Highland Medical Research Journal https://www.ajol.info/index.php/hmrj <p>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.</p> en-US highmedresj@gmail.com (Professor Emmanuel I Agaba) maxwell_akanbi@yahoo.com (Professor Emmanuel I Agaba) Fri, 17 Sep 2021 10:36:42 +0000 OJS http://blogs.law.harvard.edu/tech/rss 60 Indications and outcomes of bone marrow aspiration cytology in a Nigerian tertiary hospital: The Federal Medical Centre, Yola experience https://www.ajol.info/index.php/hmrj/article/view/214584 <p><strong>Background</strong>: Bone marrow aspiration (BMA) cytology is a useful investigative tool in the diagnosis of haematological and non- haematological disorders. The purpose of this work was to identify the main indications and diagnostic outcomes of BMA cytology in our facility.</p> <p><strong>Methods:</strong> A retrospective review of all BMA cytology reports of patients that underwent this procedure in Federal Medical Centre, Yola from January 2018 to December 2019 was carried out.</p> <p><strong>Results</strong>: A total of one hundred and four (104) patients underwent BMAs in the period under review. This comprised of 59 (56.7%) males&nbsp; and 45 (43.3%) females. Their ages ranged between 3 and 82 years with median age of 38 years and interquartile range (IQR): 22-55. The most common clinical indication for BMA was recurrent anaemia which accounted for 64.4% of all indications, while the most frequent diagnostic outcome was Megaloblastic Anaemia accounting for 34.6%.</p> <p><strong>Conclusion:</strong> It is concluded that the commonest indication for BMA cytology in our facility is recurrent anaemia. The most frequent&nbsp; diagnostic outcome is megaloblastic anaemia. Considering its safety and cost-effectiveness, BMA cytology is a valuable diagnostic&nbsp; procedure among patients presenting with recurrent anaemia in our environment</p> Jasini James, Ochaka J. Egesie, Obadiah D. Damulak, Ezra D. Jatau, Ayuba Zakari, Chinedu N. Okeke, Chavala G. Nathan, Aisha Bornoma, Anita J.D. Sayi Copyright (c) https://www.ajol.info/index.php/hmrj/article/view/214584 Fri, 17 Sep 2021 00:00:00 +0000 Labour analgesia: A survey of the practice of health care workers in North Central Nigeria https://www.ajol.info/index.php/hmrj/article/view/214585 <p><strong>Background</strong>: Labor is among the most painful experiences a woman will endure. Labor analgesia in low income countries as against&nbsp; developed countries is not in widespread use. This is as a result of issues related to awareness, culture, acceptability and availability of analgesia. This study aims to assess the knowledge, attitude and practices for labor analgesia amongst healthcare workers.<br><strong>Methods:</strong> This was a descriptive cross-sectional questionnairebased study on the knowledge and practice of labor analgesia among practitioners at the Departments of Obstetrics and Gynecology and Family Medicine of the Federal Medical Centre, Keffi.<br><strong>Results:</strong> This study found that despite 92.3% having had education about labor analgesia and 95.2% of respondents believing labor pain should be relieved, 19.2% still believed labor analgesia should not be routinely prescribed. In addition, about 35% of the surveyed health workers had never counseled pregnant women on any form of intra-partum analgesia before, while about 24% had never prescribed labor analgesia.<br><strong>Conclusion:</strong> We found that despite adequate awareness of labor analgesia, a lot of health care workers in the obstetrics unit unfortunately fail to counsel patients on and prescribe labor analgesia. </p> Uche A. Akunaeziri, Abayomi I. Alao, Adeola F. Afolabi, Samuel Pam, Gerald T. Igwemadu Copyright (c) https://www.ajol.info/index.php/hmrj/article/view/214585 Fri, 17 Sep 2021 00:00:00 +0000 Knowledge, attitude and practice of hospital waste disposal among cleaners in a tertiary health institution in Plateau State, Nigeria https://www.ajol.info/index.php/hmrj/article/view/214586 <p><strong>Background:</strong> Hospital waste disposal has become an important public health concern especially in low and middleincome countries.&nbsp; Health hazards could occur where there are inadequate and improper techniques in handling these wastes. The aim of this study was to assess the knowledge, attitude and practice of hospital waste disposal among cleaners in a tertiary hospital of Plateau State, Nigeria.<br><strong>Method:</strong> This was a cross-sectional study carried out among 206 cleaners. Data was collected using a semi-structured interviewer-administered questionnaire. Knowledge, attitude and practice were all graded and scored. Analysis was done using Epi Info version 3.5.4 at a confidence level of 95% and pvalue of &lt; 0.05.<br><strong>Results:</strong> The mean age of respondents was 36.9 ± 9.5 years. The highest level of education was secondary school among 110 (54%) of them and 169 (82%) had been working for =10 years. Knowledge, attitude and practice was good among 83 (41%), 203 (98%) and 17 (8.3%) of respondents respectively. Knowledge grade and previous training were found to have a statistically significant relationship with practice on biomedical waste disposal (p &lt; 0.05).<br><strong>Conclusion:</strong> The study revealed a lack of knowledge and poor practice of hospital waste disposal among hospital cleaners though with most having a good attitude. The hospital needs to train and retrain hospital cleaners, adopt and enforce guidelines specific for their use on medical waste disposal.</p> Chundung A. Miner, Esther L. Ismaila, David S. Omeiza, Beauty C. Ejinmah, Namang D. Akims Copyright (c) https://www.ajol.info/index.php/hmrj/article/view/214586 Fri, 17 Sep 2021 00:00:00 +0000 Knowledge and attitudes of informal workers in Jos-Jarawa Council ward of Plateau State, towards the National Health Insurance Scheme https://www.ajol.info/index.php/hmrj/article/view/214587 <p><strong>Background:</strong> Health insurance has been accepted as an optimal strategy for addressing financial constraints to universal health care. At its introduction in 2005, the Nigerian National Health Insurance Scheme targeted universal coverage by 2015. However, five years&nbsp; afterwards, less than 5% of the population is covered, mostly the formal sector, while largely excluding the informal sector. This study assessed knowledge and attitudes of informal workers towards the scheme in Jos- Jarawa Council Ward of Plateau State. The findings will foster a better understanding of artisans’ health insurance behaviours, and inform future designs of the scheme.</p> <p><strong>Method:</strong> A descriptive, cross sectional design was adopted. One hundred sixty five participants were conveniently sampled and socio-demographic, knowledge and attitudes data of artisans about health insurance collected, using a pretested interviewer administered semi-structured questionnaire. Data analysis was conducted using Epi Info version 3.5.4. Statistical 2 software and Chi-square (X ) was applied to test for statistical significance.</p> <p><strong>Results:</strong> One hundred and eleven (67.3%) of the 165 participants were males and 54 (32.7%) were females, with age range of 15-55 years and median age of 31 years. Majority of the respondents (83.6%) had poor knowledge of the scheme, while155 (93.9%) had negative&nbsp; attitude towards the scheme. Statistically significant relationships existed between education and knowledge, education and attitude and monthly income and attitude about the scheme by respondents.</p> <p><strong>Conclusion:</strong> Knowledge of, and attitudes towards health insurance among artisans was low and poor respectively. Ministries of health and&nbsp; related agencies need to improve health insurance literacy interventions targeting informal workers</p> Iornumbe J. Usar, Joseph T. Akosu Copyright (c) https://www.ajol.info/index.php/hmrj/article/view/214587 Fri, 17 Sep 2021 00:00:00 +0000 Assessing pre-prosthetic rehabilitation outcome of amputees with major limb amputation at the National Orthopaedic Hospital, Dala, Kano https://www.ajol.info/index.php/hmrj/article/view/214588 <p><strong>Background:</strong> Major limb amputation is the removal of part or a whole of a limb proximal to the wrist or the ankle. It is the last, albeit&nbsp; valuable option when limb salvage is impossible. It impacts negatively on patients’ participation in valued activities, body image&nbsp; perception and quality of life, hence multi-disciplinary approach is rewarding.<br><strong>Methods:</strong> A hospital based prospective study carried out at the National Orthopaedic Hospital, Kano between August 2014 and July 2015. A proforma was filled which included demographics, clinical history, diagnosis, type of surgery done and clinical outcome. Rehabilitation was assessed using functional independent measure. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 16.0 for windows.<br><strong>Results:</strong> Fifty four participants completed the study. Patients' age ranged from 18-82 years. Mean age for females was 33 years±16.51 and males 28.36 years±16.62. Thirty (55.6%) were between the ages of 18-30years. Majority(94.4%) were of the working age group (18-60years). Amputations due to trauma (n=46) had higher Functional Independent Measure (FIM) mean score of 117.50±3.582 with a p-value of 0.00 (not significant).&nbsp; Upper limb amputations (n- 15) had better FIM score of 118.67±0.62 with a p-value of 0.00. Patients 60 years&nbsp; and below (n=51) recorded FIM scores of 118.29±1.171 with a P-value of 0.00.(better than the elderly). Females (n=12) had better FIM mean score of 117.67±2.84 with a P-value of 0.00.<br><strong>Conclusion:</strong> Pre-prosthetic rehabilitation is better in amputations due to trauma, in females, younger age group and in upper limbs.</p> Shem B. Yilleng, Celestine A. Nkanta, Ichia I. Onche, Mike B. Ode, Femi O. Taiwo, Aminu M. Nurudeen, David G. Mancha, Idumagbodi Amupitan Copyright (c) https://www.ajol.info/index.php/hmrj/article/view/214588 Fri, 17 Sep 2021 00:00:00 +0000 Pattern of discharge against medical advice amongst paediatric in-patients at Federal Medical Centre, Azare, Nigeria https://www.ajol.info/index.php/hmrj/article/view/214589 <p><strong>Background:</strong> Discharge against medical advice (DAMA) is a common problem in health care delivery in developing countries, including Nigeria. Children are vulnerable in this situation as they may neither comprehend nor contribute to the decisions and it may be that DAMA is not in their best interest. We therefore sought to determine the prevalence rate of DAMA amongst paediatric in-patients at the Federal Medical Centre, Azare.<br><strong>Methods:</strong> This was a retrospective study carried out over a 3 year period from January 2011 to December 2013. Hospital Numbers of&nbsp; patients who were discharged against medical advice were identified from the ward admission and discharge registers for the Paediatric medical ward (PMW) and Special Care baby Unit (SCBU). Folders were retrieved; relevant clinical and socio-economic data were extracted as well as duration of hospital stay. Data was analyzed to generate rates and percentages.<br><strong>Results:</strong> A prevalence rate of DAMA was 4.3% amongst the 3896 children admitted into the wards. PMW had a prevalence rate of 3.5% and SCBU had a prevalence of 6.8%. Acute infections accounted for the majority of admissions, the mean duration of hospital stay was less than one week and the most common documented reason for DAMA was financial constraints (15.5%) on the part of the caregivers.<br><strong>Conclusion:</strong> DAMA is still frequent amongst paediatric patients and financial constraint is the most common reason given by caregivers for the request. Laws and policies enabling health insurance coverage of all children or provision of free health care should be made.</p> Maimuna O. Yusuf, Iragbogie A. Imoudu, Hayatu Ahmad Copyright (c) https://www.ajol.info/index.php/hmrj/article/view/214589 Fri, 17 Sep 2021 00:00:00 +0000 Barriers and facilitators of health-enhancing physical activity behavior among health professional students in a nigerian university setting https://www.ajol.info/index.php/hmrj/article/view/214590 <p><strong>Background:</strong> Health-enhancing physical activity (HEPA) is very beneficial to humans. However, physical activity levels are declining in&nbsp; many countries even among health care professional students. The aim of this study was to investigate the perceived facilitators and barriers to the practice of HEPA among clinical students in a Nigerian University setting.</p> <p><strong>Methods:</strong> The study utilized a mixed method design, which consisted of cross-sectional survey of 217 clinical students and explorative qualitative study involving 21 clinical students of a Nigerian University. Exercise Barriers Scale and Facilitators of Physical Activity&nbsp; Questionnaire with Likert scale response options were used to assess the perceived barriers and facilitators of HEPA respectively. Descriptive statistics were used to summarize the data obtained from the cross-sectional study. Content thematic analysis was used to analyze the explorative qualitative study.</p> <p><strong>Results:</strong> The female participants were 111 (51.85%) and 106 (48.15%) were male participants. The mean (± standard deviation) age of all the participants was 22 ± 2 years. The facilitators of HEPA among the participants include fitness and health benefits; opportunity to interact with others; availability of conducive environment for exercising; availability of time for physical activity and social support. Barriers to HEPA reported by the participants are tiring and fatiguing nature of exercise; lack of convenient schedule at exercise facilities; few available places for exercise, lack of motivation; and study overload.</p> <p><strong>Conclusion:</strong> Barriers and facilitators of HEPA among college clinical students are very remediable factors. University management can encourage students' participation in HEPA by creating enabling environment and time for recreation.</p> Nse A. Odunaiya, Theodora A. Agboola, Emmanuel Okoye, Oluwafemi O. Oguntibeju Copyright (c) https://www.ajol.info/index.php/hmrj/article/view/214590 Fri, 17 Sep 2021 00:00:00 +0000 Outcome of open inter-locking nail for femoral shaft fractures: an effective alternative in a resource restricted environment https://www.ajol.info/index.php/hmrj/article/view/214591 <p><strong>Background:</strong> Femoralshaft fracture remains one of the commonest fractures in adults arising from high velocity forces. Though closed interlocking nail is the standard of management of closed femoral shaft fractures, however it is not always an obtainable resource in poor settings where ignorance on the part of the patient and absence of required equipment for closed reduction on the part of surgeon makes open interlocking nail popular and the best resort. The aim of the study was to show our experience using open locked intramedullary nail in femoral shaft fractures<br><strong>Methods:</strong> This study is a prospective descriptive study carried out at the Orthopaedic Unit of Barau Dikko Teaching Hospital and Rapha Specialist hospital in Kaduna.<br><strong>Results:</strong> In our study, 75% of patients were aged between 21-40 years with mean age of 32.5±5.7 years. The average time of union both radiological and clinically was 13 – 16 weeks in about 34.4% of cases. 23 (71.9%) of our patients had no post up complications, however 2 patients had superficial wound infection, 3 (9.4%) patients had knee stiffness, 2 (6.3%) patients had a &lt;2cm shortening, 1(3.1%) patient had osteomyelitis and 1 (3.1%) patient had an implant failure.<br><strong>Conclusion:</strong> Our study showed a favorable outcome for open interlocking nail in the treatment of closed diaphyseal fractures even in a resource -restricted environment.</p> Nuhu Yusuf, Maryam Z. Danmutum, Godswill J. Auta, Idumagbodi Amupitan Copyright (c) https://www.ajol.info/index.php/hmrj/article/view/214591 Fri, 17 Sep 2021 00:00:00 +0000 Avascular necrosis in children with sickle cell disease: prevalence and pattern of presentation in Jos, Nigeria https://www.ajol.info/index.php/hmrj/article/view/214592 <p><strong>Background:</strong> <em>Avascular necrosis</em> (AVN) is a common orthopaedic complication of sickle cell disease (SCD). Despite the previously reported childhood-onset of AVN, its actual prevalence among children with SCD in Nigeria is not known. Hence, we determined the prevalence and pattern of presentation of AVN in a homogenous paediatric population with SCD in Jos.<br><strong>Methods</strong>: A cross-sectional study of children with SCD aged 5-17 years using a review of data from the SCD-registry of the Paediatric Haematology-oncology unit of Jos University Teaching Hospital from January 2016 to January 2021.<br><strong>Results</strong>: Of the 589 children, 523(88.8%) had haemoglobin SS genotype while 59 (10%) and seven (1.2%) had haemoglobin SS+F and SC genotypes respectively. Thirty- eight children (20 males (52.6%) and 18 (47.4%) females) were diagnosed with AVN of the femoral head giving an overall prevalence of 6.5%. Five of the 38 children had a concomitant AVN of the shoulder giving a prevalence of 0.8%. Their ages at the time of diagnosis of AVN ranged from 7-17 years (mean: 13.6±3.2 years). The prevalence of AVN increased from 1.9% to17.3% among age groups 5-9 years and 15-17 years respectively. Majority of the children (75.8%) presented at the late stages of the disease.<br><strong>Conclusion:</strong> Avascular necrosis of the hip is common among children with SCD and it could occur early in childhood. Most of the children presented at the late stages of the disease. Therefore, we recommend early and routine screening of children with SCD for AVN in Nigeria.</p> Akinyemi O.D. Ofakunrin, Edache S. Okpe, Tolulope O. Afolaranmi, Yetunde F. Taiwo, Femi O. Taiwo, Prince S. Anyebe, Ezra D. Jatau Copyright (c) https://www.ajol.info/index.php/hmrj/article/view/214592 Fri, 17 Sep 2021 00:00:00 +0000 Poor compliance with lifestyle modifications and related factors in hypertension https://www.ajol.info/index.php/hmrj/article/view/214594 <p><strong>Background:</strong> Lifestyle modification (LSM) is the first step in the management of hypertension, and it has good outcomes. These outcomes can only be achieved with good compliance. However, the level of compliance with LSM is not established in our setting. Hence, we sought to determine the level of compliance with LSM, and the related factors in hypertensive patients.<br><strong>Methods:</strong> This was a cross - sectional study of hypertensive patients in a tertiary health centre. An intervieweradministered questionnaire was used to obtain data on socio - demographic variables, and assess the practice of seven aspects of LSM. Compliance with each LSM, and the different LSM assessed were determined. Chi square test was used to determine associations, and p values = 0.05 were significant.<br><strong>Results:</strong> There were 254 respondents with a median age of 63 years, and 104(40.9%) were males. Compliance with each LSM was regular exercises 12.1%; salt restriction 26.4%; increased intake of fruits 21.3% and vegetables 13.4%; low fat diet 31.1%; cessation of smoking&nbsp; 96.6%; and alcohol moderation 87.4%. Generally, sixty – eight (26.8%) had good compliance, while 186 (73.2%) had poor compliance. The association of gender, educational status, and duration of hypertension gave p values of 0.009, 0.006, and 0.00 respectively.<br><strong>Conclusion:</strong> Compliance with LSM is poor among hypertensive patients. Regular physical exercise, increased intake of vegetables and fruits were the least practiced. Low educational status, long history of hypertension, and male gender are the related factors. Measures to address these factors should be initiated.</p> Ehi J. Ogbemudia, Francis E. Odiase Copyright (c) https://www.ajol.info/index.php/hmrj/article/view/214594 Fri, 17 Sep 2021 00:00:00 +0000 Jos christmas eve bomb blast: confronting new challenges with old resources https://www.ajol.info/index.php/hmrj/article/view/214595 <p><strong>Background</strong>: Jos, Nigeria has witnessed several mass casualty incidents from sectarian crises, with mechanisms of injury mainly from blunt forces and use of machetes and less from gunshots. In December 2010, for the first time, twin bomb blasts detonated at a market generating casualties and triggering another crisis. We sought to describe peculiarities of this novel mechanism of mass casualty.<br><strong>Methods</strong>: A retrospective descriptive study of patients who presented to our hospital with injuries sustained following the Jos Christmas Eve bombing of 2010.<br><strong>Results</strong>: Of the 90 patients that presented over 4 days, 81 were males and 9 females. Age ranged from 2 to 76 years with a mean of 36.2 years, SD=± 16. There were 31 (34.4%) blast injuries and 35 (38.9%) gunshot injuries. Majority of the wounds involved the lower limbs in 39(43.3%) patients, and upper limbs in 24(26.6%). Forty three (47.8%) patients required only debridement and 13(14.4%) needed only wound dressing. Definitive procedures done were open reduction and internal fixation in 7(7.7%) patients, laparotomy in 5(5.5%), amputation and local wound exploration in 3(3.3%) each, and chest tube insertion in 2(2.2%) patients. Duration of hospital stay ranged from 0-84 days. More than half of the 14(15.5%) complications were infective in origin. There were 7(7.7%) mortalities. The hospital cost was 14 times higher than that of previous crisis that did not involve bomb blast.<br><strong>Conclusion</strong>: The bomb blasts generated predominantly limb injuries that required a lot of resources and prolonged hospital care..A disaster response protocol that envisages injuries arising from this mechanism is essential.</p> Solomon D. Peter, Kenneth N. Ozoilo, Andrew H. Shitta, Joseph D. Shilong, Idumagbodi Amupitan, Michael B. Ode, Emmanuel O. Ojo, Simon J. Yiltok, Benjamin T. Ugwu Copyright (c) https://www.ajol.info/index.php/hmrj/article/view/214595 Fri, 17 Sep 2021 00:00:00 +0000 Seroprevalence of rubella virus infection in women with recurrent miscarriage: a case control study in Jos, Nigeria https://www.ajol.info/index.php/hmrj/article/view/214598 <p><strong>Background:</strong> Recurrent pregnancy loss is an emotionally and physically tasking situation for couples, especially in developing countries where lack of children is a cultural taboo. <em>Rubella</em> infection in early conception has a 90% probability of developing congenital rubella&nbsp; syndrome (CRS) or miscarriage. The aim of this study was to compare the seroprevalence of <em>rubella</em> virus infection in women with and without recurrent miscarriage.</p> <p><strong>Methods:</strong> It was a hospital based case control study. Sampling was done by purposive. Subjects were recruited consecutively until the&nbsp; required number was reached. Control subjects were selected by simple random sampling. Healthy postnatal women who consented for the study were asked to pick a piece of paper from a covered container, those who picked yes were then recruited. A semi structured researcher administered questionnaire was used to collect data. Enzyme-Linked Immunosorbent Assay (ELISA) was used to check for <em>rubella</em> specific IgG and IgM. We compared the prevalence of rubella virus infection in cases and controls by Chi-square analysis. A p-value &lt; 0.05 was considered significant.</p> <p><strong>Results:</strong> The overall mean age of the participants was 30.62±3.60 years. None of the participants had received rubella virus vaccination. The seroprevalence rates of <em>rubella</em> IgG and IgM among the cases were 85% and 16.7%, while in the controls were 80% and 13.3%. The prevalence of Primary + + <em>rubella</em> infection (IgG IgM ) was 10 (16.7%) and 8 (13.3%) among the cases and the controls respectively. Rubella virus + - seropositivity (IgG IgM ) was 68.3% among cases versus 66.7% - - among controls, and rubella virus seronegativity (IgGIgM) was 15.0% and 20.0% among cases and control respectively.</p> <p><strong>Conclusion:</strong> The high seroprevalence of rubella virus infection observed in this study suggest that majority of women in our setting are exposed to <em>rubella</em> virus infection before pregnancy. There was no significant difference in the seroprevalence of rubella virus infection between women with and those without a history of recurrent miscarriage.</p> Dalyop D. Nyango, Bulus M. Guna, Patrick H. Daru, Amaka N. Ocheke Copyright (c) https://www.ajol.info/index.php/hmrj/article/view/214598 Fri, 17 Sep 2021 00:00:00 +0000 Erratum https://www.ajol.info/index.php/hmrj/article/view/214599 <p>No Abstract.</p> Emmanuel I. Agaba Copyright (c) https://www.ajol.info/index.php/hmrj/article/view/214599 Fri, 17 Sep 2021 00:00:00 +0000 Gynaecomastia, erectile dysfunction and subfertility from tramadol abuse in a protracted case of left tilbiofibula nonunion: A case report https://www.ajol.info/index.php/hmrj/article/view/214600 <p><strong>Introduction</strong>: The abuse of tramadol is on the increase and has attained epidemic proportion globally. Tramadol, a synthetic opioid is frequently prescribed to manage moderate to severe pain. The aim of this case report is to highlight the possible rare side effects of tramadol abuse in an orthopaedic surgical patient.<br><strong>Case report:</strong> A 37 year old married school teacher who had left Tibiofibular nonunion resulting from a poorly managed Gustillo-Anderson IIIc tibio-fibular fracture in a road traffic crash about 7 years earlier with associated chronic pain, deformity and limb length inequality for which he started selfmedication with tramadol, escalating to 1.5grams per day over the 7 year period. He had two children but his wife had not conceived in the past six years and there was associated poor erection. Examination findings of dysfunctional and insensate foot, tanner stage IV bilateral gynaecomastia and a score of 10 out of 30 on assessment of erectile dysfunction using international index of erectile function (IIEF) questionnaire. Ultrasound report showed normal breast tissues and loss of normal testicular echotexture, high luteinising hormone level and low testosterone level. His rehabilitation included tramadol withdrawal therapy, below knee amputation and prosthetic fitting . At his six months follow up visit, he had improved IIEF score of 20, his hormonal levels had normalized, and his wife was pregnant.<br><strong>Conclusion</strong>: Prolonged use of high doses of tramadol is an uncommon cause of gynaecomastia, erectile dysfunction and subfertility essentially due to testicular atrophy and testosterone suppression. Clinicians should prescribe this medication with caution and adopt multimodal analgesia therapy in management of chronic pain.</p> Theclar O. Iyidobi, Ndubuisi E. Duru, Franklin C. Onye, Uche S. Ozioko, Cajetan U. Nwadinigwe, Remigus T. Ekwunife, Emmanuel C. Iyidobi Copyright (c) https://www.ajol.info/index.php/hmrj/article/view/214600 Fri, 17 Sep 2021 00:00:00 +0000