Jos Journal of Medicine

Violence against health care workers: Why de-escalation must become a core clinical skill

Bwatyum Annah Gyang — 2026-09-07

No Abstract

Antibiotics susceptibility pattern of Salmonella typhi isolates in Jos University Teaching Hospital, Plateau State, Nigeria

J.N. Nakah — 2026-09-07

Background: Enteric fever (typhoid fever) is caused by Salmonella enterica serotype Typhi (S. Typhi). It is
transmitted through ingestion of food or drinks contaminated by the faeces or urine of infected individuals. Typhoid
fever is endemic in many developing countries and remains a major public health challenge despite improvements in
the provision of potable drinking water and environmental sanitation. Traditionally, first-line treatment includes
Chloramphenicol, Ampicillin, Amoxicillin, Trimethoprim-Sulphamethoxazole and Fluoroquinolones. In case of
quinolone resistance, Azithromycin and third-generation Cephalosporins such as Ceftriaxone are recommended as
they are the second-line treatment for typhoid fever. For severe infections, parenteral antibiotics including thirdgeneration cephalosporins, fluoroquinolones, and carbapenems are commonly used.
Aim: This study aimed to determine the antibiotic susceptibility patterns of Salmonella Typhi isolated from patients
in Jos University Teaching Hospital (JUTH), Plateau State, Nigeria.
Methods: The study was a descriptive cross-sectional study involving a total of 40 non-replicated isolates of
Salmonella Typhi recovered from clinical specimens (blood and stool) of patients attending JUTH, Plateau State,
Nigeria. The selection was done consecutively until 40 isolates were obtained from 2112 Gram-negative bacilli. The
isolates were identified phenotypically and confirmed using Nested polymerase chain reaction (PCR). Antimicrobial
susceptibility testing was performed using the modified Kirby-Bauer disk diffusion method according to Clinical
Laboratory Standards Institute (CLSI) guidelines. The antibiotics tested include; ampicillin (10ìg) chloramphenicol
(30ìg), trimethoprim-sulfamethoxazole (1.25/23.75ìg), tetracycline (30ìg), ciprofloxacin (5ìg), ceftriaxone
(30ìg), ceftazidime (30ìg), meropenem (10ìg), Amoxicillin-clavulanate (20/10ìg), aztreonam (30ìg), and
azithromycin (15ìg).
Results: A total of 40 S. Typhi isolates were analyzed. High susceptibility to meropenem (92.5%) was observed,
followed by ciprofloxacin (65.0%) and amoxicillin-clavulanate (62.5%). Moderate susceptibility of 40.0% was noted
for both ceftriaxone and aztreonam. In contrast, resistance was high to trimethoprim-sulfamethoxazole (72.5%),
tetracycline (72.5%), ampicillin (70.0%), azithromycin (65.0%), and chloramphenicol (62.5%). Multidrug resistance
was detected among 37 (92.5%) isolates.
Conclusion/Recommendations:The study demonstrated a high prevalence of multidrug-resistant S. Typhi isolates,
with marked resistance to commonly used first-line agents such as trimethoprim-sulfamethoxazole, tetracycline,
ampicillin, and chloramphenicol, and also to the second-line agent azithromycin. These findings highlight the urgent
need for continuous antimicrobial resistance surveillance, rational antibiotic use, and strengthened infection
prevention strategies to guide effective treatment of enteric fever in this setting.

Anthropometric parameters as determinants of pre-diabetes in middle-aged adults attending the General Outpatient Clinic of Jos University Teaching Hospital, Jos, Nigeria

Chris Mbubah — 2026-09-07

Background: Prediabetes is a condition in which blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes mellitus. It is estimated that 10–23% of individuals with prediabetes progress to type 2 diabetes within five years. Early identification provides an opportunity for intervention to prevent disease progression.
Aim: To determine the best anthropometric predictor of prediabetes among middle-aged adults attending the General Outpatient Clinic (GOPC) of Jos University Teaching Hospital.

Methods: This was a hospital-based descriptive cross-sectional study conducted among 265 middle-aged adults (45–65 years) attending the GOPC of Jos University Teaching Hospital (JUTH). Data were collected using a structured, interviewer-administered questionnaire to capture socio-demographic characteristics and relevant clinical measurements. Anthropometric parameters (weight, height, and waist and hip circumferences) were measured to calculate Body Mass Index (BMI) and Waist-Hip Ratio (WHR), and fasting blood sugar was measured with a calibrated glucometer. Data were analysed using SPSS version 23.0. Statistical significance was set at p<0.05.
Results:The prevalence of prediabetes was 43.4%. Mean waist circumference, hip circumference, BMI, and WHR were significantly higher among participants with prediabetes (p<0.05). Receiver operating characteristic (ROC) analysis showed that waist circumference had the highest predictive value with an AUC of 0.908 (95% CI: 0.873–0.943).
Conclusion: There was a significant correlation between fasting blood sugar and anthropometric measurements. The best anthropometric predictor of prediabetes was waist circumference (WC), followed by body mass index (BMI). Routine clinical screening using waist circumference and BMI is highly recommended for middle-aged adults to ensure early detection and management of prediabetes.

Effect of clonidine as an adjuvant to bupivacaine in spinal anaesthesia for prostate brachytherapy

Olusola K Idowu — 2026-09-07

Background: Spinal anaesthesia is the preferred technique for patients scheduled for brachytherapy, particularly for urological, gynaecological, and lower rectal cancers, due to its quick onset of sensory block, effective analgesia, and overall efficacy as an anaesthetic agent. When combined with clonidine as an adjuvant to low-dose bupivacaine, it may also prolong the duration of both sensory and motor blocks, making it suitable for day-case procedures and other related interventions.

Objective: To study the effect of clonidine as an adjuvant to low-dose bupivacaine when given intrathecally, and to compare the efficacy in terms of duration of analgesia and complications.

Method: Aprospective randomized double-blind controlled study was conducted at the University College Hospital, Ibadan, Nigeria, involving 44 patients scheduled for prostate brachytherapy. Patients were randomized into two groups: Group BC (study group) and Group B (control group). Group BC received 10mg of 0.5% bupivacaine plus clonidine, while Group B received 15 mg of 0.5% heavy bupivacaine (3 mL). The duration of sensory and motor blocks, time to first request for analgesic (TFA), and Bromage score were determined and compared using a t-test for TFA and a chi-square test for the Bromage score. Structured questionnaires were used to collect patients' information following informed consent, and data analysis was® performed using the Statistical Package for Scientific Solutions (IBM SPSS version 23.0 ). Results were presented using frequency tables, bar charts, graphs, and pie charts.

Results: There was no difference in the demographic characteristics and other clinical conditions. The preoperative numerical rating scale (NRS) score also showed no statistically significant difference between the groups. However, the duration of anaesthesia was prolonged in the clonidine-bupivacaine group, compared to the bupivacaine group, with p = 0.013. The sensory block was denser in the clonidinebupivacaine group compared to the bupivacaine group, and the participants in the clonidine-bupivacaine group also showed a higher level of satisfaction compared to the bupivacaine group. There was no difference in the length of hospital stay between the groups.

Conclusion: In our study, 75 ìg intrathecal clonidine used as an adjuvant to 10 mg hyperbaric bupivacaine significantly prolonged the duration of analgesia without increasing complications.

Community health officer training during the COVID-19 pandemic: Trainee insights on virtual versus face-to-face Learning

Dabota Yvonne Buowari — 2026-09-07

Background: Medical education is necessary for all healthcare workers as medicine is not static, with discoveries and inventions. It was a challenging task during the COVID-19 pandemic due to the various preventive strategies to contain the spread of the severe acute respiratory syndrome coronavirus-2 (SAR-C0V-2), for instance, physical and social distancing, lockdowns, and curfews.
Aim of Study: To determine the preferred method of learning of Community Health Officer (CHO) trainees at the University of Port Harcourt Teaching Hospital during the COVID-19 pandemic.
Methodology: This is a prospective cross-sectional study conducted among community health officers' trainees undertaking the Community Health Officers Training Programme at the University of Port Harcourt Teaching Hospital, Rivers State. A self-administered 12-item semi-structured questionnaire was utilized for the study. The study was carried out in 2021.
Results: The number of participants in this study was 33; it comprised 21(63.6%) females and 12(36.4%) males; 25 (75.8%) were already working. Most of the participants (78.8%) joined the lectures online from home. The majority of the participants (63.6%) preferred virtual teaching to having the lectures face-to-face, and 11(33.3%) believed that the face-to-face learning format worked better for them than the virtual teaching format. The perceived benefits of virtual learning over face-to-face teaching are convenience (30%), saving time (18%), being stress-free (11%), and enhancing learning (9%). The most perceived drawbacks of virtual teaching are the cost of data (21%), distractions (11%), and poor information and computer technology skills (7%). The perceived drawbacks of face-to-face learning are time-consuming (9%) and poor attendance participation (7%), among other reasons. No significant difference existed in achieving the objectives of learning between learning virtually (45.5%) or physically (face-to-face) (54.5%). In a non-pandemic world, 63.6% would prefer web-based learning.
Conclusion: Medical education has continued despite the curfews, lockdowns, and social and physical distancing as preventive measures during the pandemic. Information technology is relatively not well established in Nigeria, coupled with the challenges of epileptic electricity and the high cost of internet services. Achievement of the learning objectives is guaranteed irrespective of the way the academic content is delivered.

Electrocardiographic variability in dextrocardia with situs solitus and dextrocardia with situs inversus: A pattern or coincidence

Enenche Alex Augustine — 2026-09-07

Introduction: Dextrocardia is a rare congenital anomaly characterized by the abnormal positioning of the
heart within the chest cavity, which presents diagnostic challenges in clinical practice. An
electrocardiogram (ECG) is the most commonly used diagnostic modality for heart disease. The typical
ECG finding in a patient with dextrocardia is variable across different populations.
Aim: In this study, we report cases of a 63-year-old and a 47-year-old patient who were diagnosed with
dextrocardia with sinus inversus and situs solitus, respectively. We aim to compare their clinical
presentation and corresponding electrocardiographic findings with a view to determining common
presentation patterns of Dextrocardia in our population.
Results: The ECG findings were of predominantly negative P wave and QRS complex, with positive P
wave and positive QRS complex in aVR, while the second patient had a positive Pwave with QRS complex
predominantly negative in lead III, aVF, aVL, and precordial leads V1-V4.
Conclusion: Dextrocardia, though a rare condition, exists among the population; the majority are
asymptomatic, but some may present with symptoms that could be cardiac or non-cardiac. ECG variability
exists among patients with dextrocardia with situs inversus and dextrocardia with situs solitus, and
confirmation with clinical findings is important.

Tenon's patch grafting for traumatic corneal perforation in a child: A cost-effective globe-saving approach in a resource-limited setting

Tenmang Panshak Elisha — 2026-09-07

Background: Corneal perforation is an ophthalmic emergency that threatens both vision and the integrity of the globe. Prompt intervention is essential to prevent irreversible visual loss and preserve the anatomical integrity of the globe. In many low-resource settings, access to donor corneal tissue and tissue adhesives is often limited, making alternative approaches necessary.
Case Presentation: We report the case of a six-year-old Nigerian girl who presented with a three-week history of right eye trauma following an injury with a wooden stick. She complained of pain, tearing, redness, photophobia, foreign body sensation, and progressive reduction in vision. Examination revealed a 4 × 4 mm inferior corneal perforation with iris prolapse, a shallow anterior chamber, and hypotony. The patient underwent examination under anaesthesia, excision of non-viable prolapsed iris tissue, and Tenon's patch grafting with placement of a bandage contact lens.
Outcome:The anatomical integrity of the globe was successfully restored. By four weeks after surgery, the eye was quiet, tearing had resolved, and visual acuity had improved to 6/9. The sutures and bandage contact lens were removed after eight weeks, and the patient remained stable on follow-up.
Conclusion:Tenon's patch grafting is an effective and inexpensive option for managing moderate-sized corneal perforations in resource-constrained environments. It provides tectonic support, promotes healing, and avoids the challenges associated with donor tissue availability and graft rejection.

A very curious case of the flying femoral head – an open anterior neck of femur fracture-dislocation with femoral head lying outside

N.S. Jeplah — 2026-09-07

Introduction: Hip dislocations are typically high-energy injuries, with posterior dislocations accounting for most cases. Anterior hip dislocations are uncommon, while open anterior dislocations associated with a femoral neck fracture are exceptionally rare. These injuries usually result from high-energy trauma and are often accompanied by extensive soft tissue damage. Here, we report a case of a 35-year-old man with open femoral neck fracture dislocation.

Case study: The patient is a 35-year-old man with left open anterior femoral head dislocation and ipsilateral basicervical femoral neck fracture (Gustilo and Anderson 3A) with only a small strand of soft tissue holding the exteriorised femoral head following a tricycle-motor vehicular crash. The patient was resuscitated and had wound debridement, completing the removal of the femoral head, irrigation of the wound with normal saline, direct closure of the wound, and weighted skeletal traction application. The patient is being considered for total hip replacement after infection control and initial care.

Conclusion: Although femoral neck fracture is a common orthopaedic injury, it is rarely associated with open anterior fracture dislocation. Appropriate diagnosis, injury classification to aid treatment planning, and multidisciplinary management are necessary for optimal outcome.