Annals of African Medicine
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   2020| July-September  | Volume 19 | Issue 3  
    Online since August 19, 2020

 
 
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REVIEW ARTICLE
Moving towards ideal and appropriate models of anticoagulation management service
Anakwue Raphael
July-September 2020, 19(3):153-163
DOI:10.4103/aam.aam_30_19  PMID:32820726
It is now known that thrombotic disorders such as venous thromboembolism, ischemic stroke, and myocardial infarction contribute significantly to global morbidity and mortality. Anticoagulation service must respond to this new development. Warfarin has continued to provide the backbone for anticoagulation service for decades but with considerable drawbacks. The introduction of nonVitamin K oral anticoagulants (NOACs) has created new challenges. This article seeks to discuss how the establishment of appropriate models of anticoagulation could contain the draw backs of the old anticoagulants and improve on the compliance, availability, affordability, and accessibility of newer anticoagulants. Successful anticoagulation has always been defined by a scientific balancing of the risk of thrombosis and the complication of hemorrhage. To be able to maintain such optimal anticoagulation requires rational drug prescription (physician factor), institutelization of monitoring of therapy (anticoagulation clinic factor) as well as active participation of patients receiving therapy (patient factor). New models of service can be created out of this triad in a bid to replace the old routine medical care model. New models of anticoagulation service should include appropriately trained professionals such as Physicians, Pharmacists, Clinical Pharmacologists, Nurses, and Laboratory Scientists who are knowledgeable in diagnostic, management, and monitoring of anticoagulation. The different models of anticoagulation service discussed in this article clearly demonstrate the need for restructuring of this life saving service particularly in the era of NOAC. Newer models of care that should provide safe, efficacious, and cost-effective services are needed.
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ORIGINAL ARTICLES
Determinants of quality of life in adults living with epilepsy
Kazeem Ayinde Ayanda, Dauda Sulyman
July-September 2020, 19(3):164-169
DOI:10.4103/aam.aam_20_18  PMID:32820727
Background: Quality of life (QOL) is a vital outcome measure in people living with epilepsy. The aim of this study is to determine the sociodemographic and clinical factors that predict poor QOL in patients with epilepsy. Materials and Methods: This is a descriptive cross-sectional study that was carried out at the outpatient psychiatric clinic of Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria, for 6 months. Seventy-four patients with epilepsy who met the inclusion criteria were recruited to participate in the study. The mental health of these patients and their QOL were assessed using the Mini-International Neuropsychiatric Interview and the short form of the World Health Organization QOL instrument, respectively. Data were analyzed using epi-info version 6.04d, and logistic regression analysis was performed to determine factors that predict poor QOL. Results: Psychiatric disorder was found in 33 (44.6%) of the respondents. The presence of these psychiatric disorders was predictive of poor score on the overall QOL (odds ratio [OR] = 0.382; 95% confidence interval [CI] = 0.145–0.983; P = 0.0046), physical (OR = 0.269; 95% CI = 0.100–1.722; P = 0.009), and psychological health domain (OR = 0.269; 95% CI = 0.102–0.709; P = 0.008). Longer duration of epilepsy was predictive of a poor score on the health satisfaction item (OR = 0.202; 95% CI = 0.06–0.679; P = 0.010) while being single was predictive of poor score on the social relationship domain (OR = 0.177; 95% CI = 0.065–0.482; P = 0.001)Conclusion: The presence of psychiatric disorder, long duration of epilepsy, and being single were predictive of poor QOL. The importance of social relation, prompt seizure control, and efficient collaboration between psychiatrist and other medical professionals in the care of patients with epilepsy cannot be overemphasized.
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Audit of carotid doppler sonography: Spectrum of findings at a tertiary hospital in Northwestern Nigeria
Anas Ismail, Abdulmalik M Aliyu, Mansur A Ramalan
July-September 2020, 19(3):170-175
DOI:10.4103/aam.aam_52_18  PMID:32820728
Introduction: Doppler sonography of the cervical segment of the carotid arteries is becoming a popular tool for evaluating atherosclerosis of the carotid artery. We present the audit of findings on carotid ultrasound examination among patients with clinical suspicion and risks for cerebrovascular disease and possible correlates in Northern Nigeria. Materials and Methods: We performed carotid ultrasound examination on all patients referred for screening and clinical suspicion of cerebrovascular disease within the year 2017. The patients' characteristics, risk factors, presence of atheroma and characteristic of the atheroma, degree of stenotic disease as well as the presence of incidental ultrasound findings were reviewed and documented. Results: Out of the 62 patients, 55 (88.7%) of them had various degrees and types of atheromatous plaques in different segments of the cervical carotid arteries, whereas 7 (11.3%) were normal. The predominant risk factor was smoking followed by diabetes mellitus, whereas the highest indication for the scan was transient ischemic attack. Incidental thyroid lesions such as nodules and cysts were encountered in 14 (22.6%) of the patients. There is a statistically significant difference between sex and age with the side of lesion, degree of stenosis, segment involved, and type of atheromatous plaque. Conclusion: There is a statistically significant difference between sex and age with the side of lesion, degree of stenosis, segment involved, and type of atheromatous plaque. About one-fifth of our patients had incidental thyroid lesions. Therefore, routine screening of population at risk is highly recommended.
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Prevalence of hepatitis B virus infection among pregnant women in Jos, Nigeria
Francis Ajang Magaji, Mark Ojogba Okolo, Z Hassan, Iornum H Shambe, Victor Chung Pam, Amaka Ngozi Ocheke, Esther S Yiltok, Williams Golit, Stephen Ajen Anzaku, Martins Daloek, Jerry Ogwuche, Godwin E Imade, Christain Isichie, Jsiah T Mutihir, Stephen Oguche, Oche Agbaji, Jonah Musa, Solomon Ateine Sagay, AI Zoakah, Susan E Cohn
July-September 2020, 19(3):176-181
DOI:10.4103/aam.aam_20_19  PMID:32820729
Objectives: The study sought to determine the prevalence and risk factors associated with Hepatitis B surface antigenemia (HBsAg) positivity among pregnant women in Jos, Nigeria. Methodology: This was a cross-sectional study carried out among the pregnant population in five healthcare facilities in Jos, between November 1, 2017 and April 30, 2018. Informed consent was obtained, and data on sociodemographic and risk factors for hepatitis B virus (HBV) infection were collected. Hepatitis B viral infection was assessed using the in vitro HBsAg diagnostic rapid kit (Acon Laboratories, USA). Descriptive statistics, Chi-square test, and logistic regression were performed to identify predictors of HBV infection in the study population. All statistical analyses were carried out on STATA version 15. Results: Of the 3,238 women enrolled, 7.4% (241/3238) (95% confidence interval [CI] = 6.6% to 8.4%) were HBsAg positive. The absence of HBV vaccination (adjusted odds ratio [AOR] = 2.49; 95% CI = 1.49–4.09; P < 0.001), co-infection with HIV (AOR = 1.90; 95% CI = 1.18–3.08; P = 0.009), and higher parity (AOR = 1.37; 95% CI = 1.04–1.79; P = 0.024) were independently associated with HBV infection in pregnancy. Conclusions: The prevalence of HBV infection among pregnant women was high, especially among those without prior vaccination for HBV, those with HIV co-infection and higher parity.
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CASE REPORTS
Conservative esthetic management of severe dental fluorosis with in-office power bleaching
Ambar W Raut, Vijay Mantri, Priyanka V Gedam, Pooja P Phabyani
July-September 2020, 19(3):211-214
DOI:10.4103/aam.aam_52_19  PMID:32820736
Fluorosis is an endemic disease, prevailing in about 25 countries globally. Dental fluorosis is an acquired defect of enamel due to the exposure of an individual to excessive fluoride levels during tooth development. It could result in mild-to-severe discoloration of teeth, which might necessitate esthetic correction. Bleaching is one of the common treatment modalities used in the esthetic correction of such cases. In-office power bleaching is one of the techniques of tooth bleaching that involves clinical application and activation of the bleaching agent with light to accelerate the bleaching process. This case report describes the esthetic correction of severe dental fluorosis by power bleaching, without any need for invasive treatment. This report suggests that in-office power bleaching is an effective and conservative method for esthetic correction of tooth discoloration in severe dental fluorosis.
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ORIGINAL ARTICLES
Snakebite in children in Nigeria: A comparison of the first aid treatment measures with the world health organization's guidelines for management of snakebite in Africa
Obinna Chukwuebuka Nduagubam, Onyinye H Chime, Ikenna K Ndu, A Bisi-Onyemaechi, Christopher B Eke, Ogechukwu F Amadi, Obianuju O Igbokwe
July-September 2020, 19(3):182-187
DOI:10.4103/aam.aam_38_19  PMID:32820730
Background: Snakebite and envenomation remains a public health problem with significant morbidity and mortality in children in developing countries. The World Health Organization (WHO) in 2010 developed guidelines for the prevention and management of snakebite in Africa. Aim: The aim of this study was to compare the pattern of first aid treatment among children presenting with snakebite/envenomation with the 2010 WHO guideline for the prevention and clinical management of snakebite in Africa. Patients and Methods: All children who presented with snakebite over a 7-year period in a teaching hospital in Enugu, Nigeria. The first aid treatment given to these children was obtained and was compared with the provisions of the WHO guideline for the prevention and clinical management of snakebite in Africa (2010). Data collected were analyzed using SPSS version 22. Results: Five (71.4%) of the snakebites occurred in the rainy season and in the dark involving the lower limbs in 85.7% of cases. Six (87.5%) of the patients received one form of first aid before presentation to a health facility. None received first aid interventions in line with the WHO recommendation. Topical application of herbal concoctions to the site of the bite (37.5%) was the most common intervention. One (14.3%) of the children was promptly brought to the health facility following snakebite. The interval from bite to presentation to the health facility ranged from 1 to 12 h (median 5 h: 43 min). Conclusion: Huge gaps still exist in the first aid treatment given to snakebite victims compared to the WHO guidelines.
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CASE REPORTS
Refractory lupus panniculitis treated successfully with rituximab: Two cases
Partisha Gupta, Aditya Dhanawat, Ipsita Mohanty, Prasanta Padhan
July-September 2020, 19(3):207-210
DOI:10.4103/aam.aam_42_19  PMID:32820735
Lupus panniculitis is usually difficult to treat, and the patient is often put on multiple immunosuppressives with variable clinical response and relapses, notwithstanding the long-term side effects. We describe two cases of refractory lupus panniculitis which have been treated successfully with rituximab which is a chimeric anti-CD20 antibody. It reduces the number of circulating mature B-cells, thereby reducing the autoantibodies and the mediators of inflammation. Rituximab is a good alternative to patients who are not responsive to conventional treatment options for lupus panniculitis. There have been few side effects reported by the patients, but the clinical response and psychological well-being clearly outweigh them.
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ORIGINAL ARTICLES
Clinicopathologic profile of sinonasal neoplasia in Kano, Northwestern Nigeria: A 10-year single-institution experience
Abdulrazak Ajiya, Hamisu Abdullahi, Iliyasu Yunusa Shuaibu
July-September 2020, 19(3):191-197
DOI:10.4103/aam.aam_46_19  PMID:32820732
Background: Sinonasal neoplasia comprises approximately 3% of all head-and-neck tumors. However, the incidence of these tumors may be greater in some parts of the world including Asia and Africa. Aim and Objective: The study aimed to review the clinical and histopathological pattern of sinonasal neoplasms in Kano, Nigeria. Materials and Methods: The records of patients managed for sinonasal neoplasia at the Department of Otorhinolaryngology, Aminu Kano Teaching Hospital, Kano, Nigeria, over a period of 10 years were reviewed. Information obtained from the case files included demographic characteristics, tumor characteristics, and clinical information. The data obtained were analyzed using SPSS version 23. Results: A total of 245 patients were reviewed with sinonasal neoplasms. Among these, 168 (68.57%) were males, with a sex ratio (M:F) of 2.18:1. The mean age was 40.2 ± 18.9 years. Malignant sinonasal neoplasm constituted 55.92%% of the sinonasal neoplasia, with peak age at the fifth decade. Squamous cell carcinoma was the most common histological subtypes seen in 50.36% of the patients. Inverted papilloma was the most common benign sinonasal neoplasia (42.59%). The most common symptom presented by the patients was nasal obstruction (77.55%), mostly presented within 6 months of onset of symptoms (63.67%), and farmers were the predominant (27.76%). The most common treatment modality was surgical extirpation (54%), and most of the patients presented with Stage IV disease (88%). The site of tumor was found to statistically correlate with the type of tumor among the patients (P ≤ 0.0001), whereas the type of tumor and site of tumor correlated significantly with the duration of symptoms before the presentation. Conclusion: Malignant sinonasal disease is the predominant sinonasal neoplasm in this environment, and most of the patients presented with advanced disease.
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Evaluation of pulse pressure and proportional pulse pressure as predictors of severity among patients having heart failure with reduced ejection fraction
Gnanamoorthy Kothai, A Janani, Athanallur Raman Malathy, Prasanna Karthik Suthakaran
July-September 2020, 19(3):188-190
DOI:10.4103/aam.aam_43_19  PMID:32820731
Introduction: Proportional Pulse Pressure (PPP) is a significant risk indicator in heart failure. PPP is a simple, inexpensive and easily measurable clinical index. This non-invasive test provides useful prognostic information for patients with heart failure with reduced ejection fraction (EF) particularly in those with an EF < 30% where lower proportional pulse pressure independently predicts mortality. Methods: A prospective observational study involving 150 patients with reduced ejection fraction was done. Detailed history, clinical examination and parameters like pulse pressure, proportional pulse pressure were evaluated and correlated with ejection fraction. Results: The mean age of the patients was 58.99 ± 11.03 years and the majority of the study participants (57.33 %) were between 45 and 65 years of age. The most common etiology of heart failure (HF) was coronary heart disease in this study (76%). Proportional Pulse pressure showed significant association with ejection fraction. The specificity for detecting heart failure was more for proportional pulse pressure and systolic blood pressure (95 % each). Conclusion: Proportional Pulse Pressure may help to identify HF patients who present with low cardiac output, low ejection fraction, and worse prognosis. Our current observations reinforce the importance of clinically based skills that must not be forgotten when managing HF.
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Asymptomatic Rotavirus infections among children in Maiduguri, Borno state, Northeast, Nigeria
Monilade T Akinola, Auwalu Uba, Ahmed F Umar, Ediga B Agbo
July-September 2020, 19(3):198-202
DOI:10.4103/aam.aam_55_19  PMID:32820733
Background: Rotavirus remains one of the main causative agents of gastroenteritis in young children. This happens, especially in countries (e.g., Nigeria) that have not yet introduced the vaccine into the national immunization program. A significant prevalence of Rotavirus infection both in children and adults without major symptoms has earlier been reported. This study aimed at defining the prevalence of asymptomatic Rotavirus infection from apparently healthy children in Maiduguri, Borno State, Northeastern Nigeria. Methods: A total of 269 stool samples were randomly collected from apparently healthy children <15 years of age from July 2017 to June 2018. All samples were screened using a commercially available enzyme-linked immunosorbent assay kit for the presence of Rotavirus antigen. The Rotavirus-positive samples were further subjected to polyacrylamide gel electrophoresis (PAGE) to determine their RNA electropherotypes. Results: A total of 59 stool samples (19.9%) were Rotavirus positive with peaks observed in the cold dry season, among male children, and 6–10 years of age group. A total of 50 randomly selected Rotavirus-positive samples were subjected to PAGE, and none of the samples showed either long or short profiles. Conclusion: This study shows that Rotavirus can be shed into environments without any signs and symptoms. In view of this, the Rotavirus vaccine should be considered a priority and be introduced in the existing national immunization program in Nigeria, particularly in Borno State.
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Demographic pattern of chronic lymphocytic leukemia in a tertiary hospital in Calabar, South-South Nigeria
Kingsley Akaba, Ofem Enang, Hilary Igwilo, Victor Eduve, Edakabasi Akaba, Omini Cletus, Olukayode Oshatuyi
July-September 2020, 19(3):203-206
DOI:10.4103/aam.aam_60_19  PMID:32820734
Background: Chronic lymphocytic leukemia (CLL) is a heterogeneous group of monoclonal forms of lymphoproliferative disorder, which is usually common among older adults. There is an increasing trend in the number of patients presenting with the disease. Aim: This study aims to determine the epidemiology pattern of CLL in Cross River state. Methodology: A retrospective study with 10-years data (2010–2019) obtained from the register of the Department of Haematology and Blood Transfusion, University of Calabar Teaching Hospital, Calabar. The data collected include the date of presentation, the age, gender, location of residence, and occupations of the patients. Results: A total of 47 cases were seen during the 10-year period, with a male: female ratio of 1:1. The mean age at presentation was 59 years. The majority of the patients were in their fifth and sixth decades of life. Most patients (44.68%) practice farming as their profession. Conclusion: The study has reawaken our consciousness on the increasing trend on the epidemiological burden of CLL in our environment and will help to enhance further investigation into the relationship between the rising trend and available possible risk factors in our environment.
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