Knowledge and Practice of the Referral System under the National Health Insurance Scheme among Medical and Dental Practitioners of A Large-Accredited Facility in Kano, Nigeria.

BACKGROUND: Studies on healthcare professionals' knowledge about the National Health Insurance Scheme (NHIS) are scarce. Therefore, we assessed the knowledge and practice of the NHIS referral system among Medical and Dental practitioners in a tertiary hospital in Northwest Nigeria. METHODS: This cross-sectional study involved 242 medical and dental practitioners randomly selected from nine departments for over 6-weeks. A structured self-administered questionnaire was used to collect data. Data were analyzed using descriptive and inferential statistics. RESULTS: The respondents' mean age was 35.7±6.0 years; they were predominantly males (64.9%). Their mean overall knowledge score was 58.9±23.0%, with 66.9% of respondents having inadequate overall knowledge of the NHIS referral system. Practice department (Fishers 2 exact, P=0.0019), perceived knowledge of the referral system (ꭓ =8.169, P=0.004), and having been referred as an enrolee (ꭓ2 = 6.358, P=0.012) were associated with overall-knowledge. Obstetrics-and-Gynaecology (odds ratio[OR]=0.29, 95% confident interval [CI] [0.88-0.98]), Dental and-Maxillofacial-Surgery (OR=0.08, 95%CI[0.01-0.98]), and Otorhinolaryngology (OR=0.18, 95%CI[0.04-0.80]) respondents were less likely to have adequate overall-knowledge.Although 56.2%, 50.4%, 20.7%, and 89.7% were enrolees, had received treatment as enrolees, had been referred as enrolees and treated other enrolees, respectively, an unimpressive proportion had sighted a referral letter (64.9%) or authorization code on the letter (25.2%), referred an enrolee from their department previously (51.2%) or used the NHIS referral form to write referrals (38.8%). CONCLUSION: The overall knowledge of the NHIS referral system was inadequate. The practice of the referral system was below expectation. Therefore, training medical and dental practitioners on the NHIS referral system is necessary. Training should target those who are least likely to have adequate overall knowledge.

CONTEXTE: Les études sur les connaissances des professionnels de la santé concernant le Régime d'assurance maladie national (NHIS) sont rares. Nous avons donc évalué les connaissances et la pratique du système de référence du NHIS parmi les médecins et dentistes d'un hôpital tertiaire du Nord-Ouest du Nigeria. MÉTHODES: Cette étude transversale a impliqué 242 médecins et dentistes sélectionnés de manière aléatoire dans neuf départements pendant plus de 6 semaines. Un questionnaire structuré auto-administré a été utilisé pour recueillir des données. Les données ont été analysées à l'aide de statistiques descriptives et inférentielles. RÉSULTATS: L'âge moyen des répondants était de 35,7 ± 6,0 ans ; ils étaient principalement des hommes (64,9 %). Leur score moyen global de connaissances était de 58,9 ± 23,0 %, avec 66,9 % des répondants ayant une connaissance globale insuffisante du système de référence du NHIS. Le département de pratique (test exact de Fisher, P=0,0019), la connaissance perçue du système de référence (ꭓ 2 =8,169, P=0,004) et avoir été référé en tant qu'adhérent (ꭓ 2 = 6,358, P=0,012) étaient associés à la connaissance globale. Les répondants en obstétrique-gynécologie (rapport des cotes [OR]=0,29, intervalle de confiance à 95 % [IC] [0,88-0,98]), en chirurgie dentaire et maxillo-faciale (OR=0,08, IC à 95 % [0,01-0,98]), et en oto-rhino-laryngologie (OR=0,18, IC à 95 % [0,04-0,80]) étaient moins susceptibles d'avoir une connaissance globale adéquate. Bien que 56,2 %, 50,4 %, 20,7 % et 89,7 % étaient adhérents, avaient reçu un traitement en tant qu'adhérents, avaient été référés en tant qu'adhérents et avaient traité d'autres adhérents, respectivement, une proportion peu impressionnante avait vu une lettre de référence (64,9 %) ou un code d'autorisation sur la lettre (25,2 %), avait référé un adhérent de leur département précédemment (51,2 %) ou avait utilisé le formulaire de référence du NHIS pour écrire des références (38,8 %). CONCLUSION: La connaissance globale du système de référence du NHIS était insuffisante. La pratique du système de référence était en deçà des attentes. Par conséquent, la formation des médecins et dentistes sur le système de référence du NHIS est nécessaire. La formation devrait cibler ceux qui sont moins susceptibles d'avoir une connaissance globale adéquate. MOTS-CLÉS: Connaissances et Pratiques, Professionnels de la santé, Régime national d'assurance maladie, Nigeria, Renvoi.

A novel bioinformatic method for the identification of antimicrobial peptides in metagenomes.

AIMS: This study aimed to develop a new bioinformatic approach for the identification of novel antimicrobial peptides (AMPs), which did not depend on sequence similarity to known AMPs held within databases, but on structural mimicry of another antimicrobial compound, in this case an ultrashort, synthetic, cationic lipopeptide (C12-OOWW-NH2). METHODS AND RESULTS: When applied to a collection of metagenomic datasets, our outlined bioinformatic method successfully identified several short (8-10aa) functional AMPs, the activity of which was verified via disk diffusion and minimum inhibitory concentration assays against a panel of 12 bacterial strains. Some peptides had activity comparable to, or in some cases, greater than, those from published studies that identified AMPs using more conventional methods. We also explored the effects of modifications, including extension of the peptides, observing an activity peak at 9-12aa. Additionally, the inclusion of a C-terminal amide enhanced activity in most cases. Our most promising candidate (named PB2-10aa-NH2) was thermally stable, lipid-soluble, and possessed synergistic activity with ethanol but not with a conventional antibiotic (streptomycin). CONCLUSIONS: While several bioinformatic methods exist to predict AMPs, the approach outlined here is much simpler and can be used to quickly scan huge datasets. Searching for peptide sequences bearing structural similarity to other antimicrobial compounds may present a further opportunity to identify novel AMPs with clinical relevance, and provide a meaningful contribution to the pressing global issue of AMR.

Hormonal Profile of Women Attending Fertility Clinic in Zaria, North-west, Nigeria.

BACKGROUND: Infertility affects approximately 186 million people worldwide and 8-12% of couples of reproductive age worldwide. Female infertility remains the commonest gynaecological case attended to in many fertility centres across Nigeria with a national prevalence of infertility between 10-23.6%. The hypothalamic-pituitary-gonadal (HPG) axis of hormonal interplay and organ sensitivity account for about 19% of the cause of infertility in females in Nigeria and the laboratory assessment of the hormones of this axis have been a significant goal standard in the diagnosis as well as treatment. OBJECTIVES: The study investigated the pattern of the HPG hormones seen in infertile women in a Nigerian fertility treatment centre to identify and classify the causes. METHODS: A descriptive cross-sectional randomized study of 125 participants was selected and stratified into 47 primary and 78 secondary infertility participants respectively, conducted between Oct 2016 and August 2017. The control participants consisted of apparently healthy women, age-matched. Serum levels of four hormones [luteinizing hormones (LH), follicle-stimulating hormones (FSH), prolactin, and oestradiol] were assayed using the ELISA technique. The data were analyzed using SPSS version 20, p-value ≤ 0.05 was considered significant. RESULTS: The mean age of infertile women was 30.4±5.8 years. Serum levels of prolactin (10.6±9.3) and oestradiol (301±157.9) were significantly (p= ≤ 0.05) higher among the participants. However, the levels of LH and FSH were similar among the participants and controls (p = ≤0.77 and ≤0.07 respectively). CONCLUSION: Hyperprolactinaemia and oestradiolaemia are characteristics of secondary female infertility in Nigeria. Laboratory evaluation of the hypothalamic-pituitary-gonadal axis with thyroid hormones cannot be over- emphasized for a proper diagnosis and impact on the treatment of infertility.

CONTEXTE: L'infertilité touche environ 186 millions de personnes dans le monde et 8 à 12 % des couples en âge de procréer. L'infertilité féminine reste le cas gynécologique le plus fréquent dans de nombreux centres de fertilité au Nigeria, avec une prévalence nationale de l'infertilité comprise entre 10 et 23,6 %. L'axe hypothalamohypophyso- gonadique (HPG) de l'interaction hormonale et de la sensibilité des organes représente environ 19 % des causes d'infertilité chez les femmes au Nigeria et l'évaluation en laboratoire des hormones de cet axe a été une norme importante dans le diagnostic et le traitement. OBJECTIFS DE L'ÉTUDE: L'étude a examiné le profil des hormones HPG observées chez les femmes infertiles dans un centre Nigérian de traitement de la fertilité afin d'identifier et de classer les causes. MÉTHODES: Une étude descriptive transversale randomisée de 125 participants a été sélectionnée et stratifiée en 47 participants d'infertilité primaire et 78 participants d'infertilité secondaire respectivement menée entre octobre 2016 et août 2017. Les participants de contrôle étaient des femmes apparemment en bonne santé appariées par l'âge. Les niveaux sériques de quatre hormones (hormones lutéinisantes (LH), hormones folliculo-stimulantes (FSH), prolactine et oestradiol) ont été dosés en utilisant la technique ELISA. Les données ont été analysées à l'aide de SPSS version 20, la valeur p d"0,05 a été considérée comme significative. RÉSULTATS: L'âge moyen des femmes infertiles était de 30,4±5,8. Les niveaux sériques de prolactine (10,6±9,3) et d'oestradiol (301±157,9) étaient significativement (p= ≤ 0.05) plus élevés chez les participantes. Cependant, les niveaux de LH et de FSH étaient similaires chez les participants et les témoins (p = ≤ 0.77 and ≤ 0.07 respectivement). CONCLUSION: L'hyperprolactinémie et l'oestradiolémie sont des caractéristiques de l'infertilité féminine secondaire au Nigeria. L'évaluation en laboratoire de l'axe hypothalamo-hypophysogonadique avec les hormones thyroïdiennes ne peut pas être trop soulignée pour un diagnostic approprié et un impact sur le traitement de l'infertilité. Mots clés: Profil, Hormones de reproduction, Infertilité.

Identification of HPV16's E6 gene in suspected cases of cervical lesions and docking Study of its L1 protein with active components of Echinacea purpurae.

Background: HPV 16 is the primary etiologic agent of cervical cancer and the presence of L1 and E6 oncoproteins are largely responsible for its virulence. It was the objective of this study to identify HPV16 isolates from suspected cases of cervical cancer at Specialist Hospital Sokoto and Sir Yahaya Memorail Hospiatal Birnin Kebbi, Nigeria and also to identify potent HPV16's L1 protein inhibitor using in silico analysis. Methods: A total of 144 cervical samples consisting of 21 low grade squamous intraepithelial lesion, 6 high grade lesion and 117 negative pap smears were collected. The samples were subjected for molecular detection using PCR targeting E6 gene of the virus. Data generated for the molecular prevalence was statistically analyzed using Chi-square method. AutoDock Vina was used to carry out the molecular docking between 2hr5 and Chicoric acid, curcumin and Echinacoside. Results: Out of the 144 samples, 24 samples were positive for the PCR representing 16.9% molecular prevalence rate. There is statistically significant association between cyto-diagnoses and presence of HPV16 (P < 0.05). Docking analysis showed that the Chicoric acid components of Echinacea purpurae have strong binding affinity (-8.7 kcal/mol) to the L1 protein of the HPV. Conclusion: This study provides data on HPV 16 epidemiology in northern Nigeria, and also provides novel evidence for consideration on certain interacting residues, when synthesizing Anti-HPV compounds in the wet lab.

Informed Consent: The Surgical Patient's Experience in a Tertiary Hospital in Northwest Nigeria.

BACKGROUND: Obtaining informed consent (IC) before a surgical procedure is the cornerstone of medical practice. The practice of IC continues to evolve as litigations increase. Most studies on patients' perspectives of IC are either old or were done in southern Nigeria. This study assessed the surgical patients' IC experience in a tertiary hospital in northwest Nigeria. METHODS: This cross-sectional study assessed 244 consecutive patients who had elective surgeries in surgical departments of a tertiary hospital. Pretested questionnaires were used to collect data regarding their perception of the meaning of IC, the process of obtaining it, satisfaction with how it was obtained, and factors associated with satisfaction on how consent was obtained. RESULTS: Most were females (61.9%); their mean age was 34.8±14.3 years; 52.9% and 61.9% of respondents did not believe that IC enables patient-clinician shared decision-making or patient's self-decision making, respectively. Most were allowed to ask questions (83.2%), received information on the surgical procedure (91.4%), diagnosis (97.9%); however, 38.5% and 48.8% did not receive information about surgical procedures' immediate and long-term complications, respectively. Surgical procedure explanation was mostly provided by Resident Doctors (53.7%). Most (88.9%) were satisfied with how IC was obtained; satisfaction was associated with being allowed to ask questions, receiving explanations on diagnosis, surgical-procedure, complications of surgery, available alternative treatments, and when the resident/ consultants gave the explanation (all P<0.05). CONCLUSION: Deficiencies exist in the process of getting IC. Satisfaction with this process was high though associated with following the recommended strategies. Improving the IC process will require appropriate interventions in this and similar settings.

CONTEXTE: Obtention du consentement éclairé (CI) avant une intervention chirurgicale la procédure est la pierre angulaire de la pratique médicale. La pratique de l'IC continue d'évoluer à mesure que les litiges augmentent. La plupart des études sur les patients les perspectives d'IC sont soit anciennes, soit ont été faites dans le sud du Nigeria.Cette étude a évalué l'expérience IC des patients chirurgicaux dans un tertiaire hôpital dans le nord-ouest du Nigeria. MÉTHODES: Cette étude transversale a évalué 244 études consécutives les patients qui ont subi des chirurgies non urgentes dans les services chirurgicaux d'un tertiaire hôpital. Des questionnaires prétestés ont été utilisés pour recueillir des données concernant leur perception de la signification de l'IC, le processus d'obtention,la satisfaction à l'égard de la façon dont il a été obtenu et les facteurs associés à la satisfaction quant à la façon dont le consentement a été obtenu. RÉSULTATS: La plupart étaient des femmes (61,9 %); leur âge moyen était de 34,8 ±14,3 ansannées; 52,9 % et 61,9 % des répondants ne croyaient pas que l'IC permettait la prise de décision partagée patientclinicien ou l'auto-décision du patientfaire, respectivement. La plupart ont été autorisés à poser des questions (83,2 %),reçu de l'information sur l'intervention chirurgicale (91,4 %), le diagnostic(97,9%); toutefois, 38,5 % et 48,8 % n'ont pas reçu d'information sur les complications immédiates et à long terme des interventions chirurgicales, respectivement. L'explication de la procédure chirurgicale a été principalement fournie par médecins résidents (53,7 %). La plupart (88,9 %) étaient satisfaits de la façon dont IC a été obtenu; la satisfaction était associée au fait d'être autorisé àposer des questions, recevoir des explications sur le diagnostic, la procédure chirurgicale,complications de la chirurgie, traitements alternatifs disponibles et quandle résident/les consultants ont donné l'explication (tous P<0.05). CONCLUSION: Des lacunes existent dans le processus d'obtention de l'IC.La satisfaction à l'égard de ce processus était élevée, bien qu'elle soit associée à en suivant les stratégies recommandées. L'amélioration du processus de CI permettra nécessitent des interventions appropriées dans ce contexte et dans des contextes similaires. Mots-clés: Consentement éclairé, Kano, expérience du patient, chirurgiepatients, hôpital tertiaire.

THYROID DYSFUNCTION IN WOMEN OF REPRODUCTIVE AGE: LABORATORY PROTOCOL FOR INFERTILITY EVALUATION.

Background: Infertility in developing counties worldwide is associated with many social, financial, and medical challenges. With a prevalence rate of between 10 - 14 % and biochemical etiology of about 80% of the cases among Nigerian women, laboratory diagnosis has gradually assumed an important role in improved diagnosis. Objective: The aim was to evaluate the prevalence of thyroid dysfunction in infertility and need to evaluate. Methods: This was a descriptive cross-sectional case study of one hundred and twenty-five (125) women selected by stratified random sampling method into two groups of primary and secondary infertility. A total of 125 healthy fertile women served as the control group. Serum freeT3 (fT3), feeT4 (fT4), and TSH were analyzed using commercial ELISA kits. Data were analyzed using SPSS version 20.0 and the p-value of ≤0.05 was considered statistically significant. Results: Twenty participants (16%) were observed to have associated thyroid dysfunction with infertility. The commonest thyroid dysfunction was overt hypothyroidism (9.6%) and subclinical hypothyroidism (4.0%) respectively and this was found to be commoner in secondary infertility (21.8%). Conclusion: Thyroid function evaluation (especially serum TSH) should be included as a routine assessment in infertility protocol, especially in secondary infertility cases.

Missed Elevated Blood Pressure in Triaged Outpatients: A Preliminary Cross-Sectional Multicentre Study in Northern Nigeria.

BACKGROUND: Hypertension is a common medical condition but largely undiagnosed, untreated, poorly controlled, and undertreated in low- and middle-income countries. Studies have reported missed hypertension during triage in Emergency Departments; however, little is known about missed elevated blood pressure (EBP) during triage in primary care settings. This study assessed the prevalence and predictors of missed EBP among triaged patients attending General Outpatient Clinics in Northern Nigeria. METHODS: This was a descriptive cross-sectional multi-centre study involving 187 adults randomly selected from patients triaged in four General Outpatient Clinics in northern Nigeria. An investigator-administered questionnaire was employed to obtain data regarding participants' socio-demographic, triage blood pressure (BP) measurement, physician-led BP measurement, and physicians' clinical decision characteristics. Chi-square test and logistic regression analysis were used to determine factors associated with and predictors of missed EBP, respectively. RESULTS: Participants' mean age was 40.6±14.7years. They were predominantly females (122, 65.2%). EBP was missed in 28 (15%) participants at the triage. Participants' age (>40years) (Odds ratio [OR]=3.82, 95% Confidence interval [CI]=1.43-10.22, P=0.008), study site (OR=0.32, 95% CI=0.12-0.82, P=0.018) and perceived receipt of explanation on BP measurement procedure (OR=2.97, 95% CI=1.25-7.07, P=0.014) were predictors of missed EBP among participants. CONCLUSION: The prevalence of missed EBP was low but remarkable because of its huge public health implications. Age, study site, perceived receipt of explanation on BP measurement procedure predicted missed EBP. Effective interventions are needed to curtail missed EBP in these and similar settings.

RÉSUMÉ: L'hypertension est une condition médicale courante mais en grande partie non diagnostiquée, non traitée, mal contrôlée et sous-traitée dans les pays à revenu faible et intermédiaire. Des études ont signalé une hypertension manquée lors du triage dans les services d'urgence; Cependant, on sait peu de choses sur l'hypertension artérielle (EBP) manquée lors du triage dans les établissements de soins primaires. Cette étude a évalué la prévalence et les prédicteurs de l'EBP manquée parmi les patients triés fréquentant les cliniques externes générales dans le nord du Nigeria. MÉTHODES: Il s'agissait d'une étude multicentrique transversale descriptive portant sur 187 adultes choisis au hasard parmi des patients triés dans quatre cliniques ambulatoires générales dans le nord du Nigéria. Un questionnaire administré par l'investigateur a été utilisé pour obtenir des données concernant les données sociodémographiques des participants, la mesure de la pression artérielle (PA) au triage, la mesure de la PA dirigée par un médecin et les caractéristiques de décision clinique des médecins. Un test du chi carré et une analyse de régression logistique ont été utilisés pour déterminer les facteurs associés et les prédicteurs de l'EBP manquée, respectivement. RÉSULTATS: L'âge moyen des participants était de 40,6 ± 14,7 ans. Il s'agissait majoritairement de femmes (122, 65,2 %). L'EBP a été manquée chez 28 (15 %) participants au triage. Âge des participants (> 40 ans) (rapport de cotes [OR] = 3,82, intervalle de confiance à 95 % [IC] = 1,43 à 10,22, P = 0,008), site d'étude (OR = 0,32, IC à 95 % = 0,12 à 0,82, P = 0,018) et la réception perçue d'explications sur la procédure de mesure de la PA (OR=2,97, IC à 95 %=1,25-7,07, P=0,014) étaient des prédicteurs d'EBP manquée chez les participants. CONCLUSION: La prévalence de l'EBP manquée était faible mais remarquable en raison de ses énormes implications pour la santé publique. L'âge, le site d'étude, la réception perçue d'explications sur la procédure de mesure de la PA prédisaient une EBP manquée. Des interventions efficaces sont nécessaires pour réduire l'EBP manquée dans ces contextes et similaires. MOTS CLÉS: tension artérielle élevée, hypertension, absence, consultations externes, soins primaires, triage.

Transmission dynamics of SARS-CoV-2: A modeling analysis with high-and-moderate risk populations.

Nigeria is second to South Africa with the highest reported cases of COVID-19 in sub-Saharan Africa. In this paper, we employ an SEIR-based compartmental model to study and analyze the transmission dynamics of SARS-CoV-2 outbreaks in Nigeria. The model incorporates different group of populations (that is, high- and- moderate risk populations) and is use to investigate the influence on each population on the overall transmission dynamics.The model, which is fitted well to the data, is qualitatively analyzed to evaluate the impacts of different schemes for controlstrategies. Mathematical analysis reveals that the model has two equilibria; i.e., disease-free equilibrium (DFE) which is local asymptotic stability (LAS) if the basic reproduction number ( R 0 ) is less than 1; and unstable for R 0 > 1 , and an endemic equilibrium (EE) which is globally asymptotic stability (LAS) whenever R 0 > 1 . Furthermore, we find that the model undergoes a phenomenon of backward bifurcation (BB, a coexistence of stable DFE and stable EE even if the R 0 < 1 ). We employ Partial Rank Correlation coefficients (PRCCs) for sensitivity analyses to evaluate the model's parameters. Our results highlight that proper surveillance, especially movement of individuals from high risk to moderate risk population, testing, as well as imposition of other NPIs measures are vital strategies for mitigating the COVID-19 epidemic in Nigeria. Besides, in the absence of an exact solution for the proposed model, we solve the model with the well-known ODE45 numerical solver and the effective numerical schemes such as Euler (EM), Runge-Kutta of order 2 (RK-2), and Runge-Kutta of order 4 (RK-4) in order to establish approximate solutions and to show the physical features of the model. It has been shown that these numerical schemes are very effective and efficient to establish superb approximate solutions for differential equations.

Caring for Children with Congenital Heart Diseases:Economic Burden of Pre-Surgical Management on Nigerian Families.

BACKGROUND AND OBJECTIVES: Managing children with Congenital Heart Disease (CHD) attracts enormous cost especially in resource-poor settings like Nigeria. This study sought to determine the healthcare costs of pre-surgical management of CHD and describe its catastrophic effects on households. METHODS: Using a semi-structured interviewer-administered questionnaire, caregivers of children with CHD were interviewed. Family income, type of CHD, co-morbidity, healthcare payment mechanism and healthcare cost were explored over 3 months prior to the study. Healthcare costs were then averaged to obtain monthly estimates. Catastrophic health expenditure (CHE) was defined as healthcare spending above 10% family monthly income. Factors associated with increased healthcare spending in CHD management were explored using the Kruskal Wallis test of significance. RESULTS: Of the 108 parents interviewed, 81.0% paid for healthcare using out-of-pocket payment mechanism. The median direct monthly medical and non-medical costs were N==3,625 (range: N==200 - N==59,350) [$10.07; range:$0.56-$164.86] and N==420 (range: N==150 -N ==11,000) [$1.17; range $0.42-$30.56] respectively. Hospitalisation and transportation accounted for majority of the direct medical and non-medical costs, respectively. About 36.1% of families suffered financial catastrophe. Catastrophic overshoot and mean positive overshoot were 5.6% and 30.8% above the 10% income threshold, respectively. The healthcare spending was significantly higher in families of children with CHD complicated with heart failure (p=0.001) and pulmonary hypertension (p=0.038) and those who suffered financial catastrophe (p=0.001). Health insurance did not significantly reduce healthcare spending among the insured(p=0.630). CONCLUSION: The economic burden of pre-surgical management of children with CHD is high in Nigeria. Appropriate interventions governmental and non-governmental organisations are needed to cushion the burden of healthcare costs on affected families.

Relationship between serum level of ionized calcium, magnesium, phosphate, vitamin D and parathyroid hormone with stages of CKD

Background: Chronic kidney disease is defined as either damage or a decreased Glomerular Filtration Rate of less than 60ml/min/1.73m2 for 3 or more months. There is destruction of renal mass with irreversible sclerosis and loss of nephron leading to a progressive decline in GFR.Secondary hyperparathyroidism hyperphosphataemia, hypocalcaemia and vitamin-D deficiency are common complications of CKD. Objective: To determine relationship between serum level of ionised calcium, magnesium, phosphate, vitamin-D and parathyroid hormone with stages of CKD. Method: This study was conducted at ABUTH Zaria. 125 consecutive adult patients in various stages of CKD who presented were enrolled and 125 apparently healthy matched for sex and age controls were also recruited. Results: 9% of patients were in stage-1, 16% in stage-2, 22% in stage-3, 12% in stage-4 and 41% in stage-5. Serum ionised calcium, vitamin-D and eCrCl showed a progressive decline as the stage of CKD advances, while serum phosphate, creatinine and iPTH showed a progressive increase as the stage of CKD advances. Changes in serum magnesium showed a slight change with advancing stages of CKD. The difference in mean serum levels of calcium, phosphorus, vitamin-D, parathyroid hormone, creatinine and eCrCl with different stages of CKD were statistically significant. eCrCl correlated negatively with phosphate and iPTH while serum creatinine correlated negatively with calcium and positively with phosphate and iPTH. Conclusion: Majority of CKD patients were in late stage. Correlation of analytes with stages was more in late stages and biochemical derangements occurred in late, rather than early stages of CKD

Diagnosing Premalignant Lesions of Uterine Cervix in A ResourceConstraint Setting: A Narrative Review.

Cervical cancer is an important public health problem whose prevention should be integrated in all existing primary health care and women's health programmes in Nigeria and other developing countries. Cervical cancer is the second most common female malignancy in the world and it is the leading cause of cancer related deaths among women in developing countries. Furthermore, developing countries account for 80% of global deaths from cervical cancer. Early cancer detection remains a vital strategy for disease treatment and prevention; therefore the need for routine cervical screening cannot be overemphasized. Given the scope of the cervical dysplasia problem in our country, coupled with the difficulties that have been encountered in many of our health centres when attempting to implement cytology-based screening and colposcopy/biopsy programmes which remains the gold standard, there is the need to find an alternative, low-resource screening option. In most developing countries, patients often present late with advanced cancer of the cervix. Given the difficulty of ensuring high quality cytology-based services in many settings coupled with the absence of colposcopy, visual inspection of cervix with acetic acid (VIA) is a promising option in the new approach to screening for precancerous lesion, especially for low-resource settings. The front line doctor (family physician) and other para-medical staff, including nurses and midwives, require easily implemented procedures and protocols to be able to identify early cervical dysplasia and allow measures to be undertaken to prevent progression to carcinoma.

Retrospective study of bovine tuberculosis in Gombe Township Abattoir, Northeastern Nigeria.

Tuberculosis (TB) is a major global public health problem. The World Health Organization (WHO) estimates that there are 8 million new cases and 3 million deaths in humans due to the disease each year. A retrospective abattoir study of bovine tuberculosis in Gombe Township Abattoir in Northeastern Nigeria was carried out from 2008 to 2015 using the abattoir records. Out of 154,562 slaughtered heads of cattle examined at postmortem, 1202(0.78%) had typical tuberculous lesions and overall total prevalence rate of 0.78%. The annual prevalence was significantly higher in 2015(1.04%) with the lowest records in 2011(0.34%). The annual prevalence rate showed intermittent increase in levels above the expected prevalence and there was a statistically significant difference in the relative annual prevalence rate of the disease in the abattoir. The distribution and occurrence of the disease in rainy season were higher than that in the dry season. The disease also appeared to be more prevalent in the rainy season 792(65.90%) compared with the dry season 410(34.10%) and the difference was statistically significant (χ2 = 15.45, p < 0.05). It was concluded that bovine TB is prevalent in Northeastern Nigeria, with indications of epidemics status in Gombe state.

Cardiac Troponin T and creatine kinase MB fraction levels among patients with acute ischemic stroke in Nigeria.

BACKGROUND: Stroke has been a global burden, with increasing morbidity and mortality. Serum cardiac troponin t (cTnT) and creatine kinase (CK-MB) fraction are reported to be elevated in patients admitted with acute ischaemic stroke and high level of these biomarkers indicated more severe stroke and neurologic deficit in some of the patients. OBJECTIVE: To evaluate the serum levels cardiac troponin t (cTnT) and creatine kinase MB fraction (CK-MB) in patients with acute ischaemic stroke and relate the analytes to severity of stroke. METHOD: Patients with clinical diagnosis of ischaemic stroke diagnosed, confirmed by brain Computerized Tomography scan and equal number of apparently healthy age and sex-matched were recruited. Serum cardiac troponin t (cTnT) and creatine kinase MB fraction (CK-MB) were analysed using ELISA method and Stroke severity was determined using National Institute of Health Stroke Score (NIHSS). RESULTS: Mean serum cardiac troponin t (cTnT) and creatine kinase MB fraction (CK-MB) in stroke patients were found to be higher than age sex matched control (p<0.05). NIHS Score of 12.2 ± 5.43 and 9.78 ± 3.97 were observed in Patients with elevated and normal cTnT respectively (p=0.009) while NIHS Score were similar in patients with elevated and normal CK-MB (p = 0.772). CONCLUSION: The mean values of serum cTnT and CK-MB were higher in acute ischaemic stroke patients compared to controls. Serum cardiac Troponin t level may be a significant biomarker of the severity of stroke.

Endomyocardial fibrosis in northern nigerian girl.

Endomyocardial fibrosis (EMF) is a disease of the tropics and subtropics; and the most common cause of restrictive cardiomyopathy. In Nigeria, it is more common in the rain forest zone; though few case reports have been documented in the Northern part of Nigeria; it is often more common amongst adolescents and young adults and in individuals of low socio-economic class. They may be asymptomatic for years with many presenting late in the course of the disease. However, a case of EMF in a 10-year-old Hausa girl who first presented at the age of 8-years and was also from a middle class family fully domiciled in northern Nigeria is reported.

Indications for tonsillectomy and adenoidectomy: our experience.

BACKGROUND: Infection and obstruction are the most common indications for performing tonsillectomy and adenoidectomy. In the past, infection was the main indication for these procedures; however, in the last few decades obstruction is said to be more prominent as an indication when compared to infection. OBJECTIVE: The objective of this study was to report our observations of indications for tonsillectomy and adenoidectomy. MATERIALS AND METHODS: This is a 2 year retrospective analysis of case records of patients aged 0-18 years who have had tonsillectomy, adenoidectomy and adenotonsillectomy performed in a tertiary hospital. STATISTICAL ANALYSIS USED: IBM SPSS (for windows, version 19) software was used to analyze this data. RESULTS: A total of 115 patient's records were reviewed. Moreover, 33.9% were children under 3 years, 60.0% were between 4 years and 10 years and 6.1% were between the ages of 11 years and 18 years. Obstruction accounted for a total of 68.7% while infection accounted for only 31.3% of the indication for these procedures. CONCLUSION: Obstruction as an indication is proportionally higher in younger children while infection is proportionally higher in older children.

Breastfeeding and Weaning Practices among Nigerian Women

Background: Infant feeding is an important determinant of child well­being. The practice of exclusive breastfeeding over the years is declining despite efforts at all levels to improve it; and with globalization there is concern of possible drift in the traditional weaning practices among Nigerian women. This study, therefore, seeks to determine the breastfeeding and weaning patterns among mothers attending two health facilities in the northern and southern parts of Nigerian.Materials and Methods: This was prospective cross­sectional study involving mothers seen in Paediatrics Outpatient and Child Immunization Clinics. This study involved two hospitals in northern and southern Nigeria respectively. Results: Two hundred breastfeeding mothers were recruited into this study. 75% of the mothers were in 25­40 years group and the majority of them (40.0%) commenced breastfeeding after 60 min of delivery. 83% of the mothers were aware of exclusive breastfeeding, but only 40.5% practiced it; their main reasons were that: Breastfeeding was not enough for the growth and development of the child (26.1%) and that breast­milk did not contain enough water; however most mothers' breasts fed for >12 months. About 44.5% of the mothers introduced complementary feeds between 4 and 6 months, and most complimentary meals (53.5%)were maize­based. 61½% of the mothers abruptly stopped breastfeeding, and the practice of separating the child from the home during weaning was reported in only 16% of the mothers.Conclusion: Exclusive breastfeeding is still unacceptably low among Nigerian women despite anincreased level of awareness

Bacterial isolates in blood cultures of children with suspected septicaemia in Kano: a two-year study.

AIMS AND OBJECTIVE: Septicaemia is a common condition in children with a resultant high morbidity and mortality. The gold standard for diagnosis of septicaemia is the isolation of bacterial agents from blood cultures. The study was done to determine the common aetiology of septicaemia in children and their antibiotic susceptibility pattern in Kano, Nigeria. MATERIALS AND METHODS: A retrospective study with a review of blood culture reports of paediatric patients aged 0-15 years, suspected of septicaemia, from October 2006 to October 2008 in the Medical Microbiology department of Aminu Kano Teaching Hospital Kano. Kano. Nigeria was carried out. RESULTS: Out of a total of 3840 blood culture samples, only 18.2% (n=700) was culture positive. Gram-negative and gram - positive bacteria constituted 69.3% (n=2661) and 30.7% (n=1179) respectively. The most prevalent bacterial isolates were Escherichia coli with 44.3% (n=310/700) and Staphylococcus aureus 30.7% (n=215/700). Escherichia coli were sensitive to ceftriaxone, ciprofloxacin, gentamicin and clavulinate - amoxyl. CONCLUSION: The commonest bacterial isolate from blood culture of children with suspected septicaemia in Kano is Escherichia coli. The most sensitive and preferable among the tested antibiotics is ceftriaxone. Rational use of antibiotics with regular antibiotic susceptibility surveillance studies is recommended to maintain high antibiotic therapeutic profile.

Liver function tests profile in cancer patients on cytotoxic chemotherapy: a preliminary report.

AIMS AND OBJECTIVES: To assess liver function in Nigerian cancer patients undergoing cytotoxic chemotherapy, with a view to contributing to the existing literature and possibly making recommendations for better management of the affected patients in Nigerian hospitals. PATIENTS AND METHODS: Serum levels of total bilirubin (TB), alanine amino transferase (ALT), aspartate amino transferase (AST), alkaline phosphatase (ALP), total protein (TP), albumin (ALB) and De Ritis ratio (AST/ALT) were determined in 50 cancer patients both before and after chemotherapy and 50 age- and sex-matched control individuals. The data obtained were analysed using Microsoft Office Excel 2003. Two-tailed student's t- test for matched samples and Pearson's linear correlation statistical methods were employed for the analyses. RESULTS: The levels of serum ALT, AST, ALP and TB, ALB, TP and AST/ALT were significantly higher in cancer patients than in controls both before and after chemotherapy, with more pronounced elevations after chemotherapy. There were positive and significant correlations between cycles of chemotherapy and the serum liver function tests. CONCLUSION: The findings from the present study conclude that there is slight difference when compared to controls in liver function test profile in cancer patients even before commencement of chemotherapy with a worsening of the profile of patients after chemotherapy. This difference in liver function also increases with the cycles of chemotherapy.

Anti-Retroviral Therapy Induced Diabetes in a Nigerian

Background:Anti-retroviral therapy (ART) using Highly Active Anti-retroviral Therapy (HAART) has led to considerable reduction in morbidity and mortality associated with human Immune deficiency virus (HIV) infection.This has led to increased life expectancy in HIV infected individuals on one hand; and side effects of chronic administration of these drugs on the other. One of such untoward effects is the association of anti-retroviral drugs especially the protease inhibitors (PI's) with metabolic derangements such as dyslipi- daemia; lipodystrophy; insulin resistance and rarely Diabetes mellitus. Although there is extensive literature on this dysmetabolic syndrome in the Western World; there is to our knowledge no previous report from Nigeria. Objective: to report a case of diabetes mellitus following the initiation of anti-retroviral therapy. Methods: a case report of diabetes mellitus induced by anti-retroviral therapy in a 48 year old Nigerian male. Conclusion: Awareness and high index of suspicion is required to identify the metabolic complications of ART