Annals of Ibadan Postgraduate Medicine

The basics of sample size estimation: An editor’s view

2023-08-03T00:46:36+00:00

No Abstract.

Phq-9 diagnostic accuracy and optimal cut-off for depression Among patients with stroke in Nigeria

2023-08-03T00:50:09+00:00

Background: Depression is one of the most common and devastating consequences among stroke survivors. In spite of the availability of treatment for depression, the non- or under-detection precludes patients from benefiting from it.
Objectives: This study sought to validate the Patient Health Questionnaire (PHQ- 9) as a tool for detecting depression among patients with stroke.
Methodology: A cross-sectional design comprising of adult patients diagnosed with stroke, who were attending the Neurology out-patient clinic of the University of Port Harcourt Teaching Hospital was employed in the study. The Receiver Operator Characteristics (ROC) curve and validity tests were performed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID-DSM IV) as the gold standard. The optimal PHQ-9 cut-off was determined using Youden Index. Kappa statistics was performed at p<0.05.
Results: The study had a total of 197 stroke cases with PHQ-9 and SCID-DSM IV findings. The median age was 54 years (range: 35-76 years). ROC Curve for PHQ-9 revealed an Area under the Curve (AUC) value of 0.93(95% CI: 0.88- 0.98). The optimal cut off value of six was obtained based on Youden Index. Sensitivity, specificity, positive predictive and negative predictive values at the optimal cut-off were 88.7%, 93.1%, 82.5% and 95.7% respectively. The Kappa statistics yielded 0.80 (95% CI: 0.68-0.86).
Conclusion: PHQ-9 is a useful screening tool for identifying depression among patients with stroke. An optimal cut-off score of six for PHQ-9 should be adopted for patients with stroke in Nigeria to identify depression, and the provision of holistic care.

Staged versus simultaneous approach in complex bilateral total knee replacement: experience from tertiary institution in Nigeria

2023-08-03T00:54:13+00:00

Background: Bilateral end-stage knee osteoarthritis is a common presentation. The decision facing both patient and surgeon is whether to undertake the replacement of both knees in one sitting i.e. simultaneous bilateral total knee replacement (SMTKR) or to undertake this as a staged bilateral total knee replacement (STTKR). The decision is made harder by the presence of severe coronal and sagittal plane deformities and associated bone loss. We present our results of treating such patients with a focus on a trilogy of cost, complication and functional outcome following SMTKR.
Methodology: A retrospective review of 31 patients who presented with bilateral knee arthritis. 19 underwent SMTKR and 12 underwent STTKR. Data on the trilogy of complication, cost and functional outcome were collected and analysed
Result: Our cohort of patients was overwhelmingly female in both groups at overall F/M = 30/1. Patients in the SMTKR group were slightly younger at a mean of 65 years compared to 69 years in the STTKR group. Mean Oxford Knee Score (OKS) improved significantly in all groups, mean of 54 in SMTKR and 56 in the STTKR groups. There was one fatality in the STTKR from upper GI bleeding and 1 revision for bone graft failure. The overall cost is less with SMTKR.
Summary: SMTKR is a safe and effective undertaking in properly selected patients with bilateral end-stage knee arthritis with severe deformities. Significant experience is however needed to successfully tackle complex deformities and such procedures should be undertaken by experienced arthroplasty surgeons.

A study of skin sepsis amongst abattoir workers in Moniya, Ibadan, Oyo State, Nigeria

2023-08-03T00:58:52+00:00

Background: Skin sepsis is a pyodermal infection caused by Lancefield’s group streptococci and Staphylococcus aureus . It is characterized by discolored and mottled skin, cellulitis, impetigo and multi-systemic collagen muscularitis and can be transmitted from person to person.
Objective: This study sampled the skin of consented abattoir workers in Moniya Ibadan, for clinical sepsis, with a view to establishing a causal relationship between the infection obtained and the abattoir workers examined.
Methodology: A total of 100 meat handlers’ hands and forearms were examined. Swabs were taken from lesions which appeared clinically to be infected and then propagated on selective culture media designed for staphylococci and streptococci. Conventional biochemical tests and Lancefield determination were carried out as considered appropriate.
Results: Of the 100 swabs from the categories of abattoir workers examined, 43 streptococci (35 from lesion 8 from wound) and 36 Staphylococcus aureus (20 from lesion and16 from wound) were obtained. The regression analysis from the grouping of gender, causative agents and specific infection as a predictor of infection were recorded to be significant (b = 0.18; t = 1.74; p < 0.05) for the nature of but non-significant (b = -0.067; t = -0.649; p > 0.05) for the gender.In-vitro antigen antibody reaction on StreptexM kit elicited varied reactions to Lancefield’s serological grouping (A (56%), B (9%) C (7%) G (22%) and L (7%). Resistance of Staphylococcus aureus in varying percentages (Tetracycline and gentamicin 62%, meropenem and ceftriaxone 100%, amikacin, 10%, and vancomycin 80%) to conventional antibiotics were observed.
Conclusion: From this study point of view, the causal relationship between the infection and the infected has been established, from the pathogens of pyodermal origin contacted from cows, that causes sepsis across all the category of abattoir workers studied. There is a need to provide an ideal functioning abattoir fully equipped with required facilities for safety and ease of execution of duties.

Fluoride content of commercially packaged sachet water in Ibarapa land, southwest, Nigeria

2023-08-03T01:04:49+00:00

Background: Fluoride concentration (F conc) in water is a major determinant for the occurrence of dental caries and dental fluorosis. In most homes of rural communities, especially in developing countries, there is a major reliance on sachet water as an alternate low-cost drinking water. This study aims to determine the fluoride concentrations of common commercially packaged sachet water in Ibarapa land, Southwestern, Nigeria.
Methods: An observational study was conducted using convenience sampling of all commercially packaged sachet water for drinking in Ibarapa land, Southwestern, Nigeria. Thirteen samples of sachet water were obtained from Ayete (2), Igboora (6) and Lanlate (5). F conc of the sachet water was determined in triplicate using the Fluoride Ion-Selective Electrode by direct analysis. Temperature and pH of water were also measured. Results were analysed using SPSS version 23.
Results: The F conc, temperature and pH range were 0.03 mgF/l - 2 mgF/l, 26.4OC – 27.2OC and 6.90 – 8.19 respectively. The minimum F conc in all samples was 0.03ppm at pH 6.90 while maximum was 2ppm at pH 7.78. F conc in 2 (15.4%), 8 (61.5%) and 3 (23.1%) water samples were 0.5-0.6 mgF/l, <0.5 mgF/l and >0.6 mgF/l respectively. No sachet water had fluoride levels printed on their labels.
Conclusion: F conc of the sachet water varied, with the majority of samples having low concentrations. Attention needs to be paid to both low levels and high levels of fluoride in drinking water to ensure safety and protective benefit.

Peculiarities of psoriasis in a black African cohort: A histopathologic study

2023-08-03T01:07:49+00:00

Background: Clinical and histopathologic observations have indicated that psoriasis is not rare in our population as previously thought. The initial rarity also led to paucity of studies on the disorder including histopathologic features in our practice setting. To date, there is no report on the histopathologic features of psoriasis indigenous to our practice environment.
Objective: To evaluate the frequency of occurrence of the various histopathologic features of psoriasis in patients from this environment and identify any peculiarities that exist in black African patients.
Methods: A cross-sectional study of patients diagnosed clinically with psoriasis at the University College Hospital, Ibadan between January 2015 and October 2016. After baseline sociodemographic data, all patients had baseline clinical examination and were offered skin biopsy after obtaining informed consent. The biopsy specimen was examined for histopathologic features of psoriasis after routine processing and staining using a pretested proforma with the frequencies of each diagnostic feature reported in percentages.
Results: Forty-four patients with plaque psoriasis were analyzed. The mean age of the patients studied was 39.84 ± 20.97 years with a male to female ratio of which was almost equal. The most consistent epidermal changes in decreasing other of frequency were acanthosis, hypogranulosis, hyperkeratosis followed by elongation of rete ridges while dermal features were dermal infiltration by inflammatory cells, and dilatation of superficial dermal vessels. Munro¾s microabscesses were found in less than half of the patients biopsied. Some of the patients were found to have atypical changes.
Conclusions: Histopathological features of psoriasis in the study is similar to what has been previously established universally but typical features such as Munro’s micro abscesses and Kogoj’s spongiform pustules are less frequently seen than expected. Atypical changes such as dermal melanophages and periadnexal infiltration by inflammatory cells may also be seen.

Adjunct music therapy and haemodynamic balance in mandibular third molar surgery: A randomized clinical study

2023-08-03T01:12:37+00:00

Introduction: There are conflicting evidences that music can improve psychoemotional stability and haemodynamic changes during surgeries, as well as improve doctor-patient relationship and the overall clinical outcome. This method is cheaper, devoid of side effects of drugs and provides a memorable experience to patient.
Aim: This study sets out to investigate the effect of adjunct music therapy on haemodynamic changes in patients undergoing transalveolar mandibular third molar surgery in a tertiary hospital in southwest Nigeria.
Methodology: A total of 146 participants between 21 and 55 years were randomized by balloting into music and non-music groups with equitable gender distribution. For participants in the music group, third molar surgery was performed with selected music tracks played via both external speaker and later headphone while the control group had the stages progress without musical intervention. The blood pressure, pulse rate, respiratory rate were recorded at predetermined interval. Normality of data distribution was tested using Shapiro-Wilk test. Student t-test was used to compare mean for quantitative variables between the groups. The chi-square test was used to compare proportions and to investigate association between categorical variables (p<0.05).
Result and Conclusion: There was no significant difference in the blood pressure, pulse rate and respiratory rate between participants in this study. This suggests that music therapy confers no significant advantage in stabilizing the blood pressure, respiratory and pulse rates of patient during mandibular third molar surgery.

Feeding practices and nutritional status of under-five children in a peri-urban setting in Ibadan, southwest Nigeria: A comparative cross-sectional study

2023-08-03T01:15:31+00:00

Background: Existing literature suggests inequalities in nutritional and feeding practices for children in rural communities compared to their urban counterparts. However, with increasing urbanization and changing social norms, re-assessment of rural-urban differences in feeding practices for under-five children is essential.
This study therefore aimed to assess the feeding practices and nutritional status of children in a peri-urban setting in Ibadan.
Methods: We conducted a community-based cross-sectional comparative study in peri-urban LGA (Lagelu) in Ibadan. Participants were 617 caregivers of underfive children identified, from wards typical of rural and urban settings, through a multistage sampling technique. Caregivers’ sociodemographic details, 24-hour dietary recall of the child’s feeding, and anthropometric measurements were obtained.
Results: Nearly half of the children were 2 years or older (rural: n=142, 47.2%; urban: n=147, 46.2%). There was significant difference between settings in terms of maternal age and education, father’s education, caregiver’s occupation and socioeconomic status. In total, 611 children (99.0%) were breastfed. Of those breastfed, 45% and 39% in rural and urban settings respectively were initiated within an hour of delivery. Children in rural setting had longer duration of breast feeding. However, they are less likely to be exclusively breast fed for 6 - months compared with children whose caregivers are urban dwellers. Dietary diversity was similar in both settings but higher among males. (20.3% male, 11.7% female in rural; 17.3% male and 15.5% female in urban). Overall, 108 (22.3%), 107 (21.9%), 152 (30.6%) and 34 (7.0%) of children aged 6-59 months were cachetic, underweight, stunted, and overweight respectively but commoner among children in rural settings.
Conclusion: Feeding and nutrition programmes need to apply a gender lens if sustained behavioural interventions on child nutrition are to reach equitable outcomes.

Audit of the practice of day case surgery in the division of paediatric surgery, university college hospital, Ibadan

2023-08-03T01:19:57+00:00

Background: Paediatric day case surgery refers to planned procedures on patients on a non-resident basis but requires some facilities and time for recovery before discharge home on the day of surgery. This study was conducted to audit paediatric day case surgery practice at our centre, and to determine the outcome of day case surgeries.
Patients and Methods: This is a retrospective study of cases seen over a period of 12 years, 2010 to 2022. These patients’ data were assessed from their case notes and information obtained for each of the patients included age, gender, diagnosis, type of operation, type of anesthesia and post operative complications. The data were analyzed using SPSS version 22.0 for windows.
Results: A total of 1,211 patients were recruited, with a M: F; 6: 1. The age of patients ranged from one week to 15 years with a median age of two years. A higher proportion of case load involved infants and toddlers compared to the other paediatric age groups. In this review, the largest volume of cases was seen in the last five years with the peak in 2018 (202). The right groin for an isolated diagnosis was operated in 381 (59 %) patients compared to the left 265 (41 %). The mean duration of surgery time was 40 minutes. Most of the patients had General Anesthesia (GA) with endotracheal tube, face mask, and laryngeal mask airway (LMA) using isoflurane, halothane and propofol at different times as anesthetic agents. There were no re admissions or mortality, however two of our patients had recurrence necessitating a re-do surgery.
Conclusion: Groin hernias are the most common day cases in children in our facility. Day case paediatric surgery is safe, and outcome is generally good, when well managed.

Duodenal leiomyoma as a rare cause of gastrointestinal bleeding in a Nigerian- case report with presentation of minimally invasive therapeutic intervention

2023-08-03T01:24:09+00:00

Findings from Nigerian pathological series have supported international reports about the rarity of the occurrence of duodenal leiomyomas. More recently, case reports from the country have detailed interventional radiological techniques being deployed successfully in the control of massive bleeding from the gastrointestinal system. The article seeks to document these rare elements coming together in a Lagos, Nigeria-based center in the case of bleeding duodenal leiomyoma in an elderly gentleman which was successfully controlled by selective transcatheter arterial embolization.

Professor Samuel Omokhodion: Nigeria’s icon of paediatric cardiology

2023-08-03T01:27:38+00:00

Samuel Omokhodion was born to Pa Jacob Avblimen and Madam Victoria Edewede Omokhodion of Emuhi Ekpoma, Esan West Local Government of Edo State on 9th March 1953, in Ondo state while his father was working in the Civil Service of the old Western Region of Nigeria. Samuael Omohodion attained the illustrious age of 70 years in December 2022. This edition of chronicles examines his biography - early life, career in paediatric cardiology, number of publications, professional affiliations, and priestly calling.