Nigerian Medical Journal

Anaesthetic Management of a Patient with Dyke-Davidoff-Masson Syndrome Undergoing Robotic Thermocoagulative Hemispherotomy: A Case Report

Chandini Kukanti, Sumit Roy Chowdhury, Umadevi Manyam, Navdeep Sokhal — Thu, 02 Apr 2026 00:00:00 +0000

Dyke-Davidoff-Masson Syndrome (DDMS) is a rare neurological disorder characterized by cerebral hemiatrophy and compensatory calvarial changes, typically resulting from early-life cerebral insults. Patients may present with drug-resistant epilepsy (DRE), hemiparesis, and developmental delay. Due to its rarity and heterogeneous clinical presentation, diagnosis is often delayed or missed. We present the anaesthetic management of a 36-year-old male with DDMS undergoing Robotic Thermocoagulative Hemispherotomy (ROTCH) for DRE. The patient had a longstanding history of focal seizures since infancy and right-sided weakness. Radiological evaluation revealed left cerebral hemiatrophy, white matter volume loss, and compensatory hyperpneumatization of the frontal sinus. The procedure was performed under general anaesthesia with meticulous perioperative planning. Anaesthetic considerations included continuation of antiepileptic medications, potential alterations in drug metabolism due to hepatic enzyme induction, and careful airway management in view of craniofacial asymmetry. Robotic hemispherotomy was completed successfully without complications. The postoperative course was uneventful with a notable reduction in seizure frequency. This case underscores the importance of individualized anaesthetic strategies in patients with DDMS, highlighting the value of comprehensive preoperative assessment, attention to systemic anomalies, and intraoperative management in robotic neurosurgery. Additionally, it demonstrates the feasibility and efficacy of ROTCH as a minimally invasive surgical approach for refractory epilepsy in DDMS. Increased awareness and documentation of such rare cases are crucial for guiding clinical practice and optimizing outcomes in complex neuroanaesthetic scenarios.

Granular Cell Tumour of the Tongue: A Case Report of the Rare Lesion

Thu, 02 Apr 2026 00:00:00 +0000

Granular Cell Tumour (GCT) is a rare and painless benign soft tissue neoplasm of Schwann cell derivative. It is a slow-growing, firm, and solitary nodule usually smaller than 3 cm in diameter that frequently occurs in females between 4^th-6^th decade of life. We aim to describe the clinical presentation of the granular cell tumour (GCT) and the histopathological tools used to achieve its definitive diagnosis.We present a case of GCT of the tongue in a 46-year old female who presented with a year-old painless swelling on the tongue in our dental clinic. There was associated tenderness but disturbed deglutition. Clinical examination revealed a firm swelling in the right anterior two-thirds. Differential diagnoses made were chondroma, fibroma, and rhabdomyoma. Excisional biopsy for histopathological and immunohistochemical evaluation was diagnostic of GCT.GCT may be confused with other oral lesions clinically, but the use of histopathological and immunohistochemical tools confirmed its diagnosis.

Use of Oral Sildenafil in the Management of Persistent Pulmonary Hypertension of the Newborn: A Case Report and Review of Literature.

Thu, 02 Apr 2026 00:00:00 +0000

Persistent pulmonary hypertension of the newborn (PPHN) arises from failure of the normal circulatory transition that occurs postnatally and is characterised by increased pulmonary vascular resistance, leading to significant respiratory distress and hypoxaemia. Oral sildenafil administration is a potential alternative treatment for PPHN, especially when inhaled nitric oxide is unavailable.A 72-hour-old term male neonate was referred on account of respiratory distress, and cyanosis was noticed at 30 minutes of life with RR of 76 bpm and SPO2 of 57% in room air. The baby was pale, cyanosed, icteric, and febrile (39.5°C). An initial assessment of Severe NNJ 2⁰ to EONNS with background cyanotic congenital heart disease was made. An echocardiogram with colour Doppler interrogation confirmed the diagnosis of Persistent pulmonary hypertension of the newborn. The baby was commenced on compounded oral sildenafil @ 2mg/kg/dose 6 hourly in addition to oxygen therapy. Baby improved and was subsequently discharged home on oral sildenafil, which was discontinued after a normal repeat ECHO Scan done at 2 months of life. Oral compounded sildenafil was found to be a useful alternative in managing PPHN.

Septic Arthritis Caused by Carbapenem-Resistant Acinetobacter Baumannii with Paradoxical Minocycline Sensitivity: A Case Report

Ankit Batra, Ashok Kumar, Aarushi Batra — Thu, 02 Apr 2026 00:00:00 +0000

Multidrug-resistant (MDR) organisms are emerging as an important cause for septic arthritis and one of the major projected reasons for global mortality. Carbapenem-resistant Acinetobacter baumannii (CRAB) is among the most challenging bacteria due to limited and often toxic treatment options, and with documented infection-related mortality up to 70% in some settings, as compared to an approximate 25% for susceptible isolates. We describe a rare case of septic arthritis from Northern India due to a CRAB isolate that was resistant to nearly all routine and last-line antibiotics. However, paradoxically, it remained susceptible only to minocycline. The case was treated by minocycline therapy along with surgical management, resulting in a marked clinical improvement and recovery of functional joint mobility on follow-up. This case report draws attention to new challenges faced by physicians in the management of septic arthritis with increasing carbapenem resistance, particularly in low- and middle-income settings. It supports the relevance of “older” antibiotics such as minocycline, when guided by a culture and sensitivity-based approach, and underlines the importance of strict antimicrobial stewardship to counteract the rising antimicrobial resistance (AMR) challenge.

The Yellow Dialyzer Sign: An Unassuming Indicator of Occult Jaundice in Patients with End-stage Kidney Disease. A Case Report

Chimezie Godswill Okwuonu, Rasheed Abiodun Balogun — Thu, 02 Apr 2026 00:00:00 +0000

In patients with end-stage renal disease (ESRD), diagnosing jaundice can be challenging because uremic skin changes and anuria may obscure classic signs such as scleral icterus and dark urine. We report a rare case in which discoloration of the hemodialysis circuit provided the first clue to occult hyperbilirubinemia. A 35-year-old woman with ESRD secondary to lupus nephritis presented for hemodialysis with features of uremia and fluid overload. Physical examination revealed no scleral icterus or skin discoloration. After a 2-hour session using a low-flux polysulfone dialyzer, a striking yellowish discoloration of the dialyzer membrane was noted. Laboratory evaluation, prompted by this observation, revealed marked unconjugated hyperbilirubinemia, elevated lactate dehydrogenase, low haptoglobin, and hemoglobinuria, confirming intravascular hemolysis complicating systemic lupus erythematosus. The yellow discoloration was attributed to the adsorption of bilirubin-albumin complexes onto the hollow fibers of the dialyzer membrane. The patient was treated with high-dose oral prednisolone for autoimmune hemolytic anemia associated with a lupus flare. Over three weeks and six subsequent dialysis sessions, hemolysis markers normalized, the yellow discoloration resolved, and her clinical condition improved significantly. Yellowish staining of the dialyzer membrane is an uncommon but important bedside sign of hyperbilirubinemia in patients undergoing dialysis. This extracorporeal indicator may reveal serious conditions such as intravascular hemolysis or hepatic dysfunction when conventional clinical signs are absent. Careful inspection of the dialysis circuit can facilitate early diagnosis, prompt treatment, and improved outcomes in this vulnerable population.

A Double Tragedy of Coexisting Penile Fracture and Urethral Injury: A Case Report and Review of Literature

Thu, 02 Apr 2026 00:00:00 +0000

Penile fracture coexisting with urethral injury is very rare.We present a 35-year-old businessman with complaints of penile pain and a popping sound during sexual intercourse. Examination revealed a deformed phallus consistent with eggplant deformity, blood at the tip of the meatus and suprapubic swelling. A diagnosis of penile fracture coexisting with urethral injury and acute urinary retention was made. Immediate surgical intervention revealed a 1.5 x 0.5cm ventral transection of the mid-bulbar urethral and the right corpus cavernosum. He subsequently had urine diversion via suprapubic cystostomy, repair of ruptured tunica albuginea covering the corpora and urethroplasty over a size 16-FR silicone urethral catheter. Patient did well postoperatively with normal urination two weeks postop following removal of urethral stent.Penile fracture coexisting with urethral injury is a rare but serious urological emergency. Prompt detection and surgical intervention are crucial for a successful outcome.

Beckwith–Wiedemann Syndrome Presenting with Transient Features of Congenital Adrenal Hyperplasia in a Nigerian Neonate

Thu, 02 Apr 2026 00:00:00 +0000

Presentation of Beckwith–Wiedemann syndrome (BWS) is widely variable. Congenital adrenal hyperplasia (CAH) is the leading cause of atypical genitalia in the female newborn. Beckwith–Wiedemann syndrome was previously not recognized as a possible cause of a false diagnosis of CAH. A late preterm (gestational age of 36 weeks) female presented at the 3^rd hour of life with an anterior abdominal wall defect and swelling. Examination revealed coarse facial features, macroglossia, omphalocele major, prominent labia majora with hyperpigmented and enlarged clitoris. Weight was >97^th percentile for age and sex, with length and occipitofrontal circumference at 95^th and 50^th percentiles, respectively. Initial blood investigations revealed hypoglycaemia, hyponatraemia, hypocortisolaemia, elevated testosterone and 17-hydroxyprogesterone with female internal genitalia suggesting CAH. She was commenced on hydrocortisone. Omphalocele was managed conservatively. Abdominal ultrasound scan showed no enlargement of the adrenal glands or tumours. Genetic analysis showed hypomethylation at KCNQ1OT1: TSS-DMR (IC2) within 11p15.5, confirming a diagnosis of BWS. Clitoromegaly resolved spontaneously at six months of life without any surgical intervention, with normal pigmentation of the external genitalia. Steroids were tapered off, and repeat adrenal metabolites are normal. BWS may present with transient features suggestive of CAH.

Cultural Factors Influencing Prostate Cancer Screening Uptake in Urban Ogun State, Nigeria: A Review of Evidence

Thu, 02 Apr 2026 00:00:00 +0000

This review examined how cultural influences shape prostate cancer screening uptake among men in urban Ogun State, Nigeria, where screening rates remain low despite increasing disease burden and service availability. A scoping review of literature published between 2015 and 2025 was conducted using databases including PubMed, Scopus, Web of Science, African Journals Online, and Google Scholar, with additional relevant seminal studies considered. Eight eligible studies were synthesised thematically to identify recurring patterns in beliefs, attitudes, and practices affecting screening behaviour. The evidence showed that cultural misconceptions often framed prostate cancer as spiritual or incurable, discouraging early detection; masculinity norms portrayed screening as a sign of vulnerability; and reliance on traditional medicine frequently replaced biomedical screening. Cultural influences also intensified structural barriers such as cost, distance, and stigma, though culturally sensitive education and community engagement were noted to improve acceptance. Overall, screening uptake is shaped by interconnected cultural and structural factors. Improving early detection requires culturally responsive interventions that promote awareness, engage community and religious leaders, and strengthen accessible, community-based screening services.

Neoadjuvant Chemotherapy Response in Breast Cancer among Nigerian Women: A Systematic Review and Meta-Analysis (2000–2025)

Thu, 02 Apr 2026 00:00:00 +0000

Background: Neoadjuvant chemotherapy (NACT) is increasingly employed for locally advanced breast cancer in Nigeria, but treatment outcomes remain heterogeneous and often uncertain relative to global standards.

Methodology: We systematically reviewed Nigerian studies on NACT outcomes using PubMed, Embase, Scopus, Web of Science, AJOL, and grey literature through September 2025. Eligible studies included women receiving NACT who reported an objective response rate (ORR) or a pathologic complete response (pCR). Quality was assessed using ROBINS-I or RoB-2, and certainty was rated using GRADE. Pooled estimates were generated with random-effects (DerSimonian–Laird) models.

Results: Eleven studies (n = 629 women) met the inclusion criteria. Early anthracycline-based cohorts showed ORR = 51–93% with rare pCR. Contemporary anthracycline–taxane regimens achieved pCR ≈ 20%, the highest in HER2-positive and triple-negative disease. Pooled ORR = 66% (95% CI: 55–76%; I² = 46%) and pooled pCR = 20% (95% CI: 15–25%; I² = 39%). Excluding a non-standard single-agent trial raised pCR to 21%. The HER2-targeted ARETTA trial achieved pCR = 53%, approximating global benchmarks. Although one comparative study showed lower Nigerian pCR (5% vs 27% U.S.), survival appeared similar among patients completing multimodality therapy (observational finding). Certainty of evidence was rated low-to-moderate (GRADE).

Conclusions: NACT in Nigeria achieves consistent clinical downstaging but modest pCR outside HER2-targeted settings. Expanding access to biomarker testing, taxanes, trastuzumab (including biosimilars), and ensuring therapy completion are essential to close the global outcome gap.

Caesarean Deliveries in Internally Displaced Parturients at a Tertiary Hospital in Sub-Saharan Africa: A Five-Year Robson-Based Review

Thu, 02 Apr 2026 00:00:00 +0000

Background: Caesarean section (CS) is a common but important obstetric procedure that saves maternal and neonatal lives when complications occur. However, rising CS rates, especially among vulnerable populations such as internally displaced persons (IDPs), raise concerns about appropriate use, equity, and outcomes.

Aim: This study aimed to assess the frequency, pattern, and outcomes of caesarean deliveries among IDP women in a tertiary hospital in sub-Saharan Africa using the Robson Ten-Group Classification System.

Methodology: A retrospective, descriptive study was conducted at Benue State University Teaching Hospital, Nigeria, Sub-Saharan Africa, over a five-year period (March 2018 to February 2023). Data were obtained from clinical records of 167 IDP women who underwent CS. Deliveries were categorised using the Robson classification. Maternal, foetal, and obstetric characteristics were analysed using descriptive statistics.

Results: The mean age of respondents was 27.3 ± 6.3 years. Most were multiparous (88.0%), married (94.6%), and engaged in farming (74.9%). Only 13.2% were booked for antenatal care. Robson group 3 (multiparous, term, spontaneous labour, no previous CS) was the largest contributor to overall CS (26.3%), followed by group 5 (multiparous with previous CS; 19.2%) and group 7 (multiparous breech; 18.5%). The overall CS rate was 46.5%. Most patients (91.0%) had no postpartum complications. Live births accounted for 87.4% of deliveries, while 10.2% were stillbirths and 2.4% early neonatal deaths. APGAR scores at the 5th minute were ≥7 in 88.5% of cases.

Conclusion: The CS rate among IDP women was high, with Robson group 3 contributing the most, even though composed of women often considered low-risk. These findings show the importance of close monitoring in labour, antenatal care and audit systems to improve outcomes in displaced populations.

The Second Twin: Outcomes and Lessons in a Northern Nigerian Tertiary Hospital.

Thu, 02 Apr 2026 00:00:00 +0000

Background: Twin pregnancy is traditionally high risk, and with rising incidence, there is a need for evaluating the outcomes as a marker of the quality of care offered. There is some evidence to suggest that the second twin is at higher risk of adverse fetal outcomes, though several studies, especially in more advanced healthcare settings, have debunked this. There is a need for robust evidence on second twin outcomes in low-resource settings like ours to enable standardization and improved quality of care, which will lead to improved fetal outcomes. The objective of this study is to compare the delivery outcomes of first and second twins in terms of Apgar scores and stillbirth rates.

Methodology: The records of women who presented with twin gestation to the delivery suite, from January 2016 to December 2022, were retrieved using a structured proforma. Delivery outcomes were the Apgar scores at one and five minutes, and stillbirth rates.

Results: The most common presentation of the second twin was cephalic, and the mode of delivery was via CS. There was no statistically significant difference in Apgar score and stillbirth rate between the first and second twins. However, in those that had vaginal deliveries, the first- and fifth-minute Apgar scores were significantly lower in the second twin than the first twin.

Conclusion: There were no significant differences in adverse fetal outcomes between the first and second twins in the general population. However, the second twin may be at higher risk of birth asphyxia in twins delivered vaginally.

Pattern of Expression of Oestrogen and Progesterone Receptors in Ovarian Carcinoma from a Tertiary Center in Nigeria: A 10-Year Retrospective Study.

Thu, 02 Apr 2026 00:00:00 +0000

Background: Ovarian cancer (OC) is the seventh most common malignancy among women globally and a major cause of cancer-related mortality, with approximately 239,000 new cases and 152,000 deaths each year. Despite extensive research, there is currently no effective public health screening method for early detection, as commonly used investigations such as CA-125 testing, transvaginal ultrasonography, and bimanual examination lack sufficient diagnostic accuracy. This study evaluated the patterns of oestrogen receptor (ER) and progesterone receptor (PR) expression in ovarian cancer cases in Kano State, Nigeria.

Methodology: Relevant demographic data were obtained from laboratory records. Archival formalin-fixed, paraffin-embedded tissue blocks were examined using haematoxylin and eosin staining, followed by immunohistochemical analysis for ER and PR. Tumours were classified according to histological type and grade, and receptor expression was assessed based on immunostaining. Statistical analysis was performed using SPSS, version 26.

Result: Sixty ovarian cancer cases were analysed, with patient ages ranging from 10 to 75 years (mean age 52 ± 14 years). High-grade serous carcinoma (HGSC) was the predominant histological subtype, accounting for 63.3% of cases, followed by mucinous carcinoma (15%). Endometrioid carcinoma and malignant Brenner tumour each represented 8.3% of cases, while low-grade serous carcinoma was the least common (5%). Most cases occurred in the sixth decade of life, with HGSC comprising 74% of tumours in this age group. Oestrogen receptor (ER) positivity was observed in 40% of cases, with HGSC showing the highest ER expression. In contrast, progesterone receptor (PR) positivity was low (15%), with most PR-positive cases also being HGSC.

Conclusion: OC incidence increased with age, predominantly affecting women aged 50 years and above. The relatively high ER expression and low PR expression highlight the potential role of hormone receptor profiling in guiding personalised treatment strategies for ovarian cancer in this setting.

A Descriptive National Survey of Post-COVID Experiences of Nigerian Surgical Trainees

Obinna Remigius Okwesili, Ikenna Ifeanyi Nnabugwu, Solomon Kenechukwu Anyimba — Thu, 02 Apr 2026 00:00:00 +0000

Background: Medical training was disrupted during the COVID-19 pandemic, with an unprecedented reduction in elective, emergency surgical, and clinical procedures. This led to great interest in the use of virtual lectures, virtual conferences, webinars, and other technology-based resources such as telehealth consultations. This trend has introduced changes that have transformed surgical training/fellowship. The study aims to explore the transformation in clinical practice and residency training induced by the COVID-19 pandemic in a low- and middle-income country such as Nigeria, and ways of aligning with global trends.

Methodology: This was a quantitative questionnaire-based cross-sectional study. The survey link was distributed through professional WhatsApp® platforms of the residency associations of diverse surgery training institutions in Nigeria, and via email.

Results: There were 157 respondents. Urology (26.1%) and orthopaedic surgery (22.3%) had the highest numbers of respondents. The major cases done after the lockdown decreased COMPARED to the period before the lockdown. The residents using the audio form of telemedicine increased from 48% in the pre-COVID period to 61% in the post-COVID period. The video form increased from 4.5% to 21%, and those using internet Apps for clinical consultation increased from 13.4 % to 31.8%. McNemar’s test was significant for the differences in responses before and after COVID for audio telemedicine (p = 0.011), video (p = 0.000), and internet App telemedicine (p = 0.000). In the pre-COVID period, lectures, tutorials, and seminars were frequently delivered in-person (96.2%), while in the post-COVID period, they were predominantly done virtually (74.5%). Pearson’s chi-square test showed no significant associations between the stage of training and the responses (p > 0.05).

Conclusion: The pandemic affected surgical training for fellowships, hastening the adoption of virtual platforms, simulation technology, remote teaching, and mentorship into many fellowships’ curricula, giving rise to a flexible hybrid model of surgical fellowship.

Incidence of Post Dural Puncture Headache (PDPH) Following Subarachnoid Block in Lower Segment Caesarean Section: A Hospital-based Prospective Observational Study

Priyabrata Mohanty, Koshy Varghese, Umesh Kumar Singh — Thu, 02 Apr 2026 00:00:00 +0000

Background: Post-dural puncture headache (PDPH) remains one of the most distressing complications of spinal anaesthesia, particularly relevant in obstetric anaesthesia where subarachnoid block is commonly employed for caesarean sections. This study aimed to determine the incidence of PDPH following subarachnoid block in patients undergoing lower segment caesarean section (LSCS) and identify associated risk factors in a tertiary care hospital in Eastern India.

Methodology: This prospective observational study was conducted over 18 months (January 2019 to June 2020) at Tata Main Hospital, Jamshedpur. A total of 1305 patients undergoing LSCS under subarachnoid block were enrolled. Patient demographics, obstetric history, and anaesthetic technique-related variables—including needle size, number of attempts, and operator experience—were recorded. Patients were followed postoperatively for five days for the onset of headache and assessed clinically for PDPH.

Results: The overall incidence of PDPH was 1.5% (19/1305 patients). Among patients reporting headache, 56% experienced onset within 24-48 hours, with predominantly mild intensity and postural characteristics. The headache duration averaged 27.2±11.6 hours. The number of dural puncture attempts was significantly associated with PDPH occurrence (p=0.030), with incidence rising from 1.2% in a single attempt to 8.3% in ≥2 attempts. No significant associations were found with age, needle gauge, gravida status, operator experience, or bupivacaine dose.

Conclusion: This study demonstrated a low PDPH incidence following spinal anaesthesia for caesarean section. Technical precision in achieving successful first-attempt spinal anaesthesia emerged as the most critical factor in preventing PDPH, emphasizing the importance of operator skill over traditional risk factors.

Exploring the Persistence of Female Genital Mutilation: Primary Healthcare providers experience and their Perspective on Elimination.

Thu, 02 Apr 2026 00:00:00 +0000

Background: Female genital mutilation/cutting (FGM/C) remains widespread in Nigeria. With an estimated 19.9 million survivors, Nigeria accounts for the third highest number of women and girls who have undergone FGM worldwide. This study, therefore, aimed at identifying the factors that sustain the practice despite its illegality. Primary healthcare providers' experience and their perspectives on the elimination of FGM/C.

Methodology: This study used a descriptive qualitative design based on grounded theory. We used purposive sampling to identify and recruit primary health care providers. In-depth interviews and focus group discussions were conducted, and qualitative analysis was undertaken to develop a conceptual framework for understanding both the roots and the drivers of FGM.

Results: Historical traditions and religious rites preserve FGM and ensure its continuity, and older women and peers are a source of support for the practice through the pressure they exert. The easy movement of circumcisers across communities helps to perpetuate the practice, as does the belief that FGM will reduce promiscuity. Data collected between October and December 2023 were transcribed verbatim and thematically analyzed. Three themes exploring healthcare providers' perspectives on elimination of FGM/C were identified, namely understanding laws against FGM/C; perspectives on culturally sensitive education; and exploring public awareness raising activities in Nigeria.

Conclusion: Female Genital Mutilation continues to persist despite its illegality because of social pressure on women/girls to conform to social norms, peer acceptance, fear of criticism, and religious reasons. Implementing interventions targeting schools, religious leaders, older men, women, and strengthening Violence Against Persons (Prohibition) Act (VAPP) will help eradicate the practice.

Department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria

Thu, 02 Apr 2026 00:00:00 +0000

Background: Secondary peritonitis is a common surgical emergency in the developing world. It is associated with high morbidity and mortality rates despite advancements in treatment. This study aimed to determine the causes and treatment outcomes of secondary peritonitis following gastrointestinal perforation in a suburban Nigerian teaching hospital.

Methodology: This prospective study was conducted over one year, enrolling 64 patients with secondary peritonitis due to gastrointestinal perforation. Sociodemographic and clinical data were collected, and samples were analysed using standard procedures. Statistical analysis was performed using STATA software version 16.

Results: The study included 64 patients who met the inclusion criteria, 43 (67.19%) males and 21 (32.81%) females, with a male-to-female ratio of 2:1 and a mean age of 41.21± 2.79 years. Only 4 (6.25%) patients presented within 24 hours of the onset of symptoms, while 14 (21.88%) patients presented in shock. Gastroduodenal perforation (42.2%), ruptured appendicitis (37.5 %), and typhoidal perforation (12.5 %) were the main causes of secondary peritonitis. Complications occurred in 29.7% of patients, with surgical site infections being the most common. The mortality rate was 10.9 %, with comorbidities (p=0.005) and postoperative complications (p=0.004) significantly associated with outcomes.

Conclusions: Common causes of secondary peritonitis following gastrointestinal perforation in this study were gastroduodenal perforation, ruptured appendicitis, and typhoidal perforation. Postoperative complications were linked to mortality, emphasizing the importance of prompt evaluation and resuscitation to prevent complications. Only associations, not predictors, were identified. The limitation of this study is the relatively small sample size, which limits the generalizability of the findings to the Nigerian population. Consequently, larger, preferably multicenter studies are recommended.

Testicular Salvage Rate among Patients with Testicular Torsion in Abuja, Nigeria

Thu, 02 Apr 2026 00:00:00 +0000

Background: Testicular torsion (TT) represents a critical urological emergency characterized by the twisting of the spermatic cord necessitating immediate surgical intervention to prevent irreversible ischemic damage to the testis. The testicular salvage rate (TSR) is influenced by demographic, logistical, and institutional factors. However, there is a paucity of data on this subject in our setting. The study aims to determine the TSR among patients who had TT at Federal Medical Centre, Abuja, and to clinically review the presentations and outcomes of surgical intervention of this urologic emergency.

Methodology: We retrospectively reviewed the electronic medical records (EMRs) of all patients who had emergency scrotal exploration for testicular torsion between December 2022 and November 2025. The demographics, clinical presentation, intraoperative findings, procedures performed, and surgical outcomes were documented and analyzed.

Results: A total of 46 patients with TT had scrotal exploration within the study period. Their mean age was 20.3 ± 6.5 years, with an age range of 5- 39 years. The peak age group was 11-20 years. The right-to-left laterality ratio was 1.6: 1. No statistically significant difference was found in the monthly incidence of torsion. Only 13(28.3%) presented within the 6 hours of onset of symptoms, while long mesorchium was the most common anatomic predisposing factor identified (n=21, 45.7%). The commonest associated symptom was abdominal pain (32.6%). Of the 18 patients who had orchidectomy, 12 had ≥540-degree twist of their spermatic cords and gangrene of testes. The testicular salvage rate was 67.4%. Median hospital stay was 1 day (range 1-4 days)

Conclusion: Despite more than 70% of our patients presenting with delays, prompt surgical intervention achieved a salvage rate of 67.4%. Further research is necessary to investigate the long-term outcomes for patients post-salvage and evaluate the functional efficacy of the preserved tissue.

Prevalence, Pattern, and Correlates of Psychiatric Morbidity among Patients living with Cancer in Nigerian Hospitals

Thu, 02 Apr 2026 00:00:00 +0000

Background: Cancer is a growing public health concern in Nigeria and other developing countries, with many patients presenting late and experiencing psychiatric comorbidities. The aim of this study was to determine the prevalence of psychiatric morbidity among cancer patients.

Methodology: This cross-sectional study involved 230 cancer outpatients at the National Hospital Abuja, using a socio-demographic questionnaire, the General Health Questionnaire-12 (GHQ-12) for screening, and the Mini International Neuropsychiatric Interview (MINI) 6.0 for psychiatric diagnosis.

Results: This study found psychiatric morbidity in 49 (21.4%) respondents. Major Depressive Disorder was found in 39 (17.0%) respondents. Prevalence of other psychiatric morbidity in total respondents was suicidal 13 (6.0%), Generalized Anxiety Disorder 9 (3.9%), Alcohol abuse 2 (0.9%), Psychotic disorder 2 (0.9%), Mania 1 (0.4%), and Hypo-mania 1 (0.4%). The presence of psychiatric morbidity had a statistically significant association with years of awareness of diagnosis (χ2=8.98, p=0.03), past history of mental illness (χ2=17.82, p=0.001), disclosure of diagnosis (χ2=11.43, p=0.01, prognosis (χ2=7.49, p=0.01), and treatment options (χ2=13.18, p=0.001).

Conclusion: About one in five cancer patients in this study was fou nd to have psychiatric morbidity similar to other Nigerian findings. The presence of psychiatric morbidity has a statistically significant association with years aware of diagnosis, past history of mental illness, and disclosure of diagnosis, prognosis, and treatment options.

Association of BMI Grading with Aortic Pulse Wave Velocity and Augmentation Index in a Population of West India

Jayesh Dalpatbhai Solanki, Pankti Prathmesh Bhatt, Param J Kakadia — Thu, 02 Apr 2026 00:00:00 +0000

Background: BMI is graded differently in Asians, and its association with pulse wave analysis (PWA) based arterial stiffness (AS) parameters are unknown in the Indian population. We studied these AS parameters in relation to BMI grading as per ESI (Endocrine Society of India) for association, if any.

Methodology: This is a secondary pooled analysis of previously published data of normal (n=1186), diabetics (n=328), hypertensives(n=309), and diabetic hypertensives(n=401). Oscillometric PWA (Mobil-o-graph, IEM, Germany) was used to derive aortic BP (aBP), aortic pulse wave velocity (aPWV), augmentation index (AIx), and reflection %. All participants in each group were divided into BMI-based subgroups as per the ESI criteria for Indians. PWA parameters were compared among BMI-based subgroups in each of the four study groups.

Results: Aortic pressures, AIx, aPWV, and Ref% were significantly associated with BMI grading only in the normal subgroup and not in the other three groups with at least one of either diabetes or hypertension. In the multivariate linear regression model, BMI-based grading was not associated with aPWV or AIx after adjusting for gender, age, mean blood pressure, heart rate, and presence of diabetes and/or hypertension.

Conclusion: It suggests arterial stiffness to be a poorly BMI-dependent parameter and calls for more studies for its consolidation.

Shadows of Dependence: Temperament and Behavioural Changes among Children of Fathers with Opioid Dependence

Vijay Kumar Saini, Tanu Gupta, Dheeraj Goya, Pratibha Gehlawat, Pranshu Singh — Thu, 02 Apr 2026 00:00:00 +0000

Background: Parental opioid dependence has been associated with increased behavioural and emotional difficulties in children, including internalizing and externalizing problems. Despite the high prevalence of opioid use in our region, research on its impact on children of fathers with opioid dependence remains scarce. This study aimed to assess temperament and behavioural problems among children of fathers with opioid dependence.

Methodology: In this observational case-control study, 30 children of fathers with opioid dependence were compared with 30 age and gender matched controls. Information was collected from mothers. Mothers were screened for psychopathology using the General Health Questionnaire (GHQ), and children’s behavioural and temperamental characteristics were assessed using the Child Behaviour Checklist (CBCL) and Malhotra's Temperament Schedule (MTS).

Results: No significant differences were observed between groups regarding age and gender. Children of opioid-dependent fathers exhibited significantly higher CBCL scores across internalizing domains (Anxious/Depressed: p=0.021; Withdrawn/Depressed: p=0.043; Somatic Complaints: p=0.004) and externalizing domains (Aggressive: p=0.001; Rule-Breaking: p=0.003). Significant temperament differences were observed, with lower sociability (p<0.001), higher emotionality (p<0.001), and greater distractibility (p=0.001) in these children in comparison to controls, while energy and rhythmicity did not differ significantly.

Conclusion: Based on our findings, early identification and clinical screening are recommended to detect these behavioural and temperamental problems in childhood, as they may otherwise increase the risk of substance use and psychiatric disorders later in life. Family-centered interventions, along with supportive policy measures, can help prevent long-term adverse mental health outcomes in this vulnerable population.

Nigerian Nurses’ and Nurse Educators’ Readiness for Technology and Artificial Intelligence in Training and Practice: A Cross-Sectional Survey in Oyo State, Nigeria.

Thu, 02 Apr 2026 00:00:00 +0000

Background: Globally, AI and technology are being integrated into nursing education and practice, providing students with realistic patient care scenarios for safe, hands-on learning. These technological advancements and AI have also aided Nurses in documentation and data input, allowing nurses to focus more on patient care. However, the adoption of AI and other technologies in Nigeria’s nursing environment is still in its early stages compared to more developed countries.

This study investigates the readiness of Nigerian nurses and nurse educators in Oyo state to integrate technology and Artificial Intelligence (AI) into their training and clinical practice.

Methodology: A quantitative survey design was employed, with 115 registered nurses from Oyo State, Nigeria, participating.

Results: The study reveals moderate levels of technological use, with 73% of respondents having used some form of technology or AI tools in their practice. Perceptions towards AI integration were predominantly positive, with over 95% agreeing on its potential to improve healthcare delivery and patient outcomes. Readiness to utilise AI was high, with almost all respondents (97.4%) ready to utilise AI tools in practice. Key barriers to adoption included unavailability of necessary technologies (65.2%), insufficient infrastructure (62.7%), and inadequate training (60.8%). The study found significant associations between previous utilisation of AI, practice designation and readiness to utilise AI, as well as between nursing roles and perceptions of AI integration.

Conclusion: These findings highlight the need to develop and implement comprehensive AI training programs for Nurses, focusing on hands-on experience and understanding of AI applications in patient care. Given the high level of readiness, tailored training programs can help close the gap created by inadequate training.

Atherogenic Indices and Cardiovascular Risk in Post-Menopausal Women: A Comparative Study of Natural Versus Surgical Menopause

Thu, 02 Apr 2026 00:00:00 +0000

Background: Menopause is associated with an increased risk of cardiovascular disease (CVD) due to changes in lipid metabolism. The study objective is to compare lipid profile, atherogenic indices, and cardiovascular risk in women with surgical versus natural menopause, and to assess their correlation with Framingham Risk Score (FRS).

Methodology: This observational study included 120 postmenopausal women aged 40–65 years (natural menopause, n=98; surgical menopause, n=22). Demographic and anthropometric data, as well as blood samples, were collected. Lipid profile, atherogenic indices, and FRS were calculated and compared between groups using appropriate statistical analyses.

Results: Atherogenic indices were elevated in the surgical menopause group(p=0.000) versus those with natural menopause. FRS analysis showed 50% of surgical menopause cases had high cardiovascular risk (>20%) compared to 7.2% in natural menopause. Positive correlations existed between FRS and lipid parameters, including total cholesterol (r = 0.513, p < 0.000), non-HDL cholesterol (r = 0.569, p < 0.000), triglycerides (r = 0.235, p = 0.010), CRI I (r = 0.661, p < 0.001), CRI II (r = 0.319, p < 0.001), and AC (r = 0.381, p < 0.001).

Conclusion: Surgical menopause is linked to higher cardiovascular disease risk compared to natural menopause. The strong correlation of lipid ratios with FRS in the present study reinforces their potential utility as practical adjuncts to established risk prediction tools. These findings highlight the importance of menopause type in CVD risk assessment and the need for monitoring women undergoing surgical menopause.

Epidemiology and Spatial Dynamics of NIE-ZAS-1 and Related Lineages in Nigeria, 2020–2025

Thu, 02 Apr 2026 00:00:00 +0000

Background: Nigeria continues to face persistent circulation of circulating vaccine-derived poliovirus type 2 (cVDPV2), driven by sustained transmission of dominant viral lineages and intermittent emergence of new strains. Since 2020, the NIE-ZAS-1 lineage has remained the most epidemiologically significant strain, with ongoing spread across multiple states. This study describes the temporal, spatial, and lineage-specific transmission dynamics of NIE-ZAS-1 and emerging related lineages between 2020 and 2025.

Methodology: We conducted a descriptive epidemiological and spatial analysis of poliovirus lineage surveillance data across Nigeria from 2020 to 2025. Genetic lineage classifications (NIE-ZAS-1, NIE-YBS-1, NIE-YBS-2, NIE-BOS-1, NIE-KTS-1) were analyzed by state, year, and quarter. Geographic diffusion patterns were reconstructed using state-level detection timelines, frequency counts, and directional spread from presumed origin states.

Results: NIE-ZAS-1 originated in Zamfara State in 2020 and expanded to at least 21 states by 2025, accounting for the majority of detections throughout the study period. Transmission showed marked seasonality, with consistent Q3 peaks. In contrast, newer lineages such as NIE-YBS-1, NIE-YBS-2, NIE-BOS-1, and NIE-KTS-1 demonstrated limited spatial spread and short-lived circulation, largely confined to Borno, Yobe, and Kano states. Despite reductions in case counts in some quarters, no lineage showed sustained interruption of transmission by 2025.

Conclusion: Persistent cVDPV2 transmission in Nigeria is driven predominantly by the long-standing NIE-ZAS-1 lineage, with emerging strains failing to replace but adding complexity to the transmission landscape. These findings underscore the need for geographically targeted, lineage-informed vaccination strategies, enhanced surveillance in origin and amplifier states, and intensified efforts during high-risk seasonal periods.

Effectiveness of Conventional & Jigsaw Method of Self-directed Learning and Interactive Lecture in Undergraduate Physiology Teaching – A Comparative Study.

Debasish Chakraborty, Satabdi Saha — Thu, 02 Apr 2026 00:00:00 +0000

Background: Medical professionals are expected to be lifelong learners, and the contemporary medical curriculum emphasizes learner-centered education with active student participation. The Competency-Based Medical Education framework promotes the use of active learning strategies such as self-directed learning (SDL), problem-based learning, and small group teaching. However, evidence comparing conventional SDL, the jigsaw method of SDL, and interactive lectures in undergraduate physiology remains limited. This study aimed to compare the effectiveness of these teaching–learning methods among first-year MBBS students at Agartala Government Medical College.

Methodology: This educational interventional crossover study was conducted among 150 first-year MBBS students at Agartala Government Medical College from March to August 2025. Students were exposed to interactive lectures, conventional SDL, and the jigsaw method of SDL across cardiovascular (CVS), respiratory (RS), and central nervous system (CNS) modules. Knowledge was assessed using 10-item multiple-choice pre-tests and post-tests. Data were analyzed using paired and unpaired Student’s t-tests. Standardized effect sizes were calculated using Cohen’s d. A p-value <0.05 was considered statistically significant.

Results: Baseline pre-test scores were comparable across groups (p>0.05; d ≤0.32). Post-test scores were significantly higher with the jigsaw method of SDL compared to conventional SDL for CVS (78.47±11.15 vs 71.09±18.77; p=0.024; d=0.48), RS (84.52±9.16 vs 75.65±15.44; p=0.002; d=0.70), and CNS (83.26±26.34 vs 60.00±19.79; p<0.001; d=1.00). Interactive lectures performed better than conventional SDL for CVS (82.89±16.18 vs 71.09±18.77; p=0.002; d=-0.67) and CNS (71.06±13.87 vs 60.00±19.79; p=0.002; d=-0.65). Jigsaw method SDL was superior to interactive lectures for RS (84.52±9.16 vs 71.92±16.24; p<0.001; d=0.96) and CNS (83.26±26.34 vs 71.06±13.87; p=0.006; d=0.58).

Conclusion: Jigsaw-based self-directed learning is more effective than conventional SDL and interactive lectures in undergraduate physiology teaching, particularly for integrative topics. Its structured cooperative framework produces meaningful educational gains and supports the objectives of competency-based medical education.

The Tyranny of Time: Analyzing Waiting Time as a Critical Driver of Patient Satisfaction in a Nigerian Tertiary Hospital.

Selekeowei Peter Kespi Kpuduwei — Thu, 02 Apr 2026 00:00:00 +0000

Background: Prolonged waiting time is a ubiquitous challenge in public hospitals in low-and-middle-income countries (LMICs), significantly impacting patient satisfaction and service quality. The study’s objective is to analyze the components and impact of waiting time on patient satisfaction at the National Hospital Abuja (NHA).

Methodology: In a cross-sectional study of 300 outpatients, time spent at different service points (records, nursing, doctor consultation, laboratory, pharmacy) and total hospital time were recorded. Satisfaction with these times was measured on a 5-point Likert scale. Data were analyzed using descriptive statistics and an independent samples t-test.

Results: The mean total time spent in the hospital was 247.5 minutes (~4 hours). The longest waiting time was to see a doctor (112.6 ± 86.6 minutes), while the shortest was with records staff (20.7 ± 29.5 minutes). Despite the long wait to see a doctor, patients were "Very Satisfied" (mean=3.60) with the consultation time itself. Overall satisfaction with waiting time (responsiveness) was the lowest among all quality domains (mean=2.99). Insured patients spent a longer total time (267.9 min) than uninsured patients (230.8 min), but satisfaction levels did not differ significantly (P-value = 0.33).

Conclusion: Waiting time, particularly for physician consultation, is a major bottleneck and a key dissatisfier at the NHA. The discrepancy between long waits and high consultation satisfaction suggests that patients value the interaction once it occurs. To improve satisfaction, hospital administration must address the systemic failure of non-individualized appointment scheduling. Implementing a time-specific scheduling system is recommended as a crucial quality improvement intervention.

Drug Use Burden and Enforcement Indicators in Nigeria: A Retrospective Ecological Analysis

Ovie Martin Albert, Alexander Arthur — Thu, 02 Apr 2026 00:00:00 +0000

Background: Nigeria faces a substantial burden of illicit drug use alongside intensified enforcement activity. However, the geographic correspondence between enforcement indicators and population-level drug use burden remains poorly characterised. This study provides an ecological assessment of enforcement–burden alignment in Nigeria and introduces a Total Seizure-to–Any-Drug-User Ratio (TSUR) as a policy-relevant surveillance metric.

Methodology: We conducted a retrospective ecological analysis of Nigeria’s six geopolitical zones. Drug use burden was obtained from the 2018 Drug Use in Nigeria survey; seizure, arrest, and conviction data were extracted from National Drug Law Enforcement Agency (NDLEA) reports (2021–2022). We calculated a Total Seizure-to–Any-Drug-User Ratio (TSUR; kg seized per 1,000 estimated past-year users) using 2018 survey denominators and 2021–2022 NDLEA seizure totals. Associations were assessed using Spearman’s rank correlation (n = 6 zones). To evaluate robustness to temporal mismatch, we conducted sensitivity analyses assuming ±10–20% changes in zonal prevalence.

Results: Past-year drug use prevalence ranged from 10.0% to 22.4% across zones. National seizures increased substantially between 2021 and 2022 and were dominated by cannabis by weight. TSUR varied markedly across geopolitical zones (<5 kg to >300 kg per 1,000 users), indicating substantial geographic differences in seizure intensity relative to the 2018 baseline distribution of drug users. Zone-level correlations between seizure weight and estimated users were positive but statistically unstable, given the small number of aggregate units.

Conclusions: Marked regional variation exists in both drug use burden and enforcement activity across Nigeria. Using a historical demand-side baseline and subsequent enforcement indicators, this analysis demonstrates only partial geographic concordance between seizures and estimated user burden. The TSUR provides a transparent, scalable metric for contextualising enforcement activity alongside epidemiological estimates in data-constrained settings, when interpreted cautiously.

Effect of Hyperglycemia on Serum Uric Acid Levels in Patients with Type 2 Diabetes Mellitus

Thu, 02 Apr 2026 00:00:00 +0000

Background: Type 2 diabetes mellitus (T2DM) is a significant public health problem, particularly in Nigeria, with increasing prevalence worldwide. Hyperglycemia in T2DM is associated with various metabolic disturbances, including alterations in uric acid metabolism. This study investigates the effect of hyperglycemia on the serum uric acid (SUA) levels in patients with T2DM.

Methodology: This cross-sectional observational study included 100 participants comprising 70 patients with T2DM and 30 age- and sex-matched non-diabetic individuals in the control group. Blood samples were obtained to measure fasting and postprandial plasma glucose and SUA levels. Statistical analyses were conducted to compare the groups.

Results: A total of 100 participants were recruited for this study. The results indicated that diabetic patients had significantly higher fasting SUA levels (0.45 ± 0.16 mmol/L) when compared to the control group (0.28 ± 0.05 mmol/L, p = 0.02). Similarly, postprandial SUA levels were elevated in diabetic patients (0.58 ± 0.16 mmol/L) compared to controls (0.30 ± 0.06 mmol/L, p = 0.022). No statistically significant difference was observed between fasting and postprandial SUA levels within the diabetic and control groups (p>0.05).

Conclusion: Hyperglycemia in individuals with T2DM is significantly associated with increased serum uric acid levels. These findings show the clinical relevance of monitoring SUA in patients with type 2 diabetes.

Appraisal of Clinical Application of Oxygen Prescription and Administration in Nigeria

Thu, 02 Apr 2026 00:00:00 +0000

Background: Oxygen is one of the world's most used therapies. Its safe and effective use requires a good knowledge of oxygen therapy guidelines. This study assessed the knowledge of oxygen prescription practices among health workers in Nigeria.

Methodology: This was a descriptive, cross-sectional survey among health workers in Nigeria. A self-administered, semi-structured electronic questionnaire was used to collect data. Data collected included sociodemographic details, awareness of oxygen therapy guidelines, knowledge of oxygen prescription practices, and challenges of oxygen administration. The outcome measures were to determine health workers' knowledge of safe oxygen prescription and to identify barriers to safe oxygen prescription and administration.

Results: A total of 133 responses were received, comprising 67 (50.4%) physicians and 66 (49.6%) nurses at all levels of public and private health facilities. All respondents have at least one year of working experience. Most respondents (60.9%) had prescribed and/or administered oxygen in the preceding month, but only 36.8% had received training after their basic qualification. Only 60.9% were aware of the existence of an oxygen therapy guideline. The mean percentage score on knowledge of oxygen therapy was 69.3 ± 12.7%. The score was significantly higher among doctors (p < 0.001). The average score for sections assessing oxygen delivery practices and factors affecting pulse oximetry was lower (55.1% and 55%, respectively) than that of the other sections. Cost was the most prominent barrier to oxygen administration. Only 17.3% of respondents reported having an oxygen prescription chart in their hospital. Respondents in public tertiary hospitals were less likely to have pulse oximeters readily available (p = 0.003).

Conclusion: Few healthcare professionals receive training on oxygen therapy. Although overall knowledge was fair, performance on questions assessing oxygen delivery practices was much lower. There is a need for regular in-service training on oxygen therapy for healthcare workers.

Prophylactic Efficacy of Intravenous Nefopam Versus Ondansetron in Preventing Post-Spinal Shivering in Parturients Undergoing Elective Caesarean Section: A Double-Blind Randomised Controlled Trial

Thu, 02 Apr 2026 00:00:00 +0000

Background: Post-spinal shivering (PSS) is a frequent complication of spinal anaesthesia during caesarean section, causing patient discomfort and potential physiological disturbances. Both nefopam and ondansetron possess anti-shivering properties; however, comparative evidence in obstetric patients is limited. The objective of this study is to compare the efficacy and safety of intravenous nefopam and ondansetron in preventing post-spinal shivering in women undergoing elective caesarean section under spinal anaesthesia.

Methodology: This randomised controlled study included 96 ASA II parturients scheduled for elective caesarean section under spinal anaesthesia. Participants were randomly allocated into three groups (n = 32 each). Group N received intravenous nefopam (0.15 mg/kg), Group O received intravenous ondansetron (0.1 mg/kg), and Group P received 10 mL of normal saline as a placebo. The medications were administered 15 minutes before spinal anaesthesia. Patients were monitored for the incidence and severity of shivering using the Crossley and Mahajan scale. Side effects and the need for rescue medication (intravenous pethidine 0.5 mg/kg) were also recorded. Statistical significance was set at p < 0.05.

Results: The incidence of PSS was significantly lower in Group N (18.8%) and Group O (18.8%) compared with Group P (59.4%) (p < 0.001). Severe shivering (grades 3–4) occurred only in the placebo group (40.5%). Consequently, the need for rescue pethidine was significantly higher in Group P (37.5%), while none of the patients in Groups N or O required it (p < 0.001). Postoperative nausea was less frequent in Group O (3.1%) and Group N (12.5%) compared with Group P (25%) (p < 0.05). Mild injection-site pain occurred only in Group N (9.4%).

Conclusion: Intravenous nefopam and ondansetron are similarly effective in preventing post-spinal shivering and reducing rescue analgesia requirements during caesarean section under spinal anaesthesia. Ondansetron showed better antiemetic effect, while nefopam was associated with mild injection-site discomfort.

Correlates of Risk Factors for Hemodialysis in Kano, Nigeria

Usman Muhammad Ibrahim — Thu, 02 Apr 2026 00:00:00 +0000

Background: Kidney diseases are on the increase, with renal replacement therapy (RRT) in the form of dialysis or kidney transplant becoming increasingly inaccessible to underserved individuals. This study aimed to identify the correlates of risk factors for hemodialysis in Kano, Nigeria.

Methodology: A retrospective cross-sectional study design was used to review the records of patients from Kano State enrolled for hemodialysis from January, 2019 to December, 2022.

Results: A total of 443 patients were provided with hemodialysis. More cases were identified from urban areas of the State. The minimum age of the patients was 6, and the maximum was 100, with a median of 50 (interquartile range=34, 60) years. The majority of the patients (72.0%) had chronic kidney disease (CKD), while acute kidney injury (AKI) and acute on chronic kidney disease (AOCCKD) were found in (15.6%), and (12.4%) respectively. Similarly, a significantly higher proportion of mortality and post-partum hemorrhage (PPH) was recorded among patients with AKI. While higher proportions of hypertensive and diabetic patients had CKD. However, a significantly higher proportion of patients with AOCCKD had chronic glomerulonephritis (CGN)

Conclusions: Hemodialysis is an important RRT. The majority of patients studied had CKD, with hypertension and DM as the major correlates for hemodialysis, followed by AKI, with PPH and sepsis as the major correlates, while AOCCKD had CGN as the major correlate. The government and all relevant stakeholders should target the preventive strategies of all the correlates and improve the quality of RRT.

Assessment of Informed Consent Practices in Surgical Procedures at a Tertiary Care Hospital of Northeast India: A Cross-Sectional Study.

Nani Gopal Das, Abhik Sil, Nirmalendu Das, Papiya Paul — Thu, 02 Apr 2026 00:00:00 +0000

Background: Informed consent is an ethical and legal prerequisite for surgical care, yet its quality and comprehensibility vary widely across clinical settings. Factors such as communication barriers, limited patient understanding, and time constraints, especially in emergency surgeries, can compromise the consent process. This study assessed the quality of informed consent practices in major surgical departments of a tertiary care hospital in Northeast India and examined determinants of patient understanding and satisfaction.

Methodology: A cross-sectional study was conducted among 400 postoperative patients recruited consecutively from General Surgery, Orthopaedics, Obstetrics and Gynaecology, ENT, and Ophthalmology departments. Data were collected using a pre-validated Informed Consent Quality (ICF) checklist, a structured interview schedule, and a five-point satisfaction scale. Statistical analysis included chi-square tests, independent t-tests, ANOVA, Pearson’s correlation, multivariable logistic regression to identify predictors of satisfaction, and multiple linear regressions to determine predictors of ICF quality. A p-value <0.05 was considered statistically significant.

Results: The mean ICF Quality Score was 7.8 ± 1.9, and the mean Satisfaction Score was 4.1 ± 0.8. Elective surgeries showed significantly higher ICF quality and satisfaction than emergency procedures (p < 0.05). Time spent on consent (β = 0.34, p < 0.001), patient awareness (β = 0.28, p < 0.001), and understanding (β = 0.22, p < 0.001) emerged as independent predictors of ICF quality. Satisfaction was significantly associated with higher ICF scores, local language use, and adequate discussion of complications. Emergency status remained a negative predictor in regression analysis.

Conclusion: Effective communication, adequate time allocation, and use of local language substantially improve the ethical quality of surgical informed consent. Structured templates and AETCOM-based training may strengthen consent practices in Indian teaching hospitals.

Impact of COVID-19 Outbreak on Dental Services Utilisation Among Patients Visiting a Tertiary Health Facility in South-South, Nigeria

Thu, 02 Apr 2026 00:00:00 +0000

Background: COVID-19 caused significant disruption to dental services worldwide, with Nigeria restricting care to emergencies, which could have worsened existing access barriers. Empirical data from the South-South region remains limited. Objective: To evaluate the impact of COVID-19 on dental service utilisation, barriers, perceived oral health outcomes, and post-pandemic recovery among patients at a tertiary facility in South-South Nigeria.

Methodology: A descriptive cross-sectional study of 120 adults attending the University of Benin Teaching Hospital dental clinic from March 2020 to December 2021, using an interviewer-administered questionnaire. Data were analysed with SPSS v25.

Results: Utilisation sharply declined during the pandemic, with 53.3% not attending the clinic versus 35.8% before the pandemic. Major barriers included fear of infection (29.2%) and lack of information about services (16.7%). Post-pandemic attendance improved but remained slightly below pre-pandemic levels. While 40.8% reported improved oral health due to increased self-care, 17.5% reported deterioration. Most participants were satisfied with current service availability (58.3%) and perceived improved access (60.8%).

Conclusion: COVID-19 significantly reduced dental utilisation due to fear and restricted access. Although recovery is underway, preventive visits remain low. Public education, tele-dentistry, and enhanced emergency preparedness are recommended.

Spatiotemporal trends of wildfire distribution and smoke exposure metrics across selected provinces in Canada.

Chukwubuikem Cornelius Okafor, Afusat Adesina , Ndubuisi Emuka Opurum — Thu, 02 Apr 2026 00:00:00 +0000

Background: Wildfire activity in Canada has intensified remarkably in recent years, leading to a record-breaking 2023 season during which transboundary smoke dispersed and affected populations across North America and Europe. Beyond immediate fire-related hazards, wildfire smoke represents a severe environmental and public health threat. Increasing fire frequency, duration, and severity have been linked to climate change, land-use transformation, and prolonged drought.

Methodology: An ecological time-series analysis at the provincial level was used to examine spatiotemporal trends in wildfire distribution and PM₂.₅ metrics. Two primary data sources were integrated: wildfire activity indicators (area burned and number of fires) and air quality measurements (PM₂.₅ concentrations and high-risk air quality days). Data were aggregated at the provincial level for each calendar year, enabling temporal trend analysis and ecological correlation assessment. PM₂.₅ concentrations were used as a proxy for wildfire smoke exposure. R statistical software (version 4.4.1) was used for visualization and regression analysis.

Results: Temporal trend analysis revealed consistent increases in burned area across the provinces. Ontario demonstrated the largest proportional growth despite non-significant interannual differences. Heat-map visualization demonstrated significant spatial and temporal variability in wildfire burned areas. Quebec recorded the highest wildfire extent in 2023 (>4 million hectares), while British Columbia and Alberta each exceeded 1 million hectares. Ontario consistently exhibited lower burned areas compared to the other provinces.

Conclusion: The results from the study revealed that fire intensity, scale, and persistence play a more critical role in determining pollution exposure than the number of fire events alone. These findings highlight the complex interplay between climatic, environmental, and human influences in shaping wildfire dynamics and their public health implications across Canada.

Alarming Antimicrobial Prescribing Patterns at a Tertiary Hospital in Nigeria: A Point Prevalence Survey using the Global-PPS Protocol

Thu, 02 Apr 2026 00:00:00 +0000

Background: Antimicrobial resistance is a critical threat in Nigeria, where inappropriate prescribing remains one of the major drivers. This study evaluated antimicrobial use patterns at Usmanu Danfodiyo University Teaching Hospital (UDUTH) using the Global Point Prevalence Survey methodology.

Methodology: A cross-sectional survey was conducted October 21-25, 2024 across all inpatient wards using standardized GPPS protocols. Data collectors received virtual training through the Fleming Fund project. All patients admitted before 8:00 AM on survey days were included, with data collected on antimicrobial prescriptions, indications, and quality indicators.

Results: A total of 262 inpatients were surveyed, with 195 prescribed antimicrobials, yielding a high overall prevalence of 74.4%. Ward-specific analysis revealed statistically significant variation: Neonatal wards had universal use (23/23, 100%; p<0.001), significantly higher than Adult Medical (50/79, 63.2%; p<0.001) and Paediatric Surgical (24/39, 61.5%; p=0.002) wards. Paediatric Medical ward use (33/36, 91.7%; p<0.001) was also significantly higher. The high rates in Adult Surgical (44/53, 83.0%) and Adult Intensive Care (15/18, 83.3%) wards were not statistically significant (p>0.05) from the hospital average. A total of 437 antimicrobial agents were prescribed which was dominated by antibacterials (310/437, 71.0%), primarily third-generation cephalosporins (83/310, 26.9%). Empiric therapy accounted for 85.7% of treatments. Critical documentation gaps and low guideline compliance (medical: 11.5%; surgical: 1.6%) were observed. AWaRe classification showed 61.0% Watch antibiotic use, and 37.5% (164/437) of prescribed doses were missed, primarily due to patients inability to afford (120/164, 73.2%)

Conclusion: UDUTH exhibits excessive antimicrobial use with significant, non-random inter-ward variation, dominated by broad-spectrum agents and poor prescribing quality. These findings stress an urgent need for targeted antimicrobial stewardship programs, strengthen diagnostic infrastructures, and policies to ensure affordable access.

Determinants of Surgical Wound Infection at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.

Godwin Pius Ohemu, Mary A. Alex-Wele, Kelechi E. Okonta, Kennedy T. Wariso — Thu, 02 Apr 2026 00:00:00 +0000

Background: This study determined the prevalence and associated risk factors of surgical wound infections (SWI) among adult patients who underwent general surgery at the University of Port Harcourt Teaching Hospital (UPTH), Nigeria. Ethical approval for this study was obtained from the UPTH Ethics Committee.

Methodology: A retrospective cross-sectional study was conducted using medical records of 440 adult patients (≥18 years) who underwent surgery between 2018 and 2023. Data on demographics and clinical characteristics were extracted following the United States Centers for Disease Control and Prevention criteria. Chi-square tests, t-tests, and multivariable logistic regression were used to identify independent predictors of SWI.

Results: Overall SWI prevalence was 7.3% (32/440; 95% CI: 5.0-10.1%). Mean age was 41.9 (14.1) years, and 60.0% were female. All patients received postoperative antibiotic prophylaxis. Patients with SWI were younger (mean: 35.0 vs 42.8 years; p < 0.001) and had longer hospital stays (median: 11 vs 7 days; p = 0.004). In multivariable analysis, each additional year of age reduced SWI odds by 5% (adjusted OR = 0.95; 95% CI: 0.92-0.98; p = 0.004), while gender and surgery type were not significant. Assessment of comorbidities (diabetes, smoking, obesity) was precluded by incomplete documentation (60% missing) and very low documented prevalence (3-4% vs expected 10-30%). No significant temporal trend in SWI prevalence was observed from 2018 to 2023 (p = 0.43).

Conclusion: SWI prevalence at UPTH was 7.3%, with younger age identified as an independent risk factor. Improved preoperative screening and prospective surveillance with targeted preventive measures for younger surgical patients may help reduce SWI rates.

Psychosocial Adaptation, Disability, and Resilience among Individuals with Amputations in an Indian setting

Thu, 02 Apr 2026 00:00:00 +0000

Background: Traumatic amputations significantly affect physical function, coping, and self-esteem, highlighting the need for comprehensive rehabilitation and holistic nursing care. The study aims to assess the functional disability, coping strategies, and self-esteem of patients with upper or lower limb amputation.

Methodology: Overall, 250 subjects were recruited from various departments and their services for this cross-sectional correlational study. Data was collected using standardized tools such as the WHODAS 2.0 – 36 Item questionnaire (α=0.98), Coping Inventory for Stressful Situations–SF21 (α=0.81), and Rosenberg’s Self-esteem scale (α=0.88) by using a researcher-administered method. Descriptive and Inferential statistics were used for analysis.

Results: The findings revealed that 240 (96%) had a severe functional disability, 140 (56%) had a medium level of coping, and 200 (80%) had average self-esteem. Severe functional difficulty 180 (72%) was seen in participation. The majority had a medium level of avoidance coping 140 (56%). Correlation analysis showed a moderate negative association between functional disability and coping strategies (r = −0.514, p < 0.001), a weak negative association between functional disability and self-esteem (r = −0.140, p = 0.027), and a weak-to-moderate negative association between coping strategies and self-esteem (r = −0.280, p < 0.001). These findings indicate statistically significant associations among functional disability, coping strategies, and self-esteem.

Conclusion: The study reveals a deeper connection between functional disability, coping strategies, and self-esteem among amputated patients, pressing the critical need for targeted nursing assessments and strategic interventions.

Urine Iodine Concentration Trends During Pregnancy in The North-Central Region of Nigeria

Terry Gbaa, John Bolodeoku, Victor Uwe, Arome Okeme — Thu, 02 Apr 2026 00:00:00 +0000

Background: Pregnancy is a hyperdynamic state that significantly strains the mother's iodine stores due to the demands of the foetus. Iodine deficiency poses significant risks during pregnancy, affecting maternal and foetal health. Thyroid hormones, which are vital for brain development, rely on iodine, and deficiencies can lead to conditions like hypothyroidism and goitre. Monitoring urinary iodine concentration (UIC) is crucial for assessing iodine status, especially in pregnancy, where iodine plays a pivotal role in neurodevelopment. The aim of this study is to determine the urine iodine concentration changes and its adequacy in pregnancy.

Methodology: This descriptive cross-sectional study was conducted over a period of nine (9) months (June 2019–February 2020). The study comprised a cohort of 250 pregnant women who were attending their antenatal clinic visits. These participants were selected randomly using a table of random numbers. Spot Urine samples were analysed using the Sandell-Kolthoff technique to measure UIC. The data were analysed using Statistical Package for Social Sciences (SPSS) version 21 (IBM, Chicago, IL, USA).

Results: The mean ± SD urine iodine concentration in the 1^st, 2^nd , 3^rd was (192.02 ± 40.71 µg/L; 185.49 ± 32.94 µg/L I;186.54 ± 35.35 µg/L; p=0.135) respectively Urine iodine Concentration across the 3 trimesters <150 µg/L(<0.01); 150-250 µg/L(<0.01); >250 µg/L(<0.01). The participants’ chronological ages ranged from 17 to 44 years. The mean ± SD, 1^st, 2^nd , 3^rd (26.40 ± 4.70; 27.00 ± 5.10; 28.20 ± 5.20; p=0.211) years respectively. The Pearson (-0.439; p <0.05) of urine iodine concentration and thyroglobulin.

Conclusion: This study highlights the continued need for public health initiatives that promote iodine awareness and the use of iodized salt among women of reproductive age. Furthermore, the inclusion of thyroglobulin measurement alongside urinary iodine concentration may provide a more comprehensive assessment of thyroid function during pregnancy.