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

Background: Emerging epidemiological data suggest that Hypertension (HTN) has become a significant public health challenge in sub-Saharan Africa. HTN in young adults is a problem lacking relevant attention because it is still erroneously considered a disease of the old. This study aimed to determine the prevalence of hypertension and its associated risk factors in undergraduate medical students at the University of Nigeria, Enugu Campus, Enugu State, Nigeria.

Methodology: This was a cross-sectional study conducted between March and April 2021. This study recruited 279 consenting medical students (136 males and 143 females) aged 18-35 years. They were administered with a structured questionnaire. Data on sociodemographic information and risk factors for hypertension were collected. Blood pressure, waist circumference, weight, height, and body mass index were measured using standard methods. All data collected were carried out following the Institutional ethical guidelines and that of the Helsinki as revised in 2000. Data were analyzed using IBM Statistical Package for Social Sciences version 25, and statistical tools employed include descriptive statistics and Chi tests. Results were recorded as mean standard deviation, and statistical significance was taken at p<0.05.

Results: This present study has shown a prevalence rate of 19.93% for hypertension. Isolated diastolic hypertension constituted a greater burden with a prevalence of 13.65% than systolic Hypertension (0.74%) and systolic-diastolic Hypertension 5.4%. The prevalence of prehypertension was 48.7%, with a higher incidence observed in females (25.8%), individuals aged 21-25 years (26.4), and those with normal BMI (35.1%). A significant association was observed between the stage of hypertension and gender (p = 0.005), and age category (p = 0.037). Of the examined cohort, 7.75% were underweight, 16.5% overweight, and 2.2% obese. Notably, systolic, and diastolic blood pressure, weight, as well as waist circumference showed significant (p = 0.01, p = 0.007, p =0.01 and p<0.0001 respectively) increases concomitant with advancing age.

Conclusion: There is an increased prevalence of prehypertension and hypertension among young adults. This calls for a comprehensive national screening, public enlightenment, and targeted prevention programs that foster healthy lifestyle behaviours, physical activity, and healthy eating among students.

Background: Air pollution from vehicular emission and other sources accounts for over seven million global deaths annually and contributes significantly to environmental degradation, including climate change. Vehicular emission is not prioritized for control in Nigeria, thus undermining public health and the Sustainable Development Goals 3, 11 and 13. This study aims to characterize vehicular emissions in Abuja municipality and quantify exhaust air pollutants of commonly used vehicles.

Methodology: Cross-sectional exhaust emissions study of vehicles in Abuja Municipal Area Council. Information on the type and age, fuel type, purchase and use category of 543 vehicles on routine Annual Road Worthiness Test at the Computerized Test Center, Abuja. Exhaust levels of CO, CO₂ HCHO and PM₁₀ were measured using hand-held devices. IBM SPSS version 26.0.0.0 (2019) statistical software.

Results: Toyota brand comprised 52.5% of the vehicles. Over 80% were older than 10 years; 85.5% preowned and 87.3% used for private purposes. PMS was the dominant fuel used (91.1%). Except PM₁₀, older vehicles emitted higher levels of the measured pollutants than newer ones. The differences were significant for CO and HCHO. Diesel-fueled and commercial vehicles also emitted higher levels of CO, HCHO and PM₁₀ compared to PMS-fueled and private vehicles respectively.

Conclusions: Strong regulatory policies that discourage over-aged vehicles; speedy adoption of the ECOWAS guidelines on cleaner fuels and emission limits; and coordinated implementation of effective Inspection & Monitoring programme by relevant government agencies are required to safeguard public health and the environment. We also recommend the introduction of vehicles powered by alternative energy, use of bicycles, designation of one-way traffic and pedestrian zones.

Key message: Reducing the threats to the public's health from vehicular air pollution in Abuja municipality requires strong policy and coordinated monitoring programs for effective control.

Background: Maintaining normal amniotic fluid index and normal hemoglobin level is crucial for normal fetal development. Their reduction can lead to maternal and fetal morbidity in the form of operative delivery and poor perinatal outcome such as, low birth weight. There is an association between oligohydramnios and anaemia, although there is scarcity on this correlation in literature. Early detection of oligohydramnios can improve maternal and perinatal outcome. This study aimed to investigate the association between oligohydramnios and anaemia during the third trimester of pregnancy.

Methodology: This retrospective cohort study was conducted at NESCOM Hospital, Pakistan. The study spanned from August 1, 2021, to July 31, 2022.

Results: The study included 109 pregnant individuals with oligohydramnios, resulting in an incidence of 22% among the total of 551 deliveries during the study period. The average age of participants was 29.75 years. The average gestational age was 33.52 weeks, with a range of 28 to 38 weeks. The analysis indicated that 44.03% of cases with oligohydramnios were associated with anaemia, followed by idiopathic causes (41.28%). Pearson's correlation revealed a significant association between oligohydramnios and anaemia (r = 0.307, p = 0.001), supporting the hypothesis of a potential interconnection between these two conditions. Regarding delivery outcomes, 81.6% underwent cesarean section, emphasizing the need for careful management in cases of oligohydramnios and anaemia. Neonatal outcomes indicated that 1.8% and 44.5% of neonates were extremely low birth weight and low birth weight, respectively.

Conclusion: This study provides empirical evidence supporting a significant association between oligohydramnios and anaemia in the third trimester.

With increasing survival following the use of antiretroviral therapy, adolescents living with Human Immunodeficiency Virus (ALHIV) could have complications such as delayed puberty and psychological complications. In Nigeria, there is limited data on the association between delayed sexual maturation and psychosocial dysfunction in ALHIV. The objective of this study was to determine the prevalence and the association between delayed sexual development (DSD) and psychosocial dysfunction (PSD) in ALHIV and compare it with uninfected adolescents.

Methodology: This was a cross-sectional study conducted at the Lagos University Teaching Hospital (LUTH), Nigeria and it involved 144 ALHIV and an equal number of HIV-negative controls who were matched for age, sex and social class. Information was obtained from participants using interviewer-administered questionnaires; their stages of sexual development and their psychosocial function were assessed using Tanner staging criteria and the Paediatric Symptom Checklist tool respectively. Data were analysed using the Statistical Package for Social Sciences software version 23.

Results: The mean (±SD) age of ALHIV and the HIV-negative controls was 14.8 (±3.0) and 14.8 (±2.9) years respectively. All the ALHIV were on HAART and 99.3% were in clinical stage 1. There was no significant difference between the prevalence of DSD among the ALHIV (9.4%) and the HIV-negative controls (6.4%) (p= 0.402). The prevalence of PSD in ALHIV and HIV-negative controls were 4.9% and 5.6% respectively (p=0.791). There was no significant association between PSD and DSD in both groups of study participants (p=0.459 and p=0.301).

Conclusion: The prevalence of PSD and DSD were low and similar among adolescents with and without HIV, and no association was found between PSD and DSD. However, routine screening of adolescents for PSD should be practised for early identification and prompt management where indicated.

Retained intra-abdominal foreign bodies are rare and most occur following abdominal or gynaecological surgery. Sponges are the most retained foreign body. The foreign bodies range from surgical instruments, including abdominal pads and gauze to artery forceps; to a pen cap. Retained objects can also be self-inserted. The authors report a case series on the outcome of retained foreign bodies in the intra-abdominal cavity managed in the general surgery service of the University College Hospital, Ibadan over 12-years.

Background: Hypertension is a major global health concern requiring precise risk assessment. Brain Natriuretic Peptide (BNP) has emerged as a potential biomarker, but its relationship with hypertension severity requires exploration to evaluate its potential as a risk prediction tool. This study aimed to assess the relationship between serum BNP levels and the severity of hypertension in a population of Nigerian patients.

Methodology: This was an analytical cross-sectional case-controlled study involving 103 hypertensive patients and 98 controls. Participants were grouped based on World Health Organization (WHO) criteria for diagnosis of Hypertension and the severity of hypertension was categorized based on blood pressure readings. The mean BNP levels were assessed among different hypertension grades, while logistic regression was used to assess the odds of higher severity with elevated BNP.

Results: Serum BNP levels were significantly higher in hypertensive individuals (616.5 ± 66.3 pg/mL) compared to controls (501.1 ± 84.6 pg/mL) and varied significantly across different hypertension grades (p = 0.000). A positive correlation was observed between serum BNP and hypertension severity (r = 0.736, p < 0.001). Logistic regression analysis indicated increasing odds of higher severity with elevated BNP from Grade 1 to Grade 3 hypertension.

Conclusion: This study established a positive correlation between serum BNP levels and hypertension severity, indicating its potential as a predictive biomarker for risk stratification in hypertensive individuals.

Background: Pregnancy serves as a physiological stress test for the thyroid which often leads to dysfunction in women with limited thyroid reserves. The occurrence of gestational thyroid dysfunction is linked to unfavourable obstetric and foetal outcomes. Globally, iodine deficiency is a prominent causative factor for thyroid dysfunction. The study aimed to determine the prevalence and pattern of thyroid dysfunction among pregnant women in Enugu, South-east Nigeria.

Methodology: This hospital-based descriptive cross-sectional and observational study was conducted over six months on selected participants from pregnant women attending antenatal clinics at the study sites. Maternal clinical and demographic risk factors for thyroid dysfunction were evaluated in a cohort of 318 pregnant women. An analysis of variance (ANOVA) was performed to compare participants' thyroid status across different trimesters of pregnancy, and different thyroid and nutritional iodine states.

Results: The prevalence of thyroid dysfunction in the study population is 6.6%. Hypothyroidism was detected in 5.3% of the participants, consisting of 3.8% sub-clinical hypothyroidism and 1.6% overt hypothyroidism. Sub-clinical hyperthyroidism accounted for 1.3% of all participants; no overt hyperthyroidism was detected in this study.

Conclusion: There is a relatively high prevalence of gestational thyroid dysfunction in the study population with hypothyroidism being the predominant disorder. This highlights the need for region-specific considerations in antenatal care to facilitate early detection and effective management of gestational thyroid dysfunction, thereby mitigating potential adverse maternal and foetal outcomes.

Background: Magnesium sulphate (MgSO₄) administered for twenty-four hours is the drug of choice for seizure prophylaxis in patients with preeclampsia with severe features. Due to its narrow therapeutic index, a reduction in the duration of MgSO₄ administered in the postpartum period may not only prevent the occurrence of seizures but also reduce the adverse effects associated with this drug. This study aimed to compare the efficacy of the 12-hour and 24-hour Pritchard's MgSO4 maintenance regimen on the occurrence of seizures and maternal outcomes in patients with preeclampsia with severe features.

Methodology: A triple-blind randomized controlled trial was conducted among women with preeclampsia with severe features between 1st June 2022 and January 31st, 2023. The primary outcome measure was the occurrence of seizure in either arm of the study. One hundred and forty-six women were randomized into two groups, those who received a 12-hour MgSO₄ regimen and placebo for the remaining twelve hours (Group I) and those who received a 24-hour MgSO₄ regimen in the postpartum period (Group II). The collected data was coded and analyzed using Statistical Product and Service Solutions (SPSS) version 26 and p<0.05 was considered significant.

Results: There was no statistically significant difference between the two groups concerning the occurrence of seizures, the need to recommence MgSO₄, clinical evidence of toxicity and adverse effects of MgSO4. There was also no statistically significant difference between the two groups in the total dose of MgSO4 administered, duration of urethral catheterization and duration of hospital admission. No maternal mortality was recorded in this study.

Conclusion: The results of this study suggest that the 12-hour MgSO₄ maintenance regimen is as efficacious as the traditional 24-hour regimen in preventing seizures without worsening maternal outcomes.

A quality management system for clinical and public health research operations is indispensable because it ensures the integrity and reliability of research outcomes. By implementing a robust quality management practice in research implementation and operation, research teams can uphold the highest standard of research conduct, thereby enhancing the credibility and trustworthiness of research findings. This paper elucidates the significance and role of a quality management system in clinical and public health research operations and its efficacy in minimising and eliminating protocol deviations and highlights the key steps in setting up a quality management system for research operations.

Background: The fear of positive HIV results has been reported as a determinant of HIV testing among pregnant women and women of reproductive age. When pregnant women know about discriminatory practices toward other people based on their HIV-positive status, it may impact their testing for HIV. Therefore, the purpose of this study was to examine the association between Nigerian pregnant women's knowledge of discriminatory practices against persons living with HIV and their self-reported HIV testing during antenatal visits or childbirth.

Methodology: A secondary analysis of data from 659 t women who had experienced pregnancy aged 15-49 years from the 2013 Nigeria Demographic Health Survey (NDHS) was done. Multivariable logistic regression analysis was done to determine the association between knowledge about discriminatory practices towards HIV-positive individuals (independent variable) and HIV testing during pregnancy (dependent variable) after controlling for covariates (demographic characteristics). A P-value of ≤ 0.05 was taken as statistically significant.

Results: Bivariate logistic regression analysis findings showed that educational level, place of residence, and religion statistically significantly predicted HIV testing of pregnant women, while age categories and marital status did not. The women's knowledge of discriminatory practices towards persons living with HIV/AIDS was not statistically significant at Alpha = 0.05 (AOR,1.51; 95% CI: .46, 4.95) Higher levels of education (Primary Education, AOR = 1.81; 95% CI: 1.03, 3.18; Secondary Education, AOR = 3.73; 95% CI: 1.92, 7.25; Higher Education, AOR = 10.92; 95% CI: 4.25, 28.05) and those living in urban areas (AOR = 1.62; 95% CI: 1.04, 2.51) were significantly associated with testing for HIV in the stepwise multivariable regression model of pregnant women's knowledge of discriminatory practices towards persons living with HIV/AIDS.

Conclusion: Although knowledge of discriminatory practices did not predict pregnant women's HIV testing in this study, interventions by stakeholders to eliminate or reduce these practices should be stepped up towards facilitating positive social change.