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World Journal of Psychiatry 2018年第1期8卷 20-26页

作者： Basant K Puri Mary Egan fintan wallis Philip Jakeman Department of Medicine Hammersmith HospitalImperial College London Department of Radiology University Hospital Limerick Centre for Interventions in Infection Inflammation and Immunity University of Limerick

AIM To investigate the repeatability of proton magnetic resonance spectroscopy in the in vivo measurement of human cerebral levels of choline-containing compounds(Cho).METHODS Two consecutive scans were carried out in six healthy resting subjects at a magnetic field strength of 1.5 T. On each occasion, neurospectroscopy data were collected from 64 voxels using the same 2 D chemical shift imaging(CSI) sequence. The data were analyzed in the same way, using the same software, to obtain the values for each voxel of the ratio of Cho to creatine. The Wilcoxon related-samples signed-rank test, coefficient of variation(CV), repeatability coefficient(RC), and intraclass correlation coefficient(ICC) were used to assess the repeatability. RESULTS The CV ranged from 2.75% to 33.99%, while the minimum RC was 5.68%. There was excellent reproducibility, as judged by significant ICC values, in 26 voxels. Just three voxels showed significant differences according to the Wilcoxon related-samples signed-rank test. CONCLUSION It is therefore concluded that when CSI multivoxel proton neurospectroscopy is used to measure cerebral choline-containing compounds at 1.5 T, the reproducibility is highly acceptable.

关键词： Cerebral metabolites Chemical shift imaging Choline Neurospectroscopy Neuropsychiatric disorders

Lassa Fever Case Report: Challenges in Making Early Diagnosis

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Advances in Infectious Diseases 2020年第4期10卷 228-234页

作者： Peter Ekpunobi Chime Ethel Nkechi Chime Edmund Ndibuagu fintan Chinweike Ekochin Sussan Arinze-Onyia Bibiana Oti Department of Medicine Enugu State University of Science and Technology Teaching Hospital Enugu Nigeria Department of Otorhinolaryngology University of Nigeria Teaching Hospital Enugu Nigeria Department of Otorhinolaryngology Enugu State University of Science and Technology Teaching Hospital Enugu Nigeria Department of Community Medicine Enugu State University of Science and Technology Teaching Hospital Enugu Nigeria

Introduction: Lassa fever is a disease of public health importance because of the associated morbidity and high case fatality rate among hospitalized patients. Even after recovery, there may be residual problems such as sensorineural hearing loss. The initial presentation of Lassa fever may be with non-specific symptoms similar to what is seen in the more common febrile illnesses such as malaria or typhoid fever. In such a setting therefore, timely diagnosis of Lassa fever may be difficult. Case Report: We report a case of Lassa fever that presented to our institution. She was a middle aged woman who had non-specific symptoms of febrile illness and who died in less than 48 hours of admission. She had a subtle bleeding on the lip just before death which was what raised the suspicion for Lassa fever. Laboratory confirmation of Lassa fever was made retrospectively. Conclusion: When the presenting symptoms are non-specific, a high index of suspicion is required for timely recognition of Lassa fever. Early diagnosis is important for prompt therapeutic intervention as well as for limiting the spread of the disease. This is the second case of Lassa fever presenting to our hospital, but the first published case of Lassa fever from our hospital.

关键词： Lassa Fever Lassa Virus Lassa Fever Diagnosis Lassa Fever Symptoms and Signs

Does Pre-Operative Tranexamic Acid Increase the Incidence of Thromboembolism in Primary Lower Limb Arthroplasty?

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Open Journal of Orthopedics 2013年第6期3卷 249-252页

作者： Veenesh Selvaratnam James R. Fountain Nigel J. Donnachie Thomas G. Thomas fintan A. Carroll Wirral University Teaching Hospital NHS Foundation Trust Wirral UK Wirral University Teaching Hospital NHS Foundation Trust Wirral UK.

Introduction: Tranexamic Acid (TA) has been shown to decrease peri-operative bleeding in primary lower limb arthroplasty surgery. There are still concerns with regards to the increased risk of thromboembolic events with the use of TA. The aim of this study was to assess whether the use of pre-operative TA increased the incidence of Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) in Total Hip Replacement (THR) and Total Knee Replacement (TKR). Methods: Patients who underwent primary THR or TKR between August 2007 and August 2009 were identified from the databases of three surgeons within the lower limb arthroplasty unit. A retrospective case notes analysis was performed. DVT was diagnosed on Duplex Ultrasound Scan and PE on CT Pulmonary Angiogram. A positive result was a diagnosis of DVT or PE within 3 months of surgery. Results: 701 patients underwent primary THR and TKR over the 2-year period. 320 patients (189 THR, 131 TKR) received TA pre-operatively. 381 patients (190 THR, 191 TKR) did not receive TA prior to surgery. A total of 8 (2.5%) patients who received TA were diagnosed with either a DVT (4) or PE (4) post operatively. In those patients not receiving TA, 6 had a DVT and 4 had a PE, a total of 10 (2.6%). Conclusion: Pre-operative use of Tranexamic Acid in primary THR and TKR does not increase the incidence of DVT and PE.

关键词： Tranexamic Acid DVT PE TKR THR

Addition of castor oil as a booster in colon capsule regimens significantly improves completion rates and polyp detection

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2021年第6期12卷 103-112页

作者： Serhiy Semenov Mohd Syafiq Ismail fintan O'Hara Sandeep Sihag Barbara Ryan Anthony O'Connor Sarah O'Donnell Deirdre McNamara Gastroenterology Department Tallaght University HospitalDublin D 24Ireland Trinity Academic Gastroenterology Group Trinity College DublinDublin D 2Ireland

BACKGROUND Incomplete excretion rates are problematic for colon capsule endoscopy(CCE).Widely available booster regimens are *** published data on one day preparation CCE protocol using castor oil appeared *** To assess the impact of adding castor oil to a standard split-dose(2-d)preparation in an unselected Western patient *** All patients aged 18 or more referred to our unit for a CCE over a 5-mo period were prospectively *** were retrospectively identified from our CCE *** patients received split bowel preparation with Moviprep■[polyethylene glycol(PEG)-3350,sodium sulphate,sodium chloride,potassium chloride,sodium ascorbate and ascorbic acid for oral solution;Norgine B.V,United States],a PEG-based solution used predominantly in our colonoscopy *** booster regimen included Moviprep■with 750 mL of water(booster 1)on reaching the small bowel.A further dose of Moviprep■with 250 mL of water was given 3 h later and a bisacodyl suppository(Dulcolax■)10 mg after 8 h,if the capsule was not *** addition to our standard booster regimen,cases received an additional 15 mL of castor oil given at the time of booster 1.A nested case control design with 2:1 ratio(control:case)was *** demographics,completion rates,image quality,colonic transit time,diagnostic yield and polyp detection were compared between groups,using a student t or chi-square tests as *** One hundred and eighty-six CCEs[mean age 60 years(18-97),56%females,n=104],including 62 cases have been *** breakdown included 96 polyp surveillance(51.6%),42 lower gastrointestinal symptoms(22.6%),28 due to incomplete colonoscopy(15%),18 anaemia(9.7%)and 2 inflammatory bowel disease surveillance(1.1%).Overall,CCE completion was 77%(144/186),image quality was adequate/diagnostic in 91%(170/186),mean colonic transit time was 3.5 h(0.25-13),and the polyp detection rate was 57%(106/186).Completion rates wer

关键词： Castor oil Colon capsule endoscopy Bowel preparation Completion rates Excretion rates

Hypergonadotrophic Hypogonadism with Cerebellar Ataxia in a Twenty-Six-Year-Old Female: A Case Report

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Open Journal of Modern Neurosurgery 2024年第1期14卷 83-90页

作者： Bibiana I. Oti Geoffrey Okorie Peter Chime Ethel Chime Birinus Ezeala-Adikaibe Casmir Orjioke fintan Ekochin Michael C. Abonyi Enugu State University Teaching Hospital Enugu Nigeria University of Nigeria Teaching Hospital Ituku-Ozalla Nigeria

Gordon Holmes Syndrome is a rare inherited disease characterized by both neurological and reproductive signs and symptoms. Most patients develop neurologic challenges in early adulthood and cerebellar ataxia occurs as the disease progresses. In the majority of patients, hypogonadism is hypogonadotropic but rarely hypergonadotropic. We report a case of a 26-year-old female in Nigeria, with hypergonadotropic hypogonadism and cerebellar atrophy from a non-consanguineous marriage and no family history.

关键词： Gordon Holmes Syndrome Hypergonadotrophic Hypogonadism Cerebellar Ataxia Neuroendocrine Disorder

Correlates of Tobacco and Marijuana Use among Urban Dwellers in Enugu, Nigeria

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Open Journal of Preventive Medicine 2019年第7期9卷 80-94页

作者： Onodugo Obinna Donatus Orjioke Casmir Obumneme Bennett Anyim Ezeala-Adikaibe Birinus Adikaibe Chime Peter Onodugo Pauline Nkiruka Mbadiwe Nkeiruka Obumneme-Anyim Ijeoma Nnenne Ekochin fintan Achor Justin Ezeala-Adikaibe Ngozi Praise Department of Medicine University of Nigeria Teaching Hospital Enugu Nigeria Department of Medicine Enugu State University of Science and Technology Teaching Hospital Enugu Nigeria Department of Pediatrics University of Nigeria Teaching Hospital Enugu Nigeria Federal Neuropsychiatric Hospital Enugu Enugu Nigeria Department of Community Medicine University of Nigeria Teaching Hospital Enugu Nigeria

Introduction: Tobacco and marijuana use is a public health challenge all over the world and especially in Sub Saharan Africa. The combination of low socioeconomic status and substance use can be described as a social and economic disaster for many poor families of Africa. While majority of studies concentrated on cigarette smoking, few studies in Nigeria has been conducted on non-smoke forms of tobacco. The burden of marijuana abuse is also rising in the Nigeria. Similar to cigarette smoking, cannabis use is more common among males. Knowledge of the pattern of tobacco and cannabis use in the community is important considering the public health implications. The aim of this study was to determine the prevalence of tobacco (cigarette smoking and snuff) and cannabis use among adults in an urban communities Enugu, southeast Nigeria. Methods: This was a cross-sectional descriptive study conducted in urban slum settlements in Enugu, the capital of Enugu State, southeast Nigeria. Using a semi structured questionnaire, we collected data selected socio-demographic characteristics, including tobacco use and cannabis use in the last 30 days. The study was conducted between August and December 2013. For database management and statistical analyses, we used the SPSS version 23. Results: The total number of individuals recruited in the study was 1572;844 (52.8%) females and 728 (45.5%) males with a male to female ratio of 0.9:1. Tobacco was used by a total of 270 (17.2%) individuals within the last 4 weeks and marijuana by 23 (1.5%) of the population. Overall, 280 (17.8%) used either one or both tobacco and marijuana. While snuff was predominately used from 60 years and above, cigarette smoking peaked at 30 - 39 years and marijuana use peaked at a younger age of 20 - 29 years. Cigarette smoking positively correlated with male gender (male 1, female 0) and alcohol use (Yes 1, No 0). P Conclusion: The prevalence of cigarette smoking (5.5%), snuff (11.6%) and marijuana use (1.6%) wa

关键词： Tobacco Cigarette Snuff Alcohol Marijuana Nigeria

Helicobacter pylori:High dose amoxicillin does not improve primary or secondary eradication rates in an Irish cohort

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World Journal of Clinical Cases 2024年第16期12卷 2773-2779页

作者： Conor Costigan Aoife M O'Sullivan Jim O'Connell Shreyashee Sengupta Thomas Butler Stephen Molloy fintan John O'Hara Barbara Ryan Niall Breslin Sarah O'Donnell Anthony O'Connor Sinead Smith Deirdre McNamara Trinity Academic Gastroenterology Group School of Medicine-Trinity College DublinDublin D2Ireland Department of Gastroenterology Tallaght University HospitalDublin D24 NR0AIreland

BACKGROUND Helicobacter pylori(***)eradication rates have fallen globally,likely in large part due to increasing antibiotic resistance to traditional *** areas of high clarithromycin and metronidazole resistance such as ours,Maastricht VI guidelines suggest high dose amoxicillin dual therapy(HDADT)can be considered,subject to evidence for local *** this study we assess efficacy of HDADT therapy for *** eradication in an Irish *** To assess the efficacy of HDADT therapy for *** eradication in an Irish cohort as both first line,and subsequent therapy for patients diagnosed with *** All patients testing positive for *** in a tertiary centre were treated prospectively with HDADT(amoxicillin 1 g tid and esomeprazole 40 mg bid×14 d)over a period of 8 *** was confirmed with Urea Breath Test at least 4 wk after cessation of therapy.A delta-over-baseline>4%was considered *** demographics and treatment outcomes were recorded,analysed and controlled for basic demographics and prior *** *** One hundred and ninety-eight patients were identified with *** infection,10 patients were excluded due to penicillin allergy and 38 patients refused follow up *** all 139 were included in the analysis,55%(n=76)were female,mean age was 46.6 ***,93(67%)of patients were treatment-naïve and 46(33%)had received at least one previous course of *** groups were statistically ***-reported compliance with HDADT was 97%,mild side-effects occurred in 7%.There were no serious adverse drug *** the eradication rate for our cohort was 56%(78/139).Eradication rates were worse for those with previous treatment[43%(20/46)vs 62%(58/93),P=0.0458,odds ratio=2.15].Age and Gender had no effect on eradication *** Overall eradication rates with HDADT were *** being a simple and possibly better tolerated regime,these results do not

关键词： Helicobacter pylori eradication Helicobacter pylori High dose amoxicillin High dose amoxicillin dual therapy Triple therapy

Extended 72-hour patency capsule protocol improves functional patency rates in high-risk patients undergoing capsule endoscopy

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World Journal of Gastrointestinal Endoscopy 2024年第12期16卷 661-667页

作者： fintan John O'Hara Conor Costigan Deirdre McNamara Department of Gastroenterology Tallaght University HospitalDublin 24 D24 NR0AIreland Trinity Academic Gastroenterology Group School of Medicine-Trinity College DublinDublin 24 D24 NR0AIreland

BACKGROUND Capsule endoscopy(CE)is a pivotal diagnostic tool for gastrointestinal(GI)disorders,yet capsule retention poses a significant risk,especially in patients with known risk *** patency capsule(PC)helps assess the functional patency of the GI tract to mitigate this ***,the standard 28-hour protocol for confirming patency often results in high false-positive rates,unnecessarily excluding many patients from undergoing diagnostic *** To investigate the use of a 72-hour extended patency protocol to improve functional patency rates in patients at risk of capsule *** We performed a prospective,open-label study evaluating an extended 72-hour protocol for confirming functional patency with the *** over six months,135 patients with risk factors for capsule retention were *** primary endpoint was the capsule retention rate in patients with confirmed functional *** endpoints included the rates of confirmed patency via self-reporting or radiology,small bowel transit times,and adverse *** Functional patency was confirmed in 48.9%(n=66)of patients within 28 hours,with an additional 17.4%(n=12)confirmed within 72 hours,increasing the overall patency rate to 57.8%.There was no significant difference in small bowel transit time between patients confirmed for patency at 28 hours vs those confirmed at 72 ***,no capsule retention was observed in patients who were confirmed for patency under the extended ***,50%(n=39)of patients who proceeded to CE had clinically significant *** Extending the patency assessment protocol to 72 hours significantly improves the rate of confirmed functional patency without increasing the risk of capsule *** protocol is safe,effective,and cost-neutral,allowing more patients to benefit from *** studies are recommended to refine the protocol and enhance its clinical utility.

关键词： Capsule endoscopy Retention Patency Small bowel

The Prevalence of Stroke Survivors in Urban Slums in Enugu, Nigeria

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Open Journal of Preventive Medicine 2019年第6期9卷 51-67页

作者： Oluchi Stella Ekenze Ezeala-Adikaibe Birinus Adikaibe Onodugo Obinna Chime Peter Orjioke Casmir Onodugo Pauline Nkiruka Mbadiwe Nkeiruka Onyekonwu Chinwe Ijoma Nkemdilim Uchenna Okoye Julius Uwabunkeonye Obumneme-Anyim Ijeoma Nnenne Ekochin fintan Ernest Okwundu Nwazor Emmanuel Uzodimma Iwuozo Department of Medicine University of Nigeria Teaching Hospital Enugu Nigeria Department of Medicine Enugu State University of Science and Technology Teaching Hospital Enugu Nigeria Department of Pediatrics University of Nigeria Teaching Hospital Enugu Nigeria Department of Medicine Federal Medical Center Owerri Nigeria Federal Medical Center Makurdi Nigeria

Background: Stroke is one of the commonest non-communicable diseases and the commonest cause of death in adult neurology wards. Stroke preva-lence in sub Saharan Africa has dramatically increased over the past decades possibly due to changing life styles, poverty, poor health infrastructures which had led to increased risk factors for stroke. Poor nutrition and lack of access to standard medical care, predispose to high rates of stroke morbidity and mor-tality hence possible low prevalence. Little is known about the prevalence of stroke in people with low socio-economic status in Nigeria. Objectives: The main objective of this study was to determine the prevalence of stroke in two urban slums in south east Nigeria. Materials and Methods: This was a cross sectional descriptive study carried out in two slums in Enugu, South East Nige-ria. Participants were screened using a stroke specific questionnaire and further examined by two independent neurologists for evidence of focal neurological deficits. Analysis was done by SPSS version 22. Results: A total of 1440 par-ticipants were surveyed in the study;769 (53.4) females and 671 (46.6%) males. About 22.3% (321) screened positive for various neurological diseases out of which 17 (5.3%) had evidence for stroke giving an overall prevalence of 1.2% (males 9 (1.3%) vs females 8 (1%) p = 0.6). The mean age of stroke sur-vivors was 60.1 years, similar in males and females (p = 0.6). The odds ratio for stroke from 40 years showed progress increment doubling between 60 and 70 years and tripled between 40 and 70 years. Age, lower level of education, positive history of hypertension, sickle cell disease, leg swelling and use of snuff positively are correlated with clinical diagnosis of stroke. Conclusion: The prevalence of stroke in two urban slums in Enugu metropolis was 12/1000. Hypertension, diabetes, use of snuff, and low levels of education were signifi-cant risk factors for stroke. Public health educational measures, promoti

关键词： Stroke Prevalence Nigeria

Medical Morbidity Profile of Adults in a Rural Community in Enugu, Southeast Nigeria: A Cross Sectional Survey

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Health 2023年第7期15卷 711-727页

作者： Nkeiruka Chigekwu Mbadiwe Birinus Adikaibe Ezeala-Adikaibe Celestine Chibuzor Okwara Monday Umeh Nwobodo fintan C. Ekochin Casmir Orjioke Nkiruka P. Onodugo Titus Okpara Denise Paul Okoli Uzoma C. Okechukwu Mark Ezeme Obumneme B. Anyim Grace O. Eneh Obinna Donatus Onodugo Innocent Okoye Uchenna N. Ijoma Department of Medicine Enugu State University Teaching Hospital Enugu Nigeria Department of Medicine University of Nigeria Teaching Hospital Enugu Nigeria Memfys Hospital for Neurosurgery Enugu Nigeria Anambra State University Teaching Hospital Awka Nigeria

Introduction: People in rural communities are exposed to the risk factors for non-communicable disease as those in urban areas. Correct interpretation and management of symptoms are important in primary care especially in rural communities where diagnostic facilities are not readily available. Materials and Methods: This was a cross-sectional study carried out in a village in Enugu South Local Government area of Enugu State. Thorough medical history was taken from all eligible participants who gave their consent. Data were analyzed using SPSS version 26. Results: Data from a total of 1019 (64.7%) out of 1576 participants were analysed. Fever was by far the most common presenting complaint 580 (56.9%) of all participants and 67.9% of medical complaints seen in the clinic. This was followed remotely by musculoskeletal problems and neurological problems 15.6% and 3.8% of the participants respectively. Across all age groups, febrile illness was more than non-febrile illness except in those 65 years. Generalized body pains 74 (7.3%), back pains 55 (5.1), headache 33 (3.2%) and abdominal pains 24 (2.4%) were the commonest symptoms presented by the participants. About 15 (1.5%) of the population surveyed had had trauma/surgery in the past. This was twice the number who presented to the clinic with symptoms related to injury and trauma 7 (0.7%). Conclusions: Fever and musculoskeletal pains are the dominant medical complaints presented by adults in a rural community clinic. This may be related to the season of the year and the occupation of the population studied.

关键词： Symptoms Infectious Diseases Non-Communicable Diseases Rural Community Southeast Nigeria