Background: The diaphragm is a fibro-muscular partition that separates the relatively low-pressure thoracic cavity from the relatively high-pressure abdominal cavity. This difference in pressure causes transmigration of abdominal contents into the thoracic cavity whenever there is a defect, often resulting in cardio-respiratory disturbances.Objective: To describe the profile of diaphragmatic hernias managed in three tertiary hospitals in, South-East Nigeria and compare same with global outcomes.Methodology: Retrospective study of patients with different types of diaphragmatic hernias managed in three centre over a 13-year period was done. Data on demography, types of hernias, mode of presentation, diagnostic methodology, treatment offered and prognosis including complications were obtained from Record Departments of each hospital.Results: There were a total of 44 patients with male to female ratio of 9:2. The ages ranged from 21 days to 840 months. The profile of the hernias was congenital (n=8, 18.2%), acquired traumatic (n= 30, 68.2%) and acquired non-traumatic (n=6, 13.6%). Among the congenital types-four (50%) were central, three (37.5%) were posterior while one (12.5%) was anterior. In the acquired traumatic types, left side was dominant. In the hiatal hernia (acquired non-traumatic), types 1 has the highest occurrence followed by type IV. Associated injuries in traumatic diaphragmatic hernias were the determinants of morbidity.Conclusion: Thoraco-abdominal hernias as described are not uncommon in our centre. Multidisciplinary approach and functional Intensive care unit (ICU) played significant role in the outcome of congenital diaphragmatic hernias. Keywords: Profile, Diaphragm, Hernias, Enugu
Background: Retained placenta is one of the major causes of primary and secondary post-partum haemorrhage and is associated with increased risk of maternal morbidity and mortality.Objective: To determine the prevalence, evaluate the risk factor, clinical presentation and treatment outcome of retained placenta in the University of Port Harcourt Teaching Hospital (UPTH).Methodology: This was a retrospective study from January 1st, 2014 to December 31st, 2018. Relevant information were retrieved from patients’ clinical records and analysed using statistical package for social science (SPSS) version 25.Result: The prevalence of retained placenta was 0.98%. forty-six out of 50 patients (92.0%) with retained placenta had unsupervised home deliveries which accounted for majority of the risk factors. Thirty-nine (78.0%) patients presented with snapped umbilical cord, 24 (48.0%) patients with active vaginal bleeding and seven (14.0%) patients were in circulatory shock at presentation. Manual removal of placenta was carried out for all patients as the major mode of management while 21 (42.0%) patients had concomitant oxytocin administration. Thirty (60%) patients had primary postpartum haemorrhage. Twenty-six (52%) patients had anaemia at presentation while 6 (12%) and 2 (4%) patients had puerperal sepsis and genital tract lacerations, respectively. No maternal mortality from retained placenta was recorded within the study period.Conclusion: Retained placenta is essentially a disease of the unbooked patient and can lead to dire consequences. The utilization of antenatal care, skilled birth attendance and the provision of emergency obstetric care services can reduce the adverse effects of retained placenta.
Background: Adherence to standard precautions (SP) is critical to reducing the burden of nosocomial infections. Objective: We assessed the knowledge and practice of SP among healthcare workers (HCWs). Methodology: A cross-sectional study was conducted among HCWs in Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi Anambra State, Nigeria using self-administered questionnaire and key informant interview. Results: Mean age and employment duration of subjects were 33.4±11.9 and 6.0 ± 6.7 years, respectively. Majority of the 341 HCWs had heard about SP (82.1%) and agreed that it should be applied to all patient care (78.0%). Only 45.7% of them correctly cited ≥2 components of SP. Two-third of participants reported that SP was poorly practiced in their unit mainly due to inadequate supply of materials (63.1%), inadequate staff training/retraining (62.2%), inadequate support by management (51.4%) and unavailable standard operating procedures (SOPs) on SP (37.8%). Compliance with SP and specifically, personal protective equipment (PPE) use were 65.1% and 76.2%, respectively. Profession (p=0.023), awareness about SP (p<0.001), SOP display in prominent places (p<0.001) and regular supply of running water (p<0.001) were significantly associated with SP compliance. Key informant interview revealed lack of written SP policies or its communication to HCWs, lack of training/retraining of HCWs and lack of materials required for SP practice. Conclusion: Knowledge of basic concept and practice of SP was not satisfactory among HCWs. Major barriers to SP were lack of materials, training and active support by hospital management. Awareness, SOP display in prominent places and regular supply of running water positively influenced SP compliance. Having written policies and communicating such to all HCWs, consistent supply of necessary materials, intensified training, and regular supervision are recommended Keywords: Universal precautions, Nosocomial infections, Tertiary hospitals, Health Personnel, Nigeria
Background: A missed or non-diagnosed otitis media with effusion at very early age in life can impair the cognitive developmental milestone, especially hearing. Therefore, early diagnosis and treatment (medical, surgical or physiological) is pertinent. A search for an inexpensive, minimally invasive method led to the development of EarPopper®Methodology: A prospective interventional study on the use of EarPopper® in the treatment of otitis media with effusion. The EarPopper® uses the Politzer method of pressure equilibration to decongest the middle ear through the Eustachian tube.Result: Seven patients (4 males, 3 females) aged between 11 and 54 years were enrolled. Five were bilateral and 2 were unilateral (12 ears). All had type B curves and mild to moderate conductive hearing loss. The pre-therapy EarPopper Scoring System were 60-98%, while the post therapy result dropped to 0-25%.Conclusion: The EarPopper® showed a good prospect in the treatment of otitis media with effusion in an African population. Key words: Otorhinolaryngologic diseases, EarPopper Scoring System, Pilot study, Ear diseases, Otitis media
Carotid body tumour is an uncommon tumour with potential to cause marked haemodynamic instability intraoperatively and turbulent post-operative recovery. A carefully planned anaesthesia is very important for a successful peri-operative management.We report a case of a 44-year-old male that had carotid tumour excision under general anaesthesia. Nitroglycerin was used for hypotensive anaesthesia. Patient was electively ventilated post operatively in the Intensive Care Unit (ICU). Anaesthetic challenges encountered were discussed Key words: Neck, Paraganglioma, Resection, General anaesthesia
Background: Depressive disorders are the leading causes of ill-health and disability globally. Depression among adolescents is usually associated with a range of adverse later outcomes which include suicidality, and general poor physical and mental health.Objective: To determine and compare the prevalence of depressive disorders among in-school adolescents in urban and rural areas of Anambra State.Methodology: This was a cross-sectional analytical study of urban and rural in-school adolescents in Anambra State, Nigeria. A total of 1187 secondary school adolescents in government-owned schools in Anambra State was selected using multi-stage sampling technique. Patient Health Questionnaire-9 (PHQ-9) was the study instrument.Results: The mean age of the participants was 15±2 years. The overall prevalence of depression was 12.5%. The proportion of urban participants identified with depression was significantly higher than that of their rural counterparts (14.5% versus 9.6%). Multiple regression showed that increased odds of developing depression are associated with urban setting (p = 0.001), female gender (p=0.018), and late adolescence (p=0.025).Conclusion: This study showed that depressive disorders are prevalent among in-school adolescents in Anambra State, with some of the associated factors being urban setting, female gender and late adolescence. There is need for multi-sectoral intervention programs to address these identified factors. Key Words: In-school adolescents, Depressive disorders, Nigeria, Urban-rural, Patient health questionnaire-9 (PHQ-9)
Background: This is the first base line research on different primary ovarian lesions in Histopathology department, Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi since the institution of the hospital.Objectives: To determine the different patterns of ovarian lesions in relation to age and histopathological features and compare these patterns with local and international studies. The study will also highlight the most common histologic variants in our environment and make recommendations depending on the outcome of the research.Methodology: The pathology report forms of all the gynaecological lesions in histopathology department NAUTH, Nnewi, were studied. The processed tissue and the slides stained with regular histochemical stain (Haematoxylin and Eosin) technique in this 5-year study period were reviewed by the researchers using multi-headed microscope (CARL ZEISS®).Results: Of the 130 cases that were analysed, 91 (70.0%)cases were neoplastic while 39(30.0%) cases were non-neoplastic lesions. Benign neoplasms were the most common neoplasm and accounted for 56.0% (51 cases) followed by invasive malignant neoplasms with 31.9% (29 cases) while borderline and indeterminate tumours, were 3.3% (3 cases) and 8.8% (8 cases). respectively. Among the benign neoplastic lesions, mature cystic teratoma was the most common tumour (no= 22, 16.9%) with the patients’ mean age of 33.1 ±SD 13.0, followed by serous cystadenoma (no=15, 11.5%) with a mean age of 33.4 ±SD 12.9. However, high grade papillary serous cystadenocarcinomas (no=13, 9.8%) were the highest recorded invasive malignant lesions with a mean age of 49.8 ± SD 15.9) followed by choriocarcinoma (no.=5, 3.8%) with a mean age of 35.3 ±SD 9.7. Immature teratoma and mucinous cystadenocarcinoma were 4 (3.1%)cases each with mean ages of 20.8 ± SD 13.9 and 55.3 ± SD 14.3, respectively. Malignant germ cell tumours; immature teratoma and choriocarcinoma, formed only 28.1% of all germ cell tumours. Of the non-neoplastic lesions, corpus luteum cyst and follicular cyst were the most common with 11 cases (8.5%) and 10 cases (7.7%), respectively.Conclusion: Ovarian neoplasia are quite diverse, and in our environment, benign lesions of the ovary were far more common than malignant cases and tend to occur at the reproductive age group. Surface –epithelial neoplasms were more common than germ-cell tumours with a ratio of 1.4:1. Majority of invasive malignant cases were high grade serous cystadenocarcinoma. Keywords: Corpus luteum cyst, Follicular cyst, Teratoma, Cyst adenoma, Borderline tumour, Serous cystadenocarcinoma
Background: Respiratory illnesses are a major cause of morbidity and mortality in children worldwide. The impact is more profound in low and middle income countries.Objective: To determine the pattern of the respiratory illnesses in children that presented to the Children Emergency Room (CHER) of Nnamdi Azikiwe University Teaching Hospital Nnewi, a tertiary hospital in South-East Nigeria, over a 5-year period.Methodology: Clinical records of all children presenting over a 60-month period (July 2011 to June 2016) were retrieved and analyzed. Their age, gender as well as outcome of admission within 72hours in the CHER were reviewed.Results: A total of 4622 children were admitted over the specified period. Six hundred and sixty-eight (14.45%) had an Acute Respiratory Illness(ARI). Age range of the children was I month to 17years, mean age was 2.33 (± 3.56) years.Bronchopneumonia occurring in 27 (41.01 %)children was the most common diagnosis; followed by Bronchiolitis in 78 (11.68%), Aspiration pneumonitis in 41 (6.14%) and Acute Asthma in 40 (5.99%). There was equal gender distribution among the modal age of presentation.Majority of the cases 367 (54.94%) were transferred to the ward for continued care within 72hours of admission, while 54 (8.08%) died. The aetiology of the respiratory pathology (infectious or not) had a significant association with outcome of 72hours of admission in CHER (p = 0.01).Conclusion: Prevalence of ARIs among toddlers is still high. Efforts have to be re-enforced in order to reduce the negative impact of respiratory illness on child health and survival in the sub region. Key Words: Acute pulmonary morbidity, Chest infections, Paediatrics, Healthcare centre
The consumables and materials including the hospital space required for supportive therapies are in short supply with respect to COVID-19 management. To this end, an alternative supportive measure is needed for the patients to hang on, until optimal condition is made available. It is in this vein, that we describe a hand-held-respirator improvised for oxygen supplementation in a 51-yearold COVID-19 positive patient diagnosed of moderately severe disease. Keywords: SARS COV2, EarPopper®, Corona virus disease, Respirator
Partial penile injuries though rare are associated with much distress and anxiety. The management of the penile-injured patients can be challenging. Prompt surgical intervention may result in good outcome. We present a young man with near- total penile amputation injury who did well following prompt penile reconstruction attempt. Keywords: Penile injury, Penile trauma, Penile reconstruction, Urethral injury
Background: Hyperbilirubinaemia is a common clinical manifestation of several neonatal disorders, one of which is Glucose-6-Phospate Dehydrogenase(G6PD) deficiency. Objective: To determine the treatment outcome of hyperbilirubinaemia in relation to the G6PD status of icteric neonates in our environment. Methodology: This was a cross sectional study of 150 icteric neonates enrolled consecutively as they were admitted into the Special Care Baby Units (SCBUs) of the Jos University Teaching Hospital, Bingham University Teaching Hospital, and the Plateau State Specialist Hospital. The neonates were reviewed clinically for fever, jaundice, cyanosis among other features. Blood sample was collected for Full Blood Count (FBC), Reticulocyte Count, Serum Bilirubin (SB) and G6PD assay using the Pointe Quantitative Diagnostic Kit (USA). G6PD deficiency was defined by enzyme activity < 6.0 IU/gHb. Results: Subjects comprise of 92 (61.3%) males and 58 (38.7%) females (M: F= 1.6:1) with median age at presentation of 3 (Interquartile range-IQR: 1-4) days. One hundred and five (70%) were delivered at full-term gestation (≥37weeks) while 45 (30%) were delivered preterm(37weeks). Twenty-nine (19.3%) had history of jaundice in siblings. Fifty (35.7%) had birth weight < 2500g while 90 (64.3%) have normal birth weight. Their mean haemoglobin concentration was 15.90 ± 2.23 g/dl while median reticulocyte count was 2.5 (IQR: 2-3) %. Sixty-one (40.7 %) of the studied neonates were G6PD deficient with mean G6PD activity of 3.99(IQR: 2.72-4.94) IU/gHb and median concentration of total serum bilirubin of 205(IQR: 170.0-281.6) μmol/L. Mode of treatment of hyperbilirubinaemia in 88 (58.7%) of the studied subjects was by phototherapy, with 36 (59.0%) of them G6PD deficient. Sixty-two (41.3%) were treated with phototherapy and exchange blood transfusion. One hundred and twenty-two (81.3%) of all the subjects were discharged home fully recovered, 2 (1.3%) had acute bilirubin encephalopathy while mortality was recorded in 14 (9.3%). Conclusion: Significant populations of icteric neonates in our environment are G6PD deficient and they turn out with a relatively good treatment outcome irrespective of their G6PD status. Key words: Exchange blood transfusion, DAMA, Jaundice, Phototherapy
Background: Nonalcoholic fatty liver disease (NAFLD) is a common metabolic disorder characterized by accumulation of excess fat in the liver in the absence of significant alcohol consumption. This condition has been linked to certain risk factors such as obesity, Type 2 diabetes, and dyslipidaemia. Data in the developing economies are very scanty, hence the need for this study.Objectives: To ascertain the frequency and correlates of NAFLD among adult Nigerians and staging this condition using ultrasound. It also aimed at evaluating correlations between NAFLD and possible associated factors such as obesity, type 2 diabetes and dyslipidaemia.Methodology: Consenting adult patients attending Out Patient Clinic at Nnamdi Azikiwe University Teaching Hospital (NAUTH) who do not have significant alcohol consumption and were serologically negative for Hepatitis B or C infections were recruited for the study. Biodata and other relevant clinical histories were taken and clinical anthropometric measurements obtained. Blood samples were taken from the patients to assess their fasting blood glucose, liver function tests and fasting lipid profiles. An experienced ultra-sonographer performed abdominal ultrasound scan looking for presence of NAFLD and staged it. Data were analysed with statistical package for social sciences software(SPSS), version 17Results: A total of 102 individuals participated in the study, 46(45.1%) females and 56(54.9%) males. The mean age of the study participants was 53.1±16.4 years (range 22-88 years). Female male ratio was 1:1.2. About thirty-one percent of the patients studied had NAFLD. Both the mean BMI and mean Waist Circumference were higher among subjects with NAFLD compared to those without ultrasonographic evidence of NAFLD, with p-values of ˂0.001 and 0.008 respectively. Diabetes mellitus was significantly present among the participants with NAFLD compared to those participants without evidence of NAFLD (53.1% vs 27.1%, p=0.011). Hypertension had a similar relationship, but not significant (p = 0.121).Conclusion: The prevalence of NAFLD seems to be high in this hospital based study and important correlates are obesity and Diabetes mellitus. Key Words: Fatty liver disease, Obesity, Type 2 diabetes, Hyperlipidemia, Metabolic syndrome, Insulin resistance
Spinal cord injuries can be highly disabling. Although effective treatment for spinal cord injuries remains limited, operative stabilization and decompression of the neural canal may give rise to a better outcome and a faster rehabilitation. We report the operational management and rehabilitation of a 30-year-old woman who sustained L1 traumatic spinal cord injury with paraplegia (ASIA B) after being hit on the back by a pack of falling bricks. She sustained multiple vertebral fractures and a traumatic spondylolisthesis of L2/ L3, with canal stenosis were noted at the same level on MRI. Pedicle screw fixation of L1 to L4 (free-hand technique) was done with decompression of L2/L3 segments. Immediate recovery of power to the hip flexors was noted on the second post-operative day, with corresponding reduction in low back pain and subsequent mobilization on wheel chair at the end of the second post-operative week. At the end of the eight post-operative week, patient began full weight bearing on a Zimmer’s frame without support. Key words: Spondylolisthesis, Neural canal, ASIA, Spinal recovery
Background: Bacterial vaginosis are among the most common causes of abnormal vaginal discharges and both represent consequences of imbalance in normal vaginal flora and pH.Objective: The aim of this study was to determine and compare the prevalence of Bacterial vaginosis (BV) and colonization with Candida among women attending Obstetrics and Gynecology clinics in a tertiary hospital.Methodology: This was a hospital based cross-sectional study. Pregnant and non-pregnant women attending Obstetrics and Gynaecology clinics in Uyo, Nigeria were interviewed using a structured questionnaire and self-administered vaginal swabs were collected by each participant. Nugent score was determined by Gram stain of smears of vaginal swabs while colonization by Candida was determined by inoculating each swab onto Saboraud’s agar and checking for growth of characteristic colonies after overnight incubation at 37°C. Chi square test was used to determine associations between variables.Results: Nugent score was positive for bacterial vaginosis in 40% of participants and Candida colonization was present in 49.52% of participants. There was significant association between BV status and colonization with Candida spp.Conclusion: There is an inverse relationship between BV and Candida colonization among participants in this study. Keywords: Bacterial vaginosis, Candidiasis, Vaginal discharge, Uyo.
Background: Hepatitis B and C viruses are common and preventable causes of liver disease. Health care workers are prone to infection by the hepatitis B and C viruses. In Nigeria there is no current guideline on vaccination of health care workers especially health care interns.Objective: To determine the knowledge, attitude and practice of health care interns and students towards hepatitis virus infection prevention.Methodology: This is a cross-sectional descriptive questionnaire-based study which was carried out among healthcare professional interns and medical students. Informed consent and ethical approval were obtained for this survey. Data entry and analysis was done using SPSS version 22 and appropriate descriptive statistics was applied.Results: A total of 253 interns of several healthcare professional groups and medical students took part in the survey. The healthcare interns were 115 (45.5%) and medical students were 138 (54.5%). They were 112 males (44.3%) and 141 females (55.7%), with age range 18-40 years and mean age of 22.9± 3.2 years. The respondents that knew that both hepatitis B and C were infective in nature were 225 accounting for 90.7% of respondents. The respondents with good knowledge on the modes of transmission of hepatitis were over 90% for known modes of transmission while those that knew of mother to child transmission accounted for 77.6% (n=180). Regarding the attitude of the respondents toward hepatitis B and C, only 60.4% (n=148) thinks that they are at risk of getting hepatitis infection. Those that have not received any form of hepatitis B vaccination were 163 accounting for 65.4% (n=163/253) of respondents. A high percentage of the respondents 97.8% (n=223/253) knew hepatitis B and C can cause liver disease.Conclusion: Despite a good knowledge of hepatitis B and C infectivity, attitude towards prevention of the infection was poor. The study reveals an urgent need for adequate and effective government and institutional policies towards prevention of viral hepatitis. Key words: Hepatitis B, Hepatitis C, Prevention, Interns, South- East Nigeria.
Background: Malaria in pregnancy has severe negative effects on maternal health and birth outcomes. Avoiding contact with mosquitoes by use of insecticide treated mosquito nets (ITNs) can prevent or reduce disease burden. A recent synthesis of data from national malaria control programmes has shown that levels of knowledge and utilization of ITNs by pregnant women in many sub-Saharan African countries remain far below national and global strategic targets.Objective: To investigate the level of knowledge and use of ITNs in prevention and control of malaria among pregnant women attending antenatal clinics in health facilities in Enugu metropolis.Methodology: A cross-sectional descriptive survey of 350 pregnant women drawn from three Local Government Areas in Enugu metropolis participated in the study. Descriptive statistics, Logistic regression and Spearman’s correlation were used for data analyses.Results: The level of awareness of ITNs among female urban dwellers in Enugu is high (98.3%), with radio and television (178; 50.9%) being the main sources of information. The predominant sources of these nets are health centres (281; 74.6%) and markets (35; 10%). Most women only used the nets when they wish to sleep at night (213; 60.9%) and the nets were only washed when dirty (62; 18.4%). Consistent use of nets was observed among most women (239; 68.3%) and usually when there was increased perceived risk of exposure to mosquitoes. Age, educational level, marital status and number of children were determinants of ITN use (p < 0.05).Conclusion: Majority of the pregnant women totaling 316 (90%) had adequate knowledge of use of ITNs for malaria prevention and control. Knowledge also translated to improved use of ITNs among the respondents. The findings also revealed that knowledge of ITN use and social factors (age, education, ethnicity, marital status and number of children) had significant influences on the use of ITNs. Key Words: Knowledge, Utilization, Insecticide treated nets, Pregnant women, South-East Nigeria
Respiratory diphtheria is an acute and infectious disease that can progress to cardiac and neurological complications ultimately resulting in increased morbidity and mortality in affected individuals. Diagnosis was made in line with the WHO clinical case definition for Diphtheria. This is a report of two probable cases of complicated respiratory diphtheria presenting within 3 weeks of each other to the Paediatrics Department of Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi, Anambra state, South-East Nigeria. The first patient was a 5-year-old female who presented on referral with a history of fever, throat pain, noisy breathing and facial fullness, in whom bull neck appearance and membrane in the throat was observed. She was tachycardic, in respiratory distress, had elevated jugular venous pulse (JVP), soft tender liver and a greyish membrane in the throat. She was managed as a case of Diphtheric Carditis and discharged after 17 days on admission in stable condition. The second patient was also a 5-year-old, male, who presented with a history of fever, difficulty in swallowing, change of voice (progressing from hoarseness to whispers), cough and staggering gait. Onset of the illness was associated with membrane in the throat, bull neck and stridor. Examination revealed cranial nerve deficits, aphonia, hypotonia and staggering gait. CSF analysis was within normal. He was managed as a case of Diphtheric Neuropathy and was discharged home in stable condition after 16 days on admission. C. diphtheria IGG done 2 weeks post discharge was 0.19 IU/ml. The cases suggest that respiratory diphtheria still occurs in children in our environment. A high index of suspicion is needed to diagnose and properly nurse these children back to health. Keywords: Corynbacterium diphtheriae, Paediatric Pulmonology
Background: Oral diseases are one of the most common non-communicable diseases. They are also the most neglected particularly in children.Objective: To determine the pattern and trend of oral diseases among children who presented in the dental clinic of a Nigerian Tertiary hospital over 58 months.Methodology: A retrospective study that assessed for oral diseases among children using the dental health records.Results: 1104 cases presented at the dental clinic, comprising 546 males and 558 females with a ratio of 1:1.02. The mean age of the subjects was 10.6 years ± 4.2 with an age range of 1 month to 17 years. Close to ninety-eight percent of cases reviewed were symptomatic. Across all age groups, dental caries and its sequalae was observed in 62.2% of cases and this was independent of age group and year of presentation (p<0.0001).Conclusion: An increasing trend of oral diseases was observed annually with the leading diagnosis been dental caries and its sequalae.
