Category: Nevin Manimala

Clin Transplant. 2026 Aug;40(8):e70634. doi: 10.1111/ctr.70634.

ABSTRACT

BACKGROUND: The objective of this study is to evaluate the association between two imaging-derived measures-anteroposterior diameter (APD) and lateral abdominal wall-IVC distance (L-IVC)-and liver transplant (LT) waitlist outcomes.

METHODS: Retrospective cohort study of 520 adult LT candidates listed at a single academic transplant center from January 1, 2015, to December 31, 2023. APD and L-IVC were measured using cross-sectional abdominal imaging and categorized into three groups using interquartile thresholds: APD (<15.0 cm, 15.0-20.0 cm, >20.0 cm) and L-IVC (<10.0 cm, 10.0-12.5 cm, ≥12.5 cm). The primary outcome was time to LT; the competing outcome was waitlist removal due to death or clinical deterioration. Sub-distribution hazard ratios (SHRs) were estimated using competing risks regression. Harrell’s C-statistic and bootstrap comparisons were used to evaluate discrimination versus height, BMI, and body surface area (BSA).

RESULTS: Among 520 candidates (mean [SD] age, 55.7 [10.9] years; 37.5% women), small APD (SHR = 0.51; CI: 0.33-0.72; p = 0.02) and L-IVC (SHR = 0.39; CI: 0.21-0.62: p < 0.001) were associated with lower transplant probability. Candidates with larger APD (>20.0 cm) had the highest risk of waitlist removal (SHR = 1.47; CI:1.02-1.87; p = 0.04). L-IVC was most strongly associated with LT (C-statistic = 0.65) and waitlist removal (C-statistic = 0.67). In sex-stratified models, men with small APD or L-IVC had significantly lower transplant probability, while women with mid-range APD (15.0-20.0 cm) or L-IVC ≥ 12.5 cm had the highest transplant likelihood.

CONCLUSION: Anatomical measurements derived from imaging are more strongly associated with liver transplant waitlist outcomes, outperforming height, BMI, and BSA.

PMID:42553999 | DOI:10.1111/ctr.70634

Niger Med J. 2026 Mar 2;67(2):476-485. eCollection 2026 Mar-Apr.

ABSTRACT

BACKGROUND: Despite increasing e-cigarette use among young adults, data on medical students’ knowledge, attitudes, and practices (KAP) remain limited. This study assessed KAP regarding e-cigarettes and examined the influence of sociodemographic factors on their use.

METHODOLOGY: A cross-sectional study was conducted among 311 MBBS students at RUHS College of Medical Sciences, Jaipur. A validated 37-item questionnaire assessed sociodemographic details and KAP. Responses were recorded on a 5-point Likert scale. Data were analyzed using SPSS version 26 with descriptive statistics, independent t-tests, ANOVA, and chi-square tests. Subgroup analysis compared ever-users and never-users.

RESULTS: Among ever-users, the majority were male (74%) and aged 19-23 years (78%). Knowledge gaps were evident, with 23% unaware of e-cigarette types and 63% perceiving them as less harmful than conventional cigarettes. While most participants recognized nicotine-related harms (91%), awareness of regulatory measures was lower, including the national ban (61.6%) and prior taxation (57.5%). Over half (58.9%) considered e-cigarettes not cost-effective. Ever-users demonstrated relatively more favorable attitudes (43.8%); however, most rejected perceived social benefits (75.3%) and supported regulatory bans (56.2%). Overall use was low, with 76.5% reporting no lifetime use; among ever-users, occasional use predominated (43%).

CONCLUSION: Medical students displayed partial awareness and permissive attitudes, but ever-users showed inconsistent cessation behaviors. These findings underscore the need for targeted education and structured cessation support to address rising e-cigarette use in this vulnerable group.

PMID:42553993 | PMC:PMC13436990

Niger Med J. 2026 Mar 2;67(2):451-462. eCollection 2026 Mar-Apr.

ABSTRACT

An appropriate sample size is essential to determine methodological steps that underpin the scientific validity, ethical integrity, and practical feasibility of biomedical and health research. Inadequate estimation may lead to underpowered studies or unnecessary resource use and participant exposure. This article provides a practical overview of statistical power analysis and sample size determination using the G*Power software (version 3.1.9.7), which is a freely available tool for researchers. The Core statistical concepts, including hypothesis formulation, effect size estimation, significance level (α), statistical power (1-β), and their dynamic interrelationship, are outlined. The article further describes the G*Power software ecosystem, its graphical user interface, supported statistical test families, and the distinct modes of power analysis. Step-by-step methods with realistic research scenarios demonstrate sample size calculation for commonly used statistical tests, including independent and paired t-tests, z-tests for proportions, one-way ANOVA, correlation analysis, and multiple linear regression. The article also highlights common pitfalls, limitations of G*Power, and advanced considerations in sample size estimation. This article aims to provide researchers with a structured framework for accurate sample size estimation, thereby enhancing study quality, reproducibility, and ethical responsibility in biomedical research.

PMID:42553991 | PMC:PMC13436992

Niger Med J. 2026 Mar 2;67(2):791-805. eCollection 2026 Mar-Apr.

ABSTRACT

BACKGROUND: Iron deficiency (ID) is a common comorbidity in patients with heart failure (HF) and is associated with reduced functional capacity, diminished quality of life, and increased mortality. This study aimed to determine the prevalence of ID and its clinical characteristics.

METHODS: This descriptive cross-sectional study involved 136 patients with chronic HF at the University of Port-Harcourt Teaching Hospital. Informed consent was obtained. Blood samples were collected for a full blood count and serum ferritin analysis, while echocardiography was performed for all study participants.

RESULTS: The mean age was 59.2±14.9years, with 51% being males. Notably, 41% of the patients exhibited low ferritin levels (≤100ng/ml), indicating the presence of ID. Among patients with ID, 19.7% had anemia. Although patients aged 65 years and above tended to have lower ferritin levels, this difference was not statistically significant (p=0.141). In contrast, statistically significant associations were observed between ID and gender, with females being more susceptible to iron deficiency (p=0.036). However, normal levels of N-Terminal-prohormone-Brain Natriuretic Peptide (NT-Pro-BNP) and high sensitivity – C Reactive Protein(hs-CRP) were significantly linked to ID (p=0.001 & p=0.004, respectively), and there was no significant correlation between ejection fraction and ferritin levels.

CONCLUSION: Iron deficiency, with or without anemia, is prevalent in chronic heart failure patients, particularly among females and even in persons who have normal levels of markers of HF severity such as hs-CRP and NT-pro-BNP. Regular screening for ID is vital to identify and manage this comorbidity, as iron correction can lead to improved functional capacity and reduced morbidity and mortality associated with heart failure.

PMID:42553980 | PMC:PMC13436994

Saudi J Anaesth. 2026 Jul 2;20(3):519-524. doi: 10.4103/sja.sja_102_26. eCollection 2026 Jul-Sep.

ABSTRACT

CONTEXT: Effective postoperative analgesia after cesarean delivery is essential for early functional recovery. Ultrasound-guided transversus abdominis plane (TAP) block reduces postoperative pain and opioid consumption; however, its effects beyond analgesia remain unclear.

AIMS: To evaluate the effects of TAP block on postoperative pain, maternal self-efficacy, and early recovery after elective cesarean delivery.

SETTINGS AND DESIGN: This prospective randomized study was conducted at a tertiary care center between December 2024 and March 2025.

MATERIALS AND METHODS: Women undergoing elective cesarean section under spinal anesthesia were randomized to receive either bilateral ultrasound-guided TAP block (20 mL of 0.25% bupivacaine per side) or standard analgesia. Maternal self-efficacy was assessed at 48 hours postpartum using the Parent Self-efficacy Scale. Secondary outcomes included postoperative pain scores, time to first breastfeeding and mobilization, rescue analgesic use, neonatal caregiving duration within 24 hours, and length of hospital stay.

STATISTICAL ANALYSIS USED: Appropriate parametric or non-parametric tests were applied, with P < 0.05 considered statistically significant.

RESULTS: A total of 128 patients completed the study. The TAP block group showed significantly lower pain scores, reduced rescue analgesic requirements, earlier breastfeeding and mobilization, longer neonatal caregiving duration, shorter hospital stay, and higher maternal self-efficacy scores (P < 0.05).

CONCLUSION: Ultrasound-guided TAP block provides effective analgesia and supports early functional recovery after cesarean delivery, with additional benefits on maternal self-efficacy.

PMID:42553979 | PMC:PMC13436911 | DOI:10.4103/sja.sja_102_26

Niger Med J. 2026 Mar 2;67(2):669-682. eCollection 2026 Mar-Apr.

ABSTRACT

BACKGROUND: Sickle cell anaemia (SCA) is a hereditary haemoglobin disorder associated with significant cardiovascular complications. Blood pressure abnormalities, including both hypertension and hypotension, are increasingly recognized as important contributors to morbidity in affected children. This study aims to determine the prevalence of hypertension and hypotension among children with SCA in steady state and during vaso-occlusive crisis, and to compare these findings with age- and sex-matched controls with normal haemoglobin genotype (HbAA).

METHODOLOGY: This cross-sectional study included 135 children with SCA aged 2-17 years, evaluated during both steady state and crisis, alongside age- and sex-matched HbAA controls. Blood pressure was measured using a standard mercury sphygmomanometer (Accoson) with appropriately sized cuffs. Data were analysed using appropriate statistical methods, with significance set at p<0.05.

RESULTS: In the steady state, 4.4% of children with SCA were hypertensive, and 11.1% were hypotensive. During the crisis, 6.7% were hypertensive and 6.7% hypotensive. Among controls, 4.4% were hypertensive and 2.2% hypotensive. Mean systolic and diastolic blood pressures were comparable across steady state, crisis, and control groups (p=0.462). In the crisis group, haemoglobin concentration showed a significant negative correlation with diastolic blood pressure (r = -0.37, p = 0.011). Age demonstrated strong positive correlations with both systolic and diastolic blood pressures in the steady state (r = 0.78 and 0.79, respectively; p = 0.001) and during crisis (r = 0.66 and 0.57, respectively; p = 0.001).

CONCLUSION: Blood pressure abnormalities, encompassing both hypertension and hypotension, occur in children with SCA irrespective of clinical status. Despite comparable mean blood pressure values, acute crises are associated with dynamic variations influenced by age and haemoglobin levels. Routine and vigilant blood pressure monitoring is essential for early detection and optimal management.

PMID:42553978 | PMC:PMC13436986

Niger Med J. 2026 Mar 2;67(2):593-605. eCollection 2026 Mar-Apr.

ABSTRACT

BACKGROUND: Owing to the background physiologic derangements in critically ill patients, the risk of peri-intubation adverse events is higher than is seen in the operating room. Despite the burden of the problem, very little local data exists in Nigeria and sub-Saharan Africa. The objective of this study was to determine the incidence and risk factors for peri-intubation adverse events in the intensive care unit (ICU).

METHODOLOGY: This was a prospective, observational, multi-centre study involving critically ill adults requiring endotracheal intubation in the ICU between February and September 2024. The primary outcome measure was the incidence of peri-intubation adverse events (hypotension, hypoxia, cardiac arrest, and aspiration of gastric content) within 30 minutes of intubation. The secondary outcome measures included risk factors for these adverse events and their correlation with the length of ICU stay and 30-day in-hospital mortality. Data were analysed using SPSS version 25.

RESULTS: Fifty-one intubations involving 50 patients were included. Respiratory failure and neurological impairment were the major reasons for intubation (49.0% and 35.3%, respectively). The incidences of adverse events were hypotension (60%), severe hypoxia (32.6%), cardiac arrest (13.7%) and aspiration pneumonitis (17.8%). At least one adverse event was recorded in 74.8% of the intubations. We identified multiple intubation attempts as central to the occurrence of most adverse events. The probability of survival was higher in those with an adverse event, but it was not statistically significant.

CONCLUSION: Adverse events following intubation are common among critically ill patients in Nigeria. While hypotension was the most common complication, severe hypoxaemia emerged as the most lethal. Further research is needed on this subject.

PMID:42553977 | PMC:PMC13437006

Clin Orthop Surg. 2026 Aug;18(4):687-694. doi: 10.4055/cios25351. Epub 2026 Apr 1.

ABSTRACT

BACKGROUND: Superior labrum anterior to posterior (SLAP) lesions with paralabral cysts are uncommon. Although various procedures have been suggested, there is no consensus on the optimal choice. The purpose of this study was to compare clinical and radiological results between 2 procedures: SLAP repair with cyst decompression (RD group) and subpectoral biceps tenodesis with cyst decompression (TD group).

METHODS: Arthroscopic surgery for management of a paralabral cyst with a SLAP lesion was performed from January 2009 to January 2023 in 42 patients (RD group: 17, TD group: 25), who were available for a minimum 12-month follow-up. The visual analog scale (VAS) pain score, University of California, Los Angeles (UCLA) score, activities of daily living (ADL) score, and Subjective Shoulder Value (SSV) were evaluated. Postoperative magnetic resonance imaging (MRI) and manual muscle testing (MMT) were performed 6 months after surgery.

RESULTS: The mean age of patients in the RD group was 40.0 years and that of the TD group was 46.4 years (p = 0.014). Both groups showed significant improvement in the VAS pain score, UCLA score, ADL score, SSV score, and MMT after surgery. However, no significant difference was observed between the 2 groups. All but 1 patient in the RD group were able to return to work and sports at preoperative levels. This patient was diagnosed with brachial plexopathy after surgery and showed spontaneous improvement. Twenty-five of 42 patients (59.5%) underwent follow-up MRI 6 months after surgery, and there was no recurrence of the ganglion cyst with complete resorption.

CONCLUSIONS: Compared with cyst decompression and SLAP repair, cyst decompression combined with subpectoral biceps tenodesis demonstrated no statistically significant differences in clinical and radiographic outcomes in this retrospective cohort of patients with SLAP lesions and concomitant paralabral cysts. The findings of our study suggest that biceps tenodesis may be an effective surgical alternative for patients with compromised biceps integrity.

PMID:42553972 | PMC:PMC13437143 | DOI:10.4055/cios25351

Niger Med J. 2026 Mar 2;67(2):523-533. eCollection 2026 Mar-Apr.

ABSTRACT

BACKGROUND: Despite the formal launch of Nigeria’s Maternal and Perinatal Death Surveillance and Response (MPDSR) national guideline in 2016, limited data exist on actual practice among healthcare workers. This study assessed MPDSR practice and its determinants among healthcare workers in three referral hospitals in Edo State, Nigeria.

METHODOLOGY: A cross-sectional study was conducted among 221 healthcare workers in Central Hospital, Benin, University of Benin Teaching Hospital, and Irrua Specialist Teaching Hospital. MPDSR practice was assessed using three indicators: having received MPDSR training, having ever reported maternal death, and having attended maternal death reviews. Respondents who engaged in at least two of these three practices were classified as having good practice. Data were analyzed using IBM SPSS version 25, with the chi-square test and binary logistic regression. Statistical significance was set at p < 0.05.

RESULTS: Only 50 (22.6%) healthcare workers demonstrated good practice of MPDSR, while 171 (77.4%) had poor practice. Training coverage was critically low (8.6%), one-third (33.9%) had ever reported a maternal death, and 48.9% had attended maternal death reviews; of these, 91.7% were passive attendees only. Multivariate analysis identified older age, good knowledge, and positive attitude toward MPDSR as independent predictors of good practice, while female sex was independently associated with lower odds of good practice (all p < 0.05).

CONCLUSION: Poor MPDSR practice prevails in the selected hospitals, with critical deficits in training coverage, death reporting, and meaningful review participation. Improving practice requires scaled-up training, strengthened reporting systems, and targeted strategies addressing knowledge, attitudinal, and gender-related barriers.

PMID:42553968 | PMC:PMC13436998

Niger Med J. 2026 Mar 2;67(2):509-522. eCollection 2026 Mar-Apr.

ABSTRACT

BACKGROUND: Breast cancer is one of the most common cancers among women in Nigeria. Human epidermal growth factor receptor 2 (HER2) is an important prognostic and predictive biomarker that guides targeted therapy. The tumour grade is an important prognostic factor and is also important in the treatment of patients. In a resource-limited setting, cell block cytology may serve as an alternative for initial biomarker assessment and also as an initial diagnostic tool for planning definitive management. The study aims to compare HER2 overexpression of breast carcinoma using cell blocks and corresponding paraffin wax-embedded (FFPE) tissue blocks and to evaluate the concordance between both methods.

METHODOLOGY: This was a one-year prospective study involving 83 cases of breast carcinoma patients with both cell block and corresponding FFPE tissue specimens. HER2 immunohistochemistry was performed using the ASCO/CAP 2018 guideline. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated with 95% confidence intervals (CI). Concordance was assessed using Cohen’s kappa statistic. McNemar’s test was used for paired comparisons.

RESULTS: The mean age of the study participants was 43.1 ±13.1 years, with a peak age group of 40-49 years. IHC HER2 overexpression was done on both cell blocks and histological blocks. In cell blocks, HER2 expression showed 15 cases (18.1%), 65 cases (78.3%), 3 cases (3.6%) were positive, negative, and equivocal, respectively while from histologic tissues, 15 cases (18.1%), 63 cases (75.9%), 5 cases (6.0%) were also positive, negative and equivocal respectively. The overall concordance rate between the two methods was 93.5%, with concordance rates of 100% for HER2-positive cases, 96.9% for HER2-negative cases, and 60% for equivocal cases. Sensitivity and specificity of cell block HER2 assessment were 96.9% (95% CI: 82.9-99.9) and 100% (95% CI: 94.3-100.0), respectively. The PPV of HER2 assessment on cell block was 100.0% (95% CI: 78.2-100.0), and the NPV was 97.1% (95% CI: 89.9-99.6). The kappa coefficient for agreement was 0.935, indicating excellent agreement. McNemar’s test showed no statistically significant difference (p = 0.480). Equivocal (2+) cases were included without FISH confirmation. Most of the cases were invasive ductal carcinoma (NST), accounting for 97.6% (81 cases).

CONCLUSION: Cell block cytology demonstrates strong concordance with FFPE tissue for HER2 assessment and may serve as a reliable alternative for initial triaging in resource-limited settings, particularly where tissue is not readily feasible. However, confirmatory testing on tissue biopsy remains essential, particularly for equivocal cases.

PMID:42553962 | PMC:PMC13437011