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

AtwoliL,¹ErhaborGE,²GbakimaAA,³HaileamlakA,⁴NtumbaJ-M K,⁵KigeraJ,⁶Laybourn-Langton L,⁷Mash B,⁸Mohia J.⁹MulaudziFM,¹⁰Ofori-AdjeiD,¹¹OkonofuaF,¹²RashidianA,¹³El-Adawy M,¹⁴SidibéS,¹⁵Snouber A,¹⁶TumwineJ,¹⁷YassienMS,¹⁸YongaP,¹⁹ZakhamaL,²⁰ZielinskiC.²¹

1. Editor-in-Chief,East African Medical Journal.

2. Editor-in-Chief,West African Journal of Medicine.

3. Editor-in-Chief,Sierra Leone Journal of Biomedical Research.

4. Editor-in-Chief,Ethiopian Journal of Health Sciences.

5. Chief Editor,Annales Africaines de Medecine.

6. Editor-in-Chief,Annals of AfricanSurgery.

7. University of Exeter.

8. Editor-in-Chief,African Journal of Primary Health Care & Family Medicine.

9. London School of Medicine and Tropical Hygiene.

10. Editor-in-Chief,Curationis.

11. Editor-in-Chief,Ghana Medical Journal.

12. Editor-in-Chief,AfricanJournal of Reproductive Health.

13. Executive Editor,Eastern Mediterranean Health Journal.

14. Director of Health Promotion,Eastern Mediterranean Health Journal.

15. Director of Publication,Mali Médical.

16. Managing Editor,Journal de la Faculté de Médecined’Oran.

17. Editor-in-Chief,African Health Sciences.

18. Editor-in-Chief,Evidence-Based Nursing Research.

19. ManagingEditor,East African Medical Journal.

20. Editor-in-Chief,La Tunisie Médicale.

21. University of Winchester.

Mikhail A, Salahu D, Atiku M, Adesope S,Abdurrahman A, Abdullahi MM

Background:Endotracheal intubation usually aided by the muscle relaxant suxamethonium can elicit responses and changes which are hazardous in some patients including children; suxamethonium is also contraindicated in some patients. Fentanyl, a short-acting opioid maybe a suitable alternative with varying results.

Objective: This study compares the changes associated with the facilitation of endotracheal intubation with either the commonly used suxamethonium or fentanyl.

Methods: Eighty two American Society of Anaesthesiologist (ASA) physical status classification I and II patients aged between 3 and 12 years scheduled for surgeries requiring general anaesthesia with endotracheal intubation received either 3 μg/kg fentanyl (group F) or 1.5 mg/kg suxamethonium (group S)following induction of anaesthesia with propofol. Haemodynamic parameters: pulse rate (PR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were assessed post-intubation at 1, 3, 5 and 10 minutes respectively. The incidence of side effects and post-intubation upper airway events were also observed.

Results:Patients in group S experienced a significant increase in HR when compared to baseline values (p=0.0001). The SBP and DBP were significantly lower than baseline values in patients in group F (p<0.023). MAP increased in group S and declined in group F at all study timings. However, the post-intubation MAP was significantly lower than the baseline only at the 5th minute (p=0.026). There were no records of postoperative upper airway injuries, hypotension, bradycardia, desaturation, masseter spasm and malignant hyperthermia in the two study groups.

Conclusion: Propofol-Fentanyl produced more stable parameters compared to propofol-suxamethonium. No significant difference in terms of side effects between Propofol-Fentanyl and propofol-suxamethonium.

Key words: Fentanyl, Suxamethonium, Propofol, Facilitation, Endotracheal intubation

Background: Laparoscopic surgical services are well established in most hospitals in developed countries but not in developing countries like Nigeria. Moreover, the scope of healthcare financing like the health insurance scheme in Nigeria has not expanded to accommodate laparoscopy. Basic surgeries like appendicectomy, cholecystectomy and advanced surgery like hemicolectomy form common surgical procedures now performed via laparoscopy in Nigeria. Objective: To share our experiences with laparoscopic general surgical operations performed in a private hospital in Abuja, Nigeria.

Methods: Retrospective study of 119 patients who had laparoscopic general surgeries over 5 years period at a private hospital in Abuja, Nigeria, from January 2017 to December 2021. The variables analysed were patients’ demographic data, diagnosis, type and duration of operations and outcome.

Results: One hundred and nineteen patients had laparoscopic surgery over the period. Of these, majority were females 71 [59.7%] and males 48 [40.3%] giving M:F of 1:1.5. The age range of patients was 12 to 81 years and the mean age was 43.4 years ± 14.0. A higher proportion of the patients [58%, n=69], were aged 40 years and above. The commonest procedures done were laparoscopic cholecystectomies [49.6%, n=59], followed by appendicectomies [21.0%, n=25]. Seven [5.9%] patients had laparoscopic adhesiolysis and drainage of liver cysts each, laparoscopic fundoplication 5 [4.2%] and left hemicolectomy 3 [2.5%]. The commonest postoperative complication was surgical port site infection 4 [3.4%].

Conclusion: The scope of laparoscopic general surgeries provided in a private hospital in Abuja, Nigeria is broad and safe. The outcomes are comparable to those from other centres in the region.

Keywords: General surgery, laparoscopy, Private Hospital, Abuja

Oyediji FJ,Mpyet CD

Background: With multiple medical specialities and subspecialties, the choice of a lifelong speciality can be a daunting task. Most medical students commence undergraduate training without complete knowledge of all the medical specialities available. Considering that various factors affect the choice of a speciality, practice
location and productivity, this study sought to assess ophthalmologists’ job satisfaction, remuneration and scope of practice.

Methods: A semi-structured, pre-tested self-administered questionnaire was distributed to 140 consenting Ophthalmologists and ophthalmic Residents that attended the 2016 Annual Scientific Conference of Ophthalmological Society of Nigeria. Information obtained included participants’ socio-demographic data, practice environment, remuneration, job satisfaction, and areas participants felt required a change in their ophthalmic practice. Responses were analysed using IBM Statistical Package for the Social Sciences 16.0 (IBM Corp., Armonk, NY, USA).

Results: One hundred and five (75%) of the 140 questionnaires were filled and returned. The median age of participants was 35 years (range: 21-70 years) and 54.3% were females. Most Nigerian ophthalmologists practice in urban area. Consultants do more research spending an average of 6.44 hours per week on research. Most respondents (70, 66.7%) felt fairly compensated for their work with government-employed earning significantly less (₦4.2million/annum) than their private sector counterparts (₦6.3 million/annum). Most respondents (99[94.3%]) reported high levels of job satisfaction and 69(65.7%) were fairly productive.

Conclusion: Despite the discrepancies in remuneration in private versus public sector ophthalmologists and trainees, most survey participants feel satisfied with their current level of remuneration and productivity.

Keywords: Practice, Remuneration, Work satisfaction, Nigeria, Ophthalmologists, Ophthalmology residents

YahyaH.

Background: Skin diseases are common in African patients with HIV infection. They are often the first clinical manifestations of immune deficiency and their frequency increases as impaired immunity worsens and decreases as immunity improves with antiretroviral drugs (ARV). Objective: To report the relative incidence and clinical presentation of HIV-related skin disease over 20 years when diagnosis and treatment availability varied.

Methods: Records of patients with HIV-related skin disease attending a dermatology clinic in Kaduna, Nigeria from 2001 to 2021 were reviewed.

Results: HIV-related skin disease was diagnosed in 525/29,278 (1.8%) patients with 610 episodes of skin disease: Mean age 36.2 years (range:4 – 68 years), 60% age < 40, males 55%. Almost 72% of patients were seen between 2001 and 2010 and only 9.3% were seen after 2015. Patients seen between 2001 and 2010 were significantly less likely to know their HIV status (19.9% vs. 80.1%, P = 0.000) and be receiving ARV (21.5%, vs. 51.4%, P = 0.000) than those seen between 2011 and 2021. The most common skin conditions were: pruritic papular eruption 33%, herpes zoster 19.7%, Kaposi sarcoma 11%, atopiform dermatitis 8.9%, and seborrheic dermatitis 3.8%. Plane warts, adverse drug reactions, folliculitis, furunculosis, genital herpes simplex, psoriasis, dermatophyte infection, and molluscum contagiosum were also seen. Almost 60% of patients a had CD4 count < 200 cells/ml at presentation.

Conclusion: We noted a marked change in the frequency and pattern of disease between 2001-2010 and 2011-2021 likely due to the increased availability of care and treatment over the period.

Keywords: HIV, Skin disease, Relative incidence, Kaduna-Nigeria, sub-Saharan Africa

BadukuTS, YusufA,ThompsonM.

Background: Stroke is a leading cause of morbidity and mortality worldwide, most of which occur in low and middle-income countries. Neuroimaging is the cornerstone for guiding its management, and computed tomography (CT) is an established tool for its diagnosis.

Objective: The purpose of this study was to examine recent CT brain findings among stroke patients in a rural-based, private teaching hospital in south-west Nigeria, and to compare them with previous findings within Africa.

Methods: This is a retrospective study conducted for thirty months in the Radiology Department of Babcock University Teaching Hospital, Ilisan- Remo, Nigeria. Brain CT images and reports performed between 1st November 2019 and 30th April 2022 were retrieved, processed and analyzed.

Results: The patients were 199 males (62.6%) and 119 females (37.4%), with a mean age of 61.7 years. The highest frequency wasbetween the ages of 70 and 74 years. The most frequent presenting complaint was the inability to move (21.5%). Infarcts constituted the majority of lesions while the most frequent CT findings were left-sided hemispheric infarcts (13.7%).

Conclusion: The result of the study showedamalepreponderanceintheincidenceofcerebrovascularaccidents(CVA).Thereisalsoa preponderance of ischaemic over haemorrhagic CVA. Left-sided hemispheric lesions are more frequent.

Keywords: Cerebrovascular accident, Computed Tomography, Babcock University Teaching hospital, South-
West Nigeria

Usman B, Mohammed B, Daibu U,Bukar A A, Zarami A B

IbrahimBA,AkuhwaRT,AdamuAI, IbrahimHU,AliyuI

Background:Congenital melanocytic nevi are common and vary in size. Some can be quite extensive but are usually benign. However,a giant congenital nevus is rare and has the potential for malignant transformation. Giant nevus could occur in any part of the body; though it is most common on the trunk, it rarely covers over three-quarters of the skin. It is known to be associated withother congenital malformations such as spina bifida and foot deformity. Very few cases of bulky perineal naevocytoma associated with giant congenital melanocytic naevi have been reported in the literature.

Case summary:We report a case of a 2 day old female neonate with a giant melanocytic nevus that covers about 85% of the whole body associated with a bulky perineal naevocytoma arising within the lesion.

Conclusion: Such extensive lesion is at high risk of malignant transformation and has a major psychosocial impact on the caregivers.

Keywords: perineal naevocytoma, congenital, melanocytic, nevus, neonate.

Zarami AB, Chiwar H, Bata MG, Nggada HA, Pindiga UH

Background: Epstein-Barr virus (EBV)-associated adenocarcinoma constitutes 10% of gastric carcinomas worldwide. The EBV-positive adenocarcinoma has a unique genomic aberration with a low mutation burden and thus carries a good prognosis. The distinct salient genomic features have provided a guide to targeted therapy and the possibility of a clinical trial for emerging drugs in EBV-positive gastric adenocarcinomas. We retrospectively reviewed ten cases to determine the frequency of this association in our environment. Methods: The study was an analytical case-control study. Non-probably purposive sampling method was adopted; ten formalin-fixed and paraffin-embedded tissue blocks from surgically resected gastric adenocarcinoma seen at the Histopathology Department of the University of Maiduguri Teaching Hospital were selected and used. The PCR was done at National Trypanosomiasis Centre, Kaduna using 129 bp primers. The patient biodata and EBV status were entered into a computer and analysed using SPSS version 23. Proportions were calculated using the Chi-square test and a p-value of <0.05 was considered statistically significant. Results: Ten cases were retrieved. There were 6 females and 4 males with F:M ratio of 3:2 and a mean age of 52.7 ± 10.26 SD with an SE of 0.661. Seventy percent of the cases were positive for EBV while 30% were negative. Four out of the 6 females were positive for EBV DNA and 3 out of the 4 males were positive for EBV DNA. Fifty percent of the positive cases were found within their 4th decade of Life. There was no statistical significance between the histological types and EBV status (p=0.467). Conclusion: The study has shown a high frequency of EBV-DNA detection in patients with gastric adenocarcinoma in our environment, with 50 % occurring in the 4th decade of life. We recommend a further study with larger sample size and analysis of exome and genome sequencing of EBV in patients with gastric adenocarcinoma to increase our understanding of its prognosis and treatment.

Keywords: EBV-DNA, PCR, Gastric adenocarcinoma, Targeted immunotherapy

Background: Inappropriate estimation of endotracheal tube pressure can result in significant harm to the patient, and the use of a manometer is the only reliable way of ensuring an optimal pressure range (20-30cmH2O). In the absence of a manometer, the Pilot balloon palpation (PBP) technique is commonly employed in our environment.

Aim: This study compared the accuracy of a newer method of ETTc inflation called passive release technique using loss of resistance (LOR) syringe with the PBP technique in determining optimal ETTc pressure.

Methods: One hundred and eighty ASA I and II patients, aged 18 – 65 years, scheduled for elective procedures under general anesthesia with ETT were randomized into 2 groups with one group having their cuff pressures measured by pilot balloon palpation (PBP) and the other using a loss of resistance syringe (LOR). The cuff pressure was then measured in each group using a sensitive manometer.

Results: The mean ETTc pressure was found to be significantly higher in the PBP group than in the LOR group (64.28 ± 31.12 and 29.64 ± 11.68; p= 0.0001). The LOR technique was found to be significantly more accurate in ETTc pressure estimation than the PBP techniques (59.3 vs 27.8%; p = 0.0001).

Conclusion: Passive release technique using LOR was found to be significantly more accurate compared to PBP in optimal ETTc pressure estimation.

Key words: Endotracheal tube cuff pressure, pilot balloon palpation, loss of resistance syringe.

Musami U.B, Abdulmalik J.O, M. W Ali, Dahiru A. M. C, Mahmood M. Y, Wakawa I. A

Background: North-Eastern Nigeria has high birth rates, low literacy levels and low rates of premarital screening for haemoglobin genotype. This probably explains the high prevalence of sickle cell disease (SCD) among children and adolescents. SCD is a chronic disease associated with high rates of co-morbid mental health disorders affecting both the sufferers and caregivers. Despite this burden, there are very few studies that evaluated mental health disorders among people living with SCD in this region.

Objectives: To determine the prevalence of depression, suicidality, and anxiety among children and adolescents with SCD and the sociodemographic correlates associated with them.

Methods: This was a single-centre, hospital-based, cross-sectional study conducted at the University of Maiduguri Teaching Hospital. Children and adolescents with SCD were recruited for the study and issued a pretested sociodemographic questionnaire (Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Aged Children Present and Lifetime Version [K-SADS-PL]). Data was analysed using SPSS version 20.

Results: There were a total of 165 participants with a mean age of 11.2 ± 3.2 years comprising 83 (51.9%) males. Majority (98.1%) had only primary education, and most (83.8%) reside in an urban area. About 77% were diagnosed to have SCD before the age of 8, and 57.5% have received care for more than 5 years. Emotional disorders were present in 53.1% of the participants. These consist of anxiety disorder 38.1%, separation anxiety 28.8%, depression 20.6%, agoraphobia 13.1%, suicidality 5%, panic disorder 3.8%, social phobia/ specific phobia 3.1%, and general anxiety disorder 2.5% respectively. Statistically significant association (P<0.005) was found between emotional disorders and monogamous families, and parents’ occupation,

Conclusion: There is a high prevalence of emotional disorders amongst children and adolescents living with sickle cell disease attending clinics in Maiduguri, which correlated with monogamous family structure, low socioeconomic status. Routine screening for emotional disorders among children and adolescents living with chronic disorders attending the paediatric clinic should be considered and psychosocial support should be provided.

Key words: Emotional disorders, sickle cell disease, Nigeria

Rabiu A, Getso HA, Mahmud A

Background: Many studies have shown that working mothers face challenges in achieving exclusive breastfeeding (EBF). The practice of breast milk expression (BME) is an important strategy to achieve EBF. Aim: To assess the practice and influence of BME on EBF among working mothers with infants up to six months of age attending the immunization clinic of Aminu Kano Teaching Hospital (AKTH), Kano.

Methods: This was across-sectionall study among working breastfeeding mothers attending the immunization clinic of AKTH. A structured interviewer-administered questionnaire was used to obtain data on knowledge and practice of BME. Data collected were analysed using SPSS windows version 21. A χ2 test was used to compare variables where appropriate.

Result: Three hundred and ten breast feeding mothers participated in the survey. The mean age ±SD of respondents were (30.68 ± 5.6). Their median parity was 3. Only 103(33.2%) practiced BME. Reason given by half (54.8%) of respondents who practiced BME was to achieve six months of EBF which was found to be statistically significant (p-value =0.001).

Conclusion: Although most working mothers have fair knowledge on expression and storage of breast milk, only a minority put that into practice, and the main reason for practicing BME was to achieve six months of EBF. Age of mother, ethnicity and reason for BME were found to be statistically significant (χ2 = 52.7, P= 0.01), (χ2 =7.99, P = 0.046), (χ2 = 305.5, P = 0.001).

Key words: Breast milk Expression, Exclusive Breast Feeding, Influence, Practice.

Nafisat T. Abdullahi, Rabiu I. Jalo, Abubakar S. Abubakar, Usman M. Ibrahim, Shaheeda L. Farouk, Aminatu A. Kwaku, Fatimah I. Tsiga-Ahmed, Aishatu L. Adamu, Musa M. Bello, Amole T. Gboluwaga, Auwalu U. Gajida, Isa S. Abubakar

Background: Ensuring access to skilled birth attendants (SBA) during childbirth is critical for maternal and newborn survival, especially in underserved rural communities of northern Nigeria.

Methods: We assessed the utilisation of SBA in rural communities of Kano state. Using a cross-sectional study design with a concurrent mixed method of data collection, multi-stage and purposive sampling techniques were employed to select respondents of the quantitative and qualitative components of the study, respectively. Focus group discussions and key informant interviews were conducted to assess the perception of women, husbands and delivery service providers regarding the utilisation of SBA.

Results: Of the 194 women, 38(19.6%) were attended to by SBA, 138(71.1%) by unskilled birth attendants and 18(9.3%) had solitary birth. Furthermore, facility-based delivery was only 14.9% as the majority of the women delivered at home. Previous hospital delivery (p=0.02, aOR = 4.5; 95% CI=1.4-14.8) and husband’s level of education (p=0.03, OR = 5.9; 95% CI=1.3-27.3) were found to be independent predictors of utilisation of SBA. Perceptions regarding utilisation of SBA varied, ranging from a general preference for home delivery with the assistance of a traditional birth attendant to a predisposition towards hospital delivery with the assistance of SBA. Factors that contributed to adherence to traditional birthing practices included healthcare workers’ negative attitudes, manpower gap, lack of equipment and supplies and inadequate functioning health facilities.

Conclusion: Utilisation of SBA in rural communities of Kano state is low. Efforts should be made to increase women’s and men’s awareness, improve health facilities, and ensure improved and equitable access and availability of skilled delivery care services.

Keywords: utilisation, skilled birth attendant, women, rural, Kano

Nosakhare J. Iduoriyekemwen, Alphonsus N. Onyiriuka, Wilson E. Sadoh, Moses T. Abiodun

Timothy A. Ehwarieme1 and Anwuli Emina2

Background: Hypertension is a public health challenge that has been increasing alarmingly in both low and high-income countries. This study aims to determine the prevalence of hypertension and its associated factors among adult residents in Imoru community.

Methods: A descriptive cross-sectional design was used to surveysample size of 316 randomly selected participants. A well-structured questionnaire, blood pressure apparatus, weighing scale, and calibrated meter rule were used to collect data. Data were analyzed using descriptive statistics and hypothesis tested using multiple logistic regression at a 5% level of significance. Result: Of the 316(100%) participants, 177(56%) were males with M: F ratio of 1:0.79. The prevalence of hypertension was found to be 37.7%. The level of knowledge of Hypertension is evenly distributed with 83(26.3%) having poor knowledge, 152(48.1%) having fair knowledge, and 81(25.6%) having good knowledge. Risk factors identified are consumption of fatty food, adding table salt to meals, performing stressful activities, consumption of red meat, consumption of processed and canned foods, and addition of condiments to foods (average mean >2.5). Factors influencing these practices are affordability, availability, culture, and ignorance. There is a positive significant correlation of SBP (R2 = 0.1854, p =0.021; p =0.002) /DBP (R2 = 0.0458, p =0.002) and BMI. Females are two times (OR: 1.86; CI = 0.343-2.159) more likely to have good knowledge than males.

Conclusion: There is a high prevalence of hypertension in the study population. There is a need for concerted efforts by health policymakers and all stakeholders towards putting in place effective primary and secondary preventive strategies.

Keywords: Knowledge, risk factors, hypertension, Prevalence, Practices associated with risk

Adamu Abubakar. Abba Bukar Z. Ahmed Mohammed N. Amina Muhammad A. Aliyu Mohammad Kodiya

Background: Kaposi sarcoma (KS) is an uncommon vascular neoplasm that commonly involves the skin of the upper and lower extremity and to a lesser extent, mucosa of the different anatomical sites of the body. It rarely occurs in the head and neck mucosa, the most common site being the oral cavity. Nasal mucosal involvement is extremely rare. To the best of our knowledge, only nine cases of KS of the nasal cavity were reported in the English literature. We present a rare differential to be considered when dealing with patients with nasal mass.

Case summary: A 47 year old Nigerian woman presented with 3 years history of recurrent epistaxis, a right nasal mass, progressive right nasal obstruction, rhinorrhoea and anosmia. She is diabetic and hypertensive. Examination revealed a polypoid mass occupying the whole of the right cavity with associated contact bleeding.

Conclusion: Nasal KS is a rare malignancy that involved the nasal mucosa. To our knowledge, only nine cases of primary nasal KS were reported in the literature of which only a few were not associated with AIDS. Though rare, it should be entertained as one of the differential diagnoses of nasal masses in adults even in those with HIV-negative status We present the fifth case of primary nasal KS not associated with AID
Keywords: Kaposi sarcoma, nasal cavity, acquired immunodeficiency syndrome

Background: Osteochondritis is a necrotic involvement of the subchondral bone and cartilage opposite. Its most common location is the medial femoral condyle. The technique of Wagner’s autoplastic grafting was modified or adapted to a limited technical platform. To share an unusual experience with the scientific community.

Summary: A dissected osteochondritis of the left femoral condyle was diagnosed in a 15-year-old patient. The treatment was a modified open-centre surgery according to Wagner. The results were satisfactory in both immediate and late post-surgery.

Discussion: The classic Wagner technique uses a unique plugin that is fixed by patching. In this work, the graft was triple and fixed by screws.

Conclusion: The working conditions can lead to the use of a modified classical technique

Keywords: Femur; Mosaicoplasty; Osteochondritis

Zarami AB, Abe MA, Adamu AI, Tarfa H, Pindiga UH

Background: Xanthogranulomatous inflammation (XGI) is a rare form of chronic inflammation characterized by the presence of lipid-laden macrophages, multinucleated giant cells, and cholesterol crystals. It is an uncommon finding in the breast. Our literature search revealed twenty-four documented cases in the English literature.
Case report: An 18-year-old female presented with a mass in the left upper lateral quadrant of the breast with ulceration for a 1-month duration. The mass was initially small about 2cm in its widest diameter and continued to increase in size to 5 x 3 cm. The overlying skin is smooth and not attached to the underlying structures. It is firm with mild tenderness and ill-defined margins. Two months later she developed a left breast ulcer that measured 2 x 1 cm on the surface of the lump. It has a sloping edge with a necrotic floor. There was no associated axillary lymphadenopathy. Fine needle aspiration cytology suggested an inflammatory process. Tissue biopsy histology shows abundant foam cells, multinucleated giant cells of foreign body type as well as numerous lymphoplasma cells infiltrating the breast tissue with geographic areas of necrosis in keeping with xanthogranulomatous mastitis.
Conclusion: Xanthogranulomatous mastitis is a very rare entity, it is self-limiting in most cases. The diagnosis of XGM can be made by excluding other diseases that elicit inflammation in the breast. The lesion can mimic granular cell tumor, histiocytoid carcinoma, invasive carcinoma NST, and lipid-rich breast cancer; therefore, clinicians should always consider these as differential diagnoses to avoid unnecessary surgery.
Keywords: Xanthogranuloma, Mastitis, Rare

Karthik Shunmugavelu

Ebeigbe JA, Onoabhagbe SI

Background: Eyelash extensions are used to enhance the length, curliness, fullness and thickness of the natural eyelashes. The use of eyelash extensions is a common cosmetic practice among young women. This involves attaching synthetic eyelashes by means of an adhesive to the eyelashes.

Objective: The aim of this study was to assess the awareness and knowledge of female undergraduates of the University of Benin on the possible dangers of use of eyelash extensions.

Method: This was a descriptive cross-sectional study using questionnaires. Study population comprised female undergraduates in the University of Benin. A structured questionnaire assessing demographic variables, knowledge of eyelash extensions, usage as well as awareness of ocular complications was distributed among 2057 females aged 16-35 years with a mean age of 20 (±2.1 SD) years. Data obtained from the participants was processed using the statistical package for social sciences (SPSS) version 22.0 and presented in percentages and tables.

Results: We found that 99.76% (n=2052) of respondents were knowledgeable about eyelash extensions. Over two-thirds of the respondents had fixed eyelash extensions (67.77%). Cosmesis/beauty was the most common reason for fixing eyelash extensions (65.42%, n=912). About seventy-one percent (70.73%) of those who had fixed eyelash extensions knew about some complications from the use of eyelash extensions. The most common complication experienced was itching (62.7%). Social event outings were the major reason given why over two-thirds of respondents fixed eyelash extensions (69.80%, n=973),

Conclusion: Eyelash extensions has become a very popular procedure especially among young female students of higher institutions and may cause ocular problems. Adequate attention should be paid to the potential ocular health risks of the procedure and those who want to undergo this procedure, should be enlightened.

Key words: Eyelash, cosmesis, complications, eyecare, extensions

Background:The intrauterine contraceptive device (IUCD) is a commonly used method of birth control that requires minimal skill and does not interfere with fertility once removed. It has been reported to produce inflammation and cervical cytopathology which can result in premalignant changes.

Objective: To determine the cytopathological changes among copper-containing IUCD and injectable contraceptive users at Aminu Kano Teaching Hospital.

Method: This was a comparative cross-sectional study, of two groups of 140 consenting women using the copper T IUCD and another 140 using the injectable contraceptive who came for follow-up after four weeks of insertion at the family planning clinic over a period of 10 weeks. A structured questionnaire was administered and information on socio-demographic data and contraceptive behaviour were obtained. A Pap smear was taken from the two groups and reported according to the Bethesda system.

Results: A negative smear with inflammation was found among 60(43.5%) women using the IUCD, compared to 31(22.8%) using the injectable contraceptive. Also, negative smear without inflammation was found in 76(55.1%) of the women on IUCD compared with 105(77.2%) on injectable contraceptives (p-value 0.012). Only 2(1.5%) of the women on the IUCD had low-grade squamous intraepithelial lesion, but none in the other group. Parity and duration of use for each of the methods had no statistically significant association with cytological findings in each of the groups (p-value 0.533 and 0.495 for parity and duration respectively). However, marital status had a statistically significant association with inflammatory changes (p-value< 0.001).

Conclusion: There were more inflammatory cytological changes among women using IUCD compared with those using the injectables.

Keywords: cervical cytopathology, intrauterine device, injectable contraceptives, comparative study

Background: Gestational gigantomastia is a rare disorder with unknown aetiology. It commonly occurs during the first and early second trimesters and mostly affects women during their second and third decades of life. The disease has been reported to be more common among Caucasians than Blacks and involves both breasts in 92% of cases. There are no standard treatment protocols for the disease, however, both medical use of bromocriptine and simple mastectomy have been applied.

Case summary: We present a case of 32-year-old un-booked female, G8P7+0, 7 alive, who presented with bilateral breast enlargement with ulceration at 25 weeks’ gestation. The diagnosis was confirmed by tissue biopsy and simple mastectomy was done and the pregnancy was allowed to continue to term. Conclusion: This case report describes the first case of gestational gigantomastia in our environment and the seventh case reported in Africa to increase our awareness on how to diagnose and rule out other causes of bilateral massively enlarged breasts during pregnancy and the treatment options for this distressing clinical condition.

Keywords: Breast, Bilateral, Gestational gigantomasti

Magaji OG1 , Annongu IT2 , Chia DM2 , Hameed M2 , Farate A3 , Angbalaga A1 , Bulus PU1

Background: Ear diseases and their associated problems are common presentations in clinics worldwide, but are seen more in developing countries. They are causes of morbidity and frequent hospital visits, thereby consuming many man-hours. There is limited literature regarding the burden of ear diseases among Africans, and Nigerians in particular. The advent of computed tomography (CT) and magnetic resonance imaging (MRI) have immensely changed the management pathway of hearing impairments, particularly in the developing world. CT has been shown to be useful for demonstrating the detailed anatomy and pathology of the temporal bone and its surrounding tissues.

Objective: This study aims to determine the clinical presentations and CT pattern of hearing impairments among patients that were referred for CT in the Radiology Department of an ENT hospital in Kaduna, Nigeria.

Method: The study is a twenty-four months’ hospital-based retrospective study at the Radiology Department of the National Ear Care Centre, Kaduna which is a mono-specialty referral centre for ear, nose and throat pathologies. CT of the petro-mastoid region was done for 117 patients as a result of hearing impairment. A retrospective analysis of request cards, duplicate copy of radiology reports, soft copy of their CT images and patients’ folders were considered. All patients with history of hearing loss from other causes were included.

Results: A total of 117 patients were recruited for this study, with a female preponderance. The most frequently affected age group were those within the 3rd decade of life. Ear discharge was the most frequent presenting complaint and mastoid opacification constituted the highest frequency of occurrence on CT followed by mastoid wall scleroses, but 5.9% of the CT images were normal.

Conclusion: CT findings, along with the clinical examination is a powerful diagnostic tool in the diagnosis of hearing loss and also provides sufficient information to the ENT surgeon regarding the extent of disease process, complications, and anatomical variants which may influence management.
Key words: clinical, computed tomography pattern, hearing loss

Ehwarieme Timothy A 1 and Awhim Blessing 2

Background: The prevalence of chronic renal failure (CRF) is becoming alarming among patients which necessitates management with dialysis. Objective: This study assessed the level of adherence to haemodialysis among chronic renal failure patients.

Method: A descriptive cross-sectional survey design was adopted in a sample size of 200 patients attending a nephrology unit in a tertiary hospital in Benin using a standardized instrument (ESRD-AQ) and a convenience sampling technique. Data obtained was analysed using descriptive statistics while hypotheses were tested using Chi-square and multiple logistics regression at 5% significant level.

Result: Majority 167(83.5%) have a poor level of knowledge, 147(73.5%) have a poor level of adherence. Financial constraints, lack of transportation, forgetfulness, and long waiting times were factors affecting adherence. Multiple logistics regression shows that respondents 18 – 30years are nine times (O.R. = 9.23; C.I. = 0.94-90.92) more likely to adhere than those who are greater than 60years, Males are 12% (O.R. = 0.88; C.I. = 0.40-1.90) less likely to adhere than females. Married patients are twice (O.R. = 2.40; C.I. = 0.65-6.39) more likely to adhere than those who are not, while respondents who are not educated are less (O.R. = 0.80; C.I. = 0.19-3.49) likely to adhere than those with college/university certificate.

Conclusion: participants in this study had low level of knowledge as well as low adherence. There is a need for a structured teaching/awareness programme on the importance of adherence to dialysis to motivate individuals who have CRF and improve adherence thereby reducing suffering and improving quality of life. Keywords: Adherence, Knowledge, Haemodialysis, Perceived factors, Chronic renal failure

Abdullahi Mohammed1 , Aliyu G. Ganiyu2

Background: The possible impact of high intake of dietary acid on pancreatic β-cells dysfunction and insulin resistance in type 2 diabetic patients has been suggested from previous studies; but findings across different study groups are conflicting. Objective: To determine the impact of dietary acid load on pancreatic β-cell dysfunction and insulin resistance in a group of patients with uncomplicated type 2 diabetes mellitus

. Method: Study subjects were categorized in to four quartiles according to their dietary acid intake. Assessment of dietary intake was done using a food frequency questionnaire and the Nigerian Food Composition Table. Acid forming potential of our local diets were estimated as Potential Renal Acid Load (PRAL) scores. Pancreatic β-cell function and insulin resistance were estimated as HOMA-β and HOMA-IR respectively. Results: Degree of pancreatic β-cells function was observed to be significantly lower in subjects in the highest quartile of the PRAL score (p for trend < 0.05). There was a statistically significant trend with higher intake of dietary acid associated with increased degree of insulin resistance (p for trend< 0.05). Dietary acid load was found to be a significant predictor of pancreatic β-cells dysfunction among the study subjects.

Conclusion: Among subjects with type 2 diabetes mellitus in this study, consumption of a diet loaded with high acid forming potential food items was associated with greater insulin resistance and lower insulin secretion ability. High intake of dietary acid might be an additive mechanism contributing to deterioration of glycemic control in type 2 diabetic patients in our setting.

Keywords: Dietary acid; Diabetes mellitus; Pancreatic β-cell functio

Background: Globally, head injury is a leading cause of morbidity and mortality among the young productive age group. Expanding Extradural haematoma is potentially a life-threatening condition, and could leave a surviving patient with a life-long disability. Usually, the clinical diagnoses supported by skull X-ray showing fracture are confirmed with Computed Tomography Scan (CT Scan) when available. When CT Scan is not available but all evidence is pointing towards an Extra Dural Haematoma, can one still go ahead with the Exploration?

Case Summary: We present a 27-year-old man with a 21-hour history of Motor Vehicle Accident, loss of consciousness, Lucid interval and right hemiparesis. No seizure or vomiting. Other systems were essentially normal. His Glasgow Coma Scale score was 10/15 (EO=2, BVR=3, BMR=5). He had Left-Sided Fixed Dilated Pupil (FDP). Skull X-ray revealed a left-sided comminuted fracture involving the temporal, parietal, and occipital bones. CT Scan was not available (non-functional at the time). Based on the clinical diagnoses supported by the fracture on the skull X-ray, he had an urgent Exploratory burr hole where Extra Dura Haematoma was found and evacuated. The postoperative period was uneventful.

Conclusions: The availability and functionality of CT Scans are still a problem in Low and Medium Income countries. Therefore, an Exploratory burr hole to diagnose an intracranial haematoma and its evacuation may be valid.

Key words: Head injury, Extradural Haematoma, Dilated pupil, Exploratory Burr hole.

Kefas Mari Mbaya1 , Abubakar Farate2 , Hassan Mohammed Dogo3 , Abba Bukar Zarami4 , Chubado Tahir1

Background: Carcinoma of the prostate is the most common cancer in Nigerian men but skin metastasis is infrequently encountered. Cutaneous metastasis is associated with poor prognosis and most patients rarely survive for more than one year from the time of appearance of skin lesion.

Case summary: We report a case of an 80-year-old man who presented with a history of recurrent nodular lesion of the right thigh for five years which later became ulcerated. The skin lesion was treated with wide local excision and split-thickness skin grafting. The patient refused bilateral orchidectomy; he was then treated with androgen deprivation therapy (ADT). The skin graft healed well after one month of surgery. Unfortunately, the patient died six months after the commencement of treatment from lung and liver metastases.

Keywords: Prostate cancer, Cutaneous metastasis, Long-term survival, Skin graft

Background: Obesity is a medical condition that is characterized by excess adipose tissue deposition and inflammatory state that result in poor health and changes in haematological parameters. Objectives: This study aims to evaluate pattern of changes in hematological parameters among obese and non-obese individuals in Sapele, Nigeria.

Method: This study was carried out at Central Hospital, Sapele, General Hospital, Oghara and Biomed Diagnostic Centre, Sapele in Southern Nigeria. 415 subjects with ages between 18 and 65years were enrolled for this study including 312 obese experimental subjects (comprising of 111 males and 201 females) and 103 non-obese normal control subjects (comprising 40 males and 63 females). 5.0mls of venous blood was collected from all subjects into EDTA container and Full Blood Count was determined using Sysmex XN330 automated haematology analyzer.

Result: Packed Cell Volume of the obese and non-obese individuals were 39.52±3.80% and 39.55±0.55% while obese and non-obese persons had total white blood cell count of 6.38±0.54 X109/L and 5.94±0.28X109/L respectively. Monocyte count of obese and non-obese individuals was 6.40±0.23X109/L and 5.14±0.18X109/L while Neutrophil-lymphocyte ratio (NLR) of obese and non-obese people was 1.57±0.21 and 1.18±0.05 respectively.

Conclusion: People with obesity had significantly higher values of monocyte count and NLR when compared to non-obese individuals while there was no significant difference in measured hematological parameters among obese and non-obese people in Sapele Southern Nigeria.

Keywords: Hematological, Parameters; Obesity, Sapel

Murtala Yusuf, 1,2 Aisha Aminu Sharif1

Background: Urethral stricture is an unnatural narrowing or loss of urethral compliance due to spongiofibrosis that leads to bladder outflow obstruction. Its management is still a great challenge in our region.

Objectives: To share our experience about urethral strictures managed in a rural tertiary health center in Nigeria. Method: Retrospective study of urethral strictures managed over 5-year period at a tertiary health center in Nigeria. Only Patients that had surgical procedures for urethral stricture with at least one post-op follow-up were included. Age, stricture characteristics, and treatment outcome were analyzed.

Results: Only 74 out of 91 patients have complete records, hence selected and studied. Their mean age was 49.66yr (±19.41), the principal symptom was a weak urinary stream (86.49%), with acute urine retention in 56.76%. Suprapubic cystostomy was done in 77.03%. The strictures were post-inflammatory (60.81%), Post-traumatic (27.03%) and recurrent (10.81%). The strictures were predominantly bulbar (55.41%). The median duration of symptoms to the time of presentation was 135days. Majority (55.41%) had anastomotic urethroplasty. Post-op complications were seen in 43.24%. Most patients (77.03%) had no significant lower urinary tract symptoms at a median (interquartile range) of 58days (37 to 135) postoperative period. There was a significant improvement in median international prostate symptom score at 6 weeks, 6 months, and 1 year after surgery compared to pre-operative symptoms.

Conclusion: Financial constraints, inadequate facilities and specialists are the major challenges. Increased patients’ health awareness, universal (free or subsidized) healthcare coverage may help in alleviating some of the challenges.

Keywords: urethral stricture, lower urinary tract symptoms, international prostate symptoms score, acute urine retentio