Afrimedic Journal

Pattern of Antibiotics prescription in a tertiary hospital in Delta state, Nigeria.

Sun, 10 Jul 2022 03:33:22 +0000

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.
Drug utilization studies are intended to provide
information on prescription patterns to ensure
rational drug use.

Objective: The study aimed at describing antibiotic
prescription patterns in Delta State University
Teaching Hospital, Delta State, Nigeria.

Methods: A retrospective cross-sectional study was
conducted on antibiotic prescriptions pattern at
Delta State University Teaching Hospital using 17
core quantitative prescribing indicators which
determined the availability of a Standard Treatment
Guidelines and Essential Medicine List at the facility.
The study was conducted for a period of six months.
A total of 420 prescriptions were studied. Data
collected was analyzed using SPSS version 23. Results
were presented as frequency (percentages), mean,
tables and charts.

Results: The average number of antibiotics
prescribed per encounter (ANAPE) was found to be
1.49, with an average cost of NGN 2404 per
hospitalization. The percentage of prescriptions by
generics was 58.65%. The prevalence of
inappropriate prescription was found in 67.5% of
patients. The most commonly prescribed class of
antibiotics were Cephalosporin 149(23.8%),
Nitroimidazole 150(23.93%), and Penicillin
134(21.36%). In-depth interviews of the health
professionals revealed factors that influenced
antibiotic prescription pattern including: diagnosis
uncertainty, doctor’s hierarchy, external influence by
manufacturer among others.

Conclusion: There was inappropriate prescription of
antibiotics with increased risk of developing
resistance hence increasing financial burden on
patient. Intervention programs, strategies, policies,
and reforms should be put in place to address this
problem

The epidemiology, management and complications of tibia fractures treated in major hospitals in Imo state, southeast Nigeria.

C.U Nwadinigwe, S.N Ukibe, C.C Eke, T.N Ugorji, K.C Chikezie — Sun, 10 Jul 2022 00:00:00 +0000

Tibia fractures constitute one of the most common
types of trauma in Imo state. A retrospective
epidemiological study was conducted in three major
hospitals in Imo state to evaluate the distribution and
pattern of tibia fractures treated in the state
between 2012 and 2016. Information was sourced
from medical records at Federal Medical Centre,
Owerri, Christina Specialist Hospital, Owerri and Imo
State University Teaching Hospital, Orlu respectively.
Out of a total of 150 cases treated, 79 (52.7%) were
males while 71 (47.1%) were females. The most
frequently affected group were patients aged 25-34
years (36, 24%) followed by people aged 15-24 years
(33, 21.3%). The most common cause of tibia fracture
was road traffic accidents (RTAs) (52%) followed by
fall from a height (44%). Majority (83, 55%) of the
cases were open fractures while 53 (35%) were closed
fractures. The study concludes that tibia fractures
affected more male than female people in their
youthful age and was mainly due to RTAs. Concrete
measures should be taken to reduce the incidence of
tibia fractures in the state and its consequences.

Self-help treatment methods and aetiology of infertility among couples seeking in-vitro fertilization in a private fertility clinic, Awka, Nigeria

I.S Okwelogu, N.R Agbakoba, J.I Ikechebelu, K.C Anukam — Sun, 10 Jul 2022 04:19:14 +0000

BACKGROUND
Infertility is considered a serious problem in low and
middle-income countries due to the premium placed
on childbearing.

OBJECTIVES
To determine self-help treatment methods, aetiology
of infertility, sources of information for Assisted
Reproductive Technology and sources of verbal or
physical abuse of women seeking Assisted
Reproductive Technology.

MATERIALS AND METHODS
This is a cross-sectional descriptive study. A total of
thirty-six couples were recruited for in-vitro
fertilization using systematic sampling technique.
Structured questionnaires were administered to all
the selected subjects in order to extract relevant
baseline information on self-help treatment methods
and socio-demographic data. Inclusion criteria were
subjects consenting to participate in this study, those
within age range between 25 and 60 years old, those
whose infertility (primary or secondary) is persisting
longer than one year and those who have not been
receiving antibiotics treatment before the
commencement of the study. Subjects were excluded
on the basis of being under 25 years old, those
receiving antibiotics treatment before the study and
those not visiting the clinics for assisted
reproduction. Clinical and laboratory techniques
were used to determine the causes of the subject’s
infertility. Sono saline hysterogram and laparoscopy
and dye test were used to reveal the aetiology of
female infertility while semen analysis was used to
assess the male subjects.

RESULTS
A total of thirty-six women were recruited for in-vitro
fertilization and embryo transfer (IVF/ET) procedure.
Majority of the subjects 15 (41.7%) had previously
self-treated infections with herbal medications only.
Fourteen women (38.9%) reported frequent abuse by
their family relatives either verbally or physically for
their infertility. Blocked fallopian tubes was the
commonest aetiology of infertility in females 15
(41.7%) as revealed by laparoscopy and dye test. It
was observed that the 21 couples (58.3%) who had
previous history of sexually transmitted diseases
recorded highest frequency in the distribution of
potential risk factors associated with genital
bacterial infections. Twenty-three couples (63.9%)
reported social media as the most frequent sources
of information for Assisted Reproductive Technology
(ART).

CONCLUSION
Social media has been reported as the major source
of information concerning assisted reproductive
technology among couples. Bilateral tubal blockage
and poor semen quality are the commonest
aetiology of infertility in this study. Majority of the
subjects had treated sexually transmitted infections
with herbal medications. However, there is urgent
need for public education on the contribution of
couples to infertility and current treatment methods.

Impact of hand washing training on pharmacy students; a quasi-experimental study.

Sun, 10 Jul 2022 04:45:57 +0000

Background: Globally, poor hand washing practices
have led to a remarkable increase in the rate of
infection and spread of infectious diseases. Hands are
the main route of germ transmission during medical
management. Hence, hand washing is an effective
measure to prevent the transmission of infectious
diseases in healthcare.

Objective: The study assessed the impact of hand
washing training on pharmacy students’ knowledge
of hand washing.

Methods: The study employed quasi-experimental
study design. Pre-test data collection was carried out
with a structured questionnaire to assess the
student’s knowledge of hand washing technique at
baseline. This was followed by an educational
workshop on proper hand washing technique and
post-test data collection using the same
questionnaire. All the students (299) who gave their
informed consent participated in the study. Mean
score of individual response was computed for the
different sections of the questionnaire. Data analysis
was performed using SPSS version 22 computer
software. Statistical analysis was done using Paired ttest.
A value of p<0.05 was considered significant.

Results: Out of the 299 students that indicated
willingness to participate in the study, only 284
completed the post-test questionnaire. The baseline
results revealed that majority of the respondents
have good general knowledge on proper hand
washing technique based on cutoff value of >4.
However, the educational workshop had significant
impact on the students’ hand washing technique in
all the three domains assessed with p-values of 0.000
for each domain.

Conclusion: This study suggests that handwashing
training had a positive impact on the students’
handwashing knowledge.

Consensual coital laceration of the posterior vaginal fornix with hemorrhagic shock in a teenage girl: Diagnostic and management challenges.

Sun, 10 Jul 2022 05:02:57 +0000

INTRODUCTION

Life threatening injuries can result from consensual
coitus. In most parts of Africa where children are
raised without adequate sex education, and sex is
seen as shameful topic and taboo in extreme cases,
coital injuries are unlikely to be reported or may be
misdiagnosed and mismanaged. This may result in
morbidities and mortalities. Scarcity of data on this
subject underscores the need for this case report to
create awareness and add to the body of knowledge.
Case report: Patient was 17-year old student who
presented with hemorrhagic shock to the emergency
unit of a reference hospital in Southern Nigeria with a
4 hour history of torrential vaginal bleeding and 2
fainting episodes following consensual coitus. History
was misleading as patient, initially, denied any
history of sexual activity. However, with a more
tactful and empathic approach, the patient admitted
having consensual coitus prior to symptoms. On
examination, she was found to have sustained
lacerations of the posterior vaginal fornix. She was
promptly resuscitated and a repair under anesthesia
was done in the theatre. She was transfused with 2
units of blood and discharged in good condition after
48 hours on admission.

CONCLUSION
Consensual coital injuries could be life threatening,
yet may be misdiagnosed and poorly managed due to
shame and stigma associated with it in our
environment. Lack of awareness, low index of
suspicion, poor approach to history and management
could lead to poor outcome. High index of suspicion,
tact, privacy, empathy, good clinical judgment and
multidisciplinary approach to care are essential to
early diagnosis and good management of coital
injuries.

Neglected anterior shoulder dislocation + Hill-sachs lesion: when masterly inactivity fails, what’s next?

H.O Obiegbu, C.U Ndukwu — Sun, 10 Jul 2022 05:13:53 +0000

Background: Anterior shoulder dislocation is a
disabling injury affecting all age groups. Although
rarely missed, neglected shoulder dislocation may
occur in unconscious patients or due to inadequate
treatment as is common in low income countries.
Methodology: We report the management of a 26
year old man who presented with a five month
history of neglected anterior shoulder dislocation,
with gross limitation on all range of motion of the
affected shoulder. X-rays done (antero-posterior and
lateral views of the shoulder) also revealed a
malunited greater tuberosity fracture; for which the
patient had an open reduction and a Bristow-Laterjet
procedure.

Results: There was marked improvement in
symptoms and in the range of motion. There was
also no episode of re-dislocation within the follow up
period of two years.

Conclusion: Open reduction and the Bristow Laterjet
procedure is an effective way of managing the
neglected shoulder dislocation.

Synchronous bilateral ureteral ligation and urinary bladder injuries following emergency hysterectomies: Early surgical intervention is a resuscitatory measure.

Sun, 10 Jul 2022 05:29:35 +0000

Synchronous iatrogenic ureteral and bladder injuries
following emergency pelvic surgeries, though
uncommon, cause morbidities and mortalities. They
are potential causes of severe and debilitating
obstructive nephropathies as well as avoidable
litigations in surgical practice. Delay at initiating
surgical treatment worsens outcome. Management is
extremely challenging with attendant complications.
We report two cases of iatrogenic bilateral ureteral
ligation with synchronous posterior urinary bladder
lacerations. Both patients developed anuria at the
immediate post-operative period, with worsening
bilateral flank pains, abdominal distension, leakage
of urine per vaginam and poor performance status.
Both patients were uremic. Emergency exploratory
laparotomies were done, with release of ligatures,
stenting of both ureters and repair of bladder wall.
Accurate diagnosis with early surgical intervention is
lifesaving.

Missing intrauterine device in the descending mesocolon: Retrieval under fluoroscopy guidance in a reference hospital in southern Nigeria

I.O Eze, U.I Okeke, M.U Elendu, C.O Elegbua, C Bala, S.T Afolayan — Sun, 10 Jul 2022 05:42:10 +0000

INTRODUCTION: Displaced/missing intrauterine
device (IUD) is one of the known complications
associated with the uses of IUD. Missing IUD, even
when asymptomatic, is always of concern to patients
and relatives, and could result in serious morbidity.
Retrieval of missing IUD depends on location,
facility/equipment, surgeon’s skill and experience,
and patient’s factor.

Case report: A 36 year old multipara with missing IUD
(LydiaTMCU 375 sleek) following treatment for
intrauterine adhesions. With imaging studies, the IUD
was localized at different anatomical positions with
time giving an impressing of “mobile” missing IUD. It
was subsequently retrieved in a purulent mass in the
descending mesocolon via a laparotomy aided with a
C-arm fluoroscopy imaging peri/intraoperatively.

Conclusion: Missing IUD could be lodged in unusual
anatomical locations presenting diagnostic and
treatment challenges. Imaging aids with requisite
skills and experience may be required for good
management. We believe this case is one of such,
and sharing our experience will add to the body of
knowledge

Catheter introducer aided percutaneous suprapubic cystostomy: description, and precautions

C.O Onuigbo, J.A Abiahu, T.U Mbaeri, A.M.E Nwofor, O.O Mbonu — Sun, 10 Jul 2022 05:52:16 +0000

INTRODUCTION
Acute urinary retention is a urological emergency
that requires immediate urinary bladder
decompression through the most expedient route.
We have identified catheter introducer aided
percutaneous suprapubic cystostomy (SPC) to be a
procedure of choice when there is a failed urethral
catheterization.

METHODOLOGY
Step by step approach to the procedure of catheter
introducer aided percutaneous SPC including
important precautions and illustrative pictures are
presented.

CONCLUSION
Speed, safety and reduced cost are the major
benefits of catheter introducer aided percutaneous
SPC in a developing region of the world. Patients and
materials selection are keys to reducing
complications.