Journal of Global Medicine

Refractory ischaemic priapism following the concomitant use of Viagra and cocaine: a case report

Jomo Kugblenu — 2024-10-14

Introduction: Ischaemic priapism is a urological emergency which drugs, sickle cell disease, haematological dyscrasias, and neoplastic syndromes may cause. We report a case of a 48-year-old male who presented with refractory ischaemic priapism following the concomitant use of recreational Viagra and cocaine.

Case Report: A 48-year-old man presented to the Emergency Department (ED) with painful sustained priapism for 24 h, following Viagra and cocaine usage. Initial treatment of ejaculation and cold compresses did not help at home for 24 h. At a presentation in the ED, there was failed penile aspiration and injection of sympathomimetic, intracavernosal adrenoceptor agonist Phenylephrine was to little effect. Penile blood gas showed evidence of ischaemic priapism. The patient was transferred to a tertiary centre, where he underwent a penile aspiration, injection of further sympathomimetic, and corpora-spongiosum shunting under GA. Once back at the ward, he still had recurrent priapism. He was informed that he will have permanent damage and will need a penile implant. He was discharged and sent home with Co-amoxiclav and codeine, with a Urology outpatient follow-up in 4 weeks. Eventually, the patient underwent penile implantation, which 6 weeks later was complicated by penile abscess and required incision and drainage. This case report highlights the dangers of refractory ischaemic priapism following the concomitant use of recreational Viagra and cocaine. Concomitant drug abuse puts the patient at risk of full or partial penectomy, owing to possible failure of first-line management steps due to the propensity of cocaine to cause refractory priapism. Mechanisms of action of the drugs were described in this case report.

A case of Cardiocondyla aural parasitosis in Middle East Refugee Camp: insect removal in resource poor environment

David Cuthbert — 2024-06-04

We present a case of successful removal of aural foreign bodies from the external otic canal. In this scenario, the foreign bodies were an uncommon insect, the Cardiocondyla. The Cardiocondyla species is within the family Formicidae, otherwise known as the ant. The patient was seen in a remote location, a refugee camp in Jerash, Jordan, with limited resource accessibility. The insects and all aural foreign body contents were successfully debrided with gentle irrigation. This case presents the opportunity to evaluate an alternative insect removal technique when resources are not available. It also reviews the classic recommended techniques, assesses the risks and sequela of retrieval, and appraises the threat of formicidae exposure in the wild.

Point of care ultrasound in acute settings – a narrative review

Ernest Olszewski — 2024-03-20

Point of care ultrasound (POCUS) has become a standard assessment tool for the acute medical practitioner. Ultrasound has traditionally been the preserve of radiologists and cardiologists; however, the use by practitioners outside these specialties in the treatment of acutely ill patients began in the emergency department. Patients presenting with trauma or shock were assessed looking for life threatening injuries to inform immediate management.

Over the years and more recently during the COVID-19 pandemic, numerous POCUS protocols have been developed to standardise the practice of POCUS and to guide training. However, there are pitfalls to POCUS which include cross-contamination of infection, inter and intra-observer variability, bias, and retention of skills amongst practitioners.

The use of POCUS has increased in resource limited settings as ultrasound machines have become cheaper and more portable. However, challenges remain with considerable lack of trained healthcare staff and paucity of training opportunities. This has led to a considerable variability in the practice of POCUS in these settings.

Artificial intelligence (AI) is increasingly being leveraged as a medium to improve image acquisition, interpretation, and POCUS training. POCUS devices are also significantly smaller, cheaper, and more portable, increasing their availability to resource poor settings. There is potential for remote training platforms to improve access to learning opportunities in resource poor countries.

An integrative review of parent-partnerships within neonatal care facilities in low- and lower-middle-income countries

Tom Coghlan — 2024-05-21

Background: Neonatal deaths in low-income countries account for a disproportionate percentage of all-mortality rates of children under 5. Parental-participation in neonatal care has been proven to improve outcomes for key developmental factors that influence morbidity and mortality of infants.

Objectives: This review aims to explore the current models of parent-partnership used in neonatal care facilities and identify factors that influence effective utilisation in low-resource nations.

Methods: This Integrative Review was performed by searching the databases of CINAHL, Medline and Global Health. The search was conducted using key-terms relating to Neonatology, Kangaroo Mother Care and Parent-Partnerships. Papers published between 2011 and 2021, from lower- and lower-middle-income countries, were included.

Results: The search identified 336 publications. Following screening and full-text review, 24 studies were identified that satisfied the inclusion criteria. Data were quality-appraised using the Mixed-Methods Appraisal Tool and extracted utilising the framework described by Whittemore and Knafl.

The analysis produced nine key themes – KMC as the predominant model of parent-partnership; the positive impact parent-partnerships have upon infants; the positive impact for parents; positive impact for nursing staff; enabling and limiting factors that influence implementation; pre-existing social and cultural barriers; task-sharing between staff and family; and how education influences perceptions.

Conclusions: Economic, social and cultural factors have been identified that strongly influence and inhibit the widespread use of parent-partnerships in neonatal care facilities. KMC is the predominant model of parent-partnership. A future or adapted form of healthcare in these facilities should include a structured approach of education, empowerment, enhanced male and community involvement that simultaneously accommodates to the psychosocial needs of the family unit.

Abstracts of the 2024 Medical Association of Nigerians across Great Britain (MANSAG) Annual Educational Symposium on 11th May 2024

Andrew Alalade — 2024-05-21

The Main Supplementary page is at Vol 4, No.S1 (2024), and this will lead to the landing pages of individual abstracts.

Psychological safety in students’ clinical learning environment – thematic analysis of open-ended questions and DREEM questionnaire assessment

Constantine Ezeme — 2024-10-15

Introduction: The learning environment impacts students’ motivation, success and fulfilment, and central to this is the psychological safety of students. Psychologically safe environments lead to collaboration, positive learning experiences and effective practitioners. This study assessed the perception of clinical learning environments of medical and nursing students (NSs) using the Dundee Ready Education Measure (DREEM) and with two open-ended questions (OEQs): their memorable learning experience and the effect of being in medical school on their lives.

Methods: This was a cross-sectional study using validated DREEM questionnaires and two OEQs: ‘tell us about a memorable learning experience in medical/nursing school’ (MLE) and ‘what impact has your time in medical/nursing school had on your life’ (IoL). Data were collected from fourth- to sixth-year clinical medical, and first- to third-year NSs. Questionnaire data were analysed using the Statistical Package for Social Sciences. For the OEQs, an inductive approach was used for coding and thematic analysis. Coding was both semantic and interpretive.

Results: One hundred and ninety-three students completed the validated questionnaires. Fifty-seven (29%) and 59 (30%) answered the OEQs MLE and Impact IoL, respectively. Thirty-four per cent of medical and 7% of NSs had a negative response to one of the two OEQs. Six themes emerged from the memorable learning experience question, three of which centred around student-centred teachings and two around emotional responses and psychological safety. ‘I reviewed my materials over and over, ate well, put on my best clothes and went to present. It was beautiful’, a third-year medical student. ‘The tutor was a great teacher who, when he teaches, students learn’, an NS. There were four themes on the impact on life questions, and these centred around personal development, social awareness, aspirations and psychological safety. ‘It has made me see that broken people break others’, a third-year medical student.

The mean total DREEM score was 111 ± 10.2, interpreted as more positive than negative. In only two of the five DREEM domains, perception of the atmosphere and social self-perception were more negative than positive findings. Whilst there was near unanimity about their teachers being knowledgeable, and most students felt teachers were well-prepared for their teaching sessions, complaints about behaviours that adversely affected learning because of their negative impact on psychological safety in the clinical learning environment were very common.

Conclusion: Despite the overall positive picture of clinical learning environments, there are significant areas of students’ welfare that need addressing to ensure psychologically safe clinical learning environment. Students’ feedback feeding into annual appraisals, and pedagogic courses are means to achieving students-centred learning environments.

Determinants of Covid-19 Treatment Outcomes among Patients Admitted at an Infectious Disease Centre in sub-Saharan Africa

Wulaimat Abimbolanle Adekunle — 2024-06-05

Background

Although the COVID-19 epidemic seems to have ceased, with only few new sporadic cases seen, reports of new strains of the virus could lead to a resurgence and death. Hence, this study identified the factors influencing COVID-19 treatment outcomes among patients in Ibadan, Nigeria.

Objective

To identify the determinants of COVID-19 treatment outcomes among patients admitted at the Infectious Disease Centre, Olodo, Ibadan, Nigeria.

Method

A facility-based retrospective study was conducted. A review of the records of all cases (932) of laboratory confirmed COVID-19 positive patients, who received treatment between April 2020 and January 2022 at the Centre was conducted. Data was analysed at the level of significance of 5%.

Results

The mean age (S.D.) of the patients was 36.97 (14.6) years, while the mean number of days on admission was 14.87 (11.33) days. Most were males (66.7%). Many (51.5%) were symptomatic at admission, 4% had co-morbidities. The other disease conditions present included obesity, asthma, diabetes and hypertension. At admission, 45.8% had a low body temperature and about a quarter (29.7%) had a high respiratory rate. More than half (63.3%) had a high lymphocyte count, while 41.1% had low neutrophil count. The case fatality rate was 3.3%. Patients’ occupation (OR = 0.56, p = 0.01), pulse rate (OR = 1.00, p = 0.00), blood pressure (OR = 2.97, p = 0.007) and oxygen saturation (OR = 0.05, p = 0.00) were significantly (p <0.05) associated with COVID-19 treatment outcomes.

Conclusion

Patients’ occupation was a positive predictor of treatment outcomes, hence patients’ occupation should be considered in the classification of disease severity of the infection and subsequent treatment.

From the Journals: Important excerpts from other main journals

Olanrewaju Amusat — 2024-10-08

Current status and the future trajectory of geriatric services in Nigeria

Ogugua Osi-Ogbu — 2024-10-15

The world population of people aged 65 and above, termed as older persons, is increasing rapidly. The number of people aged 65 years or older worldwide is projected to more than double, rising from 761 million in 2021 to 1.6 billion in 2050. The number of people aged 80 years or older is growing even faster. Population ageing is an irreversible global trend. It is the inevitable result of the demographic transition – the trend toward longer lives and smaller families – that is taking place even in countries with relatively youthful populations.

In 2021, one in 10 people worldwide were aged 65 or above. In 2050, this age group is projected to account for one in six people globally [1]. People are living longer because of better nutrition, sanitation, healthcare, education, and economic well-being. With increasing age, older adults become at greater risk for diseases, disability, and side effects of medications. The common geriatric syndromes suffered by older persons include degenerative joint diseases, falls and mobility issues, sensory impairments (visual and hearing), dementia, sleep disturbances, frailty, and urinary incontinence. These syndromes are described as ‘Giants of Geriatrics’ on account of the impact on quality of life, and functional status of older persons.

Geriatricians provide person-centered holistic care that attempts to preserve function and maintain a good quality of life by deploying the comprehensive geriatrics assessment and management approach which involves a multidisciplinary team (MDT). Nigeria has an increasing ageing population that will benefit from a healthcare system that is aligned to their peculiar care needs in the different settings care will be sought. This can be achieved by building capacity in the various disciplines involved in providing comprehensive care to older persons, and including geriatric medicine in the training curriculum for medical students, nurses and all allied health workers.

After the Cass Report, what now for puberty blockers?

Olufunso Adedeji — 2024-10-15

A world beyond borders: rethinking global oncology in 2024

Olubukola Ayodele — 2024-03-08

Reflections of an allied health professional in a surgical world

Toni Collier — 2024-08-26