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

Amelanotic vulvar malignant melanoma is an exceedingly rare and aggressive malignancy, accounting for only 2% of vulvar melanomas and presenting unique diagnostic challenges due to its lack of pigmentation. This report discusses the case of a 57-year-old postmenopausal woman who presented with a 2x2 cm greyish-white growth on the labia majora, accompanied by itching and burning for three months. Clinical examinations and routine investigations were inconclusive, necessitating a biopsy for definitive diagnosis. Histopathological analysis revealed nests of atypical cells exhibiting high-grade features, including a high nuclear-to-cytoplasmic ratio, vesicular chromatin, prominent eosinophilic nucleoli, and mitotic activity. The absence of melanin pigment complicated the diagnosis, requiring immunohistochemical confirmation with markers such as S100, Melan-A, and HMB45. Differential diagnoses, including poorly differentiated squamous cell carcinoma, neuroendocrine tumor, and adenocarcinoma, were meticulously excluded through morphological and immunohistochemical evaluation. This case underscores the critical importance of histopathological examination and immunohistochemistry in accurately diagnosing vulvar lesions, particularly in amelanotic variants, where clinical presentation can mimic other malignancies. Given the high metastatic potential and poor prognosis of vulvar melanoma, early recognition, accurate diagnosis, and prompt surgical intervention, including wide local excision and lymphatic dissection, are essential. This case highlights the need for heightened clinical suspicion and a multidisciplinary approach in managing rare vulvar malignancies to optimize patient outcomes.

Background: The Ebola Virus Disease (EVD) has a high risk of death killing an average of about 50% of those infected. Several outbreaks have occurred intermittently since the disease was first described. The 2014 outbreak was the largest and most complex in recorded history. Rumours were rife especially through social media that a salt ritual amongst other unverified claims could prevent or cure EVD. This study aimed to determine the knowledge, perception and practices to prevent EVD in Calabar and to highlight the role of social media in health seeking behaviours.

Methodology: This was a mixed method study, a combination of cross-sectional design and Focused Group Discussion conducted between November 2016 and June 2017.

Results: Ninety-three percent (93%) of the respondents had heard about EVD with the radio (82%) being the dominant source of information. Virus as the causative agent and contact with body fluids as the most common mode of transmission were correctly identified by 72%. Fever ranked as the most common symptom by 75% and washing of hands (60%) was perceived as the most common way to prevent EVD. Sixty-three percent (63%) responded that salt is used to cure EVD,57% participated in the salt ritual and 85% of those who partook in the salt ritual later realized it did not cure or prevent EVD.

Conclusion: People should be encouraged to seek health related information from the appropriate sources. Effective and sustained communication strategies are advocated to mitigate rumour mongering and misinformation to curb unhealthy practices.

Background: Haemoglobinopathies are autosomal recessive inherited disorders affecting haemoglobin structure or production. Over 1,000 haemoglobin variants have been identified, with carriers often asymptomatic or exhibiting mild anaemia. When both parents are carriers, there is a 25% risk per pregnancy of having a child with a severe form of the disease. Our study aims to (i) describe the epidemiological profile of different haemoglobinopathies, (ii) evaluate the variety of haemoglobinopathies and carriers, and(iii) estimate the prevalence of haemoglobinopathies and carriers.

Methodology: This retrospective cross-sectional study included 5,000 cases obtained from multiple screening camps organized by Ma Sarada Charitable Dispensary & Pathology Centre. All available high-performance liquid chromatography (HPLC) reports with corresponding patient clinical histories and complete blood count results were reviewed. Patients with a history of blood transfusion were excluded from the study to prevent alteration of hemoglobin profiles. Data was extracted and analysed to determine the prevalence and types of haemoglobinopathies in the study population.

Result: Beta thalassemia carrier is the most common haemoglobinopathy (6.36%) detected in West Bengal, followed by HbE carrier. HbE disease, Hb E beta thalassemia, Hb S carrier, Hb S disease, and HPHF trait are the other haemoglobinopathies, also found in this study. Most of the patients are male (11.27%). Among the districts, Beta thalassemia carrier is mostly found in North 24 Parganas, and Hb E carrier is mostly found in South 24 Parganas. Other haemoglobinopathies are also mostly found in North 24 Parganas.

Conclusion: This study highlights a significant prevalence of beta thalassemia and other hemoglobinopathies in the screened population, underscoring the urgent need for widespread screening programs to identify asymptomatic carriers. Early detection through high-performance liquid chromatography (HPLC) can facilitate timely genetic counseling and intervention, thereby helping to prevent disease transmission. Although HPLC interpretation demands specialized training, it remains a reliable and practical screening tool when performed promptly after blood collection to minimize diagnostic errors.

Background: Assessments in medical education must reliably evaluate competencies while addressing potential gender disparities. This study examines the reliability of psychiatry competency assessments among final-year medical students at the University of Ilorin, Nigeria, and explores gender differences in performance. The aim was to evaluate the internal consistency of formative (progressive assessment) and summative (final MBBS) examinations, analyse correlations between assessment components, and compare gender-based performance.

Methodology: A retrospective analysis of all 137 (77 male, 60 female) final year medical students' psychiatry competence assessments was conducted. Reliability was measured using Cronbach's alpha, correlations between exam components were assessed via Pearson's correlation, and gender differences were analysed using t-tests and Cohen's d.

Results: The combined assessments showed high reliability (α = 0.857), though lower for females (α = 0.553 vs. males: α = 0.618). Progressive assessment correlated moderately with theory components (Multiple Choice Questions: r = 0.507) but weakly with clinical tools (picture test: r = 0.158). Females outperformed males in both theory (mean difference: +1.71, p = 0.001) and clinical exams (mean difference: +1.08, p = 0.019), with moderate effect sizes (Cohen's d = 0.63 and 0.42, respectively).

Conclusion: While the assessment system demonstrates strong overall reliability, gendered disparities suggest a need for more equitable evaluation methods. Females consistently outperformed males, but lower reliability in their combined scores calls for refined formative tools. Integrating more multimodal assessments may enhance fairness and validity.

Bilateral metachronous testicular torsion is rare, few cases are reported in the literature. A high clinical index of suspicion is required to avoid a delay in diagnosis and intervention on the part of the managing physician and if necessary avoid delayed referral. It is also important to educate patients on the possibility of this condition and the need for timeous presentation at the hospital to avoid testicular loss. We present a case of a 24-year-old who presented 48 hours after sudden onset of left testicular pains after an initial delay of 24 hours at a private hospital, where he had analgesics and antibiotics. He previously had right orchidectomy 10 years ago for right testicular torsion and left orchidopexy, after an initial delay in presentation. Examination findings revealed an oedematous left hemiscrotum, tender with hard, indurated knotted mass and absent testis in right hemiscrotum. He immediately had scrotal exploration with findings of a gangrenous left testis with 540 degrees anticlockwise twist, he subsequently had orchidectomy. Post-operative recovery was uneventful. Hormonal parameters revealed hypergonadotrpic hypogonadism, 2weeks after surgery, he was placed on testosterone replacement therapy and counselled for immediate sperm banking. Bilateral testicular torsion is rare, it is important to emphasize to the patients that it can occur, despite orchidopexy, therefore the need to present early to avoid testicular loss and the challenges of hypogonadism and infertility. In the literature it is documented that use of non-absorbable sutures and more than two-point fixation may reduce risk of recurrent testicular torsion.

Background: Intra-operative purulent peritoneal fluid aspirate for microscopy, culture, and sensitivity during appendicectomy is practiced by some surgeons to help in the post-operative management of patients if the patients get unwell, requiring a change of the prescribed pre-operative antibiotics. This study aimed to evaluate if there are benefits from purulent peritoneal fluid aspirate culture results during appendicectomy.

Methodology: This was a retrospective review of medical records and operation notes of all the patients who had an appendicectomy with purulent peritoneal fluid that was aspirated for microscopy culture and sensitivity in the last 3 years (May 2019 to April 2022).

Results: A total of 73 patients had purulent peritoneal fluid culture results and received perioperative intravenous antibiotics. There were 52 (71%) bacteriological positive culture results from the purulent peritoneal fluid aspirates and 21 (29%) negative peritoneal pus culture results. The most common antibiotics administered were a combination of co-amoxiclav and metronidazole 45 (61.6%). One-quarter of the preoperative antibiotics were changed due to the positive microbiology culture results from the peritoneal pus aspirates. The main reasons for the change in antibiotics were intra-abdominal collections and wound infection in 21 (28.8%) of the patients, and Streptoccocus anginosus was the most common organism isolated. A re-operation and/or ultrasound-guided drainage of intra-abdominal collections were avoided in 13 out of 17 patients due to the change of the pre-operative antibiotics following the results from the purulent peritoneal fluid.

Conclusion: The intra-operative purulent peritoneal fluid culture results during appendicectomy contributed positively towards the post-operative management of patients.

Background: The financial burden of caring for a child living with epilepsy and its effect on the family's financial status and quality of life are understudied. This study aimed to determine the cost of care for children with Epilepsy in Port Harcourt.

Methodology: A purposive sampling method was employed. Participants were 37 children with epilepsy and their parents/caregivers. An interviewer-administered semi-structured questionnaire was used to obtain information on the socio-demographic, estimates of the financial costs of epilepsy care, the effect of caregiving on caregiver productivity and income.

Results: The average monthly income per family is $332.80 ± $116.82. The majority, 32(86.5%), financed epilepsy care via out-of-pocket payments. The average cost of epilepsy care is $66 per month ($792 per annum), accounting for 20% of the average family income. There was a negative correlation between hours spent on caregiving and household income (rho =-0.288; p-value = 0.084). Over two-thirds (67.6%) of the caregivers consider their overall well-being negatively affected by having a child with epilepsy.

Conclusion: The cost of care of childhood epilepsy in southern Nigeria is high and takes up a significant proportion of household income. Concerted efforts need to be made to encourage subscription to health insurance to alleviate the financial burdens on families.

Background: Hemolytic Disease of the Fetus and Newborn (HDFN) is a significant neonatal condition resulting from ABO and Rhesus (Rh) blood group incompatibility between mother and fetus. Adequate knowledge and positive attitudes among pregnant women toward blood grouping can help prevent complications. This study assessed the Knowledge and Attitude of Pregnant Women on ABO and Rhesus Grouping towards Preventing Neonatal Hemolytic Disease at Rasheed Shekoni Federal University Teaching Hospital, Dutse, Jigawa state.

Methodology: A descriptive cross-sectional study was conducted among 316 pregnant women receiving antenatal care at the hospital. A structured questionnaire was used to collect data on socio-demographic characteristics, knowledge of ABO and Rh blood grouping, and attitude toward their importance in preventing HDFN. Data were analyzed using descriptive and inferential statistics.

Results: The majorities of respondents (46.2%) were aged 26-30 years and most had at least a secondary education (57.2%). Awareness of ABO and Rh blood groups was high, with 70.3% of respondents knowing their blood group and Rh status. However, only 16.5% demonstrated good knowledge of HDFN, while 33.2% had poor knowledge. Awareness of preventive measures, including the anti-D immunoglobulin, was low (17.4%). Despite knowledge gaps, attitudes were positive, with 87.7% recognizing the importance of blood grouping in pregnancy, and 98.4% supporting public health campaigns on the topic. Age (p = 0.001), educational level (p = 0.001), occupation (p = 0.001), family income (p = 0.001) and number of pregnancies (p = 0.003) were significantly associated with knowledge levels. Attitude was also significantly associated with age (p = 0.003), educational level (p = 0.003) and family income (p = 0.024).

Conclusion: While awareness of blood grouping was high, knowledge of HDFN and its preventive measures remained limited. Strengthening antenatal education and implementing targeted awareness programs are essential to improve understanding and ensure the effective prevention of HDFN.

Background: Orthodontic treatment for malocclusion is one of the costly dental treatments globally, leading to the general belief that it is mostly accessible to individuals in the high socioeconomic category (SEC) in Nigeria. This study aims to assess the socio-economic characteristics of Nigerian orthodontic patients.

Methodology: This was a descriptive cross-sectional study, conducted in Lagos State, Nigeria, from March to August2025. The study sites were Lagos University Teaching Hospital and Hilton Dental Services, a major private orthodontic clinic in Lagos. Data was collected using a 15-item structured interviewer questionnaire, analyzed with SPSS version 26 statistical software using descriptive (frequency and percentage) and inferential (Fisher's exact test) statistics. The level of significance was set at p > 0.05.

Result: A total of 309 respondents participated; 220 females and 89 males, with a mean age of 24.8 ± 10 years. Most, 217 (70.2%), were at the tertiary education level. The majority (197, 63.8%) fell into the high SE category, and rented apartments were the most common type of housing. Respondents from the high SEC agreed that SE status serves as a barrier to accessing orthodontic treatment. However, it was not a factor in choosing the treatment facility. Out-of-pocket payment was the most common method used for paying for orthodontic treatment.

Conclusion: Socioeconomic status has a significant impact on access to orthodontic treatment, and most orthodontic patients belong to the higher socioeconomic category. Recommendation is the main reason for choosing a treatment facility.

Background: One common chronic liver illness is non-alcoholic fatty liver disease (NAFLD) affecting individuals across various body weights. Traditionally associated with obesity, NAFLD is now increasingly observed in overweight and lean individuals as well. This research investigates the clinical, metabolic, dietary pattern, and socio-demographic differences of NAFLD in lean, overweight, and obese individuals across various centers in two Indian states.

Methodology: Conducted as a cross-sectional observational study with 154 NAFLD patients aged 18-65 years across four centers [Odisha (OD) -3; Uttar Pradesh (UP) -1], the research utilized a self-administered questionnaire to gather socio-economic, biochemical, and clinical data. Data analysis involved Chi-square tests at a 0.05 significance level. Trail Registration: CTRI/2024/04/065699.

Result: The majority of NAFLD cases were found in obese patients (37.01% in Odisha and 35.06% in UP). Overweight NAFLD was more common in UP (10.39%), while lean NAFLD was more prevalent in Odisha (7.14%). Obesity was significantly associated with diabetes in both states (p=0.020). Constipation was notable in overweight and obese groups (p=0.001 and p=0.027), and bloating was more frequent in overweight individuals (p=0.064). Loss of appetite was significant among lean NAFLD patients. Biochemical parameters and food consumption across ten food groups showed no significant variation.

Conclusion: Overall, NAFLD was more common among obese patients, highlighting the need for tailored dietary interventions based on body type.