Highland Medical Research Journal

Distribution and outcomes of neonatal admission hypothermia in a tertiary hospital in Jos Nigeria

Fri, 08 Dec 2023 00:00:00 +0000

Background: Admission hypothermia (AH) is common and associated with adverse neonatal outcomes. The association of severity of AH with mortality is emerging however, the widely used WHO classification of neonatal hypothermia has limitations. We therefore sought to determine the severity distribution of AH, agreement between the two methods ofclassification and estimate risk of mortality in hospitalised neonates.

Methods: It was a retrospective crossectional study of 540 neonatal admissions. Anonymized data extracted from the unit electronic records. The WHO method was compared with a new method of classification of hypothermia.

Results: The prevalence of AH was 41.9% with 104 (48.0%), 88(38.9%), 23(10.2%) and 11(4.9%) neonate with Grade I(mild), Grade II, Grade III, and Grade IV (severe) AH respectively. There was moderate agreement between both methods of classifications (? = 0.740, p <0.001). Mortality was 3.4 folds in neonates with AH (16.8%) compared to those with normothermia (5.6%) (crude odds ratio [cOR] =3.381, 95% CI= 1.677-6.816). The proportion of mortality increased with severity of hypothermia with mortality rates of 14.4%, 15.9%, 21.7% and 36.4% in neonates with Grade I, Grade II, Grade III 2and Grade IV hypothermia respectively (÷ for trends= 16.407, p=<0.001). After correcting for the effect of admission age, gestational age and birth weight, there was a 6 fold increase in the risk of mortality in neonates with Grade IV(severe) AH (adjusted OR = 6.393, 95%CI= 1.552- 26.331).

Conclusion: The new method had an advantage of identifying a subpopulation of neonates with severe AH with increased risk of mortality therefore recommended.

Lifestyle habits of offspring of patients with type 2 diabetes mellitus

Jemimah O. Edah, Gabriel Odoh, Godwin O. Osaigbovo, Fabian H. Puepet — Fri, 08 Dec 2023 00:00:00 +0000

Background: To determine the lifestyle habits of offspring of patients with type 2 diabetes mellitus (T2DM) and the practice of diabetes mellitus (DM) screening among them.

Materials and Methods: This was a hospital based descriptive cross-sectional study conducted at the Jos University Teaching Hospital (JUTH). Participants were offspring of patients with T2DM who accompanied their parents to the DM clinic or took care of their parents while on admission in the hospital. They were recruited consecutively after obtaining consent. A questionnaire was used to obtain socio-demographic and clinical data from the participants. Anthropometric measurements were taken to determine Body Mass Index (BMI) and Waist Hip Ratio (WHR).

Results: A total of 100 offspring were recruited, males being 53 (53%) with a female: male ratio of 1:1.13. The mean age ± SD of the study population was 33±10 years. Less than half 49 (49%) of the participants engaged in some form of exercise. Twenty-four (24%) and 18 (18%) participants consumed fruits and vegetables daily respectively. Less than half 40 (40%) of the participants had been screened for DM at some point in their lives. Daily intake of fruits (OR 3.45, 95% CI 1.11-10.70) and vegetables (OR 4.19, CI 1.13-15.52) were found to be independently associated with DM screening.

Knowledge of healthcare workers on vertical transmission of hepatitis at a secondary healthcare facility in Northern Nigeria

Fri, 08 Dec 2023 00:00:00 +0000

Background: Viral hepatitis is a major global public health challenge. Hepatitis B virus (HBV) and Hepatitis C virus (HCV) lead to chronic diseases in several millions of people. They can be spread by mother to child transmission (MTCT) at birth. Awareness of healthcare workers (HCWs) on MTCT of HBV and HCV is key in the prevention. Hence, we sought to assess the knowledge of HCWs on MTCT as a route of transmission of the HBV and HCV.

Methods: The study was cross-sectional. Respondents were selected using simple random sampling technique. Data collection was by self-administered questionnaires and data was analyzed using SPSS version 23. Chi-square test was done to determine the relationship between sociodemographic characteristics and the level of knowledge, and at 95% confidence interval, a P-value less than 0.05 was considered to be statistically significant.

Results: Eighty-one HCWs participated in this study, with 50 (51.7%) females. The mean knowledge score was 7.76 ± 1.60 with 22 (27.2%) of the respondents having good knowledge. Twenty-two (27.2%) and 24 (29.6%) of the HCWs knew respectively that HBV and HCV could be by MTCT. There was a statistically significant relationship between cadre of HCW and level of knowledge (p < 0.01).

Conclusion: Most of the HCWs had poor knowledge on MTCT of viral hepatitis. Majority of them did not know MTCT as a route of transmission of viral hepatitis. We recommend that HCWs need retraining to improve knowledge on MTCT of viral hepatitis.

Increased mortality in patients suspected of having Covid-19: Findings at a treatment center in Delta State

Fri, 08 Dec 2023 00:00:00 +0000

Background: At the beginning of the COVID-19 pandemic there was great anxiety amongst healthcare workers because of the high infectivity and significant mortality associated with the disease. Also, patients were anxious about accessing medical facilities for fear of being labeled as suspected cases of COVID-19 infection. Therefore, we decided to determine the outcome of hospital admission among COVID-19 suspected cases.
Methods: This was a retrospective descriptive study of patients suspected of having COVID-19 as defined by the Nigeria Center for Disease Control, who were admitted to Delta State University Teaching Hospital, Oghara. The medical history, clinical examination, and test results of these patients were documented in their case notes and charts. Relevant data were extracted from these case notes and charts into a Microsoft Excel spreadsheet.
Results: During the study period 68 patients were admitted to the Treatment Center; 22 (32.3%) of them tested positive for SAR-CoV-2, while the other 46 (67.7%) tested negative. The patients who were SARS-CoV-2 negative had a statistically significant higher case fatality 20/46 (43.5%) than those that were SARS-CoV-2 positive 3/22 (13.6%) (p = 0.012). However, there was no statistically significant difference between the two groups in age, presence of co-morbidities, the severity of symptoms, intubation, dialysis, and the need for supplemental
oxygen (p > 0.05). The time from admission to death for the negative cases was significantly shorter, compared to the positive cases. They died within an average of a day on admission compared to those that tested positive (5-6days); p-value = 0.009.
Conclusion: This study shows that among patients suspected of having COVID-19, those who tested negative for SAR-CoV-2 had higher mortality than those who tested positive. Future studies should explore if this increased mortality is related to the initial fear and misconceptions about the disease amongst the population in general and health care workers in particular.

Severity of preeclampsia and maternal serum lactate dehydrogenase: Is there a link?

Fri, 08 Dec 2023 00:00:00 +0000

Background: Preeclampsia (PET) is one of the most common medical conditions complicating pregnancy and an important cause of maternal and neonatal morbidity and mortality. Predicting the severity of this disease is crucial for good management outcome. Serum lactate dehydrogenase is a marker of tissue damage and preeclampsia is associated with significant tissue damage.

Methods: This was a comparative cross-sectional study involving 55 preeclamptic women aged 18-40 years with gestational age >20 weeks and 55 normotensive pregnant women matched for age, gestational age and parity recruited from the Antenatal clinic of Jos University Teaching Hospital. Socio-demographic, biophysical and obstetric data were obtained. Serum lactate dehydrogenase levels were assayed and both groups were followed up till delivery and their pregnancy outcome noted. Data was analyzed using IBM SPSS version 22.0, P<0.05 was considered significant.

Results: The mean serum LDH level of the study group (355±364IU/L) was significantly higherthan the control group (136±50IU/L), P <0.001. The mean serum LDH level among preeclamptics with complications was significantly higher (880±12.6IU/L) compared to preeclamptics without complication (266.2±151.2IU/L), P <0.001.

Conclusion: Serum Lactate Dehydrogenase is a good marker of preeclampsia and higher levels of Lactate Dehydrogenase among preeclamptic patients could be a predictor of possible complications.

Poorer early treatment outcomes among Human Immunodeficiency Virus -1 infected patients initiating antiretroviral therapy in the “test and treat” era in Nigeria

Fri, 08 Dec 2023 00:00:00 +0000

Background: Antiretroviral therapy (ART) initiation timing has undergone changes over time, with updates to recommendations for same-day ART initiation. The objective of this study was to compare early treatment outcomes in a large Nigerian ART center between the pre-"test and treat" and "test and treat" eras.

Methods: The study was a retrospective cohort analysis of 1782 patients who started ART in the pre-"test and treat" era (prior to April 1, 2017) and the "test and treat" era (April 1, 2017, to December 31, 2019) at the Jos University Teaching Hospital (JUTH) ART clinic. Data were extracted from an electronic medical record system. Multivariable logistic regression identified predictors of early immunologic and virologic failure.

Results: Of the participants, 1452 (81.4%) were in the pre-"test and treat" group, and 330 (18.5%) were in the "test and treat" group. Patients in the "test and treat" group had a higher proportion of early immunologic failure (58%) compared to the pre-"test and treat" group (37%). The odds of early immunologic failure were higher in the "test and treat" era (OR 5.88; 95% CI 3.29-10.52). Patients in the "test and treat" era had three times greater odds of early virologic failure (OR 3.46; 95% CI 1.70-7.01).

Conclusions: The study found that the "test and treat" strategy resulted in poorer early immunologic improvement and viral suppression compared to the era of CD4+ cell count guided treatment initiation. Additional interventions may be necessary to improve the effectiveness of the "test and treat" strategy, particularly in resource-limited settings.

The impact of isolation on the psychological wellness of COVID-19 discharged patients during the pandemic in Jos, North Central, Nigeria

Fri, 08 Dec 2023 00:00:00 +0000

Background: Being isolated by whatever means has profound consequences on an individual. Isolation and COVID-19 are double jeopardy worthy of investigating. We therefore sought to determine how isolation impacted on the psychological wellbeing of discharged COVID-19 patients.

Methods: A cross-sectional study on 116 participants who met the discharge criteria of the NCDC interim guidelines within COVID-19 outbreak. A proforma assessed the age, gender, and educational level, length of stay and presence of symptoms of COVID-19. Others assessed were perception of stigma, modes of admission etc. The General Health Questionnaire-12 (GHQ-12), screened for mental wellness and assessed the impact of isolation on psychological wellbeing of discharged COVID-19 patients.

Results: One hundred and sixteen (116) discharged COVID-19 participants were screened. The mean age and GHQ-12 scores of the participants were 38.7±14.6 years and 2.88±2.1, respectively. There were more men (59%) with 67.2% of the assessed participants were 'ever married and 43% had tertiary education. Sixty-two percent (62%) had voluntarily admission. About 14% had symptoms on admission. The mean length ofstay was 10.4±4.1 days with 43% having stayed for more than 10 days. Thirty-eight per cent (38%) had psychological problems/ distress. Furthermore, 56% experience a perceived stigma and significantly associated with psychological problems/ distress (p= 0.020). Fifty-six per cent of the assessed were Christians and were significantly associated withpsychological problems/ distress (p= 0.014). There was a significant negative relationship between 'not being aware of stigmatization' and psychological problems/ distress (B= -1.566, p=0.018, CI=0.057-0.769))

Conclusion: Isolation impact considerably on the psychological wellbeing of infected COVID-19 patients.

Quality of Healthcare in Acute Heart Failure Management in a Tertiary Hospital

Fri, 08 Dec 2023 00:00:00 +0000

Background: Acute heart failure (AHF) often requires hospitalization for optimal management and the quality of healthcare (QOHC) depends on the implementation of key quality indicators (KQI). However, the QOHC in AHF patients is not established in our locale. We therefore sought to determine the QOHC in hospitalized AHF patients in a tertiary health center.

Methods: It was a retrospective study of hospitalized AHF patients in a tertiary center. Demographic, and clinical data were extracted from the records. The QOHC was determined by the frequency of implementation of KQI in cases recommended for the KQI. Suboptimal, and optimal QOHC were determined by a mean frequency of less than 100%, and 100% respectively.

Results: Seventy nine cases of AHF were managed in the general wards. The mean age was 60.49 ± 17.42 years, and 41 (51.9%) were males. Fifty cases (63.3%) had heart failure with reduced ejection fraction. The frequencies of KQI implementation were left ventricular ejection fraction assessment 70 (88.8%), use of Angiotensin converting enzyme inhibitors (ACEI)/Angiotensin receptor blockers (ARB) 39 (78%), Beta Blockers 36 (72%), anticoagulant 10 (90.9%), patient education 0(0%), and scheduled appointment 71 (89.9%). The mean frequency was 69.9%. Fifty-five (69.7%), and 24 (30.3%) of cases had optimal and suboptimal QOHC respectively. Blood pressure, and duration of hospitalization differed in both groups, p values of 0.000, and 0.016 respectively.

Conclusion: The QOHC in hospitalized AHF patients is suboptimal in terms of usage of guideline directed medical therapy (GDMT), lack of patient education, and poor infrastructure. Measures to address these problems should be initiated.

Prevalence and types of refractive error among students presenting to a federal university school clinic in North-Central Nigeria

Fatima H. Umar, Ruth J. Alfin — Fri, 08 Dec 2023 00:00:00 +0000

Background: Uncorrected refractive error (URE) is a major public health problem with extensive negative social and economic impact on patients. It can limit educational and employment opportunities of affected individuals. We sought to determine the prevalence and types of refractive error (RE) among students presenting to a federal university school clinic in North-central Nigeria.

Methods: A school based retrospective study where the records of all students seen at the eye unit of the university clinic between March, 2019 and March 2020 was done. Details of student's refractions were retrieved from their records and categorized based on distant and near RE types. For each student, the eye with the better vision was used for the analysis. Myopia was defined as an error of greater or equal to -0.50DS; hypermetropia as an error of greater than or equal to + 0.50DS; while astigmatism was defined as an error of greater than or equal to 0.50DC. Data was analyzed using Statistical Package for Social Student version 21.

Results: A total of three hundred and twenty-two students were seen in the eye unit of the university clinic during the study period, of which 95 (29.5%) underwent refraction. RE was found in 81 of them giving a RE prevalence of 25.2%. There were more females 49 (58.0%) than males with RE with a M: F of 1:1.4. With an age range of 17-58 years, the most frequent age group was 17-26 years (51.8%). Myopia was the predominant RE 31(38.3%) and hypermetropia was the least RE found in 4 (4.9%) eyes.

Conclusion: Uncorrected refractive error is common among university students presenting to the eye unit of the university clinic with myopia being the most common type. There is therefore, a need to establish regular and effective screening programmes that will promote early detection and correction in order to forestall its negative impact on students' academic performance.

Chronic myeloid leukaemia (CML) presenting with pleural effusion

Fri, 08 Dec 2023 00:00:00 +0000

Background: Chronic myeloid leukaemia presenting with pleural effusion as the initial clinical manifestation is very rare and poorly understood.
Case Presentation: We report a 34year old woman with CML (accelerated phase) in whom the initial clinical presentation was pleural effusion. She had a four week history of chest pain and cough, one week history of progressive difficulty in breathing and a history of weight loss and recurrent low-grade fever. On examination, she was a chronically ill-looking young woman in respiratory distress, pale, with tachycardia, tachypnoea and stony dull percussion notes and absent breath sounds on the right hemi-thorax. She also had splenomegaly and hepatomegaly. An initial diagnosis of disseminated Tuberculosis was ruled out by a full blood count and bone marrow aspiration cytology suggestive of a chronic myeloid leukaemia and confirmed by positive BCR-ABL transcripts. She was commenced on cytoreduction but demonstrated features of Tumour Lysis Syndrome after initiation of cytore-duction despite prophylaxis, warranting multidisciplinary care and haemodialysis. When she became clinically stable, she was referred for enrolment into Glivec International Patient Assistance Program (GIPAP) and she was commenced on Imatinib mesylate 600mg daily on account of CML in accelerated crisis. However, she was lost to follow up after her enrolment into the program.
Conclusion: Pleural effusion as the initial clinical manifestation of chronic myeloid leukemia (CML) is very rare so high index of suspicion should be maintained in the context of these unusual manifestations of CML.

Angiolymphoid hyperplasia with eosinophilia in a 27 year old male: A case report in Jos, North Central Nigeria

Fri, 08 Dec 2023 00:00:00 +0000

Background: Angiolypmphiod hyperplasia with eosinophilia (AHLE), also known as epithelioid hemangioma or histiocytoid hemangioma is a very rare vasoproliferative disorder with an obscure aetiopathogenesis. It mostly affects the head and neck regions of young women. It appears as a dark hyperpigmented or erythemathous nodular subcutaneous swelling depending on skin colour of the individual. Histologically it appears as proliferating small to medium sized blood vessels with epithelioid like endothelial lining cells within a lymphoid background punctuated by eosinophils. Even though it is mostly self limiting, surgery is one of the good modalities for its treatment.

Case presentation: A 27 year old male Nigerian presenting with dark hyperpigmented nodular growths on the right pinna and the left posterior auricular area. Had no history of ear piercing or injury prior to the onset of the growths. The masses measured about 4 by 2 by 1.5 cm and non tender. No regional lymphadenopathy felt on palpation or peripheral blood eosinophilia. Complete surgical excision of the two masses was done and specimen taken for histological evaluation. A diagnosis of ALHE was made. There was no recurrence of the growth two years after the surgery.

Conclusions: AHLE is very rare lesion and might be mistaken for other lesions that share gross or histological features with it. Histological diagnosis of the lesion is pertinent before definitive treatment. This will allow choice of preferred modality by the patient and the clinician. There are several treatment modalities for this lesion, but surgical excision is currently recommended.