Afrimedic Journal

Career Choices of Medical Doctors In Anambra State, Nigeria And Factors Influencing Their Choices: The Need For Balance

2024-07-15T10:02:41+00:00

Background:
One of the most challenging decisions for any
medical graduate is the career pathway choice. A lot
of factors are known to influence this decision.
Medical graduates make career choices without
reference to societal needs. Some specialties end up
being competitive while some are faced with
shortages. There is need for a balanced distribution
of specialists if the general populace will be served
by the right mix of medical specialists.
Objective:
The study sought to determine the factors
influencing career choices amongst medical doctors.
Methods:
This was a cross-sectional study of doctors in
Anambra State. Stratified sampling technique with
proportionate allocation was used to select the
required number of doctors from each category of
doctors. Simple random sampling was then used to
select the respondents from the various groups.
Data was collected using semi-structured, pre-tested
and validated questionnaire. Analysis was done using
SPSS V 24.
Results:
Two hundred and ninety respondents were recruited
with 62.8% being males. The mean age of
respondents was 39.47 ± 9.25 years. Those who had
opted not to specialize in any area were 13.1%.
More than half of the respondents (59%) were
distributed among the four major specialties of
Surgery, Obstetrics & Gynaecology, Internal
Medicine and Pediatrics respectively. The major
factors that were found to influence choice of
specialty were personal interest, perceived
competence and future job opportunities in that
specialty. The commonest reasons for change of
from initial desired specialty were stressful nature of
specialty and previous negative experiences.
Conclusion:
Many factors are involved in physician’s choice of
career after graduation. While some specialties have
enough doctors with intense competition, some
other specialties are faced with dire physician
shortages. There is a need for these factors to be
critically analyzed in order to achieve a balanced
distribution of physicians for effective healthcare
service in these communities.

An Evaluation of Impact of Obesity on Male Fertility in Nigerian Men Retrospective Cohort Study at 68 Nigerian Army Reference Hospital Yaba.

2024-07-15T09:56:32+00:00

BACKGROUND: Infertile men contribute an intriguing 30-
50% of infertility burden worldwide. This is even more
worrisome in Nigeria being one of the countries located
in the infertility belt of Africa. The rising trend in male
factor infertility is evidenced by the decrease in seminal
fluid parameters which has since been used as a
surrogate marker of male fecundity.
This study analysed the effect of body mass index on
seminal fluid parameters of men who sought fertility
treatment at 68 Nigerian Army Reference Hospital Yaba,
Lagos. (68 NARHY) over a five-year period.
METHODS: This was retrospective cohort study of the
cases of infertile couples that attended Gynaecology and
Urology clinics of 68 NARHY from 1st January 2019-
December 31st, 2023. A purposely designed proforma
using the WHO manual for the examination of human
semen was used for data collection. Outcome measures
were volume of semen, total sperm number, sperm
concentration, PH, agglutination, liquefaction, motility,
morphology, vitality, and white blood cell count. Data was
analysed using SPSS version 23. Data were presented as
means and proportions. P-value of < 0.05 was used as the
level of significance.
RESULTS: Overall, 562 couples attended Gynaecology and
urology clinics with fertility-related concerns within the
study period with a retrieval rate of 98.3%. Age and BMI
of the participants significantly affected sperm motility,
and morphology. (p-values of 0.001, and 0.002
respectively).
CONCLUSION: Obesity presents a myriad of problems as
regards to male sexuality and fertility. This study has
demonstrated that increasing age has a negative effect
on sperm morphology, and total motility with obesity
also showing additional negative effect on the above and
sperm concentration.

A Missed Bronchial Foreign Body Presenting with Pneumomediastinum And Subcutaneous Emphysema

2024-07-15T09:44:59+00:00

Background: Pnemomediastinum with subcutaneous emphysema is a rare but potentially fatal sequalae of bronchial foreign body aspiration. An 18-month-old female presented to the Accident and Emergency (A&E) department with a 28-hour history of sudden onset choking, cough, shortness of breath and fever. At the onset of symptom, some pieces of groundnut seed were found in her immediate surroundings, but no eyewitness accounted of what transpired. Oxygen saturation was 64% on intranasal Oxygen support. The child had cardiac arrest twice and was resuscitated; first at presentation and then on the theatre table, during induction of anaesthesia. Bronchoscopy revealed edematous bronchus; secretions were suctioned, and the visible groundnut seeds lodged within the bronchial lumen retrieved. Further careful search revealed no other obvious remnant. Symptoms improved immediate postop but deteriorated about 12 hours later, with worsening dyspnoea, fever, pneumomediastinum and subcutaneous emphysema. She had a revision bronchoscopy, and another piece of ground-nut seed was identified and retrieved. All respiratory symptoms gradually resolved within the next 48hours, and she was discharged home.

Conclusion: Though an uncommon mode of presentation, foreign body aspiration should be ruled out in any child with unexplained subcutaneous emphysema around the lower neck and upper chest region in the presence of other acute lower respiratory tract symptoms. Emergency bronchoscopy remains the gold standard of treatment.

Variations in Red Blood Cell and White Blood Cell Indices Among Persons Living With HIV on Treatment and Treatment Naïve at Nnamdi Azikiwe University Teaching Hospital, Nnewi

2024-07-15T10:10:13+00:00

Background
Human immunodeficiency virus (HIV) infection is
associated with variable haematological
manifestations which are more common among
persons living with HIV (PLWH) than the general
population.
Objectives
This cross-sectional study was designed to
ascertain the variations in red blood cell and white
blood cell indices in PLWH on antiretroviral
treatment and those that are treatment naïve at
NAUTH, Nnewi.
Methods
The study included a total of 180 adult participants
which comprised eighty PLWH on antiretroviral
treatment (PLWH on ART), forty PLWH not on ART
(PLWH non-ART) and sixty HIV negative control
subjects. Red blood cell and white blood cell
indices were measured using
Diatron’shaematology auto-analyser.
Results
The Red blood cell count, Haematocrit and
Haemoglobin levels were significantly lower in
PLWH not on ART when compared to PLWH on
ART and HIV negative subjects. Mean cell
haemoglobin concentration (MCHC) were
significantly lower in PLWH on ART and PLWH not
on ART compared to HIV negative subjects. The
Mean cell volume (MCV) was significantly higher in
HIV negative subjects compared to PLWH on ART
and PLWH not on ART, while the total white blood
cell count was significantly higher in HIV negative
subjects compared to PLWH not on ART. The
monocyte count was significantly higher in PLWH
on ART compared to PLWH not on ART and HIV
negative subjects.
Conclusion
HIV infection results in significant variations in
some red cell and white cell indices. The negative
variations improve among PLWH on ART
compared to PLWH not on ART. This affirms the
favourable prospects of antiretroviral therapy in
resolving derangements in some haematological
parameters.