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   Table of Contents - Current issue
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April-June 2020
Volume 29 | Issue 2
Page Nos. 187-339

Online since Friday, June 26, 2020

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REVIEW ARTICLE  

Anticoagulation in sub-saharan africa with the advent of non-vitamin K antagonist oral anticoagulants p. 187
Raphael Chinedu Anakwue
DOI:10.4103/NJM.NJM_12_20  
Background: Since the approval of warfarin, a Vitamin K antagonist anticoagulant (VKA), no other oral anticoagulant existed for patients who needed long-term anticoagulation therapy until the recent introduction of non-VKA oral anticoagulants (NOACs). NOACs came to fill in therapeutic gaps associated with VKA. Dedicated anticoagulation clinics has improved the outcome of using VKA. However, with the arrival of NOACs, it is not clear how they will fit into these clinics.Methods: We searched PubMed, Google Scholar, Medline, and African Journals OnLine for articles on anticoagulation management and NOACs. Results: There were very few dedicated anticoagulation management centers in Sub-Saharan Africa, notably in Nigeria, South Africa, Kenya, Uganda, Namibia, Ghana, Botswana, Namibia, and Cameroun and warfarin was the anticoagulant used. NOACs were not used regularly. None of these anticoagulation clinics had incorporated NOACs management into their routine service as was done for VKA. Conclusion: Anticoagulation clinics in Sub-Saharan Africa must include NOACs as part of their area of service in addition to warfarin. The use of NOACs in Africa will leap frog if proper anticoagulation management policy and structure are laid out, the cost of NOACs are reduced, and emphasis is given to retraining of staff.
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ORIGINAL ARTICLES Top

Analgesia Self-Medication practice and pentazocine dependency in adult sickle cell patients in Southeast Nigeria p. 197
Theresa Nwagha, Omotowo Ishola Babatunde
DOI:10.4103/NJM.NJM_1_20  
Background: Painful crisis is a debilitating hallmark characteristic feature of sickle cell disease (SCD). Analgesia medication is the standard of care. Self-medication is becoming a quick fix for pain resolution for persons living with SCD. The aim of this study was to evaluate analgesia self-medication practice and pentazocine dependency among adult sickle cell patients. Methods: A descriptive cross-sectional study was conducted among 111 adults with SCD attending sickle cell clinic at the University of Nigeria Teaching Hospital (UNTH) Ituku Ozalla Enugu and Alex Ekwueme Federal University Teaching Hospital Abakiliki (AEFUTHA) Ebonyi. Data were analyzed using SPSS version 22. A P < 0.05 was considered statistically significant. Results: The proportion of adults SCD participants in the study was 45.4% from UNTH Enugu and 54.6% from AEFUTHA Ebonyi. The proportion of male and female who self-medicated was 61.5% and 38.5%, respectively. The prevalence of analgesic self-medication was found to be 28.8%. Analgesics most and least frequently self-administered were paracetamol 50.5% and morphine 0.9% most reported reason for self-medication was “treatment delays in hospital” 73%. Dependency to pentazocine was 22.5%. Age was a significant predictor of self-medication among adult SCD patients. Conclusion: This study shows high prevalence of self-medication and dependency to pentazocine. There should be strict regulation on the use of pentazocine.
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Prevalence and factors associated with parvovirus B19 infection among blood donors: A hospital-based study in South-West, Nigeria Highly accessed article p. 203
Ipeola P Awolesi, Sarah O John-Olabode, Gbenga Olorunfemi, Iwuchukwu O Ajie, Olufemi A Oyedeji, Alani S Akanmu
DOI:10.4103/NJM.NJM_6_20  
Background: Parvovirus B19 (B19V) is a transfusion transmissible infection that can result in severe consequences in vulnerable population that includes pregnant women, immunocompromised and chronic hemolytic anemia patients. The aim of this study was to determine the prevalence and factors associated with B19V infection amongst blood donors in South–West Nigeria. Materials and Methods: We conducted a comparative cross-sectional study to determine the seroprevalence of B19V immunoglobulin M (IgM) antibody among 183 blood donors at the blood bank of a tertiary hospital. The results were analyzed with SPSS 23 software, prevalence and associated factors were determined using frequencies and logistic regression, respectively. Results: The prevalence of B19V IgM was 7.1% (95% confidence interval: 4–11) with a higher prevalence among male donors compared to females (84.6% vs. 15.4%, P = 0.54). There was a statistically significant difference in the seropositivity of B19V IgM amongst the ethnic groups with the Yoruba ethnic group having a higher proportion of B19V IgM-positive participants P = 0.04. Ethnicity, gender, and steady employment were also associated with increased odds of infection, while increasing age appeared to be protective; though none of these factors were statistically significant. Conclusion: This study has shown that there is still high exposure to transfusion transmissible B19V infection.
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Amputation-related phantom limb pain in Nigeria: A prospective cohort study p. 208
Arinze D. G. Nwosu, Ifeanyi A Anikwe, Bonaventure I Eze, Edmund N Ossai, Fidelis A Onyekwulu
DOI:10.4103/NJM.NJM_11_20  
Background: Phantom limb pain (PLP) is a common and distressing complication of limb amputations. Literature on PLP in Nigeria and indeed Africa is scant despite the high rate of amputations in published works. We sought to highlight the burden of PLP among Nigerian amputees in order to improve awareness and care by health-care providers. Patients and Methods: In this prospective cohort study, consecutive limb amputees were recruited and relevant data were collected by in-person interview at 1 week postamputation and subsequently by telephone survey at 6 months and 12 months. The sociodemographic and clinical information of the amputees were recorded, as well as presence of PLP and the treatment offered by the attending physician. The Chi-square test of statistical significance and multivariate analysis using binary logistic regression were used in the analysis, and the level of statistical significance was determined by P < 0.05. Results: One hundred and fourteen consecutive limb amputations were carried out in 113 patients over a 1-year period. The period prevalence of PLP was 63.6%, and of these, only 8.6% had this documented in their medical record. No predictor of PLP was identified in the cohort. Conclusion: PLP is highly prevalent among limb amputees in our cohort. We call for improved awareness and practice relating to PLP among health-care providers and partners, considering the vast population of amputees in the region.
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Intestinal helminthic infection among children with sickle cell anaemia in Abakaliki, Ebonyi State: Prevalence and predictors for its development p. 217
Emmanuel Onoh, Pius C Manyike, Uzoamaka V Muoneke, Clifford O Okike, Charles Ikegwuonu, Bede C Ibe
DOI:10.4103/NJM.NJM_16_20  
Background: The sickle-cell gene is widespread in Africa and anemia, a common finding in sickle cell anemia (SCA) may occasionally result from other nonhemolytic causes such as helminthic infestations. The study is aimed at demonstrating the prevalence of intestinal helminths, risk factors of intestinal helminthic infection, and the hemoglobin level of infected children with SCA in Abakaliki, Ebonyi State. Subjects and Methods: This is a hospital-based cross-sectional study conducted between August and October 2018 involving 120 children aged 2–18 years with SCA. Risk factors for intestinal helminthic infections were assessed using a structured questionnaire. Stool was analyzed using the Kato-Katz method while the hemoglobin level was analyzed using an automated machine. Results: Among the recruited children, 55.8% were male within the age range 2–18 years with a mean age of 8.6 (±4.6 standard deviation [SD]) years and 9.1 (±3.9 SD) years for the boys and the girls, respectively. Eleven stool samples contained intestinal helminths. Lack of/poor handwashing before eating (P = 0.003) and after defecating (P < 0.001) were some of the predictors of having intestinal helminths, while sociodemographic factors such as Socioeconomic status (P < 0.001), level of education (P = 0.015), position of child in the family birth order (P = 0.028) and residence (P < 0.001) were all statistically significant to the development of intestinal helminths in the study children. The median hemoglobin of subjects who were infected with intestinal helminths was 6.5 g/dl compared to 7.9 g/dl in noninfected subjects (P = 0.010). Conclusions: Although the prevalence of intestinal helminthic infection among SCA patients in Ebonyi State is low, it has been linked to a number of risk factors and associated with lower hemoglobin levels among infected subjects.
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The civilian vascular trauma in a low-income country: The determinant factors of morbidity and mortality p. 224
Ikechukwu A Nwafor, John C Eze, Bolaji A Akanni
DOI:10.4103/NJM.NJM_23_20  
Background: Civilian vascular injury is relatively common in the West African subregion, but it is highly underreported. Aim/Objective: The aim of the study was to evaluate the patients managed for civilian vascular surgeries and to determine the factors causing morbidity and mortality in low-income countries. Materials and Methods: This is a retrospective study spanning a period of 13 years (2007–2019) of civilian vascular injuries managed in a tertiary hospital in a low-income country. We obtained data from our hospital record department. Data obtained and analyzed were demography, etiology, vessels affected, pattern of presentation, stratification, and treatment. Results: Within the envisaged period, 58 patients were affected in civilian vascular trauma with a mean of 4.5 cases per year. The male-to-female ratio was 0.9:0.1. The age range of patients affected was from 0–10 to 71–80, with the age group of 21–30 years being the most affected. Male was more affected (87.9%). Motor vehicle crashes were the most common etiology agent (42.0%). The femoral artery was the most commonly injured vessel (31.3%). In the pattern of presentation, bleeding with shock was dominant (49.8%). Lateral tarsorrhaphy accounted for the major vascular treatment interventions (30.2%). Conclusion: The outcome was very variable and depended on warm ischemic time, type and/or mechanism of injury, collateral blood supply at the site of injury, and comorbidity.
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Low serum calcium levels occur in Nigerian adults with type 2 diabetes and correlates negatively with their glycosylated hemoglobin levels: A case-control study p. 229
Harriet Chioma Nwankwor, Chidimma Brenda Nwatu, Celestine C Okwara, Ekenechukwu Esther Young, Louis C Olisaka, Nonso C Ezomike, UV Muoneke
DOI:10.4103/NJM.NJM_25_20  
Background: The prevalence of diabetes mellitus (DM) has increased globally making it a major public health concern. Serum calcium levels, together with other minerals, play an important role in the regulation of plasma glucose. The aim of this study was to determine the serum calcium levels in individuals with Type 2 DM (T2DM) as well as its relationship with their clinical characteristics and glycemic control. Materials and Methods: This was a cross-sectional study carried out at the University of Nigeria Teaching Hospital, Enugu State. A total of 300 participants were recruited, comprising 150 participants with DM and 150 age- and gender-matched normal participants as control. A questionnaire was administered to obtain clinical characteristics. Serum calcium and glycosylated hemoglobin (HbA1c) were measured. Mean ± standard deviation was calculated, and an independent t-test was used to determine the mean difference. Pearson's correlation was done to establish the correlation between serum calcium and HbA1c. Data were analyzed with SPSS version 23. Results: This study showed that the mean serum calcium level for the T2DM participants was significantly reduced (2.16 ± 0.17) when compared to that of the controls (2.21 ± 0.17)(P= 0.02). Furthermore, individuals with T2DM showed a significant negative correlation between serum calcium levels and HbA1c-a long-term measure of glycemic control (r = 0.273; P = 0.001). Conclusion: Participants with T2DM were found to have a lower mean level of serum calcium. In addition, T2DM participants who had poor glycemic control were more likely to have hypocalcemia.
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Serum cytokine profile (Interleukin-6) among women with pelvic organ prolapse p. 234
Kenneth C Ekwedigwe, Ileogben Sunday-Adeoye, Monday O Eliboh, Maradona E Isikhuemen, Henry Uro-chukwu, Paul Ezeonu
DOI:10.4103/NJM.NJM_47_20  
Background: Pelvic organ prolapse (POP) is a common gynecological problem, particularly in the grand multipara. There are indications that serum concentration of cytokines is higher in women with POP and even more so when there is evidence of infection. This study assesses the serum cytokine level (interleukin [IL]-6) in women with POP. Materials and Methods: This study was conducted among 96 women with POP and a control group of 96 women. A case–control study using a quota system nonprobability sampling technique was done. The serum cytokine level was determined using a commercial standard enzyme-linked immunosorbent assay kit. Results: The mean age and parity were 53.54 ± 10.1 years and 7.04 ± 2.33, respectively. The mean level of serum IL-6 and standard error of mean was 95.79 ± 18.6, ±1.9 as against 17.92 ± 7.62, ±0.78 for control and as against <20 pg/ml for the general population.P values were 0.00 and 0.08, respectively. The result showed that IL-6 was significantly increased in women with POP. Conclusion: This study suggests that cytokine levels were significantly elevated in patients with POP.
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Utilization and Factors Affecting Utilization of Contraception among HIV-Positive Male Patients in Saye, Zaria p. 239
Ayandunmola F Oyegoke, Aisha Abubakar
DOI:10.4103/NJM.NJM_49_20  
Introduction: Sub-Saharan Africa continues to carry the full consequences of health and socioeconomic impact of HIV, with about 25.8 million and 66% of people with HIV infection living in the region. The overall prevalence of contraceptive use in Nigeria is low, especially among men; the uptake of contraception and the type of contraceptive use are heavily influenced by the male/husband dominance in the society/family. Methodology: The study was carried out among HIV-positive male patients in Saye, Zaria, using a descriptive cross-sectional study among 265 respondents. Chi-square and multivariate logistic regression were used to determine factors influencing contraceptive usage. Results: The mean age of respondents was 45.6 ± 11.7 years. Only 61.9% of the respondents have ever used contraception, out of which 56.7% are currently using contraception. The identified reason for not using contraception was because they both were HIV positive (29%). There was a significant association between age, marital status, and level of education of respondents and current use of contraception with a P value of 0.001, <0.001, and 0.004, respectively. Conclusion: There were low usage of contraception and poor acceptance of vasectomy. There should be adequate policies in place by the government to encourage male involvement in the utilization of contraception.
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Eliminating discrimination and enhancing equality: A case for inclusive basic education rights of children with Albinism in Africa p. 244
Olanike S Adelakun, Mary-Ann O Ajayi
DOI:10.4103/NJM.NJM_50_20  
Background: Various international treaties have acknowledged the rights of children to education; however, for millions of children, this right is just a dream, especially with a vulnerable group of children with physical challenges and other disabilities. Reports by the UN gives an estimate of a significantly large number of children who are yet to take advantage of good quality education. This article examines the plight of children with albinism who suffer discrimination both at the special and regular schools largely because the nature of their disability is not physical. Children with albinism have their right to education and in education limited by the difficulty to understand their impairment both at school and at home leading to entrenched discrimination and inequality, which ultimately erodes their human dignity. Methodology: This article adopts the desk research argues that the proper application of the concept of inclusive basic education of children with albinism will help eliminate discrimination and enhance equality of education of children with albinism. Conclusion: The article concludes that the existing legal framework abound, but proper implementation of article 24 of the Convention on the Rights of Persons with Disabilities will enhance the desired equality.
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Ultrasound findings in the gallbladder of sickle-cell patients: A cross-sectional Study in Enugu, Nigeria p. 252
Enyereibe C Ajare, Philip C Okere, Augustine C Onuh, Emeka K Mgbe, Emmanuel A Nwobi, Emmanuel N Obikili
DOI:10.4103/NJM.NJM_53_20  
Background: Sickle-cell disease (SCD) causes chronic and recurrent hemolysis which is a recognized risk factor for gallbladder (GB) disease. The prevalence of GB disease in SCD is high and increases with age. Cholelithiasis and cholecystitis are relatively common GB diseases in SCD. They are important causes of acute abdominal pain in SCD and also increase morbidity. Ultrasound is a cheap and noninvasive means of evaluating the GB; it has a high degree of accuracy and is widely available.Aims: The aim of this study is to sonographically evaluate the GB of SCD patients in steady state at the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, and to determine the prevalence of specific GB diseases in SCD patients. Materials and Methods: A prospective cross-sectional study of 130 known SCD patients attending sickle-cell clinics at UNTH and 130 controls. Ultrasound of the GB was done after at least 6 h fast, using a Dp2200 mindray mobile ultrasound machine equipped with a 2.5–5 MHz convex probe. The data were analyzed using the SPSS software version 16. Results: The GBs of 130 consecutive SCD participants and 130 control group were sonographically evaluated. The prevalence of cholelithiasis in SCD was 10.8%, whereas the prevalence of cholelithiasis in the control group was 3.1%. No other GB diseases were seen. The mean dimensions of the GB for the study group were length (65.78 ± 9.85 mm), width (29.15 ± 6.01 mm), depth (25.58 ± 5.81 mm), wall thickness (1.59 ± 0.74 mm), and volume (26.52 ± 11.18 cm3). Conclusion: The prevalence of cholelithiasis in sickle cell disease in southeast Nigeria is 10.8% while the prevalence of cholelithiasis in the control population is 3.1%.
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Audit of open pediatric tracheostomies at the University College Hospital, Ibadan p. 256
Oyeleye A Oyelakin, Adebolajo A Adeyemo
DOI:10.4103/NJM.NJM_54_20  
Background: Tracheostomy is the creation of a communication between the trachea and the overlying skin, maintained by a tube. This is done either by an open or percutaneous technique. Anatomical and physiological variation of the paediatric trachea and adjoining structures necessitates finite skills and consistent competence in performing pediatric tracheostomies, lack of which may cause higher mortality and morbidity outcome in tracheostomies in the pediatric age group. Objectives: There are inadequate local data on the outcomes of pediatric tracheostomies; therefore, we conducted a local audit of pediatric tracheostomy to describe our experience. Methods: A retrospective study of pediatric patients who had tracheostomies from June 2011 to December 2017 was done. Results: Thirty-four patients were identified, all of whom had an open tracheostomy. The age range was 3 weeks to 16 years; M: F ratio was 2.4:1. Indications for surgery were obstructive (88.2%) and prolonged-assisted intubation (11.8%). Recurrent respiratory papillomatosis, retropharyngeal abscess, and foreign-body aspiration were the main obstructive causes. Three patients (8.8%) had repeat procedures, and these patients were initially discharged on tracheostomy tube and instructions were given for home care. Conclusion: Despite the evolving local challenges peculiar to clinical practice in developing countries, the outcome of pediatric tracheostomy in our hospital is good.
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Pediatric blood culture isolates and antibiotic sensitivity pattern in a Nigerian tertiary hospital p. 261
TO Ogunkunle, MB Abdulkadir, OS Katibi, SO Bello, RA Raheem, R Olaosebikan
DOI:10.4103/NJM.NJM_55_20  
Introduction: There is a significant variation in the bacterial pathogens implicated in childhood septicemia and their antibiotic sensitivity pattern from place to place. Sustained monitoring of this dynamics is therefore critical to rational antibiotic use. Materials and Methods: This study was thus conducted to determine the etiology of childhood septicemia and their antibiotic sensitivity pattern. Blood culture results (contaminants excluded), age, and sex of all pediatric patients with suspected septicemia between January 2013 and December 2014 were retrieved. Data were analyzed using SPSS version 20. Results: Over a 2-year period, a total of 3680 blood samples were processed. Pathogenic bacteria were isolated in 701 samples (19%).Staphylococcus aureus was the most common isolate (41.4%) and was most sensitive to ampicillin-sulbactam (89%). Klebsiella species (21.7%), coagulase-negative Staphylococcus (14.7%), and Pseudomonas aeruginosa (11%) were other common organisms isolated. Virtually, all the isolates demonstrated a reliable susceptibility to ciprofloxacin except for S. aureus and Klebsiella species which were most sensitive to ampicillin-sulbactam and imipenem, respectively. Conclusion: In conclusions, S. aureus is the leading cause of childhood septicemia in this locale. The significant rate of isolation of the supposedly less virulent organisms calls for an urgent review of potential risk factors and an appraisal of the hospital infection control policies and structures.
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An audit of vaginal hysterectomy and pelvic floor repair for uterovaginal prolapse in South-East Nigeria p. 265
Kenneth C Ekwedigwe, Maradona E Isikhuemen, Ileogben Sunday-Adeoye
DOI:10.4103/NJM.NJM_56_20  
Aim: The study aimed to audit vaginal hysterectomies and pelvic floor repair performed for women with uterovaginal prolapse as a quality assessment of the procedure. Materials and Methods: In this study conducted at the National Obstetric Fistula Center, Abakaliki, case folders of women who had vaginal hysterectomy and pelvic floor repair for uterovaginal prolapse between June 2012 and December 2016 were reviewed. Relevant data were extracted using a pro forma and analyzed using the Statistical Package for the Social Sciences, software version 21. Results: The case records of 358 women who had a vaginal hysterectomy and pelvic floor repair were reviewed. Their mean age and parity were 53.44 ± 10.54 years and 6.92 ± 2.47, respectively. Complications were recorded in 49 (14%) of the patients, and these were intraoperative bleeding requiring blood transfusion in 15 (4.2%), postoperative intraabdominal bleeding requiring exploratory laparotomy in 7 (2%), urinary tract infection in 5 (1.4%), hospital re-admission following vaginal bleeding in 2 (0.6%), and vaginal discharge in 13 (3.6%). The long-term complication that was observed following the procedure was vault prolapse in 7 (2%). There was 1 (0.3%) mortality. Conclusion: Vaginal hysterectomy with pelvic floor repair is a relatively safe procedure in women with uterovaginal prolapse. There are morbidities associated with this procedure.
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Aural foreign bodies in children p. 269
Adekanye Abiola Grace, PM Francis, RB Mgbe, ME Offiong, C O N Enyuma, AN Umana
DOI:10.4103/NJM.NJM_57_20  
Background: Pediatric aural foreign bodies (FB) are relative medical emergencies. Primary care physicians, pediatricians, and otorhinolaryngologists commonly encounter them. Objective: The objective was to carry out a retrospective analysis of pediatric aural FB managed in otorhinolaryngology department of the University of Calabar Teaching Hospital, Nigeria. Materials and Methods: A total of 157 children with aural FB managed at the Department of Otorhinolaryngology, University of Calabar Teaching Hospital, Nigeria, from January 2015 to December 2018 were reviewed with regard to the type of FB, location, in the ear, methods of removal, complications, age, and sex. Results: Of the 157 children, 54.1% were males and 45.9% females. Male: female ratio was 1.2:1. Ninety-five (60.5%) were below the age of 5 years, 46 (29.3%) were 6–10 years of age, and 16 (10.2%) were in the age group of 11–15 years. The most common objects were beads, papers, and cotton. Most presentations (86%) were within 24 h. Seven patients (4.5%) required surgical removal under general anesthesia. Most of the patients (92.4%) had no complications. Morbidities include bleeding from the ear canal 6 (3.8%), canal abrasions/lacerations 4 (2.5%), and tympanic membrane perforations 2 (1.3%). Conclusion: Aural FBs are common conditions in children in our environment. Most of these can be successfully removed by skillful personnel, adequate immobilization, and proper instrumentation. Pediatricians, family physicians, and other health workers should not hesitate to refer to otorhinolaryngologists, uncooperative/apprehensive children, those with a history of attempted removal by their parents or caregivers, or FB whose contour, composition and position in the canal cannot be fully assessed.
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Domestic violence: The pre- and post-diagnosis experience of women living with HIV in a rural community in Northwest Nigeria p. 273
Adewale O Ashimi, Taiwa G Amole, Haliru Ibrahim
DOI:10.4103/NJM.NJM_58_20  
Background: Domestic violence (DV) is a fundamental human right problem. Stigma and discrimination increase the incidence and affects care. Objectives: This study aimed at determining the prevalence, types of DV pre- and post-diagnosis of human immunodeficiency virus (HIV), perpetrators, and the response to it in a rural community in Northwest Nigeria. Materials and Methods: A descriptive and cross-sectional study of 261 women was done. The sample was selected by proportionate allocation and systematic sampling. Data of respondents were obtained employing an interviewer-administered questionnaire. The analysis was done using Chi-square, Fishers exact, and McNemar's tests. Results: Less than one-quarter of respondents, 60 (23.0%) and 62 (23.8%), had experienced at least one form of DV pre -and post-diagnosis, respectively. The types observed were mainly verbal (44/60 [73.4] and 55/62 [88.7]) and psychological (43/60 [71.6%] and 40/62 [64.5%]) pre- and post-diagnosis, respectively. The difference in the experience of DV pre- and post-diagnosiss was not statistically significant. Majority of the perpetrators were the current husband (n = 37; 59.7%) and siblings (n = 9; 14.5%); educational level and occupation were significantly associated with the occurrence of DV (P < 0.05). Conclusion: Although the prevalence of DV among women living with HIV was high, the pre- and post-diagnoses of violence experienced were the same. DV should be included as part of the care and management of this group of women.
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Tooth loss and predictors of tooth extractions due to dental caries among adults: A multi-center study in North-eastern Nigeria p. 279
Paul Ikhodaro Idon, Abdulmumini Mohammed, Yahaya Abdulmanan, Olawale Akeem Sotunde, Janada Yusuf, Taiwo Omoniyi Olalekan, Yusuf Halidu Bako
DOI:10.4103/NJM.NJM_60_20  
Background: Tooth loss and the level of edentulism may be an indication of a populations' oral health. The aim of this study was to evaluate the contribution of dental caries to tooth loss, as well as its predictors among adults in North-eastern Nigeria. Methods: A cross-sectional survey over a 2-month period of all adult patients who had tooth extractions in three dental centers across North-eastern Nigeria. Data on sociodemographics (age, gender, and level of education), history, and examination findings were collected with a preformed questionnaire to include the frequency and reasons for the use of dental facilities, previous tooth extractions and reason for extractions, missing teeth, and present diagnosis for the teeth to be extracted. Bivariate and multivariate analyses were used to determine the association and relationships between missing teeth, extractions due to caries and population variables. Results: The prevalence of preextraction tooth loss was 37.98% with a mean tooth loss of 3.05 ± 3.15 per participant, 2.24 ± 1.46 among the 35–44 years old and highest (10.08 ± 8.02) among the 65–74 years old participants. Age was the single significant predictor of tooth loss (β = 0.428, P < 0.001). Molars were the most extracted teeth, with 78.13% of all extractions due to caries and its sequelae. Significant correlations existed between age (r = −0.144, P = < 0.001), level of education (r = −0.118, P = 0.004), and extractions due to caries and its sequelae and were significant in the regression model. Conclusion: Caries and its sequelae were the major reasons for missing teeth as well as for current extractions. Molars were the teeth most affected. Age and level of education were the important determinants of extractions due to caries and its sequelae.
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Uptake and discontinuation of jadelle implant use in University of Calabar Teaching Hospital, Calabar, Nigeria p. 286
Patience O Odusolu, EM Eyong
DOI:10.4103/NJM.NJM_61_20  
Background: Contraception is known to contribute to a reduction in maternal mortality rates directly. Jadelle implant is a long-lasting, reversible contraceptive that is safe, highly effective, and convenient. Objectives: The objectives of this study were to determine the sociodemographic profile, side effects, and reasons for discontinuation among users of Jadelle in the University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria. Methodology: This was a 5-year retrospective study carried out at UCTH, Calabar, Nigeria. Case files of women who accepted and inserted Jadelle implant between January 1, 2013, and December 31, 2017, were retrieved, and data were extracted for the study. Descriptive and analytical statistics of the data using mean and standard deviation were done, and results were presented in frequency and percentage tables. Results: A total of 270 women accepted and inserted Jadelle implant during the period under review with a mean age of 33.0 ± 6.2. Majority of the clients were Christians 98.1%, and 85.9% had at least secondary school education. About half (49.6%) of these women had a desire for future fertility, whereas 49.7% have had four or more children. Sixty-one percent (61.5%) of the clients had previously used a form of contraception. Menstrual irregularities were the most commonly reported side effect (55.0%) as well as the most common reason for removal and discontinuation of the implant (43.3%). Conclusion: Jadelle is a highly effective, safe, and reversible method of contraception. The most commonly reported side effect was menstrual irregularities, which was also the most common reason for discontinuation in the UCTH, Calabar, Nigeria.
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Urologic emergencies in a low-resource setting: A 10-year review from South-Western Nigeria p. 291
AA Salako, TA Badmus, RN Babalola, MC Igbokwe, RA David, C Onyeze, A Laoye, IA Akinbola
DOI:10.4103/NJM.NJM_62_20  
Background: Emergency presentations are quite an important aspect of the urologic practice, and prompt attention is necessary to relieve symptoms, limit morbidity, and prevent mortality. Adequate knowledge of the pattern of emergency urologic presentations might aid rapid diagnosis and provide data for hospital and public health planning purposes. We present our experience with urologic emergencies in our hospital. Objectives: The objective was to describe the pattern of presentation and the peculiar challenges of urologic emergencies in a typical low-resource setting in South-Western, Nigeria. Patients and Methods: A retrospective review of all patients with urologic complaints who presented acutely to the accident and emergency department (AED) of our hospital, between January 2008 and December 2017, was done. Data were analyzed using the Statistical Package for Social Sciences version 20. Results: There were 1102 patients seen with urologic complaints, which constitute 3.2% of the total patients presenting to our AED over the 10-year period reviewed. Urinary retention (28.7%) and gross hematuria (19.5%) were the most common emergency urology presentations, whereas urethral injury was the most common mode of urologic trauma (59%). Over half (53%) of the patients with hematuria had a urologic malignancy. Prostate cancer was the leading urologic malignancy presenting to the AED. Testicular torsion and priapism were predominantly found in young male patients. There were 2.7% mortalities, with complicated prostate cancer, the leading cause (66.7%). Immediate causes of mortality were metastatic disease and urosepsis. Conclusion: Urologic emergencies are a probable cause of morbidity and mortality in our setting. Adequate knowledge of the pattern of patient presentation might aid diagnosis, improve outcomes, and provide data for hospital and public health planning purposes.
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Clinical profile and electrolyte abnormalities in hospitalized under-five children with acute gastroenteritis in a tertiary health facility p. 295
Christopher B Eke, Ikenna K Ndu, Benedict O Edelu, Nwachinemere D Uleanya, Uchenna Ekwochi, Josephat M Chinawa, Ikenna C Nwokoye, Anthony N Ikefuna
DOI:10.4103/NJM.NJM_64_20  
Background: Electrolyte abnormalities constitute the leading causes of morbidity and mortality in younger children with acute gastroenteritis. The aim of the study was to determine the clinical profile and pattern of electrolyte abnormalities in under-five children hospitalized for acute gastroenteritis from November 1, 2014, to January 31, 2015. Methodology: This was a cross-sectional descriptive study among hospitalized under-five children with acute diarrhea who were consecutively recruited from November 1, 2014, to January 31, 2015. Relevant clinical data were obtained, while the physical examination was done on all subjects. Serum electrolytes values were determined using the ion-selective electrode system and compared with standard reference ranges. The data were analyzed using SPSS version 21.0 with the level of statistical significance set at P < 0.05. Results: A total of 108 under-five children were studied. The majority (101; 93.5%) were <24 months of age, while 41 (38%) of low socioeconomic class background. Metabolic acidosis was the most common electrolyte abnormality followed by hyponatremia and hypokalemia occurring singly or in combination. The case fatality rate was 13 (12.0%). The electrolyte derangements associated with mortality were hypokalemia and acidosis: 11 (84.6%) each, 9 (69.2%) had hyperchloremia, while 6 (46.2%) were reported to have hyponatremia. Conclusion: Electrolyte derangements are common in under 5 years children with acute diarrhea with increased mortality in those with severe acute malnutrition. Proper health education is needed to ensure adequate nutrition and timely use of low-osmolar oral rehydration solution as well as early referral of cases with persistent gastrointestinal losses in order to save lives.
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Preparedness of Nigerian health institutions toward managing lassa fever epidemic and Covid-19 pandemic p. 303
Shehu S Umar, Bilqis O Muhammad, S Babandi Zaharadeen
DOI:10.4103/NJM.NJM_71_20  
Objectives: The objective is to assess standard practice of healthcare workers and preparedness of their healthcare institutions toward controlling spread of infectious diseases. Background: With the on - going epidemic of Lassa fever and the rising incidence of Covid-19 pandemic in Nigeria, there has been efforts from government and stakeholders in health towards controlling the surge of these diseases. This study is a multi-center survey involving frontline health-care workers, from 102 health institutions. Methodology: Pretested self-administered questionnaires were sent through online Google form to health-care workers across various health institutions through their respective social media platforms. Their consent was sought and the questionnaires were filled through registered emails. Multiple entry from same individual was prevented. The number of respondents was 451. The information gathered include biodata of health-care workers, details of their cadre and years of practice, their level of standard precautions and preparedness of their health institutions. Data gathered were collated, summarized, and analyzed using simple tables with proportions. Results: The practice of standard precaution was inadequate with only 59.4% of respondents washing their hands regularly after touching patients or carrying out procedures, while only 34.4% of them used face masks while consulting patients with respiratory symptoms. As for preparedness of health institutions in control of Lassa fever and Covid-19, 63.1% and 77.6% of respondents affirmed that their health institutions had written protocol of managing infectious diseases and had organized workshop on Lassa fever and/or Covid-19, respectively, while only 45.5% and 20% of respondents had dedicated isolation wards and functional intensive care units in their health institutions. Conclusion: The standard safety precautions by health-care workers were suboptimal and preparedness of their health institutions was generally inadequate for the management and control of infectious diseases.
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Determining factors for the choice of medical career among the final year medical students of a private university in Nigeria p. 308
Abiodun Idowu Okunlola, Olakunle Fatai Babalola, Cecilia Kehinde Okunlola, Adedayo Idris Salawu, Olabisi Timothy Adeyemo, Idowu Oluwaseyi Adebara
DOI:10.4103/NJM.NJM_79_20  
Background: Medical education worldwide is more expensive compared to other university courses due to the structure of the training into two phases: basic medical sciences and clinical sciences, each with extensive syllabuses and involves an array of professionals in various specialties. The burden of medical education was largely borne by the government in Nigeria until recently when the private sector forayed into the provision of tertiary education including medical education. Methods: The study was a cross-sectional survey study. All 94 final year medical students of Afe Babalola University, Ado-Ekiti, a private sector-owned university in South Western Nigeria, were invited to participate in the study. The institutional ethical approval was sought and obtained (ERC/2020/04/07/364A). Structured self-administered questionnaires were used to collect relevant data. Participation in the study was voluntary and confidential. The data obtained were analyzed using SPSS version 20.0 (SPSS Inc., Chicago, IL, USA). Results: Eighty-three (88%) final year medical students participated and returned completed questionnaires out of 94 students. Further analyses were on the number of the respondents (n = 83). Fifty-seven (68.7%) of the respondents were female, whereas 26 (31.3%) of the respondents were male. The mean standard deviation age was 23 (1.6) years, and the age ranges between 20 and 30 years. Parental influence and personal interest were the two most important factors that influenced the decisions for medical education. Fifty-seven (68.7%) of the respondents prefer to practice outside Nigeria, 25 (30.1%) respondents will like to practice in Nigeria but in urban areas, whereas only 1 (1.2%) of the respondents will prefer to practice in a rural area. Conclusion: The choice of medical education and future specialty is multifactorial but the most important factors are personal interest and parental influence. The choice of where to practice is mostly determined during the undergraduate program, and it tends toward continuous emigration of doctors to developed countries.
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Adherence to protective measures against hearing-related hazards of mobile phone users among university students p. 312
Auwal Adamu, Abdulrazak Ajiya, Hamisu Abdullahi, Muhammad Ghazali Hasheem, Nafisatu Bello-Muhammad
DOI:10.4103/NJM.NJM_3_20  
Background: Mobile phone is an integral part of the society used by almost all. Youth in Nigerians are recognized as the most active users of mobile phones. There are about 1.1 billion youth people globally at risk of noise-induced hearing loss from unsafe listening. The awareness and adherence to hearing conservation measures against the hearing-related hazards of mobile phones have not been evaluated in our environment. Aims: To determine the knowledge and adherence to protective measures against the hearing-related hazards of mobile phones among university students. Materials and Methods: The study was a cross-sectional descriptive type, conducted among university students. Ethical clearance was obtained from the institutional review committee, a multistage random sampling technique was used to recruit the participants, and a specially designed and validated questionnaire was used to collect the data. The data were analyzed using Statistical Product and Service Solutions (SPSS) version 20.0. Results: The age of the respondents ranged from 16 to 40 years with a mean age of 23.6 ± 5.3 years. Very few of the participants (19.1%) adhere to protective measures to mitigate hearing-related hazards of mobile phones, although about half (52.1%) had good knowledge of hearing conservation measures. There was a statistically significant association between knowledge of hearing-related hazard of mobile phone (P = 0.038) and knowledge of protective measures (P = 0.000) with the adherence to protective measures, respectively. Conclusions: The knowledge and adherence to protective measures against the hearing-related hazards of mobile phones were poor among the respondents.
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CASE REPORTS Top

Systemic lupus erythematosus masquerading as disseminated tuberculosis: Case report in a Nigerian adolescent p. 317
Sylvester Sunday Edward, Perpetua Okwuchi Obiajunwa, Olusola Ayewale Ayeleke
DOI:10.4103/NJM.NJM_2_20  
Systemic lupus erythematosus (SLE) is a connective tissue disorder whose manifestations may mimic other common chronic diseases in children. In developing countries, its diagnosis is often delayed or missed leading to delay in instituting appropriate treatment and invariably high mortality. We report the case of A. B who was a 13-year-old girl referred from a peripheral hospital with chronic cough, weight loss, and dyspnea. She had signs of heart failure and developed depression as well as oliguria. The patient also had pleural effusion, but aspirate result was negative for Mycobacterium tuberculosis and cytology. She commenced antituberculous drugs and dexamethasone with other supportive care but died after 19 days on admission. Serum assay was positive for antinuclear antibody. SLE is a potential masquerader of chronic diseases such as tuberculosis. Delay in diagnosis and treatment is associated with poor outcome; hence, there is a need for high index of suspicion for early diagnosis with prompt initiation of appropriate treatment.
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Mermaid syndrome in Enugu, Nigeria p. 321
Johnpaul Ejikeme Nnagbo, Chukwudi Cyril Dim, Hyginus Uzo Ezegwui
DOI:10.4103/NJM.NJM_10_20  
Mermaid syndrome is a type of gross fetal anomaly, characterized by the fusion of lower extremities, absent external genitalia, and apparently well-formed abdomen, chest, upper extremities, and head. The neonatal mortality rate due to this anomaly is high, but the disorder is relatively rare. Hence, few cases have been reported in the medical literature, and none in University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State.
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Hormonal contraceptive induced immune thrombocytopenic purpura p. 324
Z Ayuba, HT Idi, YB Ngamdu, AA Buba, AB Tsuung
DOI:10.4103/NJM.NJM_48_20  
Immune thrombocytopenic purpura (ITP) is an acquired disorder of platelets that clinically manifests with mucocutaneous bleeding. There are several causes of ITP, but its association with hormonal contraceptive implants has not been widely reported. A 39-year-old Para 10+0 7 alive presented to the Yobe State University Teaching Hospital with complaints of nasal bleeding, gum bleeding, purpura, and menorrhagia, which were noticed a month after insertion of a Levonorgestrel – containing hormonal contraceptive implant, at a Primary Healthcare facility. Complete blood count, peripheral blood film, and bone marrow aspiration cytology led to the diagnosis of ITP. Epistaxis was managed conservatively. The patient was placed on prednisolone with a noticeable increase in platelet count and remarkable improvement in the clinical state. ITP is a complication of the hormonal contraceptive implant. Clinicians should be aware of the possible association of contraceptive implants and ITP.
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Penoscrotal angioedema in an 8-year-old boy following insect bites p. 328
Friday Emeakpor Ogbetere, William Omon Akerele
DOI:10.4103/NJM.NJM_52_20  
Angioedema in children displays a varied etiology and clinical manifestations, unlike adult angioedema. As opposed to angioedema in adults, pediatric angioedema majorly results from food, insect bites, and drugs. Reactions to insect bites, both allergic and toxic, are frequently encountered in pediatric medical practice but rarely seen in urological practice. Here, we present a case of penoscrotal angioedema resulting from an insect bite in the affected region. This case report emphasizes the need to consider penoscrotal angioedema as an important differential diagnosis of genital swelling, as early diagnosis may obviate fatal complications.
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Emphysematous pyelonephritis in a type II diabetic woman p. 331
Nonyelum Jisieike-Onuigbo, Bartholomew Ozuemba, Arinze Anyanor, Amaka Osakwe, Chidozie Ndulue, Eze Hycainth, Fidelis Oguejiofor, Charles Odenigblo
DOI:10.4103/NJM.NJM_59_20  
Mrs. E. J. N is a 57-year-old Type II diabetic who presented to the emergency unit of internal medicine with a 1-week history of reduction in urine output and passage of foul-smelling urine with associated fever, nausea, vomiting, and right flank abdominal pain. This clinical case was diagnosed as emphysematous pyelonephritis with the help of ultrasonography. She recovered with medical therapy. This case highlights that aggressive medical management in severe cases may obviate the need for potentially dangerous surgical interventions in resource-limited settings.
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Solar maculopathy arising from nondeliberate sun gaze p. 334
Oraegbunam H Nnenna, Etim A Bassey, Uchenwa Ezemba
DOI:10.4103/NJM.NJM_65_20  
Solar maculopathy occurs as a result of the effects of exposure of the macula to the harmful light spectrum from the sun. Phototoxic damage of the macula occurs as a result of the exposure to sunlight with some resultant visual deficit. The effect is common during a solar eclipse, where people directly watch the occurrence without sun-filter glasses. Solar maculopathy is also known to occur during religious rituals, and in schizophrenic patients who stare at the sun. Clinical history, subtle clinical biomicroscopic, and optical coherence tomography (OCT) findings are the key in making a diagnosis. Management is conservative with OCT follow-up. Solar maculopathy from nondeliberate sun gazing is not common. We report the case of a 24-year-old African who developed solar maculopathy after nondeliberate exposure to sunlight.
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LETTER TO EDITOR Top

Guillain–Barre syndrome: A rare occurrence following scrub typhus p. 337
Abhishek Juneja, Kuljeet Anand, Mansi Shah
DOI:10.4103/NJM.NJM_36_20  
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ERRATUM Top

Tobacco abuse and it's health effect p. 339

DOI:10.4103/NJM.NJM_98_20  
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