Archive 2014 No 11 Vol 1

Ibrahim AW,Wakil MA, Jidda MS, Omeiza BA, Pindar SK, Rabbebe IB, Yusuph H

Background:Depression is the commonest neuropsychiatric disorder among people living with HIV (PLHIV) but it remains highly underdiagnosed among this vulnerable group due mainly to low index of suspicion on the part of clinicians and the lack of brief, reliable and valid screening instruments in the very busy clinics of sub-Saharan Africa. Objective:This study assessed the predictors of depression among adults on highly active antiretroviral therapy (HAART) at the University of Maiduguri Teaching Hospital (UMTH) as well as evaluated the psychometric properties of the shorter version Beck Depression Inventory (BDI-II) among the subjects. Methods:This was a two-staged cross sectional survey conducted on 303 adults on HAART who were selected through the systematic random sampling technique at theARTclinic of the UMTH. In the first stage, anonymous sociodemographic questionnaire and the BDI – II were administered, while in the second stage, subjectswhomet the cut off score of 18 together with 30% of those with lower scores were administered the depressive disorder module of the composite international diagnostic interview (CIDI) as the gold standard. Bivariate and logistic regression analyses were used to determine the predictors of depression while Cohen's Kappa, Cronbach's alpha and the validity coefficients were computed to determine the psychometric properties. Results:Over 20% of the subjects were depressed. Female gender, past history of psychiatric illness, family history of psychiatric ailment and short duration of HIV seropositivity were significant predictors of depression with the following odds ratios; O.R. = 2.820, p = 0.006, O.R. = 23.420, p = <0.001, O.R. = 7.872, p = 0.002 and O.R. = 0.332, p = <0.001 respectively. The psychometric properties were excellent with Kappa and Alpha values of 0.9 each, sensitivity and specificity of 90% each, with positive and negative predictive values of 91% each.. Conclusion:Depression affects one out of every five HIV+ subjects and the BDI – II is a valid instrument for the detection of depression in this group. We therefore recommend the routine screening of depression among adults on HAART with vulnerability factors using this instrument.

Background:Sleep plays an essential and critical role in growth and development of children. The consequences of sleep disturbance in children include: impaired immunologic function, reduced alertness, deficits in cognition, memory and learning. Objectives: This study aims to assess sleep disturbances in children with adenotonsillar enlargement. Methodes: This is a preliminary report of a study on children with adenotonsillar enlargement at the Otolaryngologic clinics of Aminu Kano Teaching Hospital, Kano Nigeria Results:A total of 38 consecutive patients with adenotonsillar enlargement were studied; 20 (52.60%) were males and 18 (47.40%) were females. Their ages were between 1 and 10years; the mean age was 3.67 years. The mean duration of symptom was 1.17 years (SD = 0.84). The overall mean sleep disorder score was 1.94 0.15. The mean score for males was 1.66 0.21 and that for females was 2.24 0.19. The mean sleep disorder score for children 5years was 1.90 0.15, while that for children > 5years was 2.04 0.42. The mean score for children with snoring was 3.58 0.26. There was no significant correlation between the age of the patients, duration of symptoms and the degree of snoring. Conclusion:This study found a good sleep health in children with adenotonsillar enlargement except for those children that presented with snoring as their primary complaint.

Ebeigbe JA, Ighoroje AD

Background:The menstrual cycle has been reported to affect many physiological processes. While the effects of the menstrual cycle on ocular parameters have been studied extensively in Caucasian women, not much is known about its effect on tear volume and stability in Nigerian women. Objectives:To investigate the changes in tear volume and stability during the different phases of the menstrual cycle in Nigerian women. Methods:A longitudinal study of one hundred healthy women with a regular cycle of 26 to 29 days was carried out. The women were between 20 to 35 years old with mean age of 30 ± 2.1 years. Tear volume was measured by the Schirmer's tear test, while tear stability was measured by the non invasive tear break up time (NITBUT). Results:The difference in mean tear volume across the phases of menstrual cycle was statistically significant (p = 0.001). Tear volume reduced during ovulation and rose again during the luteal phase. This difference was statistically significant (p=0.04). The difference in tear volume between the follicular phase and the luteal phase was not significant (p=0.3). Increase in mean tear stability between the follicular and ovulatory phases was marginally statistically significant (p=0.046). However, there was no statistically significant difference between the ovulatory and luteal phases (p=0.44).Conclusion:The findings of this study suggest that hormonal variation during the different phases of the menstrual cycle influence tear volume and tear stability in healthy young women of reproductive age. These changes may be clinically significant particularly in contact lens wearers where fluctuations in ocular parameter may alter the contact lens fit, leading to a possible change in comfort and reduced visual acuity.

Adamu MD, Muhammad N

Background:The provision and uptake of low vision services is said to be poor globally and is almost negligible in low income countries. Objectives:To describe the first one year of low vision service provision in Sokoto state. Methods:A retrospective review of all patients with low vision referred to the low vision unit of Usmanu Danfodiyo University Teaching Hospital and Specialist Hospital, Sokoto during the study period was undertaken. The WHO definition of low vision using visual acuity cut off point (best corrected visual acuity of <6/18 to light perception in the better eye) was used to enlist study participants. Data was extracted from the medical records of all the patients diagnosed with low vision. The information extracted included age, sex, sociodemographic details, presenting and best corrected visual acuities for near and distance, diagnosis, the spectacles and low vision device prescribed. Data was analyzed using simple percentages and proportions. Results:A total of 46 patients (0.45% of all patients seen -10,201) were diagnosed with low vision. The sex distribution was 65.2% males and 34.8% females. The age range of the patients was from 9 years to 69 years with a mean age of 29.3 ± 1.66 years. The major causes of low vision in this study were glaucoma (52.2%), retinitis pigmentosa (26.1%), optic atrophy (8.7%), pathologic myopia (6.5%) and albinism (2.2%) . The most prescribed devices were spectacle magnifiers and telescopes (41.3% both) followed by handheld magnifier (13%) and stand magnifier (4.3%). The most dispensed devices were spectacle magnifiers and telescope at 41.6%, handheld magnifiers 12.5%, and stand magnifiers 4.2%. Conclusion:Low vision service provision in Sokoto state is one of the challenges of eye care service provision in the state. The commonest cause of low vision was found to be glaucoma while Spectacle magnifiers and Telescopes were found to be the commonest prescribed and dispensed low vision devices. The provision and uptake of low vision services is said to be poor globally and is almost negligible in low income countries.

Yongu WT, Elachi IC, Kortor JN, Mue DD, Gajir T

Background:Road traffic accidents are emerging as a global public health concern but not enough attention is given to it in terms of public health enlightenment and strategic policies by governments to achieve sustained control. Objective:This study is aimed at identifying the characteristics of injuries presenting in this new teaching hospital following road traffic accidents (RTAs) and determining the common causes of these crashes. Method:This was a prospective study designed for all patients who presented to the Accident and Emergency Department of Benue State University Teaching Hospital following RTA over 12 months (July 2012 to June 2013). A questionnaire was filled at presentation and completed at the time of discharge from the hospital. Results: There were a total of 58 patients 31 males and 27 females giving a ratio of 1.1:1. Themeanage was Range 2 – 82years). Most 37(63.8%) of them were within the age range 21 to 40 years. The month of July 2012 recorded the highest number of patients 14(24.1%). Most of the accidents 35(60.3%) resulted from vehicle-vehicle collision and buses 24(41.4%) were the commonest vehicles involved in road traffic crashes followed by motorcycles 18(31.1%) and cars 14(24.1%). Majority of the patients were passengers 33(56.9%) and multiple injuries were recorded in 32(55.2%) followed by lower limbs only in 12(20.7%). Fractures occurred in 44(75.6%) of the patients followed by lacerations 9(15.5%), dislocation 2(3.2%) and others 3(5.2%). Complete recovery occurred in 32(55.2%) and were discharged. Eight (13.8%) were referred, 5(8.6%) recovered but with some residual deformity at the time of discharge, 3(5.4%) patients died and 8(13.8%) discharged against medical advice (DAMA). patients had multiple injuries with an average injury severity score (ISS) of 13.7 range (2-32). Major injuries with ISS > 15 occurred in 16 patients. Conclusion:Fractures and lacerations were the commonest injuries sustained following RTA. Most of the patients had multiple injuries leading to death in 3 patients. There is need to further equip and prioritize the resources available to the hospital to cater for the growing percentage of multiply injured patients.

Muhammad Z, Ugwa, EA, Onuorah C

Background:Maternal and perinatal healths are very important public health issues. The availability and quality of health care delivery systems of any nation is its maternal and perinatal
mortality statistics. Objective:To determine the pattern of maternal and perinatal morbidities among mothers who are booked for antenatal care in Aminu Kano Teaching Hospital and those who did not and to determine the factors which contribute to these outcomes. Methods:Women who did not have antenatal care (unbooked mothers) at Aminu Kano Teaching Hospital and those who had (booked mothers) between 1 July, 2006 and 31 June, 2009, were retrospectively studied for maternal complications and perinatal outcome. The indices of outcome measured in this study were Caesarean section rates, antepartum eclampsia, antepartum haemorrhage, postpartum haemorrhage, low birth weight, low Apgar scores, stillbirth, and foetal macrosomia. Both groups had their deliveries supervised at Aminu Kano Teaching Hospital. The data between the two groups were compared. Results:A total of 11,035 deliveries were conducted during the study period. Of these, 8,292(75%) were booked while 2,743(25%) of total deliveries were unbooked.Amongthe booked group, 6,363 files were retrieved giving a file retrieval rate of 76.7% while in the unbooked group, 1,998 case files were retrieved, giving a file retrieval rate of 72.8%. Compared with booked mothers, unbooked mothers had more maternal complications and poorer perinatal outcomes. Caesarean section rate is significantly commoner among the unbooked patient (25.52% against 6.47%, P=0.000), antepartum eclampsia occur commonly in the unbooked patients (5.94% against 0.87% P=0.000),antepartum haemorrhage also occur significantly in the unbooked patients (2.95% against 0.47%, P=0.000). Postpartum haemorrhage is commoner in the booked patients (2.73% against 1.07% P=0.000).Low birth weight is commoner among the babies of the unbooked patient (21.51% against 7.22%, P=0.000), low Apgar scores is higher among babies of the unbooked patient (17.17% against 4.29%, P=0.000).There was no
statistical difference in the occurrence of stillbirth between booked and unbooked patients(15.13% against 2.56% P=0.133). Conclusion:There is a significantly higher maternal and perinatal complication in the unbooked women than the booked. There is also a positive correlation between unbooked mothers and an increased risk of maternal and foetal adverse outcomes and that parity, distance and maternal age affect these outcomes.

ATTAH RAPHAEL A, OMOLE-OHONSI A

Background:Tubal ligation may be good for women seeking out a safe, effective, permanent and convenient form of contraceptive. However, due to variety of reasons, there is aversion to it especially in developing world. Objective:To determine the incidence, socio-demographic characteristics of acceptors, indications and complications of tubal ligation (BTL) at Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria. Methods:A retrospective study of BTL at AKTH, was conducted over a five year period, between 1 January, 2008 to 31 December, 2012. The records of women who had BTL/ used other contraceptive methods were retrieved from the medical Records Department and family Planning Clinic. Results:Period prevalence of BTL was 2.6% among contraceptive acceptors. The mean age and parity were 35.0±5.0 and 6.0±2.0 respectively. Majority of those that had BTL, had only Quaranic education 23(34.3%). Majority of cases (82.1%) were done during caesarean section / laparotomy. Postpartum BTL accounted for 11.9%, while interval BTL accounted for 6%. BTL in patients with ruptured uterus (31.3%) was the commonest indication. One of the acceptor came back with regrets. Only 4.5% had complications, which were not primarily due to the procedure. Conclusion:BTL is a safe and effective method of sterilization. Utilization of BTL especially postpartum and intervalBTLis still low in our community.

Ngamdu YB, Kodiya AM, Sandabe MB, Garandawa HI, Isa A

Background:Cerumen auris (Ear wax) is the among common ear disorders seen by the General Practitioners (GPs). Cerumen auris removal is an otorhinolaryngological procedure most commonly performed by the GPs and it is their commonest source of iatrogenic otologic problems. This survey was conducted among GPs to seek their knowledge of managing cerumen auris and its outcome in North-Eastern Nigeria. Methods:This is a descriptive cross sectional study on the management of cerumen auris among GPs practicing in North- Eastern Nigeria. Closed ended structured questionnaires were administered to GPs during continuous medical education sessions carried out in four states (Adamawa, Borno, Gombe and Yobe)s of the North Eastern Nigeria from June to December, 2011. Data collected were analysed using SPSS computer software version 16.0. Results:a total of 130 questionnaires were administered to the GPS, 91% were completed and retrieve. Eight-five per cent of the respondents were males and 15% were females. About 14% of the GPs had no otoscope nor were it provided by their hospital. Sixty-nine of the GPs see less than 11 patients with cerumen auris per month, 1.7% see between 31 and 40 patients per month and none see greater than 40 patients per month. About 13% of the GPs diagnosed cerumen auris with history alone. About 55% of the GPs use wax softeners and ear syringing together as form treating cerumen auris. Ear pain is the commonest complication encountered by the patients after ear syringe. Conclusion:Application of wax softeners followed by ear syringing is the mode of treatment adopted by most practitioners, although they don`t follow the standard method. There is a need for continuous medical education on the management of cerumen aurisamongGPS.

Aliyu S, Ibrahim AG, Lawan AM, Ali N, Salim MU

SUMMARY:Femoral hernias are uncommon of all external abdominal hernias; however they are the most commonly incarcerated external hernias, leading to significant morbidity and
mortality. Rarely, such strangulation of viscusmayresult in spontaneous fistulation with its sequellae of fluids and electrolytes imbalance, anaemia, and malnutrition.Wereport a case of spontaneous enterocutaneous fistula resulting from neglected strangulated femoral hernia.

MUSTAPHA Z , TAHIR N , AMEADAJI M , MINOZA K , PINDIGA UH , OKEDAYO M

SUMMARYLipomas are the most frequent mesenchymal soft tissue tumors, but breast lipomas are usually small, asymptomatic and incidental findings on mammograms. This benign
neoplasm can be treated by simple excision.Wereport a rare case of a Giant breast lipoma in a 30 year old woman, histologically confirmed by ultrasound guided core tissue breast biopsy.