10.18639/RABM.2017.03.523636
Short Communication
Nov 30, 2017
Dermatoglyphics (fingerprint) indicates epidermal ridge patterns of sole, palm, fingers, and toes. It is unique for each person, because it is determined by interaction of genes and intrauterine environment. Once dermatoglyphic patterns are formed, it is not affected by age, development, and environmental changes in postnatal life. Therefore, they exhibit positive values in predicting various genetically influenced disorders. Dermatoglyphics plays an important role in medicolegal, anthropology, and genetic studies. Diabetes mellitus, hypertension, Down syndrome, bronchial asthma, schizophrenia, and breast cancer are some of the diseases that can be screened by dermatoglyphic identification.
10.18639/RABM.2017.03.513787
Original Research Article
Nov 30, 2017
The pains and challenges of pregnancy and delivery are made worse when the resultant neonate dies. Fortunately, many of these neonatal deaths can be prevented if autopsies are routinely conducted to ascertain the immediate and remote causes of death toward subsequent prevention. Unfortunately, there is paucity of studies on neonatal autopsy rates (NARs) in many developing countries, with few reports indicating unacceptably low rates. This study was therefore aimed at assessing the trend in neonatal deaths and autopsy rates in Calabar, Nigeria. Trend analysis of retrospective data obtained from medical records of neonatal deaths and deliveries was conducted. Neonatal mortality rate (NMR) and NAR were obtained for each of the years within 2004-2013. Ethical approval was obtained from the ethical committee of University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria. In the 10-year study period, there were 22,916 deliveries with a male:female ratio of 1:0.95. There were 1136 neonatal deaths, yielding a total NMR of 49.6 per 1000 live births (ranging from 26.7 in 2011 to 93.7 in 2004). Bimodal peak in NMR was found at 2008 and 2012. Eighty six neonatal autopsies were conducted within the study period yielding a mean autopsy rate of 7.57%, ranging from 0% in 2008 to 25.0% in 2013. This study found unacceptably high NMR and low NAR in the study setting. There was, however, gradual decrease in mortality and increase in autopsy rates through the study period. It is essential to redouble the efforts at improving public health education and awareness on the relevance of autopsy toward improved health service delivery. Similar studies are recommended in other similar and dissimilar settings.
10.18639/RABM.2017.03.516137
Original Research Article
Oct 25, 2017
We performed a hospital-based survey of time to theatre, between arrival at the emergency room for acute surgery cases and surgery intervention, in nine subdepartments of surgery in Sanglah Hospital. The objective of this study was to obtain the determinant factors that affect the time to theatre of acute surgery cases in Sanglah Hospital. There were 321 acute surgery cases during July–October 2016. The majority of them were of 65 years old (90.7%) and male cases (69.8%). There were 67% patients from outside of Denpasar city. The predominant cases were in traumatology subdepartment (47.7%), neurosurgery (24.9%), and orthopedic (11.8%). The average time to theatre was 649.83 min, and the surgery duration was 156.38 min. An analysis of the independent t-test of time to theatre showed a significant difference in age category (p 5 0.042); the analysis showed that the time to theatre that differed in categories of gender was significant (p 5 0.006). The time to theatre was significantly different if managed by traumatology subdepartment than others (p 5 0.006) and in the type of surgery (p 5 0.001) performed. This research concluded that the time to theatre of acute surgery was affected by the age of the patient, gender of patient, subdepartment category, and type of surgery. One factor that plays a key role in the efficiency of the acute surgical time is to identify the patients who require emergency or urgent surgery.
10.18639/RABM.2017.03.509940
Original Research Article
Sep 30, 2017
Cluster differentiation 4 (CD4) count estimation, which is not readily available in most resource poor settings in Nigeria, is an important indexdetermining commencement of antiretroviral therapy (ART). It is imperative for physicians who come in contact with these patients in such settings to recognize other parameters to evaluate these patients. The clinical correlates of diarrhea and gut parasites among human immunodeficiency virus (HIV)-seropositive patients attending our special treatment clinic were studied. Three hundred and forty consenting HIV-positive adult subjects were enrolled. Their stool and blood specimens were collected for a period of three months. Stool samples were analyzed for the presence of diarrhea and gut parasites. The patients were clinically evaluated by physical examination for the presence of pallor, dehydration, oral thrush, wasting lymphadenopathy, dermatitis, skin hyperpigmentation, and finger clubbing. Participants with diarrhea represented 14.1% of the population, while 21.5% harbored one or more parasites. In the subjects with diarrhea, 14.6% harbored gut parasites. The presence of diarrhea was associated with a low CD4 count. Clinically, oral thrush, wasting, and rashes were more reliable predictors of low CD4 count levels; whereas, the presence of pallor, dehydration, wasting, and rashes correlated with the presence of diarrhea. HIV patients presenting with pallor, dehydration, wasting, and rashes should be evaluated for the presence of diarrhea. The clinical variables associated with low CD4 count in this study may guide commencing antiretroviral therapy in resource poor settings.
10.18639/RABM.2017.03.515394
Original Research Article
Sep 29, 2017
Sickle cell anemia (SCA) is an inherited disorder of hemoglobin. Each year over 150,000 children in Africa are born with SCA. Cognitive impairment is a common complication of SCA. This case-control study evaluated cognitive function in 41 adolescents and adults with SCA and an equal number of healthy demographically matched controls using the community screening interview for dementia (CSID), Trail Making Test A (TMTA), Saint Louis University Mental Status examination (SLUMS), and Mini Mental State Examination (MMSE). Mood (anxiety and depression) was assessed using the Hospital Anxiety and Depression Scale (HADS). The controls had better total scores on all screening instruments; however, the difference between their performance and that of the SCA adults was not statistically significant; SLUM (p 5 0.179), TMTA (p 5 0.359), MMSE (p 5 0.241), and CSID (0.494). On specific task, the controls performed significantly better based on SLUM (naming), p 5 0.016; SLUM (repetition), p 5 0.015; SLUM (recall), p 5 0.003; and CSID (language expression), p 5 0.001. The systolic blood pressure (SPB) was inversely correlated with the MMSE scores (p 5 0.009). In addition, there was direct linear correlation between the creatinine levels and the MMSE scores (p 5 0.009). The proportion of SCA patients compared with the controls that had abnormal mood were anxiety (7.3% vs. 4.9%), borderline anxiety (17.1% vs. 4.9%), depression (2.4% vs. 2.4%), and borderline depression (14.6% vs. 2.4%). SCA was associated with an increased prevalence of cognitive impairment in adults when compared to controls. SCA is associated with a higher proportion of mood abnormalities.
10.18639/RABM.2017.03.509325
HIV and AIDS
Sep 28, 2017
Human immunodeficiency virus (HIV)-infected individuals have been shown to have a high prevalence of sleep disturbances. Both the effects of the virus and the antiretroviral drugs may cause sleep disturbances. We sought to determine the prevalence and predictors of sleep disorders among HIV seropositive adult subjects presenting at an outpatient hospital setting. One hundred and fifty six subjects were recruited for the study by using a sleep disorder screening questionnaire. The mean ages of the participants were 38.7 6 9.23 and 39.5 6 9.23 for those with and those without sleep disorder, respectively. The prevalence rate of sleep disorders was 46.2%. Elevated systolic blood pressure, lower CD4 count levels, and being on the highly active antiretroviral therapy combination TDF/3TC/ATZ/lpvr were associated with sleep disorders. The high prevalence rate observed necessitates routine screening for sleep disorders among HIV/AIDs patients.
10.18639/RABM.2017.03.518093
Original Research Article
Sep 28, 2017
Infection with hepatitis B or C viruses is still one of the most dreaded infectious diseases worldwide. Health education and screening, particularly among vulnerable groups, are the most cost-effective interventions that can be provided in developing countries. Facility and community-based provision, of effective strategic health education and counseling, are dependent on better understanding of the factors that may be associated with the level of knowledge on hepatitis. One of such groups is men who sleep with men (MSM) or homosexuals, who are at high risk of hepatitis infection through unprotected anal intercourse. This study was therefore aimed at assessing the knowledge of hepatitis infection among MSM in Calabar, a metropolitan city in the oil-rich Niger-Delta region of Nigeria. Cross-sectional study design was utilized. The snow-ball sampling method was used to recruit subjects, with self-administration of structured questionnaires. Questionnaire assessed awareness, causes, sources, consequence, and prevention of hepatitis infection. Knowledge scores were obtained for each subject. Chi-square was used to assess factors associated with knowledge, with p-value fixed at 0.05. Sixty-nine (69) consenting subjects were surveyed, with mean age of 22.5 6 3.2 years, ranging from 16 to 31 years. Mean knowledge percentage score was 43.5 6 32.0, ranging from 0% to 100%. Age group, occupation, and other sociodemographic characteristics were not significantly associated with the knowledge of hepatitis infection. There is inadequate knowledge of hepatitis infection among MSM in the study area. This inadequacy appears worse among receivers, who are even at higher risk of sexually transmitted infections compared with inserters. These findings have implications for control of viral hepatitis in sub-Saharan Africa.
10.18639/RABM.2017.03.455896
Original Research Article
Aug 31, 2017
This research was conducted for estimating the knowledge and prevention of nosocomial infection among ward nurses at Federal Medical Centre (FMC), Umuahia Abia state. Four objectives were set, and four questions were formulated. A descriptive survey research method was used for the study. A sample size of one hundred and fifty (150) nurses was drawn from eight wards (medical and surgical), at FMC, Umuahia. A self-developed questionnaire with seventeen (17) structured questions was the instrument of data collection. Data were collected, analyzed, and presented in tables, pie chart, bar chart, histogram, and percentages. The results revealed that the nurses were well knowledgeable about nosocomial infection, although little deficiencies existed in the area of infection control practice and compliance, such as hand washing frequency. This study therefore recommends continuing education/seminar/workshop for all health care givers, to sensitize them with the knowledge and practice of nosocomial infection.
10.18639/RABM.2017.03.470880
Review Article
Aug 31, 2017
This paper reviews the pathophysiology of cervical spondylotic myelopathy (CSM) and several surgical approaches for the treatment of CSM. CSM is a degenerative disease with severe morbidity. The pathophysiology of CSM involves static, dynamic, and ischemic factors. The management of mild CSM typically involves conservative treatments and medication; whereas, moderate and severe CSM are better treated surgically. Surgical treatments for CSM are basically classified into anterior and posterior surgeries. The common techniques are anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), laminectomy, and laminoplasty. Each technique has its own advantages and disadvantages. In this paper, we review the research papers from PubMed database to elaborate the advantages and disadvantages of each technique.
10.18639/RABM.2017.03.487382
Review Article
Aug 21, 2017
Osteoarthritis (OA) is the most common form of arthritis that affects cartilage joints and leads to disability. OA becomes the major public health problem, as it is the most leading cause of disability and morbidity worldwide. Treatment choices for OA can be classified into several categories such as non-pharmacologic, pharmacologic, surgical therapy, and cell-based therapy. There is no curative treatment for OA, while conventional treatments that are commonly used focus on alleviating the pain as the main symptom of the disease. Mesenchymal stem cells (MSCs) that can be found in several tissues of human body offer a new strategy for OA treatment owing to their ability to differentiate into chondrocytes. This article provides an overview about the basic concept of osteoarthritis as well as an insight about the MSCs therapy, including their basic characteristics, source, and transplantation strategies in the OA area.
10.18639/RABM.2017.03.460868
Cardiovascular Disease
Aug 17, 2017
Cardiovascular diseases (CVDs) have continued to be a leading cause of death among adults. Civil servants constitute vital workforce, and high CVD burden in this group has implications for national productivity. Unfortunately, guided cardiovascular health education interventions are uncommon. This study assessed the effect of an educational intervention on knowledge and practice of CVD prevention among Nigerian civil servants. Quasi-experimental study design was employed among subjects in distant communities in Cross River State. Multistage technique was used to recruit 172 subjects into one control group (Ogoja) and two intervention groups (Calabar and Ikom). The first intervention group received 4-h daily, 5-day cardiovascular health education, with emphasis on burden, risk factors, and preventive measures including nutrition, stress, alcohol, medicals, exercise, and smoking. The second intervention group received the same content of education, but with the use of Food, Rest for stress management, Alcohol, Medicals, Exercise, and Smoking (FRAMES) as guide for delivery. Questionnaires were used to assess knowledge and practice at baseline and post-intervention. Data were analyzed using SPSS version 20.0. Knowledge scores and practice of CVD prevention were compared between study groups using inferential statistics. Mean age was 46.3 7.4 years, and no significant difference in sociodemographic characteristics was observed by comparing the study groups (p 0.05). Baseline knowledge and practice of preventive measures were generally poor, and no significant difference was observed by comparing the groups (p 0.05). At 12 weeks post-intervention, knowledge of CVD was higher in the intervention groups compared with the control group (p 0.05). Unlike control group, both intervention groups had improvement in physical exercise, medical screening, and fruit consumption (p 0.05). There was no significant difference in postintervention knowledge and practice of CVD prevention by comparing both intervention groups (p 0.05). For effective delivery of cardiovascular health education, the use of “FRAMES” is as effective as its nonuse. Further studies in other settings are recommended.
10.18639/RABM.2017.03.457021
Review Article
Jul 14, 2017
Diarrhea pathophysiology and constipation are multifactorial gastrointestinal (GI) disorders characterized by intestinal peristalsis disruption of and an irregularity in secretion/absorption process. Oxidative stress, as an imbalance in prooxidants/antioxidants, has recently been recognized as a significant player in these GI disturbances. In this respect, numerous studies were performed and have shown that the deleterious effects on GI tract were accompanied by accumulation of oxidants and depletion of antioxidant system. Antioxidant remedy is necessary in scavenging free radicals and reactive oxygen species preventing oxidative stress-induced GI interruptions.
10.18639/RABM.2017.03.456895
HIV and AIDS
Jul 07, 2017
The emergence of a chronic medical illness such as Human Immune Deficiency Virus and Acquired Immunodeficiency Syndrome (HIV/AIDS) may be the time when people turn to the Sacred through spirituality and religion. HIV is a chronic illness that requires strict adherence to medication regimens that may be influenced by spirituality/religion. This study was aimed at finding the association between spirituality/religion and adherence to highly active antiretroviral therapy (HAART) in adult HIV/AIDS patients. This is a cross-sectional descriptive study of 370 patients. Adherence was measured using an adapted adult AIDS clinical trial group (AACTG) and visual analogue scale (VAS) tools. Spirituality was assessed using Functional Assessment of Chronic Illness Therapy-Spirituality Expanded (FACIT-Sp-Ex) scale, religiosity with Duke University Religion index (DUREL), and religious coping with Brief Religious Coping (RCOPE) scale. Adherence rates were 86.2 and 43.8% using AACTG and VAS tools, respectively. Statistical significant correlation was found between spirituality and adherence to HAART (r 5 0.265; p 5 0.00). Also, significant correlation was found between positive religious coping and adherence (r 5 0.15, p 5 0.003). Odds ratio indicated that female respondents were 1.6 times more likely to be adherent, compared with males. Similarly, every unit rise in spirituality score yielded a 1.3 times increased likelihood of adherence to HAART on multiple logistic regression of adherence to HAART with relevant predictors. Both spirituality and positive religious coping have positive influence on optimal adherence. Therefore, the training of health care personnel to assess and provide spiritual care and involvement of chaplains/religious leaders is advocated for improved adherence.
10.18639/RABM.2017.03.455029
Diabetes
Jun 26, 2017
The amount of glycosylated hemoglobin (HbA1c) reflects the long-term glycemic control of patients with diabetes. HbA1c also predicts the risk for the development of diabetic complications such as cardiovascular disease (CVD). Patients with type-2 diabetes and the characteristic of dyslipidemia are frequently found. Also, dyslipidemia plays as an independent risk factor for CVD. This study was aimed to evaluate the relationship between glycemic control status with serum individual lipid profiles and lipid ratios in patients with type-2 diabetes. This cross-sectional study consisted of 80 patients. Depending on the HbA1c level, the patients were divided into two groups, good glycemic control group (HbA1c 7.0%, n 5 15) and poor glycemic control group (HbA1c 7.0%, n 5 65). The association of HbA1c with individual lipids (TC, TG, HDL-C, LDL-C, Non- HDL-C) and lipid ratios (TC/HDL-C, TG/HDL-C, LDL-C/HDL-C, monocyte/HDL-C) were analyzed. The value of individual lipids and lipid ratios did not correlate with HbA1c level (p-value 0.05). Parameters of individual lipids and lipid ratios were not independently associated with poor glycemic control, which was analyzed by logistic regression. ROC analysis found both LDL-C and LDL-C/HDL-C were not accurate to be used as a prognostic indicator of poor glycemic control in patients with type-2 diabetes (p 5 0.155, p 5 0.297, respectively). The present study found that there was no association between individual lipids and lipid ratios with glycemic control status.
10.18639/RABM.2017.03.454939
Case Report
Jun 15, 2017
Threadlike filarial nematodes have been identified as the causative agent of filariasis. Cutaneous filariasis is caused primarily by Loa loa, Onchocerca volvulus, and Mansonella streptocerca. These parasites occupy the subcutaneous layer of the skin. However, other filarial parasites are usually associated with varying degrees of dermatological manifestations. In the present discourse, two cases of cutaneous filariasis were diagnosed in two female patients (21 and 40 years old, respectively) in Remitch Clinic and Maternity located in a nonriverine community in Ekpoma, Edo State, Nigeria. In this report, patients with body mass index (BMI) of 18.97 and 23.45 kg/m2, respectively, presented on two different occasions at least 6 months apart with hyperpigmented skin lesions in the upper and lower limbs, respectively. There was associated intense pruritus with no evidence of lymphadenopathy and lymphoedema. Following laboratory confirmation of filariasis, the patients were placed on a single oral dose combination of albendazole (400 mg) 1 ivermectin (200 mcg/kg), while oral doses of loratadine 10 mg were administered daily for 5 days. Patients were carefully followed up for 6 weeks during which recession of the lesion and untoward reactions were monitored. It was observed that within 6 weeks of treatment, there was a dramatic recession of skin lesion. Adverse effect reported from use of the combination was mild. This case report revealed that cutaneous filariasis is not an uncommon presentation of filariasis infestation in Nigeria. The report also validates the safety and efficacy of the combination in the management of cutaneous manifestation of the disease.
