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   2015| January-June  | Volume 15 | Issue 1  
    Online since December 10, 2015

 
 
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ORIGINAL ARTICLES
Serum electrolyte profiles of under-five Nigerian children admitted for severe dehydration due to acute diarrhea
AN Onyiriuka, EC Iheagwara
January-June 2015, 15(1):14-17
DOI:10.4103/1596-4078.171374  
Background: Serum electrolyte disturbances are common in under-five children with acute diarrhea but may remain unrecognized, resulting in morbidity and sometimes mortality. Objective: The objective was to assess the type and prevalence of electrolyte abnormalities in severely dehydrated under-five children with acute diarrhea at the point of hospital admission. Patients and Methods: This was a descriptive, hospital-based cross-sectional study of children aged 1–59 months with severe dehydration due to acute diarrhea. Serum electrolyte profiles were determined. Outcome measures such as death or survival were recorded. The co-morbidities were also recorded. Results: Of the 63 children studied, 50 (79.3%) subjects were aged below 36 months. Vomiting and fever accompanied diarrhea in 33 (52.4%) of the cases. The frequencies of the various types of dehydration were hyponatremic in 41 (65.1%), isonatremic in 17 (27.0%), and hypernatremic in 5 (7.9%) of the children. Of the electrolyte abnormalities observed, hyponatremia and hypokalemia ranked first and second in frequency, respectively. The overall case fatality rate was 6 (9.5%). All the patients that died were aged below 24 months. 5 (83.3%) of the 6 patients that died had a combination of metabolic acidosis in association with one or two other electrolyte abnormalities. 6 (10.5%) of the 57 patients that survived had normal serum electrolyte profiles. Conclusion: Hyponatremia, hypokalemia, and metabolic acidosis were the leading electrolyte abnormalities in acute diarrheal illnesses and were responsible for most diarrhea-related deaths, particularly when measles or bronchopneumonia is a co-morbid condition.
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CASE REPORTS
Symptomatic hypermetropia with glycemic control in a recently diagnosed diabetic
SA Badmus, OH Onakpoya, AO Adeoye, BO Adegbehingbe
January-June 2015, 15(1):55-57
DOI:10.4103/1596-4078.171384  
Changes in refraction are one of the problems that have been associated with changes in blood glucose level as well as glycemic control. A 52-year-old teacher was seen on account of bilateral poor vision a few days after commencement of treatment for diabetes mellitus. Unaided visual acuity (VA) was count fingers at 3 m in either eye which improved to 6/18 with a pin-hole. Refraction at presentation was +2.50DS/−0.50DC axis 90° in the right eye improving VA to 6/5 and +3.00DS/−0.50DC axis 90° in the left eye improving VA to 6/9. No other ocular abnormality was detected. Uncorrected VA improved to 6/12 and 6/18 in the right and left eyes respectively after 2 weeks of control of blood sugar. Refraction changed to +1.00DS and +2.00DS/−0.50DC axis 140 in the right and left eyes, respectively, improving VA to 6/4 in both eyes. Rapid glycemic control caused temporary severe visual impairment in the patient presented. It is important for the endocrinologist to be aware of this possibility and warn patients to avoid medical mistrust.
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ORIGINAL ARTICLES
Noise Pollution: Knowledge, Attitudes and practice of sawmill workers in Osun State, Nigeria
J. A. E. Eziyi, IO Akinwumi, IO Olabanji, OO Ashaolu, YB Amusa
January-June 2015, 15(1):36-39
DOI:10.4103/1596-4078.171380  
Background: Literature on awareness of the harmful effect of noise on the health, hearing, and the quality of life of Nigerians engaged in noisy occupation is scarce. Objective: The objective was to assess the knowledge, attitudes, and practice of sawmill workers and owners to noise pollution; and the need for prevention with the use of hearing protection devices. Subjects and Methods: This was a purposive sampling of sawmills in 6 local government areas in Osun state. The respondents were studied using interviewer-administered questionnaires. The workplace noise levels were assessed. Results: A total of 412 male respondents, consisting of 400 sawmill workers and 12 sawmill owners were studied. The mean age of the respondents was 32 years. Average time of exposure to noise was 10 h/day. The average level of noise at the sawmills was 108 ± 9 dB. 140 (35.0%) sawmill workers could not identify the sources of noise correctly. 140 (85.0%) would endure noise exposure, and 376 (94.0%) did not know that hearing loss could be due to noise exposure. 176 (44.0%) of the workers believed that noise had no impact on health, while 373 (93.3%) did not believe that noise was associated with a change in productivity. None of the sawmill owners was familiar with policy on noise control and none of them provided earmuffs or plugs for their workers. Conclusion: Sawmill workers and their employers in the present study were not aware of the harmful effects of noise on their health. Hearing protection devices were therefore not available or worn by most sawmill workers. The sawmill workers were thus at risk of developing noise-induced hearing loss.
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Neonatal morbidity among infants of diabetic mothers in Sagamu: A 10-year eview
OB Ogunfowora, TA Ogunlesi, TI Runsewe-Abiodun, MB Fetuga
January-June 2015, 15(1):40-44
DOI:10.4103/1596-4078.171375  
Background: Diabetes in pregnancy constitutes a high risk factor for increased maternal and perinatal morbidity and mortality. There is inadequate knowledge of the diabetic pregnancy and its impact on neonatal health in our environment, hence the need for more research. Objective: To describe the morbidity pattern among infants of diabetic mothers (IDMs). Materials and Methods: Hospital records of all neonates diagnosed as IDMs and admitted into the neonatal ward of a tertiary hospital in South-Western Nigeria over a 10-year period were reviewed. Relevant data were extracted and analyzed. Results: Twenty-four cases met inclusion criteria, with a slight male preponderance. Mean (standard deviation [SD]) gestational age was 38.1 (1.8) weeks while the mean (SD) birth weight was 3.9 (0.4) kg. Fifty-eight percent of the subjects were delivered by cesarean section. 12 (50%) babies were macrosomic while the most common morbidities among the subjects were hypoglycemia, neonatal jaundice, and birth asphyxia which were observed in 75%, 75%, and 33.3% of the study population, respectively. Less frequently observed conditions include prematurity, transient tachypnea of the newborn, neonatal sepsis, and birth injury. 2 (8.3%) babies presented with congenital malformation affecting the heart and central nervous system, respectively. There was only one case of mortality. Conclusion: IDMs are prone to macrosomia, hypoglycemia, neonatal jaundice, and birth asphyxia in our environment. Early antenatal screening of all pregnant women for diabetes mellitus is required and good glycemic control of diabetic pregnancies should be the ultimate goal in order to minimize neonatal complications.
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Child survival dynamics in Nigeria: Is the 2006 child health policy target met?
JO Akinyemi, AS Adebowale, EA Bamgboye, O Ayeni
January-June 2015, 15(1):18-26
DOI:10.4103/1596-4078.171378  
Background: The childhood mortality rate in Nigeria continued to remain high. Unfortunately, information on the regional trajectories, progress, and sociodemographic determinants of childhood mortality in Nigeria are not readily available. The objectives of this study are to describe the childhood mortality trajectory in Nigeria, assess progress made toward achieving the 2006 child health policy targets, and determine the peculiar factors associated with childhood mortality in Nigeria regions. Materials and Methods: Birth history data from the Nigeria Demographic and Health Surveys for 1990, 2003, 2008 and 2013 were analysed. Childhood mortality levels were derived using indirect demographic techniques. Locally weighted scatterplot smoothing technique was employed to ascertain the childhood mortality trajectory. Weibull frailty models were fitted to determine the influence of unmeasured variables and factors associated with childhood death in each region. Results: Childhood mortality stagnated at 207/1000 live births until the year 2000, after which there was a linear decline to 137/1000 live births in 2010 at an annual rate of 4.91% (confidence interval: 4.52–5.29). The rate of decline was least in the South West (2.97%) and highest in the North Central (7.40%). Multivariate analysis revealed that unmeasured community factors played significant roles in North East and North West. Birth interval < 24 months, multiple births, and young maternal age were risk factors across all regions. Conclusions: Nigeria child survival dynamics differ between the Northern and Southern regions and rural and urban locations. Only the North Central and South-South regions are on course to achieve the 2006 targets for under-five mortality reduction. Multiple birth, short birth intervals, and young maternal age at child's birth were risk factors for childhood mortality in the six geo-political regions in Nigeria.
  1,950 14 7
Perceived hindrances and factors influencing acceptability of HIV/AIDS counseling and testing among commercial drivers in Ile-Ife
MY Ijadunola, TO Ojo, O Ogunlesi, A Adewumi, RO Kolade, B Thomas
January-June 2015, 15(1):30-35
DOI:10.4103/1596-4078.171371  
Background: HIV/AIDS Counseling and Testing (HCT) is an effective tool in HIV prevention and control. However, perceived hindrances may limit the utilization of HIV Counseling and Testing (HCT) services, particularly among high-risk groups. Therefore, this study assessed perceived hindrances and factors influencing the acceptability of (HCT) among commercial drivers. Methods: This was a cross-sectional survey of commercial drivers in Ife Central Local Government Area. Data were analyzed using Statistical Package for Social Sciences for Windows version 20. The dependent variable for the multiple regressions was commercial drivers willingness to uptake free HCT services in their motor parks, while independent variables were their age, marital status, and the level of education. Results: Three-hundred commercial drivers were surveyed. 76 (25.3%) of respondents had previously undergone HIV test. 184 (61.3%) of the 300 respondents were willing to uptake HCT services. Perceived possible hindrances to HCT uptake were fear of a positive HCT test by 259 (86.3%), stigmatization by 260 (86.7%), lack of in-depth knowledge about HCT 258 (86.0%), and confidentiality concerns by 267 (89.0%) while 151 (50.3%) perceived poor access to HIV testing services as a hindrance. Multivariate analysis revealed that drivers aged 30–39 years were twice more likely to accept HCT service compared to their 20–29-year-old colleagues. Car drivers were twice more likely to accept HCT compared to bus drivers, whereas drivers with secondary education were four times less likely to accept HCT compared with their colleagues with tertiary education. Conclusion: This study revealed that a high proportion of drivers was willing to uptake HCT services. The introduction of free HCT education and services at motor parks would, therefore, enhance HCT uptake.
  1,891 15 1
Paracetamol-induced liver damage: Ameliorative effects of the crude aqueous extract of Musanga cecropioides
SI Omoruyi, AB Enogieru, OI Momodu, BA Ayinde, BD Grillo
January-June 2015, 15(1):2-7
DOI:10.4103/1596-4078.171381  
Objective: The protective role of the aqueous stem bark extract of Musanga cecropioides against paracetamol-induced liver damage was investigated in Wistar rats using silymarin as a reference drug. Materials and Methods: The animals were randomly assigned into five groups of six rats each (A, B, C, D, and E). Rats in group A served as controls and received an equivalent volume of distilled water used to dissolve the extract. To effect liver damage, animals in groups B-E were administered paracetamol at 500 mg/kg body weight orogastrically for 14 days using a metal cannula. Animals in groups C, D, and E were simultaneously pretreated with silymarin at 25 mg, 250 mg, and 500 mg, of the extract, per kg body weight, respectively. The effects of M. cecropioides and silymarin were examined on hepatic marker enzymes; aspartate amino-transferases (AST), alanine amino-transferases (ALT), alkaline phosphatase (ALP), and total protein (TP). Antioxidant enzyme activities such as superoxide dismutase (SOD), catalase (CAT), and lipid malondialdehyde (MDA), as well as changes in liver histology, were also evaluated. The animals were sacrificed via cervical dislocation and blood was collected via cardiac puncture into plain bottles. Furthermore, liver tissues were excised and processed for routine hematoxylin and eosin staining. Results: M. cecropioides and silymarin produced significant (P < 0.05) hepatoprotective activity by decreasing the serum levels of AST, ALT, ALP, and lipid peroxidation marker, MDA significantly (P < 0.05) increased the levels of TP, SOD, and CAT except for the group administered 250 mg/kg of M. cecropiodes. Liver histology revealed the presence of vacuolations and mild chronic infiltrates of inflammatory cells in the livers of paracetamol treated animals. Pretreatment with silymarin and M. cecropioides extract produced a remarkable reduction in the severity of vacuolations. Conclusion: Crude aqueous extract of M. cecropioides protected against paracetamol-induced liver damage perhaps, by its antioxidative effect on hepatocytes, hence eliminating the deleterious effects of toxic metabolites of paracetamol.
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REVIEW ARTICLE
All-cause mortality among elderly patients admitted to the medical wards of hospitals in Africa: A systematic review
LA Adebusoye, MO Owolabi, SZ Kalula, A Ogunniyi
January-June 2015, 15(1):45-51
DOI:10.4103/1596-4078.171372  
Geriatric medicine as a speciality is just evolving in Africa. There is scanty data on the mortality and associated factors among elderly patients admitted to the hospital medical wards in Africa. The objective of this review was to identify, describe, and analyze systematically the available studies on all-cause mortality and associated factors among elderly patients admitted to the medical wards of a hospital in Africa. Online and hand-based systematic searches were conducted for literature (primary and secondary) describing the mortality in elderly patients admitted to the medical wards of a hospital in Africa. These included original research, review articles, proceedings, and transactions from 1969 to 2014. All identified studies were screened using the Population, Intervention, Comparison, and Outcomes criteria. Five studies describing 3427 hospitalized elderly patients reported 773 deaths giving an unadjusted proportion of admissions which resulted in in-hospital deaths of 22.6% (range: 6.8–44.7%). This was higher among the males (38.8–48.0%) compared with the females (29.4–40.7%). There was no significant association between the age and mortality. Mortality was high among patients who had stroke, meningitis, septicaemia, renal failure, chronic liver disease, chronic obstructive pulmonary disease, severe asthma, and heart failure. High mortality was associated with high serum creatinine and urea, tachycardia, reduced length of stay from admission to death, and low serum protein. In conclusion, the few available data showed high unadjusted all-cause mortality among hospitalized elderly patients in Africa. More studies are needed in Africa to quantify this health burden and identify the major factors causing the high mortality in elderly patients.
  1,654 14 2
ORIGINAL ARTICLES
The third ventricle in Kaolin-induced hydrocephalus in juvenile rats
OA Ayannuga
January-June 2015, 15(1):8-13
DOI:10.4103/1596-4078.171376  
Background: The enlargement of the third ventricle in hydrocephalus has mechanical effects on the structures that form its boundaries such as thalamus and hypothalamus. This may explain some of the symptoms associated with hydrocephalus. While the lateral ventricles had been widely investigated in hydrocephalus, studies of the third ventricle are sparse. The present study set out to investigate the ependymal lining and the direction of enlargement of the third ventricle in hydrocephalus. Materials and Methods: Three-week old rats were divided into 6 groups (A-F) of five each. Groups A-C were experimental and sacrificed after 1, 4, and 8 weeks of induction, respectively, while groups D-F served as age-matched controls. Hydrocephalus was induced by intracisternal injection of 0.04 ml of 200 mg/ml kaolin suspension. Rats were sacrificed by cervical dislocation and approximately 1 mm thick coronal brain slices were obtained at optic chiasma level. Slices were fixed in 10% formal saline, processed and stained with hematoxylin and eosin. Results: Compared with corresponding control rats, the lateral ventricle width was significantly increased in 1 and 8 weeks postinduction experimental rats (P = 0.005 and 0.012 respectively), while supero-inferior distance of the experimental third ventricle was significantly lower at 1-week postinduction (P < 0.001), and increased at 8-week postinduction (P = 0.025). However, differences in the inter-thalamic distance at 1- and 8-week were not statistically significant (P = 0.14 and 0.224, respectively). Ependymal detachment was patchy and generalized at 1 and 4 weeks, respectively. Thinned and detached ependymal lining were noted 8-week postinduction. Conclusion: Kaolin-induced hydrocephalus caused early ependymal detachment in the third ventricle of rats, while ependymal thinning and villi sparing was a feature of chronicity. The third ventricle enlarges in the supero-inferior direction, this might explain some symptoms associated with hydrocephalus.
  1,606 15 -
Assessing the impact of polio eradication initiative and routine immunization in Zamfara State, North-West, Nigeria
KM Yusuf, ED Jatau, OS Olonitola, SE Yakubu, BS Ahmed, ZA Gaiya, AE Yahaya, YY Pala
January-June 2015, 15(1):27-29
DOI:10.4103/1596-4078.171383  
Background: Evaluation of effectiveness of polio immunization has to be monitored continuously, particularly in endemic countries so that the immunity status can be precisely and effectively established. The aim of the present study was to determine the seroprevalence of poliovirus antibody in Zamfara State, Nigeria. Materials and Methods: This was a cross-sectional study of children aged 0–59 months. The children were randomly selected across the state. Blood samples collected from the children were tested for the presence of antibodies to poliovirus. Results: Blood samples from 63 (78.8%) of the 80 children had antibodies to all the three poliovirus serotypes. Seventy-five (93.8%), 68 (85.0%), and 75 (93.8%) of blood samples had antibodies to poliovirus serotypes 1, 2, and 3 respectively. All (100.0%) blood samples from children in the age group of 48–59 months tested positive for poliovirus. All (100.0%) the females had poliovirus antibody. In general, poliovirus antibody prevalence increased with increase in oral polio vaccine doses received. Urban children had higher poliovirus antibody prevalence of 81.0%, higher than their rural counterpart. Children whose fathers were educated up to tertiary level had 100.0% poliovirus antibody. There was no association among seroprevalence of poliovirus antibody and number of vaccine doses received and location of child's place of residence. Prevalence of poliovirus antibody was statistically significant based on age and father's educational level (χ[2] = 0.1360, χ[2] = 0.2923, respectively, P < 0.05). Conclusion: For the state to sustain the gains made in interrupting poliovirus transmission, more work need to be done so as to close the gap observed in the study.
  1,397 14 1
CASE REPORTS
A case of a giant intracranial arachnoid cyst mimicking cerebrovascular accident in a sickle cell disease patient
EO Komolafe, OA Dada, AM Owojuyigbe, OF Owagbemi
January-June 2015, 15(1):52-54
DOI:10.4103/1596-4078.171379  
Stroke or cerebrovascular accident (CVA) is a common vascular neurological condition. Many cranial lesions produce stroke-like features and may be mistaken for stroke. The aim of case report was created the awareness of the possibility of rare conditions such as this benign giant arachnoid cyst presenting with neurological symptoms mimicking CVA. We present a case of a 53-year-old female sickle cell disease patient who had features highly suggestive of CVA and had been previously managed as such before presenting to us. The patient had cranial magnetic resonance imaging as part of her neurologic evaluation, and this revealed a giant intracranial arachnoid cyst. She subsequently had craniotomy for excision of the mass lesion following which she had an uneventful postoperative recovery and sustained neurological improvement. This case illustrates similarities in the presentation of CVAs and intracranial arachnoid cysts. The value of brain imaging in the evaluation of patients with clinical features of CVA is also shown. This imaging was essential in arriving at an accurate differential diagnoses of CVAs and thus direct appropriate treatment.
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EDITORIAL
From the Editor-in-Chief table
JA Owa
January-June 2015, 15(1):1-1
DOI:10.4103/1596-4078.171385  
  1,147 15 1
LETTER TO EDITOR
From a single case to epidemics: Fear and misconceptions mitigating against effective control of Ebola virus disease outbreak in South-Western Nigeria
AW Olalekan
January-June 2015, 15(1):58-59
DOI:10.4103/1596-4078.171382  
  1,100 14 1