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   Table of Contents - Current issue
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September-October 2022
Volume 31 | Issue 5
Page Nos. 491-604

Online since Tuesday, November 29, 2022

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REVIEW ARTICLES  

Feasibility of Day-Case laparoscopic cholecystectomy: A narrative review Highly accessed article p. 491
Ibrahim Umar Garzali, Mohammad N M Alhuniti, Ramadan Hassanat, Yousef Alsardia, Ali Aloun
DOI:10.4103/NJM.NJM_69_22  
Gallstone disease was considered a rare disease in West African subregion, however with increasing urbanisation and lifestyle change, the incidence of the disease is rising. Laparoscopic cholecystectomy is the best treatment for gall stone disease. Initially, laparoscopic cholecystectomy required inpatient care after surgery, but for the past 30 years, there is a shift toward performing the procedure as a daycase. Day-case laparoscopic cholecystectomy was first reported in early 1990s, but in most countries of West Africa, cholecystectomy is still an inpatient procedure and this has been an additional strain to the health-care community as the number of personnel needed for postoperative care can be directed toward the care of other patients if the surgery is performed as a daycase. It has also been reported that increased use of day surgery would reduce waiting times and reduce last minute cancellations by the hospital. Although laparoscopic cholecystectomy was added to the basket of day-case procedures in the early 1990s, initial progress was slow because the procedure was not widely accepted as suitable for day case surgery. In sub-Saharan Africa, only Sudan, Nigeria, Tanzania, and South Africa have reported attempts at day-case laparoscopic cholecystectomy with good outcome.
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Review article: Urethral catheters and catheterization techniques Highly accessed article p. 497
Ngwobia Peter Agwu, Ahmed Mohammed Umar, Ugbede Emmanuel Oyibo
DOI:10.4103/NJM.NJM_99_21  
Background: The urethral catheter is an essential medical device that is used in everyday medical practice worldwide. The urethral catheter has evolved over the years with several modifications and improvements to overcome the shortcomings of previous productions. With several indications, it remains one of the most commonly used devices traversing almost all specialties in the field of medicine; however, the process of urethral catheterization is occasionally challenging and may result in injury to the urethra. The attendant complications following its passage far outweigh its cost and the required skills to necessitate appropriate insertion. Knowledge of the type of urethral catheter, training with regard to its insertion, care while in situ, and competency of the attendant caregivers are required for safe catheterization. Aim: This review aims to disseminate knowledge on urethral catheter types, insertion procedures, and its attendant complications so that doctors and other health-care professionals may safely perform this necessary procedure. Materials and Methods: A review of internatinal literature was conducted using PubMed database and goggle search using key words such as urethral catheter materials and types. Result: 105 articles were identified and found suitable for the study.
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ORIGINAL ARTICLES Top

Knowledge of community-based health insurance and associated factors among artisans in a selected community of Ekiti State Highly accessed article p. 509
OE Elegbede, Kabir Adekunle Durowade, Taofeek Adedayo Sanni, Tope Michael Ipinnimo, Ayo Kamal Alabi
DOI:10.4103/NJM.NJM_47_22  
Background: The Community-Based Health Insurance Scheme (CBHIS) (National Health Insurance Scheme [NHIS]) pools the risk of high costs of health care across a large number of individuals, and it permits payment of a premium based on the average cost of health care for the group of people. This function of spreading risk in NHIS helps in making the cost of health-care services affordable for many individuals. Aim: This study which is aimed at assessing the knowledge of Community-Based Health Insurance (CBHIS) among artisans in Ekiti State will help in identifying and implementing strategies to widen health insurance services to this group of nonformal sector. Materials and Methods: A descriptive cross-sectional study was conducted among 416 respondents using a systematic random sampling technique among the skilled occupational group vis-a-vis bricklayers, carpenters, electricians, hair stylist, and tailors. Data were collated using an interviewer-administered semi-structured questionnaire and analysed using IBM SPSS version 23. Chi-square and binary logistic regression were used to assess the association between dependent and independent variables. P < 0.05 was taken as statistically significant. Results: The study participant mean age was 29.7 ± 10.9 years, majority were females (57.5%), and 46.9% had tertiary education. 53.1% were aware of health insurance, but only 24% were aware of CBHIS. Just about a fifth of the respondents (18.3%) had good knowledge of CBHIS. Significant factors and predictors of knowledge of CBHIS in this study include female gender, tertiary level of education, higher family income, and higher frequency of illness. Conclusion: The awareness and knowledge of CBHIS among artisans in Ekiti State is still very low. Factors associated with the low knowledge include gender, level of education, frequency of illness, and family income. Therefore, efforts at improving awareness and educating members of the public about the scheme will be beneficial.
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Toward eradication of child labour: Assessment of the present situation in a Nigerian City p. 515
Adaobi Ijeoma Bisi-Onyemaechi, Ugo Nnenna Chikani, Pascal Uwadiegwu Chime, Ngozi Rita Mbanefo, Obinna Chukwuebuka Nduagubam, Ndubuisi Anyele Uwaezuoke
DOI:10.4103/NJM.NJM_67_22  
Background: Child labour deprives children of their childhood, their potential, and their dignity and is harmful to their physical and mental development. Aim: The aim of this study was to determine the pattern and adverse effects associated with child labour in Enugu, Nigeria. Patients, Materials and Methods: This was a cross-sectional study using an in-depth interviewer-administered questionnaire guide on child labour and adverse effects among children aged 6 to <18 years. Results: The most common labour was hawking (39.2%) and shopkeeping (22.8%). Majority of the children work to support their families. Adverse conditions experienced by the participants include prolonged work hours (100%), assault (15.8%), hunger (15.2%), sexual abuse (14.6%), and accidents (9.9%). Children aged 6–12 years were at a higher risk of sexual abuse (P = 0.005, odds ratio = 2.463, 95% confidence interval = 1.311–4.630). Conclusion: Children in Enugu are still involved in the various forms of child labour which have detrimental effects on their well-being.
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Paediatric cataracts in a tertiary eye centre in South-South Nigeria: An initial audit of surgical outcome p. 521
Elizabeth Dennis Nkanga, Sunday Nnamdi Okonkwo, Ernest Ikechukwu Ezeh, Chineze Thelma Agweye, Affiong Andem Ibanga, Dennis George Nkanga
DOI:10.4103/NJM.NJM_40_22  
Background: Paediatric cataracts is a leading cause of treatable blindness and a major cause of blindness in developing nations. Aim: To present an audit of paediatric cataract and paediatric cataract surgery in a Tertiary Eye Care facility in the South-South Geopolitical Zone of Nigeria during the Seeing is Believing Project intervention. Materials and Methods: A retrospective study of case notes of children who received surgical and adjunctive treatment for cataracts in the Calabar Children's Eye Centre during the 24-month study period from November 1, 2017, to October 31, 2019, was undertaken. Results: Of the 128 children who met the inclusion criteria, 73 (57.0%) were males and 55 (43.0%) were females, giving a male: female ratio of 1.3:1.0. The mean age of patients in years was 5.9 ± 4.1 years, median/interquartile range was 5.0/5. The most frequent diagnosis was bilateral cataracts affecting 80 (62.5%) children. Systemic comorbidities were found in 13/128 (10.2%), of which 7/13 (53.8%) were congenital rubella syndrome. Ocular comorbidities (40.6%) were more common than systemic comorbidities, and sensory esotropia presented most frequently (16.4%). More patients with congenital cataracts had ocular comorbidities, and this association was statistically significant, P < 0.001. The proportion of patients with good visual outcomes was highest among those with bilateral cataracts (64.8%), and ocular comorbidities were a significant negative predictor of best corrected postoperative visual acuity. A total of 94/128 (73.4%) patients received intraocular lens implants, and the most common postoperative complications were visual axis opacification (VAO) 37/69 (53.6%) and fibrinous uveitis 26/69 (37.7). Conclusion: Paediatric cataracts were often bilateral and congenital. Postoperative complications like VAO are common and can be detected early and treated to improve visual outcomes with good follow-up strategies.
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Risk assessment for type 2 diabetes mellitus among participants in a market survey at Ebonyi State, South East Nigeria, using finnish diabetes risk score questionnaire p. 530
Chidiebere Valentine Ugwueze, Bede I Nnolim, Nnamdi C Anikpo, Kenechukwu Emmanuel Onyekachi, Cosmas Kenan Onah, Oluomachi Esther Chukwu, Chinweuba Michael Abonyi, Basil Chukwuma Ezeokpo, Onyechi M Modebe
DOI:10.4103/NJM.NJM_79_22  
Background: Type 2 diabetes mellitus is a metabolic disorder arising from insulin resistance and/or decreased insulin secretion and has continued to affect people across all economic levels in society. Due to the high prevalence of undiagnosed diabetes, it has become very imperative to emphasize screening in any given population, especially in developing countries. Aim: The aim of the study was to determine the risk factors and prevalence of diabetes mellitus among participants using the FINDRISC questionnaire. Materials and Methods: The study was a cross-sectional study which involved 200 participants but 197 had complete data. Anthropometric, blood pressure, and fasting/random blood glucose measurements were carried out. The data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 23. Results: The mean age of respondents was 41.8 ± 16.3 years. There were 104 males and 93 females. Most of the respondents were traders constituting 51.8% of the study population. The 10-year risk categorization of respondents showed that 57.9% had low risk, 17.8% with slightly elevated risk, 12.2% had moderate risk, 10.7% with high risk, and 1.5% with a very high risk of developing diabetes. The average risk score was 7.4 ± 5.4 with a range of 0.0–24.0. The mean weight, height, and body mass index were 69.6 ± 14.4 kg, 165.3 ± 8.6 cm, and 25.5 ± 5.2 kg/m2, respectively. The mean systolic and diastolic blood pressures were 126.9 ± 20.3 mmHg (range: 80–205) and 76.6 ± 12.9 mmHg (range of 50–130), respectively. Conclusion: Approximately, 25% of respondents have a moderate-to-very high risk which emphasizes the need for continuous screening of the population, especially in public gatherings.
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Ossifying fibroma of the jaws: Review of 57 cases in Enugu and of global literature p. 535
Chukwubuzor Udokwu Okwuosa, Mark Chukwuemeka Nwoga, Akinyele O Adisa
DOI:10.4103/NJM.NJM_87_22  
Background: There are very few reports of the clinicopathological features of ossifying fibroma (OF) of the jaws in Enugu, South-east Nigeria. Aims: To study the prevalence and clinicopathological features of OF in Enugu. Patients, Materials and Methods: An eight-year retrospective study of patients with OF of the jaws was carried out in a tertiary hospital in Enugu, Nigeria. The clinical records, radiographs, histopathology reports, and slides of 87 patients with fibrous lesions, archived in the department of oral pathology and oral medicine were identified and examined. The cases diagnosed with OF by histological examination were retrieved and studied. The data were analysed using the descriptive statistics and presented in the form of frequency tables. The test for a statistical association was carried out using the Chi-square statistics. Results: There were 644 orofacial lesions and 13.5% (87) of these were fibro-osseous tumours. OF constituted 8.9% (57) of the orofacial lesions and 65.5% (57) of fibro-osseous tumors. The male-to-female ratio was 1:1.7. The overall mean age at tumour-onset was 24.1 ± 13.1 years, (range: 5–60 years). The age group at which OF occurred most frequently (43.9%) was 11–20 years. The mandible was the most common site of occurrence, 64.9% (37), while the radiographic features were well-circumscribed opacity 24.6% (14), and mixed lucency–opacity, 22.8% (13). Conventional 54 (94.7%) and juvenile-psammamatoid 3 (5.3%) subtypes were identified. Conclusion: OF is the most prevalent fibro-osseous lesion, occurred mostly in the second decade and exhibits a lower mean age of onset in male patients.
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Pattern of benign breast diseases in Abakaliki, South Eastern Nigeria, A 5 year retrospective study p. 540
Felix O Edegbe, Joseph Chukwuma Uzoigwe, Chinedu O Ndukwe, Anayo A Nwachukwu, Ngozi Immaculata Ugwu, Oluomachi C Nnachi, Uchechukwu N Agada, Ugochukwu Uzodimma Nnadozie
DOI:10.4103/NJM.NJM_60_22  
Background: There is a rise in the trend of benign breast diseases (BBDs) currently; this is made possible through public awareness of the disease. Aim: To determine the pattern of BBDs in a 5-year retrospective study was the aim of this study. Materials and Methods: A 5-year retrospective study and all histopathologically proven BBDs from January 2015 to December 2020 were reviewed. Software, version 21 of the statistical package for the social sciences (SPSS) was used for data analysis. Results: Cases of BBDs diagnosed within the study period were 143 and were made up of 5 (3.5%) males and 138 (96.5%) females, with a ratio of 1: 28. Among the females, the most commonly affected age group was 21–30 years contributing 57.8% (80/138), followed by ≤20 years contributing 36.2% (50/138). Among males ≤20 years of age group are mostly affected and contributing 60% (3/5). Fibroadenoma accounted for 62.9% (90/143), followed by fibrocystic disease (FCD) contributing 16.8% (24/143). The less common breast diseases in this study were fat necrosis, lipoma, granulomatous mastitis, periductal mastitis, and cysticercosis accounting for 0.7% each. Conclusion: Fibroadenoma remains the most common BBD although higher than in the earlier study, followed by FCD in our centre. Females constituted most of the affected individuals (21–30 years). The practice of breast self-examination should be encouraged to detect and treat lumps which may be malignant early enough to reduce morbidity and mortality.
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Factors affecting outcome in reverse transcriptase-polymerase chain reaction-positive lassa fever patients with acute kidney injury: A retrospective analysis p. 544
Alhaji Abdu, Maigari M Ibrahim, Lawal Suleiman Muhammad, Yakubu Kabir Audi, Umar M Sabo, Jibrin B Yusuf
DOI:10.4103/NJM.NJM_78_22  
Abstract: Lassa fever (LF) is a viral haemorrhagic fever (VHF) endemic in the West African sub-region. It causes regular outbreaks with a significant case fatality rate (CFR). An estimated 100,000–300,000 people are infected with Lassa fever virus (LASV) every year in West Africa. Acute kidney injury (AKI) is a recognized complication of LF and may contribute significantly to the high CFR. We retrospectively studied 187 reverse transcriptase-polymerase chain reaction (RT-PCR)-positive LF patients admitted and managed at the infectious diseases centre of Abubakar Tafawa Balewa University Teaching (ATBUTH), Bauchi, to shed more light on the effect of AKI on the outcome. Materials and Methods: The case files of 187 RT-PCR-positive LF patients admitted between January 2018 and December 2020 at the infectious disease centre of ATBUTH were retrieved. We performed parametric and nonparametric statistical analyses including logistic regression to determine factors associated with poor outcomes. Results: During the study period, 187 RT-PCR-positive LF patients were admitted and treated in our centre; 130 (69.5%) were males and 27 (30.5%) were females. The mean age of presentation was 37.3 ± 15.5 years, and nearly all the patients presented with fevers of varying duration. There were 53 deaths with a CFR of 28.3%. More than 2/3 of the deaths were among the age group of 18–47 years. AKI was observed in 12.8% of the patients whose mean age was 37.17 ± 13.13 years. AKI was significantly associated with poor outcomes. Raised systolic blood pressure (odds ratio [OR] = 1.042, 95% confidence interval [CI] 1.008–1.076, P = 0.014) and serum creatinine (OR = 0.952, 95% CI 0.904–1.002, P = 0.000) were found as significant risk factors for developing AKI. Conclusion: Lassa fever is a multisystemic illness. Kidney involvement occur early and can lead to acute kidney injury with its attendant complications. Our study highlighted the significance of AKI as a contributor to poor outcome among patients with Lassa Fever infection.
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Microalbuminuria and its associated risk factors among human immunodeficiency virus-infected patients attending a tertiary care facility in Kano, Northwest Nigeria p. 549
Bawa Ibrahim Abubakar, Oiza Ozioroko Aliu-Isah, Sanni Musa, Kabiru Abdulsalam, Isah Adagiri Yahaya
DOI:10.4103/NJM.NJM_86_22  
Background: Human immunodeficiency virus (HIV) infection affects multiple organs and the kidney is a common target, thereby making renal disease one of the recognised complications of HIV infection. Microalbuminuria represents an early, important marker of kidney damage in several disease conditions including HIV-infected highly active antiretroviral therapy (HAART)-naïve patients. Early detection of microalbuminuria is critical to slowing down the progression of kidney dysfunction to chronic kidney disease in HIV-infected patients. Determination of predictive factors for microalbuminuria in these group of patients may serve as avenues for intervention to prevent HIV-associated renal diseases. Aim: The aim of the study was to determine the prevalence and risk factors of microalbuminuria in HIV/AIDS-infected adults on HAART at Aminu Kano Teaching Hospital, Kano, Nigeria. Patients, Materials and Methods: A descriptive cross-sectional study was carried out among 500 subjects including 250 HAART-treated and 250 HAART-naïve HIV/AIDS participants. An interviewer-administered structured questionnaire was used to collect relevant demographic and clinical information. Blood and urine samples were collected for serum creatinine and urinary albumin and creatinine measurements, respectively, and the results were collated and analysed. Comparison of categorical variables was done using Chi-square/Fisher's exact test, where applicable with level of significance set at P < 0.05. Results: The prevalence of microalbuminuria among the two groups studied was found to be high (22.8% for HAART naïve versus 18.4% for HAART treated, respectively) while the risk factors identified were estimated glomerular filtration rate, low CD4 count, and duration of HIV treatment. Conclusion: The major predictors of microalbuminuria include low CD4 count, duration of HIV infection (<30 months), and duration of HAART treatment (<30 months).
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Thyroglobulin as an evolving biomarker of iodine reserve in thyroid dysfunction assessment in pregnancy p. 556
Terry Terfa Gbaa
DOI:10.4103/NJM.NJM_82_22  
Background: Despite the use of routine thyroid function tests, thyroid dysfunction is often missed in pregnant women, who may have fluctuating iodine reserves and this may be associated with an increased risk of adverse maternal and fetal outcomes due to thyroid dysfunction. Therefore, thyroglobulin (Tg) as a marker of iodine reserve may be added to improve the diagnostic value of the thyroid testing panel. Materials and Methods: This study was a multicenter descriptive cross-sectional study with 501 healthy pregnant women, carried out over 9 months, in which blood and urine (spot) specimens were collected and analysed for serum thyroid-stimulating hormone, free thyroxine, free triiodothyronine, and Tg using enzyme-linked immunosorbent assay, and urinary iodine concentration by modified Sandell–Kolthoff reaction. Results: The prevalence of thyroid dysfunction in pregnant women using thyroid function tests alone was 12.4% (62) with 9.6% (48) being hypothyroid and 2.0% (10) hyperthyroid. The addition of Tg was able to identify more participants with thyroid dysfunction who were iodine deficient, and initially missed using thyroid function tests alone. This newly added biomarker to routine thyroid function tests profile increased the prevalence of thyroid disorders in this study population from 12.4% (62) to 17.6% (88) (P < 0.01), whereas urine iodine concentration was adequate for each trimester falling within the WHO range of 150–249 μg/l. Conclusion: The true prevalence of thyroid dysfunction in pregnant women in Makurdi was 17.6%. The addition of Tg had an impact on thyroid function tests by identifying more participants with iodine-related thyroid dysfunction, who were missed in the initial assessment of the thyroid. The mean urine iodine concentration was adequate, falling within the WHO range of 150–249 μg/l.
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Identifying primary health-care challenges using the importance–Performance analysis: Implications for a low- and middle-income country p. 562
Daprim Samuel Ogaji
DOI:10.4103/NJM.NJM_83_22  
Background: Including patient's evaluation in the comprehensive measurement of primary health-care (PHC) performance is a valid and reliable approach for the assessment and improvement of local PHC system. Aim: This study demonstrates the use of the importance–performance analysis (IPA) for identifying challenges in PHC centers in Obio-Akpor. Materials and Methods: This was a quantitative survey of first-time visitors to four PHC centers in Obio-Akpor. A total of 337 participants were selected from a two-stage sampling approach and administered the Patient Evaluation Scale which was structured to elicit their ratings on the importance of PHC centers' attributes before and the performance on these attributes after their encounter with the facility. Descriptive and inferential statistics were performed using the SPSS version 21, and PHC centers' attributes were aggregated across each of the four IPA quadrants. Results: The response rate was 89% and the Cronbach's alpha coefficient was 0.91 and 0.94 for the importance and performance measurement scales, respectively. More of the respondents were below 40 years (87.7%), female (73.7%), and currently married (69.3%). Observed areas of concentration for PHC improvement were staff availability during operating times, ease of payment, waiting time, convenience of operating hours, and availability of electricity in the facility. Conclusion: Findings provide evidence of patients' concerns in the local PHC system. Subsequent validation and focused interventions aimed at resolving identified challenges can positively influence the demand and social relevance of PHC in this setting.
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The mental well-being of physicians in Nigeria during the COVID-19 pandemic p. 569
Dabota Yvonne Buowari, Aminat Oluwabukola Jimoh, Ogechukwu Mary-Anne Isokariari, Mary Oluwakemisola Agoyi, Omoadoni Diana Emeagui, Nana Awaya Emeribe, Evonemo Susan Esievoadje, Chioma Laura Odimegwu, Vivian Ifeoma Ogbonna
DOI:10.4103/NJM.NJM_52_22  
Background: The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), the causative agent of the coronavirus disease-2019 (COVID-19) has caused a crisis in healthcare systems worldwide. Doctors are on the frontline in the fight against this war. The frontline workers are putting in all their efforts and skills to caring for patients who have contracted this novel contagious virus. The mental well-being of doctors is important. The SARS-CoV-2 has become a nosocomial infection and occupational hazard to healthcare workers. Aim: The aim is to investigate the mental well-being of doctors' practicing in Nigeria during the COVID-19 pandemic. Materials and Methods: This is part of a larger study. It is a cross-sectional survey carried out among doctors in Nigeria. Two questionnaires were adapted and used for this which included the World Health Organisation (WHO-5) well-being index, a validated and reliable short questionnaire on mental well-being. Participants in the study were recruited online. The research populations are doctors and dentists working in Nigeria. Results: The participants were 302 comprising 195 (64.6%) women doctors. The mean WHO well-being index for women was 69.90 ± 18.81, t = 3.295; P = 0.001 which was statistically significant. Multiple regression analysis of predictors of WHO well-being among medical doctors amidst the COVID-19 pandemic for the female gender coefficient = −4.384; P = 0.048. The female gender was a predictor of poor well-being. Conclusion: The mental well-being of doctors is very important. Female doctors had significantly lower mental well-being compared to their male counterparts. Physicians should have access to psychological support from their employers regularly.
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Pancreatic cystic lesions: An 11 years (2010–2020) of experience at Usmanu Danfodiyo University teaching hospital, Sokoto p. 576
Bello M Bashir, Stephen P Agbo, Muhammad Muktar Umar, Ibrahim Umar Abubakar, Hamza Ibrahim Sani, Mikailu Abdullahi, Faruk O Emetuma
DOI:10.4103/NJM.NJM_73_22  
Background: Pancreatic cystic lesions are heterogeneous lesions that could be benign, borderline, or malignant. Neoplastic cystic lesions/tumours are rare tumours of the exocrine pancreas; difficult to diagnose preoperatively, and they account for 2%–10% of pancreatic tumours. Pancreatic pseudocyst is the most typical benign cystic pancreatic lesion arising from pancreatic ductal inflammation or ductal disruption. Both benign and malignant cystic pancreatic lesions are amenable to surgical treatments, with a good prognosis. Aim: The aim is to present our 11yrs of experience in the management of pancreatic cystic lesions. Materials and Methods: We conducted a retrospective review of pancreatic cystic lesions managed at the General Surgery Unit of Usmanu Danfodiyo University, Sokoto, Nigeria, from 2010 to 2020. A retrospective review of the case notes of patients was done with an emphasis on biodata, presentation, investigations treatment offered, complications, and follow-up were analysed using the Statistical Package for the Social Science (SPSS) version 22, Inc. (Chicago II, USA). Results: We managed 28 patients over 11 years. Three patients had pancreatic cystic tumours, whereas 25 patients had pancreatic pseudocysts. The age ranges of the patient with pancreatic cystic tumours are 29–50 years with a male-to-female ratio of 2:1. All the patients had tumour excision with histology revealing two pseudopapillary tumours of the pancreas and one serous cystadenoma. The age range of patients with pseudocyst is 27–42 years with a male-to-female ratio of 1:3.1, and most of the patient had internal drainage. Conclusion: Pancreatic cystic tumours are uncommon pancreatic neoplasms that are amenable to surgical interventions with a good prognosis. Pancreatic pseudocyst was seen mainly in females within the young age group. Both benign and neoplastic pancreatic cystic lesions are amenable to surgical intervention with a good prognosis.
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An analysis of the practice of accompanying paediatric patients for dental treatment in Kano, Nigeria p. 581
Chizoba Chineme Okolo, Yewande Isabella Adeyemo, Chikaodi O Oguchi, Abdulrahman B Malami, Olubukola Olamide Olatosi, Folakemi Oredugba
DOI:10.4103/NJM.NJM_96_22  
Background: Children rely on an accompanying adult to access and get consent for their medical care. Parents usually serve as the accompanying adults; however, there are situations when they must delegate that duty. Aim: This study aimed to analyze the practice of accompanying children for dental treatment in northern Nigeria and describe the circumstances surrounding their visit for dental treatment. Materials and Methods: This was a retrospective study of all new patients (and their accompanying adults) who visited the paediatric dentistry clinic at Aminu Kano Teaching Hospital in Kano between January 2017 and June 2020. Descriptive statistics were presented using means, standard deviations, percentages, and frequencies. Bivariate (Chi-square test), multivariate analysis, and two-way analysis of variance were performed to determine the associations between the dependent and independent variables. The level of statistical significance was set at P < 0.05. Results: Data from 1656 children were analyzed. 46.6% (n = 770) of the children were female. Majority of the children (66.1%) were accompanied by their mothers and most (69.5%, n = 1151) of the accompanying adults were female. Fathers mostly accompanied the male children: this finding was statistically significant (P = 0.001). The proportion of children accompanied by their mothers was much higher among the younger children (P < 0.001). Conclusion: In Kano, parents most frequently accompanied pediatric patients to dental appointments. Mothers were the most common companions for very young children as well as female children. The health-seeking behaviour in northern Nigeria appears to be influenced by culture and religion.
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Breast cancer knowledge and screening practices among female nurses in a tertiary hospital in North Central, Nigeria p. 585
Adekunle Adedapo Abiodun, Joy Anastasia Abiodun, Adewale E Eletta, Alexander Gomna, Adedeji O Adekanye, Yemisi Okunoye-M, B Suleiman Abdullahi, Sunday A Okinbaloye, Taofeeq Abdulrahman, Alfa Yusuf, Bosede Rotimi
DOI:10.4103/NJM.NJM_80_22  
Background: Breast cancer is a global burden and has become a major public health concern. Early diagnosis through screening is the best way to achieve cure, reduce morbidity and mortality from breast cancer. Many of the women in this environment have little or no knowledge about breast cancer and the attitude and orientation of health-care professional are important determinants of the use of breast screening program. Aim: The aim of the study was to evaluate the knowledge and practice of breast cancer screening among female nurses in the Bida, Niger state. Materials and Methods: This study was a cross-sectional conducted among female nurses in Federal Medical Centre, Bida, between May and August 2021. The questionnaire contained 20 questions on the knowledge of breast cancer. Each correct answer had a score of 1 and 0 for an incorrect answer or “don't know.” The overall score was calculated for each respondent by summing up the symptom and risk score. It was graded as 0–9 = Poor and 10–20 = Good. Data collected were analyzed by computer analysis using the SPSS version 25. Results: A total of 150 female nurses participated in the study with mean age of 41.7 ± 8.1 years. Overall assessment of the respondent's knowledge of breast cancer revealed that 112 (74.7%) of them had good knowledge and 38 (25.3%) had poor knowledge. Only 59 (38.3%) practice breast self-examination monthly. Concerning clinical breast examination, 22 (14.7%) of them have had their breast examined before by a health professional while 12 (8%) of the participants had done mammography before. Conclusion: Our findings highlight that the knowledge of breast cancer among female nurses was good but it has not really translated into practices of the preventive measures for early detection of breast cancer.
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COVID-19 experiences and vaccine confidence among health workers and non-health workers p. 591
Beckie Tagbo, Adaobi Bisi-Onyemaechi, Chinedu Chukwubike, Ejivina Okafor
DOI:10.4103/NJM.NJM_66_22  
Background: The severe acute respiratory syndrome coronavirus 2 virus has been associated with unprecedented morbidity and mortality globally. This has resulted in the development of prevention protocols aimed at controlling the viral pandemic. Vaccine development and vaccination were also initiated to achieve herd immunity against the virus. High vaccine confidence levels are required to mitigate vaccine hesitancy and increase the uptake of the COVID vaccines and successful control of the pandemic. Aim: The researchers in this study set out to investigate COVID-19 experiences and public confidence in COVID-19 vaccination. Materials and Methods: A survey using both online and hard copy validated questionnaires was carried out among 431 consenting research participants in 6 countries across 3 continents (Africa, North America, and Europe). Results were analysed using SPSS version 23. Results: Fifty (11.6%) of the participants had COVID-like symptoms in the last one year though only one-fifth (10, 20%) of these were tested. Hydroxychloroquine was taken by 72 (16.7%) in the past 12 months. Two hundred and sixty-five (65.5%) expressed willingness to take the COVID vaccine. Recommendations by health workers and departments were significantly associated with vaccine confidence and uptake. More than half (249, 57.8%) of the participants acknowledged the presence of rumors against the vaccine. Suggestions to increase COVID-19 vaccine confidence include: vaccines should be available in all testing centres; government should address other welfare issues first before vaccination and increased efforts toward confidence-building on the vaccine. Conclusion: Majority of the study participants were positively disposed to accepting the COVID-19 vaccine however the presence of rumors concerning the vaccine still poses a significant threat to COVID-vaccine confidence.
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CASE REPORT Top

Visual improvement following trabeculectomy in a 17-year-old p. 597
Tarela Frederick Sarimiye, Joyce Ofuadarho
DOI:10.4103/NJM.NJM_84_22  
Glaucoma is a leading cause of blindness globally; however, in terms of the irreversibility of blindness, it is the number one cause. Glaucoma treatment aims at slowing the progression and reducing the risk of further structural and functional damage as much as possible. A rare subset of glaucoma is juvenile open-angle glaucoma (JOAG) diagnosed in individuals between 3 and 40 years of age. The JOAG tends to have rapid progression and it is associated with higher intraocular pressure (IOP) and fluctuations compared to primary open-angle glaucoma. The IOP also tends to be refractory to medical therapy control and often requires surgical intervention. In the treatment of glaucoma, functional improvement is not an expectation. This is a case report of a JOAG patient with visual improvement following trabeculectomy. A 17-year-old female presented with a 4-year history of gradual visual loss in both eyes. Diagnosed elsewhere to have glaucoma with no known baseline IOP value and is already on travoprost. Visual acuity (VA) at presentation was counting finger (close to face right eye, 2 m left eye) and IOP were 22 and 19 mmHg, respectively. The patient subsequently underwent trabeculectomy with mitomycin C in both eyes at a single sitting. She had a marked improvement in vision postoperatively. At 6 weeks postoperative review, VA was 6/36 and 6/18 in the right and left eyes, respectively, and pressures were 9 and 8 mmHg, respectively. There is currently no proven mechanism to explain visual recovery; however, visual improvement may have resulted from some reversal of retinal ganglion cell damage following significant IOP lowering. Improvement in vision is not an expectation following treatment for glaucoma; however, some case reports have reported this occurrence following trabeculectomy. Hence, even in very advanced presentations, especially in young individuals as in this case, there should not be hesitation with surgical intervention following appropriate counseling.
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SPECIAL ARTICLE Top

Legal imperatives of medical negligence and medical malpractice p. 600
Hassan King Obaro
DOI:10.4103/NJM.NJM_57_22  
Medical negligence and malpractice are becoming a growing concern in Nigeria; even though many victims do not know how to go about seeking redress or demand justice, medical practitioners, too, do not understand the legal implications of their actions. Medical negligence and malpractice are tortious liabilities that can also result in criminal liabilities. It is a fact that health-care practice will occasionally result in circumstances where health seekers suffer some distress or permanent injury in the course of handling by medical practitioners. This distress or injury can be a result of either commission or omission due to the actions or inactions of the medical practitioner. This review was embarked upon using thoroughly studied recent and older literature concentrating on research indications resulting from the fields of medicine and law within and without Nigeria. Common acts that could give rise to lawsuits on medical negligence and medical malpractice include doctor's illegible handwriting, prescription and medication errors, misdiagnosis or failure to diagnose, improper medical treatment, leaving surgical instruments in patients after surgery, lack of informed consent, failure to refer a patient to a specialist, breach of confidentiality, extortion, and deception among others. For liability to come up in negligence, it is imperative that the three main fundamentals of negligence, which include that a duty of care is owed, there was a breach of the duty of care, and injury or permanent disability suffered as a direct consequence of a breach of the duty of care must be well established and proved beyond a reasonable doubt. The inability of a victim to successfully prove a case of negligence against a medical practitioner does not totally absolve a practitioner from charges related to other offences under other aspects of the law, hence the fact that negligence is difficult to prove does not leave a patient deprived of other legal opportunities as may be considered appropriate. Even though the law protects the medical practitioner to the level that liability for medical negligence and medical malpractice has to be proved beyond a reasonable doubt, much more legal protection is needed to allow medical practitioners to discharge their duties of saving lives. Medical practitioners need to be aware of their limits as well as the legal implications of their work; this can be achieved by incorporating medicolegal principles into medical education for medical students, as well as periodic medicolegal lectures for medical practitioners.
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