Annals of African Medicine
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   2019| January-March  | Volume 18 | Issue 1  
    Online since February 5, 2019

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Hemorrhoidal disease: Predilection sites, pattern of presentation, and treatment
Emeka Ray-Offor, Solomon Amadi
January-March 2019, 18(1):12-16
DOI:10.4103/aam.aam_4_18  PMID:30729927
Background: An engorgement and prolapse of the anal cushion lead to haemorrhoidal disease. There are different anatomical sites and presentation of this common pathology which affects the quality of life. Aims: To study the predilection sites, presentation and treatment of haemorrhoidal disease. Patients and Method: A cohort study of patients diagnosed with haemorrhoids at an Endoscopy centre in Port Harcourt, Rivers State Nigeria from February 2014- July 2017.The patients were divided into 2 groups: A - asymptomatic and B- symptomatic. Variables studied included: demographics, anatomic variations, grade of haemorrhoids, clinical presentation and treatment. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 20.0. Armonk, NY. Results: One hundred and twenty- one cases were included in study. There were 76 males and 45 males with age range from 15 -80 years (mean 51.9±13.1yrs). Bleeding per rectum was the most common presentation. The position frequency of haemorrhoids in decreasing order were: right posterior (34.1%); right anterior (28.2%); left lateral (17.1%); left posterior (7.6%). Multiple quadrants were affected in 58(72.5%) cases of external haemorrhoids. Grade I, II and III haemorrhoids were seen in 38 (31%), 31(26%) and 21(17%) cases respectively. Conclusion: The most common anatomical site of external haemorrhoids is the right posterior quadrant position; frequently, multiple sites are simultaneously affected. Goligher classification Grade 1 hemorrhoids are effectively treated by injection sclerotherapy using 50% dextrose solution; a cheap and physiologic sclerotherapy agent.
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Platform switching technique and crestal bone loss around the dental implants: A systematic review
Shivangi Gupta, Robin Sabharwal, Jazib Nazeer, Lavina Taneja, Basanta Kumar Choudhury, Sudipta Sahu
January-March 2019, 18(1):1-6
DOI:10.4103/aam.aam_15_18  PMID:30729925
Background: The overall success of dental implants depends on the crestal bone support around the implants. During the initial years of dental implant placement, the bone loss around the implants determines the success rate of treatment. Platform switching (PLS) concept preserves the crestal bone loss, and this approach should be applied clinically for the overall success of dental implants. Purpose: The purpose of this study is to discuss the literature dealing with the concept of PLS concept and preservation of marginal bone, the mechanism by which it contributes to maintenance of marginal bone, its clinical applications, advantages, and disadvantages, to assess its survival rates. Materials and Methods: PubMed and Google Scholar search was done to find out the studies involving PLS concept from 2005 to 2017. Data were analyzed using SPSS statistical software. Results: Literature search revealed studies involving concepts of PLS, comparison of platform-switched and nonplatform-switched implants, case reports on PLS, and studies with histological and finite element analyses regarding PLS. Conclusion: PLS helps preserve crestal bone around the implants, and this concept should be followed when clinical situations in implant placement permit.
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Acute perforated appendicitis in adults: Management and complications in Lagos, Nigeria
Olanrewaju Samuel Balogun, Adedapo Osinowo, Michael Afolayan, Thomas Olajide, Abdulrazzak Lawal, Adedoyin Adesanya
January-March 2019, 18(1):36-41
DOI:10.4103/aam.aam_11_18  PMID:30729931
Background: Acute perforation of the appendix is one of the complications of appendicitis that is associated with increased morbidity and mortality and hence regarded as a surgical emergency. Risk factors for perforated appencidicits include extremes of age, male sex, pregnancy, immunosuppression, comorbid medical conditions and previous abdominal surgery. Objectives: This study focuses on the pattern of presentation, risk factors, morbidity and mortality of patients managed for perforated appendicitis in our centre. Subjects and Methods: We conducted a seven-year retrospective review of consecutive adult patients who had surgery for perforated appendicitis in our centre. Results: The perforation rate in the study was 28.5%. The peak age of presentation was between 21-30 years. Forty-two (71.1%) of the patients under study were males. Only 3 (5.1%) of the cohorts had history of recurrent abdominal pain. Majority of the patients were in the American Society of Anesthesiologists (ASA) II (44.1%) and III (42.4%) categories. Surgical site infections (SSI) (18.6%), wound dehiscence (15.2%) and pelvic abscess (13.5%) were the most common complications. The Incidence of SSI was found to correlate with male gender, (P = 0.041), co-morbidity (P = 0.037) and ASA score (0.03) at 95% confidence interval. Routine use of intraperitoneal drain after surgery for perforated appendicitis did not appear to reduce the incidence of pelvic abscess. No mortality in the studied population. Conclusion: Appendiceal perforation was more common in male patients with first episode of acute appendicitis. Previous abdominal surgery and comorbid medical conditions were of lesser risk factors for appendiceal perforation in our patients. Surgical site infection was the commonest complication after surgery.
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Standard treatment guidelines: Perception and utilization in a tertiary health care facility in South-South, Nigeria
A Stephen Ayinbuomwan, Ambrose O Isah
January-March 2019, 18(1):47-50
DOI:10.4103/aam.aam_25_18  PMID:30729933
Background: The Nigerian National Standard Treatment Guidelines (NSTG) was introduced in 2008 and the second edition was launched in 2017. This study evaluated the level of awareness, acceptance, and use of this tool within the Nigerian health-care system. Methodology: This study was carried out at the University of Benin Teaching Hospital, Benin City, Nigeria. A semistructured questionnaire was administered to doctors in the hospital. Information sought included the biodata, awareness of the STG, publication and use of the STG, the perceived advantages and disadvantages, and suggestions on how to improve its use. Results: There were 155 respondents with a mean age of 34.1 ± 6.4 years and response rate of 77.5%. The level of awareness was 46.5%, with 21.9% having received lessons on the subject; 53.0% received lessons as students. Awareness of the date of the initial introduction of the STG at the national level was 4.5% with 1.3% aware of the current edition of the NSTG. The description of the STG was satisfactory in 27.7% participants. Again only 20.6% currently use the NSTG, with 12.3% rating the entire STG utilization as successful. Conclusion: There is low awareness and poor utilization of the STG among doctors in the facility which may be a reflection of the situation in other health facilities in the country. There is need to encourage the use of this clinical tool to ensure appropriate use of medicines and delivery of health care in resource-limited settings.
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Plantar ulcer occurrence among leprosy patients in Northern Nigeria: A study of contributing factors
Gidado Mustapha, Joshua Olusegun Obasanya, Clement Adesigbe, Kuye Joseph, Chukwueme Nkemdilim, Mansur Kabir, Tahir Dahiru
January-March 2019, 18(1):7-11
DOI:10.4103/aam.aam_162_16  PMID:30729926
Background: The study was conducted in three major leprosy referral hospitals in Northern Nigeria, which are NKST Rehabilitation Hospital, Benue State, Yadakunya Leprosy Hospital, Kano, and National Tuberculosis/Leprosy Training Hospital, Zaria. The main objective of the study was to investigate factors responsible for the occurrence of ulcers among leprosy patients reporting to the leprosy referral hospitals. Materials and Methods: An analytic study of case–control design was used, with patients having plantar ulcers as cases and those without as control. Semi-structured was administered to all cases and controls. Results: A total of 242 patients were studied; 124 patients (51.2%) had plantar ulcers whereas 118 (48.8%) had no ulcers (controls). A Chi-square test was used in the analysis to compare cases and controls. The study found differences between cases and controls with respect to patients release from treatment (RFT), gender, availability and utilization of footwear, age, occupation, and educational status. Footwears were provided to most patients, i.e. 60.8% late (i.e., after developing plantar ulcers); however, there was very good utilization of the footwears among those who had the footwears, 65.3%. Knowledge of self-care was higher among 64.5% of cases compared to only 28.1% of the controls. Conclusion: Ulcer still remains a major problem among leprosy patients, especially RFT (76.6%) and most cases are provided with footwear late. Self-care knowledge is higher among cases than controls.
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Pattern of noma (cancrum oris) and its risk factors in Northwestern Nigeria: A hospital-based retrospective study
Semiu Adetunji Adeniyi, Kehinde Joseph Awosan
January-March 2019, 18(1):17-22
DOI:10.4103/aam.aam_5_18  PMID:30729928
Background: Noma (cancrum oris) remains the scourge of children and the “face of poverty” in Sub-Saharan Africa. Recent data on the burden of noma and its risk factors are needed for evaluating and redesigning interventions for its prevention and control. Objectives: This study aimed to determine the pattern of noma and its risk factors in Northwestern Nigeria. Materials and Methods: It was a retrospective study that looked into cases of noma (cancrum oris) admitted into the Noma Children Hospital, Sokoto, Nigeria, between January 1999 and December 2011. Information on patients' bio-data, the site and severity of lesions, and presence of trismus and its severity were extracted from the patients' case files and analyzed using descriptive statistics. Results: One hundred and fifty-nine (8.3%) of the 1923 patients admitted to the hospital from January 1999 to December 2011 were diagnosed with fresh noma. The mean age of the patients was 3.0 ± 1.4 years, and majority of them, 139 (87.4%) were aged 1–5 years. The soft-tissue lesions essentially involved multiple sites but most commonly the outer and inner cheeks (84.3%). The most common risk factors identified were measles (47.2%) and protein-energy malnutrition (42.1%). There were rises and falls in the prevalence of noma in the period studied. Conclusion: This study showed a high burden of noma in Northwestern Nigeria, mostly among children aged 1–5 years, and with soft-tissue lesions involving multiple sites. Measles and malnutrition were the major risk factors identified, and the disease trend showed a wave-like pattern. There is an urgent need to eliminate the disease in Nigeria through prevention and control of infectious diseases and malnutrition.
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A comparison of leadership competencies among doctors practicing in public and private hospitals in Jos metropolis of Plateau State, Nigeria
Kenneth Yakubu, Musa Dankyau, Maxwell Lodenyo
January-March 2019, 18(1):23-29
DOI:10.4103/aam.aam_9_18  PMID:30729929
Aim: This study aimed at assessing and comparing perceived leadership competencies of doctors occupying managerial positions in a public and various private hospitals in Jos metropolis of Plateau state, Nigeria. Materials and Methods: This was a cross-sectional, comparative multicenter study. It involved self-assessment by 27 doctors occupying managerial positions in public and private hospitals within Jos metropolis and peer-assessments by 89 health and nonhealth professionals who worked with the doctor–managers at the time of the study. The National Center for Healthcare Leadership competency model was used as the assessment tool. Results: We found that perceived leadership competencies were low for all doctor–managers irrespective of their hospital affiliation. Distributions of these competencies varied with the private sector showing superiority for certain competencies. Conclusion: Perceived leadership competencies were low for the doctor–managers assessed. This calls for an innovative approach to the training and practice of health management in Jos Metropolis.
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The effect of body mass index and gender on lipid profile in children and adolescents in Saudi Arabia
Asmaa Adel Milyani, Abdulmoein Eid Al-Agha
January-March 2019, 18(1):42-46
DOI:10.4103/aam.aam_17_18  PMID:30729932
Objectives: The objectives of this study were to study the relationship between lipid profile components among different body mass index (BMI) groups and investigate the association between gender and BMI. Methodology: This cross-sectional study included 218 children and adolescents; 104 males and 114 females. Accepted age range was from 2 to 18 years. Data were collected from February to May during the year of 2017 and were analyzed using the Statistical Package for the Social Sciences. Standard deviation (SD) for BMI was calculated based on the World Health Organization guidelines. Lipid profile results were reviewed from laboratory reports. Results: Nearly 10.6% of the study population were found to be overweight; another 22.1% were suffering from obesity, of which 7.1% were morbidly obese. Children who had high levels of low-density lipoprotein (LDL) and low levels of high-density lipoprotein (HDL) were found among higher BMI groups, with elevated cholesterol levels noted in patients of increased weight. An increase in HDL levels was noted in 71% of the children who avoided fast-food consumption. Significant gender predisposition to changes in BMI was not found (P = 0.467). Conclusion: High BMI was found to be associated with increased levels of LDL cholesterol and decreased levels of HDL cholesterol. No significant association between gender and changes in lipid profile was established (P = 0.898). Recommendation: All pediatricians must keep an open eye on overweight and obese children, routinely taking their weight measurements and screening for dyslipidemia by obtaining a full lipid profile for every child whose weight is 2 SDs above the mean.
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Disseminated cysticercosis in an immunocompetent individual
Kothai Gnanamoorthy, Prasanna Karthik Suthakaran
January-March 2019, 18(1):51-53
DOI:10.4103/aam.aam_76_17  PMID:30729934
Cysticercosis is a major public health problem, particularly in developing countries. It is caused by the larvae of the cestode Taenia solium (pork tapeworm). It usually presents as a solitary lesion in the muscle or brain (neurocysticercosis). Disseminated cysticercosis is an uncommon manifestation, especially in an immunocompetent individual. We hereby report the case of a 31-year-old male who presented with new-onset generalized tonic–clonic seizures and who also had multiple soft-tissue swellings all over his body. Imaging studies revealed multiple cysticerci in the brain parenchyma, extraocular muscles, and muscles of all the four limbs, which was subsequently established by histopathology also. The patient was started on anticonvulsants, steroids, and albendazole following which he made a complete recovery.
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Spectrum of high risk human papillomavirus types in women in Kaduna State, Nigeria
Sheba Joseph Magaji, Maryam Aminu, Helen Ileigo Inabo, Adekunle O Oguntayo
January-March 2019, 18(1):30-35
DOI:10.4103/aam.aam_10_18  PMID:30729930
Context: Infection with oncogenic or high-risk human papillomavirus (hrHPV) types acts as carcinogens in the development of cervical cancer. Aim: The aim of the study was to detect the genotypes of some hrHPVs among women attending selected hospitals in Kaduna State, Nigeria. Settings and Design: Hospital-based and cross-sectional that involved the use of structured questionnaires to obtain sociodemographic and clinical data. Materials and Methods: Two hundred and seventy-six cervical scraping samples were screened for both HPV and squamous intraepithelial lesion (SIL) using enzyme-linked immunosorbent assay and conventional Pap smear, respectively. Samples positive for HPV antigen and SIL were subjected to polymerase chain reaction (PCR) to detect the viral type. Statistical Analysis Used: Data were analyzed using the frequency procedure of Statistical Analysis System version 9.2, at 0.05 level of significance and 95% confidence interval. Results: Of the 276 cervical scraping samples, only 24 (8.7%) were positive for HPV antigen, whereas 17 (6.2%) were positive for SIL. When thirty of these positive samples were subjected to PCR, the DNA of hrHPV was detected in 20 (66.6%) of the positive samples. The HPV types detected in the study were 16 (36.7%), 18 (40.0%), 31 (16.7%), and 45 (3.3%). Conclusion: The findings from this study have shown that there is a high possibility of detecting the DNA of hrHPV in women that are infected with HPV and those that have cervical dysplasia, which points out the possibility of these women developing cervical cancer.
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