Jos Journal of Medicine

Reducing the risks of nuclear war —the role of health professionals

2024-04-09T17:16:34+00:00

No abstract

Fructosamine as an index of glycaemia of type 2 diabetes mellitus patients at Jos University Teaching Hospital

2024-04-10T05:06:29+00:00

Introduction: With increasing prevalence of DM worldwide and imported lifestyle changes in our environment, there is a compelling need for adequate treatment and improved/novel monitoring tools.Fructosamine therefore may be useful as a complementary or substitute monitoring index given that is cheaper, technically easier to perform than HbA and the assays have now been standardized and 1c automated. This study aimed to determine the serum fructosamine concentration and the albumin adjusted fructosamine in type 2 diabetes mellitus patient as a measure of monitoring plasma glucose.
Methods: A cross-sectional study involving 180 study participants. A structured questionnaire was administered. The analysis was done using SPSS. Descriptive and inferential statistics were used with p < 0.05 considered statistically significant. Ethical clearance and informed consent were obtained before the commencement of the study. Participants were T2DM patients of JUTH aged 18-65 years while controls were healthy non-diabetic consenting staff of JUTH/clinical students of University of Jos. Samples collected were assayed for HbA1c, fasting glucose, Fructosamine and albumin.
Results: A hundred and twenty T2DM and 60 controls participated in the study. There were more females (87) than males (33) T2DM patients. The mean Fasting Blood Glucose (FBG), Fructosamine, HbA1c and Albumin amongst patients was 9.4±4.9 mmol/L, 392.5±137.1 μmol/L, 8.6±2.7% and 48.0±5.4 g/L compared to controls of 4.8±0.5 mmol/L, 258.7±21.0 μmol/L, 5.6±0.5 % and 50.9±2.6 g/L respectively. The differences in the mean FBG, fructosamine and HbA levels among patients and controls was IC statistically significant (P<0.001). Adjusted fructosamine using three different formulae showed higher adjusted fructosamine in patients than in controls (P<0.001). Serum Albumin however was significantly higher in controls than patients with a p-value of less than 0.001.
Conclusion: This study has shown that serum fructosamine correlate significantly with the FBG among T2DM patients and even revealed a slightly better correlation than HbA and can therefore be used to 1c monitor blood glucose level among T2DM patients requiring a shorter period of follow-up and with financial constraints.

Factors contributing to home delivery amongst women utilizing antenatal services in Jos University Teaching Hospital

2024-04-10T05:25:30+00:00

Background: Unskilled home delivery is a threat to maternal and child health and one of the factors associated with the very high maternal and fetal mortality is the occurrence of home deliveries as they are largely unplanned, accidental and unhygienic. The objective of this study was to determine the prevalence of home delivery among antenatal clinic attendees as well as factors contributing to their choice of place of delivery.
Methods: This was a cross sectional descriptive study that sampled the opinions of three hundred and forty (340) consenting pregnant women in Jos University Teaching Hospital using pretested and semi structured questionnaires which were self administered. Chi-squared test of statistical significance was used determine relationships between relevant variables with p value set at 0.05.
Results: The prevalence of home delivery was 23.5% and high cost of hospital deliveries was the most predominant reason for home deliveries by the participants (76.5%). Other reasons for home delivery included unexpected labour (75.6%), long distance from the health facility (66.5%) and unfriendly attitude of health workers (49.1%) amongst others. Home deliveries was significantly associated with low educational attainment (p<0.0001), polygamous family setting (p<0.05), Hausa Fulani ethnicity (p<0.0001), Islamic religion (p<0.0001) and petty trading (p<0.0001). Obstetric complications were also more likely when respondents delivered at home compared to hospital deliveries.
Conclusion: The high prevalence of home deliveries attributable to the inability of women to afford the cost of hospital deliveries shows the need for a subsidization of maternal and child health services, improved economic empowerment of women and elimination of bureaucracy and bottlenecks that increases the cost of institutional deliveries.

Echocardiographic assessment of pulmonary hypertension in patients with chronic kidney disease seen at the Jos University Teaching Hospital

2024-04-10T05:33:51+00:00

Background: Pulmonary hypertension (PH) is common in patients with chronic kidney disease (CKD) and is an independent predictor of mortality. It is a major public health issue that can lead to renal failure, heart disease, and early mortality. This study aims to assess the prevalence of pulmonary hypertension in patients with chronic kidney disease seen at JUTH.
Methods: A hospital-based cross-sectional study was conducted where 69 CKD patients were selected using a convenience sampling technique. The mean pulmonary arterial pressure (mPAP) of CKD patients was determined using transthoracic echocardiography. Chi-square and ANOVA were used to test for a significant difference in the prevalence of PH in different stages of CKD and levels of PAP based on severity in CKD patients respectively.
Results: Out of the 69 participants, 18 (26.1%) had elevated mPAP that was >24mmHg, of which 16 (23.3%) were mildly elevated with an mPAP of 29.6 mmHg, 1(1.4%) were moderately elevated with mPAP of 46.0 mmHg, and 1(1.4%) also had severely elevated PAP with a mean value of 58.0 mmHg. Most of the CKD patients were in stage 5 – 13(18.8%) while a few were in stage 2 and stage 3 representing 1 (1.4%) each.
Conclusion: Patients with CKD frequently experience pulmonary hypertension, and this rises as renal failure worsens. Therefore, echocardiography is advised for assessing pulmonary pressures in CKD patients in stage 3 and above, and for subsequent monitoring of the disease progression and response to treatment.

Challenges in early diagnosis of heart failure in Sub Saharan Africa – a review

2024-04-10T05:41:35+00:00

Heart Failure, a rising public health concern has become more prevalent in the Sub Saharan Africa (SSA) in recent times. It is a major cause of high mortality and morbidity with frequent hospitalizations and high economic cost. Majority of heart failure cases in the SSA are due mainly to hypertensive disease, non–Ischemic causes (Cardiomyopathy), and rheumatic disease. However, the reverse is the case in high income countries where heart disease is linked to ischemic causes. Generally, hypertension has been reported to be a major cause of heart failure across the globe. The most challenging aspect in the diagnosis of heart failure in SSA is the lack of basic tools and the necessary human resources. Also, the unavailability of support facilities and services, high cost of drugs, weak health care systems that are over burdened with infectious diseases and poor access to guideline–directed medical treatment. Overall, prevention of hypertension, community blood pressure screening, physical activities, healthy living and working environment as well as access to effective health care are necessary preventive measures of cardiovascular diseases in SSA. This review is an observational study of 20-yr duration to examine the challenges of early diagnoses of heart failure in SSA and how to overcome them.

The effect of storage on full blood count in different anticoagulants

2024-04-10T05:46:49+00:00

Background: The effect of storage on full blood count in different anticoagulant was determined in view of its importance on the reliability and validity of test results as the quality of sample stored would determine the quality of results.
Methodology: A total of twenty-five samples of apparently healthy individual were assessed for their Packed cell volume (PCV), total leucocytes count (TLC), platelets count and blood cell morphology by storing 2mls each of their blood sample in Ethylenediamine tetra acetic acid (EDTA), trisodium citrate, lithium heparin, fluoride oxalate and CPDA anticoagulants for a period of 24hrs, 48hrs 72hrs, and 96hrs at 40C to determine any changes that would occur.
Result: The PCV record a higher result (35.18 - 40.02%) with statistically significant different PCV of sample in EDTA, CPDA and those in trisodium citrate, lithium heparin (P< 0.05). Fluoride oxalate and trisodium citrate had more degenerative changes on the red blood cell morphology than EDTA and CPDA, Lithium heparin showed significant changes for white blood cell count, mild thrombocytopenia was found in samples stored after 72hrs in all anticoagulant as compared with initial platelet estimate at the time of collection. On the other hand, no significant changes of white blood cell morphology occurred after their storage in all anticoagulant except fluoride oxalate. The result showed more degenerative changes in fluoride oxalate, trisodium citrate and lithium heparin than CPDA and EDTA. Samples stored for 24 hours at 40C would not result in significant changes in blood parameters.
Conclusion: Based on these findings EDTA is the recommended anticoagulant of choice for haematological work and storage of specimen for analysis should not be encouraged as it adversely affects full blood count. Also, haematological laboratories are advised not to keep samples beyond 24 hours at 40C for reliability of test results.

Burnout and perceived family and social support of a cross-section of female senior registrars in the Nigerian residency programme

2024-04-11T15:18:38+00:00

Background- Burnout has been noted to be increasing in prevalence among doctors undergoing residency training, and the female gender is especially vulnerable to burnout. Not many studies have isolated female doctors in residency as subjects for a study on burnout rates and related factors. This study was designed to measure the burnout rate and perceived family and social support among female doctors across residency training programmes in Nigeria.
Methodology- This was a cross-sectional study which used the Oldenburg Burnout Inventory (OLBI) Instrument to assess the burnout rate and the multidimensional scale of perceived social support to assess the perceived support received by the study respondents. Data for a total of 55 respondents was analysed using the 6.2.14, Microsoft Excel 2021 (v16.0)
Results- The study respondents were distributed across 11 residency specialty areas located across Nigeria with an age range of 29- 50 years, an average age of 35.1±3.55 years. Most (89.2%) of the study respondents were married and had been in the residency programme for an average of 3.9±1.41 years. The majority (63.6%) of the study respondents were found to have high burnout, with 32.7% having moderate burnout and 3.7% had low burnout. The exhaustion component was overwhelming (96.35% had high exhaustion) while 100% had low disengagement) in the burnout spectrum. The study respondents perceived that they received the most support from their spouses (94.6%), parents (93.9%), siblings (88.9%) and friends (86.5%) and at the time of the survey, they noted that their most significant source of stress was from coworkers (72%).
Conclusion- There is a need to explore the workplace of Female Doctors in residency to address the factors that increase their vulnerability to stress and subsequently burnout.

Knowledge, attitude and practice of hepatitis b and its transmission from mother to child among pregnant women attending antenatal clinics in Jos University Teaching Hospital

2024-04-11T16:58:43+00:00

Background: Hepatitis B virus(HBV) infection remains a serious public health problem worldwide. Mother-to-child transmission (MTCT) of HBV is the major mode of transmission in HBV-endemic areas, including Nigeria, where little is known about pregnant women's knowledge of and attitudes towards HBV infection and MTCT.
Methodology: A cross-sectional study conducted over a 3-month period among 361 consenting pregnant women attending antenatal clinic at the Jos University Teaching Hospital, Plateau State, Nigeria. A structured self-administered questionnaire was used to extract information from the respondents. Data was analyzed with IBM SPSS statistics version 23.0
Result: Socio-demographic characteristics of participants revealed that most of the participants(47.1%) were aged between 27-38 years. The Majority were married (93.6%), Christains (62.6%), resided in Urban areas (68.1%), had tertiary education (57.3%) and were unemployed (41.6%). Overall 51.0% of the participants had adequate knowledge about the Hepatitis B virus while most of the pregnant women (59.3%) had negative attitude toward Hepatitis B. Practice of safety measures for Hepatitis showed that about half (51.2%) of the participants had done screening for Hepatitis. The level of vaccination against Hepatitis B was however low (36.0%) among the study participants.
Conclusion: The results highlighted the need to prioritize educating pregnant women and mothers in future public health campaigns to increase knowledge, reduce misperception and improve hepatitis B vaccination. The overall knowledge of participants was found to be inadequate, and their attitude and practice were also limited. In this study, poor knowledge about the transmission of HBV from mother to child was evident.

Assessment of knowledge of risk factors for ectopic pregnancy and associated factors among female undergraduates of University of Jos

2024-04-11T17:10:58+00:00

Background: Ectopic pregnancy a major gynaecological problem and leading cause of maternal mortality. It is assuming greater importance from increasing incidence and impact on women's fertility; as late presentation makes its burden larger among women in developing countries.
Objective: To assess the level of knowledge and prevalence of risk factors for ectopic pregnancy among female undergraduates of the University of Jos.
Method: A cross-sectional survey carried out among 347 students who lived in the hostels of the University of Jos using a multistage sampling technique. Data was analyzed using SPSS. Descriptive statistics was presented as frequencies and percentages. Other statistical tests used include Chi-square and Fisher's exact at p<0.05 level of significance.
Results: Almost a quarter (24.8%) of the participants had good knowledge, about half (49.0%) had moderate knowledge while slightly above a quarter (26.2%) had poor knowledge of ectopic pregnancy. A statistically significant relationship was observed when multiple sexual partners (X²=63.42; p=0.000); prior PID (X²=117.22; p=0.000); OCP use (X²=93.50; p=0.000); induced abortion (X²=140.62; p=0.000); tubal surgery(X²=88.09; p=0.000); smoking (X²=7.76; p=0.021); and the number of sexual partners was compared with knowledge of ectopic pregnancy (X²=36.20; p=0.003), but none when marital status was compared with knowledge (X²12.302; p=0.138). The most prevalent risk factors included the use of oral contraceptives, prior PID 37(10.7%), alcohol intake 34 (9.8%), induced abortion 33(9.5%) and multiple sexual partners 43(16.3%) of 264 sexually active respondents.
Conclusion: Women of reproductive age group should be educated on the knowledge of symptoms and risk factors of ectopic pregnancy to reduce the morbidity and mortality associated with it.

Postdate unruptured ovarian ectopic pregnancy: A case report

2024-04-11T05:11:36+00:00

Advance ovarian ectopic pregnancy (OEP) is a very rare condition and is typically difficult to diagnose and associated with high maternal and neonatal morbidity and mortality. We present a case report of a primigravida diagnosed with a postdate ovarian ectopic pregnancy at laparotomy