Ibom Medical Journal

Psychological consequences of the Coronavirus Disease 2019 (COVID-19) pandemic on doctors

Buowari D. Y. — 2022-09-01

The COVID-19 pandemic has changed the world. The pandemic has had several impacts on healthcare workers who are at the frontline of screening, triaging and caring for both suspected and confirmed cases, no matter if they are asymptomatic or symptomatic. This has therefore affected the mental health of doctors. Several studies have found that mental health issues such as anxiety, depression, post-traumatic distress syndrome, and insomnia just to mention a few are on a rise among healthcare workers including doctors. This is a review article on the psychological consequences of the COVID-19 pandemic.

Psychosocially-Assisted Pharmacological Treatment of Opioid Dependent Adults: A Systematic Review

Wayah S. B. — 2022-09-01

Background: Opioid dependence is a conundrum that significantly contributes to global mortality, crimes, and transmission of diseases such as hepatitis (B and C), human immunodeficiency virus and perhaps, coronavirus disease 2019 (COVID-19). There are contradictory findings on the efficacy of psychosocially-assisted pharmacological treatment of opioid dependence in adults.
Objective: The overall objective of this research is to investigate if psychosocially-assisted pharmacological therapy has significantly better effect than pharmacological therapy with regards treatment outcomes of opioid dependent adults.
Methods: All methods employed in this study are in conformity with the preferred reporting items for systematic reviews and meta-analysis (PRISMA) framework for systematic review which involve identification, screening, eligibility and inclusion. This systematic review involved PubMed literature search on randomized controlled trials published between 1st January 2015 to 1st October 2021.
Results: PubMed search yielded 5,216 articles which were screened using inclusion and exclusion criteria resulting in 19 articled being retained for data extraction. Of the 19 articles used in this study, 13 (68.4%) articles having a combined sample size of 1,928 (60.6%) showed that addition of psychosocial intervention to pharmacotherapy significantly improved abstinence from opioid abuse.
Conclusion: The outcome of evaluation of the overall evidences presented in the 19 articles used in this study is that psychosocially-assisted pharmacological therapy is significantly better than pharmacological treatment with respect to enhancement of abstinence from opioid abuse among opioid-dependent adults. Additionally, this study has provided specific combinations of psychosocial and pharmacological treatment that can produce significant beneficial effect on opioid abstinence. The huge downturn in randomized controlled trials on treatment of opioid dependence among adults has been highlighted in this study.

Histopathological pattern of endoscopic gastric biopsies in dyspeptic patients in a Nigerian population

Raphael S. — 2022-09-01

Background and Objective: Dyspepsia is one of the most common complaints encountered in the general outpatient and gastroenterology clinics in Nigeria. Histopathological assessment of endoscopic gastric mucosa biopsy is crucial to delineate the exact cause of dyspepsia to guide patients’ management. This study aimed to determine and document the histopathological basis of dyspepsia among dyspeptic patients at our facility.

Material sand Methods: This was a three year descriptive retrospective study and the materials consisted of all gastric endoscopic biopsies taken from clinically diagnosed dyspeptic patients sent to the Department of Histopathology of the Federal Medical Centre, Owerri, Nigeria.

Results: The biopsies were from 64 (53.2%) male patients and 56 (46.8%) female patients, giving a male to female ratio of 1.14:1. The age range of the patients was 28-82 years with a mean of 56 years at presentation. Helicobacter Pylori (H. Pylori) bacilli were identified in the samples of 42 (35%) patients but absent in samples of 78 (65%) patients. The histopathological pattern of the aetiological basis of dyspepsia in this study consisted of gastritis (96, 80%), functional (17, 14.2%), adenocarcinoma (4, 3.3%) and polyps (3, 2.5%). H. Pylori bacilli were seen only in patients with gastritis (42/96, 43.8%), and it affected 19 (45.2%) male patients and 23 (54.8%) female patients. Chronic active H. Pylori associated gastritis (24, 25%) was the most common form of gastritis seen during the study period.

Conclusion: The main organic cause of dyspepsia in our setting was chronic gastric followed in the distant by gastric adenocarcinoma and polyp. Dyspepsia and H. Pylori associated gastritis did not show a significant gender predilection.

Knowledge and Attitude towards Pregnancy Care and Delivery among Male Commercial Motorcyclists in Ibadan, Nigeria

Ibirongbe D. O. — 2022-09-01

Background: Men’s influences are gradually being recognised in pregnancy and delivery care. The study aims to determine the knowledge and attitude of male commercial motorcyclists on pregnancy care and delivery of women.

Materials and Methods: This cross-sectional study was conducted among married male commercial motorcyclists, operating in Ibadan North Local Government Area selected using a cluster sampling technique. Data was collected using a pre-tested, structured interviewer-administered questionnaire, and analysed using SPSS version 16. Each section was evaluated using rating of a three-point Likert scale with each item scored based on responses ranging from disagree to agree. Results were presented in tables and charts.

Results: Four hundred and fifty three male commercial motorcyclists were interviewed. The mean age was 34.2±7.3years, 301 (66.4%) had secondary education, while 390 (86.1%) were in a monogamous marriage. Thirty 30(6.6%) respondents did not know when their wives registered for ANC while majority, 444(98.1%) did not know the duration of their wives’ labour. Few respondents 46 (10.2%) recognized vaginal bleeding as a common danger signs in pregnancy while 277 (61.1%) agree that women should have at least four ANC visits before delivery. Many of the respondents 315 (69.6%) had good knowledge, and 304 (67.1%) had positive attitude towards antenatal and delivery care.

Conclusion: Educational efforts on maternal health care should also focus on the men to improve their knowledge, attitude and involvement in antenatal and pregnancy.

Immunohistochemical Survey of Invasive Ductal Carcinoma of the Breast, using ER, PR, HER2 and KI-67 biomarkers, in Uyo, Nigeria

Eziagu U. B. — 2022-09-01

Background: Breast’s Invasive Ductal Carcinoma (IDC), which is the commonest type of malignancy in females worldwide, can be characterized using immunohistochemistry in view of personalized cancer therapy. In this study, we aimed to determine the pattern of immunohistochemical profiles of IDC using oestrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor 2 receptor (HER2) and proliferative index (Ki-67) biomarkers in our tertiary healthcare facility in Uyo, Akwa Ibom State, Nigeria given the dearth of its data in our environment.

Materials and methods: We carried out a retrospective hospital-based immunohistochemical study of archival IDC tissue blocks over a four- and half-year period. Using systematic random sampling method, 64 formalin fixed paraffin embedded (FFPE) IDC tissue blocks were selected for this study. We carried out immunohistochemical evaluation using ER, PR, HER2 and Ki-67 biomarkers. Subsequently, we presented the results and classification schemes as text, tables, graphs, and photomicrographs.

Results: We found that the proportion of expressions were ER-negative (88.7%), PR-negative (87.3%), HER2-negative (68.3%) and Ki-67 (<20%) being 83.6% respectively. The immunohistochemical-based classification which was done using combined immunohistochemical profiles of ER/PR/HER2 and ER/PR/HER2/Ki-67 biomarkers respectively, revealed five immunohistochemical-based subtypes. These subtypes were ER-positive luminal A (ER+/±PR+/HER2-) [5.56%], ER-positive luminal B (ER+/±PR+/HER2+) [5.56%], HER2-overexpression (ER-/±PR+/HER2+) [16.66%], Triple negative (ER-/PR-/HER2-) [66.67%] and Unclassified subtypes (ER-/PR+/HER2-) [5.56%]. Furthermore, these five subtypes were further subcategorized into low (Ki-67 <20%) and high (Ki-67 ≥20%) proliferation subtypes accordingly.

Conclusion: The commonest pattern of immunohistochemical profile expression of IDC in Uyo was found to be the Triple negative subtype.

COVID-19: Socio-demographic determinants of knowledge

Ogbondah B. O. — 2022-09-01

Background: Knowledge on etiology, risk factors, mode of transmission, signs and symptoms of COVID-19 is an essential element in pandemic control. Assessing the level of knowledge and determining sources from which information were derived is a fundamental element of situation analysis imperative in COVID-19 control.

Materials and method: The study is a cross sectional study. All eligible visitors who presented at the general out-patient department for Medicare were enlisted into the study until required sample size was achieved. Pre-tested interviewer administered questionnaire was used to elicit information from respondents. Statistical analysis was done with multinomial logistic regression analysis using SPSS version 23.1 with statistical significance set at 0.05. Ethical approval and permission for the study from relevant authorities were granted.

Results: Over all composite score for good knowledge was 1037(35.4%) with predominant statistically significant difference in knowledge. There was better knowledge score for females, public servants, married persons, respondents aged 31-40 years and those who had tertiary education.

Conclusion: Knowledge of COVID 19 was poor. Higher educational qualification enhances better knowledge. Females, public servants, married persons, respondents who attended tertiary institution and those aged 31-40 years had better knowledge score.

Biochemical aspect of crime: a case study of testosterone levels among rapists in Enugu State

Nwachukwu C. F. — 2022-09-01

Testosterone concentration is a contributing factor to rape tendency. Our research aimed to determine the plasma testosterone concentrations in male rapists. Subjects (100) recruited from Enugu state prison grouped viz: Violent-rapist (VR), nonviolent-rapist (NVR), violent child-molester (VCM), nonviolent child-molester (NCM), and none rapist (NR). The blood sample was collected in the morning (8-9) for four months by veno-puncture and used in the determination. The testosterone levels determination was by the enzyme-linked immunosorbent assay method. The results indicated the mean age of 33 (VR), 34 (NVR), 46 (VCM), 47 (NCM), and 32 (NR). The age at first intercourse was highest in NCM (18) and lowest in VR (13). Heterosexuals were highest in VR (14) and lowest in NCM (6). Homosexuals were highest in NCM (4) and non in VM, NVR, and NR (0). In bisexuals, NVR and NCM were the highest (4), the NR (1) was the lowest. The concentrations of testosterone (in ng/100ml) were 8.65 (VR), 9.23 (NVR), 9.63 (VCM), 7.73 (NCM) and 7.95 (NR). The testosterone concentration of the VR, NVR, and VCM is higher than NR. The NCM was lower than the NR. This result suggests that VR, NVR, and VCM are associated with higher testosterone concentrations in males. The modest associations indicate that there might be other influencing factors. The relationship between testosterone levels in rapists and child molestation is, at best, tentative. In some people, hormonal factors might influence the likelihood of rape and child molestation.

Evaluating the effect of antidiabetic treatment on haemostatic and fibrinolytic parameters among type 2 diabetics in Ilorin, Nigeria

Abolarin A. T. — 2022-09-01

Background: Type 2 Diabetes Mellitus is a disease of epidemic proportions and many patients are at a great risk of premature mortality and complication of atherothrombotic disorders affecting coronary, cerebral and peripheral arterial trees. Increased Plasminogen Activator Inhibitor Type 1 inhibits fibrinolysis and predicts cardiovascular risk in those living with Type 2 Diabetes. This study aimed to determine the effect of antidiabetic treatment on haemostatic and fibrinolytic parameters among Type 2 Diabetic subjects in Ilorin.

Methods: This was a comparative cross-sectional study involving 78 Type 2 diabetic patients, (39 treatment naïve, 39 treatment experienced). Full blood count was performed using Sysmex XP 300 while Prothrombin time was determined using one stage test of Owren. Activated partial thromboplastin time was determined by method of Proctor and Rapaport. Fibrinogen and Plasminogen Activator Inhibitor type-1 were assayed using AssayMax Human Fibrinogen ELISA and AssayMax Human PAI-1 ELISA kit. Data Analysis was done using SPSS version 25.0.

Results: Mean PAI-1 levels were significantly higher in treatment naïve diabetics when compared to treatment experienced diabetics (2.44 ±2.57 vs 2.51±1.47 ng/ml p=0.002) as were fibrinogen levels (434.65±366.15 vs 482.24± 299.64mg /dl; p = 0.048). PAI -1 levels were lowest among diabetics treated with Metformin + DPP4 inhibitors, while fibrinogen levels were lowest among those treated with Metformin + sulfonylurea combination.

Conclusion: Oral hypoglycaemic treatment, combination therapy in particular, improves fibrinolysis in type 2 diabetics thereby reducing the risk of cardiovascular disease in type 2 diabetes mellitus patients.

Audit of Adenotonsillar surgeries in a Tertiary Facility in Uyo, South-south Nigeria

Inoh M. I. — 2022-09-01

Background: Adenoid and tonsils are lymphoid tissues that occupy the nasopharynx and tonsillar fossae and serve as the initial site of immunological contact for inhaled and ingested antigens. Adenoidectomy, tonsillectomy or adenotonsillectomy is a lifesaving surgical procedure and remains a leading reason of surgical admission in general otorhinolaryngological practice both in developed and developing countries.
The study aims to audit adenotonsillar surgeries in the Department of Ear, Nose and Throat in University of Uyo Teaching Hospital, and compare findings with similar studies.

Method: This is a retrospective study of patients who had adenoidectomy, tonsillectomy, or adenotonsillectomy over 5 years from January 2015 to December 2019 at the Department of Ear, Nose, and Throat, University of Uyo Teaching Hospital, Uyo, Akwa Ibom state, south-south Nigeria.

Results: A total of 526 patients were recruited, and this accounted for 38.7% of the total ENT surgeries performed within the study period. Ages ranged from 6 months to 72 years, with a mean age of 11.89+1.03. The majority of the patients were aged between 1-5 years and the commonest presenting symptom was snoring and mouth breathing (79.5%). Sleep-disordered breathing (55.7%) was the main indication for the surgeries. Adenotonsillectomy (61.0%) was the commonest surgery performed. About 1.0% of the patients had recurrent adenoids.

Conclusion: The surgeries were of immense necessity to the patients as all presenting complaints and pre-operative diagnoses became completely resolved.

Initiation, maintenance and continuation of exclusive breast feeding: Socio-demographic and maternal correlates for abandonment

Ogbondah B. O. — 2022-09-01

Background: Exclusive breast feeding (EBF) has been shown to be an important and effective feeding practice essential for infant development. Initiation, maintenance and continuation of EBF were associated with several maternal and socio-demographic characteristics which influence EBF abandonment.

Methodology: The study is a prospective cross-sectional study conducted at the child health clinic in general hospital Bonny, in Bonny Island. The study population were nursing mothers of infants six months and below. All eligible nursing mothers that presented to the clinic were enlisted into the study until the required sample size was achieved. Study tool was a structured interviewer administered questionnaire. Multinomial regression analysis was done using SPSS with statistical significance set at 0.05.

Result: Results reveal significant statistical association between duration of EBF and some maternal variables such as parity, ante-natal attendance, breast feeding counselling, birth interval, gestational age and mode of delivery. Also, significant association was seen between duration of EBF and socio-demographic characteristics such as maternal occupation, income, education and marital status.

Conclusion: Abandonment of EBF before and its continuation up to six months can be influenced by socio-demographic factors such as maternal occupation, income and marital status. Other maternal variables which also influence EBF include ante-natal care attendance including the number of times of breast-feeding counselling, mode of delivery, gestational age, parity and birth interval.

Diagnostic urethrocystoscopy: A five-year review of indications and findings in a tertiary hospital in Nigeria

Abdullahi M. — 2022-09-01

Background: Urethrocystoscopy is defined as endoscopic visualization of the urethra and the urinary bladder for the purpose of diagnosis or treatment of diseases of the lower urinary tract.
Objective: To study the indications, diagnosis and complications of diagnostic urethrocystoscopy in our hospital.

Materials and method: It was a retrospective descriptive study of all patients who had diagnostic urethrocystoscopy in our hospital between January 2016 to December 2021. Institutional ethical clearance was obtained. Particulars of the patients were collected from the operating theatre register and their medical case files were retrieved. Information about the patients’ bio-data, presentation, clinical/radiologic diagnosis, urethrocystoscopic findings and its complications were extracted.
The generated data was analyzed using statistical package for social sciences (SPSS) version 21 and results presented in tables, text and figures.

Results: A total of 673 patients had urethrocystoscopy/cystoscopy during the period out of which we recovered full medical records of 592 patients whose data were analyzed.
The patient’s age ranges between 9 to 86years with mean age of 43.7±9.3SD years and M: F = 3.9:1. The indications for diagnostic urethrocystoscopy were lower urinary tract symptoms [LUTS] (48.8%), bladder tumour (29.2%) and haematuria (11.1%) among others. The urethrocystoscopic diagnoses were bladder tumour (37.8%), prostate enlargement (19.1%) and urethral stricture (6.9%) among others. The complications recorded were urethral/bladder bleeding (2.4%), urosepsis (1.4%) and urethral/bladder injury (0.3%).

Conclusion: Urethrocystoscopy is a necessary tool for comprehensive practice of urology owing to its vital role in the diagnosis and treatment of different kinds of lower urinary tract diseases and it is generally a safe procedure.

Surface anatomy as a relevant tool in contemporary medical education and clinical practice

Dim E. M. — 2022-09-01

The study of human surface anatomy is largely descriptive with interest on the form, proportions of the human body, and the surface landmarks which correspond to deeper structures hidden from view, both in static pose and in motion. From the point of view of first principles in establishing diagnoses and planning appropriate treatment, it is difficult to divest anatomy from clinical medicine. The advent of contemporary, modern and state of the arts diagnostic aids appears to be eroding the relationship between surface anatomy and the teaching and practice of clinical medicine. The aim of this work is to re-emphasize the role of surface anatomy in the teaching and practice of clinical medicine. This is especially relevant at a time like this, when state of the arts imaging techniques seem to be making clinical skills acquisition and demonstration unpopular. A systematic review of the literature on the subject of surface anatomy as it relates to clinical medicine was done. Perspectives on surface anatomy in relation to the teaching and practice of clinical medicine were extracted and presented.

Corpus luteum rupture mimicking acute appendicitis

Ezem U. — 2022-09-01

Acute abdomen is a common presentation in women in the reproductive age. It may be caused by diverse conditions. The case below presented with classical signs and symptoms of appendicitis. Haemoperitoneum seen at laparotomy suggested a diagnosis of ectopic pregnancy .The diagnosis of ruptured corpus luteum cyst (RCLC) was made only after histology. The symptoms, signs and diagnosis of RCLC are discussed. The case highlights the need for circumspection in the diagnosis of the cause of acute abdomen. The current trend favours conservative management of RCLC thus the need for a high index of suspicion is emphasized to avoid unnecessary surgery.

Subarachnoid lavage following inadvertent intrathecal injection of tranexamic acid

Salahu D. — 2022-09-01

Tranexamic acid (TXA) is a commonly used antifibrinolytic drug during surgical procedures to reduce blood loss. An Inadvertent intrathecal injection of TXA may lead to serious side effects including seizures and ventricular fibrillation with reported fatalities. We report a case of an inadvertentintrathecal injection of TXA which occurred as a result of similarities in appearance between TXA and heavy bupivacaine ampoules. The patient had subarachnoid lavage after experiencing back pain, systemic hypertension followed by generalized tonic clonic seizures.

Giant plexiform neurofibroma of lower limb: Importance of radiology in diagnosis, complications and management

Udeagu G. C. — 2022-09-01

Plexiform neurofibromatosis is reported to occur in 26.7% of patients with type I neurofibromatosis. Plexiform neurofibromas present at, or soon after, birth as areas of hyperpigmentation, thickening of the skin and excess hair. In 50 percent of cases, it results from autosomal dominant transmission and in the remaining 50 percent of cases it arises as a spontaneous genetic mutation with no known cause. It affects all three germ layers and it is capable of involving any organ system. Plexiform neurofibroma pathognomonic of von Recklinghausen disease (neurofibromatosis type 1) and the gene responsible for the disorder is located in the chromosome region 17q11.2. The aim of this article is to report a rare case of giant plexiform neurofibromatosis in 15 year old Nigerian boy, its complications, its association with birth mark and hyperpigmentation, and its management.