Jos Journal of Medicine

Views of early career doctors on residency training and clinical practice in Nigeria: A qualitative report from charting study

Thu, 01 Apr 2021 00:00:00 +0000

In Nigeria, Early Career Doctors (ECDs) constitute a significant number of the doctor's health workforce and play a crucial role in health service delivery. However, there is a paucity of data concerning attitude, perception, and challenges in training and skill acquisition faced by ECDs undergoing residency training in Nigeria. This study is a component of Challenges of Residency training and early career doctors in Nigeria (CHARTING study) a multicentre and multidisciplinary study that explored the views of ECDs on residency training and clinical practice in Nigeria.

Methods: Focus Group Discussions (FGD) were conducted among fourteen respondents, to address specific aspects of the residency training program and encourage respondents to express themselves about issues relevant to their personal experiences as regards the assessment of practice and proffer recommendations. Discussions were digitally recorded with an audio recorder. Audio-recordings was transcribed verbatim. Transcripts were analysed, and coding was done using NVivo 12 program.

Results: All the study participants expressed various degrees of dissatisfaction and challenges such as lack of up to date knowledge, poor&contingent rewards, workload distribution, lack of mentorship, and unequipped facility during the residency training program. Majority of the study participants considered the program is currently skewed towards service delivery at the detriment of training and research.

Conclusion: The study provided robust information on the knowledge of the trainees' perception of the residency training program in Nigeria as well as the challenges of residency training among ECDs as regards their experience and practice; it also proffered recommendations to mitigate the challenges.

Keywords: Career, Internship, Postgraduate, Registrar, Trainee, Residency, Doctors, Dentist, Early Career Doctors, Nigeria, Education, Graduate Medical, Residency

Spirituality And Medicine: Should Patients Be Allowed to Exhibit Their Religious and Spiritual Beliefs While Receiving Medical Care?

Dabota Yvonne Buowari — Thu, 01 Apr 2021 00:00:00 +0000

Background: Religion is a collective worship while spirituality is an individual practice of religious beliefs. There are various religious and spiritual perception to disease, ill-health and caring for the sick.
Case Summary: This is a case of a 27 year old Nigerian motor mechanic who presented with hypovolaemic shock due to chronic diarrhoea. Access to intravenous cannulation for resuscitation was difficult and patient and his caregivers suggested that money be used to torch the intravenous cannula for intravenous access to be successful. The patient was not allowed to torch the intravenous cannula with money. Intravenous access was successful after two more attempts as the patient was in shock at presentation.
Conclusion: Patent education is necessary at all times as various beliefs may be attached to the illnesses. Though patients may have psychological satisfaction if allowed to practice their religious beliefs while receiving medical care, it may cause conflict.

Evaluation of infertile women using transvaginal ultrasound in a tertiary health facility

H.O. Kolade-Yunusa, H.I. Abdullahi , A.J. Salaam — Thu, 01 Apr 2021 00:00:00 +0000

Background: Ultrasound is one of the first imaging modalities in evaluation of infertile women and generally all women undergo an initial pelvic ultrasound to detect any probable cause of infertility. The aim is to document transvaginal ultrasound findings in women being evaluated for infertility.
Materials and methods: This was a descriptive cross-sectional study conducted at the radiology department, University of Abuja teaching hospital, between May 2015 and April 2016. All patients who were being evaluated for infertility and had a trans-vaginal scan within the study period were documented.
Result: The mean age of two hundred and three infertile patients evaluated with mean age of 32±19 years and age range of 15-49years. The predominant age group was 25-34 years accounting for 86(42.4%). Primary infertility constituted 85(41.9%) while secondary infertility was 118(58.1%).Out of 203 patients, 110(54.2%) had normal findings on TVS while the remaining 93(45.8%) of patients had abnormal ultrasound. This was statistically significant p=0.02.Uterine fibroid, fluid in POD, polycystic ovary were the common pathologies seen on TVS with uterine fibroid the most common. The commonest combined TVS findings were fluid in POD, endometritis and hydrosalphinx. There was significant difference between right and left ovarian volume among infertile patients with polycystic ovaries.
Conclusion: The study has showed high yield of sonographicabnormalities detected on TVS among patients with infertility further buttressing the pivotalrole of TVS as an invaluable tool for investigating infertile women.

Keywords: Infertility,transvaginal,ultrasound, women

Determinants of severity of hyperbilirubinaemiaamong glucose-6- phosphate dehydrogenase deficient neonates in Jos north central Nigeria

E.D. Jatau, O.D. Damulak, B.O. Toma, V.T. Ma'an , O.A. Adeyemi , O.J. Egesie — Thu, 01 Apr 2021 00:00:00 +0000

Introduction: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an inherited disorder capable of causing severe neonatal hyperbilirubinaemia, kernicterus and death. Identifying such neonates and other factors that could aggravate their clinical states have definite place in managing them for favourable outcomes.
Materials and Methods: One hundred and fifty (150) icteric neonates admitted into the Special Care Baby Units of the Jos University Teaching Hospital, Plateau State Special Hospital and the Bingham University Teaching Hospital were recruited for this study. It was a cross sectional descriptive study conducted between March 2013 and February 2014. Parental consents were obtained and Clinical information was gathered using a questionnaire, weight were measured in grams while laboratory investigations that included Full
Blood Count (FBC), Reticulocyte Count, Serum Bilirubin (SB) Assay and G6PD activity levels were carried out.
Results: Mean age of the studied neonates at presentation was 3.28 ± 3.11 days while mean age of detection of jaundice was 2.86 ± 1.67. One hundred and five (70%) were delivered at full-term gestation (>37weeks) while 45 (30%) were delivered preterm (<37 weeks) with twenty-nine (19.3%) having history of jaundice in siblings. Fifty (35.7%) had birth weight of less than 2500g while the birth weight of 10 (6.7%) were unknown. Sixty-one of these neonates (40.7 %) were G6PD deficient with mean total serum bilirubin of 205.01 ±
96.57µmol/L.
Conclusion: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a common enzyme disorder among neonates presenting with hyperbilirubinaemia which can be aggravated by other factors.

Key words: Determinants, Hyperbilirubinaemia, Glucose-6-phosphate dehydrogenase deficiency, Neonates

Comparison of the knowledge of ionizing radiation among radiodiagnostic staff of Secondary and Tertiary Hospitals in Jos

C.C. Ani, A.I. Zoakah — Thu, 01 Apr 2021 00:00:00 +0000

Background: Adequate knowledge of not only the benefits in clinical use but also of the potential dangers of ionizing radiation is crucial among staff of radio-diagnostic departments. This balance properly equips the staff and impacts professional practice. The level of such knowledge can be verified among the various cadre of staff in a radio-diagnostic department and comparison madebetween different tiers of health institutions.
Methodology: Across-sectional study was conducted in 2 tertiary hospitals and 2 secondary hospitals in Jos, Plateau State, Nigeria between August 2019 and October 2019. All staff of radio-diagnostic departments of the 4 hospitals filled up a distributed questionnaire sheet. The semi structured, validated and selfadministered questionnaire included parts comprising questions about the socio-demographics of the included subjects and on knowledge of ionizing radiation. The retrieved questionnaires were scored and
graded and recorded. The data were analyzed using SPSS version 23.
Results: A total of 60 staff of Radio-diagnostic departments of the involved hospitals participated in the study, made up of 47(78.3%) males and 13(21.7%) females with age range between 24 and 57 years and a mean age of 39 ± 11.2 years. Fifty one (85%) of the participants were staff in the tertiary hospitals while 9 (15%) were in the secondary hospitals. Most of the staff who participated in the study had a good knowledge of ionizing radiation (47; 78.3%). The proportion of participants with good knowledge of ionizing radiation
was higher among the radio-diagnostic staff in the tertiary hospitals (40/51; 78.4%) compared to those in the secondary hospitals (7/9; 77.8%). This difference between the staff in the two categories of health institutions 2 was however not statistically significant, χ =0.0019, p=0.965.
Conclusion:Sufficientbasic knowledge of ionizing radiation subsists among the radio-diagnostic staff of secondary and tertiary hospitals in Jos.

Key Words: Comparison, Knowledge, Ionizing, Radiation, Secondary, Tertiary, Hospital

The practice of hepatocellular cancer surveillance in Nigeria

Thu, 01 Apr 2021 00:00:00 +0000

Background: Hepatocellular cancer is a disease of global and public health importance due to the widespread distribution of risk factors and associated high case fatality. Hepatocellular Cancer (HCC) in Sub-Saharan Africa is commonly seen among the younger age groups (<45 years) who present mostly in the terminal stage, when the disease is not amenable to any curative therapy. Hepatocellular Carcinoma surveillance employs the use of simple, cheap and readily available investigations, to detect early curable cancer in individuals with risk factors for HCC.
Objectives:The aim of this study is to assess the practice of hepatocellular cancer screening among physicians.
Methodolgy:This is a nationwide online survey carried out among physicians who care for patients with HCC. A questionnaire was sent out via a web link to all consenting doctors in Nigeria. The responses were collated in a cloud-based application and data was analysed using Epi-info version 20.
Results:Atotal of 218 respondents, 142 were males (65.1 %) with a mean age of 37.6 ± 5.7 years. The modal age group was 31-40 years 153 (69.5%). The main factors considered as a hindrance to surveillance were; the cost of the tests (57.7%), failure of return of patients (50.5%) and not being aware of a surveillance program (45.2 %). The majority of the respondents were Gastroenterologists and Family Physicians. 54% of the gastroenterologists and 64% of the family physicians have never offered HCC surveillance to their patients.
Conclusion:This survey highlights a knowledge gap in HCC surveillance among physicians. There is a need to make HCC
surveillance a daily routine among patients at risk by all physicians.

Keywords: Surveillance, Hepatocellular Carcinoma, HBV, HCV, Cancer screening.

Tinea capitis infection among school children in rural setting of Jos north-central, Nigeria

Thu, 01 Apr 2021 00:00:00 +0000

Background: Tinea capitis is a common infection of the scalp and hair shaft caused by dermatophytes. It is an infection associated with low socioeconomic status and poor personal hygiene.
Methods: This was a cross sectional study involving pupils in two public schools in rural setting with clinical features suggestive of tinea capitis. Scrapings were collected from the scalp of the pupils between September 2018 and February 2019 and subjected to laboratory analysis of microscopy and culture. The data obtained was analyzed using SPSS version 20 statistical software.
Results: Atotal of 67 pupils with clinical features of tinea capitis had positive cultures in the laboratory (21.5%), most of the pupils were of age range 4-8years (56.7%) and mainly males 167(52.2%). Factors associated with spread of tinea capitis were not statistically significant except for the sharing of towel(P<0.001). Trichophyton mentagrophyte (40.3%) was the most isolated agent of tinea capitis followed by Microsporumgypseum (31.3%)
Conclusion: Tinea capitis infection remains a problem associated with rural settlement and poor personal hygiene. A nationwide surveillance is required to prevent the spread.

Keywords: Tinea capitis, Trichophyton mentagrophyte, Dermatophytes, Microsporumgypseum

A review of present management of castrate resistant prostate cancer

Chimaobi Gideon Ofoha — Thu, 01 Apr 2021 00:00:00 +0000

Prostate cancer is the most common cancer among Sub-Saharan Africans. Androgen deprivation therapy remains the mainstay for the management of advanced prostate cancer. However, treatment failure is the rule after a predictable response to androgen deprivation with subsequent development of castrate resistant prostate cancer.Several pathways in the propagation of castrate resistant prostate cancer have been elucidated,thus leading to development of novel agents in the management of this otherwise lethal disease.Importantly, most of these cellular alterations still require the presence of some, albeit lower, androgen concentrations. Consequently, it is recommended that ADT be continued for the remainder of a patient's life. This review gives a summary of the current and approved treatment options for castrate resistant prostate cancer.

Keywords: Castrate, resistant, prostate cancer, cytotoxic therapy, Immunotherapy, antiandrogen therapy

The prevalence of gastrointestinal stromal tumour as seen in the Jos University Teaching Hospital (Juth), Jos, North Central Nigeria

Thu, 01 Apr 2021 00:00:00 +0000

Background: Gastrointestinal stromal tumours (GIST) represent 1% of all malignant tumours of the gastrointestinal tract (GIT). However, it is the most common Mesenchymal tumour of the GIT with majority (40 to 60%) arising from the stomach.
Objective: To determine the prevalence of GISTamong patients in Jos University Teaching Hospital between 2005 and 2012.
Methodology: Five (5) antibodies were used on the Mesenchymal tumours (CD117, CD34, Desmin, SMA and S100). Diagnosis of specific Mesenchymal tumours was based on histological patterns of the tumours on H and E stained slides and immunostaining characteristics of the tumours.
Results: Seven Mesenchymal tumours seen within the study period. This comprises of 6 GIST and 1 Leiomyosarcoma.
Conclusions: This study shows that even though GISTis a rare tumour, it is the commonest Mesenchymal tumour of the stomach. It also shows that they are commonly positive for both CD117 and Cd34.

Keywords: GIST, Mesenchymal Tumour, Gastrointestinal Tract, Stomach

Determination of relationship between thyroid gland volume and parity, smoking habits and alcohol consumption

Thu, 01 Apr 2021 00:00:00 +0000

Objective: This study is aimed at investigating possible relationship between thyroid gland volume, parity, smoking and alcohol consumption.

Background: The thyroid gland is one of the largest endocrine glands in the body that produces thyroid hormones, principally thyroxine (T ) and triiodothyronine (T ). These hormones regulate the rate of 4 3 metabolism and control the growth and rate of function of many other systems in the body. Any factor that affects thyroid gland volume, would affect production and function of thyroid hormones in the body.

Materials And Methods: Ultrasound of the neck in patients that fulfill recruitment criteriaand presenting to radiology department
between 2011 and 2012, were evaluated for the study. Demographic data, indications and findings were evaluated.

Results: A total of 400subjects were involved in the study, with more female non-smokers(250) and nonalcoholics(231) than males. There was variation in size of thyroid gland in non-alcoholics (Mean thyroid volume = 5.58±2.60)compared to alcoholics(Mean thyroid volume = 6.14±2.74), indicating the goitrogenic effect of alcohol.There is an increase in thyroid volume with increase in smoking, though not significant. Parity does not have significant effect on thyroid volume in this study, with P-value of 0.128.

Conclusion: Cigarette smoking, alcohol and pregnancy are associated with increase in thyroid volume. This has been attributed to the goitrogenic effect of nicotine, alcohol and pregnancy hormones. The effects of nicotine and alcohol on thyroid gland, is seen in both males and females. Although pregnancy is noted to cause increase thyroid volume, there was increase in volume with increase in
parity in this study.

Key Word: Determination, Thyroid volume, Parity, Smoking and Alcohol consumption.

The burden of hepatitis c virus infection and access to treatment among rural dwellers in a north central Nigeria

Tochukwu A. Uchendu, Joel T. Daboer, Chikwe Amaike — Thu, 01 Apr 2021 00:00:00 +0000

Hepatitis C virus infection is a public health disease but the efforts to control it have not fully integrated indigent rural dwellers. This study explores the burden of the disease in Jengre, a rural population in Nigeria. It is a mixed retrospective and qualitative study. Data on 1,339 persons who received HCV testing in Jengre SDA Hospital (over a one year period) was collated and analyzed. All 7 healthcare providers in the hospital were recruited into a focused group discussion on hepatitis C treatment and their experiences in the hospital. A prevalence of 18.4% was obtained and 11.7% among apparently healthy individuals. The prevalence of hepatitis C in this study is among the highest in the world and there is a total absence of treatment available to those who are infected. This leaves the patients helpless and portends a grave danger to the realization of international hepatitis C elimination goals.

Keywords: Hepatitis, Nigeria, epidemiology, prevalence, HCV

How much do antenatal care attendees in a tertiary hospital in Jos, north central Nigeria know about gestational diabetes?

F.A. Elachi, C. Anyaka , A.N. Ocheke , C.C. Ekwempu — Thu, 01 Apr 2021 00:00:00 +0000

Background-The increasing prevalence of GDM has attracted global concern. The associated hyperglycaemia is a source of perinatal morbidity and mortality. Knowledge of GDM is known to prevent complications to mother and baby through adoption of life style modification behaviour and good health seeking behaviour.
Methodology- It was a cross sectional study conducted over a 3 month period. Women were recruited into the study from the antenatal clinic. A structured questionnaire was used to extract information from the respondents. Data was analyzed with EPI INFO 3.5.4 CDC Atlanta, USA.
Results- The response rate was 96.2%. The mean age of the respondents was 29±6 years. Only 2% had no formal education while 46.6% had tertiary education. Most of the women (55.3%) were unemployed and 53.0% of the women were multiparous. The respondents generally have a good knowledge of GDM with an average score of 9±3. The awareness on GDM and its risk factors and awareness on screening and treatment were good. Only 41.5% of the women knew GDM resolves after pregnancy. Knowledge on the other consequences of GDM was good. Health professionals and friends and family served as source of information on GDM in 80.9 and 60.1% of the women respectively.
Conclusion- the knowledge of antenatal women in our centre is good. Continuous training of health workers and women empowerment are strategies that can maintain and improve this knowledge.

Key words: Gestational diabetes, Antenatal care attendees, Knowledge

Aural foreign bodies encountered in a Tertiary Health Facility Bingham University Teaching Hospital Jos

Nimkur L. Tonga, Audu Modu, D. Dajam — Thu, 01 Apr 2021 00:00:00 +0000

Introduction-Aural FB is anything but wax lodged in the ear; it could be organic or inorganic, animate or inanimate. Common Fbs are grains/seeds, cotton buds, beads, etc. commonly introduced by children due to curiosity and adventurous exploration of body orifices. Removal by trained personnel and specialists is safe with minimal or no complications but attempts or removal by unqualified personnel can present severe complications.
Method- A three year retrospective study to evaluate aural FB encountered in a tertiary institution; data of 234 patients with aural FBs were collected and analyzed.
Results-234 patients were evaluated, 136 males and 96 females-thus having a M:F= 1.4:1. Most of the FB occurred in the age range of 0-10 years with grains/seeds as the commonest FB. Cotton buds were seen mostly in adults. Most of them were removed in clinic settings without complications.
Conclusion- Removal of aural FBs by untrained or nonprofessionals can present with severe complications thus attempts at removal should be avoided; referral to the trained professionals is advised for a save outcome.