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   Table of Contents - Current issue
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July-September 2021
Volume 24 | Issue 3
Page Nos. 99-144

Online since Friday, October 29, 2021

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ORIGINAL ARTICLES  

Apolipoprotein B/A1 ratio as a potential marker of cardiovascular risk in women p. 99
Olufisayo Gabriel Ayoade, Sarah Ifreke Essien, Oyebola Sonuga
DOI:10.4103/smj.smj_62_20  
Background: There has been a significant steady rise in the prevalence of cardiovascular disease (CVD) among Nigerian women within the last decade. The balance between pro-atherogenic particles and antiatherogenic particles has been markedly reflected in the apolipoprotein B/A1 ratio (Apo B/A1), and this ratio has been shown to be the strongest single lipoprotein-related cardiovascular risk factor. The cutoff value for the apo B/A1 ratio that defines high cardiovascular risk has been proposed to be 0.8 for women. This study is to determine the apo B/A1 ratio in apparently healthy Nigerian women and to evaluate the relationship of this ratio with other lipid indices. Methods: A total of 161 apparently healthy female adults between the ages of 30 and 66 years were selected for this study over a period of 6 months. Plasma total cholesterols (TC), triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C) were measured using the enzymatic methods, whereas low-density lipoprotein cholesterol (LDL-C) was calculated using the Friedewald formula. Apolipoprotein A1 and B were determined using immunoturbidimetry methods. Results: The mean of plasma apo B/A-I ratio in the studied participants was 0.68, with values ranging from 0.27 to 1.46. The percentage of participants with the apoB/apoA-I ratio exceeding 0.8 (the cutoff value for CVD risk) was 24.2%. The participants with apoB/apoA-I >0.8 were characterized by higher mean TC (216 mg/dl vs. 171 mg/dl; P < 0.001), TG (80 mg/dl vs. 66 mg/dl; P = 0.007), LDL-C (163 mg/dl vs. 120 mg/dl; P < 0.001), and lower HDL-C (36 mg/dl vs. 43 mg/dl; P < 0.001) compared with women with apoB/apoA-I < 0.8. Conclusion: This study has demonstrated that the women with apo B/A1 >0.8 have worse atherogenic lipid profile (high plasma TC, TG, low-density lipoprotein cholesterol, and low high-density cholesterol). It has also shown that only the apoB/A-I ratio correlates with other lipid markers; it should be considered as a potential useful tool in cardiovascular risk assessment in women. Its potential use in the national guideline for assessment and management of dyslipidemia will be invaluable.
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Acceptance of repeat cesarean section and its determinants among a Nigerian pregnant women population p. 104
Roy Ngozi Maduka, Nosakhare Osasere Enaruna
DOI:10.4103/smj.smj_4_20  
Background: Many women who need caesarian section in most sub Saharan Africa do not get it or do so too late, thereby resulting in an unnecessary increase in maternal and perinatal adverse outcome. Refusal of caesarian section has been attributed to poverty and sociocultural factors. Objective: The objective of the study was to determine the level of acceptance of repeat cesarean section (CS) among pregnant women attending care in a government-funded health facility with a policy of free maternity care services. Materials and Methods: This cross-sectional study surveyed 157 consecutive consenting antenatal clinic clients with previous CS presenting for booking in Central Hospital, Agbor, Delta State, Nigeria. The women completed a questionnaire with sections on sociodemographic attributes, inquiry about previous CS outcome and associated factors, a desire to accept a repeat CS if clinically indicated in index pregnancy, as well as reasons to decline a repeat CS. Results: The acceptance rate of repeat CS was 54%. Women with two or more previous CS were more likely to accept repeat CS (71.8% vs. 48.3%, prevalence ratio: 1.5; P = 0.02). There was no sociodemographic variable or any event related to the previous CS which was significantly associated with the women's choice regarding repeat CS. The rejection of repeat CS was mainly due to concerns about postoperative pain and being tagged with “failure of womanhood.” Conclusions: The level of acceptance of repeat CS in Central Hospital, Agbor, is low despite the policy of free maternity care. Along with the increasing effort to make health care affordable, attention needs to be paid to the role of patient and community engagement in the form of health education and continuous counseling to address noncost barriers to achieving improved maternal and perinatal health indices.
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Study on concordance of specific cytological diagnosis with histology in a teaching hospital p. 111
Akinfenwa Taoheed Atanda, Ramat Olayinka Faro-Tella
DOI:10.4103/smj.smj_63_17  
Background: Fine-needle aspiration cytology (FNAC), a cheap screening technique, has helped reduce the diagnostic turnaround time of palpable swellings from different anatomical sites. In light of the technique increasingly being used as a definitive diagnostic tool, it is thus important to evaluate its accuracy in making specific diagnosis beyond just being a screening tool. Objective: To determine the concordance rate between cytological and histological diagnosis Materials and Methods: Cytology and corresponding histology reports for lesions from patients with maxillofacial, lymph node, and abdominal swellings, where both were available, were compared for the concordance of specific cytological diagnosis with final histological diagnosis. Results: In the 10-year (2006–2015) studied, there were 177 complete cases in which specific diagnoses were made on cytology; of these, 135 (75.3%) were in concordance with histological diagnoses. Concordance for intra-abdominal, maxillofacial, and lymph node aspirates was 90.2%, 85.5%, and 62.9%, respectively. Cytological concordance of specific diagnosis for benign and malignant lesions was 70.7% and 79.5%, respectively. Concordances for lymphomas, carcinomas, and sarcomas were 84.1%, 68.2%, and 66.7%, respectively. The specific cytologic diagnosis was enhanced by preaspirate ultrasound scan while the absence of immunocytochemistry hampered accuracy in specific diagnosis of nodal non-Hodgkin's and Hodgkin's lymphoma (66.7% and 42.9%), respectively. Conclusion: This study concludes that FNAC is a simple technique with fairly reliable utility in proffering specific diagnosis on suitable lesions. However, in developing countries where repertoire of antibodies for immunocytochemistry may be limited, the accuracy will be improved by good clinical history and preaspirate ultrasound where necessary.
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Disease mortality audit in a Nigerian tertiary care center p. 117
Obiora Jude Uchendu
DOI:10.4103/smj.smj_51_19  
Background: Mortality audit is in developing countries is sparse despite its importance in guiding decision-making toward reversing the present high death rate. Objective: The study aims to study the profile of in-hospital mortality in a Nigerian hospital. Materials and Methods: This is a retrospective review of the records of all in-hospital mortalities at Delta State University Teaching Hospital, Nigeria, from 2016 to 2018. Information extracted from the records included age, sex, year, and cause of death. The causes were further classified with Global Burden of Disease 2017 classification. Analysis was with SPSS version 21. Results: A total of 1044 mortalities were recorded during the 3-year period, giving a mortality rate of 12.6%, with a male to female ratio of 1.3:1 and a mean age of 42.36 ± 25.23. The peak fatality were in early neonatal and 50–54 years of age group accounting for 96 (9.1%) and 87 (8.3%) cases, respectively. Communicable, maternal and nutritional diseases, noncommunicable diseases and injuries accounted for 276 (26.4%), 642 (61.5%), and 126 (12.1%) fatalities, respectively. The leading causes of fatality are stoke (17.1%), road injuries (7.7%), neonatal disorders (7.6%), HIV/AIDS (6.0%), chronic kidney disease (5.7%), diabetes mellitus (4.6%), chronic liver disease (4.4%), maternal disorders (2.6%), upper digestive system diseases (2.3%), and breast cancer (2.3%). Conclusion: The mortality pattern show male predominance, peak at neonatal period and preponderance of noncommunicable diseases, road injury and HIV/AIDS-related deaths. Increased government funding, universal health coverage, public education, and lifestyle modification are paramount to reducing mortality.
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A review of presentations and outcome of severe malaria in a tertiary hospital in northwestern Nigeria p. 124
Ibrahim Aliyu, Halima Umar Ibrahim, Umma Idris, Helen Akhiwu, Umma Abdulsalam Ibrahim, Ismail Inuwa Mohammed, Godpower Chinedu Michael
DOI:10.4103/smj.smj_44_20  
Background: Severe malaria is a major public health challenge and a leading cause of morbidity and mortality in tropical countries. Severe malaria is defined as life-threatening manifestation in the presence of asexual forms of Plasmodium falciparum in the peripheral blood; it is also caused by Plasmodium vivax and Plasmodium knowlesi. Materials and Methods: This was a 2-year point retrospective review of cases of severe malaria seen in the Emergency Pediatric Unit of Federal Medical Centre, Birnin Kudu, Jigawa state, between August and November, for each of the years 2016 and 2017. Results: Two hundred and fifty-seven cases of severe malaria were recorded during the study period: 106 (41.2%) cases in 2016 and 151 (58.8%) cases in 2017. There were 156 (60.7%) males and 101 (39.3%) females with a male-to-female ratio of 1.5:1. Their ages ranged from 0.3 to 14.0 years, with a mean age of 4.4 ± 3.6 years. Prostration was the most common form of severe disease; this was followed by multiple convulsion and severe malarial anemia. The year 2017 recorded more cases of severe malaria in all the age groups and majority of the cases were 5 years and below; and these observations were statistically significant for those with hypoglycemia (χ2 = 9.834, df = 2, P = 0.007) and hyperparasitemia (χ2 = 6.226, df = 2, P = 0.044). Majority of the subjects fitted with more than one form of severe malaria; most had two to three combinations. This observation was also statistically significant (χ2 = 12.950, df = 6, P = 0.042). Conclusion: Severe malaria remains a huge strain on the health system; prostration, multiple convulsion, and severe malaria anemia are the most common forms.
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Management of patients with patent ductus arteriosus: Challenges and outcome in low-resource settings p. 129
Ismail Inuwa Mohammed, Jameel Ismail Ahmad, Tunde Oyebanji Nurein, Naseer Ahmad Ishaq, Ibrahim Aliyu
DOI:10.4103/smj.smj_66_20  
Background: Patent ductus arteriosus (PDA) is quite a common acyanotic congenital heart disease (CHD). Its ligation in Sub-Saharan Africa is challenging due to lack of adequate cardiothoracic surgeons. We, therefore, present our experience and our challenges in our center with limited resources. Objectives: To determine the challenges and outcome of surgical ligation of PDA in our center. Methods: This was a retrospective review of all PDA ligations done from January 2012 to December 2017. Data were extracted from the operation theater register and patients files. Information such as age, sex, symptoms at presentation, intraoperative findings, and outcome of surgery were analyzed. Discordances between echocardiography and intraoperative finding of PDA were noticed in only two cases, and these were excluded from the study because PDA was not seen intraoperatively and they were referred for further evaluation. Statistical Package for the Social Sciences version 16 was used for data entry and analysis. Results: Twenty-five patients had PDA ligation during the study period; the subjects comprised 17 females and 8 males with a male-to-female ratio of 1:2. Two adult cases were recorded. Three cases had other associated CHD. All surgeries were carried out successfully and only a single case of complication was reported (4%, chylothorax). Conclusion: PDA ligation is relatively safe if properly done with successful outcome.
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Assessment of communication skills of interns in pediatrics using mini-clinical evaluation exercise p. 134
Bindu T Nair, Vandana Negi, Abhishek Prakash
DOI:10.4103/smj.smj_56_20  
Background: Interns who would be the future doctors are not being observed for communication skills at their workplace. The Mini-clinical evaluation exercise (mini-CEX) can be used as a “Work Place Based Assessment” (WPBA) tool for the assessment of the communication skills of the interns and also for giving immediate feedback. This study was done to evaluate the acceptability, feasibility, and effectiveness of mini-CEX for improving the communication skills of interns in Pediatrics. Materials and Methods: It was a prospective interventional study which was conducted in the Department of Pediatrics. Forty interns and six faculty who volunteered participated in the mini-CEX encounters. The structured assessment mini-CEX form by the American Board of Internal Medicine was used. Each intern faced six assessment sessions on mini-CEX forms with each of the faculty. At the end of the internship rotation, the perceptions of the interns and faculty were gathered by an anonymous validated questionnaire containing both close-ended (using 5-point Likert scale) and open-ended questions. Statistical Analysis Used: The descriptive data were analyzed on the Statistical Package for the Social Sciences (SPSS) version 23. also done. Qualitative data of open-ended questions were done by thematic analysis. Results: Most interns (87.5%) and all faculty (100%) felt that mini-CEX helped them in achieving good communication skills. Comparison between the 1st and the 6th encounter of mini-CEX showed an increase in the mean score values for all skill competencies, and this improvement was statistically significant (P < 0.001). Conclusions: Mini-CEX is an acceptable, feasible, and effective WPBA tool for communication skills training of interns in pediatrics.
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CASE REPORT Top

Neonatal dengue as never before - A case series p. 140
Alimelu Madireddi, Vinod Kumar Mandala, Narahari Bapanpally, Rakesh Kotha, Kalyan Chakravarthy Konda, R Haripriya
DOI:10.4103/smj.smj_41_20  
Dengue is a Flavivirus, affecting about 100 million people annually and mainly in the tropical and subtropical countries. Neonatal dengue is uncommon and usually by vertical transmission or, in the postnatal period, by horizontal transmission. We describe the clinical profile, management and outcome of neonates with dengue infection. Ten patients were prospectively recruited from August to November 2019 during dengue epidemic season at Niloufer Hospital, Hyderabad, India. Four babies had vertical mode of transmission while 6 had horizontal mode of transmission. All babies were positive for Ns1 antigen and IgM dengue serology, confirming dengue infection. Fever, flushing and thrombocytopenia were observed in all the babies while 2 babies had hypotension requiring inotropes. Oxygen supplementation was required in 8 babies. There was no recorded mortality. We conclude that neonatal dengue should be considered as a differential diagnosis in a neonate with sepsis and thrombocytopenia especially in endemic regions. Judicious use of fluids (avoid excessive) and inotropes (dopamine) form the cornerstone of dengue management in neonates.
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