Nigerian Quarterly Journal of Hospital Medicine

Pattern of Ear, Nose, and Throat Diseases in Pediatric Patients attending a Naval Reference Hospital in Lagos, Nigeria

CN Asoegwu — 2022-08-19

Background: Ear nose and throat diseases are known to be common in children. Hearing, breathing, smelling, swallowing, and speech are commonly affected by these diseases. The pattern of these diseases in children is not well documented.
Objective: This study aimed to study the pattern of ear nose and throat diseases seen in pediatric patients attending the clinic at a reference military hospital in Lagos.
Methods: Medical records of patients aged between 0 and 14 years managed between August 2014 and December 2017 at the Nigerian Navy Reference Hospital, Lagos, were reviewed.
Results:1618 (47.1%) of the 3436 patients seen during the study period were children. Children of personnel were 591 (36.5%) while 1027 (63.5%) were civilian's children with a ratio of 1:1.7. There were 879 (54.3%) males and 739 (45.7%) females. 1065 (65.8%) of the patients aged were 0 to 5 years. Patients with ear diseases were 923 (57.0%), nose diseases were 152 (9.4%), throat diseases were 532 (32.9%) and head and neck diseases were 11 (0.7%).
Conclusion: Children constitute a large proportion of patients that attend ear nose and throat clinics. Adenotonsillar hypertrophy, otitis media, rhinitis, and foreign body insertion into the ear and nose are the common ear nose and throat diseases noted. Health planners in Lagos state and the local governments, in particular, should adequately provide ENT care in their hospitals.

Tuberculosis Pleural Effusion: Demography, Clinical Characteristics and Adenosine Deaminase levels in Lagos, Nigeria

E Ogunieye — 2022-08-19

Background: Tuberculosis is a major public health problem most especially in underdeveloped countries. The global burden of this disease is huge and affects nearly one third of the world population with a disproportionately low prevalence in developed economics. Tuberculosis is an infectious disease caused by mycobacterium tuberculosis which mostly affects the lungs primarily. Tuberculous pleural effusion (TBE) is one of the commonest forms of extrapulmonary tuberculosis, most especially in tuberculosis endemic areas and in the HIV positive population. When a patient presents with an undiagnosed pleural effusion, the diagnosis of pleural tuberculosis should be strongly considered particularly in tuberculosis endemic arrears. Tuberculosis pleural effusion is usually lymphocytic and demonstration of adenosine deaminase (ADA) above 40IU/L is diagnostic. Untreated TBE may be complicated with loculation and pose complex challenges in management.
Objective: The objective of the study was to describe the demographic pattern, clinical characteristics and adenosine deaminase level of tuberculosis pleural effusion in a tertiary hospital in Lagos Nigeria
Method: This study was a hospital based retrospective study performed at the Lagos University Teaching Hospital, from January 2018 through December 2020. Case notes of 66 patients in whom tuberculous pleural effusions were diagnosed based a pleural biopsy and or isolation of tuberculosis bacilli in the pleural fluid were studied for the demography of the patients, clinical characteristic of the fluid and value of the Adenosine deaminase level in the pleural fluid, if it was carried out.
Result: A total number of 66 patients were studied with 62.1% males, and 37.9% females and the mean age was 39.39 years (SD 16.98). The effusion was on the left side in 62.11% of patents, on the right side in 34.81% and bilaterally in 3% of patients. In 84% of patients, about two third of the corresponding hemithorax was opacified. The pleural fluid was serous in 80.3% of cases and purulent in 19.7% of cases. The pleural fluid adenosine deaminase (ADA) was determined in 57 patients and ranged from 44 to 120 with a mean of 63.84 (SD 16.393).
Conclusion: Tuberculosis pleural effusions are largely serous effusions most commonly found on the left hemithorax with a high adenosine deaminase level above 40ui/L. Therefore, adenosine deaminase determination is a highly reliable and sensitive test in the diagnosis of tuberculosis pleural effusions

Preeclampsia-induced Alterations in Liver Enzymes and Creatinine - Pattern of derangement in Enugu, Nigeria

HC Okoye — 2022-08-19

Background: Preeclampsia is a serious complication of pregnancy which contributes to maternal morbidity and mortality globally. It is a multisystem disorder with hematologic and biochemical alterations. Its management
poses several challenges especially in resource-poor countries. Alterations in liver enzymes and renal function are prevalent but varying levels have been reported in different studies somewhat posing some challenges with
diagnostic criteria.
Objectives: To characterize the varying abnormalities of liver enzymes and creatinine among preeclampsia patients in Enugu, Nigeria.
Methods: This was a cross-sectional study involving pregnant women diagnosed with and managed for preeclampsia. Serum levels of creatinine, aspartate transaminase and alanine transaminase were assayed using an automated Chemistry Analyzer. Statistical analysis was done with SPSS version 22. Student's t-test was used to compare the mean differences between severe and mild preeclampsia groups
Results: The study included 45 preeclampsia patients with mean (SD) age 29.1 (5.9) years. Mean (SD) systolic and diastolic blood pressures were 175.7 (21.3) and 112.1 (12.4) mmHg respectively. Mean (SD) values for participants with mild and severe features were: ALT 23.5(6.4) and 35.4 (12.8) IU/L; AST
30.7 (12.3) and 42.1 (12.0) IU/L and creatinine 65.3(9.6) and 9.1 (29.2)μmol/l. All patients with mild features had normal serum creatinine and ALT values. Though some patients with severe features had elevated biomarker levels, none had transaminase levels above the cut-off for severe disease. All analytes showed statistically significant difference between participants with severe and mild features.
Conclusion: Findings in the present study demonstrated varying serum levels of biomarkers which ranged between normal and elevated but none of the patients had transaminase values diagnostic of severe disease. A
review of diagnostic criteria as it pertains to liver transaminases may be considered for the local population to guard against missed detection of patients at risk of preeclampsia.

Knowledge and Practice of Infection Control Measures among Cleaners in Lagos University Teaching Hospital, Idi- Araba Lagos

AA Farotimi — 2022-08-19

Background: Healthcare workers including cleaners are at risk of contracting infection. Hospital cleaners play important roles in the prevention of health care associated infections and cleanliness of the environment, but they are not easily recognised as healthcare workforce. This study assessed knowledge and practice of infection control measures among cleaners in Lagos University Teaching Hospital, Idi-Araba, Lagos.
Materials and methods: This was a cross-sectional descriptive study that was made up of 230 respondents. Convenience sampling technique was used for the selection of the respondents. A structured pretested questionnaire was used for data collection. The reliability values of the instruments using Cronbach alpha were 0.76 and 0.80 for knowledge and practice respectively. Data were analysed using SPSS version 23. Descriptive statistics of frequency counts, percentage, bar chart, pie chart and mean were used to analyse the demographic variables and research questions; inferential statistics of Chi-square was used to test the three hypotheses generated at 0.05 level of significance.
Result: Findings showed that the mean age of respondents was 35.23 years; 144 respondents (62.6%) had secondary education; 205 respondents (89.1%) have had training on infection control. 225 respondents (97.8%) had adequate knowledge (Good 21.30% and Moderate 76.50%) regarding infection control measures though 38 respondents (16.5%) did not know that they should use heavy duty gloves when tying waste and 24 respondents (10.4%) did not know that latex gloves should not be reused. On practice, all the respondents (100%) had adequate practice (Good 11.1% and Moderate 88.9%) but 7 respondents (3.0%) never changed gloves immediately when torn and 28 respondents (12.2%) never used heavy duty gloves for waste disposal. On respondents' exposure/injury experience, 121 respondents (52.6%) had ever experienced sharps' injury and 117 respondents (50.9%) did not report the experience. 133 respondents (57.8%) had not received vaccination for Hepatitis B; 180 respondents (78.3%) had ever been tested for HIV out of which 8 respondents (3.5%) were positive. There is statistically significant relationship between knowledge and practice of infection control measures (p=0.002), no significant relationship between previous training and knowledge (P=0.797) and between previous training and practice (p=0.066).
Conclusion: Majority of the respondents had adequate knowledge and practice of infection control measures. Notwithstanding, there should be adequate training to address the gap in proper use of different types of gloves and in their exposure/injury experience.

Impact of Mycobacterium Africanum on the Sensitivity and Specificity of MPT64 Antigen Immunochromatographic Assay

N Onyejepu — 2022-08-19

Background: The MPT64 antigen is a protein predominantly secreted by Mycobacterium tuberculosis complex (MTBC) in cultures and is used for its rapid differentiation from other clinically relevant nontuberculous
mycobacteria (NTM). However, reports have shown that truncation of this protein and or presence of Mycobacterium africanum restricted within the West African region may have reduced sensitivity to MPT64 antigen as an identification tool for MTBC.
Objective: We evaluated the performance of MPT64 antigen immunochromatographic assay to detect MTBC in culture isolates grown from clinical specimen.
Methods: 149 mycobacterial isolates grown on Lowestein Jenseen (LJ) media from pulmonary TB patients, 8 reference mycobacterial and a non-mycobacterial strain were investigated for the presence of MPT64 protein using a commercial assay kit. The result was compared to growth of cultures on LJ containing para-nitrobenzoic acid (PNB) and line probe assay (LPA) characteristics of the isolates.
Results: The presence of MPT64 antigen band was observed in one hundred and twenty-one isolates but absent in 28 isolates which was concordant with results obtained for growth on PNB and LPA. The sensitivity, specificity, positive predictive and negative predictive values were 100% respectively.
Conclusion: The good sensitivity and specificity of the assay showed MPT64 antigen as an excellent identification tool for MTBC.

Awareness and Knowledge of Congenital Clubfoot Among Antenatal Clinic Attendees in Calabar

CO Anisi — 2022-08-19

Background: Congenital clubfoot is the commonest congenital musculoskeletal malformation of the limbs. In developed nations where most deliveries take place at standard healthcare facilities, diagnosis is usually made at birth and proper documentation and registration done. This is contrary to what obtains in under-developed countries, resulting in significant numbers of missed cases, and largely in under-reporting of the disease. Adequate knowledge of congenital clubfoot among pregnant women would reflect on the health seeking behavior of nursing mothers, leading to early detection and prompt treatment of the disease.
Objective: To determine the level of knowledge and perception of congenital clubfoot among pregnant women attending antenatal clinic in Calabar, Nigeria
Methods: Pregnant women attending antenatal sessions at the University of Calabar Teaching Hospital, Calabar were recruited for the study. Healthcare professionals amongst the pregnant women were excluded from the study. Using a structured researcher-administered questionnaire, respondents' basic sociodemographic data as well as their level of awareness and general knowledge of congenital clubfoot including its risk factors and treatment modalities were recorded. Based on their response, respondents' level of awareness and knowledge of clubfoot was categorized into: poor, inadequate and adequate levels.
Results: A total of 163 consenting pregnant women who attended antenatal sessions at the antenatal clinic of the University of Calabar Teaching Hospital over a 3-month period participated in the study. Majority of the respondents (N = 159, 97.55%) were between the ages of 20 and 39 years. The predominant educational status amongst the respondents was tertiary education (N = 112, 68.71%). Most of the respondents (N = 67, 41.1%) were primigravida. Majority of the respondents (N = 97, 59.51%) had poor general knowledge of congenital clubfoot. There was no significant relationship between respondents' general knowledge of congenital clubfoot and their age (X2 = 5.620, p = 0.326) and educational status (X2 = 9.219, p = 0.351).
Conclusion: Poor general knowledge of congenital clubfoot amongst most antenatal clinic attendees in Calabar does not correlate with their age and educational status. Medical education and health awareness campaigns should be incorporated into antenatal sessions in order to increase the awareness of congenital clubfoot among pregnant women.

Morphorlogy of Tumours of the Neurocranium: A Report of Cases and Review of Literature

MO Udoh — 2022-08-19

Background: Skull bone tumors are rare, but include a vast repertoire of lesions. Although tumours are not a common cause of skull bone pathology, they should form part of the differential diagnoses in patients presenting with neurological symptoms, visible/palpable head lumps, and/or skull bone abnormalities on imaging. There is little systematic reporting globally, and not much local data is available on these tumours in Nigerians.
Aims: This retrospective study of tumours of the neurocranium, documents the histologic types of tumours encountered seen in a tertiary facility in South-South Nigeria, and discusses their clinicopathologic features and epidemiological characteristics, in the light of existing literature.
Methods: Data on cranial vault and skull base tumours histologically diagnosed in 15 years including histological diagnoses, tumour location, and other clinical and demograghic data, was analysed using SPSS 20 (SPSS Inc, IL, USA).
Results: 17 skull bone tumors were diagnosed in 15 years. Male-female ratio was 1:1.4. 70.6% of patients were below 40 years of age. The mean age of patients was 29.31 ± 23.13 years. Primary bone tumours made up 70.59% tumours. The ratio of malignant to benign tumours was 1:1.1. The most common tumour was Fibrous Dysplasia (29.41%). Other primary skull lesions encountered include, Epidermoid inclusion cysts of the skull, Osteoma, Chordoma, Osteosarcoma, and Undifferentiated small cell sarcoma of bone.
Conclusions: The small number of tumours encountered in this study limits the inferences that can be drawn based on observations, but documenting skull lesions encountered provides an aid in approaching the differential diagnosis of skull tumors in our environment.

Time to wound healing and determinants of delayed wound healing among Buruli ulcer patients in Nigeria.

AO Meka — 2022-08-19

Background: Little is known about the healing time of ulcers in Buruli Ulcer (BU) and its determinants among BU patients in endemic settings.
Objective: The objective of this study was to evaluate the healing time and determinants of prolonged wound healing among BU patients in Nigeria.
Methods: This was a prospective cohort study of all BU patients managed in BU treatment centres in three states in Nigeria during April 2017 to August 2019.
Results: A total of 46 BU patients were enrolled during the study period; 25 (54.3%) were male, 30 (65.2%) were adults, and 43 (93.5%) of the participants presented as new case. Also, 42 (91.3%) presented with ulcer, 40 (87.0%) had single lesion, 38 (82.6%) had lesions occurring on the lower limb, and 26 (56.5%) presented as advanced ulcer lesions that are more than 15cm in diameter (category III lesion). The overall median (IQR) healing time was 109 (60, 146) days. The median healing time did not differ by gender, age group, HIV status or patient classification (P >0.05). However, the median healing time for patients with limitation of movement at diagnosis was 146 days, compared with 69 days for patients without limitation of movement at diagnosis (P = 0.028). Also, the median healing time was significantly associated with duration of the BU illness (P = 0.009).
Conclusions: In Nigerian patients with BU, the time to complete healing of lesions is generally long. We found that duration of BU illness and having a limitation of movement at diagnosis were associated with longer healing time.

Oral Health Literacy among a Selected Group of Final year Medical Students in Nigeria

CL Nzomiwu — 2022-08-19

Background: Oral health literacy affects the oral health and quality of life of an individual and may be influenced by age, gender, and socioeconomic status of that individual.
Objectives: The aim was to assess the level of oral health literacy among a group of final year medical students and evaluate the association between age, gender, socioeconomic status and, their level of oral health literacy.
Methods: A cross-sectional study among final-year medical students was carried out using the oral health literacy-adult questionnaire (OHL-AQ). Data were analysed using Statistical Package for Social Sciences (SPSS) version 22 and statistical significance was considered at p<0.05
Results: The mean age of the participants was 25+ 4.0 years. Majority (67.3%) had adequate level of oral health literacy with a mean oral health literacy score of 12.3+3.0. There were no statistically significant associations between the age of students, gender and level of oral health literacy, however females had better oral health literacy scores than the males. A higher proportion (76.6%) of those of high socioeconomic status (SES) had higher level of oral health literacy (p=0.02). Females had higher level of decisionmaking ability than the males (p=0.01) while those of high socioeconomic status had higher level of comprehension (p=0.004) and listening ability (p=0.04) than those in middle and low socioeconomic status.
Conclusion: Participants of high socioeconomic status had higher level of oral health literacy, better comprehension of questions on oral health and listened to instructions better. Females made better oral health decisions than males.

Burden of Care and Perceived Psychosocial Outcomes Among Family Caregivers of Patients Living with Cancer in Teaching Hospital in Lagos

OM Kolawole — 2022-08-19

Background: The scourge of cancer is a major public health concern globally as it is one of the leading causes of morbidity (terminal illness), with its incidence increasing worldwide. Caregiving especially by a family member of cancer patient is critical in the overall management of cancer. The emotional and physical burden shouldered by this primary caregiver is always enormous being that they help the cancer patient to be active and remain connected to their communities.
Objectives: This study assessed level of burden of care and perceived psychosocial outcomes among family caregivers of patients living with cancer in LUTH, Idi-Araba, Lagos.
Method: This quantitative cross-sectional descriptive study utilized a probability sampling method to select 320 caregivers who were direct family members but 315 were validated for the study as they completely filled a validated Burden Scale for Family Caregivers (BSFC-28) (r=0.82) and Zarit Burden Interview (ZBI) questionnaire (r=77). Data obtained using pre-tested questionnaire, with an overall Cronbach's Alpha score of (r=0.8), analyzed electronically using SPSS and presented in frequency tables. Descriptive statistics of frequencies, percentages, mean scores and standard deviation were used to answer the research questions.
Result: The results revealed that mean age was 31.1 ± 0.67 years and majority (61.3%) were females. The mean burden of care was 2.86 and 90.5% of caregivers were burdened. However, most were moderately affected by the burden of care (mean=2.86). About 51.1% were severely affected psychologically while 58.1% were severely affected socially in the course of caring for their cancer relatives. There was statistically significant association between respondents' social demographic characteristics of age, educational level and marital status and burden of care as but no statistically significant association of gender, occupational status and burden of care as (p>0.05).There was significant relationship between the burden of care and psychological effect of caregiving with (r= .175, p=.002) and social effect of caregiving with (r= .173, p=.002).
Conclusion: The study concluded that diverse burden of care was experienced by the family caregivers thus calling for initiation and regular maintenance of a routine of assessment for all caregivers of people living with cancer by healthcare providers for better understanding of the burden they face and how to help ameliorate them.

Antimicrobial Drug Resistance, A 'Triad' of Epidemiological Factors.

OL Okunye — 2022-08-19

Over the years, as understanding of the factors associated with antimicrobial drug resistance has progressed, epidemiological study has broadened to include human behaviours, complexity of environment as well as pathogens as a triad of epidemiological factors responsible for the alarming upsurge of antimicrobial drug resistance. The effect on humans and how these challenges can be resolved need immediate attention. Antimicrobial resistance is the reduction in the efficacy of a drug such as antimicrobial drug in curing a microbial mediated infection. The use and misuse of antimicrobial drugs in human medicine and animal husbandry has been implicated as one of the causes of the unabated rise in the number and types of microorganism resistance leading to deaths of millions of people worldwide. Organisms that elicited drug resistant against many antibiotics are numerous and also the drugs(antibiotics) that were once known as 'magic bullets' have become metabolic precursor pools for these microorganisms to thrive, irrespective of their nomenclature as broad spectrum, narrow spectrum, extended spectrum etc and this has increase the morbidity and mortality rate and incurred higher healthcare cost. This review X-rayed the expanding scope of antimicrobial resistance, examined the triads of epidemiological factors in relation to social, economic and disease burdens that promotes the upsurge of resistance to conventional antibiotics and therapeutic failures and proffers useful recommendations that could be helpful in alleviating the problem.

Sickle Cell Disease: Pathophysiology, Complications, and Recent Therapeutic Insights in a low Resource Economy

PO Osho — 2022-08-19

Sickle cell disease is the commonest form of haemoglobinopathy caused by elevations of intraerythrocyte and total blood viscosity that causes increased morbidity and mortality. It also and also has effect on the healthcare sector and economy of many nations predominantly in sub-Saharan Africa countries. Sickle cell disease occurs as a mutation in the b-globin chain of the hemoglobin molecule of red blood cells that leads to its characteristic sickle shape. Sickle cell disease is seen more among black Africans and African Americans and has also been linked with its occurrence with malaria dominated areas. It is one of the commonest genetic disorder in low resource economies around the world including the most populous black nation-Nigeria, which bears the largest health burden in sub-Saharan Africa. Despite this, enough is not being done in Nigeria with respect to financing of researches and advancements of drugs to battle the disease. Pathophysiology of the clinical features of sickle cell disease is often described in 3 phases namely. Vaso-occlusion is the most common leading factor to many other clinical features. Although, prognosis of sickle cell disease is dependent on age, access to care, availability of drugs, haplotype and trained personnel. stem cell transplantation, still remain the only curative management for now, although a recent therapy is undergoing trial to combat the root cause of the disease with other drugs being used to reduce the effects of pain. In this article, we offer a detailed understanding of Pathophysiology of sickle cell disease, examine common treatment of the disease in Nigeria. We also discuss emerging therapies undergoing trial to combat the root cause and manifestation of the effect of Sickle cell disease. In-depth review of literature on the study was retrieved from the relevant Hematological journals and textbooks abstracted and indexed in PubMed, Google Scholar, ProQuest and Science Direct This article connects the pathophysiology and the management of sickle cell disease alongside the psychosocial influence it has on its patients in a low resource economy like Nigeria. The study also discovered that researches on alternative drugs that provide better treatment option and better quality of life than the primary sickle cell disease drug-Hydroxyurea, has reached advanced stages. Although curiosity in sickle cell research has flourished, more clinical trials need to commence and subjected to more thorough examinations and analysis than have been used in the past especially in Nigeria.