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

Background: Attitudes and beliefs regarding HIV among adolescents and young adults (AYA) may influence practices that increase the risk of HIV transmission. The study aimed to determine the attitudes and beliefs regarding HIV among senior secondary students and their sexual practices.

Methodology: It was a cross-sectional descriptive study that involved 1,200 adolescents and young adults (AYA) aged 14-24 years in senior secondary schools in Abakaliki. Information was obtained using a two-part pre-tested questionnaire that tested attitudes and beliefs regarding HIV using a 6-item questionnaire and another part sought information on biodata and sexual practices. The p-value of < 0.05 was statistically significant.

Results: The median (IQR) age of participants was 16.0 (9.0) years, and the majority (64.4%, 773/1,200) were females with a male-to-female ratio of 1.0: 1.8. Seven hundred and thirty (60.8%) had positive attitudes and beliefs towards HIV. Although 628 (52.3%) were willing to be tested for HIV, only 25.6% (307/1,200) have ever been tested for HIV. Three hundred and fifty-five (29.6%) of them had engaged in sexual activities, of which 145 (12.1%) had multiple sexual partners. There were significant relationships between attitude, beliefs, and age ((χ²= 39.69. p = <0.001), willingness to test for HIV (χ² = 10.20. p= 0.002), and having multiple sexual partners (χ²= 5.49, p= 0.019).

Conclusion: Positive attitudes and beliefs regarding HIV were high but were not reflected in their practices. Sustained efforts toward effective HIV-related health education in schools and improved adolescent-friendly health services where HIV screening is readily accessible are recommended.

Background: The hypertriglyceridemic waist (HTGW) phenotype was introduced as a means of identifying individuals at risk of developing metabolic syndrome as well as cardiovascular diseases and diabetes. However, studies surrounding the prevalence of the phenotype and its relationship with established markers of cardiometabolic risk, especially in the Nigerian population, remain sparse. This study aimed to determine the prevalence of the HTGW phenotype and explore its relationship with cardiovascular risk markers, namely Castelli Risk Indices I and II (CRI-I and CRI-II), Atherogenic Index of Plasma (AIP) and serum triglyceride-HDL cholesterol ratio (TG/HDL).

Methodology: In this retrospective cross-sectional study, the records of 206 patients presenting at a cardiac hospital from November 2022 to October 2023 were analysed. The HTGW phenotype was deemed present with a waist circumference of at least 94cm in men or 80cm in women and a serum triglyceride level of 150mg/dl or more in both sexes.

Results: At-risk waist circumference was more prevalent in women (92.7% vs 77.3%; p=0.002). The prevalence of the HTWG phenotype in the patient cohort was 29.6%, with more males than females (31.8% vs 27.1%) presenting with the phenotype (p=0.004). Patients with the phenotype also had higher systolic blood pressure, waist circumference, body mass index, triglycerides, AIP, and TG/HDL (all p<0.0005). The HTWG phenotype was also associated with a lower HDL and LDL cholesterol (p<0.0005) as well as a lower CRI-II (p=0.049).

Conclusion: The HTWG phenotype correlates with an increased cardiometabolic risk among Nigerians. This finding warrants the implementation of routine anthropometric and serum triglyceride measurements in screening programmes and hospitals for the early detection of individuals at risk of developing cardiovascular diseases.

Background: Microalbuminuria, an early indicator of kidney damage in Sickle Cell Disease (SCD) patients, is linked to a heightened risk of chronic kidney disease (CKD) in adulthood. This study investigates the determinants of microalbuminuria in paediatric SCD patients in South-South Nigeria.

Methodology: This cross-sectional study was conducted over six months at the Rivers State University Teaching Hospital, Nigeria, involving 60 children with [HbSS genotype, SCD] in a steady state. Data collection included demographics, past medical history, clinical measurements, and laboratory assessments of urine and blood samples. 'Steady state' was defined as SCD with a known 'steady state' haemoglobin level and stable clinical state for ≥ 3 months. Microalbuminuria was defined spot urine albumin-creatinine ratio of 30mg/g to <300 mg/g.

Results: Of the 60 children recruited, 31 children (51.7%) were males. The mean age was 9.6 ± 4.3 years. The prevalence of microalbuminuria was 16.7% (CI: 8.29 - 28.5%) and associated risk factors were hypertension (p = 0.017), use of Hydroxyurea (p = 0.008), and Ciklavit (p = 0.025), but not NSAIDs (p = 0.046). There was a significant negative correlation (ɼ = -0.28; p = 0.032) between haemoglobin level and microalbuminuria.

Conclusion: This study provides insights into the factors associated with microalbuminuria in children with SCD in our setting and highlights the need for early screening for markers of CKD among children with SCD. Further research is needed to ascertain the potential benefits of addressing anaemia and reducing haemolysis in mitigating the occurrence of microalbuminuria among children with SCD.

Background: Infection with the human immunodeficiency virus and hepatitis viruses B and C have been reported to be endemic in some Nigeria's institutions of higher learning. Several studies have reported varying prevalence rates for hepatitis B and C viruses and HIV among undergraduate students in Nigerian universities.

Methodology: A cross-sectional descriptive prevalence study of hepatitis B and C viruses and HIV among students at Federal University of Health Sciences, Azare conducted on the 2nd of December 2023. Screening for hepatitis B and C viruses and HIV was done using standard procedures. Ethical approval was obtained in addition to individual consent from all participants.

Results: Three hundred students with the mean age of 19.43±2.352 years were studied. 96.7% were aged 24 years or younger; females being the majority [185, 61.7%]. The majority of the participants were in their 200 level (190, 63.3%). Ten health-related programmes were represented in the survey. Twelve participants (4%) were positive for HBsAg; nine (75%) being males. One participant was positive for HBeAg, while only three (1%) of the participants had evidence of prior HBV vaccination, thus giving us a window of opportunity for vaccination. None of the participants had evidence of infection with HCV or HIV.

Conclusion: Screening students of health-related courses should be routinely done to ascertain their status to prevent occupational exposures and transmission in the healthcare setting. Results from this survey will inform formulation of policies that will protect our future healthcare force and safeguard the lives of patients.

Background: Bone marrow (BM) in addition to being the origin of primary hematological malignancies is also commonly involved in metastatic solid tumors. Bone marrow examination includes aspiration and biopsy, and it is a well-known procedure not only to diagnose hematological malignancies but also for staging and prognosis of various solid tumors. The presence of metastasis in the bone marrow is of grave prognostic significance and it is imperative to rule out marrow involvement in any malignancy where curative treatment is considered. The study's objectives were to evaluate the clinical, hematological, and biochemical characteristics of patients with BM metastases of solid tumors diagnosed by bone marrow (BM) aspiration and trephine biopsy and to find out the accuracy rate of diagnosing metastatic infiltration between bone marrow aspiration, trephine imprints, and trephine biopsy procedures.

Methodology: It was a 4.5-year retrospective hospital-based observational study where relevant clinical, biochemical, and hematological parameters including bone marrow aspirate and biopsy were analyzed and compiled from hospital medical records.

Results: The total number of BMA and trephine biopsies that came during the duration of 4.5 years were 3850 and 2980 respectively. Out of the 3850-bone marrow aspiration and 2980 trephine biopsies received in the dept of Hematology, 305 cases were referred to look for metastatic bone marrow infiltration. Out of these 305 cases, 69 cases showed the presence of metastatic deposits (12.6%). 45 patients (65.2%) were males, and 24 patients (34.7%) were females with M:F ratio of 1.8:1. Most common age group was 51-60 years (31.8%). The most common complaints were fever, body aches, weight loss, and weakness. Clinical examination revealed pallor in 38 out of 69 cases (55%) and organomegaly in 14 cases (20.2%). Microcytic hypochromic anemia (26%) was the most common finding on peripheral blood smear examination followed by pancytopenia (18.8%). The biochemical findings most commonly observed were raised LDH (60.8%), serum PSA (36.3%), and alkaline phosphatase (21.7%).

Conclusion: Trephine biopsy is a sensitive method for detecting marrow metastasis and should be done in all cases being investigated for this purpose. BMA alone may miss marrow metastases in almost half of cases. Trephine imprint cytology is more sensitive than BMA and can provide rapid diagnoses while waiting for trephine biopsy results.

This scoping review aims to assess the literature on genetic modifiers of leg ulcers in sickle cell disease, evaluating available evidence, methodologies, and research gaps. A major morbidity in sickle cell disease is the development of leg ulcers. This clinical syndrome of SCD leg ulcers (SLU) has continued to be an enigma due to its multifactorial evolution, dearth of promising guidelines on treatment, and generally unsatisfactory response to treatment. Underlying genetic susceptibilities for SLU may impact counselling, prognostication, risk of development, severity as well as response to interventions. Hence the need for this scoping review. This scoping review will collate and assess studies in English on genetic markers of SLU among all SCD age groups, genders, races, and regions. Genetic or molecular markers to be assessed among patients with sickle cell leg ulcers included, genetic markers of Inflammation, vasculopathy, tissue damage, oxidative stress, coagulopathy as well as genetic predispositions that have been studied in relation to SLUs across all countries. This includes most common biomarkers that promote development of SLU, the single nucleotide polymorphic markers (SNPs) that work through the MAPK and SMAD signaling pathway. A PubMed search of all fields for literature published in English using the strategy (sickle cell) AND (leg ulcer), and (sickle cell) AND (leg ulcer genetics) from 1998 to 2023 (last 25 years) will be undertaken. This will be modified, according to the inclusion criteria, as appropriate across other databases. The other databases will include Google Scholar, web of Knowledge, Scopus, New Zealand Science, Silver chair, Taylor and Francis+NEJM, and journals.lww.com.

Surrogacy involves a woman (surrogate) who consents to carry a pregnancy on behalf of an individual or a couple who cannot conceive for medical reasons. Surrogacy is gaining popularity in Nigeria among infertile couples, partly because surrogacy provides an easier means to having children than adoption. Surrogacy can be either gestational or traditional. Though surrogacy gives hope to infertile individuals, it also comes with peculiar challenges that affect the newborn with medical, ethical, and legal dimensions that caregivers need to be aware of. We present three sets of preterm triplets conceived by Invitro fertilization (IVF), carried by gestational surrogacy, and managed in our facility. This case report highlights challenges encountered while managing these neonates to create awareness and suggest solutions and guidance to neonatal practitioners. Topmost challenges include the unsustainability of feeding with the mother's own milk, lack of kangaroo mother care, abandonment of care by commissioning parents, delay in getting consent for treatment/procedures, determining the legal status of the child vis-à-vis simple issues such as changing the name of the child from that of the surrogate to that of the commissioning parents. The hospital's legal and welfare departments were key resource units and were involved early in managing these neonates. One baby from each set of triplets was successfully discharged home to the commissioning parents. In conclusion, surrogacy is becoming increasingly common as a means of becoming parents for infertile individuals. There is an urgent need for proper regulation and legal framework for surrogacy and assisted reproduction in Nigeria.

Background: Immunization is a very cost-effective and readily available intervention capable of preventing Vaccines Preventable Diseases (VPDs). This study aimed to identify and compare the prevalence and factors associated with zero-dose immunization status among children of nomadic and non-nomadic Fulani in Yobe State, North-East Nigeria.

Methodology: A comparative cross-sectional design was used to study 348 nomadic, and 345 non-nomadic under-five children, selected using a multi-staged sampling technique. Data were collected using interviewer administered questionnaire, observation of child immunization card, and recall by the caregivers, and were analysed using IBM SPSS version 22.0 with a statistical significance set at P ≤5%.

Results: The maximum age of the nomadic caregivers was 60 and the minimum was 17 years with a mean ±SD of 28.2±7.7 years. The maximum age of the non-nomadic caregivers was 78 and the minimum was 17 years with a mean ±SD of 33.0±10.0 years. The prevalence of zero dose children among nomadic and non-nomadic Fulani were (70.1%, 242), (61.8%, 63) respectively. The zero-dose children were significantly higher among nomads (87.2%, p<0.001) and non-nomad (54.4%, p<0.001) with no available child immunization card.The children of vaccines hesitant caregivers of nomads and non-nomads were 10 or more times more likely to be zero dose than non-hesitant caregivers (adjusted odds ratio [aOR] =477, 95% CI = [177-13031]), and (Adjusted odds ratio [aOR] =9.7, 95% CI = [2.1-44.3]) respectively.

Conclusion: The burden of zero-dose was alarmingly high among nomads compared to non-nomad Fulani despite widespread immunization outreach services in the study area. The government and relevant stakeholders should intensify Context-specific health promotion activities and outreach services targeting these underserved populations.

Newborn jaundice (NNJ), especially due to ABO incompatibility, is a major global health concern. Phototherapy is standard treatment, with exchange transfusions reserved for severe cases. However, in some babies these therapies may be ineffective, requiring additional immunomodulatory treatments. Limited access to these treatments in developing countries creates a critical gap, worsening jaundice severity. A 22-hour old term neonate presented with rapidly progressive severe neonatal hyperbilirubinemia (NNJ) within 15 hours of life, consistent with ABO incompatibility based on discordant maternal and infant's blood types (mother: O, baby: B-positive). Despite aggressive initial management with phototherapy and exchange transfusions, the NNJ exhibited limited improvement. Sepsis and G6PD deficiency were considered as potential contributing factors, although confirmatory testing for G6PD deficiency was deferred due to unavailability of the diagnostic test in our setting. Given a sibling's documented successful response to methylprednisolone for a similar presentation, a brief course of low-dose intravenous methylprednisolone (1mg/kg/day in 2 divided doses) (off-label use) was cautiously initiated. This resulted in a rapid and significant improvement in the neonate's hyperbilirubinemia. Methylprednisolone was prescribed for 3 days after which it was discontinued. Following close observation for 3 days and confirmation of no neurological sequelae, the neonate was discharged home in stable condition. Managing severe, worsening NNJ, especially with multiple aetiologies, is complex. Standard therapies may be inadequate. While promising, immunomodulatory therapies like IVIG may be limited in resource-poor settings. Methylprednisolone shows potential but lacks strong clinical evidence. Well-designed studies are essential to explore its safety and efficacy, particularly in developing countries with limited treatment options.

Background: Nigeria makes a substantial contribution to the global burden of stillbirths. Stillbirth accounts for about 50% of perinatal mortality and the stillbirth rate is an indicator of the quality of antenatal and intrapartum care. The study sought to determine the prevalence and determinants of stillbirths.

Methodology: This was a retrospective, unmatched case-control study over two years from May 2022 to April 2024. Cases were women with stillbirths that occurred at a gestational age of ≥28 weeks, while controls were women with livebirths, in a 1 case for 2 controls ratio. Data extracted from the hospital records, using a predesigned collection form, included demographic, medical, obstetric and neonatal characteristics as exposure variables. Data was analysed with SPSS version 25, using descriptive and inferential statistics. Multivariate logistics regression was used to determine adjusted odds ratios with 95% confidence intervals and a P-value of <0.05.

Results: There were 3,425 livebirths and 120 stillbirths, giving a stillbirth rate of 35 per 1000 livebirths. Analysis was performed for 114 cases and corresponding 228 controls, 6 cases were excluded for incomplete data. Maternal age ranged from 20-48 years and parity from 0-7, with no statistical difference between either group (P=0.982 and P=0.638 respectively). There were 58(50.9%) macerated and 56(49.1%) fresh stillbirths, with 21(37.5%) of the fresh stillbirths alive at presentation. Factors associated with stillbirth after multivariate analysis included unbooked status (aOR=9.64; P=0.0001), vaginal delivery (aOR=2.04; P=0.034), abruptio placenta (aOR=25.58; P=0.007), preterm delivery at GA ≤36weeks (aOR=3.26; P=0.012), and low birth weight <2500g (aOR=3.53; P=0.016). Obstructed labour and ruptured uterus were significant in bivariate analysis but could not be fitted into multivariate analysis because of non-occurrence in controls.

Conclusion: The stillbirth rate at our Centre was 35 per 1000 livebirths. Associated factors for stillbirth were unbooked status, vaginal delivery, abruptio placenta, preterm delivery and birth weight <2500g.