Ibom Medical Journal

Anaemia of inflammation in sickle cell disease: A review of aetiopathogenesis, management, and prevention of sterile and septic inflammation in patients with sickle cell disease

Ahmed SG — 2025-01-01

Background: SCD is strongly associated with sterile inflammation (STERIN) and septic inflammation (SEPTIN). Thus, in addition to haemolysis, anaemia in SCD has dual ‘inflammatory’ components; (1)-anaemia of sterile inflammation (ASTERIN) and (2)-anaemia of septic inflammation (ASEPTIN). Hence, the need to explore the relatively understated but important concept of ‘anaemia of inflammation in SCD’.

Objectives: The objectives of this review are tri-fold; (1)-To reappraise the aetiopathogenesis of STERIN and SEPTIN in SCD; (2)-To highlight the roles of STERIN and SEPTIN in causation of ASTERIN and ASEPTIN in SCD; and (3)-To underscore the roles of mitigators of STERIN and SEPTIN in managing/preventing ASTERIN and ASEPTIN in SCD.

Methodology: Literature search was done using terms relevant to ‘SCD/inflammation/anaemia’. Only articles on aetiopathogenesis, management, and/or prevention of STERIN/ASTERIN and/or SEPTIN/ASEPTIN were selected.

Results: Hyper-inflammation in SCD has dual components; STERIN (caused by tissue injury/haemolysis) and SEPTIN (caused by infections). Accordingly, ‘anaemia of inflammation in SCD’ has dual components; ASTERIN and ASEPTIN. ASTERIN is driven by STERIN, which is relentless and occurs even in steady-state, and is often aggravated by crisis and/or autoimmune diseases. ASEPTIN is driven by SEPTIN, which occurs only during infections. Hence, during infection, ASTERIN and ASEPTIN act synergistically to worsen anaemia and increase transfusion risk in SCD. Mitigators of STERIN (e.g., hydroxyurea, immune-modulators) and SEPTIN (e.g., anti-microbials, vaccines) have beneficial roles in managing and preventing ASTERIN and ASEPTIN in SCD.

Conclusion: Anaemia in SCD has significant inflammatory components. Hence, managing/preventing STERIN and SEPTIN are important strategies for down-regulating ASTERIN and ASEPTIN, improving Hb-concentration, and reducing transfusion risk in SCD.

Prevalence, presentation, risk factors and awareness of oral cancer: A systematic review of the Nigerian experience

Egbunah UP — 2025-01-01

Background: Oral cancers are malignant neoplasia of the lip and/or oral cavity that represent a major part of head and neck carcinomas (HNCs) along with laryngeal and pharyngeal carcinomas. Although oral cancers can be considered a health burden, available evidence on the actual burden in Nigeria is sparse.

Aims: The aim of this review was to determine the prevalence, presentation, risk factors, and awareness of oral cancer in different geopolitical zones in Nigeria.

Methods: Systematic literature searches were conducted in PubMed (NLM), Cochrane, Ovid Medline, OpenGrey and Google scholar databases, to identify publications on the prevalence, presentation, risk factors, and awareness of oral cancer in different geo-political zones in Nigeria.

Results: Oral cancer was found to be the most common form of HNCs in several of the included studies. Although reports from included studies varied across geopolitical zones in Nigeria, generally, oral cancers were most found in males, between the 5^th and 6^th decade, and the tongue, palate, maxilla, and mandible were common sites. In addition, a suboptimal level of awareness of oral cancer was reported by the majority of reviewed studies.

Conclusion: This review showed variations in prevalence, presentation, and risk factors of oral cancer across different geopolitical zones in Nigeria and highlighted the low level of knowledge and awareness of oral cancer among the Nigerian population.

Hyperglycemia, an abnormality that results from a breakdown of normal glucose control processes is also the result of molecular mechanisms to protect the insulin receptor? A hypothesis

Zerón HM — 2025-01-01

Background: Deficiency in either β-cell mass or function, or both, can lead to insufficient levels of insulin, resulting in hyperglycemia and diabetes mellitus.

Aim: This review raises the hypothesis that hyperglycemia is the result of cellular protective mechanisms of the insulin receptor.

Methodology: The methodology was a comprehensive review of existing literature on the insulin receptor and its response against molecular aggressors.

Results: Here we hypothesize that hyperglycemia is the result of a cellular mechanism of insulin receptor down-regulation to preserve its function, and at the same time, the β-cell efficiency is diminished by the initial hyperinsulinemia, which is read as a negative feedback that, if it is long-lasting, becomes irreversible due to chronic apoptotic and dedifferentiation processes.

Conclusion: An increase in glucose plasma levels and its poor control triggers serious injuries caused by glucotoxicity and lipotoxicity, which affects mainly the pancreas but also leads to a systemic damage, triggering the activation of protective pathways attempting to preserve the homeostasis and prevent progression. In turn, these pathways produce an increase in glucose by decreasing the number of insulin cell receptors, thus avoiding deleterious effects on the cell.

Ectopic Pregnancy: A Review of Prevalence, Clinical Presentation and Outcome in Gusau, Northwest, Nigeria

Shittu MA — 2025-01-01

Background: The prevalence of ectopic pregnancy in Zamfara state is unknown and gynaecological emergency admissions for this condition are on the increase.

Aim: To determine the prevalence, risk factors, clinical presentation and outcome of patients managed for ectopic pregnancy at the Federal Medical Centre Gusau, Zamfara State, Nigeria, from January 2014 to December 2020.

Methodology: This was a retrospective study of ectopic pregnancies at Federal Medical Centre Gusau, Nigeria from January 2014 to December 2020. Participants’ medical records were retrieved to collate socio‑demographic, clinical characteristics, management and outcome information. Data was analysed with SPSS software version 26. Means, frequency and percentages were used to present the significance of the results.

Result: A total of 64 women were managed for ectopic pregnancy between January 1^st 2014 and December 31st 2020 in Federal Medical Centre, Gusau. During this period, there were 20,836 deliveries, giving an incidence of 0.31% (3.1 per thousand deliveries). The Mean age of the patients was 27.4 ± 5.5 years. Amenorrhea, abdominal pain and vaginal bleeding were the most common presentations (100%, 98.4% and 96.9% respectively). The commonest risk factor was a previous history of unsafe abortion in 18/64 (28.1%). The ectopic pregnancy was ruptured in 57 of 64 patients (89.1%), and 5 (8.8%) presented in hypovolaemic shock. Laparotomy was done for all the patients and salpingectomy was performed in 98.4%. Anaemia was the most common complication in 45 of 64 (70.3%) necessitating blood transfusion. There was no case fatality in the study.

Conclusion: The incidence of ectopic pregnancy in our centre was low, the most common risk factor was a previous history of unsafe abortion. The majority of the patients presented late with an already ruptured ectopic pregnancy. Early localisation of pregnancy with the aid of an ultrasound in women with a missed period would identify those with an ectopic pregnancy before it ruptures.

Premalignant features of the prostate can be ameliorated by Uvaria chamae root extract: Modeling prostate cancer with cadmium and alternative treatment option in adult Wistar rats

Edem GD — 2025-01-01

Background: Prostate cancer is the most commonly diagnosed cancer and the leading cause of cancer deaths in males worldwide. Mortality attributed with prostate cancer is strongly associated with the age of an individual with relatively higher incidence noticed among aged males.

Aim: The present study was carried out to assess the ameliorative effects of Uvaria chamae root extract on cadmium-induced carcinogenic potentials in adult male Wistar rats.

Materials and Methods: Sixty (60) adult male rats weighing between 200-210g were used in the current study. They were randomly divided into 10 groups of 6 animals per group (n=6). Group 1 received water and diet alone, group 2 received 3mg/kg of cadmium alone once weekly for 28days. Group 3-6 received 3mg/kg of cadmium for 28days followed by 150mg/kg of casodex, 2500mg/kg, 1500mg/kg and 1000mg/kg of Uvaria chamae root extract respectively for 28days. Group 7 received 150mg/kg of casodex alone for 28days. Group 8-10 received 2500mg/kg, 1500mg/kg and 1000mg/kg of Uvaria chamae root extract alone for 28days. The animals were sacrificed after the last dose schedule, blood sample taken for hormonal assay and prostate tissues were preserved in 10% buffered formalin for histology.

Results: Cadmium was found to raise the serum levels of testosterone, FSH, LH, prolactin and estradiol. However, administration of different doses of the root extract of Uvaria chamae decreased the serum levels of the hormones. Administration of 3mg/kg of cadmium alone caused appearance of histological features including small and crowded glands, undulating acini with contours and rigid lumen, nuclear atypia, nuclear hyperchromasia and infiltration of inflammatory cells. These histological features are often encountered in premalignant lesions of the prostate gland. The different doses of the root extract of Uvaria chamae was able to ameliorate the carcinogenic potentials exerted by cadmium on prostate tissues. These ameliorative changes were conspicuous in 2500mg/kg and 1500mg/kg treated groups respectively when compared to control and standard.

Conclusion: This investigation suggests that, the root extract of Uvaria chamae possesses strong cancer ameliorative tendencies through hormonal regulation. Further research should be conducted to isolate the bioactive ingredients responsible for this important therapeutic ability of Uvaria chamae for the sole purpose of anti-cancer drug production.

Biochemical Investigation into the Benefit of Quercetin Supplementation in Hypoxic Mice

Otomewo LO — 2025-01-01

Context: Since the proper flow of oxygen into the human body signifies one of the core features of living organisms, a shortage in supply poses a significant threat to survival.
Objective: This study aimed to investigate the effects of intermittent hypoxia on mice and the benefit of pre-administered quercetin on such effects.

Materials and Methods: Thirty (30) mice were procured and shared into five (5) experimental groups comprising six (6) mice each (n=6). Group I was the normal control group, group II was the negative group and groups III-V were the quercetin groups. Group I and II received distilled water while III-V received quercetin in different doses (10, 20 and 40 mg/kg p.o.). Also, all groups were subjected to the hypoxia protocol except group I. All treatments were carried out for seven (7) days. Afterwards, blood obtained via cardiac puncture, brains and lungs of select mice were respectively subjected to haematological evaluation and intense biochemical analysis. Also, specific lung tissue was subjected to histology using Hematoxylin and Eosin staining procedure.

Results: Quercetin significantly (p<0.05) slowed the rate of possible progression of systemic inflammation by enhancing antioxidant systems in the lungs and brain by increasing glutathione, catalase and superoxide dismutase activity in addition to displaying anti-inflammation by inhibiting the activity of myeloperoxidase. Also, quercetin significantly increased red blood cell and haemoglobin content when compared with the model group.

Conclusion: Quercetin attenuated hypoxia-induced biochemical alterations in major organs of the body which can be accredited to its antioxidative, neuroprotective and anti-inflammatory properties.

Evaluation of Simulation-based Training in Airway Management among Maiden Workshop Participants in Enugu, Nigeria: A Mixed-method Study

Nwosu ADG — 2025-01-01

Context: Simulation-based training is a growing format in healthcare education in Nigeria. So far, most evaluation of the outcome have been limited to the usual pre- and post- tests of knowledge acquisition.

Objective: To evaluate our simulation-based airway training, identify the challenges and their potential solutions.

Materials and Methods: This study was conducted in the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu in April, 2024; seven months after the maiden simulation-based airway workshop. We applied the 4-level Kirkpatrick model of training evaluation to assess the outcome of the workshop. The attendees of the aforementioned simulation-based airway management workshop were invited as participants for the workshop evaluation. A mixed-method research design encompassing focus-group discussions and questionnaire-based survey was used for data collection.

Results: Twenty-nine respondents completed the questionnaire-based survey (six anaesthesia fellows, fifteen residents, eight anaesthetic technicians). Only seventeen respondents (58.6%) have had previous exposure to manikin-based training. The overall satisfaction rating with the SBT was 82.3±11.0 [0-100 scale]. The perceived learning from the SBT was adjudged to be greater in technical skills and knowledge than communication skills. Following the training, the trainees’ behaviour improved with the regular provision and use of gum-elastic bougies during endotracheal intubation. While most participants expressed the desire for more frequent training, some recommended the use of manikins with difficult airway as the means to enhance the SBT.

Conclusion: The training positively impacted on the trainees’ learning and behaviour. Most respondents requested more frequent training sessions as the means of enhancing the training

The prevalence of sexual dysfunction, anxiety and depression in pre-dialysis chronic kidney disease patients in Uyo, Nigeria

Akpan EE — 2025-01-01

Background: Chronic kidney disease (CKD) is a progressive condition that spans years or even decades. It is therefore associated with comorbidities as well as other complications among which include erectile dysfunction (ED), anxiety, and depression.

Method: This was a cross- sectional descriptive study involving 54 male pre-dialysis patients seen in the renal clinic of the University of Uyo Teaching Hospital, Uyo, Nigeria. The history of erectile dysfunction (ED) was taken using the abridge five-item version of the 15-item well-validated International Index of Erection Function (IIEF-5) questionnaire. Anxiety and depression were evaluated using the simple hospital anxiety and depression scale (HADS) screening tool.

Results: Fifty-four (54) pre-dialysis male patients were recruited, aged between 26 and 67 with a mean age of 49.65 ±8.37. Only 1(1.87%) was single, 53(98.13%) were married. The prevalence of erectile dysfunction was 81.5%. Erectile dysfunction had a significant association with depression and anxiety. Respondents had Anxiety, with a Borderline of 7(29%), clinical casenesss 31(57.4%) against normal of 16 (29.6%). While 35(64.8%) had depression, borderline 15(27.8%), caseness of 20(37%) against normal 19(35.2%). Anxiety and depression had a strong association with erectile dysfunction p= 0.02 and p= 0.01 respectively.

Conclusion: There is a high prevalence of ED, anxiety, and depression among pre-dialysis male patients. ED is strongly associated with anxiety and depression.
There is a need always to evaluate our male CKD patients for ED, anxiety, and depression and possibly consider treatment in severe cases.

Menstrual Hygiene Awareness, Practices and Health Implications Among Adolescent Girls in Ukpom Abak, Akwa Ibom State, South-South Nigeria

Johnson OE — 2025-01-01

Background: Menstrual hygiene management (MHM) is crucial for the health and well-being of adolescent girls. In many developing countries, including Nigeria, awareness and resources for proper MHM are lacking. This study aimed to assess the awareness, practices and associated menstrual hygiene health problems related to among adolescent girls in Ukpom Abak.

Materials and Methods: A cross-sectional study was conducted among 169 adolescent girls. Data were collected using structured questionnaires and analyzed with SPSS version 17.0 using descriptive statistics and Chi-square test to examine the association between menstrual hygiene products and lower urinary tract symptoms. The level of significance was set at 0.05.

Results: The mean age of the respondents was 12 ± 0.95. Alternatively, 12 (standard deviation = 0.95). Most participants were aware of menstruation before menarche (79.9%), with mothers being the primary source of information (42.6%). Sanitary pads were the most recognized (73.4%) and used (67.5%) menstrual hygiene products. Despite this, 57.4% of the respondents used reusable cloths. Some health issues around menstruation were reported, including abnormal vaginal discharge (60.4%), lower abdominal pain (47.3%) and genital itching (36.1%). There was a significant association between the type of menstrual hygiene products used and lower urinary tract symptoms (p<0.0001).

Conclusion: The study highlights the need for improved menstrual health education and access to affordable menstrual hygiene products. Comprehensive interventions are necessary to promote proper menstrual hygiene practices and reduce health risks associated with inadequate menstrual hygiene management.

Infant and young child feeding practices associated with nutritional status among children attending child welfare clinic in Kericho County, Kenya

Cheruiyot DK — 2025-01-01

Background: Breastfeeding is widely recognized as the gold standard for infant feeding in the first six months of life, providing essential nutrients and antibodies for optimal growth and development. However, suboptimal breastfeeding practices and inadequate complementary feeding can contribute to malnutrition. This study assessed complementary feeding practices associated with nutritional status in breastfed children.

Materials and methods: The study population were children aged 6 to 59 months in Kericho County. The study was designed as an institutional based cross-sectional survey of children seen in Kericho County Referral Hospital and Kakaptet Sub- County Hospital. Simple random sampling was used to select 172 study participants across these hospitals. Descriptive statistics, chi square and Fischer’s exact tests were carried out. Additionally, both unadjusted and adjusted odds ratio were obtained using multinomial regression analysis. Ethical standards were strictly adhered to throughout the study.

Results: Findings revealed that 75 (43.6%) children were aged between 24 and 59 months, 55 (32%) were aged 9 to 23 months and 42 (24.4%) were aged 6 to 8 months. Approximately two-thirds of caregivers had attained secondary education (n=77, 44.8%). Stunting was prevalent in 25% of the children, while both wasting and underweight affected 23.8%. Approximately 39% of caregivers introduced their children to complementary feeds before six months of age. Only 39.2% of children aged 6 to 23 months consumed five or more food groups for minimum dietary diversity (MDD). In the study, 95.9% of the children met the recommended minimum meal frequency (MMF), but only 39.2% had the minimum acceptable diet (MAD).

Conclusion: Introduction of complementary food after 6 months reduced the likelihood of wasting and stunting. Implementing targeted nutrition interventions for children aged 6 to 59 months in Kericho County is imperative.

Exploring patient-centered barriers to hemophilia care in Southern Nigeria: Study Protocol

Eguzo K — 2025-01-01

Background: Hemophilia is a rare, inherited bleeding disorder which affects about three out of every one million Nigerians. Evidence shows that most PLwH in Nigeria do not know enough about the condition and face some barriers. The goal of this paper is to describe the study protocol used to develop and validate tools that would explore the barriers and knowledge gaps related to hemophilia, as a part of a larger needs assessment study.

Methods: This exploratory mixed methods study used surveys and focus group discussions (FGD). Participants included PLwH/caregivers (i.e. PLwH) and healthcare professionals (HCP) in southern Nigeria. Study instruments were tested for validity and reliability by a purposive sample of target participants. Quantitative data was analyzed using descriptive and inferential, while thematic analysis was used for qualitative data.

Results: Thirty-seven individuals participated in the pre-testing of both survey tools (HCP – 18; PLwH – 19). For the PLwH, their average age was 37±19 years and had been associated with hemophilia for about 10 years (IQR: 2,12). Whereas the average years in practice for the HCPs was 13±6 years and had encountered about 20 patients (IQR: 6, 32) with hematologic disorders in the previous month. A Cronbach's alpha of 0.92 (PLwH Survey) and 0.91 (HCP survey) was obtained for the surveys, indicating excellent internal consistency. FCD revealed concerns about the introduction of the surveys, their length, and time required to complete the questions. The surveys were revised as needed.

Conclusion: The tools developed to evaluate barriers and knowledge about hemophilia by PLwH and HCPs were valid, appropriate and reliable. It is important therefore to deploy the instrument on a larger scale with the expectation that findings from that study would be valid, reliable and useful in planning future interventions regarding hemophilia.

Predominance of metallo-beta-lactamase blaVIM Genes in Clinical Isolates from Health Facilities in Nigeria: Role in Multidrug Resistance Surge

Etang UE — 2025-01-01

Background: The predominance of metallo-beta-lactamase (MBL) genes in Gram-negative bacteria (GNB) has been reported to contribute immensely in the emergence of multi-drug resistance (MDR) strains in hospital environments worldwide.

Aim: This study aimed to investigate the molecular characteristics of MBL genes in MDR-GNB in selected health facilities in Akwa Ibom State, Nigeria.

Materials and methods: A descriptive cross-sectional study was conducted in three health facilities in the State. One hundred and sixty (160) samples each of wound, urine and blood were collected aseptically from consented patients and analyzed using standard laboratory procedures. Identification, antibiotic susceptibility testing and phenotypic detection of MBL-producers were done using the VITEK®2 system, Kirby-Bauer disc diffusion and imipenem+EDTA CDT, respectively. Polymerase chain reaction was used to investigate the characteristics of MBL encoding genes: blaVIM, blaNDM and blaIMP.

Results: Out of 135 GNB identified, 60.7% exhibited MDR and 53(39.3%) were MBL-producers. Of the MBL genes screened, only the blaVIM was detected in 5(23.8%) of the 21 selected strains screened. The breakdown of blaVIM gene detection rate among isolates from wound, blood and urine samples were 20%, 11.1% and 3.4%, respectively. The GNB that harboured the blaVIM genes were Serratia marcescens, Klebsiella pneumoniae and Escherichia coli recovered from wounds as well as Proteus mirabilis and Pseudomonas aeruginosa recovered from blood and urine samples, respectively.

Conclusion: Findings of this study highlight the importance of the blaVIM gene in conferring multidrug among the Gram-negative bacteria, and the need to establish antimicrobial resistance surveillance network and policy to determine appropriate empirical treatment regimen among hospitals in the State.

Assessment of factors influencing job satisfaction among healthcare workers' in public hospitals in Nairobi County, Kenya

Lifuleze CM — 2025-01-01

Background: According to (Kalinski, 2020) Job satisfaction is a complex combination of psychological, emotional feeling and other environmental factors that can affect an employee positively and give them a sense of achievement on the job. Further, He implys that job satisfaction can be linked to doing a job one enjoys, being productive and getting positive intrinsic rewards like enthusiasm, and contentment. On March 14, 2024 the healthcare worker’s through their union representatves (KMPDU & KNUN) announced a nationwide strike in Kenya. This strike lasted for 56 days and was called off on May 8^th 2024 after negotiations, the government officials agreed to some of the union demands. (MoH, 2024). It is evident that Healthcare workers are dissatisfied and the link to the major causes is not clear.

Objective: This study sort to investigate the factors influencing job satisfaction among healthcare workers' in public hospitals in Nairobi County, Kenya based on Herzberg’s Motivation Theory.

Methodology: This study employed a cross-sectional research design, targeting healthcare workers from five select Hospitals in Nairobi County, Kenya. A sample of 400 participants was selected using stratifed random sample based on proportioanl allocation. The data collection instrument was self-administered questionnaires and analysis done using the SPSS software, version 26.0, with the level of significance set at 0.05. Analyzed data was presented using tables with both descriptive, and inferentiall statistics i.e. Chisquare, Odds Ratios and Confidence Intervals.

Results: The study found that promotions ( p-value<0.001) with OR =1.790 and 95% CI = (1.090, 2.939), Training and development (p-value<0.001) with OR = 1.960 and 95% CI = (1.214, 3.165), Communication (p-value=0.001) with OR = 1.189 and 95% CI = (0.687, 2.059), Supervision (P-Value < 0.001) with OR = 1.380 and 95% CI = (0.805, 2.365), quality of buildings in terms of space (p-value<0.001) with OR = 1.505 and 95% CI = (0.924, 2.453), Equipment adequacy (p-value<0.001) with OR = 2.871 and 95% CI = (1.698, 4.854), Availability of PPEs’ (p-value=0.022) with OR = 2.394 and 95% CI = (1.316, 4.357), and Availability of amenities such as toilets and water (p-value=0.04) with OR = 1.844 and 95% CI = (1.458, 2.556) had a statistically significant effect on satisfaction/dissatisfaction by Healthcare workers.

Conclusion: The study was able to established that there are factors determining job satisfaction among healthcare workers in Public hospitals in Nairobi County, Kenya. They include salaries, fringe benefits, training and development, recognition and reward, supervision and management, communication, equipment and utilities, lighting and ventilation, and conducive work environment. Over (70%) of the respondents were not satisfied with their work environment. This study recommends that employers should come up with clear guidelines on rewards such as merit-based promotions, training, and development opportunities through programs such as in-service training and compensation for extra training that HCWs incur expenses for, and more resources should be invested towards the construction of more hospital spaces and improving the quality of the available hospital spaces.

A histomorphological assessment of endoscopic biopsies in patients with upper gastrointestinal diseases in a tertiary hospital setting in Nigeria

Charles NC — 2025-01-01

This is a prospective, observational and descriptive study of all the upper gastrointestinal endoscopies (UGIE) that were performed between January 2020 and December 2022.

All UGIE and biopsies were performed by one endoscopist. Clinical information on age, sex, presenting complains, endoscopic findings and provisional diagnosis were retrieved from laboratory forms.

Results: A total of 273 biopsies were obtained from 181 patients, 6 (2.2%) from the upper and lower esophagus sphincter, 180 (65.9%) from different parts of the gastrum and 87 (31.9%) from the first and second parts of the duodenum.

The most common indication for upper endoscopy was dyspepsia. Of all the esophageal biopsies, 83.3% of them had no pathology. Only 3 (1.6%) cases of the gastric biopsies were histologically confirmed to be gastric adenocarcinoma. The vast majority of the gastric lesions were inflammatory. Chronic gastritis was seen in 92.7% of cases. Only one (1.1%) case of malignant duodenal lesion was seen (1.1%). Of the 273 UGIE biopsies, only 4 (1.5%) malignant lesions were seen.

Conclusion: A baseline data of the pattern of UGIE in Akwa Ibom State has been documented. Chronic gastritis is very common, while esophageal lesions and gastric malignancies are rare.

The effect of hyoscine butyl bromide on the active phase of labour among primiparous women delivered at the Jos University Teaching Hospital

George OC — 2025-01-01

Background: Labour is a physiological process to expel products of conception to the external environment. More often than not, it results in the delivery of a healthy baby to a happy mother. However, it has also been associated with a significant number of adverse maternal and fetal outcomes. Over the years several steps and interventions have been taken to reduce these adverse outcomes. One of such intervention is the reduction of the duration of labour which has been found to improve neonatal outcomes. Hyoscine-Butyl Bromide has been shown to reduce the duration of labour, however, it is currently not recommended for labour intervention because no beneficial effects have been associated with its use yet and it remains an area prioritized for research.

Objective: To establish the effects of Hyoscine Butyl-bromide in the outcome of labour among primiparous women delivering at the Jos University Teaching Hospital (JUTH) and to contribute towards the management of these patients.

Design: This was a hospital-based double-blind placebo-controlled clinical trial

Methodology: In this study 120 women were recruited by convenience sampling and randomized into the 3 arms of the study. One arm received placebo, 2^nd arm received 20mg of Hyoscine-Butyl Bromide and the 3^rd arm received 40mg of Hyoscine-Butyl Bromide (HBB). Their labours were managed actively and outcomes were documented in a proforma. Statistical analysis was done using SPSS software version 20 and results calculated.

Results: Ninety-seven women had spontaneous vaginal delivery, 18 had Caesarean Sections and 5 had operative vaginal delivery. The mean duration of active phase of labour in the placebo arm was 325.84 minutes, it was 272.35 minutes in the 20mg HBB arm and 265.03 minutes in the 40mg HBB arm. This difference however was not shown to be statistically significant. There was no significant increase in adverse neonatal outcomes in any of the groups and there were no noted improved maternal or neonatal outcomes. Side effects were noted to be more in the 40mg HBB group.

Conclusion: There was an average of 53 minutes reduction in the duration of active phase of labour with the administration of 20mg of Hyoscine Buytl Bromide and a further average reduction of 7 minutes by an additional 20mg of Hyoscine Butyl Bromide.

There is not enough evidence from this study to recommend the use of hyoscine butyl bromide as an intervention in labour due to the absence of any beneficial effect and the presence of some unpleasant side effects.

Assessment of Antenatal Breastfeeding Education, Early Initiation and Exclusive Breastfeeding practices of mothers attending a secondary healthcare facility in Southern Nigeria

Isara AR — 2025-01-01

Background: Antenatal Breastfeeding education is teaching women about breastfeeding during pregnancy before the baby arrives. The content of breastfeeding education given to mothers during antenatal care visits can play critical role in the adoption of early breastfeeding initiation in the immediate postpartum period and subsequent increase in the rate of exclusive breastfeeding.

Objective: This study assessed the antenatal breastfeeding education, early initiation of breastfeeding and the practice of exclusive breastfeeding among mothers attending a secondary healthcare facility in Benin City, Nigeria.

Materials and methods: A cross-sectional study utilizing a mixed method approach comprising both quantitative and qualitative data collection methods. Mothers who had vaginal delivery were recruited consecutively from the postnatal ward to participate in the study. Ethical approval was obtained from the Ethics and Research Committee of Edo State Hospitals Management Board.

Results: A total of 360 mothers aged 18 to 42 years were interviewed. Majority, 334 (92.8%) received breastfeeding education while pregnant, predominantly during ANC, 309 (92.5%). The main contents of the breastfeeding education received were importance of exclusive breastfeeding, 265 (79.3%), and care of breast in preparation for breastfeeding 258 (77.2%). Only 170 (47.2%) prepared their breast for breastfeeding, 133 (36.9%) commenced breastfeeding within one hour of delivery, while 276 (76.7%) practiced exclusive breastfeeding at 6 weeks postpartum.

Conclusion: This study showed that the content of breastfeeding education given to mothers was inadequate. The preparation of the breast for breastfeeding was inadequate and early initiation of breastfeeding following delivery was low. But the rate of exclusive breastfeeding at 6 weeks postpartum was encouraging.

Knowledge of clear aligner therapy in orthodontics among dental practitioners in Benin city, Nigeria

Otaren NJ — 2025-01-01

Background: Clear aligners have been used in orthodontics since 1946 when Dr Harold Kesling introduced the use of a series of thermoplastic tooth positioners to obtain tooth alignment.

Aim: The aim of this study is to assess the knowledge of clear aligner therapy among dental practitioners in Benin City, Nigeria.

Methods: This cross-sectional study was carried out among Dental practitioners in Benin City, Nigeria. The study population consisted of Dental practitioners in both private and government hospitals in Benin City, Nigeria. Twenty-nine (59.2%) were dental officers, while 20 (40.8%) were dental resident doctors of the University of Benin Teaching Hospital, giving a total population of 49. The study instrument was a self-administered questionnaire. Data was computed and analyzed using SPSS version 21.0 software. Statistical significance was set at P<0.05.

Results: Forty- nine (49) respondents constituted the study participants. The mean age of the study participants was 34.14±4.3 years. Majority of the respondents know about clear aligners. The resident doctors had a higher population of knowledge of clear aligners (95.0%), but there was no statistically significant difference between the two groups (P>0.05). Majority of the respondents believe that clear aligners cannot correct all types of malocclusion.

Conclusion: This study carried out among dental practitioners in a Nigerian population showed that majority of them know about clear aligners, and most of them got the information from friends.

Evaluation of cosmetic outcome and patient satisfaction following adhesive strips and staples wound closure in primary total knee arthroplasty

Essien UE — 2025-01-01

Background: Most surgical wound closure techniques include using materials that may require removal after surgery. Surgical skin sutures and staples are popular skin closure materials that require removal after surgery and are usually associated with patient discomfort and crosshatching of the skin.

Adhesive strips are a newer, non-invasive technique for skin closure in orthopaedic procedures, and they have been documented to have fewer wound-related complications.

The cosmetic scores of surgical scars can be assessed by the Hollander Wound Evaluation Score (HWES), the visual analogue scale (VAS), and the numeric rating scale (NRS).

Objective: Patient satisfaction with surgical scars between adhesive strips and skin staples was compared via the Hollander wound evaluation score, visual analogue scale score, and Numeric rating scale score. To compare wound cosmesis between adhesive strips and skin staples using the Hollander wound evaluation score and visual analogue score. To compare pain on removal of wound closure material using the numeric rating scale.

Method: Group A received skin closure with adhesive strips, whereas Group B received skin closure with staples. In week 2, the assessment of discomfort from removing coaptive material for patients in groups A and B was performed using the numeric rating scale score. At week 6, the surgical scar was assessed using the VAS score and the HWES. The outcome measures were scar cosmesis and pain score on the removal of skin closure material.

Results: There was a statistically significant difference in the NRS score with participants in the adhesive strip group having a lower score, with a P value of 0.000 (<0.05). The VAS score and HWES were higher in the adhesive strip group than in the skin staple group, with a P value of 0.000 (<0.05).

Conclusion: Patients in the adhesive strip group experienced less pain and discomfort at strip removal and were more satisfied with their scars. The cosmetic scores for scars in the adhesive strip group were significantly higher than those in the skin staple group.

Sexual practices and risky sexual behaviours among public secondary school adolescents in a local government area in Ekiti State, Nigeria

Ojo JO — 2025-01-01

Background: Sexual practices and risky sexual behaviours among adolescents have great consequences on their health, well-being, and career prospects. We assessed sexual practices and risky sexual behaviours among public secondary school adolescents in Ido/Osi Local Government Area, Ekiti State, Nigeria.

Methods: A cross-sectional study was conducted among 400 in-school adolescents selected using multistage sampling. Data was obtained using semi-structured self-administered questionnaires developed by the researchers after consulting several literatures. Data was analyzed using IBM SPSS software version 25.0.

Results: The mean age ± standard deviation of the respondents was 14.5 ± 2.0 years and 55.5% of them were females. About one-third, 31.3% of respondents have had a boyfriend/girlfriend. Out of these, 41.2% and 5.0% had 2 and 3 boys/girlfriends respectively. About one-quarter, 23.2% had ever touched someone’s genitals (vagina or penis) while 22.6% had ever masturbated.

About one-fifth, 22.1% of the respondents had been exposed to sexual intercourse, during their first sexual intercourse, 75.0% had it willingly, 17.9% were self-persuaded and 7.1% had forced sex. Out of the sexually exposed, 9.5% had their first sexual experience with a stranger, 16.7% had multiple sexual partners, 25.0% inconsistently made use of condoms and 46.4% had engaged in sex in exchange for material/ financial gains.

Conclusion: About a third of the adolescents have had a partner while one-fifth have been exposed sexually with a huge proportion (25%) at risk of sexually transmitted infections and unwanted pregnancy due to their inconsistent use of condoms. We recommend sex education in secondary schools as well as strategies that will encourage safe sexual practices among adolescents.

Prevalence of Probable Sarcopenia and Associated Lifestyle Factors among Elderly Retired Nigerian Soldiers

Ajuonuma FO — 2025-01-01

Background: Probable Sarcopenia is the age-related decline in muscle strength. It is a pre-sarcopenic state that is amenable to lifestyle modification. This study aimed to determine the prevalence of probable sarcopenia and the modifiable lifestyle factors associated with it among the elderly retired Nigerian soldiers.

Methodology: The study was a hospital based cross sectional study. Eligible participants were recruited for the study using a systematic random sampling method. A total of 327 participants were recruited for the study. Data on demographic characteristics and lifestyle risk factors were obtained. Probable sarcopenia was diagnosed by low grip strength. Frequency of the risk factors were determined, Chi square test was used to test for the association between the risk factors and probable sarcopenia. Multivariable logistic regression analysis was used to identify the independent predictive risk factor associated with probable sarcopenia among the participants.

Result: The proportion of the study participants found to have probable sarcopenia was 63.3%. Lack of regular physical exercise was the only lifestyle risk factor that showed significant association with probable sarcopenia (P < 0.05). Multivariable logistic regression analysis showed that lack of regular physical exercise is an independent predictor of probable sarcopenia among the participants.

Conclusion: There is a high prevalence of probable sarcopenia among elderly retired Nigerian soldiers. Routine screening by healthcare providers with hand-held dynamometer is recommended for its early identification and adoption of regular physical exercise as a lifestyle after retirement can prevent its progression.

Mitigating Mercury Chloride-Induced Spleen Toxicity in Wistar Rats: The Efficacy of Newbouldia laevis Ethanol Extract

Calmday-Ombo D — 2025-01-01

Background: Mercury chloride toxicity poses significant health risks, particularly affecting organs such as the spleen. Newbouldia laevis is reputed for its medicinal properties, yet its potential to counteract mercury chloride-induced splenic toxicity remains largely unexplored. This study investigated the effects of ethanol extract of N. laevis on mercury chloride-induced spleen toxicity in Wistar rats.

Method: Eighteen adult Wistar rats, weighing between 160g and 200g, were randomly divided into six groups of three rats each. Group A served as the control, while Group B and C received 250mg/kg and 500mg/kg of N. laevis ethanolic extract, respectively. Group D and E were treated with 250mg/kg and 500mg/kg of the extract combined with 4mg/kg of mercury chloride, respectively, and Group F received 4mg/kg of mercury chloride only. After 28 days of treatment, the rats were sacrificed under chloroform anesthesia. Blood samples were collected for hematological analysis, and the spleens were harvested for histological assessment.

Results: The results indicated a significant decrease in white blood cell count in the group treated with 500mg/kg of the extract alone, while other hematological parameters remained unchanged. There were no significant changes in body and organ weights, except for a decrease in body weight in the 500mg/kg extract-only and 250mg/kg + mercury chloride groups. Histologically, mercury chloride induced splenic necrosis and follicular hypertrophy, whereas the extract showed no effect on the follicle but caused red cell sequestration.

Conclusion: Combined treatments displayed varying effects, with a low extract dose and mercury chloride showing a normal follicle but increased red cell sequestration. These findings suggest that Newbouldia laevis offer protective properties against mercury chloride-induced spleen damage.

Assessment of Lipid Profile among Women with Malignant and Non-malignant Breast Lesions in a Tertiary Hospital, Nigeria: A Pilot Study

Ajeigbe AK — 2025-01-01

Context: Breast cancer (BC) is the most common cancer in women. Reports suggest a possible relationship between lipids and BC; but the pattern of lipid profile in breast lesions is unknown.

Objective: to evaluate the lipid profile of women with BC and compare with benign breast lesions and controls.

Study design: Women (107) undergoing breast imaging in Ile-Ife were enrolled for this pilot study and stratified into BC, benign breast lesion (BBL), and controls. Information was obtained by a structured proforma followed by anthropometric measurements and the collection of blood for lipid assays (Total cholesterol [TC], triglyceride [TG], and high-density lipoprotein cholesterol [HDLc]) done on an autoanalyzer. Very low-density lipoprotein cholesterol (VLDLc) and Low-density lipoprotein cholesterol [LDLc] were calculated using the Friedewald equation. Mean serum concentrations of lipids were considered as normal, low, or high using standard cutoff. Data was analyzed by SPSS 22 using ANOVA. P < 0.05 was considered significant.

Results: Women with BC were significantly younger (51.6±10. 3 vs 62.5±9.5 and 59.0±12.7 years), and had significantly lower mean TG (1.1±0.4 vs 1.5±0.7 and 1.4±0.5 mmol/L), VLDLc (0.51±0.19 Vs 0.69±0.32 and 0.62±0.25 mmol/L) and HDLc (1.1±0.4 vs 1.4±0.3 and 1.5±0.3 mmol/L) than BBL and controls respectively. P < 0.05 However, women with BBL had significantly higher mean TC (6.0 ±1.2 vs 4.8±1.1 and 5.2±1.1 mmol/L), LDL-c (3.9±1.3 vs 3.2 ±0.9 and 3.2±1.0 mmol/L) respectively. P < 0.05

Conclusions: The BC group had hypoalphalipoproteinaemia while the BBL group had hypercholesterolemia. The dyslipidemia in BC is an independent cardiovascular risk factor.

Quality assessment of packaged water brands in a university teaching hospital in southern Nigeria

Ekanem AM — 2025-01-01

Background: Every year, globally, high rates of morbidity and mortality from waterborne diseases are reported due to non-compliant packaged water that fails to meet recommended safety standards. While studies have assessed the quality of drinking water in communities, researches on water quality in healthcare facilities are scarce. Healthcare facilities must ensure safe drinking water sources, to prevent complicating patient illnesses or prolonged hospital stay.

Objective: This study aimed at determining the conformity of bottled and sachet water brands available in the University of Uyo Teaching Hospital to both national and international guidelines for drinking water quality.

Methodology: This was a facility based descriptive cross-sectional study involving the physicochemical and biological analysis of 10 randomly selected packaged water (5sachet and 5 bottled water) brands. Results of analysis were compared with values in WHO Guidelines and the Nigerian Industrial Standards for Drinking Water Quality.

Results: Physical analysis of the water samples revealed no abnormalities. Electrical conductivity, total dissolved solids and magnesium hardness were increased in both bottled and sachet water brands. 60% of the sachet water samples showed evidence of gross bacterial contamination (>50cfu/ml) while 20% of the bottled water samples were grossly contaminated.

Conclusion: Sachet water brands failed to meet minimum standards in most of the parameters assessed. In contrast, bottled water brands were found to be of relatively safer quality. Bottled and sachet water brands sold in the healthcare facilities should undergo regular quality analyses to ensure patient safety.

Impact of canalplasty on the surgical outcomes of type-1 tympanoplasty: experience in a tertiary care teaching hospital

Das SR — 2025-01-01

Context: Canalplasty restores the normal width and shape of the external auditory canal (EAC) for passage of sound. It is required as a co-surgical procedure with tympanoplasty in some cases; where the entire tympanic membrane and anulus cannot be seen during surgery due to the bony overhang or narrowing.

Objective: The aim of the study was to determine the surgical outcome of canalplasty in patients with CSOM undergoing type-I tympanoplasty. Widening of the external auditory canal, called canalplasty helps in a better placement of the tympanic membrane graft with a better visualization and with a correct understanding of the effect of canalplasty on the outcome of type I tympanoplasty.

Methods: A total of 110 patients diagnosed with chronic otitis media mucosal disease with a central dry perforation involving the tympanic membrane were included. The group A included 55 cases that underwent tympanoplasty with canalplasty; while the group B with 55 cases underwent tympanoplasty without canalplasty.

Results: Analysis was done for graft uptake, hearing improvement and time taken for the postoperative recovery. In terms of graft uptake, both groups achieved a success rate of 98.2%. The improvement in postoperative hearing in cases with canalplasty was statistically significant p<0.05. Time taken for complete postoperative recovery in the two groups was statistically insignificant.

Conclusion: Anatomical and technical factors diversely affect the functional outcome of tympanoplasties. Canalplasty helped in a better visualization and placement of the graft. Time spent on drilling in canalplasty was compensated by the time gained in grafting of the neo-tympanum. The procedure prevented graft lateralization due to the accurate exposure of the annulus. Postoperative care was easier in cases of tympanoplasty with canalplasty.

Association between prostate-specific antigen density and prostate cancer prediction among Nigerian men

Abudu EK — 2025-01-01

Background: Prostate - specific antigen density (PSAD) has been shown as a valuable diagnostic and predictive tool for prostate cancer.

Objectives: To ascertain the utility of PSAD in predicting prostate cancer in patients with PSA > 4 .0 ng/ml.

Subjects & Methods: The study was an analytic cross-sectional study comprising 382 patients at the University of Uyo Teaching Hospital with PSA levels of > 4.0 ng/ml and normal or abnormal digital rectal examination findings. PSAD was computed and transrectal ultrasound guided prostate biopsies were performed. Statistical analysis was done using a statistical package for social sciences version 24 (SPSS, IBM, Chicago, IL, United States). Appropriate test statistics including mean, standard deviation, Chi-square, t-test, Fischer’s exact test, Pearson’s r-test) with p-value < 0.05 considered as significant.

Results: The mean age for all the patients was 55.7 + 2.6 year while the mean ages of 52.9 + 3.3 years and 65.1 + 11.3 years were for patients with benign and malignant prostate diseases respectively. 26.2 % were adenocarcinomas. The mean and median of PSAD for prostate cancer were 0.31 + 0.23 and 0.31 ng/mL/cm3 respectively. PSAD had positive predicting association with prostate cancer risk (p=0.004) using univariate logistic regression. The Area Under the Curve (AUC) and optimal cut-off point for the PSAD was 0.9 (95% CI: 0.83–0.97) and 0.052 respectively, indicating strong diagnostic performance for predicting prostate cancer. PSAD showed statistical significance in cancer detection (p < 0.001) with a detection rate, sensitivity and false positive rate of 90.0 %, 85.0 % and 8.0 % respectively.

Conclusion: A PSAD of 0.052 ng/ml/cm³ can be used as a cut-off value to predict prostate cancer when evaluating patients with raised PSA in our population.

Viable ectopic pregnancy with hemoperitoneum

Obiozor CG — 2025-01-01

Pregnancy is said to be ectopic when it occurs outside the uterus, most commonly in the fallopian tube. There is high index of suspicion when a pregnant woman experiences any of these symptoms in the first trimester: vaginal bleeding, lower abdominal pain, and amenorrhea. An elevated BhCG level above (2000 mIU/ml) with an empty uterus on a transvaginal ultrasound is necessary for confirming ectopic pregnancy diagnosis. Ectopic pregnancy can be managed medically with methotrexate or surgically via laparoscopy or laparotomy depending on the hemodynamic stability of the patient and the size of the ectopic mass.
We present a case of a left-sided viable ectopic pregnancy with massive hemoperitoneum in a 31-year-old primigravid female, who presented to a peripheral radiological centre in Umuahia Abia state with history of amenorrhea for two months severe abdominal pain and signs of hypovolemic shock. The patient was scanned trans-abdominally and findings revealed an empty uterine cavity and a live11 weeks fetus (measured by CRL), The fetus was seen within a gestational sac in the left side of the abdominal cavity floating in a free fluid in keeping with ruptured tubal ectopic pregnancy of 11wks duration. The patient underwent urgent exploratory laparotomy which revealed a ruptured left tubal ectopic pregnancy with significant intra-abdominal haemorrhage. Surgical intervention was successfully performed, culminating in the removal of the ectopic pregnancy, salpingectomy and hemostasis of the bleeding vessels. The patient recovered well postoperatively and was discharged with appropriate follow-up care. This case highlights the importance of early recognition, radiological evaluation and prompt management of ectopic pregnancies to prevent life-threatening complications.

Impalement injury to the head with intact neurology following spontaneous Dane gun explosion: Two case reports and review of the literature

Yahaya A — 2025-01-01

Introduction: Impalement brain injury is a complex brain trauma resulting from unusual mechanisms, especially in areas bedevilled by civil unrest.

Objective: To describe the successful management of impalement head injury in our centre.

Case description: A 22 and 18-year-old man presented with altered consciousness following head trauma by a recoiled metallic part of the Dane gun. Clinical and radiological evaluations were in keeping with the impalement head injury. They were successfully managed by foreign object retrieval, antibiotics, and anticonvulsants and discharged home with no neurological deficits.

Conclusion: The two cases of impalement head injury had remarkable recovery following prompt surgical removal, antibiotics and wound care.

Spontaneous bilateral chronic subdural haematoma in an 8-month-old male with osteogenesis imperfecta: A case report

Ekpene UU — 2025-01-01

Osteogenesis imperfecta is a rare inherited collagen disease that presents most commonly with increased bone fragility. We present an 8-month-old male child with a 5-month history of progressive abnormal increase in the size of the head and a history of multiple long bone fractures not preceded by trauma and blue sclerae. Cranial CT scan showed bilateral frontoparietal chronic subdural haematoma. X-rays of the limbs showed healed left humeral and right femoral fractures.

He underwent bilateral burrhole and drainage of haematoma with a good postoperative outcome.

Osteogenesis imperfecta with spontaneous bilateral chronic subdural haematoma is rare, thus informs this case report.

Case presentation: Breast abscess

Obiozor AC — 2025-01-01

Background: Breast abscess is a localized collection of pus within the breast tissue, often caused by bacterial infection like staphylococcus and salmonella organisms. It typically arises as a complication of mastitis. Breast abscesses, although more prevalent in lactating women, can occur in non-lactating women like in this case presentation and can pose a diagnostic challenge. Predisposing factors includes trauma to the breast, breast surgery, or preexisting conditions like diabetes or immunosuppression. Clinically, a breast abscess presents with symptoms such as localized pain, swelling, redness, and sometimes fever and malaise. Diagnosis, is primarily based on clinical examination, laboratory tests and imaging studies, such as mammography, ultrasound in order to confirm the presence and extent of the abscess. Treatment involves antibiotics to address the infection and drainage of the abscess, either through needle aspiration or surgical intervention, to remove the pus and alleviate symptoms. Prompt treatment is crucial to prevent complications such as sepsis or chronic infection. The prognosis is generally good with timely and appropriate management, although recurrence can occur.

Methods: This case report presents the radiological evaluation of a breast abscess in a 25-year-old non-lactating woman who presented in a radio-diagnostic centre in Umuahia with complaints of breast swelling, breast pain and fever for one week. Consent was taken from the patient and clinical examination revealed a small skin ulceration over the right breast mass, febrile patient with temperature of 38 degrees centigrade, laboratory test revealed elevated leucocytes with white blood cell count of (15,000/µL) and neutrophilia., fine needle aspiration biopsy/culture revealed staphylococcus aureus, imaging modalities, including mammography revealed a radio-dense mass in the right breast middle ring. Ultrasound revealed a Hypoechoic mass with thick wall, internal echoes and posterior acoustic enhancement with surrounding area of increased vascularity in the upper outer quadrant middle ring which is consistent with an abscess cavity. The diagnosis of breast abscess was confirmed, and appropriate treatment was administered.

Conclusion: This report aims to underscore the crucial role of radiological assessment, laboratory tests in diagnosing breast abscesses, thereby facilitating prompt and effective management.