O. Ariyo, B. O. Olaniyi, O. D. Onojade and F. S. Oladipo

Background: Knowledge and attitude of health workers affect caregivers’ infant feeding practices. However, information on the knowledge and attitudes of health workers in private hospitals is lacking. This study was designed to assess the infant feeding knowledge, attitude, and personal experiences of health workers in private hospitals in Ibadan, Nigeria. This cross-sectional study involved sampling of 108 consenting health workers of registered private health facilities offering ante-natal care services in Ibadan North communities of Oyo State, Nigeria. Data were collected using a semi-structured questionnaire including the socio-demographic characteristics, knowledge, and attitude of infant feeding practices. Knowledge was assessed using a 19-point scale categorized as good (≥13) and poor (<13). Attitude was assessed using a 65-point scale, categorized as good (≥33) and poor (<33). Data were analysed using descriptive statistics at p<0.05. Eighty five percent of the health workers were female, 51.9% were aged 21-30 years, 48.1% were married, and 25.9% were degree holders. Only 47.2% had attended infant feeding training recently, 57.0% had good knowledge and 53.0% had good attitude. Only 30.6% knew early initiation of breastfeeding, and 30.6% knew continued breastfeeding up 24 months and beyond. Just 49.1% considered breastfeeding in public non-embarrassing, and 33.3% agreed that infants less than six months should not be given water. There is evidence of limited knowledge and poor attitude towards the recommended infant feeding practices among the health workers in private health facilities in Ibadan. Periodic training on infant feeding for health workers in private health facilities is hereby recommended.

Key words: Exclusive breastfeeding, early initiation, private hospital, personal experience

Raji S.O., Ismaila A.I., Amina S.M., A. Adam.

Introduction: Hajj and Umrah are the main pilgrimages recommended in the Islamic faith to be performed at least once in a lifetime by those who have the wherewithal. It is one of the largest mass gatherings worldwide. 1 Muslims all over the world (over 180 countries) visit the Great Holy Mosque in the city of Mecca to perform the prescribed religious rites of the main pilgrimage (Hajj) which spans the second week of the twelfth month (Zul-hijja) of the Islamic lunar Calendar. The lesser/minor pilgrimage (Umrah) can be performed at any time of the year. Most hujajs (pilgrims) from outside Saudi Arabia perform Umrah and Hajj in a single journey (tamatui). Some faithfuls also perform the lesser pilgrimage (Umra) in the last ten days of the month of Ramadan (9 th month of the Islamic lunar calendar) due to the additional merits and blessings of this last third of the fasting month and additional opportunity of performing other meritorious and rewarding acts of worship such as i'tikaf (seclusion) in the Great Holy Mosque.

Umweni A.A, Otaren N.J.

Background: Although digit sucking is normal in infants and young children, prolonged duration of these habits might have consequences for the developing orofacial structures and occlusion. It is advisable to intercept the habit between the ages of 4 and 7 years. We report the case of a 9 year old boy who presented with a history of chronic digit sucking habit with associated hyperkeratosis/hyperpigmentation of the left cheek from repeated mechanical trauma from his left ring finger while he sucked his left index and middle fingers. The lesion is about 5mm in diameter. Full orthodontic assessment of the patient was carried out and habit breaking appliance instituted after counseling mother and child. Occlusal problems were reversed after habit cessation. Six months after breaking the habit, the hyperkeratosis/hyperpigmentation of the left cheek was still present even though it is reduced. This is an unusual finding in a child with chronic digit sucking habit.

Umar H.U., Mohammed L.M., Farouk A.G., Mustapha Z.

Background: Spondylocostal dysostosis (Jarcho-Levin Syndrome) is a rare congenital abnormality of spines and ribs which usually presents with trunk dwarfism, scoliosis, and respiratory symptoms. Its occurrence can be sporadic or familial. The clinical characteristics are vertebral abnormalities of hemivertebrae, butterfly vertebrae, scoliosis and variable rib abnormalities. Imaging is critical in its evaluation and management. Case Presentation: A 4-day-old child of a non-consanguineous couple delivered with swelling at the back. The family history was unremarkable for congenital anomalies. Clinical examination and radiological findings was consistent with spondylocostal dysostosis. Conclusion: Spondylocostal dysostosis is a rare musculoskeletal abnormality. Imaging plays a vital role in its diagnosis. An early diagnosis is necessary to prognosticate and institute appropriate management.

Key words: Spondylocostal dysostosis, Jarcho-Levin, Hemivertebrae , Rib anomalies, Congenital scoliosis.

Muhammad A.S., Aminu M.B., Dattijo L.M., Oluwagbemiga U.O., Ezugwu O.P.

Background : Fibroids are benign neoplasms of the uterus arising from smooth muscle. They are also termed uterine leiomyomas. It is the most common growth found in the female reproductive system and may undergo malignant transformation in less than 1% of cases to form leiomyosarcoma. Fibroids may present with abnormal uterine bleeding and pelvic pressure symptoms. Fibroid polyp can be a cause for concern especially if it grows so large to cause symptoms of obstructive uropathy. Thus, the patient may present with dysuria, anuria, or even necroturia as seen in our patient. Case summary: We present a case of 40-year-old P 5 + 0, A 3 lady, whose last childbirth was 10 years before presentation. She presented with 3 years history of recurrent vaginal bleeding, dizziness, and a mass protruding through her vagina. Her packed cell volume was 14%. She was fully investigated and upon catheterization, nectroturia was observed. She was counselled and had vaginal polypectomy. Conclusion: Necroturia associated with uterine fibroid polyp is a rare occurrence, hence physicians should have a high index of suspicion when evaluating patients with necroturia.

Baba M.M., Buba F., Talle M.A., Garbati M.A, Abdul H., Mairari F.G.

Background : Human immunodeficiency virus-infected patients are at increased risk of cardiovascular diseases compared with the general population, and right ventricular systolic dysfunction is said to be associated with poor outcomes. We therefore assessed right ventricular systolic function using tissue Doppler-derived tricuspid lateral annular systolic velocity (S`) among HIV-infected patients on highly active antiretroviral therapy (HAART). We evaluated its relationship with viral load and cd4 cells count. Methods: The study was a cross-sectional conducted among HIV-infected patients receiving HAART at the Federal Medical Centre, Nguru, Yobe State, Northeastern Nigeria using tissue Doppler-derived tricuspid lateral annular systolic velocity (S`). Results : One hundred and seven (107) subjects were recruited into the study comprising thirty-seven (34.6%) males and seventy (65.4%) females. Ninety-six (89.71%) had preserved right ventricular systolic function (RVSF) while 11(10.28%) had reduced RVSF. The mean CD4 cells count of patients with preserved RVSF and those with reduced RVSF were 838.37±27.50 and 301.66±12.38 respectively (P = <0.001). Similarly, the mean viral load of patients with preserved and reduced RVSF were 547.90±10.75 and 10293.00±74.67 respectively (P = <0.001). Pearson Correlation analysis between CD4 cell count and S` revealed a positively significant relationship (r = 0.894, P = < 0.001); while the relationship between viral load and S` was negative but significant (r = -0.879, P = < 0.001). Conclusion: The prevalence of right ventricular systolic dysfunction among patients with HIV on HAART was found to be 10.28%. There was a positive and significant correlation between the parameter of RVSF (tissue doppler derived tricuspid lateral annular systolic velocity) with CD4 cell count and a negative but significant correlation with HIV viral load.

Keywords: Right ventricular systolic function, Tissue Doppler derived lateral tricuspid annular systolic velocity (S`), CD4 cells, viral load.

Kwari SD, Chama CM, Gadzama GB

Background: Asymptomatic bacteriuria (ASB) is a common medical complication of pregnancy and may be associated with acute pyelonephritis, preterm labour and delivery, intrauterine growth restriction (IUGR), low birth weight (LBW), anaemia, hypertension and long-term renal dysfunction. Routine screening and treatment of ASB in pregnancy are recommended. Objectives: This study determined the prevalence, common organisms implicated, their antibiotic sensitivity pattern and the foetomaternal outcome of pregnant women with ASB. Methods: We conducted a prospective study at the Department of Obstetrics and Gynaecology, University of Maiduguri Teaching Hospital (UMTH), Maiduguri, Nigeria. One hundred and fifty pregnant women attending antenatal booking were consecutively recruited. We collected demographic and clinical information. A clean catch midstream urine specimen was collected for culture and sensitivity. The women were followed up to delivery and foetomaternal outcome were obtained. Results: The prevalence of ASB was 22%. Escherichia Coli was the most predominant organism isolated in 45.4%. Nitrofurantoin (90.9%), Ceftriaxone (87.8%) and Co-Amoxiclav (84.8%) showed the highest activity against the isolated microbes and were resistant to Ampicillin (87.9%) and Cloxacillin (79.7%). ASB is associated with an increased risk for UTI (P-value = 0.001), pyelonephritis (0.002), anaemia later in pregnancy ( ? 0.001), preterm delivery ( ? 0.001), low birth weight ( ? 0.001) and admission to SCBU (0.023). Conclusion: The prevalence of ASB is high and associated with significant maternal and perinatal morbidity. We recommend screening all pregnant women attending antenatal clinics for ASB and appropriate treatment given.

Key words: Asymptomatic bacteriuria, pregnancy, prevalence, foetomaternal outcome, urine culture, Nigeria.

Usman AU, Natalia A, Ibrahim DM

Background: Elective surgeries include procedures done to correct non-life-threatening medical problems as well as to alleviate conditions causing psychological stress or other potential risks to patients. This study described the pattern of elective Gynaecologic surgeries conducted in Obstetrics and Gynaecology department of Aminu Kano Teaching hospital, over a five-year period. Objective: To describe the pattern of elective gynaecologic surgeries conducted in Obstetrics and Gynaecology Department of our hospital over a five-year period. Methods: A retrospective study of all elective surgical procedures conducted at the Obstetrics and Gynaecology department of Aminu Kano Teaching hospital from 1st September, 2012 to 31st August, 2017 was conducted. Theatre operation register and gynaecological ward admission records were retrieved and reviewed. Information extracted include: age of patient, indication for the surgery, type of surgery conducted, nature of procedure (minor, intermediate and major), the cadre of surgeon and assistant(s) performing the surgery and the type of anaesthesia used for the surgery. Results: The total number of elective gynaecologic surgeries conducted over the study period was eight hundred and two (802) accounting for 19.4% of all surgical procedures. Uterine fibroid was the commonest indication for surgery with myomectomy being the commonest surgical procedure performed constituting 181(30%) of all gynaecologic operations. Hysterectomy was the second commonest procedure 115 (19%) indicated most commonly by uterine fibroids 53(46%). Conclusion: This study demonstrated 19.4% prevalence of elective gynaecological procedures in our centre. Consultants are the leading surgeons in most of the procedures and a significant association was found between the nature of the procedure and the cadre of surgeon. There is need to strengthen the postgraduate training of Resident doctors by exposing them to more hands-on training on major procedures.

Key words: Elective, gynaecological surgery, procedure

Background: Children with epilepsy are considered to be at an amplified risk for injuries as compared to the general population. The increased risk may occur directly as a result of the seizure or due to other comorbid conditions that predispose to injuries. Objectives: This study aimed to determine the frequency and the pattern of seizure-related injuries in children aged 0-17 years with epilepsy seen at the University of Benin Teaching Hospital, (UBTH), Benin City, Nigeria. Methods: Consecutive cases of children with epilepsy seen at the Paediatric Neurology Clinic of UBTH, Benin-City over a period of 6 months were evaluated for injuries in the preceding 12 months using a structured questionnaire. Results: A total of 119 respondents were involved in the study, 50 (42.02%) sustained an injury at some point in the preceding 12 months. Participants in the middle socio- economic class had more seizure-associated injuries (n = 25, 59.5%), compared to those in the low socio-economic class (n = 20, 42.0%) and high socio-economic class (n = 5, 18.5%); P = 0.003. Seizure-related injuries were associated most with generalized seizure (50.5%) when compared with focal seizures (14.3%) P = 0.001. Among the subjects, a tonic-clonic seizure was the most common subtype of generalised seizure (p =22.306, p = < 0.001). The commonest seizure-related injuries are skin bruises (35.1%), followed by soft tissue lacerations (22.8%). Strong association between epilepsy-related injuries and compliance to anti-epileptic drugs (AEDs) were noted. Conclusion: Children with epilepsy are at higher risk of injury and this risk is modified by some factors like socioeconomic status, seizure type, and compliance with medication

Key words: Seizure, Children, Injuries, Epilepsy

Usman B, Abubakar AM

Background: Ventriculoperitoneal shunt (VP–shunt) is one of the easiest and most common ways of treating hydrocephalus worldwide. Common post-operative complications include shunt malfunction (obstruction, disconnection, fracture), infection of skin and hardware, exposed/extruded shunt, calcification and per anal extrusion. Objectives: A 5-year retrospective review of all complications observed among infants with VP Shunt in our centre. Methods: The study period was between July 2017 and June 2022. Extracted data included: Demographic data on the Age and sex at presentation, type of Hydrocephalus, and the observed complications. Results: Forty-six infants comprising 32 (70%) boys and 14(30%) girls had VP Shunt, with ages (number) of < 1 month (26.1%), 1 – 6 Months (43.5%), and 7 – 12 Months (30.4%). Types of Hydrocephalus were congenital (A. S. in 13, NTD associated in 18) and acquired (post meningitis in 13, IVHP in 2). Complications were observed in eight (17.4%), consisting of 6(75%) Males and 2(25%) Females, with M: F of 3:1. Complications among the eight (8) patients include: Shunt Obstruction (50.0 %), Shunt Disconnection (12.5 %), Shunt Infection (50.0 %), Skin Infection (25.0 %), Shunt calcification ( 12.5 %), Exposed Shunt( 12.5 %), Extruded Shunt (12.5%), Per anal protrusion (12.5 %) and Death (25.0 %). Conclusions: Outcomes were very good, with few manageable complications.

Keywords: Children, Complications, Hydrocephalus, Infants, VP – Shunt

Husain Yahya

Background: Background: Lichen planus (LP) is a chronic inflammatory papulosquamous autoimmune disease which predominantly affects the skin but may also affect mucous membranes and nails. It is commoner in adults and occurs in all races. Reports about LP from northern Nigeria are scanty. Objective: To report the relative prevalence, duration, clinical presentation, and outcome of treatment for patients with LP seen over 20 years. Methods: Retrospective review of records of patients diagnosed with LP in two dermatology clinics in Kaduna, Nigeria from September 2001 – August 2021. Results: Of 39,037 patients with new skin disease, 335 (0.9%) were diagnosed with LP: mean age 37.6 years (range 5 -81), 11.3% < 18 years and 55% < 40 years, male- female ratio 1:1. The median duration at presentation was 8 weeks (75% = 16 weeks). The lower legs (65%), lower arms (61.2%), abdomen (31.6%), upper arms (29%), upper back (28.1%), lower back (27.2%), chest (22.4%) and thighs (21.5%) were the most frequently affected sites. The oral mucosa, penis and nails were affected in 6, 9 and 2 patients only. Itching (97%), hyperpigmentation (26.6%), and Koebner’s phenomenon (23%) were also present. Classic LP accounted for 88.1% while hypertrophic LP (12.5%) and annular LP (6.3%) were other variants, some patients with multiple variants. Just over 7 % of patients had previous disease (median interval 7 years). Hepatitis C virus antibody was positive in 6.2%. All patients were treated with topical steroids but 45% required oral prednisolone. On follow-up, LP had resolved in 79.4% of patients. Conclusion: Lichen planus affected a younger population, presented in a classic way in most patients, affected the oral and other mucosae much less frequently and responded well to topical and systemic steroids.

Key words: Lichen planus, clinical presentation, Kaduna-Nigeria

Abdullahi MA, Kabir MA, Mustapha MI, Mamuda AA, Shamsudeen MB

Background: Symmetrical peripheral gangrene (SPG) is a rare clinical entity leading to ischemic necrosis of extremities. We report a case of SPG in patient brought into the orthopaedic clinic of Aminu Kano Teaching Hospital (AKTH), Kano, two days after applying a beautification substance called Henna. Case Summary: We report a case of a 28-year-old lady who presented at the emergency department of AKTH with a complaint of extreme pains in both hands and feet. The patient noticed a gradual darkening of the fingers and toes two days after applying the Henna, associated with severe pain at rest. She was thoroughly evaluated and examined for other possible risk factors or illnesses, but none was found. The patient was counselled and she subsequently consented to amputation. The gangrenous parts of the digits of her fingers and the tarsometatarsal of her feet were amputated bilaterally and the procedure was carried out successfully. Conclusion: To our knowledge, this is the first case report of symmetrical peripheral gangrene occurring after routine application of Henna as a beautification agent. No other possible risk factor was identified. We highlight the possibility of a beautification agent (Henna) as a causative factor of SPG. Thus, women should be careful of the mixtures in Henna that could lead to SPG.

Key words: Symmetrical, Bilateral, Gangrene, Henna, Amputation

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

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

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

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

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

5. Chief Editor,Annales Africaines de Medecine.

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

7. University of Exeter.

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

9. London School of Medicine and Tropical Hygiene.

10. Editor-in-Chief,Curationis.

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

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

13. Executive Editor,Eastern Mediterranean Health Journal.

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

15. Director of Publication,Mali Médical.

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

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

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

19. ManagingEditor,East African Medical Journal.

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

21. University of Winchester.

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

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

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

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

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

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

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

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

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

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

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

Keywords: General surgery, laparoscopy, Private Hospital, Abuja

Oyediji FJ,Mpyet CD

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

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

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

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

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

YahyaH.

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

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

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

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

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

BadukuTS, YusufA,ThompsonM.

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

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

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

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

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

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

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

IbrahimBA,AkuhwaRT,AdamuAI, IbrahimHU,AliyuI

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Key words: Emotional disorders, sickle cell disease, Nigeria

Rabiu A, Getso HA, Mahmud A

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

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

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

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

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

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

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

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

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

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

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

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

Timothy A. Ehwarieme1 and Anwuli Emina2

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

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

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

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

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

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

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

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

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

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

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

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

Keywords: Femur; Mosaicoplasty; Osteochondritis

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

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