Atypical presentation of mpox in Irrua environs: a case report.

BACKGROUND: Mpox, previously known as monkeypox, -is an orthopoxvirus infection of the skin and previously a public health emergency of international concern. It reemerged in Nigeria over 5 years ago and has since spread to other parts of the world. This is a case report of a confirmed patient who was managed at Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria before the global surge. This report shows peculiar differences from previous patients managed at the same center in terms of the relatively prolonged eruptive phase, possible seasonal occurrence of mpox in the community, and some traditional care for mpox and skin rashes. It also corroborates previous reports of possible sexual transmission of mpox in Nigeria before the report from the global outbreak. CASE PRESENTATION: The patient is a 30-year-old Nigerian male artisan with a 2-month history of raised rashes on the body that started on the genitals then involved other parts of the body. There was history of sore throat and unprotected sex with a female partner with similar rash whose other sexual history could not be ascertained. There was also history of "seasonal" rash in his village for about 7 years prior to his symptoms. Examination showed multiple vesicles and some nodules (ulcerating, healing, and healed) on the face, trunk, limbs, gluteal region, scrotum, palms, and sole, an almost circumferential penile ulcer, and lymphadenopathy. Polymerase chain reaction skin samples sent for mpox returned positive, while retroviral and coronavirus disease 2019 screenings were negative. He was managed in isolation while contact tracing in the affected community was initiated. CONCLUSION: Atypical presentations of mpox, as managed in Irrua before the global surge, emphasize the varied spectrum of presentations (typical and atypical) in Nigeria. Therefore, there is a need for a higher index of suspicion for the uncommon presentations which will strengthen case recognition, case management, and community-based interventions as well as surveillance in the prevention and control of mpox in Irrua, its environs, Nigeria, and the world.

Eclampsia in Irrua Specialist Teaching Hospital: a five-year review.

OBJECTIVE: The contribution of Eclampsia to maternal mortality in Nigeria is well documented. In Irrua it accounts for over 25% of maternal deaths. Addressing Eclampsia is therefore a priority programme of the Irrua Safe motherhood Initiative. AIM: The aim of this study is to determine the incidence of eclampsia, its clinical correlates and outcome. Finally strategies will formulate programme implementation. MATERIALS AND METHODS: This is a retrospective study of cases of eclampsia in Irrua Specialist Teaching Hospital, Edo state; over a five-year period. Information was retrieved using a structured proforma. Statistical analysis was done using the excel statistical package and the Epi info 2002 statistical software. RESULTS: Seventy eight (78) were admitted in the 5 year study. This accounted for 2.52% of total labour ward admission. However only 74 case notes were available for analysis. 70/74 of the patients were unbooked emergencies. Among the unbooked patients. 38/70 (54.29%) of the unbooked had not received any antenatal care whatsoever. The incidence was disproportionately higher in younger women and teenagers as well as in primigravida. 55/74 (74.32%) had preceding headache while 21.62% had a prior history of blurred vision, 14.86% had epigastric pain.16.22% had restlessness while 10.81% had nausea and vomiting each. The perinatal mortality rate was 28.38% while the maternal mortality ratio was 22.97%. Maternal mortality was associated with poor urinary output (0.0003), history of native medication (0.0199), number of fits (0.00209). Platelet count below 50,000/ml, highest systolic blood pressure above 200 mmhg (0.000018) and pulmonary oedema (0.000558). CONCLUSION: Addressing Eclampsia in Irrua will include community campaigns, capacity building, retraining of staffs within the hospital and improved facilities for the management of cases.

Chronic uterine inversion secondary to submucous fibroid: a case report.

A rare case of non-puerperal chronic uterine inversion secondary to sub mucous fibroid in a 38-year-old woman is presented. There was complete uterine inversion with the incarcerated inverted uterus protruding through the vvgina beyond the vulva. The sub mucous fibroid was attached to the fundus. At laparotomy, a dimple with a constriction ring was found in the position of the uterus. The distal ends of the fallopian tubes and part of the ovary were visible through the constriction ring. Histological examination of the uterus and fibroid following hysterectomy confirmed their benign nature.

Maternal mortality and delay: socio-demographic characteristics of maternal deaths with delay in Irrua, Nigeria.

BACKGROUND: Maternal mortality ratio of Nigeria is one of the highest globally. The delay in getting prompt and appropriate treatment in the event of a complication during pregnancy is one of the identified factors in maternal deaths. This study assessed the contribution of delay to maternal deaths and also determined the sociodemographic characteristics of patients with maternal deaths with associated delay. METHODS: This is a cross-sectional descriptive study of all maternal deaths in Irrua specialist Teaching Hospital, Nigeria between January 1999 and December 2003. Statistical analysis was done using 1 tailed Fisher's exact test. The level of significance was inferred at p < 0.05 RESULTS: The mortality ratio in the study period is 1747/ 100,000 live births. Delay was associated with 77.8% of all maternal deaths. Type I delay was the major problem contributing 57.1%. Identified risk factors for delay in this study are; unbooked status, low socioeconomic status and marital status. CONCLUSION: The recent launch of the National Health Insurance Scheme in Nigeria may improve access to health care of patients with pregnancy complications. Better living standards with improved social infrastructures as well as retraining of health personnel are also suggested.

The demographic characteristics and health seeking behaviour of unbooked patients in Irrua Specialist Teaching Hospital.

BACKGROUND: The Obstetric outcome of the patients who receive antenatal care and deliver at the Irrua Specialist Teaching Hospital is reasonably satisfactory. Our major challenges arise from unbooked emergencies. The aim of this study was to determine the frequency of unbooked patients in the Irrua Specialist Teaching Hospital, their clinical presentation, their demographic characteristics as well as their obstetric outcome. METHODS: A structured proforma was used to collect relevant information over a one-year period from patients' case notes, theatre records and labour ward records. RESULTS: During the study period, unbooked patients constituted 14.7% of all deliveries. They had a higher proportion of teenagers (p < 0.0000) and women over 40 years (p < 0.0000) when compared to the booked patients. There were also a higher proportion of primigravidas and grandmultiparous women but these did not reach statistical significance. Unbooked patients are also more likely to be single (p < 0.001) and polygamous (p < 0.0002) when compared to the booked patients. The diagnosis on admission included obstructed labour (18.2%), intrauterine fetal death (14.9%), ante partum haemorrhage (12.4%), post date (12.4%) and eclampsia (8.3%). Eighteen (14.9%) of the unbooked patients had no antenatal care whatsoever, while sixteen 13.2% had been visiting TBAs for some care in pregnancy. Maternal mortality for the unbooked patients was 5/121 (4.1%). There was no maternal death amongst booked patients during the study. CONCLUSION: The unbooked patients are relatively high-risk patients with some social disadvantage. They have a high maternal mortality.

Maternal mortality and delay: socio-demographic characteristics of maternal deaths with delay in Irrua; Nigeria

Background: Maternal mortality ratio of Nigeria is one of the highest globally. The delay in getting prompt and appropriate treatment in the event of a complication during pregnancy is one of the identified factors in maternal deaths. This study assessed the contribution of delay to maternal deaths and also determined the sociodemographiccharacteristics of patients with maternal deaths with associated delay. Methods: This is a cross-sectional descriptive study of all maternal deaths in Irrua specialist Teaching Hospital; Nigeria between January 1999 and December 2003. Statistical analysis was done using 1 tailed Fisher's exact test. The level of significance was inferred at p 0.05 Results: The mortality ratio in the study period is 1747/100;000 live births. Delay was associated with 77.8 of all maternal deaths. Type I delay was the major problem contributing 57.1. Identified risk factors for delay in this study are; unbooked status; low socioeconomic status and marital status. Conclusion: The recent launch of the National Health Insurance Scheme in Nigeria may improve access to health care of patients with pregnancy complications. Better living standards with improved social infrastructures as well as retraining of health personnel are also suggested

The Demographic Characteristics and Health Seeking Behaviour of Unbooked Patients in Irrua Specialist Teaching Hospital

Background: The Obstetric outcome of the patients who receive antenatal care and deliver at the Irrua Specialist Teaching Hospital is reasonably satisfactory. Our major challenges arise from unbooked emergencies. The aim of this study was to determine the frequency of unbooked patients in the Irrua Specialist Teaching Hospital; their clinical presentation; their demographic characteristics as well as their obstetric outcome. Methods: A structured proforma was used to collect relevant information over a one-year period from patients' case notes; theatre records and labour ward records. Results: During the study period; unbooked patients constituted 14.7of all deliveries. They had a higher proportion of teenagers (p

The Demographic Characteristics and Health Seeking Behaviour of Unbooked Patients in Irrua Specialist Teaching Hospital

Background: The Obstetric outcome of the patients who receive antenatal care and deliver at the Irrua Specialist Teaching Hospital is reasonably satisfactory. Our major challenges arise from unbooked emergencies. The aim of this study was to determine the frequency of unbooked patients in the Irrua Specialist Teaching Hospital; their clinical presentation; their demographic characteristics as well as their obstetric outcome. Methods: A structured proforma was used to collect relevant information over a one-year period from patients' case notes; theatre records and labour ward records. Results: During the study period; unbooked patients constituted 14.7of all deliveries. They had a higher proportion of teenagers (p

Obstetric hysterectomy: fifteen years' experience in a Nigerian tertiary centre.

The aim of this study was to determine the incidence, indications, associations and complications of obstetric hysterectomy in our centre with a view to suggesting ways of improving outcome. This is a descriptive study of patients who had obstetric hysterectomy in the University of Benin Teaching Hospital from January 1986 to December 2000. Data obtained from hospital records were analysed using appropriate computer statistical software for graphs and chi(2) test. In the period under study there were 20 344 deliveries. There were 46 obstetric hysterectomies, resulting in an incidence of 0.226%. Incidence increased with increasing maternal age from 0.10% at 20 years to 0.706% at 40 years and above. Incidence also increased with parity from 0.028% at para 0 to 1.298% for grandmultiparous women. The indications for the procedure were ruptured uterus 14/40 (35.0%), atonic postpartum haemorrhage 13/40 (32.5%) and placenta praevia 9/40 (22.5%); 12/40 (30.0%) of patients had previous caesarean sections. Subtotal hysterectomy had been undertaken in 43.5% of cases. There was a maternal mortality rate of 12.5%. Mortality was associated with torrential continuing haemorrhage and septicaemia. Urinary tract injury occurred in 7.50% of patients. Injury to the urinary tract was associated with previous caesarean section and total hysterectomy. Obstetric hysterectomy can have grave consequences. Availability of blood products, intensive monitors and limitation of family size is advised.