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   Table of Contents - Current issue
July-September 2022
Volume 19 | Issue 3
Page Nos. 71-109

Online since Thursday, August 25, 2022

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The Dermatological Diseases as part of Internal Medicine Conditions p. 71
Olusola Olabisi Ayanlowo
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Vitreoretinal manifestations of human immunodeficiency virus infection and acquired immunodeficiency syndrome in patients attending an antiretroviral therapy clinic in Nigeria: A cross sectional study p. 73
Yewande O Babalola, Tunji S Oluleye, Adeyinka O Ashaye
Background: The human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) is a multi-systemic disease with known manifestations involving all ocular structures from the orbit and ocular adnexa, anterior segment to the retina and vitreous. Some of these manifestations including cytomegalovirus (CMV) retinitis and HIV retinopathy are HIV/AIDS-defining illnesses. The aim of this study is to determine the vitreoretinal manifestations in patients with HIV/AIDS attending an antiretroviral therapy clinic in Nigeria. Methods: This was a prospective, cross-sectional study of consenting, confirmed HIV/AIDS patients attending an antiretroviral therapy clinic in Nigeria. All willing, consecutive patients who gave an informed consent were recruited. Sociodemographic data and clinical information were collected with the use of a structured interviewer–administered questionnaire. Best-corrected visual acuity was recorded. Anterior segment and ocular adnexa examination was performed with a pen torch. Detailed anterior and posterior segment examination was performed with slit lamp biomicroscopy with Volks +78 diopter lens and binocular indirect ophthalmoscopy. The data were analyzed with SPSS (statistical package for social sciences) version 16. Ethical approval was obtained from the institutional ethics committee. Results: Three hundred and eighteen patients were studied of which 85 (26.7%) had disorders affecting the retina and vitreous. The female-to-male ratio was 2:1. More than a third of patients (38.7%) were in the 40–49 years of age group and the mean age was 47.2 years. The most common vitreoretinal lesion was presumed ocular toxoplasmosis present in 9.7% of all respondents. This was closely followed by HIV retinopathy in 3.5%, ocular tuberculosis in 1.8%, and CMV retinitis in 1.6% respondents. Two hundred and seventy-seven (87.1%) respondents were on highly active antiretroviral therapy and 41 (12.9%) were not on treatment. Conclusion: A high prevalence of ocular conditions especially those affecting the retina and vitreous exists in patients with HIV/AIDS attending the antiretroviral therapy clinic in a tertiary hospital in Nigeria. Regular eye examinations are recommended for these patients to prevent potentially visual debilitating disorders.
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Elevated homocysteine and crises state in patients with sickle cell anemia: A comparative study p. 80
Adebukola K Orolu, Titilope A Adeyemo, Alani Sulaimon Akanmu
Background: High plasma concentration of homocysteine (Hcy) is a well-established risk factor for several disorders, including cardiovascular disease, stroke, venous thrombosis, and arteriosclerosis. Folic acid deficiency leads to an increase in homocysteine. This study aimed to test whether elevated serum homocysteine, diminished folate, and B12 levels correlate with the frequency of crisis in sickle cell disease (SCD). Methods: This was a comparative cross-sectional study conducted on 110 adults consisting of participants with SCD in vaso-occlusive crises (VOC), SCD in hyperhemolytic crises (HHC), SCD in steady-state (SS), and healthy controls. Serum homocysteine, folate, and B12 levels were determined using the Enzyme-linked immunosorbent assay method. The level of statistical significance was defined as P < 0.05, at a 95% confidence interval. Results: The mean age of all participants was 25.5 ± 5.8 years. There was a statistically significant difference in mean serum homocysteine levels with mean levels of (11.9 ± 4.5, 13.1 ± 5.4, 10.3 ± 2.3, 9.9 ± 2.5 μmol/L) in participants in VOC, HHC, SS, and controls, respectively (P = 0.016). With a cut-off of <15 μmol/L, hyperhomocysteinemia was seen in 31.% and 26.7% of participants in HHC and VOC, respectively. Conversely, no participant in the SS or the control group had hyperhomocysteinemia. Serum folate (nmol/L) level was lower, though not significantly, in the HHC group than in the other groups, with 9.9 ± 5.5 versus 12.7 ± 6.8, 11.8 ± 4.1 and 12.7 ± 2.2 nmol/L for the VOC, SS, and control group, respectively (P = 0.121). A significant inverse correlation was found between homocysteine and folate (correlation coefficient − 0.589 and P < 0.001) in all study participants. Conclusion: This study reveals significantly higher homocysteine levels in participants with sickle anemia in vaso-occlusive and hyperhemolytic crises (HHCs), highlighting homocysteine and folate role in the pathogenesis of these events.
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Feeding practices and nutrition in children of working and stay-At-Home mothers: A comparative study p. 86
Sananda Kumar, Barathy Chandrasegaran, Devi Kittu, RL Jayavani, Shanthi Ananthakrishnan
Introduction: Exclusive breastfeeding (EBF) for the first 6 months of life and timely introduction of complementary feeds (CFs) with continuation of breastfeeding up to 2 years or beyond are optimum infant and toddler nutrition practices. Mother's employment status influences the feeding practice which in turn can have a negative impact on the growth and development of the infant. The objectives of the study were to determine and compare breastfeeding and CF practices in working and stay-at-home mothers attending our health facility and its effect on the growth of their children. Methods: This observational comparative study was done on 200 mothers, 100 working mothers and 100 stay-at-home mothers of children aged 1–24 months after obtaining written consent. Data were recorded in a pretested semi-structured questionnaire using interview method. Details were elicited regarding feeding practices and illnesses in the child. Each infant's growth and development were assessed using the World Health Organization growth chart and Trivandrum development chart. Statistical tests used were descriptive statistics for frequencies, means and standard deviation, Chi-square for proportions, and Student's t-test for means. A P < 0.05 was considered statistically significant. Results: EBF for 6 months was given by 37% (37/100) of stay-at-home and 45% (45/100) of working mothers (P = 0.251). Breastfeeding beyond 6 months was given by 94.7% (n = 71/75) of stay-at-home and 93.8% of working mothers (n = 90/96, P = 0.800), and beyond 12 months by 61.1% n = 33/54) and 54.8%, respectively, (n = 40/73, P = 0.477). CF was initiated by 180 days by 44% of stay-at-home (44/100) and 55% of working mothers (55/100, P = 0.120). Underweight, wasting, and stunting were seen in 12%, 10%, and 13% (12/100, 10/100, 13/100), respectively, of stay-at-home and 14%, 15%, and 13% (14/100, 15/100, 13/100), respectively, of working mothers and there was no statistical difference between the two groups. A higher frequency of diarrheal episodes was observed in babies of working mothers (6/100, 6% vs. 18/100, 18%, P = 0.009). Conclusion: There was no statistical difference between stay-at-home and working mothers in time of initiation of first feed, giving colostrum, EBF rate, continued breastfeeding beyond 12 months, and age of initiation of CF. Thus, the nutrition and health status of children in both groups were comparable except acute diarrheal illness which was more in babies of working mothers.
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Clinico-odontological management of medically compromised patients during intra-alveolar exodontia in Saudi Arabia: A retrospective study p. 92
Ramat Oyebunmi Braimah, Dawood Ali-Alsuliman, Bandar Alyami, Abdurrazaq Olanrewaju Taiwo, Adebayo Aremu Ibikunle, Abdullah S Al-Walah
Objective: Worldwide, the increase in chronic comorbid medical conditions in the young and elderly is of a major concern, especially in Saudi Arabia. Therefore, the objective of the present study was to investigate the prevalence and clinico-odontological management of medically compromised during intra-alveolar exodontia in Saudi Arabia. Methods: This 5-year retrospective study was conducted on patients who had intra-alveolar extraction of teeth at the department of oral and maxillofacial surgery of a government referral hospital, between January 2016 and December 2020. Data on the age, gender, comorbid medical conditions, and management protocols which include general, specific, and special consultations with relevant specialties were also recorded and analyzed. Results: The prevalence of comorbidities in 8065 patients seen during the study period was 19.6%. There were 1578 (748 [47.4%] males and 830 [52.6%] females) patients with age range of 10–102 years. The mean (±standard deviation) of 36 (16.6) was observed. The most frequent spectrum of medical conditions discovered included endocrine (458 [29.0%]), cardiac (259 [16.4%]), respiratory (79 [5.0%]), central nervous system (83 [5.2%]), and autoimmune (54 [3.4%]). Five hundred and sixteen (32.7%) patients had combined medical conditions. Out of the 1578 patients with medical conditions, 1554 (98.5%) were on routine prescription medications. Conclusions: The current study observed that 19.6% of patients presenting for intra-alveolar tooth extractions were medically compromised. Majority were in middle age and were female. Endocrine and cardiac abnormalities were most prevalent medical conditions. Prescription medications were observed in 98.2%.
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Knowledge, attitude, and experiences of using penicillin G, as a prophylaxis for rheumatic fever and rheumatic heart diseases among nurses in Addis Ababa, Ethiopia: A cross-sectional survey p. 98
Mekuye Aliye Ibrahim, Tamirat Moges Aklilu
Background: The rate of benzathine penicillin G (BPG) injection to prevent rheumatic heart disease (RHD) is insufficient owing to poor knowledge and the negative attitude of health workers. We aim to investigate the gap of knowledge, attitude, and experience of clinical nurses at the primary health-care level who had not received training on rheumatic fever (RF)/RHD prevention to get information on their training need. Methods: A cross-sectional survey was conducted on clinical nurses at randomly selected health centers in Addis Ababa. After interviewing with semi-structured questionnaires, the data were analyzed on SPSS software version 25. Results: A total of 278 nurses (92% response) with a mean age of 28 years were analyzed. The knowledge scores on “organisms causing tonsillopharyngitis (TP),” “the route of administration of penicillin,” and “when to give BPG after preparation” were good (≥75%). Participants' score was poor (<50% score) in the knowledge of “duration of treatment of tonsillopharyngitis, frequency of chemoprophylaxis of RF/RHD, and the relationship between throat infection and RF.” Knowledge on “prevention of pain using lidocaine,” “warming the syringe and allowing alcohol to dry from the swab before injecting” were also good. In contrast, knowledge of “delivering injection very slowly,” “using vibration before/during injection, and “distracting patient using conversation” was poor. Attitude was positive to statements such as “single dose BPG injection given every 3–4 weeks,” “BPG injection is effective in the treatment of streptococcal pharyngitis and the prevention of RF/RHD,” “good patient – health provider relationship enables the success of prophylaxis.” and “educating patients, health-care providers and their caregivers help adherence to BPG prophylaxis. Fear of anaphylactic reaction, pain at the injection site, and blockage of the syringe during injection were the negative experiences reported. Conclusions: The knowledge of clinical nurses on the prevention of RF/RHD was generally good. However, their knowledge of safe injection techniques was partial. On the other hand, most attitude statements were positive. Fear of anaphylactic shock while injecting BPG, pain, and blockade of the syringe was the common barriers experienced.
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Association of serum uric acid and non-motor symptoms in Parkinson's disease: A cross-sectional study from a movement disorders clinic in Lagos, Nigeria p. 104
Olanike A Odeniyi, Oluwadamilola O Ojo, Ifedayo Adeola Odeniyi, Njideka Ulunma Okubadejo
Background and Objective: The role of serum uric acid (SUA) as a biomarker in Parkinson's disease (PD) remains exploratory and has not been described in our population. The objective of this study was to explore the profile of SUA and its relationship to nonmotor symptoms (NMS) burden in PD. Methods: This cross-sectional study recruited 70 persons with PD and 140 matched healthy controls in Lagos, Nigeria. PD was diagnosed using the United Kingdom PD Society Brain Bank criteria. NMS were assessed with the NMS Questionnaire (NMS-Quest). SUA was measured using standard methods. Results: The mean ages of PD and controls were 63 ± 9.4 years and 62.9 ± 8.8 years, respectively (P = 0.65), with no difference when compared by sex. The median PD duration (interquartile range [IQR]) was 4 (4.25) years. Median Hoehn and Yahr stage (IQR) was 2.5 (1.0). The mean total unified Parkinson's disease rating scale score was 70.7 ± 23.7. The mean NMS-Quest score was 8.5 ± 3.8. Mean SUA level was significantly lower in PD compared to controls (2.42 ± 0.75 mg/dL vs. 3.73 ± 1.09 mg/dL [P = 0.000]). There was a nonsignificant inverse linear trend of association (r = −0.184; P = 0.126) between the total NMS-Quest score and SUA level in PD. Logistic regression analysis revealed hyposmia and memory impairment were significantly related to lower SUA levels (P = 0.02 and P = 0.04, respectively). Conclusion: Our study corroborates the potential of SUA as a serum biomarker in PD and a possible role in defining non-motor symptom burden. Further exploration to clarify the association and interrogate the impact of interventions is warranted.
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