109-bomj-vol16no2

M Okoh, JE Enabulele

Garbati MA, Mubi BM, Gali RM, Jidda BU, Mshelia DS

Background: Most publications on disturbance of thyroid function among patients with drug resistant tuberculosis (DR-TB) have focused mainly on the effects of treatment with second line drugs. Some patients with newly diagnosed DR-TB are likely to have disturbed thyroid function at baseline. These groups of patients need to be actively looked out for in order to institute appropriate therapy to prevent further deterioration.

Methods: This is a prospective review of thyroid function on patients newly diagnosed with RifampicinResistant TB/Multidrug resistant TB (RR-TB/MDR-TB) who underwent baseline thyroid function test (TSH, T3 and T4) at the University of Maiduguri Teaching Hospital (UMTH) between January 2016 and December 2018.

Results: Sixty-two patients were diagnosed with RR-TB, 58% of them were females, with ages ranging between 16 and 70 years. Forty-seven (75.8%) were aged between 20 and 49 years. The baseline results showed that 77.4% were euthyroid, while 16.1% had one form of thyroid disorder or another; Nonthyroidal illnesses (NTIs) were reported in 6.5% of the study population. Of the 16.1% of results that indicated presence of thyroid disorders, 60% were hyperthyroid, 10% had subclinical hyperthyroidism, 20% subclinical hypothyroidism and only 10% were hypothyroid.

Conclusion: Determination of baseline thyroid function in newly diagnosed patients with DR-TB is vital to identify patients with baseline thyroid dysfunction. This will guide proper intervention before commencing second line anti-TB medications that are known to affect thyroid function. Follow-up thyroid function tests, especially among those with hyperthyroidism will show the effect of thionamide therapy and whether they progress to develop any alterations in the reported parameters.

Background: Bacterial infections are the most common cause of postoperative endophthalmitis with gram positive bacteria accounting for most cases. The flora of the eyelids and conjunctiva are the most frequent source of infection. Knowledge of the conjunctival bacterial flora is therefore important to provide an informed choice of appropriate antibiotics for postoperative prophylaxis in patients undergoing cataract surgery or other intraocular surgeries.

Objectives: To determine the bacterial normal flora of the conjunctiva and their antibiotic sensitivity with a view to determine the appropriate choice of prophylactic postoperative antibiotic in patients undergoing cataract surgery in Maiduguri.

Materials and Methods: This was a prospective cross-sectional study conducted on adult patients scheduled for cataract surgery at the University of Maiduguri Teaching Hospital and the State eye hospital Maiduguri from February 2018 to October 2018. Surgery was either small incision cataract surgery (SICS) or extra capsular cataract surgery (ECCE) with lens implantation. The sample included one hundred eyes of one hundred patients

Results: A total of 95 eyes of 95 patients was analysed. The patients were between the ages of 18-85 years with a mean age of 58.11+- 12.3 years, with a male to female ratio of 1.1:1. Positive bacterial cultures were found in 31 (32.6%) of the patients and negative cultures were found in 64 (67.4%) of the patients. In 28 (90.3%) of the patients the bacteria cultured were gram positive while in 3 (9.7%) the bacteria were gram negative rods. The commonest bacterial isolate was Staphylococcus epidermidis, isolated in 14 (45.2%) patients followed by Staphylococcus aureus in 13 (41.9 %). Ciprofloxacin was the most sensitive (93.3%) antibiotics tested followed by chloramphenicol (87.5%),

Conclusion: The commonest bacterial isolate was Staphylococcus epidermidis, followed by Staphylococcus aureus. Ciprofloxacin was the most sensitive antibiotic tested followed by chloramphenicol

Background: Publication of a scientific research in a peer-reviewed journal is one of the most common written means of disseminating of findings which is of importance to all researchers. However, it is also an area that often present challenges, and can result in disagreements among researchers, especially regarding the choice of journal for publication Objective: To determine the factors influencing journal publication choice among University of Benin lecturers.

Methods: This prospective cross-sectional study was conducted among lecturers across the thirteen (13) faculties in University of Benin, Benin City. Data collection tool was a nineteen (19) item, selfadministered questionnaire which elicited information on demographic characteristics, human determinant of journal publication choice and factors influencing journal publication choice. Six (6) of the questions were demographic characteristics which assessed age, sex, status, experience, faculty and department of participants. One question which assessed the human determinants of journal choice was a semi-structured question containing both closed and open-ended response options. The remaining twelve (12) questions assessed factors influencing the journal choice. The responses were scored as irrelevant = 1, less important = 2, important = 3 and extremely important = 4. The mean and standard error of mean were computed for each variable to determine the most ranked factor.

Results: A total of 53 lecturers who have worked between 1 and 38 years compromising 39 (73.6%) males and 14 (26.4%) females from 33 departments of all the 13 faculties were studied. The journal choice is mainly a sole decision (66.0%) of the principal investigator. Prestige, promotion and journal impact factor were the three most ranked factors in journal publication choice. The ranking of the factors was not influenced by sex, faculty, academic status, and years of experience of the participants.

Conclusion: Data from this study revealed that journal choice is mainly a sole decision of the principal investigator and the factors that influenced the choice were prestige, promotion and journal impact factor. Nation-wide study is highly recommended

Background: Hypertension has been identified as the leading risk factor for mortality, and is ranked the third leading cause of disability-adjusted life-years. Men are generally at greater risk for cardiovascular and renal disease than age-matched premenopausal women. Our study aimed to determine the variation in blood pressure control between male and female hypertensive patients receiving care in a Nigerian tertiary hospital.

Method: The study was a cross-sectional study of consecutive hypertensive patients receiving care at the Federal Medical Centre Nguru Yobe State Nigeria from June 2016 to December 2016. A prevalidated questionnaire was used, and controlled hypertension defined as blood pressure of less than 140mm Hg systolic and less than 90mm Hg diastolic was determined based on a blood pressure reading at the time of consultation.

Results: Two hundred and ninety-one (291) participants comprising 134 (46%) males and 157 (54%) females were consecutively recruited. Two hundred and thirty-eight (81.7%) were hypertensive, while 53 (18.2%) had hypertension and diabetes. The mean age of the participants was 56.15 ± 12.72. Males were older than the females (60.11±11.63 and 52.78±12.68, p value<0.001). Mean systolic blood pressure was comparable in males (135.97±23.40) and females (139.81±24.79) participants (P = 0.17). However, the females had a higher diastolic blood pressure than males (84.52±12.58 vs 81.42±12.51, p=0.03), uncontrolled hypertension was documented in 172 (59.1%) participants. The rate of hypertension control did not differ between males and females (44.8%vs 37.6%, p=0.213).

Conclusion: The rate of uncontrolled hypertension was high among the participants. Women were found to have a significantly higher diastolic blood pressure compared to the male counterpart however, there was no significant difference in systolic blood pressure between the male and female subjects. Age, body mass index and eGFR independently predicted uncontrolled hypertension.

Background: The shortage of radiotherapy services in Nigeria has led to tremendous suffering for breast cancer patients across the country. The aim of this study is to explore the effect of distance on the care of breast cancer patients in Nigeria.

Materials and Methods: This was a retrospective study of breast cancer patients from 1st January 2003 to 31st December 2012 in University College Hospital (UCH), Ibadan. Data obtained included biodata, disease features and follow-up information using a structured questionnaire. Univariate, bivariate and multivariate statistics was used to analyse the data.

Results: We studied 504 breast cancer patients. The mean age of the patients was 47.7 (±10.6) years, late presentation with symptoms beyond 3 months was seen in 88.1% while advanced stage disease was seen in 58.7% of patients. Patients that lived at distances within 50 km and beyond 50 km from UCH, Ibadan were 74 (14.7%) and 430 (85.3%) respectively. Majority of the patients 87.3% completed treatment, however, 94.8% of patients treated during the period discontinued follow-up care at the end of the study. The reasons for discontinuation were “death”, “financial constraints” and “referred back to distant primary surgeon after treatment” accounting for 90 (18.8%), 230 (48.1%) and 158 (33.1%) respectively. The factors affected by distance were socioeconomic status [OR=2.9; 95% CI=1.42-6.01], bilateral breast cancer disease [OR=14.22; 95% CI = 7.32 – 27.620], left breast disease (OR=11.45; 95% CI = 5.89 – 22.62) and reasons for discontinuing follow-up care: financial constraints [OR=2.0; 95% CI =0.9 – 3.2], and referred back to primary breast surgeon [OR=3.0; 95% CI =1.3 – 6.0].

Conclusion: Long distance and shortage of functioning radiotherapy centres in Nigeria are critical challenges for breast cancer treatment, leading patients to late presentation with advanced disease and poor compliance with follow-up care. Therefore, more centres should be built in each state to minimise these challenges.

Background: This study was undertaken to compare the effect of two surgical techniques of cataract extraction on corneal endothelial cell density in eyes of Nigerian adults with uncomplicated age-related cataract with the view to improving surgical visual function and quality of life.

Materials and Methods: It was a prospective randomized non blinded hospital based interventional study. Two hundred and seventy-seven (277) eyes of 269 eligible patients with cataract were randomized to either manual small incision cataract surgery (MSICS) or conventional extracapsular cataract extraction (ECCE). The endothelial cell density (ECD), Coefficient of variation (CV), and Hexagonality (%) were measured pre-operatively, at one, four and twelve weeks post-operatively with a non-contact specular microscope (CSO SP 02). Statistical analysis – Data obtained were entered into microsoft Excel and analyzed using SPSS version 16 software.

Result: Of the 277 eyes studied, 263 (94.9%) were analysed. The mean age of patients for MSICS and ECCE was 64.03 (SD + 11.2, range 40 – 95 years) and 62.69 (SD +10.48, range 42 – 94 years) respectively. The Male to female ratio was 1.9:1, in the two study groups. Pre-operatively, corneal parameters (mean ECD, CV and hexagonal cells) were similar between the two surgery groups. Postoperatively cataract surgery induced a mean endothelial cell density loss of 5.31% at one week, 7.28% at 4 weeks and 7.06% at 12 weeks in the study population. There was no statistically significant difference in the mean endothelial cell density loss between MSICS and ECCE groups.

Conclusion: Both MSICS and ECCE induced fairly equal moderate and reversible degree of endothelial cell density loss in adults with uncomplicated age related cataract.

Background: Malaria still remains the leading cause of morbidity and mortality among children in Nigeria. The initial decrease in the global burden of uncomplicated malaria reported by World Health Organization in 2014 was lost; presently 80% of cases of Malaria reported in the world are in the sub-Saharan African region in which Nigeria is the most populous country. In the insurgency-infested north eastern Nigeria, effort at reduction of malaria cases has not only stagnated but the gains have been reversed. Objective: To determine the burden of severe malaria during the period of high transmission in a region infested by insurgency.

Materials and Methods: We retrospectively reviewed all the records of children admitted with malaria into the paediatric wards of the specialist hospital in 2017, at the peak of malaria infestation. Rapid assessment kit was used to make the diagnosis of malaria. Children with packed cell volume of less 15% transfused with blood were recorded.

Results: Of the 2,316 children admitted, severe malaria constituted 1832 (79.1%), of which 104 (5.7%) died. About a quarter (23.4%) of these children had blood transfusion.

Conclusion: Malaria infestation was high especially in the latter half of the raining season; there is need to have a multi-pronged and coordinated strategy to halt this ugly trend and ensure qualitative blood transfusion services in the community during this peak period.

Background: The significance of recovery time and adequate postoperative analgesia for day case surgery has led to various trials of drug combinations in other to get the benefit of both early recovery with prolonged postoperative analgesia. Various intravenous analgesic agents in combination with propofol has been tried in an attempt at finding the ideal drug combination for short surgical procedures.

Objectives: This study compared the recovery time and time of first request for postoperative analgesia of two drug combinations: propofol-ketamine and propofol-fentanyl used as the sole anaesthetic agents for short surgical procedures in adult’s day case surgery.

Methods: One hundred and eight adults aged 18 to 50 years of either gender with ASA physical status I or II scheduled for elective short surgical procedures were randomly allocated into group K and F, comprising of 54 patients each. Group K received propofol-ketamine while group F received propofol-fentanyl for induction and maintenance of anaesthesia. Vital signs were recorded at the time of induction, maintenance and recovery. Recovery time was assessed using Steward Recovery Score. Postoperative analgesic requirement was assessed based on pain score using the Verbal Rating Scale.

Results: Demographic and clinical characteristics such as age, sex, weight, duration of surgery and types of surgical procedures used were comparable between the two groups. Recovery time was prolonged in group K compared to group F (p=0.01). Time for first request of postoperative analgesia was found to be significantly shorter in group F (p=0.01).

Conclusion: Both propofol-ketamine and propofol-fentanyl combinations produced effective postoperative analgesia and appreciable recovery time for daycase surgery. While Propofol-fentanyl has a shorter recovery time, Propofolketamine has a longer period of postoperative analgesia.

Background: The existence of calculi in the urinary tract are well known urological conditions. A giant bladder calculus is one weighing more than 100g and is a rare finding in present-day urological practice.

Case summary: The patient is a 58-year-old man who presented with a 20year history of progressive irritative Lower Urinary Tract Symptoms (LUTS) associated with poor stream which improves with change in posture. He had episodes of intermittent painful terminal haematuria and pyuria with occasional fever. About three months to his presentation, he developed progressively worsened constipation. He also had weight loss and anorexia. On examination, His vital signs were normal. There was a suprapubic mass about 6cm above pubic symphysis, smooth surface, hard, mobile and bi-manually palpable. The prostate was not enlarged on digital rectal examination. His Abdominopelvic ultrasound scan and KUB revealed a giant bladder calculus with bilateral hydronephrosis. Urine Microscopy, Culture and Sensitivity (M,C,S) showed numerous red blood cells, pus cells, and cultured Klebsiella spp sensitive to Ciprofloxacin. Serum Electrolytes, Urea and Creatinine were normal. He was treated for Urinary tract infection then had cystolithotomy. Intraoperative findings were a giant bladder calculus, thickened bladder wall and hyperaemic bladder mucosa. The bladder mucosal biopsy revealed chronic inflammation on histology. The calculus weighed 1000g. Post-operative recovery was uneventful, the catheter was removed and the patient was discharged home 2 weeks after surgery with resolution of all lower urinary tract symptoms. He had remained symptom-free in his last follow up visit which was 1year post operation.

Conclusion: A giant bladder calculus is a rare finding in contemporary urological practice.

Jidda MS, Amodu M, Victor CO, Abdu W, Wakil MA

Background: Suicide is the second leading cause of death among youths aged 10-24 years worldwide. Suicidal ideation, therefore, represents a growing global public health issue among youths and adolescents. Exposure to psycho-trauma due to Boko Haram conflict puts the adolescent in especially difficult circumstances that predisposes them to a range of mental health challenges including suicide.

Aim and Objective: The aim of the study is to assess the rate of suicidal ideation and attempt and the significant variables associated with these phenomena.

Methodology: A cross sectional study with stratified sampling techniques was used to recruit a sample of 300 secondary school adolescents. Data was extracted using the BDI and BSI.

Results/ Discussion: A total of 300 students were recruited into the study with a mean age of 16.5 years and SD (2.3). 52.3% were females. 40.7% have been directly exposed to violent acts of terrorism. 28% report suicidal ideation and 1.3 have attempted suicide. Spearman’s rank correlation was run to determine the relationship between the level of depression and suicidal ideation. There was a moderate positive correlation between the degree of depression and suicidal ideation which was statistically significant (rs=0.413; p=0.0001).

Conclusion: There is a high rate of exposure to psycho-trauma and suicidal ideation among adolescent students in Maiduguri. Targeted intervention to assist this demographic is relevant to the postconflict reconstruction effort to be designed by the national health system. Key

Sulaiman MM1, Shettima J2, Lawan M1, Loskurima U1, Ummate I1, Pindiga UH3

Ahmadu MS, Farouk AG, Ahidjo A, Tahir A