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

Background: This study is therefore aimed at assessing upper urinary tract stone characteristics, the outcome of retrograde intrarenal surgery with laser lithotripsy, and factors predicting stone-free status.

Methodology: This was a retrospective cross-sectional study carried out on all patients who had retrograde intra-renal surgery with laser lithotripsy for upper urinary tract stones from 2021-2023 at the Urology unit, department of Surgery, University of Benin Teaching Hospital. Electronic medical records were retrieved with data on demographics, serum calcium level, and non-contrast computed tomography scans assessing stone size, location, laterality, multiplicity, density, and renal anatomy.

Results: The data Thirty- three patients were extracted and analysed with a mean age of 43,70+/- 11.44 years, 54.5% of patients were male. The mean duration of admission was 2.4+/-1.5 days. The mean body mass Index was 26.84+/- 4.37 kg/m2. All patients had flank pains; 7(41.2%) patients had bilateral renal stones. The majority of renal stones 8(47.1%) were located in the lower pole of the kidney. A greater proportion of calculus was ureteric 23(69.7%), mean stone size was 13.2+/- 15.2mm, while mean stone density was 817+/- 285.5 HU. Fifteen participants (45.5%) had multiple stones. Stone clearance assessed on imaging was 75.8%. Age, sex, stone size, density and location, and multiplicity of stones were statistically significant determinants of stone clearance (p= 0210, 1.000, 0.220, 0.380. 0.366 and 1.000) respectively, similarly, no statistically significant predictors of stone clearance were found in this study.

Conclusion: The study revealed a predominance of upper urinary tract stones in males, with most patients being overweight. There was a weak correlation between stone density and serum calcium level in this study. Findings in this study revealed no statistically significant determinant or predictors of stone clearance.

Background: Surface features present on the dorsal surface of the tongue along with colour and shape are unique characteristics of every individual. Tongue print is being considered as a new biometric and forensic authentication tool. This digital photographic study was conducted to analyze and compare morphological differences on the dorsal surface of the tongue which can serve as a valuable tool in forensic odontology.

Methodology: The present study utilized a digital photographic method. Patients who visited the outpatient department (OPD) of the dental institution for availing necessary dental treatment were included in the study. The final study sample comprised 316 subjects which were recruited by systematic random sampling. The shape, surface texture, colour etc. of the tongue were recorded. Descriptive statistics and chi-square tests were used for statistical analysis. Significance was set at p≤0.05.

Results: The majority of the subjects (60.13%) had a 'U-shaped' tongue. 'Tongue fissures/cracks' and 'Smooth Tongue' were the two prominent surface textures present among 59.18% and 35.13% of the study subjects respectively. The shape and surface texture of the tongue were significantly associated with the gender of the study subjects. Non-visibility of median septum was found more among females than males. More than two-thirds of the subjects (77.51%) belonging to the age group of 18-30 years had pink-coloured tongues and the findings were highly significant (p=0.00).

Conclusion: In addition to rugoscopy and cheiloscopy, the study of lingual morphology may be one of the secure methods for identification in forensic dentistry.

The mental health of university students has become a significant cause for worry and public health concerns globally. Studies suggest that many mental health problems for example, depression, anxiety, phobia, suicidal behaviour, and substance use disorder among others, typically arise within the age bracket of 15-25 years, which coincides with the period when many individuals are pursuing higher education. Implementing structural interventions and broad organizational reforms to address student mental health has proven to be advantageous. The potential benefits that can be achieved from investing in students' mental health are improved academic performance, student success and a reduction in discontinuous school enrolment or dropout especially in resource-limited environments. This report presents a research-based multidisciplinary mental health program being implemented at a Nigerian University called the University of Ilorin Tertiary Institution Mental Health Programme (Unilorin TIM Healthcare Programme), aimed at addressing the mental health needs of tertiary institution students. The programme which incorporates preventive education such as enlightenment programs on campus, workshops on stress management, resilience building and coping strategies, amongst other initiatives has recorded significant benefits with positive feedback from the beneficiaries. It is hoped that it will be a model for other institutions within and outside Nigeria. Newborn jaundice (NNJ), especially due to ABO incompatibility, is a major global health concern. Phototherapy is the 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.

Background: Laryngoscopy and tracheal intubation are related to sympathetic stimulation and lead to hypertension and tachycardia. These changes in hemodynamics may increase the risk of myocardial ischemia. As a result, effective blunting of these unpleasant responses is required. This study aimed to compare the effects of dexmedetomidine and fentanyl bolus administration on attenuation of hemodynamic response to tracheal intubation in patients undergoing laparoscopic cholecystectomy surgeries.

Methodology: A total of 136 patients of both genders undergoing elective laparoscopic cholecystectomy surgeries satisfying inclusion criteria were randomly allocated into 2 groups (group D and group F). Group D received 1mcg/Kg of dexmedetomidine (Dexa) intravenous (IV) in 100ml of normal saline over 10 minutes and 5ml of normal saline over 3 minutes before induction. Group F received Inj. Fentanyl 2mcg/Kg diluted in 100 ml of normal saline over 10 minutes and 5ml of normal saline 3 minutes before induction. The patients were ventilated for 3 minutes by bag and mask. After 3 minutes of ventilation, endotracheal intubation was done. Vitals (systolic blood pressure, diastolic blood pressure, mean arterial blood pressure, heart rate) were recorded from the time of intubation to 10 minutes after that at 1 minute interval.

Results: In both groups, heart rate increased significantly immediately following intubation (p = 0.002). In dexmedetomidine group heart rate, mean arterial pressure, systolic and diastolic blood pressures were significantly controlled at various time points in comparison to fentanyl group after laryngoscopy and intubation.

Conclusion: Dexmedetomidine in a dose of 1mcg/kg causes greater and sustained attenuation of haemodynamic response to endotracheal intubation among the patients of cholelithiasis undergoing laparoscopic cholecystectomy surgeries as compared to fentanyl. Therefore, it can be used as an effective alternative to opioids for induction of general anaesthesia in patients undergoing laparoscopic cholecystectomy surgery.

Background: Hyperprolactinaemia can cause infertility. Serum prolactin and clinical features of hyperprolactinaemia may vary between obese and non-obese infertile women. Identifying the differences may inform changes in the management of obese women with hyperprolactinaemia. This study aimed to compare the serum prolactin levels and the clinical features of hyperprolactinaemia in obese and non-obese infertile women in Kano.

Methodology: This was a comparative cross-sectional study comprising 160 obese infertile women (study group) and another 160 non-obese infertile women (control group). Participants were recruited in the gynaecology clinics of Aminu Kano Teaching Hospital (AKTH) and Murtala Muhammed specialist Hospital (MMSH). Serum prolactin and clinical features of those with hyperprolactinaemia were analysed using SPSS 23. P-values ≤ 0.05 were considered significant. Odd ratios at 95% confidence were calculated.

Results: The mean serum prolactin levels were 28.18 ± 10.53ng/ml and 17.50 ± 8.00 ng/ml in the obese and non-obese women respectively (P=0.0001). All categories of hyperprolactinaemia were more common (P=0.001) amongst the obese infertile women. The prevalence of hyperprolactinaemia was 37.5% and 18.1% in the obese and non-obese arms respectively (P=0.0001). However, 23.1% obese hyperprolactinaemic infertile women presented with galactorrhoea compared to 64.0% of the non-obese counterparts (P= 0.0001). Abnormal menstrual flow and galactorrhoea were observed more in moderate-markedly elevated serum prolactin level as seen in 65.2% and 69.6% respectively compared to those with mildly elevated serum prolactin level.

Conclusion: Obese infertile women have higher baseline and prevalence of hyperprolactinaemia than their non-obese counterparts. However, non-obese hyperprolactinaemic infertile women presented more with galactorrhoea.

Background: The Nigeria National Health Insurance Authority (NHIA) is the official Social Health Insurance Agency of the Federal Government established to provide quality healthcare services to Nigerians at affordable cost, sufficient to address catastrophic health expenditures. One key indicator of quality healthcare services is patient satisfaction. This National Survey aimed to assess enrollees' satisfaction with healthcare services under this organization.

Methodology: This was a cross-sectional, observational study conducted among enrollees of NHIA in four Nigerian cities (Aba, Kano, Lagos, and Onitsha) from three randomly selected geopolitical zones of the federation. A sample size of 1,043 was proportionately allocated to the study states based on the number of enrollees in the state (Aba 204; Kano 250; Lagos 359 and Onitsha 230). Data were collected as exit interviews with adapted validated interviewer-administered questionnaires. Quantitative data were analyzed using a statistical package for social science (SPSS v. 21). Logistic regression was done to determine predictors of satisfaction with services. A p-value of <0.05 was considered statistically significant.

Results: A total of 1043 respondents were interviewed, with 451 from private healthcare facilities and 592 from public facilities. There were 599 (57.49) dependents and 444 (42.62) principal enrollees. The majority, 608 (58.3%) were females. The mean age of respondents was 38.83 years and 679 (65.1%) had tertiary education. Overall, 928 (89%) of the respondents were satisfied with NHIA healthcare services with the following predictors: marital status, time spent in the hospital, and services received from healthcare providers.

Conclusion: Most of the study participants were satisfied with the services provided by the Authority. However, there are identified limitations and administrative challenges at the facility levels that need attention to further enhance quality services and overall patients' satisfaction.

Background: Cholera remains a disease of public health importance in Nigeria associated with high morbidity and mortality. On the 4^th of June 2024, the Nigeria center for disease and control prevention (NCDC) through the Disease Surveillance and Notification Officer (DSNO) reported an increase in the number of reported cases of vomiting and diarrhea in Toru-Orua village, Sagbama Local Government Area Council, Bayelsa State, Nigeria. A team of researchers were deployed to investigate the outbreak with the objectives of verifying the diagnosis, identifying risk factors and instituting appropriate control measures to control the outbreak.

Methodology: We conducted a case-control study. We defined a cholera case as any person aged ≥5 years with acute watery diarrhea in Toru - Orua community. We identified community controls. A total of 93 cases and 118 controls were recruited. Structured questionnaires were administered to both cases and controls. Four stool samples from case-patients and two water samples from the community water source were collected for laboratory investigation. We performed univariate and bivariate analysis using Epi-Info version.

Results: The mean age of cases and controls was 20.3 years and 25.4 respectively (p value 0.09). Females constituted 50% (cases) and 60% (controls). The attack rate was 4.3% with a case fatality rate of 13%. Four stool (100%) specimen tested positive for Vibrio cholerae. The water source and environment were polluted by indiscriminate defecation. Compared to controls, cases were more likely to have drunk from the river forcados (OR 14.2, 95% CI: 5.5-36.8) and living in households (HH) with more than 5 persons/HH (OR 5.9, 95% CI: 1.3-27.2). Good hand hygiene was found to be protective (OR 0.3, 95% CI: 0.1-0.7).

Conclusion: Vibrio cholerae was the cause of the outbreak in Toru - Orua. Drinking water from river forcados, living in overcrowded HH and poor hand hygiene were significantly associated with the outbreak. We initiated hand hygiene and water treatment to control the outbreak.

Background: This study assessed the knowledge, attitude and extent of research involvement among resident doctors at a tertiary health facility in Osun state, Nigeria, and identified its associated factors.

Methodology: This was a cross-sectional study of 199 resident doctors selected via a simple random sampling technique. A structured self-administered questionnaire was used to obtain data with the outcome variable being the resident doctors' total score on extent of research involvement. Data analysis was done using the Stata 17 software.

Results: The respondents' mean age was 34.1±4.6. Only 34(39.1%) of those receiving mentorship in research ranked the support received as good, with majority 177(88.9%) still desirous of a mentor in research. About 121(60.8%) of the residents had good knowledge of basic research but only 58(29.2%) of them had a positive attitude towards research. Only 23(11.6%) reported confidence in research and needing no guidance. Their mean perceived research ability and extent of research involvement scores were 40.3±8.9 and 4.9±2.8 respectively. Their perceived ability to conduct research (β=0.10, 95% CI: 0.07 to 0.14, P<0.000), being dental residents (β=1.23, 95% CI: 0.45 to 2.02, P=0.002), a perceived need for assistance in research, (β=1.08, 95% CI: 0.16 to 2.01, P=0.022), and the types of research designs ever conducted significantly influenced positively their extent of research involvement.

Conclusion: The majority of the resident doctors studied are poorly involved in research despite their knowledge of basic research, with a gross unmet need for guidance in conducting research. Innovative efforts are needed to link their knowledge about research to conducting one.

Background: Neurofibromas are the most common benign nerve sheath tumours occurring as solitary sporadic tumours or multiple Syndromic tumours associated with neurofibromatosis type 1(NF1). In Nigeria and West Africa, there is a paucity of literature and studies on neurofibromas. This study aims to analyse the histopathologic and immunohistochemical patterns of neurofibromas and determine the frequency, demographic and anatomic distributions.

Methodology: The study was a hospital-based retrospective study, and the study population constituted all surgical specimens submitted for histological examination to the Department of Pathology between 1^st January 2010 to 31^st December 2019 reported as neurofibroma. Records were retrieved from the archives and subjected to histopathologic and immunohistochemical analysis following standard protocols. Collated data was analysed, slides were reviewed, and results were presented in frequency distribution tables and statistical charts.

Results: A total of 125 cases were seen constituting 8.3% of all soft tissue tumours seen. Neurofibromas were more prevalent in females with a male-to-female ratio of 1:1.15. The age ranged between 2-70 years with a mean age of 25.38 years and the highest frequency of occurrence was in the second decade of life. The most frequent anatomic site of occurrence was the head and neck region. Most of the tumours 103 (82.4%) were sporadic while 22(17.6%) were Syndromic and associated with NF1. A malignant transformation of a pre-existing neurofibroma in an NF1 patient was seen. The most common histologic variant seen was the conventional variant. Ninety percent of these tumours showed SOX10 immunopositivity, 91% showed S100 immunopositivity and 95% showed CD34 immunopositivity. Calretinin expression was low showing 16%. No hot spots labeling index seen with Ki67 antibody.

Conclusion: Neurofibromas are more common in females in our environment and the most frequent anatomic site of involvement is the head and neck region.

Background: Diabetes is a major public health challenge in Saudi Arabia, with rising prevalence and significant associated complications. The increasing burden of diabetes in the region necessitates a comprehensive understanding of its prevalence, determinants, and the effectiveness of public health strategies. This study aimed to assess the prevalence and determinants of diabetes using online assessment tools.

Methodology: A cross-sectional design was employed, utilizing online surveys to collect data from adults across various regions of Saudi Arabia. The survey included questions on demographics, diabetes status, lifestyle habits, and self-reported health outcomes. Data analysis involved logistic regression to identify risk factors and chi-square tests to explore associations between diabetes knowledge and management practices.

Results: The study found a diabetes prevalence of 27% among participants, with a higher prevalence in females (26%) compared to males (20%). Young adults (ages 18-35) showed a prevalence rate of 19%. Significant associations were observed between diabetes and lifestyle factors; smokers had a 30% higher likelihood of diabetes than non-smokers. Only 40% of respondents demonstrated adequate knowledge regarding diabetes management, which correlated negatively with effective disease control (p<0.05).

Conclusion: This study highlights the high prevalence of diabetes in Saudi Arabia, particularly among females and young adults. The regression analysis revealed significant predictors of diabetes diagnosis, including awareness of risk factors, physical activity levels, gender, and education level. The findings highlight the need for targeted educational and public health strategies to enhance diabetes awareness and promote healthier lifestyles. Further research is needed to evaluate the impact of these strategies on diabetes outcomes.