Orient Journal of Medicine https://www.ajol.info/index.php/ojm <p>The <em>Orient Journal of Medicine</em> is a Nigerian journal publishing articles in clinical or laboratory medical sciences.</p><p>Other websits related to this journal: <a title="http://www.orientjom.com/" href="http://www.orientjom.com/" target="_blank">http://www.orientjom.com/</a></p> Nigerian Medical Association of Anambra en-US Orient Journal of Medicine 1115-0521 Letter to the editor: The Role of Early Amniotomy and The Risk of Vertical Transmission of Hepatitis B Virus https://www.ajol.info/index.php/ojm/article/view/205008 <p>No Abstract</p> Uchenna A Umeh Chuka C Agunwa Ijeoma J Ilo Copyright (c) 2021-03-24 2021-03-24 33 1-2 1 5 Respiratory Illnesses Presenting to The Children’s Emergency Room of a Tertiary Hospital in South–East Nigeria: A Retrospective Study https://www.ajol.info/index.php/ojm/article/view/205010 <p><strong>Background:</strong> Respiratory illnesses are a major cause of morbidity and mortality in children worldwide. The impact is more profound in low and middle income countries.<br><strong>Objective:</strong> To determine the pattern of the respiratory illnesses in children that presented to the Children Emergency Room (CHER) of Nnamdi Azikiwe University Teaching Hospital Nnewi, a tertiary hospital in South-East Nigeria, over a 5-year period.<br><strong>Methodology:</strong> Clinical records of all children presenting over a 60-month period (July 2011 to June 2016) were retrieved and analyzed. Their age, gender as well as outcome of admission within 72hours in the CHER were reviewed.<br><strong>Results:</strong> A total of 4622 children were admitted over the specified period. Six hundred and sixty-eight (14.45%) had an Acute Respiratory Illness(ARI). Age range of the children was I month to 17years, mean age was 2.33 (± 3.56) years.<br>Bronchopneumonia occurring in 27 (41.01 %)children was the most common diagnosis; followed by Bronchiolitis in 78 (11.68%), Aspiration pneumonitis in 41 (6.14%) and Acute Asthma in 40 (5.99%). There was equal gender distribution among the modal age of presentation.<br>Majority of the cases 367 (54.94%) were transferred to the ward for continued care within 72hours of admission, while 54 (8.08%) died. The aetiology of the respiratory pathology (infectious or not) had a significant association with outcome of 72hours of admission in CHER (p = 0.01).<br><strong>Conclusion:</strong> Prevalence of ARIs among toddlers is still high. Efforts have to be re-enforced in order to reduce the negative impact of respiratory illness on child health and survival in the sub region.</p> <p><strong>Key Words</strong>: Acute pulmonary morbidity, Chest infections, Paediatrics, Healthcare centre</p> Ogochukwu C Ofiaeli Chizalu I Ndukwu Chisom A Nri-Ezedi Ogochukwu R Ofiaeli Copyright (c) 2021-03-24 2021-03-24 33 1-2 6 12 Histopathological Profile of Primary Ovarian Lesions in Nnewi, Nigeria: A 5 Year Retrospective Study https://www.ajol.info/index.php/ojm/article/view/205045 <p><strong>Background:</strong> This is the first base line research on different primary ovarian lesions in Histopathology department, Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi since the institution of the hospital.<br><strong>Objectives</strong>: To determine the different patterns of ovarian lesions in relation to age and histopathological features and compare these patterns with local and international studies. The study will also highlight the most common histologic variants in our environment and make recommendations depending on the outcome of the research.<br><strong>Methodology:</strong> The pathology report forms of all the gynaecological lesions in histopathology department NAUTH, Nnewi, were studied. The processed tissue and the slides stained with regular histochemical stain (Haematoxylin and Eosin) technique in this 5-year study period were reviewed by the researchers using multi-headed microscope (CARL ZEISS®).<br><strong>Results:</strong> Of the 130 cases that were analysed, 91 (70.0%)cases were neoplastic while 39(30.0%) cases were non-neoplastic lesions. Benign neoplasms were the most common neoplasm and accounted for 56.0% (51 cases) followed by invasive malignant neoplasms with 31.9% (29 cases) while borderline and indeterminate tumours, were 3.3% (3 cases) and 8.8% (8 cases). respectively. Among the benign neoplastic lesions, mature cystic teratoma was the most common tumour (no= 22, 16.9%) with the patients’ mean age of 33.1 ±SD 13.0, followed by serous cystadenoma (no=15, 11.5%) with a mean age of 33.4 ±SD 12.9. However, high grade papillary serous cystadenocarcinomas (no=13, 9.8%) were the highest recorded invasive malignant lesions with a mean age of 49.8 ± SD 15.9) followed by choriocarcinoma (no.=5, 3.8%) with a mean age of 35.3 ±SD 9.7. Immature teratoma and mucinous cystadenocarcinoma were 4 (3.1%)cases each with mean ages of 20.8 ± SD 13.9 and 55.3 ± SD 14.3, respectively. Malignant germ cell tumours; immature teratoma and choriocarcinoma, formed only 28.1% of all germ cell tumours. Of the non-neoplastic lesions, corpus luteum cyst and follicular cyst were the most common with 11 cases (8.5%) and 10 cases (7.7%), respectively.<br><strong>Conclusion</strong>: Ovarian neoplasia are quite diverse, and in our environment, benign lesions of the ovary were far more common than malignant cases and tend to occur at the reproductive age group. Surface –epithelial neoplasms were more common than germ-cell tumours with a ratio of 1.4:1. Majority of invasive malignant cases were high grade serous cystadenocarcinoma.</p> <p><strong>Keywords:</strong> Corpus luteum cyst, Follicular cyst, Teratoma, Cyst adenoma, Borderline tumour, Serous cystadenocarcinoma</p> Ifeoma F Ezejiofor Nnamdi S Ozor Chika C Ogbu Olarinde O Olaofe Felix E Menkiti Copyright (c) 2021-03-25 2021-03-25 33 1-2 13 21 Knowledge and Compliance with Standard Precaution Among Healthcare Workers in A South-East Nigerian Tertiary Hospital https://www.ajol.info/index.php/ojm/article/view/205054 <p><strong>Background:</strong> Adherence to standard precautions (SP) is critical to reducing the burden of nosocomial infections.</p> <p><strong>Objective: </strong>We assessed the knowledge and practice of SP among healthcare workers (HCWs).</p> <p><strong>Methodology:</strong> A cross-sectional study was conducted among HCWs in Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi Anambra State, Nigeria using self-administered questionnaire and key informant interview.</p> <p><strong>Results: </strong>Mean age and employment duration of subjects were 33.4±11.9 and 6.0 ± 6.7 years, respectively. Majority of the 341 HCWs had heard about SP (82.1%) and agreed that it should be applied to all patient care (78.0%). Only 45.7% of them correctly cited ≥2 components of SP. Two-third of participants reported that SP was poorly practiced in their unit mainly due to inadequate supply of materials (63.1%), inadequate staff training/retraining (62.2%), inadequate support by management (51.4%) and unavailable standard operating procedures (SOPs) on SP (37.8%). Compliance with SP and specifically, personal protective equipment (PPE) use were 65.1% and 76.2%, respectively. Profession (<em>p</em>=0.023), awareness about SP (<em>p</em>&lt;0.001), SOP display in prominent places (<em>p</em>&lt;0.001) and regular supply of running water (<em>p</em>&lt;0.001) were significantly associated with SP compliance.</p> <p>Key informant interview revealed lack of written SP policies or its communication to HCWs, lack of training/retraining of HCWs and lack of materials required for SP practice.</p> <p><strong>Conclusion:</strong> Knowledge of basic concept and practice of SP was not satisfactory among HCWs. Major barriers to SP were lack of materials, training and active support by hospital management. Awareness, SOP display in prominent places and regular supply of running water positively influenced SP compliance.</p> <p>Having written policies and communicating such to all HCWs, consistent supply of necessary materials, intensified training, and regular supervision are recommended</p> <p><strong>Keywords</strong>: Universal precautions, Nosocomial infections, Tertiary hospitals, Health Personnel, Nigeria</p> Chinyere U Onubogu Ogochukwu C Ofiaeli Adaora N Onyeyili Iloduba N Aghanya Nwanneka O Ugwu Raymond C Okechukwu Emeka S Edokwe Chibuzo U Ndukwu Obiageli F Emelumadu Copyright (c) 2021-03-25 2021-03-25 33 1-2 22 34 The Profile of Diaphragmatic Hernias in three tertiary hospitals in South-East Nigeria: A 13-Year Review https://www.ajol.info/index.php/ojm/article/view/205059 <p><strong>Background:</strong>&nbsp;The diaphragm is a fibro-muscular partition that separates the relatively low-pressure thoracic cavity from the relatively high-pressure abdominal cavity. This difference in pressure causes transmigration of abdominal contents into the thoracic cavity whenever there is a defect, often resulting in cardio-respiratory disturbances.<br><strong>Objective:</strong> To describe the profile of diaphragmatic hernias managed in three tertiary hospitals in, South-East Nigeria and compare same with global outcomes.<br><strong>Methodology</strong>: Retrospective study of patients with different types of diaphragmatic hernias managed in three centre over a 13-year period was done. Data on demography, types of hernias, mode of presentation, diagnostic methodology, treatment offered and prognosis including complications were obtained from Record Departments of each hospital.<br><strong>Results</strong>: There were a total of 44 patients with male to female ratio of 9:2. The ages ranged from 21 days to 840 months. The profile of the hernias was congenital (n=8, 18.2%), acquired traumatic (n= 30, 68.2%) and acquired non-traumatic (n=6, 13.6%). Among the congenital types-four (50%) were central, three (37.5%) were posterior while one (12.5%) was anterior. In the acquired traumatic types, left side was dominant. In the hiatal hernia (acquired non-traumatic), types 1 has the highest occurrence followed by type IV. Associated injuries in traumatic diaphragmatic hernias were the determinants of morbidity.<br><strong>Conclusion</strong>: Thoraco-abdominal hernias as described are not uncommon in our centre. Multidisciplinary approach and functional Intensive care unit (ICU) played significant role in the outcome of congenital diaphragmatic hernias.</p> <p><strong>Keywords:</strong> Profile, Diaphragm, Hernias, Enugu</p> Ikechukwu A Nwafor John C Eze Achike S Ezeanwu Anthony C Eze Uchenna S Onoh Copyright (c) 2021-03-25 2021-03-25 33 1-2 35 40 Depressive Disorders Among In-School Adolescents: How Prevalent in Anambra State, Nigeria https://www.ajol.info/index.php/ojm/article/view/205062 <p><strong>Background:</strong> Depressive disorders are the leading causes of ill-health and disability globally. Depression among adolescents is usually associated with a range of adverse later outcomes which include suicidality, and general poor physical and mental health.<br><strong>Objective</strong>: To determine and compare the prevalence of depressive disorders among in-school adolescents in urban and rural areas of Anambra State.<br><strong>Methodology:</strong> This was a cross-sectional analytical study of urban and rural in-school adolescents in Anambra State, Nigeria. A total of 1187 secondary school adolescents in government-owned schools in Anambra State was selected using multi-stage sampling technique. Patient Health Questionnaire-9 (PHQ-9) was the study instrument.<br><strong>Results:</strong> The mean age of the participants was 15±2 years. The overall prevalence of depression was 12.5%. The proportion of urban participants identified with depression was significantly higher than that of their rural counterparts (14.5% versus 9.6%). Multiple regression showed that increased odds of developing depression are associated with urban setting (p = 0.001), female gender (p=0.018), and late adolescence (p=0.025).<br><strong>Conclusion:</strong> This study showed that depressive disorders are prevalent among in-school adolescents in Anambra State, with some of the associated factors being urban setting, female gender and late adolescence. There is need for multi-sectoral intervention programs to address these identified factors.</p> <p><strong>Key Words</strong>: In-school adolescents, Depressive disorders, Nigeria, Urban-rural, Patient health questionnaire-9 (PHQ-9)</p> Ahoma V Mbanuzuru Richard Uwakwe Prosper OU Adogu Chinomnso C Nnebue Ifeoma B Udigwe Chinyere M Mbanuzuru Copyright (c) 2021-03-25 2021-03-25 33 1-2 41 51 Use of EarPopper® for The Treatment of Otitis Media with Effusion: A First Pilot Study in Africa https://www.ajol.info/index.php/ojm/article/view/205092 <p><strong>Background:</strong> A missed or non-diagnosed otitis media with effusion at very early age in life can impair the cognitive developmental milestone, especially hearing. Therefore, early diagnosis and treatment (medical, surgical or physiological) is pertinent. A search for an inexpensive, minimally invasive method led to the development of EarPopper®<br><strong>Methodology:</strong> A prospective interventional study on the use of EarPopper® in the treatment of otitis media with effusion. The EarPopper® uses the Politzer method of pressure equilibration to decongest the middle ear through the Eustachian tube.<br><strong>Result:</strong> Seven patients (4 males, 3 females) aged between 11 and 54 years were enrolled. Five were bilateral and 2 were unilateral (12 ears). All had type B curves and mild to moderate conductive hearing loss. The pre-therapy EarPopper Scoring System were 60-98%, while the post therapy result dropped to 0-25%.<br><strong>Conclusion</strong>: The EarPopper® showed a good prospect in the treatment of otitis media with effusion in an African population.</p> <p><strong>Key words:</strong> Otorhinolaryngologic diseases, EarPopper Scoring System, Pilot study, Ear diseases, Otitis media</p> Titus S Ibekwe Enoch A Dahilo David O Folorunsho Toochukwu Uzochukwu Bosa Egbe Oladeji R Quadri Frederick Damtong Basil C Nwankwo Iboro Etukumana Ibeneche O Gbujie Copyright (c) 2021-03-25 2021-03-25 33 1-2 52 56 Carotid Body Tumour Excision: A Case Report of Anaesthetic Challenges in A Regional Hospital in South-East Nigeria https://www.ajol.info/index.php/ojm/article/view/205095 <p>Carotid body tumour is an uncommon tumour with potential to cause marked haemodynamic instability intraoperatively and turbulent post-operative recovery. A carefully planned anaesthesia is very important for a successful peri-operative management.<br>We report a case of a 44-year-old male that had carotid tumour excision under general anaesthesia. Nitroglycerin was used for hypotensive anaesthesia. Patient was electively ventilated post operatively in the Intensive Care Unit (ICU). Anaesthetic challenges encountered were discussed</p> <p><strong>Key words:</strong> Neck, Paraganglioma, Resection, General anaesthesia</p> Fidelis A Onyekwulu Chidiebele S Ikenga Uchenna S Onoh Copyright (c) 2021-03-25 2021-03-25 33 1-2 57 61 Cast report: Intrauterine Retention of Fetal Bones: An Unusual Cause of Infertility https://www.ajol.info/index.php/ojm/article/view/205099 <p>Couples presenting with infertility face peculiar sociocultural problems, these are especially evident in African countries where a very high premium is placed on children and childbearing.<br>We report a case of a 30-year-old nullipara with a 3-year history of secondary infertility who on investigation was found to have fetal bones from an earlier incomplete abortion. She achieved pregnancy within three months of endoscopic removal of the fetal bones.</p> <p><strong>Keywords:</strong> Intrauterine bone fragments, Secondary infertility, Foreign body, Termination of pregnancy</p> Chukwuemeka O Ezeama Chukwuemeka C Okoro Joseph I Ikechbelu Copyright (c) 2021-03-25 2021-03-25 33 1-2 62 66 Case Report: Improvised Hand-Held Respirator: Life-Saving in The Management of Moderate to Severe COVID-19 https://www.ajol.info/index.php/ojm/article/view/205102 <p>The consumables and materials including the hospital space required for supportive therapies are in short supply with respect to COVID-19 management. To this end, an alternative supportive measure is needed for the patients to hang on, until optimal condition is made available. It is in this vein, that we describe a hand-held-respirator improvised for oxygen supplementation in a 51-yearold COVID-19 positive patient diagnosed of moderately severe disease.</p> <p><strong>Keywords:</strong> SARS COV2, EarPopper®, Corona virus disease, Respirator</p> Titus S Ibekwe Copyright (c) 2021-03-25 2021-03-25 33 1-2 67 70