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   Table of Contents - Current issue
January-March 2020
Volume 23 | Issue 1
Page Nos. 1-71

Online since Wednesday, March 18, 2020

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Pregnancy outcomes among women with early-onset severe preeclampsia managed conservatively Highly accessed article p. 1
Johnbosco Ifunanya Nwafor, Darlington- Peter Chibuzor Ugoji, Blessing Idzuinya Onwe, Vitus Okwuchukwu Obi, Chuka Nobert Obi, Victor Jude Uchenna Onuchukwu, Chukwunenye Chukwu Ibo
Background: Conservative management of early-onset severe preeclampsia is gaining widespread acceptance among obstetricians despite well-known maternal risks associated with it. There is limited data on the outcome of pregnancy of women managed with this modality of management in Nigerian setting. Objective: We determined the maternal and perinatal outcome of women managed conservatively for early-onset severe preeclampsia. Materials and Methods: This was a 7-year retrospective study of 118 women with early-onset severe preeclampsia that were managed conservatively at the Alex Ekwueme Federal University Teaching Hospital, Abakaliki. The data were entered and analyzed using the SPSS software version 22.0 (SPSS Inc., Chicago, IL, USA). Results: The median duration of expectant management was 12 days (range 3–20 days). The mean gestational age at delivery was 33.4 ± 2.5 weeks. The most common indication for delivery was uncontrolled hypertension (35.6%). Adverse maternal outcomes found in the study included abruptio placentae (11%), acute renal failure (2.5%), pulmonary edema (0.8%), eclampsia (11.9%), disseminated intravascular coagulation (2.5%), Haemolysis, elevated liver enzymes and low platelet (HELLP) syndrome (2.5%), and maternal death (2.5%). Perinatal mortality occurred in 68 (57.6%) cases in the study. Perinatal survival improved significantly with gestational age, with reductions in perinatal mortality of approximately 50% per week between 28 and 34 weeks' gestation on admission. Conclusion: Delayed delivery of women with early-onset severe preeclampsia improved perinatal outcome in this study, but it was associated with considerable maternal morbidity and mortality. Therefore, proper patient selection, adequate counseling of women on the risks and benefit of conservative management, close maternal monitoring, and the presence of advanced neonatal care are necessary to optimize pregnancy outcome when this management modality is adopted.
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Kidney transplant-related medical tourism in patients with end-stage renal disease: A report from a renal center in a developing nation p. 7
Hamidu Muhammad Liman, Muhammad Aliyu Makusidi, Aminu Muhammad Sakajiki
Background: Kidney transplant-related medical tourism is still prevalent in developing countries for patients with end stage renal disease. Objectives: We set out to review our single centre experience with kidney transplant-related medical tourism. Materials and Methods: We reviewed the demographic and clinical characteristics of our endstage renal disease patients who opted for kidney transplant over an 11 year period. Endpoint was kidney transplantation. Data was analysed with SPSS Statistical software Version 20. Results: A total of 27 patients were referred for kidney transplant evaluation, out of which 12(44.4%) were transplanted. All the 15 patients who were not transplanted died within one year of returning to our centre. The finding of co-morbidity during pre-transplant evaluation and lack of a suitable donor were the major reasons for our patients returning without a transplant. Of those who were transplanted, 5(41.7%) patients died from various complications. Conclusion: Kidney transplant-related medical tourism is still prevalent in Nigeria. Comorbidity and lack of suitable donor remain important impediments to kidney transplantation even when finance is available. Local Kidney transplant needs to be encouraged in Nigeria.
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Hip circumference correlates negatively with insulin resistance in type 2 diabetic patients p. 12
Nafisa Yusuf Wali, Mukhtar Isyaku Gwarzo, Salisu Ahmed Ibrahim
Background: Body adiposity is a known factor in the development of insulin resistance. Not much is known on the association between insulin resistance and indices of obesity in type 2 diabetic African population. Objective: This study investigated the relationship between insulin resistance and anthropometric measurements in the black African population using the homeostasis model assessment of insulin resistance (HOMA-IR). Materials and Methods: A descriptive cross-sectional design was used to study a random sample of 183 type 2 diabetic patients and 96 nondiabetic controls. Anthropometric parameters were measured using an appropriate technique. Fasting blood glucose was estimated using a glucose oxidase method. Serum insulin level was estimated using enzyme-linked immunosorbent assay kits. Data were analyzed using the Statistical Package for the Social Sciences version 23.0. HOMA-IR score was used to determine insulin resistance. Results: Diabetic males had greater waist–hip ratio than their normal controls (percentage difference: −3.23, P = 0.02) while diabetic females had greater body mass index (BMI) (percentage difference: 7.62, P = 0.04) and waist circumference (percentage difference: 10.6, P = 0.001) than their normal controls. There were a negative correlation between hip circumference (HC) and insulin resistance in the type 2 diabetic patients and a positive correlation between BMI and insulin resistance in the nondiabetic controls. However, there was no significant correlation between other anthropometric parameters and insulin resistance in both the type 2 diabetic and control groups. Conclusion: HC has a negative correlation with insulin resistance in the black African type 2 diabetic patients. There is a need for further research in this area to reduce diagnostic costs in low-resource settings.
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Reliability of transcutaneous bilirubin estimation during phototherapy in term infants: A hospital-based observational study p. 17
Jehangir Allam Bhat, Sajad Ahmad Sheikh, Zubair Ahmad Wani, Roshan Ara, Sami Ullah Bhat
Background:Blood sampling method is the most common but invasive method for bilirubin estimation. Transcutaneous bilirubin (TCB) estimation, on the other hand is non-invasive. Objectives: The aim was to compare neonatal bilirubin estimation by serum bilirubin and transcutaneous bilirubinometer methods both pre- and during phototherapy and establish the precision of transcutaneous bilirubinometer. Materials and Methods: This prospective hospital-based observational study was conducted on 350 term neonates over a period of 2 years. Bilirubin was estimated in all newborn by both serum bilirubin and transcutaneous method, at the time of admission in nursery (prephototherapy), at 6 h after phototherapy (while neonates were still under phototherapy treatment), and at withholding phototherapy, and a photo opaque patch of 2.5 cm was used to cover the area on midforehead and transcutaneous bilirubin was estimated from this area after removing it during phototherapy. All data were tabulated and analyzed by relevant statistical tests. Results: A total of 350 term healthy newborns with mean gestational age of 38 ± 2 weeks and mean birth weight of 2.97 ± 0.9 kg were studied. Correlation analysis revealed a significant correlation between total serum bilirubin and transcutaneous method (TCB) measurements of bilirubin. When these methods were compared at pre-phototherapy, at 6 hours after phototherapy and before withholding phototherapy, correlation coefficient(r) of 0.9571, 0.7988, and 0.9206 were seen respectively. The precision levels of transcutaneous bilirubinometer (BiliCheck™) were good because plotting of Bland–Altman graphs showed maximum (>97%) data within agreement limits at all stages of phototherapy. Conclusion: Our study revealed good correlation and precision of transcutaneous bilirubinometer both before and during phototherapy. Thus, it supports the previous studies which justify the use of transcutaneous bilirubinometer in assessing newborn jaundice during phototherapy.
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Determinants of discordant immune response in a cohort of human immunodeficiency virus-infected patients initiating antiretroviral therapy p. 22
Abdullahi Umar, Mufutau Muphy Oripelaye, Fatai Olatunde Olanrewaju, Olaniyi Onayemi, Olayinka Abimbola Olasode, Olumayowa Abimbola Oninla
Background: The introduction and wide use of highly active antiretroviral therapy (HAART) have significantly resulted in decline in morbidity and mortality from human immunodeficiency virus (HIV) infection and its related complications. These drugs can effectively induce virological suppression of the HIV-RNA replication to below the level of quantification, with eventual rise in the CD4+ cells counts. This is the therapeutic goal of using HAART in HIV-infected patients. However, some HIV-infected patients commencing HAART might have adequate virological suppression without a corresponding rise in CD4+ cells count-a phenomenon referred to as discordant immune response (DIR) or immunological nonresponse. Objective: The objective is to determine the factors associated with DIR among HIV-infected patients with adequate virological suppression, after initiating HAART. Materials and Methods: This study was a descriptive, retrospective, cross-sectional study that analyzed data from 200 HIV-infected adults that have been on HAART for 12 months descriptive statistics were used to describe the demographic profile of the participants, and binary logistic regression was used to assess the factors predicting DIR among the studied population. Results: One hundred and thirty-six (68%) were female with a mean age of 40.5 ± 10.9 years. The mean baseline CD4+ cells count was 162 ± 95.9 cells/mm3. Twelve months after HAART initiation, 64 (32%) of patients were immunological nonresponders. On multivariate analysis (logistics regression), patients initiating treatment at a higher CD4+ cells count >200 cells/mm3 (adjusted odds ratio [AOR] 3.89; confidence interval [CI]: 1.64–9.22; P = 0.002), the presence of anemia (hemoglobin <11.0 g/dl) (AOR 2.58; CI: 1.11–5.98; P = 0.027), and hepatitis C virus (HCV) positivity (AOR 9.84; CI: 3.10–18.12; P = 0.003) were independently associated with the development of DIR among the studied population. Conclusion: DIR among the studied population was common and associated with high baseline CD4+ cells count, baseline anemia, and HCV positivity from our HIV-infected patients. Thus, there is a need for adequate evaluation and monitoring of at-risk individuals to improve clinical outcomes.
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Impact of micronutrients on the psychological well-being of highly active antiretroviral therapy-naïve human immunodeficiency virus-infected patients p. 29
Victor Obiajulu Olisah, Tajudeen Abiola, Christopher I Okpataku, Reginald O Obiako, Ishaq A Audu
Background: In human immunodeficiency virus (HIV)-infected persons, low serum concentrations of vitamins and minerals, termed micronutrients, may be associated with an increased risk of psychiatric morbidity and HIV disease progression. Objectives: This study investigated the effects of micronutrient supplementation on psychological well-being of highly active antiretroviral therapy (HAART)-naïve HIV-infected patients. Materials and Methods: A total of 90 HAART-naïve HIV-infected patients completed the Distress Thermometer and its Problem Checklist, the Hospital Anxiety and Depression Scale, the Oslo Social Support Scale, and the 14-Item Resilience Scale (RS-14) at baseline. They all received a micronutrient supplement for 6 months, and 68 of the participants who remained in treatment at 6 months were reassessed with the same instruments. Results: There was no significant difference between sociodemographic characteristics of participants at baseline and 6 months. After 6 months of micronutrient supplementation, participants were found to have significantly lower mean scores on the anxiety (P = 0.003), depression (P = 0.001), and overall distress (P = 0.001) subscales and significantly higher mean scores on the RS (P = 0.025). Conclusion: Micronutrient supplementation can reduce the experience of distress, anxiety, and depression and increase the resilience in HAART-naïve HIV-infected persons.
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Hematological profile of human immunodeficiency virus-infected children p. 36
Surajudeen Oyeleke Bello, Esther Solomon Audu, Ikrama Hassan
Background: Hematological disorder has been shown to be one of the leading manifestations of human immunodeficiency virus (HIV) infection. This could be from the virus itself or the accompanying opportunistic infections including malignancies. The manifestations include among others, anemia, leukopenia and thrombocytopenia. Objectives: The objective of this study is to determine the prevalence of anemia, leukopenia, and thrombocytopenia as well as assessing the relationship between antiretroviral therapy (ART) regimen and anemia. Materials and Methods: The study was a prospective study among HIV-infected children and adolescents aged 2 years to <18 years receiving ART at the Dalhatu Araf Specialist Hospital, Lafia Nasarawa State. A total of 263 clients were recruited consecutively. Known sickle-cell disease patients, those with ongoing sepsis and or those recently transfused were excluded from the study. Data were analyzed using the SPSS version 20.0 through a univariate and multivariate analysis, and reporting was done in tables and figure. Results: There are slightly more males than females, with a male-to-female ratio of 1.02:1. Children aged between 2 and 9 years accounted for over two-third of the study population. The prevalence of anemia, leukopenia, and thrombocytopenia was 32.7%, 11.4%, and 3.04%, respectively. More than two-third of the participants was on zidovudine-based regimen, and there is a statistically significant association between anemia and the use of zidovudine-based ART regimen. Conclusion: Anemia is the most common hematological abnormality among HIV-infected children and adolescents. There is an association between the use of zidovudine and occurrence of anemia. The use of alternative drug to zidovudine is advocated.
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Perception of cervical cancer and its cytological screening among medical students p. 41
Said Mohammed Amin, Kabiru Abdullahi, Mukhtar Muhammad, Liman Idris Mohammed, Rabiah Ahmad Mahmoud, Rukayya Babandi Muhammad
Introduction: In Nigeria, cancer of the cervix is known to be the second commonest malignancy among females. In developed countries, there has been a paradigm shift attributed to effective cervical cancer screening predominantly using the Papanicolaou (Pap) smear. This screening tool is highly sensitive and specific; having a commendable positive predictive value as well as relatively cheap and effective means of screening cervical cancer for early detection. Objectives: The aim of this study is to assess the perception of Pap smear among medical students in College of Health Sciences, Usmanu Danfodiyo University, Sokoto (CHS-UDUS) in order to be able to recommend ways for improving acceptability, usage, and dissemination of information of the screening tool (Pap smear). Materials and Methods: The study utilized a cross-sectional study design. Preclinical students of CHS-UDUS were selected using random sampling technique. Pretested semi-structured, self-administered questionnaires were administered on the students. Quantitative variables were analyzed and presented using measures of central tendency [mean and median] and measures of dispersion (standard deviation), while Chi-square test was used in bivariate analyses, to determine the statistical association between the categorical groups, with a P < 0.05 considered as statistically significant. Results: Preclinical medical students in UDUS were found to have high awareness of cervical cancer-screening (82%) which made them positively disposed toward the screening tool. Most of them (75.6%) believe that Pap smear is effective in detecting cervical cancer. Majority of respondents obtained their information from routine lectures (81%) as against mass media (7%) and other extraneous source. However 42.8% were unaware of Pap smear screening services availability in their institution. Conclusion: The level of awareness about cervical cancer screening is high among the study population. Future studies should concentrate on utilization of this service in later life of young students.
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Patterns of morbidity and mortality among neonates seen in a tertiary hospital p. 47
Umar Also, Garba Dayyabu Gwarzo
Background: Neonatal period is the first 28 days after birth. It carries high risk of morbidity and mortality. This risk is higher in developing countries. Nigeria, where about 700 babies die daily, contributes about 8% of the world's annual neonatal deaths. There is a paucity of published study of neonatal morbidity and mortality in this part of Nigeria. Objectives: We determined the pattern of neonatal morbidity and mortality, and neonatal mortality rate in a public tertiary health facility in Jigawa State, Nigeria. Materials and Methods: We conducted a hospital-based retrospective study of all babies admitted during the neonatal period between January 1, 2016, and December 31, 2017. Data on the patients' age, weight, diagnosis, and outcome were extracted from their file and analyzed. Ethical clearance was obtained before the commencement of the study. Results: Records of 522 newborns were analyzed. Common morbidities were neonatal sepsis, prematurity, and birth asphyxia. The mortality rate was 13.2%. Highest mortality (44.8%) occurred within 24 h of admission, and neonatal tetanus had the highest case fatality rate of 42.8%. Conclusions: Neonatal sepsis, prematurity, and birth asphyxia were the major causes of morbidity. Mortality rate was high (13.2%), and tetanus had the highest case fatality rate. These can be prevented.
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Caregiver's acceptability of zinc tablet for treatment of childhood diarrhea in rural and urban communities p. 51
Ibrahim Rabiu Jalo, AM Jibo, AU Gajida, AA Kwaku, N Awaisu, AM Yusuf, AI Kauranmata, S Yusuf, SY Shuaibu, A Musa, IS Abubakar
Background: Zinc supplementation is a simple and affordable strategy for managing acute diarrhoea and preventing subsequent growth faltering and malnutrition. It has been shown that ORS and supplemental zinc, combined with continued feeding are the recommended interventions for treating diarrhoea among children. Objective: To determine the knowledge and acceptability of Zinc tablets in treatment of childhood dirrhoea. Materials and Methods: A comparative cross-sectional design was used. Data was analysed at univariate, bivariate and multivariate level using SPSS version 20. Results: Knowledge of caregivers about zinc treatment was found to be fair (40.4%) in both settings; up to 136 (45.0%) of the respondents had good knowledge. Over a half 84 (56.0%) of caregivers in the urban community compared to a quarter 52 (34.2%) of those in the rural community had good knowledge. This difference was statistically significant between urban and rural caregivers (P < 0.00). Up to 180 (81.1%) of the caregivers that have used zinc had good level of acceptability. Respondent's level of acceptability of zinc was similar in the urban 98 (81.7%) and rural communities 82(80.4%) respectively. Conclusion: There exist a wide gap between knowledge of zinc supplementation and its acceptability among caregivers and health education should be tailored to address the knowledge gaps of mothers and target women who are more at risk of poor practice.
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Disclosure of status among Human Immunodeficiency Virus-infected adolescents p. 60
Eno Eloho Ekop, Adaora Adeline Okechukwu
Background: Disclosing a positive Human Immunode ciency Virus (HIV)-infection status to a child pose major challenges to caregivers for various reasons. Objective: This study aims to determine the prevalence, pattern and effect of disclosure among HIV-infected adolescents attending a tertiary hospital in Nigeria. Materials and Methods: A cross-sectional study among adolescents attending the HIV Paediatric clinic at the University of Abuja Teaching Hospital, Gwagwalada. A questionnaire was administered after ethically age-appropriate consent and assent had been obtained from the adolescents or adolescent/caregiver pairs. Blood was also drawn for CD4 count and viral load assay. Results: One hundred and forty-five adolescents participated in the study. Eighty (55.2%) were males, 78(53.8%) aged 10-13 years while 91(62.7%) had secondary level of education. Fifty-nine (40.7%) adolescents had been disclosed to. The mean age of disclosure was 14.6±2.2. Disclosure was mostly by mothers (n = 32; 22.1%), at home (n = 43; 29.7%) and their status revealed by 14 (23.7%) of the adolescents to mainly their siblings (n = 10; 6.9%). At disclosure, 19 (13.1%) felt bad/sad while 18 (12.4%) were indifferent. The preferred age for disclosure was 14–16 years (n = 33; 22.8%). There was a statistically significant relationship between disclosure and; adolescents' age (P = <0.001), mean age of disclosure (P = <0.001); social class (P = 0.046); caregivers' educational level (P = < 0.01) and CD4 count (P = 0.003) but none for gender (P = 0.59), type of ARV medication (P = 0.519), self-reported adherence (P = 0.476) and viral load (P = 0.729). Conclusion: Disclosure prevalence was low. Caregivers should be better counseled and encouraged on the importance of early disclosure.
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Parotid gland neoplasms presenting as discrete infra-auricular swellings p. 67
Seidu Adebayo Bello, Bamidele Adetokunbo Famurewa, Osawe Felix Omoregie
Background: Parotid gland neoplasms usually present as pre-auricular swellings. Sometimes, they present as solitary infra-auricular swellings which make their localization difficult as they may be confused with submandibular gland or other lateral upper neck masses. Clinicopathological reports of discrete infra-auricular parotid lesions and their surgical managements are few. Objectives: To describe the clinical features and management of discrete infra-auricular parotid masses in a series of Nigerian patients seen during a surgical outreach mission. Methodology: This is a retrospective study of all infra-auricular swellings managed by a Nigerian surgical mission over 6 years. Patients' demographics, duration of swelling, symptoms, treatment, histopathological diagnosis, postoperative complications were retrieved from patients' records. Results: A total of 124 facial tumors were seen, of which 15 (12.1%) were parotid tumors. Eight cases (53.3%) of parotid tumors presented as discrete infra-auricular masses. Age range was 13–57 years (mean = 40.9 ± 15.4 years) with male predilection. Duration of swelling was between 1 and 15 years. All lesions were treated with extracapsular dissection. One patient had postoperative facial nerve paresis, but no facial palsy and sialocele. The histopathological results were 5 (62.5%) pleomorphic adenomas, 1 (12.5%) Warthin's tumor, and 2 (25%) low-grade mucoepidermoid carcinomas. Conclusion: Discrete infra-auricular swellings may present as benign and malignant parotid gland neoplasms.
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