Annals of Ibadan Postgraduate Medicine

Bibliometric analysis and impact factor of annals of Ibadan Postgraduate Medicine Journal between 2003-2023: The pivotal roles of the frontiersman

K.I. Egbuchulem, G. Adebayo, I. Adeagbo, O.S. Michael — Wed, 08 May 2024 00:00:00 +0000

Introduction: Bibliometric appraisal of a research publication outfit of this nature
serves as a tool to evaluate the direction of research activities of Annals of Ibadan
Postgraduate Medicine Journal as it pertains to article publication between 2003
and 2023, and to determine the research impacts on the body of knowledge. The
essence of this review is to determine the quantum volume of research output,
nature of publication, regional distribution, and citations.
Methodology: Information was transcribed on the cataloguing cards for the
generation of data bank. Subject analysis was carried out using Medical Subject
Headings of 2023 edition. Excel spreadsheet was used to analyze the data. Univariate
analysis was done and presented in frequency and proportions. Descriptive statistics
were presented in charts, line graphs, and tables.
Results: Five hundred and fifty-two research articles were submitted during this
period (2003 - 2023) while 21 out of this are still in the peer review cycle and has been
carried forward to year 2024. Of the 531 reviewed, 441 was published with a manuscript
acceptance rate of 83%. The highest number of articles, 45 (8.2%) was published in
2023, followed by 2021 with 39 articles (7.1%) and the least published year was 2003
with eight. AIPM has contributed significantly to the body of knowledge with a total
of 441 research output over this period, out of which we had 309 publications between
2008 - 2021 with 2,869 citations. Oyo State recorded the maximum number of
publications in terms of geographical distribution with most of the authorship
from Ibadan.
Conclusion: AIPM has contributed significantly to the body of knowledge with a
total of 441 research output, and manuscript acceptance rate of 83%. Also, a 2,869
citations were recorded over a 13-year period. There was a gradual increase in research
output during the period.

Sexual risk behaviours and compulsive sexual behaviour disorders among military personnel in Ibadan

A.A. Adetoro, A.M. Adebayo, O.A. Atariata — Wed, 08 May 2024 00:00:00 +0000

Background: Military personnel (MP) are exposed to situations such as loneliness and alcohol use that lead to sexual risk behaviours (SRBs) with serious implications for the spread of sexually transmitted infections (STIs). Compulsive sexual behaviour disorder (CSBD) is a psychosexual condition that is characterized by a consistent failure to control sexual behaviour and continuation of the behaviour despite the consequences. The prevalence of CSBD is underreported due to the sensitive nature of the behaviour. This study thereby assesses SRBs and CSBD and associated factors among MP.

Methods:A cross-sectional study among 406 MP in Ibadan using a convenient sampling method to select the personnel serving in the two military barracks in Ibadan. MP available on the days of data collection were interviewed. A semi-structured, interviewer-administered questionnaire was used to obtain information on SRBs and CSBD. Descriptive and inferential statistics were done and the Chi-Square test was used to test for association between independent and outcome variables at p < 0.05.

Results:The mean age of respondents was 30.1±10.1 years. Above half (52.7%) were aged 20 - 30 years, 70.7% were males, and 56.6% were not living with a partner. The prevalence of SRBs among respondents was 79.6% while the prevalence of CSBD was 6.4%. Gender and marital status were predictors of SRBs.

Conclusion: The majority of MP engaged in SRBs while less than one-tenth had CSBD. Gender and marital status were predictors of SRBs. Risk reduction counseling was recommended for MP.

Effectiveness of teachers in the detection of eye disorders among primary school children in Abakaliki Metropolis, Ebonyi State Nigeria

Wed, 08 May 2024 00:00:00 +0000

Background: Schoolteachers who have knowledge on eye diseases can detect early children with eye disorders and refer them promptly to an eye specialist. The aim of this study is to assess the effectiveness of teachers in a vision screening program for primary school children in Abakaliki.

Methods: This descriptive cross-sectional study was conducted among 20 randomly selected primary schoolteachers in Abakaliki to screen for vision abnormalities and detect eye problems among 350 children from 5 schools. Teachers participated in a 2-day training using a modified training algorithm on vision screening using a Snellen’s chart and in the identification of common ocular abnormalities. Data was analysed using IBM SPSS version 26 statistical program and a p-value of <0.05 at 95% confidence level was statistically significant.

Results: A total of 379 children were enrolled into the study however, 350 (92.3%) children participated in the study. School teachers correctly identified 283 (92.8%) children who had normal vision and 33(73.3%) who had impaired vision. Overall 60 (17.1%) children with perceived eye defects were referred to the ophthalmologist for re-examination. Refractive error and allergic conjunctivitis were the most common eye problems identified and children with refractive error and other ocular morbidity were referred to the base hospital.

Conclusion: Teachers are a valuable resource in the detection of eye disorders among school children. Their effectiveness can be further enhanced by regular training, and collaboration with eye care professionals. Addressing these limitations through policy implementation can lead to better eye health outcomes for school children in Nigeria.

Predictors of acute heart failure outcomes at University College Hospital, Ibadan, Nigeria

O. Adebayo, A. Adebiyi, O.S. Ogah, M.A. Adeoye, A. Aje, O.O. Oladapo — Wed, 08 May 2024 00:00:00 +0000

Background: Studies of acute heart failure (AHF) outcomes suggest that there are different predictors of mortality depending on region, ethnicity, and gender.

Objective: The purpose of this study was to identify predictors of six months’ post discharge outcome among AHF patients in a Nigerian tertiary hospital.

Methods and Materials: This study was a prospective observational study conducted at the cardiology unit of the Department of Medicine at the University College Hospital Ibadan. One hundred and sixty AHF participants > 18 years old were recruited.

Results: The mean age of the cohort was 58.0±15.1 years and most were males (59.4%). The independent predictors for death outcome after six months of discharge for AHF and the adjusted hazard ratio) (95% CI) were male gender 2.77 (1.17 -6.56); p = 0.020; systolic blood pressure (mmHg) 0.98 (0.96 - 0.99); p = 0.011; and the presence of hepatomegaly 2.58 (1.02 - 6.51); p = 0.045. Independent predictors for readmission or rehospitalization within 6 months after discharge were presence of right abdominal pain adjusted HR (95% CI): 2.07(1.14 - 3.76), p=0.017; SBP 0.98(0.96 - 0.99), p=0.005. Independent predictors for composite endpoint were male gender: adjusted HR: 2.08 (1.16 - 3.72), p= 0.014 and pericardial effusion and tamponade: 5.31(1.79 - 15.74), p=0.003.

Conclusion: The study provided an insight into the factors contributing to outcomes six-month after admission in a tertiary centre in South-Western Nigeria, and it highlighted the predictive role of systolic blood pressure.

A randomised controlled trial on clinical efficacy of sodium perborate mixed with distilled water and 30% hydrogen peroxide in the lightening of non-vital discoloured anterior teeth

A.D. Odofin, J. Taiwo, I.A. Solanke, O. Ibiyemi, A.O Afolabi — Wed, 08 May 2024 00:00:00 +0000

Objective: To compare the effectiveness of sodium perborate mixed with distilled water and sodium perborate mixed with 30% hydrogen peroxide as non–vital bleaching agent of anterior discolored teeth.

Materials and methods: A randomized controlled trial was undertaken among 61 patients who presented with 70 discolored anterior teeth at the Conservative and Family Dentistry Clinics of the University College Hospital, Ibadan, Nigeria. The 70 teeth were randomly allocated into two groups of treatments. In Group A, the test group, the coronal part of endodontically treated teeth was further treated with sodium perborate mixed with distilled water while group B, the control group, the coronal part of endodontically treated teeth were also further treated with sodium perborate mixed with 30% hydrogen peroxide. Information on study participants biodata and satisfaction with treatment were obtained. Tooth shade assessment was done using shade guide units of the vitapan shade guide at baseline and during recall visits on days 7, 14, and 21. Frequencies, means and standard deviations were generated. Chi-squared test was used to determine the association between two categorical variables at p<0.05.

Results:In the control group the mean ± SD tooth shade was 12.5 ±3.2, 8.7 ± 3.8, 4.9 ± 2.8 and 3.1 ± 2.2 at baseline, Day 7, Day 14 and Day 21 respectively. In the test group, the corresponding values are 12.8 ± 3.2, 9.6 ± 3.9, 5.6 ± 3.0 and 4.0 ± 2.9. The mean ± SD tooth shade scores of control and test group was 12.5 ± 3.2 and 12.8 ± 3.2 respectively (p = 0.15). Twenty-two (62.9%) and 19(54.3%) of the study participants in the control and test groups respectively reported that they were extremely satisfied (p=0.60).

Conclusion: The effectiveness of sodium perborate mixed with distilled water and sodium perborate mixed with 30% hydrogen peroxide in lightening the coronal part of endodontically treated non-vital discolored anterior teeth were similar. Both bleaching agents demonstrated similar patient satisfaction.

The effect of skin antisepsis after primary skin closure on the incidence of surgical site infection after abdominal surgery for sepsis: A preliminary report of a randomised controlled trial

Wed, 08 May 2024 00:00:00 +0000

Background: The role of skin antisepsis after skin closure in abdominal surgery for sepsis is not well reported. This study assessed the effect of skin antisepsis following primary skin closure on surgical site infection (SSI) after contaminated and dirty abdominal surgery.

Methods: This was a randomised controlled trial involving adult patients undergoing laparotomy for sepsis. Patients were randomised into a Control (C) group where the wound edge was cleaned once with 70% isopropyl alcohol before being covered with a dry sterile gauze dressing and a Povidone-iodine (PI) group in whom the wound edge was cleaned once with 70% isopropyl alcohol, then covered with a 10% povidone iodine-soaked gauze dressing. Both groups were compared for the presence of SSI. Statistical significance was set at a p value of <0.05.

Results: Thirty-seven patients (C group = 18; PI group = 19) were recruited. The median age was 36 years (Interquartile range, IQR = 72) with a male-to-female ratio of 2.7:1. The overall incidence of SSI was 48.6% (n = 18), comparable between the C group (n=10, 55.6%) and PI group (n = 8; 42.1%) (p = 0.413). In-hospital mortality rate was 10.8 % (n = 4), equally distributed between the groups (p = 1.000). The length of hospital stay was 8 days (IQR = 15) in the C group and 7 days in the PI group (IQR =9) (p = 0.169).

Conclusion: In laparotomy for sepsis, skin antisepsis after primary skin closure had no effect on the incidence of surgical site infection.

Response to the COVID-19 outbreak: Lessons from a Tertiary Healthcare Facility in Southwest Nigeria

Wed, 08 May 2024 00:00:00 +0000

Background: Mitigating the risk of nosocomial infection is one of the core functions of healthcare managers in hospital environments. This study aimed to describe the COVID-19 outbreak response in a tertiary healthcare facility in Nigeria.

Methods: A qualitative cross- sectional study was conducted among representatives of Heads of Infection Control Committees and units, the Accident and Emergency unit, Family Medicine unit, and Private Suites on the COVID-19 outbreak response at the University College Hospital, Ibadan, Nigeria. Data were analyzed using Colaizzi’s phenomenological method.

Results: Overall, seven (six physicians and one nurse) HCWs were interviewed; six (71.4%) males and two (28.6%) females. The average age of the key informants was 45 ± 4.73 years. Four themes were identified. Theme one “Essentials of screening protocol and screening area” described the development of screening protocol, and dedication of a triage area. Theme two “Infection prevention and control within consultation premises” detailed adequate spacing; hand hygiene, use of personal protective equipment; environmental sanitation; and waste management. Theme three “Mounting up surveillance in the response activity” specified communication with the Disease Surveillance Unit; and surveillance activities. Theme four “Training and psychosocial support for staff” described staff training, and provision of psychosocial care to infected staff.

Conclusion: The COVID-19 outbreak measures implemented by the management of the University College Hospital, Ibadan were aimed at ensuring that the hospital does not get overwhelmed by the surge in COVID-19 cases. In order to improve outbreak response in hospital settings, it is important to undertake training, modify hospital practices, and evaluate implemented measures.

Dental age estimation using the radiographic visibility of periodontal ligament around lower third molars among selected Nigerians

O.I. Opeodu, O.F. Sigbeku — Wed, 08 May 2024 00:00:00 +0000

Background: Age estimation for sporting activities, legal age determination and migration purpose is oftentimes essential, which makes the need for a scientifically proven method of age estimation an important aspect of medical practice. Forensic odontology is an essential aspect of forensic practice and may be a veritable tool in age estimation.

Aim and Objective: The objective of this study was to evaluate the usefulness of orthopantomograms (OPG) in age estimation among selected Nigerians.

Methodology: A retrospective assessment of 202 OPGs was done to review the visibility of the periodontal ligament of third molars with completed root formation according to the methods described by Olze et al (2010). Individual ages were then calculated by deducting date of exposure from the date of birth recorded in years. Mean age with standard deviation were calculated for each group.

Results: Assessing the minimum and maximum age at which each of the stages of the radiographic visibility of the periodontal ligament as seen on the OPGs revealed that there was a gradual increase in the age at which the stage increment occurred, with a few exceptions. Comparison of the radiographic visibility of the periodontal ligament revealed that males tend to achieve early periodontal visibility stages compared to females, but the reverse was observed in later stages. Age 17 is more than likely attained in any person found within stages 1 to 3 as the minimum age found in these stages were above 17 years.

Conclusion: With a few exceptions, the assessment of periodontal ligament visibility on OPGs can adequately predict the age of individuals. Thus, the use of this method may need to be combined with other methods in accurate determination of dental age in instances of forensic age estimation.

Obstructed congenital hernia of umbilical cord in a Nigerian newborn and its diagnostic conundrum

A.A. Ishola, K.I. Egbuchulem, D.I. Olulana — Wed, 08 May 2024 00:00:00 +0000

Background: Congenital Hernia of umbilical cord (CHUC) is a rare presentation. The failure of return of intestinal loops following physiological herniation has been postulated as the embryological basis of this condition. This is usually mistakenly termed as omphalocele minor. We aim to highlight this rare finding, the clinical features, diagnostic dilemma, and management of CHUC.

Case Presentation: He is a 4-day old male with obstructed CHUC. He had an oedematous umbilical stump, with circumferential normal abdominal wall skin folds in the form of a collar wrapping round the proximal aspect of the protrusion. The umbilical defect measured about 4 cm in diameter. Subsequently, surgical reduction and repair of defect was done, with resolution of symptoms.

Conclusion: CHUC though a rare entity and easily missed, accurate diagnosis and management offer good prognosis. Also, recognition will prevent iatrogenic bowel injury from careless clamping of the cord with associated morbidity and mortality. It also helps to prevent mis categorization and prevent unwarranted anxiety with misdiagnosis.

Aquaporin-4 (AQP-4) immunoglobulin g seropositive Neuromyelitis Optica: A review and case report

C. Nwaze, Y. Eghwrudjakpor, N. Chinedu-Anunaso — Wed, 08 May 2024 00:00:00 +0000

Background: Neuromyelitis optica spectrum disorder (NMOSD) is a relatively new terminology composed to encompass patients with neuromyelitis optica (NMO) and related immunological conditions. The diagnosis of this condition requires a seropositive aquaporin-4 immunoglobulin G (AQP-4 IgG), the presence of at least one core clinical characteristic and the exclusion of alternative diagnoses. Very few cases have been reported in sub-Saharan Africa.

Objective: The aim of this article is to report a classical case of NMOSDwith AQP-4 IgG seropositivity and normal brain, cervical and thoracic MRI findings.

Result: We report a 25-year-old Nigerian woman who presented with recurrent and alternating weakness, pain and numbness of all limbs, associated with episodic painful left-sided tonic spasms and urinary incontinence. She had earlier had symptoms of recurrent, episodic and alternating loss of vision in both eyes, associated with ocular pain. Examination findings revealed an intact mental status, no cranial nerve deficit and no focal limb weakness. Right-sided deep tendon reflexes were exaggerated. Vital signs were within normal limits. Brain MRI, Cervical spine MRI and Thoracic spine MRI all revealed normal findings. Serum aquaporin-4 IgG assay returned positive with a titer of 1:32. She was commenced on high dose steroids and there was gradual improvement of symptoms.

Conclusion: These findings confirmed the diagnosis of neuromyelitis optica spectrum disorder, and satisfies the diagnostic criteria published in 2015 by the International Panel for NMO Diagnosis (IPND)

Foetus-in-fetu, a paediatric rarity in an infant at Irrua Specialist Teaching Hospital, Irrua, Nigeria

Wed, 08 May 2024 00:00:00 +0000

Introduction: Fetus in fetu is a paediatric rarity. It involves the presence of a mass resembling a fetus inside the body of a child or an adult. It is described as a twin growing inside the body of the other. It can be located in different parts of the body but commonly the retroperitoneum. It is usually benign.

Case presentation: The patient was a 4 month old male infant who presented to the hospital with complaints of abdominal distention. The distention was noticed two months prior to presenting to our hospital. The distension was generalized and has been progressively increasing until presentation. There was no associated abdominal pain and no other abdominal symptoms.

Conclusion: Treatment is by complete excision for histological examination.

Preliminary report on the use of nutraceuticals in the management of sickle cell anemia: A case series

A.D. Ajibade, O.S. Michael — Wed, 08 May 2024 00:00:00 +0000

Background: There is growing recognition of the benefits of nutraceuticals in the management of sickle cell disease but a scarcity of reports on their use. Nutraceuticals are food or parts of food that provide medical or health benefits. They include botanicals, functional foods and medicinal foods. This is a preliminary report on the use of nutraceuticals in the management of a small cohort of children with sickle cell disease in Nigeria.

Patients and Methods: the retrospective audit of clinical outcomes was carried out at a brain center located within the Federal Capital Territory, Abuja, Nigeria. Children, aged 1 to 12 years, presenting with sickle cell anaemia were evaluated at baseline and at six months after the commencement of a cocktail of nutraceuticals using an objective grading tool. Changes in weight, haematocrit and frequency of sickle cell crises were determined. On account of the small sample size, Wilcoxon sign test was used to determine the similarity / difference between the average values of weight, PCV, and crises obtained at enro7lment and six months.

Results: Ten children with sickle cell anaemia were placed on nutraceuticals therapy. The average age of the children was 8.5 (range 1 – 12) years. Aroga immune support was the commonest component of the nutraceutical cocktail given to the children. There was a rise in average weight (from 21.8 to 23.0 Kg, p-value 0.236) and average haematocrit (22.8 to 27.2, p-value 0.011) at six months compared to values obtained at baseline. There was also a fall in the average frequency of sickle cell crises at six months compared to values obtained at baseline (from 7.4 to 3.2, p-value 0.011). Overall, eight out of the ten children showed moderate to good clinical improvement. There was no documentation of any adverse reaction to the medications in any of the children.

Conclusion: The results suggest that the use of nutraceuticals may be beneficial in the management of sickle cell anaemia in children. However, the results are preliminary and will require stronger evidence. There is a need for controlled clinical trials for using larger sample sizes. Such clinical trials of unconventional therapies should be conducted with great care and concern for the safety of the participants.

Inferior vena cava filter placement for prevention of pulmonary thromboembolism: Case series from northwestern Nigeria

Wed, 08 May 2024 00:00:00 +0000

Background: Inferior vena cava (IVC) filter placement is an image-guided procedure aimed at primarily preventing pulmonary thromboembolism in patients with lower limb venous thromboembolic (VTE) disease. In Northern Nigeria with a relatively high incidence of thromboembolic disease such as Deep vein thrombosis, reports on IVC filter placement are largely low. We report the feasibility of IVC filter placement on eight patients for the first time in a typical low-resource setting in Northern Nigeria.

Case Presentations: We had an equal number of males and females of the eight patients. Their ages ranged from 20 to 80 years. Five patients presented with bilateral lower limbs Deep vein thrombosis (DVT) of which one had a pulmonary embolism. Two other patients had extensive left femoral DVT and one had extensive IVC, iliac, femoral, and popliteal veins thrombosis. The medical records of seven patients, who had IVC filter placement in our department, were reviewed. The IVC filter was deployed with the aid of a C-arm fluoroscopic unit. In a single case, access was secured via an indwelling dialysis catheter.

Conclusions: All the patients had successful deployment with satisfactory postprocedure conditions. The intended benefit of pulmonary embolism prevention was achieved in the series of procedures that were performed. Indicating the value of IVC filter even in resource-poor settings and effort should be made towards exploring such intervention.

Non-traumatic Ectopia lentis in a paediatric ophthalmology practice, Ibadan, Nigeria

M.O. Ugalahi, E.O. Onebunne, B.A. Olusanya, A.M. Baiyeroju — Wed, 08 May 2024 00:00:00 +0000

Background: Non-traumatic ectopia lentis is a rare ocular disorder usually associated with syndromes like Marfans’s syndrome, Weil- Marchesani and Homocystinuria. Ectopia lentis can lead to profound visual loss from refractive errors, glaucoma as well as retinal detachment if left unattended.

Aim: The aim of this study was to describe the clinical profile of patients with non-traumatic ectopia lentis in a paediatric ophthalmology clinic in Ibadan, Nigeria.

Methods: The clinical records of children <16 years diagnosed with non- traumatic ectopia lentis at the Paediatric Ophthalmology Clinic, University College Hospital Ibadan, from May 1, 2015 to Dec 31, 2019 were retrospectively reviewed. Information on demography, family history, visual acuity (VA), mean refractive error (spherical equivalent), and management was retrieved.

Results: Clinical records of 25 patients were reviewed. The mean age was 8.9 (±3.41) years with a range of 2-15 years. Sixteen (64%) patients were males. All the patients had bilateral involvement. A positive family history of ectopia lentis was elicited in 6 (24%) patients. Thirteen (52%) patients had a Marfanoid habitus and superior displacement of the lens was observed in 26 (52%) eyes. The presenting visual acuity was <6/60 in 22 (44%) eyes. The spherical equivalent of the refractive errors ranged from -20.00DS to +13.25DS. Twenty (40%) eyes underwent surgery within the period of the study and the best corrected postoperative visual acuity improved by 2 or more lines in 12 (60%) of operated eyes.

Conclusion: Severe visual morbidity was common in this cohort of patients with ectopia lentis in our practice. Treatment provided some improvement in vision which highlights the need to encourage early presentation for care. Detailed family history is important as a few of the patients were diagnosed following acceptance of our invitation to siblings for ophthalmic evaluation.

The ideal house officer: Trainee’s perspectives

Wed, 08 May 2024 00:00:00 +0000

Introduction: The housemanship period is a peculiar time in a doctor’s career, and some have described it as a “Nuisance year” during which the junior doctor assumes many roles at the same time - as a doctor of his patients, a student of his trainers (Resident doctors and Consultants) and a teacher of medical students. He is also at the same time undergoing training and research to practice as a professional in an increasingly competitive society-https://youtu.be/SaaQmMHy_qI.

Nigerian perspective: A typical House officer is seen neatly dressed with black circles around the eyes depicting tiredness, ward coat pockets stuffed with enough materials to start up a new ward; ranging from continuation sheets, syringes, water for injection, capillary tubes, hand gloves, investigation forms, commonly used drugs, cannula, torniquet et cetera, smart shoes and feet ready to move on large doses of caffeine, and with carbonated drinks at arm’s reach for a quick glucose rush for the day. He or she is faced with institutional problems, staff and workplace disharmony ranging from lack of adequate residential apartment for interns, early daily resumption and retires much later than the team to effectively carry out the work plan among acute shortage of staff. Majority of interns also try to adapt to the internship workings because they are new to the system, and some health workers typically try to take advantage of them which sometimes interfere with their work and the intern struggles to give the patients his best. Despite all these, the house officer interacts with the patient and relatives more often than the rest of the team. He builds the trust, respect, and confidence the patient has for the team as he represents not only himself but also the team.

Conclusion: As once said by Sir William Osler - the great physician whose name is still being invoked in modern day medicine - that “his time was ripe for him, and he was ripe for his time”. Trainees must always make themselves “ripe for their time”, and the relevant authorities must also make time “ripe for trainees”. The ideal scenario will then be a nexus of an ideal trainee and an ideal work environment.