Featured Papers

done_all Clinical Sciences

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    AN ASSESSMENT OF AN INTEGRATED MULTIPHASIC COMMUNITY OUTREACH IN A LOCAL GOVERNMENT AREA IN NORTHERN NIGERIA.

  • person_outlineAuthor(s): Orji CJ, Chime OH, Ezechukwu C
  • subjectCategory: Clinical Sciences
  • access_time24 September, 2019
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    In 2015, the National Agency for the Control of AIDS (NACA) in partnership with the Subsidy Reinvestment and Empowerment Program (SURE-P) conducted an integrated multi-disease HIV counseling and testing outreach campaign in Tudun Wada LGA of Kano State, Nigeria to assess the prevalence of HIV and other communicable and non-communicable diseases in that local council. Data on different aspects of the screening and treatment campaign were collated using a Federal Government of Nigeria outreach client data form and analyzed using Statistical Package for Social Sciences.  A total of 3114 members of the community registered for the outreach but only 2869 accessed services. While 51.6% of all the clients were females, 29.9% were in full employment, 8.9% had a body mass index above 25kg/m2, 52.1% engaged in very active exercise and only 7.9% ate fruits daily. About 40.8%,12%, 8.6% and 0.7% tested positive for malaria, HBsAg, HCV and HIV/AIDS on screening with rapid diagnostic kits. Even though 25.4% and 25.1% had a family history of hypertension and diabetes only 4% and 6.5% had abnormal readings using standardized WHO recommended cut-off points. Malaria and peptic ulcer disease were the most prevalent diseases seen and managed by the medical teams with rates of 59.8% and 22.8% respectively. The integrated multi-diseases outreach carried out in this local council was well attended. Clients were screened for both communicable and non-communicable diseases and referred to the general hospital in the area for follow-up and further management. Political support from the National Agency for the Control of AIDs, the state government and from relevant line ministries, robust advocacy, communication with electronic and print media, training of teams and sustained social mobilization were veritable tools to the overall success of the campaign in Kano State.

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    ASSESSMENT OF THE DIAGNOSTIC VALUE OF MAGNETIC RESONANCE IMAGING DERIVED SPACE AVAILABLE FOR THE CORD IN PREDICTING THE RISK OF SUB-AXIAL CERVICAL SPINAL CORD INJURY

  • person_outlineAuthor(s): Ndubuisi CA, Inojie MO, Ohaegbulam SC
  • subjectCategory: Clinical Sciences
  • access_time24 September, 2019
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    Space available for the spinal cord (SAC) is a measure of cord functional reserves. Reduction in SAC value may predispose to cord injury. This study assessed the accuracy of MRI derived SAC in predicting the risk of spinal cord injury by comparing the subaxial cervical spine SAC values obtained in asymptomatic Nigerians and those with traumatic cervical spine cord injury (CSCI). Prospective, cross-sectional MRI-based study of selected 100 consenting asymptomatic adults and 88 CSCI patients done in Memfys Hospital, Enugu Nigeria from 2012 to 2017. SAC was calculated by subtracting disc level midsagittal cord dimension from corresponding level spinal canal dimension. Age range was between 21 to 50yrs. Data was analyzed using inferential and descriptive statistics. Mean SAC was used in calculating the sensitivity and NPV for SCI at each level. Average SAC value for each disc level for the asymptomatic and those with CSCI respectively were: C3/4 (4.9 + 1.2mm, 2.5 +/-1.7 mm), C4/5 (4.5+/-1.0mm, 2.2+/-1.4mm), C5/6 (4.7+/-1.0mm, 2.3+/-1.6mm), C6/7 (5.1+/-1.1mm, 2.7+/-1.9mm), C7/T1 (5.7 +/-1.2mm, 4.2+/-1.9mm). P-values were <0.05 especially at C4/5 and C5/6. Frequencies of cord injury level were: 43.2% (C5/6), 28.4% (C4/5), 17.1% (C6/7), 5.7% (C3/4), 3.4% (C7/T1), and 2.2% (C2/3). MRI derived SAC has a sensitivity of 93% and NPV of 90% in predicting an individual’s risk of SCI. SAC has a high sensitivity and NPV and will be a good screening tool in predicting the risk of subaxial CSCI. SAC is significantly lower in the CSCI group especially at C4/5 and C5/6 levels.

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    Are medical students satisfied with medical training? A study among students of College of Health Sciences, Ebonyi State University Abakaliki, Nigeria

  • person_outlineAuthor(s): Ossai EN, Alo AT, Onwe BC, Okoro DO, Ezeagu NE, Ogbonnaya LU.
  • subjectCategory: Clinical Sciences
  • access_time29 March, 2019
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    Undergraduate medical training is considered the most important stage in medical education. The study was designed to determine whether medical students of Ebonyi State University Abakaliki, Nigeria were satisfied with their training in Medicine. This was a descriptive cross-sectional study. All medical students of the institution who have spent one full academic session in the university were included in the study. Information was obtained using a self-administered questionnaire. Three hundred and eighty five students participated in the study representing a response rate of 83.7%. The mean age of respondents was 23.2±3.4 years and majority, 64.2% were males. Majority, 62.6% were satisfied with quality of lecturing. A minor proportion, 19.5% were of the opinion that the university library was well equipped. Also, 27.3% opined that medical training obtained in the university matches international standards. Majority, 57.4% were satisfied with their training in Medicine. Predictors of satisfaction with medical training included being willing to study Medicine again, (AOR= 2.8, 95% CI: 1.8- 4.3) and having good interactions with lecturers during classes, (AOR= 2.0, 95% CI: 1.1- 3.4). Majority of the respondents were not satisfied with the state of infrastructure in the institution. Perhaps, this prompted the students to infer that their training does not meet international standard. However majority of the students were satisfied with their medical training. There is need to improve on the state of infrastructure/amenities in the medical school. A supportive academic staff especially during academic activities is invaluable in the training of medical doctors and should be encouraged.

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    Cases of Brought in Dead (BID) in the Accident and Emergency Department of a Tertiary Hospital in Enugu, Nigeria: A Retrospective Study

  • person_outlineAuthor(s): Edeh AJ, Okenwa WO, Osondu CT
  • subjectCategory: Clinical Sciences
  • access_time19 December, 2018
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    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.

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    Psychosis in Poorly Controlled Diabetes Mellitus. A Case Study

  • person_outlineAuthor(s): Ezeme MS.
  • subjectCategory: Clinical Sciences
  • access_time18 December, 2018
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    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.

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    Exploring HIV Self-Stigma in Enugu State Nigeria

  • person_outlineAuthor(s): Chime OH, Ndibuagu EO, Igweagu CP
  • subjectCategory: Clinical Sciences
  • access_time18 December, 2018
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    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.

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    Twin Discordance Secondary to Suspected Spontaneous Superfetation: A Case Report.

  • person_outlineAuthor(s): Ekwochi U, Asinobi IN, Amara MO
  • subjectCategory: Clinical Sciences
  • access_time18 December, 2018
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    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.

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    Factors Determining Prescribers’ Initiation of Empirical Antibiotic Therapy.

  • person_outlineAuthor(s): Okpara TI, Neboh EE
  • subjectCategory: Clinical Sciences
  • access_time8 December, 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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    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.

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