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   Table of Contents - Current issue
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April-June 2019
Volume 22 | Issue 2
Page Nos. 47-108

Online since Thursday, June 20, 2019

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ORIGINAL ARTICLES  

Outcome of hyperglycemic emergencies in a tertiary hospital, South East, Nigeria Highly accessed article p. 47
Marcellinus O Nkpozi, Ignatius U Ezeani, Ibitrokoemi F Korubo, Sunny Chinenye, Assumpta U Chapp-Jumbo
DOI:10.4103/smj.smj_71_17  
Background: Hyperglycemic emergency (HE) is typically represented by diabetic ketoacidosis, (DKA) and hyperosmolar hyperglycemic state (HHS). It is a common cause of hospitalization due to diabetes mellitus (DM) and is associated with considerable mortality. In South East Nigeria, there is a paucity of studies on the treatment outcome of HE, hence the need for this study. Objective: The aim and objective of the study were to determine the outcome of treatment of adult persons living with diabetes managed for HE at Federal Medical Centre (FMC), Umuahia. Materials and Methods: This was a prospective study in which 110 consecutive adult patients managed for HE at FMC, Umuahia, were recruited. Data obtained included a total number of medical and diabetic admissions within the study period. For participants that met the inclusion criteria for the study, their bio-data, blood pressures, level of consciousness at presentation or while being treated, random plasma glucose, plasma electrolytes, urea, creatinine, and plasma 3-beta-hydroxybutyrate were noted and/or measured. Similarly, urine sample was collected from each participant for analysis (glucose, protein, and ketone). The outcome measures were patient's survival, hospitalization duration, and death. Analysis of data was done using SPSS 20.0 and the level of statistical significance was set at P < 0.05. Results: Of the 110 participants recruited, there were 46 (41.8%) males and 64 (58.2%) females. HE constituted 15.6% of the total medical admissions within the study period with a mortality of 10%. DKA and mixed form of HE were the predominant patterns in the study. While hospitalization duration was variable, no female participant was discharged against medical advice. Conclusion: The study showed that HE is a frequent acute complication of DM in this region of Nigeria and that HE typically presents as DKA and mixed form. Hospitalization for HE had a variable duration with a significant mortality.
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Prevalence and correlates of anemia in type 2 diabetes mellitus: A study of a Nigerian outpatient diabetic population p. 55
Oyindamola Ibukun Awofisoye, Jokotade Oluremilekun Adeleye, John Ayodele Olaniyi, Arinola Esan
DOI:10.4103/smj.smj_65_18  
Background: Anemia is reportedly common in type 2 diabetes mellitus (T2DM), and it is often unrecognized or overlooked, despite its contribution to the morbidity and mortality. With the growing burden of diabetes in sub-Saharan Africa, the occurrence of anemia among T2DM patients needs to be adequately characterized. Objective: We aimed to determine the prevalence and correlates of anemia among Nigerian patients with T2DM attending a tertiary outpatient clinic. Materials and Methods: It was a cross-sectional study involving 155 patients with T2DM and 78 controls without diabetes. Full blood count, serum creatinine, fasting plasma glucose, glycosylated hemoglobin (HbA1c), and spot urinary albumin–creatinine ratio were determined in the patients. The frequency and determinants of anemia among the participants were determined. Results: Anemia was found in 45.2% of the T2DM patients, compared to 28.2% of the controls (P = 0.012). The T2DM patients were twice as likely to have anemia as the controls. Among the T2DM patients with anemia, majority (68.6%) had a normocytic anemia, while 25.7% and 5.7% had microcytic and macrocytic anemia, respectively. The independent predictors of anemia were longer duration of diabetes and lower estimated glomerular filtration rate (eGFR) with odds ratio of 2.1 and 4.7, respectively. Conclusion: Anemia is common in T2DM patients including those with normal eGFR. Longer duration of diabetes and declining eGFR were the major factors associated with anemia. Screening for anemia is recommended for patients with T2DM as part of their routine annual evaluation, especially in those with longer disease duration and eGFR <60 ml/min.
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Risk factors for chronic kidney disease among in-school adolescents in Ibadan, Southwest, Nigeria p. 64
Olufolake Onuche Abu, Yemi Raheem Raji, Olukemi Kehinde Amodu
DOI:10.4103/smj.smj_21_18  
Background: Chronic kidney disease (CKD) a common noncommunicable diseases associated with high morbidity and mortality. Epidemiology of CKD in Sub-Saharan Africa suggests high burden of CKD with early onset. The adolescent age group has been reported to be at increased risk of kidney disease arising from prevalent risky behaviors and obesity. The in-school adolescents constitute a large group of at-risk individuals that are easily accessible for screening. Objective: This study aimed to determine the prevalence of kidney CKD and its risk factors among in-school adolescents. Materials and Methods: This was a cross-sectional study of 420 in-school adolescents in Ibadan, Southwest Local Government Area, Ibadan, Nigeria. A pretested questionnaire was administered to the participants selected using multistage clustered sampling technique. Anthropometric and blood pressure measurements were taken, urine samples were collected for dipstick urinalysis, while 80 participants provided blood for serum creatinine and estimated glomerular filtration rate (eGFR). Results: A total of 420 in-school adolescents participated in the study, the mean age was 14.0 ± 2.3 years and 57.4% were female. The mean body mass index, mid-upper arm circumference (MUAC), and median eGFR were 19.9 ± 3.7 kg/m2, 20.8 c ± 3.7 cm, 96.1 (36.6–156) ml/min/1.73 m2, respectively. The common risk factors for CKD were herbal consumption (59.2%), abnormal MUAC (47.1%), and truncal obesity (28.3%). Proteinuria, hematuria, and CKD were observed in 10%, 16%, and 21.3% of the participants, respectively. Excess body weight (odds ratio [OR], 5.03), abnormal MUAC (OR, 4.11), hypertension (OR, 2.51), and family history of kidney disease (OR, 1.58) were independently associated with CKD. Conclusions: CKD and its risk factors were common among in-school adolescents and the occurrence of CKD was associated with excess body weight, abnormal MUAC, hypertension, and family history of kidney disease.
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Acute stroke in Jos University Teaching Hospital: Cranial computed tomographic findings and accuracy of the clinical diagnosis p. 71
Yetunde Folake Taiwo, Emmanuel Owoicho Igoh, Charles Chibuzor Ani, Stephen Daniel Pam, Kenneth Yakubu, Femi Olu Taiwo
DOI:10.4103/smj.smj_31_18  
Background: Cranial computed tomography (CT) is an invaluable tool useful in promptly differentiating hemorrhagic from ischemic stroke. However, due to the cost of CT, there has been a reliance on the World Health Organization (WHO) clinical diagnosis of stroke in some low-resource settings. Objective: The aim of the present study is to determine the pattern of acute stroke as seen on CT and to determine the accuracy of the clinical diagnosis using the WHO method. Materials and Methods: This was a cross-sectional descriptive study conducted from September 2014 to June 2015. We included 150 consecutive patients aged 18 years and above with acute stroke. Initial physician diagnosis using the WHO method was obtained, followed by a radiological evaluation using CT. The Statistical Package for the Social Sciences version 20.0 with results represented in simple proportions and percentages. Statistical level of significance was set at P ≤ 0.05. Results: The mean age (standard deviation) was 57.97 (14.2) years with females making up 50.7% (76/150). Ischemic stroke was found to be the more common type of acute stroke (69.3%) (104/150) with the parietal lobe being the site most commonly affected by both strokes types. The positive predictive and negative predictive values of the WHO clinical diagnosis for ischemic and hemorrhagic strokes were 79.13% and 68.97% and 68.97% and 79.13%, respectively. Conclusions: A low accuracy in the WHO clinical diagnosis of stroke was observed. Ischemic stroke is the more common stroke and parietal lobe the most commonly affected site.
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Prevalence and outcome of hypoglycemia in children attending emergency pediatric unit of a specialist hospital in Nigeria p. 77
Abdullahi Musa, Bilkisu Garba Ilah, Aminu Muhammad Sakajiki, Akeem Oladiran Adeniji, Ibrahim Yusuf
DOI:10.4103/smj.smj_12_18  
Background: Hypoglycemia is a common metabolic problem encountered in pediatric emergency admissions. The absence of clinical symptoms does not preclude the presence of hypoglycemia as presentation may vary from asymptomatic to central nervous system and cardiopulmonary disturbances. If untreated, hypoglycemia can result in permanent neurological damage or even death. Objectives: The objective of the study is to determine the prevalence, associated factors and outcome of hypoglycemia in pediatric emergency admissions at Ahmad Sani Yariman Bakura Specialist Hospital, Gusau, Nigeria. Materials and Methods: The study was a prospective cross-sectional study involving children aged 1 month–13 years. Blood glucose was determined at admission using Accu-Chek® Active Blood Glucose Meter, and hypoglycemia was defined as blood glucose levels <2.8 mmol/L (<50 mg/dL). Age of the patients, sex, interval of last meal, presenting complaints diagnoses were recorded. Results: A total of 154 children were studied. Thirty (19.5%) were infants and 71 (46.1%) were under-fives. Eighty-seven (56.5%) were males with male to female ratio of 1.3:1. The prevalence of hypoglycemia was 22.1%. The predominant disease conditions the children with hypoglycemia presented with were severe malaria, acute diarrheal disease, and sepsis. The prevalence of hypoglycemia was significantly higher among children whose last meal was 8 h and above before presentation (42.9%). Children who presented with hypoglycemia were significantly more likely to die (odds ratio [OR] =13.3; 95% confidence interval [CI] =4.6–38.7). Among those with hypoglycemia, males were significantly more likely to die (OR = 4.2, 95% CI = 1.0–18.0). Hypoglycemia was significantly associated with mortality in children with severe malaria and pneumonia (P = 0.04 and 0.01, respectively). Conclusion: The prevalence of hypoglycemia is still high in our emergency admissions. It is associated with significant mortality especially among male children and those presenting with severe malaria and pneumonia. We recommend that hypoglycemia sought for and promptly treated in children presenting to emergency to reduce mortality.
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Prevalence of hyperhomocysteinemia and hypovitaminosis B12 among acute ischemic stroke patients p. 82
Hafsatu Maiwada Suleiman, Ibrahim Aliyu Sambo, Sani Atta Abubakar, Elbashir Mohammed Jibril, Muhammad Ibrahim Zaria, Rasheed Yusuf, Rabiu Adamu, Mohammed Manu, Bello Yusuf Jamoh
DOI:10.4103/smj.smj_70_17  
Background: Deficiency of Vitamin B12 can lead to hyperhomocysteinemia. Hyperhomocysteinemia constitutes an abnormally high level of homocysteine in the serum, above the upper limit of normal for an environment. The two conditions are significant risk factors for the development of stroke. There is a paucity of data on the prevalence of these biochemical risk factors in stroke patients in our environment which brought about this study. Objective: The objective of the study was to determine how prevalent hyperhomocysteinemia and hypovitaminosis B12 are in acute ischemic stroke patients in Zaria. Materials and Mthods: This is a cross-sectional prospective study conducted from February 2014 to March 2015 in ABUTH Zaria. One hundred patients with clinical diagnosis of first-ever ischemic stroke confirmed by brain computed tomography scan, and another apparently healthy age- and sex-matched one hundred controls were recruited. Their fasting serum homocysteine and Vitamin B12 were determined using the enzyme-linked immunosorbent assay technique. Prevalence of high homocysteine and low Vitamin B12 was determined. Results: Thirty-four percent (34%) of patients had high and 66% patients had normal serum homocysteine, whereas 81% of patients had low and 19% of patients had normal serum Vitamin B12, and the difference was found to be statistically significant (P < 0.05). There was significant negative correlation between serum homocysteine and Vitamin B12 among cases with P = 0.04 and r = −0.198. Conclusion: The Prevalence rates of hyperhomocysteinemia and hypovitaminosis B12 among ischemic stroke pateints were 34% and 81%, respectively.
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D-dimer levels as marker of deep vein thrombosis in patients with cervical cancer: A study of a northern Nigerian patient population p. 86
Marliyya Sanusi Zayyan, Godfrey Kama Katung, Hassan Abdul-Aziz, Joseph Bako Igashi
DOI:10.4103/smj.smj_59_17  
Background: Cervical cancer is the most common genital tract malignancy in Nigeria and an important cause of cancer-related death in women. Patients with advanced cervical cancer are often victims of deep venous thrombosis (DVT) that increases morbidity and mortality. Strategies at screening and early diagnosis enable prompt treatment which improves quality of life. Objectives: The objective of this study is to determine the plasma D-dimer level in patients with cervical cancer and its relationship to the presence of DVT, Well's score, and stage of malignancy. Materials and Methods: It is a prospective cross-sectional descriptive study of patients with histological diagnosis of cervical cancer in a Nigerian population. Patients' clinical, laboratory, and radiological data were obtained, and their body mass index (BMI) was calculated. Well's chart 17 was used to categorize patients using a cutoff of 2. Plasma D-dimer was quantified by immunoturbidimetric method and interpreted as significant if >0.099 g/dl. High-resolution ultrasound with 5–10 MHZ linear probe was used to evaluate the lower limbs veins of the patients. Data were analyzed with SPSS version 20. The test of association was done using Chi-square with a P < 0.05 considered statistically significant. Results: A total of 77 patients were enrolled, but 67 patients had complete data. The mean age was 54.7 ± 11.2 years. The average parity was 7.5 ± 3.1. Majority (47.8%) had normal BMI. D-dimer was positive in 58 (87%). Of the 17 (25%) with both elevated D-dimer and high probability of DVT, 5 (29%) had DVT. The incidence of DVT among our study population was 7.5%. There was statistically significant relationship between stage of disease and an elevated D-dimer value (χ2 = 5.82, α = 0.016, 95% confidence interval). Conclusion: Deep vein thrombosis occurred only in patients with high D-dimer and high Well's score, which makes their combination relevant in early diagnosis. Advanced age, high parity advanced stage of disease was the main associated risk factors. All cases with DVT occurred in patients with squamous cell cancer.
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Spinal anaesthesia in paediatric orthopaedic services: A five year experience in a Nigeria hospital p. 92
Idehen Hanson Osazuwa, O Imarengiaye Charles
DOI:10.4103/smj.smj_42_18  
Background: The role of spinal anesthesia (SA) as a primary anesthetic technique in children is not a common practice in many centers in Nigeria. The reason for the poor utilization might be due to lack of expertise in pediatric SA, fear of adverse effect such as spinal cord injury. Objectives: This study is a retrospective audit of the anesthetic technique in the pediatric age group in a private orthopedic hospital in Nigerian. The outcome of this study will help reduce the misconception regarding its practicability and safety. Materials and Methods: This is a 5-year single center retrospective study of the anesthetic choice for surgeries on the lower limb in the pediatric age group in an orthopedic hospital. The survey extended from 2012 to 2016 and all relevant information obtained from the medical records of the surgical theatres of the hospital as well as anesthetic records of the patients. The children were assigned to four groups: I – neonates; II – infants 1 month–2 years; III – children 2–12 years; and IV – 12–16 years. Results: A total of 156 patients' records were reviewed. Spinal-induced hypotension occurred only in 4 patients (2.56%). All the 4/44 patients (9.09%) who had hypotension were in the adolescent age group. Conclusion: This study showed the feasibility of SA and good safety profile in the pediatric age group.
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Inflammatory and reactive lesions of the orofacial region in an African tertiary health setting p. 96
Benjamin Fomete, Rowland Agbara, Davis Sunday Adeola, Daniel O Osunde
DOI:10.4103/smj.smj_35_17  
Background: Chronic inflammatory and reactive lesions are tumor-like hyperplasia that are produced in association with chronic local irritation or trauma. These proliferations are painless pedunculated or sessile masses in different colors, from light pink to red. The surface appearance is variable from nonulcerated smooth to ulcerated growth, and they from a few millimeters to several centimeters in size. Common examples in the oral cavity include pyogenic granuloma (PG), epulis, traditional clinical name for gingival reactive proliferations, Irritation fibroma, epulis fissuratum, and giant cell granulomas which could either be of peripheral or central origin. Objective: To describe the pattern of inflammatory and reactive lesions of orofacial region. Materials and Methods: A retrospective study of patients attending the oral and maxillofacial clinic between January 2006 and December 2014 was undertaken. Results: One hundred and twelve patients, comprising 61 (54.5%) males and 51 (45.5%) females were seen over the period of study. Their age ranged from 1 to 80 years with a median age of 26.5 years. PG was the most frequently reported lesion accounting for 32 (28.6%). This was followed by nonspecific chronic inflammation (n = 23; 20.5%), epulis/peripheral giant cell granuloma (n = 13; 11.6%), granulation tissue (n = 10; 8.9%), and central giant cell granuloma, (n = 8; 7.1%). Conclusion: The results of the study show that inflammatory and reactive lesions are common in the study population.
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CASE REPORTS Top

Merkel cell carcinoma: A case report p. 102
Ismail Inuwa Mohammed, Ali Bala Umar, Jameel Ahmad, Ibrahim Aliyu, Tunde Oyebanji, Shehe Abdurrahman
DOI:10.4103/smj.smj_42_17  
Merkel cell carcinoma (MCC) is a rare type of skin cancer which often appears on sun-exposed areas. It is a fairly common tumor among the Caucasians but rarely occurs among Africans. Therefore, we report the case of a 25-year-old African woman who presented initially with painless swelling on the left upper limb which progressively increased in size and became painful with associated ipsilateral supraclavicular lymph node enlargement and lymphedema. She had excisional biopsy and histology which revealed MCC. The patient was subsequently referred for chemotherapy.
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Primary progressive multiple sclerosis in a 10-year-old Nigerian boy p. 105
Jane Owo Anyiam, Sani Musa, Hadiza Aliyu, Robinson Daniel Wammanda
DOI:10.4103/smj.smj_13_18  
Multiple sclerosis (MS) is generally believed to be extremely rare in black African children, and the primary progressive form is the rarest type. We describe a case of primary progressive multiple sclerosis (PPMS) in a 10-year-old Nigerian boy and highlight the challenges of management in a resource-limited setting. He presented with 2 years history of inability to neither walk nor use the left upper limb, and a year history of progressive loss of vision. The symptoms were insidious in onset and associated with nasal and slurred speech, hesitancy, incomplete voiding, and occasional jerky movement of the lower limbs. Examination revealed a cheerful child with good memory and intelligence. There were reduced muscle power and lead-pipe rigidity in all the limbs except the right upper limb which was normal. Fundoscopy revealed bilateral optic atrophy. The diagnosis of PPMS was made by the typical clinical presentation, and brain and spinal cord magnetic resonance imaging (MRI). We had no facilities for cerebrospinal uid monoclonal IgG. This case highlights the need for pediatricians in the tropics to have a high index of suspicion and for healthcare systems to be equipped with facilities to accurately diagnose pediatric MS.
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