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   Table of Contents - Current issue
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July-September 2019
Volume 22 | Issue 3
Page Nos. 109-156

Online since Thursday, September 26, 2019

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ORIGINAL ARTICLES  

Demographic profile and pattern of fatal firearm injuries in an urban city in south-South Nigeria Highly accessed article p. 109
Obiora Jude Uchendu, Nkadi Francis Nwachokor, Eseroghene Arthur Ijomone
DOI:10.4103/smj.smj_46_18  
Background: Recurrent war, agitation, and terrorism in West African sub region have encouraged access to both local and imported firearm with a consequent increase in circulating firearm in Nigeria. Objective: This study aims to describe the demographic profile and pattern of firearm injuries in Warri, Delta state, Nigeria. Materials and Methods: This is a descriptive retrospective study of autopsied firearm deaths in Warri, Delta state from January 1, 2003, to December 31, 2016. The relevant information for this study was extracted from coroner forms and autopsy notes. Results: A total of 421 cases of firearm-related deaths comprising 399 males and 22 females were investigated. The ages of the victims ranged from 0.4 to 69 years, with a mean of 33. 99 (±11.36) years and a peak age group in the third decade. Homicide was the circumstance of death in 416 (98.8) cases, while accident accounted for the remaining 5 (1.2%) cases. Rifled guns and shotguns were the weapons used in 262 (62.2%) and 159 (37.7%) cases, respectively. Businessmen, civil and public servant, artisans, unemployed youths, students, and marine workers were the victims in 101 (24%), 79 (18.8), 71 (16.6), 39 (16.6%), and 36 (6.2%) of the cases, respectively. The victims hailed from multiple tribes with the Urhobos, Igbos, Ijaws, and Itsekiris accounting for 152 (36.1), 52 (12.4%), 38 (9.0%), and 28 (6.7%) of the cases, respectively. Conclusion: Firearm injury is a major cause of unnatural death in this region, affecting young males across all socioeconomic class of resident tribes. Amicable resolution of the lingering crisis in the Niger Delta region, reducing unemployment rate, educating, and re-orienting the youths, strict regulation of firearm possession, enforcement of law and order, and upgrading of the state of the health facility in Delta state will go a long way in ameliorating this ugly trend.
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Knowledge and prevalence of diarrheal disease in a suburban community in north western Nigeria p. 114
Victoria Nanben Omole, Teyil Mary Wamyil-Mshelia, Ramatu Aliyu-Zubair, Onyemocho Audu, Abdulrazak A Gobir, Bilkisu Nwankwo
DOI:10.4103/smj.smj_50_18  
Background: Diarrheal disease is the second leading cause of under-five mortality, accounting for 700,000–800,000 preventable deaths, globally. Most of these occur in rural and suburban areas of developing countries. Correct knowledge about the dynamics of the disease is crucial in arresting and reversing its prevalence. Objective: The objective of the study was to determine the prevalence of diarrheal disease in a suburban community and explore the knowledge of the disease among mothers of children <5 years of age therein. Materials and Methods: A cross-sectional, descriptive study was conducted among 350 mothers of under-fives in a suburban community. Respondents were selected by multistage sampling method and interviewed using interviewer-administered, closed-ended questionnaires. Results: About 89.4% of the respondents had correct perception of the definition of diarrhea. Over 60% of them had correct knowledge of the cause (s) of diarrheal disease, and none was ignorant of the potential complications. Both point and period prevalences for the disease were 13.14% and 30.29%, respectively, and these were relatively higher than local, regional, and national values. Conclusion: The good knowledge of diarrheal disease observed among respondents was not reflected in the unacceptably high prevalence and frequency of the disease. This may be attributable to the challenges of poor water sources and insanitary environmental conditions. Public health interventions are recommended with particular attention to environmental sanitation and water supply in suburban and rural communities.
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Pencil grip patterns among pupils p. 121
Igho Emmanuel Odokuma, Efe Jennifer Ojigho
DOI:10.4103/smj.smj_75_17  
Background: Pencil grip describes the position of the fingers in gripping a pencil. It commences in the preschool years with the introduction of pencils markers, and other graphomotor skills, therefore, relevant to graphologists, forensic medicine, and anthropology. Objective: This investigation aimed at describing the diversity of pencil-grip patterns among pupils in Delta State, Nigeria. The effects of sociodemographic factors, handedness, and handwriting speed on pencil-grip patterns were also highlighted. Materials and Methods: A stratified random sampling was employed in this cross-sectional study. A total of 284 pupils between the ages of 1 and 10 years were investigated. Pupils were observed while writing from their textbooks. Photograph of the writing hand was captured with the digital canon camera. Handwriting speed was determined by a speed score (L/min) and timed for 60 s for each participant. Data were analyzed using the Statistic Package for the Social Sciences 20. The Kruskal–Wallis (K.W.) test was used to establish the relationship between pencil-grip patterns and sociodemographic factors, handedness along with handwriting speed. Results: Findings showed that the age had a statistically significant effect on pencil-grip patterns among nursery pupils at P < 0.05 (K.W. = 23.78, df = 4, and P= 0.00). It was also observed that the gender had a statistically significant effect on pencil-grip patterns among primary pupils (P < 0.05)(K. W. = 6.89. df = 1, and P= 0.00). Conclusion: The dynamic tripod grip was predominant among participants; however, there were variations in grip patterns among participants which were attributed to the effect of some sociodemographic factors.
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Fibrous histiocytoma of the orofacial region in Nigerians: A retrospective review of 11 cases p. 127
Rowland Agbara, Benjamin Fomete, Athanasius Chukwudi Obiadazie, Kelvin Uchenna Omeje, Modupeola- Omotara Samaila, Sunday Olusegun Ajike
DOI:10.4103/smj.smj_65_17  
Background: Fibrous histiocytoma (FH) is a rare tumor that may exhibit benign, borderline, or malignant features. It has a site predilection for the skin of the extremities. Occurrence in the orofacial area is very rare. Objective: This review highlights the clinic-epidemiologic characteristics of 11 patients with orofacial FH (OFH) diagnosed at a tertiary health facility Materials and Methods: All cases with a histological diagnosis of OFH seen at the oral and maxillofacial surgery clinic of a regional university teaching hospital in Nigeria between May 1995 and June 2016 were retrospectively studied. Data retrieved were analyzed using the Statistical Package for the Social Sciences version 16 (SPSS Inc., Chicago, IL, USA). Findings from descriptive statistics were represented in the form of tables and charts. Results: Eleven patients were seen within the years reviewed, and the most common clinical presentation was jaw swelling. There were gender and site predilections for male individuals and mandible, respectively. Surgery was the main modality of treatment used and this consisted of maxillectomy (n = 1; 9.1%), mandibulectomy (n = 3; 27.3%), soft-tissue excision (n = 2; 18.2%), and a combination of jaw resection with soft-tissue excision (n = 1; 9.1%). Two patients (18.2%) presented with recurrence 1 year and 5 months postsurgery, respectively. Conclusions: OFH is rare. Early diagnosis and adequate margin of excision/resection at the first surgery is important in achieving control, and long-term follow-up remains the rule.
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Awareness of stroke, its warning signs, and risk factors in the community: A study from the urban population of Benin City, Nigeria p. 134
Edith Kayode-Iyasere, Francis Ehidiamen Odiase
DOI:10.4103/smj.smj_4_18  
Background: Stroke is increasingly a major cause of mortality and morbidity in Nigeria. Studies in Nigeria regarding public awareness of stroke are few and mainly hospital based. Objectives: This study was designed to assess the level of public awareness of stroke, its warning signs, and risk factors in the urban population of Benin City, Nigeria. Materials and Methods: This was a cross-sectional study carried out in Benin City, Edo State, Nigeria. Participants were recruited randomly in public places and interviewed face to face with a questionnaire to determine their demographics, knowledge of stroke, its warning signs, and risk factor with source of information on stroke. Data analysis was with the Statistical Package for the Social Science (SPSS) version 21with a level of significance of P < 0.05. Results: Five hundred and twenty-five respondents were recruited with a median age of 42 (12.1) years. The most identified risk factor for stroke and warning sign for stroke by respondents were hypertension (93.2%) and sudden-onset loss of speech (77.3%), respectively. Faith-based settings (39.5%) were the most common sources of information about stroke while hospital settings accounted for only 12.1%. The awareness of stroke campaign 9.97 (confidence interval [CI], 5.75–17.3, P≤ 0.001) and awareness that the brain is involved in stroke 7.51 (CI, 4.11–13.72, P≤ 0.001) were significantly associated with identifying at least one warning sign of stroke. Conclusion: Awareness of stroke, its risk factors, and warning signs is good in this urban community of Benin, but the major sources of information are from faith-based settings. It is recommended that efforts should be sustained at continuous health education campaigns, and it is hoped that other avenues of information, mass media, and hospital settings should be optimized to ensure robust knowledge about stroke.
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Prevalence of hepatitis B in human immunodeficiency virus patients in Kubwa General Hospital p. 140
Osaze Ojo, Sohmicit Mamven, Richard Akintayo, Chukwuebuka Onyegiri
DOI:10.4103/smj.smj_5_18  
Background: Both human immunodeficiency virus (HIV) and hepatitis B infections are endemic in sub-Saharan Africa and both viruses have common routes of transmission. Objectives: To determine the prevalence of hepatitis B virus (HBV) in patients with HIV in Kubwa General Hospital, Abuja, Nigeria. Materials and Methods: We carried out a retrospective study of HBV positivity among patients diagnosed with retroviral disease seen over a 1-year period. Results: The case folders of a total number of 332 patients with HIV who received care over the study period were reviewed. Men and women accounted for 30.42% and 69.58%, respectively, with a male-to-female ratio of about 1:2. Their mean age was 34.76 ± 8.84 years, while the median age was 33.5 years. The categorization of the age groups was as follows: young (<40 years; 72.29%), middle age (40–65 years; 27.41%), and elderly (>65 years; 0.3%). Hepatitis B co-infection was present in 9.24% of patients with HIV. The mean CD4 count was 409.33 ± 262.22. The classification of CD4 count values was as follows: <200 (24.83%), 200–500 (47.20%), and > 500 (27.97%). Those who were either married (58.91%) or were single (32.32%) constituted the majority of the patients. Unprotected sex (73.79%), harmful traditional practice 17 (5.12%), history of blood transfusion (5.12%), intravenous drug abuse (0.60%), and commercial sex worker (0.30%) were the commonly identifiable risk factors. Conclusion: Among patients living with retroviral disease, hepatitis B infection is more prevalent in women as well as in young and middle-aged patients compared with the elderly. Unprotected sex was the most common identifiable risk factor for hepatitis B positivity.
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Profile of botulinum toxin injections in a neurology outpatient service Hospital: A preliminary report p. 145
Frank Aiwansoba Imarhiagbe
DOI:10.4103/smj.smj_2_18  
Background: The use of botulinum toxin in neurology outpatient service is at its infancy in sub-Saharan Africa owing largely to the prohibitive cost and lack of requisite expertise in the use of the toxin. This leaves a huge gap in the treatment of focal dystonias and dyskinesias. Objective: The objective of this study is to profile the use of botulinum toxin in a neurology outpatient service in Nigeria. Methods: Ten consecutive patients with different neurologic disorders who had the injection of onabotulinum toxin type A (Otesaly ®, Guangzhou Boss Biological Technique Ltd., China) were reviewed for demographics and clinical diagnosis and whether or not they have been exposed to botulinum toxin before, units of botulinum toxin received, and response to the injection. Botulinum toxin was supplied with strict adherence to the cold chain prescription (2°C–8°C) and constituted with normal saline before injection, and all injections were given by a neurologist-trained hands-on in the use of botulinum toxin. Results: The mean age of study participants was 54.77 ± 10.17 years and all of them were males. Blepharospasm alone or as part of Meige syndrome with spasmodic dysphonia was the most frequent clinical diagnosis, which accounted for 7 (70%) of the total; 1 (10%) had cervical dystonia and 2 (20%) had hemifacial dyskinesia. The median dose of botulinum toxin type A injected was 83.33 units (interquartile range [IQR]: 50–100) and the median duration of symptoms was 5 years (IQR: 5–10). Eight (80%) cases had good response with moderate-to-complete resolution of symptoms by Jankovic rating 0–2. Conclusion: The gap in the treatment of craniocervical dystonias and blepharospasm as the dominant presentation is obvious.
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CASE REPORTS Top

Management of tetralogy of Fallot with Blalock–Taussig shunt alone in a low-resource setting p. 149
Ehi Judith Ogbemudia, Stanley Okugbo
DOI:10.4103/smj.smj_22_18  
The outcomes of management of Tetralogy of Fallot (TOF) in children with only BT shunts have not been widely reported. Therefore, we present a 29-year-old man with complaints of progressive easy fatigability and effort intolerance. He was diagnosed with TOF in infancy and had both left- and right-sided BT shunts without corrective surgery. Examination revealed an asthenic young man with conjunctival plethora, cyanosis, digital clubbing, and hypertension. Chest X-ray, electrocardiography, and echocardiography revealed the typical anomalies of TOF. He has been referred for corrective surgery. Despite two previous BT shunts, the investigations still revealed the structural anomalies of TOF; this confirms BT shunt is not the definitive treatment but a palliative measure. Total corrective surgery remains the definitive treatment of TOF. Patients and their caregivers should be counseled on this and on the need for early corrective surgery.
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Lumbar plexiform neurofibroma, short stature, and kyphoscoliosis in neurofibromatosis-1: A Rare entity p. 153
Ernest Ndukaife Anyabolu
DOI:10.4103/smj.smj_24_18  
The incidence of neurofibromatosis (NF), comprising NF-1 and NF-2, seems to be rising in Nigeria. The features of NF-1 have not been completely identified in the country. This case report documents a rare massive lumbar plexiform neurofibroma in NF-1, associated with short stature and kyphoscoliosis. The patient was a 38-year-old man who presented on account of a lumbar swelling for 2 months. He has multiple café-au-lait hyperpigmented lesions, multiple neurofibromas, a massive plexiform neurofibroma in the left lumbar area, a short stature, and kyphoscoliosis. His nephew has a similar skin lesion but has no plexiform neurofibroma. Computed tomography scan showed a massive neurofibroma in the lumbar region without evidence of malignant transformation. Concomitant occurrence of a massive plexiform neurofibroma, short stature, and skeletal abnormalities in NF-1, though rare, was presented. The patient had a massive lumbar plexiform neurofibroma, short stature, and kyphoscoliosis in NF-1.
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