A case of lupus nephritis flare-up in severe COVID-19 infection.

The novel Coronavirus disease 2019 (COVID-19) had rapidly spread and became a worldwide pandemic since its detection in Wuhan, China. The disease has caused significant morbidity and mortality, particularly among patients with comorbidities. The current treatment involves supportive management alongside antiviral therapy and immunosuppressant therapy in severely affected patients. We describe a case of a patient with underlying lupus nephritis (LN) who presented with severe COVID-19 infection and concomitant LN flare with acute kidney injury (AKI). The patient was treated with antiviral therapy, Favipiravir, considering his risk of developing severe COVID-19 infection. As the patients would usually have AKI alongside LN flare, we administered initial steroid therapy at a lower dose (Methylprednisolone 50mg daily) and oral hydroxychloroquine despite the initial concerns on immunosuppressant usage in COVID-19 infections. Although our patient recovered relatively well from COVID- 19 infection, he continued to have positive reverse transcriptase-polymerase chain reaction (RT-PCR) nasopharyngeal swab for COVID-19 up to 29 days of illness. His kidney function stabilised despite having persistent nephrotic range proteinuria. Hence, the attending team decided to pulse the patient with a high dose steroid (IV Methylprednisolone 250mg OD for three days) after two weeks of illness despite the persistent positive swab. The patient's condition continued to improve, and this case illustrates an approach in treating COVID-19 with concomitant active immune-mediated glomerulonephritis. We find that it is safe to institute high dose immunosuppressant in recovered COVID-19 patients two weeks after the illness.

Lung computed tomography patterns of a cluster of asymptomatic young males with COVID-19 admitted to a teaching hospital in Kuala Lumpur.

BACKGROUND AND OBJECTIVE: Coronavirus Disease 2019 (COVID- 19) was first reported in Malaysia in March 2020. We describe here the clinical characteristics and computed tomography (CT) patterns in asymptomatic young patients who had laboratory-confirmed COVID-19. METHODS: This is a retrospective observational study where 25 male in-patients with laboratory-confirmed COVID-19 in Hospital Canselor Tuanku Muhriz. Demographics, clinical data and CT images of these patients were reviewed by 2 senior radiologists. RESULTS: In total there were 25 patients (all males; mean age [±SD], 21.64±2.40 years; range, 18-27 years). Patients with abnormal chest CT showed a relatively low normal absolute lymphocytes count (median: 2.2 x 109/L) and absolute monocyte count (median: 0.5 x 109/L). Lactate dehydrogenase was elevated in 5 (20%) of the patients. The procalcitonin level was normal while elevated levels of alanine aminotransferase, total bilirubin, platelet and C-reactive protein were common. Baseline chest CT showed abnormalities in 6 patients. The distribution of the lesions were; upper lobe 3 (12%) lower lobe 3 (12%) with peripheral distribution 4 (16%). Of the 25 patients included, 4 (16%) had ground glass opacification (GGO), 1 (4%) had a small peripheral subpleural nodule, and 1 (4%) had a dense solitary granuloma. Four patients had typical CT features of COVID-19. CONCLUSION: We found that the CT imaging showed peripheral GGO in our patients. They remained clinically stable with no deterioration of their respiratory symptoms suggesting stability in lung involvement. We postulate that rapid changes in CT imaging may not be present in young, asymptomatic, non-smoking COVID-19 patients. Thus the use of CT thoraxfor early diagnosis may be reserved for patients in the older agegroups, and not in younger patients.

Practice of safety measures among inter-city commercial vehicle drivers in Kwara State, Nigeria.

INTRODUCTION: The incidence of Road Traffic Crashes (RTC) is rising world-wide, with 1.24 million people killed on the world's roads in 2010 due to non-compliance with safety measures. The objectives of the study was to determine the practice of safety measures and prevalence of road crashes among inter-city commercial vehicle drivers in Kwara State, Nigeria. METHODS: A descriptive cross-sectional study done by interviewer-administered questionnaire and blood alcohol concentration of respondents was determined using Breathalyzers. A total of 410 respondents were involved by multi-stage sampling technique; data analysis was done using EPI INFO version 3.5.1 software package. Level of significance was < 0.05 at 95% confidence level. RESULTS: More than eighty per cent of the respondents practiced safety measures and checked their vehicles before embarking on a journey. More respondents who practiced safety measures carried out driving test before issuance of license compared with those who did not (p = 0.001). Some respondents tested positive for alcohol with mean blood alcohol concentration of 23.28 ± 23.32 µg/dl. About a third of the respondents had road traffic crashes in the past. CONCLUSIONS: The drivers demonstrated good safety measures and practices before embarking on a journey. Safety practices were influenced by driving test before issuance of license. Sensitization and orientation of drivers on relevance of driving test before issuance of driving license should be promoted by all stakeholders in road safety. The enforcement of laws by government is critical to addressing challenges of road safety and security by ensuring appropriate driving test before licensing.

Clinical Presentation and Outcome of Impalement Craniocerebral Injuries - A CASE SERIES.

Non-missile, low-velocity penetrating craniocerebral injuries are uncommon among civilians and unlike missile injuries, are associated with localized brain injury and subsequent good outcome if managed appropriately. Penetrating injuries to the brain caused by a retained, relatively blunt or sharp object that perforate the brain along its longitudinal axis producing a wound track corresponding to its length of penetration, are called impalement injuries. Most of the impalement craniocerebral injuries are accidental and varying objects have been reported. We report our experience with the management of seven cases of impalement craniocerebral injuries. Five of the patients were adult male while two female children were involved. One case was from assault, others resulted from accidental injury. Left side of the cranium was more commonly involved. The impaled objects in this study included a lead pencil, a screw driver, a branch of a tree, and other metallic objects. Most of the patients had craniectomy and water tight dura repair during remover of the impaled object. All patients made good recovery following surgical intervention. Management principles entail early recognition, deliberate and careful debridement, and judicious antibiotic therapy. The surgical approach to these injuries varies, depending on the route of entry.

INTRAMEDULLARY TUBERCULOMA OF THORACIC SPINAL CORD IN AN APPARENTLY HEALTHY NIGERIAN: CASE REPORT.

Spinal intramedullary is an uncommon form of tuberculosis causing spinal cord injury in this environment. We report a case of thoracic intramedullary tuberculoma in an immunocompetent male Nigerian with negative screening for tuberculosis. He presented with 8 months history of back pain and 2 months history of progressive weakness in both lower limbs. Physical examination revealed a well-nourished man with spastic paraplegia. Chest radiograph and CT scan were normal but Magnetic resonance imaging (MRI) of the thoracolumbar region showed cord oedema and circumscribed intramedullary lesions at D12 and L1 levels with target sign. The patient was promptly prepared and had D12 and L1 laminectomy and posterior myelotomy with excision of the intramedullary lesion. Histology showed granulomatous lesion with central caseation in keeping with a tuberculoma. He was treated with a 4-drug antituberculous regimen with physiotherapy and he made complete neurological recovery 8 months post-operatively. Intramedullary tuberculoma should be considered in differential diagnosis of intramedullary tumors in this environment. Treatment with antituberculous drugs results in good outcome.

Outcomes of intensive care management of traumatic brain injury in a resource-challenged tertiary health centre.

BACKGROUND: Improved surgical care and protocol-driven intensive care interventions for head injured patients have contributed to the overall reduction in mortality in developed countries. The aim of this study is to highlight the clinical outcomes of patients with severe traumatic brain injury managed in the multispecialty ICU of our institution. STUDY DESIGN: The medical records of all patients with severe TBI managed in our 3-bedded non-dedicated ICU over a 24-month period were reviewed. Data on demographic characteristics, mechanism of injury, neuroimaging and interventions were obtained and the primary outcome measure was the mortality. RESULTS: Fifty one patients, age ranged from 2-75 years and median age of 30 years were studied. The male sex was more involved (M;F of 12;1) and motorcycle crashes caused the majority of the injury (19,{37%}). None of the patients received pre-hospital care and about half (25 {49 %}) presented six hours post trauma. Cranial CT scan showed intracranial haemorrhage in 7 of the 21 patients stabled for neuroimaging. Overall mortality was 70%, with highest mortality recorded in those who did not have post injury brain CT scan (58% vs 82%, p = 0.066). CONCLUSION: Mortality from severe TBI is very high in our environment where routine pre-hospital care and prompt transfer to neurosurgical centres are not practiced. Lack of facilities for monitoring intracranial pressure and arterial blood gases in our ICU also contributed to the high mortality.

Reproductive Health Problems and Health Seeking Behavior of Female Sex Workers in Sabon Gari Local Government Area; Zaria; Nigeria

Background: The sexual and reproductive health needs of sex workers have been neglected both in research and public health interventions. Among the reasons for this are the condemnation; stigma and ambiguous legal status of sex work in Nigeria. This study was aimed at determining the reproductive health problems and health-seeking behavior of brothel-based female sex workers (FSW). Materials and Methods: This cross-sectional study was conducted among brothel-based FSW in Sabon-Gari Local Government in Zaria; Nigeria between 1 st January 2011 and 31 st June 2011. A total of 208 FSW were randomly selected and information was obtained with the use of the semi-structured questionnaire. Data entry was done with the help of structured codes in Microsoft Excel. Descriptive analysis was carried out using the statistical package (SSPS 16-University of Bristol). Results: Majority 90.7 of the respondents had experienced reproductive morbidity in the last 3 months. Frequently experienced symptoms were vaginal discharge (63.8); acute lower abdominal pain (57.5); menstrual irregularities (37) and genital ulcer (32.3). Genital tear occurred in only 25 (9.8) respondents. Furthermore; 178 (63.6) had a termination of unwanted pregnancies. Most (32.3) sought care for their reproductive health problems from chemist shops; followed by the private hospitals in 23.6

Knowledge of Glasgow coma scale by physicians in a tertiary health institution in Nigeria.

AIMS AND OBJECTIVES: The Glasgow coma scale (GCS) form the basis for important management decisions by the attending physicians or other health personnel in the care of comatose patients. Inaccurate reporting may result in unnecessary treatment and diagnostic tests. The purpose of this study is to assess the knowledge of GCS among physicians in different specialties of training in a tertiary centre in Nigeria. MATERIALS AND METHODS: The study was a descriptive survey conducted among doctors at the University of Ilorin Teaching Hospital (UITH) Ilorin, in North Central Nigeria. Physicians from different specialties and all levels of training were surveyed. Questionnaires were administered simultaneously within a department without prior notification. Participants were instructed not to use any reference materials while completing the questionnaire. RESULTS: Majority of the physicians could indicate correctly what GCS stands for (97%) and identify each category correctly. However, only 37% could score all the categories correctly. There was a positive impact in theoretical knowledge and recall among respondents who has had training in GCS. The level of training of respondents correlated well with recall of GCS with Residents and interns faring better than fellows and medical officers. Recall of GCS scoring was least among Physicians in family medicine compared to physicians in other specialties. CONCLUSION: Improved training with retention strategies in the use of the GCS and retraining of all physicians involved in the management of the comatose patients should be the focus of future strategic plans.