Repair complications following surgical repair, such as leakage, are associated with high mortality, highlighting the importance of determining the best method for closing perforated peptic ulcers. Accordingly, we compared methods of primary closure for perforated peptic ulcers. We conducted a literature search of PubMed, EBSCOhost, and the Cochrane Library for randomized trials that compared different techniques for open repair of giant and normal-sized perforated peptic ulcers (Graham’s patch, modified Graham’s patch, omental plugging, figure-of-eight repair, duodenal exclusion, jejunal serosa patch, and simple repair without an omental patch). The primary outcome was leakage of the repair. In total, 20 randomized controlled studies, mainly conducted in Asia and Africa, with six interventions and 1323 patients, were used for this network meta-analysis. Omental plugging was associated with the lowest postoperative leak rate for treating normal-sized perforated peptic ulcers (odds ratio [OR]: 0.0727; credible interval [CrI]: 0.00397, 0.608; P score=77.57
Research indicates that men exhibit poor health-seeking behaviour despite their educational and socioeconomic status. Health-related quality of life (HRQOL) is a useful indicator of overall health and has gained widespread acceptance as a patient-centred approach to assessing overall health status. This cross-sectional survey aimed to assess HRQOL and examined its association with sociodemographic characteristics among outpatient adult males attending a primary care clinic at the University of Ilorin Teaching Hospital (UITH), Ilorin. An interviewer-administered questionnaire was administered to 392 adult male patients at the general outpatient clinic of the UITH over three months. The HRQOL was assessed with the World Health Organization Quality of Life abridged version (WHOQOL-BREF). Analysis of variance (ANOVA) and T-test were used to determine the mean difference between sociodemographic characteristics and mean domain HRQOL scores. Respondents scored highest in the physical domain, 65.35 ± 11.12 and scored lowest in the environmental domain, 50.22 ± 8.44 amongst the four measured domains. Respondents younger than 30, those who earned more and had a tertiary education scored highest across all HRQOL domains. Single respondents had the highest mean scores in the physical and psychological domains, while separated/divorced respondents had the highest mean scores in the environmental domain. The retired respondents scored poorly across all domains (p < 0.05). Significant disparities in HRQOL were observed across age, education and income categories. These findings underscore the need for interventions that address social and economic disadvantage among men and support the integration of HRQOL assessment into routine outpatient care.
Background Nigeria bears the highest burden of maternal deaths globally; however, limited evidence exists on the work environments in which Skilled Health Personnel (SHPs) deliver maternity care and how these conditions shape care processes. Work-related stress (WRS), which arises when job demands exceed available resources, may undermine workforce wellbeing, care quality, and patient safety. Although workforce shortages and resource constraints are widely recognised challenges in LMICs, empirical evidence linking workplace stress to maternity service delivery remains limited. This study assessed the burden, drivers, consequences, and coping strategies associated with WRS among SHPs in Northern Nigeria. Methods We conducted a convergent mixed-methods study involving 194 SHPs from 48 public and private facilities in Kaduna, Bauchi, and Kwara States. Quantitative data were collected using the USDAW Workplace Stress Questionnaire, a single-item current stress measure, and a 1–10 stress severity scale and analysed using descriptive statistics and bivariate tests (Spearman’s correlation, t-tests, and ANOVA). Qualitative data from 7 focus group discussions and 8 key informant interviews were thematically analysed. Results Overall, 76% (147/194) of SHPs reported current stress, and 73% (107/147) attributed their stress primarily to work-related factors. Workload pressures were prominent: 36.6% worked > 60 hours/week, and 24.7% saw > 40 patients/day. Frequently reported stressors were heavy workload (39.2%), overcrowding (32.5%), and lack of equipment (31.4%). Stress severity was strongly correlated with heavy workload (r = 0.58, p < 0.01) and inadequate breaks (r = 0.50, p < 0.01). Mean stress scores differed significantly by cadre (F(12,181) = 2.58, p = 0.004; η² = 0.145), with higher levels among junior cadres. Qualitative findings described physical and emotional strain and perceived impacts on consultation quality of provider–patient interactions. Most participants (88.1%) reported no formal workplace stress support systems. Conclusion WRS among SHPs providing maternity care in Northern Nigeria is widespread, driven by structural and organisational conditions. Addressing WRS through workload-responsive staffing, supportive supervision, and institutionalised psychosocial support should be integrated into maternal health system strengthening efforts. Strengthening workforce wellbeing may be critical for sustaining safe, responsive, and high-quality maternity care delivery in high-burden settings.
Pott’s puffy tumour remains an important clinical entity despite advances in antimicrobial therapy, owing to its propensity for intracranial extension and potential for adverse outcomes. We report three adolescents with Pott’s puffy tumour managed at a Nigerian neurosurgical centre, highlighting the spectrum of intracranial complications, including a rare case of interhemispheric subdural empyema. Three adolescent males aged 15–18 years presented with frontal scalp swelling, headache and fever following paranasal sinus infection. Neuroimaging demonstrated frontal sinusitis with associated intracranial suppurative complications. The first patient had a bifrontal extradural abscess and underwent drainage of the subperiosteal and extradural abscesses with excision of the necrotic frontal bone, combined with functional endoscopic sinus surgery, resulting in complete recovery. The second patient presented with seizure and hemiparesis secondary to frontal convexity and interhemispheric subdural empyema. He underwent burr hole drainage of both empyemas with endoscopic sinus surgery and achieved complete neurological recovery following prolonged antimicrobial therapy. The third patient had frontal osteomyelitis, a frontal subperiosteal abscess with a right frontal extradural abscess but was discharged against medical advice before definite surgical treatment because of financial constraints. Pott’s puffy tumour remains an important complication of frontal sinusitis in adolescents and should prompt careful evaluation for intracranial extension. Early multidisciplinary management, incorporating timely neurosurgical drainage, definitive treatment of the underlying sinus infection, and antimicrobial therapy results in favourable outcome. This series broadens the recognized spectrum of intracranial complications associated with Pott’s puffy tumour by highlighting the occurrence of interhemispheric subdural empyema in this clinical setting.
Atrophic acne scarring is a common complication of acne vulgaris and is associated with a significant psychosocial burden. Among the various treatment options available, microneedling and chemical peels are widely used due to their accessibility and favourable safety profiles. However, uncertainty remains regarding their comparative effectiveness and safety. Hence, the aim of this review is to compare the effectiveness of microneedling versus chemical peels in improving the severity of atrophic acne scars and to evaluate patient satisfaction and adverse events associated with these interventions. Randomized and non-randomized clinical trials were included. Outcomes were categorized as clinically significant improvement (≥50% improvement), any improvement (≥1 grade improvement), and continuous measures of scar severity. Dichotomous outcomes were pooled using risk ratios (RR), while continuous outcomes were analyzed using standardized mean differences (SMD). Outcomes that could not be quantitatively synthesized were analyzed narratively. A total of 11 studies comprising 713 participants were included. Meta-analysis of clinically significant improvement (five studies; n = 215) showed no significant difference between microneedling and chemical peels (RR = 0.97; 95% CI: 0.82-1.15; p = 0.74; I² = 0%). However, microneedling was associated with a significantly higher likelihood of achieving any improvement (four studies; n = 264; RR = 1.79; 95% CI: 1.37-2.34; p < 0.0001; I² = 0%). Analysis of continuous outcomes (four studies; n = 211) showed no significant difference, with a trend favouring chemical peels (SMD = -0.27; 95% CI: -0.91 to 0.38; p = 0.41; I² = 80%). Findings on patient satisfaction were inconsistent, while adverse events varied between interventions, with microneedling associated with greater procedural pain and chemical peels associated with burning sensations and exfoliation. Microneedling and chemical peels appear to be broadly comparable in the treatment of atrophic acne scars, with no clear evidence of superiority. While microneedling may be more effective in achieving minimal improvement, and chemical peels may show advantages in certain continuous measures, these differences are not consistent across outcomes. Treatment decisions should therefore be individualized. Further high-quality studies with standardized outcome measures are needed to strengthen the evidence base.
