Nigerian Journal of Medicine <p><em>Nigerian Journal of Medicine</em> ( NJM) , is the official publication of Nigerian Association of Resident Doctors ( NARD), established in 1990. It is an international peer-reviewed print and online bi-monthly journal.</p> <p>NJM publish scientific reports on human subjects in the form of original articles, review articles, case reports and letters. The journal covers technical and clinical studies related to medicine, dentistry and allied sciences. Articles with clinical interest and implications are only considered for publication.</p> <p>The journal allows free access ( Open Access) to it's contents.</p> <p>Other websites related to this journal: <a href="" target="_blank" rel="noopener"></a> and <a href="" target="_blank" rel="noopener"></a></p> Medknow en-US Nigerian Journal of Medicine 1115-2613 On acceptance, the copyright of the paper will be vested in the Journal and Publisher. Correlation between Physical Activity and Premenstrual Syndrome: A Narrative Review <p><strong>Background</strong>: Premenstrual syndrome (PMS) is a prevalent condition among sexually active women that manifests itself through a variety of physical, emotional, and behavioral symptoms during the end of the secretory phase of the menstrual cycle.</p> <p><strong>Aim</strong>: This study aims to review studies that correlate physical activity with PMS.</p> <p><strong>Materials and Methods</strong>: The literature search took place in four databases from the year 2000 to 2019.</p> <p><strong>Results</strong>: Eight studies reported a positive correlation between physical activity, exercises, and PMS, while two reported a negative correlation.</p> <p><strong>Conclusion</strong>: Physical exercise and PMS have a favorable association, according to the examined papers.</p> Ezugwu Uchechukwu Antonia Nseka Elizabeth Godwin Ojukwu Chidiebele Petronilla Ekechukwu Nelson Echezona Ezeigwe Anne Uruchi Igweagu Chukwuma Paulinus Ezugwu Lazarus Eneje Copyright (c) 2022-04-22 2022-04-22 31 1 1 7 Trends in Trauma Services: A Review of the Nigerian Experience <p>Trauma care has been ongoing in Nigeria since the Colonial period when wounded soldiers from World War II were rehabilitated at a hospital in Lagos. This has evolved into a point that we now train specialists in trauma care in many hospitals in the country. In spite of progress made, trauma remains a neglected disease in Nigeria, organized trauma services remain a mirage and traditional bone setter’s practice prevails with dismal outcomes. The purpose of this review is to appraise how Nigeria as a country has fared in the provision of trauma services and the way forward.</p> Theophilus Maksha Dabkana Friday Titus Nyaku John Enekele Onuminya Mutaleeb Shobode Copyright (c) 2022-04-22 2022-04-22 31 1 8 12 National Survey on Discharge against Medical Advice among Patients with Musculoskeletal Trauma in Nigeria <p><strong>Background</strong>: Patients in our environment sometimes discharge themselves against medical advice. Many of them do this due to the cost of treatment and a belief in the efficacy of traditional bone setters (TBS). This is the first multi‑center study in our environment comparing the differences across ethnic groups, religions, and geographical regions.</p> <p><strong>Aim</strong>: The study aimed to hightlight the burden of DAMA among patients with musculoskeletal injuries.</p> <p><strong>Patients, Materials and Methods</strong>: This was a health facility-based cross-sectional study of patients with musculoskeletal injuries who presented to the Accident and Emergency departments of five selected health facilities across Nigeria over a six‑month period.</p> <p><strong>Results</strong>: A total of 601 patients were enrolled in this study. One hundred and ninety‑four (32.3%) respondents discharged themselves against medical advice and the major reason given for the discharge against medical advice (DAMA) was the cost of treatment (49.1%) and a preference for the care given by TBS by relatives (33.5%) and the respondents (29.8%). The educational status of respondents, ethnic group, and access to health insurance, duration of admission, and frequency of fractures were predictors of DAMA. Respondents with postgraduate qualifications were much less likely to DAMA, adjusted odds ratio 0.36; confidence interval: 0.15–0.86, P = 0.021. Furthermore, respondents from Ibibio, Fulani, and Tiv ethnic groups were 3.79, 2.58, and 2.56 times more likely to DAMA, respectively. Respondents with health insurance coverage were less likely to DAMA.</p> <p><strong>Conclusion</strong>: The prevalence rate of DAMA amongst patients with musculoskeletal trauma in Nigerian tertiary hospitals is relatively high. The predictors of DAMA identified in this study call for improvements in education and mandatory health insurance cover. From the findings in this study, reducing out‑of‑pocket costs to patients may be the most important step in improving access to orthodox treatment of musculoskeletal injuries. Further studies are suggested to determine why some ethnic nationalities had a higher prevalence of DAMA.</p> Christian Chukwuemeka Madubueze Ugochukwu Chinyem Madubueze Njoku Isaac Omoke Alfred F.I. Una Oladimeji Ranti Babalola Sikiru Alabi Edwin Maduakonam Dim Copyright (c) 2022-04-22 2022-04-22 31 1 13 19 Perception of Postgraduate Medical Trainers and Trainees on Residency Training Program in a Developing Country and its Influence on Brain Drain <p><strong>Background</strong>: Nigeria has been faced with the challenge of massive efflux of senior trainees and young consultants. It is commonly believed that the emigration is for economic reasons.</p> <p><strong>Aim</strong>: We studied the trainer’s and trainee’s perception of residency in Nigeria and its influence on brain drain.</p> <p><strong>Materials and Methods</strong>: This cross‑sectional study was carried out using an online survey platform. Invitation to complete the survey was sent out through closed social media groups (Facebook, WhatsApp, and Telegram) and e‑mail. These groups were specifically for doctors who had their basic medical education in Nigeria and presently working in Nigeria or outside the borders of Nigeria.</p> <p><strong>Results</strong>: Most respondents were in training and were between 25 and 44 years old. The top reason for emigration for trainees already abroad was to improve the quality of their training while the top reason for trainees planning to emigrate was to get better training. There was a discordance between the mentorship methods employed by trainers and preferences of trainees. While majority of the trainees already abroad were unlikely to return, most of the trainees considering emigration were willing to stay if training improved.</p> <p><strong>Conclusion</strong>: Nigerian trainers and trainees have similar perceptions about residency training, and the brain drain being experienced presently may be reversible with improvement in training in the country.</p> Tosin Olusoga Akinyemi Olukemi O. Lawani Ahmed Adekunle Adewole Sebastine Oseghae Oiwoh Copyright (c) 2022-04-22 2022-04-22 31 1 20 24 Surgeons’ Disposition on the Use of Autologous Blood Transfusion in Tertiary Hospitals in Enugu, Nigeria <p><strong>Background</strong>: The need for autologous blood transfusion in our tertiary hospitals to restore patients’ hemodynamics with little or no complications cannot be overemphasized.</p> <p><strong>Aims</strong>: This study is aimed at assessing surgeons’ challenges and patients’ readiness to accept autologous blood transfusion.</p> <p><strong>Materials and Methods</strong>: It was a cross‑sectional study conducted at Enugu State University Teaching Hospital, University of Nigeria Teaching Hospital, Enugu, and National Orthopaedic Hospital, Enugu, from September to December 2020. A convenient sampling method was adopted in the distribution of questionnaires, and a total of 67 surgeons were enrolled in the study. Collated data were analyzed using SPSS software 21.</p> <p><strong>Results</strong>: The study revealed that 60% of the respondents claimed that commercial donors were observed to be the major source of allogenic blood donation. Consequently, 34.3% and 80.6% of the respondents admitted that blood‑borne transmissible infections and blood transfusion reactions, respectively, were still a challenge in their practice. The outcome from this study also showed that 59% of the respondents claimed that their patients are not knowledgeable enough to make informed decision on the use of autologous blood transfusion while 52.4% of the respondents admitted that they do not have the facility for processing autologous blood transfusion. For the surgical specialties, all were willing to prescribe autologous blood transfusion for their patients, though no statistical difference (P &lt; 0.05) exists among the specialties.</p> <p><strong>Conclusion</strong>: Autologous blood transfusion has remained the mainstay as effective and safest means of blood transfusion in overall patient care; hence, surgeons should incorporate this concept into their practice to enable patients make an informed decision.</p> Uche Sebastine Ozioko Emmanuel Chino Iyidobi Ignatius Ikemefuna Ozor Ifeanacho Ezeteonu Abireh Onyinye Mary Ozioko Chisom Ogbonnaya Mbaeze Prince Chukwuemeka Okolo Copyright (c) 2022-04-22 2022-04-22 31 1 25 28 Clinical Characteristics of COVID‑19 Patients Admitted at the Federal Medical Center, Abeokuta <p><strong>Background</strong>: As the coronavirus disease 2019 (COVID‑19) continues to ravage the world as a pandemic, there is a paucity of data in resource poor countries like ours on the clinical characteristics of these patients.</p> <p><strong>Aim</strong>: The aim of our study was to find the sociodemographic, clinical, and laboratory characteristics of COVID‑19 patients admitted in our facility between May and July 2020.</p> <p><strong>Materials and Methods</strong>: A cross-sectional observational study was carried out on COVID‑19 patients admitted during the study period. Their baseline demographic, clinical, and laboratory details were obtained from their clinical notes, recorded electronically, and analyzed. Results: Twenty‑six COVID‑19 patients were admitted during this period, with a mean age of 47.19 (standard deviation 16.56) years, and more males 16 (61.5%). Fever was the most common complaint 17 (65.4%), followed by breathlessness 15 (57.7%), weakness 11 (42.3%), and cough 9 (34.6%). Hypoxemia (SPO2 &lt;93%) was present in 10 (38.5%)of patients at admission, with dyspnea being the most common abnormality on general physical examination 20 (76.9%). Eleven (42.3%) patients had associated comorbidities with hypertension being the most common 7 (43.7%), followed by diabetes mellitus 4 (25.0%). Just 3 (11.5%) patients had mild disease, 13 (50.0%) had moderate disease, and 10 (38.5%) had severe disease. Lower respiratory tract infection or suspected COVID‑19 was the initial diagnosis in 10 (38.5%) of patients at admission, while 16 (61.5%) were admitted with other diagnosis. Leukocytosis was found in 8 (30.8%) patients, 14 (53.8%) patients had anemia, elevated urea in 20 (76.9%), and elevated Creatinine in 11 (42.3%). Seventeen (65.4%) patients were discharged home, 2 (7.7%) referred to another center for hemodialysis, while 7 (26.9%) died.</p> <p><strong>Conclusion</strong>: Understanding the clinical and laboratory characteristics of COVID‑19 in our local environment will be integral to earlier identification and treatment outcomes for our patients.</p> Ayanfe Omololu Omobola Yetunde Ojo Segun Adebisi Victor Nwadike Oluwatomiwa Ajayi Tolulope Adesomi Oreoluwa Alade Copyright (c) 2022-04-22 2022-04-22 31 1 29 34 The Risk Factors Associated with Rotavirus Gastroenteritis among Children Under Five Years at University of Maiduguri Teaching Hospital, Borno State, Nigeria <p><strong>Background:</strong> Diarrhea is a major cause of childhood morbidity and mortality in both developing and developed countries. It remains a common cause of hospitalization worldwide. Rotavirus is a cause of acute watery diarrhea in children under five years of age. The incidence of diarrhea decreases with increasing age.</p> <p><strong>Aim</strong>: This study aimed at finding some risk factors associated with rotavirus infection in children &lt;five years of age presenting with acute diarrhea at the university of Maiduguri teaching hospital.</p> <p><strong>Patient, Materials and Methods</strong>: This is a cross-sectional study. Atotal of 173 children &lt;five years presenting with diarrhea of &lt;two weeks were recruited for the study. Stool samples were collected, and rotavirus antigen was detected using immunochromatographic, and the positive sample was then further analyzed using reverse transcriptase polymerase chain reaction for the VP4 and VP7 genotyping. The risk factors were analyzed using multivariate analysis conditional regression model after collecting data using a well‑structured questionnaire.</p> <p><strong>Results</strong>: The Source of water supply and presence of persons with gastroenteritis in the household were found to be risk factors for acquiring the infection with statistically significant P &lt; 0.05. Breastfeeding was found to be protective of rotavirus gastroenteritis.</p> <p><strong>Conclusion</strong>: Rotaviruses cause morbidity and mortality in children under five years of age. In view of the associated risk factors, making available safe drinking water and encouraging good personal hygiene is important. Promotion of exclusive breastfeeding and vaccination is advocated. Public health strategies like creating awareness to affected communities are a good strategy.</p> Kellu Bukar Ali Galadima Bala Gadzama Sambo Bello Zailani Yahaya Mohammed Batula Bishara Daggash Yakubu Mohammed Yakubu Baba Abubakar Sadiq Shettima Ashe Baba Kadaura Mairo Usman Copyright (c) 2022-04-25 2022-04-25 31 1 35 40 Early Detection of Paediatric Cancer: Equipping Primary Health‑Care Workers in Nigeria <p><strong>Background</strong>: Paediatric cancer patients in Nigeria continue to arrive at specialist centers with advanced‑stage disease. The reasons for this are myriad, not least of which are delays in detection, diagnosis, and referral for treatment. While delayed presentation has often been reported from the perspective of delays from caregivers’ decisions, institutional deficiencies in the health care system may account for an unmeasured portion of the factors leading to delayed presentation. This project centered around training of health‑care professionals at community level to detect potential paediatric cancer signs and refer appropriately.</p> <p><strong>Aim</strong>: The aim of the study is to access the immediate impact of training on early detection and referral of possible paediatric cancer cases in the community and primary level health care workers and professionals in the Southwest Nigeria.</p> <p><strong>Materials and Methods</strong>: This was a retrospective review of the training impact in three South‑Western states in Nigeria. Scores before and after the training were analyzed using the IBM SPSS statistics, version 23 (IBM, Armonk, NY, USA).</p> <p><strong>Results</strong>: A total of 732 primary health care workers were trained. In the pre assessment evaluations, 44.8% of participants reported that cancer did not occur in children, 47.2% did not know any referral pathway for a child suspected of cancer. The post training assessment indicated an improvement in participants’ understanding of common paediatric cancers types and how to refer a suspected case for specialist diagnosis and attention. Mean scores before and after the training were 3.5/15 and 12.5/15, respectively.</p> <p><strong>Conclusion</strong>: Training health-care professionals working at the community level can have an immediate and measurable impact on early detection and referral for paediatric cancers, as seen by the difference in pre training and post training assessment scores. There remains a need for continuous training to ensure early referral and ultimately increase survival indices of children diagnosed with cancer in Nigeria.</p> Adedayo Olufemi Joseph Onyinye D. Balogun Adeseye M. Akinsete Muhammad Yaqub Habeebu Mutiu Alani Jimoh Nwamaka N. Lasebikan Kanyinsola A. Oyeyinka Korede T. Akindele Opeyemi Mercy Awofeso Copyright (c) 2022-04-25 2022-04-25 31 1 41 47 Efficacy of Admission Cardiotocography in Early Stage of Labour in Predicting Perinatal Outcome among Parturients in a Tertiary Health Facility in Ogun State, Southwest Nigeria <p><strong>Background</strong>: Some fetuses will present with hypoxia at admission into the labour room and may not be able to withstand the stress of frequent and adequate uterine contractions. Admission cardiotocography (CTG) in early labour has been thought to be useful in detecting babies with such conditions therefore affording the obstetrician early intervention to prevent adverse perinatal outcome.</p> <p><strong>Aim</strong>: This study aims to determine the predictive value of admission cardiotocogram in early labour in the early detection of fetal hypoxia and its adverse perinatal outcome.</p> <p><strong>Patients,Materials and Methods</strong>: It was a prospective cross‑sectional study among low‑ and high‑risk pregnant women in a tertiary health institution in Abeokuta, Southwest Nigeria. Two hundred participants with singleton fetus in cephalic presentation were recruited consecutively at term in early first stage of labour and were subjected to 20 min admission CTG (ACTG). The resulting cardiotocograms were classified into reactive, suspicious or pathological and further management was based on the cardiotocogram findings. Perinatal outcomes were assessed and statistical analysis done using IBM SPSS version 20. The main outcome measures were mode of delivery and perinatal outcome using Apgar scores, neonatal pulse oximetry, and neonatal unit (NNU) admission.</p> <p><strong>Results</strong>: Seventy percent of the participants were multipara, 42% were aged between 26 and 30 years. Suspicious and pathological CTGs were 9% and 1%, respectively. Operative delivery, birth asphyxia, and NNU admission of babies were more common among the non‑reactive (suspicious/pathological) CTG groups compared to reactive CTG group. The test, in predicting perinatal asphyxia, has low sensitivity (42.86%) and positive predictive values (15%) but high specificity (91.19%) and negative predictive values (97.78)</p> <p><strong>Conclusion</strong>: ACTG is a simple, noninvasive screening tool in labour. It is highly effective in predicting fetuses unlikely to develop birth asphyxia but not so effective at predicting those likely to develop asphyxia. The test should be used with caution.</p> Oluwole Olutola Ojo David O. Awonuga Iyabode Olabisi Florence Dedeke Olaide Rufus Adenaya Adedoyin Olatunde Ade‑Onojobi Oluwaseyi Isaiah Odelola Elizabeth Oluwakemi Grillo Copyright (c) 2022-04-25 2022-04-25 31 1 48 53 Evaluation of the Pattern and Quality of Referrals from Inpatient Wards to Hematology Department of a Tertiary Hospital in Nigeria <p><strong>Background</strong>: The overall quality of care may be hampered by poorly written referrals. Referral letters should be detailed to elicit prompt response by the invited unit. This will enhance ideal management of cases that are referred.</p> <p><strong>Aim</strong>: The aim of the study is to determine the quality (content and usefulness) of referral letters received from inpatient clinical wards of University of Nigeria Teaching Hospital (UNTH), Ituku/Ozalla by hematology department of the hospital.</p> <p><strong>Materials and Methods</strong>: This was a retrospective study of all referral letters received in hematology department of the hospital over a 1‑year period (January to December, 2019) using a validated questionnaire.</p> <p><strong>Results</strong>: A total of 231 referral letters were received and evaluated. The median age of the patients was 35 (range: 20–59) years with male‑to‑female ratio of 1:1.3. Initial statement identifying the reason for the referral was observed in 88.7% (n = 205). Majority (176/213, 82.5%) of the referrals did not include the results of investigations the patients did before the referral. Less than a quarter of the referrals (41/231, 19.3%) contained information on the treatment given to the patient. More than one‑tenth (24/231), 11.3%) of the referrals were unhelpful while 13.6% (n = 29) were helpful.</p> <p><strong>Conclusion</strong>: The referrals sent to the hematology department were deficient in quality. These deficiencies could be ameliorated by tutoring the younger doctors on the content of an ideal referral letter. Furthermore, a well‑structured “referral form” with prompts for easy filling could be designed by hospitals as a guide to physicians for writing appropriate referral letter.</p> Angela Ogechukwu Ugwu Ikechukwu Okwudili Anigbogu Copyright (c) 2022-04-25 2022-04-25 31 1 54 58 Associations of Untreated Caries and Experience among WHO‑Recommended Adult Age Groups <p><strong>Background</strong>: The shift in caries burden from children to adults and its rise among this population necessitates epidemiological studies to provide data on the trend and modifiable factors.</p> <p><strong>Aim</strong>: This study aimed to determine prevalence of untreated caries, its contribution to caries experience, and related factors among WHO‑recommended adult age groups.</p> <p><strong>Patients, Materials and Methods</strong>: A cross‑sectional study was conducted over a six-month period in 2021 among 451 adults recruited from a patient population in Northeast Nigeria. Sociodemographic characteristics and oral health practices were recorded. Intraoral assessment for untreated caries, filled, and missing teeth were carried out according to the WHO criteria. Data analysis included logistic regression to produce a model for predictive risk for caries, with emphasis on the WHO recommended adult age groups.</p> <p><strong>Results</strong>: The prevalence of untreated caries (81.6%) was significantly (P &lt; 0.05) related to age, occupation, education, dental visits, snacking, and toothbrushing frequency. It accounted for 65.7% of the overall decayed, missing, and filled teeth score (3.35 ± 3.00) and was significantly higher for participants &lt;25 years(P = 0.044) compared to the middle aged (35–44 years) and elderly (65–74 years), classIII occupation (P = 0.020), no formal education (P = 0.002), and irregular dental visits (P = 0.019). Occupation (β = 0.131, P = 0.016) and level of education (β = −0.132, P = 0.006) were significant predictors of dental caries occurrence.</p> <p><strong>Conclusion</strong>: Caries experience was low, but the prevalence of untreated caries was very high and more common among younger adults. Socioeconomic status was an important determinant of caries presence.</p> Paul Ikhodaro Idon Oluwafeyisayo Francis Ikusika Temiloluwa Olawale Ogundare Janada Yusuf Lillian Lami Enone Aliyu Bappa Aliyu Copyright (c) 2022-04-25 2022-04-25 31 1 59 67 Clinical Status of Sickle Cell Anemia and the Impact on the Caregivers Finances at a Tertiary Hospital, North‑West Nigeria <p><strong>Background</strong>: Chronic condition like sickle cell anemia (SCA) is known to deplete family resource. The clinical status of children with SCA affects finances of the caregivers.</p> <p><strong>Aim</strong>: The study aimed at determining the clinical impact of children with SCA on their caregivers’ finances with the view to reduce the disease‑associated financial burden.</p> <p><strong>Patients, Materials and Methods:</strong> It was a cross-sectional study of 133 caregivers and their children with SCA managed at the sickle cell disease (SCD) clinic of the Paediatric Department of Barau Dikko Teaching Hospital, Kaduna, North‑Western Nigeria conducted between February and April 2016. A structured SCD burden interview was used. It has a total of 16 questions for four domains. The domain on the family finances has 3 questions each with a score ranging from 0 to 3. The clinical status of children with SCA was assessed using clinical parameters such as number of painful crisis, hospitalization, blood transfusion, and school absenteeism over the previous year.</p> <p><strong>Results</strong>: About 63 (47.4%) of the caregivers were more than 35 years of age. Eighty‑four (63.2%) were Hausas, 100 (75.2%) were Muslims, and 114 (85.7%) were married. Those with secondary education were 45 (33.8%), 43 (32.3%) were unemployed, and 42 (31.6%) were unskilled laborers. Source of their health‑care financing was mainly out of pocket in 126 (94.7%) while 47 (35.3%) had an average monthly income between ₦20,000 and ₦50,000. More than half of the caregivers 82 (61.7%) were not member of a social group. The statistical analysis of the clinical status of the children with sickle cell anemia on their caregivers finances revealed significant relationship between number of school absenteeism of the children and finances of the caregivers(P = 0.010).</p> <p><strong>Conclusion</strong>: Clinical status of children with SCA affects caregivers’ finances.</p> Ramatu Abubakar Habibatu Zubairu Dabo Samira Muhammad Badamasi Aishatu Kabir Abubaka Copyright (c) 2022-04-25 2022-04-25 31 1 68 73 Derangements of Liver Enzymes in a Study of 201 COVID‑19 Patients in Abuja, Nigeria’s Federal Capital Territory <p><strong>Background</strong>: Several studies reveal abnormalities in liver function tests of COVID-19 patients. However, there are little data on African patients.</p> <p><strong>Aim</strong>: This study aimed to evaluate liver function tests (LFT) in severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) infected patients admitted in Asokoro COVID‑19 Isolation and Treatment Centre in Abuja, Nigeria.</p> <p><strong>Patients, Materials and Methods</strong>: This was a retrospective study of 201 laboratory‑confirmed SARS‑CoV‑2‑infected patients hospitalized in Asokoro District Hospital COVID‑19 Isolation and Treatment Centre between April 10 and July 31, 2020. Demographic, clinical, and laboratory data were obtained, and the outcome measure was LFT abnormalities at presentation. Statistical analysis was done using IBM SPSS Version 24, with P &lt; 0.05 considered statistically significant.</p> <p><strong>Results</strong>: Patient median age was 39.3 years(IQR: 26–52); 65.7% were males and 33.8% were health workers. Approximately 49.2% of patients were overweight or obese. Hypertension (22.9%) and diabetes mellitus(7.5%) were the most common comorbidities and only 1% had a known history of liver disease. Abnormal LFTs were observed in 53% of patients(n = 106), most frequently elevated direct bilirubin (78.3%) and alanine aminotransferase (38.7%). Comorbidities were not found significantly associated with LFT abnormalities. Females (odds ratio [OR] = 0.367 P = 0.004 confidence interval [CI] 0.186–0.724) and patients aged 20–29 years (OR = 0.067 P = 0.043 [CI] 0.005–0.916) were found less likely to have abnormal LFTs.</p> <p><strong>Conclusion:</strong> Regardless of clinical status at presentation, about half of SARS‑CoV‑2 patients admitted at the Asokoro Isolation and Treatment Centre in Abuja had abnormal LFT results. It is therefore recommended that LFT is included as a part of baseline investigations during the management of COVID‑19 for improved outcomes.</p> Adaeze Chidinma Oreh Isaac Olubanjo Akerele Chidi Valentine Nnabuchi Dorcas Yetunde Obazee Henry Chijioke Onyegbutulem Copyright (c) 2022-04-25 2022-04-25 31 1 74 81 Chronic Urticaria in Blacks: Is Autoimmunity An Important Etiological Factor? <p><strong>Background</strong>: The etiology and pathophysiology of chronic urticaria is poorly understood with several implicated factors. The role of autoimmunity has been explored by several studies with such studies on chronic urticaria lacking in the black population despite the significant morbidity caused by chronic urticaria.</p> <p><strong>Aim</strong>: We assessed the possible contribution of autoimmunity in the etiology of chronic urticaria using autologous serum skin testing (ASST).</p> <p><strong>Materials and Methods</strong>: Sixty consecutive patients with chronic spontaneous urticaria (CSU) with age‑ and sex‑matched controls in a ratio of 2:1 had ASST done for comparison. Student’s t‑test and Chi‑square were used to compare means and percentages, respectively.</p> <p><strong>Results</strong>: The male:female ratio of CSU was 1:2.5 with females presenting more often. The ASST was noted to be significantly positive in patients compared to controls with a positivity rate of 68.3% in the former compared to 16.7% in the latter (P = 0.0001). A higher incidence of angioedema was also documented in patients with a positive ASST in association with urticaria (23/28, P = 0.04).</p> <p><strong>Conclusion</strong>: Overall, we conclude from our study that autoimmunity may be a possible cause of chronic urticaria in Nigerians which may also be extrapolated to other black population. Patients with positive ASST may have more severe disease which may be important when educating and counselling the patients about the course of the disease. This study is the first to assess the possible role of autoimmunity in a predominantly black population and will serve as a baseline for future studies.</p> Shakirat Ajoke Gold‑Olufadi Olusola Ayanlowo Ayesha Omolara Akinkugbe Erere Otrofanowei Copyright (c) 2022-04-25 2022-04-25 31 1 82 85 Pattern of Blood Component Request and Utilization in a Tertiary Hospital in Nigeria <p><strong>Background</strong>: Blood transfusion being a life‑saving procedure plays a vital role in the management of patients in the clinical practice. The challenges of inadequate voluntary blood donors and poor storage facilities made availability of sufficient safe blood difficult in developing countries. All efforts should therefore be put in place to ensure judicious use of the available blood by separating each unit of blood donated into components and giving individual patient only the required blood component rather than giving whole blood.</p> <p><strong>Aim</strong>: This study was conducted to look into the pattern of blood components request and utilization in a tertiary hospital in Nigeria to assess its effectiveness in reducing blood wastage.</p> <p><strong>Materials and Methods</strong>: This is a hospital‑based retrospective study. Blood Bank registers for blood component request and utilization were analyzed over a period of 20 months. Units of blood products requested and units used were considered during this period with emphasis on request to transfusion ratio.</p> <p><strong>Results</strong>: Highest blood product request was from pediatrics ward. Total blood product request for male was higher than for female. Highest blood product request was packed cell with request to transfusion ratio of 1.01, followed by fresh‑frozen plasma, request to transfusion ratio 1.0 and platelet, request to transfusion ratio 1.14.</p> <p><strong>Conclusion</strong>: Appropriate blood product request maximizes utilization, minimizes wastage, thereby increasing efficiency of the blood bank staff by reducing the unnecessary workload of cross matching, issuing of blood and wastage of reagents.</p> Ajayi Adeleke Ibijola Oluwafemi Johnson Adegbamigbe Abiodun Idowu Okunlola Kabir Adekunle Durowade Idowu Adebara Kolawole Asimiyu Fasakin Copyright (c) 2022-04-25 2022-04-25 31 1 87 91 Pattern of Common Hormonal Disorders among Patients with Polycystic Ovarian Syndrome at a Tertiary Health Facility in Nigeria <p><strong>Background</strong>: Polycystic ovarian syndrome (PCOS) is a disease associated with multiple reproductive and metabolic endocrine disorders. It is associated with cardiometabolic complications with established morbidity and mortality.</p> <p><strong>Aim</strong>: We studied the pattern of these endocrine disorders associated with PCOS will aid the understanding of the pathophysiology of this relatively incompletely understood syndrome, particularly among Africans.</p> <p><strong>Patients, Materials and Methods:</strong> One hundred adult females aged between 18 and 44 years, who were newly diagnosed with PCOS, and 100 age‑matched non‑PCOS women were involved in the study. Their serum samples were analyzed for follicle‑stimulating hormone (FSH), luteinizing hormone (LH), prolactin, progesterone, estradiol, testosterone, leptin, and anti‑Mullerian hormone (AMH) using ELISA method.</p> <p><strong>Results</strong>: The mean age of the test subjects in this study was 26.4 ± 6.0 years versus 33.3 ± 6.6 years in controls. The mean weights and body mass index of the test subjects and controls were 89.1 ± 13.9 kg versus 64.7 ± 11.3 kg, P = 0.04, and 34.01 ± 3.5 kg/m<sup>2</sup> versus 23.8 ± 3.9 kg/m<sup>2 </sup>, P = 0.034, respectively. The mean serum LH was significantly higher among subjects than that of controls (11.4 ± 7.4 vs. 5.7 ± 4.8 mIU/mL, P = 0.001); similarly the mean serum LH: FSH ratio was significantly higher among subjects and controls in this study (1.9 ± 1.1 vs. 1.1 ± 0.8, P = 0.042). Serum AMH, insulin, leptin, and testosterone levels were higher among subjects than controls (7.5 ± 5.4 vs. 2.7 ± 0.4 ng/mL, P = 0.001, 21.6 ± 7.3 vs. 18.0 ± 3.01 µIU/mL, P = 0.004, and 18.6 ± 4.0 vs. 3.5 ± 1.5 ng/mL, P = 0.003, 1.0 ± 0.2 vs. 0.6 ± 0.2 ng/mL, P = 0.042, respectively). Mean serum prolactin was significantly higher among subjects when compared to controls. The prevalence of hyperinsulinemia, hyperleptinemia, and hyperandrogenemia among subjects in this study was higher when compared to controls.</p> <p><strong>Conclusion</strong>: PCOS is a disease of multiple and inter‑related endocrine disorders; a study of the frequencies and distributions of these associated disorders can aid the understanding of the pathophysiology of the disease particularly among Africans where limited studies have been carried out.</p> Waliu Olatunbosun Oladosu Olanrewaju Saheed Jimoh Wasiu Adebisi Adeniyi Adewale Mukaila Alayo Aminat Olayinka Ahmed Sekinat Titilayo Raji‑Olarinoye Taofeeq Abiodun Ajadi Sikiru Abayomi Biliaminu Copyright (c) 2022-04-25 2022-04-25 31 1 92 97 Comparative Sonographic Assessment of Thyroid Volume in Adult Diabetics and Nondiabetics in the University of Uyo Teaching Hospital, Uyo <p><strong>Background</strong>: Diabetes mellitus and Thyroid disorders are known to mutually influence each other. Thyroid dysfunction especially when undiagnosed has a negative impact on metabolic control, likewise, increased levels of insulin in insulin resistance has a proliferative effect on thyroid tissue.</p> <p><strong>Aims</strong>: The study aimed to sonographically measure and compare Thyroid gland volume (TV) in adults with diabetes and apparently healthy subjects, as well as determine the effect of thyroid stimulating hormone (TSH), glycosylated haemoglobin (HbA1c) and anthropometry on TV.</p> <p><strong>Patients, Materials and Methods</strong>: This was a casecontrolled study carried out over 6 months in the University of Uyo Teaching Hospital, from April to September 2019, among 70 adult diabetics and an equal number of non-diabetics. The thyroid volume was correlated with gender, age, height, weight, BMI, waist circumference, duration of diabetes, TSH and HbA1c.</p> <p><strong>Results:</strong> The overall mean TV was higher in diabetics (6.8 ± 3.5cm3 versus 6.3 ± 2.9cm3). Among those with diabetes, TV was significantly higher in those with poor glycemic control (p=0.020). A positive correlation was found between TV and duration of diabetes and height. The mean thyroid volume was higher among the male population of both groups. An equal number of subjects had abnormal (high) TSH levels in both study arms. There was no correlation between TV and most of the anthropometric indices.</p> <p><strong>Conclusion:</strong> Sonographic thyroid volume is higher among diabetics and it has a positive correlation with gender, height, duration of diabetes and HbA1c.</p> Uzoma Oluchi Obasi Akintunde Olusijibomi Akintomide Copyright (c) 2022-04-25 2022-04-25 31 1 98 105 Bilateral Congenital Anophthalmia: A Report of Two Cases and a Case for Increased Anomaly Ultrasound Scans Coverage in Pregnancy in Nigeria <p>This is a report of two cases of patients with bilateral congenital anophthalmos who presented to a tertiary hospital, in Ibadan Southwest Nigeria, with the aim of highlighting the need for increased implementation of fetal anomaly scans coverage during pregnancy in Nigeria. Information on patients’ sociodemographic data, clinical features, and management are described. Both patients presented because of the inability of the parents to view the globes after delivery. Ophthalmic examination and ocular ultrasonography confirmed bilateral absence of the eyeballs in both patients and the parents were counseled on the anomaly including its treatment and prognosis.</p> Ezinne Obioma Onebunne Mary Ogbenyi Ugalahi Bolutife Ayokunnu Olusanya Aderonke Mojisola Baiyeroju Copyright (c) 2022-04-25 2022-04-25 31 1 106 109 Management of Achalasia in Pregnancy in a Resource‑Poor Setting <p>Achalasia is a rare motility disorder of the esophagus. Of more rarity is its occurrence in pregnancy. The disease is associated with varying degrees of malnutrition, with intrauterine growth restriction and even fetomaternal death reported in worse cases. Its diagnosis is usually confused for hyperemesis gravidarum in early pregnancy, and diagnosis is thus often delayed until the disease is advanced. Its evaluation and treatment pose a challenge due to associated fetomaternal risks of management. A case of achalasia diagnosed in the second trimester of pregnancy was presented. The patient was evaluated and subsequently had laparotomy and modified Heller’s esophagocardiomyotomy with a good outcome. Based on a review of the literature and own experience, an algorithm is proposed for its evaluation and treatment in a resource‑poor setting.</p> Ikechukwuka Ifeanyichukwu Alioke Copyright (c) 2022-04-25 2022-04-25 31 1 110 113 Utilization of Orthodox Eye Care Services among Visually Impaired Adults in Jos North Local Government Area of Plateau State <p><strong>Background</strong>: Evidence shows that poor utilization of available eye care services by potential beneficiaries is a major barrier to reducing the burden of visual impairment (VI) and blindness.</p> <p><strong>Aim</strong>: We sought to determine the extent of utilization and barriers to uptake of orthodox eye care services among adults with VI in Jos, the capital of Plateau state, Nigeria.</p> <p><strong>Materials and Methods</strong>: A population-based cross-sectional study using cluster sampling technique was conducted. Twenty‑two clusters were chosen: from each cluster, 39 persons recruited for participation were interviewed to obtain demographic data and then examined to determine the visual acuity. Individuals with visual acuity of &lt;6/18 had detailed ocular examination. Information on access to any eye services in the locality was obtained. The data from individual subjects were collated and analyzed using the statistical package for social sciences version 20.</p> <p><strong>Results</strong>: The study sample included 858 participants. Of the 160 participants with VI, 92 (57.5%) had sought eye care whereas 68 (42.5%) did not. It was found that utilization of eye services varied across the wards with Tafawa Balewa (100%), Vandapuye (100%), and Jenta Apata (100%) wards having the highest percentage of eye care utilization whereas Kabong (0%) and Mazah (11.1%) had the lowest eye care utilization rate. Factors associated with previous use of eye services were literacy (odds ratio = 1.41, P = 0.10) and blindness (odds ratio = 1.37, P = 0.09). Cost 39 (57.4%), being destined to be visually impaired 13 (19.1%), and old age 7 (10.3%) were found to be the most cited barriers to the use of eye services.</p> <p><strong>Conclusion</strong>: The use of eye care services among visually impaired participants was low in this urban local council; this can be enhanced by health education and awareness campaigns. The role of community participation in eye care is important so as to improve the uptake of existing eye services.</p> Fatima Hudu Umar O.P. Odugbo C.D. Mpyet Copyright (c) 2022-04-25 2022-04-25 31 1 114 118