Port Harcourt Medical Journal, a publication of College of Health Sciences, University of Port Harcourt, Nigeria, is a peer-reviewed online journal with Triannual print on demand compilation of issues published. The journal’s full text is available online at http://www.phmj.org.ng. The journal allows free access (Open Access) to its contents and permits authors to self-archive final accepted version of the articles on any OAI-compliant institutional / subject-based repository.
College of Health Sciences, University of Port Harcourt, Nigeria
The journal grants the right to make small numbers of printed copies for their personal non-commercial use under Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported License.
*]:pointer-events-auto scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]" dir="auto" data-turn-id="request-WEB:ed85297c-8ec8-490b-94ac-2965495f8175-4" data-testid="conversation-turn-2" data-scroll-anchor="true" data-turn="assistant"> Artificial intelligence (AI) has become a buzzword these days.1,2 AI represents the simulation of human intelligence in machines designed and programmed to think and learn like people. 2 In essence, AI refers to the ability of computers to perform tasks that typically require human intelligence, such as reasoning, problem-solving, and learning.1 The World Health Organization (WHO) has proposed that AI be seen as the performance by computer programmes of tasks that are commonly associated with intelligent being.3 AI has found applications across various sectors, including academia, government, industry, social, and economic service organizations.1 The healthcare field is no exception to the application of AI with the rapid development of algorithms and computational models that enable machines and systems to perform tasks such as natural language processing, pattern recognition, problem-solving, and decision- making.1 Hence, it can be opined that AI is a powerful and disruptive area of computer science, with the potential to fundamentally transform the practice of medicine and the delivery of healthcare.4 The term artificial intelligence (AI) was first used by John McCarthy at the Dartmouth Conference in 1956,5,6 and since then the field has been constantly explored and AI has now become an all-pervading influencer on how we do things, from the very simple to the most complex.5 Healthcare systems around the globe face significant challenges in achieving the ‘quadruple aim’ for healthcare which are to improve population health, improve the patient’s experience of care, enhance caregiver experience and reduce the rising cost of care.4 AI has had profound impact on diagnosis, treatment and healthcare delivery. The applications in healthcare include transformative diagnostics, personalized treatment strategies and enhanced patient care among others. 1-6 In the area of transformative diagnostics, AI leverages on machine learning algorithms to analyze vast data sets quickly and accurately. 1-6 In this regard, it has found its place in imaging and radiology demonstrating remarkable proficiency in image interpretation as well as enhancing the early detection of cancers. 1-6 AI has also made substantial strides in pathology and laboratory medicine as it accelerates the diagnostic process and reduces the likelihood of human error. 1-6 In personalized treatment strategies, AI has been at the forefront. Through the utilization of big data and predictive analytics, AI can analyze individual patient data to tailor treatment plans that are more effective with fewer adverse effects. 1-6 AI has accelerated the drug discovery and development process, allowing researchers to target specific biological mechanisms with better precision. 1-6 AI has contributed to the optimization of therapeutic approaches with AI systems having the capability to adapt treatment plans in real time. 1-6 AI has also enhanced patient care experience. It has been utilized in remote patient monitoring enabling early intervention in case of deteriorating health, reducing hospital readmissions and enhancing overall patient wellbeing.1-6 Through predictive analytics, AI can anticipate potential risks, predict likelihood of future health issues , enabling healthcare professionals to implement preventive measures.1-6 Despite these applications, concerns have been raised as it relates to the adoption and deployment of AI in the healthcare sector. These include ethical and privacy, social sustainability, governance, technical, unreliability and trustworthiness as well as healthcare providers and professional liability challenges among others. 1-6 In this issue, Akadiri and Yarhere 7 through a narrative review compared the development and implementation of AI in dental practice across major global regions with a view to identifying strategic priorities for accelerating responsible and equitable AI adoption with a focus on Africa and the West African subregion. They note that West Africa remains at an early stage of adoption, characterized by significant oral health needs, limited digital infrastructure,scarce research, and minimal clinical deployment in contrast to high-income regions. They conclude that bridging this gap will require investment in digital infrastructure, context-appropriate AI applications, local data development, capacity building, and ethical governance frameworks. It is hoped that the outlook will change over time.
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Anaesthetic management of superior vena cava syndrome in a 14- year-old undergoing mediastinal mass excision: a case report
*]:pointer-events-auto scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]" dir="auto" data-turn-id="request-WEB:ed85297c-8ec8-490b-94ac-2965495f8175-26" data-testid="conversation-turn-22" data-scroll-anchor="true" data-turn="assistant"> Background: Superior vena cava syndrome occurs when there is obstruction of blood flow through the superior vena cava to the right atrium and is mostly seen in patients with mediastinal masses. It can be a medical emergency associated with respiratory and cardiovascular collapse and requires immediate evaluation and treatment. Aim: This is a case report of the approach to anaesthetic and intensive care of a 14-year-old scheduled for elective sternotomy for an obstructive mediastinal mass with typical presentations of superior vena cava syndrome. Case Report: A 14-year-old male patient was diagnosed with features suggestive of superior vena cava syndrome following presentation at the children emergency ward of the University of Port Harcourt Teaching Hospital, Nigeria, and after initial management of acute asthma on account of frequent respiratory distress. Following detailed preoperative assessment and preparation, meticulous anaesthetic care and monitoring contributed to a safe outcome despite challenging perioperative cardiorespiratory events typical of patients with such syndrome. The respiratory and cardiovascular variables later returned to normal values following sternotomy and debulking of the mediastinal mass and recovery was uneventful in the Intensive care unit from where he was finally discharged to the ward after 48 hours. Conclusion: Diagnosis of superior vena cava syndrome can be masked by other common causes of airway obstruction. These patients pose a high anaesthetic risk perioperatively. Management includes surgical approach while specialised anaesthetic care is crucial to a safe outcome.
Home massage tool induced acute thoracic spinal epidural haematoma – a case report
Background: Spinal epidural haematoma is a rare but potentially devastating condition that may present as an acute neurosurgical emergency. Prompt recognition and intervention are critical to prevent permanent neurological deficits. Aim: To report a rare case of spinal epidural haematoma following the use of a home massage tool and to highlight the importance of early diagnosis and urgent surgical management. Case Report: We present a 72-year-old man who was admitted into the emergency room after developing weakness of both lower extremities following the use of a home massage tool. Definitive diagnosis was made after magnetic resonance imaging was done. He subsequently underwent an emergency decompressive laminectomy and evacuation of the haematoma. Conclusion: Spinal epidural haematoma can present as a surgical emergency. Early diagnosis with magnetic resonance imaging and prompt surgical decompression are essential for favourable outcomes. With the increasing availability and use of commercial body massagers, greater public awareness and caution are warranted.
Assessment of readiness to wean an elderly patient from mechanical ventilation using clinical and diaphragmatic ultrasound predictors: a case report
*]:pointer-events-auto scroll-mt-(--header-height)" dir="auto" data-turn-id="752637dc-deaa-483b-bd6a-e2c2e5f00628" data-testid="conversation-turn-19" data-scroll-anchor="false" data-turn="user"> *]:pointer-events-auto scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]" dir="auto" data-turn-id="request-WEB:ed85297c-8ec8-490b-94ac-2965495f8175-24" data-testid="conversation-turn-20" data-scroll-anchor="true" data-turn="assistant"> Background: Weaning from mechanical ventilation is a critical and high-risk phase of intensive care management, particularly in elderly patients. One-fifth of mechanically ventilated patients experience difficulty during weaning and conventional clinical assessment may be unreliable, necessitating the use of objective physiological indices. Weaning predictors such as the rapid shallow breathing index and diaphragmatic ultrasonography have been shown to support decision-making when clinical evaluation is limited. Aim: Report the use of combined clinical criteria and diaphragmatic ultrasound parameters in assessing readiness for weaning from mechanical ventilation in an elderly patient with cognitive impairment. Case Report: A 70-year-old female with multiple ischaemic cerebrovascular accidents and vascular dementia was admitted following head trauma complicated by bilateral subdural haematomas. She underwent burr-hole evacuation and required postoperative mechanical ventilation with sedation. After 26 hours of ventilatory support, standard clinical criteria for weaning were fulfilled. Spontaneous breathing test was performed using low-level pressure support ventilation. Objective weaning predictors were assessed, including the rapid shallow breathing index and diaphragmatic ultrasound parameters. Rapid shallow breathing index was 38 breaths/min/L. Diaphragmatic ultrasonography demonstrated a diaphragm thickening fraction of 41.25% and a diaphragm excursion of 162 mm. Spontaneous breathing test was completed successfully without respiratory distress or haemodynamic instability. Conclusion: This case highlights the clinical value of integrating conventional weaning criteria with diaphragmatic ultrasound assessment in elderly patients with neurological and cognitive impairment. Objective evaluation of diaphragmatic function enhances confidence in extubation decisions and may reduce the risk of weaning failure in complex clinical settings.
Comparison of SIGN interlocking nailing and compression plating in the treatment of aseptic non-union of femoral shaft fractures
*]:pointer-events-auto scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]" dir="auto" data-turn-id="request-WEB:ed85297c-8ec8-490b-94ac-2965495f8175-20" data-testid="conversation-turn-16" data-scroll-anchor="true" data-turn="assistant"> Background: Aseptic non-union of the shaft of femur presents a treatment challenge with the need for prolonged hospitalization, multiple procedures and economic burden. The choice of treatment is influenced by facilities available in a specified centre. Aim: To compare the results of SIGN interlocking nailing and compression plating in the treatment of aseptic non-union of femoral shaft fractures. Methods: Prospective cohort study conducted over a period of thirty-one (31) months (August 2015 to March 2018). Patients with aseptic non-union of femoral shaft fractures who presented to orthopaedic units of University of Port Harcourt Teaching Hospital, Port Harcourt over the study period were recruited into the study. They were randomly grouped into two—A and B. Group A had open reduction and internal fixation with SIGN interlocking nail, while group B had their fractures fixed by compressive plate osteosynthesis. The patients were followed up for at least six months and the results compared. Results: Forty out of 42 patients completed the study. The SIGN interlocking nailing group had a union rate of 80% (n=16) in six months, while the compression plating group had 95% (n=19). The observed difference was not statistically significant (p=0.342). The two groups also had statistically comparable intra-operative blood loss, wound infection rates, duration for wound healing, post-operative limb shortening and duration of post-operative hospital stay. Conclusion: SIGN interlocking nailing and compression plating are effective methods of treatment of aseptic non-union of femoral shaft fractures. They are comparable with respect to variables evaluated in this study.
Correlation between third molar impaction and mandibular anterior segment crowding
*]:pointer-events-auto scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]" dir="auto" data-turn-id="request-WEB:ed85297c-8ec8-490b-94ac-2965495f8175-18" data-testid="conversation-turn-14" data-scroll-anchor="true" data-turn="assistant"> Background: Anterior crowding represents a discrepancy between mesiodistal tooth widths and available alveolar space. The role of third molar eruption in the development of lower incisor crowding remains controversial. Aim: To evaluate the correlation between mandibular third molar impaction and lower anterior segment crowding. Methods: A retrospective study was conducted at the Orthodontic Unit, Lagos University Teaching Hospital, over four years (Jan 2019 to Dec 2022). Patients aged 18 years and above with erupted permanent teeth and complete clinical records were recruited. Panoramic radiographs and study casts were assessed for third molar impaction status and tooth-bone ratio. Data were analyzed using SPSS version 23, employing descriptive (frequency and percentages) and inferential (Chi-square) analysis with significance set at p < 0.05. Results: Of 794 panoramic radiographs assessed, 181 adult patients (122 females, 59 males) met inclusion criteria. Lower incisor crowding was present in 72 patients (39.8%), while 74 (40.1%) had unilateral or bilateral third molar impaction. A significant association was found between third molar impaction and crowding (p = 0.032), with over 50% of patients with impaction showing crowding. However, the association between impaction symmetry and crowding severity was not statistically significant (p = 0.066). Conclusion: A significant correlation exists between third molar impaction and anterior segment crowding. Patients with impacted third molars are more likely to have mandibular anterior crowding.
Pattern of lip competence and its association with malocclusion traits: a retrospective analysis of cases seen at a tertiary institution
Background: The lips are central to facial aesthetics, but it is their competence pattern that determines whether they meet aesthetic standards or not. Aim: To assess the pattern of lip competence and its relationship to overjet and other malocclusion traits in patients seen at a tertiary hospital in South-South Nigeria and gender variations. Methods: A retrospective study was conducted from June 2015 to June 2025. Case notes of 454 orthodontic patients who attended the hospital’s orthodontic unit were reviewed. Case notes lacking complete information were excluded. Data on socio-demographics, overjet, molar relationship, and lip patterns were collected and analyzed using IBM SPSS version 26. Descriptive statistics (frequencies and percentages) and inferential statistics (Chi-square test) were used, with level of significance set at p < 0.05. Results: Of the 454 patients, 179 (39.4%) were males, and 275 (60.6%) were females, with a mean age of 15.36 ± 8.05 years. The 10–19-year age group had the highest representation (261, 57.5%). Incompetent lip seal was most prevalent in Angle’s Class II malocclusion (75.0%) and also common in Class I (65.3%) cases. Increased and normal overjet were significantly associated with incompetent lips (75.4% and 51.4%, respectively; p = 0.001). Incompetent lips were more common in females (61.8%). Conclusion: Incompetent lip seal was associated with both increased and normal overjet and was more associated with Angle’s class I malocclusion.
Dental pain and oral health-related quality of life of patients attending a Nigerian tertiary hospital - a cross-sectional study
*]:pointer-events-auto scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]" dir="auto" data-turn-id="request-WEB:ed85297c-8ec8-490b-94ac-2965495f8175-14" data-testid="conversation-turn-10" data-scroll-anchor="true" data-turn="assistant"> Background: Poor oral health significantly compromises quality of life. While the link between oral conditions and Oral Health-Related Quality of Life (OHRQoL) is established, specific data on the impact of dental pain from various oral conditions in Nigerian patient populations is scarce. This study addresses that gap. Aim: To assess the impact of dental pain on OHRQoL among patients at the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria. Methods: A descriptive, cross-sectional study conducted among patients attending the University of Port Harcourt Teaching Hospital (UPTH). Semi-structured questionnaires were used for data collection. The questionnaire had three sections. Section A included information on socio-demography, Section B on diagnosis and duration of dental pain, and Section C on the short form of the Oral Health Impact Profile questionnaire (OHIP-14) to evaluate the QHRQoL of dental pain among patients. Data were analysed using SPSS version 27.0, with statistical significance set at p < 0.05. Results: There were 212 participants [66 (31.1%) males and 146 (68.9%) females]. 'Physical pain' was the most severely affected domain. Maxillofacial fractures (mean OHIP-14: 31.3 ± 13.8), pericoronitis (28.6 ± 10.9), and dental caries (27.5 ± 11.5) had the highest negative impact. Most participants with these conditions reported negative OHRQoL impact (p <0.001). Gingivitis had the least impact. Conclusion: Dental pain, particularly from maxillofacial fractures, pericoronitis, and caries, greatly impairs OHRQoL. Hence, the need for targeted, prompt management of painful dental conditions to improve patient well-being and highlights the value of OHRQoL measures in clinical assessment.
Comparing the effectiveness of tetracycline sclerotherapy versus placebo in the prevention of postmastectomy seroma among female patients in a tertiary hospital in Southern Nigeria
Background: Postmastectomy seroma is the commonest complication following mastectomy. It is a cause of significant morbidity for the patient and its management is challenging. Several attempts have been made to prevent or reduce the occurrence of postmastectomy seroma and the results have been inconclusive. Tetracycline is an effective sclerosant and has shown effectiveness in the management of seroma. Aims: To evaluate the effectiveness of tetracycline sclerotherapy in the prevention of post-mastectomy seroma among women undergoing modified radical mastectomy for breast cancer. Methods: Seventy-six (76) female patients with histological diagnosis of breast cancer were randomised into 2 groups. Following Auchincloss modified radical mastectomy, both groups had their wounds irrigated with distilled water. Group A in addition, had a suspension of tetracycline instilled. Daily measurements and recording of the drainage volume was done and drain was removed when drainage volume was less than 30mls per day on two consecutive days. The patients were assessed for post- operative pain and other wound complications. Results: Most patients presented with advanced disease and the predominant histologic sub-type was invasive ductal carcinoma. Seroma was the most common complication followed by wound infection. The incidence of seroma was lower in the tetracycline group 1 (2.6%) than in the control group 5 (13.2%) though this difference did not reach statistical significant (p = 0.089). The application of topical tetracycline did not adversely affect healing of the wound. Conclusion: Patients that had topical tetracycline applied to their wound following mastectomy had reduced incidence of seroma formation though not statistically significant.
Maternal “near miss” and maternal mortality at a tertiary health facility in Delta State, South-South Nigeria
*]:pointer-events-auto scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]" dir="auto" data-turn-id="request-WEB:ed85297c-8ec8-490b-94ac-2965495f8175-6" data-testid="conversation-turn-6" data-scroll-anchor="true" data-turn="assistant"> Background: Maternal mortality and morbidity statistics serve as important indicators of the quality of healthcare delivery in a country or health facility. Aims: To determine the institutional maternal mortality ratio (MMR), maternal near miss incidence ratio (MNMR), maternal near miss to maternal mortality ratio, mortality index, and factors that contributed to maternal outcome, at the Delta State University Teaching Hospital (DELSUTH), Oghara, Delta State. Methods: This was a retrospective study, conducted at the Department of Obstetrics and Gynaecology, DELSUTH, Oghara. The medical records of maternal deaths and maternal “near miss”, from June 1, 2019, to June 30, 2024, were retrieved. The data analysis was with SPSS version 25. Statistical level of significance was set at P< 0.05. Results: The study recorded 1,037 live births, 54 maternal deaths, and 129 maternal near miss events. The maternal mortality ratio was 5,200 / 100,000 live births, during the study period. The maternal near miss incidence ratio was 124.3 /1000, while the maternal near miss to mortality ratio was 2.4, and the mortality index was 29.5%. The leading cause of mortality and morbidity was hypertensive disorders of pregnancy, which accounted for 59.3% and 73.6%, respectively. Conclusion: The findings indicate that the maternal health indices are consistent with those of an over-strained healthcare facility, reflecting the consequences of delayed presentation of complicated obstetric cases. These highlight systemic challenges in timely access to obstetric care and emphasize the importance of strengthening antenatal care and referral services.
Emergence of artificial intelligence in dentistry across global regions: focus on Africa and the West African subregion
Background: Artificial intelligence (AI) is transforming diagnostic and therapeutic pathways in dentistry, although the pace and extent of its adoption vary significantly across regions. Aim: This article compares the development and implementation of AI in dental practice across major global regions and identifies strategic priorities for accelerating responsible and equitable AI adoption in West Africa. Methods: A structured search of the global literature was conducted to identify English-language publications on AI applications in dentistry from 2015 to the present. Searches were performed across major scholarly databases using combinations of keywords related to AI and dentistry. Retrieved publications were screened using predefined eligibility criteria and subjected to narrative review to extract information on domains of AI application, stages of implementation, digital infrastructure readiness, regulatory context, and regional adoption patterns. A comparative thematic synthesis was then conducted to categorize regions by stage of AI emergence and to identify key drivers and barriers to adoption. Results: The initial search yielded 1,125 publications. After abstract screening and eligibility filtering, 109 publications remained, and full-text review identified 16 core articles for analysis. High-income regions demonstrate rapid progression from proof-of-concept models to clinically integrated AI tools. In contrast, West Africa remains at an early stage of adoption, characterized by significant oral health needs, limited digital infrastructure, scarce research, and minimal clinical deployment. Conclusion: Bridging this gap will require investment in digital infrastructure, context-appropriate AI applications, local data development, capacity building, and ethical governance frameworks.
Making use of available health resources in Nigeria
Health care systems around the globe are struggling with limited resources.1 These resources are not only financial but also resources in terms of personnel, competences, equipment, pharmaceuticals, facilities.1 Hence, public health systems, which are those that provide publicly funded healthcare, are under a great deal of pressure from the global economic crisis, under-staffing, and budgetary constraints.2 This has further been compounded by the COVID-19 pandemic which has revealed the massive shortcomings of health systems globally, particularly in developing countries like Nigeria, with weak healthcare infrastructure and chronic high morbidity and mortality from both infectious and non-infectious diseases.3 Rising health care demand, an increase in the burden of diseases on infrastructure, technology improvements, shifting service models, rising customer expectations, and shifting service accessibility also place pressures that affect health systems globally.2 As a result of these challenges, there is a need to prioritize and allocate available resources for the general good of all the citizenry.1 For hospitals, this would imply that they cannot continue to operate as they did in the past if they want to survive. 4 The hospitals will have to learn to meet rising healthcare demands without a proportionate increase in resources.4 They will have to cope with higher expectations in relation to the quality of treatment and care rendered, but also increasingly of the quality of the patient experience and workplace environment.4 Hence, hospitals will have to become considerably more efficient in the way they operate.4 Effective capacity management is one of the key components that hospitals will require to achieve optimal resource efficiency and thrive in this harsh environment.4 It is key to achieving optimal resource utilization through aligning resources, processes, and planning across individual providers and networks as well as a fundamental component in any strategy to ensure that hospitals survive in a world where resources are scarce and there are higher demands.4 Effective capacity management is a solution that encompasses the entire organization.4 In the context of Nigeria, it is recommended that there should be optimal allocation of scarce medical resources in ways that would maximize health care delivery benefits to the greatest number of people, give priority to those worse off, ensure equality and promote continued care provision for all conditions.3 Funding priority should be given to essential prevention and treatment services for communicable diseases, including immunizations; services related to reproductive health, including pregnancy and childbirth; core services for vulnerable populations, such as infants and older adults; provision of medicines; management of emergency health conditions and common acute illnesses; and auxiliary services, such as basic diagnostic imaging, laboratory, and blood bank services.3 Nigerian policymakers should also ensure that social protection services are instituted and maintained;3 and the government should ensure accountability for all funds released.3
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Assessment of medical students’ perception of anatomical pathology teaching methods
Background: Anatomical pathology is an essential component of medical training in the 4th year of medical school and the learning process may be impacted by the effectiveness of delivery methods. This study aimed to assess the perception of medical students on the teaching methods in anatomical pathology. Methods: A descriptive cross-sectional survey was conducted between January 2024 and January 2025 among medical students across four universities in Southern Nigeria: University of Port Harcourt, Bayelsa Medical University, Gregory University, and Niger Delta University. A structured questionnaire was used to collect data on attendance, preferences, and perceptions of different teaching methods. Responses were entered into Microsoft Excel and analysed in SPSS, applying descriptive statistics such as frequencies and percentages. Results were presented in tables and figures for clarity. Results: A total of 215 students from four the medical schools responded to this study. The majority were in their 5th year of study. Lectures were the preferred teaching method (65.6%), followed by practical demonstrations (26%) and seminar (8.4%). Students rated the quality of pathology lectures as predominantly good. All the practical demonstration tools were said to make Anatomical pathology more understandable. Among interactive study methods, group discussion was the most preferred. Conclusion: This study revealed a strong preference among medical students for lectures, practical sessions, as well as group discussions in learning Anatomical Pathology. These findings highlight the need for educators and medical education college boards to integrate and strengthen these interactive and hands-on teaching approaches within the anatomical pathology curriculum.
Intracranial subdural haematomas: a rare but disabling complication of spinal anaesthesia
Background: Intracranial subdural haematomas (SDH) after subarachnoid blocks (SAB) are a very rare complication, which results in persistence of post procedure headaches and neurologic deterioration. Acute change in CSF pressure dynamics resulting in tears of bridging veins has been implicated. Aim: To highlight our findings of intracranial SDH following SAB in the period 2018 to 2023 in Port Harcourt. Methods: Patients who had persistent headaches with neurologic deterioration after SAB had brain imaging done. Those with SDH were recruited. They had burr hole evacuation of haematomas. Results: Twelve patients (11 females), with a mean age of 41.0±9.8 years were recruited. Ten patients had SAB, and 2 had Combined spinal epidural (CSE) anaesthesia. SAB was done with size 22G spinal needle in 3 patients and 24G in 5 patients. Confusion, headaches, alteration in consciousness, and paresis occurred in 66.7%, 100%, 75% and 83.3% of patients respectively. 16.7% patients were Mark-Walder grade IV, 8.3% grade III, 41.7% grade II, and 33.3% with grade I. 41.7% patients had bilateral SDH and 33.3% had left SDH. Chronic SDH was noted in 41.7% patients and others had subacute SDH. Mean interval between onset of symptoms to surgery was 6.3±7.3 days. Clinical recoveries were noted in all patients with postoperative modified Rankin Scale (mRS) scores at 14 days of 0. Conclusion: Intracranial subdural haematomas may be rare but are a major cause of headaches with neurologic deteriorations after subarachnoid blocks. A high index of suspicion and prompt management results in good outcomes.
Awareness of gingival enlargement and pattern of dental care utilization amongst hypertensive patients in a Nigerian tertiary hospital
Background: Some antihypertensive drugs have been implicated in drug-induced gingival enlargement (DIGE), however, there is paucity in the literature on the level of awareness of DIGE among these patients. Hence, this study aims to assess the awareness, prevalence of DIGE, and the impact of dental care service (scaling and polishing) on the prevalence of DIGE among hypertensive patients at the University of Port Harcourt Teaching Hospital (UPTH). Methodology: A cross-sectional study was conducted among hypertensive patients attending the Cardiology Outpatient Clinic at UPTH. Participants were selected using the convenience sampling method. Data collection was done using structured questionnaires, medical records and clinical oral examinations. Information on demographic variables, duration of antihypertensive medication use and dental care service utilization were also recorded. Data was analysed with significance set at p<0.05. Results: There were one hundred and fifty (150) respondents; 64 males and 86 females, with an M: F of 1:1.25. The prevalence of gingival enlargement was 29.3%, with higher prevalence in patients on calcium channel blockers (Amlodipine) in combination with Angiotensin II receptor blocker (Telmisartan). None of the subjects was aware of gingival enlargement in hypertensive patients. Level of education, type of antihypertensive medications and no scaling & polishing were significantly associated with increased prevalence of gingival enlargement (p = 0.000). Conclusion: The prevalence of drug-induced gingival enlargement among the participants was 29.3%, with grade I (interdental) gingival enlargement being more common and among subjects on long-term use of CCBs in combination with ARBs. All subjects were unaware of drug-induced gingival enlargement in hypertensive patients. There was a negative association between oral hygiene status and drug-induced gingival enlargement.
Dental emergencies at the University of Port Harcourt Teaching Hospital
Background: Dental emergencies represent a significant burden in both developed and developing countries, often requiring immediate intervention to manage pain, infection, trauma, or life-threatening complications. Aim: This study aimed to evaluate the spectrum, frequency, and demographic distribution of dental emergencies presenting at the University of Port Harcourt Teaching Hospital (UPTH). Methods: A retrospective, descriptive cross-sectional analysis was conducted on all dental emergencies presenting to UPTH’s Dental Out-Patient Clinic and Emergency Department from January 2023 to December 2024. Data were collected from clinical records and analyzed using descriptive statistics and chi-square tests. Results: A total of 1,598 cases were recorded, with the majority (94.1%) presenting at the dental out-patient clinic. The mean age of the patients was 33.2 ± 16.8 years, and females accounted for 59.0% of the cases. Odontogenic infections were the most common emergencies (86.5%), particularly acute apical periodontitis (61.5%). Traumatic dental injuries constituted 6.4%, while jaw and soft tissue trauma accounted for 3.9%. Significant associations were found between type of emergency and age, gender, and route of presentation (p < 0.001). Trauma-related cases were predominantly seen in males and presented more frequently at the emergency unit. Conclusion: Dental emergencies at UPTH were predominantly odontogenic infections presenting at the out-patient clinic, while trauma-related cases were more likely to present through the emergency department.
The aftermath of sexual violence among young adult females in Southern Nigeria: disclosure, care-seeking, consequences and effects on sexual behaviour
Background: In spite of the high worldwide prevalence of sexual violence which disproportionately affects women and girls, care and support services for the victims are often deficient for various reasons including non-disclosure due to stigma, shame and inability to access help. Aim: This study examined the aftermath of sexual violence among female undergraduates of the Niger Delta University, Bayelsa State who reported having experienced sexual violence. Methodology: Data of the 83 (19.2%) victims identified through a cross-sectional study of 429 female undergraduates selected by systematic random sampling was extracted to determine the pattern of disclosure, care-seeking, consequences and effects on sexual behaviour. Data analysis employed SPSS version 29 and Chi-square test was used to determine sociodemographic factors significantly associated with disclosure with the level of significance set at p<0.05. Results: The victims were aged 15-29 (mean 21.9 ± 2.8) years and 35(42.2%) disclosed their experiences to a third party with commonest reasons for non-disclosure being shame and self-blame [33(68.8%)]. There was no significant association between disclosure and sociodemographic factors (p>0.05). Over half [57(68.7%)] did not seek medical care, mostly due to fear of disclosure. Vaginal pain [33(39.8%)] and depression [81(97.6%] were the commonest physical and psychological consequences reported. The main effects on sexual behaviour included risky sexual behaviour [25(64.1%)] aversion to sex [15(38.5%)] and engagement in same-sex relationships [6(15.4%)]. Conclusion: The study confirms previously documented poor disclosure and care-seeking behaviors with many physical and psychological consequences and negative effects on sexual behaviour for the victims of sexual violence.
Promotion of a healthy workplace in the health sector
The WHO has defined a healthy workplace as one in which workers and managers collaborate to use a continual improvement process to protect and promote the health, safety and well-being of all workers and the sustainability of the workplace by considering the following, based on identified needs: health and safety concerns in the physical work environment; health, safety and well-being concerns in the psychosocial work environment including organization of work and workplace culture; personal health resources in the workplace; and ways of participating in the community to improve the health of workers, their families and other members of the community.1 This definition is intended chiefly to address primary prevention, which entails, the prevention of injuries or illnesses from happening in the first place. However, secondary and tertiary prevention may also be included by employer-provided occupational health services.1 Also, this definition, is intended to create a workplace environment that does not cause re-injury or reoccurrence of an illness when someone returns to work after being away with an injury or illness, whether work-related or not.1 In addition, it is intended to mean a workplace that is supportive and accommodating of older workers, or those with chronic diseases or disabilities.1 A healthy workplace is particularly important in the health sector. Hospitals and health services are generally considered as relatively unhealthy workplaces for health workers, who may experience various physical and psycho-social burdens during work hours.2 As a result, the workplace can aggravate the health of health workers and therefore it is a necessity to have a healthy workplace for the health workers. Promotion of healthy workplaces includes three main components, which generally is within the responsibility of management. These three main components, include : a healthy and safe workplace; staff training in health promotion skills aiming at better health gain for patients and community; and health promotion activities for staff. 2
How prompt do patients receive orthopaedic care in tertiary health facilities in resource-constrained setting?
Background: The timeliness domain of quality plays prominent role in assessing the quality of emergency medical care and trauma care. Prompt services reduce morbidity, mortality, man-hour and resource wastages in the health system. Delays in accessing care are common in health facilities in most low- and middle-income countries. Aim: To determine the waiting time before orthopaedic services were received at the various units by ambulatory adults at the University of Port Harcourt Teaching Hospital. Methods: This time-flow study for receipt of orthopaedic services by ambulatory patients in the University of Port Harcourt Teaching Hospital used a longitudinal study design. Responses from consecutively sampled patients were analyzed using Statistical Package for Social Sciences (SPSS) version 23 for windows. Results: A total of 442 patients gave consent and were recruited into the study but only 430 patients gave complete responses to the questionnaires giving a response rate of 97.3%. The mean age was 38.5 +/-14.8 years. The mean time from when a patient was referred to see the orthopaedic doctor to the commencement of orthopaedic consultation was 2.6 days; while that for receiving radiologic services after seeing the orthopaedic doctor was 1. 9 days. At the doctor’s station, 50 % of patient waited for 33.34minutes before orthopaedic service was rendered. Visit status, gender and educational qualification showed strong association with waiting times at the records, nursing station and doctor’s station respectively. Conclusion: Waiting time is an important indicator to the quality of care received and reducing it is key to improving care quality.
Teachers' perspective on epilepsy: examining their knowledge and attitudes in three selected schools in Rivers State, Nigeria
Background: Epilepsy is a common brain disease known for its high risk of discrimination and social stigmatisation. The unpredictable nature of the disease makes a child prone to seizure episodes in school. Teachers can play a vital role by providing the required support and prompt intervention. This study examined the knowledge and attitudes of teachers towards epilepsy. Methods: A cross-sectional study carried out among classroom teachers in Rivers State. Data were collected through a semi-structured self-administered questionnaire. SPSS version 25 was used for analysis, while descriptive and inferential statistics were conducted. Results: Subjects were 132 teachers; 91 (68.9%) were females. The majority, 96 (72.7%), teach in public schools and had first degree as the highest level of education. Most, 128(97%), were aware of epilepsy; 18 (13.6%) believed it was caused by witchcraft; 34 (25.8%) responded that it is contagious; while 66 (50.0%) reported that traditional drugs are used for treatment. Fifty-seven (43.3%) of the teachers opined that children with epilepsy should attend a special school, and 33 (25.0%) believe that having a child with epilepsy would disrupt the class's educational activities. Fifty-five (41.7%) of the teachers had poor attitude towards children with epilepsy, and 53 (36.4%) had poor knowledge of immediate care for a convulsing child. An increase in knowledge was associated with a corresponding increase in positive attitude. Conclusion: Most teachers had moderate to good knowledge of epilepsy, but their attitude and practices towards children with epilepsy were poor. Well-structured training programmes are needed to equip teachers to provide seizure first aid in schools.
Attention deficit and hyperactive disorder among primary school children in Obio/Akpor Local Government Area of Rivers State: prevalence and predictive factors
Background: Attention deficit/hyperactivity disorder (ADHD) is a common neurobehavioral disorder that affects children. A consistent pattern of inattention and hyperactivity or impulsiveness, or both, is the hallmark. These behaviours are typically considered age-inappropriate. Risk factors for ADHD are numerous, including prematurity, low birth weight and neurologic factors. This study aims to determine the prevalence and predictors of ADHD among primary school children in Rivers State. Methods: A cross-sectional analytic study was conducted in 2025 among pupils aged 6-12 years. A self-administered questionnaire and the Vanderbilt ADHD Diagnostic Rating Scale (VADRS) were used as study tools. Data were analysed with SPSS version 25. Results: Of the 396 subjects, 39 (9.8%) were identified with ADHD using the teacher version VADRS, whereas the prevalence was 14 (3.5%) using the parent version. More males, 26 (12.7%), had ADHD compared to 13 (6.8%) females. The sex difference in prevalence was significant (p = 0.005). The inattentive subtype was more common (56.4%), with males under 10 years more affected. Male sex (OR=2.01; p=0.05; 95% CI: 1.00–4.04), family history of ADHD (OR=8.05; p=0.0004; 95% CI: 2.07-41.35), preterm delivery, low birth weight, and delivery outside a health facility were significant predictors of ADHD. Conclusion: The prevalence of ADHD is increasing in tandem with the global trend. In our environment, positive family history, prematurity, low birth weight and deliveries in places with unskilled birth attendance are associated with higher risks of ADHD. There is a need to create awareness among the populace to reduce the preventable risk factors.
Multilayer intraoperative monitoring: clinical use of capnography during neuraxial block in Port Harcourt, Nigeria
Background: The concept of multilayer defence, often applied in advanced air defence systems, is also relevant in perioperative patient safety through the use of multiple, complementary monitoring modalities. Capnography, which provides continuous real-time assessment of end-tidal carbon dioxide (EtCO₂), is traditionally employed during general anaesthesia but has emerging value as an additional layer of intraoperative monitoring during neuraxial anaesthesia. Aim: To evaluate the impact of incorporating capnography as an adjunct to standard monitoring on respiratory event detection and patient satisfaction during neuraxial anaesthesia. Methods: A randomised controlled trial was conducted across five hospitals in Port Harcourt, Nigeria, all equipped with capnography facilities. A total of 250 adult patients undergoing elective surgery under neuraxial anaesthesia were randomly allocated to two groups: Group A (standard monitoring) and Group B (standard monitoring plus capnography). Primary outcomes included the ability to detect apnoea, sedation-related respiratory changes, and sudden desaturation. Secondary outcomes were operative duration and patient satisfaction. Data were analysed using IBM SPSS version 26. Results: Capnography enabled earlier detection of desaturation events—within 20 seconds—compared to pulse oximetry, and identified apnoea and sedation-related respiratory pattern changes in 98% of cases. No significant difference in operative duration was observed between the two groups. Patient satisfaction was significantly higher in the capnography group (mean score: 4.5 ± 0.4) compared to the standard monitoring group (3.9 ± 0.5; p < 0.001). Conclusion: The addition of capnography to standard monitoring during neuraxial anaesthesia significantly enhances perioperative safety through earlier recognition of respiratory compromise and improved patient satisfaction.
University of Port Harcourt Teaching Hospital
Association of the use of interdental cleaning aids with periodontal disease at the periodontal clinic in a tertiary hospital
Background: Plaque biofilm, the aetiological factor for periodontal disease, forms more in interdental areas of the teeth, which are not easily cleansed with tooth brushes, hence, the need for interdental cleaning aids. Aim: This study aims to assess the association of interdental cleaning usage with oral hygiene status and periodontal status of patients attending the periodontal clinic of the University of Port Harcourt Teaching Hospital (UPTH). Methods: This was a cross-sectional study conducted among participants who attended the Periodontology Clinic, UPTH. Data was collected using semi-structured questionnaires and was analysed using SPSS. P values < 0.05 were considered statistically significant. Results: There were 108 participants (48 males and 60 females), with age range of 17-78 years. 101 (93.52%) of the participants used interdental aids, more females 57(56.4%) used interdental cleaning aids. Majority of participants (71.3%) used wooden toothpicks. Participants who used interdental cleaning aids had mean OHI-S score of 2.48 ± 1.0, while those who did not, had mean OHI-S score of 2.89 ± 1.04 (p = 0.330). Among the participants who used interdental cleaning aids, 8 (7.9%) had CPI 0, 66 (65.3%) had CPI 2 and 19 (18.8%) presented with CPI 3, while among those who did not, 2 (28.6%), 4(57.1%), and 1 (14.3%) respectively had CPI 1, CPI 2, CPI 4 (p = 0.024). Conclusion: There was a statistically significant association between interdental cleaning aids and periodontal health status but not with oral hygiene status. Gingival bleeding was the most common complaint.
Training, knowledge, and attitude of non-anaesthetist doctors to cardiopulmonary resuscitation in a South-South teaching hospital in Nigeria: a cross-sectional study
Background: Cardiopulmonary resuscitation, when done properly, improves the survival rates of patients with in-hospital cardiac arrest. The American Heart Association recommends retraining every two years and simulations every three months. Lack of frequent training results in poor performance and outcomes. Aim: To evaluate the training, knowledge, and attitude to cardiopulmonary resuscitation amongst non-anaesthetist doctors in a teaching hospital in South-South Nigeria. Methods: A custom-designed online-based questionnaire, reviewed by CPR providers, was distributed among non-anaesthetist doctors to obtain information on training, knowledge, and attitudes toward CPR. The knowledge component of the questionnaire covered basic life support. Availability and knowledge of the use of AEDs were also assessed. Results: One hundred and thirteen (55%) doctors out of 204 non-anaesthetist doctors participated. Ninety-one (80.5%) respondents had received formal training on Basic Life Support CPR, with 44 (38.9%) having received their training over 5 years prior. The overall knowledge score of the respondents ranged from 24.0 – 84.0, with a mean score of 56.96 ± 12.72. Most respondents had a positive attitude towards performing mouth-to-mouth ventilation during CPR. One hundred and ten (97.3%) indicated interest in learning CPR techniques. Conclusion: The overall training of a considerable number of doctors was inadequate, with the majority being out of certification. Additionally, the knowledge competence among respondents was found to be insufficient. However, the general attitude towards CPR was favourable. To improve knowledge, confidence, and, most importantly, patient outcomes, it is imperative that CPR training be required for all medical, nursing staff, and healthcare workers.
Renewable energy as a solution to the power challenges of public hospitals in Nigeria
One of the major issues challenging Nigeria is poor and epileptic power supply.1 This cuts across all sectors but the impact on the health sector is enormous. Asides the poor power supply, the cost of providing power through the national grid to the public hospitals is enormous. The public hospitals have found it difficult paying those bills and this has led to disconnection of hospitals from the national grid.2 These have led to public hospitals seeking alternative means of power supply. It had been reported that less than 30% of health facilities in low and middle income countries have access to reliable energy sources, truncating health outcomes and endangering patients in critical conditions.3 Hospitals are energy-intensive facilities that require significant amounts of electricity for heating, cooling, lighting, ventilation, water supply and operation of essential medical equipment. 4-7 The daily activity of a hospital demands an enormous amount of electrical energy to meet medical and comfort needs.5 The high energy demand of hospitals is mainly attributed to various factors such as 24/7 operation, specialized medical equipment, temperature and humidity control, and lighting requirements.4 Modern health facilities in high- and middle-income countries are among the largest commercial consumers of energy. 6,7 As healthcare facilities strive to provide optimal patient care, it becomes imperative to address the energy efficiency challenges to ensure the sustainability of healthcare delivery.4 Reliable power supply is associated with improvements in the quality of health care delivery.3 Poor power supply which is particularly apparent in low- and middle-income countries (LMICs), commonly disrupts essential health services.3,8 Unreliable electricity leads to insufficient use of health technologies, interruptions in the use of essential medical and diagnostic devices, vaccine spoilage, increased fuel costs and waste for health facilities – limiting healthcare capabilities in already disadvantaged areas.3,6 Stable power supply allows new heights in achieving SDG 3 (SDG 3) which seeks to guarantee healthy lives and promote well-being for all at all ages, and SDG7 which seeks sustainable energy for all in LMICs.3
Retaining the health workforce in the healthcare system of Nigeria
Healthcare is centrally positioned within the United Nations 2030 sustainable development agenda under sustainable development goal (SDG 3) which seeks to guarantee healthy lives and promote well-being for all at all ages. 1,2 Central to the attainment of this goal is a motivated human resource for health (HRH) workforce that delivers quality healthcare to the world’s population. 1,2 Human Resources for Health (HRH) has been defined as all people engaged in actions whose primary intent is to enhance health. 3,4 It refers primarily to the health workforce or health workers. The World Health Organization (WHO) defines health workers to be people in the formal and informal sector who are engaged in the promotion, protection or improvement in population health. 5 The health system comprises of activities with the primary goal of improving health. The WHO recognizes HRH as one of the six main building blocks of the health system which also includes finance, services, technologies, information and governance. 5,6 Human resource is considered to be the heart of the health system in any country and can be described as the most important component of the healthcare system. 2,4,5,6 The health workforce is thus the cornerstone of every health system, and is critical to the provision of good quality health services, improving population health, ensuring universal health coverage and the achievement of the Sustainable Development Goals. 2,7 The WHO emphasizes that health systems can only function well when they have sufficient, well-trained, competent, responsive, motivated, productive and fairly distributed health staff. 4
Recurrent Atelectasis in a Previously Healthy Child: A Case Report and Literature Review
Background: Atelectasis is the partial or complete collapse of a lung or its segment. The diagnosis of atelectasis in children calls for urgent identification and management of the underlying cause. There is a need for high index of suspicion of foreign body aspiration (FBA) in children with atelectasis even in the absence of a positive history. The aim of this report is to present a case of atelectasis from foreign body aspiration (FBA), without a suggestive history, in a previously healthy boy and review the relevant literature. Case Report: A 10-year-old boy presented with a 2-week history of cough, weight loss and fever which failed to subside on out-patient treatment. He denied history of FBA. He was managed for left lobar pneumonia with lung collapse 3 months earlier with good response. He remained well till his re-presentation with features of recurrent left lobar pneumonia and lung collapse. He was re-admitted, re-evaluated, treated with remarkable improvement, then referred for further evaluation. Repeat chest CT identified foreign body (FB) in the airway and on rigid bronchoscopy, a biro end was extracted. Similar symptoms have not recurred. Conclusion: Primary care providers and paediatricians must remain alert to FBA as a cause of atelectasis even in the absence of a positive history.
Genital and oral warts co-presentation in a patient attending the sexually transmitted infection clinic in a tertiary facility in Rivers State, Nigeria
Background: Human papillomavirus is an ubiquitous virus causing various types of warts, including genital and extra-genital lesions. Aim: To report a case of co-presentation of genital and extra-genital wart (oral wart) at the University of Port Harcourt Teaching Hospital (UPTH). Case Report: Case notes of a patient who presented to the Reproductive Health/Sexually Transmitted Disease Clinic, UPTH, between July and September, 2024 with genital and oral warts were reviewed. Clinical features, findings on physical examination, results of investigations, treatment modalities, and outcomes were documented. The case was a 24-year-old man who had several growths in the penis and buccal cavity. In the course of the examination, he had several genital warts of varying consistencies. He received counseling, drug treatment, and podophyllin painting. Conclusion: Genital and extra-genital warts pose significant physical and psychological burdens. This case report highlights the importance of understanding the diverse presentation of warts and provides good guidance for healthcare workers in the management of warts. Irrespective of the site and type of wart, a good history, exhaustive physical examination, accurate diagnosis, and tailored treatment are crucial for effective management.
Epidemiology, outcomes and challenges of cleft palate surgeries in Port Harcourt: a 10-year retrospective study
Background: Cleft palate is a significant congenital condition affecting feeding, speech, hearing, and psychosocial development. In low-resource settings like Nigeria, limited access to specialized care often results in delayed treatment and poor outcomes. Aim: To investigate the epidemiology, outcomes and challenges of cleft palate surgeries in Port Harcourt, Nigeria. Methods: A retrospective study of patients who underwent cleft palate repair from January 2015 to December 2024 at the University of Port Harcourt Teaching Hospital, Port Harcourt. Data were obtained from the Smile Train Express database and included demographics, age at presentation, cleft type, associated anomalies, surgical techniques, and complications. Analysis was conducted using Microsoft Excel and SPSS version 20. Results: The mean age at surgery was 2.5 years (range: 6 months–25 years) with slight male preponderance. Majority underwent surgery between the ages of 9 months and 3 years. Unilateral cleft palate was present in 70% of cases; bilateral in 30%. Associated anomalies, primarily cardiac and auditory, were noted in 20%. Primary repair was performed in 80%, predominantly using the von Langenbeck technique. The overall complication rate was 15%, with wound infections (8%) being most common, followed by fistula formation (4%) and respiratory complications (3%). Conclusion: There is a slight male preponderance among those who had surgery for cleft palate. There were more unilateral cleft palates than bilateral cleft palates. Associated anomalies were identified in one-fifth of the patients. Primary cleft palate repair was the most frequently performed procedure using the von Langenbeck technique. The most common complication was wound dehiscence.
Self Monitoring of Blood Glucose among Persons Living with Diabetes Mellitus in a Tertiary Hospital in Southern Nigeria
Background: Self-monitoring of blood glucose is a critical part of diabetes management. It promotes personal responsibility, provides opportunities for better control and allows for detection of blood glucose extremes, while reducing fluctuations. It also helps both the patient and the provider make informed decisions and potentially reduces complications. Studies have shown that haemoglobin A1c levels are lower if glucose is tested more frequently. Aim: To determine the frequency of self-monitoring of blood glucose, among patients living with diabetes mellitus in a tertiary Hospital in Southern Nigeria. Methods: This was a cross-sectional study of 85 patients attending the medical outpatient clinic of University of Port Harcourt Teaching Hospital in 2023 using a self-administered questionnaire. Data was analysed using the SPSS version 26. Results: A total of eighty-five (85) patients between the ages of 20 to 80 years were recruited, 34(69%) were females and 26 (31.0%) were males. Of all participants 73.5% owned a glucometer and 26.5% didn't own one. Only 79% performed self-monitoring of blood glucose while 21% did not perform it. Slightly above a quarter checked their blood glucose once daily (26.6%), 13.9% checked more than once a day, 11.4% checked once a week and others checked less frequently. Conclusion: The frequency of practise of self-monitoring of blood glucose was higher (79%) than previous studies. Over a quarter 26.6% checked daily and 13.9% checked more than once a day. Persons living with diabetes mellitus should be encouraged to practise individualised SMBG to achieve better glycaemic control and have better outcomes.