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   Table of Contents - Current issue
Coverpage
January-March 2018
Volume 5 | Issue 1
Page Nos. 1-35

Online since Wednesday, June 20, 2018

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REVIEW ARTICLE  

Could preanesthesia assessment clinics be of benefit in modern anesthetic practice in Nigeria? p. 1
Saidu Yusuf Yakubu
DOI:10.4103/ssajm.ssajm_6_17  
Preanesthesia assessment is the process of clinical evaluation conducted before anesthetic care. The benefits of outpatient preoperative assessment clinics were discovered and exploited in the developed world for more than 68 years. Surprisingly, these clinics have not been set up and used in Nigeria for the care of surgical patients. A review of operation records in a tertiary healthcare facility over an 18-month period revealed that about 35% of elective surgical cases were cancelled weekly due to reasons ranging from lack of power to lack of sterile gowns, lack of water, and the inadequate preparation of patients among others. Of these, the inadequate preparation of surgical patients accounted for one out of every five elective cases cancelled. These cancellation rates were high. Currently, preanesthesia assessment is routinely performed in the evening of the day preceding planned surgery. This does not allow sufficient time to fully optimize patients with preexisting morbid conditions such as diabetes mellitus, hypertension, thyroid disease, and other chronic illnesses, some of which may require specialist consultation. The pilot study also revealed that relevant investigations ordered by the anesthetists were not usually performed due to the short notice, which resulted in the cancellation of the planned surgery. This article reviewed relevant journals on the structure and benefits of preanesthesia assessment clinics with a view of determining whether the establishment of such clinics could address these shortcomings in surgical care delivery.
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ORIGINAL ARTICLES Top

Cecal intubation time during colonoscopy: Do waist circumference and waist-to-hip ratio play better roles than body mass index? p. 6
Adegboyega Akere, Morenike A Osundina
DOI:10.4103/ssajm.ssajm_31_17  
Backgroundand Aim: Among the factors that influence cecal intubation time (CIT) are gender, the quality of bowel preparation, age, prior abdominal surgery, constipation, the experience of the endoscopist, body mass index (BMI), the amount of visceral fat, and waist circumference (WC). This study aimed to compare the effects of WC and waist-to-hip ratio (WHR) to that of BMI on CIT. Patients and Methods: One hundred patients had colonoscopy during the study period. The height and weight of each patient were taken using a stadiometer. BMI was calculated by dividing the weight in kilogram by the square of the height in meter. WC (cm) was measured at a point midway between the subcostal margin and the upper border of the iliac crest. Hip circumference (HC in cm) was measured at the greatest point between the iliac crest and the thighs. WHR was calculated by dividing the WC by the HC. Results: There were 60 (60%) males and 40 (40%) females. Mean age was 60.0 ± 13.1 years (range 27.0–87.0 years). Mean CIT was 1009.5 ± 410.7 s (range 329.0–2110.0 s). Mean BMI, WC, HC, and WHR were 25.5 ± 5.6, 92.2 ± 13.7 cm, 97.5 ± 11.7 cm, and 0.9 ± 0.1, respectively. Age ≥60 years and BMI ≤24.9 kg/m2 were significantly associated with a prolonged CIT in males. In both genders, WC and WHR were not significantly associated with CIT. Conclusion: Higher BMI, WC, and WHR were associated with shorter CIT. However, among these parameters, only BMI was found to be significantly associated with CIT in males.
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Comparison of three phenotypic methods for the screening of carbapenem resistance among clinical isolates of Enterobacteriaceae p. 10
Yahaya Mohammed, Sambo B Zailani, Anthony O Onipede, Bala G Galadima, Baffa S Ibrahim, Mohammed M Manga, Muhammad Zainu Sabitu, Mahmoud M Dalhat, Patrick Nguku
DOI:10.4103/ssajm.ssajm_4_17  
Background: The global use, misuse, and abuse of broad-spectrum antibiotics coupled with failure of development of newer effective antibiotics have led to the rapid spread of carbapenemase producing Gram-negative Enterobacteriaceae. The lack of capacity for effective diagnosis results in increased morbidity, prolonged hospitalization, suboptimal treatment leading to treatment failure, and increased healthcare cost. Aims/objectives: We set out to determine the best method(s) for the phenotypic screening of carbapenem resistance among the species of Enterobacteriaceae at University of Maiduguri Teaching Hospital (UMTH). Materials and Methods: We screened all patients admitted into various wards/units of UMTH over a 6-month period to isolate Enterobacteriaceae. We used an interviewer-administered questionnaire to obtain some basic information from the patients. We confirmed the species of Enterobacteriaceae using Microbact Gram-negative 24E test kit. All confirmed isolates were screened for carbapenem resistance with Meropenem and Ertapenem antibiotic discs (10 μg, Oxoid, UK) according to the Clinical and Laboratory Standards Institute (CLSI) guideline. Minimum inhibitory concentration (MIC) using Etest of Imipenem (Biomeriux) was also determined based on CLSI recommendations. Modified Hodge test method was considered as a gold standard for confirmatory test. The three methods were compared with the gold standard. Results: We isolated 225 Enterobacteriaceae from 225 patients. Klebsiella pneumoniae had the highest proportion of 73 (32.4%). The sensitivity of the different methods in increasing order was 95.7% for Meropenem disk (10 μg), 100% for Ertapenem disk (10 μg), and 100% for Imipenem MIC. Conclusion: In view of cost and availability, the Ertapenem disc (10 μg) method can be used for the screening of carbapenem-resistant Enterobacteriaceae. For the routine screening of carbapenem resistance Enterobacteriaceae in our clinical laboratories, the Ertapenem disc (10 μg) method is recommended.
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Levels of neonatal care services in Kaduna state p. 15
Abdulkadir Isa, Adebiyi N Mustapha, Adeoye Gbemiga, Ogala N William
DOI:10.4103/ssajm.ssajm_8_18  
Introduction: Neonatal medicine is a specialized aspect of pediatrics. The availability and accessibility of efficient newborn units are essential for improved newborn health and survival. In the structure of our healthcare system in Nigeria, neonatal units are meant to be the component units of secondary and tertiary healthcare facilities. Aims: The study aimed at determining the availability of neonatal units and the levels of care services in Kaduna state, Northwestern Nigeria. Settings and Design: This was a cross-sectional, descriptive study. Materials and Methods: The study was a survey of all hospitals in Kaduna state including public and nongovernment healthcare facilities. Information on the availability of newborn unit, staffing, and equipment was obtained and units were categorized into the levels of care. Statistical Analysis Used: Data obtained were summarized and presented in proportions and simple percentages. Results: A total of 33 public nonprimary healthcare facilities and 25 nongovernment specialist facilities operated in the state. Only two (one each state and federal owned) of these 33 public facilities, both of which were tertiary healthcare facilities, had an operational neonatal unit while 15 of the 25 specialist nongovernment facilities operated a neonatal unit. All the neonatal units were of level I category except for the state-owned tertiary facility, which was of level II category and the federal-owned tertiary facility, which was of level III category. Conclusions: The number of neonatal units and levels of care in both public and private health facilities in the state are grossly inadequate. Improving these may result in improved neonatal care in the state.
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The Effect of food hygiene training among street food vendors in Sabon Gari Local Government Area of Kaduna State, Nigeria p. 20
Ahmad A Umar, Aliyu T Mande, Jamila Umar
DOI:10.4103/ssajm.ssajm_30_17  
Background: The training of food handlers with regard to the hazards associated with their products, its safe handling, and the preparation of food following good hygienic practices, as practicable under local street-vending conditions, is an essential part of any strategy to improve the safety and quality of street-vended food. People are becoming increasingly concerned about the health risks posed by microbial pathogens and potentially hazardous chemicals in food, especially those that may enter food during its preparation or while serving. This study assessed the effect of health education training on food hygiene habits among street food vendors in Sabon Gari Local Government Area (LGA) of Kaduna State, Nigeria. Materials and Methods: A quasi-experimental study consisting of pre- and postintervention components was conducted among 109 adult street food vendors who sell cooked food or other food items by the roadside or open spaces in Sabon Gari LGA. Multistage sampling technique was used for selecting the respondents. Training intervention was conducted for the study group over a period of 6 weeks, and data were collected using observation checklist and pretested interviewer-administered structured questionnaire with closed-ended questions before and after intervention. The data obtained were analyzed using the Statistical Package for the Social Sciences version 20.0 software (IBM-SPSS Inc., Chicago, IL, United States). Results: There was significant improvement in the knowledge and the practice of food hygiene, from 46.7 to 53.3%, among the street food vendors in the study area after the training intervention. However, change with regard to knowledge and the practice of food hygiene seen in the street food vendors belonging to the control LGA at the end of the study was from 50.4 to 49.6%. In the intervention arm of the study, there were changes in food hygiene (30.9–69.1%) and environmental sanitation (23.1–76.9%) practices. In addition, it was also determined whether the changes were statistically significant or not. However, changes seen in the control LGA were not as remarkable, with food hygiene and environmental sanitation practices improving from 49.0 to 51.0% and 46.8 to 53.2%, respectively. Conclusion: There was improvement in the knowledge and the practice of food hygiene among street food vendors in the study area after the training intervention. Hence, appropriate authorities should ensure a periodic training of street food vendors on food hygiene.
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CASE REPORTS Top

Anterior staphyloma in a 6-month-old, severely malnourished child following measles: A case report p. 29
Sani M Mado, Hafsat W Idris, Sakinatu M Abdullahi, Sani Musa
DOI:10.4103/ssajm.ssajm_23_17  
Xerophthalmia is an important cause of preventable blindness in Nigerian children. Vitamin A deficiency is not the only cause of staphyloma. The vitamin A deficiency can lead to degenerative changes with subsequent softening of the cornea and protrusion of the uveal tissues through the weakest points. We highlight an under-reported case of right anterior staphyloma in a marasmic, 6-month-old child with probable vitamin A deficiency following measles infection. The child developed a measles-like rash and protrusion of the right eye, associated copious purulent discharge, reddening, and sticking of the eyelids against a background recurrent fever, diarrhea, and progressive weight loss. There was preceding poor nutritional history and the parents are of low socioeconomic background. There was a loss of vision in the right eye and perception of the hand movement in the left eye. He had saline irrigation of the eye, systemic and topical antibiotics, vitamin A in addition to the nutritional rehabilitation, fluid, and electrolytes management. The patient improved significantly and was discharged and followed up at the gastroenterology and ophthalmology clinics. Nutritional rehabilitation using high protein and calories diet, which was cereal-based, was continued at an outpatient basis in addition to growth monitoring. Evisceration of the right eye was planned and the child was yet to have the surgery at the time of writing this report.
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Palm fronds and animal jaw in the vagina mimicking advanced cancer of the cervix p. 32
Aisha Mustapha, Oluwafumbi M Olajide, Rabi’at M Aliyu, Bimbo A. O Kolawole
DOI:10.4103/ssajm.ssajm_11_17  
Herbal intravaginal medications are not uncommon in northern Nigeria, often used as aphrodisiacs or less commonly, to treat infective gynaecological conditions. Most of these medications are self-inserted. We report an unusual case of a 20-year-old patient with sickle cell disease with primary infertility who was referred from a general hospital with both clinical and radiologic evidence of advanced cancer of the cervix, for expert management. Speculum examination revealed copious dark frothy malodorous vaginal discharge with a huge necrotic irregular cervical mass extending to the upper two third of the vagina. Digital pelvic examination performed to clinically stage the tumor revealed the mass was made up of organized palm fronds and animal jaw, which were probably inserted for the patient 2 months ago as a therapy for primary infertility. The herbs were evacuated to reveal ulcer craters on the cervix, which bled on contact. Patient responded to antibiotic therapy and is being followed up in our clinic for the primary infertility.
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