Nigerian Medical Journal

Cardiac Autonomic Neuropathy: Comparative performance of Phase-Rectified Signal Averaging methods with Cardiac Autonomic Reflex Tests and Time Domain Heart rate variability

Stigi Joseph — 2026-03-02

Background:Phase-Rectified Signal Averaging (PRSA) methods, Deceleration (DC), and Acceleration Capacity (AC), provide a comprehensive assessment of cardiac autonomic function (CAN). There are no published studies comparing PRSA methods with conventional methods such as Time Domain Heart Rate Variability (TD-HRV) or Cardiac Autonomic Reflex Tests (CARTs), nor have they described a cut-off value for AC and DC to distinguish patients with CAN (+ve) from those without CAN (-ve). Our study compares PRSA methods with conventional methods and defines cut-off values for AC and DC to diagnose CAN.

Methodology:We studied two cohorts: 126 individuals with normal ventricular function (derivation cohort) and 143 individuals with Left Ventricular Dysfunction (validation cohort). These patients underwent CARTs and supine, resting ECG recordings for 2 to 3 minutes. The patients were categorized as CAN +Ve and CAN -Ve based on TD-HRV parameters and the CARTs. Two different CART criteria were studied: the All-India Institute of Medical Sciences (AIIMS-AFT) criteria and the 2011 Toronto Consensus recommendations. Patients with and without CAN were segregated by AC and DC values, and the methods were compared. The cutoff values for DC and AC were calculated using the ROC curve method from the derivation cohort and verified in the validation cohort.

Results:A reduction in DC values and an increase in AC values indicate a higher chance of CAN. The cut-off values of -7 for AC and 7 for DC provide the highest accuracy in detecting CAN prevalence. Both values have an AUC of nearly 0.9. Reclassifying both cohorts as CAN +Ve based on the derived cut-offs and comparing with the prevalence determined by conventional methods results in kappa values ranging from 0.5 to 0.7.

Conclusions:A decrease in DC value and an increase in AC value are associated with a higher probability of CAN. An AC value ≥ -7 and a DC value ≤ 7 indicate good accuracy in identifying CAN.

Comparative Evaluation of HER2 Overexpression in Breast Carcinoma Using Cell Blocks and Corresponding Formalin-Fixed Paraffin-Embedded Tissue Blocks: A Prospective Study

Adeyemi Sofoluwe Gbenga — 2026-03-02

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.

Simulation-Based Learning in a Resource-Limited Setting: Perspectives of Clinical Medical Students in North-Western Nigeria.

Jamilu Garba — 2026-03-02

Background: Simulation-based learning (SBL) is an emerging educational methodology that actively engages students and helps bridge the gap between theoretical knowledge and practical clinical skills. It allows students to learn in realistic clinical scenarios using manikins and trained actors (standardized patients) in a controlled learning environment. Well-designed simulation exercises can enhance both technical and non-technical competencies among medical students. This study aimed to assess the knowledge, attitudes, and perceptions of clinical medical students toward simulation-based learning at Ahmadu Bello University, Zaria, North-Western Nigeria.

Methodology: A descriptive cross-sectional study design was employed. Data were collected using a pretested, structured, closed-ended, self-administered questionnaire. A total of 138 clinical medical students of Ahmadu Bello University, Zaria, were selected using a stratified random sampling technique. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 25.0, and results were presented using tables and charts. Associations between categorical variables were assessed using the Chi-square test, with statistical significance set at p < 0.05.

Results: The mean age of the respondents was 24.76 ± 1.93 years. More than two-thirds (70.3%) of the respondents had good knowledge of SBL, while the majority demonstrated positive perceptions (90.6%) and positive attitudes (92.7%) toward simulation-based learning. A statistically significant association was observed between attitude and perception toward simulation-based learning as a method of clinical training.

Conclusion: The findings indicate that most respondents possessed good knowledge of simulation-based learning and expressed positive attitudes and perceptions toward its use. The majority were satisfied with SBL as a teaching method. Therefore, simulation-based learning should be incorporated into the medical school curriculum to enhance clinical training.

Effect of Hands-on Biostatistics Training on Postgraduate Nursing Students' Knowledge and Attitude at a Tertiary Care Institution, Sub-Himalayan Region: a quasi-experimental study

Xavier Belsiyal — 2026-03-02

Background: Biostatistics is a vital component of healthcare, enabling nursing students to interpret and analyze health-related data effectively. However, gaps in statistical knowledge persist, making it essential to address these deficiencies to ensure professional competence and uphold ethical standards. The aim of this study was to assess the impact of hands-on biostatistics training on postgraduate nursing students' knowledge and attitude at a tertiary care institution in Rishikesh, located in the sub-Himalayan region.

Methodology: A quasi-experimental design was adopted for this study. Total enumerative sampling was used to recruit 38 postgraduate nursing students from a tertiary care institution in Rishikesh, located in the sub-Himalayan region. The intervention comprised 16 hours of expert-led hands-on training. The variables assessed were knowledge of and attitude toward biostatistics.

Results: The mean age of the participants was 25.21 ± 3.54 years. The majority were female (89.5%, n = 34). Most participants (76.3%, n = 29) had not received prior statistical training. Significant improvements were observed in overall biostatistics knowledge scores across all domains (p = 0.001), overall attitude scores (p < 0.001), and the perceived difficulty domain (p = 0.006).

Conclusion: The study indicates that hands-on biostatistics training improved postgraduate nursing students' knowledge and positively influenced their attitudes toward biostatistics. However, the findings are exploratory and context-specific and may be influenced by potential biases. Integrating such training into nursing curricula could enhance statistical literacy and support research participation and evidence-based practice. This will serve as a foundation for advancing the nursing discipline.

Maternal and Perinatal Death Surveillance and Response: An Evaluation of Practices Among Healthcare Workers in South-South, Nigeria

Victor Ohenhen — 2026-03-02

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.

Quantitative Volumetric Analysis of the Brain Using Magnetic Resonance Imaging in Sickle Cell Anaemia

Mohammed Abba Suwaid — 2026-03-02

Background: Sickle cell disease (SCD) is a group of inherited hemoglobinopathies caused by a mutation in the β-globin gene, with sickle cell anaemia (SCA) representing the homozygous and most severe form. The disease burden is highest in sub-Saharan Africa, India, and the Mediterranean region. Neurological complications, including overt stroke and silent cerebral infarcts (SCI), contribute significantly to morbidity, with a markedly increased risk observed among affected individuals. The objective of the study is to assess and compare brain gray matter and white matter volumes in patients with sickle cell anaemia with and without silent cerebral infarcts, and in healthy controls.

Methodology: This cross-sectional study included 264 participants divided into three groups: SCA patients with SCI, SCA patients without SCI, and age- and sex-matched healthy controls. All participants underwent brain magnetic resonance imaging using a 1.5 Tesla scanner. Image segmentation and volumetric analysis were performed using the Computational Anatomy Toolbox (CAT12).

Results: White matter volume was significantly reduced in SCA patients, both with and without SCI, compared to controls. Gray matter volume was significantly increased in SCA patients, particularly among those without SCI, relative to controls.

Conclusion: Sickle cell anaemia is associated with significant reductions in white matter volume and alterations in gray matter volume, highlighting the impact of the disease on brain structure even in the absence of overt neurological deficits.

Caesarean Section Techniques among Senior Obstetricians in Nigeria: A Descriptive Multicentre Survey

Gabriel Dogbanya — 2026-03-02

Background: Caesarean section (CS) is one of the most commonly performed surgical procedures worldwide, yet considerable variation exists in operative techniques, particularly in low and middle-income countries. The aim of this study is to determine the common surgical techniques employed by senior obstetricians in Nigeria and evaluate the associations with demographic and institutional factors.

Methods: A descriptive cross-sectional multicentre online survey was conducted between May 2023 and May 2024 among practising Senior Registrars and Consultants in Obstetrics and Gynaecology across Nigeria. Using a structured, pretested questionnaire, data were collected on sociodemographic characteristics, preoperative, intraoperative, and postoperative CS practices. Data were analysed using R statistical software, with descriptive statistics and multivariate analyses performed. Statistical significance was set at p < 0.05.

Results: A total of 293 complete responses were analysed. The mean age of respondents was 42.1±7.6 years, with a mean work experience of 11.9±6.4 years; 66.6% were male, and 78.8% practiced in federal tertiary hospitals. The most commonly reported techniques included skin preparation with Savlon plus alcohol (73.4%), Pfannenstiel abdominal incision (71.0%), bladder flap creation (73%), controlled cord traction for placental delivery (68.9%), double-layer uterine closure (99%), visceral peritoneal closure (60%), and subcuticular skin closure (96.6%). Routine postoperative thromboprophylaxis was used by only 18.4% of respondents. Most surgical choices were not significantly associated with age, work experience, or place of practice, except for visceral peritoneal closure, which varied by institution (p = 0.043).

Conclusion: CS practices among obstetricians in Nigeria showed some consistency in key operative steps such as Pfannenstiel incision, double-layer uterine closure, and subcuticular skin closure, alongside notable variation in other aspects, particularly thromboprophylaxis use. These findings highlight the influence of institutional practice patterns and underscore the need for context-specific, evidence-based guidelines to harmonise CS techniques and optimise maternal outcomes nationwide.

Awareness of Oral Health and Dental Care Practices among Children with Endocrine Disorders and their Caregivers at Lagos University Teaching Hospital, Nigeria

Omolade Ademiposi Osibogun — 2026-03-02

Background: Endocrine disorders in children can present with various oral manifestations that may impact overall health and quality of life. Despite this, awareness of these oral implications among patients and caregivers is often limited. Understanding this gap is essential for improving multidisciplinary care and oral health outcomes. This study aims to assess the awareness of oral health and dental care practices of children and caregivers with endocrine disorders.

Methodology: A cross-sectional study was conducted at the Paediatric Endocrinology Clinic of Lagos University Teaching Hospital (LUTH), Lagos, Nigeria. Ethical approval, informed consent, and assent were obtained. Fifty children aged 7–18 years with confirmed endocrine disorders and their caregivers were recruited. Data collection involved structured questionnaires and intraoral examinations. Statistical analysis was done with a level of significance set at p< 0.05.

Results: The mean age of patients was 11.52 ± 4.9 years, with females representing 54% of the participants. Type I Diabetes Mellitus was the most frequent endocrine condition (54%). Awareness of the oral implications of endocrine disorders was very low (12%). The majority of patients (70%) had never visited a dentist. Similarly, most caregivers (66.0%) had never visited a dentist. The presence of oral manifestations showed no statistically significant association with age group, sex, or caregiver educational level.

Conclusion: Oral abnormalities are frequent among paediatric patients with endocrine conditions, yet both patients and caregivers demonstrate low awareness of these complications. Greater collaboration between endocrinologists and dental professionals, alongside promoting oral health education, is crucial to improving oral health outcomes in this population.

A 7-Year Review of Urological Injuries arising from Obstetric and Gynaecological Surgeries in Abuja, Nigeria

Muftau Jimoh Bioku — 2026-03-02

Background:
Collateral injuries to the urinary tract during obstetric and gynaecological (O&G) surgeries are not uncommon. Delay in recognition of such mishaps may lead to significant morbidity and mortality. This study aims to document the incidence, clinical presentations, aetiology, types and management of urologic injuries arising from O&G surgeries.

Methodology:
Retrospective review of electronic medical records of all patients with urologic injuries arising from O&G surgeries managed by the urology unit of Federal Medical Centre, Abuja, from January 2019 to December 2025. The extracted data included biodata, clinical presentation, initial O&G diagnoses, types of injuries, timing of injury recognition, and reconstructive surgeries performed, as well as outcomes. These were analysed using SPSS 27.0.

Results:
There were 19 patients (0.26%) with urologic injuries out of 7,312 O&G surgeries performed within the study period. The mean age of the patients was 39.4 ± 9.6, with ages ranging from 27 to 64 years. Total abdominal hysterectomy was the leading offending surgery (n=10, 52.6%). The commonest initial diagnosis was uterine leiomyoma (n=8, 42.1%). Bladder injury (n=10, 52.6%) was more common than ureteric injury (n=9, 47.4%) in our study. Most of the injuries were recognized intra-operatively (57.9%). We did not record any mortality.

Conclusion:
Urologic injuries during obstetric and gynaecological surgeries, though rare, can lead to significant morbidity. Our study found that total abdominal hysterectomy is the most common procedure associated with these injuries, primarily bladder injuries, most of which were detected during surgery. This underscores the necessity for increased surgeon awareness to prevent complications. Despite the low incidence and no mortality in our cohort, ongoing monitoring and the use of improved surgical techniques are crucial.

Blood Pressure Differences among Obese, Overweight, and Normal-Weight Adolescents in Enugu Metropolis: A Comparative Study

Josephat M. Chinawa — 2026-03-02

Background: Hypertension is a major modifiable cardiovascular risk factor, and increasing adolescent obesity is strongly linked to early-onset hypertension and an increased risk of cardiovascular complications in adults. This study compared blood pressure among obese, overweight, and normal-weight adolescents and examined associated anthropometric factors and patterns.

Methodology: This comparative cross-sectional study included 486 adolescents (162 normal-weight, 162 overweight, and 162 obese) from secondary schools in Enugu. The participants were selected via multistage sampling. Anthropometric and blood pressure measurements were obtained via standardized methods, with blood pressure classified by age-, sex-, and height-specific percentiles. The data were analysed via SPSS v26, with significance set at p < 0.05.

Results: A significant association was observed between body weight and hypertension (χ² = 45.5, p = 0.0001), with the prevalence increasing from 3.7% in normal-weight participants to 12.3% in overweight participants and 38.9% in obese participants. Both systolic and diastolic blood pressure differed significantly across the groups (p = 0.0001). Systolic blood pressure increased progressively across all categories (p < 0.05), whereas diastolic blood pressure was significantly greater in obese participants. Significant positive correlations were found between blood pressure and anthropometric indices, particularly in the overweight and obese groups (p < 0.05). Hypertensive participants had significantly higher systolic blood pressure across all groups, with obese hypertensive participants also having higher diastolic pressure.

Conclusion: This study demonstrated that obesity is strongly associated with an increased risk of elevated blood pressure among adolescents. Blood pressure increases progressively with increasing body weight, with obese adolescents being disproportionately affected. Waist circumference has emerged as a key predictor of elevated blood pressure, underscoring the importance of central adiposity in cardiovascular risk stratification. These findings highlight the growing burden of obesity-related elevated blood pressure in adolescents and the need for early detection and intervention.

Blood Pressure Abnormalities Amongst Children with Sickle Cell Anaemia in Steady State and in Crises Attending a Tertiary Hospital in South East Nigeria

Josephat M Chinawa — 2026-03-02

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.

Knowledge of Acute Rheumatic Fever (ARF) Among Adolescents in Enugu Metropolis.

Josephat M. Chinawa — 2026-03-02

Background :ARF is a major public health issue among children with increased morbidity and mortality. This study aims to ascertain the level of awareness and knowledge of the college adolescent children on acute ARF.

Methodology: This was a cross-sectional study carried out among 553 adolescents from ten secondary schools in Enugu metropolis over a 4-month period.

Results: A total of 553 adolescents were studied, with a mean age of 14.4 ± 2.7 years and a female predominance (64.9%). Overall, awareness of rheumatic fever was good (63.3%), with health workers, peers, and social media as the major information sources. Knowledge of key symptoms such as joint pain (95.3%), sore throat (94.2%), and shortness of breath (81.7%) was high, and most respondents correctly identified preventive measures (87.5%) and treatment options (89.3%). The mean knowledge score was 23.1 ± 5.8. Significantly higher knowledge was observed among respondents aged <15 years, those in junior secondary school, those with parents having tertiary education, and those from a higher socio-economic class. Junior secondary school status remained an independent predictor of good knowledge.

Conclusion: This study demonstrates that although awareness of rheumatic fever among adolescents is relatively high, comprehensive knowledge, particularly regarding disease burden, is inadequate. Significant socio-demographic disparities in knowledge exist, influenced by age, educational level, parental education, and socio-economic status. Bridging the gap between awareness and accurate knowledge is essential to improving early recognition, prevention, and control of rheumatic fever and its long-term complications.

Psychological distress, coping methods and self-care among people with diabetes mellitus in Ibadan.

Lucia Yetunde Ojewale — 2026-03-02

Background: Diabetes mellitus (DM) is a chronic metabolic disorder associated with serious complications if poorly controlled. Beyond routine clinical follow-up, people with diabetes (PWD) are required to engage in sustained self-care activities. Fear of complications and the demands of self-management may lead to psychological distress, which can negatively influence coping strategies and adherence to self-care practices. The study aims to determine the level of psychological distress among people with diabetes mellitus and to assess its relationship with coping styles and diabetes self-care activities.

Methodology: This descriptive cross-sectional study was conducted among PWD attending the Medical Outpatients’ Clinic of the University College Hospital, Ibadan. Two hundred participants completed a structured questionnaire comprising the Diabetes Distress Scale (DDS), a modified Brief Coping Orientation to Problems Experienced (Brief-COPE), and the Summary of Diabetes Self-Care Activities (SDSCA). Ethical approval was obtained from the institutional review board (UI/EC/24/0064; 21 February 2024). Data were analysed using SPSS version 26, employing descriptive statistics, independent t-tests, and chi-square tests, with statistical significance set at p< 0.05.

Results: The mean age of respondents was 57.54 ± 10.87 years, with females constituting 51% of participants. Approximately 64% had attained tertiary education. High psychological distress was observed in 38% of respondents. The most commonly reported coping strategies were problem-focused approaches, including taking actions to improve situations and reframing diabetes positively, as well as seeking emotional support. High psychological distress was significantly associated with the use of avoidant coping strategies (p< 0.001). A significant association was also found between psychological distress and poor diabetes self-care practices (p = 0.041).

Conclusion: Psychological distress is common among people with diabetes and adversely affects coping mechanisms and self-care activities. Integrating routine psychological screening and promoting positive coping strategies within diabetes self-management education may improve overall patient outcomes.

A Comparative Study on Oxytocin Versus Carbetocin in Prevention of Primary Postpartum Haemorrhage After Childbirth

Anwesha Dasghosh — 2026-03-02

Background: Postpartum haemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide. Effective prophylactic uterotonic agents are essential for preventing primary PPH after childbirth. The study aims to compare the effectiveness and safety of oxytocin versus Carbetocin in preventing primary PPH following both vaginal and caesarean deliveries in a tertiary care setting in Eastern India.

Methodology: This prospective, open-label, randomized controlled superiority trial was conducted over 18 months (October 2022–March 2024) at B.R. Singh Hospital, Kolkata. One hundred and twenty pregnant women aged 18–35 years with singleton pregnancies ≥37 weeks undergoing normal vaginal delivery or caesarean section were randomized into two groups. The Oxytocin group (n=60) received 10 IU intravenously with a maintenance dose, while the Carbetocin group (n=60) received 100μg intravenously without a maintenance dose. Primary outcomes included total blood loss and incidence of PPH. Secondary outcomes included uterine atony and additional uterotonic requirements, hemodynamic changes, change in hemoglobin levels, and maternal side effects.

Results: Carbetocin significantly reduced total blood loss in both delivery modes (p<0.001). PPH incidence was lower with Carbetocin (17.9% vs 29.6% in caesarean delivery; 9.4% vs 27.3% in vaginal delivery). Post-delivery haemoglobin levels were significantly higher, and haemoglobin drop was significantly lower in the Carbetocin group. Uterine atony occurred less frequently with Carbetocin (23.3% vs 43.3%, p<0.05). Carbetocin caused minimal hemodynamic changes compared to the significant hypotensive effects of oxytocin.

Conclusion: Carbetocin is superior to oxytocin in preventing primary PPH, offering better efficacy and safety profile through reduced complications.

Clinical Characteristics of Iron Deficiency in Patients with Chronic Heart Failure at a Major Referral Centre in Southern Nigeria

Aisha O Ajala — 2026-03-02

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.

Knowledge, Attitude, and Practices regarding E-cigarette use among Undergraduate Medical Students at a Tertiary-care Medical College in India

Darsh Udawat — 2026-03-02

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.

The Rating of Nigerian Neurosurgical Facilities Based on the Availability of Sub-Specialty Services in 2024

Sunday Nkwerem — 2026-03-02

Background: Nigerian neurosurgery is striving to catch up with emerging sub-specialties, in accordance with international best practices. The study aims to profile the available sub-specialty services in Nigerian neurosurgery and rate the facilities based on their capacities.

Methodology: A cross-sectional study involving all centres with full-time neurosurgical services in Nigeria. Data collection was done electronically with questionnaires, WhatsApp, and short message services (SMS), from practising and resident neurosurgeons per centre. Clarifications on equivocal responses were sought by direct phone interviews. The rating of facilities was based on the availability of 7 major sub-specialty services – spine instrumentation / C-Arm, operative microscopy, trans-sphenoidal/-nasal cranial procedures, neuroendoscopy, aneurysmal clipping, neuronavigation and aneurysmal coiling. Scores and ratings were done based on the number of available services.

Results: A total of 44 neurosurgery facilities were profiled, 38 (86.4%) being government-owned, and 6 (23.6%) privately-owned. Of the 38 government facilities, 30 are federal. The modal available service is spine instrumentation/C-Arm fluoroscopy (78%), then operative microscopy (58.5%) and trans-sphenoidal/-nasal cranial procedures (51.2%). The mean subspecialty services are as follows: spine instrumentation/C-arm 0.8, operative microscopy 0.6, transsphenoidal/nasal procedure 0.5, neuroendoscopy 0.4, aneurysm clipping 0.4, neuronavigation 0.1, aneurysm coiling 0.04. Amongst the top-10 facilities, 7 are government and 3 privately-owned, but amongst the top-3 facilities, 2 are privately-owned. All 10 lowest-ranked facilities are government-owned.

Conclusions: Spine surgery and operative microscopy are more readily available in Nigeria, while aneurysmal clipping and coiling and neuroendoscopy services are poor in Nigeria. Despite the government-owned institutions being in the lead, the privately-owned institutions have massive future prospects.

A comparison study of Optical Coherence Tomography Angiography Peripapillary Vessel Density in Early Glaucomatous and Normal Nigerian Eyes

Godswill Nathaniel — 2026-03-02

Background: This study aimed to determine and compare the peripapillary vessel density (VD) in normal and early glaucomatous Nigerian eyes using Optical Coherence Tomography Angiography (OCTA), to provide evidence for the use of OCTA in enhancing the early diagnosis of glaucoma in Nigeria.

Methodology: This was a hospital-based cross-sectional comparative study of 90 early glaucomatous participants and 90 normal participants. Participants aged 40 and above, with open anterior chamber angles (Schaffer’s) on gonioscopy, vertical cup disc ratio (VCDR)>0.4 and Central Visual Field (CVF) Mean deviation (MD) less than -6 dB, with glaucoma hemifield test (GHT) outside normal limits on a reliable 24-2 perimetry (Humphrey Field analyser II, Zeiss Humphrey Matrix 715) were recruited as early glaucomatous while aged matched control with vertical cup disc ratio <0.4, intact neuro-retinal rims, healthy OCT determined RNFL thickness and GCC, and a normal visual field test results were recruited as normal participants. The participants had a complete anterior and posterior segment examination. One eye of each participant had OCTA scans. The average peripapillary Vascular density in each optic nerve head (ONH) quadrant was determined using Angiovue OCTA (Optovue Inc., Fremont, CA, USA). The relevant data were analysed using the Statistical Package for Social Sciences (SPSS) version 26 with statistical significance set at p<0.05 and 95 % confidence interval.

Results: The mean peripapillary VD was significantly reduced in the early glaucomatous eyes (50.21 ± 4.54) compared to the normal (54.60 ± 2.50) eyes (p <0.001). The peripapillary VD in the optic nerve head quadrants followed a similar trend of being lower in the early glaucomatous eyes (p<0.001).

Conclusion: The reduced peripapillary VD in early glaucoma denoted a reduction in ONH perfusion in early glaucoma, and highlighted the usefulness of OCTA peripapillary VD in the early diagnosis of glaucoma in Nigerian eyes.

Effect of Musical Therapy on Hemodynamic Parameters and Inflammatory Markers in Patients Undergoing Surgery for Varicose Veins Under Spinal Anaesthesia.

Mohammad Pervez Alam — 2026-03-02

Background: Surgical procedures are frequently accompanied by anxiety, hemodynamic instability, and inflammatory responses, which may delay recovery. Music therapy is a safe, cost-effective, non-pharmacological intervention that has been shown to reduce perioperative stress and improve patient well-being. This study assessed its effects on hemodynamic parameters, inflammatory markers, anxiety, and patient satisfaction in patients undergoing varicose vein surgery under spinal anaesthesia.

Methodology: Sixty-four patients (16–65 years, ASA I–II) scheduled for elective varicose vein surgery under spinal anaesthesia were randomised into two groups: control (C) and music therapy (M). Group M listened to self-selected music one hour before and during surgery, while Group C received standard care. Primary outcomes were changes in hemodynamic variables and inflammatory markers; secondary outcomes included perioperative anxiety and postoperative satisfaction.

Results: Group M demonstrated significantly lower heart rate, systolic, diastolic, and mean arterial pressure compared with Group C (p < 0.05). Postoperative inflammatory markers were also reduced in Group M (CRP 2.75 ± 1.07 vs. 4.22 ± 1.79 mg/L; ESR 9.81 ± 3.06 vs. 13.69 ± 2.88 mm/hr; IL-6 1.56 ± 1.38 vs. 3.13 ± 3.21 pg/mL; all p < 0.01). Anxiety scores declined in Group M (39.16 ± 4.18) but increased in Group C (62.97 ± 7.77; p < 0.001). Patient satisfaction was markedly higher in the music group (p < 0.001).

Conclusion: Music therapy enhanced hemodynamic stability, reduced anxiety and inflammatory markers, and improved patient satisfaction in patients undergoing varicose vein surgery under spinal anaesthesia.

The Impact of US Government Stop-Work Order and Limited Waiver on HIV Program in LASUTH, Nigeria: A Retrospective Review

Akinsegun Akinbami — 2026-03-03

Background: Human Immunodeficiency Virus (HIV) management programme is largely donor-driven in Low- and Medium-Income Countries (LMIC), including Nigeria. The programme was temporarily disrupted following a stop work order (SWO) issued by the United States Government in January, 2025. The study retrospectively reviewed the impact of the SWO on HIV management at LASUTH, Nigeria.

Methods: This is a retrospective study reviewing the impact of the SWO on the management of HIV programmes at LASUTH. The data of all the five thousand five hundred and thirty-eight (5538) HIV patients who registered before January, 2025 were reviewed to determine the impact of the SWO on the programme. HIV testing services (HTS), missed appointments, retention rate and viral load coverage were assessed. The data obtained were presented in a graphical format.

Results: There was a 30% drop in the HTS, a rise in the missed appointment from six (6) to ninety-one (91), a drop in the retention rate from 97.8% to 96.6% and viral load coverage from 99.1% to 95.1%.

Conclusion: The HIV testing services, missed appointment, retention rate, and viral load coverage were negatively impacted during the stop work order. Countries in LMIC should de-emphasize dependency on donor funding of HIV programmes.

Effect of SMS Reminders on Medication Adherence in Schizophrenia: A Quasi-Experimental Study in Nigeria

Abdullahi Yakubu — 2026-03-02

Background: Medication non-adherence remains a major obstacle in schizophrenia management. In resource-limited settings such as Nigeria, mobile health strategies like short message service (SMS) reminders present a practical and low-cost intervention to improve adherence. This study aimed to evaluate the effect of SMS reminders on medication adherence among patients with schizophrenia at a tertiary hospital in Nigeria.

Methodology: A 24-week quasi-experimental study was conducted among 300 outpatients, randomly assigned using computer-generated random numbers to an intervention group (n=150) that received daily SMS reminders and bi-weekly motivational messages, or a control group (n=150) that received usual care. Adherence was measured using the Morisky Medication Adherence Scale (MMAS-8) at baseline, 12 weeks, and 24 weeks. Statistical analyses included descriptive and inferential methods.

Results: All 300 participants completed the study (0% attrition). Mean adherence scores in the intervention group increased significantly from 4.6 (±1.3) to 7.1 (±0.9) (p < 0.001), while the control group showed negligible improvement (4.7 ±1.2 to 5.0 ±1.2; p = 0.59). High adherence was attained by 74.7% (n = 112) of the intervention group compared to 32.7% (n = 49) of controls (p < 0.001). A significant group × time interaction effect was found (F = 122.7, p < 0.001). Logistic regression identified SMS intervention as a strong independent predictor of high adherence (AOR = 5.82; 95% CI: 3.45–9.81).

Conclusion: SMS reminders significantly enhanced medication adherence among schizophrenia patients in a low-resource setting. Incorporating such digital tools into standard care may greatly improve treatment outcomes.

Perceptions and Barriers to Utilisation of Primary Health Care Services among 1,010 households in Health District IV, Lagos State

Adedoyin O. Ogunyemi — 2026-03-02

Background: Primary Health Care (PHC) forms the backbone of public health and is central to achieving universal health coverage in Nigeria. Yet, its utilisation remains inconsistent, even in urban settings. This study assessed household perceptions, barriers, and factors influencing PHC utilisation in Health District IV, Lagos State.

Methodology: A community-based cross-sectional survey was conducted among 1,010 households in Health District IV of Lagos State, using a multistage sampling technique. Data was collected through a structured interviewer-administered questionnaire assessing socio-demographic characteristics, awareness and perceptions of PHC services, and PHC utilisation in the preceding year.

Results: About half (51%) of the respondents utilized PHC services in the preceding year, predominantly for illness-related care rather than preventive services. The majority (85.9%) were aware of a PHC close to their residence, and 97.5% correctly identified its location. Concerning non-utilization of services, more than half (59.9%) of respondents reported they had not fallen ill. Other barriers included alternative health seeking behaviour (12.2%), long patient waiting time (9.4%), absence of medical doctors (8.2%), poor staff attitudes (7.3%). Health insurance coverage was low (20.7%), and half perceived costs as moderate.

Conclusions: Despite high awareness, PHC utilisation remains moderate and predominantly curative. Strengthening service organisation, enhancing financial risk protection, and improving community engagement are essential to reposition PHCs to deliver comprehensive, people-centred care.

Incidence and Risk Factors for Adverse Events During Intubation among Critically Ill Patients in Nigeria.

ThankGod Chukwunnonso Okonkwo — 2026-03-02

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.

Refractory Temporal Gelastic Seizure: A Case Report

A. F. Okafor — 2026-03-02

Gelastic seizures are rare epileptic events characterized by sudden, unprovoked bursts of laughter that are typically associated with hypothalamic hamartomas but may also arise from cortical epileptogenic foci. We report the case of an eight-year-old boy born prematurely at 28 weeks’ gestation who presented with a two-year history of recurrent hypermotor seizures, loss of consciousness, behavioral arrest, falls, and frequent episodes of inappropriate laughter. Video electroencephalography demonstrated epileptiform activity consistent with left temporal lobe epilepsy with mild diffuse encephalopathy, while a 1.5 Tesla brain magnetic resonance imaging (MRI) showed no structural abnormality. Clinical evaluation also revealed mild microcephaly and learning difficulties. Initial treatment with carbamazepine followed by combination therapy with levetiracetam failed to adequately control seizures. However, seizure frequency improved after substitution of levetiracetam with lamotrigine. This case highlights that gelastic seizures may originate from the temporal lobe even in the absence of hypothalamic hamartoma and may be resistant to first-line therapy. Awareness of this rare presentation may facilitate earlier recognition and optimization of treatment strategies in affected patients.

A Case Report of Childhood Polyarteritis Nodosa: A Rare Vasculitic Disorder with Multisystem Involvement

Fatima Ishaq Abubakar — 2026-03-02

Background:Childhood polyarteritis nodosa (cPAN) is a rare systemic necrotizing vasculitis affecting small- and medium-sized arteries. Its heterogeneous clinical manifestations often delay diagnosis, yet early recognition is essential to prevent organ damage. According to the EULAR/PRINTO/PRES criteria, diagnosis requires evidence of necrotizing vasculitis in medium- or small-sized arteries or characteristic clinical features such as skin involvement, myalgia, hypertension, or peripheral neuropathy. This case adds to the limited literature by presenting a severe multisystem form of cPAN in a young child who achieved favorable outcomes with timely corticosteroid therapy.

Case Presentation:A 3-year-old girl presented with a 6-month history of recurrent fever, painful subcutaneous nodules, pruritic rashes, digital gangrene, myalgia, arthralgia, proteinuria, hematuria, and hypertension. Histopathologic examination of skin and subcutaneous nodules demonstrated necrotizing vasculitis of medium-sized arteries, fulfilling the EULAR/PRINTO/PRES classification criteria for cPAN. Treatment with oral prednisolone (1 mg/kg/day) and supportive care led to rapid improvement, including regression of skin lesions, normalization of inflammatory markers, resolution of renal involvement, and sustained remission during follow-up.

Conclusion:This case highlights the need for high clinical suspicion of cPAN in children presenting with multisystem symptoms and characteristic cutaneous findings. Early diagnosis supported by established criteria and prompt corticosteroid therapy, combined with multidisciplinary care, can significantly improve outcomes and reduce long-term morbidity.

Elucidating the Nexus of Mitochondrial Dysfunction and Oncometabolite Accumulation in Tumorigenesis

Abraham Ehinomhen Ubhenin — 2026-03-02

Cancer is a complex disease driven by disruptions in cellular metabolism and mitochondrial function, enabling malignant cells to proliferate unchecked, evade apoptosis, and metastasize to distant organs. This exhaustive review elucidates the metabolic dysregulations inherent to cancer, with a particular focus on mitochondrial dysfunction, the accumulation of oncometabolites, and the reprogramming of metabolic pathways. A comprehensive literature search was conducted across major scientific databases, including PubMed, Web of Science, Scopus, and ScienceDirect, spanning January 2010 to March 2025. Controlled vocabulary and Boolean operators were employed to capture relevant studies, focusing on cancer metabolism, metabolic reprogramming, tumour markers, oncometabolites, mitochondrial dysfunction, and regulatory pathways. Extracted data were organized into thematic areas, and a qualitative synthesis approach was used to integrate findings, identifying common mechanistic patterns underlying tumour initiation, progression, and metastasis. The Warburg effect, a typical feature of cancer metabolism, is characterized by a predilection for aerobic glycolysis, thereby supporting biosynthetic processes and contributing to tumour microenvironment acidification and immune suppression. Mitochondrial dysfunction triggers genomic instability and oncogenic transformation. Meanwhile, oncometabolites like 2-hydroxyglutarate, fumarate, and sarcosine disrupt cellular signalling and epigenetic regulation, promoting tumour growth and progression. The clinical significance of tumour markers and metabolic biomarkers is underscored, and the systemic metabolic sequelae of cancer, including cancer-associated cachexia, are expounded upon. In glioblastoma, Aurora kinase A inhibition reverses the Warburg effect, decreasing glucose uptake and boosting oxidative phosphorylation. Cancer-associated fibroblasts exhibit aerobic glycolysis, promoting tumor growth and metastasis via the reverse Warburg effect. Glycolysis inhibition suppresses tumor growth in pancreatic cancer, and the Warburg effect contributes to chemoresistance by upregulating glycolytic enzymes and increasing lactate production. Targeting the Warburg effect, including inhibiting glycolytic enzymes and modulating mitochondrial function, offers potential therapeutic strategies for cancer treatment. This review provides a comprehensive exposition of the biochemical mechanisms underpinning metabolic derangements in cancer, which may unveil novel avenues for diagnostic and therapeutic interventions.

Ganoderma applanatum Polysaccharides in Obesity-Associated Dysglycaemia and Liver Injury: Gut–Liver Mechanisms and Translational Gaps

Adamou Mfopa — 2026-03-02

Obesity-associated dysglycaemia and metabolic dysfunction-associated steatotic liver disease (MASLD) arise from interacting inflammatory, oxidative, lipotoxic, and gut-liver mechanisms. Ganoderma applanatum polysaccharides are an under-characterized candidate adjunct, but their translational relevance remains uncertain. The study aims to narratively review mechanistic and preclinical evidence linking G. applanatum polysaccharides with obesity-associated dysglycaemia and liver injury and to identify key translational gaps. A structured narrative review of PubMed/MEDLINE and Google Scholar literature, complemented by backward citation screening, was undertaken. Evidence on preparation chemistry, structural features, metabolic and hepatic outcomes, gut-liver mechanisms, and clinical translation was synthesized qualitatively. Available evidence is limited and predominantly preclinical, with MACAPOS-2 obese rat studies providing the main G. applanatum data. Defined water-soluble preparations have been associated with improved glucose tolerance, insulin responsiveness, dyslipidaemia, oxidative stress markers, aminotransferases, and histologic liver injury. A biologically coherent explanation is gut-centered modulation involving microbiota remodelling, microbial metabolite signalling, barrier reinforcement, and downstream attenuation of endotoxemia-linked hepatic inflammatory and oxidative stress. However, the evidence base is constrained by preparation heterogeneity, incomplete structural characterization, modest sample sizes, limited direct measurement of gut-liver pathway engagement, and heavy reliance on a single research network. G. applanatum polysaccharides should currently be viewed as preparation-specific, biologically plausible immunometabolic modulators rather than clinically ready therapies. Progress requires structurally defined preparations, independent replication, mechanism-anchored biomarkers, and adequately powered human studies in carefully phenotyped populations.

A Practical Methodological Primer on Sample Size Determination Using G*Power for Biomedical Research

Vipin Patidar — 2026-03-02

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 GPower 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 GPower 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.

Post-operative complications following colorectal cancer surgery in Nigeria and Ghana: A systematic review

Obinna Ugwu — 2026-03-02

Colorectal cancer is the third most common cancer worldwide. There is a rising incidence of colorectal cancer in low- and middle-income countries, including Nigeria and Ghana. Surgical treatment for colorectal cancer has demonstrated efficacy, albeit with a higher incidence of postoperative complications in low- and middle-income countries. This review aimed to explore the complications following surgery for colorectal cancer, in Nigeria and Ghana. This review was guided by the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline. We searched Science Direct, MEDLINE, Embase, CINAHL, Scopus, and APA PsycINFO databases. All searches were conducted in August 2024. All study designs reporting surgical treatment of colorectal cancer within the past 10 years in Nigeria and Ghana were included. Four authors extracted the data, and a fifth author reviewed the data for accuracy and completeness. The Joanna Briggs Institute critical appraisal tools for cross-sectional, case series, and case-control studies were used for data quality assessment. A total of eleven studies with 6971 patients were included in this review. Males accounted for 57.1% of the patients and 42.9% were females. Study designs were mostly cross-sectional with sample sizes ranging from 2 to 4898. About half (50.7%) of the surgeries performed for colorectal cancer were hemicolectomies. A total of 530 postoperative complications were reported with the most reported as surgical site infection 27.5%. Other postoperative complications were death (21.7%), fascial/wound dehiscence (12.6%), bowel obstruction (11.1%), fistulae (10.6%), anastomotic leak (6.4%), bleeding (1.5%) and others (8.3%). There is a significant burden of postoperative complications following colorectal cancer surgery. The findings from this review suggest that there are key challenges with surgical treatment for colorectal cancer in the West African region that need to be addressed to improve the postoperative outcomes of patients.

Student Involvement In Health-Related Conferences In Nigeria: A Scoping Review

Paul Tunde KingPriest — 2026-03-02

Participation in scientific conferences supports the career trajectories of healthcare students. Although these benefits are well established, student involvement in conferences in low- and middle-income countries has not been systematically examined. This scoping review mapped the extent to which health-related conferences held in Nigeria intentionally incorporated student-focused provisions. This was conducted in accordance with the Joanna Briggs Institute methodology and reported using the PRISMA ScR framework. Fully in-person and hybrid national and international health-related conferences held in Nigeria between October 2023 and September 2025 were eligible. Searches were conducted across professional association websites, conference webpages, and social media, with supplementary enquiries to organisers where required. Records were independently screened and data extracted on student invitations, registration support and other student-focused measures. Data were analysed descriptively and synthesised narratively. 80 conferences met the inclusion criteria. 54, 67.5% were national events and conducted fully in-person (58, 72.5%), mostly in Abuja, the Federal Capital Territory (26, 32.5%), Lagos (16, 20%), and Rivers (6, 7.5%) states. Invitations directed specifically to students were identified in 13.8% of conferences, while 7.5% included student-specific abstract presentation categories. Subsidised student registration fee was offered by 19 (23.8%) of conferences. No conferences provided bursaries, travel or accommodation support; student-led sessions. Student involvement in health-related conferences held in Nigeria during the review period was limited. The absence of student representation, combined with geographic clustering of events, constrains equitable access for students. Deliberate strategies to embed student-focused provisions within conference planning are needed to engender early career development.

Prevalence of Respiratory Disorders and Associated Factors among Coal Mine Workers, Narrative Review

B Athira — 2026-03-02

The potential of pneumoconiosis was only discussed in the pretext of coal mining, but there is a new spectrum of respiratory diseases affecting coal miners termed as coal mine dust lung disease. In this narrative review, an attempt has been made to understand the prevalence of respiratory disorders among coal miners. A narrative synthesis was undertaken, using thematic analysis to synthesize the findings of the studies included within the review. The final narrative synthesis contains 12 studies. The majority of the studies were conducted in the USA. Among the total sample of 35,480 from 4 articles, a cumulative prevalence of 4.5% was found for Coal workers' pneumoconiosis in the studies conducted in mines of USA. Whereas the study in South Africa revealed a prevalence of 2.59%. The review has found a strong association of years of coal dust exposure with the occurrence of respiratory disorders among coal mine workers. Smoking is also found to be strongly associated with increasing the risk of respiratory disorders. So the review recommends an appropriate workplace culture, including respiratory hygiene, protection and avoiding habits like smoking among coal mine workers. The occupational surveillance for respiratory disorders among the workers needs to be strengthened.

Reconsidering Routine Appendectomy in Ovarian Neoplasms: Implications for Diagnostic Staging

Abdullahi Mohammed — 2026-03-02

Dear Editor,

Although the current International Federation of Gynecology and Obstetrics (FIGO) guidelines permit omitting appendectomy if the organ appears macroscopically normal,[1] this "visual-only" assessment lacks diagnostic validity in complex ovarian neoplasms. Preserving the appendix creates a “diagnostic vacuum”, resulting in under-staging and diagnostic uncertainty. Amidst the ongoing debate regarding appendectomy during gynaecological surgeries, the necessity of an appendectomy is often unknown until the final pathology report. [2,3] This letter highlights two scenarios where its absence almost hindered a definitive diagnosis.

Brief Background and Guidelines on the Current FIGO Recommendation on Cancer of the Ovary, Fallopian Tube, and Peritoneum: 2025 Update

In 2025, Renz et al. established the current global benchmark for staging ovarian, fallopian tube, and primary peritoneal cancers,[1] shifting towards selective surgery to minimize morbidity. Under these standards, appendectomy is indicated only for mucinous tumours, pseudomyxoma peritonei, or grossly abnormal appendix (defined by increased diameter, discoloration, or visible nodules). [4] This conservative posture relies on the statistically low rate of occult (microscopical) primary appendiceal tumours in a macroscopically normal appendix. [5]

However, a critical clinical gap exists where intra-operative frozen section is unavailable. Without real-time histology, surgeons are unable to definitively distinguish mucinous from non-mucinous ovarian epithelial tumours during primary surgery. Omitting appendectomy based on a “grossly normal” appearance frequently necessitates a second, avoidable surgery for diagnostic validation and staging if a mucinous morphology is later confirmed. Consequently, lack of immediate diagnostics transforms conservative surgery into a pathway of increased morbidity and delayed staging, often leaving the primary site as “undesignated” when definitive identification is impossible. [4,6,7]

Brief Background of the College of American Pathologists (CAP) Current Cancer Protocol (2024) for the Examination of Specimens from Patients with Primary Tumours of the Ovary, Fallopian Tube, or Peritoneum

The College of American Pathologists (CAP) Cancer Protocol (Version 1.5.0.0, June 2024), aligned with National Comprehensive Cancer Network [NCCN] guidelines, establishes the mandatory framework for pathological evaluation and synoptic reporting of ovarian, fallopian tube, and primary peritoneal neoplasms. Central to this protocol is the requirement that the “Primary Site” (Note C) be explicitly identified. [8] The guidelines acknowledge a significant historical shift in diagnostic practice, where the determination of the primary site was often based simply on the “dominant mass” encountered during surgery. However, the CAP protocol emphasizes that this historical reliance on organ size frequently resulted in extra-ovarian primary sites, such as those originating in the appendix or other gastrointestinal primaries, being mistakenly identified as primary ovarian or peritoneal neoplasms.

The most dangerous diagnostic hurdle in ovarian mucinous neoplasms is the “maturation phenomenon” or “mimicry study,” where metastatic low-grade appendiceal mucinous neoplasm (LAMN) to the ovary histologically mimics a primary ovarian mucinous cystadenoma or carcinoma. [9,10] These cases are often missed without examining the appendiceal source. For the pathologists, the absence of the appendix, the most common site of metastatic origin for most pelvic tumours presents a critical diagnostic and documentation challenge. While CAP technically allows for “undesignated” or “unknown” primary site categories, it strongly advises against their use. Instead, CAP protocol encourages using validated algorithms and criteria such as the Seidman or Yemelyanoava Algorithms, and Hart- Norris Criteria in differentiating primary bilateral ovarian tumours from metastatic ovarian tumours. [11, 12, 13] In the absence of a histological negative from the appendix, pathologists are unable to fulfill the mandate for a primary definitive site with absolute certainty. (Table 1) shows a comparison of recommendations and protocols for Appendectomy in ovarian neoplasms.

The Role of Cybersecurity Education in Nigeria’s Healthcare Sector

Emmanuel O. Oisakede — 2026-03-02

Background: Nigeria’s uptake of digital health through electronic records, telemedicine and connected devices has expanded the cyber-attack surface of health facilities. Cybersecurity failures are not only data-governance problems; they can interrupt prescribing, diagnostics, referral pathways and emergency workflows, with downstream implications for patient safety and trust. Evidence from hospital incidents shows that ransomware and recovery efforts can disrupt services and degrade the timeliness of care when staff are unprepared, underscoring the need to treat cyber resilience as a clinical quality domain.

Main Argument: This letter argues that the most scalable risk reduction in low-resource settings is workforce capability: many healthcare breaches exploit human and workflow weaknesses rather than novel technical exploits. We outline a minimum, role-based cybersecurity education package for medical students and practicing clinicians covering: (1) governance, policies and third-party risk management; (2) core technical controls clinicians encounter daily (access control, encryption, patching, segmentation and logging); (3) training and awareness focused on phishing, social engineering and safe downtime workarounds; (4) incident response and recovery integrated into clinical continuity planning; and (5) compliance and ethics aligned to Nigeria’s data protection requirements.

Conclusion: Embedding these competencies in curricula, accreditation and continuing professional development, reinforced through drills and monitoring, can protect sensitive information and keep essential services running during disruption.

Implementation of Non-communicable Diseases Interventions in Primary Health Care Facilities and at the Community Level in Nigeria: A call to Action and Partnership

Adebowale Femi Akinwumi — 2026-03-02

The burden of Non-communicable Diseases (NCDs) is on a steady rise in many developing countries, including Nigeria. There are proven population and individual-based cost-effective interventions adopted by the World Health Organization (WHO) for prevention and control of NCDs at the primary health care (PHC) facilities and the community level. Gaps exist in the country’s health system, hindering the implementation of essential NCDs interventions at the PHC and community levels. The Nigerian Federal Government has acknowledged the high prevalence of many NCDs and the risk factors, and taken steps to address this challenge, including the launch of eight national policy and guideline documents on NCDs. Document analysis was done to identify important areas for partnership and collaboration by the WHO, Federal Ministry of Health and Social Welfare (FMHSW), states’ Primary Health Care Development Agencies (states’ PHCDAs), and non-governmental organizations focused on NCDs in Nigeria. There is an urgent call for the implementation of the WHO package of essential NCD interventions in the PHC facilities and community level across Nigeria. Finally, a case example is made for an institutional support to Ekiti State, South-West Nigeria, a sub-national unit in the country, and an additional five other states, each from five remaining geopolitical zones, for an eighteen-month pilot implementation of essential interventions for prevention and control of NCDs based on three criteria. This could be scaled up across Nigeria following a review of the success and lessons learnt from the implementation of these NCDs interventions in the pilot states.