Orient Journal of Medicine

Ebstein's Anomaly of Tricuspid Valve Presenting with Supraventricular Tachycardia: A Case Report

Chukwunonso Emegoakor — 2024-06-05

Ebstein's anomaly is a rare congenital malformation of the heart. It is characterized by apical displacement of the tricuspid valve leaflets with consequent 'atrialization' of part of the right ventricle. It is commonly associated with conduction system abnormalities and accessory pathways. This is a report of a 25-year-old man presenting with eight months history of recurrent, paroxysmal palpitations which occurred several times a week. On cardiovascular examination, he was normotensive with tachycardia, raised jugular venous pressure, pulsating neck vessels and a loud pulmonary component of second heart sound. Electrocardiogram revealed regular narrow complex tachycardia with right ventricular hypertrophy and right axis deviation. Trans-thoracic echocardiography demonstrated the presence of Ebstein's anomaly of the tricuspid valve. The patient was medically treated with a beta blocker, digoxin and amiodarone. He was subsequently referred to have electrophysiology study for possible radiofrequency ablation and/or surgery which he declined. We present this rare case because it also highlights the difficulties in assessing advanced cardiac interventional therapy such as electrophysiology study in our environment.

The Roles of Acute and Chronic Marrow Dysfunctions in the Aetiology of Anaemia in Sickle Cell Disease: Pathogenesis and Management

Sagir Ahmed — 2024-01-20

Background: Majority of the literature regarding the pathophysiology of anaemia in sickle cell disease (SCD) is focused on intravascular and extravascular red cell haemolysis with relatively little reference to reduced red cell production due to a myriad of marrow dysfunctions. Objectives: The aim of this overview is thus to present a comprehensive but concise narrative review of the aetiopathogenesis and management of anaemia due to acute and chronic marrow dysfunctions in patients with SCD. Methodology: Online literature search was conducted using search terms relevant to anaemia due to acute or chronic marrow dysfunctions in patients with SCD. Only articles that examined aetiopathogenesis and/or management of marrow dysfunction vis-à-vis anaemia in SCD were selected. Results: Literature search revealed that in addition to ineffective erythropoiesis, SCD patients also suffer from both benign and malignant forms of acute and chronic marrow dysfunctions. Marrow dysfunctions in SCD arise from separate or combined effects of marrow ischemia, deficiencies of micronutrients, renal insufficiency, infection of marrow precursors, haemophagocytic syndrome and myelosuppressive, dysplastic, and oncogenic effects of chemotherapy, gene therapy, and stem cell transplant. Conclusion: Marrow dysfunction is an important cause of anaemia in SCD. While transfusion support provides general short-term management, blood and marrow analyses are often necessary for accurate aetiological diagnosis. The Long-term and definitive management of marrow dysfunctions in SCD is determined by the aetiology, and it ranges from haematinics, antimicrobials, immune modulation, differentiation therapy, chemotherapy, dialysis, and/or erythropoietin supplements.

Relationship Between Individual Dietary Diversity Grade and Malnutrition among School Aged Children

Jacinta Chinyere Elo-Ilo — 2024-10-08

Background: Malnutrition is one of the major predisposing factors to infectious diseases globally especially among school aged children. Low grades of individual dietary diversity is a suspected risk factor for childhood malnutrition. Objective: To determine the relationship between individual dietary diversity grade and childhood malnutrition among 6-12-year old school pupils. Materials and Methods: This was a cross-sectional descriptive study that enrolled 203 primary school pupils. Socio-demographic data was collected using a pretested interviewer administered questionnaire. The number of food groups present in their immediate past 24-hour dietary recall was used to grade the dietary diversity of each study subject. Data was analyzed using Statistical Package for Social Sciences (SPSS) software version 25.0. The association between dietary diversity grades and occurrence of malnutrition was determined. Level of significance for tests of association was set at 5%. Results: The result showed that out of 203 subjects that were enrolled for data analysis, 105(51.7%) were males, and 117(57.6%) were 6-8 year old. Forty one (20.2%), 69(34.0%), 93(45.8%) were from upper, medium and low socio-economic class (SEC) classes respectively. Out of 203 subjects, 54(26.6%) had high Individual Dietary Diversity Grade IDDG (IDDS >5), 56(27.6%) had medium IDDG (IDDS 3-4) and 93(45.8%) had low IDDG (IDDS 1-3). Low SEC and lowest dietary diversity grade were significantly associated with occurrence of childhood malnutrition. (P< 0.05). Conclusion: Low IDDG and SEC were associated with malnutrition. Nutritional counseling on the need to increase dietary diversity grade of school children can help mitigate the impact of malnutrition.

Utilization of Community Based Health Insurance Scheme among the Vulnerable: An Urban City Experience in Nigeria

Amaka Obi-Nwosu — 2024-01-20

Background: Universal health coverage is based on the declaration that health is a fundamental human right with equity being paramount. The National Health Insurance Scheme (NHIS) was set up by the Nigerian government to enable every citizen to access basic health care as part of universal health coverage. The community-based health insurance scheme (CBHIS) as part of the NHIS was at the same time also set up to take care of the informal sector. This is meant to ensure that not just a particular group has access to health care but is also available to all individuals within different groups by whatever classification that is used. Objective: We sought to assess the utilization of CBHIS among a group of low-income earners (petty traders) in the urban city of Nnewi in South Eastern Nigeria. Methodology: This is a cross-sectional descriptive study of 400 petty traders using a multi-stage sampling technique. Data was collected using a pretested, semi-structured interviewer-administered questionnaire. Statistical Analysis was done using SPSS V25. Ethical approval was obtained from the health research and ethics committee of Nnamdi Azikiwe University Teaching Hospital, Nnewi. Result: The majority (62.5%) of the petty traders were females with 26% of them aged between 36 and 45 years. While 56.5% of the people were aware of the existence of CBHIS in their community, only 27.5% utilized it. Major factors preventing utilization were feelings of loss of money if no sickness was recorded, lack of trust in the insurance scheme, poor understanding of the scheme structure, and difficulty in locating service providers. Conclusion: Access to basic healthcare services is essential for every individual. Families need to be protected from the financial hardship of huge medical bills. Although there is a high level of acceptance of CBHIS, utilization remains very low. The poor knowledge of the availability of the scheme, operational system of the scheme, and lack of funds has contributed to poor enrollment among the vulnerable.

Aetiology and Demographic Pattern of Chronic Kidney Disease in a Tertiary Health Institution in South-East Nigeria: A Four-Year Review

Nonyelum Jisieike-Onuigbo — 2024-06-05

Background: In sub-Saharan Africa (SSA), chronic kidney disease (CKD) is considered to be more common in men, the young and middle aged; while hypertension and glomerular diseases are the main causes of CKD. However its causes, and demographic distribution differ regionally. This may be due to variations in exposure to communicable and non-communicable diseases, differences in prevalent behavioural practices like cigarette smoking, genetic factors. Objectives: This study sought to explore the demographic characteristics and causes of chronic kidney disease seen in a tertiary hospital in Anambra State, South-Eastern Nigeria. Methodology: Medical records of all adults with kidney disease, aged 18 years and above, seen at the nephrology clinics over a four year time span with a diagnosis of CKD were reviewed. Results: The median age of the study cohort was 57 years (range = 18 to 94 years). More than 60% of CKD patients were older than 50 years and the peak age ranged between 51 to 70 years. Females accounted for 51.7% of patients and the male: female was 0.9:1. The most frequent causes of CKD were hypertensive nephropathy (46.7%) followed by diabetic kidney disease (27.9%). Only 3.06% of patients had chronic glomerulonephritis. Conclusion: The CKD population in Anambra State, south-east Nigeria is older than what have been reported previously from most other parts of SSA; also the sex disparity seen in earlier studies has disappeared. Importantly, diabetes is becoming an important cause of CKD in this sub-region. Earlier recognition and better treatment of Diabetes mellitus are necessary to reduce the burden of CKD in Anambra State.

Male Involvement in the Maternal Utilization of Health Services among Childbearing Women in Tertiary Healthcare Outstations in South-East Nigeria

Silvia Isioma Ezemenahi — 2024-01-20

Background: In African societies, males play the role of decision-makers and providers. It has become necessary for maternal and child survival, to involve them in maternal health service utilization actively. This concept will not only improve maternal outcomes but also strengthen the relationships within the family. Objective: This study sought to assess male involvement in maternal utilization of health services among childbearing women in Nnamdi Azikiwe University Teaching Hospital (NAUTH), Anambra state, Nigeria outstations. Methodology: A cross-sectional survey was conducted involving 200 consented male participants whose spouses had earlier provided consent and met the eligibility criteria. The participants were chosen through simple random sampling between February 1st and March 1st, 2021. Data was gathered using a semi-structured, interviewer-administered questionnaire and subsequently analyzed using Statistical Package for Social Sciences (SPSS) version 24.0. The study's level of significance was established at P < 0.05 for all analyses. Results: The mean age and standard deviation of the respondents was 41.15±5.98 years. Only 35% and 29% of respondents ever accompanied their spouses to antenatal and postnatal visits respectively. The majority accompanied their spouses to the hospital for delivery but only 22% were present in the delivery room. Busy work schedules were identified as major reasons for low levels of involvement. Conclusion: The study showed a low level of involvement among participants in spouses' maternal health services. The positive attitude shown by the participants is an indication that if proper awareness campaigns are organized, men can improve their rate of involvement in the utilization of maternal health services.

Haematological Parameters of Acute Stroke Patients Managed at a Tertiary Hospital in Abakaliki Nigeria: A Case-Control Study

Chukwuemeka Eze — 2024-01-20

Background: Changes in the haematological indices could have implications for stroke risk, management plan and outcome. There is limited data on the pattern of haematological parameters of acute stroke patients in Nigeria despite its impact on stroke risk, management and outcome. Objectives: To determine the pattern and the prognostic implications of the haematological parameters in acute stroke patients managed over a-nine-year-period at a Tertiary Hospital in Abakaliki Nigeria. Methodology: This was a retrospective hospital-based case-control study of the haematological parameters of acute stroke patients seen over a nine-year-period at a tertiary hospital in Abakaliki Nigeria. Results: The mean total white blood cell count and percentage neutrophil in the case group were significantly higher than the control group while the mean packed cell volume did not show any significant difference. Further analysis of the case group revealed that the mean packed cell volume was significantly lower among female patients, the elderly age group, those with low education attainment, impaired renal status, short admission duration, haemorrhagic stroke and admitting hypertension. Conclusions: Elevated total white blood cell count and differential neutrophilia were significantly associated with acute stroke. Changes in haematological parameters have implications for stroke risk and outcome.

Compliance to National Healthcare Waste Management Guidelines by Healthcare Workers and Facilities in Abakaliki South-East Nigeria

Bernard Ituma — 2024-05-11

Background: Healthcare wastes are wastes generated across different healthcare settings (hospitals, laboratory, nursing homes, etc). Poor management of these wastes potentially exposes health workers, waste handlers, patients and public to infection. Objectives: To explore knowledge and practice of healthcare waste management (HCWM) among health workers as well as adherence to national healthcare waste management guidelines by health-care facilities in Abakaliki, Nigeria. Methodology: This was a descriptive cross-sectional study of 350 respondents (nurses, medical laboratory scientists and cleaning staff) selected from four healthcare facilities in Abakaliki. Data were collected with semi-structured questionnaires and were analysed using IBM-SPSS version 25. Results: The respondents were composed of nurses (49.1%), medical laboratory scientists (32.3%) and cleaning staff (18.6%). The mean age was 32.6 ± 4.5 years and mean work experience was 4.9 ±2.1 years. Among the respondents, 55(15.7%) had completed secondary education and 284(81.1%) tertiary education. More than three-quarter, 275(78.6%) had received training in HCWM. The mean knowledge and practice scores were 88.2% and 92.1% respectively. The mean facility implementation of national HCWM plan score was 36.4%. Conclusion: The study revealed high knowledge and practice of HCWM among respondents and low facility implementation of national HCWM guidelines. It is therefore recommended that health managers should ensure full and proper facility implementation of national HCWM guidelines vis-a-vis provision of standard operating procedures, administrative support and regular staff training program.

Erectile Dysfunction in Men Presenting at a Tertiary Hospital in South East Nigeria

Bede Azudialu — 2024-06-05

Background: Sexual health is an integral part of general health which is often neglected. Sexual dysfunction is a common problem that affects the quality of life of both patients and their sexual partner(s). Erectile dysfunction (ED) is one of the most prevalent sexual dysfunctions in men. Objective. To determine the prevalence of erectile dysfunction and the associated factors among adult males attending the general outpatient at Federal Medical Center(FMC) Umuahia, South East Nigeria. Methodology. This was a cross-sectional study involving 421 respondents recruited by systematic random sampling from the General Outpatient Clinic, FMC Umuahia using the International Index of Erectile Function (IIEF-5) scale. Results. The mean age of respondents was 35.2 ± 12.0 years. Among the respondents, 219(52%) had ED while a greater proportion of those who had ED had mild ED 109 (49.8%). The prevalence of ED increased in age from 41.9% in respondents < 40years to 70.2% in respondents ≥ 40 years (p < 0.05). The other factors associated with ED on bivariate analysis include tobacco use (p < 0.05), alcohol intake (p < 0.05), diabetes mellitus, hypertension, use of anti hypertensive drugs, use of oral hypoglycemic drugs. Conclusion. Erectile dysfunction is a common problem among the males in our study population. About five out of every ten adult men in this study have Erectile dysfunction (ED).

Level of Concordance Between Urine Drug Test Results and Self-Report Among Patients Attending the Substance Use Disorders Clinic in Federal Neuropsychiatric Hospital Maiduguri

Placidus Ogualili — 2024-05-11

Background: Substance use disorders are among the most common disorders seen in the Mental Health facility. Discrepancies in harmonising self-reports and laboratory results significantly mar the assessment of these disorders. So many factors account for this, such as the timing of the test and the nature of the substance used, among others. Objectives: The study determined the sociodemographic and clinical correlates involved with regard to agreeableness between self-report and urine drug test results among patients being treated for substance use disorders. Methodology: A cross-sectional study from March to May 2022 involved patients treated for substance use disorders at Maiduguri. The authors encountered 109 clients based on scheduled appointments using information from the register kept by health records staff. The study pathway included information, obtaining consent, and administering questionnaires designed by the authors along with the Drug Abuse Screening Test version 10 (DAST-10). Seventy-five (75) patients all met our inclusion criteria and thus fully participated. Results: The minimum age was 18 years, and the maximum was 58 years. Sixty-nine (92%) were males. Thirty-one (41.3%) of them were secondary school leavers, and 17 (22.7%) were in higher institutions. Sixteen (21%) were Civil servants, and 5 (6.7%) were unemployed. A bivariate association using chi-square and t-test showed that academic qualification related significantly with DAST-10 score (P = 0.005). Occupation was also associated significantly with DAST-10 score (P = 0.033). The UDT report was positive for 67(89.3%) but only tallied with self-report for 23 (30.7%) participants. There was a wide margin of disagreement between substances detected by UDT and self-report of substance use. Conclusion: Self-report of substance use did not directly concur with UDT results. This underscores the need for further scrutiny and caution while using any approach as a stand-alone, especially when planning for interventions.