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

Background: COVID-19, which is caused by the SARS-CoV-2 virus, is associated with abnormalities of biochemical parameters. There are indications that some of these biochemical parameters can differ according to the severity of the disease and the outcome of the infection. This study describes and compares laboratory findings among COVID-19 patients hospitalized at a facility in Southwestern Nigeria according to disease severity and mortality.

Methodology: Records of 223 patients with COVID-19 disease admitted between March 2020 and May 2021 were retrospectively collected. Socio-demographic characteristics, laboratory parameters, and patient outcomes were obtained. Patients were classified according to COVID-19 severity. Laboratory parameters were compared between patients with severe and non-severe disease and between survivors and non-survivors.

Results: Of the 215 patients with some laboratory data included in the analysis, there were 133 (62%) males, and 56.7% were aged above 60 years. A total of 71.6% had severe COVID-19 and 48.4% died during hospitalization. The severe disease occurred significantly more frequently among non-survivors (P0.01). Higher leukocyte and neutrophil counts, urea levels, D-Dimer, and fasting blood glucose levels occurred significantly more frequently in both severe disease and mortality categories. Additionally, elevated GGT and CRP were significantly more common in those with severe than non-severe disease while lower hemoglobin, hematocrit, albumin, and higher creatinine levels were significantly more common in non-survivors.

Conclusion: Our study found that certain readily obtainable biochemical parameters occur more frequently with severe disease and/or mortality amongst patients hospitalized with COVID-19 in sub-Saharan Africa and might be useful for prognostication and allocation of resources.

Healthcare started as a one-man business where only the doctor received, reviewed, diagnosed, prescribed, dispensed the treatment, and nursed the patient. There was no regulation, and hence society relied solely on the doctor's morals for appropriate treatment, professional handling of patients, and confidentiality. The doctor was highly regarded in society and was close to royalty. The perceived benefits and lack of external regulation bred charlatans and eroded society's confidence stimulating the development of the Hippocratic Oath. The Hippocratic Oath has progressively evolved in tandem with developments in society to what it is today. From the Hippocratic Oath, medical ethics sprung and evolved. We review several oaths that abound in medical practice and their evolution over the years to what we have today as the Physician's Pledge. We reviewed several articles published in English within ten years based on specified search terms for conformity. The selected articles were screened for relevance to the research topic, and necessary data were extracted. The Oath, though controversial in origin, evolved from a one-liner "primus non nocere" to what it is today, having started as a document heavily influenced by religion to become completely secular. It also transitioned from relying on the physician's morality for compliance to becoming externally enforceable. The transformations of the Oath and Ethics, which could be seen as the compartmentalization of the Oath based on this study, resulted from landmark events in society and changes in religious ideologies and societal morals. The existence of many forms of the Oath was also established. Some of the Oaths were also adapted to suit the morals and beliefs of the areas used. In conclusion, concluded that the "One Oath for All" era is over. We propose an Oath or Pledge that will suit our society to avoid going counter to our laws.

Background: Systemic arterial hypertension is an independent predictor of cardiovascular diseases including aortic root dilation. Aortic root dilation is a hypertension-mediated organ damage entity regardless of age, gender, and body size. This study aims at determining the prevalence and associations of aortic root dilatation among treatment naïve hypertensive patients.

Methodology: The study was a cross-sectional study conducted at the University of Maiduguri Teaching Hospital from June 2019 to June 2021. Study participants were treatment naïve hypertensive patients recruited consecutively from the outpatient clinic of the hospital and normotensive sex- and age-matched controls. End diastolic aortic root diameter was measured using 2D transthoracic echocardiography at the annulus, sinuses of Valsalva, and Sinotubular junction by leading-edge to a leading-edge convention as recommended by the American Society of Echocardiography in parasternal long-axis view.

Results: Three hundred treatment naïve hypertensive patients (39.0% females) and 300 health normotensive age-and sex-matched controls (38.3% females) were enrolled. The mean ages of the patients and controls were 46.4±12.5 years and 46.4 ± 12.4 years respectively. The mean aortic root diameter (in mm) was significantly higher in the treatment naïve hypertensive arm of the study at the levels [AoA (24.7 ± 3.9mm versus 22.5 ± 2.0mm, p = 0.002), SoV (33.1 ± 3.4mm versus 31.4 ± 3.4mm, p = 0.023), and STJ (27.8 ± 3.5mm versus 25.9 ± 2.2mm, p = 0.002)]. Males had larger absolute aortic root diameters than females, however, after indexing aortic root diameters for BSA, there was no significant difference. The prevalence of aortic root dilatation amongst the treatment naïve hypertensive patients was 1.3% at all considered levels.

Conclusion: The aortic root dimensions in the treatment naïve hypertensive patients were larger than in normotensive adults. The prevalence of aortic root dilation at all levels amongst treatment naïve hypertensive patients is 1.3%.

Background: Dental caries is one of the most prevalent oral diseases affecting children and adult populations worldwide. The distribution and severity of dental caries vary in different parts of the world and within the same region or country. However, few studies have focused on the burden of caries among Nigerian adults. Therefore, this study aimed to determine the severity and pattern of dental caries among the adult population in the Kano metropolis.

Methodology: This was a cross-sectional study in which adults were interviewed using an interviewer-administered semi-structured questionnaire. Examiners used the criteria set by the World Health Organization (WHO) for assessing Decayed, Missing, and Filled Teeth (DMFT). Field examinations were carried out under artificial light with a wooden spatula, dental mirror, and a Community Periodontal Index of Treatment Needs (CPITN) probe.

Results: Respondents' mean (±standard deviation (SD) age was 41.2 (±12.78) years. The mean DMFT for the population was 3.58 (±3.53). One-in-three respondents (33.3%) had very low DMFT while one in five (20.0%) had very high DMFT. Severe dental caries as indicated by very high DMFT were more prevalent among women (22.2%), respondents with informal education (61.5%), and those who had a family history of dental caries (28.4%).

Conclusion: The severity of dental caries among the adult population in the Kano metropolis was low. Interventions should be focused on women, those with informal education and positive family history.

Background: The epidemic of cardiovascular diseases (CVD) is a global phenomenon, and approximately 80% of all cardiovascular-related deaths occur in low and middle-income countries including Ethiopia. The aim of this study was to determine the pattern of cardiac admission and its outcome among the annual medical admissions in Addis Ababa.

Method: This was a retrospective, cross-sectional study to evaluate the pattern of cardiac diseases and outcomes among medical admissions at St Paul Specialized Hospital Millennium Medical College from the 1st of Jan 2020 to the 1st of Jan 2021.

Results: The proportion of cardiac admission was 26% among 1,165 medical admissions. The most common cardiac admission was advanced congestive heart failure (CHF) (74% (224)), followed by hypertensive heart disease (HHD) (48.5%) and valvular heart disease (VHD)(23.5%), respectively. Chronic Rheumatic valvular heart disease (CRVHD) was 91.5% of the total VHD and was significantly higher among rural residents and younger populations (p<0.001). Over 12% of CRVHD patients were complicated with cardio-embolic stroke, constituting one-third of the total annual ischemic stroke admissions. Hypertension ((54%,) (164)) was the leading risk factor and was more common among urban residents (p=0.001). The mean duration of total hospital stay was 18.33 days. In-hospital mortality was 23.8% and was associated with shorter hospital stays (p<0.001). The most common immediate cause of death was sepsis of chest focus with multiorgan failure(27.8%), followed by fatal arrhythmia (20.8%) and brain herniation (15.3%), respectively.

Conclusion: Cardiac diseases are common in the study area causing significant mortality among medical admissions. Therefore, early risk assessment, adequate disease control, and stringent inpatient care should be among the priorities to reduce cardiovascular morbidity and mortality.

Background: The fear of neurology and neurosciences has been referred to as neurophobia. Neurophobia is a global phenomenon, that is worse in sub-Saharan Africa due to its impact on the already established huge gap in the neurologist-to-population ratio. The need to identify modifiable factors that could curb neurophobia stirred the current study, which aimed to determine the correlates of neurophobia among undergraduate clinical students.

Methodology: A cross-sectional design was adopted involving 173 undergraduate clinical students selected via stratified sampling. Content validated, self-administered questionnaire was utilized to obtain data on the perception of neurology, neurophobia, and demographic/academic-related characteristics. Bivariate and multivariate analyses were performed at the 0.05 significant level.

Results: The mean age (±SD) of the participants was 25.8(±2.2) years with a male-to-female ratio of 1:1.2. More than half of the undergraduate clinical students perceived neurology as being badly taught (77.5%), difficult to learn (83.2%), and with complex clinical examination (85.5%). The prevalence of neurophobia was 76.3% (n=132). The significant correlate of neurophobia was perceived poor knowledge of neurology. Students with poor perceived knowledge of neurology were about two times more likely to have neurophobia than those with perceived good knowledge (AOR=2.14; 95%CI: 1.04-4.41).

Conclusion: Approximately 8 in 10 undergraduate clinical students in Nigeria have neurophobia and the significant determining factor is their perceived poor knowledge. The need to adopt educational models that would strengthen academic prowess in neurology is strongly advocated as most of the students felt that the course was being badly taught.

Key messages: Neurophobia among clinical undergraduate students is rampant, and without timely educational intervention, the existing wide gap in the neurologist-to-population ratio could worsen. Our findings highlight the dire need to institute educational models tailored to attaining better teaching aids, peer discussions, and bedside teaching among clinical undergraduate students.

The absence of the Meibomian gland is a rare cause of evaporative dry eye disease. A 45year old Lady, a known patient of our clinic whom we have been managing for allergic conjunctivitis for the past 5 years, started complaining of her eyes feeling dry and foreign body sensation 2 years ago. Her ocular surface disease index was 12.5, dry eye symptom score was 7 out of 14. She had no Meibomian orifices on her lower lid margin, but the upper lid orifices were present in both eyes, with normal expression of fluid when expressed. There were 23 and 25 Meibomian orifices opening in the upper lids respectively, the meiboscore in both upper lids were 0 and in both lower lids were 3, the tear film breakup time was 2 seconds in both eyes, the Schirmer's test I was 5mm and 7mm, the Schirmer's test II was 3 and 6 mm in the right and left eye respectively. The conjunctiva was normal, the cornea in the right eye had punctate epithelial erosions in the inferior 1/3^rd of the cornea, and the left cornea was not stained. Other than these findings the anterior and posterior segment were essentially normal. Anterior segment OCT pictures of the everted lids showed the Meibomian gland superiorly and these were absent inferiorly. She has been placed on Gutt Sodium Hyaluronate 0.2%, 3 hourly, and OcHypromellose Opthalmic Gel 0.3% enriched with Carbomer 980 USP 0.25% at night. She says her symptoms resolved while on these medications. Although the congenital absence of the Meibomian gland is rare, they can present late with dry eye symptoms and mimic allergic conjunctivitis symptoms. We should examine the Meibomian orifices of all our patients to identify those with these abnormalities early. The report also highlights the importance of anterior segment OCT in evaluating the Meibomian gland.

Background: Clinical deterioration in critically ill patients is a common phenomenon that can occur several hours before an adverse outcome. Early detection of subtle changes in vital signs, such as alterations in pulse rate and blood pressure, is crucial for preventing adverse events. However, these are not often recognized early enough to prompt quick intervention. The use of warning scores or assessment systems in the management of the critically ill in Nigeria has not been well evaluated. We assessed the association between the National Early Warning Score (NEWS) system and outcomes particularly mortality among the critically ill at the Jos University Teaching Hospital (JUTH), Nigeria.

Methodology: This study is a retrospective study involving adults admitted to the medical and surgical wards between January 2021 and July 2021. Patient medical records were used to obtain data such as socio-demographics, and vital signs, which were used to compute the NEWS variable, diagnosis, length of stay, outcomes, and complications. Patients were classified as low, medium, and high-risk based on their NEWS scores within the first 24 hours of admission and 24 hours prior to the outcome of interest (death or discharge).

Results: A total of 405 patients were included in this study. Patients with low, medium, and high-risk NEWS scores within the first 24 hours of admission, had an 11.1%, 9%, and 17% chance of death respectively. In the NEWS score high-risk group 24 hours prior to outcome (death or discharge), the risk of mortality increased to 20.6% and there was a four-fold increase in odds of death.

Conclusion: Our results showed that the NEWS score predicted outcome and may suggest that the implementation of the NEWS score as a routine tool for monitoring inpatients at the Jos University Teaching Hospital could help to detect patients at risk of adverse events.

Background: Several efforts have been put in place to reduce the global burden of malaria especially in children and in sub-Saharan Africa. The study aimed to evaluate the impact of malaria control activities on the trend of childhood malarial diseases at a tertiary hospital in South-south Nigeria.

Methodology: A retrospective review of the case records of all malaria diagnoses including in-patient, out-patient, and emergency room, seen in the Department of paediatrics at the University of Port Harcourt Teaching Hospital from January 2006 to December 2018 was conducted.

Results: There were 41, 863 malaria cases diagnosed over the 12 years with a decline in yearly diagnosis and admissions, from the year 2006 through 2018. Total malaria admissions were 578, (44.5/ year), giving a severe malaria incidence of 1.26%, and there were 164 malaria death cases, with a yearly average of 12. The causes of death in the children with malarial parasitaemia were severe anaemia in 75 (45.7%), hypoglycaemia in 14 (8.5%), cerebral malaria in 17 (10.4%), and prostration with other co-morbidities, 22 (13.4%). Thirty-six children (22%) were convulsing and died soon after admission, with a compounding diagnosis of aspiration and respiratory failure.

Conclusion: There is a gradual reduction in childhood malaria disease, admission, and death, though this is slower than anticipated based on efforts and strategies put in place by the Nigerian government and various organizations.