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   Table of Contents - Current issue
January-June 2018
Volume 17 | Issue 1
Page Nos. 1-65

Online since Monday, July 2, 2018

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Nutritional status of perinatally HIV-infected children on antiretroviral therapy from a resource-poor rural South African community p. 1
Antonio George Lentoor
Objective: In Sub-Saharan Africa, millions of children are suffering from HIV and coexisting child undernutrition. Despite efforts to curb the spread of HIV through the availability of treatment and various nutritional programmes, it has been argued that undernutrition remains highly prevalent in rural areas. The objective of this study was to describe the prevalence and psychosocial factors influencing the nutritional status in the sample of rural-based HIV-infected children on antiretroviral therapy. Materials and Methods: Anthropometric and home environment data were collected from 152 perinatally HIV-infected children on antiretroviral therapy who lived with their primary caregivers in a rural Eastern Cape community. Results: More than half of the sample of children had inadequate nutritional status. The prevalence of stunting particularly was high (36.2%), while 12% were underweight and only 2.7% presented with wasting. Coexisting poor quality home-environment (P < 0.01) added to this burden. Younger age children who lived with a younger biological caregiver were found to present more with stunting than older age children (χ2 [n = 152] = 14.79, P = 0.005), but no significant differences were observed for underweight or wasting. Conclusion: It is important in a context such as South Africa, with the double burden of HIV infection and poverty, that all efforts be directed at alleviating undernutrition. Early pediatric HIV management should not only focus on the provision of treatment but should also prioritize the quality of care of HIV-positive children in the home to improve on their nutritional health.
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The effect of bacterial colonization of the embryo transfer catheter on Outcome of In vitro Fertilization–Embryo transfer treatment p. 7
Roy N Maduka, James A Osaikhuwuomwan, Michael E Aziken
Background: In vitro fertilization–embryo transfer (IVF − ET) has become a core treatment method for managing infertility. Bacterial contamination of the ET catheter may affect outcome, but there is still no consensus of evidence. Objectives: This study aims to assess the effect of bacterial colonization of the ET catheter tip on the clinical pregnancy rate in an IVF–ET treatment. Methods: An analytical cross-sectional study among women undergoing IVF–ET treatment was undertaken. The patients selected had both cervical swab and the tip of the ET catheter cultured. The patients were grouped into positive (bacterial isolated) and negative (no bacterial isolated) based on the culture result. The clinical pregnancy rate (primary outcome) between the two groups was compared. Results: A total of 80 patients were selected. In 34 patients (42.25%), the cervical culture was positive, while 46 patients (57.50%) had negative cervical culture. Catheter tip culture was positive in 27 patients (33.75%) and negative in 53 patients (66.25%). The predominant microorganisms isolated were Escherichia coli (23.75%), Staphylococcus spp. (18.75%), and Streptococcus spp. (15.00%). The clinical pregnancy rate was 26.25%. The significant factors affecting clinical pregnancy were the age of the patient (P = 0.044), duration of infertility (P = 0.01), and culture result (P = 0.03). Conclusion: Bacterial colonization of the ET catheter tip is associated with a reduction in the clinical pregnancy rate. Utility of routine cervical swab; microscopy, culture, and sensitivity at recruitment of patients for IVF–ET treatment is highlighted.
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Prevalence and antibiogram pattern of Salmonella enterica serotypes in Garhwal Region: First report from foothills of himalayas p. 14
Vikrant Negi, Monika Pathania, Rajat Prakash, Deepak Juyal, Munesh Kumar Sharma, Shekhar Pal
Introduction: Enteric fever, caused by Salmonella enterica subsp. enterica serotype Typhi and Paratyphi, is endemic in India with an incidence of 102–2219/100,000 populations. The definitive diagnosis of enteric fever in patients with compatible clinical picture is isolation of Salmonellae from blood, bone marrow, stool or urine, and demonstration of four-fold rise in antibody titer to both O and H antigen of the organism between acute and convalescent-phase sera. Aim: The aim of the study was to study the prevalence of various serotypes of S. enterica and their antibiogram in foot hills of Himalayas. Materials and Methods: During February 2012–January 2013, all clinically suspected patients were screened for enteric fever by Widal tube agglutination test. For the isolation of etiology, venous blood, stool and urine specimen were obtained from patients with antibody titer of ≥80 and 160 for anti-O agglutinin and anti-H agglutinin of Salmonella typhi, respectively, and ≥20 for anti-H agglutinin of S. paratyphi A and S. paratyphi B. Characterization and antibiogram determination of the isolates was done by conventional microbiological methods including Kirby–Bauer's disc diffusion technique. Result: Among 1173 suspected cases, 373 showed a high titer of antibodies against O (≥80), H (≥160), AH (≥20), and BH (≥20) antigens. A total of 81 isolates were obtained from 76 patients (29 from blood and 49 from stool and three from urine), of which 54 were identified as Salmonella typhi, 20 as Paratyphi A and seven as Paratyphi B. Extended-spectrum beta-lactamase production was observed in four isolates of S. typhi. Ciprofloxacin followed by co-trimoxazole was resistant to 46.5 and 36.5% of the isolates, respectively. Conclusion: This report indicates a significant percentage of drug resistance in S. enterica serotypes in Garhwal region. Periodic monitoring of the antibiogram pattern along with the implementation of strict antibiotic policies and patient education is needed.
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Musculoskeletal tumors of the extremities: Challenges and outcome of management in a Nigeria Tertiary Hospital p. 20
ON Salawu, OM Babalola, GH Ibraheem, C Nwosu, AK Suleiman, DM Kadir, BA Ahmed, JO Mejabi, AA Fadimu, TO Adeyemi, WO Olawole
Background: Patients with musculoskeletal tumors in developing countries often present late to the hospital and this poses serious challenges to the management, especially for malignant tumors. This study aims to highlight the various types of musculoskeletal extremity tumors seen in a Nigerian tertiary health center during the study period, the challenges encountered in managing them, and the outcome of the management. Materials and Methods: A prospective study in which all consenting patients with musculoskeletal extremity tumors who presented to the center from April 2015 to March 2017 were recruited. Results: Seventy-two patients were managed during the study period. The mean age was 22.1 ± 4.5 years and the age group most affected was the 11–20 years group, n = 22 (30.6%). Male-to-female ratio was 1.6:1. The femur was the most commonly involved bone. Forty tumors were benign while 32 were malignant tumors. Osteochondroma was the most common benign tumor while osteosarcoma was the most common malignant tumor. The challenges encountered during the management were a late presentation, poverty, and traditional bonesetter intervention before the presentation. Patients with benign tumor had excision with good outcome in all. Twenty (62.5%) of the patients with a malignant tumor had the ablative procedure, two of these 20 patients died within 6 months of treatment, while 12 (37.5%) of the patients with malignant tumor refused the treatment. Conclusion: Management of musculoskeletal extremity tumors is highly challenging in this part of the country, especially the malignant types, due to the challenges mentioned. There is a need for more awareness about the disease, the Government should subsidize the cost of management of this disease, and more specialty training of personnel is necessary for appropriate management of the diseases.
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Lead in potable water sources in Anambra State, South East, Nigeria p. 26
Ignatius C Maduka, Anthony I Anakwuo, Nnamdi P Ogueche
Introduction: Due to lack of treated water supply in major cities and settlements in Anambra state, Nigeria, majority of the population obtain potable water directly from boreholes, streams, sachet, harvested rain, and well water sources. Lead-laden potable water may be a major cause of mortality and morbidity in Anambra state, Nigeria. Objective: This study was conducted to determine the presence of lead in potable water sources in Anambra state, Nigeria. Materials and Methods: Water samples were systematically collected from 81 water sampling sites in different senatorial zones of the state. Lead was estimated in the water samples using Varian AA240 atomic absorption spectrophotometer. Results: The mean levels of lead in the water samples in all the senatorial zones of the state were higher than the maximum contaminant limit (0.01 mg/L) set by the World Health Organization (WHO). The mean level of lead in harvested rain, sachet, and stream waters (0.34 ± 0.23, 0.37 ± 0.08, and 0.23 ± 0.06 mg/L, respectively) was higher in Anambra South senatorial zone compared to the WHO maximum contaminant limit. Furthermore, Anambra South has higher (P < 0.001) mean lead level compared to the North and Central senatorial zones. Conclusion: This study reveals significantly high lead levels in potable water sources in Anambra state, Nigeria. The water samples should be well treated to remove this harmful toxic heavy metal which is very dangerous to health.
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Anesthesia for emergency cesarean section: A comparison of spinal versus general anesthesia on maternal and neonatal outcomes p. 31
Vitus Okwuchukwu Obi, Odidika Ugochukwu J. Umeora
Background: Despite the relative safety of cesarean section (CS), increasing CS rate is a cause for concern to obstetricians and anesthetists because of the attendant increased health risk one of which is the risk of anesthesia. The choice of anesthesia for cesarean section depends on the indication for the surgery, the urgency of intervention required, the maternal and/or fetal status, and the patient's desires. Despite the paradigm shift toward spinal anesthesia, general anesthesia is still commonly administered in our facility for some specific indications. Objective: This study was aimed to evaluate the maternal and neonatal outcomes in patients who had emergency CS under spinal anesthesia compared with those who had general anesthesia. Materials and Methods: This was a retrospective study comparing the obstetric outcome of patients who had emergency CS under spinal anesthesia compared with those who had the surgery under general anesthesia. Data analysis was done using statistical Epi Info version 7.2.1. Results: The most common indication for surgery in the spinal group was cephalopelvic disproportion while that for the general anesthesia group was antepartum hemorrhage/placenta previa. Patients who had spinal anesthesia had less intraoperative blood loss compared with those who had general anesthesia (814 ± 124 vs. 842 ± 324; P = 0.0007). There was a significant difference in the intraoperative blood loss >1000 ml among women who had spinal anesthesia relative to women who had general anesthesia (odds ratio [OR]: 0.6832, 95% confidence interval [CI]: 0.3390–0.9779; P = 0.0005). Spinal anesthesia was associated with a reduced risk of having a 1st-min Apgar score <7 (OR: 0.6096, 95% CI: 0.4066–0.9140; P = 0.016). There was no significant difference in the 5th-min Apgar score in both groups. There was also no significant difference in the number of neonates admitted into the Intensive Care Units. The maternal and perinatal mortality was not different in both groups. Conclusion: Spinal anesthesia was associated with reduced risk of blood loss and reduced risk of low Apgar score in the 1st min. There was no difference in the 5th-min Apgar score and maternal and neonatal mortality.
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Incidence and pattern of dog bite injuries treated in the emergency room of a teaching hospital South East Nigeria p. 35
Njoku Isaac Omoke, Ndubuisi Onu Chukwueloka Onyemaechi
Background: Dog bite injury treated in the emergency room varies from and within subregions in pattern and potential risk of transmission of rabies. This variation has implications in its morbidity and mortality. The aim of this study was to determine the incidence and pattern of dog bite injuries treated in a teaching hospital emergency room setting of a developing country. Patients and Methods: This was a retrospective study of the entire patients with dog bite injury treated in the emergency room of Federal Teaching Hospital Abakaliki from January 2006 to December 2015. Results: Dog bite injury necessitated visit in 74 patients with an incidence of 2 per 1000 emergency room attendances, and a male to female ratio of 1:1.1. The mean age of the patients was 25.5 ± 1.87 years, and peak age group incidence was 5–9 years. Lower extremity was involved in 77.5% of the injuries, and buttock was the predominant site of injury in 0–4 years old. Fifty-one (68.9%) owned dogs and 23 (31.1%) stray dogs were involved in the attack. There was unprovoked attack in 81.1% of cases, and 51 (68.9%) sustained Grade II injury. Twenty-eight (37.8%) of the dogs had anti-rabies vaccination. Fifty-four (73%) patients had no prehospital care while 64 (86.5%) received postexposure anti-rabies vaccine. Majority of the patients 73 (98.7%) recovered fully. One (1.4%) patient that presented with clinical rabies self-discharged against medical advice. Conclusion: The incidence of dog bite injury is within worldwide range though the female gender bias is unprecedented. We recommend preventive strategies based on the observed pattern and improvement in the rate of prehospital care and higher coverage of anti-rabies vaccination of dogs.
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Prevalence and risk factors for helicobacter pylori infection in gastroduodenal diseases in Kano, Nigeria p. 41
Ahmad Kumo Bello, Ali Bala Umar, Musa Muhammad Borodo
Background: Helicobacter pylori (H. pylori) has been well noted as a causative agent of many diseases in the gastrointestinal (GI) tract notably, gastritis, peptic ulcer disease, and gastric adenocarcinoma. Determining the burden and the risk factors for acquiring this infection may be crucial to containing it and its sequelae in Kano, Nigeria. Methodology: The study was cross-sectional in design. Questionnaires were administered in dyspeptic patients to obtain the relevant clinical, and sociodemographic data. Upper GI endoscopy was performed in the patients, and gastric biopsy specimens were taken and sent to the histopathology laboratory for assessment and H. pylori identification. Results: Of the 306 participants, 136 (44.4%) were males, while 170 (55.6%) were females, with male: female ratio of 1:1.3. The ages of the participants ranged from 18 to 84 years with a mean of 41.2 ± 15.3 years. Of the 306 samples, 250 (81.7%) were positive for H. pylori. This gives H. pylori prevalence of 81.7%. Only 4 (1.3%) of the participants belonged to the higher social class, out of which 25% had positive H. pylori, while 230 (75.2%) participants belonged to the lower socioeconomic class with 87.8% H. pylori prevalence. The lower social class had a significant association (P < 0.0001) with increased H. pylori infection. A total of 290 subjects (94.8%) shared a room with three or more other siblings in childhood, out of which 233 (80.3%) had H. pylori. Only 80 subjects (26.1%) used pipe-borne water in childhood, while 226 (73.9%) sourced their water from either well, pond or stream during childhood. Conclusion: This study showed a high prevalence of H. pylori in Kano, and low socioeconomic status, unclean water source, overcrowding, and cigarette smoking were significant risk factors for H. pylori infection.
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Work-Related respiratory symptoms and cardiopulmonary function impairment of factory workers in a cement company in South-West Nigeria p. 47
Happiness Anulika Aweto, Bosede Abidemi Tella, Adetutu Islamiyyah Lateef
Background: Cement factory workers are exposed to dangerous cement dust while at workplace especially in the developing countries where little or no safety standards are followed. This study investigated the work-related respiratory symptoms and cardiopulmonary functions' impairment in cement factory workers in South-West, Nigeria. Materials and Methods: Seventy cement exposed workers and 70 age-matched unexposed individuals participated in this cross-sectional study. A self-administered questionnaire was used to assess their sociodemographic characteristics, clinical details, and respiratory symptoms. Selected cardiopulmonary parameters of participants were measured. Data were analyzed using the Statistical Package for Social Sciences version 20.0. Independent t-test was used to compare the selected cardiopulmonary parameters of the two groups. Results: The mean age of cement-exposed group was 31.57 ± 8.32 years, and the unexposed group was 31.50 ± 8.57 years. The prevalence of respiratory symptoms among the cement-exposed group were as follows: 71.4% for cough, 45.7% for phlegm, 67.1% for wheeze, 38.6% for breathlessness, and 48.6% for chest tightness while those for the unexposed group were as follows: 50% for cough, 15.7% for phlegm, 5.7% for wheeze, 2.9% for breathlessness, and 7.1% for chest tightness. There were significant differences between the mean values of forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1)/FVC ratio, peak expiratory flow rate, systolic blood pressure, and diastolic blood pressure (P < 0.05) of the cement-exposed group and those of the unexposed group. Conclusion: Respiratory symptoms were higher among cement factory workers than the age-matched unexposed individuals. FVC, FEV1, FEV1/FVC ratio, and peak expiratory flow rate were reduced while blood pressure was increased in cement factory workers.
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Diagnostic reference levels for mammography examinations in North Eastern Nigeria p. 54
Dlama Zira Joseph, Christian Chukwuemeka Nzotta, Joseph Dimas Skam, Mohammed Sani Umar, Dambele Y Musa
Background: Diagnostic reference levels (DRLs) plays an important role in health-care delivery and radiation safety of patients. This study was carried out as part of a comprehensive project to establish DRLs for the radiological examinations for the first time in North Eastern Nigeria. Objective of the Study: The aim is to establish DRL for mammography examination in North Eastern Nigeria and to compare it with other established works. Materials and Methods: This study is a prospective cross-sectional study conducted in two university teaching hospitals in North Eastern Nigeria. Sixty patients were recruited for the study. Thermoluminescent dosimeter (TLD) chips were exposed for craniocaudal (CC) and mediolateral examinations to record the entrance skin dose (ESD). TLD readings were obtained at the Center for Energy Research and Training Zaria, Kaduna State, Nigeria. Dance formula was used to convert ESD to mean glandular dose (MGD). Student's t-test was used to determine the relationship between the mean ESD obtained in the two centers and Pearson's correlation was used to determine the relationship between the MGD and anthropotechnical parameters. Statistical significance was set at P < 0.05. Results: The total MGD for this study was 0.31 ± 0.05 mGy and 0.69 ± 0.11 mGy for CC and mediolateral oblique (MLO), respectively. DRL was 0.63 mGy and 1.04 mGy for CC and MLO, respectively. There was no statistically significant relationship (P > 0.05) between the MGD and anthropotechnical parameters. The DRL in this work were higher when compared with international established work. Conclusion: There is need for optimization of our radiology practice in North Eastern Nigeria and most centers in Nigeria.
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A 10-Year review of ultrasonographic findings of scrotal diseases in Ibadan, South Western, Nigeria p. 60
Ademola Joseph Adekanmi, Adenike Temitayo Adeniji-Sofoluwe, Gbolahan Obajimi, Ekwutosi Okafor
Introduction: Despite the importance of a thorough clinical evaluation, ultrasonography has emerged as the mainstay of imaging of the scrotum and its contents. Differentiation of testicular lesions and that of adjacent scrotum and content is usually difficult clinically. Scrotal ultrasound (SUSS) is highly sensitive in the detection of intrascrotal abnormalities and in differentiating testicular from paratesticular lesions. SUSS accurately determines the location and nature of palpable lesions and reveals nonpalpable scrotal masses. The aim of this study is to report the various indications for SUSS in this setting and to describe the sonographic findings in these patients. Materials and Methods: A retrospective and descriptive study carried out to evaluate scrotal ultrasound scans performed on 442 patients referred for various clinical indications from the clinics and units of the University College Hospital, to the Radiology department of the same hospital which serves as referral center in Ibadan, and the South-Western Nigeria; over a 10 year period from January 2006 to December 2015, a tertiary health Institution. Results: The mean age of the study population was 36.13 years ± standard deviation 15.88 years. Most of the patients (57.1%) were within the age group of 30 and 49 years. The leading clinical indication for ultrasound referral was infertility/infertility related issues in 56.1% of the total patients. Testicular masses were clinically detected and required SUSS for confirmation in 4.5% of the study population. On USS, the average testicular volume in adults with normal study was 16.38 cm3 and 15.99 cm3 on the right and left side, respectively. The most common USS findings were varicocele (29.4%), this was bilateral in more than half of the cases. Hydrocele was the second most common finding in 18.78% and often bilateral. Testicular masses were seen in 11.1% and were cystic in nature in more than half of the study population. Conclusion: Infertility/infertility related diagnosis were the most frequent indications for testicular ultrasound in adults in our environment. We recommend SUSS as a routine investigation in suspected scrotal/testicular pathologies.
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