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

Background: Depression in adolescents could be highly distressing and may exert a huge burden on the growing individuals transiting to adulthood. Adolescents are confronted with high expectations and societal demands which may place serious burdens on them and lead to depression. This study intended to study the pattern of depression among adolescents in Ilesa with a view to providing information that could serve as an empirical basis for strategic interventions for the affected adolescents.

Methodology: A descriptive cross-sectional study was conducted among 302 secondary school adolescents in Ilesa East LGA. These subjects were selected using a multistage sampling method. Adolescents' socio-demographics were assessed with a socio-demographics questionnaire. The PHQ-9 was used to assess depression among adolescents. Data was entered and analyzed using Statistical Package for the Social Sciences version 21 (SPSS 21) and analyzed. The test of associations between the outcome variable and categorical variables was done with Chi- square and p<0.05 was taken as the level of significance.

Results: The results showed that seventy-nine out of the 302 adolescents screened with PHQ 9 had depression with prevalence of 26.2%. The prevalence of depression was significantly higher in adolescent girls than in boys (χ2=9.782,p=0.002); and significantly pronounced in early adolescents compared to the middle and late adolescents (χ2=14.205, p=0.001).

Conclusion: The Prevalence of depression was high among the adolescents in Ilesa and commoner among the early and females' adolescents.

Background: Cryptogenic steatotic liver disease (CSLD) is a novel subject where the liver has significant steatosis but without a known cause or abnormal cardiometabolic risk factors. It is a growing global health concern with an unclear etiology. Despite the increasing prevalence of CSLD, particularly in regions undergoing rapid urbanization and lifestyle changes, there is limited research on its risk factors in Nigeria. This study investigated the relationship between physical activity and CSLD in a Nigerian population.

Methodology: A case-control study was conducted in tertiary institutions in Zaria, Nigeria. A total of 362 participants were recruited, comprising 181 individuals with CSLD diagnosed via ultrasound and 181 age- and sex-matched healthy controls. Lifestyle, anthropometric, and biochemical data were collected, with physical activity levels classified into sedentary, mild, moderate, and strenuous categories. Statistical analyses, including chi-square tests and logistic regression, were performed to assess associations between physical activity and CSLD.

Results: There was no significant difference in age (p = 0.5578) or sex distribution (p = 0.9160) between CSLD cases and controls. However, a significant association was observed between CSLD severity and physical activity levels (χ²= 172.1, p < 0.0001). Sedentary individuals had a higher risk of CSLD, while moderate physical activity was the most protective (OR: 0.001, p < 0.001). These findings suggest that an inactive lifestyle is a strong risk factor for CSLD.

Conclusion: Sedentary behavior is an independent risk factor for CSLD, while regular physical activity, particularly moderate exercise, is protective. Public health initiatives promoting physical activity should be prioritized to mitigate CSLD progression and its complications. Further longitudinal research is needed to explore genetic predispositions and assess the long-term impact of lifestyle modifications on CSLD outcomes.

Due to its ubiquitous use in diverse sectors, artificial intelligence (AI) has been hailed as the fourth industrial revolution. AI's potential has not been fully realised in Nigeria's medical space, notably in paediatric care. We discuss how AI can improve paediatric care in Nigeria, focusing on early diagnosis, precision medicine, and remote monitoring. AI must overcome several obstacles to be appropriately integrated into paediatric care. The disparity between training data and healthcare settings can cause algorithmic bias, diagnostic errors, and flawed treatment recommendations. More substantial patient privacy rights and transparent AI algorithms are needed to build healthcare workers and patient trust in AI and ease AI adoption. This paper contends that medical curricula must include training in AI and related fields to equip future Nigerian paediatricians with the skills to maximise AI's potential. Meanwhile, Nigerian paediatricians and AI specialists must join forces to adapt AI technologies to Nigeria's particular needs.

Background: Over time, disease outbreaks in Nigeria have been attributed to under-reporting by healthcare workers. Disease surveillance and notification are important for early detection of disease outbreaks, timely response, and reduction of morbidity and death. This study assessed the knowledge and practice of disease surveillance and notification (DSN) among health workers in public health facilities in Wamakko LGA of Sokoto State.

Methodology: A descriptive cross-sectional study was conducted among 167 healthcare workers of all cadres in six primary health facilities. Data was collected from participants selected via convenience sampling method, using an interview-based semi-structured questionnaire. Data were analyzed using descriptive and inferential statistics.

Results: Most of the participants were Community Health Extension Workers (CHEW) (34.1%). The majority were aware that some diseases required notification (98.8%), where or who to report/notify diseases (83.8%), and of the DSN system (68.9%). The practice of disease notification was also comparatively good. Educational qualification (p=0.004) and years of working experience (p=0.041) were found to be significantly associated with the level of knowledge on disease surveillance and notification. There was no significant association between the level of practice of DSN and the level of knowledge (p=0.515), work experience (p=0.303), supervision (p=0.372), and motivation/incentives to disease reporting (p=.293). The notable identified challenges to disease reporting were the non-availability of reporting forms and stationery.

Conclusion: Even though disease notification and surveillance are common in Nigeria, the practice and specific use of the surveillance and notification tools still fall short of the standard required for effective monitoring of the trend of disease and forestalling outbreaks. Regular training and revision courses on DSN for healthcare workers at the LGA level, especially on the uses of each DSN form are recommended.

Background: Oligohydramnios, traditionally associated with adverse perinatal outcomes, often prompt early delivery via caesarean section, even in otherwise uncomplicated pregnancies. However, emerging research suggests that isolated oligohydramnios may not significantly impact neonatal outcomes, warranting re-evaluation of current management strategies. This study aimed to assess maternal and fetal outcomes in patients with idiopathic oligohydramnios diagnosed between 34-40 weeks of gestation, compared to low-risk pregnancies with normal amniotic fluid volume.

Methodology: A prospective case-control study was conducted in a tertiary care hospital in Eastern India over a period of one year. The study enrolled 100 pregnant women divided into cases: women with idiopathic oligohydramnios (amniotic fluid index [AFI] ≤5 without any identifiable maternal, fetal, or placental cause) and controls: gestational age-matched women with normal AFI (5-25 cm). Maternal characteristics, labor course, mode of delivery, and neonatal outcomes were analyzed. Statistical analysis was performed using SPSS, with p<0.05 considered significant.

Results: The rate of labor induction was significantly higher in cases compared to controls (50% vs. 20%, p=0.001). Meconium-stained liquor (44%) and non-reactive cardiotocography (NRCTG) (60%) were more common in the oligohydramnios group. Caesarean section rates were markedly higher among cases (78% vs. 32%, p<0.001), primarily due to fetal distress (71.8%). Newborns of cases had a higher incidence of small-for-gestational-age (SGA) status (56%). APGAR scores <7 at 1 and 5 minutes were more frequent in cases, with significantly higher neonatal intensive care unit (NICU) admissions (60% vs. 16%, p<0.001).

Conclusion: Isolated oligohydramnios is associated with increased obstetric interventions, higher caesarean rates, and adverse neonatal outcomes, including SGA and higher NICU admissions, despite reassuring antenatal fetal surveillance. These findings suggest the need for individualized care and close fetal monitoring rather than automatic early delivery in isolated oligohydramnios cases.

Beta-thalassemia intermedia (β-TI) is a genetic disorder characterized by chronic anaemia resulting from ineffective erythropoiesis. While management typically involves transfusions and pharmacological therapies, these carry risks like iron overload and variable efficacy. Alternative approaches, such as neurotherapy, offer potential for improving haematological outcomes without invasive interventions. The aim of this study was to evaluate the impact of neurotherapy as a complementary treatment in a 44-year-old female patient with β-TI. A 44-year-old female with β-TI underwent 48 neurotherapy sessions over three months (four sessions per week). Therapy targeted specific pressure points to stimulate organ functions critical for haemoglobin synthesis and overall health, including the pancreas, kidneys, thyroid, and liver. Techniques focused on improving erythropoietin production, enhancing iron metabolism, and promoting globin chain synthesis. Following therapy, the patient's haemoglobin level increased from 5.9 g/dL to 9.7 g/dL, with improvements in haematocrit, MCV, MCH, MCHC and ferritin levels. Platelets, serum TSH and ESR showed significant reductions, while vitamin B12 normalized. Clinically, the patient reported increased energy levels, reduced fatigue, and improved physical activity tolerance. No adverse effects were observed, and the patient expressed high satisfaction with the outcomes. This case highlights the potential of neurotherapy as a safe and effective adjunctive treatment for β-TI. By improving haematological parameters and alleviating fatigue, neurotherapy could serve as a valuable addition to the therapeutic toolkit for managing this condition.

Background: Seborrhoeic dermatitis (SD) is a common dermatosis worldwide and ranks among the ten most prevalent skin conditions in Nigeria and Africa. However, studies on SD in African populations are sparse. This study aimed to document the demographic and clinical characteristics of adult SD patients in Lagos, Nigeria.

Methodology: A prospective, hospital-based case-control study was conducted at a tertiary dermatology clinic between January and July 2019. It included 80 newly diagnosed SD patients and 80 age- and sex-matched healthy controls. Demographic and clinical data were collected using structured questionnaires, detailed skin examinations,10% KOH microscopy of lesional scrapings, and blood tests for random blood sugar and HIV serology. Severity was classified using a modified SD severity scoring system. Data analysis was performed using Epi Info version 7.2 and SPSS version 22.

Results: The mean patient age was 32 years, and 52.5% were female. Most patients had recurrent, scaly, and pruritic lesions on the face, scalp, and trunk, with 81% reporting recurrences. Aggravating factors included hot and humid weather, stress, and inappropriate skincare. Family history of SD and medicated soap use were common (66.3%). Embarrassment due to lesions was reported in 93.8% of cases. Self-medication with triple-action creams, antihistamines, and herbal remedies was found in 91.3%. Moderate severity was most frequent, and hypo- and hyperpigmentation were more common than erythema. HIV infection and abnormal glycemic levels occurred in 2.5%.

Conclusion: Seborrhoeic dermatitis is a recurrent inflammatory dermatitis occurring predominantly among young adults in Lagos. It is often moderately severe, aggravated by exogenous factors, and causes patient embarrassment. Further research on SD is needed to develop more effective treatment modalities.

Background: In many cultures, pepper is used for its dietary and medicinal benefits. The aim of the present study was to investigate and compare the effects of different varieties of pepper on intestinal motility and post-prandial bicarbonate concentration in guinea pigs.

Methodology: The study was conducted using 50 adult guinea pigs separated into groups of 5 each; Group 1 served as control. The experimental groups received respectively black, green, and red pepper extracts in concentrations of 25mg/kg, 50mg/kg, and 75mg/kg. For each experimental group, pepper was administered together with a mixture of Evans blue dye and Arabic gum and allowed for one hour. Each animal was thereafter, anesthetized and the intestines dissected out. For each animal, the total length of the intestine as well as the distance travelled by the test meal from the pyloric sphincter were measured and recorded. Intestinal transit was expressed as the percentage of the distance travelled by the test meal to the total length of the intestine. Concomitantly, blood samples were collected to determine the post-prandial bicarbonate concentration.

Results: The result showed that all three varieties of pepper caused a significant rise in the percentage of intestinal transit (in 1hr) (p < 0.05) and by implication reduction in the intestinal transit time. However, a significant dose-dependent effect was observed in the groups receiving black and green pepper respectively (p < 0.05). This suggests an inverse relationship between the concentrations of black and green pepper with the intestinal transit time. The post-prandial bicarbonate concentrations of the different experimental groups were not significantly changed compared to their control (p > 0.05). This suggests that none of the pepper types given their respective concentrations significantly stimulated gastric acid secretion.

Conclusion: All three pepper types increased intestinal motility without causing any significant effect on gastric acid secretion.

Background: Patients with cleft lips and palate (CLP) pose a high perioperative risk. Specialized anaesthesia is therefore required to improve outcomes. The experience with anaesthesia for patients scheduled for cleft surgeries at the University of Port Harcourt Teaching Hospital, a Smile Train partner hospital in Nigeria-West Africa (a low- and middle-income country-LMIC), from January 2020 to June 2023 is hereby presented.

Methodology: Data on demography, clinical and perioperative characteristics of patients billed for CLP surgery from January 2020 to June 2023 were collected, using records from patient's folders, anaesthetic and theatre registers. SPSS v.22 was used for analysis and results presented as frequencies and percentages.

Results: A total of 94 patients were anaesthesized during the study period, including 10(10.6%) preoperative cancellations that were optimized. The mean age was 54.7±73.8 months, M:F ratio was 1:1.2, paediatric patients were 90(95.7%) and general anaesthesia (GA) with controlled ventilation was 93(98.9%). Surgeries were CP-49(52.1%), CL-42(44.7), and palatal fistula repair-3(3.2%). Preoperatively, 4 (4.3%) each had anaemia and upper respiratory tract infection which were treated. Mandatory monitoring included non-invasive blood pressure 94(100%), pulse oximetry 94(100%), ECG 94(100%) and end tidal CO2 93(98.9%). Intraoperatively, difficult intubation 6(6.4) and hypoxaemia 4(4.3%) were encountered; and postoperatively there was respiratory obstruction in 4(4.3%). All complications were successfully managed with full recovery.

Conclusion: With specialised perioperative care, anaesthesia for cleft surgeries can be associated with good outcomes in low- and middle-income countries (LMIC).

Background: Malaria in pregnancy continues to be a major public health problem in sub-Saharan Africa. Pregnant women are at a higher risk because asymptomatic malaria infections may lead to detrimental pregnancy outcomes. Early diagnosis is the main strategy to reduce these adverse outcomes; however, conventional rapid diagnostic tests (RDTs) are inadequate for detecting low-density infections. There are prospects that ultra-or highly sensitive RDTs may improve the detection of malaria in these populations. The objective of this study is to assess and compare the diagnostic accuracy of ultrasensitive and conventional RDTs for malaria in asymptomatic pregnant women at the Benue State University Teaching Hospital, Makurdi.

Methodology: This was a cross-sectional comparative study conducted in the antenatal clinic of Benue State University Teaching Hospital, Makurdi, Nigeria. It involved 107 asymptomatic pregnant women whose peripheral venous blood samples were obtained and tested with conventional RDT (co-RDT) and ultra-sensitive RDT (us-RDT) to detect Plasmodium falciparum in peripheral blood. The results from microscopy were used as the reference standard. Results were categorised as positive and negative.

Results: The overall prevalence rate of P. falciparum was 14% using microscopy, followed by us-RDT (12.1%) and co-RDT (2.8%). The us-RDT showed a higher sensitivity (66.7% vs. 13.3%), positive predictive value (83.3% vs. 50.0%), negative predictive value (94.7% vs. 87.4%), and test accuracy (93.5% vs. 86.0%) compared to co-RDT. In comparison, the specificity of both tests was similar (97.8%). There was a significant difference in diagnostic performance between the two RDTs (p=0.002).

Conclusion: The study suggests that ultrasensitive RDTs are a more effective test for detecting P. falciparum infection in asymptomatic pregnant women compared to conventional RDTs. This may have important implications for clinical decision-making and the management of malaria in pregnancy.