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

Ileal perforation is a fatal surgical complication of typhoid fever. Acute psychosis occurring together with perforation presents a fatal outlook. This is made worse by these patients presenting late for appropriate intervention. A patient with sickle cell disease in addition to ileal perforation and psychosis presents a clinical picture the outcome of which is unpredictable. It could occasionally cause diagnostic dilemma and a great clinical challenge. Typhoid fever, a bacterial disease of low- income countries could be prevented by an improvement in socioeconomic conditions of the people. This will prevent or reduce to the barest minimum the occurrence of these fatal outcomes associated with its complications. This is the case report of a 19-year-old Haemoglobin SC (HbSC) with ileal perforation and acute psychosis.

Background: Patient centred care has a correlation to effectiveness of patient engagement, patient care, and perceived quality of care. Even in the emergency room, awareness of diagnosis and treatment plan is a critical component in every doctor-patient interface as it enhances patient-centred care. This study aims to assess awareness of diagnosis and treatment plan among patients in the accident and emergency department.

Methodology: This is a cross-sectional study conducted at the accident and emergency department of the University of Port Harcourt Teaching Hospital.

Result: One hundred and ninety-seven respondents were recruited into this study comprising of 51.3% males and 48.8% females. Most 86.8% of the respondents were aware of their diagnosis, of which 91.8% knew the accurate diagnosis. Majority 84.8% of the respondents were aware of the treatment, while 68.8% of the respondents were aware of the names of the medications, most of the respondents 59.4% had no knowledge of the side effects of the medications. The majority, 61.4% were involved in the management decision. No significant relationship existed between the socio-demographic characteristics and knowledge of diagnosis and treatment plan.

Conclusion: The chaotic and overcrowded nature of the accident and emergency department should not hamper the delivery of patient centred care. Although, findings obtained from this study reveal that majority of the respondents are aware of their diagnosis and treatment plan, a portion of respondents do not understand their plan of care; this indicates the need for further studies to identify interventions that would ensure that gaps in the physician -patient communication are filled as this optimizes patients' satisfaction of care received, gives better sense of control of their total situation and better quality of life.

Background: Acute episode of pain is the most frequent symptom for which patients with sickle cell disease (SCD) seek medical attention. The neuropeptide Substance P (SP) has been suggested as a possible aetiologic factor. This study compared the serum levels of SP in SCD subjects in painful vaso-occlusive crisis with those in steady state and normal HbAA subjects.

Methodology: This case-controlled study investigated eighteen SCD patients in vaso-occlusive crisis (VOC) and eighteen in steady state, while fourteen HbAA subjects were recruited as controls. Blood was collected in plain bottles and subsequently, the serum was separated for SP assay using the ELISA technique. Each sample was run, and results were confirmed in duplicate. Optical density was read at an absorbance of 450nm.

Results: The study showed that SP was significantly higher in SCD patients in steady state (184.79±18.67ng/L versus 104.17±19.24ng/L) compared to the controls (t=2.97, p=0.006); while the values obtained in those in VOC (375.78±76.21ng/L) were also significantly higher (t=2.433, p=0.02) than those in steady state (184.79±18.67ng/L). The SP value in the SCD patients in VOC was almost twice as much as those in steady state and about three times as much as the value in the controls and the differences were statistically significant (t=7.72, p=0.001).

Conclusion: The study showed significantly higher SP levels in VOC compared to steady state or HbAA subjects suggesting that SP may be a marker for pain sensitisation.

Background: Even though the vaginal route is said to be the gynaecologist route of surgery, abdominal hysterectomy remains the predominant method of uterine removal in most parts of the world, despite the evidence of the safety of vaginal hysterectomy. The study aims to determine the prevalence, socio-demographic variables, indications as well as outcome of vaginal hysterectomy at Federal Teaching Hospital (FTH) Katsina, during the 5-year study period.

Methodology: A five-year retrospective study on vaginal hysterectomy was conducted in Federal Teaching Hospital, Katsina from 1^st January 2015 to 31^st December 2019.

Results: The rate of hysterectomies (Abdominal & Vaginal) was 21.6% of the total major gynaecological surgeries performed during the study period. Vaginal hysterectomy accounted for 6.7%. The mean age and parity of the patients were 56.06+/- 9.55 years and 10.17+/- 4.57 respectively. The commonest indication was Utero-vaginal Prolapse (88.9%) and 80.5% (29) of the patients had no complications. Most of the patients (94.4%) were discharged within 7 days of surgery and there was no fatality.

Conclusion: The rate of vaginal hysterectomy in our centre is low. Most of the patients were grand multiparous with the main indication being Uterovaginal prolapse. It is associated with favourable outcomes and very low complication rates.

Background: Patients living with HIV infection remain at increased risk of cardiovascular diseases and sudden cardiac death. Various prevalence of electrocardiographic (ECG) abnormalities among HIV-infected patients were reported: Attamah et al reported the prevalence of electrocardiographic abnormalities among HIV-infected patients as 34.5%, while Orunta et al reported a prevalence of 42.9%, and Njoku et al reported a prevalence of 93.0%. Human immunodeficiency virus-infected patients are at increased risk of developing prolonged QT interval. Sani et al reported the prevalence of prolonged corrected QT interval among HIV-infected patients as 45.0%. Innocent et al reported a prevalence of48.0%, while Ajala et al reported a prevalence of 18%. Prolonged QTc interval increases the risk of premature ventricular contraction which can degenerate into ventricular tachycardia and or ventricular that can result in sudden cardiac death.

Methodology: The study was a cross-sectional conducted among HIV-infected patients receiving HAART at the Federal Medical Centre Nguru, Yobe State, North Eastern Nigeria.

Results: One hundred and seven (107) subjects were recruited into the study comprising thirty-three (37.0%) males and 70(65.4%) females. The mean CD4 cell count, and viral load of the studied patients were 612.64±34.75 cells/μL and4646.30±58.68 copies/mL respectively. Twenty (18.7%) patients had prolonged QTc interval, this gave us the prevalence of prolonged QTc in this study as 18.7%. The commonest cardiac rhythm was sinus rhythm (69.2%), followed by sinus tachycardia (26.2%) and atrial fibrillation 5(4.7%). Other electrocardiographic findings include First-degree atrioventricular block was seen in seven (6.5%) patients, Premature ventricular contractions were found in16.8%, RBBB was observed in 2.8%, 3.7% of patients had LBBB and 4.7% had left posterior hemiblock. The distribution of QTc interval according to CD4 cells count and viral revealed a statistically significant difference across the groups. All the patients with prolonged QTc interval had lower CD4 cells count and higher viral load suggesting that HIV disease severity is associated with prolonged QTc interval.

Conclusion: In conclusion, the study revealed that the prevalence of prolonged QTc interval among HIV infected patients on highly active antiretroviral therapy was found to be 18.7%, and that HIV disease severity increases the risk of developing prolonged QTc interval.

Background: Methicillin-Resistant Staphylococcus aureus (MRSA) is both a human commensal and a pathogen that causes neonatal infection which is associated with significant morbidity and mortality. Its genetic flexibility and versatility have equipped it with the ability to develop resistance to numerous antibiotics. Outbreaks of infections in neonatal intensive care units as well as community infections have been reported mostly in developed countries. However, there is a paucity of data on neonatal MRSA infection in developing countries. The study aims to highlight cases of MRSA infection, describe the clinical presentation, and outline the antibiotic susceptibility pattern among term neonates in our facility.

Methodology: It was a prospective cross-sectional hospital-based study carried out from October 2018 to July 2019. A total of 248 term neonates with suspected sepsis were enrolled in the study and had their blood samples taken for investigations including blood culture. Bacterial identification and antibiotic susceptibility patterns were carried out using MicrobactTM24E (Oxiod UK) and Staph ID and modified Kirby-Bauer disk diffusion technique respectively.

Results: Out of the 248 subjects enrolled in the study, 34.2% had proven sepsis, with Staphylococcus species accounting for 56.4% of these cases. Among those with staphylococcal sepsis, 56.3% were found to have MRSA infection. Notably, the majority (94.4%) of cases originated from outside the hospital, presenting as neonatal sepsis with non-specific clinical features. Sensitivity testing revealed that ciprofloxacin and chloramphenicol were the most effective antibiotics against the identified pathogens.

Conclusion: The presence of MRSA infections in neonates poses a critical public health threat. This trend underscores the emergence of antimicrobial resistance, potentially compromising treatment efficacy and jeopardizing neonatal well-being. Urgent and decisive measures are necessary to curb this trajectory.

Background: Although several studies on the pattern of oro-facial pain have been reported, none have been reported on the prevalence and risk factors of severe oro-facial pain. This study aims to determine the prevalence and predictors of severe oro-facial pain among patients in a Nigerian tertiary hospital.

Methodology: The prospective cross-sectional study was conducted at the Department of Oral Diagnosis of a Nigerian tertiary hospital from January to December 2023 on all consecutive patients who presented to the centre with orofacial pains. The data collected were age, gender, occupation, level of education and marital status. Other data collected were ethnicity, smoking, alcohol intake, location of pain, causes of pain, and pain severity. Both descriptive and inferential statistics were performed. All data were analysed with SPSS version 26 (IBM Corp, Armonk, NY, US). A p-value less than 0.05 was considered significant.

Results: The age range was 17-85 years with a mean age of 36.6 ±16.7 years. Almost two-thirds (64.1%) of the patients were females. Most (46.1%) of the patients were skilled workers. Almost half (48%) of the recruited patients were single. The prevalence of severe pain among patients with orofacial pain was 45.3%. There was no relationship between sociodemographic factors and the prevalence of severe orofacial pain except the ethnicity of the patients (p = 0.012). There was no association between clinical factors and severe orofacial pain (p>0.05).

Conclusion: The prevalence of severe pain among patients with orofacial pain was relatively high and this severity was only influenced by their ethnicity. It is therefore recommended that a high index of attention is given to orofacial pain patients and a reduction of waiting time for the same individuals.

Background: Obesity is linked to non-communicable conditions. We looked at obesity using four definable criteria and their relationship to biochemical and inflammatory indicators of cardiovascular diseases (CVDs) in people living with HIV (PLHIV).

Methodology: This cross-sectional study involved 140 randomly selected HIV-infected patients attending HIV clinics at the Jos University Teaching Hospital and Faith Alive Foundation in Jos, Nigeria. Anthropometric measurements such as height, weight, waist circumference, and hip circumference were taken to identify those with obesity. Fasting plasma glucose, lipid profile, High-sensitivity CRP (hsCRP), and HIV-related markers were evaluated.

Result: The mean (SD) age of the participants was 42.5 (8.8) years, and the majority (71.4%) were females. The prevalence of Obesity based on Body-Mass-Index (BMI), International Diabetes Federation (IDF), Adult Treatment Panel (ATP), and Waist-Hip-Ratio (WHR) criteria were 18.6%, 50.7% 34.3%, and 45.7% respectively. Obesity concordance among the criteria for obesity was highest between IDF and ATP (Kappa= 0.673, p<0.001); and least between BMI vs WHR (Kappa= 0.124, p<0.073). Only 9.3% had obesity by all 4 criteria. BMI was independently associated with hypertension but not glycaemic status nor dyslipidaemia while Obesity by WHR was significantly associated with hypertension and dyslipidaemia, after adjusting for age and sex. There was no significant association between Obesity by all the criteria and HIV-related parameters such as duration of HIV infection, Antiretroviral (ARV) use, and CD4 counts (p>0.05).

Conclusion: Our study urges a unified assessment of obesity and a more prominent use of parameters of central obesity, for assessing cardiovascular risk in PLHIV.

Background: With the limited number of trained health care providers in Nigeria, PPMVs are inevitable, especially in rural areas for the supply of drugs, and integration through appropriate referral practices is quintessential. This study assessed the knowledge, attitude, and practice of patient referral among PPMVs in a setting with limited hospital infrastructure.

Methodology: This cross-sectional descriptive survey was conducted in Obio-Akpor, Rivers State using a structured questionnaire that measured the participants' socio-demographic characteristics as well as knowledge, attitude, and practice of patient referral. Descriptive and inferential analyses were conducted with SPSS version 25 and a p-value <0.05 was considered significant.

Results: Most of the respondents reported moderate knowledge, attitude, and practice (62.4%, 73.4%, and 58% respectively) of patient referral. Multivariate analysis showed statistically significant inverse relationships between years of experience and odds of their knowledge, attitude, and practice of referral. PPMVs with 3 years of experience reported significantly higher odds of adequate knowledge (AOR = 178.96; 95%CI: 60.15 - 532.49; p-value <0.005), attitude (AOR = 7.38;95%CI: (3.78 - 14.40; P-value <0.005) and practice (AOR = 131.56; 95%CI: 53.50 - 323.51; p-value <0.005) than those with above 10 years of experience after controlling for the effects of other variables. The most frequently reported barrier to referral was fear of losing clients while most referrals were for laboratory investigations.

Conclusion: Most PPMVs reported moderate knowledge, attitude, and practice of patient referral. PPMVs were aware of the benefits of referrals but concerned about losing their clients to formal healthcare facilities.