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   Table of Contents - Current issue
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July-September 2018
Volume 21 | Issue 3
Page Nos. 117-180

Online since Thursday, October 4, 2018

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ORIGINAL ARTICLES  

Prevalence, risk factors, and outcomes of obstructed labor at the University of Maiduguri Teaching Hospital, Maiduguri, Nigeria Highly accessed article p. 117
Babagana Bako, Emmanuel Barka, Abubakar A Kullima
DOI:10.4103/1118-8561.242748  
Introduction: Obstructed labor is a common cause of feto-maternal morbidity and mortality in Maiduguri, Nigeria. This study aimed to determine the prevalence, causes, risk factors, and outcome of obstructed labor at the University of Maiduguri Teaching Hospital (UMTH). Materials and Methods: This was a retrospective observational study of all cases of obstructed labor managed from January 2012 to December 2014 at the UMTH, Maiduguri, Nigeria. For each case, the next woman who delivered without obstruction was used as a control. Data were analyzed for sociodemographic variables, labor, delivery and postdelivery events using SPSS version 20.0. The Chi-square test and odds ratio (OR) were used and statistical significance set at P < 0.05. Results: The prevalence of obstructed labor was 2.13%. Cephalopelvic disproportion, persistent occipitoposterior position, and malpresentation were seen in 65.37%, 16.58%, and 11.71%, respectively. The risk factors were teenage pregnancy (χ2: 26.96, P < 0.0001, OR: 4.44, 95% confidence interval [CI]: 2.45–8.05), nulliparity (χ2: 50.70, P < 0.0001, OR: 4.63, 95% CI: 2.99–7.15), illiteracy (χ2:53.91, P < 0.0001, OR: 5.26, 95% CI: 3.31–8.33), and unbooked status (χ2: 113.26, P < 0.0001 OR: 11.9, 95% CI: 7.24–19.61). Complications were observed in 37.56% of the women with obstructed labor. The common morbidities were wound sepsis, ruptured uterus, and puerperal sepsis, seen in 16.59%, 13.17%, and 7.81%, respectively. The case fatality rate was 0.98% and perinatal mortality was 34.15%. Conclusion: Obstructed labor is common in Maiduguri. We recommend amelioration of the risk factors through advocacy, girl child education, and public enlightenment on the need for antenatal care and hospital delivery, identification, and referral of high-risk patients.
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A 5-year review of measles cases admitted into the emergency paediatric unit of a tertiary hospital in Sokoto, North-Western Nigeria p. 122
Khadijat O Isezuo, Tahir Yusuf, Paul K Ibitoye, Maryam A Sanni, Nma M Jiya, Usman M Sani, Murtala M Ahmad, Baba Jibrin, Usman M Waziri, Mikailu A Jangebe
DOI:10.4103/smj.smj_38_17  
Background: Measles is a vaccine preventable viral infection which is still responsible for significantly high morbidity and mortality in Sub-Saharan Africa. Failure of routine immunization programs heralds a dismal outlook for this potentially eradicable viral infection. The objective of this study was to determine the hospital prevalence, vaccination status, pattern of complications, and outcome of children admitted with measles into the Department of Pediatrics of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. Materials and Methods: This was a 5-year retrospective study from January 1, 2011 to December 31, 2015. Case folders of children below 15 years who were admitted with measles were retrieved, relevant information extracted, and entered into a pro forma. Data was analyzed using SPSS version 22. Results: Total admissions were 6104, out of which 204 were due to measles (prevalence, 3.3%). The mean age was 27.4 ± 18.9 months (range 6–96 months). Those aged 1–5 years were 144 (70.6%). The male-to-female ratio was 1.3:1. Only 28 patients (13.7%) had measles vaccination. Observed complications included bronchopneumonia in 168 (82.4%), acute laryngotracheobronchitis in 24 (11.8%), febrile convulsion in 20 (9.8%), encephalitis in 17 (8.3%), ocular complications in 12 (5.9%), and suppurative otitis media in 6 (2.9%) patients. The presence of complications was related to age <5 years (P = 0.0001) but not to vaccination status (P = 0.41). Forty-four patients died (21.6%), whereas 33 patients (16.2%) had residual problems at discharge. Outcome was related to vaccination status (P < 0.05). Conclusion: Measles is still a significant problem in the study area and it is associated with high morbidity and mortality. More efforts at prevention is necessary.
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Medication use practices and inspection of returned pills during follow-up attendance at a tertiary care hypertension clinic in Nigeria p. 128
Abimbola O Olowofela, Ambrose O Isah
DOI:10.4103/smj.smj_20_17  
Background: Medication use practices in the treatment of hypertension (HTN) have been shown to determine outcomes. This study characterizes the profile of medication practices by hypertensive patients attending a tertiary health-care facility in Nigeria. Materials and Methods: This was a cross-sectional study in the outpatient HTN clinic of a tertiary hospital in southern Nigeria. Hypertensive patients seen during routine clinic visits were given the usual clinic instructions and requested to come with all medicines including herbal medications in their possession at their subsequent visits. A semi-structured observer-administered questionnaire was used to document all information sought and on medicines inspected. Data collected were analyzed and presented descriptively. Results: A total of 509 patients were recruited into the study (M:F ratio 1:2.2) aged 22–97 years. The mean(SD) number of all medicines used by the patients was 5.5 ± 2.While the mean(SD) number of antihypertensive medicines was 2.9 ± 1.3 with 75 patients (14.8%), 135 (26.6%), 144 (28.3%) and 154 (30.3%) on 1, 2, 3, and 4 or more antihypertensive medicines respectively. Calcium channel blocker was the most used antihypertensive medicine, 350 (68.8%). Of interest, was the use in 68 (13.4%) patients of unprescribed herbal medicines. A number of patients, i.e., 205 (40.2%) had discrepancy between their prescribed medicines and that presented to the clinic. This included the use of nonprescribed medicines, including analgesics (35%), vitamins (28.1%), nonsteroidal anti-inflammatory drugs (17.1%), and food supplements (6.8%). Conclusion: This study highlights the profile of antihypertensive medication use, revealing the significant use of nonprescribed medicines and factors likely to influence outcomes of therapy. It further underscores the importance of careful inspection during clinic attendance of all medication being taken by the patient.
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Subdermal contraceptive implants: Experience at a tertiary health institution in Southwestern Nigeria p. 137
Adewale Samson Adeyemi, Kola Musiliudeen Owonikoko, Daniel Adebode Adekanle, Olufemi Aworinde
DOI:10.4103/smj.smj_7_18  
Background: Norplant, a six-rod implant, was the first-generation subdermal contraceptive implant containing levonorgestrel. This had been replaced with the second-generation Implanon® and Jadelle®, which contain one rod and two rods, respectively. These second-generation implants have been shown to be as effective as the first-generation Norplant, but with less cumbersome insertion and removal techniques. The aim of this study is to evaluate the prevalence and use of subdermal contraceptive implants and the side effects among contraceptive method acceptors. Materials and Methods: A retrospective review of the case notes of clients who chose subdermal implants as a contraceptive method at Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso between 1 January 2014 and 31 December 2016. Mean and standard deviation were used to summarize continuous variables whereas frequency and percentage were used for categorical variables. Level of significance was set at a value of P < 0.05. Results: One hundred and forty-two clients made Implanon (115) and Jadelle (27) their contraceptive method of choice during the study period, accounting for 15.3% of the 928 contraceptive acceptors. Most of the acceptors were married (93.7%), and child spacing was mostly the reason for their choice (55.6%). The duration of the use of the method ranged between 6 and 49 months, and only 25 (17.6%) discontinued the method during the study period. The reason to discontinue the method was mostly to conceive (80%). Subdermal implants were well tolerated by the clients as 112 (78.9%) reported no unwanted side effects, and irregular vaginal bleeding was the most unwanted side effect in those that had them (59.3%). Conclusion: Subdermal implant contraceptives were well tolerated by the clients, and most clients did not report any side effects.
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Prevalence of gastroesophageal reflux disease among patients with dyspepsia undergoing endoscopy in a tertiary hospital in Nigeria p. 141
Abubakar Sadiq Maiyaki, Musa Muhammed Borodo, Adamu Alhaji Samaila, Abdulmumini Yakubu
DOI:10.4103/smj.smj_18_17  
Background: Dyspepsia is a symptom complex rather than a specific disease entity. It can be caused by various diseases that could be organic or functional dyspepsia. Gastro-esophageal reflux disease (GORD) now accounts for the majority of upper gastrointestinal symptoms. Clinical judgment alone is unsatisfactory and unreliable in confirming the etiology due to the overlap which exists between the clinical presentations of the disease conditions causing dyspepsia. This study aimed to determine the burden of GORD among patients with dyspepsia. Materials and Methods: The study was carried out between May and August 2009. A total of 170 dyspeptic patients were recruited consecutively as they were referred to the Gastroenterology Unit of Aminu Kano Teaching Hospital for upper gastrointestinal endoscopy. After obtaining a signed written informed consent from each patient a prepared questionnaire on relevant demographic, and clinical history relating to GORD was administered. Upper gastrointestinal endoscopy was then performed on each subject after an overnight fast of at least 8 h. GORD was defined as symptoms of heartburn and/or regurgitation lasting longer than 6 months with or without erosive esophagitis, Barrett's esophagus, esophageal peptic stricture, ulcer or adenocarcinoma on endoscopy. Results: The prevalence of GORD was found to be 24.1% among the dyspeptic patients in this study Endoscopy positive accounted for 16 (9.4%) while endoscopy negative accounted for 25 (14.7%) of GORD. Reflux symptoms were observed in 63 (37.1%) of the patients studied. Heartburn had a high specificity (92.3%) and negative predictive value (77.3%) with low sensitivity (14.6%) and positive predictive value (37.5%), while for regurgitation specificity was 91.6%, negative predictive value of 63.6%, sensitivity of 11.1% and positive predictive value of 43.8% for endoscopy positive GORD. Conclusion: Gastroesophageal reflux disease is a common disease for which patients are referred for upper gastrointestinal endoscopy.
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Intestinal metaplasia and glandular atrophy in patients with chronic gastritis in Ilorin p. 146
David Eyitayo Ibikunle, Olatunde O Kazeem Ibrahim, Enoch O Abiodun Afolayan
DOI:10.4103/smj.smj_29_17  
Background: Intestinal metaplasia and glandular atrophy are pre malignant conditions occurring as a complication of prolonged, untreated or poorly treated chronic gastritis. This study aims at detecting the presence and severity of intestinal and glandular atrophy. Method: A retrospective study of 316 cases meeting the inclusion criteria with a male to female ratio of 1.1:1 were enlisted into the study spanning a 5-year period. Results: Intestinal metaplasia was reported in 64 (20.2%) cases with majority 36 (56.3%) graded as mild intestinal metaplasia. Complete intestinal metaplasia was seen in 44(68.8%) and incomplete in 20(31.2%). Glandular atrophy was reported in 137(43.3%) cases with majority 97(70.8%) graded as mild. Patients that are 41 years and above were responsible for more than 70% of all cases of intestinal metaplasia and glandular atrophy. The result in this study is comparable to similar studies by sister institutions. Conclusion: It is our recommendation therefore that all patients that are 40 years and above with unresolving dyspepsia be referred to the gastroenterologist for a proper evaluation to prevent these complications and ultimately reduce the occurrence of gastric malignancies.
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Echocardiographic pattern of heart diseases at a Southwest Nigerian private clinic p. 153
Ebenezer Adekunle Ajayi, Oladapo A Adewuya, Afolabi Akinsanmi Ohunakin, Olatunji Bukola Olaoye
DOI:10.4103/smj.smj_19_17  
Background: Echocardiography is a noninvasive tool to evaluate morphological and hemodynamic features of the heart. Though echocardiography is increasingly being used in Nigeria, it is still mostly concentrated in the urban areas in government-owned tertiary health facilities. Materials and Methods: Echocardiograms of 1132 adult patients referred to the echocardiographic laboratory of a private clinic in Nigeria for cardiac evaluation over a 7-year period were retrospectively studied. Results: The age range was 18–95 years with a mean of 52.35 ± 18.03 years. The indications for echocardiography were systemic hypertension (42.5%), congestive cardiac failure (16.8%), and chest pain (9.5%). The common echocardiographic diagnoses were hypertensive heart disease (HHD), 39.9% and valvular heart disease (VHD), 15.0%. Rheumatic heart disease accounted for 67.7% of those diagnosed of VHD or 10.2% of the study population. Congenital heart disease was diagnosed in 1.7% of the cases comprising ventricular septal defect (0.5%), atrial septal defect (0.5%), persistent patent ductus arteriosus (0.4%), and bicuspid aorta (0.2%). The confirmation rate for HHD was 66.1%, while 70% and 57.1% of those referred on account of unexplained leg swelling and dyspnea, respectively, had heart disease. Heart disease was confirmed in 45.5% of the patients referred for routine test. Conclusion: Systemic hypertension and HHD was the most common indication for echocardiography and the most common echocardiographic diagnosis, respectively, in our study population. Rheumatic heart disease was the most common VHD. Echocardiographic confirmation rate was high in patients referred for HHD, and echocardiography may be useful in the evaluation of patients with unexplained leg swelling and dyspnea.
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Basic hemostatic parameters in adults with sickle cell anemia at Ahmadu Bello University Teaching Hospital, Zaria Nigeria p. 157
Ibrahim Usman Kusfa, Sirajo Mohammed Aminu, Aisha Indo Mamman, Abdulaziz Hassan, Aliyu Ahmadu Babadoko, Muktar Haruna Mohammed, Ismaila Nda Ibrahim, Yahaya Garba
DOI:10.4103/smj.smj_2_17  
Background: Reports from various studies showed that patients with sickle cell anemia (SCA) have altered components of hemostasis such as platelet function, the procoagulant, anticoagulant, and the fibrinolytic pathways. These altered components may be different or the same based on regions, racial, or environment. Determining the basic hemostatic parameters in our environment is imperative because from records this may be the first time such a study is being carried out and the altered components so involved may give an insight as to the clinical phenotypes we have in our setting. The data obtained from this study may also provide reference values appropriate for therapeutic intervention. The objective of this study is to determine some basic hemostatic parameters in patients with SCA in steady state attending the hematology clinic of Ahmadu Bello University Teaching Hospital Zaria, Nigeria. Materials and Methods: We conducted a case–control study involving fifty patients with SCA (HbSS) in steady state and 25 healthy volunteers with normal hemoglobin (HbAA) as controls between the ages of 15 and 50 years, with females comprising 40 (53.0%) and 35 (47.0%) males. Steady state refers to a point in time where a patient with SCA is not experiencing an acute painful crisis or any changes due to therapy for at least four consecutive weeks after a previous painful crisis. Platelet count was determined by hematology analyzer (Sysmex XT–2000i, Sysmex Corporation, CPO Box1002 Kobe 650–8691, Japan) while bleeding time (BT) was performed using Ivy's method, using disposable Bevel lancet with the test carried out in duplicate and superficial veins were avoided. Prothrombin time (PT), activated partial thromboplastin time (APTT), and thrombin time (TT) were estimated using semi-automated coagulation analyzer. Results: The age ranges of both the patients and the controls were 15–50 years and 15–34 years with mean ages of both was 23.80 ± 7.46 and 24.28 ± 3.48 years (P = 0.76) respectively. Females comprised 53.0% of all the study participants. The mean values of hemostatic parameters in the SCA and controls groups were: Platelets (499.82 ± 208.23 vs. 230.36 ± 106.65 × 109/L, 95% confidence interval [CI]; 180.9881, 357.9319, P < 0.0001), BT (2.99 ± 0.98 vs. 2.94 ± 0.92 min, −0.4219, 0.5139, P = 0.845), PT (12.43 ± 3.11 vs. 13.18 ± 1.11 s, 95% CI; −2.0335, 0.5335, P 0.248), ±8.80 vs. 17.20 ± 5.11 s, 95% CI; 0.4874, 8.0846, P = 0.028), respectively. Conclusion: A significant increase in platelet count, TT and a significant decrease in APTT were observed in patients with SCA. These can be an evidence of hypercoagulable nature of SCA. We recommend that patients with SCA, especially those with frequent and severe vaso-occlusive crises should have these basic hemostatic tests as a baseline and during routine clinic follow-up for improved patient management.
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Factors influencing health-seeking behavior of health workers in a Tertiary Health Institution in Sokoto, Northwest Nigeria p. 162
Habibullah Adamu, Alfa Yusuf, Christopher Udah Inalegwu, Rabi Adamu Sufi, Aisha Nana Adamu
DOI:10.4103/smj.smj_55_16  
Background: Health-care workers have the potential to acquire or transmit infections during the course of their work. There is, therefore, a need to assess the pattern of their health-seeking behavior. This study aimed to determine the pattern of health-seeking behavior of health workers in a tertiary hospital in Northwest Nigeria. Materials and Methods: It was a cross-sectional descriptive study where multistage sampling technique was used to select 160 health workers, including doctors, nurses, and laboratory scientists. A semi-structured questionnaire was used to collect data which were analyzed using Statistical Package for the Social Sciences (SPSS) version 20.0 and Microsoft Excel 2010. Results: The mean age of the respondents was 34.57 ± 7.2 years, with males slightly more represented (54.4%) than females (45.6%). Nearly 43% were doctors, 47.0% were nurses, and 9.7% were laboratory scientists. Almost all the respondents (99.3%) felt that periodic medical checkups were important and 65.8% of them have had one before. Up to 75.2% of them often sought the attention of a doctor whenever they fell sick. Majority (75.2.%) of them practiced self-medication, with various forms of antimalarials, antibiotics, and analgesics being the commonly used drugs. The major factor preventing the respondents from going for voluntary medical checkup was the fear of the outcome of investigation (P = 0.012). Conclusion: The perception of respondents regarding periodic medical checkup was generally good. Self-medication was found to be high among respondents. Age, gender, profession, and duration of practice were found to affect both preventive and curative health-seeking behaviors.
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CASE REPORTS Top

An aberrant presentation of medial collateral ligament ganglion cyst: The value of magnetic resonance imaging in diagnosis p. 171
Ganesh Prasad, Sonam Sherbaz, Simon Cockshott
DOI:10.4103/smj.smj_15_17  
Soft-tissue cystic swellings at the knee joint level are commonly diagnosed as meniscal cysts. We present an interesting case diagnosed as a recurrent meniscal cyst, having had previous three surgical excisions but turned out to be a medial collateral ligament ganglion cyst, confirmed on a magnetic resonance imaging (MRI) scan. This was totally excised and went on to heal with no signs of recurrence after 6 months of follow-up. We have learnt that all recurrent cystic swellings at knee joint level should be approached with caution and we recommend MRI as the gold standard for further evaluation to aid in appropriate surgical management.
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Bilateral cortical blindness with Anton–Babinski syndrome in an elderly Nigerian woman: Challenges for tertiary prevention p. 175
Obehi Aituaje Akoria, Francis Ikechukwu Enebe
DOI:10.4103/smj.smj_31_17  
Anton–Babinski syndrome (Anton's syndrome) is well described in the scientific literature even though it is a rare neurological condition. Most publications have highlighted the anatomy, neurophysiology, and pathology of visual anosognosia, which is the hallmark of the syndrome. We are not aware of any published report of cortical blindness with Anton's syndrome from Africa. We report a catastrophic complication of severe hypertension in an elderly Nigerian woman who was on follow-up for stroke, chronic heart failure, diabetes mellitus, and glaucoma. She developed bilateral cortical blindness with Anton's syndrome as a complication of severe hypertension, following 3 weeks of missed medications. This report highlights some challenges of tertiary prevention in this elderly woman without health insurance, who before becoming blind, had been largely dependent on family members' goodwill for her medical care.
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LETTER TO THE EDITOR Top

Antimicrobial resistance surveillance system in Nigeria: Suggested models p. 179
Yahaya Mohammed, Baffa Sule Ibrahim, Salma Muhammad Galalain, Mahmoud M Dalhat, Patrick Nguku
DOI:10.4103/smj.smj_17_17  
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