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   Table of Contents - Current issue
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January-June 2021
Volume 18 | Issue 1
Page Nos. 1-54

Online since Tuesday, May 4, 2021

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REVIEW ARTICLE  

Changing pattern of adult intestinal obstruction in Nigeria: A narrative review p. 1
Ibrahim Umar Garzali, Amina Ibrahim El-Yakub
DOI:10.4103/njbcs.njbcs_14_20  
Intestinal obstruction is a failure of craniocaudal propagation of intestinal contents and may be due to a mechanical or functional pathology. Acute mechanical intestinal obstruction is one of the leading causes of surgical admissions in most emergency departments worldwide and is a significant cause of morbidity and mortality, especially when associated with bowel gangrene or perforation. It accounts for 15% of all emergency visits from acute abdominal pain. In Nigeria and most of Africa, external hernias were the main causes of intestinal obstruction throughout the 20th century; however, at the onset of the 21st century, some reports have shown a rising frequency of adhesive obstruction in our environment. We conduct this narrative review to determine if there is a changing pattern of adult intestinal obstruction in Nigeria. Literature search was conducted by two independent reviewers. The keywords used were “adult,” “intestinal obstruction,” “cause,” and “Nigeria.” The keywords were combined using the Boolean logic. The keywords were searched in PubMed and Google Scholar. The overall mean age of the study population is 44.3 years, with a male-to-female ratio of 3.6:1. Of the 1435 cases of intestinal obstruction reported in the studies selected, post-operative adhesive intestinal obstruction was responsible for 590 of them, which is equivalent to 41.1% of all the obstruction. Obstructed external hernias were responsible for 357 cases of obstruction, which is equivalent to 25.9%. The most common cause of intestinal obstruction in Nigeria is post-operative adhesion.
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ORIGINAL ARTICLES Top

Prevalence of electromechanical dyssynchrony among heart failure patients in a Nigerian tertiary hospital p. 5
Bashir Garba Ahmad, Muhammad Sani Mijinyawa, Mahmoud Umar Sani
DOI:10.4103/njbcs.njbcs_4_20  
Context: Heart failure (HF) is among the most important causes of morbidity and mortality worldwide. Cardiac dyssynchrony, a situation associated with a difference in the timing of contractions in different chambers and/or segments of the heart, is frequently seen in patients with HF and is a poor prognostic marker if left untreated. There is limited information on the prevalence of dyssynchrony among HF patientsin our environment. Aims: We set out to assess the prevalence of electromechanical dyssynchrony using electrocardiography and echocardiography among HF patients in a Nigerian tertiary hospital. Settings and Design: We conducted a prospective observational study among adult HF patients in our hospital. Methods and Materials: One hundred patients were consecutively recruited and detailed history and examination were done. Electrical and mechanical dyssynchrony were measured using electrocardiography and echocardiography, respectively. Statistical Analysis: Data were analysed using Microsoft Excel 2003 and the Statistical Package for the Social Sciences version 16 software. Results: A total of 100 participants were recruited, 67% were females. The mean age of the study population was 41.95 ± 16.07 years. Electrical dyssynchrony (QRS ≥120 ms) was found in 11%, interventricular and intraventricular dyssynchrony were seen in 79% and 75%, respectively. There was a significant association between prolonged QRS and intraventricular dyssynchrony, and between inter and intraventricular dyssynchrony. Conclusion: Electromechanical dyssynchrony is prevalent among HF patients in our environment. Larger multicentre studies are needed in our country to fully define the burden of dyssynchrony and study the characteristics of patients with it in order to properly manage them.
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Prescription pattern and blood pressure control among patients on antihypertensive medications attending a tertiary hospital in Lagos: A cross-sectional study p. 9
Sunday Oladunjoye Ogundele, Adeola Olubunmi Ajibare, Mumuni A Amisu, Akinola Olusola Dada
DOI:10.4103/njbcs.njbcs_12_20  
Context: Hypertension is a disease of global public health importance affecting an estimated 1 billion people worldwide. Hypertension accounts for about 10.4 million deaths in 2017. Many guidelines are available for the management of hypertension, but despite this, there are wide variations in physicians' choice of antihypertensive medications for blood pressure (BP) control. Aims: We reviewed the prescription pattern of antihypertensive medication and the level of BP control in patients with hypertension. Settings and Design: This is a cross-sectional study among hypertensive patients attending follow-up clinics of a tertiary hospital. Methodology: Structured questionnaires were used to collect information on the antihypertensive medications and clinical profiles of the study participants. Questionnaires were administered to participants during the attendance of the follow-up clinic to capture information relevant to the study. Information retrieved from patients includes details about their baseline demographic characteristics, clinical history, antihypertensive drug history and blood BP recordings. The study protocol was reviewed and approved by the institutional ethics committee. Statistical Analysis: Data were analysed using Microsoft Excel 2003 and the Statistical Package for the Social Sciences version 22.0 software. Results: A total of 489 hypertensive patients took part in the study. The study found that the rate of BP control was 44.6% among the participants. Calcium channel blockers (CCBs) are the most common antihypertensive medication prescribed in our clinics. There was no significant relationship between how long a patient had been attending the follow-up clinic and the level of BP control in patients who have attended the clinic for a minimum period of 3 months. Conclusion: BP control was less than optimal in more than half of the participants, and the most commonly prescribed antihypertensive medication were CCBs.
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Is the nature (extent and characteristics) of schistosoma-induced chronic inflammation organ dependents? p. 14
Shamsu Sahalu Bello, Akinfenwa Taoheed Atanda, OA O. Olatunde, SL Gana, AB Ibrahim-Saad
DOI:10.4103/njbcs.njbcs_28_20  
Context: Pathogenesis of schistosomiasis related bladder cancer has been attributed to induced chronic inflammation and its sequelae. There is paucity of studies on the inflammatory cell profile. Aim: This study, therefore, aims to characterise the degree and repertoire of this inflammatory response. Settings and Design: A retrospective study of all non-neoplastic cases of schistosomiasis histologically confirmed between January 2012 and December 2019 in a tertiary hospital. Materials and Methods: Data were retrieved from archives and slides made for the cases were evaluated for ova density, type and degree of inflammation and pattern of fibrosis. Statistical Analysis: The degree of inter observer variation (kappa value) was also calculated while statistical significance was set at P ≤ 0.5 at 95% confidence interval. Results: Eighty one cases were diagnosed in the study period. The mean age was 33.8 years and M:F ratio was 15:1. Bladder, ureter, gastrointestinal tract, testes and other less frequent sites accounted for 58.0%, 12.0%, 8.0%, 8.0% and 7.4% of cases, respectively. Eosinophilic infiltration and granulomatous reaction were predominantly minimal even in cases with significant oviposition. There was no significant difference between ova density and degree of overall inflammation (P = 0.9) or between ova density and degree of lymphocytic infiltration (P = 0.2). Similarly, even though fibrosis was more frequent in cases with high ova density, no significant difference was found in cases with low ova density. Conclusion: Even though carcinogenesis in bladder schistosomiasis has been attributed to chronic inflammation and fibrosis, this study, however, showed that there are no statistically significant differences between schistosoma ova density and degree of inflammation as well as fibrosis in both bladder and other organs.
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Dietary pattern of undernourished children and their Vitamin A status in institute of child health Ahmadu Bello University Teaching Hospital Zaria p. 18
Sakinatu Mahadi Abdullahi, Yakubu Mela Alhassan, Mairo Adamu Bugaje, Shehu Abubakar Akuyam
DOI:10.4103/njbcs.njbcs_11_20  
Context: Vitamin A deficiency (VAD) affects an estimated six million pre school children in Nigeria and 20 million in Africa. When associated with severe undernutrition, it increases both morbidity and mortality of under five children. Aims: The study was aimed to determine the dietary pattern and its relationship with Vitamin A levels in undernourished children and controls in Institute of Child Health (ICH), Ahmadu Bello University Teaching Hospital Zaria. Settings and Design: This was a case–control, hospital based descriptive study carried out at the ICH Banzazzau, Zaria. Materials and Methods: Systematic sampling method was adopted to select undernourished children aged 6–59 months for the study. A semi-quantitative food frequency questionnaire was developed following the International Vitamin A Consultative Group guidelines for dietary assessment of Vitamin A intake. The questionnaire consisted of a list of 22 food items obtained during survey from local markets. Serum Vitamin A level was analysed by high performance liquid chromatography. The frequency of values below a cut off, usually taken as 0.70 μmol/L (20 μg/dl) for low and 0.35 μmol/L (10 μg/dl) for deficiency. Statistical analysis: The data were analysed using the Statistical Package for the Social Sciences version 20.0. Results: The prevalence of low serum Vitamin A level (10–<20 μg/dl) in this study among the cases is 16.7%, with the highest prevalence of 15.9% seen in severe wasting. However, the prevalence of cases with deficient serum Vitamin A (<10 μg/dl) was 4.5% in which severe wasting accounted for all the cases. Interestingly, the prevalence of low serum Vitamin A levels among the controls was also found to be 16.7%, and there was no VAD among the control groups. About 20% of children in Zaria (controls) were moderate to high risk of poor intake, while 37.3% were at low risk and 42.7% had satisfactory intake of Vitamin A rich foods. Among the malnourished patients, 53.4% were at moderate to high risk of poor intake, while 21.3% were at low risk and 25.3% had satisfactory intake of Vitamin A rich foods. Conclusion: This study simply demonstrated low intake of Vitamin A among undernourished children in Zaria.
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Prevalence of low back pain among street cleaners in Northeastern Nigeria p. 24
Adetoyeje Oyeyemi Yunoos, Usman Sani Dankoly
DOI:10.4103/njbcs.njbcs_41_19  
Context: Street cleaners assume bending and twisting positions for a long period while on the job, making them to be susceptible to low back pain (LBP). Aims: This study was aimed at determining the prevalence of LBP among street cleaners in North-eastern Nigeria. Settings and Design: Sample of convenience was to recruit 381 participants who were street cleaners working within Maiduguri Metropolitan Council. Subjects and Methods: A conveniently sampled participants (n = 381) completed sociodemographic form, Nordic LBP Questionnaire and LBP risk factors form. Descriptive statistics were used to summarise the data, and Chi-square statistics were used to explore the differences in LBP prevalence by sociodemographics. Results: The present study shows a 12-month LBP prevalence rate of 78.2% and a crude point (7 days) prevalent rate of 55.1% among the workers, and this condition tend to occur more frequently among those in the age group between 58 and 67 years than their counterparts in the lower age groups (P = 0.001). Male cleaners tend to report LBP more frequently than their female counterparts (P = 0.011), and those with primary or qur'anic education also reported LBP more frequently than their counterparts with secondary or tertiary education (P = 0.046). Performing the same task over and over and working in the same position for long periods were the most frequently chosen risk factors pre-disposing the workers to LBP on their job. Conclusions: The present study identified the needs for workers ergonomic education and employers' consideration for ergonomically fit tools, as potential solution to addressing LBP as an occupational hazard among the workers.
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Obstetric performance of women with advanced maternal age in Ahmadu Bello University Teaching Hospital, Zaria p. 31
Umma Suleiman Bawa, Abimbola Omolara D. Kolawole, Abdullahi Jibril Randawa
DOI:10.4103/njbcs.njbcs_7_17  
Context: Consequent upon changes in social norms over the years, there has been an increase in the age of marriage and childbirth in women. The older parturient poses a great challenge to the managing obstetrician and a greater challenge to attaining safe motherhood. Aim: To determine the obstetric performance and complications developed during pregnancy and delivery of women with advanced maternal age. Settings and Design: This was a retrospective (case–control) study. Setting: This study was conducted in an ANC and labour ward of ABUTH, Zaria, Nigeria. Materials and Methods: The antenatal and delivery records of women with advanced maternal age (≥35 years) and those within 20–25 years of age from 2002 to 2006 were reviewed. Records of 294 women with advanced maternal age, and 322 of those aged 20–25 years were used. Results: A total of 57% of women with advanced maternal age developed complications compared with 24% in those aged 20–25 years. A total of 13% had chronic hypertension, while 26.2% had pregnancy-induced hypertension. Labour was augmented in 12.2% of those who had spontaneous vertex delivery and 6.2% had EMLSC/S. Low birth weight babies occurred in 11.6% necessitating admission into the SCBU and 5.4% had stillborn. Conclusion: This shows the considerable risk in pregnancies of women with advanced maternal age. It is recommended that to minimise complications; preconception care, antenatal care and skilled attendant at delivery are paramount.
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Dental caries prevalence, restorative needs and oral hygiene status in adult population: A cross-sectional study among nurses in Jos University Teaching Hospital, Jos, Nigeria p. 35
Abiodun Enoch Idowu, Babatunde O Fakuade, Olaniyan O Taiwo, John O Majekodunmi, Olohigbe O Alufohai, Fatima K Sandabe
DOI:10.4103/njbcs.njbcs_32_20  
Context: Dental caries affects the quality of life and it is the most common oral health challenges worldwide. While dental caries prevalence is well documented to be declining in many developed countries, the prevalence among adult population in Nigeria is yet to be fully documented. Aim: This study aimed to determine dental caries prevalence, restorative needs, and oral hygiene status among nurses. Materials and Methods: This was a descriptive cross-sectional study. The study participants were recruited by simple random sampling technique. The nurses' caries status was determined using the WHO-recommended D-decayed, M-missing, F-filled, T-teeth (DMFT) index. Restorative index was used to determine the restorative needs while simplified oral hygiene index (OHI-S) by Green and Vermilion was adopted for the assessment of oral hygiene status. Statistical Analysis Used: Descriptive statistics and Chi-squared tests were used for data analysis. This was done using SPSS version 23.0. Results: A total of 251 subjects participated in this study. The age range was 19–64 years, and the mean age was 38 ± 9.88. Among the participants, 60.6% have experienced dental caries inform of filled, decayed and missing teeth. Dental caries prevalence was 43.8% and the mean DMFT was 2.06 ± 2.46. Met need index and restorative index were 0.46 and 14.6% respectively. Using OHI-S, 22.7% had good, 66.1% fair, and 11.2% had poor oral hygiene status. Conclusion: The prevalence of dental caries among nurses 'the adults' study population was high with low secondary prevention and low Restorative index. Majority had 'fair' Oral hygiene status.
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Reasons and pattern of teeth extraction in a maxillofacial clinic in Northern Nigeria p. 42
Benjamin Fomete, Rowlan Agbara, Love C Nzomiwu, Theophilus E Agho, Zakka G Baraya
DOI:10.4103/njbcs.njbcs_1_21  
Context: Exodontia or teeth extraction make up the majority of workload in the minor surgery of most oral and maxillofacial surgery clinics in our environment. Extraction of teeth represents different percentages amongst children and adult populations and private and public clinics, respectively, also. Aims: The aim of this study was to determine the indications for and pattern of teeth extraction in patients presenting at the maxillofacial surgery clinic. Settings and Design: Records of patients who had teeth extractions at the Oral and Maxillofacial Surgery Clinic between 1st January 2006 and 31st December 2018 were retrieved and retrospectively studied from the Medical Records and the Minor Surgery register book. Methods and Materials: The biodata and indications for extraction were recorded. Results: A total of 1220 records from the year 2006 to 2018 were used to conduct the research. They comprised 636 (52.1%) males and 584 (47.9%) females. Their age range was 2 years to 92 years with a mean age of 31.8 ± 14.6. The most predominant age group that attended clinic for extraction was the 20–29 years of age accounting for 35.6% of the study participants with more males 228 (52.3) than the females 208 (47.7). Conclusion: Dental caries and its sequelae continue to be the leading cause of tooth extraction in our environment, followed by tooth impaction as well as pericoronitis around impacted teeth.
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CASE REPORTS Top

Bilateral pelvic kidneys in a haemophiliac p. 46
Mohammed Aliyu Abdulmalik, Atiku Hafiz, Mohammed Alhaji Mustapha
DOI:10.4103/njbcs.njbcs_5_20  
Renal migration anomalies are rare and often under-reported. Kidneys that fail to ascend to their normal location in the renal fossa are usually termed 'ectopic' kidneys, which can be unilateral or bilateral. Those that fail to ascend above the pelvic brim are commonly termed pelvic kidneys. We present a case of a 41-year-old male haemophiliac on routine investigation with a previous history of anaemia and bone pains, currently asymptomatic. He was found to have malrotated pelvic kidneys with vascular anomalies. Even though most patients with pelvic kidneys are asymptomatic, they are usually discovered in childhood or as young adults. This case is important because, in addition to the late discovery of the bilateral pelvic kidneys, there is coexistence of a bleeding disorder which may pose a challenge in patients' management. This is to also make the patient aware of his condition and avoid taken unnecessary risk which might make his condition worse.
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Chronic pyogenic osteomyelitis of the Rib: A case report in a sickle cell disease patient p. 49
Kabir Musa Adamu, Ismail Muhammad Inuwa
DOI:10.4103/njbcs.njbcs_20_20  
Rib osteomyelitis is extremely rare and accounts for <1% of haematogenous osteomyelitis. We report a rare case of chronic pyogenic osteomyelitis involving the rib in a 29-year-old female sickle cell disease (SCD) patient who presented with recurrent discharging sinus over the right chest wall for 20 years. The patient had partial excision of the 5th rib/sequestrectomy with chest tube insertion. She did very well and was discharged after chest tube removal to the orthopaedic outpatient department for follow-up. Being of various aetiology with non-specific clinical manifestation, its diagnosis is challenging. Clinicians should be aware of the possibility of rib osteomyelities in a SCD patient. Early recognition and prompt treatment allow high cure rate.
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An unusual case of limited gastric linitis plastica in a Nigerian: A review of clinical, endoscopic and radiologic diagnostic aspects p. 52
Aderemi O Oluyemi, Adekunle O Adeyomoye
DOI:10.4103/njbcs.njbcs_21_20  
Linitis plastica is considered to be one of the rarer types of gastric cancers. The involvement of only the fundus is the least common of the morphologic variants. This limited type is hardly ever documented among sub-Saharan African patients in scientific literatures. This case report presents one such unique case. Using unique attributes of this case's presentation, this article reviews clinical, endoscopic and radiologic aspects of the diagnosis of this unusual malignant entity.
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