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   Table of Contents - Current issue
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October-December 2018
Volume 21 | Issue 4
Page Nos. 181-228

Online since Monday, December 31, 2018

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ORIGINAL ARTICLES  

Growth patterns of preterm infants: A prospective study in an indigenous African population p. 181
Rosena Olubanke Oluwafemi, Moses Temidayo Abiodun
DOI:10.4103/smj.smj_14_18  
Background: Optimal growth of preterm infants reflects their overall health status; however, indigenous growth charts are rarely available to monitor them adequately in infancy. Objectives: The aim of this study was to describe growth patterns of preterm infants and to generate percentile charts as well as relevant predictive equations for expected weight-for-age in their various birth weight categories. Materials and Methods: This was a prospective, analytic study. Anthropometric measurements of eligible consecutive preterm babies were monitored biweekly/monthly in infancy. Temporal changes in body weights and occipitofrontal circumferences (OFCs) were presented graphically. The Pearson's correlation coefficient was done to derive predictive equations. LMS chartmaker light version 2.54 (Medical Research Council, UK) generated percentile charts. P < 0.05 was considered statistically significant. Results: A total of 154 preterm infants were recruited during the study period, with a male-to-female ratio of 1:1.5. Their mean gestational age (GA) was 31.3 ± 2.4 weeks, and mean birth weight was 1510.8 ± 347.5 g. Average daily weight gains were 9.4, 17.4, and 20.0 for extremely low birth weight (ELBW), very LBW (VLBW), and LBW, respectively, in the 1st month (F = 1.733, P = 0.183). The peak weight gain period occurred at the 4th month for ELBW (28.3 g/day), 5th month for VLBW (38.3 g/day), and 7th month for LBW (38.3 g/day). There was a strong positive correlation of their body weight with their postnatal age (y = 505.6x + 1511.5; R2 = 0.92) as well as OFC with age (y = 1.33x + 29.94; R2 = 0.94). Growth charts for weights and OFCs were generated showing 5th, 50th, and 95th percentiles. Conclusion: The preterm infants gained weight with increasing postnatal age following an initial weight loss in the early neonatal period. Their relative growth velocities were similar in all birth weight categories.
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The use of hydroxycarbamide in children with sickle cell anemia p. 189
Hafsat Rufai Ahmad, Jamilu Abdullahi Faruk, Adekunle Matthew Sobowale, Amos Solomon, Adebiyi Niyi Mustapha, Olufemi Gboye Ogunrinde
DOI:10.4103/smj.smj_29_18  
Background: Although hydroxycarbamide (hydroxyurea [HU]) has been in use for decades in both adults and child populations with sickle cell disease (SCD), its reported use has remained low in Africa and Nigeria where the largest number of SCD patients reside. Availability, cost, and concerns about safety and efficacy are some of the challenges to its use. Objectives: This study highlights the experience of using HU for children with sickle cell anemia in Ahmadu Bello University Teaching Hospital, Zaria. Materials and Methods: A descriptive, retrospective observational study of children is presented. Demographic, clinical, and laboratory features of children on HU, the indications for therapy and adverse clinical events encountered were analyzed. Results: A total of 165 children were treated with HU over a 4-year period, their ages ranging between 0.9 and 17 years. A total of 85 (47.5%) had HU for >12 months, while 61 (34.1%) were on treatment <11 months, while 19 (10.2%) were lost to follow-up. There was a significant increase in the weight, height, fetal hemoglobin, mean corpuscular volume, and a significant reduction in white cell counts; with no differences in the packed cell volume, hemoglobin concentration, creatinine, alanine transaminase, and bilirubin levels. Adverse events and/or comorbidities were reported in 48 (56.5%) patients, while one patient discontinued treatment because of skin rash. Conclusion: This study highlights the increased utilization of HU among children in an African region, the observed clinical events, and laboratory parameters. The benefits are demonstrable, and the drug-related organ toxicities appear minimal.
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Oral manifestations of dengue fever p. 194
Sethuraman Govindaraj, Ramesh Jayaraman, M Jonathan Daniel, Saravanan Subbiah, Srinivasan Subramanian Vasudevan, Jimsha Vannathan Kumaran
DOI:10.4103/smj.smj_28_18  
Background: Dengue is a life-threatening viral infection which has become an epidemic in India in the postmonsoon period (August–November). It mostly associated with nonspecific fever and rashes, arthralgia, myalgia, and thrombocytopenia in severe cases. Objective: This study aimed to study the oral manifestations of dengue fever and to observe the various features of oral presentation then to validate the significance and importance of oral manifestation in the diagnosis of dengue fever. Materials and Methods: Patients meeting the inclusion criteria were subjected to detailed history, oral examination, and relevant investigations. Results: Intraoral manifestations were present in 24 (48%) patients, anf these included petechiae (29.2%), bleeding gums (16.6%), ulcer (4.2%), dryness of mouth (4.2%), and combined features (45.8%). Extraoral manifestations were present in 4% of the cases. Conclusion: This study highlights the thrombocytopenia related oral haemosrrhagic manifestations of dengue fever.
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Target organ damage among subjects with high-normal blood pressure in a Nigerian tertiary health institution p. 199
H Saidu, KM Karaye, BN Okeahialam
DOI:10.4103/smj.smj_66_17  
Background: There is paucity of data on the relationship between high – normal blood pressure (BP) and target organ damage (TOD) in sub-Saharan Africa including Nigeria. This study therefore, aimed to assess target organ damage (TOD) among subjects with high – normal BP in comparison with hypertensives and subjects with optimal BP. Materials and Methods: The study was cross-sectional and comparative conducted at Aminu Kano Teaching Hospital, Kano on eligible subjects aged 18 years and above. Three groups comprising of randomly selected subjects (high -normal (group 1), hypertension (group 2) and optimal BP (group 3)), with each group having 100 in number were studied. Funduscopy and relevant investigations including transthoracic echocardiography were carried out. High – normal BP was defined as systolic BP of 130 -139mmHg and/or diastolic BP of 80-89mmHg. Results: The mean age of subjects in group 1 was 27.32 ± 8.20 years and 60% were female, 34.04±6.25 years for group 2 and 53% were female, and 52.81 ± 13.3 years for group 3 and 56% were female (P = < 0.001). The most prevalent TOD was left ventricular hypertrophy, present in 62% of hypertensives, 14% of those with high-normal BP and 2% of those with optimal BP(P = <0.001). Micro albuminuria and slight increase in creatinine were found in 12.9% and 6% of subjects with high-normal BP; 25.7% and 25% of hypertensives and 4.1% and 3% of subjects with optimal BP. The study found a significant progressive increase in both cardiovascular disease risk factors and target organ damage (TOD) as BP increased across the blood pressure categories from optimal BP to high – normal BP and to hypertension (P = <0.05). Conclusion: Subjects with high-normal BP had significantly higher prevalence of both TOD and cardiovascular disease risk factors than those with optimal BP but lower than hypertensives, suggesting that efforts to control BP should start early to reduce the complications of high BP.
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Snakebites in a Nigerian children Population: A 5-year review p. 204
Ikenna Kingsley Ndu, Benedict Onyeka Edelu, Uchenna Ekwochi
DOI:10.4103/smj.smj_18_18  
Background: Snakebite envenomation is a worldwide problem, which is an important cause of death in the developing countries and still remains a neglected public health problem. Children sustain more severe toxicity from envenomation compared to adults and thus have different outcomes. Objectives: This study was carried out to review the demographics, risk factors, interventions, and outcomes of snakebite victims in the pediatric age group in Enugu, Southeast Nigeria, to improve the existing database. Materials and Methods: This was a descriptive, retrospective study conducted at the children emergency room (CHER) of Enugu State University Teaching Hospital (ESUTH), Enugu. The admission records of all the children that were admitted into CHER of ESUTH over a 5-year period (January 2012 to December 2016) were reviewed. Analysis was mainly descriptive. Frequency distributions of all relevant variables were reported as tables and prose. Test of significance for discrete variables was done using the Chi-square test. P <0.05 was regarded as statistically significant. Results: There were 5182 admissions with 13 cases of snakebite, giving a prevalence rate of 0.25%. Late presentation was significantly associated with longer duration of hospitalization (P = 0.026, χ2 = 4.952). Five (30.8%) patients had complications distributed as follows: one gangrenous limb (7.7%), one necrotic ulcer (7.7%), and three compartment syndromes (23.1%). Prehospital visit interventions included visit to the native doctor, local incision, application of herbs, tourniquet, and black stone application. One of the patients died, giving a case fatality rate of 7.7%. Conclusions: The prehospital emergency interventions given to snakebite victims still reflect practices that are harmful. It is possible that the majority of snakebite cases in our environment do not present to the health facilities. More efforts are required to improve the health-seeking behavior and emergency interventions for snakebite victims.
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Pattern of hearing loss in a tertiary hospital in the North Western Nigeria p. 208
Iliyasu Yunusa Shuaibu, Dotiro Chitumu, Ibrahim Babatunde Mohammed, Nurudeen Adebola Shofoluwe, Mohammed Aminu Usman, Aminu Bakari, Lateef Kunle Lawal
DOI:10.4103/smj.smj_57_17  
Background: Hearing impairment is a major public health problem in developing countries. According to the World Health Organization, approximately 15% of the world's adult population has some degree of hearing loss. About one-third of those who are affected have disabling hearing loss and two-third of them live in developing countries. Aim: This study aims to determine the causes and pattern of hearing loss in Zaria, North Western Nigeria. Materials and Methods: This was a retrospective study conducted at ear, nose, and throat unit of Ahmadu Bello University Teaching Hospital Zaria, Kaduna Nigeria. The hospital is a tertiary health-care facility in North Western Nigeria and is a referral center to many primary, secondary, tertiary and private health facilities in Nigeria. The records of all patients who were managed for hearing loss in our unit over a period of 5 years between January 2011 and December 2015 were reviewed. Information obtained from the case files included demographic characteristics, main presenting symptoms, and causes of hearing loss. Findings of pure tone audiograms, tympanograms, and otoacoustic emission were also recorded. The data obtained were analyzed using statistical package for Social Science Version 21. Results: Of the 277 patients who presented with hearing loss, only 144 met the inclusion criteria. There were 86 (59.7%) males and 58 (40.3%) females with sex ratio (M:F) of 1.4:1. The mean age was 29.9 years with standard deviation of ±2.18. The most common cause of hearing loss was presbyacusis 24 (16.7%) followed by ototoxicity 14 (9.7%), most of the patients 91 (63.2%) had bilateral hearing loss while 53 (36.8%) had unilateral hearing loss. Majority 112 (77.8%) had sensorineural hearing loss, followed by 24 (16.7%) conductive and mixed 8 (5.5%). Majority of the patients 94 (64.3%) had mild to moderately severe with the remaining 50 (34.7%) having severe to profound hearing losses, respectively. Tympanometric findings showed that 118 (90.8%) and 11 (8.5%) had Types A and B tympanograms, respectively. Conclusion: Majority of the patients were adult with bilateral mild to moderately severe sensorineural hearing loss. Age-related hearing loss was the most common cause of hearing loss followed by ototoxicity.
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Morbidity and mortality profile of patients seen in medical emergency unit of a Teaching Hospital in Nigeria: A 4-year audit p. 213
Bello Yusuf Jamoh, Sani Atta Abubakar, Sani Muhammad Isa
DOI:10.4103/smj.smj_27_17  
Background: Ahmadu Bello University Teaching Hospital (ABUTH) Zaria is strategically located to serve as referral center for most stable and emergency cases in the northwestern part of Nigeria. Patients also come on self-referral. Objective: This study aimed to describe the pattern of medical presentation and outcomes at the emergency unit of ABUTH over a 4-year period. Materials and Methods: A review of medical admissions into the Emergency unit of ABUTH, Zaria, between January 2013 and December 2016 was carried out using the case records of patients as well as register of admissions and discharges, information obtained were entered into a predetermined questionnaire. Results: The patients admitted during the period numbered 5193, with age range of 15–92 years. There were 2895 (56.0%) males and 2298 (44.0%), with a male-to-female ratio of 1.3:1. Emergencies attributable to infectious diseases occurred with the highest frequency (20.6%), followed by gastrointestinal (20.5%), renal (14.5%), endocrine (13.8%), respiratory (12.4%), cardiac (9%), neurological (2.8%), and hematological (1.1%). There was a significantly (P < 0.001) higher occurrence of noncommunicable diseases (71.5%) than communicable diseases (28.5%), as well as higher male cases in renal, respiratory, hematological emergencies (P < 0.05). There were more admissions in the wet season, (April to September) while the October to January period consistently recorded the low admission rates. An increasing trend in emergency medical admissions was observed, being highest in the year 2016. The median duration of stay was 4.5 days (range of 0–12 days). The outcomes of admission revealed 470 (9%) deaths, 2012 (37%) direct discharges, and 2801 (54%) transfers to male or female medical wards. Cases of tetanus had the highest case fatality rate (45%) while hypertensive emergencies had the lowest (4%). Conclusion: There is a rising trend of communicable as opposed to non-communicable diseases' emergencies in Zaria. Of the non-communicable diseases, incidence of gastro-intestinal emergencies was the highest while that of haematology was the least. The intra-hospital mortality rate attributable to medical emergencies is relatively lower in Zaria.
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Turnaround time for electrolytes, urea, and creatinine in a clinical laboratory p. 218
Ekiye Ayinbuomwan, Tomi Mathew Adaja
DOI:10.4103/smj.smj_36_17  
Background: Timeliness is expressed as the turnaround time and is often used by the clinician as a benchmark for laboratory performance. Clinicians depend on fast turnaround time to achieve early diagnosis and treatment of their patients and early patient discharge from emergency departments or hospital in-patient services. Determination of the turnaround time would enable a critical self- appraisal of our laboratory services and improve our turnaround time. Objective: This study assessed the turnaround time for electrolytes, urea and creatinine tests from the emergency departments of the hospital. Materials and Methods: An observational study was conducted between September and October 2016 amongst patients from the Intensive Care Unit, Accident and Emergency Department and Children Emergency Room, whose blood specimens were received at the Chemical Pathology Department for emergency electrolytes, urea and creatinine tests. A total of 122 specimens were randomly selected and the average time taken to complete each phase was measured and the overall turnaround time calculated. Data was analysed using statistics software SPSS (version 13.5). Results: Audited cases consisted of 20 (16.4%) specimens from the Intensive Care Unit, 40 (32.8%) from the Children Emergency Room and 62 (50.8%) from the Accident and Emergency Department. The average turnaround time for the Accident and Emergency Department, Intensive Care Unit, and Children Emergency room were 6.5hours, 4.2hours and 5.2hours respectively. Conclusion: This study revealed that the turnaround time for electrolytes, urea and creatinine for patients in the emergency units is quite long and requires some improvement which could be done with the use of Laboratory Information System to track specimens from the various emergency units of the hospital.
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CASE REPORT Top

Multi-organ dysfunction syndrome as the first presentation of acute brucellosis, a case report and literature review p. 222
Ibrahim Masoodi
DOI:10.4103/smj.smj_11_18  
Multiple organ dysfunction syndrome (MODS) is a continuous process with incremental degrees of physiologic derangements in individual organs. The alteration in organ function can vary widely from a mild degree of organ dysfunction to completely irreversible organ failure. MODS, as defined, is a clinical syndrome characterized by the development of progressive and potentially reversible physiologic dysfunction in two or more organs or organ systems that are induced by a variety of acute insults, including sepsis. The cornerstone in the management remains correction of the triggering agent. The clinical scenario of a young male who presented with progressive shortness of breath, renal failure, and epistaxis (MODS) at presentation is discussed in this report. The diagnosis of this patient was clinically quite challenging. On evaluation, he proved to have multi-organ failure due to Brucella melitensis. The patient improved with conventional B. melitensis treatment. The Brucella infection is a male predominant disease and frequently presents with typical symptoms of fever, fatigue, etc., and the diagnosis often is straightforward, but the reports of atypical presentation have been described in the literature. The heaviest disease burden of B. melitensis lies in countries of the Mediterranean basin and Arabian Peninsula. However, the disease is not uncommon in India, Mexico, and Central America. Hence, clinicians need to be aware of this clinical entity all over the globe. The report of the case and brief review of literature are presented in this report.
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LETTER TO THE EDITOR Top

Benefits of human parvovirus B19 testing in sickle cell anemic patients and blood donors in Nigeria p. 227
Idris Abdullahi Nasir, Maryam Muhammad Zakari, Adamu Idris, Abdurrahman Elfulaty Ahmad
DOI:10.4103/smj.smj_40_17  
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