Ibom Medical Journal

Prevalence and Risk Factors Associated with Diabetes Mellitus in Public Secondary Schools Teachers in Ekiti State

Elegbede O. E. — 2022-05-01

Background: Diabetes Mellitus is a non-communicable disease and a leading cause of morbidity and mortality in the world. The estimated prevalence of diabetes in Africa is 1% in rural areas and ranges from 5% to 7% in urban sub-Saharan Africa. 3 Nigeria is the most populous country in African and she contributes about one sixth of the Africa’s diabetic population. This study is aimed at determining the prevalence of diabetes mellitus and accessing its risk factors among public secondary school teachers in Ekiti State.

Methodology: This survey is a cross-sectional study carried out among 357 public school teachers in Ekiti State using a multi stage sampling technique. Data was gathered using a semi structured questionnaire and Accu Check Glucometer machine for Fasting Blood Sugar. Analysis was done using SPSS version 23 and level of significance was taken as P = 0.05.

Result: Mean age was 42.9±9.2 years. Prevalence of Diabetes Mellitus was 5.6%. Family history (15%), Alcohol intake (14.0%) and smoking (11.2%) were major risk factors in the respondents. Poor vision is the main complication being experienced by the respondents (40.3%). Predictors of Diabetes Mellitus as found by this study include increasing age (starting from above 40years), cigarette smoking, alcohol intake and positive family history.

Conclusion: Prevalence of Diabetes Mellitus is high compared to what it was before. Alcohol intake, smoking and family history were major risk factors while poor vision is the commonest complication. It is recommended that all efforts must be made to put in mechanism that will halt this undesired progression through control of risk factors.

Patients’ reactions to digital rectal examination of the prostate

Elijah Asuquo Udoh — 2022-05-01

Background: Digital rectal examination (DRE) of the prostate is a simple, fast, cost effective and safe procedure, however, because of previous painful experience, some men may refuse it. Other negative factors include cultural barriers, fear of discovering cancer and embarrassments. However, some men accept DRE because of their symptoms and wishes to contribute to science. The aim of this study was to examine how previous experience of DRE could influence a repeat and to further evaluate their impression before and after DRE including pain score.
Patients and Methods: We evaluated one hundred patients who met the inclusion criteria using a structured questionnaire that detailed information on patients biodata, their previous DRE experiences, expectations before and reactions after a repeat. Pain score was also examined using visual analog scale of 0 to 10. Data were collated and analysed using statistical package for social sciences (SPSS) version 20.0. P-value was set at <0.05.
Results: Mean age of patients was 64.88±7.53 years ranging from 46 to 82 years. Forty five percent of them complained of pain from previous DRE while 55% reported no pain. Forty one percent of the men anticipated pain before this present procedure but only 8% of them reported that it was painful and humiliating after the procedure. Fifty nine percent had good impression before DRE and after the procedure 92% reported good impression. All patients expressed their willingness to repeat DRE in future if need be and to encourage friends who may need DRE evaluation of their condition. Mean pain score was 0.59 ± 1.349 (0 – 9).
Conclusion: Patients previous experience of DRE could negatively influence a repeat procedure because of pain, improper counseling apart from some cultural barriers. DRE in the hands of Urologists has been better tolerated than other clinicians. This calls for proper exposure of medical students to this procedure and need for continuous medical education for other clinicians for skills improvement.

Prevalence and Determinants of the use of Enema in under-five children in Akwa Ibom State

Ekanem A. M. — 2022-05-01

Background: Use of enema in children across clinical and community settings are associated with risks. This study seeks to determine the prevalence of enema practice in under-five children, substances used as enema and the reasons for enema practice by mothers.
Materials and Methods: This was a descriptive cross sectional study among 252 consecutively recruited mothers of under-five children attending immunization/well babies clinics in 2 health centres in Akwa Ibom state using a semi-structured self and interviewer administered questionnaire for data collection. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 17.0 at a level of significance of P<0.05.
Results: One hundred and sixty-nine (67.1%) respondents had ever given enema to their children. Mothers (69.2%) administered enema to their children which most often (72.8%) was recommended to them by others. Herbal enema was preferred to chemical and plain water enema. Common reasons for enema administration were in preparation for administration of antimalarial to ensure its effectiveness (60.4%), to relief constipation (49.7%) and abdominal pains (46.7%) and treatment of fevers (41.4%). Predictors of enema practice were age of the child (OR 0.4, 95% CI 0.212-0.765, p=0.005) and ethnic origin of the mothers (OR 9.4,95% CI 4.024-22.104, p<0.001).
Conclusion: The practice of enema is common in the study area. Health practitioners should be aware of this practice in the communities, seek for this history during clinical consultation and make concerted effort in educating the mothers and other caregivers against this practice.

Fixed-prosthodontics in Nigerian private practice settings

Ikusika O. F. — 2022-05-01

Context: Private practice dentistry is predominant in Nigeria. Audits of fixed-prosthodontic practice in these settings are rare and will highlight capacity and guide training. This study aimed to assess the scope and quality of fixed-prosthodontic practice in such settings in Nigeria.

Objectives: The study sought to assess:

Participants’ sociodemographic and their diagnostic and preoperative practices.
The quality of impression making and operative technique, reviews and maintenance, temporization
practices and communication with the laboratory.
The range of treatments given and provision of advanced treatments.

Materials and Methods: An adapted questionnaire was administered electronically on Nigerian dentists practicing fixed-prosthodontics in private practice settings. Retrieved data underwent descriptive statistics and associations were tested with the Fischer’s Exact and Chi-Square tests using IBM SPSS Statistics version 21. Statistical significance was set at p≤0.05.
Results: A total of 100 valid responses with a male:female ratio of 2.1:1 from 16 states were retrieved. Fifty-nine participants had only first degrees and mean experience was 14.3±9.5 years. There were 27 adequate responses with regards to range of treatments offered. Sixty-three participants practiced direct temporization. Twenty-one and 14 participants regularly practiced implantology and CAD/CAM dentistry respectively. Direct temporization was significantly associated with increasing education (X2=6.03, p=0,05) and experience (X2=13.2, p=0.03).
Conclusion: Only a few Nigerian dentists in private practice gave an adequate range of treatment. Most of them prefer direct temporization. Implantology and CAD/CAM dentistry practice are improving, but are still not very common.

Retinal changes among pre-eclamptic patients in University of Benin Teaching Hospital, Benin, Nigeria

Uwagboe P. N. — 2022-05-01

Background: Preeclampsia is one of the hypertensive disorders in pregnancy that contributes significantly to maternal and fetal morbidity and mortality, with the impact felt more in developing countries. It is characterized by endothelial dysfunction and vasospasm of vessels which can be observed by an ocular fundal examination. The aim of this study was to determine the ocular fundus findings of women with preeclampsia.

Methods: This was a cross-sectional study, carried out at the University of Benin Teaching Hospital involving a total of 220 pregnant women. The women were divided into two groups of 110 pregnant women (A&B).Their Age and Gestational age was cross-matched and retinopathy graded according to Keith and Wagner classification. Group A was made up of Preeclamptic women and Group B was made up of healthy pregnant women. Visual acuity was measured using Snellens’ chart, and the fundus was examined with direct ophthalmoscope.

Results: This showed that the retinal changes observed in the preeclamptic women were associated with their age (P = 0.009), gestational age (P = 0.044), blood pressure (P = 0.001), Proteinuria (P = 0.001), Severity of the disease (P = 0.001), visual acuity (P = 0.035) as well as with the visual symptoms (P = 0.001) but not statistically significant with the gravida (P = 0.799).

Conclusion: Our study highlights the importance of timely ophthalmoscopy which helps to assess severity of disease (pre-eclampsia) which affects the decision of induction of delivery to predict and prevent possible complications which in turn immensely helps in judicious management of disease. Also, the study revealed that preeclamptic women who are multigravida are more likely to have retinopathy than primigravida.

Correlates of exclusive breast feeding among nursing mothers attending child health clinic at a general hospital in Rivers State Nigeria

Bright O. Ogbondah — 2022-05-01

Background: Early initiation of breast feeding and feeding exclusively for six months have great implication for the survival, well-being and growth of new borne. Factors such as maternal age, occupation, religion, spouse age, spouse occupation, parity, antenatal care (ANC) attendance, mode of delivery (MOD) and birth order are significantly associated with exclusive breast feeding (EBF)

Methodology: The study is a descriptive cross-sectional study conducted among nursing mothers attending child health clinic in General Hospital Bonny, in Bonny Island, Rivers State, Nigeria. All eligible nursing mother who presented at the clinic were enlisted for the study. Enlistment of eligible participants was done on every child welfare clinic day. Data was collected using a pretested, interviewer administered, structured questionnaire which was adapted and prepared in English Language. Categorical data was analyzed using multinomial logistic regression model with statistical significance set at 0.05.

Result: Results from this study identified significant association between EBF and some maternal variables such as age, occupation and religion. Spouse age and occupation were significantly associated with EBF. ANC attendance, gestational age, MOD, parity and birth order were also significant variables associated with EBF.

Conclusion: Maternal variables such as age, occupation, religion, parity, MOD, ANC attendance including spouse age and occupation significantly influence EBF of new borne.

Cadmium and Mercury Exposure: Oxidative, Neurobehavioural and Histological Alterations to the Cerebellum of Wistar Rats

Adaze B. Enogieru1 — 2022-05-01

Background: The unprecedented increase in metal exposure has been aided by modern industrialization and anthropogenic activities. Cadmium and mercury are recognized as two of the most common heavy metals with destructive impacts on most organ systems. The present study was designed to investigate and improve existing literature on the possible deleterious effects of cadmium and mercury exposure.

Methods: Adult Wistar rats were treated with cadmium chloride (5 mg/kg/day) and mercury chloride (4 mg/kg/day) for 14 days. Body, brain and cerebellar weights, motor deficits, antioxidant and lipid peroxidation activities as well as histological alterations to the cerebellum were evaluated at the end of the experiment.

Results: Findings showed a significant reduction in body and brain weights, dysregulation of antioxidant enzymes activity and impaired locomotion and exploratory activity in treated rats. Also, an increase in lipid peroxidation and degeneration of Purkinje cells of the cerebellum was observed in treated rats.

Conclusion: Overall, these results corroborate previous findings that cadmium and mercury induce deleterious effects on the cerebellum and central nervous system. In addition, this study helps to provide an anatomical perspective and information on the exact cerebellar changes induced by cadmium and mercury in Wistar rats.

Assessment of Willingness to pay for Community-Based Health Insurance among Artisans in a selected Community of Ekiti State, Southwest Nigeria

Elegbede O. E. — 2022-05-01

Background: Community-based health insurance (CBHI) has emerged as a more efficient and equitable approach to healthcare financing. It was designed to ensure that sufficient resources are made available for members to access effective healthcare. This study assessed the willingness to pay (WTP) for CBHI among artisans in a town in Ekiti State, South West Nigeria.

Methods: This was a cross-sectional survey conducted among 416 artisans in a town in Ekiti State. A semi-structured interviewer-administered questionnaire was designed and used for data collection on sociodemographic data and WTP for CBHIS. Data entry and analysis was done using IBM SPSS software version 25.0.

Results: The mean age and standard deviation of the respondents was 29.7±10.9 years with male to female ratio of 1:1.4. Most of the respondents were willing to pay (86.3%) and willing to enroll other household members (73.6%) in the CBHI. A large percentage (44.3%) of those willing to pay were ready to pay between ₦1,000-₦5,000 (US$2.63–US$13.16) per year while 39.6% preferred frequency of payment to be annually. Positive predictors of WTP for CBHI were age groups ≥50 years and 40-49 years than <20 years (AOR:13.270, 95%CI: 1.597-110.267; AOR:142.996, 95%CI: 10.689-1913.009). Females than males (AOR:9.155, 95%CI: 3.680-22.775), tertiary level of education than no formal of education (AOR:23.420, 95%CI: 1.648-850.921), no children than ≥5 children (AOR:20.099, 95%CI: 2.705-149.364), earn ≥₦30,000 (US$78.95) than <₦30,000 (AOR:2.248, 95%CI: 1.278-6.499). often and somethings fall ill than seldom fall ill (AOR:6.505, 95%CI: 1.623-26.065; AOR:4.889, 95%CI: 1.674-14.279)

Conclusion: WTP for CBHI was high among the artisans, however, there is a variation across the amount and frequency of payment. Therefore, policy that is flexible enough to allow artisans enroll and pay a premium that is affordable, at an acceptable frequency, should be formulated by the Government.

Scourge of Peripheral Artery Disease in a Low-Income-Setting: The Role of Vascular Surgery

Nwafor I. A. — 2022-05-01

Background: Peripheral artery disease (PAD) is a progressive disorder characterized by stenosis and/or occlusion of large and medium-sized arteries, other than those that supply the heart (coronary artery disease, CAD) or the brain (cerebrovascular disease). It is increasingly becoming a challenge in developing countries owing to poverty and ignorance.

Objective: To review the scourge of peripheral artery diseases in our institution in a low-income setting with a view to determining the role of a vascular surgeon.
Materials and method: Over a period of 15 years (2006 to 2021), patients with documented PAD were reviewed. Data of the patients were retrieved from the record department and such data included demography, aetiology/risk factors, clinical features and investigative parameters as well as modes of treatment especially vascular surgery.

Results: There were 35 patients which comprised 20 males and 15 females with male to female ratio of 4:3. Age range affected most was 71-80 years. Aetiologically, artherosclerosis was dominant. Leriche Fontaine classification used in clinical evaluation showed that type III was dominant. 6 Ps (pain, pulselessness, paralysis, paraesthesie, pallor and poikilothermia) of vascular ischemia were evident. Doppler/duplex ultrasound and computer angiography were used in diagnosis. Medical and or surgical treatments were used in patients’ management. Vascular and or orthopedic surgery played significant role.

Conclusion: PAD affects the lower extremities more commonly than the upper extremity vessels especially in the elderly leading to intermittent claudicationn which is the most recognized symptomatic subset of lower extremity PAD. Morbidity and mortality emanating from inadequate revascularization are burden to emerging economy like ours.

Therapeutic potential of concurrent administration of Hippocratea africana and Eremomastax speciosa in the treatment of Plasmodium berghei infected mice

Anthony F. Uwah — 2022-05-01

Context: Despite the commonness of polyherbal therapy among the locals in the treatment of malaria in Nigeria, there are no adequate data on the therapeutic potentials and safety profile of these herbal combinations. The use of these plants in combination in the treatment of suspected and confirmed malaria infection is very common among the Niger Delta dwellers in Nigeria.

Aim: To evaluate the therapeutic potential of co-administration of Hippocratea Africana, a medicinal plant with well documented antimalarial properties, and Eremomastax speciosa, a tropical plant with well reported antianaemic potential and haematoprotective properties.

Materials and Methods: Thirty albino mice, whose weights ranged between 32 - 37g, were divided into five groups having six mice in each. Clinical features, weight changes and parasite clearance were evaluated to determine therapeutic potential of treatments.
An inoculum which consisted of 5 x 107 Plasmodium berghei infested erythrocytes per ml of blood from a donor mouse with 64% parasitaemia was injected into each mouse by intraperitoneal route. The mice were kept at room temperature of 28.0 ± 20C for 7 days for the parasite to develop. A non-parasitized mice group served as normal control. After parasitaemia was confirmed using standard procedure, 200mg/kg and 300mg/Kg body weights of Hippocratea Africana root bark and Eremomastax speciosa leaf extracts respectively, were administered by oral routes to the respective groups of mice for 6 days. A parasitized group was treated with fixed doses of 3mg/kg body weight of Artemether and 18mg/kg body weight of Lumefantrine. Another parasitized group was left untreated.

Results: Mice treated concurrently with the extracts of H. africana and E. speciosa showed a significant improvement in clinical signs in comparison to the untreated group. The mean body weights of mice administered both extracts was significantly (P < 0.05) increased when compared to the parasitized untreated mice and those treated with extracts separately. The mice treated concurrently with the two extracts also showed significant (P < 0.05) reduction in percentage parasitaemia and significant (P < 0.05) increase in percentage parasite clearance comparable to that of Artemether-lumefantrine. The parasitized untreated group recorded 50% mortality, while the group treated concurrently with the two extracts did not record any mortality.

Conclusion: Concurrent administration of E. speciosa crude leaf extract and H. africana ethanolic root extract had good therapeutic potential in the treatment of Plasmodium berghei infected mice. This justified the use of these extracts by Sub-Saharan African traditional medical practitioners and Nigerian Niger Delta rural dwellers in the treatment of human malaria.

Consensual coital vaginal laceration in hypovolaemic shock: A report of two cases

Michael Archibong — 2022-05-01

Background: Certain life-threatening complications and morbidities may occur following consensual sexual intercourse which may not be commonly experienced in clinical practice. One of such complications is hypovolaemic shock resulting from profuse bleeding.

Methods: Two cases of vaginal laceration complicated by hypovolaemic shock following consensual sexual intercourse are presented.

Results: Both patients had resuscitation with intravenous fluid, blood transfusion and subsequent examination under anaesthesia with repair of laceration in theater. Post-operative recovery period was uneventful and they were both discharged after proper counselling.

Conclusion: Bleeding from coital laceration could be life threatening. Prompt treatment should be instituted in such cases.

Abdominal pain in the female patient: A case of concurrent acute appendicitis and infected ovarian cyst

Kabir Musa Adamu — 2022-05-01

Background: Abdominal pain is a common presentation in women of child bearing age. It has a broad diagnosis that includes disorders of the gastrointestinal, gynaecological, vascular, urogenital, and pulmonary systems. It may be caused by infections, inflammatory, anatomic or neoplastic processes. Its management varies by aetiology, and accurate diagnosis is key to avoiding inappropriate treatment. In some rare instances, acute appendicitis has been shown to occur simultaneously with a variety of gynaecologic diseases, which can add to the diagnostic dilemma.

Method: We report a case of concurrent acute appendicitis and infected ovarian cyst in a 49 year old P6+4A6 who presented with recurrent abdominal pain for 4 years duration.
Result: She had oophorectomy and appendicectomy. She did well post operatively and was discharged to outpatient department after stitches removal.

Conclusion: Abdominal pain, being from various aetiology in women of child bearing age, detail history, thorough physical examination, and necessary imaging investigations need to be done to avoid misdiagnosis and inappropriate treatment.

Aggressive central giant cell granuloma of the mandible: A case report and review of literature

Uchechukwu B. Eziagu — 2022-05-01

Mandibular aggressive central giant cell granuloma is a rare non-neoplastic giant cell tumour characterised by pain, bone destruction, tooth root resorption, jawbone cortical perforation, and high recurrence rate. This is a case of a 10-year-old boy who presented to the Dental Surgical outpatient clinic of University of Uyo Teaching Hospital with a three-year history of left jaw swelling. The clinical diagnosis was fibrous dysplasia of the left hemi-mandible. Consequently, left hemi-mandibulectomy was performed, and subsequent histopathological diagnosis was aggressive central giant cell granuloma of the mandible. This article presents this rare diagnosis and explores its classification, aetiopathogenesis, clinico-pathological features and management.