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   Table of Contents - Current issue
Coverpage
July-September 2020
Volume 29 | Issue 3
Page Nos. 341-538

Online since Friday, September 18, 2020

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EDITORIAL  

Research scholarship among early career doctors in Nigeria p. 341
Oladimeji Adebayo, Lawson O. Obazenu, Fahd Hassan
DOI:10.4103/NJM.NJM_139_20  
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REVIEW ARTICLES Top

Prediabetes in sub-saharan Africa: Pathophysiology, predictors, and prevalence Highly accessed article p. 343
Chidimma Brenda Nwatu, Ekenechukwu Esther Young
DOI:10.4103/NJM.NJM_30_20  
Prediabetes – comprising impaired fasting glycaemia (IFG) and/or impaired glucose tolerance (IGT) – is a transitory median interphase between normal blood glucose levels and diagnostic levels of diabetes. The raised blood glucose levels surreptitiously damage the body's organ systems and are often an augury of type 2 diabetes mellitus (T2DM), the two having been found to share similar pathogenesis. Current concepts in the pathogenesis of prediabetes support a pentad of mechanisms responsible for its development. Majority of the countries in Sub-Saharan Africa belong to the low and middle income category, whose population accounts for more than 70% of the 352 million adults (20–79 years) worldwide with IGT (one component of prediabetes), as at 2017. The presence of prediabetes increases health care related expenditure in individuals and takes a toll on the workforce. Nigeria (West Africa) is currently among the top ten countries with the highest number of individuals with IGT as at 2017, and Ethiopia (East Africa) has been projected to join Nigeria in this category by 2045. A PubMed and MEDLINE search was conducted using the keywords prediabetes, Sub-Saharan Africa, prevalence, and pathophysiology. Major studies were identified and reviewed. Numerous large scale studies have revealed that progression from prediabetes to T2DM is not relentless. Structured and intensive lifestyle modifications aimed at modest weight loss, increased physical activity, and healthy dietary habits have shown to halt or slow the progression to T2DM, and in some cases, even reverse prediabetes, with such individuals regaining normal blood glucose levels.
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Universal healthcare coverage and medical tourism: Challenges and best practice options to access quality healthcare and reduce outward medical tourism in Nigeria Highly accessed article p. 351
Opubo Benedict da Lilly-Tariah, Salami Suberu Sule
DOI:10.4103/NJM.NJM_67_20  
Background: Universal healthcare coverage (UHC) leads to access to quality healthcare. Improved quality healthcare can stem outward medical tourism (MT). This review examined challenges and best practice policy options to implement UHC and how it can reduce outward MT in Nigeria. Methodology: The designed search terms used were “universal health coverage,” “quality healthcare” “medical tourism,” “access to healthcare,” “primary health care,” “healthcare financing,” “private health insurance,” “social health insurance,” and “Nigeria healthcare system.” Peer-reviewed research articles and institutional reports published between January 2000 and March 2020 were searched using four databases: PubMed, National Library of Medicine, Web of Science, and Library of Congress. EndNote X9 software and Google search engine were used to access these databases and documents, and 124 publications were retrieved and 106 were reviewed. Results: Majority of publications reviewed emphasized building health infrastructure, developing skills and human resources for health, and funding for equipment and drugs. Expanding healthcare coverage through social health insurance, developing a financial system to protect the poor, access to quality healthcare, and reinvigoration of primary healthcare (PHC) were common themes. About 50% of the studies identified unavailability of quality healthcare services, inequalities in the supply side of healthcare services, issue of human resources, and health sector implementation shortfall as challenges to UHC. Another 50% of the studies reviewed identified poverty and poorly funded PHC as a barrier to UHC. Almost all the studies (100%) identified cost-effectiveness, safety, and quality of healthcare services as drivers of MT in all countries. Conclusion: Improving the quality of healthcare delivery, increasing accessibility, affordability, and timeliness of access by the population through UHC can stem MT.
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COVID-19 at the community level: What are the countermeasures? Highly accessed article p. 362
Damilola Ayowole, Vivian Ogbonna, Abimbola Amoo, Tosin Babarinde, Jacob Nwafor, Ugo Enebeli, Aliyu Sokomba, Oladimeji Adebayo, Olayinka Stephen Ilesanmi
DOI:10.4103/NJM.NJM_109_20  
Although several efforts have been implemented to prevent and control the coronavirus disease 2019 (COVID-19) pandemic at the population level, varying outcomes have been reported in several quarters, despite the implementation of socio-behavioral methods commonly at the population level to stop the human-to-human transmission. We did a narrative review of relevant articles of identified countermeasures at the population level, for curbing the COVID-19 pandemic. The key findings were evidence measures such as physical distancing, quarantine, isolation, screening, active case detection, and risk communication if properly implemented. Other countermeasures identified were air disinfection and lockdown restrictions. Air disinfection has a potentially harmful effect on humans, while lockdown restrictions have been counterproductive in many settings. In conclusion, many of these public health measures are with peculiarities and needs to be contextualized to be effective in curbing the pandemic. Further research and regular assessments are needed on the countermeasures.
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ORIGINAL ARTICLES Top

Prevalence and predictors of depression among tuberculosis patients in Kano, North-West Nigeria p. 369
Taiwo Gboluwaga Amole, Abdulrasheed Hassan Yusuf, Auwal Sani Salihu, Fatima Ismail Tsiga-Ahmed
DOI:10.4103/NJM.NJM_9_20  
Background: The magnitude of depression as comorbidity militating against a positive outcome in the management of tuberculosis (TB) patients in northern Nigeria is largely unknown. This study assessed the magnitude of depression and its predictors among TB patients in Kano metropolis, northern Nigeria. Materials and Methods: A cross-section of 325 TB patients attending directly observed treatment, short-course (DOTS) clinics in Kano metropolis were studied using a pro forma and the Patient Health Questionnaire-9, which obtained information on depression. Data were analyzed using SPSS v. 21.0. Results: Among the 325 respondents, the prevalence of depression was 48.6% (n = 158). Of those who were depressed, the majority had the mild form (n = 120; 75.9%). The predictors of depression were: the age group <30 years, (adjusted odds ratio [aOR] = 0.33, 95% confidence interval [CI] = 0.14–0.85), being HIV negative (aOR = 0.34, 95% CI = 0.15–0.64), persistence of TB symptoms (aOR = 3.58, 95% CI = 1.92–6.90), presence of side effects of anti-TB drugs (aOR = 2.11, 95% CI = 1.46–5.99), and smoking cigarette (aOR = 3.49, 95% CI = 1.22–9.81). Conclusion: The prevalence of comorbid depression among TB patients is high. Achieving cure and preventing undesirable treatment outcomes in this region would involve a holistic approach that considers the interplay of patient's behavioral, social, and medical factors.
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Learning styles of fresh clinical students in ophthalmology at the University of Ibadan, Nigeria: A pilot study p. 377
Tunji Sunday Oluleye, Yewande Olubunmi Babalola, Bolutife Ayokunnu Olusanya, Oluwole Iyiola Majekodunmi, Modupe Adedotun Ijaduola
DOI:10.4103/NJM.NJM_13_20  
Background: The College of Medicine, University of Ibadan, Nigeria, is using a new curriculum for its learners. Therefore, knowing the learning styles of the learners will help the teachers formulate appropriate teaching strategies. The aim of the pilot study was to determine the learning styles of the 1st-year clinical students rotating through ophthalmology with a view to recommending appropriate teaching strategies to the teachers for the smooth running of the new curriculum. Methodology: The first fifty set of students sent to the department of ophthalmology for ophthalmology rotation was used as a pilot. A total of 47 students completed the study. Three students voluntarily did not participate in the study.Design: VARK questionnaire-assisted testing of learning styles was used for the study. It consists of 16 questions with four options testing each domain of visual (V), auditory (A), write or reading (R), and kinesthetic (K) ways of learning. Multiple responses were allowed. The total responses were computed at the end to give an idea of the learning styles of the students.3 Results: A total of 1192 responses were received from 47 students (25 males and 22 females), with a male-to-female ratio of 1.1:1. The Auditory and kinesthetic ways of learning were responsible for 669 (56%) responses. There was no statistically significant difference among the sexes. Conclusion: The most preferred learning styles were the auditory and kinesthetic ways of learning. Teachers should consider direct instructions and more hands-on teaching of their students while formulating a teaching plan.
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Oral hygiene practices and status among orthodontic patients in a Nigerian Teaching Hospital p. 384
Anne Nkechi Ndukwe, Ifeoma Linda Utomi, Onyinye Dorothy Umeh, Kehinde Adesola Umeizudike
DOI:10.4103/NJM.NJM_14_20  
Background: Orthodontic treatment is performed to correct occlusal problems and improve the dentofacial complex; however, it comes with its peculiarities, such that patients require strict adherence to optimum oral hygiene. When oral hygiene is compromised during orthodontic treatment, accumulation of dental plaque on the appliance can lead to periodontal problems and dental caries. Aim: To assess the oral hygiene practices and status of orthodontic patients attending the Lagos University Teaching Hospital. Materials and Methods: Interviewer-administered questionnaires were used to assess the patients attending the orthodontic clinic for their routine appointments. Their oral hygiene status was assessed using the Simplified Oral Hygiene Index by Greene and Vermilion. The data were analyzed using Statistical Package for the Social Sciences (SPSS version 21.0). Results: One hundred and ten subjects (73 females and 37 males) with a female-to-male ratio of 2:1 were recruited for the study. The mean age of the subjects was 20.7 ± 7.89 years. All the subjects used a toothbrush to clean their teeth. Only 22.7% of the subjects brushed their teeth once daily, while 65% of the subjects brushed twice daily and 20% brushed more than twice a day. About 44% had good oral hygiene, 49.1% had fair oral hygiene, while 6.4% had poor oral hygiene. There was no statistically significant difference in the relationship between toothbrushing techniques, frequency of toothbrushing, and oral hygiene status. Conclusion: All the patients used toothbrush and toothpaste to clean their teeth. Majority of them had acceptable oral hygiene status irrespective of the frequency of toothbrushing.
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Primary school teachers' knowledge of immediate management of permanent tooth avulsion p. 390
Emmanuel Obiajulu Amobi, Nneka Kate Onyejaka, Chidozie Ifechi Onwuka, Linda Oge Okoye
DOI:10.4103/NJM.NJM_22_20  
Background: This study assessed primary school teachers' knowledge of immediate management of tooth avulsion in Enugu, Nigeria. Methods: This was a cross-sectional study of 135 primary school teachers in Enugu metropolis of Enugu State, Nigeria. Data on sex, age, academic qualification, school type, years of service, and the knowledge of immediate management of avulsed tooth among primary school teachers were collected using a self-administered questionnaire. The data were analyzed using the SPSS software version 18. The level of significance was set at P < 0.05. Results: The age of study participants ranged from 20 to 58 years. Many teachers in public schools 73 (54.1%) and those with bachelor degree in education 69 (51.1%) participated in the study, They were mostly females 123 (91.1%). The year of service of the teachers ranged from 1 year to 35 years. Only 25 (18.5%) of the teachers had good knowledge of the immediate management of avulsed teeth. Six (4.4%) knew that re-implantation was the immediate treatment for an avulsed permanent tooth. However, there was a significant association between sex (P < 0.001) and having good knowledge of the management of avulsion, but there was no significant association between age (P = 0.42), school type (P = 0.27) qualification (P = 0.09), year of service (P = 0.42), and having good knowledge of the management of avulsion. Conclusion: Few primary school teachers had good knowledge of immediate management of avulsed tooth indicating the need for increased oral health awareness among teachers in the study area.
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Self-reported training needs among physicians in a tertiary institution, Southwest, Nigeria: An application of hennessy-hicks training needs assessment tool p. 396
David Ayobami Adewole, Folashayo Ikenna Peter Adeniji, Adesola Victor Makanjuola
DOI:10.4103/NJM.NJM_27_20  
Background: To keep pace with existing as well as emerging public and population health challenges, continuing in-service professional development (CPD) of physicians is paramount. This study assessed the training needs of physicians in a tertiary hospital in Ibadan, South-West, Nigeria. Methods: This study utilized a descriptive cross-sectional design. Three hundred and fifty-five physicians were randomly selected. Data were collected with the aid of the Hennessy-Hicks Training Needs Assessment tool. The instrument has five broad sub-sections: Research/audit, communication/teamwork, clinical tasks, administration, and management/supervisory tasks. In all, these subsections are made up of 30 items with their roles/tasks and were used to assess the training needs of individual study respondents. Charts and proportions were utilized to present the CPD training needs reported by physicians. Mann–Whitney U test was used to examine the difference in training needs between consultants and resident doctors. Results: A larger proportion of the study respondents were middle-aged adults. Respondents' ages were fairly distributed across the varying age brackets. Respondents within the age bracket 35–39 were the highest (30.36%), followed by those within ages 30–34 years (24.09%). With regard to training needs and capacity development, research/audit skills had the highest need (0.83). Furthermore, training that enhances managerial/supervisory skills had a rating of 0.68. Clinical tasks and administration tasks have the same rating (0.63), whereas communication/teamwork had the lowest rating. Consultants expressed higher training needs compared with resident doctors across all task domains. Conclusion: Quest for skills in research had the topmost priority among physicians, and thus, majority were likely to be receptive to training and acquisition of new skills. Future CPD training should reflect the critical needs for performance improvement, as indicated in this study.
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Bilateral inguinal hernia: Epidemiology and outcomes of surgical treatment in Southeast Nigeria p. 401
Aloysius Ugwu-Olisa Ogbuanya, Uchenna Dilibe
DOI:10.4103/NJM.NJM_28_20  
Background: In the past, bilateral inguinal hernias were repaired sequentially to avoid tension in the suture line which was thought to be responsible for high recurrences, but the use of prosthetic meshes to repair the hernia simultaneously has become the standard practice. The purpose of this study is to document the incidence and repair outcomes of bilateral inguinal hernias in our environment. Patients and Methods: This was a 10-year retrospective study of patients who had surgical repair of bilateral inguinal hernia. Results: A total of 308 patients with bilateral inguinal hernias were evaluated, representing 16.6% of all patients with inguinal hernias during the period of study. There were 302 males and six females. Nearly one-quarter (23.4%) presented emergently, but none had complications in both groins. The risk factors for the disease were many. Precisely, 299 (97.1%), 248 (80.5%), 212 (68.8%), 59 ((19.2%), and 36 (11.7%) patients were males, 46 years and above, engaged in regular strenuous activities, had raised intra-abdominal pressure and had a positive family history of bilateral hernias, respectively. Approximately three-quarter (75.3%) were direct, 15.6% indirect, and 9.1% were both direct and indirect. Mesh repair was used in 36.4% of the elective repairs, while the remaining 150 elective cases were repaired using either Modified-Bassini (76, 32.2%) or nylon darn (74, 31.4%) method. Overall, morbidity, mortality, and recurrence rates were 23.1%, 1.6%, and 1.9%, respectively. Morbidity was mainly due to wound infections (10.1%), seroma (3.9%), chronic groin pain (2.0%), bowel injury (1.3%), and others (3.9%). Four deaths occurred in patients with bowel resections complicated with sepsis, enterocutaneous fistula, and abdominal compartment syndrome (one, one, and two patients, respectively). The fifth death was from sepsis in an elderly patient who had laparotomy without intestinal resection. Conclusion: The use of mesh for simultaneous repair of elective bilateral inguinal hernia is associated with lower rates of recurrence and comparable rates of wound infections and seroma compared to suture-based repairs. Simultaneous bilateral repair with mesh implants is therefore feasible, safe, and effective in our environment.
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Awareness of noise-induced hearing loss among residents in a metropolitan city in South-south Nigeria p. 407
Abiola Grace Adekanye, Glory Mbe Egom Nja, Moses Olukayode Ojo, Robert Bassey Mgbe, Mbora Effanga Offiong, Aniefon Ntuen Umana
DOI:10.4103/NJM.NJM_40_20  
Background: Exposure to loud noise and its attendant health and social effects is a public health problem. Its significance has not been adequately determined in developing countries. Noise-induced hearing loss is permanent and can be acquired at home, schools, concerts, churches, mosques, sporting events, and at workplaces. The objective of this study is to assess respondents' awareness of noise-induced hearing loss, experiential symptoms and sources of noise pollution in a Metropolitan City in South-South, Nigeria. Methods: A cross-sectional descriptive study using interviewee questionnaire was employed. The respondents comprising of secondary school pupils, undergraduates, tricycle riders, and staff of the tertiary institution who participated at awareness campaign programs on World Hearing Day, World Family Day, and at a religious crusade ground in a tertiary institutions. Data were analyzed using IBM statistical product and service solution version 26.0. Results: There were 274 respondents, age range from 10 to 74 years, 73.7% (n = 202) were male and 26.3% (n = 72) female, male:female = 2.8:1. The overall level of noise-induced hearing loss (NIHL) awareness was 69.34% (n = 190). The greater proportion of respondents 236 (86.13%) knew that excessive noise could cause hearing loss. The common symptoms experienced by the respondents were 147 (53.6%) hyperacusis and tinnitus 142 (51.8%). Conclusion/Recommendation: Awareness it NIHL was greater among male, undergraduates between the ages of 20 and 29 years. Children's toys were poorly reported as a source of noise. There was poor awareness of the incurable nature of NIHL. A continuous public health education on sources and prevention of NIHL is advocated for early evaluation and intervention.
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Comparative pre- and post-treatment effects of Nigella sativa oil on lipid profile and antioxidant enzymes in a rat model of diabetes mellitus p. 415
Abdulwasiu A. Busari, Abdullahi A. Adejare, Sidikat O. Kelani, Khalid O. Imam, Abdulhakeem A. Awesu, Idayat Adefila-Sanni
DOI:10.4103/NJM.NJM_42_20  
Background: Lipid profile dysregulation and oxidative stress are important risk factors for cardiovascular disease in diabetic individuals. Nigella Sativa (NS) oil has been reported to have a favorable effect on triglycerides (TG) in rat models of diabetes mellitus. There is a dearth of information available about preventive or corrective use to manage and ameliorate diabetes. Aim: This study sought to ascertain the comparative pre and post-treatment effects of the oil on TG, cholesterol, high-density lipoprotein (HDL), low-density lipoprotein, and key antioxidant enzymes levels in diabetic rats. Methods: Thirty (30) Wistar rats were divided into 6 groups of 5 rats each as follows: Group I rats took normal chow ad libitum and served as Control. Group II rats were induced with diabetes using streptozocin (50 mg/Kg BW). Group III and IV rats were pre-administered with 0.5 and 1 ml of the oil, respectively, before induction, whereas Group V and VI rats were treated with 0.5 and 1 ml of the oil after induction. The listed parameters were assessed in the plasma at the end of the study. Results: Diabetes induction caused a significant increase in the TG level. There was no significant change in the oxidative stress parameters. Only post-administration caused a significant reduction in TG level, whereas both pre and post-administrations caused a significant improvement in HDL levels. Both pre- and post-administrations caused an increase in superoxide dismutase and catalase levels when causing a significant reduction in malondialdehyde level. Conclusion: Post-induction treatment may be more effective in the correction of lipid dysregulation and oxidative stress in diabetes.
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Prevalence of anterior cruciate ligament injury among amateur footballers in Enugu, South-East Nigeria: The need for injury prevention programs p. 422
Christian Chibuzor Ndubuisi, Ugochukwu Uzodimma Nnadozie, Emelie Moris Anekwu, Charles Chidiebele Maduba, Henry Chinedum Ekwedigwe, Petronilla Chidiebele Ojukwu, Canice Anyachukwu, Geraldine Ndubuisi
DOI:10.4103/NJM.NJM_43_20  
Background: Anterior cruciate ligament (ACL) injury is debilitating to any footballer. The injury is sustained in different ways during sporting events. There is need for injury prevention programs among the growing population of amateur footballers. Aim: This study was carried out to determine the prevalence of ACL injury among Amateur footballers in Enugu, South-East Nigeria. Methodology: An observational study involving 825 of the registered amateur footballers in Enugu Metropolis. Oral interview and adapted knee pain evaluation form were used to screen for knee injuries and followed by Lachman and Pivot shift test to confirm ACL injury. Results: The mean age of the participants was 22.7 ± 3.1. The prevalence of ACL injury was 3.6% among the study population (8% for females and 3.5% for males), 56.6% among the participants with a history of knee injuries. Nearly 37.3% of the injuries occurred as a result of torsion/twist, which is a noncontact mechanism, 3.3% due to overuse, 13.3% due to contact/person, and 10.0% due to contact/friction. 70.0% of the injuries occurred during a training session, while 30.0% occurred during competition. Furthermore, 50.0% of athletes sought medical attention from traditional bone setters, 6.7% from physiotherapists, 10.0% from medical doctors, while 30.0% had self-medication. Conclusion: The prevalence of ACL injury among amateur footballers in Enugu, South-east Nigeria, falls within that obtained among athletes worldwide, with most of the injuries occurring from noncontact mechanisms during a training session. The prevalence is more in females than males.
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Pediatric thyroid disorders in two teaching hospitals in South-West Nigeria p. 428
Isaac Oludare Oluwayemi, Emmanuel Oluwatosin Adeniji, Ezra Olatunde Ogundare, Temitope Opeyemi Ayeni, Odunayo Adebukola Temitope Fatunla
DOI:10.4103/NJM.NJM_45_20  
Background: Normal thyroid function is essential for optimal physical growth and neurocognitive development in children. Thyroid disorder is the second most common cause of paediatric endocrine diseases. Undetected hypothyroidism in children is a major preventable cause of neurocognitive disability. Down syndrome patients constitute a significant proportion of congenital hypothyroidism. Aims and Objectives: The aim of this study was to describe and compare the pattern of pediatric thyroid disorders seen at EKSUTH and LTH. Materials and Methods: The index study is a descriptive study of all children managed for Pediatric thyroid disorders at EKSUTH and LTH over a 10 year period from March 2010 to March 2020. Results: Twenty four children presented with thyroid disorder accounting for 12.7% of the total 189 endocrine patients managed in both health facilities. The mean age at presentation was 4.9 years (age range: 3 months to 14 years). Majority, 13 (54.2%), were aged less than 5 years at presentation. M:F =1:1. Hypothyroidism was the most common thyroid disorder, accounting for 91.7% of all thyroid disorders, seen at the two Teaching Hospitals. Congenital hypothyroidism (58.3%) was the most common type of hypothyroidism and Down syndrome accounted for 57.1% of all the children with congenital hypothyroidism. Majority, 87.5%, of the patients were managed successfully with Levothyroxine while one patient with suspected malignant thyroid mass had thyroidectomy and was also given Levothyroxine. Conclusion: Congenital hypothyroidism is the most common pediatric thyroid disorder at EKSUTH and LTH.
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Photogrammetric analysis of nasofacial angle among the Urhobo subjects p. 433
Enaohwo Taniyohwo Mamerhi
DOI:10.4103/NJM.NJM_51_20  
Background: All known anthropometric angles are evidently characterized by the feature of structural and functional variation according to gender, ethnic, and ecological influences. Knowledge of craniometric variation in the nasofacial angle among the Urhobo subjects appears limited, prompting the conduct of this study. Aim: The aim of the current anthropometric study was to evaluate a sample population of Urhobo subjects, by photogrammetric techniques, to establish the normal value of their nasofacial angle, and its associated variation. Materials and Methods: The noninvasive technique of angular photogrammetry was adopted for this investigation. This method incorporates the use of angular analysis of standardized left lateral facial cephalograms of 1000 Urhobo subjects, between 18 and 60 years of age. Selected craniofacial landmarks include the glabella, nasion, and nasal dorsum. Results: Descriptive analysis of data obtained from sampled Urhobo subjects revealed a mean nasofacial angle of 39.81° ± 4.81° and 39.45° ± 4.04° for males and females, respectively. Obtained means were not gender-specific on t- test analysis. Conclusion: While research findings did not demonstrate statistically significant gender differences, the obtained results would still have beneficial forensic and archaeological applications in reaching conclusions regarding subject identity, particularly in scientific expeditions in the politically volatile study area.
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Impacts of a pilot of community antiretroviral group initiative on HIV-positive patients in a tertiary health facility in Abuja, North Central Nigeria p. 437
Henry Chijioke Onyegbutulem, Benjamin J. Pillatar, Edna U. Afiomah, Felicia W. Sagay, Oma N. Amadi, Musa Dankyau
DOI:10.4103/NJM.NJM_69_20  
Background: Decentralization, as seen in community antiretroviral group (CAG), has resulted in a significant decline in deaths from AIDS-related causes with projected further benefits in middle- and low-income countries, such as Nigeria. After 2 years of CAG implementation in our facility, this study is designed to assess its impacts on the pilot-cohort of patients, (individual and group), and the hospital facility. Materials and Methods: Pooled data from the CAG register of the pilot cohort of 84 clients, was used for the study. Review of data at entry and 2 years after was done. A questionnaire was used to obtain additional qualitative data. This was administered to all the eighty-four pilot patients and 31 caregivers. Results: There were eight locations, with 84, clients, 62 females and 22 males. The mean/standard deviation of age was 39.38 ± 9.68 years. There were significant increases in weight (kg), (from 65.94 ± 11.012 to 70.69 ± 11.465, P < 0.001), body mass index (kg/m2), (from 24.77 ± 3.879 to 26.79 ± 4.282 P < 0.001), packed cell volume (%) from (31.19 ± 5.014 to 35.64 ± 5.131, P < 0.001), CD4 (cells/mm3), (from 394.36 ± 193.094 to 563.87 ± 220.137 P < 0.001). The viral load suppression was sustained, reducing even further, from 85.06 ± 182.329 to 31.10 ± 46.648 copies/ml, P < 0.001. Retention in care and outcomes were better. Conclusions: From this pilot, the CAG model has shown promise in reducing attrition, improving quality of care, and other direct and indirect benefits, including; cardiovascular, nutritional, and socioeconomic. This has justified the scale-up of this laudable model that will further improve the quality of care given to the patients and the overall quality profile of the facility and system.
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Prevalence and pattern of stimulants use among long-distance truck drivers in a truck part in Kaduna State, Nigeria p. 445
S Babandi Zaharaddeen, Abdulhakim A. Olorukooba, Aminu Lawal, Ibrahim Abdullahi, Salamatu Belgore, Bashar M. Jibril
DOI:10.4103/NJM.NJM_72_20  
Background: Stimulant use is recognized as an important factor in road safety worldwide, and concerns are growing over the incidence of road traffic accidents among drivers who drive under the influence of stimulants. Yearly, more than 1.25 million people lose their lives as a result of road traffic accidents, many of which are associated with stimulant use. Aim: The study aimed to assess the prevalence, pattern, and factors associated with stimulant use among long-distance truck drivers in a truck part in Kaduna State, Nigeria. Methods: A cross-sectional study was conducted in a truck park in Marraraban Jos in Kaduna State. A structured, interviewer-administered questionnaire was used to obtain data. A total of 152 respondents were interviewed. Data were analyzed using SPSS version 20. Chi-square and Fisher's exact tests were used to identify the relationship between categorical variables with a level of significance at P < 0.05. Results: A total of 152 respondents participated in the study with a mean age of 33 ± 5 years. The prevalence of stimulant use was 64.5%. Only 92 (60.7%) drivers reported using stimulants on rare occasions. Years of driving experience was found to be associated with stimulant use (P = 0.031). Other sociodemographic variables were shown not to be significantly related to stimulant use. Conclusion: The prevalence of stimulant use was found to be high among the drivers, with less experienced drivers more likely to use stimulants. Efforts on improving road safety should include reducing stimulant use, especially among the younger less experienced drivers.
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Eclampsia: A five-year retrospective review in Sagamu, South-West Nigeria p. 450
Oluwaseyi Isaiah Odelola, Adebayo Adekunle Akadri, Akintunde Akinpelu, Micheal O Elegbede, John Ogunyemi, Mutiu Abiodun Popoola
DOI:10.4103/NJM.NJM_73_20  
Context: Eclampsia is one of the leading causes of maternal and perinatal morbidity and mortality in developing countries. This is the result of poor health-seeking behavior of pregnant women and inadequate comprehensive emergency obstetric services. This study reviewed the presentation and management of eclampsia in Sagamu over a 5-year period. Aims: This study aims to determine the prevalence, pattern of clinical presentation and fetomaternal outcomes of eclampsia. Settings and Design: This was a retrospective study conducted in Olabisi Onabanjo University Teaching Hospital Sagamu, Ogun state. Subjects and Methods: Relevant information was retrieved from case notes of all patients who presented with eclampsia from January 2014 to December 2018. Data were analyzed using SPSS version 21. Results: Out of the 4656 deliveries, there were 45 cases of eclampsia giving a prevalence of 0.97%. The modal age was 20–24 years. Majority were unbooked 41 (91.1%) and 29 (64.4%) of the women were nulliparas. Antepartum eclampsia was commonest occurring in 36 women (80%). The most common premonitory symptom was headache occurring in as high as 37 women (82.2%). Most of the patients 37 (84.4%) had an abdominal delivery. There were two maternal mortalities (4.4%) and four perinatal deaths (8.9%). There was no statistically significant association between factors such as booking status, type of eclampsia, mode of delivery and parity, and the fetal outcome (APGAR score at 1 min). Conclusions: Eclampsia is still one of the preventable causes of maternal and perinatal mortality in our environment. The prevalence of eclampsia in sagamu was 0.97%. Improved health-seeking behavior, antenatal care monitoring, and prompt diagnosis and management of preeclampsia will invariably reduce the prevalence of eclampsia.
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Outcomes of tunneled and nontunneled internal jugular catheters for hemodialysis at Zenith Medical and Kidney centre, Nigeria p. 455
Ade Emmanuel Faponle, Olalekan O. Olatise, Martin Igbokwe, Stephen Olabode Asaolu
DOI:10.4103/NJM.NJM_77_20  
Objectives: Tunneled and nontunneled jugular access routes are the most widely used routes for hemodialysis (HD) in developing countries. This study was a retrospective review of the utility, safety, and outcomes of both tunneled and nontunneled curved internal jugular catheter use in patients with end-stage renal disease (ESRD) in Zenith Medical and Kidney Centre, Abuja, Nigeria. Materials and Methods: This is a retrospective study of 100 ESRD patients on maintenance HD at the center between June 2019 and December 2019. All patients on maintenance dialysis with tunneled and nontunneled curved internal jugular catheter were observed for immediate and short-term complications associated with the catheter. Results: Among the patients, 90 (90.0%) had tunneled dialysis catheters placement and dialyzed with it, while 10 (10%) patients had nontunneled dialysis catheters use. While 90 (90%) of the patients with the dialysis catheters developed no complications, ten (10%) patients had catheter-related complications either during catheter insertion or while it was being used for dialysis. The most common in this study was reactionary hemorrhage which occurred in 5% of the patients evaluated. Ten (10%) of the patients with catheter placement required ultrasonic guidance. No death was recorded during catheter placement. Conclusion: Internal jugular tunneled and Non tunneled dialysis catheters (NTDCs) are safe with good outcomes among our ESRD patients.
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Intravitreal antivascular endothelial growth factors for retinopathy of prematurity in Ibadan: Method of administration p. 460
Yewande Olubunmi Babalola, Tunji Sunday Oluleye, Oluwole Iyiola Majekodunmi, Modupe Adedotun Ijaduola
DOI:10.4103/NJM.NJM_81_20  
Purpose: To outline the method of administration of intravitreal antivascular endothelial growth factor (anti-VEGF) for retinopathy of prematurity (ROP) for the purpose of improved eye care among neonates. Background: ROP is a major potential, but largely preventable cause of blindness in the pediatric population. ROP has been shown to be a two-stage event with an initial disruption to normal retinal vessel growth, which is then accompanied by the second stage of vessel development. Preterm infants have undeveloped retinas, with avascular areas at the periphery. Subsequently, as the infant grows, these undeveloped retinas lacking an adequate supply of oxygen then stimulate angiogenic factors for the development of new vessels. Some predisposing risk factors include inappropriate oxygen therapy and lower birth weights. Initially, ROP was documented to be sporadic in most regions of Africa, but due to the recent advancement in medical facilities and personnel training, more preterm babies are surviving, thereby increasing the rate of ROP. Our hospital, the University College Hospital, Ibadan, has been assessing preterm babies for signs of ROP in conjunction with the neonatologists for the last four years, with various stages of ROP being diagnosed and treated. Intravitreal use of anti-VEGF has been accepted as a valuable therapy in preventing the development of advanced cases of ROP. The purpose of this study is to describe the method of administration of this important medication. Conclusion: Intravitreal anti-VEGF may prevent avoidable blindness in babies with ROP. However, to prevent devastating complications, appropriate techniques and the guidelines given in this study should be considered to minimize complications.
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Preliminary findings on metastatic brain tumors in Enugu, Southeast Nigeria p. 466
Mark C Chikani, Samuel Okpara, Mesi Mathew, Augustine Onuh, Vitalis Okwor, Wilfred Mezue
DOI:10.4103/NJM.NJM_86_20  
Background: Metastatic brain tumors (MBTs) are the most common brain neoplasms seen clinically and are often associated with poor outcomes. This study highlights the demographic, clinical, and radiological profiles as well as outcomes of MBTs managed in a tertiary hospital in Southeast Nigeria. Methods: This was a 1-year prospective observational study of patients with MBT who presented to the neurosurgery unit of the University of Nigeria Teaching Hospital, Enugu, from December 2018 to November 2019. Data on the demography, clinical and radiological features, treatment, and outcomes were collected and analyzed. Results: Of the 31 patients with MBTs, 58.1% were female and 41.9% male. The mean age was 51.0 ± 15.2 years. The most common presenting features were limb weakness (77.4%), headache (58.1%), and personality changes (54.8%). About a quarter (26.7%) were fully conscious at presentation. Only 45.2% knew that they had a systemic malignancy (SM) before presentation. The breast (29.0%), lungs (22.6%), and skin (19.3%) were the common sources of metastases. The lesions were solitary in 25.8% and multiple in 74.2%. They were predominantly frontal (80.6%), with bilateral distribution in 64.5% of patients. Radiotherapy was done in 58.1% and surgery in 6.5% of patients. Prior knowledge of the existence of a SM (P = 0.045) and unilateral brain involvement (P = 0.013) were associated with better 30-day survival. Conclusion: The breast is the most common source of brain metastasis. Prior knowledge of the existence of a SM and unilateral brain involvement is associated with better short-term survival.
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A survey of community opinion and perceptions toward gamete donation in north central Nigeria p. 471
Nkeiruka Ameh, Nana H. Madugu, Thompson Odeku, Mary Ogbe, Adegboyega M. Oyefabi
DOI:10.4103/NJM.NJM_90_20  
Background: Gamete donation supports in vitro fertilization services. Donation of gametes began in the developed world in 1884, but there is no documentation of when it started in Nigeria. The donors may be sourced from the community where such services are available. The objectives of this study are to determine the opinion of a community in north-central Nigeria toward gamete donation and determine the factors that influence their opinion. Materials and Methods: This is a cross-sectional survey of 300 individuals in a community regarding their opinions and perceptions about gamete donation in the setting. The survey involved using a questionnaire with the questions structured in a Likert format. Results: Two hundred and four (68%) of the respondents had knowledge of gamete donation, and 96 (32%) had none. Fifty-five (18%) respondents did not support gamete donation, whereas 153 (51%) did. Fifty-five (18%) disagreed and 158 (52.7%) agreed that gamete donation is justified. Forty-one (14%) disagreed, while 201 (67%) agreed that financial gain is the reason for gamete donation. One hundred disagreed (33.3%) and 113 (37.7%), respectively, agreed that religious beliefs prevent people from donating or receiving gametes. Forty-seven (16%) agreed, and 180 (60%) disagreed that donation can lead to childlessness in the future. Ninety-three (31%) agreed while, 130 (43.3%) disagreed with the possibility of their acceptance of gamete donation if needed. Eighty (2.6%) will not while 149 (49.6%) will support a friend/acquaintance who wants to donate their gamete. Significantly, more males agreed that religion forbids donating or receiving gametes (P = 0.047). Conclusion: There is a high awareness and favorable predisposition toward gamete donation but a low willingness to donate or accept same. More advocacy and enlightenment are needed to increase the participation of this community in gamete donation.
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Willingness of in-patients to uptake the vital contributor social health insurance program in a teaching hospital, Southwest Nigeria p. 476
Oluwaseun T. Esan, Kehinde O. Falayi, Bolurin A. Adekunle, Temitope Akinwunmi, Oyetade O. Ajao, Yahaya Abubakar
DOI:10.4103/NJM.NJM_95_20  
Background: The introduction of the Vital Contributor Social Health Insurance (SHI) Program in Nigeria was to scale up access to health insurance and achieve universal health coverage. However, many Nigerian in-patients still pay out-of-pocket for health services. This study aimed to determine Nigerian in-patients' willingness to pay for the Vital Contributor SHI Program. Methodology: A cross-sectional analytical study conducted among 133 adult in-patients and care-givers of pediatric in-patients of a tertiary health facility in southwestern Nigeria, not under a health insurance cover, and recruited through a simple random sampling technique. Data were collected using an interviewer-administered questionnaire. Willingness to Pay was assessed using the double contingent valuation by the Bidding method. Descriptive and inferential statistical analysis was performed using the IBM SPSS version 20 with inference made at P > 0.05. Results: Findings showed a low awareness (42.1%) of the National Health Insurance Scheme (NHIS), and much lower awareness of the Vital Contributor Insurance Scheme, (27.1%). A high proportion of the respondents (67.7%) were willing to participate in the scheme, whereas 67.3% of those not willing to participate gave insufficient funds as the reason. The median maximum amount of premium respondents were willing to pay annually was ₦15,000 ($38) and ₦5000 ($12.8) interquartile range. Respondents in the working population (P = 0.032), with some form of education (P = 0.002), having difficulty with paying their medical bills (P = 0.044), who were aware of the Vital Contributor Scheme (P = 0.001) and were knowledgeable about the NHIS benefits (P = 0.026) were significantly more willing to uptake the Vital Contributor SHI Scheme. Conclusion: Although awareness of the Vital Contributor SHI Scheme is low, the proportion of respondents willing to partake in it is satisfying. Increased targeted awareness campaigns should improve uptake. Health management organizations should take the lead in the awareness creation process.
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Determinants of outcome in febrile children admitted into the emergency rooms of two tertiary hospitals in Enugu Southeast Nigeria p. 486
Obianuju O. Igbokwe, Ogochukwu N. Iloh, Benedict O. Edelu, Obinna C. Nduagubam, Ikenna K. Ndu
DOI:10.4103/NJM.NJM_101_20  
Introduction: Febrile illnesses have continued to be the highest causes of mortalities in children admitted to the children emergency rooms in Nigeria. This study was carried out to review the determinants of outcome in children admitted for febrile illness into the emergency rooms of two tertiary institutions in Enugu, Nigeria. Materials and Methods: This was a retrospective study of 335 children who presented with fever to the emergency rooms over one year (January–December 2018). Their case records were retrieved, and the necessary information was obtained using a structured questionnaire. Statistical analysis included odds ratio and Chi-square test. Results: The mean age of the children was 43.20 ± 50.30 months. The mean temperature at presentation was 38.2°C ± 0.9°C. Fever of 39.0°C or above at presentation and fever duration of >2 days were significantly associated with fatal outcome. Children residing in rural areas or referred from other health facilities were more likely to die. The risk of dying from fever was highest when it was associated with diarrhea, weakness, pallor, convulsions, unconsciousness, and difficult/fast breathing. Conclusion: Most of the factors responsible for mortality in febrile children are largely preventable and treatable when the presentation is early.
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The prediction of fetal maturity and gestational age by ultrasonic measurement of distal femoral epiphyseal secondary ossification center p. 491
Benjamin E. Udoh, Akwa E. Erim, Emem B. Umana
DOI:10.4103/NJM.NJM_103_20  
Objective: The aim of this study was to determine the diameters of the distal femoral epiphyseal secondary ossification center (DFOC) in the various gestational ages (GAs) as well as to create a novel equation, through which GA can be calculated from the measurement of DFOC. Materials and Methods: EDAN Digital ultrasonic diagnostic imaging system (model DUS 3 made by EDAN, Korea) and a 3.5MHz Convex transducer were used for the sonographic measurement. Ultrasonographic examinations were performed on 999 normal singleton pregnancies with GAs ranging from the 28th to the 41st weeks. Patients were recruited from the University of Calabar Teaching Hospital to Assurance Medical Diagnostic Center, where the ultrasonographic examinations were carried out. Images of the long axis of the fetal femur were taken. The DFOC was visualized as a small echogenic, ovoid structure lying adjacent to the distal femur. Three measurements of the DFOC diameter (in mm) were taken from outer to outer margins, and the largest diameter was recorded. Other measurements obtained include femur length, abdominal circumference biparietal diameter, head circumference, fetal weight (FW), and GA. Results: DFOC increased with GA. A strong positive relationship was observed between DFOC and GA with a correlation coefficient of r = 0.85. DFOC also increased with FW with a correlation coefficient of r = 0.83. The equation (GA = 30.84 + [1.25 × DFOC in mm]) relates GA to DFOC. Conclusion: The diameter of the distal femoral epiphyseal secondary ossification center is a useful parameter for estimating GA and assessment of fetal maturity in the third trimester.
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Does load position on the trunk affect cardiopulmonary responses of the bearer during simulated front and back infant carrying methods? p. 494
Chidiebele Petronilla Ojukwu, Cyprian Ifeanyi Nnamoko, Adaora Justina Okemuo, Stephen Sunday Ede, Ijeoma Judith Ilo, Chioma Nneka Ikele, Theresa Odunayo Akinola
DOI:10.4103/NJM.NJM_117_20  
Background: The position of the infant on the trunk during back and front infant carrying methods (ICMs) may be a potential factor of maternal physiological changes. Related information is necessary for the establishment of guiding principles for infant carrying tasks. Thus, this study was carried out to evaluate cardiopulmonary responses to infant-load positions on the trunk during simulated back and front ICMs. Materials and Methods: Twenty-three nulliparous females completed four trials while walking with a 6 kg simulated infant, being carried in four trunk positions (upper back, lower back, upper front, and lower front). Cardiopulmonary indices (systolic blood pressure, diastolic blood pressure, respiratory rate, and heart rate) and rating of perceived exertion were assessed pre- and post-trials. Results: All the cardiopulmonary indices did not change significantly (P > 0.05) as the infant load moved from upper to lower trunk positions during the back and front ICMs. However, marginal differences were observed. Participants perceived the lower back and upper front ICMs as less exerting than the upper back and lower front ICMs. Conclusions: Infant-load position on the trunk is not an important factor in the cardiopulmonary responses to back and front infant carrying tasks, although the lower back and upper front ICMs were perceived to be more comfortable.
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Histopathological evaluation of myometrial lesions of the uterus in Nnewi teaching hospital: (Five-year retrospective study) p. 499
I. F. Ezejiofor, O. O. Olaofe, Ogbu C. Chika, F. E. Menkiti, A. S. Enesi, E. G. Ike
DOI:10.4103/NJM.NJM_146_20  
Introduction: A 5-year retrospective study to evaluate the lesions of myometrium (both nonneoplastic and neoplastic) in the hysterectomy and myomectomy specimens received in our institution. Aim: This research will serve as a baseline study of different myometrial lesions in the histopathology department of Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi. This is the first of such a study since the institution of the department. The study will also highlight myometrial lesions in relation to the age and mode of presentations as well as histopathological features. Methodology: The pathology report forms in the histopathology department NAUTH, Nnewi, were retrieved, and relevant information was extracted. A total of 290 cases of myometrial lesions were obtained within the study period, of which 283 cases that fulfilled the inclusion criteria were analyzed. The processed tissues and the slides stained with regular histochemical stain (hematoxylin and eosin) technique in this 5-year study period were reviewed by the above researchers using multi-headed microscope (®CARL ZEISS). Results: The myometrial lesions observed include leiomyoma, leiomyomata, leiomyosarcoma, leiomyoma coexisting with adenomyosis, adenomyosis, invasive carcinosarcoma, and hemorrhagic necrosis following uterine rupture. The age range at the presentation was between 10 and 80 years. The mean age for leiomyoma was 39.24 ± 8.41 standard deviation (SD), whereas the mean age for adenomyosis was 43 ± 9.86 SD. Leiomyoma was the most common myometrial lesion with a frequency of 93.9% (266 cases) and show degenerative changes in 139 cases (52.%) Followed by coexisting leiomyoma with adenomyosis which had a frequency of 3.9% (11 cases). A total of 184 leiomyoma cases with a frequency of 69.2% occur in multiple nodules. Adenomyosis alone had a frequency of 3.18% (9 cases). Therefore, the total number of adenomyosis in this research was 20 cases. Menorrhagia was the most common clinical symptoms with a frequency of 31.4% (82 cases). Leiomyosarcoma had a frequency of 1.77% (5 cases), whereas the least represented were hemorrhagic necrosis and invasive carcinosarcoma with frequencies of 2 (0.8%) and 1 (0.4%), respectively. Conclusion: (1) Leiomyoma is the most common myometrial lesions and tends to coexist in a few cases with adenomyosis while majority of them show degenerative changes. (2) Menorrhagia is the most common presenting symptoms of myometrial lesions while the histologic examination is the only tool to differentiate these myometrial lesions with similar clinical symptoms.
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Human immunodeficiency virus self-testing: Perspectives from primary healthcare workers in Enugu state, southeast Nigeria p. 504
George O. Ugwu, Casmir N. Ochie, Thaddeus C. Asogwa, Cosmas K. Onah, Nympha O. Enebe, Godwin U Ezema
DOI:10.4103/NJM.NJM_128_20  
Background: Stigmatization remains an intractable issue surrounding human immunodeficiency virus (HIV) management. Testing services are the gateway to treatment and prevention. HIV-self testing (HIVST) is a panacea to this stigmatization. It is a simple friendly testing technique. This study assessed issues surrounding the HIVST from the perspectives of the primary health-care workers in Enugu State. Methods: A cross-sectional study was carried out using a semi-structured interviewer-administered questionnaire. A convenience sampling of 238 respondents were sampled from the 17 local government areas of the state. Analyses were performed using IBM-SPSS version 23. Ethical approval was obtained from the Enugu State Ministry of Health. Results: The majority of the respondents were within the age of 31–50 years 84 (35.3%), predominantly females 203 (85.3%) and mainly married 191 (80.3%). Half of them had practiced for over 10 years and 145 (60.9%) had good knowledge of HIV screening. However, 23.9% understood HIVST as a testing modality approved by the World Health Organization. A handful of them, 25 (10.5%) correctly identified the 5Cs of HIV testing. Only 162 (68.1%) of the health-care workers reported stigma as the most perceived problems of the present testing modality and 146 (61.3%) expressed a preference for HIVST over previous methods. Age was found to be a determinant of good knowledge of HIVST, as being within the age group of 20–40 years has a 1.83 greater odds of good knowledge of HIVST than, 41–60 years age group (Adjusted odds ratios = 1.830; 95% confidence interval 1.081–3.099). Conclusion: Most of the Primary health-care workers in Enugu State had poor knowledge of HIVST. These workers could benefit from awareness creation and training on HIVST by public health specialists to improve their knowledge.
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CASE REPORTS Top

Transient neonatal pustular melanosis: A possible cause of antibiotic misuse in neonates p. 511
Dorathy Chinwe Obu, Obumneme Benaiah Ezeanosike, Kambiri Phina Muojiuba, Olapeju Wunmi Daniyan, Nnamdi Benson Onyire
DOI:10.4103/NJM.NJM_19_20  
The presence of pustules or vesiculo-pustular lesions in newborns is always a cause of concern both to the family and the attending physician. Transient neonatal pustular melanosis (TNPM) is a benign idiopathic skin condition characterized by vesicles, superficial pustules, and pigmented macules, usually occurring in newborns at birth. It is self-limiting with spontaneous resolution. We report a case of TNPM in a term female who was managed without antibiotic administration and hospital admission.
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Advanced abdominal pregnancy: The challenges of management p. 514
Gerald Tochukwu Igwemadu, Olubunmi Tunde-Olatunji, Uche Augustine Akunaeziri, Enang Eno Enang
DOI:10.4103/NJM.NJM_34_20  
Advanced abdominal pregnancy is a rare form of ectopic pregnancy with a high morbidity and mortality rate for both mother and fetus. It is usually seen in low resource setting where antenatal care attendance is poor resulting in late presentation and often with complications. While diagnosis can present a puzzle, a high index of suspicion is important. The management is challenging especially when undiagnosed. A case of an unbooked abdominal pregnancy that presented at 31 weeks 2 days' gestational age which resulted in a live female newborn with severe hydrocephalus at a tertiary hospital in North-central Nigeria is presented.
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Renal artery aneurysm at a Nigerian tertiary centre: Case report and review of literature. p. 517
Rereloluwa Nicodemus Babalola, Stephen Odunayo Ikuerowo, Olufunmilade Akinfolarin Omisanjo, Abimbola Ayodeji Abolarinwa
DOI:10.4103/NJM.NJM_66_20  
Renal artery aneurysms are rare urologic conditions, with rupture being the most feared complication. We discuss the management of two women with this disease at our center. The first was a 58-year-old woman who presented with torrential hematuria and hemodynamic compromise. Abdominal computed tomography (CT) angiography revealed a left renal artery aneurysm, and she had emergency nephrectomy. The second was a 40-year-old woman with recurrent flank pain of 2 years duration. Serial CT scans showed a calcified renal aneurysm remaining stable over this period. She was managed nonoperatively, with serial follow-up imaging to determine if future intervention is warranted. We conclude on the need for adequate evaluation and imaging to promptly diagnose renal artery aneurysms, and that care should be individualized.
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Posterior cerebral artery ischemic stroke in a patient with hypoplastic P1 segment of the posterior cerebral artery p. 520
Abiodun Idowu Okunlola, Tayo Ibrahim, Timothy Oladele Majengbasan, Cecilia Kehinde Okunlola, Olakunle Fatai Babalola
DOI:10.4103/NJM.NJM_91_20  
Posterior circulation stroke usually presents with clinical challenges, and symptoms may include blindness. Hypoplastic or atretic cerebral artery may be a risk factor for future ischemic stroke. We present a 75-year-old male patient with posterior cerebral artery ischemic stroke who presented with sudden visual deterioration, and brain magnetic resonance angiography showed hypoplastic right P1.
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Acute inferior mesenteric venous thrombosis in a child p. 524
Chimezie Innocent Madubogwu
DOI:10.4103/NJM.NJM_100_20  
Inferior mesenteric venous thrombosis is a very rare condition with serious management challenge, especially in a resource-poor environment. The acute variety is associated with high morbidity and mortality, especially if there are accompanying bowel infarction and peritonitis. The case of a 12-year-old boy was referred from a private hospital after a failed attempt at appendicectomy. The patient presented with features of generalized peritonitis and severe sepsis. Exploratory laparotomy after optimization showed massive hemorrhagic ascetic fluid, extensive left colonic gangrene extending from distal transverse colon to the sigmoid colon, and thrombosis in the branches of the inferior mesenteric vessel. The patient died 36 h postoperatively at the intensive care unit. A high index of suspicion and early bowel resection in cases of associated bowel infarction will improve outcome.
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Hemiballismus in subcortical lacunar infarcts p. 527
Chinyelu Uchenna Ufoaroh, Overcomer Nnaemeka Agah, Nnamdi Morah, Ernest Ndukaife Anyabolu
DOI:10.4103/NJM.NJM_111_20  
Chorea-hemiballismus is the most common movement disorder, and it commonly results from vascular lesions in the subthalamic nucleus. Rarely, it can result from lacunar infarcts. Here is illustrated a 95-year-old male with sudden-onset left-sided chorea-hemiballismus of 2 weeks, without any other neurological deficit, who was not a diabetic patient and had no form of acidosis or electrolyte abnormality. Computerized tomogram, serial 32 slides pre- and post-contrast images showed small non-enhancing, hypodense foci within the right frontal subcortical region adjacent to the frontal horn of the right lateral ventricle as well as within the lentiform nucleus. There were no mass effects seen. A diagnosis of hemiballismus from subcortical lacunar infarct was made. The hemiballismus was controlled after 2 weeks of haloperidol and clonazepam therapy, among others, with a substantial reduction in the abnormal movements. Hemiballismus attributable to subcortical lacunar infarcts though rare was presented.
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LETTER TO EDITOR Top

Phenytoin-induced lupus erythematosus in a young child p. 531
Abhishek Juneja, Kuljeet Anand
DOI:10.4103/NJM.NJM_38_20  
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SPECIAL ARTICLE Top

Common errors in proposals and dissertations and how to avoid them: A resident's guide p. 533
Osita Ede, Cajetan U. Nwadinigwe, Iheuko S. Ogbonnaya, Gabriel O. Eyichukwu, Chukwuemeka B. Eze, Amechi U. Katchy, Ugochukwu N. Enweani
DOI:10.4103/NJM.NJM_116_20  
Background: The dissertation is now a necessary part of the fellowship examinations of both the West African college of surgeons and physicians and the national postgraduate medical college of Nigeria. Many resident doctors are confused about how to get on with their proposals and the dissertations. This confusion often leads to frustrations, and in extreme cases to unnecessary delay in attempting the examinations when due. Aim: This study aims to identify the common errors made by resident doctors in the proposal and dissertations and to recommend the solutions to such problems. Methods: This survey is based on a direct interview with experienced examiners in both colleges. The examiners were asked to list what they observed as the common problems they identified concerning the proposal and dissertation of residents. The answers were collated and categorized according to the frequencies of problems identified. Based on the response of the examiners, a questionnaire was designed and administered to the senior residents who are at various stages of writing their dissertations. Results: Some of the findings include starting the proposal too late, difficulty in choosing a topic, mediocre and tedious literature search, difficulty in finding appropriate supervisors, poor appreciation of basic research design and necessary statistical tests, improper presentation of results and wrong referencing. Others are editorial mistakes, pagination errors, and the lack of knowledge on proper attitude and skill during the defense. Conclusion: Starting too late is the most common error made by the resident doctor in the dissertation. Residents should choose a topic within 6 months of passing the membership examination.
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