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   Table of Contents - Current issue
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March-April 2022
Volume 31 | Issue 2
Page Nos. 119-232

Online since Friday, April 29, 2022

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EDITORIAL  

The world is bright, save your sight: Why you should take your eye checks serious Highly accessed article p. 119
Olabisi O Yeye-Agba, Osamudiamen Cyril Obasuyi, Maryam Babba Danagundi, Ugochukwu Anthony Eze, On behalf of Academic Committee of Young Ophthalmologists Forum of the Ophthalmological Society of Nigeria
DOI:10.4103/NJM.NJM_203_21  
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REVIEW ARTICLES Top

Outcome following ovarian drilling in Nigerian women with polycystic ovary syndrome: A systematic review p. 121
Nkeiruka Ameh, Adebiyi G Adesiyun, Jude E Okohue, Nathaniel D Adewole
DOI:10.4103/NJM.NJM_1_22  
Background: Polycystic ovary syndrome (PCOS) is a common condition characterized by endocrinopathies which can lead to infertility. Various modalities of treatment have been employed including ovarian drilling, but the outcome of such ovarian drilling in Nigerian women is not known. Aim: This is a systematic review of the outcome of ovarian drilling on the menstrual pattern and pregnancy rate in Nigerian women. Materials and Methods: Google scholar and PubMed databases were searched for studies that relate to PCOS management using ovarian drilling and other modalities in Nigeria. The citation lists of relevant articles and studies were also searched. Case reports, retrospective studies, and prospective studies were included. Review articles, systematic reviews, and meta-analysis were excluded. Six studies were found to be suitable and consisted of two case reports and prospective studies each, respectively, and one clinical trial and retrospective study each, respectively. Results: There were a total of 107 patients aged 17–49 years. While all the patients presented with a complaint of abnormal menstruation, 50%–70% complained of inability to conceive. All the patients had used clomiphene citrate as first-line drug to manage their complaints. Ovarian drilling was carried out using the conventional unipolar diathermy and 4 or more drills per ovary. Following the procedure, 76% resumed normal menstruation and 30% conceived. Conclusion: Reports of ovarian drilling in Nigeria reveal a positive outcome but the number of published studies are few and quality of evidence low. Further well-designed studies including randomized controlled trials are needed to make definite conclusions.
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A systematic review of urethral complications following male circumcision: The importance of provider training Highly accessed article p. 125
Musa Yahaya Muhammad, Christian Agbo Agbo
DOI:10.4103/NJM.NJM_4_22  
Background: Male circumcision is one of the most common elective surgical procedures worldwide. Adverse events affecting the urethra may occur following the procedure. Aim: The aim of this paper is to provide a review of the existing literature on urethral complications of male circumcision. Materials and Methods: A search of PubMed and Google Scholar was conducted between November 20, 2020, and November 30, 2020 and updated on January 12, 2021. Several keywords related to male circumcision were searched on the two databases. A further manual search of the reference lists of relevant papers was carried out. Studies that reported frequencies of urethral complications following circumcision were included in the analysis. A total of 83 candidate papers were identified and studied before arriving at 38 studies that contained sufficient information suitable for the analysis. Results: Overall, we found that the reported frequencies of urethral complications of male circumcision varied (range 0.01% to 39%; median 1.7%). Meatal stenosis (MS) and urethrocutaneous fistula (UCF) were by far the most frequently reported urethral complications of male circumcision with cases reported in 30 and 18 studies, respectively. Meatitis and urethral stricture were the other urethral complications found in our search. Conclusion: The urethral complications of male circumcision we found were UCF, MS, meatitis/meatal ulcer, and urethral stricture. Neonatal circumcision and circumcision by untrained providers are associated with higher incidences of urethral tragedies following male circumcision. The type of male circumcision provider is also a determinant of the frequency of complications.
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Accessibility and utilization of family planning services in Nigeria during the coronavirus disease-2019 pandemic Highly accessed article p. 133
Evonemo Susan Esievoadje, Chioma Laura Odimegwu, Mary Oluwakemisola Agoyi, Aminat Oluwabukola Jimoh, Omoadoni Diana Emeagui, Nana Emeribe, Vivian Ifeoma Ogbonna, Mininim Oseji, Dabota Yvonne Buowari
DOI:10.4103/NJM.NJM_8_22  
Background: Family planning services are an important aspect of reproductive health as it helps in the improvement of maternal health. During the coronavirus disease-2019 (COVID-19) pandemic, several measures were taken by the Nigerian government to control the virus, which included restriction of movements including curfews and lockdown. Aim: This article is a review of the impact of the COVID-19 pandemic on the accessibility of family planning services in Nigeria. Materials and Methods: This is a narrative review of articles related to the accessibility of family planning services during the COVID-19 pandemic. The literature search was done using Medline, Google Scholar, and PubMed. The keywords used for searching for the literature were COVID-19 and family planning services in Nigeria. The literature search review was done from June 2020 to November 2021. Results: The study found both supply- and demand-side service disruptions. There was a disruption in the supply chain management system, affecting the production and distribution of family planning commodities. The demand-side issues were because of the lockdown measures on health seeking behaviour, absence, and increased cost of transportation. Conclusion: Accessing and utilizing various contraceptive methods were disrupted by the COVID-19 pandemic. This is due to several factors including the restriction of movements put in place by the Nigerian government to control the pandemic. The improvement of the use of various pregnancy preventive strategies has the potential to reduce poverty. It is imperative to develop adaptive systems to provide ongoing contraceptive services, by implementing innovations to sustain demand and supply of family planning services during pandemics.
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ORIGINAL ARTICLES Top

Fetal kidney length: A likely sole index for gestational age determination in late pregnancy and certain abnormalities p. 138
Akintunde Olusijibomi Akintomide, Samuel Archibong Efanga
DOI:10.4103/NJM.NJM_199_21  
Background: The Obstetric management of a pregnancy relies on the knowledge of an accurate gestational age especially in unregistered cases. Aims: The aim of this study was to sonographically evaluate the fetal kidney length as a potentially dependable direct measurement parameter, to estimate gestational age in the second and third trimesters. Patients, Materials and Methods: The study involved 236 participants with 20 to 34 weeks pregnancies, referred to the Radiology department of the University of Calabar teaching hospital for obstetric ultrasound scan, within a three-month period. The fetal kidney lengths were measured, in addition to the routine parameters, which included head circumference and femur length. The estimated gestational ages derived from the routine parameters, were correlated with the kidney and femur lengths and head circumference. The data were analyzed using SPSS version 22.0. Results: Fetal kidney length increased in direct proportion to gestational age. It had a significant positive correlation coefficient (0.982) with the estimated gestational age, similar to the head circumference and femur length. Fetal kidney lengths in millimeters were nearly equal to the estimated gestational ages in weeks, especially from the thirtieth week. Conclusion: Fetal kidney length is a viable, simple and direct method for determination of gestational age of pregnancies in the second and third trimesters. Since fetal kidney length assessment is said to remain reliable after 34 weeks, unlike the head circumference and femur length, it can serve as the sole index of gestational age assessment late in pregnancy, especially in fetal structural abnormalities.
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Pertrochanteric hip fracture fixation with 3 hole and 4 hole dhs side plates - A retrospective patient record review p. 144
Tosin Olusoga Akinyemi, Syed Mannan, Funbi Anthony Ayeni
DOI:10.4103/NJM.NJM_120_21  
Introduction: Dynamic hip screw fixation (DHS) with a 4-hole side plate and 4 bi-cortical screws is considered by many to be the standard implant for extracapsular hip fractures. The 4-hole side plate, however, has several disadvantages including longer incision, increase in operating time, bleeding and increased wound morbidity. Biomechanical studies have shown that most of the force in a 4-hole DHS fixation is borne by the proximal three screws. This study (specifically) compares the outcome of fixation using 3-hole and 4-hole DHS in extracapsular hip fracture fixations (with the hypothesis being that 3-hole plate is adequate even in unstable intertrochanteric fractures. Patients and Methods: A total of 72 consecutive patients who had DHS fixation with either a 3 hole or 4 hole DHS side plate and who were either directly operated or supervised by a single consultant were recruited. Fractures were classified using the AO fracture classification system as stable (AO/OTA 31A1–31A2.1) and unstable (31A2.2–31A3.3 subtypes) for ease of comparison. Failure was defined as metalwork breakage, nonunion, screw cut-out or pull out or any other complications of bone healing requiring a revision. Results: A total of 23 patients (68.1%) were female, whereas 49 patients (31.9%) were male. Fractures in 33 patients were classified as stable with the (AO/OTA 31A1–31A2.1) and unstable in 39 patients with (31A2.2–31A3.3 subtypes). Thirty-three (45.8%) patients had fixation with 3-hole side plate, whereas 39 (55.2%) patients had fixation with 4-hole side plate. In the 3 hole group, 17 patients had stable fractures, whereas 16 patients had unstable fracture configuration while in the 4-hole DHS side plate group, 16 patients had stable fracture configuration, whereas 23 patients had unstable fracture. The mean change in hemoglobin was lower for the 3-hole DHS group (3 hole-6.64 g/l versus 4Hole 12.41 g/l) (t = 1.732, P = 0.090, P ≤ 0.05). One patient in each group also had metalwork failure with screw cut-out through the head and the other being (screw breakage) complete failure of the screw necessitating conversion to total hip arthroplasty. Conclusion: Three-hole DHS plate offers comparable outcome with its 4-hole counterpart even with unstable intertrochanteric fractures, with slightly less blood loss and smaller scars.
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Retinoblastoma in Calabar Nigeria: An 18-Month Retrospective Review of Clinical Presentation at a Tertiary Eye Center p. 149
Elizabeth Dennis Nkanga, Iwassam Elemi Agbor, Sunday Nnamdi Okonkwo, Ido Didi Fabian, Ekpereonne Babatunde Esu, Dennis George Nkanga, Friday Akwagiobe Odey, Jacintha Banku Okoi-Obuli
DOI:10.4103/NJM.NJM_184_21  
Background: Retinoblastoma, although rare, is the most frequently occurring primary intraocular tumor of childhood. While a cure is often achieved where appropriate treatment is instituted early in the disease, late presentation often leads to unsuccessful treatment interventions. Aim: The aim of this study is to provide baseline information on the clinical presentation of retinoblastoma as seen in a tertiary pediatric eye care facility in Calabar, Nigeria. Materials and Methods: A retrospective review of case files of children presenting to the Calabar Children's Eye Center (CCEC) with retinoblastoma over 18 months from January 1, 2018 to June 30, 2019 was done. Results: Data were collected from 39 children with retinoblastoma who met the inclusion criteria. There were 22 (56.4%) males and 17 (43.6%) females, and the age range was 7–41 months, with a mean age of 25.6 (±9.0) months. Unilateral disease was seen in 27 (69.2%) participants, whereas 12 (30.8%) had bilateral disease. Although multiple symptoms were seen in many participants protrusion of eye was the most frequently occurring first symptom, (17, 44.0%) followed by red eye (13, 33.0%), whitespot in eye (5, 13.0%), and abnormal alignment (4, 10.0%) among study participants. The lag time from recognition of symptoms to initial consultation ranged from 1 to 25 months, with a mean lag time of 9.13 ± 5.68 months. The ICRB classification system was most frequently used, 27 (69.2%), followed by cTNMH 11 (28.2%), and International Intraocular Retinoblastoma Classification 1 (2.6%). The International Retinoblastoma Staging System was representative. Of the 78 eyes studied, (51, 65.3%) had different stages of retinoblastoma with the majority presenting as advanced retinoblastoma (46, 90.2%). Conclusions: Retinoblastoma is seen at the CCEC. Although the most frequent symptom was protrusion of eye, the lag time was often several months long. Most patients presented late with advanced ocular retinoblastoma and or extraocular disease.
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Violence and mental health among adolescents in South East Nigeria p. 156
Maduka D Ughasoro, Vivian Ozoemena Onukwuli, Obinna E Onwujekwe, Benjamin S. Chudi Uzochukwu, Bassey Ebenso, Chinedu C Okoli, Chizoba F Achor
DOI:10.4103/NJM.NJM_133_21  
Background: There is a rise in the prevalence of mental illness among adolescents and the impact of violence on this rising trend requires to be evaluated. Aim: The aim of the study is to better understand the impact of violence on adolescent's mental health. Materials and Methods: The study was a cross-sectional school-based study. Adolescents in the selected schools were interviewed using a structured questionnaire. Information on previous experience of violence, the action is taken, and the effect on them was collected. Data were entered and analyzed using SPSS. The level of significance was at P < 0.05. Results: A total of 716 adolescents were studied over a one month period. The prevalence of violence was 87%. About 57.2% of the violence occurred at home, 44.2% was carried out by relatives and 49.2% happened within the past six months. Sexual abuse was 10.2%. Among the adolescents that experienced violence, 58.7% suffered some form of mental illness. There was a significant difference between the action the adolescents took after the violent incident and the action that was considered appropriate for it (P = 0.00001). Female gender (P = 0.042), not living with parents (P = 0.015) and poverty (P = 0.00001) significantly correlate with adolescent violence. Conclusion: Violence is high among adolescents and associated with a high prevalence of mental illness. Interventional measures targeted at reducing violence by improving poverty alleviation programs that empower families to carter for their children should be implemented.
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Quality of life of patients with diabetes mellitus attending a tertiary hospital in Uyo, South–South Nigeria p. 163
Uduakobong Morgan Morgan, Etukumana Etiobong
DOI:10.4103/NJM.NJM_94_21  
Background: Diabetes mellitus (DM) is one of the noncommunicable diseases that influence the quality of life (QoL) of people living with the disease. It is a known metabolic condition with a feature of excessive blood glucose levels due to defects in insulin production, insulin action, or both. Assessment of QoL is useful in the measurement of outcomes during the management of chronic diseases. Aim: This study aims at determining the QoL of patients with DM that presented at the general outpatient clinic (GOPC) of a tertiary hospital in South–South Nigeria. Patients, Materials and Methods: A cross-sectional study of 134 patients suffering from DM who attended either the GOPCs or diabetic clinics of the University of Uyo Teaching Hospital was done between January and March 2018. A semi-structured questionnaire was used to obtain information from the respondents on sociodemographic characteristics, duration of DM, and presence or absence of hypertension. The following assessments were done on the respondents: blood pressure, body mass index, and glycated hemoglobin levels. The assessment of the QoL of patients was done using WHOQoL-Bref instrument. Descriptive statistics of the data was done. Mean and standard deviation (SD) were computed from the continuous variables, while frequency and percentages of categorical variables were also determined. Odds ratio was employed to compare differences in proportions or groups. The level of statistical significance was set at P < 0.05. Data analysis was done using Epi Info version 3.5.4. Results: The respondents consisted of 82 females and 52 males (M: F = 1:1.6) with a mean age of 54.79 (±SD 10.53) years. The overall QoL was good (91%). Poor monthly income was associated with poor QoL. Conclusion: The study finding indicated that poor income adversely affects the QoL of persons with DM. Chronic medical conditions such as DM require long-term care with financial/economic implications. Consequently, support systems (financial support inclusive) need to be strengthened for a better QoL.
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An assessment of factors motivating patients to seek orthodontic treatment in a South-Western Nigerian teaching hospital p. 168
Anne Nkechi Ndukwe, Oluranti Olatokunbo daCosta, Oluwatosin Oluyemi Sanu, Michael Chukwudi Isiekwe
DOI:10.4103/NJM.NJM_87_21  
Background: Motivation is a concept that describes the conscious or unconscious stimuli for the action toward a desired goal. The motivations for seeking an orthodontic treatment among the population are diverse. Identifying the underlying motivation for treatment is helpful in reducing dissatisfaction with orthodontic treatment outcome. Aim: This study aimed to assess motivating factors for seeking orthodontic treatment and to compare these factors between adolescents and adults attending a Nigerian teaching hospital. Patients, Materials and Methods: Self-administered questionnaires were distributed among 130 subjects (79 adolescents and 51 adults). The subjects were asked to assign a score to the motivating factors listed based on their relative importance using a 5-point Likert scale which ranged from 1 to 5, with 5 rated as very important and 1 rated as very unimportant. The choice of motivating factors was compared between the adolescents and adults and between sexes in each group. Data obtained were analyzed using IBM Statistical Package for Social Sciences (IBM SPSS) version 21.0. P ≤ 0.05 was considered statistically significant. Results: Improvement in dental appearance was the main motivating factor for almost all subjects and there was no statistically significant difference between adolescents (60.8%) and adults (68.6%), P = 0.591. A significantly higher (P < 0.001) number of the adults, (35, 68.6%) chose improvement in facial aesthetics as a motivating factor for orthodontic treatment compared with 29 (44.6%) adolescents. The least motivating factors which were chosen by adolescents were improvement in chewing (9, 13.8%) and relief of temporomandibular joint symptoms (4, 6.2%). There was no statistically significant difference in the choice of motivating factors between female and male in both the adolescent and adult groups. Conclusion: Aesthetic concerns were the most important motivating factors in adolescents and adults seeking orthodontic treatment.
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Prenatal Alcohol Intake and Knowledge of its Effect: A Survey of Pregnant Women Attending a General Hospital in South East, Nigeria p. 174
Chisom Joy Mbadugha, Joyce Chinenye Arinze, Nneka Chekwube Odoh, Adaobi Lilian Obiekwu, Ngozi Joy Omotola, Chiamaka Jennifer Okafor
DOI:10.4103/NJM.NJM_151_21  
Background: Alcohol consumption during pregnancy is a major public health concern due to its noxious effect on both the mother and fetus. Aim: The study aim was to determine the prevalence of prenatal alcohol intake, knowledge of its effects, and associated factors among pregnant women attending antenatal clinic, Poly General Hospital, Enugu. Materials and Methods: A descriptive cross-sectional survey was adopted and simple random sampling was employed to select 248 pregnant women from the total population. Data were obtained using structured questionnaires, summarized using descriptive statistics, and presented in tables. Statistical analysis for associations between level of educational attainment, occupation of the pregnant woman, and knowledge of the effects of alcohol consumption was performed using Chi-square tests. Results: The prevalence of alcohol use during pregnancy was 40.3% with beer (48.8%) and palm wine (48.8%) being the major alcoholic beverages taken. Majority (59.7%) of the participants had good knowledge of the effects of alcohol consumption in pregnancy while less than half (33.9%) had good knowledge of the effect on the unborn baby. Previous drinking habits before pregnancy (3.48 ± 0.84) and unwanted pregnancy (3.17 ± 0.93) were the major perceived factor influencing their alcohol intake. Educational level was not significantly related to knowledge of alcohol effects on pregnancy. Conclusion: Regardless of the knowledge of the harmful effect of alcohol on the fetus and maternal health, a significant proportion of mothers continue to consume alcohol during pregnancy. Therefore, there is a need for widespread education of women of childbearing age focused on driving behavioural change with regards to alcohol intake in pregnancy.
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Effects of birth preparedness and complication readiness on pregnancy outcome in Nigeria p. 182
Uchenna Anthony Umeh, Chioma Roseline Umeh, Emmanuel Onyebuchi Ugwu, Obioha Odoeme Imediegwu, Nnaemeka Christopher Oguejiofor, Bukar Alhaji Grema, Ogochukwu Theophilus Nwankwo, George Uchenna Eleje, Polycarp Uchenna Agu
DOI:10.4103/NJM.NJM_196_21  
Background: Birth preparedness and complication readiness (BPCR), a component of focused antenatal care, has a great potential to reducing maternal and newborn deaths in low-income countries. However, the success of this strategy is not well known in most of sub-Saharan Africa, and the effectiveness of the strategy has not been widely studied. Aims: This study aimed at evaluating the effects of BPCR on pregnancy outcome. Materials and Methods: This was an observational cohort study of eligible consecutive pregnant women presenting in labour at a tertiary hospital in Abakaliki, Nigeria. Maternal and neonatal outcomes of labour were compared between women who had a birth plan (n = 115) and a control group without a birth plan (n = 115). Results: The mean age of the parturients was 27.87 ± 5.20 years. Women who had a birth plan were less likely to have postpartum anaemia (P < 0.001), receive blood transfusion (P < 0.001), and have prolonged hospital stay (P = 0.03). Their neonates were at less risk of low birth weight (P = 0.02) and admission into newborn special care unit (P = 0.003). There was no association between BPCR and incidence of Caesarean section (P = 0.65) and maternal satisfaction (P = 0.20). Conclusion: The practice of BPCR in Abakaliki, Nigeria, is associated with some favourable maternal and neonatal outcomes. The study findings indicate the need for more advocacies for adequate implementation of BPCR during pregnancy in Nigeria.
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Information communication technology in medical practice: Pattern of usage and knowledge among doctors in a tertiary health institution in Southeastern Nigeria p. 187
Jude-kennedy C Emejulu, Sunday Patrick Nkwerem, Mary C Adimekwe
DOI:10.4103/NJM.NJM_183_21  
Background: Information communication technology (ICT) is increasingly being used in medicine for teaching and clinical practice. It reduces physical contact and travel time and minimizes the risk of nosocomial infections, including COVID-19. It provides good channels of interaction among medical practitioners as well as between physicians and patients. In Sub-Sahara Africa, the windows of opportunity provided by these platforms, especially WhatsApp, Instagram, electronic mail, are still underused. Reasons include hostile legal atmosphere. Aim: This study aims to review the level of use and awareness of legality of WhatsApp, E-mail, and Instagram in a tertiary hospital in the South Eastern Nigeria. Materials and Methods: This was a cross-sectional study in which a pro forma was generated and sent to the contacts of doctors working in the above institution. The forms willingly filled and turned in were analyzed. Results: About 108 respondents willingly filled and turned in their forms. M: F ratio was 2:1, the modal age group was 20–30 years. About 36.6%, 22.6%, 12.9%, and 8.6% of respondents were in surgery, pediatrics, internal medicine, and family medicine, respectively. About 98.1% of respondents believed in the use of ICT; however, only 10% of respondents used it frequently in the management of patients. Among those respondents that used it, it was mostly for inpatient care. About 43.3% of respondents are convinced that there is no legal backing for ICT in Nigeria. About 86.6% of respondents are waiting to take advantage of ICT when proper law is put in place. Conclusion: There is a need for better advocacy and amendment of relevant law to enhance use of ICT.
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Knowledge of the glasgow coma scale among physician interns in a Nigerian tertiary health facility p. 193
Toyin Ayofe Oyemolade, Mojirade A Akinkunmi, Oluwakemi Comfort Ogunyileka, Folawemimo M Arogundade, Busayo A Ehinola, Amos O Adeleye
DOI:10.4103/NJM.NJM_191_21  
Background: The Glasgow coma scale (GCS) is the most utilized level of consciousness scale globally. Insufficient working knowledge of the GCS by physicians may contribute to poor outcomes in patients with altered levels of consciousness. Aim: This study aims to assess the knowledge of the GCS among the physician interns, also known as house officers, in a rural tertiary health facility in Nigeria. Materials and Methods: This was a questionnaire-based survey among physician interns in a rural tertiary hospital in Nigeria. Results: All the 77 respondents graduated from medical school within 2 years of the study. Seventy-two (93.5%) of the participants had been actively involved in the management of patients at the hospital's accident and emergency department within a month before the study, while 71.4% had been involved in emergency care outside the accident and emergency department within a month prior. Seventy-five (97.4%) conceded to having received didactic lectures on the GCS in the course of their medical training. About three-quarters (74.03%) of the respondents correctly defined GCS as GCS; about 85.7% were able to correctly identify all the clinical variables of the GCS, while only 15.6% could correctly describe and score all the parameters of the grading scale. The eye-opening response was the most correctly remembered (64.9%), followed by the verbal response (42.9%), while the motor response was remembered by 29.9% of the respondents (P = 0.04). Only 36 (46.8%) participants were aware of any subsequent modification to the original GCS score. Conclusion: The working knowledge of GCS is poor among physician interns surveyed in this study. The clinical variable of the GCS with the highest number of items, the motor response, was the least correctly remembered.
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Preventive measures of vaso-occlusive crisis among sickle cell disease patients in South-Eastern Nigeria: How much do our patients know? p. 197
Chilota Chibuife Efobi, Angela Ogechukwu Ugwu, Ngozi Immaculata Ugwu, Helen Chioma Okoye, Chihurumnanya Alo
DOI:10.4103/NJM.NJM_17_22  
Background: Vaso-occlusive crisis (VOC) is a feature of sickle cell disease (SCD), an inherited medical condition which is more common in Sub-Saharan Africa especially Nigeria and is saddled with multi-systemic complications. Knowledge and practice of preventive measures of VOC by patients may reduce the risk of morbidity and mortality. Aim: The purpose of this manuscript is to determine the knowledge, attitude, and practice of the various preventive measures of VOC by patients and their relationship with their frequency of painful crisis. Materials and Methods: A cross-sectional descriptive survey was used. This study was conducted between August, 2018, and February, 2019. Participants were selected consecutively as they came for clinic consultations. Demographic characteristics and the knowledge, attitude, and practice of various preventive measures of VOC were obtained using a structured interviewer-administered questionnaire. The analysis was performed using Statistical Package for the Social Sciences software version 23.0. Descriptive and inferential statistics were used with P < 0.05 which was considered statistically significant. Ethical clearance and informed consent were obtained before the commencement of the study. Results: A total of 154 SCD patients participated in the study and were made up of 73 (47.4%) males and 81 (52.6%) females, with a male-to-female ratio of 1: 1.1. Majority of the respondents (76.6%) had good knowledge of preventive measures toward VOC in SCD. This study also found that 59 (38.3%) participants had good practice of preventive measures toward VOC while 95 (61.7%) had fair practice. Majority (68% [40/59]) of those who had good practice of preventive measures were less likely to have more than three crises in a year compared to those who do not practice good preventive measures, though not statistically significant (OR = 2.489, P = 0558) (confidence interval = 0.480 – 0.637). Conclusion: Majority of the patients have good knowledge and practice of preventive measures of VOC and this appears to have reduced the frequency of their crisis in a year. Health education for sickle cell patients is an important tool that may reduce morbidity and mortality by reducing the frequency of crisis.
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Paediatric cardiac anaesthesia perspective in komfo anokye teaching hospital kumasi: A 10-year review p. 202
Sanjeev Singh, Isaac Okyere, Arti Singh
DOI:10.4103/NJM.NJM_12_22  
Background: Infant mortality due to congenital malformations has an incident rate of 8 cases per 1000 live births. Due to Africa's inadequate health-care systems, congenital cardiac disease (CCD) remains a paediatric health-care issue. CCD patients undergo an open-heart operation (OHO) at the Komfo Anokye Teaching Hospital (KATH) in Kumasi. Aim: This study aimed to compare trends of cardiac anaesthesia protocols before and after 2014 and to assess the efficiency and quality of surgical care provided to children with CCD following the implementation of new cardiac anaesthesia protocols in 2014. Materials and Methods: Groups A and B were represented by the years before and after 2014. This was a retrospective study involving 118 patients who underwent OHO under general anaesthesia from 2007 to 2016 after obtaining Institutional ethical approval. Results: In Groups A and B, the mean length of hospitalization in days and cardiac care unit stay in days were (6.87 ± 3.51 and 4.20 ± 3.66) (P = 0.046) and (3.14 ± 2.37 and 1.96 ± 2.85) (P = 0.382), respectively. In Group B, ultrafast track extubations increased from 7.25% to 39.71% (P = 0.021), while patients mean mechanically ventilation time decreased by 82.34 ± 11.70–23.48 ± 7.94 h (P = 0.018). In the first 48 h, the chest tube's postoperative drainage reduced by 133 ± 28.46–95 ± 20.38 ml (P = 0.018) and haemorrhage leading to re-exploration decreased 11.77%–1.50% (P = 0.019). After 2014, postoperative haemorrhage, the chest tube's drainage, and re-exploration were statistically significantly reduced by tranexamic acid. Conclusions: This ten-year program primarily focused on selecting simple cases and simplifying anaesthesia protocols after 2014. Given the success of our OHO program at KATH Kumasi, there is a need for a paradigm shift to sustain OHO programs in other parts of Africa.
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Correlation of Axial Length, Lens Thickness, and Anterior Chamber Depth in Patients Undergoing Cataract Surgery p. 208
Ernest Ikechukwu Ezeh, Elijah Ndubuisi Chinawa, Roseline Nkeiruka Ezeh
DOI:10.4103/NJM.NJM_9_21  
Background: Axial length, lens thickness and anterior chamber diameter are valuable parameters used in determining the refractive status of the eye. Aim: To determine the correlation between axial length (AL), crystalline lens thickness (LT), and preoperative anterior chamber depth (ACD) among patients undergoing cataract surgery. Patients, Materials and Methods: It was a cross-sectional study done over a one-year period. One hundred and fifty-one adults with cataract in both eyes were consecutively recruited. Using an optical biometer Ultrasound A/B Scan (Chong Qing Kang Hua S&T Co., Ltd, CAS-2000BER [Model A], China), ocular biometric data including AL, ACD, and LT were assessed for both eyes before cataract operation for either eye. Pearson's correlation and regression analyses were applied to determine relationships between the biometric variables. Statistically, significance was taken as P < 0.05. Results: One hundred and fifty-one (302 eyes) adult participants were studied, consisting of 77 (51.0%) males and 74 (49.0%) females. The age range was 12–88 years, with a mean age of 57.73 ± 14.87 years (95% confidence interval, 54.70–59.90). Correlation analysis revealed that AL and ACD were positively correlated (r = 0.164, P = 0.002). AL and LT demonstrated a statistically insignificant and very weak positive correlation (r = 0.071, P = 0.217). ACD was negatively correlated with LT (r = −0.375, P = 0.000). On multiple regression, AL (z-score = 0.191) and LT (z-score = −0.387) were significant predictor estimates of the regression model for ACD (P = 0.000); a hypothetical equation for ACD was generated: ACDpredicted = 2.978 + (−0.522 × LT in mm) + (0.106 × AL in mm). Conclusion: LT is an important biometric parameter that should be considered, along with other biometric parameters, in determining effective lens position in patients undergoing cataract surgery. The narrowing of ACD with age is largely due to increasing LT. Using an optical biometer, ACD is predominantly influenced by LT than the AL.
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Outcome of delivery among HIV-Positive women that attended the antenatal clinic at the University of Benin teaching hospital, Benin City, Nigeria p. 212
Aisha Yibaikwal Shehu, Esohe Olivia Ogboghodo, Nosakhare Enaruna, Mustapha Abubakar Jamda
DOI:10.4103/NJM.NJM_35_22  
Background: Human immunodeficiency virus (HIV) has been reported to be associated with several adverse pregnancy outcomes. There are limited data on the extent by which HIV-positive pregnant women in this part of the world are affected. Aim: The aim of this study was to assess the pregnancy outcome of HIV-positive pregnant women who attended the antenatal clinic. Materials and Methods: A retrospective analysis of the case notes of HIV-positive women that enrolled in the prevention of mother-to-child (PMTCT) clinic from January 1, 2020, to December 31, 2020. All data collected were entered and analyzed using the IBM SPSS version 25.0 software. Results: A total of 1817 women attended the antenatal clinic and 127 (6.9%) were HIV positive and enrolled in the PMTCT program. Out of the 127 HIV-positive women, only 102 (85.0%) utilized the delivery service. HIV was found to be more common among women within the age group of 30–39 years. Majority 105 (82.6%) of the women were aware of their HIV status before index pregnancy and were on treatment, 62 (60.78%) of the women had a vaginal delivery, whereas 34 (33.3%) had a caesarean delivery. A total of 6 (4.7%) women had a miscarriage. There was no maternal death. Of these pregnancies, 7 (5.5%) were stillbirths, 18 (18.8%) were preterm deliveries, and 10 (11.2%) had a low birthweight. Conclusion: Despite antiretroviral therapy, HIV-positive pregnant women had adverse pregnancy outcomes; therefore, they should be managed with a multidisciplinary approach to ensure good maternal and fetal outcomes.
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CASE REPORTS Top

Huge pelvic lipomatosis as an unusual cause of acute urinary retention p. 216
Joseph Amauzo Abiahu, Dubem Ejikeme Orakwe, Timothy Uzoma Mbaeri, Onyekachi Amos Onu, Chinonso Odo
DOI:10.4103/NJM.NJM_159_21  
Pelvic lipomatosis is a benign tumor of adipose tissues rarely seen in young males. Its clinical presentation is variable. Acute urinary retention is unusual pattern of presentation. This reports a case and management of huge pelvic lipomatosis in a 33-year-old African male presenting with lower urinary tract symptoms and acute urinary retention. The relevant literatures were also reviewed.
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Conservative management of button battery ingestion using honey in a paediatric patient p. 219
Nnamdi Benson Onyire, Linda Nneka Nwokeji-Onwe, Charles Izuchukwu Ikegwuonu, Maria-Lauretta Orji
DOI:10.4103/NJM.NJM_193_21  
Button battery ingestion is a form of foreign-body ingestion usually seen among children. Its ingestion could be symptom free and sometimes fatal. The interval between swallowing and final destination of the button battery has some clinical importance to its management. This is a case report of an eight-year-old boy, who ingested a 25 mm-sized button battery which was detected in the lower esophagus by a plain X-ray, managed conservatively with honey, and was later passed out of stool after 36 h.
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Perimortem caesarean section p. 222
Olufemi Augustine Solaja, Akintunde Olusegun Fehintola, Adedapo Omowonuola Adetoye
DOI:10.4103/NJM.NJM_200_21  
Maternal cardiopulmonary arrest is a very rare event whose prognosis might depend on the response to the event. We present the case of an unbooked G5P4 who had an arrest following two eclamptic fits. She had an on-site perimortem cesarean section and was delivered of a live female baby with a birth weight of 4.95 kg. She was subsequently transferred to the intensive care unit where she later died 5 days postdelivery. The baby was discharged home 4 days postdelivery with no neurological deficit. In managing such cases, multidisciplinary management must be the approach from the point of making the diagnosis to performing a resuscitative hysterotomy, as such reducing cardiac arrest delivery interval to the barest minimum.
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An unusual cause of pyogenic liver abscess. The conundrum of broom splinter. Report of two cases p. 225
Olanrewaju Samuel Balogun, Emmanuel A Jeje, Adedeji Lukman Fatuga, Oluwole Ayoola Atoyebi
DOI:10.4103/NJM.NJM_2_22  
Pyogenic liver abscess is an uncommon but potentially fatal disease. Very few cases of liver abscess due to foreign bodies have been reported. We report our experience in two patients who were successfully managed for liver abscess due to impaled broom splinter. Broom splinters were swallowed unnoticed during consumption of Jute leaves (Corchorus olitorus) (”Ewedu”) soup. Definitive diagnoses in both cases were made at surgery. This is the first case of broom stick-induced liver abscess to be reported in the literature.
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Management of bilateral congenital upper eyelid eversion in a neonate p. 229
Sunday Nnamdi Okonkwo, Elizabeth Dennis Nkanga, Nkama Mbang Etiowo, Justina Egwa Iyam
DOI:10.4103/NJM.NJM_205_21  
Congenital upper eyelid eversion is a rare condition characterized by the prolapse of chemosed palpebral conjunctiva from everted eyelids. Initial conservative management option commonly used in the treatment was unsuccessful in resolving the condition in our patient. However, temporary tarsorrhaphy resulted in satisfactory resolution. This case gives further credence to the effectiveness of temporary tarsorrhaphy as a surgical option in the management of congenital upper eyelid eversion.
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ERRATUM Top

Erratum: A survey of paediatric eye diseases in a tertiary hospital, Southwest Nigeria p. 232

DOI:10.4103/NJM.NJM_36_22  
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