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

Background: Mentor mothers (MMs) are women living with HIV who provide peer education, advice, support, and mentorship for HIV-positive women undergoing Prevention of Mother-to-Child Transmission of HIV (PMTCT) during pregnancy and after delivery. This study aimed to explore their experiences and the impact of the work on their psychosocial well-being, as well as the strategies they adopt to cope with the same.

Methodology: We conducted a qualitative study using in-depth interviews among 16 MMs in Taraba State, Nigeria, between September and November 2022.All interviews were recorded using a voice recorder. The collected data were transcribed and translated into English for analysis. Thematic analysis was applied to analyse the data.

Results: The key themes identified from MMs' account of their lived experiences as mothers living with HIV and providing support to other HIV positive (+) women were their fears and distress at diagnosis, disclosure challenges, stigma, and discrimination, the place of good counselling in helping newly diagnosed to accept and adhere to treatment, the ill-feelings evoked from repeated telling of their own stories to new clients, some negative impact on their psychosocial wellbeing, and various strategies to cope with the demands of the program.

Conclusion: The study concluded that there was no serious negative impact on the psychosocial well-being of the MMs from their work. They adopt various strategies, such as religious activities and relaxation with family and friends, to keep this intact. This program should therefore be scaled up with holistic support for the health and well-being of the MMs themselves.

Background: Cancer can have an impact on Quality of Life (QoL), which can be influenced by an individual's culture and value system.

Methodology: The study was a cross-sectional descriptive study involving all women with gynecological malignancies accessing care at Ahmadu Bello University Teaching Hospital, Zaria. The sample size constituted all women diagnosed with any gynecological malignancy who accessed care in Ahmadu Bello University Teaching Hospital within six months from the start of data collection. This period was from October 1st, 2023, to March 31st, 2024. A total of 176 cases were identified. The WHOQOL BREF was used to assess QoL. Scores greater than one standard deviation above the mean were considered good, scores less than one standard deviation below the mean were regarded as poor, while scores that fell between them were deemed fair.

Results: The mean age of respondents was 49.4 ± SD15.0 years. The mean overall quality of life and overall health were 3.18 ± SD 1.1 and 3.10 ± SD 1.1, respectively. The overall quality of life was poor in 19 (26%) of respondents, and only 7 (9.6%) of respondents had a good quality of life. The majority had a fair overall QoL. The overall QoL was significantly affected by the stage of disease (p=0.04) and treatment status (p=0.02).

Conclusions: QoL concerns need to be addressed while offering care for women with gynecological malignancies.

Shoulder Injury Related to Vaccine Administration (SIRVA) is a preventable iatrogenic condition caused by improper injection technique into the deltoid region. It can result in significant pain, inflammation, and impaired function. We report a case of a healthy adult female who developed acute shoulder pain and fatigue within hours of receiving an intramuscular tetanus toxoid vaccine. With no prior history of shoulder pathology, clinical evaluation supported a diagnosis of SIRVA. Conservative treatment with NSAIDs and physical therapy led to partial symptom relief, though some pain persisted a month later. This case highlights the importance of correct vaccination techniques and early recognition of SIRVA to mitigate its impact.

Background: Immuno-suppression in women living with HIV (WLHIV) increases the persistence of high-risk human papillomavirus (HPV) and reduces the ability to clear cervical precancerous lesions; as such, WLHIV are more predisposed to cervical cancer. Widespread use of antiretroviral therapy (ART) among WLHIV enhances immune reconstitution, controlling HIV replication and reversing the weakened immune system. This impedes HPV persistence and the development of precancerous lesions. The immune status of WLHIV is related to their CD4 count and viral load. These factors are impacted by the duration of effective ART. This study aimedto determine the association between cervical precancerous lesions with viral load, CD4 count, and duration on ART among WLHIV.

Methodology: A retrospective study on 1113 WLHIV aged 16 -55 years screened for cervical cancer using visual inspection with acetic acid (VIA) and visual inspection with Lugol's iodine (VILI) within a 16-month period in Faith Alive Hospital, Jos, Nigeria. Sociodemographic characteristics of study participants, CD4 count, viral load, duration on ART, and screening results were documented. The data were analysed using IBM-SPSS 26, and logistic regression was performed to determine factors associated with pre-cancerous lesions.

Results: The prevalence of cervical precancerous lesions was 9.1%, the prevalence of suspected cancer was 1.6% and the mean age of clients with pre-cancerous lesions was 41.32±9.89 years. Unsuppressed baseline viral load (≥1000 copies/ml) and <6 months of exposure to ART were found to be strongly associated with cervical precancerous lesions.

Conclusion: This study demonstrated a higher burden of cervical precancerous lesions in viral unsuppressed women on ART initiation and in women with <6 months of exposure to antiretroviral therapy. Early commencement and prolonged use of ART on WLHIV to ensure early and sustained viral suppression to reduce the risk of cervical cancer is recommended.

Background: Perineal pain following episiotomy repair is a common complaint after vaginal delivery and may be severe, requiring the use of strong analgesics. Diclofenac is a non-steroidal anti-inflammatory drug commonly used for pain relief. This study aimed to compare the effectiveness of rectal versus oral Diclofenac in the management of pain post-episiotomy repair.

Methodology: A prospective double-blind randomized controlled study was carried out involving 132 booked mothers who had episiotomy repair after vaginal delivery at a tertiary hospital in Port Harcourt, Nigeria. They were randomized into two groups and received either rectal diclofenac 100mg and oral placebo 12 hourly (Group A), or oral diclofenac 100mg and rectal placebo 12 hourly (Group B), for 48 hours following the repair. Perineal pain was measured using Visual Analogue Scale (VAS). Both groups were monitored for 48 hours (pain relief assessed at 6, 12, 18, 24, 36 and 48) and the analgesic effectiveness compared. The data obtained was analysed using IBM SPSS version 24. The recruitment spanned from 1st September 2023 to 30th January 2024.

Results: Both groups were similar in their baseline socio-demographic characteristics. The overall mean pain score was significantly lower in the rectal diclofenac group than the oral diclofenac group (4.14±0.42 vs. 4.30±0.44, t=2.01, p=0.048). Majority of the participants in the rectal route expressed more satisfaction (66.7% vs. 37.1%, χ2=23.08, p<0.01). The mean time interval (hours) between drug administration and the first urine void was similar in both groups (3.19±3.13 vs. 3.29±3.11, t=0.29, p=0.74), and there was no difference in the requirement for additional analgesia (12.1% vs. 9.1%, χ2=0.32, p=0.57).

Conclusion: Diclofenac suppository was more effective in management of perineal pain following episiotomy repair and the participants in the rectal route group expressed more satisfaction than their counterparts who received the oral drug.

Background: Non-traumatic coma (NTC) is a common neurological emergency associated with high morbidity and mortality. This study investigates the clinical features and outcomes in children at the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Rivers State.

Methodology: A prospective study was conducted from 2021-2023 involving 406 patients who presented with NTC in the children's emergency ward and were consecutively recruited into the study. Consent was obtained from parents/caregivers. Data on age, sex, and clinical history were collected. The aetiology of NTC was determined based on history, clinical examination, and laboratory investigations. The degree of encephalopathy was assessed at presentation using Glasgow's coma score. All patients were followed up until discharge to evaluate the outcome.

Result: A total of 5120 patients aged 1 month to less than 18 years were admitted, with 406 cases of NTC, indicating a prevalence (406/5120) of 7.9%. Of the 406 patients, 194 (47.8%) were males. Their ages ranged from 3 months to 17 years (mean age, 6.13±5.10 years). The prevalence of NTC was higher among under five years old. Fever (76.1%), convulsions (63.8%), and vomiting (53.2%) were the common complaints presented. Two hundred and forty-one (59.4%) patients presented with mild encephalopathy. The primary causes of NTC were CNS infection in 280 (69.0%), metabolic or toxic causes in 44 (10.8%), and epileptic causes in 27 (6.6%). Seventy-one (17.5%) patients died, while 319 (78.6%) were discharged. Among those discharged, 10.0% had mild disability, 3.4% severe disability, and 1.3% remained in a permanent vegetative state. The outcomes were influenced by sex, level of encephalopathy at presentation, age, and the need for ICU care.

Conclusion: NTC is common in children, CNS infections, particularly cerebral malaria and meningitis, were the predominant causes. Implementing measures to prevent these infections is important in our setting, where resources are limited for adequate management.

Background: Protein-energy malnutrition (PEM) is one of the major risk factors for vitamin A deficiency (VAD), which may be complicated by xerophthalmia. There have been several interventions employed to tackle VAD in our environment. However, there are limited recent local studies assessing the interplay between VAD and the burden of xerophthalmia in under-five children with PEM. The study aims to determine the association between serum vitamin A levels and xerophthalmia among under-five children with PEM.

Methodology: This was a prospective cross-sectional study conducted among 200 children between the ages of 6 to 59 months newly diagnosed with protein-energy malnutrition at the study centre. Data was collected using a structured proforma, which included sociodemographic variables and ocular examination findings. Blood samples were collected to analyse serum vitamin A levels using an ELISA kit (Aviva systems®).

Result: There were 153 (76.5%) children with PEM who had low serum vitamin A levels. Xerophthalmia was found in 12 (6%) children. Xerophthalmia was only seen in those with low serum vitamin A and was statistically significantly higher in children with very low levels of vitamin A (1.5% vs 12.9%, p = 0.002). Blinding forms of xerophthalmia were seen in 3 (1.5%) of the children.

Conclusion: The prevalence of vitamin A deficiency and xerophthalmia is still considerably high and of public health significance among children with PEM in our environment.

Meckel-Gruber Syndrome (MGS) is a rare and lethal autosomal recessive disorder characterized by a triad of occipital encephalocele, polycystic kidneys, and polydactyly. The worldwide incidence varies from 1 in 13,250 to 1 in 140,000 live births, with a 25% reoccurrence rate. Prenatally, diagnosis can be made by ultrasonography for fetal anomalies at 11 to 14 weeks of pregnancy, which can guide management decisions. We report a female baby with the characteristic features of this syndrome, which was confirmed by autopsy findings.

Background: Thyroid dysfunction is a common complication but is less diagnosed most times with pediatric chronic kidney disease (CKD), where impaired renal function disrupts thyroid hormone metabolism. This study is aimed at assessing thyroid function specifically FT4, FT3, and TSH in pediatric CKD patients, while exploring variations by age and sex.

Methodology: In a cross-sectional design, 150 children within the ages of 1-18 years with CKD stages 2-5 or on renal replacement therapy were examined using standardized immunoassays and eGFR determined via the Schwartz formula.

Results: The results showed a 25% prevalence of hypothyroidism, with females exhibiting higher dysfunction rates than males. With age, FT4 and FT3 levels increased from infancy to adolescence, while TSH decreased, reflecting a maturing hypothalamic-pituitary-thyroid axis. Significantly, strong positive correlations were observed between eGFR and both FT3 (r = 0.78) and FT4 (r = 0.76), whereas TSH showed no notable relationship with kidney function.

Conclusion: These findings suggest that thyroid dysfunction in pediatric CKD is primarily caused by decreasing FT3 and FT4 levels. Early, tailored thyroid screening is recommended to improve growth, neurodevelopment, and overall outcomes in this vulnerable population.