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

Background: Asthma is a common chronic disease, and asthma control is the major therapeutic objective, thus ensuring a good health-related quality of life. This study aimed to evaluate the level of asthma control in a sample of asthmatic patients followed in allergology consultation during our training using the asthma control test (ACT) and its correlation with other parameters.

Methodology: This is a cross-sectional study of 66 asthmatic patients who were followed in pulmonology consultation at Agadir University Hospital after completing the asthma control test questionnaire over 6 months (June to December 2021).

Results: The age of the patients ranged from 17 to 76 years, with an average age of 41.36 +/- 13.31 years. There was a predominance of females in this sample, representing 54.5% of the patients against 45.5% of males. All patients were on inhaled corticosteroid therapy (ICS) (as monotherapy in 25.8% of cases and in combination with a long-acting beta-2 mimetic (LABA) in 74.2% of cases). 60.6% of the patients were from low socioeconomic levels, of which 28.8% were from rural areas. 22.7% of the participants were illiterate. Allergic rhinitis was found in 66.6% of patients and allergic conjunctivitis in 45.5%. Active smoking was found in 16.7% of cases. Obesity was found in 10 patients (15.2% of cases). According to the ACT, asthma was totally controlled in 37.9% of cases and partially controlled in 43.9% of patients.

Conclusion: The level of asthma control found in this study was lower compared to other populations. The study also showed that better ACT scores and asthma control correlated with higher socioeconomic levels.

Background: Blood transfusion holds a significant place in the practice of surgery, including orthopaedic surgeries. The aim of this study was to evaluate the intraoperative use of blood and blood products among orthopaedic patients operated at the Rivers State University Teaching Hospital from January 2021 to December 2021, focusing on the demographics of patients, number and type of surgeries needing a blood transfusion, and the number of blood transfusions.

Methodology: A retrospective observational study was carried out at the operating theatre of a referral tertiary hospital using a designed proforma to extract data from the registers of operated orthopaedic patients.

Results: There were 168 males and 145 females who were operated on, and 43 (13.74%) of them had intra-operative blood transfusion. Patients between 41 to 50years and 51 to 60 years dominated the distribution with a total of 20 (46.5%), out of 59 blood transfusions carried out. The surgical condition requiring the highest number of blood transfusions was fractures (29), followed by foot gangrene (17) occasioned by diabetes mellitus and peripheral vascular disease. Open reduction and internal fixation for fractures (18) constituted the highest single type of surgery carried out within the study period.

Conclusion: A bimodal age distribution was observed in intraoperative blood transfusion requirements. The orthopaedic intraoperative blood transfusion burden was 13.74%, mainly for open reduction and internal fixation for fractures.

Background: Unconsciousness occurs when a patient enters a sleeplike state but cannot be aroused, and it is not due to physiological drowsiness. It is a common presentation in the Accident and Emergency Department (A&E), and a burden to the emergency physician especially when the cause is unknown. The cause of coma may be trauma or non-trauma related. There is a shortage of data on the aetiology and outcome of unconsciousness in developing countries including Nigeria.

Methodology: This cross-sectional study investigates 765 unconscious patients using convenience sampling from September 2023 to June 2024 at the A&E of the University of Port Harcourt Teaching Hospital. The World Health Organization emergency unit form was adapted for this study.

Results: The total population of this study is 765, 55.16% males and 44.84% females. A majority of the cases 81.83% were not related to trauma. The commonest causes of unconsciousness were stroke, diabetic complications & emergencies, traumatic brain injury, metastatic neoplasm, HIV AIDs related disease and hypertensive emergency. Most of the patients 494(64.58%) died while in A&E, 116 (15.16%) were transferred to the ward and 56 (7.58%) were discharged against medical advice.

Conclusion: Unconscious patients are a challenge in the emergency room. Stroke and diabetic emergencies are the commonest causes of non-trauma-related aetiologies while traumatic brain injury is the most common cause of trauma-related aetiology of unconsciousness.

Abdominal ectopic pregnancy is a rare type of ectopic pregnancy associated with high maternal and perinatal mortality. We present a case of a 28-year-old now primipara who was misdiagnosed to have abruptio placentae and ruptured uterus on two different occasions from a primary health care center but was found to have an advanced abdominal ectopic gestation at 21 weeks gestational age. The patient was managed by exploratory laparotomy and is currently doing well. Abdominal ectopic pregnancy, though rare, does occur in our setting, and a high index of suspicion is necessary to make a diagnosis. Prompt diagnosis will help in managing the patient hence reducing morbidity and mortality.

Background: Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels. Yoga is a low-cost, easily accessible lifestyle modification program that holds as an approach to decreasing cardiometabolic risk factors and increasing exercise self-efficacy among high-risk subjects. This study aimed to assess the impact of the yogic lifestyle (including diet) on cardiovascular risk scores by using the Framingham (FRS), QRISK3 score, and World Health Organization (WHO) CVD risk prediction charts at baseline, three months, and six months. The present study compares and correlates FRS, QRISK3, and WHO cardiovascular risk scores.

Methodology: The experimental interventional study was conducted among the high-risk population at RUHS College of Medical Sciences and Associated Group of Hospitals, Jaipur. Framingham risk Score, QRISK3 score, and WHO CVD risk prediction charts were used as a method of measurement for the outcome of interest at baseline, three months, and six months in the study and control group. Randomization and allocation in yoga and control groups were performed using computer-generated random numbers. The statistical analysis was done using advanced SPSS-22 software at significant level tests as p≤0.05, ensuring the highest level of accuracy. Data were analyzed using a one-way variance ANOVA test analysis at baseline, three, and six months. Pearson correlation analysis was done to compare different risk scores.

Results: Participants had a mean age of 48.43 ± 6.4 years. Baseline values (mean±SD) of FRS, Qrisk3, WHO were 24.59±10.15,28.59±10.11,15.71±6.07. After six months of yogic lifestyle, these values decreased significantly to 15.1±7.05, 20.09±7.08, and 13.85±4.96. The decrease in cardiovascular scores was statistically significant (p<0.0001), providing strong evidence for the effectiveness of the yogic lifestyle. Pearson correlation analysis results depict that FRS and Q risk 3 (r=0.840, p<0.0001), FRS and WHO risk chart (r=0.768, p<0.0001), Q risk3 and WHO risk chart (r=0.778, p<0.0001) have a statistically significant strong positive correlation.

Conclusion: This study's findings suggest that a 24-week yogic lifestyle intervention (including diet) significantly decreased FRS, Q RISK 3, and WHO CVD risk scores among high-risk subjects compared to the control group.

Fallopian tube papilloma (FTP) is one of the benign lesions of the oviduct and is a rare proliferative epithelial lesion. Low incidence and underreporting of the disease limit our knowledge of these lesions. These lesions cause a diagnostic dilemma and need to be differentiated from several other conditions of the fallopian tubes both benign and malignant. Fallopian tube papilloma may lead to tubal obstruction and can be a cause of subfertility, ectopic gestation, or mass lesions in the fallopian tubes and hence should be considered as an important differential while managing these women. A high index of suspicion is required, and the final diagnosis can only be made after histopathological results. The reporting of such lesions is important to know the true prevalence of these tumors and to increase our knowledge about these benign neoplasms. This systematic review of case reports was done to enhance knowledge regarding the etiology, natural course, complication, and recurrence of FTP. An electronic search of Scopus, Pubmed, Embase, Web of Science, Google Scholar, and other databases was conducted for case reports and case series published in English from inception till January 2024.

Background: The learning environment (LE) plays a crucial role in the performance and training of medical students. Different tools have been used to assess the LE with various conclusions. However, the John Hopkins Learning Environment Scale (JHLES) which is a relatively newer scale is more specific, less cumbersome to administer, and has a wider scope. The study aims to assess the perception of the LE of undergraduate medical students in a Nigerian institution using the JHLES.

Methodology: This was a cross-sectional study carried out on clinical medical students of the College of Health Sciences, University of Jos. A self-administered questionnaire containing socio-demographic data and the 28 JHLES questions was used. Data was analysed using SPSS version 25.0. The Overall mean JHLES Score was obtained by calculating the average of the JHLES scores attained by all participants.

Results: A total of 400 clinical medical students were enrolled and a mean JHLES Score of 77.90 (±14.03) was obtained. The males were found to have statistically significantly higher mean JHLES scores than the females, particularly in the domain of Faculty relationships, Academic climate, and Mentoring. The domain of "community of peers" had the highest ratings while "mentoring" and "meaningful engagement" recorded the least scores.

Conclusion: The clinical medical students had a fair perception of their LE. The areas of strength should be encouraged while faculty may enact programs that will improve the domains with low scores to ultimately make better the learning environment and training of these future doctors.

Background: There is increasing awareness of disrespect and abuse (DAA) during childbirth. Globally, DAA during delivery is a common cause of suffering and violation of the human rights of birthing mothers. Respectful maternal care is necessary to improve the quality of care and uptake of institutional delivery services to reduce maternal and perinatal morbidity and mortality. The study aims to determine the prevalence, common forms, and perception of maternal DAA among mothers who just gave birth and are still in the hospital.

Methodology: A cross-sectional study on 261 consenting postnatal women at four public healthcare facilities in Lagos, Nigeria. An interviewer-administered pretested questionnaire was used to obtain data on sociodemographic characteristics and experiences of DAA. We analysed the data using Statistical Package for Social Sciences (SPSS) version 25. Logistic regression analysis was used to assess significant risk factors for DAA during delivery and early puerperium.

Results: The prevalence of DAA during childbirth was 82%. Perceptions of non-consented care and abandonment/neglect were the most reported forms of DAA reported by 86.8% and 45.6% of respondents, respectively. The odds for DAA were four times greater in women who had pregnancy complications compared to those who did not (aOR: 4.50, 95%CI: 1.5013.46) and doubled in women who had vaginal delivery compared to Caesarean section (aOR: 2.10, 95%CI: 1.07-4.12).

Conclusion: DAA is prevalent during childbirth in our public healthcare facilities. This goes against the proposed standard of care where respectful maternal care is every womans right, posing a risk for reduced use of institutional delivery services.

Radiological requests are vital communicative tools by Physicians to Radiologists. Improperly filled radiological requests are frequently encountered in our practices as radiologists; a trend which can negatively impact patient care. A properly filled request will prevent unwarranted radiation exposures and improve service delivery by Radiology departments. This article amply expresses our practice experiences (not unique to our centre alone) as they relate to poorly filled radiological investigation requests and the practical approach we have developed and adopted over time which has been quite helpful in addressing this age-long problem.

Background: Anthrax is a life-threatening zoonotic disease caused by Gram-positive, spore-forming bacterium Bacillus anthracis. It manifests as a cutaneous, gastrointestinal, and respiratory disease. The cutaneous form ranges from a self-limiting lesion to severe edematous lesions with toxemic shock. Of recent, increasing cases of anthrax have been reported in Nigeria warranting heightened surveillance. A patient with skin lesions suggestive of cutaneous anthrax and toxic manifestations is reviewed to emphasize the need for a high index of suspicion.

Case report: A 14-year-old boy presented with skin lesions of one month involving the hands, face, and legs, left lower limb swelling of two weeks, fever of 10 days, and fast breathing of five days duration. There was a positive history of contact with cattle carcasses at the abattoir. He was febrile (38.1^oc), mildly pale, and mildly dehydrated, oxygen saturation was 95%. He was tachypnoeic and tachycardic with a low-volume pulse. There was extensive left lower limb swelling, a raised necrotic ulcer with a black surface on the calf, measuring 9cmx5cm with serosanguinous discharge, and another confluent vesicular lesion on the anterolateral aspect of the left leg measuring 8cmx6cm. Differential diagnoses considered were cellulitis, osteomyelitis, leishmaniasis, and malignancy.

Result treatment & outcome: His packed cell volume was 33%, retroviral screening, and hepatitis screening were nonreactive, and erythrocyte sedimentation rate was 3mm/hr. Leg X-ray was normal. Other investigations could not be done due to financial constraints and the patient's demise. He received intravenous (IV) fluid, IV ceftriaxone, IV metronidazole, tetanus toxoid, and antiseptic wound dressing. He succumbed to the illness 72 hours later. Anthrax was considered after the patient's demise due to the type of skin lesion and progression of the illness in line with the standard case definition.

Conclusion: Cutaneous anthrax with systemic manifestations should be considered as a probable diagnosis in patients with typical skin lesions and toxic features.