Orient Journal of Medicine

Clinicopathological Correlates of Patients with Prostate Cancer in a Tertiary Hospital in Northwestern Nigeria

Emmanuel U. Oyibo — 2023-05-15

Background: Worldwide, prostate cancer is a common cause of significant morbidity and mortality in ageing men. Digital rectal examination(DRE) and serum total prostate specific antigen(tPSA) are widely used tools for prostate cancer(CaP) screening and diagnosis before transrectal ultrasound (TRUS)- guided prostate biopsy. Objectives: This study aimed at finding the clinical, biochemical, radiological and pathological correlates in patients with an enlarged prostate and elevated serum tPSA.

Methodology: This is a 12-month cross-sectional study of 80 male patients aged 50 years and above with lower urinary tract symptoms(LUTS), abnormal digital rectal examination and/or elevated PSAgreater than 4ng/mL. Aged-matched males were also included as a negative biopsy group with serum levels of tPSA determined using ELISA methods among both groups. Clinical, procedural (TRUS guided biopsy) assessment, transrectal ultrasound-guided biopsies of the prostate for histological characterisation of all patients and Gleason score categorization for prostate in cancer group were done. The relationship between serum tPSA and Gleason score of prostate cancer patients was determined using Spearman's correlation.

Results: The mean serum total PSAin patients with prostate cancer and the negative biopsy group was 82.93 ± 35.02 and 28.85±30.92 ng/ml respectively. The majority of the patients in the prostate cancer group (90.0%) had suspicious findings on DRE compared to the negative biopsy group (46.2%). There is a positive correlation between serum tPSA and Gleason score in patients with prostate cancer. Serum tPSA levels were significantly lower in the negative biopsy group. The Gleason score pattern of distribution among patients with Prostate cancer showed that the majority had a score greater than 8 and ISUP Grade V.

Conclusion: Findings of elevated total serum PSA and abnormal digital rectal examinations in patients with an enlarged prostate in our practice are predictive of high Gleason score prostate cancer on TRUS-guided biopsy of the prostate.

Prevalence and Pattern of Infectious (Septic) Arthritis in Immunocompromised Patients in a Tertiary Institution in Southern Nigeria

Chukwuemeka N. Chibuzom — 2023-05-15

Background: Infectious (septic) Arthritis in immunocompromised (HIV/AIDS) patients can lead to mortality if not diagnosed early and treated properly. The incidence of this condition across the globe is wide and varied. There is paucity of epidemiologic data in our environment.

Objectives: The purpose of this study was therefore to evaluate the prevalence and pattern of presentation of infectious (septic) arthritis in our local environment and compare it with the global trend.

Materials and Methods: Blood samples from 360 HIV/AIDS patients aged 19 to 67years suspected to have infectious (septic) arthritis were analyzed for Full blood count, ESR, CD4 count, and blood culture. Synovial fluid from the involved joint was analyzed for white cell count, microscopy culture and sensitivity, and assay for tuberculosis using the ZN stain technique. Mantoux test was done in those suspected to have tuberculous arthritis. Data were analysed using SPSS version 25.

Results: Sixteen of the 360 participants had infectious (septic) arthritis involving twenty joints of the appendicular skeleton, and three spinal involvements. 50% of these had acute septic arthritis, 25% had HIV associated arthritis, 12.5% had tuberculosis of the spine, while 6.25% each had tuberculous arthritis, and tuberculous arthritis coexisting with tuberculosis of the spine. 62.5% had staphylococcus aureus, 25% streptococcus pyogenes, while 12.5% were Klebsiella Species. ZN stain was positive in two cases.

Conclusion: The prevalence of infectious (septic) arthritis in HIV/AIDS immunocompromised patients in our environment was 4.4%. Acute septic arthritis was commonest infectious arthritis in this group of patients with Staphylococcus aureus being the commonest organism isolated. The knee joint was the most commonly affected joint.

Quality of Life of Patients with Obstructive Sleep Apnea on CPAP Treatment in South West Nigeria: A Preliminary Report

Oluwafemi T. Ojo — 2023-05-15

Background: Obstructive sleep apnea (OSA) is rising in Africa. The treatment of the disease involves the use of continuous positive airway pressure (CPAP) machine. Information on the quality of life of patients with OSA on CPAPtherapy in Nigeria is scarce.

Objectives: This study assessed the quality of life of patients with OSA on CPAP treatment in Lagos. The study also evaluated the daytime wakefulness, perception of quality of night sleep as well as the physical and emotional activities of the patients.

Methodology: This was a cross-sectional study using a semi-structured questionnaire done at Lagos State University Teaching Hospital from September 2021 to December 2021. All consenting patients with previous diagnosis of OSA with polysomnography who have been regular on CPAP therapy for at least three months were recruited. Patients were contacted via WhatsApp, telephone or physical interview.

Results: A total of 23 patients were contacted, of which 19 patients consented. There were 13 males and 6 females with a mean age of 53.63+/-13.1 years. All the participants had improvement in their general state of health. Majority of the patients had improvement in their sleep quality, day-time sleepiness and snoring (n=17:89.5%, n=14:72% and n=12:63.2% respectively). Majority of the patients have no physical limitation on moderate activities (n=12:63.2%). while 47.4% of responders have no social activities interference.

Conclusion: CPAP usage in patients with obstructive apnea is associated with improved snoring, sleep quality, day-time somnolence and general quality of life.

Basic Life Support Skills Training Among Healthcare Workers in Nigeria: A State-Wide Evaluation in the Niger-Delta Region

Queeneth N. Kalu — 2023-05-16

Background: Healthcare systems are designed to efficiently minimize morbidity and mortality, especially through employment of diverse skills, including provision of Basic Life Support (BLS). Unfortunately, many healthcare workers (HCWs) lack BLS skills, which are essential for the reduction of preventable sudden deaths resulting from sudden cardiac arrest.

Objective: A statewide assessment of the proportion of HCWs with BLS training, as well as the number available for such training in public primary and secondary healthcare facilities in Cross River State, Southern Nigeria, a low-middle income country (LMIC) setting.

Methodology: By total enumeration, public primary and secondary healthcare facilities, in each of the 18 Local Government Areas (LGAs) in Cross River State, Southern Nigeria, were studied using descriptive crosssectional design. Structured proforma was used to obtain data on number of doctors, nurses, Community health officers (CHOs) and Community Health Extension workers (CHEWs) as well as the number that have been trained on BLS/CPR in each facility. The Cross River State Research Ethics Committee approved the study, which was conducted for eight (8) weeks. The proportion of healthcare facilities with at least 1 doctor, nurse and staff trained on BLS/CPR were determined. Chi-square inferential statistic was used to compare these proportions between the three districts of the state. Also, Analysis of variance (ANOVA) was used to compare the mean number that had been trained on BLS per facility between these districts. P-value was set at 0.05.

Results: Two hundred and five (205) healthcare facilities within the 18 L.G.A.s were surveyed. Sixteen (16) health facilities (7.8%) had staff that were trained on BLS. Seventy-five (75) staff had training on BLS, yielding average of 0.37 trained staff per facility. Approximately one-tenth of facilities (10.2%) had a doctor, while one-third (34.1%) had a nurse. Less than one-tenth (9.3%) of health facilities had at least a doctor and nurse that may be available for BLS training. There were community health officers and community health extension workers in both rural and urban facilities but none was a trained BLS provider. There was also no staff trained on BLS in any health facility located in seven LGAs. Arelatively higher proportion of facilities with staff trained on BLS was found in Odukpani (16.7%), Yakurr (20.0%) and Bekwarra (16.7%). In comparison with the southern and northern districts, there was a higher average number of staff trained on BLS per facility in the central district (p<0.00).

Conclusion: There is gross lack of BLS trained HCWs in most healthcare facilities in Cross River State. Considering the high and increasing burden of cardio-metabolic diseases and sudden cardiac arrest events in Nigeria, this largely unmet need for BLS training warrants concerted efforts at institutionalization of the requisite skill acquisition among HCWs in the region.

Socio-Demographic Correlates of Antiretroviral Treatment Adherence among Paediatric HIV Patients Under Care at A Tertiary Health Institution in South-East Nigeria

Cletus O. Akahara — 2023-05-16

Background: Antiretroviral treatment adherence is the strongest predictor of successful treatment outcome among HIV-infected patients on treatment.

Objective: To determine the correlation between the sociodemographic factors of our HIV-infected patients and their antiretroviral treatment adherence, at a tertiary hospital in South-East Nigeria.

Methodology: This is a cross-sectional survey of 210 HIV-infected children accessing care at a tertiary hospital in South-East Nigeria using self-report method of adherence assessment. Adherence to combined antiretroviral therapy (cART) is defined as when a patient did not miss more than 1 dose of the prescribed cART medication in the preceding 2 weeks prior to the study.

Result: Majority, 191 (91%), of the subjects adhered. There was a significant relationship between cART adherence and educational level (0.004), duration of treatment (0.001), but not to the socio-economic status (0.001).

Conclusion: The cARTadherence level in this study was 100% in 91% of the subjects studied. There was no statistically significant relationship between cART adherence and the socio-economic status of the subjects.

Knowledge, Beliefs and Misconceptions about Epilepsy and its Treatment in a Rural Community in South-Eastern Nigeria

Chinomnso C. Nnebue — 2023-05-16

Background: Epilepsy is not only one of the oldest known neurological disorder but also one of the most prevalent chronic brain disorder worldwide. The social pathology associated with epilepsy drives the people with epilepsy (PWE) and their families into the shadows and widens epilepsy treatment gap. How much the social aspects of epilepsy and epilepsy care has changed in rural African communities in the globalized world is yet to be fully elucidated.

Objectives: This study aims to determine the level of knowledge and attitude towards epilepsy and the people living with epilepsy (PWE) by adult inhabitants of a rural southeastern Nigerian community.

Methodology: This was a cross sectional door-to-door population survey. Interview on select aspects of knowledge and attitude to epilepsy was conducted using a pretested semi- structured questionnaire.

Results: Three hundred and seven (90.3%) of the respondents reported awareness of epilepsy, 61(18%) had good knowledge on epilepsy but attitude towards epilepsy was negative. The key source of information on epilepsy for 133 (43.3%) respondents was health workers, while 125 (40.7%) reported that epilepsy was a medical disease. Associations existed between level of knowledge on epilepsy and gender (p=0.0023); marital status (p=0.0012) and educational attainment (p= 0.0476).

Conclusions: Awareness of epilepsy though high among the rural inhabitants yet a wide gap still exist regarding the knowledge and attitude towards epilepsy. It is hoped that with adequate culturally appropriate educational programs, channelled through the media and health workers in rural communities the existing gap in knowledge and treatment will be bridged.

Laryngeal Papillomatosis in an Adult Patient Undergoing General Anaesthesia: An Incidental Finding

Ifeatu O. Oranusi — 2023-05-16

Laryngeal papillomatosis is a rare respiratory tract disease of viral aetiology. It presents with airway obstruction, cough and voice affectation. Immunodeficiency and sexual behavior are predisposing risk factors. The index patient is a 32-year-old female in whom laryngeal papillomatosis was incidentally discovered during general anaesthesia and laryngoscopy, who developed recurrent disease following excision biopsy. For diagnosis, high index of suspicion is important, the slightest symptoms should be evaluated and neck x-rays and indirect laryngoscopy are valuable. Treatment is difficult and costly, entailing repeat surgeries and adjuvant drug therapies.