Showing papers in "Nigerian Medical Journal in 2019"

Factors Associated with Safe Disposal Practices of Child's Faeces in Nigeria: Evidence from 2013 Nigeria Demographic and Health Survey.

Abstract: Background: Stool disposal practices have been shown to be associated with childhood diarrhea. There exist variations in explanatory variables of safe child's faecal disposal practices depending on the context of the study. Thus, the need for this study to assess factors associated with safe disposal practices of children's faeces in Nigeria. Methods: This study utilized the 2013 Nigeria Demographic and Health Survey data. Child's faecal disposal practice was classified as safe and unsafe as defined by the World Health Organization/UNICEF Joint Monitoring Program. Binary and multivariate logistic regression models were used to identify factors associated with safe faecal disposal practices. The analysis was restricted to a weighted sample of 19, 288 youngest children in the households. Results: Overall, the prevalence of safe disposal of child's faeces was 59.4%. Safe child's faeces disposal was the highest among older women (64.4%), highly educated women and their husbands (67.1%) and (66.4%), respectively; among rich households (72.3%), Muslim (68.7%), urban areas (68.8%), and in North West zone (78.4%). In multivariate analysis, safe faecal disposal was significantly associated with the age of mother, maternal education level, wealth index, religion, source of water, and type of toilet facility. Marital status, geopolitical zone, having diarrhea in the past 2 weeks before the survey and sex of the child were not significant determinants of safe faecal disposal practice. Conclusion: Understanding the prevailing faecal disposal practices is a prerequisite to the formulation of effective intervention strategies. It is pertinent, therefore, that programs and interventions designed to improve safe child's faecal disposal practices need to take into consideration the factors identified in this study.

Components and Risk Factors of Metabolic Syndrome among Rural Nigerian Workers.

Abstract: Background: Metabolic syndrome (MetS) is a serious public health risk predisposing the workforce to cardiovascular diseases and diabetes. Aim: The aim of this study was to determine the components and risk factors of MetS among Nigerian teachers and bank workers (BWs). Settings and Design: The cross-sectional study was conducted in Idemili South Local Government Area, Southeast Nigeria. Materials and Methods: The study involved 427 teachers and 66 BWs in 14 secondary schools and 5 microfinance banks, respectively. Data collection methods included questionnaire, lipid profile, fasting plasma glucose (FPG), weight, height, waist circumference, and blood pressure (BP) measurements. Inferential statistical analysis involved Pearson correlation and Chi square with Cochran–Mantel–Haenszel test. Significance was accepted at P 0.05) between occupations, age, and gender. Females were more likely to have abdominal obesity (P

Prevalence of Psychosocial Stress and Its Risk Factors among Health-care Workers in Nigeria: A Systematic Review and Meta-Analysis.

Abstract: Context: Health-care workers experience psychosocial stress in their workplace. Available statistics are at variance, and hence, the need to know the overall prevalence of psychosocial stress among Nigerian health-care workers and associated risk factors. Aims: The aim of this study was to determine the prevalence of psychosocial stress and its risk factors among health-care workers in Nigeria through meta-analysis. Materials and Methods: PubMed, CINAHL, and Google Scholar databases were searched for articles. Search terms include “psychosocial stress,” “occupational health,” and “Nigerian health-care worker.” Articles were included if they used validated psychosocial stress assessment instruments. Of the 17 articles with data on psychosocial stress prevalence, eight met all inclusion criteria. Each article independently reviewed by the authors and relevant data abstracted. Statistical analysis was done using MedCalc version 18.10. Results: Overall, the prevalence of psychosocial stress was 61.97% (95% confidence interval [CI]: 41.013–80.823) based on analyzed eight articles with the sample size of 1763. Work overload rate at 67.72% (95% CI: 33.24–93.76) was the most prevalent psychosocial stress risk factor. Other risk factors were poor communication and staff attitude and lack of resources and equipment at 50.37% (95% CI: 13.35–87.16) and 62.4% (95% CI: 7.70–99.9), respectively. Headache, with neck and back pain, was the most prevalent psychosocial stress-related health outcome at 73.26% (95% CI: 66.14–79.82). Conclusion: Prevalence of psychosocial stress is high among health-care workers in Nigeria, necessitating preventive measures

Soil-transmitted Helminths and Associated Risk Factors among Elementary School Pupils in Dadin Kowa, Jos.

Abstract: Background: Soil-transmitted helminths are intestinal parasites of humans transmitted through contaminated soil. They are considered neglected tropical diseases found mainly in areas with warm and moist climates where living condition and personal hygiene are poor. Aim: The aim of this study was to determine the prevalence of soil-transmitted helminths among primary school pupils in Kangang community of Dadin Kowa, Jos. Materials and Methods: This was a cross-sectional study of 136 elementary school pupils from three selected schools in Kangang community in Dadin Kowa of Jos South Local Government Area of Plateau State between April 2018 and June 2018. Stool samples were collected from all the consented participants in a sterile, universal sampling container prelabeled with the participant's identification number. The samples were analyzed within 2 h of collection using parasites concentration technique and microscopy. The results obtained were analyzed using SPSS version 21. Results: The prevalence of soil-transmitted helminthiasis among the study population was 42.6%. Ascaris lumbricoides (25.7%) was the most common parasites, followed by Trichuris trichiura (10.3%). Hookworm infection was observed in 5.1%, while strongyloidiasis caused 1.5% of STHs. The male participants had a prevalence of 55.2% compared to the females who had a prevalence rate of 44.8%. Based on the schools where the participants were recruited, STHs was more prevalence among participant from KS school with rate of 51.2% followed by EBI school (40.0%), while LP school had the least infection rate of 38.1%. Conclusion: This study revealed the prevalence of STHs among school pupils in Kangang community of Dadin kowa, Jos, as 42.6%. A. lumbricoides was the most common STHs in the area. Males were more infected than females. Age and type of toilet used by the participant were found to be significantly associated with STHs infection.

Assessment of Antimicrobial Effectiveness of Neem and Clove Extract Against Streptococcus mutans and Candida albicans: An In vitro Study.

Abstract: Background: There is increasing interest to develop antimicrobial aids from alternative sources such as medicinal plants for the treatment of infectious diseases. Neem and clove are known to have antimicrobial properties. Aim: The study aimed at detecting the antibacterial and antifungal activity of neem and clove extract against Streptococcus mutans and Candida albicans. Materials and Methods: Strains of S. mutans and C. albicans and selective media for growing micro-organisms were procured. Antimicrobial activity was assessed using two methods, by determining the minimum inhibitory concentration (MIC) using the broth dilution method and determining the zone of inhibition using well diffusion method on mitis salivarius bacitracin selective for S. mutans and Saboraud's dextrose agar plates for C. albicans. One way ANOVA with post hoc analysis was done to compare the antimicrobial activity of extracts and 0.2% chlorhexidine. Results: MIC of neem extract was found to be 4.2 mg/ml and 5.0 mg/ml against S. mutans and C. albicans, respectively. While for cloves, it was 5.5 mg/ml for both. Neem had the highest antibacterial activity with a mean zone of inhibition of 11.4 mm followed by chlorhexidine and cloves whereas antifungal activity was highest for chlorhexidine (14.4 mm) followed by neem and clove. Conclusion: The result of the study established that both plant extracts possess antimicrobial activity against common microbes present in the oral cavity.

Assessment of GeneXpert MTB/RIF Performance by Type and Level of Health-Care Facilities in Nigeria.

Abstract: Setting: Nigeria adopted GeneXpert MTB Rif as a primary diagnostic tool were available and accessible since 2016. The current geographical coverage of GeneXpert machines by LGAs stands at 48%, with a varied access and utilization. Objectives: To assess the association between the type and level of health facilities implementing GeneXpert MTB/Rif and performance outcome of the machines in Nigeria. Study Design: Retrospective secondary data analysis of GeneXpert performance for 2017 from GXAlert database. The independent variables were type and levels of health care facilities, and dependent variables were GeneXpert performance (utilization, successful test, error rates, MTB detected, and Rifampicin resistance detected). Results: Only 366 health care facilities are currently implementing and reporting GeneXpert performance, the distribution is 86.9% and 13.1% public and private health care facilities respectively, and only 6.3% of the facilities are primary health care. Of 354,321 test conducted in 2017, 91.5% were successful, and among unsuccessful test 6.8% were errors. The yield was 16.8% MTB detected (54,713) among which 6.8% had Rif resistance. The GeneXpert utilization rate was higher among private health care facilities (55.8%) compared to 33.3% among public health care facilities. There was a statistically significant difference in the number of successful test between public and private health facility-based machines as determined by one-way ANOVA (F(1,2) = 21.81, P = 0.02) and between primary, secondary and tertiary level health facility-based machines (F(1,2) = 41.24, P < 0.01). Conclusion: Nigeria with very low TB coverage should rapidly scale-up and decentralize GeneXpert services to the private sector.

Immunohistochemical Expression of Vimentin in Invasive Breast Carcinoma and Its Correlation with Clinicopathological Parameters.

Abstract: Introduction: Breast carcinoma (BCa) is one of the most common cancers among women globally. Increased vimentin expression has been reported in various epithelial cancers. Aim: This study examines the expression of vimentin in BCa and its correlation with various prognostic factors such as tumor size, histological grade, lymph node status, estrogen receptor (ER), progesterone receptor (PR), HER2/neu, and Ki67 status. Materials and Methods: Seventy cases of BCa diagnosed between 2014 and 2015 were included in the study. A technique of manual tissue microarray was employed for the analysis of expression of immunohistochemical (IHC) markers such as vimentin, ER, PR, HER2/neu, and Ki67. Results were subjected to statistical analysis. Results: Vimentin was found positive in 53 (75.7%) cases of BCa, of which 18 cases (25.7%) were triple-negative BCa (TNBC). Positivity for ER, PR, Her2, and Ki67 was 32.8%, 31.4%, 60%, and 99%, respectively. Vimentin expression was significantly associated with ER negativity. All 53 cases expressing vimentin showed positive Ki67 labeling index; however, this was not statistically significant. Maximum vimentin expression was observed in the age group >50 years, postmenopausal women, BCa cases showing lymphovascular invasion (LVI), axillary lymph node metastasis, higher stage and higher grade of tumor, negative PR expression, and positive HER2/neu expression. However, this was not statistically significant. In TNBC, vimentin expression was significantly associated with histological grade and LVI. Conclusion: Vimentin expression was associated with well-established poor prognostic factors of BCa. Vimentin expression if routinely included in histopathology report would aid in better understanding of tumor behavior.

Hypertension in children: Could the prevalence be on the increase?

Abstract: Background: In children particularly in the developing world, there is a tendency to downplay the role of primary hypertension in their health. In adults, a number of factors have clearly been associated with the incidence of hypertension. Knowledge of the prevalence of hypertension and its associated factors among children in our environment is important and could inform the need for lifestyle changes and routine blood pressure (BP) checks in children so as to reduce BP-related health risks. Aim: The aim of this study is to document the prevalence of hypertension and its risk factors among children in Enugu, Nigeria. Materials and Methods: Children aged 6–17 years attending the outpatient clinic of a tertiary hospital, were enrolled for the study. Their socioeconomic status (SES), weight, height, BP, and dipstick urinalysis were measured using standardized methods. Adherence to Mediterranean diet was assessed using the Mediterranean Diet Quality Index (KIDMED). The prevalence of hypertension and the influence of these factors on their BP were analyzed. Results: Forty-six (9%) of the 491 participants had hypertension. Of these 46 hypertensive children, 72% were females while a significantly higher proportion 57% (P = 0.006), were in the age group 13–17 years. While age, gender, and the presence of protein in urine were significantly associated with hypertension in these children; body mass index, diet, family history of hypertension, and SES were not. Conclusion: The prevalence of hypertension in children in this environment is high and appears to be increasing. There is need for routine BP and urinalysis check for all children in our clinics and wards.

Knowledge of cervical cancer and the uptake of the Papanicolaou smear test among public secondary school teachers in Akwa Ibom State, Nigeria

Abstract: Background: Cervical cancer is a public health problem that disproportionately affects women in less-developed countries despite the availability of effective screening tools. The objective of this study was to determine the level of knowledge of cervical cancer and uptake of the Papanicolaou (Pap) smear test among teachers in public secondary schools in Akwa Ibom State, Nigeria. Methodology: This was a cross-sectional descriptive study among 370 female teachers in public secondary schools in Akwa Ibom State, Nigeria. Data were collected with a self-administered questionnaire and were analyzed using Stata software version 10. Results: The mean age of respondents was 37.9 ± 7.9 years. More than two-thirds (71.0%) of the respondents had low knowledge of cervical cancer risk factors, whereas 168 (57.9%) respondents had low knowledge of the symptoms. Among the 226 (77.9%) respondents who knew that cervical cancer was preventable, only 65 (28.8%) had high knowledge of preventive measures. About 42.2% of respondents were aware of the Pap smear test and only 8.4% had ever had a Pap smear test. There were significant associations between knowledge of symptoms, prevention of cervical cancer, and the uptake of the Pap smear test (P < 0.05). Conclusion: The levels of knowledge of risk factors, symptoms, and methods of prevention of cervical cancer were low in this study. This may have accounted for the low uptake of the Pap smear test. Regular and comprehensive health education concerning cervical cancer and its prevention is advocated in the media and clinics to encourage higher uptake of the Pap smear test.

Profile of medicolegal deaths in females: an autopsy-based study

Abstract: Background: The rate of female medicolegal deaths (MLD) due to homicides and road traffic accidents (RTAs) is the highest in Africa, compared to the rest of the world, though there is scanty literature locally on this subject. Materials and Methods: The major sources of information reviewed in this study were the autopsy registers and autopsy reports of the police clinic, Benin City, Edo State, over 10 years. Results: A total of 331 female medicolegal autopsies were performed, accounting for 21.8% of all cases. The mean age of cases was 40.11 ± 20.25. Age group of 30–39 years accounted for 22.1% (n = 73) of cases, closely followed by the age group of 20–29 years, which accounted for 20.5% (n = 68) of cases. Accidental deaths accounted for 36.9% (n = 122) of cases. RTA was the most common cause of accidental deaths (n = 105; 86%). The most common pattern of RTA was a vehicle knocking down a pedestrian as seen in 45 cases (42.9%). The most common age group involved in RTA was 20–29 years (n = 23; 22%). For homicides, shotguns were mainly used (n = 31; 31.6%), distantly followed by those caused by the use of sharp objects (n = 17; 17.3%) and most cases belonged to the age groups of 40–49 years and 30–39 years (21.5% and 19.5%, respectively). In 5 (71.4%) cases, hanging was the method of choice for suicide. A majority of suicide victims (n = 4; 57.1%) were aged between 30 and 39 years, with an average age of 36.3. Diseases of the cardiovascular system accounted for 41.8% (n = 41) of cases, whereas pregnancy-associated deaths (excluding criminal abortions) accounted for 29.6% (n = 29) of cases in the natural causes group. Preeclampsia/eclampsia (n = 9; 31%) followed by postpartum hemorrhage (n = 8; 27.6%) were the leading causes of maternal deaths. Conclusion: There is a need to provide basic infrastructure, formulate policies, and implement them, to reduce female MLD, which a significant number of them are preventable.

Short-Term Outcomes of Treatment of Boys with Posterior Urethral Valves.

Abstract: Background: Posterior urethral valve (PUV) is a significant cause of morbidity and mortality among male children resulting in renal failure in 25%–30% before adolescence irrespective of initial treatment. This study aimed at evaluating the early outcomes of children managed for PUV. Materials and Methods: This was a prospective study of all children who were treated for PUV between 2012 and 2016 at a single referral institution. Information reviewed included demographic and clinical data, imaging findings, pre- and post-operative serum electrolytes, and postoperative renal outcomes. Results: Twenty-nine male children were managed for PUV at a median age of 6 months including 7 (24.1%) neonates. Two (6.9%) patients had antenatal diagnosis. Micturating cystourethrogram confirmed PUV in all patients. Fourteen (48.3%) patients had impaired renal function (IRF) at presentation and 8 (57%) had improved renal function (RF) after initial catheter drainage. The mean creatinine at presentation was 1.86 ± 1.69 mg/dl and the mean serum creatinine following initial catheter drainage was 0. 93 ± 0.49 mg/dl (P = 0.003). For those patients with normal RF, the mean creatinine at presentation was 0.81 ± 0.22 mg/dl versus 0.74 ± 0.21 mg/dl (P = 0.012), following initial catheter drainage. Children with IRF on admission had mean creatinine at presentation of 2.61 ± 2.00 mg/dl compared to 1.17 ± 0.53 mg/dl (P = 0.002) after initial catheter drainage. Valve ablation was achieved with Mohan's valvotome in 26 (96.3%) patients. All patients had good urine stream at a median follow-up of 5 months. Four (13.8%) patients developed IRF at follow-up. Renal outcomes of patients presenting before 1 year and those presenting after 1 year were similar. Two children died preoperative of urosepsis and one out of hospital death given an overall mortality of 10.3% (n = 3). Conclusion: There was significant improvement in RF after initial catheter drainage. The incidence of IRF at follow-up was 13.8%. Long-term follow-up is necessary to identify patients at risk of end-stage renal disease.

Academic Implications of Uncorrected Refractive Error: A Study of Sokoto Metropolitan Schoolchildren

Abstract: Background: The Sustainable Development Goal 4 ensures that all children have an inclusive and equitable quality education. However, uncorrected refractive errors (UREs) have been a major cause of limitations with regard to quality education as vision plays a vital role in child learning and development. Thus, any problem affecting the child's vision could adversely affect the quality of the child's education. Aims: The aim of this research was to assess the quality of education of the children with URE in Sokoto metropolis, Sokoto State, Nigeria. Methods: A cross-sectional survey of schoolchildren in four randomly selected primary schools within Sokoto metropolis was carried out from July 2016 to October 2016 using the illiterate “E” chart and a pinhole. Relevant history and basic ocular examinations were done using a multistage sampling technique. Statistical Analysis: Data were analyzed using the Statistical Package for Social Sciences (IBM SPSS) version 20. Results: A total of 113 students were surveyed; 56 (49.6%) males and 57 (50.4%) females. The age range was between 5 and 15 years, and the mean age was 10.89 ± 2.27 years. The prevalence of URE was 9.7%, with more than half of the students within the age group of 10–12 years (P = 0.018) and more common in females (54.5%) than males (45.5%) (P = 0.775). More than 90% of the respondents had never had a prior eye examination. The average mean academic performance of the pupils with URE (49.54% ±10.49%) was statistically significantly lower than those without refractive error (71.08 ± 10.09), mean difference = 21.55 (95% confidence interval, 15.18–27.92) (t = 6.70, P = 0.000). Conclusions: The negative implications of URE on the quality of education and other socioeconomic aspects of life underscore the need to increase efforts on its screening and increase other relevant interventional measures.

Abdominal Pregnancy: A Case Report of a Viable Nondysmorphic Fetus.

Abstract: Abdominal pregnancy is a rare form of ectopic gestation. It accounts for about 0.4% of all cases of ectopic pregnancy, and often associated with significant morbidity and mortality. Clinical presentation varies, and diagnosis is commonly challenging. Although ultrasound is helpful in early gestation, this could be unsatisfactory at advanced gestational age. Hence, a high index of suspicion is required in the diagnosis. We present a case of secondary abdominal pregnancy in a 27-year-old gravida 2 para 0 + 1 at an estimated gestational age of 33 weeks and 5 days. She had ultrasound scan done at 9 weeks and 2 days confirming the diagnosis, but declined surgery to seek spiritual intervention. She subsequently presented with generalized abdominal pain and fainting attack. She had exploratory laparotomy with delivery of a live female baby with no congenital anomaly. The placenta was attached to the left infundibulopelvic ligament and was delivered wholly without remnants. She was discharged on the 8th postoperative day, and the baby was discharged after 14 days from the neonatal intensive care unit. Accurate diagnosis and prompt intervention with evaluation of placenta attachment is vital to prevent adverse consequences.

Spectrum of endocrine disorders as seen in a tertiary health facility in Sagamu, Southwest Nigeria

Abstract: Background: There is dearth of records on prevalence and spectrum of adult endocrine disorders in Nigeria. Objective: To document the spectrum of endocrine disorders as seen in endocrinology, diabetes, and metabolism (EDM) outpatient clinic, Department of Medicine of Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State over a 3-year period. Methods: This was a retrospective study of the medical records of all new consultations seen in the EDM outpatient clinic between January 2016 and December 2018. All endocrinology diagnoses were classified according to the 10th revision of the International Statistical Classification of Diseases and Related Health problems (ICD-10). Information on demographic, source of referral, baseline clinical, and biochemical indices were gleaned and subjected to descriptive statistics using SPSS version 21, and results were presented as proportions (frequencies and percentages) and mean (±standard deviation). Results: Two thousand seven hundred and sixty-five patients were seen and managed at EDM outpatient clinic over the specified time frame. Eight hundred and sixty-three were new cases, age range 16–88, mean of 54.10 (±13.9) years with female preponderance 520 (60.3%) and female-to-male ratio of 1.5:1. The internal referral system constituted the main means of referral to the EDM clinic. The most common endocrine referrals were diabetes mellitus (DM) (697, 80.8%) and thyroid disorders (119, 13.8%) followed by metabolic syndrome (29, 3.36%) and hypothalamic–pituitary disorders (HPOs, 9, 1.04%). Conclusion: The common endocrine cases seen in Sagamu are DM, thyroid diseases, metabolic syndrome, and HPO similar to worldwide trend.

High Risk of Drug-drug interactions among Hospitalized Patients with kidney Diseases at a Nigerian Teaching Hospital: A Call for Action.

Abstract: Background: Potential drug–drug interactions (DDIs) are increasingly common in clinical practice, especially among individuals with chronic conditions, such as chronic kidney dysfunction. However, data relating to DDIs among chronically ill patients are limited in Nigeria. We, therefore, investigated the prevalence and pattern of DDIs among patients with kidney diseases on admission at a tertiary hospital in Lagos, Nigeria. Materials and Methods: This was a prospective observational study involving 61 adults with kidney diseases and on admission in medical wards of the study center, over a 3-month period. Data extractions were with a purposefully designed pro forma to extract relevant data on demographic, clinical, and dosing regimens of the prescribed drugs for individual patients. Potential DDIs were identified, and their severity was rated using the MICROMEDEX® software database (IBM® Watson–Truven Health Analytics), which is available online with limited access. Results: Of the 61 patients evaluated, majority were males (34; 55.7%), were elderly (26; 42.6%), and had chronic kidney disease Stage 3 (40; 65.5%). The most common cause of kidney disease was hypertension (20; 32.8%). Out of the 542 prescriptions received by the patients, potential DDI was observed in 508 (93.7%) prescriptions. Clinically significant drug interactions (CSDIs) were detected in 486 (85.7%) prescriptions. Pharmacodynamic DDIs (466; 91.7%) were the most common. Pill burden exceeding 25 pills/day was present in nine (14.8%) patients. The severities of the potential DDIs were major (135; 24.9%), moderate (333; 61.4%), and minor (38; 7.1%). Only two different potential DDIs were rated X (contraindicated). Conclusion: Exposure to drugs with potential DDIs was very common among patients with kidney diseases. Most of the CSDIs observed were of major severity. The use of DDI checker before prescribing drugs for individuals with kidney diseases could avert clinically significant interactions.

Encapsulated Sinonasal Schwannoma Mimicking an Antrochoanal Polyp.

Abstract: Extracranial schwannomas are uncommon neoplasms of the sinonasal tract arising from peripheral nerve shealth. Mostly acapsulated on histology, but few cases of encapsulated schwannomas have been reported. Its symptoms are nonspecific and initial clinical diagnosis is frequently missed. We report a 13-year-old boy with a huge, encapsulated sinonasal schwannoma initially thought to be an antrochoanal polyp. Computed tomography scan demonstrated a huge irregularly shaped mildly enhancing isodense mass in the right nasal cavity with lateral extension to the ipsilateral maxillary sinus, superior extension into the ethmoids and frontal sinuses and posteriorly into the nasopharynx. The tumour was completely excised via a lateral rhinotomy and patient is still on follow-up.

A Study on Childhood Epilepsy among Traders in Benin City Nigeria.

Abstract: Background: Epilepsy is a serious childhood disease associated with stigmatization in the community. Despite the deleterious effect of the disease on childhood brain growth and development, the disease is treatable. Objective: The aim of this study is to document the knowledge of childhood epilepsy by community members using traders (market women and men in a popular market in Benin City, Nigeria) as a case study. Methodology: This was a descriptive cross-sectional study carried out in April 2018. Data collection was by researcher-administered questionnaire. The respondents were traders (women and men) in Edaiken market Benin City Nigeria who were recruited consecutively during the period of the study. The analysis was performed using the Statistical Package for the Social Sciences version 21, and the level of statistical significance of variables was set at 95% confidence level and P < 0.05. Results: Of the 500 respondents, 47 (9.4%) males and 453 (90.6%) females; mean age (standard deviation) was 35.3 ± 9.4 years. Total knowledge score of childhood epilepsy in this study was 27.6%. Only 116 (23.2%) study participants gave correctly a description of epileptic fits in a child. Although majority 71.0% said that epilepsy has the medical cure, none was able to mention any known drugs for the treatment of epilepsy and 72.6% said that they would use traditional remedies. Conclusion: The overall observed knowledge score of childhood epilepsy was low. Although most respondents stated that epilepsy has medical cure, majority preferred the traditional options for treatment. These findings, therefore, highlighted the need to enlighten the public about childhood epilepsy and its medical treatment options.

The Role of a Minimum Immunohistochemical Antibody Panel in Confirming Undifferentiated Nasopharyngeal Carcinoma: A Cross-Sectional Study at the Muhimbili National Hospital, Dar-es-Salaam, Tanzania

Abstract: Introduction: Nasopharyngeal carcinoma (NPC) is a malignant epithelial neoplasm arising in the nasopharyngeal mucosa that shows light microscopic and/or ultrastructural evidence of squamous differentiation. Immunohistochemistry (IHC) can be used to reliably distinguish undifferentiated NPC from other malignant tumors, and the technique may be a necessary tool toward the arrival of a definitive diagnosis, particularly when dealing with challenging cases. Materials and Methods: This was a cross-sectional hospital-based study which was conducted at Muhimbili National Hospital. The study involved 120 patients with NPC who were diagnosed on histopathological basis between 2009 and 2013. Results: The sensitivity and specificity of hematoxylin and eosin (H and E) stain in diagnosing NPC were 99% and 30.4%, respectively. The accuracy of H and E stain to diagnose NPC and lymphoma was 94.2% and 30.4%, respectively. CD45 antibody helped to confirm 16 cases which were diagnosed as NPC on H and E stain to be lymphoma. Further, AE1/AE3 antibody helped to confirm one case who was diagnosed as rhabdomyosarcoma on H and E stain to be NPC. Conclusions: The sensitivity and accuracy of H and E stains to diagnose NPC were very high whereas the specificity was very low. A significant proportion of previously diagnosed NPC cases by routine H and E stains were confirmed not to be so by a minimal IHC antibody panel of pan-cytokeratin cocktail (AE1/AE3) and leukocyte common antigen (CD45). This highlights the paramount importance of a minimum IHC panel in assisting to obtain a definitive diagnosis in challenging cases of NPC.

An Autopsy Study of Pattern and Yearly Trend of Homicide in Warri, Nigeria.

Abstract: Background: Homicide is a common cause of unnatural death and an index of the level of security of the state. The aim of this study was to analyze all autopsied unnatural homicide cases in Warri, Nigeria from 2003 to 2016 with emphasis on age, sex, regional distribution of injury, and circumstance of death. Materials and Methods: Six hundred and seventy-four cases were studied and relevant information extracted from police and autopsy records. These information were analyzed using SPSS 21. Results: Unnatural homicide cases accounted for 69.1% of 975 medicolegal deaths autopsied in this region, with a male to female distribution of 14:1. The mean age of the victims was 33.2 years with the highest incidence occurring in the 3rd decade. Firearms, sharp weapons, blunt weapons, suffocation, and burning were the methods used in 426 (63.2%), 162 (24.0%), 73 (10.8%), 11 (1.7%), and 2 (0.3%) cases, respectively. The chest, the head, and the neck were the most common parts of the body affected representing 275 (40.8%), 162 (24%), and 52 (7.7%) of cases. Conclusion: Unnatural death as a result of homicide is very common in the study area and mainly perpetrated using firearms and sharps with young males being the most vulnerable age group. The head, chest, and neck are more commonly affected regions of the body.

Blood Pressure Changes among Patients Undergoing Hemodialysis in Yenagoa, Nigeria

Abstract: Introduction: Hemodialysis (HD) is a common modality of renal replacement therapy in Nigeria. Despite its usefulness, it may have complications such as intra-dialytic hypotension (IDH) and intra-dialytic hypertension (IDHTN), both of which may impact negatively on the patient. The aim of the study was to examine blood pressure (BP) changes during HD, to determine the frequency of IDH and IDHTN in patients undergoing HD, and to possibly identify associated factors. Materials and Methods: The study design was a retrospective review of records of patients who had HD in the Rainbow Dialysis Center, a foremost private dialysis center in Bayelsa State. The records of all adults who had HD in the center from June 2014 to June 2018 were reviewed. Data retrieved include sociodemographics, type and cause of renal disease, and clinical and laboratory parameters such as BPs, packed cell volume, urea, and creatinine. Statistical Analysis Used: Data were analyzed with SPSS version 20.0. Data were presented in tabular forms. Variables were expressed as mean with standard deviation, frequencies, and percentages. The means were compared using Student's t-test or analysis of variance where appropriate. Chi-square test was used to compare proportions. Statistical significance was set at P 0.05). Older age was positively and significantly associated with IDHTN (P = 0.047). Conclusions: IDH and IDHTN were prevalent among the patients studied, with the latter being slightly more likely to occur with advancing age. There is a need for adequate BP monitoring and management during HD.

Keystone Flaps in Urethroplasty: Reconstruction in a Complex Case of Panurethral Stricture Disease.

Abstract: Panurethral strictures are a surgical challenge for a reconstructive urologist more so in situations where local tissue for reconstruction is deficient. Two-stage urethroplasty is the preferred option in such cases. In some complex stricture diseases where patients are not willing for multiple procedures, permanent perineal urethrostomy can give a good functional outcome. Keystone flaps have been used as a simple and effective method of wound closure in other areas of the body that would otherwise have required complex flap closure and skin grafting. We describe, for the first time, a case of inflammatory panurethral stricture disease complicated by Fournier gangrene with extensive penile, scrotal, and perineal skin deficit managed with a perineal urethrostomy, with the help of keystone design perforator island flaps with successful outcome.

Stump Appendicitis due to Retained Fecalith after Laparoscopic Surgery.

Abstract: Stump appendicitis is a rare cause of right iliac fossa pain in patients with a previous history of appendectomy for acute appendicitis. The presentation is often delayed and may pose a clinical diagnostic challenge to the surgeon. More often, a high index of suspicion backed with relevant radiologic investigations is required for diagnosis. Open and laparoscopic appendectomy may be complicated by stump appendicitis. We report our experience in a 49-year-old Nigerian who presented to us with recurrent right iliac fossa pain and abdominal distension of 2 weeks' duration. The patient had laparoscopic appendectomy 1 year prior to presentation to us. A diagnosis of stump appendicitis with small-bowel obstruction was made with an abdominal computed tomography scan. He had an open stump appendectomy and small-bowel adhesiolysis with a good postoperative outcome.

Initial experience with central venous line insertion in a tertiary health institution in Nigeria

Abstract: Background: Central venous catheterization is an uncommon procedure in most hospitals in the West African subregion. This article presents our initial experience with central line insertion. Materials and Methods: Catheter sizes ranged from 5 fr for children and 7 fr for adult for intravenous therapy, while size 7 fr polyurethane catheters were used for children requiring hemodialysis and sizes 12–14 fr silicone catheters for adolescents and adults requiring hemodialysis'. Data were collected prospectively using a structured pro forma over a 2-year period (June 2010–May 2012) and analyzed with SPSS 15. Results: A total of 77 lines were inserted four as tunneled lines and 73 as nontunneled lines. Forty-seven (61.0%) patients were male, 30 (39.0%) were female, with age range of 1–80 years. The success rate was 97.4%. The overall complication rate was 16.9%. Conclusion: Our initial experience with the use of central venous lines, was marked by a high success rate, few manageable complications and no mortality over the study period. Majority of insertions were done by the bedside under local anesthesia lending credence to the assertion that it is a relatively safe procedure that can be done by any adequately trained doctor and should, therefore, be encouraged in our hospitals.

A Comparative Study of Serum Ferritin Levels Among Unfit and Fit Blood Donors

Abstract: Background: Cheap methodologies are being utilized by low-resource countries to determine blood donors' fitness. Important hematological biomarkers might have to be evaluated to enhance the use of these methods. Aims: The study evaluated the pattern of serum ferritin in 18–24 fit and unfit prospective blood donors (PDBs) and the prevalence of iron store deficiency. Settings and Design: This study was a cross-sectional, comparative study which was conducted at the blood donor clinic of the Lagos University Teaching Hospital. Materials and Methods: Blood samples were collected by venipuncture into sodium-ethylenediaminetetraacetic acid and plain bottles. The latter was centrifuged and used for ferritin determination via human ferritin enzyme-linked immunosorbent assay test kit, while the former was used for red cell indices analysis using an autoanalyzer. Statistical Analysis: Data were analyzed using SPSS version 20, values were presented as mean ± standard deviation, and P ≤ 0.05 was considered statistically significant. Results: A total of 263 PDB were recruited into the study consisting of 210 (79%) males and 53 (21%) females, with a mean age of 32.88 ± 8.22. Only 110 (41.8%) of the participants were considered fit, while 153 (58.2%) were unfit using copper sulfate specific gravity. There was no statistically significant difference (P = 0.301) in the mean level of serum ferritin in unfit blood donors (74.5 ± 90.8 μg/L) compared to that of the fit blood donors (61.5 ± 54.5 μg/L). The prevalence of iron store depletion among blood donors in Lagos state was 11.8% (31 of 263) with a higher proportion (7.6%) occurring among unfit donors. However, low levels of serum ferritin (<15 μg/L) were significantly associated with the occurrence of anemia (hemoglobin < 12.5 g/gl) among unit donors (19%; P = 0.05). Conclusion: Although serum ferritin depletion appears to be higher in the unfit blood donors, the use of serum ferritin as an index for the screening and determination of PDBs' fitness requires further evaluation.

In what ways might stories and anecdotes impact upon the quality of small group teaching in obstetrics and gynecology

Abstract: Objectives: The aim of this study was to find out how stories and anecdotes might improve the quality of the daily morning obstetrics and gynecology (O and G) teaching and determine if the emotions generated by the stories and anecdote deepened the understanding of medical topics. Materials and Methods: The overarching approach to this study was action research. On two occasions, I told stories using PowerPoint presentation during the morning teaching in the O and G seminar room to 10 and 11 learners instead of the traditional factual presentation of a medical topic. The learners ranged from the 3rd-year medical students to 4th-year specialist trainees in O and G and a consultant anesthetist. Each learner completed a feedback questionnaire at the end of the teaching session. I noted the learners' comments and analyzed written feedback. Results: More than 90% of the learners agreed or strongly agreed that the stories were appropriate for their level of training, and on both occasions, every single learner agreed or strongly agreed that the stories improved the quality of the morning teaching. On both days all but one learner agreed or strongly agreed that the stories improved their understanding of the medical topics, and a senior O and G trainee wrote that the story was: “useful – improved my understanding of situation involved.” The stories generated a lot of emotion in the learners, emotions that deepened their understanding of the topic covered. Conclusion: Stories and anecdotes appear to improve the quality of teaching, and this was the case regardless of level of training and experience of the learner. Hence, stories and anecdotes may be an excellent teaching tool in a setting like the morning teaching where the learners are quite varied.

Towards 2030 Target for Hepatitis B and C Viruses Elimination: Assessing the Validity of Predonation Rapid Diagnostic Tests versus Enzyme-linked Immunosorbent Assay in State Hospitals in Kaduna, Nigeria.

Abstract: Introduction: Sub-Saharan Africa accounts for 25% of the estimated global 325 million people with chronic hepatitis B and C virus infections. Weak blood transfusion systems facilitate the spread of both hepatitis B and C virus infections. This is worsened by the absence of sustainable quality assurance programs and perennial shortage of sensitive screening kits. We aim to compare the validity of rapid diagnostic tests (RDTs) with the World Health Organization-recommended quality-assured enzyme-linked immunosorbent assay (ELISA) screening method for these viruses. Materials and Methods: We conducted a cross-sectional study on consecutive blood donor samples. Two hundred and sixty-four blood donor samples screened for hepatitis B and C viruses using RDTs were retested at a National blood transfusion service, Kaduna, Nigeria. Data were analyzed using OpenEpi version 3.01 to determine the sensitivity, specificity, and predictive values of RDTs versus ELISA. Results: The sensitivities of the RDTs at 95% confidence interval (CI) were low – 40% (19.8–64.3) and 50.0% (18.8–81.2) – for hepatitis B surface antigen (HBsAg) and hepatitis C virus (HCV) antibody, respectively. The specificities and 95% CI were high – 99.9% (97.8–99.9) and 100.0% (98.5–100) for HBsAg and HCV antibody, respectively. Conclusion: Predonation RDTs screening of blood donor samples for hepatitis B virus and HCV in hospital donation units performed poorly compared to quality-assured ELISA screening in Kaduna. The risk of transmitting viral hepatitis through blood transfusion still exists. We recommend quality-assured ELISA screening of all donated units for HBsAg and HCV antibody to reduce the risk of these transfusion-transmitted infections.

Hypertension and Sudden Unexpected Deaths: An Autopsy Study of Four Hundred and Seventy-Seven Brought-in-Dead in a Tertiary Health Center.

Abstract: Introduction: Hypertension is an important and major public health concern globally. One of the major causes of sudden death worldwide is hypertension. This study is to present the morphological pattern of deaths at autopsy of those patients who were brought-in-dead (BID) and who had hypertensive heart disease (HHD) as the underlying illness. Materials and Methods: This is a 6-year retrospective autopsy study of BID patients as a result of HHD seen at our department between January 1, 2010, and December 31, 2015. The autopsy findings and data retrieved were analyzed using IBM Statistical Package for Social Sciences version 20. Test for statistical significance was set at P < 0.05. Results: A total of 477 deaths (44%) as a result of HHD were recorded out of the 1016 BID during the period under study. The age ranged from 21 to 92 years with a mean age of 52 ± 14.0 years and a male to female ratio of 1.8:1. The 5th decade of life was the most common age group encountered. The most common cause of death was acute left ventricular failure (67.8%), and myocardial infarction was the least common (1.7%). Conclusions: Acute left ventricular heart failure was the most common cause of sudden death as a result of hypertension and was followed by intracerebral hemorrhage. In the female gender, sudden deaths were most common in the 6th decade and in the male gender most sudden deaths were seen in the 5th decade.

The Impact of 6-month Micronutrient Supplementation on Viral, Immunological, and Mental Health Profile of a Cohort of Highly Active Antiretroviral Therapy-Naive HIV-Positive Patients in Northern Nigeria.

Abstract: Background: HIV is a chronic disease with inflammatory reactions involving numerous elements of the immune system, resulting in an increased risk for other physical and psychiatric morbidities. Micronutrients, some of which possess anti-inflammatory properties, may help prevent the development of psychological disorders such as anxiety and depression in people living with HIV disease. Objectives: This study examined the profile of viral load, CD4 cell count, C-reactive protein, anxiety, and depression among highly active antiretroviral therapy (HAART)-naive HIV-positive patients receiving micronutrient supplementation over a 6-month period. Materials and Methods: A total of ninety HAART-naive HIV-infected patients completed the Hospital Anxiety Depression Scale. Their blood samples were taken for serum viral load, CD4 cell count, and C-reactive protein at baseline. They all received a micronutrient supplement for 6 months, and 68 participants who remained in treatment at 6 months were reassessed with the same parameters. Results: After 6 months of micronutrient supplementation, the participants were found to have statistically significantly lower mean scores on the anxiety (t-test = 2.970,P = 0.003) and depression (t-test = 3.843,P = 0.001) subscales. They also had statistically significantly lower median CD4 cell count (P = 0.00) and C-reactive protein serum measures (P = 0.04). The median viral load decreased although the difference was not statistically significant. Conclusion: Micronutrient supplementation may reduce inflammatory reactions, anxiety, and depression in HAART-naive HIV-infected persons.

Validation of Age Determination with Historical Events in Birnin Kebbi, Northwest Nigeria.

Abstract: Context: Birth registration is not universal and remains elusive for some people living in developing countries, such as Nigeria; hence, age determination for healthcare and health-related research is often problematic. Aims: The aim is to validate the use of a historical events' scale as a tool for estimating the age of Nigerian adults residing in Birnin Kebbi, Northwest Nigeria. Settings and Design: A cross-sectional survey was conducted in Birnin Kebbi, a metropolitan capital city of Kebbi state, Northwest Nigeria, and included adults aged 18 years and older with a valid document indicating their year of birth. Subjects and Methods: Seven historical events comprising major national events were cross-referenced to the individual's personal history to estimate their ages, which were then compared to their documented ages. Statistical Analysis Used: Relationship of the documented and estimated ages was assessed with the Spearman's rank-order correlation and intraclass correlation coefficient (ICC) analyses. Results: A total of 288 subjects (63.2% males) with a mean documented age of 34.5 ± 11.3 (range 18–75) years were surveyed. The mean estimated age was 32.5 ± 11.18 years. Spearman's rank-order correlation analysis showed a statistically strong positive correlation between the actual and estimated ages (0.953, P < 0.001). The ICC between documented and estimated ages was 0.968 (95% confidence interval = 0.959–0.975). Conclusions: The use of this tool in Nigerian adults provides a reasonably accurate age estimation. Its use in populations and communities with inadequate birth registration may improve the quality of age-related health data in Nigerian adults.

Awareness of papanicolaou smear and visual inspection with acetic acid as screening tools for cervical cancer among women attending the general outpatient clinic of a Tertiary Institution in North Central Nigeria

Abstract: Background: Cervical cancer is the second most common cancer in women worldwide and the leading cause of cancer deaths in developing countries. Knowledge and awareness of the disease in Africa are very poor, and mortality from the disease is still very high. Screening in most developing countries is mainly opportunistic. This study was undertaken to determine the level of awareness of Papanicolaou (Pap) smear and visual inspection with acetic acid (VIA) as screening methods for cervical cancer to assist in the early diagnosis of the disease. Materials and Methods: This hospital-based, descriptive, cross-sectional study involved women aged 21–65 years who attended the general outpatient clinic of Dalhatu Araf Specialist Hospital, Lafia, either as patients or patients' relatives during the study period. A simple random sampling technique was used to recruit 239 participants using the Leslie Kish formula. Data collected about the participants included sociodemographic background, gynecologic and other relevant medical histories, awareness of cervical cancer, and awareness of Pap smear and VIA as screening tests for cervical cancer. The results were reported as frequencies and percentages only. Results: Only 28 (11.7%) study participants had heard about cervical cancer and only 10 (4.2%) were aware of Pap smear as a screening test for cervical cancer. None of the participants were aware of VIA as a screening test for cervical cancer. Conclusion: This study revealed that the level of awareness about cervical cancer among the study participants was low. No participant was aware of VIA as a screening method for cervical cancer, but a small percentage of the participants were aware of Pap smear test. It is recommended that efforts should be intensified to improve the awareness of population at risk of cervical cancer.