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   Table of Contents - Current issue
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July-December 2019
Volume 16 | Issue 2
Page Nos. 79-148

Online since Tuesday, November 19, 2019

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ORIGINAL ARTICLES  

Association of vitamin D with diabetic neuropathy among Sudanese patients with type 2 diabetes mellitus Highly accessed article p. 79
Ibrahim Wagea Alla Dalia, M Abdalla Abdelmula, Abdelrahman Elbashir Zeinab, A Abdrabo AbdElkarim
DOI:10.4103/njbcs.njbcs_8_19  
Background: Neuropathy is a common diabetic microvascular complication which reduces quality of life; causing pain and irritation in lower limbs and may result in amputation. Several Studies documented that vitamin D deficiency have extra skeletal effects including poor glycemic control and microvascular complications. Objectives: To explore the relationship between levels of vitamin D and diabetic neuropathy in Sudanese patients with type 2 diabetes mellitus. Methods: In this cross-sectional case control and hospital based study conducted at Jabber Abu Eliz Diabetes Centre (JAEDC), from February 2015 to November 2018, Sixty diabetic patients (thirty patients with neuropathy and thirty patients without neuropathy), and sixty healthy subjects were compared in terms of levels of vitamin D, C-peptide, lipid profile, HbA1C, C-reactive protein, and MAU. SPSS software was used for analysis of clinical variables. Results: Vitamin D levels where significantly decreased in diabetic patients and also in those with neuropathy when compared to those without neuropathy (P < 0.05) Vitamin D correlated significantly with age P (0.016), insignificantly with disease duration, BMI, HbA1C and MAU (P > 0.05). 86.8% of patients with neuropathy had vitamin D deficiency and 6.6% had insufficiency. Vitamin D levels where significantly reduced with increasing severity of neuropathy (P 0.001). Conclusion: Vitamin D levels are significantly decreased in diabetic patients especially in those with neuropathy. Severity of neuropathy is significantly correlated to severity of vitamin D deficiency. Diabetic patients should be screened for vitamin D level and supplementation should be prescribed to correct the deficiency.
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Prevalence and determinants of glucose intolerance in a Northern Nigerian population: Role of insulin resistance p. 83
Yakubu Lawal, Fatima Bello, Felicia E Anumah, Adamu G Bakari
DOI:10.4103/njbcs.njbcs_36_18  
Background: Insulin resistance is a major factor in the pathogenesis of type 2 diabetes mellitus. This study is aimed at determining the prevalence of insulin resistance in a Northern Nigerian population. Other objectives include determining the interrelationship between body mass index (BMI), waist circumference (WC), waist–hip ratio (WHR), insulin resistance, and plasma glucose levels; and establishing whether insulin resistance is a significant determinant of glucose intolerance in the studied population. Materials and Methods: In total, 400 subjects were recruited using cluster sampling from their respective communities after due consent. Relevant biodata were documented and appropriate examinations including anthropometric measurements were carried out. Oral glucose tolerance test was carried out and fasting plasma insulin levels were also measured. Insulin resistance was calculated using homeostatic model assessment of insulin resistance.Results: The prevalence of insulin resistance was 36.6%, whereas that of glucose intolerance (prediabetes 17.2% and diabetes 9.3%) was 26.5%. Logistic regression analysis showed that insulin resistance, BMI, WC, waist–height ratio, and WHR were significant determinants of glucose intolerance. Conclusions: The prevalence of insulin resistance and glucose intolerance were high. Markers of insulin resistance and some key markers of obesity were important determinants of glucose intolerance in this study.
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Misoprostol for treatment of incomplete abortions by gynecologists in Nigeria: A cross-sectional study p. 90
Godwin O Akaba, Habiba I Abdullahi, Adamu A Atterwahmie, Udo I Uche
DOI:10.4103/njbcs.njbcs_12_19  
Introduction: Misoprostol is approved for treatment of incomplete abortion in Nigeria, but subjective evidence suggests that it is seldom used by gynecologists in Nigeria for this indication. The purpose of the study was to determine the rate of utilization of misoprostol for treatment of incomplete abortion by gynecologists in Nigeria and perceived barriers to its use for this indication. Materials and Methods: This was a cross-sectional study of gynecologists who attended the 2017 Society of Gynaecology and Obstetrics of Nigeria, Conference held in Sokoto state, Nigeria as well as a retrospective review of Post abortion care services in three Nigerian tertiary hospitals for a period of one year (1 January-31 December, 2017). Results: Misoprostol was used in the treatment of first trimester abortions in 19/343 (5.5%) compared to manual vacuum aspiration (MVA) 324/343 (94.5%) in the tertiary hospitals. The major perceived barrier in the utilization of misoprostol for treatment of first trimester incomplete abortion was the preference of MVA to misoprostol by the provider (32%) and was followed closely by not being sure of the brand of the misoprostol (31%). Other reasons included that misoprostol was not effective (6%), side effects (8%), high cost (5%), unavailability (1%), not conversant with dosage regimens (1%), and others (16%). Overall, 51% of responders confirmed that they do not have a written onsite protocol for the management of first trimester incomplete abortions in their institutions. Conclusions: There is poor utilization of misoprostol, barriers to its use, and absence of protocols/guidelines for the treatment of first trimester incomplete abortions in most gynecological departments of Nigeria's public health institutions. It is expedient for gynecologists in Nigeria to put in place processes that ensures translation of evidence-based research findings into practice and policies towards improving maternal health in Nigeria.
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Awareness of cervical cancer and its risk factors among gynaecology clinic attendees p. 95
Aisha A Buba, Idris I Jalo, Mohammed B Kawuwa
DOI:10.4103/njbcs.njbcs_10_19  
Background and Aims: Death from cervical cancer is preventable through effective cervical cancer screening and treatment of premalignant disease. Several studies have identified the lack of awareness and inadequate knowledge about cervical cancer among barriers to prevention of cervical cancer. Determining the level of awareness of cervical cancer may inform strategies that could empower women with adequate knowledge on cervical cancer and its prevention. This study aims at determining the level of awareness of cervical cancer and its risk factors among Gynaecology clinic attendees. Methods: The study was conducted in the State Specialist Hospital Damaturu, from July 2017 to May 2018. It was a descriptive cross sectional study conducted among 200 Gynae -clinic attendees, aged 15-60 years. The researchers administered structured questionnaires to obtain the data. Results: Of the 200 women interviewed, only 46 (23%) of them heard of cervical cancer. The radio (media) was the commonest source of information in majority (93%) of those that were aware of cervical cancer. 75% of the respondents did not know most of the risk factors of cervical cancer. Conclusion: The knowledge of cervical cancer and its risk factors was generally poor among the respondents. The media especially the radio could play an important role in raising awareness on cervical cancer.
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Pre-labor rupture of membrane in Aminu Kano teaching hospital: A 2-year review p. 99
Natalia Adamou, Ibrahim Danladi Muhammad, Usman Aliyu Umar
DOI:10.4103/njbcs.njbcs_1_19  
Background: Prelabor rupture of the membranes (PROM) is the rupture of fetal membranes before the onset of labor and it complicates about 8% of pregnancies at term and 3% of pregnancies before term. This study evaluated the maternal characteristics and pregnancy outcomes in different gestational ages in patients with PROM in Aminu Kano teaching hospital Kano, Nigeria, between August 2015 and July 2017.Materials and Methods: This was a retrospective analysis of all cases managed for PROM between 1st August 2015 and 31st July 2017 in the department. All patients admitted with PROM were included. Information extracted includes maternal demographic and obstetrical variables, duration of conservative management, mode of delivery, birth weight, Apgar score. Data was collated and analyzed using SPSS version 22. Descriptive variables were presented in tables and tests of significance were done using Chi-square test. Results: A total of 6,658 deliveries were recorded during the study period. There were 109 cases of premature rupture of fetal membranes, out of which 60 (0.9%) were cases of preterm PROM, whereas 49 (0.7%) were cases of term PROM. Hence, the prevalence of PROM over the study period was 1.6%. The duration of membrane rupture has shown a statistically significant association with neonatal outcome with patients presenting within 24 h of membrane rupture having better outcomes. Conclusion: The prevalence of preterm and term PROM in this study was low and majority of the patients had active management with good neonatal outcome. The duration of membrane rupture affects neonatal outcome.
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Maternal predictors of blood transfusion among neonates in the Neonatal Intensive Care Unit of Ahmadu Bello University Teaching Hospital Zaria, Nigeria p. 103
Ibrahim Usman Kusfa, Aisha Indo Mamman, Mohammed Sani Shehu, Isa Abdulkadir, Ismaila Nda Ibrahim, Aliyu Dahiru Waziri, Sani Awwalu, Aisha Maude Suleiman, Haruna Mohammed Muktar, Tukur Dahiru
DOI:10.4103/njbcs.njbcs_18_19  
Background: Maternal health and healthcare accessibility are important determinants of neonatal survival. Pregnancy-related complications may lead to maternal anemia and, maternal micronutrient deficiency, conditions which could result in neonatal anemia necessitating transfusion. Objectives: To determine maternal predictors of neonatal blood transfusion. Methods: We conducted a case–control study on mother–infant pairs of cases and controls. A semi-structured questionnaire was used to collect information. Logistic regression was used on maternal predictors, and the level of significance was set at ≤0.05. Results: The overall mean (±standard deviation) age of mothers in both case and control groups was 21.79 ± 10.71 years, respectively. The likelihood of neonatal transfusion was increased by parity of ≥5 [odds ratio (OR): 3.1, 95% confidence interval (CI) = 1.26–7.39], while age of ≥18 years at first marriage, attainment of at least secondary school, four antenatal care (ANC) visits before delivery, birth interval of ≥2 years, and hematinics use during pregnancy were associated with reduced neonatal blood transfusion (OR: 0.36, 95% CI = 0.14–0.96), (OR: 0.66, 95% CI = 0.32–1.37), (OR: 0.70, 95% CI = 0.25–1.99), (OR: 0.55, 95% CI = 0.19–1.62), and (OR: 0.63, 95% CI = 0.17–2.36), respectively. Conclusion: We found that high parity, teenage mothers, inadequate ANC visits, short birth interval, and hematinics noncompliance during pregnancy were all associated with increased need of blood transfusion among neonates.
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High hemolytic markers in G6PD-deficient compared to G6PD-normal male leprosy patients p. 109
Ibrahim Musa Idris, Aisha Kuliya-Gwarzo, SG Ahmed
DOI:10.4103/njbcs.njbcs_29_18  
Introduction: Glucose-6-phosphate dehydrogenase (G6PD) deficiency (Gd) is the most common enzymopathy, which is inherited as an X-linked recessive disorder. Individuals with Gd are prone to hemolysis upon exposure to oxidant stress. Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. Both leprosy and Gd are common in Nigeria, and treatment of leprosy with dapsone can precipitate hemolysis in Gd. Aims: The aims of this study were to determine the prevalence of Gd, and compare the hematological and biochemical indices of Gd with G6PD-replete (Gd+) male leprosy patients in Kano, Nigeria. Settings and Design: This was a cross-sectional study. A total of 198 male participants with leprosy were recruited at the Yadakunya leprosarium in Kano, Nigeria. Materials and Methods: Relevant data were obtained through questionnaires and case notes review. Venous blood was collected for analysis. Statistical Analysis: Unpaired t test and Chi square test were used for comparison of variables. Results: The prevalence of G6PD deficiency was 9% in male leprosy patients. Mean Hb of Gd(10.56 ± 2.82 g/dl) was lower than Gd+(12.9 ± 2.31 g/dl), P value < 0.001. Platelet (293.52 × ±3.19 × 109/l vs. 176.31 ± 2.83 × 109/l; P value < 0.001), reticulocytes (4.49 ± 2.72% vs. 2.01 ± 1.07%, P value < 0.001), bilirubin [1.04 ± 0.22 mg/dl vs. 0.46 ± 0.27 mg/dl; P value < 0.001], and lactate dehydrogenase (LDH) [269.82 ± 58.54 mg/dl vs. 130.26 ± 51.83 mg/dl; P value <0.001] were higher in Gd than Gd+. Conclusion: Lower Hb and higher hemolytic markers in Gd indicate ongoing hemolysis, which can be precipitated by dapsone.
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Personal hygiene of street-food vendors in Sabon-Gari local government area of Kaduna State, Nigeria p. 114
Ahmad A Umar, Muhammad N Sambo, Kabiru Sabitu, Aliyu T Mande, Jamila Umar
DOI:10.4103/njbcs.njbcs_30_17  
Background and Aims: Street-food vendors play an important role in the aetiology of food borne disease outbreaks. Food borne disease pathogens may be transferred by street-food vendors to food either directly or by cross contamination. This study assessed the personal hygiene among street-food vendors in Sabon Gari Local Government Area of Kaduna State. Methods: It was a cross sectional study conducted among 109 adult street-food vendors who sell cooked food or food items by the road side or open spaces in Sabon Gari LGA. Multistage sampling technique was used to select the respondents. Data was collected using observation checklist and pretested interviewer administered structured questionnaire with closed-ended questions. The data obtained was analysed using IBM SPSS statistics 20. Results: Most of the street-food vendors were within age group 35-44 years (40.4%). Most (49.5%) of the people who patronized street-food vendors were passers-by and more than half of the street-food vendors operate under a shade (50.5%). All the street-food vendors did not receive training on personal hygiene. More than half of the street-food vendors 55 (50.4%) had poor personal hygiene. Also 103 (94.5%) and 100 (91.7%) of the food vending sites has chairs/benches where customers could sit to eat and cooking spot separated from the serving area, respectively. Conclusion: Most of the street-food vendors had poor personal hygiene, however majority had a fairly good environmental sanitation status around their vending sites. Formal training on personal hygiene should be conducted among all street-food vendors in the LGA in order to improve on their personal hygiene practice for the vending of safe food to their consumers.
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Oral hygiene status and dental awareness of non – dental health professionals in Aminu Kano Teaching Hospital, Kano State, Nigeria p. 121
Olohigbe O Alufohai, Juliana O Taiwo, Balarabe Sani
DOI:10.4103/njbcs.njbcs_3_19  
Background and Aims: The oral hygiene status of individuals may be a strong indication of the extent of their dental awareness. The level of awareness can make a great difference in the quality of oral health care that can be rendered to patients. The aim of this study is to evaluate the oral hygiene status and dental awareness of non-dental health professionals in Aminu Kano Teaching Hospital, Kano State, Nigeria. Methodology: A total of 425 participants selected by multistage sampling technique fulfilled the inclusion criteria for this study. They included 238 males and 187 females. Each respondent completed an informed consent sheet and a modified questionnaire on dental awareness. They were examined immediately after to assess oral hygiene status using the Simplified Oral Hygiene index by Greene and Vermillion (1964). Results: Majority of study participants displayed moderate dental awareness. Dental awareness was categorized as poor, low, moderate, high and excellent using a researcher's analysis index. 56.5% displayed moderate awareness. Using the simplified oral hygiene index by Greene and Vermillion (1964), 60.94% were found to have fair oral hygiene. A strong statistically significant difference was observed in dental awareness among the professional specialties and ethnic groups. A very strong statistically significant difference was seen in the oral hygiene status. Conclusion: The dental awareness of the cadre of health professionals included in this research is considered unsatisfactory while the oral hygiene status of majority of the respondents needs improvement. These findings will therefore necessitate interventions to upgrade their awareness level and oral hygiene.
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Work-related musculoskeletal disorders among Nigerian police force p. 127
Adamu Ahmad Rufai, Adewale Luqman Oyeyemi, Stanley Monday Maduagwu, Abah Daniel Fredrick, Isma'ila Adamu Saidu, Salamatu Umar Aliyu, Aliyu Lawan
DOI:10.4103/njbcs.njbcs_2_19  
Background: Work-related musculoskeletal disorders (WMSDs) have become a cause for concern in both the developed and developing countries. Objective: To determine the prevalence of WMSDs among the Nigerian Police Force in Maiduguri. Methods: A total of 253 police officers participated in this cross-sectional study. Modified Nordic Questionnaire was administered to assess the WMSDs of the participants. Descriptive statistics of mean, standard deviation, frequency, and percentages were used to describe the data, while the differences in the prevalence of WMSDs by sociodemographic characteristics and occupational factors were tested with Chi-square statistics. Results: The 12-month prevalence of WMSDs was 80.6%. Lower back was the most commonly affected body region with 74.1%. About 71% of police officers had a gradual onset of WMSDs. A majority of the participants (56.6%) identified working in the same position for a long period as the most common risk factor for WMSDs. Significant difference in the 12-month prevalence of WMSDs was found among police officers of different age groups (χ2 = 7.85; P= 0.002), years of working experience (χ2 = 10.05; P= 0.007), and hours spent at work per day (χ2 = 9.87; P= 0.007). Conclusion: There was a high 12-month prevalence of WMSDs among the police officers with the lower back being the most commonly reported body region. The prevalence of WMSDs was associated with higher age, higher working experience, and longer working hours/day. There is the need to integrate ergonomic education in the training of police officers to prevent/reduce the occurrence of WMSDs among this population.
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A review of primary malignant cutaneous soft tissue tumors seen in a tertiary institution p. 134
Akhator T Azeke, Dele E Imasogie
DOI:10.4103/njbcs.njbcs_5_19  
Introduction: The baseline data of primary malignant cutaneous soft tissue tumors in this environment had been determined. It is important that as the years roll by, data collection and analyses are indispensable to determine the current trend of this tumor on one hand and compare it with the baseline data from previous studies on the other hand. The aim of this study is therefore to determine the frequency and the histopathological types of primary malignant cutaneous soft tissue tumors at the University of Benin Teaching Hospital (UBTH), Benin City, Edo State, Nigeria. Methodology: This was a retrospective study of all primary malignant cutaneous soft tissue tumors that were histologically diagnosed from 1st of January 2004 to 31st of December 2013 in the Department of Morbid Anatomy, UBTH. Data were obtained from departmental archives. Data analysis was done using the SPSS statistical package version 16 (V.16.0). Results: A total of 187 malignant cutaneous tumors were diagnosed over the study period, and 87 (46.52%) of these cases were primary malignant cutaneous soft tissue tumors. Their mean age was in the fourth decade of life. Females were slightly more affected with a male:female ratio of 1:1.2. The histopathological types were angiosarcomas (2.3%), dermatofibrosarcoma protuberance (10.3%), and Kaposi's sarcoma (87.4%) in increasing order of frequency. Conclusion: The earlier determined reference point data of primary cutaneous soft tissue tumors in our environment were updated to include cutaneous angiosarcoma, thus bringing this rare tumor to the attention of both the pathologist and dermatologist. An increase in the frequency of dermatofibrosarcoma protuberance and Kaposi's sarcoma was also noted.
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CASE REPORTS Top

HCC presenting as left breast swelling in a young patient: A case report p. 137
Ahmad K Bello, Muhammad M Borodo
DOI:10.4103/njbcs.njbcs_39_17  
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths seen more in males than females. Risk factors include hepatitis B viral infection and aflatoxin contaminated food products. Metastatic lesions are common to the lungs, skull, para-aortic lymph node, bone, and adrenal glands. Breast metastasis are rare with few reported cases worldwide. We present a case of HCC with metastasis to the left breast. HCC should be considered as a differential in patients with unilateral gynaecomastia, particularly in patients with risk factors for chronic liver disease.
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Subcutaneous fat necrosis: A case report p. 141
Abdulkadir Isa, Usman Nazir, B Aliyu Usman, L Abubakar Muhammad
DOI:10.4103/njbcs.njbcs_42_17  
Subcutaneous fat necrosis (SCFN) is a rare dermatologic condition which until recently was thought to occur only in term neonates. Its presentations are protean and early in the disease; it mimics other more common neonatal dermatologic conditions. Although benign, it runs a prolonged course and may be associated with some complications and therefore needs to be differentiated from other more life-threatening neonatal dermatologic conditions. We present a case of a term neonate with histology report highlighting some characteristic features of SCFN and the need to differentiate it from sclerema neonatorum (SN), a condition associated with fatal outcome.
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Furuncular myiasis in two Nigerian siblings – Case report and review of the literature p. 145
Halima Kabir, Ramatu J Abdallah, Nurat O Lawal, Zubaida L Farouk
DOI:10.4103/njbcs.njbcs_12_18  
Myiasis is an infestation of the body of a mammal by fly larva that grows inside and feeds on the tissue of the host. It is endemic to sub-Saharan Africa, southeast Mexico, South America, and Central America. It can occur in any age group and has no sex predilection. It is mostly seen among the rural population with many cases unreported and undiagnosed. We report two otherwise healthy Nigerian siblings with furuncular myiasis, who were initially diagnosed with furunculosis and received antibiotics from various hospitals without improvement. The larvae were removed with forceps after application of petroleum jelly and had full healing of all lesions on follow-up. Furuncular myiasis should be considered a differential diagnosis of furunculosis that is not responding to antibiotics, especially in travellers to endemic areas.
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