BoMJ vol17no1

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January - June 2020
Volume 17 | Issue 1

This journal has been online since Saturday, April 05, 2013

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Dose Fractionation Schemes for Palliative External Beam Radiotherapy on Painful Bone Metastasis from Breast Cancer

Hassan Ibrahim, Usman Bello

Background: The efficacy of palliative external beam radiotherapy (PRT) for relief of metastatic bone pain had been well established, a single fraction is as effective as multiple fractions in relieving bone pain, but variation exist among the radiation oncologist in our environment on the ideal dose per fraction regimen.

Methods: We retrospectively reviewed data from breast cancer patients treated with PRT using linear accelerator for metastatic bone pain in University College Hospital Ibadan between 2005 and 2009. The extracted information includes bio-data, presenting symptoms, metastatic sites, and bone pain assessment before and after four weeks of PRT using visual analogue pain scale (VAS), radiation doses, fractionation numbers and number of re-irradiation.

Results: There were 161 eligible breast cancer patients who were treated with PRT secondary to painful bone metastases between 1st January 2005 and 31st December 2009. Majority were females with only 1.2% male patients (Figure 1). Table 1 showed demographic characteristics of treated patients with mean age of 45.2 years, pain was the major presenting complaint (92.5%) and multiple bony metastases constituted the highest metastatic presentation (52.2%). Table 2 shows patient’s responses to PRT treatment for pain relief (complete responses of 88.8% and 11.2% partial responses). No significant association between patient’s responses to PRT and magnitude of radiation doses delivered. However, fractionation sizes were significantly associated with re-irradiation p-value < 0.05.

Conclusion: No differences exist between various dose fractionation schemes in terms of relief from painful bony metastases. However, shorter dose fractionation schemes are associated with re-irradiation of previously irradiated sites.




Anterior Tibial TuberosityAvulsion: A Case of Late Diagnosis

Dabkana Theophilus Maksha, Nyaku Titus Friday

SUMMARY: Avulsion fracture of the anterior tibial tubercle (ATT) results from an abrupt traction of the patella tendon mostly occurring in adolescent males. Early diagnosis is critical for proper patient management. We report a case of an 18-year-old male student with a sixteen months history of pain in the anterior aspect of the right knee and inability to fully extend the right knee following injury sustained while playing football. The patella tendon was not palpable when the knee was extended, with a palpable bony mass floating below the patella. Lateral X-Ray of the right knee showed a triangular bony mass below the lower pole of the Patella. A diagnosis of an anterior tibial tuberosity avulsion was made




Knowledge and awareness of undergraduate university students towards eye donation in north-west, Nigeria: a cross-sectional study

Monsudi KF, Abubakar IB, Ayodapo AO, Ribadu DY

Background: Corneal blindness still remains a large contributor of childhood blindness in Africa. Corneal transplant is a sight saving procedure that is still lacking in most of African countries despite the first successful corneal transplant in 1905 by Dr. Eduard Zirm. The cornea eye bank and transplant procedure in Nigeria is still in the infancy stage despite Federal Government of Nigeria acknowledged the need for an eye bank and promulgated the decree No. 23 titled Corneal Grafting Decree 1973.

Objectives: To assess the level of knowledge and awareness on eye donation among the undergraduate students of Kebbi State University of Science and Technology.

Methods: A cross-sectional study was undertaken among undergraduate university students, using a pre-tested, self-administered questionnaires. Information on the socio-demographics, the participants’ knowledge and willingness to donate eye was obtained. The questionnaires were analyzed using SPSS version 20.

Results: Of 281 participants, 157 (55.9%) were males and Muslim 204 (72.6%). Few students 59 (21%) were willing to donate their eyes after death, while131 (46.6%) were not willing to donate their eye because of their religious belief. Ninety-three (33.8%) of the students support eye donation. Television was the main 94 (33.5%) source of information about eye donation.

Conclusion: The knowledge and awareness of eye donation among the students was low. Furthermore, majority were not willing to donate their eye mostly because of their religious belief. Health education on eye donation is needed to increase the uptake of eye donation among population




Giant Dermatofibrosarcoma: A case report

Ogah SA, Fadahunsi OO, Awelimobor D, Adeyemi OW, Agu EE, Ajiboye OO

SUMMARY: Dermatofibrosarcoma Protuberans (DFSP) is a rare skin tumour with high recurrences. World Health Organization report has shown it to be a slow growing, nodular neoplasm of intermediate grade malignancy that is found almost exclusively in the dermis from where it often invades the subcutaneous tissue. It is more common in adults than children, in blacks than whites and on the trunk than other parts of the body. Management is challenging due to its propensity to recur after local wide excision and for this reason, it is believed that combining either wide local excision with Mohs micrographic surgery or adjuvant chemotherapy or radiation therapy may reduce its recurrence. In this follow up case report, we present a 53year-old man who had wide local excision of his recurrent facial DFSP 14months post-surgery. His past medical history has shown that the man has had this tumour excised 13 times in other hospitals prior to his first presentation to us 14 months ago. In multiple recurrences with previous surgical scars in which free margin is doubtful as noticed in our case, adjuvant radiotherapy will be of benefit. This was recommended to the patient during his first surgery but could not have it done due to some logistics reasons




Self-reported prevalence of missing teeth and unmet prosthetic treatment needs among a population of Nigerian undergraduate students

Omo JO, Enabulele JE

Background: Tooth loss is an indicator of the oral health status of the population. In developing countries, missing tooth/teeth replacement constitutes a high unmet dental need. Missing tooth/teeth among undergraduate student is a cause for concern.

Objective: This study was designed to assess the self-reported prevalence of missing teeth and unmet prosthetic needs among university undergraduate students.

Methods: Data for the study was collected by means of a self-administered questionnaire. The questionnaire consisted of 3 sections: the first section sought demographic information, the second section consisted of 5 questions that tried to find out the missing teeth status of the respondents and the third section tried to find out prevalence of missing teeth and the unmet prosthetic needs of the respondents. Data obtained was analyzed using IBM SPSS version 21.0. Descriptive statistics (frequencies and counts), cross-tabulations as well as Chi square were used to analyze the data.

Result: More than half (64.1%) were females while 67.3% were between 16 and21 years of age. The prevalence of missing teeth among the respondents was 38.3% with missing anterior teeth making up 56.1%. Of the respondents who had missing teeth 60.5% had a form of replacement for their missing teeth bringing the unmet prosthetic need to 39.5%. There was a statistically significant association between tooth missing and replacement status with a higher proportion (66.3%) of anterior teeth being replaced. There was no statistically significant association between missing teeth and gender, age group, marital status, faculty of study and level of study.

Conclusion: The prevalence of missing teeth and unmet prosthetic need was high, highlighting the need for oral health education and increased awareness of the possible prosthetic rehabilitation procedures available for replacing missing teeth.




Recurrent transverse lie in an Arcuate Uterus: A Case Report and Literature Review

Okonkwo Susan Gana

Arcuate uterus is a mild form of uterine anomaly that may go unnoticed during a reproductive life of a woman. While it is shrouded in controversy in categorization and diagnosis, studies have shown that arcuate uterus is associated with Endometriosis. Arcuate uterus is rarely associated with reproductive failure. However, malpresentation, preterm birth and miscarriages have been found to be associated with arcuate uterus. Transverse lie is a presentation commonly associated with uterine anomalies. The uterine cavity distortion and reduction in capacity seen in arcuate uterus may explain the increase incidence of Transverse lie as demonstrated in the case report




Comparative Analysis of Psychiatric Morbidity of Women with Infertility and Those Attending Family Planning Clinic in a Tertiary Facility in North-East Nigeria

Hauwa Ahmed Kudale, Aishatu Yusha’u Armiya’u, Lubuola Issa Bamidele

Background: Infertility is a major life crisis often associated with mental health consequences. It is particularly relevant in African setting including Nigeria where women are largely blamed for the cause of infertility with its attendant shame, guilt, anxiety and hopelessness.

Objective: The aim of this comparative study was to assess and compare psychiatric morbidity of women with infertility and those who attend family planning clinic.

Methodology: This descriptive cross-sectional study was done using consecutive sampling technique to select 400 women in each group of those attending fertility and family planning clinics. Data were collected using semi-structured socio-demographic questionnaire, self-administered General Health Questionnaire-12 and Hamilton Depression and Anxiety Scale after matching the groups by their age, marital status and years of education.

Results: The study found 37.6% of those who attend fertility clinic to have met HADS cut off score for depression as against 6.8% of the family planning clinic attendees. Similarly, for anxiety subscale; a high proportion of infertile group (40.3%) met anxiety cut off compared to those who attend family planning clinic. In the same manner, attendees of the fertility clinic significantly experienced high rate of psychiatric morbidity (52.9) on the GHQ compared to those attending family planning clinic (32%).

Conclusions: This study revealed that Nigerian infertile women seeking treatment are exposed to several mental health consequences such as anxiety and Depression amongst others with devastating effects on the mental health and well-being of the infertile women. Consequently, a comprehensive biopsychosocial intervention should be integrated into the overall management of infertility to improve their quality of life and chances of conception




Association between maternal lipid profile and gestational diabetes mellitus

Jibrin BI, Akaba GO, Isah. AY, Dalili MS, Ekele BA

Background: Dyslipidemia is the third component of metabolic syndrome and is a well-known cardiovascular risk factor. However, the association of dyslipidemia with gestational diabetes mellitus is still a subject of ongoing research in Nigerian obstetric populations.

Objective: To determine the relationship between second trimester maternal fasting plasma lipid constituents and gestational diabetes mellitus.

Methods: This was a prospective nested case-control study that enrolled 288 pregnant women out of which 36 women with GDM (cases) where matched with 72 without GDM (controls) following results of oral glucose tolerance testing and plasma fasting lipid profiles done between 24-28 weeks. The patients were followed up until delivery to document maternal and fetal outcomes. Data was analyzed using Statistical Package for Social Sciences (SPSS). Categorical variables were presented in percentages while continuous variables were expressed as means (±Standard Deviation). Student t-test and Chi-square test or Fishers exact test were used for comparing variables between the two groups. A p-value of <0.05 at 95% confidence interval was considered statistically significant.

Results: The overall mean plasma lipid levels for the four lipid constituents in the study population were 187.9mg/dL, 163.5mg/dl, 49.1mg/dL and 108.1mg/dL for TC, TG, HDL-c and LDL-c respectively. The mean plasma triglyceride was significantly higher in cases compared to the controls: 187.0±67.7mg/dL vs. 151.7±66.4mg/dL, (p = 0.01). Abnormal triglyceride was significantly associated with GDM (AOR: 4.8, 95% CI (1.6-14.4), (p= 0.005).

Conclusion: Maternal dyslipidemia (abnormal triglyceride) was shown to be significantly associated with GDM in this study and it appeared to be causally related




Changes in Corneal Endothelial Cells Following MSICS VERSUS Conventional ECCE in a Tertiary Eye Hospital in North Western Nigeria

Saudatu M Umar, Murtala M. Umar, Mansur Rabiu, Mahmoud B Alhassan, Victoria Pam


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.



  Ease of Laryngeal Mask Airway Insertion – Comparison of Propofol versus Thiopentone and Lignocaine in Adult Patients
Samuel Isaiah Nuhu, Gabriel Adanu Ajogwu, Henry Yammoh Embu, Erdoo Suckie Isamade

Background: A patient is required to be fully relaxed and airway reflexes should be adequately suppressed to allow for smooth insertion of a laryngeal mask airway (LMA).Propofol and a variety of other induction agents and their combinations have been tried to ease its insertion. The use of cheaper alternatives in our environment is highly desirable.

Aims and objectives: To compare the ease of insertion of LMA in patients given propofol alone versus thiopentone with lignocaine, as well as assessing the cost effectiveness of these agents in our hospital setting.

Methods: This is arandomised single blind prospectivestudy carried out in a Public Tertiary Academic Health Institution. Sixty-four ASA I and II patients equally randomized into 2 groups scheduled for short (not lasting more than one hour) elective gynaecological, orthopaedic, urological and general surgical procedures were recruited into this study. Patients were premedicated with fentanyl intravenously and pre-oxygenated for five minutes. This was followed by an induction dose of either (group A) or a sequence of lignocaine and (group B) given by a trained assistant. With the patients in the sniffing position, LMA insertion was attempted immediately after induction of anaesthesia by the anaesthetist (researcher) who observed the ease of LMA insertion using presence or absence of adverse airway responses to LMA insertion such as coughing, gagging, laryngospasm, head and limb movement or inadequate jaw relaxation. These responses were graded as; no response, mild response, moderate response and severe response. Overall assessment of the ease of LMA insertion was then done combining these graded adverse airway responses as; excellent if there were no adverse airway responses, good if responses were mild, satisfactory if responses were moderate and poor if responses were severe with additional anaesthetic required to allow LMA insertion.

Results: The average age in group A was 36.5±14 whereas in group B it was 38.7±05 with the p=0.493.There were 22 (56.4%) male patients in group A compared to 17 (43.6%) male patients in group B with p=0.528; whereas, there were 10 (40.0%) female patients in group A compared to 15 (60.0%) female patients in group B with p=0.326. Excellent LMA insertion were observed in 28 (87.5%) patients in group A compared to 27 (84.4%) patients in group B (P= 0.893); Good LMA insertion in 2 (6.3%) patients in group A compared to 1 (3.1%) patient in group B (p= 0.564); Satisfactory in 2 (6.3%) patients in group A compared to 4 (12.5%) patients in group B (p= 0.655).

Conclusion: Thiopentone together with Lignocaine provided optimum conditions for laryngeal mask airway insertion comparable to that provided by propofol alone.




Socio-demographic and Nutritional Assessment of Under five Children in Benue State North Central Nigeria

Ogbeyi Ofikwu Gabriel, Ochoga Martha Omoo, Afolaranmi Tolulope Olumide, Ajeh Anthony

Background: Globally, malnutrition is a major public health concern. Under nutrition in Nigeria is a long standing problem since independence and the magnitude is on the increase. This is so because food consumption both in quantity and quality has decreased considerably due to unemployment and other harsh economic conditions.

Objectives: The study aimed at assessing the socio-demographic and Nutritional status of under- five Children in Benue State North Central Nigeria.

Methods: A cross sectional survey was conducted using quantitative data collection methods. The study involved interviews using questionnaires for socio-demographic variables, immunization, breast feeding practices and anthropometric measurements. Data were analyzed using SPSS version 21. Ninety five percent confidence interval was used while a p-value of ≤ 0.05 was considered statistically significant.

Results: Two hundred and twenty three under five children and their mothers were assessed for nutritional status using selected and sensitive anthropometric methods. The results showed that children with mothers/caregivers without formal education had weight and height 36.4% and 70.5% below normal respectively. Mothers with income less than twenty thousand per annum had children with height 53.3% below normal while those earning above twenty thousand naira per year had weight 41.0% and height 62.9% below average respectively. Furthermore, children without appropriate immunization for age had 29.9%, 53.2%, and 36.9% below normal for weight, height and mid upper arm circumference respectively. There was a statistically significant relationship between weight, height and mid upper arm circumference with the age of children (p=0.00, 0.002, 0.001 respectively) with respect to their nutritional status.

Conclusion: The nutritional need of a child is complex. There is need for proper nutritional education




Glomerular Filtration Rate in Homozygous Sickle Cell Disease children in Steady State and Healthy Nigerian Children: A Comparative Study in north-eastern Nigeria

Farouk AG, Ibrahim BA, Sulaiman MM, Asheikh MM, Yusuf H, Musa AH

Background: Homozygous sickle cell disease (HSCD) is the most common inherited blood disorder of public health importance worldwide, with Sub-Saharan Africa accounting for a third of the global burden. The effect of HbS on the kidneys results in sickle cell nephropathy, which contributes to increased mortality among HbSS patients beyond third decade of life. Glomerular filtration rate (GFR) is an important renal function test for evaluating progress of sickle cell nephropathy, however, this is seldom done to HbSS patients especially in the insurgency that devastated the North-eastern part of Nigeria, where displacement of people has led to increase in diarrhoeal diseases with its complications which also contributes to renal diseases, hence the need for this study.

Objective: To determine the baseline glomerular filtration rate of homozygous SCD in steady state and compare same with normal controls.

Methods: This is a prospective comparative study conducted at the University of Maiduguri Teaching Hospital (UMTH). The study population consisted of age and sex matched HbSS subjects in steady state and children with haemoglobin AA genotypeaged 3-14 years. The study was conducted over a period of 6 months. Anthropometry and serum creatinine of the subjects were determined and GFR calculated using Schwartz formula.

Results: Two hundred and twenty children consisting 110 HbSS and 110 controls were enrolled. This consist of 106 males and 114 females with M:F ratio of 0.9:1. Mean ages of HbSS patients and HbAA subjects were 8.2years and 7.9 years respectively. The mean GFR (SD) was 125.9 (31.9) ml/min/1.73m2 and 93.0 (16.1) ml/min/1.73m2 for the HbSS and HbAA controls, the difference between the means was significant (P<0.001). The normal GFR range for the controls was 77 to 109 ml/min/1.73m2. Sixty-seven (61%) casesand 86 (78%) controls had GFRs within normal range. There was statistically significant difference for GFRs above and below the normal range (Z-score=6.2 & -2.9, p<0.001 & p<0.004).

Conclusion: About a third of HbSS children in steady state have elevated GFR, this suggests the presence of moderate renal pathology. Regular monitoring of these children will lead to improvements in management of sickle cell nephropathy and their quality of life




Duration of Breast Feeding and Outcome of HIV-Exposed Infants seen at a Tertiary Health Facility in Sokoto

Yusuf T, Jega MR

Background: Appropriate infant feeding is still a challenge to HIV-positive mothers especially in the developing world despite their desire to breast feeding beyond the WHO recommended 12 months’ duration.

Objective: To determine the duration of breast feeding and correlate with outcome of HIV-exposed infants in UDUTH, Sokoto.

Methods: This descriptive observational study was conducted among HIV-exposed infants attending Paediatric ART(PMTCT) clinic, UDUTH, Sokoto. The demographics, infant post-exposure prophylaxis, duration of breast feeding and results of early infant diagnosis (EID) of the infants using HIV-DNA PCR machine; and maternal highly active antiretroviral therapy (HAART) history were documented. The data were analyzed using SPSS version 24.0. A p-value of ≤0.05 was taken as significant.

Results: One hundred and sixty-three HIV-positive mother-infant pairs were studied, 103(61.7%) of the HIV-positive mothers were aged 25-34 years, 105(62.9%) were of lower socio-economic class and 94(56.3%) had informal education. One hundred and fifteen (62.5%) were on TDF/3TC/EFV and 143 (85.6%) were on HAARTs prior to the index pregnancy. One hundred and sixty-three of the HIV-exposed infants studied were breast-fed and 165 (98.8%) had nevirapine as infant PEP. The mean duration of breast feeding among HIV-exposed infants was 13.2(±3.5) months with a range 6 – 20 months. Ninety-eight (60.1%) infants were breastfed beyond 12months. All the HIV-exposed infants were not infected at the end of breastfeeding for 12 months or more.

Conclusion: Majority of the HIV-positive mother’s breastfed beyond WHO recommended 12 months and their infants were uninfected. This may support the upward review of the duration of breast feeding of HIV-exposed infants in our community




Lateral Ventricle Epidermoid Cyst Presenting with Right Hemiparesis and Blindness: A Case Report and Review of Literature

Mohammed B, Zarami AB, Usman B, Pindiga UH

Summary:Epidermoid cyst of the CNS is rare, slow growing, benign neoplasm derived from the remnant of neural tube. It accounts for 0.2% of all intracranial neoplasms. Intraparenchymal and lateral ventricles are the rarest sites within the CNS. The lesion is asymptomatic at the early stage but later may present with mass effects and cranial neuropathies. We present our index case of a 23year old male who presented late with a rare lateral ventricle epidermoid cyst associated with calcification resulting to left hemiparesis and blindness. The excised tumour mass aggregate was 11cm and weighed 15g. This is an index case in our region. Lateral ventricle epidermoid cyst is a rare neoplasm that may mimic neurocysticercosis, choroid plexus papilloma and dermoid cyst at both clinical and imaging levels. The treatment of choice is surgical excision; however, there is recurrence rate of 33%with increased chances of chemical meningitis. Nevertheless, the tumour rarely transforms to squamous cell carcinoma.


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Written by Administrator On Sunday, 24 March 2013 17:23
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