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   2016| July-September  | Volume 19 | Issue 3  
    Online since October 14, 2016

 
 
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ORIGINAL ARTICLES
Pattern of adverse events following immunization in nourished and malnourished infants in Kano, North-Western Nigeria
Umar Muhammad Lawan, Gboluwaga Taiwo Amole, Nafisa Yusuf Wali, Mahmud Gambo Jahun, Abubakar Mohammed Jibo, Asmau Abdurrazaq Nakore
July-September 2016, 19(3):131-136
DOI:10.4103/1118-8561.192394  
Background: Adverse events following immunization (AEFI) occur in both nourished and malnourished babies but are often mislabeled as manifestations or complications of background condition or disease especially among malnourished infants. Aim/Objective: To study the pattern of AEFIs in nourished and malnourished infants in Kano. Materials and Methods: Descriptive cross-sectional design was used to study 372 eligible infants aged 0–11 months old. All infants immunized in the first quarter of 2014 that had up to date immunization card qualified for the study. Data were analyzed using SPSS version 16.0. Results: The mean age of the infants was 3.5 ± 3.1 months, with male being 53.5%, and well nourished being 88.4%. Prevalence of AEFI was 33.1% (nourished), 48.8% (malnourished), and 34.9% overall. Fever occurred in 79.8% nourished and 95.2% malnourished infants. Localized pains and/or swelling occurred in 29.3% nourished and 47.6% malnourished, but abscess or ulceration around vaccination site occurred only in the nourished infants and was significantly associated with the 1st immunization visit. Most AEFI were experienced around the 1st three immunization visits. Majority of the AEFI, experienced, nourished (58.7%), and malnourished (52.4%), occurred within 1–11 h and was mild to moderate in severity in 99.1% and 100% of the respective groups. Conclusion and Recommendation: Focused research on vaccine formulation and safety, and recurrent training of immunization workers on vaccine administration, and early and prompt treatment of AEFI are paramount.
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REVIEW ARTICLE
Autopsy and religion: A review of the literature
Akinfenwa Taoheed Atanda, Ali Bala Umar, Ibrahim Yusuf, Mohammed Ibrahim Imam, Alfa Alhaji Sule
July-September 2016, 19(3):119-124
DOI:10.4103/1118-8561.192393  
In spite of immense benefits derivable from carrying out autopsy on the dead, its practice has been very limited in northern Nigeria. One of the reasons for this is the perception that religion opposes the practice of autopsy. Using online search engines and religious doctrinal literature including the Qur'an, Bible and Talmud, a review of their teachings regarding autopsies was conducted. Findings were then harmonized with the practice of autopsy in its present form. Available literature reveals that the religious impediments include the permissibility or otherwise of the procedure, timing, opposite sexes seeing the corpse's nakedness, body mutilation, exhumation of the dead and retention of organs or tissues for teaching purposes. This study concludes that no religion expressly condemns the practice of autopsying the dead, and that the meeting points for various religions and the practice of autopsy is the need for learning and dispensation of justice. However, there is also a common agreement on the need for the procedure to be done promptly and to maintain the dignity of the dead during the procedure.
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ORIGINAL ARTICLES
Preference of specialty choices among final year medical students of Bayero University Kano
MO Asani, GD Gwarzo, MJ Gambo
July-September 2016, 19(3):155-158
DOI:10.4103/1118-8561.192392  
Background: The choosing of a career specialty by medical students can be a complex and confusing issue. Several studies have demonstrated that medical students often show a strong preference for particular specialties even before graduation. This study aims to find out the specialty choices and the factors that influence the choices of final year medical students of Bayero University Kano. Materials and Methods: This is a cross-sectional study. The sample population involves all final year medical students of the Bayero University Kano. Ethical consent was obtained from the relevant authority. The subjects were given self-administered questionnaires. Chi-square or Fisher's exact test was used to assess the association between choice of specialty and demographic variables. P < 0.05 was considered as significant. Results: Total number of respondents is 71. The core clinical specialties account for 70.3% of the first choice among respondents: Obstetrics and gynecology – 19 (28.5%), surgery – 14 (20.9%), internal medicine – 8 (11.9%), and pediatrics – 6 (9%). None of the students chose pathology, microbiology, family medicine, and ENT as the first choice. The major reasons given for the choice of future career are personal interest and a better outcome for patients. There was no association between choice of future career and demographic variables. Conclusions: The preferences do not reflect the present demands of the health needs in Nigeria, therefore, there is need for healthcare planners, policy makers, and medical educators to strengthen mentorship processes and career guidance in undergraduate medical education.
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LETTER TO THE EDITOR
Hyperinsulinemia with acute severe malnutrition
Ibrahim Aliyu
July-September 2016, 19(3):168-169
DOI:10.4103/1118-8561.192396  
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ORIGINAL ARTICLES
Prevalence of self-reported halitosis and associated factors among dental patients attending a tertiary hospital in Nigeria
Kehinde Adesola Umeizudike, Olufemi Elijah Oyetola, Patricia Omowunmi Ayanbadejo, Grace Onyenashia Alade, Priscilla Okhiabigie Ameh
July-September 2016, 19(3):150-154
DOI:10.4103/1118-8561.192398  
Objectives: To determine the prevalence of self-reported halitosis among dental patients seen in a teaching hospital. Materials and Methods: This was a cross-sectional study that included 135 dental patients enrolled at the Oral Diagnosis/Periodontology Clinics of the Lagos University Teaching Hospital. Self-administered questionnaires were used to assess self-reported halitosis (oral malodor) in the subjects. Association between self-reported halitosis and sociodemography (age, gender, education, marital status, ethnicity, and religion) and intraoral findings (gingivitis, periodontitis, tongue coating, caries, and number of mobile teeth) was determined. Results: The prevalence of self-reported halitosis was 14.8% and was significantly associated with age of 40 years and above (P = 0.025), and male gender (P = 0.032). Subjects with gingivitis were 2 times more likely to have halitosis than those without gingivitis (odds ratio [OR] = 2.19 while subjects with tongue coating were 2 times more likely to have halitosis than those without tongue coating OR = 2.02. About 50% perceived halitosis by themselves, 25% by family and friends, and 20% from presumed actions of people around them. The majority (70%) of the patients perceived the halitosis from their mouths, 30% from their mouth and nose. Most (75%) of the subjects had perceived the halitosis for more than 4 weeks while only 3% had sought professional treatment. Conclusion: Older age of 40 years and above and male gender were the factors associated with self-reported halitosis in this study. The health-seeking behavior of the patients for the treatment of the halitosis was poor.
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Comparison of health-care expenditure of obese and non-obese patients attending a tertiary health-care institution in Northwest, Nigeria
Musa Usman Umar, Abubakar Sanusi, Muhammad Rayyan Garba
July-September 2016, 19(3):125-130
DOI:10.4103/1118-8561.192391  
Background: The World Health Organization estimates that obesity is responsible for between 2% and 7% of global health-care spending. Obesity has a huge public health significance considering that about a third of the global population is either overweight or obese, and Nigerian's obesity burden is also increasing. The aim of the study is to compare the pattern of health-care expenditure between obese and nonobese. Materials and Methods: This was a comparative study of patients attending the general outpatient department of Aminu Kano Teaching Hospital, Kano, Nigeria. A questionnaire to assess the pattern of health-care expenditure based on the Andersen Behavioral Model was adopted for this study. Results: Of the 325 participants, 117 (36%) were obese, while 208 (64%) were nonobese. Obese individuals had statistically significant higher median cost of total inpatient cost at ₦88000 compared to ₦45000 (P = 0.015). The total outpatient cost was statistically higher for obese compared to nonobese (P < 0.001), so also was the cost of physician consultation (P < 0.001), laboratory and radiological tests (P < 0.001), cost of medication (P < 0.001), and alternative health-care services (P = 0.003). For indirect cost, the difference in mean number of days given excused duty from work and unable to carry out household activities were statistically higher for obese than nonobese (t-test = 3.068; P = 0.002) and (t = test = 5.995; P < 0.001), respectively. Conclusion: In this study, the cost differential of obesity compared to nonobese individuals was substantial, and this is likely to place a lot of economic burden to the individual and the health-care system.
  1 4,609 294
Benign tumors of the breast in Kano, Northern Nigeria: A 10-year experience and review of literature
Mohammed Ibrahim Imam, Raphael Solomon, Ibrahim Yusuf
July-September 2016, 19(3):137-141
DOI:10.4103/1118-8561.192397  
Background: Benign breast tumors are common worldwide and various reports suggest an increasing incidence in Nigeria which necessitates an urgent need to differentiate it from malignant tumors. The study was carried out to classify and determine the pattern, frequency, age, and sex distribution of benign breast tumors seen in a tertiary hospital. Materials and Methods: This was a 10-year retrospective study of all benign breast tumors diagnosed at the Pathology Department of a teaching hospital from January 1 2001 to December 31 2010. Results: A total of 1566 breast tumors were diagnosed during the study period, 1035 cases of benign breast tumors constituting 66.3% of all breast tumors were seen. The female to male ratio was 72.9:1. The overall mean age for benign breast tumor was 29 years with a peak age occurrence in the third decade. Fibroadenoma (FA) was the most common benign breast tumor followed by fibrocystic change and they accounted for 47.1% and 25.4% of benign breast tumors with mean age of 24.7 years and 33.4 years, respectively. FA has a peak occurrence in the third decade while fibrocystic change has a peak occurrence in the fourth decade. Other major tumors encountered were tubular adenoma (6.0%), lactating adenoma (5.6%), benign phyllodes (4.8%), sclerosing adenoma (3.3%), and blunt duct adenoma (2.5%). Gynecomastia (1.4%) was the only benign breast tumor seen in males.Conclusions: Benign breast tumors are quite common, presenting mostly as FA and fibrocystic change. The tumors are seen in both sexes with a striking female preponderance and occurred predominantly in young females with a peak in the third decade. The findings are generally similar to the most previous studies from Nigeria, Africa, and the Western world with minimal variations.
  1 5,646 359
Clinical pattern and outcome of acute kidney injury patients from a Tertiary Health Institution in Northwestern Nigeria
Makusidi Aliyu Muhammad, Hamidu Muhammad Liman, Abdulmumini Yakubu, Muhammad Danasabe Isah, Sadiq Abdullahi, Adindu Chijioke
July-September 2016, 19(3):142-145
DOI:10.4103/1118-8561.192399  
Background: Acute kidney injury (AKI) is a common cause of hospitalization associated with high mortality, especially in developing countries. Despite better understanding of the pathophysiology, mortality from AKI remains source of concern worldwide. AKI varies between countries and even within the same environment due to diverse diagnostic criteria. Studies from developing nations have alluded to the high incidence of AKI from preventable and potentially reversible causes affecting predominantly children and young adults. The growing concern as to whether the pattern and outcome have changed in recent times prompted this study. Materials and Methods: All the patients that met RIFLE criteria for the diagnosis of AKI were audited with specific reference to clinical pattern and outcome in Northwestern Nigeria. Results: A total of 318 patients (198 males and 120 females) that met RIFLE criteria for AKI were seen with age range and mean of 20–80 years and 42.0 ± 12.0 years, respectively. Severe gastroenteritis, septicemia, obstetric complications, and toxic nephropathies were leading causes of AKI. Main clinical features in order of magnitude were oliguria, fever, body swelling, unusual weakness, and vomiting. Sixty-eight percent had hemodialysis while 32% were managed conservatively. Overall, mortality was 26.4%, and conservative management was associated with higher mortality than those that had hemodialysis. Factors associated with high mortality were late presentation, severe anemia, and sepsis. Conclusion: AKI is common in our setting and causes are largely preventable and treatable. Identification and prompt correction of reversible causes and timely referral of severe cases to nephrologists are of immense importance.
  1 7,040 333
CASE REPORT
Total anomalous pulmonary venous connection in a 9-year-old girl at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
Usman Muhammad Sani, Isezuo K Omeneke, Usman Muhammad Waziri
July-September 2016, 19(3):164-167
DOI:10.4103/1118-8561.192400  
Total anomalous pulmonary venous connection (TAPVC) is a rare cyanotic congenital heart disease in which all the four pulmonary veins drain into the right atrium instead of the left. Without surgical intervention, 80% of the patients die before the age of 1 year. We report a 9-year-old girl with unrepaired supracardiac TAPVC complicated by severe pulmonary artery hypertension. The patient was managed conservatively including the use of pulmonary antihypertensive (sildenafil), with significant improvement. She is currently on follow-up at our pediatric cardiology clinic. TAPVC requires surgical intervention in early infancy to prevent the onset of pulmonary hypertension, which may contraindicate surgery. High index of suspicion and improved diagnostic skill will enhance early diagnosis and enable timely intervention.
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ORIGINAL ARTICLES
Risk factors of acute otitis externa seen in patients in a Nigerian tertiary institution
Mohammed Abdullahi, D Aliyu
July-September 2016, 19(3):146-149
DOI:10.4103/1118-8561.192395  
Background: Acute otitis externa is a common clinical problem which is associated with preventable risk factors. Objective: The aim of this study is to determine the practices that are risk factors in patients with acute otitis externa in a Nigerian tertiary institution. Patients and Methods: This was a 6-month cross-sectional study of patients with acute otitis externa carried out between April and September 2013 at the Ear, Nose, and Throat Clinic of the Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. Results: A total of 2350 patients were seen during the study period, of which 88 (3.7%) were diagnosed with acute otitis externa. The males and females were 32 (36.4%) and 56 (63.6%), respectively, with a ratio of 1:1.8 The age range was 3 months to 70 years, with the mean age of 18.9 years. Self-ear cleaning with cotton bud 65 (73.9%) constituted the majority of object introduced into the ear canal(s) and the reasons for self-ear cleaning were because of itching of the ear(s) in 47 (53.4%), habitual 9 (10.2%), and perceiving that the ears were dirty 32 (36.4%). The introduction of extraneous moisture into the ears was seen in 46 (52.3%) including self-medication with topical antibiotic, instilling plain and soapy water in the ear canal(s), and swimming. The comorbid conditions which are known risk factors for otitis externa were seen in 35 (39.8%) patients, of which allergy was the most frequent with 22 (25%), followed by diabetic mellitus 7 (8%) and AIDS 6 (6.8%). Only 14 (16%) of these patients had their comorbid conditions diagnosed at their first presentation. Conclusion: Self-ear cleaning with cotton bud was the major risk factor seen in our patients with otitis externa, followed by the introduction of extraneous moisture into the ear canals and untreated comorbid risk factors for acute otitis externa. These risk factors are preventable through creation of awareness and prompt treatment of other associated disease conditions.
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A decade experience with the use of clozapine in a Nigerian tertiary hospital
MM Yerima, AW Ibrahim, UB Musami, SK Pindar, BM Kundi
July-September 2016, 19(3):159-163
DOI:10.4103/1118-8561.192390  
Background: Clozapine as the prototypical atypical antipsychotic has proven benefits in treatment-refractory schizophrenia as well as reduced propensity for extrapyramidal side effects. Literature is lacking from Nigeria on experience with clozapine use, the characteristics of patients and white blood cell (WBC) counts monitoring practices. This study looks at the demographic and clinical characteristics as well as WBC monitoring practices of patients on clozapine. Materials and Methods: This is a retrospective, descriptive study that surveyed all patients on clozapine in the center for a decade. Descriptive statistics as well as inferential statistics, such as Chi-square, analysis of variance (ANOVA), and correlation coefficient, were used to analyze the data using IBM SPSS Statistics 20. Results: In the period covered by the study, 70 patients were found to have been on clozapine. The mean age of the patients was 39.4 years with standard deviation (SD) of 13.7 years. The majority of the patients were males making up 61.4% of the study sample. The predominant ethnic group of the patients was Kanuri making 60% of the sample. Up to 60% of the patients had at least primary school education while the remaining 40% had no formal education. The majority of the patients had a diagnosis of schizophrenia, which made up 65.7%. The mean number of WBC count checks was 4.1 (SD = 4.8). ANOVA shows that there was no statistically significant association between the number of WBC count checks and the educational attainment of patients or their diagnosis (education: F = 1.354, P = 0.266; diagnosis: F = 2.07, P = 0.097). Conclusion: Clozapine still remains the antipsychotic of last resort in a number of psychiatric patients which, therefore, underscores the importance of studying the patients on the medication.
  - 4,751 229
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