Nevin Manimala

Niger J Clin Pract. 2023 Sep;26(9):1377-1382. doi: 10.4103/njcp.njcp_246_23.

ABSTRACT

BACKGROUND: With the increasing medical brain drain in Nigeria, there is a need to train and graduate more doctors to fill in the gaps created to mitigate the effects. To meet this goal, the trainers need to evolve and have the competency to deliver quality training for many more enrollees in medical schools.

AIM: This study aimed to gather information about the perception of medical teachers’ need to obtain certification in medical education and what this will achieve in scaling up the competency and number of graduating medical doctors.

SUBJECTS AND METHODS: Medical teachers in Nigeria participated in this mixed (quantitative and qualitative) study. Four hundred medical consultants and teachers were randomly selected and sent a semi-structured pre-validated questionnaire; also, a panel discussion was conducted with six medical teachers with other special assignments in universities and postgraduate colleges. Quantitative data were analyzed using Statistical Package for the Social Sciences (SPSS) 24, differences in proportions were calculated using the Chi-square test, and P values <0.05 were considered significant.

RESULTS: Two hundred and thirty-eight (59.5%) participants completed the form, 63 (26.5%) had practiced for <5 years, and 114 (47.9%) had >10 years of practice experience. A majority of 168 (70.6%) were physician lecturers in federal or state universities, and 15.5% had obtained certifications of any kind in medical education. Over 80% perceived that medical education training should not be a prerequisite to teach, but a similar percentage believed that faculty medical education training can help scale up the training competency and the number of graduating medical doctors.

CONCLUSION: To scale up the number and competency of graduating medical doctors, medical teachers need to acquire core teaching competency. The respondents and discussants believe that when these core teaching competencies have been fully developed, it will be easier to increase the number of medical students’ enrollees, teach them their curriculum through innovations, and graduate them with improved competencies.

PMID:37794553 | DOI:10.4103/njcp.njcp_246_23

Niger J Clin Pract. 2023 Sep;26(9):1361-1367. doi: 10.4103/njcp.njcp_170_23.

ABSTRACT

BACKGROUND: There have been many testicular losses due to testicular compartment syndrome (TCS). Studies are ongoing to lower the pressure within tunica vaginalis during TCS.

AIMS: To provide enough space for reperfusion of the testicular tissue and to reduce intratesticular pressure by resecting testicular tissue in the affected testis for treatment of TCS.

MATERIALS AND METHODS: The study was designed as a prospective randomized animal study. A total of 24 Wistar albino adult rats were randomly divided into three groups. After torsion surgery group 1 underwent detorsion + testicular tissue resection (TTR), while only detorsion was performed in group 2. The control group did not undergo any procedures. At the postoperative 5^th day all subjects were sacrificed, and their testes were evaluated in terms of histologic findings, apoptosis, and microangiogenesis. One-way ANOVA and Tukey’s test were used for analysis.

RESULTS: According to Johnsen scores, all the groups were statistically different from each other and the damage in group 1 was less than in group 2 (P < 0.05). Factor VIII expressions in surgical groups were significantly higher than in the control group (P < 0.05). However, the surgical groups did not show any significant difference between each other (P > 0.05). Apoptotic cell counts were higher in both surgical groups than in the control group. Also, there was significantly higher apoptotic cell count in group 2 than in group 1 (P < 0.05).

CONCLUSIONS: The injury secondary to TCS is lower when TTR is performed. In the cases in which tunica vaginalis graft could not be obtained or in the delayed cases, TTR may be useful.

PMID:37794551 | DOI:10.4103/njcp.njcp_170_23

Niger J Clin Pract. 2023 Sep;26(9):1348-1353. doi: 10.4103/njcp.njcp_110_23.

ABSTRACT

BACKGROUND: The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused a pandemic named coronavirus disease 2019 (COVID-19) that has become the greatest worldwide public health threat. Although different treatment recommendations are offered for COVID-19 infection, steroid treatment remains important.

AIM: We aimed to demonstrate the effect of pulse steroid therapy (PST) on inflammatory markers and patient outcomes in moderate/severe COVID-19 pneumonia.

MATERIALS AND METHODS: We retrospectively analyzed the patients 18 years and older hospitalized in our hospital’s COVID-19 clinics between April 1, 2020, to June 30, 2020, and July 1, 2021, to November 30, 2021. Patients in the moderate/severe COVID-19 pneumonia category, according to the World Health Organization COVID-19 guidelines, were included in the study. The demographic characteristics of the patients, treatments, inflammatory markers, and patient outcomes (need for intensive care, length of hospital stay, high-flow nasal oxygen (HFNO) requirement, mechanical ventilation (MV), and mortality rates) were recorded and analyzed.

RESULTS: Patients who received PST had more advanced age (P < 0.01), more comorbidities (P < 0.001), and more HFNO need (P < 001) compared with the patients who did not receive PST. There was no statistically significant difference between clinical outcomes: the need for intensive care, length of hospital stay, need for MV, and mortality rates (P = 0.54, P = 0.3, P = 0.14, and P = 0.09, respectively). When we evaluated the unvaccinated patients, there was a statistically significant difference in the MV need and mortality rates between those who received PST and those who did not (P = 0.017, P = 0.014, respectively).

CONCLUSION: It was observed that PST provided similar mortality, ICU, and MV requirements in patients with older age and comorbidities. Lower MV requirements and mortality were observed in the unvaccinated group receiving PST compared with the unvaccinated group not receiving steroids. PST is still promising in COVID-19 infection, and more studies are needed for standard doses and applications.

PMID:37794549 | DOI:10.4103/njcp.njcp_110_23

Niger J Clin Pract. 2023 Sep;26(9):1335-1341. doi: 10.4103/njcp.njcp_69_23.

ABSTRACT

BACKGROUND: Social achievement goals such as the desire to receive positive feedback from the social environment or avoid negative feedback are situations that affect an individual’s quality of life and predispose them to mental disorders.

AIM: The aim of this study is to investigate the relationship between social achievement goals and self-esteem, depression, and anxiety in medical school students.

MATERIALS AND METHODS: 400 participants, 201 of whom were female volunteers, between the ages of 18-30, studying at the Faculty of Medicine were evaluated. Sociodemographic Data Form, Social Achievement Goal Orientation Scale, Beck Anxiety Inventory, Beck Depression Inventory, and Rosenberg Self-Esteem Inventory Sub-Scale were applied to the participants.

RESULTS: A negative correlation between social development goals and depression (rs = -0.218, P < 0.001) and anxiety (rs = -0.188, P < 0.001), and a positive correlation with self-esteem (P = 0.002) were found. A statistically significant and positive correlation between social performance-avoidance goals and depression (rs = 0.233, P < 0.001) and anxiety (rs = 0.245, P < 0.001), and still statistically significant, and negative relationship with self-esteem (P = 0.001) were found. While social performance-approach goals were positively correlated with anxiety (rs = 0.192, P < 0.001) and depression (rs = 0.108, P = 0.03), no statistically significant correlation was found with self-esteem (P = 0.129).

CONCLUSION: It has been seen that our study generally supports the other studies in the literature concerning the relations between social achievement goal subgroups and self-esteem, depression, and anxiety in university students. It will be possible to contribute to the findings with studies encompassing university students from different cities and departments and studies with a large number of participants other than students.

PMID:37794547 | DOI:10.4103/njcp.njcp_69_23

Niger J Clin Pract. 2023 Sep;26(9):1319-1325. doi: 10.4103/njcp.njcp_54_23.

ABSTRACT

BACKGROUND: Sepsis monitoring tissue perfusion is crucial for detecting circulatory failure early, implementing the right treatments, and assessing response. Insufficient oxygenation leads to a rise in lactate level and has been shown to be useful in predicting mortality and morbidity in newborns. There have not been many studies on how lactate measurement affects neonatal sepsis diagnosis and prognosis.

AIM: The aim of our study was to determine the impact of lactate on early diagnosis and prognosis in neonatal sepsis.

MATERIALS AND METHODS: Eighty-seven newborns diagnosed with neonatal sepsis at a neonatal intensive care unit between January 2010 and July 2021 were included in the study. Venous blood gas, lactate, and C-reactive protein (CRP) levels and complete blood count on the first, second, and third day of hospitalization were noted. Lactate values were correlated with other variables to determine the impact of hyperlactatemia on morbidity and to determine factors affecting the length of stay. IBM SPSS Statistics version 22.0 for Windows was used to analyze the data (SPSS Inc., Chicago, IL, United States).

RESULTS: A strong negative correlation between lactate and oxygenation and perfusion indicators (HCO₃, BE, PaO₂) during the therapeutic process was observed. With treatment, the initial measured lactate value decreased, and a significant increase in CRP and oxygen saturation was observed, which was interpreted as the observation of an early lactate response to infection before a CRP response. The initial lactate level, as well as the change in lactate levels, was not, however, significantly correlated with the length of stay.

CONCLUSION: Lactate can be used in the early diagnosis of neonatal sepsis and for determining prognosis.

PMID:37794545 | DOI:10.4103/njcp.njcp_54_23

Niger J Clin Pract. 2023 Sep;26(9):1297-1302. doi: 10.4103/njcp.njcp_22_23.

ABSTRACT

BACKGROUND: Inflammation biomarkers known as acute phase reactants (APRs) show significant variations in serum concentrations during inflammation brought on by both viral and noninfectious diseases. The erythrocyte sedimentation rate (ESR), the C-reactive protein (CRP), the lactate dehydrogenase (LDH), the ferritin, the fibrinogen, the procalcitonin, the D-dimer, and the troponin I are all significant APRs. During inflammation, the serum levels of each of these positive APRs rise. The sensitivity and specificity of hematologic parameters and indices are as high as the inflammatory biomarkers mentioned above for monitoring disease severity and treatment response.

AIM: We aimed to evaluate the differences in hematological parameters and indices, and to reveal their treatment and prognostic values, especially in deceased patients with COVID-19.

MATERIALS AND METHODS: The hemogram parameters of 169 critical patients with COVID-19 (125 males and 44 females) who received inpatient treatment at ….

between 1 March 2020 and 31 December 2021 were analyzed retrospectively. The patients were divided into two groups-deceased (77) and surviving (92)-noting demographic data such as age and gender. All analyses were performed using SPSS 25.0.

RESULTS: Analyses of the hematological parameters used during the treatment processes revealed statistically significant differences between the two patient groups. White blood cell (WBC), neutrophil, and neutrophil-to-lymphocyte ratio (NLR) values were significantly higher (P = 0.019, P = 0.000 and P = 0.000, respectively) for deceased subjects, while lymphocyte, platelet and plateletcrit (PCT) values were significantly lower (for all values, P = 0.000). Platelet volume (MPV) and platelet distribution width (PDW), as well as MPV/PLT, PDW/PLT, MPV/PCT, and PDW/PCT, levels were significantly higher in deceased subjects (P = 0.000). Particularly in our deceased cases, receiver operating characteristic analyses were performed to reveal the importance of such analyses in prognostic status evaluation in COVID-19 since the hematological parameters are quite different. Cut-off values were determined for each parameter, and sensitivity and specificity ratios were calculated. While the sensitivities of MPV/PLT, PDW/PLT, MPV/PCT, and PDW/PCT indices are over 80%, neutrophil and white blood cell sensitivities were found to be lower (74%, 68.8%, respectively).

CONCLUSION: In addition to NLR, which is an important biomarker, the hematological indices MPV/PLT, PDW/PLT, MPV/PCT, and PDW/PCT can be used to determine the risk of death in patients with severe COVID-19.

PMID:37794542 | DOI:10.4103/njcp.njcp_22_23

Niger J Clin Pract. 2023 Sep;26(9):1257-1263. doi: 10.4103/njcp.njcp_503_22.

ABSTRACT

BACKGROUND: Bidirectional relationship exists between diabetes mellitus and periodontitis. Glycated albumin is an emerging biomarker to assess intermediate glycemic control. Salivary glycated albumin has not been evaluated in periodontitis.

AIM: The aim of the study was to compare salivary glycated albumin in periodontitis patients with and without diabetes mellitus before and after periodontal therapy.

MATERIALS AND METHODS: This comparative cross-sectional study was conducted in the Department of Periodontics. Ninety subjects (mean age 41.8 ± 6.82) were categorized into three groups. Clinical examination and saliva sample collection were done at baseline and 4 weeks after scaling and root debridement. Salivary glycated albumin levels were estimated using an enzyme-linked immunosorbent assay. One-way analysis of variance with post hoc test and paired t-test was done for inter- and intra-group comparison. The optimal cut-off value was calculated using the receiver operating characteristic curve and by maximization of the Youden index.

RESULTS: Mean salivary glycated albumin was the highest in diabetic patients followed by non-diabetic periodontitis patients and least in healthy controls. All the intergroup comparisons were significant. A cut-off value of 72.19 ng/ml of salivary glycated albumin could predict diabetic status with a sensitivity and specificity of 75%. Salivary glycated albumin was significantly reduced in a similar manner in both groups after periodontal therapy (19.4% and 18.5%).

CONCLUSION: Periodontitis patients with diabetes mellitus were presented with the highest salivary glycated albumin. Non-surgical periodontal therapy resulted in a similar reduction of salivary glycated albumin in periodontitis with and without diabetes mellitus.

PMID:37794537 | DOI:10.4103/njcp.njcp_503_22

Niger J Clin Pract. 2023 Sep;26(9):1249-1256. doi: 10.4103/njcp.njcp_449_22.

ABSTRACT

BACKGROUND: Severe neonatal hyperbilirubinemia is a known risk factor for sensorineural hearing loss which is usually undiagnosed in our environment until school age due to a lack of routine screening programs.

MATERIALS AND METHODS: This cross-sectional study conducted between August 2020 and February 2021 employed a universal sampling of consecutive eligible participants after their mothers’ consent. Hearing screening was conducted using an automated auditory brainstem response (AABR) device (Otoport OAE + ABR^®). The proportion of AABR screening failure was assessed while associated clinical risk factors were determined using logistic regression. Statistical significance was set at 5% for all comparative analyses.

RESULTS: One hundred and sixty newborns below 28 days of age, delivered at 34 weeks gestation and above, who had jaundice were recruited. The prevalence of screening AABR failure in at least one ear was 26.2%. Significant risk factors for AABR screening failure in addition to extreme and hazardous hyperbilirubinemia were acute bilirubin encephalopathy (ABE) (Odds Ratio (OR) =4.44, 95% CI = 3.19-6.17), birth weight below 2500 g (OR = 3.16, 95% CI = 1.48-6.77), dull tympanic membrane (TM) (OR = 5.94, 95% CI = 2.36-14.92) and exchange blood transfusion (OR = 4.84, 95% CI = 1.87-12.58).

CONCLUSION AND RECOMMENDATIONS: The prevalence of AABR screening failure was high, and a dull TM was its strongest predictor among late preterm and term neonates with hyperbilirubinemia. Otoscopy should be included in the care of newborn with hyperbilirubinemia and screening programs established to mitigate hearing loss among high-risk neonates in Abuja.

PMID:37794536 | DOI:10.4103/njcp.njcp_449_22

Niger J Clin Pract. 2023 Sep;26(9):1234-1241. doi: 10.4103/njcp.njcp_410_22.

ABSTRACT

BACKGROUND: Cervical spondylopathy is a common musculo-articular disorder, multiple exercises are recommended. Chinese fitness exercises are prevalent and used to treat various diseases.

AIM: To explore the efficacy of Chinese fitness exercise Yi Jin Jing exercise in intervening the cervical spondylopathy in adolescents.

PATIENTS AND METHODS: The study was conducted in 60 adolescent patients with cervical spondylopathy, with 30 patients in each group.

METHODS: The study was conducted in 60 adolescent patients with cervical spondylopathy, with 30 patients in each group. The observation group was required to take Yi Jin Jing exercise, and the control group took the brisk walking exercise. The first week was the preparatory period for the patients, and then the participants were required to do exercises three times a week for at least 30 minutes in the later 3 weeks. Before and after treatment, Neck Disability Index (NDI) scores, pain visual analog scale (VAS) scores, and cervical curvature in both groups were observed, and the incidence of adverse events in both groups was recorded during the trial.

RESULTS: The NDI and VAS scores in both groups statistically decreased after intervention and mildly increased at follow-up, while the reduction in scores of the Yi Jin Jing group was more significant. Cervical curvature in both groups improved on day 28 compared to day 0. There were no adverse reactions during the evaluation period.

CONCLUSION: The Chinese health-care qigong Yi Jin Jing exercise is more effective than brisk walking in improving the cervical range of motion and relieving pain in adolescents with cervical spondylopathy. Trial registration/Protocol registration: Clinical Trial Registry (ChiCTR2000030723).

PMID:37794534 | DOI:10.4103/njcp.njcp_410_22

Eur J Med Res. 2023 Oct 4;28(1):396. doi: 10.1186/s40001-023-01399-7.

ABSTRACT

AIMS: To evaluate the effect of antibiotic prophylaxis(AP) in the prognosis of Post-neurosurgical meningitis(PNM) patients.

METHODS: A cohort analysis was performed using the clinical database in Beijing Tiantan Hospital and Capital Medical University. Data were collected on patients with the diagnosis of PNM (n = 3931) during 2012.01 to 2022.04. The microbial distribution, types of AP, and 42 and 90 days survival analysis of AP patients were evaluated using probable statistical methods. Independent risk factors for mortality were established by constructing a logistic regression analysis.

RESULT: A total of 1,190 patients were included in this study, Klebsiella pneumoniae, Acinetobacter baumannii, and Staphylococcus aureus occupied the highest proportion. Of them, 929 cases received AP, cefuroxime and ceftriaxone are the most frequent used antibiotics. In addition, We found that PNM patients without AP significantly increased the 42 days and 90 days all-cause mortality rates. The use of different levels of AP did not improve patient outcomes, and ICU admission and assisted mechanical ventilation (AMV) were identified as independent mortality risk factors for PNM patient received AP.

CONCLUSIONS: AP plays an important role in the prognosis of PNM patients and has a significant function in improving prognosis. The prevention of PNM with antibiotics prior to neurosurgery should be emphasized in clinical practice, and appropriate selection of antibiotics is necessary to prevent the occurrence of infection and inhibit the emergence of antibiotic-resistant bacteria.

PMID:37794524 | DOI:10.1186/s40001-023-01399-7