The study was conducted at a tertiary hospital in Port Harcourt, Nigeria. A total of 150 women who had elective caesarean delivery were randomised into 3 groups using computer-generated random sequence numbers. Group A - had the urethral catheter removed immediately, Group B - after 6 hours, and Group C - after 24 hours post-operation. The women were assessed for significant bacteriuria and need for re-catheterisation as the primary outcomes; interval to first micturition and maternal discomfort as the secondary outcomes. Data was analysed using IBM SPSS version 23.

Results: Overall incidence of significant bacteriuria was 12%. The difference in incidence was 0(0%), 6(12%), and 12(24%) for the Immediate, 6-hours and 24-hours groups respectively,(p>0.001).Urinary retention requiring re-catheterization was also significant, highest in the Immediate group 8(14%), 2(4%) in the 6-hours group and none in the 24-hours group. The mean interval to first micturition was highest in the 6-hour group, least in the 24-hour group and intermediate in the Immediate group (9.52±6.26, 5.16±3.80, and 6.92±3.36, respectively<0.001). Most participants had mild discomfort, and the difference between groups was insignificant (p=0.445).

Conclusion: Immediate catheter removal had a lower risk of significant bacteriuria but increased urinary retention, while the 24-hour removal had reduced urinary retention but was fraught with significant bacteriuria. The 6-hour removal had a modest risk for both significant bacteriuria and urinary retention. The 6-hours removal offers a balance and should be a safer option.

Background: Epilepsy, whether occurring alone or with cerebral palsy (CP), is among the most common neurological disorders seen in paediatric neurology clinics in Nigeria. Management requires accurate diagnosis and classification, which becomes more challenging when epilepsy coexists with CP. Electroencephalography (EEG) is a valuable tool for confirming and characterising epileptic activity. This study aimed to compare the clinical and EEG characteristics of children with CP and epilepsy (Group 1) and those with epilepsy without CP (Group 2) in a Nigerian tertiary institution.

Methodology: This prospective, cross-sectional, comparative study was conducted from March 2022 to February 2023. A total of 121 children with epilepsy and CP (Group 1) and 124 with epilepsy only (Group 2), aged 6 months to 15 years, were consecutively recruited. Clinical profiles and EEG findings were compared. Data were analysed with SPSS version 25.0, with p < 0.05 considered significant.

Results: The median age at epilepsy onset was 12 months (IQR: 9.5) in Group 1 and 49 months (IQR: 58.7) in Group 2, showing a significant difference (p < 0.001). Uncontrolled epilepsy was more common in Group 1, occurring in 50 of 72 (69.4%) on antiepileptic drugs, compared to 12 of 69 (17.4%) in Group 2 (p < 0.001). Generalized-onset epilepsy was most frequent in both groups (59.5% vs. 54.8%, p = 0.844). West and Lennox-Gastaut syndromes appeared only in Group 1, while Doose syndrome occurred only in Group 2.

Conclusion: A disparity was observed between clinical and electroencephalographic (EEG) classifications, particularly among children with epilepsy and cerebral palsy. EEG evaluation is therefore recommended as an essential component of epilepsy management in this population.

Background: Cervical cancer is the second most common cancer in women in Nigeria and is largely preventable. However, in Nigeria, the absence of universal screening means individual awareness and knowledge significantly impact screening uptake. Previous studies have reported mixed results regarding awareness and screening rates.The study assessed cervical screening uptake rate among women of reproductive age.

Methodology: It was a descriptive cross-sectional study among women of reproductive age across the three senatorial districts in Ogun State, Nigeria, using interviewer-administered questionnaires following ethical approval. Data analysis was performed using IBM SPSS version 25. The outcome variables included the level of awareness and knowledge of cervical cancer and its pre-malignant screening, as well as the level of uptake of cervical cancer.

Results: A total of 1310 women were interviewed, with 1233 responses analyzed. The mean age of the respondents was 32.33 ± 6.25 years. Of the respondents, 592 (48.0%) were aware of cervical cancer, 281 (22.8%) were aware of cervical screening, and 141 (11.4%) had good knowledge of cervical cancer. Eighty (6.49%) participants had been screened at least once, and only nine had been screened at least twice. The majority of the women, despite the poor awareness and knowledge levels, were willing to be screened in the future. There was a statistically significant association between cervical cancer awareness and uptake of screening (X² = 9.282, df =1, P-value = 0.002).

Conclusion: Awareness, knowledge, and screening uptake remain low among women in Ogun State. However, awareness of cervical cancer positively influences screening participation. Therefore, extensive awareness campaigns are recommended to improve screening rates and reduce cervical cancer prevalence.

Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major cause of preventable morbidity and mortality in hospitalized patients. While VTE is well-established in pancreatic malignancy, its association with non-neoplastic pancreatic conditions, particularly acute pancreatitis (AP), is less clearly defined and frequently underrecognized in clinical practice. This narrative review aims to explore and synthesize existing literature on the thromboembolic complications associated with AP, highlighting the underlying pathophysiological mechanisms, clinical implications, and current gaps in prophylactic and therapeutic strategies. We reviewed published studies from major databases up to June 2025, focusing on epidemiological trends, pathological mechanisms related to inflammation-induced thrombosis, and clinical outcomes in patients with AP complicated by VTE. The review discusses pathogenesis, epidemiology, clinical features and diagnostic challenges due to symptom overlap, current pharmacologic and non-pharmacologic management strategies, and the limited but growing real-world evidence on anticoagulation in this setting.

The case report demonstrates the utility of point-of-care ultrasound (POCUS) for both diagnosis and ultrasound-guided intervention in managing cardiac tamponade in a paediatric patient. A 10-year-old child presented with a six-week history of cough, weight loss, and a two-week history of respiratory difficulty, orthopnoea, and generalized body swelling, starting in the legs. He had progressive easy fatigability over the last three months. An external chest X-ray indicated a globular heart, suggestive of pericardial effusion to rule out cardiomyopathy. Cardiac POCUS revealed a massive pericardial effusion with tamponade physiology. Immediate ultrasound-guided pericardiocentesis was performed, draining 800 ml of purulent fluid, followed by an additional 200 ml with an underwater seal setup. Post-procedure, serial POCUS examinations were conducted to monitor for adequate drainage and to detect any possible re-accumulation of pericardial fluid. The symptoms resolved, and a 2-week follow-up showed sustained improvement. This case underscores the vital role of POCUS in both the prompt diagnosis and safe, accurate ultrasound-guided pericardiocentesis in emergent cardiac care for paediatric patients.