Featured Papers

done_all Clinical Sciences

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    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.

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    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.

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    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.

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    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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    HAEMODIALYSIS AT ENUGU STATE UNIVERSITY TEACHING HOSPITAL ENUGU NIGERIA: 1ST YEAR EXPERIENCE

  • person_outlineAuthor(s): Okafor UH, Nwoye EO, Ogbobe OA
  • subjectCategory: Clinical Sciences
  • access_time3 April, 2018
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    Renal replacement therapy plays a key role in the management of patients with kidney failure. In most economically disadvantaged nations including Nigeria, haemodialysis is the most available renal replacement therapy. Haemodialysis center was started at Enugu state university teaching hospital on 1st March 2016. The objective of the study is to analyze the activity of the center during the first year of its establishment. This is a retrospective cross sectional study. All the patients that were treated at the center from 1st March 2016 to 28th February 2017 were recruited for the study. Their clinical and laboratory data pre, intra and post-dialysis were entered into a spread sheet and analyzed using SPSS statistical package. A total of 108 patients were dialyzed with a male: female ratio of 1.5:1. The mean age was 46.2±18.1 years, most of the patients were Ibos and of low/middle socioeconomic status. The mean PCV was 22±0.037%, mean serum sodium was 129.8±8.6mmol/l, mean serum potassium was 4.9±0.10mmol/l, mean serum urea was 24.8±12.9mmol/l, and mean serum creatinine was 913.8±424.7umol/l. The month of March had the least(32) sessions of haemodialysis and September had the highest (66)number of sessions. 84.3% had haemodialysis for less than a month and only 4.8% had haemodialysis for at least 6 months. Majority of the patients (67%) had less than 5 sessions of haemodialysis. One (0.9%) patient and 5 (4.8%) patients used ateriovenous fistula and internal jugular catheter as vascular access respectively; others used femoral vein vascular access. Infection, hypertension, hypotension and bleeding were the common complications. One year operation of the haemodialysis at Enugu state university teaching hospital was remarkable; however patients were unable to sustain haemodialysis.

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    ANTIBIOTIC RESISTANCE PATTERN IN TWO NIGERIAN TERTIARY HOSPITALS

  • person_outlineAuthor(s): Okpara TC, Ugochukwu AI, Isah AO, Neboh EE
  • subjectCategory: Clinical Sciences
  • access_time3 April, 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. It`s use has been found to be associated with various degrees of antibiotic resistance leading to difficulty in managing these various morbidities. The resistance pattern has been found to co-relate strongly with the pattern of antibiotic use. The study is a retrospective study which aimed at studying the resistance pattern to various antibiotics in two Nigerian teaching hospitals located at different geographical areas of the country. The study aimed at determining the factors associated with increased resistance to antibiotics. The pattern of resistance was found to be higher in the rejoin with more frequent use of antibiotics and some recommendations were proposed as a measure of reducing antibiotic resistance to the barest minimum.

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    PRE-SLEEP CRYING IN INFANTS: THE PERCEPTION OF PARENTS IN THE SOUTH EASTERN REGION OF NIGERIA.

  • person_outlineAuthor(s): Ndu IK, Manyike CP, Ekwochi U, Igbokwe OO, Edelu BO, Adimorah GN
  • subjectCategory: Clinical Sciences
  • access_time3 April, 2018
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    Crying describes a category of behavioral states and serves many purposes in infants, especially to shut out disturbing stimuli and it is of etiologic significance for eliciting appropriate care for infants. Children are usually unhappy about going to bed and sometimes react to sleepiness by crying. Therefore, they need sleep training in order to transition successfully to sleeping on their own. Sleep is important for both parents and their babies and serious consequences can arise from parental chronic sleep deprivation as a result of the infant’s inability to fall asleep his own. More efforts are required to create awareness about appropriate care of the crying infant and correct any harmful practices in our environment. This was a hospital based study carried out in the infant immunization clinics of Enugu State University Teaching Hospital Enugu over a six month period from October 2016 to March 2017. A total of five hundred and eleven respondents participated in the study. Among the respondents, 92.6% had experienced pre-sleep cry in their children. Seventy four percent would respond to the crying infant adjusting to sleeping alone by soothing and cuddling, 1.5% would give sedatives, while 0.6% would ignore the infant completely. We recommend that more efforts should be channeled towards counseling parents and caregivers about effective sleep training techniques so they can make informed choices and reduce the risk of future complications related to poor sleep training techniques.

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    IMPACT OF SCHOOL ABSENCE ON ACADEMIC PERFORMANCE OF SCHOOL CHILDREN WITH ASTHMA IN ENUGU, NIGERIA

  • person_outlineAuthor(s): Nduagubam OC, Oguonu TA, Ojinnaka N, Ibekwe RC
  • subjectCategory: Clinical Sciences
  • access_time20 December, 2017
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    A number of factors are thought to influence the academic performance of children with asthma and absence from school is one. Reports on the impact of school absences on the academic performance of children with asthma are limited and the findings are inconsistent. The impact of school absences on the academic performance of children with asthma in Enugu, Nigeria is determined in this study. Children with Asthma (Subjects) aged 5–11 years were recruited consecutively at the weekly asthma clinic of the University of Nigeria Teaching Hospital (UNTH) Enugu, Nigeria. Their age- , sex- and socio-economic class - matched non- asthmatic classmates (Controls) were recruited from the school. The total number of days of school absence for 2012/2013 academic session was obtained for each pair of pupils from the class attendance register. Academic performance was assessed using the average of the overall scores in the three term examinations of same session. The median number (range) of days of absence from school for the entire study population was 6 (1 - 41) days. The median number (range) of days absent from school was 9 (1 - 29) days for the subjects and 3 (1 - 41) days for the controls. The difference was highly statistically significant (U= 5103, p < 0.001). The number of controls who had average and good academic performance was higher than that of subjects. However there was no significant association between academic performance and school absence in both subjects (2   = 3.92, d.f = 2, p = 0.141) and controls (2 = 0.59, d.f = 1, p = 0.444). We concluded that although children with asthma miss more school days than their non –asthmatic classmates, this does not significantly affect their academic performance.

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    CHILDHOOD DREADLOCKS (DADA HAIR): PERCEPTION AND HEALTHCARE SEEKING BEHAVIOR OF CARE-GIVERS IN A DEVELOPING COUNTRY.

  • person_outlineAuthor(s): Ndu IK, Ayuk AC , Osuorah DIC , Ubesie A, Ekwochi U, Chinawa JM, Asinobi IN, Amadi OF , Okeke I, Obu HA
  • subjectCategory: Clinical Sciences
  • access_time20 December, 2017
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    The word "dada" is used to describe dreadlocks. Several cultural beliefs and practices are associated with concept of the “dada” child and this influence the health care seeking behaviour of caregivers. To determine the perception of caregivers about childhood dreadlocks (Dada hair) and its effect on the health care seeking behavior of care givers in Enugu South-East Nigeria. A cross sectional study involving care-givers seen at the two tertiary health institutions in Enugu State, South Eastern Nigeria.  Interviewer administered questionnaires were used to obtain data from the study participants. There were 273 respondents, 90.1% of whom were females and 40% were of low socioeconomic status (SES). One hundred and twenty three (45%) participants believed in the concept of childhood dreadlock but only 27 (9.9%) reported previously or currently having a child with dreadlocks. Thirteen percent were of the view that under no circumstances should dreadlocked hair be washed or combed while 20% opined that a special ritual should be performed by a religious representative before cutting or shaving the dreadlocked hair. Fourteen percent of the caregivers believed that illness in a child with dreadlocks was of supernatural origin and would not respond to treatment with conventional medicine. For respondents that accept the use of conventional healthcare medicine during ill health of a dada child, twenty nine (11%) would refuse any medical interventions that would involve shaving the hair for venous access or neurosurgical procedures until the necessary ceremony had been performed. Only mother’s level of education was significantly associated with belief in the concept of the “dada” child. There is need for appropriate enlightenment of parents and care givers especially in the lower educational group about the importance of seeking healthcare and other necessary preventive strategies for the dada child while still respecting their cultural belief in the concept of childhood dreadlocks.

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