Archive 2012 - No 2

Introduction: HIV/AIDS is by far the most prominent emerging infectious disease, causing unsurpassed morbidity and mortality than its peers. Free ART was introduced by World Health Organization as part of universal access to ART. Despite this, patients still incur out-of-pocket expenses when accessing it.

Objective: To assess the additional out-of pocket expenditure incurred annually by patients receiving free ART in a Tertiary Health Facility.

Method: A cross-sectional descriptive study involving 85 HIV positive patients receiving free ARTS at Ahmadu Bello University Teaching Hospital, Nigeria. Respondents were selected by simple random sampling. Data was collected using standard structured interviewer-administrated questionnaire. SPSS statistical package was used for data analysis.

Result: Most of the respondents (45.6%) are in the 30-39 years age group and are mostly females (65.9%) residing in Zaria (51.8%). They visit the clinic at least once a month, spending money on feeding, transportation, substitute labour, non-ART drugs, among others. On average, such expenditure amounts to $200.52 annually, while their average annual income is $1751.98. There was a statistically significant association between monthly income and occupation in respondents who feel regular clinic2 attendance is difficult to sustain financially (X = 45.682, df 30, P=0.033).

Conclusion: HIV/AIDS patients receiving free ARTS incur significant out-of-pocket expenses while accessing treatment. There is need for the program to move beyond free ARTS and introduce some financial relief such as Government subsidy and an 'AIDS Allowance' for the patients (especially the low income ones).

Background: Tuberculosis is endemic in developing countries but has re-emerged as a public health issue with the coming of Human immunodeficiency virus infection even in the developed world. Objective: To compare the detection rates of Mycobacterium tuberculosis in sputum specimens between Ziehl-Neelsen staining technique and Fluorescent microscopy.

Methods: It was a retrospective study carried out from between June 2010 and May 2011 in a tertiary health centre in North-eastern Nigeria. In the first six months (June 2010-November 2010) detection of Mycobacterium tuberculosis was done using the Ziehl-Neelsen (ZN) staining technique and in the last six months (December 2010-May 2011) detection was by Fluorescent-Auramine technique of Mycobacterium tuberculosis.

Results: One thousand four hundred and eighty six (1486) patients were used, with 764(51.4%) females and 722 (48.6%) males. Sixty nine (10.6%) were positive for Mycobacterium tuberculosis using the Ziehl Neelsen method while 122 patients (14.4%) were positive for Mycobacterium tuberculosis using the Fluorescent Microscopy method p=0.029.

Conclusion: The six months comparison of the two methods (ZN and FM) showed that the detection rates of acid- fast bacilli in sputum specimens had increased from 10.6% to 14.4 % respectively which is statistically significant.

Background: Testicular torsion is one of the commonest urological emergencies affecting adolescents and young adults worldwide. Favourable outcome depends on severity and timely intervention. Delayed presentation, missed diagnoses and prolonged reaction time are associated with high testicular loss due to gangrene while the reverse is associated with high testicular salvage rate.

Materials and Methods: We retrospectively reviewed all cases of testicular torsion in University of Maiduguri Teaching Hospital [UMTH] between January 2008 and December 2011. Information was obtained from clinical notes and laboratory investigations.

Results: A total of 56 patients were studied. The age ranged from 11-35 years with a mean of 23+ 17.5 years. Majority (91%) of the patient were in their second and third decades. Most, 41 (73.21%) presented during the cold harmattan season (November to February). Only 11 (19.64%) presented within golden 4 hours from onset of symptoms, 30 (53.56%) between 4 to 24 hours while 15(26.79%) presented beyond 24 hours. Twenty-two (39.29%) had scrotal exploration within 4 hours of presentation to the emergency unit, while 26 (46.43%) within 4 to 12 hours, and 8 (14.29%) had delay beyond 12 hours. The study found associated anomalies in the torted testes which includes horizontal lie 9( 13.85%), long mesochium 5(7.69%), hydrocele 4 (6.15%), and 1(1.54%) each of hernia, varicocele, atrophy and patent processus vaginalis. There was no mortality and morbidity was limited to minor surgical site wound infection.

Conclusion: High index of suspicion, prompt and adequate intervention were associated with high testicular salvage rate.

Background: Intrauterine contraceptive device is effective, reversible and long term contraceptive method that is widely used in our environment with high acceptability and continuation rate. Objective: To determine the socio-demographic characteristics of acceptors and their experience with Intrauterine contraceptive device [IUCD] in University of Maiduguri Teaching Hospital [UMTH].

Methodology: This was a retrospective study of acceptors of intrauterine contraceptive device (IUCD) at the family planning unit of the University of Maiduguri Teaching Hospital during thest period 1st January 2008 to 31 December 2008.

Results: A total of 1273 new contraceptive acceptors were seen at the family planning clinic during the study period, of which 710 (55.77%) women accepted and were given IUCD as a contraceptive method. Women aged 20-29 years comprised 45.8% of the acceptors and 96% of them were married. Grandmultiparous women constituted 43.24% and over 32% of the women had no formal education. Up to 70.98% of the acceptor used IUCD for child spacing and the commonest reason for discontinuation was the desire for pregnancy (5.21%). After a year, the continuation rate was 61.7% and the failure rate was 1.3% and all the pregnancies were intrauterine. In conclusion, the socio-demographic characteristics of IUCD acceptors are similar to previous studies but the level of education of the clients is lower. It is an effective contraceptive with high acceptability and continuation rate.

We report a 46 year old woman who developed isolated right hypoglossal nerve palsy two weeks after traditional uvulectomy. Radiological and other general haematological investigations were normal. Isolated unilateral hypoglossal nerve palsy is rare. Thorough physical examination and meticulous investigation is advocated where available

Hepatocellular carcinoma is a common malignancy, however skin metastasis is rare. We report a 65years old male farmer, who presented with a recurring anterior chest wall mass, of several months duration. He had an ulcerated, spontaneously bleeding exophytic tumour on his anterior chest wall, over the lower sternum and upper abdomen. Histologic diagnosis was metastatic hepatocellular carcinoma. The case serves as an example that unusual presentations can occur for hepatocellular carcinoma, necessitating a thorough preoperative assessment of cases presenting similarly.