Patients In Enugu Research Articles

Detection of microbial pathogens colonizing foot ulcers of diabetic patients in Enugu, Nigeria

Background: Diabetic foot ulcer (DFU) is a major complication of diabetes mellitus (DM) which is associated with high morbidity and mortality. There is high rate of bacteria colonization especially in those with tendencies for poor wound dressing. This is accompanied by high rate of inappropriate antibiotic usage. The aim of this study is to characterize microbial pathogens colonizing foot ulcers of diabetic patients in Enugu, Nigeria, and to determine the antibiotic susceptibility of these isolates.Methodology: This was a descriptive cross-sectional study of consecutively enrolled diabetic patients with foot ulcers in two tertiary healthcare facilities in Enugu, Nigeria, between May 2021 and February 2022. A structured questionnaire was used to obtain socio-demographic and clinical data of the patients. Pus samples and/or tissues were collected from the ulcer lesion of each patient for aerobic and anaerobic microbial cultures and biochemical identification using standard conventional techniques.Results: A total of 310 diabetic patients with foot ulcers were recruited into the study, with 62.3% (193/310) males and 37.7% (117/310) females, and mean age of 56.0±13.9 years. Bacteria and yeast were isolated from samples of 280 (90.3%) patients while samples of 30 (9.7%) patients had no microbial growth. Males had higher frequency of microbial isolates (90.7%, 175/193) than females (89.7%, 105/117), while the age group ≤ 40 years had higher frequency of microbial isolates (100%, 43/43) compared to other age groups, although the differences are not statistically significant (p>0.05). The distribution of the isolates showed that 15.7% (44/280) were monomicrobial while 84.3% (236/280) were polymicrobial. The highest single isolate was Bacteroides fragilis with 5.0% (14/280), followed by Staphylococcus aureus with 3.2% (9/280). Bacteroides fragilis and S. aureus occurred as the highest combined bacteria isolates with 5.7% (16/280). Most of the patients were colonized by combination of bacterial isolates. The susceptibility indicates that most of the anaerobic bacteria were sensitive to metronidazole while S. aureus isolates were resistant to ofloxacin at a rate of 65.0%. Conclusion: The findings in this study showed that there is high bacteria and fungi colonization of foot ulcers of diabetic patients in Enugu, Nigeria. Routine care of wounds especially frequent changes of dressing materials and the use of potent antiseptics, are recommended.
 Contexte: L'ulcère du pied diabétique (UPD) est une complication majeure du diabète sucré (DM) associée à une morbidité et une mortalité élevées. Il existe un taux élevé de colonisation bactérienne, en particulier chez les personnes ayant tendance à mal panser les plaies. Cela s’accompagne d’un taux élevé d’utilisation inappropriée d’antibiotiques. Le but de cette étude est de caractériser les agents pathogènes microbiens colonisant les ulcères du pied des patients diabétiques à Enugu, au Nigeria, et de déterminer la sensibilité aux antibiotiques de ces isolats.
 Méthodologie: Il s'agissait d'une étude transversale descriptive portant sur des patients diabétiques recrutés consécutivement et souffrant d'ulcères du pied dans deux établissements de soins de santé tertiaires à Enugu, au Nigeria, entre mai 2021 et février 2022. Un questionnaire structuré a été utilisé pour obtenir des données sociodémographiques et cliniques du les patients. Des échantillons de pus et/ou des tissus ont été prélevés sur la lésion ulcéreuse de chaque patient pour des cultures microbiennes aérobies et anaérobies et une identification biochimique à l'aide de techniques conventionnelles standard.
 Résultats: Au total, 310 patients diabétiques souffrant d'ulcères du pied ont été recrutés dans l'étude, avec 62,3% (193/310) d'hommes et 37,7% (117/310) de femmes, et un âge moyen de 56,0±13,9 ans. Des bactéries et des levures ont été isolées à partir d'échantillons de 280 (90,3%) patients, tandis que des échantillons de 30 (9,7%) patients ne présentaient aucune croissance microbienne. Les hommes présentaient une fréquence plus élevée d'isolats microbiens (90,7%, 175/193) que les femmes (89,7%, 105/117), tandis que le groupe d'âge ≤ 40 ans présentait une fréquence plus élevée d'isolats microbiens (100.0%, 43/43) par rapport aux autres groupes d’âge, bien que les différences ne soient pas statistiquement significatives (p>0,05). La répartition des isolats a montré que 15,7% (44/280) étaient monomicrobiens tandis que 84,3% (236/280) étaient polymicrobiens. L'isolat le plus élevé était Bacteroides fragilis avec 5,0% (14/280), suivi de Staphylococcus aureus avec 3,2% (9/280). Bacteroides fragilis et S. aureus étaient les isolats bactériens combinés les plus élevés avec 5,7% (16/280). La plupart des patients étaient colonisés par une combinaison d’isolats bactériens. La sensibilité indique que la plupart des bactéries anaérobies étaient sensibles au métronidazole tandis que les isolats de S. aureus étaient résistants à l'ofloxacine à un taux de 65,0%.
 Conclusion: Les résultats de cette étude ont montré qu'il existe une forte colonisation bactérienne et fongique des ulcères du pied des patients diabétiques à Enugu, au Nigeria. Des soins de routine des plaies, des changements particulièrement fréquents des matériaux de pansement et l'utilisation d'antiseptiques puissants sont recommandés.

Assessment of Nutritional Status among Elderly Hospitalized Patients in Enugu, Nigeria: A Hospital-based Study.

The ageing population worldwide presents a significant challenge for healthcare systems, with malnutrition being a common problem among elderly individuals, particularly those hospitalized. Assessing nutritional status is crucial for identifying and addressing malnutrition in this population. This study aimed to assess the prevalence of malnutrition among elderly hospitalized patients in a Nigerian tertiary healthcare setting. This was a hospital-based descriptive and cross-sectional study conducted from March to June 2023, involving 122 patients aged 60 years and above. Demographic data and anthropometric measurements were collected, and the Short-form Mini Nutritional Assessment (MNA-SF) tool was used to assess nutritional status. The reliability of the MNA-SF was assessed using Cronbach's α coefficient and item-to-total score correlations. The mean MNA score was 14.4 ± 5.3, with 71.3% of participants classified as malnourished, 22.1% at risk of malnutrition, and 6.6% well-nourished. Significant differences were observed in the body mass index (BMI) of nourished, at-risk, and malnourished individuals respectively (23.3 ± 3.6 kg/m2, 22.5 ± 3.8 kg/m2, and 19.6 ± 2.8 kg/m2, p < 0.001). The MNA-SF tool demonstrated acceptable reliability (Cronbach's α coefficient = 0.777), with significant correlations between total MNA scores and most MNA-SF questions. The high prevalence of malnutrition among elderly hospitalized patients in this Nigerian tertiary hospital emphasizes the importance of implementing routine nutritional screening protocols and targeted nutritional interventions for improved health outcomes among the elderly.

Hemogram Response to Vasoclusive Crisis in Sickle Cell Patients in Enugu, South East, Nigeria

Vasoclusion crisis is a major cause of morbidity and mortality in patients with Sickle Cell Anemia (SCA). There are currently a paucity of data on the hemogram response to vasoclusive crisis in patients with SCA in the Enugu metropolis. The present study is designed to determine the hemogram response to vasoclusive crisis in SCA patients compared to steady state and controls. A total of 150 subjects comprising 75 confirmed SCA patients (35 males and 40 females) aged between 16 and 30 years from Sickle Cell Clinic and 75 apparently healthy age and gender-matched controls of the Enugu State University of Science and Technology Teaching Hospital Enugu State participated in the study. Sample size was calculated using single proportion method. Ethical clearance was obtained from the Ethical Review Board of the hospital. Informed consent was obtained from subjects. Blood sample (5.0 ml) was collected from each subject and 3.0 ml was dispensed into ethylene diamine tetracetic acid tubes for estimation of the hemogram using Mindray 530-BC hemoanalyser. The hemogram revealed significant decrease (p &lt; 0.05) in Hemoglobin (Hb) during crisis (9.17 ± 0.91 g/dl) and during stead-state (11.63 ± 0.45 g/dl) and in hematocrit (Hct) during crisis (34.80 ± 3.03%) and during steady state (34.90 ± 1.37%) compared to controls Hb (13.5 ± 0.5 g/dl) and Hct (39 ± 1.5%). The total white blood cell count (TWBC) (8.3 ± 2.0 x 109/l) significantly increased (p &lt; 0.05) in crisis compared to TWBC (5.2 ± 1.0 x 109/l) and (5.5 ± 0.5 x 109/l) for the steady-state and controls respectively while the Platelet (PLT) significantly increased (p &lt; 0.05) in crisis (200 ± 55.05 x 109/l) compared to PLT (164 ± 45.39 x 109/l) and (150 ± 20.0 x 109/l) for the steady-state and controls respectively. This finding provides scientific data for changes in the hemogram in sickle cell patients during crisis and steady state.

Use of methylene blue dye for lymphatic basin mapping and sentinel lymph node biopsy in breast cancer patients in Enugu, Nigeria.

Sentinel lymph node biopsy is the current standard of care for axillary staging and further treatment planning in patients with clinical axillary node-negative breast cancer. Sentinel node (SN) biopsy was designed to accurately stage the axilla and minimize the side effects of conventional axillary-lymph-node dissection without sacrificing oncologic outcomes. Sentinel lymph node biopsy is normally performed with nuclear scan and patent blue violet or isosulfan blue. These are expensive and not commonly available in resource-poor regions such as West Africa. Methylene blue dye is a commonly used agent in a wide range of clinical diagnostic procedures and has been used by other investigators to perform this procedure. This study was designed to demonstrate the feasibility and effectiveness of SN biopsy in the management of axillary node-negative breast cancer in resource-limited populations using methylene blue dye. To determine the efficacy of methylene blue dye as a single tracer in lymphatic basin mapping and sentinel lymph node biopsy in patients with clinical axillary node-negative breast cancer. This was a prospective, case-controlled study involving 28 consecutively presenting female patients with clinical axillary node-negative breast cancer at the University of Nigeria Teaching Hospital, Enugu. Each of the patients had lymphatic basin mapping and sentinel lymph node biopsy with a sub-areola-subdermal injection of methylene blue dye. The SN (s) were then removed using the dye as the marker. Each patient then had a mastectomy or wide local excision as appropriately planned and conventional levels I and II axillary dissection was performed in the same sitting. The SNs and other axillary nodes were reviewed independently by our institution's pathologist. Each patient's axillary dissection specimen acted as her control for the study. The SNs were identified in 24 (85.7%) patients. There was a demonstrable learning curve with an improvement in identification rate in the later half of the cases (92.9%) compared to the earlier half of the cases (78.6%). A range of 1-3 nodes and a mean of 1.78 nodes were obtained. A sensitivity of 90.9%, specificity of 79.6%, false-positive rate of 28.6%, false-negative rate of 9.1%, and accuracy of 95.8% were obtained. There was no incidence of allergic/hypersensitivity reaction. Sentinel lymph node biopsy with methylene blue dye can be applied with high accuracy within resource-limited environments. However, there is a definite short learning curve that must be overcome and the procedure validated before clinical application in decision-making.

RESISTANCE PATTERN OF ANTIBIOTIC ON RE-EMERGING ESBL PRODUCING Escherichia coli AND Salmonella species ISOLATED FROM DIARRHOEA PATIENT IN TWO HOSPITALS IN ENUGU

Antimicrobial resistance among Enterobacteriaceae is unavoidable in modern medicine, and it is a major concern in the treatment of bacterial infections both in the hospital and in the community. Extended spectrum β-lactamases (ESBL) are enzymes produced by a range of Gram negative bacteria that provide greater antibiotic resistance. This article aims to determine the antimicrobial resistance pattern of re-emerging ESBL producing Enterobacteriaceae isolated from diarrhea patients in Enugu. Its objective is to isolate ESBL producing bacteria, investigate the prevalence of ESBL producing bacteria in patients and determine antimicrobial sensitivity profile. Clinical stool samples were collected from diarrhea patients from two hospitals in Enugu and were isolated on Cysteine Lactose Electrolyte Deficient (CLED) and Salmonella Shigella agar, a total of 35 isolates were obtained from which only 9 isolates were identified as potential Esbl producing organisms after phenotypical method and double disk synergy.

Prevalence of pre-operative anemia and associated blood transfusion among obstetrics & gynecological patients in Enugu

Prevalence of pre-operative anemia and associated blood transfusion among obstetrics & gynecological patients in Enugu

Prevalence of pre-operative anemia and associated blood transfusion among obstetrics &amp; gynecological patients in Enugu

Background: One of the major preparations before any surgery is to ensure that the patient has adequate blood levels. Anemia, according to the WHO is a common condition in which the number of red cells (and consequently their oxygen carrying capacity) is insufficient to meet the body’s physiological needs. It is diagnosed as hemoglobin concentration of less than 11g/dl and 12g/dl in pregnant and non-pregnant women respectively. However, Nigerian women with hemoglobin levels between 10g/dl and 11g/dl go through pregnancy and surgeries without any apparent ill effects. Aim: To determine the prevalence of pre-operative anemia and associated transfusion among gynecological and obstetric surgical patients in a tertiary hospital Materials &amp; Methods: This a retrospective study of 596 patients who had surgeries in the obstetric and gynecological department of ESUT in 2021 due to various obstetric or gynecological indications. Data was collected with a structured proforma and analyzed using Statistical Package for Social Sciences computer software for Windows version 20.0 presented in tables, charts, means, frequencies and percentages. Results: The results of the data analysis are presented in the tables below. Table 1 showed the distribution of the patients according to their age, marital status and occupation. Majority of the patients,209(35%) were above 36 years whereas 141(23.7%) were less than 25 years. Four hundred and three (67.7%) were married whereas 51(8.6) were widowed. Of all 320(53.7) were self-employed whereas 115(19.3%) were unemployed.

Prevalence of Post-Operative Anaemia and its Complications among Obstetric and Gynaecological Patients in Enugu

Prevalence of Post-Operative Anaemia and its Complications among Obstetric and Gynaecological Patients in Enugu

Prevalence of rifampicin resistant tuberculosis among pulmonary tuberculosis patients In Enugu, Nigeria.

We determined the prevalence of rifampicin resistance in pulmonary tuberculosis patients in Enugu Nigeria. A prospective hospital-based study involving 1300 presumptive multidrug-resistant tuberculosis patients was conducted in Enugu between April 2017 and 31st March, 2019.Participants age ranged from 15 years and older and each submitted one sputum specimens Sputum specimens were analyzed using the Gene Xpert MTB/RIF assay to detect resistance to rifampicin according to manufacturer's protocol. The prevalence of rifampicin resistant tuberculosis was 6.8% (95% CI: 5.5- 8.3). Rifampicin resistance was significantly higher in males (9.0%) than females (4.2%) (P = 0.036< 0.05). Most of the cases were seen in the age group 35-44 years (28.4%). Prevalence of rifampicin resistant tuberculosis was 2.7% in treatment naive (new) patients and 4.1% in patients on anti-tuberculosis therapy (previously treated). The prevalence of rifampicin resistant tuberculosis in Enugu was high. Rifampicin resistance in treatment naive (new) patients was also high. This study therefore highlights that active transmission of Multidrug-resistant tuberculosis among young males could be on-going.

Prevalence and Pattern of Thyroid Dysfunction in HAART-Naïve HIV Patients in Enugu, Nigeria: A Cross-Sectional Comparative Study

Background: HIV/AIDS is a multi-system disease that has been associated with several endocrinopathies including thyroid dysfunction. Thyroid dysfunction in patients with HIV/AIDS, among other factors, may arise from the direct cytopathic effects of HIV on the thyroid gland in addition to the adverse effects of highly active anti-retroviral drugs (HAART).&#x0D; Study objective: The study aimed to determine the prevalence and pattern of thyroid dysfunction in HAART naïve HIV patients in Enugu.&#x0D; Materials &amp; methods: Study was cross sectional, casecontrol based, involving 250 HAART naïve HIV sero-positive patients and 250 HIV sero-negative subjects. Anthropometric measurements and physical examination were done. Assay for fT3, fT4, TSH (for thyroid function) was done using the Enzyme Linked Immunoassay (ELISA) method. Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 23.&#x0D; Results: The HAART naïve sero-positive cohorts comprised 112 males and 138 females while the control subjects consisted of 125 males and 125 females. Mean ages (years) of test and control groups were 38.84± 10.60 and 39.58 ±11.68 respectively. Prevalence of thyroid dysfunction among the study subjects was 36.4% and 7.6% in the controls. Subclinical hypothyroidism was the most common prevalent type of thyroid dysfunction in both test and control groups at 17.6% and 7.2% respectively. In the test group, sick euthyroid syndrome (17.2%) ranked second while in the controls, primary hypothyroidism (7.2%) was the second commonest dysfunction.&#x0D; Conclusion: Thyroid dysfunction was more common in HAART-naïve HIV sero-positive subjects than in the general population with subclinical hypothyroidism emerging as the commonest abnormality.

Complementary and Alternative Medicine Use among Gynaecological Cancer Patients in Enugu, South-East Nigeria

INTRODUCTION: The high cost and associated adverse effects of conventional therapy make the patients seek complementary and alternative medicine. Complementary and alternative medicine use may contribute to the delay the patients have before seeking orthodox care.&#x0D; &#x0D; OBJECTIVES: To determine the prevalence, pattern, factors responsible for complementary and alternative medicine use and if complementary and alternative medicine use causes delay in seeking orthodox care among gynaecological cancer patients in Enugu. &#x0D; &#x0D; MATERIAL &amp;amp; METHODS: A pretested, semi-structured interviewer-administered questionnaire -based cross-sectional survey of 396 eligible gynaecological cancer patients recruited from both University of Nigeria Teaching Hospital, Enugu and Enugu State University of Science and Technology Teaching Hospital, Enugu between January, 2018 and June, 2020. The data was analyzed using the statistical package for social sciences version 23 (IBM SPSS, Chicago, IL).&#x0D; &#x0D; RESULTS: The mean age of the respondents was 57.3 years and it ranged from 41 to 77 years. Cervical cancer (76%) was the most common type of gynaecological cancer. A total of 283(71.5%) of the respondents used complementary and alternative medicine. Herbs (65%) were the most common type of complementary and alternative medicine used. Majority (56.9%) of complementary and alternative medicine users rarely used it. A total of 178(62.8%) complementary and alternative medicine users presumed that it would cure them while 105 (37.1%) presumed that it would relieve the symptoms of their cancer. However, 197 (69.6%) complementary and alternative medicine users stated that there was no actual benefit from its use. The low educational status has a statistically significant influence on complementary and alternative medicine use among the respondents(P-value=&amp;lt;0.0001). Complementary and alternative medicine use had a significant influence on delay to seek orthodox care among the study participants (P-value=&amp;lt;0.0001). Majority (84.5%) of the doctors, caring for the patients, were not aware of the patients&amp;rsquo; use of complementary and alternative medicine.&#x0D; &#x0D; CONCLUSION: Complementary and alternative medicine use among gynaecological cancer patients is high in Enugu. It also delays their presentation for orthodox care. Female education and public sensitization on the effect of complementary and alternative medicine use is necessary to curb this trend.

Glaucoma in self-reported relatives and non-relatives of Igbo glaucoma patients in Enugu, Nigeria

Purpose: To compare proportion of glaucoma and the associated factors among self-reported relatives and non-relatives of predominantly Igbo glaucoma patients Methods: An analytical cross-sectional survey of participants attending a free eye screening dedicated to relatives of glaucoma relatives in Enugu, Nigeria was carried out in July 2017. Non-relatives of glaucoma patients were expected to present for the free screening hence they were allowed to participate to prevent false claims. All participants were interviewed and underwent ophthalmic examinations. Glaucoma diagnosis was based on the ISGEO classification criteria adapted for Nigeria. Participants were subsequently grouped as glaucoma relatives and general population. Results: Forty-two and 56 participants were included in the relatives and general population groups respectively. The proportion of glaucoma in the relatives and general population groups was 43% and 20% respectively. The odds of having glaucoma was three times higher in relatives of patients than in general population (OR= 3.07, 95% CI; 1.25 – 7.5 p=0.013). About 52% of first-degree relatives were diagnosed with glaucoma. In the relatives’ group, 100% of siblings, 40% of children and 0% of parents had glaucoma. Proportion increased with age. Relatives were significantly younger than their probands at diagnosis (16years, p= 0.000). Only 5.6% of the relatives’ group were previously aware of diagnosis. Intraocular pressure and central cornea thickness were similar in both relatives and general population groups. Conclusions: In this screened Igbo population, over one-third of the relatives’ group and about one fifth of general population had glaucoma. Relatives were diagnosed at an earlier age. These findings will aid the advocacy for routine glaucoma family screening services.

Glaucoma in self-reported relatives and non-relatives of Igbo glaucoma patients in Enugu, Nigeria

Glaucoma in self-reported relatives and non-relatives of Igbo glaucoma patients in Enugu, Nigeria

Co-infection of hepatitis C virus infection as determinants of increased hepatotoxicity among tubrculosis patients in Enugu, Nigeria

Background: Tuberculosis is a devastating disease due to high rate of multidrug resistance. The coinfection with hepatitis C virus (HCV) may enhance the development of hepatotoxicity. There is paucity of data in Nigeria on impact of HCV and TB coinfection. This study was aimed to determine the prevalence of hepatitis C virus in tuberculosis patients and ascertain the association of drug induced hepatotoxicity. Methods & Materials: This is a cross-sectional study that enrolled 148 patients with laboratory confirmed pulmonary tuberculosis between March 2018 and February 2019. The patients were categorized into three groups: group 1, patients that were on DOTS therapy; group 2, those that were newly diagnosed of TB and group 3, those that had completed six months therapy. Information on alcohol intake, cigarette smoking and duration of DOTS (group 1) were obtained. A single blood sample was collected and used for detection of anti-HCV antibodies by recombinant-ELISA, and estimation of Alpha-fetoprotein and liver enzymes. The data obtained were analyzed by chi-square test and the strength of association were measured with logistic regression analysis. Results: The tuberculosis patients comprised of 56.1% (83/148) that were on DOTS, 33.8% (50/148) newly diagnosed and 10.1% (15/148) of those that had completed DOTS, with mean age of 35.7 ± 15.1. The overall prevalence rate of HCV infection in TB patients was 23.6% (35/148). The prevalence of HCV infection in group 1, group 2 and group 3 of the TB patients were 27.7%, 20% and 13.3% respectively. The occurrence of hepatotoxicity, due to increased liver enzymes, was more in patients coinfected with HCV, with 26.5%, 16.0% and 13.3% in group 1, group 2 and group 3 respectively. Severe hepatotoxicity, 2.4%, was observed among the DOTS group. Mild liver inflammation was observed in 18.0% of the TB patients infected with HCV and those not infected were 42.1%, as assessed by alpha-fetoprotein increase >11 ng/ml. The predicting factors for hepatotoxicity were age, alcohol intake and cigarette smoking. Conclusions: The findings in this study showed high prevalence of HCV in TB patients which may complicate the anti-TB drug metabolism in the liver resulting to drug induced hepatotoxicity and liver inflammation.

Factors associated with depression and anxiety among glaucoma patients in a tertiary hospital South-East Nigeria.

To explore the factors associated with depression and anxiety among glaucoma patients. This was a cross-sectional study involving adult glaucoma patients, who attended the eye clinic of Enugu State University Teaching Hospital, Parklane, Enugu, from April to September 2018. In total, 182 glaucoma patients with no other significant ophthalmic or medical conditions were recruited. Information on their socio-demographic and clinical characteristics was obtained using a close-ended, interviewer-administered questionnaire. Detailed ophthalmic evaluation to characterize the glaucoma was done. Depression and anxiety were assessed using the hospital anxiety and depression scale. Data were analyzed using SPSS version 21. Bivariate analysis was done to identify factors associated with depression and anxiety. The level of significance was at P < 0.05. The participants were mainly females, 108 (59.3%), married, civil servants with tertiary education and mean age of 59.7 ± 13.3 SD years. Majority of them had advanced stage of primary open angle glaucoma. Eighty (44%) of the participants had anxiety, while 76 (41.8%) had depression. Severe/blind stage of glaucoma and reduced visual acuity were significantly associated with anxiety and depression; occupation (trading) and intraocular pressure of <21 mmHg also significantly associated with depression. The prevalence of anxiety and depression among glaucoma patients in Enugu was high. Severe/blind stage of glaucoma and reduced visual acuity were the most important factors that associated with both anxiety and depression. Incorporating a psychological health approach to glaucoma care especially in patients with severe glaucoma and reduced visual acuity may promote effective communication between clinicians and patients and treatment adherence.

Pattern of malocclusion and caries experience in unrepaired cleft lip and palate patients in Enugu.

Clefts are common birth defects, usually accompanied by various malformations that include malocclusions, and may be associated with tooth decay. The aim of this study was to assess the malocclusion and caries status of the patients with unrepaired clefts who presented at the National Orthopaedic Hospital Enugu. A cross-sectional, descriptive study was conducted among patients with unrepaired cleft lip and/or palate that presented at the National Orthopaedic Hospital, Enugu between January 2009 and December 2011. Detailed records of 140 patients with cleft deformities who presented to the hospital within the study period were analyzed for the cleft pattern, whereas those patients above 6 years of age (52 patients) were analyzed for malocclusion using the Angle's classification of malocclusion. Assessment for dental caries according to WHO guidelines was made for all the patients. There were 74 males and 66 females. Cleft lip with or without alveolus involvement had equal prevalence (47.1%) (66 patients) with combined cleft lip and palate; eight patients had isolated cleft palate (4.71%). Angle's class 1 malocclusion was statistically significantly higher than other classes (P = 0.000). Class I malocclusion was seen in 38 patients (73.1%), whereas class 111 was seen in 8 patients (15.4%) and class 11 in 6 patients (11.5%). Eight patients (100%) who developed class 111 malocclusion all had a hard palatal defect. Proclining of maxillary anterior teeth (increased overjet) was the most common orthodontic anomalies, reported in 25 patients (48.1%) (P = 0.002). Caries prevalence of 12.9% was observed in this study. Caries experience was statistically significantly higher in deciduous than permanent teeth (P = 0.002). The high prevalence of malocclusion in these cleft patients emphasizes the need for an interdisciplinary team approach and early inclusion of dental care especially oral hygiene to prevent tooth decays.

Delays in presentation and treatment of breast cancer in Enugu, Nigeria.

To assess the delays and define the causes of delay in presentation and treatment of breast cancer patients in Enugu, Nigeria. A cross-sectional survey of breast cancer patients using a semi structured questionnaire. Surgical Oncology unit, University of Nigeria Teaching Hospital Enugu, (UNTH-E), Nigeria. 164 consecutively presenting breast cancer patients seen between June 1999 and May 2005. Most of the patients (82.3%) reported for initial evaluation at a modern health facility while 17.5% reported first to alternative practitioners. Forty six patients (26.4%) presented within a month of noticing the symptoms while 72 (45.3%) delayed more than 3 months. In contrast, 18 (17%) were seen at the site of definitive treatment within one month of seeking help at the initial hospital while 73.4% had a delay of more than 3 months after the initial hospital contact. Institutional or physician induced delays were present in 46.2% of the cases while patient related delays were present in 79.2% of cases. Only use of alternative practitioners for initial treatment was significantly related to delays of more than three months before presentation (p = 0.017). For breast cancer prevention programs in Nigeria to succeed, they must in addition to breast awareness and screening programs, address the institutional bottlenecks, the dearth of knowledge among primary care physicians and improve referrals from alternative practitioners and prayer houses.

Follow-up and adherence to glaucoma care by newly diagnosed glaucoma patients in enugu, nigeria

ABSTRACTPurpose: To determine uptake, adherence and influencing factors to follow-up care by newly diagnosed glaucoma patients from free eye screening exercise.Methods: The study was a cross-sectional survey of newly diagnosed glaucoma patients during free eye screenings carried out in March and October, 2016 in Enugu, Nigeria. Data on participants were analyzed after a minimum of 6 months from the screening for uptake and adherence to follow-up care. Qualifying patients had questionnaires administered to them by phone interview. Information requested regards awareness, knowledge on diagnosis as well as reasons for non-uptake and non-adherence.Results: 182 newly diagnosed glaucoma patients were included of which 121 (66.5%) were males, with median age of 50years.About 164 (90.1%) had at least a primary education. There were more self- employed persons 59 (32.4%) compared to other occupations. Uptake of follow up care was 17.6% (32/182). Adherence rate was 25% (8/32). Major reasons for non-uptake were lack of funds 54.9% (n = 50/91), distance 11% (n = 10/91) and receiving care from other facilities 11.0% (n = 10/91). Others include discourteous staff behavior and lack of information on diagnosis. Similarly, major reasons for non-adherence were lack of funds 44.4% (n = 8/18) and distance 22.2% (n = 4/18). Knowledge and prior awareness of glaucoma were found to be significantly associated with uptake of follow up care (p = 0.020).Conclusion: Uptake and adherence to follow-up was found to be low in this study population mainly attributed to cost, distance and poor knowledge of glaucoma natural history. Reviewing cost/out of pocket expenditure, providing care closer to patients, adequate education of staff and patients may significantly improve uptake of care after initial diagnosis.

Assessment of Systemic Fungal Infections among Diabetic Patients in Enugu, Nigeria

Assessment of Systemic Fungal Infections among Diabetic Patients in Enugu, Nigeria

Electrocardiographic abnormalities in treatment-naïve HIV subjects in south-east Nigeria.

SummaryBackground:Cardiac complications of human immunodeficiency virus (HIV) infection are important causes of morbidity and mortality. We set out to determine the electrocardiographic (ECG) abnormalities in treatment-naïve HIV-positive patients in Enugu, south-east Nigeria.Methods:This was a cross-sectional study involving 250 HIV-positive and 200 HIV-negative subjects. Demographic and anthropometric data, relevant investigations and ECG results were compared between the groups.Results:An abnormal ECG was present in 70% of the HIV-positive patients, sinus bradycardia in 64%, QTC prolongation in 48%, T-wave inversion in 21.6%, Wolf–Parkinson– White syndrome in 0.8%, abnormal P waves in 12.8%, 1st degree heart block in 2.4%, ST depression in 30%, and left-axis deviation in 1.6%. Underweight was associated with ECG abnormalities (p = 0.001). The HIV-positive patients had more ECG abnormalities than the HIV-negative subjects (p = 0.001).Conclusion:Electrocardiographic abnormalities were common in treatment-naïve HIV-positive patients in Enugu, Nigeria. The 70% prevalence of ECG abnormalities in treatment-naïve HIV-positive patients was high. There is a need to evaluate HIV-positive patients at onset for cardiac and non-cardiac abnormalities detectable by ECG.