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   Table of Contents - Current issue
Coverpage
October-December 2022
Volume 27 | Issue 4
Page Nos. 319-420

Online since Thursday, September 22, 2022

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REVIEW ARTICLES  

Improving access to diabetes care in Nigeria – The GIFSHIP opening Highly accessed article p. 319
Chidimma B Nwatu
DOI:10.4103/ijmh.ijmh_33_22  
Diabetes mellitus, has continued on a relentless upward trajectory globally, with profound socio-economic consequences. Not surprisingly, the International Diabetes Federation in collaboration with the World Health Organization and the United Nations; in commemoration of the World Diabetes Day 2021, aptly chose the theme – ‘Access to Diabetes Care - If Not Now, When?’ for the year 2021 (the centenary anniversary of insulin discovery), till 2023; to underscore the difference which having access to diabetes care can make, in relation to diabetes management. The Group, Individual and Family Social Health Insurance Program (GIFSHIP) is a non-formal sector insurance package for individuals; groups; and family units in Nigeria, recently introduced by the federal government, to improve universal health coverage. The inherent positive contributions of the GIFSHIP, towards improving access to diabetes care in Nigeria was reviewed. MEDLINE, Omni and Google Scholar searches were conducted using keywords - access to diabetes care, barriers to diabetes care, GIFSHIP, and Nigeria. Relevant studies were extracted and reviewed. Authors summarized health care access, narrowing down to diabetes care access. The opportunity for improved access to diabetes care, which the GIFSHIP presents was highlighted. The role of the Diabetes Association of Nigeria (DAN) in advancing the uptake of, and utilization of the GIFSHIP package for their members, was explored. The GIFSHIP showed great promise for improving access to diabetes care in Nigeria, while the DAN was projected as an effective channel for dissemination and uptake of the GIFSHIP among individuals with diabetes.
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Evolution of COVID-19-related olfactory disorders: A systematic review and meta-analysis p. 326
Foster T Orji, James O Akpeh, Nekwu E Okolugbo, Ethel N Chime
DOI:10.4103/ijmh.ijmh_42_22  
Recently acquired olfactory dysfunction (OD) has emerged as one of the hallmark manifestations of the novel coronavirus disease (COVID-19), but the evolution of its spontaneous recovery has remained inconclusive, with reports of persistence of OD beyond 6 months of onset. We undertook this systematic review and meta-analysis with a view of generating a pooled recovery rate of COVID-19-associated ODs and attempt to examine the predictors of olfactory recovery. A systematic search of Scopus, Google Scholar, and PubMed databases, comprising all longitudinal studies reporting the trajectory of COVID-19-related OD, was carried out. The pooled recovery rate was estimated with random-effects model, and the potential heterogeneity of the subgroup sources was analyzed using a meta-regression test. After the Preferred Reporting Items for Systematic Reviews and Meta-Analysis selection process, 28 studies from 16 countries were included, with a total of 5,175 OD patients, among 11,948 COVID-19 cases. The estimated global pooled recovery rate of OD was 82.7% (95% confidence interval, 77.46–88.04%), with a pooled median duration of OD of 11.6 days. Only 2 out of 28 studies had recovery data beyond a period of 2 months. But no significant difference was found in the recovery rate regarding the length of follow-up (P = 0.840). Studies that conducted objective olfactory assessments showed a significantly higher recovery rate than those with subjective assessments (P = 0.001). Although 10 studies (36%) reported >90% recovery, 9 studies (32%) documented persistence of OD in >25% of their patients. Five out of six studies showed that hyposnia tended to show complete recovery than anosmia. Age, co-morbidities, and intranasal treatments had no effects. Test of homogeneity between subgroups using Cochran’s Q test was not significant (Q = 0.69, P = 0.40). Our meta-analysis revealed high rates of early- and medium-term recovery of COVID-19-related OD. However, it also showed disturbing rates of persistence of OD. Anosmia tended to be predictive of residual OD than hyposmia. Age, comorbidities, intranasal corticosteroid, and decongestants had no effects on OD recovery.
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ORIGINAL ARTICLES Top

Tertiary Institutions’ Social Health Insurance Program: Awareness, knowledge, and utilization for dental treatment among students of a Nigerian University p. 337
Nkolika P Uguru, Chibuzo C Uguru, Udochukwu U Ogu, Prince C Agwu, Chinyere C Okeke, Nneka Onyejaka, Ogochukwu Forchu, Ngozi Eze
DOI:10.4103/ijmh.ijmh_20_22  
Background: Awareness and knowledge can play key roles in influencing the utilization of health insurance programs in Nigeria. Objectives: This study aims to investigate the awareness and use of the Tertiary Institutions/Voluntary Participant Social Health Insurance Program (TISHIP) for undergraduate dental services. Materials and Methods: A cross-sectional descriptive study was conducted in the Enugu Campus of the University of Nigeria and the study population comprised full-time undergraduate students of the institution with a total sample size of 400. Results: Majority (66.7%) of the respondents were aware of the TISHIP, but 37% were aware that it covered dental treatments, and 16.1% had received dental treatment under TISHIP. Fifty point eight percent (50.8%) of the respondents were not registered under the insurance program. The reason respondents had not registered was because majority (49.7%) were not aware of the compulsory registration into the scheme. Respondents agreed that TISHIP would promote equity in healthcare delivery (57.5%), promote improved health facilities (39.4%), and 52.5% were willing to participate in the scheme while 47.9% were undecided on whether TISHIP was worth the financial contribution. Presumed high cost of dental treatment (51.9%) and non-availability of materials for dental treatment at dental facilities (50.8%) were factors that affected the utilization of TISHIP (P < 0.05). Conclusion: Despite the positive effect of TISHIP in cushioning the cost of dental care, utilization is poor, thus there is a need to scale up awareness among the students’ population.
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The effect of avocado seed extract (Persea Americana) on carbide induced hepatoxicity in adult Wistar rats Highly accessed article p. 344
Nneoma V Okpala, Joseph I Adinma, Mark M Edet, Damian N Ezejindu
DOI:10.4103/ijmh.ijmh_21_22  
Background: Persea Americana is reported to have medicinal value. Calcium Carbide (CaC2), a fruit-ripening agent, has been shown to be toxic to body organs. Objective: To determine the effect of avocado seed extract (ASE) on CaC2-induced hepatotoxicity in rats. Materials and Methods: Four experimental groups, each of 5 adult wistar rats were fed respectively with normal diets (group A); 250 mg/kg ASE (group B); 100 mg/kg CaC2 (group C); combination of 100 mg/kg CaC2 and 250 mg/kg ASE – group D. Changes in the rats’ behaviours, body weights, and liver function were assessed over 21 days. Data were analyzed using SPSS. The cumulated rat weights, rat liver weights and serum liver enzyme levels for groups B, C, and D rats were compared with group A. Results: Abnormal behavior was most observed in group C rats. Rats in group A showed a significant increase in weight before and three weeks following administration of feeds while rats in groups B, C, and D showed significant decrease in weight – more marked in group C rats. Only the mean liver weights of rats in group C showed significant decrease compared to that in group A, P = 0.001. Similarly, only the cumulated liver enzyme levels of rats in group C demonstrated significant increase when compared to group A rats - indicating hepatotoxicity. Conclusion: In this study, hepatotoxicity occurred in CaC2-administered rats. However, the combination of CaC2 and ASE showed no liver toxicity indicating a mitigating effect of ASE to CaC2-induced hepatotoxicity.
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Perception and attitude of clinical medical students to COVID-19 containment measures p. 350
Samuel R Ohayi, Awoere T Chinawa, Ifeoma N Asimadu, Josephat M Chinawa
DOI:10.4103/ijmh.ijmh_10_22  
Background: The strain put on the health systems by the COVID-19 pandemic is very significant. Measures of containment includes closure of schools, wearing of face mask, use of hand sanitizers, etc. Objectives: To determine the perception and attitude of clinical medical students to COVID-19 containment measures. Materials and Methods: This study was a cross-sectional study which utilized an online survey protocol. A self-selecting sampling method was used to select students. Data were analyzed using the Statistical Package for Social Sciences, version 20, Chicago (Ill., USA). Results: Medical students hazarded wearing of face mask 154(87.0%) and the use of hand sanitizers 59(89.8%) as the most useful containment measures against COVID-19 pandemic. Sixty six participants (37.3%) had good preventive practices. The age range of 20–25 years and male gender “disagreed” that government stoppage of medical education is an appropriate measure against COVID 19 pandemic. (p = 0.01, and 0.02, respectively). Only 10.2% of participants believed that the government is also affected by this containment measure. Age range of 20–25 years and being a catholic are predictors of good preventive practices (P = 0.05, and 0.04, respectively). Conclusion: A little proportion of medical students had good preventive practices against COVID-19. And a good proportion repudiated the policy of closure of schools during the pandemic. Factors such as male gender, and being within the 20–25 years age bracket were predictors of students’ rejection of the government’s policy on closure of schools as a containment measure for COVID pandemic.
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Malaria in pregnancy: Assessment of doctors’ conformity to monthly intermittent preventive treatment in a Sub-Saharan African Country p. 356
Edith C Ikpeama, Peter C Udealor, Chidinma I Onwuka
DOI:10.4103/ijmh.ijmh_36_22  
Background: Administration of intermittent preventive treatment (IPT) in pregnancy is recommended for all pregnant women living in areas of stable malaria transmission. In order to increase the chances of a parturient receiving adequate number of IPT in pregnancy, World Health Organization (WHO) now recommends that it should be commenced from second trimester and given every month (at least 4 weeks apart) until the time of delivery, however, this recommendation is not being practiced by all doctors attending to pregnant women. Objective: To determine the conformity of Doctors to monthly prescription of IPT till delivery. Materials and Methods: This was a cross-sectional survey of antenatal clinic Doctors’ prescription of IPT during pregnancy in Enugu state. Information obtained included the socio-demographic characteristics of the Doctors, knowledge of IPT in pregnancy for malaria and implementation of the new IPT policy. A P-value of <0.05 was considered statistically significant. Results: A total of 119 doctors participated in the study. The mean age of the doctors was 36.15 +/- 2.42 years. One hundred and seven (89.9%) of the respondents had good knowledge that IPT is for prevention of malaria. One hundred and eighteen (99.2%) used sulphadoxine-pyrimethamine for IPT. One hundred and fourteen (95.8%) respondents knew that IPT should be commenced in second trimester, and 85.7% conformed to the new monthly policy of IPT prescription. Among the 20.2% of doctors who prescribed IPT only for 2 – 3 times during pregnancy, 13 (54.2%) gave the reason that they were comfortable with the old pattern of stopping at 36 weeks. There was significant association between knowledge of IPT in pregnancy and year of attainment of MBBS (P = 0.015). Age (P = 0.006) and level of practice (P = 0.002) were significantly associated with practice of the new IPT in pregnancy policy. Conclusion: There was high conformity to monthly IPT prescription until delivery among doctors in Enugu, Nigeria.
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Immediate anxiety and depression disorders during the initial stage of the 2019 coronavirus disease (Covid-19) epidemic among the general population in Nigeria p. 362
Sunday O Olarewaju, Oluwatosin S Jegede, Grace Ijitade, Ayodeji M Akande
DOI:10.4103/ijmh.ijmh_18_22  
Background: During the initial stage of Covid-19 outbreak in Nigeria, the government took drastic steps in controlling it; this included a total lockdown which left many with fears and worries about their health and household economy. The mental health of people in the society was becoming an issue that cannot be ignored. There was a dearth of information on the impact of Covid-19 on the mental health of the general population. Objectives: This study was therefore conducted to explore the prevalence of immediate anxiety and depression disorders and to identify associated factors during the initial stage of Covid-19 outbreak in Nigeria. Materials and Methods: The study was conducted in 2020 and was cross-sectional analytical in design. The study population included Nigerians above the age of 18 years. A total of 305 people participated in the study. Data were collected using a structured electronic questionnaire and analyzed using IBM SPSS version 25. Based on the Hospital Anxiety and Depression Scale (HADS), respondents were categorized into normal, having borderline, or having psychological disorders (anxiety or depression). Results: The median age of respondents was 30 years (interquartile range 23, 41.5). Three hundred and four respondents were aware of Covid-19. One hundred and twenty-five (41.0%) were assessed to be normal during the initial stage of Covid-19 in Nigeria, 44 (14.4%) had borderline psychological disorder, and 136 (44.6%) had either anxiety or depression. Respondents with occupation classified as others were found to be 52.1% times less likely to have anxiety or depression disorders when compared with civil servants (P = 0.045; 95% confidence interval = 0.23 - 0.99). Conclusion: Our study shows that anxiety and depression were widespread during the initial stage of Covid-19 outbreak. Mental health services would be essential in taking care of the psychological needs of Nigerians, especially those who have experienced and survived the scourge of the pandemic.
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Prevalence, outcomes, and predictors of antepartum hemorrhage due to placenta previa in Nigeria p. 371
Johnpaul E Nnagbo, Matthew I Eze, Joseph O Ezugworie, George O Ugwu, Emeka I Iloghalu, Eziamaka P Ezenkwele, Elija N Onwudiwe, Onyemaechi S Okoro, Leonard O Ajah, Emmanuel O Izuka, Charles O Adiri, Peter O Nkwo, Emmanuel O Ugwu, Chukwuemeka A Iyoke, Euzebus C Ezugwu, Polycarp U Agu
DOI:10.4103/ijmh.ijmh_24_22  
Background: Despite the enormous burden of antepartum hemorrhage (APH) due to placental previa, there are not much recent data on prevalence, outcomes, and predictors of this major obstetric condition in low-resource settings. Objectives: The objectives of this study are to determine the prevalence, outcomes, and predictors of APH due to placenta previa in Enugu, South-East Nigeria. Materials and Methods: It was a retrospective review of pregnant women admitted to the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria, with a diagnosis of APH due to placenta previa from January 1, 2010 to January 31, 2019. Relevant data such as biodata, obstetrics characteristics, and management protocols were extracted from eligible case notes retrieved from the Medical Records Department of the hospital. Results: Of the 6001 pregnant women managed, 91 had APH due to placenta previa, giving a prevalence rate of 1.5% (91/6001). In terms of maternal and fetal outcomes, no maternal death or delivery due to fetal distress was recorded. Thirty-seven (40.7%) women had primary postpartum hemorrhage (PPH), 1.1% had obstetric hysterectomy due to PPH, 45.1% had blood transfusion, 51% were delivered due to intractable APH, 98.9% of the babies were delivered alive, 39.6% required admission into newborn special care unit, and 40.7% had babies with low birth weight. The predictors of APH due to placenta previa were low socioeconomic status (P = 0.011, odds ratio [OR] = 0.15, 95% confidence interval [CI]: 0.03–0.64), high parity (P = 0.032, OR = 6.61, 95% CI: 1.18–37.02), adopting conservative management (P = 0.004, B = 2.765, OR = 0.06, 95% CI: 0.01–0.40), and unbooked status (P = 0.018, B = 2.724, OR = 15.24, 95% CI: 1.61–144.16). Conclusion: The prevalence of PPH in the study population is high and the outcome is favorable. It is predicted by the unbooked status, multiparity, and adopting conservative management. The study findings should guide obstetricians in counseling and managing women with APH due to placenta previa.
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Demographic features of users and uptake of intrauterine contraceptive device (IUCD) and reasons for removal at University of Calabar Teaching Hospital, Nigeria: A 5-year review p. 379
Patience O Odusolu, John J Egbe, Komommo O Okpebri, Praise A Uduigwomen
DOI:10.4103/ijmh.ijmh_31_22  
Background: Intrauterine contraceptive device (IUCD) is an effective long-acting reversible contraceptive method that is suitable for women of reproductive age. Despite this, its uptake by women in Nigeria is not optimum. Objectives: The objectives were to determine the uptake, demographic characteristics of users, and reasons for the removal of IUCD use at the University of Calabar Teaching Hospital (UCTH), Nigeria. Materials and Methods: This was a retrospective study of family planning clients, who accepted and inserted IUCD at UCTH, Calabar, between January 1, 2013, and December 31, 2017. Case records of clients were retrieved and reviewed. Data extracted were entered into excel and analyzed using SPSS. Results: Out of 10,102 clients during the period, 1,032 clients accepted and inserted IUCD, giving an uptake rate of 10.2%. There was a gradual decline in the uptake of IUCD from 383 (37.1%) in 2013 to 96 (9.3%) in 2017. The sociodemographic features of IUCD users showed a mean age of 33.53 ± 5.94 with the majority, 696 (67.4%) having tertiary education. The majority were para 3 or 4 and accounted for 627 (60.7%), whereas 662 (64.2%) had previously used a modern contraceptive method. Sixty-five (6.3%) clients had their IUCD removed. The commonest reason for the removal was desire to get pregnant, 44 (67.7%), and side effects of IUCD (20.6%). Conclusion: There was a low uptake of IUCD, with a decline in the trend over the study period. Side effects affected the removal of the the IUCD. There is a need for awareness creation and education of women, appropriate counseling, and good patient selection in order to increase uptake.
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Fluid aspirates of ameloblastoma: Types, prevalence, and prognostic relevance p. 385
Mark C Nwoga
DOI:10.4103/ijmh.ijmh_41_22  
Background: Ameloblastoma is a benign cystic odontogenic tumor common in Nigeria. The cystic cavities frequently contain tumor fluids, which may be obtained by needle aspiration. The tumor fluids help in the clinical differential diagnosis. The types, prevalence, and relevance of ameloblastoma fluid aspirates have been mostly unreported. Objectives: The aim of this study was to identify the types and prevalence of fluid aspirates of ameloblastoma and evaluate its prognostic relevance. Materials and Methods: This was a 7-year retrospective study of consecutive patients with ameloblastoma at a tertiary hospital in Enugu, Nigeria. The tumor fluids obtained by needle aspiration are categorized based on visual appearance. The data retrieved from case files, biopsy forms, histopathologic reports, and other records in the departmental archives were analyzed with IBM SPSS Statistics, version 24.0. Results: Tumor fluid aspirate yield was positive in 80.4% ((n=74) of patients with ameloblastoma. There were aspirates from 82.4% (n=61) cases of primary ameloblastoma and 17.6% (n=13) cases of recurrent ameloblastoma. The aspirates obtained were dark-brown 41.9%, straw-colored 37.8%, serosanguinous 10.8%, and purulent 9.5%. The type of aspirate was influenced by the primary or recurrent status of ameloblastoma (P = 0.04). Straw-colored aspirate was obtained from 92.9% of primary ameloblastoma and in 73.1% of patients <20 years of age. Recurrent ameloblastoma typically yielded dark-brown aspirates in 76.9% of recurrences. Conclusion: The association of some tumor fluids with primary and recurrent ameloblastoma could improve the understanding of the recurrence potential of the disease and influence treatment planning.
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Assessment of sociodemographic predictors of iron deficiency among secondary school students in Misau LGA, Bauchi State, Northeastern Nigeria p. 392
Rufai A Dachi, Sani Awwalu, Falmata G Mustapha, Saleh Yuguda, Hassan Abdulaziz, Hassan A Odebiyi
DOI:10.4103/ijmh.ijmh_26_22  
Background: Iron is an essential micronutrient found in red meat, vegetables, and dairy products. Iron deficiency (ID) is associated with poor growth and impaired cognitive development, lowered immunity with increased risk to infectious diseases, and reduced productivity. Objective: We determined some sociodemographic predictors of ID among secondary school students in Bauchi State, Northeastern Nigeria. Materials and Methods: This was a cross-sectional study of secondary school students in Bauchi State, Northeastern Nigeria. Four hundred and twenty (420) secondary school students were enrolled using stratified sampling with proportional allocation. Data on age, gender, and sociodemographic parameters were collated. Body mass indices (BMIs) were computed while blood was taken for hemoglobin concentration and iron status determination. Collated data were analyzed using JASP 0.11.1.0. Multiple logistic regression analyses were used to adjust for possible confounders in the observed significant relationships. Level of significance was set at P ≤ 0.05. Results: The mean age of the students was 16.5 ± 1.9 years with females constituting 210 (50.0%). Median (interquartile range) monthly incomes for fathers and mothers were 150 (100, 200) USD and 50 (30, 70) USD, respectively. Median BMI and hemoglobin concentration (Hb) were 17.9 (16.4, 19.6) kg/m2 and 13.7 (12.7, 14.7) g/dL, respectively. Anemia was present in 62 (14.8%) participants, whereas ID was present in 213 (50.71%) participants. There was a statistically significant relationship between reduced intake of meat together with gender and iron status with females having a higher risk of having ID compared with males (P < 0.05). Conclusion: Female gender and decreased daily intake of meat are important predictors of ID among secondary school students in Bauchi State, Nigeria.
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Effect of nursing audit and feedback on orthopedic patients’ care outcomes in selected hospitals in southeastern Nigeria p. 397
John E Anieche, Anthonia U Chinweuba, Oluchukwu G Okonkwo, Ifeoma H Obidife, Ngozi E Makata, Chinemerem Eleke
DOI:10.4103/ijmh.ijmh_43_22  
Background: Despite the proven benefits of audit and feedback interventions in record keeping, very few studies have examined its effect on patient outcomes when applied in nursing practice. Objective: This study examined the effect of nursing audit and feedback on orthopedic patients’ outcomes in three tertiary hospitals in southeastern Nigeria. Materials and Methods: A single-group, pretest–posttest design was applied to a convenience sample of 150 orthopedic patients from November 2019 to March 2021. Data were collected using a structured questionnaire and analyzed with SPSS 25. Results: At baseline, the majority of the respondents rated their perceived general health (54.7%), physical function (60.7%), role performance due to physical limitations (55.3%), role performance due to emotional limitations (65.3%), vitality (38.0%), mental health (38.0%), and social function (45.3%) as fair, but rated their bodily comfort (44.7%) as poor. At 21 days after audit and feedback, the majority of the respondents rated their perceived general health (40.0%), role performance due to physical limitations (74.7%), mental health (58.0%), and social function (54.6%) as very good; physical function (60.7%) and role performance due to emotional limitation (50.7%) as good, but rated their vitality (44.7%) and bodily comfort (61.4%) as fair. Comparing between baseline and 21 days after audit and feedback revealed a significant improvement in perceived health status in all measured subdomains of health (P ≤ 0.001). Conclusions: Nursing audit and feedback is a feasible method of evaluating and enhancing patient outcomes. Audit and feedback should be considered by nurse managers for integration into routine clinical procedures.
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Perception of ocular complications among patients with diabetes mellitus attending tertiary hospitals in Enugu, Nigeria p. 404
Ifeoma N Asimadu, Suhanyah Okeke, Nkiru N Kizor-Akaraiwe, Nkeiruka C Mbadiwe, Chidi F Mbakigwe
DOI:10.4103/ijmh.ijmh_44_22  
Background: Diabetes mellitus can lead to sight and life-threatening complications. It affects people in both developed and developing countries. Many diabetics present to the eye clinics with undetected advanced eye complications. Aim: The study aimed at evaluating the perception of the ocular complications of diabetes and how it influences the attitude and practice of the diabetics attending the eye clinics. Materials and Methods: A cross-sectional study was conducted in two tertiary hospitals in Enugu over a 3-month period. An interviewer-administered questionnaire was used to assess their perception, and hence their attitude and practice toward diabetic eye complications after obtaining their informed consents. Results: A total of 884 diabetics participated. There were 337 (38.1%) males and 547 (61.9%) females. A majority, 523 (59.2%), were in the age range of 51–70 years. Only 40.7% knew that diabetes affects the eyes; 60.2% did not know that good blood sugar control will help prevent eye complications; 41.1% knew they needed to see the eye specialist from time to time but not necessarily for routine check-up. Only 9.1% saw the eye specialists routinely; the remaining 90.9% never went for routine eye check as only 40.72 knew it affects the eyes. Conclusion: There was poor perception of the disease and its complications, which led to poor practice such as no regular, periodic eye examinations. There is a dire need for education of the diabetics, building of multidisciplinary effective strategies and policies with the view to decreasing the burden of the disease especially in the developing countries.
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Surgical management prospects for myasthenia gravis in Nigeria: A preliminary report of Enugu experience p. 410
Ijeoma B Ndionuka, Ikenna O Onwuekwe, Stella O Ekenze, Birinus Ezeala-Adikaibe
DOI:10.4103/ijmh.ijmh_39_22  
Background: Myasthenia gravis (MG) is an acquired autoimmune neuromuscular disease characterized by fatigable and variable weakness of skeletal muscles as a result of autoimmune attack on postsynaptic antigenic targets. There is paucity of data on the outcome of treatment options available in resource-poor settings. Objective: The aim of this study was to determine the treatment outcome of surgical thymectomy for MG with regard to the local experience in Enugu, southeast Nigeria. Materials and Methods: It was a preliminary report of patients with MG seen at the Neurology Clinic of the University of Nigeria Teaching Hospital, Enugu, Nigeria, from February 2016 to October 2019. The treatment outcomes of the patients were analyzed following thymectomy to determine the effectiveness of the surgical management. Data obtained included patients’ age, response to treatment, intensive care unit (ICU) stay, and total hospital stay. Results: The mean age of the patients was 35.7 ± 15.1. The mean duration of stay at the ICU was 3.9 ± 4.6 days, while the mean total hospital stay was 12 ± 9.70 days. All the patients (100%) had symptomatic improvement following thymectomy and 40% had remission. Conclusion: The general outcome of MG patients following thymectomy was favorable. Thymectomy appears to improve the prognosis of MG in the local setting of Enugu, Nigeria.
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CASE REPORT Top

Hematometra in pubertal girls: A report of two cases and review of literature p. 414
Christopher C Amah, Ijeoma C Obianyo, Nene E Agugua-Obianyo, Henry C Nnaji, Obioma A Okezie
DOI:10.4103/ijmh.ijmh_19_22  
Haematometra in pubertal girls is a late presentation of congenital genital malformations. A diagnosis of the anomaly is preferably made before menarche. This will avoid the psychosocial trauma and other complications at puberty. We draw attention to the two cases we managed, reviewed the literature, discussed the specific pitfalls in our setting and arouse clinical awareness to the problem. two cases of haematometra in pubertal girls are discussed and the literature is reviewed. The first case is a 12-year-old girl who presented with cyclic lower abdominal pain, abdominal mass and no menarche. Following investigations, a diagnosis of cervicovaginal atresia was made. She eventually had hysterectomy done by request. She is awaiting vaginoplasty. The second patient is a 14-year-old girl who presented with primary amenorrhoea, cyclic lower abdominal cramps and abdominal mass. A diagnosis of imperforate hymen was made. The hymen was excised and the vulva (introitus) re-epithelialized. Both patients have been followed up for 4 years and have been symptom free. Our literature review shows that haematometra presenting in pubertal girls is rare and the causes are commonly congenital. It is either due to malformation of the Mullerian duct system, the urogenital system, or the external genitalia. Associated malformation of the urinary system is significant. Haematometra can pose challenges in management especially in a low resource setting. Early diagnosis and multidisciplinary approach are mandatory to proffer adequate treatment and avert psychological, sexual and reproductive health complications.
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