Nigerian Medical Journal

Serum zinc levels in apparently healthy children in Nigeria: Are they acceptable Chukwu Uchenna Kennedy, Nduagubam Obinna Chukwuebuka, Ekwochi Uchenna Nigerian Medical Journal 2020 61(6):291-296 Introduction: Despite the importance of zinc in the human body, there is paucity of data on the zinc status of Nigerian children. The aim of this study was to determine the serum zinc levels of children attending the pediatric outpatient clinic of a tertiary hospital in South East Nigeria and to assess their need for routine zinc supplementation. Materials and Methods: One hundred children aged 5–60 months were recruited consecutively from the pediatric outpatient clinic. Their socioeconomic class (SEC) was assessed using the tool developed by Oyedeji. Physical examination was carried out to exclude malnutrition and/or liver disease. Samples were collected in the morning from nonfasting subjects and were analyzed using atomic absorption spectrophotometer. Serum zinc deficiency was defined as zinc level <80 μg/dl. Results: The overall median (range) serum zinc level was 83.3ug/dl (60–105 μg/dl) while the median (mean rank) serum zinc levels among male and female subjects were 83.4 μg/dl and 84.2ug/dl, respectively (U = 1071.00; P = 0.228). A total of 26 (26%) apparently healthy children had low serum zinc levels. There was no association between gender and serum zinc levels (χ[2] = 2.163; P = 0.141). A significant positive but weak relationship was found between SEC and zinc levels (r = 0.208, P = 0.038) but not between serum zinc levels and age of the children (r = 0.185, P = 0.065). Conclusion: A significant proportion of Under-5s could have low serum zinc levels. Routine zinc supplementation may be necessary among this age group in Nigeria.

Perspectives of final year students and newly qualified doctors of the teaching of preclinical courses at the college of health sciences, Obafemi Awolowo University, Ile-Ife, Nigeria Beatrice Oluyomi Emma-Okon, Olufemi Kolawole Ogundipe, Josephine Adetinuola Eniola Eziyi Nigerian Medical Journal 2020 61(6):297-302 Background: It is established that there is a strong relationship between perception and outcome of learners' satisfaction, achievement, and success and that a positive learning environment well received by learners is necessary for positive learning outcomes. This study is a first step in providing an answer to the question “how do learners perceive preclinical medical education in Ife” with the aim of obtaining information which can serve as basis for the review of teaching methods and improvement of learning environment. Methodology: A questionnaire adopted from two validated questionnaires (Dundee Ready Education Environment Measure questionnaire from Dundee and another from a study carried out in Bangladesh) was administered to 187 respondents comprising 106 final year students and 81 newly qualified doctors to obtain the information about their perception of teaching and learning of the three major preclinical participants. Items were rated using the 5-point Likert scale, and each item was scored 4-0. Data were analyzed using the descriptive and inferential statistics. Values were expressed as the mean of scores. Results: The mean gross scores for the 19 items rated for anatomy, biochemistry, and physiology were 28.92, 35.76, and 45.06 (out of 76), respectively. Physiology had the highest score in all the subdomains examined, with 62% of the respondents rating their overall quality of learning experience in the subject “very good.” Scores for perception of learning environment were generally low (7.54 ± 0.43, 10.44 ± 0.42, and 12.51 ± 0.47, out of a total of 28 for anatomy, biochemistry, and physiology, respectively). Conclusion: The opinion of learners in this study emphasizes the need for the improvement of teaching methods and learning environment.

Diagnostic accuracy of fine-needle aspiration cytology in head and neck lesions from a tertiary health facility in Southwestern Nigeria Victor I Akinmoladun, Olalere Omoyosola Gbolahan, Timothy O Aladelusi, Gabriel O Ogun, Mustapha A Ajani Nigerian Medical Journal 2020 61(6):303-306 Background: Fine-needle aspiration cytology (FNAC) is widely employed as an initial investigative tool in the diagnosis of various lesions in the body, however, it is limited in the provision of precise architectural detail of lesions. This is said to be responsible for the wide variation in the documented usefulness and accuracy relative to histopathology. This study aimed to correlate cytopathological and histopathological examination (HPE) of head and neck lesions, and assess the usefulness and accuracy of FNAC in our center. Materials and Methods: This was a retrospective study that utilized historical data obtained from case notes and histopathology records of 91 patients that had both FNAC and HPE done for head and neck lesions in our center during the study. The FNAC results were correlated with that of the histopathological diagnosis to obtain the accuracy of the FNAC diagnosis. Diagnostic validity of FNAC in terms of sensitivity, specificity, and predictive value were also evaluated. Results: A total of 91 FNAC-HPE sample pairs were included. The Sensitivity and specificity for benign lesion was 95.4% and 42.3%, respectively, while for sensitivity and specificity for malignant lesion was 31.8% and 96.9%, respectively. The overall Sensitivity and specificity for cytology was 96.8% and 30.4%, respectively. Conclusion: FNAC appears to be a useful tool in the initial assessment of head and neck lesions in our center, however, the high rate of missed diagnosis especially as concerned malignancies has dire negative treatment implications. There is need to develop capacity for improved skill in making cytopathologic diagnoses among anatomical pathologists involved in the use of FNAC as diagnostic and screening tool.

Demographics, cost, and sustainability of haemodialysis among end-stage kidney disease patients in Southern Nigeria: A single-center study Effiong E Akpan, Udeme E Ekrikpo, Emmanuel Edet Effa, Aniema I. A. Udo, Victor A Umoh Nigerian Medical Journal 2020 61(6):307-311 Context: Access to chronic hemodialysis for patients with end-stage kidney disease has improved over the years. However, it is unclear if this has resulted in lower cost and improved dialysis vintage. Aim: We aimed to assess the demographics, cost implication, and sustainability of maintenance hemodialysis in our cohort of end-stage kidney disease (ESKD) patients. Methods: Retrospective descriptive study of ESKD patients on maintenance HD from 2014 to 2018 using hemodialysis records. Time-to-HD discontinuation and reasons for discontinuation were recorded. Using Kaplan–Meier graphs, the time-to-dialysis discontinuation experience of the cohort was shown. Log-rank test was used to compare the experience between both genders. Univariable and multivariable Cox proportional hazard models were built to identify independent associations with time-to-dialysis discontinuation. Results: Over the 5-year period, 702 individuals initiated HD, males were older than females, the complete cohort contributed 65,714 person-days to the study and the median time-to-HD discontinuation was 10 days (interquartile range, 2–42). Females had a shorter time to HD discontinuation (8 days [1–32 days]) compared to males (11 days [2–48 days]). Only 28.5%, 15.3% and 8.3% of the patients had HD beyond 30, 90, and 180 days, respectively. About 128 (18.2%) had thrice-weekly HD. Most sustained the treatment for the 1st week. Majority (98.4%) of the patients were presumed dead, while 4 (0.65%) were still alive and 6 (0.98%) had renal transplantation. All patients who discontinued dialysis did so for financial reasons. Multivariable Cox proportional hazards model showed that individuals who could afford dialysis more than once a week had reduced hazard of dialysis discontinuation. Conclusion: Most patients cannot sustain HD beyond a few weeks for financial reasons. Several cost containment strategies need to be deployed to bring down the cost of care.

Hysteroscopy findings after two previous failed In vitro fertilisation cycles: A case for routine hysteroscopy before In vitro fertilisation? Jude Ehiabhi Okohue, Sunday Omale Onuh, Joy Ose Okohue Nigerian Medical Journal 2020 61(6):312-315 Background: The success rates of in vitro fertilisation (IVF) cycles have remained low. The condition of the uterus plays a significant role in the IVF treatment outcome. Unfortunately, some uterine pathologies are missed on routine ultrasound scans performed before IVF. Objective: To document the hysteroscopy findings following normal ultrasound scan endometrial assessments in women with two previous failed IVF cycles, seen at a private fertility unit. Materials and Methods: This is a retrospective descriptive study. The electronic medical records were retrieved for patients who underwent hysteroscopy after two consecutive failed IVF cycles despite normal ultrasound scan findings between April 1, 2010, and March 31, 2017. Data, including age, findings at hysteroscopy, and IVF/intracytoplasmic sperm injection treatment outcomes following hysteroscopy, were documented. The results are presented as frequency distribution tables. Results: A total of 77 patients had normal ultrasound scan findings after two previous failed IVF cycles, requiring a hysteroscopy during the study period. This represented 7.7% of the 1,002 hysteroscopies performed during the same period. The age range was 25–54 years, with a mean age of 37 ± 4.3 years. A majority of the women (59, 76.6%) had no pathology on hysteroscopy, while 14 (18.2%) had intrauterine adhesions. Three patients (3.9%) had endometrial polyps, and one patient (1.3%) had a subseptate uterus. Following hysteroscopy, 24 patients (31.2%) became pregnant, 29 patients (37.6%) had failed IVF cycles, while the remaining 24 patients (31.2%) were lost to follow up. Conclusion: This study has added to the body of evidence that suggests that routine hysteroscopy before IVF is capable of picking up missed pathologies that might otherwise negatively impart IVF success rates. More RCT are, however, needed to determine the effect of routine hysteroscopy on IVF treatment outcomes.

Correlates of socio-demographic variables and attitude to condom use in HIV/AIDS prevention among students in some selected Nigerian Universities Francis Ikechukwu Duru, Oshiozokhai Eboetse Yama, Dolapo Duro, Amos Amoo Odetola, Timothy Danboyi, Ohunene Makoju Avidime, Kabir Ahmed Mohammed Nigerian Medical Journal 2020 61(6):316-322 Background: Unprotected heterosexual sexual act has been correlated with unwanted pregnancy and sexually transmitted diseases (STDs) especially HIV/AIDS, which still has a high endemicity in Africa. This study aimed to determine the association between socio-demographic variables (SDVs), sexual experience, and the use of condom. Setting and Design: This was a cross-sectional study comprising 542 undergraduate students, randomly selected from three Nigerian universities. Methodology: Well-structured open-ended questionnaires were administered to respondents. Bivariate analysis was used to determine the association between SDVs and attitude to condom use and between the SDVs, sexual experience and the use of condom. Data were analyzed using Epi6 6.04 and SPSS 10.0 software packages. Pearson's Chi-square (χ[2]) and Fisher's exact tests were used as applicable. The level of significance was set at P < 0.05. Results: Approximately 46% of the respondents were sexually active (consisting of about 71% of those 25–29 years old and 58% of the males [P < 0.001]). About 50.4% had a single sexual partner and 86.7% had “ever used” condom. The most common reasons given for use of condom were prevention of pregnancy (91.7%) and STDs (89.1%). All the SDV except religion significantly (P < 0.05) accounted for the disparity in sexual attitudes of the students. Those aged 25 years and above, males and Tiv tribe were more likely to indulge in sexual activities (P < 0.001). More females (98%) compared to males (83%) had ever used condom in their sexual experience (P = 0.010), while there was no significant association between any of the SDVs and use of condom in the last sexual exposure (P > 0.05). Conclusion: SDVs play a role in determining the attitude of students towards condom use and sexual experiences. Programs regarding sexual and reproductive health including safe sex education especially among young Nigerian students should be developed or strengthened.

Comparative assessment of the goldmann applanation and noncontact tonometers in intraocular pressure measurements in a sample of glaucoma patients in the Cape Coast Metropolis, Ghana Samuel Kyei, Cynthia Pakyennu Gboglu, Michael Agyemang Kwarteng, Frank Assiamah Nigerian Medical Journal 2020 61(6):323-327 Objectives: The objective of the study was to explore the usage of the Goldmann applanation tonometry and noncontact tonometry interchangeably in the measurement of intraocular pressure (IOP) in glaucoma patients. Materials and Methods: The study involved 441 clinically diagnosed glaucoma patients receiving care at a referral facility. IOP measurements were obtained using both the Noncontact tonometer and Goldmann applanation tonometer The repeatability of the measures was analyzed by comparing the repeated measures of the devices using paired t-test and calculating the correlation coefficient. A Bland–Altman analysis was used to determine the limits of agreement between the two procedures. Results: There were 271 (61.5%) males and 170 (38.5%) females and their age ranged from 18 to 73 years (mean age = 49.37; standard deviation ± 14.81 years). The findings of the study showed significantly lower readings (P < 0.001) of the GAT (right eye = 17.40 ± 7.48 mmHg; left eye = 16.80 ± 7.49 mmHg) compared to the NCT (right eye = 20.15 ± 8.30 mmHg; left eye = 19.74 ± 8.31 mmHg). There was a strong positive correlation between the GAT and NCT findings in the right eye (r = 0.871, n = 441, P < 0.001) and in the left eye (r = 0.887, n = 441, P < 0.001). There was a wide limit of agreement between NCT and GAT measurements. Conclusion: There was statistically significant higher measures obtained with NCT than the GAT but did not exceed the allowable inter-device difference. There was a strong positive correlation between GAT and NCT measurements. However, it is strongly recommended that these devices are not used interchangeably in the monitoring of IOP in glaucoma due to the wide range of limits of agreement.

Surgical management of peptic perforation in a tertiary care center: A retrospective study Tamal Kanti Sengupta, Gautam Prakash, Saugata Ray, Manoranjan Kar Nigerian Medical Journal 2020 61(6):328-333 Background: The purpose of this study is to estimate disease burden, clinical features, and outcome in the emergency surgical management of peptic perforation in a rural government tertiary care center where patients are socioeconomically very poor and also impacted by lack of good quality health-care facility. Materials and Methods: The study had retrospectively analyzed 121 patients with peptic perforation who had undergone emergency laparotomy at Midnapore medical college, West Bengal, India, from June 2018 to December 2019. All patients >12 years were included in this study. Exclusion criteria were other traumatic and nontraumatic gastrointestinal perforations. Results: The study population had 112 males and 9 females with a mean age of 44.80 ± 15.29 years and maximum incidence in the 6th decade (P = 0.001). Smoking and alcohol were associated with 54.5% and 49.6%, respectively. The symptoms were pain abdomen (100%) with vomiting (38.8%) and fever (33.9%). The signs of hypotension, peritonitis, distension, and pneumoperitoneum were observed in 34.7%, 64.5%, 39.7%, and 83.5%, respectively. Only 20.7% of patients were admitted within the first 24 h. The mean duration of symptoms was 2.3 days. Most perforations were located on the duodenum (74.4%) with duodenal to gastric perforation ratio 2.9:1. The mean size was 1.02 cm. Chest infection (19%) was the most common complication. The mortality rate was 9.1%. The mean length of hospital stay was 11.1 days. Conclusion: Peptic perforation remains a major disease burden in our environment predominantly due to late presentation, leading to high morbidity and mortality.

Conduct disorder among primary schoolchildren in Southern Nigeria Mkpouto Udeme Akpan, Ekemini Joseph Hogan, Frances Sam Okpokowuruk, Enobong Emmanuel Ikpeme Nigerian Medical Journal 2020 61(6):334-339 Background: Conduct disorder is a mental disorder characterized by hostile and sometimes physically violent behavior. It is a source of concern not only to the parents but also to the children's teachers and the community. Its prevalence rate in our environment is unknown. Aim: The aim of the study is to determine the prevalence rate of conduct disorder among primary school pupils in Ikot-Ekpene, Southern Nigeria. Materials and Methods: Vanderbilt attention-deficit hyperactivity disorder (ADHD) diagnostic teacher rating scale for oppositional defiant disorder/conduct disorder was administered on 1174 pupils aged 6–12 years drawn from 12 primary schools in Ikot-Ekpene, Akwa-Ibom State, Nigeria. Parents of the pupils with conduct disorder completed a pro forma on their sociodemographic characteristics. Results: One hundred and fifteen of the studied 1174 pupils had conduct disorder with a prevalence rate of 9.8%. A greater number of males had conduct disorder with a male-to-female ratio of 4.75:1. Children from upper social class comprised the highest number with conduct disorder. Younger children (6–9 years) were more affected (76.5%) than the older ones. The predominant symptom exhibited by the children was difficult temperament. Comorbidities associated with conduct disorder were ADHD, anxiety disorder, and depression. Conclusion: The prevalence rate of conduct disorder is within the global range in our environment and tends to affect the younger children. Policy should be put in place to screen these children at school entrance so as to render appropriate health intervention.

Clinical characteristics and outcomes of hemodialysis in a new center in Northern Nigeria Alhaji Abdu, Ibrahim Maigari Mahmood, Kabeer Yakubu Audi, Mustapha Sabo Umar Nigerian Medical Journal 2020 61(6):340-344 Background: Hemodialysis is the most common renal replacement therapy (RRT) modality in Africa and few countries enjoy reimbursement from the government to fund it. Africa contributes <10% of the total RRT patients worldwide this is mainly due to high cost. Aims and Objectives: We aimed to review the clinical characteristics and outcomes of patients requiring hemodialysis in our center over a 7 years period, to highlight the enormous challenges encountered. Materials and Methods: This is a retrospective study of patients aged 15 years and above that was seen between April 2010 and March 2017 at the Hemodialysis unit of Abubakar Tafawa Balewa University Teaching Hospital. Information was extracted from the patient's case folders and dialysis charts. Results: In total, 226 patients had hemodialysis over the period, 124 (54.9%) were male and 102 (49.1%) were female. Sixty-one (27%) patients had acute kidney injury (AKI), 143 (63.3%) had chronic kidney disease (CKD), whereas 22 (9.7%) had acute-on-CKD. A total of 2215 sessions of hemodialysis were done in the period, of which 782 (35.3%) were for AKI and 469 (21.2%) for acute on CKD. A total of 138 (60.6%) patients were discharged and 58 deaths were recorded. Conclusion: Although there is rapid proliferation of hemodialysis facilities in the country, many patients could not afford adequate hemodialysis. Inadequate dialysis due to finances was the main cause of death in these category of patients.

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