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   Table of Contents - Current issue
Coverpage
January-April 2018
Volume 12 | Issue 1
Page Nos. 1-55

Online since Tuesday, October 23, 2018

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REVIEW ARTICLE  

Reminiscing the recent incidence of monkeypox in Nigeria: Its ecologic-epidemiology and literature review Highly accessed article p. 1
Idris Abdullahi Nasir, Amos Dangana, Iduda Ojeamiren, Anthony Uchenna Emeribe
DOI:10.4103/phmj.phmj_47_17  
Monkeypox (MKPX) is a rare viral zoonosis which was first discovered in a laboratory in Denmark in 1958. This critical review involved literature search of data on the history of MKPX virus (MKPXV), its emergence and re-emergence, molecular virology, global epidemiology and geographical distribution, the recent outbreak of MKPX in Nigeria, diagnostic and treatment considerations using Google Scholar, PubMed and Scopus. Findings from this review revealed that the first human cases of MKPX were diagnosed and differentiated from smallpox in the early 1970s. Since this period, several cases have been reported in rural, rainforest areas of West Africa and the Congo Basin, especially in the Democratic Republic of Congo, Cote d'Ivoire, Cameroon, Midwest of the United States of America, South-Sudan, Central African Republic, and recently in Nigeria. The outbreaks in the non-endemic areas of the US and Sudan occurred due to zoonotic transmission of the virus into these nonrain forested areas. The geographical spread of MKPXV until date has renewed research efforts in unravelling environmental factors that favour ecological niche of this pathogen. This study aimed to review both biotic and abiotic factors that are responsible for the expansion of the ecological niche and geographic distribution of human MKPX in Nigeria. It appears that environmental factors, conflict and globalisation are responsible for the increasing risk of animal-human transmission through direct contact between the cutaneous or mucosal lesions of the infected animal and the compromised skin barrier of a human, and the consumption of poorly cooked-infected flesh. Lymphadenopathy is a distinguishing clinical feature of MKPX from other pox-like illnesses. Laboratory diagnosis of anti-poxvirus antibodies in an unvaccinated person with a clinical history of severe illness and total body rash is suggestive of MKPX infection. The lack of sufficient data to guide the identification of potential reservoir hosts, and public health intervention strategies/surveillance, inadequate training for health workers, unavailability and inaccessibility of suitable diagnostic assays, vaccines and anti-viral treatment could be some of the reasons cases of MKPX re-emerge when not successfully contained, especially in endemic regions.
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ORIGINAL ARTICLES Top

Knowledge and practice of infection control of doctors in different medical specialities of a tertiary hospital in South-South Nigeria Highly accessed article p. 10
Adjugah Joshua Uvieroghene, Ordinioha Best
DOI:10.4103/phmj.phmj_42_16  
Background: Hospitals in Nigeria are increasingly becoming epicentres of epidemic diseases in addition to the usual nosocomial infections. Infection control measures have been identified as capable of preventing these hospital-acquired infections, but studies indicate that the knowledge of the measures, even among doctors are poor, and practice of them is even poorer, due to a multiplicity of factors. This study examined possible differences in the knowledge and practice of the infection control measures among doctors in four different medical specialities at the University of Port Harcourt Teaching Hospital, south-south Nigeria. Methods: A cross-sectional study design was used, with data collected using a structured questionnaire and observational checklist. The questionnaire was administered to the doctors in the clinical departments, while the checklist was used to assess the compliance of the doctors and their practice environment to the infection control guidelines. Results: The respondents had a mean age of 36.03 ± 6.81 years and 74.00% of them had a working experience of five or more years. Most of the respondents were resident doctors. The respondents had very good knowledge of the infection control measures, with a mean knowledge score of 9.19 ± 0.946. There is a statistically significant difference in the knowledge score of the different cadres of respondents (P = 0.0001), but not among those in the different clinical departments (P = 0.208). The practice of the infection control measures was poor among 92.5% of the respondents, with a mean practice score of 7.48 ± 2.599 especially among the junior doctors (P = 0.0001) and doctors with less working experience (P = 0.0001). Conclusion: The knowledge of infection control measures among the respondents is high; however, the practice is very poor. Efforts are therefore needed to encourage practice, to help reduce the incidence of hospital-acquired infections.
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Clinicopathologic analysis of tonsillectomy tissues in a tertiary health centre in Benin City, Nigeria p. 18
Johnson Ediale, EE Ugiagbe, CA Okolosi-Patani, Jennifer Edewede Ediale
DOI:10.4103/phmj.phmj_38_17  
Background: Tonsillectomy is a common surgical procedure in otorhinolaryngology, indications for which should be met before surgery. To subject tonsillectomy tissue specimen to histologic analysis has become an issue of debate in recent times, thus necessitating a review of tonsillectomy tissues at the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria. Aim: The aim of this study is to determine the indications for tonsillectomy and relevance of histologic diagnosis of tonsillectomy tissue specimen. Methods: A 5-year retrospective study; January 2010–December 2014 of tonsillectomy tissue specimens received in the Department of Pathology of UBTH were evaluated with regard to patients' clinical information and histologic diagnosis. Results: A total of 224 patients with M: F ratio of 1.2:1 was reviewed. Obstructive airway disease was the most common indication for surgery; 167 (73.2%), whereas the predominant histologic diagnosis was reactive lymphoid hyperplasia; 219 (97.8%). Five (2.2%) of the tissue specimens showed features of malignancy. Conclusion: The most common indication for tonsillectomy was obstructive airway disease. Although the majority of tissue specimens revealed benign features, the recorded number of the malignant specimen was quite considerable. Thus, there is the need to subject all tonsillectomy tissues to histologic analysis.
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Prevalence of anaemia in the antenatal booking population at Ahmadu Bello University teaching hospital, Kaduna, Nigeria p. 23
Polite I Onwuhafua, Ijeoma C Ozed-Williams, Abimbola Omolara Kolawole, Marliya S Zayyan, Joel Adze
DOI:10.4103/phmj.phmj_32_17  
Background: Anaemia has been associated with poor materno-foetal performance among pregnant women in Nigeria. The objective, therefore, of this study is to determine the prevalence of anaemia at the time of antenatal booking and the associated factors in the hospital. Methods: Four hundred and seventy-seven women were studied prospectively over 3 months in the antenatal booking clinic, and their characteristics compared with their haemoglobin (Hb) levels. Results: Age range was 15–46 years, and mean Hb concentration was 10.76 g/dl. Nearly 53.05% of the study population had Hb <11.0 g/dl, but only 20.76% had Hb <10.0 g/dl. Nearly 1.89% had severe anaemia (Hb <8.0 g/dl) while 20.12% had Hb of 12.0 g/dl or more. The strongest association was last obstetric event occurring <1 year before current pregnancy (χ2 6.17, odds ratio 3.97 and P = 0.01). Older women (35 years or more) had a higher prevalence (30.95%) than younger women (19.77%). Only two of the 15 teenagers (13.33%) were anaemic. Six women (1.26%) had sickle cell Hb and it seemed the presence of Hb C tempered the anaemia. Parity and social class were not significant associations. With a mean booking gestational age of 22.49 weeks for the group, 77.77% of the anaemic women booked earlier than 28 weeks. Only two (2.03%) booked later than 34 weeks. Conclusion: Anaemia is still highly prevalent in the society, and the existing mechanisms for its correction should be reassessed for effectiveness and adequate utilisation in the antenatal clinic. Most anaemic women booked early, therefore, allowing enough time for correction before delivery.
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Institutional protocol and retrospective analysis of 23 cases of palatal pleomorphic adenoma at a Nigerian tertiary hospital p. 28
Kelvin U Omeje, Roland Agbara, Otasowie D Osunde, Akinwale A Efunkoya, Ibiyinka O Amole
DOI:10.4103/phmj.phmj_23_17  
Background: Pleomorphic adenoma (PA) of the minor salivary gland is the most common benign tumour of the minor salivary glands as majority of the tumours of the minor salivary gland are malignant. The most common site of occurrence of PA of the minor salivary gland is the palate. The major challenges in the surgical management of these cases include management of associated primary haemorrhage and prevention of recurrence. This study documents the experiences gained from management of 23 cases at a Nigerian tertiary hospital. Methods: A retrospective review of patients who had surgical excision of histologically diagnosed PA of the palate was conducted amongst patients attending maxillofacial outpatient clinic over a 5-year period (January 2012–December 2016). The information retrieved from the patients' case files included the sociodemographics as well as clinical characteristics. The data were analysed using the Statistical package for the Social Sciences (SPSS) software version 15.0 (SPSS Inc., Chicago, IL, USA). Results: A total of 23 cases of PA were operated in 23 patients. Fourteen of these were female, while 9 were male, giving a gender ratio of 1:1.5 (m:f). Ages of the patients ranged from 19 to 51 years, with a mean age (standard deviation) at 33 (7.1) years. Clinical symptoms varied from painless asymptomatic palatal swelling to complaints of mild discomfort. The sizes of the lesions ranged from 2 cm to 10 cm in the widest diameter (mean 4.6 ± 3.2 cm). The duration of hospital stay ranged from 7 days to 14 days (mean 5 ± 4.1 days) which was counted from the date of admission to the date of discharge. Surgical treatment in all cases was excision with a margin of grossly intact tissue as well as overlying mucosa. Conclusion: PA of minor salivary glands of the palate can be complicated by an eventful primary haemorrhage and tumour recurrence. Ligation of related vasculature and complete surgical excision will guarantee cure and uneventful surgery.
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A comparative study of blood loss during caesarean myomectomy and caesarean section p. 33
Uyoata U Johnson, Bright Ighodaro Obasuyi
DOI:10.4103/phmj.phmj_17_17  
Background: Uterine enlargement and associated increase in its vascularity during pregnancy are believed to increase the risk of haemorrhage and thus caesarean myomectomy is often avoided. However, some reports have claimed that caesarean myomectomy is safe during caesarean section. Aim: This study aims to compare blood loss during caesarean myomectomy and caesarean section with a view to determine the safety of carrying out a caesarean myomectomy. Methods: A retrospective review of all parturient that had caesarean myomectomy (study group) or caesarean section (control group) in a Cottage Hospital in the Niger Delta from September 2011 to August 2012 was carried out. The patients with incomplete data, those with previous abdominal surgery and placental disease and emergency caesarean section were excluded from the study. Data were collated on intraoperative blood loss, intraoperative blood transfusion and packed cell volume (PCV) change. Data were analysed using the SPSS version 16.0 software. Results: There was no statistical difference in the mean age of the parturient in the study (31.3 ± 3.9 years) and control (30.9 ± 3.4 years; P = 0.72) groups. The mean estimated blood loss between the study group (670.8 ± 227.9 ml) and control group (575.0 ± 226.5 ml) was not statistically significant (P = 0.15). However, the PCV change between the study group (7.5% ±3.4%) and control group (5.2% ±2.9%) was statistically significant (P = 0.002), with a higher incidence of post-operative anaemia observed in the study group (P = 0.035). Conclusion: Caesarean myomectomy significantly increases the risk of intraoperative blood loss which can easily be underestimated, resulting in undertransfusion and anaemia with its associated complications. Caesarean myomectomy should, therefore, be carried out when benefits outweigh the risk and appropriate precaution should be put in place to manage possible intra- and post-operative anaemia.
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Aerodigestives foreign bodies: Clinical profile and management p. 37
Amina Lami Okhakhu, Ngozi Carol Onyeagwara
DOI:10.4103/phmj.phmj_9_18  
Background: Upper aerodigestive foreign bodies are a common occurrence in otorhinolaryngologic practice. We present our experience with the management of upper aerodigestive foreign bodies over a 5-year period at the Ear, Nose and Throat Department of the University of Benin Teaching Hospital, Benin City, Nigeria. Methods: A retrospective review of medical records and theatre documents of patients presenting with aerodigestive foreign bodies between January 2010 and December 2014 were carried out. Results: A total of 82 cases of aerodigestive foreign bodies were seen comprising of 53 males and 29 females in a ratio of 1.8:1. Age ranged from 9 months to 85 years. The group most at risk of aerodigestive foreign bodies are those aged between 0 and 4 years. Common foreign bodies were parts of toys, fishbone and groundnut in children and dentures and fishbone in adults. Conclusion: Aerodigestive foreign bodies are a common occurrence especially in the paediatric age group. Early detection and removal can forestall complications.
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Effect of cigarette smoking on salivary electrolyte composition in a sub-urban Nigerian population p. 41
Omorede E Osayande, O Osayande
DOI:10.4103/phmj.phmj_38_16  
Background: Cigarette smoking is a factor that affects the health of humans. It has been shown to be an important risk factor for a variety of disorders such as disease of the lungs, brain damage and has also been linked to the development of periodontal disease. There are, however, few and conflicting studies on its effect on salivary electrolyte composition. Aim: The aim of this study is to evaluate the effect of chronic cigarette smoking on electrolyte concentration of saliva and to determine its effect on normal oral homeostasis. Methods: A total of 40 male subjects of between 25–40 years were divided into two groups, A and B. Group A comprised of 20 smokers and Group B, 20 non-smokers. Saliva from each subject was collected into a plain sample bottles and immediately analysed. Results: Results showed a significantly lower concentration of Na+ and Cl and a significantly higher HCO3 and K+ in smokers than non-smokers. Conclusion: This shows that the concentration of electrolytes in the saliva may be affected by the chronic use of tobacco which could have adverse consequences on the normal homeostasis of the oral environment especially with regard to increased salivary alkalinity as a result of increased salivary bicarbonate.
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Prevalence and pattern of inflammatory dermatoses and skin cancers in highly active antiretroviral therapy-experienced and highly active antiretroviral therapy-naive patients in the University of Benin Teaching Hospital, Benin City, Nigeria p. 46
Roli Cynthia Madubuko, Abel Nze Onunu
DOI:10.4103/phmj.phmj_5_18  
Introduction: Highly active antiretroviral therapy (HAART) reduces morbidity, mortality and prolong life in patients with human immunodeficiency virus (HIV) infection. Only a few studies have compared the prevalence and pattern of inflammatory dermatoses and skin cancers in HAART-naïve and HAART-experienced HIV-infected patients. Aim: The aim of this study was to determine the prevalence and pattern of inflammatory dermatoses and skin cancers in HAART-experienced and HAART-naive patients in the University of Benin Teaching Hospital, Benin City, Nigeria. Methods: This was a comparative cross-sectional study that involved 330 HAART-experienced patients and 330 HAART-naive patients. Patients were examined for inflammatory dermatoses and skin cancers. Skin biopsies were done where applicable for diagnostic accuracy. Results: The mean age of the HAART-experienced group and HAART-naïve group was 42.39 ± 10.1 years and 39.9 ± 11.2 years, respectively. The male-to-female ratio of the HAART-naive and HAART-experienced population was 1.9:1 and 3:1, respectively. The median CD4 count of the HAART-naive group was significantly lower than the HAART-experienced group (275.5 vs. 487 cells/μ P ≤ 0.01). Skin cancers were present in 1.8% of the HAART-naïve group but absent in HAART-experienced patients (P ≤ 0.01). The prevalence of inflammatory dermatoses was 36 (10.9%) in the HAART-naïve group and 8 (2.4%) in the HAART-experienced group (P < 0.01). Pruritic papular eruption was the most common inflammatory dermatoses in both groups with a prevalence of 7.6% and 1.2% in the HAART-naïve and HAART-experienced groups, respectively. Conclusion: Inflammatory dermatoses and skin malignancies were more common in HAART-naive HIV-infected patients compared to HAART-experienced patients. HAART may reduce the cutaneous morbidity in HIV patients.
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