Congenital Heart Diseases Diagnosed on Transthoracic Echocardiography: Perspectives from the University of Maiduguri Teaching Hospital, Nigeria

In a retrospective study of 1224 transthoracic echocardiograms performed between January 2011 and December 2013, we evaluated the spectrum of congenital heart disease (CHD) diagnosed at a tertiary referral centre in Maiduguri, north-eastern Nigeria. Diagnosis of CHD was made in 88 (8.3%) subjects, comprising 23 (26.1%) adults and 65 (73.9%) aged less than 18 years. Forty six (52.3%) of those with CHD were females, while 42 (47.7%) were males. The frequencies of the CHD in decreasing order were: ventricular septal defect 23 (26.1%), tetralogy of Fallot (TOF) 14 (15.9%) and atrial septal defect (ASD) and atrioventricular septal defect (AVSD) were 11 (12.5%) each. One of the patients with AVSD had Ellis Van Creveldt syndrome. Six (6.8%) cases of patent ductus arteriosus (PDA) were diagnosed in those younger than 18 years, while all the 5 (5.7%) cases of Ebstein’s anomaly were diagnosed in adults. There were 6 (6.8%) cases of Eisenmenger syndrome involving three cases of AVSD, one case of ASD and two cases of Ebstein’s anomaly. Timely definitive cares for these patients are still lacking in Nigeria and many areas of sub-Saharan Africa. We recommend sensitization of all relevant clinicians to actively look for congenital heart defects. Pulse oximetry and postnatal echocardiographic new-born screening which were previously validated should be implemented at secondary and tertiary levels, and efforts should be made towards providing the needed care for patients with CHD.

Sudden Cardiac Death: Clinical Perspectives from the University of Maiduguri Teaching Hospital, Nigeria

Despite tremendous advances in the management of cardiovascular diseases and cardiac arrest, there is paucity of information regarding sudden cardiac death in sub-Saharan Africa. We present a two-year review of sudden cardiac death cases among patients managed at a Nigerian tertiary hospital. Patients admitted from January 2012 to December 2013 were prospectively followed-up and cases of sudden cardiac death identified. Diagnosis was based on records of events preceding death, direct interview of attending physician/nurses, and family members/eye witnesses for out-of-hospital sudden cardiac death. Causes of death were obtained from the death certificates for cases of in-hospital events. Three hundred and eighty eight (M:F = 1:1.3) patients with a mean age of 42.22 ± 19.30 years were admitted into the cardiac unit during the period, out of whom 56 (14.4%) died. Twenty three (41.1%) were classified as sudden cardiac death. The predominant etiology was ischemic cardiomyopathy (39.1%), followed by peripartum cardiomyopathy (21.7%) and dilated cardiomyopathy (17.4%). Rheumatic heart disease was diagnosed in 17.4%, while 4.3% had pulmonary hypertension. Nineteen (82.6%) of the subjects had congestive cardiac failure. Hypokalemia and hypocalcaemia were recorded in 2 (8.7%) patients who developed prolongation of the QT interval following commencement of diuretics. Chest-compression-only cardiopulmonary resuscitation was attempted in 12 (52.1%) with a success rate of 8.3%. Sudden cardiac death is common among our patients admitted with cardiovascular diseases. The most common etiology is ischemic cardiomyopathy, followed by peripartum cardiomyopathy. Most of the victims were young, and there were no optimum resuscitative measures.

External Genitalia Gangrene: Clinical, Therapeutic Aspects and Prognosis at University Hospital Souro Sanou of Bobo Dioulasso (Burkina Faso)

Objective: To describe the clinical aspects and the management of external genitalia gangrene in the Urology department of the Bobo Dioulasso CHUSS. Patients and methods: This was a retrospective and descriptive study over a period of 6 years from January 2011 to December 2016, which covered 54 patients hospitalized in the urology department of the University Hospital Souro Sanou for external genitalia gangrene. Results: The mean age of our patients was 53.8 years. The large ulcero-necrosis of scrotum was the main reason for reference. Our patients consulted on average 8.23 days after the onset of symptomatology. A risk factor was found in 44.2% of cases and a cause was identified in 65.3% of patients. A urogenital cause was present in 32.7%. Probabilistic antibiotic therapy and medical reanimation were systematic at admission. Debridement was performed on average 18 hours after admission and 10 patients had more than one debridement. We noted a mortality rate of 5.5%. Conclusion: Fournier’s gangrene is a serious infectious disease whose diagnosis is often delayed in our context. Early surgical debridement remains the essential therapeutic gesture to reduce mortality.

Down Regulated Protein C Plasma Levels in the Absence of Factor V Leiden Mutation in HIV Patients: An Observational Study in Maiduguri, North-Eastern Nigeria

Background: As life expectancy of HIV-infected patients increases with use of highly active antiretroviral therapy (HAART), protean haematologic manifestation including decreased activity of natural anticoagulants such as protein C may occur in the absence of genetic risk factors. Based on this preposition, we assessed the plasma level of protein C, and prevalence of factor V Leiden mutation among HIV-infected individuals. Our cohort consisted of 499 HIV-infected patients, of which 250 had AIDS, while 249 were either asymptomatic or had minor mucocutaneous infection consistent with WHO clinical stages I and II without features of AIDS. We also evaluated 251 healthy, HIV-negative subjects as controls. All participants were tested for plasma protein C levels and factor V Leiden (FVL) mutation (Arg 506 Gln) by automation and amplification created restriction enzyme site (ACRES) polymerase chain reaction, respectively. The prevalence of reduced protein C plasma levels among HIV positive patients was 20%;it was more prevalent among those that had AIDS compared with those without features of AIDS, but within WHO clinical stage I and II, (93.3% vs 6.7%) respectively. None of the control patients had either reduced protein C nor FVL mutation. All participants that demonstrated reduced protein C plasma levels demonstrated normal FVL genotype (1691G/G). Conclusion: Decreased protein C plasma levels can occur in HIV-infected patients in the absence of factor V Leiden mutation. The risk increases with severity of the disease. Deranged protein C plasma level increases the risk of hypercoagulable state in patients with advanced HIV disease;it should be considered among the causes of thrombo embolism in this group of patients.

Evaluation of Condom Use and Associated Factors among Adult HIV Clients in Maiduguri, North Eastern Nigeria: A Comparative Cross Sectional Study

Objective: To assess the pattern of condom use among HAART naive and experienced patients in north eastern Nigeria. Methods: An interviewer-administered questionnaire was used to assess the pattern of condom use among 201 HIV clients. Participants included for this comparative cross sectional study were divided into two group: HAART experienced participants that had been on therapy for at least 12 months and HAART naive participants that had been registered at least 3 months before the beginning of the study. Results: Almost half of the HAART naive and substantial proportion of HAART experienced couples never used condom. Few (13.4%) HAART experienced and 16.5% naive participants always used condom. Inconsistent condom use among HAART naive and experienced partners was 38.8% and 41.8% respectively. Spouse notification of HIV was significantly associated with the use of condoms (p = 0.02;OR 1.32, 95% CI: 1.06 - 1.64). The stepwise logistic regression indicated that female (OR 2.40;CI: 1.09 - 3.82), partner notification of HIV sero-positive status (OR 1.32;CI: 1.06 - 1.64, yes versus none), occupation as a civil servant (OR 1.40;CI: 0.15 - 1.05), are factors independently associated with condom use in our studied participants. Conclusion: We report that condom use is uncommon among HIV clients in our environment. Condom is significantly influenced by partner notification of HIV seropositive status, occupation as a civil servant and female gender. This study supports an absence of association between condom uptake and HAART use. Intensive and regular condom counselling for every HIV-positive outpatient who attends the clinic in our environment is expedient. We recommend interventions directed at increasing condom use among HIV clients in our environment.

Detection, Biochemical and Molecular Characterization of Clostridium sporogens in Nono: A Nigerian Traditionally Fermented Yoghurt Drink

Nono is a traditionally fermented milk drink commonly consumed in the Northern parts of Nigeria. It is produced through the spontaneous fermentation of raw cow milk by Lactic Acid Bacteria (LAB), a process that could result to the contamination of the product with such pathogenic organisms as Clostridia spp. The aim of this research was therefore to determine the incidence of Clostridia species in thirty-two (32) ready-to-drink nono samples collected directly from a number of Fulani vendors in randomly selected locations within the Federal Capital Territory (FCT), Abuja, Nigeria. Isolated organisms were further subjected to some morphological and biochemical characterizations using standard microbiological procedures. The results obtained indicate that fourteen (14) isolates were putatively identified to be Clostridium sp., out of which five (5) isolates were confirmed to be Clostridium sporogens by a BLAST analysis of their respective 16SrRNA nucleotide sequence. It was concluded that, the detection of these pathogenic strains in frequently consumed product like nono could pose a public health risk and proactive measures to prevent an outbreak of food borne illness from nono consumption, were recommended.

Apert Syndrome: A Case Report and Review of Literature

Apert syndrome, also known as acrocephalosyndactyly, is one of the causes of craniofacial syndrome or deformity. It is a rare congenital disorder characterized by premature fusion of cranial sutures (craniosynostosis), malformation of skull, hands, face and feet. This congenital deformity has incidence of 1/50,000 to 1/80,000 live births and is an autosomal dominant in inheritance. Apert syndrome, fibroblast growth factor receptor 2 (FGFR2) and the missense substitution mutations occur at adjacent amino acids (i.e. Ser252Trp, Ser 252Phe, Pro253Arg) between the second and third extra cellular immunoglobulin domain of FGFR2, which maps to chromosome bands 10q26. Increased paternal age has been implicated in the development of Apert syndrome. The syndrome has to be thoroughly evaluated as early definitive diagnosis is important in order to distinguish Apert syndrome from other forms of craniosynostosis like Carpenter syndrome, Crouzon disease, Pfeiffer and Saethre-Chotzen syndrome. It is generally accepted that management of Apert syndrome is multidisciplinary in approach, which should compose of neonatologists, neurosurgeons, craniofacial surgeons, plastic surgeons, otolaryngologists, orthodontists, orthopaedic surgeons, ophthalmologists, radiologists, geneticists, clinical psychologists and speech and language pathologists for the effective management of this condition. Early diagnosis and treatment is important because Apert syndrome when treated early has good prognosis in adult life.

Pilot Study: Magnesium Sulphate Administration and Early Resolution of Hypoxic Ischemic Encephalopathy in Severe Perinatal Asphyxia

Introduction: Perinatal asphyxia is one of the leading causes of perinatal death and a recognized cause of neuromotor disability among survivors. About 20% - 30% of asphyxiated newborns who develop hypoxic ischemic encephalopathy (HIE) die during the neonatal period, and one third to one half of survivors are left with cerebral palsy and mental retardation. Objective of the Study: Was to determine the effect of magnesium sulphate as neuroprotective drug in hypoxic ischemic encephalopathy resulting from severe perinatal asphyxia. Materials and Methods: A prospective administration of magnesium sulphate to 52 severely asphyxiated newborns with hypoxic ischemic encephalopathy was conducted over one year period from 1st August 2017 to 31st July 2018. Results: Most (96.2%) of patients were term baby (GA ≥ 37 weeks). Most (90.4%) were in-hospital born, vaginal delivery accounted for 55.8% and 44.2% assisted delivery respectively. About one half (55.8%) of the patients commenced MgSO4 therapy at <6 hours after birth, while 30.6% and 16.6% commenced MgSO4 therapy at 6 - <24 hours and >24 hours after birth respectively. Time of commencement of first enteral feeding (p = 0.018) and time to full enteral feeding (p = 0.015) showed significant correlation with the survival without neurological deficit. The earlier the commencement of MgSO4 therapy, the better the proportion with strong palmar grasp, sucking reflex, tone and early resolution of encephalopathy. Conclusion: All the study subjects treated with magnesium sulphate had impressive improvement;however there is a need to conduct randomized placebo-controlled trial treatment of severe perinatal asphyxia so as to determine its effects on early resolution of hypoxic ischemic encephalopathy/neuroprotective activity.

Arrhythmogenic Ventricular Dysplasia/Cardiomyopathy: Insights from the Rationale of Disease Nomenclature and Clinical Perspectives

“Arrhythmogenic right ventricular dysplasia” (ARVD), a heart muscle disorder characterized by the presence of fibro-fatty tissue and ventricular electrical vulnerability related to sudden death, was first described in 1977 by a French team. Since then, other terms such as “arrhythmogenic right ventricular cardiomyopathy” (ARVC), “arrhythmogenic cardiomyopathy” (AC), “left-dominant arrhythmogenic cardiomyopathy” (LDAC), and “arrhythmogenic left ventricular dysplasia” (ALVD) have been introduced. These changes in nomenclature of the same disease entity are based on different explanations of pathomorphologic patterns. The dysplasia theory claims cardiac growth “maldevelopment” whereas the cardiomyopathy has been seen as an atrophy from acquired injury (myocyte death) and repair (fibrofatty replacement). The other area of divergent opinion is with regards to involvement of both ventricles rather than being an isolated right ventricular anomaly that may result in increased likelihood of diagnosing the concealed form manifesting with pre-dominant left ventricular arrhythmias. Multiple line of evidences support common disease path-ways: Presence of fibro-fatty and superimposed myocarditis, desmosome mutations and malfunc-tion. These compelling data regarding the heart growth, and pathological, clinical, phenotype/ genotype correlates have advanced our understanding of arrhythmogenic ventricular dysplasia/ cardiomyopathy and increased the diagnostic accuracy as well as providing an avenue for future development of new mechanism-based therapies.

A Comparative Study of Fungal and Some Aflatoxin Contents of Freshly Fried and Stored <i>Sallah</i>Meat from Danbatta Local Government Area of Kano State, Nigeria

A comparative study of Fungi (yeast and moulds) and their toxic metabolites was carried out on offal and muscles of freshly fried and stored Sallah meats from rams, bulls, goats and camels slaughtered for sacrifice in Danbatta Local Government Area, Kano State, Nigeria. The objective was to determine the effects of frying and four weeks storage at ambient temperatures on the mycological loads of the fried and stored meats. A total of seventy two (72) samples of muscles and offal were collected from six different and randomly selected households that slaughtered and fried any of the four animals during that period. The samples were analyzed immediately as freshly fried, and then stored for a period of four weeks during which analyses were conducted at the second and fourth weeks. An analysis of variance (ANOVA) was used to compare between the fungal loads and the toxin contents in the stored meat. Results revealed the presence of Mucor, Rhizopus stolonifer, Aspergillus niger, Saccharomycetes, Penicilium spp and Aspergillus flavus;and that, Aspergillus flavus and Mucor were the highest in the frequency of occurrence among the meat samples. The fungal counts expressed as colony forming units (cfu) per gram of meat, ranged from lowest of 0.43 × 103 and the highest of 5.40 × 103 cfu/g in offal of camels and goats, respectively. The results of analyses for aflatoxins revealed the presence of the four types of aflatoxins namely: B1, B2, G1 and G2, in very few of the samples analyzed. The concentrations, expressed in ppb, were in the order of B1 > B2 > G2 > G1 in the muscles and offal of the slaughtered animals;and the toxins were far below the lethal doses recorded in literature. It was concluded that, the fungal organisms were detected in the fried Sallah meats, but not in significant numbers as to cause health risks to the consumers within the short storage time.

Clinical Features and Haematological Indices of Neonatal Septicaemia in Poor Resource Setting

Background: The burden of neonatal septicaemia has remained high worldwide and even more severe in the developing countries like ours. Clinical manifestation is variable and non-specific thereby resulting in delay in diagnosis. Blood culture which is the gold standard for diagnosis of neonatal septicaemia (NNS) has many drawbacks due to long waiting time for culture process, low yield, improper inoculation adding to the problem of late diagnosis. Haematological parameters have been utilized in rapid and early diagnosis of NNS and prompt treatment thus circumventing problems associated with drawbacks in blood culture. Objective: The study was to identify the common clinical features of neonatal septicaemia and haematological indices that were commonly utilized in rapid diagnosis of NNS, and also to determine their sensitivity, specificity, positive predictive and negative predictive value. Materials and Methods: The study was prospective and neonates that had clinical features suggestive of neonatal septicaemia were enrolled consecutively into the study. The patients were appropriately investigated including blood cultures, CSF cultures and urine among others, also blood sample for packed cell volume (PCV), total white cell count (TWBC), absolute neutrophil count (ANC), absolute platelet count (APC). Immature to mature neutrophil ratio (I/MNR), immature to total neutrophil ratio (I/TNR) and micro-ESR (erythrocyte sedimentation rate) was also done and analyzed. Results: The common clinical symptoms were fever 39.5%, poor feeding 33.6%, excessive cry 38.7%, difficulty in breathing 50.0%, yellowish skin 26.9%, while the common physical signs were hyper/hypothermia 41.1%, tachypnoea 41.2%, septic umbilical stump 64.0%, hepatomegally 37.3% and convulsions 42.0%. Blood culture yield was positive in 41.82% and mortality was as high as 28.00%, the incidence of NNS was 5.9/1000 live births. The haematological parameters as marker of NNS PCV, TWBC, ANC, APC, I/MNR, I/TNR and micro-ESR individually were statistically significant (P < 0.05), also their individual sensitivity, specificity, positive and negative predictive values were highly associated with neonatal septicaemia. However, when they were tested in combinations these markers of neonatal septicaemia had low sensitivity, specificity and their predictive values were weak in excluding NNS. Conclusions: The need for early and rapid diagnosis of NNS is pertinent, culturing of the appropriate specimens remains the only way to identify the aetiological organisms, but is associated with delay. Haematological indices are excellent markers of NNS and analysis is rapid and can easily be done in our laboratory settings, and when utilized efficiently, it would circumvent the delay associated with blood culture for long waiting period for the result, thereby reducing morbidity and mortality.

A Comparative Study of Ear Diseases in School Children from Lower versus Higher Socioeconomic Status

Background: Preventable otologic conditions have been found to be important health issues among paediatric age group. Poor socioeconomic status and inappropriate management services in developing countries lead to various complications despite the fact that most of these diseases are self-limiting. The aim of this study was to determine the prevalence and pattern of ear diseases in school children of high and low socioeconomic status in Yola, Nigeria. Methods: This study was conducted in March 2017 in two primary schools (private and public) in Yola among 6 - 8 years old pupils. Approval for the study was obtained from Federal Medical Centre, Yola and consent was obtained from the parents/guardians and the school authorities. Using a health questionnaire, a brief ENT history was obtained from children in years 1 and 2 of each school. Otoscopic examination, audiometry and tympanometry were then carried out. Data collected was analysed using SPSS version 20. Results: One hundred and three children were studied. The age range was 6 - 8 with mean age of 6.8 ± 0.9 and 53 (51.5%) boys. Fifty-two (50.5%) were from public school (low socio-economic class) and 51 (49.5%) from private (high social class). Wax was the most common ear condition encountered affecting 37 (35.9%) children, and the number was similar in both groups. Otitis media with effusion (OME) was encountered in seven children evenly split between the two groups showing a point incidence of 6.8%. There was hearing loss in 13 (12.6%) children, and this was also similar in the two groups. Conclusion: Wax impaction was the commonest otologic disease encountered. Our study also showed a point incidence of 6.8% for OME, but there was no statistical difference between the two groups, and neither was there any statistically significant difference between the two groups in any of the other diseases encountered.

Achondrogenesis Type II in a Live Term Newborn Infant: A Case Report

Background: Achondrogenesis type II is a lethal form of osteochondrodysplasia characterized by short trunk, disproportionately large head, prominent forehead, micrognathia, extreme micromelia, anasarca, large abdomen and poor ossification of the bones. The children with achondrogenesis are usually born premature, or die in the neonatal period mostly from respiratory failure. We report the case of a live term newborn infant with achondrogenesis type II who died shortly after birth. Methods: We report a case of achondrogenesis type II in a live male newborn. Results: We report the case of a term male infant delivered to a 24-year-old woman with a chondrogenesis type II confirmed radiologically but died at age 5 days. Conclusion: Whenever a skeletal dysplasia in a fetal dwarfism is suspected, a proper work-up plan should be done to evaluate family history. A clinical, radiographic and histopathologic examination, should be done and confirmed by genetic study. Following evidence-based diagnosis, patients could be offered termination of pregnancy after counseling.