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   Table of Contents - Current issue
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January-June 2018
Volume 20 | Issue 1
Page Nos. 1-77

Online since Tuesday, May 29, 2018

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ORIGINAL ARTICLES  

Study of the effect of pantoprazole on glycemic control of type-2 diabetes mellitus in tertiary care center and hospital in North India p. 1
Prabhat K Agrawal, Subhash Chandra, Arvind K Jaiswal, Ashish Gautam, Pradeep Kumar Maheshwari
DOI:10.4103/jomt.jomt_2_18  
Context: Type 2 diabetes mellitus (type 2 DM) is a heterogeneous and complex combination of metabolic condition caused by high levels of blood glucose and insulin resistance or insulin deficiency. Some studies suggest the increased levels of gastrin following the administration of proton pump inhibitors (PPIs), which seek to improve glycemic status and increased pancreatic insulin content. Aim: We determined the effect of pantoprazole on glycemic control in patients with type 2 DM. Material and Methods: Two groups, each with 30 patients of type 2 DM under treatment with oral hypoglycemic agent, were considered for this study. Patients were treated for 24 weeks with placebo or 40 mg pantoprazole tablets twice daily. Fasting blood glucose (FBG), postprandial blood glucose (PP blood glucose), as well as glycated hemoglobin (HbA1C) before and after treatment were measured. Study: Duration 1 year. Statistical Analysis: A hospital-based, randomized, double-blind, placebo-controlled study was used. Data were expressed as mean with standard deviation, numbers, and percentage. Baseline parameters and laboratory safety parameters were compared using appropriate parametric and nonparametric tests. A P value <0.05 was considered as significant. Results: The mean FBG readings at baseline in the intervention and control groups were 170.47 ± 16.65 and 163.39 ± 14.95 mg/dL, respectively, and those at the end of intervention were 157.95 ± 14.37 and 165.32 ± 12.40 mg/dL. The within-group changes in the intervention group were statistically significant (P = 0.003). The statistical analysis between groups after intervention showed a significant differences (P = 0.03). HbA1C changes in the intervention and control groups in the study were 0.53 ± 0.03% and 0.20 ± 0.08%, respectively, but a decrease in the intervention group was statistically significant (P = 0.005). In the end, the change between the two groups was also statistically significant (P = 0.005). Conclusions: There is a significant reduction in FBG, PP blood glucose, and HbA1C after 24 weeks of pantoprazole (40 mg BID) administration, which improved glycemic control in type 2 DM patients. PPI such as pantoprazole may be a new therapeutic approach in type 2 DM in future.
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Basic anthropometric parameters and ventilatory function indices among current cigarette smokers p. 6
Muhammad D Isah, Muhammad A Makusidi, Anas A Sabir, Juliana U Okpapi, Chibueze H Njoku, Abdullahi A Abba
DOI:10.4103/jomt.jomt_24_17  
Background: Ventilatory function indices [forced vital capacity (FVC), expiratory volume in 1 (FEV1), and FEV1/FVC] are a function of the basic anthropometric parameters (weight and height). Cigarette smoking is an important confounder in the relationship between ventilatory function indices and basic anthropometric parameters. Aim: To determine the relationship between anthropometric parameters and ventilatory function among male adult cigarette smokers. Materials and Methods: This is a community-based cross-sectional study incorporating 200 male participants (150 cigarette smokers and 50 non-smokers) who met inclusion criteria using stratified random sampling technique. Participants were drawn from local governments that constituted Sokoto metropolis. Subsequently, participants had a questionnaire adapted from European Community Respiratory Health Survey administered to collect demographic, clinical and cigarette smoking data. Ventilatory function test was performed using Clement Clarke One Flow Spirometer, version 1.3 Revision 0 (Clement Clarke International, Edinburgh, UK). The highest value of each ventilatory function indices (FEV1, FVC, FEV1/FVC) was chosen for analysis. Data were summarized, and statistical tests were applied using the software Statistical Package for Social Sciences, version 19 (IBM SPSS Inc., Chicago, IL, USA). Result: The majority of study participants among cigarette smokers and control were young, single and had a form of formal education. There was no significant difference in the mean of anthropometric indices [weight, height, body mass index (BMI)] of participants (cigarette smokers) and control (non-cigarette smokers). Twenty-nine (58%) non-cigarette smokers were overweight/obese as against 35 (23.3%) participants among cigarette smokers observed to be equally overweight/obese. Mean values of the ventilatory function indices except FVC were low among study participants as compared with control. Furthermore, the mean FEV1/FVC between participants (75.60 ± 7.53) and control (82.48 ± 6.11) was statistically significant (P = 0.001). A significant correlation between anthropometric parameters (height and BMI) and ventilatory function indices (FEV1 and FVC) was observed among study participants and control. Conclusion: Ventilatory function indices are associated with anthropometric parameters among cigarette smokers. Although, BMI did not significantly affect decline in ventilatory function indices among cigarette smokers, an inverse relationship was observed between them.
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Determinants of health-related quality of life in stroke survivors in Kano, Northwest Nigeria p. 11
Salisu Aliyu, Aliyu Ibrahim, Hadiza Saidu, Lukman F Owolabi
DOI:10.4103/jomt.jomt_26_17  
Background: The long-term consequences of stroke, particularly among the young and middle-aged population in sub-Saharan Africa, constitute a major challenge to the labor work force in resource-limited settings. Previous studies have focused mainly on mortality, recurrence, and functional recovery but less on the quality of life of these patients. We sought to assess the determinants of the health-related quality of life (HRQoL) of stroke survivors in Kano, Northwestern Nigeria. Material and Methods: A prospective case–control study conducted at Aminu Kano Teaching Hospital, Nigeria over a period of 18 months where 310 (155 patients with stroke and 155 sex- and age-matched healthy controls) participants were assessed using the health-related quality of life in stroke patient-40 (HRQoLISP-40) questionnaire. Multiple logistic regression was used to identify the independent predictors of global HRQoL after controlling for other covariates. Results: The overall mean global HRQoL scores among the patients with stroke and the controls were 66.1 vs. 86.1, respectively, with a mean difference of −20.0. There mean difference in the physical and spiritual spheres were −28.1 vs. −9.1, respectively. Determinants of the poor quality of life in the stroke survivors were aphasia, lesion location, and poststroke depression. Conclusion: The HRQoL among the stroke survivors was poor, which demonstrates that the determinants if effectively subjected to evidenced-based therapeutic interventions may lead to improvement in their overall functional recovery and societal reintegration.
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Comparative sonographic assessment of renal dimensions and clinicobiochemical parameters among diabetic and nondiabetic adults in Benin City, Nigeria p. 17
Emilomo O John, Blessing O.-E Igbinedion, Adenike O Akhigbe
DOI:10.4103/jomt.jomt_27_17  
Background: Diabetes mellitus affects all major organs of the body including the kidneys. One of its effects on the kidney is alteration of renal volume. Aim: The aim of this study was to sonographically evaluate and compare the renal volume in patients with diabetes and nondiabetic controls. This study also correlated the effect of biochemical and anthropometric measurements with the renal volume. Materials and Methods: The study is prospective, comparative, and cross-sectional involving ultrasonic measurement of renal dimensions of 150 adults with diabetes and 150 nondiabetic adults at the University of Benin Teaching Hospital, Benin City, using a Sonace X6 ultrasound machine (Medison Inc., Seoul, South Korea). The anthropometric measurements and biochemical estimation of fasting blood sugar, glycosylated hemoglobin, plasma creatinine, and urinary protein were performed. Results: The right and average renal volumes were higher in the diabetics than that in the nondiabetics. The left renal volume, although higher in diabetics, was, however, not statistically significant (P = 0.219). The renal volumes (right, left, and average) showed positive correlation with height, weight, and body mass index for the group of adults with diabetes and the nondiabetic groups. The renal volumes also correlated negatively with a duration of diabetes at significant statistical levels (r = −0.453, P = 0.012; r = −0.424, P = 0.020; r = −0.404, P = 0.027 for right, left, and average kidney volumes, respectively). Conclusion: Renal changes in diabetics that affect its dimensions are demonstrable sonographically. Hence, ultrasound plays some role in monitoring diabetics.
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An epidemiologic study of traumatic head injuries in the emergency department of a tertiary health institution p. 24
Regina C Onwuchekwa, Richard C Echem
DOI:10.4103/jomt.jomt_28_17  
Introduction: Head injury (HI) is defined as physical damage to the brain or skull caused by external forces. The aim of this study was to examine the epidemiology of HI-related emergency department visits in our institution. Materials and Methods: This was a retrospective study of all patients with HI presenting at the accident and emergency department (AED) of the University of Port Harcourt Teaching Hospital from January 2013 to December 2014. The variables extracted for the study included patients’ age, gender, etiology, the severity of injury, the period of presentation, and the outcome of the management of HI by the AED. Results: HI occurred in 415 (30.9%) of the patients with trauma (1344) and 3.6% of all AED admissions (11,393). Of the patients with HI, 319 (76.9%) were males, and 96 (23.1%) were females. The male/female ratio was 3.3:1. The median age was 27 years (range − 1 month to 100 years). The highest frequency of 133 (32.0%) was in the age range of 21–30 years followed by 98 (23.6%) in the age range of 31–40 years. The most common etiologic factor was road traffic accident (RTA) [260 (62.6%)]. Most of the HIs were mild [162 (39.0%)]. More patients presented at night [161 (38.8%)]. There were 94 deaths, giving a case fatality rate of 22.6%. Conclusion: The 21–40 years age bracket was more affected by HI. RTA was the major cause of HI in our environment. The evening and night periods recorded the highest HI visits to the AED.
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Intermittent preventive therapy in pregnancy with sulfadoxine/pyrimethamine for malaria prophylaxis among parturients in Ilorin, Nigeria p. 30
Abiodun S Adeniran, Moji U Mobolaji-Ojibara, Kikelomo T Adesina, Abiodun P Aboyeji, Munirdeen A Ijaiya, Olayinka R Balogun
DOI:10.4103/jomt.jomt_32_17  
Background: The use of intermittent preventive treatment in pregnancy with sulfadoxine/pyrimethamine (IPTp-SP) for malaria remains an important tool for improving pregnancy outcome in malaria endemic areas. Objective: To assess the knowledge, attitude, and factors associated with the use of IPTp-SP among antenatal clinic attendees in Ilorin. Materials and Methods: A prospective, multicentre, cross-sectional study among consenting parturients receiving antenatal care at three public health facilities in Ilorin, Nigeria. Statistical analysis was conducted with the Statistical Package for the Social Sciences version 20.0 software (SPSS Inc., Chicago, IL, United States) with the calculation of percentages, chi square, odds ratios (ORs), and confidence intervals (CIs); P < 0.05 was considered significant. Results: There were 422 participants with mean age of 28.8 ± 4.7 years and 368 (87.2%) were aware of the use of IPTp-SP for malaria prevention, while 388 (91.9%) were willing to use IPTp-SP. Only 154 (36.5%) had prescription for IPTp-SP among whom 139 (90.3%) were compliant; IPTp-SP uptake in preceding pregnancy was 148 (59.7%). The most common reason for the nonuse of IPTp-SP prescribed was the fear of harm to the fetus (53.3%). Significant determinants of willingness to use IPTp-SP were maternal age (P = 0.007) and monthly income (P = 0.013), IPTp-SP use in preceding pregnancy (P = 0.001), and the treatment for malaria in index pregnancy (P = 0.014). On logistic regression, maternal age <20 years (OR = 36.457, 95% CI = 2.260–588.011; P = 0.011) and the use of IPTp-SP in preceding pregnancy (OR = 0.051, 95% CI = 0.010–0.252; P = 0.001) were significant predictors of willingness to use IPTp-SP. Conclusion: Parturients desire IPTp-SP, but the prescription rate by healthcare providers was low. Healthcare providers should increase the prescription and address the concerns about its teratogenicity. Governments and other agencies should prioritize free provision and the availability of SP at health facilities.
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Hematological profile of predialysis chronic kidney disease patients in a tertiary hospital in Southern Nigeria p. 36
Ikponmwosa O Iyawe, Oluseyi A Adejumo
DOI:10.4103/jomt.jomt_1_18  
Background: Chronic kidney disease (CKD) is associated with variable changes in the hematological parameters. Anemia is the most common abnormality, however, both number and function of white cells and platelets may be affected. These abnormalities are associated with poor overall clinical outcome. This study assessed the hematologic profile of pre-dialysis CKD subjects and associated factors. Materials and Methods: This was a cross-sectional study that assessed and compared the hematologic profile in 100 pre-dialysis CKD subjects and 90 healthy controls. P value of <0.05 was taken as significant. Results: Mean age of the CKD and control subjects were 49 ± 14 years and 52 ± 13 years respectively. Ninety (90%) of CKD subjects had anaemia, significantly higher than 26(28.8%) in the control group (P = 0.000). The proportion of CKD subjects with leukocytosis was significantly higher than the control subjects (P = 0.007). There was no significant difference in the proportion of CKD and control subjects with thrombocytopenia (P = 0.64). The mean cell volume was significantly lower in the CKD group compared to the control subjects (P = 0.000) . Severity of anaemia was significantly associated with CKD stage (P = 0.000) but not with etiology (P = 0.27). Conclusion: Anaemia was highly prevalent in our pre-dialysis CKD patients and was significantly associated with CKD stage. White cell count was also significantly higher in the CKD subjects and this may reflect increased risk of cardiovascular morbidity and mortality.
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A comparative analysis of mothers’ preference for specific type of phone-derived reminders for routine immunization appointments in Ilorin, Nigeria p. 42
Rasheedat M Ibraheem, Moshood A Akintola, Mohammed B Abdulkadir, Muhammed A.N Adeboye, Mohammad J Mohammad
DOI:10.4103/jomt.jomt_7_18  
Background: Forgotten immunization appointment is a factor associated with low immunization uptake in Nigeria which could be addressed by a reminder-based intervention. Thus, there is a need to identify the type of reminder which would be preferred by the recipients which was the aim of this study conducted in Ilorin, Nigeria. Materials and Methods: A descriptive, cross-sectional study involving 363 mothers was conducted at two public-based immunization centers. Responses on willingness to receive text message or call reminders, preferred timing of appointment, and language of communication, willingness to pay, antenatal, and delivery characteristics were obtained via questionnaires. Data were analyzed with the Statistical Package for the Social Sciences version 20.0 software (IBM Corporation, Virginia, USA). Results: Text messages were preferred by 189 (52.1%) mothers and call by 174 (47.9%) mothers. A day prior to the scheduled appointment was the preferred timing by 322 (88.7%) mothers. The local language was preferred by 133 (76.4%) mothers who wanted calls, and 154 (81.5%) mothers who preferred text messages wanted English language. Logistic regression identified the odds of mothers preference for text message compared with calls was eightfold to fivefold among those aged 21–25 and 31–35 years, respectively compared with those aged <21 years, with each P < 0.005. Willingness to pay at most 50 naira for the reminders increased by eightfold among those who preferred text messages compared with calls (odds ratio 8.4; 95% confidence interval 2.8–25.1). Conclusion: Phone-derived reminders are a possible deployable tool for increasing immunization coverage in Nigeria. The optimal timing for sending reminders is the day preceding the appointment. Call reminders are preferred delivered in the local language, whereas English is preferred for text messages.
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Presentation and survival in patients with hematologic malignancies in Jos, Nigeria: A retrospective cohort analysis p. 49
Ochaka J Egesie, Patricia A Agaba, Olugbenga A Silas, Chad Achenbach, Ayuba Zoakah, Oche Agbaji, Jeremiah A Madaki, Edith N Okeke, Lifang Hou, Atiene A Sagay, Robert Murphy
DOI:10.4103/jomt.jomt_8_18  
Background: Hematologic malignancies cause significant morbidity and mortality and are not uncommon in resource-limited low-income countries. However, the types, pattern of presentation, and treatment outcomes vary across regions. We assessed the presentation and overall survival (OS) over an 11-year period in adult patients with hematologic cancers in Jos, North Central Nigeria. Materials: and Methods This retrospective outcome study evaluated patients who presented with hematologic malignancies between 2005 and 2015 at the Jos University Teaching Hospital, Jos. Variables of interest were abstracted through chart reviews. Descriptive statistics were used to evaluate baseline and follow-up parameters. OS was assessed by using Kaplan–Meier method. Results: Sixty patients, contributing 25,994 person-days of follow-up were evaluated. The mean age was 43 ± 17 years and 61.7% were males. Thirty-one patients (51.7%) presented with leukemia, 45.0% with lymphoma, and 3.3% with multiple myeloma. Forty-two (70.0%) presented with advanced disease, 5 (5.2%) were human immunodeficiency virus positive and 4 (6.7%) had died at the end of follow-up. OS was 84.3% (95% confidence interval: 58.1–94.7). Survival differed by disease group (P = 0.01) and having fever at presentation (P = 0.02). Conclusion: We found long-term OS to be impacted by disease type and status of fever at presentation. Disease-specific strategies to improve early diagnosis and therapies are needed to ensure optimal outcomes in Nigerian patients.
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Thyroid profile in nondialysis-dependent patients with chronic kidney disease in a tertiary hospital in southern Nigeria p. 57
Enajite I Okaka, Ekiye Ayinbuomwan
DOI:10.4103/jomt.jomt_12_18  
Background: Chronic kidney disease (CKD) affects the hypothalamus–pituitary–thyroid axis and peripheral metabolism of thyroid hormones, which affects the concentration and activity of the hormones. Subclinical hypothyroidism (SCH) is the most common thyroid abnormality reported among patients with CKD and it has been associated with increased cardiovascular risk. The objective of this study was to determine thyroid hormone levels and thyroid disorders among Nigerian nondialysis-dependent patients with CKD. Materials and Methods: A cross-sectional, observational study was conducted in a tertiary hospital in southern Nigeria. Nondialysis-dependent patients with CKD attending the renal outpatient clinic of the hospital were recruited over a period of 3 months. Control participants were recruited from healthy consenting hospital staff. Patients with known thyroid disease were excluded. Serum thyroxine (T4), triiodothyronine (T3), and thyroid stimulating hormone (TSH) levels were assayed using the enzyme-linked immunosorbent assay method. Results: Forty patients with CKD (26 men and 14 women) and 20 healthy adults (10 men and 10 women) were studied. The mean age of patients and controls were 54.9 ± 13 years and 44.7 ± 7.3 years, respectively. The mean T4 levels for patients and controls were 4.98 ± 1.23 μg/ml and 5.49 ± 1.06 μg/ml, respectively. The median (interquartile range) values of T3 and TSH for patients were 0.8 (0.7) ηg/ml and 2.6 (3.1) μIU/ml, while that of the controls were 1.85 (2.1) ηg/ml and 1.4 (3.1) μIU/ml. Overt biochemical hypothyroidism was seen in 22% of patients while 10% of patients had SCH. Conclusion: Overt biochemical hypothyroidism was more prevalent among nondialysis-dependent patients with CKD compared to SCH in this study. A larger population study should be performed to confirm this finding among Nigerian patients with CKD.
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The prevalence and pattern of central nervous system anomalies in a neonatal unit in a tertiary hospital in Jos, north-central Nigeria p. 63
Bose O Toma, Danaan J Shilong, David D Shwe, Gyang M Bot, Udochukwu M Diala, Akinyemi O Ofakunrin, Anyebe Prince, Peter O Binitie
DOI:10.4103/jomt.jomt_10_18  
Background: Congenital anomalies are an important cause of neonatal deaths, chronic illness, and disability and are most common in low- and middle-income countries. Central nervous system (CNS) congenital anomalies are one of the most common abnormalities. Information on the burden and types of CNS anomalies will facilitate health system planning and an efficient allocation of scarce resources. We determined the prevalence and pattern of CNS congenital anomalies in a neonatal unit in Jos, north-central Nigeria. Materials and Methods: A retrospective descriptive study of all neonates admitted with CNS congenital anomalies into the neonatal unit of Jos University Teaching Hospital (JUTH) from October 2013 to September 2016 was conducted. Results: One hundred and fifty-five (14.8%) of the 1046 babies admitted during the period had congenital anomalies. Twenty-seven babies (14 males and 13 females) had CNS anomalies giving a prevalence rate of 2.6%. CNS anomalies constituted 17.4% of the 155 babies admitted with congenital anomalies. All 27 (100%) of the babies were born outside the teaching hospital, with 13 (48.2%) of them delivered at home. Neural tube defects (NTDs) were the most common CNS malformations (26; 96.3% of the CNS anomalies). Talipes equinovarus was the most common associated anomaly (6; 22.2% of the babies). Conclusion: The prevalence of CNS anomalies among admitted neonates in the JUTH is high. NTDs were the most common CNS anomalies, with myelomeningocele being the single most common disorder.
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Photodermatoses in the Nigerian albino: A study in an urban hospital in southern Nigeria p. 68
Madubuko C Roli, Onunu Abel
DOI:10.4103/jomt.jomt_30_17  
Introduction: The tropical sunshine is deleterious to the albino skin predisposing their melanin deficient skin to lentigenes, dermatoheliosis, actinic keratosis, and skin cancers. Many of them die in the early adulthood or middle age from cutaneous malignancy. We determined the prevalence and types of photodermatoses and their relationship with sun protective methods in people living with albinism in Benin City, Nigeria. Materials and Methods: This was a descriptive cross-sectional study that involved 73 albinos and 73 age and sex-matched controls. Data were collected using an interviewer-administered questionnaire and relevant information on sociodemographics, history of dermatological problems, and use of sun protection methods were obtained. Diagnosis of photodermatoses was made on clinical grounds, and dermatoscopic evaluation and skin biopsy punches were utilized where applicable to boost diagnostic accuracy. Results: The mean ages for the albino population and their controls were 24 ± 11 years and 24 ± 11 years, respectively (P = 0.994). The male:female ratio of both groups was 1:1.3 The prevalence of photodermatoses in the albino population vs. control was 57 (78.1%) vs. 7 (9.6%) (P≥0.001). The observed photodermatoses in albino population were solar lentigenes 46 (63.0%), photoaging 33 (45.2%), actinic keratosis 22 (28.6%), sun burn 12 (16.3%), and skin cancers 9 (12.3%). Photodermatoses in the albinos, occurred more frequently in those who did not use sun screens and this finding was statistically significant for solar lentigenes (P = 0.038). The spectrum of photodermatoses seen in the controls included exogenous ochronosis 6 (8.2%) and polymorphic light eruptions 1 (1.4%). Conclusion: Photodermatoses are highly prevalent in albinos. The common types were solar lentigenes, photoaging, and actinic keratosis. Photodermatoses are more common in albinos, who do not use sun protection.
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CASE REPORT Top

Patella gigantism following traditional bonesetter treatment p. 74
Somiari L Harcourt, Richard C Echem
DOI:10.4103/jomt.jomt_3_18  
The patella is the largest human sesamoid bone, lies within, and is an important component of the knee extensor mechanism. Tumors and tumor-like lesions of the patella are rare. Fractures of the patella are relatively uncommon and account for 1% of all musculoskeletal system fractures. These fractures can be managed by traditional bonesetters with attendant complications. To report a case of patella gigantism following a patella fracture which was treated by a traditional bonesetter. An 18-year-old male Nigerian presented with a 2-year history of anterior left knee swelling following a motorcycle accident. A diagnosis of closed patella fracture was made, but he declined orthodox treatment. Treatment had been from traditional bonesetters who were massaging the knee regularly for about 2 years. Clinical and radiographic examinations revealed an enlarged patella. He had patellectomy and reconstruction of the extensor mechanism of the left knee. The patella measured 22 cm × 18 cm and weighed 0.5 kg, which was regarded as a giant patella. Histopathological report of the excised patella revealed patella sclerosis. He made an uneventful recovery and presently walks about unaided. Patella gigantism can occur following treatment of patella fracture by traditional bonesetters. We recommend patellectomy and reconstruction of the extensor mechanism, whenever a giant patella is encountered.
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