vol18no1

Otaniyenuwa Obarisiagbon, Andrew Obi

Adeyeye FM, Iseh KR, Aliyu D

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Baduku TS, Sheyin J, Isa FB

Background: Ear diseases and their associated problems are common presentations in clinics worldwide, but are seen more in developing countries. They are causes of morbidity and frequent hospital visits, thereby consuming many man-hours. There is limited literature regarding the burden of ear diseases among Africans, and Nigerians in particular. The advent of computed tomography (CT) and magnetic resonance imaging (MRI) have immensely changed the management pathway of hearing impairments, particularly in the developing world. CT has been shown to be useful for demonstrating the detailed anatomy and pathology of the temporal bone and its surrounding tissues.

Objective: This study aims to determine the clinical presentations and CT pattern of hearing impairments among patients that were referred for CT in the Radiology Department of an ENT hospital in Kaduna, Nigeria.

Method: The study is a twenty-four months’ hospital-based retrospective study at the Radiology Department of the National Ear Care Centre, Kaduna which is a mono-specialty referral centre for ear, nose and throat pathologies. CT of the petro-mastoid region was done for 117 patients as a result of hearing impairment. A retrospective analysis of request cards, duplicate copy of radiology reports, soft copy of their CT images and patients’ folders were considered. All patients with history of hearing loss from other causes were included.

Results: A total of 117 patients were recruited for this study, with a female preponderance. The most frequently affected age group were those within the 3rd decade of life. Ear discharge was the most frequent presenting complaint and mastoid opacification constituted the highest frequency of occurrence on CT followed by mastoid wall scleroses, but 5.9% of the CT images were normal.

Conclusion: CT findings, along with the clinical examination is a powerful diagnostic tool in the diagnosis of hearing loss and also provides sufficient information to the ENT surgeon regarding the extent of disease process, complications, and anatomical variants which may influence management.
Key words: clinical, computed tomography pattern, hearing loss

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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