Ibom Medical Journal

Screening for genes Encoding Virulence Factor in Salmonella serovar Typhimurium isolated from Tiger nut Juice

Peter IU — 2024-09-01

Background: Tiger nut juice is a popular non-alcoholic beverage in Nigeria, but it can be contaminated with bacteria that pose a risk to consumers. A study in Ogbete market, South Eastern Nigeria, aimed to identify virulence genes in Salmonella enterica subsp. enterica serovar Typhimurium found in tiger nut juice to assess the potential health threat.

Materials and Methods: Fifty tiger nut juice with codes ATC1, MECB2, BNC3, CHA4, ERT5, TYR6, VMA7, EKA8, TMM9, and ORU10 were randomly purchased from Ogbete market vendors. Standard microbiological techniques and Polymerase Chain Reaction (PCR) were used to screen the samples for S. Typhimurium presence and its virulence genes including invA, spvB, pefA, csgA, orgA, msgA, spaN, spiA, spvC, sipB, and sefA.

Results: Our study found that 48.0% of the samples tested positive for S. Typhi. S. Typhi positive culture rates varied by sample location: ATC1 (10%), MECB2 (4.0%), BNC3 (6.0%), CHA4 (2.0%), ERT5 (8.0%), TYR6 (0.0%), VMA7 (6.0%), EKA8 (0.0%), TMM9 (8.0%), ORU10 (6.0%). PCR amplification of the virulence gene showed the presence of invA, spvB, pefA and csgA in all isolates. S. Typhimurium isolates from samples TYR6, VMA7, EKA8, TMM9, and ORU10 lacked orgA and msgA genes. Other virulence genes identified include spaN (40-100%), spiA (40-100%), spvC (25-100%), sipB (20-100%), and sefA (100%).

Conclusion: Our findings reveal that tiger nut juice contained Salmonella Typhimurium harboring numerous virulence genes. Therefore, to prevent the general public's health from being harmed by tiger nut drinks contaminated with Salmonella Typhimurium, relevant regulatory bodies should enforce strict hygienic practices during the production, handling, and distribution of tiger nut juice.

A study to evaluate the efficacy of intravenous Magnesium Sulphate administration on lactate clearance in critically ill patients

Rani A — 2024-09-01

Background: Magnesium (Mg) is crucial for normal mitochondrial function in human body. It functions as an important cofactor for numerous biological reactions involving ATP-generating enzymes such as mitochondrial ATP synthase and Na+/K+ ATPase.

Method: This prospective, randomized, interventional study involving two groups of critically ill patients in ICU with hypomagnesaemia. One group received intravenous administration of magnesium sulphate while the second group received intravenous administration of placebo.

Results: Comparison of serum lactate levels between cases and controls (n = 84) was statistically insignificant. Lactate clearance between cases and controls was comparable. Comparison of arterial blood gases between cases and controls was found to be statistically insignificant. Comparison of biochemical parameters between cases and controls. Hospital stay duration of cases and controls was found to be comparable. Mortality between cases and controls was comparable.

Conclusion: There was a significant proportion of critically ill patients with serum hypomagnesemia however intravenous magnesium sulphate administration did not significantly affect the lactate clearance, the days on mechanical ventilation, duration of ICU stay or the mortality.

Determinants of utilisation of the clinical practice guideline in acute management of patients with acute traumatic spinal cord injury in Nsih, Kenya

Eke CI — 2024-09-01

Background: Spinal cord injuries have severe implications for public health all around the world. As a result, there is an urgent need to evaluate variables that influence the utilisation of the clinical practice guidelines for their acute care management.

Objective: The study’s objective was to assess the determinants of the utilisation of the CPG in the acute management of patients with acute traumatic spinal cord injuries among healthcare workers at NSIH, Kenya.

Material and methods: An analytical cross-sectional design was employed in this study. A census sampling with a sample size of 40 was employed in the study. A semi-structured research questionnaire was used to collect the quantitative data. The chi-square test was used for bivariate analysis and binomial logistic regression was used for multivariate analysis. The cutoff for statistical significance was p<0.05.

Results: The level of utilisation of the clinical practice guideline was low(22.5%). The presence of trained healthcare workers was a determinant of the level of utilisation of the CPG while years of working experience and the presence of adequate healthcare providers among others were not associated with the level of utilisation of the CPG.

Conclusion: The study concluded that the level of utilisation was low (22.5%) and further concluded that training on CPG influenced its utilisation by the healthcare providers. There is a need for CPG training programmes, the development of guideline implementation tools, and feedback mechanisms for CPG performance assessment.

Cardiopulmonary Resuscitation: Knowledge, Attitude, and Experience of House Officers and Junior Residents in a Tertiary Health Institution in Nigeria

Chukwu IS — 2024-09-01

Background: From time to time, doctors would be faced with situations requiring them to perform Cardiopulmonary Resuscitation (CPR) on patients. They would also play a leading role in the training of lay Responders. It is therefore important that doctors have the right attitude, sufficient knowledge and experience for satisfactory performance. To gain insight into this and act appropriately is the aim of this study.

Method: This is a cross-sectional study of House Officers and Junior Residents in the Federal Medical Centre Umuahia. Data was collected, using a questionnaire that was based on the 2005 American Heart Association (AHA) Guidelines for CPR and Emergency Cardiovascular Care (ECC). The data was fed into a password protected computer and analyzed using the Statistical Package with Social Sciences (SPSS).

Results: The total number of doctors was 69; with a mean age (years) of 31.45, a Standard deviation (SD) of 3.96 and a range of 24 – 40. Males were 54 (78.26%); females were 11 (15.94%); and 4 (5.80%) did not provide their gender. House Officers were 23 (33.33%) and Junior Residents 46 (66.67%). Only 13 (18.84%) of the respondents had a score of ≥ 50%. Some (60.87%) had not been faced with making contact and ventilating a patient with their mouth. Some of the respondents (86.96%) had been faced with requirement for chest compression on a patient. Most (78.26%) had never ventilated someone with their mouth while 15 (21.74%), only Junior Residents, had done so. The mean of survival rates expected by the respondents (N=55) was 55.10% (SD 21.01).

Conclusion: The knowledge and experience of Junior Residents and House Officers are low and their expectations concerning survival following CPR too high and unrealistic. Training in CPR is important to them but most of them would not make contact and ventilate an adult with their mouth and some would not do so for a neonate or a child. Periodic training of the doctors in all aspects of CPR is proposed to enhance their knowledge and modify their attitude.

Impact of Malondialdehyde (MDA) Level on Semen Plasma In Male Infertility

Osazee K — 2024-09-01

Background: Male factor infertility contributes to 40% of couples seeking fertility treatment, and about 50% of such couples require assisted reproduction technology as a mainstay treatment modality. Evidence has shown that a significant amount of sperm damage is orchestrated by reactive oxygen species (ROS). The imbalance phase between the oxidant and antioxidant can lead to various pathological conditions culminating in abnormal sperm quality. MDA as a biomarker for lipid peroxidation has been studied. However, the impact of its concentration on sperm quality and function is yet to be demonstrated. Despite the perceived association with male infertility.

Materials and Method: A total of 90 men were recruited. Forty-five of them were classified as fertile. They consisted of 25 sperm donors of proven fertility and 20 men in an infertile relationship of purely female aetiology. In contrast, the remaining 45 participants had at least one defect in routine sperm parameters and were considered as having male infertility. Semen samples were produced by masturbation after a period of 3–5 days of abstinence and then analyzed for sperm count, motility, and morphology as per WHO guidelines. Semen MDA was determined using the thiobarbituric acid assay (Buege and Aust, 1978).

Result: Sperm count, sperm total motility and sperm morphology were significantly lower (p<0.01) in infertile males compared to healthy fertile males. The level of oxidative stress to which the participants' spermatozoa were exposed was determined by the levels of MDA in the seminal plasma. MDA level was significantly (p<0.01) elevated in infertile males compared to healthy fertile males.

Conclusion: The association between oxidative stress and male infertility is established. MDA, a valuable biomarker of oxidative stress, could serve as an adjunct investigation when evaluating infertile males.

Acute Kidney Injury among hospitalised children in a young tertiary centre in south-south, Nigeria: An observational prospective study

Briggs DC — 2024-09-01

Background:

Context: Paediatric acute kidney injury (AKI) often goes unrecognised in resource-limited emergency room settings and is a major contributor to morbidity and mortality. It is necessary to define the epidemiology of AKI in referral hospital settings where none exists.

Objective: To determine the pattern, risk factors and outcome of acute kidney injury among children admitted into the Children's Emergency Room of Rivers State University Teaching Hospital (RSUTH).

Methods: This prospective observational study involved all paediatric cases with KDIGO-defined AKI between October 2020 and October 2023 followed up for 3 months. Patients’ data prospectively documented included age, sex, presenting symptoms, diagnosis, blood pressure, urine output, blood chemistry, treatment, and outcome. Data were analysed.

Results: Forty-three cases of AKI were seen, giving an incidence of 15.0 per 1000, 38 (88.4% were community-acquired). The mean age was 5.8 ±5.2 years (range: 2 months to 16 years) and 27(62.8%) were males. AKI was present in 38(88.4%) at presentation and 20(46.5%) had KDIGO stage III. The top four causes were: sepsis 16(37.2%), Primary renal diseases 10(23.3%), malaria 8(18.6%), gastroenteritis 5(11.6%). Seven (16.3%) required dialysis and mortality occurred in 7(16.3%). The risk of mortality was increased in those with sepsis [RR:13.6 (1.46 – 127.1)], late presentation [1.28(1.07 – 1.5)] and requiring dialysis [3.86(1.09 – 13.59)]

Conclusion: AKI is common in the children's emergency room of RSUTH. Early presentation, screening for AKI and prompt treatment of underlying causes are imperative to improve outcomes. Funding and support for paediatric dialysis programmes for severe AKI are needed.

Variability of optic nerve sheath diameter measurement on computed tomography; need for standardization

Itanyi UD — 2024-09-01

Context: Computed tomography measurement of optic nerve sheath diameter (ONSD) is established for the indirect evaluation of intracranial pressure in traumatic brain injury (TBI). There is however a significant difference in the reported values across different techniques with no clear-cut range of values agreed upon.

Objective: To measure the ONSD of patients with TBI and those with normal brains using different window settings and locations and compare with published values.

Methodology: Comparative evaluation of 300 ONSD measurements obtained from cranial CT examinations at the Radiology department of a tertiary institution. Seventy-five patients had radiologic signs of TBI while 75 had normal findings (controls). For each subset, ONSD was measured at 3mm and 8mm retrobulbar regions using spine window (ww/wl 250/50). ONSD was measured using additional settings (mediastinal ww/wl 450/60 and soft tissue 380/40) for controls. Correlation between age, gender, and side of the ONS complex at different lengths and contrast settings were also evaluated.

Results: The age range of the patients was 1-78 years, mean age of 40.4 years ± 21.7 with male: female ratio of 3:1. The mean ONSD was statistically different (p<0.0001) using the different window settings with the highest value obtained with the mediastinal window. There was also a significant difference(p <0.0001) between the ONSD of TBI and control patients at 8mm and 3mm retrobulbar regions but no correlation with gender, age, and side.

Conclusion: Significant variations in the CT measurements of ONSD with regards to retrobulbar locations and window settings highlight the need for standardization of protocols. Measurement taken at 3mm retrobulbar using a spine window setting shows greater distensibility and details of the optic nerve and allows for more reliable measurements.

The refractive status of children with Down’s syndrome in Benin City, Edo State

Osaiyuwu AB — 2024-09-01

Background: Down’s syndrome is an autosomal chromosomal disorder in humans and individuals with the condition are usually at a risk of various ocular conditions ranging from mild to moderate symptoms compared to those without Down’s syndrome. The purpose of this study was to evaluate the refractive status of children with Down’s syndrome between 5-18 years.

Materials and methods: This cross sectional study assessed the refractive status of 50 children with Down’s syndrome from selected special need schools in Benin City, Edo State, Nigeria. The visual acuity assessed with the use of Lea symbol chart and non-cyclopegic refraction was performed with the streak retinoscope. Hyperopia, Myopia, Hyperopic astigmatism and Myopic astigmatism of 0.25D and above respectively were considered as significant refractive error.

Results: A total of 50 children with Down’s syndrome were evaluated; 25 (50%) male and 25(50%) females with a mean age of 12.48 ± 3.028 years. Majority of the participants 45 (90%) had refractive error, with hyperopia being the most prevalent refractive error occurring in 40% (20) of the participants, followed by hyperopic astigmatism 30% (15), then myopia 12%(6) and lastly myopic astigmatism 8%(4) of the total participants. There was no significant relationship between gender and the different types of refractive errors.

Conclusion: Hyperopia was the most common type of refractive error observed in this study. It is necessary that urgent and early eye care services are provided for children with Down’s syndrome in the hope of improving their quality of life.

Prevalence of molar incisor hypomineralisation among school children in a Nigerian rural community

Osadolor OO — 2024-09-01

Background: Molar incisor hypomineralisation is a qualitative defect of enamel. The diagnosis of molar incisor hypomineralisation is clinical and it can be challenging to manage.

Objective: To determine the prevalence of molar incisor hypomineralisation among public school children aged 12 – 15 years in a south-eastern Nigerian rural community.

Methodology: A cross sectional descriptive study of 12-15 year old school children was done in a rural public technical college and three public secondary schools selected in Nkanu–West and Udi local Government Area of Enugu State respectively. Socio-demographic data was obtained using semi--structured questionnaire. Tests of association between dependent variables and independent variables were conducted using Fisher’s exact test. Inferential analysis to determine predictors of molar incisor hypomineralisation was done using logistic regression analysis (binary). Statistical analysis was done using SPSS Version 25. P values ≤ 0.05 were accepted as being statistically significant.

Results: One hundred and forty (47.3%) males and one hundred and fifty six (52.7%) females were seen and examined. The mean age of the children was 13.56 ± 1.1. The prevalence of molar incisor hypomineralisation was 2.4%. Molar incisor hypomineralisation was seen more in males than females. There was no significant association between MIH, sex (p = 0.71) and age (p = 0.59). There was significant association between MIH and socioeconomic status (p= 0.05). Socio-economic status was a predictor for molar incisor hypomineralisation (P = 0.04, OR = 0.20, 95% CI = 0.043- 0.944)

Conclusion: Molar incisor hypomineralisation can affect the quality of life of children. Visit to dental clinic is recommended.

Latent tuberculosis: Epidemiology, diagnostic and treatment challenges in Nigeria

Onukak AE — 2024-09-01

Background: Tuberculosis (TB) remains a significant global health challenge, causing considerable morbidity and mortality worldwide. Despite advancements in healthcare, TB continues to prevail, particularly in resource-limited settings. Understanding latent tuberculosis infection (LTBI) is critical for TB control strategies.

Objective: This review aimed to assess LTBI epidemiology together with diagnostic and treatment challenges in Nigeria.

Methods: Search of relevant articles on Latent tuberculosis in Nigeria compared to other countries published between 2008 and 2023 were undertaken mainly using Google scholar and PubMed. Related articles from websites of World Health Organization and Federal Ministry of Health, Nigeria were also retrieved and reviewed.

Results: LTBI represents a substantial reservoir for TB, with one-quarter of the world's population harboring the infection. The epidemiology of LTBI in Nigeria mirrors the global pattern, with a high prevalence observed among vulnerable populations. Diagnosis of LTBI relies on indirect methods, including tuberculin skin tests (TST) and interferon-gamma release assays (IGRAs). Challenges in treating LTBI persist, including poor screening tools, low treatment compliance, and adverse drug reactions. Addressing these issues requires a comprehensive approach, including improved screening, patient education, and healthcare infrastructure strengthening, to enhance LTBI management and contribute to TB control efforts globally and in Nigeria.

Conclusion: Screening and treatment of LTBI remains a crucial preventive intervention for TB eradication. Innovative dedicated policies with augmented research and strategies would be necessary to establish a successful LTBI program in Nigeria.

Introduction to cardiac electrophysiology and assessment of sinus node and atrio-ventricular conduction

Uwanuruochi K — 2024-09-01

Background: Interest in cardiac electrophysiology is increasing in sub-Saharan Africa, but the interpretation of results is poorly understood. Cardiac electrophysiology is the study of electrical activity of the heart by virtue of catheters that are positioned in the heart, as opposed to leads placed on the chest surface. It is useful in identifying sites of origin of various cardiac arrhythmias, diagnosing conduction abnormalities and treating various arrhythmias.

Material and method: This study is a review of cardiac electrophysiology methods. It aims to help physicians understand and interpret cardiac electrophysiology reports.

Fetomaternal outcomes among pregnant women with diabetes mellitus in Aminu Kano Teaching Hospital: A five-year review

Gaya SA — 2024-09-01

Background: Diabetes mellitus is one of the oldest diseases known and is among the largest global health emergencies of 21st century. It is associated with adverse obstetric outcome.

Method: The study was a retrospective review of patients with diabetes mellitus in pregnancy at the obstetrics and gynecology department of AKTH from January 2016 to December 2020. Case folders were retrieved and information on bio-data, obstetric history, treatment received, maternal and fetal complications were collected on a proforma. Data was analyzed using SPSS version 23, presented on tables and charts, and summarized using standard deviation as well as rate and proportions. Chi – square test was used to test for significance.

Result: The prevalence of diabetes in pregnancy was 1.26%; 78.4% were GDM and 21.6% were pre-gestational diabetes. The mean age was 32.6±4.6 years, with 36.4% were in age group 30-34years. About 95% were multiparous while only 4.5% were primiparous. About a quarter (15.9%) had normal BMI, 34.1% overweight and 31.8% obesity. Fetal macrosomia accounted for 10.2%, respiratory distress syndrome 4.5%, neonatal jaundice 3.4%, hypoglycemia 6.8% and congenital anomaly 2.3%. Pregnancy induced hypertension was noted in 12.5%, 5.7% had preterm labor, and 12.5% had miscarriage. Polyhydramnios was present in 2.3%, 11.4% had infection and 55.7% normal outcome.

Conclusion: Prevalence of DM in pregnancy was 1.26%. DIP is an increasing health problem with fetomaternal complications. Maternal complications include preeclampsia, miscarriage, infection, preterm labor and polyhydramnious, while fetal complications include fetal macrosomia, hypoglycemia, IUGR and congenital anomaly.

Methods of nerve localization during peripheral nerve block in some hospitals in Nigeria

Imarengiaye CA — 2024-09-01

Background: The correct needle placement and deposition of the local anaesthetic agent in proximity to the intended nerve is the hallmark of a peripheral nerve block (PNB).

Methods: This questionnaire-based study investigated the various methods of nerve localization during peripheral nerve block by anaesthetists in Nigeria and the pattern of utilization. A total of 120 questionnaires were distributed to 6 tertiary hospitals in Nigeria to elicit responses on the approaches to nerve localization at PNB. The commonly practiced methods of nerve localization and reasons for the performance or non-performance of the various approaches were also interrogated.

Results: A total of one hundred and nine (109) of the one hundred and twenty (120) questionnaires were returned (response rate of 90.8%). The majority of respondents (71.6%) were male. The cadres of respondents were Registrar (49.5%), Senior Registrar (27.5%), and Consultant (23.0%). The Anatomical approach was the most utilized (45.9%) as compared to Peripheral Nerve Stimulation (24.8%), Ultrasound-guided blocks (12.8%), or combined Peripheral Nerve Stimulation and ultrasound-guided blocks (16.5%). Lack of skills (73.4%) and absence of appropriate technology (26.6%) were the major reasons for the non-performance of some methods of nerve localization.

Conclusion: This survey indicates that Anaesthesiologists in Nigeria use mainly the anatomical approach to peripheral nerve block. Emphasis should be on personnel development rather than over-reliance on hi-tech approaches to nerve localization as this will allow for widespread application of available methods.

Burden of indirect costs: Are we overlooking this amongst patients with long-term medical conditions?

Mariere UI — 2024-09-01

Background: Increasing prevalence of long-term medical conditions (LTMCs) has made them recognized as the leading cause of diseases and deaths globally. Patients with LTMCs may have to stop work or have their household members stop working to care for them.

Objectives: This study determines the indirect cost burden of patients with prevalent long-term medical conditions (LTMCs) using public health facilities in Yenagoa, Bayelsa State.

Methods: A cross-section of 339 adult patients attending medical out-patient clinics for four LTMCs namely Hypertension (HTN), Diabetes mellitus (DM), Tuberculosis (TB) & Human Immune deficiency virus (HIV) disease across three specialist hospitals. Indirect cost was determined as number who stopped or reduced work, average missed work days, forgone activities and caregivers’ burden.

Results: Greater majority of study participants were females. About a third (29.5%) of participants stopped/reduced work in the past year and the median missed work days per month was 5 days. Patients with non-communicable diseases (52.9%) had higher significant finding of forgoing leisure activity than those with the communicable diseases (30.5%), (p <0.05). Paid work was the most forgone activity in other to attend clinic visits. Children (66.7%) were the most accompanying persons for clinic visits and majority (65.0%) reported having to miss school of work in other to accompany for clinic visits.

Conclusions: LTMCs are associated with heavy indirect costs with potentially reduced economic productivity. Findings can guide the design of more responsive policies including work-place programs.

Prevalence and factors associated with signing against medical advice among psychiatric inpatients at Usmanu Danfodiyo University Teaching Hospital, Sokoto

Yakubu AI — 2024-09-01

Background: Leaving against medical advice (LAMA) is common and poses significant challenges among psychiatric inpatients, reflecting patients' legal rights while remaining linked to severe noncompliance, higher morbidity and mortality, increased readmissions, substantial costs, and distress for psychiatrists.

Aim: To the determine the prevalence and factors associated with signing against medical advice (SAMA) among psychiatric inpatients at Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria.

Materials and methods: A retrospective study was conducted over an eight-year period on 435 patients admitted to the psychiatric ward at Usmanu Danfodiyo University Teaching Hospital. Socio-demographic and clinical data were analyzed using SPSS software. The statistical significance of the findings was assessed using Chi-squared and Fisher's exact tests, with a 5% significance level.

Results: The prevalence of signing against medical advice among psychiatric inpatients was 10.2%. There was a statistically significant association between signing against medical advice and gender (P = 0.012), but no significant association was found with diagnosis (P = 0.337) or length of stay (P = 0.074).

Conclusion: The high prevalence of signing against medical advice among psychiatric inpatients is associated with factors such as female gender. However, there is a significant lack of research on this issue in Nigeria, highlighting the need for further studies with rigorous methodologies. Standardized definitions, reporting, and targeted interventions are crucial to address this problem and its complications.

Knowledge, attitude and eye care practices of dental professionals in a tertiary hospital in Kano, Nigeria

Okolo C — 2024-09-01

Background: Dental professionals are at high risk for eye injuries and eyestrain due to the nature of their work.

Aims: This study aimed to evaluate the knowledge, attitudes, and practices of eye care among dental professionals in Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria.

Methods: A cross-sectional survey was conducted among 102 dental professionals at AKTH. A Simple random sampling technique using the one-time balloting system was used in selecting participants for this study. A self-administered questionnaire was used to collect data on participants' demographics, eye health knowledge, attitudes, and practices. Data collected was analysed using the Statistical Package for Social Sciences version 25 (SPSS version 22).

Results: The mean age of participants was 34.0 ± 7.5 years with a sex distribution of 3:2 male to female ratio. The majority were dentists (63.7%). Forty percent of participants use prescribed spectacles. The most common eye conditions reported were myopia (29.3%) and astigmatism (21.9%). Overall, participants had poor knowledge of eyecare. About 45.1% knew that eye check-ups should be done annually, and same proportion had heard of refractive surgery. Professional cadre and spectacles-use were the only demographic factors associated with eye care knowledge. The majority of participants (81.4%) had a positive attitude towards eyecare, but only 10.8% used vision enhancers (ocular loupes and binoculars/magnifiers). The most common reasons for not using vision enhancers were lack of provision by their employers (56%) and non-availability (15.4%).

Conclusion: Dental professionals in this study exhibited limited knowledge of eyecare, positive attitude towards eyecare but low utilization of vision enhancers that are important for increased workplace efficiency and safety. It is imperative to ensure that dental professionals adopt best practices to prevent workplace hazards.

Healthcare practitioners’ Knowledge and Awareness on current guideline for management of hypertension in Nigeria: A cross-sectional web-based survey

Shogade TT — 2024-09-01

Background: Hypertension is the most common cardiovascular disease in Nigeria. Adequate knowledge of healthcare practitioners on current guidelines management of hypertension have been associated with a reduction in its morbidity and mortality.

Objective: This study aimed to determine the knowledge and awareness of health workers on current guideline in management of hypertension.

Methods: This was a descriptive cross-sectional web-based survey of 396 Nigerian health workers. An adopted self-administered e-questionnaire was used to collect data related to health workers' characteristics. SPSS version 22.0 was used to determine awareness, knowledge scores/grades and descriptive statistics.

Results: Data analyzed showed 54.7% were male and predominant age group 38.5% was 40-49 years. A proportion of 50.8% were specialists and 60.1% practice in tertiary hospitals. Only 41.2% were very familiar with current guidelines though majority 76.7% of the participants were very confident that patients should continue taking their drugs when blood pressure is controlled. The median knowledge score was 2/6 and very few 6.8% had good knowledge grade(5-6/6). No association was found between knowledge grade and studied factors.

Conclusions: The knowledge of the current guidelines is not optimal, even though both international and national hypertension guidelines are available to health workers. There is urgent need for comprehensive nationwide increased awareness and advocacy for its use among healthcare practitioners for effective improvement in the care of patients with hypertension in Nigeria.

Correlation of the middle cerebral artery blood flow velocity with age and Haemoglobin values of children with Sickle cell anaemia in Uyo

Ahunanya CN — 2024-09-01

Introduction: Sickle cell anaemia (SCA) occurs in 1-3% of the Nigerian population. It is the most common cause of stroke in children. The time-averaged mean of the maximum velocity (TAMMV) in the Middle cerebral arteries (MCA) measured by transcranial Doppler (TCD) ultrasonography can estimate the risk of stroke in SCA children. Some clinical factors associated with abnormal TAMMV flows and first stroke (infarctive) in children with SCA are age and low haemoglobin.

Aim: To determine the association between TAMMV of the middle cerebral artery (MCA) in patients with SCA with their age and haemoglobin values and compare it with age and sex-matched children with Haemoglobin AA (HbAA) genotype.

Method: This was a comparative cross-sectional descriptive study conducted among 40 confirmed HbSS patients in steady state and a comparison group of 40 healthy HbAA age and sex-matched children. Demographic and medical data were obtained using a structured proforma. Haemoglobin concentration was estimated for all participants. TCD ultrasound was performed for all participants using the Stroke Prevention Trial in Sickle Cell Anaemia (STOP) protocol. Data was analysed in Statistical Package for Social Science version 22.0 (SPSS Inc., IL, USA).

Results: The mean and standard deviation (Mean±SD) age of HbSS patients was 9.1 ± 4.4 years. The majority (42.5%) of the HbSS children were in the 10-14 years age group. The HbSS patients had a consistently lower mean Hb than the HBAA participants across all age groups and this was statistically significant. (p=<0.001, <0.001, <0.001 and 0.001 respectively).

There was a significant difference in mean MCA velocity between HbSS and HbAA in the age groups above 5 years. (p <0.001). In addition, a significantly moderate positive correlation was observed between the Right MCA velocity and age in the HbSS population (r = 0.451, p = 0.004). While a significant negative correlation was observed between the measured TAMMV of the right MCA and the haemoglobin concentration in both the HbSS and HbAA groups (r = -0.490, p = 0.002) and (r = -0.600, p <0.001).

Conclusion: Our study has observed a positive correlation between age and MCA TAMMV and a negative correlation between Hb concentration and TAMMV in SCA children. The maintenance of adequate Hb in children with SCA is important in reducing the development of abnormal TAMMV velocities which carries a significant risk of stroke.

Preferred mode of delivery and its determinants among nulliparous women attending antenatal clinic in a secondary health facility in south-south Nigeria

Maduka NR — 2024-09-01

Background: Multiparous women’s preferred mode of delivery is partly influenced by their experiences in their previous deliveries. For the nulliparous women, the possible influencers of their preferred mode of delivery could be multifactorial including narrations from multiparous women regarding their experiences in previous deliveries.

Objective: The aim of the study was to evaluate the preferred mode of delivery and its determinants among nulliparous women attending Antenatal clinic (ANC) in a secondary health facility in south-south Nigeria.

Materials and methods: This was a cross sectional study conducted at the antenatal clinic of Central Hospital Agbor, Delta state, Nigeria. A total of 221 consecutive consenting nulliparous women who came for ANC registration were recruited for the study after obtaining their informed written consent. Questionnaire was used to seek for their sociodemographic characteristics, their preferred mode of delivery and possible influencers of their decision.

Results: The preference for vaginal delivery (VD) was 70.6% while 5.4% preferred Caesarean section (CS). Twenty four percent (24.0%) had no preference and will accept CS if advised by the Doctor. Factors significantly associated with preference for CS were advanced maternal age, occupation and a previous history of miscarriage. Reasons given by women for preferring VD were to experience labour, avoid CS pain, fear of death, avoid CS scar and delayed recovery while those who preferred CS cited advanced maternal age, to avoid labour pain, for the safety of baby and mother and to avoid multiple vaginal examinations and episiotomy.

Conclusion: The preference for CS was 5.4% while 24.0% had no preference and would accept CS following Doctors advice despite the policy of free maternity care. There is the need to address non-cost barriers through ANC health education to improve acceptance of CS

Knowledge of danger signs, pregnancy complications and associated factors among males in Ogbomoso, Nigeria

Bobo TI — 2024-09-01

Background: Maternal mortality remains high in low-income countries. Men are major predictors of the frequency and quality of maternal healthcare especially in this part of the world and their support can significantly improve maternal health outcomes.

Objectives: To assess the knowledge of danger signs and complications of pregnancy as well as the associated factors among married men in Ogbomoso.

Methodology: It was a community-based cross-sectional study that involved multistage sampling technique to select study respondents in Ogbomoso town. It made use of a semi-structured questionnaires to obtain data from the respondents.

Results: Most of the respondents in this study were between 38 to 47 years of age (36.4%). The most common occupation indicated was Artisans/Traders (44.7%). Vaginal bleeding was the most recognized danger sign, with 72.5% of respondents recognizing it and it was found that the majority of respondents (97.6%) considered antenatal care to be important. The most common reason cited for the importance of antenatal care was for the safety of the mother and baby (82.8%). Only 48.5% of men reported accompanying their wives for their antenatal care appointments. 20.6% of the respondents decide wives’ attendance at antenatal care visits.

Conclusion: The current study's findings indicate that is inadequate knowledge of danger signs during pregnancy among men in Ogbomoso. Interventions to improve men's knowledge should be implemented to enhance maternal and child health outcomes.

Enterococcus-associated urinary tract infections, their prevalence and antibiotic resistance

Obe OA — 2024-09-01

Background:

Methodology: A retrospective study was conducted using the Medical Microbiology Laboratory records of the Lagos State University Teaching Hospital. The study reviewed the in vitro antibiotic susceptibility patterns of urinary bacterial isolates from April 2020 to March 2021, focusing on Enterococcus spp. Bacteria were isolated and identified from routine urine samples using standard bacteriological methods and the Analytical Profile Index (API). Antibiotic susceptibility tests (AST) were performed using the modified Kirby-Bauer disk diffusion method, with susceptibility breakpoints determined by the Clinical and Laboratory Standards Institute (CLSI) guidelines.

Results: A total of 82 patients (5 outpatients and 77 inpatients) with Enterococcus-associated UTIs were identified. The species distribution was 70.7% E. faecalis and 29.3% E. faecium. E. faecium exhibited greater resistance to levofloxacin and tetracycline but greater sensitivity to amoxicillin compared to E. faecalis. Both species showed high sensitivity to tigecycline, meropenem, and fosfomycin.

Conclusion: The prevalence of Enterococcus-associated UTIs in this study was 3.6% (82/2253), with hospital-acquired Enterococcus spp. accounting for 3.4% (77/2253). E. faecium isolates were significantly more resistant to levofloxacin and tetracycline than E. faecalis. The high rate of multidrug resistance (MDR) in both species underscores the importance of promoting rational antibiotic use to prevent the emergence of resistant organisms.

Delusional halitosis: Treatment outcome of a multidisciplinary approach

Otakhoigbogie U — 2024-09-01

Objective: This study aims to validate a protocol for a multidisciplinary management of delusional halitosis and to assess their outcome of treatment.

Method: A prospective study of 61 patients with complaint of chronic bad breath and initial diagnosis of psychological halitosis after assessment with halitosis questionnaires and clinical examination. A final diagnosis of pseudo halitosis or delusional halitosis was made based on the patients’ response to oral hygiene prophylaxis, antimicrobial treatment and counseling for 2 weeks. The delusional halitosis patients were treated in a ‘Joint Clinic’ of oral medicine physician and mental health experts, using a 5-step treatment protocol over a 4-week period. Treatment outcomes for the delusional halitosis patients were evaluated using patient’s self-assessment, WHO well-being index, psychological score and other mental health instruments.

Results: There were 33 (54.1%) delusional halitosis patients among the psychological halitosis patients. Twenty (60.6%) patients out of the 33 (100%) delusional halitosis patients attended the ‘joint clinic’. Six (30.0%) of the 20 treated patients had improved self-esteem, while only 1 (5.0%) and 3 (15.0%) showed improvement in state anxiety and trait anxiety respectively. Normal psychological score was found in 1 (25.0%) out of 4 (100%) patients that claimed to be ‘cured’, and 3 (50.0%) out of 6 (100%) patients had ‘improved’ final self-assessment.

Conclusion: Preliminary findings suggest early signs of recovery, with improvement in self-esteem, anxiety and psychological problems in delusional halitosis patients.

Effect of calabash chalk geophagy on the epididymis of adult male Wistar rats

Odiase DE — 2024-09-01

Context: Calabash chalk is also known as poto in English. It is a naturally occurring mineral and is chiefly composed of fossilized seashells as constituent. It is traditionally consumed by communities for pleasure and also constitutes major remedy for morning sickness in pregnancy.

Objective: This study is aimed at determining the effect of calabash chalk on the body weight and epididymis of adult male Wistar rats.

Materials and method: Twenty (20) rats weighing between 180 and 200g were divided into four groups and five rats were assigned to each (A-D). Group A served as control, animals in this group were given rats feed and water only. Group B animals were administered 100mg/kg of dissolved calabash chalk daily. Group C animals were administered 200mg/kg of dissolved calabash chalk. Group D animals were administered 400mg/kg of dissolved calabash chalk. All experimental animals were allowed free access to regular feed and water and were sacrificed on the 56th day of research. Epididymal tissues were harvested for assessment of sperm parameters and histological processing.

Results: The results show no statistical significant differences (P>0.05) in the sperm parameters across all groups. Also, there were no significant changes in the contents and histoarchitecture of the epididymes of the treatment groups when compared with the control group.

Conclusion: We could conclude that Calabash Chalk has no deleterious effects on the sperm quality and histoarchitecture of the epididymis of adult Wistar rats.

Does intraprocedure patient positioning affect outcome of chemical pleurodesis for malignant pleural effusion?

Akpan AF — 2024-09-01

Background: Chemical pleurodesis using tetracycline is an acceptable and commonly employed palliation for malignant pleural effusion. Rotation of patient during pleurodesis using the powder from tetracycline capsule is still practised in some centres and is undoubtedly associated with additional stress on the patients. The practice of rotation can only be eliminated after a properly designed study on the outcome of pleurodesis with rotation and non-rotation would fail to show benefit of rotation.

Objective: To determine the association between patients positioning and the outcome of tetracycline pleurodesis in patients with malignant pleural effusion.

Patients and methods: It is a prospective randomized study involving adults patients with cytologically proven malignant pleural effusion. Patients were randomized into 2 groups (rotation and supine) using alternate sampling technique. Tube thoracostomy was done and tetracycline pleurodesis using 2g of powder from tetracycline capsule via slurry instillation method was carried out. The outcome of the pleurodesis was assessed with a chest radiograph on the 30th day after removal of chest tube.

Results: There were 51 patients studied with malignant pleural effusion. These consisted of 12 males (23.5%) and 39 females (76.5%). Twenty-five patients (49.0%) were rotated in the study while 26 patients (51.0%) were on supine position. A total of 30 patients (58.8%) achieved complete response, 16 patients (31.4%) achieved partial response while 5 patients (9.8%) had failed response. The study also showed that in the rotated group, 23 patients (92%) had successful response and 23 patients (88.5%) in the supine group also achieved successful response (P = 0.175); there was no significant difference between the two groups.

Conclusion: This study showed that, though the powder from tetracycline capsule is only slightly soluble in water, it gives a good and similar successful outcome in both arms of the study. This implies that positioning of patient during pleurodesis plays no significant role in the outcome of tetracycline pleurodesis using the powder from tetracycline capsule.

Demographic Characteristics and ABO Blood Group Genotypes Influence Susceptibility to Computer Vision Syndrome (CVS) in Lagos, Nigeria

Yahaya T — 2024-09-01

Background: Computer devices have become an important part of human life because they make work easier and thus increase output. However, the use of computer devices has led to the occurrence of computer vision syndrome (CVS). The current study was aimed at determining the demographic characteristics, influence of ABO blood groups, and diseases associated with CVS in Lagos, Nigeria.

Materials and Methods: Structured questionnaires were used to collect demographic information from 153 CVS patients at Unique Eyes Center, Lagos. The data collected includes age, gender, educational level, ethnicity, religion, type of device use, duration spent on devices, marital status, and diseases frequently expressed. The ABO blood groups of the participants were thereafter collected from their medical records.

Results: The results showed that 89 (58.70%) of the respondents were males, while 64 (41.83%) were females. Most of the respondents were > 40 years old, with 78 members (50.98%), followed by age class 21–40 with 48 members (31.37%) and age class 10–20 with 27 members (17.65%).With respect to respondents educational status, 2(1.31%) had primary education, 28(18.30%) had secondary education while the majority 123(80.39%) had tertiary education. Regarding the marital status, married participants were 72 (47.06%) in number, others included singles 48 (31.37%), divorced 18 (11.76%), and widowed 15 (9.80%). There were 81 (52.94%) Christians, and 72(47.06%) Muslims. The Yoruba ethnic group made up 78 (50.98%), while others were Igbo 43 (28.10%), and Hausa/Fulani were 32 (20.92%). A total of 110 (71.90%) used desktops, 28 (18.30%) used androids, and 15 (9.80%) used laptops or iPads. One hundred and sixteen (75.82%) participants used computer devices continuously, while 37 (24.13%) used them intermittently. People with non-O blood types constituted the majority, of which those with type A blood were the most affected, having accounted for 51 (33.33%) of the overall population. Headache, blurred vision, eye strain, double vision, and neck/shoulder/back pain were strongly associated with CVS in the study area.

Conclusion: The results suggest that demographic characteristics and ABO blood groups genotypes influence susceptibility to CVS among computer users in Lagos. Non-O blood group individuals, mainly type A blood are particularly at risk. People are advised to limit time spent on computer devices and get regular eye tests.

Distribution of ABO-Rh(D) blood group among nursing students: A tool for female health education

Adegoke AO — 2024-09-01

Background: The International Society of Blood Transfusion has documented 30 distinct blood group systems; the ABO and Rh systems are regarded as the most important blood group systems. Determining the ABO-Rh (D) blood group is vital in clinical settings to prevent the possibility of incompatibility and Rhesus D alloimmunization.

Objective: This study aimed to provide information on the distribution of blood groups and Rh factor among Bowen University Teaching Hospital School of Nursing students with the view of educating students about the risks of rhesus incompatibility.

Material and Methods: retrospective cross-sectional study which reviewed the preschool entry medical records of Nursing students of Bowen University Teaching Hospital Ogbomoso from 2019-2022. The data were systematically collated, analyzed and used to generate frequency tables.

Results: a total of 216 records were reviewed. The majority were females (84.3%), less than or equal to 18 years (48.6%) and with blood group O (44.4%) and rhesus positivity (94.0%). None from the male gender had an AB blood group. Prevalence of Rh(D) positive was higher among females (85.3%) while Rh(D) negative was higher among males (14.7%). There was a significant association between gender and Rhesus factor.

Conclusion: the findings from this study shows that blood group O and Rh(D) positive had the highest prevalence while the blood group AB and Rh(D) negative had the lowest prevalence. Therefore, effort should be made to educate the few who could suffer adverse events from Rhesus incompatibility.

What is the Justified Death Attitude? Explicit V.S Implicit evaluation of Justified Death Attitude scale with Victim and Assailant’s attention

Zandian P — 2024-09-01

Background: “JD is imminent and likely paradoxical reactions against self perceived threat to keep of self in modification for elimination of the opponent mentally or physically”. Assailants’ attention is "a data directive system with quantifying less hot cognition and the least of data collections in the fight-or-flight response”; victims’ attention "a data directive system with quantifying more hot cognition and the most data collections in the fight-or-flight response”. We compare explicit and implicit evaluations of the JDAS.

Method: We selected 1089 participants for neutral facial patterns normalization, normal finds participants, and neuropsychological doing tasks with quota, convenience, and Poisson samplings, respectively. Samples are collected in three Iran’s provinces. 100 subjects participated with an analogue method to normalize 400 neutral pictures in likeness of Iranians and attractiveness of faces. 989 subjects carried out Millon Clinical Multiaxial Inventory (MCMI II) to find normal participants for the third step. 100 subjects did tasks to compare and evaluate JDAS agents.

Results: Participants evaluated 400 pictures to determine 120 attractiveness of faces and likeness of Iranian pictures using an analogue method. The results showed:

In explicit assessments, only "I" sense of self showed significant differences among general participants, though it was less severe.

General implicit assessments indicated significant differences among the senses of self related to nationality, denomination, and "I," respectively.

Guilty implicit assessments revealed significant differences among three senses of self: nationality, denomination, and "I," respectively.

Both explicit and implicit assessments of the JDAS for victim and assailant agents showed significant differences.

Conclusions: Threatening information against self agents strengthens endangered parts of the self. Normal criminals exhibit less empathy towards victims. Denomination, nationality, and "I" self agents are found to be independent self agents. It highlights the complexity of self-identity, revealing socially, and roles of social and cognitive factors in shaping attitudes towards JD.

Sonographic evaluation of the impact of umbilical cord insertion site on fetal weight

Efanga SA — 2024-09-01

Background: Abnormal insertion of the umbilical cord (UC) into the placenta may initiate fetal growth restriction and potentially complicates labor with intrapartum hemorrhage. The aim of this study was to sonographically determine the relationship between umbilical cord insertion types and estimated fetal weight (EFW).

Methods: This prospective cross-sectional study was done in a 7-month period and recruited 220 pregnant women with 27 to 37 weeks gestation attending the antenatal clinic of the Hospital. Ultrasound scan was done on the women to determine UC insertion and EFW. Data was analyzed using SPSS 23.0.

Results: Peripheral UC had significantly higher EFW, age and BMI (P=0.000), (P=0.009) and (P=0.003). The difference in EFW between peripheral UC and central UC in BMI ≥ 30 kg/m2 was significant within the 31st – 32nd week of gestation (P=0.001) and 33rd – 34th week of gestation (P=0.034). EFW was least in velamentous UC subtype (1.385±0.12 kg) compared to central UC type (1.95±0.65 kg), eccentric UC subtype (2.29±0.77 kg) and marginal UC subtype (2.47±0.83 kg). Peripheral UC was significantly associated with BMI (P=0.000), employment status (P=0.048), past history of CS (P=0.000) and placental location (P=0.001).

Conclusion: Fetal weight, in the third trimester, is greater in obese pregnant women with peripheral umbilical cord insertion, except with velamentous cord insertion, and this is significant between 31st and 34th weeks of gestation. Peripheral umbilical cord insertion is significantly associated with high maternal BMI, posterior placental location, past history of cesarean section and being employed.

Knowledge of pre-invasive cervical cancer and its prevention using HPV vaccine among first-year school of midwifery students, FMC Nguru, Yobe State, northeastern Nigeria

Abubakar SM — 2024-09-01

Background: Pre-invasive cervical cancer is a precursor of cervical carcinoma if left untreated it takes about ten to twenty years for the pre-invasive lesion to develop into cervical cancer. It starts from cervical intraepithelial neoplasia, which constitutes CIN 1 CIN 2, and CIN 3, with the latter covering the entire thickness of the epithelium. The prevalence of pre-invasive cervical lesions was 7.7% in Makurdi north-central Nigeria, 4.8% in Zaria Northwestern Nigeria, and 7.7% in Egypt. Progressive infection with high-risk HPV in over 95% are associated with CIN and cancer of the cervix, fortunately, these viruses can be prevented using HPV vaccines if given appropriately and to the right population.

Method: The study was a cross-sectional type aimed at exploring the knowledge of the participants on the pre-invasive cervical lesions and their prevention using the HPV vaccine using a semi-structured questionnaire in FMC Nguru.

Results: The total number of participants was 29 (n=29). The mean age of the respondents was 20.9 +/-2. 8SD. Among the participants, 19 (65.5%) are aware that pre-malignant cervical cancer can progress to cancer of the cervix, and 9(31%) are aware that pre-malignant cervical lesions, can be asymptomatic. Only 13(44.8%) are aware that Human Papillomavirus is a risk factor for CIN whereas 21(72,4%) are aware that HPV can be prevented using a vaccine.

Conclusion: There is good knowledge among the students on the pre-invasive cervical lesion of the cervix and its vaccine prevention, however, the majority are not aware that HPV is an important risk factor for CIN, hence more work needs to be done to enlighten the students on this to enhance the acceptability of the human papilloma vaccine.

Anxiety, depression and their correlates among patients with acute heart failure in South Western, Nigeria

Oladimeji Adebayo — 2024-09-01

Introduction: Psychological distress in heart failure has been relatively neglected by researchers and practitioners, and early detection and treatment may improve the prognosis and patient's quality of life. This study sought to assess psychological distress exemplified by depression and anxiety among acute heart failure (AHF) patients seen at a large teaching hospital in South West Nigeria.

Method: The study was a cross-sectional study of 153 consecutively admitted AHF patients who completed the Patient Health Questionnaire-9 and the Generalised Anxiety Disorder 7-item questionnaires. The report of this article adhere to the STROBE reporting guideline. Data was analysed using standard statistical methods.

Results: A total of 153 participants with AHF completed the study. The mean age±SD of participants was 57.7±15.0years. The prevalence of depression of any severity was 26.8% while that of anxiety was 9.2%. History of alcohol intake, male gender, and higher score of anxiety were independently associated with depression while the presence of higher depressive scores was the sole independent factor associated with anxiety.

Conclusion: Psychological distress is present in AHF patients, so clinicians must evaluate these problems early in all such patients, address their specific needs, and intervene through a team approach when necessary.

Barriers to prompt diagnosis and management of children with hearing loss

Ekere I — 2024-09-01

Background: Paediatric hearing loss is associated with a significant public health burden, though early detection and treatment curtails the limitations associated with hearing loss. Despite the obvious advantages of early detection and treatment, multiple barriers exists. This study explored major barriers experienced by caregivers and teachers to timely detection and management of children with hearing loss in Ibadan metropolis.

Methods: A mixed-methods descriptive cross-sectional study was done. The study population were parent/caregivers of children with hearing loss aged 6-12 years residing in the study area. A four-stage sampling technique was used to select respondents for the study. A total of four Focused Group Discussion (FGD) and 203 questionnaires were administered to the target population. Qualitative data were analysed using ATLAS.ti software (Version 7) while quantitative data were analysed using descriptive and inferential statistics. (p-value <0.05).

Results: The FGDs revealed that mothers do not recognize the signs and symptoms of hearing loss and experienced difficulty seeking healthcare because of embarrassment/shame. High transportation costs to special schools and communication difficulties were examples of barriers to management identified. The qualitative data showed that among caregivers, identified barriers to management were: difficulty in learning sign language, financial handicap, high transportation costs.

Conclusion: The major barriers to timely detection and management of children with hearing loss were transportation costs to health facilities and special schools, financial inability to utilize care in health facility, and caregiver embarrassment to seek medical help.

Treatment of a localized exogastric gastrointestinal stromal tumour (GIST) with long-term follow up: A case report and review of literature

Ekpemiro UC — 2024-09-01

Background: Gastrointestinal stromal tumour (GIST) is a rare entity. The diagnosis, treatment and follow-up pose a challenge in our environment. We describe the presentation, diagnosis, treatment, and long-term follow-up of a patient with a localized, large exogastric GIST.

Method: The case notes of a 51-year-old woman who presented with a one-year history of upper abdominal swelling with no associated symptom was reviewed.

Result: On examination, an oval intraperitoneal mass at the epigastrium measuring 16 x 14cm which was freely mobile, smooth, firm, non-tender with dull percussion notes was found. She subsequently had resection of a large exogastric mass with a histologic diagnosis of GIST. Following tumour resection with a wide margin of gastric wall, she has done well so far for ten (10) years.

Conclusion: Wide margin gastric resection may suffice in the treatment of a large localized gastric GIST when it is exogastric.

Ascending colon adenocarcinoma presenting as appendicitis

Adejumo AA — 2024-09-01

Background: Appendicitis is a pathology that occurs more in the younger population. The occurrence of appendicitis in the middle aged is uncommon and presentations may be sinister to other causes. The clinical presentation of appendicitis in our index patient with incongruous laboratory findings prompted further evaluation that eventually revealed the underlying cause.

Method: A middle-aged man presented with features of recurrent appendicitis with equivocal laboratory work-up. Abdominal sonography as well as computerized tomograms (CT scan) were done as well as colonoscopy.

Result: Abdominal sonography was inconclusive and contrast-enhanced CT scan done was suggestive of appendicitis as a stenosing lesion of the proximal right colon. Colonoscopy done revealed proximal ascending colon tumor which was biopsied with histopathology report of adenocarcinoma.

Conclusion: The unusual occurrence of appendicitis in the middle-aged should prompt the likelihood of an underlying pathology hence; the surgeon should always broaden his mind when evaluating such.

Malnutrition-related diabetes mellitus in a destitute male Nigerian

Ubani BC — 2024-09-01

Background: Malnutrition-Related Diabetes Mellitus (MRDM) formerly called “Tropical Diabetes” is a rare type of diabetes mellitus (DM), associated with long-term malnutrition.

Objective: To create awareness about this rare disease in the phase of a dwindling global economy and the need for a more focused screening in vulnerable groups.

Methodology: We reviewed the case records of the patient in terms of clinical presentation, imaging and laboratory parameters.

Case Summary: A 19-year-old destitute male, resident in a rural-community in Nigeria, presenting with abdominal pains for 6 months, bilateral leg swelling for 5 months and lower limbs paresthesia for a month. He was diagnosed with DM a year previously, took insulin for a month, thereafter resorted to herbal remedies due to financial constraints, but later left home to beg in the streets due to hunger. Examination: Chronically-ill looking, markedly dehydrated and pale, with fluffy and pluckable hairs, peripheral oedema, multiple oral ulcers and bilateral parotid fullness. Weight was 35kg, height 1.65m and BMI was 12.9 kg/m2.
Laboratory parameters: Marked glycosuria, absent ketonuria, beside random blood glucose (RBG) was unrecordably high (> 33 mmol/L), laboratory RBG was 63mmol/L, normal E/U/Cr and lipid profile, HbA1c of 13.8%, elevated alanine transaminase, low total serum proteins and albumin. Abdominal USS revealed normal-sized pancreas with diffuse echogenicity and multiple faint calculi. Plain abdominal x-rays showed multiple pancreatic calculi. A diagnosis of MRDM, fibro-calculous pancreatic (FCPD) type was made.

Treatment: Insulin, antibiotics, anti-neuropathic drugs, high-calorie/high-protein diet were given, with good clinical improvement within two months.

Conclusion: Regular screening for MRDM in vulnerable groups will allow early detection and treatment of affected individuals.

Clinically Normal Appendix in an Elective Right Inguinal Hernia Repair: Case report

Idowu NA — 2024-09-01

Background: Small bowel and omentum are the most common structure seen in an inguinal hernia sac. Appendix as a content of an inguinal hernia sac is extremely rare. We report this clinical entity due to its rarity.

Case report: We report a 56 year old man who was seen at the surgical outpatient department of our center with a history of simple symptomatic right inguinal hernia. He had an elective inguinal hernia repair. A clinically normal appendix was seen in the hernia sac. It was reduced during the surgery. He was discharged satisfactorily.

Conclusion: A clinically normal appendix may be a content of an inguinal hernia sac.

Readiness for pericardiocentesis in cardiac tamponade: A case report

Odu C — 2024-09-01

Mortality is preventable in cardiac tamponade. We report a 23-year old woman with massive pericardial effusion who had an adverse outcome. We discuss measures which if followed will improve outcome in emergency pericardiocentesis.

Inadvertent drug plastic foil aspiration mimicking status asthmaticus

Nwafor CC — 2024-09-01

Background: Violent asphyxia is mechanical obstruction, resulting in generalized hypoxia, and can result in death of the victim.

Case report: A 28-year-old non-asthmatic male presented with a day history of difficulty in breathing. He also had a history of aspiration of some unknown drugs (one of them together with the plastic foil) two weeks prior to presentation. On the second day of admission, he became restless, slumped and died. A post mortem examination showed a drug plastic foil imparted in a lacerated infraglottic portion of the larynx. The cause of death was concluded as violent asphyxia (choking), due to drug plastic foil impaction.

Conclusion: In addition to the numerous list of materials that can cause FBI is drug plastic foil. if not removed on time causes impaction and laryngeal laceration, laryngeal spasms, laryngotracheobronchitis, vagal inhibition asphyxia and death.

Multiple food allergy presenting as Heiner syndrome in a Nigerian infant – Case report

Ikobah JM — 2024-09-01

Background: Heiner syndrome (HS) is a rare non-IgE mediated hypersensitivity to cow’s milk or multiple food allergy characterized by chronic respiratory symptoms with chest X-ray infiltrates and resolution of these symptoms on dietary elimination of cow’s milk.

Case report: We present the case of a 9- month-old male with history of cough, fever, difficult breathing and wheezing who was initially managed for bronchopneumonia with no improvement of symptoms. With subsequent review, the history of allergy to cow’s milk, eggs, and crayfish with positive maternal history of food allergy was obtained. Elimination of offending foods led to symptom resolution and a re-challenge led to reappearance of symptoms.

Conclusion: This case report highlights the need for a high index of suspicion of HS in children with respiratory symptoms and a positive history of food allergy.