Sulaiman H., Gadzama D.A., Jibril M.B.

Background: Community participation is a process where community members come together to identify and plan how to solve their needs. It is thought that community participation in primary health care will result in more accessible, relevant, and acceptable services which will in turn result in better health outcomes and patient satisfaction. This study sought to determine the level of community participation in Ward Development Committee from the perspectives of the committee members, Healthcare workers and community members. Objective: to evaluate the extent of Ward Development Committees' (WDCs) involvement in community-based initiatives and projects. Methods: The study was a descriptive cross-sectional study, conducted in Kudan Local Government Area of Kaduna State, Nigeria. All HCWs who had been in service for at least 6 months and WDC members who had served on the committee for at least 6 months were involved in the study. A multistage sampling technique was used to select the respondents from the community. Data was collected using a semi- structured interviewer-administered questionnaire developed by the researchers. The level of community participation was assessed by adapting Rifkin’s model for assessing community participation which has 5 indicators; needs assessment, organization, resource mobilization, leadership, and management. Results: From the perspective of the healthcare workers, ward development committee and community members, the level of community participation was 5 in organization and 4 in Leadership, Resource mobilization and Management, respectively. This indicates wide participation. The level of community participation is 3 in Needs Assessment from the perspective of healthcare workers and Ward Development Committee members and 1 for community members indicating moderate and narrow community participation. Conclusion: While community participation in Kudan’s WDC activities is commendable, there is potential for enhancement. We recommend that the government develops a policy on community engagement to ensure comprehensive community participation in all health-related projects.

Umar UH, Adamu A, Yunusa DM, Farate A, Lawan MM, Ahmadu MS, Ahidjo A, Mustapha Z

Background: Paranasal sinuses (PNS) are air-filled spaces which surround the nasal cavity. Sinonasal diseases (SNDs) are various pathologies ranging from inflammatory to benign and malignant neoplasms of the PNS and nasal cavity. Rhinosinusitis (RS) is the most frequent SND and its prevalence in the general population is relatively high, worldwide. Objective: To evaluate the computed tomographic findings of patients with SNDs in Maiduguri, North-eastern Nigeria. Methods: This was a retrospective study on CT scans of patients with SNDs who were referred to the Department of Radiology, Federal Neuro-psychiatric Hospital Maiduguri and State Specialist Hospital Maiduguri for computed tomography (CT) scans of PNS from January 2019 to December 2022. Data were retrieved and recorded from archives of the Departments which include age, sex, clinical presentations and CT findings. Data were analysed using IBM SPSS version 23. Results: The CT scans of one hundred and forty-six patients were reviewed; the majority of them being adolescents and young adults, with a mean age of 34.6 ± 16.1 years and a male-to-female ratio of 1.8:1. The commonest clinical presentation was nasal obstruction and inflammatory SNDs were the most frequent subgroup of aetiology. Mucosal thickening was the most frequent CT finding, and the most common CT diagnosis was RS. The maxillary sinus was the site that was mostly involved. Also, the lesions of SNDs were mostly multiple and bilateral. Conclusion: SNDs are common health conditions and the findings in this study showed that CT was a useful diagnostic tool. CT also helped to establish the extent of disease making it easier for preoperative preparation in case of surgical intervention. Rhinosinusitis was the most common inflammatory SND in this study.

Keywords: Computed tomography, Paranasal sinus, Sinonasal disease, Inflammatory, Rhinosinusitis, Polyposis

Umweni A.A, Otaren N.J.

Background: Diabetic nephropathy (DN) is the leading cause of end-stage renal disease (ESRD) worldwide and it is estimated that more than 20% of type 2 diabetic patients may develop ESRD during their lifetime. methods: The study is a prospective ultrasonographic evaluation of kidney volumes in 228 adults with type 2 diabetes and 228 normal non-diabetic adult controls carried out at Aminu Kano Teaching Hospital, Nigeria from June 2015 to May 2016. The data were analysed using computer-based SPSS version 23 software for Windows. Results: The 228 patients with type 2 diabetes studied were composed of 120 (53%) females and 108 (47%) males with a mean age of 47.7years, (range 29– 67 years), while the 228 normal control group were composed of 108 (47%) females and 120 (53%) males with a mean age of 46.9 years, (range 28- 69years). The age difference between the study and control groups was not statistically significant (p=0.43). The mean renal volumes were significantly higher in the study group (114.10+3.97ml) compared to the control group (95.34+2.59ml); this was statistically significant (p=0.001). The mean renal volumes were higher in males compared to the females in both the study group and the control (p=0.001). The left mean renal volumes were higher than that of the right in both the study and the control groups (p=0.001). There was, however, no significant correlation between renal volume and BMI (p=0.086). Conclusion: The mean renal volume is significantly higher among diabetics compared with normal controls. Patients with Type 2 diabetes mellitus have no significant correlation between renal volume and BMI.

Keywords: Type 2 diabetes Mellitus, BMI, renal volume.

Kwari SD, Chama CM, Mairiga AG

Background: Teenage pregnancy is becoming one of the most important social and public health problems worldwide, with a varying prevalence rate. It is associated with adverse maternal and fetal outcomes. Objective: To determine the maternal and fetal outcomes of teenage pregnancy at a tertiary care hospital. Method: A retrospective case-control review of all teenage pregnancies seen at the University of Maiduguri Teaching Hospital over ten years was carried out. The outcome was analysed and compared with that of older mothers who served as controls. Result: Teenage pregnancies accounted for 7.3% (n =1558) of the 21,310 deliveries within the study period. The mean age was 18.1 years. The majority of the teenagers were nulliparous (80.3%) and had no formal education (54.8%). Pregnancy-induced hypertension (22.9 % vs. 7.5% P<0.0001), preeclampsia (5.0% vs. 1.8% P0.001), eclampsia (9.7% vs. 3.6%, P<0.0001), malaria (19.0% vs. 6.4% P<0.0001), anaemia (16.5% vs. 11.5% P<0.0001), blood transfusion (7.5% vs. 1.8% P0.001), urinary tract infection (11.8% vs. 1.1%, P<0.0001), and duration of hospital stay (3.52 vs. 2.42 P0.003) were significantly higher in teenage mothers. Similarly, preterm delivery (21.1% vs 6.4% P <0.0001), low birth weight (22.2% vs. 6.1% P<0.0001), birth asphyxia (6.1% vs. 3.6% P 0.0001), and stillbirth (6.8% vs. 3.6% P 0.001) rates were higher in the teenage group. Teenagers were also more likely to be delivered by caesarean section (18.3% vs. 10.7% P <0.0001) and to have instrumental deliveries (5.0% vs 1.4% P< 0.0001). Conclusion: pregnancy among teenagers is associated with poorer maternal and fetal outcomes compared with older mothers.

Keywords: teenage pregnancy, maternal outcome, fetal outcome, tertiary care setting

Asheikh MM, Yusuf HM, Garba MA, Farouk AG, Abatcha MB, Mustapha MG

Background: Background: Fever is a common symptom in children and urinary tract infection (UTI) is one of the most common causes of fever in children. This study evaluated the co-morbidities associated with UTI in febrile children at the University of Maiduguri Teaching Hospital. Methods: Proforma detailing the history, physical examination and clinical diagnosis of the subjects were lled for all the 200 children aged 2 months to 15 years who were consecutively recruited. Urine samples were collected from each of the subjects for dip-stick urinalysis as well as microscopy, culture, and sensitivity. Data was analysed using IBM SPSS version 25. Results: Thirtynine subjects had UTI giving a prevalence of 19.5%. The common symptoms in the subjects with UTI were poor appetite and vomiting. Genito-urinary symptoms were not common among the children studied. Co-morbidities associated with UTI were malaria, (OR = 2.808; 95%CI = 1.243 – 6.346; p = 0.013), acute respiratory tract infection (OR = 0.324; 95%CI = 0.073 – 1.439; p = 0.139) and enteric fever (OR = 1.382; 95%CI = 0.544 – 3.515; p = 0.497), with malaria being the most common co-morbidity. Conclusion: Co-morbidities in children presenting with fever are common, especially in developing countries and the occurrence of UTI in the absence of genito-urinary symptoms in febrile children is not uncommon. Recommendations: Clinicians managing febrile children should have a high index of suspicion for UTI even in the absence of genito-urinary symptoms and evaluate the children for co-morbidities, for appropriate management..

Keywords: urinary tract infection, co-morbidity, fever, children, Maiduguri.

Musa A, Abba U, Ahmad A, Muhammad KG, Nehemiah BV, Jibril MB Ibrahim AM

Background: Premarital screening remains the only realistic approach to reduce the burden of genetic diseases such as sickle cell disease and other sexually transmitted diseases like HIV and Hepatitis B which remain a serious public health concern. The study was conducted among GOPD attendees of Bauchi State Specialist Hospital to assess their knowledge, attitude and practice of premarital screening and to find a way of increasing the awareness to the general public. Methods: A descriptive cross-sectional study was employed using a semi- structured interviewer-administered questionnaire to 331 respondents among GOPD attendees of Bauchi State Specialist Hospital. The data was analyzed using SPSS version 22.0 and level of significance was set at 0.05. Results: The mean ±SD age of the respondents was 32.2 ±11.9 and 70.7% of the respondents have good knowledge, 73.1% positive attitude and 74.3% good practice of premarital screening. Formal levels of education, age, religion, tribe, gender, occupation and marital status were the factors associated with the knowledge, attitude and practice of the premarital screening among the GOPD attendees: levels of education, gender, age and occupation for knowledge, levels of education for attitude and age for practice; remained independent predictors of knowledge, attitude and practice of the premarital screening among the GOPD attendees. Conclusion: This study shows that there is good knowledge and attitude of Premarital Screening among the study participants. However, the practice is relatively poor when compared to the other two variables. Government should sustain the awareness campaign by engaging the stakeholders, media, non-governmental organizations, religious bodies, hospitals and schools.

Keywords: Knowledge, attitude, practice, premarital screening, Bauchi

Daibu U, Usman B, Mohammed B

Background: Neurosurgical conditions are fairly common in our facility. They present to the emergency unit and trauma centre in an emergency state, and otherwise to the outpatient clinic of our facility. Our facility has three (3) neurosurgeons, addressing the growing burden of neurosurgical conditions. There is little information on the pattern of presentations of these non-emergency neurosurgical conditions to the outpatient clinic in our centre. Objective: To determine the pattern of presentations of non-emergency neurosurgical conditions at our facility's outpatient clinic. Patients and Methods: A prospective observational study that recruited all patients with non-emergency neurosurgical conditions who presented to the outpatient neurosurgical clinic of the University of Maiduguri Teaching Hospital from February 2023 to January 2024. Data was analyzed using a statistical package for social sciences (SPSS) version 26. Results: A total of 139 patients were recruited during the study period. The majority (67.6%) were males with a male-to-female ratio of 2.1:1. The most common age range at presentation was 17-45 years (37.4%) with a mean age of 37years ± 20.104 SD. Back pain (25.9%) from lumbar spondylosis was the most common clinical symptom, followed by weakness of the limbs (13.6%). Forty-six-point seven percent (65 patients) presented with cranial pathologies, while 49.7% (69 patients) presented with spinal pathologies. Spondylosis (27.3%) and hydrocephalus (9.4%) were the most common diagnoses at presentation in adults and children, respectively. Majority (62.6%) of the patients required surgical intervention at the time of presentation. Conclusion: Lumbar spondylosis and hydrocephalus are our facility's most common indications for outpatient neurosurgical consultations.

Keywords: Neurosurgical conditions, Outpatient clinic, Spectrum, Presentations, Maiduguri

Azees A. S, Adebisi O. I, Olubodun T, Adeniyi M. A

Mshelia DS, Gali RM, Dogo HM, Ummate I, Ibrahim AG, Musa AH, Medugu JT, Dungus MM, Bukar B, Genesis RY.

Background: A lot of attention has been drawn to primary hyperparathyroidism (PHPT) and vitamin D as risk factors of urolithiasis due to their association with calcium metabolism and stone formation. This study intends to assess the Vitamin D status of stone formers and prevalence of primary hyperparathyroidism amongst them in Maiduguri, Nigeria. A cross-sectional descriptive study was conducted in the University of Maiduguri Teaching Hospital from February 2018 to January, 2019. Eighty five stone formers who consented were recruited. ELISA technique and autoanalyzer (Cobas C311, ISN) was used for sample analysis. IBM SPSS version 26.0 was used for statistical analysis. The prevalence of PHPT in the stone formers was 8.2%. The most common site where stones were found is the kidney (68.2%). A total of 45 (52.9%) have vitamin D3 deficiency or insufficiency, 29 (34.1%) had optimal vitamin D3 levels and 1 (1.2%) had hypervitaminosis D3. Twelve patients had hypoalbuminemia, 24 patients had elevated inorganic phosphate, 8 patients had hypercalcaemia, 17 had hypocalcaemia, while 21 had hyperuricaemia. Given the high incidence of vitamin D deficiency/insufficiency in PHPT in this study and previous findings, evaluating vitamin D and calcium levels could be beneficial for a
thorough assessment of urinary tract stone formers.

Keywords: Urolithiasis, Primary hyperparathyroidism, Vitamin D3 status.

Bobo TI, Bakare TY, Afolabi OA, Adeniji DO, Ladoye OO

Background: Introduction: Emergency peripartum hysterectomy is a life-saving surgical procedure, the procedure is usually performed when all conservative measures have failed to achieve haemostasis during life threatening obstetric haemorrhage. Objective: This was to review emergency peripartum hysterectomy performed in Bowen University Teaching Hospital (BUTH), Ogbomoso, South- West, Nigeria between 1st January, 2014 and 31st December, 2023. Methods: A retrospective review of cases of emergency peripartum hysterectomy between January, 2014 and December, 2023. Result: During the 10- year study period, 6,734 deliveries occurred in the hospital and 42 cases of emergency peripartum hysterectomy were performed giving a prevalence of cases as 0.6% or 6 per 1000 deliveries. The mean age of the studied patients was 35 ± 3.856 years with (28.9%) of the patients being within 26-30 years of age. Majority (71.1%) were multiparous with the modal parity of 3. Majority (63.2%) of the patients were unbooked and fourteen (36.8%) were booked. The leading indication for hysterectomy was uterine rupture 21 (55.3%), 9.4% had maternal death, 54.8% of the patients had stillbirth and 5.3% had early neonatal death. Conclusion: The risk factors associated with EPH should be identified during the antenatal period and pregnant women in high-risk group should be delivered by skilled birth attendants. There is need to enlighten women in our communities on the benefits of antenatal care services and hospital delivery as well as the dangers of delivering under unskilled supervision.

Keywords: Uterine rupture, caesarean section, emergency peripartum hysterectomy, maternal mortality

Lawan M, Loskurima U, Ndahi AA, Habib AG, Ladu AI, Shettima J, Amali AO, Chiroma I, Dungus MM, EmeanwuCH, Tijjani ZM, Ummate I

Background: Sickle cell anaemia (SCA)is a common life-threatening haematological disorder that affects millions of people worldwide. Albuminuria has been identified as an early marker of sickle cell nephropathy. The study aimed to determine the prevalence, pattern and risk factors associated with proteinuria among patients with SCA in Maiduguri. Methods: This was a cross-sectional descriptive study that involved 240 patients with SCA attending the heamatology clinic, UMTH and 240 controls with Hb AA that fulfilled the inclusion criteria. The participants were screened for proteinuria (albuminuria or overt proteinuria) using spot urine to assess for albumin creatinine ratio (ACR). The glomerular filtration rate was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Albuminuria was defined as a UACR of 3.4 – 33.9 mg/mmol while overt proteinuria as a UACR of > 33.9mg/mmol. Results: The mean age of the SCA group was 23.95±5.93 years while that of the control group was 24.69±6.58 years (p =0.313). The prevalence of albuminuria and proteinuria were significantly higher among the SCA group compared with the control group, 23.3% vs 10.4% and 12.1% vs 4.2% respectively. (p-value <0.001). Serum creatinine levels correlated positively with albuminuria (r = 0.178; p = 0.006), while PCV correlated negatively with albuminuria (r = -0.178; p=0.006). Albuminuria and high diastolic blood pressure were predictors of kidney disease (odds ratio 0.937, 95% CI 0.019 - 0.981, p = 0.002 and 0.971,95% CI 0.937 - 0.971, p = 0.001 respectively. Conclusion: Albuminuria is a marker of early-stage kidney disease in patients with SCA in Maiduguri. Albuminuria correlates with low PCV and elevated serum creatinine levels in SCA patients.

Keywords: Sickle cell anaemia, Albuminuria, kidney disease, northeastern Nigeria.

Arfo FS, Adamu A, Buba B, Shettima HB, Zarami AB

Background: Schwannomas are rare tumours which arise from the sheaths of Schwann cells either from the peripheral, autonomic or central nervous system. It is rare and very few have been reported locally. We report a case of schwannoma, in a 40-year-old woman who presented with a ten-month history of right lateral neck mass which was slow-growing and painless. There were no associated obstructive or toxic symptoms. Examination revealed a well-demarcated right-sided lateral neck mass in zone II of the neck measuring 13 X 6cm, firm, non- tender, not attached to the overlying skin and mobile in the horizontal plane. She had an examination under anaesthesia and total excision of lateral neck mass. Histopathological examination of the mass revealed features in keeping with schwannoma. The patient did well postoperatively.

Keywords: schwannoma, lateral neck mass, histopathology

Oduola owoo LT, Oduola owoo BB, Said AA, Rasheed MW, Omidiji O, Odetayo OF, Idowu NA

Background: Germ cell tumour (GCT) of malignant origin is a rare and heterogeneous group of tumours in the paediatric population. It could be seminomatous and non-seminomatous. The non-seminomatous group is less commonly seen. The most commonly seen type under the non-seminomatous group under the age of three years is the yolk sac tumour. The majority of yolk sac tumours is seen in the gonad while very few develop in extra gonadal sites such as the sacrococcygeal region, retroperitoneum, mediastinum, pelvis and stomach among others. Extra gonadal germ cell tumour is extremely rare in the cervix and when it occurs there may be challenges in the management. We report this case due to its rarity and the possibility of cure by chemotherapy, thus preserving fertility. Case Presentation: A 2-year-old female toddler presented with a 9-month history of persistent bleeding and discharge per vagina. At first, the bleeding was once a month and progressively worsened to once a day. There was no change in bowel and urinary habits. There was a pooling of blood in the vaginal vault on pelvic examination, otherwise unremarkable. Abdominopelvic ultrasound scan and magnetic resonance imaging were suggestive of a tumour of the uterine cervix. The mass was excised and sent for histopathological analysis. The histology of the mass showed a yolk sac tumour. Other laboratory investigations including tumour markers were essentially normal. She had treatment with bleomycin, etoposide, and cisplatin regimen (BEP) of chemotherapy as against radical surgery for potential preservation of fertility. She is five years on follow–up at the time of this report. There was no clinical, laboratory, or radiological evidence of recurrence. Conclusion: The 2-year-old female toddler responded well to chemotherapy. This obviated the need for radical surgery. There was preservation of potential for future fertility.

Keywords: Yolk sac, tumour, chemotherapy, uterine cervix.

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.