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   2020| January-February  | Volume 61 | Issue 1  
    Online since March 2, 2020

 
 
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ORIGINAL ARTICLES
The risk of obstructive sleep apnea among patients with type 2 diabetes mellitus
Victor Aniedi Umoh, Effiong Ekong Akpan, Udeme Ekpeyong Ekrikpo, Alphonsus Udo Idung, Eyo Effiong Ekpe
January-February 2020, 61(1):32-36
DOI:10.4103/nmj.NMJ_129_19  
Context/Aims: Obstructive sleep apnea (OSA) and Type 2 diabetes mellitus share obesity as a common risk factor. The presence of OSA may contribute to increased morbidity and mortality of diabetes. Despite their close association, OSA is not routinely evaluated in diabetic patients. This study was conducted to determine the risk of OSA among Type 2 diabetes mellitus patients. Methods: Type 2 diabetic patients attending a tertiary hospital in Nigeria were evaluated for OSA risk using the Berlin Questionnaire. Other parameters measured included anthropometry and blood pressure (BP). Results: Three hundred and twenty-seven patients participated in this survey: 177 (54.1%) were female and 150 (45.9%) were male. The average age of the patients was 56.2 ± 9.3 years. Seventy-eight (44.8%) females were obese compared to 30 (20.0%) males,P < 0.001. Two hundred and one (61.5%) patients were previously known hypertensives with only 48 (23.9%; 95% confidence interval [CI]: 18.2–30.4) of them having good BP control. One hundred and sixty-two (49.5%, 95% CI; 44.0–55.1) patients had a high risk for OSA: 96 (54.2%; 95% CI: 44.6–61.7) females and 66 (44.0%; 95% CI: 35.9–52.3) males. The strongest predictor for a high risk of OSA was poorly controlled BP with an odds ratio of 2.6 (95% CI: 1.6–4.3). Conclusion: This study has demonstrated that there is a high risk of OSA among Type 2 diabetic patients and that OSA risk is significantly associated with poor BP control and obesity. We recommend that diabetic patients should be assessed for OSA risk as part of their routine evaluation.
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CASE REPORT
Heart failure with recovered ejection fraction: Report of a case in Jos, Nigeria
Basil N Okeahialam, Alfred C Ikeme
January-February 2020, 61(1):48-50
DOI:10.4103/nmj.NMJ_294_16  
Some patients in heart failure (HF) are able to withstand treatment, recover ejection fraction (EF) enough to require little or no further treatment. They belong to the distinct entity now called HF with recovered EF where patients start as HF with reduced EF and with treatment end up as HF with mid-range EF or even HF with preserved EF. This case report is on one such patient who presented in HF with features of dilated cardiomyopathy. With treatment, he promptly came out of HF, and myocardium remodeled toward recovery of function, which also reflected on electrocardiographic voltages. He remained out of failure despite deescalation of anti-failure regimen. Characterizing this group well will permit a paradigm shift in the management of HF; with the understanding that the myocardium can recover function or go into remission depending on underlying pathology.
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ORIGINAL ARTICLES
Near miss and maternal mortality at the Jos University Teaching Hospital
Ephraim Samuels, Amaka Ngozi Ocheke
January-February 2020, 61(1):6-10
DOI:10.4103/nmj.NMJ_103_18  
Background: Some women who enter pregnancy in a healthy state may survive with serious complications while others may die. This study sets out to determine the frequency of maternal near-miss (MNM) and maternal death. It also intended to identify common causes and determinants. Materials and Methods: This was a cross-sectional study from June 2012 to May 2013 that involved women who were admitted for delivery, within 42 days of delivery or termination of pregnancy and those who died from pregnancy, childbirth, or puerperal complications. Data obtained were analyzed using Epi info 2002. Results: There were 105 maternal near misses and deaths. Nineteen of them were mortalities, whereas 86 were MNMs. The maternal mortality ratio over the period was 806/100,000 live births and near miss was 3649/100,000 live birth. Hypertensive disorders in pregnancy were the leading cause of maternal deaths (47.36%) and MNMs (47.7%). Maternal deaths (57.9%) and near misses (43%) were the highest among those that treatment was instituted after 60 min and within 30–60 min of diagnosis, respectively. The consultants were the highest level of expertise involved in the management of 73.3% and this group recorded the least maternal death and highest MNM. Conclusion: Hypertensive disorder was the leading cause of MNM and mortality. Involving the highest level of expertise in patient management and reducing the time interval between diagnoses and instituting definitive treatment is essential for a better outcome. Health institutions will benefit from the evaluation of their quality of obstetric care by including near miss investigations in their maternal death enquiries.
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Challenges of tuberculosis control in Lagos state, Nigeria: A qualitative study of health-care providers' perspectives
Olusola Adedeji Adejumo, Olusoji James Daniel, Victor Abiola Adepoju, Toriola Femi-Adebayo, Bisola Ibironke Adebayo, Andrew Oseghae Airauhi
January-February 2020, 61(1):37-41
DOI:10.4103/nmj.NMJ_108_19  
Background: Tuberculosis (TB) burden in Nigeria is a reflection of the challenges of TB control strategy in the country. This study explored the challenges encountered by the health workers in public and private TB treatment centers in Lagos, Nigeria. Methods: In-depth interviews were held with 34 health workers providing TB services in private and public health facilities and the Lagos state Program Officer between October 1, 2016 and January 31, 2017. The transcripts were read severally and coded for qualitative data analysis. Themes were developed from coding. Results: Insufficient or lack of funds to track patients lost to follow-up, conduct home visits, collect drugs from the central stores, and shortage of laboratory reagents were some of the logistical challenges encountered by the health workers. There was shortage of health workers and some were yet to be trained resulting in work overload. This was situation aggravated by the frequent redeployment and health worker attrition in the public and private sector respectively. Conclusion: The government need be proactive and show leadership by finding lasting solutions to the logistical and human resource challenges facing the LAgos State TB and Leprosy Program.
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Hypertensive disorders in pregnancy: Pattern and obstetric outcome in Bida, Nigeria
Haruna Idris, Nwachukwu Chiemezie Nwagbo Duum, Umar Gati Adamu, Rasheedat Morayo Abdullateef, Isah Aliyu Yabagi
January-February 2020, 61(1):42-47
DOI:10.4103/nmj.NMJ_29_18  
Context: Cases of hypertensive disorders in pregnancy (HDP) are an increase in developing economies. Identifying the pattern of HDP in a particular community and documenting their management outcome may allow for proper planning by all stakeholders. Aims: The objective was to determine the pattern and management outcome of hypertensive disorders among pregnant women. Settings and Design: This was a prospective cohort study involving 183 consecutive cases of HDP at Federal Medical Centre, Bida, Niger State, Nigeria, between September 2015 and August 2016. Subjects and Methods: Pregnant women with hypertension were recruited and managed according to the departmental protocol. They were followed up till 6 weeks after delivery; fetal and maternal outcomes were documented. Statistical Analysis Used: Data were analyzed using the SPSS software version 23. The level of statistical significance was set at P < 0.05. Results: A total of 1956 deliveries occurred during the study with 183 cases of HDP, giving an incidence of 9.4%. Pregnancy-induced hypertension alongside preeclampsia constitutes the majority of HDP during the study and had accounted for over 64%. Women who did not receive antenatal care in our center were at significantly greater risk of eclampsia (P = 0.000), abruption placentae (P = 0.003), maternal death (P = 0.002), very low-birth-weight (LBW) babies (P = 0.002), extremely LBW babies (P = 0.03), and perinatal death (P = 0.000). Conclusion: The need for prenatal screening that enables the early identification and prompt management of all expectant mothers with HDP is advised.
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An overview of peripheral artery disease in the elderly: A study in a tertiary hospital Southern Nigeria
Iboro Samuel Akpan, Osahon Enabulele, Afolabi Joseph Adewole
January-February 2020, 61(1):1-5
DOI:10.4103/nmj.NMJ_142_19  
Background: The incidence of Peripheral Artery Disease (PAD), one of the manifestations of atherosclerosis, is increasing worldwide with significant effects on the quality of life. The disease is a strong prognostic marker for future cardiovascular events in people over 60 years, but relatively little is known about the condition among the elderly in sub-Saharan Africa. Objective: The objective of this study was to determine the prevalence and pattern of peripheral artery disease in elderly patients. Materials and Methods: A cross-sectional hospital-based study was carried out among elderly patients aged 60 years and above attending the Geriatric Clinic of the Department of Family Medicine of University of Benin Teaching Hospital, Edo State, Nigeria, from September to November 2017. Using systematic random sampling technique, 370 respondents were recruited from a sampling frame of 2160 respondents and a sampling fraction of 6. A structured questionnaire was administered to collect data on sociodemographic characteristics, lifestyle variable, and medical history. The ankle-brachial index (ABI) and toe-brachial index (TBI) were used to assess for PAD. The analysis was done using descriptive statistics. Results: The mean age was 69.3 ± 7 years comprising 76.5% females, 50% of the respondents were married, while 47% were widowed. The ABI showed 35.4% prevalence of PAD, while TBI for respondents with elevated ABI was 45.0%. Conclusion: The study showed a point prevalence of PAD to be 37.8%. From the total respondents, 45.7% had mild, while 2.9% had severe PAD. Routine screening for PAD is recommended for the early detection and management.
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A comparison of pain scores in neonatal circumcision with or without local anesthesia in Jos, Nigeria
Aminu Gango Fikin, Stephen Yohanna
January-February 2020, 61(1):11-15
DOI:10.4103/nmj.NMJ_68_19  
Introduction: Neonatal circumcisions are commonly performed in Nigeria, most often without anesthesia. The aim of this study was to determine whether anesthesia was required for neonatal circumcision. Materials and Methods: All new-born male neonates presenting for routine circumcision were considered for inclusion in the study. This was a randomized control study, comparing pain scores during circumcision with local anesthesia or without local anesthesia. A total of 72 neonates were randomly assigned to the two groups using computer-generated random numbers, with 36 in each group. The neonates were not matched for age or weight. All the anesthetic procedures and circumcisions were performed in identical manner by the principal investigators using the plastic bell technique. Approval for the study was obtained from the Research Ethics Committee of the hospital. Written voluntary informed consent was obtained from the parents of the neonates. Results: The mean age and weight of the neonates in the study were 17 ± 2 days and 3.2 ± 0.68 kg, respectively. The mean Neonatal/Infant pain score was 4.8 in the local anesthesia group and 6.0 in those without anesthesia. The mean transcutaneous PO2 was 90.47 ± 7.53 in those with anesthesia compared to 85.83 ± 5.61 in those without anesthesia. The mean heart rate was 133.88 ± 35.00 beats/min in the anesthesia group compared to 152.11 ± 79.80 in those without anesthesia. Neonates circumcised without local anesthesia had higher respiratory rate compared to those circumcised with local anesthesia. Conclusion: Neonates circumcised without local anesthesia had higher mean pain scores, heart rate, lower oxygen saturation and increased mean respiratory rate than those that had local anesthesia. Local anesthesia should be routinely used during neonatal circumcision.
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Unilateral sinonasal masses: Review of clinical presentation and outcome in Ahmadu Bello university teaching hospital, Zaria, Nigeria
Iliyasu Yunusa Shuaibu, Muhammed Aminu Usman, Abdulrazak Ajiya
January-February 2020, 61(1):16-21
DOI:10.4103/nmj.NMJ_128_19  
Background: Unilateral persistent nasal obstruction may indicate the presence of sinonasal lesion, which could be inflammatory or neoplastic. It is a common practice to assume that unilateral nasal mass in adults is either inverted papilloma or a malignant lesion. Objectives: The objective is to study the pattern of clinical presentation and outcome of treatment of patients managed for unilateral nasal masses at Ahmadu Bello University Teaching Hospital, Zaria. Materials and Methods: The record of patients managed for unilateral nasal masses over 5 years between January 2013 and December 2017 was reviewed. Data obtained for this study included demographic characteristics such as age, sex, occupation, main presenting symptoms, duration of symptoms, histological type, type of treatment given, and current status of patients. The data were analyzed using the Statistical Package for the Social Science version 23.0. Results: A total of 38 cases were reviewed for this study and there were 25 (65.8%) males and 13 (34.2%) females with a sex ratio (male: female) of 1.9:1. The mean age was 50.8 years, with the standard deviation of ± 13.7. Rhinorrhea, nasal blockage and the presence of nasal growth were the most common symptoms at presentation seen nearly in all the patients. Inflammatory polyp 16 (42.1%) was the most common histological type observed in this study. The majority of patients with malignant sinonasal masses had well-differentiated squamous cell carcinoma 5 (13.2%). Most of our patients 29 (76.3%) presented to the hospital within 1–3 years of the onset of the symptoms. The majority of our patients 26 (68.4%) did very well and were discharged from the clinic following resolution of their symptoms. Three (7.9%) had recurrent nasal mass. We recorded three cases of mortality from the 38 patients managed. Conclusion: Inflammatory polyp was the most common unilateral sinonasal mass followed by inverted papilloma. A thorough clinical evaluation of any patients with prolonged nasal symptoms will go a long way in the early detection of these lesions.
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Reported adherence to antihypertensive treatment and outcome at postmortem in Southwestern Nigerians
Uchenna Simon Ezenkwa, Sebastian Anebuokhae Omenai, John Olufemi Ogunbiyi
January-February 2020, 61(1):22-26
DOI:10.4103/nmj.NMJ_99_19  
Background: Systemic hypertension is referred to as a silent killer. Knowledge of disease and religious use of medication could mitigate against complications in hypertensives. This study evaluated outcome among decedent essential hypertensive patients in southwestern Nigeria in relation to their compliance with prescribed antihypertensive medication. Materials and Methods: This is a 10-year retrospective review of routine postmortem data. Archival postmortem records from January 1, 2008 to December 31, 2017 in the Department of Pathology, University College Hospital, Ibadan, Nigeria, were reviewed. Data extracted from the records included age, gender, knowledge of hypertension status, systolic and diastolic blood pressure at time of diagnosis, reported adherence to medications, complications of systemic hypertension, duration of survival from diagnosis to demise, cause of death, body length, and heart weight at autopsy. Descriptive, Students t-test, Chi-square test, Pearson correlation and Cox proportional-hazards model statistics was conducted using SPSS version 20 (IBM SPSS Statistics for windows, IBM Corp., Armonk, N.Y., USA).P < 0.05 was considered significant. Results: Eighty-one cases met the inclusion criteria, consisting of 60 males and 21 females with overall mean age of 55.65 ± 12.1 years. Seventy-five (91.7%) cases were known hypertensives prior to admission or demise while 6 (8.3%) were not known hypertensives. The duration of survival from diagnosis to death ranged from 1-month (0.08 years) to 31 years with overall mean duration of 5.2 years. Fifty-two (63.4%) of the 75 known hypertensive cases had documented medication compliance. Medication noncompliant cases had lower mean survival interval (5 vs. 8 years), died younger (53.5 ± 10.8 years vs. 54.8 ± 15.5 years), had higher mean blood pressures (systolic blood pressures: 197 ± 45.8 mmHg vs. 180 ± 55.4 mmHg; diastolic blood pressures: 117 ± 27.2 mmHg vs. 101 ± 32.8 mmHg) and heavier heart weights (476 ± 142 g vs. 390.8 ± 107.6 g). However, only the difference in heart weight was statistically significant (P < 0.036). Age and mean systolic blood pressures were correlated with interval from diagnosis to death (r = 0.5,P < 0.000; r = −0.4,P< 0.017, respectively). Death from complications of hypertension and all-cause mortality occurred with higher frequencies among medication noncompliant cases (40 vs. 12). Conclusion: Noncompliance with antihypertensive medication is associated with more cardiovascular and all-cause mortality among Southwestern Nigerians with essential hypertension.
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Enrollees' knowledge and satisfaction with national health insurance scheme service delivery in a tertiary hospital, South West Nigeria
David Ayobami Adewole, Folashayo Ikenna Peter Adeniji, Susan Elemeyi Adegbrioye, Oluyinka Motunrayo Dania, Temitope Ilori
January-February 2020, 61(1):27-31
DOI:10.4103/nmj.NMJ_126_18  
Background: Social health insurance scheme provides a platform for mobilizing revenue for health and enhances universal health-care coverage. In addition, knowledge about patients' satisfaction with health care under the scheme will help in identifying gaps and provides evidence toward strengthening the scheme. This study assessed enrollees' knowledge about the National Health Insurance Scheme (NHIS) and satisfaction with health services provided under the scheme. Materials and Methods: The study was a descriptive cross-sectional survey conducted among the NHIS enrollees accessing health-care services in the University College Hospital, Ibadan. A total of 373 individuals were consecutively recruited for the study, and a semi-structured, pretested interviewer-administered questionnaire was used to obtain information from respondents. Descriptive statistics was used to present results, and Chi-square test was used to test for the association between categorical variables. The level of significance was set at P < 005. Results: The mean age was 42.5 ± 10.0 years. Of the respondents, 209 (56.0%) were male and 359 (96.2%) were married. About two-thirds, 227 (60.9%), had good knowledge about the NHIS. Majority of the respondents 303 (81.2%) reported paying for some of the costs of service (drugs, laboratory tests, consultation fees, and X-ray) through out-of-pocket and of these, 218 (71.9%) reported that such payments were occasional. Overall, slightly more than half, 197 (52.8%), of the respondents were satisfied with service delivery under the scheme. Female respondents were significantly more satisfied with health-care services (χ2 = 3.894,P = 0.048). Conclusion: There was good knowledge of NHIS, but the level of satisfaction with service delivery was not outstandingly appreciable. There is an urgent need to improve on all areas of quality of service to improve satisfaction with care among enrollees in the scheme.
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