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   2017| January-February  | Volume 58 | Issue 1  
    Online since November 15, 2017

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Epidemic preparedness and management: A guide on Lassa fever outbreak preparedness plan
Akinola Ayoola Fatiregun, Elvis Efe Isere
January-February 2017, 58(1):1-6
DOI:10.4103/0300-1652.218414  PMID:29238121
Epidemic prone diseases threaten public health security. These include diseases such as cholera, meningitis, and hemorrhagic fevers, especially Lassa fever for which Nigeria reports considerable morbidity and mortality annually. Interestingly, where emergency epidemic preparedness plans are in place, timely detection of outbreaks is followed by a prompt and appropriate response. Furthermore, due to the nature of spread of Lassa fever in an outbreak setting, there is the need for health-care workers to be familiar with the emerging epidemic management framework that has worked in other settings for effective preparedness and response. This paper, therefore, discussed the principles of epidemic management using an emergency operating center model, review the epidemiology of Lassa fever in Nigeria, and provide guidance on what is expected to be done in preparing for epidemic of the disease at the health facilities, local and state government levels in line with the Integrated Disease Surveillance and Response strategy.
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Epidemiology, triggers, and severity of childhood asthma in Ilesa, Nigeria: Implications for management and control
Bankole Peter Kuti, Kehinde Oluyori Omole
January-February 2017, 58(1):13-20
DOI:10.4103/0300-1652.218412  PMID:29238123
Background: Knowledge about childhood asthma in a locality will assist clinicians to adequately manage the condition. This study set out to report the epidemiology, triggers of exacerbation, comorbid conditions, and severity of childhood asthma at a tertiary health facility in Nigeria and the implication of these, in management and symptoms control. Methods: Over a 15-month study period, children (aged <15 years) with physician-diagnosed asthma were consecutively recruited at the pediatric chest clinic of the hospital. Sociodemographic history, triggers, and comorbidities in the children were recorded. The severity and level of symptoms control were determined using Global Initiative for Asthma criteria. The children were examined and had lung function test. Appropriate descriptive and inferential statistics were used to analyze the data obtained. Results: A total of 110 children were recruited for the study with an overall male preponderance 1.6:1, however, more adolescent females than males were observed. The ages of the children ranged from 10 months to 14 years with mean (standard deviation) of 6.4 (3.9) years. The median (interquartile range) age at diagnosis was 2.5 (1.5–6.0) years. The comorbidities were allergic rhinoconjunctivitis (45.5%), atopic dermatitis (10.9%), and overweight/obesity (7.3%). The recognizable triggers of exacerbations were respiratory tract infections (RTIs) seen more in preschool than school age children (χ2 = 6.225; P = 0.031), exercise, dust, and fumes. Mild intermittent asthma (82.7%) was the most common forms, 13 (25.0%) of the children who had Spirometry had obstructive ventilatory pattern and 17.3% had suboptimal asthma control. Conclusion: The majority of children with asthma at the Wesley Guild Hospital, Ilesa were school age children, however, 10% were <2 years and most asthmatics (72.7%) were diagnosed before age five. RTI is a major trigger of exacerbation and more than one-half had other allergic conditions which should be looked for and managed to ensure successful asthma management.
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Rare craniofacial cleft in a dark-skinned African population
O Olalekan Adeosun, Stephen Agbomhekhe Ogah
January-February 2017, 58(1):21-25
DOI:10.4103/0300-1652.218415  PMID:29238124
Background: Craniofacial clefts are congenital anomalies which pose a management challenge to cleft surgeons, especially in developing countries. The aim of this study is to share our experience regarding the management of these atypical facial clefts. Patients and Methods: This prospective study was carried out from May 2009 to May 2014 at Federal Medical Centre, Nguru, Nigeria. Diagnosis was based on clinical examination and Tessier classification was used to describe these clefts. Results: A total of seven patients with rare facial clefts were seen. There were four cases of midline clefts, two cases of bilateral clefts, and one case of multiple facial clefts. All cases were surgically treated, except one case of premaxillary agenesis type holoprosencephaly. Conclusion: To achieve an optimal management of patients with rare facial cleft, a well-equipped craniofacial center must be established which is still lacking in low-resource centers
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Evaluation of outcomes of tuberculosis management in private for profit and private-not-for profit directly observed treatment short course facilities in Lagos State, Nigeria
Olusola Adedeji Adejumo, Olusoji James Daniel, Andrew Folarin Otesanya, Shukrat Olajumoke Salisu-Olatunj, Husseine A Abdur-Razzaq
January-February 2017, 58(1):44-49
DOI:10.4103/0300-1652.218417  PMID:29238128
Background: The engagement of private practitioners in the public-private mix of tuberculosis (TB) management started in 2007 in Lagos State Nigeria. This study compared the treatment outcomes of patients managed at private for profit (PFP) and private not for profit (PNFP) directly observed treatment short course (DOTS) facilities. Methods: A retrospective review of treatment cards of TB patients managed between January 1, 2012, and June 30, 2012, in seven PFP and four PNFP DOTS facilities that served as treatment and microscopy center under the Lagos State TB and Leprosy Control Programme (LSTBLCP) at least 2 years before data collection was conducted. Results: A total of 372 treatment cards of TB patients were reviewed, of which 132 (35.5%) and 240 (64.5%) were from PFP and PNFP DOTS facilities, respectively. Treatment success rate was higher among patients managed at PFP (89.4%) DOTS facilities than PNFP (81.3%) DOTS facilities (P = 0.04). The proportion of patients lost to follow-up (12.5% vs. 8.3%), dead (3.3% vs. 1.5%) and treatment failure (2.5% vs. 0.8%) was higher among patients managed at PNFP DOTS facilities (P > 0.05). The odds that patients treated at PFP DOTS facilities had treatment success were about four times higher than PNFP DOTS facilities when other variables have been controlled for (P < 0.05). Conclusion: There is need by the LSTBLCP to engage more private practitioners to increase case detection and improve treatment outcomes of TB patients.
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Right ventricular function in patients with heart failure in a cardiac clinic in Southwest Nigeria
Adeseye A Akintunde
January-February 2017, 58(1):7-12
DOI:10.4103/0300-1652.218411  PMID:29238122
Background: Right ventricular (RV) function is an important entity in heart failure. Patients with RV dysfunction (RVD) have poorer prognosis and exercise tolerance than those with preserved RV systolic function. Tricuspid annular plane systolic excursion (TAPSE) has been proposed as a simple and reproducible parameter for the qualitative assessment of RV systolic function/ejection fraction (EF). This study aims at describing RV function/RVD among heart failure patients in a specialized cardiac facility in Southwestern Nigeria. Materials and Methods: One hundred and thirty-two patients with clinical diagnosis of heart failure were recruited into the study between June 2011 and December 2014. Baseline data, laboratory investigations, electrocardiography, and echocardiography were taken for the participants. RV function was assessed with TAPSE. Statistical analysis was done using Statistical Package for Social Sciences 16.0 (Chicago Ill. USA). P < 0.05 was considered statistically significant. Results: The mean age of study participants was 62.1 ± 14.2 years. RV systolic dysfunction (TAPSE <20 mm) was found in 86 (65.2%) of all patients while moderate-to-severe RVD (TAPSE <15 mm) was found in 26 (19.7%) patients. Those with RVD are more likely to be older and had a larger left ventricular internal diastolic dimension than those without RVD. Systolic blood pressure, diastolic blood pressure, and EF were significantly lower among patients with RVD than those with normal RV function. Conclusion: RVD is common and is associated with more advanced heart failure and possibly worse prognosis among Nigerians with heart failure. Screening for RVD is encouraged to identify and aggressively treat to reduce the associated increased mortality.
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Determinants of contraceptive use by women in the central senatorial zone of Bayelsa State, Nigeria: A cross-sectional survey
Numonyo Duabo Dambo, Israel Jeremiah, Akhtar Wallymahmed
January-February 2017, 58(1):26-31
DOI:10.4103/0300-1652.218409  PMID:29238125
Background: Contraceptives are known to contribute to maternal health and well-being as well as improve child survival. Due to the multiethnic nature of Nigeria, it is known that the factors that influence contraceptive use may vary from one location to another and as such a blanket policy by the federal government on improving contraceptive use may not take into account the subtle differences in sociocultural practices that may influence contraceptive use. The aim of the study was to determine the contraceptive prevalence and explore factors that determine the use of contraceptives among women of Bayelsa Central Senatorial Zone. Materials and Methods: A cross-sectional survey of 210 women aged between 18 and 49 years who completed a close-ended questionnaire was carried out. Descriptive analysis was done for sociodemographic data, and tests of significance were done using SPSS version 20. Results: The prevalence of modern contraceptives in the Central Senatorial Zone of Bayelsa State was 36.8%. Condoms were the most common type of contraceptives used. Education, religious beliefs, and knowledge of fertile days were factors that significantly predicted contraceptive use. Age and number of children influenced the type of contraception a woman used. Conclusion: The contraceptive prevalence in this study is high. The factors that determine contraceptive use such as education and religion have been identified and can be leveraged upon to increase its use.
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Persistent hypocalcemia and hungry bone syndrome after parathyroidectomy and renal transplantation in a patient with end-stage renal disease
Hamid Tayyebi-Khosroshahi, Farahnoush Farnood, Maryam Ghorbanian, Farid Karkon-Shayan, Mohammad Naghavi-Behzad
January-February 2017, 58(1):50-52
DOI:10.4103/0300-1652.218416  PMID:29238129
Hungry bone syndrome (HBS) defines as persistent and severe hypocalcemia after parathyroidectomy surgery. It is treated by oral or venous discrimination of calcium carbonate. The present treatment is mostly effective. Hereby, we describe a 60-year-old man who had developed hyperparathyroidism secondary to end-stage renal disease and then parathyroidectomy was performed for him twice before renal transplantation. Up to 500 vials of calcium gluconate (100 mg/ml calcium gluconate 10%) were administered for him to control serum calcium level after parathyroidectomy and renal transplantation. Furthermore, high-dose calcium carbonate was administered for his outpatient care. Therefore, HBS, which was resistant to standard treatment, was detected for him.
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Should venous doppler ultrasonography be routinely applied before lower extremity major orthopedic surgery?
Hasan Gocer, Ali Kemal Yazici, Ahmet Veysel Polat
January-February 2017, 58(1):32-36
DOI:10.4103/0300-1652.218410  PMID:29238126
Background: Hip-knee arthroplasty and knee arthroscopy (KA) is frequently applied in the orthopaedic surgery. The approach does not exist related with the preoperative asymptomatic deep venous thrombosis (DVT). In this study, the patients who would undergo surgery lower extremity were screened for asymptomatic DVT, using the venous Doppler ultrasonography (USG). Patients and Methods: DVT was screened by venous Doppler USG in the patients who would undergo hip-knee arthroplasty and KA between the dates of November 2013 and September 2015. The patients were investigated regarding the age, gender, and the planned operation. The cases were separated to the following three groups: group I (<49 years), Group II (49–69 years), and Group III (≥70 years). Results: The study included 222 patients; of these, 174 were female and 48 were male. Group I, Group II, and Group III included 45, 115, and 62 patients, respectively. Of the six patients determined to exist with DVT, 2 (1.73%) were in Group II, and 4 (6.45%) were in Group III. Conclusion: Although the differences were not found to be statistically significant, it may be useful to screen asymptomatic DVT by Doppler USG in the preoperative period in the 70-year-old male patients, and in those over 70.
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Comparison between brain natriuretic peptide and calcitonin gene-related peptide in children with dilated cardiomyopathy and controls
Noor Mohammad Noori, Alireza Teimouri, Iraj Shahramian
January-February 2017, 58(1):37-43
DOI:10.4103/0300-1652.218413  PMID:29238127
Background: Dilated cardiomyopathy (DCM) is revealed with the left ventricular dilatation and systolic dysfunction. Objective: This study was performed to determine the level of calcitonin gene-related peptide (CGRP) and brain natriuretic peptide (BNP) in children with DCM and controls and comparison of these two biomarkers in patients. Materials and Methods: This study was performed from April 2014 to March 2015 on patients with DCM. The levels of BNP and CGRP were measured by ELISA, and final amounts of biomarkers were compared with the echocardiographic finding. Results: In this study, the mean age was 10.567 ± 5.50 and 12.135 ± 4.626 years for controls and cases, respectively (P = 0.321). The majority of echocardiographic indices in the left and right heart had different means in cases and controls (P < 0.05). Means of BNP were 213.814 ± 309.601 and 2.76 ± 1.013 for case and control, respectively (P < 0.001). Means of CGRP were 2.278 ± 1.586 and 1.488 ± 0.501 for cases and controls, respectively, (P = 0.001). In the patients group, however, no significant relationship was observed between CGRP level and Ross classification but observed a direct relationship of Ross classification with BNP (χ2 = 15.845, P < 0.05). Conclusions: The present research was performed on DCM patients and showed that most echocardiographic parameters, mean of CGRP and mean of BNP increased in patients compared to healthy children. The severity of illness based on the Ross classification showed significant and positive correlation with BNP level but not with CGRP. Probably, it could be concluded that BNP would be a better biomarker in DCM patients.
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