The processes through which patients in hyperglycaemic state among diabetes manifest psychosis is unclear; and it is not uncommon for clinicians to expose them to antipsychotics, when in fact, the psychosis can resolve with anti-diabetic control measures. The first case was a 67-year-old diabetic patient who was non-compliant with his medications and presented with 2 weeks history of irrational speech, poor sleep, and commanding auditory hallucination. Systemic examinations were not remarkable, laboratory tests were normal except urgent random blood glucose = 412 mg/dl. Fasting blood glucose values during the first 3 days of admission were 197mg/dl, 202mg/dl and 180mg/dl respectively. The second case was a 49-year-old widow, with poorly controlled diabetes, who presented with 3 days history of aggressive behaviour, disorientation, restlessness, visual hallucination, poor attention/concentration, and impaired memory. Other systemic examinations were essentially normal, and the only significant laboratory investigation was random blood glucose of 380mg/dl. Fasting blood glucose during the first 3 days of admission was 210 mg/dl, 197mg/dl and 170mg/dl respectively. Both cases resolved without use of antipsychotic drugs. Control of elevated blood glucose is crucial in treatment of diabetes with psychosis. Further research to elucidate the pathophysiology of psychosis in hyperglycaemia among diabetics is paramount.
World Health Organization cites fear of stigma as the main motive behind people's reluctance to get tested for HIV/AIDS, disclose their HIV status, take ARV drugs and access other ART services. This study explored self-stigma and factors influencing it among persons living with HIV/AIDS in Enugu State. This was a cross-sectional study, involving eight hundred and forty adults living with HIV/AIDS accessing care across eight health facilities. Data was done using interviewer-administered questionnaires. Frequencies and proportions were generated. Chi square test of statistical significance was used to determine the factors that influenced self-stigma. Multivariate analysis using binary logistic regression was utilized to predict the probability of the occurrence of the outcome variable. 69.2% of respondents were classified as having high self-stigma. 95.2% had disclosed their HIV status. Residence in rural areas (AOR 0.807, 95% CI: 0.580 - 1.122) and socio-economic status (AOR 1.415, 95% CI: 1.0- 1.9) predicted high self-stigma. As low socio economic status and area of residence were found to influence self-stigma among respondents in the study, there is a call for persons living with HIV/AIDS to be economically empowered by the government with more emphasis on those residing in rural areas.
Spontaneous conception of an additional fetus in the presence of an ongoing pregnancy is quite rare and remains a puzzle in the human reproductive cycle. Although several theories have been proposed, none has satisfactorily explained the mechanism of this deviation from the natural human reproductive events. We report a case of a set of twin with dichorionic placentation, discordant birth weight, maturation and estimated Gestational Age (to the tune of 4 weeks) necessitating variation in their neonatal care plan. Mother did not employ any form of Assisted Reproductive Technique (ART) in their conception. The authors diagnosed possible twin superfetation. Its rarity in human prompted this report as an addition to the few existing reports and also to raise a higher index of suspicion among clinicians concerned with the delivery and care of newborns.
Health Services in many developing countries like Nigeria are weak and various mortality rates are high. Mortality statistics on BID in Nigeria are few and seem to study mainly trauma relates cases. This study was aimed at assessing the epidemiology of cases of BID in the A & E of a tertiary hospital in Enugu. Retrospective analysis of all cases of BID in a new A & E unit over a 24-month period was done from the hospital records. The results showed that 382 major medical and surgical emergencies out of 8950 patients that presented were seen over the period. There were 88 cases (23.03%) of major emergencies recorded as BID. They were 48 males and 40 females. 19 cases of BID were accident related (21.59% of BID). BID presenting to our A & E is high relative to our major emergencies. We must conduct research to understand this phenomenon more.
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.
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.
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.
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.
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.
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.
The Editor in Chief, Journal of Experimental Research Department of Anatomy, Enugu State University of Science and Technology, College Of Medicine (ESUCOM), GRA Enugu, Nigeria.
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Enugu State University of Science and Technology