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   Table of Contents - Current issue
October-December 2019
Volume 26 | Issue 4
Page Nos. 195-246

Online since Friday, October 4, 2019

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Absence of human leukocyte antigen-B*57:01 amongst patients on antiretroviral therapy in Nigeria: Implications for use of abacavir p. 195
Oche O Agbaji, Maxwell O Akanbi, Ihedinachi Otoh, Patricia E Agaba, Rolake Akinsola, Victoria Okolie, Placid O Ugoagwu, Aliyu A Babadoko, Adewumi Adediran, Finomo O Finomo, Jonah O Abah, Haruna M Muktar, Alani S Akanmu
Background: The presence of human leukocyte antigen (HLA) B*57:01 allele predicts hypersensitivity reaction (HSR) to abacavir (ABC), a nucleoside reverse-transcriptase inhibitor used for human immunodeficiency virus (HIV) treatment. However, the prevalence of this allele amongst Nigerians with HIV is yet to be established. We aimed to determine the prevalence of HLA-B*57:01 allele amongst Nigerians with HIV infection. Methods: We conducted a multicentre cross-sectional epidemiologic survey. Between April 2016 and April 2017, patients were enrolled across five HIV treatment facilities in Nigeria. Participants' demographic information and their history of ABC exposure were obtained, and venous blood was obtained for HLA typing. Results: One thousand five hundred and four (1504) adults were enrolled, with a mean age of 44.6 ± 10.7 years, 1078 (71.7%) were female. 1463 (97.3%) were on antiretroviral therapy. ABC use was reported by 12 (0.8%) participants and none reported HSR. Of 1500 blood samples that were processed, 1458 (97.2%) were successfully typed. Of these, 132 (9.1%) were HLA-B*57 positive using non-specific low-resolution HLA-B*5701 primer mix. On further analysis, none of the 132 samples (0%) had the HLA-B*5701 allele. Conclusion: HLA-B*5701allele is rare amongst Nigerians.
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Ocular morbidity and utilisation of protective eyewear among carpenters in Mushin local government, Lagos, Nigeria p. 199
Onyinyechukwu Mary-Angela Onyekwelu, Olufisayo Temitayo Aribaba, Kareem Olatunbosun Musa, Oluwatobi Olalekan Idowu, Monsurah Olabimpe Salami, Yvonne Nwamaka Odiaka
Context: Proper use of protective eyewear (PEW) is important in the prevention of occupational eye injury. Aim: The aim of this study was to determine the ocular morbidity and utilisation of PEW among carpenters in Mushin Local Government, Lagos, with a view to promoting ocular health and safety in the workplace. Subject and Methods: This was a cross-sectional study of one hundred and fourteen (114) carpenters that were enrolled into the study. Interviewer-administered questionnaires were used to collect information on socio-demographics, work-related ocular history, awareness and utilisation of, as well as barriers to utilisation of PEW. Ophthalmic examination was done. In-depth interviews were also carried out to probe the barriers to utilisation of PEW. Quantitative responses were analysed using the IBM SPSS software, and content data analysis was performed for qualitative responses. Results: The prevalence of reported work-related eye injury and complaints were 30.7% and 32.5%, respectively. The prevalence of ocular morbidity among the respondents was 74.6%. Seventy-seven respondents (67.5%) were aware of PEW; only 21.1% owned PEW, whereas the utilisation level was 26.3%. In-depth interviews revealed ignorance, forgetfulness, and unfamiliarity as the key barriers to PEW use. The odds of using PEW were about three-fold with previous eye injury at work and history of eye complaint. Conclusions: This study demonstrates a significant prevalence of ocular morbidity and poor utilisation of PEW among carpenters in Mushin, Lagos. There was a significant relationship between previous eye injury or complaint and PEW use. Thus, there is a need to create awareness among carpenters and develop occupational safety policies to improve the use of PEW.
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Ocular manifestations of leukaemia: A teaching hospital experience p. 205
Olubanke Theodora Ilo, Adetunji O Adenekan, Adegboyega Sunday Alabi, Adeola O Onakoya, Olufisayo Tade Aribaba, Michael Olufemi Kehinde, Omolola Salako
Background: Knowledge of the ophthalmic manifestations of leukaemia is important not only because of the frequency with which changes are seen but because the eye often reflects the disease state of the illness, and once identified, prompt referral, early treatment can be instigated, blindness can be averted and a life may be saved. These manifestations are often overlooked because of the underestimation of the magnitude of the ocular sequelae which may be blinding. Aim: This study aims to describe the ophthalmic findings in adult leukaemic patients at two teaching hospitals in Lagos, Nigeria. Patients and Methods: This was a clinic-based, comparison multicentre study conducted at Lagos University Teaching Hospital and Lagos State University Teaching Hospital over a 9-month period of May 2012–January 2013. The cases were newly diagnosed leukaemic patients (acute and chronic) from the haematology clinics. Controls were escorts of apparently normal patients. Detailed ocular examination was carried out after written informed consent was obtained. Analysis was done using SPSS 17. Results: A total of 160 eyes in 80 individuals examined comprised forty cases and forty controls. The results of the cases were compared with the age- and sex-matched controls. Leukaemic-related ophthalmic manifestations were present in 56 eyes (70.0%) of the cases studied. Findings in cases were periorbital oedema in 8 eyes (10%), subconjunctival haemorrhage in four eyes (5%), intraretinal haemorrhage as found in 25 eyes (31.3%), retinal venous tortuosity in 21 eyes (26.3%), Roth spots in 19 eyes (23.8%) and retinal infiltrates in 17 eyes (21.3%). Conclusion: Ophthalmic disorders occur in adult patients living with leukaemia. Prompt initial and periodic ophthalmic evaluation is recommended in all leukaemic patients.
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Drug treatment presentations at a treatment centre in southern Nigeria (2015–2018): Findings and implications for policy and practice p. 211
Bawo O James, Sunday O Olotu, Olaniyi O Ayilara, Olubukola O Arigbede, Goodnews I Anozie, Hope O Ogiku, Joy O Ariyo, Veronica Efiong, Adeola O Adeyelu, Majesty A Oni, Dora O Odu
Introduction: Recent evidence suggests that rates of drug use and abuse in Nigeria exceed the global average. There is a strong treatment demand for psychoactive drug use disorders in Nigeria; however, it is not known whether available treatment facilities are attending to the array of treatment needs. This audit compares the pattern of presentations at a tertiary facility with a community-based survey. Methods: A review of cases (n = 212) seen at a regional drug treatment facility over a 4-year period, using local data retrieved from the Nigerian Epidemiological Network of Drug Use (NENDU) and comparison with data from the recently published national drug use survey. Results: Nine out of ten clients seen were male (93.4%). About half (49.5%) of the clients used psychoactive substances for the first time between ages 10 and 19 years. Cannabis was the primary drug of use overall and also among males, while females were more likely to present with opiate abuse. Over half had a co-occurring physical or mental disorder, and a minority had received testing for hepatitis C in the past 12 months. Conclusion: Although patterns of drug abuse presentations were consistent with findings from a national community-based survey, there was an under-representation of females in treatment. Implications for policy development and practice are discussed.
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Predictors of mortality in outborns with neonatal sepsis: A prospective observational study p. 216
Rajkumar Motiram Meshram, Vishal S Gajimwar, Swapnil D Bhongade
Background: Neonatal sepsis-related mortalities are the outcome of a complex interaction of maternal–foetal colonisation, transplacental immunity and physical and cellular defence mechanisms of neonates. Objective: The objective of this study was to evaluate the risk factors of mortality in outborn neonatal sepsis. Materials and Methods: A 1-year prospective observational study was undertaken at a tertiary care centre. All referred neonates with maternal and neonatal risk factors of sepsis were enrolled. Blood culture, sepsis screen and other relevant investigations were performed. Results: The mortality rate of neonatal sepsis among outborns was 38.24%. The common presentations of these neonates were respiratory distress, lethargy and hypothermia. On univariate analysis, significant risk factors for mortality included male sex (P = 0.05), weight on admission <1500 g (P < 0.001), hypothermia (P = 0.003), respiratory distress (P = 0.04), cyanosis (P = 0.001), convulsions (P = 0.02), prolonged capillary refill time (P < 0.001), thrombocytopenia (P < 0.001), abnormal radiological finding (P = 0.01), cerebrospinal fluid cellularity (P = 0.002) and positive C-reactive protein (P < 0.001). Maternal factors such as hypertension in pregnancy (P = 0.001) and antepartum haemorrhage (P = 0.03) were associated with statistically significant mortality. Gestational age (odds ratio [OR]: 0.49, confidence interval [CI]: 0.26–0.90, P = 0.02), weight on admission (OR: 1.57, CI: 1.08–2.27, P = 0.01), age at admission (OR: 0.89, CI: 0.78–0.99, P = 0.04), distance travelled with neonate (OR: 1.01, CI: 1.00–1.01, P = 0.003), duration of hospital stay (OR: 0.69, CI: 0.63–0.74, P < 0.001), hypothermia (OR: 1.87, CI: 1.01–3.42, P = 0.04), convulsion (OR: 2.88, CI: 1.33–6.20, P = 0.007), cyanosis (OR: 2.39, CI: 1.07–5.35, P = 0.03) and prolonged capillary refill time (OR: 3.34, CI: 1.78–6.24, P < 0.001) were the independent predictors of mortality in neonatal sepsis. Conclusion: Gestational age; birth weight; long distance travelled with neonate and presentation with hypothermia, cyanosis, convulsions and prolonged capillary refill time were the independent risk factors for mortality in neonatal sepsis among outborns.
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The use of uterine artery doppler indices for prediction of pre-eclampsia in Port-Harcourt, Nigeria p. 223
Emecheta Gabriel Okwudire, Omolola Mojisola Atalabi, Ugonna Micheal Ezenwugo
Context: Pre-eclampsia (PrE), a clinical syndrome characterised by elevated blood pressure arising after 20 weeks of gestation, is a leading cause of maternal death worldwide. We evaluated the role of uterine artery Doppler (UtAD) in screening for PrE among unselected, pregnant women. Methodology: This was a prospective cohort study of 170 healthy gravid women between 18 and 26 weeks of gestation recruited consecutively from the Antenatal Clinic of Braithwaite Memorial Specialist Hospital, Port-Harcourt, Nigeria, between July 2016 and June 2017. All had UtAD scans with an abnormal result defined as pulsatility index (PI), resistance index or systolic/diastolic (S/D) ratio >95th centile for gestational age or proto-diastolic notching. Outcome was obtained from antenatal records. Data were analysed using Statistical Package for Social Sciences, version 20 at statistical significance level of P < 0.05. Results: The prevalence of PrE was 7.6%. There was significant association between an abnormal PI (χ2 = 16.29, P = 0.00), S/D ratio (χ2 = 8.55, P = 0.00) and the combined result (χ2 = 11.5, P = 0.007) with subsequent PrE. The highest sensitivity (53.8%) was obtained for the combined result with specificity, negative predictive value (NPV) and positive predictive value of 86.6%, 95.8% and 25%, respectively, area under the curve (AUC) of 0.71 (95% confidence interval [CI]: 0.534–0.871). A normal result had a very high NPV for all indices. The accuracy for the prediction of severe PrE was greater for all indices being highest for the combined result AUC of 0.830 (95% CI: 0.624–1.000; P = 0.01). Conclusion: Abnormal UtAD indices were associated with PrE and may be used in PrE screening.
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Alcoholism amongst geriatric patients attending general practice clinic of a Teaching Hospital in Benin City, Nigeria p. 230
Ehigiator Okohue Adayonfo, Afolabi Joseph Adewole, Mary Ehimigbai
Context: Alcoholism or alcohol use disorder (AUD) is common among the elderly, though under-recognised and underreported. This under-reporting is especially so in Africa, including Nigeria where there is near absence of study on the subject matter. Aims: This study aims to determine the prevalence of alcoholism amongst geriatric patients at the general practice clinic (GPC) of a teaching hospital and to assess some associated socio-demographic factors. Materials and Methods: The study was cross-sectional and descriptive, conducted at the GPC of the University of Benin Teaching Hospital, Benin City, Nigeria. Four hundred and twenty-two geriatric outpatients completed the geriatric version of the Short Michigan Alcoholism Screening Test and a socio-demographic data collection sheet. Cross-tabulation of categorical variables was performed by means of IBM SPSS statistics for windows version 19.0, with the level of significance set at P <0.05. Results: The prevalence of AUD was 10.2%; the prevalence amongst males and females was 18.1% and 5.3%, respectively. AUD was present in 14.4%, 6.84% and 4.55% of those who had marital conflict, chronic pain and difficulty with walking, respectively. Sex, age group, financial difficulty, chronic pain and difficulty with walking were significantly associated with AUD. Conclusions: The prevalence of AUD amongst geriatric patients is relatively high. The deleterious effects of alcoholism may be worse in the elderly due to changes that occur with aging and their likelihood to be on medications that may interact adversely with alcohol.
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Ectopic pregnancy in Dalhatu Araf Specialist Hospital Lafia Nigeria – A 5-year review p. 235
Chidiebere Nwakamma Ononuju, Adejo Emmanuel Ogbe, Lucky Lohnan Changkat, Blaise Ogedi Okwaraoha, Uzoma Emmanuel Chinaka
Context: Ectopic pregnancy is a common life-threatening emergency and a notable cause of maternal morbidity and mortality. Aims: This study aims to determine the prevalence of ectopic gestation, the associated risk factors, the pattern of presentation and management of ectopic pregnancy in Dalhatu Araf Specialist Hospital (DASH) Lafia. Patients and Methods: This was a retrospective study of all cases of ectopic pregnancy managed at the gynaecological unit of the DASH Lafia, North-central Nigeria from 1st January, 2013 to 31st December, 2017. The data were analysed with simple descriptive statistics and were reported as frequencies and percentages. Results: During the 5-year period, there were a total of 93 ectopic pregnancies, 10,401 deliveries and 3399 gynaecological admissions in the hospital. The prevalence of ectopic pregnancy was 0.89% of all deliveries and 2.74% of all the gynaecological admissions. The majority of the patients were in the age group of 26–30 years, and significant number of the affected them were nulliparous, 30 (32.3%). Furthermore, majority of the patients had past history of sexually transmitted diseases 48 (51.6%), multiple sexual partners 40 (43.0%) and induced abortions. Abdominal pains, amenorrhoea and vaginal bleeding were the most common presenting complaints. Unilateral salpingectomy was done for majority of the patients. Conclusions: Ectopic pregnancy is an important gynaecological challenge associated with notable morbidity. Past history of sexually transmitted diseases, multiple sexual partners and induced abortions were the associated risk factors identified, and nulliparous women were mostly affected. This can limit their future reproductive accomplishments. Targeted health education campaigns should be embarked on to enlighten this group of women and the public at large.
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Incidence, spectrum and outcome of congenital anomalies seen in a neonatal intensive care unit in Southern Nigeria p. 239
Rosena Olubanke Oluwafemi, Moses Temidayo Abiodun
Background: Congenital anomalies (CAs) refer to defects that are present in a newborn but occurred during intrauterine life. They can be due to genetic, modifiable environmental or multifactorial causes. There was no prior report of their burden in our state. Aims: This study aims to describe the incidence, spectrum, predisposing factors and outcome of CAs in our setting. Methods: It was a total population study of all neonates with major birth defects admitted into the unit during the study period. Their clinical–demographic features, diagnoses and outcome were entered into an excel sheet. Clinical detection of birth defects was based on standard diagnostic criteria. The data were analysed using IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Patterns and outcome of birth defects were presented as proportions. Selected characteristics were tested for possible association with birth defect using Fisher's exact test. The level of significance was set at P < 0.05. Results: The incidence of major CAs was 4.3/1000 live births. Female neonates were more affected (59.0%). Participants' mean gestational age was 37.7 ± 3.3 weeks. Central nervous system anomalies were the most common (38.5%) birth defects. These were followed by musculoskeletal, body wall and digestive system anomalies: 28.2%, 23.1% and 10.3%, respectively. One-third (33.3%) of the infants had multiple anomalies. Nearly three quarters of them (74.0%) were referred, 18.0% died while 5.0% were discharged alive. Conclusion: A wide range of CAs occur in our setting with dire consequences. Provision of relevant specialised multidisciplinary care is desirable. Furthermore, pubic enlightenment on its modifiable possible causes can reduce the burden.
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Multiple pigmented macules as a sequel of cosmetic lip micro-pigmentation: New clinical presentation of tattoo reactions p. 244
Bahareh Abtahi-Naeini, Zabihollah Shahmoradi, Mahdi Hadian, Elmira Niknami, Ali Saffaei
Cosmetic tattooing using micro-pigmentation has gained popularity in recent years. Tattoos can cause a broad range of clinical and psychosocial problems. Several medical complications may arise after tattooing. A 35-year-old female was referred with an 8-week history of grey-to-smoky hyperpigmentation of permanent makeup of lips and lip lines. Histopathological examination revealed lichenoid lymphocytic infiltrations in the dermis. Clinical and histopathological findings were compatible with the diagnosis of multiple pigmented macules as a sequel of cosmetic lip micro-pigmentation. Here, we report the first case of lichenoid-type tattoo reactions with new presentation as multiple asymptomatic pigmented macules after lip tattooing. The current report emphasises the requirement of a skin biopsy of all tattoo reactions. Considering the new component in the tattoo material, a dermatologist should be aware of the new clinical presentation of tattoo reactions that may occur.
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