archive vol17 no2

Dalhat Salahu, Alhassan Mohammad Datti

Abubakar Garba Farouk, Halima Umar Ibrahim, Bello Abdullahi Ibrahim, Hassan Abdullahi Elechi, Jamila Audu Idrisa, Modu Gofama Mustapha

Background: Sickle cell anaemia (SCA) is a very common disorder among indigenous people of Borno and Yobe States in the North-eastern region of Nigeria. It is characterized by recurrent episodes of severe bone pain from occlusion of blood vessels by sickled red cells. Hypertension in children with sickle cell anaemia is rare and when present may be secondary to other disease process and more rarely may be essential hypertension. However, when hypertension occurs in SCA patients, it accelerates the progression of complications such as cerebrovascular accident and sickle cell nephropathy, hence the need to study the pattern of blood pressure in these patients. Early detection of hypertension can help in forestalling its progression and preventing its devastating complications such as cerebrovascular accident.

Objectives: To compare the arterial blood pressures of children with sickle cell anaemia in steady state with those of age and sex-matched healthy controls.

Methods: The study design was cross-sectional comparative. Minimum sample size of 54 was determined using Taylor’s formula. Subjects were recruited systematically by enrolling every other patient as they present at the Paediatric Haematology clinic. The controls were apparently healthy age and sex-matched haemoglobin AA children. Anthropometric parameters and the blood pressure were measured and recorded appropriately. Blood pressure was classified using published normative data.

Results: A total of 54 children with sickle cell anaemia in steady state and 159 normal children as controls were enrolled. The ages of both the SCA and controls ranged from 3 to 14 years, with median age of 8 years. Of the 54 SCA children 28 (52%) were males while 26 (48%) were females. Mean packed cell volume of the SCA children was 22 ± 3.5. Although 8 (14.8%) of the SCA children were hypertensive, there was no significant difference in the mean systolic blood pressure (96mmHg) of children with sickle cell anaemia compared to controls (99mmHg) P = 0.078 while, the mean diastolic blood pressure (65mmHg) of the control was significantly higher than that of SCA cohort (59) P ≤ 0.0001.

Conclusion: Hypertension is not rare among children with sickle cell anaemia. This stresses the need regular BP recording during follow-up in order to prevent devastating events such as cerebro-vascular accident.

Alhassan Datti Mohammed, Adesope Saheed, Salahu Dalhat

Background: Inadequate anaesthesia during Laryngeal Mask Airway (LMA) insertion may make correct positioning difficult or even impossible.

Objective: This prospective study was designed to compare the ease of LMA insertion in patients who received propofol alone and patients who received a combination of propofol with low dose (0.1 mg/kg) suxamethonium.

Methods: Eighty ASA I and II consenting patients aged 18 to 60 years undergoing elective procedures under general anaesthesia and spontaneous ventilation were recruited and randomly allocated into two groups with each receiving either 5 mls of 0.9% saline (group P) or 0.1 mg/kg suxamethonium, made up to 5 mls (group S), 30 seconds post induction with intravenous (iv) propofol 2.5 mg/kg delivered over 30 seconds. The overall insertion conditions (scored from grade of jaw relaxation, ease of insertion, severity of airway response in terms of coughing, gagging, laryngospasm and patient movement) during first attempt of LMA insertion and the number of attempts made were then accessed. The number of attempts before successful LMA insertion as well as incidence and duration of apnoea post induction were recorded.

Results: Excellent overall insertion condition occurred in 40% of patients in group S compared to 15% in group P, satisfactory in 30% of patients in group S compared to 35% in group P, and poor in 30% of patients in group S compared to 50% of patients in group P.

Conclusion: The combination of propofol plus low dose suxamethonium for LMA insertion was found to provide better grades of overall insertion condition. The number of attempts before successful insertion was however comparable.

Background: Hysterosalpingography (HSG) is the radiographic evaluation of the uterus and fallopian tubes and is used predominantly in the evaluation of infertility. HSG can cause discomfort or pain during or after the procedure, up to 72 % of women complain of significant discomfort with this test. This pain can hinder patient’s co-operation, therefore limiting the usefulness of the procedure, and willingness to do other similar diagnostic studies. It can also result in fortuitous tubal blockade by provoking cornual spasms.

Objectives: To compare the effect of intracervical block with 1% lidocaine and intramuscular diclofenac 75mg in decreasing pain perception during hysterosalpingography.

Methods: The study was carried out between September 2016 and January 2017. One hundred and forty women with infertility referred for hysterosalpingography were randomly recruited and assigned to two study groups. Women in the study group A were given an intracervical block with 1% lidocaine while women in the Study Group B were given intramuscular diclofenac sodium 75mg 30 minutes before the procedure. Pain levels during specified stages of HSG were assessed using visual analogue score. The statistical package for social sciences (SPSS) version 16.0 was used to analyze the data. The data obtained were presented in tables. Categorical data were analyzed using chi-squared test and Fishers exact correction, continuous data were analyzed using student t-test; level of significance (p-value) was set at p< 0.05.

Results: There was no statistically significant difference in the two study groups in their baseline characteristics; but there were statistically significant differences in some gynaecological characteristics that include previous vaginal delivery and previous pregnancy loss. The two most painful steps of the procedure were during grasping of the cervix and uterine distension with contrast medium mean visual analogue score (VAS) of 4.26±1.62 and 6.37±1.62 (t = -7.726, p-value <0.001), 6.14±1.85 and 7.37±2.23 (t = -3.543 p-value 0.001) respectively in groups A and B.

Conclusion: There was significant reduction in VAS pain scores with intracervical block with lidocaine when performing HSG for infertility.

Background: The thyroid serves the body with important endocrine functions. A variety of influences impinges on the incidence and pathomorphological picture of the thyroid gland. These influences that include: iodine deficiency; iodine sufficiency; gender and; imaging technology are elucidated further in this work. We used the Google search engine to search for literature on the subject from the internet. Iodine is associated with increased incidence of nodular goiter and follicular carcinoma. The world over the last few decades had transited from an era of iodine deficiency to its sufficiency leading to an increase in incidence of thyroiditis and papillary thyroid carcinoma. Estrogen and Estrogen receptor discovered in the thyroid is implicated in the increased frequency of thyroid disorders in females. Finally, advancement in thyroid imaging technology and its utilization has led to over-diagnosis and overtreatment of thyroid diseases

Background: Poor nutrition contributes to deaths associated with the infectious diseases especially among under-5 children in developing countries. The growth of young children could be impacted with increasing burden of HIV/AIDS and increasing food insecurity. This results in an increased malnutrition among this vulnerable group.

Objective: To determine the nutritional status of children aged ≤5 years newly diagnosed with HIV infection in UDUTH, Sokoto.

Methods: A prospective descriptive cross-sectional study among children aged ≤5 years newly diagnosed with HIV infection at the Paediatric units and Paediatric ART Clinic, UDUTH, Sokoto between January 1st, 2015 and December 31st 2019. The nutritional status was determined using WHO growth standards. The data were analyzed using SPSS version 22.0 and p-value ≤0.05 was taken as significant.

Results: Sixty-seven children aged ≤5 years were diagnosed with HIV infection in UDUTH within the period. Twenty (30.3%) were aged 1.1 – 2.0 years with the mean age of 2.9(±1.4) years. The M:F ratio approximately 2:1. Forty-five (67.2%) were from lower socio-economic class. Sixteen (23.9%) were diagnosed using PCR for HIV-DNA. Forty-eight (71.6%) presented in clinical stage I. Twenty-three (34.3%), 24 (35.8%) and 12 (17.9%) of the children were stunted, underweight and wasted respectively. The rate of undernutrition was found to be significantly related to the age of the child (p=0.03) and socio-economic status of the family (p=0.02).

Conclusion: The nutritional status of young children newly diagnosed with HIV infection was suboptimal and majority was stunted and underweight in our environment

Ibrahim UM, Ibrahim RJ

Background: Arrow injury is one of the causes of non-missile penetrating head injury. Penetration may be through natural openings like the eye, nose, or a thin bone. At presentations, most patients are clinically stable. However, some may present with catastrophic vascular injury. Non-contrast Computed Tomography (CT scan) with or without angiography, when indicated, is essential for surgical planning. When impacted to a bone, craniectomy is an option, but when not impacted the best option is a craniotomy with antegrade extraction under vision especially when the arrow is barbed. Often surgery may involve multiple specialists. Broad-spectrum antibiotic prophylaxis is advised likewise tetanus and seizure prevention. Postoperatively patients are followed up and complications are treated.

Background: Central venous catheters are increasingly becoming the most common access at initiation of hemodialysis. They are associated with short term complications such as infections and long term problems resulting in stenosis of the central venous systems.
We report two patients with end stage renal disease, who developed stenosis of the superior vena cava following long term placement of internal jugular catheters for maintenance hemodialysis.

Background: Congenital diaphragmatic hernias are developmental defects involving the diaphragm. Three major types have been identified; Bochdalek hernia, Morgagni hernia, and hiatus/hiatal hernia, with the postero-lateral Bochdalek type being the most common. Rare concomitant existence with intrathoracic kidney was reported. Cases of left sided Bochdalek hernia were previously reported in the literature but none is associated with intrathoracic kidney. A successfully surgically treated rare case of right sided Bochdalek hernia co-existing with intrathoracic kidney in a neonate is therefore presented.