Ibom Medical Journal

Prevalence, pattern and factors associated with workplace violence against healthcare workers in Nigeria: A systematic review

Afolabi AA, Ilesanmi OS, Chirico F — Wed, 01 May 2024 00:00:00 +0000

Context: Workplace violence (WPV) against healthcare workers (HCWs) is mostly endured, underreported, or neglected in Nigeria.

Objective: This study aimed to describe the prevalence, pattern, and predictors of WPV against HCWs in Nigeria.

Methods: A systematic review was conducted using pre-defined keywords. The review was performed in line with the PRISMA guidelines on PubMed, Google Scholar, Scopus, and Web of Science. The population, intervention, comparator, and outcome (PICO) elements for this study were as follows: Population: Nigerian Healthcare workers; Intervention: Exposure to WPV; Comparator: Non-exposure to WPV; Outcome: Mental and Physical health outcomes of exposure to WPV. Of the 18,140 articles retrieved, 15 cross-sectional studies met the inclusion criteria and were included in the review. In all, 3,245 HCWs were included, and consisted majorly of nurses and doctors.

Results: The overall prevalence of WPV (Physical > Verbal/Psychological > Sexual) against HCWs ranged between 39.1%-100%. The predictors of WPV are younger ages (AOR = 2.513, p = 0.012), working in psychiatric unit (AOR = 11.182, p = 0.006), and increased frequency of interaction with patients, and mostly perpetrated by patients and their relatives. Many health facilities lacked a formal reporting system and policies to protect HCWs from WPV.

Conclusion: WPV against HCWs is a public health problem in Nigeria with dire implications on HCWs; the victims, and the aggressor. Administrators of health facilities should design protocols for WPV reporting, recognition, and management. Patient and 'relatives' education on the 'facilities' policy against WPV should be undertaken, while orientation sessions on the risk factors for HCWs are scheduled.

Aetiology of sickle cell ischemic priapism: the pathophysiologic triad of hyperhaemolysis, hyperviscosity and hypercoagulability, and their therapeutic implications

Ahmed SG, Ibrahim UA — Wed, 01 May 2024 00:00:00 +0000

Context: Majority of literature regarding pathophysiology of sickle cell ischaemic priapism (SCIP) is focused on penile veno-occlusion due to hyperhaemolysis-induced vasculopathy with little reference to SCD-associated hyperviscosity and hypercoagulability, each of which can also potentially cause penile veno-occlusion and SCIP.

Objective: This review has triple objectives to: (1)-reappraise role of hyperhaemolysis in aetiopathogenesis of SCIP; (2)-highlight roles of hyperviscosity and hypercoagulability in aetiopathogenesis of SCIP; and (3)-underscore aetiologically-determined therapeutic implications in managing SCIP due to hyperhaemolysis, hyperviscosity, and hypercoagulability.

Methodology: Online literature search was conducted using terms relevant to SCD and priapism. Only articles that reported aetiopathogenesis and/or management of SCD-associated priapism vis-à-vis hyperhaemolysis, hyperviscosity, and/or hypercoagulability were selected.

Results: SCIP has three aetiopathogenetic categories: (1)-hyperhaemolysis vis-à-vis penile venous vasculopathy; (2)-hyperviscosity vis-à-vis penile venous sludging; and (3)-hypercoagulability vis-à-vis corporal cavernosal thrombosis. Irrespective of aetiopathogenesis, short-term management of SCIP is prompt decompression to avert erectile dysfunction. However, long-term management differs with respect to aetiology. Aetiologically rational long-term management (ARLTM) for hyperhaemolysis-induced SCIP should be based on up-regulators of nitric oxide and PDE-5 (e.g., hydroxyurea or PDE-5 inhibitors). However, ARLTM for hyperviscosity-induced SCIP should aim at reducing microvascular endothelial-adhesion, sludging, and viscosity by using p-selectin inhibitors (crizanlizumab), while ARLTM for hypercoagulability-induced thrombotic SCIP should obviously be anticoagulation.

Conclusion: Hyperhaemolysis is the prototype and predominant aetiology of SCIP. However, veno-occlusive SCIP may occur due to any one of SCD-associated pathophysiologic triad of hyperhaemolysis, hyperviscosity, and hypercoagulability. While penile decompression remains universal short-term management of SCIP, long-term management should be rationally determined by aetiopathogenesis.

Early childhood caries among pre-school children in rural areas

Osadolor OO, Osadolor AJ — Wed, 01 May 2024 00:00:00 +0000

Background: Early childhood caries can occur and exist among children in slums areas, rural areas and under-served communities. Africa has countries with rural areas inhabited by diverse ethnic populations of pre-school children, with their parents and family members.

Method: An electronic literature search in Science direct and PubMed was done in January, 2024 using the Population, Concept and Context framework. Search terms and keywords were combined by Boolean operators. Two independent investigators screened titles and abstracts of publications on early childhood caries among pre-school children in rural areas. The inclusion criteria was original (primary) research articles with accessible full text, related to early childhood caries among pre-school children in rural areas, carried out in Africa, published in English and in electronic databases. Original research articles related to early childhood caries among pre-school children in urban, semi-urban or sub-urban areas, hospital based studies, studies with participants selected from rural and urban or rural and semi-urban communities, review articles, systematic reviews, thesis or dissertations were excluded during screening.

Results: Three articles with accessible full texts were included as it was assessed to meet the aim of the review. The study designs of the included studies were cross-sectional study, randomized, controlled field trial and a case-control study respectively. The studies were carried out in rural areas of Uganda and Egypt respectively.

Conclusion: Early childhood caries has multifactorial aetiology. More studies from diverse ethnic population in Africa countries will fill the gaps in knowledge and add to the existing literature.

Overview of the role of medical robotics in day-to-day healthcare services: A paradigm shift in clinical operations

Ikpe AE, Ohwoekevwo JU, Ekanem II — Wed, 01 May 2024 00:00:00 +0000

Background: Medical robotics has become an integral part of day-to-day healthcare services, revolutionizing the way medical procedures are performed and improving patient outcome.

Aim: This study explored the role of medical robotics in healthcare, focusing on its impact on various aspects of patient care.

Methodology: The methodology used in this study involved a comprehensive review of existing literature on medical robotics and its applications in healthcare settings.

Results: The findings reveals that medical robotics has significantly enhanced the precision, efficiency, and safety of medical procedures, leading to reduced invasiveness, and faster recovery times for patients. Additionally, medical robotics has enabled healthcare providers to perform complex surgeries with greater accuracy and minimal invasiveness, ultimately improving the quality of care for patients. The findings obtained from this study also showed that robotic surgery results in fewer complications and shorter hospital stays compared to traditional surgical methods. This results in a growing adoption of robotic-assisted surgery in various medical specialties, such as urology, gynaecology, and orthopaedics. In addition to surgical procedures, medical robotics is also being used in diagnostic and therapeutic applications. For example, robotic systems are being developed for minimally invasive procedures, such as biopsies and drug delivery. Furthermore, robotic devices are being used in rehabilitation and physical therapy to assist patients in regaining mobility and function.

Conclusion: One of the main concerns is the cost of implementing and maintaining robotic systems, which can be prohibitive for some healthcare facilities. Also, there are concerns about the potential for errors and malfunctions in robotic systems, which could compromise patient safety. Overall, the integration of medical robotics in day-to-day healthcare services has proven to be a game-changer, offering new possibilities for the future of healthcare delivery.

Sensitivity and Specificity of Digital Rectal Examination for the Diagnosis of Prostate Cancer at the Kano Teaching Hospital - A Comparative Analysis

Bashir Y, Ayun C, Muzzammil A, Sharfuddeen AM, Sani AA, Sani UA — Wed, 01 May 2024 00:00:00 +0000

Background: Prostate cancer (CaP) is the most common non-cutaneous cancer among males and the fourth most common cause of cancer in males globally. Unfortunately, Sub-Saharan Africa lacks the relevant resources and organized screening program that has led to the late presentations in the region. Digital rectal examination (DRE) is a test commonly used to screen for prostate carcinoma and is by far the oldest and cheapest modality available for screening.

Objective: We hypothesized that digital rectal examination has a correlation to the diagnosis of prostate cancer. This study was meant to evaluate the sensitivity and specificity of DRE in the diagnosis of prostate cancer and compare the outcome to published data.

Methodology: This is a prospective study conducted at the Aminu Kano Teaching Hospital involving 87 symptomatic patients who were screened for prostate cancer (2014). Patient with DRE suspicious of malignancy i.e. (nodular, hard, asymmetrical prostate) or PSA >4ng/ml despite the prostate consistency were included in the study. The digital rectal exams were performed in a lateral decubital position to assess the prostate consistency and underwent transrectal ultrasound guided sextant biopsy for histological diagnosis.

Results: There was a total of 87 participants that underwent DRE in the study with age range from 50 – 96 years. Univariate analysis showed a mean age of 68.1 years with standard deviation of (SD +9.4). The detection rate of prostate cancer was 28.7%. Bivariate analysis of DRE to diagnosis of prostate cancer showed a sensitivity of 68.0% and specificity of 83.9%. The positive predictive value and the negative predictive value were 63.0% and 86.7% respectively. The study showed some evidence of a relationship between DRE and the diagnosis of prostate cancer with a (Pearson Chi Square Test=23.4, df=1,) with a statistical significance (p=<0.001).

Conclusion: PSA and Digital rectal exam combined have a higher sensitivity in the diagnosis of prostate cancer. However, DRE alone has a lower sensitivity but a much higher specificity in the diagnosis of CaP. DRE still has a role in the diagnosis of CaP because it is minimally invasive, cheaper and can detect some prostate cancers that are missed by PSA screening.

The Influences of Ethnicity, Gender, Generation, and Mental Health over Justified Death Attitude

Zandian P, Seydi Z, Benyamin K, Tayeri N — Wed, 01 May 2024 00:00:00 +0000

Background: Justified Death Attitude (JDA) is a new term about one’s agreement with killing someone else. Previous studies have shown the Justified Death Attitude Scale (JDAS) is valid and reliable. We also know that some variables like major and gender are associated with JDA, but we do not know how gender, ethnics, generation, and sanity differently would affect JDA.

Objectives: This was a cross-sectional study to evaluate the effect of ethnics, generation, gender, and sanity on the attitude of the people about justified death.

Method: In 2022, 744 participants, including 368 male and 376 female participants were selected through convenience sampling method in Tehran, Ilam, Khorramabad, and Sanandaj. Participants were stratified according to age (528 adults, 216 older adults), religion (538 Shiite, 108 Sunni, and 98 Assyrian participants), and sanity status (460 normal and 284 participants with possible mental illness). Participants filled out General Health Questionnnair-12 (GHQ 12) and Justified Death Attitude Scale (JDAS).

Results: Older, Shiite, and Sunni participants agreed more with death penalties, but younger and Assyrian participants disagreed more with death penalties. Furthermore, young, Assyrian agreed more often with euthanasia. Different generations think significantly differently about the type and severity of execution and euthanasia.

Conclusion: The more diverse the sociocultural background, the more different is the attitude about justified death. That might be due to dissimilar crystallization of sense of self in different socio-cultural backgrounds and through different cognitive processes.

A seven-year review of emergency peripartum hysterectomy in a tertiary hospital in northern Nigeria

Shittu MA, Olaoye SO, Fasanu OT — Wed, 01 May 2024 00:00:00 +0000

Background: Emergency peripartum hysterectomy (EPH) is surgical removal of the uterus during childbirth or within its immediate 24 hours, a lifesaving procedure done as the last resort to control obstetric haemorrhage.

Objectives: To determine the incidence, indications, and complications of peripartum hysterectomy.

Methods: The study is a retrospective review of emergency peripartum hysterectomies performed at the Centre from 1^st January, 2015 to 31^st December, 2021. The patients’ case folders were retrieved from the medical records department and relevant information obtained using a structured data extraction format. The data was analyzed using SPSS version 26. Means, frequency, and percentages were used to present the significance of the results.

Results: A total of 46 EPH were performed between January 2015 and December 2021 out of 20,832 deliveries within the same period, giving an incidence of 0.22% (2.2 per thousand deliveries). Indications were uterine rupture (78.2%), uterine atony (10.9%), abruptio placentae (4.3%), placenta previa (4.3%) and placenta accreta spectrum (2.2%). Subtotal hysterectomy was performed in most cases (39/46; 84.8%). The most common complication was intraoperative haemorrhage requiring blood transfusion (100%). Other complications included severe post-operative anaemia, wound sepsis, paralytic ileus and enterocutaneous fistula. The maternal case fatality was 4 (8.7%) and all the mortality cases were unbooked patients.

Conclusion: The incidence of emergency peripartum hysterectomy is relatively low in our study and uterine rupture is the most common indication. EPH is associated with significant maternal morbidity and mortality, and this is related to booking status. Hence, enlightening women on antenatal care and hospital delivery will help in reducing maternal morbidity and mortality.

Grand-multiparity and its impact on delivery outcomes: A ten-year retrospective study at Aminu Kano Teaching Hospital, Kano

Adeyemi MT, Adamou N, Omeje I, Muhammad ID — Wed, 01 May 2024 00:00:00 +0000

Background: Grandmultiparity, defined as having given birth to the fifth to ninth child, and great grandmultiparity, involving ten or more childbirths, present obstetric challenges due to their association with high-risk pregnancies. Adverse outcomes can strain resources and healthcare systems. This retrospective study examines the delivery outcomes of grandmultiparous women at Aminu Kano Teaching Hospital over a decade.

Methods: A retrospective analysis covered January 2012 to December 2021, involving women who delivered at the hospital. Data, including socio-reproductive characteristics, mode of delivery, complications, and outcomes, were extracted from records. SPSS version 25 was used for statistical analysis (p < 0.05).

Results: Grandmultiparous women accounted for 8.4% of parturients, primarily aged 30-39 (76.8%) with parity ranging from 5 to 9 (90.9%). Approximately 52% received antenatal care at the hospital or peripheral facilities. Most (73.2%) had spontaneous vaginal deliveries, 25.2% underwent cesarean sections, and 1.6% had instrumental deliveries. Complications included postpartum hemorrhage (27.6%), hypertensive disorders in pregnancy (19.9%), and malpresentation (7.2%). Neonatal outcomes revealed 21.8% low birth weight, 9.6% macrosomic infants, and 6.2% birth asphyxia.

Conclusion: The study highlights that grandmultiparity remains evident among parturients in tertiary hospitals, primarily in older and less educated women. It underscores the need for vigilant antenatal care to mitigate associated risks and improve maternal and neonatal outcomes. Tailored interventions for grandmultiparous women are essential to ensure their well-being and that of their newborns in high-risk pregnancies.

Predictors of expressed emotion among the caregivers of patients with severe mental illnesses attending a tertiary health facility in Kano

Aghukwa NC, Baguda AS, Fawaz B, Aminu IS — Wed, 01 May 2024 00:00:00 +0000

Background: Expressed Emotion (EE) measures the emotional climate between caregivers and patients with major mental disorders. High EE could trigger relapses in schizophrenia and other conditions. However, the factors influencing high EE were poorly understood, especially in Africa. This study explored the socio-demographic, personality, and patient-related predictors of high EE among caregivers in Kano.

Objectives: The study aimed to estimate the prevalence of high EE and its associations with socio-demographic factors, personality traits, and patients’ illness characteristics.

Methods: The study utilized a descriptive cross-sectional design, encompassing 270 patients diagnosed with schizophrenia or bipolar disorder, each accompanied by their corresponding caregiver, totalling 270 caregivers. All participants attended the psychiatric clinic at Aminu Kano Teaching Hospital. The data collection process involved questionnaires and interviews, addressing socio-demographics, illness characteristics, personality traits, and expressed emotion (EE).

Results: We analyzed the socio-demographic factors and EE of 250 patients and their corresponding 250 caregivers. High EE was prevalent (42.8%) due to critical comments and emotional over-involvement. Caregivers scored high on all personality traits, but only neuroticism correlated positively with EE (r = 0.130, p < 0.05). EE was lower for bipolar disorder than for schizophrenia (r = -.126, p < .05). EE also increased with patient symptoms, caregiver burden, and relapse frequency.

Conclusion: Caregivers of patients with schizophrenia and bipolar disorder in Kano showed high expressed emotion (EE). However, none of the analyzed factors, including socio-demographic and personality traits, emerged as significant predictors of EE. Further research is needed to improve interventions and support strategies for caregivers of individuals with severe mental illnesses.

In-Hospital Continuous Medical Education during the COVID-19 Pandemic

Buowari DY — Wed, 01 May 2024 00:00:00 +0000

Background: The coronavirus disease 2019 (COVID-19) is a highly contagious disease as it is spread by contact with infected surfaces and inhalation of droplets. Several measures have been put in place to prevent the COVID-19 infection one of which is social distancing and physical distancing. Some in-hospital continuous medical education was suspended during the pandemic.

Objective of Study: The objective of the study is to investigate the impact of social distancing on In-hospital continuous professional development during the COVID-19 pandemic.

Research methodology: This is a cross-sectional study conducted among doctors working in Nigeria irrespective of their cadre or location. A self-administered online questionnaire was used to generate data for this study. There was no risk of participating in the study.

Results: The respondents in this study were 62. The majority 51(82.3%) had different in-hospital continuous medical education (CME) activities during the first wave of the COVID-19 pandemic when there was a ban in Nigeria on the gathering of more than 20 persons; the CME activities were via Zoom video conferencing 44 (71%) App. The majority of the respondents however preferred a face-to-face (physical) meeting [40(74.2%)] and also learnt better during a face-to-face meeting [46(74.2%)].

Conclusion: CME is very important in healthcare so COVID-19 did not stop it although it went through a lot of transformation in the mode it was delivered.

Psychiatry as a career choice: determinants of attraction towards psychiatry among final year medical students in a Nigerian university

Wed, 01 May 2024 00:00:00 +0000

Background: Despite an increase in the overall number of medical students, the shortage of psychiatry trainees in Nigeria and worldwide reflects diminishing interest in psychiatry among medical students. The study examined the degree and factors influencing attraction towards psychiatry as a career choice.

Method: A cross-sectional study of 71 final-year medical students who enrolled at the Usmanu Danfodiyo University Sokoto State (UDUS), Northwest Nigeria between 2006/07 and 2013/14 academic session were interviewed in 2021 while in 600 level. The questionnaires were adapted from similar studies.

Results: The ATP-30 revealed a high prevalence of negative attitudes towards psychiatry, the degree of preference for psychiatry as a career option was classified as low and high. Almost half (47.9%) of the participants had a low degree of preference for psychiatry as a career choice. Most (92.9%) of the participants rated job satisfaction (p<0.001) and intellectually challenging (86.7%) (p<0.001) poorly, as negative influences for not being attracted towards psychiatry as a career choice. A low proportion (8.5%) of the participants selected psychiatry as their most preferred area of specialization. Generally, the majority (85.7%) viewed psychiatry as not attractive. Among the participants, the majority perceived psychiatry as unattractive. Students' misconceptions about job satisfaction and the negative view of not being intellectually challenging were the associated factors for the negative views towards psychiatry.

Conclusion: There is a need for strategy and policy to promote interest in psychiatry early in medical school and residency programs as recommended by the World Psychiatric Association.

Ileostomies for severely ill children with ileo-colic intussusception: our experience at the University of Uyo Teaching Hospital

Akpanudo EI, Ituen AM, Eyo AE, Emmanuel EM — Wed, 01 May 2024 00:00:00 +0000

Context: Complicated intussusception is associated with life-threatening intestinal gangrene and peritonitis. In critically ill children, a primary ileocolic anastomosis may increase their morbidity and mortality and, thus, a temporary ileostomy may be a safer option.

Objective: The purpose of this study is to report the indications, outcomes, and complications after temporary ileostomies for infants with ileocolic intussusception in our institution.

Materials and methods: This was a retrospective study of infants who had ileostomies created in our institution following complicated ileocolic intussusceptions between January 2014 and December 2022. The indications, postoperative complications, duration of hospital stay, and recovery were noted and compared.

Results: Thirty-four infants had ileostomies created for complicated ileocolic intussusception during this period. There were 13 girls and 21 boys aged 3-10 months (median = 6 months). The indications for ileostomy were intestinal gangrene, colonic perforation, peritonitis, and haemodynamic instability. Ileostomies were created in the primary surgery in 24 patients while 10 had stomas created as a secondary procedure following an anastomotic dehiscence. Postoperative complications occurred in 25 patients (73.5%). Four children died shortly after surgery from the primary disease, while one child died from re-feeding syndrome. Children who required stoma creation following dehiscence of a primary anastomosis had more complications, a longer hospital stay, and a longer delay in commencing feeds. However, there was no difference in mortality rates or time of stoma closure.

Conclusion: Temporary ileostomies could potentially reduce intussusception-related mortality and morbidity, ultimately improving the outcome of very ill infants.

A comparative study on some cardiovascular indices among morticians exposed to formaldehyde in Benin City, Nigeria

Ebojele FO, Iyawe VI — Wed, 01 May 2024 00:00:00 +0000

Background: Some cardiovascular indices among morticians exposed to formaldehyde in a Teaching hospital and General hospital were studied.

Materials and Methods: Thirty subjects were studied and divided into three groups A, B, and C with 10 subjects in each group. Group A served as control with nil exposure to formaldehyde while groups B and C served as the test groups. Subjects in group B were morticians working in the Teaching hospital while subjects in group C were morticians working in the General hospital. Anthropometric measurements were taken and some cardiovascular indices were measured which included pulse rate, systolic blood pressure, diastolic blood pressure, pulse pressure, and mean arterial pressure. Statistical analysis was done using Graph Pad Prism version 8.0.1. Results were presented as Mean ± SEM. Analysis of Variance was used to compare the means of test and control values while post hoc test was done using Tukey’s multiple comparisons test and a P-value of less than 0.05 was considered as statistically significant.

Results: Results revealed significant increase in pulse rate, systolic blood pressure, diastolic blood pressure, pulse pressure, and mean arterial pressure among morticians of the Teaching hospital and General hospital when compared to the control and those of the General hospital morticians were higher compared to the Teaching hospital morticians.

Conclusion: It was therefore concluded that exposure to formaldehyde has deleterious effects on the cardiovascular health of morticians hence, there is an urgent need to seek ways of reducing the atmospheric levels of formaldehyde in our mortuaries in order to protect the cardiovascular health of the morticians.

Prevalence and determinants of depression among patients attending adult HIV clinic of University of Uyo Teaching Hospital, Uyo, Southern Nigeria

Okeke DO, Udoh SB, Jiman AC, John E — Wed, 01 May 2024 00:00:00 +0000

Background: Mental health challenges particularly depression is common among people living with HIV/AIDS and has been largely neglected. This is of great concern because depression is associated with high morbidity among its sufferers. An assessment of depression among PLWHA and its predictors will enhance their quality of life and improve their health outcomes.

Aim: To determine the prevalence and determinants of depression among patients attending the adult HIV clinic in University of Uyo Teaching Hospital, Uyo, Nigeria.

Method: This was a cross-sectional descriptive study conducted at the adult HIV outpatient clinic of University of Uyo Teaching Hospital Uyo. A total of three hundred and fifty one eligible respondents were recruited over three months. Their levels of perceived social support, depression, HIV stigma and substance abuse were assessed using the Multidimensional Scale of Perceived Social Support (MSPSS), Patient Health Questionnaire 9 (PHQ 9), Internalized AIDS-related Stigma Scale and CAGE questionnaire respectively.

Results: The mean age of the respondents was 39.8 ± 10.7 years. Two hundred and sixty six (75.8%) of the respondents were females, while eighty five (24.2%) were males. The overall prevalence of depression was 10%. Majority of respondents had disclosed their status and were experiencing HIV stigmatization representing 84.6% and 95.4% respectively. Most of the respondents (65.8%) had low perceived social support. Depression was found to be statistically associated with unskilled workers (χ2 = 13.08, p = 0.008), unmarried respondents (χ2 = 8.45, p = 0.03), low perceived social support (χ2 = 7.76, p = 0.02), shorter duration of ART use (χ2 = 8.41, p = 0.04), adverse life events (χ2 = 4.05, p = 0.04) and increasing levels of HIV stigma (χ2 = 7.66, p = 0.02) among the study participants.

Conclusion: The findings of this study showed that the prevalence of depression in PLWHA was high. Therefore, the screening and prompt treatment of depression in HIV positive persons should be inculcated into their management plan. Furthermore, policies should be made to minimize discrimination and stigmatization of PLWHA in the communities and healthcare systems. Finally, the relevant stakeholders should work in unison to improve the social welfare conditions of HIV infected persons.

A seven-year review of paediatric mortality in the University Of Uyo Teaching Hospital, Uyo, Nigeria

Akpan UM, Ekpenyong EE, Dickson AJ, Oloyede IP — Wed, 01 May 2024 00:00:00 +0000

Background: Childhood mortality has become one of the world’s targets for reduction as encapsulated in the Sustainable Development Goals (SDG). Although mortality among children aged younger than 5 years has declined globally in the past two decades, considerable geographical differences exist and remain disproportionately high in sub-Saharan Africa and Southeast Asia. Many hospital-based studies in Nigeria have shown the predominance of infectious diseases such as sepsis, bronchopneumonia, and HIV/AIDS as the leading causes of childhood mortality.

Methods: The study was conducted at the Department of Paediatrics of the University of Uyo Teaching Hospital (UUTH), Uyo, Akwa Ibom State, Nigeria. The study was a descriptive, cross-sectional and retrospective review of all the deaths among the hospitalized children from 1^st January 2015 to 31^st December 2021.

Results: A total of 191 deaths in the Paediatrics Department of the University of Uyo Teaching Hospital were recorded, 99 males (51.3%) and 92 females (47.7%). This study shows that 27.00% of children who died where infants, 28.30% were children 1-5 years and 44.50% were children above 5 years. The commonest cause of childhood mortality in this study was severe sepsis (30.00%), followed by HIV/AIDS (11.40%), bronchopneumonia (9.84%).

Conclusion: Most of the leading causes of childhood mortality in Nigeria are infectious diseases. These are largely preventable and leave room for improvement in our practice of Infection Prevention and Control (IPC), appropriate community education on hygienic practices and prevention of HIV/AIDS.

Macula Lesions in Retinitis Pigmentosa

Babalola YO, Adebusoye SO — Wed, 01 May 2024 00:00:00 +0000

Aim: To describe the pattern of macula lesions in patients with retinitis pigmentosa attending a Retina outpatient clinic in Ibadan, Nigeria.

Methodology: A retrospective review of patients with retinitis pigmentosa seen at the Retina clinic of the University College Hospital, Ibadan, Nigeria between May 2018 and June 2022. Data analysis was by SPSS (version 23) and statistical significance was placed at p < 0.05.

Results: Forty-six (2.4%) of 1911 patients seen at the retina clinic during the study period had a diagnosis of retinitis pigmentosa. There were 24 (55.8%) males and 19 (44.2%) females. The mean age was 39.4 ± 19.2 years (range of 9 to 78 years). Eighty-six percent of patients were of the Yoruba ethnic group. The most common ocular complaint was poor vision which was present in forty patients (93.0%), followed by poor night vision in 26 (74.3%) patients and loss of peripheral vision in 11 (47.8%) patients. Visual impairment was present in 72.2% of patients. Maculopathy accounted for 61.3 percent of patients with visual impairment. Fifty-three (68.9%) eyes had macula lesions. This accounted for 62. 8% of all patients with RP. The macula lesions include atrophic maculopathy, cystoid macula oedema and epiretinal membrane. Atrophic maculopathy was the most common maculopathy. Coexisting ocular morbidities such as cataract dominantly of the posterior subcapsular morphology was present in 33 (42.3%) eyes while glaucoma was present in two eyes of a single patient.

Conclusion: Macula lesions in retinitis pigmentosa may be a main cause of visual impairment in this population. Atrophic maculopathy is the most prevalent macula lesion associated with RP in this study.

Psychometric evaluation and validation of the Brain Fag Syndrome Scale among students at Bayero University Kano

Gudaji MI, Aghukwa NC, Baguda AS, Fawaz B, Aminu LS — Wed, 01 May 2024 00:00:00 +0000

Background: This study delved into the Psychometric Evaluation and Validation of the Brain Fag Syndrome Scale (BFSS) among students at Bayero University Kano. Documented extensively among African students, particularly in academic settings, Brain Fag Syndrome (BFS) is rooted in recurrent mental exhaustion impacting students emotionally and physically. As the concept of BFS as an exhaustion syndrome emerged, a thorough examination of its psychometric properties became essential.

Methods: Employing a cross-sectional survey design, 625 3^rd-year undergraduate students from Bayero University Kano were randomly selected, representing 89.3% of the intended sample size. Socio-demographic characteristics were explored, scale reliability was measured using Cronbach's alpha, and Exploratory Factor Analysis (EFA) was conducted to unveil the BFSS latent structure. The Brain Fag Syndrome and Fatigue Assessment Questionnaire development stemmed from identified components related to Fatigue and Exhaustion.

Results: Analysis with SPSS v26 included all 625 participants with complete data. BFSS exhibited moderate to good reliability (Cronbach's alpha ≈ 0.738). EFA identified a distinct "Fatigue and Exhaustion Factor," strongly linked to fatigue and concentration challenges. A scree plot aided in retaining optimal factors, highlighting the dominance of the identified factor.

Conclusion: This study significantly contributes to the validation of the Brain Fag Syndrome Scale (BFSS) and the derivation of a prototype questionnaire for fatigue and exhaustion syndrome. The identified factors align with the evolving understanding of BFS as an exhaustion syndrome, informing diagnostic criteria refinement and enriching the discourse on students' psychological well-being within a cultural context.

Childhood Wilm’s tumour in Aba, South East Nigeria

Ekpemo S, Eleweke N — Wed, 01 May 2024 00:00:00 +0000

Background: Wilm’s tumour is still a problem to paediatric oncologist in developing countries due to poverty, late presentation, high cost of chemotherapeutic drugs, ignorance and religious beliefs.

Objective: To review the clinical presentation, management and outcome of Wilm’s tumour in Aba, South East Nigeria.

Methods: The Demography, clinical presentation, investigation results, operative findings and outcome of patients less than 15 years old managed for Wilm’s tumour at the paediatric surgery unit of the Abia State University Aba, South East Nigeria from 2010 to 2020 were retrospectively reviewed.

Results: There were 30 children (M: F 2 :1) with histological confirmed nephroblastoma over the 10 year period. Their median age was 5. Age range 4-15years. Palpable abdominal mass was the main presentation in all the patients. Treatment consisted of nephro-ureterectomy followed by adjuvant chemotherapy with Vincristine, Cyclophosphamide and Actinomycin D. Adriamycin was added for metastatic disease and anaplasia. Fifteen of the patients had stage III disease, 10 had stage II disease and 5 had stage IV disease. Stage I disease was not encountered. Five patients had inoperable tumour requiring preoperative chemotherapy. Five patients died from the complication of chemotherapy treatment. Seven relapsed with poor outcome, with a mean follow up of 20 months, 20months survival rate is 40%.

Conclusion: There is high rate of morbidity and mortality from nephroblastoma in our environment due to late presentation, poverty, ignorance and poor compliance to treatment. The outcome will be improved through health enlightenment and healthcare funding.

A study on Awareness and Knowledge of Surgical Site Infection among Dental Patients in a Nigerian Tertiary Hospital

Igbinosa L, Edetanlen EB, Babalola YO — Wed, 01 May 2024 00:00:00 +0000

Background: Risk of surgical site infection (SSI) can be reduced or eliminated if its awareness and knowledge is optimal among patients.

Aim: The aim of this study was to assess the level of awareness and knowledge of SSI among dental patients in a Nigerian Tertiary Hospital.

Materials and methods: This was a cross-sectional study design conducted in hospital setting on adult Nigerian population visiting a tertiary hospital between December, 2022 and February, 2023. The data was collected with a pretested 36-item, structured, close-ended, self-administered and interviewer -administered questionnaires. The data collected were socio demographic characteristics, past admission, days of hospitalization, reason for admission and history of SSI. Other collected data were awareness and knowledge of SSI. Both descriptive and inferential statistics were analyzed. The data was entered and analyzed using the statistical package for the social sciences (SPSS), version 26 (IBM, Armonk, NY, United States of America). A critical probability level (p-value) of <0.05 was used as the cut-off level for statistical significance.

Results: A total of 102 dental patients were interviewed in this study. The age range and the mean age were 20 -76 years and 45.3± 5.1 years respectively. There was slight (55.9%) preponderance of female gender. Only 24(23.5%) respondents had heard of SSI and this was mainly through medical personnel. The majority (76.5%) of the respondents had never seen anyone diagnosed of SSI. Few (6.9%) respondents claimed they were enlightened about SSI prior to surgery. Overall, half (50%) of the respondent had poor knowledge while only 13(12.7%) had good knowledge. Marital status, level of education and previous admission were significantly associated with poor knowledge (p<0.05).

Conclusions: The awareness and knowledge of surgical site infection among patients in this study were relatively poor. Therefore, awareness campaign among Nigerian population can help improved the level of knowledge for better wound care and quality care.

Physical survey on the health hazards of welding activities on welding operators in Uyo, Nigeria

Ekefre A, Ekanem II, Ikpe AE — Wed, 01 May 2024 00:00:00 +0000

Background: Welding operators are subjected to several forms of hazards during welding activities.

Aim: The study aimed to identify the common practices in welding operations, assess the potential health hazards associated with these practices, and propose recommendations for improving the well-being of welding operators.

Methodology: The survey was conducted at different welding workshops in Uyo, Akwa Ibom State, Nigeria. A total of 100 welding operators were observed and interviewed to gather data on their working practices and the health effects they experienced.

Results: The findings revealed that the most common welding practices included manual metal arc welding, gas metal arc welding, and gas tungsten arc welding. These practices involved exposure to various hazards such as fumes, gases, noise, and ultraviolet radiation. The survey also found that a significant number of welding operators reported experiencing health issues such as respiratory problems, skin irritation, eye injuries, and hearing loss. These health effects were attributed to the lack of proper ventilation, inadequate personal protective equipment, and poor ergonomic practices in the welding workshops.

Conclusion: The findings of this study highlights the importance of addressing the health hazards associated with welding operations to ensure a safer and healthier work environment for improved work conditions and well-being of welding operators. In light of the findings, several recommendations including the implementation of proper ventilation systems, provision of adequate personal protective equipment, regular health screening for welding operators, and training programs on safe welding practices is proposed in order to improve the well-being of welding operators

Demographic distribution of allergic conjunctivitis in selected schools in Ovia North East Local Government Area, Benin City, Edo State

Okoro CC, Odigie OM, Ozigis M — Wed, 01 May 2024 00:00:00 +0000

Background: The burden of allergic diseases and conjunctivitis has been on the increase, especially in developing countries, prompting several studies across varying populations to investigate the causes and prevalence of these conditions. Epidemiological studies have been concerned largely with the prevalence of allergic conjunctivitis in the adult population and little is known about its prevalence in the paediatric population. The purpose of this study was to determine the prevalence of allergic conjunctivitis among school children in Ovia North East Local government Area, Benin City.

Materials and Methods: A cross-sectional study was conducted using a sample size of 300 children aged 5 to 17 years from selected schools. Case history was taken through a structured questionnaire after which the children were screened. Visual acuity was measured using the Snellen Acuity chart. Internal and external eye examinations were done using a direct ophthalmoscope, magnifying loupe and penlight respectively. Data obtained was presented in percentages and tables. Chi square test was utilized to test for association between variables.

Results: A total of 190 participants were examined: 78 males and 112 females (12.9± 2.39 years). The study revealed that allergic conjunctivitis was present in 48.4% (92) of the participants, with itching being the most commonly experienced symptom. There was no association between allergic conjunctivitis and either age or gender (p<0.05).

Conclusion: Allergic conjunctivitis was prevalent among children in the southern part of the country, stating the need for enlightenment among parents/guardians, use of relief methods, and recommendation of further research.

Adolescents in urban and rural communities in Rivers state, Nigeria: Factors influencing access and utilization of reproductive health services

Ogbonna VI, Alabere ID, Babatunde O — Wed, 01 May 2024 00:00:00 +0000

Introduction: Reproductive health services (RHS) are used and accessed differently in rural and urban areas, though to what extent is unknown. In Rivers State, Nigeria, we identified and examined the characteristics impacting adolescents' access to and use of RHS in rural and urban areas.

Methods: A cross-sectional comparative study design was employed, five hundred and seven adolescents—255 from urban and 252 from rural communities—were surveyed. Access and utilization were measured and using adjusted odd ratios in multivariate logistic regression models, predictors of access and utilization were identified.

Results: The corresponding median ages and interquartile ranges were 16.0 (14–19) and 14.0 (12–16) years, respectively. RHS utilization was low, with 57 (22.6 percent) in rural areas and 65 (25.5 percent) in urban areas. There was also a lack of access to services; only 8 (3.17 percent) rural and 81 (31.76 percent) urban residents had economic access to RHS. Access and utilization were predicted by age, level of education, awareness of RHS, sexual experience in both communities, beliefs that condoms can prevent STIs/ HIV, and exposure to mass and socio-media influenced access and utilization of RHS. Specifically, age group (15-19 years) of respondents was found to be a significant predictor of utilization of RHS for both urban (cOR=4.32, 95% CI; 0.82-22.69, p=0.001) and rural (aOR=7.65, 95% CI; 1.99-29.40, p=0.003) adolescents.

Conclusion: Adolescents in urban areas have more access (3 in 10) and utilization of RHS compared with their rural (3 in 100) counterparts. There is a need to promote information and education on RHS among adolescents, especially in rural areas.

Physicians’ awareness and use of drug-drug interactions software: A preliminary study

Oriaifo OG, Opadeyi AO, Isah AO — Wed, 01 May 2024 00:00:00 +0000

Background: Drug-drug interactions software is used as a tool to investigate clinically harmful interactions. Prescribers need to be aware of these tools to improve the quality of drug prescriptions, thus ensuring better patient care. Drug-drug interactions are a common avoidable type of adverse drug reactions, which can have detrimental effects on patients in the form of drug toxicity

Objective: To determine the awareness of prescribers and the use of drug-drug interaction software.

Method: The awareness of physicians of drug interaction software was assessed. A self-administered questionnaire was administered to all resident physicians in the Department of Internal Medicine, University of Benin Teaching Hospital to assess their awareness and use of the drug-drug interaction software. The information sought includes sociodemographic characteristics, Physician’s awareness, and use of drug interaction software. The results are presented descriptively.

Results: Thirty-four medical residents filled out the self-administered questionnaire. The number of physicians aware of drug-drug interactions software was 30 (82.2%) for Medscape, Drugs.com 21 (61.8%), Lexi-interact 4(11.8%), and 3 (8.8%) for Epocrates. Medscape interaction checker was most used by 26 (76.5%) while Micromedex was least used by one (2.9%) medical resident.

Conclusion: Physicians were largely aware of and used Medscape.

Assessment of depressive symptoms among post stroke patients attending a Nigerian tertiary hospital

Wed, 01 May 2024 00:00:00 +0000

Background: Post Stroke Depression (PSD) occurs in a significant number of patients and constitutes an important complication of stroke, leading to greater disability as well as increased mortality. This study examined depressive symptoms among post stroke patients attending neurology clinic in a tertiary hospital in Northwest Nigeria.

Methods: This cross-sectional study was carried out among 83 stroke survivors. Participants were administered socio-demographic, clinical characteristics pro-forma questionnaire and depression subscale of the Hospital and Anxiety Depressive Scale (HADS).

Results: The 83 participants recruited for study had a mean age of 56.8 years (s.d. = 10.2) and 62.7 % were female. Majority (60.2%) had formal education, 83.1% were employed, and 73.5% were married. Overall, the prevalence of depressive symptoms was 34.9% while 2.4% were rated as having severe depressive symptoms. Unemployment, having disabilities and post stroke complications were significantly associated with depressive symptoms.

Conclusion: The presence of depressive symptoms among stroke patients supports the need to consider routine screen for psychiatry morbidity among patients with medical condition that causes disabilities. Disability has been identified as the main predictor of depressive symptoms. In view of this, psychosocial evaluation and intervention should be integrated into clinical care of stroke patients for early detection of depressive symptoms.

Prevalence and pattern of sleep problems among older persons attending a tertiary hospital in Nigeria

Akinola OA, Etukumana EA, Morgan UOM — Wed, 01 May 2024 00:00:00 +0000

Background: Sleep disturbances are common symptoms in adults and are related to various factors, but they are not an inherent part of the ageing process.

Objective: To determine the prevalence and pattern of sleep problems among older persons attending the General Out-patient Clinics in a tertiary health-care facility in Uyo, Nigeria.

Materials and Methods: This was a hospital-based cross-sectional descriptive study on older persons attending the GOP clinics of the University of Uyo Teaching Hospital. Using a semi-structured interviewer administered questionnaire, information on the sociodemographic characteristics and the sleep history of the respondents were obtained. Data entry and analysis were done using Epi info^® version 3.5.1.

Results: The prevalence of sleep problems was 64.5% with early awakening being the commonest sleep problem (50.5%) experienced by the respondents.

Conclusion: The prevalence of sleep problems is high in this study, and there is need for counselling of older persons on how to improve their sleeping habits.

An ethnic model along differentiation between justified death attitude and polls in a cross-cultural generational study

Zandian P, Seydi Z, Benyamin K, Tayeri N — Wed, 01 May 2024 00:00:00 +0000

Background: “Justified Death Attitude (JDA) is imminent and likely paradoxical behavior against self threat to keep of self in modification for elimination of the opponent mentally or physically”the first author defined. The former studies have indicated that Justified Death Attitude Scale (JDAS) has both validity and reliability of the young majority society Shia, but we do not know whether or not it is a valid or reliable scale of minority societies Sunni, Assyrian and the old generation. If it has, can the scale discriminate between the JDA and the poll?

Objectives: It is a cross-sectional study to evaluate development of JDAS comprehensively because different generations, multi ethnicities, and social variables affect attitude and cognition persistently.

Method: 744 participants (368 male and 376 female) were selected through the convenience sampling method in Tehran, Ilam, Khoram Abad, and Sanandaj. The participants were of the following demographic properties: 528 adult and 216 older adult participants; 538 Shia, 108 Sunni, and 98 Assyrian participants; 460 normal and 284 abnormal participants. Participants carried out the General Health Questionnaire-12 (GHQ-12) and JDAS. 115 answer sheets were cancelled (less than 5%).

Results: A Pearson product-moment correlation coefficient, binomial tests, Chi square tests, and Jonckheere-Terpstra tests are performed to analyze the data. Multiethnic studies indicate that JDAS is a valid scale for adult and older adult participants and Shia, Sunni, and Assyrian participants (p>0.05). Meanwhile, attitude and polls are two different phenomena in the collision between capital punishment, the kind of death penalties, the agreement of euthanasia, and kind of euthanasia %61, %57, %56, and %61, respectively, because of different propositional and associative processes. The Chi-square indicates that gender, generations, ethnics, and sanity influence polls significantly. In line with the ethnic model of JDA, ethnics influence legal and medical subscales significantly according to Jonckheere-Terpstra tests.

Conclusion: The bases of polls and attitude are conformity and self, respectively. So, the poll coefficient of error is very high to assess social ideas. Although you could find some similarities between polls and attitude, they are different phenomena principally.

Assessment of the acceptance and implementation of child survival strategies among mothers in some selected communities in south-south Nigeria

Peters GE, Ekpenyong AU, Moffat BE, Akpan-Idiok PA — Wed, 01 May 2024 00:00:00 +0000

Objective: The aim of this study was to assess the acceptance and implementation of child survival strategies through knowledge and practices among mothers in some selected communities in south-south Nigeria.

Method: A descriptive survey method was used for the study and Rivers state which is in South-South Nigeria was randomly selected for the pilot study. The study was conducted between September 2021 and August 2023 and a sample size of Six Hundred respondents were randomly selected from the three senatorial districts of Rivers State. The instrument used for data collection was researchers’ constructed questionnaire with 17 items grouped into A and B. Section A contained information on demographic data of the respondents while section B focused on the Knowledge, practices and factors that influenced the acceptance and implementation of child survival strategies among mothers in some selected Local Government Areas in Rivers state. Data was analysed using descriptive statistics of percentages in frequency and tables.

Results: The results of the findings showed a high level of knowledge (100%) and its components like skilled child birth attendance (92%), exclusive breastfeeding (83%), immunization (96%) and family planning (78.5%). Also majority of the mothers actually practiced the components of child survival strategies in this study, except family planning services (16%) despite being in the peak of their reproductive years and already having between four to six children. Other factors such as the attitude of the health workers and educational background of mothers were also identified as barriers to the practice of child survival strategies.

Conclusion: It was therefore recommended amongst others that government at all levels should embark on aggressive health enlightenment campaign to further sustain these practices and also improve the acceptance and implementation of the practices of other child survival strategies yet to be accepted by mothers.

Large submucous uterine fibroid mass

Obiozor AA, Obiozor CG — Wed, 01 May 2024 00:00:00 +0000

Background: Uterine fibroids or leiomyomas, are common benign tumors originating from the smooth muscle cells of the uterus. While typically asymptomatic, large submucous fibroids can cause significant clinical manifestations, including abnormal uterine bleeding, pelvic pain, and reproductive issues. Radiological imaging, such as ultrasound, played a crucial role in the accurate diagnosis and characterization of these fibroids, guiding appropriate clinical management decisions.

Methods: We present a case report of a 28-year-old female with complaints of heavy menstrual bleeding and pelvic discomfort. Clinical evaluation prompted the utilization of radiological imaging techniques to assess the uterine anatomy. Ultrasound was employed to visualize and characterize the large submucous uterine fibroid mass. Imaging findings were correlated with clinical symptoms to formulate an appropriate treatment plan.

Results: ultrasound revealed a large submucous uterine fibroid mass measuring 105.7mm x 75.6mm x 79.6mm in its dimensions. The fibroid was heterogeneous in its echo texture and it is located in the submucosal layer of the uterus. Doppler imaging demonstrated some areas of flow within the fibroid mass. The correlation of imaging findings with clinical symptoms aided in determining the extent of fibroid-related symptoms and guiding further management decisions.

Conclusion: This case report underscores the significance of radiological imaging, particularly ultrasound in diagnosing and characterizing large submucous uterine fibroid masses. Accurate radiological assessment is crucial for determining the appropriate course of clinical management, which may include medical therapy, minimally invasive procedures, or surgical intervention. The collaborative approach between gynecologists and radiologists is pivotal in optimizing patient care for individuals with symptomatic uterine fibroids.

Diabetes and Cervical Necrotizing Fasciitis: A Case Report

Uwanuruochi VN, Ogba JA, Iwegbu IO, Uwanuruochi K, Udeke U — Wed, 01 May 2024 00:00:00 +0000

Introduction
Cervical necrotizing fasciitis in diabetics is under-reported in the literature. We present a case report and discuss salient points in its management.

An aberrant right subclavian artery in a chronic obstructive airway disease patient

Elendu KC, Chima E, Uwanuruochi K — Wed, 01 May 2024 00:00:00 +0000

Background: A seventy-six year old man, known hypertensive, presented with chest pain of five years duration, associated with exertional breathlessness, wheeze, cough, leg swelling and fatigue. His chest radiograph showed signs of hyperinflation, and chest computer tomography showed an aberrant right subclavian artery. We discuss the implications of this finding to diagnosis, and clinical management.

Skene’s gland abscess: a rare case report

Muhammad AS, Gabi UI, Ja’afaru UH, Kabir AM — Wed, 01 May 2024 00:00:00 +0000

Background: The Para urethral gland of Skene is a pair of glands in the vestibule on the distal two-thirds of the female urethra, they are homologous to the male prostate gland and are believed to secrete fluid that lubricates the urethral opening. They contain about 6 to 30 small glands. The grand’s duct can get infected and hence inflamed obstruct. The secretion may accumulate leading an abscess formation. The patients may develop fever, dysuria, or dyspareunia. On examination, there may be a visible palpable Para urethral mass which may be unilateral or bilateral, it may also be tender. The incidence of Skene’s gland abscess is unknown, it is common in premenopausal women usually in the third and fourth decades of life. Trans trans-perineal ultrasound scan is very useful in the diagnosis but MRI is the gold standard. An important differential diagnosis is urethral diverticulitis which can be distinguished using these imaging modalities.

Case report: We present a 30 years old nulliparous single lady who had a 2-year history of vaginal swelling and superficial dyspareunia we made a final diagnosis of palpable skene’s gland abscess, which was treated by marsupialization.

Interstitial lung disease; a need for oxygen concentrator rental business in Nigeria?

Ugwuanyi O, Adjeroh M, Obodozie C, Offiah E, Uwanuruochi K — Wed, 01 May 2024 00:00:00 +0000

Background: Patients with chronic obstructive airway diseases often need domiciliary oxygen supply.

Case report: We report an elderly woman with interstitial lung disease that was dependent on intranasal oxygen. We discuss the need for rental oxygen concentrator business in Nigeria.

Key Message: Rental oxygen concentrator business will make oxygen concentrators affordable in Nigeria

Vulva lesions seen at a tertiary health centre in southwest Nigeria

Olaofe OO — Wed, 01 May 2024 00:00:00 +0000

Background: Some researchers have emphasised the need for more studies on vulvar cancers. The aim of our study is to describe the vulvar lesions identified in biopsies seen in our department over a five-year period to serve as baseline data for future studies.

Methods: We conducted a five-year cross-sectional study on all vulva specimens received by the department of Morbid Anatomy and Forensic medicine at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria. From the departmental records, we retrieved data on the patients' biodata, medical history, and vulva lesion diagnosis.

Results: We recorded 15 vulva biopsies during the study period, with an age range of 13 to 80 years. Two cases were benign tumours, and two cases were inflammatory in nature. A case of a pre-malignant lesion was seen. Nine cases were malignant tumours, all of which are epithelial in origin. We saw two non-neoplastic lesions. These are acute on chronic inflammation and lichen sclerosus et atrophicus.

Of the malignant tumours seen, five were well-differentiated squamous cell carcinoma (SCC), two were moderately differentiated SCC, and two were cases of verrucous carcinoma. One case of verrucous carcinoma and a well-differentiated SCC had a background HIV.

Conclusion: Vulva lesions are rarely seen at our centre. The absence of preinvasive lesions in our study may be due to the late presentation of cases in clinics or the reluctance of gynaecologists to take biopsies of non-tumoral lesions of the vulva. HIV may be associated with an increased risk of HPV-related cancers.

Suicidal attempt in a patient with gambling disorder: A rare case report

Shehu SN, Gado HU, Abioda DI, Adebayo AS, Abubakar A — Wed, 01 May 2024 00:00:00 +0000

Background: Gambling disorder is characterized by a compulsive, repetitive and maladaptive pattern of gambling that results in significant distress. It is now classified into the “Substance-Related and Addictive Disorders'' group in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Some participants do present with psychiatric complications ranging from mood, substance use, abnormal personality traits and even suicidality. This comorbidities complicates both presentation and treatment.

Methods: In this report, we presented a case of a 32 year old civil servant who presented with repeated engagement in online sport gambling with ensuing accrued debts, strained interpersonal relationships, depressive symptoms and subsequent suicidal attempt by hanging himself in a closed room at night. This was a rare case of pathological gambling that was complicated by a severe depressive episode and suicidal attempt with a fatal means (hanging) in a patient with family history of gambling and psychotic illness.

Conclusion: Pathological gambling is an addictive behavior with far reaching consequences such as mood disorders, suicidal behaviors and subsequent affectation of functioning of the individuals involved. Early detection and prompt intervention is essential to prevent further complications.

Amoebic liver abscess in an adult Nigerian: A case report

Obiozor AA, Obiozor AC — Wed, 01 May 2024 00:00:00 +0000

Background: Amoebic liver abscess (ALA) is a parasitic infection caused by Entamoeba histolytica. ALA is a significant health concern, particularly in regions with poor sanitation and hygiene practices. Radiological imaging plays a crucial role in the diagnosis and management of ALA.

Methods: We present a case report of a 40-year-old male patient with ALA. The patient presented to a radio diagnostic centre in Umuahia with right upper quadrant abdominal pain, fever,diarrhea and weight loss. Radiological evaluation was performed using abdominal ultrasound and contrast-enhanced CT scan. The imaging findings were correlated with clinical presentation and laboratory investigations.

Results: The radiological findings revealed a focal hypoechoic lesion in the right hepatic lobe with ill-defined margins and internal echoes suggestive of liquefaction. The contrast-enhanced CT scan confirmed the presence of a well-defined, hypodense lesion with peripheral enhancement and central hypoattenuation. No evidence of biliary ductal dilatation or vascular invasion was observed. Based on the findings, a diagnosis of ALA was made, and the patient was initiated on intravenous metronidazole therapy. Follow-up imaging demonstrated a decrease in abscess size and resolution of internal echoes, indicating a positive response to treatment.

Conclusion: Radiological imaging, including ultrasound and CT scan, plays a pivotal role in the diagnosis and management of ALA. The characteristic imaging findings, such as hypoechoic lesions with internal echoes and peripheral enhancement with central hypoattenuation, aid in differentiating ALA from other hepatic lesions. Early diagnosis and prompt initiation of appropriate therapy are crucial for favorable patient outcomes. Radiological follow-up allows monitoring of treatment response and guides further management decisions.

Recurrent subdural hemorrhages and evaluation of annual prostate screening

Iheanacho J, Uwanuruochi K — Wed, 01 May 2024 00:00:00 +0000

We report a 76-year old man who had cerebellar hemorrhage and recurrent subdural hematoma. Investigations revealed that these were metastases from cancer of the prostate. We discuss the need for annual prostate cancer assessment in our environment

Key Message: The indications for annual examination of the prostatic specific antigen in elderly men should be appreciated.