Annals of Ibadan Postgraduate Medicine

The future is yesterday: Automating the thought process, animpending assault on academic writing

K.I. Egbuchulem, H.D. Ogundipe, K. Uwajeh2 — Thu, 15 Feb 2024 00:00:00 +0000

No Abstract

Left ventricular noncompaction cardiomyopathy: A scoping review

Thu, 15 Feb 2024 00:00:00 +0000

Introduction: There has been an upsurge in the reporting of cases of Left Ventricular Noncompaction (LVNC) cardiomyopathy in medical literature in the last 35 years due to advances in medical imaging. The condition was first described in 1926 and the first reported case by echocardiography was in 1984. The American Heart Association considers LVNC a primary cardiomyopathy of genetic origin, while the European Society of Cardiology and the World Health Organization grouped it as an unclassified cardiomyopathy. Its variability in terms of genetic profile, phenotypic expression, clinical presentation, and histopathological findings makes it somewhat a variant of other cardiomyopathies.

Case presentation: Patients with LVNC cardiomyopathy may not have any symptoms or may present with ventricular arrhythmias, heart failure, thromboembolism, or sudden death. LVNC cardiomyopathy diagnosis is typically made by echocardiography, although there are higher resolution cardiac imaging techniques. Management will depend on the patient’s clinical presentation. Due to its genetic association, there is a need to screen living relatives once the diagnosis is made in an individual.

Conclusion: The aim of this paper is to review current knowledge on this condition.

Retrospective evaluation of MRI pattern of glioblastoma in a Tertiary Hospital in Nigeria

G.I. Ogbole, O.A. Ogunleye, M.C. Nweke, J.A. Akinmoladun — Thu, 15 Feb 2024 00:00:00 +0000

Introduction: Malignant gliomas, especially glioblastomas, are among the most aggressive and devastating of cancers, commonly producing profound progressive disability and leading to death in most cases. Conventional magnetic resonance (MR) imaging with gadolinium-based contrast agents is the most widely established and most useful tool in the characterization of cerebral tumors including Glioblastomas. This study aims to describe the imaging characteristics of Glioblastoma in African patients using conventional MR imaging.

Methodology: This was a retrospective cross-sectional study carried out at a Nigerian tertiary hospital. The demographic data, MR images and reports of patients with imaging and histological diagnosis of Glioblastoma between January 2003 and September 2017 were retrieved and reviewed. All the recorded data were analyzed using simple proportion and descriptive statistics with the Statistical Package for Social Sciences (SPSS) version 20.0 software for Windows.

Results: One hundred and twenty-two (122) patients had brain tumors during the review period, out of which 14 (11.5%) had histologically confirmed glioblastoma. The male- to -female ratio was 2.5 to 1.0. The age ranged between 14 and 72 years with a mean age of 49.6 years SD ±16.3. Twelve (85.7%) patients had solitary tumors and 2 (14.3%) had multiple tumors. Six (42.9%) were found on the right hemisphere only, 5 (35.7%) were found on the left hemisphere while 3 (21.4%) traversed both hemispheres. All tumors showed inhomogeneous enhancement and significant midline shift to the contra-lateral side of greater than 3mm. Only 1 (7.1%) tumor showed evidence of intra-tumoral bleed detected on T2* sequence.

Conclusion: Glioblastoma is a known aggressive brain tumor with unique MR imaging characteristics. While midline shift is typical, intra- tumoral bleeding may be an uncommon finding at presentation in our center.

Safety netting concept in primary care consultation

Thu, 15 Feb 2024 00:00:00 +0000

Introduction: Patient safety in primary care setting is important and effort geared towards this cannot be over-emphasised. Patient safety can be achieved through various means, but one mechanism to improve patient safety in resourceconstrained settings is through a practice known as safety netting. Safety netting is widely recommended in national guidelines with varying definitions and scope; hence there is no consensus on when safety netting should be used and what should be the content.

Methodology: A narrative overview of the evidence on safety netting concept in primary care consultation was conducted. Scholastic articles and Papers by International organizations were searched using terms like ‘safety netting’, ‘primary care consultation’, ‘family physician’, ‘consultation technique’, and ‘patient safety’ in primary care. Most resources found were in the developed countries (the West) and none was found in Africa or the Middle East. Safety netting is a technique in consultation to communicate uncertainty, provide patient information on red- flag symptoms, and plan for future appointments to ensure timely re-assessment of a patient’s condition. The content of safetynetting advice may encompass the chronology of the illness, advice on worrying symptoms to look out for, and specific information on how, when and where to seek help. Safety netting was considered to be particularly important when consulting with the acutely unwell, patients with multi-morbidity, children and those with mental health problems.

Conclusion: Safety netting is more than solely the communication of uncertainty within a consultation. It should include plans for follow-up as well as important administrative aspects, such as the communication of test results. Effective safety netting should be geared towards the patient and provide enough practical clue for self-care and re-consultation.

Microbacterial profile of surgical site infection and their pattern of sensitivity in Tertiary Hospital in North Central Hospital, Nigeria

A.A. Abiodun, A.O. Adekanye, C.N.D. Nwachukwu, T.S. Ayanbeku, J.A. Abiodun4 — Thu, 15 Feb 2024 00:00:00 +0000

Background: Surgical site infections (SSI) remain a problem in surgical practice despite the improvement in advanced technology and the use of antibiotics. Also, there is also a growing menace of antibiotic resistance which poses a great challenge in treating SSI. The study aimed to find out the most common bacterial pathogens responsible for surgical site infection and their antibiotic sensitivity profile.

Material and Methods:It was a descriptive study carried out in Federal Medical Centre, Bida. 500 surgical procedures were carried out and samples were obtained from 73 patients that showed clinical evidence of SSI for culture and susceptibility test. Samples were collected from each patient using a swab stick. Bacteriological culture examination and identification were done following standard microbiological techniques. Susceptibility testing was performed by Kirby-Bauer technique according to Clinical and Laboratory Standards institute 26th edition. Data were analysed using SPSS 26.

Results: Out of the 73 samples taken, 83 isolates were obtained while five samples yielded no growth. Gram-negative bacteria (GNB) were predominant in 73(88.1%) with the dominant being E. Coli species (38.6%). From the strains that were isolated, there were 9(10.8%) Staph aureus was the only Gram-positive organism. Concerning antibiotic susceptibility, the results demonstrated remarkably high multidrug resistance. However, the meropenems and amikacin demonstrated good activities against all gram-negative isolates. The resistance pattern of enterobacteriaceae to tested antibiotics were to ciprofloxacin (90.2%) levofloxacin (82.2%) augmentin (88.5%) ceftriaxone (85.2%) ceftazidime (80.3%), gentamicin (80.3%) meropenems (14.8%) amikacin (16.4%.).

Conclusions: The study demonstrated a high alarming rate of multidrug resistance following SSI and this should call for concerns and surveillance among surgeons.

Demographics of collaborators investigating the Nigerian medical and dental interns: A medical internship training in Nigeria (minting) study collaboration

Thu, 15 Feb 2024 00:00:00 +0000

Introduction: The internship period is a peculiar time in a doctor’s career, and some have described it as a “nuisance year” during which the junior doctor assumes many roles at the same time. Junior doctors especially house officers are faced with many unique challenges; this is even more pronounced in poor resource settings like Nigeria. This study aimed to unravel and improve understanding of the challenges faced by medical and dental interns in Nigeria.

Methodology: A nine-member House officers Research and Statistics Committee (HRSC) was immediately set up to include three senior colleagues - Senior Registrars and Registrar. To carry out her responsibility efficiently the committee created the House Officers Research Collaboration Network (HRCN), a 103- member team comprising medical and dental interns from across Nigeria under a collaborative - Medical INternship Training in Nigeria (MINTING) study.

Result: Out of a total of the 103 House Officers Research Collaboration Network, 80 of them participated in this survey giving a 78% response rate. Ten of the intern Collaborators had additional qualification and seven of them had BSc as an initial degree. About 66 % of the Collaborators have never authored any publication. Of the 27 that have published an article; three collaborators are said to have published 15, 13, 16 articles respectively. Male collaborators where more likely to have published at least one article in the past. Thirty one of the 80 Collaborators have never been in a research collaborative group prior to this MINTING collaborative.

Conclusion: This commentary is set out to describe in detail Nigerian House Officers initiative in terms of the structure, functions, operational modalities, and to investigate the demographics of the HRCNcollaborators which showed that over two third of collaborators have never authored any publication and about a third of them have never been involved in collaborative research. We also believe the findings will serve as policy guide and benchmark in training the critical medical health force

Post-operative intensive care unit admission for elective brain tumour surgeries: A Nigerian neurosurgical unit experience

O.O. Agboola, O.O. Idowu, J.A. Balogun — Thu, 15 Feb 2024 00:00:00 +0000

Background: Patients, post elective brain tumour surgeries, are usually admitted into the Intensive Care Unit (ICU) for quick identification of life-threatening complications or for elective ventilation. The Covid-19 pandemic exerted additional strain on the limited ICU spaces. This study was to probe the need for ICU admission following elective surgery for brain tumour in our environment on the background of enormous constraints.

Methods: Data was collected prospectively from patients who had elective brain tumour surgery over 12-months at the University College Hospital, Ibadan. Data included the indications for ICU admission and outcome. Chi-square test and Student t-test were used for analysis at α < 0.05.

Results: There were 56 patients with a mean age of 44.6 years and M:F ratio of 1:1. 61.8% of the patients were admitted into the ICU for observation. Patients who had open surgeries were 2 times more likely to be admitted (p<0.01; OR = 2.2, CI: 2.0 – 36.8) than those who had endoscopic surgeries. Awake craniotomy patients did not require ICU care compared with the 63% of the patients who had General Anaesthesia + Endo Tracheal Tube (GA+ETT). Patients with skull base and posterior fossa tumours were more likely to be admitted into the ICU (p=0.036). Of the 34 patients admitted into the ICU, 11(19.6%) had prolonged ICU stay and were 2 times more likely to die compared with those with short admissions (p<0.01; OR = 2.5, CI: 2.29 – 70.02).

Conclusion: Observation is the main reason patients are admitted into the ICU. The endoscopic and awake surgery approaches appear to preclude the need for ICU admission, thus capable of cutting costs.

Clinico-demographic profile and treatment of patients with prostate cancer in a north- central Nigerian Teaching Hospital

J.O. Akhaine, S.I. Shuaibu, O.I. Osunaiye, C.G. Ofoha — Thu, 15 Feb 2024 00:00:00 +0000

Background: Prostate cancer is one of the most common malignancies afflicting men worldwide. In the male population, it is estimated that one in seven will be diagnosed and one in 38 will die from prostate cancer. Majority of patients in Sub Saharan Africa present with advanced disease.

Objective: To identify among prostate cancer patients, the age, clinical manifestation and stage at presentation as well as treatment received.

Materials and Method: The study reviewed patients with prostate cancer at the Jos University Teaching Hospital between January 2014 and December 2017. The demographic and clinical characteristics as well as treatment given were analysed.

Results: A total of 82 patients were studied. Age range was 41-100 years with a median of 67.9 years. The peak age group was 71-80 years, accounting for 41.4% of patients. Lower urinary tract symptom was present in all patients at the time of presentation. 59.8% of these patients presented with metastatic symptoms. Persistent low back pain was seen in 61.2 % of patients with metastatic symptoms, and digital rectal examination was suggestive of malignancy in 62.2% of patients. PSA was >20ng/ml in 73.3% of patients. Histology for all patients was adenocarcinoma, with a predominant Gleason score of 8 (29.3%). Bilateral total orchidectomy was offered in 59.8% of patients.

Conclusion: Majority of patients with carcinoma of the prostate in Jos have features of metastasis at the time of diagnosis. Orchidectomy is the most common treatment offered in our environment.

Asymptomatic bacteriuria as a predictor of pre-eclampsia: A case-controlled study

A.A. Adeyemo, O.O. Bello, O.C. Idowu — Thu, 15 Feb 2024 00:00:00 +0000

Background: Pre-eclampsia, an important cause of maternal and perinatal morbidity and mortality world-wide has been linked to subclinical infections, with maternal infection and inflammation postulated in its aetio-pathogenesis including asymptomatic bacteriuria which is common in pregnancy. The Obejctive of the study is to determine the relationship of asymptomatic bacteriuria as a risk factor for pre-eclampsia.

Methodology: A hospital-based case-control study among 28 pre-eclamptic pregnant women (cases) and 56 healthy pregnant women (controls) at gestational age of at least 28 weeks at the University College Hospital, Ibadan, between January 2019 and August 2019. Controls were matched with cases in age, parity and gestational age. Asymptomatic bacteriuria was determined with mid- stream urine analysis for microscopy and culture and data collected using an interviewer administered questionnaire with other details from medical records extracts. Chi- square, and multivariate regression analysis were used to assess statistical significance, odds ratio and adjusted odds ratio respectively, with P-value <0.05 and 95% confidence interval (CI).

Results: There was a significant association between asymptomatic bacteriuria and pre-eclampsia. The rate of asymptomatic bacteriuria was about three times higher in women with pre-eclampsia compared to those without pre-eclampsia and 1.23 times higher after adjusting for confounders (OR: 2.9, AOR:1.23). There was no significant relationship between sterile pyuria and pre-eclampsia (p-value: 0.92)

Conclusion: This study supports the proposition that asymptomatic bacteriuria is a risk factor for pre-eclampsia. It has not however shown whether the association is causal or casual. Further studies will be needed to explain this.

Knowledge and attitude of Iranian dental students about smoking cessation counseling

M.A. Hashemipour, M. Poyayi, A. Roshani — Thu, 15 Feb 2024 00:00:00 +0000

Introduction and Aims: Today, smoking is recognized as the biggest cause of preventable premature death. dentists can play a very important role in motivating and providing smoking cessation counseling and play this role of line requires gaining sufficient knowledge and education during the student period. Therefore, the purpose of this study is to determine the knowledge and attitude of dental students in Kerman in the field of smoking cessation counseling.

Methods and materials: This study was descriptive-analytical and crosssectional. The study population was fourth, fifth and sixth year dental students. A questionnaire was used to assess participants knowledge and attitude towards smoking cessation, using the 5 As of smoking cessation. Data were collected using a questionnaire and analyzed using SPSS 21, t-test and chi-square software.

Results: This study showed that the mean score of students’ knowledge was 2.13 ± 14.12. There was a significant relationship between knowledge score, gender (women more than men) and the presence of a smoker in the family (P = 0.01, 0.001, respectively). Also, the mean attitude score was 36.25 41 5.41. There was a significant relationship between attitude score, gender (women more than men) and the presence of a smoker in the family (P = 0.01, respectively).

Conclusion: Results of this study showed that the students have good knowledge of the 5As (Ask, Advice, Assess, Assist, Arrange) but that they did not have much information about some parameters under Assess. Also, they have a positive attitude in this regard. Moreover, students believed that time limitations in dental visits and concerns on the effectiveness of smoking cessation consultations are the major obstacle in implementing a smoking cessation plan.

Challenges of Renal Replacement Therapy in Nigeria: Solutions from medical students’ perspectives

A.S. Adetunji, T.S. Fatokun — Thu, 15 Feb 2024 00:00:00 +0000

Introduction: During our posting at the Renal Unit, Department of Medicine, University College Hospital, Ibadan, we observed numerous difficulties encountered by patients requiring renal replacement therapy and the family members/caregivers of these patients. These are broadly categorized into patents’ related challenges, institutional inadequacies, infrastructural challenges, policy, and funding issues.

Perspective: Patients’ challenges are poor health-seeking habits culminating in late diagnosis in advanced uremic state and poor economic status resulting in catastrophic out-of-pocket spending. Institutional and infrastructural challenges include epileptic power supply in the dialysis unit, a lack of necessary materials needed for dialysis, among others. Policy issues included the absence of an organ donor system and regulations guiding them. More importantly, there is insufficient support from the government concerning patients with end-stage kidney disease.

Conclusion: Tackling the management of end-stage kidney disease would require paying attention to and addressing these challenges.

MRI training in Africa

G.I. Ogbole, A.E. Adepoju, A. Ibrahim, T.O. Togunwa, F.A. Nkeakam — Thu, 15 Feb 2024 00:00:00 +0000

Introduction: This article presents an overview of MRI training in Africa, emphasizing its current status and the obstacles it encounters, with a report from a recent MRI workshop held in Uganda in September 2022. Africa’s medical imaging sector faces unique challenges due to limited access to advanced technology, skilled professionals, and educational resources. While some regions have made notable strides in establishing MRI training programs, others struggle with a shortage of qualified MRI technicians and radiologists. These disparities underscore the urgent need for a more equitable distribution of resources and expertise across the continent. The aim of the MRI workshop was to initiate actions to address these challenges. This workshop leveraged the expertise of MRI clinicians and scientists to devise strategies for enhancing MRI training in Africa. The report outlines the key outcomes, recommendations, and initiatives resulting from this collaborative endeavor.

Conclusion: This report offers a crucial overview of MRI training in Africa, highlighting its challenges and disparities. It emphasizes the necessity of coordinated efforts to improve MRI education, ultimately contributing to enhanced healthcare outcomes for Africa’s population.

A rare metachronous colonic volvulus

Thu, 15 Feb 2024 00:00:00 +0000

Introduction: Colonic volvulus is a common cause of large bowel obstruction with the sigmoid colon most commonly affected. Volvulus of the transverse colon is an uncommon occurrence. Rarer still is a transverse colon volvulus developing after surgery for a sigmoid colon volvulus. Early diagnosis is critical as delay in detection and intervention is associated with the risk of complications – perforation, peritonitis, and death.

Case presentation: We report the case of an 86-year-old man who presented with features of large bowel obstruction 14 months following a sigmoid colectomy for a sigmoid colon volvulus.

Conclusion: A metachronous transverse colonic volvulus is uncommon. Preoperative diagnosis is challenging as there are no defining radiographic features compared to the volvulus of the sigmoid colon with the classical omega sign. Most cases are diagnosed intra-operatively. Bowel resection and anastomosis in a single stage is a safe option.

Intestinal obstruction from Meckel’s diverticulum in an adult; unsuspected but found- A case report

O.A Ajagbe, M.C Okor, O.T Ojediran, O.E Dada, O.O Ayandipo, M.A Ajani — Thu, 15 Feb 2024 00:00:00 +0000

Introduction: Most cases of Meckel’s Diverticulum (MD) are asymptomatic and when symptomatic, preoperative diagnosis of MD maybe a dilemma. Intestinal obstruction is a major complication in the adult population.
Case presentation: We report a case of a 24-year-old female presenting with intestinal obstruction from Meckels Diverticulum.
Conclusion: MD is largely asymptomatic in adults, however may be present and should be included in our array of differential diagnoses.

Spontaneous transvaginal intestinal evisceration in an elderly woman

Thu, 15 Feb 2024 00:00:00 +0000

Introduction: Transvaginal intestinal evisceration is a rare surgical emergency that is associated with morbidity and mortality. Only a few cases of transvaginal evisceration have so far been described. The predisposing risk factors associated with this clinical condition are multifactorial.

Case presentation: We report a case of an 85-year-old female that presented with spontaneous small bowel evisceration through the vagina. The loops of the small bowel appeared edematous and thickened but there was demonstrable visible peristalsis. She had no previous laparotomy or vaginal surgery. An emergency laparotomy was performed, and the small bowel was reduced into the abdomen through the vaginal defect. Afterward, a total abdominal hysterectomy was performed with the closure of the vaginal vault. The postoperative period was uneventful.

Conclusion: The spontaneous evisceration of bowel loops can be successfully managed when patients with such cases present early and promptly managed. Prompt diagnosis and surgical management are crucial to prevent complications. If the eviscerated viscera are non-viable, resection and restoration of bowel continuity are imperative. Management should be individualized and multidisciplinary.

Non-communicating hydrocoele of the canal of Nuck: A rare finding in a rural-dwelling Nigerian woman

K.I. Egbuchulem, B.A. Akinboyewa, C.O. Onwurah — Thu, 15 Feb 2024 00:00:00 +0000

Background: The surgical condition termed hydrocoele of the canal of Nuck is one of the rarest clinical entities in the female group. It occurs due to the failure of obliteration of the derivative of the peritoneum, the processus vaginalis. It usually presents with painless inguinal swellings and is sometimes associated with features of intestinal obstruction if there is hernia coexisting with it that has become obstructed. Abdominopelvic ultrasonography and magnetic resonance imaging provide the basis for diagnosis, where these imaging modalities are available. However, a definite diagnosis may only be made during surgery. Definitive treatment includes groin exploration and excision of the cyst with high ligation of the neck of the sac up to the peritoneal pouch, along with repair of the inguinal hernia, if present.

Case Presentation: We present a rare case of a 34-year-old woman who presented with clinical features of a left inguinolabial swelling post-surgery, and diagnosed as left recurrent irreducible inguinal hernia. Intraoperatively, a cystic swelling with serous collection was observed. She had hydrocoelectomy and repair of the left groin surgical wound.

Conclusion: Hydrocoele of the canal of Nuck may be misdiagnosed as inguinal hernia because of its rarity, lack of adequate knowledge regarding the entity and paucity of literature on the subject matter. This report is to furthermore increase our level of awareness of this condition especially after a previous groin surgery

Claude syndrome: A case report

I.K. Chukwuocha, O. Oguntiloye, A. Fagbemi, O. Olalusi, V. Onyenokwe — Thu, 15 Feb 2024 00:00:00 +0000

Introduction: Detailed description of infarction of the midbrain is sparse likely due to the complex arterial supply of this region of the brain. Among the ventral midbrain syndromes reported is Claude syndrome. This syndrome caused majorly by a vascular insult to the ventromedial midbrain, characteristically presents with ipsilateral third cranial nerve palsy and contralateral hemiataxia. It is a rare syndrome and only a few cases have been reported since 1912 when it was first described by Henri Claude.

Case presentation: A 45-year-old male, who developed sudden onset dysarthria, right third cranial nerve palsy and left sided ataxia. An infarct in the right ventromedial midbrain was revealed on magnetic resonance imaging of the brain.

Conclusion: We describe a case report of a middle-aged man with minimal vascular risk factors (ASCVD = 1.3%) for stroke, who presented with features suggestive of Claude syndrome.

Acute choreo-dystonia in a newly diagnosed patient with diabetes mellitus: A case report and review of literature

T.O. Akande, O.V. Olalusi, D.I. Olulana — Thu, 15 Feb 2024 00:00:00 +0000

Introduction: Diabetes mellitus is a disease with diverse macrovascular and microvascular consequences. One of the unusual effects of hyperglycemia is involuntary movement, termed hyperglycemia-induced involuntary movement. This could range from hemibalismus, chorea, choreo-atethosis, tremors to dystonia. Chorea associated with dystonia is a less commonly reported manifestation. When it is focal, it can be misdiagnosed as stroke or seizure disorder. To the best our knowledge, there is hitherto no case report in sub-Saharan Africa describing the occurrence of focal choreo-dystonia in type 2 Diabetes Mellitus.

Case presentation: Here, we present a case of a middle-aged Nigerian woman with focal choreo-dystonia of the right upper limb accompanying the diagnosis of type 2 diabetes. Achieving euglycemia with insulin resulted in complete resolution of the choreo-dystonia.

Conclusion: Doctors in resource-constrained settings should be aware of this presentation to avoid misdiagnosis and to provide prompt and goal-oriented management with a view to reducing morbidity and attendant health-care costs.

A rare finding of distal penile furuncular myiasis in a child of a Nigerian health care worker

K.I. Egbuchulem, H.D. Ogundipe, D.I. Olulana, T.O. Ojediran — Thu, 15 Feb 2024 00:00:00 +0000

Introduction: Myiasis is the infestation of tissues of humans and other living vertebrates with the larva of flies, and it can affect any part of the body. Cutaneous myiasis is the commonest form of presentation. Furuncular myiasis which is a sub-type of cutaneous myiasis typifies the presentation in this index patient. It is commonly caused by Cordylobia anthropophaga in Sub-Saharan African countries including Nigeria. It commonly occurs among rural dwellers, as well as people of low socio-economic and poor educational status.

Case presentation: We present a case of balanitis from distal penile myiasis in a 3 year 8-month-old male child of a health worker in a tertiary hospital in Nigeria.

Conclusion: It is believed that with adequate knowledge, measures such as good hygiene and proper drying and ironing of underwear are helpful.

ABC’s of house job in Uch, Ibadan

Thu, 15 Feb 2024 00:00:00 +0000

No Abstract