Ibom Medical Journal

Systematic Review of Work-life Balance among Early Career Doctors

Soneye O. Y. — 2023-01-01

Background: Early Career Doctors (ECDs) are medical doctors who are in their internship, postgraduate specialist training and medical/dental officers below the rank of principal medical/dental officers. The long hours of work, staff-shortage and various expectations at this formative stage expose ECDs to potential negative outcomes including poor work-life balance.

Methods: This systematic review included all available original articles on the work-life balance among ECDs world-wide between 2006 and 2020. PubMED, Google Scholar and African Journals Online (AJOL) databases were searched, and the review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results: The literature search yielded 145 articles, and after screening 33 articles were included in this review. Twenty (87.9%) of the studies were cross sectional studies, 5 (15.2%) were prospective cohort studies and 1 (3%) was an interventional study, sample size ranged from 21 to 4,581 ECDs with a mean age range 24-35±7yrs. Positive work-life balance was reported among ECDs in 4.7% Karachi, 21% Ireland, 23% USA, 27% Australia; major determining factors include work-load and burn-out, female gender, specialty and location of practice, flexibility of work schedule; and the impacts are burn-out and reduced career satisfaction.

Interpretation: Work-life balance among ECDs is poor worldwide, and is worse amongst the more junior cadre and female gender. It is recommended that reduction in work hours, improved wages, social and organizational support could improve the quality of work-life balance among ECDs.

Pneumococcal vaccine uptake and its associated factors among adult patients with congestive cardiac failure seen in a tertiary facility in Lagos, Nigeria

Ajibare A. O. — 2023-01-01

Background: Patients with congestive cardiac failure (CCF) are at increased risk of morbidities and mortality associated with pneumococcal infections and thus should be vaccinated against Streptococcus pneumoniae. However, there is dearth of scientific data on pneumococcal vaccine uptake in this environment. This study set out to assess the vaccination status and its associated factors among CCF patients in Lagos State University Teaching Hospital (LASUTH), Lagos, Nigeria.

Methodology: A questionnaire based cross-sectional study of one hundred patients with CCF conducted at the adult cardiology out-patient clinic of LASUTH between December 2021 and March 2022. Socio-demographic and clinical characteristics were recorded as well as Pneumococcal vaccination status, source of vaccination, challenges and reasons for non-vaccination. The likelihood of recommending vaccination for others was also obtained.

Results: The mean age of the study population was 51.55±16.36 years (range 21-78 years). The male to female ratio was 56:44. Pneumococcal vaccination rate was 9% with only 4% fully vaccinated. Lack of information about vaccine was the commonest reason for non-vaccination. Healthcare providers were the source of vaccine information in only 58% of the vaccinated subjects. Majority of the vaccinated respondents (67%) had their vaccines outside the country and most of them will likely recommend vaccination to others.

Conclusion: Pneumococcal vaccination rate among CCF patients was poor. Better patients’ education and prompt vaccine recommendation by the managing physicians will improve vaccination uptake. A National guideline for adult pneumococcal vaccine in Nigeria is desirable.

Dental caries; its sequelae and treatment among patients in a tertiary hospital in north–western Nigeria: A retrospective study

Bala M — 2023-01-01

Background: Dental caries has been the most prevalent dental disease that affect human dentition. Lack of early visitation to the dentist and, awareness could lead to tooth mortality. This study aims to describe the pattern of dental caries, sequelae and, treatment among patients attending the dental clinic of Yariman Bakura Specialist Hospital Gusau (YBSH).

Materials and method: This is a 4year retrospective study conducted at YBSH Gusau. After obtaining ethical approval from the Hospital’s Research and Ethics committee, patients’ case notes from 18 years who were treated for dental caries and sequelae were retrieved. Demographic variables, presenting complaints, the number of carious teeth, frequency of teeth brushing, history of dental visitation, diagnosis and, the treatment offered were also recorded. Data recorded were analyzed using SPSS version 25.

Result: There were 100 (40.3%) males and 148 (59.7%) females in the age range of 18 –78 years with a mean±SD of 36.4±12.3years. Toothache in 159 (64.1%) was the main presenting complaint and, 168 (67.7%) of the study population visited a dentist for the first time. The majority 212 (85.5%) of the patients brush their teeth once daily. Permanent mandibular first molar 103 (41.5%) was the highest tooth affected by caries and apical periodontitis 66 (26.6%) constitute the majority of diagnoses. Dental extraction 171 (69.0) was the most treatment done.

Conclusion: Dental caries is a major public health problem that could lead to sequelae with life threatening consequences. Majority of those affected had not visited dentist before and could only afford tooth extraction as their preferred treatment option. Poor access to dental facilities and lack of awareness could have been the barrier to early presentation.

Anthropometry of thyromental distance of adult Ibibios and Annangs in Akwa Ibom State, Nigeria

Ekanem A. U. — 2023-01-01

The thyromental distance (TMD) is defined as the distance from the thyroid notch to mental prominence with the head fully extended. The objective of this study was to investigate thyromental distance among adults of Ibibio and Annang Ethnic groups of southern Nigeria. A total of 600 volunteers consisting of 313 (52.2%) males and 287 (47.8%) females, aged between 21-50 years were measured. Annang males and females had higher thyromental distance of (7.27 ± 0.06 cm; 6.91±0.05 cm) compared to the Ibibio males and females (7.13±0.06cm; 6.82±0.05 cm), respectively. The mean thyromental distance of the Annang subjects was significantly higher at p˂ 0.03 than that of the Ibibio adults. In most cases the highest mean thyromental distance was recorded within the 31-40 years age range.

The Coronavirus Disease Pandemic and the Basic Reproduction Number (R0) in Nigeria: What Does the Data Reveal?

Onwube O — 2023-01-01

Nigeria continues to record increasing number of persons infected with the coronavirus disease. Within the African region, Nigeria has the second-highest number of infected persons after South Africa, representing 9.95% of the region’s total coronavirus disease cases as at June 1, 2020, despite its strict containment measures. With the fears of a second wave of the coronavirus (the COVID-19 Delta Virus), another lockdown might likely be. But can we establish a correlation between infected persons and those prone to infection (susceptible) as well as the correlation strength in Nigeria? Using both a descriptive and econometric technique, the study analyzed the reality of the transmission rate and the rising figures of the coronavirus infections and found that there exists a weak correlation between the infected and the susceptible and that the basic reproduction number (R0) is less than 1 suggesting that the rate of transmission is low and the virus might not be endemic. The study, therefore, recommends that the containment measures of sanitizing/washing hands, physical distancing, and using face coverings are just enough to stem the tide. However, sustained lockdown measures will be too costly for the economy and a second lockdown will be highly unnecessary.

Sonographic Measurement of the Spleen in the healthy adult Nigerian Population in Enugu State, Nigeria

Anthony, A. Obiozor — 2023-01-01

Context: measurement of the spleen with ultrasound in order to obtain normal lengths (nomogram) is possible because ultrasound is devoid of ionizing radiation, it is real time, readily available, cheap easily reproducible and has high specificity and high sensitivity values.

Aim: Sonographic measurement of the spleen was carried out in 500 healthy adult Nigerians in Enugu State in order to determine the nomogram for the spleen and to correlate the measurements with the sex, age, height, weight and body mass index, so as to find out whether there is a significant difference in the size of this organ as compared to other races in the reviewed literature.

Materials and Methods: Measurement of the spleen was carried out in 500 healthy adult Nigerians comprising 195 males (39%) and 305 females (61%). The individuals were not less than twenty (20) years as at the time of data collection. The data was analyzed using SPSS statistical package version 20.0. The mean, median, variance, standard deviation of the spleen sizes were evaluated and correlated with the age, sex, weight, height and body mass index of the subjects.

Results: the mean splenic length for males was 104.1±14.5mm and 103.3±13.4mm for females with P values of 0.515. The mean splenic width was 62.9±12.8mm for males and 60.3±10.6 for females with P values of 0.013 which is significant showing that males have longer splenic width than females. There was a significant relationship between age and spleen width in both sexes with P values of 0.001. There is also a significant correlation of the spleen dimension with body mass index in both sexes with P values <0.05. Furthermore, the result shows that there was a correlation of the splenic length and width with age. There was also positive correlation of the splenic length with Body Mass Index P values 0.014, height P values 0.000 but not with subject’s weight P values 0.311.

Conclusion: There is significant correlation of the spleen width with height, weight but not with body mass index. Males have greater splenic width than females. There is also a significant correlation of the splenic length and width with age.

Prevalence of pain among adult patients living with HIV in Uyo, South-South, Nigeria

Etta O. — 2023-01-01

Background: HIV infection is a major global public health issue. Pain is a common and debilitating symptom of HIV disease which is gravely underestimated and treated.

Patients And Methods: This was a cross-sectional survey conducted at the HIV Clinic of the University of Uyo Teaching Hospital, after obtaining approval from the Research Ethical Committee. Data was obtained using a Data Sheet and Brief Pain Inventory (BPI) questionnaire. Information obtained included demographic characteristics, duration of infection, clinical stage and treatment. The BPI asked patients to report if they experienced pain, pain score, treatment and interference with their quality of life.

Results: A total of 210 patients participated in the study, 60 males and 150 females, the prevalence of pain was 29.5%, and the average duration of pain was 4-9 months. The commonest site of pain was waist (39.3%), followed by headache (13.1%), neck (11.5%) and Knee (11.5%). Majority of the patients (53.4%) rated their average pain between 1 – 4 on the numerical rating scale. Most of the patients received over the counter analgesics (29.5%) while 27.9% did not take any medication at all. Majority of the patients with pain had mild interference with their quality of life.

Conclusion: The Prevalence of pain among adult HIV Patients is high and grossly undertreated. Training of health workers in pain management may improve the situation.

Minimizing adverse effects of subjective measurement of endotracheal tube cuff pressure: Can the use of the loss of resistance technique help?

Mamuda A — 2023-01-01

Background: Appropriate endotracheal tube cuff (ETTc) pressure estimation is essential to prevent airway complications. The pilot balloon palpation technique is the commonly used method of cuff inflation. It is however subjective thus prone to over or under estimation thus unreliable.

Objective: To determine if the use of the passive release technique of cuff inflation would reduce commonly encountered airway complications following ETT intubation.

Methodology: Patients scheduled for elective procedures under general anaesthesia with ETT were recruited into the study, 108 ASA I and II patients aged between 18-65 years were randomized into 2 groups with one group having their cuff inflated using the pilot balloon palpation (PBP) technique and the other by the use of a loss of resistance syringe (LOR). Airway complications were then assessed and compared between the 2 groups.

Results: The incidences of sore throat, cough and hoarseness were significantly lower in the LOR group compared to the PBP group (35.2vs79.6%, 14.8 vs64.8% and 7.4 vs 79.6% respectively; p = 0.0001 in each case).

Conclusion: Passive release technique using LOR was found to be less associated with post-endotracheal intubation airway complications than PBP technique

A retrospective autopsy-based survey of fatal traumatic brain injuries in Benin City, Nigeria

Udoh M. O — 2023-01-01

Background: Traumatic brain injury (TBI) is major cause of death in young adults. It results from external force to the head causing injury to the contents of the skull with or without damage to the skull itself.

Aims and objectives: To describe the autopsy findings in patients with Traumatic brain injuries.
Materials and Methods: A Retrospective Study of findings in patients who suffered Traumatic Brain Injuries as seen at autopsy. The historical and autopsy data of all Traumatic brain injury patients whose bodies were received between 2011 and 2021 were analyzed.

Results: TBIs account for 66.7% of traumatic deaths in our institution. Male to female ratio was 1:0.22, and mean age was 39.30±16.65 years. The most common cause of TBI was road traffic accidents (90.9%), with gunshots (5.6%) as a distant second. Intracranial hemorrhages were present in 99.6% of cases and almost all (98.8%) died as a result of Raised Intracranial pressure associated with intracranial hemorrhage. The most common pattern was Subdural hemorrhage (62.65%); followed by Subarachnoid hemorrhage (52.35%); Intraparenchymal hemorrhage (40.88%), Epidural hemorrhage (18.24%); and intraventricular hemorrhage (9.71%). Skull fractures were present in 41.6% of cases.

Conclusion: RTA is the most common cause of traumatic brain injury in our study and the leading cause of traumatic deaths. Multiple injuries appears to contribute less to mortality amongst our TBI patients but this may be due to under reporting of injuries found in polytraumatized patients. Morbidity and mortality due to TBI, and trauma in general, will be reduced by improving road safety, and functional protocols for emergency and prehospital care of trauma patients.

Prevalence, pattern and factors associated with undernutrition among Primary school aged children in Rivers State Nigeria

Osaro B. O — 2023-01-01

Background: Undernutrition among children contributes to the high diseases burden in Nigeria and other developing countries undergoing nutritional transition. It presents as underweight, stunting and thinness/wasting.

Objective: This study looked at the pattern of undernutrition among primary school aged children in Rivers State.

Materials and Methods: This is a cross-sectional descriptive study among primary school-aged children in Rivers State Nigeria recruited through a multistage sampling method. Information on socio-demography, dietary habit and physical activity of the pupils were obtained from parents who gave informed consent while weight and height measurements were carried out directly on assenting pupils. Data was analyzed using IBM SPSS Statistics version 23 and WHO Anthroplus software. Results were presented in frequency table. Test of statistical significance was done at P < 0.05

Results: A total of 465 pupils aged 5 – 13 years participated in the study. Mean age was 8.64 ± 0.113 years.
Twenty-nine (6.2%) of the pupils were stunted, 8 (1.7%) were severely stunted; 19 (4.1%) were thin/wasted and 18 (3.9%) were severely thin/wasted; 12 (3.1%) were under-weight and 4 (1.0%) were severely underweight. Stunting and underweight were associated with type of school, place of residence, class of pupils, occupation and level of education of parents (P < 0.05); thinness/wasting was associated with only birth order (P < 0.05). Undernutrition was not associated with physical activity and dietary habit.

Conclusion: Stunting was the commonest pattern of undernutrition among primary school age children in Rivers State Nigeria followed by underweight and thinness/wasting.

Dental treatment needs among students with disabilities in Sokoto, Nigeria

Ogbeide M. E — 2023-01-01

Background: Individuals with disabilities experience more dental problems and have more unmet dental needs, and face additional challenges accessing dental treatments. It is imperative therefore to carry out a study that would assess the dental treatment needs of this vulnerable population to aid the planning of appropriate oral health programs tailored towards their peculiarities.

Objective: To determine the dental treatment needs among students with disabilities in Sokoto, Nigeria

Methods: The study was a descriptive cross-sectional survey conducted in Sokoto State among students with disabilities. IBM SPSS version 23.0 was used to analyze data via descriptive statistics. The results were displayed in charts and frequency tables.

Results: Two hundred and thirty-six students with disabilities, 69 (29.2%) females and 167 (70.8%) males were recruited in the study. Preventive treatment need was the most required treatment need 65 (27.5%), it also accounted for the highest mean number of teeth per subject (0.86 ± 1.80) requiring treatment. The hearing-impaired group required the most treatments across the various treatment types [i.e. preventive treatment needs 26 (40.0%), conservative treatment needs 31 (53.4%), endodontic treatment needs 8 (44.4%), oral surgery treatment needs 13 (44.8%)], except in the prosthodontic treatment needs, which was required more by the intellectually impaired group 8 (42.1%).

Conclusion: The present study shows high dental treatment needs among students with disabilities in Sokoto, with preventive and restorative treatments accounting for the bulk of treatment required by the study population. The Hearing-impaired group had the most required treatment needs compared to others.

Occupational Exposure to Waste: Effect on Weight, Pre-diabetes, Cough and Flu in a waste-treatment Facility in Lagos, Southwestern Nigeria

Yahaya T. — 2023-01-01

The Simpson Transfer Loading Station in Lagos, Nigeria, was established to treat and reduce waste volume before being transferred to permanent dumpsites. This study determined the demographic characteristics of workers and the effects of occupational exposure to waste in the facility. Structured questionnaires were used to collect demographic data from 21 study participants, including age, gender, educational level, and frequent diseases expressed. After that, the body mass index (BMI) and fasting blood glucose of the participants were measured using a glucometer. The results showed that 18 (85.71%) of the respondents were male, while 3 (14.29%) were female. Most of the respondents were in the age class 31–40 years old, with 11 members (52.38%), followed by the age class > 40 with 7 representatives (33.33%), and the age class 21–30 with 3 members (14.29%). Respondents with primary education made up 2 (9.52%) of the total, those with secondary education made up 6 (28.57%), and those with tertiary education consisted of 13 members (61.90%). Four (19.01%) of the respondents had normal body weight, 9 (42.86%) were overweighed, and 8 (38.10%) were obese. Fifteen (71.43%) of the respondents had normal blood glucose, 5 (23.41%) were pre-diabetic, and 1 (4.76%) was diabetic. One (4.76%) of the respondents reported headache, 7 (33.33%) complained about flu, and 13 (61.90%) reported cough. It can be inferred from the results that occupational exposure to waste had negative effects on the workers. Management and workers in the facility need to take steps to reduce occupational exposure to waste and prioritize personal hygiene.

Medical Brain Drain in Nigeria: A Health System Leadership Crisis

Ipinnimo T. M. — 2023-01-01

The problem of shortage of healthcare professionals in sub-Saharan Africa including Nigeria which has about 25% of the global disease burden but less than 2% of the healthcare workforce has been further compounded by the medical brain drain. The medical brain drain in Nigeria could be attributed to the failure of health system leadership in the country that stems from poor insight and neglect of the problem. Nigeria’s healthcare professionals have been migrating in drones to the United Kingdoms, United States, Canada, Australia and other developed nations. To stem this tide, there is a need for the government at all levels to prioritize this menace on the political agenda and work in conjunction with healthcare institutions administrators, other leaders and stakeholders within the health sector to promote and improve welfare, working conditions, job security and satisfaction among healthcare workers as no other category of workers are so essential to the well-being of the people.

Complete pachydermoperiostosis with diffuse keratoderma mimicking thyroid Acropachy: A case report and review of literature

Ajani A. A — 2023-01-01

Pachydermoperiostosis (PDP) is a rare genodermatosis with prominent cutaneous, soft tissue and skeletal manifestations. It can mimic secondary causes of hypertrophic osteoarthropathy such as thyroid acropachy. Cutaneous manifestations can be debilitating and constitute critical clues to formulating an accurate diagnosis. Palmoplantar keratoderma is a seldom reported manifestation of the disease hence, its significance as a phenotypic variant of pachydermoperiostosis is unknown.
We describe a rare case of complete pachydermoperiostosis with diffuse palmoplantar keratoderma in a young African man presenting with hyperhidrosis, hyper-defecation and weight loss who had been previously misdiagnosed with thyroid acropachy. The aim is to provide a detailed clinical description of both common and unconventional features of this rare disease.
Pachydermoperiostosis manifests with diverse genotypic and phenotypic characteristics that can mimic treatable, secondary causes of hypertrophic osteoarthropathy. Keratoderma and hyper-defecation are seldom reported manifestations that may represent unique variants of PDP. Awareness of characteristic dermatological manifestations of the disease can enhance early and accurate clinical diagnosis and prevent needless investigations.

Chronic Uterine Inversion due to Sub mucous Leiomyoma: Surgical Management with Reversed Technique of Vaginal Hysterectomy

Daneji S. M. — 2023-01-01

Chronic uterine inversion is a very rare and life-threatening disease. It requires emergent treatment. Non puerperal uterine inversion is a rare clinical problem with diagnostic and surgical challenges. The patient may present with severe vaginal bleeding, discharge or pelvic pain. We are presenting a case report of a chronic non puerperal uterine inversion in a 30year old woman, she presented with vaginal bleeding, and a mass protruding from the vagina. Reversed technique of vaginal hysterectomy was done for her. Early diagnosis, immediate resuscitation and early treatment are important to prevent further complications.

Hailey-Hailey disease misdiagnosed as candidal intertrigo: Case report of a rare skin disease

Ogunoye B. T. — 2023-01-01

Hailey–Hailey disease (HHD) is a rare autosomal-dominant blistering disorder characterized by macerated velvety, fissured, hypertrophic plaques with characteristic involvement of the intertriginous areas. The diagnosis is often suspected by the clinical appearance of the lesions in intertriginous areas as well as positive family history and confirmed by histological analysis of the lesional skin biopsy. A diagnosis of HHD is rarely made in this environment due to its resemblance to other dermatoses of the intertriginous areas and the rarity of the condition itself. We present a case report of HHD, a rare hereditary disease, involving two unrelated Nigerians seen in our dermatology clinic, who were diagnosed and successfully managed at our centre.