Annals of Ibadan Postgraduate Medicine

The prevalence of dental caries among children in orphanages in Ibadan

O.E. Ayebameru — 2024-08-08

Background: A number of challenges are being faced by children in orphanages, a major one being their oral health as a common unmet need. Studies have shown high prevalence of dental caries and oro-facial trauma. This has been attributed to overcrowding, lack of adequate staff, poor oral hygiene, improper dietary habits, inadequacies in the orphanage system, as well as inadequacies in the healthcare system. This study aimed at assessing the prevalence and factors affecting dental caries and trauma among children in orphanages in Ibadan.

Materials and Method: All the children within the age group (7 – 15 years) in all the 18 registered orphanages in the 5 Local Government Areas within Ibadan metropolis were recruited into the study. Intra-oral examination was done under natural light and caries detection was done using tactile and visual method. Sterile mouth mirrors and CPI probes were used for this purpose. Dental caries status and the predisposing factors in each child were assessed. Presence of dental trauma and the predisposing factors were also assessed. Data processing was carried out with the aid of SPSS version 21.

Results: One hundred and forty-six children participated in the study, 51.4% of them were males while 48.6% were females. The age range and the mean age of the children were 7 – 15 years 9. 69 ± 3.78 respectively. The prevalence of dental caries among the children was 17.8% while that of dental trauma was 7.5%. The mean DMFT/dmft was found to be 0.42 ± 1.06. Gender and the presence of deep pits and fissures were the statistically significant predictors of dental caries.

Conclusion: Oral health is of utmost importance across all ages, much more pertinent among institutionalized children who are prone to dental caries and trauma as revealed by this study. An average child in an orphanage may be affected by both dental caries and trauma, but appears to be more prone to dental caries in this environment.

Apolipoprotein E gene polymorphisms and plasma lipids in persons living with HIV: A cross sectional study

M.A. Kuti — 2024-08-08

No Abstract

White cerebellum sign as a dark prognostic indicator of cerebral injury: A case report

O.A. Badejo — 2024-08-08

Introduction: The white cerebellum sign (WCS) is a classical but rare radiological finding usually associated with irreversible diffuse hypoxic-ischemic cerebral injury. Very few cases exist in the literature globally, especially from the West African region, as a potential hallmark of poor prognostic outcome. We describe the white cerebellum sign in a Nigerian pediatric patient, managed for severe head injury.

Case Presentation: A fourteen-year old boy presented to our emergency department with loss of consciousness following a pedestrian road traffic accident. Physical examination revealed a critically ill boy with fever, hypotension, tachycardia, gasping respiration, GCS 3, bilateral dilated unreactive pupils, absent corneal, gag and oculocephalic reflexes. He was thus diagnosed of severe traumatic brain injury and brainstem dysfunction. He had endotracheal intubation, ventilatory and inotropic support. Cranial computerized tomography scan of the patient showed radiological features in keeping with the WCS. His clinical status remained poor until he suffered a cardiac arrest about twelve hours after admission.

Conclusion: WCS has been reported in relation to child abuse, anoxic-ischemic brain injury, inflammatory and metabolic brain disorders and trauma. It is a classical radiological description of diffuse cerebral edema alongside relatively normal cerebellar hemispheres and brainstem. Management of this pathology is symptomatic, and aims to ameliorate the associated raised intracranial pressure, control seizures and prevent cerebral infarction. The index patient, who presented 24 hours after severe head injury with associated early post-traumatic seizures, respiratory failure and brainstem dysfunction, had an unfavourable outcome consistent with previous reports of WCS. We have reported the rare but classical white cerebellum sign. It remains a grave prognosticator of cerebral injury and should be sought for in the neuroimaging of patients with acute brain insults.

Quality of prescriptions received by patients with hypertension attending a Secondary Health Facility in Ibadan, Oyo State

A.B. Ibraheem — 2024-08-08

Background: High-quality prescription (HQP) which is a key player in optimal blood pressure control reflects good prescribing process and thus quality health care.

Aims: To determine quality of prescription and its correlates in patients with hypertension attending a secondary health facility in Ibadan, Nigeria

Methodology: A cross-sectional hospital-based study among 347 known hypertensive patients attending the Medical Outpatient clinic of Jericho Specialist hospital, Ibadan. Quality of prescription was determined using prescription quality index (PQI) tool and it was categorized into high, mediumand low-quality prescriptions. The respondents were recruited using a simple random sampling technique (computer generated random number). Data was analyzed using SPSS version 2020. Mean, standard deviation, Chi-square and Spearman correlation were used for data analysis and level of significant was set at <0.05.

Results: The mean (PQI) was 31.4±5.6; less than half of the patients 163 (47.3%) had low PQI, while medium and high PQI was found in 41(11.8%) and 143 (41.2%) patients respectively. There was a significant difference in the quality of prescriptions between male and female hypertensive patients (X²=15.85, pvalue<0.0001). Two-thirds of the patients, 229(66.0%) experienced associated health problems and this was significantly inversely correlated with prescription quality (r=-0.33, p<0.001).

Conclusion: The study revealed marginally low quality of prescription, statistically significant poor-quality prescription among the male patients and higher number of comorbidities significantly correlated negatively with prescribing quality. Thus, to comply with high quality prescriptions, combined medications among hypertensive patients with comorbidities should be used cautiously.

Ultrasound imaging and pathologic features of idiopathic scrotal calcinosis in a young adult Nigerian and review of the literature

S.J. Ayilara — 2024-08-08

Background: Idiopathic scrotal calcinosis is a rare and benign disease of the scrotal skin that presents as solitary or multiple painless calcified nodules or papules in the absence of systemic disorders of calcium or phosphorus metabolism. Although some theories have been proposed as to the cause of this rare disease, the exact cause remains unknown. In a resource-poor medical setting like Nigeria, a confident diagnosis of this condition can be made with ultrasonography.
Objective: The objective of this report is to emphasize the role of ultrasound in the imaging diagnosis of idiopathic scrotal calcinosis.
Case Presentation: This is a case report of a 38-year-old man who presented with recently discharging but longstanding multiple painless scrotal nodules of 22-years duration.
Conclusion: This case illustrates the prompt and accurate diagnosis of idiopathic scrotal calcinosis using an ultrasound, a readily available imaging modality in a low-resource setting. Although histology remains the gold-standard for diagnosing idiopathic scrotal calcinosis following surgical excision, this benign disorder has unique sonographic characteristics that could aid the radiologist in making a confident diagnosis.

Clinical profile and pattern of dementia in a geriatric centre

O.O. Elugbadebo — 2024-08-08

Background: Knowledge on the clinical presentation of dementia is essential for appropriate care, especially in Low-and-Middle-Income Countries where these cases are on a sharp rise and can also aid early detection of other underlying conditions. This study sought to provide a broad and updated socio-demographic, clinical profile, pattern of diagnosis and treatment features of people diagnosed with dementia in this setting.

Method: A retrospective cohort study which reviewed the medical case records of all older adults with dementia receiving treatment at the psychogeriatric and the neurology clinic of the Geriatric Centre (N=192). A proforma was designed to collect information from the case records.

Results: The mean (±SD) age of the participants was 74.0(±7.2) years, 97.9%lived with other persons, 50.0% had at least one comorbidity and 52.6% presented late for treatment. Overall, hypertension (64.1%) and diabetes (22.4%) were the most common comorbidity, 55.2% had complaints bordering on behavioural problems; irrational speech (31.3%) being the most common, while 91.7% had forgetfulness as a cognitive symptom.

Conclusions: A high rate of comorbidities, as well as late presentation was common among the participants. Our findings appraise the clinical importance of detailed knowledge of the patterns and profiles of older adults with dementia for early presentation and treatment.

A lump model for medical students’ clinical evaluation

S.A. Ademola — 2024-08-08

Introduction: Soft tissue masses are commonly encountered in surgical and general medical practice. The graduating medical student should therefore be competent in the physical examination of a lump. Paucity of real patients makes it paramount that models be used for teaching and evaluation. This study purposed to describe the perception of graduating medical students to the use of a low-cost lump model for Objective Structured Clinical Examination (OSCE).

Methods: This was a cross-sectional survey of final year medical students who participated in a surgery OSCE utilizing an innovative low-cost lump model.

Results: One hundred and sixty students undertook the OSCE examination while 130 (81.3%) students completed the survey questionnaire. One hundred and forty students (87.5%) passed (score ³ 5) the skills assessment using the lump model. The median age of the students who completed the questionnaire was 25 (range 24-27) years. There were more males N=84 (65.6%) than females N= 44 (34.4%). Two thirds (67.2%; n=84) of the students said the model simulated a true lump. Nearly all the students agreed that the signs of site (97.6%; n=127), size (97.6%; n=127), shape (95.4%; n=124) and transillumination (95.4%; n=124) were clearly demonstrable with the model. A lower proportion of agreements were seen with signs such as tenderness (64.6%; n=82), attachment (77.7%; n=80) and warmth (58.6%; n=75) while more students disagreed with pulsatility (51.5%; n=67)

Conclusion: The medical students had a positive perception to the use of the model. However, further refinements would be needed for more signs to be demonstrable.

Adverse childhood experiences and sexual risk behaviour in students of a Tertiary Institution in southwest Nigeria

O.O. Sekoni — 2024-08-08

Introduction: Adverse Childhood Experiences (ACE) are negative occurrences in childhood, including abuse (emotional, physical, and sexual abuse), neglect (emotional and physical) or household dysfunctions, which are linked to compromised health and well-being in adulthood. The consequences are wide and diverse including Sexual Risk Behaviour (SRB).

Aim: We embarked on this study to identify types and prevalence of ACE as well as the association between ACE and the adoption of SRB among the students of a tertiary institution in Oyo State, Nigeria.

Subjects and Methods: A descriptive cross-sectional study was conducted amongst students of Oyo State College of Agriculture and Technology. A questionnaire was used to obtain information on sociodemographic characteristics, ACE and SRB. Descriptive and inferential statistics were used to analyse the data as applicable.

Results: A total of 395 respondents participated in the study. The mean age of respondents was 21.06±3.13years. Emotional abuse and physical neglect had the highest prevalence of 65.6% and 44.3% respectively. Unprotected sex was the most prevalent SRB (19.5%). Majority (91.4%) of the respondents had experienced at least one ACE. There was a graded dose response between ACE and SRB. Participants with sexual risk behaviour were twice likely to have been exposed to household dysfunction (OR: 2.2 CI 1.3 - 3.7).

Conclusion: ACE and its subsequent effect on developing SRB have been demonstrated; its prevention and early identification should be an integral part of public health programs.

Determinants of outcome of neonatal surgical emergencies in Gombe: A 3-year retrospective review

S. Adamu — 2024-08-08

Background: Mortality associated with neonatal surgical emergencies is high, due to late presentation and delayed surgical intervention in developing countries. The aim of this study is to determine factors associated with poor outcome of neonatal surgical emergencies at a Federal Teaching Hospital Northeastern Nigeria.

Methods: A retrospective study of 85 neonates aged 1-28 days was carried between June 2019-May 2022. Records of the neonates with surgical emergencies were retrieved and analyzed with the SPSS Version 20.

Results: A total of 85 neonates, 55 (64.8%) males and 30(35.3%) females were analyzed. The average duration of symptoms at presentation is about 5.3-day range 1-10days. About 51(60.0%) neonates presented after 24 hours of life 34(40.0%) within 24 hours of life, out of which were 12(35.3%) neonates with gastroschisis presenting after 8hours with severe hypothermia axillary temperature of 32.1^o Celsius. The 46 (90.2%) neonates presenting after 24hours of life had travelled distances of 50- 100Kms to get to the hospital, out of which about 31(67.4%) arriving the following day, with about 9(29.0%) who had gastroschisis noticed to be lifeless at presentation. Overall, about 26(30.6%) died due to late presentation, delayed surgical intervention and lack radiant warmers.

Conclusion: Late presentation delayed surgical intervention are common causes of mortality in neonates with surgical emergencies in Gombe

Current lines and angles used in paediatric foot radiograph: A scoping review of literature

J. Doski — 2024-08-08

Objective: This article aimed to review the main currently described lines and angles and gather them in a single article and arrange them in a systematic way to facilitate the process of assessment of the pediatric foot for deformities.

Methods: The review was a scoping literature review. Electronic database websites such as PubMed, Europe PMC, Cochrane Library, and Google Scholar in addition to some books on anatomy and human movements biomechanics, diagnostic radiology, and orthopedics were searched for relevant articles for the topic of the present review. No statistical analysis was applied in this review.

Results: Data from thirty articles included in this review were arranged into different subheadings. In the anteroposterior view (AP), assessment of the hindfoot deviation was by the AP talo- calcaneal angle (Kite’s angle); the forefoot and midfoot for abduction and adduction alignment was by the AP talo-first metatarsal angle, the talo-second metatarsal angle, the calcaneo-second metatarsal angle, the calcaneofifth metatarsal angle; the forefoot and midfoot rotation was by observing the normal proximal convergence of the metatarsal bones axes. In the lateral view, assessment of the hindfoot sagittal plane alignment was by the lateral tibio-calcaneal angle; hindfoot varus or valgus deviation by the lateral talo-calcaneal angle; talus bone alignment by talar declination angle and the tibio-talar angle; calcaneal bone alignment by the calcaneal inclination angle and the tibio-calcaneal angle, the midfoot and forefoot sagittal plane alignment for the plantar arch by the lateral talo-first metatarsal -Meary’s- angle, the calcaneal inclination angle, and the lateral calcaneofirst metatarsal -Hibbs- angle; forefoot and midfoot rotational alignment by observing the overlap shadows of the metatarsals’ shafts and drawing their axes.

Conclusion: Drawing certain lines and angles with a systematic approach to assess different regions of the foot in the radiographic films of children can facilitate the process of assessment of the foot (as a whole) for deformities.

Major depressive disorders in paediatric surgical patients: An overview of the Nigerian adolescents

O.A. Afolabi — 2024-08-08

Introduction: Less than three decades ago, depression was seen as a predominantly adult disorder as children were considered too developmentally immature to experience depressive disorders, and adolescent low mood was considered as part of ‘normal’ teenage mood swings. Major depressive disorder in children and adolescents is a serious psychiatric illness especially in paediatric surgical patients. This may be due to their altered metabolic rate and heighten metabolic response to trauma which has significant implications for the psychological development of the child, yet it remains under-recognized and undertreated. The well-being of the care givers is also not left out as the care givers are inundated with the task of sourcing and providing finance for hospital care., in addition to the stress of providing care for the patient. This may result in loss of man hour, sleeplessness, and physical exhaustion associated with caring for these ill children which can ultimately significantly increase the risk of them having depressive episode. The aim of this commentary is to highlight the fact that paediatric surgical patients are not exempt to having a major depressive disorder and the care givers should also be evaluated during hospital admission of their wards.

Methodology: This is a commentary on depressive disorders among Nigerian paediatric surgical patients. Related publications on children and adolescents presenting to hospital were searched using the domain – Depression in Nigerian adolescent, Paediatric surgery patients on PubMed, Google Scholar, and MEDLINE to appraise this review.

Conclusion: Mood disorders, especially depression in children and adolescents have been studied increasingly over the last two decades and surgical conditions worsen the outlook, culminating in increased knowledge about the presentation, and treatment. Despite this, it is still often missed or misdiagnosed because it sometimes presents with uncharacteristic symptoms. Prevalence of depressiion among paediatric surgical patient were found to be between 46-82% in this review among Nigerian patients.

The prevalence of dental caries among children in orphanages in Ibadan

O.E. Ayebameru — 2024-08-08

Assessment of the level of awareness, knowledge, and risk perception of community members about Mpox infection in Nigeria

D. Bakare — 2024-08-08

Background: Since the resurgence of mpox disease in 2017, Nigeria alone has accounted for about 60% of confirmed cases reported in the African region. This study therefore aimed to understand the knowledge and perception of the general public towards the mpox infection.

Methods: We conducted a cross-sectional study among 958 community members across three states (Oyo, Lagos and Jigawa) in Nigeria. Knowledge of mpox infection was assessed across four domains: (1) general knowledge, (2) transmission, (3) signs and symptoms, and (4) prevention and treatment where we assigned a score of 1 for each correct response. Binary logistic regression was conducted to explore factors associated with knowledge of mpox infection at 5% level of significance. We assessed perception of mpox infection across 5 constructs (perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and self-efficacy) from the health belief model, using 3-point Likert scales. We used Kruskal-Wallis and Mann-WhitneyU tests to assess factors associated with each construct.

Results: Overall, only about one-third (38.3%) of community members were aware of mpox infection. There were variations in perceptions and knowledge across the three states. Knowledge of mpox infection transmission, prevention, and treatment was low across the states. Only 28.9% of respondents knew that sharing utensils with an infected person is a means of contracting the disease, and just 15.9% were aware that mpox infection may resolve spontaneously. The mean of general knowledge scores was higher in Jigawa 14.8 (±3.2) compared to Lagos 12.1 (±4.1) and Oyo states 12.5 (±5.6) (p<0.001). Respondents with tertiary-level education (p=0.001) were significantly more likely to perceive themselves as susceptible to mpox while males (p<0.001) and respondents who live in Jigawa state (p=0.002) were significantly more likely to perceive mpox as severe with 90.5% believing that being infected will stop their daily activity (p<0.001). Perceived barriers to adherence to mpox preventive strategies were higher in Jigawa state (p<0.001), with 68.3%reporting that use of hand sanitizers might be expensive for them.

Conclusion: The analysis of our findings revealed significant knowledge gaps and a very low level of public awareness about mpox. Key areas of limited knowledge included the disease’s route of transmission, as well as its prevention and treatment. To control the spread of mpox infection, there is need to strengthen public health risk communication focusing on the transmission and preventive actions.

After action review as a tool to improve a tertiary hospital’s response to outbreaks: Experience from Irrua Specialist Teaching Hospital

J. Okoeguale — 2024-08-08

No Abstract

Goserelin inhibiting uptake on sodium pertechnetate Tc-99 mthyroid scan: A case report

Y.A. Onimode — 2024-08-08

Introduction: Thyroiditis may be induced by goserelin (a long acting analogue of gonadotropin - releasing hormone) prescribed for the treatment of pain and bleeding of endometriosis. Goserelin induced thyroiditis has a possibility of affecting thyroid function and hence may cause poor uptake on sodiumpertechnetate Tc-99m thyroid scan.

Case presentation: This case report highlights a rare instance of a middleaged woman with symptomatic toxic goitre whose sodium pertechnetate Tc99m thyroid scan uptake was inhibited by goserelin therapy.

Conclusion: Medical personnel caring for patients on goserelin need to be aware of the possibility of it affecting thyroid function.

Body stalk anomaly: Clinical and histopathologic findings of this rare anomaly in a Nigerian newborn

K.I. Egbuchulem — 2024-08-08

Introduction: Body stalk anomaly (BSA) is a rare and severe congenital malformation in which the exact pathophysiology is still unknown. The possible causes of body stalk anomaly include early amnion rupture with direct mechanical pressure and amniotic bands, vascular disruption of the early embryo, or an abnormality in the germinal disk.

Case presentation: We report a case of sonologically delayed diagnosis of BSA which was confirmed post-delivery following histopathological examination and we reviewed relevant literature regarding this phenomenon. Sonographic features of the foetus included a wide anterior abdominal wall defect (omphalocele) with protrusion of the liver into the amniotic cavity. The umbilical arteries show normal calibre, flow, velocimetry, and spectral waveform.

Conclusion: Body stalk anomaly is accepted as a fatal anomaly, so it is important to differentiate it from other anterior abdominal wall defects prenatally and this could guide the management options.

White cerebellum sign as a dark prognostic indicator of cerebral injury: A case report

O.A. Badejo — 2024-08-08

Ultrasound imaging and pathologic features of idiopathic scrotal calcinosis in a young adult Nigerian and review of the literature

S.J. Ayilara — 2024-08-08

Objective: The objective of this report is to emphasize the role of ultrasound in the imaging diagnosis of idiopathic scrotal calcinosis.

Case Presentation: This is a case report of a 38-year-old man who presented with recently discharging but longstanding multiple painless scrotal nodules of 22-years duration.

Conclusion: This case illustrates the prompt and accurate diagnosis of idiopathic scrotal calcinosis using an ultrasound, a readily available imaging modality in a low-resource setting. Although histology remains the gold- standard for diagnosing idiopathic scrotal calcinosis following surgical excision, this benign disorder has unique sonographic characteristics that could aid the radiologist in making a confident diagnosis.

Major depressive disorder: Cognitive, emotive and motivational consequences in adolescents

K. Uwajeh — 2024-08-08

No Abstract

A perspective of evidence-based medicine

S. Kadiri — 2024-08-08

No Abstract

Emerging infections in contemporary times; what does the future hold?

O. Adekanmbi — 2024-08-08

No Abstract