Nigerian Journal of Medical and Dental Education

Oral Cancer: Diagnostic Considerations

EV ORIKPETE — 2023-07-03

Globally, oral cancer is among the top 10 most common cancers, and despite being largely preventable, the global incidence is still on the rise. The major risk factors for oral cancer in the Western world are tobacco and alcohol consumption, but in Nigeria, other risk factors like poverty, malnutrition, poor oral hygiene, kolanuts, immune suppression and chronic malaria may play a greater role. The overall prognosis for oral cancer is poor, with a 5-year survival rate of about 50%, although this is due to late presentation and delays in diagnosis. When diagnosed early, oral cancer is potentially curable, and the 5-year survival rate increases to over 80%. So, efforts should be geared towards prevention and early diagnosis. Biopsy for histopathologic examination is the gold standard for the diagnosis of oral cancer, but other methods that have been used for oral cancer screening include visual oral examination, vital staining, cytology, and light-based methods e.g. autofluorescence. In recent times, artificial intelligence and use of salivary biomarkers have shown promise in improving the early diagnosis of oral cancer.

Patient related factors play the major role in delaying the diagnosis of oral cancer, as patients often delay seeking professional advice for up to 6 months or more from when they first notice any oral symptom that may be linked to oral cancer. Public education, improvement in health-seeking behaviour, better healthcare facilities and use of adjunctive screening methods will help in reducing incidence of oral cancer as well as the associated morbidity and mortality

Challenges in the Management of Oral Cancers: An Audit of Cases Treated in a Teaching Hospital North-West Nigeria

OO OMISAKIN — 2023-07-03

Background: Oral cancer is a disease in which malignant cells form in the mouth. It is a subset of head and neck cancer. The effective management of these cancers has been a challenge to the clinician due to high mortality rate that result from these tumours. Despite several approaches to its treatments, the prognosis has been poor.

Objectives: To evaluate various challenges encountered in the management of oral cancers in our Centre

Materials and Methods: This study was retrospective in design. We audited patients with oral cavity malignancies that presented in the Maxillofacial Unit of Barau Dikko Teaching Hospital, Kaduna, from January, 2009 to July 2022. Information was collected from patients’ record which includes: age, gender, site of occurrence, duration of the tumour, treatment giving, recurrence rate, challenges in the management and prognosis.

Results: One hundred and sixty-three patients were included in the study. The mean age was 37.64 years and males were more affected than females in the ratio of 2.32: 1.51. The mandible was the site most affected (n=52, 31.90%), then maxillae (n=40, 24.54%), tongue (n=28, 17.19%), cheek (n=15, 9.20%), Gingivae (n=10, 6.14%), floor of the mouth (n=8, 4.90%), lip (n=7, 4.29%) and least affected oropharynx (n=3, 1.84%). Late presentation in the hospital, ignorance of the nature of the tumour by the patient, cultural belief that cancer cannot be treated, high cost of treatments, poverty, and tumour recurrence were our challenges.

Conclusion: The challenges in the management of oral cancers can be mitigated by creating awareness among the people on how to detect early onset of the cancer and various preventive measures such as avoidance of tobacco and alcohol use. There is need for urgent establishment of more cancer treatment centers in the North western part of Nigeria where access to treatment at an affordable fee will be possible. The accurate mortality rate of these oral cancers cannot be determined in this study because many patients that were treated refused to come for review appointments.

Learning effectiveness of the online mode of study during the COVID-19 pandemic: Perspectives of the clinical medical and dental students from a Nigerian university

ME OSUH — 2023-07-03

Introduction: The Coronavirus pandemic resulted in a global lockdown which had a major impact on Education. The training of the medical and dental students whose structure is largely based on hands-on, face-to-face teachings and physical engagements had to change into a virtual mode of training. This study assessed the perspectives of the clinical medical and dental students at the University of Ibadan, Nigeria about the effectiveness of the E-learning mode of study occasioned by the COVID-19 pandemic.

Methods: The study design was a descriptive cross-sectional survey using the proportionate stratified sampling technique to recruit participants. An online self-administered questionnaire was used to collect data on sociodemographic characteristics and perceived effectiveness of the e-learning mode of study from the clinical students. Chi-square and logistics regression tests were conducted at a 5% level of significance.

Results: A total of 395 undergraduate clinical students in their various study levels (400 level- 77, 19.5%; 500 level- 153, 38.7%; 600 level- 165, 41.8% were involved. They were mostly males (56.2%), and their MBBS: BDS ratio was 3: 1. The mean (SD) age was 24.23 (2.65) years with ages ranging between 20-40 years. Overall, the majority of participants (335, 84.8%) perceived that the e-learning method of study was ineffective for learning. Although the majority of the respondents (77.5%) admitted that the COVID-19 pandemic affected their general learning negatively, most of them found online communication with teachers through chat boxes more effective and believed students used it freely (86.1%; 68.4% respectively). In terms of collaboration with colleagues, learning satisfaction, and evaluation of student performance, most participants did not consider the e-learning method effective (82.0%; 69.1%; 56.7% respectively). Students perceived effectiveness of the e-learning method improved with a rising level of study, increasing age, and among those with positive attitudes towards e-learning (p=0.003; p=0.038; p<0.001, respectively).

Conclusion: Although the clinical medical and dental students considered the online learning method, during the COVID-19 pandemic lockdown as beneficial as it enabled the continuity of their education, they had a low perception of its effectiveness as a mode of learning.

Work Place Stress Amongst Health Workers at the University of Benin Teaching Hospital, Benin City, Nigeria

IO AINA — 2023-07-03

Background: An individual's health and outlook on life are both improved in many ways by having a job. The amount of stress that some individuals experience at work, however, far surpasses any potential advantages and sometimes endangers their health. One of the most serious concerns linked with having a job is stress. Therefore, the aim of the study was to assess workplace stress among healthcare workers at the University of Benin Teaching Hospital (UBTH, Benin City.

Methods: A descriptive cross-sectional study was conducted at UBTH, Benin City from June to December 2022. Simple random sampling technique was applied to recruit study participants. Data were collected using structured self-administered questionnaire. Descriptive univariate and bivariate statistics were carried out. The statistical association was declared using adjusted odds ratio at 95% confidence interval (CI) and P-value of less than 0.05.

Results: A total of 101 study participants were involved in the study, and the response rate was 100%. More than half, 61 (60.4%) of the participants were females. Forty-one (40.1%) of the participants were between the ages of 30 – 39 years. The prevalence of work-place stress in this study was 18.8%. There was no significant association between socio-demographic characteristics and prevalence of workplace stress.

Conclusion: Workplace place stress among the health-care personnel in this study is low.

Knowledge and Practice of Informed Consent Among Oral Healthcare Providers in a Tertiary Health Facility in the South-South of Nigeria

HA OMOKHUA — 2023-07-03

Background: Informed consent has become a global practice recognized in clinical practice. Patients are getting more aware of the types of treatments they are given and the patient’s rights to information about the treatment procedures they receive are also on the rise

Objective: To assess the knowledge and practice of informed consent among dental healthcare providers.

Methods: This was a descriptive cross-sectional study that was conducted in the dental clinic of the University of Benin Teaching Hospital from June to December 2022. The research was carried out among 105 dental healthcare providers through self-administered, structured questionnaires. Data was analyzed using SPSS version 25; Frequency and descriptive statistics were generated, and Chi-square and Fisher’s exact tests were used to examine differences between groups. P value less than 0.05 was regarded as statistically significant.

Results: Of the 130 questionnaires shared, 105 respondents filled and returned representing a response rate of 80.8%. The majority (81.9%) of respondents had excellent knowledge of informed consent while only a little more than half (60.0%) had a good practice of informed consent. There was a statistically significant relation between the practice of informed consent and the gender of the respondents. (p-0.042) The mean knowledge scores were highest among males (3.9+0.440) and dentists (3.9+0.402) with a strong association(p-0.006). Males (2.7+0.497) recorded higher practice scores and those who had practiced for more than 15 years recorded better practice of informed consent. The majority (70.5%) of the respondents favoured verbal consent.

Conclusion: The study noted excellent knowledge among the respondents which did not translate to good practice as only a little over half (60.0%) of the respondents recorded good practice of informed consent.

Healthcare-Associated Infections and Control Strategies

AJ IGUNMA — 2023-07-03

Background: According to the WHO, HAI is an infection occurring in a patient during the process of care in a hospital or other healthcare facility which was not present or incubating at the time of admission. This includes infections appearing more than 48 hours after admission, those acquired in the hospital but appearing up to 30 days after discharge, occupational infections among staff as well as, neonatal infections acquired either at birth or during hospitalization. The triage of HAI includes susceptible hosts, the presence of pathogenic organisms in the healthcare environment, and an appropriate vehicle for the transfer of the pathogens. HAI is estimated to cause about 40% of all neonatal deaths depending on environmental factors and differences in clinical practices. Generally, 16% of all hospitalized patients in developing countries are diagnosed with HAI.

Predisposing factors: This includes; admission as an emergency, ICU admission, hospital stay longer than seven days, and invasive procedures.

Aetiology: Although all microorganisms are capable of causing HAI, few organisms are notorious in this regard such as Staphylococci (MRSA), Escherichia coli (ESBL), Klebsiella pneumoniae (ESBL strains), and Pseudomonas aeruginosa

Prevention: Hand washing, screening, and categorization of patients into cohorts. Transmission-based precautions, and Antibiotic stewardship are the common measures to mitigate HAI

Conclusion HAIs constitute a major barrier to the safety of patients and care providers in the healthcare space. It is opined that hand and environmental hygiene, with antibiotic stewardship among other strategies when adequately practiced will help in minimizing HAIs and improve treatment outcomes.

Recent advances in the surgical management of urinary stones in Nigeria

SO OSAGHAE — 2023-07-03

From 2017 to the present, there has been considerable interest and efforts geared toward replacing open surgical treatment of urinary calculi in the Nigerian government's public healthcare system with minimally invasive lithotripsy approaches. This article is a brief review and commentary on both the progress that has been made in the public teaching hospitals, and the epidemiology, natural history, causes, clinical features, diagnosis, and surgical options in the management of kidney, ureteral, and bladder calculi. The definition, nature, models, and role of lithotripsy were described. The latter part of the article gives a contemporaneous account of the time trends in the development of lithotripsy in public teaching hospitals. Lastly, the areas for development in the future, within the government’s public teaching hospital system were outlined.

Reducing the risks of nuclear war – the role of health professionals

2023-08-01

Reducing the risks of nuclear war – the role of health professionals