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   Table of Contents - Current issue
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May-June 2019
Volume 60 | Issue 3
Page Nos. 99-164

Online since Wednesday, August 21, 2019

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REVIEW ARTICLE  

Preimplantation genetic testing for breast cancer p. 99
Eunice I Oribamise, Oladapo A Ashiru, Ebele C Iloabachie, Jumoke G Osumah, Oladimeji O Moruf
DOI:10.4103/nmj.NMJ_124_18  
Breast cancer (BC), a malignant tumor characterized mainly by a lump in the breast and a change in breast shape, has plagued many women of childbearing age in Nigeria today. This has thus propelled many to find both prophylactic and curative agents to combat BC in affected persons. This article extensively reviews a method of preventing BC in the offspring of affected parents, known as preimplantation genetic testing (PGT) – an assisted reproductive technique that selects genetically unaffected embryo(s) to be transferred to the uterus of a mother upon in vitro fertilization and standard genetic analysis. The present study also seeks to present the techniques involved in PGT that have been reported to prevent the inheritance of BC, its benefits and risks, related case studies in Africa and other continents, and ethical issues surrounding the application of assisted reproduction for BC testing. To achieve these, a thorough search was conducted in reputable scientific journals of reproduction and cancer, and expert knowledge was consulted with regard to these aspects of health and reproduction. Upon reviewing this very important subject, it was confirmed that the beneficial role of assisted reproduction in the field of science and the homes of many cannot be overestimated. This review of the role of PGT in BC prevention will enlighten the understanding of many – creating awareness that with PGT, BC-affected women can have not only children, but also healthy and genetically unaffected children.
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ORIGINAL ARTICLES Top

Occupational hazards and health problems among butchers in Uyo, Nigeria p. 106
Ofonime Effiong Johnson, Aniekan Jumbo Etokidem
DOI:10.4103/nmj.NMJ_57_19  
Introduction: Butchers are exposed to various types of hazards in the course of their work, which could lead to health problems of varying severity. The aim of this study was to identify the occupational hazards and health problems of butchers in Uyo and also assess the physical conditions of their slaughter facilities. Materials and Methods: A descriptive cross-sectional study was carried out among 157 butchers in Uyo using a semi-structured questionnaire for data collection. Facility assessment was made using a checklist. Analysis was carried out using Statistical Package for Social Sciences version 20. Level of significance was set at 0.05. Results: The mean age of respondents was 33 ± 9.94 years. Most respondents were males (83.4%). The most commonly reported workplace hazards were knife (93.6%), bones (57.3%), and slippery floor (24.8%). The most common health problems were knife cuts (87.3%), cuts from bones (50.3%), and neck pain (36.9%). Having injuries from live animals and back pain were significantly associated with working with cows (P < 0.05). The most common de-furring method was burning with firewood (61.1%). The slaughter facilities lacked many expected amenities of a standard abattoir. Conclusion: Identified hazards and health problems of butchers were numerous. The slaughter facilities lacked appropriate equipment that promotes workers' health and safety. It is recommended that slaughter facilities be upgraded to meet the standard abattoir practice. Regular training of butchers should be organized by their association to encourage safer practice, including the use of appropriate protective wears. Use of the chemical method of de-furring should also be encouraged to limit exposure to harmful gases.
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Association between common etiologies and precipitants of acute decompensated heart failure p. 113
Ehi J Ogbemudia, Austine O Obasohan
DOI:10.4103/nmj.NMJ_63_19  
Background: Acute decompensated heart failure (ADHF) comprises the etiology of heart failure and the precipitant of acute decompensation. Early identification of the precipitant of ADHF is important in management, but an association between the precipitant and etiology of ADHF has not been established. Objective: The objective of this study is to determine whether the precipitant of acute decompensation is associated with the etiology of heart failure. Methods: This was a prospective observational study conducted over 2 years. Patients with ADHF secondary to common etiologies such as hypertension and rheumatic heart diseases (RHD) were enrolled in the study. The demographics, precipitants, and relevant variables on echocardiography and electrocardiography were documented. The frequencies of the etiology and precipitants of heart failure were derived. The Chi-square test was used to determine an association between categorical variables, and independent t-test was used to compare the means of continuous variables. A value of P < 0.05 was considered statistically significant. Results: There were a total of 190 participants. Hypertensive and RHD were 96 (50.5%) and 94 (49.5%), respectively. One hundred and three (54.2%) were females and males were 87 (45.8%). The precipitants were pneumonia 104 (54.7%), arrhythmias 47 (24.7%), urinary tract infection 36 (19.5%), and infective endocarditis 3 (1.6%). The association between these etiologies and precipitants of ADHF yielded a value ofP = 0.597. Conclusion: There is no association between the precipitant and etiology of ADHF. Therefore, the precipitant of ADHF should be actively sought for in every case for optimal management and better outcomes.
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Knowledge and parity: Perspectives of usage of emergency contraceptive pills among women of a rural area of Delhi p. 117
Monalisha Sahu, Pragti Chhabra, Vaishali Gautam
DOI:10.4103/nmj.NMJ_121_17  
Context: Correct use of emergency contraceptive pills (ECPs) may prevent up to 95% of unwanted pregnancies which may significantly decrease unsafe abortions and maternal mortality. Aims: Assessment of knowledge and use of ECPs among women and to explore factors associated with them. Materials and Methods: This was a facility-based cross-sectional study. Data were collected using a prestructured, pretested questionnaire from 381 reproductive age women (15–49 years) selected by systematic random sampling. Statistical Package for the Social Sciences version 16 and Epi info (version 7.0.) were used for all statistical analyses. Descriptive analysis was performed, and results were expressed in terms of frequencies and percentages. The Chi-square and Fisher's exact test were used as tests of significance in univariate analysis. Determinants of use of ECPs were identified using logistic regression. Results: Of 381 women interviewed, awareness level of ECPs (ever heard about ECPs) was found to be 34% (n = 128). Ever use of emergency contraception was reported by 38 (9.7%). Age (odds ratio [OR] = 3.02, 95% confidence interval [CI] [1.88–4.87]), education (OR = 0.086, 95% CI [0.047–0.158]), husband's education (OR = 0.11, 95% CI [0.067–0.187]), socioeconomic status (OR = 6.14, 95% CI [3.28–11.51]), and family status (OR = 2.6, 95% CI [1.59–4.24]) were found to be significantly associated with the use of emergency contraceptives. Conclusions: The study identified that most respondents lack adequate knowledge about ECPs, and ever use of ECPs was very low. Factors that were associated with the use of ECPs were age, literacy, socioeconomic status, and knowledge about the method. Creating a sustainable awareness on ECPs and their use may serve them with power to control their parity.
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An autopsy study of pattern and yearly trend of homicide in Warri, Nigeria p. 122
Nkadi Francis Nwachokor, Obiora Jude Uchendu, Eseroghene Arthur Ijomone
DOI:10.4103/nmj.NMJ_142_18  
Background: Homicide is a common cause of unnatural death and an index of the level of security of the state. The aim of this study was to analyze all autopsied unnatural homicide cases in Warri, Nigeria from 2003 to 2016 with emphasis on age, sex, regional distribution of injury, and circumstance of death. Materials and Methods: Six hundred and seventy-four cases were studied and relevant information extracted from police and autopsy records. These information were analyzed using SPSS 21. Results: Unnatural homicide cases accounted for 69.1% of 975 medicolegal deaths autopsied in this region, with a male to female distribution of 14:1. The mean age of the victims was 33.2 years with the highest incidence occurring in the 3rd decade. Firearms, sharp weapons, blunt weapons, suffocation, and burning were the methods used in 426 (63.2%), 162 (24.0%), 73 (10.8%), 11 (1.7%), and 2 (0.3%) cases, respectively. The chest, the head, and the neck were the most common parts of the body affected representing 275 (40.8%), 162 (24%), and 52 (7.7%) of cases. Conclusion: Unnatural death as a result of homicide is very common in the study area and mainly perpetrated using firearms and sharps with young males being the most vulnerable age group. The head, chest, and neck are more commonly affected regions of the body.
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Comparison of papanicolaou smear quality with the anatomical spatula and the cytobrush–spatula: A single-blind clinical trial p. 126
Kabiru Afolarin Rabiu, Ugochi O Nzeribe-Abangwu, Fatimat Motunrayo Akinlusi, Taiwo Ganiyat Alausa, Idayat Adejumoke Durojaiye
DOI:10.4103/nmj.NMJ_49_19  
Background: The Papanicolaou (Pap) smear is a standard test for cervical cancer screening; however, the most important challenge is high false-negative results due to inadequate sampling using the Ayres spatula. The cytobrush has been used in combination with the Ayres spatula (cytobrush spatula) in an attempt to improve the quality of smears with additional costs. The aim of this study was to compare the Pap smear quality with the anatomical spatula (with extended tip) and the cytobrush–spatula. Materials and Methods: This was a prospective single-bind clinical trial. One hundred and ten sexually active women aged between 22 and 65 years were randomized into groups, each having two smears at the same time: one with a cytobrush–spatula and another with an anatomical spatula. Fifty-five patients were randomized to have the anatomical spatula first to obtain their smears and 55 were randomized to have the cytobrush–spatula first to obtain their smears. Slides were assessed by a pathologist. Results: There was no significant difference in the quality of the smears using the two devices with respect to cellular adequacy (P = 0.3532), absent blood staining (P = 0.7766), presence of endocervical cells (P = 0.3502), and evidence of transformation zone sampling using the Bethesda criteria (0.4028). Kappa analysis shows moderate inter-rater agreement between the two devices by ability to show evidence of transformation zone using British Society for Clinical Cytology and Bethesda criteria. Conclusions: There was no significant difference in the quality of smears obtained using the two different methods. The anatomical spatula can be used as a single device in conventional cytology in place of the cytobrush–spatula with the aim of improving the quality of smears without necessarily increasing the cost.
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Estimation of superoxide dismutase levels in saliva and gingival crevicular fluid among smokers and non-smokers in periodontitis patients - An observational study p. 133
K SV Ramesh, P Swetha, P Mohan Kumar, N VS Sruthima, C Naresh Kumar
DOI:10.4103/nmj.NMJ_56_19  
Background: Smoking, which is an important risk factor for periodontitis, induces oxidative stress in the body and causes an imbalance between reactive oxygen species (ROS) and antioxidants, such as superoxide dismutase (SOD). The present study was done to quantify and compare the level of SOD enzyme levels in gingival crevicular fluid (GCF) and saliva among smokers and nonsmokers. Methodology: One hundred and thirty-five individuals in the age range of 20–55 years, including 45 light smokers, 45 heavy smokers, and 45 nonsmokers (controls), were selected and the clinical parameters recorded were plaque index, probing depth, and attachment loss. Smokers were divided into light smokers (<10 cigarettes/day) and heavy smokers (>10 cigarettes/day) and into three subgroups: healthy, mild periodontitis, and moderate periodontitis. GCF and saliva samples were collected then SOD levels were analyzed using spectrophotometric assay. Results: The mean levels of SOD in the GCF and saliva of smokers were decreased compared to controls. Intra- and inter-group analyses showed a significant reduction in the levels of SOD in the GCF and saliva of heavy smokers compared to light smokers and the control group. Conclusions: There was a progressive reduction in SOD levels from healthy nonsmokers to light smokers to heavy smokers.
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Initial experience with central venous line insertion in a tertiary health institution in Nigeria p. 138
Sunday Adoga Edaigbini, Muhammad Balarabe Aminu, Ibrahim Zira Delia, Istifanus Bala Bosan, Adeola Abosede Orogade, Ndubuisi Anumenechi
DOI:10.4103/nmj.NMJ_238_16  
Background: Central venous catheterization is an uncommon procedure in most hospitals in the West African subregion. This article presents our initial experience with central line insertion. Materials and Methods: Catheter sizes ranged from 5 fr for children and 7 fr for adult for intravenous therapy, while size 7 fr polyurethane catheters were used for children requiring hemodialysis and sizes 12–14 fr silicone catheters for adolescents and adults requiring hemodialysis'. Data were collected prospectively using a structured pro forma over a 2-year period (June 2010–May 2012) and analyzed with SPSS 15. Results: A total of 77 lines were inserted four as tunneled lines and 73 as nontunneled lines. Forty-seven (61.0%) patients were male, 30 (39.0%) were female, with age range of 1–80 years. The success rate was 97.4%. The overall complication rate was 16.9%. Conclusion: Our initial experience with the use of central venous lines, was marked by a high success rate, few manageable complications and no mortality over the study period. Majority of insertions were done by the bedside under local anesthesia lending credence to the assertion that it is a relatively safe procedure that can be done by any adequately trained doctor and should, therefore, be encouraged in our hospitals.
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Clinical presentation and management outcome of emergency adolescent gynecological disorders at Federal Teaching Hospital, Abakaliki, Nigeria p. 144
Chidebe Christian Anikwe, Kenneth Chinedu Ekwedigwe, Nnabugwu Alfred Adiele, Cyril Chijioke Ikeoha, Obiora Godfrey Kingsley Asiegbu, Ugochukwu Uzodimma Nnadozie
DOI:10.4103/nmj.NMJ_55_19  
Background: Gynecological emergencies which affect the adolescents may pose a serious challenge to both the patient and the gynecologist. Objectives: The objective of this study is to determine the clinical presentations and management outcomes of emergency adolescent gynecological disorders at Federal Teaching Hospital, Abakaliki. Materials and Methods: This is a retrospective review of all cases of adolescent gynecological emergencies managed at Federal Teaching Hospital Abakaliki between January 1, 2012, and December 31, 2014. Data obtained from their case notes were analyzed using the IBM statistics version 20 (IBM Corp., Armonk, NY, USA). Data were presented using percentages and pie chart. Results: The prevalence of adolescent gynecological emergency disorders was 5.1%. The majority (82%) of the patients belong to the age bracket 15–19 with a mean age of 16.7 (2.4) years. About 90% of the patients were nulliparous. Unmarried patients comprised 80% of the study group. Vaginal bleeding was the most common clinical presentation (86%). The two most common diagnoses were abortion (60%) and sexual assault (26%). Only 10% of sexually active adolescent were using any form of contraception. Care received includes manual vaccum aspiration, laparotomy, and antibiotics. Blood transfusion was given in 18% of the cases. No death was recorded in all the cases. Conclusion: Abortive conditions and sexual assault were the most common clinical diagnosis among adolescents in the study. The percentage of adolescent assaulted in our study is unacceptable and should be prevented and efforts should be made to reduce the high unmet need for contraception seen in the study.
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The impact of 6-month micronutrient supplementation on viral, immunological, and mental health profile of a cohort of highly active antiretroviral therapy-naive HIV-positive patients in Northern Nigeria p. 149
Victor Obiajulu Olisah, Tajudeen Abiola, Christopher I Okpataku, Reginald O Obiako, Ishaq A Audu, Bashir A Yakasai
DOI:10.4103/nmj.NMJ_74_19  
Background: HIV is a chronic disease with inflammatory reactions involving numerous elements of the immune system, resulting in an increased risk for other physical and psychiatric morbidities. Micronutrients, some of which possess anti-inflammatory properties, may help prevent the development of psychological disorders such as anxiety and depression in people living with HIV disease. Objectives: This study examined the profile of viral load, CD4 cell count, C-reactive protein, anxiety, and depression among highly active antiretroviral therapy (HAART)-naive HIV-positive patients receiving micronutrient supplementation over a 6-month period. Materials and Methods: A total of ninety HAART-naïve HIV-infected patients completed the Hospital Anxiety Depression Scale. Their blood samples were taken for serum viral load, CD4 cell count, and C-reactive protein at baseline. They all received a micronutrient supplement for 6 months, and 68 participants who remained in treatment at 6 months were reassessed with the same parameters. Results: After 6 months of micronutrient supplementation, the participants were found to have statistically significantly lower mean scores on the anxiety (t-test = 2.970,P = 0.003) and depression (t-test = 3.843,P = 0.001) subscales. They also had statistically significantly lower median CD4 cell count (P = 0.00) and C-reactive protein serum measures (P = 0.04). The median viral load decreased although the difference was not statistically significant. Conclusion: Micronutrient supplementation may reduce inflammatory reactions, anxiety, and depression in HAART-naive HIV-infected persons.
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The prevalence pattern of locomotor disability and its impact on mobility, self-care, and interpersonal skills in rural areas of Jodhpur District p. 156
Kriti Mishra, V Siddharth, Pankaj Bhardwaj, Abhay Elhence, Divesh Jalan, Pankaja Raghav, Syed Esam Mahmood
DOI:10.4103/nmj.NMJ_144_17  
Context: Impact of disability is deleterious, affecting an individual's every aspect. Majority of disabled reside in rural areas of developing countries. Moreover, different types of disability add to its wide spectrum. All these make it a major health issue. Aims: The aim of this study was to note the prevalence rate and pattern of locomotor disability in a rural population of Jodhpur District and to observe its impact on mobility, self-care, and interpersonal skills of disabled. Settings: This study was carried out in rural field practice area of the Community and Family Medicine Department of tertiary care setup. Design: This was a cross-sectional study. Materials and Methods: House-to-house survey for a sample size of 1656 was conducted by a team of trained doctors, therapists, and anganwadi workers for identification of locomotor disability applying a pretested survey questionnaire. Statistical Analysis: SPSS version 22 was used for descriptive analysis of variables (frequency distribution), and the Chi-squared test was used for the association of sociodemographic factors with performance qualifier score. Results: The prevalence rate of 2.08% for locomotor disability (male = 57% and female = 43%) was noted, with 31% from 40 to 60 years, 49% were illiterate, and 60% were from lower class. The main etiologies were cerebrovascular accident (25%) and cerebral palsy (23%). About 80% faced some difficulties in mobility domain, 57% in self-care, and 63% in interpersonal skills. Statistically significant association was seen for self-care domain with education level (P = 0.04) and for interpersonal skill domain with age groups and diagnosis (P = 0.022 andP = 0.035, respectively). Conclusion: The overall prevalence of locomotor disability in rural Jodhpur was 2.08%, higher for males and higher from 40 to 60 years. Most disabled were illiterate and were from low socioeconomic status. Self-care, mobility, and interpersonal skills were primarily affected and require proper intervention.
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Towards 2030 target for hepatitis B and C viruses elimination: Assessing the validity of predonation rapid diagnostic tests versus enzyme-linked immunosorbent assay in state hospitals in Kaduna, Nigeria p. 161
Ismaila Nda Ibrahim, Aisha Indo Mamman, Muhammad Shakir Balogun, Aliyu Ahmadu Babadoko, Abdulaziz Hassan, Benjamin Augustine, Aisha Maude Suleiman, Ibrahim Usman Kusfa
DOI:10.4103/nmj.NMJ_93_18  
Introduction: Sub-Saharan Africa accounts for 25% of the estimated global 325 million people with chronic hepatitis B and C virus infections. Weak blood transfusion systems facilitate the spread of both hepatitis B and C virus infections. This is worsened by the absence of sustainable quality assurance programs and perennial shortage of sensitive screening kits. We aim to compare the validity of rapid diagnostic tests (RDTs) with the World Health Organization-recommended quality-assured enzyme-linked immunosorbent assay (ELISA) screening method for these viruses. Materials and Methods: We conducted a cross-sectional study on consecutive blood donor samples. Two hundred and sixty-four blood donor samples screened for hepatitis B and C viruses using RDTs were retested at a National blood transfusion service, Kaduna, Nigeria. Data were analyzed using OpenEpi version 3.01 to determine the sensitivity, specificity, and predictive values of RDTs versus ELISA. Results: The sensitivities of the RDTs at 95% confidence interval (CI) were low – 40% (19.8–64.3) and 50.0% (18.8–81.2) – for hepatitis B surface antigen (HBsAg) and hepatitis C virus (HCV) antibody, respectively. The specificities and 95% CI were high – 99.9% (97.8–99.9) and 100.0% (98.5–100) for HBsAg and HCV antibody, respectively. Conclusion: Predonation RDTs screening of blood donor samples for hepatitis B virus and HCV in hospital donation units performed poorly compared to quality-assured ELISA screening in Kaduna. The risk of transmitting viral hepatitis through blood transfusion still exists. We recommend quality-assured ELISA screening of all donated units for HBsAg and HCV antibody to reduce the risk of these transfusion-transmitted infections.
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