Kwari SD, Chama CM, Gadzama GB

Background: Asymptomatic bacteriuria (ASB) is a common medical complication of pregnancy and may be associated with acute pyelonephritis, preterm labour and delivery, intrauterine growth restriction (IUGR), low birth weight (LBW), anaemia, hypertension and long-term renal dysfunction. Routine screening and treatment of ASB in pregnancy are recommended. Objectives: This study determined the prevalence, common organisms implicated, their antibiotic sensitivity pattern and the foetomaternal outcome of pregnant women with ASB. Methods: We conducted a prospective study at the Department of Obstetrics and Gynaecology, University of Maiduguri Teaching Hospital (UMTH), Maiduguri, Nigeria. One hundred and fifty pregnant women attending antenatal booking were consecutively recruited. We collected demographic and clinical information. A clean catch midstream urine specimen was collected for culture and sensitivity. The women were followed up to delivery and foetomaternal outcome were obtained. Results: The prevalence of ASB was 22%. Escherichia Coli was the most predominant organism isolated in 45.4%. Nitrofurantoin (90.9%), Ceftriaxone (87.8%) and Co-Amoxiclav (84.8%) showed the highest activity against the isolated microbes and were resistant to Ampicillin (87.9%) and Cloxacillin (79.7%). ASB is associated with an increased risk for UTI (P-value = 0.001), pyelonephritis (0.002), anaemia later in pregnancy ( ? 0.001), preterm delivery ( ? 0.001), low birth weight ( ? 0.001) and admission to SCBU (0.023). Conclusion: The prevalence of ASB is high and associated with significant maternal and perinatal morbidity. We recommend screening all pregnant women attending antenatal clinics for ASB and appropriate treatment given.

Key words: Asymptomatic bacteriuria, pregnancy, prevalence, foetomaternal outcome, urine culture, Nigeria.

Usman AU, Natalia A, Ibrahim DM

Background: Elective surgeries include procedures done to correct non-life-threatening medical problems as well as to alleviate conditions causing psychological stress or other potential risks to patients. This study described the pattern of elective Gynaecologic surgeries conducted in Obstetrics and Gynaecology department of Aminu Kano Teaching hospital, over a five-year period. Objective: To describe the pattern of elective gynaecologic surgeries conducted in Obstetrics and Gynaecology Department of our hospital over a five-year period. Methods: A retrospective study of all elective surgical procedures conducted at the Obstetrics and Gynaecology department of Aminu Kano Teaching hospital from 1st September, 2012 to 31st August, 2017 was conducted. Theatre operation register and gynaecological ward admission records were retrieved and reviewed. Information extracted include: age of patient, indication for the surgery, type of surgery conducted, nature of procedure (minor, intermediate and major), the cadre of surgeon and assistant(s) performing the surgery and the type of anaesthesia used for the surgery. Results: The total number of elective gynaecologic surgeries conducted over the study period was eight hundred and two (802) accounting for 19.4% of all surgical procedures. Uterine fibroid was the commonest indication for surgery with myomectomy being the commonest surgical procedure performed constituting 181(30%) of all gynaecologic operations. Hysterectomy was the second commonest procedure 115 (19%) indicated most commonly by uterine fibroids 53(46%). Conclusion: This study demonstrated 19.4% prevalence of elective gynaecological procedures in our centre. Consultants are the leading surgeons in most of the procedures and a significant association was found between the nature of the procedure and the cadre of surgeon. There is need to strengthen the postgraduate training of Resident doctors by exposing them to more hands-on training on major procedures.

Key words: Elective, gynaecological surgery, procedure

Background: Children with epilepsy are considered to be at an amplified risk for injuries as compared to the general population. The increased risk may occur directly as a result of the seizure or due to other comorbid conditions that predispose to injuries. Objectives: This study aimed to determine the frequency and the pattern of seizure-related injuries in children aged 0-17 years with epilepsy seen at the University of Benin Teaching Hospital, (UBTH), Benin City, Nigeria. Methods: Consecutive cases of children with epilepsy seen at the Paediatric Neurology Clinic of UBTH, Benin-City over a period of 6 months were evaluated for injuries in the preceding 12 months using a structured questionnaire. Results: A total of 119 respondents were involved in the study, 50 (42.02%) sustained an injury at some point in the preceding 12 months. Participants in the middle socio- economic class had more seizure-associated injuries (n = 25, 59.5%), compared to those in the low socio-economic class (n = 20, 42.0%) and high socio-economic class (n = 5, 18.5%); P = 0.003. Seizure-related injuries were associated most with generalized seizure (50.5%) when compared with focal seizures (14.3%) P = 0.001. Among the subjects, a tonic-clonic seizure was the most common subtype of generalised seizure (p =22.306, p = < 0.001). The commonest seizure-related injuries are skin bruises (35.1%), followed by soft tissue lacerations (22.8%). Strong association between epilepsy-related injuries and compliance to anti-epileptic drugs (AEDs) were noted. Conclusion: Children with epilepsy are at higher risk of injury and this risk is modified by some factors like socioeconomic status, seizure type, and compliance with medication

Key words: Seizure, Children, Injuries, Epilepsy

Usman B, Abubakar AM

Background: Ventriculoperitoneal shunt (VP–shunt) is one of the easiest and most common ways of treating hydrocephalus worldwide. Common post-operative complications include shunt malfunction (obstruction, disconnection, fracture), infection of skin and hardware, exposed/extruded shunt, calcification and per anal extrusion. Objectives: A 5-year retrospective review of all complications observed among infants with VP Shunt in our centre. Methods: The study period was between July 2017 and June 2022. Extracted data included: Demographic data on the Age and sex at presentation, type of Hydrocephalus, and the observed complications. Results: Forty-six infants comprising 32 (70%) boys and 14(30%) girls had VP Shunt, with ages (number) of < 1 month (26.1%), 1 – 6 Months (43.5%), and 7 – 12 Months (30.4%). Types of Hydrocephalus were congenital (A. S. in 13, NTD associated in 18) and acquired (post meningitis in 13, IVHP in 2). Complications were observed in eight (17.4%), consisting of 6(75%) Males and 2(25%) Females, with M: F of 3:1. Complications among the eight (8) patients include: Shunt Obstruction (50.0 %), Shunt Disconnection (12.5 %), Shunt Infection (50.0 %), Skin Infection (25.0 %), Shunt calcification ( 12.5 %), Exposed Shunt( 12.5 %), Extruded Shunt (12.5%), Per anal protrusion (12.5 %) and Death (25.0 %). Conclusions: Outcomes were very good, with few manageable complications.

Keywords: Children, Complications, Hydrocephalus, Infants, VP – Shunt

Husain Yahya

Background: Background: Lichen planus (LP) is a chronic inflammatory papulosquamous autoimmune disease which predominantly affects the skin but may also affect mucous membranes and nails. It is commoner in adults and occurs in all races. Reports about LP from northern Nigeria are scanty. Objective: To report the relative prevalence, duration, clinical presentation, and outcome of treatment for patients with LP seen over 20 years. Methods: Retrospective review of records of patients diagnosed with LP in two dermatology clinics in Kaduna, Nigeria from September 2001 – August 2021. Results: Of 39,037 patients with new skin disease, 335 (0.9%) were diagnosed with LP: mean age 37.6 years (range 5 -81), 11.3% < 18 years and 55% < 40 years, male- female ratio 1:1. The median duration at presentation was 8 weeks (75% = 16 weeks). The lower legs (65%), lower arms (61.2%), abdomen (31.6%), upper arms (29%), upper back (28.1%), lower back (27.2%), chest (22.4%) and thighs (21.5%) were the most frequently affected sites. The oral mucosa, penis and nails were affected in 6, 9 and 2 patients only. Itching (97%), hyperpigmentation (26.6%), and Koebner’s phenomenon (23%) were also present. Classic LP accounted for 88.1% while hypertrophic LP (12.5%) and annular LP (6.3%) were other variants, some patients with multiple variants. Just over 7 % of patients had previous disease (median interval 7 years). Hepatitis C virus antibody was positive in 6.2%. All patients were treated with topical steroids but 45% required oral prednisolone. On follow-up, LP had resolved in 79.4% of patients. Conclusion: Lichen planus affected a younger population, presented in a classic way in most patients, affected the oral and other mucosae much less frequently and responded well to topical and systemic steroids.

Key words: Lichen planus, clinical presentation, Kaduna-Nigeria

Abdullahi MA, Kabir MA, Mustapha MI, Mamuda AA, Shamsudeen MB

Background: Symmetrical peripheral gangrene (SPG) is a rare clinical entity leading to ischemic necrosis of extremities. We report a case of SPG in patient brought into the orthopaedic clinic of Aminu Kano Teaching Hospital (AKTH), Kano, two days after applying a beautification substance called Henna. Case Summary: We report a case of a 28-year-old lady who presented at the emergency department of AKTH with a complaint of extreme pains in both hands and feet. The patient noticed a gradual darkening of the fingers and toes two days after applying the Henna, associated with severe pain at rest. She was thoroughly evaluated and examined for other possible risk factors or illnesses, but none was found. The patient was counselled and she subsequently consented to amputation. The gangrenous parts of the digits of her fingers and the tarsometatarsal of her feet were amputated bilaterally and the procedure was carried out successfully. Conclusion: To our knowledge, this is the first case report of symmetrical peripheral gangrene occurring after routine application of Henna as a beautification agent. No other possible risk factor was identified. We highlight the possibility of a beautification agent (Henna) as a causative factor of SPG. Thus, women should be careful of the mixtures in Henna that could lead to SPG.

Key words: Symmetrical, Bilateral, Gangrene, Henna, Amputation

O. Ariyo, B. O. Olaniyi, O. D. Onojade and F. S. Oladipo

Background: Knowledge and attitude of health workers affect caregivers’ infant feeding practices. However, information on the knowledge and attitudes of health workers in private hospitals is lacking. This study was designed to assess the infant feeding knowledge, attitude, and personal experiences of health workers in private hospitals in Ibadan, Nigeria. This cross-sectional study involved sampling of 108 consenting health workers of registered private health facilities offering ante-natal care services in Ibadan North communities of Oyo State, Nigeria. Data were collected using a semi-structured questionnaire including the socio-demographic characteristics, knowledge, and attitude of infant feeding practices. Knowledge was assessed using a 19-point scale categorized as good (≥13) and poor (<13). Attitude was assessed using a 65-point scale, categorized as good (≥33) and poor (<33). Data were analysed using descriptive statistics at p<0.05. Eighty five percent of the health workers were female, 51.9% were aged 21-30 years, 48.1% were married, and 25.9% were degree holders. Only 47.2% had attended infant feeding training recently, 57.0% had good knowledge and 53.0% had good attitude. Only 30.6% knew early initiation of breastfeeding, and 30.6% knew continued breastfeeding up 24 months and beyond. Just 49.1% considered breastfeeding in public non-embarrassing, and 33.3% agreed that infants less than six months should not be given water. There is evidence of limited knowledge and poor attitude towards the recommended infant feeding practices among the health workers in private health facilities in Ibadan. Periodic training on infant feeding for health workers in private health facilities is hereby recommended.

Key words: Exclusive breastfeeding, early initiation, private hospital, personal experience

Raji S.O., Ismaila A.I., Amina S.M., A. Adam.

Introduction: Hajj and Umrah are the main pilgrimages recommended in the Islamic faith to be performed at least once in a lifetime by those who have the wherewithal. It is one of the largest mass gatherings worldwide. 1 Muslims all over the world (over 180 countries) visit the Great Holy Mosque in the city of Mecca to perform the prescribed religious rites of the main pilgrimage (Hajj) which spans the second week of the twelfth month (Zul-hijja) of the Islamic lunar Calendar. The lesser/minor pilgrimage (Umrah) can be performed at any time of the year. Most hujajs (pilgrims) from outside Saudi Arabia perform Umrah and Hajj in a single journey (tamatui). Some faithfuls also perform the lesser pilgrimage (Umra) in the last ten days of the month of Ramadan (9 th month of the Islamic lunar calendar) due to the additional merits and blessings of this last third of the fasting month and additional opportunity of performing other meritorious and rewarding acts of worship such as i'tikaf (seclusion) in the Great Holy Mosque.

Umweni A.A, Otaren N.J.

Background: Although digit sucking is normal in infants and young children, prolonged duration of these habits might have consequences for the developing orofacial structures and occlusion. It is advisable to intercept the habit between the ages of 4 and 7 years. We report the case of a 9 year old boy who presented with a history of chronic digit sucking habit with associated hyperkeratosis/hyperpigmentation of the left cheek from repeated mechanical trauma from his left ring finger while he sucked his left index and middle fingers. The lesion is about 5mm in diameter. Full orthodontic assessment of the patient was carried out and habit breaking appliance instituted after counseling mother and child. Occlusal problems were reversed after habit cessation. Six months after breaking the habit, the hyperkeratosis/hyperpigmentation of the left cheek was still present even though it is reduced. This is an unusual finding in a child with chronic digit sucking habit.

Umar H.U., Mohammed L.M., Farouk A.G., Mustapha Z.

Background: Spondylocostal dysostosis (Jarcho-Levin Syndrome) is a rare congenital abnormality of spines and ribs which usually presents with trunk dwarfism, scoliosis, and respiratory symptoms. Its occurrence can be sporadic or familial. The clinical characteristics are vertebral abnormalities of hemivertebrae, butterfly vertebrae, scoliosis and variable rib abnormalities. Imaging is critical in its evaluation and management. Case Presentation: A 4-day-old child of a non-consanguineous couple delivered with swelling at the back. The family history was unremarkable for congenital anomalies. Clinical examination and radiological findings was consistent with spondylocostal dysostosis. Conclusion: Spondylocostal dysostosis is a rare musculoskeletal abnormality. Imaging plays a vital role in its diagnosis. An early diagnosis is necessary to prognosticate and institute appropriate management.

Key words: Spondylocostal dysostosis, Jarcho-Levin, Hemivertebrae , Rib anomalies, Congenital scoliosis.

Muhammad A.S., Aminu M.B., Dattijo L.M., Oluwagbemiga U.O., Ezugwu O.P.

Background : Fibroids are benign neoplasms of the uterus arising from smooth muscle. They are also termed uterine leiomyomas. It is the most common growth found in the female reproductive system and may undergo malignant transformation in less than 1% of cases to form leiomyosarcoma. Fibroids may present with abnormal uterine bleeding and pelvic pressure symptoms. Fibroid polyp can be a cause for concern especially if it grows so large to cause symptoms of obstructive uropathy. Thus, the patient may present with dysuria, anuria, or even necroturia as seen in our patient. Case summary: We present a case of 40-year-old P 5 + 0, A 3 lady, whose last childbirth was 10 years before presentation. She presented with 3 years history of recurrent vaginal bleeding, dizziness, and a mass protruding through her vagina. Her packed cell volume was 14%. She was fully investigated and upon catheterization, nectroturia was observed. She was counselled and had vaginal polypectomy. Conclusion: Necroturia associated with uterine fibroid polyp is a rare occurrence, hence physicians should have a high index of suspicion when evaluating patients with necroturia.

Baba M.M., Buba F., Talle M.A., Garbati M.A, Abdul H., Mairari F.G.

Background : Human immunodeficiency virus-infected patients are at increased risk of cardiovascular diseases compared with the general population, and right ventricular systolic dysfunction is said to be associated with poor outcomes. We therefore assessed right ventricular systolic function using tissue Doppler-derived tricuspid lateral annular systolic velocity (S`) among HIV-infected patients on highly active antiretroviral therapy (HAART). We evaluated its relationship with viral load and cd4 cells count. Methods: The study was a cross-sectional conducted among HIV-infected patients receiving HAART at the Federal Medical Centre, Nguru, Yobe State, Northeastern Nigeria using tissue Doppler-derived tricuspid lateral annular systolic velocity (S`). Results : One hundred and seven (107) subjects were recruited into the study comprising thirty-seven (34.6%) males and seventy (65.4%) females. Ninety-six (89.71%) had preserved right ventricular systolic function (RVSF) while 11(10.28%) had reduced RVSF. The mean CD4 cells count of patients with preserved RVSF and those with reduced RVSF were 838.37±27.50 and 301.66±12.38 respectively (P = <0.001). Similarly, the mean viral load of patients with preserved and reduced RVSF were 547.90±10.75 and 10293.00±74.67 respectively (P = <0.001). Pearson Correlation analysis between CD4 cell count and S` revealed a positively significant relationship (r = 0.894, P = < 0.001); while the relationship between viral load and S` was negative but significant (r = -0.879, P = < 0.001). Conclusion: The prevalence of right ventricular systolic dysfunction among patients with HIV on HAART was found to be 10.28%. There was a positive and significant correlation between the parameter of RVSF (tissue doppler derived tricuspid lateral annular systolic velocity) with CD4 cell count and a negative but significant correlation with HIV viral load.

Keywords: Right ventricular systolic function, Tissue Doppler derived lateral tricuspid annular systolic velocity (S`), CD4 cells, viral load.