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

Background: India's aim to achieve tuberculosis (TB) eradication by 2025 necessitates the engagement of all stakeholders, encompassing both private and public sectors, across all phases of the TB program - spanning from diagnosis to the curative outcome. However, certain private practitioners pursue an individualized approach instead of adopting a collective strategy, thereby contributing to the emergence of multidrug-resistant tuberculosis. Consequently, in order to formulate an enhanced strategy that fosters improved collaboration and professional behavioral change among all partners, it is imperative to comprehensively assess their level of knowledge. This study aims to assess the knowledge level of private practitioners with regard to the diagnosis and management of pulmonary tuberculosis cases within the framework of the Revised National Tuberculosis Control Program (RNTCP).

Methodology: A descriptive cross-sectional study was conducted among 78 selected private practitioners located in seven towns within the Sonepat district of Haryana State, India. The study was approved by the ethics committee of Bhagat Phool Singh Government Medical College for Women, Sonepat, Haryana. Data collection involved the utilization of a self-administered, pre-tested, semi-structured questionnaire. Descriptive analysis was applied, utilizing proportions and percentages.

Results: The collective understanding of private practitioners concerning Tuberculosis and RNTCP was found to be deficient. Around one-third of the practitioners reported that they had not received any visits from health workers in relation to RNTCP. A mere 33% of the practitioners had attended any Continuing Medical Education (CME) sessions, and only a quarter of the participants expressed an intention to collaborate with the RNTCP program.

Conclusions: In conclusion, this study underscores the necessity for RNTCP to focus on fostering the willingness of private practitioners to engage with the program, while simultaneously enhancing their knowledge about Tuberculosis and RNTCP.

Background: Diabetes Mellitus (DM) is a chronic Non-Communicable Disease (NCD) with rising prevalence worldwide. DM increases the risk for depression as the prevalence of depression has been reported to be three times more in diabetics than in non-diabetics. Though depressive symptoms are more common in diabetes, they are not usually recognized and treated. Little is known about the predictors of depression in this group of people, especially among the Nigerian population. This study explored the sociodemographic factors associated with depression in patients with type 2 DM without prior psychiatric history.

Methodology: This was a cross-sectional study conducted among two hundred and sixty-four patients using structured questionnaires. Data were analyzed using the Statistical Package for Social Sciences version 20. Chi-square tests were performed to compare associations between categorical variables. A probability (p) value less than 0.05 was taken as statistically significant.

Results: Females [176 (66%)] were three times more than males [88 (33.3%)] respectively. The prevalence of depression was 49.2%. Level of education (p= 0.008), occupation (p= 0.014), and social class (p= 0.040) were significantly associated with depression among the respondents. Depression was higher among the older age group, females, and the widowed.

Conclusion: Females and older adults were more affected by depression. The predictors of depression were level of education, occupation, and social class. Thus, there is a need to screen those who have been diagnosed with T2DM for depression, especially females and older adult patients.

Background: Low back pain (LBP) is a common musculoskeletal disorder, that significantly impedes productivity. This study aims to ascertain the risk factors responsible for developing low back pain and the impact on personal workplace service delivery among Anesthetist's practicing in Rivers and Bayelsa States of Nigeria.

Methodology: A cross-sectional survey was conducted, A self-administered questionnaire reflecting the modified Oswestry Disability Index (ODI) was used to detect the risk factors and assess the severity and impact of low back pain on this group of professionals. The prevalence of low back pain was calculated and described by using frequency tables. A multivariate logistic regression model was fitted to identify factors associated with the prevalence of low back pain. Significance was considered at p<0.05 with a 95% confidence interval.

Results: A total of 65 anesthetist's responded, giving a response rate of 90%. There were more males (52.3%) than females (47.7%). The majority (69.2%) of those who responded had low back pain, more in females (53.3%) compared to males (46.7%) although not significant. (P=0.994); Majority had moderate pain 58.6%, 22.7% severe and 20.5% mild pain. There was no association between low back pain and age (P=0.130), gender(P=0.994), marital status (P=0.333) and BMI (P=0.164). Bending (P=0.032), lifting (P=0.024), and standing(P=0.016) were predictive variables for low back pain and were statistically significant P<0.05.

Conclusion: Using the Oswestry pain assessment tool for LBP, the estimated prevalence of low back pain was more than fifty percent among the respondents. In this study, frequent bending and twisting, prolonged standing, and lifting were important significant associated factors in the development of LBP among anesthetist's.

Background: Being a frequently used approach by otorhinolaryngologists, Endoscopic sinus surgery (ESS) has been useful in the surgical management of different sinonasal conditions in this era. Although ESS is most commonly performed for inflammatory and infectious sinus diseases since its introduction in the 1960s by Prof. Messserklinger and Wigand, the current advancement in instrumentation has led to an increase in its indications. This study therefore aimed at auditing the ESS done at a tertiary hospital in our settings.

Methodology: This was a retrospective descriptive cross-sectional study which was conducted at Muhimbili National Hospital. It involved all patients who underwent ESS in the department of otorhinolaryngology. Information was extracted from patients' files, ledger, and admission books. The obtained data were analyzed using a statistical package for social sciences (SPSS) version 22. Descriptive statistics were performed to present the frequency distribution of the demographic characteristics, indications for ESS, and mean for the length of hospital stay.

Results: Out of 1261 surgeries done during the study period, 6.7% (84/1261) were endoscopic sinus surgeries. Of patients who underwent ESS, an almost equal proportion of males and females was found and ages ranged from 8 to 71 years with a mean age of 32 .2 ±16 .9 years. The commonest indication for ESS was sinonasal polyposis at 50.0% (42/84) followed by chronic rhinosinusitis at 20.4% (17/84). The majority of patients 52.4% (44/84) had a hospital stay of 1-3 days. The mean length of postoperative hospital stay following ESS in this study was found to be 2.8 days.

Conclusion: Endoscopic sinus surgeries accounted for 6.7% of all surgeries with sinonasal polyposis being the commonest indication and the estimated mean length of postoperative hospital stay being 3 days.

Background: Oligohydramnios is defined as amniotic fluid index (AFI) less than or equal to 5cm. A borderline AFI has been defined as an AFI of 5.1cm to 8cm. The incidence of borderline AFI compared with a normal AFI (8.1cm to 18cm) is 6% to 44% in different studies. A decrease in amniotic fluid leads to serious complications for the mother and fetus. The study objective was to evaluate if an injection of Enoxaparin improves the amount of liquor in oligohydramnios in the third trimester of pregnancy.

Methodology: A randomized controlled trial was conducted at a tertiary care obstetric center, involving a total of 130 participants. Inclusion criteria include participant in 3^rd trimester of pregnancy, singleton pregnancy, intact amniotic membranes, and no known medical disorder. Patients with multiple pregnancies, ruptured amniotic membranes, anomalous fetuses, and known medical disorders were excluded. These participants were divided into two groups, each consisting of 65 participants. Group A received conventional treatment (intravenous fluid, tablet Aspirin, and rest in lateral position), while Group B received an injection of enoxaparin in addition to conventional treatment. AFI measurements were performed in the radiology department by radiologists using standard 4 quadrant measurements, twice weekly after the initiation of the treatment. The weight of the baby noted at birth and admission to neonatal intensive care was noted to assess the health of the neonate. Data was analyzed on SPSS (statistical package for social sciences) version 23.

Results: In group A, the AFI increased after treatment in 47(72.3%) patients, remained static in 6(9.2%) patients, and decreased in 12(18.4%) patients. Whereas in group B, AFI increased in 31(68.8%) patients and decreased in 14(31.3%) patients, p= 0.334.

Conclusion: The findings in the current study did not demonstrate any significant effect of the use of injection enoxaparin in improving borderline oligohydramnios. Further research is needed to apply this research to the general population.

Background: Hepatitis B Virus Hepatitis B Virus (HBV) infection is a global public health problem. It is highly endemic in Nigeria and it is estimated that about 9-12% of the total population of Nigeria are chronic carriers of hepatitis B surface antigen. Epidemiological data on (HBV)infection among pregnant women in Nigeria are very scarce, especially in rural areas. The purpose of this study was to determine the prevalence and potential perinatal transmission among rural pregnant women in Abakaliki Nigeria.

Methodology: A cross-sectional study was conducted among pregnant women accessing antenatal care at the Federal Teaching Hospital, Abakaliki. We consecutively recruited 300 pregnant women attending antenatal consultations. A pretested questionnaire was used to collect socio-demographic data and factors associated with HBV infection. The presence of hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), and human immunodeficiency virus (HIV) were determined using commercial test strips. A chi-square test was used for the analysis.

Results: The mean age was 31.8 (SD6.2) years. All women were married and (23.4%) were farmers while (47.0%) had secondary education. Sixteen women (5.3%) were HBsAg-positive, of whom (6.3%) were positive for HBsAg. The prevalence of HIV infection was (0.3%). Overall, (6.3%) women were co-infected with HIV and HBV. Independent correlates of HBV infection included a history of Jaundice (p = 0.046) history of sexually transmitted infections (p=0.005) and concurrent infection by HIV (p < 0.0001).

Conclusion: The prevalence of HBV infection among pregnant women in Abakaliki was intermediate. The relatively high rate of women positive to both HBsAg and HBeAg suggests that perinatal transmission of HBV might be the prevailing mode of HBV transmission in this area.

Background: Alcohol plays a significant role in road traffic accidents in Ghana. However, little is known about the perspectives of victims who suffer road traffic accidents, RTAs, and the extent to which alcohol use disorder is involved.

Methodology: We conducted a three-month cross-sectional study in a teaching hospital involving 102 patients involved in a road accident and presented to the hospital's emergency. The Alcohol Use Disorder Identification Test, AUDIT, was used to assess for Alcohol Use Disorder, AUD, at a score of 8. In addition, we used open-ended questionnaires to assess their perception of alcohol use and road accidents.

Results: Of the 102 respondents, 75% were males, and 60% were between 15 and 35 years old. About 69% of respondents admitted to using alcohol, while 31%, including a single female, screened positive for alcohol use disorder. A significant majority of about 90% of respondents believed in some myths of alcohol use in Ghana, and a similar percentage were aware of the risks alcohol use posed to road use. Over 30% of respondents, mainly drivers or riders, had used alcohol within 12 hours of the accident. All but three respondents knew alcohol-induced aggression and poor coordination of movements. A similar number of respondents knew alcohol made people cross roads carelessly and were hyperactive or disinhibited.

Conclusion: Alcohol use and alcohol use disorder are significantly high among persons presenting with RTA to the emergency. Knowledge of the deleterious effects of alcohol is high, yet their behavior did not reflect the knowledge. Therefore, a significant reduction in RTA can be achieved by enforcing blood alcohol concentration limits for road users and intensive education to the populace.

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.