West African Journal Of Medicine[JOURNAL]
Sun
200 papers
Pulmonary Aspergillosis Complicated by Recurrent Pneumothorax in a Healthy Nigerian Adolescent at Cedar Crest Hospital, Abuja - A Diagnostic Conundrum (Case Report).
Oyedeji OA, Alabi VO, Onoh EA … +3 more , Agboola AS, Princewill-Nwajiobi PI, Alioke II
West Afr J Med · 2025 Jan · PMID 40548510
Pulmonary Aspergillosis and recurrent pneumothorax are rare paediatrics conditions posing a diagnostic difficulty when presenting together in a patient. We report the case of a male Nigerian adolescent presenting with fe...
Pulmonary Aspergillosis and recurrent pneumothorax are rare paediatrics conditions posing a diagnostic difficulty when presenting together in a patient. We report the case of a male Nigerian adolescent presenting with features of community acquired pneumonia (CAP) and recurrent pneumothoraces. He had several courses of empirical antibiotics indicated for CAP with partial evidence of improvement and underwater seal drainage chest tube, for the pneumothorax severally. The pneumothorax resolved after each course of antibiotics but re-occurred after removal of closed tube thoracotomy drainage (CTTD). A galactomannan antigen test done, after six weeks of admission was positive for Aspergillus. Administration of Voriconazole, was associated with resolution of the lung opacities and recurrent pneumothorax. The diagnostic conundrum is discussed with a view to increase disease awareness among physicians working in similar resource limited setting and improve similar case management.
A Short Review of Migraine headaches in Nigeria: Epidemiology, Current Challenges, Treatment Approaches, and Future Directions for Improved Management.
Osonuga A, Osonuga AA, Okoye GC … +4 more , Osonuga OA, DaCoasta A, Osonuga AC, DaCosta D
West Afr J Med · 2025 Jan · PMID 40548491
BACKGROUND AND OBJECTIVE: Migraine, a leading cause of global disability, disproportionately burdens low-resource countries like Nigeria, where healthcare inequities, cultural stigma, and infrastructural gaps hinder effe...
BACKGROUND AND OBJECTIVE: Migraine, a leading cause of global disability, disproportionately burdens low-resource countries like Nigeria, where healthcare inequities, cultural stigma, and infrastructural gaps hinder effective management. Despite global advances in migraine therapeutics, Nigeria's burden remains understudied, with fragmented data on epidemiology, treatment access, and outcomes. METHODS: We conducted a narrative review of the literature on migraines in Nigeria using sources such as PubMed, MEDLINE, African Journals Online (AJOL), and Embase. This review synthesizes a broad range of peer-reviewed articles, regional reports, and gray literature to provide an interpretative overview of the topic. RESULTS: Available evidence suggests that migraine prevalence in Nigeria is estimated at 15-20%, with urban areas reporting rates as high as 26% and a pronounced gender disparity (3:1 female-to-male ratio). Rural regions experience significant underreporting, often attributed to cultural interpretations of migraine symptoms as spiritual phenomena. Most patients rely on over-the-counter analgesics, with 30% developing medication-overuse headaches. Advanced therapies such as triptans and CGRP inhibitors are largely inaccessible due to prohibitive costs. CONCLUSION: Nigeria's approach to migraine care lags significantly behind global standards, underscoring the need for context-specific innovations. Priority areas include the expansion of telemedicine to overcome specialist shortages, incentives for local medication production, and the integration of traditional healers into formal referral networks. Policy reforms and collaborative efforts among stakeholders are essential to align Nigeria's migraine management with evidence-based practices, ultimately reducing the burden on individuals and the economy.
Assessing the Efficacy of Peko-D Forte as Add-on Therapy for Parkinson's Disease: A Proof of Concept, Double-Blind, Placebo-Controlled Study.
Olalusi OV, Oguntiloye OO, Makanjuola AI … +4 more , Yaria JO, Chukwuocha I, Akinyemi RO, Ogunniyi A
West Afr J Med · 2025 Jan · PMID 40548419
BACKGROUND: Hypoestes rosea, an endemic shrub in Nigeria and Cameroon with documented anti-inflammatory properties, has been shown to modify disease progression in transgenic mouse models with Parkinson's Disease PD. We...
BACKGROUND: Hypoestes rosea, an endemic shrub in Nigeria and Cameroon with documented anti-inflammatory properties, has been shown to modify disease progression in transgenic mouse models with Parkinson's Disease PD. We investigated the efficacy and side effect profile of Hypoestes rosea (Peko-D forte) in improving motor performance of PD patients. METHODS: This double-blind, randomized, placebo-controlled, proof-of-concept (phase I) study involved 19 patients with mild to moderate PD. Routine dopaminergic therapy was maintained. Following randomization, half of the patients received 4 capsules each of 350 mg Peko-D forte tablets, and the other half, 4 capsules of matching placebo (USP-grade starch) for 8 weeks. After a wash-out period of 4 weeks, patients were switched over (cross-over design). The effects of the medication on motor activity were analyzed using the Unified Parkinson's Disease Rating Scale (UPDRS). RESULTS: Overall, 14 patients completed the study, comprising 93% males with a mean age of 72 (13.2) years. Their median (IQR) UPDRS score at baseline of 18 (13-20) improved significantly with both Peko-D forte 12 (6 - 16) and placebo 12.5 (9- 15) (p<0.001). Compared to baseline, Peko-D forte improved bradykinesis, rest tremor amplitude and frequency, and rigidity. There was no significant difference between the median UPDRS score with the use of Peko-D forte compared to placebo. The test drug had 93% tolerability with a good side effect profile. CONCLUSION: Peko-D forte improved motor functions in PD, and it is safe and tolerable. Its efficacy is unclear due to the lack of significant difference between the test drug and placebo. Larger studies will be needed to confirm its efficacy. Clinical Trials.org (NCT04858074).
Diagnostic Performance of Xpert MTB/RIF Assay in Adults with Presumed Pulmonary Tuberculosis at Uyo, Nigeria.
Udoette SB, Onukak AE, Ugwu UV … +3 more , Iroezindu MO, Unigwe US, Umoh VA
West Afr J Med · 2025 Jan · PMID 40546122
BACKGROUND: Tuberculosis (TB) is a disease of immense public health importance in sub-Saharan Africa. Xpert MTB/RIF assay, a relatively recent, rapid molecular testing modality offers potential solutions to most of the c...
BACKGROUND: Tuberculosis (TB) is a disease of immense public health importance in sub-Saharan Africa. Xpert MTB/RIF assay, a relatively recent, rapid molecular testing modality offers potential solutions to most of the challenges associated with TB diagnosis. OBJECTIVE: This study determined the diagnostic performance of Xpert MTB/RIF assay in adults with presumed pulmonary tuberculosis (PTB). METHODS: This was a descriptive cross-sectional study involving consenting adults with presumed PTB at the University of Uyo Teaching Hospital, Uyo, southern Nigeria. A structured questionnaire was used to collect participants' data. All participants submitted 2 sputum samples (spot and early morning). Sputum smear microscopy, Xpert MTB/RIF assay and mycobacterial culture were done. They also had chest radiography. RESULTS: They were 230 participants in the study. Seventy-nine (34.3%) patients were living with HIV. Xpert MTB/RIF assay detected MTB in 65 (28.3%) patients with 2 (3.1%) of them having rifampicin resistance. M. tuberculosis was isolated from sputum culture in 69 participants while the result was negative in 151 participants. The culture results of these 220 patients were used as the reference standard for the determination of the sensitivity and specificity of Xpert MTB/RIF assay. The overall sensitivity and specificity of the assay were 88.4% and 98.7% respectively. Younger age, longer duration of cough, weight loss, low body mass index (BMI) and positive smear status were independent factors associated with MTB detection using the assay. CONCLUSION: Xpert MTB/RIF assay is a highly sensitive and specific modality for pulmonary TB diagnosis when compared with mycobacterial culture, which is the gold standard.
Population Survey on Contributing Factors to Sustained Prevalence of Sickle Cell Disease in Nigeria.
Ugwu AO, Okamkpa CJ, Anigbo CS … +5 more , Muoghalu EA, Obodo OI, Onwasigwe CR, Ekwueme PC, Ene GU
West Afr J Med · 2025 Jan · PMID 40544512
BACKGROUND: According to the World Health Organization, about 5% of the world's population has the abnormal haemoglobin gene with Nigeria having the highest burden of sickle cell disease (SCD). Concerted efforts should t...
BACKGROUND: According to the World Health Organization, about 5% of the world's population has the abnormal haemoglobin gene with Nigeria having the highest burden of sickle cell disease (SCD). Concerted efforts should target the reduction of SCD prevalence. OBJECTIVE: This study aimed to determine the various factors that contribute to the non-dwindling prevalence of SCD in Nigeria. METHODS: A community-based cross-sectional survey was carried out on 883 respondents aged 18 years and above between February 2021 and March 2023 in Enugu State, Nigeria. Interviewer-administered questionnaires were used to obtain relevant socio-demographic data, family history of SCD, knowledge of their haemoglobin phenotype, and information on any previous misdiagnosis of their haemoglobin phenotype. Statistical Package for the Social Sciences (SPSS) software program, version 26.0 (Chicago, Illinois) was used for data analysis. A value of P < 0.05 was considered statistically significant. RESULTS: Median age was 43 years with a range of 18-88 years. Seven hundred and forty-three (743/883, 81.1%) have done the test to ascertain their haemoglobin phenotype. On the other hand, 140 respondents (15.9%) have never done the test due to: lack of awareness (35/140, 25%); financial difficulties (53/140, 37.8%); religious reasons (35/140, 25%); discordant results (301/743, 40.5%) and not knowing where to go for the test (17/140, 12.1%). The distributions of the haemoglobin phenotypes were: HbAA (519/743, 69.9%); HbAS (196/743, 26.4%) and HbSS (28/743, 3.8%). CONCLUSIONS: Over one-tenth (15.9%) of the study population do not know their haemoglobin phenotype status and their reasons for non-testing are varied. The population prevalence of SCD (3.8%) is higher than the previously reported national prevalence range of 1 - 3%. Addressing the identified barriers to non-testing might help in checking the increasing prevalence of SCD in Nigeria.
The Interplay Between Fibroblast Growth Factor-23 (Fgf-23) and Traditional Biomarkers of Chronic Kidney Disease - Mineral and Bone Disorder.
Ezeugonwa RS, Bamikefa TA, Ayoola YA … +8 more , Sanni IO, Alaya RO, Omotoso BA, Hassan MO, Adamu S, Okunola OO, Sanusi AA, Arogundade FA
West Afr J Med · 2025 Jan · PMID 40544508
INTRODUCTION: Chronic kidney disease (CKD) is a global health challenge affecting 11-13% of the world's population. Chronic kidney disease - mineral and bone disorder (CKD-MBD) has been recognized as an important complic...
INTRODUCTION: Chronic kidney disease (CKD) is a global health challenge affecting 11-13% of the world's population. Chronic kidney disease - mineral and bone disorder (CKD-MBD) has been recognized as an important complication of CKD. There has been an increasing interest in fibroblast growth factor 23 (FGF-23), regarding its roles in the pathophysiology, diagnosis, and management of CKD-MBD but its relationship with other biomarkers of CKD-MBD has not been well investigated in sub-Saharan Africa, especially in Nigeria. METHOD: This study aimed to assess the levels of FGF-23 in patients with kidney disease: Improving Global Outcome (KDIGO) CKD stages 3a to 5 and its relationship with traditional biomarkers of CKD-MBD. One hundred and thirty-eight (138) participants, 103 patients and 35 controls, completed the study. Serum intact parathyroid hormone (iPTH), FGF-23, and calcium among others were measured and a structured, interviewer-administered questionnaire was used to collect data. Data collected were analyzed using the Statistical Package for Social Sciences version 20 (SPSS 20). RESULTS: The mean serum levels of FGF-23 were different between patients (241.05 ± 3.40pg/ml) and the controls (133.66 ± 2.35pg/ml; p=0.009), and the same applied to the mean serum levels of iPTH for patients and controls (56.15 ± 43.48pg/ml vs 20.11 ± 5.57pg/ml, p = 0.009). The FGF-23 levels increased from stages 3 to 5; however, in stage 5 CKD, those on dialysis had lower iPTH and FGF-23 compared to those who were yet to commence dialysis. In the CKD arm, the calcium-phosphate product had a positive correlation with both FGF-23 and iPTH (r = 0.212; p = 0.01, and r = 0.195; p = 0.022, respectively). The prevalence of CKD-MBD increased as CKD progressed through stages 3 to 5 (72%, 90% and 100% respectively). CONCLUSION: The prevalence of CKD-MBD was very high in this study, the rate progressively increased as GFR declined. FGF-23 showed a weak correlation with Ca x P product but did not correlate with calcium, phosphate, or iPTH.
A Social Media Survey on the Prevalence of Post-COVID Neurologic Complications Among Nigerians.
Akase IE, Awodumila SO, Nwanmah CE … +12 more , Ojo OO, Agabi OP, Ede O, Nwaokorie FO, Anyanwu RA, Ghajiga PS, Kalejaiye O, Perez-Giraldo GS, Orban ZS, Jimenez M, Koralnik IJ, Okubadejo NU
West Afr J Med · 2025 Jan · PMID 40544471
BACKGROUND AND OBJECTIVE: Cultural barriers and perceptual factors that are peculiar among Africans are known to limit the number of people seeking medical care for post-COVID conditions. The aim of this social media sur...
BACKGROUND AND OBJECTIVE: Cultural barriers and perceptual factors that are peculiar among Africans are known to limit the number of people seeking medical care for post-COVID conditions. The aim of this social media survey was to ascertain the burden of post-COVID neurologic complications in Nigeria in individuals with confirmed COVID-19. METHODS: We performed a cross-sectional web-based survey of persons with PCR-confirmed or suspected SARS-CoV-2 infection in Nigeria with incident infection between March 2020 and April 2022. Our survey utilized Kobo Toolbox® and was disseminated via several online platforms (including WhatsApp ®, Facebook®, and Twitter (X)®). Participant demographics, COVID-19 symptom profile, SARS-CoV-2 test results, and the occurrence of persistent neurological symptoms were documented. RESULTS: We analyzed the data of 963 participants with confirmed or suspected COVID-19 infection. The mean age was 36.9 ± 9.9 years, and 555/963 (57.6%) were female. Only 174/963 individuals (18.1%) had SARS-CoV-2 PCR confirmation at any point during the pandemic, of which 133 (76.4%) had accompanying symptoms consistent with the case definition. A total of 47/174 (27.0%) of the PCR-positive participants reported post-acute COVID symptoms, and 46/174 (26.4%) had post-COVID neurologic complaints. The most commonly reported symptoms were fatigue (25; 14.4%), generalized body weakness (22; 12.6%), and difficulty remembering things (15; 8.6%). Slightly over half of those with post-COVID symptoms (25/47; 53.2%) sought care, with 21/25 (84%) presenting to a medical facility. Others presented either to a community pharmacy (1/25) or a patent medicine store (3/25) for care. CONCLUSION: Despite low testing rates in Nigeria, the prevalence of post-COVID neurologic complications is approximately 1 in 4 individuals. Further studies on the prognosis and management of post-COVID neurologic sequelae in Nigeria are warranted.
Symptoms and Physiological Parameters of Obstructive Sleep Apnoea Patients Diagnosed with a Portable Sleep Monitor: Implications and Challenges.
Nwosu NI, Odinaka CV, Nlewedim PI … +5 more , Udeh CF, Obiefuna AG, Abazie UC, Onyedum CC, Chukwuka JC
West Afr J Med · 2025 Jan · PMID 40544469
BACKGROUND: Obstructive sleep apnoea is a chronic, debilitating condition that if left undiagnosed and untreated is associated with adverse clinical events. The WatchPAT® is a portable wrist-worn sleep study device that...
BACKGROUND: Obstructive sleep apnoea is a chronic, debilitating condition that if left undiagnosed and untreated is associated with adverse clinical events. The WatchPAT® is a portable wrist-worn sleep study device that uses peripheral arterial tonometry with pulse oximetry and actigraphy to assess respiratory disturbances. Unlike other level 111 sleep monitors, it measures actual sleep time, distinguishes between REM and Non-REM sleep stages, and thus generates actual apnoea-hypopnoea index. OBJECTIVES: The study was done to assess symptoms of obstructive sleep apnoea, evaluate physiological parameters recorded by the sleep monitor and highlight changes encountered in deploying the monitor for diagnosis of sleep apnoeas. METHODS: It was a cross-sectional study. A structured Questionnaire was administered to all patients to obtain data regarding their symptoms, co-morbidities and socio demographics. Sleep study was conducted using a Watch-PAT® portable monitor. Data were entered first on Microsoft excel sheet and analysed using SPSS version 25. RESULTS: Thirty-eight participants, mean age 49±14 years (17 to76 years) were studied (females, 73.7%). Thirty-four (89.5%) of them were diagnosed with OSA. Sixteen (47.0%), 9 (26.5%) and 9 (26.5%) had severe, moderate and mild OSA respectively. Commonest symptoms were snoring (85.7%), abrupt awakening accompanied by gasping/choking at night (65.8%) and non-refreshing sleep (60.5%). Memory loss occurred significantly among those with severe OSA compared with mild and moderate OSA (X2=9.920, p=0.007). Seventeen participants (44%) had excessive daytime somnolence (EPSS > 10). Those with severe OSA recorded the lowest minimum pulse (median 42.5, IQR 39.3-51.8), highest maximum pulse (median 130bpm, IQR 114-138), and lowest minimum SPO2 (median 70%, IQR 64.3-80.3). Severe OSA was associated with reduced mean percentage of REM sleep (14.6%) compared to moderate (25.1%) and mild (16.1%) OSA. CONCLUSION: Diagnosing OSA objectively using a portable sleep monitor such as WatchPAT® is feasible. Snoring (85.7%) was the commonest symptom among those diagnosed with OSA. Physiological parameters obtained from the monitor provide the clinician the requisite information with which to persuade patients of a need for intervention. However, cost of CPAP machine and mandibular advancement device delayed immediate intervention.
Kaolin-Induced Hydrocephalus in the Developing Rat Brain: Deficits of Visual Perception and Structural Changes in the Visual Cortex.
Shokunbi MT, Olopade FE, Femi-Akinlosotu OM … +2 more , Adekanmbi AJ, Akpoke OA
West Afr J Med · 2025 Jan · PMID 40544446
BACKGROUND AND OBJECTIVES: Cortical visual deficits occur in hydrocephalus but the morphological changes in the visual cortex are not fully understood. This study assessed the population and cytoarchitecture of neurons i...
BACKGROUND AND OBJECTIVES: Cortical visual deficits occur in hydrocephalus but the morphological changes in the visual cortex are not fully understood. This study assessed the population and cytoarchitecture of neurons in the cortex of neonatal and juvenile rats, in relation to the findings on assessment of visual perception. METHODS: Hydrocephalus was induced by injecting sterile kaolin (150 mg/l) into the cisterna magna of neonatal (7 days old) and juvenile (4 weeks old) rats. Vision was assessed using a dark chamber preference test prior to sacrifice at two and four weeks for the neonatal rats, and four and eight weeks for the juvenile rats following kaolin injection, at which time significant ventriculomegaly and cortical thinning were apparent in the parieto-occipital region. Tissue samples from the visual cortex were processed for modified Golgi, haematoxylin and eosin, and Nissl stains. RESULTS: The hydrocephalic rats failed the dark chamber tests of transition, peeping and preference and lacked a distinct horizontal layering of the visual cortex. There was neuronal degeneration as evidenced by increased pyknosis, and increased cytoplasmic eosinophilia. The size and dendritic branching of pyramidal neurons in layer 5 were reduced. This was especially notable in the juvenile group after four weeks of hydrocephalus. The density of layer 5 pyramidal neurons was reduced in both neonatal and juvenile hydrocephalic rats at the two time points of assessment. CONCLUSIONS: The results showed that hydrocephalus altered the morphology of the pyramidal neurons of the visual cortex, and suggest that these changes were associated with deficits in visual perception.
Quality of Life Assessment Among Patients with Papulosquamous Disorders in Southern Nigeria.
Sokunbi EA, Madubuko CR, Okwara BU … +4 more , Omatighene EO, Elimian HO, Oiwoh SO, Onunu AN
West Afr J Med · 2025 Jan · PMID 40544438
BACKGROUND: Papulosquamous disorders (PSDs) are a broad group of relatively common dermatoses that run a chronic course; usually with unsatisfactory outcomes which impacts on the Quality of Life (QOL) of subjects. Few st...
BACKGROUND: Papulosquamous disorders (PSDs) are a broad group of relatively common dermatoses that run a chronic course; usually with unsatisfactory outcomes which impacts on the Quality of Life (QOL) of subjects. Few studies have attempted to quantify their burden on QOL in this environment. This study aims to assess the disease impact on QOL of affected subjects. METHODS: This was a descriptive cross-sectional study conducted at the University of Benin Teaching Hospital, Benin City among two hundred subjects with PSDs. Consecutive patients with PSDs were recruited for this study after obtaining ethical approval. The Dermatology Life Quality index (DLQI) questionnaire was used to estimate the impact of these dermatoses on the QOL of subjects. Data was analysed using IBM SPSS version 21. RESULT: PSDs affected all age groups with a mean age of 40.9 ± 16.4 years. Male: female ratio was 1: 1.30. The mean DLQI score was 9.5 ±5.9. Pityriasis rubra pilaris subject recorded the highest burden with DLQI score of 14.0 ±5.0, followed by psoriasis; 11.7 ± 6.3. Over half (57%) of participants had severe impact on their QOL; 34.0% had "extremely large" impact. QOL were similar among gender; but worse in extremes of age. The most commonly affected domains using the DLQI questionnaire were the "symptoms" and "feelings" domains; with 34% and 21% affected respectively. CONCLUSION: Most subjects had severe impact on their QOL from these dermatoses; which mostly affected the symptoms and feelings of participants. Efforts to improve treatment outcome through interdisciplinary care alongside psychological assessment should be escalated.
Addressing the Silent Strain: Unmasking Post-COVID Neurologic Complications in Resource-Limited Settings.
Erhabor GE
West Afr J Med · 2025 Jan · PMID 40544426
Abstract loading — click title to view on PubMed.
Cardiotoxicity in a Patient with Multiple Relapses of Non-Hodgkin Lymphoma.
Alburqueque-Melgarejo J, Valverde-Graciano LJ, Roque-Quezada JC … +3 more , Virú-Flores HM, Beltrán-Gárate B, Villela L
West Afr J Med · 2024 Dec · PMID 40392979
BACKGROUND: Chemotherapy-induced cardiomyopathy is one of the most important adverse effects in cancer treatment. Many chemotherapeutic agents are known to be cardiotoxic, including anthracyclines, monoclonal antibodies,...
BACKGROUND: Chemotherapy-induced cardiomyopathy is one of the most important adverse effects in cancer treatment. Many chemotherapeutic agents are known to be cardiotoxic, including anthracyclines, monoclonal antibodies, alkylating agents, and protein kinase inhibitors. OBJECTIVE: It is intended to indicate a mechanism of multiple cardiac injury after exposure to various chemotherapeutic agents with cardiotoxic potential. This article illustrates the case of a 70-year-old male patient diagnosed with non-Hodgkin's lymphoma with multiple relapses and malignant transformation to diffuse large B-cell lymphoma who received multiple cycles of chemotherapy with periods of complete remission, who presented to the hospital emergency with decompensated reduced ejection fraction heart failure (EF:40%). RESULTS: During the hospitalization the patient suffered refractory electrolyte imbalances and hospital-acquired infections. Although the patient received hypertonic saline solution, multiple potassium challenges, and extended spectrum antibiotics, the patient passed away. CONCLUSION: Exposure to different chemotherapeutic agents with cardiotoxic potential included in non-Hodgkin lymphoma treatment schemes can trigger myocardial injury by different mechanisms. Cardiooncology is a field that is emerging and working on new strategies for the diagnosis, prevention, and management of chemotherapy-induced cardiotoxicity.
Kartagener Syndrome: A First Report of Two Cases from Benin, West Africa.
Ade S, Akanni D, Efio M … +4 more , Djibril A, Adjanayo A, Savi de Tove KS, Harries AD
West Afr J Med · 2024 Dec · PMID 40392963
BACKGROUND: Kartagener Syndrome is a rare autosomal recessive genetic disorder, belonging to the larger group of diseases of primary ciliary dyskinesia, including situs inversus. This underdiagnosed disease, especially i...
BACKGROUND: Kartagener Syndrome is a rare autosomal recessive genetic disorder, belonging to the larger group of diseases of primary ciliary dyskinesia, including situs inversus. This underdiagnosed disease, especially in developing settings, may be potentially responsible for the impairment of the quality of life of patients and can even be life-threatening. We report on two patients with this condition in Benin, in whom the diagnosis had not previously been made, despite a long history of upper and lower respiratory symptoms. The patients were admitted with complications, a superinfection of bronchiectasis complicated by pneumonia and purulent pleurisy in a 30-year-old male and by a refractory hypoxemia, acute pulmonary heart disease in another 32-year-old male. Treatment outcome was favourable in the first case, but less satisfactory in the second one.
Coronary Cameral Fistula in a Nigerian Adult with Chest Pain: A Rare Cause of Angina.
Badero O, Osibowale B, Kushimo O … +4 more , Agaja O, Asogwa F, Prince J, Okonkwo L
West Afr J Med · 2024 Dec · PMID 40392933
BACKGROUND: Coronary artery fistulas (CAFs) are rare defects in the coronary circulation with majority being asymptomatic. A coronary cameral fistula (CCF) is a type of CAFs with an abnormal communication with a cardiac...
BACKGROUND: Coronary artery fistulas (CAFs) are rare defects in the coronary circulation with majority being asymptomatic. A coronary cameral fistula (CCF) is a type of CAFs with an abnormal communication with a cardiac chamber. It is often diagnosed while patients are being investigated for coronary artery disease and diagnosis requires high index of suspicion especially in patients with angina with no obstructive lesions. Symptomatic cases have variable clinical manifestation which depends on the size, origin and drainage site. Coronary computerised tomographic angiography (CCTA) has emerged as investigation of choice in investigating CAFs due to its high spatial and temporal resolution facilitating accurate assessment of the complex anatomy of CAFs. Treatment strategy for CCF is individualised with consideration for its symptomatology, haemodynamic significance and potential complication. Early diagnosis and treatment can improve outcomes in symptomatic patients. CASE REPORT: We report the first case of coronary cameral fistula in Nigeria diagnosed by angiography and confirmed by coronary CTA. The patient was managed conservatively with antiplatelets and long-acting nitrates and monitored closely at outpatient follow up.
Chemotherapy and Radiotherapy-Induced Oral Mucositis: The Potentials of Metabolomics in the Management.
Otakhoigbogie U, Onyia NE, Uzodufa SA
West Afr J Med · 2024 Dec · PMID 40392875
BACKGROUND: Oral mucositis (OM) is a debilitating complication commonly experienced by patients undergoing chemotherapy and/or radiotherapy for head and neck cancers. The pathogenesis of OM involves multifaceted interpla...
BACKGROUND: Oral mucositis (OM) is a debilitating complication commonly experienced by patients undergoing chemotherapy and/or radiotherapy for head and neck cancers. The pathogenesis of OM involves multifaceted interplay of inflammatory, immune, and cellular damage pathways triggered by cancer therapy. The pathogenesis of OM can be delineated into five overlapping phases: initiation, signaling, signal amplification, ulceration, and healing. METABOLOMICS: The large-scale study of metabolites which are small molecules involved in cellular processes, has emerged as a powerful tool in understanding complex conditions like oral mucositis (OM). This detailed literature review synthesizes current knowledge on the metabolomics of OM, with a focus on its application to understanding the pathogenesis, identifying predictive biomarkers, and exploring therapeutic strategies. CONCLUSION: The field of metabolomics has revolutionized the understanding of oral mucositis by providing a dynamic snapshot of the metabolic alterations associated with it. It is a powerful tool for identifying potential biomarkers for early diagnosis, monitoring, and treatment optimization.
Global Insights into the Impact of Endothelial Dysfunction on Coronary Artery Disease: A Systematic Review.
Ismail A, Isyaku K, Sani MU
West Afr J Med · 2024 Dec · PMID 40392755
BACKGROUND: Coronary artery disease (CAD) is a major global health issue, especially in low- and middle-income countries (LMICs). The dysfunction of the vascular endothelium plays a critical role in CAD progression. OBJE...
BACKGROUND: Coronary artery disease (CAD) is a major global health issue, especially in low- and middle-income countries (LMICs). The dysfunction of the vascular endothelium plays a critical role in CAD progression. OBJECTIVES: This systematic review evaluated existing literature on the role of endothelial dysfunction in the progression of CAD. METHODS: The review protocol was registered with PROSPERO (CRD42024539722). A comprehensive literature search identified 70 relevant articles. After removing 15 duplicates, 55 studies were screened based on title and abstract, leading to the exclusion of 35 articles that did not meet the inclusion criteria. Finally, 15 studies, encompassing a total of 3,673 subjects (with individual study sample sizes ranging from 14 to 936, and a median of 106), were included in the review. RESULTS: The 15 studies (3,673 subjects, 1998-2023) included 9 cross-sectional, 5 cohort, and 1 retrospective study. CAD diagnosis was confirmed via angiography (10 studies) or other methods like stress ECG and cardiac enzymes. Endothelial dysfunction was assessed using FMD (8 studies) and other techniques. Five studies linked endothelial dysfunction to CAD severity, while cohort studies suggested its role in predicting adverse cardiovascular events, even with normal angiograms. CONCLUSION: This systematic review highlights the crucial role of endothelial function in CAD and emphasizes the importance of endothelial function in risk assessment, early detection, and guiding treatment decisions in CAD.
Blood Pressure and Associated Risk Factors for Hypertension in Children with Sickle Cell Anaemia Attending University of Nigeria Teaching Hospital, Enugu, South-East Nigeria.
Okongwu IO, Adiele DK, Mbanefo N … +3 more , Okongwu I, Ikefuna AN, Ibadin MO
West Afr J Med · 2024 Dec · PMID 40392594
INTRODUCTION: Sickle Cell Anaemia (SCA) is the homozygous state of heamoglobin SS gene. It is highly prevalent in Sub-saharan Africa with Nigeria ranking highest for people living with the disease. Blood pressure recordi...
INTRODUCTION: Sickle Cell Anaemia (SCA) is the homozygous state of heamoglobin SS gene. It is highly prevalent in Sub-saharan Africa with Nigeria ranking highest for people living with the disease. Blood pressure recording in individuals with SCA has been known to be influenced by certain factors such as age, sex, body mass index and hemoglobin level. AIM: The study seeks to examine the relationship of certain pre-selected factors -age, gender, body mass index, disease severity and microalbuminuria/proteinuria on the blood pressure of children with SCA and document the relationship (if any) between above factors and the blood pressure readings of Nigerian children with SCA. METHODOLOGY: A cross-sectional hospital-based study that consecutively recruited 106 children with sickle cell anaemia (HbSS) aged 3-17 years in steady state as well as age and sex-matched controls with HbAA genotype. Sociodemographic, clinical and anthropometric parameters were obtained. Severity of the disease and renal complication were assessed using Adeleke scoring method and microalbuminuria/ proteinuria assay. Subjects in crisis or had crisis in the past 4 weeks or genotype HbSC were excluded. For controls (genotype AA), those on management for congenital heart disease (CHD), hypertension and renal pathology were excluded. RESULTS: Weight and body mass index (BMI) were significantly lower in subjects compared to controls (p = 0.010 & 0.029 respectively). In subjects, the most common clinical attributes at presentation was bone pain (31.1% subjects), previous hospital admission (74.5%) and known steady state PCV (33.9%). Most of the subjects (87.74%) had mild SCA disease severity. Only two subjects (1.8%) had elevated BP while one subject (0.9%) had hypertension.Microalbuminuria (28.2%) and proteinuria (13.2%) were seen in subjects. While one control had elevated BP, none had hypertension. There was an initial positive relationship between increasing age (p= 0.007), low BMI (p= 0.008), presence of microalbuminuria/ proteinuria (Renal injury) p= 0.03 and raised blood pressure,but none of these associations was found to be an independent predictor of hypertension. CONCLUSION/ RECOMMENDATION: Elevated diastolic blood pressure and diastolic hypertension in children with SCA were shown to have an initial positive association with increasing age, low BMI and renal injury. These should be guarded against by instituting screening program and measures to stall progression.
Primary and Delayed Primary Wound Closure in Low Energy Open Tibia Shaft Fracture: Randomized Controlled Study.
Adedire A, Oluwadiya KS, Ajibade A
West Afr J Med · 2024 Dec · PMID 40392542
BACKGROUND: Traditionally, delayed primary and secondary wound closure are commonly used for the treatment of open fractures especially before the advent of modern antibiotics. Despite the availability of antibiotics, pr...
BACKGROUND: Traditionally, delayed primary and secondary wound closure are commonly used for the treatment of open fractures especially before the advent of modern antibiotics. Despite the availability of antibiotics, primary wound closure is still not frequently used even for the treatment of low-energy open tibia shaft fractures especially in developing countries. MATERIALS AND METHODS: Sixty-four patients with GustiloAnderson type I and II tibia fractures were recruited for this randomized prospective intervention study to compare the infection rate, duration of wound healing, duration of hospital stay, and cost of treatment between primary and delayed primary wound closure. We randomized 68 patients into two blocks of 34 participants each using a randomization plan generated on the website, randomization.com. Each random number in a sealed serially numbered brown envelope. Clinical information and clinical findings were entered into a proforma, and data obtained were analyzed. RESULTS: The majority of cases, 54 (84.4%), were Gustilo-Anderson type II. The infection rate was higher for primary wound closure (9.6%) than for delayed primary wound closure (3.0%). The mean duration of wound healing was 14.8 (±3.8) days for primary wound closure, which was significantly shorter than the 16.1 (±2.0) days recorded for delayed wound closure (p= 0.08). Also, the mean duration of hospital stay was shorter for patients treated with primary wound closure (4.1 ±3.6) days than for delayed wound closure patients 4.7 (±1.3); with a p value of 0.37. The mean cost of treatment for primary wound closure (N34,487 ±4911.4) was significantly less than that for delayed primary wound closure (N 40,536 ±1709.0), with a p-value of 0.01. CONCLUSION: Primary wound closure for low-energy open tibia shaft fractures is both more cost-effective and associated with a shorter time to wound healing compared to delayed primary closure. Therefore, primary wound closure should be used for low energy tibia shaft fracture even in low and middle-income countries. KEY WORDS: Open fracture, Tibia shaft, Wound closure, Management.
Early Detection of Anthracycline-Induced Cardiotoxicity in Female Breast Cancer Patients Using Speckle Tracking Echocardiography in an African Tertiary Institution.
Orimolade OA, Ogah OS, Adebiyi A … +4 more , Aje A, Adebayo OM, Oguntade A, Ogundiran TO
West Afr J Med · 2024 Dec · PMID 40392219
BACKGROUND: Although, survival rates have improved in breast cancer care, cardiotoxicity from chemotherapy used for breast cancer has emerged as an important cause of morbidity in these individuals. This study evaluated...
BACKGROUND: Although, survival rates have improved in breast cancer care, cardiotoxicity from chemotherapy used for breast cancer has emerged as an important cause of morbidity in these individuals. This study evaluated early myocardial dysfunction using two-dimensional (2D) speckle tracking echocardiography in breast cancer patients treated with anthracyclines. METHODOLOGY: Sixty-two patients with anthracycline naïve breast cancer and 62 controls were studied. All patients were treated with standard regimens containing epirubicin. Echocardiography was done at three time points (baseline, one month and three months). Left ventricular ejection fraction and global longitudinal strain were measured. RESULTS: The mean age of the subjects was 47.6±10.46 years, obesity was the most common co-morbidity (27.4%) followed by hypertension (14.5%). Over the three month-follow-up period, the left atrial volume increased from 21.4±6.90mls/m2 at baseline to 24.8±6.38mls/m2, the mean left ventricular ejection fraction decreased from 62.4±9.35% at baseline to 54.8±7.22%, and the average left ventricular global longitudinal strain decreased from -19.0±5.91% at baseline to -16.1±3.70% by three month-follow-up. The percentage change in GLS at one month was 15.98% compared to 4.06% change in ejection fraction at one month follow-up. Thirty-five patients (56.5%) developed cardiotoxicity; however, no significant predictor of cardiotoxicity was noted. CONCLUSION: This study showed reduced left ventricular ejection fraction, reduced left ventricular global longitudinal strain, and increased left atrial volume over a period of three months in breast cancer patients treated with anthracycline-based chemotherapy. It also confirms the usefulness of speckle tracking echocardiography in evaluating breast cancer patients pre-, intra-, and post-chemotherapy.
Audit of Operative Site Marking Practice in a Tertiary Hospital in Nigeria: A Key Step in Patient Safety.
Agbaje AA, Adesunkanmi AO, Ubom AE … +11 more , Lawal AO, Adesunkanmi AK, Ogunmodede OG, Emeka O, Olugbami AM, Eliboh MO, Ezeaku CO, Ogbuagu EU, Obaleye PO, Aderounmu AA, Komolafe EO
West Afr J Med · 2024 Dec · PMID 40392140
BACKGROUND: Wrong-site surgery (WSS) is the most frequent sentinel event, accounting for 13.4 % of all sentinel events, with an incidence of 0.09 - 4.5 per 10,000 surgeries. Adherence to recommendations for surgical site...
BACKGROUND: Wrong-site surgery (WSS) is the most frequent sentinel event, accounting for 13.4 % of all sentinel events, with an incidence of 0.09 - 4.5 per 10,000 surgeries. Adherence to recommendations for surgical site marking to prevent WSS remains poor, with paucity of data on WSS due to underreporting. METHODS: The first institutional audit of preoperative site marking in Nigeria was prospectively conducted in the 11 surgical and obstetrics and gynecology units of the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria, between March-April 2024. Data obtained was analysed using the Statistical Product and Service Solutions (SPSS) version 25. Associations between surgical characteristics and operative site marking were ascertained using chi square, with the level of significance set at a P value of <0.05. RESULTS: Surgical site marking was done for only 36.4 % of surgeries involving laterality. Surgical site was marked in 90.2 % of cases by junior resident doctors (RDs) and nurses, and paper tape was used for marking in 92.2 % of cases. There were significant associations between surgical site marking and surgical specialty (P<0.001) and urgency of surgery (P=0.001), with ophthalmology (94.0 %) and general (17.6 %) surgeries, elective surgeries (41.8 %), consultant/attending-led surgeries (41.1 %), and major surgeries (43.8 %) involving laterality being significantly more likely to be marked compared to emergency (0.0 %), RD-led (29.3 %) and minor (30.3 %) surgeries. CONCLUSION: The practice of surgical site marking in OAUTHC is low. There is need for institutional and national protocols on surgical site marking and the education of surgical and theatre staff on its benefits, to engender a change of practice for patient safety.
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