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

Otaniyenuwa Obarisiagbon, Andrew Obi

Adeyeye FM, Iseh KR, Aliyu D

Background: Epistaxis is a life threatening otorhinolaryngological emergency presenting as acute or chronic recurrent bleeds.

Objectives: The study was designed to evaluate the treatment modality used in managing patients with epistaxis in Sokoto.

Methods: It was a prospective hospital-based study involving 135 patients presenting with epistaxis to Usmanu Danfodiyo University Teaching Hospital (UDUTH). Information on treatment received, blood transfusion, hospital admission and length of hospital-stay were obtained.

Results: A total of 133 (98.5 %) patients were managed non-surgically, while 2 (1.5 %) patients received surgical intervention. Of those who received non-surgical treatment; 60 (44.4%) had anterior nasal packing, while 27 (20.0%) had endoscopic cauterization. Out of this, 25 (18.5%) had endoscopic chemical cauterization for bleeding in the Little`s area, retrocolumellar and septum, whereas 2 (1.5%) had bipolar cauterization for bleeding on the Woodruff`s plexus. Twenty (14.8%) patients had both anterior and posterior nasal packing, 15 (11.1%) had combined nasal pinching and ice pack, while 11 (8.2%) had posterior nasal packing only. Two (1.5%) patients had ligation of the internal maxillary artery (surgical intervention).Of all the patients presented, 22 (16.3%) required blood transfusion during their management and 43 (31.9 %) needed admission. The duration of hospital-stay ranged from 1 to 9 days with a mean of 5.7 ± 1.9 days.

Conclusion: Non-surgical intervention is the most common modality used in managing epistaxis in the study centre, with anterior nasal packing as the major method employed. In addition, some patients required blood transfusion and hospital admission.
Keywords: Epistaxis, Nasal packing, Blood transfusion, Hospital-stay

AB Zarami, A Kabir, SS El-Buba, UH Pindiga

Background: Unnatural death refers to premature death against the course of nature which results from homicides, accidents and suicides. The prevalence is rising worldwide and is considered one of the commonest causes of mortality. Among all the unnatural deaths in the western world, fire-arm death constitutes most of the cases and accounting for 4.43 deaths per 100,000 annually. In Nigeria, there is a paucity of data on unnatural deaths despite the rising incidence of deaths due to insurgency, banditry, kidnapping, political and ethnic crises, that prompted the need for this study.

Method: The study was a hospital-based, ten-year retrospective survey. Non-probability purposive sampling method was used from three selected hospitals in Borno State. All cases of unnatural deaths from the mortuary logbooks from 2009-2018 available were recorded along with the deceased demography. The results were analyzed using Microsoft Excel, 2010 and were displayed in a frequency table, bar charts and pie chart.

Results: There were 1,029(4.9%) cases of unnatural deaths during the study period (2009-2018). The unnatural death frequency peaked in 2014 with 260 (25%) cases. Gunshot death was the commonest and accounted for 387 (38%) cases. Road traffic accident and bomb blast were 2nd and 3rd with 291 (28%) and 196 (19%) cases respectively. Males were more affected than females by a ratio of 4:1. The age ranges were between 3 to 75 years. The commonest age group involved was 21-30 (34%) years. Most of the unnatural deaths occurred in urban [715 (69%)] than rural areas [(314 (31%)] cases respectively.

Conclusion: The study has highlighted an increased incidence of unnatural deaths in Borno state due to insurgency with gunshot fatality being the commonest cause of death. To the best of our knowledge, this is the first report of unnatural deaths during the civil unrest in Borno state. We suggest a community-based study to effectively plan for mitigation and prevention of unnatural death in Nigeria.
Keywords: Unnatural, Death, Insurgency, Borno State.

Ogbeyi Ofikwu Gabriel, Jenewari Atiye Joseph, Abah John Paul, Rimamnunra Grace, Ogbeyi Aba Francis

Background: Nigeria is one of the countries that have the least routine immunization coverage in the world. Morbidity and mortality caused by vaccine preventable diseases are very high in Nigeria. Immunization could be routine or supplemental campaigns. Routine immunization refers to the nationally scheduled regular administration of vaccine dosages to infants at specified ages. Children are usually taken to the health facility by their parents or care givers to receive age-appropriate doses of antigens.

Objectives: The aim of this study was to assess maternal characteristics such as knowledge, perception and practice and the immunization status of their children 0 to 5 years.

Methods: This was a cross- sectional study of rural cooperative women who had an index child of less than five years and were eligible. The 252 respondents were selected using computer generated numbers. A questionnaire was used to collect information on demography, knowledge, perception and practice of immunization.

Results: The mean age of the respondents was 27.98±6.45 and over 59% of the children were between 0-6 months. Over 86% had formal education, 96.0% were aware of routine immunization and 94.0% believed vaccines could prevent diseases. Eight-five percent took their children for immunization and 92.0% immunized their children at appropriate age. Awareness of routine immunization and took child for immunization all had statistically significant association with mothers’ education (p=0.05).

Conclusion: Routine immunization coverage in Nigeria is low. The results of this study had shown that mothers in Nigeria had improved in taking their children for immunization. This indicated that immunization uptake had also improved compared to previous reports.
Keywords: Children, diseases, education, immunization, prevention, Nigeria

Baduku TS, Sheyin J, Isa FB

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

Ibrahim HU, Farouk AG, Ahmadu MS, Usman AU, Mala MB, Ibrahim BA

Background: North-eastern Nigeria has the second-highest regional prevalence of sickle cell gene in the country after the South-west. This high prevalence has been believed to be sustained by the high rates of consanguineous marriages and intermarriages between the ethnic group in this region particularly the Kanuris and Shuwa Arabs. The dearth of data on splenic sizes among these patients living in this malaria-endemic sub-region. Narrative reports from the African region in general, have suggested that splenomegaly tends to persist to a comparatively much older age in these patients, attributed to the effect of recurrent malaria infection and/or hyperactive malarial splenomegaly syndrome.

Objectives: This study was aimed to determine the sizes of the spleen in children with homozygous sickle cell disease using ultrasonography and the variations that occur in advancing age, and to compare it with foetal haemoglobin levels (HbF).

Methods: Children with homozygous sickle cell disease aged 5-15 years, attending the Paediatric Haematology clinic of the University of Maiduguri Teaching Hospital (UMTH) were consecutively selected over six months. Demographic data, clinical details of previous crises and transfusions were recorded and had their foetal haemoglobin (HbF) quantified for all the subjects with the use of the Betke method of Alkali denaturation. Splenic sizes were determined using an ultrasound scanner (Aloka SSD 3500, Japan) with a 3.5 MHz sector transducer and ultrasound gel was used to optimize the image. A slightly lateral decubitus position during deep inspiration was used to expose the area of interest appropriately. Longitudinal size measurement was taken in the oblique plane between the most superior medial and the most inferior lateral borders of the spleen and the coronal size were determined along with the eleventh intercostal space. Values obtained was correlated with the height, a standard in assessing the longitudinal dimension of the spleen.

Results: A hundred and twenty children with SCA in steady-state were evaluated, comprising 59 boys and 61 girls. Their ages ranged from 5-15 years, with a mean of 10.1 ± 3.5 years. Autosplenectomy was seen in 12 (10%) of our patients who were seven years and above while seven (5.83%) had splenomegaly. The mean HbF of the total population studied was low 6.2% ± 0.98 and the difference in the mean HbF level of patients with autosplenectomy (6.6% ± 0.96) compared to those with splenomegaly (6.1% ± 0.54) was not statistically significant (p-value = 0.28)

Conclusion: The Foetal haemoglobin level was not significantly related to the presence or absence of splenomegaly in these children, although those with splenomegaly had lower mean HbF than those with autosplenectomy. It is recommended that early determination of HbF and possibly commencing hydroxyurea may improve the care of children with HSCD.
Keywords: Autosplenectomy, foetal haemoglobin, homozygous sickle cell disease, splenic size, ultrasonography.

Lawan M, Sulaiman MM, Shettima J, Yauba MS, Loskurima U

Background: Central venous catheterization is a common procedure done to access a large vein for obtaining blood in haemodialysis, monitoring of central venous pressure and administration of fluids and drugs. Complications such as malposition of the CVC may occur following catheterization. Case Summary: We report a case of a 12-year-old male child managed for end stage kidney disease who had malposition of CVC into the left internal jugular vein after left subclavian vein insertion.

Conclusion: Complications following CVC insertion are common. Real-time ultrasound guidance and post procedure chest radiograph are useful means for prevention and early detection of complications.
Key words: Malposition, central venous catheter, haemodialysis

Background: Tuberculosis (TB) remains a disease of public health importance owing to its contribution to morbidity and mortality. It is a chronic infectious respiratory disease that is vaccine preventable and therapeutically curable. Besides, TB is a leading cause of death across all age groups but worse among children. Malnutrition has been shown to be a common risk factor of childhood tuberculosis.

Objectives: The burden and treatment outcome of childhood TB was determined.

Methods: A retrospective study of childhood tuberculosis using purposely kept register at both the Emergency Paediatrics Unit (EPU) and the Directly Observed Treatment Short course (DOTS) centre of the Hospital. We included children aged < 18 years either admitted at the EPU or seen at the Paediatric and or General outpatient department of the Hospital from 1st January 2019 to the 31st December 2019, with presumptive TB and sent to the DOTS centre for treatment.

Results: The mean age of the children was 7.7±3.2 years. Childhood TB accounted for 88 (7.1%) of the 1243 EPU admissions and accounted for 25.2% of the TB cases managed at the DOTS unit in 2019. Of the 88 children, males were 49. More of the patients (84.1%) had pulmonary tuberculosis. Gene Xpert TB detection rate was 60.2%. Two - third (65.9%) of the cohort were successfully treated. One – quarter (26.1%) of the cases were loss to follow – up, while 8% died on treatment.

Conclusions: One quarter of the burden of tuberculosis at our facility occurred in childhood, and two – third had pulmonary affectation. Approximately two third of these study population were successfully treated. One quarter was loss to follow-up, while one out of every twelve died during the course of treatment.
Keywords: Burden, Childhood tuberculosis, Tertiary health facility, Outcome.

Aliyu Ibrahim, Hasiya T. Ismail, Lukman Femi Owolabi , Adesola Ogunniyi

Background: Stroke play a leading role in emergency admissions in developing countries and has contributed immensely to the huge financial burden to both the patient and the society especially in sub-Saharan Africa. Assessment of some routine acute phase biomarkers may aid in predicting mortality and functional outcomes in acute ischemic stroke.

Objectives: To assess the role of routinely estimated C-reactive protein (CRP), Erythrocyte sedimentation rate (ESR), and platelet count in predicting mortality and short-term functional outcomes among patients with AIS in Kano, North western Nigeria.

Methods: A case-control study where one hundred and twenty acute ischemic stroke patients and sixty age and sex matched healthy controls, were enrolled over a period of 10 months. Data on socio-demographic information and clinical characteristics were collected. Blood samples for acute phase biomarkers; C-reactive protein (C-RP), Erythrocyte sedimentation rate (ESR), and platelet count were collected and analyzed. The patients were followed up for 30-days and data on mortality and functional outcome using Modified Rankin Scale (MRS) was collected and analyzed using SPSS version 20.0 (IBM Armonk, NY).

Results: The mean age of patients and their controls were 61.9±11.8 years and 61.8±12.4years and were predominantly of female gender (cases, 70/120 vs controls, 35/60). The mean of CRP, ESR, and platelets count for the cases and controls were 77.6±23.7 mg/L vs. 6.3± 2.8 mg/L, 53.4±30.2mm/hr vs. 12.2± 8.1mm/hr and 182.5±19.1/µL vs 251.4± 53.8/µL respectively. NIHSS was shown to independently predict 30-day mortality (Adjusted HR 1.10; 95% CI:1.02-1.18), p=0.011) after AIS. Additionally, elevated SBP, DBP, NIHSS and C-RP were shown to be associated with a poor 30-day functional outcome.

Conclusion: The study showed that elevated levels of serum C-RP and ESR and a reduced platelet count predict higher mortality and poor functional outcomes in acute ischemic stroke. Assessment of some inexpensive routinely estimated acute phase biomarkers will guide therapy and help reduce overall mortality and improve short term functional outcomes in our resource-challenged environment.
Key words: Biomarkers, mortality, functional outcome, ischemic stroke

Systemic hypertension, affecting about one billion people worldwide, is the most prevalent modifiable risk factor for cardiovascular diseases and related disability. Secondary hypertension is a common problem among young adults. Case Summary: We report a case of a 23year old man who presented to the emergency room with 8-month history of progressive general body weakness preceded by numbness and paraesthesia initially involving the left then the right lower limbs with family history of hypertension. Blood Pressure was 150/80mmHg.His serum potassium was 1.6mmol/L (Normal range 3.0-5.0) other electrolytes, urea and creatinine were normal. Urinary potassium was 215mmol/24hr (Normal range < 20mmol/24hrs). A diagnosis of severe hypokalaemia in a hypertensive patient with Liddle’s syndrome was made. He was commenced on oral Moduretic (contains Amiloride and hydrochlorothiazide because Amiloride or triamterene only formulation is not available) and intravenous potassium replacement.

Conclusion: Our index case is a 23year old young man known hypertensive who presented with quadriparesis and spontaneous hypokalaemia with family history of hypertension. The likely cause of his hypertension and hypokalaemia is Liddle’s syndrome, however plasma aldosterone concentration, plasma renin activity and genetic studies were not available for us to confirm this diagnosis. Even though this form of hypertension is rare, there is a need for a high index of suspicion for it by the clinicians whenever hypertension is diagnosed in a young individual especially in Maiduguri, Nigeria which have a high prevalence of renal impairment among young individuals’ majority of whom have background hypertension.
Keywords: Hypokalaemia, Liddle’s syndrome, Quadriparesis, Secondary hypertension, Systemic hypertension

Gowri Balakrishnana, Janani Anand Kumar, Jaganbabu Palaniappan, Karthik Shunmugavelu

Mandibular tori are usually asymptomatic bony protuberances present unilaterally or bilaterally. They are formed by dense cortical bone externally and covered with a thin layer of poorly vascularized oral mucosa. They usually present as a very slow and progressive growth that can stop spontaneously. Treatment is not usually advocated unless it hinders prosthetic treatment or if any complication occurs.
Keywords: Mandibular tori, Asymptomatic, Bilateral

Usman Muhammad Ibrahim, Hafsat Umar Sani, Mustapha Zakariyya Karkarna, Abubakar Mohammed Jibo, Musa Muhammad Bello, Auwal Umar Gajida, Abba Ahmed Danzomo, Muktar Ahmed Gadanya

Background: Caffeine being the major component in the energy drink is known to produce some negative effects and therefore its abuse may result in significant public health challenges.

Objectives: This study aimed to determine knowledge, attitude and practice of energy drinks consumption among undergraduate students of Bayero University Kano, Northwest Nigeria.

methods: A descriptive cross-sectional study design was used to study 381 undergraduate students selected using a two-staged sampling technique. Data were collected using interviewer administered questionnaires. The SPSS version 21 was used for data analysis with a p- value of = 5% considered statistically significant.

Result: The age of the respondents ranged from 17 to 49 years with a Mean± SD of 23.1±3.6years. The majority of the respondents were Muslims (91.6%). More than one-quarter (31.0%) of the respondents were studying health-related courses in the University. Up to 13% of the respondents had satisfactory knowledge of energy drinks while 79% had negative attitudes towards energy drink consumption. The knowledge of energy drinks consumption was found to be significantly associated (p<0.05) with sex, residence, sponsorship and influence on choice. The practice was significantly associated with sex, faculty and influence on choice. Further, the attitude was significantly associated (p<0.05) with age, sex, tribe and influence on choice.

Conclusion: The majority of the respondents had unsatisfactory knowledge and practice of energy drinks and negative attitude towards its consumption. The government should ensure strategies that can promote healthy consumption of energy drinks.
Keywords: Prevalence, energy drinks, knowledge, attitude, practice

Yauba MS, Sulaiman MM, Farouk AG, Mustapha Z, Abdurahaman A, Mbititng HW

Background: Measurement of the length and width of the kidneys using ultrasound scan is used to evaluate its rate of growth and the extent of kidney affectation by disease. Renal growth correlates well with somatic growth and is influenced by changes in the age, nutritional status and disease. Knowing renal size in relation to age and body size of a child will help to detect deviation from normal especially in diseased conditions that causes enlargement or reduction in renal size.

Objectives: To determine the renal size of normal children by ultrasonography and correlation of renal size with age of the children.

Methods: The data for renal size (renal length), sex and age of 404 children aged 1 month to 14 years were obtained. The (bipolar) lengths of both right and left kidneys were measured with ultrasonography by a sonographer. The age and sex each child was recorded in a preformed proforma. The weight was measured in the Children Outpatient Department (COPD) of State Specialist Hospital Maiduguri, Borno state using a standard weighing scale.

Results: Four hundred and four (404) normal children aged 1 month to 14 years had abdominal ultrasound scan (USS) done. Their mean age was 7.9 (± 4.2 SD) years. There were 208 (51.5%) females and 196 (48.5%) males with female to male ratio of 1.1: 1. The mean age of females was 7.8 ± 4.2 SD while that of males was 8.0± 4.2 SD. There was no significance difference in their mean ages; p=0.494. There was rapid increase in the renal length in the first year of life and there was no statistically significant difference (p=0.50) in the mean renal length between males and females. There is good correlation between age and right renal length (r = 0.680) but low correlation (r = 0.290) between age and left kidney.

Conclusion: There was rapid increase in the renal length in the first year of life and there is good correlation between age and renal size.

Dalhat Salahu, Alhassan Mohammad Datti

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

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

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

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

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

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

Alhassan Datti Mohammed, Adesope Saheed, Salahu Dalhat

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Ibrahim UM, Ibrahim RJ

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

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

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

Jibo AM, Abulfathi AA, Iliyasu Z

Lamaran Makama Dattijo, Mahmud Abdulwahab, Ayyuba Rabiu

Auwal Umar Gajida, Idris Usman Takai, Emmanuel Ajuluchukwu Ugwa, Murtala Yusuf

Yekeen Ayodele Ayoola, Ismail Olayemi Ayanbisi, Adah Bonny Ejeh, Okezie Ejeagba, Adamu Adamu, Henry Ifeanyichukwu Okolie

Musa Muhammad Babandina, Idris Nasir Abdullahi, Anthony Uchenna Emeribe, Halima Ali Shuwa, Lawal Olayemi, Peter Omale Musa

Tukur MA, Gali RM, Mshelia DS, Geresis RY, Numan AI, Medugu JT

Stephen Agbomhekhe Ogah

Ahmadu MS, Luntsi G, Umar UH, Farate A

Nasiru Raheem, Dauda W Wadinga, Haruna A Nggada, Jesini Ngamdu

Umar UH, Yunusa DM, Farate A, Bakari AA