Nigerian Medical Journal

Are preoperative serum cancer antigen 125 levels a prognostic factor for outcome in epithelial ovarian cancer? A systematic review

Shittu Adamu Muhammad — 2024-05-31

Background: Most patients with epithelial ovarian cancers (EOC) present with advanced-stage disease because of
non-specific symptoms and a lack of reliable strategies for early diagnosis. Cancer antigen 125 (CA-125) is
suggested as a useful prognostic biomarker, its serum level is raised in over 80.0% of patients with EOC. Primary debulking surgery (PDS) followed by chemotherapy is the conventional treatment, but neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) is offered to patients with unresectable disease. There are inconsistencies regarding the role of preoperative CA-125 serum levels to adopt in stratifying patients for treatment choice that offers the most benefit. This review aimed to determine the role of preoperative CA-125 levels in predicting optimal cytoreduction and the association between optimal cytoreduction and survival outcomes in patients with EOC.
Methodology: Three electronic databases CINAHL, Cochrane Library, and PubMed were searched for potentially relevant articles from 2016 to 2021 on the role of preoperative CA-125 levels in predicting optimal cytoreduction and survival in patients with epithelial ovarian carcinomas.
Conclusions: In patients who underwent NACT-IDS, a lower preoperative CA-125 value is a predictor of optimal cytoreduction, and an increase in preoperative CA-125 value is consistently associated with a decrease in optimal cytoreduction. There was insufficient data to assess overall survival. However, a raised preoperative CA-125 level is a poor predictor of the chance of achieving optimal cytoreduction and the rate of optimal cytoreduction was a weak predictor of overall survival in women who had primary debulking surgery.

The role of medical and dental consultants’ association of Nigeria (MDCAN) in enhancing competency of graduating medical students and preventing disruptions in academic calendars in Nigeria: A review.

Uche R Ojinmah — 2024-05-31

In Nigeria, the medical education system faces challenges ranging from inadequate infrastructure to a lack of
qualified personnel. These challenges not only affect the competency of graduating medical students but also lead
to disruptions in academic calendars. The role of the Medical and Dental Consultants Association of Nigeria
(MDCAN) in addressing these issues is crucial. This review examines the impact of MDCAN in enhancing the
competency of graduating medical students and preventing disruptions in academic calendars in Nigeria. It
discusses the importance of maintaining academic continuity and explores the reasons why disruptions in academic
calendars are not viable options for pressuring the government to improve doctors' and lecturers' welfare packages.
Through an analysis of relevant literature, this review underscores the significance of collaboration between
stakeholders to ensure the quality of medical education and the smooth functioning of academic institutions in
Nigeria. Ultimately, this paper proffers some solutions to mitigate the negative effects of strikes and improve the
quality of undergraduate medical education.

Interesting breast tumours: A tripod of cases

Guddi Rani Singh — 2024-05-31

Knowledge regarding the lesser common breast tumours, including malignant papillary neoplasms and glycogen-rich clear cell carcinoma, is limited. Overall, cases of papillary carcinoma of the breast fare better than invasive
breast carcinoma, from the data available in literature. Glycogen-rich clear cell carcinoma is characterized by the
presence of clear cells, having mostly a poorer prognosis. We hereby present three such cases which would add to
the existing available information. Case 1 is a 79-year-old female who presented with a left breast lump and bloody
nipple discharge. Mammography suggested a malignant lesion, with FNAC suspicious of malignancy. Surgery was
done and histopathological examination showed irregular islands of tumour cells having papillary fronds with
absence of myoepithelial layer. Immunohistochemically, the tumour was GATA3, CK7, ER, PR positive, HER2
negative, with Ki67 index 10%. The case was diagnosed as Solid papillary carcinoma. Case 2 is a 57-year-old
female presenting with a left breast lump along with bloody nipple discharge. Mammography and FNAC were in
favour of malignancy. A trucut biopsy was done, and microscopy revealed a tumour having >90% papillary architecture
with an infiltrative pattern. Features were suggestive of Invasive breast carcinoma with papillaroid features. The
tumour was GATA3, CK7, ER, PR positive, HER2 negative, with Ki67 index 15%. Case 3 is a 70-year-old female
presenting with a right breast lump with nipple retraction. Mammography and FNAC were suggestive of
malignancy. Trucut biopsy followed by microscopy revealed polygonal tumour cells with clear cytoplasm in a nested
pattern, showing positive staining for Periodic Acid Schiff. Immunostaining showed GATA3 positive, PAX8
negative, ER and PR positive, HER2 negative, and Ki67 index 20%. A diagnosis of Invasive breast carcinoma with
Glycogen-rich clear cell pattern was made. Identifying these rare entities is important along with assessing
hormone status for avoiding overtreatment and undertreatment and applying appropriate targeted therapies.

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Research output in orthopaedics and sports medicine from Nigeria and Africa – A bibliometric analysis

Kingsley Kelechi Ekwe — 2024-05-31

Background: Nigeria has a relatively large scientific community that produces an adequate research output among
African countries. Not many studies have analysed the research output in orthopaedics and sports medicine from
Nigeria and Africa. Hence, we aimed to analyze the research output in orthopaedics and sports medicine from
Nigeria and Africa.
Methodology: We used the SCOPUS data from the Scimago Journal & Country Rank website. It allows us to draw
various journal metrics for research.
Results: Between 1996 and 2022, Nigerian research publications in orthopaedics and sports medicine had grown
from 4 in 1996 to 39 in 2022 (a 10-fold growth) but overall is 62nd in the world representing 0.07% of publications
in the period. In the same period, Africa published 8297 papers in orthopaedics and sports medicine representing
only 1.24% of the global publications in this field.
Conclusion: There is low research output in Orthopaedics and Sports Medicine from Nigeria and, the whole
African continent. However, there has been a growth in the publications from Africa.

Factors determining satisfaction with service delivery at family medicine clinics of a tertiary hospital in North Central Nigeria.

Tensaba Andes Akafa — 2024-05-31

Background: Patients’ satisfaction with service delivered at the healthcare facility is a critical index of
quality of care in the health industry. Hence, it is paramount to ascertain patients’ satisfaction to improve
service delivery.
Methodology: The study was a cross-sectional design conducted among 104 patients aged 18 to 65 years
who were on follow-up for chronic diseases at the Family Medicine Clinics. Data was collected from the
participants via an interviewer-administered questionnaire. Statistical significance was determined using
paired samples t-test, Chi-square, and logistic regression was set at a p-value of ≤ 0.05.
Results: The study used 104 patients with chronic diseases. The mean age of the study population (N =
104) was 51.83± 9.37 years. The ages ranged from 21-69 years.65 (62.5%) were females; male to female
ratio was 1:1.7. The majority of them had formal education 59 (56.7%). There were no statistically
significant differences in the socio-demographic characteristics. Waiting time was found to be the most
significant predictor of patient satisfaction in this study (P=0.003; O. R=3.17, CI=1.03-1.15). The overall
satisfaction score with service delivery in the study area was 71.4%.
Conclusion: Patients recorded a high level of satisfaction with service delivery 71.4% for the care
received at the study site, particularly during their experiences with the physicians, pharmacists, lab
scientists, nurses, and record officers, and the neatness of the clinic’s environment. The results indicate
that good communication has a positive effect on patients’ level of satisfaction. Henceforth, service
providers should employ patient-centered communication to improve the quality of care.

Effect of envenomation on serum hepatic biomarkers in snake (echis ocellatus) bitten individuals in Zamko comprehensive health centre of the Jos university teaching hospital, North Central Nigeria

Abdulazis Longwap — 2024-05-31

Background: Snake bite is a neglected public health issue in many tropical and subtropical countries of the world.
About 5.4 million snakebites occur each year, resulting in 1.8 to 2.7 million cases of envenomation yearly. Hepatic
markers have been reported to rise 3-6 hours after injection of venom in experimental animals. This study aims to
biochemically assess ALT, AST, and GGT levels as biomarkers of Echis ocellatus envenomation in victims of
snake bite presented at JUTH Comprehensive Health Centre Zamko 6 hours post-bite and compared with values in
those bitten by non-venomous snakes.
Methodology: The study was a comparative cross-sectional study where serum levels of AST, ALT, and GGT were
compared between the study group and the control group.
Results: Of the 150 respondents, 75 from each study group, 90(60.0%) were Male while 60(40.0%) were Female,
with a Male to Female ratio of 1.5:1. The most predominant age group was 20-29 years 57(38.0%), the mean age
was 39 years. The most predominant occupation was farming 82(54.7%). The majority 82(54.7%) had a secondary
level of education. 91(60.7%) were married. A large majority of 123(82.0) had Christianity as their religion. We
found a significant increase in the levels of AST (47.45IU/L) and GGT (61.62 IU/L) in the study group compared
to AST (25.88IU/L), GGT (29.61IU/L) in the control group at p<0.05, while the level of ALT was similar in both
groups at p>0.05.
Conclusion: This implies that serum levels of AST and GGT can be used to diagnose envenomation in snakebite
patients.

Profile of cataract surgical patients at the national eye centre, Kaduna, Nigeria.

Thelma Imaobong Ndife — 2024-05-31

Background: Cataract surgery has evolved over the years. This study aims to highlight the profile of the patients that
underwent cataract surgery at a tertiary hospital with emphasis on patient demographics, surgical techniques performed,
intraocular lens powers implanted, and the complications managed.
Methodology: A retrospective cross-sectional descriptive study of all patients who had undergone cataract surgery
within two years at the National Eye Centre, Kaduna, Nigeria. Data extracted from the electronic version of the manual
cataract surgical records included the patient's age, sex, comorbidities, technique of cataract surgery performed, the
intraocular lens powers implanted, and complications encountered. Intraoperative and postoperative complications up to
the twelfth week were considered. All patients had biometry-guided intraocular lens implantation.
Results: One thousand four hundred and seventy- two (1,472) patient records of all ages met the inclusion criteria with a
male-female ratio of 1.4:1. The mean age was 51.4 ± 22.6 years. The difference in the mean age of the sexes was
statistically significant (p=0.01) and 95% CI was 7.37- 10.40 years. Glaucoma was the most common ocular comorbidity
142(9.65%) and only 5% (74) had systemic comorbidities. The mean intraocular lens (IOL) power was 19.25 ±
1.8Diopters (Range 10.5D to 26D). The commonest surgery performed was small incision cataract extraction with
posterior chamber intraocular lens implant (SICS + PCIOL) 91.2% followed by Trabeculectomy with SICS + PCIOL
(3.87%). Phacoemulsification accounted for 2.72% of surgeries. Intra-operative complications were posterior capsular
rent in 7.1% (104) and vitreous loss in 4% (58). The commonest post-operative complications were corneal edema6.9%
(103) and striae keratopathy 4.6% (68).
Conclusion: Most cataract patients were male, above 50 years of age, and likely to be older than the females at surgery.
The most performed surgical technique was small incision cataract surgery with posterior chamber intraocular lens
implantation (SICS + PCIOL) while the mean intra-ocular lens power was 19.25 ± 1.8Dioptres. Globally accepted
cataract surgical techniques utilizing recent technological advancements were employed with biometry-guided
intraocular lens power calculation and implantation. Complications fell within the accepted global rates

Influence of physical activity on health-related fitness in young adults: An observational research

Karampreet Kour Buttar — 2024-05-31

Background: Health-related fitness directly depends on the level of physical activity (PA) of the individual.
Inactivity contributes to around 3.3% of all deaths, making the lack of exercise and sedentary lifestyles
among the young generation a current source of concern. There is a paucity of research on the association
between PA and health-related physical fitness among young people. In the perspective of this, the
objective of this research was to find out the effect of PA levels on physical fitness in healthy adults.
Methodology: A total of 419 students between the ages of 18 and 25 participated in this cross-sectional
survey. The “Global Physical Activity Questionnaire (GPAQ)” was used to evaluate the PA. Their body
fat percentage was measured using a skin fold caliper, followed by measurement of VO2max using a gas
analyzer and hand grip strength and endurance assessment with the help of a computerized dynamometer.
For statistical analysis, Karl Pearson's correlation coefficients and the ANOVA test were utilized.
Results: PA was positively correlated with VO2 max (r=0.429), and handgrip strength (r=0.408) while
negatively correlated with body fat % (r=-.315). VO2 max, body fat, and hand grip strength differ
significantly amongst participants having different physical activity levels. (p-value =<0.05)
Conclusion: This research concludes that PA is associated with physical fitness. PA will lead to a definite
improvement in overall physical fitness. With the help of the results of this study, young adults can be
motivated for physical fitness.

Prevalence and factors associated with workplace violence in a tertiary healthcare facility in Nigeria.

Peter Elom — 2024-05-31

Background: Healthcare workers globally are at an increased risk of workplace violence. Adverse effects such as physical
injury, reduced quality of care to patients and lower productivity with associated costs to employers occur. Non-reporting
hinders the implementation of effective prevention. This study aimed to assess the prevalence, reasons for non-reporting of
workplace violence, and knowledge of prevention prior to designing intervention strategies in the study location where there is
a paucity of research on this issue.
Methodology: This cross-sectional study was conducted at a Teaching Hospital in Abakaliki, Ebonyi State, for 4 weeks in
2020 among 205 employees. The hospital was stratified into Clinical, Nursing Services, Pharmacy, Laboratory, and
administrative divisions; proportionate allocation and random sampling were used to select the allocated samples. A structured
questionnaire was used to collect data. Descriptive statistics determined the measures of central tendencies and dispersion,
while bivariate analysis of the variables was done using Pearson’s Chi-Square test. Statistical significance was set at p < 0.05
with a confidence level of 95%.
Results: The mean age of the participants was 39.1 ± 7.8 years. The prevalence of workplace violence was 70%. The most
common reason for non-reporting was complexities and time-consuming reporting procedures (26.5%) followed by fear of
reprisal on career (22.4%). The proportion of respondents with good knowledge of workplace violence prevention strategies
was high (69.8%). Gender (p = 0.03), work setting (p = 0.006), previous workplace violence training (p = 0.005) and
knowledge of workplace violence preventive strategies (p = 0.04) had statistically significant associations with experience of
workplace violence.
Conclusion: The high prevalence of workplace violence suggests a need for a workplace violence prevention program which
should include a simple process of reporting and training. The improved awareness from previous training may account for the
significant association with workplace violence.

A 2-year review of stroke admissions and short term out-come predictors in a teaching hospital, Southeast, Nigeria.

Ernest Nwazor — 2024-05-31

Background: Stroke is a common neurological disorder with a huge global burden in terms of mortality and
morbidity. Epidemiological evidence has shown that modifiable risk factors are responsible for more than
90% of all strokes. Stroke outcome in hospitalized patients is influenced by several variables, such as socio-demographic factors, stroke subtype, and admission severity. The interaction between stroke outcomes and
these parameters is often complex. The study is aimed to profile hospitalized stroke patients and determine
outcome predictors.
Methodology: A descriptive retrospective study of 100 patients hospitalized for acute stroke. Their medical
records were reviewed for demographic and clinical variables and relevant data were retrieved and analysed
using appropriate statistical methods.
Results: Of the 100 acute stroke patients studied, 36% were men and 64% were women. The mean age was
65.16±15.72. About 78% had ischemic strokes while 21% had haemorrhagic strokes. The commonest risk
factor was hypertension (71.2%). On multivariate analysis, stroke subtype, and admission duration were
significantly linked to stroke outcome.
Conclusion: Ischemic stroke comprises more than two-thirds of stroke admissions, with hypertension being
the most common risk factor and stroke case fatality of 23%. Stroke subtype and admission duration
significantly predicted stroke outcomes. The need to step up measures aimed at improving acute stroke care in
hospitalized patients is imperative as this will hopefully improve overall outcomes in resource-constrained settings such as Nigeria.

Clinical profile and middle cerebral artery velocity of children with sickle cell anaemia seen in UUTH, Uyo, Akwa Ibom state, Nigeria.

Iso Precious Oloyede — 2024-05-31

Background: The risk of stroke in individuals with Sickle Cell Anaemia (SCA) can be assessed by routine non-invasive measurement of their cerebral blood flow using a Transcranial Doppler (TCD) ultrasound scan. This study
aimed to determine the difference in blood flow velocity parameters in the middle cerebral artery (MCA) of
children with sickle cell anaemia compared to a normal age-matched population.
Methodology: This was a hospital-based comparative cross-sectional study among 40 SCA patients aged 3-16
years, in steady state and 40 age and sex-matched HbAA healthy subjects. This study lasted from June to October
2019. Medical history was retrieved using a structured questionnaire. The time-averaged mean of maximum
velocity (TAMMV) of the right and left MCA was measured using non-imaging TCD.
Results: The mean age ± SD of the SCA patients was 9.1 ± 4.4 years. The SCA patients and sex and age-matched
HbAA group consisted of 23 (57.5%) males and 17 (42.5%) females respectively. SCA patients had a significantly
lower mean ± SD haemoglobin (Hb) than the controls (7.1 ± 1.1g/dl vs 11.1 ± 1.4g/dl; p<0.001). The right MCA of
the patients with SCA had a significantly higher mean flow velocity compared to the controls (94.1 ± 23.1 vs 55.0
± 8.8cm/sec, p<0.001).
Conclusion: The mean TAMMV recorded in the SCA subjects were significantly higher than that of the non-SCA
subjects. There is a need to ensure that TCD ultrasound is employed as a routine screening tool for stroke risk
among SCA patients in Nigerian tertiary health institutions.

Utilization and findings of flexible naso-pharyngo-laryngoscopy in upper airway disorders: A clinic audit

Idris Abdullahi — 2024-05-31

Background: Flexible naso-pharyngo-laryngoscopy (NPL) has become an essential clinical tool for evaluating
patients with upper airway disorders in otorhinolaryngology. It has been established to be a simple, cost-effective,
and minimally invasive technique with good diagnostic yields. This study aimed to audit the procedure of flexible
NPL done in our clinic for over 2 years and analyzes the technique, indications, and findings of the procedure.
Methodology: A retrospective cross-sectional study among all the patients who presented to our ENT clinic in
ABUTH Zaria, from July 2021 to June 2023 with upper airway symptoms or neck swelling who had flexible NPL
done in the clinic. The records of these patients were reviewed, and information extracted including age, sex, use of
anaesthesia, indications and findings of the procedure were entered in SPSS and analysed.
Results: Flexible NPL was done in 266 patients aged 4 months to 85 years. Only 3% of the patients required local
anaesthesia. The commonest indications were for preoperative evaluation of goitre (26.7%), suspected adenoid
hypertrophy (18.4%), complaints of hoarseness (18.8%), and foreign body sensation (12%). The commonest
diagnoses made were adenoid hypertrophy (19.9%), laryngeal tumour (5.3%), nasopharyngeal tumour (4.9%),
vocal cord palsy (4.9%), rhinitis (4.5%) and pharyngitis (4.1%), laryngitis (3.0%), laryngopharyngeal reflux
disease (3.0%) and vocal cord nodule (2.3%).
Conclusions: Office flexible NPL was done commonly for preoperative evaluation of goitre, suspected adenoid
hypertrophy, hoarseness, and foreign body sensation. The commonest pathologies were adenoid hypertrophy,
laryngeal tumour, nasopharyngeal tumour, vocal cord palsy, rhinitis, pharyngitis, and laryngitis.

An audit of mortality pattern in the neonatology unit of the university of Uyo teaching hospital, Uyo, Nigeria: A seven-year review.

Enobong Edet Ekpenyong — 2024-05-31

Background: Most neonatal deaths occur in low and middle-income countries (LMICs). These deaths can be
prevented through universal access to basic high-quality in-patient health services. Prematurity, neonatal sepsis,
and perinatal asphyxia have been reported as the leading causes of in-patient neonatal deaths. This study aimed to
assess the trend of neonatal mortality in our hospital, determine the pattern and causes of neonatal mortality, and
evaluate the factors associated with neonatal mortality in our facility.
Methodology: This was a retrospective cross-sectional descriptive study conducted in the Special Care Babies
Unit (SCBU) and Sick Babies Unit (SBU) of the University of Uyo Teaching Hospital, over seven years (2015-
2021). Demographic, clinical, and mortality data was extracted from the case record files of patients into a
structured proforma and analyzed.
Results: There was a total of 228 deaths comprising 130 males (57.02%) and 98 (42.98%) females. The median
age at demise was 4.00 (IQR = 1.00 – 12.00) days for both genders.
The majority (71.50%) of deaths occurred in the Sick Babies Unit. More males died than females (57% vs 43%).
The three leading causes of death were: prematurity (38.60%), neonatal sepsis (38.16%), and birth asphyxia
(13.60%).
Conclusion: The leading causes of neonatal mortality in our environment are prematurity and neonatal sepsis.
There is a need for increased community education on antenatal care, training of traditional birth attendants,
improved newborn transportation facilities, and provision of neonatal intensive care facilities.