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

Background: Several African countries, including Nigeria, continue to have a high prevalence of cervical cancer due to a lack of knowledge about screening and prevention measures, with diagnosis most usually confirmed when the prognosis is poorest. This study evaluated the Pap smear pattern and the level of cervical cancer awareness among females of reproductive age in Ondo Town, Nigeria.

Methodology: This cross-sectional study included 102 female participants aged 30 to 54. The stained smears were analyzed and reported using the Bethesda reporting system. A semi-structured questionnaire was used to obtain information from participants, and the data obtained was statistically analysed using ANOVA for variable comparison across groups, with a confidence interval of 95% considered statistically significant and a p-value of less than 0.05 reported.

Results: Findings revealed that 90.2% of the evaluated smears were negative for squamous intraepithelial lesions and malignancy, while low-grade squamous intraepithelial lesions were detected in 7.84% of cases, and reactive cellular changes accounted for 1.96% of the studied population. Additionally, there was a considerable level of awareness regarding cervical cancer (72.5%) and cervical cancer screening (54.9%); however, only 45.1% of the women had ever undergone a Papanicolaou smear, and an even smaller proportion (19.6%) reported routine screening. The low uptake of cervical cancer screening as a routine test may be attributed to the absence of effective, widespread, or systematic cervical cancer screening programs in Ondo town.

Conclusion: There is a significant relationship between age, risk exposure, and development of cervical lesions among participants in this study. Awareness and lifestyle factors are also key determinants of cervical lesion development and the uptake of cervical cancer screening. Although participants demonstrated awareness of cervical cancer, their knowledge of its preventive measures remained limited. It is recommended that health education campaigns be expanded to enhance the uptake of screening services.

Background: Typhoid ileal perforation is a life-threatening disease affecting the northwestern Nigeria, with high morbidity and mortality, especially in those with multiple poor prognostic factors. The popular surgical approaches are primary closure of the perforation and ileostomy. It is debatable which approach has better outcomes in our environment. This study compared outcomes of the use of ileostomy to primary closure in patients with two or more poor prognostic factors, assessing 30-day mortality, surgical site infection (SSI), and time to oral intake.

Methodology: The study was conducted at Aminu Kano Teaching Hospital, Nigeria over one year, involving 56 patients randomized into two groups: Group A (ileostomy, n=28) and Group B (primary closure, n=28). Exclusions included moribund patients, non-typhoid ileal perforations, and decompensated systemic diseases. Postoperative complications, mortality, and recovery parameters were analyzed using SPSS version 25, with statistical significance set at p<0.05.

Results: Results showed that 64% of patients were aged 12-20 years. SSI was high in both groups (71.9% ileostomy, 82.1% primary closure). Major complications like burst abdomen (32%) and fecal fistula (32%) occurred only in the primary closure group. Patients with ileostomy resumed oral intake earlier (2.30±0.61 days vs. 3.71±0.76 days). Overall mortality was 14.3%, with higher deaths in the primary closure group (21.4% vs. 7.1% in ileostomy).

Conclusion: While SSI and mortality were more frequent in the primary closure group, the difference was not statistically significant. However, ileostomy demonstrated advantages, including fewer severe complications and faster recovery of enteral feeding. The study suggests that individualized surgical approaches, considering patient risk factors, may improve outcomes in typhoid ileal perforation cases. Ileostomy may be preferable in high-risk patients due to its lower complication rates and quicker postoperative recovery.

Background: Obesity and cancer increase thrombosis risk. IL-6 and TNF-α, are key inflammatory cytokines, which may contribute to hypercoagulability in newly diagnosed, chemotherapy-naïve obese cancer patients, warranting further investigation. This study aimed to investigate the serum levels of these inflammatory biomarkers and risk of VTE in chemotherapy naïve obese cancer patients (CNOCPs).

Methodology: The study was cross-sectional analytical in design. The participants consisted of newly diagnosed patients with solid malignancies recruited from adult oncology clinics of a Nigerian tertiary hospital. They were grouped into two: case group (n = 37) consisting of chemotherapy naïve OCPs and control group (n = 63) consisting of chemotherapy naïve non-OCPs Patients were risk assessed using the Khorana scoring system. All the patients' serum samples were assayed by ELISA technique for IL-6 and TNF-α. History of VTE was obtained from the patients' case notes and by direct interviews with the patients.

Results: The mean age of the participants was 48.44±13.4 (range = 20 - 76) years, and the mean BMI was 26.80±6.3Kg/m². The mean levels of IL-6 and TNF-α were significantly higher in chemotherapy naïve OCPs than the controls (7.9 ± 1.2 vs. 6.5 ±1.2, p < 0.001 and 5.2 ± 2.3 vs. 4.1 ± 1.9, p = 0.012 respectively. Also, chemotherapy naïve OCPs had a three-fold higher risk of VTE than the controls (OR: 3.0; 95% CI: 1.1-7.5; p= 0.03).

Conclusion: The inflammatory biomarkers were significantly higher in chemotherapy naïve OCPs than the non-obese controls. Additionally, they are at higher risk of VTE. These findings could strengthen clinicians' disposition for prompt initiation of thromboprophylaxis in OCPs.

Background: Left Ventricular Hypertrophy (LVH) is a key component of hypertensive heart disease. The prevalence of hypertensive LVH ranges from 19% to 48 % in untreated hypertensive patients amongst the Western population but is 46% to 63% in Nigeria. The study aims to highlight the prevalence of LVH and to determine the pattern of LV geometry and the LVH phenotype in newly diagnosed hypertensive patients.

Methodology: The study was cross-sectional, and observational between June 2019 and June 2021. The study population comprised 300 newly diagnosed hypertensive adult patients aged 18 years and above, and 300 Healthy age, sex-matched non-hypertensive adults as control groups. An echocardiography was performed and the diagnostic criteria for LVH, LV Geometry and LVH phenotype were used based on the American Society of Echocardiography and the European Association of Cardiovascular Imaging.

Results: The total number of study participants was 600, three hundred newly diagnosed hypertensive patients and three hundred normotensive controls. The male participants comprised 180 (60%) of the newly diagnosed hypertensive cases and 120 (40%) of the normotensive controls, while the female participants accounted for 168 (56%) of the hypertensive group and 132 (44%) of the control group, respectively. Overall, 59% of newly diagnosed hypertensive patients had LVH. Concentric LVH was the commonest LV geometry with a prevalence of 37% among newly diagnosed hypertensive patients. Fifty-five point four per cent (55.4%) of newly diagnosed hypertensive patients had concentric non-dilated hypertrophy.

Conclusion: LVH is highly prevalent and occurs in more than half of newly diagnosed hypertensive patients. The commonest LV geometry is concentric hypertrophy, and the LVH phenotype of concentric non-dilated Hypertrophy accounts for more than half of LVH.

Background: Hyperglycaemia in pregnancy (HIP) represents one of the most common medical challenges in pregnancy and the leading cause of adverse pregnancy outcomes the world over. Normal pregnancy is characterized by physiological adaptations such as progressive gestation-dependent increases in maternal triglycerides and total cholesterol which could be affected by insulin resistance, a common denominator affecting glucose and lipid metabolism. The study aimed to compare the patterns among pregnant women with HIP and those without HIP and determine the correlates of dyslipidaemia in pregnant women with HIP.

Methodology: This was a descriptive cross-sectional study. A total of 204 participants were recruited, made up of 65 women with HIP (cases) and 139 normoglycaemic women (controls). The data collected included demographics, anthropometric measurements, and medical history. Lipid profile assays were done using Roche Cobass C111 automated analyser (sdLDL was isolated using the Hirano method prior to analysis).

Results: The prevalence of HIP was found to be 31.7% among the study population. Dyslipidemia defined by LDL, TG, TC, HDL, and sdLDL was seen in 60%, 38.5%, 22.5%, 19%, and 30% respectively. Women with HIP had a slightly higher risk of dyslipidemia than normoglycaemic women. Overall, the difference in dyslipidemia between HIP and normoglcaemic women was not statistically significant.

Conclusion: Dyslipidemia in pregnancy is a relatively common finding in the Nigerian population. However, the pattern of dyslipidemia in normoglycaemic pregnant women is largely similar to the pattern seen in women with hyperglycaemia in pregnancy in the Nigerian population.

Coarctation of the aorta is an obstructive form of congenital heart defects that presents with upper limb hypertension. If untreated, Coarctation of the aorta can lead to left ventricular dysfunction and cerebral vasculopathy. Missed diagnosis due to its subtle presentation is common with attendant complications. This is a case report of an apparently healthy 3-year-old boy who lapsed into a coma after a trivial fall. He had upper limb hypertension and the pulses in the lower limbs were barely palpable. Brain computed tomography (CT) revealed non-traumatic haemorrhagic stroke and echocardiography showed severe left ventricular hypertrophy and severe coarctation of the aorta. Coarctation of the aorta can manifest as chronic upper limb hypertension in children with complicated non-traumatic haemorrhagic stroke. Routine blood pressure measurement in young children can serve as a screening tool for early diagnosis of the condition.

Background: Accurate prediction of stroke outcomes in resource-limited settings remains challenging. This study assessed the utility of neuroimaging findings in predicting mortality among acute ischaemic stroke patients at the University of Maiduguri Teaching Hospital, Nigeria.

Methodology: This prospective study enrolled 171 consecutive adults with acute ischaemic stroke between January and December 2023. All patients underwent non-contrast brain CT scanning, with infarct volume calculated using standardized measurements. The primary outcome was 30-day mortality. Multivariate logistic regression analysis identified independent predictors of mortality, which were used to develop a risk stratification system.

Results: Large infarct volume (>100,000 mm³) emerged as the strongest independent predictor of mortality (aOR 6.82, 95% CI 2.0522.68, p=0.002), followed by multiple territory involvement (aOR 3.42, 95% CI 1.43-8.17, p=0.006). The developed risk score demonstrated good discriminative ability (AUC 0.775, 95% CI 0.689-0.860) and stratified patients into three risk categories with mortality rates of 8.2% (low), 11.8% (intermediate), and 42.0% (high) (p<0.001).

Conclusion: Specific neuroimaging parameters can effectively predict early mortality in acute ischaemic stroke. The developed risk stratification tool could improve patient care in resource-limited settings.

Background: Graves' disease has a familial predisposition with about 15% of the patients having a close relative with the same disorder, while about 50% of the relatives of patients with Graves' have circulating thyroid autoantibodies. This study determined and compared the prevalence of thyroid dysfunction, and autoimmunity among healthy individuals, and first-degree relatives of patients with Graves' disease at Aminu Kano Teaching Hospital (AKTH), Kano.

Methodology: A cross-sectional descriptive study design was used to study 87 first degree relatives of patients with Graves' disease comprising of 5.7% fathers, 3.4% mothers, 29.9% brothers, 29.9% sisters, 16.1% sons, and 14.9% daughters; as well as 87 age and gender-matched controls selected using a systematic sampling technique. A pretested interviewer-administered questionnaire was administered to the eligible study participants. Anthropometric and clinical parameters were measured, and blood samples were assessed for TSH, fT3, fT4, anti-TPO, and anti-Tg antibodies. Data was analysed using SPSS version 22 for Windows with an α value of ≤0.05.

Results: The mean ±SD age of the study subjects and controls were 29.4±9.0 years, and 31.6±8.8 years respectively. About half 45 (51.7%) of the respondents were males among the study subjects and controls respectively. Up to 12.6% of study subjects had raised thyroid stimulating hormone (TSH). Overt hypothyroidism was observed among 5.7% of study subjects and none among the controls. Anti-thyroid peroxidase (anti-TPO) antibodies were positive among 4.6% of the study subjects while 1.1% of controls had positive anti-TPO antibodies. Anti-thyroglobulin antibody (anti-Tg) positivity was found among 23.0% of study subjects, while 9.2% of controls had positive anti-Tg antibodies.

Conclusion: Primary Hypothyroidism was the predominant thyroid dysfunction found amongst the relatives of patients with Graves' disease. The government and relevant stakeholders should develop a model that will mandate screening and follow-up amongst the first-degree relatives of patients with Graves' disease.

Background: Mucormycosis, an invasive fungal infection caused by Mucorales, has emerged as a significant concern in COVID-19 patients, particularly in regions heavily affected by the pandemic. Liposomal Amphotericin B is the primary treatment modality for mucormycosis; however, data on its efficacy and safety in COVID-19-associated mucormycosis are limited. This prospective observational study aimed to evaluate the management of mucormycosis in COVID-19 and post-COVID patients treated with Liposomal Amphotericin B at a dedicated COVID-19 hospital in IGIMS, Patna from Eastern India. Primary objectives were the study of liposomal amphotericin for the initial treatment of mucormycosis and treatment outcomes. The secondary objective was to study various complications of Liposomal Amphotericin B therapy.

Methodology: In total, 121 adult patients diagnosed with mucormycosis and either active COVID-19 infection or in the post-COVID recovery phase were included in the study. The treatment outcomes, complications, and factors influencing patient prognosis were assessed. Data analysis was performed using SPSS statistical software, including logistic regression and Cox Proportional Hazards modelling.

Results: Most patients achieved resolution of mucormycosis infection (70.2%), but the mortality rate was notable at 24.8%. Adverse events including nephrotoxicity (20.7%), infusion-related reactions (12.4%), and electrolyte imbalances (33.1%) were prevalent. Logistic regression analysis identified that older age (p = 0.002), diabetes (p = 0.01), delayed treatment initiation (p = 0.001), higher doses of Amphotericin B (p = 0.04), and pre-existing renal impairment (p = 0.01) were significant predictors of treatment outcomes. Cox Proportional Hazards modelling showed a trend towards improved outcomes with longer treatment duration (p = 0.06).

Conclusion: This study provides added information into the management of mucormycosis in COVID-19 patients treated with Liposomal Amphotericin B. Despite achieving a relatively high-resolution rate, the significant mortality and complication rates underscore the challenges in managing this fungal infection.

Background: Type 2 cardiorenal syndrome (Type 2 CRS) describes a relationship in which chronic congestive heart failure causes a progressive and permanent chronic kidney disease. Heart failure (HF) and chronic kidney disease (CKD) share similar cardiovascular risk factors and have a bi-directional relationship. A comprehensive approach including early screening of HF patients for CKD as well as management involving the nephrologist and cardiologist will most definitely reduce morbidity and mortality. The aim of this study was to determine the prevalence of and correlates for Type 2 CRS among HF patients in JUTH, Jos-Nigeria.

Methodology: A hospital-based cross-sectional descriptive study carried out in JUTH involving 120 patients with chronic HF recruited consecutively. History, physical examination and laboratory investigations including urinalysis using albustix were performed on all subjects. CKD was determined using estimated glomerular function rate (eGFR) and persistent albuminuria. The data were analyzed using Epi Info (CDC, Atlanta GA) and p-values <0.05 were considered statistically significant.

Results: The mean age of the participants was 52.00 ± 11.44 years, majority of whom were females consisting of 58.3%. The prevalence of CRS was 37.5%. Majoity (66.7%) of the patients had mild CRS, while 26.7% had moderate CRS, and only 6.7% had the severe CRS. The predictors of CRS were diabetes (OR=6.230; CI=2.094-19.093), New York heart Association (NYHA) grading I (OR=0.017; CI=0.002-0.142) and II (OR=0.089; CI=0.016-0.483), raised jugular venous pressure (JVP) (OR=7.099; CI=2.671-18.865), loud pulmonary component of the second heart sound (P2) (OR=3.769; CI=1.726-8.232), systolic dysfunction (EF<45%) (OR=3.316; CI=1.487-7.395), anaemia (OR=5.091; CI=1.657-15.640), albuminuria (OR:0.014, CI=0.004-0.052), rural/suburban dwelling (OR=2.875; CI=1.335-6.192) and increased cardiothoracic ratio (CTR) (OR=3.237; CI=1.019-10.278).

Conclusion: The frequency of Type 2 CRS among CHF patients in JUTH was high. The predictors of chronic CRS include diabetes mellitus, NYHA grade, raised JVP, loud P2, systolic dysfunction, anaemia, albuminuria, rural/suburban dwelling and increased CTR. These findings highlight the urgent need to incorporate screening for CKD among stable heart failure patients at regular intervals, and early referral to the nephrologist to prevent further deterioration to ESRD.