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

Background: Cervical cancer is an important contributor to morbidity and mortality in low Human Development Index (HDI) countries where organized cervical cancer screening is often lacking. There is a paucity of data on the prevalence of cervical precancerous lesions in Bauchi, Nigeria.

Methodology: This cross-sectional study was carried out in selected hospitals in the 3 senatorial zones of Bauchi State. Sociodemographic and reproductive data were collected using a data collection tool, and cervical smears were collected and stained using a manual liquid-based cytology (LBC) method.

Results: Out of 458 women who underwent screening, 410 (89.5%) of the participants had a negative smear. Low-grade squamous intraepithelial lesions (LSIL) and Atypical squamous cells of undetermined significance (ASC-US) were the most common diagnostic categories of abnormal smears, together accounting for 78.9% of abnormal pap smear results. The chances of developing cervical precancerous lesions were higher in women <35 years (p<0.05). There was no statistically significant association between precancerous lesions and age at sexual debut or marital status (p>0.05).

Conclusion: There is a need to implement organized state-wide screening programmes within the state to improve detection rates of cervical pre-cancerous lesions and eventually a reduction in cervical cancer mortality and morbidity statistics in the country.

Background: Acute kidney injury (AKI) is related with higher death rates, longer hospital admissions, and an increased chance of developing chronic kidney disease (CKD). Serum creatinine, a conventional biomarker for AKI diagnosis, has limitations since it rises slowly after renal injury and is dependent on muscle mass and hydration state. Neutrophil gelatinase-associated lipocalin (NGAL) has emerged as a promising early biomarker, appearing in urine and plasma within two hours of kidney injury. This study investigates the diagnostic accuracy of NGAL against serum creatinine in diagnosing AKI in pediatric patients. The aim of this study is to assess the sensitivity and specificity of •NGAL in diagnosing AKI in pediatric patients compared to serum creatinine. By assessing the reliability of NGAL, the study aims to enhance early detection and management techniques for AKI in children.

Methodology: A cross-sectional analytic study was carried out over a 12-month period at a tertiary hospital's pediatric nephrology department. The study included 200 children aged 1 month to 18 years who had been admitted with symptoms that put them at risk for AKI, such as sepsis, dehydration, and nephrotoxic medication exposure. Blood samples were taken at admission and 24 hours later to determine serum creatinine and NGAL levels. An enzymatic colorimetric technique was used to determine serum creatinine, and an enzyme-linked immunosorbent assay (ELISA) was used to detect NGAL. Data was analyzed with SPSS software, and diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis.

Result: NGAL revealed superior diagnostic accuracy, with an area under the curve (AUC) of 0.94 against 0.72 for creatinine. NGAL demonstrated greater sensitivity (92% vs. 68%) and specificity (88% vs. 62%), especially in infants. The ROC curve demonstrated NGAL's excellent diagnostic performance in all pediatric age groups. Conclusion: This study shows that NGAL is a more reliable early biomarker for AKI in pediatric patients than serum creatinine. Its implementation in clinical practice could lead to early diagnosis and treatments, lowering the risk of severe kidney injury and improving pediatric patient outcomes.

Background: Migraine is frequently overlooked and underdiagnosed among school-aged children and adolescents, despite its potential to cause significant morbidity, negatively affect quality of life, and lead to school absenteeism. Its sporadic nature and low fatality often result in an underestimated public health burden. While migraine and headache associated with refractive errors are reported globally among adolescents, data from African settings remain limited. This study aimed to determine the prevalence of migraine headache and its association with refractive errors (type and severity) among secondary school students.

Methodology: This cross-sectional, descriptive, multi-school study involved secondary school students selected via multistage sampling with probability proportional to size. Eligible students underwent visual acuity testing, ocular examination, and refraction. Migraine was assessed using criteria from the International Classification for Headache Disorders and an interviewer-administered semi-structured questionnaire.

Result: A total of 775 students from 6 schools participated, including 352 (45.4%) males and 423 (54.6%) females, with a mean age of 14.5 ± 1.85 years. The prevalence of migraine headache was 18.3%, with gender-specific rates of 10.2% in males and 25.1% in females. There was a significant association between migraine and both the type and severity of refractive error. Students with mild refractive error had 3.42 times higher odds of migraine (95% CI, 1.74-6.75) than those with moderate error. Astigmatism was associated with 1.53 times, increased odds, of migraine (95% CI, 0.98-2.40) compared to myopia.

Conclusion: Migraine is common and underdiagnosed among secondary school students and is significantly associated with refractive errors. Periodic school eye screenings that assess both refractive errors and migraine headaches, with appropriate referral pathways, are recommended.

Background: Rising incidents of deaths due to analgesic abuse are public health concerns globally. A good level of awareness and understanding of the determinants of analgesic abuse can reduce mortalities associated with the condition. This study assessed the awareness and determinants of analgesic abuse among undergraduate students of the University of Port Harcourt.

Methodology: A descriptive cross-sectional study design with multi-stage sampling was employed. An online self-administered questionnaire was used to collect information from 362 undergraduate students at the University of Port Harcourt. The data was analyzed using IBM Statistical Product and Service Solutions (SPSS) version 27. Data were summarized using means, frequency, proportions, Chi-square, and regression analysis; a p-value of <0.05 was considered significant.

Results: The awareness of risks associated with analgesic abuse was low in 47.4% and high in 10.9% of the respondents. Pharmacy students and females had higher levels of awareness. Peer pressure, availability of analgesics on campus/local stores, offer of analgesics by peer(s), and knowledge of someone who has experienced the adverse effects of analgesic abuse were significant determinants; however, only availability of analgesics on campus/local stores and offer of analgesics by peer were significant determinants of analgesic abuse from the bivariate logistic regression.

Conclusion: The result showed that the majority of the respondents had low levels of awareness of risks associated with analgesic abuse, with females and pharmacy students showing higher levels of awareness. Peer pressure, availability of analgesics on campus/local stores, offer of analgesics by peers, and knowledge of someone who has experienced the adverse effects of analgesic abuse were significant determinants of analgesic abuse. Comprehensive educational/awareness programmes that cut across all departments and genders addressing analgesic abuse and policies to regulate the availability of analgesics on campus should be established in the institution.

Background: Bone marrow examination is a crucial diagnostic tool for both hematological and non-hematological disorders, ranging from benign to malignant ones. It is a relatively simple and easy procedure for evaluating pyrexia of unknown origin, as it often leads to an etiological diagnosis. The study aims to evaluate the clinico-hematological profile in various infections infiltrating bone marrow and study the spectrum of morphologic alterations in bone marrow aspirate in various infections.

Methodology: This retrospective observational study was conducted at a tertiary care center in Bihar, India, over a 4.5-year period (June 2019-December 2023). All patients referred to the haematology section for bone marrow aspiration and/or biopsy based on strong clinical and morphological suspicion of infection were included. Cases with inadequate marrow samples or lacking corroborative infection evidence were excluded.

Result: The study included a total of 52casesdemonstratingthe presence of bone marrow infections. Out of 52 cases, bone marrow aspirations were done in all cases, whereas bone marrow biopsy was done in 23(44.2%) cases only. There were 39 (75%) cases of adults and 13 (25%) of children; and the mean age of presentation was 35.3 years (range, 1-72 years).On clinical examination, anemia was the most common symptom (82.6%), followed by splenomegaly (78.8%). On bone marrow examination, an increase in plasma cells was the most striking finding, accounting for 67.3% (n=35), followed by erythroid hyperplasia and an increased number of macrophages showing features of hemophagocytosis in 50% and 32.6% of cases, respectively. A total of 41 cases showed the presence of Leishmania Donovani (LD) bodies. Granulomas were seen in 09 cases (17.3%), out of which 05(9.6%) cases showed AFB positivity.

Conclusion: Bone marrow examination plays a pivotal role in diagnosing various infectious diseases, particularly in patients presenting with pyrexia of unknown origin, cytopenias, or unexplained hematological abnormalities. Morphological analysis, along with specialized staining techniques, allows the identification of a broad spectrum of infectious agents, spanning from parasites and bacteria to fungi.

Background: Malaria is a life-threatening parasitic infection primarily found in the tropics, and seasonal malaria chemoprevention (SMC) is one of the strategies used to protect children. Despite years of implementation, gaps remained in terms of knowledge and uptake among caregivers. This study aimed to assess the knowledge and uptake of SMC among caregivers of children at a tertiary hospital in Kaduna State, North-western Nigeria.

Methodology: Using a cross-sectional study, 234 caregivers of under-five children were selected from immunization and paediatric clinics through systematic sampling. An interviewer-administered questionnaire was used to collect data on sociodemographic characteristics, knowledge and uptake of SMC during the preceding SMC campaign. Data was analysed using IBM SPSS Statistics, and a chi-square test was used to check for associations between relevant variables. A p-value <0.05 was considered statistically significant.

Result: All the respondents were females, 226 (95.4%) were married, 175 (73.8%) were Hausa and 98 (41.4%) were unemployed. Up to 182 (76.8%) had heard of SMC, 156 (65.8%) knew it as a drug for prevention, 128 (54.0%) correctly identified it as a rainy season activity, and overall, 128 (54.0%) had good knowledge of SMC. A total of 137 (58.4%) had taken at least one dose of SMC during the last campaign, but only 65 (27.2%) received all four doses. Of the 100 (41.6%) who missed SMC, reasons included not knowing about SMC (54.0%) and the child being absent (20.0%) during distribution. Factors associated with SMC uptake included education, occupation, ethnicity, religion and knowledge on SMC (p< 0.05).

Conclusion: Despite good awareness, gaps in knowledge persist with many unable to identify the purpose, duration or eligibility for SMC. Uptake of SMC was moderate, with only a third receiving full coverage. Health authorities should intensify efforts towards community enlightenment and adaptive programming to bridge the identified gaps.

The incidence of tuberous sclerosis seems to be rising in Nigeria. Tuberous sclerosis with cerebral, renal, thyroid, and dermatological manifestations have not been completely identified. This case report documents a rare case of tuberous sclerosis with cerebral and dermatological lesions, renal cysts, and hypothyroid state. A 28-year-old female patient who presented in our clinic with a history of recurrent seizures for 19 years, a shagreen patch on the right lumbar area, scarring alopecia, and puckering facial angiofibroma. No member of her family had a similar illness. Computerized tomography scan showed multiple echoic cysts in the two kidneys. Her thyroid function tests revealed a hypothyroid state. Brain computerized tomography showed subependymal calcified nodules of the lateral ventricles and prominence of the cerebral sulci, more at the vertex. Electroencephalogram findings were normal. She was placed on oral Carbamazepine 400mg BD and has remained seizure-free for two years. Tuberous sclerosis with concomitant renal, cerebral, and dermatological lesions and hypothyroidism, though rare, was presented. The patient had tuberous sclerosis with renal cysts, subependymal nodules, and prominence of the cerebral sulci, with recurrent seizures, ash leaf/shagreen patches, scarring scalp alopecia, and a hypothyroid state.

Background: This study aimed to characterize the clinical and sociodemographic profiles of Nigerian patients with early-stage primary open-angle glaucoma (POAG), with the goal of highlighting the significance of timely diagnosis in enhancing glaucoma treatment outcomes.

Methodology: This cross-sectional study involved participants aged ≥ 40 years with early POAG. The participants underwent a slit-lamp examination of the anterior and posterior segments. The examination included gonioscopy, after which only eyes with open angles were selected. A central visual field test was conducted, and one eye of each participant who met the criteria for early POAG was selected for optical coherence tomography/angiography test (OCT/A). The relevant data were analyzed using the Statistical Package for Social Sciences (SPSS) version 26, with statistical significance set at p<0.05, with a 95% confidence interval.

Results: There were 90 participants with a mean age of 54.5 ± 10.1 years, comprising 54 males (60%). All participants had a best-corrected visual acuity (BCVA) of at least LogMAR 0.48, and the mean central visual field (CVF) MD was -3.50 ± 1.0 dB. The mean retinal nerve fiber layer (RNFL) thickness was 97.79 ± 17.33. The mean peripapillary vessel density (VD) was 50.21 ± 4.54%. Nearly half (47.8%) of the participants had other systemic medical conditions, primarily hypertension or hyperlipidemia.

Conclusion: Patients with early POAG were asymptomatic and had good visual acuity and minimal RNFL thickness reduction. This highlights the importance of routine hospital screening of people 40 years and older to aid early diagnosis of POAG.

Background: To report the outcomes of patient-tailored concurrent combined surgery for retinal ischemia and intraocular pressure (IOP) control in neovascular glaucoma (NVG) with or without cataract. Methodology: Ninety-seven (97) eyes with NVG seen between January 2022-September 2023 at a tertiary eye care centre, 6 eyes (4 proliferative diabetic retinopathy and 2 retinal vein occlusion) that underwent concurrent retinal and glaucoma procedures with or without cataract surgery, were recruited. Outcomes after surgery were based on the World Glaucoma Association guidelines on the reporting of glaucoma surgical trials that comprise functional and surgical parameters.

Results: The IOP reduced by>50% from baseline in all 6 eyes, with one eye developing shallow AC by overstraining and 3 eyes developing transient self-resolving hyphema. Two eyes received additional bevacizumab (n=1) or ranibizumab (n=1) injections for persistent DME at 4 and 5 months after surgery. The final IOP was reduced in all eyes at the final follow-up of 6±1.2 months, with one eye requiring 2 medications for IOP control.

Conclusion: The outcomes after concurrent retinal and glaucoma filtering surgery in NVG may provide favourable outcomes comparable to the traditional stepwise approach to management provided these are offered on a case-case basis.

Background: The organization of mental health services and management of mental health disorders are driven by the availability of information on patterns and prevalence of such conditions. To the best of our knowledge, no study has presented the pattern of mental illness in Sierra Leone disaggregated by ICD (International Classification of Diseases) categorization. This study aims to establish the socio-demographic profile and ICD11 diagnostic categorization of mental health patients in Sierra Leone.

Methodology: All patients registered at SLPTH Kissy from 1st January 2021 to 31st July 2023 were eligible for the study. Data were retrospectively collected from the digital register of patients. Abstracted variables included patients' age, sex, marital status, district of residence, and diagnosis. Each of the diagnoses was further classified into one of the broad ICD-11 mental health diagnostic categories. Statistical analysis was done in Microsoft Excel and SPSS software.

Result: There were 4020 individual patients, translating to an average of 130 new registrations monthly. The age range of patients was 4 to 96 years, with a median (IQR) age of 30(23 -40) years. About 87% of all patients were below 50 years of age. Of the 4020 patients, 2591 (64.5%) were males while 1429(35.5%) were females (P<.001). Disorders due to substance abuse accounted for 38.9% of all presentations, followed by schizophrenic and mood disorders at 25.1% and 19.0% respectively. Disorders of substance use, and Schizophrenia/primary psychotic disorders were significantly more prevalent in males, while Mood disorders were significantly more prevalent in females.

Conclusion: Mental Health disorders in Sierra Leone showed comparable socio-demographic patterns with findings in regional studies. There are significant gender differences in the frequency of some ICD categories of mental disorders. Substance use is a foremost cause of severe mental illness; thus, campaign of demand reduction will improve the mental health situation of the country.