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   Table of Contents - Current issue
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October-December 2018
Volume 25 | Issue 4
Page Nos. 197-269

Online since Friday, December 21, 2018

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ORIGINAL ARTICLES  

Assessment of iron deficiency anaemia and its risk factors among adults with chronic kidney disease in a tertiary hospital in Nigeria p. 197
Yemi Raheem Raji, Samuel Oluwole Ajayi, Titilola Stella Akingbola, Olupelumi A Adebiyi, Kayode S Adedapo, Batunde Lawal Salako
DOI:10.4103/npmj.npmj_106_18  PMID:30588939
Introduction: A substantial proportion of patients with chronic kidney disease (CKD) develop iron deficiency anaemia (IDA). Despite the association of IDA with adverse cardiovascular outcomes, it remains underdiagnosed and poorly managed. Up to 70% of patients with CKD are anaemic at the time of initiating dialysis, while the predictors of IDA in these patients in our setting are unknown. This study aimed to determine the prevalence and risk factors for IDA in patients with CKD. Materials and Methods: This is a case–control study of 157 patients with CKD and 157 age and gender matched subjects without CKD. Information obtained from the participants were socio-demographic details, aetiology of CKD, medication history and features of IDA. All participants had serum ferritin, total iron binding capacity (TIBC), transferrin saturation (TSAT), highly sensitive C-reactive protein, serum creatinine and complete blood count determined. Results: The median estimated glomerular rate (22.7 [3.4–59.5] vs. 110.2 [60.3–152.8] ml/min/1.73 m2, P < 0.01), the mean haemoglobin concentration (9.3 ± 2.6 vs. 11.4 ± 1.7 g/dl, P < 0.01), and TSAT (27.9% ± 6.4% vs. 34.8% ± 8.1%, P < 0.04) were significantly lower in patients with CKD. The mean age, serum ferritin and TIBC were similar in both groups. The prevalence of absolute (24.8% vs. 13.4%, P < 0.01) and relative (17.8% vs. 7.6%, P < 0.01) iron deficiencies were higher among individuals with CKD compared to the controls. Female gender (odd ratio [OR]:1.50, 95% confidence interval [CI]:1.0267–4.1163, P < 0.04) and severity of CKD (OR: 3.43, 95% CI: 1.5568–7.8324, P < 0.02) were independently associated with IDA. Conclusion: IDA is common among individuals with CKD while female gender and severity of CKD were factors that independently predicted IDA.
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Depression among ambulatory adult patients in a primary care clinic in southeastern Nigeria p. 204
Gabriel Uche Pascal Iloh, Grace Uzoamaka Aguocha, Agwu Nkwa Amadi, Miracle Erinma Chukwuonye
DOI:10.4103/npmj.npmj_107_18  PMID:30588940
Background: Depression is a global health problem that occupies eminent position in clinical and community mental health. As the global prevalence of depression increases, the sociomedical challenges associated with it increase, especially in resource-constrained environment. Aim: The study was aimed at describing depression among ambulatory adult patients in a primary care clinic in Southeastern Nigeria. Patients and Methods: A cross-sectional descriptive hospital-based study was carried out on 400 adult patients in a primary care clinic of Federal Medical Centre, Umuahia. Data on relevant epidemiological variables were collected using pre-tested, structured interviewer-administered questionnaire. Patient Health Questionnaire-9 was used to assess for depression. Data were analysed using the Statistical Package for the Social Sciences software version 21. Test of associations was done using Chi-test and logistic regression, and P < 0.05 was considered statistically significant. Results: The age of the study participants ranged from 18 to 78 years with mean age of 38 ± 9.2 years, and there were 40.5% males. The prevalence of depression was 48.5% with the most common type being mild depression (32.3%). Occurrences of symptoms were most frequent and severe in the home environment (59.8%) and during the night (62.9%). Hypertension (35.5%) and alcohol use (57.5%) were the most common medical condition and substance used, respectively. Depression was significantly associated with elderly age (P = 0.005), females (P = 0.017), physical inactivity (P = 0.039) and psychosocial stressors (P = 0.042). The most significant predictor of depression was elderly age (adjusted odds ratio = 2.50; 95% confidence interval [1.40–3.78]; P = 0.001). Older persons were three and half times more likely to have depression when compared to their counterparts who were younger. Conclusion: This study has demonstrated high prevalence of depression and some epidemiological factors in the occurrence of depression among the study participants. Depression occurred predominantly among the elderly, females, physically inactive, hypertensive and those who had psychosocial stressors. Occurrences of symptoms were most frequent at home and nighttime. The most commonly used substance was alcohol.
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Transabdominal repair of vesicovaginal fistulae: A 10-year tertiary care hospital experience in Nigeria p. 213
Rufus Wale Ojewola, Kehinde Habeeb Tijani, Emmanuel Ajibola Jeje, Moses Adebisi Ogunjimi, Emmanuel Abayomi Animashaun, Olanrewaju Nurudeen Akanmu
DOI:10.4103/npmj.npmj_154_18  PMID:30588941
Background: Vesicovaginal fistula (VVF) is still a major cause for concern in many developing countries. Arguments continue as to the best approach for repair. This study aimed to present our experience with transabdominal VVF repair. Subjects and Methods: This was a 10-year retrospective review of transabdominal VVF repair. Important data extracted from the case notes included patients' demography, aetiology, previous repair, operative findings, procedures and treatment outcome. Data were analysed using SPSS version 21. Bivariate analysis of factors affecting treatment outcome was carried out with the level of significance set at P < 0.05. Results: Fifty-three VVF repairs were carried out in 51 patients. Mean age was 29.8 ± 15.4 years. Forty-five (84.9%) had previous repairs. The aetiologies of VVFs were prolonged obstructed labour in 41 (80.4%) and post-operative in 10 (19.6%). Forty-one repairs were through a transperitoneal transvesical approach whereas 12 had an extraperitoneal transvesical approach. The fistulae diameter ranged from 0.3 to 2.8 cm with an average of 1.64 cm. Six had ureteric re-implantation; (bilateral in two patients). Repair was successful in 47 (88.7%) cases, which translated to the overall success rate of 92.1% in the 51 patients treated. Success rate was higher (95.6%) for the subset of patients who had previous transvaginal repairs. Catheter blockage in the post-operative period was a significant factor that had effect on outcome (P < 0.015). Conclusion: Transabdominal repair recorded an excellent result in patients who had previously failed transvaginal repairs and may be considered as the first option in these patients.
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Ultrasonographic characterisation of obstructive uropathy in Nigerian women with uterine fibroids p. 220
Bukunmi Michael Idowu, Bolanle Olubunmi Ibitoye, Victor Olufemi Oyedepo, Stephen Olaoluwa Onigbinde, Tolulope Adebayo Okedere
DOI:10.4103/npmj.npmj_122_18  PMID:30588942
Objectives: The objective of this study was to determine the prevalence of upper renal tract obstructive changes in women with uterine fibroids using ultrasonography (USG). Methods: We enrolled 140 women with uterine fibroids and performed USG of the uterus and upper renal tract with full and empty urinary bladders, respectively. The number of fibroid nodules and the uterine volume were determined. The presence of hydronephrosis was graded and documented. Uterine volumes >200 cm3 were denoted as large and vice versa. Statistical analysis was done using Chi-square and non-parametric tests. Results: The median uterine volume was 556 cm3. Application of a 200 cm3 cut-off value yielded 126 (90%) large uterine volumes and 14 (10%) small uterine volumes. Of the 140 women enrolled, 52 (37.1%) had renal backpressure changes. Of these 52 patients, 51 (98.1%) had uterine volumes >200 cm3. Both kidneys were affected in the vast majority (36 out of 52 = 69.2%) of those with renal backpressure changes, and 23 (44.2%) of the 52 women with renal backpressure changes had mild (Grade 1) hydronephrosis, while 25 (48.1%) had moderate (Grade 2) hydronephrosis. When unilateral, however, backpressure changes were significantly more common on the right side. Conclusion: Approximately one in three women with fibroids had renal backpressure changes in this study. Large uterine volume is a key predisposing factor. Routine sonographic assessment of fibroids should include a focused/targeted evaluation of the kidneys.
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Experience and knowledge of child abuse and neglect: A survey among a group of resident doctors in Nigeria p. 225
Olubukola Olamide Olatosi, Philip U Ogordi, Folakemi A Oredugba, Elizabeth O Sote
DOI:10.4103/npmj.npmj_92_18  PMID:30588943
Background: Child abuse and neglect (CAN) is a significant public health problem. Dentists are in good position to identify and report cases of CAN. Aim: The aim of this study was to determine the experience and knowledge of CAN among a group of Nigerian dental residents. Materials and Methods: This was a cross-sectional study carried out among dentists attending a postgraduate update course. Data were collected to assess the knowledge of respondents on the forms of CAN, indicators and risk factors. Respondents' professional experiences were also assessed as well as actions taken and possible barriers to reporting suspected cases. Results: Data were collected from 179 respondents, with a mean age of 33.1 ± 5.2 years. The respondents demonstrated good knowledge of the forms of child abuse, with an average score of 95.2%. The risk factors for CAN were correctly identified by 153 (85.5%) respondents as children with physical/mental disabilities, 151 (84.4%) as products of unwanted pregnancies, 128 (71.5%) as children from polygamous families and 122 (68.2%) as children from low socioeconomic families. Physical, sexual and emotional abuse and neglect were majorly identified as bruises behind the ears, 162 (90.5%); oral warts, 114 (63.7%); poor self-esteem, 158 (88.3%) and untreated rampant caries, 137 (76.5%), respectively. Seventy-four (46.5%) of the respondents did not evaluate children for CAN and only 12 (14.1%) of those who observed suspected cases of CAN reported to the social service. Lack of knowledge of referral procedures and concerns about confidentiality were the major barriers to reporting cases of CAN. Conclusion: The dentists had good theoretical knowledge of the indicators, risk factors and signs of CAN but lagged in clinical detection and reporting of such suspected cases. There is a need for continuing education and advancement of the postgraduate dental curriculum to improve the educational experiences with regard to CAN.
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Foeto-placental parameters in normal pregnancy and factors affecting them p. 234
Ochuwa Adiketu Babah, Ayodeji A Oluwole, Opeyemi R Akinajo, Emmanuel Owie, Ephraim O Ohazurike
DOI:10.4103/npmj.npmj_97_18  PMID:30588944
Objective: The aim of this study was to evaluate foeto-placental (F/P) parameters, namely foetal birth weight, placental weight (PW) and F/P weight ratio, in normal pregnancy and factors affecting them. Methodology: A retrospective study was conducted on labour ward data obtained over a period of 3 years (2015–2017). Only deliveries above 28-week gestational age which met other selection criteria were included in the study. Their sociodemographic parameters, PW, foetal birth weight, foetal outcome and Apgar scores were extracted from the delivery registers. The F/P weight ratio was calculated from the values obtained. All data collected were subjected to statistical analysis using SPSS version 20. Results: The mean age ± standard error of mean of parturient was 31.84 ± 0.18 years. A larger proportion, 1455 (80.7%) of the women were booked. The mean gestational age ± standard deviation at delivery was 37.81 ± 2.72 weeks. Foetal weight (FW), PW and F/P weight ratio rise progressively with advancing gestational age in normal pregnancy, the FW rising faster than the placenta which gains weight slowly. The F/P ratio rises steadily initially and then abruptly from 42-week gestational age as the foetus outgrows the placenta, after which there is a sharp decline from 43-week gestational age. FW, PW and F/P ratio are significantly affected by gestational age and booking status (P = 0.000). Parity and foetal sex were found to have significant influence on FW alone (P = 0.026 and P = 0.000, respectively). Conclusion: This study clarifies the need to avoid undue prolongation of pregnancy beyond 42 weeks to avert adverse consequences which may be related to the differential growth in the foetus and placenta.
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Dental caries and oral hygiene status: Survey of schoolchildren in rural communities, Southwest Nigeria p. 239
Clara Arianta Akinyamoju, David Magbagbeola Dairo, Ikeola Adejoke Adeoye, Akindayo Olufunto Akinyamoju
DOI:10.4103/npmj.npmj_138_18  PMID:30588945
Purpose: Dental caries and poor oral hygiene cause pain and have an effect on activities of children such as playing, sleeping, eating and school attendance. Previous studies on the prevalence of dental caries and poor oral hygiene have focused more on urban than rural communities in the developing countries. The objective of the study was to assess dental caries and oral hygiene status of schoolchildren in rural communities. Materials and Methods: It was a cross-sectional study involving 778 schoolchildren from 12 public primary schools. A pre-tested, semi-structured interviewer-administered questionnaire was used to obtain information on socio-demographics and oral health practice. Dental caries was assessed using the decayed, missing and filled teeth (DMFT) index and oral hygiene status by the simplified oral hygiene and gingival indices. Results: The mean age of the children was 11.0 ± 1.8 years, and the prevalence of dental caries was 12.2% with a mean DMFT/dmft of 0.2 ± 0.7. Children aged 10–12 years were 3 times more likely to have caries on ≥1 tooth (P = 0.01, confidence interval = 1.3–6.7). Herbal remedies were more often (35.3%) used to manage dental problems. The mean simplified oral hygiene and gingival indices were 1.7 ± 0.9 and 1.1 ± 0.5, respectively. Conclusion: The occurrence of dental caries appears to be increasing in rural Nigerian schoolchildren, but still within WHO limits. Oral hygiene status was poor and gingivitis was common.
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Review of 109 cases of primary malignant orofacial lesions seen at a Nigerian Tertiary Hospital p. 246
Olufunlola Motunrayo Adesina, Olujide Oladele Soyele, Elijah Olufemi Oyetola, Olawunmi Adedoyin Fatusi
DOI:10.4103/npmj.npmj_115_18  PMID:30588946
Background: Orofacial malignancy is a growing health issue common in developing regions of the world. Presentation patterns are myriad with geographic variations. Advanced stage owing to late presentation constitutes a significant public health burden. The site and type of the lesions are valuable in diagnosis and patient management. Aim: This study aims to review cases of primary orofacial malignancies at the OAUTHC Dental Hospital. Objectives: The objective of the study was to determine the prevalence of histologically diagnosed orofacial malignancies, the relative frequencies, types and site of distribution. Materials and Methods: Records of patients with orofacial malignancies at the OAUTHC, Dental Hospital over a period of 10 years (January 2008–December 2017) were reviewed, demographic data (age, gender and site), history of tobacco use were retrieved and entered into a pro forma. The data obtained were analysed with STATA 11. Statistical significance was set at P < 0.05. Results: Of 375, 109 cases of neoplasms seen were primary malignant tumours, with prevalence rate of 29.1%. There were 71 (65.1%) males and 38 (34.9%) females (male:female ratio of 1.87:1), mean age (48.7 ± 19.3 years) and range (4–94 years). Affected sites were mandible (41, 37.6%), maxilla (39, 35.8%), palate (17, 15.6%) and others. Lesions were mainly squamous cell carcinomas (SCC: 46, 42.2%), salivary gland adenocarcinomas (SGAs, 25, 22.9%) including 8 (32%) cases of adenoid cystic carcinoma (ACC). Others were odontogenic carcinoma (18, 16.5%) and lymphoma (8, 7.3%). Most specimen analysed were hard tissues (n = 63, 57.8%). Thirty-four (73.9%) cases of SCC and 66 (60.6%) cases of primary malignancies were in the 5th–9th decades of life. This was statistically significant at P = 0.000. Conclusion: SCC was more prevalent than salivary and odontogenic carcinomas. ACC and mucoepidermoid carcinoma were two most common SGAs. Metastatic tumours to the jaws are rare.
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Combined intrarectal lidocaine gel and periprostatic nerve block: A ‘balanced’ anaesthesia for transrectal ultrasound-guided prostate biopsy? p. 252
Taiwo Opeyemi Alabi, Kehinde Habeeb Tijani, Adekunle Ayokunle Adeyomoye, Emmanuel Ajibola Jeje, Charles Chidozie Anunobi, Moses Adebisi Ogunjimi, Rufus Wale Ojewola, Olanrewaju Nurudeen Akanmu, Abisola Ekundayo Oliyide, Dubem Ejikeme Orakwe
DOI:10.4103/npmj.npmj_145_18  PMID:30588947
Background and Aim: Periprostatic nerve block (PNB) which appears to be the gold standard for pain relief during transrectal ultrasound-guided prostate (TrusP) biopsy has been proven to be lacking in providing satisfactory anaesthesia during transrectal ultrasound (Trus) probe insertion into the anorectum necessitating the addition of another technique to produce a ‘balanced’ anaesthesia. The aim of this study was to determine whether combined intrarectal lidocaine gel and periprostatic nerve block (cGPNB) will provide adequate anaesthesia at all stages of TrusP compared with caudal block (CB). Patients and Methods: Data were prospectively collected from patients with indications for TrusP who were randomly assigned to either cGPNB (Group A) or CB (Group B). Comparative analysis of the numerical rating pain score (NRS) between two groups was done after administration of anaesthesia, Trus probe insertion, biopsy needle puncture of the prostate and 1 h after biopsy. Results: There were 56 patients in Group A and 53 in Group B. There was no significant difference in NRS grouping between the two arms of the study after administration of anaesthesia (P = 0.93), biopsy needle puncture of the prostate (P = 0.28) and 1 h after the procedure (P = 0.39). There was no statistically significant difference in the number of patients with no/mild pain between the two arms of the study during probe insertion (P = 0.65). None of the patients in both arms of the study had severe pain. Across Group A and B, 35 (62.5%) versus 40 (75.5%), 20 (35.7%) versus 11 (20.8%) and 1 (1.8%) versus 2 (3.8%) adjudged the procedure as very tolerable, fairly tolerable and intolerable respectively (P = 0.20). All the patients in Group A versus 49 (92.5%) in Group B will choose the same anaesthesia for subsequent biopsies (P = 0.11). Conclusions: cGPNB provides balanced anaesthesia at all stages of TrusP with excellent patient tolerability.
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Knowledge and attitude of women on genital cosmetic surgery at University College Hospital, Ibadan, Nigeria p. 257
Oluwasomidoyin Olukemi Bello, Olatunji O Lawal
DOI:10.4103/npmj.npmj_139_18  PMID:30588948
Background: Female genital cosmetic surgery (FGCS) is performed in other to restore or enhance the female genitalia. Materials and Methods: This is a cross-sectional study assessing the knowledge and attitude of 310 women attending gynaecology clinic towards FGCS at University College Hospital, Ibadan, Nigeria. Data were analysed using SPSS 20. Results: Mean age of respondents was 33.28 ± 7.68 years. Majority were married (76.1%) in monogamous family (87.7%) and almost half (49.7%) were multipara. About 56.1% had vaginal delivery of which 84.5% had perineal tear or/and episiotomy. Overall, 27.7% had heard about FGCS and 84.2% had positive attitude towards the procedure. Respondents' age, marital status and occupation were associated with their knowledge and attitude to FGCS. Women with skilled occupation were more likely to have the knowledge and positive attitude to FGCS. Conclusion: The knowledge of FGCS was low; however, majority had positive attitude towards it because of its associated sexual and psychological satisfaction.
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CASE REPORT Top

Spontaneous globe rupture in a blind glaucomatous eye: A report of three cases p. 264
Darlingtess Abies Oronsaye, Dumebi Hedwig Kayoma
DOI:10.4103/npmj.npmj_113_18  PMID:30588949
This paper aims to report cases of spontaneous globe rupture in the blind eyes of three elderly patients with end-stage glaucoma some of which were possibly structurally compromised with topical traditional eye medications and steroids. These patients presented to the ophthalmology department of the University of Benin Teaching Hospital with a history of bleeding from one of their eyes and no antecedent history of trauma. They were known glaucoma patients who were blind with previously recorded high intraocular pressures. Evisceration was performed for two of the cases while enucleation was performed for one shortly after presentation.
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SHORT COMMUNICATION ARTICLE Top

Adaptable skull stand: An indigenous innovation p. 267
Adeola A Olusanya, Bolutife A Olusanya
DOI:10.4103/npmj.npmj_103_18  PMID:30588950
The aim of this report is to describe the structure and advantages of an innovative and indigenous device, the adaptable skull stand, which serves the purpose of holding a skull model steady in a variety of positions without the need for an assistant.
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