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

In Nigeria, the medical education system faces challenges ranging from inadequate infrastructure to a lack of qualified personnel. These challenges not only affect the competency of graduating medical students but also lead to disruptions in academic calendars. The role of the Medical and Dental Consultants' Association of Nigeria (MDCAN) in addressing these issues is crucial. This review examines the impact of MDCAN in enhancing the competency of graduating medical students and preventing disruptions in academic calendars in Nigeria. It discusses the importance of maintaining academic continuity and explores the reasons why disruptions in academic calendars are not viable options for pressuring the government to improve doctors' and lecturers' welfare packages. Through an analysis of relevant literature, this review underscores the significance of collaboration between stakeholders to ensure the quality of medical education and the smooth functioning of academic institutions in Nigeria. Ultimately, this paper proffers some solutions to mitigate the negative effects of strikes and improve the quality of undergraduate medical education.

Background: Most neonatal deaths occur in low and middle-income countries (LMICs). These deaths can be prevented through universal access to basic high-quality in-patient health services. Prematurity, neonatal sepsis, and perinatal asphyxia have been reported as the leading causes of in-patient neonatal deaths. This study aimed to assess the trend of neonatal mortality in our hospital, determine the pattern and causes of neonatal mortality, and evaluate the factors associated with neonatal mortality in our facility.

Methodology: This was a retrospective cross-sectional descriptive study conducted in the Special Care Babies Unit (SCBU) and Sick Babies Unit (SBU) of the University of Uyo Teaching Hospital, over seven years (2015-2021). Demographic, clinical, and mortality data was extracted from the case record files of patients into a structured proforma and analysed.

Results: There was a total of 228 deaths comprising 130 males (57.02%) and 98 (42.98%) females. The median age at demise was 4.00 (IQR = 1.00 - 12.00) days for both genders. The majority (71.50%) of deaths occurred in the Sick Babies Unit. More males died than females (57% vs 43%). The three leading causes of death were: prematurity (38.60%), neonatal sepsis (38.16%), and birth asphyxia (13.60%).

Conclusion: The leading causes of neonatal mortality in our environment are prematurity and neonatal sepsis. There is a need for increased community education on antenatal care, training of traditional birth attendants, improved newborn transportation facilities, and provision of neonatal intensive care facilities.

Background: Stroke is a common neurological disorder with a huge global burden in terms of mortality and morbidity. Epidemiological evidence has shown that modifiable risk factors are responsible for more than 90% of all strokes. Stroke outcome in hospitalized patients is influenced by several variables, such as socio-demographic factors, stroke subtype, and admission severity. The interaction between stroke outcomes and these parameters is often complex. The study is aimed to profile hospitalized stroke patients and determine outcome predictors.

Methodology: A descriptive retrospective study of 100 patients hospitalized for acute stroke. Their medical records were reviewed for demographic and clinical variables and relevant data were retrieved and analysed using appropriate statistical methods.

Results: Of the 100 acute stroke patients studied, 36% were men and 64% were women. The mean age was 65.16±15.72. About 78%had ischemic stroke while 21% had haemorrhagic strokes. The commonest risk factor was hypertension (71.2%). On multivariate analysis, stroke subtype and admission duration were significantly linked to stroke outcome.

Conclusion: Ischemic stroke comprises more than two-thirds of stroke admissions, with hypertension being the most common risk factor and stroke case fatality of 23%. Stroke subtype and admission duration significantly predicted stroke outcomes. The need to step up measures aimed at improving acute stroke care in hospitalized patients is imperative as this will hopefully improve overall outcomes in resource constraint settings such as Nigeria.

Background: Following curricular revisions at the Faculty of Dentistry of the Obafemi Awolowo University, no formal evaluation of its alignment and implementation has been carried out.This study aimed to evaluate the alignment of an Oral surgery curriculum and to determine students' learning experiences and perceptions of the curriculum.

Methodology: This was a mixed-method study conducted at Obafemi Awolowo University, Ile-Ife, Nigeria. This ethically approved study adopted a mixed-method descriptive approach to data collection and analysis. Data collection followed a sequential, phased approach comprising document analysis, curriculum mapping, questionnaire survey, and focus group discussions.Quantitative data collected via questionnaires were analyzed descriptively. Qualitative data from focus group discussions were analyzed using a hybrid deductive-inductive thematic analysis by the researchers to generate relevant themes.

Results: The curriculum data reveal that the oral surgery course is well-aligned. Furthermore, each course outcome utilizes different methods of assessments and teaching/learning activities (TLAs). Focus group discussions yielded four themes and two sub-themes. The main themes included curriculum alignment, implemented teaching and learning activities, feedback, and curriculum renewal, while the subthemes were recommended TLAs and student learning experiences.

Conclusions: The curriculum evaluation identified strengths of the course as multiple student assessment methods and potential areas for improvement. These improvements included updating the content of the course and including more variety in teaching and learning methods. The authors identified potential learning gaps that require curriculum renewal. Evaluation of the entire program is recommended for comparison.

Background: Pulmonary tuberculosis may result in haematogenous and lymphatic extension in case of failure of early detection, or immunocompromised status, leading to extrapulmonary tuberculosis. Rare sites of extrapulmonary tuberculosis include the gastrointestinal tract, musculoskeletal system, genital tract, middle ear and pericardium. Histopathological findings of macro-confluent granuloma with or without caseous necrosis, along with detection of acid-fast bacilli (AFB) on Ziehl-Neelsen (ZN) staining, and GeneXpert for detection of Mycobacterium tuberculosis DNA, are key in establishing a diagnosis of tuberculosis.

Methodology: Biopsy-proven extrapulmonary granulomatous lesions were included in this study. Histopathological evaluation of all extrapulmonary biopsy specimens sent to the Department of Pathology were done for the presence of granuloma and necrosis, and ZN staining for AFB was done in all the cases of granulomatous lesions with or without the presence of necrosis. The same cases, with biopsy specimens sent in normal saline, were re-evaluated in a molecular laboratory with the help of GeneXpert MTB to detect the DNA of Mycobacterium tuberculosis. All biopsy specimens from extrapulmonary sites which were sent to the Department of Pathology were used for DNA extraction.

Results: Out of the 10 cases of extrapulmonary granulomatous lesions, 8 showed caseous necrosis on microscopy, and 7 showed the presence of acid-fast bacilli on Ziehl-Neelsen staining. GeneXpert detected DNA of Mycobacterium tuberculosis in 9 cases.

Conclusion: Extrapulmonary tuberculosis rarely occurs as primary, and mostly spreads from lung parenchyma via a haematogenous route. Tuberculosis of the gastrointestinal tract, peritoneum, lymph nodes, and solid viscera are together termed abdominal tuberculosis. Entities like tuberculosis of the pericardium and ear are extremely rare. Extrapulmonary tuberculosis should be a differential in cases of chronic non-responding cases with diagnostic dilemmas. To avoid diagnostic delay, in cases of high suspicion, one should go for biopsy along with ZN staining for diagnostic confirmation as this is cost-effective, followed by GeneXpert for Mycobacterium tuberculosis in highly suspected cases with absent caseous necrosis and negative ZN staining.

Background: Different studies have identified the prognostic factors of COVID-19 infection. These studies have revealed that COVID-19 infection is more severe in males than in females. The aim of our study was to compare the severity of COVID-19 infection between males and females in terms of clinical, biological, radiological, and evolutionary aspects.

Methodology: This is a cross-sectional observational study conducted in patients hospitalized with COVID-19 infection over a 6-month period from 1 August 2021 to 1 February 2022.

Results: The comparison of clinical, biological, radiological, and evolutionary severity factors of covid-19 infection between the two sexes revealed that this infection was more severe in males. Statistically significant differences were noted for the rate of high dimers (p =0.01) and for lung involvement greater than 25% on chest CT (Computed tomography) (p =0.008).

Conclusion: The severity of covid-19 infection in men is due to biological differences between men and women in the renin-angiotensin system, the immune system, genetics, and sex hormones. Further research into the pathophysiological mechanisms behind this finding is needed.

Platinum-based chemotherapy after surgical cytoreduction is the universal treatment for advanced ovarian cancer (OC), however, about eighty percent of patients experienced relapse and progression-free survival remained poor. Patients who relapsed within one year of treatment eventually become resistant to second-line chemotherapy. Poly-ADP-ribose polymerase inhibitors are a novel class of targeted therapy that could overcome these challenges by augmenting the chemotherapeutic activity of other cytotoxic agents. Cumulative Index to Nursing and Allied Health Literature (CINHAL), Cochrane and PubMed databases were searched for potentially relevant primary publications from 2011 to 2022 reporting on efficacy and safety of combination of a PARP inhibitor and chemotherapy versus chemotherapy in recurrent OC and reviewed. The outcomes of interest assessed qualitatively were progression-free survival (PFS) and grade 3 or higher adverse events (AEs) as measures of efficacy and safety respectively. Eight randomized controlled trials (RCTs) were included in the systematic review comprising 3,021 patients evaluated efficacy and safety of PARP inhibitors: Olaparib, niraparib and veliparib with combinations of bevacizumab, carboplatin, cisplatin, cediranib, cyclophosphamide and paclitaxel. 824 patients had 33 BRCA mutation while 1,430 had wild-type BRCA, an allele that confers increased risk of cancer. Most patients had platinum-sensitive cancers. There was significant prolongation of PFS with PARP inhibitor and chemotherapy combination compared to chemotherapy in all included trials except one which combined veliparib with cyclophosphamide. The prolongation of PFS was more remarkable in patients with BRCA mutation and occasionally patients with wild-type BRCA. Niraparib and veliparib were notably associated with grade 3 or higher anaemia, neutropenia, and thrombocytopenia, olaparib caused fatigue and gastrointestinal disturbances while bevacizumab and cediranib caused hypertension. This review suggested combined PARP inhibitor and chemotherapy significantly prolonged progression-free survival especially in patients with BRCA mutation compared to chemotherapy and the combined therapy is safe.

Background: To deal with COVID-19, vaccination is a strategy adopted by many countries including the Democratic Republic of the Congo (DRC). The first phase of vaccination was conducted in 2021 as part of the country's Expanded Program on Immunization (EPI). To evaluate it, an intra-action review was conducted. It identified a low proportion of vaccinated vulnerable populations, namely health professionals (1.8%), chronically ill (0.09%), and older adults aged ≥ 55 (0.4%). The objective was to explore perceptions and barriers to acceptance of the COVID-19 vaccine in the DRC among the vulnerable populations targeted by the EPI.

Methodology: A qualitative study was conducted between September 2021 and June 2022 in Kinshasa, DRC. Semi-structured focus groups were conducted with each group separately using a single interview guide. It included five categories: socio-demographic information, COVID-19 vaccine status, perceptions towards the COVID-19 vaccination, vaccine hesitancy and perceptions towards the COVID-19 vaccination campaign.

Results: Three focus groups were conducted. In total, we had 16 participants with eight health professionals, four chronically ill participants, and four older adults. The majority were married (68.7%) and came from urban areas (68.7%). The sex ratio was at 1 and more than one-third had an education level equivalent to a master's degree (37.5%). Half were vaccinated against the COVID-19 (50.0%). The main perceptions and hesitancy factors were the lack of trust and knowledge of the vaccine's properties, benefits, and risks. Adjustment of the information messages which, according to participants, were not clear and poorly adapted to the needs of each group is the main element to improve the vaccination campaign.

Conclusion: This study represents an important step to improve the COVID-19 vaccination campaign in the DRC. It showed the different barriers to the COVID-19 vaccines acceptance among vulnerable populations.

Background: Depression affects individuals across all age groups, genders, and socio-economic backgrounds. Socio-demographic correlates of depression may include factors such as age, gender, education level, income, and marital status. These factors, including the presence of chronic diseases, have been shown to impact the prevalence and severity of depression. This study assessed the prevalence of depressive symptoms and its association with socio-demographic correlates and co-morbid chronic medical conditions among adult patients attending a National Health Insurance Clinic of a tertiary health facility in Southwest Nigeria.

Methodology: A hospital-based descriptive cross-sectional study was conducted between April - May 2023 in which 250 consenting adult patients were recruited using a systematic random sampling technique. Respondents' information on socio-demographic profiles and awareness of co-morbid medical conditions were assessed using semi-structured interviewer-administered questionnaires. Depressive symptoms were determined using the Patient Health Questionnaire. Data were analyzed using SPSS version 20. The strength of the association between independent and dependent variables was measured using chi-square and the p-value was set as <0.05.

Results: The mean age of respondents was 38.96±13.096 years (range: 18-80 years). There were 159 (63.6%) females. The prevalence of depressive symptoms was 44.8%. There was a statistically significant association between age, gender, marital status, monthly income, presence of chronic diseases, and depressive symptoms.

Conclusion: The prevalence of depressive symptoms among adult patients attending the National health insurance clinic was 44.8%. These findings call for health policies to integrate and strengthen mental health in NHIA primary care.

Introduction: The presence of other respiratory pathogens in patients with SARS-CoV-2 infection has been described as a striking feature. However, data on adenovirus co-infection rates and clinical impacts in COVID-19 patients is limited. The purpose of this study is to compare the prevalence of respiratory adenoviruses in children under 15 years of age in Positive and Negative SARS-CoV-2 patients.

Methodology: From September 2020 to January 2021, nasopharyngeal swabs were obtained from 280 patients below 15 years old with influenza-like infection symptoms suspected to be COVID-19 and referred to hospitals in Hamadan province. Nucleic acid was extracted using a High Pure Viral Nucleic acid extraction kit for both viral RNA and DNA. Reverse transcription real-time PCR for detecting SARS-CoV-2 and Real-time PCR for Human Adenoviruses were used.

Results: Out of 280 examined samples, 11.7% tested positive for AdV, of which 18 samples originated from the SARS-CoV-2 positive group and 15 samples were from the SARS-CoV-2 negative group. Of 18 co-infected samples, which were categorized in three different ranges of age including, 0-5, 6-10, and 11-15 years old were 11, 4, and 3 patients respectively. Also, 14 patients were hospitalized. Compared with AdV-positive patients, children with Co-infection with SARS CoV-2 had lower levels of white blood cell (WBC) count while erythrocyte sedimentation rate (ESR) and C-reaction protein (CRP) had increased levels.

Conclusion: We report a substantial burden of AdV co-infection in pediatric COVID-19 patients. This study revealed most AdV infections lead to hospitalization and change in paraclinical parameters.