Annals of Ibadan Postgraduate Medicine <p>The <em>Annals of Ibadan Postgraduate Medicine</em> is a peer-reviewed, international, medical journal published bi-annually by the Association of Resident Doctors, University College Hospital, Ibadan, Nigeria. The journal has a vision to regularly publish first-class and widely cited articles in different specialities of medical sciences and related subjects. It welcomes contributions from all fields of medicine including medical technology, as well as economic, social and ethical issues that are related to the practice of medicine, especially in developing countries of the world. The journal publishes review and original articles, commentaries, book reviews, meeting reports, addresses and speeches, correspondences etc.</p><p>Other websites related to this journal: <a title="" href="" target="_blank"></a> and <a href="" target="_blank"> </a></p> en-US Annals of Ibadan Postgraduate Medicine 1597-1627 <span style="font-family: Garamond; font-size: small;"><span style="font-family: Garamond; font-size: small;"><p>On acceptance, the copyright of the paper will be vested in the Journal and Publisher.</p></span></span> Effect of training on knowledge and attitude to standard precaution among workers exposed to body fluids in a tertiary institution in south-west Nigeria <p><strong>Introduction</strong>: Standard precaution in the workplace reduces the risk of occupational hazards among workers exposed to body fluids of humans and animals. Training on standard precaution has been recommended as a strategy to improve knowledge, attitude and&nbsp; compliance to these guidelines. This study therefore determined the effect of training on knowledge and attitude to standard precaution among workers exposed to body fluids of humans and animals in the University of Ibadan, South-west, Nigeria.<br><strong>Methods</strong>: This was an interventional study among workers exposed to body fluids of humans and animals. A total survey of all faculties where staff and student come in contact with human and animal body fluid was done. Selected staff were trained for two days on standard precaution. A self-administered questionnaire was used to obtain information on socio-demographic information, knowledge and&nbsp; perception of staff on standard precaution. The maximum obtainable knowledge and attitude scores were 27 and 6 points respectively. The mean knowledge and attitude score were determined at pretest and post-test. Frequency, proportion, mean and standard deviation were used for summary statistics and an independent t-test was performed to test for association. Statistical significance was set at 5%.<br><strong>Results</strong>: A total of 136 and 123 responses were obtained at pre-test and posttest respectively. A little over half of the respondents were females (51.5%) and below 40 years (54.4%). The mean knowledge score among the workers increased from 22.59 ± 3.4 at pre-test to 22.83 ± 3.2 at post-test, but it was not statistically significant. However, the mean post-test attitude score (5.10 ± 1.4) was significantly different from the pre-test attitude score (4.49 ± 1.5).<br><strong>Conclusion</strong>: Training improved the knowledge and attitude of workers exposed to body fluids of humans and animals working in the University of Ibadan on standard precaution. Periodic training on standard precaution is therefore recommended to sustain a proper attitude to standard precaution guidelines.</p> O.C. Uchendu A.P. Desmenu E.T. Owoaje Copyright (c) 2021-07-30 2021-07-30 18 2 100 105 Methods of payment for health care and perception of a prepayment scheme among auto-technicians in Abuja, Nigeria <p><strong>Background:</strong> The National Health Insurance Scheme (NHIS) in Nigeria has succeeded in enrolling only a minute fraction of the population. Studies on the scheme among informal sector employees are required to plan a scale up of the programme in this group which represents the majority of the working population in the country.</p> <p><strong>Objective:</strong> This study sought to assess the method of payment for health care, awareness of and the perception about the NHIS among auto-technicians in Abuja, Nigeria.</p> <p><strong>Method:</strong> A cross-sectional descriptive survey was conducted among auto-technicians in Abuja Municipal Area Council (AMAC), Nigeria.&nbsp; Data was collected using interviewer-administered questionnaire, and analyzed with SPSS version 17.</p> <p><strong>Results</strong>: A total of 351 auto-technicians and allied workers participated in the study. Post-secondary education [(Odds Ratio (OR) = 7.78, 95% CI = 1.61 – 37.54, p = 0.01)] and having a spouse who is gainfully employed [(OR = 3.67, 95% CI = 1.04-12.93)] predicted awareness of the NHIS. Older people above forty years of age were significantly less likely to be aware of the NHIS, (OR = 0.27, 95% CI = 0.08 – 0.92, p = 0.036).</p> <p><strong>Conclusions</strong>: Despite the glaring need and willingness of the participants to enroll&nbsp; in a prepayment scheme for health, workers in the&nbsp; informal sector of the economy may remain unreached by NHIS due to lack of awareness and skepticism. Strategic steps to remove ignorance and dispel doubts is imperative for scale up of the NHIS in the informal sector. </p> D.A. Adewole M.D. Dairo V.N. Shaahu S.A. Olowookere Copyright (c) 2021-07-30 2021-07-30 18 2 106 113 Prevalence, knowledge and preventive practices against hypertension among police officers in Ibadan <p><strong>Background:</strong> Hypertension is a major global health problem. Armed forces personnel are at increased risk of hypertension due to the&nbsp; nature of their occupation as early responders. There is dearth of data on knowledge and prevalence of hypertension among police officers in Ibadan, Nigeria. This study was conducted to address this gap in knowledge.<br><strong>Methods:</strong> A total of 170 police officers participated in the study. A questionnaire was used to document demographic profile, knowledge and practices to prevent hypertension. Abdominal circumference and blood pressure were measured among study participants. A digital Omron HEM 8712 blood pressure monitor was used to assess BP and a non-stretchable measuring tape was used to determine waist circumference. Hypertension was assessed by &gt;140/90 mmHg and abdominal obesity by &gt;80cm for female and &gt;94cm for male.<br><strong>Results:</strong> Mean age of respondents was 36.7±8.4 years; more than half (64.7%) were males. Majority (47.6%) had fair knowledge of hypertension. The prevalence of abdominal obesity and hypertension were 51.7% and 17.5% respectively. About a tenth (11.4%) were both hypertensive and obese. More females than males’ respondents had abdominal obesity (p=0.00); while more males (19.3%) than females (14.0%) were hypertensive (p=0.39). About twothird (68.2%) reported involvement in unhealthy preventive practices including consumption of alcohol, foods high in salt and fat content, and tobacco smoking. Older, married and senior officers were significantly at higher risk of being hypertensive than younger, never married, and junior officers.<br><strong>Conclusion:</strong> Police officers have adequate knowledge of hypertension but many in this group are hypertensive. Clinical and educational interventions are recommended to address the problem.</p> O.J. Hussain A.J. Ajuwon Copyright (c) 2021-07-30 2021-07-30 18 2 114 121 Characterization of alveolar soft part sarcoma of the tongue: A clinico-pathologic study and scoping review <p><strong>Background</strong>: Alveolar soft part sarcoma (ASPS) is a rare malignant soft tissue tumour. There is a dearth of literature analyzing its features on the tongue.<br><strong>Objectives</strong>: This study aims to conduct a scoping review to describe the essential clinico-pathologic features, treatment modalities and outcome of previously reported tongue ASPS (TASPS) and new cases at our center.<br><strong>Methods</strong>: A search of databases (PubMed, Medline, Cochrane and Google Scholar) and the internet for articles on TASPS written in English was conducted. Information extracted included clinico-pathological and demographic data. Descriptive statistics was used for analysis.<br><strong>Results</strong>: A total of 49 articles were eligible for this study. In all, 81 cases were utilized. Asian studies accounted for most cases 35(43.2%) and a slight female preponderance of 1.1 was seen. Most cases - 38 (46.9%), occurred in the 1st decade and the base of tongue was the most common location in 19 (39.6%) cases. Also, tumour metastasis was present in 14 (25.9%) cases. Transcription Factor E3 (TFE3) – 8 (24.2%) and Neuron Specific Enolase (NSE) – 8 (24.2%) were the most common immunohistochemical stains used and were both expressed 7 out of 8 cases (87.5%). Most common treatment modality was surgery and 42 (82.4%) cases managed by surgery alone were free of disease at &lt; 5 years of follow up.<br><strong>Conclusions:</strong> TASPS slightly affected the female gender and tongue base more commonly. It occurred more in the first two decades of life. Use of standard investigative tools for management will allow for better appraisal of research findings.</p> <p>&nbsp;</p> A.O. Akinyamoju O.O. Gbolahan B.F. Adeyemi Copyright (c) 2021-07-30 2021-07-30 18 2 122 134 Pattern of liver cancer admissions at the University College Hospital, Ibadan - A 4-year review <p><strong>Background:</strong> Liver Cancer (LC) is a common malignancy globally, and it exacts an enormous toll on the health care system. Therefore, it is imperative to have an epidemiological profile for effective planning.<br><strong>Methods</strong>: This study examined the basic demographic, admission profile and outcome of this category of patients through a retrospective cross-sectional study. The study was carried out using data of clinical diagnoses of LC admitted into the Gastro-intestinal Unit (GLU), Department of Medicine, University College Hospital, Ibadan between 1st January 2011 and 31st December 2014.<br><strong>Results</strong>: Two hundred and six patients (16.8%) had diagnoses of LC out of the 1228 total cases admitted by the GLU. The total male&nbsp; patients were 147(71.4%) and female 59 (28.6%) while the most prominent age group for both genders and males were 41-50 years in the male group and 51-60 years among females. The mean + SD and median hospital stay was 10.6±11.6 days and eight days for LC patients, respectively. The intrahospital fatality rate was 37.9% and occurred mainly within five days of admission.<br><strong>Conclusion</strong>: Liver Cancer is an important disorder in gastrointestinal practice and had high fatality within a few days of admission; hence, efforts should be made to improve the care of the patients. </p> O. Adebayo A. Lawal O.S. Ola Copyright (c) 2021-07-30 2021-07-30 18 2 141 145 Prosthodontic rehabilitation of maxillofacial defects in a Nigerian Teaching Hospital: A 9-year review <p><strong>Objectives</strong>: The objective was to review patients treated with maxillofacial prostheses in a Nigerian teaching hospital to assess the types of prostheses provided for them.<br><strong>Methodology:</strong> This was a retrospective study of patients treated with maxillofacial prostheses over a period of nine years. The socio-demographic data of the patients, types of defect, causes of defects, location of defect, types of maxillofacial prostheses and the indications for prostheses were obtained from the patients’ case records. Case records with incomplete information were excluded. All data generated were analysed using the IBM SPSS version 20. Fisher’s exact test was used to test for statistical significance.<br><strong>Result</strong>: Case records of eighty-two patients treated with maxillofacial prostheses were reviewed. Forty-three (52.4%) of the patients were males while 39 (47.6%) were females. The age ranged from 6 to 76 years with the mean age being of 38.76 (SD±18.3) years. The majority, 58 (70.7%) of the patients were of lower social-economic class. Sixty-six (80.5%) patients had prostheses for maxillary defects, while only one (1.2%) patient had prosthesis for nasal defect. Twenty (30.3%) of the 66 patients that had maxillary defects had definitive obturators, while only three (4.5%) had all the three types of obturator. Surgical recession of tumours of the jaw was the major cause (85.4%) and mastication (70.7%) was the major indication for the prescription of obturators.<br><strong>Conclusion</strong>: The majority of the patients were of the lower social class and maxillary obturator was the major form of maxillofacial&nbsp; prostheses provided for patients in this study. Most of the defects are caused by surgical recession of tumours of the jaw and mastication was the major indication for the prescription of obturators.</p> T.J. Ogunrinde D.M. Ajayi O.O. Dosumu O.F. Olawale A.A. Olusanya Copyright (c) 2021-07-30 2021-07-30 18 2 146 151 A 5-year review of ultrasonographic evaluation of ocular diseases at the University College Hospital IBADAN, south-west, Nigeria <p><strong>Background:</strong> Orbito-ocular diseases are a major public health issue, often causing visual impairment with serious socioeconomic&nbsp; implications on individual lives. Ocular ultrasonography is an invaluable diagnostic tool when clinical examination of the ocular fundus is difficult.<br><strong>Objectives:</strong> To describe the indications, sonographic findings, and contribution of orbito-ocular ultrasonography to the management of orbito-ocular diseases in the University College Hospital, Ibadan.<br><strong>Materials and Methods:</strong> A retrospective review of B-mode ocular ultrasound findings and hospital data of all patients referred to the Radiology department of the University College Hospital, Ibadan for ocular Ultrasound between January 2014 - December 2018.<br><strong>Results:</strong> There were 142 patients, aged 1-85 years, (median age =28 years). 72 (50.7%) patients were under 30 years of age, and 50 (35.2%) were pediatric cases. Male to female ratio was 1.84:1. The commonest presenting complaint was blurred vision in 97 (68.3%) cases,&nbsp; followed by eye trauma in 54 (38.0%). B-mode Ultrasound, demonstrated cataract in 63 (44.4%,) cases, vitreous hemorrhage in 42 (29.6%), retinal detachment in 27 (19.0%), vitreous detachment in 19 (13.4%), normal findings in 17 (12%) and orbital tumors in 13 (9.2%) patients.<br>B-mode ultrasound scan and clinical diagnosis demonstrated good agreement in 91 /142 cases (64.1%), partial agreement in 23/142&nbsp; (16.2%) cases, and no agreement in 28 (19.7%). Kappa agreement scores, K were 74.3% and 70.9%, for ruptured globe and cataract respectively.<br><strong>Conclusion</strong>: Orbito-ocular ultrasonography contributes significantly to the diagnosis of orbito-ocular disease and shows good correlation with clinical diagnoses. However, a future study with larger numbers is required.</p> A.J. Adekanmi O.A. Ogun A.T. Adeniji-Sofoluwe M.O. Obajimi Copyright (c) 2021-07-30 2021-07-30 18 2 152 159 Adenoid cystic carcinoma misinterpreted as antrochoanal polyp: A rare presentation <p>Adenoid cystic Carcnoma (ACC) is an uncommon malignant tumour accounting for &lt; 1% of all oral and maxillofacial tumors. However, in the sinonasal tract, ACC is the most common salivary gland tumor. The sinonasal ACC is asymptomatic initially or causes non-specific&nbsp; symptoms that are similar to those caused by inflammatory sinus disease and local neurological symptoms such as trigeminal neuralgia in advance stage due to perineural invasion by the tumour.We present a case of 35-year-old female who presented with complaints of nasal obstruction and headache. CT scans revealed an antrochoanal polyp without any bony involvement. The histopathological examination revealed unremarkable respiratory epithelium with underlying sheets and acini of small hyperchromatic cells with hyaline-like material in the lumina, confirming adenoid cystic carcinoma. The highlight of this case is that sinonasal polyps are not always inflammatory in origin, these can be neoplastic also.</p> <p>&nbsp;</p> J.N. Bharti R.K. Brar J.S. Nigam S. Sehgal Copyright (c) 2021-08-02 2021-08-02 18 2 160 162 Congenital granular cell tumour of the newborn: A case report of the rare lesion <p>Congenital granular cell tumour [CGCT], a benign soft tissue tumour was a surprise discovery to the parents as well as the obstretical staffs at birth. It developed in the maxillary left canine region causing oral disfigurement and feeding problems. Diagnosis was essentially clinical and confirmed by histology. Surgical excision was done. We describe a case of CGCT in a 3-week old female neonate in the paediatric dentistry unit of LASUTH</p> B.O. Castano A.C. Oluwarotimi O.A. Adesina A.O.S. Ayodele Copyright (c) 2021-08-02 2021-08-02 18 2 163 166 Posterior uveal effusion post trabeculectomy in unilateral infantile glaucoma: A case report and management challenges <p>Choroidal effusion is an abnormal collection of fluid within the suprachoroidal potential space. It is a common complication following glaucoma filtering surgeries such as trabeculectomy. It is a clinical diagnosis that sometimes goes undetected or unreported, except when symptomatic. Reported incident rates is 7.9 – 18.8% for serous effusions and 0.7 – 3% for haemorrhagic effusions. This report aims to highlight a case of choroidal effusion after trabeculectomy and its management challenges.<br><strong>Case Report</strong>: A seven year old boy presented to our facility with history of cloudy appearance of the right eye of five years duration. He was diagnosed with right infantile glaucoma. Intraocular pressures (IOP) were 44mmHg and 18mmHg right and left eyes respectively. Patient subsequently had right trabeculectomy. He developed hypotony at post-operative day two and a right choroidal effusion was noticed at post-operative day four. As a result of this, he initially had a right anterior chamber reformation with ocular viscoelastic on day seven. Later, a compression suture over the bleb and sclerostomy was performed 11 days post initial surgery. Choroidal&nbsp; effusion&nbsp; progressively regressed post-operatively and completely resolved at day five post-sclerostomy and effusion drainage.<br><strong>Conclusion</strong>: Choroidal effusion is a common complication after trabeculectomy in which conservative management results in resolution. However, when conservative management fails, surgical intervention should not be delayed to maximize good outcome.</p> T.F. Sarimiye A.S. Ata A.A. Olagunju Copyright (c) 2021-08-02 2021-08-02 18 2 167 169 Initial experience with 3d-ultrasound as an adjunct to 2dultrasound in fetal anomaly diagnosis in a Nigerian diagnostic facility <p><strong>Introduction:</strong> Two-Dimensional ultrasound (2DUS) has been the preferred screening method for fetal abnormalities for several decades.&nbsp; Three-dimensional ultrasound (3DUS) is a technique that converts standard 2D grayscale ultrasound images into a volumetric dataset which allows visualization of the fetus in all three dimensions at the same time. It provides an improved overview and a more clearly defined demonstration of adjusted anatomical planes. The use of 3D imaging is however limited to being an adjunct to 2DUS in the&nbsp; visualization of fetal anomalies. The objective of this study is to highlight the importance of adding three dimensional ultrasound (3DUS) to two-dimensional ultrasound (2DUS) during fetal anomaly screening.<br><strong>Methodology:</strong> This is a descriptive study conducted at a private fetal diagnostic center, in Nigeria between January 2014 and December&nbsp; 2016. The diagnosis of fetal anomalies was first made with 2DUS after which they were evaluated with 3D ultrasound images displayed on the monitor.<br><strong>Results:</strong> Nine fetuses with various fetal anomalies diagnosed on 2DUS were selected for further evaluation with 3DUS. These anomalies include a neck mass, lumbar spinal abnormality, bilateral cleft lip, thanatophoric dysplasia, anencephaly, omphalocele, posterior urethral valve with anhydramnios and ambiguous genitalia diagnosed. These anomalies were better demonstrated on 3DUS.<br><strong>Conclusion:</strong> 2DUS remains the mainstay imaging modality in screening for fetal anomalies. However, 3DUS may complement 2DUS by allowing better delineation of anomalies and gives the parents a better visualization and understanding of identified anomalies, thereby assisting in informed decision making.<br><br></p> J.A. Akinmoladun V.O. Oboro T.I. Adelakun T.I. Adelakun Copyright (c) 2021-08-02 2021-08-02 18 2 170 177 Multiple saccular aneurysms of the abdominal aorta: A case report and short review of risk factors for rupture on CT scan <p><strong>Introduction</strong>: Saccular abdominal aortic aneurysms (SAAA) are rare types of abdominal aortic aneurysm. It has a higher risk of rupture, hence must be repaired at smaller diameter. Mortality from rupture of an abdominal aortic aneurysm is high and has been reported to be about 90%.<br><strong>Case presentation</strong>: This is the case of a 37-year-old woman with chronic waist pain and abdominal discomfort. Clinical examinations revealed a pulsating abdominal mass. Doppler ultrasound and abdominopelvic contrast enhanced CT scan showed multiple saccular aneurysms of the infrarenal abdominal aorta. This patient had no identified predisposing factor. She was being worked up for surgery, but eventually died of rupture, the most dreaded complication 3 days prior to surgical repair.<br><strong>Conclusion:</strong> The risk factors for rupture found in this patient were the size and type (saccular) of the aneurysm, intraluminal thrombus in addition to the multiplicity of the aneurysm as well as their adjacent positions; that probably led to arterial wall stress.</p> M.S. Durojaye T.O. Adeniyi O.A. Alagbe Copyright (c) 2021-08-02 2021-08-02 18 2 178 180