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
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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.
Burn Injuries in a Tertiary Hospital setting: Risk Factors and Outcomes
Background: Burn injuries constitute a major cause of trauma-related morbidity and mortality, particularly in low- and middle-income countries. Aim: To identify the risk factors and clinical outcomes of burn injuries managed at the University of Port Harcourt Teaching Hospital. Methods: This was a retrospective study of all burn patients managed by the Plastic Surgery Unit of the University of Port Harcourt Teaching Hospital (UPTH), a tertiary referral centre located in Port Harcourt, Rivers State, South-South Nigeria from 1st April 2015 to 31st March 2023 to assess the risk factors and outcomes. Data on demographics, burn aetiology, severity, and outcomes were analyzed. Results: A total of 703 burn patients were admitted, with a male-to-female ratio of 1.1:1. The younger age groups were mostly affected. Majority of burn injuries occurred in individuals from low and middle-income settings. The most common causes were kerosine burns, petrol burns and gas burns. Flame burns were the most common aetiology (76.6%), followed by scalds (11.7%), electrical burns (4.6%), and chemical burns (1.5%). The mortality rate was 39.2% and increased with the total burn surface area. Conclusion: Burn injuries are common. The younger age group are commonly affected. There was a male preponderance. Majority of burn injuries occurred in individuals from low and middle-income settings. The most common causes were kerosine burns, petrol burns and gas burns. Flame burns were the most common followed by scalds. The mortality rate was 39.2% and it increased with the total burn surface area.
Intrathecal versus epidural morphine for analgesia following excisional haemorrhoidectomy: a comparative analysis
Background: Postoperative pain remains a significant concern in open excisional haemorrhoidectomy, especially for patients with third- and fourth-degree haemorrhoids, which are often associated with severe pain, bleeding, and other debilitating symptoms. Poorly managed postoperative pain adversely affects recovery. Aim: To compare postoperative pain scores using the Visual Analogue Scale (VAS) after the administration of intrathecal morphine versus epidural morphine, both combined with intravenous paracetamol and rectal diclofenac suppository, for pain management following open excisional haemorrhoidectomy. Methods: A prospective, randomized controlled study was conducted at the University of Port Harcourt Teaching Hospital (UPTH) over 4years on adult patients with third- or fourth-degree haemorrhoids, for open haemorrhoidectomy. The differences between the two groups were measured using Student t-test and Chi-squared test and were considered statistically significant if p< 0.05. Results: A total of sixty-six patients completed the study: 30 patients in Group A (intrathecal morphine) and 36 in Group B (epidural morphine). The mean time to a VAS score ≥ 5 cm was significantly shorter in Group A (8.3 ± 4 hours) compared to Group B (24 ± 6.8 hours), with a p-value of 0.0001. Patient satisfaction was reported by 78% of patients in Group A and by all patients (100%) in Group B (p < 0.01). Conclusion: Epidural morphine, in combination with intravenous paracetamol and rectal suppository, provided superior postoperative pain relief following haemorrhoidectomy and facilitated earlier ambulation compared to intrathecal morphine.
Effectiveveness of e-learning in the delivery of medical and dental education in a tertiary institution in Nigeria
Background: Following the gradual shift from classroom learning to more remote settings using E-learning platforms, it has, therefore, become necessary to investigate the effectiveness and perceptions of students about online learning in respect of medical and dental education. This study aims, therefore, to determine the effectiveness of e-learning in the delivery of medical and dental education. Methods: A cohort study involving two groups of final-year medical and dental students at the University of Port Harcourt was performed. One group received 30mins online lecture while the other received 30mins physical lecture and their respective performances were assessed afterwards. A self-administered questionnaire was employed to collect additional data including sociodemographic, effectiveness of e-learning, perceptions of e-learning and classroom learning, and problems associated with online learning and classroom learning. The collected data was analyzed using SPSS version 27 software for Windows. Significance level was set at p<0.05. Results: Eighty-six final-year students; 74 (86.05%) medical and 12 (13.95%) dental students participated in this study. There were 34.88% males and 65.12% females, The group that had onsite lecture had a mean performance score of 2.93 while the online cohort had a mean score of 2.15. Independent samples t-test showed a statistically significant association t(84)= 3.332, p <0.05. The classroom cohort was associated with a statistically significant more effective learning. Conclusion: On-site learning was more effective than an on-line learning. The respondents also had a better perception of learning in the classroom compared to learning on-line.
Microbial profile of infections amongst adult in-patients in selected intensive care units in Port Harcourt: a comparative study
Background: The intensive care unit should maintain a minimal presence of pathogenic organisms that could potentially lead to severe infections, particularly in an environment where numerous procedures and interventions compromise the body's normal mucosal defenses. Aim: To evaluate the prevalence and distribution of common and clinically relevant microorganisms within selected Intensive Care Units (ICUs) in Port Harcourt, Nigeria. Methods: A prospective, non-randomized study covering January 2022 to December 2024. The study sites were the intensive care units of three hospitals in Port Harcourt: namely the University of Port Harcourt Teaching Hospital (UPTH), Sterling Specialist Hospital, and Prime Medical Consultants. Clinical specimens, including blood samples, urine specimens, respiratory secretions, wound swabs, and venous catheter tips, were collected and analyzed. Data were analyzed using SPSS version 25. Results: Of the 238 specimens, 186 (78.8%) yielded positive cultures. Gram-negative bacteria (GNB) constituted 68.29% of isolates, followed by Gram-positive bacteria (23.66%) and fungi (8.06%). The most frequently isolated microorganisms were Klebsiella pneumoniae (23.12%), Escherichia coli (19.36%), Pseudomonas aeruginosa (14.52%), Proteus mirabilis (8.60%), and Enterobacter cloacae (2.69%). Among Gram-positive bacteria, methicillin-resistant Staphylococcus aureus (MRSA) accounted for 15.59% of cases, while Streptococcus species constituted 8.07%. Fungal infections accounted for 8.06% and were represented by Candida albicans (5.91%) and non-albicans Candida species (2.15%). UPTH recorded the highest microbial burden, particularly with multidrug-resistant pathogens, compared to the private hospitals. Conclusion: The study revealed a marked variation in antimicrobial resistance patterns among hospitals, with public hospital demonstrating a notably higher rate of multidrug-resistance in comparison to private hospitals.
Anaesthesia for children with ocular injuries in a tertiary hospital
Background: Eye injuries in childhood are common and an important cause of non-congenital unilateral blindness. The anaesthetic management of paediatric ocular trauma deserves the special skills of the anaesthetist to improve safety. This study determined the nature of ocular trauma and the perioperative anaesthetic management of the peculiarities of the paediatric patient with eye injury. Methods: Ophthalmic theatre registry records of surgical procedures done in the paediatric ophthalmology unit from January 1, 2017, to December 31, 2023 were reviewed. The nurses' records, case notes, and patients' anaesthetic records were examined for demographic features, nature of ocular trauma, surgical procedures, type of surgery, and others for each patient. Results: A total of 426 children presented to the unit and 139 (32.6%) had traumatic eye injury; 40 females (28.8%) and 99 males (71.2 %). Male children were over twofold more likely to suffer eye injury (p = 0.0001, OR 2.5, 95%CI = 1.65 – 3.92). The injuries were open globe (n = 97, 69.8%) or close globe (n = 23, 16.5%) and others (n=19, 13.7%). Most of the surgeries were performed under general anaesthesia (84.9%). Tracheal intubation was achieved using succinylcholine (63.6%) or non- depolarising muscle relaxants (36.4%). Few children received premedication (18.7%) and senior registrars and consultants provided care. Conclusion: Anaesthesia for paediatric ocular trauma should be conducted as specialized care by senior anaesthetists. The dilemma of a full stomach in a child with ocular trauma and the use of succinylcholine for tracheal intubation should be attended to with clinical prudence.
Post-tonsillectomy pain management in University of Port Harcourt Teaching Hospital: a comparison between suppository diclofenac and suppository acetaminophen
Background: Post-tonsillectomy pain management poses a challenge due to limited treatment options. With opioid analgesics largely contraindicated, non-opioid analgesics are mainstay of treatment. Aim: This study compared effects of diclofenac and acetaminophen suppository on post-tonsillectomy analgesia and oral intake among paediatric patients at the institution of study. Methods: This was a single blind randomized controlled study involving 60 paediatric patients undergoing tonsillectomy under GA, randomized into Groups A (diclofenac sodium suppository) and B (acetaminophen suppository) of 30 patients each for post-operative analgesia. Pain scores in both groups using the FLACC Scale 24 hours post-operatively, time to first oral intake and frequency, rescue analgesia and duration of hospital stay were monitored. Results: Patients mean age was 3.71±1.30 years. Group A had lower pain scores across all time intervals (p = 0.01). Rescue analgesia was 19(63.4%) and 27(90.0%) in Groups A and B respectively (p = 0.05). Although the difference in time to first oral intake was shorter in Group A (388.7min vs 488.7min; p = 0.33), frequency of oral intake (p = 0.01) and duration of hospital stay (p = 0.05) were better in Group A. Conclusion: Diclofenac suppository was more effective for post-tonsillectomy pain than acetaminophen suppository. Rescue analgesia requirement was high in both groups but significantly lesser in Group A. No significant difference occurred in time to first oral intake, but there was significantly better oral intake and lesser duration of hospital stay in Group A.
Copyright (c) 2025 Okechi Chibuzo Mbalaso, Olubusola Temitope Alagbe-Briggs, Opubo Benedict da Lilly-Tariah (Author) https://creativecommons.org/licenses/by-nc-sa/4.0
Severe malaria associated acute respiratory distress syndrome: a case report
Background: Severe malaria is known to have multisystemic effects involving the brain, the kidneys, and occasionally the lungs, causing acute lung injury and, a part of the spectrum, acute respiratory distress syndrome. Aim: To report a case of severe malaria associated with acute respiratory distress syndrome in a Nigerian teenager. Methods: Electronic medical records at the emergency unit, the female ward, and the intensive care unit provided all the details about the patient’s clinical course for this report. Case Report: A 15-year-old girl presented to the A&E with a fever and vague abdominal pain. Malaria parasite test was negative. Urinary tract infection was suspected, empirical antibiotics were initiated, with little relief. The fever persisted and a repeat malaria test on the second day was positive. Oral antimalarial medication was administered on an outpatient basis. She represented later the same day with fever and respiratory distress. Laboratory test showed thrombocytopaenia. Chest radiograph showed bilateral lung infiltrates. Antibiotics were continued, and oxygen supplementation with no relief. The next day, dyspnoea worsened, with severe hypoxaemia. This necessitated intensive care unit admission. Non-invasive mechanical ventilation (continuous positive airway pressure ventilation) and parenteral artesunate were initiated and given for four days with full recovery. Conclusion: Severe malaria from plasmodium falciparum with associated acute respiratory distress syndrome (ARDS) can occur with high morbidity and mortality. This necessitates prompt recognition, intervention, and early intensive care unit admission, initiation of continuous positive airway pressure ventilation (CPAP), and intravenous antimalarial treatment for a good outcome.
Safety and satisfaction level of magnesium sulphate following two routes of administration for the prevention of postoperative sore throat
Background: Tracheal intubation for general anaesthesia can be associated with distressing postoperative sore throat (POST). Different pharmacological agents via different routes have been studied for its prevention, but few studies have focused on the acceptability and safety of agents employed. This study compared the safety profile with use of intravenous and nebulised magnesium sulphate (MgSO4), as well as patients’ satisfaction level. Methods: Eighty-four patients were randomized into three groups. Group I patients were nebulised with 3mls of normal saline (NS) and received 30mg/kg of IV MgSO4 in 50mls of NS. Group II patients were nebulised with 225mg (3mls) of isotonic MgSO4 and infused with 50mls of NS. Patients in group III were nebulised with 3mls of NS and infused with 50mls of NS.. Incidence of POST was assessed using a four-point scale proposed by Stout et al. The safety of MgSO4 was assessed by measuring serum magnesium levels, and Likert scale was used to assess satisfaction levels following use of study medication. Data were analysed using SPSSv22. Results: There were 84 patients with mean age of 35.2 years. Overall incidence of POST was 30.1%. Although the serum magnesium level was statistically higher among group I patients (p <0.01), all the patients in this study had serum magnesium level within the normal limit. No patient expressed dissatisfaction with the use of MgSO4. Conclusion: Magnesium sulphate, administered intravenously or by nebulisation, is effective in reducing postoperative sore throat. Patients expressed satisfaction and there was no significant rise in serum magnesium levels detected.
Clinical experience with electrolyte flux after transurethral resection of the prostate (TURP) in selected private clinics in Port Harcourt Nigeria
Background: As men age towards the fifth decade, the prostate enlarges and occasionally could become a source of urinary tract obstruction requiring advanced technology with attendant risks to relieve obstruction. Aim: To study the electrolyte changes in patients presenting for TURP. Methods: A cross-sectional and descriptive design, conducted at selected private hospitals with standard endourology services in PortHarcourt between June 5, 2018, to June 30, 2024. Adult males aged ≥47 years with prostate volumes ≥ 80 grams, scheduled for monopolar Transurethral Resection of the Prostate (TURP) were recruited. Data were retrieved retrospectively from theatre register, patients’ files, laboratory and ward registers. Demographic variables, preoperative and postoperative electrolyte values, resection time, total volume of water consumed were retrieved. A sample size of 246 patients was determined using the Cochrane formula for estimating a single population proportion. Data analysis was performed using IBM SPSS Statistics version 20.1. Results: Two hundred and forty-six patient records were analysed with 165 having complete data representing 67.07%. The mean age was 69 ± 5.0 years. Range 47-92 years. The Mean volume of water used was 35± 2.3litres and the duration of resection was 90±3.4 mins. Hyponatremia was noticed in 30(18.2%) postoperatively and clinically presented as Nausea, vomiting, hypoxaemia and restlessness. Duration of resection, increased volume of irrigation fluid were risk factors. Managed with 3% sodium chloride, sodium bicarbonate and normal saline. Conclusion: Hyponatremia is a common complication of TURP with monopolar resection using water or glycine. It is imperative to measure electrolyte level before and after TURP.
Surgical case cancellation in a tertiary hospital in Yenagoa, Nigeria
Background: The efficiency of patient care in an operating theatre and by extension the hospital can be assessed by examining the rate of cancellation of surgical procedures. Case cancellation may significantly decrease the quality of healthcare delivery and reduce the income generated while increasing hospital running costs. There is also a significant impact on the patient and family. Aim: This study was carried out in our centre to identify the case cancellation rate, factors responsible for and associated with such cancellations and suggest mitigating measures. Methods: A hospital-based cross-sectional study of surgical case cancellations carried out over a 6-month period at a tertiary hospital in Nigeria. Case notes and theatre records of patients booked for elective and emergency procedures over the study period were utilized. A standardized data form was used, with retrieved data entered into Microsoft Excel and exported to IBM Statistical Package for Social Sciences (SPSS) version 21 for analysis. Results: Three hundred and thirty-four cases were recorded in this 6-month period. Two hundred and fifty two (75.4%) were elective procedures while eighty two (24.6%) were emergencies. The average case cancellation rate was 26.2%. Fifty percent of case cancellation reasons were patient-related. The most common patient-related cause was unfitness for surgery (46.1%). Hospital-related factors accounted for 28.01% of cancellations. Conclusion: Cancellation of surgical cases remains one of the most important challenges facing a hospital surgical service. Financial constraints encountered by patients can be relieved by the expansion and modification of government health insurance schemes. Hospitals are encouraged to periodically identify factors causing cancellations and solve them.
Patients’ preference for different tonometers in a tertiary ophthalmic clinic
Background: Intraocular pressure measurement is a routine examination in the Eye clinic, and it is essential in the management of glaucoma. Aim: To assess the preference of patients for three different types of tonometers used at the Eye clinic of the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. Methods: This was a comparative cross-sectional study of adults 18 years and older. Their intraocular pressure (IOP) was measured using Perkins applanation tonometer (PAT), Pulsair non-contact tonometer (NCT) and iCare rebound tonometer (RBT). Their preferred tonometer and reasons for their choices were elicited. Results: There were 69 (75%) male and 23 (25%) female respondents in the study. The mean age was 38.84±13.34 years, with an age range of 18 - 71years. Majority of participants preferred the NCT (43.4%, 40), followed by PAT (31.5%, 29 while the RBT (20.7%,19) was the least favourite instrument and 4.4% of participants had no preference. There was a statistically significant difference in the preference of the three tonometers, P value = 0.004 (<0.05). With the iCare, most participants preferred it for the following reasons - no pain or discomfort (n=5; 26.3% each) and no eye drops (26.3%). With the NCT, the reasons given were speed (n=7; 17.5%), no pain (37.5%) and no eye drops (10%). For the PAT, the commonest reason for preference was no pain (65.5%). Conclusion: Majority of the participants in this study preferred the NCT, followed by the PAT and RBT tonometers respectively.