Annals of African Medicine
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   2015| October-December  | Volume 14 | Issue 4  
    Online since October 16, 2015

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Is Helicobacter pylori infection a risk factor for idiopathic thrombocytopenic purpura in children?
Alireza Abdollahi, Saeed Shoar, Shadi Ghasemi, Oloomi-Yazdi Zohreh
October-December 2015, 14(4):177-181
DOI:10.4103/1596-3519.153357  PMID:26470742
Background: Idiopathic thrombocytopenic purpura (ITP) is an autoimmune bleeding disorder, which occurs as a result of autoantibodies attachment to the platelets surface and subsequent destruction. Several organisms can mimic features of human antigens (Ags) and induce autoantibody production. One of these organisms is Helicobacter pylori (HP). We assessed the prevalence and relationship of HP infection with ITP in a population of children. Materials and Methods: One hundred and six children younger than 18 years old were enrolled in this case-control study in which 42 children with ITP were in the case group and 64 healthy children were in the control group. Stool exam for detection of HP-Ag were performed and the variables were compared between the two groups. Results: Mean ± standard deviation age of case and control group was 6.4 ± 3.4 and 8.6 ± 4.4 years old, respectively. HP stool Ag differ significantly between the case and the control groups (P < 0.05). Conclusion: Our results support the role of HP in ITP of children, and urea breath test or Ag detection of HP in stool of these patients is recommended.
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QTCinterval prolongation in HIV-negative versus HIV-positive subjects with or without antiretroviral drugs
Olarinde Jeffrey Ogunmola, Yusuf O Oladosu, Michael A Olamoyegun
October-December 2015, 14(4):169-176
DOI:10.4103/1596-3519.152072  PMID:26470741
Background: QTc interval prolongation signifies an increased risk of life-threatening arrhythmia and sudden cardiac death. Cardiac manifestations of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome have become increasingly important causes of morbidity and mortality. We investigated HIV-positive patients to determine the effects of HIV infection, antiretroviral drugs, and identifiable confounders on QTc prolongation. Materials and Methods: A case-control study was conducted in a rural tertiary health center in Nigeria. Data collected included demographic variables, body mass index, blood pressure, HIV status, antiretroviral treatment (ART), duration of HIV infection and treatment, CD4 T-lymphocyte count, heart rate (HR), and QT interval. QT was corrected for HR using Bazett's formula. Results: The sample frame comprised 89 (42.4%) HIV-negative subjects (39.3% male, 60.7% female; mean age, 36.28 ± 7.03 years); 45 (21.4%) HIV-positive, ART-naïve patients (31.1% male, 68.9% female; mean age, 36.48 ± 9.12 years); and 76 (36.2%) HIV-positive patients on ART (27.6% male, 72.4% female; mean age, 39.00 ± 7.68 years). The QTc interval and resting HR were higher in HIV-positive, drug-naïve patients than in the other two groups (P < 0.001). Female sex was associated with prolonged QTc intervals in all groups. Conclusion: HIV-positive patients may be at higher risk of sudden cardiac death due to fatal arrhythmia secondary to QTc interval-related cardiac events. Healthcare providers should be aware that a prolonged QTc interval is a potential indicator of increased cardiovascular risk and should exercise caution in prescribing potentially QT-prolonging medications to HIV-positive patients.
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The relationship between self-monitoring of blood glucose and glycaemic control among patients attending an urban diabetes clinic in Nigeria
Sandra Omozehio Iwuala, Michae Adeyemi Olamoyegun, Anas Ahmad Sabir, Olufemi Adetola Fasanmade
October-December 2015, 14(4):182-187
DOI:10.4103/1596-3519.155992  PMID:26470743
Background/Objective: Self-monitoring of blood glucose (SMBG) is a component of modern diabetes mellitus (DM) self-management. Its value is discussed controversially, and its impact in resource poor settings has been infrequently studied. The aim of this report is to determine the pattern of SMBG and its relationship with glycemic control amongst type 2 DM (T2DM) patients attending an urban DM clinic in Lagos, Nigeria. Methods: Data were collected from patients with T2DM in a cross-sectional study, using systematic random sampling, with an interviewer-administered questionnaire investigating demographic data, DM history and SMBG practice. Weight, height, fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) were measured. Results: One hundred patients were studied consisted of 62 (62%) females and 38 (38%) males. The mean age, body mass index and HbA1c of the study population were 59.9 (9.5) years, 26.2 (5.6) kg/m2 and 7.9 (2.2%). The median (interquartile range [IQR]) FPG and duration of DM were 107.0 (82.0–142.0) and 8.5 (5.0–15.0) years respectively. SMBG was practiced by 40 (40.0%) patients with a median (IQR) of 6 (4–15) times/month. SMBG was performed more frequently by persons with tertiary level of education (P = 0.04) and DM duration ≥8.5 years (P = 0.04). The mean HbA1c in the group who practiced SMBG was lower though not statistically significant compared to the group that did not (7.8% vs. 8.0%, P = 0.61) practiced. The Spearman's rank correlation coefficient between the frequency of SMBG and HbA1c was −0.025, and P = 0.81 among the entire T2DM patients. Conclusion: There was no statistically significant relationship between SMBG and glycemic control. There is a need for larger studies to be carried out in order to justify the value of SMBG in resource poor settings.
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Oral diseases and diabetes: Nigerian medical and dental caregivers' perspective
Matthew A Sede, Adebola O Ehizele
October-December 2015, 14(4):193-199
DOI:10.4103/1596-3519.158525  PMID:26470745
Objectives: The objective was to determine the knowledge of medical and dental caregivers regarding the link between oral diseases and diabetes mellitus (DM); and their role in the management of the oral complications of DM. Materials and Methods: This comparative study was carried out among a group (n = 100) of resident doctors undergoing postgraduate training in medicine and dentistry at a Nigerian Teaching Hospital. A 28-item self-administered questionnaire was used for data collection and it elicited information on respondents' demographics, practice behaviors, knowledge about link between oral diseases, and DM, as well as their knowledge about oral complications of DM. Results: Majority of the dental senior residents (83.3%) had adequate knowledge of the oral manifestation of DM and the link between oral disease and DM while only 43.8% of the medical junior residents had adequate knowledge (P = 0.060). Majority (63.0%) who strongly agreed that physicians need to collaborate with dental professionals to reduce DM patients' risk of developing oral diseases belonged to the dental group (P = 0.040) and only 35.3% of medical group strongly agreed that physicians should be taught how to screen for oral disease in DM patients (P = 0.009). A vast majority (89.6%) of the medical group however felt that they needed additional information about the link between oral disease and DM (P = 0.036). Conclusion: The findings indicate that there is still a major gap in knowledge of the link between oral diseases and DM; as well as a poor appreciation of the need for a collaborative management of DM patients by medical and dental practitioners.
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Relative expression of α-smooth muscle actin and matrix metalloproteinases-2 in ameloblastoma of a black African sub-population
Akinyele O Adisa, Samuel E Udeabor, Bukola F Adeyemi, Kubesch Alica, Patrick Booms, Shahram Ghanaati, Robert A Sader
October-December 2015, 14(4):188-192
DOI:10.4103/1596-3519.152075  PMID:26470744
Background: Ameloblastoma although a benign odontogenic tumor, is locally invasive. The abundant presence of myofibroblasts (marked by α-smooth muscle actin [α-SMA]) in the stroma and expression of matrix metalloproteinase-2 (MMP-2) in the neoplastic or stromal cells have been linked with the tumor's ability for both local and distant spread. We aim to estimate the relative expression of α-SMA and MMP-2 in ameloblastoma from a black African subgroup to gauge their relative potential for enhancing local invasiveness and hence, their prospects as possible chemotherapeutic targets. Materials and Methods: Twenty-five formalin-fixed paraffin-embedded blocks of ameloblastoma cases from Nigeria were prepared for antibody processing to α-SMA (Dako Monoclonal Mouse Anti-Human α-SMA antibody clone 1A4) and MMP-2 (Abcam Mouse Monoclonal Anti-MMP-2 antibody [CA-4001/CA719E3C] ab3158). The score for percentage positivity of the tumor cells and the score for staining intensities were then multiplied in order to generate an immunoreactive score. Results: α-smooth muscle actin was only expressed in the fibrous connective tissues adjacent to the tumor islands while MMP-2 was expressed in the ameloblasts, stellate reticulum, and the connective tissues in varying proportions. All the variants analyzed expressed α-SMA mildly or moderately, except for the follicular variant that either did not express α-SMA or expressed it mildly. The highest number of strong immunoreactivity to MMP-2 in the ameloblast region was found in the plexiform variant. Conclusion: Chemotherapeutic targeting of both molecules may, therefore, be a vital step in the control of local ameloblastoma invasiveness.
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Central serous chorioretinopathy in Benin City, Nigeria
Odarosa Magdiel Uhumwangho, Rita Omoso Momoh
October-December 2015, 14(4):163-168
DOI:10.4103/1596-3519.158522  PMID:26470740
Background: Central serous chorioretinopathy (CSCR) is a retinal cause of visual loss. The aim of this report is to describe the pattern of presentation of CSCR in patients presenting to a tertiary hospital in Nigeria within a specified period. Materials and Methods: The case folders of all patients in which a diagnosis of central serous retinopathy (CSR) was made from January 1, 2012 to December 31, 2014 were retrieved, data extracted and reviewed. Results: There were a total of five patients within the study period made of four males and one female. There were two cases of bilateral CSCR and three cases of unilateral CSCR. There was a positive history of underlying anxiety or stress related conditions in all the patients. One patient with bilateral CSCR was on systemic prednisolone for arthritis. Confirmatory investigations were performed in all patients. Four patients had fundus fluorescein angiography which showed smoke stack and ink blot patterns in two patients, respectively. Two patients had optical coherence tomography showing macular neurosensory detachment, with one having associated pigment epithelial detachment. Vision improved in all patients with conservative management, reduction in anxiety/stress related activities and steroid use discontinuation in the patient with chronic steroid use. Conclusion: CSR has a favorable outcome with appropriate intervention.
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Insights from the Ebola virus disease outbreak
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
October-December 2015, 14(4):200-201
DOI:10.4103/1596-3519.150098  PMID:26470746
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