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   2016| April-June  | Volume 19 | Issue 2  
    Online since July 12, 2016

 
 
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ORIGINAL ARTICLES
Training-of-trainers of nurses and midwives as a strategy for the reduction of eclampsia-related maternal mortality in Nigeria
Jamilu Tukur, Mohammed Salisu Ishaku, Babatunde Ahonsi, Ayodeji Babatunde Oginni, Gloria Adoyi
April-June 2016, 19(2):63-68
DOI:10.4103/1118-8561.186034  
Background: Preeclampsia and eclampsia (PE/E) are major contributors to maternal and perinatal mortality in Nigeria. Despite the availability of current curriculum at Nigerian schools of nursing and midwifery, the knowledge on the management of PE/E among the students has remained poor. In order to reduce maternal and perinatal mortality in developing countries, targeted training and supportive supervision of frontline health care providers have been recommended. Methodology: A total of 292 tutors from 171 schools of nursing and midwifery participated in the training of the trainers' workshops on current management of PE/E across the country. Pre- and post-test assessments were administered. Six months after the training, 29 schools and 84 tutors were randomly selected for follow-up to evaluate the impact of the training. Results: Significant knowledge transfer occurred among the participants as the pretest/posttest analysis showed knowledge transmission across all the 13 knowledge items assessed. The follow-up evaluation also showed that the trained tutors conducted 19 step-down trainings and trained 157 other tutors in their respective schools. Subsequently, 2382 nursing and midwifery students were properly trained. However, six of the monitored schools (24.2%) lacked all the essential kits for teaching on PE/E. Conclusion: Updating the knowledge of tutors leads to improved preservice training of the future generation of nurses and midwives. This will likely result in higher quality of care to patients and reduce PE/E-related maternal and perinatal mortality. However, there is need to provide essential training kits for teaching of student nurses and midwives.
  2,232 195 -
Impact of national health insurance scheme on blood pressure control in Zaria
Albert Imhoagene Oyati, Adeola A Orogade, Pascal Chika Azuh, Peter Dodo Yakubu, Vincent Y Shidali
April-June 2016, 19(2):69-73
DOI:10.4103/1118-8561.186037  
Background: National Health Insurance Scheme (NHIS) was commenced in Nigeria in 2001 to ensure wider access to health care services. This study determined the impact of NHIS implementation on blood pressure (BP) control among patients with systemic hypertension, regularly attending the Cardiac Clinic, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria. Materials and Methods: Patients with systemic hypertension, both NHIS and non-NHIS beneficiaries attending a tertiary health facility in Zaria, Nigeria, were seen in a prospective cross-sectional study. Demographic and clinical characteristics were obtained. Access to treatment and relevant investigations were compared. BP levels were analyzed and compared in both groups at enrollment in the clinic and at the point of this study. Results: Sixty-five percent, (70/107) of the clinic attendees were on the NHIS scheme and were significantly younger than non-NHIS patients (t = 2.03, P = 0.03). Mean body mass index (BMI) was equally high (t = −1.222, P = 0.22) and there was similar access to medications (χ2 = 0.08, P = 0.77). Mean systolic BP (SBP) and diastolic BP (DBP) at enrollment were significantly higher in NHIS patients (t = −3.064, P = 0.003 for mean SBP and t = −4.115, P = 0.0001 for mean DBP), respectively. However, BP control in both groups at the end of the study did not show any significant difference (χ2 = 0.02, P = 0.89). Conclusion: NHIS uptake among these patients is high. There was no difference in BP control among the insured and nonbeneficiaries. A study of a larger number of patients over a longer period is suggested.
  2,162 157 -
ABSTRACTED ARTICLE
Abstract Proceedings (Part II) of the 56th annual general conference and delegate meeting of the Nigerian medical association held in giginya-coral hotel, Sokoto, Nigeria 24th April-1st may 2016 chairman scientific subcommittee: Prof. S. A. Isezuo

April-June 2016, 19(2):104-117
DOI:10.4103/1118-8561.186042  
  2,081 134 -
ORIGINAL ARTICLES
Awareness of blood pressure status, undiagnosed hypertension and proteinuria among adults in Umuahia, South-East Nigeria
Chimezie Godswill Okwuonu, Nnamdi Ezekiel Ojimadu, Oluchi Justina Chimezie, Uche Madudonu, Nkechi Ogbulafor, Okechukwu Samuel Ogah
April-June 2016, 19(2):82-88
DOI:10.4103/1118-8561.186035  
Background: Hypertension and proteinuria are risk factors for cardiovascular disease. They are also important risk factors for further deterioration of renal function in chronic kidney disease (CKD) irrespective of the cause of CKD. Both are asymptomatic at early stages and can only be detected during medical consultation for a related or unrelated illness. Materials and Methods: This was a cross-sectional study carried out to assess awareness of blood pressure (BP) status among adults in a semi-urban community in Southern Nigeria. The magnitude of undiagnosed hypertension and proteinuria in the community was also assessed. BP measurement was by standardized method while proteinuria was detected by use of urinary dipstick. Data was analyzed using SPSS version 21.0. Results: A total of 389 people were recruited. There were 223 (57.3%) males and 116 (42.7%) females. Only 104 (26.7%) were aware of their BP status before the study. Awareness was higher in females but did not differ significantly among the different age groups, educational status or occupations. Hypertension was newly diagnosed in 105 (27%) of the participants while proteinuria was diagnosed in 47 (12.1%). Proteinuria and overweight were higher among participants with prehypertension than other BP categories. Conclusions: The study revealed a low level of awareness of BP status and a high prevalence of undiagnosed hypertension and proteinuria in the community. Concerted efforts are needed to improve the awareness of BP and other risk factors for cardiovascular and kidney diseases.
  1,965 148 -
CASE REPORTS
Variants of gallbladder adenocarcinomas: Five case reports
Subhajit Das, Debjit Banerjee, Soumit Mondal, Pankaj Tayal
April-June 2016, 19(2):94-97
DOI:10.4103/1118-8561.186036  
Conventional adenocarcinomas comprise of about 90% of all gallbladder neoplasms; among them, pancreatobiliary is the most common phenotype followed by intestinal and gastric foveolar types. Papillary variant is the second most common form of adenocarcinoma affecting the gallbladder. Mucinous adenocarcinoma and signet-ring cell carcinoma are rarer variants with grave prognoses. We report five cases of gallbladder neoplasms with four different histopathological features. (1) To report the rare neoplasms of the gallbladder for the future researches on their histopathology-based targeted therapy. (2) To describe the clinico-pathogical characteristics of the rare variants of gallbladder neoplasm.
  1,689 103 -
Horizontally placed sigmoid mesocolon and a redundant loop of sigmoid colon filling the pelvic cavity
Satheesha B Nayak, Ravindra S Swamy, Abhinitha Padavinangady, Naveen Kumar, Ashwini P Aithal, Surekha D Shetty
April-June 2016, 19(2):98-100
DOI:10.4103/1118-8561.186039  
The sigmoid colon, when longer than its usual length is known as dolichosigmoid or redundant sigmoid colon. In the present case, the redundant sigmoid colon was about 20” long, and its distal part was “M” shaped. Its mesocolon was having a short 3” root attached to first sacral vertebral segment horizontally with the absence of its usual right and left limbs. The extra length of the sigmoid colon and atypical attachment of its mesocolon may favor the volvulus formation. Such variation may also cause constipation and pose difficulty in radiological diagnosis and instrumentation, making it clinically and surgically important.
  1,668 85 -
ORIGINAL ARTICLES
The necessity of full sepsis screen in neonatal sepsis: Experience in a resource-limited setting
Kenneth Ikenna Onyedibe, Mark Ojogba Okolo, Bose Toma, Tolulope Afolaranmi
April-June 2016, 19(2):89-93
DOI:10.4103/1118-8561.186041  
Background: Diagnostic tests that differentiate infected from noninfected neonates have the potential to make a significant impact on neonatal care. A full sepsis screen may be necessary to make a diagnosis of neonatal sepsis. Objective: The objective of this study was to evaluate the necessity of routinely collecting blood, urine, and cerebrospinal fluid (CSF) samples from every neonate suspected of sepsis. Materials and Methods: This was a cross-sectional study conducted in a Tertiary Care Hospital in Nigeria. The Integrated Management of Childhood Illnesses (IMCI) criteria for diagnosis of neonatal sepsis were used to select subjects into the study. Blood samples, CSF, and urine samples were collected from 165 neonates and processed by standard microbiologic methods. Results: A total of 68 isolates were recovered from 165 sets of blood culture samples representing 41.2% positive blood culture results. Only 3 (1.8%) organisms were isolated from 165 CSF samples. Five (3%) isolates were recovered from 165 urine samples. The three isolates from CSF were the same with blood isolates from the same neonates. Similarly, four of the five neonates with urine isolates also had blood isolates of the same organism. Conclusion: The findings of this study suggest that a properly collected blood culture sample is the most appropriate sample for recovering the causative organism in neonatal sepsis whereas other samples such as CSF and urine should be collected only when there are specific indications such as an obvious focus of infection in these sites. A full sepsis screen may not be necessary in most cases so as not to put the already sick neonate through unnecessary and sometimes harmful procedures.
  1,608 128 1
CASE REPORTS
Autoimmune pancreatitis with pancytopenia: A rare occurrence
Arulprakash Sarangapani, Subash Chandra Samal, Manoj Kumar Sahu, George M Chandy
April-June 2016, 19(2):101-103
DOI:10.4103/1118-8561.186033  
Autoimmune pancreatitis (AIP) is considered a distinct type of pancreatitis with an autoimmune pathogenesis. Patients with AIP often develop extrapancreatic lesions such as biliary lesions, sialadenitis, retroperitoneal fibrosis, swelling of lymph nodes, chronic thyroiditis, and interstitial nephritis, suggesting that AIP may be a systemic disease. Moreover, several cases of immune thrombocytopenia and few with neutropenia complicated with AIP have been described. The pathogenesis of thrombocytopenia associated with AIP is still unclear; however, autoimmune processes are suggested. On the other hand, cases of pancytopenia complicated by AIP have not yet been reported. We herein report a very rare case of pancytopenia associated with AIP.
  1,599 96 -
REVIEW ARTICLE
Role of genetics in the etiopathogenesis of genetic generalized epilepsy: A review of current literature
SA Balarabe, MM Watila
April-June 2016, 19(2):53-58
DOI:10.4103/1118-8561.186038  
Until recently, genetic generalized epilepsy (GGE) was believed to be of presumed genetic etiology with no identifiable genetic mutation or demonstrable epigenetic abnormality. A wide range of epileptic disorders has clue for an inherited susceptibility. Monogenic disorders associated with epilepsy mental retardation and structural brain lesion typified by heterotopias, tuberous sclerosis, and progressive myoclonus epilepsies account for about 1% of epilepsies. This review focuses on the role of genetic mutations and epigenetic rearrangements in the pathophysiologic mechanism of GGE. To achieve this; PubMed, EMBASE, and Google Scholar were systematically and comprehensively searched using keywords (“epilepsy” “juvenile myoclonic epilepsy (JME),” “typical absences,” “idiopathic generalized epilepsy,” “JME,” “juvenile absence epilepsy,” “childhood absence epilepsy” “generalized tonic-clonic seizure” “GTCS”). Most GGE has evidence of underlying genetic inheritance. Recent animal studies have shown that early detection and treatment of genetic generalized epilepsies can alter the phenotypic presentation in rodents. These findings suggest a critical period in epileptogenesis, during which spike-and-wave seizures can be suppressed, leading to chronic changes in the brain (epileptogenesis) and the preceding dysfunctions may, therefore, be targeted using therapeutic approaches that may either delay or inhibit the transition to active epileptic attack. The interplay between genetic mutations and epigenetic rearrangements play important roles in the development of GCE and that this process, especially at crucial developmental periods, is very susceptible to environmental modulations.
  1,360 140 -
ORIGINAL ARTICLES
A 20 year retrospective histomorphological analysis of juvenile soft tissue tumors
Odokuma Emmanuel Igho
April-June 2016, 19(2):74-81
DOI:10.4103/1118-8561.186032  
Introduction: Soft tissue tumours (STT) are defined traditionally as mesenchymal proliferations that occur in the extra-.skeletal nonepithelial tissues of the body excluding viscera, meninges and lymphoreticular system. These tumours occur in children where they may result in severe debilitating disease. This study was therefore aimed at determining the age, gender and site distribution of soft tissue tumours in the young. Materials and Methods: The records of all pathology consultations during the 20 year period from (1990-2010), from the Department of Morbid Anatomy/Histopathology, University of Benin Teaching Hospital from birth to 20 years, were utilized for this study. The lesions were standardized in accordance with the world health organization (WHO) classification. Permission for this study was obtained from the UBTH ethics committee (protocol number ADM/E22/A/VOL.VII/142). Results: A total of 139 lesions were recorded, 72 males and 67 females with a male/female ratio of 1.1:1. Benign tumours constituted 113(81%) while malignant tumours accounted for 26(19%). This study demonstrated that, nerve sheath tumours and vascular tumours accounted for 25% of STT in children followed by adipocytic tumours 22%, skeletal muscle tumours 17%, fibrohistiocytic tumours 7%, fibroblastic tumours 5%, and perivascular tumours 1% respectively. Majority of these tumours were located in the head and lower extremities with fewer in the upper extremities and trunk. These lesions were predominant in females of the older age group (10-20 years) unlike in their male counterparts. Conclusion: This study has shown that benign soft tissue tumours are more prevalent than the malignant varieties in juveniles.
  1,288 90 -
A comparison of carotid intimal thickness and other risk factors in patients with prediabetes and normoglycemic subjects in the Eastern India
Somak Kumar Das, Saikat Ghosh, Tanusree Nath, Chanchal Kumar Jana
April-June 2016, 19(2):59-62
DOI:10.4103/1118-8561.186040  
Introduction: Prediabetes is a precursor to diabetes; it is an intermediary state between normoglycemia and hyperglycemia. This metabolic state keeps company with major risk factors for atherovascular disease. The risk of coronary artery disease (CAD), including myocardial infarction, is higher in prediabetes patients compared to normal population. Aim: The aim of this study is to assess the prevalence of prediabetes in the patients with CAD and to compare the glycemic status, carotid intimal thickness (CIMT) and other risk factors in the prediabetes patients and normoglycemic subjects. Materials and Methods: One-hundred and fifty CAD patients and 80 control subjects who were age and sex matched were studied. Fasting blood glucose, a 2 h glucose tolerance test and CIMT were compared in both groups. Results: Mean age in the control group was 59.93 ± 10.84 years whereas it was 61.0 ± 11.02 years in the CAD. The mean CIMT was more and statistically significant in the case group. Impaired fasting glucose (IFG) was found in 30 (20%) cases and impaired glucose tolerance (IGT) was found in 45 (30%) cases, and both IFG and IGT were found in 12 (8%) cases. The prevalence of prediabetes in this study was 58%. Nondiabetic CAD patients had statistically higher fasting glucose level, 2-h oral glucose tolerance test values, total cholesterol and very low density lipoprotein levels than control patients. Conclusion: These findings stress the need for early screening and management of prediabetes preventing further progression to diabetes and CAD, even in rural patients.
  1,180 104 -
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