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   Table of Contents - Current issue
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July-September 2020
Volume 27 | Issue 3
Page Nos. 147-260

Online since Friday, July 17, 2020

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REVIEW ARTICLES  

COVID-19 pandemic: A global health burden Highly accessed article p. 147
Oluwatosin Wuraola Akande, Tanimola Makanjuola Akande
DOI:10.4103/npmj.npmj_157_20  PMID:32687112
Coronavirus disease 2019 (COVID-19) pandemic began in China with a group of severe pneumonia cases, later identified to be caused by the severe acute respiratory syndrome coronavirus 2 in December 2019. Thailand reported the first COVID-19 case outside of China on 13th January 2020, Africa reported its first case in Egypt on 14th February 2020 and Nigeria reported its index case of COVID-19 on 27th February 2020. Virtually, all countries in the world are affected, with over 5 million cases reported globally. A literature search was conducted using publications from academic databases and websites of relevant organisations. The disease is associated with typical and atypical signs and symptoms, mimicking other common illnesses. Nigeria is now in the phase of widespread community transmission as almost all the states have reported confirmed cases. The pandemic has shown a wide range of case-fatality rate (CFR) globally; this is postulated to be related to the demographics, existing health systems and probably other unidentified factors. There has been a steady increase in the burden caused by the disease in Nigeria with a relatively stable CFR, which is lower than the global CFR. Health systems have responded with the guidelines for prevention, management, and surveillance of the disease, while effort is being put in place to find a vaccine and a specific therapy for the cure of the disease. The pandemic has had a severe effect on health systems globally, including an unintended disruption in the service delivery of other diseases. It has the potential to disrupt the weak health system in Nigeria significantly. As such, a combination of non-pharmaceutical preventive measures that are cost-effective needs to be scaled up to prevent it from further weakening the existing health system.
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Rubella transmissibility and reproduction number (Ro): A critical appraisal of the prospects for its control in Nigeria p. 156
Kabir Adekunle Durowade, Omotosho Ibrahim Musa, Gordon Kayode Osagbemi
DOI:10.4103/npmj.npmj_84_20  PMID:32687113
Rubella is a highly contagious disease of public health importance that is endemic in Nigeria. Rubella with its devastating sequel, congenital rubella syndrome, is a neglected disease with no surveillance system in place and no national incidence figure in Nigeria. This article, therefore, seeks to do reviews of rubella transmissibility, its reproduction number and the prospects for its control in Nigeria. This is a review of literatures with triangulation of findings along the objectives and the use of available secondary data to analyse the prospects of rubella control in Nigeria. Data were analysed and presented with appropriate tables and charts. A number of factors can fuel rubella transmission causing increase in reproduction number, Ro.The high birth rate, poor rubella surveillance and non-inclusion of rubella vaccines in the routine vaccination schedule among others are some of the factors working against a good outlook for rubella control in Nigeria. The Nigerian government should control the growing population, ensure a robust surveillance for rubella and incorporate rubella-containing vaccine in the immunisation schedule for infants with regular vaccination campaigns for older children and adults.
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ORIGINAL ARTICLES Top

Spirometric abnormalities following treatment for pulmonary tuberculosis in Ilorin, Nigeria p. 163
Olutobi Babatope Ojuawo, Ademola Emmanuel Fawibe, Olufemi Olumuyiwa Desalu, Ayotade Boluwatife Ojuawo, Adeniyi Olatunji Aladesanmi, Christopher Muyiwa Opeyemi, Mosunmoluwa Obafemi Adio, Alakija Kazeem Salami
DOI:10.4103/npmj.npmj_18_20  PMID:32687114
Background: Pulmonary tuberculosis (PTB) contributes significantly to morbidity and mortality worldwide, and despite microbiological cure for the disease, many patients still demonstrate residual respiratory symptoms and spirometric abnormalities. Aim and Objectives: The study aimed at identifying the prevalence, pattern and factors associated with spirometric abnormalities in patients successfully treated for PTB in Ilorin, Nigeria. Materials and Methods: This was a hospital-based cross-sectional study at the pulmonary outpatient clinics of the University of Ilorin Teaching Hospital and Kwara State Specialist Hospital, Sobi, Ilorin. A total of 308 consenting patients who had been certified microbiologically cured for bacteriologically confirmed PTB in the preceding 3 years had assessment of residual pulmonary symptoms, spirometry and plain chest radiograph. Results: The prevalence of abnormal spirometry following treatment for PTB was 72.1% (confidence interval: 0.6682–0.7695), with restrictive pattern being the predominant abnormality (42.2%). Over half of the patients (56.5%) had at least one residual respiratory symptom. The significant predictors of abnormal spirometry were PTB retreatment (adjusted odds ratio [aOR] = 6.918; P = 0.012), increasing modified Medical Research Council dyspnoea scores (aOR = 7.935; P = 0.008) and increasing radiologic scores (aOR = 4.679; P ≤ 0.001) after treatment. Conclusion: There is significant residual lung function impairment in majority of the individuals successfully treated for PTB in Ilorin. This highlights the need for spirometric assessment and follow-up after treatment.
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Comparison of clinical efficacy of long- versus short-acting gonadotrophin-releasing hormone agonists for pituitary down regulation in In vitro fertilisation cycles p. 171
Maureen Uche Umemmuo, Efena Russ Efetie, Chris Ovoroyeguono Agboghoroma, Jafaru Alunua Momoh, Joseph Ifeanyichukwu Ikechebelu
DOI:10.4103/npmj.npmj_65_20  PMID:32687115
Background: Gonadotrophin-Releasing Hormone agonist (GnRHa) – long and short acting – is used for pituitary down regulation prior to ovarian stimulation in in vitro fertilisation (IVF) treatment. However, there are controversies in the literature as to their effectiveness, dose of gonadotrophin needed subsequently for ovarian stimulation and the clinical outcome. Objective: The objective of the study was to compare the efficacy of single-dose long-acting GnRHa – goserelin – and daily dose short-acting GnRHa – buserelin – for pituitary down regulation and their clinical outcome in IVF treatment. Materials and Methods: This prospective comparative study was undertaken at the IVF centre in National Hospital Abuja, a public tertiary hospital in Nigeria. A total of 114 IVF patients were consecutively allocated into either long-acting GnRHa – goserelin – 3.6 mg single dose (Group A) or short-acting GnRHa – buserelin – 0.5 mg daily (Group B) both starting on day 21 of the cycle preceding the IVF treatment. The effects on pituitary down regulation and treatment outcomes were compared. Results: Time taken (days) to achieve down regulation (22.6 ± 4.3 vs. 26.1 ± 8.0; P = 0.084) and the mean number of human menopausal gonadotrophin (HMG) doses used (57.7 ± 13.7 vs. 54.2 ± 16.7; P = 0.222) were similar in the two groups. Although the number of oocytes retrieved (9.9 ± 6.7 vs. 7.2 ± 5.0; P = 0.02) and fertilised (6.2 ± 4.4 vs. 4.6 ± 3.5; P = 0.04) were significantly higher in Group A, there was no statistically significant difference in the number of embryos (4.4 ± 2.6 vs. 4.0 ± 3.0; P = 0.850) and clinical pregnancy rate at 6 weeks (49.2% vs. 43.6%; odds ratio 1.249; confidence interval = 0.579–2.612; P = 0.578) in both the groups. While group B had a significantly higher number of hospital visits (P = 0.0001) as well as a higher number of injections (P = 0.0001), the mean cost of GnRHa and gonadotrophin used was significantly higher in Group A (P = 0.043). Conclusion: Single-dose long-acting GnRHa is as effective as daily dose short-acting GnRHa for pituitary desensitisation prior to controlled ovarian stimulation in IVF cycles.
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Ectopic pregnancy at the Lagos University Teaching Hospital, Lagos, South-Western Nigeria: Temporal trends, clinical presentation and management outcomes from 2005 to 2014 p. 177
Joseph Ayodeji Olamijulo, Babasola Oluwatomi Okusanya, Muisi Alli Adenekan, Aloy Okechukwu Ugwu, Gbenga Olorunfemi, Osemen Okojie
DOI:10.4103/npmj.npmj_35_20  PMID:32687116
Background: There is uncertainty in the trend of ectopic pregnancy incidence in the Southwest region, though the region has a lower fertility rate and a higher contraceptive use than some other regions of Nigeria. The study objective was to determine the temporal trends, presentation and management outcome of ectopic pregnancy at the Lagos University Teaching Hospital (LUTH), Lagos, South-Western Nigeria over a decade. Subjects and Methods: This is a retrospective study of ectopic pregnancies at LUTH, Lagos, Nigeria, from January 2005 to December 2014. Participants' medical records were used to extract socio-demographic, clinical characteristics, management and outcome data. Joinpoint regression modelling (version 4.7.1) was used to evaluate the trends while descriptive statistics were conducted using Stata version 14 software. Results: There were 434 cases of ectopic pregnancies giving an overall incidence of 2.2/100 deliveries and 3.50/100 gynaecological admissions. Overall, there was a 59.7% increase in the ectopic pregnancy rate from 1.81/100 deliveries in 2005 to 2.89/100 deliveries in 2014. Join point regression revealed two trends. There was an initial non-significant decrease in incidence of ectopic pregnancy from 2005 to 2010 (annual percent change [APC] = -1.5%, 95% confidence interval [CI]: -8.1% to 5.6%, P = 0.6). However, there was a statistically significant increase in incidence of ectopic pregnancy at an average of 11.6% per annum from 8.6/100 deliveries in 2011 to 25.4/100 deliveries in 2014 (APC = 11.6%, 95% CI: 1.2% to 23.1% P < 0.001). About one-third (33.9%) of the patients with ectopic pregnancy were within the age range 25–29 years while the majority (68.0%) presented at 9–10 weeks of gestational age. The most common identifiable risk factor was previous pelvic infection (35.71%). Majority (96.5%) had tubal pregnancy and all the cases had laparotomy. There were six maternal deaths giving a case fatality rate of 1.4%. Conclusion: The hospital had an increased trend in the incidence of ectopic pregnancy from 2005 to 2014. Frontline health workers need high index of suspicion in the prompt diagnosis and intervention of ectopic pregnancy among women in the reproductive age.
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Soil-transmitted helminthiasis: A neglected tropical disease among urban slum dwelling school-aged children of a sub-Saharan African city p. 184
Ijeoma Onyinye Ohuche, Adaeze Chikaodinaka Ayuk, Agozie Chukwunedum Ubesie, Justus U Onu, Bede C Ibe
DOI:10.4103/npmj.npmj_38_20  PMID:32687117
Background: The need to generate a robust epidemiological data on the neglected tropical diseases is imperative, in order to encourage access to formal care, drive public policies and ensure the allocation of resources by policy-makers. Objectives: The objective of this study was to determine the prevalence of soil-transmitted helminthiasis (STH) and its association with nutritional variables among primary school pupils living in urban slums in a South-Eastern sub-Saharan African city of Enugu, Nigeria. Methods: The stool samples of school-aged children living in urban slums were analyzed for ova of the helminths using the Kato-Katz methods, whereas the nutritional assessment (weight and height) was obtained and analyzed to indicate acute or chronic malnutrition. Degrees of helminthic load were then classified. The socioeconomic status was determined while the prevalence of STH and the relationship between it and the nutritional stratus was assessed to ascertain any significance between being malnourished and having STH as this will inform policy decisions. Results: There were a total of 371 analyzed stool samples from 228 females (61.5%) and 143 males (38.5%), with 285 (76.8%) from the lowest socioeconomic class. The prevalence of STH was 18.1%, while that of acute and chronic malnutrition were 3.3% and 7.5%, respectively. The intensity of infestation was, however, light, with the highest mean egg intensity of 74.4 ± 32.8 documented for ascariasis. There was no statistically significant association between the presence of STH and various indices of acute and chronic malnutrition (P > 0.05). Conclusion: STHs prevalence is high among children living in urban slums. Nutritional status was, however, not adversely affected by helminthic infestation.
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Pattern of haemoglobin phenotypes in newborn infants at the national hospital abuja using high performance liquid chromatography p. 190
Ramatu Mohammed-Nafiu, Lamidi Isah Audu, Mu'uta Ibrahim, Tambi T Wakama, Effiong J Okon
DOI:10.4103/npmj.npmj_39_20  PMID:32687118
Background: Haemoglobin (Hb) disorders are among the most common blood genetic disorders worldwide, and they constitute an important cause of morbidity and mortality, especially in Nigeria. Despite the clinical significance of early diagnosis, newborn screening for these conditions is not routinely done in Nigeria. Objective: This study was undertaken to document the pattern of Hb phenotypes of newborn babies at the National Hospital Abuja and highlight the relevance of neonatal screening for early diagnosis of abnormal Hb phenotypes in Nigeria. Subjects and Methods: A prospective study of eligible newborn babies delivered in the hospital at the study site was undertaken following parental informed consent. Venous blood was collected from the babies into an ethylenediaminetetraacetic acid sample bottles. The samples were analysed using high-performance liquid chromatography (HPLC) techniques, and the Hb phenotypes obtained were documented. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 20 (IBM-SPSS, Armonk, NY, USA). Results: Three hundred and eleven newborns (male = 173, female = 138) aged 0–28 days were recruited. Two hundred and thirty-six (75.9%) babies had Hb AA (FA) phenotype, 63 (20.3%) Hb AS (FAS), 6 (1.9%) Hb SS (FS), 4 (1.3%) Hb AC (FAC) and 2 (0.6%) had abnormal HbA variants. The overall prevalence of abnormal Hb phenotype was 24.1%. The results showed a significant association of sex (P = 0.003) and ethnicity (P = 0.047) with Hb phenotype. Conclusion: There is a wide spectrum of abnormal Hb phenotypes in Nigeria, and these phenotypes can easily be detected at birth using HPLC. We, therefore, recommend routine neonatal screening for sickle cell disease by HPLC in Nigeria.
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Determinants of willingness to participate in health insurance amongst people living with HIV in a tertiary hospital in South-East Nigeria p. 196
Chihurumnanya Nwachi Alo, Ijeoma Nkem Okedo-Alex, Ifeyinwa Chizoba Akamike
DOI:10.4103/npmj.npmj_11_20  PMID:32687119
Background: Waning donor funding and poor country ownership of HIV care programmes are challenges for the sustainability of care for people living with HIV (PLHIV) in Nigeria. Health insurance presents a viable alternative for funding of HIV care services. This study assessed the determinants of willingness to participate in health insurance amongst PLHIV in a tertiary hospital in South-East Nigeria. Methods: Across-sectional survey was conducted amongst 371 PLHIV on treatment at Federal Teaching Hospital, Abakaliki, Nigeria, using a semi-structured, interviewer-administered questionnaire. Chi-square test and logistic regression were conducted with SPSS version 20 at 5% level of significance. Results: Respondents were mostly males (51.8%) with a mean age and monthly income of 45.4 ± 10.3 years and $74.1 ± 42, respectively. Majority were willing to participate (82.5%) and to finance health insurance (65.2%). The major reasons cited by those unwilling to participate were poor understanding of how the system works and lack of regular source of income. The predictors of willingness to participate were female gender (adjusted odds ratio [AOR] = 2.9; 95% confidence interval [CI]: 1.6–5.7), being currently unmarried (AOR = 4.3; 95% CI: 2.3–7.8), being self-employed (AOR = 2.2; 95% CI: 1.2–3.9), having family size >5 (AOR = 3.1; 95% CI: 1.7–5.9) and having less than secondary school education (AOR = 4.3; 95% CI: 2.3–7.8). Conclusion: Majority of the respondents surveyed were willing to participate in, and finance health insurance. Willingness to participate was more amongst vulnerable subgroups (females, unmarried, self-employed, poorly educated and those with large family size). We recommend the inclusion of health insurance in the care package of PLHIV.
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Patient safety in a Resource-constrained Context: A cross-sectional study of experience, drivers, barriers and preventive measures for safety incidents and accidents amongst medical doctors in South-east Nigeria p. 202
Gabriel Uche Iloh, Ekene Agartha Emeka, Augustine Obiora Ikwudinma, Agwu Nkwa Amadi
DOI:10.4103/npmj.npmj_45_20  PMID:32687120
Background: Globally, safety of patients in healthcare environment has been an issue of the decade, especially in resource-constrained settings. The Hippocratic maxim primum non nocere requires medical practitioners to give utmost importance to the principle of beneficence and safety in attending to patients. It is a current paradigm in quality of care metrics that determines what happens to patients who interface with the healthcare system. Aim: The study was aimed at describing the experience, drivers, barriers and preventive measures for patient safety incidents and accidents in a cross-section of medical practitioners in Abia State, Southeast Nigeria. Participants and Methods: This was a cross-sectional study carried out on 185 physicians in Southeast Nigeria. Data collection was done using a pre-tested, self-administered questionnaire that elicited information on experience, drivers, barriers and preventive measures for patient safety incidents. Results: The mean age ± standard deviation of the respondents was 36 ± 5.6 years, with a range of 25–72 years. There were 163 (88.1%) males and 22 (11.9%) females. Lifetime and previous 1-year committal of patient safety incidents were 100% (185/185) and 61.0% (113/185), respectively, with the most committed safety incident being medication errors. The most common driver of patient safety incidents was physician stress and burnout (100%) (185/185), whereas the most common barrier was communication (100%) (185/185). The most common preventive measure was patient safety incident reporting system (100%) (185/185). One-year committal of patient safety incidents was associated with duration of practice <10 years (P = 0.00001) and sex (P = 0.011). Conclusion: Patient safety incidents occurred amongst the study participants, with the most committed safety incident being medication errors. The most common driver was physician stress and burnout. The most common barrier was communication and feedback barrier, whereas the most common preventive measure was patient safety incident reporting system. Patient safety information, education and training should be the target for continuing professional development in order to safeguard the health of the patients in healthcare environment.
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At-birth vaccination timeliness: An analysis of inborns in the highlands of Jos, North-Central Nigeria p. 209
S David Danjuma, A Ishaya Ibrahim, Nathan Yakubu Shehu, M Udochukwu Diala, C Victor Pam, Christopher O Ogbodo
DOI:10.4103/npmj.npmj_44_20  PMID:32687121
Introduction: Immunisation and vaccination programmes are preventive and cost-effective child health interventions for reducing childhood mortality and disability from infectious diseases. Timely administration of these vaccines is important to ensure their effectiveness in disease prevention. Aim: The aim was to determine the timeliness, barriers and predictors of at-birth vaccinations. Materials and Methods: This was a cross-sectional study of 355 mother–newborn pairs using simple random sampling technique by balloting. SPSS version 23.0 was used for data analysis. Crude and adjusted odds ratios (AORs) were used as point estimates in the binary logistic regression model, while 95% confidence interval (CI) was used as the interval estimate. A P < 0.05 was considered statistically significant for the study. Results: The mean age of the mothers was 31.0 ± 6 years. The median age of newborns at vaccination was 18 h (IQR = 1 - 17) h. About 185 (52.1%) of the newborns studied were males. Only 191 (53.8%) newborns received at-birth vaccination within 24 h of life. Weekend delivery, birth outside vaccination days, delivery during public holidays and vaccine stock-outs were barriers to timely vaccinations. Private hospital delivery was an independent predictor of delayed at-birth vaccinations (AOR = 2.616; 95% CI = 1.382–4.951). Conclusions: Our study has identified weekend delivery, preterm birth, delivery outside vaccination days and vaccines stock-outs as barriers to timely at-birth vaccinations. Private hospital delivery is a significant predictor of delayed at-birth vaccinations.
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Assessment of burnout amongst resident doctors in Benin City, Edo State, Nigeria p. 215
Esohe Olivia Ogboghodo, Oghoritsewarami Mary Edema
DOI:10.4103/npmj.npmj_37_20  PMID:32687122
Background: Burnout amongst healthcare professionals has gained significant attention over the last few decades. As a result of the intense demand from the work environment, clinicians are susceptible to developing burnout beyond the usual workplace stress. Residency training, in particular, can cause significant degree of burnout. Aim: The aim was to determine the prevalence and pattern of burnout amongst resident doctors in Benin City. Materials and Methods: This study utilised a descriptive, cross-sectional study design. A total population study was carried out amongst resident doctors in Benin City. The tool for data collection was a pretested Maslach Burnout Inventory Questionnaire–Human Services Survey for Medical Personnel. Data were analysed with IBM SPSS version 22.0 software. The level of significance was set at P < 0.05. Results: A total of 448 resident doctors with a mean age (standard deviation) of 33.9 ± 0.4 years participated in this study. A higher proportion (279, 62.3%) of the respondents were males. A total of 267 (59.6%) respondents suffered emotional exhaustion (EE), while depersonalisation and reduced personal accomplishments were suffered amongst 211 (47.1%) and 153 (34.2%), respectively. The overall prevalence of burnout was 41.7%. Long duration of call hours (P < 0.001) and speciality (P = 0.039) were found to be significantly associated with burnout. Conclusion: Burnout was prevalent amongst resident doctors in Benin City. EE was the most reported type. There is a need for relevant stakeholders to re-structure the residency programme by reducing the duration of call hours and increasing the number of resident doctors on call per shift to further address modifiable risks amongst the would-be specialists.
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A cross-sectional study of co-morbid generalized anxiety disorder and major depressive disorder in patients with tension-type headache attending tertiary health care centre in central rural India p. 224
Ajinkya Sureshrao Ghogare, Pradeep Shriram Patil
DOI:10.4103/npmj.npmj_23_20  PMID:32687123
Background: Tension-type headache (TTH) is one of the most common reasons patients seek medical treatment. Psychiatric co-morbidities such as anxiety and depression have been commonly observed in patients with TTH. Objective: The objective was to study the prevalence and severity of co-morbid generalized anxiety disorder (GAD) and major depressive disorder (MDD) in patients with TTH. Materials and Methods: The present cross-sectional study was conducted in the Tertiary Health Care Centre in Central Rural India, with a sample size of 85. Data were recorded in the predesigned, semi-structured questionnaire. Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HDRS) were used to categorise the co-morbid anxiety and depression. Results: About 48.2% of the study participants were in the age group of 31–40 years with a mean age of 36.8 ± 7.1 years. Higher proportions of female study participants (64.7%) were observed. Majority of the study participants were literate (76.5%), employed (57.7%), married (78.8%) and had rural residence (54.1%). The prevalence of co-morbid GAD was 70.6%, whereas the prevalence of co-morbid MDD was 54.1%. According to HAM-A, 31.8% had mild, 21.2% had moderate, while 17.6% had severe anxiety levels. According to HDRS, 34.1% had mild, 16.5% had moderate and 3.5% had severe co-morbid depression. Conclusion: TTH is frequently associated with co-morbid GAD and MDD.
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Use of psychoactive substances among patients presenting at the emergency department of a tertiary hospital p. 230
Datak Delashik Dapap, Christopher Izehinosen Okpataku, Moses David Audu
DOI:10.4103/npmj.npmj_5_20  PMID:32687124
Background: Psychoactive substance use is frequently encountered in hospitals' emergency departments (EDs). It accounts for major health-care problems frequently leading to accident and ED admissions, yet it is frequently unidentified. The aim of this study was to determine the prevalence and pattern of psychoactive substance use among patients presenting in the Accident and EDs and to compare the case detection rate of psychoactive substance use between self-report questionnaire and biochemical markers (e.g., urine toxicology). Methods: To achieve this, 200 consenting participants attending the accident and emergency unit of a tertiary hospital were consecutively enlisted into the study within 2 weeks. They were screened for psychoactive substance use with the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and the urine drug test (UDT). Results: The lifetime prevalence of psychoactive substance use was 45.5%, while the past 3 months (recent use) prevalence was 27.0%. The pattern of psychoactive substance use revealed that alcohol was the predominant psychoactive substance use with a lifetime prevalence of 13.0% and recent use of 12.0%. The UDT significantly detected more patients who used psychoactive substance compared to self-report (P < 0.001). Conclusion: The prevalence of drug use recorded among attendees of the accident and emergency unit was high in this study. The UDT significantly detected more patients who used psychoactive substances compared to self-report (P < 0.001). Several patients with major health problems as a result of psychoactive substance use were identified with the aid of these screening tools.
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Pattern of congenital hand anomalies at a tertiary plastic surgery service in South-Western Nigeria: A 10-year, cross-sectional retrospective review p. 237
Afieharo Igbibia Michael, Samuel Adesina Ademola, Olayinka Adebanji Olawoye, Ayodele Olukayode Iyun, Odunayo Moronfoluwa Oluwatosin
DOI:10.4103/npmj.npmj_81_20  PMID:32687125
Context: Although congenital hand anomalies are among the more common musculoskeletal anomalies worldwide, we do not know its prevalence in our practice. Aims: The aim of the study was to determine the pattern of congenital hand anomalies presenting to our tertiary plastic surgery outpatient service in South-Western Nigeria. Materials and Methods: This is a cross-sectional retrospective analysis of outpatient cases of congenital hand anomalies presenting over a 10-year period. Descriptive and inferential statistics were performed using frequencies, Student's t-test and Chi-square as appropriate. The data were analysed using IBM SPSS Statistics 23.0. The statistical significance value was set at P < 0.05. Results: One hundred and twenty-two cases were identified. The highest number of cases was seen in the year 2012, 23 patients (19.3%). There was a male preponderance of 66 patients (55.1%). Thirty-two patients (26.2%) presented as neonates and 36 (29.5%) as infants. Bilateral anomalies were seen in 67 patients (54.9%). The most common anomaly was failure of differentiation, 88 patients (72.1%) followed by duplication, 26 patients (21.3%). Syndactyly with 43 patients (35.2%) was the most common anomaly under failure of differentiation. No significant associations were found between the type of anomaly and gender or laterality. Conclusions: Syndactyly was the most common congenital hand anomaly in this study. There was a preponderance of bilateral involvement in both syndactyly and polydactyly.
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CASE REPORT Top

Management of a giant prostatic enlargement: Case report and review of the literature p. 242
Rufus Wale Ojewola, Kehinde Habeeb Tijani, Adedeji Lukman Fatuga, Chigozie Innocent Onyeze, Chike John Okeke
DOI:10.4103/npmj.npmj_69_20  PMID:32687126
Giant prostatic enlargement often referred to as giant prostatic hyperplasia (GPH) is a rare condition described as a massive prostatic enlargement >500 g. Up until now, the total number of GPH reported worldwide in medical literature is < 30. To the best of our knowledge, only one case of a giant prostate has been reported in Nigeria. We report a case of a giant prostatic enlargement treated by open simple retropubic prostatectomy in a 73-year-old man who was suffering from lower urinary tract symptoms and persistent visible (gross) haematuria necessitating repeated blood transfusions. Transrectal ultrasound (TRUS) scan revealed a markedly enlarged prostate measuring 565 ml with a suspicious nodule and prostate-specific antigen level of 48.5 ng/ml. He had a 20-core TRUS-guided prostatic biopsy which showed benign prostatic hyperplasia. We performed a retropubic open simple prostatectomy for complete enucleation of the adenoma. Specimen weighed 512.5 g with dimensions of 17 cm × 16 cm and a volume of 528 ml. Histological examination showed prostatic fibromuscular hyperplasia with a focus of adenocarcinoma. The patient had an uneventful post-operative recovery and was discharged within a week post-surgery. Urethral catheter was removed after 2 weeks with satisfactory outcome.
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LETTER TO THE EDITOR Top

Paediatric priapism in emergency medicine p. 248
Emanuele Baldassarre, Ilaria Prosperi Porta, Lorna Spagnol
DOI:10.4103/npmj.npmj_144_20  PMID:32687127
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SPECIAL ARTICLE Top

A proposed research misconduct policy for universities and postgraduate colleges in developing countries p. 250
Adedoyin Adekunle Adesanya
DOI:10.4103/npmj.npmj_51_20  PMID:32687128
Research misconduct policy (RMP) is a legal document that shows the definitions of the various types of misconduct, describes the inquiry and investigation of allegations, and the appropriate penalties that should be imposed. The presence of the adopted RMP on the website of a university or postgraduate college is an indication of the level of commitment to promote the proper handling of misconduct cases. Perusal of the websites of top universities in developing countries revealed that many do not have RMP on their websites. The probable starting point for combating research misconduct at the national or institutional level is by acquisition of RMP. The purpose of this article is to propose a modern, structured and cost-effective RMP for universities and postgraduate colleges in developing countries. The bibliographic database, PubMed, was searched using the terms 'research misconduct' and 'research misconduct policy'. All relevant articles from the search and some RMPs of universities, national agencies and global health organisations available on the Internet were carefully studied. A formulated RMP, based on the Final Rule of the United States, Public Health Services Policies on Research Misconduct of 2005 and the Regulations of the University Grants Commission of India of 2018, is hereby presented. In the proposed RMP, plagiarism was stratified into four levels in ascending order of severity so that imposed penalties are commensurate with the seriousness of misconduct. The zero tolerance for plagiarism in the core work areas was adopted. The proposed RMP was designed to act as a template. It should be modified as required based on the prevailing local circumstances and made fit for purpose. Universities, postgraduate colleges and journals should have RMP on the homepage of their websites.
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INVITED COMMENTARY Top

'Publish and flourish or perish': Ensuring integrity in research conduct and reporting p. 259
Adesola Ogunniyi
DOI:10.4103/npmj.npmj_180_20  PMID:32687129
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