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   Table of Contents - Current issue
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October-December 2021
Volume 28 | Issue 4
Page Nos. 233-306

Online since Monday, November 29, 2021

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ORIGINAL ARTICLES  

Phenotypic profile and antibiogram of biofilm-producing bacteria isolates from diabetic foot ulcers in Zaria, Nigeria p. 233
Yahaya Usman, Adamu Girei Bakari, Idris Nasir Abdullahi, Abdurrahman El-Fulaty Ahmad, Fatima Sani-Bello, Atiene Solomon Sagay, Adebola Tolulope Olayinka
DOI:10.4103/npmj.npmj_552_21  
Background: Diabetic foot ulcers (DFUs) present with high morbidity and reduce patient's quality of life. There is a gross paucity of data on biofilm-producing bacteria in DFU Infection in North-Western Nigeria. The study sought to determine the biofilm-forming ability of bacteria isolates from DFUs and determine their antimicrobial susceptibility pattern in Zaria, North-Western Nigeria. Materials and Methods: This hospital-based cross-sectional study of patients with DFUs was conducted from June 2018 to February 2020. Consecutive biopsies were aseptically collected. Bacteria were isolated and identified using a Microgen kit. Biofilm forming ability and antibiogram of isolates were determined using microtitre plate and disk diffusion methods, respectively. Results: Of the 225 participants enrolled, males constituted the majority, 144 (64.0%) with 88 (36.0%) females, the median age of participants was 54 (48–60) years, and the age range was 36–77 years. A total of 172 bacteria were isolated, and 123 (71.5%) were biofilm producers. Staphylococcus aureus (26.7%) was the highest biofilm producer, while Citrobacter freundii and Stenotrophomonas maltophilia were the least biofilm producers, 1 (0.6%) each. A disproportionate resistance pattern was demonstrated among the biofilm and non-biofilm producers against the cephalosporins tested, ceftazidime (68% vs. 18%), ceftriaxone (50% vs. 8.0%) and cefotaxime (21% vs. 0.0%). About 46% and 68% of the biofilm producers were resistant to gentamycin and ciprofloxacin, respectively. While only 2% of the non-biofilm producers were resistant to imipenem, 11% of the biofilm producers were resistant to it. Conclusion: These findings revealed a high proportion of biofilm-producing bacteria and were more resistant than non-biofilm producers.
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Determinants of correct knowledge of coronavirus infection and COVID-19 disease pandemic among pregnant women in South-West Nigeria p. 240
Rukiyat Adeola Abdus-Salam, Temitayo Victor Lawal, Olatunji Okikiola Lawal, Fatima Motunrayo Akinlusi, Oluwasomidoyin Olukemi Bello, Imran Oludare Morhason-Bello
DOI:10.4103/npmj.npmj_650_21  
Background: As the spread of COVID-19 continues, the disease and its sequels affect antenatal, intrapartum and post-partum care, thus making pregnant women and their babies vulnerable. This study assessed the knowledge of COVID-19 disease and determinants of correct knowledge among pregnant women at the University College Hospital, Ibadan, Nigeria. Methods: A cross-sectional study was conducted among pregnant women. Data collected were analysed with STATA 16.0 software. Descriptive, bivariate and multinomial regression analyses were performed. The primary outcomes were awareness of COVID-19 (yes/no), correct knowledge, and determinants. Results: Three hundred and eighty participants were interviewed. The mean age was 32 years (±4.78). A little over a third (37%) were aged 30-34 years, married (97.1%), Yoruba (86.6%), had tertiary education (89.0), in skilled occupation (54.6%) and not well-exposed to media (56.7%). The knowledge of COVID-19 was good (15%), fair (79%), and poor (6%). About 19.6%, 66.7% and 13.7% of participants who had poor, fair and good knowledge, respectively, believed that COVID-19 exists (P = 0.007). The factors associated with good knowledge include occupation, income, level of education and exposure to media (P value <0.05). On multinomial logistic regression, occupation was significantly associated with good knowledge, while being less exposed to media was significantly associated with having poor knowledge. Conclusion: Pregnant women had fair knowledge of COVID-19 disease; occupation, level of education, exposure to media and income are associated with having correct knowledge. Misinformation and misconception about COVID-19 disease may affect maternal health utilization and pregnancy outcomes. Antenatal care presents an opportunity to provide health education and increase the knowledge of COVID-19 among pregnant women.
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Risk of exposure of dental personnel to COVID-19 and their compliance with COVID-19 safety guidance for the dental practice p. 247
Uchenna P Egbunah, Omolola O Orenuga, Wasiu L Adeyemo
DOI:10.4103/npmj.npmj_599_21  
Background: To curb the spread of the coronavirus disease 2019 (COVID-19), several guidelines for dental practice were proposed by dental practice regulating bodies. Assessing the level of compliance to these guidelines by dental personnel will provide an evidence-based report of their adherence to COVID-19 guidance and if improvement on this is required. Aim: To assess the risk of exposure of dental personnel to COVID-19 in the dental facility and their level of compliance with COVID-19 guidance for the dental practice. Methodology: This was a descriptive cross-sectional study conducted at the Dental Centre of the Lagos University Teaching Hospital, (LUTH) Lagos, Nigeria. Participants were dental personnel (resident doctors/house officers, dental nurses, dental hygienists and dental technologists) at the Dental Centre, LUTH. COVID-19 risk assessment and compliance with COVID-19 dental practice guidance were assessed using a self-administered questionnaire. Results: A total of 131 dental personnel aged 29.4 ± 5.16 years participated in this study. High risk of COVID-19 exposure was noted in trainees in conservative dentistry, paediatric dentistry, oral and maxillofacial surgery, and in dental hygienists. Eight dental personnel (6.1%) reported a confirmed diagnosis of COVID-19. Majority of included specialties reported a low (<50%) to moderate (>50%– <80%) level of compliance with the pre-treatment, during treatment and post-treatment guidance. Conclusion: Although dental personnel at the Dental Centre, LUTH had a high risk of exposure to COVID-19, they showed low-to-moderate compliance with pre-treatment, during treatment and post-treatment guidance which led to a relatively high incidence of COVID-19 transmission in the dental clinic.
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Intimate partner violence among obstetric population at university of Abuja teaching hospital, Abuja, Nigeria p. 255
Bilal Sulaiman, Kate Ifeoma Omonua, Oluwatunmobi Rachel Opadiran, Aliyu Isah Yabagi
DOI:10.4103/npmj.npmj_413_21  
Background: Perpetrators of intimate partner violence (IPV) did not spare pregnant women despite their physiological and anatomical changes in pregnancy. The epidemiology and outcomes of IPV change with time in the society. Study Objectives: The objective of the study was to determine the prevalence of and risk factors associated with IPV among pregnant women attending antenatal clinic. Settings and Design: This was a cross-sectional, hospital-based study conducted at the Antenatal Clinic of the Department of Obstetrics and Gynaecology, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria. Subjects and Methods: This study involved 403 pregnant women. The Hurt, Insult, Threaten and Scream (HITS) questionnaire was used to collect information and data recorded and analysed using SPSS version 23. Descriptive and inferential statistics (Chi-squared, Fisher's test and logistic regression) were used. Level of significance was set at P < 0.05. Results: The prevalence of IPV in pregnancy was 56.3% and the modal score was 4. About 11.9% of the women had a positive (severe) HITS score while 38.4% of the women experienced insult as the most common form of violence. There was a statistically significant association between the level of the score and marriage settings (P < 0.001), education of the woman (P < 0.001), education status of the husband (P < 0.001), occupation of the woman (P < 0.001), occupation of the husband (P < 0.001) and social habit of the husband (P < 0.001). Conclusion: The prevalence of IPV was high from this study. Improvement in education status of the husband and employment status of both the wife and the husband can significantly affect violence against women positively in our society.
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Clinical profile and treatment outcome of laryngeal cancer in a Nigerian Tertiary hospital p. 259
Iliyasu Yunusa Shuaibu, Abdulrazak Ajiya, Shofoluwe Nurudeen Adebola, Sunday Adeyemi Adewuyi, Usman Mohammed Aminu, Auwal Adamu
DOI:10.4103/npmj.npmj_657_21  
Background: Laryngeal cancer is one of the most common malignancies of the upper aerodigestive tract worldwide, and its management may sometimes be challenging, especially in developing countries due to late presentation, poverty and limited resources. Aim: This study aims to highlight the clinical profile and treatment outcome of laryngeal cancer in our centre. Patients and Methods: This was a retrospective review of patients who were managed for laryngeal cancer between January 2011 and December 2020. Results: There were 90 (89.1%) males and 11 (10.9%) females, with a male-to-female ratio of 8.2:1. The age ranged from 22 to 82 years, with a mean age of 57.2 ± 12.7 years. Fifty patients (49.5%) presented more than 1 year after the onset of the symptoms. Squamous cell carcinoma (SCCA) was the only histological diagnosis observed in our patients. The laryngeal cancer was transglottic in location in 45 (44.6%) patients, while 50 (49.5%) patients presented with Stage III disease. Twenty-one (20.8%) patients had total laryngectomy. Amongst the patients managed, 17 (17.0%) were still on follow-up. Up to 37 (37.0%) were referred for radiotherapy elsewhere after chemotherapy. Forty-one of the patients (40.0%) died during the course of their management. There was a statistically significant association between having definitive surgical management and survival beyond 5 years (Chi-square test = 8.635, P = 0.003). Conclusion: Majority of the patients presented late with transglottic SCCA. Surgical extirpation of the lesion was associated with better prognosis in our patients.
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Distribution pattern and prevalence of haematological cancers among adults in Abakaliki, South-Eastern Nigeria p. 266
Ngozi Immaculata Ugwu, Augustine Ejike Okoye, Collins N Ugwu, Festus E Iyare, Felix Osogu Edegbe, Gabriel Chima Ugwu, Ejike Felix Chukwurah, Ikeagwulonu Chinaza Richard, Davidson Okwudili John, Ugochukwu Uzodimma Nnadozie, Emmanuel Uchechukwu Nwokwu
DOI:10.4103/npmj.npmj_636_21  
Background: Haematological cancers are clonal diseases of the blood and blood-forming organs, with the distribution pattern not known in our locality. This study aimed to describe the distribution pattern and prevalence of haematological cancers among adults in Abakaliki, Nigeria. Materials and Methods: This was an 8-year retrospective study in which the hospital records/case notes of adult patients diagnosed and managed for haematological cancers from May 2012 to April 2020 were reviewed. Data obtained were analysed with the SPSS software, version 20. Results: One hundred and thirty-five cases of haematological cancers were included in the study, with 72 (53.4%) males and 63 (46.6%) females and male-to-female ratio of 1.1:1. The age range was 18–82 years, with a mean age of 49 ± 17 years. Lymphoid malignancies predominate more than myeloid (101 [74.8%] vs. 34 [25.2%]). The leukaemias were more predominant than the lymphomas and myeloma accounting for 48.2%, 36.3% and 7.4%, respectively. Chronic leukaemias were more common than the acute leukaemias with chronic lymphocytic leukaemia (CLL) being the most common accounting for 24.4% of haematological cancers. In general, non-Hodgkin's lymphoma (NHL) was the most common haematologic cancer accounting for 35 (25.9%), followed by CLL 33 (24.4%), chronic myeloid leukaemia (CML) 17 (12.6%), Hodgkin's lymphoma (HL) 14 (10.4%) and multiple myeloma (MM) 10 (7.4%). Others include acute lymphoblastic leukaemia (ALL) 9 (6.7%) and acute myeloblastic leukaemia (AML) 6 (4.4%). Myelodysplastic syndrome (MDS) and polycythaemia vera (PV), each contributed 3% while myelofibrosis (MF) and essential thrombocythaemia (ET) contributed 1.5% and 0.7%, respectively. Conclusion: This study has shown that haematological cancers are not uncommon in our locality with NHL being the most common, followed by CLL, CML, HL, MM, ALL, AML, MDS, PV. MF and ET in that order. The burden of haematological cancers in Ebonyi State, Nigeria is therefore significant and should be prioritised in health-care policy formulation and management.
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Sexual practices, risk perception and HIV self-testing acceptability among long-distance truck drivers in Ekiti State, Nigeria p. 273
Adekunle Olatayo Adeoti, Olufemi Olumuyiwa Desalu, Kehinde Sunday Oluwadiya
DOI:10.4103/npmj.npmj_618_21  
Background: HIV/AIDS is a global health challenge with a high burden in sub-Saharan Africa. Long-distance drivers are a high-risk group whose assessment of HIV status, awareness and willingness to undergo HIV self-testing (HIVST) could help prevent the spread of HIV infections. Objective: This study examined the sexual practices, risk perception and HIVST acceptability among long-distance truck drivers in Ekiti State, Nigeria. Methods: A cross-sectional study was conducted among long-distance truck drivers between September 2019 and December 2019. A semi-structured questionnaire was designed to investigate the perceived sexual risk factors and willingness to undergo HIVST. Results: Of the 306 drivers that participated in the study, almost half (49.8%) had their first sexual experience before they turned 18 years. About one-third (38.6%) had multiple sex partners and (34.0%) patronised commercial sex workers in the past 6 months. Consistent use of condoms was reported in a negligible percentage (3.0%), while 7.4% used intravenous drugs. Two-thirds of the respondents were interested in HIVST, while 32.2% knew their HIV status. Significant factors associated with multiple sex partners were the duration of working as a long-distance truck driver and patronage of sex workers. Conclusion: A significant proportion of the long-distance drivers were engaged in unsafe sexual practices and are at risk for HIV transmission. Considering the mobile nature of the long-distance drivers, the risky practices of these workers require intense advocacy, testing and treatment to reduce HIV transmission. Scaling-up testing using HIVST has the potential to bridge the gap in the diagnosis of HIV among long-distance drivers who are willing to be tested.
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Thyroid dose and cancer risk from head and neck computed tomography at two selected centres in Nigeria p. 278
Olufisayo Olalekan Awe, Rachel Ibhade Obed, Ademola Joseph Adekanmi, Godwin I Ogbole, Alaba Tolulope Agbele
DOI:10.4103/npmj.npmj_611_21  
Objective: The objective of this study was to evaluate the thyroid glands' radiation dose and the risk of thyroid cancer induction from head or neck computed tomography (CT) examinations. Methods: In a prospective study, we evaluated all participants of all ages and sex referred for Head or Neck CT Scan at the University College Hospital, Ibadan and Me Cure Healthcare Limited, Ibadan, Oyo State, Nigeria. Thyroid radiation dose was estimated with impact scan calculator, and real-time dose measurement with thermoluminescent badge dosimeters (TLDs). Data were analysed and P < 0.05 was considered statistically significant. Results: One hundred and sixty-three participants (128 adults and 35 children) participated in the study. In most participants (74%), the tube voltage was 120 kVp. The estimated median thyroid gland dose by the imPACT scan calculator was 4.95 mGy (range = 1.20–30.0 mGy) and 4.40 mGy (range = 3.0–5.10 mGy), while the real-time dose measured by the TLD was 4.79 mGy (range = 1.73–96.7 mGy) and 2.33 mGy (range = 1.20–3.73 mGy) at Centre A and B, respectively. The estimated median thyroid cancer risk was 2.88 × 10−6 (maximum range of 52 × 10−6) at centre A and a median value of 3.20 × 10−6 with a cancer risk estimate that may reach 17.9 × 10−6 recorded at centre B, compared to a cumulative thyroid cancer risk of 0.12 × 10−5 among the general Nigerian population. Conclusions: Scanner specifications and technique may significantly contribute to variations seen in thyroid radiation doses. There may be a need to optimise centre protocols and apply dose reference levels for head and neck CT examinations to reduce thyroid cancer risk in Nigeria.
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Prevalence of malnutrition and its associated sociodemographic and clinical factors among adolescents in selected schools of Urban Puducherry, India p. 285
Sneha Anil Wangaskar, Swaroop Kumar Sahu, Marie Gilbert Majella, Sathish Rajaa
DOI:10.4103/npmj.npmj_684_21  
Background: In India, adolescents constitute 21% of the total population. Majority of boys and girls in developing countries enter adolescence as undernourished, making them more vulnerable to several diseases. Objective: Among adolescents in selected schools of urban Puducherry, we determined the prevalence of malnutrition and also assessed the sociodemographic and clinical factors associated with undernutrition. Materials and Methods: A cross-sectional analytical study was conducted among adolescents (10–18 years) in selected public schools of Urban Puducherry. Data were collected using semi-structured and pre-tested questionnaires. The data collection period was between September and October 2019. Malnutrition was assessed by the World Health Organisation recommended Height-for-age and body mass index-for-age cut-offs using AnthroPlus software. Results: A total of 144 (28.9%) boys and 355 (71.1%) girls were included in the study (N = 499). The prevalence of malnutrition was 46.8% (95% confidence interval [CI]: 42.5–51.3). The prevalence of undernutrition was 33.3% (Stunting [21.6%] and Thinness [15%]). The prevalence of overweight and obesity were 10.2% and 5.8%, respectively. Male gender was found to be an independent risk factor of undernutrition (annual percentage rate = 1.4; 95% CI: 1.0–1.9); and known risk factors such as socio-economic status, parental education were not significantly associated with undernutrition. Conclusions: One in every two school-going adolescents was malnourished. Despite the high prevalence of undernourishment, over nourishment was also commonly observed. Educating parents and students about growth monitoring and dietary habits might help in bringing down the burden of malnutrition.
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Developing a programme for training phonological awareness and assessment of its effectiveness on reading skills of elementary first graders with cochlear implant p. 291
Yoones Amiri Shavaki, Farzad Weisi, Mohammad Kamali, Zahra Soleymani, Zohre Arani Kashani, Vahid Rashedi
DOI:10.4103/npmj.npmj_648_21  
Background: The current study aimed to develop a comprehensive phonological awareness intervention to train all levels of phonological awareness skills and to investigate its effect on the reading abilities of cochlear implanted children. Materials and Methods: This study was the single-subject intervention. Phonological awareness intervention programme was developed and validated by experts' opinions. Six elementary first graders with cochlear implants and weak or delayed reading development, in 5–7-year-old range, were trained in phonological awareness skills. 'Auditory test of phonological awareness skills' was used to evaluate the subjects' phonological awareness skills. Nama reading test was also used to determine the level of reading performance. Results: The results showed that all six subjects with cochlear implants had improvements of both phonological awareness skills and reading skills after participating in the phonological awareness intervention programme. This improvement was not only observed immediately after intervention but was also preserved in follow-up. Conclusion: The findings of this study demonstrated the importance of planning an intervention programme about phonological awareness skills for elementary first graders with cochlear implant, and the important role of such an intervention programme in improving their performance in phonological awareness tasks, and then in reading tasks consequently. The importance of improvement in these skills could considerably affect these children's linguistic and psychological abilities, which may facilitate their education at higher grades.
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CASE REPORT Top

Ablepharon macrostomia syndrome: Absent prepuce in the first case report in West Africa p. 298
Ezinne Ifeyinwa Nwaneli, John Onwura Chukwuka, Chinenye Maryjane Uju, Chukwunonso Obed Epundu
DOI:10.4103/npmj.npmj_318_20  
Ablepharon macrostomia syndrome (AMS) is an extremely rare congenital ectodermal dysplastic disease characterised by craniofacial, skin, skeletal and genital abnormalities. Very few cases have been reported since the first case report in 1977. We report the case of a 6-day-old male delivered to unrelated parents. He was dysmorphic with absent eyelids, eyelashes and eyebrows, large fish-shaped mouth, hyperpigmented thick anterior abdominal wall, absent prepuce amongst other features. Skull X-ray showed poorly developed zygomatic bones. The patient is being managed as a case of AMS in a multidisciplinary fashion. There is no agreement on the mode of inheritance, but authors have suggested autosomal recessive, autosomal dominant, sporadic and familial occurrences. The absence of the prepuce and hyperpigmentation of the anterior abdominal wall as was seen in our patient has not been reported. More case reports are needed to delineate the spectrum of clinical features in AMS.
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CASE SERIES REPORT Top

Case series of retinopathy of prematurity blindness in Nigeria: A wakeup call to policy makers, hospitals, ophthalmologists and paediatricians Highly accessed article p. 303
Dupe Serifat Ademola-Popoola, Adeola O Onakoya, Chinyelu Nkemdilim Ezisi, Valentina Winifred Okeigbemen, Ada E Aghaji, Kareem Olatunbosun Musa, Adedayo Omobolanle Adio, Yusuf A Ibrahim, Ngozi Chinyelu Oguego
DOI:10.4103/npmj.npmj_595_21  
Background Statement: Inadequate retinopathy of prematurity (ROP) screening coverage portends a high risk for increasing the cases of ROP blindness. This study aims to report the clinical profile of pre-term babies who developed ROP blindness, highlight the usefulness in determining screening criteria and the role of private hospitals in ROP blindness prevention. Case Series Report: Online Google form and telephone survey was conducted from May to December 2020 among paediatric ophthalmologists who provided the clinical details of ROP blind children seen between 2016 and 2020. The main outcome measured included type of the hospital of birth, gestational age, birth weight, ROP Screening and treatment, and blinding ROP Stage among children born premature. The SPSS-IBM version 26 was used for the analysis. Eighteen children blind from ROP with an equal male-to-female ratio were reported. Mean gestational age was 28.4 ± 2.2 weeks (range 26 - 34 weeks, median was 28.0 weeks). Mean birth weight was 1173.7 ± 317.9 grams (range 776 - 2100 grams, median 1125 grams). Six (33.3%) babies were born in private hospitals between 28 and 32 weeks. Sixteen (88.9%) children never had ROP screening. Fifteen (83.3%) were blind in both eyes. Six (33.3%) had Stage IVb and 12 (66.7%) Stage V. Conclusion: About 90% of the babies who became blind did not undergo ROP screening. It is crucial that all babies born at 34 weeks or earlier and have birth weight of < 1500 grams in public/private hospitals be screened for ROP to prevent this avoidable blindness in Nigeria.
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