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

Statins, widely prescribed for their efficacy in reducing low-density lipoprotein cholesterol (LDL-C) and preventing atherosclerotic cardiovascular disease, are generally well tolerated. However, muscle-related adverse effects, particularly statin-associated myopathy, can significantly impact patient function and adherence. This case report describes an 83-year-old man who developed progressive proximal muscle weakness, fatigue, and recurrent falls following initiation of high-dose atorvastatin after a ST-elevation myocardial infarction. Clinical and laboratory evaluation, along with the temporal association and improvement after drug withdrawal, supported a diagnosis of self-limited toxic statin myopathy. Extensive differential diagnosis excluded other neuromuscular, endocrine, and vascular causes. Prompt discontinuation of atorvastatin, supportive care, and physiotherapy led to marked functional recovery. This case highlights the spectrum of statin-induced muscle toxicity, emphasises diagnostic vigilance in older adults, and underscores the importance of personalised therapy and early intervention to mitigate adverse outcomes.

Background: Stroke is a major cause of morbidity and mortality globally, with a particularly high burden in low- and middle-income countries such as Nigeria. Early identification of biomarkers, such as serum Galectin-3, which plays a role in inflammation and tissue remodeling, may improve diagnostic accuracy and patient outcomes in acute ischemic stroke. This study aimed to compare serum Galectin-3 levels between patients with acute ischemic stroke and age- and sex-matched stroke-free controls.

Methodology: A prospective comparative cross-sectional study was conducted at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. A total of 100 first-ever acute ischemic stroke patients and 100 apparently healthy controls were recruited. Serum Galectin-3 levels were measured using an enzyme-linked immunosorbent assay (ELISA). Statistical analysis was performed to compare Galectin-3 levels between groups using the Statistical Package for the Social Sciences (SPSS), version 24.0.

Results: The median serum Galectin-3 level was significantly higher in stroke patients compared to controls [60 (55.00-63.00) vs 56 (49.00-62.00), p = 0.003]. The two groups were comparable in age and sex distribution, but hypertension and diabetes were significantly more prevalent among stroke patients. Elevated serum Galectin-3 levels were positively associated with stroke diagnosis.

Conclusion: Serum Galectin-3 is significantly elevated in acute ischemic stroke patients compared to stroke-free individuals. Galectin-3 could serve as an important biomarker for acute ischemic stroke, aiding in timely diagnosis and management.

Background: The study aimed to determine the correlation between the number of significant rib fractures in patients with blunt chest trauma (BCT) and the amount of haemothorax as recorded by Closed Thoracostomy Tube Drainage (CTTD).

Methodology: This was a cross-sectional study of all patients with significant rib fractures following BCT over a period of two years. "Significant rib fractures" was defined as the fracture of 3 or more ribs with 50% or more displacement of each fractured rib edge. Patients with massive haemothorax, patients with severe neurological, or patients who required emergency thoracotomy were excluded.The diagnosis of rib fracture was made by standard chest radiograph or Chest Tomography Scan.Descriptive analyses were reported as mean and standard deviation (SD) for the variables. Pearson correlation test was conducted to test the relationship between the numbers of fractured ribs with the amount of haemothorax as recorded by CTTD with P-value significant at<0.001.

Result: Sixteen patients who met the criteria were analysed with a mean age of 46.5years±(SD16.47), the mean number of fractured ribs was 4.5±1.37, the mean amount of drained blood was 605.3ml±(SD244.3) and the mean amount of drained blood per the number of each fractured rib was 134.5ml±54.29.The Pearson Correlation test was strongly positive at,r=0.80 with (P< 0.001).

Conclusion: In any patient with BCT, and with fractured of 3 or more ribs, there may be the need to institute a CTTD irrespective of whether the chest radiograph or chest computerized scan shows immediate evidence of significant haemothorax.

Background: Normal blood glucose supply and metabolism are of utmost importance for growth and normal brain development in the foetus and newborn. Disorders in glucose supply or metabolism can result in hypoglycaemia or hyperglycaemia. Considering the increasing trend of caesarean section (CS) worldwide, including Nigeria, it is important to determine the incidence and type of dysglycaemia in neonates delivered by CS. The study objective was to compare the blood glucose (BG) levels of newborns delivered by CS with those by vaginal delivery (VD).

Methodology: This was a prospective observational study of 164 neonates, of which 85 were delivered through CS and 79 through VD. A pretested questionnaire was used to obtain information on sociodemographic variables, gestational age, feeding time of the new-born and maternal fasting time, while BG was determined using Accu-chek Multiclix. Every tenth sample was also tested in the laboratory for quality control.

Results: The mean (SD) cord blood glucose level was lower in the CS (68.7(10.1) mg/dl) than VD neonates (80.9(11.5) mg/dl, p = <0.001). The mean (SD) blood glucose level at 2 hours of life was also lower in CS (62.5(10.0) mg/dl) than VD neonates (71.2(10.9) mg/dl, p = <0.001). Factors that were significantly associated with cord BG levels were gestational age, maternal fasting time and mode of delivery. At two hours of life, cord blood, neonatal feeding time, gestational age and birth weight were significantly associated with neonatal BG levels.

Conclusion: Cord and neonatal BG were significantly lower in neonates who were delivered via CS compared to those delivered vaginally.

Background: Immature teeth must be managed by apexification as there is no definite apical stop. Use of intracanal medicaments prior to apexification affect the sealing ability of apical plug. Present study was done to compare the effect of various intracanal medicaments: Metapex, Chlorhexidine digluconate, Curcuma longa, and Triple antibiotic paste (TAP) on the sealing ability of MTA and Hydroxyapatite as an apical plug.

Methodology: 130 single-rooted teeth were divided into two experimental groups (n=60 each) [Group I: MTA; Group II: Hydroxyapatite], and two control groups (n=5 each) [Group IIIA: MTA; Group IIIB: Hydroxyapatite] based on the apical plug used. Experimental groups were subdivided, based on intracanal medicaments [Group IA and IIA - Metapex; Group IB and IIB - 2% Chlorhexidine digluconate, Group IC and IIC - Curcuma longa, Group ID and IID - TAP]. After biomechanical preparation, simulation of immature apex was done using peeso-reamer. Intracanal medicaments were placed, and study samples were incubated for 7 days. Then all medicaments were removed using H-files, followed by retrograde apical placement, obturation, and restoration. Samples were subjected to dye penetration test, followed by clearing procedure. Apical microleakage was assessed using stereomicroscope at 40X. Data collected was subjected to statistical analysis using SPSS version 20.0 (p=0.05).

Results: Apical dye penetration was minimum in control group, followed by Group IB (0.17±.46) < IIB (0.53±.57) < IIC (0.90±.96) < IID (0.93±.59) < IC (1.83±.83) < ID (1.91±.81) < IIA (2.13±.81) < IA (2.31±.73).Intragroup comparison for apical microleakage was statistically significant (p<0.001), whereas intergroup comparisons were statistically significant except for group IA v/s IIA, IB v/s IIB, IC v/s IIA, ID v/s IIA.

Conclusion: Hydroxyapatite showed better sealing ability than MTA with all intracanal medicaments. Sealing ability was minimal with Metapex, followed by Turmeric, TAP, and 2% Chlorhexidine.

Background: Digital technology offers promising solutions for monitoring pregnant women but client's readiness for its adoption in Nigeria remains underexplored. This study assessed antenatal clients' perceptions and readiness for digital health adoption.

Methodology: This cross-sectional survey involved 228 antenatal clients recruited through systematic sampling. Participants completed the 16-item Technology Readiness Index (TRI 2.0) and supplementary perception scales on 5-point response scales. Respondents were categorised as explorers, pioneers, skeptics, paranoids, or laggards based on their TRI scores. The range of Cronbach's alpha for scales was: 0.80-0.92. Data were analysed using SPSS version 29, applying descriptive and generalised linear regression analyses, with statistical significance set at p ≤ 0.05.

Results: The response rate was 100% and most participants were aged 25-34 (43.9%), married (51.8%), and held tertiary education (38.6%). Ownership of digital devices was smartwatches (6.1%), smartphones (25.9%), and computers (26.3%). Clients prioritised e-prescription (3.09±1.11) and access to personal health information (3.08±1.13) as top benefits of remote services. TRI Scores were overall TRI (3.00±0.31), optimism (3.12), innovativeness (3.22), discomfort (3.12), and insecurity (3.19). Majority (90.4%) were classified as skeptics. Unemployed clients showed lower acceptance of devices for remote maternal monitoring (B = -0.13, 95% CI: -0.24, -0.01, p = 0.033).

Conclusion: Despite the global momentum toward digital maternal health solutions, antenatal clients in Nigeria demonstrate low digital engagement and are predominantly skeptics. Targeted interventions including digital literacy campaigns, improved trust through data privacy protections, and broader infrastructural investments are critical for promoting equitable adoption of remote digital maternal health solutions.

Embryonal rhabdomyosarcoma is a distinct subtype of rhabdomyosarcoma commonly seen in children less than 5 years of age, but it can appear at any age. It's frequently seen at the head and neck region, but rare sites include the ear. It often presents with facial nerve palsy. We present two extraordinary cases of embryonal rhabdomyosarcoma in the middle ear in a 3-year-old boy and girl.

Achilles tendon injuries are commonly encountered in orthopaedic practice. The Achilles tendon is prone to rupture, and this negatively imparts ambulation. The diagnosis is clinical. Treatment options have evolved from conservative to surgeries, however there is no consensus on the most superior option of treatment. This narrative review aims to highlight the evolution in clinical diagnosis and treatment of Achilles tendon ruptures and discuss the current evidence in the treatment with emphasis on outcome measures of each treatment modality. Relevant studies on Achilles tendon ruptures with emphasis on treatment options, their strengths and weaknesses were reviewed. The treatment of Achilles tendon rupture has evolved from conservative options to surgeries. The surgical options include open repair, percutaneous repair, endoscopic repair, and ultrasound-guided repair. However, there is still no consensus on the most superior option for treating Achilles tendon injuries. Each method has its pros and cons. Conservative treatment has the appeal of the absence of scars, low cost and shorter duration of hospital stay. However, ankle stiffness, and late return to work are important drawbacks. Open surgery has the advantage of early return to function and low re-intervention rates. Surgical scars, likelihood of infection and cost are major disadvantages. Appropriate patient selection guided by the severity of the injury, the age of the patient, pre-injury status, work demand for the patient, experience of the surgeon, available resources, local soft tissue condition, and the patient's preferences are key to successful outcome.

Background: Human Immunodeficiency Virus (HIV) remains a major public health concern in Nigeria, which has been rated as having a high HIV burden globally. Antiretroviral therapy (ART) has significantly improved life expectancy and reduced HIV-related morbidity and mortality. However, ART is associated with adverse drug reactions (ADRs), which can lead to treatment failure, regimen changes, and non-adherence, ultimately affecting patient outcomes.

Methodology: This was a retrospective cohort study of newly initiated people living with HIV (PLHIV) accessing care at the Lagos State University Teaching Hospital (LASUTH), Ikeja. All newly initiated HIV patients receiving antiretroviral therapy (ART) at LASUTH between March 2023 and March 2025 were included. Data collected during the study period were abstracted, and individuals who experienced an adverse drug reaction (ADR) were recorded. Data was analysed using the Statistical Package for the Social Sciences (SPSS) version 27.0. Statistical significance was established at p ≤ 0.5.

Results: Overall, 533 newly initiated into treatment in the study period. Out of the newly initiated (533), a total of 65 reported adverse reactions to the drugs of treatment, which constituted 12.1% prevalence of ADR in the newly initiated. The mean age of all participants was 40.50 ± 11.76 years. All the newly initiated (100%) were on Tenofovir, Lamivudine, and Dolutegravir (TLD) combination. Pruritus is the commonest symptom in both females and males.

Conclusion: The ADR prevalence among the newly enrolled PLHIV is 12% and pruritus is the commonest ADR seen among the newly enrolled.

Background: Helicobacter pylori (H. pylori) infection is a significant public health concern, contributing to various gastrointestinal disorders, including peptic ulcers and gastric cancer. The infection is highly prevalent in Africa, but still diagnostic and treatment challenges persist in primary care settings. Effective treatment regimens are therefore crucial for eradicating this infection and preventing complications. This study aimed to develop a consensus-based algorithm for H. pylori management optimized for Primary care settings utilizing data from primary care physicians, patient screening, and treatments.

Methodology: A cross-sectional study was conducted among forty-four primary care physicians involved in diagnosing and treating H. pylori infection. They were provided with a data Collection Form (DCF) and an H. pylori rapid antibody test kit. All the questionnaire responses and the result of rapid antibody test were recorded and analyzed. A panel of experts involving senior family medicine doctors, and a gastroenterologist via a modified Delphi process of discussions on the DCF responses, and test results from the 44 physicians arrived at a consensus-based treatment algorithm developed to guide clinical decision-making for H. pylori management.

Results: This study comprised 245 patients with a female preponderance and mean age of 35.0±11.5 years. The most common symptoms from the DCF were epigastric pain, nausea/vomiting and bloating in 74.5%, 52.7% and 35% respectively while the mean duration of symptoms was 3weeks. Constipation and irritability were the least common symptoms with heartburn reported less frequently in the H. Pylori positive cases. 79.9% of the 245 patients were H. Pylori treatment naïve with a higher likelihood (57.1%) of having a positive antibody test. It was recommended that both treatment experienced and naïve patients with epigastric or abdominal pain, nausea vomiting and/or bloating with symptom duration > 2weeks be tested and eradicated while those with alarm symptoms be referred to the specialist.

Conclusion: The proposed algorithm provides a comprehensive guide for Physicians at the primary and secondary care level in selecting the most effective treatment regimen for H. pylori infection. H. Pylori antibody testing is a primary screening tool for patients with persistent symptoms or those lasting greater than 2weeks and where positive confirmatory test is recommended.