West Africa Journal of Medicine

EDITORIAL: Exploring Dermatoglyphic Screening for Hypertension, Strengthening Mental Health Care in Primary Health Settings, and Other Innovative Approaches to Improve Healthcare Outcomes

2025-06-24T08:34:53+00:00

Exploring Dermatoglyphic Screening for Hypertension, Strengthening Mental Health Care in Primary Health Settings, and Other Innovative Approaches to Improve Healthcare Outcomes

As we usher in this new issue, it is our pleasure to present a diverse array of thought-provoking research, clinical insights, and innovations that contribute significantly to the advancement of medical knowledge in our region and beyond. We extend our sincere gratitude to the authors whose diligent work, dedication, and valuable contributions have made this edition possible. Your commitment to improving healthcare through rigorous research is truly commendable. Additionally, we are immensely grateful to our esteemed reviewers and other stakeholders, whose expertise and thoughtful feedback continue to elevate the quality and impact of our journal. Your steadfast support ensures that the West African Journal of Medicine remains a premier platform for scholarly dialogue and collaboration. As always, this edition addresses pressing health issues impacting our communities, innovative healthcare solutions, and future directions. We hope the articles featured in this issue will inspire ongoing discussions and encourage collaboration.

Hypertension remains the most common cardiovascular risk factor globally and a leading contributor to the risk of cardiovascular events and mortality. While the condition is influenced by a mix of genetic and environmental factors, identifying individuals predisposed to hypertension before its onset could be instrumental in early intervention and prevention. (1) A recent study investigating the use of dermatoglyphics — the analysis of skin patterns, especially fingerprints — as a potential method for determining predisposition to hypertension offers fascinating insights. The study, conducted at the University College Hospital in Ibadan, Nigeria, involved 384 participants, half of whom were hypertensive and the other half normotensive. By analysing participants' fingerprints, the researchers determined whether dermatoglyphic features could offer clues about genetic predisposition to hypertension. The study used a fingerprint scanner, which provided accurate and automated data to reduce human error. The findings revealed no significant differences in the level 1 dermatoglyphic details (the general fingerprint patterns) between hypertensive and normotensive groups. However, a noteworthy discovery emerged when the researchers examined level 2 details — the minutiae of the fingerprint patterns, including features such as bifurcations, trifurcations, and ridge endings. These finer details showed significant differences between the hypertensive and normotensive groups, suggesting that they may serve as a marker for hypertension predisposition.

The study builds on previous research on dermatoglyphics, which has explored the link between fingerprint patterns and various health conditions, including hypertension. (2 – 4) It improved on previous methods with the use of digital methods to collect and analyse fingerprint data, minimizing human error and offering a higher level of precision. The significance of minutiae such as bifurcations and ridge endings in differentiating between hypertensive and normotensive individuals is a crucial finding. These minute features of the fingerprint have been linked to genetic factors and prenatal development, offering a unique window into an individual’s genetic predisposition to hypertension. The ability to predict hypertension risk through these characteristics would be a ground-breaking advancement in early health screening, potentially allowing for more targeted and effective interventions. (3 – 5)

The study represents an exciting step toward the potential use of dermatoglyphics as a non-invasive, cost-effective screening tool for hypertension. As the global burden of hypertension continues to rise, the need for early detection and prevention has never been more urgent. If future research can confirm and expand upon these findings, dermatoglyphic screening could become a valuable part of routine health assessments, offering individuals and healthcare providers a new way to assess and manage hypertension risk before it becomes a serious health issue.

Another study by Omobowale et al. assessed the self-rated competence of Primary Health Care (PHC) workers in mental health care in Oyo State, Nigeria. The research, involving 40 workers from 33 Local Government Areas, found that more than half rated their competence as good, especially in diagnosing mental illnesses, but one-third lacked confidence in managing psychosis. Challenges such as inadequate resources, funding, and stigma were identified. While it is encouraging that a majority of PHC workers felt confident in diagnosing mental illnesses, the fact that a significant proportion lacked confidence in managing some complex conditions is concerning. This gap in competence points to the urgent need for training programs to build skills in recognizing and managing mental health disorders prior to possible referral, particularly given the increasing burden of mental health issues across West Africa.

One critical factor influencing the ability of PHC workers to provide effective mental health care is the lack of resources. Many PHC centres in the region operate with limited access to diagnostic tools, medications, and mental health specialists, which hinders the delivery of quality care. Additionally, the stigma surrounding mental health continues to be a significant barrier, both within healthcare systems and in communities at large. Overcoming these stigmas requires targeted public health campaigns that promote mental health awareness and reduce the negative perceptions associated with mental illness. To improve the situation, there must be a concerted effort to enhance the training and support of PHC workers. Furthermore, fostering collaboration between mental health specialists and PHC workers could improve knowledge sharing and provide a more integrated approach to care. Additionally, greater investments in mental health resources, including funding for medication and treatment programs, are essential to ensure that PHC workers are equipped to deliver effective and comprehensive mental health services. Addressing these challenges will go a long way toward improving mental health care at the primary level and ensuring better outcomes for patients.

Some of the other articles featured in this issue include the work by Akabueze and colleagues investigating the association between anti-chlamydial antibodies and tubal factor infertility in women in Enugu, Nigeria. They found a 28% prevalence of chlamydial seropositivity, with women with tubal factor infertility nearly twice as likely to test positive for the antibodies. The study recommended using serum anti-chlamydial antibody testing as a screening tool for tubal infertility. Oladokun et al. compared ketamine and midazolam as procedural sedatives in paediatric dentistry, reporting that Midazolam showed better patient behaviour, while ketamine facilitated easier local anaesthesia and dental exams. However, ketamine led to longer recovery times and more side effects. Despite these differences, both sedatives were deemed acceptable by dental practitioners and guardians.

The spectrum of articles also draws attention to the importance of translating discoveries into practical solutions that address pressing health challenges. Collaboration between researchers, healthcare providers, and policymakers is key to bridging the gap between research and practice, ensuring that knowledge reaches those who need it most, particularly in resource-limited settings. By promoting evidence-based practices, we can make significant strides in improving healthcare in West Africa and beyond. Again, we invite authors to submit their manuscripts – original research, reviews, case reports, etc. – for subsequent editions, contributing to the ongoing dialogue and advancement of healthcare.

Prof G.E Erhabor

Editor-in-chief

Dr T.O Olajubu

Dept of Family Medicine

OAUTHC, Ile-Ife

References

Zappa M, Golino M, Verdecchia P, Angeli F. Genetics of Hypertension: From Monogenic Analysis to GETomics. J Cardiovasc Dev Dis. 2024 May 18;11(5):154. doi: 10.3390/jcdd11050154.
Shakir II, Sheikhi S, Mahmood M, Khan N, Rathan R, Salama M. A Study of Dermatoglyphics Patterns in Relation to the Levels of Perceived Stress. New Emirates Medical Journal. 2024 Jan;5(1):e02506882292950.
Mouneshkumar CD, Anand S, Shilpa RH, Haidry N, Kulkarni P, Gupta A. Dermatoglyphics and Cheiloscopy patterns in hypertensive and type 2 Diabetes mellitus patients: An observational study. Journal of Family Medicine and Primary Care. 2021 Mar 1;10(3):1177-82.
Pasha MI, Zeba A, Ahmed MM, Sarwari KN. A study of the dermatoglyphic pattern in essential hypertension subjects in Kalaburagi test. Indian Journal of Clinical Anatomy and Physiology. 2023 Jan 19;8(2):102-5.
Shirali A, Chowta KN, Ramapuram JT, Madi D, Chouhan RR. A “Handy” tool for hypertension prediction: Dermatoglyphics. Indian Heart Journal. 2018 Dec 1;70:S116-9.

CASE REPORT: Forearm Auto-Transplantation of Adenomatous Parathyroid Tissue to Prevent Post-Surgical Hypoparathyroidism: A Case Report

2025-06-24T11:42:09+00:00

Background: Primary hyperparathyroidism (PHPT) is commonly treated surgically, though post-surgical hypoparathyroidism (PoSH) is a significant concern. Most studies focus on the auto-transplantation of healthy parathyroid glands, especially in multi-gland disease cases such as multiple endocrine neoplasia type 1 (MEN1) syndrome. However, limited data exist on auto-transplantation of pathological glands in single-gland disease due to concerns over recurrence.

Objectives: This case report describes the successful management of persistent PHPT using the auto-transplantation of adenomatous parathyroid tissue, preventing long-term hypoparathyroidism.

Methods: A male patient in his 40s presented with persistent PHPT after previous surgery and inadvertent excision of three normal parathyroid glands. Re-operative exploration with excision of the last remaining parathyroid gland was performed, and the excised tissue was transplanted into the forearm.

Results: Six months post-surgery, the patient was weaned off active vitamin treatments as hypoparathyroidism resolved. Five years after surgery, calcium and parathyroid hormone (PTH) levels remained normal, with no recurrence of hypercalcaemia.

Conclusions: This case illustrates that forearm auto-transplantation of pathological parathyroid tissue can restore parathyroid function, prevent long-term hypoparathyroidism and avoid recurrence over a five year period.

ORIGINAL: Self-rated Competence and Role of Primary Health Care Workers in Mental Health Care Delivery in Oyo State, Nigeria

2025-06-24T08:57:27+00:00

Background: The mental health treatment gap in Nigeria remains wide, with only 20% of individuals accessing appropriate care. Integrating mental health services into the Primary Health Care (PHC) system has been identified as a strategy to address this problem. The Oyo State PHC Board recently appointed mental health desk officers across its 33 Local Government Areas to provide services and facilitate referrals.

Objectives: This study aimed to evaluate the roles and self-rated competence of PHC workers in mental health care delivery in Oyo State.

Methods: A cross-sectional study was conducted among 40 PHC workers including mental health desk officers across all the 33 Local Government Areas in Oyo State. Data on socio-demographic characteristics, self-rated competence, roles, training needs, and challenges were collected via a self-administered questionnaire. Data were subjected to bivariate and multivariate analysis using SPSS version 26 at p-value ≤0.05.

Result: About 57.5% of the respondents rated their competence as good, with notable competence in diagnosing mental illnesses and developing treatment plans, yet 32.5% lacked confidence in psychosis management. Only 20% identified their roles in sensitisation and awareness creation on mental health-related activities. Challenges included insufficient resources, funding, and stigma associated with mental health conditions. While a significant association was found between years as mental health desk officers and self-rated competence (P=0.000), this was not significant in multivariate analysis.

Conclusion: The study highlights the necessity for targeted interventions, training initiatives, and collaborative strategies to address gaps in competence and role identification among PHC workers, crucial for effectively addressing escalating mental health needs within communities.

ORIGINAL: Association Between Anti-Chlamydial Antibodies and Tubal Factor Infertility in South Eastern Nigeria

2025-06-24T09:22:44+00:00

Background: Chlamydia Trachomatis infection often runs an asymptomatic course with long-term sequelae. It commonly affects the fallopian tubes and could result in tubal blockage. A study of antichlamydial antibodies, a marker of the disease's presence, could help understand the disease burden in a given population.

Objective: To determine the prevalence of anti-chlamydial antibodies, and its association with tubal infertility among female partners of infertile couples in Enugu, South-eastern Nigeria.

Methodology: It was a cross-sectional analytical study involving two groups of infertile women attending gynaecology clinics of two tertiary institutions in Enugu, south-eastern Nigeria. Group A (Study group) had tubal factor infertility (n = 143) while Group B (Control) had non-tubal factor infertility (n = 143). Data were obtained using a structured, interviewer-administered questionnaire. Peripheral blood samples were collected and analyzed for anti-chlamydial antibodies using Human chlamydial trachomatis ELISA kits. Statistical package for social science (SPSS) version 25.0 was used for analysis. P-value of <0.05 was statistically significant.

Result: The overall prevalence of chlamydial seropositivity was 28.0%. Women with tubal factor infertility were almost twice more likely to have chlamydial seropositivity than those with non-tubal factor infertility (33.6% vs 22.4%; OR = 1.75; 95% C.I = 1.03 - 2.96; p = 0.036). Bilateral tubal occlusion (66.4%) was the commonest tubal pathology identified in the hysterosalpingogram.

Conclusion: Anti-chlamydial antibodies were significantly associated with tubal factor infertility in Enugu, South-eastern Nigeria. It is recommended that serum anti-chlamydial antibody testing could be adopted as a screening test for tubal infertility in the study population.

ORIGINAL: Assessing the Safety of Ketamine as a Procedural Sedative in Paediatric Dentistry: A Comparative Study with Midazolam

2025-06-24T09:59:25+00:00

Sedation has been employed to improve patient's cooperation. This has contributed to quality of treatments as well as improving the patients' and practitioners' experience during some procedures especially among children. The price of some of the newer sedatives can hamper the use in resource-constraint environments, hence the need to explore other cost-effective options. We compared the safety of oral ketamine against oral midazolam among 100 ASA I and II children aged between 3 and 7 years requiring dental treatments in a tertiary hospital in Lagos, Nigeria. The patients were divided into 2 equal groups by balloting using the opaque envelope method. Group A received Ketamine (7.5 mg / kg) while group B received Midazolam (0.75 mg / kg). The intravenous formulation was mixed with apple juice and administered orally. The patient's vital signs were monitored and the behaviour during procedure was assessed using the Frankl behaviour rating scale. Time to respond to verbal stimulus was recorded. The demographic characteristics and ASA status were similar between the 2 groups (p>0.05). the behaviour of the patients was better among the children in the midazolam group (p=0.026). the ease of administration of local anaesthesia (p=0.012) and examination of the buccal cavity after the procedure (p=0.019) was better in the ketamine group but there was no significant difference in the overall assessment of adequacy of sedation (p= 0.196). The trend of vital signs was similar between the 2 groups (P>0.05). Recovery was longer in the ketamine group (p=0.001). Side effects like vomiting, nystagmus, hypersecretion and somnolence, were significantly higher among the ketamine group, p<0.05. there was no significant difference in the acceptability of both drugs to the dental surgeons and the guardians of the patients (p= 0.093 and 0.308, respectively). Both drugs provided adequate conditions for complete treatments in the study groups. Although the side effect profile was better in the midazolam group, both were acceptable to both dental practitioners and the guardians of the patients.

ORIGINAL: Trichoscopic Evaluation of Normative Values of Scalp Hair Density in an African Population from Nigeria: A Cross-Sectional Study

2025-06-24T10:14:05+00:00

Background: Reports of hair density (HD) on healthy scalp of Africans is rare. Our study aimed to document normative scalp HD values in an African population.

Methods: A cross-sectional study of the healthy scalp of 909 individuals aged 5-45 years was conducted in 2023. Phototrichoscopic measurements were taken from four scalp sites (frontal, temporal, vertex and occipital). Hair parameters were compared between genders and across age groups. Data was analyzed using the IBM statistical package version 26.0.

Results: The mean age of the participants was 21.8 ± 11.02 years and they were 52.1% female. The number of hair strands (HS) from each pilosebaceous unit (PU) was 1 in 99.9% and 2 in 98% of the participants. HD ranged from 113 - 660/cm2 with a median (IQR) of 330.0 (301.0, 368.0) and was highest at the frontal scalp area. HD and total number of HS were significantly higher in all scalp sites in males (p=0.001) except for the frontal scalp site, p=0.283. HD and number of HS were highest in the fourth decade of life (median HD (IQR); 339 (301, 386), mean HS/PU; 37.09±6.96) and least in the first decade of life (median HD (IQR); 320 (292, 358), mean HS/PU; 35.18± 6.26) irrespective of the scalp site, P<0.001.

Conclusions: The hair density of Africans is high. The number of HS from each PU and HD varies with the scalp site, age and gender. These findings from the African scalp are relevant in the management of Africans who have hair loss and in those who require restoratives surgeries.

ORIGINAL: Family Planning Service Uptake in Hospitals in Rivers State, Nigeria

2025-06-24T10:32:06+00:00

Introduction: Family planning refers to a couple's ability to have the number of children they want by spacing out their children appropriately or a person's ability to avoid unintended pregnancies by using various contraceptive methods and infertility treatment. All hospitals in Rivers State, Nigeria, that provide primary care and offer family planning services were included in the study.

Aim: To describe the pattern of family planning service uptake in the hospitals in Rivers State.

Methodology: An 8-year retrospective review of data collection from the District Health Information System 2 (DHIS 2) platform in the Health Management Information System in Rivers State was conducted from 2014 - 2021. Data from 387 health facilities was obtained from the DHIS 2 platform and reviewed. The inclusion criteria were all the family planning data in the platform from the various health facilities in the LGAs in the State, during the time of review while the exclusion criteria was the health facilities that didn't provide any family planning data. Data was represented as frequencies, percentages, and charts.

Results: During the period under review, the Family Planning clinics counselled a total of 931,774 individuals, of whom 421,785 (45.3%) accepted family planning services. Condoms (65.3%) were the most widely utilized contraceptive, whereas bilateral tubal ligation (0.1%) was the least utilized. Methods like injectables, implants, oral contraceptive pills, and intrauterine contraceptive devices accounted for 16.1%, 9.4%, 7.8%, and 1.3%, respectively. A significant increase was observed in the trend of the use of condoms, injectables, and oral contraceptive pills between 2014- 2021.

Conclusion: There was an increasing trend in the utilization of family planning services among women of childbearing age in the State during this eight-year period. Condom being the most utilized indicated that it was the most accepted and approved by clients in family planning clinics in Rivers State. The knowledge of contraceptive utilization trends can be used to monitor and appraise the acceptance and approval of each method and family planning program over a period.

ORIGINAL: Comparative Study of Serum Malondialdehyde in Women with Cervical Cancer and Women with High-Risk Human Papillomavirus Infection at The Lagos State University Teaching Hospital, Lagos

2025-06-24T10:40:43+00:00

Background: Cervical cancer is a common cause of cancer-related morbidity and mortality among women in developing countries. HPV infection has been detected in more than 99% of cervical cancers throughout the world. Among the effective factors in the progression of HPV infection is oxidative stress which can influence the host immune responses to viral proteins and viral genes expression.

Aim: To determine the association between serum malondialdehyde concentration in women with cervical cancer and women with high-risk human papillomavirus infection at the Lagos State University Teaching Hospital, Lagos (LASUTH).

Methods: This was a comparative cross-sectional study where 90 women from the gynaecology and colposcopy as well as medical oncology clinics of LASUTH were recruited using convenience sampling method. This study comprised 30 women with histologically confirmed cervical cancer, 30 women with high-risk human papilloma virus infection and 30 apparently healthy women negative for high-risk human papilloma virus infection. Fasting blood samples of consenting women were obtained and serum malondialdehyde were measured using spectrophotometric method. Data was given as mean ± standard deviation (SD) and significant differences between means were assessed by Student's t-test. Analysis of data was carried out by using the statistical package for social sciences (SPSS) version 23 software. P-value of <0.05 was considered statistically significant.

Results: Results indicated that the mean serum malondialdehyde levels were significantly higher among women with cervical cancer (6.13 ± 4.1 nmol/l) and those with high-risk HPV infection (5.61±3.0nmol/l) compared to women negative for high-risk HPV infection (0.35±0.2nmol/l). A statistically significant association was observed between cervical cancer and negative high-risk HPV infection(p<0.001). However, no significant association was found between cervical cancer and positive high-risk HPV infection (p = 0.57).

Conclusion: The study's conclusion highlighted significantly elevated serum malondialdehyde levels in women with cervical cancer and high-risk HPV infection compared to those without high- risk HPV infection, indicating increased oxidative stress. It also noted no significant disparity in serum malondialdehyde levels between women with cervical cancer and those with high-risk HPV infection. The findings underscored the importance of conducting serum antioxidant studies in these women to mitigate oxidative stress.

ORIGINAL: Comparative Effectiveness of Paracetamol, Ibuprofen, and their Combination in Managing Post-Endodontic Treatment Pain

2025-06-24T10:54:18+00:00

Background: Although endodontic treatment is intended to eliminate long-term pain, pain after this treatment is commonly reported. Non-opioid analgesics like non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol, have been used with great success in treating patients with endodontic pain.

Objectives: This study seeks to compare the effectiveness of doses of paracetamol, ibuprofen; each drug used alone, and a combination of both drugs in the management of post endodontic treatment pain.

Method: A randomized placebo-controlled single-blind comparative study involving 80 patients who had endodontic treatment (instrumentation) was conducted by putting the patients into four groups of 20 patients each: paracetamol group, ibuprofen group, paracetamol + ibuprofen group, and placebo group. Numerical rating scale (NRS) was used to measure pain intensity at 0, 0.5, 1, 1.5, 2, 2.5, 3, 4, 5 and 6 h after drug administration. Inferential statistics included the Friedman's Test with Kruskal-Wallis H post-hoc test. Level of significance was set at 95% (p-value < 0.05).

Results: Paracetamol was more effective compared to ibuprofen, the combination and placebo in the relief of post-endodontic pain within the first 2 h after administration of medications (p < 0.05). Ibuprofen + paracetamol combination showed a better relief of pain than ibuprofen alone within the first 2 h after administration but this was not statistically significant (p > 0.05).

Conclusion: Paracetamol significantly reduced post-endodontic pain better than ibuprofen and its combination with paracetamol within the first two hours.

ORIGINAL: Adult Intussusception: A 10-year Institutional Review

2025-06-24T11:15:11+00:00

Background: Intussusception occurs when a proximal bowel segment telescopes into the lumen of adjoining distal bowel. Adult intussusception (AI) is a rare cause of intestinal obstruction. The preoperative diagnosis remains a challenge due to the nonspecific nature of presenting symptoms.

Objective: To present our institutional experience with the presentation and management of AI.

Patients and methods: A retrospective analysis of 10 cases of AI managed between January 2015 and December 2024. Data were extracted from the patients' medical records and analysed using SPSS version 21. Results were presented in tables as frequency and simple percentages.

Results: During the study period, 10 cases of AI were managed, comprising of 5 males and 5 females, giving a male to female ratio of 1:1. The patients' ages ranged between 29 and 75 years with a mean age of 43.2 years. Most of the patients presented with symptoms of intestinal obstruction including nausea and vomiting. The symptoms' duration varied from 3 days to 180 days, with majority (60%) presenting with subacute symptoms. Ileocolic (40%) was the commonest variety. Lymphadenitis (30%) and idiopathic (20%) were the commonest lead points. Adenocarcinoma accounted for 10%. All 10 patients had surgical intervention that included right hemicolectomy (50%), segmental ileal resection (30%) and segmental ileal resection with subtotal colectomy (10%). There were two morbidities and one mortality.

Conclusion: AI is rare in our facility occurring equally in both sexes. Surgery was the mainstay of treatment. A high index of suspicion, aided by appropriate imaging techniques, is critical to achieving good management outcome.

ORIGINAL: Dermatoglyphic Characteristics in Adults with Primary Hypertension in Southwestern Nigeria

2025-06-24T11:23:59+00:00

Dermatoglyphics is genetically determined and the traits remain unchanged until decomposition after death. These traits reflect prenatal developmental stability. Dermatoglyphics details are studied from level 1 to level 3. Hypertension is a pathological condition influenced by genetics and environmental factors. The aim of this study is to investigate the use of dermatoglyphics as noninvasive screening tool to determine predisposition to hypertension. The participants were 384 (192 normotensive and 192 hypertensive), from University College Hospital Ibadan. Fingerprints were obtained using fingerprint scanner Dermalog LF10, Hamburg, Germany. GraphPad Prism 8.4.3 was used for T-test and ANOVA for association between the variables. Level 1 details did not reveal significant difference between hypertensive and normotensive. Level 2 details (minutiae) revealed significant difference (p<0.05) between hypertensives and normotensives. The level 2 details of dermatoglyphics may be a screening tool for predisposition to hypertension.