The Nigerian Postgraduate Medical Journal[JOURNAL]
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200 papers
Integrating Three-dimensional Multicolour Holography in Endocrine Surgery: An Innovative Approach.
Badge AK, Singh BR, Bankar NJ … +1 more , Ade V
Niger Postgrad Med J · 2026 Jul · PMID 42390525 · Publisher ↗
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Orthopaedic Implant Surgery or Trauma as a Trigger for Necrobiosis Lipoidica: A Manifestation of an Immunocompromised Cutaneous District?
Awake P, Salwe L, Dongre A
Niger Postgrad Med J · 2026 Jul · PMID 42390524 · Publisher ↗
Necrobiosis lipoidica (NL) is a rare chronic granulomatous skin disorder most commonly associated with diabetes mellitus, typically presenting in middle-aged women. We report an unusual case of NL in a young, non-diabeti...
Necrobiosis lipoidica (NL) is a rare chronic granulomatous skin disorder most commonly associated with diabetes mellitus, typically presenting in middle-aged women. We report an unusual case of NL in a young, non-diabetic male following orthopedic surgery involving a metallic implant. The patient developed characteristic well demarcated, atrophic, violaceous-brown plaques with violaceous borders localized over shin area of his left lower leg. Histopathological examination confirmed the diagnosis of NL, showing palisading granulomas with necrobiosis and lipid-laden macrophages. Notably, there was no history of diabetes, hypothyroidism, glucose intolerance, or autoimmune disease. This case highlights a rare presentation of NL potentially triggered by local immune dysregulation by trauma, surgery and the presence of a metallic implant. The report underscores the importance of considering NL in the differential diagnosis of persistent postsurgical cutaneous lesions, even in non-diabetic individuals, and raises questions about trauma, implant-related immune dysregulation, or microvascular changes as possible pathophysiological mechanisms.
A Case of Isolated Hydrosalpinx Torsion in a Young Female: Diagnostic and Surgical Challenges.
Bhure M, Jajoo S, Jajoo S
Niger Postgrad Med J · 2026 Jul · PMID 42390523 · Publisher ↗
Isolated torsion of a hydrosalpinx is an exceptionally rare gynaecological emergency that often presents with vague and non-specific symptoms, leading to delays in diagnosis. Hydrosalpinx is a known predisposing factor f...
Isolated torsion of a hydrosalpinx is an exceptionally rare gynaecological emergency that often presents with vague and non-specific symptoms, leading to delays in diagnosis. Hydrosalpinx is a known predisposing factor for tubal torsion, yet isolated involvement without ovarian pathology is uncommon. We report the case of a 22-year-old woman presenting with acute right lower abdominal pain and vomiting, in whom ultrasonography demonstrated a cystic adnexal lesion distinct from the ovary. Laparoscopic evaluation confirmed isolated torsion of the right hydrosalpinx with necrosis, necessitating salpingectomy. Early laparoscopic intervention enabled prompt recovery and preservation of ovarian function. This case highlights the importance of maintaining a high index of suspicion for isolated tubal torsion in reproductive-aged women presenting with acute pelvic pain.
Binswanger's Disease: A Diagnostic Challenge in a Middle-aged Male.
Khan MF, Negandhi P, Khan S … +2 more , Acharya S, Reddy N
Niger Postgrad Med J · 2026 Jul · PMID 42390522 · Publisher ↗
Binswanger's disease, a rare form of subcortical vascular dementia, presents with a progressive decline in cognitive and motor functions due to chronic small vessel ischemic changes in the brain. Its clinical presentatio...
Binswanger's disease, a rare form of subcortical vascular dementia, presents with a progressive decline in cognitive and motor functions due to chronic small vessel ischemic changes in the brain. Its clinical presentation often overlaps with other neurological conditions, particularly Wernicke's encephalopathy, leading to potential diagnostic delays. We report the case of a 45-year-old male who presented with altered mental status, gait abnormalities, memory impairment and ocular pain. Given his significant history of alcohol consumption, an imperial diagnosis of Wernicke's encephalopathy was made, and treatment was commenced with thiamine supplementation. However, the persistence of behavioural changes, right-sided pyramidal signs, extrapyramidal features and cognitive deficits prompted further evaluation. The clinical findings, combined with the patient's history of hypertension, diabetes and prior stroke, led to the diagnosis of Binswanger's disease. This case highlights the importance of considering vascular dementia in differential diagnoses of subacute encephalopathy and emphasises early recognition to initiate appropriate management.
Medullary Thyroid Carcinoma Masquerading as Tuberculosis Reactivation: A Case of Diagnostic Concealment in an Occult Thyroid Nodule.
Girepunje A, Bhake A, Agrawal A … +2 more , Yadav K, Naseri S
Niger Postgrad Med J · 2026 Jul · PMID 42390521 · Publisher ↗
Medullary thyroid carcinoma (MTC) with tumour-associated granulomas presents a significant diagnostic challenge in tuberculosis (TB)-endemic regions, particularly when thyroid nodules are non-palpable. We report a 75-yea...
Medullary thyroid carcinoma (MTC) with tumour-associated granulomas presents a significant diagnostic challenge in tuberculosis (TB)-endemic regions, particularly when thyroid nodules are non-palpable. We report a 75-year-old woman with treated pulmonary TB who presented with dyspnoea and pleural effusion, leading to initial clinical suspicion of TB reactivation. An incidental non-palpable thyroid nodule discovered on ultrasound was revealed to be MTC with epithelioid granulomas on fine-needle aspiration cytology. The absence of a palpable neck mass diverted clinical attention towards pulmonary TB, demonstrating how thyroid malignancy can remain concealed by TB manifestations. Elevated serum calcitonin (620 pg/mL) and Congo red-positive amyloid deposits confirmed MTC post-thyroidectomy. This case underscores the critical importance of systematic calcitonin testing in granulomatous thyroid lesions, even in non-palpable nodules, to prevent delayed cancer diagnosis in TB-prevalent healthcare settings.
The Role of Medical Laboratories in Public Health Surveillance.
Tiwade YR, Noman O
Niger Postgrad Med J · 2026 Jul · PMID 42390520 · Publisher ↗
Medical laboratories play a critical role in public health surveillance by providing accurate and timely data for detecting, monitoring and responding to public health threats. This short communication highlights the imp...
Medical laboratories play a critical role in public health surveillance by providing accurate and timely data for detecting, monitoring and responding to public health threats. This short communication highlights the importance of medical laboratories in disease detection, outbreak management and the continuous monitoring of endemic and emerging health threats. It also discusses the challenges laboratories face in this role and suggests strategies for enhancing their contribution to public health surveillance.
Comparative Analysis of the Clinical Outcomes, Complications and Patient Satisfaction of One-stage versus Two-stage Bilateral Total Knee Arthroplasty.
Salihu MN, Arojuraye SA
Niger Postgrad Med J · 2026 Jul · PMID 42390519 · Publisher ↗
BACKGROUND: The safety of single-stage bilateral total knee arthroplasty (TKA) has been a subject of debate due to concerns of morbidity and mortality. The advantages of one-stage (OS) bilateral TKA include shorter recov...
BACKGROUND: The safety of single-stage bilateral total knee arthroplasty (TKA) has been a subject of debate due to concerns of morbidity and mortality. The advantages of one-stage (OS) bilateral TKA include shorter recovery time, a shorter hospital stay and perhaps reduced total treatment costs. AIMS: This study aimed to evaluate the clinical outcomes and complications following OS versus two-stage (TS) bilateral TKA for severe osteoarthritis of both the knees. PATIENTS AND METHODS: This retrospective comparative analysis was carried out between January 2021 and December 2025 at the National Orthopaedic Hospital, Dala, Kano, and the University of Abuja Teaching Hospital, Gwagwalada. Clinical outcomes using the KSS scoring system and the rate of complications were recorded. Patients' satisfaction was also documented using the Likert scale. The statistical analysis was performed using SPSS version 26.0. Using a level of significance of 0.5, the two independent groups were compared using independent Student's t -test. RESULTS: There was no significant difference in post-operative KSS between the two groups ( P = 0.717). The mean post-operative KSS in the OS and TS groups were 97.78 ± 1.78 and 97.76 ± 1.74, respectively. Post-operative complications also did not significantly differ in the two groups ( P = 0.712). CONCLUSION: In properly selected cases, OS bilateral TKA is less expensive and yields clinical outcomes, complication rate and patient satisfaction comparable to those of a TS procedure.
Morphological and Morphometric Study of the Adult Human Acetabulum in South-Western Nigeria: Clinical Relevance in Hip Arthroplasty Surgery.
Akinmokun OI, Akinrele ZT, Nnanna OT … +3 more , Oni LO, Ubezuo DG, Shoneye OP
Niger Postgrad Med J · 2026 Jul · PMID 42390518 · Publisher ↗
BACKGROUND: The acetabulum is the structure that the head of femur articulates with to form the hip joint. Knowledge of its structure and dimensions is helpful in clinical and forensics settings. Data on its dimensions a...
BACKGROUND: The acetabulum is the structure that the head of femur articulates with to form the hip joint. Knowledge of its structure and dimensions is helpful in clinical and forensics settings. Data on its dimensions are sparse in Southwestern Nigeria. In hip joint arthroplasty, metal backed acetabular cup implant is inserted into this structure. The implants used are designed based on the anatomic findings of countries where these implants were made. AIMS: The study aimed to provide data from Southwestern Nigeria and to correlate the distances between bony prominences in the hemipelvis that will be useful to implant manufacturers. MATERIALS AND METHODS: This was a prospective, descriptive and observational study that involved the measurements of parts of the acetabulum and distances between some bony points of 78 cadaveric hemipelvic bones. Parameters documented included 'Vertical diameters' (VDs), 'Transverse diameters' (TDs), 'Total diameters' (VD + TD)/2, acetabular depth and morphology of the anterior acetabular ridge. The acetabular rim thickness was also estimated. The distance between the anterior superior iliac spine (ASIS) and pubic tubercle (PT) was measured and documented. Data obtained from the study were transferred into Microsoft Excel 2010 (by Microsoft Corporation, Redmond. Washington) and analysed with Stata 13 (StataCorp, Texas, USA). RESULTS: The mean VD, TD and total diameters measured were 57.6 mm, 56.2 mm and 56.9 mm and 51.0 mm, 49.5 mm and 50.3 mm for outer and inner diameters of the acetabulum, respectively. The mean acetabular rim thickness estimated was 3.3 mm for each acetabular rim along the vertical and transverse axes for both left and right sides. Mean acetabular depth was 27.2 mm. The curved pattern was the most common anterior acetabular ridge observed. There was no statistically significant relationship between the acetabular diameters and the distance between ASIS and PT. CONCLUSION: This study has contributed data that would be useful to orthopaedic surgeons, implant manufacturers and forensic pathologists. These data should be used when population specific acetabular cup implants are being considered. This study documented no significant statistical relationship between the acetabular diameter and the distances between any of the bony prominences around the hemipelvis. Therefore, no equation could be generated for pre-operative estimation of acetabular diameter. The use of plain radiograph remains the reliable method for pre-operative estimation of the acetabular diameter.
The Use of Primary Healthcare Services by University Students in Marrakech-Safi Region, Morocco: Cross-sectional Study.
Khachay FE, Mansoury O, Nouari N … +4 more , Ouahid H, Sebbani M, Amine M, Adarmouch L
Niger Postgrad Med J · 2026 Jul · PMID 42390517 · Publisher ↗
BACKGROUND: The health status of students affects their learning, quality of life and relationships during their academic and personal life. Access to and use of youth-friendly health services by young people is an impor...
BACKGROUND: The health status of students affects their learning, quality of life and relationships during their academic and personal life. Access to and use of youth-friendly health services by young people is an important issue that should be taken into account by health authorities when providing services to this group. OBJECTIVE: The objective is to describe the use of primary healthcare (PHC) services by the student population in the Marrakech-Safi region. MATERIALS AND METHODS: A cross-sectional survey was conducted among students enrolled at public universities in the Marrakech-Safi region, Morocco, during the academic year 2023-2024. A self-administered questionnaire was completed by 605 participants. Studied variables included socio-demographic data, student knowledge and use of PHC services. RESULTS: Among the participants, 73.1% were female and the average age of the sample was 22.03 ± 4.7 years old. A proportion of 64.8% [95% confidence interval (60.8%, 68.6%)] of the respondents had used PHC facilities in the past 12 months, with an average of 2.1 ± 1.9 visits, 31% of them were from rural areas. The use of PHC facilities was significantly associated with monthly family income ( P = 0.014) and income-generating activity ( P = 0.033). CONCLUSION: Improving living conditions broadly, especially the socio-economic conditions of young students, may be a sustainable approach to remedy obstacles linked to access to care, and in particular the use of PHC facilities.
Prevalence and Antimicrobial Resistance of Non fermenting Gram-negative Bacilli Isolated from Blood Culture Samples in a Tertiary Care Hospital.
Poddar A, Tiwade YR, Karmakar SN
Niger Postgrad Med J · 2026 Jul · PMID 42390516 · Publisher ↗
BACKGROUND: Non-fermenting Gram-negative bacilli (NFGNB) are emerging as a significant cause of bloodstream infections (BSIs), a major concern of morbidity and mortality worldwide. The high intrinsic resistance of NFGNB...
BACKGROUND: Non-fermenting Gram-negative bacilli (NFGNB) are emerging as a significant cause of bloodstream infections (BSIs), a major concern of morbidity and mortality worldwide. The high intrinsic resistance of NFGNB to antimicrobial compounds makes treatment of BSI difficult and expensive. AIMS: This study aimed to determine the prevalence of NFGNB and the antimicrobial susceptibility pattern of the isolates. METHODOLOGY: A total of 1230 blood culture samples were received in the department of microbiology during the study period of 3 months, which were processed by standard microbiological procedures. Antimicrobial susceptibility tests were performed using Clinical and Laboratory Standards Institute (CLSI) guidelines. RESULTS: Out of 255 (20.73%) positive blood culture samples, 105 (8.5%) Gram-negative bacilli were isolated, of which 41 (3.33%) NFGNB were identified. The most common isolate identified is Pseudomonas aeruginosa (21), followed by Acinetobacter spp. (20). A higher percentage of antibiotic resistance was seen for Acinetobacte r spp. and even higher antibiotics like ceftazidime (87.5%) and gentamicin (92.5%). CONCLUSION: This study will help us start empirical treatment and implement proper hospital infection control measures.
Unravelling the Association of Cognitive Impairment among Type 2 Diabetes Mellitus Patients: A Cross-sectional Study.
Jabeen M, Banu FZ, Sherigar A … +5 more , Radhakishan M, Ananthesh L, Alex A, Subramanya C, Mateti UV
Niger Postgrad Med J · 2026 Jul · PMID 42390515 · Publisher ↗
BACKGROUND: Patients with diabetes are increasingly susceptible to complications, one of the most overlooked being cognitive impairment. As the majority of people with diabetes remain undiagnosed for cognitive disorders...
BACKGROUND: Patients with diabetes are increasingly susceptible to complications, one of the most overlooked being cognitive impairment. As the majority of people with diabetes remain undiagnosed for cognitive disorders and with the rising incidence of diabetes, early identification is essential. AIM: The aim of this study was to determine the prevalence and predictors of cognitive impairment among type 2 diabetes mellitus patients. MATERIALS AND METHODS: A cross-sectional study was conducted among 138 participants at a tertiary care teaching hospital. All the patients who were aged 18 years or above and who were on antidiabetic medications were included. Patients with a known history of dementia and those on Vitamin B12 supplementation were excluded. The Montreal Cognitive Assessment scale was used to assess cognitive impairment. Predictors of cognitive impairment were identified using multiple linear regression analysis. P < 0.05 was considered statistically significant. RESULTS: The mean age of participants was found to be 58.4 ± 10.6 years. The cognitive impairment was found among 130 (94.2%) diabetes patients. More than half of the participants, 73 (52.9%), had mild cognitive impairment and 44 (31.9%) had moderate impairment, whereas 13 (9.4%) were found to have severe cognitive impairment. Among the predictors, females had significantly lower cognitive scores than males (β = -2.76, P = 0.005), and participants with only primary education scored significantly lower than graduates (β = -3.94, P < 0.001). CONCLUSION: A high prevalence of cognitive impairment was found among diabetic patients. Hence, there is a need for healthcare policymakers to integrate cognitive screening into routine diabetes care to ensure early detection and improve patient outcomes.
What Predicts Attention-Deficit/Hyperactivity Disorder Literacy in Primary Schoolteachers?
Jome JJ, Prabhu V, Sekaran VC … +1 more , Lakshmi RV
Niger Postgrad Med J · 2026 Jul · PMID 42390514 · Publisher ↗
BACKGROUND: Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition affecting children's learning and behaviour. Teachers play a pivotal role in early identification, yet little is known...
BACKGROUND: Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition affecting children's learning and behaviour. Teachers play a pivotal role in early identification, yet little is known about factors predicting their ADHD literacy in India. AIMS: This study was conducted to evaluate the Mental Health Literacy (MHL) of primary schoolteachers regarding ADHD and to identify the predictors of MHL among teachers. METHODS: A cross-sectional, quantitative study was conducted among 303 primary schoolteachers. The study period was from December 2023 to June 2024. The study was conducted in Varkala and Attingal educational subdistricts of Thiruvananthapuram district. There are a total of 110 schools in both Attingal and Varkala subdistrict. A stratified cluster sampling technique was used to recruit the participants. Data were collected using a semi-structured validated questionnaire. Furthermore, the Knowledge of Attention Deficit Disorder Scale (KADDSs) was used. Descriptive and inferential statistics were used to assess knowledge and compare across socio-demographic characteristics. Binomial logistic regression was used to identify the predictors of MHL. RESULTS: The majority of participants (56.8%) were in the age group of 35-50 years, with 94.4% being female. Most teachers (38%) had more than 10 years of teaching experience. The study found that 98.7% of teachers had a low level of knowledge related to ADHD. The mean knowledge scores showed significant association with socio-demographic characteristics such as marital status ( P = 0.01), status of work ( P = 0.004), type of school ( P < 0.001), teaching hours per week ( P = 0.005), medium of instruction ( P = 0.03) and average class strength ( P < 0.001). The school area and average class strength were significant predictors influencing the MHL of teachers (adjusted odds ratio [AOR]: 3.40, 95% confidence interval [CI]: 1.22-9.44; AOR = 2.38, 95% CI: 1.37-4.15, respectively). CONCLUSION: Findings show that most teachers have low ADHD knowledge, influenced by socio-demographic factors, with school area and class strength significantly predicting MHL. This highlights the need for targeted training to improve teachers' ability to support students with ADHD.
Construction and Validation of an Osteoporosis Risk Prediction Model for Elderly Population based on National Health and Nutrition Examination Survey Data.
Lao Y, Liang Z, Ling H … +2 more , Li W, Lu R
Niger Postgrad Med J · 2026 Jul · PMID 42390513 · Publisher ↗
BACKGROUND: Osteoporosis is a systemic bone disease characterized by low bone mass and destruction of bone microstructure, which is prone to fractures. It is more common in the elderly. Against the context of global popu...
BACKGROUND: Osteoporosis is a systemic bone disease characterized by low bone mass and destruction of bone microstructure, which is prone to fractures. It is more common in the elderly. Against the context of global population aging, osteoporotic fractures have become a major public health burden. OBJECTIVE: To construct and validate a nomogram model for predicting osteoporosis risk in elderly individuals aged ≥60 years based on National Health and Nutrition Examination Survey (NHANES) data. MATERIALS AND METHODS: This cross-sectional study included 3,422 participants aged ≥60 years from the NHANES database (2017-March 2020). Osteoporosis was defined as a dual-energy X-ray absorptiometry (DXA) T-score ≤ -2.5. Demographic characteristics, biochemical indicators, anthropometric measurements, and inflammation-related indices were collected. Univariate and multivariate logistic regression analyses were used to identify independent predictors of osteoporosis. The dataset was randomly divided into a training set (70%) and a validation set (30%). A nomogram model was then developed and validated using area under the curve (AUC), calibration curves, and decision curve analysis (DCA). RESULTS: The results showed that female gender (5.92[3.21,10.91], P < 0.001), age (1.06[1.03,1.09], P < 0.001), height (0.94[0.91,0.96], P < 0.001), BMI(0.97[0.95,1], P = 0.038), drinking history (1.78[1.02,3.12], P = 0.043), history of kidney disease (1.96[1.06,3.62], P = 0.033), previous hypercholesterolemia (1.47[1.03,2.09], P = 0.036), and difficulty falling asleep (1.6 [1.12,2.28], P = 0.010) were independent predictors of osteoporosis in the elderly. The nomogram demonstrated its good discrimination ability with AUC values of 0.806 in the training set and 0.793 in the validation set. Calibration curves showed good agreement between predicted and observed outcomes, and DCA confirmed clinical applicability. CONCLUSION: This study developed a clinically applicable prediction model to identify elderly individuals at high risk of osteoporosis, aiding early intervention and reducing adverse outcomes.
Barriers to the Nursing Process in Iraqi Nursing Education and Practice: Cross-sectional Study.
Mustafa MAK, Mousa AM, Majeed HM
Niger Postgrad Med J · 2026 Jul · PMID 42390512 · Publisher ↗
BACKGROUND: The nursing process is an essential component of nursing practice and education, functioning as a systematic, evidence-based approach to patient care. OBJECTIVES: the main objective is to identify and compare...
BACKGROUND: The nursing process is an essential component of nursing practice and education, functioning as a systematic, evidence-based approach to patient care. OBJECTIVES: the main objective is to identify and compare the specific barriers faced by faculty, nursing students and nursing managers in implementing the nursing process. MATERIALS AND METHODS: This study employed a descriptive and cross-sectional design to investigate the perceived barriers to the implementation of the nursing process amongst nursing faculty members, undergraduate nursing students and nurses. The study was conducted across a range of governmental and educational institutions located in nine Iraqi provinces. A structured questionnaire was used as the primary data collection tool. It consisted of two parts: (1) demographic information and (2) 15 items assessing perceived barriers to implementing the nursing process using a five-point Likert scale. The data were analysed using the SPSS version 29. RESULTS: the results show that the overall effect level of barriers as perceived by different roles as follows, majority (70%) rated the barriers as having a moderate effect, about 27%-29% considered the effect high, while only a few saw it as low. CONCLUSIONS: This study concluded that reveal that the most significant obstacles to implementing the nursing process stem from institutional and administrative short comings, such as inadequate managerial support, lack of standardised documentation systems and unclear policies. Healthcare institutions should establish clear policies, provide adequate staffing and implement standardised tools to facilitate the use of the nursing process.
Operative Management of Anal Fistula in Lagos: Outcomes and Complications.
Balogun OS, Lawal AO, Osinowo AO … +3 more , Makanjuola AO, Oluseye OO, Adesanya AA
Niger Postgrad Med J · 2026 Jul · PMID 42390511 · Publisher ↗
BACKGROUND: Fistula-in-ano (FIA) describes an anal condition in which there is a connecting tract between the perianal skin and the lining of the anal canal. Surgery is the mainstay of treatment. Disease recurrence and a...
BACKGROUND: Fistula-in-ano (FIA) describes an anal condition in which there is a connecting tract between the perianal skin and the lining of the anal canal. Surgery is the mainstay of treatment. Disease recurrence and anal incontinence are major concerns in surgery for FIA. The conventional fistulotomy and fistulectomy have demonstrated superiority over the endoscopic and other sphincter-sparing treatments for FIA. AIMS: The study aimed at reporting our experiences of surgery for fistula-in-ano. There is a scarcity of local studies on FIA in Nigeria, hence the need to report our experience with surgery for FIA. METHODOLOGY: This is a retrospective review of available records of FIA cases in patients aged 16 years or more managed between February 2016 and February 2025. Information on demographical characteristics, clinical/radiological features and the type and number of surgical treatments for complete healing were retrieved from the records for analysis. Excluded from this study were patients with incomplete records and patients with secondary fistulae. Data analysis was performed using SPSS. RESULTS: We analysed records of 30 cases of FIA. There were 24 males (80%) and 6 females (20%) giving a ratio of 4:1. The mean age of all patients was 40.8 ± 10.8 years (range: 24-60 years). The modal age group was between 30 and 39 years. Twenty-seven cases (90%) were primary FIA; all patients presented with recurrent anal discharge of pus. Twenty-three patients (76.6%) presented with perianal pain. The number of external openings recorded was single in 22 patients (76.6%). Three patients presented with horseshoe-type FIA. Low-type fistula accounted for 90% of cases. Surgical treatments offered were anal fistulectomy in 11 patients (36.7%), partial fistulectomy and insertion of cutting seton in 11 (36.7%) patients, anal fistulotomy in seven patients (23.3%). Procedure-related complications occurred in six patients (20%). Occasional faecal incontinence was documented by two patients (6.7%). Recurrence after healing of the fistula tract was seen in two patients (6.7%). CONCLUSION: FIA occurs mostly in males; the majority are of low posterior type. Surgical deroofing or excision of the tract with surgical or seton fistulotomy has a good success rate. It is recommended as the first line of treatment in low-resource settings.
Litigation Prevention, Mediation and Alternative Dispute Resolution in Health Care: A Narrative Review of Perspectives from Orthopaedics and Spine Practice.
Ajiboye LO, Galadima AB, Aliyu NA … +1 more , Hussaini MM
Niger Postgrad Med J · 2026 Jul · PMID 42390510 · Publisher ↗
BACKGROUND: Healthcare litigation is increasing globally and imposes significant emotional, financial and reputation and trust-related costs. Orthopaedic and spine surgery carry particularly high medico-legal risk becaus...
BACKGROUND: Healthcare litigation is increasing globally and imposes significant emotional, financial and reputation and trust-related costs. Orthopaedic and spine surgery carry particularly high medico-legal risk because of technical complexity, uncertain outcomes and heightened patient expectations. Alternative dispute resolution (ADR), especially mediation, offers confidential and collaborative means to both prevent and resolve conflict. OBJECTIVES: To (i) examine litigation-prevention strategies and ADR modalities applicable to orthopaedic and spine practice; (ii) synthesise common sources of conflict, the advantages of ADR over litigation and implementation challenges within the Nigerian health system and (iii) propose recommendations for hospital governance, professional regulation and incorporation of ADR training in medical education. METHODOLOGY: A narrative review of English-language literature was conducted across biomedical databases and grey sources using predefined keywords ADR, ADR processes with outcome and barriers in low- and middle-income countries, and patient safety. Eligible studies included empirical research and programme reports. Thematic synthesis focused on conflict drivers, mediation, on medical litigation, orthopaedics, policy and legal analyses, preventive mechanisms and spine surgery. RESULTS: One hundred and fifty-two sources met the inclusion criteria. Major conflict drivers were consent and communication failures, poor documentation, expectation-outcome mismatch, disputes over surgical indication, peri-operative complications, implant and device issues, financial hardship and delayed presentation. ADR consistently showed advantages in cost, timeliness, confidentiality, therapeutic relationship preservation and learning potential. Barriers included weak institutional ADR frameworks, limited mediator clinical literacy, fragmented regulation, low insurance penetration and poor quality-improvement data. CONCLUSIONS: ADR provides an effective, confidential approach to reducing litigation in orthopaedic and spine practice by addressing communication failures early and preserving therapeutic relationships. Strengthening consent, documentation, institutional ADR pathways and mediator clinical skills, supported by policy reforms and ADR education, can reduce preventable conflicts and promote safer, more accountable surgical care in Nigeria.
Causal Effects of Metabolic Factors on Pancreatic Ductal Adenocarcinoma Risk: A Mendelian Randomization Study.
Zhou J, Yu Y, Xia T … +1 more , Chen C
Niger Postgrad Med J · 2026 Jul · PMID 42390509 · Publisher ↗
BACKGROUND: Epidemiological studies focusing on pancreatic ductal adenocarcinoma (PDAC) have consistently reported robust positive associations between metabolic factors and PDAC. In the realm of evaluating the causal im...
BACKGROUND: Epidemiological studies focusing on pancreatic ductal adenocarcinoma (PDAC) have consistently reported robust positive associations between metabolic factors and PDAC. In the realm of evaluating the causal implications of these factors on PDAC, Mendelian randomisation (MR) demonstrates distinct advantages over traditional observational research approaches. Therefore, an MR study was meticulously designed and executed to elucidate the causal relationship between obesity-related metabolic factors and PDAC. AIMS: This study aimed to explore the relationship between PDAC and obesity-related metabolic factors. MATERIALS AND METHODS: We identified instrumental variants corresponding to 30 exposures. These exposures could be classified into four distinct groups, namely traits related to glucose metabolism-related traits, lipid metabolism-related traits, body fat distribution and body mass index (BMI)-related traits. Summary-level data for PDAC were obtained from FinnGen consortia. MR analysis was conducted using three methods including inverse-variance weighted, weighted median and MR-Egger. Heterogeneity and horizontal pleiotropy were assessed to ensure result reliability. RESULTS: Our research findings demonstrated significant causal relationships among body fat distribution, BMI-related traits and PDAC. Specifically, parameters such as arm predicted mass, leg predicted mass, leg fat mass, trunk predicted mass, waist circumference, whole body fat mass, BMI, weight and basal metabolic rate exhibit positive associations with PDAC. Conversely, other risk factors, including the waist-to-hip ratio (WHR) and WHR adjusted for BMI, present negative associations. CONCLUSIONS: This study provided evidence that some obesity-related metabolic factors were correlated with PDAC. Specifically, significant correlations were observed between PDAC and certain body fat distribution as well as BMI-related traits.
A Randomised Controlled Trial Comparing Early versus Interval Laparoscopic Cholecystectomy for Acute Calculous Cholecystitis: A Study of Feasibility and Outcomes.
Kumar A, Kumar S, Rahman RA … +2 more , Verma A, Gupta SK
Niger Postgrad Med J · 2026 Jul · PMID 42390508 · Publisher ↗
BACKGROUND: Acute calculous cholecystitis (ACC) is a common surgical emergency. The optimal timing for laparoscopic cholecystectomy (LC) remains controversial. AIMS: This study compared outcomes between early LC (ELC) an...
BACKGROUND: Acute calculous cholecystitis (ACC) is a common surgical emergency. The optimal timing for laparoscopic cholecystectomy (LC) remains controversial. AIMS: This study compared outcomes between early LC (ELC) and interval LC (ILC) for ACC. MATERIALS AND METHODS: A prospective randomised controlled trial was conducted with 100 patients equally allocated to ELC (within 72 h) or ILC (6-8 weeks post-conservative management). Primary outcomes included operative time, conversion rate and total hospital stay. Secondary outcomes assessed intraoperative events and post-operative complications. RESULTS: Mean operative time was significantly longer in the ELC group (95.47 min vs. 73.69 min, P = 0.001). Total hospital stay was shorter with ELC (6.50 days vs. 10.80 days, P = 0.009). Conversion rates were higher in the ILC group (18% vs. 8%, P = 0.245). Bile duct injuries occurred exclusively in the ELC group (8% vs. 0%). Significant intraoperative bleeding (80% vs. 56%) and total postoperative complications (30% vs. 8%, P = 0.006) were more frequent with ELC. CONCLUSION: ELC reduces hospital stay but is associated with longer operative times and higher complication rates. ILC may offer a safer operative field but extends overall treatment duration. Timing should be individualised based on patient factors, surgical expertise and institutional resources, with stringent adherence to safety principles.
Surgical Hotspot: Evaluating the Safety of Day-case Early Cholecystectomy for Acute Cholecystitis.
Ekwesianya AC, Enayathulla F, Jesudoss A … +1 more , Ayantunde AA
Niger Postgrad Med J · 2026 Jul · PMID 42390507 · Publisher ↗
BACKGROUND: Laparoscopic cholecystectomy is increasingly being performed as a day-case procedure globally, and the previously held notion of 'interval cholecystectomy' is now being abandoned in favour of early cholecyste...
BACKGROUND: Laparoscopic cholecystectomy is increasingly being performed as a day-case procedure globally, and the previously held notion of 'interval cholecystectomy' is now being abandoned in favour of early cholecystectomy. Cholecystectomy for acute cholecystitis is associated with an increased risk of operative difficulty and intraoperative complications. AIMS: This study aimed at is to assess the safety of day-case laparoscopic cholecystectomy (DCLC) for acute cholecystitis. METHODS: Author to summarize the data collected over 3 years (February 2022 to January 2025) on patients scheduled for either 'urgent' or 'very urgent' laparoscopic cholecystectomy for acute cholecystitis. Data analysis was done with IBM SPSS Statistics 29.0.1.0. RESULTS: A total of 190 patients (age range 22-96 years, median 54) underwent urgent or very urgent laparoscopic cholecystectomy for 'hot gallbladder'; 145 (76.3%) were discharged on the same day, while 45 (23.7%) required overnight admission due to surgical difficulty or significant co-morbidities requiring monitoring. Out of the 145 day-case patients, the mean intraoperative difficulty score was 2.34 (on a scale of 1-4), with surgery durations ranging from 25 to 205 min (median of 75 min). Only four patients (2.8%) were readmitted within 30 days due to subhepatic abscess, post-operative pain, wound collection and hernia, but none required reoperation, and there was no mortality. CONCLUSION: DCLC for acute cholecystitis is safe and feasible for the majority of patients, even in complex cases. These results support the increasing role of early and day-case surgery in the management of acute cholecystitis. Enhanced pre-operative patient selection and optimisation, judicious use of surgical drains, streamlined theatre logistics and improved perioperative pain management could further improve the success of day case surgeries and enhance patient quality of life after laparoscopic cholecystectomy.
The Role of Digital Therapeutics and Artificial Intelligence in Chronic Disease Management: A Narrative Review.
Shendre SH, Mendhe H, Borkar S … +1 more , Nair N
Niger Postgrad Med J · 2026 Jul · PMID 42390506 · Publisher ↗
We conducted research showing that chronic disease management continued to challenge healthcare systems, payers, and patients. At the same time, digital therapeutics emerged as a promising and potentially transformative...
We conducted research showing that chronic disease management continued to challenge healthcare systems, payers, and patients. At the same time, digital therapeutics emerged as a promising and potentially transformative approach. They supported better management of long-term conditions, improved patient outcomes, and helped streamline healthcare delivery. We carried out a comprehensive literature search to identify both original reports and reviewed publications. The search covered multiple databases, including Google Scholar and PubMed, and we also gathered relevant information from credible online sources such as the World Health Organization and India's National Crime Records Bureau. Using these findings, the narrative explained how digital therapeutics reshaped chronic disease management by highlighting key benefits, the technologies that enabled these solutions, and the expected impacts on both clinical and economic outcomes. We also discussed the obstacles the sector encountered as it developed, and we considered the future prospects of digital therapeutics in chronic care. In conclusion, digital therapeutics offered personalised care, improved patient engagement and adherence, provided real-time monitoring and feedback, enhanced accessibility and convenience, and were cost-effective in managing chronic disease; however, challenges such as cybersecurity concerns, reliability of data, the digital divide, and a lack of extensive clinical validation needed to be addressed for widespread adoption. While the evidence to date suggested clear clinical and economic promise, realizing that promise required coordinated action stronger clinical trials to build robust evidence, clear regulatory pathways to ensure safety and efficacy, investment in secure interoperable infrastructure, and targeted efforts to close the digital divide so vulnerable populations were not left behind; policymakers, clinicians, payers, and technology developers had to collaborate to translate innovation into equitable, scalable care improvements.
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