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   Table of Contents - Current issue
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July 2020
Volume 23 | Issue 7
Page Nos. 889-1032

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REVIEW ARTICLE  

Iron deficiency anemia in pregnancy in Nigeria—A systematic review Highly accessed article p. 889
NI Ugwu, CJ Uneke
DOI:10.4103/njcp.njcp_197_19  
Anemia in pregnancy is a public health problem in Nigeria and it is more than likely that iron deficiency is the major cause. This study aimed to review relevant publications in order to summarize the prevalence of iron deficiency anemia, risk factors associated with iron deficiency, anemia in pregnancy as well as factors associated with compliance to routine iron therapy. MEDLINE Entrez PubMed search was performed in August 2017 and studies that investigated iron deficiency anemia in pregnancy in Nigeria from 1968 to 2017 were sought. Search keywords included “iron deficiency anemia, pregnancy, Nigeria.” Only studies that provided information on the prevalence of iron deficiency anemia, risk factors associated with iron deficiency anemia and risk factors associated with compliance to routine iron therapy in pregnancy in Nigeria were eligible and were selected. Inclusion criteria were original scientific investigations, not reviews, studies conducted in Nigeria between 1968 and 2017 and studies written in the English language. A total of six relevant studies that fulfilled the study inclusion criteria were identified out of 36 studies found. All the studies reported a high prevalence of iron deficiency anemia among pregnant women and risk factors associated with iron deficiency anemia in pregnancy include multiparity, third trimester of pregnancy, and low socioeconomic status. Risk factors associated with noncompliance to routine iron therapy include poor utilization of antenatal services, low educational attainment, distance to a health facility, single or teenage pregnancy, increasing age of the pregnant women, and living in the rural areas. The prevalence of iron deficiency anemia among pregnant women was reported to be high. Awareness creation and education on the importance of family planning and proper utilization of antenatal care services should be encouraged. There should be economic empowerment of women, provision of health facilities to areas where they are absent to encourage early booking and utilization of antenatal care services.
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ORIGINAL ARTICLES Top

Comparison between mesh fixation and non-fixation in patients undergoing total extraperitoneal inguinal hernia repair p. 897
A Acar, I Kabak, HK Tolan, T Canbak
DOI:10.4103/njcp.njcp_398_19  
Background: The most important advantages of laparoscopic hernia repair include less postoperative pain, good cosmetic results, and early return to daily activities. Different methods and mesh types are used in inguinal hernia repair. Aims: The objective of this study was to evaluate the complications and recurrence rates in patients who underwent laparoscopic inguinal hernia repair with and without mesh fixation. Subjects and Methods: A total of 183 patients who underwent total extraperitoneal (TEP) inguinal hernia repair in the general surgery clinic between January 2012 and January 2015 patients operated due to inguinoscrotal hernia and those lost to follow-up were excluded from the study. Patients were divided into two groups. Group 1 consisted of patients in whom 3D (Bard 3D Max) mesh was used and fixed with symphysis pubis absorbable tucker, while group 2 included patients without mesh fixation. All statistical analyses were performed using SPSS 22.0 statistical package software. The differences were considered statistically significant if the P value was less than 0.05. Results: In the study, 178 patients were included. The median age was 48 years. Of all patients, 98 had right-sided, 72 left-sided, and eight bilateral hernias. The mean follow-up duration was 45 months. The demographic data between the groups were similar. Operation time was 51.82 ± 18.87 min in group 1 and 52 ± 19.92 in group 2 (P = 0.089). No statistically significant difference was found between both groups in terms of the development of early and late complications. Intraoperative complications, port-site hernia, and mortality were not seen in any patient. Conclusion: TEP seems to be a safe and effective surgical approach in inguinal hernia treatment with acceptable operation times and postoperative results. It was determined that not performing mesh fixation in the TEP application did not cause a statistical increase in morbidity and recurrence rates.
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The effect of different mouthwashes on bacteremia after debonding p. 900
Y Akbulut
DOI:10.4103/njcp.njcp_664_19  
Objectives: This study aims to investigate the effects of various mouthwashes on bacteremia development following a debonding process, which is performed after orthodontic treatment. Subjects and Methods: The study included patients who received fixed orthodontic treatment and were indicated for debonding. A total of 40 patients in four groups were selected for the study; no mouthwash (Group 1), mouthwash containing 0.12% chlorhexidine-gluconate (Group 2), mouthwash containing essential-oils (Group 3), and mouthwash containing 7.5% povidone-iodine (Group 4). Before (T0) and following (T1) the debonding procedure, blood samples were obtained from the patients. Then, the blood samples were placed in blood culture bottles to investigate bacterial growth. Results: Based on the results of the study, it was determined that the blood samples obtained at T0did not indicate any bacterial growth. Furthermore, it was observed that the blood samples obtained at T1included Streptococcus viridans, Streptococcus oralis, Streptococcus mutans, and Staphylococcus aereus growth, respectively, in 4 patients from Group 1 while Streptococcus salivarius growth was observed in 1 patient from Group 3 in addition to Streptococcus mitis growth in 1 patient from Group 4. No bacterial growth was observed in Group 2. While the results obtained between Group 1 and Group 2 were statistically significant, no statistically significant difference was observed between other groups. Conclusions: Finally, it was determined that the mouthwash 0.12% chlorhexidine-gluconate was statistically significant in comparison to the control group. It can be concluded that this mouthwash can be used to decrease bacterial density in oral flora before debonding procedures.
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Assessment of health-related quality of life of chronic kidney disease patients in aminu kano teaching hospital, Kano p. 906
BL Ademola, PN Obiagwu, A Aliyu
DOI:10.4103/njcp.njcp_589_19  
Background: The prevalence of chronic kidney disease (CKD) is increasing globally. Recently, the concept of Health-Related Quality of Life (HRQOL) is receiving attention as a measure of treatment outcome in addition to traditional morbidity and mortality rates. Objective: To assess the HRQOL of CKD patients stages 1-5 using the Kidney Disease Quality of Life questionnaire (KDQOL). Methodology: The study was a cross-sectional study of CKD patients at a teaching hospital in north-western Nigeria during the study period. The quality of life, sociodemographic, clinical, and laboratory variables were assessed using a pro forma and the KDQOL questionnaire during regular clinic visits/dialysis sessions. Age and sex-matched healthy volunteers without evidence of renal disease were recruited from the hospital environment into a comparison group. Results: A total of 150 subjects with CKD and 150 individuals in the comparison group completed the study with 77 males and 73 females for both groups. The mean ± standard deviation (SD) ages of the CKD and comparison group was 52.83 ± 14.21 and 52.43 ± 14.50 years, respectively. Subjects in the comparison group had higher physical composite summary (PCS) and mental composite summary (MCS) scores than individuals with CKD (P value < 0.05). Subjects with CKD showed a progressive decline in the scores of all HRQOL domains with advancing CKD stages (P value < 0.05). Conclusions: The results suggest that subjects with CKD have worse HRQOL domain scores when compared to the normal population and these scores progressively worsened with advancing CKD stages.
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Molecular analysis and genotyping of methicillin-resistant Staphylococcus aureus strains isolated from different clinical sources p. 912
MU Sogut, B Bas, M Bilgin, MG Sezener, A Findik
DOI:10.4103/njcp.njcp_88_19  
Background: Investigating genetic relatedness between methicillin-resistant Staphylococcus aureus (MRSA) strains from humans and different animal species may clarify the epidemiological characteristic of MRSA infections together. Aim: The aim of the study was to perform genotypic characterization and type strains of MRSA isolated from different clinical sources, by molecular techniques. Materials and Methods: The molecular characterization of the strains was performed by polymerase chain reaction (PCR), using several specific oligonucleotides. These were as follows: S. aureus species-specific sau gene, mecA gene coding PBP2a responsible for methicillin resistance, femA gene coding for a protein, which influences the level of methicillin resistance of S. aureus, and is universally present in all MRSA strains; spa gene coding for protein A; coa gene coding for coagulase, and blaZ gene coding for the production of beta-lactamase. To determine the genetic diversity of these strains, random amplified polymorphic DNA–polymerase chain reaction (RAPD-PCR) was performed. Results: Among the 415 S. aureus strains, 61 were phenotypically identified as MRSA, and confirmed as S. aureus by amplification of sau gene. However, 90.16% of the strains were mecA positive, while all were negative for femA gene. The presence and polymorphism of coa and spa genes were investigated and 83.60% and 18.03% strains were positive for coa and spa, respectively. While these strains were grouped into six coa-types by PCR, no polymorphism was found for spa gene among strains having only single 190 bp of the band. bla genes were found in 75.40% of strains. These strains were divided into 12 RAPD types. Conclusions: The results showed the relatively high heterogeneity and variation of coa gene among MRSA strains, while further studies on sequencing of these strains may identify which sequence type is predominant in this region.
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A situational report on low vision services in tertiary hospitals in South-East Nigeria p. 919
HI Monye, F Kyari, RO Momoh
DOI:10.4103/njcp.njcp_375_19  
Background: The prevalence of functional low vision in southeast Nigeria is reportedly the highest in the country. Aim: This study evaluated the state of low vision services and perceptions of providers and users of the service in tertiary hospitals in the region, to facilitate advocacy and planning. Methods: This was a cross-sectional survey of available low vision services in the nine tertiary hospitals in Southeast Nigeria utilizing mixed methods. Data were collected on human resources, service delivery, and low vision equipment and devices. In-depth interviews were conducted to determine the perceptions of providers and users of the service. Results: Varying levels of low vision services were actively provided in three of the nine hospitals surveyed. Services, equipment, and devices were suboptimally available. The three functional centers had a combined output of 61 patients seen within 6 months preceding the study and had at most two-thirds of required equipment. Low vision devices (LVDs) were available in varying degrees in only four (44%) of the hospitals. Twenty-one (7.6%) of the 278 eye care personnel had some low vision training across seven hospitals. The challenges highlighted by providers were mainly inadequate funding (infrastructure, training, and equipment), communication gaps, and bureaucracy. Poor awareness, affordability, acceptability, and accessibility of LVDs were major constraints for users. Conclusion: Low vision services are available in some tertiary facilities in southeast Nigeria. Improved funding and better awareness of the availability of low vision services by eye care providers and the general public are needed to strengthen services.
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Effects of short inter-pregnancy interval on maternal and perinatal outcomes: A cohort study of pregnant women in a low-income country p. 928
CC Onwuka, EO Ugwu, SN Obi, CI Onwuka, CC Dim, GU Eleje, EC Ezugwu, PU Agu, UI Nwagha, BC Ozumba
DOI:10.4103/njcp.njcp_423_19  
Background: Short inter-pregnancy interval (IPI) is a potential risk factor for adverse pregnancy outcomes. Previous reports from sub-Sahara Africa documented increasing incidence of short IPI but evidence is lacking in its effect on pregnancy outcome. Aim: The study aimed to determine the effect of short IPI on pregnancy outcome in Nigeria. Subjects and Methods: It was a prospective cohort study of 271 pregnant women receiving antenatal care in a tertiary hospital in Nigeria. For every eligible woman with short IPI (<18 months) recruited; a suitable control with IPI ≥18 months was selected. Statistical analysis was both inferential and descriptive using the statistical package for social sciences version 24 (SPSS Inc. Chicago, Illinois, USA) for windows. A P value of less than 0.05 was considered statistically significant. Results: Incidence of maternal anemia was higher in women with short IPI than control (RR: 2.091; 95% CI: 1.4433.031; P < 0.001). Other maternal and perinatal outcome measures including premature rupture of membranes, preterm labor/delivery, pregnancy induced hypertension, third trimester bleeding, postpartum hemorrhage, and inadequate gestational weight gain did not show any significant association with short IPI (P > 0.05). Conclusion: Short IPI is associated with anemia in pregnancy in Nigeria. Public health campaigns for improvement in uptake of family planning services and breastfeeding may help reduce the incidence of short IPI and anemia in low income countries.
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Subjective and objective evaluation of pain for older adults with knee osteoarthritis in Saudi Arabia: A reliability study p. 934
K Alahmari, SP Silvian, I Ahmad, RS Reddy, VN Kakaraparthi
DOI:10.4103/njcp.njcp_270_19  
Aims: This study establishes the reliability and validity of pain pressure threshold (PPT) in evaluating pain for older adults with knee arthritis, and explores the importance of using a standard tool to measure pain in older adults. Methods: The study consisted of a group of 31 older adult patients with bilateral symptomatic knee osteoarthritis, intra- and inter-rater reliability, and concurrent validity that were assessed for PPT and were compared with standard visual analogue scale (VAS). Physical therapy intervention was provided to combat the pain. Results: The PPT showed excellent intra-assessor reliability by not only meeting acceptable standards but also representing very high values. The intra-assessor reliability between test sessions was excellent. The inter-assessor agreement was also very high before treatment. The highest ICC showed very good agreement (0.860) during the initial treatment for pain pressure measurement. The study also established concurrent validity of VAS and PPT (before treatment and after treatment), where the rho correlation was high (-0.708 and -0.625) and significant, indicating that PPT is adequately sensitive for detecting changes over time. Conclusion: PPT is a reliable and valid tool for measuring pain, and it helps clinicians understand the prognostic effect of the intervention, especially in older adults. The tool is consistent at measuring pain and is a valid tool compared to subjective pain scoring.
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Population-based prevalence and associated risk factors of hypertension among adults in Benue State, Nigeria p. 944
D Osunkwo, A Mohammed, M Kamateeka, P Nguku, CD Umeokonkwo, OS Abolade, M Ibrahim, K Ibrahim, H Nwokeukwu, AI Zoakah
DOI:10.4103/njcp.njcp_354_19  
Background: The increasing prevalence of hypertension in low- and middle-income countries is associated with increased morbidity and mortality. Aim: To determine the prevalence of hypertension and associated risk factors in Benin state, Nigeria. Materials and Methods: A population-based cross-sectional study was conducted among 1265 adults selected by multistage sampling technique. The World Health Organization (WHO) STEPwise approach was used to collect data. Data were analyzed using Statistical Package for the Social Sciences (SPSS) software program, version 23.0 (IBM). We estimated prevalence and odds of hypertension at 5% level of significance. Results: The prevalence of hypertension was 35.6%. The odds of hypertension was higher among age 30–39 (aOR: 2.0; 95% CI: 1.3–3.1) compared to age 18–29 years, males (aOR: 1.4; 95% CI: 1.1–2.0) compared to females, overweight (aOR: 2.3; 95%CI: 1.6–3.2), and obesity (aOR: 4.9; 95%CI: 3.2–7.7) compared to normal weight, and high cholesterol (aOR: 1.6; 95% CI: 1.1–2.3) compared to normal cholesterol. Conclusion: The prevalence of hypertension was high among young adults in Benue State. The associated risk factors for hypertension were age, sex, overweight, obesity, and high total cholesterol.
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Evaluating efficacy of different post materials and lengths on bonding strength between root canal dentin and post restorations: An experimental study p. 950
M Ulgey, R Zan, O Gorler, G Yesilyurt, F Cotur
DOI:10.4103/njcp.njcp_481_19  
Background: During post restoration, different root structures require several types of posts to increase duration of their clinical use. Several materials have been investigated to enhance their quality and optimize their length according to the available root canal. Aims: The aim of this study was to determine the effect of zirconia, fiber, and ceromer posts with 3- and 6-mm post sizes on the bonding strength of them to root canal dentinal wall with the means of pull-out bond strength test. Methods: Forty-eight single-rooted mandibular human premolar teeth were collected and prepared for this in vitro study. With resin cement, 3- and 6-mm study posts including zirconia, fiber, and ceromer were luted to prepare teeth. For the retention testing, the pull-out force was applied to each specimen parallel to longitudinal axis of both the post and tooth. Results: Both type of materials and size of posts changed the value of bonding strength. In all the post types, 6-mm ones performed better. Overall, the best bonding strength was obtained with fiber posts and the better bonding strength was obtained with zirconia; however, ceromer provided the least bonding strength. Conclusion: Current experiments supported that 6-mm post size can increase the bonding between root canal dentin and studied posts. When considering post materials, fiber provided the best bonding strength in current laboratory setup. Second, zirconia had meaningfully acceptable bonding strength; however, the bonding strength of ceromer posts was not favorable. Further studies optimizing post fabrication techniques of root materials may increase the bonding strength of posts to human dentin to an acceptable clinical degree.
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Effect of surface characteristic of different restorative materials containing glass ionomer on Streptococcus mutans biofilm p. 957
OS Kelten, OK Hepdeniz, Y Tuncer, DA Kankaya, O Gurdal
DOI:10.4103/njcp.njcp_538_19  
Aim: The aims of this study were to evaluate the surface morphology and surface roughness of restorative materials containing glass ionomer, analyze Streptococcus mutans biofilm formation on the surface of materials, and determine the correlation between surface roughness and biofilm. Materials and Methods: Four restorative materials: resin-modified glass ionomer; giomer; amalgomer; and glass carbomer were used and for each material, 6 mm in diameter and 2 mm in thickness disc-shaped specimens were prepared to evaluate the surface morphology (n = 3), surface roughness (n = 16), and biofilm (n = 20). Surface morphology was analyzed with a scanning electron microscope. Surface roughness was evaluated via an atomic force microscope. The biofilm was evaluated by counting the colony-forming units. Surface roughness measurements were evaluated using a one-way analysis of variance and Tukey HSD test. Biofilm parameters were analyzed using the Kruskal-Wallis H and Mann-Whitney U test. Pearson's correlation test was used to determine the correlation between surface roughness and biofilm. Results: While the highest roughness values were obtained for amalgomer and glass carbomer, the lowest roughness values belonged to giomer and resin-modified glass ionomer. Statistically significant differences in the number of adherent bacteria were observed between the materials only on day 1. No statistically significant correlation was determined between surface roughness and biofilm. Conclusions: The resin content and small filler particle size of material positively affect surface roughness. However, there is no direct relationship between surface roughness and biofilm.
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Cancellation of elective surgical cases in a nigerian teaching hospital: Frequency and reasons Highly accessed article p. 965
CJ Okeke, AO Obi, KH Tijani, UE Eni, CO Okorie
DOI:10.4103/njcp.njcp_650_19  
Background: Dwindling economic resources and reduced manpower in the health sector require efficient use of the available resources. Day of surgery cancellation has far reaching consequences on the patients and the theatre staff involved. Full use of the theatre space should be pursued by every theatre user. Objective: The study aimed to report on the rates and causes of day of surgery cancellation of elective surgical cases in our hospital as a means towards proffering solutions. Materials and Methods: It was a retrospective study of all elective cases that were booked over a 15-month period from January 2016 to March 2017. Cancellation was said to have occurred when the planned surgery did not take place on the proposed day of surgery. Cancellations were categorized into patient-related, surgeon-related, hospital-related and anesthetist-related. Reasons for the cancellations were documented. Data were analyzed using Statistical Package for the Social Sciences (SPSS) software program, version 22. Variables were compared using Chi-square tests. A value of P < 0.05 was considered statistically significant. Results: During the 15-month period, a total of 1296 elective surgeries were booked. Of this, 118 (9.1%) cases were cancelled. Patient-related factor was the most common reason (47.5%) followed by surgeon-related factor (28%). Lack of funds was the most common patient related-reason for cancellation. Majority of the cancelled cases were general surgical cases (36.4%) followed by orthopedics (25.4%) and urology (11%). Seventy percent of the cancelled cases were first and second on the elective list. Conclusion: The cancellation rate in this study is high. The reasons for these cancellations are preventable. To ensure effective use of the theatre, efforts should be made to tackle these reasons.
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Prevalence and pattern of skin diseases in patients with diabetes mellitus at a tertiary hospital in Northern Nigeria p. 970
H Sani, AB Abubakar, AG Bakari
DOI:10.4103/njcp.njcp_95_19  
Background: Diabetes mellitus is one of the most common metabolic disorders with a rising prevalence. It cuts across all ages and socioeconomic status. Various skin lesions are frequently observed in diabetic patients. Aims: This study was carried out to determine the prevalence, pattern, and determinants of skin diseases in diabetic patients at the Barau Dikko Teaching Hospital, Kaduna, North West Nigeria. Materials and Methods: One hundred consecutive diabetic patients attending the clinic were included in the study. Results: Many of the patients had more than one skin condition at a time. The most prevalent skin diseases were idiopathic guttate hypomelanosis which was seen in 61% of patients, infections from fungal, bacterial, and viral causes occurred in 30% of patients, other skin disorders were diabetic dermopathy seen in 17% of patients, palmoplantar hyperpigmentation was seen in 13% of patients, while pruritus occurred in 12% of patients and xerosis was seen in 10% of patients. Conclusion: Skin disorders are common among diabetic patients at Barau Dikko Teaching Hospital, Kaduna, North West Nigeria.
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Preoperative appendix diameter obtained by computerized tomography scanning predicts conversion from laparoscopic to open appendectomy p. 975
OM Akturk, M Cakir, D Yildirim, YM Vardar, S Ozdemir, M Akinci
DOI:10.4103/njcp.njcp_360_19  
Background: Open appendectomy (OA) has been the gold standard for a long time. Laparoscopic appendectomy (LA) has gained wide acceptance and popularity, outdoing open approach. Yet, conversion may be required when laparoscopic approach fails. Aims: To predict conversion from laparoscopic appendectomy to open appendectomy sing Oreo-ratio radiological appendices diameter. Materials and Methods: This is a retrospective cohort study conducted on 320 (included) patients who underwent appendectomy between January 2018 and August 2018 in the General Surgery departmentof Haseki Training and Research Hospital, Istanbul, Turkey. Appendiceal diameter obtained during preoperative radiological screening was evaluated about its relationship to conversion from LA to OA. Age, sex, inflammatory serum parameters and pathology reports were also investigated. Results: A total of 269 (84%) cases were started LA and 17 (6,3%) laparoscopic cases were converted to open. The appendix diameter, the grade of inflammation (perforated or gangrenous), age, and c-reactive protein (CRP) were found to have significant importance in conversion, P = 0.003, P = 0.000, P = 0.042, and P = 0.018, respectively. When a cutoff of 50 years was chosen for age, the odds ratio (OR) was 3. For the appendiceal diameter of 14 mm, the OR was 3.0286. Conclusion: Preoperative evaluation of appendix diameter is a quick and useful method for a surgeon to distinguish cases with risk of conversion in the emergency department. The other risk factors associated with conversion of LA to OA are grade of inflammation, age and CRP levels.
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Improved survival and survival without bronchopulmonary dysplasia in very low birth weight infants after active perinatal care p. 980
T Zhang, J Chen, H Wu, W Pan, X Yang, Y Li, M Liu, Y Huang
DOI:10.4103/njcp.njcp_533_19  
Background: Perinatal and neonatal care for very low birth weight (VLBW) infants have changed significantly during the past two decades. However, it is unclear how these changes have affected neonatal mortality and morbidity in developing countries. Objectives: The aim of this study was to investigate the impact of the advanced neonatal care on short-term outcomes of VLBW infants. Methods: A retrospective study was performed to compare the mortality and morbidity of VLBW infants between period I (2007-2011) and period II (2012-2016) in our unit. Results: A total of 188 infants in period I and 214 infants in period II were evaluated. The overall in-hospital mortality for VLBW infants dropped from 26.1% in period I to 13.1% in period II. The incidence of birth asphyxia decreased significantly during period II (10.1% [period I] vs 3.7% [period II]). The rate of nasal continuous positive airway pressure (NCPAP) use (69.8% vs 87.1%) and the duration of NCPAP therapy (median: 3 days [period I] vs 5 days [period II]) increased significantly, while the proportion of infants treated with mechanical ventilation and the duration of mechanical ventilation significantly decreased. There was a significant increase in the proportion of survivors without major neonatal morbidity, mainly due to a significant increase in the incidence of survival without bronchopulmonary dysplasia (BPD) (72.7% vs 82.8%). In contrast, the incidence of late-onset sepsis increased significantly during period II (7.9% vs 19.4%). Conclusions: Active perinatal care is associated with improvements in survival and survival free of BPD for VLBW infants. However, late-onset sepsis is still a major concern.
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Managerial competencies-A survey of healthcare managers in a tertiary hospital in Calabar, South-South Nigeria p. 988
U Okonkwo, B Ekpeyoung, A Ndep, G Nja
DOI:10.4103/njcp.njcp_667_19  
Background: Tertiary hospitals are specialized institutions that provide managed care for patients. It has been shown that the productivity of any organization/institution is as good as the performance of its managers. Aim: This study assessed the management knowledge of Healthcare Managers in a tertiary hospital in Calabar, Nigeria. Methodology: This was a descriptive cross-sectional study that employed a structured questionnaire (adapted from the Health Leadership Alliance competency directory). Data were analyzed using SPSS version 20. Results: A total of 266 managers were included in this studywith a M: F ratio of 1.3:1. The knowledge rating of role of non-clinical professionals, regulatory agency standards, preparation of business communication, change process management and policy formulation and analysis varied significantly among the three levels of management (p < 0.05). Less than 50% of operational and middle managers rated themselves as experts in all the competency domains while majority (80%) of strategic managers rated themselves as more than proficient in most of the competency items. Conclusion: There is inadequate managerial knowledge at all levels of management in a typical tertiary hospital in Nigeria with the potential to impact negatively on quality healthcare delivery.
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Emigration plans after graduation of clinical medical students of ebonyi state university Abakaliki, Nigeria: Implications for policy p. 995
EN Ossai, AF Una, RC Onyenakazi, EU Nwonwu
DOI:10.4103/njcp.njcp_705_19  
Objective: To determine the emigration plans after graduation of clinical medical students of Ebonyi State University Abakaliki, Nigeria. Methods: A descriptive cross-sectional study design was used. All clinical medical students of the University willing to participate were included. Information was obtained using a pre-tested self-administered questionnaire. Outcome measure included proportion of students willing to emigrate and those willing to practice in rural areas after graduation. Results: A total of 285 students participated in the study, (response rate, 92.5%). Majority, 93.3% intend to pursue specialist training after graduation. Minor proportion, 13.9% intend to specialize in Nigeria, whereas 74.4% prefer to specialize outside Nigeria. Major reasons for preferring specialist training abroad included good equipment/facilities, 33.8%, better remuneration/quality of life, 27.8%; and improved skills, 18.7%. Countries of interest for training outside Nigeria included Canada, 28.3%; United Kingdom, 23.2%; and the United States of America, 18.2%. Minor proportion, 17.2% intend to practice in rural area after graduation. Predictors of willingness to emigrate included being in 400 level class, (adjusted odds ratio (AOR) =2.0, 95% CI = 1.1–4.1), being single, AOR = 4.0, 95% CI = 1.2–13.3) and having decided on specialty of choice, (AOR = 2.6, 95% CI = 1.5–4.5). Predictors of willingness to serve in rural area included family residence in urban area, (AOR = 0.2, 95% CI = 0.2–0.8) and intention to specialize in Nigeria, (AOR = 3.7, 95% CI = 1.6–8.5). Conclusions: Majority of students intend to pursue specialist training and prefer training abroad. Minor proportions were willing to specialize in Nigeria and serve in rural areas. The students may have perceived medical practice in Nigeria as serving in rural areas hence students willing to work in rural areas were more likely to specialize in Nigeria. This may adversely affect health service delivery in Nigeria if left unchecked. Nigerian authorities should ensure that medical graduates willing to practice in Nigeria are not deterred. Also, plans to encourage doctors to practice in Nigeria should receive desired attention.
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Ultrasound evaluation of testicular vein diameter in suspected cases of varicocele: Comparison of measurements in supine and upright positions p. 1004
UR Ebubedike, SU Enukegwu, AM Nwofor
DOI:10.4103/njcp.njcp_579_19  
Background: Scrotal ultrasonography has high sensitivity in the detection of intra-scrotal abnormalities. Various ultrasonographic parameters such as the spermatic cord diameter, venous diameter, and venous retrograde flow in either supine or upright positions with or without Valsalva maneuver have been investigated to assess patients suspected of having varicocele. Aims: This study aimed at comparing testicular vein diameter in supine and upright positions using ultrasonography. Methodology: This is a prospective multicenter study conducted between September 2018 and June 2019. Eighty-two consenting suspected cases of varicocele, 20 years and above, referred for scrotal ultrasonography were included in this study. Results: The study population had a mean age of 42.9 + 14.89 (SD) with a range of 20–96 years. The highest number of participants fell within the age range of 30–39 years 23 (28%). Varicocele was demonstrated in 96.3% of the patients. More patients showed sonographic evidence of varicocele in the upright position, on the right 50 (61%) as well as left 50 (61%). Bilateral varicocele had a higher frequency in the upright position 45 (54.9%), while supine was 23 (28%). Upright position had the widest diameter in 72% of participants on the right and 82% on the left. The upright position also showed higher average vein diameter of 2.6 mm and 2.9 mm on the right and left, respectively, while it was 2.2 mm and 2.3 mm for right and left in the supine position. Conclusion: The upright position is more predictive of varicocele in scrotal ultrasound examination for suspected cases of varicocele. We recommend an upright position where one position is to be used.
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Laboratory results and clinical findings of children with hydatid cyst disease p. 1008
T Tartar, U Bakal, M Sarac, A Kazez
DOI:10.4103/njcp.njcp_531_19  
Objectives: The relationship hydatid cyst (HC) is a parasitic disease that is endemic worldwide. Aims: To study the clinical findings and laboratory results of patients with hydatid disease. Materials and Methods: Total number of patients (n = 78) who underwent surgery for HC disease from 2000 to 2017 were retrospectively evaluated. The patients' demographic characteristics, reasons for admission into hospital, lesion location and size, laboratory results, and complications were recorded. Results: Of the HCs, 59% and 26.9% were located in the liver and lungs, respectively. The rate of multiple organ involvement was 10.3%. A total of 16 (20.5%) cases had ruptured HCs (7 livers, 7 lungs, 1 spleen, and 1 omentum). There was no significant difference in the rate of eosinophilia between patients with and without cyst rupture (P = 0.9). Indirect hemagglutination (IHA) tests yielded negative results in 38.9% of the patients; among them, 32.1% had ruptured HCs. A negative IHA test result was significantly associated with rupture (P = 0.046). No significant difference between rupture and cyst size or location was found. Conclusions: HC rupture was not correlated with cyst size. The sensitivity of serological tests and the blood eosinophil count was low, even in cases of ruptured HCs. The recurrence rate can be reduced by open surgery and medical treatments.
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The morphometric analysis of the male cadaveric native knees of the ethnic igbos of South East Nigeria and its implication in total knee replacement p. 1013
AU Katchy, AU Agu, E Esom, IT Ikele, MA Okeke, AU Ugwu
DOI:10.4103/njcp.njcp_700_19  
Background: In spite of its consideration as a very successful procedure nearly all total knee replacement (TKR) prostheses were designed based on the parameters of male 4,Western, and primarily white native knees. Mismatch between prosthesis and bone surface or malposition can lead to poor outcome of TKR. Aim: To determine the parameters of the native knee of the ethnic Igbos of South East Nigeria, determine any correlations amongst them ,compare the values with that of other populations and discuss its implication in total knee replacement. Materials and Method: The study was carried out on male adult cadavers with normal knees found at the museum of the Department of Anatomy University of Nigeria and all cadavers whose knees were deformed or had any pathological condition were excluded from the study. There were 60 knees from 30 male cadavers. Measurements were taken independently from the distal femur and proximal tibia with a method with the aid of a Vernier sliding calipers. Results: The determined values of the parameters of the cadaveric knees in centimeters are as follows: FLAP: M=7.10,SD=.44, FMAP: M=6.83,SD=.42, FML:M=7.78,SD=.40, FAR: M=1.10,SD=.06, TLAP:M=4.65,SD=.23, TMAP:M=5.17,SD=.27, TML: M=7.88,SD=.29, TAR:M=1.53. SD=.06. Conclusion: The normal values of the knee parameters of the native knee of the ethnic Igbos of the South Eastern Nigeria has been established and these should be taken into consideration by medical engineers during component design and arthroplasty surgeon during total knee replacement. There are correlations between these parameters that could be useful as a decision making tool during TKR and finally, the differences between these parameters and that of ethnic Western and Asian populations should be noted by implant manufacturers and arthroplasty surgeons.
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CASE REPORTS Top

Maxillofacial rehabilitation of nasal defect with nasal prosthesis using donor method: A case report p. 1022
MI Mathar, SM Shamsudeen
DOI:10.4103/njcp.njcp_657_19  
Maxillofacial prosthetics is the branch of prosthodontics which involves rehabilitation of the defects in the maxillofacial region involving the hard and soft tissue with the prosthesis. Facial defects that occur in the midfacial regions are commonly due to trauma and neoplasms like basal cell carcinoma which involves the nose. Reconstruction of the nose is an important esthetic challenge due to its esthetic and retention problems. This article emphasis rehabilitation of the nasal defect of a patient with nasal prosthesis using donor method.
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Evaluation of healing by Cone Beam Computed Tomography (CBCT) using Platelet-Rich Plasma (PRP) + β -Tricalcium Phosphate (β -TCP) and Platelet Rich Fibrin (PRF) + β -Tricalcium Phosphate (β - TCP) in periapical lesions: Case report p. 1026
M Kavitha, R Krishnaveni, AM Swathi, MH M Abubacker
DOI:10.4103/njcp.njcp_54_20  
When teeth have responded poorly to conventional endodontic treatment or when they cannot be treated adequately by nonsurgical means, surgical endodontics remains the treatment of choice. Healing of apical lesions occurs by repair, most of the time. “Repair is the healing of a wound by tissue that does not fully restore the architecture or function of the affected unit”. Since this is not ideal, newer regenerative procedures that aim to restore lost tissue have been introduced. β -Tricalcium phosphate is an alloplastic bone graft material that forms a scaffold for closing the bony defect. It is osteoconductive. Platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) are platelet concentrates, rich in growth factors and they promote regeneration by osteoinduction. This article describes cases of bone augmentation with a combination of PRP + β -TCP and PRF + β -TCP for treatment of the chronic periapical lesion. The cases were followed for six months and one year and healing was evaluated quantitatively using cone beam computed tomography.
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LETTER TO EDITOR Top

Sudden olfactory and gustatory dysfunctions: Important red flags in COVID-19 p. 1030
AJ Fasunla, TS Ibekwe
DOI:10.4103/njcp.njcp_172_20  
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