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   Table of Contents - Current issue
July-December 2018
Volume 15 | Issue 2
Page Nos. 105-166

Online since Friday, September 14, 2018

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How common is post-neonatal tetanus in Rasheed Shekoni Specialist Hospital, Jigawa, North Western Nigeria? p. 105
Umar Also, Garba D Gwarzo
Background: Tetanus, caused by Clostridium tetani neurotoxin, is still an important cause of morbidity and mortality in children in developing countries. Children usually present with trismus followed by spasms of skeletal muscles. Tetanus infection can easily be prevented through immunization. However, despite provision of routine immunization schedule by government-based hospital at all levels of care, there is still poor immunization uptake which in association with dangerous traditional practices in the area leads to high burden of the disease. Materials and Methods: This was a retrospective hospital-based study. It was conducted at the Department of Paediatric of Rasheed Shekoni Specialist Hospital, Dutse, Nigeria. Medical records of all children between the ages of 1 month and 13 years, who were admitted between May 2014 and April 2017, with a diagnosis of tetanus were retrieved and analyzed. Diagnosis of tetanus is clinical based on the presence of trismus and spasms. Information obtained included biodata, immunization status, onset and duration of symptoms, length of hospitalization, and outcome. Results: Children admitted with tetanus in the period of study were 25, but only 20 qualified for analysis. The prevalence of tetanus was 1.03%. Twelve (60%) were in the 5–9 years age group. Majority (75%) were males, from rural areas (75%), and did not receive any immunization (65%). Circumcision was the portal of entry in 30%. All had generalized tetanus, and mortality rate was 25%. Conclusion: There is need to strengthen routine immunization and introduce booster immunization into the area to prevent post-neonatal tetanus.
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Hand hygiene practice among healthcare workers in a public hospital in North-Western Nigeria p. 109
Garba D Gwarzo
Background: Hospital-acquired infection is still a major cause of morbidity and mortality in hospitals. Compliance with hand hygiene by healthcare workers is an important preventive measure. However, many healthcare workers do not wash their hands properly or not at all. This cross-sectional study was conducted to assess the practice of hand washing among healthcare workers in a tertiary hospital in Nigeria. Patients and Methods: Healthcare workers were randomly selected and were asked, using a questionnaire, regarding hand hygiene in their working places. Results: A total of 173 healthcare workers who had contact with patients participated in the study. They included doctors, nurses, physiotherapists, laboratory scientists, and technicians. Majority (54.3%) of them were males and 60.1% worked in a health facility for 5 years or less. All participants practiced hand washing at work but only 127 (73.4%) washed their hands correctly. Contact with body fluids was the major (87.3%) reason for washing hands. Soap and water only were used by 58.4% and hands were air dried by 45.1%. The main constraint to hand hygiene was lack of alcohol hand rub, soap, and water. Knowledge of hand washing was from multiple sources. Conclusion: Compliance with hand hygiene was good. Alcohol hand rub, water, and soap should always be available.
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Prevalence of hepatitis B viral infection at paediatric gastroenterology clinic of ABUTH, Zaria p. 114
M Mado Sani, W Idris Hafsat, M Abdullahi Sakinatu, Aliyu Ibrahim, Musa Sani, M Yakubu Alhassan
Background: Hepatitis B viral (HBV) infection occurs worldwide and is highly endemic in sub-Saharan Africa and southeast Asia. Materials and Methods: This was a retrospective review of cases of childhood HBV infection seen at gastroenterology clinic of ABUTH, Zaria from July 1st 2009 to June 30th 2015. Results: Four hundred and six subjects were seen in the gastroenterology clinic during the 6-year period under review. Ninety-two of these had HBV infection giving a prevalence of 22.7%. Sixty-three (68.5%) were males and 29 (31.5%) females giving a male to female ratio of 2.2:1. The age of the subjects ranged from 1 to 14 years with mean value of 8.0 ± 3.0 years. Use of contaminated sharps was the most common identifiable source of infection. Eighty-five (92.4%) of the cases were not vaccinated against HBV infection. Twenty-seven (64.3%) of the 42 available subjects at 6 months of follow-up were still HBsAg positive. All the 42 subjects that were available for follow-up for 6 months were on Livolin forte (supplement containing phosphatidylcholine and vitamins). Twenty-five of the 92 hepatitis B surface antigen (HBsAg) positive children tested positive for e antigen and 13 (52.0%) of these remained positive at 6 months follow-up. All the 27 subjects with chronic HBV infection were further evaluated for eligibility for antiviral therapy. Fever, abdominal pain, and yellowness of the eyes were the most common complaints whereas joint pain was the least reported. Conclusion: Childhood hepatitis B viral infection is a serious problem affecting more males. Use of sharps is the most common modality of transmission, whereas at the 6th month of follow-up visit, most of the subjects were in the immune clearance phase of chronicity.
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Comparative study of patients' satisfaction between national health insurance scheme-insured and un-insured patients attending a Northern Nigerian tertiary hospital p. 118
Muhammad Rayyan Garba, Muktar Ahmed Gadanya, Zubairu Iliyasu, Auwal Umar Gajida
Background: Periodic patients' satisfaction surveys provide feedback to hospital management and staff regarding the quality of services rendered. Objectives: This study assessed and compared clients' satisfaction between National Health Insurance Scheme (NHIS) insured and un-insured patients attending Aminu Kano Teaching Hospital. Materials and Methods: A cross-sectional design, using a mixed method of data collection was used to assess the levels of satisfaction of 149 NHIS-insured and 150 un-insured patients selected by systematic sampling. Using structured interviewer-administered questionnaires and focused group discussions (FGD), patient satisfaction was assessed and analysed using SPSS statistical software, with p-value set at 0.05. Results: The two study arms were not statistically different in all the socio-demographic characteristics assessed (P > 0.05). Eight aspects of care were significantly different between the two study groups at bi-variate level. However, on multivariable logistic regression, only two factors remained independent predictors of difference between the two groups: 'overall time spent in the hospital' (aOR; 95% CI: 0.41; 0.23, 0.69) and 'satisfaction with last visit out of pocket expenditure' (aOR; 95% CI: 0.40; 0.21, 0.83). 'Duration of NHIS registration', 'time taken to hospital' and 'last visit out of pocket expenditure' were found to be determinants of satisfaction. The FGDs revealed improvements in services upon getting insured, with the main areas of dissatisfaction being; waiting time, appointment intervals, missing laboratory results and costs. Conclusion: Patients generally expressed high levels of satisfaction with the different aspects of care provided in the hospital, with the insured patients having higher levels of satisfaction in nearly all domains. Improved NHIS coverage could markedly improve patients' access and satisfaction with services.
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Effects of urbanization on digit length, second-to-fourth digit ratio (2D:4D), and blood pressure among the hausa ethnic group of Kano, Nigeria p. 127
Abdullahi Y Asuku, Barnabas Danborno, Shehu A Akuyam, James A Timbuak, Lawan H Adamu
Background: Urbanization and its attendant lifestyle modifications have been shown to affect body compositions, anatomical variables, and phenotypes, and body composition and phenotypes are important determinants of blood pressure. The present study aimed at investigating the effect of urban dwelling on digit length, second-to-fourth digit ratio (2D:4D), and blood pressure in a sample of urban and rural population of Hausa ethnic group in Kano, Nigeria. Materials and Methods: The study design was cross-sectional and included 465 (266 males and 199 females) persons of Hausa ethnic group residing in Kano. The mean age was 34.4 years for males and 32.0 years for females. Systematic random sampling technique was employed for subject recruitment. Height, weight, digit lengths, and digit ratios were obtained using standard anthropometric techniques. Blood pressure was measured following standard clinical procedure. Results: The results showed that both systolic and diastolic components of blood pressure were significantly higher in urban than in rural participants. While the length of the ring (4th) finger was significantly higher in the rural participants, there was no statistically significant rural–urban difference in the length of the index (2nd) digit. 2D:4D was significantly lower in the rural than in urban participants. The rural–urban difference in the digit ratio was more marked in the male participants than in females and more marked in the right hand than left hand. Conclusion: Diastolic and systolic components of blood pressure are significantly higher in the urban participants. Urban–rural difference in 2D:4D was observed among Hausa population.
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Experiences and challenges of managing mass casualty during industrial action in Aminu Kano Teaching Hospital, Kano p. 132
Bashir Yunusa, Sani Ali Aji, Sharfuddeen Abbas Mashi, Muzzammil Abdullahi, Mohammed Kabir Abubakar, Abdurrahman Abba Sheshe, Lawal Barau Abdullahi, Hassan Ismail, Ismail Mohammed Inuwa, Mahmud Atiku, Musa Muhammed Bello
Introduction: A mass casualty incident (MCI) is an infrequent event that requires coordinated action under time constraints. With the emergence of Boko Haram, coupled with industrial disharmony and recurrent strike actions among health workers; there were series of terrorist's attacks when either the Doctors or other health-care providers were on strikes. Objective: The aim of this study is to determine the pattern of injuries, presentation-intervention interval and the challenges of mass casualty management. Methods: This was a retrospective study among 37 multiply injured patients of suicide bombing and shooting who were admitted at Aminu Kano Teaching Hospital from 28th November 2014 to 5th February 2015. Their case notes were retrieved, information obtained includes types of the injuries and intervention among others which were analysed using SPSS version 16. Results are presented in tables and figures. Results: There were a total of 194 patients who presented to the accident and emergency unit of the hospital. The mean age (±standard deviation) was 33.4 ± 19.25 years. Twenty (10%) were dead on arrival, 37 (20%) had major injuries. More than half of the victims were operated within 6 h of presentation. About 78% had single system injuries, whereas 22% had multiple organ system injured. Up to 25% had at least two units of blood transfused. Conclusion: We were able to intervene in 3% of patients within the first 3 h of presentation and another 30% within 6 h. We would have done better if there were no industrial disputes.
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Sonographic breast density pattern among Nigerian women in Zaria p. 138
SA Olarinoye-Akorede, A Adamu, MS Balogun
Background: Increased breast density is a known risk factor for breast cancer; as such, it is a pertinent consideration for any breast cancer awareness and screening exercise. Ultrasound is the most frequently requested breast imaging examination and is the preferred imaging modality for assessing dense breasts. Objectives: This paper aims at describing the sonographic breast density patterns among women in Zaria using the American College of Radiology breast imaging and reporting data system (BIRADS) lexicon to estimate the prevalence of different breast sonographic patterns in Zaria and to relate this with age, parity, and menopausal status of the women studied. Materials and Methods: This was a cross-sectional descriptive study of the sociodemographic and sonographic data of 503 women who presented for breast ultrasound at the Radiology department of Ahmadu Bello University Teaching hospital, Zaria, Nigeria between July 2014 and December 2016. Breast scans were performed using a Mindray DC-8 Ultrasound machine, equipped with a 7–12 mHz transducer. Data were analyzed using statistical package for social sciences software for windows version 20 (SPSS, Inc. Chicago Illinois, USA). Results: Five hundred and three women participated in the study. There were 415 premenopausal and 88 postmenopausal women whose mean age was 36.1 ± 12.8 years. The most common breast density pattern was heterogenous (49.1%), which was independent of family history of breast cancer. The least common breast density pattern was homogenous fibroglandular. Breast density decreased significantly with increasing age, parity, and menopausal status (P < 0.001). Conclusion: Heterogenous pattern (ACR type 3) was the predominant breast density pattern in this study. Because this breast pattern has been significantly associated with breast cancer, further studies are needed to estimate cancer risk among our women.
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Utilization of antithrombotic medicines in primary prevention and risk assessment of deep vein thrombosis at a tertiary care teaching hospital p. 142
Chandresh B Dumatar, Sandip S Jadav, Aashutosh J Patel
Background: Deep vein thrombosis (DVT) and pulmonary embolism (PE) are common preventable conditions often associated with high morbidity if not treated promptly. Evaluation of antithrombotic drugs is essential in considering the spectrum of use and the risks associated with their therapy in patients with DVT. Therefore, this study was undertaken to evaluate the usage pattern of antithrombotics and assessment of DVT risk in primary prevention of DVT at a tertiary care teaching hospital. Materials and Methods: It was an observational, prospective and single-center study carried out over a period of 18 months. Out of 26,687 hospitalized patients assessed for eligibility as per Wells' score. Only 186 patients met inclusion criteria, but 164 patients were analyzed for primary prevention and risk assessment of DVT. Results: Out of 164 patients of primary prevention of DVT, 54 (32.92%) patients were given thromboprophylaxis for DVT. Out of 54 patients, 23 patients were given warfarin either alone or in combination with other drugs, whereas aspirin was given as a single drug in two patients only. No modification in the treatment of either anticoagulant or antiplatelet drugs was observed in patients for primary prevention of DVT (n = 54). As per Wells' score, 87 patients were considered to be “high” risk of DVT, but only six patients developed DVT versus, whereas 31 patients were considered to be of “moderate” risk, only two patients developed DVT. Conclusion: Few patients of primary prevention of DVT received adequate antithrombotic thromboprophylaxis. Heparin and warfarin were mainly used for thromboprophylaxis of DVT. DVT prophylaxis is very important and thromboprophylaxis is the mainstay of treatment among patients of primary prevention of DVT.
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Screening for retinopathy of prematurity by practicing paediatricians and ophthalmologists in Nigeria: A survey of attitude and experience p. 148
Musbahu Sani Kurawa, Isyaku Mohammed, Zubaida Ladan Farouk, Abdulsalam Muhammed
Background: We set out to determine whether routine screening of at risk babies for retinopathy of prematurity (ROP) is done by ophthalmologists in Nigeria and determine if paediatricians routinely refer at risk babies to ophthalmologists for ROP screening. The general attitude of paediatricians and ophthalmologists to screening of acute ROP was also investigated. Materials and Methods: Data were obtained using a structured self-administered questionnaire. This was administered separately to paediatricians and ophthalmologists attending their annual national conferences in the year 2015. Data obtained were analysed using the SPSS (version 16, SPSS Inc., Chicago, USA). Results: One hundred and nine respondents comprising 66 (60.55%) paediatricians and 43 (39.45%) ophthalmologists were involved. Nineteen (28.78%) paediatricians and 8 (18.60%) ophthalmologists were found to routinely refer or screen at risk babies for ROP. The absence of a screening protocol was the overall main reason given for not screening for ROP. Among ophthalmologists, perception that ROP was a rare disease was the major reason given. Despite this, a majority (81.65%) of all respondents advocated for the routine screening for ROP in Nigerian babies. Conclusion: There was a generally poor referral and screening of at risk babies for ROP among this group of Nigerian paediatricians and ophthalmologists. Apart from ophthalmic manpower improvement, the provision of a national protocol or local unit-specific protocols for ROP screening could help improve the situation.
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Perception of clinical year medical students on teaching and learning of pharmacology in a second-generation university in Northern Nigeria p. 152
Muhammad Tukur Umar, Ridwanu Abubakar Zauro
Objective: There is a global dearth of clinical pharmacologists despite the critical role clinical pharmacology plays in health-care delivery, not only in developing economies like Nigeria but worldwide. There is also a growing negative attitude among undergraduate medical students towards pharmacology. In a bid to control this trend, there is a need to assess the attitude and feedback of medical students in teaching and learning of pharmacology. This will provide a platform from which appropriate intervention can be effected. Materials and Methods: It was a cross-sectional descriptive study using semi-structured self-administered questionnaires. A total of 167, 500 and 600 levels medical students participated in the study selected by multistage sampling technique. The questionnaire was designed based on a 4-point Likert scale, containing three sections. The data generated were analyzed using SPSS statistics version 20. Results: Majority of the respondents were males within age brackets of 18–25 years. Only 22.6% (odds, 0.29; 95% CI, 0.20–0.42) agreed to consider taking pharmacology as a specialty at postgraduate training; none was strongly inclined. Majority (98.7%, odds, 76.5; 95% CI, 20.8–281) of the participants agreed that pharmacology is important, exciting, and indispensable in clinical practice. About 72.9 of the students (odds, 2.69; 95% CI, 1.89–3.83) admitted that pharmacology was difficult and volatile. Slightly over 70% favored audiovisual-aided lecture during class session. Conclusion: Despite demonstrated interest in pharmacology, there was general negative attitude toward it among the respondents.
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Enhancing granulation in a post-mucormycotic maxillectomy defect with honey: A review of literature and illustrative case p. 156
OF Ikusika, IO Amole, AA Akinlade
Background: Infection with mucorales is a rare complication of uncontrolled diabetes. The infections are angio-invasive and have poor prognosis. The rhino-cerebral presentation of mucomycosis requires maxillectomies and aggressive antifungal therapy. The chances of recurrence remain high even with the best form of treatment. Honey has been used since ancient times as a dressing for wounds. It is said to aid wound healing by promoting the formation of granulation tissue. This property may be useful in cases where maxillectomy defects cannot be skin grafted. Patients and Methods: A review of literature on rhino-cerebral mucormycosis and the angiogenetic, antiseptic/healing characteristics of honey was carried out with the aim of highlighting its benefits in the intraoral perioperative management of craniomaxillofacial/rhino-cerebral mucormycosis. An illustrative case is presented to showcase these properties in the management of a 47-year-old diabetic male patient who presented with palatal mucormycosis, with treatment involving the therapeutic, surgical, and the reconstructive aspects of care. Results: Following intensive systemic antifungal use and surgical debridement, the patient developed extensive necrosis of the residual palatal defect which was refractory to eradication. The introduction of a pack impregnated with honey into the defect produced significant improvement in intraoral wound healing. This was accompanied by a rapid granulation of the defect resulting in a clean site. Conclusion: Topical honey dressings are recommended as an effective adjunct to conventional therapies for managing post-rhino-cerebral mucormycotic maxillectomy defects.
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Multidrug-resistant infection following snakebite envenoming: A case report p. 161
Hamza Muhammad, Halilu Sadiq, IM Nashabaru, Abdallah Sanda, Faruk Abdullahi, Usman Bello, Abdulrazaq G Habib
Snake Bite Envenoming (SBE) is a major under-appreciated medical and public health problem causing significant mortality and morbidity, particularly among rural dwellers throughout the tropics. Occasionally, snakebite may lead to important complications such as amputation, blindness resulting from spitting cobra (Naja nigricollis) induced venom ophthalmia, foetal loss, wound infection, tetanus and scarring with potential for malignant transformation. Here, we report a case of a 13 year old student bitten by a snake whose bite site became infected with multidrug resistant Methicillin Resistant Staphylococcus aureus (MRSA). He was bitten on the neck, in the night while sleeping on his bed. The bite site suppurated, the skin underwent necrosis and began to discharge thick brownish pus necessitating surgical exploration to drain deep-seated abscesses. The patient survived the acute phase after receiving intravenous polyvalent anti-snake venom (EchiTab-Plus(R)) and intravenous Levofloxacin in addition to wound care. The case stresses the need for comprehensive care of victims of snakebite. This care should be multidisciplinary, and health care workers should be educated on snakebite wound care and management.
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Cor pulmonale in an unusual case of obstructive adenoid enlargement p. 164
Emmanuel S Kolo, Hamisu Abdullahi, Ibrahim Aliyu
Enlargement and infection of the adenoids and tonsils are associated with problems of otitis media, sinusitis, obstructive sleep disordered breathing, and alterations of facial growth. In addition, they may also lead to cardiopulmonary disorders in children. This report aims to highlight the cardiopulmonary sequelae in a child with obstructive adenoid enlargement and temporomandibular joint ankylosis in our practice. The child presented at 6 years of age with complaints of noisy breathing, blocked nose, mouth breathing, and loud snoring. Her condition deteriorated with frequent apneic attacks, easy fatigability, and swelling of the legs. The blood pressure was 100/60 mmHg, the jugular venous pressure was elevated, with displaced apex beat at the sixth left intercostal space, anterior axillary line, with parasternal heave. There were first and second heart sounds with a loud P2. The findings on electrocardiogram and echocardiogram confirmed a diagnosis of cor pulmonale secondary to severe obstructive adenotonsillar disease. A flexible nasopharyngoscopy revealed a bilateral grade IV adenoidal obstruction of the choanae. She was managed for heart failure and had emergency tracheostomy. Subsequently, she had endoscopic transnasal microdebrider-assisted adenoidectomy. She has improved remarkably and on follow-ups at the ENT, pediatric, and MFU clinics. In conclusion, pulmonary hypertension and cor pulmonale, even though rare, are possible complications of untreated adenotonsillar hypertrophy in children.
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