Faculty of Clinical Sciences

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    Pilot Experience with Infrared Photocoagulation As an Office Based Procedure for the Treatment of Hemorrhoids.
    (IOSR Journal of Dental and Medical Sciences, 2016-05) Ale A. F; Achinge G. I; Peter S. D; Shitta A. H; Isichei M. W; Misauno M. A
    There are many minimally invasive modalities in use for the treatment of hemorrhoids, most of which are unavailable in our setting. This study sought to describe our recent experience with infrared photocoagulation with a view to stressing it's suitability as an office based procedure for treating hemorrhoids. A prospective study of consecutive patients presenting with symptomatic hemorrhoids was conducted over a 3 year period. 21 (22.3%) patients had grade 1 hemorrhoid, 53 (56.4%) had grade 2 and 20 (21.3%) had grade 3 hemorrhoids. All 20 patients with grade 3 hemorrhoids at re-assessment after 2 weeks, the grade had changed to 2. 53 (56.4%) patients had 2 sessions of treatment at 2 weekly interval, while 41 (43.6%) patients had a single session of treatment to cure symptoms. 60 (63.8%) patients had minor post procedure hemorrhage, 14 (14.9%) had mild post procedure pain, 4 (4.3%) had recurrence of symptoms and were treated via open hemorrhoidectomy, while 16 (17.0%) had no procedure related complication. Infrared photocoagulation is an effective, safe and well tolerated procedure for the outpatient treatment of hemorrhoids and may be used to downstage grade 3 hemorrhoids.
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    Knowledge and use of oral rehydration solution in the home management of diarrhea among mothers of under fives in Jos, Plateau State
    (International Journal of Biomedical Research, 2017) Danjuma A Bello; Tolulope O Afolaranmi; Zuwaira I Hassan; Faith C Ogbonna; Patrick G Inedu; Cecilia Ejiga; Olubunmi O Chirdan
    Background: Diarrheal disease is one of the leading causes of pediatric morbidity and mortality worldwide, with an estimated 1.8 million childhood deaths annually, accounting for 17% of childhood deaths. Death can occur following severe dehydration if body fluids and electrolytes are not replenished either through the use of Oral Rehydration Salt (ORS) solution or intravenous fluid. Hence, this study was conducted to determine the level of use of ORS among mothers of under fives. Methodology: This was a cross sectional study conducted among 158 mothers of under-fives attending the FHC between November 2014 and April 2015 using quantitative method of data collection. Epi info statistical software version 3.5.4 was used for data analysis with a 95% confidence interval was used in this study and a p-value of ≤ 0.05 was considered statistically significant. Result: The mean age of the respondents in this study was 29 ±5 years. Good knowledge of ORS was found among 94 (59.5%) of the respondent with a corresponding 96 (60.8%) engaging in good use of ORS in the management of diarrhoea disease for their under five children. Use of ORS in management of diarrhoea disease was significantly influenced by level o knowledge of ORS, age of the mothers, availability of prep-packed ORS and tertiary education. Conclusion: This study revealed a fairly high level of knowledge and practice of ORT in the home management of diarrhoea amongst mothers of under–fives.
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    Factors influencing the pattern of malnutrition among acutely ill children presenting in a tertiary hospital in Nigeria
    (Niger J Paed, 2014) Ocheke IE; John C; Puoane T
    ntroduction: The bur-den of childhood malnutrition in Nigeria has remained unchanged for nearly a decade between the two Demographic and Health Surveys (NDHS) of 2003 and 2008. The causes of malnutrition are complex and multifactorial. It results from the interplay of so-cioeconomic, dietary inadequacy and environmental factors. Objective: To describe factors that influence the pattern of malnutri-tion in acutely ill children in a tertiary Hospital in central Nige-ria. Methods: Cross sectional and descriptive study. Children aged 6 to 59 months presenting with acute illnesses to the paediatric emergency unit were concurrently recruited over a 7 month period, (April-October 2012). All had comprehensive clinical assess-ment done including anthropom-etric (weight, mid arm circumfer-ence, height/length) measure-ments and z-scores calculated for the individual nutritional charac-teristics. Results: A total of 379 children were recruited with a mean age of 21.7±13.9 months. There was no difference in the mean age be-tween male and female (P=0.8). The prevalence of wasting was (26.9%), (18%) for stunting and (18.9%) for underweight. The prevalence of severe wasting, WHz scores <-3SD was (5.9%), (5.4%) for stunting and (4.6%) for underweight. The highest preva-lence of wasting and stunting were in age groups 6-11 and 12-23 months, at 9.3% and 6.3% respec-tively. The factors associated with malnutrition included early intro-duction of complementary diets, number of children in the home, maternal illiteracy and lower so-cioeconomic status of the parents. Female children were commenced on complementary diets much ear-lier than male (P=0.01). Conclusion: This study demon-strates the association between childhood malnutrition and factors such as early initiation of comple-mentary diet, maternal illiteracy, number of children in the home and poor parental socioeconomic status
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    PREVALENCE OF POSTDURAL PUNCTURE HEADACHE AMONG CAESAREAN SECTION PATIENTS IN NORTH CENTRAL NIGERIA
    (Kanem Journal of Medical ScienceS, 2017) Samuel I Nuhu; Henry Y Embu; Iornum Shambe
    Background: Spinal anaesthesia is now a popular choice for Caesarean sections in Africa but one of the draw-back is the development of post-dural puncture headache (PDPH) and it could be quite distressing to a mother. Identifying risk factors and reducing the prevalence is pertinent. This study sought to determine the prevalence of PDPH among patients who underwent Caesarean sections in a tertiary hospital in Jos, Plateau State, Nigeria and some of its possible associated factors.Method: It was a prospective study of all Caesarean sections done under spinal anaesthesia between November 2016 and June 2017. Spinal anaesthesia was performed on 236 parturients using Quincke-type needles sizes 23-26G. In the postoperative period, all the patients were followed-up to determine the incidence, onset, and severity of post-dural puncture headache. Epi-info version 7 was used for data analysis. Results: The prevalence of PDPH was 22.03%. Most of the parturients who developed PDPH in our study were of mild to moderate intensity using the numeric rating scale. Twenty six (11%) had mild, while 11 (4.7%) had moderate intensity of headache and which was resolved with treatment. Conclusion: The prevalence of PDPH is high in the obstetric population especially with the use of traumatic Quincke-type needles. Deliberate efforts must be made to reduce its occurrence by acquiring of small calibre pencil-point needles and training staff on how to use it.
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    A CASE AGAINST THE MEMBERSHIP PROGRAMME PROPOSAL OF THE WEST AFRICAN COLLEGE OF SURGEONS
    (78 JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS, 2012) AJAO OG,; UGWU BT
    Following the meeting held in Accra, Ghana in September 2012, a draft proposal on Harmonization of Surgical Training was submitted for final consideration by the four Colleges in the West African Sub- region. The Council of the West African College of Surgeons (WACS) was mandated to produce a Membership Curriculum separate from the Part 1 programme of the Fellowship Examination. This, in essence, means that there is a proposal to have a Membership Examination and certification in addition to the well established Fellowship Examination and certification. This means that there will be a lower standard of examination for Membership certification than the Fellowship Examination. The President of WACS in the presidential address in Liberia at the 52™ annual meeting made an allusion to “the reluctance of Faculty of Surgery to go along with the Membership” plan. We fully support the reluctance of the Faculty of Surgery in this regard, and the following will explain our position. It was George F. Will writing for Newsweek Magazine some years back that stated that what people learn from History is that people do not learn from History. This statement could not be truer when we consider this proposal.
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    A Comparison of Iron and Folate with Folate Alone in Hematologic Recovery of Children Treated for Acute Malaria
    (The American Society of Tropical Medicine and Hygiene, 2010) Samuel N. Gara; Aboi J. K. Madaki; Tom D. Thacher
    Concern has been raised that iron supplementation for treatment of acute malaria may worsen the severity of malaria. We compared the effect of iron and folate with folate alone on hematologic recovery in children treated for acute malaria. We randomized 82 children 6-60 months of age from Nigeria with smear-positive malaria and anemia (hematocrit < 33%) to receive iron (2 mg/kg/day) plus folate (5 mg/day) or folate alone in addition to antimalarial drugs. The mean ± SD hematocrit at baseline was 28.5% ± 2.9%. At four weeks, the mean hematocrit increased by 2.5% ± 1.6% in the iron plus folate group and by 1.4% ± 1.0% in the folate alone group (P = 0.001). Baseline hematocrit, iron supplementation, weight for height, and weekly meat intake were significant predictors of final hematocrit. The effect of iron was not significantly modified by baseline hematocrit, weekly meat intake, nutritional status, mother's education, sex, or age of the child. Iron supplementation improved hematologic recovery in children with malarial anemia.
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    Awareness, Attitudes and Perception of Antenatal Patients to Caesarean Section: The Jos, Nigeria Experience
    (International Journal of Advanced Research in Gynaecology and Obstetrics, 2018) Orokpo Christopher Egbodo; Uche A Akunaeziri; Adikpe E Edugbe; Iornum H Shambe
    Background: Caesarean section (CS) rates have been increasing steadily globally. Although caesarean section is becoming increasingly safe, women still have aversion for caesarean section in our environment. Objective: To determine the perception, knowledge and attitude of antenatal clinic (ANC) attendants in Jos University Teaching Hospital towards caesarean section as a mode of delivery. Method: This was a descriptive cross-sectional study. A pre-tested structured questionnaire was administered to pregnant women who receive care at the antenatal clinic of the Jos University Teaching Hospital between 1st December 2013 to 31st January 2014. Results: The average age of the respondents was 29.06±6.00 years, while the average income per month was 6786 ± 1053.92 naira. Fifty-five (24.2%) of the respondents did not know any indication for caesarean section while one hundred and seventy-two knew at least one correct indication out of which four (1.8%) knew three correct indications for caesarean section. Caesarean section was considered to be dangerous by 55.1%. The commonest reason given was that the mother could die (47.37%). Vaginal delivery was preferred by 88.5%, 6.20% had no preference while 5.30% preferred caesarean section. The commonest reason given for preference for vaginal delivery was that it is safer (32.34%). Eleven out of 12 respondents that preferred caesarean section preferred it because the stress of labor is eliminated. The commonest reasons for aversion to caesarean section was fear of operation (48.98%), lack of finance (30.61%) and fear of being stigmatized (26.53%). There was statistical significant relationship between income, religion and willingness to undergo caesarean section. Conclusion: There is a high level of awareness of caesarean delivery among ANC attendants at the Jos University Teaching Hospital. Client education is necessary to address some concerns on safety of the operation, indications for the operation, and stigmatisation.
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    Acalculous cholecystitis in Nigerian children
    (Pediatr Surg Int, 2003) Chirdan L.B.; lya D.; Ramyil V.M.; Sule A.Z.; Uba A.F.; Ugwu B.T.
    Sixteen children with acalculous cholecystitis (AC) were treated over a 9-year period (13 male and 3 female). Their ages ranged from 8 to 18 years (median 11). Eight (50%) presented with complications (perforation 4, gangrene 2, empyema 2): 13 (80%) presented with acute AC with a duration of symptoms of 2 weeks or less while 3 (20%) presented with chronic AC with symptoms present for more than 3 months. The diagnosis was made by ultrasound except in the patients with complications, who were diagnosed at laparotomy. Salmonella typhi was cultured in the bile and blood in 2 cases and the Widal titre was significantly elevated in 4 others. One child had chronic blockage of the cystic duct by a lymph node; in 9 there was no identifiable cause. Open cholecystectomy was successfully performed in 15 cases, while | child was managed non-operatively. The need for early diagnosis of cholecystitis in children is obvious if the potentially life-threatening complications of perforation and gangrene are to be avoided.
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    Mortality among pulmonary tuberculosis and HIV-1 co-infected Nigerian children being treated for pulmonary tuberculosis and on antiretroviral therapy: a retrospective cohort study
    (Original article, 2016-12) Augustine O. Ebonyi; Stephen Oguche; Oche O. Agbaji; Atiene S. Sagay; Prosper I; Okonkwo; John A. Idoko; Phyllis J. Kanki
    Mortality data, including the risk factors for mortality in HIV-infected children with pulmonary TB (PTB) being treated for PTB and who are on antiretroviral therapy (ART), are scarce in Nigeria. We determined the mortality rate and risk factors for mortality among such children, at the pediatric HIV clinic of the Jos University Teaching Hospital (JUTH) in Jos, Nigeria. Methods We performed a retrospective cohort study on 260 PTB-HIV-1 co-infected children, aged 2 months to 13 years, being treated for PTB and on ART from July 2005 to March 2013. The mortality rate and associated risk factors were determined using multivariate Cox proportional hazards modelling. Results The mortality rate for the study cohort was 1.4 per 100 child-years of follow-up. Median follow-up time was 5.2 years (IQR, 3.5-6.0 years) with total study time being 1159 child-years. The median age of those who died was lower than that of survivors, 1.9 years (IQR, 0.6-3.6 years) versus 3.8 years (IQR, 1.8-6.0 years), p=0.005). The majority of the deaths occurred in males (13, 81.2%), those <5 years of age (14, 87.4%) and those who had severe immunosuppression (11, 68.8%). Risk factors for death were age (with the risk of dying decreasing by 25% for every 1 year increase in age, adjusted hazard ratio (AHR)=0.75 [0.58-0.98], p=0.032), male gender (AHR=3.80 [1.07-13.5], p=0.039) and severe immunosuppression (AHR=3.35 [1.16-9.66], p=0.025). Conclusion In our clinic setting, mortality among our PTB-HIV co-infected children being treated for PTB and on ART was low. However, those presenting with severe immunosuppression and who are males and very young, should be monitored more closely during follow-up in order to further reduce mortality.
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    Department of Ophthalmology