Afrimedic Journal <p><strong>The <em>Afrimedic Journal</em> (AJ)</strong> is a semi-annual, multidisciplinary medical journal published by the Association of Resident Doctors, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria. The purpose of this journal is to promote clinical and academic excellence in basic and clinical medical sciences as well as dentistry.</p> <p>We consider any original work that advances or illuminates medical science or practice. Contributions may be in the form of review articles, original articles, case reports, short communications and letters to the editor. The AJ will also publish articles on socio-economic, political and legal matters related to medical practice; conference and workshop reports and medical news.</p> <p>The journal allows free access to its contents. Therefore, authors are required to pay a token charge for processing and publication of manuscripts including color reproduction of photographs. All submissions are subject to peer review by the Editorial Board and by expert reviewers in appropriate specialties.</p> en-US <p>On acceptance, the copyright of a manuscript will be vested in the journal and publisher. Articles published in Afrimedic journal are distributed under the terms of the Creative Commons Attribution License which allows for unrestricted use, distribution and reproduction in any medium, for any non-commercial purpose, subject to proper citation of the original work.</p> (Dr. Agbanu Chiemezie) (Eugene Akanegbu) Sun, 10 Jul 2022 05:56:17 +0000 OJS 60 Pattern of Antibiotics prescription in a tertiary hospital in Delta state, Nigeria. <p>Background: Antibiotics are drugs commonly used in hospitals but are prescribed inappropriately in most cases. This has led to the emergence of bacterial resistance and an increase in the cost of treatment.<br>Drug utilization studies are intended to provide<br>information on prescription patterns to ensure<br>rational drug use.</p> <p><br><strong>Objective</strong>: The study aimed at describing antibiotic<br>prescription patterns in Delta State University<br>Teaching Hospital, Delta State, Nigeria.</p> <p><br><strong>Methods</strong>: A retrospective cross-sectional study was<br>conducted on antibiotic prescriptions pattern at<br>Delta State University Teaching Hospital using 17<br>core quantitative prescribing indicators which<br>determined the availability of a Standard Treatment<br>Guidelines and Essential Medicine List at the facility.<br>The study was conducted for a period of six months.<br>A total of 420 prescriptions were studied. Data<br>collected was analyzed using SPSS version 23. Results<br>were presented as frequency (percentages), mean,<br>tables and charts.</p> <p><br><strong>Results</strong>: The average number of antibiotics<br>prescribed per encounter (ANAPE) was found to be<br>1.49, with an average cost of NGN 2404 per<br>hospitalization. The percentage of prescriptions by<br>generics was 58.65%. The prevalence of<br>inappropriate prescription was found in 67.5% of<br>patients. The most commonly prescribed class of<br>antibiotics were Cephalosporin 149(23.8%),<br>Nitroimidazole 150(23.93%), and Penicillin<br>134(21.36%). In-depth interviews of the health<br>professionals revealed factors that influenced<br>antibiotic prescription pattern including: diagnosis<br>uncertainty, doctor’s hierarchy, external influence by<br>manufacturer among others.</p> <p><br><strong>Conclusion</strong>: There was inappropriate prescription of<br>antibiotics with increased risk of developing<br>resistance hence increasing financial burden on<br>patient. Intervention programs, strategies, policies,<br>and reforms should be put in place to address this<br>problem</p> B.O Ogbonna, S.O Ovwighose, N.N Okpalanma, H.N Mmaduekwe, A Okeke, M.U Anetoh, U.A Adenola, I.B Umeh , L.I Ejieh, J.I Nduka Copyright (c) 2022 Afrimedic Journal Sun, 10 Jul 2022 03:33:22 +0000 The epidemiology, management and complications of tibia fractures treated in major hospitals in Imo state, southeast Nigeria. <p>Tibia fractures constitute one of the most common<br>types of trauma in Imo state. A retrospective<br>epidemiological study was conducted in three major<br>hospitals in Imo state to evaluate the distribution and<br>pattern of tibia fractures treated in the state<br>between 2012 and 2016. Information was sourced<br>from medical records at Federal Medical Centre,<br>Owerri, Christina Specialist Hospital, Owerri and Imo<br>State University Teaching Hospital, Orlu respectively.<br>Out of a total of 150 cases treated, 79 (52.7%) were<br>males while 71 (47.1%) were females. The most<br>frequently affected group were patients aged 25-34<br>years (36, 24%) followed by people aged 15-24 years<br>(33, 21.3%). The most common cause of tibia fracture<br>was road traffic accidents (RTAs) (52%) followed by<br>fall from a height (44%). Majority (83, 55%) of the<br>cases were open fractures while 53 (35%) were closed<br>fractures. The study concludes that tibia fractures<br>affected more male than female people in their<br>youthful age and was mainly due to RTAs. Concrete<br>measures should be taken to reduce the incidence of<br>tibia fractures in the state and its consequences.<br><br></p> C.U Nwadinigwe, S.N Ukibe, C.C Eke, T.N Ugorji, K.C Chikezie Copyright (c) 2022 Afrimedic Journal Sun, 10 Jul 2022 00:00:00 +0000 Self-help treatment methods and aetiology of infertility among couples seeking in-vitro fertilization in a private fertility clinic, Awka, Nigeria <p><strong>BACKGROUND</strong><br>Infertility is considered a serious problem in low and<br>middle-income countries due to the premium placed<br>on childbearing.</p> <p><br><strong>OBJECTIVES</strong><br>To determine self-help treatment methods, aetiology<br>of infertility, sources of information for Assisted<br>Reproductive Technology and sources of verbal or<br>physical abuse of women seeking Assisted<br>Reproductive Technology.</p> <p><br><strong>MATERIALS AND METHODS</strong><br>This is a cross-sectional descriptive study. A total of<br>thirty-six couples were recruited for in-vitro<br>fertilization using systematic sampling technique.<br>Structured questionnaires were administered to all<br>the selected subjects in order to extract relevant<br>baseline information on self-help treatment methods<br>and socio-demographic data. Inclusion criteria were<br>subjects consenting to participate in this study, those<br>within age range between 25 and 60 years old, those<br>whose infertility (primary or secondary) is persisting<br>longer than one year and those who have not been<br>receiving antibiotics treatment before the<br>commencement of the study. Subjects were excluded<br>on the basis of being under 25 years old, those<br>receiving antibiotics treatment before the study and<br>those not visiting the clinics for assisted<br>reproduction. Clinical and laboratory techniques<br>were used to determine the causes of the subject’s<br>infertility. Sono saline hysterogram and laparoscopy<br>and dye test were used to reveal the aetiology of<br>female infertility while semen analysis was used to<br>assess the male subjects.</p> <p><br><strong>RESULTS</strong><br>A total of thirty-six women were recruited for in-vitro<br>fertilization and embryo transfer (IVF/ET) procedure.<br>Majority of the subjects 15 (41.7%) had previously<br>self-treated infections with herbal medications only.<br>Fourteen women (38.9%) reported frequent abuse by<br>their family relatives either verbally or physically for<br>their infertility. Blocked fallopian tubes was the<br>commonest aetiology of infertility in females 15<br>(41.7%) as revealed by laparoscopy and dye test. It<br>was observed that the 21 couples (58.3%) who had<br>previous history of sexually transmitted diseases<br>recorded highest frequency in the distribution of<br>potential risk factors associated with genital<br>bacterial infections. Twenty-three couples (63.9%)<br>reported social media as the most frequent sources<br>of information for Assisted Reproductive Technology<br>(ART).</p> <p><br><strong>CONCLUSION</strong><br>Social media has been reported as the major source<br>of information concerning assisted reproductive<br>technology among couples. Bilateral tubal blockage<br>and poor semen quality are the commonest<br>aetiology of infertility in this study. Majority of the<br>subjects had treated sexually transmitted infections<br>with herbal medications. However, there is urgent<br>need for public education on the contribution of<br>couples to infertility and current treatment methods.</p> I.S Okwelogu, N.R Agbakoba, J.I Ikechebelu, K.C Anukam Copyright (c) 2022 Afrimedic Journal Sun, 10 Jul 2022 04:19:14 +0000 Impact of hand washing training on pharmacy students; a quasi-experimental study. <p><strong>Background</strong>: Globally, poor hand washing practices<br>have led to a remarkable increase in the rate of<br>infection and spread of infectious diseases. Hands are<br>the main route of germ transmission during medical<br>management. Hence, hand washing is an effective<br>measure to prevent the transmission of infectious<br>diseases in healthcare.</p> <p><br><strong>Objective</strong>: The study assessed the impact of hand<br>washing training on pharmacy students’ knowledge<br>of hand washing.</p> <p><br><strong>Methods</strong>: The study employed quasi-experimental<br>study design. Pre-test data collection was carried out<br>with a structured questionnaire to assess the<br>student’s knowledge of hand washing technique at<br>baseline. This was followed by an educational<br>workshop on proper hand washing technique and<br>post-test data collection using the same<br>questionnaire. All the students (299) who gave their<br>informed consent participated in the study. Mean<br>score of individual response was computed for the<br>different sections of the questionnaire. Data analysis<br>was performed using SPSS version 22 computer<br>software. Statistical analysis was done using Paired ttest.<br>A value of p&lt;0.05 was considered significant.</p> <p><br><strong>Results</strong>: Out of the 299 students that indicated<br>willingness to participate in the study, only 284<br>completed the post-test questionnaire. The baseline<br>results revealed that majority of the respondents<br>have good general knowledge on proper hand<br>washing technique based on cutoff value of &gt;4.<br>However, the educational workshop had significant<br>impact on the students’ hand washing technique in<br>all the three domains assessed with p-values of 0.000<br>for each domain.</p> <p><br><strong>Conclusion</strong>: This study suggests that handwashing<br>training had a positive impact on the students’<br>handwashing knowledge.</p> B.O Ogbonna, K Nwanga, H.N Maduekwe, N.N Okpalanma, U Eze, S.O Ovwighose, A Okeke, M.U Anetoh, U.A Adenola, I.B Umeh, L.I Ejieh, J.I Nduka, N.N Ajagu Copyright (c) 2022 Afrimedic Journal Sun, 10 Jul 2022 04:45:57 +0000 Consensual coital laceration of the posterior vaginal fornix with hemorrhagic shock in a teenage girl: Diagnostic and management challenges. <p><strong>INTRODUCTION</strong></p> <p>Life threatening injuries can result from consensual<br>coitus. In most parts of Africa where children are<br>raised without adequate sex education, and sex is<br>seen as shameful topic and taboo in extreme cases,<br>coital injuries are unlikely to be reported or may be<br>misdiagnosed and mismanaged. This may result in<br>morbidities and mortalities. Scarcity of data on this<br>subject underscores the need for this case report to<br>create awareness and add to the body of knowledge.<br>Case report: Patient was 17-year old student who<br>presented with hemorrhagic shock to the emergency<br>unit of a reference hospital in Southern Nigeria with a<br>4 hour history of torrential vaginal bleeding and 2<br>fainting episodes following consensual coitus. History<br>was misleading as patient, initially, denied any<br>history of sexual activity. However, with a more<br>tactful and empathic approach, the patient admitted<br>having consensual coitus prior to symptoms. On<br>examination, she was found to have sustained<br>lacerations of the posterior vaginal fornix. She was<br>promptly resuscitated and a repair under anesthesia<br>was done in the theatre. She was transfused with 2<br>units of blood and discharged in good condition after<br>48 hours on admission.</p> <p><br><strong>CONCLUSION</strong><br>Consensual coital injuries could be life threatening,<br>yet may be misdiagnosed and poorly managed due to<br>shame and stigma associated with it in our<br>environment. Lack of awareness, low index of<br>suspicion, poor approach to history and management<br>could lead to poor outcome. High index of suspicion,<br>tact, privacy, empathy, good clinical judgment and<br>multidisciplinary approach to care are essential to<br>early diagnosis and good management of coital<br>injuries.</p> I.O Eze, M.J Salihu, C.U Innoeze, C.O Elegbua, S.T Afolayan, J.A Adaji, C.A Meremikwu Copyright (c) 2022 Afrimedic Journal Sun, 10 Jul 2022 05:02:57 +0000 Neglected anterior shoulder dislocation + Hill-sachs lesion: when masterly inactivity fails, what’s next? <p><strong>Background</strong>: Anterior shoulder dislocation is a<br>disabling injury affecting all age groups. Although<br>rarely missed, neglected shoulder dislocation may<br>occur in unconscious patients or due to inadequate<br>treatment as is common in low income countries.<br>Methodology: We report the management of a 26<br>year old man who presented with a five month<br>history of neglected anterior shoulder dislocation,<br>with gross limitation on all range of motion of the<br>affected shoulder. X-rays done (antero-posterior and<br>lateral views of the shoulder) also revealed a<br>malunited greater tuberosity fracture; for which the<br>patient had an open reduction and a Bristow-Laterjet<br>procedure.</p> <p><br><strong>Results</strong>: There was marked improvement in<br>symptoms and in the range of motion. There was<br>also no episode of re-dislocation within the follow up<br>period of two years.</p> <p><br><strong>Conclusion</strong>: Open reduction and the Bristow Laterjet<br>procedure is an effective way of managing the<br>neglected shoulder dislocation.</p> H.O Obiegbu, C.U Ndukwu Copyright (c) 2022 Afrimedic Journal Sun, 10 Jul 2022 05:13:53 +0000 Synchronous bilateral ureteral ligation and urinary bladder injuries following emergency hysterectomies: Early surgical intervention is a resuscitatory measure. <p>Synchronous iatrogenic ureteral and bladder injuries<br>following emergency pelvic surgeries, though<br>uncommon, cause morbidities and mortalities. They<br>are potential causes of severe and debilitating<br>obstructive nephropathies as well as avoidable<br>litigations in surgical practice. Delay at initiating<br>surgical treatment worsens outcome. Management is<br>extremely challenging with attendant complications.<br>We report two cases of iatrogenic bilateral ureteral<br>ligation with synchronous posterior urinary bladder<br>lacerations. Both patients developed anuria at the<br>immediate post-operative period, with worsening<br>bilateral flank pains, abdominal distension, leakage<br>of urine per vaginam and poor performance status.<br>Both patients were uremic. Emergency exploratory<br>laparotomies were done, with release of ligatures,<br>stenting of both ureters and repair of bladder wall.<br>Accurate diagnosis with early surgical intervention is<br>lifesaving.</p> E.A Obiesie, D.E Orakwe, U.V Nwadi, A.M.E Nwofor, C.K Oranusi, T.U Mbaeri, J.A Abiahu, O.A Onu, C Odo, C.M Agbanu, O.O Mbonu Copyright (c) 2022 Afrimedic Journal Sun, 10 Jul 2022 05:29:35 +0000 Missing intrauterine device in the descending mesocolon: Retrieval under fluoroscopy guidance in a reference hospital in southern Nigeria <p><strong>INTRODUCTION</strong>: Displaced/missing intrauterine<br>device (IUD) is one of the known complications<br>associated with the uses of IUD. Missing IUD, even<br>when asymptomatic, is always of concern to patients<br>and relatives, and could result in serious morbidity.<br>Retrieval of missing IUD depends on location,<br>facility/equipment, surgeon’s skill and experience,<br>and patient’s factor.</p> <p><br><strong>Case report:</strong> A 36 year old multipara with missing IUD<br>(LydiaTMCU 375 sleek) following treatment for<br>intrauterine adhesions. With imaging studies, the IUD<br>was localized at different anatomical positions with<br>time giving an impressing of “mobile” missing IUD. It<br>was subsequently retrieved in a purulent mass in the<br>descending mesocolon via a laparotomy aided with a<br>C-arm fluoroscopy imaging peri/intraoperatively.</p> <p><br><strong>Conclusion:</strong> Missing IUD could be lodged in unusual<br>anatomical locations presenting diagnostic and<br>treatment challenges. Imaging aids with requisite<br>skills and experience may be required for good<br>management. We believe this case is one of such,<br>and sharing our experience will add to the body of<br>knowledge</p> I.O Eze, U.I Okeke, M.U Elendu, C.O Elegbua, C Bala, S.T Afolayan Copyright (c) 2022 Afrimedic Journal Sun, 10 Jul 2022 05:42:10 +0000 Catheter introducer aided percutaneous suprapubic cystostomy: description, and precautions <p><strong>INTRODUCTION</strong><br>Acute urinary retention is a urological emergency<br>that requires immediate urinary bladder<br>decompression through the most expedient route.<br>We have identified catheter introducer aided<br>percutaneous suprapubic cystostomy (SPC) to be a<br>procedure of choice when there is a failed urethral<br>catheterization.</p> <p><br><strong>METHODOLOGY</strong><br>Step by step approach to the procedure of catheter<br>introducer aided percutaneous SPC including<br>important precautions and illustrative pictures are<br>presented.</p> <p><br><strong>CONCLUSION</strong><br>Speed, safety and reduced cost are the major<br>benefits of catheter introducer aided percutaneous<br>SPC in a developing region of the world. Patients and<br>materials selection are keys to reducing<br>complications.</p> C.O Onuigbo, J.A Abiahu, T.U Mbaeri, A.M.E Nwofor, O.O Mbonu Copyright (c) 2022 Afrimedic Journal Sun, 10 Jul 2022 05:52:16 +0000