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   Table of Contents - Current issue
Coverpage
September-October 2020
Volume 61 | Issue 5
Page Nos. 227-290

Online since Tuesday, October 13, 2020

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REVIEW ARTICLE  

Lessons learned from strategies for promotion of evidence-to-policy process in health interventions in the ECOWAS region: A rapid review p. 227
Chigozie Jesse Uneke, Issiaka Sombie, Ermel Johnson, Bilikis Iyabo Uneke
DOI:10.4103/nmj.NMJ_188_20  
Context: The West African Health Organization (WAHO) is vigorously supporting evidence-informed policymaking (EIPM) in the countries of West Africa. EIPM is increasingly recognized as one of the key strategies that can contribute to health systems strengthening and the improvement of health outcomes. The purpose of this rapid review is to examine two key examples of evidence-based strategies used to successfully implement health interventions in each of the West African countries and to highlight the lessons learned. Methods: A rapid review technique, defined as a type of knowledge synthesis in which systematic review processes are accelerated and methods are streamlined to complete the review more quickly, was used. A PubMed search was conducted using the combination of the following keywords: Health, policy making, evidence, plus name of each of the 15 countries to identify studies that described the process of use of evidence in policymaking in health interventions. Two examples of the publications that fulfilled the study inclusion criteria were selected. Results: Among the key processes used by the countries to promote EIPM in health interventions include policy cycle mechanism and political prioritization, rapid response services, technical advisory group and steering committees (SCs), policy dialog, capacity-strengthening mechanisms, local context evidence and operational guidelines, multisectoral action and consultative process.Conclusion: Various degrees of success have been achieved in by West African countries in the promotion of EIPM. As the science of EIPM continues to evolve and better understanding of the process is gained among policymakers, more studies on effective strategies to improve the evidence-to-policy process are advocated.
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ORIGINAL ARTICLES Top

Effect of vitamin D supplementation on thyroid autoimmunity among subjects of autoimmune thyroid disease in a coastal province of India: A randomized open-label trial p. 237
Kishore Kumar Behera, Gautom Kumar Saharia, Debasish Hota, Durgesh Prasad Sahoo, Madhusmita Sethy, Anand Srinivasan
DOI:10.4103/nmj.NMJ_200_20  
Objective: Hashimoto's thyroiditis (HT) is a variant of autoimmune thyroid disorders (AITD) which has been associated with vitamin D (vit-D) deficiency. However, whether vit-D supplementation is linked to reduction of thyroid autoantibodies and improvement of thyroid function is not well characterized. The present study was planned to evaluate the effect of vit-D supplementation on possible improvement of thyroid autoantibody titer and thyroid hormone profile in patients with AITD subjects. Methods: Twenty-three patients of HT were given weekly supplementation of 60,000 IU vit-D for 8 weeks followed by once a month for another 4 months. After 6 months of vit-D supplementation, thyroid autoantibody titer (TPO antibody) and thyroid hormone profile was rechecked. Results: Mean serum vit-D was increased significantly from 15.33 ± 5.71 to 41.22 ± 12.24 ng/mL (normal levels) after supplementation. There was significant increase in thyroid autoantibody titre (from 746.8 ± 332.2 to 954.1 ±4 59.8 IU/ml; P = 0.006) and TSH level (7.23 ± 3.16 to 3.04 ± 2.62 (mIU/L); P = 0.01) following 6 months of vit-D supplementation. Conclusion: Vitamin-D levels were low in AITD patients in eastern India and, its supplementation in HT patients increased thyroid antibody titer and there was significant reduction in serum TSH and increased in free T4.
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Hand bacterial repopulation dynamics following two methods of surgical hand preparation during elective orthopedic surgeries p. 241
Thompson Ehis Akpokonyan, Oluwadare Esan, Innocent Chiedu Ikem, Kwashie Ajibade Ako-Nai, Blessing Itohan Omo-Omorodion
DOI:10.4103/nmj.NMJ_185_19  
Context: Antiseptic hand preparations are routine prior to surgical procedures to reduce microbial load on the operating gloved hands. Two methods of surgical hand preparations available are the antibacterial detergent hand wash and an alcohol-based hand rub. Aim: The aim of the study was to compare quantitatively, the efficacy of the two methods in hand bacterial reductions during elective orthopedic surgeries. Setting and Design: This comparative study was conducted at the orthopedic surgery department of a tertiary health facility. Subjects and Methods: One-hundred and sixty dominant hands of operating surgeons and nurses involved in forty elective orthopedic surgeries were studied. The subjects were randomly assigned to either the antibacterial detergent hand-washing (HW) or the alcohol-based hand-rubbing (HR) groups. Swab samples were obtained from the hands before and after hand preparations and at the end of surgeries following removal of the operating gloves. These samples were then subjected to culture. The bacterial counts on these were then obtained through an automated colony counter, and the results were expressed in logarithmic values (log10). Statistical Analysis Used: The analysis was done using IBM SPSS software version 20. The mean results obtained were subjected to an independent t-test analysis with the statistical significance level set at P < 0.05. Results: Both methods of hand antisepsis showed comparable efficacies in attaining surgical hand hygiene at 1-min postapplication (P = 0.73). HR group, however, showed greater sustained effects during the period of surgeries, though not statistically significant (P = 0.18). Conclusion: Scrubbing using the HR method is a viable alternative to the HW method during elective orthopedic surgery.
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Prevalence and risk factors of human immunodeficiency virus and hepatitis C virus infection among pregnant women attending antenatal care at a tertiary hospital in Abuja, Nigeria p. 245
Chris Ovoroyeguono Agboghoroma, Binyerem Chigbonwu Ukaire
DOI:10.4103/nmj.NMJ_241_19  
Context: Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) co-infection in pregnant women has increased potential for Mother-to-Child Transmission risks of both viruses. The reports on the prevalence and risk factors for HIV and HCV co-infection in pregnancy are limited in Nigeria. Aim: The aim of the study is to determine the prevalence and potential risk factors for HIV and HCV infection among pregnant women in Abuja. Study Design: A cross-sectional seroprevalence study carried out on pregnant women attending antenatal clinic of a tertiary hospital in Abuja from July 1st to October 31st 2016. Patients were recruited consecutively and counselled for HIV and HCV. Structured questionnaire was used to collect socio-demographic data, and information on potential risk factors for HIV and HCV infections. Blood samples were collected for HIV and HCV screening using rapid test kits following the national testing algorithm. Data generated were analyzed with statistical package for social sciences (SPSS) version 20.0. P-value less than 0.05 was considered statistically significant. Result: 252 pregnant women participated in this study. The mean age of the study population was 31.7 ± 4.9 years. The prevalence of HIV and HCV was 12.3% and 1.2% respectively. The prevalence of HIV/HCV co-infection was 0.8%. The prevalence of HCV among HIV positive cohorts was 6.5%. HIV infection was significantly associated with history of blood transfusion (P = 0.047), presence of tattoo/scarification marks (P = 0.009) and multiple sexual partners (P < 0.0001). HCV infections was not significantly associated with any of the risk factors studied. Conclusion: HIV prevalence is high among the pregnant women. HCV co-infection is common in women who are HIV infected. HIV infection unlike HCV was significantly associated with history of blood transfusion, presence of tattoo/scarification marks and multiple sexual partners.
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Computed tomographic imaging appraisal of traumatic brain injury in a tertiary hospital in South-South Nigeria: A 6-year review Highly accessed article p. 252
Felix U Uduma, Philip Chinedu N. Okere, Ubong U Ekpene, Timothy E Nottidge
DOI:10.4103/nmj.NMJ_10_20  
Background: Computed tomography (CT) remains the gold standard in imaging evaluations of traumatic brain injury (TBI). TBI on its own has become a major concern in developing countries with its untoward effects. Objectives: The objective was to appraise the craniocerebral computed tomograms of patients who had TBIs. Materials and Methods: A retrospective study of patients who underwent craniocerebral CT on account of head injury in the University of Uyo Teaching Hospital, Uyo, Nigeria, from November 13, 2013 to May 31, 2019 was done. The duration was regardless of the disjointed periods of service interruption. Patients' demographic and CT features were evaluated with application of simple analysis of data. Results: Two hundred and thirty-two patients were evaluated with minimum and maximum ages of 6 months and 78 years, respectively. Males were predominant with a ratio of 2.74: 1. Most affected age ranges were 30–39 years (23.27%) and 20–29 (22.84%). Normal brain CT was seen in 44 patients (18.97%). The most frequent lesion in patients with abnormal CT was intracranial hemorrhages (n = 188, 81.03%). Here, extra-axial hemorrhages (n = 100, 53.19%) supersede intracerebral hemorrhages (n = 88, 46.81%). Half of the intracerebral hemorrhages were multiple. Calvarial fractures were seen in 34.48% (n = 80) of patients. The most common localization was the facial bones (n = 24, 30.00%), whereas the least site was the occipital bone (n = 4, 5.00%). Fifteen percent of the patients had multiple fractures which also included base of the skull. Conclusion: TBIs commonly occur among young active males. The most frequent lesion is intracranial hemorrhages with extra-axial bias.
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The burden of visual impairment and blindness from vitreoretinal diseases: A Nigerian tertiary hospital retina unit experience p. 257
Oluwatoyin Helen Onakpoya, Patrick Udonwa, Oluwaseun Olaniyi Awe
DOI:10.4103/nmj.NMJ_210_16  
Objective: The objective of this study is to determine the burden of visual impairment and blindness from vitreoretinal diseases in the retina unit of a Nigerian tertiary hospital. Methodology: A prospective, cross-sectional study on all consecutive new patients presenting with vitreoretinal diseases (VRD) at the vitreoretinal (VR) clinic at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife from May 2011 to April 2014. Patient's bio-data, presenting complains, Snellen's or tumbling E-chart visual acuity unaided, slit-lamp examination of the vitreous and fundus with +90/+78D, binocular indirect ophthalmoscopy as well as slit-lamp examination of anterior segment, and applanation tonometry findings were recorded in predesigned pro forma. Visual acuity was categorized using WHO/ICD. The data were analyzed using the SPSS software version 16 for simple frequencies and presented. Results: Of 2025 eyes reviewed, 112 (49.8%) eyes were visually impaired and 67 (29.8%) were blind. Eight (5.2%) patients were bilaterally blind. Diabetic retinopathy was the most common cause of bilateral blindness (25%), and concurrently, the most common VRD (29.8%). All categories of visual loss were more prevalent among the aged ≥65 years. More males (62.2%) were blind from VRD. Cataract was the most common ocular comorbidity seen (43.6%). Conclusion: The burden of visual impairment and blindness from VRD is large; eye health education for early presentation for eye care as well as the development of VR care with infrastructure upscale to include optical coherence tomography, laser, and surgical care for prompt diagnosis and treatment will be of benefit in reducing the burden.
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Risk factors for postcesarean wound infection in a tertiary hospital in Lagos, Nigeria p. 262
Kabiru Afolarin Rabiu, Fatimat Motunrayo Akinlusi, Adeniyi Abiodun Adewunmi, Taiwo Ganiyat Alausa, Idayat Adejumoke Durojaiye
DOI:10.4103/nmj.NMJ_1_20  
Background: There has been a global increase in cesarean section rates. While this has improved perinatal outcome, it is associated with complications such as wound infection. We determined risk factors for cesarean section wound infection in a tertiary hospital in Lagos, Nigeria. Materials and Methods: We prospectively studied a cohort of 906 women who had cesarean section at the Obstetrics Unit of the Lagos State University Teaching Hospital between January 1, 2011, and December 31, 2011. A comparison was made between 176 women who had wound infection and 730 women who did not using logistic regression. Results: Of the 2134 deliveries during the study, 906 (42.5%) had cesarean section and of which 176 (19.4%) had wound infection. Independent risk factors for wound infection were: preoperative anemia (adjusted odds ratio [aOR] = 1.88; 95% confidence intervals [CI] = 1.03–3.41; P = 0.0396), presence of diabetes mellitus (aOR = 7.94; 95% CI = 1.60–39.27; P = 0.0111), HIV infection (aOR = 6.34; 95% CI = 1.74–23.06; P = 0.0051), prolonged operation time (aOR = 2.30; 95% CI = 1.19–4.42; P = 0.0127), excessive blood loss at surgery (aOR = 5.05; 95% CI = 2.18–11.66; P = 0.0002), and chorioamnionitis (aOR = 9.00; 95% CI = 1.37–59.32; P = 0.0224). Conclusions: Patients with HIV infection, diabetes mellitus, preoperative anemia and chorioamnionitis have an increased risk of postcesarean wound infection as is when surgical time exceeds 1 h or when associated with blood loss >11.
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CASE REPORTS Top

Spontaneous ovarian hyperstimulation syndrome: A report of two cases from different pathogenesis p. 269
Nkem Nnenna Nwafor, Nsikak Paul Nyoyoko
DOI:10.4103/nmj.NMJ_183_20  
Spontaneous ovarian hyperstimulation syndrome (s-OHSS) is a rare finding that occurs in early pregnancy. There is a rapidly increasing ovarian size secreting vasoactive substances that lead to fluid shift into third spaces. This occurs in the absence of exogenous hormonal therapy. We present two cases of s-OHSS. A 35-year-old gravida 4 para 3 presented with complaints of progressive abdominal pain, distension, nausea, vomiting, and difficulty in breathing at 10 weeks gestation. On imaging, a singleton intrauterine gestation, enlarged ovaries containing multiple cysts, and moderate ascites were seen. Second, a 17-year-old primigravida presented with abdominal distension and pain and bleeding per vaginam following 4 months amenorrhea. A bulky uterus containing a large hyperechoic structure with multiple cystic spaces in keeping complete molar gestation and enlarged ovaries containing multiple cysts were seen on ultrasound imaging. The singleton gestation was managed successfully to term with conservative therapy tailored to clinical symptoms.
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Parathyroid adenoma with unusual presentations of rib bone and thoracic vertebrae fractures in a premenopausal female in Ibadan, Nigeria p. 273
Omolade O Adegoke, Mustapha A Ajani, Babatope L Awosusi, Francis A Onakpoma, O Saiki, A Daniel
DOI:10.4103/nmj.NMJ_29_20  
Parathyroid adenoma is the most common cause of primary hyperthyroidism which leads to abnormal calcium homeostasis, hypercalcemia, and reduction in bone density. A 37-year-old female referred from a private health facility with a 1-year history of upper back swelling and pain. The pain was worse when sitting down for long periods and with movement and relieved by rest. There was no antecedent history of trauma, but the patient had noticed poor appetite and weight loss. There were no constipation, no abdominal discomfort, and no symptom suggestive of hyperthyroidism or hypothyroidism. General physical examination revealed kyphoscoliosis, and vital signs were within normal limits. Spine X-ray showed features of cervical spondylosis. Computed tomography (CT) scan and magnetic resonance imaging showed pathologic fractures of the right 9th rib, anterior wedge compression, and reduction of T4 vertebrae with other abnormalities at T4–T5, T5–T6, T7–T8, T10–T11, and L4–L5 vertebrae. Bone marrow aspiration and serum electrophoresis were within normal limits. Serum calcium showed hypercalcemia. A CT scan of the neck was done which showed features of a right superior parathyroid adenoma. Blood count, other serum electrolytes, and thyroid function tests were all normal. A parathyroidectomy with right thyroid lobectomy was done. Histopathological examination of the resected parathyroid gland showed a diagnosis of parathyroid adenoma. A high index of suspicion is needed to diagnose this unusual presentation of parathyroid adenoma. Radiological imaging is an important tool for early diagnosis.
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Penetrating arrow injuries of the head-and-neck region: Case series and review of literature p. 276
Hamisu Abdullahi, Auwal Adamu, Muhammad Ghazali Hasheem
DOI:10.4103/nmj.NMJ_17_20  
Penetrating arrow injuries of the head-and-neck region are rare in the developed countries, but they are common in the rural communities of our country. Arrow shot to the head-and-neck region can be life-threatening due to the presence of major vessels and vital organs. Management of arrow injury to the head-and-neck region is seriously challenging, extraction of the arrows are usually difficult due to the proximity to vital structures, unskilled removal may worsen the existing injury or result in inadvertent damage to the vital structures. We presented the four cases of arrow shot to the head-and-neck region, three were managed successfully, and one was brought in dead probably due to attempt at the removal at home or poisonous nature of the arrow. Therefore, the aim of this report is to highlight our experience and challenges in the management of penetrating arrow injuries to head-and-neck region and to review some literature reports.
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Rifampicin-resistant tuberculosis in a toddler: A report of a rare paediatric case in obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria p. 281
SS Edward, JI Akande, PO Obiajunwa
DOI:10.4103/nmj.NMJ_210_20  
The emergence of resistant strains of mycobacterium tuberculosis (TB) to antituberculous drugs has compounded the management of the chronic infection. More than 90% of rifampicin (RIF)-resistant isolates are also isoniazid resistant; hence, rifampicin resistance (RR) is a surrogate marker for multidrug resistant TB (MDR-TB). Although there are limited reports of pediatric RR/MDR-TB in Nigeria, there had not been similar report in our hospital until now. A 2-year-old girl was admitted with 2-month history of fever, cough with dyspnea, and progressive weight loss. There was no known contact with adult who had chronic cough; the toddler and her parents have not been treated for TB in the past. Her chest X-ray showed nodular opacities, while gastric washout for GeneXpert MTB/RIF confirmed RIF-resistant TB. The parents declined screening for TB despite counseling. The patient was subsequently referred to a specialized center for the management of drug-resistant TB, but the parents failed to go for the treatment. Young children are at risk of developing TB disease and MDR/RR-TB, which is more complex to manage than drug-susceptible TB due to longer treatment duration, increased toxicity, as well as poor parental compliance to the demand of treatment.
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Juvenile dermatomyositis in an 11 year old Nigerian-boy: A case report and review of literature p. 284
Olusola Adetunji Oyedeji, Saheed B. A. Oseni, Olamide Valentine Kayode, Oladapo Adedayo Kolawole, Musa Tawakalit Lily
DOI:10.4103/nmj.NMJ_128_18  
We report the case of an 11-year-old boy with proximal myopathy, heliotrope, and Gottron papule-like rashes. Serum chemistry revealed muscle enzyme elevations, whereas muscle biopsy histology showed necrosis and inflammation, which were in keeping with juvenile dermatomyositis. Plain radiographic examination of the thigh 3 weeks after commencing treatment with prednisolone was normal. The aim of this presentation is to highlight the diagnostic challenges posed by this rare condition in a resource-limited setting and to underscore the need for prompt diagnosis and appropriate management. We hope that this report will assist physicians practicing in similar settings to make a prompt and accurate diagnosis when confronted with the same disease.
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Sideswipe injury of the knee: The new face of an old foe? p. 288
Olugboyega Abimbola Oyewole, Ajibola B Oladiran, Tolulope O Ogunrewo, Richard Adelana Omoyeni
DOI:10.4103/nmj.NMJ_156_19  
The term “sideswipe injury” has become synonymous and used interchangeably with the term “traffic elbow.” However, with the continuous rise in the use of the tricycle as a means of public transportation in some developing countries, a rise in sideswipe injuries of various severities is being experienced. We report a case of sideswipe injury to the left knee region of a 45-year-old female who was a passenger in the backseat of a tricycle. She sustained a severe injury to the soft tissues and bones around the knee and the popliteal region, with disruption of the neurovascular bundles in the popliteal fossa necessitating an above-knee amputation.
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