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   Table of Contents - Current issue
January-February 2021
Volume 30 | Issue 1
Page Nos. 1-121

Online since Monday, February 15, 2021

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Cutaneous malignant melanoma in skin of color individuals Highly accessed article p. 1
Ehiaghe Lonia Anaba
Cutaneous malignant melanoma (CMM) is a malignancy with a worldwide incidence. Literature is replete in the Caucasian population, but in skin of color, there is a dearth of literature. Documented reports of the epidemiology of cutaneous melanoma reveal a low incidence in the skin of colour individuals (SCIs). However, this incidence is rising. It is also documented that when CMM does occur, it is commonly acral, unlike in Caucasians in whom it is truncal, and the most common histopathological pattern is acral lentiginous melanoma. There are as yet no observed differences in the histopathology of melanoma in individuals with skin of color and that in Caucasians. SCIs have a low awareness of CMM with consequently advanced lesion presentation, ulcerated lesions, and poor survival compared to Caucasians. The genetics of CMM in the skin of color has not been well studied. The only available study of the genetics of melanoma reveals a difference in melanoma genetics between SCIs and Caucasians. In SCIs, due to the low incidence of cutaneous melanoma, cutaneous melanoma is commonly misdiagnosed. This misdiagnosis can be both clinical and histopathological. Awareness of the features of cutaneous melanoma and sun protection practices is poor in individuals with skin of color. A high index of suspicion should be entertained of any hyperpigmented lesion in any SCI, especially if it is acral and a histopathological assessment should be made as early treatment improves survival.
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A rapid review of the reopening of schools in this COVID-19 pandemic? How ready are we in Nigeria? Highly accessed article p. 8
Chinonyelum Thecla Ezeonu, Chigozie Jesse Uneke, Paul Olisaemeka Ezeonu
Reopening schools raise several ethical issues, including safety, privacy, autonomy, vulnerability. Some countries have gradually reopened their schools with explicit guidelines for safety. The safe reopening of schools demands sensitivity to community inequities. We aimed to conduct a rapid review of the strategies adopted in the reopening of schools in some countries amid the Covid-19 and highlight the lessons learned and to consider the feasibility of some of the existing Nigerian guidelines on school reopening. A rapid review technique using PubMed search was conducted using the combination of the following keywords: Covid-19, school, reopening along with a Google search using the phrase 'schools reopened in COVID-19 pandemic.' Ten articles met the inclusion criteria and were reviewed. Eight countries namely China, Taiwan, South Korea, Norway, Denmark, Germany, Australia, and Israel were identified. All the countries started with phased reopening and a reduction in class size. Wearing masks was mandatory in some countries. Hand hygiene and strict cleaning of high-touch surfaces were ensured. The Nigerian government's guidelines towards the reopening of schools sound good, but the feasibility, acceptability, and effectiveness need to be objectively assessed and contextualized across all tiers of the government and at all levels of development to avoid COVID -19 resurgence.
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Sonographic evaluation of maternal splenic dimensions in normal pregnancy p. 17
Benjamin Effiong Udoh, Ekaete Vincent Ukpong, Samson Omini Paulinus, Comfort Okokon, Akwa Egom Erim
Aim: We aimed to establish sonographically the range of splenic dimensions in healthy pregnancy and to investigate their relationships with gestational age, maternal age body mass index (BMI), and parity of the mother. Materials and Methods: A prospective cross-sectional descriptive study of splenic dimensions was performed on 339 healthy, normal pregnant women aged 23–42 years. The spleen was measured with women in supine position on the couch. Scanning of the spleen was done with the women in deep inspiration so that the spleen descends. A Sonoline Omnia ultrasound imaging system with serial number 526,206,526 and model number Cc-13 H71 fitted with a 3.5 MHz ultrasound probe was used in scanning the spleen along the lower left costal margin from the 9th to the 11th rib at the anterior, mid, and posterior axillary lines with the woman in the right lateral decubitus position using the oblique intercostal approach. Data were analyzed using SPSS software version 20.0 (SPSS Inc., Chicago, IL, USA). The relationship between splenic dimensions and gestational age, maternal age, and BMI was assessed using Pearson's correlation coefficient. P ≤ 0.05 was considered statistically significant. Results: The result of the study shows that the mean length, width, thickness, and volume of the spleen of the mothers were 11.9 ± 0.7 cm, 5.7 ± 0.7, 9.5 ± 0.8 cm, and 381.6 ± 111.4 cm3, respectively. Gestational age was significantly correlated positively with splenic length and splenic volume of the mother (r = 0.37 and 0.31, P = 0.000). Conclusion: Splenic dimensions are higher in pregnant women compared to values reported for nonpregnant women and increases with gestational age and BMI of the mother.
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Cervical hemilaminectomy in the management of degenerative cervical spine myelopathy: Utilization and outcome from a neurosurgical institution in Nigeria p. 21
Chika Anele Ndubuisi, Ned Michael Ndafia, Samuel Chukwunonyerem Ohaegbulam
Introduction: Hemilaminectomy is one of the surgical options for managing cervical spondylotic myelopathy. However, it has not gained the expected popularity. This paper aims to review the utilization of hemilaminectomy, the outcome, and complications observed among patients managed with the procedure for advanced multilevel degenerative cervical myelopathy. Methods: Retrospective longitudinal analysis was done at a neurosurgical hospital in Enugu, Nigeria, between years 2010 and 2019. The Study analyzed 46 patients that had cervical hemilaminectomy for multilevel degenerative cervical myelopathy. Excluded from the study were patients offered cervical hemilaminectomy for other indications including tumor and trauma. Patients were assessed by comparing preoperative, and follow-up modified Japanese Orthopedic Association (mJOA) score and Cobb lordotic angles. The minimum postoperative follow-up period was for 1 year. Results: The mean age was 61 (43–88) years; male-to-female ratio was 3.6:1. Symptoms duration ranged from 6 months to 10 years, and 31 (67.4%) patients had significant comorbidities. The average operation time was 2 h 36 min (0.5–3.0 h). The mean blood loss was 260 mL (100–800 mL). Right hemilaminectomy was done for 37 (80.4%) patients. The average preoperative and postoperative Cobb lordotic angles were 10.90° ± 2.4° and 9.98° ± 2.1°. The mean preoperative mJOA was 8.2 ± 1.4. On follow-up 1 year after surgery, the mean mJOA score was 12.2 ± 1.1 (P = 0.0001). The neurological recovery rate at 1-year follow-up was 50.5%. One patient each experienced a transient postoperative drop in neurology, postoperative respiratory distress, and surgical site infection. Conclusion: Cervical hemilaminectomy for multilevel degenerative cervical spine myelopathy has the potential to achieve clinically satisfactory neurological improvement without significantly compromising stability and other serious long-term complications.
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Telemedicine for children with sickle cell anemia in a resource-poor setting during COVID-19 pandemic: An observational study p. 28
Anthony Chibueze Nlemadim, Jacintha Banku Okoi-Obuli, Friday Akwagiobe Odey, Martin Madu Meremikwu
Background: The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic has continued to disrupt medical care among patients with sickle cell anemia (SCA). The city lockdowns and restrictions to minimize virus transmission in countries have created gaps in the optimal management of children with SCA. Aim: The aim of this study was to access the clinical experience in the use of mobile health telemedicine for the care of children with SCA. Methods: At the start of national lockdown, text messages were sent to parents of children with SCA who are attending a tertiary hospital in Nigeria. The message included advice to call consultants in the pediatric hemato-oncology unit whenever their wards were sick or due for a routine clinic visit. Information obtained include date of call or text message, complaints, intervention prescribed, and feedback from the parents. Results: There were 115 calls and 43 texts from the parents from April through July 2020. The proportion of calls increased from 16.5% to 33.9%, while texts increased from 23.3% to 30.2% over the months. Responses were significant (P = 0.047). Respiratory symptoms (40%) were the most common complaints. The most frequent interventions were counseling (59%) and drug prescriptions (31%) with the resolution of most symptoms by day 7 (P < 0.001). Parents (60.8%) preferred phone interactions across the months (P < 0.05). No confirmed case of SARS-CoV-2 was recorded. Conclusion: Mobile health telemedicine is a beneficial tool in the maintenance of care and possibly prevention of SARS-CoV-2 infection among children with SCA in a resource-limited region. Efforts should be made by stakeholders to institute and promulgate telemedicine during this pandemic.
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Hypocalcemia and vaso-occlusive painful crises in pediatric sickle cell anaemia p. 34
Anthony Chibueze Nlemadim, Henry Chima Okpara, Chigozie Ikechukwu Uzomba, Maxwell Udo Anah, Martin Madu Meremikwu
Background: Low serum calcium (hypocalcemia) occurs in sickle cell anaemic (SCA) children. Concomitant presence of prolonged corrected QT (QTc) interval on electrocardiogram can ascertain hypocalcemia, especially during vaso-occlusive painful crises (VOC). Aim: The aim of the study was to determine the relationship between hypocalcemia and VOC. Methods: It was a prospective cohort study of 38 SCA children aged 4–17 years during VOC and when the same children were in steady state. Information regarding bone pain and clinical examination were obtained, following which electrocardiography was done during both clinical states. Blood was drawn for total calcium and serum albumin estimation. Results: The mean (standard deviation [SD]) of total calcium was significantly lower during VOC (1.90 [0.19] mmol/l) than during follow-up steady state (2.24 [0.22] mmol/l), P < 0.001. The mean rank of QTc interval was significantly higher during VOC (19.93) than in follow-up steady state (14.50), P < 0.001. Total calcium negatively correlated with QTc intervals during VOC (rs[36] = −0.36, P = 0.029) and follow-up steady state (rs[36] = −0.49, P = 0.002), while QTc interval was highly predictive of hypocalcemia (area under the curve [AUC] = 0.82, P < 0.001). Similarly, total calcium was highly predictive of VOC (AUC = 0.89, P < 0.001) at cutoff point of 2.13 mmol/l with 89.5% sensitivity and 81.6% specificity. Hypocalcemia was significantly observed during VOC than follow-up steady state (89.5% vs. 21.1%, P < 0.001) with odds ratio of 21.28 (95% confidence interval: 0.012–0.189; P < 0.001). Conclusion: Total calcium <2.13 mmol/l is associated with VOC. Regular total calcium tests should be done. SCA children may benefit from routine oral calcium to reduce frequency of VOC.
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Coping strategies of infertility clients attending gynecological clinic in South-eastern Nigeria p. 40
Ijeoma Onyinyechi Maduakolam, Uchenna Anthony Umeh, Ifeoma Francisca Ndubuisi, Agnes Chinyere Onyekachi-Chigbu
Background: Infertility is the failure of a couple to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse. It causes psychological and social consequences for couples. This study aimed to ascertain the “Coping strategies of infertility clients attending gynecological clinic in South-eastern Nigeria.” Subjects and Methods: A cross-sectional descriptive survey was used. One hundred and twenty participants were drawn from a population of one hundred and fifty clients, using the power analysis formula of sample size calculation. Participants were selected using a purposive sampling technique. One hundred and seventeen participants were analyzed using the Statistical Package for the Social Sciences version 25. Descriptive and inferential statistics were used at a 0.05 level of significance. P < 0.05 was considered statistically significant. Results: Majority of the participants use self-controlling, positive reappraisal coping strategy, and social seeking support strategy. There is no significant difference in the mean responses of male and female participants with infertility on their use of coping strategies. The respondents used more self-controlling (86.3%) strategies than they used positive reappraisal (62.4%), escape-avoidance (59.8%), and other coping strategies (47.0%) and these showed statistical significance (P < 0.05). Even though they used social support seeking as much as they used self-controlling strategies, this finding was not significant (P > 0.05). Furthermore, gender was found to have a significant influence on the coping strategies among the study participants (P < 0.05). Conclusion: The couple's capacity to adapt to infertility-related stress depends on the coping strategies, which have different impacts on individuals' mental health. Hence, this study suggested the need for health-care providers to integrate psychological counseling into the care of clients with infertility challenges.
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Burden of care among caregivers of patients with bipolar affective disorder at the Federal Neuropsychiatric Hospital, Calabar p. 47
Chidi John Okafor, Thomas Emedoh
Background: The advent of community-based care and de-institutionalization of persons with mental disorders have led to a progressive shift of care from formal health-care systems to informal care providers such as the family. This shift of care, from hospitals to the families, has led to a significant level of the burden on the family caregiver. This study aimed to identify factors which are associated with burden of care among caregivers of patients with bipolar affective disorder (BAD) seen at the Federal Psychiatric Hospital, Calabar. Materials and Methods: A simple random sampling technique of “yes or no” balloting was utilized to select 105 caregivers of bipolar patients seen at the outpatient clinic of the hospital. The selected caregivers (those who picked “yes”) were recruited along with their respective patients after obtaining their consent. They were assessed using a set of five questionnaires, of which three (Patient Health Questionnaire-9 [PHQ-9], Young Mania Rating Scale [YMRS] and Brief Psychiatric Rating Scale [BPRS]) were administered by the researchers on the patients whereas the remaining two (sociodemographic questionnaire and Family Burden Interview Schedule) were self-completed by the caregivers. Results: One hundred out of the 105 caregivers who were recruited completed the study procedure and returned properly filled questionnaires. The rates of objective and subjective burden on the caregivers were 79% and 74%, respectively. While the objective burden was associated with the patient's educational attainment and his/her scores on the YMRS and BPRS, the subjective burden was associated with the caregiver's monthly income and marital status, the patient's gender, number of suicide attempts, and scores on PHQ-9, YMRS, and BPRS. Of all the variables, the patients' scores on YMRS (P = 0.025) and PHQ-9 (P = 0.011) were the significant predictors of objective and subjective burden, respectively. Conclusion: This study identified the extent and factors associated with burden of care on caregivers of patients with BAD. Awareness of those factors might guide clinicians in instituting treatment strategies toward reducing the burden on caregivers.
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Assessment of zinc level and its relationship with some hematological parameters among patients with sickle cell anemia in Abakaliki, Nigeria p. 55
Ngozi Immaculata Ugwu, Clifford Okike, Collins N Ugwu, Chinonyelum T Ezeonu, Festus E Iyare, Chihurumnanya Alo
Background: Sickle cell anemia (SCA) is an inherited hemoglobin (Hb) disorder with susceptibility for oxidative damage due to chronic redox imbalance in red blood cells (RBCs) which often results in hemolysis, endothelial injury, recurrent vaso-occlusive episodes, and derangement in hematological parameters. Zinc is an antioxidant which helps to reduce oxidative damage. This study aimed to assess the serum level of zinc and its relationship with some hematological parameters in patients with SCA (HbSS). Materials and Methods: This was a cross-sectional comparative study which involved HbSS patients in steady state with sex- and age-matched HbAA control. Assay of Hb phenotype, serum zinc level, and some haematological parameters were done. Ethical approval was gotten from the institutional review board, and each participant gave informed written consent before recruitment into the study. Analysis of all data obtained was done using SPSS software, version 20. Results: Thirty adult patients with SCA and thirty sex- and age-matched controls with a mean age of 26.7 ± 7.6 years and 27.7± 5.3, respectively, were studied. There was a significant decrease in serum zinc level among patients with HbSS compared to those with HbAA (P = 0.038). Similarly, patients with HbSS had significantly lower Hb level, packed cell volume, and RBC count compared to HbAA control (P < 0.05). On the contrary, patients with HbSS had significantly higher white cell count and platelet count compared to HbAA individuals (P < 0.05). Correlation between serum zinc level and blood counts showed weak positive relationship between zinc level and Hb level (r = 0.04, P = 0.8) and weak negative relationship between serum zinc level and platelet count (r = −0.3, P = 0.1), as well as zinc and white blood cell (WBC) count (r = −0.2, P = 0.4). Conclusion: There was a significantly low level of zinc among patients with HbSS compared with HbAA controls. Patients with HbSS had zinc levels that weakly correlated with Hb level positively but weakly negatively correlated with platelet and WBC counts. Further studies are required on a wider scale to assess whether zinc supplementation may improve blood counts in patients with SCA.
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Surgical outreach as a tertiary hospital's corporate social responsibility: Shall we do more? p. 60
Olakunle Fatai Babalola, Abiodun Idowu Okunlola, Tayo Ibrahim, Adedayo Idris Salawu, Timothy Oladele Majengbasan, Idowu Oluwaseyi Adebara, Adeniyi Steven Hassan
Introduction: The underserved populations of the rural and suburban communities of developing countries are challenged by the twin hurdles of low-income earning and out-of-pocket payment for surgical care services. This study aims at appraising the process, outcome, and impact of a free surgical outreach programme carried out by a Federal Teaching Hospital in South-western Nigeria. Methods: A free day-case surgical outreach programme was announced through a popular radio jingle for a period of 1 week to attract would-be beneficiaries of the programme. A 2-day screening exercise was conducted by the concerted efforts of various specialists in the department of surgery and ophthalmology to select those who are suitable for day-case surgery. A cross-sectional survey of patients who participated in the 5-day surgical outreach programme was carried out. A structured questionnaire was used to obtain information on biodata, diagnosis, surgical operations, complications, and level of satisfaction. A 3-point bipolar satisfaction outcome scale was used to assess the level of satisfaction. The data obtained were analyzed using the SPSS software version 20.0. Results: One hundred and fifty-eight patients were screened, but only 124 participated. Ophthalmic cases constituted 60.5%, whereas the rest (39.5%) were non-ophthalmic cases. Patients with cataract were 73 (58.9%) of all the surgical lesions operated during the outreach programme. Two (1.6%) patients with pterygium were the other ophthalmic cases, whereas the non-ophthalmic cases were mainly hernias. A total of 129 surgical operations were performed in the 124 patients, with 5 (0.4%) of them having bilateral cases. One hundred and seventeen patients (94.4%) expressed satisfaction with their experience of the programme. Conclusions: Optimal corporate social responsibility of tertiary hospitals can be performed effectively and satisfactorily through a properly organized surgical outreach.
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Effects of distal mandibular skeletal injury on temporomandibular joint soft tissue without bony injury to the joint: An arthroscopic screening survey p. 66
Darpan Bhargava, Yogesh Sharma, Sivakumar Beena, Ganesh Koneru, Ankit Pandey
Introduction: Trauma to the temporomandibular joint (TMJ) may be associated with injury to its associated soft tissues along with the bony condyle. However, it is often neglected that even in the absence of fracture of the mandibular condyle, there may be damage to the associated soft tissues of the joint. The routine radiographic study does not reveal the soft-tissue injury around the joint and its extent. Such injuries may progress to temporomandibular joint disorders (TMDs) in the future. Materials and Methods: A prospective study was conducted among 50 patients diagnosed with anterior mandibular fractures without condylar fracture. The patients were assessed for soft-tissue injury around the TMJ using an arthroscopic examination by a single qualified operator. Patients were evaluated clinically and arthroscopic examination was performed to examine the TMJ soft tissues at the time of surgery for facial fracture reduction under general anesthesia. Results: Among the 50 patients, n = 37 (74%) patients had severe injury to the soft tissues surrounding the TMJ. Majority of the patients had arthroscopic evidence of soft-tissue injury around the joint. Conclusion: From this study, we observe that patients with mandibular fracture without condylar involvement should be evaluated for TMJ soft-tissue injuries and subjected to long-term follow-up to prevent TMDs in the late postoperative period.
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Assessment of resident doctors' perception of postgraduate medical education in Nigeria using the SPEED tool: A pilot study p. 71
Funmilola T Taiwo, Oluwaseyitan A Adesegun, Akolade O Idowu, Andrew Mene, John O Imaralu, Adesola O Adekoya, Bamikole T Osibowale
Background: Obtaining feedback from trainees is important in the evaluation and evolution of Postgraduate Medical Education (PME), and policies made based on their felt needs would go a long way in making residency training a worthwhile experience. This pilot study aimed to assess resident doctors' perception of the training content, atmosphere, and organization using the Scan of Postgraduate Educational Environment Domains (SPEED) tool. Methodology: This was a cross-sectional study conducted amongst resident doctors at Babcock University Teaching Hospital (BUTH) in Nigeria, between May and August 2019. A self-administered questionnaire was used to collect participants' sociodemographic data, their perception of PME in their respective departments, as well as the strengths and weaknesses of the training programmes. Validity and reliability indices were assessed, and descriptive, inferential, and correlational analyses were run where appropriate. Results: The mean score for the resident doctors' perception of training content, atmosphere, and organization was 4.0 ± 0.4, 4.2 ± 0.5 and 3.69 ± 0.60 respectively, out of a maximum of 5, indicating a positive perception of training in BUTH. The major strengths perceived by most residents were good inter-personal relations between residents and their trainers, as well as conducive learning and work environment; while the weaknesses include poor remuneration and limited staffing which hampers rotations. Conclusion: Resident doctors in BUTH mostly had a positive outlook on their training. This study serves as a reference point for local policy change (in BUTH), and a framework from which future studies on PME can emerge.
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Hepatitis B virus knowledge and vaccination status among health-care workers in Calabar, Nigeria p. 79
Mbang Kooffreh-Ada, Dorothy Okpokam, Evaristus Chukwudike, Afiong Oku, Soter Ameh, Emmanuel Effa
Background and Objectives: The World Health Organization estimates that 2 million health-care workers (HCWs) are at risk of occupational exposure to hepatitis B virus (HBV), with the majority (90%) of such infections arising in sub-Saharan Africa. This study aimed to determine HBV knowledge and vaccination uptake among HCWs. Materials and Method: This was a cross sectional analytical study conducted among 392 HCWs from two major health institutions in Calabar i.e. the University of Calabar Teaching Hospital (UCTH) and the General Hospital Calabar (GHC), Cross river State. Multi-staged sampling method comprising of two stages was used to recruit participants into the study. The study population comprised of doctors, nurses, laboratory scientists/technologist, and other categories of HCWs such as pharmacists, ward orderlies, and mortuary attendants. A semi-structured self-administered questionnaire was used to obtain data on the socio-demographic characteristics of HCWs, the knowledge of HCWs regarding HBV and vaccine. The analysis of data was done using the Statistical Package for Social Sciences version 20. Study Design: This was a cross-sectional, study of HCWs in Calabar. Sampling Method: Multi-staged sampling method was used to select participants from two major health institutions in Calabar, i.e., the University of Calabar Teaching Hospital (UCTH) and the General Hospital Calabar (GHC). Thereafter, through balloting, simple random sampling technique was used to recruit the participants. Study Population: Three hundred and ninety-two HCWs were recruited from UCTH and GHC under the following categories: doctors, nurses, laboratory scientists/technologist, and other categories of HCWs such as pharmacists, ward orderlies, and mortuary attendants. Data Management: A semi-structured self-administered questionnaire was used to obtain data on the socio-demographic characteristics of HCWs, the knowledge of HCWs regarding HBV and vaccine. The analysis of data was done using the Statistical Package for Social Sciences version 20. Results: Overall, 67.9% of the respondents were found to have adequate knowledge of HBV vaccination and infection. Less than half (43.4%) of HCWs admitted receiving three doses (i.e., full coverage) of the vaccine. Difficulty in accessing the vaccine (48, 23.4%) was identified as the major reason given for suboptimal vaccination. Conclusion: The knowledge of HBV infection and vaccination is quite modest among HCWs in Calabar. Despite this observation, the vaccination status among HCWs is unsatisfactory. The implication of the findings of our study for health policy and practice is to prevent further occupational exposure of HCWs to HBV infection through mandatory vaccination.
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Steroid response rate in childhood nephrotic syndrome at a tertiary hospital in South-Eastern Nigeria p. 86
Chikaodili Adaeze Ibeneme, Ezinwa Olekaibenma Ezuruike, Emeka Felix Onuh
Background: Response to corticosteroids in childhood nephrotic syndrome (NS) remains the best prognostic marker of the disease. African children have been noted to respond poorly to corticosteroids. However, recent reports in some parts of Nigeria suggest high steroid responsiveness. Objectives: This study was done to determine the steroid response rate and associated clinical variables among children with NS in Umuahia, South-Eastern Nigeria. Patients and Methods: A retrospective, descriptive study of all the children managed for NS from June 2013 to June 2018 was retrieved and relevant information obtained. Data analysis was done using the SPSS software version 20.0 for Windows® (IBM SPSS Inc. 2011 Chicago, Illinois, USA). Results: A total of 30 children aged 2 years to 15 years with a median of 8 years were studied. Male-to-female ratio was 2:1. Fifteen patients achieved remission with steroid with remission rates of 50% overall and 62.5% among children with idiopathic NS. Patients that achieved remission had a lower mean age (mean difference = -5.13, confidence interval [CI] −7.73, −2.54; P < 0.001) compared to those that had steroid resistance. The frequency of steroid resistance in males was not different from females (odd ratio = 1, CI = 0.22–4.56; χ2 = 0.00 P = 1.00). Children aged 5 years and below had the highest remission rate, whereas those above the age of 10 years were all steroid resistant. There was no significant mean difference in the levels of serum albumin and total cholesterol among the children who achieved remission compared to nonresponders. Frequencies of hematuria, hypertension, and raised serum creatinine were not significantly different between the two groups. Conclusions: About two-thirds of children with idiopathic NS in our center achieve complete remission with steroid therapy, whereas about one-third have steroid resistance which predominates after the age of 10 years. Frequency of some clinical variables such as hematuria, hypertension, and raised serum creatinine did not significantly differ among steroid responders compared to nonresponders.
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Assessing research engagement of resident doctors in training in Northwestern Nigeria p. 91
Shehu Salihu Umar, Zaharadeen Shuaibu Babandi, Auwal Garba Suleiman, Umar Muhammad Umar, Abdulhakeem Abayomi Olorukooba, Aisha Jamila Ahmad, Bilqis O Muhammad, Abubakar Ibrahim Umar, Adam Ahmad, Lawson O Obazenu
Background: Residency training develops trainees to practice evidence-based medicine using knowledge acquired through researches. Resident doctors are not just expected to be consumers of good researches but are also expected to build their competencies in conducting researches in their fields of specialization. They are expected to engage in journal clubs as well as scientific paper presentations in local and international conferences under the mentorship and guidance of their trainers. In addition, trainers in residency training supervise the compulsory dissertation of senior residents under them. Objectives: We aimed to assess research engagement of resident doctors in training and pattern of submission and approval of their dissertation proposal. Methodology: It was a descriptive cross-sectional descriptive study involving resident doctors in accredited hospitals in Northwestern Nigeria. Electronic questionnaires were distributed to respondents via their verified electronic media contacts. Data were collected within a period of 1 month from July 10 to August 6, 2020. Data were analyzed using mean, standard deviation, simple tables as well as Z-test and Chi-square test. The level of significance was set at 0.05 for decision purposes. Results: A total of 120 questionnaires were completed. The mean age of respondents was 38.0 ± 3.8 years, with majority being males 88 (83.3%), and 107 (89.2%) being married. Only 12 (10%) and 44 (36.7%) respondents had published manuscript before and since commencement of residency training, respectively. There was a significant difference between manuscript publication before and since commencement of residency training (P = 0.012). Only 32% of the respondents who submitted their dissertation proposal to the colleges did so within 12 months of success in their Part 1 fellowship examination. There was no association between the publication of manuscript during residency training and submission of dissertation to either National Postgraduate Medical College of Nigeria (P = 0.190), West African College of Surgeons (P = 0.686), or West African College of Physicians (P = 0.317). Conclusion: Research engagement by resident doctors from this study was not satisfactory. Publication of manuscript by resident doctors was associated with prior publication before commencement of residency training and type of training hospital.
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Undiagnosed hypertension and diabetes: concordance between self-reported and actual profile among traders in Nigerian market p. 98
Sidney Kelechi Oparah, Ofonime Nkechinyere Ukweh, Ikechukwu Henry Ukweh, Joy N Iya-Benson
Background: Hypertension and diabetes rank high among cardiovascular risk factors, and in Africa, many affected persons are undiagnosed. Urban market traders are constrained from regular clinic visits by the fear of revenue loss occasioned by their absence from the stores, contributing to the reportedly high rates of undiagnosed and poorly treated cardiovascular conditions. This study determined the rate of undiagnosed hypertension and diabetes among traders in an urban market in Calabar, Nigeria. Methods: In this cross-sectional study, we used an interviewer-administered questionnaire to collect data from 105 traders at Marian market Calabar, including information on demographic characteristics and self-reported statuses regarding hypertension and diabetes. Subsequently, blood pressure and random blood sugar values were measured. Results: Forty-three (41.0%) of the respondents correctly reported their statuses regarding hypertension and 93.3% of the respondents correctly reported their statuses regarding diabetes. 62 (59%) and 7 (6.7%) of them had hitherto undiagnosed hypertension and diabetes, respectively. Only two (9.5%) out of those with a self-reported history of hypertension had normal blood pressure values. There was no agreement between the self-reported and actual profiles of hypertension among the respondents (kappa = 0.000, P = 0.008), and a weak level of agreement between the self-reported and actual profiles of diabetes among the respondents (kappa = 0.559, P < 0.001). Educational level was the identified predictor of correct self-report of status regarding hypertension (P = 0.031); Conclusion: There was a high rate of undiagnosed hypertension and, to a lesser extent, diabetes among this set of urban market traders.
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Testicular atrophy following inguinal hernia repairs: Are we doing enough in prevention and counseling? p. 105
Friday Emeakpor Ogbetere, Udoka Imoisili
Testicular atrophy is a rare complication of hernia repairs which often results in litigations. While early detection and treatment of ischemic orchitis obviate this grave complication, good communication and adequate counseling are known to minimize the associated litigations. Herein, we report two cases of testicular atrophy following herniorrhaphy. Both patients noticed scrotal pain and swelling within three days after the surgery and were given antibiotics and analgesia by the attending surgeons. They subsequently developed a gradual reduction in testicular volume after two months with severe atrophy of the affected testis. The objectives of this case series are to emphasize the need for immediate evaluation of genital symptoms such as scrotal pain, swelling, and redness after inguinal hernia repairs and the need to counsel patients for possible orchitis, atrophy, and testicular loss before any groin surgery.
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A rare complication of burr hole drainage of chronic subdural hematoma: Cerebrospinal fluid leak via the subdural drain, case report with literature review p. 108
Henry Olayere Obanife
Chronic subdural hematoma is a common neurosurgical problem, especially in the elderly, which is frequently treated by burr hole drainage. Recurrence is the most frequent complication of chronic subdural hematoma surgery reported in literature. However, cerebrospinal fluid leak resulting subgaleal pseudomeningooele has been reported. We report a 67-year-old man who had burr hole drainage of chronic subdural hematoma and subsequently developed cerebrospinal fluid fistula which was drained by subdural drain inserted intraoperatively. A 67-year-old right-handed man who presented with nine days' history of progressive pan-cranial persistent headache following a fall from the bathroom associated with irrational behavior and weakness of the left side of the body. His Glasgow Coma Score (GCS) was 12/15, with generalized hypertonia, left-sided hemiparesis, and left-sided grade + 3 deep tendon reflexes. Brain computed tomography scan [Figure 1] showed right-sided fronto-temporoparietal chronic subdural hematoma with midline shift and effacement of the ipsilateral lateral ventricle. He had right frontal and right parietal burr holes, such as subdural hematoma and insertion of nonnegative subdural drain through the parietal burr hole. He developed cerebrospinal fluid leak, which drained into the drainage bag and subsequently managed conservatively. Cerebrospinal fluid leaks can occur following burr hole drainage of chronic subdural hematoma. Subdural drain inserted intraoperatively is helpful in preventing the sequelae of cerebrospinal fluid accumulation in the subdural and subgaleal spaces.
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Crystalline maculopathy: A report of two patients in Ibadan, Southwestern Nigeria p. 112
TS Oluleye, YO Babalola, OI Majekodunmi, MA Ijaduola, Olabimpe Ruth Abiola
We present two patients with crystalline maculopathy seen at the Eye Clinic of the University College Hospital, Ibadan, Nigeria. Both patients had diabetes, with the first patient having systemic hypertension controlled on medications. There was no history of kola nut ingestion in the two patients. Medical examination by the internist revealed no other systemic disease. The central vision was good in both patients. Optical coherence tomography localized the crystals to the inner retina, and there was no associated macular edema. Some pathogenetic mechanisms are proffered based on available literature.
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Intensive care management of multi-systemic complications following major postpartum haemorrhage in a Resource-limited setting: A case report p. 116
Ifeanyichukwu Michael Chukwu, Nosakhare Philomena Edomwonyi, Charles Ehichoya Ikhifa, Julian Ojebo, Benedict Chuks Ezeife, Mojolaoluwa Oluwatomisin Adeaga, Lawson Ohwofasa Obazenu
Postpartum hemorrhage with its attendant systemic complications can pose a challenge in the developing world, resulting in morbidity and mortality. We present a case of an unbooked 38-year-old para-3 woman, who had elective Cesarean section at term on account of placenta praevia type IV under spinal anesthesia in a private facility. She developed major obstetric hemorrhage that necessitated massive blood transfusion and emergency hysterectomy. She was managed in the intensive care unit for 43 days and remained unconscious for 35 days. She developed many systemic complications that necessitated a multi-disciplinary management with a favorable outcome. She was transferred to the general ward where she spent 30 days before she was discharged home in a satisfactory condition.
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Time for the longitudinal or routine study of critical indicators of early-career doctors in Nigeria p. 120
Oladimeji Adebayo, Okhuaihesuyi Uyilawa
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