vol12-issue2-july-december-2015

BABADOKO, AA., MUKTAR, HM., MAMMAN, AI.

Background:Background: Most laboratories in resource-constrained countries, cannot routinely use standard methods to measure markers of disease progression useful in staging and initiation of antiretroviral therapy due to high cost more so with the ongoing reduction of support by the implementing partners. The objective of this study is to determine whether Absolute Lymphocyte Count (ALC) can serve as a surrogate for CD4+ T-Lymphocyte Cell Count (CCC) for initiating highly active antiretroviral therapy (HAART) in HIV-infected treatment naïve patients in our setting. Methods: A total of 400 adult Nigerians infected with HIV-1 and who were previously antiretroviral naïve, were recruited into the study at Ahmadu Bello University Teaching Hospital, HIV subspecialty clinic. They were assessed clinically and immunologically and categorized into three clinical stages; A, B, and C according to CDC criteria. Absolute Lymphocyte Count and CCC values were tested for correlation and their validity determined using SPSS version 20 and Chi square statistics. Results: The patients comprised of 187 males (46.8%) and 213 (53.2%) females. One hundred and eight (27%) of the study subjects were in stage A, 153 (38.5%) in stage B, and 139 (34.8%) in stage C. The mean ALC of stage C subjects is significantly lower than that of stage A subject's p < 0.05. The mean CCC values declines significantly from stage A through B to C p ≈ 0. There was a positive and significantly correlation coefficient between ALC and CCC in stage C; r 0.28, P < 0.05. In all the subjects and in the stages, sensitivity and specificity of a low ALC value to predict a low CCC value were low. Conclusion: Absolute Lymphocyte Count is not a reliable and sensitive surrogate of CCC in all HIV infected patients however it is only useful in immunocompromised patients to determine the optimal time to initiate HAART..

Background:Intima media thickness of the carotid arteries has been used as a subclinical index of atherosclerosis in patients with diabetes mellitus and has also been used in epidemiological and interventional studies as a surrogate index of atherosclerosis. However, to date, there is paucity of data on sonographic carotid artery intima media thickness (IMT) measurements and the prevalence of carotid atherosclerosis and stenosis among adult diabetic patients in our environment. Objective: The objective of this study was to evaluate carotid artery intima media thickness among adult diabetic patients using carotid duplex ultrasonography (CDUS). Methods: This was a cross-sectional study carried out at the University of Maiduguri Teaching Hospital, Nigeria. One hundred and twenty adult diabetic patients aged 20 - 78 years had CDUS for measurements of carotid artery intima media thickness. Measurements were taken at 1cm below and 1cm above the carotid bulb for the common carotid (CCA) and internal carotid arteries (ICA) respectively. Pearson's correlation and Student t-test were used to compare the means between the variables. Results: There were 72(60%) male and 48(40%) female diabetic patients aged 20 to 78 years (mean = 50.03±11.4 years). Mean intima-media thickness, in millimeters (mm), for normal (non-stenotic) carotid arteries on the right and left were (CCA=0.71±0.09 and 0.70±0.08; ICA=0.71±0.08 and 0.69±0.09) and abnormal (stenotic) on the right and left were (CCA=0.84±0.17 and 0.83±0.19; ICA=0.98±0.10 and 1.03±0.10) respectively. A total of 75 patients (62.5% of study population) had no carotid artery stenosis; 38 patients (31.7%) had <50% carotid stenosis; 6 patients (5.0%) had 50-69% carotid stenosis; and 1 patient (0.8%) had 72% carotid stenosis. The prevalence of carotid stenosis in diabetic patients was 37.5% in this study. There was positive and significant correlation between percentage degree of stenosis with IMT (r=≥ +0.5; p=<0.05). Conclusion: The findings of this study have indicated the presence of atherosclerotic and haemodynamic changes in the carotid arteries of adult diabetic patients in this environment who are at risk of developing stroke from carotid stenosis. CDUS has proved to be a valuable diagnostic and screening tool in the evaluation of these patients because of its safety, low cost, wide availability, and accuracy in detecting carotid artery disease

Background:The maternal mortality ratio in Chad is 1099 per 100,000 live births. According to the WHO, 80% of the maternal deaths are preventable if appropriate measures were taken. Objective: to determine the proportion of preventable deaths and to identify the elements linked to maternal death in N'Djamena south District Hospital. Materials and Methods: This was a retrospective, descriptive study spanning over two years, from January, 1st 2013 to December, 31th 2014 carried out in N'Djamena South District Hospital concerning analysis of maternal deaths in southern N'Djamena district. All patients that died during the pregnancy or within 42 days postpartum in N'Djamena south district hospital during this survey were included. Results: During this survey, we recorded 52 maternal deaths for 7439 deliveries giving a maternal death rate of 699 per 100,000 deliveries.The age group between 25-29 years was the most represented with 34.6%.The majority of patients (73.1%) were referred and 48 patients (92.3%) had less than 4 prenatal consultations. The causes of maternal deaths were dominated by: delay seeking medical care, delay in accessing health facilities, and the delay in accessing efficient care .Obstetrical pathologies (direct causes) were responsible for 92.3% of deaths, these pathologies were: hemorrhage, eclampsia, abortion and infections. In 07.7% indirect causes were noted. Twenty five patients (48.2%) received medical care within 30min-1h after diagnosis. Conclusion: The maternal death remains a public health problem that persists in Chad. Its reduction requires the removal of delays.

TAKAI IU, RAHILA G, IBRAHIM AS

Background:The use of 3 doses of intermittent preventive therapy (IPT) for malaria among HIV positive pregnant women is an ante-natal preventive measure for malaria. Objectives: The study is aimed at determining the prevalence of malaria parasitaemia and clinical malaria among HIV positive antenatal clinic attendees who had intermittent preventive therapy for malaria. Materials and Methods: This was a one year retrospective study of HIV positive pregnant women in Aminu Kano Teaching Hospital, Kano, who had antenatal care between 2nd January and 31st December, 2013. Information such as parity, gestational age at booking, number of IPT given, previous malarial treatment and results of blood smear for malarial parasites, were obtained and analysed. Results: A total of 1800 women had antenatal care over the study period, out of which 110 were HIV positive, giving a sero-prevalence rate of 6.1%. Up to 55.5% of them booked at gestational age of 16-20weeks. Ninety women (81.8%) had 3 doses of sulphadoxinepyrimethamine (SP) for IPT. Thirty eight women (34.5%) had positive smear for malarial parasites, with 68.4% occurring among the primigravidae at 16-20 weeks of gestation in 60.5%. Thirty four (30.9%) women were treated for clinical malaria. Thirteen of them (38.2%) had recurrence with 9 (60.2%) occurring in primigravidae. Conclusion: The prevalence of malarial parasitaemia is high despite the use of 3 doses of SP for IPT. The prevalence and recurrence was higher in primigravidae. Other means to support drug preventive measures should be stressed.

YERIMA MM, IBRAHIM AW, PINDAR SK, WAKIL MA, MUSAMI UB

Background: Mental disorders are quite prevalent and cause significant burden and disabilities. The access of much of the world's population, especially in low and middle- income countries (LMICs), to mental health services is inadequate despite the enormous needs for those services. There is a potential opportunity in recruiting medical students to take up psychiatry as a career to ensure the future of mental health services delivery in Nigeria. This study examines the factors that determine the choice of specialty, especially psychiatry, with the aim of improving mental health care delivery. Materials And Methods: A cross-sectional study of medical students from the University of Maiduguri to determine factors that affect their career choices with special emphasis on psychiatry. Results: Participants in the study were 117 students mean age of 26years ± 2.9 SD. Majority were males (66.7%). Most were fifth year students (83.8%). All participants said they would specialize and some of the factors they would consider were “sheer interest" and clinical man-hours required in 41.9% and 23.1% respectively. Obstetrics and gynecology (O&G) had the highest number of prospective specialists followed by Surgery, Internal medicine, and Pediatrics in 27.4%, 22.2%, 15.4%, and 12.8% respectively. Laboratory medicine and Psychiatry, respectively, trailed with 6.0% and 5.1%. Most (54.7%) would consider Psychiatry as a second option while 45.3% wouldn't. “Longer duration of Psychiatric clinical posting” as well as “more mentoring” will make them consider psychiatry (60.6% and 68.3% respectively). Only 29.1% of the respondents were discouraged by Stigma from considering Psychiatry. There was association between potential specialty and sex of the students (÷2 =23, p=0.028). There was also significant association between being Muslim and considering psychiatry as second option (÷2= 6.2, p= 0.013) with odds ratio of 2.74 and (95% CI, 1.23- 6.12). Conclusion: Medical students could be encouraged to take up psychiatry as a specialty by paying attention to the factors that determine how they choose a specialty and the factors that may encourage or dissuade them from taking up psychiatry. This will have far reaching positive consequences towards improving the population access to mental health services.

AMUTTA SB, ABDULLAHI M, ALIYU D, MANYA C, YIKAWE SS, SOLOMON JH

Background:The pattern of ear, nose, throat, head and neck diseases varies from one geographical location to another and hospital admission usually required for optimum management. Objective: The aim of this study is to assess the pattern of Ear, Nose and Throat in-patient diseases and make recommendations to improve health care services. Methods: This was a six year retrospective study of ear, nose, throat, head and neck in-patients. Data analysed include demographic data, religion and diagnosis. Results: A total of Eighteen thousand and ninety three (18,093) patients were managed in the Ear, Nose and Throat department from January 2006 to December 2012. One thousand two hundred and twenty six (1,226) patients were managed in the in-patient unit comprising male708 (57.8%) and female 518 (42.3%) with male: female ratio 1.4:1. Hospitalisation rate was 6.8%. The six most frequent reasons for the hospital admission were tonsillitis 224 (18.3%) patients, followed by epistaxis 105 (8.6%), nasal masses 100 (8.2%), neck and laryngeal trauma 91 (7.4%), chronic suppurative otitis media 74 (6.0%), nasal and facial trauma accounted for 74 (6.0%). Conclusion: The pattern of otorhinolaryngeal, head and neck diseases among the in-patients in this study varied with age and site of the lesion. Tonsillitis and Epistaxis being the most common reasons for admission, they can be handled by the general practitioners, hence, the need to create awareness on the management of these lesions to provide the Otorhinolaryngologist ample time to attend to complicated diseases

YAYA UM

ABSTRACT: Job Stress comes as a result of incongruity between an employee and his job. This brings about psychological and physiological changes in the life of the worker, thus it, affects his/her general wellbeing and productivity. This article focused on the impact of job-related stress on the wellbeing of employees and the role of counselling in its prevention and management. The paper talked about the concepts of stress, job stress, causes, signs and symptoms, adverse effects and prevalence rate of job-related stress on employees. Lastly, the article presented empirical findings, such as counselling employees on how to cope with psychological distress and adverse effect of psychological trauma, which improve wellbeing of workers.

PINDIGA UH, MALAMI SA, ADOGU IA, KEFAS JB, EMUAN TO

Background: A villous adenoma of the appendix is an extremely rare tumour of the appendix even rarer is its occurrence on schistosomal granulomatous appendicitis. It is therefore usually an incidental finding during appendicectomy. Most series on appendiceal tumours accounts for less than 7% as villous adenomas. The index case histologically shows acute appendicitis, schistosomal granulomata and a villous adenoma. There may be an aetiological relationship between schistosomiasis and the villous adenoma of the appendix in this case since schistosoma related colonic squamous cell carcinomas have been observed in endemic arrears. Treatment is limited to appendicectomy and praziquantel therapy but post-operative colonoscopy is recommended due to the risk of colonic schistosomiasis and malignancy in patients with appendiceal neoplasms. We therefore report this rare pathological triad.