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

Background: Maternal haematological status and concurrent blood-borne viral infections play a crucial role in determining pregnancy outcomes. This study assessed haematological profiles and the prevalence of blood-borne viruses among pregnant women attending a tertiary military hospital over a four-year period.

Methodology: A retrospective cohort analysis was conducted using clinical records of 499 pregnant women who attended antenatal care at the 68 Nigerian Army Reference Hospital, Yaba, Lagos, Nigeria. Data on demographics, complete blood count, and serology for blood-borne viruses were extracted into a structured proforma. It was analysed using statistical package of social sciences (SPSS) version 29. Descriptive statistics were presented using tables and charts. Associations were tested, with statistical significance set at p<0.05.

Results: Participants had a mean age of 36 ± 2.3 years. Blood group O was most common 245(49.7%), with the least being AB blood group which accounted for 48(9.6%). Haematocrit was lowest in the third trimester (31.21 ± 4.1%, p<0.001), while 1^st and 2^nd trimester haematocrits were 33.49±3.4 and 31.73±3.1 respectively. Anaemia was significantly associated with primiparity (p=0.04), HIV infection (p=0.03), and the Hb AS genotype (p=0.01). HIV prevalence was 30 (6.0%) higher than that of hepatitis B 27(5.4%) and Hepatitis C 7(1.4%).

Conclusion: HIV prevalence (6.0%) was higher than hepatitis B and C, and primiparous women showed significant anaemia with low haematocrit values. These findings call for targeted nutritional support and strengthened antenatal screening for blood-borne viruses to improve maternal and fetal outcomes.

The deadly COVID-19 outbreak which started in Wuhan city of China in December 2019, created a dangerous Public Health Disaster the world has ever witnessed. Bats have been widely recognised as natural reservoir hosts of several zoonotic diseases, such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) caused by coronaviruses. A new bat coronavirus similar to the virus resembling COVID-19, has been discovered recently by researchers at the Wuhan Institute of Virology in China. The new virus named as 'HKU5-CoV-2, carries the risk of animal-to-human transmission. This paper shares the most recent information on the virus and views of other eminent scientists regarding its potential to start another pandemic.

Background: Fractures of the patella, though not so common, are prone to complications. Injuries to the patella often disrupts the extensor mechanism of the knee and increases the likelihood of patella-femoral joint incongruence. The aim of this study was to determine the outcome of treatment of patella fracture in two tertiary health institutions in South-south Nigeria.

Methodology: A retrospective descriptive study was conducted among patients who had patella fractures over a five-year period, using hospital records. The data obtained were analyzed and formed into tables, charts and figures.

Results: Thirty-nine patients were recruited into the study. Patella fractures were most predominant in the age bracket 31-40 years (30.8%), while the least was noted in the age group 61-70 years (5.1%). Road traffic accidents were the most common etiological factor (53.8%). Majority of the patients had transverse fractures (61.5%), while severely committed fractures constituted the least (2.6%). Four patients (10.3%) had open fractures. Majority of the patients had surgical treatment with tension band wiring (25 patients). The outcomes were good within the period of follow-up.

Conclusion: The result showed that patella fractures are common in young population. Patients receive optimum care with good outcome in the two centers involved in this study.

Background: Research and academic publications are crucial for Indian physicians' professional growth, evidence generation, and academic advancement. It often contributes to the "publish or perish" culture. This study aims to assess Indian physicians' perceptions and self-appraisal on academic publications, for those practicing evidence-based medicine (EBM).

Methodology: A cross-sectional online survey with proper consent was conducted over two months, targeting Indian physicians practicing EBM to evaluate their views on research and publications.

Results: A total of 320 physicians participated (mean age 41.15 ± 8.94 years; 68.8% male). Most held post-graduate degrees (73.4%) and worked in government-run institutions (56.6%). A large proportion (88.7%) had prior publications, with a preference for PubMed/Medline-indexed journals (40.0%). Sixty-five percent balanced clinical and academic roles. Physicians were motivated by career advancement (31.6%) and professional recognition (34.7%). Behavioral patterns showed "addiction-like" tendencies, with many frequently checking publication metrics and tracking manuscript progress. Physicians with post-graduate qualifications, particularly in medicine, were more engaged in these behaviors. Those in central government teaching institutions showed even greater engagement.

Conclusion: This study reveals the complex dynamics of academic publishing among Indian physicians, highlighting the pressures of the "publish or perish" culture. Institutions should focus on fostering quality over quantity in publishing, providing mentorship, and promoting ethical practices to mitigate these pressures.

Background: Peripheral Arterial Disease (PAD) is a significant complication among patients with Type 2 Diabetes Mellitus (T2DM), characterized by atherosclerosis that leads to reduced blood flow to the extremities. This article assesses the traditional risk factors for PAD and the predictive value of the new inflammatory biomarkers like fibrinogen and C-reactive protein (CRP), and the implications of PAD in T2DM patients, drawing from recent studies and findings. The presence of PAD in T2DM patients poses serious health risks, including increased risk of foot ulcers, limb amputation, and cardiovascular events, necessitating comprehensive cardiovascular risk management. The study aims to assess the effectiveness of various diagnostic tests for PAD, particularly the Ankle-Brachial Index (ABI), in detecting PAD and stratifying cardiovascular risk in T2DM patients.

Methodology: The study population comprises the recruitment of 112 Type 2 DM patients and an equal number and sex matched healthy participants as controls from three centres in Calabar, making a total of 224 participants. Socio-demographic information was collected. After physical examination and anthropometric measurements, the ABI was performed using a Doppler ultrasound device. Descriptive statistics were used to summarize clinical and demographic characteristics, and comparative analysis was done using chi-square for categorical variables and t-test for continuous variables. Logistic regression was used for independent risk factors associated with PAD.

Results: The median ages for the Type 2 DM patients and the controls were 58 years (IQR 10) and 58 years (IQR 11), respectively. The prevalence of PAD using ABI<0.9 in this study was 37.5% in people living with type 2 diabetes and 14.3% in controls. The prevalence of PAD for Type 2 DM patients and controls using symptoms of palpation of pedal pulsations and intermittent claudication was 17.0% vs 3.6% and 11.6% vs 2.7% respectively. There was a statistically significant relationship between advanced age, hypertension, duration of diabetes, glycaemic control, fibrinogen, as well as CRP, and PAD among people living with Type 2 diabetes. After multiple regression analysis, the predictors of PAD in this study were age, duration of Diabetes, and elevated serum CRP. There was no correlation between smoking, obesity, and lipid profiles with PAD.

Conclusion: There is a high prevalence of peripheral artery disease among people with T2DM in Calabar. The use of ABI is of great value in the detection of PAD, as evidenced by a more objective assessment of PAD compared to intermittent claudication and reduced/absent pedal pulses. Routine screening of PLWDM for PAD using ABI would enhance early diagnosis and intervention.

Secondary syphilis is commonly associated with well-known cutaneous and mucosal manifestations, including maculopapular rashes and condylomata lata. However, clinical presentation can vary significantly, often resembling other dermatological or infectious conditions, which can lead to diagnostic delays and challenges, particularly in immunocompetent individuals. We report the case of a 26-year-old heterosexual Asian man working as a baggage handler at a busy international airport, who presented with a rapidly progressive, painful rash. Initially treated with flucloxacillin, his condition worsened, spreading to his face, trunk, and mucous membranes, accompanied by fever, tachycardia, and difficulty swallowing. Physical examination revealed widespread umbilicated vesicles, haemorrhagic blisters on his right lower leg, and ulcers in the oral cavity. Despite negative results for common viral infections (HSV, VZV, HIV) and autoimmune disorders, serological testing for syphilis revealed a positive rapid plasma regain test, confirmed by a positive treponemal antibody EIA test and subsequent clinical improvement with appropriate antibiotic therapy. Following the diagnosis of secondary syphilis, the patient was treated with benzathine penicillin and supportive care. He experienced a mild Jarisch-Herxheimer reaction, which resolved with monitoring. A subsequent infection of a fungating lesion (bacteria superimposition) on the right shin was managed with amoxicillin/clavulanic acid. By the patient's follow-up visit, the skin lesions had markedly improved, and he was discharged with ongoing care and penicillin treatment. This case highlights the importance of considering syphilis in the differential diagnosis of atypical cutaneous and mucosal lesions, especially when presenting with systemic symptoms. The diagnosis of secondary syphilis can be challenging due to its diverse clinical manifestations, which may mimic other infectious or autoimmune conditions. A careful diagnostic approach, including serological and polymerase chain reaction testing, is essential for accurate diagnosis and effective treatment. This case also emphasizes the need for timely public health intervention and education in high-risk populations.

Background: Waiting time at a trauma centre (TC) before injured patients receive treatment is critical to treatment outcomes. The study aims to find the impact of the government's free emergency services on the waiting time before treatment is initiated.

Methodology: This was a retrospective study of the admitted emergency patients at the Trauma Centre, of Usmanu Dan fodio University Teaching Hospital (UDUTH), Sokoto, Nigeria, from November 2024 to March 2025. Patients' presentation time was classified as less than 6 hours or more than 6 hours before admission and waiting time as less than 15 minutes or greater than 15 minutes. The outcome was either satisfactory or unsatisfactory. Chi-Square was used to analyse categorical data. The level of significance was set at P<0.05.

Results: There were 366 patients included in the study. The average waiting time before intervention (in minutes) was 10.5±0.242. Most patients (42/11.5%) had a waiting time of 7 minutes. The male-to-female ratio was 2.1 to 1. The mean age of patients was 35.87±17.20. Cases seen were fractures & dislocations (122/33.3%), gunshot wounds (62/16.9%), head injuries (43/11.7%), burns (38/10.4%), spinal cord injuries (33/9.0%), abdominal injuries (26/7.1%), urologic injuries (21/5.7%) and others (21/5.7%) include chest injuries, soft tissues, limbs gangrene etc. There were 252 (58.9%) patients who presented less than 6 hours post-injury, while 114 (31.1%) presented after 6 hours. Patients who started receiving treatment on admission <16 minutes were 298 (81.4%), and those at >15 minutes were 68 (18.6%). Associating injury duration (<6 hours vs. >6 hours) and treatment outcomes, p-value=0.0001, OR=4.90, 95% CI=2.39-10.04. At the same time, associating waiting time before treatment and treatment outcomes, the p-value=0.0001, OR=5.29, 95% CI=10.77. Following the paired sample t-test of the 2 groups between the median (10.0), the p-value was 0.0001.

Conclusion: There was an improvement in the waiting time for the initiation of treatment. This was largely influenced by the presence of free ambulance services, available free medications and surgical interventions.

Background: Poor glycemic control remains a significant Public Health problem among people living with HIV(PLWH) and diabetes in Africa and Uganda specifically. Dual diagnosis of HIV and diabetes is associated with high costs of management and poor prognosis. This study aimed to determine the baseline glycemic control of PLWH and diabetes and associated factors in Eastern Uganda.

Methodology: This study employed quantitative methods along with a cross-sectional analytical study design. A total of 257 participants (ten didn't participate) from Mbale and Soroti Regional Referral Hospitals participated in this study from May 1 to July 30th, 2024. The sample size was determined using the modified Cochrane formula, and participants were selected using simple random sampling. An electronic questionnaire was used to collect socio-demographic and clinical data. An automated Finecare HbA1c analyser was used to determine the HbA1c levels of participants. The data was analysed using Stata version 15. Multivariable logistic regression analyses were conducted to identify associated factors. At p<0.05, statistical significance was established.

Results: The median age was 51(44, 60). The female participants comprised 152 (59.1%), and 52 (20.2%) of the total participants had a tertiary education. More than half, 136 (52.9%), had HbA1c above 7%. The age group above 50 years, having more than three children, and tertiary education were positively associated; however, only the tertiary level of education was statistically significant after adjusting for confounders, aPOR 3.9(95% CI:1.1-14.2), p=0.037.

Conclusion: The prevalence of poor glycemic control among people living with HIV and diabetes at Mbale and Soroti Hospitals in Uganda is high at 52.90%. The age group above 50 years, having children and tertiary education were positively associated with poor glycemic control. Routine HbA1c testing and immediate evidence-based management by health workers are encouraged among clients over 50, those with children, and those with tertiary education.

Background: Medical education is known to be demanding and stressful, often leading to mental health challenges such as stress, anxiety, and depression among students. Understanding the prevalence and factors contributing to these issues is crucial for effective intervention and support.

Methodology: A descriptive cross-sectional study was conducted among 400 medical students at the College of Health and Medical Sciences at Babcock University. Data was collected using a standardised questionnaire comprising sections on sociodemographic characteristics, depression (PHQ-9), anxiety (GAD-7), stress (PSQ), and health-seeking behaviour. Statistical analysis was performed using SPSS version 22, with descriptive statistics and chi-square tests applied. The value for p was <0.05, which is statistically significant.

Results: The prevalence of depression was 53.5% with 186(45.3%) having mild depression, more than half of the respondents had minimal anxiety, 202(50.5%), and a high level of stress, 214(53.5%), respectively. Factors affecting mental health included lack of institutional support 170 (42.5%), poor awareness of available services 125 (31.3%), and poor utilization of mental health services 310, (77.5%). Age was found to be statistically significant (x2=15.792, P=0.015) in terms of anxiety level. Additionally, significant associations were observed between stress and depression (x2=37.497, P<0.001), as well as between stress and anxiety (x2=44.286, P<0.001).

Conclusion: This study shows that the levels of depression, anxiety, and stress are moderately high among the medical students, underscoring the urgent need for intervention and support mechanisms. Enhancing institutional support, integrating mental health education into the curriculum, and conducting regular screenings will go a long way in creating a supportive environment conducive to the mental well-being and academic success of its medical students.

Background: Persistent congestion in acute heart failure (AHF) is associated with worse clinical outcomes. The use of steroids may provide therapeutic benefits by alleviating congestion, overcoming diuretic resistance, and mitigating the harmful effects of neurohormonal activation. This approach could potentially improve hemodynamic status and support better management of AHF, ultimately leading to enhanced patient recovery and reduced complications.

Objective: To evaluate the efficacy and safety of steroids in acute heart failure (AHF) as compared to the standard of care (SOC).

Search strategy: We used PubMed, Scopus, Google Scholar, and a manual search to identify Randomized controlled trials published up to October 15, 2024.The protocol was registered in PROSPERO (CRD42024601261).

Selection criteria: All full-text randomized control trials (RCTs) that investigated steroids in heart failure were included. Results were pooled, where appropriate, using a random-effects model.

Results: Three RCTs with 563 participants [282 Steroid, 281 (SOC)] were identified. No statistically significant difference is seen in mortality as well as NT-proBNP levels between the steroid plus SOC and control group (RR=0.59, 95% CI=0.06-6.13, p=0.66, (I⊃2;=51%, p=0.15) and (MD=0.14, 95% CI=-0.62 to 0.90, p=0.71, I⊃2;=91%, p<0.0006), respectively.

Conclusion: Steroids have no significant effect on all-cause mortality or NT-proBNP levels in patients with AHF.