Throughout the past 200 years, epidemics of meningococcal infection have been noted in Northern Nigeria. Consequently, control of meningococcal meningitis is one of the major priorities in infection control in the region. The proportions of cases of invasive meningococcal disease (IMD) caused by the five common serotypes (A, B, C, Y, and W135) vary among different regions and within specific geographic locations. Hence, effective and comprehensive disease control can only be achieved with the use of vaccines that target all of these disease-causing serotypes. Vaccines for the majority of meningococcal serogroups implicated in causing IMD are available in developed countries and have proven effective in reducing the disease incidence. However, the overall success of a vaccine depends on its coverage of the at-risk population as well as safety and effectiveness of the vaccine at preventing disease. Therefore, maximizing the global impact of these vaccines requires having them made available in regions with the high incidence of the disease, like Northern Nigeria, where rates of meningococcal disease are several times higher than in industrialized nations, and the reported mortality is usually high.

Background: Gestational diabetes mellitus (GDM) results from an imbalance between insulin resistance and insulin secretion capacity during pregnancy. Tumor necrosis factor-alpha (TNF-α) is an inflammatory cytokine that is proposed to be involved in the pathogenesis of the insulin resistance, but the findings from studies across different ethnic groups are inconsistent or even conflicting. Aim: The aim of this study is to determine the relationship between maternal circulating level of TNF-α and insulin resistance in pregnant Nigerian women with GDM. Methodology: This was a cross-sectional analytical study involving 100 women with GDM and another 100 pregnant women with normal gestation. They were evaluated between 24 and 28 weeks' gestation. Diagnosis of GDM was based on the WHO diagnostic criteria. Fasting serum insulin and TNF-α levels were measured. Insulin resistance index was calculated as homeostasis model assessment of insulin resistance. Multivariate correlation analysis was used to determine the relationship between the maternal serum level of TNF-α and the insulin resistance. Results: Pregnant women with GDM had greater insulin resistance than observed in the normal controls (3.14 ± 0.19 vs. 2.89 ± 0.20, P < 0.05). There was a positive correlation between serum TNF-α level and insulin resistance among the pregnant women with GDM (r = 0.49, P < 0.05). Multiple linear regression analysis indicated that TNF-α is a predictor of insulin resistance in pregnancies complicated by GDM. Conclusion: It is concluded that among pregnant Nigerian women with GDM in this study, increased serum TNF-α level is associated with greater insulin resistance independent of age and body mass index.

Background: Malaria contributes significantly to under-5 morbidity and mortality in Sub-Saharan African countries including Nigeria. The rollback malaria (RBM) initiative and millennium developmental goal 6 are the programs targeted at reduction in malaria burden. The target year here is 2015; it would be needful to determine the impact of these programs on lives of at-risk population. Objectives: To determine caregivers' perception and utilization of insecticide-treated mosquito net (ITN) for their children/wards under 5 years of age. Methods: It was a cross-sectional, descriptive, hospital-based study conducted at Federal Teaching Hospital, Abakaliki, between April 1, 2014, and October 31, 2014. A structured questionnaire was used to assess caregivers' perception and utilization of ITN. Relevant information collected from the respondents included awareness of what ITN is and its use, ownership, source and utilization of ITN, and frequency of antimalaria use for febrile episodes. Data were analyzed using Statistical Package for the Social Sciences (SPSS) Windows Program (SPSS Inc., Chicago, IL, USA) version 20.0 while the level of statistical significance was set at P < 0.05. Results: A total of 410 caregivers were interviewed; 362 (88.3%) were mothers. Three-hundred and eighty-four (93.7%) participants knew that ITN prevents mosquito bite that cause malaria infection, 81.2% (333/410) have at least one ITN in their homes, but only 215 (52.4%) use the ITN every night. Caregivers who used ITN regularly used antimalaria for their under-5 quarterly (34.9%) and rarely (33.9%). A significant relationship existed among socioeconomic class, knowledge of ITN, source of knowledge of ITN, frequency of anti-malaria use, and utilization of ITN. Conclusion: The study observed that awareness and ownership of ITN are high among study participants, but its utilization was suboptimal compared to RBM target for 2010 (80.0%). Health education and free distribution of ITNs should be further strengthened particularly among mothers of childbearing age and younger children.

Context: Pink colored acrylic does not always satisfactorily replicate the natural gingival color, especially in individuals with pigmented mucosa. In such situation clear acrylic denture base material can be used. Hence, there is a need of a comparative study of the mechanical properties of the clear and pink colored denture base resins. Aims: The aim of this study is to compare the mechanical properties, i.e., tensile, flexural, compressive, and impact strength (IS) of clear and pink colored denture base resins. Settings and Design: This was comparative in vitro study. Materials and Methods: A total of 80 specimens were divided into two groups of 40 specimens each of clear and pink colored acrylic resin. Specimens for testing flexural, tensile, compressive, and ISs of acrylic resin (10 in each group) were divided. A universal testing machine was used for measuring flexural, tensile, and compressive strength (CS) while the Izod/Charpy impact tester was used for IS. Results: The mean tensile strength for clear resin (n = 10) was 30.90 ± 1.663 MPa and that for pink resin (n = 10) was 31.30 ± 8.166 MPa. The mean residual flexural strength for clear resin (n = 10) was 75.60 ± 17.212 MPa, whereas for pink resin (n = 10) was 76.10 ± 14.130 MPa. The mean CS for clear resin (n = 10) was 84.60 ± 2.503 MPa and for pink resin (n = 10) was 85.40 ± 16.222 MPa. The mean IS for clear resin (n = 10) was 11.50 ± 5.104 MPa. While for pink resin (n = 10) was 11.90 ± 1.370 MPa. Conclusions: The results show that clear acrylic resin denture base material has mechanical properties similar to that of pink acrylic resin denture base material.

Background: Empathy is one of the cardinal components for physician–patient relationships, optimal outcomes in patient care, improved patient satisfaction, greater adherence to therapy, and lower malpractice liability. It is also considered an essential quality for health-care professionals to practice medicine. The aim of the present study was to assess the empathy level of medical students of Universiti Pertahanan Nasional Malaysia (UPNM) National Defense University of Malaysia, Kuala Lumpur, Malaysia. Methods: This was a cross-sectional study conducted in 2017 which recruited medical students of UPNM. The Empathy Quotient, a self-reported questionnaire, was utilized for data collection. The total empathy score of the questionnaire is 80. Results: Majority of the respondents were male (60.9%), year-V students (26.6%), Malay (70.5%), and cadet officer (69.6%). The overall mean score achieved by the respondents was 36.76 ± 9.18, and 74.4% of the respondents scored more than 30. The empathy scores of the students were significantly affected by the gender (t = 2.371; df = 205; P < 0.05), year of study (F = 2.553; df = 4/202; P < 0.05), and examination grades (F = 3.488; df = 2/204; P < 0.05). The findings showed that female students are more empathetic than their male counterparts. Further, the post hoc Tukey test analysis revealed that Year-V students are more empathetic than their junior counterparts and students who got highest grade are more empathetic. Conclusions: To improve the empathy level of the UPNM medical students, appropriate educational strategies and interventions should be designed and implemented in the curriculum to inculcate, maintain, and enhance empathy.

Background: Traditional contraceptive methods (TCMs) have been used by our ancestors for a long time in child spacing before the advent of the modern contraceptive methods but even with the introduction of the modern methods some women prefer and are still using TCMs. Aim: The aim of this study was to assess the utilization of traditional contraceptives in child spacing and its association with family size among women of child-bearing age attending primary healthcare centers in Kano. Materials and Methods: This was a cross-sectional study among 400 women attending primary healthcare centers in Kano. Their sociodemographic characteristics, number of children, knowledge, and use of traditional contraceptives were recorded on a pretested questionnaire. Results: The mean age ± standard deviation (SD) was 29.1 ± 6.22 years. The mean number of children (±SD) was 3.9 ± 2.27. A total number of 280 (70.0%) participants knew about TCMs, but only 147 (36.8%) used these methods and among those that used TCMs, herbal medicine was the most used method (n = 67, 45.6%). There was no statistically significant difference between the mean number of children of the respondents who used traditional contraceptives and those who did not (t = 0.382, df = 398, P = 0.703, 95% confidence interval:−0.374–0.555). Educational status was significantly associated with the use of traditional contraceptives (χ² = 8.327, P = 0.005). Conclusion: There was more knowledge of traditional than modern contraceptive methods. Herbal medicine was the most commonly used method. There was poor utilization of the modern contraceptive methods and fair utilization of the TCMs. The study showed no clear benefit of traditional contraceptive usage over its nonuse in reducing family size.

Background: Fasting during the holy month of Ramadan is a religious obligation for all Muslims who represent 1.8 billion of the world population (24%). This study explores the effect of Ramadan fasting on the blood glucose, glycated hemoglobin (HbA1c), lipid profile, sleeping quality, and essential lifestyle parameters and also explores the safety of fasting for a whole month among diabetic patients. Aim: The aim of the present study was to assess the impact of Ramadan fasting on the blood glucose, HbA1c, lipid profile, sleeping quality, and lifestyle parameters among patients with type 2 diabetes mellitus (T2DM) in Turkey. Subjects and Methods: A total of 1780 diabetic patients were approached, and 1246 (70%) participated in this cross-sectional study carried out during the period from May 27, 2017, to June 24, 2017. Data analysis comprised sociodemographic features, lifestyle habits, blood pressure measurements, serum lipid profiles, serum calcium, Vitamin D 25-hydroxy, uric acid, and HbA1c at before 4 weeks and after 12 weeks from Ramadan. Results: Out of 1246 patients, 593 (47.6%) were male and 653 (52.4%) were female. The mean ± standard deviation age of the patients was 50.39 ± 15.3 years. Males were significantly older than females (51.53 ± 12.56 vs. 49.26 ± 14.4; P = 0.003, respectively). Significant differences were found in Vitamin D, blood glucose, HbA1c level, creatinine, bilirubin, albumin, total cholesterol, triglycerides, high-density lipoprotein-cholesterol (female), low-density lipoprotein-cholesterol (male), uric acid, and systolic and diastolic blood pressure after and before the holy month of Ramadan (P < 0.05 for each). HbA1c (P < 0.001), physical activity (P < 0.001), hours of sleeping (P < 0.001), systolic blood pressure (BP) (mmHg) (P = 0.007), BMI (P = 0.016), diastolic BP (mmHg) (P = 0.018), family history (P = 0.021), and smoking (P = 0.045) were identified as significantly associated with Ramadan fasting as contributing factors. Conclusion: In one of the largest studies of its kind, we show that Ramadan fasting has positive effects on T2DM patients as it reduces their blood pressure, blood glucose, HbA1C, and BMI. Furthermore, there are improvements in the duration of sleep and physical activity, the role of Ramadan fasting in diabetes therapy has been confirmed.

Background: Cholera is endemic in sub-Saharan Africa, especially in areas affected by natural disaster and human conflict. Northeastern Nigeria is experiencing a health crisis due to the destruction of essential amenities such as health infrastructure, sanitation facilities, water supplies, and human resources by Boko Haram insurgents. In 2017, a cholera outbreak occurred in five local government areas (LGAs) hosting internally displaced persons. The Nigeria Center for Disease Control, World Health Organization, Mĕdecins Sans Frontiĕres International, and several other organizations supported disease containment. An emergency operating center (EOC) established by the State Ministry of Health (SMoH) then coordinated the outbreak response. Methods: We conducted a retrospective analysis of data extracted from the line list utilized by the SMoH to investigate outbreaks. We evaluated the outbreak by time, place, and person. Attack rate by LGA and age-specific case fatality rate (CFR) was calculated based on cases with complete records for age, sex, place of residence, date of symptom onset, and disease outcome. Results: A total of 5889 cholera cases were reported from five LGAs with an overall attack rate of 395.3/100,000 population. Among 4956 cases with documented outcome, the overall CFR was 0.87%, with CFR ranging from 0% to 6.98% by LGA. The age-specific CFR was highest among those aged ≥60 years (1.92%) and least among those aged 20–29 years at 0.3%. The epidemiological curve revealed two peaks that coincided with periods of heavy rain and flooding. Conclusion: This study reports on the largest ever documented cholera outbreak in five LGAs in Borno State. The outbreak was focused in LGA hit hardest by the destructive activities of insurgents and then spread to neighboring LGAs. The low CFR recorded in this cholera outbreak was achieved through timely detection, reporting, and response by the coordinated efforts of the EOC established by the SMoH that harmonized the outbreak response.

Background: Bidi smoking is a serious health hazard which is common throughout South Asia and parts of the Middle East. It has been strongly implicated to various benign and malignant lesions of oral cavity and oropharynx. These tobacco-filled leaves deliver more than three times the amount of nicotine, carbon monoxide, and tar as cigarettes which exert injurious effects on cells reflected in terms of accelerated proliferative activity in normal oral mucosal cells. Aim: This study aimed to compare the exfoliated cells from the oral mucosa of bidi smokers and nonsmokers, with emphasis on proliferative activity. Materials and Methods: Exfoliative smears were obtained from the oral mucosa of forty participants (twenty nonsmokers and twenty smokers) with age group ranging from 30-80 years, in and around Barwala (Haryana). The cytologic smears were evaluated using Papanicolaou (PAP) stain and AgNOR in order to evaluate the presence of cytological alterations suggestive of inflammation, dysplasia, keratinization, and proliferative activity of epithelial cells. Only PAP Class I and Class II smears were observed. Results: Comparison of the mean number of AgNORs showed a significant difference between nonsmokers and smokers. Inflammatory alterations were found in 70% of smokers and 55% of nonsmokers. A significant difference in proliferative activity was observed between smokers and nonsmokers classified as PAP Class II. Conclusion: A significant difference of AgNORs/nucleus was observed between bidi smokers and nonsmokers.

Context: Erectile dysfunction (ED) is a strong predictor of poor quality of life in men with type 2 Diabetes mellitus (T2DM). Several studies evaluating ED in men with diabetes mellitus have been carried out, but few of these have been done in Nigeria. In Enugu, South East Nigeria, paucity of studies on this subject was observed. Aims: This study aims to determine the prevalence and predictors of ED in men with T2DM attending the diabetes clinics. Settings and Design: A descriptive cross-sectional study of men with T2DM in UNTH and Saint Mary's Hospital, Enugu, was carried out. The systematic sampling method was used to recruit participants. Subjects and Methods: Data collection from participants and their hospital records was done using semi-structured questionnaire. ED was assessed using the 5 items, international index of erectile function questionnaire. Statistical Analysis Used: Data analysis was done using SPSS version 20 and results presented as texts and tables. P value was set at <0.05. Results: A total of 325 participants with mean age of 57.8 ± 13.2 years were involved out of which 94.7% had ED. The proportion of participants with ED had increased with its severity. Predictors of ED included poor glycemic control, longer duration of diabetes, overweight/obesity, and older age. Poor ED health-seeking behavior and treatment were noted. Conclusions: The prevalence of ED is high. Lifestyle interventions targeted at improving glycemic control and weight loss may reduce the burden of this complication. We recommend objective ED screening using standard but brief instruments as part of routine evaluation of men with T2DM.

E. N was a 48-year-old man referred from a peripheral hospital to the Maxillofacial unit of Ahmadu Bello University Teaching Hospital, Zaria, on account of 1-year history of left-sided jaw pain and swelling, particularly after meal. The conventional plain radiograph of the jaws appeared normal as there was no opacity of soft tissue or calcific density visualized. Sialography revealed an oval-shaped filling defect in the dilated left Wharton's duct, which could suggest radiolucent calculus. Ultrasound scan showed the lesion as a brightly echogenic mass surrounded by anechoic clear fluid (saliva), casting posterior acoustic shadow. A diagnosis of left submandibular sialolithiasis was made. The maxillofacial surgeons decided to remove the calculus surgically, but the patient refused surgery and then defaulted from subsequent follow-up visits.

Avascular necrosis (AVN) of the femoral head is a well-recognized complication of steroid treatment. Exogenous glucocorticoids' administration and alcoholism are the most common nontraumatic etiologies. AVN secondary to endogenous hypercortisolism (HC) is rare; very few case reports are available on this complication. We describe a 28-year-old female that has presented an AVN with Cushing's syndrome. Biochemical investigations confirmed HC. Magnetic resonance imaging (MRI) showed a pituitary adenoma that was resected transsphenoidally. The postoperative failure directed to radiosurgery treatment. Then, the patient then expressed a significant clinical improvement while developing adrenocorticotropic deficiency; hence, steroids were indicated. During the discovery of Cushing disease, the patient presented also limping and progressive pain in right hip. The pelvis MRI showed an AVN of the right femoral head. The patient underwent a total replacement of the right hip sine presenting an extensive AVN. This case elucidates that AVN could be an early manifestation of Cushing's disease.