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

Background: Gestational weight gain (GWG) is an important determinant of maternal and foetal wellbeing. Evidence suggests that there is heterogeneity in GWG across countries and regions based on the influence of several factors. This study was designed to investigate GWG, associated factors, and pregnancy outcome among women who gave birth at Babcock University Teaching Hospital, Nigeria.

Methodology: A prospective cohort study carried out on 220 pregnant women who registered for antenatal care before gestational age of 13 weeks and recruited between June 2022 and May 2024. GWG was categorized into adequate, inadequate or excessive according to the United States Institute of Medicine (IOM) guidelines. Logistic regression analysis was used to investigate predictors of GWG, while Relative Risk was reported for pregnancy outcomes.

Result: Adequate GWG, inadequate GWG and Excessive GWG were achieved by 29.1%, 40.5% and 30.5% of the women, respectively. The median (95% CI) GWG in all study participants was 9.8 (8.8-10.3) Kg. Older maternal age [OR 2.5(1.3-5.0); P=0.013], multiparity [OR 8.2(1.3-51.8); P=0.025] and middle/upper socioeconomic class [OR 14.6(2.1-99.2); P=0.006] predicted increased likelihood of inadequate GWG while being overweight [OR 0.2(0.1-0.4); P<0.001] and obese [OR 0.06(0.02-0.20); P<0.001] were associated with reduced likelihood of inadequate GWG. None of the variables studied predicted excessive GWG. In terms of pregnancy outcome, women with inadequate GWG had a 30% reduced risk of caesarean delivery compared to those with adequate GWG [RR 0.7(0.6-0.9); P= 0.036]. The mean birth weight of babies born to women with inadequate GWG was significantly lower than that of babies born to women with adequate GWG (T-test = 2.998; P=0.003).

Conclusion: A substantial proportion of study participants had suboptimal GWG (inadequate and excessive), with only a third meeting the IOM recommendations. There is a need for targeted counselling for older, multiparous, and upper socioeconomic class women on adequate GWG.

Background: Malignant peripheral nerve sheath tumours (MPNSTs)are uncommon, aggressive sarcomas arising from a peripheral nerve or extra neural soft tissue and show evidence of nerve sheath differentiation. These tumours exhibit variability in grade and can either occur as familial or sporadic tumours. Immunohistochemistry is a paramount tool in the evaluation of these tumours. This study aimed at analyzing the histopathological and immunohistochemical patterns of these tumours and determining the frequency, demographic and anatomical site distribution.

Methodology: This was a 10-year retrospective hospital-based study. Formalin fixed paraffin embedded tissue blocks were sectioned and the slides werereviewed and interpreted. Morphological features were noted and immunohistochemical analysis was performed using four primary antibodies. Descriptive statistical analysis was used to collate and analyse data, and statistical test was used where necessary. The results were presented on statistical charts and tables.

Result: In this series, 20 cases of MPNSTs were seen with a male predilection. The 3^rd and 4^th decades were the most frequent decades of occurrence, and most tumours occurred in the gluteal region (eight cases) constituting 40% of all anatomical site's distribution. Borderline/intermediate grade tumours (Grade 2) were the most frequent grade. S100 (25%) and SOX10 (35%) showed low positive immunoexpression. Most of the tumours had low proliferative index or labelling hot spots with Ki67 antibody.

Conclusion: Malignant peripheral nerve sheath tumours are uncommon and tend to be sporadic in our region. Most of these tumours are borderline/intermediate grade tumours (Grade 2) showing low immunoexpression to antibodies employed with varying intensities.

Background: High-altitude illness (HAI) is a spectrum continuum ranging from innocuous high-altitude headache (HAH) to severe, potentially fatal high-altitude cerebral edema (HACE) with acute mountain sickness (AMS) and high-altitude pulmonary edema (HAPE) in the middle of the gamut. MRI brain findings in such patients have prognostic implications, especially the diffusion and susceptibility-weighted imaging.

Methodology: Twenty-one devotees visiting a high-altitude cave temple, in whom there was a clinical suspicion of high-altitude cerebral edema after the ascent, were included in this study. All the patients met the criteria for diagnosis of acute mountain sickness (AMS) as well as HACE. MRI brain was done in all 21 patients with special emphasis on diffusion and susceptibility-weighted imaging.

Results: Diffusion restriction with T2/FLAIR hyperintensity was present in the splenium of the corpus callosum in all 21 patients. Other sites involved were centrum semiovale and deep white matter (90.5%), middle cerebellar peduncles (66.7%), and posterior limb of the internal capsule (57%). SWI revealed multiple tiny cerebral microbleeds in splenium, deep white matter, and middle cerebellar peduncles.

Conclusion: This study suggests the evolution of diffusion restriction, T2/FLAIR hyperintensity, and cerebral microbleedsin the splenium of the corpus callosum and white matter in HACE corresponds well with the temporal evolution of cytotoxic, ionic,and vasogenic cerebral edema underpinning the role of brain water dyshomeostasis central to the pathogenesis of HACE.

Metastatic pulmonary calcification, also called MPC, is a metabolic abnormality resulting in pulmonary calcium deposition. Our patient is a known biopsy-proven SCC of the mid-esophagus with extensive widespread alveolar calcifications on a background of renal and ureteric stones. It is important to note that, although the disease is known as metastatic, it is a rather benign lung illness with an excellent long-term prognosis. To our knowledge, this kind of cohabitation has never been documented before.

Background: Malaria is a significant source of mortality and morbidity, particularly among children under the age of five. Meanwhile, the multi-causation theory in public health views disease and health development as underpinned by several variables, including social and demographic factors. Therefore, this study investigates the sociodemographic factors associated with malaria among under-five children in Nigeria.

Methodology: This study used secondary cross-sectional data collected from the 2018 Nigeria Demographic and Health Survey (NDHS). The sample for this study was 10,352 children. The response variable was malaria rapid diagnostic tests (RDTs) results, while the independent variables considered were children's age, residential area, zone, mosquito net ownership, gender, mother's level of education, and wealth status. Analysis was done using bivariate analysis and binomial logistic regression at a 0.05 significance level and 95% confidence interval.

Result: Children's age was statistically significant with malaria (χ2 = 166.200, p = 0.000). Malaria had a statistically significant relationship with mother's level of education (χ2 = 762.530, p = 0.000). The relationship between malaria and wealth index was statistically significant (χ2 = 1020.442, p = 0.000). The result shows that children living in rural areas were more prone to have malaria infection than children living in urban areas (OR = 1.633, p = 0.000).

Conclusion: Children's age, wealth index, mother's level of education and place of residence are key predictors and factors associated with malaria infection among under-five children in Nigeria. Therefore, broad-based programmes and interventions should be increased to tackle malaria incidence and prevalence.

Background: The use of traditional and complementary medicine is increasing worldwide. This study aims to assess the knowledge, attitudes and practices regarding the use of traditional medicine (TM) by patients with ischemic heart disease (IHD) in Oman.

Methodology: This was a cross-sectional study based on a previously validated questionnaire conducted among patients attending a Cardiology outpatients' clinic.

Result: There were 103(mean age 45.1+13.4 years; 85 or 82.5% male) responses to the questionnaire of which 70(67.9%) had previously used at least one form of TM. Those who had used TM were older (48.1+13.4yrs vs 41.2+10.9 years; p=0.01). However, there was no difference between the gender, educational status or occupation between the two groups. Cupping was the most common (58 out of 70 or 82.8%) followed by herbal medications (52 or 74.2%) and branding (47 or 67.1%), TM was used mainly for non-cardiac indications such as headache (47 or 67.1%), back pain (42 or 60%), abdominal pain (41 or 58.5%) and only 30 (42.8%) using it for chest pains. Majority of those who had used (65 out of 70 or 92.8%) said that they felt it was effective and 58 (82.8%) said that they would try it again. However, only 21.4% said that they would recommend it to others.

Conclusion: Our study demonstrates that there is widespread use of TM practices among patients with IHD in Oman and their use should be monitored due to the potential for interactions with regular medications and side effects.

Optic disc coloboma is a rare congenital anomaly of the optic nerve. We report a case of bilateral optic disc coloboma with coexisting unilateral retino choroidal coloboma in an adolescent from Northwestern Nigeria, who presented with complaints of difficulty seeing distant objects for 3 months, associated with ocular pains, tearing, and headache while reading. She had never worn spectacles. No previous history of systemic illnesses or trauma. Developmental milestones were optimal for age. Ocular examination revealed a best corrected visual acuity of 6/5 and 6/6 in the right and left eyes respectively. Dilated fundoscopy revealed an enlarged bilateral optic disc with a white bowl-shaped excavation, absent inferior neuro retinal rim, thin superior rim, and an area of well-defined oval retino choroidal defect, located inferior and slightly temporal to the right optic disc. No syndromic features or any ocular complications associated with optic disc and retino choroidal colobomas were seen.

Background: Accurate early identification of pregnancies at high risk for adverse fetal outcomes (small-for-gestational-age [SGA], preterm birth, stillbirth) enables targeted interventions. The study aims to pilot the development and internal validation of a point-based Fetal Risk Score (rFRS₅) incorporating ten routine maternal parameters, and to compare its performance against a simpler four-item score (FRS red).

Methodology: In this single-centre, retrospective cohort study of 118 pregnant women, we assigned points based on clinically meaningful ranges for age, parity, BMI, blood pressure, 24-hour proteinuria, haemoglobin, platelets, ALT, AST, and LDH. We computed rFRS₅ (0-19 points) and FRS_red (0-6 points). Discrimination was assessed using the ROC AUC (5-fold cross-validation), and calibration was evaluated using the Brier score and calibration curves. Optimal thresholds were determined by sensitivity/specificity trade-offs. Variables for score development were selected a priori based on clinical relevance and published evidence. Internal validation was performed using five-fold cross-validation and calibration methods.

Result: rFRS₅ achieved ROC AUC 0.80 and Brier score 0.219; FRS red achieved ROC AUC 0.82 and Brier score 0.220. For rule-out (sensitivity 100 %), rFRS₅ < 2 and FRS red < 2 both provided NPV 100 %. For rule-in, FRS red ≥ 6 yielded specificity 94 % and PPV 50 %, outperforming rFRS₅ (specificity 68 %, PPV 40 %).

Conclusion: In this pilot study, both scores effectively stratify fetal risk, with the simpler FRS red offering superior rule-in performance in resource-limited settings. Larger, prospective studies are warranted to confirm these findings.

Incisional hernias are part of the workload of the General Surgeon, for which there are known risk factors, and surgical repair can be challenging. The aim of this study was to report an unusual presentation of a giant incisional hernia with a protruding pregnant uterus and thinned-out ulcerated skin, seen at the Rivers State University Teaching Hospital in Port Harcourt in the year 2024.A 38-year-old female, Gravida 2 Para1, who presented with protrusion of the lower abdomen, pain, and bleeding from a sore at the lower abdomen. She had a previous Caesarean section complicated by wound sepsis and prolonged hospital stay. Significant examination findings included enlarged (gravid) pendulous abdomen, a broad sub-umbilical mid-line scar, an overlying area of shallow ulcer (10cm by 6cm), surrounding hyperpigmented skin, and tenderness at the sub-umbilical area. There was a protruding mass that measured 20cm by 14cm at presentation, which increased in size, extending to the mid-thigh at the time of surgery. She had multi-specialty care that ended with an elective repeat Caesarean section, hernia repair, abdominoplasty, and the outcome of care was satisfactory. A complicated giant incisional hernia is reported in a patient with gestational diabetes mellitus. A successful outcome was guaranteed by prolonged admission and multidisciplinary care.

Intussusception is a recognized cause of bowel obstruction and is significantly more common in paediatric patients. Adult intussusception is rare and usually results from a predisposing factor in most patients. These factors may include benign lesions, malignant lesions, or bowel wall abnormalities such as inflammatory bowel disease. We report on a case of a patient who presented with recurrent colicky central abdominal pain, anorexia, vomiting with occasional constipation and diarrhoea for six months. She was assessed and investigated with abdominal USS and Computer Tomography (CT) Scan, which showed features of intussusception, with telescoping of the jejunum with proximal bowel distension suggesting bowel obstruction. The patient underwent emergency laparotomy and surgical resection, and histopathology confirmed the lead point as intraluminal lipoma. We present a case of jejuno-jejunal intussusception in an adult, which is not commonly seen. The history of recurrent colicky abdominal pain and CT abdomen, together with an abdominal ultrasound scan (USS), was important in establishing a preoperative diagnosis, and histology confirmed lipoma as a lead point. Despite the conservative approach described in the literature, surgery continues to be the only option in patients who are unstable with persistent colicky abdominal pain, vomiting, abdominal distension, and constipation; Surgery is advocated for all adult patients. Adult intussusception is not a common condition and can be difficult to diagnose, posing a diagnostic conundrum. Patients with intussusception may report a relatively long period of recurrent colicky abdominal pain that might worsen acutely following complete obstruction. Abdominal CT scan is a very useful investigation in the preoperative diagnosis of intussusception, with histopathological confirmation of lipoma as a lead point.