Consensual coital vaginal laceration in hypovolaemic shock: A report of two cases

Background:Certain life-threatening complications and morbidities may occur following consensual sexual intercourse which may not be commonly experienced in clinical practice. One of such complications is hypovolaemic shock resulting from profuse bleeding.AbstractMethods:Two cases of vaginal laceration complicated by hypovolaemic shock following consensual sexual intercourse are presented.Results:Both patients had resuscitation with intravenous fluid, blood transfusion and subsequent examination under anaesthesia with repair of laceration in theater. Post-operative recovery period was uneventful and they were both discharged after proper counselling. Conclusion:Bleeding from coital laceration could be life threatening. Prompt treatment should be instituted in such cases

Catastrophic health expenditure in sub-Saharan Africa: systematic review and meta-analysis

Objective To estimate the incidence of, and trends in, catastrophic health expenditure in sub-Saharan Africa. Methods :We systematically reviewed the scientific and grey literature to identify population-based studies on catastrophic health expenditure in sub-Saharan Africa published between 2000 and 2021. We performed a meta-analysis using two definitions of catastrophic health expenditure: 10% of total household expenditure and 40% of household non-food expenditure. The results of individual studies were pooled by pairwise meta-analysis using the random-effects model. Findings : We identified 111 publications covering a total of 1 040 620 households across 31 sub-Saharan African countries. Overall, the pooled annual incidence of catastrophic health expenditure was 16.5% (95% confidence interval, CI: 12.9­20.4; 50 datapoints; 462 151 households; I2 = 99.9%) for a threshold of 10% of total household expenditure and 8.7% (95% CI: 7.2­10.3; 84 datapoints; 795 355 households; I2 = 99.8%) for a threshold of 40% of household non-food expenditure. Countries in central and southern sub-Saharan Africa had the highest and lowest incidence, respectively. A trend analysis found that, after initially declining in the 2000s, the incidence of catastrophic health expenditure in sub-Saharan Africa increased between 2010 and 2020. The incidence among people affected by specific diseases, such as noncommunicable diseases, HIV/AIDS and tuberculosis, was generally higher. Conclusion :Although data on catastrophic health expenditure for some countries were sparse, the data available suggest that a non-negligible share of households in sub-Saharan Africa experienced catastrophic expenditure when accessing health-care services. Stronger financial protection measures are needed.

Management of malignant pleural effusion (MPE) in a Tertiary Hospital in a low-income-country: challenges and prospects

Background: In the West African sub-region, significant morbidity and mortality are known to affect patients with malignant pleural effusion (MPE) but are highly under reported unlike USA, Europe or South Africa. Aim/Objective: To review cases of MPE in our tertiary hospital in the last 13 years with a view to determining the challenges and prospects. Materials and Method: This is a retrospective study spanning over a decade from January, 2007 to December, 2019. Malignant pleural effusion from various neoplasms constitutes the commonest thoracic malignancy in our tertiary hospital. After 13 years of management of such patients, we reviewed the datafrom the hospital record's department. The data obtained were demography, aetiology, total number of pleural fluid specimens for cytology and pleural biopsies submitted for histology, pleurodesis and other treatment modalities. Result: 211 patients with MPE were admitted and managed during the period under review. Of these numbers, 135(64.0%) were confirmed cytologically positive (MPE). 76(36.0%) tested falsely negative and were initially regarded as paramalignant, later confirmed MPE. The age affected was from 7 to 81 years with a mean of 44 years. Of 211 patients with MPE, 94 were males while 117 were females, with a male to female ratio of 4:5. Aetiologically, metastatic breast cancer was the highest followed by advance lung cancer. Conclusion: Submission of insufficient samples resulted in false negative cytology. Review of recurrent pleural effusion and exophytic tumour at the sites of CTTD resulted in late diagnosis of MPE. Additionally, prolonged hospital stay awaiting CTTD and cytology results are among the challenges

COVID-19 infection: Knowledge, attitude, practices, and impact among healthcare workers in a South-Eastern Nigerian state

Introduction: The coronavirus disease (COVID-19) infection rate and mortality among Nigerian health care workers appear to be on the increase. This study determined the level of knowledge, attitude, practices, and impact of COVID-19 infection on healthcare workers (HCWs) working in a South-Eastern Nigerian state.Methodology: This was a web-based, cross-sectional study conducted among healthcare workers in South-eastern, Nigeria during the lockdown period. Socio-demographic profile, knowledge of COVID-19, fears and impact concerning COVID-19, attitude of health workers to work, preventive practices during this pandemic period were obtained. Data were analysed using STATA 16.0. Chi-square and Fisher's exact tests of association were used to determine the association between variables, with the significance level set at p < 0.05. Results: A total of 403 health care workers participated in the study. Majority of participants (n = 357, 88.59%) had good knowledge and good preventive practices (n = 328, 81.39%) of COVID-19. A significant proportion of respondents had a poor attitude to work (n = 101, 25.06%) and an attitude of indifference (n = 233, 57.82%). Almost half (48.64%) of participants had been negatively affected by COVID-19. Knowledge significantly influenced practice (p = 0.029). Lack of Personal protective equipment, fear of dying and going to common places, had a significant impact on the attitude of workers. Conclusion: Good knowledge which influenced practice, high use of preventive practices, with associated poor and indifferent attitude was noted among healthcare workers. Fear of death and lack of personal protective equipment had a strong impact on attitude. Female HCWs had poorer attitude to work than males

COVID radiology preparedness in Nigeria: How ready are we?

The novel human coronavirus (COVID-19) began in Wuhan China as an interstitial pneumonia of unidentifiable origin in December 2019 and thereafter spread its tentacles all over the world.There is a need for radiology departments in both government and private facilities to be prepared to meet this crisis. Their efforts should be geared not only toward diagnosis, but also to preventing patient-to-patient, staff-to-patient, and staff-to-staff transmission of infection by utilizing social distancing measures and personal protective equipment (PPE).Aim: To evaluate the preparedness of radiologic departments of government hospitals and private centers, by assessing the outlay of the facility and likelihood to attend to COVID patients, type of equipment in the centers, and plans in place for protection of staff and the public.Materials and Methods: The radiology departments of government and private facilities in each geopolitical zone of the country were randomly selected to discuss radiology preparedness in Nigeria using preset guidelines which were sent to radiologists at the facilities. Written informed consent was obtained from the radiologists at the participating centers. Ethical approval was also obtained from the Lagos University Teaching Hospital Health Research Ethics Committee.Results: A total of twelve centers were included in the study, comprising eight government and four private centers. All had plans in place to attend to COVID patients; majority were in the process of developing standard operating procedures (SOPs). Majority of the government facilities lacked mobile equipment and adequate PPEs, with only one computed tomography machine and no holding area in some of the facilities for symptomatic patients unlike the private facilities. They, however, had infection control teams in place.Conclusion: Private radiological centers appear better prepared and more equipped to cope with the crisis than government hospitals. Adequate PPEs, mobile equipment, and isolation rooms need to be provided for the government facilities. Radiology information systems should be installed for remote viewing. Training and retraining on COVID management and decontamination should be conducted periodically. SOPs should be drafted universally and modified for each facility

The menace of incomplete data: a review of tuberculosis DOTS data at a tertiary hospital in southern Nigeria

Background: This paper presents data from a TB-DOTS centre in southern Nigeria in a bid to explore the peculiarities with incompleteness and identify weakness in data management and to proffer solutions to the problem going forward.Methods: This was a cross-sectional records review of 146 patients seen from 2012 to 2015. Results: The degree of data completeness reduced progres-sively in the course of treatment. From 73.3%, initial complete-ness of AAFB documentation reduced to 37.0% at the second month, and further to 14.4% at the fifth month. Mean weight gain was significant in all TB patients treated (p<0.001), but weight at the beginning and end of treatment course was recorded in just over a third of patients. Data on treatment outcome was not available for 83 (56.8%) of patients. Only 43 (29.5%) were recorded as cured but inference from the incom-plete AFB statistics showed the numbers should be higher. Conclusion: Significant gaps in TB data management create difficulties with TB program evaluation. Health workers at TB/DOTS sites need to be abreast with record keeping and adapt eTB manager for local use

The prevalence liver function and immunologic status of children with HIV and Hepatitis B virus coinfection in Enugu, Nigeria

Background: Hepatitis B Virus (HBV) co-infection is prevalent among HIV infected individuals because of shared routes and mechanisms of transmission. The multidimensional immunosuppression from HIV infection causes impaired spontaneous recovery from an acute HBV infection; predisposing to chronic infection which is worsened by younger age at infection. Co-infection increases the risk of HBV replication; hepatotoxicity and liver related deaths from Highly Active Antiretroviral Therapy (HAART). The study was undertaken to highlight the burden of co-infection among HIV positive children in Enugu; determine the associated risk factors and compare the effect of co-infection between co-infected and non-co-infected children using liver enzyme and CD4 counts. Materials and Methods: A cross sectional study was carried out among HIV positive children attending the Paediatric ARV clinic of the University of Nigeria Teaching Hospital; Ituku-Ozalla. A total of 140 HIV infected children aged 18 months to 15 years were recruited. An interviewer questionnaire was administered. Hepatitis B surface antigen (HBsAg) was determined using Determine test Kit. Baseline and recent CD4 counts/CD4% were retrieved from the patients' folders. Results: Fourteen (10%) were positive for HBsAg. The highest prevalence of HBsAg was observed among children aged 11- 15 years. The higher the socioeconomic class the less likely the HBsAg positivity. Seven (50%) of the co-infected children had elevated baseline ALT compared with 57 (45.2%) of non-co-infected children though the difference was not statistically significant (t = 0.6; P = 0.56). After the initiation of HAART; 10 (76.9%) of the co-infected and 18 (15.1%) of the non-co-infected children had elevated ALT. The baseline median CD4 count among children = 6 years was 230 cells/mm3 and 360 cells/mm3 respectively among the co-infected and nonco- infected; (P = 0.67). However; in children = 5 years; it was 25% and 15 % respectively (P =0.06). Conclusion: HBV co-infection among HIV infected children is common in our environment; and co-infection is associated with impaired immunity and probably liver enzyme derangement

Prevalence and risk factors for hepatitis c and human immunodeficiency virus co-infection among children in Enugu, Nigeria

Background: Hepatitis C virus (HCV) and Human Immunodeficiency virus (HIV), are major public health challenges in the developing world especially sub-Saharan Africa. The aim of this study was to determine the prevalence and risk factors of Hepatitis C virus infection among children infected with HIV. Methods: This was a cross-sectional study conducted at the Paediatric HIV Clinic, UNTH, Enugu between July and December 2009. Antibodies to HCV were analyzed by newer generation rapid chromatographic immunoassay method using the Chromatest one step HCV test kit. The data was analysed using the Statistical Package for Social Sciences (SPSS) version 15 statistical software. The chi squared test was used to test for significant association of categorical variables. A p-value of <0.05 was accepted as significant. Results: One hundred and eighteen children HIV-infected children, aged between eighteen months to fifteen years were included in the data analysis. Eight of the HIV infected subjects were positive for HCV, giving an HIV-HCV co-infection prevalence of 6.8%. Co-infection was more prevalent among males and in those in age group 11-15 years. Blood transfusion, irrespective of frequency (p<0.015), and injections for immunization (p<0.049) were the significant risk factors noted Conclusion: There is need for strengthening of existing preventive strategies against HCV and HIV infections such as screening of donor blood and safe injection practices in our locality

Pattern and Clinical Profile of Children with Complex Cardiac Anomaly at University of Nigeria Teaching Hospital; Ituku-Ozalla; Enugu State; Nigeria

Background: Complex congenital cardiac abnormalities are rare among children and contribute to mortality and morbidity. The prevalence and pattern of presentation vary from lace to place.Materials and Methods: The objective of this study was to determine the clinical profile and pattern of presentation of complex congenital cardiac malformations among children attending a tertiary hospital in Enugu State. A cross-sectional retrospective study in which a review of the records of children who attended the children outpatient clinic of University of Nigeria Teaching Hospital (UNTH); Ituku-Ozalla; Enugu State over a 5-year period (January 2007-June 2012) was undertaken. Results: Thirty one thousand seven hundred and ninety-five (31;795) children attended the outpatient clinic of the hospital over the study period; of these; 65 had cardiac diseases; from which 16 were found to have congenital complex cardiac abnormalities of various types; giving a prevalence of 0.05. Complex abnormalities seen in these children are Tricuspid atresia with various associations; cor triatriatum; single ventricle; and large ASD (atrio-septal defect) with complete AVCD; cor triatriatum sinistrum with cardiomyopathy; DORV (double outlet right ventricle) with left sided aorta; hypoplastic tricuspid valve with a PDA (patent ductus artriosus); TOF (tetralogy of fallot); prolapse of aortic valve; and pulmonary regurgitation. One of these complex cardiac anomalies presented with Turner's syndrome and another with VACTERAL association. Conclusions:The results of this study show that 0.05 of children who presented at cardiology clinic of a teaching hospital in Enugu State had congenital complex cardiac abnormalities and that the commonest forms seen were those with cor triatriatum and TOF

Prevention of Sexual Assault in Nigeria

Sexual assault occurs commonly worldwide and is particularly pervasive in the developing world. The background to sexual violence is important in the understanding of the ramifications of the problem. Some elements that offer the means to the prevention of sexual assault in the community are important highlights especially where the means - expertise and facilities - for managing cases of sexual assault is grossly inadequate. These concepts; though are applicable universally; are however discussed in the context of the developing world and with particular emphasis on the Nigerian situation. Their applicability in sexual assault prevention is derived from previous studies in different parts of the world that highlight the viability of these interventions. Therefore if one posits that sexual assault can be prevented; certain responsibilities are imperative; some challenges must be anticipated; and special needs/circumstances should be catered for

Assessing the Knowledge and Skills in Clinical Ophthalmology of Medical Interns: Survey Results from Enugu; South-Eastern Nigeria

Purpose: To compare the skills and knowledge of clinical ophthalmology among medical interns in Enugu; Nigeria; to the recommendations of the International Council of Ophthalmology (ICO). Materials and Methods: A questionnaire-based cross-sectional survey was conducted of Medical Interns attending the University of Nigeria Teaching Hospital and Enugu State University Teaching Hospital; from April 2010 to June 2010. Data on cohort demographics; undergraduate ophthalmology exposure; clinical skills and diagnostic competencies were collected and analyzed. Statistical significance was indicated by P 0.05. Results: The cohort comprised 81 males and 48 females (sex ratio . The duration of undergraduate ophthalmology exposure ranged from 1 to 4 weeks. Exposure was often adequate in cornea/external eye (95.3); lens/cataract (95.3) and glaucoma (92.2); but not in vitreo-retinal disease (47.3); neuro-ophthalmology (45.7) and refractive surgery (0.0). The majority were competent at visual acuity testing (97.7) and visual field examination (93.0). There was lower competency at anterior chamber assessment (49.6) and slit-lamp examination (39.5). The majority could confidently diagnose conjunctivitis (96.1) and cataract (90.7); but not strabismus (42.6) or macular degeneration (20.2). Conclusions: Medical interns in Enugu displayed gaps in their undergraduate ophthalmology exposure; clinical knowledge and skills. This has implications for stakeholders in medical education and eye care delivery. Review of the curriculum; provision of training resources and compliance with ICO guidelines could address the deficiencies

Brain Computed Tomography of Patients with HIV/AIDS before the Advent of Subsidized Treatment Program in Nigeria

Background: The objective is to study intracranial complications of HIV/AIDS using brain-computed tomography in patients who presented with neurological features before the advent of subsidized HIV/AIDS treatment program with highly active antiretroviral therapy (HAART) in Nigeria. Materials and Methods: Retrospective study of patients' records retrieved from radiology and medical records departments of the hospital. The studied patients had HIV/AIDS and presented with neurological features and underwent CT scan. Results: A total of 36 patients who tested positive for HIV and who presented with neurological features suspected to be complications of AIDS were examined with CT scan. They consisted of 24 male and 12 females. The male to female ratio was 2:1. The age of the patients ranged from 27 to 45 years. Seventeen patients (47.2) were aged 30-34 years. Twenty-four patients (60) were single while 12 (40) were married. Twenty-seven patients (75) were infected with HIV 1 and 2; five patients (13.9) were infected only with HIV-1 while four were infected with only HIV-2. Presenting neurological complaints include left hemiplegia 13 (36.1); right hemiplegia 6 (16.7); coma 7 (19.4); memory loss/dementia complex 5 (13.9); convulsion with coma 2 (5.6); left hemi-pariesis with memory loss 2 (5.6); and staggering gait 1 (2.8). The findings in CT scan include infarcts-like lesions 14 (38.9); multiple ring-enhancing lesions 7 (19.4); cerebral atrophy 5 (13.9); multiple nodular lesions 4 (11.1); acute intracerebral hemorrhage 3 (8.3); cerebral hemiatrophy 2 (5.6); and solitary ring-enhancing lesions 1 (2.8). Eight patients with single or multiple ring enhancing lesions were treated with empirical treatment for toxoplasmosis but only three (37.5) made full recovery. Conclusion: Brain CT scan showed extensive structural damages in patients with HIV/AIDS who were not treated with HAART. Out-of-pocket payment for investigations and treatment and absence of HAART could be partly responsible for high rate of advanced disease

The Prevalence and Antimicrobial Susceptibility Profile of Methicillin-Resistant Staphylococcus Aureus Isolates from Clinical Specimens in a Tertiary Hospital; South East Nigeria

Pathogenic microorganisms resistant to commonly used antibiotics are of worldwide concern. Methicillin-resistant Staphylococcus aureus (MRSA) has been reported worldwide and causes both hospital and community-associated infections in humans. Sixty-five (65) Staphylococcus aureus isolates from clinical samples were screened for methicillin resistance in order to evaluate the prevalence of methicillin-resistant strains at Ebonyi State University Teaching Hospital; Abakaliki and to determine the antimicrobial susceptibility profile of MRSA strains. Susceptibility testing of the isolates to oxacillin and to some other conventional antimicrobial sensitivity discs commonly used in the study area was done using Kirby-Bauer disc diffusion technique. Of the 65 Staphylococcus aureus isolates screened; 15 (23) were susceptible to methicillin while 50 (77) were resistant to methicillin. The Methicillin-resistant isolates showed 100resistance to ciprofloxacin; ceftriaxone; nitrofurantoin and erythromycin. The percentage resistance recorded for other antibiotics were ofloxacin (88); ampicillin (76); gentamicin (72); while the lowest resistance; (40) was recorded for vancomycin. It was noted that vancomycin is still the antibiotic of choice for the treatment of MRSA infections. It was concluded that the prevalence of MRSA is high in the study area; and this should necessitate caution in the prescription of antibiotics without proper indication

Lipid profile in HIV/AIDS patients in Nigeria

Introduction: Alterations of serum lipid profiles have been reported widely among Human Immuno deficiency Virus (HIV) positive patients on Highly Active Anti Retroviral Therapy (HAART). However; there are few data on serum lipid profile among treatment na?ve HIV positive patients in our environment. Objectives: To describe the pattern of lipid profile among treatment na?ve HIV positive patients and changes following HAART initiation. Methods: One hundred and thirty HIV positive patients seen in HIV center in an urban area in Nigeria and 44 matched individuals were recruited. Data were collected on socio demographic characters; baseline lipid profiles and CD4 count. Values of lipid parameters were retrieved after 12 months on HAART. Results: The mean Low density lipoprotein(LDL) was 2.26+ 0.9 mmol/l among the test group compared with 0.96+0.39mmol/L among the control ;p value =0.000 .The mean High density lipoprotein (HDL) was also significantly lower;0.8+ 0.6mmol/L reaching a dyslipidemic level; in the HIV positive group than the control; p value = 0.00. Tuberculosis /HIV co infected patients had a significantly elevated mean LDL; p=0.002. Conclusion: Abnormality of serum lipid is common among treatment na?ve HIV patients seen in Nigeria. The NNRTI regimen is associated with elevation of HDL and some stabilization of TC and TG

Depression among patients with diabetes mellitus in a Nigerian teaching hospital

Objectives. Depression is associated with diabetes mellitus and affects treatment goals negatively. We aimed to determine the prevalence of depression and identify its socio-demographic or clinical correlates among patients with diabetes mellitus attending an out-patient clinic in Nigeria. Methods. Two hundred consecutively recruited diabetes patients (index group) were compared with a similar number of apparently healthy controls in a cross-sectional survey. In both groups, in addition to obtaining socio-demographic details; depression was diagnosed using the Schedule for the Clinical Assessment in Neuropsychiatry (SCAN), while the Beck Depression Inventory (BDI) was used to assess depression symptom severity. Results. Sixty (30) diabetes patients met a SCAN diagnosis for clinical depression, compared with 19 (9.5) in the control group. Having a smaller income and more children were significantly correlated with higher depression symptoms on the BDI. Conclusion. Depression is highly co-morbid with diabetes mellitus. The care of individuals with diabetes mellitus should include the screening and possible treatment for depression in order to achieve and sustain treatment goals

Presentation of Colorectal Cancers in Benin-City; Nigeria

Background: Colorectal cancer is a major cause of cancer death worldwide; and the prevalence in Nigeria appears to be increasing due to a shift to western diets. We undertook a retrospective analysis of colorectal cancers seen at the University of Benin Teaching Hospital; Benin City from January 1983 to December 2002. Methods: One hundred and two cases involving the large bowel were encountered. These were analysed for age; sex; site; histological type and clinical features. Results: The mean age was 44.5 +/-4.5 years. Males accounted for 56 (54.9) cases; while 46(45.1) were females. Seventy two (70.2) of the tumours were located in the rectum. Adenocarcinoma was the predominant histological type; with 89 (87.2) cases. Fifty two (51) cases presented with intestinal obstruction. Conclusions: Conclusion; colorectal cancers are not rare in our environment as previously believed; though; the frequency in Benin City is relatively low

A Study of Extracranial Aneurysms at UNTH in Enugu; Nigeria

Previous studies on aneurysms in Nigeria have either been case reports or studies of peripheral aneurysms. No study has comprehensively evaluated all aspects of this disease as an entity among Nigerians. The need therefore arises to re-evaluate this lesion so as to make deductions on incidence; sex ratio; aetiology and management. This is a retrospective descriptive study of arterial aneurysms at the University of Nigeria Teaching Hospital (UNTH); Enugu. Those treated between January 1993 and December 2002 were included for the study. Datawere obtained frommedical records for all patients admittedwith aneurysms over the study period. Atotal of 26 patientswere admitted during the period; but 24 case noteswere analysed. The age rangewas 10-75 yearswithmale: female ratio of 1.4:1. Traumatic pseudo aneurysms accounted for 16 cases (67.0)while true aneurysms comprised the remaining.Of all the aneurysms; femoral artery with most of the pseudo aneurysms had 8 out of 24 (33.0).This is followed by the infra-renal abdominal aorta (5/24; 21.0) and other sites (11/24; 46.0). Diagnoses were made clinically in most cases and by abdominal ultrasonography in abdominal aortic aneurysms. Twenty-one patients had surgical interventionwith 9.5operativemortality. The incidence of aneurysm is low in our locality (2.6/year) based on the rate of diagnosis.Abdominal aorta harbours most of the true aneurysms with diameter ranging from 8.0-15.0cm without rupture. Untreated; all will eventually rupture with catastrophic consequences. Treatment involved excision with graft interposition. This is not only expensive but the graft is often not readily available. As a solution; grafts should be stocked with drug revolving fund

The Incidence; Pattern and Management Outcomes of Early Pregnancy Losses at the Ebony State University Teaching Hospital; Abakaliki

Background: Early pregnancy losses are a source of deep emotional trauma to any woman; her family and the attending Gynaecologist. This study evaluated the prevalence; pattern and management outcomes of such losses at a tertiary Health Institution. Methods: Data of all women who suffered early pregnancy losses between 1st January; 2002 and 31st December; 2004; were reviewed in a descriptive study. Information obtained from their case notes which related to the early pregnancy event; their socio demographics; obstetric history and management outcomes were collated. Univariate analysis was performed and frequency tables and figures were constructed where appropriate. Results: Early pregnancy losses comprised miscarriages; molar pregnancy and ectopic gestations accounted for 32.1of all gynaecological admissions during the period. Miscarriages were the commonest diagnosis and incomplete abortion constituted the bulk of this. Women of all parities were involved but rate of loss increased down the socio economic class strata. Majority were unbooked. A maternal mortality rate of 1.8attended all forms of early pregnancy losses during the period. Conclusion: Early pregnancy loss constitutes a major gynaecological problem in our centre. Health care providers must institute prompt and appropriate clinical management for a good clinical outcome