Nigerian medical journal : journal of the Nigeria Medical Association最新文献

{"title":"A Rare Case of Hemobilia due to Hepatic Artery Pseudoaneurysm (HAPA) in the right Hepatic Artery-Segment 8 branch and its Management via Coil Embolization.","authors":"Hasan Hüseyin Zorlu, Abdülkerim Şalkacı","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Upper gastrointestinal bleeding (UGIB) is a common case encountered in gastroenterology practice, and one of its very uncommon causes is hemobilia. 25-30% of hemobilia cases present with the triad of UGIB, right upper quadrant (RUQ) pain, and jaundice (Quinke's triad). The probable complications related to hemobilia, such as acute cholecystitis, acute cholangitis, and acute pancreatitis, basically arise from cholestasis due to the blood clots plugging the biliary lumen. [2] Underlying pathologies of hemobilia are mostly iatrogenic (such as hepatobiliary interventional procedures) or trauma, whereas vascular causes are one of the fewest. Hemobilia originating from a ruptured spontaneous hepatic artery pseudoaneurysm (HAPA) is even rarer. [1] We report this case to highlight the diagnostic challenge and successful management of a rare spontaneous segmental HAPA presented with hemobilia.</p>","PeriodicalId":94346,"journal":{"name":"Nigerian medical journal : journal of the Nigeria Medical Association","volume":"67 4","pages":"1649-1653"},"PeriodicalIF":0.0,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adolescent Acceptance of Diphtheria Booster Dose in Kano, Nigeria: A Cross-Sectional Mixed-Methods Study.","authors":"Ahmad Ibrahim, Hadiza Musa Abdullahi, Khadija Yahaya, Rabiu Ibrahim Jalo, Abubakar Sadiq Abubakar, Nura Abubakar, Isah Ibrahim, Aminatu Kwaku Chiroma","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Diphtheria remains a vaccine-preventable disease of public health concern in low- and middle-income countries, with recurrent outbreaks linked to immunity gaps among older children and adolescents. In Nigeria, although routine infant immunisation coverage has improved, uptake of recommended booster doses among adolescents remains suboptimal. This study assessed factors associated with acceptance of the diphtheria booster dose among in-school adolescents in Kano metropolis, northern Nigeria.</p><p><strong>Methodology: </strong>A cross-sectional explanatory sequential mixed-methods study was conducted among 650 adolescents aged 10-19 years. Quantitative data were collected using a structured questionnaire and analysed with descriptive statistics, chi-square tests, and logistic regression. Qualitative data were obtained through focus group discussions and key informant interviews with adolescents, parents, and teachers, and analysed thematically to contextualise quantitative findings.</p><p><strong>Results: </strong>Overall, 81.8% of respondents expressed willingness to accept the diphtheria booster dose. In adjusted analysis, acceptance was significantly associated with being in senior secondary school (aOR = 2.21; 95% CI: 1.31-3.75). Parental marital status (aOR = 0.56; 95% CI: 0.34-0.91), parental education (aOR = 0.58; 95% CI: 0.35-0.94), and knowledge of the booster dose (aOR = 0.20; 95% CI: 0.10-0.41) were also significantly associated with acceptance. Qualitative findings revealed that willingness was often conditional on parental approval, perceived vaccine safety, and service availability. Key barriers included poor awareness, misconceptions, fear of side effects, and limited parental involvement, while facilitators included school-based health education, peer influence, parental encouragement, teacher support, and school-based vaccination platforms.</p><p><strong>Conclusion: </strong>Although stated willingness to accept the diphtheria booster dose was high, acceptance is influenced by school-related, parental, and perceptual factors. Strengthening school-based vaccination platforms, enhancing parental engagement, and implementing culturally sensitive communication strategies may improve booster uptake and prevent future outbreaks.</p>","PeriodicalId":94346,"journal":{"name":"Nigerian medical journal : journal of the Nigeria Medical Association","volume":"67 4","pages":"1606-1616"},"PeriodicalIF":0.0,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Pre-Operative Vaginal Preparation with 0.3% Chlorhexidine-Cetrimide Versus 10% Povidone-Iodine on Post-Caesarean Section Infection - A Randomized Controlled Trial.","authors":"Olohitai Gladys Ohiomoba, Saheed Adebawale Ogunme, Adebayo Job Adekunle, Samuel Okwuchukwu Ilikannu","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Caesarean section (CS) is one of the most frequently performed surgeries worldwide. Pre-operative vaginal cleansing before caesarean section may reduce bacterial inoculation and subsequent postoperative infections. The objective of the study was to compare the efficacy of pre-operative 0.3% chlorhexidine-cetrimide vaginal cleansing with 10% povidone-iodine in preventing post-caesarean infectious morbidities.</p><p><strong>Methodology: </strong>This multicentre, single-blind, randomised controlled trial enrolled 250 women undergoing elective or emergency caesarean section. Participants were randomised in a 1:1 ratio to receive pre-operative vaginal cleansing with either chlorhexidine-cetrimide or povidone-iodine. Follow-up occurred until hospital discharge and at two and six weeks postpartum. Data were analysed using SPSS version 28.0, with statistical significance set at p < 0.05.</p><p><strong>Results: </strong>Both antiseptic agents were well tolerated, with no significant adverse effects reported. Compared with the chlorhexidine-cetrimide group, women in the povidone-iodine group had significantly higher rates of postoperative fever (66% vs 34%; p = 0.009) and surgical site infection (69.6% vs 30.4%; p = 0.049). Overall, chlorhexidine-cetrimide was associated with a lower incidence of composite post-caesarean infectious morbidity.</p><p><strong>Conclusion: </strong>Both pre-operative vaginal cleansing agents were safe and well tolerated among CS patients. However, chlorhexidine-cetrimide was more effective than povidone-iodine in reducing post-caesarean infectious morbidity, including fever and wound infection.</p>","PeriodicalId":94346,"journal":{"name":"Nigerian medical journal : journal of the Nigeria Medical Association","volume":"67 4","pages":"1513-1529"},"PeriodicalIF":0.0,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unmasking a Hidden Burden: Chemotherapy-Induced and Exacerbated Diabetes in Paediatric Cancer: A Report of Two Cases.","authors":"Elizabeth Eberechi Oyenusi, Ugonna Olaraiche Fakile, Rebecca Ene Ojabo, Oluwadamilola Moromoke Oladipo, Adeseye Michael Akinsete","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>L-asparaginase and corticosteroids, essential components of paediatric leukaemia and lymphoma treatment, are associated with hyperglycaemia and, rarely, diabetic ketoacidosis (DKA). Chemotherapy-induced diabetes is an under-recognised complication in pediatric oncology in resource-constrained settings.</p><p><strong>Case 1: </strong>A 4-year-old female with newly diagnosed Acute Lymphoblastic Leukaemia (ALL) was commenced on chemotherapy with prednisolone, 6-mercaptopurine, vincristine, doxorubicin, cyclophosphamide, L-asparaginase and cytarabine. However, on the 7^th day of initiating chemotherapy, urinalysis showed glycosuria (+++) and absent ketonuria. Fasting blood glucose (FBG) was 7.4mmol/L. She had generalized boils and poor intravenous (IV) site wound healing. Her body mass index (BMI) was normal. Glycosylated haemoglobin A1c (HbA1c) showed diabetic levels of 7.7%. Serum C-peptide, amylase, and lipase were normal. She was managed with subcutaneous basal and premeal boluses of insulin and monitored by 8-point blood glucose monitoring with good control. Insulin was tapered off when hypoglycaemic episodes set in. She remained normoglycaemic and is being monitored closely.</p><p><strong>Case 2: </strong>An 11-year-old male was diagnosed with NHL, and chemotherapy was initiated with a regimen consisting of cyclophosphamide, vincristine, oral prednisolone, intrathecal methotrexate, and hydrocortisone. After 8 days on chemotherapy, FBG and RBG were 8.7mmol/L and 9.3mmol/L, respectively. No typical symptoms of DM were noted. Physical examination revealed acanthosis nigricans, BMI of 21.1kg/m² (overweight), and blood pressure (130/75 mmHg) readings of systolic hypertension and diastolic pre-hypertension. Investigations showed HbA1c of 6.8%, increased serum C-Peptide of 34.39ng/ml (0.78-5.19), confirming insulin resistance. A diagnosis of type 2 DM, possibly exacerbated by steroid therapy, was made. Treatment was commenced with metformin 500mg nocte. The FBG has normalized.These cases demonstrate that early detection of hyperglycaemia during childhood cancer chemotherapy is a low-cost, high-impact intervention that can prevent life-threatening complications such as DKA and its associated morbidity and mortality, especially in resource-constrained settings.</p>","PeriodicalId":94346,"journal":{"name":"Nigerian medical journal : journal of the Nigeria Medical Association","volume":"67 4","pages":"1654-1658"},"PeriodicalIF":0.0,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare Financing, Service Quality, and Utilisation in Delta State, Nigeria: An Integrative Literature Review.","authors":"Blessing Osagumwendia Josiah, Narayanasamy Siddaiyan Santhi, Timothy Wale Olaosebikan, Israel Opeyemi Fawole, Oyindamola Tomisin Ajayi, Opeoluwa Oluwatoyin Olabode","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Nigeria's health system has been heavily dependent on out-of-pocket (OOP) payments, exposing households to financial hardship and limiting access to essential care. Empirical evidence on how financing arrangements shape service quality and healthcare utilisation at the subnational level is limited. This integrative review synthesised studies from Delta State to clarify these relationships and inform strategies for advancing Universal Health Coverage (UHC).</p><p><strong>Methodology: </strong>A systematic search of major biomedical and regional databases identified English-language primary studies published between 2010 and 2024 on healthcare financing, service quality, utilisation, and related access barriers in Delta State. Eight eligible studies were critically appraised using established tools and integrated through narrative synthesis.</p><p><strong>Results: </strong>Across the studies, OOP payments dominated healthcare financing, particularly at tertiary facilities. Prepayment through the NHIS and DSCHS was concentrated among formally employed, urban, or more health-literate groups. User fees, difficulties completing insurance enrolment, medicine stock-outs, long waiting times, and negative staff attitudes were consistently reported as barriers undermining both perceived service quality and actual service use. Maternal health evidence highlighted continued reliance on traditional birth attendants, driven by perceptions of more respectful interpersonal care and stronger sociocultural alignment. The studies suggest limited risk pooling, operational weaknesses in insurance schemes, and persistent organisational and sociocultural barriers interact to constrain equitable utilisation.</p><p><strong>Conclusion: </strong>Despite the small and heterogeneous evidence base, the findings suggest that reducing OOP dependence, strengthening State and National insurance schemes, and addressing service delivery and sociocultural barriers are essential for equitable progress toward UHC in Delta State.</p>","PeriodicalId":94346,"journal":{"name":"Nigerian medical journal : journal of the Nigeria Medical Association","volume":"67 4","pages":"1258-1270"},"PeriodicalIF":0.0,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Histopathological Study of Prostate Core Needle Biopsies in Enugu, Southeast Nigeria and the Role of Immunohistochemistry in Resolving Diagnostic Dilemmas.","authors":"Christian Sunday Nnamani, Chukwuma Joseph Uzoigwe, Solomon Kenechukwu Anyimba, Martin Arinze Nzegwu, Edegbe Felix Osuogu","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Prostate lesions constitute a major cause of morbidity and mortality in Nigerian adult males. Prostate cancer (Pca) is now being reported as the second most frequently diagnosed malignancy in adult males. On some occasions, histopathological results may be inconclusive with the tissue sample tagged 'suspicious' of prostate cancer. Immunohistochemistry using Alpha methyl acyl CoA racemase (AMACR) and High molecular weight cytokeratin (HMWCK) can be used to clarify such cases. The study aims to evaluate the role of immunohistochemistry in resolving diagnostic dilemmas following core needle prostate biopsy.</p><p><strong>Methodology: </strong>This was a retrospective study performed between January 2013 and December 2017. The Hematoxylin and Eosin (H&E) stained slides and their corresponding archived formalin-fixed paraffin tissue blocks of cases over the study period were retrieved and reviewed. The suspicious cases were subjected to immunohistochemistry using AMACR and HMWCK to determine their actual status.</p><p><strong>Results: </strong>A total of 1838 prostate biopsy cases were received over the five-year period. A mean age of 69±9 years was observed, while the most common Gleason score was 6 [International Society of Urological Pathology (ISUP) grade group 1]. Among the 1838 prostate biopsy cases retrieved, 147 cases were excluded because of incomplete data. Hence, 1691 core needle prostate biopsies were used for the study. The highest number of core needle prostate biopsy cases were benign (57.8%), followed by malignant lesions (39%), whereas 3.4% were suspicious. Among the cases with suspicious status, 67.2% were AMACR marker positive and HMWCK marker negative, while 32.8% were AMACR marker negative and HMWCK marker positive. Therefore, 67.2% of the suspicious cases were resolved to be malignant and 32.8% were resolved to be benign.</p><p><strong>Conclusion: </strong>Immunohistochemistry is very useful in resolving cases of suspicious prostate lesions. The required staining apparatus should be made readily available in our tertiary centers.</p>","PeriodicalId":94346,"journal":{"name":"Nigerian medical journal : journal of the Nigeria Medical Association","volume":"67 4","pages":"1430-1439"},"PeriodicalIF":0.0,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Assessment of the Incidence of Fever among Prophylactic Acetaminophen-Treated and Non-Treated Infants after Pentavalent Vaccine in a Tertiary Institution in Abakaliki, Southeast Nigeria.","authors":"Helen Chiamaka Nwamini, Chinonyelum Thecla Ezeonu, Uzoma Vivian Asiegbu, Maria-Laretta Chito Orji","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Post-immunization fever is common and may reduce vaccine acceptance. Although prophylactic acetaminophen has been shown to decrease fever after DPT vaccination, evidence following pentavalent vaccination is limited. This study compared the incidence of fever in infants who received prophylactic acetaminophen with those who did not after pentavalent vaccination in two hospitals in Abakaliki, Southeast Nigeria.</p><p><strong>Methodology: </strong>It was an open-label, parallel-group randomized controlled trial with 160 mother-infant dyads in the intervention group and 160 mother-infant dyads in the control group, conducted in two immunization clinics in Abakaliki. The infants (cases) received acetaminophen (Emzor brand) before the vaccination. A digital thermometer was given to each mother, taught how to use it, followed by hands-on sessions. Mothers were called at intervals of 6, 12, 18, 24, 30, 36, 42, and 48 hours to check and report thermometer readings, and fever was defined as a reading of 37.40 °C and above. Data were analyzed using IBM SPSS Statistics version 26, and statistical significance was set at p < 0.05.</p><p><strong>Results: </strong>The mean temperatures were consistently higher in the intervention group compared to the control group. More participants reported fever at 6, 12, 18, and 24^th hours in the intervention group compared to the controls. These relationships were statistically significant.</p><p><strong>Conclusion: </strong>This study did not demonstrate a reduction in fever among infants receiving prophylactic acetaminophen. Efforts should be geared towards proper and sustained health education on immunization for women of childbearing age.</p>","PeriodicalId":94346,"journal":{"name":"Nigerian medical journal : journal of the Nigeria Medical Association","volume":"67 4","pages":"1440-1450"},"PeriodicalIF":0.0,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical Cancer Screening Utilization and Its Correlates Among Women of Reproductive Age in North Central Nigeria: A Cross-Sectional Study.","authors":"Oluwasegun Ajala Akanni, Idris Muhammad Yakubu, Adegoriola Olubisi Ojurongbe, Matthew Olusegun Fijabiye, Olamide Ishola, Odunayo Akanni, Rabiu Muhammad Dansabo","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Cervical cancer remains a significant public health challenge in Nigeria despite the availability of screening methods. This study investigated the utilization of cervical cancer screening and associated factors among women of reproductive age attending Federal Medical Center (FMC), Keffi.</p><p><strong>Methodology: </strong>A cross-sectional study was conducted among women aged 15-49 years using a systematic random sampling method. Of 400 eligible women approached, 384 completed the questionnaire (response rate: 96.0%). Data were collected with structured questionnaires and analyzed using SPSS v26. Chi-square tests and logistic regression were used to examine associations at p ≤ 0.05.</p><p><strong>Results: </strong>Only 24% of participants had ever undergone cervical cancer screening, while 76% had never been screened. Among those screened, 65.2% utilized government facilities, and 34.8% used private hospitals. Major barriers to screening included Cost (34.2%), Lack of Awareness (30.2%), not knowing where to access services (15.1%), and the belief that screening is unnecessary without symptoms (15.1%). Multivariable logistic regression confirmed Age (aOR = 0.08; 95% CI: 0.01-0.65; p = 0.018), Marital Status (aOR = 0.09; 95% CI: 0.02-0.43; p = 0.002), Educational Status (aOR = 3.43; 95% CI: 1.34-8.76; p = 0.010), Occupation (aOR = 0.29; 95% CI: 0.11 - 0.79; p = 0.016), and Ethnicity (aOR = 0.32; 95% CI: 0.13 - 0.77; p = 0.011) as independent predictors.</p><p><strong>Conclusions: </strong>The uptake of cervical cancer screening services among women at FMC Keffi is low. Cost, poor awareness, limited knowledge of service locations, and misconceptions were key barriers. Marital status, education, occupation, and ethnicity predicted screening uptake. Reducing costs and improving targeted health education may increase utilization.</p>","PeriodicalId":94346,"journal":{"name":"Nigerian medical journal : journal of the Nigeria Medical Association","volume":"67 4","pages":"1463-1472"},"PeriodicalIF":0.0,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geospatial Distribution and Predictors of Unmet Need for Contraception Among Women in Zaria LGA, Kaduna State, Nigeria.","authors":"Jamilu Garba, Tukur Dahiru, Shefa'atu Shehu, Ahmad Bello, Umar Tanimu, Umar Yahaya, Fahad Abubakar Saulawa, Mukhtar Abdurrahman Danmallam","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Despite the global increase in contraceptive use, millions of women in developing countries still wish to delay or avoid pregnancy but are not using any method of contraception for various reasons. This gap contributes to unintended pregnancies, thereby increasing the risk of unsafe abortions, as well as maternal and neonatal morbidity and mortality. This study aimed to assess the geospatial distribution and predictors of unmet need for contraception among married women in Zaria LGA.</p><p><strong>Methodology: </strong>A community-based cross-sectional study was conducted among 2,880 women selected from 90 enumeration areas using a two-stage stratified cluster sampling technique. Data were collected using two adapted standardized questionnaires. Spatial analysis and binary logistic regression were performed to identify spatial distribution and predictors of unmet need for contraception, with statistical analysis conducted using Stata version 17 and ArcGIS Pro version 3.1.</p><p><strong>Results: </strong>The overall prevalence of unmet need for contraception was 25.7%, comprising 15.2% for spacing and 10.5% for limiting. Spatial analysis revealed significant clustering of unmet need for contraception, with hotspot areas predominantly located in the rural parts of the LGA. Significant predictors of unmet need included women in the second wealth quintile (aOR = 1.370, 95% CI: 1.025-1.831), women who had ever born 1-2 children (aOR = 0.530, 95% CI: 0.301-0.792), and women whose most recent childbirth occurred 1-2 years prior to the survey (aOR = 1.530, 95% CI: 1.178-1.987).</p><p><strong>Conclusion: </strong>Unmet need for contraception remains high in Zaria LGA. Spatial clustering and hotspot areas were predominantly observed in rural settings, highlighting persistent geographic inequities in access to and utilization of family planning services. Scaling up area-specific, community-based family planning interventions in identified hotspot areas may help reduce the burden of unmet need for contraception.</p>","PeriodicalId":94346,"journal":{"name":"Nigerian medical journal : journal of the Nigeria Medical Association","volume":"67 4","pages":"1473-1490"},"PeriodicalIF":0.0,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeting Novel Pathways in Pulmonary Arterial Hypertension: A Systematic Review and Meta-Analysis of New Therapeutic Agents.","authors":"Ashi Meel, Darsh Udawat, Alka Bansal, Bhavesh Meel","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary arterial hypertension (PAH) is a progressive condition marked by vascular remodelling, increased pulmonary vascular resistance, and right ventricular dysfunction. Current vasodilator therapies fail to reverse disease progression. Alternative molecular pathways may offer improved therapeutic outcomes and potentially modify the disease course. This systematic review and meta-analysis evaluated the efficacy and safety of emerging PAH therapies targeting alternative pathways, including bone morphogenetic protein signalling, rho-kinase inhibition, estrogen modulation, AMP-activated protein kinase activation, phosphodiesterase-5 inhibition, soluble guanylate cyclase stimulation, and regenerative stem cell therapy.</p><p><strong>Methodology: </strong>A systematic review was performed following PRISMA guidelines. Randomised controlled trials (RCTs) and phase I-III studies assessing novel therapies were included. Primary outcomes were six-minute walk distance (6MWD) and haemodynamic parameters. Secondary endpoints included brain natriuretic peptide (BNP)/N-terminal pro-BNP (NT-proBNP), World Health Organization Functional Class (WHO-FC), tricuspid annular plane systolic excursion (TAPSE), and safety profile. Meta-analysis employed a random-effects model.</p><p><strong>Results: </strong>Thirteen trials (1,782 participants) met inclusion criteria. Sotatercept improved 6MWD, pulmonary vascular resistance (PVR), and NT-proBNP. Riociguat enhanced haemodynamics and WHO-FC. Metformin plus bosentan improved exercise capacity and right ventricular function. Udenafil and fasudil showed modest benefits, while anastrozole had mixed results with possible sex-specific effects. Cardiosphere-derived stem cells showed early promise for right ventricular recovery. Heterogeneity was high across studies.</p><p><strong>Conclusion: </strong>Novel therapies targeting non-vasodilatory pathways show promise in PAH, though pooled estimates were limited by extreme heterogeneity. At the individual trial level, sotatercept (0.7 mg/kg), riociguat (2.5 mg), and metformin (500 mg with bosentan) showed the most favourable benefit profiles. Standardised trial designs and consistent outcome reporting are needed to confirm these potential disease-modifying effects.</p>","PeriodicalId":94346,"journal":{"name":"Nigerian medical journal : journal of the Nigeria Medical Association","volume":"67 4","pages":"1297-1319"},"PeriodicalIF":0.0,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}