An Assessment of the Knowledge and Practice of Telemedicine Among Medical Doctors in University of Nigeria Teaching Hospital (UNTH), Ituku-ozalla, Enugu State, Nigeria.

Background: The outbreak of the novel SARS-COV-2 virus, created a paradigm shift in the practice of medicine, a speciality well known for its integration of clinical expertise and manual dexterity in the management of its patients. Telemedicine, a previously less conventional approach in developing countries, has now come to the forefront of patient care. This study assessed the knowledge and practice of telemedicine among doctors in the University of Nigeria Teaching Hospital, Ituku-Ozalla in Enugu state.Methodology: A questionnaire-based survey was used to obtain relevant information among 149 doctors in the University of Nigeria Teaching Hospital (UNTH), including their knowledge and awareness of telemedicine, its relevance and impact on the clinical outcomes of patients as well as factors limiting its use. Data was analyzed and presented in tables, graphs and pie charts.Results: There were 149 doctors, who were mostly aged 15 – 30 years (63%). Most 146 (98%) have heard about telemedicine but only 100 (67.3%) have consulted using telemedicine. Doctors were more likely to employ telemedical consultation for follow-up and emergency scenarios but least likely to use telemedicine for first-time visits and the management of chronic diseases.Conclusion: There is a good knowledge of telemedicine among medical doctors in UNTH but ICT illiteracy, inadequate patient-doctor interaction, patients’ preference, lack of internet access, high cost of set-up and maintenance and ethical issues were some of the factors limiting its practice.

Becker’s nevus syndrome: a case report

Background Becker’s nevus syndrome is a syndrome characterized by the presence of a Becker’s nevus with ipsilateral breast hypoplasia or hypoplastic defects of the muscle, skin, or skeleton. The nevus usually consists of a circumscribed, unilateral, irregularly shaped hyperpigmented macule, commonly occurring around the anterior upper trunk, with/without hypertrichosis and/or acneiform lesions. This rare syndrome has not been reported in our locality to the best of our knowledge. Case presentation We report the case of a 15-year-old Igbo female patient who presented to our pediatric endocrinology clinic, University of Nigeria Teaching Hospital, Enugu, with complaints of asymmetry of the breasts and hyperpigmented macules on the side. Based on her symptoms, diagnosis of Becker’s nevus syndrome was made. The diagnosis of Becker’s nevus syndrome is mostly clinical, based on the presence of a Becker’s nevus with ipsilateral breast hypoplasia or hypoplastic defects of the muscle, skin, or skeleton. In our patient, there was a Becker’s nevus with ipsilateral breast hypoplasia. This syndrome, belonging to the class of epidermal nevus syndromes, is very rare, and is usually benign. She was placed on spironolactone tablets 50 mg daily, which have been associated with an improvement in the size of the hypoplastic breast, and her fears were allayed. Conclusion This syndrome has not been reported in our locality to the best of our knowledge and, therefore, has a propensity for misdiagnosis by clinicians because of its rarity. We therefore report this to create awareness among clinicians regarding this condition that is associated with much psychosocial trauma among patients, and that can be easily managed with oral spironolactone.

Pregnant women utilization of dental services: still a challenge in low resource setting

Background Poor oral health in pregnancy can be associated with poor pregnancy outcome, however, dental consultation among pregnant women appears to be low. Methods This was a questionnaire-based study of 413 women who attended the antenatal clinic of University of Nigeria Teaching Hospital (UNTH), Ituku/Ozalla, Enugu. The information obtained was analyzed using SPSS version 22. A p-value of less than 0.05 was considered statistically significant. Results Only 36 (8.7%) of the respondents had dental consultations in index pregnancy for complaints such as tooth ache and decay (66.7%) and pain as well as swelling of the gum (33.3%). The most common reason given for not visiting a dentist during the index pregnancy was the visit not being relevant to their pregnancy outcome (69.2%). After counseling them, only 249 (60.3%) agreed to have dental consultation during subsequent pregnancies. The relationship between visiting the dentist and place of residence (< 0.001), occupation (0.019) and frequency of brushing/ changing of brush (0.005, < 0.001 respectively) were statistically significant. Conclusion The prevalence of dental consultation during pregnancy is very low. Pregnant women should be encouraged to have routine dental consultation with oral health counseling and check-up incorporated as part of routine antenatal care.

Nurses Perception towards the Care of Patients with Terminal Illness in University of Nigeria Teaching Hospital, Enugu State, Nigeria

Background: Part of becoming a good nurse is being able to understand one’s own perception of death and dying, which can affect the quality of care a patient with terminal illness will receive. This study was carried out to assess the nurses perception towards the care of patients with terminal illness in University of Nigeria Teaching Hospital, Enugu State, Nigeria Part of becoming a good nurse is being able to understand one’s own perception of death and dying, which can affect the quality of care a dying patient will receive. Methods: A descriptive survey method was used, and the population of 284 nurses was used, the instrument used for data collection was questionnaire and checklist developed based on the objectives of the study. The data collected were analyzed and presented using descriptive statistics of frequency and percentages. Results: The result of the study revealed that Nurses at UNTH have a positive perception of deaths with the most prevalent nurses perception being death is the cessation of all life processes (100%), In caring for the dying patients; 97.6% agreed that it is a good thing to care for the dying, 98% agreed that the rights of the patients should be protected even till death, 97.3% nurses should aim at achieving a peaceful death in all patients at the end of life and 97.6% agreed that it is good to involve the family members in the care of the dying patient. The study revealed religion (65.8%), belief (84.6%), previous experience with a dying patient (79.1%) and loss of a loved one (79.4%) as personal factors which influenced the perception of nurses towards the care of the dying. Furthermore, 78.7% and 72.8% of the respondents identified Euthanasia and Advance directive as legal and ethical factors influencing the care of the dying (x-0.728 with a p-value of 0.502).Also, in examining the relationship between nurses perception of death and their years of experience the result showed that the years of experience did not significantly influence nurses care of the dying (x=4.653, with a p-value of 0.166). Conclusion: It is however recommended that basic knowledge and continuing educational program on palliative care should be made available for student nurses and practicing nurses respectively.

Relationship of oxidative stress and antioxidant response with vaso-occlusive crisis in sickle cell anaemia

Background: Though sickle cell anaemia (SCA) is known to promote oxidative stress, there is paucity of information on the relationship between oxidative stress and vaso-occlusive crisis (VOC). Objective: This study was undertaken to evaluate the relationship of oxidative stress and antioxidant response with VOC in SCA. Methods: A cross-sectional case-control study was carried out at University of Nigeria Teaching Hospital (UNTH), Itu- ku-Ozalla, Enugu Nigeria involving 116 individuals which included 36 SCA subject, 40 sickle cell carriers (AS) and 40 healthy individuals (AA). Baseline information as well as the frequency of VOC was obtained from the participants and anaemia as well as oxidative stress and antioxidant indices were assessed in blood. Results: Anaemia was prevalent (88.9 %) in SCA individuals compared to AS (52.5%) and AA (47.5 %) individuals. Nitric oxide scavenging (NOS) and superoxide dismutase (SOD) activities as well as glutathione level were significantly (p<0.005) lower while catalase activity was higher in SCA individuals compared to controls (AA and AS). Higher malondialdehyde (MDA) level was associated with very severe VOC while low level of NOS activity was associated with severe VOC in SCA individuals. Conclusion: Sickle cell anaemia exhibited oxidative stress and alteration in the levels of antioxidant indices which was pos- sibly associated with vaso-occlusive crisis. Keywords: Sickle cell anaemia; oxidative stress; antioxidant; vaso-occlusive crisis.

Prevalence and Pattern of Diabetic Ketoacidosis among Children an Enugu, Southeast Nigeria: a 10 Year Retrospective Study

Diabetic ketoacidosis (DKA) is the most severe complication in pediatric cases of type 1 diabetes and also the leading cause of death in these children. There is a broad geographic variation in the frequency of DKA at the onset of diabetes. This study sought to determine DKA's prevalence and pattern in Enugu and review the treatment and outcome over ten years. This retrospective study conduct in the Children Emergency Rooms (CHER) of the two tertiary institutions in Enugu State, southeast Nigeria: Enugu State University Teaching Hospital (ESUTH) and the University of Nigeria Teaching Hospital (UNTH). The biochemical criteria for the diagnosis of diabetic ketoacidosis (DKA) base on the presence of hyperglycemia (blood glucose > 11 mmol/L), acidosis (serum bicarbonate < 15 mmol/L), and ketonuria (urine ketone ?1+). A total of 16,488 children were admitted during the ten years, of which 21 children presented with DKA, representing a prevalence of 0.13%. Six (28.6%) of the patients were newly diagnosed diabetics, while fifteen (71.4%) known diabetics, of which 9 (60%) were presenting with DKA for the first time. A total of two patients died, giving a mortality rate of 9.5%. The rest treated and discharged. The total hospitalization duration ranged from 1–31 days, with a mean duration of 13.3 ± 7.5 days. This study has revealed some of the challenges with the management of children with DKA and the unacceptably high mortality rate.