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   2018| Jul-Dec  | Volume 7 | Issue 12  
    Online since November 19, 2018

 
 
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ORIGINAL ARTICLES
The usefulness of aortic arch width measurements on chest radiographs of adult patients with systemic hypertension and hypertensive heart disease
Solomon Daniel Halilu, Joshua Oluwafemi Aiyekomogbon
Jul-Dec 2018, 7(12):51-55
DOI:10.4103/nnjcr.nnjcr_25_17  
Background: Systemic hypertension is a worldwide epidemic and often called a silent killer. It is the most common cardiovascular disease among Africans, and an acknowledged potential risk factor for the development of complications such as stroke, hypertensive heart disease, hypertensive heart failure, and end-organ damage to the brain, eyes, and kidneys. Systemic hypertension and hypertensive heart disease are major causes of widened aortic arch width (AAW) which is evident on chest radiographs. Aim and Objectives: This study is aimed to establish the usefulness of AAW measurements on chest radiographs of patients with systemic hypertension and hypertensive heart disease among adults in Zaria. Materials and Methods: The present study was carried out in the Department of Radiology, Ahmadu Bello University Teaching Hospital, Zaria. Consecutive 305 hypertensive patients and equal number of normotensive individuals, age- and sex-matched controls were recruited. The chest radiographs of the participants were taken according to the standard technique. Results: The mean AAW for the hypertensive patients and controls were 4.34 cm ± 0.79 cm and 3.35 cm ± 0.63 cm, respectively. There was a significant correlation between AAW and blood pressure, particularly in patients <50 years of age. Other variables such as age, body mass index, hypertensive heart disease, and cardiothoracic ratio also correlated positively with AAW. Conclusion: The AAW showed a positive correlation with age and blood pressure with the relationship been more positive with blood pressure. Hypertensive heart disease also correlated positively with AAW.
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Vaginal hysterectomy at university of Abuja teaching hospital: A 5-year review
Amos Aku Atta, Habiba Ibrahim Abdullahi
Jul-Dec 2018, 7(12):48-50
DOI:10.4103/nnjcr.nnjcr_23_17  
Background: Vaginal hysterectomy is associated with less morbidity and mortality. However, its use appears to be underutilized in most settings in Nigeria. Objectives: The objective of the study was to determine the incidence, indications, and outcome of vaginal hysterectomy at a Nigerian Teaching Hospital. Study Design: A retrospective study of all the hysterectomies performed in the Hospital between January 1, 2010 and December 31, 2014. Results: During the period of study, there were 902 major gynecological operations, of which vaginal hysterectomy accounted for 33, giving an incidence of 3.7%. Vaginal hysterectomy was highest among patients aged 60 years and above accounting for 54.6%. The most common indication for vaginal hysterectomy was uterovaginal prolapse constituting 75.8%. The complication rate was 27.3% with postoperative pyrexia constituting 57.1% of all the complications, while hemorrhage was the least, constituting 3.0%. There was no mortality recorded. Conclusion: The incidence of vaginal hysterectomy was 3.7%. Uterovaginal prolapse was the most common indication, while postoperative pyrexia was the most common complication found.
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Knowledge, attitude, and perception of parents of children with congenital anomalies seen at a new tertiary hospital in Nigeria
Samson Olori
Jul-Dec 2018, 7(12):56-59
DOI:10.4103/nnjcr.nnjcr_27_17  
Context: Congenital anomalies (CAs) which are also known as birth defects constitute a major deficit in health indices of the world. They occur in 3%–5% of all live births and are responsible for high mortality and morbidity, especially in the infancy. Aim: This study aims to evaluate the knowledge, attitude, and perception of CAs by parents in our environment. Materials and Methods: This was a cross-sectional study in which consenting parents whose children had CAs were asked to participate by completing the semi-structured questionnaire at the end of clerking their children who presented to the pediatric surgical outpatient clinic of our hospital. The questionnaires were self-administered except for few parents who were not literate for whom an interpreter was engaged to assist them in completing the forms. Results: Sixty forms were returned completed, but seven were rejected due to poor completion representing 11.6% of the total questionnaires. The modal age at which the children presented was 0–1 month. There were 32 males and 21 females children giving a male-to-female ratio of 1.5:1. Of a total of twenty-one different CAs, Hirschsprung's disease, and spinal bifida were the most common CAs, each accounting for seven (13.2%). Twenty-two (41.5%) of respondents thought the condition could affect the development of their children, but only 20 (37.7%) could state how they would. Fifteen (28.8%) respondents believed that the defects would negatively impact the social rating and societal relevance of their children; however, 37 (37.2%) thought otherwise. Conclusion: In this study, parental concerns about the cosmetic effects and growth deficit were high. Parent's disposition on how to raise their children with these CAs points to the level of knowledge they had about them.
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Patterns and predictors of management strategies of dysmenorrhea among ghanaian undergraduate students
Ayokunle Osonuga, Martins N Ekor, Osonuga A Odusoga
Jul-Dec 2018, 7(12):39-42
DOI:10.4103/nnjcr.nnjcr_14_18  
Background and Aim: Dysmenorrhea is a major medical problem as it is the most common gynecological disorder of females of reproductive age and a major complaint of women presenting to a gynecologist. It has a repertoire of negative consequences, which can be severely incapacitating, even though not life-threatening. Our study was an attempt to understand the way Ghanaian undergraduate students managed dysmenorrhea and to see if differences exist in the way medical and nonmedical students managed it. Methodology: The study was a descriptive cross-sectional study involving 200 female undergraduate students (100 medical and 100 nonmedical students) of the University of Cape Coast, Ghana. Data were analyzed using standardized and acceptable statistical tools. P < 0.05 was considered statistically significant. Results: Only 8.9% of the women with menstrual pain sort formal medical advice for dysmenorrhea, while others either practiced self-management or did nothing (88.7%). Females with severe dysmenorrhea were more likely to seek medical help (P < 0.05). Nonmedical students were more likely to seek medical help than their counterparts in medical school. Although analgesic use was high in this study (58.9%), with the use of nonsteroidal anti-inflammatory drugs predominating (72.1%), only 28.2% had very effective control of menstrual pain. This resulted in the high use of combination of pharmacologic and nonpharmacologic means in pain control in 53.3%. Conclusion: Pain relief was grossly inadequate in this study; we advocate for widespread health education on the management of dysmenorrhea among females and their families. Healthcare personnel are also encouraged to treat patients with dysmenorrhea with empathy and offer them the best care available so as to improve their quality of life.
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Palpable breast masses in a tertiary institution of South-South Nigeria; fine-needle aspiration cytology versus histopathology: A correlation of diagnostic accuracy
Musa Itopa Stephen, Seleye-Fubara Daye, Solomon Raphael
Jul-Dec 2018, 7(12):43-47
DOI:10.4103/nnjcr.nnjcr_20_17  
Background and Objective: Fine-needle aspiration cytology (FNAC) of the breast, as part of the triple assessment approach to the diagnosis of palpable breast masses, has become a valuable preoperative tool. It is fast, inexpensive, and minimally invasive and thus has gained wide acceptance in the preoperative assessment of breast masses. This study aims to determine the diagnostic accuracy of FNAC of palpable breast masses in a tertiary hospital in Nigeria. Materials and Methods: This is a prospective comparative study comprising the reports of the FNAC of palpable breast masses and their subsequent tissue biopsy diagnoses recorded over 1 year from September 1, 2013, to August 31, 2014. Results: A total of 100 consecutive FNAC reports were made during the study period. There were 98 females (98%) and 2 males (2%). The age range of the patients was 18–65 years with a mean age of 42.5 years at presentation. On cytodiagnosis; 14 (14%) cases were inadequate samples (C1), 52 (52%) cases were benign (C2) lesions, 2 (2%) cases were suspicious probably benign (C3) lesions, 4 (4%) cases were suspicious probably malignant (C4) lesions, and 28 (28%) were malignant (C5) lesions. The cytology reports were correlated with the subsequent histological diagnoses. Of the 14 C1 reports, 13 were confirmed on tissue histology as benign lesions and the remaining 1 as malignant. Fifty-one of the 52 C2 reports were confirmed as truly benign (true negatives) and the remaining 1 as malignant (false negative). The overall suspicious rate (C3 and C4) was 6% with the 2 C2 reports confirmed as benign and 3 of the 4 C4 reports confirmed on histology as malignant. All 28 malignant (C5) reports were confirmed by tissue histology as malignant (true positive). The absolute sensitivity was 84.9%, complete sensitivity was 93.9%, specificity was 98.2%, positive predictive value (C5) was 100%, negative predictive value (C2) was 98.2%, false-negative rate was 3.0%, and suspicious rate was 4.3%. Conclusion: FNAC of palpable breast masses shows high sensitivity and specificity in our center. It is strongly recommended to be done on all patients presenting with palpable breast masses to ensure quicker pathologist–surgeon communication, patients' triage, and early establishment of definitive treatment outline.
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Clinical pattern of human immunodeficiency virus-associated sensory neuropathy among adults in Kano, Northwestern Nigeria
Musbahu Rabiu, Aliyu Ibrahim, Ahmad Maifada Yakasai, Muhammad Hamza, Lukman Femi Owolabi
Jul-Dec 2018, 7(12):69-74
DOI:10.4103/nnjcr.nnjcr_6_18  
Background: Peripheral neuropathy has implications for drug adherence and quality of life including the physical and emotional functioning in human immunodeficiency virus (HIV)-positive individuals. The debilitating impact on the ability to carry out their daily tasks is considerable and may sometimes become longstanding. The study assessed the frequency and determinants of HIV-associated sensory neuropathy (HIV-SN) in Kano, Northwestern Nigeria, with a view to provide optimal care. Methodology: A cross-sectional survey where the brief peripheral neuropathy screening (BPNS) benign familial neonatal seizures tool was administered to 380 HIV-positive clinic attendees using systematic random sampling was carried out. Potential risk variables were subjected to multivariate analysis modeling using logistic regression statistics to determine if they are independent predictors of the HIV-SN. Results: Of the 380 study participants, 263 (69.2%) were females, with a mean age of 37.4 ± 9.9 years. The mean CD4 count and duration of the diagnosis of HIV infection of the participants were 484.5 ± 254.9 cells/mm3 and 60.9 ± 43.5 months, respectively. Using the BPNS screening (BPNS) tool, 29.2% (111/380) of the participants had HIV-SN. Independent determinants of HIV-SN in our included age >40 years (odd ratio [OR] 5.86, 95% confidential interval [CI] = 2.48–13.88, P < 0.001) and type of highly active antiretroviral therapy combination used (OR 0.36, 95% CI = 0.17–0.73, P = 0.005). Conclusion: The frequency and determinants of HIV-SN prompt the need to strengthen early screening and treatment of HIV-infected patients by physicians managing them, to improve their overall quality of life.
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CASE REPORT
Idiopathic peripheral lower-limb gangrene in infancy
TD Sough, CC Madubueze
Jul-Dec 2018, 7(12):75-78
DOI:10.4103/nnjcr.nnjcr_18_18  
Idiopathic peripheral lower-limb gangrene in infancy is a rare condition with attendant difficulty in making adequate or accurate diagnosis, as there are no clear-cut causes of the condition as the name suggests. The predisposing factors are important to consider as a guide for diagnosis and treatment, but timely intervention to restore the normal physiological status of the patient and reverse progression of ischemia is much more important. This is a presentation of two cases that were similarly managed for peripheral lower-limb idiopathic gangrene. Both cases were male infants. The conservative approach adopted in both cases yielded remarkable results.
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ORIGINAL ARTICLES
Cardiovascular risk factors in a sampled cluster of geriatric Nigerians in a tertiary hospital in South-Eastern Nigeria: Implications for primary care geriatric cardiovascular health advocacy
Gabriel Uche Pascal Iloh, John Nnaemeka Ofoedu, Okechukwu Kalu Iro
Jul-Dec 2018, 7(12):60-68
DOI:10.4103/nnjcr.nnjcr_28_16  
Background: Cardiovascular (CV) risk factors tend to aggregate in geriatric population with variable distribution. These risk factors may act as alert signals for proactive geriatric CV health programs. Aim: This study was aimed at determining the frequencies of nonconstitutional CV risk factors in a sampled cluster of geriatric Nigerians in a tertiary hospital in South-eastern Nigeria. Setting and Design: This was a cross-sectional study carried out on a sampled of 280 geriatric Nigerians at the primary care clinic of Federal Medical Centre, Umuahia, Nigeria, between May 2012 and October 2012. Subjects and Methods: Geriatric Nigerians aged 60 years and above were screened for nonconstitutional risk factors of CV disease. The data collected included sociodemographic variables, metabolic, dietary, and behavioral risk factors using a structured, pretested, and researcher administered the questionnaire. Results: The top five most common CV risk factors were as follows: physical inactivity (67.1%), inadequate fruits consumption (65.7%), hypertension (48.2%), abdominal obesity (47.9%), and dyslipidemia (36.8%). Others were general obesity (31.1%), inadequate vegetable consumption (22.5%), diabetes mellitus (15.7%), habitual use of alcohol beverages (9.0%), habitual use of snuff (3.9%), and nonhabitual smoking of cigarettes (2.8%). Conclusion: This study has demonstrated that risk factors of CV disease exist among geriatric Nigerians in primary care with five most frequent being physical inactivity, inadequate fruits consumption, hypertension, abdominal obesity, and dyslipidemia. Screening geriatric Nigerians for modifiable CV risk factors should be integrated into geriatric primary health care in the study area.
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