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   Table of Contents - Current issue
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January-April 2019
Volume 13 | Issue 1
Page Nos. 1-45

Online since Friday, June 14, 2019

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REVIEW ARTICLE  

Inflammatory chorioretinopathies (White Dot Syndromes), diagnosis and management: A review of the literature Highly accessed article p. 1
Bassey Fiebai, Safinatu Wada Mohammed
DOI:10.4103/phmj.phmj_21_18  
Background: The white dot syndromes or inflammatory chorioretinopathies are a heterogenous group of diseases of unknown aetiology, characterized by the appearance of white dots on the fundus. These group of disorders include, acute posterior multifocal placoid pigment epitheliopathy (APMPPE), serpiginous choroiditis, multiple evanescent white dot syndrome (MEWDS), multifocal choroiditis and panuveitis (MCP), punctate inner choroidopathy (PIC), and diffuse subretinal fibrosis (DSF). They appear to have similar modes of presentation, but subtle differences noted help in their diagnosis coupled with and imaging techniques aids in the management of these disorders. Aim: This study aims to review relevant literature available on inflammatory chorioretinopathies, their diagnosis and management. Methods: Review of pertinent literature and available publications using the terms 'White Dot Syndrome (WDS)', 'inflammatory chorioretinopathies' acute multifocal placoid punctate epitheliopathy, birdshot chorioretinopathy, serpiginous choroiditis, multifocal choroiditis and panuveitis and punctate inner choroiditis were sought for using a comprehensive literature search of PubMed and MEDLINE. All relevant articles, full length and abstract that had information on clinical presentations, investigations and available treatment modalities were included. Additional papers were also selected from reference lists of papers identified by the electronic database search. Results: Reviewed information shows that the WDS though similar in presentation are still considered to be separate disease entities and not really a spectrum of the same disease as some postulate. Most are self-limiting and visual prognosis is generally good. Newer treatment modalities uncovered in this review include the use of intravitreal anti-vascular endothelial growth factors in the treatment of sight-threatening complications such as choroidal neovascularisation. Conclusion: This article has reviewed inflammatory chorioretinopathies or WDS as reported in literature over 4 decades. An appreciable data exist and reviewed information reveals that WDS are a heterogeneous group of disorders with similar aetiology and modes of presentation but with some subtle distinct characteristics. Further studies on predictors of foveal involvement would inform what prophylactic treatments maybe beneficiary in preventing visual loss.
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ORIGINAL ARTICLES Top

Evaluation of the psychological distress experienced by spouses of women undergoing anaesthesia for caesarean section p. 7
Sotonye Fyneface-Ogan, Chukwuma Okeafor, Alfred Tamunoigbanibo Aggo
DOI:10.4103/phmj.phmj_4_19  
Background: Caesarean section (CS) could serve a challenging situation to spouses and family of women, more so as these women are meant to undergo anaesthesia. Little evidence exists with regard to the psychological impact of this on these families. Aim: The study was aimed to evaluate psychological distress among spouses of women undergoing anaesthesia for CS and also to identify the coping strategies used by the participants. Methods: Ninety-one husbands of women undergoing anaesthesia for CS were consecutively recruited. They were given a self-administered study protocol consisting of sociodemographic questionnaire, General Health Questionnaire (GHQ-12) and the Brief Cope Inventory. P < 0.05 was considered statistically significant. Results: Fifty participants (54.9%) were found to have psychological distress (GHQ of 3 and above). Psychological distress was significantly more amongst younger participants (20–39 years' age group: 100% and 30–39 years' age group: 57.4%, P < 0.05). A significantly higher proportion (72.4%) of participants were unemployed, whereas those without previous experience of birth (85.0%) had psychological distress (P < 0.05). However, employment status (OR=3.5; 95%CI; 1.24-9.98) and previous birth experience [(OR 95% CI, 6.3 (1.59 - 24.78)] predicted the outcome of psychological distress among the participants on multivariate analysis. The mean scores on the coping subscales of substance use, positive reframing, planning and self-blame were significantly higher among those with psychological distress in comparison to those without psychological distress (P < 0.05). Conclusion: The prevalence of psychological distress is high among the husbands of women undergoing anaesthesia for CS. Substance use, positive reframing, planning and self-blame were more observed among those with psychological distress.
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Analgesia for procedural pain: Current practice among Nigerian paediatricians p. 13
Zakari Aliyu Suleiman, Israel Kayode Kolawole, Kazeem Adewale Adegboye, Muhammed Akanbi Adeboye, Chuma Everestus Onuchukwu, Surajudeen Bello, Aminudeen Abdulrahman
DOI:10.4103/phmj.phmj_3_19  
Background: Minor procedures such as venepuncture and lumbar puncture among others are routinely performed in the neonatal intensive care units (NICUs) and paediatric wards. These procedures are accompanied by varying degrees of pain which, if not addressed, can lead to undesirable physiological, cardiovascular, respiratory, hormonal, metabolic and behavioural responses. This study evaluated the current strategies for reducing procedural pain in children in Nigeria. Methods: This was a questionnaire-based, cross-sectional random survey of the current practice of analgesic techniques for procedural pain among 240 respondents out of 700 consultant paediatricians and residents who attended the annual Paediatric Association of Nigeria Conference in 2018. Results: The male-to-female ratio was 1:1.3, the mean age of the respondents was 38.28 ± 7.36 years and the median year of practice was 10 years. Of the surveyed respondents, consultants and trainees constituted 40.8% and 59.2%, respectively, whereas 46.2% and 51.3% of them assessed pain and routinely administered analgesia to treat procedural pain, respectively. Breastfeeding and topical analgesic agent were prescribed by 18.3% and 12.9% of the respondents, respectively. Pain of venous access and lumbar puncture were treated by 38.8% and 19.6% of the respondents, respectively. Only 13.3% of the respondents have institutional guidelines for pain assessment and treatment in their practice locations. Conclusion: The survey showed that, even though a sizeable proportion of paediatricians do assess pain and provide some form of analgesia for procedural pain, there is a lack of institutional pain treatment guidelines in most hospitals attending to the medical needs of children in Nigeria.
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Knowledge, attitude and practice of home management of diarrhoea among mothers of under-fives in Samaru, Kaduna State, Nigeria p. 19
Victoria Nanben Omole, Teyil Mary Wamyil-Mshelia, Grace Awawu Nmadu, Nafisat Ohunene Usman, Emmanuel Ayuba Andeyantso, Farouk Adiri
DOI:10.4103/phmj.phmj_23_18  
Background: Diseases associated with diarrhoea rank second among the top five diseases which account for childhood morbidities and mortalities in developing countries. Home-based management of diarrhoea is a globally recommended approach to reversing this trend and averting preventable deaths among under-five children. Aim: To explore the knowledge of, attitudes to and the practice of home management of diarrhoea (HMD) among mothers of under-five children. Methods: A cross-sectional, descriptive study was conducted in Samaru, Kaduna State, Nigeria, among mothers of under-fives, selected by multistage sampling method. Data were collected using interviewer-administered, close-ended, structured questionnaires, and then cleaned for errors and electronically analysed. Results: The awareness of the concept of HMD was universal. Diverse methods were mentioned by respondents, ranging from recommended to inappropriate options. The knowledge of oral rehydration salts was high (93.7%), with the main source of information being health facilities. However, only 34.4% of the respondents would resort to using ORS for HMD, and the overall practice of any form of HMD was only 64%. Conclusion: The knowledge of both recommended and inappropriate methods of HMD was demonstrated among respondents. Their awareness of ORS was high. However, the actual practice of HMD was relatively low. The promotion of positive HMD methods of fluid and electrolyte replacement; continuous, nutritious feeding and zinc supplementation for children with diarrhoea among mothers and caregivers is recommended.
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Fasting blood glucose profile of tuberculosis patients in Port Harcourt, Nigeria p. 26
Inumanye N Ojule, Arinze I Opara
DOI:10.4103/phmj.phmj_22_18  
Background: The inter-relationship between tuberculosis (TB) and diabetes mellitus (DM) continues to trigger global interest, especially due to increasing prevalence of TB, propelled largely by the HIV epidemic and almost on an equal scale by the increasing incidence of diabetes worldwide, especially in the developing countries. Aim: The aim of this study is to determine the fasting blood glucose (FBG) profile of TB patients in Port Harcourt, Rivers State, Nigeria. Methods: A facility based cross sectional study. A total of 225 adult patients on intensive phase treatment for TB at the two facilities were recruited into the study. Purposive sampling was used to recruit participants into the study in that all the consecutive patients newly diagnosed and attending the clinics during this period were recruited. A semi-structured questionnaire was administered to all participants for medical and socio-demographic data. FBG estimation was done for all the study participants after 8 h of overnight fast using a standardised glucometer. The World Health Organisation criteria were used to classify the study participants into normal, impaired fasting glucose (IFG) and frank DM. Data analysis was carried out using the Statistical Package for the Social Sciences Version. 18. Results: About 5.3% of the participants already knew they were diabetic. The prevalence of newly diagnosed frank diabetes was 8.6%. We obtained prevalence of 15.5% for IFG among the study participants. Conclusion: Our findings confirm a high prevalence of IFG and DM among TB patients in our locality.
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Clinical profile of patients with uterine rupture at a tertiary facility in North Central Nigeria p. 32
Folorunsho B Adewale, Abiodun S Adeniran, Munirdeen A Ijaiya
DOI:10.4103/phmj.phmj_20_18  
Background: Uterine rupture is a major obstetric emergency and an important cause of maternal and perinatal morbidity and mortality. Aim: To determine the prevalence, clinical presentation, management options and pregnancy outcomes following uterine rupture. Methods: It is a 5-year, descriptive, retrospective study of parturients who had uterine rupture between 1 January 2011 and 31 December, 2015, at Federal Medical Centre, Bida, North Central Nigeria. The case files of all parturients who had uterine rupture during this period were retrieved from the Medical Records department, and relevant information including maternal age, risk factors for uterine rupture, presenting symptoms, site of rupture and the definitive treatment as well as maternal and neonatal outcome using a data collection sheet was entered into a computer with SPSS version 20.0, which was also used for the analysis. Results: The prevalence of uterine rupture was 1 in 202 deliveries (48/9,718); of these, 24 (50.0%) were aged 36–40 years and 28 (58.3%) were grandmultipara (parity ≥5); 42 (87.5%) cases had previous uterine scar, whereas 15 (31.3%) had labour augmentation with oxytocin while attempting vaginal birth after caesarean section. The common presenting complaints were intrapartum vaginal bleeding (24; 50%) and abdominal pain (10; 20.8%). The most common site of rupture was anterolateral (24; 50.0%), while the most common surgical intervention was uterine repair with bilateral tubal ligation (30; 62.5%). The case fatality rate was 18.8% (9/48), neonatal survival rate was 12.5% (6/48) and perinatal mortality rate was 875/1000 deliveries (42/48). Conclusion: Uterine rupture remains an important cause of poor pregnancy outcomes in low-income settings. Previous caesarean delivery is the most common risk factor; women attempting vaginal birth after caesarean delivery should be managed by skilled health personnel in facilities with provision for emergency surgical intervention.
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Compliance and effectiveness of syndromic approach in females with reproductive tract infections p. 37
Harmanjeet Kaur, Divya Goel
DOI:10.4103/phmj.phmj_17_18  
Background: India has strengthened its fight against sexually transmitted infections (STIs) and reproductive tract infections (RTIs) by implementing syndromic approach at peripheral health centres. However, effective control of STIs and RTIs still remains a huge challenge. One of the biggest hurdles could be patient compliance towards the complete course of treatment. Yet, little is known about its association with the effectiveness of syndromic management of STIs and RTIs. Aim: This study aimed to assess the patient compliance with syndromic management and its effectiveness. Methods: A prospective, analytic study was conducted at a tertiary care hospital in Haryana, India, from March to November 2016. One hundred female patients suffering from any of the following complaints, (a) vaginal discharge; (b) cervical discharge; (c) lower abdominal pain; (d) burning micturition and (e) itching, were screened for RTIs. All eligible patients were interviewed in depth, and treatment was given to them according to syndromic management guidelines of National AIDS Control Organization (NACO). Patients were assessed in terms of clinical cure at the end of the treatment. Assessment of compliance to treatment regimen was made by using modified Morisky scale. Data were entered into excel sheet and analysed by SPSS software version 20 by IBM, Chicago, IL, USA. Chi-square and Fisher's exact test were applied. P <0.05 was considered statistically significant. Results: Out of the 100 patients, 68 were cured. Of the 68 cured patients, 66 (97.1%) participants had high motivation, whereas 57 (83.8%) patients had high knowledge. Of the 32 patients who were not cured, 29 (90.6%) participants had low motivation and 30 (93.8%) participants had low knowledge. P values of motivation (<0.001) and knowledge (<0.001) between cured (66) and uncured (32) patients were highly statistically significant. Conclusion: This study showed the effect of compliance on the effectiveness of syndromic management but did not find the array of factors which could affect the compliance.
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Post-adenotonsillectomy analgesia in children: The place of non-steroidal anti-inflammatory drugs p. 41
Uju Matilda Ibekwe, Ediriverere Oghenekaro
DOI:10.4103/phmj.phmj_15_18  
Background: Adenotonsillectomy and tonsillectomy are common surgeries carried out in children under 15 years of age with associated significant pains; therefore, adequate post-operative pain management is mandatory to ensure full recovery. Non-steroidal anti-inflammatory drugs (NSAIDs), being cheap and readily available, could be used to achieve this. Objective: The objective was to determine the effectiveness of post-operative analgesia in these children using NSAIDs – diclofenac sodium/ibuprofen. Methods: All children admitted for adenotonsillectomy/tonsillectomy in the Ear, Nose and Throat surgery department from April 2016 to March 2017 were recruited. All the patients had diclofenac suppository at 1.5 mg/kg immediate post-operative period and then 12 hourly for 48 h and subsequently ibuprofen oral suspension at 5 mg/kg/dose 8 hourly for 5 days. Swallowing and the time of commencement of oral intake were used as indices to ascertain effective or adequate analgesia. The time of commencement of oral intake both for liquids and solids including the duration of hospital stay was documented and analysed using SPSS software version 20.0. The results were presented using simple statistical tables. Results: A total of 78 children were recruited, of which only 75 underwent the full study. The age ranged from 11 months to 14.5 years with 47 males and 28 females. The age group of 2.6–4.5 years was the most commonly seen, which constituted 43.59%, whereas 46.67% of these patients commenced oral intake in 0–6 h post-operation. There was no post-operative bleeding recorded. There was a mortality of 3.85%. Conclusion: NSAIDs at regular intervals offer effective analgesia after adenotonsillectomy and appear to be safe in children.
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