Medical

The relationship between demographic parameters and optic disc findings in neuro-ophthalmic patients in Port Harcourt, Nigeria: Initial report Chinyere Nnenne Pedro-Egbe, Ireju Onyinye Chukwuka Port Harcourt Medical Journal 2018 12(3):107-110 Background: Neuro-Ophthalmology subspecialty is a newly established Unit at the Eye Department of University of Port Harcourt Teaching Hospital. There are hardly any data on neuro-ophthalmic conditions in our environment, so this study will provide the much needed baseline data for future reference. Aim: This is an initial report to identify the spectrum of optic disc findings and determine their relationship with demographic characteristics (age and gender) of patients seen at the Neuro-ophthalmology Clinic of University of Port Harcourt Teaching Hospital. Methodology: This was a hospital-based cross-sectional study with minimum sample size calculated using the formula for cross-sectional studies.7 Using the 95% level of significance, estimated proportion of 0.5, level of precision of 0.10 and non-response rate of 80%; a sample size of 133 was appropriate for the index study. One hundred and thirty three case notes with complete records were retrieved and data extracted on age, sex, presenting symptoms and signs, visual acuity, fundus findings, investigation results, diagnosis and treatment. Data was analyzed with SPSS version 20 and a p-value of 0.05 considered significant. Results: There were 133 patients with a mean age of 37.50±17.51. There were 70 males and 63 females. Most patients had disc pallor - constituting 51.8%; others were disc edema (3.8%), papilledema (3.8%), hyperemia and perivascular sheathing. Fifty-two patients (39.1%) however had normal discs. Disc pallor (64.4%) and temporal disc pallor (66.7%) were commoner in males; but papilledema was commoner in females (80%). These differences were statistically significant (p=0.048). Conclusion: Optic disc findings in neuro-ophthalmic patients this study shows that disc pallor was associated more with the male gender while papilledema was commoner in females.

Ototoxicity: Scope and pattern in a tertiary hospital in Port Harcourt, Nigeria Uju Matilda Ibekwe, Chibuike Nwosu, Jephtah Kpopene Port Harcourt Medical Journal 2018 12(3):111-116 Background: Ototoxicity is a common cause of avoidable hearing loss in our environment. It is also an important factor of public health importance in developing countries. The aim of this study is to examine the pattern, note the prevalence and highlight the common medications implicated in ototoxicity in our environment. Methods: This study is a 6-year retrospective review of patients diagnosed with ototoxicity that were managed at the otorhinolaryngology clinic from January 2011 to December 2016. The patients' case files and the clinical registries were the source of data. The data extracted for analysis were demographics, type of medication used, route of administration, duration, otologic symptoms, time of presentation and pure-tone audiometric findings. Data were analysed using SPSS software version 20. Results: One hundred and thirty-six patients with ototoxicity were seen within the 6-year period, of which 71 had complete medical records and these were analysed. There were 37 males (52.1%) and 34 females (47.9%), giving a ratio of 1:1. The most common age group affected was 28–38 years. Unknown or unidentified medications (38%) were the most common cause of ototoxicity; among the known drugs, injection gentamicin (17%) and chloroquine (17%) were the most common implicated drugs, followed by quinine (12.7%). All the patients presented with hearing loss. Tinnitus was seen in 83.1%, whereas 22.5% had vertigo. Majority (56.3%) of the patients had severe-to-profound sensorineural hearing loss. There were more bilateral (80.3%) than unilateral (19.7%) cases. Majority (63.3%) of the patients presented after 2 weeks of the onset of symptoms. Conclusion: Ototoxicity is still prevalent in our environment, with chloroquine and gentamicin being the most commonly implicated drugs. Most of the patients were found to have bilateral severe-to-profound sensorineural hearing loss.

Adolescent sexual behaviour in Pokhara Submetropolitan Municipality, Nepal Sandip Pahari, Bishwas Acharya, Hoshiar Singh Chauhan Port Harcourt Medical Journal 2018 12(3):117-121 Background: Risky sexual behaviour among adolescents is an emerging problem in Nepal. Aim: To assess the sexual behaviour and media influence and determine the association of watching porn movies and sexual activity with sociodemographic factors among adolescents in Pokhara submetropolitan municipality, Nepal. Methods: An institution-based, cross-sectional study was conducted among 302 adolescents of higher secondary schools in Pokhara submetropolitan municipality, Nepal, using self-administered questionnaire technique. Data were collected and analysed using SPSS software version 21. Results: Out of 302 respondents, 81 (27%) had sexual intercourse, whereas 221 (73%) did not have sexual intercourse. There was a statistical association between exposure to porn movies with age (P = 0.038), caste (P ≤ 0.05), gender (P < 0.001), monthly family income (P < 0.001), monthly pocket money (P < 0.001) and time spent on watching computer (P < 0.001). Presence of television in personal bedroom of the adolescents was significantly associated with the number of times they watched the porn movies (P = 0.013). Involvement in sexual intercourse was significantly associated with age (P < 0.001), type of family (P = 0.008), gender (P = 0.001), monthly family income (P = 0.014), monthly pocket money (P < 0.001), exposure to porn movies (P < 0.001) and presence of boyfriend/girlfriend (P < 0.001). Conclusion: Sexual behaviour among adolescents was found to be high. Reproductive and sex education should be introduced into the school curriculum to minimise and control premarital and unsafe sex.

Staging and grading chronic viral hepatitis: A teaching hospital experience using an objective histological activity index in a tropical population Usman Bello, Yawale Iliyasu Port Harcourt Medical Journal 2018 12(3):122-126 Background: Chronic viral hepatitis (CVH) is the leading cause of chronic liver diseases (CLD) and exhibit diffuse parenchymal damage requiring a systematic assessment of disease extent and progression. Aims: The aim of this study is to determine the epidemiological pattern and grade/stage all cases of CVH using Ishaq Modified Histologic Activity Index (HAI); then share and to compare our experience with similar works elsewhere. Methods: Ten years (2006–2015) liver biopsies received in the Department of Pathology, Ahmadu Bello University Teaching Hospital Zaria, were fixed in formalin, embedded in paraffin and stained with routine and special stains were reviewed, graded and staged using Ishaq HAI. Data were analysed and presented in statistical frequency distribution tables and figures. Results: CVH formed 55.2% was the most common of liver diseases. There were119 male and 47 female with male-to-female ratio of 2.5: 1 and peaked in the third decade of life. Nearly 42.2% had modified Ishaq HAI score of 4–8, while 28.3% and 27.1% had score 1–3 and score 9–12, respectively. Only 2.4% had score of 13–18. Nearly 70.5% of cases were between Stages 0 and 2, 25.9% of cases were Stage 3and 4 while only 6% were in Stage 5. Hepatitis B virus (HBV) was the most common aetiology and found in 77.7% of cases, 13.3% were associated with hepatitis C virus (HCV) and HBV/HCV co infection in 9.0%. Conclusions: CVH was the most common form of CLD, peaked in the third decade of life. Nearly 42.2% were in mild grade disease while 70.5% had Stage 2 and below disease. HBV infection was the most common aetiology.

Acceptance of mobile phone short message service for childhood immunisation reminders by Nigerian mothers Kelechi Kenneth Odinaka, Benedict Onyeka Edelu, Kingsley Ihedioha Achigbu Port Harcourt Medical Journal 2018 12(3):127-130 Background: Missed immunisation appointments are a common occurrence among Nigerian children, and it is due largely to forgetfulness on the part of the parents/caregivers. Although the use of mobile phones is widely available to Nigerian mothers, the readiness of Nigerian mothers to accept a mobile phone short message service (SMS) for interacting with immunisation providers, specifically, for tracking immunisations appointments, notifying absence of vaccines and accessing other vaccine information remains uncertain. Aim: The aim of this study was to assess the acceptance of mobile phone text messaging for childhood immunisation reminders by Nigerian mothers as well as its determinants. Methods: A descriptive cross-sectional, questionnaire-based study carried out over 3 months (June–August 2017) at the Federal Medical Centre, Owerri, Nigeria. Results: A total of 253 mothers were interviewed. About 27% of the mothers reported to have missed their babies' immunisation appointments in the past. Mothers who are currently married (χ2 = 5.954, P = 0.015) and those with higher levels of education (χ2 = 13.001, P = 0.005) were significantly less likely to forget their child's immunisation dates. Majority (75.9%) believe that reminders will reduce missed immunisation appointments. A greater proportion (61.7%) of the mothers would accept a phone reminder for their babies' immunisation appointments. Many (76.9%) of them were willing to pay for such services. Conclusion: Forgetfulness is one of the major reasons for missed immunisation appointments among mothers in Nigeria. Considering the acceptance of SMS by the majority of the mothers studied, there is no doubt that its adoption in Nigeria will create a positive impact in improving immunisation of children in Nigeria.

Abruptio placentae: Epidemiology and pregnancy outcome in a low-resource setting Abiodun S Adeniran, Callistus O Elegbua, Grace G Ezeoke, Kikelomo T Adesina, Olayinka R Balogun Port Harcourt Medical Journal 2018 12(3):131-135 Background: Abruptio placentae are a life-threatening obstetric emergency associated with high maternal, foetal and neonatal morbidity and mortality. Aim: The aim of this study is to determine the modes of presentation, management and pregnancy outcome of pregnancies complicated by abruptio placentae at a tertiary health facility. Methods: A descriptive study (retrospective) of women managed for abruptio placentae over a period of 3 years. The inclusion criteria were diagnosis of abruptio placentae (clinical or radiological), delivery at the study site and availability of the case files for review. Exclusion criteria included patients with other conditions except abruptio placentae, delivery at other facilities or failure to retrieve the case files. Data collection was from the case files of participants, and the results were represented in tables. Results: Out of 8,931 deliveries during study , 64 had for abruptio placentae (prevalence 0.72% or 7.2/1000); however, 60 satisfied the inclusion criteria and were included in subsequent analysis. Twenty (33.3%) were above 35 years old, 14 (23.3%) were grandmultipara and the most common risk factor was hypertensive disorders (26; 43.3%). Thirty (50.0%) presented with vaginal bleeding, retroplacental clot was present at delivery in 27 (45.0%), 37 (61.7%) had emergency abdominal delivery, 51 (85.0%) had anaemia at presentation while 37 (61.6%) had blood transfusion. Forty-four (73.4%) were preterm (mean gestational age 35 ± 2.9 weeks) and neonatal survival was 50.0%; among survivors, 25 (83.3%) required neonatal intensive care due to perinatal asphyxia. Perinatal mortality was 50% (500/1,000), but no maternal death among study participants. Conclusion: Abruptio placentae remain a potential cause of maternal, foetal and neonatal complications; however, emergency caesarean delivery appears to improve neonatal survival in complicated cases with live foetuses.

Paediatric presentation of ear cleaning in a West African country Waheed Atilade Adegbiji, Toye Gabriel Olajide, Chukwuemeka Clement Nwawolo Port Harcourt Medical Journal 2018 12(3):136-141 Background: Ear cleaning is very common medico-social habit among children worldwide. This study aimed at determining the prevalence, socio-demographic features, clinical presentation, associated complications and management of paediatric ear cleaning in a tertiary hospital in a West African country. Methods: This was a prospective cross-sectional hospital-based study which was carried out in Ear, Nose and Throat department of Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria, over a period of 6 months, between July and December 2017. Consent was obtained from the patients/parents/guardian. The instrument of data collection was a pretested interviewer-assisted questionnaire. Data obtained was collated and analysed using SPSS version 16.0. Results: Prevalence of ear cleaning in paediatric age group was 91.1%. Males were more affected and accounted for 53.4%. The most common reason for ear cleaning was due to personal hygiene. Ear cleaning was done in 57.1% of the children by their mother. Bilateral ear cleaning was noted in 45.3% of patients, 31.6% in the right ear and 23.1% in the left ear. Majority (65.5%) of patients believed that ear cleaning were beneficial. The commonly used object in ear cleaning were cotton bud, finger, sticks and writing material in 35.2%, 18.6%, 13.8% and 13.4%, respectively. Common clinical features among the patients were dirty/earwax, otalgia and itching in 33.6%, 30.8% and 25.9%, respectively. Short time (acute) ear cleaning in 57.9% was more common than long time (chronic) ear cleaning in 42.1%. The frequency of ear cleaning was done on a daily basis in 55.9% of patients, in 21.5% of patients weekly. In 12.6% of patients monthly while 10.1% of patients used to clean their ears occasionally. Major clinical diagnoses of ear cleaning in children were 26.3% personal hygiene, 19.4% allergy and 17.8% earwax. Common complications were external auditory canal injury in 32.4%, impacted foreign body in 21.5% and traumatic perforated tympanic membrane in 6.5%. About 42.9% of our patient obtained information about cleaning of ear from family, 29.6 % from neighbourhood while 27. 5% did not obtained information from anywhere. Treatment included conservative/medical treatment in 60.7%, foreign body removal in 21.5% and impacted earwax removal in 17.8%. Conclusions: Ear cleaning is a common otological habit among children. Personal hygiene was the most common reason for ear cleaning and with cotton bud been being the most common object used. The habit is associated with avoidable complications. Health education and treatment of underlying causes is paramount to reduce this habit.

The burden of coexistent allergic rhinitis and allergic conjunctivitis on health-related quality of life Shuaib Kayode Aremu, AbdulAkeem Adebayo Aluko, Tayo Ibrahim Port Harcourt Medical Journal 2018 12(3):142-146 Background: Allergic rhinitis (AR) is a symptom complex of consisting of nasal congestion, rhinorrhoea, sneezing and nasal itching arising from an IgE-mediated allergic reaction and inflammation of the mucosal lining of the nose and contiguous mucosal membranes usually due to airborne allergen. AR may occur in isolation or may coexist with allergic conjunctivitis (AC). Aim: The aim of this study is to assess and evaluate the importance of health-related quality of life (HR-QoL) in patients suffering from concomitant AC with AR with different types of quality-of-life instruments. Methods: A sum of 220 patients who attended the outpatient department of ENT clinic were involved in this study. All patients undertook an ophthalmologic examination for coexistent AC. The rhino conjunctivitis quality of life questionnaire (RQLQ) was used to evaluate the quality of life in all patients. Results: The mean age of the 220 patients (116 females and 104 males) involved in the study was 26.8 years. The male-to-female ratio was 1:1.1. Of the 220 patients, 55% studied up to secondary school graduation and 18% dwelt in the rural area. In the assessment of the statistics obtained from the AR and conjunctivitis symptom scoring, the mean total complaint score was found to be 13.2 ± 4.0. Conclusion: AR can vary based on a region's flora, weather and socioeconomic status. AR could lead to severe impairment in HR-QoL.

DiGeorge syndrome with microdeletion of chromosome 21 Ejiroghene Ogonor, Wilson E Sadoh Port Harcourt Medical Journal 2018 12(3):147-150 DiGeorge syndrome consists of abnormalities of the parathyroid, thymus and the kidneys. It also includes facial dysmorphism and cardiac defects. It is caused by a microdeletion of the long arm of chromosome 22 and occasionally chromosome 10. The case of a 12-week-old female infant with low set ears, retrognathia, micrognathia, high-arched palate, right-sided aortic arch, hypocalcaemia and truncus arteriosus which are all typical of DiGeorge syndrome and an unusual microdeletion of chromosome 21 is presented.

Patience with patients LS Vagish Kumar Port Harcourt Medical Journal 2018 12(3):151-151