Annals of African Medicine
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   Table of Contents - Current issue
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April-June 2020
Volume 19 | Issue 2
Page Nos. 75-152

Online since Wednesday, June 3, 2020

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REVIEW ARTICLE  

The millennial generation plastic surgery trainees in sub-Saharan Africa and social media: A review of the application of blogs, podcasts, and twitter as web-based learning tools Highly accessed article p. 75
Abdulrasheed Ibrahim, Lawal M Abubakar, Daniel J Maina, Wasiu O Adebayo, Abdullatif M Kabir, Malachy E Asuku
DOI:10.4103/aam.aam_25_17  PMID:32499462
The delivery of education and training in plastic surgery in Sub-Saharan Africa face increasing challenges. These include endemic shortages of plastic surgeons within postgraduate medical school faculties, the erosion of financial and clinical resources for teaching, and more recently, the millennial generation paradigm shift. It is generally accepted that the millennial generation will be more discerning and comfortable in their requirements for web-based learning content to support their education and training in plastic surgery. We reviewed current literature including original and review articles obtained through a search of PubMed database, Medline, Google Scholar, and hand searching of bibliographies of published articles using the keywords: social media, Blogs, Twitter, plastic surgery, and millennial generation. This article defines and explores Blogs, Podcasts, and Twitter, as web-based learning tools, and discusses how to leverage social media to maximize their educational value and effectiveness.
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ORIGINAL ARTICLES Top

Determinants of occupational health hazards among roadside automobile mechanics in Sokoto Metropolis, Nigeria Highly accessed article p. 80
Oche Mansur Oche, Okafoagu Christina Nneka, Oladigbolu Remi Abiola, Ismail Raji, Ango Timane Jessica, Hashimu Abdulmumini Bala, Ijapa Adamu
DOI:10.4103/aam.aam_50_18  PMID:32499463
Background: Roadside automobile mechanics are in the course of their work exposed to several hazards that put them at risk of severe debilitating health challenges. This group of workers, however, is reported not to know much about such hazards and to have little or no training on workplace safety. Aim: The study aimed to identify the determinants of occupational health hazards among roadside automobile mechanics in Sokoto Metropolis. Methodology: This was a descriptive, cross-sectional study, and using a two-stage sampling technique, a total of 205 roadside mechanics were recruited for the study. A semi-structured interviewer-administered questionnaire was used, and the data were imputed into and analyzed using IBM SPSS. Results: The mean age of the respondents was 31.10 ± 10.19 years, and over one-third of them (38.1%) were general vehicle repairers. Majority of the respondents had good knowledge of and attitude toward workplace hazards. However, a good proportion (91.0%) of the mechanics felt that their occupation was a risky one and 80.1% ate and 86.1% drank while working. Type of training and job description were the predictors of knowledge of workplace hazards. Job description was the only predictor of attitude. Burns, bruises, headache/dizziness, and cuts were the most reported work-related illnesses and injuries. Conclusion: Although most of the auto-mechanics were aware and had good knowledge of workplace hazards, they did not adhere to safety practices in the workplace, mostly due to nonavailability of protective apparels. There is, therefore, need for continuous health education under the platform of the auto-mechanics association so that they can voluntarily adopt safety practices in their workplace.
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Biochemical pattern of thyroid function test and clinical impression of thyroid disorder in a rural tertiary health institution in Nigeria p. 89
Ahmed Kayode Jimoh, Muritala Segun Ghazal, Adewoyin Babajide Adeleke, Adebayo Augustine Adeniyi, Idowu Oluseyi Adebara, Fatai Olakunle Babalola, Gbadebo Oladimeji Ajani, Matthew Segun Agboola, Olusegun Adesola Busari
DOI:10.4103/aam.aam_31_19  PMID:32499464
Background: Thyroid disorders are one of the most common endocrine disorders seen globally. Diagnostic challenge may arise both clinically and biochemically because of the multiple function of thyroid hormones (THs). Request for thyroid function test (TFT s) may be based on clinical impression that may suggest thyroid dysfunction or obvious symptoms and signs that are diagnostic of hyperthyroidism or hypothyroidism. Materials and Methods: This retrospective study looks at the biochemical patterns of TFTs and the clinical impression of thyroid disorders in a rural tertiary institution. Information extracted from the laboratory register includes indication for the test, the hospital number, the gender, the age, and the THs assayed. The corresponding biochemical pattern of the TFT result was established. Results: A total of 297 requests were submitted for TH assay; 34 were excluded from the present study because there were no clinical information. There were 239 females and 24 males giving a female-to-male ratio of 9.9:1. Majority of the requests (36.5%) were for goiters, followed by gynecological disorders (20.9%) and clinical thyroid disorders (17.9%). About 46% (45.8%) of the goiter cases were biochemically euthyroid, whereas 13.5% were biochemically primary hyperthyroid. Among the 47 cases of thyroid disorders by the physician's clinical impression, 27.7% were euthyroid, 17% were biochemically hyperthyroid, and 10.6% were hypothyroid. Of the 55 gynecological disorders assessed, only 7.3% show biochemical evidence of TH alteration with 56.4% being euthyroid. About 47% (46.6%) of those that did routine medical examination had altered TH level that includes hyperthyroidism and hypothyroidism. Conclusion: Goiter is the most prevalent thyroid disorder in this environment. Biochemical pattern of thyroid function test in our environment was mostly euthyroid despites clinical features suggestive of thyroid disorders.
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Role of serum ferritin as a prognostic marker in acute ischemic stroke: A preliminary observation p. 95
Ravinder Garg, S Aravind, Sarabjot Kaur, Sumit Pal Singh Chawla, Simmi Aggarwal, Gitanjali Goyal
DOI:10.4103/aam.aam_35_19  PMID:32499465
Background: Acute ischemic stroke is an important cause of morbidity and mortality. Search has been on to find out the factors which can help in formulating the prognosis of acute ischemic stroke. One of the prognostic indicators, which has gained great clinical interest in recent times, is serum ferritin. Aims: To assess the serum ferritin levels in patients with acute ischemic stroke and to study the role of serum ferritin as a prognostic marker in these patients. Materials and Methods: This prospective, observational study was conducted on 50 patients of acute ischemic stroke aged ≥18 years who presented within 48 hours of onset of symptoms. Clinical severity of stroke was assessed at admission and on the 6th day using Canadian Stroke Scale (CSS), and serum ferritin levels were measured at admission and on the 6th day in all these subjects. Results: The mean serum ferritin levels at admission in patients with “more severe stroke” (CSS score at admission ≤7) and “less severe stroke” (CSS score at admission >7) were 282.77 ± 120.53 and 205.12 ± 110.96 ng/mL, respectively. The mean serum ferritin levels at admission were 173.71 ± 109.69 ng/mL in subjects who did not deteriorate and 336.86 ± 57.28 ng/mL in those who deteriorated, while the mean serum ferritin levels on the 6th day were 193.29 ± 101.88 and 343.95 ± 52.34 ng/mL in subjects who did not deteriorate and those who deteriorated, respectively. Conclusions: Serum ferritin has a significant positive correlation with the severity of acute ischemic stroke (P < 0.001), and the levels correlate with the outcome of the disease (P < 0.001); the patients with higher serum ferritin at admission tend to deteriorate more as compared to those with lower levels. Thus, serum ferritin can be used as a prognostic marker in acute ischemic stroke.
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The efficacy of two doses versus 7 days' course of prophylactic antibiotics following cesarean section: An experience from Aminu Kano Teaching Hospital p. 103
Salihu Ozegya Mohammed, Samaila Danjuma A Shuaibu, Sule Abdullahi Gaya, Ayyuba Rabiu
DOI:10.4103/aam.aam_39_19  PMID:32499466
Background: Postcesarean wound infection is a leading cause of prolonged hospital stay. Considerable debates still exist regarding choice of antibiotics, dose, and duration of use. Objectives: The objective is to compare the efficacy of 2 doses of amoxicillin-clavulanic acid versus a 7 days combination of amoxicillin-clavulanic acid and metronidazole as prophylactic antibiotics following cesarean section (CS). Methodology: It was a randomized controlled trial that was conducted among 160 women undergoing CS at Aminu Kano Teaching Hospital. Women were randomized into two groups. Group I (study group) received 2 doses of 1.2 g amoxicillin-clavulanic acid. Group II (control group) received a 7 days course of amoxicillin-clavulanic acid and metronidazole. The data obtained were analyzed using SPSS version 17. Categorical (qualitative) variables were analyzed using Chi-square test and Fisher's exact test as appropriate while continuous (quantitative) variables were analyzed using independent sample t-test. P < 0.05 was considered statistically significant. Results: There was no statistically significant association in the occurrence of fever (12.8% vs. 15.8%, P = 0.6), wound infection (6.4% vs. 10.5%, P = 0.36), endometritis (7.7% vs. 11.8%, P = 0.38), UTI (6.4% vs. 5.3%, P = 1.00), mean duration of hospital stay (129.7 vs. 134.2 h, P = 0.48), and neonatal outcomes between the two groups. There was statistically significant difference in the mean cost of antibiotics (₦2883/US$9.5 vs. ₦7040/US$23.1, P < 0.001) and maternal side effects (10.3% vs. 26.3%, P < 0.001) between the study and the control groups, respectively. Conclusion: This study found no statistically significant difference in infectious morbidity, duration of hospital stay, and neonatal outcomes when two doses of amoxicillin-clavulanic acid was compared with a 7 days course of prophylactic antibiotic following CS. The use of two doses of amoxicillin-clavulanic acid has the advantages of reduced cost and some maternal side effects. The two doses were cheaper with minimal side effects.
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Association between maternal serum homocysteine concentrations in early pregnancy and adverse pregnancy outcomes p. 113
Chidinma Magnus Nwogu, Kehinde Sharafadeen Okunade, Muisi A Adenekan, Adebayo Isaiah Sekumade, Sarah John-olabode, Ayodeji Ayotunde Oluwole
DOI:10.4103/aam.aam_41_19  PMID:32499467
Background: There is still conflicting evidence on the extent to which maternal hyperhomocysteinemia is a risk factor for pregnancy complications. Aims: The study aimed to investigate the impact of elevated maternal homocysteine concentrations on adverse pregnancy outcomes among Nigerian women in Lagos. Materials and Methods: This was a prospective cohort study conducted at the Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria. Participants were enrolled during the first trimester of pregnancy following which relevant data were obtained by the interview. Fasting blood samples were collected for the measurement of maternal homocysteine concentration using the enzyme-linked immunosorbent assay method. Pregnancy outcomes and complications were obtained by abstracting the antenatal, delivery, and newborn medical records. Preterm births, low-birth weight (LBW), and antepartum fetal death were used as confirmatory outcome variables in the final analysis. Descriptive statistics for all data were computed using SPSS version 22.0. The associations between the variables were tested and multivariate analyses were used to study the effects of the major baseline characteristics on the pregnancy outcome. P < 0.05 was considered statistically significant. Results: Hyperhomocysteinemia was recorded in 41 (24.6%) patients. Women with a high homocysteine concentration and those with a normal homocysteine level did not differ significantly in terms of age (P = 0.684), level of education (P = 0.866), and parity (P = 0.647). Women with hyperhomocysteinemia had an approximately twelve-fold higher risk of preterm birth (P = 0.001) and a ten-fold higher risk of delivering a term neonate with LBW (P = 0.004), but had no risk of antepartum fetal death (P = 0.118) compared to women with a normal homocysteine concentration. Conclusions: The prevalence of hyperhomocysteinemia among mothers in Lagos was relatively low. The associations between hyperhomocysteinemia and adverse pregnancy outcomes could have implications in future for the prevention of these adverse outcomes.
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Pattern of corneal disorders in Ekiti: A tertiary eye center experience p. 119
Iyiade Adeseye Ajayi, Olusola Joseph Omotoye, Kayode Olumide Ajite
DOI:10.4103/aam.aam_45_19  PMID:32499468
Purpose: The cornea is the most significant refractive medium in the eye. Pathologies affecting the cornea usually have a great impact on vision. The etiology of corneal disorder varies from one geographical location to another. The objective of this study was to determine the pattern of corneal disorders at Ekiti State University Teaching Hospital, Ado-Ekiti. Materials and Methods: A retrospective study of case records of patients with cornea disorders over a 5-year period was carried out. Demographic characteristics, presenting visual acuity, and risk factor for cornea disorders were retrieved. Data were entered into the Statistical Package for the Social Sciences version 20, and statistical significance was inferred at P < 0.05. Results: Corneal disorders accounted for 3.3% of the eye disorders seen during the period of study. The median age was 37 years. Males outnumbered females giving a ratio of 1.9:1 and the age range from 0.25 to 92 years. There were more females than males in the 11–20 years' age group. Students (84, 25.4%) and artisans (62, 18.8%) were the two leading occupational groups. Infectious cases constituted 27.2% of the cases. Visual acuity at presentation was <3/60 in 131 (39.7%) cases. Foreign body entry was the leading etiologic agent in 101 (30.6%) cases. Conclusion: Half of the patients were blind at presentation, and many of them presented after more than 1 week of the onset of symptoms. Corneal foreign body, trauma, and vernal keratoconjunctivitis were the leading known predisposing factors. There will be need to emphasize more on the role of protective eye devices among our people, especially those who engage in outdoor activities.
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A preprogram appraisal of factors influencing research productivity among faculty at college of medicine, University of Lagos p. 124
Folasade Tolulope Ogunsola, Oluwakemi Ololade Odukoya, Bolanle Banigbe, Sikeade Olawumi Caleb-Adepoju, Olalekan Folarin, Bosede Bukola Afolabi, Njideka Ulunma Okubadejo, Wasiu Lanre Adeyemo, Alani Sulaimon Akanmu, Akinniyi Osuntoki, Prosper Okonkwo, Robert Murphy, Phyllis Kanki
DOI:10.4103/aam.aam_54_19  PMID:32499469
Background: A defining feature of any university is its dedication to scholarly activities, leading to the generation of knowledge and ideas Research productivity is a measure of achievement of a scholar. The number of research publications in peer-reviewed journals is an important criterion for assessing productivity and prestige in the academia. Aims and Objectives: This cross-sectional descriptive study assessed the level of research productivity (RP) among junior faculty at the College of Medicine, University of Lagos, and investigated factors affecting their research output prior to the implementation of a 5-year training grant funded by the National Institutes of Health. Methods: Seventy junior faculty members attended a pre-program training, and the self-reported number of peer-reviewed publications (PRPs) was used as an indicator. Intrinsic and extrinsic factors influencing RP among the attendees were assessed and ranked. Results: The majority (42/70, 60%) of the respondents had <10 PRPs. The median (interquartile range) number of PRPs was 7 (3–18). A desire for the development of their personal skills, contribution to society, and personal research interests topped the list of intrinsic factors influencing RP. Work flexibility, research autonomy, and scholarly pursuits were the bottom three. A desire for promotion, respect from peers, and increased social standing were the top three extrinsic factors, while monetary incentives, employment opportunities, and the need to attend conferences were the lowest three. The top barriers to RP were lack of resources and lack of mentoring. Perceived older age, lack of time, and motivation were the lowest three barriers. Older age and professional cadre were associated with increased RP (P < 0.05). Conclusion: Among the participants, research output appears to be motivated primarily by a desire for personal development,promotion, and respect from peers. Lack of access to resources was the main barrier to increased RP. These factors may need to be considered when developing programs designed to promote RP.
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Evaluation of prescription pattern of analgesic use among ambulatory elderly in South-Western Nigeria p. 131
Wuraola Akande-Sholabi, Princess C Agha, Olufemi O Olowookere, Lawrence A Adebusoye
DOI:10.4103/aam.aam_57_19  PMID:32499470
Background: Inappropriate prescribing of analgesics has a global impact on the health of elderly patients and the society. Empirical evidence on the prescription of analgesics among elderly Nigerians is scarce. Objectives: The objective of the study was to evaluate the prescription pattern of analgesics and describe the co-prescribing of gastroprotective agents with non-steroidal anti-inflammatory drugs (NSAIDs) among elderly patients at the geriatric center, University College Hospital, Ibadan. Methods: A retrospective cross-sectional, hospital-based study was carried out among elderly patients (≥60 years) who were prescribed analgesics. Using a data extraction sheet, information on demographic characteristics, drug utilization pattern, and morbidities was obtained from patients' case files via electronic health records. Results: A total of 337 patients case files were reviewed, the mean age was 72 ± 8.8 years, and 210 (62.3%) were females. There were a total of 2074 medications prescribed, with 733 (35.3%) being analgesics. Majority of the elderly patients (259, 76.9%) were on nonopioids, with 252 (74.8%) on NSAIDs. Paracetamol was the most commonly prescribed analgesics (181, 24.6%), followed by diclofenac/misoprostol (177, 24.1%), opioid analgesic prescribed was 88 (12.0%), with paracetamol/codeine 58 (65.9%), and tramadol 16 (18.2%) being the most prescribed opioid. A significant proportion of the hypertensive elderly patients (160, 78.8%; P < 0.036) were on NSAIDs. The oral route of administration (302, 89.6%) was the most common route of administration. Majority (310, 92%) of elderly patients taking NSAIDs had a co-prescription for gastroprotective agents. Conclusions: Majority of hypertensive patients were on NSAIDs. This calls for prompt awareness of rational analgesic use among the elderly to improve management and their survival.
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The effect of combination of warm intravenous fluid infusion and forced air warming versus forced air warming alone on maternal temperature and shivering during cesarian delivery under spinal anesthesia p. 137
VS Meghana, Sunil Baikadi Vasudevarao, Shaila S Kamath
DOI:10.4103/aam.aam_58_19  PMID:32499471
Objective: Administration of warm intravenous (IV) fluid infusion and use of forced air warmers is the most easy and physiologically viable method for maintaining normothermia during surgery and postsurgical periods This study was conducted to assess the effect of combination of active warming (AW) methods namely warm IV fluid infusion and forced air warming versus forced air warming only (WA) on maternal temperature during elective C-delivery under spinal anesthesia. Materials and Methods: A total of 100 patients scheduled for elective c-section were grouped into those who received both warmed IV fluid infusion and forced air warmer (Combination of active warming WI= 50) and those who received only forced air warmer (WA = 50). Core body temperature and shivering incidence were recorded using a tympanic thermometer from prespinal till the end of surgery every 10 min and in postanesthesia care unit (PACU) at 0, 15, and 30 min. Results: Core temperature showed statistically significant difference in 15, 35, 45, and 55 min between air warmer and warm infusion groups and in PACU at 0, 15, and 30 min, it was statistically significant (P = 0.000) among WI group (mean temperature = 36.79°C) when compared to WA group (mean temperature = 35.96°C). There was a lower incidence of shivering in WI compared to WA group, which is statistically significant. Conclusion: Combination of warm Intravenous fluid infusion and Forced air warming is better than forced air warming alone. In maintaining near normal maternal core body temperature during elective cesarean section following spinal anesthesia. Combined warming method also reduces shivering incidence.
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CASE REPORTS Top

Solitary fibrous tumour of cervical spinal cord p. 144
Mallikarjuna Rao Koduru, Sandeep Ail, Jayarama Shetty, Vijith Shetty
DOI:10.4103/aam.aam_33_19  PMID:32499472
Solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms of fibroblastic origin. They commonly arise from visceral pleura, but also arise from nonserosal sites such as meninges, central nervous system parenchyma, and spinal cord. In the spinal cord, SFTs commonly arise from the thoracic spinal cord, followed by cervical spinal cord, lumbar spinal cord, and sacrum. Histologically, SFTs can be similar to hemangiopericytoma, schwannoma, fibrous meningioma, fibroma, gliofibroma, and ependymoma. Immunohistochemistry (IHC) plays an important role in differentiating SFTs from other identical tumors. Here, we report a rare case of SFT of the cervical spinal cord, which was initially reported as hemangiopericytoma, and the diagnosis of SFT was confirmed by IHC.
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Hypokalemic paralysis as an initial presentation of Sjogren syndrome p. 147
Durga Shankar Meena, Deepak Kumar, Gopal Krishana Bohra, Sunil Kumar Bhambu
DOI:10.4103/aam.aam_34_19  PMID:32499473
Sjogren syndrome (SS) is a systemic autoimmune disorder with predominant exocrine gland involvement leading to sicca symptoms. Among extraglandular manifestations, renal disease is the most common. Tubular interstitial nephritis and renal tubular acidosis (RTA) are the common presentations. Mild hypokalemia associated with distal RTA is common in SS, however, severe hypokalemia causing paralysis is unusual. We report the case of a 26-year-old female who presented with hypokalemic paralysis. On evaluation, distal RTA was diagnosed. Further evaluation showed positive SS-a/SS-b antibodies in high titer, which confirms the diagnosis of primary SS. Our report illustrates that SS is a rare but important cause of hypokalemic paralysis.
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Eruptive neurofibromas in pregnancy p. 150
Husain Yahya, Hadiza Sani
DOI:10.4103/aam.aam_37_19  PMID:32499474
Neurofibromatosis type 1 is the most common inherited nervous system disorder affecting 1 in 3500 live births. Cutaneous neurofibromas, the most characteristic feature of the disease, begin to appear in adolescence and continue throughout adulthood. Although neurofibromas have been noted to increase in size or number during pregnancy, there have been very few reports of eruption of a large number of lesions during this period. We report a case of a 24-year-old Nigerian woman of 32-week gestation who presented with a history of sudden eruption of neurofibromas during the current pregnancy and the previous one 3 years earlier. We discuss how hormones and growth factors contribute to the increase in numbers of neurofibromas during pregnancy, which is occasionally severe, as in our case, and the complications which may arise in the mother and fetus.
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