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

Background: Acute episode of pain is the most frequent symptom for which patients with sickle cell disease (SCD) seek medical attention. The neuropeptide Substance P (SP) has been suggested as a possible aetiologic factor. This study compared the serum levels of SP in SCD subjects in painful vaso-occlusive crisis with those in steady state and normal HbAA subjects.

Methodology: This case-controlled study investigated eighteen SCD patients in vaso-occlusive crisis (VOC) and eighteen in steady state, while fourteen HbAA subjects were recruited as controls. Blood was collected in plain bottles and subsequently, the serum was separated for SP assay using the ELISA technique. Each sample was run, and results were confirmed in duplicate. Optical density was read at an absorbance of 450nm.

Results: The study showed that SP was significantly higher in SCD patients in steady state (184.79±18.67ng/L versus 104.17±19.24ng/L) compared to the controls (t=2.97, p=0.006); while the values obtained in those in VOC (375.78±76.21ng/L) were also significantly higher (t=2.433, p=0.02) than those in steady state (184.79±18.67ng/L). The SP value in the SCD patients in VOC was almost twice as much as those in steady state and about three times as much as the value in the controls and the differences were statistically significant (t=7.72, p=0.001).

Conclusion: The study showed significantly higher SP levels in VOC compared to steady state or HbAA subjects suggesting that SP may be a marker for pain sensitisation.

Background: Even though the vaginal route is said to be the gynaecologist route of surgery, abdominal hysterectomy remains the predominant method of uterine removal in most parts of the world, despite the evidence of the safety of vaginal hysterectomy. The study aims to determine the prevalence, socio-demographic variables, indications as well as outcome of vaginal hysterectomy at Federal Teaching Hospital (FTH) Katsina, during the 5-year study period.

Methodology: A five-year retrospective study on vaginal hysterectomy was conducted in Federal Teaching Hospital, Katsina from 1^st January 2015 to 31^st December 2019.

Results: The rate of hysterectomies (Abdominal & Vaginal) was 21.6% of the total major gynaecological surgeries performed during the study period. Vaginal hysterectomy accounted for 6.7%. The mean age and parity of the patients were 56.06+/- 9.55 years and 10.17+/- 4.57 respectively. The commonest indication was Utero-vaginal Prolapse (88.9%) and 80.5% (29) of the patients had no complications. Most of the patients (94.4%) were discharged within 7 days of surgery and there was no fatality.

Conclusion: The rate of vaginal hysterectomy in our centre is low. Most of the patients were grand multiparous with the main indication being Uterovaginal prolapse. It is associated with favourable outcomes and very low complication rates.

Background: Patients living with HIV infection remain at increased risk of cardiovascular diseases and sudden cardiac death. Various prevalence of electrocardiographic (ECG) abnormalities among HIV-infected patients were reported: Attamah et al reported the prevalence of electrocardiographic abnormalities among HIV-infected patients as 34.5%, while Orunta et al reported a prevalence of 42.9%, and Njoku et al reported a prevalence of 93.0%. Human immunodeficiency virus-infected patients are at increased risk of developing prolonged QT interval. Sani et al reported the prevalence of prolonged corrected QT interval among HIV-infected patients as 45.0%. Innocent et al reported a prevalence of48.0%, while Ajala et al reported a prevalence of 18%. Prolonged QTc interval increases the risk of premature ventricular contraction which can degenerate into ventricular tachycardia and or ventricular that can result in sudden cardiac death.

Methodology: The study was a cross-sectional conducted among HIV-infected patients receiving HAART at the Federal Medical Centre Nguru, Yobe State, North Eastern Nigeria.

Results: One hundred and seven (107) subjects were recruited into the study comprising thirty-three (37.0%) males and 70(65.4%) females. The mean CD4 cell count, and viral load of the studied patients were 612.64±34.75 cells/μL and4646.30±58.68 copies/mL respectively. Twenty (18.7%) patients had prolonged QTc interval, this gave us the prevalence of prolonged QTc in this study as 18.7%. The commonest cardiac rhythm was sinus rhythm (69.2%), followed by sinus tachycardia (26.2%) and atrial fibrillation 5(4.7%). Other electrocardiographic findings include First-degree atrioventricular block was seen in seven (6.5%) patients, Premature ventricular contractions were found in16.8%, RBBB was observed in 2.8%, 3.7% of patients had LBBB and 4.7% had left posterior hemiblock. The distribution of QTc interval according to CD4 cells count and viral revealed a statistically significant difference across the groups. All the patients with prolonged QTc interval had lower CD4 cells count and higher viral load suggesting that HIV disease severity is associated with prolonged QTc interval.

Conclusion: In conclusion, the study revealed that the prevalence of prolonged QTc interval among HIV infected patients on highly active antiretroviral therapy was found to be 18.7%, and that HIV disease severity increases the risk of developing prolonged QTc interval.

Background: Methicillin-Resistant Staphylococcus aureus (MRSA) is both a human commensal and a pathogen that causes neonatal infection which is associated with significant morbidity and mortality. Its genetic flexibility and versatility have equipped it with the ability to develop resistance to numerous antibiotics. Outbreaks of infections in neonatal intensive care units as well as community infections have been reported mostly in developed countries. However, there is a paucity of data on neonatal MRSA infection in developing countries. The study aims to highlight cases of MRSA infection, describe the clinical presentation, and outline the antibiotic susceptibility pattern among term neonates in our facility.

Methodology: It was a prospective cross-sectional hospital-based study carried out from October 2018 to July 2019. A total of 248 term neonates with suspected sepsis were enrolled in the study and had their blood samples taken for investigations including blood culture. Bacterial identification and antibiotic susceptibility patterns were carried out using MicrobactTM24E (Oxiod UK) and Staph ID and modified Kirby-Bauer disk diffusion technique respectively.

Results: Out of the 248 subjects enrolled in the study, 34.2% had proven sepsis, with Staphylococcus species accounting for 56.4% of these cases. Among those with staphylococcal sepsis, 56.3% were found to have MRSA infection. Notably, the majority (94.4%) of cases originated from outside the hospital, presenting as neonatal sepsis with non-specific clinical features. Sensitivity testing revealed that ciprofloxacin and chloramphenicol were the most effective antibiotics against the identified pathogens.

Conclusion: The presence of MRSA infections in neonates poses a critical public health threat. This trend underscores the emergence of antimicrobial resistance, potentially compromising treatment efficacy and jeopardizing neonatal well-being. Urgent and decisive measures are necessary to curb this trajectory.

Background: Although several studies on the pattern of oro-facial pain have been reported, none have been reported on the prevalence and risk factors of severe oro-facial pain. This study aims to determine the prevalence and predictors of severe oro-facial pain among patients in a Nigerian tertiary hospital.

Methodology: The prospective cross-sectional study was conducted at the Department of Oral Diagnosis of a Nigerian tertiary hospital from January to December 2023 on all consecutive patients who presented to the centre with orofacial pains. The data collected were age, gender, occupation, level of education and marital status. Other data collected were ethnicity, smoking, alcohol intake, location of pain, causes of pain, and pain severity. Both descriptive and inferential statistics were performed. All data were analysed with SPSS version 26 (IBM Corp, Armonk, NY, US). A p-value less than 0.05 was considered significant.

Results: The age range was 17-85 years with a mean age of 36.6 ±16.7 years. Almost two-thirds (64.1%) of the patients were females. Most (46.1%) of the patients were skilled workers. Almost half (48%) of the recruited patients were single. The prevalence of severe pain among patients with orofacial pain was 45.3%. There was no relationship between sociodemographic factors and the prevalence of severe orofacial pain except the ethnicity of the patients (p = 0.012). There was no association between clinical factors and severe orofacial pain (p>0.05).

Conclusion: The prevalence of severe pain among patients with orofacial pain was relatively high and this severity was only influenced by their ethnicity. It is therefore recommended that a high index of attention is given to orofacial pain patients and a reduction of waiting time for the same individuals.

Background: Obesity is linked to non-communicable conditions. We looked at obesity using four definable criteria and their relationship to biochemical and inflammatory indicators of cardiovascular diseases (CVDs) in people living with HIV (PLHIV).

Methodology: This cross-sectional study involved 140 randomly selected HIV-infected patients attending HIV clinics at the Jos University Teaching Hospital and Faith Alive Foundation in Jos, Nigeria. Anthropometric measurements such as height, weight, waist circumference, and hip circumference were taken to identify those with obesity. Fasting plasma glucose, lipid profile, High-sensitivity CRP (hsCRP), and HIV-related markers were evaluated.

Result: The mean (SD) age of the participants was 42.5 (8.8) years, and the majority (71.4%) were females. The prevalence of Obesity based on Body-Mass-Index (BMI), International Diabetes Federation (IDF), Adult Treatment Panel (ATP), and Waist-Hip-Ratio (WHR) criteria were 18.6%, 50.7% 34.3%, and 45.7% respectively. Obesity concordance among the criteria for obesity was highest between IDF and ATP (Kappa= 0.673, p<0.001); and least between BMI vs WHR (Kappa= 0.124, p<0.073). Only 9.3% had obesity by all 4 criteria. BMI was independently associated with hypertension but not glycaemic status nor dyslipidaemia while Obesity by WHR was significantly associated with hypertension and dyslipidaemia, after adjusting for age and sex. There was no significant association between Obesity by all the criteria and HIV-related parameters such as duration of HIV infection, Antiretroviral (ARV) use, and CD4 counts (p>0.05).

Conclusion: Our study urges a unified assessment of obesity and a more prominent use of parameters of central obesity, for assessing cardiovascular risk in PLHIV.

Background: With the limited number of trained health care providers in Nigeria, PPMVs are inevitable, especially in rural areas for the supply of drugs, and integration through appropriate referral practices is quintessential. This study assessed the knowledge, attitude, and practice of patient referral among PPMVs in a setting with limited hospital infrastructure.

Methodology: This cross-sectional descriptive survey was conducted in Obio-Akpor, Rivers State using a structured questionnaire that measured the participants' socio-demographic characteristics as well as knowledge, attitude, and practice of patient referral. Descriptive and inferential analyses were conducted with SPSS version 25 and a p-value <0.05 was considered significant.

Results: Most of the respondents reported moderate knowledge, attitude, and practice (62.4%, 73.4%, and 58% respectively) of patient referral. Multivariate analysis showed statistically significant inverse relationships between years of experience and odds of their knowledge, attitude, and practice of referral. PPMVs with 3 years of experience reported significantly higher odds of adequate knowledge (AOR = 178.96; 95%CI: 60.15 - 532.49; p-value <0.005), attitude (AOR = 7.38;95%CI: (3.78 - 14.40; P-value <0.005) and practice (AOR = 131.56; 95%CI: 53.50 - 323.51; p-value <0.005) than those with above 10 years of experience after controlling for the effects of other variables. The most frequently reported barrier to referral was fear of losing clients while most referrals were for laboratory investigations.

Conclusion: Most PPMVs reported moderate knowledge, attitude, and practice of patient referral. PPMVs were aware of the benefits of referrals but concerned about losing their clients to formal healthcare facilities.

Background: Nigeria has one of the highest rates of cervical cancer morbidity and mortality in Sub-Saharan Africa. Both the human papillomavirus vaccine (HPV) and cervical screening are effective prevention strategies against both HPV infection and cervical cancer. Lack of awareness, limited knowledge, limited decision-making agency, lack of spousal support and stigma are barriers to uptake of these preventive measures. Cervical cancer is the second most diagnosed cancer and the third leading cause of cancer death in women worldwide. Eighty three percent (83%) of the world's new cases and 85% of all cervical cancer-related deaths occur in developing countries. It is primarily caused by human papilloma virus (HPV); a sexually transmitted pathogen that could be prevented with safe sexual practice and using vaccines, among others. The aim of the study was to assess the knowledge and attitude of reproductive age group women in low resource setting in towards cervical cancer and its prevention in Yenagoa, Bayelsa State Nigeria.

Methodology: This study employed the use of a descriptive study design to examine the knowledge and assessment of cervical cancer among women of reproductive age (19-54), about cervical cancer, its prevention, and their utilization of Pap smear screening; using a convenience sample of 406 women in two communities (Okaka and Agudama) in Yenagoa Local Government Area of Bayelsa State, Nigeria. Women voluntarily completed a structured questionnaire.

Result: Results showed that women who participated in the study were aware of cervical cancer (78.3%; n=318) but many (70.4%; n= 286) were unaware of Pap smears as the screening tests for cervical cancer. Although few of them (45.6%; n =185) knew about a screening center, out of which 17.6% (n= 32) reported that the screening center was less than 2km away from their residences.

Conclusion: There is need for health care professionals, to intensify efforts to increase awareness about cervical cancer screening and encourage women through the different clinics to use these services. The benefits of screening and early diagnosis of cervical cancer should be emphasized to enhance the utilization of cervical cancer screening services.

This comprehensive literature review is to summarize the most recent findings regarding the causes, diagnosis, and treatments of pancreatic cancer and to encourage additional investigation into this under-researched malignant tumor. Pancreatic cancer is a significant public health issue in China, with annual mortality rates almost equal to incidence rates. The disease is more prevalent in rural areas and has a poor prognosis. The data was collected from the following databases: Pub Med, Cross ref, Science Direct, Scopus, and Google Scholar we reviewed published articles from 2018 to 2023 on the annual incidence of pancreatic cancer in China is 5.1%, with only 5-7% of patients completely cured. The prognosis is extremely poor, with a 1-year survival rate of 8% and a 5-year survival rate of 3%. Pancreatic cancer has no specific clinical manifestations or tumor markers, and its characteristics are not typical of high-risk factors including smoking, alcohol, chronic pancreatitis, abnormal microorganism metabolism, blood type, and glucose and lipid levels. For increased detection and survival rates, pancreatic cancer must be diagnosed as early as possible. However, the low specificity of tumor markers calls for more study. Future treatment strategies could include immunotherapy and a microbiology-free system, and it's anticipated that they'll offer intriguing clinical applications for extending patients' lives with pancreatic cancer. Finally, we suggest measures to improve the health outcomes of pancreatic cancer patients in China.