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   Table of Contents - Current issue
Coverpage
May-August 2020
Volume 14 | Issue 2
Page Nos. 31-92

Online since Monday, September 7, 2020

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EDITORIAL  

Another phase of the Port Harcourt Medical Journal begins Highly accessed article p. 31
Richard Chinedu Echem
DOI:10.4103/phmj.phmj_25_20  
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ORIGINAL ARTICLES Top

Prevalence of self-reported occupational diseases/injuries amongst poultry farmers in Kaduna North local government area, Kaduna State p. 32
Nafisat Ohunene Usman, Adamu Uthman Shehu, Victoria Nanben Omole, Awawu Grace Nmadu
DOI:10.4103/phmj.phmj_16_19  
Background: A healthy worker is a productive worker and an asset to the organisation and the country at large. Occupational health and safety in Nigeria is in a poor state; with no comprehensive occupational health monitoring system for work-related diseases and injuries. Work-related accidents and diseases continue to be a serious problem in both developed and developing countries like Nigeria. Poultry farmers, by the nature of their job, are susceptible to occupational and environmental hazards on a daily basis. Aim: The aim of the study is to determine the prevalence of occupational hazards amongst poultry farm workers in Kaduna North local government area, Kaduna State. Methodology: This cross-sectional descriptive survey was carried out using semi-structured questionnaires to obtain information from 70 respondents selected by multi-stage sampling technique. Data were analysed based on descriptive statistics, Chi-square and Fisher's exact test using SPSS version 21. The results were presented in tables and figures. Results: Majority (75.7%) of the respondents had experienced an occupational injury/disease at work; with the most common (45.7%) being cough. There was a statistically significant relationship between work experience, highest level of education and experience of occupational injury or disease in the past year (0.0015) and (0.004), respectively. Conclusion: In view of the findings from this study, all employees should be continually informed of the hazards they will encounter in the course of their job so that even more experienced workers realise that if necessary precautions are not taken, they will susceptible to the hazards.
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Framework for a psychosocial support structure for individuals during an Ebola virus disease outbreak: Lessons from Port Harcourt experience p. 38
Chukwuma Ugochukwu Okeafor, Ibitein Ngowari Okeafor, Chidozie Donald Chukwujekwu
DOI:10.4103/phmj.phmj_25_19  
Background: The Ebola virus epidemic was reported in Lagos, Nigeria, in July 2014; this further spread to Nigeria's Oil city of Port Harcourt in September 2014. Ebola virus disease (EVD) is highly infectious with high mortality rates reported. During such an outbreak, there is a tendency to neglect the psychosocial implications of this outbreak. This research sought to propose a psychosocial support framework during an EVD outbreak. Methods: This study was a qualitative study. It employed review of literature, individual- and group-interview sessions and one of the author's (CUO) experience and challenges as the lead of the psychosocial support group (PSG) during the 2014 EVD outbreak in Port Harcourt to develop a framework on psychosocial support for EVD. Data presentation involved tables, charts and GIS map. Results: There were a total of four cases of EVD and 526 contacts in the EVD outbreak in Port Harcourt. The framework comprises four components, namely PSG, set-up/location, protocol of care and services and mobility/other logistics. A multidisciplinary team comprising psychiatrists, clinical psychologists, mental health nurses, counsellors, social workers and religious carers makes up the PSG. Set-up/location refers to the PSG operation office. The protocol of care and services are the modalities of care related to the categories of individuals requiring psychosocial support in EVD response. Conclusion: It is imperative that the psychosocial needs of individuals affected by EVD outbreak are sufficiently met. The psychosocial support framework provides a well-coordinated and structured approach in ensuring the holistic care of these individuals.
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Survival after treatment for American Joint Committee on Cancer Stage III breast cancer in Ahmadu Bello University Teaching Hospital Zaria p. 45
Stanley Emeka Nwabuoku, Peter Pase Abur, Muhammad Daniyan, Lazarus M.D Yusufu, Vincent I Odigie
DOI:10.4103/phmj.phmj_28_19  
Background: Breast cancer is the most common malignancy in women worldwide. Patients with American Joint Committee on Cancer Stage III breast cancer have been noted to have good response to neoadjuvant chemotherapy. The aim of this study is to evaluate survival of such patients after treatment at our hospital. Methods: A 5-year prospective study was conducted between January 2009 and December 2013. Patients had four courses of neoadjuvant chemotherapy (cyclophosphamide, adriamycin, paclitaxel), Auchincloss' modified radical mastectomy, two courses of adjuvant chemotherapy and adjuvant tamoxifen (premenopausal) or letrozole (post-menopausal) for ER-positive tumours. All patients had radiotherapy. Follow-up was on outpatient basis and through phone calls. Statistical analysis was done using SPSS version 21.0, survival analyses with Kaplan–Meier method, multivariate analyses done with P ≤ 0.05 regarded as statistically significant. Results: Data from 303 patients (291 females and 12 males) were analysed. One-year, 2-year, 3-year, 4-year and 5-year disease-free survival (DFS) was 79.80%, 56.57%, 51.51%, 47.47% and 47.47%, respectively. One-year, 2-year, 3-year, 4-year and 5-year overall survival (OS) was 80.80%, 61.61%, 55.56%, 51.51% and 51.50%, respectively. Initial tumour size, response to neoadjuvant chemotherapy, number of involved nodes, tumour grade and receptor status had statistically significant relationship with DFS and OS. The relationship between the patients' age, gender and both DFS and OS was not statistically significant. Conclusion: Five-year DFS and OS were 47.47% and 51.50%, respectively. Initial lesion size, response to therapy, involved nodes, tumour grade and receptor status had statistically significant relationship with DFS and OS.
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A 5-year review of obstetrics and gynaecology admission into the intensive care unit of a tertiary hospital in Northern Nigeria p. 51
Idris Usman Takai, Zainab Datti Ahmed, Usman Aliyu Umar, Jawhara Shehu Galadanci, Abdullahi Mustapha Miko Mohammad
DOI:10.4103/phmj.phmj_5_20  
Background: Obstetrics and gynaecology admissions into the intensive care units (ICUs) are quite rare. Careful evaluation and prompt intervention in these patients is required to have a good outcome. Aim: To determine the indications, incidence, interventions, outcome and causes of death in obstetrics and gynaecology patients admitted into our ICU. Methods: A retrospective descriptive study of obstetrics and gynaecology patients admitted into the ICU of Aminu Kano Teaching Hospital as conducted. Data from the patient case files and the ICU records were collected over a period of 5 years from January 2012 to December 2016 and were analysed using SPSS 18. Results: The incidence of obstetrics and gynaecology admission into the ICU was found to be 10% (65/650), out of which 84.6% (55/65) were due to obstetrics cases, while 15.4% (10/65) were due to gynaecology cases. The most common obstetrics indication was hypertensive disorders in pregnancy, mostly eclampsia (46.3%), while the most common gynaecology indication was post-operative complications (66.7%). The major interventions the patients received were blood transfusion (48.9%), mechanical ventilation (44.7%), antihypertensive therapy (42.6%), anticonvulsant therapy (34%) and oxygen therapy (40.4%). The overall mortality rate in this study was found to be 40.4%, out of which 84.2% were obstetrics cases and 15.8% were gynaecology cases. The most frequent cause of death was due to cardiac arrest (63.2%). Conclusion: Obstetrics and gynaecology admissions into the ICU were found to be very low, with eclampsia being the most common indication. All patients admitted had multidisciplinary management. An obstetrics and gynaecology ICU should be made available in proximity to the department.
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Microbial isolates from stroke patients with urinary tract infection, at the University of Benin Teaching Hospital p. 58
Francis Ehidiamen Odiase, Patrick Vincent Lofor
DOI:10.4103/phmj.phmj_1_20  
Background: Urinary tract infection (UTI) is a common nosocomial infection amongst stroke patients. It is associated with increased morbidity and mortality. Despite the impact of UTI on stroke, there is a dearth of knowledge regarding the microbial isolates from the urine of stroke patients with UTI in Nigeria. Aim: The aim of this study was to compile and describe microorganisms causing UTI in stroke patients and it is hoped to provide insight into management. Methods: This was a retrospective study, which involved review of the laboratory microbiology records of urine specimens of stroke patients with UTI who were on admission from June 2004 to June 2018 at the University of Benin Teaching Hospital. Results: A total of 2,681 stroke patients had their urine sent for microbiological assessment of which 778 (29%) had UTI. The mean age of the stroke patients with UTI was 65.9 ± 11.4 years, with 53.0% of them being female, while 69.0% had an ischemic stroke. With regard to the urine microbial isolates, Enterococcus faecalis accounted for 30.0%, Escherichia coli 19.0%, Enterobacter sakazaki and Proteus mirabilis 16.0% each, while Citrobacter freundii(0.8%) and Klebsiella pneumoniae (1.1%) were the least isolated microorganism. Conclusion: Stroke patients are at risk of developing catheter-associated UTI. Catheter-associated UTI predisposes to multidrug-resistant antibiotic isolates, attendant with poor outcome. It is hoped that rational use of antibiotics and appropriate urinary catheter application be ensured in the care of the stroke patients.
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Direct access versus physician's pre-authorized laboratory testing: The experience at a clinical laboratory in South-South, Nigeria p. 63
Esther Ifeoma Obi, Amatare Dinyain
DOI:10.4103/phmj.phmj_27_19  
Background: The traditional health-care model in this country places the physician (or appropriate ordering provider) in control of determining what diagnostic and therapeutic monitoring (including laboratory tests) is to be performed on a patient. A paradigm shift in the way medical care is provided has been observed; with a change in the delivery of health-care moving from physicians into the hands of the patients. One manifestation of this has been direct access testing (DAT) for laboratory services defined as patient (as opposed to physician) initiated testing of human specimens. Appropriateness of tests ordered and reliable interpretation of test results are some of the concerns associated with DAT. Aim: To determine the comparative evaluation of DAT compared to physicians' pre-authorised laboratory testing at a clinical laboratory. Methods: All laboratory requisition orders made to the Pathology Department at Bayelsa Diagnostic Centre, Yenagoa, Bayelsa State within a 2-year period were evaluated. Results: A total of 15,755 requisition orders were analysed. The prevalence of DAT was 21.2% compared to 78.8% of physicians pre-authorised laboratory tests. Nine out of the ten most frequently ordered investigations: full blood count, electrolyte, urea and creatinine, microscopy, culture and sensitivity, microscopic diagnosis of malaria parasite, (urinalysis, Widal test, lipid profile, liver function test and erythrocyte sedimentation rate were pre-dominantly physicians' pre-authorised requisition orders. Fasting blood glucose was the only investigation that had a higher prevalence from DAT. More than half (1753 [52.5%]) of the self-referred patients did not present with clinical history while majority (10,087 [81.2%]) with laboratory tests pre-authorised by physicians presented with clinical details. Conclusion: This study highlights that laboratory test pre-authorised by physicians still remains the traditional healthcare model in South-south Nigeria.
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Histopathological characteristics of gynaecomastia in Southwestern Nigeria: A review from a tertiary hospital p. 68
Mustapha Akanji Ajani, Ayodeji A Salami, Babatope Lanre Awosusi, Sebastian A Omenai, Oluwadamilare Iyapo, Segun Samson Odetola
DOI:10.4103/phmj.phmj_15_20  
Background: Gynaecomastia is a benign proliferation of the glandular tissue of the male breast. It is thought to be present in at least a third of men in the course of their lifetime. This study aims to review the histomorphological characteristics of gynaecomastia seen at the department of Pathology, University College Hospital (UCH), Ibadan, over 10 years period. Methods: A hospital-based retrospective study was undertaken to review the histopathology reports of all gynaecomastia cases diagnosed at the Department of Pathology, UCH Ibadan, over a 10-year period from 01 January, 2009 to 31 December, 2018. Patient's biodata, histological diagnosis and clinical details were extracted from the surgical day books and laboratory request forms. The data were analysed for the frequency distribution using the SPSS software version 22. Results: Gynaecomastia accounts for 2.5% of all breast biopsies received within the study period and accounted for 68.1% of all benign breast lesions seen in males. The left breast was the most affected with 48.8% of the cases, whereas 17.2% of the cases were bilateral. The age range of patients with gynaecomastia seen in this study is between 12 and 80 years with a mean age of 43.36 years. The most common histopathological subtype seen in this study is the florid type gynaecomastia. Conclusion: Gynaecomastia is the most common diagnosis from male breast biopsies. The left breast is the most commonly affected breast. The florid type gynaecomastia is the main histopathological variant seen in this study.
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Methicillin-resistant Staphylococcus aureus: Knowledge, attitude and perception among medical students in a private institution in Ogun State, Nigeria p. 73
Tinuade Adesola Ajani, Charles John Elikwu, Chinenye Gloria Anaedobe, Chika Celen Okangba, Babatunde Tayo
DOI:10.4103/phmj.phmj_8_20  
Background: Methicillin-resistant Staphylococcus aureus(MRSA) spread is of concern in the hospital and community. Clinical medical students can serve as vectors for the transmission of the pathogen. This study was aimed to determine the level of knowledge, attitude and perception of MRSA among clinical medical students in Babcock University, Ilishan-Remo, Ogun State, Nigeria. Methods: This was a descriptive cross-sectional study that involved 100 clinical medical students in Babcock University from March 2018 to March 2019. A structured self-administered questionnaire was used to assess the knowledge, attitude and perception of MRSA among the participants. Data were analysed using IBM SPSS version 23. The mean ± standard deviation (SD) of the correct answers to knowledge, attitude and perception of MRSA was analysed, respectively. Respondents who scored more than the mean ± SD were considered to have adequate knowledge, attitude and perception. Results: Majority (59%) had respectively poor knowledge, attitude (51%) and perception (51%) about MRSA. Among the 41% who have heard about MRSA, 30/41 (73.2%) had their source of information from classroom lectures. Fifty-seven per cent of the participants did not know the drug of choice for MRSA, whereas 32% were not sure of the importance of handwashing in the prevention of MRSA. Good knowledge and perception were significantly associated with clinical year of study (P < 0.05), whereas good knowledge was significantly associated with marital status (P = 0.029) and clinical year of study (P < 0.05). Conclusion: The level of knowledge, attitude and perception of the study participants to MRSA was inadequate.
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Assessment of various lumbosacral spine abnormalities on magnetic resonance imaging scans of patients with low back pain p. 78
Bello O Usman, Abdulfatahi A Oyewole, Nuhu D Chom, Abdulaziz Umar
DOI:10.4103/phmj.phmj_7_20  
Background: Low back pain (LBP) is a cardinal sign of many lumbosacral spine abnormalities. Magnetic resonance imaging (MRI) has revolutionised the management of LBP through precise diagnosis and accurate definition of the extent of the problem. Aim: This study was carried out to determine the lumbosacral spine abnormalities on MRI scans of patients with LBP. Methods: The prospective study was conducted within 4 years at the MRI suite of the Department of Radiology, Ahmadu Bello University Teaching Hospital, Zaria. This study included 200 patients who had LBP on whom MRI scan was performed. All MRI scans were done with permanent magnet 0.2 T 'open' MRI unit. The images were stored in a computer and subsequently viewed on the screen. Results: The MRI findings of 200 patients involved in the study showed that more males (124 [62%]) were affected than females (76 [38%]). The age of the patients ranged from 11 to 80 years, with a mean of 47.8 (standard deviation 1.4). The peak incidence of LBP was (55 [27.5%]) in the fourth and fifth decade of life. Majority of the patients (172 [86%]) had intervertebral disc prolapse/herniation. Thecal sac, spinal cord (at L1/L2 only) and cauda equina were compressed in 159 (92.4%), 4 (2.3%) and 73 (42.3%) patients, respectively. Compression of multiple structures in the spinal canal was seen in 64 (37%) patients. Conclusion: MRI examination has improved the management of patients with LBP, and the results obtained from this study will assist clinicians to quantitatively evaluate patients with LBP.
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CASE REPORT Top

Tibial tubercle avulsion fractures p. 86
Ifeanyi Charles Nwagbara
DOI:10.4103/phmj.phmj_11_20  
Tibial tubercle avulsion fractures are uncommon injuries seen in the paediatric age group which are due to an indirect force caused by the sudden contraction of the quadriceps muscles against the patellar tendon insertion on the tibia tubercle. The injury is most commonly associated with jumping and landing sports, such as basketball, long jump, high jump and football. The average age at presentation is 14.6 years and boys are predominantly affected. The child typically presents with pain in the anterior knee, joint effusion, haemarthrosis and inability to bear weight. Standard radiographs of the joint will reveal the avulsed tibia tubercle and also aid in classification of the injury. The major task in the treatment of this fracture is in maintaining a satisfactory reduction against the proximal pull of the quadriceps muscles. Satisfactory results are usually achieved, however, by operative reduction and fixation with cancellous screws, though some authors have reported good results with conservative treatment. We present a 15-year-old male adolescent who presented with tibia tubercle avulsion fracture of the right knee and was managed by open reduction and internal fixation using two cancellous screws.
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Coronavirus disease-2019 pandemic and its very high risk of international spread p. 91
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/phmj.phmj_10_20  
The coronavirus disease-2019 outbreak that has been first detected in a single city in the Wuhan city of China has eventually been reported in 216 nations and territories and has been acknowledged as one of the major public health threats. The overall risk of the spread of the disease has been graded as very high in both the regional and global settings. Such a declaration by the World Health Organization makes it imperative and compulsory for the policy makers and all the public health authorities that it is high time to implement appropriate interventions which are suitable to the local case scenario and the settings. To conclude, the international risk of transmission of infection has been identified as very high and it becomes the responsibility of each and every one of us to reduce the risk of spread of the infection.
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