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   Table of Contents - Current issue
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July-August 2022
Volume 31 | Issue 4
Page Nos. 371-490

Online since Saturday, August 27, 2022

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REVIEW ARTICLE  

The use of art-based interventions in the care of patients in health-care institutions in Nigeria: A review Highly accessed article p. 371
Emmanuel Olusola Oladeji, Constantine Ezeme, Albert Seun Bamigbola
DOI:10.4103/NJM.NJM_32_22  
Background: Arts-based Interventions involve the use of aesthetic engagements, sensory activation, evocation of emotion and cognitive stimulation and involvement of the imagination, to promote wellbeing. This include a wide range of practices, from prehistoric traditions to the modern day evidence based usage of different forms of arts for therapeutic purposes. Despite the early recognition and proven efficacy of art-based interventions, an organized structure for integration of art into healthcare is lacking in Nigeria. Aim: This review aims to explore and describe the existing literature on the use of various art forms in the care of patients in health care institutions in Nigeria. Materials and Methods: A scoping review was done. MEDLINE, Embase, African Index Medicus and PsycINFO were searched using the following key words; art in medicine in Nigeria, art therapy in Nigeria and art in health in Nigeria. The search results were screened for articles using predefined criteria. A hand search for articles and communication with Arts in Medicine Project Nigeria were also done. The articles included in the review were read and summarized using a proforma. Result: Overall there is a sparseness of academic articles on the use and effectiveness of arts-based interventions in the management of patients in health care institutions in Nigeria. The most commonly applied art forms are music and visual arts.
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ORIGINAL ARTICLES Top

Comparative Study of Bisacodyl Suppository Plus Antibiotics versus Antibiotics Alone in the Prevention of Postprostate Biopsy Infection Highly accessed article p. 374
Odo Chinonso, Anselm Okwudili Obi, Timothy Uzoma Mbaeri, Ahuizechukwu Emmanuel Obiesie, Ulebe Augustine Obasi, John Chike Okeke, Joseph Amauzo Abiahu, Alexander Maduaburochukwu Ekwunife Nwofor
DOI:10.4103/NJM.NJM_62_22  
Aims: The purpose of this study is to determine whether bisacodyl rectal suppository can reduce infective complications postprostate biopsy. Patients, Materials and Methods: This was a comparative cross-sectional study done at the urology unit of a tertiary hospital over 12 months. A sample size of 56 was determined using Fisher's formula. Both groups had tablets of ciprofloxacin 500 mg and metronidazole 400 mg at induction of anaesthesia and continued for three days postbiopsy at a dose of 500 mg twice daily and 400 mg thrice daily, respectively. In addition to antibiotics, those in Group 1 had 20 mg of bisacodyl (Dulcolax) suppositories given at night, starting two days before the procedure. The patients underwent digitally guided 10-core transrectal prostate biopsy on an outpatient basis. Blood and urine samples were taken for full blood count and urine culture, respectively, before surgery and three days after the biopsy. Statistical analysis was performed using the SPSS version 21.0. The level of significance was set at P < 0.05. Results: The mean age was 69.64 ± 9.31 with a range of 52–90 years. The peak age distribution was 70–79. In Group 1, two patients had urosepsis, one patient had urinary tract infection (UTI), and seven patients had bacteriuria, while in Group 2, four patients had urosepsis, four patients had UTI, and ten patients had bacteriuria. Conclusions: The addition of bisacodyl rectal suppository to antibiotics reduced the frequency of infective complications following prostate biopsy. The observed difference, however, was not statistically significant.
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Reduced admissions in the children's emergency room during coronavirus-19 pandemic in the university of port harcourt teaching hospital, Nigeria Highly accessed article p. 378
Iroro E Yarhere, Onyinye Oragui
DOI:10.4103/NJM.NJM_34_22  
Background: Coronavirus Disease (COVID-19), the novel global pandemic that was first reported in Wuhan, China, in 2019, and subsequently in Nigeria in 2020, and its negative impact on child health has been receiving attention in the past years. One such impact was the reduction in hospital admissions during lockdown. Aim: This study set out to evaluate the effect of the COVID-19 pandemic on the children's emergency ward attendance from January to July 2020 and that of the preceding year. Materials and Methods: Hospital records of admissions from January to July 2019–2020 were extracted and exported into IBM SSPS 24 for Mac. The diagnosis was coded using the international classification of diseases. The complex diagnoses were recoded based on the severity or chronologically important ones. Results: There was 6.6% fewer admissions in 2020 compared to 2019 (P = 0.009). The duration of illness prior to presentation, cases of acute respiratory infection, severe malnutrition, and gastroenteritis was higher in 2020. Conclusion: This study showed the impact of COVID-19 on child health vis-à-vis delay in hospital presentation, reduced hospital admissions, increase in various illnesses when compared to the preceding year as a result of increase in the risk factors that would ordinarily have been mitigated pre-COVID-19.
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Oral Health Knowledge and Behavior among Public Primary Schoolchildren in Lagos, Nigeria p. 383
Chioma Love Nzomiwu, Oladipupo Solomon Ayedun, Omolola Olubunmi Orenuga
DOI:10.4103/NJM.NJM_53_22  
Aim: To evaluate the oral health knowledge and behavior among primary school pupils. Patients, Materials and Methods: This was a cross-sectional, descriptive study, in which a systematic sampling method was used to enroll 450 subjects into the study. The data collection tool was a self-administered, structured, pretested questionnaire. Results: Of the 450 enrollees, 434 pupils who duly completed their questionnaires participated in the study. Their mean age was 11.7 ± 1.64 years and more than half (229, 52.8) of the pupils were of male gender. About half (52.3%) of the pupils had adequate level of oral health knowledge. Majority had never visited a dentist (75%) before and had never used dental floss (66.6%). A higher proportion (72.3%) of the pupils with adequate level of oral health knowledge received parental supervision during brushing, had visited the dentist, and had frequent dental visit. Conclusion: The study revealed that about half of the study population had adequate level of knowledge. It also revealed inadequate oral health behaviour among the pupils. Pupils who had adequate knowledge had better behaviour.
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Career choices and determining factors among final year medical students in Lagos Nigeria p. 390
Bode Falase, Setemi Olufemi, Ayowade Funmilayo Adeleye, Adeola O Amogbonjaye, Samiat Sunmola, Ayomide Olaiya, Omowumi Folaranmi
DOI:10.4103/NJM.NJM_38_22  
Background: Identifying the factors that influence the choices medical students make regarding their careers can prove invaluable in the management of healthcare manpower. Aim: The aim of this study was to determine the career choices and the determining factors for these choices among final year medical students at the Lagos State University College of Medicine, Nigeria. Materials and Methods: This study is a cross-sectional survey of two consecutive final year classes with a total of 141 students surveyed in February 2014 and February 2015. Results: A total of 141 students were surveyed. 75.2% intended to specialise, the most common specialties being: Surgery (29.2%), Paediatrics (14.2%), Obstetrics and Gynaecology (13.2%) and Internal medicine (13.2%). More men preferred surgery (43.5% vs 18.3%; p = 0.005) and more women paediatrics (20% vs 6.5%; p = 0.011). 24.8% did not want to specialise. The reasons included: rigours of residency (48.6%), unacceptable hours of practice (34.3%), difficulty getting placements (28.6%) and family requirements (22.9%). 48.1% of the respondents chose to do their residency abroad, 27.4% chose to stay at home and 24.5% were undecided. The main factors influencing choice of residency abroad were better exposure (88.2%), improved standards of living (82.4%), avoiding incessant strike actions (80.4%) and better financial rewards (72.5%). Conclusion: Most students showed a preference for the core clinical specialties with significant gender disparity in specialty preference. The potential for continuous 'brain drain' is also identified. Appropriate steps should be taken to mitigate the factors identified that influenced these choices, to protect the future medical workforce.
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The Spectrum of Upper Gastrointestinal Endoscopic Findings and Therapeutic Interventions in Patients Presenting with Upper Gastrointestinal Complaints: A Tertiary Care Study p. 396
Mohammed Shin, Rohith George, Santosh R Goudar, Sydney D'Souza, Ibrahim Masoodi
DOI:10.4103/NJM.NJM_55_22  
Background: Endoscopy has a great role in the diagnosis, surveillance, and management of various gastrointestinal (GI) ailments. Aims: This study aimed to evaluate the spectrum of upper GI (UGI) symptoms and correlate them with the findings on UGI endoscopic examination. Patients and Methods: This observational cross-sectional study was carried out from August 2019 to December 2020 in the adult patients presenting with UGI complaints. The patients underwent UGI endoscopy at Yenepoya Medical College Hospital, Mangalore, a tertiary care centre in southern Indian state of Karnataka. Endoscopies were performed as per the standard protocol with diagnosis based on accepted criteria. Results: A total of 450 subjects (mean age: 49.14 ± 13.9; range, 19–89; 322 [71.5%] men) were included. Among the diagnostic indications, dyspeptic symptom seen in 176 (39.1%) patients was the most frequent indication in this study cohort, followed by reflux in 73 (16.2%) patients, UGI bleeding in 69 (15.34%) patients (portal hypertensive bleeding was found to be more common than nonvariceal bleed (49:20). Antral gastritis was seen in 112 (24.9%) patients. Ninety (20%) patients were found to have esophageal varices and 47 (10.4%) had esophagitis. Biopsy showed 25.3% to be positive for Helicobacter pylori. Forty-seven (10.45%) patients with a mean age 32 ± 6.8 years with dyspeptic symptoms but no alarming symptoms had normal endoscopic examination. Conclusion: Antral gastritis was the most common endoscopic finding in patients with dyspeptic symptoms. Portal hypertension was a more common cause of UGI bleeding compared to duodenal ulcers. While the majority of the patients presenting with heartburn had esophagitis, nonerosive esophagitis was observed in 3.2% of patients.
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Knowledge and associated factors for the uptake of hepatitis B vaccine among nonmedical undergraduate students in a private university in Ekiti State, Nigeria p. 401
Olusegun Elijah Elegbede, Ayodele Kamal Alabi, Taiye Adeyanju Alao, Taofeek Adedayo Sanni
DOI:10.4103/NJM.NJM_48_22  
Background: Hepatitis B is a life-threatening viral infection that causes acute and chronic diseases of the liver. Hepatitis B infection is endemic in Nigeria with a national pooled prevalence rate of 9.5%. However, a safe and effective vaccine that offers the protection against hepatitis B virus (HBV) is available. Aim: This study assessed the knowledge of hepatitis B vaccine and the associated factors for the uptake of the vaccine among non medical undergraduate in a Private University in Ekiti State. Materials and Methods: This survey is a cross-sectional study involving 420 nonmedical undergraduate students of a private university in Ekiti State, Nigeria, using a multistage sampling technique. Data were collected using a structured pretested self-administered questionnaire between March and May 2019. Analysis was done using SPSS version 23, and the level of significance was taken as P < 0.05. Results: The mean age of respondents was 20.3 ± 2.7 years. Almost half of the students (47.4%) were within the age range of 15–19 years. Females constitute 51.4% of the respondents and mostly practiced Christianity (77.4%). The majority of respondents had good knowledge of HBV vaccine (77.6%). Just a little over a quarter (26. 9%) of the respondents have taken one or more doses of hepatitis B vaccine. There was a statistically significant association between respondents' age (P = 0.032), the college of study (P = 0.006), and good knowledge of HBV vaccine (P < 0.001) and uptake of hepatitis B vaccine. The factors associated with uptake of hepatitis B vaccine include older age group (25–29 years), studentship in the college of science, and good knowledge of hepatitis B vaccine. Conclusion: The majority of respondents had good knowledge of hepatitis B vaccine. Associated factors identified for uptake of hepatitis B vaccine include age (25–29) years, studentship in faculty of science, and good knowledge of hepatitis B vaccine. It is recommended that health education about hepatitis B and its vaccine should be offered to undergraduates to increase the uptake of hepatitis B vaccine.
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To Assess the Perception, Attitude, and Practice Related to Mucormycosis during COVID-19 Era: A Community-based Cross-Sectional Survey Using Online Platform among the Population of Gujarat, India p. 406
Yamini J Gurjar, Trusha Kansagara, Meet Chauhan, Nikita Maheshbhai Savani
DOI:10.4103/NJM.NJM_189_21  
Background: Recently, mucormycosis cases were increasingly reported in people with coronavirus disease-2019 (COVID-19), particularly from India. With the subsequent waves of COVID 19 in India, mucormycosis cases may rise again. Besides, people's perception, attitude, and practice toward mucormycosis can be explored with the web-based survey so its outcome can be used in spreading awareness among the general population. Aim and Objectives: The study's aim and objective were to assess the perception, attitude, and practice related to mucormycosis in the COVID-19 era and the associated sociodemographic factors among the general population of Gujarat. Materials and Methods: A cross-sectional community-based study was carried out for 2 months (June 21–July 21) using semistructured questionnaire in the local language. The form was circulated through WhatsApp application. The principle of the snowball technique was used for data collection. Information related to sociodemographic profile, followed by questions on perception, attitude, and practice related to mucormycosis was collected and analyzed. Results: A total of 998 responses for sociodemographic variables were obtained for the study. Seven hundred and eighty-six participants were part of the study for the assessment of perception, attitude, and practice of mucormycosis. A total of 61.45%, 61.83%, and 63.99% of participants had good perception, attitude, and practice, respectively. Binary logistic regression revealed that education and relation with health-care workers for perception, sex, and place of residence for attitude and occupation for practice were independent determinants. Conclusion: Good perception, attitude, and practice toward mucormycosis among respondents show that good efforts have been done toward Information, Education, and Communication by health authorities and mass media. Still, there is a need for more collaborative actions in spreading awareness toward the remaining population.
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Influence of Patient Satisfaction on Medication Adherence among Adult Hypertensives Attending a Health Facility in a Resource-Limited Environment in Southern Nigeria p. 410
Roy A Ofili, Anthony Ikechukwu Nwajei, Adesuwa Queen Aigbokhaode, Akinwumi Olayinka Owolabi, Mojisola Oluyemisi Owolabi, Emeka Christopher Uzundu
DOI:10.4103/NJM.NJM_204_21  
Background: Hypertension is a noncommunicable disease known to cause serious morbidity and mortality among adult population. In Nigeria, a developing nation currently experiencing harsh economic realities, the outcome of the disease can be influenced by the effect of various components of patient satisfaction on medication adherence. Aim: The aim of this study was to evaluate the influence of patient satisfaction on medication adherence and BP control among adult hypertensives attending the Medical OutPatient (MOP) Clinic of the Federal Medical Centre, Asaba, with a view to identifying those aspects of care that need improvement in health care settings thereby leading to improved patient satisfaction, better medication adherence and ultimately better BP control. Patients, Materials and Methods: This was a cross sectional study conducted among 200 adult hypertensive patients attending the MOP Clinic of the Federal Medical Centre, Asaba, from January 15th to April 15th, 2017. A semi-structured questionnaire consisting of four sections which are: sociodemographic characteristics, Modified 4-item Morisky Medication Adherence scale, patient satisfaction levels with services, and BP measurement were used for data collection. Results: A greater proportion 87 (43.5%) of the respondents rated overall satisfaction with care received as very good, while 23 (11.5%) rated it as being fair. A statistically significant relationship was noticed between overall levels of satisfaction with care and medication adherence, P < 0.001. The level of BP control among the respondents was also significantly associated with medication adherence, P < 0.001. Conclusion: Patient satisfaction was seen to have a significant association with medication adherence but not BP control. The custodians of health should endeavor to improve patient satisfaction among patients in the hospital as this study showed improved patient satisfaction to be associated with increased patient adherence to medication with attendant better BP control.
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Prevalence and determinants of herbal medicine use among adults attending the national health insurance clinic of abubakar tafawa balewa university teaching hospital, Bauchi, Nigeria p. 417
Afisulahi Abiodun Maiyegun, Yahkub Babatunde Mutalub, Attahiru Al-Hajj Muhammad, Mark Divine Akangoziri
DOI:10.4103/NJM.NJM_41_22  
Background: The use of complementary and alternative medicine (CAM) is growing worldwide, with herbal medicine often the most common CAM, especially in Sub-Saharan Africa. For optimal patient care, the clinician should know what other medications patients use and why. While many studies have been done on herbal medicine use in the general population, studies on this topic among insured patients in Nigeria are scanty, at best. Thus, there is a need for more researches in this area. Aim: This study aimed to assess the use of herbal medicine among patients enrolled in the National Health Insurance Scheme (NHIS). Patients, Materials and Methods: The participants were adult patients (at least 18 years old), of both genders, attending the NHIS Clinic of Abubakar Tafawa Balewa University Teaching Hospital, Bauchi. This was an analytical, cross-sectional study. Participants were selected by systematic random sampling. Very sick patients and those who refused to grant consent to the study were exempted. Only seven declined, giving a response rate of 98.1% (364/371). An interviewer-administered questionnaire was used to collect information on participants' biodata and the use of herbal medicine. The study was done from October 1, 2020 to December 23, 2020 over 12 weeks. Results: The lifetime prevalence of herbal medicine use was 76.65%. The most common herbs used were moringa (47.31%), garlic (46.95%), ginger (38.71%), lemon (36.20%), and black seed (33.69%). Most of the participants (67.4%) used herbs for treatment, and the main reason for use was their effectiveness (61.3%). Over a third of participants combined herbs and orthodox medicine, and 82.44% never told their doctors they used herbs. Marital status of the study participants was the only variable associated with herbal medicine use (P = 0.022 at 95% confidence level). Conclusion: Patients in the NHIS use herbal medicine, though the point prevalence is relatively lower than in uninsured patients. Hence, doctors should be careful to enquire about the herbs these patients use and counsel them appropriately.
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Impact of basic life support training on the knowledge of cardiopulmonary resuscitation among final-year medical students p. 424
Salahu Dalhat, Hassan Mujahid, Adesope Saheed, Abdullahi Mustapha Miko, Abdullahi Maryam Mohammad, Adamu Sani, Ibrahim Shuaibu
DOI:10.4103/NJM.NJM_25_22  
Background: Effective and prompt intervention following an episode of cardiac arrest increases survival probability. This underscores the need for basic life support (BLS) training among first-line health-care workers. This study assesses the impact of BLS training among final-year medical students in a Nigerian institution. Materials and Methods: Pre- and Post-BLS training questionnaires aimed at assessing knowledge of cardiopulmonary resuscitation (CPR) were administered to 72 final-year medical students. Response to 20 questions were scored (total score 20), collated, and analyzed. Knowledge was graded as good if total score was 15 and above and poor if total score was <15. Results: The lowest score pre-BLS training was 6 and the highest score was 16, with a mean of 10.68 ± 2.24. The lowest score post-BLS training was 13 and the highest score was 19, with a mean of 16.8 ± 1.52. Good knowledge of BLS was demonstrated in 8.3% and 88.9% of students pre- and post-BLS training, respectively. Conclusion: The knowledge base about CPR of final-year medical students in Nigeria is low but was remarkably improved with a focused BLS training.
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Detection of extended-spectrum beta-lactamase genes in members of the Proteeae tribe isolated from a tertiary hospital in Southeast, Nigeria p. 429
Comfort Nne Akujobi, Chinenye Vivian Okwesilieze, Iloduba Nnaemeka Aghanya, Solomon Nwabueze Ukibe, Akachukwu Egwu Okoro, Simon Nkpeh Ushie, Nkechi Perpetua Maduekwe
DOI:10.4103/NJM.NJM_39_22  
Background: Tribe Proteeae consisting of Proteus, Providencia, and Morganella species are critical opportunistic pathogens causing various health care-associated infections. Widespread extended-spectrum β-lactamase (ESBL) activities have been reported among members of these groups of organisms. Aim: This study aimed to detect ESBL genes in clinical isolates of these bacteria from Nnamdi Azikiwe University Teaching Hospital (NAUTH). Materials and Methods: Two hundred and sixteen Gram-negative bacilli isolated from patients receiving care in NAUTH were identified using the Microbact 12A Gram-negative bacilli identification system. Antimicrobial susceptibility tests were performed on the isolates using antibiotics of various classes. The isolates resistant to any third-generation cephalosporins were screened for ESBL activity using the combination disc test. The presence of cefotaximase (CTX), oxacillinases (OXA), and transmission electron microscopy (TEM) genes were determined using polymerase chain reaction. Results: Out of the 216 Gram-negative isolates, 12 (5.6%) were Proteus spp., 3 (1.4%) were Morganella spp., and 8 (3.7%) were Providencia spp. The prevalence of the Proteeae bacteria was 23/216 (10.6%). Of the 23 Proteeae bacteria, 5 (21.7%) were confirmed phenotypically as ESBL producers, while 3 (13%) expressed the actual ESBL genes. CTX, OXA, and TEM genes were detected in all three isolates. Furthermore, 13% of the isolates exhibited carbapenem resistance. Conclusion: The results confirmed that ESBL-producing Proteeae bacteria existed in NAUTH. The incidental detection of carbapenem resistance among the Proteeae isolates whispers terror in waiting because carbapenems are last-resort antibiotics for managing life-threatening ESBL infections. This worrisome development highlights the need to improve infection control practices in Nigerian tertiary hospitals drastically.
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Attitudes of female medical doctors in nigeria to cosmetic surgery: An analytic cross-sectional study p. 435
Afieharo I Michael, Ebere Osinachi Ugwu, Francisca Oluwatosin Aladesanwa
DOI:10.4103/NJM.NJM_58_22  
Background: Though increasing, the demand for cosmetic surgery in Nigeria is low compared to developed countries. Gender is the most predictive sociodemographic factor in determining attitude to cosmetic surgery. Aim: This study aimed to determine the attitudes of female medical doctors in Nigeria to cosmetic surgery. Materials and Methods: This was an analytic cross-sectional study involving female medical doctors practicing in Nigeria between September 2021 and October 2021. Self-administered questionnaires were distributed to participants via social media platforms and during the Medical Women's Association of Nigeria's 22nd Biennial Conference. Attitude to cosmetic surgery was assessed using the Acceptance of Cosmetic Surgery Scale (ACSS). An independent samples t-test/analysis of variance test was used to determine the mean significant differences between the study characteristics and ACSS scores. Sociodemographic and medical practice factors associated with willingness to undergo cosmetic surgery were determined using Chi-square/Fisher's exact test. P ≤ 0.05 was considered statistically significant. Results: There were 181 respondents. Most of them were young (mean age: 35.94 ± 7.19 years), married (126 [69.6%]), and practiced in tertiary institutions (137 [75.7%]). Sixty-two (34.3%) respondents were willing to undergo cosmetic surgery in the future, while only five (2.8%) had undergone prior cosmetic surgery. ACSS analysis revealed that most, 133 (73.5%), respondents had a positive attitude to cosmetic surgery. However, none of the study characteristics were significant predictors of attitude to or willingness to undergo cosmetic surgery. Conclusion: Most of the participants had a positive attitude to cosmetic surgery, but were unwilling to undergo one. Further qualitative studies are needed.
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Age of Pubertal Maturation of Girls in South Western Nigeria p. 443
Omosalewa Adetutu Oyewole, Abiola Oduwole, Adekunle Saheed Adediran
DOI:10.4103/NJM.NJM_70_22  
Background: Secondary sexual characteristics appear at puberty with rapid physical, emotional, and cognitive developments. In girls, thelarche is usually the first sign of puberty, followed by the growth of pubic hair. In Nigeria, unlike many developed countries, there are few studies on puberty. Aim: This study aims to document the age of attainment of all the Tanner stages of sexual maturation, the sequence of these events, and the age of attainment of menarche among female secondary school students in Abeokuta. Subjects and Methods: This was a descriptive cross-sectional study carried out among girls with an age range between 10 and 20 years of schooling in Abeokuta, South-West Nigeria. Multistage randomly selected participants answered questions on the pro forma. Physical examination including pubertal staging was done. The data were analyzed using Microsoft Excel® 2010 and SPSS 22.0. Results: Seven hundred and eleven subjects were recruited. The mean age of the subjects was 14.4 ± 1.9 years. The earliest sign of puberty among the subjects, B2, was seen at a mean age of 12.4 ± 1.5 years, followed by the onset of pubic hair development, and PH 2 at a mean age of 13.4 ± 1.7 years. The mean age of attainment of menarche was 13.1 ± 1.7 years, while the age for completion of pubic hair development is 16.2 ± 1.6 years. Out of 499 subjects who had attained menarche, 324 (64.9%) were in Stage 4 of breast development and 307 (61.5%) were in Stage 3 of pubic hair development. Conclusion: The age of onset and completion of pubertal maturation in this study is 12.4 ± 1.5 years and 16.2 ± 1.6 years, respectively. Thelarche as the first sign of puberty is followed by pubic hair development.
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Risk perception on breast cancer and acceptance of screening with mammogram by female nurses in tertiary health facilities in Jos, Plateau State, Nigeria p. 447
Barnabas Mafala Mandong, Jagshak Barnabas Mandong, Innocent Emmanuel, Ayuba Ibrahim Zoakah, Philip Ojile Akpa
DOI:10.4103/NJM.NJM_44_22  
Background: Breast cancer remains the major cause of cancer morbidity and mortality among women globally. The risk of breast cancer increases with advancing age. Screening programs have been demonstrated to significantly reduce breast cancer mortality. Aim: The main objective was to assess risk perception and acceptance of mammogram as a screening tool for the early detection of breast cancer among female nurses working in three tertiary health facilities in the city of Jos. The study also determined the factors that impede the acceptance of mammogram. Materials and Methods: Self-administered semi-structured questionnaires were administered at random to 450 female nurses across the three tertiary health facilities in the city of Jos. The questionnaires were structured into six sections, namely sociodemographic, knowledge of the risk of breast cancer, mammogram use and acceptance barriers to the use of mammogram, and possible obstacles to the utilization of mammogram. The resources were scored and graded accordingly. Results: A total of 450 nurses participated with the median age of the participants as 28 years (23–39), 66.7% were younger than 35 years of age, and 54.4% were single. The educational background showed that 53.6% had bachelor's degrees and the remaining had diplomas (46.4%). On risk perception, only 40.7% of the respondents had a good perception of risk factors for breast cancer, while 59.3% had a poor perception. Only 52 (11.6%) of the 450 participants have ever had a form of the mammogram. Conclusion: The study showed that less than half of the respondents had a good perception on the risk of breast cancer and also the rate mammogram acceptance was very low.
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Androgenetic alopecia: What impact does it have on the quality of Life? p. 455
Ademola Olusegun Enitan, Olayinka Abimbola Olasode, Olaniyi Emmanuel Onayemi, Atinuke Arinola Ajani, Olumayowa Abimbola Oninla, Fatai Olatunde Olanrewaju, Mufutau Muphy Oripelaye
DOI:10.4103/NJM.NJM_61_22  
Background: Androgenetic alopecia (AGA) is a common hair disorder resulting from a combination of genetic, hormonal, and nutritional factors. It may be associated with psychological, social, and emotional disturbances in the affected individuals and this may lead to a significant reduction in the quality of life (QoL). Aim: This study determined the impacts of AGA on the QoL among a Nigerian population. Patients, Materials and Methods: This was a hospital-based cross-sectional study involving 110 adults with AGA. Adult patients with AGA attending dermatology clinic were consecutively recruited after obtaining an informed consent. The QoL was assessed with Hairdex questionnaire. Results: The mean age of the study participants was 43.45 ± 11.72 years (age range of 23–82 years) with male-to-female ratio of 14.7:1. The AGA duration ranged from 2 to 38 years, with a mean duration of 11.5 ± 4.2 years. Significant impairment in QoL was observed among the subjects in the Hairdex domains of symptoms, functioning, emotion, stigmatization, and self-confidence. Subjects who have previously been treated were more affected compared to those who were new and were yet to receive any treatment. Conclusion: Significant proportion of individuals with AGA experience enormous impairment in the QoL, indicating the need for psychosocial support while managing such patients.
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Profile of polycythaemia vera in South Western Nigeria p. 462
Patrick Olanrewaju Osho, Maltida Adesuwa Ojo, Evelyn Salewa Osho
DOI:10.4103/NJM.NJM_56_22  
Background: Polycythaemia vera (PV) is the most common myeloproliferative neoplasms (MPNs), others include essential thrombocytosis and primary myelofibrosis. PV is a Philadelphia chromosome-negative MPN, it is a rare haematologic disorder seen primarily in adults aged 60 years and older, with a higher prevalence in men. Aim: The aim of this study is to record the prevalence and explain the epidemiological, clinical, and biological PV in teaching hospital in South Western Nigeria. Materials and Methods: Case notes of all patients with a diagnosis of polycythaemia vera managed at the University of Medical Sciences Teaching Hospital, Ondo state, over a 3-year period between January 2018 and November 2021 were reviewed. The clinical and laboratory findings were extracted from the case records. SPSS-16 (SPSS Inc., USA) and Microsoft Excel statistical software packages were used for statistical calculations. Results: A total of 26 cases of PV were managed at University of Medical Sciences, Ondo state, during the period of the review. There were 20 male and 6 female, with the mean age for males 41.61 ± 18.1 and 32.33 ± 0.52 for females. Majority of the patients in the study (53.8%) had headache and fatigue, 54.5% of the patients experienced dizziness, itching and visual disturbance, hypertension, weight loss, and subconjunctival haemorrhage were found in 6 (23.08%), 5 (19.20%), and 4 (15.40%), respectively, night sweat, dyspepsia, and splenomegaly accounted for (1) 3.85%. None of the patients experienced thrombosis and bleeding. Six of the patients were able to pay for Janus Kinase 2 (JAK2) mutation in which 4 of the results were positive for JAK2 mutation while 2 patients were able to afford to pay for serum erythropoietin; the results were below the normal value. All the patients were able to pay for full blood count, peripheral blood film, and bone marrow aspirations. The average packed cell volume for males was 59.7 ± 2.3 and 55.22 ± 4.9 for females while the mean blood and platelets count in our study was 11.19 ± 1.23 and 486 ± 122.3 × 109/l. Conclusion: The study showed a low prevalence of PV in Nigeria although most cases of PV were seen among the young adults < 60 years of age affecting their life expectancy because it has a detrimental effect on their work productivity, family life, and social life.
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Gynecological endoscopic procedures in a tertiary hospital in South-West Nigeria: A prospective study p. 467
Akintunde Olusegun Fehintola, Olufemi Timothy Awotunde, Olumuyiwa A Ogunlaja, Lawrence Olajire Olujide, Samuel E Akinola, Sunday Oladeji, Olurotimi Idowu Aaron
DOI:10.4103/NJM.NJM_65_22  
Background: After several years of struggling due to many constraints, centers in Nigeria are now performing Gynecological Endoscopy (GE) procedures. This study describes the outcome of various GE procedures in patients with gynecological complaints in a tertiary hospital in South-West Nigeria. Materials and Methods: This study was a prospective longitudinal design. All eligible patients who had endoscopic procedures in the unit between May 2014 and April 2019 were recruited. Excluded were those who refused to take part in the study. The participants were followed up for a year. Data were collected during the preoperative, intraoperative, and postoperative periods. This data included the patient's sociodemographic characteristics, indications for the procedures, procedures carried out, and the procedures' outcome. Results: Of the 287 patients who had various procedures during this period, we recruited two hundred and seventy eligible patients (94.1%) for the study. We lost fourteen patients (5.2%) to follow up. One hundred and seventy-two (63.7%) had laparoscopy only. Eighty (29.6%) had hysteroscopy and laparoscopy, while the remaining 20 (6.7%) had hysteroscopy only. Thirty-eight (14.1%) were emergencies, while 125 (46.3%) were only diagnostic. Procedures carried out include hysteroscopic removal of missing intrauterine devices (6.3%) and laparoscopic tubal sterilization with Falope ring application (5.2%). We also carried out laparoscopic ovarian drilling for polycystic ovary syndrome (19.3%). Six patients (2.2%) had their surgery converted to laparotomy. We recorded no mortality. Conclusion: Our results showed the feasibility of GE surgery in Nigeria with an acceptable outcome. Local adaption and improvisation will ensure cost reduction and widespread use of these procedures in our setting.
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Treatment of Late-Onset Blount's Disease using Linear Rail System and Double Corrective Osteotomies at the Intra-Articular and Metaphyseal Regions p. 473
Roy Efetoboh Enemudo, Omolade Ayoola Lasebikan, AT Obumse, Okhuaihesuyi Uyilawa
DOI:10.4103/NJM.NJM_20_22  
Background: Blount's disease is a developmental anomaly that affects the posteromedial aspect of the proximal tibia physis with changes seen in the epiphysis, metaphysis, and sometimes, in severe cases, the distal femur as well. It results in a posteromedial deformity, internal tibial torsion, and shortening of the affected leg. Aim: The purpose of this study is to document the results of the treatment of the late form of this deformity using intra-articular and metaphyseal osteotomies of the proximal tibia and a linear rail system (LRS) device. Patients and Methods: Six patients were treated for late-onset unilateral Blount's disease. The procedure consisted of intra-articular osteotomy below the physis to elevate the depressed medial tibia plateau and a metaphyseal osteotomy below the tibia tubercle to address any residual varus deformity, tibial torsion, and leg shortening using a LRS device. Results: The mechanical axis deviation was corrected from a mean of 6.0 cm (range of 3.1–9.6 cm) to 1.4 cm (0–2.9 cm). The tibiofemoral angle was corrected from a mean of 23.2° varus (range of 16°–30°) to a mean of 1.8° varus (range of 5° valgus–7° varus). The limb length discrepancy was corrected. Operation time was 90 min on average. The device use time was three months on average. Schoenecker outcome criteria were good for all the patients. Conclusion: The use of double corrective osteotomies at the proximal tibia and the LRS device were found to be cheap, easy to use, and very effective in the treatment of Blount's disease deformity.
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CASE REPORT Top

Congenital Ectropion in Three Babies in the University of Benin Teaching Hospital, Nigeria p. 480
Rachel Onyeka Enebe, Oseluese Anastasia Dawodu
DOI:10.4103/NJM.NJM_51_22  
Congenital ectropion is a rare condition affecting newborns, in which the upper eyelid is turned outwards. Its etiology and pathogenesis, while not yet clear, are associated with congenital lid disorders such as blepharophimosis syndrome, congenital ichthyosis, Down syndrome, and birth trauma, with a higher incidence among Africans. This article reports three cases of this rare condition and their subsequent nonsurgical management. It is important to diagnose this condition early to institute swift conservative care, rule out associated conditions, and ensure good vision in the patient.
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SPECIAL ARTICLE Top

Development of Severe Acute Respiratory Syndrome Corona Virus-2 (SARS-COV-2) Vaccines p. 484
Kenneth Ogar Inaku, Asuquo Bassey Ene, Saidu Kasimu, Debayo Moshood Bolarin
DOI:10.4103/NJM.NJM_172_21  
The new severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) brings about the coronavirus disease 2019 (COVID-19) pandemic. It is a pathogen that causes extreme respiratory tract infection, especially as the world's populations had no previous immunity and there were little or no uniformly acceptable treatment options. The virus may persist to bring about considerable morbidity and mortality except an efficient vaccine is produced. Following erstwhile evidence and experience with SARS and Middle East respiratory syndrome, the major focus to vaccine development was the spike glycoprotein, regarded as the most important target for SARS-CoV-2 immunotherapies. Collaborative efforts were undertaken to ensure that manufacturing occurred as quickly as possible to salvage the situation. Three vaccine candidates were respectively made of one protein-based vaccine, a simian-derived adenovirus vector, and one messenger RNA vaccine. Two of them published their short-term analyses and effective results after their third trial phase. The messenger RNA vaccine was first confirmed in the USA and the adenovirus-derived vaccine in the UK. This paper gives a narrative review of the literature on the present knowledge about this new virus as it concerns the drawn-up plans of COVID-19 vaccines that are not only effective but safe following the new and established approaches to vaccine development.
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