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

Background: The use of antenatal corticosteroids beyond 34 weeks of gestation to prevent certain neonatal complications remains a debate. This study sought to determine the effect of the use of antenatal corticosteroids in late preterm delivery on neonatal morbidity.

Methodology: It was a randomized double-blind placebo and active-controlled multi-arm trial. There were two study groups and one control group. It was conducted at the Department of Obstetrics and Gynaecology and the Department of Paediatrics of Ahmadu Bello University Teaching Hospital Zaria, Nigeria. Pregnant women at 34 weeks to 36 weeks 6 days of gestation scheduled for elective delivery or who had emergency delivery were recruited for the study. The first study group had 2 doses of 12mg intramuscular dexamethasone and the second study group had 2 doses of 12mg betamethasone. The control group had 2 doses of a placebo. The primary outcome was the incidence of respiratory distress syndrome evidenced by tachypnoea with grunting, recession, or nasal flaring with diffuse reticulogranular infiltrate on X-ray or respiratory distress requiring the need for respiratory support by 72 hours of age. Secondary outcome measures included the need for neonatal resuscitation at birth, admission into the Special Care Baby Unit/Neonatal Intensive Care Unit, transient tachypnoea of the newborn, and apnoea.

Results: A total of 138 mothers and 146 preterm neonates were included. A pairwise analysis was done to test for differences between the groups. There was no difference in the incidence of respiratory distress syndrome between the groups. However, the need for neonatal resuscitation was significantly higher (RR: 7.0; CI: 2.49-19.4; p = <0.001) in the placebo group when compared to the betamethasone group and also significantly higher (RR:4.0; CI: 1.86-26.03; p= 0.01) in the placebo group when compared to the dexamethasone group.

Conclusion: Antenatal corticosteroids may decrease the need for neonatal resuscitation at birth in late preterm neonates.

Funding: The research was funded by the Tertiary Education Trust Fund (TETFUND) of Nigeria. Trial registration: ClinicalTrial.gov, NCT03446937.

Background: Infectious disease treatment and prevention are threatened by antimicrobial resistance (AMR) globally. The knowledge and attitudes of doctors regarding AMR and the responsible use of antibiotics are critical to improving prescribing behaviours and mitigating the danger that AMR poses. This study aims to assess the knowledge attitudes and practices of doctors in Nigeria regarding AMR.

Methodology: This was an online survey of doctors in Nigeria. A 31-item self-administered questionnaire was distributed via an online forum for doctors. The questionnaire consisted of knowledge, attitudes, and practices sections. Demographic and practice data were also collected from respondents. Data were analyzed using IBM-SPSS and were mainly descriptive. Bivariate correlation was used to determine the relationship between knowledge attitudes and practices.

Results: Two hundred and fifty -two doctors completed the survey. There were 105 (42%) resident doctors who participated in the study. Good knowledge and fair knowledge of AMR were shown by 95(41%) and 146(58%) doctors, respectively. There were few respondents with good attitudes and practices: 40 (16%) and 16 (6%), respectively. A large proportion of respondents had fair attitudes and practices -204(81%) and 185(73%) respectively. The relationship between practice, knowledge, and attitude was negligible. (r<1, p>0.05).

Conclusion: Most doctors in this study showed fair to good knowledge, attitudes, and practices regarding AMR. Efforts to reduce the incidence of AMR should leverage the perceptions and behaviours of these healthcare workers.

Background: Knee joint pathologies/injuries are one of the most common musculoskeletal complaints in adults worldwide. The aetiologies of knee joint disorders are diverse. Magnetic resonance imaging (MRI) is a sophisticated method of detecting and characterizing knee pathologies. This study was conducted to document the clinical presentation and MRI patterns of knee joint abnormalities in a group of adults in Lagos, Nigeria, and to juxtapose it with reports from other climes.

Methodology: A retrospective hospital-based analysis of the knee MRI of 158 adult Nigerians was conducted in a single health facility. The clinical history and knee MRI findings were extracted, analyzed, and documented. Statistical significance was established at P≤0.05.

Results: There were 158 participants comprising 92 males (58.2%) and 66 females (41.8%) between the ages of 18 and 79. The mean age of the males was 44.75 ± 14.41 years, while that of the females was 47.76 ± 13.72 years (P = 0.19). A history of previous trauma was elicited in 135 (85.4%) participants. Eighty-two right knees (51.9%) and 76 left knees (48.1%) were examined. The dominant joint pathologies detected include effusion (77.2%), medial meniscopathy (48.1%), tibial abnormalities (46.2%), femoral abnormalities (46.2%), patella abnormalities (46.2%), anterior cruciate ligament disorders (37.3%), lateral meniscopathy (27.2%), medial collateral ligament disorders (22.2%), and popliteal (Baker's) cysts (15.8%). ACL abnormalities were significantly more prevalent in male subjects. Knees with ruptured sACL had significantly more joint effusion and injuries to the medial meniscus, lateral meniscus, posterior cruciate ligament (PCL), medial retinacular ligament (MRL), femur, tibia, and fibula. There was no significant difference in the frequency of abnormalities between the right and left knees.

Conclusion: Joint effusion, medial meniscopathy, osseous abnormalities (tibia, femur, patella), ACL abnormalities, lateral meniscopathy, and MCL abnormalities, in decreasing order, were the most frequent pathologies in the knee joints evaluated.

Background: Obesity and vascular ageing are two facets of type 2 diabetes (T2Ds) to study. The former can be studied by qualitative body fat analysis using bio-electrical impedance (BIA) and later with blood pressure by pulse wave analysis (PWA). We studied the association between BIA and PWA parameters in T2Ds.

Methodology: One hundred and fifty-six T2Ds on treatment were evaluated for BIA (Omron Karada Scan, China) and PWA (IEM, Stolberg, Germany). BIA parameters (weight, BMI, total body fat, visceral fat, subcutaneous fat, skeletal muscle mass) and PWA parameters (arterial stiffness, brachial haemodynamics, aortic blood pressures, central haemodynamics) were studied. Comparison, correlation, risk association, and predictions were done with a p-value < 0.05 as statistically significant.

Results: The mean age was 57.7 years, while the mean BMI was 22.8 kg/m2. The prevalence of hypertension was 50%, while the prevalence of glycaemic control was 10%. The correlation between BIA and PWA parameters in >75% instants was weak and insignificant (especially for aortic parameters and central haemodynamics). Female gender, BMI < 22.5 kg/m2, VF< 10, and low/normal TBF were associated with comparatively high PWA parameters, but inconsistently. High BMI or VF did not impose a significant Odds risk of high aortic pulse wave velocity or central pulse pressure. Visceral fat and aortic pulse wave velocities were not significantly predicted by blood pressure, BMI, and heart rate.

Conclusion: Among rural type 2 diabetics with a mean BMI of 22.8 kg/m2 and poor glycaemic control, there is largely a lack of association between obesity and vascular aging, suggesting differences in time course and pathology of the two entities in type 2 diabetics. Further studies are recommended.

Background: The prevalence and usefulness of MetS in determining CVD risk in at-risk populations are influenced by its definition. In a cohort of HIV-positive Nigerians, we evaluated MetS based on various defining criteria, their agreement with one another, and their association to a CVD endpoint, Carotid-Intimal-Media-Thickness (CIMT).

Methodology: In this cross-sectional study, 145 HIV-positive individuals who were enrolled in HIV clinics at the Faith Alive Foundation and Jos University Teaching Hospital in Jos, Nigeria, were randomly chosen. Biophysical and anthropometric measurements including blood pressure, height, weight, waist circumference, and hip-circumference, as well as clinical records, CIMT, fasting plasma glucose, and lipid profile, were assessed.

Result: The median (Interquartile range) age of the participants was 41 (35-88) years, and the majority (71.7%) were females. The prevalence of metabolic syndrome (MetS) by the Adult Treatment Panel-III (ATP), International Diabetes Federation (IDF), and Joint Interim Statement (JIS) criteria were 30.3%, 32.4%, and 35.2% respectively. MetS by all criteria was more prevalent among females and participants ≥ 40 years, p<0.05. Low HDLc (93.6-95.5%), Central obesity (86.3-95.5%), and hypertension (80.9-86.4%) were the most frequent components of MetS. HIV-related parameters were not associated with MetS. The overall agreement among MetS criteria was almost perfect between IDF and JIS criteria (k=0.94); and strong between IDF vs., ATP (k=0.82) and ATP vs. JIS (k=0.89). There was no significant difference in the median CIMT in PLHIV with and without MetS across all defining criteria.

Conclusion: The prevalence of MetS in PLHIV is relatively high, particularly among females and older individuals. The correlations between the defining criteria were fairly strong and consistent across subpopulations of PLHIV. MetS based on these criteria, however, do not significantly correlate with rising CIMT.

Background: The burden of food-borne diseases is becoming a global problem. The aim of this study was to assess and compare personal hygiene knowledge among street food vendors and canteen food handlers in the Kano metropolis.

Methodology: An explanatory sequential mixed methods study was carried out using a structured interviewer-administered questionnaire, focus group discussion guide and observation checklist, to assess and compare personal hygiene knowledge among street food vendors and canteen food handlers in Kano metropolis, Nigeria. Quantitative data was analyzed at univariate, bivariate and multivariate levels using SPSS version 20.0 at a 5% α level of significance. Thematic analysis was used to analyze verbatim transcripts from qualitative interviews.

Results: The response rates were 305/310 (98.4%) and 288/310 (92.9%) among street food vendors and canteen food handlers, respectively. The proportions of street food vendors and canteen food handlers with poor, fair and good knowledge of personal hygiene were (29.5% versus 19.8%), (51.8% versus 54.2%) and (18.7% versus 26.0%), respectively (p=0.009). There was a statistically significant association between education and knowledge of personal hygiene among street food vendors (p=0.03) and canteen food handlers (p=0.04). Though slightly better among canteen food handlers, narratives by the two groups of food handlers pointed to the general lack of awareness of basic personal hygiene which was supported by the findings from observation.

Conclusion: Personal hygiene knowledge was poor among the two groups of food handlers; therefore, the Government should ensure legislation and enforcement involving training of food vendors, periodic medical examination, and issuance of fitness certificate to all food vendors.

Background: Low back pain (LBP) is the 5th leading cause of physician consultation and is a significant cause of lost workforce hours with tremendous economic implications in every society. These findings suggest that medical practice in Nigeria is a potential risk factor for developing low back pain. Few studies have attempted to evaluate the medical specialties as risk factors for LBP. This study evaluates the prevalence of low back pain among various Specialist Medical Consultants in a typical Teaching Hospital.

Methodology: This is a descriptive cross-sectional study performed using self-administered questionnaires. The study population comprised Specialist Medical Consultants working at the University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State. The questionnaires were distributed among consultant physicians regardless of their departments. Information about their age, sex, medical specialties, presence frequency and severity of LBP; interventions received, and outcome were obtained.

Result: There were 98 respondents, 56 (57%) males and 42 (43%) females who participated in the study. The modal age of the respondents is the 41-50 years age group (45%). 44%, were from the surgical specialties (surgery, anaesthesia, oral and maxillofacial surgery, ophthalmology); 33% from the internal and family medicine specialties; (11) 11% pediatricians and (12) 12.2 % were pathologists. The prevalence of low back pain was 60.2%, slightly more prevalent in males (62%) than females (58%). Of those who have experienced low back pain, 35.6% suffered mild pain (VAS 1-4), 49% suffered moderate pain (VAS 5-7) while 17% suffered severe pain (VAS 8-10). The majority (57.6%) had suffered more than 3 episodes of LBP while 84.8% sought treatment for their symptom mostly using NSAIDS.

Conclusion: LBP has a high prevalence among Specialist Medical Consultants in UPTH potentially affecting patient treatment and student education. Most consultants take NSAIDS as treatment for low back pain.

This is a report of a 29-year-old female with a history of Schizophrenia and Cannabis Use Disorder who presented with auditory hallucinations that asked her to kill her immediate supervisor. She presented the ethical dilemma many healthcare providers face in balancing the principles of patient confidentiality with the duty to protect and beneficence. The clinicians breached the patient's right to confidentiality to protect her supervisor by informing the supervisor, their manager, and the police. However, they also ensured her job security, which she risked in an environment where mental illness is highly stigmatized. This case highlights the importance of considering the ethical principles of disclosing confidential information, such as the Tarasoff I and II, and beneficence (as her job was protected) in making clinical decisions. It also summarizes the legal precedents established by the Tarasoff cases and the implications for clinical practice.

Climate change has become a global issue and affects various regions at different levels. The hydro-climatic conditions and the natural fragility of Sub-Saharan Africa (SSA) make it prone to floods. The review was intended to comprehensively explore the determinants of floods in the continent and their effects on public health. An extensive systematic literature search in English was conducted for peer-reviewed papers, abstracts and internet articles, grey literature, and official Government documents and analysed to identify common themes, findings, and outcomes. Finally, the findings were categorized into common themes. The review revealed that the frequency and intensity of precipitations have increased in recent decades in SSA. This is worsened by anthropogenic activities including urban sprawl, population growth, and land use changes. The health effects of floods are diverse, varied, and specific to a particular context which can be immediate and long-term. The economic losses due to the flood events in the continent are huge. In conclusion, Governments across the continent need to give flood management a top priority as part of national disaster preparedness, response, and mitigation. Floods cannot be managed in isolation; it has to be incorporated into national urban planning with urbanization to make cities resilient and sustainable.

Background: Domestic violence (DV) occurs in all settings, transcending socio-cultural and demographic profiles. It is pervasive, insidious, carried out in private domain, and usually inflicted by family members. It continues over long period and limits avenues of escape for victims. The aim of this study was to assess the perception and experience of DV among rural women in Sabon Gari LGA of Kaduna State, Nigeria.

Methodology: A cross-sectional descriptive study conducted in Tohu community, Sabon Gari LGA, Kaduna State. Sample size of 365 was determined using Fisher's formula, at p-value, reliability coefficient, confidence interval, degree of freedom, and possible attrition rate of 0.5, 1.96, 95%, 0.05, and 16% respectively. The study population comprised all women of reproductive age group in Tohu. Eligible respondents who had been in the community for at least one year were included in the study, while those who were ill were excluded. A semi-structured, interviewer-administered questionnaire was administered by female research assistants, and data collected was analyzed using SPSS version 21.0. Frequencies and percentages were reported for categorical data. Respondents' perception of DV was assessed using 19 questions across 5domains. Composite score of 0-19 was expected for each respondent. Scores of >10, and <10 were considered to be good, and poor perception of DV respectively. Relationships between variables were determined using appropriate test statistics at p-value <0.05.

Results: Fifty-three percent of respondents have good perception of DV, with age, marital status, and occupation affecting respondents' perception. Seventeen percent of respondents had experienced physical and/or verbal abuse. Marital status and level of education were found to affect respondents' experience of DV.

Conclusion: DV is still rife in rural parts of Nigeria. Civil rights groups should intensify efforts toward awareness creation so that victims can report to the appropriate authorities and the perpetrators prosecuted.