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

Background: Artificial intelligence (AI) is rapidly transforming healthcare, particularly in diagnostic medical imaging. For Nigerian Oral and Maxillofacial surgeons, embracing AI technologies is essential to improve diagnostic accuracy and maintain global relevance. This study aimed to demonstrate the potential of machine learning (ML) tools in enhancing diagnostic precision in maxillofacial radiology.

Methodology: A supervised learning model was developed using Google's Teachable Machine, a no-code ML platform based on computer vision. Radiological images of histologically confirmed lesions were retrieved. Two projects were conducted: Project 1 trained the model to distinguish between malignant and benign bony jaw lesions using 46 radiographs (panoramic and sectional CT images). Project 2 trained the model to differentiate between craniofacial fibrous dysplasia and ossifying fibroma, using 40 radiographs. Each model was tested on five new images. The output probabilities were analyzed, and standard performance metrics-accuracy, precision, recall (sensitivity), and F1-score-were computed. Additionally, ROC-AUC (Receiver Operating Characteristic - Area Under the Curve) curves were generated using Python code on Google Colaboratory IDE.

Results: In Project 1, the model yielded predictive probabilities ranging from 89% to 100% for distinguishing malignant from benign lesions. In Project 2, it produced 71% to 100% probabilities for classifying fibrous dysplasia versus ossifying fibroma. Applying a 70% probability threshold for positive prediction, both models achieved perfect scores (1.0) across all performance metrics, including AUC = 1.00.

Conclusion: AI-driven computer vision models show strong potential for improving diagnostic workflows in maxillofacial imaging. Their application can support more efficient clinical decision-making. However, the use of small test samples may have resulted in overfitting. Future studies with larger datasets and increased AI literacy among clinicians are essential for real-world implementation in resource-limited settings.

Background: The phenomenology of obsessive-compulsive disorder (OCD) is influenced by culture; its understanding can enhance case identification. Insight levels and depressive symptoms may vary with OCD phenomenology, affecting management and outcomes. This study assessed the association of depression with phenomenology and insight among patients with OCD and predictors of comorbid depression severity.

Methodology: This observational study enrolled 146 participants after receiving ethical approval and consent. Obsession and compulsion were assessed using the Yale-Brown Obsessive Compulsive Scale (YBOCS). Insight and depression were assessed with the Over Valued Ideas Scale (OVIS) and the Hamilton Depression Rating Scale (HDRS). Linear regression was employed to identify predictors of the severity of depression.

Result: The sample consisted of 68.5% males, with a mean age of 31.5 years. The mean duration of OCD was 63 months. Contamination was the most common obsession; while washing or cleaning was the most frequent compulsion. Aggressive, sexual, and religious obsessions were more prevalent in males. Notably, 73.2% of patients experienced depression. Those with depression exhibited longer and more severe OCD. The severity of depression had a significant positive correlation with the duration of OCD, the YBOCS score, and the OVIS score. Female gender and higher OVIS scores were significant predictors of the severity of depression, with gender being the most important predictor.

Conclusion: Depression is quite common among patients with OCD, particularly those experiencing longer and more severe illnesses. Being female and having lower insight significantly predict the severity of depression.

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is characterized by neuropsychiatric symptoms, seizures, dysautonomia, and movement disorders. Initially identified as a paraneoplastic syndrome predominantly in young women with ovarian teratomas, it has become clear that not all affected individuals have tumors, and symptoms can occur across genders. With the availability of the NMDAR antibody assay, cases have also been identified in patients presenting with early psychosis, epilepsy, and classic limbic encephalitis. This emerging understanding enables earlier diagnosis, even in resource-limited settings, facilitating a multidisciplinary management approach that combines immunotherapies and tumor removal when indicated. This case highlights the importance of recognizing anti-NMDAR encephalitis in an 18-year-old female, emphasizing the need for prompt intervention to improve recovery outcomes.

Opioids are indispensable for managing cancer-related pain but carry risks such as immunosuppression, increased susceptibility to infections, and potential tumour progression. Balancing effective pain relief with these risks remains a critical challenge. This review examines the dual role of opioids in cancer pain management, highlighting their benefits, risks, and ethical implications while exploring strategies to mitigate adverse effects. Through a comprehensive literature review, we analysed mechanisms of opioid-induced immunosuppression, infection risks, tumour progression, and ethical prescribing practices. Additionally, strategies such as multimodal analgesia, opioid rotation, and personalised medicine were evaluated. Findings indicate that while opioids effectively alleviate cancer pain, they may suppress immune function, elevate infection risks, and potentially promote tumour progression. Mitigation strategies, including multimodal approaches, immunomodulatory interventions, and adherence to ethical principles (beneficence, non-maleficence, autonomy, and justice), are essential for safe opioid use. In conclusion, opioids remain vital for cancer pain management but require judicious application to minimise risks. Future research should prioritise non-opioid alternatives and immunomodulatory therapies to enhance patient outcomes.

Background: Induction of labour is a routine and common obstetric intervention which aims at achieving successful vaginal delivery. Over the years, attempts have been made to find a pre-induction test that can predict the success of induced labour, which may also serve as a selection criterion for determining which women should undergo labour induction. The study aims to determine whether the presence of fetal fibronectin in the cervicovaginal secretion can predict the success of induced labour.

Methodology: This was a cohort study involving 137 nulliparous women at term undergoing induction of labour. The presence of fetal fibronectin in the cervicovaginal secretion was determined using a fetal fibronectin rapid immunoassay kit. Induction of labour was done using misoprostol.

Results: Data obtained were analysed using statistical product and service solutions (IBM-SPSS) version 20.0. Data obtained were tested for normality of distribution and compared by Chi square, Students' t-test, or Mann-Whitney U as appropriate. A p-value of less than 0.05 was regarded as significant. The rate of vaginal delivery was not significantly different between fetal fibronectin positive and negative women (65% vs. 66.7%, p value- 0.839). Women who were positive for fibronectin had a significantly shorter mean duration of induction (22.8+6.1 hours versus 30.1 + 11.1 hours, P value of 0.015), had higher bishop's scores, and required fewer doses of misoprostol. Regression analysis did not find fetal fibronectin to be predictive of vaginal delivery.

Conclusion: The Presence of fetal fibronectin was not predictive of successful labour induction. Its presence may possibly be associated with a relatively shorter duration of induction.

Background: Pain has been reported as a common unpleasant experience or complication following orthodontic treatment. Despite this, the routine management of the pain remains controversial and inconsistent. This study aimed to evaluate the orthodontic patients' pain experience following orthodontic appliance installation, orthodontic pain assessment, the pain management protocol received, and the perceived possible effect of orthodontic pain on daily activities.

Methodology: This was a 12-month cross-sectional study involving orthodontic patients. A structured questionnaire was used for data collection via Google Forms. Three different sections evaluated participants' sociodemographic variables, the patient's pain experience and management of that pain, orthodontic pain perception, possible effects of orthodontic pain and the need for development of a standardized pain management protocol. Statistical analysis was performed using SPSS Version 26, IBM Corp, with significance set at P-value < 0.05.

Results: A total of 347 orthodontic patients were recruited into the study. Approximately 90% of orthodontic patients experienced pain following orthodontic appliance installation (5.59 ± 2.78), with pain medication prescribed after the onset of pain (25.9%). Pain was mostly described as distressing (47.6%) and lasting for 1 to 6 days (75.8%). There was no significant age or gender variation in pain experience. Paracetamol was the most prescribed pain control option (69%). Difficulty with feeding and brushing was the most affected daily activity. Respondents agreed on the need for a standardised pain control protocol (72.9%).

Conclusion: Orthodontic pain is an established complication following orthodontic treatment, with variation in treatment duration and intensity. It can adversely affect patients' ability to carry out daily activities, consequently affecting treatment outcomes. Efforts should therefore be made to develop a pain management protocol for holistic patient care.

Background: Discharge Against Medical Advice (DAMA) among children represents a significant public health issue in low-and middle-income countries. DAMA occurs when a patient leaves the hospital contrary to the physician's recommendation. This action can hinder effective healthcare delivery and may lead to increased rates of morbidity and mortality. The aim of this study was to assess the prevalence and underlying reasons for DAMA among paediatric patients at a tertiary healthcare facility in Nigeria.

Methodology: A descriptive retrospective study was carried out from October 1, 2020, to September 30, 2022, at the Department of Pediatrics, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria. Data such as age, gender, diagnosis, duration of hospital stay, insurance status, and the highest educational attainment and occupation of both parents were retrieved from the admission record book. These data were analyzed using proportions and Pearson's chi-square (χ²) test. A p-value of less than 0.05 was considered statistically significant.

Results: The prevalence of DAMA was 3.4%, with 30 cases recorded out of 875 admissions. A higher proportion of those discharged were females (18 out of 30; 60.0%), and the majority (27 out of 30; 90.0%) belonged to the lower socioeconomic class. Sepsis, malignancy, malaria, and sickle cell anaemia collectively accounted for 80.2% of the diagnoses. The most common reason for DAMA was financial constraint, cited in 15 out of 30 cases (50.0%). Notably, none of the patients had health insurance.

Conclusion: Financial constraints were identified as a leading cause of paediatric DAMA in our environment. Given that none of the affected patients were enrolled in any health insurance scheme, there is a need to raise public awareness about the benefits of health insurance.

Dermatofibrosarcoma protuberans is a rare tumor that accounts for a negligible percentage (approximately 0.1%) of all malignancies. It usually occurs on the trunk and upper and lower limbs. Its occurrence in the breast is uncommon. A 46-year-old Nigerian woman presented with a left breast mass of 3 years duration without clinical and radiological evidence of metastasis. Initial histological diagnosis revealed a malignant phyllodes tumour. However, immunohistochemistry showed a diagnosis of dermatofibrosarcoma protuberans. She subsequently had a wide local excision with axillary clearance and has shown no clinical and/or radiological signs of recurrence of the lesion one year following surgical removal. This case helps reiterate the need for immunohistochemistry and not only histology of all malignant breast tumours, irrespective of the nature of the presentation, mode of occurrence, and initial diagnosis. Dermatofibrosarcoma protuberans, however rare, should be considered an important diagnosis of breast malignancies. Indeed, considering the high rate of misdiagnosis of dermatofibrosarcoma protuberans, early histopathological evaluation of breast lesions is of utmost importance. Our case also demonstrates that a wide local excision that is readily available in resource-poor settings remains an extremely important option in the absence of the preferable and technical Mohs micrographic surgery (MMS).

Background: Nurses are continually subjected to physical and mental stress because of their employment. Estimating the prevalence of and its association with psychological distress among nurses is critical for developing health promotion initiatives. We conducted this study to investigate the incidence of psychological distress and related characteristics among nurses working in a teaching institute in Jharkhand.

Methodology: We conducted cross-sectional research involving 452 clinical nurses between December 2024 and February 2025. We examined psychological distress using a self-administered general health questionnaire-12 (GHQ-12). Participants with a GHQ-12 score > three were classified as having psychological distress. The chi-squared test and multiple logistic regression analysis were performed to identify the components related to psychological distress.

Result: More than one-fourth of nurses, 25.2% (95% CI: 21.3 - 29.5), had psychological distress. Psychological distress was significantly higher among age group of 26-30 years ( aPR=3.1, 95% Cl: 1.3 - 7.3) those who were not doing any physical activity (aPR=2.2, 95% Cl: 1.3 -3.6), those with poor sleep quality (aPR=2.0, 95% Cl: 1.0 -3.), and those having online screen time >3 hours (aPR=3.1, 95% Cl: 1.3 - 7.3).

Conclusion: We report a high prevalence of psychological distress among nurses, especially among the age group of 26-30 years, those having poor sleep quality, and those not doing physical activity and having online screen time of more than 3 hours. We highlight that reducing workplace stress and improving sleep hygiene can be vital in improving mental health status.

Background: Triple-Negative Breast Cancer (TNBC) is a particularly aggressive tumor. Major responses to chemotherapy in TNBC do not necessarily correlate with better survival, indicating a need for further research into treatment strategies and underlying molecular mechanisms. This study is aimed at assessing the profile of Triple Negative Breast Cancer.

Methodology: This study retrospectively evaluated the profile of TNBC patients at Lagos State University Teaching Hospital, Ikeja. Sociodemographic data, tumour grade, and type of chemotherapy administered were abstracted from the hospital's cancer register. Statistical analyses were conducted using SPSS version 27.0, with associations between sociodemographic characteristics, tumour grade, and type of therapy established using chi-square tests. Key relationships were considered statistically significant at p-values ≤ 0.05.

Result: A total of three hundred and thirty (330) patients were recruited. The mean age of presentation was 49.96 ± 11.39 years, with the minimum and maximum ages of 22 and 80 years, respectively. The most represented age group was between 41-50 years, constituting about a third of all the patients. About three quarters of the tumours were moderately differentiated. Correlating tumour grade with the age of the patients was statistically significant, p value =0.05.

Conclusions: Triple-negative breast Cancers remain a moderately differentiated tumour and are seen predominantly in the middle-aged group.