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   Table of Contents - Current issue
Coverpage
April-June 2018
Volume 5 | Issue 2
Page Nos. 37-64

Online since Thursday, November 1, 2018

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ORIGINAL ARTICLES  

Impaired cognition and normal cardiometabolic parameters in patients with type 2 diabetes in Kano, Nigeria p. 37
Isyaku U Yarube, Isyaku G Mukhtar
DOI:10.4103/ssajm.ssajm_19_18  
Background: Type 2 diabetes (T2D) has been linked with impaired cognition, elevated blood pressure, and dyslipidemia. However, these findings have not been uniform. Aim: This study aimed to assess cognition and its relation with fasting blood sugar (FBS), HbA1c, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and serum levels of triglycerides, total cholesterol, low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein (HDL) cholesterol in T2D patients. Materials and Methods: Thirty-four T2D patients attending the diabetic clinic of Murtala Mohammed Specialist Hospital, Kano, between June and December 2017 and age, sex, and level of education matched controls were recruited for the study. All participants were screened for depression using Beck’s depression inventory II. Cognitive function was assessed using Montreal Cognitive Assessment test (MoCA) version 7.3. Blood pressure was measured using mercury sphygmomanometer (Dekamet Accoson®, Harlow, Essex, UK) and Littman’s stethoscope. FBS was measured using glucometer (On Call® Plus; Alan Lab. Inc., San Diego, California, USA) after an overnight fast. HbA1c was determined using ion exchange chromatography and serum triglycerides, total cholesterol, and HDL cholesterol were determined spectrophotometrically. Data were analyzed on Statistical Package for Social Scientists version 23.0. P value ≤0.05 was considered significant. Results: Diabetic group had significantly lower MoCA score (U = 216.50, P = 0.001) compared to the controls (19.5 and 26.0, respectively). MoCA score was influenced by sex (U = 88.0, P = 0.05), level of education (X2 = 12.826, P = 0.005), and;Deg;BM;Deg;I (X2 = 8.529, P = 0.036) among diabetic patients. MoCA score was correlated with level of education of the diabetic patients (X2 = 14.664, P = 0.002). Duration of diabetes, FBS, and HbA1c had no relationship with MoCA score. The diabetic patients had statistically (U = 416.50, P = 0.048) lower serum triglycerides compared to the control group (132.5 and 155.5 mg/dl, respectively) even though both were within normal limits. Serum HDL (16.65 and 16.80 mg/dl, respectively), LDL (123.2 and 115.7 mg/dl, respectively), total cholesterol (165.20 and 164.0 mg/dl, respectively),;Deg;SB;Deg;P, DBP,;Deg;MA;Deg;P, and;Deg;BM;Deg;I were not significantly different between the two groups and were within normal limits. Conclusion: The diabetics had impaired cognition and normal cardiometabolic parameters. Routine screening for mild cognitive impairment should be employed in the management of T2D.
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Effect of CD4 T-lymphocyte count and human immunodeficiency virus (HIV) infection stage on the prevalence and pattern of rheumatologic disease in HIV-infected patients in Zaria, North-Western Nigeria p. 45
AbdulAziz Umar, Olufemi O Adelowo, Sani B Garko
DOI:10.4103/ssajm.ssajm_1_18  
Introduction Human immunodeficiency virus (HIV) infection is a scourge of the modern time. Occurring with high frequency in patients of all ages and both genders, and across all strata of the society, HIV being a systemic disease can affect the musculoskeletal system, and therefore, musculoskeletal disease maybe a presenting symptom of HIV infection. There is paucity of research on the effect of different stages of HIV and CD4 T-lymphocyte count on HIV rheumatological manifestations among Nigerian patients. This study aims at evaluating the effect of CD4 T-lymphocyte count and the stages of HIV on the prevalence and pattern of rheumatological disease in Nigerian patients with HIV infection. Objective To determine the effect of CD4 T-lymphocyte count and HIV stage on the occurrence and pattern of rheumatologic diseases among patients attending HIV clinic at Ahmadu Bello University Teaching Hospital, Zaria. Materials and Methods Between February 2011 and March 2012, 200 HIV-seropositive patients [consisting of 100 patients on combined antiretroviral therapy (cART) and 100 cART naïve patients] and 200 age and gender-matched HIV-negative controls were screened for the presence of rheumatologic disease, using a validated interviewer administered questionnaire. Information gathered on patients included sociodemographic characteristics, risk factors for HIV infection, clinical and laboratory parameters. CD4 T-lymphocyte of HIV patients and controls were quantified using flow cytometry method. CD4 categorization of patients was performed using the Centre for Disease Control Criteria, and HIV staging was done using World Health Organization criteria. Those with rheumatologic diseases were diagnosed using the American College of Rheumatology classification criteria or, where not available, other well validated rheumatological classification criteria. Data obtained were analyzed using Statistical Package for Social Sciences window software version 17.0. A P value of <0.05 was used as level of significance. Results Rheumatological disease was diagnosed in 56 (28%) of HIV-positive patients and 15 (7.5%) of HIV-negative control. The odd ratio for occurrence of rheumatologic disease in HIV-positive patients compared to control was 4.8 [95% confidence interval (CI) = 2.61–8.82, P = 0.001]. In 3% of HIV infected patients, rheumatologic disease was the reason for their 1st presentation. The spectrum of rheumatic disease seen in HIV-positive patients is as follows: HIV-associated polyarthritis in 13 (16.5%) patients, polyarthralgia in 10 (5%) patients, undifferentiated spondyloarthropathy and reactive arthritis in nine (4.5%) patients each, septic arthritis in five (2.5%), and Tuberculosis (TB) of the spine and pyomyositis in three (1.5%) patients each. CD4 T-lymphocyte count and HIV stages were independent determinants of HIV-associated rheumatologic disease. Conclusion Rheumatologic diseases occur more frequently in HIV-seropositive patients compared to HIV-negative controls, and low CD4 T-lymphocyte counts and advanced HIV stage are associated with higher prevalence of rheumatologic diseases.
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Effect of obesity on self-reported pain and functional disability in patients with knee osteoarthritis in Zaria, North Western Nigeria p. 52
AbdulAziz Umar, Olufemi O Adelowo, Juliana O Okpapi, Usman B Omuya
DOI:10.4103/ssajm.ssajm_10_18  
Introduction: Osteoarthritis (OA) is the most common causes of arthritis in human, with the knee joint being the most commonly affected. Knee OA patients often present with knee pain and varying degree of functional limitation in activities of daily living. The incidence and prevalence of knee OA increases with age and is poised to increase even further in tandem with an expected increase in life expectancy, rise in population age, and increased prevalence of obesity. Obesity is associated with the occurrence and severity of knee OA, and it is perhaps the most amenable of all knee OA risk factors. The contribution of obesity to pain and functional limitation in Nigerian knee OA patients is not well elucidated. This study aims at ascertaining the burden of obesity in Nigerian knee OA patients with regards to its prevalence, effects on pain, and functional disability. Materials and Methods: Between January 2010 and February 2011, 140 consenting knee OA patients were recruited consecutively, as they presented to the Rheumatology Clinic of Ahmadu Bello University Teaching Hospital, Zaria. Knee OA was diagnosed in patients using American College of Rheumatology clinicoradiographic criteria. Information was collected from patient using a pretested interviewer-administered structured question. Pain, stiffness, and functional disability were determined using Likert version of Western Ontario McMaster Universities Osteoarthritis index (WOMAC). Patients were grouped based on body mass index (BMI) into obese (BMI > 30 kg/m2) and nonobese (BMI < 30 kg/m2), and differences in pain intensity and functional disability were compared. Results: One hundred and forty knee OA patients comprised 120 females (85.7%) and 20 males (14.3%), with male–female ratio of 1:6. The mean age of patients was 59.6 ± 8.8 years. The mean BMI was 30.5 (±6.4) kg/m2. Twenty-seven (19.3%) patients had normal body weight, whereas 48.6% were obese. Mean duration of knee pain in patients was 3.5 (±2.9) years. Mean pain score and mean disability scores were 2.17 (±0.7) and 2.02 (±0.89), respectively. The mean pain score was higher in obese patients compared to nonobese (2.4 ± 0.78 vs. 1.93 ± 0.59, P = 0.000), and mean disability score was significantly higher in obese patients compared to nonobese (2.58 ± 0.79 vs. 1.78 ± 0.81, P = 0.000). There was moderate correlation between BMI and pain scores (r = 0.56, P = 0.000) and between BMI and functional disability scores (r = 0.5, P = 0.000). BMI was an independent predictor of functional disability. Conclusion: Pain and functional disability are more severe in obese and overweight knee OA patients compared to those with normal BMI, and obesity is an independent predictor of functional disability.
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CASE REPORTS Top

Self-inflicted genital incision: a rare case report p. 59
Matthew C Taingson, Joel A Adze, Stephen B Bature, Amina Mohammed Durosinlorun, Mohammed Caleb, Abubakar Amina, Avidime Solomon, Airede Lydia
DOI:10.4103/ssajm.ssajm_27_17  
Yankan gishiri, a genital cut, on the vagina for various illnesses is a harmful cultural practice. It is usually performed by traditional barbers. We report a case of Mrs. AA, a 20-year-old para 3 who presented with a history of a long-standing vaginal swelling which became painful after the patient made an incision on it. She was treated with antibiotics and analgesics, and subsequently had an anterior colporrhaphy.
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Neurotoxicity following snakebite and the challenges of management in an urban area—a case report p. 61
Hamza Muhammad, Sadiq Halilu, Muzammil M Yakasai, Ibrahim M Nashabaru, Abdulrazaq G Habib
DOI:10.4103/ssajm.ssajm_7_18  
Snakebites disproportionately affect the lower socioeconomic segments of the society, people with poorly constructed houses, and those with limited access to education and health care. Cases of snakebite are rare in urban areas. Therefore, health centers located in urban areas are sometimes unprepared for managing cases of snakebite. Potent snake antivenoms are not available, and most healthcare workers lack basic training needed for the management of snakebite. Here, we report a case of 28-year-old cleric who was rushed to the accident and emergency unit of an urban tertiary hospital on account of snakebite injury involving the left forearm. At presentation, there was history of persistent vomiting and hypersalivation. However, there was no history of bleeding from the site of bite, hematemesis, hematuria, or bleeding from any orifice. He later became confused with altered level of consciousness, developed bilateral ptosis, and broken neck sign. The patient survived after receiving intravenous polyvalent snake antivenom (EchiTab-plus; Instituto Clodomiro Picado, Costa Rica), which was incidentally purchased for laboratory experiment and not for patient care. The case highlights the challenges frequently encountered in the management of snakebite victims, especially in nonendemic areas; it also stresses the need for urban health centers to stock snake antivenom in their pharmacy and train healthcare workers in the management and care of snakebite victims.
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