Tertiary Hospital In Nigeria Research Articles

Dental implant treatment: Experience in a tertiary hospital in Nigeria

Dental implant treatment: Experience in a tertiary hospital in Nigeria

Oral health treatment needs and dental service utilization among outpatients with mental disorders in Nigeria: A cross-sectional study

Aim: The aim of the study was to determine the dental treatment needs and the level of dental service utilization among patients with mental disorders (PWMD). Setting: This was a cross-sectional study at a tertiary hospital in Nigeria conducted between March and November 2018. Methodology: The community periodontal index of treatment of needs and the Decayed, Missing and Filled Teeth index were used to determine the dental and periodontal treatment needs. Dental service utilization was determined using a self-reporting assessment questionnaire. All data analyses were carried out using the IBM SPSS® Statistics version 20 and the statistical significance was set at P Results: A total of 116 PWMD participated in the study with 51.7% being females. The age range was between 19 and 57 years and the mean age was 37.16 (±10.52). Dental treatment need was 40.8%, while 66% needed a range of periodontal interventions and this showed no statistically significant differences in terms of gender (P = 0.67, P = 0.15, respectively). While 32.7% had made previous dental visits, past caries experience, and other factors such as gender were significant predictors for dental visits. Conclusion: There was a high dental and periodontal treatment need among PWMD, yet the dental service utilization was low. More collaborations between oral and mental health specialists are needed to improve dental service utilization and promote holistic health care for PWMD.

Cervical Ripening for Induction of Labor: A Randomized Comparison between Vaginal Misoprostol versus Foley’s Catheter Placement in a Nigeria Tertiary Hospital

Background: Cervical ripening is prerequisite of successful induction of labor. Vaginal misoprostol and Foley’s catheter placement have been widely used for this purpose but the data are not always sufficient. We attempted to determine which (misoprostol versus Foley’s catheter) is more effective/safer in Nigerian setting. Methods: A randomized controlled trial was performed at Federal Teaching Hospital Abakaliki, Nigeria, involving 135 term pregnant women requiring cervical ripening and labor induction. Participants were randomly allocated to misoprostol versus catheter group. The following were recorded/measured/analyzed: Bishop’s score, age, parity, body mass index, gestational age, labor duration, indication, oxytocin use, mode of delivery, and Apgar score. Chi square test and t test were used where appropriate. Results: At 24 hours, all of misoprostol group were either in labor, had ripe cervix, or had delivered, whereas 35.4% of catheter group had still unripe cervix (x2 = 29.856, P = 0.0001). Misoprostol group was less likely to require oxytocin infusion (x2 = 52.600, P = 0.0001) and less likely to require cesarean delivery (cesarean: misoprostol versus catheter: 11% versus 34% (x2 = 9.800, P = 0.001)). Total medical cost for misoprostol was less than that of catheter (x2 = 14.703, P = 0.0001). Conclusion: 50 μg vaginal misoprostol, compared with catheter placement, was more effective, cheaper, and safe as a procedure of cervical ripening before induction of labor.

Viral Haemorrhagic Fever Epidemics and Health Workers: Investigating the Level of Preparedness in a Tertiary Hospital in Nigeria

Aim: This study assessed the state of infection prevention and control (IPC) with an emphasis on a hospital’s preparedness for mitigating the spread of viral haemorrhagic fevers (VHFs) to staff.
 Methods: This convergent parallel mixed-methods study obtained data on IPC using an observational checklist in clinical departments and units; key informant interviews of stakeholders; and a structured self-administered questionnaire with frontline health workers. Both qualitative and quantitative data analyses were conducted to determine the IPC practice and level of preparedness of the hospital for the threat of VHFs.
 Results: The frontline clinical staff who responded to the questionnaires were aged 31 – 40 years (53.8%), male (50.3%) and medical doctors (72.2%). Some of the respondents had received training in hand washing (41.5%), use of PPE (35.1%) and standard precaution for VHFs (26.8%). Fewer respondents consistently used gloves (36.8%), face masks (8.6%), aprons (8.5%) and sharps containers (26.7%) during patient care. Amenities available for IPC varied across the 184 clinical service points in the hospital’s 19 departments. More service points had waste bins (86%), washing sinks (80%) and running water (74%) while a few had a standard operating procedure for hand washing (6%) and cabinets for storing PPEs (12%). The most significant challenge to the use of IPC measures was the inadequacy of amenities such as full PPE gear, respirator, aprons, and face masks within the clinical service points.
 Conclusion: There is a poor level of preparedness for outbreaks of VHFs and this calls for strengthening administrative, engineering and environmental control in health facilities to stem outbreaks among health.

Clinical Profiles of Males with Graves' Disease: A Two Year Review in a Tertiary Hospital in Nigeria

Aim: Graves’ disease is the commonest cause of thyrotoxicosis and it is much less common in males. Also, there is scanty information about the clinical characteristics of males with Graves’ disease. The objectives of the study were to determine the frequency of males with Graves’ disease seen by the Endocrinology unit of a tertiary hospital and describe their clinical characteristics. Materials and methods: Clinical data was retrieved from the case records of patients with thyroid disease seen between January, 2016 and January, 2018 and analyzed using descriptive and inferential statistics. Results: 61 patients with Graves’ disease were seen out of which 6 cases were males giving a frequency of 10.9%. The male-to-female ratio was 1: 9. The mean age at diagnosis of the male cases was 45 ± 16 years. All the patients had goitre and weight loss. 50% had heat intolerance, excessive sweating, palpitation, hyperdefaecation and hand tremors. Thyroid eye disease and thyrotoxic heart disease were found in 50% of the cases respectively. There was no statistically significant difference in the initialfree thyroxine between males and females (p=0.18). There was no statistically significant association between initial free thyroxine and thyroid eye disease (p=0.39). Conclusion: Graves’ disease is 9 times commoner in females compared to males in our centre. The clinical features in males are similar to reported features in females except thyroid eye disease which appears commoner in males.

Clinical Profiles of Males with Graves’Disease: A Two Year Review in a Tertiary Hospital in Nigeria

Background and Objectives: Graves’ disease is the commonest cause of thyrotoxicosis and it is much less common in males. Also, there is scanty information about the clinical characteristics of males with Graves’ disease. The objectives of the study were to determine the frequency of males with Graves’ disease seen by the Endocrinology unit of a tertiary hospital and describe their clinical characteristics. Subjects, Materials and Methods: Clinical data was retrieved from the case records of patients with thyroid disease seen between January, 2016 and January, 2018 and analyzed using descriptive and inferential statistics. Results: 61 patients with Graves’ disease were seen out of which 6 cases were males giving a frequency of 10.9%. The male-to-female ratio was 1:9. The mean age at diagnosis of the male cases was 45 ± 16 years. All the patients had goitre and weight loss. 50% had heat intolerance, excessive sweating, palpitation, hyperdefaecation and hand tremors. Thyroid eye disease and thyrotoxic heart disease were found in 50% of the cases respectively. There was no statistically significant difference in the initial free thyroxine between males and females (p=0.18). There was no statistically significant association between initial free thyroxine and thyroid eye disease (p=0.39). Conclusion: Graves’ disease is 9 times commoner in females compared to males in our centre. The clinical features in males are similar to reported features in females except thyroid eye disease which appears commoner in males

Barriers to Knowledge Management Practices, Interprofessional Collaboration and Information Technology Application in Federal Tertiary Hospitals in Nigeria

Effective dissemination of knowledge among healthcare professionals using information and telecommunication technology has been identified as an important tools to improve qaulity service delivery. This study provide succinct explanation of the constraints of using information technology in the management of knowledge among diverse healthcare professionals in federal tertiary hospitals in Nigeria. The study specifically focus on factors militating against the effective use of information technology application to manage knowledge to promote interprofessional collaboration for improved quality service deleivery. Cross-sectional data were collected from 479 healthcare workers across the federal tertiary hospitals in Nigeria. Using the Relative Importance Index (RII), the results show that inadequate ICT infrastructure (R = 0.79), inadequate technical support (R = 0.78), ICT illiteracy (R = 0.77), inadequate management support (R= 0.76), behavioural and personal characteristics (R = 0.72), among others are the major barriers militating against interprofessional collaboration and knowledge management in federal tertiary hospitals in Nigeria. Majority of the respondents also perceived lack of time and interaction among healthcare workers, poor verbal communication, level of experience, organisational structure and hierarchy, difference in education and gender as parts of the sociocultural factors inhibiting effective management of knowledge and interprofessional collaboration among healthcare workers. The study concludes that provision of basic information and communication technology facility to healthcare workers is paramount to enhance knowledge sharing and interprofessional collaboration to improve quality health service delivery. Adequate funding, provision of medical infrastructure and basic amenities, healthcare workers eduction and orientation towards the benefits of interprofessional collaboration using the IT application are suggested as ways to improve quality healthcare services in tertiary hospiatls.

Magnitude of missed opportunities for prediabetes screening among non-diabetic adults attending the family practice clinic in Western Nigeria: Implication for diabetes prevention.

BackgroundFor many decades, hypertension guidelines recommended dual-arm blood pressure measurement. However, this practice is poor in Nigeria and its significance is largely unidentified. Hence, this study was done to determine the point prevalence of inter-arm blood pressure difference and its relationship with hypertension and diabetes mellitus.MethodsA cross-sectional study was conducted among 214 respondents at the general outpatient clinic of a tertiary hospital in Nigeria. Demographic characteristics and anthropometric indices were obtained. Blood pressure readings were obtained through sequentially repeated measurements in respondents’ arms.ResultsOne-hundred and eighty-six respondents had complete data given a completion rate of 86.9%. Systolic blood pressure was higher on the right and left arm in 102 (54.8%) and 56 (30.1%) of the respondents, respectively. Diastolic blood pressure was higher on the right and left arm in 73 (39.2%) and 63 (33.9%) of the respondents, respectively. The overall prevalence of significant systolic inter-arm difference (≥ 10 mmHg) and diastolic inter-arm difference (≥ 10 mmHg) were 24.2% and 18.8%, respectively. Significant systolic inter-arm difference (p = 0.033) and diastolic inter-arm difference (p = 0.01) were significantly more among respondents with hypertension and/or diabetes mellitus.ConclusionThe blood pressure readings in both arms were different among the majority of the respondents, being higher on the right arm in many of them. The prevalence of significant inter-arm difference was high in the unselected primary care patients studied especially among patients with hypertension and/or diabetes mellitus. Blood pressure measurement in both arms should become a routine practice during initial patients’ visits in primary care.

Teething Beliefs, Misconceptions, and Practices Among Mothers Attending a Tertiary Hospital in Nigeria: Implications for Child Health and Clinical Practice

Introduction: Teething is a physiologic process that begins during infancy. However, some mothers often attribute certain symptoms to teething. In this study, we assessed the opinions and practices of mothers attending a tertiary health facility in Nigeria on teething.
 Methods: This was a cross-sectional, descriptive study conducted among caregivers of children presenting to the out-patient department of a tertiary hospital, Southwestern Nigeria.
 Results: Five hundred and sixteen mothers were studied. The leading symptoms attributed to teething were fever 420 (81.4%), reduced food intake / appetite 320 (62.0%), diarrhoea 314 (60.9%) and vomiting 294 (57.0%). Some believed that teething is associated with convulsion 102 (19.8%), mouth ulcers 69 (13.4%), ear discharge 68 (13.2%), and no symptoms 41 (7.9%). Majority of the mothers 374 (72.5%) believed that teething requires treatment. Two hundred and four (39.5%) mothers had given their children oral analgesics for teething while 194 (37.6%) administered teething mixtures. These medications were more likely to be prescribed at the hospital or purchased over the counter (p < 0.05). Other treatments given included herbal concoction 46 (8.9%), local tooth extraction 22 (4.3%), enema 17 (3.3%), body scarifications 14 (2.7%), gum fomentation 14 (2.7%) and gum incision 12 (2.3%). Responders who attributed convulsion to teething were more likely to have incised their children’s gums (p < 0.05).
 Conclusions: This study revealed that sundry symptoms were attributed to teething and harmful home interventions were done for teething. There is a need to educate the society on teething and discourage harmful practices for teething by caregivers.

Assessment of patients waiting and service times in the ophthalmology clinic of a public tertiary hospital in Nigeria.

Long waiting time in the out-patient clinic is a major cause of dissatisfaction in Eye care services. This study aimed to assess patients' waiting and service times in the out-patient Ophthalmology clinic of UITH. This was a descriptive cross-sectional study conducted in March and April 2019. A multi-staged sampling technique was used. A timing chart was used to record the time in and out of each service station. An experiencebased exit survey form was used to assess patients' experience at the clinic. The frequency and mean of variables were generated. Student t-test and Pearson's correlation were used to establish the association and relationship between the total clinic, service, waiting, and clinic arrival times. Ethical approval was granted by the Ethical Review Board of the UITH. Two hundred and twenty-six patients were sampled. The mean total waiting time was 180.3± 84.3 minutes, while the mean total service time was 63.3±52.0 minutes. Patient's average total clinic time was 243.7±93.6 minutes. Patients' total clinic time was determined by the patients' clinic status and clinic arrival time. Majority of the patients (46.5%) described the time spent in the clinic as long but more than half (53.0%) expressed satisfaction at the total time spent at the clinic. Patients' clinic and waiting times were long, however, patients expressed satisfaction with the clinic times. Self-funded.

How mindful of their own health are healthcare professionals? perception and practice of personnel in a tertiary hospital in Nigeria.

To assess health professionals' perception and determinants of their health and practice of preventive self-care. An analytic cross-sectional design was employed, and 232 professionals were selected by stratified sampling from all health professional departments of Delta State University Teaching Hospital. Healthcare professionals who had worked in the hospital for at least six months were included in the sampling frame. Pregnant women and supernumerary professionals were excluded. A self-administered questionnaire was used, and data analysed using SPSS. The main outcome measures were the level of perception of self-health and level of practice of preventive selfcare. More than four-fifths of doctors and 64.8% of nurses had good perception of their health, with significant association between perception and service area (X2 = 11.828, p =0.008). Screening practice was lowest amongst doctors except for HIV/HBV screening. Whereas 63.4% of all participants adjudged their BMI to be normal, only 36.2% actually had normal BMI, the difference being significant (p <0.001). Almost 20% of doctors had not had a BP check in a year or more, and the same proportion of doctors and nurses had never checked their FBS. The proportion of personnel who had never checked their serum lipid profile was high among nurses (76.1%) and doctors (58.3%). Respondents had good perception but poor preventive behaviour, beginning management after disease onset. This may be ominous for the sector. Urgent health promotion action to safeguard productivity is needed. Comprehensive data from a multi-centre study will provide a deeper understanding of the issue. None declared.

Abstract IA24: Biology of aggressive breast cancer in women of African descent

Abstract Background: Breast cancer (BC) mortality rates are higher among women of African descent, including Nigerian women, compared with other racial groups. In the US, BC mortality is 40% higher among African American women compared with White women, and even after accounting for socioeconomic position (SEP), comorbidities, treatment delays, and genetic background –this disparity is still not fully explained. The higher prevalence of aggressive BC subtypes in women of African descent likely plays a role, and given the shared genetic ancestry and increasing prevalence of cardio-metabolic dysregulation in both Nigerian and African American women, we sought to examine the association between measures of cardio-metabolic dysregulation (excess adiposity, dyslipidemia, CRP) on BC risk and molecular subtype among a contemporary cohort of Nigerian women. Findings might help elucidate additional risk factors for aggressive BC in women of African descent, and inform the development of effective prevention strategies in this population Approach: A total of 301 breast cancer patients recruited from four tertiary hospitals in Nigeria, and 274 healthy community controls were included in the analysis. For both cases and controls, a comprehensive questionnaire was administered, followed by physical examination by trained clinical staff and biospecimen collection. Tumor tissue samples were shipped to the US for pathological confirmation and immunohistochemistry (for cases) and for laboratory assays of cardio-metabolic biomarkers (for cases and controls). We evaluated the associations of excess adiposity, dyslipidemia (HDL and LDL cholesterol) and CRP with breast cancer risk overall and by molecular subtype (i.e. Luminal A, Luminal B, HER2+ or triple-negative/TNBC). Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CI) after adjusting for socio-demographic and reproductive variables (age, menarche, menopause, pregnancy) Results: After adjusting for study covariates, higher BMI was associated with a 38% lower BC risk overall (aOR: 0.62; 95% CI: 0.39, 0.98), however high waist circumference was associated with a 79% increased risk of breast cancer overall (aOR: 1.79, 95% CI: 1.13, 2.82) and 2-fold increased risk of TNBC (aOR: 2.31, 95% CI: 1.00, 5.33). Lower HDL was associated with a modest, non-significantly increased risk of BC overall (aOR: 1.04, 95% CI: 0.62, 1.73), and a significant 5-fold increased risk of TNBC (aOR: 5.26, 95% CI: 1.17, 23.70). There were no significant associations observed for high LDL overall or by subtype. Separately, higher CRP (&amp;gt;10mg/L) was associated with over a 5-fold increased BC risk, and 77% increased risk of TNBC (OR: 1.77, 95% CI: 0.67, 4.66). Conclusion: Cardio-metabolic dysregulation, specifically high waist circumference, low HDL and high CRP appears to contribute to increased risk of aggressive TNBC subtype among Nigerian women and may be useful targets for clinical interventions Citation Format: Tomi Akinyemiju, MEND study co-investigators. Biology of aggressive breast cancer in women of African descent [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr IA24.

Knowledge, Behavior, Attitude and Practice of Hospital Pharmacists to Adverse Drug Reactions in the Elderly in a Tertiary Hospital in Nigeria

Knowledge, Behavior, Attitude and Practice of Hospital Pharmacists to Adverse Drug Reactions in the Elderly in a Tertiary Hospital in Nigeria

Treatment outcomes of Nigerian patients with tuberculosis: A retrospective 25-year review in a regional medical center.

Tuberculosis (TB) remains a global health challenge and leading infectious killer worldwide. The need for continuous evaluation of TB treatment outcomes becomes more imperative in the midst of a global economic meltdown substantially impacting resource-limited-settings. This study retrospectively reviewed 25-years of treatment outcomes in 3,384 patients who were managed for TB at a tertiary hospital in Nigeria. Confirmed TB cases were given directly observed therapy of a short-course treatment regimen and monitored for clinical response. Out of 1,146,560 patients screened, there were 24,330 (2.1%) presumptive and 3,384 (13.9%) confirmed TB cases. The patients' mean age was 35.8 years (0.33-101 years). There were 1,902 (56.2%) male, 332(9.8%) pediatric, and 2,878 (85%) pulmonary TB cases. The annual mean measured treatment outcomes were as follows: adherence, 91.4(±5.8) %; successful outcome, 75.3(±8.8) % potentially unsatisfactory outcome, 14.8(±7.2) %; and mortality 10.0(±3.6) %. Female, extra-pulmonary TB (EPTB), newly diagnosed, and relapsed patients compliant with treatment had successful outcomes. Adulthood and HIV infection were mortality risk factors. The mean annual successful treatment outcome is 75.3(±8.8) %. Female, pediatric, EPTB, new, and relapsed patients were predisposed to successful treatment outcomes. Lessons learned will guide future program modifications.

Cohort study on adverse drug reactions in adults admitted to the medical wards of a tertiary hospital in Nigeria: Prevalence, incidence, risk factors and fatality.

Intensive monitoring of medical patients for adverse drug reactions (ADRs) to assess prevalence, incidence, risk factors and fatality of ADRs leading to hospital admission or occurring in the hospital. Prospective cohort study on 1280 adult patients admitted to the medical wards of a tertiary institution over 12 months. Patients were assessed for ADRs during and throughout admission; causality and preventability of ADRs were assessed. Sixty-seven (5.2%) patients had ADRs, 51 (3.9%) caused hospitalisation while 17(1.3%) occurred during hospitalisation, and 42 (62.7%) of total ADRs were preventable. Nonsteroidal anti-inflammatory drugs, 14 (20.3%), antidiabetics, 12 (17.4%) and antibacterial, 11 (15.8%) were the most implicated drug classes. Gastrointestinal tract (37%), central nervous system (30.2%), and skin (24.7%) were the most affected organ/systems, while upper gastrointestinal bleeding and hypoglycaemia were the most observed ADRs. ADRs led to deaths in 7 (10.4%) patients, with an overall case fatality rate of 0.5%. The highest number of deaths were among patients with Stevens-Johnson syndrome 2/7 (28.6%) and hepatotoxicity 2/7 (28.6%). Risk factors, adjusted odds ratio (AOR [95% confidence interval, CI]) for ADRs leading to hospitalisation was male sex 3.11 (1.11, 8.73) while for ADRs during hospitalisation were number of drugs used before admission (AOR [95% CI] = 6.67 [1.16, 38.47]) and comorbidities (AOR [95% CI] = 3.0 [1.13, 8.01]). Patients admitted with ADRs had prolonged hospital stay (AOR [95% CI] = 3.37 [1.11, 8.71]). Preventable ADRs are common and important causes of hospitalisation and inpatients' morbidity and mortality among medical patients in Nigeria. Upper gastrointestinal bleeding and hypoglycaemia, resulting from nonsteroidal anti-inflammatory drugs and antidiabetic drugs were the most observed ADRs.

Serum Vitamin E Levels in Children and Adolescents with Epilepsy at a Tertiary Hospital in Nigeria

Vitamin E, the most important fat-soluble antioxidant in humans, is reported to be lower in individuals with epilepsy and may be beneficial when used as add-on therapy to antiepileptic drugs (AEDs). The study aimed to measure the serum vitamin E levels in Nigerian children and adolescents with epilepsy and explore the possible association with some of their clinical characteristics. The study was cross-sectional in design and conducted in 80 patients with epilepsy aged 3 months to 18 years attending the Pediatric Neurology clinic of Lagos University Teaching Hospital in 2017, and 80 age- and sex-matched apparently healthy controls. Serum vitamin E was assayed using reversed-phase high-performance liquid chromatography, cholesterol was assayed spectrophotometrically, and serum vitamin E/cholesterol ratio was calculated. Mean (SD) serum vitamin E level was within normal range in both patients and controls at 7.988 (1.127) μg/dl and 7.971 (0.764) μg/dl respectively (P > 0.05). However, serum vitamin E/cholesterol ratio was significantly lower in patients (0.054 ± 0.017 μg/mg) than in controls (0.061 ± 0.022 μg/mg) (P = 0.018). Also, serum vitamin E/cholesterol ratio of 51.2% of patients was in the 25th percentile compared with 22.5% of controls (P = 0.001). No significant association was found between serum vitamin E or vitamin E/cholesterol ratio and various seizure characteristics. Cholesterol-adjusted serum vitamin E level was significantly lower in Nigerian children and adolescents with epilepsy compared to age- and sex-matched controls irrespective of their clinical characteristics. Further studies are needed to evaluate the possible role of vitamin E therapy in improving seizure control and child health.

Does it happen and why? Lived and shared experiences of mistreatment and respectful care during childbirth among maternal health providers in a tertiary hospital in Nigeria

IntroductionGlobally, mistreatment during childbirth remains a powerful deterrent to skilled birth utilization. AimWe determined the perpetrated and witnessed experiences of mistreatment and Respectful Maternity Care (RMC) among maternal health providers in a tertiary hospital in Nigeria. MethodsA cross-sectional study was conducted among 156 maternal health providers in a tertiary hospital in Nigeria. Information was collected using semi-structured, self-administered questionnaires, and 3 focus group discussions. Quantitative and qualitative data analyses were performed using SPSS version 20 and thematic analysis respectively. FindingsMost respondents were males (64.1%) and doctors (74.4%) with mean age of 31.97±6.82. Two-fifths (39.1%) and 73.1% of the respondents had ever meted out or witnessed disrespectful and abusive care to women during childbirth respectively. Verbal abuse and denial of companionship in labour were major mistreatments reported qualitatively and quantitatively. About a third of the respondents mistreated women 1–2 times in a week. Younger respondents had 64% lower odds of reporting mistreatment during childbirth (AOR=0.36, 95% CI=0.14−0.96). The most and least frequently practiced RMC element were provision of consented care (62.8%) and allowing birth position of choice respectively (3.8%). Poor hospital patronage and reputation were the perceived consequences of mistreatment during childbirth. ConclusionWitnessed rather than self-perpetrated mistreatment during childbirth was more reported in addition to poor RMC practices Self-perpetrated mistreatment during childbirth was less reported among younger providers. We recommend intensification of provider capacity building on RMC with special focus on older practitioners and the provision of supportive work environments that encourage respectful maternal care practices.

Bacteriological Profiles of Pyogenic Wound Infection among Adults with Antibiotic Susceptibility Pattern at a Tertiary Hospital in Nigeria

Aims: A wide variety of aerobic and anaerobic bacteria either singly or in combination has been implicated in pyogenic wound infection and this has been associated with treatment failures due to antibiotic resistance. This study aims at investigating the agents of pyogenic wound infection and their antibiotic susceptibility.&#x0D; Study Design: A descriptive cross-sectional study conducted at the only tertiary Teaching Hospital in Uyo, Nigeria and carried out on 136 wound samples.&#x0D; Place and Duration of Study: University of Uyo Teaching Hospital, Uyo, Nigeria, between April and October, 2018.&#x0D; Methodology: Aspirated pus or wound swab samples were collected and inoculated on two separate agar plates containing 25% Sheep Blood and incubated aerobically and anaerobically at 37°C for 48 – 72 hours. Identification of isolates was performed following standard procedures. Data obtained were analyzed using SPSS software.&#x0D; Results: Of the 136 collected wound samples from 76 (55.9%) males and 60 (44.1%) females patients from ages 20 to 70 years and above, 127 (93.4%) had growth of different bacterial isolates totaling 214 in number. Among these were aerobes 132 (61.6%) anaerobes 82 (38.4%). The Gram-negative aerobes had the highest prevalence 81 (37.9%), while the Gram-positive anaerobes 20 (9.4%) was the least prevalent. Staphylococcus aureus, 44 (86.3%) and Pseudomonas aeruginosa, 24 (29.6%), were the predominant Gram-positive and Gram-negative aerobes respectively. Peptococci spp. 8 (40%) and Bacteriodes fragilis 28 (54.9%) were the predominant Gram-positive and Gram-negative anaerobes respectively. Some rarely reported pathogens revealed include Acinetobacter iwoffi, Enterobacter cloacae and Stenotrophomonas maltophilia 1(1.2%) and they showed 100% resistance to all tested antibiotics. The majority of the Gram-positive aerobes 29 (56.9%) were Vancomycin resistant and there was also an increasing prevalence of Methicillin resistant Staphylococcus aureus (45%).&#x0D; Conclusion: The bacterial agents causing pyogenic wound infection in Uyo comprised of 61.6% aerobes and 38.4% anaerobes. Some rarely reported bacteria such as Enterobacter cloacae and A. iwofii implicated in the infections were resistant to all commonly used antibiotics including Imipenem, a reserved antibiotic. Staphylococcus aureus was the commonest cause of pyogenic wound infection and up to 45% of them were Methicillin resistant.

Missed Isolated Transverse Colon Injury following Trauma at a Tertiary Hospital in Nigeria

Missed injuries have been defined by several authors some have used how clinically significant the missed injuries are [1,2] while others have used the length of time from injury to diagnosis...

Inter-Arm Blood Pressure Difference Among Nigerian Primary Care Patients— the Need for Dual Arm Blood Pressure Measurement

Background: For many decades, hypertension guidelines have recommended dual-arm blood pressure measurement. However, the practice is poor in Nigerian primary care and its significance largely unidentified. Hence, the need to determine the significance of detecting inter-arm blood pressure difference among primary care patients in our local population. This study was done to determine the point prevalence of inter-arm blood pressure difference and its relationship with hypertension and diabetes mellitus. Methods: A cross-sectional study was conducted among 214 respondents at the general outpatient clinic of a tertiary hospital in Nigeria. Demographic characteristics and anthropometric indices were obtained. Blood pressure readings were obtained through sequentially repeated measurements in respondents’ arms. Results: One hundred and eighty-six respondents had complete data given a completion rate of 86.9%. Systolic blood pressure was higher on the right and left arm in 102 (54.8%) and 56 (30.1%) of the respondents respectively. Diastolic blood pressure was higher on the right and left arm in 73 (39.2%) and 63 (33.9%) of the respondents respectively. The overall prevalence of significant systolic inter-arm difference (≥ 10 mmHg) and diastolic inter-arm difference (≥ 10 mmHg) were 24.2% and 18.8% respectively. Significant systolic inter-arm difference (p=0.033) and diastolic inter-arm difference (p=0.01) were significantly more among respondents with hypertension and/or diabetes mellitus. Conclusion: The blood pressure readings in both arms were different among majority of the respondents, being higher on the right arm in more of them. The prevalence of significant inter-arm difference was high in the unselected primary care patients studied especially among patients with hypertension and/or diabetes mellitus. Blood pressure measurement in both arms should become a routine practice during initial patients’ visits in primary care.