Nigerian Journal of Medicine

Cardiovascular health implications of worsening economic indices in Nigeria: A narrative review

Margaret Adefunke Ajibare — 2024-01-22

Poor economic indices are implicated in adverse health outcomes. Cardiovascular diseases are the leading cause of death globally with more impact in low‑.and middle‑income countries. Despite some documented associations between worsening economic indices and cardiovascular health, there is however knowledge gap on this topic in this environment. We conducted a narrative review to provide an overview of the impact of dwindling economy and cardiovascular health in Nigeria. Acomprehensive search of electronic databases including PubMed, Scopus, and Google Scholar was conducted. The search terms were cardiovascular health, economic indices, and Nigeria. Inclusion criteria were studies published in English language between 2010 and 2021. There is limited knowledge on the association between worsening economic indices and cardiovascular health in Nigeria. The Nigerian government’s spending on health care was less than the recommended 15% of the budget. There was a decline in gross domestic product from 5.31% in 2011 to 3.65% in 2021 and a rise in the inflation rate and unemployment rate from 10.84% and 3.77% to 16.95% and 9.79%, respectively, over this period. The prevalence of hypertension, diabetes mellitus, and dyslipidemia, which are the leading causes of cardiovascular morbidity, increased in the period of study. The exchange rate of naira to other global currencies worsened with attendant rise in the cost of health‑care and cardiovascular medications. There is a huge knowledge gap on the impact of worsening economic indices and cardiovascular health. However, the existing evidence showed that the Nigerian government’s spending on health is low and poor economic indices may be related to the worsening cardiovascular health in Nigeria. There is a need for more research to assess the impact of these indices on cardiovascular health.

Hearing loss among the elderly at a geriatric centre in south‑west Nigeria

Samuel Okoh Sule — 2024-01-22

Background: Aging is an unavoidable process that is connected with several health issues, including presbycusis, a degenerative disease of the cochlear hair cells and central auditory pathways with a resultant reduction in hearing acuity. In developing countries like Nigeria, little attention is given to the elderly population with possible underreporting of presbycusis, hence the need for this study. Aim: The aim of this study was to investigate hearing loss, the type, and associated risk factors among the elderly attending a geriatric clinic in South‑west Nigeria. Patients, Materials and Methods: It was a cross‑sectional study of patients aged 60 years and above in a geriatric centre. All consented participants were given a structured questionnaire to collect important data such as demographics, history of hearing loss, family history of hearing loss, risk factors, and so on. Ear examinations, otoscopy, pure‑tone audiometry, distortion‑product otoacoustic emissions, and tympanometry were also performed on all patients. Results: Ninety‑five participants, comprising 33 males and 62 females, were recruited, and their ages ranged from 60 to 89 years (74.5 ± 7.6 years). The mean pure‑tone average was 42.2 dB ± 17.4 and 39.21 dB ± 17.4 in the right and left ears, respectively. About 80% of them have a hearing threshold above 15 dB, with 13 (13.7%) being conductive hearing loss, 48 (50.6%) sensorineural hearing loss, and 15 (15.8) mixed hearing loss. Presbycusis was diagnosed in 37 (38.9%) participants. There was a significant correlation between the pure‑tone average and distortion‑product otoacoustic emissions results in both ears of the participants (P = 0.0001). Tympanograms were abnormal in 21 (22%) right ears and 27 (28%) left ears. Conclusion: Hearing loss is highly prevalent among the elderly, with presbycusis being the most common type. Periodic hearing screening for the elderly is hereby recommended.

Zinc levels in HIV‑positive children at the University of Nigeria Teaching Hospital

Uchenna Kennedy Chukwu — 2024-01-22

Background: Zinc is an abundant trace element in the body involved in many physiological processes. Its deficiency has been described in HIV‑infected children, especially in advancing illness. This study, therefore, seeks to assess zinc levels in HIV‑positive children attending the HIV clinic at University of Nigeria Teaching Hospital (UNTH). Materials and Methods: This was a descriptive, cross‑sectional study among HIV‑positive children aged 5–60 months attending the HIV clinic at UNTH. A100 participants were enrolled from August 2013 to May 2014. Data were obtained using a pro forma developed by researchers, and blood samples were collected and analysed using an absorption spectrophotometer. Serum zinc level deficiency was defined as the values <80 ìg/dL. Data analysis was conducted using the SPSS version 26. Results: Most participants were males (53.0%). Their mean age was 47 months (standard deviation = 15.7). The median serum zinc level was 55.5 ìg/dL (IQR = 35.0–84.8). The majority of the participant (72%) had zinc deficiency. There was a statistically significant relationship between serum zinc level and participants’ socioeconomic status (P < 0.05) – higher socioeconomic status was associated with higher zinc levels. Conclusion: The study showed a high prevalence of zinc deficiency in children living with HIV, with a significant relationship between serum zinc level and the participants’ socioeconomic status. There is a need for zinc supplementation for HIV children, especially the indigent ones.

Coronavirus disease outbreak: Assessing the level of preparedness for containment in healthcare facilities in Nigeria: Qualitative research findings

Damilola Ayowole — 2024-01-22

Background: The COVID‑19 pandemic has raised serious public health concerns globally. Cases keep increasing across countries: exposing the emergency‑containing capability, level of preparedness, emergency disease prevention, and risk management alertness of various healthcare facilities in managing the crisis. Aim: to assess the level of preparedness for the containment of the COVID-19 disease outbreak across healthcare facilities in Nigeria. Materials and Methods: Participants were the stakeholders within selected healthcare facilities. Data were collected via in‑depth interviews using a list of 37 structured questions to assess the level of preparedness of the Nigerian health‑care facilities in containing the COVID‑19 pandemic. The findings were manually and thematically analysed using the constructivist variant of the grounded theory methodology. Results: Overall, the level of preparedness across the selected health facilities was estimated as average, as several facilities were fairly prepared while a few others were relatively unprepared for the COVID‑19 pandemic containment. Conclusion: The COVID‑19 virus disease outbreak can be said to be fairly contained by the Nigerian health system from the standpoint of the available mortality and incidence indices. Meanwhile, there are still loopholes around financial, structural, and material provisions which are essential needs for better and sustainable pandemic containment.

Prevalence, pattern, and perception of female undergraduates about sexual harassment in a tertiary institution in southwestern Nigeria: An evaluation of the national bill on sexual harassment

Adenike Iyanuoluwa Olugbenga‑Bello — 2024-01-22

Background: A current national bill on sexual harassment proposes jail terms for failure to investigate and prosecute the offenders of sexual harassment at Nigerian colleges and universities. Aim: The study aimed to effectively evaluate the impacts of the new bill, we assessed the current prevalence rates and pattern of sexual harassment among female undergraduates in Southwestern, Nigeria. Materials and Methods: Data were obtained from 420 respondents in a cross‑sectional study design. We included female aged 18 years and above and excluded students in their first year. Data were obtained using a self‑administered questionnaire and analysed using IBM SPSS version 28. Multivariate analysis was done to identify the predictors of sexual harassment. Results: The prevalence of sexual harassment was 48.2% among participants, and the highest perpetrators of harassment were victims’ boyfriends. The common patterns of harassment experienced by respondents include sexual jokes or stories that were insulting or offensive (44.7%), brushing of body parts in an unwelcomed manner (27.8%), and persistent demand for sex by lecturers or students (20.6%) among others. After controlling for possible confounders, the odds of sexual harassment was 0.604 times (95% confidence interval: 0.388–0.942) less likely among students in higher academic years (i.e., 400 and 500 levels) compared to those in lower academic years (200 and 300 levels). Conclusion: The high prevalence of sexual harassment in our study indicates that southwestern universities are yet to meet the goals of the national bill. Institutions of higher learning are urged to discourage societal tolerance for sexual harassment by enforcing sexual harassment prevention regulations in the national bill.

Electrocardiographic abnormalities in children with human immunodeficiency virus infection presenting to the Federal Medical Centre, Umuahia, South‑east Nigeria

Chidinma Pamela Orunta — 2024-01-22

Background: With the availability of highly active anti‑retroviral therapy and attendant increased lifespan of human immunodeficiency virus (HIV)‑infected children, late complications of the disease, especially cardiovascular complications have become a growing problem for them. The cardiovascular complications of HIV infection start early in the course of the disease, although may remain asymptomatic until later in life, when they manifest with life‑threatening symptoms. The electrocardiogram (ECG) is an invaluable tool in the early diagnosis of these abnormalities. Aim: This study assessed the prevalence and types of ECG abnormalities among HIV‑infected children. Patients, Materials and Methods: It was a hospital‑based, comparative, cross‑sectional study involving randomly selected HIV‑infected children (subjects) and age‑.and gender‑matched HIV‑uninfected children (controls). Relevant information was obtained through questionnaires, medical records, and physical examination. All participants underwent a 12‑lead ECG assessment. Results: Electrocardiographic abnormalities were observed in 42.9% of subjects compared to 17.9% of controls (x² = 8.28; P = 0.004). The participants were about three times more likely to have ECG abnormalities than controls (odds ratio = 3.45, 95% confidence interval = 1.45–8.19). Left ventricular hypertrophy (LVH) was the most common abnormality in the subjects (14.3%), and compared to controls (1.8%), this was significant (x² = 0.032; P = 0.032). Other ECG abnormalities such as right ventricular hypertrophy, T‑wave changes, and T‑axis abnormalities were more prevalent among subjects (10.7%, 5.4%, and 10.7%, respectively) than controls (1.8%, 3.6%, and 14%, respectively), although not significant. Conclusion: Electrocardiographic abnormalities are quite prevalent among HIV‑infected children, with LVH being predominant. It is recommended that routine ECG evaluations be done on HIV‑infected children to enable the early detection and prompt management of these problems.

Incidence and predictive factors of lower extremity deep‑vein thrombosis in patients with neurological diseases in a sub‑Saharan tertiary hospital

Francis Chukwuebuka Campbell — 2024-01-22

Background: Deep‑vein thrombosis (DVT) is a major cause of morbidity among patients with neurological disease and is implicated in 50%–90% of pulmonary embolisms (PE). Aim: This study aims to identify the incidence and predictive factors of lower extremity (LE) DVT in high‑risk neurological patients. Materials and Methods: All patients with neurological diseases who were confined to bed for three days or more, or had elevated D‑dimer over a 22 months were included in the study. They all had routine mechanical and chemical prophylaxis. Serial color duplex ultrasonography of the LE was performed for all the patients, and the results were used to stratify them into two groups: DVT positive and DVT negative, and their clinical parameters were recorded and utilised for statistical analysis. Multivariate logistic regression analysis was used to determine the predictive risk factors. Results: A total of 611 patients were admitted, and 107 met the inclusion criteria. The mean age was 57 ± 17 years, with a male‑to‑female ratio of 1.7:1. Forty‑four (41.4%) patients had DVT (overall incidence was 7.2%). Primary intracranial tumours and craniocerebral trauma accounted for 27.2% and 20.5% of aetiology, respectively. The comparative DVT‑positive versus DVT‑negative group D‑dimer levels were 7.9 versus 4.9 mg/L (P = 0.0065), duration of immobility 65.0 versus 35.3 days (P = 0.0001), and length of hospital (LOH) stay 32.5 versus 18.2 days (P = 0.0001). The proximal LE vessels were involved in 64.2%. The PE risk was 0.98%, with three mortalities. The predictive factors on multivariate logistic regression were elevated D‑dimers (odds ratio [OR] 2.02, 95% confidence interval [CI] 1.1–4.45 P = 0.030) and preoperative immobility >seven days ([OR] 2.38, 95% [CL] 1.28–4.39 P = 0.042). Gender, C‑reactive protein, Glasgow Coma Scale, comorbidities, LOH, and chronic steroid use were not predictive. Conclusion: The overall incidence of DVT and mortality from PE were low among patients with neurological diseases. Most thrombi involved proximal LE veins. Elevated D‑dimers and preoperative immobility >seven days were predictive factors for LE DVT.

Placenta disposal practices among doctors and nurses in obstetric units of secondary and tertiary health facilities in Enugu State, Nigeria

Johnpaul Ejikeme Nnagbo — 2024-01-22

Background: Anecdotal evidence suggests that placentas may be improperly disposed of due to the lack of knowledge of the best approaches. The reason women request for their placenta in Nigeria remains unclear. Aim: The aim is to determine the knowledge and perceptions of doctors and nurses about the use of WHO guidelines for the safe disposal of hospital wastes in placenta disposal and to explore their placenta disposal practices at tertiary and secondary health facilities in Enugu state. Materials and Methods: This was a mixed-method study design in which 163 doctors and nurses drawn from 3 secondary and 3 tertiary hospitals in Enugu Metropolis were studied. Quantitative component involved the use of interviewer‑administered questionnaires. Knowledge and perceptions of respondents on the use of WHO guidelines to dispose of the placenta were documented. Knowledge of WHO guidelines was assessed and graded: good knowledge (score ≥12) and poor knowledge (score <12). Perception was assessed using 4 Likert‑type questions whose responses were scored. Mean score ≥0.5 (positive perception), mean score <0.5 (negative perception). The qualitative component involved purposive sampling of 6 nurses who were the labour ward unit heads. In‑depth interviews using semi‑structured questionnaires were conducted to ascertain their placenta disposal practices and why women request placentas in their hospitals. Analysis was done for quantitative components using IBM SPSS version 20.0. Analyses were both descriptive and inferential. Analysis of the qualitative component established three thematic areas following the transcribing and coding of the contents of the interview. Results: Thirty‑three (20.2%) and 158 (96.9%) had good knowledge (mean score = 12.7 ± 0.48) and positive perceptions (mean score = 2.96 ± 0.65), respectively, toward the use of WHO guidelines for placenta disposal. Placenta pits were the most common method for disposing of placenta. Those who request their placenta do so for cultural reasons (bury at home), avert being used for money rituals by health workers, and for the baby to be complete. Conclusion: A high proportion of doctors and nurses in Enugu state have poor knowledge but a positive perception toward WHO guidelines for disposing of placenta. The most common means of disposal was the placenta pit.

Accuracy of American College of Radiology Thyroid Imaging Reporting and Data System in characterisation of thyroid nodules: A tertiary hospital study in India

Ifsheen Fatima — 2024-01-22

Background: Thyroid nodules (TNs) are commonly and frequently encountered in the day‑to‑day clinical practice. Clinical suspicion of malignancy as well as patient anxiety is the frequent reasons for fine‑needle aspiration cytology or biopsy (FNAC/B) of TN. American College of Radiology has developed a Thyroid Imaging Reporting and Data System (ACR TI‑RADS) based on TN ultrasound features to suggest malignancy to minimise the number of TN subjected to FNAC/B. Aim to assess the diagnostic accuracy of ACR TI‑RADS in our Tertiary Hospital Health Facility. Patients, Materials and Methods: Sixty‑nine patients with TN included in our study following institutional ethics committee approval and written informed consent underwent high‑resolution ultrasonography followed by FNAC using a high‑frequency linear transducer on Siemen Acuson S3000 ultrasound scanner. The data were recorded in the predesigned proforma followed by statistical analysis to assess the diagnostic accuracy of ACR TI‑RADS. Results: Our study had female predominance (50/69) with the left side more commonly affected (37/69). The mean age of the participants was 42.2 ± 15.6 years with significantly higher age at presentation in those with malignant TN. Mixed nodules were predominant (46/69) with nearly half of the malignant nodules being solid and only 8/61 benign nodules being solid. Although the majority of the nodules were hyperechoic (50/69 including 2 malignant), a significant number of the hypoechoic/ very hypoechoic nodules (6/14) were malignant with only 8/61 benign nodules being hypoechoic. Half of the malignant nodules (4/8) had lobulated or ill‑defined margins, whereas only 2/61 benign nodules had similar margins. The majority (5/8) of the malignant TN had internal punctate echogenic foci with only 1/61 benign TN showing similar appearance. Half of the malignant TN (4/8) had lymphadenopathy, whereas it was noted in only 2/61 cases of benign TN. Conclusions: TNs though have a high prevalence, but malignant TNs are uncommon with majority being solid, taller than wider, hypoechoic with microcalcifications. The presence of adenopathy is usually a feature of malignant thyroid nodule rarely seen with benign nodules. Thus, to summarise all TNs should be thoroughly evaluated as per ACR TI‑RADS for stratification of risk of malignancy.

A comparison of the effects of preoperative administration of omeprazole and ranitidine on gastric volume and pH in patients undergoing elective surgeries under general anaesthesia

Adaobi Obianuju Amucheazi — 2024-01-22

Background: Proton‑pump inhibitors and histamine‑2‑receptor blockers act by reducing gastric volume and increasing gastric pH. These help to mitigate the effects of aspiration. However, the better of the two agents has not been established. Aim: This prospective randomised, double‑blind study was undertaken to compare the effects of omeprazole and ranitidine. Patients, Materials and Methods: One hundred and sixty American Society of Anaesthesiologist I and II adults scheduled for surgery under general anaesthesia were divided into two groups: Group R received 50 mg ranitidine and Group O 20 mg omeprazole. The drugs were given intravenously 2 h before the induction of anaesthesia. Gastric content was aspirated after induction and before extubation. The gastric volume and pH were measured and analysed. Results: The mean postintubation and preextubation gastric volumes were greater in Group R, whereas Group O exhibited an elevated mean postintubation and a significantly higher preextubation gastric pH. Conclusions: The effect of omeprazole is superior to that of ranitidine as regards increasing gastric pH and reducing volume.

Blood pressure trend in children with chronic kidney disease in Nigeria, Sub‑Saharan African region

Daberechi Kenneth Adiele — 2024-01-22

Background: Various mechanisms are involved in the development of hypertension in children with chronic kidney disease (CKD), some of which are due to the disease process, while some are due to the treatments employed in CKD. Aim: The aim of the study was to determine the trend of blood pressure in Nigerian children with CKD comparable with controls. Materials and Methods: A cross‑sectional study assessing the blood pressure of children from 6 to 17 years with CKD and selected age‑.and sex‑matched controls who were recruited consecutively at the Paediatric Nephrology Clinic and Children Outpatient Clinic of University of Nigeria Teaching Hospital. Data obtained were analyzed using the Statistical Package for the Social Sciences (SPSS) version 17. Results: The mean systolic blood pressure (SBP) was 126.08 ± 37.43mmHg for subjects compared to 105.04 ± 14.33 mmHg for controls, whereas the mean diastolic blood pressure (DBP) was 78.96 ± 22.74 mmHg for subjects compared to 66.25 ± 10.66 mmHg for controls. The distribution of SBP and DBP across the CKD stages showed more severe hypertension (Stages I and II) prevalence in the later stages of CKD (Stages 4 and 5) (x_y² = 7.21, P = 0.01, respectively). The mean value of the mean arterial blood pressure (MAP) was 94.67 ± 26.98 mmHg for subjects compared to 79.18 ± 10.61 mmHg for controls. The increase in MAP across the stages of CKD was significant. Conclusion: This study shows a high prevalence of the severe forms of high blood pressure in this group of children with CKD in the subregion.

Synopsis of clients seen at the Adolescent and Social Paediatrics unit of a tertiary health facility in South‑East Nigeria: A three‑year review

Onyinye Uchenna Anyanwu — 2024-01-22

Background: The adolescent period is a unique and crucial period of growth and development, in which the child transits from childhood to adulthood. It is characterised by several changes, both physiological and psychological, in preparation for adulthood. Thus, their health needs and health challenges differ from that of other children. Hence, the need to pay special attention to them and provide health and social support tailored toward their needs. Aim: This study aimed to determine the pattern of cases that presented to the Adolescent and Social Pediatrics Unit (ASP) of the Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AEFUTHA) over a three-year period. Materials and Methods: This was a retrospective study done to determine the pattern of cases seen at the Adolescent and Social Paediatrics Unit of the Alex Ekwueme Federal University Teaching Hospital, Abakaliki, between 2017 and 2019. Case files of all patients seen within the study period were retrieved, and all were included in the study. Relevant information such as age, gender, social class, diagnosis for both adolescent and nonadolescent age groups, treatment modalities, clinical subspecialties involved in management, and the outcome were retrieved. Data were entered and analysed using SPSS version 25, and results were presented as ratios, means, and proportions, whereas comparisons were made with the Chi‑square test or Fisher’s exact were applicable. P < 0.005 was considered statistically significant. Results: A total of 220 clients were seen over the given period. The adolescents were 148 (67.3%), whereas nonadolescents were 72 (32.7%). Among the adolescents, common diagnoses include sexual assault (24.3%), acne (8.1%), Pelvic Inflammatory Disease (PID)/sexually transmitted infection (STI) (8.1%), HIV (8.1%), somatisation disorder (6.8%), suicide attempts (5.4%), oppositional deviant disorders (4.1%), and conduct disorder (2.7%). In nonadolescents, common diagnoses include sepsis (30.6%), Severe Acute Malnutrition (SAM) (30.6%), and malaria (11.1%). There was a significant difference between the adolescents and nonadolescents with respect to diagnosis (P < 0.001), treatment modalities (P < 0.001), type of care received (P < 0.001), and outcome (P = 0.002). Conclusion: The study has portrayed that the common medical conditions seen among adolescents include sexual assault, acne, HIV, PID/STI, and somatisation. This will be useful in developing health‑care services and program geared toward adolescent health.

Insulin resistance and hypertension among type 2 diabetes subjects in a tertiary institution in South East Nigeria

Michael Chinweuba Abonyi — 2024-01-22

Background: Type 2 diabetes mellitus (T2DM) is frequently associated with hypertension (HTN), adding significantly to its overall morbidity and mortality. Aim: This study aimed to investigate the relationship between insulin resistance (IR) and blood pressure and other factors associated with both conditions. Patients, Materials and Methods: A case–control study of 180 subjects consisting of 60 with T2DM and HTN, 60 with T2DM and normal blood pressure, and 60 without T2DM or HTN (control). Sociodemographic, anthropometric, and clinical parameters were obtained from each subject and control. IR was derived from homeostasis model assessment (HOMA)‑IR index calculated from fasting blood glucose and insulin. Results: The mean age of subjects with T2DM and HTN was 49.58 ± 10.50 years, that of subjects with T2DM and normotension was 48.50 ± 10.44 years, while that of controls was 48.85 ± 10.15 years. IR (HOMA‑IR ≥2) was found in 96.7% of subjects with T2DM and HTN, 88.3% of those with T2DM and normotension, and 1.7% of subjects with neither of both conditions. Central obesity (Waist circumference “WC”), overweight, and obesity (BMI) significantly related to IR in subjects with T2DM and HTN (p = 0.020, 0.021 and 0.016 respectively) while only WC and obesity (BMI) significantly related to IR in subjects with T2DM and normotension (p = 0.001 and 0.036 respectively). Conclusions: There is a high prevalence of IR in T2DM subjects which is heightened by the presence of HTN.

Sonographic determination of thyroid gland volume among patients with type 2 diabetes mellitus in northern Nigeria

Abubakar Abubakar Aminu — 2024-01-22

Background: Thyroid disease and type 2 diabetes mellitus (T2DM) are interconnected endocrine disorders with a bidirectional relationship. T2DM patients may present with various thyroid abnormalities, such as gland enlargement and nodule formation, warranting noninvasive assessment through ultrasound scanning. Aim: This cross‑sectional study aimed to evaluate thyroid gland volume (TGV) in adult patients with T2DM using ultrasound imaging in Kano. Materials and Methods: A total of 160 participants were randomly selected and underwent sonographic scans of the thyroid gland using a medical ultrasound machine with a 7.5 MHz linear probe. Thyroid volumes were recorded, and demographic information was collected. Statistical analysis was performed using the SPSS software version 29, with significance set at P < 0.05. Results: The mean TGV ± standard deviation was 5.8 ± 3.1 cm³. Females exhibited a statistically higher TGV (6.1 ± 3.4 cm³) compared to males (5.6 ± 2.8 cm³). There was no significant difference in TGV among patients with different diabetes control habits. The mean volume of the right lobe (3.1 ± 1.8 cm³) was significantly greater than that of the left lobe (2.7 ± 1.6 cm³). TGV correlated positively with T2DM duration, age, weight, and body mass index. Conclusion: This study provides valuable insights into the TGV among patients with T2DM in Kano. The findings indicate a positive correlation between TGV and T2DM duration and demonstrate gender and laterality differences. Ultrasound‑based assessment of thyroid volume can be a valuable tool in monitoring thyroid health in T2DM patients and may aid in the early detection and management of thyroid abnormalities.

Clinical presentation and management of peripheral‑induced oromandibular dystonia in Nigeria: A case report and literature update

Nonso Emmanuel Onyia — 2024-01-22

Oromandibular dystonia (OMD) is a rare focal neurological disorder associated with impaired masticatory function, dysphagia, dysphonia, and involuntary abnormal movements of the mandible of varying severity. The peripheral-induced variant among other factors is a common aetiological factor of secondary dystonias, associated with constellations of clinical features and presents with differing responses to various treatment therapies. To report a case of oromandibular dystonia and to add to the body of literature. The case report is of a 33-year-old male who presented with complaints pain on speaking and from the temporomandibular joint area for 8 months which adversely affected patient’s work, social life and psychological well-being. Examination revealed retraction and repetitive but uncoordinated pattern of labial, cheek and masticatory muscular movement on mouth opening and closing. Diagnosis of oromandibular dystonia was made on clinical grounds. Patient was managed with a combination of medications by the oral physician, and physical therapy, which led to a significant improvement in the control of muscle contractions within 5 weeks. OMD though a rare neuromuscular condition can present to the dentist, and effective assessment, diagnosis and collaboration with relevant specialities are key to improved outcome.

Opioid‑free anaesthesia and analgesia in a sickle cell disease patient with extensive orthopaedic soft‑tissue surgery

Abayomi Kolawole Ojo — 2024-01-22

The provision of anaesthesia through techniques devoid of opioid is referred to as opioid‑free anaesthesia. Both pain crisis in sickle cell (SC) disease and poor postoperative pain care worsens patient morbidity. This is a case report of a 22‑year‑old female SC anaemia patient, who had bilateral quadricepsplasty. Sickle Cell disease is common among individuals of African race and opioids are often abused during the out‑of‑hospital treatment of pain crisis. We report the case of pentazocine addiction resulting in severe bilateral quadriceps fibrosis. Thus, it was necessary to avoid opioid‑based anaesthesia. Acombined spinal epidural anaesthesia using magnesium adjunct was applied. The analgesic function of magnesium is linked to the blockade of the N‑methyl‑D‑aspartate receptor. The subarachnoid block was achieved with 3.5 mL of 0.5% heavy bupivacaine (17.5 mg), while epidural anaesthesia was done with 14 mL of 0.25% plain bupivacaine (37.5 mg) and 1 mL of 2 mg/kg of magnesium, (i.e., 120 mg). After the surgery, the surgical sites were infiltrated with 10 mL of 0.25% plain bupivacaine (25 mg) on each limb. Intravenous magnesium‑sulfate 5 mg/kg (i.e., 300 mg), was added to 500 mL of crystalloids to run every 4 h. Furthermore, 1 mL of 2 mg/kg magnesium, (i.e., 120 mg,) was added to the 14 mL of 0.125% plain bupivacaine to make 15 mL of magnesium–bupivacaine admixture, every 4 h. These were given for 48 h. The Visual Analog Scale pain scores reduced from 9/10 to 5‑6/10 and then to 3/10 over a 6‑h period and remained at or lower than 3/10 throughout the postoperative period. Adequate haemodynamics, oxygenation, hydration, warmth, and urine output were ensured. The postoperative period was crisis free.

New‑onset idiopathic generalised seizure in a Nigerian teenager with type 1 diabetes mellitus

Victor Oladeji Adeyeye — 2024-01-22

We described a case of a 19-year-old female with a new onset Idiopathic Generalised seizure and Type 1 Diabetes mellitus(TIDM). Diagnosis of epilepsy is based on at least two unprovoked seizures. Anti‑glutamic acid decarboxylase (Anti‑GAD) antibodies positivity is a potential link between TIDM and epilepsy as seen in this case similar to other report. There is a need for careful glycaemic control in children with epilepsy and TIDM as hypoglycemia‑induced seizure must be avoided using appropriate insulin dosage.

Genital tuberculosis in a Nigerian woman with primary infertility

Aloy Okechukwu Ugwu — 2024-01-22

We present a 30‑year‑old nullipara with a two‑year history of inability to conceive and a 30‑month history of recurrent lower abdominal pain. Atransvaginal ultrasound scan showed a right complex adnexal mass measuring 70 cm × 65 cm; tumor makers were essentially normal aside marginally elevated CA‑125. She subsequently had exploratory laparotomy with right salpingo‑oophorectomy, and a histopathology examination of the specimen revealed caseous necrosis, granuloma formation with a rim of the Langhans giant cells within the wall of the fallopian tube. Serum tuberculosis (TB) QuantiFERON was also positive for Mycobacterium tuberculosis. She is currently on anti‑Koch’s and is responding to treatment. This case report aims to highlight the need for exploring other causes of chronic pelvic pain and primary infertility when evaluating women with similar history in our environment, especially in TB endemic areas.

Plexiform neurofibroma presenting as ambiguous genitalia

Obinna Remigius Okwesili — 2024-01-22

Plexiform neurofibroma rarely affects the external genitalia and is a rare cause of clitoromegaly. The essential aspect of the management is doing a clitoroplasty with the preservation of glandular and neurovascular tissues. We present the case of an 18‑year‑old female who had ambiguous genitalia due to an enlarged clitoris due to neurofibromatosis that was the size of a penis with indistinct labia majora. She was managed by carrying out a feminising genitoplasty, a combination of clitoroplasty and labiaplasty.