July-September 2014
Online since Sunday, August 17, 2014
Acute chest syndrome p. 111
Bello Jamoh Yusuf, Abdullah A Abba, Mohammed Tasiu
DOI:10.4103/2384-5147.138930
Sickle cell anaemia - the disease that combines molecular biology, clinical features, biochemistry, pathology, natural selection, population genetics, gene expression and genomics - is the world's most common life threatening monogenic disorder. Acute chest syndrome is a common complication of SCA and it has been identified as the most common cause of mortality in adult patients with SCA. In addition to elaboration of pro-inflammatory cytokines and up-regulation of cellular adhesion molecules, interplay among red cell sequestration, fat embolism and pulmonary infection, which are the pertinent pathophysiological phenomena that operate in a vicious cycle, lead to the clinical features of ACS. Chest infection, usually caused by atypical organisms, is a more common trigger in children, while fat embolism is considered as a more common trigger in adults. More common clinical features are cough, fever and chest pain, although the pattern of these symptoms varies between children and adults cohorts. The operational definition of ACS appears to be a bit loose, making it difficult to categorically distinguish from other differential diagnoses like pneumonia, especially in resource-poor areas. However, when ACS is diagnosed, treatment should be aggressive, addressing analgesia, hydration, the use of broad-spectrum antibiotics, inhaled bronchodilators, anticoagulation and blood transfusion if required. Randomized trials on efficacy of novel agents like statins, glycoprotein IIa/IIIb inhibitors and phospholipase inhibitors are still on-going.
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Depression in long-term stroke survivors p. 119
Sani A Abubakar, Reginald O Obiakor, Anas A Sabir, Emmanuel U Iwuozuo, Marthin I Magaji
The long-term consequences of stroke, especially disability have been recognized but little attention has been paid to psychological and psychiatric consequences of stroke (particularly depression) in Nigeria. Patients with depression following stroke have poorer functional outcome and increased mortality. The aim of this study was to determine the frequency of depression at 1 year poststroke and risk factors associated with poststroke depression in Zaria, Nigeria. Materials and Methods: Consecutively presenting long-term stroke survivors attending neurology outpatients' clinic were prospectively examined 1 year poststroke, sociodemographic data were obtained from the patient using structured questionnaire. Admission stroke severity was obtained retrospectively using National Institute of Health Stroke Score. Modified Rankin scale (MRS) was used to assess the level of handicap, while screening for depression was done using the Hamilton Depression Rating Scale. Results: Sixty-eight consecutive patients (36 males, 32 females) were evaluated. The mean age of the subjects was 54.99 ± 11.8 years. Thirty-eight (55.9%) patients had right hemispheric localization of stroke lesion. Eight (11.8%) of the patients evaluated remained disabled 1 year postictus, while depression was present in 11 (16.2%). Using multiple logistic regression, the major independent determinant of depression at 1 year postictus was the presence of residual disability quantified using MRS. Conclusion: Depression occurred in 16.2% of long-term stroke survivors and the most independent determinant of depression at 1 year poststroke is degree of functional disability (handicap).
Hepatoprotective effect of methanolic leaf extract of Anacardium occidentale (cashew) on carbon-tetrachloride-induced liver toxicity in wistar rats p. 124
Daniel Ikyembe, Coston Pwavodi, Abel Nosereme Agbon
Context: Anacardium occidentale (cashew) leaf is used medicinally to treat various kinds of diseases such as diabetes, fever, bronchitis, and cetera, in different parts of the world, including Nigeria. Liver diseases are a worldwide problem. Medicinal plants are being increasingly utilized to treat a wide variety of diseases, liver disorder inclusive. Aim: This study investigated the hepatoprotective activity of pre-treatment with methanolic leaf extract of A. occidentale (MLAO) against carbon-tetrachloride (CCl 4 )-induced hepatotoxicity in Wistar rats. Materials and Methods: A total of 20 Wistar rats were divided into five groups I-V of four rats each. Group I was the control, while groups II-V were treatment groups. Groups V and IV were administered MLAO (500 mg/kg and 1000 mg/kg, oral, respectively); III administered silymarin (100 mg/kg, oral) as the reference drug and group II administered CCl 4 only. Treatment lasted a week. Twelve hours after the last treatment, hepatotoxicity was induced in the treatment group animals by administering a single dose of CCl 4 (1 ml; 1:1 solution:oil, oral). Hepatoprotective effect was studied by histological and serum marker enzymes (aspartate aminotransferase [AST], alanine aminotransferase [ALT], and alkaline phosphatase [ALP]) analysis. MLAO showed significant (P < 0.05) hepatoprotective effect by lowering the levels serum liver enzymes: AST, ALT, and ALP, which were in turn confirmed by histopathological examinations of liver sections and are comparable with the reference drug. Statistical Analysis Used: One-way analysis of variance. Results: Histological and biochemical examinations of the liver showed CCl 4 -induced hepatotoxicity. Pretreatment with MLAO, especially at dose 500 mg/kg, revealed hepatoprotective effect against chemically induced acute liver toxicity by preserving the histoarchitecture of the liver and significantly (P < 0.05) reducing of the serum marker enzymes. Conclusion: MLAO possesses significant hepatoprotective activity.
An application of Kaplan-Meier survival analysis using breast cancer data p. 132
M Usman, HG Dikko, S Bala, SU Gulumbe
Aim: Kaplan-Meier estimator provides better estimates to determine the median of the distribution of breast cancer patient's survival times following their recruitment into the study. Materials and Methods: Age, sex, occupation, stage of the disease and results of the treatment of 312 breast cancer patients were the variables used in the study. The mean age of breast cancer patients was found to be 43.39 with a standard deviation of 11.74; the overall median survival time was 10 months. This indicates that 50% of breast cancer patients survived longer than 10 months after being diagnosed with the disease. Results and Discussion: Log-rank test was used to test the significant difference between the survival experiences of the patients. Age group, stage of the breast cancer and results of the treatment, indicated a significant difference, while occupations have not shown any significant difference in the survival of the breast cancer patients.
Is topical kohl ophthalmic application associated with neonatal aseptic or bacterial conjunctivitis? p. 138
Abdulkadir Isa, Samaila Elsie, Ogala William Nuhu
Background: Aseptic conjunctivitis is a recognized type of neonatal conjunctivitis which is commonly attributed to noninfective etiological agents such as chemicals, among which prophylactics used in the prevention of ophthalmia neonatorum (ON) are themselves well documented agents of aseptic neonatal conjunctivitis. In Nigeria, routine use of prophylactics in the prevention of ON remains uncommon. However, certain ophthalmic care practices with potentials for aseptic ON abound in the various communities. This study was, therefore, undertaken with a view of evaluating the role of kohl in conjunctivitis among newborns aged 0-28 days. Materials and Methods: A retrospective review of 123 neonates who presented with features of ON to the Ahmadu Bello University Teaching Hospital Zaria was conducted. Information regarding the use of kohl and the results of microscopy, culture and sensitivity evaluation of their conjunctival swabs and scrapings were extracted among others. Results: Thirty-one (25.2%) of the reviewed 123 neonates who presented with features of ON had sterile cultures of specimens obtained from their conjunctivae. Fifty-eight (47.2%) had kohl applied, while none received prophylaxis for ON. Kohl application was not significantly associated with culture isolation (P = 0.41). Conclusion: There was the prevalent use of kohl in newborns with ophthalmia. The study did not find enough evidence associating use of kohl in the etiology of ON and, therefore, calls for more extensive studies to investigate the possible relationship to enable informed policy articulation on its use or otherwise in the newborns.
Correlation between wayne's score and laboratory evidence of thyrotoxicosis in Nigeria p. 142
Anas Ahmad Sabir, Sandra Omozehio Iwuala, Olufemi Adetola Fasanmade, Sani Atta Abubakar, Garba Yunusa Haruna, Augustine Efedaye Ohwovoriole
Background: The diagnosis of thyrotoxicosis is based on clinical suspicion and confirmed by thyroid function test. In Nigeria, measurements of thyroid function tests are not readily available therefore the need for clinical assessment remains paramount in the diagnosis and management of thyrotoxicosis. Objective: The objective was to determine the relationship between Wayne's score and biochemical indices of thyroid function in Nigerians. Materials and Methods: A total of 30 newly diagnosed patients with thyrotoxicosis referred to the Endocrinology Clinic were recruited for participation in this study. All patients had detailed history taken and thorough physical examinations performed. They were also assessed using the Wayne's score. The patients also had the biochemical evaluation of their thyroid function. The relationship between the Wayne's score values and the biochemical indices were then correlated using the Pearson's correlation coefficient. Results: All the patients with elevated thyroid hormones had elevated Wayne's score. The correlation coefficient between T3 and Wayne's score was 0.79, whereas between T4 and Wayne's score was 0.81. The average Wayne's score was 31.6. There was negative correlation between age and Wayne's score (r = ­0.86). Conclusion: The Wayne's score can be used as a screening tool for thyrotoxicosis in our environment.
Stature estimation using regression equations from hand dimensions among hausa neonates of kano state, Nigeria p. 145
MH Modibbo, SS Adebisi, MG Taura, FI Rabiu, MB Garzali
Introduction: Stature (ST) (or height) of an individual is useful information for making forensic identifications. Before estimating ST, one must determine the race, sex, and age of the individual as ST varies with these variables. Most ST estimation has been reported on adults, but there is a paucity of data in the subadult group. Objectives: Firstly, the study aimed at finding the relationship (correlation) between ST and hand dimensions (hand length [HL] and hand breadth [HB]). Secondly, is to form linear regression equations that can be used to estimate ST among the Hausa neonates. Materials and Methods: A total of 549 Hausa neonates (0-28 days) were involved in the study. HL was measured from the mid-point of the distal wrist crease, to the tip of the middle finger, while HB was measured from the head of the fifth to the head of second-metacarpal bone. ST was also measured as the projective distance between the highest point on the head (vertex), and the most posterior projecting point of the heel. Results: A significant positive correlation was found between ST and hand dimensions. Regression equations were formed for each of the measured parameters for both sexes. Conclusions: The result showed that hand dimensions can be used to estimate ST in Hausa neonates of Kano State, Nigeria.
Plasma high sensitivity c-reactive protein level in children with asthma seen at Aminu Kano teaching hospital, Kano p. 148
BI Garba, M Ibrahim, A-WBR Johnson, IA Yahaya
Background: Exact pathogenesis of asthma is unknown, however the hallmark of asthma is airway inflammation and bronchoconstriction. C-reactive protein (CRP) participates in the systemic response to inflammation and is useful in assessing airway inflammation and asthma severity. Objectives: To measure the plasma levels of high sensitivity-CRP (hs-CRP) in asthmatic and nonasthmatic children, to assess the association between demographic parameters and peak expiratory flow rate with a high level of hs-CRP and also to determine if hs-CRP is a predictor of asthma severity. Materials and Methods: A case-control study in asthmatics and nonasthmatics aged 4-15 years at Aminu Kano Teaching Hospital, Kano. Controls were age and gender matched; without asthma or other atopic conditions. The plasma level of hs-CRP was determined by particle enhanced turbidimetric method. Statistical Analysis: Appropriate statistical tests for quantitative and categorical variables were determined using SPSS. A P value < 0.05 was considered statistically significant. Results: Of the 70 stable asthmatics and 70 controls recruited, 50 (71%) were males and 20 (29%) females. The male to female ratio in both groups was 2.5:1. Fifteen of the asthmatics had attack during the study period. Twenty-five (35.7%) stable asthmatics and 12 (17.1%) of the controls had high-plasma level of hs-CRP. All 15 (100%) asthmatics that presented with an attack had high-plasma level of hs-CRP. Mean ± standard deviation hs-CRP of asthmatics with attack was 21.67 ± 6.57 mg/L which was significantly higher than that of stable asthmatics (9.68 ± 6.85 mg/L, P < 0.0001) and control group (6.96 ± 4.30 mg/L, P < 0.0001). Conclusion: Mean plasma hs-CRP levels was significantly higher (P < 0.001) in asthmatics with attack than stable asthmatics and controls. Plasma levels of hs-CRP may be a good indicator of respiratory airway inflammation.
Esophageal carcinoma presenting with cutaneous nodules p. 153
I Sufyan, SA Edaigbini, AA Liman, MB Aminu, IZ Delia
Esophageal cancer accounts for 7% of all gastrointestinal cancers but presentation with metastases in the form of cutaneous nodules is a rare occurrence. Majority of esophageal cancers are mainly those of squamous cell type and so are the reported cases of cutaneous metastasis as our own case. Here we report a 55-year old man with cutaneous metastasis from esophageal squamous cell carcinoma presenting as nodules on the face back and digital pulp with associated skeletal metastasis and pathological fractures. Our case represents the third in the reported series of digital pulp metastasis from esophageal squamous cell carcinoma. The nodule may appear before or after the onset of esophageal symptoms such as dysphagia and weight loss, and is a pointer of tumor aggressiveness.
Paraparesis and pleural effusion in a young patient: A road less travelled p. 157
Kaushik Ghosh, Atri Chatterjee, Sisir Chakraborty, Rajdip Hazra, Susmita Ghosh, Sanat Kumar Jatua
Intrapulmonary teratoma is a rare tumor of the lung, which is scarcely reported to have metastasis at presentation. Here, we report a case of a 14-year-old patient admitted with paraparesis and heaviness of the right side of the chest and was found to have compressive myelopathy along with pleural effusion. He had elevated alpha fetoprotein and beta human chorionic gonadotropin. Imaging revealed a heterogeneous, massive space lesion occupying the right hemithorax and collapse of D12 vertebra with altered marrow signal causing extradural spinal compression. Cytopathology from the tumor revealed immature teratoma cells. The patient was diagnosed as a case of intrapulmonary teratoma with vertebral metastasis. He was started on bleomycin, etoposide, cyclophosphamide chemotherapy and spinal irradiation, which was unsuccessful.
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