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   2019| April-June  | Volume 18 | Issue 2  
    Online since May 8, 2019

 
 
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ORIGINAL ARTICLES
A comparative study of the efficacy of intravenous benzylpenicillin and intravenous augmentin in the empirical management of Ludwig's angina
Matthew Owusu Boamah, Birch Dauda Saheeb, Grace E Parkins, Isaac Nuamah, Tom Akuetteh Ndanu, Paa-Kwesi Blankson
April-June 2019, 18(2):65-69
DOI:10.4103/aam.aam_22_18  PMID:31070146
Background: Ludwig's angina is a potentially life-threatening condition characterized by bilateral cellulitis of the submandibular, submental, and sublingual spaces. Intravenous (I.V) penicillin G or amoxicillin-clavulanate (Augmentin) has been recommended for use as empirical management before obtaining culture and sensitivity results. Aim: The aim of this study was to compare the therapeutic efficacies and clinical outcomes of I.V benzylpenicillin with I.V Augmentin in the empirical management of Ludwig's angina. Methods: This was a prospective randomized clinical study carried out to measure the rate of swelling reduction (using the lobar rate, Adam's rate, and interincisal distance) and other clinical parameters among the two drug groups (I.V penicillin G and Augmentin). Descriptive summaries of variables were generated, and Student's t-test was used to compare the mean outcomes of the two groups. Results: A total of 26 individuals participated in the study, consisting of 46% (12) males and 54% (14) females. The participants ranged from 13 to 61 years with mean and median of 34.4 (±12.7) and 35 years, respectively. Only 8% of the cases of Ludwig's angina were not attributable to odontogenic factors, compared to 92% resulting from odontogenic causes. There was no significant difference in the efficacy of the two antibiotics used in this study. Conclusion: The efficacies and the clinical outcomes of the two antibiotics were similar. Benzylpenicillin is probably a suitable empirical alternative where Augmentin cannot be afforded, to reduce the mortality associated with the condition.
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CASE REPORTS
Successful pregnancy following acquired gynatresia
Amina Gambo Umar, Yakubu Ahmed, Jamila Abubakar Garba, Abdullahi Umar Adoke, Abdulhadi Diyo Saidu, Mairo Hassan
April-June 2019, 18(2):108-110
DOI:10.4103/aam.aam_12_18  PMID:31070154
Acquired gynatresia is a common gynecological condition in developing countries where puerperal complications and unskilled interventions prevail. A 23-year-old primipara who had spontaneous vaginal delivery complicated by gynatresia had vaginoplasty that failed due to erectile dysfunction in the spouse. She subsequently developed secondary amenorrhea and was relieved with dilatation and evacuation. She was planned for definitive surgery, however,she incidentally conceived with q pin-hole vagina. She was delivered of a live fetus at term via an elective cesarean section. This case is peculiar as spontaneous conception occurred with a pinhole opening. There is a need to adequately evaluate cases before definitive management to maximize success.
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ORIGINAL ARTICLES
Serum levels of single-carbon metabolism vitamins and homocysteine in head-and-neck squamous cell carcinoma: Preliminary report
Victor Ifeolu Akinmoladun, Olatubosun Ganiyu Arinola
April-June 2019, 18(2):60-64
DOI:10.4103/aam.aam_18_18  PMID:31070145
Background: Head-and-neck carcinomas are a heterogeneous group of malignancies arising from the upper aerodigestive tract. Tobacco and alcohol are the leading etiological factors; however, bioactive food components, including those that modulate DNA methylation, are being linked to susceptibility. This work assesses the distribution of head-and-neck cancers presenting at a tertiary health institution and determined the serum level of the vitamins and an amino acid involved in the methionine cycle, in view of increasing acceptance of the significant role of DNA methylation in the pathogenesis of cancers. Patients and Methods: This study involved 30 newly diagnosed cases of head-and-neck squamous cell carcinoma. Thirty apparently healthy volunteers served as controls. The test cases were made up of 19 males and 11 females while controls were made up of 14 males and 16 females. The median ages of the test cases and controls were 59 and 63 years, respectively. Sera obtained from participants' blood were analyzed by high-performance liquid chromatography technique. The study protocol was approved by the joint University of Ibadan/University College Hospital Institution Review Board. Results: There is a male dominance in the number of cases at male-to-female ratio of 1.7: 1. The oral cavity was the most-affected site. Serum levels of Vitamin B2, B6, B12, and homocysteine were lower in cases compared with controls but not significantly so. However, serum Vitamin A and folic acid levels were significantly lower among the cases ([0.62 vs. 0.71, z = −2.50, P = 0.02], [26.05 vs. 30.82, z = 0.20, P = 0.00]) compared with controls. Only tobacco and alcohol use showed a significant association with head-and-neck cancer, but not family history of cancer or alcohol use alone (P = 0.00). Conclusion: Significantly low serum Vitamin A and hypofolataemia are associated with head-and-neck squamous cell carcinoma. This is suggestive of a role for these vitamins in the etiopathogenesis of the disease.
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Relative frequencies of neurological disorders in Northwestern Nigeria: A retrospective study
Salisu Abdullahi Balarabe, Jamila Mohammad Kamfani
April-June 2019, 18(2):55-59
DOI:10.4103/aam.aam_13_18  PMID:31070144
Background: Early diagnosis and management of diseases takes a center stage in the control and prevention of chronic debilitating disorders. It also plays a prominent role in ensuring that patients are better equipped on how to deal with the disease burden. One reliable means of achieving this objective is to retrospectively study the frequency of common diseases. Materials and Methods: This was a retrospective study conducted between January 2010 and December 2014. Relevant data were extracted from patients' case folders. Adjustment to correct for potential biases such as multiple admissions and secondary diagnosis using a covariate on admission data was made to correct for systematic error. Information obtained was analyzed for frequency and distribution.Results: The mean age of the patients was 44.9 years (standard deviation ± 16.7), with an age range of 15–99 years. The most common neurological disorder was stroke which accounted for 21.3%, followed by spinal cord compression syndromes (20.8%), epilepsy (17.3%), parkinsonian syndromes (8.9%), headaches (7.1%), and bacterial meningitis (5.2%). The highest number of cases of neurological disorder occurred within the age group of 45–54 years. Conclusion: The outcome of this study revealed that stroke and spinal cord compression syndromes were the most common neurological disorders in our center. It also showed that individuals within their productive age (50–54 years) were more affected. Given the present state of constrained resources, coordinated efforts at the institutional, state, and federal government levels are essential to encourage prioritization, funding, and implementation of effective health-care delivery system.
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Assessment of the knowledge of fathers, uptake of routine immunization, and its associated factors in a rural community of North West Nigeria
Mansur Olayinka Raji, Abdullahi Ashiru Sani, Luqman Sanda Ibrahim, Hafsah Muhammad, Remi Abiola Oladigbolu, Aminu Umar Kaoje
April-June 2019, 18(2):97-102
DOI:10.4103/aam.aam_41_18  PMID:31070152
Introduction: Father's involvement is essential for the successful immunization of the child, as man is the head of the family and he takes responsibility for all decisions including health and financial issues. This study aimed to assess the knowledge of fathers, uptake of routine immunization (RI), and its associated factors in a rural community of North West Nigeria. Materials and Methods: The study was a community-based cross-sectional study conducted among the male heads of households residing in a rural community of Sokoto state. Systematic sampling was used to recruit 276 respondents. Data were obtained using a structured interviewer-administered questionnaire. Data obtained was entered into the IBM Software package and subsequently analyzed. Level of significance was set at 5%. Results: Only 2.5% and 1.4% of the respondents knew the age measles and yellow fever vaccines were given, respectively. Majority (75.4%) of the respondents' last-born child did not receive bacillus Calmette-Guérin at birth. Only (7.6%) of their last-born child were completely immunized for age. Majority of the respondents that had poor knowledge of RI had no formal education (P = 0.043). Conclusion: The study reported the knowledge of RI among fathers was poor. Having formal education and perception that children should be allowed to receive RI were correlates of good knowledge and uptake of RI. Parents, fathers, in particular, should be educated on the schedule of RI.
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Seroprevalence of HIV-2 and dual infection among HIV-infected individuals with clinical and laboratory features at a Tertiary Care Teaching Hospital, Mangalore: The present scenario
Jutang Babat Ain Tiewsoh, Beena Antony, Rekha Boloor
April-June 2019, 18(2):70-74
DOI:10.4103/aam.aam_23_18  PMID:31070147
Introduction: Human immunodeficiency virus (HIV) belongs to the Genus Lentiviruses and is made up of two main types HIV-1 and HIV-2 which are the causative agents of acquired immune deficiency syndrome (AIDS). It is well documented that HIV-1 infection is predominantly found, but HIV-2 infection has also been detected occasionally now and then. Objective: The objective of this study is to determine the seroprevalence of HIV-2 and dual infection in HIV-infected individuals along with the clinical presentation, co-infections, laboratory profile, and outcome of these patients. Materials and Methods: This descriptive cross-sectional study was carried out at a Tertiary Care Teaching Hospital for 2 years from August 2013 to July 2015, after obtaining approval from the Institutional Ethics Committee. Patients confirmed having HIV infection, as per the National AIDS Control Organization guidelines were included in the study. The sociodemographic pattern along with clinico-laboratory details and outcome were noted. Results and Discussion: In the present study, out of a total of 214 confirmed HIV-infected individuals, 2.8% (n = 6) were HIV-2 and 1.4% (n = 3) were dual infected where 40–50 years age group were most commonly affected. Males were more commonly affected than females in a ratio of 8:1. The most common presentation was fever (n = 5) followed by gastrointestinal (n = 5) symptoms. The most common opportunistic infection (OI) was tuberculosis (TB) (n = 4) followed by oral candidiasis (n = 2). Majority had anemia (n = 5) with raised erythrocyte sedimentation rate. Furthermore, majority (n = 7) showed improvement on discharge, whereas two (n = 2) left against medical advice and outcome is unknown. Conclusion: We conclude that the incidence of HIV-2 and dual infection does occur in our setup with males of older age group being more commonly affected where TB is the most common OI. Hence, clinicians should keep in mind that HIV-2 infection does occur and differentiating as HIV-1, HIV-2, or dual infection is important, to provide appropriate treatment which will result in decreased morbidity and mortality rates.
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Prevalence of traumatic dental injury to the anterior teeth in children attending paramilitary and nonparamilitary schools in Nigeria
Philip U Ogordi, IN Ize-Iyamu, EO Adeniyi
April-June 2019, 18(2):80-85
DOI:10.4103/aam.aam_27_18  PMID:31070149
Objective: The objective of this study was to determine the prevalence of traumatic dental injuries (TDIs) in the anterior teeth among children attending paramilitary and nonparamilitary schools in Benin City, Nigeria. Materials and Methods: A multistage sampling technique was used to select children aged 8–12 years with a previous history of trauma to the orofacial region. A self-administered questionnaire was then applied, and each participant was examined clinically. Data collected included demographic characteristics, etiology and place of injury, affected teeth, type of dental injury, lip competence, and overjet values. Analysis of data was done with the SPSS version 21.0 software. Pearson's Chi-squared test was used to determine the association between variables and odds ratio. Statistical significance was determined at P < 0.05. Results: A total number of 1352 children (mean age: 9.89 ± 1.4 years) were examined and 154 (11.4%) had a previous history of TDI. The prevalence among respondents in the paramilitary schools was 84 (6.2%) and those in nonparamilitary schools 70 (5.2%). Falls and play was the most common cause of TDI and was higher in children in paramilitary schools. Ellis Class I was the most prevalent type of injury in 91 (59.1%), tooth number 21 was the most traumatized, and the school environment was the most common place. Of the total number of respondents with TDI, the relationship between etiology with age, lip competence, and overjet was statistically significant (P < 0.05). Conclusion: The prevalence of TDI among the study participants was 11.4% and more in the paramilitary schools than the nonparamilitary.
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Serum procalcitonin levels in chronic obstructive pulmonary disease patients in North Indian Population
Sarika Pandey, Rajiv Garg, Surya Kant, Ajay Verma, Priyanka Gaur
April-June 2019, 18(2):103-107
DOI:10.4103/aam.aam_44_18  PMID:31070153
Background: Exacerbations in Chronic obstructive pulmonary disease (COPD) have a considerable impact on morbidity, mortality, and quality of life. Procalcitonin (PCT) a polypeptide normally produced in neuroendocrine cells of the thyroid and lungs is a marker of systemic inflammation and bacterial infection. Objectives: The aim of this study was to determine the levels of PCT in serum of acute exacerbation of COPD patients (AECOPD) and stable COPD patients in North Indian population. Materials and Methods: The study was conducted on 80 AECOPD and 80 stable COPD patients in respiratory medicine department at tertiary care hospital in north India. PCT levels were measured in serum by ELISA kit. GraphPad Prism version 6.01 (GraphPad software Inc.; La, Jolla, CA, USA) was used for analysis of data. Results: The present study showed that mean serum PCT levels were significantly higher in AECOPD group (1.31 ± 0.79) as compared to stable COPD group (0.1 ± 0.09) (P < 0.001). Conclusion: The study confirms that PCT levels were higher in AECOPD patients as compared to stable COPD patients. PCT could be used as a biomarker of exacerbations of COPD and can be used to target management and guiding the treatment in patients with acute exacerbations of COPD.
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Epistaxis: The demographics, etiology, management, and predictors of outcome in Jos, North-Central Nigeria
Adeyi A Adoga, Daniel D Kokong, Joyce G Mugu, Emoche T Okwori, John P Yaro
April-June 2019, 18(2):75-79
DOI:10.4103/aam.aam_24_18  PMID:31070148
Background: Epistaxis, though a mere nuisance can have life-threatening consequences. This first study from Jos on epistaxis aims to determine its sociodemographic characteristics, causes, the treatment modalities and the predictors of patient outcome. Study Design: A retrospective chart review. Methods: Health records of patients that met the inclusion criteria for epistaxis at the Jos University Teaching Hospital, Jos, Nigeria, between February 2011 and December 2015 were retrieved manually using standardized codes in the International Classification of Diseases 10th revision and studied for age, gender, associated comorbidities, treatment modalities offered, and outcome of treatment. Results: We managed 154 patients. Records of 92 patients were retrievable aged between 1 and 85 years (Mean = 37.7; standard deviation ± 16.2) with male to female ratio of 2.3:1. Patients in the third decade were the largest group. The most common cause was idiopathic. Anterior nasal bleeding occurred in 51.1%, posterior nasal bleeding in 34.8%. Conservative management was effective in 84.8%. Etiological factors other than chronic liver disease and otolaryngological malignancies showed statistically significant association with good patient outcomes (P = 0.013, P = 0.044, and P = 0.026, respectively). A mortality rate of 5.4% was recorded. Conclusion: Epistaxis of idiopathic origin occurring mostly in young males is the most common with most resolving on conservative management. Early hospital presentation, normal blood pressure at presentation and all management modalities were positive predictors of outcome in our patients.
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CASE REPORTS
Status epilepticus and bilateral middle cerebral artery infarction: A rare presentation after viper bite
Durjoy Lahiri, Vishal Madhukar Sawale, Souvik Dubey, Biman Kanti Roy, Shyamal Kumar Das
April-June 2019, 18(2):111-114
DOI:10.4103/aam.aam_21_18  PMID:31070155
Owing to the antihemostatic property of viper venom, hemorrhagic complications including intracerebral hemorrhage are the most commonly encountered after viper bite. Ischemic strokes have been rarely reported after viper envenomation, and its occurrence has been attributed to multiple mechanisms. Postsnakebite seizures are known to occur after neurotoxic bite. Here, we report the case of a viper bite victim who developed status epilepticus within 3 h after viper bite. He had only mild signs of local envenomation, and prolonged whole blood clotting time was the only manifestation of systemic envenomation. Subsequently, he was found to have developed right hemiparesis and global aphasia. Brain imaging revealed large infarcts in bilateral middle cerebral artery (MCA) territories. We report this as a unique case of viper bite which presented to the emergency room with status epilepticus. Moreover, bilateral MCA infarct, as was found in this case, is genuinely rare in scientific literature. Finally, the absence of overt features of envenomation makes this case stand out from other similar reported occurrences.
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ORIGINAL ARTICLES
Effect of scaling and root planing on gingival crevicular fluid levels of adrenomedullin in chronic periodontitis patients with and without diabetes mellitus type 2: A clinico-biochemical study
Lavanya Pragada, Dhoom Singh Mehta, V Manasa, Chandrahas Gangaram Bathini, Sneha Kesari, Ritika Bansal
April-June 2019, 18(2):92-96
DOI:10.4103/aam.aam_40_18  PMID:31070151
Background: Increased plasma adrenomedullin levels are usually observed in certain conditions such as diabetes mellitus (DM). Aims and Objectives: To gauge adrenomedullin values in the gingival crevicular fluid (GCF) of healthy individuals, chronic periodontitis (CP) patients with and without DM, and diabetics without any periodontal involvement, prior and after periodontal therapy. Materials and Methods: A total of 120 subjects were segregated into four categories of 30 each: Group 1 (healthy subjects), Group 2 (CP without DM), Group 3 (patients with CP and DM), and Group 4 (diabetics without any periodontal involvement). GCF was collected from all the patients. Nonsurgical periodontal therapy was done in Group 2 and Group 3 patients, followed up for 6 weeks, and GCF was obtained again from the same site. Enzyme-linked immunosorbent assay was used to evaluate the samples. Results: Adrenomedullin level in the GCF was high in diabetics without any periodontal involvement than in healthy individuals and significantly elevated in those with CP and DM. Reduced adrenomedullin was noted 6 weeks postperiodontal therapy. Conclusion: Adrenomedullin levels being higher in diabetics without any periodontal involvement than healthy controls suggest a link between DM and adrenomedullin. Furthermore, infection plays a noteworthy role in the elevation of adrenomedullin, indicating its role in periodontal disease progression.
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Clinicopathologic presentation of malignant orbito-ocular tumors in Kano, Nigeria: A prospective multicenter study
Saudat Garba Habib, Abdu Lawan, Pam Victoria
April-June 2019, 18(2):86-91
DOI:10.4103/aam.aam_37_18  PMID:31070150
Background: Malignant orbito-ocular tumors are major causes of morbidity and mortality in the developing countries. Their presentation, morphologic type, and management are challenging, and earlier reports were mostly retrospective surveys. Histological analysis is essential in making correct diagnosis. Here, we determined the clinical presentations and histopathologic types of orbito-ocular tumors in some tertiary hospitals in Kano, Nigeria. Materials and Methods: This was a prospective cross-sectional multicenter clinical and pathologic study conducted between June 2012 and May 2013. A structured pro forma was used to record findings, patient's biodata, clinical presentation, type of surgical intervention, and histological diagnosis. Data were analyzed with STATA version 11.0. Results: Sixty-seven eye tumors were observed among 61 patients. There were 43 males and 18 females (male-to-female ratio = 2.4:1). Patients had a mean of 13.4 ± 18.3 with a median of 4.0 (0.5–70) years with a double peak in age distribution. The most common features were visual loss (90.2%), leukocoria (59%), proptosis (55%), and fungating mass (49.2%). The symptoms were for ≥6 months in 57.4% and unilateral in 82.1%. B-scan showed retinal masses and calcifications in 13.5% and 4.5%, respectively. Confirmation by histology was achieved in 91% with the most common tumor being retinoblastoma, conjunctival squamous cell carcinoma (SCC), and rhabdomyosarcoma with frequencies of 38 (56.6%), 11 (16.4%), and 6 (9.0%), respectively. Six patients were HIV positive and all had SCC. Conclusions: Retinoblastoma was the most common malignant orbito-ocular tumor observed in this study. Patients often present late to the hospital with visual loss.
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LETTERS TO THE EDITOR
High-flow type of peripheral arteriovenous malformation causing severe cosmetic deformity
Sonal Saran, Sunil Malik, Yash Sharma, Annu Kharbanda
April-June 2019, 18(2):117-119
DOI:10.4103/aam.aam_31_18  PMID:31070157
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Pneumobilia with multiple air-fluid levels on abdominal radiography: A clincher
Sonal Saran, Sunil Malik, Annu Kharbanda, Yash Sharma
April-June 2019, 18(2):115-116
DOI:10.4103/aam.aam_30_18  PMID:31070156
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