arch-2017-01

Dauda Yahi1, Nicholas A. Ojo, Gideon D. Mshelia, Chukwuka N. Uchendu, Abba B. Zarami, Adenrele O. Adebayo

Purpose: Although benefit/risk analysis is usually undertaken prior to starting a treatment, some conditions will inevitably require the use of drugs with known side effects even during pregnancy. This is the case with dexamethasone use in ante natal care. The purpose of this review was to provide an overview of the uses of dexamethasone and its impacts on pregnancy and fertility in humans.
Data source: The review is based on literature searches using PubMed and MeSH and authors' personal manuscript/abstract files and citations of known references. Study selection: The selection of articles reflects the authors' opinion as to originality and importance in the context of the review. The review included human and some aspects of animal study.
Data extraction: The electronic searches were scrutinized and full manuscripts of all quotes considered relevant to the study were obtained. All the articles whose abstracts were not available were excluded.
Results: Dexamethasone use has evolved over the years to include fertility treatment in both males and females in addition to its use in pregnancy to prevent respiratory distress syndrome in neonates despite its side effects due to the fact that its benefits outweigh the risks.
Conclusions: Dexamethasone use has evolved over the years to include fertility treatment in addition to use in the prevention of respiratory distress syndrome. Low doses have no major adverse effects; however, repeated doses and long-term therapy are associated with more serious sequelae. It is recommended that dexamethasone therapy be incorporated into maternal and neonatal health care services

Ladu AI, Aisha MA

ABSTRACT: Chronic myeloid leukaemia is triphasic, clonal malignancy, arising from the haemopoeitic stem cell. It is characterized by the presence of philadelphia chromosome, which result from reciprocal translocation between chromosome 9 and 22. The resulting oncogen- brc-abl has proliferative activity and survival advantage against normal cell and this account for the clinical and laboratory manifestation of this myeloproliferative disorder. Imatinib, a tyrosine kinase inhibitor (TKIs) is currently the first line of treatment, however, one third of patient develope resistance to it, thus necessitating alternative TKIs. Many factors are associated with the development of resistance to imatinib, such as mutation in the brc-abl gene, increase production of the mutant protein and activation of alternatve pathways amongst other causes. The aim of this reveiw is to explore these factors, and also to avaluate current TKIs that are use as alternative in Imatinb resistant cases.

Background: Trans-vaginal sonography has revolutionized the assessment of the gynaecology patient and evaluation of early pregnancy complications. Trans-labial and trans-rectal sonographies also play some role in the evaluation of such group of women.
Objective: To assess the acceptability of women to trans-vaginal, trans-labial and trans-rectal sonography. Materials and methods: This is a cross sectional study of unselected women attending obstetrics and gynaecology clinics of the University of Maiduguri Teaching Hospital from January to March 2015.
Results: There were 164 participants with a mean age of 29±5.19 years. Majority 52(31.7 %) were aged between 25-29 years; while 26(15.9%) were more than 35 years. A large proportion of women were currently married 149(90.8%). Most, 81(49.4%) were multipara. Majority of respondents 69(42.1%) had tertiary education while 17(10.3%) had no formal education. Muslims, 144(87.8%) were in the majority. The highest proportion of women were Kanuri/Shuwa ethnic group 83(50.6%), with most 117(71.3%) being housewives. The acceptance for Trans-vaginal scan (TVS), Trans-labial scan (TLS) and Trans-rectal scan (TRS) were 106(64.6%), 124(75.6%) and 97(59.1%) respectively. Only 2(1%) had TVS previously. Reasons for not accepting the various methods include pain, fear, lack of privacy, not comfortable, may cause problems, may affect the uterus and never done it before. Peculiar reasons for not accepting TRS include the fact that it is disgusting and shameful.
Conclusion: The highest level of acceptance was for TLS, closely followed by TVS and the least was acceptability of TRS. Overall, the level of acceptance high for all the modalities studied. The reasons for not accepting the studied modalities concerns that could be allayed during counseling for the procedure as the reasons are groundless.

Abba AM , Ladu AI, Bukar AA, Abjah UAM, Kagu MB

Background: Iron deficiency remains one of the frequent complications encountered by regular blood donors, with each unit (450mls) of donated blood containing about 250mg of iron. Although most centers utilize capillary haemoglobin in determining the eligibility to serve as a donor, haemoglobin level is a poor indicator of body iron status since depletion of iron store can be present in the absence of overt anaemia. Serum hepcidin has been found to be low in people with iron deficiency, and may serve as a surrogate for depleted iron stores.
Aim: To study the levels of serum hepcidin as a marker of iron deficiency in first time blood donors and subjects with history of multiple blood donation at a tertiary hospital in North-East Nigeria.
Methods: Eligible and consenting voluntary first time and repeat blood donors were consecutively recruited at the transfusion unit of the University of Maiduguri Teaching Hospital. Serum hepcidin level was assayed in all participants using quantitative ELISA technique, and classified into low, normal and high based on recommendation of the manufacturer of assay kits.
Results: One hundred and eighty apparently healthy donors comprising 90 first time donors (control) and 90 repeat donors (subjects) were studied. Their ages ranged from 18 years to 60 years, with a mean of 30+6.20 years and 27.43+5.28 years for subjects and controls respectively (p=0.45). The median serum hepcidin of subjects and controls was 1.43(2.47) and 1.23 (2.43) respectively (p=0.375). Twenty one (23.3%) of subjects had low serum hepcidin compared to 22 (24.4%) of the controls. Serum hepcidin level did not significantly differ between male subjects and controls (p=0.079) or female subjects and controls (p=0.77) No correlation was observed between the frequency of donation and hepcidin (p=0.323).
Conclusion: There is a high prevalence of low hepcidin levels among individuals deemed eligible for blood donation in this environment. This implies that screening for donor eligibility using haemoglobin could result in use of iron deficient individuals as donors. Detection of low hepcidin in blood donors will help identify donors with low iron store, which may be important in preventing them from becoming anaemic following further donation

Buba AA, Kullima A, Isa B, Ibrahim SM, Bukar M, Audu BM

Background: In most developing countries like Nigeria, female sterilization is not a popular method of contraception.
Objective: The objective of this study was to determine the prevalence of female sterilization and socio-demographic characteristics of women who had sterilization in our setting.
Methodology: This was a retrospective study carried out between 1st January 1997 and 31 December 2006.A total of two hundred and one female sterilisation operations were performed but ten case notes were incomplete and therefore, one hundred and ninety one 191 were analyzed. Information retrieved from the case notes included the age, parity, religion, literacy, and type of bilateral tubal ligation. The data collected were analyzed using SPSS Version 16.0 statistical package and the results represented in simple tables and percentages.
Results: There were 16,319 deliveries during the study period and 201women had bilateral tubal ligation (BTL), giving a prevalence of 1.2%. The mean age at BTL was 30.18, while the mean parity was 4±0.6. Women between the ages of 30-39 constituted majority of the patients. In most of the women 138 (72.3%) bilateral tubal ligation was performed during caesarean section, while few women 16 (8.4%) had the procedure at laparotomy. The rest, 37(19.4%) women opted for interval BTL. Significantly more literate women (73%) sought for interval tubal ligation compared to non literate (23%) ones. A large number of the Muslims (87.5%) had BTL at laparotomy compared to the Christians (12.5%). P=0.002.
Conclusion: The prevalence of bilateral tubal ligation in this study is low. There is need to encourage the uptake of female sterilization in our environment

Usman Bello, Samaila Moodupeola Omotara , Yawale Iliyasu

Background: Diseases of the liver are a significant cause of morbidity and mortality in children. The patterns of hepatic disorders in this age group differ greatly from adults and show marked regional variations. The objective of this study is to document the histopathologicpattern of liver disorders in children at a major referral laboratory in Northern Nigeria.
Materials and Method: Consecutive liver biopsies received in the department of pathology, Ahmadu Bello University Teaching Hospital Zaria over a fifteen year period (2001-2015) were processed accordingly. Information on age, sex and duration of disease was retrieved from request cards. Diagnosis was made based on morphological criteria. Collected data were analyzed and presented in frequency distribution table, figures and photomicrographs.
Results: Forty seven cases were analyzed comprising 27 (57.4%) males and 20 (42.6%) females with male to female ratio of 1.3: 1. Their ages ranged from two months to 15 years with mean age of 7.5 years Children aged five years and below accounted for 44.7% of cases and of these, ten cases (47.6%) had neonatal hepatitis. Children aged 11-15 years accounted for 42.5% of cases with chronic viral hepatitis being the predominant disease occurring in 15 cases in this age group. All the chronic hepatitis cases were of hepatitis B virus (HBV) infection. Children aged 6- 10 years were the least affected and constituted 12.8% (6 cases) only with hepatic schistosomiasis accounting for half of their liver pathologies. Five of the cases were neoplastic; 4 cases (8.5%) of hepatoblastoma and 1 case (2.1%) of hepatocellular carcinoma (HCC).
Conclusion: Liver disorders in children were age specific; the most common disease in this study was chronic HBV hepatitis seen in older age group while neonatal hepatitis and biliary atresia predominates in younger children

Background: Unilateral spinal anaesthesia offers a number of advantages over the bilateral spinal technique which includes better haemodynamic stability and patient's satisfaction.
Method: Sixty four (64) patients were randomly assigned to two groups, unilateral spinal anaesthesia, (U group) and conventional bilateral spinal anaesthesia, ( B group) .The 'U'group received 2ml of 0.5% bupivacaine made up to 3ml with distilled water while, 3ml of 0.5% bupivacaine was administered to 'B' group. Patients in the 'U' group had the procedure in the lateral decubitus position and remained in that position for 20 minutes, while those in group B had the spinal injection in sitting position and were immediately positioned supine.
Results: All the 64 patients had their surgeries done under the chosen technique successfully. There were more patients in group 'B' that attained Bromage score of IV at 5min than those in group 'U' an indication that motor block was faster in the bilateral group. The haemodynamic parameters were comparable between the study groups at 5, 10, 20, 30 and 50 minutes. There was a statistically significant difference in pulse rate between the two groups at 30 minutes (p=0.04)
Conclusion: Unilateral spinal anaesthesia was more effective compared to bilateral spinal anaesthesia. However, the duration of sensory blocks was shorter and the less haemodynamic disturbances in unilateral spinal anaesthesia compared to the bilateral spinal anaesthesia for lower limb surgery.

Abubakar BM, Abubakar A, Suleiman IE, Makama BS, Abdulhafeez AA, Gashua MG

Background: Urolithiasis has been with mankind since ancient time. Although it is more common in the developed world, the pattern of presentation in the developing countries is tending towards that of developed countries. Objectives: To evaluate the pattern of presentations and treatments offered to patients with urolithiasis over the last 2 years at Federal Medical Centre (FMC), Nguru.
Materials and Methods: The study is a 2-year retrospective review of patients managed for urolithiasis at FMC Nguru. The patients' bio-data, pattern of presentation and radiological features of the stones, as well as the treatment given to the patients, were reviewed.
Results: The records of 55 patients were reviewed; the mean age was 24.1 years with a range of 1.5 to 70years. The male to female ratio was 10:1. The most common presenting symptom was painful micturition in 21 patients (38.18%). The total number of stones extracted was 58, one patient had multiple right renal pelvic calculi, another had bilateral renal pelvic stone and the third patient had bladder and distal ureteric stone. Two patients (3.64%) expelled their calculi while awaiting surgery, the remaining 53 patients (96.36%) had opened surgical treatment. Most of the stones are in the bladder in 29 patients (52%). Twenty-one patients (38.18%) had upper urinary tract stones out of which 13 were in the renal pelvis.
Conclusion: Urolithiasis is also common in the developing communities. Despite the changing pattern from lower to the upper tract in developed countries, we found lower tract stone dominating as seen in many underdeveloped. This may be attributable to yet to establish environmental or genetic factors.

BackgroundSpinal cord injury is commonly associated with morbidity and mortality. This is further worsened by inadequate rehabilitation because of dearth of infrastructure, equipment and personnel
Objectives:To identify the complications and causes of death in traumatic spinal cord injury patients.
Methodology: A 4-year retrospective review of all traumatic spinal cord injured patients treated at Benue State University Teaching Hospital Makurdi was conducted. The information on age, sex, occupation, cause, associated injuries, level of injury, neurological deficit, American spinal cord injury association (ASIA) score at presentation, complications and outcome were obtained from medical records department. Data were analyzed using Statistical Package for Social Sciences (SPSS) 17.0 (SPSS Inc. Chicago, IL, USA).
Results: There were 62 patients with a mean age of 36.02±1.67 years (range 8-77 years) consisting of 54 males and 8 females giving a male to female ratio of 6.8:1. They included students 13(21%) and farmers 10(16.1%). Road traffic crash accounted for 35(56.5%). Majority had cervical spine injury 22(62.8%) and accounted for complications in 20(36.4%). Bed sores occurred in 22(35.5%). ASIA A had the highest frequency of complications 22(35.5%). Eleven patients died giving a case fatality of 31.4%. The patients died from respiratory failure 4(36.4%) and sepsis 2(18.2%).
Conclusion: Many complications including bed sores and orthostaticpneumonia result from spinal cord injury leading to high morbidity and death from sepsis and respiratory failure

Background: Toxoplasmosis among the human immunodeficiency virus (HIV) positive individuals with low CD4+cell count can be severe leading to the reactivation of dormant bradyzoites which can lead to morbidity and/or mortality. A reservoir for T. gondii, cat is common around our study area both as pets and stray animals.
Study Objective: Is to determine the seroprevalence of T. gondii infection in this community and also to investigate the association between T. gondii infection and CD4 count other risk factors.
Methods: Blood specimens were collected from a total of 282 adult HIV positive patients attending a tertiary health facility clinic by systematic sampling and the IgG and IgM levels were detected using the enzyme-linked immunosorbent assay (ELISA) technique. Similarly blood was also collected from 60 healthy blood donors as control group.
Results: Out of a total of 282 samples analyzed, 189 were positive for IgG (67%) and 93 were negative. All 282 samples were negative for IgM antibody. A total of 280 had their CD4+cell count above 200cells/microlitre of blood and only 2 recorded less than 200. Nineteen (31.7%) of the 60 blood donors in the control group were positive for IgG and all negative for IgM. The high seroprevalence rate of IgG toxoplasma antibody among HIV positive patients as reported in this study suggests that there should be a high index of suspicion of the recrudescence of toxoplasmosis among HIV and AIDS patients in our environment and possibly elsewhere

Context: Laboratory testing constitutes an integral part of patient management and has an extensive influence on medical decision-making. The completion of laboratory investigation request forms is a vital aspect of the highly variable pre-analytical phase of laboratory testing.
Aim: We aimed to assess the adequacy of completion of investigation request forms received at our laboratory.
Methods: An audit of systematically selected laboratory investigation request forms received over a six-month period at our laboratory was performed to assess the degree of completion of these forms by requesting clinicians. Data was analysed using Microsoft Excel®.
Results: Two hundred and fifty four request forms were reviewed. None of the reviewed forms was adequately completed. The clinician's contact number was missing in all the request forms. About two-thirds of the request forms did not have the patient's hospital number (66.1%) and the referring clinician's signature (66.9%) available on them. The clinical diagnosis of the patient was not stated in 18.9% of the request forms. The patient's name, gender and age were the most frequently completed parameters in 100.0%, 98.4% and 97.2% of the request forms respectively.
Conclusion: Basic information required for the accurate interpretation of laboratory results are missing in several request forms. This may have deleterious impact on laboratory turnaround time, healthcare costs and patient management as most medical decisions are influenced by laboratory results

Background: Referrals from primary care practitioners such as optometrists to other health care providers is critical to the health care delivery system of any society.
Aim: To explore the atterns of referrals of Nigerian optometrists with respect to glaucoma and diabetic retinopathy.
Methodology: A cross-sectional exploratory survey using a 28-item questionnaire was administered to optometrists attending the 37th annual general meeting of the Nigerian Optometric Association. Responses were coded and analyzed using the Statistical Package for Social Sciences (SPSS) version 17. Appropriate descriptive and inferential statistics were used to report the pertinent findings of the study relevant to the study objective.
Results: About 70% and 93.1% of respondents refer glaucoma and diabetic retinopathy patients respectively to other care givers mainly ophthalmologists. Majority initiate treatment before referral. Female optometrists were more likely to refer both conditions. Both male and female respondents were more likely to refer diabetic retinopathy than glaucoma patients.
Conclusion: Majority of Nigerian ptometrists refer glaucoma and diabetic retinopathy patients to ophthalmologists; though more than half of the respondents will initiate treatment for glaucoma before referral. However prompt referral is highly advocated

Background: Self insertion of foreign body into the urethra to achieve orgasm is a rare secretive sexual practice, patients usually presents in the hospital with complications of the act. Vesical calculus encasing the foreign body is a rare complication.
Objectives: To report a case of vesical stone as a sequel of a rare sexual practice
Case: We report the case of 21-year-old male student who presented with progressive lower urinary tract symptoms and background history of self-insertion of foreign body into the urethra and got retained in the bladder for long. He had cystolithotomy done with findings of doughnutlike calculus encasing a coiled cable. Post-operative outcome was satisfactory.
Conclusion: Sexual gratification derived by inserting foreign body into the urethra is rare. Public health enlightenment will discourage this act and its potential complications.

Background: Generalized aggressive periodontitis is a rare periodontal disease characterized by generalized loss of alveolar bone usually affecting young individuals and may result in early tooth loss and psychological effects. Severity of the periodontal effects vary among patients and depends on duration before presentation, and may also determine the options and outcome of treatment.
Objectives: A case report of generalized aggressive periodontitis managed in our centre and review of available literature on the subject in English language.
Case: A 32-year-male who presented with 18months history of mobile, mal-aligned teeth and bad breath at the oral diagnosis clinic of the University of Maiduguri Teaching Hospital, Maiduguri. Extra-oral examination revealed bilaterally enlarged submandibular lymph nodes- firm, mobile and not tender. Intra-orally, the patient had a full complement of teeth except the lower right first premolar. Oral hygiene was fair but with presence of suppuration from the gingiva around the lower incisors and the lower right first molar
Conclusion: Clinical outcome of treatment is better with early diagnosis. A consensus on case definition is needed for epidemiological studies. The case presented demonstrated the clinical and radiological features necessary for diagnosis of the condition