Highland Medical Research Journal 2020-09-07T08:05:14+00:00 Professor Emmanuel I Agaba Open Journal Systems The aim of the <em>Highland Medical Research Journal</em> is to publish scientific research in various fields of medical science and to communicate such research findings to the larger world community. It aims to promote cooperation and understanding amoungst workers in various fields of medical science. An evaluation of the knowledge and utilization of the essential medicines list among health professionals in a tertiary institution in South-South, Nigeria. 2020-08-21T10:29:12+00:00 Stephen A. Ayinbuowan Ambrose O. Isah <p><strong>Background:</strong> The concept of essential drugs is based on the premise that a limited number of effective, safe, high quality, reasonably priced drugs are capable of satisfying the priority health care needs of the majority of the population. The Essential Medicines list is intended for use across the three levels of the health care system to promote higher quality care, better management of medicines and a more cost-effective use of available health resources. This study assessed the current status, understanding and level of penetration of the concept amongst the health care providers in a tertiary healthcare facility in South-South, Nigeria, after four decades of its introduction.<br><strong>Methods:</strong> It is a cross-sectional, descriptive study conducted between January and July 2017..<br><strong>Results</strong>: A response rate of 92.7% (278/300) was obtained for questionnaires distributed More than half of the respondents were doctors (176; 63.3%). Nurses and pharmacists were 77(27.7%) and 24(8.6%) respectively. The mean age of the respondents was 34.8 ± 7.3. Males and females were almost equal in this study (males 47.1%, females 49.6%). There was significant awareness of the EML among all the health professionals (p=0.001). Pharmacist had better understanding of the concept of the EML document (p=0.001) and also exhibited a positive attitude in making use of the document in their daily practice (p&lt;0.001) when compared with the doctors and nurses.<br><strong>Conclusion:</strong> This study found a high level of awareness of the EML among the health professionals, however it did not translate to their knowledge and utilization of the document.</p> <p><strong>Key words</strong>: Essential medicines list, Health professionals, Nigeria</p> 2020-08-21T00:00:00+00:00 Copyright (c) Hyperbilirubinaemia in glucose-6-phosphate dehydrogenase deficient neonates: the role of haemolysis 2020-08-24T06:53:20+00:00 Ezra D Jatau Obadiah D Damulak Bose O Toma Julie O Egesie Chinedu N Okeke Emmanuel A Akor <p><strong>Background:</strong> Hyperbilirubinaemia associated with varying complications is a common clinical presentation in Glucose-6- phospate dehydrogenase (G6PD) deficient neonates in our environment. This study is to determine the role of haemolysis in the pathogenesis of hyperbilirubinaemia in G6PD deficient neonates with a view to establishing an appropriate management strategy for acceptable neonatal outcome.<br><strong>Materials and Methods:</strong> One hundred and fifty neonates admitted into the Special Care Baby Units (SCBUs) of the Jos University Teaching Hospital, Bingham University Teaching Hospital, and the Plateau State Specialist Hospital with neonatal jaundice were enrolled for this study between March 2013 and February 2014. The neonates were reviewed clinically and examined for fever, jaundice, cyanosis among other features and they had blood samples collected for laboratory investigations that include Full Blood Count (FBC), Reticulocyte Count, Serum Bilirubin (SB) and G6PD assay.<br><strong>Results:</strong> Median age at presentation was 3 (IQR: 1-4) days. The mean haemoglobin concentration of the study subjects was 15.90 ± 2.23 g/dl while median reticulocyte count was 2.5 (IQR:2-3) %. Total serum bilirubin had a median concentration of 204.00 (IQR:168.25-255.50) μmol/L while median unconjugated bilirubin concentration was 184.50(IQR: 144.50- 233.71) μmol/L. Sixty-one (40.7 %) of the studied neonates were G6PD deficient with mean G6PD activity of 3.99(IQR: 2.72-4.94) IU/gHb<br><strong>Conclusion</strong>: Hyperbilirubinaemia is a common clinical finding in G6PD deficient neonates in our environment but haemolysis is not a major event in its pathogenesis.</p> <p><strong>Key words:</strong> Glucose-6-phosphate dehydrogenase, Haemolysis, Hyperbilirubinaemia, Neonates</p> 2020-08-24T00:00:00+00:00 Copyright (c) Phenotypic detection of Extended-spectrum â-lactamases (ESBLs) among Enterobacteriaceae and <i>Pseudomonas aeruginosa</i> from Mubi, Adamawa State, Nigeria 2020-08-24T07:09:47+00:00 Musa Y. Tula Osaretin Iyoha <p><strong>Background:</strong> Extended-Spectrum â-Lactamases (ESBLs) are group of enzymes produced by bacterial species which enable them to withstand the effect of cephalosporin antibiotics. They are mostly reported among Enterobacteriaceae and other Gram-negative bacteria especially <em>Pseudomonas aeruginosa.</em><br><strong>Method:</strong> One hundred clinical samples comprising of urine, high vaginal swab (HVS), sputum, stool, semen and wound swab were analysed for bacterial growth. Bacterial species isolated were subjected to antibiotic susceptibility testing and phenotypic extended-spectrum â-lactamase production (ESBL).<br><strong>Result</strong>: Only 62(62.0%) of the clinical samples yielded bacterial growth which belonged to eight (8) genera. <em>Escherichia coli (</em>35.5%) was the most predominant, followed by<em> P. aeruginosa (</em>16.1%), while the least was <em>P. mirabilis</em> (1.6%). Extended-spectrum â-lactamases (ESBLs) was observed in 27/62 isolates, an overall prevalence of 43.5% with a predominance of<em> E. coli</em> (40.7%), followed by <em>P. aeruginosa</em> (22.2%). Although the number of non-ESBL isolates (35) was more than that of ESBL isolates (27%) but with no statistical difference (P=0.703). The antimicrobial susceptibility profile of all the isolates showed that 61(98.4%) and 56(90.3%) of the isolates were resistant to the â-lactam antibiotics, ceftriaxone and cefpodoxime respectively and were variable to other antibiotics. All the ESBL producers were found resistant (100%) to ceftriaxone and cefpodoxime (all cephalosporins). Also, all ESBL producing <em>P. mirabilis, K. pneumoniae</em> and <em>P. agglomerans</em> were found resistant (100%) not only to cephalosporins antibiotics, but also to other classes of antibiotics. However, resistance to all fluoroquinolones (sparfloxacin, ciprofloxacin, perfloxacin and ofloxacin) and gentamycin was moderately low especially among ESBL producing E. coli and P. aeruginosa, while ESBL producing K. pneumoniae was susceptible to the afore mentioned antibiotics.<br><strong>Conclusion</strong>: The finding of this study is worrisome considering the fact that most of the ESBLs strains exhibit MDR phenotype. This constitutes a threat to therapy not only in the hospital environment but also in the community.</p> <p><strong>Keywords:</strong> Phenotypic, ESBLs, Enterobacteriaceae, Mubi</p> 2020-08-24T00:00:00+00:00 Copyright (c) Quality of life in people living with albinism in a tertiary Hospital in Southern Nigeria 2020-08-24T07:38:42+00:00 Cynthia R. Madubuko Emmanuel P. Kubeyinje <p>No abstract</p> 2020-08-24T00:00:00+00:00 Copyright (c) Pain management in medical wards: A single centre experience in Nigeria 2020-08-24T08:09:56+00:00 Joseph E Ojobi Theophilus E Ugwu Patrick O Idoko Monday O Ogiator Gomerep Samuel S Joseph A Orkuma <p><strong>Background:</strong> Pain is the commonest reason for hospital presentation worldwide. Its prevalence, distribution and severity are similar across different wards. However, the management of pain in medical wards is sub-optimal. The study was aimed at the determination of patients' perception of adequacy of pain management in medical wards.<br><strong>Methods:</strong> A cross sectional hospital based study of patients admitted into the medical wards of Federal Medical Centre, Makurdi over a two year period using a validated questionnaire purposively administered to consecutive patients who had diagnoses with pain as a major component (e.g. Sickle Cell Crisis, Painful Neuropathies) to capture socio - demographic and clinical parameters, diagnoses and analgesics (type, dose, escalation frequency).<br><strong>Results:</strong> There were 1,986 patients made up of 1,019 females and 967 males with mean age 53±18 years. Up to 31.1% were in their seventh decade with majority (59.3%) living in urban areas. Respondents were admitted with various painful conditions (e.g. neuropathies from diabetes and chronic kidney diseases constitute 42%). They were on appropriate analgesics at rather low doses or one off doses. Up to 62% had used bioceuticals. Majority (95.2%) of respondents felt that pain management in the medical wards was inadequate.<br><strong>Conclusion</strong>: Most (95.2%) patients felt pain management while they were on admission was not adequate. Analgesia was based on patient's complaint and the judgment of the physician.</p> <p><strong>Key Words:</strong> Pain, analgesics, medical wards, bioceuticals</p> 2020-08-24T00:00:00+00:00 Copyright (c) Thrombotic risk assessment in adult patients with lymphoid malignancies in Benin City: A cross sectional study 2020-08-27T06:59:51+00:00 Juliet I Uduebor Benedict Nwogoh <p><strong>Background:</strong> Venous thromboembolism (VTE) is a major cause of morbidity and mortality in cancer patients. Thromboprophylaxis can be used to prevent VTE in patients with malignany. Risk assessment models (RAM) can be used to identify those who may benefit from thromboprophylaxis. The study aims to determine the cancer associated thrombotic risk of patients with lymphoid malignancies.<br><strong>Methods:</strong> This was a case control study conducted at the Department of Haematology and Blood Transfusion, University of Benin Teaching Hospital, (UBTH) Benin City. Eighty two patients, 18 years and above with lymphoid malignancies and 82 controls were evaluated using the Khorana risk assessment model. Data was analyzed using SPSS version 21.<br><strong>Results</strong>: The ages of patients and controls were 54.0 ±14.0 vs. 50.0±11.0 years, p = 0.06 respectively. They included 41 (50.0%) males in the patient group and 43(52.4%) males in the controls (p =0.76). The commonest types of lymphoid malignancies amongst them were Non-Hodgkin's lymphoma (NHL) 32 ((39.0%), multiple myeloma (MM) 24 (29.3%) and chronic lymphocytic leukaemia/small lymphocytic lymphoma CLL/SLL 18 (21.9%). Patients with lymphoid malignancies had significantly higher risk scores compared to the controls. Majority of the patients have intermediate risk and 3.7% were at high risk of cancer associated thrombosis. Thirteen (15.9%) of the controls had intermediate risk while 69 (84.1%) had low risk. Patients with chronic lymphoid leukaemia/small lymphocytic lymphoma and non-Hodgkin's lymphoma had the high risk status.<br><strong>Conclusion</strong>: Thrombotic risk is largely intermediate in patients with lymphoid malignancies and thus may not require routine thromboprophylaxis. However individualized risk assessment based on the presence of additional prothrombotic factors should be considered to determine patients with lymphoid malignancies that may benefit from thromboprophylaxis</p> 2020-08-27T00:00:00+00:00 Copyright (c) Pattern of utilization of antiepileptic drugs in the first 12 months of epilepsy treatment in children 2020-08-27T07:50:29+00:00 Emeka U Ejeliogu Courage Aderonke Mary Bok Esther S Yiltok <p><strong>Background:</strong> Drug utilization studies are important methods of assessing how drugs are used in the society. Without the knowledge of how drugs are being prescribed and used, it is difficult to initiate discussion on rationale drug use and to suggest measures to change prescribing habits for better management of patients. This study therefore aimed to evaluate the pattern of utilization of antiepileptic drugs (AEDs) in the first 12 months of epilepsy treatment in children in Jos, Nigeria.<br><strong>Methods</strong>: A case record form was used to document all relevant information of children with epilepsy that were commenced on AED from January 2011 to December 2015. Information collected in the first 12 months of commencement of AED was used to evaluate the pattern of utilization of AEDs among the study subjects. Information obtained was analyzed with statistical package for social sciences software version 20.<br><strong>Results:</strong> Three hundred and eighty one subjects with a median age of 5.4 years were studied. The most frequently prescribed drug at commencement of epilepsy treatment was Carbamazepine (CBZ) (75.9%) followed by Sodium Valproate (VPA) (17.1%) while the most frequent AED combination was CBZ+VPA. Despite the fact that all the patients were commenced on monotherapy, the rate of polytherapy at 12 months was 35.2%. Deviation from standard treatment guidelines was observed in 127 (33.3%) of the subjects with the most common deviation being the use of CBZ for generalized tonic-clonic seizures.<br><strong>Conclusion:</strong> Significant deviations were observed in the utilization of AEDs in children with epilepsy. Using standard guidelines in the treatment of childhood epilepsy will reduce the rate of uncontrolled seizures and improve their long term outcome.</p> <p><strong>Keywords</strong>: Epilepsy, Children, Antiepileptic drugs, Pattern, Utilization</p> 2020-08-27T00:00:00+00:00 Copyright (c) Effect of paracetamol pre-treatment on Propofol injection pain among surgical patients 2020-08-27T08:12:01+00:00 Henry Y Embu Audu M Ngeh Erdoo S Isamade Samuel I Nuhu <p><strong>Background:</strong> Propofol injection pain is often a cause of distress for patients. This study was conducted to find the incidence of Propofol induced pain and the efficacy of Paracetamol (Acetaminophen) in the prevention of Propofol injection pain among surgical patients at a tertiary hospital.<br><strong>Methods</strong>: The study was a prospective, double blind randomized clinical trial carried out at the Jos University Teaching Hospital main theatre. Consenting American Society of Anesthesiologists (ASA) physical status I or II patients scheduled to undergo general anaesthesia for elective surgery were allocated into one of two study groups of 35 each. Group I&nbsp; was the Paracetamol (drugamol<sup>®</sup> ) group, who received 2mg/kg of intravenous Paracetamol while the control group (group II) received 5ml of 0.9% saline with venous occlusion. The venous occlusion was released 2 minutes after injecting the study drug and one-fourth of the total calculated dose (2.5mg/kg) of&nbsp; Propofol (Pofol 1% <sup>®</sup>Dongkook Pharmaceutical) was delivered through the iv line over a period of five seconds and the patients assessed for pain on a 4-point scale.</p> <p><strong>Results:</strong> The two groups were comparable in demographic characteristics and ASA classification. Twenty-one (60.0%) patients in the control group and 1 (2.9%) patient in the Paracetamol group experienced pain on injection of Propofol, p = 0.000. There were no significant haemodynamic variations between the two groups during the study period.<br><strong>Conclusion</strong>: Paracetamol when applied with tourniquet significantly attenuated Propofol injection pain in our adult patients with no significant haemodynamic variations.<br><strong>Key words:</strong> Paracetamol, Propofol, Injection pain</p> 2020-08-27T00:00:00+00:00 Copyright (c) A review of the clinicopathologic pattern of head and neck malignant tumours in Ilorin, Nigeria 2020-09-07T08:05:14+00:00 Oluyomi S Ayodele Kayodele H Omokanye Segun Segun-Busari Kazeem O O Ibrahim Abdulrhaman O Afolabi Olaleke O Folaranmi Aderinola O Wuraola Muritala Jimoh David A Dunmade Sulyman B Alabi Emmanuel F Ologe <p><strong>Background:</strong> Head and neck cancers remain a major public health concern with increasing prevalence in Africa. The aim of this study was to highlight the current trends of head and neck cancers and compare with previous studies.<br><strong>Methods:</strong> A retrospective study of head and neck cancers seen in University of Ilorin Teaching Hospital over a 6-year period (2013 – 2018) was done. Information was retrieved from the clinic, theatre and cancer registry centre. Sites of tumours, duration of symptoms before presentation, reasons for late presentation and histopathological diagnosis were extracted.<br><strong>Result:</strong> There were a total of 143 histologically confirmed head and neck cancers.. The age ranged from 2 – 100 years with a mean age of 52 years. The duration of symptoms at presentation was found to range from 3 months to 78 months. Over 80% presented late. Reasons for late presentation were financial constraints (60.5%), ignorance/wrong beliefs (32.4%), traditional treatment (41.6%) and delayed referral (22.5%). Commonest sites were sinonasal region (13.3%), larynx (11.9%), and the nasopharynx (11.2%). Of these, 58.0% were carcinomas, 25.2%were lymphomas, 7.0% were sarcomas while 9.8% were blastomas.<br><strong>Conclusion:</strong> The clinicopathologicalpattern of head and neck cancers revealed no significant change over the past 20 years. However, it is expedient to carry out this kind of study at regular intervals to enable health care professionals update existing records. It will help in the revision of policies that are tailored towards reducing the prevalence of head and neck tumours.</p> 2020-08-27T00:00:00+00:00 Copyright (c) Theatre start and turnover times in a developing country 2020-08-27T08:37:48+00:00 Samuel I Nuhu Henry Y Embu Atteh Francis D Daniel Kokong Husseina A Aliyu <p><strong>Background:</strong> Enormous amounts of resources are spent to keep the operating suites running and approximately one-third of total hospital budget is devoted to it. Delays in start or turnover times (TOT) lead to needless cancellations of procedures. Our study seeks to evaluate the causes of delay and to proffer some solutions to these identified reasons.<br><strong>Methods:</strong> A prospective observational study carried out to collect data of elective procedures using a proforma. The causes of delay in starting surgical procedures and turnover times were assessed and documented.<br><strong>Results</strong>: Three hundred and ninety seven elective procedures were evaluated between 2<sup>nd</sup> January and 31<sup>st</sup> July, 2018. All scheduled first procedures were delayed and a third (36%) of subsequent procedures was delayed for between 45-60 minutes. One hundred and forty six (27.2%) of procedures delayed were due to prolongation of time for washing of instruments by perioperative nurses after a procedure and cleaning of the theatre suite by attendants before a subsequent case was brought in. Delays due to challenges with central sterile supply department (CSSD) had 16.0% (86). Other causes of delay included delay in porters transporting patients from ward to theatre (15.6%), and collection of anaesthetic drugs from pharmacy/non-availability which accounted for 10.4%<br><strong>Conclusion</strong>: Multiple factors are responsible for delays in turnover times in the operating room. The commonest cause was washing of instruments and cleaning of theatre suites; others were challenges with the central sterile supply department (CSSD and delay in obtaining drugs from the theatre pharmacy. A multidisciplinary approach where all parties involved in surgery target these specific areas would help improve efficiency and reduce turnover times.</p> <p><strong>Keywords</strong>: Theatre, delays, turnover time, developing country</p> 2020-08-27T00:00:00+00:00 Copyright (c) Successful management of severe HELLP syndrome: A case report 2020-08-27T08:46:49+00:00 Charles U Anyaka Victor C Pam Bulus A Dabu Tinuade A Oyebode Jonathan A Karshima Ishaya C Pam Dapus O Damulak Oche O Agbaji <p>Haemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome is a severe pregnancy complication that is life-threatening for both mother and fetus. When HELLP syndrome associates with disseminated intravascular coagulation (DIC) or with other complications, it is necessary to terminate the pregnancy. We present a case of a 26-year-old primigravida with rare combination of HELLP syndrome with coagulopathy and renal complication at 34 weeks of gestation. She had emergency caesarean section followed by haemorrhagic complications, DIC and acute renal failure.&nbsp; During her stay in intensive care unit, she had massive blood transfusion and fresh frozen plasma. She had haemodialysis because of acute renal failure. A gradual improvement of her condition was observed after exploration and drainage of haemoperitoneum. After 13 days she was discharged from the intensive care unit.<br>HELLP syndrome complicated by DIC and Acute kidney injury is a condition that is associated with high maternal and perinatal morbidity and mortality. Prompt recognition, teamwork and treatment with timely administration of blood products along with other supportive care is crucial in the management of this life-threatening and challenging condition.</p> <p><strong>Key words:</strong> AKI, Preeclampsia, Disseminated intravascular coagulation, HELLP syndrome</p> 2020-08-27T00:00:00+00:00 Copyright (c) Left tubal ectopic gestation coexisting with right pyosalpinx: A case report 2020-08-27T08:50:43+00:00 Chinedu G Obikili Grace Y Yahaya Francis A Magaji <p>Ectopic pregnancy is one of the commonest gynaecological emergencies in the developing world and represents a significant proportion of maternal mortality. A common aetiologic factor is Pelvic Inflammatory disease, which leads to tubal damage that can predispose to ectopic pregnancy. Both conditions tend to be differential diagnosis of each other. However, they are rarely believed to co-exist The clinical case is of a 33-year-old nulliparous woman who presented with lower abdominal pain and vaginal bleeding following 8 weeks of amenorrhoea. She had previously attempted a surgical termination of the pregnancy and ultrasound scan showed a left adnexal mass. She had an exploratory laparotomy with findings of a left tubal ectopic and right pyosalpinx.<br>Although, pelvic inflammatory disease is generally believed not to co-exist with pregnancy, in uncommon circumstances such as these, it can occur. Dilemmas exist, particularly as to management decisions regarding surgical options for both the tube with the implantation and that with the infective inflammation. Clinicians need to be aware that coexistence is possible and management strategies perhaps need to be discussed to maximize potential fertility preservation.</p> <p><strong>Key words:</strong> Ectopic Pregnancy, Pelvic Inflammatory disease, Pyosalpinx</p> 2020-08-27T00:00:00+00:00 Copyright (c)