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

Background: Stroke remains one of the major non-communicable public health disease conditions with resultant high morbidity and mortality. Neuroimaging in the form of Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) is adjudged to be the most reliable and efficient method of accurately diagnosing stroke and ruling out differentials. However, in view of cost implication and non-availability, a clinical scoring system known as the Siriraj Stroke Score (SSS) was developed to clinically differentiate stroke types, especially in resource-limited settings. This study sought to validate and determine the role of Siriraj stroke score in the clinical evaluation of patients presenting with acute stroke.

Methodology: This is a descriptive prospective study that was conducted over a one-year period. The study populations were adult patients presenting with acute stroke in a tertiary health facility in North-Western Nigeria. Clinical details with neuroimaging in the form of a CT scan were obtained. Data obtained was analyzed using Stata 15.

Results: Fifty-four percent (54%) of patients enrolled were males and ischaemic stroke is the commonest stroke subtype present in 69% of patients studied. Altered levels of consciousness, headache and vomiting are important discriminatory variables of the scoring system. The sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and accuracy of Siriraj Stroke Score for haemorrhagic stroke is 92%, 72%, 62%, 95% and 62% respectively.

Conclusion: Siriraj Stroke Score with sensitivity greater than 90% is reliable in differentiating the stroke sub-types; the patients in the 'grey zone' will however require neuroimaging.

Background: Congenitally corrected transposition of the great arteries (ccTGA) is a rare congenital heart disease with varying regional reports in management approach. The meta-analysis is aimed to document various regional differences in the pattern, presentation, and outcomes in the management of congenitally corrected transposition of the great artery(ccTGA).

Methodology: Search engines for published articles on ccTGA were used in the meta-analysis. This includes PubMed, Google Scholar, Web of Science, Medline, and Africa journal online. Articles published between 2001 and 2024 were recruited of which the last search was done in August 2024. Selected articles were highlighted and screened by means of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Statistical heterogeneity was assessed with the I² statistics.

Results: Fifty-one full articles were screened from the initial four hundred and eighty citations. A total of 37 studies were further excluded from the 51 studies after further screening for incomplete data, case reports, non-English language reportage, and studies from autopsy findings. The resultant 14 studies were presented in PRISMA. The statistical significance was observed as evidenced by the significance heterogeneity identified in the selected studies.

Conclusion: The review had shown that children with ccTGA presented with varying features with some chromosomal correlates. Management options are directed towards a high index of suspicion, early intervention, and prompt surgical care to avert the numerous complications that follow the disease.

Background: Benign laryngeal lesions, characterized by non-cancerous growths in the larynx, significantly impact voice quality and respiratory function. These lesions, which include vocal cord polyps, nodules, papillomas, and cysts, often result from factors such as vocal abuse, viral infections, and chronic inflammation. While studies on benign laryngeal lesions are well-documented globally, data specific to Northern Nigeria remains sparse. This study aims to analyze the demographics, clinical features, treatment modalities, and outcomes of benign laryngeal lesions over a decade in a tertiary otolaryngology center in Northern Nigeria.

Methodology: A retrospective review of 176 cases of benign laryngeal lesions was conducted over 10-years (2011-2020). Data were collected on patient demographics, clinical presentation, risk factors, lesion characteristics, and treatment outcomes. All patients underwent flexible laryngoscopy, with a subset receiving CT scans and histopathological examination. The study excluded malignant lesions.

Results: The study population comprised 123 males (69.9%) and 53 females (30.1%), with a male-to-female ratio of 2.3:1. The age range of patients was from 1.5 to 69 years, with a mean age of 34.74 years (±16.64). The most common presenting symptom was hoarseness (94.8%), and most lesions were vocal cord polyps (52.3%), followed by vocal cord nodules (34.7%) and juvenile-onset respiratory papilloma (6.8%). The glottic region was the most frequent site of lesion occurrence (94.9%). Treatment primarily involved voice rest (43.2%), direct laryngoscopy with excision (22.2%), and microlaryngeal surgery (8.0%). Treatment outcomes showed a cure rate of 40.9%, with a recurrence rate of 29.0%.

Conclusion: This study provides valuable insights into the demographic and clinical profiles of patients with benign laryngeal lesions in Northern Nigeria. The findings indicate a predominance of vocal cord polyps, significant gender disparity, and the effectiveness of surgical interventions. These results align with regional and international data but highlight the need for more localized studies to better understand the epidemiology and management of these lesions in Northern Nigeria. Further research should explore specific risk factors and the longterm outcomes of different treatment modalities.

Background: High maternal mortality has remained a problem, especially in developing countries. Ensuring availability and utilization of Basic Emergency Obstetric and Newborn Care services (BEmONC) reduce maternal morbidity and mortality. The study aimed to determine the geospatial distribution, accessibility and utilization of BEmONC services in Jigawa State.

Methodology: A cross-sectional study was conducted using the WHO "30 by 7" cluster sampling technique and two-stage sampling to select 630 women and 15 Primary Health Care facilities (PHCFs) respectively. The Geo coordinates of the PHCFs and households of respondents were taken using the global positioning system (GPS) on Android devices. Data were analysed using IBM SPSS version 25 and Arc GIS version 10.6.

Results: A dispersed distribution was observed for the BEmONC facilities in two LGAs and majority of the respondents (71.9%) fall within 5 Km radius to a BEmONC facility. Only 27% of the respondents utilized BEmONC services for obstetric complications. Predictors of utilization of BEmONC were living within 5 Km to the nearest BEmONC (aOR=3.3; 95% CI=1.565 - 6.822), use of bicycle (aOR=1.930; 95% CI=1.012 - 3.679), cars (aOR=1.838; 95% CI=1.127 - 2.998), and tricycles (aOR=1.833; 95% CI=1.017 - 3.309) as means of transportation to PHCs.

Conclusions: A dispersed distribution and good physical accessibility to BEmONC facilities were found, however, utilization was poor. Distance and mode of transportation were predictors of utilization of BEmONC services. Jigawa State Government should intensify awareness campaigns to improve the utilization of BEmONC services and provide emergency transport schemes for women with obstetric complications.

Autosomal hypophosphatemic rickets though a rare genetic disorder can lead to significant discomfort to the patient resulting in clinical deterioration and a poor quality of life. We describe a case of a 33-year-old woman G2P1001 at 6 weeks of gestation with complaints of myalgia and bony pains. Keeping her history of bony pains and fractures in mind, she was further evaluated. On evaluation, she was found to have low levels of phosphates 0.99 mg/dl (2.40-4.40) and high levels of fibroblast growth factor 23 (FGF 23) 231.70pg/ml (23.20-95.40). These biochemical parameters were suggestive of hypophosphatemic rickets and further on gene sequencing she was found to have autosomal dominant hypophosphatemic rickets (HR). During her follow-up visits, her checkup and antenatal investigations were normal. Pregnancy acts as a stressor and patients with asymptomatic ADHR may present during pregnancy for the first time with the symptoms of HR. So, a high index of suspicion is required for patients reporting musculoskeletal pains in pregnancy. Early diagnosis can help the mother have a better pregnancy experience. Phosphate and vitamin D supplementation during pregnancy can help these women reduce musculoskeletal pain symptoms. Unfortunately, this patient had a spontaneous abortion in the second trimester. The overall prevalence of ADHR is less than 1 per 1,00,000 live births. Data in pregnancy with ADHR is also minimal due to the condition's rarity. Hence, more and more studies are required in pregnancy with this disease to come to any conclusion and to find any association of ADHR with pregnancy outcomes. Genetic counselling and the need for testing in newborns if symptomatic is also an essential factor to remember when coming across such antenatal patients.

Background: Pregnancy leads to physiological changes primarily driven by hormones like oestrogen and progesterone. Such changes are multi-systemic in nature including involvement of the ear, nose and throat. Such changes impair the quality of the life of pregnant women and thus requires prompt intervention during pregnancy. This study aimed to determine otorhinological disorders among pregnant women attending obstetric clinic at Benjamin Mkapa Hospital.

Methodology: A hospital-based descriptive cross-sectional study was conducted at Benjamin Mkapa Hospital from June to August 2023. A total of 246 pregnant women were recruited after consenting where data on their age, gestational age, and otological and rhinological disorders were obtained. Otoscopic and rhinoscopic examination were done and recorded in the data collection sheet. Data was analysed using a Statistical Package for Social Sciences (SPSS) version 23. A p-value<0.05 was statistically significant.

Results: This study recruited 246 pregnant women with majority 135(52.8%) in the 3^rd trimester. Pertaining otological disorders manifested by pregnant women, majority 39(15.9%) of them presented with hearing loss/reduced hearing ability, and conductive hearing loss was the most common type, 19(48.7%). Regarding rhinological disorders, 47(19.1%) pregnant women had allergic rhinitis and most of them presented with nasal obstruction 41(87.2%), nasal bleeding 12(25.5%) and pale pinkish inferior turbinate,3(6.4%). Eighty (32.7%) pregnant women had olfactory disturbance whereby most of them had reduced sense of smell 41(51.3%). The association between otorhinological disorders and gestational age was significant for only allergic rhinitis and olfactory disturbance (p-value<0.05).

Conclusion: The study concludes that otorhinological disorders are common among pregnant women, with a significant number experiencing hearing loss, allergic rhinitis, and olfactory disturbances. Specifically, allergic rhinitis and olfactory disturbances are significantly associated with the trimesters of pregnancy, while other disorders like hearing loss, Bell's palsy, otitis externa, and sinusitis do not show a significant association with the pregnancy trimesters. This highlights the need for prompt intervention to manage these conditions and improve the quality of life for pregnant women.

Malignant colonic neuroendocrine tumours are rare. Even more uncommon is their occurrence in the left colon. They also infrequently occur in males and young adults. We describe a rare case of poorly differentiated neuroendocrine carcinoma of the descending colon in a 32-year-old male who presented with signs of intestinal obstruction. He later had exploratory laparotomy and tumour resection with 5 cm gross tumour margins and Hartman-type colostomy and completed six cycles of Etoposide and Carboplatin combination. He has been tumour- and symptom-free for 36 months. Even though rare, neuroendocrine tumours should be an important differential of all colonic tumours, irrespective of the patient's age and sex, and surgeons should have a high index of suspicion for them. Although they most commonly occur in the right colon (cecum), they can also be found in the descending colon, where they can present with intestinal obstruction. Tumour resection with 5 cm gross tumour margins and Hartman-type colostomy can be handy. Etoposide and Carboplatin combination can improve overall survival in complicated World Health Organization (WHO) stage 3 neuroendocrine carcinoma with regional lymph node involvement, and generally poor prognosis, but without evidence of distant metastasis, and relatively fair performance index. Younger patients with neuroendocrine carcinomas may benefit better from platinum-based chemotherapy.

Background: Choosing the appropriate place for delivery has a significant impact on the outcome of labour and childbirth. This study aimed to identify the factors associated with the place of delivery among women in Ogun East senatorial district, Nigeria.

Methodology: Using a multistage sampling technique, a comparative cross-sectional study was conducted among 375 women in Ogun East Senatorial District. An interviewer-administered, structured questionnaire was used. Data were analyzed using IBM SPSS version 22.0. Statistical significance was set at p<0.05. Relevant descriptive and inferential statistics were calculated. Results were presented in frequency tables.

Results: More urban respondents (n=296, 78.9%) utilized health facilities as a place of delivery during their last pregnancy than rural respondents (n=288, 76.8%). The factors associated with the place of delivery included marital status, educational status, cost of health service, and proximity to the health facility.

Conclusion: The findings underscore the need for public health policies that improve rural access to affordable and nearby maternal health services, which could enhance facility-based deliveries and reduce maternal and neonatal risks.

Background: The prevalence of gestational diabetes mellitus (GDM) is dependent on the diagnostic criteria used and there is no consensus on screening methods and diagnostic criteria. The International Association for Diabetes in Pregnancy Study Group (IADPSG) recently put forward new diagnostic criteria and encourages its adoption worldwide. The aim of this study was to determine the incidence of GDM and to compare the foeto-maternal outcomes of women diagnosed with GDM in the Federal Medical Centre, Yenagoa using the WHO 1999 and IADPSG criteria.

Methodology: This was a cohort study of 340 women who were booked for antenatal care at the Federal Medical Centre, Yenagoa. Women who gave consent to participate in this study took part in a 75-gram, 2-hour oral glucose tolerance test (OGTT). The diagnosis of GDM was sought in each participant using both the WHO 1999 and the IADPSG criteria. The incidence and the foeto-maternal outcomes in women diagnosed with GDM using different criteria were compared.

Results: The incidence of GDM was 5.3% in the IADPSG (case) group and 3.8% in the WHO (control) group. This difference was not statistically significant (p = 0.18). There was no significant difference between the groups for foetal and maternal outcomes that were assessed. Maternal outcomes were pre-eclampsia (p = 0.48), polyhydramnios (p = 0.31), insulin therapy (p = 0.35), caesarean section (p = 0.28), genital tract laceration (p = 0.18) and instrumental vaginal delivery (p = 0.34). Foetal outcomes were birth weight ≥ 4kg (p = 0.07), neonatal jaundice (p = 0.38), hypoglycaemia (p = 0.46), birth injuries (p = 0.42) and shoulder dystocia (p = 0.23).

Conclusion: The application of the IADPSG criteria in our environment may lead to an increase in the number of women being managed for GDM without any appreciable improvement in foetal and maternal outcomes.

Background: Sleep is a very important physiologic process which is necessary to maintain a state of well-being. Obstructive Sleep Apnea (OSA) is prevalent among all age groups with variations in presentation and severity. It is often underreported, especially among young people in the Low- and Middle-Income Countries LMICs. This study assessed the prevalence and pattern of OSA among undergraduates enrolled at tertiary Institutions in Kwara State, Nigeria using both Epworth and Stop Bang tools.

Methodology: A campus-based study conducted among undergraduate students in Kwara state. Respondents were selected from three tertiary institutions. A total of 1,048 eligible students were selected using a multistage sampling technique. Epworth Sleepiness Scale (ESS) and Stop Bang Questionnaire (SBQ) were adapted and administered. Both descriptive and inferential analyses were conducted. The level of significance was set at a p-value of <0.05 at 95% confidence interval. Ethical approval was obtained.

Results: The mean age of respondents was 21± 2.69. More than half 634 (60.5%) of the 1048 respondents were females, with 20 (1.9%) were married. Abnormal sleepiness was reported in 151 (14.41%) while 897 (85.59%) had normal sleepiness using ESS. With the SBQ, 998 (95.2%) had a low risk while 46 (4.3%) had a moderate to high risk of OSA. Religion, increasing levels of study, and presence of chronic disease, were significantly associated with abnormal sleepiness using ESS, whereas female gender, religion, presence of chronic disease, smoking, use of sedatives and caffeine were significantly associated with OSA using SBQ.

Conclusion: The prevalence and pattern of sleep disorder among the undergraduates showed a moderate prevalence of sleep disorder and associated risks of OSA using the sleep disorder tools. There is a tendency to become a big burden with an increase in age, therefore health promotion interventions are recommended early to students to create awareness of OSA risks.