Medico-social characteristics of patients with eclampsia in a metropolitan hospital in North western Nigeria: is there a changing pattern?

Background: Eclampsia is a recognized cause of maternal and neonatal morbidity and mortality in North western Nigeria. It's a preventable obstetrics calamity were adequate antenatal care services are provided. Objective: To review medico-social characteristics of patients with eclampsia at a metropolitan Specialist Hospital in North-western Nigeria. Methodology: Eighty consecutive patients that presented with eclampsia at Murtala Mohammed Specialist Hospital were recruited for the study from 1st December, 2016 to 28th February, 2017. Data were collected using structured questionnaire, administered by research assistants. Information obtained included sociodemographic data, duration of fits before presentation and maternal-fetal outcome. Results: A total of 1931 patients delivered within the study period, among them 80 had eclampsia. This gives an incidence of 4.0%. Teenage pregnancy accounted for 35%. Forty-nine patients (61.2%) were primigravidae and up to 95% were booked. Majority of the patients 40(50%) had antepartum eclampsia while only 10(12.5%) had postpartum eclampsia. Most of the patients (73.8%) presented within 12 hours of convulsions and (87%) had vaginal delivery. There were 3 maternal deaths with case fatality rate of 3.8%. Live birth was achieved in 65%. Fresh still birth and Macerated still births were recorded in 20% and 12.5% respectively. Conclusion: The incidence of eclampsia is still high despite introduction of free maternity care services. Socio medical factors and poor quality of Antenatal Care services may be the contributing factors to development of eclampsia. There is need to review and improve the quality of antenatal care services offered at the primary health care centers

Effect of Alcohol Consumption on Platelet, Prothrombin Time and Activated Partial Thromboplastin Time of Alcoholics in Birnin Kebbi, Kebbi State, Nigeria.

Aims: Alcoholism is a global public health problem with significant socioeconomic implications. The aim was to investigate the effect of alcoholism on the haematological and haemostatic parameters of consecutively recruited alcoholics in Birnin Kebbi, Kebbi State and North Western Nigeria. Study Design and Methodology: This prospective case-control study included one hundred adults alcoholics [≥18 years), aged range (18-60), mean age (38.46 ± 13.26) and made up of 68 males (68%) and 32 females (32%)]. Fifty gender and age matched non-alcoholics were monitored as controls. Ethical approval was obtained from the research and ethics committee in the Faculty of Medical Laboratory Science of the Usmanu Danfodiyo University Sokoto, North Western Nigeria. Written informed consent was obtained from all study subjects after counselling. Place and Duration of Study: This study was carried out at the service laboratory in the Department of Haematology, Faculty of Medical Laboratory Science in Usmanu Danfodiyo University in Sokoto North Western Nigeria between May 2011 to February, 2012. Result: Participants for this study included 50 heavy alcoholics and 50 moderate alcoholics (subjects) and 50 age and gender –matched non-alcoholics (controls). Platelet count of non-alcoholics, moderate and heavy alcoholics was; 260.7 ± 48.17, 253.3 ± 43.16 and 130.6 ± 6.79 respectively. Platelet count was significantly lower among heavy alcoholics compared to non-alcoholics (p=0.0001). Although marginally higher, there was no statistically significant difference in the platelet count of moderate alcoholics and non-alcoholics (p=0.10). We observed a negative correlation between platelet count and duration of alcoholism (r=-0.62). The mean prothrombin time (PT) and activated partial thromboplastin time (APTT) values of non-alcoholics, moderate alcoholics and heavy alcoholics was; (14.46 ± 0.97 and 34.82 ± 13.71), (15.74 ± 1.26 and 35.78 ± 3.50) and (19.46 ± 0.93 and 43.42 ± 5.13) respectively. Prothrombin time and activated partial thromboplastin time values were significantly lower among heavy alcoholics compared to non-alcoholics (p=0.0001). PT and APTT were marginally higher among moderate alcoholics compared to non-alcoholics but the difference however was not statistically significant (p= 0.08 and 0.62 respectively). We observed a positive correlation between duration of alcoholism and prolonged prothrombin time and activated partial thromboplastin time (r = 0.46 and 0.55 respectively). Conclusion: Our study has shown that alcoholism produces a significant adverse effect on some haematological and haemostatic parameters. Evidenced data generated from this study can facilitate the development of a policy on the effective management of haematological and haemostatic complications associated with alcoholism. There is need to enact laws that regulate the production, sales and consumption of various alcoholic beverages to prevent abuse and protect the health of citizens.

Cancer of the cervix in unscreened West African women

Background: Cancer of the cervix remains an important health problem amongst women worldwide. Widespread comprehensive cervical cancer control programs have resulted in a marked reduction in the incidence and mortality in most developed countries. Developing countries bear over 80 of the global burden; with only 5 of the global resources for the control of cancer. Majority of the cases in these countries present late and are incurable at the time of diagnosis. Aim: To review the presentation and histopathological types of cervical cancer cases seen in Aminu Kano Teaching Hospital Kano; over a sixteen-year period (1995-2010). Materials and Methods: Case records of histopathologically diagnosed cases of cancer of the cervix were retrieved. Demographic data; stage of the tumor at presentation; and histopathologic type were extracted. The results were analyzed using descriptive statistics. Results: Six hundred and sixty gynecological cancers were seen during the study period; with cancer of the cervix accounting for 58.5 (386/660) cases. Among these cases with cancer of the cervix 71.1 (275/386) were grand multiparous and majority 89.7 346/386 presented with advanced disease. Squamous cell carcinoma (SCC) accounted for 86.3 (333/386) of the cancers; adenocarcinoma contributed 12.4;(48/386) and others contributed 1.3(5/386). Conclusion: Cancer of the cervix is the commonest gynecological cancer at Aminu Kano Teaching Hospital; Kano; Nigeria. SCC is the commonest histological type

Review of Intrauterine Adhesiolysis at the Aminu Kano Teaching Hospital; Kano; Nigeria

Background: Hysteroscopic adhesiolysis is shown to significantly improve the outcome of intrauterine adhesions (IUA). The Minimally Invasive Surgical Unit (MISU) of our Department recently acquired a hysteroscope which is being used for hysteroscopic adhesiolysis among others. Materials and Methods: There were 57 patients diagnosed to have IUA of which 54 case notes were available for analysis; giving a retrieval rate of 95. The information extracted includes age; parity; and menstrual pattern; predisposing factors; treatment option; outcome; complications and the year of the procedure. The data extracted were analyzed using Epi info Version 3.4.1. Chi squared test (Fisher's exact test) was used to test for statistical difference in the outcome of the modalities of treatment. P value of less than 0.05 was considered significant. Results: There were 57 cases of IUA out of 4160 gynecological patients seen; giving a prevalence of 14/1000. The mean age was 28.9 years (SD 4.5) and mean parity was 1.4 (SD 1.4). Etiologic factors include Dilatation and curettage (D and C) (33.3); Caesarean section (C/S) (31.5); manual removal of placenta and Pelvic Inflammatory Disease (PID) (7.4each); and unexplained (3.7). Mode of presentation was secondary amenorrhoea (50); oligomenorrhoea (22.2); and hypomenorrhoea (10). As for the management; 68had blind procedure while 25.9had hysteroscopic procedure. Lippes loop was used in all except three patients who had pediatric Foleys catheter instead. Upon follow-up 59.3resumed normal menses; 11.1had oligomenorrhoea; hypomenorrhoea 13and amenorrhoea 5.6. There was no statistical difference in the outcome of treatment between hysteroscopic adhesiolysis and the blind procedure when return to normal menses is considered as the end point; OR=2.27; CI 0.45-12.65; Fisher exact test (one-tailed) P=0.2184818. Conclusion: There was no significant difference between the blind and hysteroscopic procedures. Dilatation and curettage was found to be the commonest cause of IUA

A longitudinal study of serum creatinine levels in patients of rheumatoid arthritis on long term NSAID therapy.

AIM: Primary: To study the effect of long term NSAID therapy on serum creatinine in patients of rheumatoid arthritis. Secondary: To study the effect of discontinuation, reduction in the dose or continuation of NSAID and of rechallenge. MATERIAL AND METHODS: Case records of RA patients with a minimum two years of follow up were analysed. Age, sex, duration of RA, type, dose and duration of NSAID and DMARD therapy, co-morbid conditions and serial serum creatinine levels were charted. RESULTS: Ninety nine case records were studied. Incidence of abnormal creatinine level (renal insufficiency) defined as rise in creatinine equal to or above the upper limit of normal was 27.7%. This rise was asymptomatic in all patients. No NSAID was particularly associated with an increased risk in renal insufficiency. The rise of serum creatinine was reversible in most patients irrespective of discontinuation or continuation of NSAID but settled at a higher level. Rechallenge resulted in rise of serum creatinine in 50% patients. Hypertension, DM, IHD and diuretics carried a higher but not statistically significant risk of renal insufficiency. CONCLUSION: NSAID-induced asymptomatic rise of creatinine in patients of RA on long term NSAIDs is common. It is mostly reversible. Regular monitoring of serum creatinine is essential.

Description of age; sex and site distribution of large bowel cancer in the middle belt of Nigeria

Aims/Objective: To determine the distribution of bowel cancer with special emphasis on age; sex and site. Methods: One hundred and sixty cases of histologically confirmed large bowel cancers at Jos University Teaching Hospital between January 1991-December 2000 were reviewed. The records were collected from the registry of histopathology laboratory. Information regarding sex; age and site of cancers in the large bowel were extracted from referral forms and case notes. Results: The cancers occurred more commonly between the ages of 31 and 60 years. The site distribution showed that more men were affected than women. The rectum was the commonest site; which accounted for 56.9 followed by colon 32; caecum 8 and anal canal 3. The colonic cancers were more common in female than male; accounting for 56.9 and 43.1 respectively. Adenocarcinoma was the commonest histological type occurring in 90 percent of cases. None of the resected specimens could reveal a case of familial polyposis. Two cases of non-Hodgkin's lymphoma were recorded and one was in the youngest patient aged 10 years. There was histological evidence of schistosomiasis in two caecal and one rectal adenocarcinoma in this series. Conclusion: This study showed that bowel cancers are not rare as previously believed. The patients also present at a younger age in our population. Routine screening for bowel cancer in all risk patients should be carried out regularly so as to detect cancer early

Treatment of AA amyloidosis in rheumatoid arthritis.

Four patients of rheumatoid arthritis (RA) with biopsy confirmed AA amyloidosis were treated with chlorambucil. All had established but uncontrolled RA with a persistently raised ESR. Moderate (> 1 gm, < 3.5 gm/d) to nephrotic range (> 3.5 gm/d) proteinuria and a relatively well preserved renal function was noted in three patients. One patient had deranged renal function and required dialysis. On chlorambucil, there was complete recovery, partial improvement and no improvement in one patient each. The fourth patient required haemodialysis, did not tolerate chlorambucil and succumbed to the illness. Therapy with chlorambucil can benefit some patients of RA with AA amyloidosis. Leucopenia is the most important dose limiting side effect.

Adrenal histoplasmosis.

A 60 year old diabetic was admitted with the history of low grade fever and weight loss of six weeks duration. After investigations, he was detected to have bilateral adrenal masses which on biopsy proved to be due to histoplasmosis. He was treated with itraconazole and made complete recovery.

Neuroleptic malignant syndrome occurring in a suspected case of systemic lupus erythematosus.

The case of a 40 year old female patient of SLE who developed fatal neuroleptic malignant syndrome following administration of serenase (haloperidol) is reported. Relevant literature has been reviewed.