Featured Papers

done_all Clinical Sciences

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    Peer Support Group Participation and its Effects on HIV-related Knowledge among People Living with HIV/AIDS in Enugu State, Nigeria.

  • person_outlineAuthor(s): Chime OH, Orji CJ, Ekeleme NC.
  • subjectCategory: Clinical Sciences
  • access_time25 September, 2018
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    Positive management of patients living with HIV/AIDS requires patient knowledge on HIV-related issues as it reduces the risk of super-infection, as well as prevents spread of infection. This study aims at determining and comparing the level of HIV- related knowledge of people living with HIV/AIDS in peer and non-peer support groups in Enugu State, Nigeria.  A total of 420 HIV-positive adults in peer support and non-peer support groups each took part in this multi facility-based cross-sectional study. Interviewer-administered questionnaires were used to collect quantitative data on socio-demographic characteristics, knowledge on HIV transmission and treatment.  Differences between variables were tested for significance using Chi-square test.  Multiple logistic regression model was used to determine predictors of knowledge. Overall, knowledge on HIV was significantly higher among respondents in the peer support groups (57.4%) when compared with respondents not in peer support groups (44.0%). Lack of formal education (AOR 0.073, 95% CI: 0.007-0.758) predicted poor knowledge among respondents in peer support groups while having primary education as the highest educational qualification (AOR 0.300, 95% CI: 0.155 – 0.583) and a baseline CD4 <200cells/μl (AOR 0.448, 95% CI: 0.214 – 0.939) predicted poor knowledge among respondents, not in peer support groups. Our findings indicate that peer support education will significantly improve the level of HIV-related knowledge among PLHIV in Enugu Nigeria. Having a better understanding of the information can promote behavioural modifications resulting in better treatment outcome.

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    Effect of Age on the Space Available for the Cervical Spinal Cord (SAC) of Asymptomatic Adult Nigerians

  • person_outlineAuthor(s): Ndubuisi CA, Ohaegbulam SC, Mezue WC
  • subjectCategory: Clinical Sciences
  • access_time25 September, 2018
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    Frequency and burden of care of spinal cord injury (SCI) is high in Nigeria. Efforts should be channelled at identification of asymptomatic individuals at risk as a form of primary prevention strategy. This study analysed the age-adjusted space available for the spinal cord (SAC) values to identify age groups with critical drop in SAC values that suggest higher anatomical predisposition to SCI. This would serve as screening tool to predict risk of trauma or degenerative disease induced SCI from compromised CSF cushion. The study is a T1Wi MRI-based prospective, cross-sectional study of 100 randomly selected asymptomatic adults aged 21-50 years. SAC was calculated by subtracting disc level mid-sagittal spinal cord dimension (C) from corresponding level spinal canal dimension (S). The result revealed that the Mean-SAC for all age groups was 4.9±0.23mm. Age adjusted SAC value varied from 5.40±0.38mm (20-25 years) to 4.61±0.77mm (41-45 years) and 3.49±0.39mm (46-50 years). At C3/4 SAC was 5.54mm (21-25years) and 4.14(41-45years), 3.42mm (46-50years). (P=0.0001). At C4/5 SAC was 4.89mm (21-25years), 4.31mm (41-45years) and 3.42mm (46-50years). (P=0.015). At C5/6 SAC was 4.98mm (21-25years), 4.30mm (41-45years) and 2.97mm (46-50years). (P=0.0001). At C6/7 SAC was 5.42mm (21-25years), 4.89mm (41-45years) and 3.67mm(46-50years). (P=0.001). Pairwise comparison revealed significant drop in SAC values obtained in the 41-50 years group across all disc levels when compared with SAC value obtained from 20-40 years.(P=0.0001). Effect of age was mostly at C3/4 to C5/6 levels. This study has revealed that the study population had very small space available for the cervical spinal cord when compared with other populations and with further significant drop in SAC after 45 years of age. Small SAC values with advancing age suggest increased risk of cervical cord injury and need to utilize the magnetic resonance imaging derived SAC as screening strategy to assess the level of risk for spinal cord injury among the asymptomatic high risk individuals.

  • library_books

    Factors Determining Prescribers’ Initiation of Empirical Antibiotic Therapy.

  • person_outlineAuthor(s): Okpara TI, Neboh EE
  • subjectCategory: Clinical Sciences
  • access_time25 September, 2018
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    Antibiotics are among the most widely used drugs to treat patients with various diseases in public and private health institutions.  Some factors has been noted to affect the prescriber`s reason for empirically initiating antibiotic therapy in different disease conditions. These factors include;  News letter,  Drug presentation by pharmacy representatives, drugs in stock in hospital pharmacy, drugs in essential medicine list, age of the patient, adverse drug reaction, cost of the drug, appropriate indication and the clinical state of the patient.. The aim of the study was to determine the most common factors responsible for the prescriber`s initiation of empirical antibiotic therapy. At the end it was discovered that the clinical state of the patient, appropriate indication and the cost of the drug ranked high among the list of the factors that determine empirical antibiotic therapy.

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    Psychosocial and Biomedical Management of Gender-based Sexual violence in South East, Nigeria: a 2-year Retrospective Study

  • person_outlineAuthor(s): Orji CJ
  • subjectCategory: Clinical Sciences
  • access_time25 September, 2018
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     The lack of confidentiality and psycho-social support to the victims who seek medical treatment in our health institutions prevent them from reporting the crime and, therefore from receiving appropriate care and support. This study was carried out using data collected from TAMAR Sexual Assault Referral Center (TAMARSARC) Enugu between April 2014 and March 2016.  Over the period reviewed, 472 clients were reached with services. Young women between the ages of 11-22 years were the most affected accounting for 50.8% of all cases. 92.2% of the clients reported rape/attempted rape whilst 4.7% and 3.2% reported sexual assault and domestic violence respectively. Of the 354 recognized perpetrators, 52 (14.7%) were family members and 302 (85.3%) were non-family members whilst for the 118 unrecognized perpetrators, 89 (75.4%) were gang raped and 29 (24.6%) could not remember the number of persons that raped them. Incidence of sexual violence was greater in urban (75.8%) than in rural areas (24.2%) and out of 37 (7.8%) cases charged to court, 5 (13.5%) were discharged, 7 (18.9%) were undergoing prosecution and only assailant (0.002%) had received a jail term of 14 years. Fifteen (15) pregnancies had resulted from all cases, two (2) HIV infections were detected on routine screening of all victims and one death in a 9 years old girl that was raped by a HIV positive male. The strategic partnership between TAMARSARC and Enugu state government demonstrated the effectiveness of an integrated approach in addressing the psycho-social, legal and health needs of sexually assaulted women and girls.

  • library_books

    Choice of Anesthesia for Repair of Adult Inguinal Hernias in Enugu (Short Communication).

  • person_outlineAuthor(s): Edeh AJ, Okenwa WO, Abireh IE
  • subjectCategory: Clinical Sciences
  • access_time25 September, 2018
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    Choice of anesthesia for repair of 82 adult inguinal hernias in Enugu State University Teaching Hospital, Enugu, South- East of  Nigeria; was assessed from January 2015 to December, 2016. Traditionally, anesthesia for inguinal hernia repair has been general anesthesia. Regional anesthesia (spinal/epidural) been generally reserved for patients with poor cardio-respiratory status and local anesthesia usually for those whose age, infirmity or fear make other forms of anesthesia hazardous. Over the past 40-50 years, there has been a paradigm shift from this traditional approach such that today loco-regional anesthesia especially local anesthesia is considered the gold standard. This study found that the preferred choices of anesthesia by hernia surgeons in this tertiary health institution for repair of adult inguinal hernia is loco-regional with spinal anesthesia at 46% and local anesthesia at 40%. General anesthesia was used in only 14% of cases. The extensive use of loco-regional anesthesia improved day case inguinal hernia surgery world-wide with all its benefits.

  • library_books

    NEUROLOGICAL ADMISSIONS AT ENUGU STATE UNIVERSITY TEACHING HOSPITAL: A 5-YEAR RETROSPECTIVE REVIEW

  • person_outlineAuthor(s): Ezeala-Adikaibe BA, Aneke E, Orjioke C Okafor HU, Ezeala–Adikaibe NP, Mbadiwe N, Peter Chime P, Ekochin F, Anyim O.
  • subjectCategory: Clinical Sciences
  • access_time27 June, 2018
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    Surveys of neurologic admissions into various Nigerian health institutions show an increasing burden of disorders such as stroke in our communities. Few studies have documented the pattern and mortality on neurologic admissions in South East Nigeria. The pattern and mortality of neurologic cases admitted into the medical wards of the Enugu State University of Science and Technology Teaching Hospital was determined. Classifications of medical disorders were grouped using ICD 10 coding system. The total number of neurologic disorders recorded in the case files was 1,031(28%). The commonest causes of neurologic admission were stroke-577(56%), coma of undetermined causes 87(15.3%) and central nervous system infections 84(8.1%). Infections were the commonest causes of admission below 40 years- 48(27.6%) while stroke was the most common disorder after 40 years.  Neurologic disorders accounted for 38% of medical ward mortality with a mortality rate of 26.5% (273/1031), most of which was due to stroke 57.1%(156/273).  Case fatality rates were highest for coma (50.6%), hepatic encephalopathy 15(36.6%) and hypertensive encephalopathy 10(29.4%). The case fatality rate for stroke was 156(27%). Mortality rates closely reflected admission rates in all cases except in infectious diseases. We concluded that stroke is by far the commonest cause of neurologic admission and death in a tertiary hospital in Enugu. Well-articulated public health educational programs will go a long way to reduce morbidity and mortality of neurologic disorders.

  • library_books

    A CROSS-SECTIONAL STUDY ON NUTRITIONAL STATUS OF PRESCHOOL AGED CHILDREN IN ENUGU URBAN, NIGERIA

  • person_outlineAuthor(s): Amadi OF, Ezenwosu OU, Odetunde OI
  • subjectCategory: Clinical Sciences
  • access_time27 June, 2018
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    Reports on nutritional status of the preschool children in developing economies are very important and such studies require the use of World Health Organization (WHO) z-score system to enable international comparison. This study aimed to determine the nutritional status of preschool aged children in Enugu urban, South-East Nigeria. Four hundred and nine (409) preschool children aged 2-5 years were recruited from the schools using stratified multistage sampling method. Their anthropometry were measured, weight-for-age, height-for-age, weight-for-height and Mid Upper Arm Circumference (MUAC)-for-age were computed. The z-scores were calculated using the WHO/z-score international reference standard. The overall mean weight-for-age (W/A), height-for-age (H/A), weight-for-height (W/H) and MUAC-for-age were 17.7 ±3.7kg, 105.3 ±10.0cm, 15.8±1.4kg and 16.5 ±1.4cm respectively. Their mean z-scores were 0.92, 0.99, 0.51 and 0.35 respectively. The prevalence of underweight, wasting, stunting, low MUAC based on W/A, H/A, W/H below -2 z score of the WHO standards were 17.2%, 10.1%, 21.4% and 1.9% respectively. The prevalence of obesity using W/H greater than 2 z scores was 5.6%. The peak age incidence of malnutrition using all indices of nutritional status was 4 years. There is a high prevalence of malnutrition among preschool children in Enugu urban, Nigeria. Institution and implementation of urgent nutritional intervention programme targeting this age group is necessary to reduce this high prevalence in our environment and other developing countries.

  • library_books

    CAUSES OF DELAYED PRESENTATION IN PATIENTS WITH HYDROCEPHALUS

  • person_outlineAuthor(s): Ozor I.I, Chikani M.C, Dada O.A, Mezue W.C, Ohaegbulam S.C, Ndubuisi C.A.
  • subjectCategory: Clinical Sciences
  • access_time27 June, 2018
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    Hydrocephalus is one of the common neurosurgical conditions that present to neurosurgeons in our environment. Delay in presentation for neurosurgical care can result insignificant morbidity and mortality. Early diagnosis and prompt treatment is important to reduce morbidity and mortality in these patients. This study set out to determine the causes of delay in presentation of patients with hydrocephalus for treatment in our environment. A prospective cross-sectional study of all patients with hydrocephalus that presented between January 2012 and December 2014 was carried out. The relevant data were recorded prospectively in clinical summary forms and an electronic spreadsheet. Data was analyzed using SPSS version 22.0 (SPSS, Chicago, IL) for statistical analyses. Of the 72 patients, 50 (69.4%) experienced a delay of >4 weeks from onset of symptoms to definitive presentation to the neurosurgeon. Occurrence of neurological deterioration in those that experienced delay was statistically significant compared to patients who did not experience delay (chi square χ2 = 2.967, p = 0.002). Of the 50 patients with delayed presentation, it was due to lack of fund in 29 (58%) patients, ignorance in 11 (15.3%), religious beliefs in 7 (9.7%) and delayed referral in 3 (6.0%) patients. Barriers exist that prevent early patient presentation for neurosurgical treatment of hydrocephalus. These are all preventable and efforts should be geared towards this.

  • library_books

    PITUITARY ABSCESS MIMICKING PITUITARY MACROADENOMA: AN UNUSUAL SELLAR LESION (CASE STUDY)

  • person_outlineAuthor(s): Ozor I.I*, Okorie E.C, Tripathy L.N, Harsh J
  • subjectCategory: Clinical Sciences
  • access_time27 June, 2018
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    Pituitary abscess can be defined as an involvement of the pituitary gland by an intrasellar inflective process. Correct diagnosis is difficult before surgery. It is usually made unexpectedly at surgery or autopsy. The objectives include to draw attention of Neurosurgeons to its rarity so as to consider it in the list of differential  diagnosis of sellar lesions, offer appropriate and optimal treatment and finally to review the literature of the subject matter.  We report a sixty-three year old right handed Bhutanese referred from a Government hospital in Bhutan with recurrent intermittent headache and vomiting of two years and one week duration respectively. He was in apparent good health prior to onset of symptoms and there was no identifiable aetiology. Physical and neurological examination was unremarkable. MRI revealed a sellar lesion with parasellar extension suspected to be pituitary macroadenoma.  Patient had microsurgical trans-sphenoidal drainage of the abscess after resurcitation and optimization. Pituitary abscess was diagnosed intra-operatively. Patient was placed on antibiotics and was discharged home on a stable condition. Microbiology (culture + AFB) was negative and histology revealed a pituitary abscess in a probably existing pituitary adenoma. In conclusion, pituitary abscess still remains rare and potentially life-threatening. Diagnosis before surgery is difficult.  It should be entertained in the differential diagnosis in patients with hypopituitarism with sellar or parasellar mass.

  • library_books

    PAEDIATRIC MORTALITY AND AUTOPSIES IN ENUGU STATE UNIVERSITY TEACHING HOSPITAL, ESUTH/PARKLANE, ENUGU, NIGERIA: A 5- YEAR REVIEW

  • person_outlineAuthor(s): Nduagubam OC, Ndu IK, Bisi-Onyemaechi A, Ohayi SR, Asinobi IN, Ekwochi U, Osuorah DIC, Onyishi NT, Ogbuka F, Orjiakor CJG
  • subjectCategory: Clinical Sciences
  • access_time27 June, 2018
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    Autopsy has traditionally been the criterion for determining cause of death and has played a major role in medical education and quality control. World over autopsies are carried out to determine cause(s) of death or to confirm the pathological processes that were suspected to be deranged prior to demise. They are relevant in guiding genetic counseling and helping families that are grieving. Despite these uses and applications, autopsy rates have declined globally. This study was undertaken to identify the in-patient mortality and autopsy rate in children at the Enugu State University Teaching Hospital ESUTH/Parklane, Enugu Nigeria. The report is a retrospective review of all the deaths among the hospitalized children from 1st January 2013 to 31st December 2017. Relevant information was extracted from the hospital records of all paediatric in-patients. Autopsy reports of all paediatric autopsies were pulled from the Histopathology department of ESUTH/Parklane. Information extracted from the autopsy reports and the hospital records were recorded in the proforma. Out of 11,570 children that were admitted during the period under review, 786 (6.79%) paediatric deaths were recorded, of which 423 (53.8%) were males and 363 (46.2%) were females; giving a male: female ratio of 1.17: 1. Out of the 786 in-patient paediatric deaths, only 3 (0.4%) autopsies were conducted. We concluded that despite the importance of autopsies, paediatric autopsies are not routinely performed in our environment and new strategies are needed to increase autopsy rates.

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