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   Table of Contents - Current issue
Coverpage
October-December 2020
Volume 17 | Issue 4
Page Nos. 89-157

Online since Monday, October 19, 2020

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EDITORIALS  

Repositioning the Journal of Clinical Sciences for greater impact: Stepping out of the “comfort zone” Highly accessed article p. 89
Adesoji O Ademuyiwa
DOI:10.4103/jcls.jcls_76_20  
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COVID-19 pandemic in Nigeria: A case study of Kano State – Challenges and lessons learned Highly accessed article p. 91
Oluwakemi Ololade Odukoya, Uche Anne Omeje
DOI:10.4103/jcls.jcls_73_20  
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CLINICAL REVIEW Top

Molecular diagnosis of tuberculosis with emphasis on Xpert Mycobacterium tuberculosis assay – Clinical review p. 93
Gajanan S Gaude, Samskruti Vishwanath
DOI:10.4103/jcls.jcls_52_19  
Tuberculosis (TB), due to Mycobacterium tuberculosis(MTB), remains a major public health issue. It causes ill health for approximately 10 million people each year and is one of the top ten causes of death worldwide. For the past 5 years, it has been the leading cause of death from a single infectious agent, ranking above HIV/AIDS. Effective diagnosis of pulmonary TB requires the availability – on a global scale – of standardized, easy-to-use, and robust diagnostic tool that would allow the direct detection of both the MTB complex and the resistance to key drugs, such as rifampicin. The latter result can serve as a marker for multidrug-resistant (MDR) MTB and has been reported in >95% of the MDR-TB isolates. Here, we review some of the recent molecular methods in the diagnosis of TB.
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ORIGINAL RESEARCH REPORTS Top

Glycemic responses of local beans (Vigna unguiculata [Linn Walp] varieties) in persons with Type 2 diabetes mellitus and healthy controls - An experimental study p. 100
Oluwarotimi Bolaji Olopade, Ifedayo Adeola Odeniyi, Olufemi Adetola Fasanmade, Bolatito Opeyemi Olopade, Oluwatosin Oladayo Kayode, Anthony Chinedu Anyanwu, Patience Onyinyechi Chimah
DOI:10.4103/jcls.jcls_61_19  
Background: Medical nutrition therapy is an important aspect of managing diabetes mellitus (DM). Foods with low glycemic index are encouraged in individuals with DM. Despite the good glycemic indices associated with beans, glycemic responses of bean meals in persons with DM is unknown. The aim of this study is to determine whether there are differences in the glycemic responses of local beans (Vigna unguiculata [Linn Walp] varieties) in persons with Type 2 DM (T2DM) and healthy controls. Methods: This was an experimental study done at Lagos University Teaching Hospital over 12 weeks. Twelve consenting T2DM persons and 12 healthy controls participated in this study. Peak plasma glucose (PPG), the maximum increase in plasma glucose (MIPG), 2-h postprandial glucose (2HPPG), and incremental area under glucose curve (IAUGC) of three different varieties (V. unguiculata [Linn Walp] varieties) “oloyin,” “drum” and “sokoto white” were measured. Results: Among healthy participants “Oloyin” bean meal had the lowest values of PPG, MIPG, and IAUGC, while “drum” bean meal had the highest values of MIPG and IAUGC (P = 0.039). Among persons with DM, “Oloyin” bean meal had the highest 2HPPG, PPG but lowest MIPG values when compared with other bean meals while “drum” bean meal had the highest MIPG and IAUGC with the lowest 2HPPG of the three-bean meals. Conclusion: There were differences in the glycaemic responses of V. unguiculata (Linn Walp) varieties studied in persons with T2DM and controls. Glycaemic responses, in addition to glycemic indices of meals, should be considered in the management of persons with DM.
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Factors associated with mortality in patients with peritonitis presenting for anesthesia and surgery in a tertiary center in Nigeria - A cross-sectional study p. 108
Tinuola Abiodun Adigun, Olusola K Idowu, Omobolaji O Ayandipo, Oludolapo O Afuwape, Modupe Kuti
DOI:10.4103/jcls.jcls_7_19  
Background: Peritonitis is one of the surgical emergencies commonly encountered by the general surgeons. Sepsis, dehydration, hypovolemia, and multiple organ dysfunctions have been associated with high mortality rate. The study aimed to assess risk factors associated with mortality in patients with peritonitis presenting for anesthesia and surgery in a tertiary institution. Methods: We conducted a prospective cross-sectional study involving consenting patients managed for peritonitis under general anesthesia over a year period. A study proforma was used to collect the data on demographic characteristics and clinical and biochemical parameters. The association between postoperative mortality and demographic characteristics and clinical and biochemical parameters was determined with Chi-square test, and the level of significance was set at P < 0.05. Results: A total of 52 adult patients were studied with 38 (73.1%) males and 14 (26.9%) females. The mean age was 39.7 ± 15.3 years. Nineteen patients died, and the mortality rate was 36.5%. Mortality was more in females and in patients more than 50 years (P = 0.917 and P = 0.34), respectively. Preoperative high American Society of Anesthesiologists (ASAs) physical status (P = 0.002), higher Mannheim Peritonitis Index (MPI) scores (P = 0.005), preoperative systolic blood pressure <100 mmHg (P = 0.006) and preoperative respiratory rate more than 30 breaths/min (P = 0.002), serum creatinine level more than 1.5 (P = 0.04), and acidosis (P = 0.02) were statistically significant risk factors for mortality in this study. Conclusion: The mortality following perforation peritonitis is high in our center. Poor outcome is seen in patients with high ASA status, high MPI scores, preoperative shock, acidosis, renal failure, and tachypnea. Proper resuscitation from shock, correction of acidosis, and improving the ASA status will improve survival in patients with perforated peritonitis.
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Knowledge of SCD and psychosocial burden experienced by caregivers of children with SCD at a secondary level hospital in Lagos, Nigeria - A cross sectional study p. 113
Adedoyin A Fetuga, Mobolanle Rasheedat Balogun, Adeseye Michael Akinsete
DOI:10.4103/jcls.jcls_49_19  
Background: Sickle cell anemia (SCA) is the most prevalent genetic disease in the world and the most severe of the sickle cell disorders. Individuals with SCA undergo numerous psychosocial problems. The severity of the clinical status of SCA imposes differing degrees of suffering to patients and their relatives, and the overall health of these patients depends on the quality of life and psychological preparedness of the caregivers. This study assessed the knowledge of sickle cell disease (SCD) and the psychosocial burdens of the disease on caregivers. Methods: This was a cross-sectional study conducted at Massey Street Children Hospital. Following consent, an interviewer-administered structured pro forma was utilized for the survey. The study was approved by the Health, Research, and Ethics Committee with permission from the Lagos State Health Service Commission. Data were analyzed using Epi Info™ 7.140. Results: Two hundred and sixteen respondents were interviewed with a mean age of 37.7 ± 7.8 years. Most of the respondents were female (90.7%) and presently married (90.7%). The mean knowledge score was 7.5 ± 2.1, with most (74.1%) of the respondents having good knowledge. The vast majority of respondents had lost income or financial benefits due to time spent caring for the child (91.2%) and reported that a child's illness disturbs activities at home (77.3%). Almost all (96.8%) reported an atmosphere of tension in the homes due to a child's illness, 80.6% reported episodes of depression and feeling sorrowful, 34% felt angry with self or child, and 14.3% felt stigmatized because of child's illness. There was a statistically significant association between respondents' level of education, gender, age, relationship to a child, and knowledge of SCD, and a higher proportion of those with good knowledge had no disruption of family interactions. Conclusion: Majority of the caregivers accessing care for children with SCD had good knowledge of the disease and experienced varied degrees of disruption in their finances, family routine, and family interaction. Improving knowledge of SCD is recommended among caregivers to alleviate psychosocial burdens, especially those associated with family interactions.
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The clinical profile and outcome of children with acute malnutrition in a tertiary health center in North-West Nigeria: A 1-year retrospective review p. 120
Ibrahim Aliyu, Halima Umar Ibrahim, Umma Idris, Godpower Chinedu Michael, Umma Abdulsalam Ibrahim, Abdulsalam Mohammed, Ibrahim Ahmad, Junaid Muhammad Habib
DOI:10.4103/jcls.jcls_55_19  
Background: Acute malnutrition is broadly classified as severe acute malnutrition (SAM) or moderate acute malnutrition (MAM). It affects almost 20 million children worldwide, with majority of the cases in developing countries. In Africa, it was estimated that about 5%–15% of deaths in children age ranging from 0 to 59 months are due to SAM. Therefore, this study sought to determine common clinical features and outcome in children with acute malnutrition. Methods: A retrospective descriptive study was conducted at the Federal Medical Centre Birnin Kudu, Jigawa State. Case files of patients admitted into the Emergency Pediatric unit and Ppediatric Medical Ward over the period of 1 year (January–December 2017) with a diagnosis of acute malnutrition were reviewed. Results: There were 123 cases of acute malnutrition during the study period: 53 (43.1%) males and 70 (56.9%) females. There were 103 (83.7%) cases of SAM and 20 (16.3%) cases of MAM. Among the SAM cases, there were 70 (56.9%) cases of marasmus, 10 (8.1%) cases of kwashiorkor, and 23 (18.7%) cases of marasmic kwashiorkor. Infection was the most common morbidity associated with SAM. Relatively death was mostly witnessed in the marasmic kwashiorkor subgroup (17.4%). However, majority of the subjects who spent 1–2 weeks on admission were discharged without complications, while death occurred mostly in those who spent <7 days on admission and this observation was statistically significant (Fisher's exact = 32.351, P = 0.001). Conclusion: Marasmus remains the most common form of SAM, and infection is a common comorbidity; however, majority of our cases were discharged without any noticeable complication.
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Relating oral hygiene, gingival, and periodontal status with nicotine dependence among smokers - A cross-sectional study p. 127
Chibuzor Osediye Boi-Ukeme, Clement Chinedu Azodo
DOI:10.4103/jcls.jcls_35_19  
Background: The objective was to examine the oral hygiene, gingival, and periodontal status among smokers and to relate them with nicotine dependence. Methods: The cross-sectional study was carried out among smokers and nonsmokers in Benin-City, Edo State. Data collection was done through questionnaire and oral examination. The indices applied were Fagerstrom test, Simplified Oral Hygiene Index (OHI-S), Gingival Index (GI), Community Periodontal Index, and tooth mobility index. Results: A total of 40 (20 smokers and 20 nonsmokers) persons participated in the study. The mean OHI-S for smokers was 2.87 ± 0.92 while that of nonsmoker was 2.20 ± 0.73 and this was statistically significant (P = 0.015). The mean GI for smokers was 1.04 ± 0.36 while that of nonsmoker was 0.80 ± 0.22 and this was statistically significant (P = 0.018). The mean number of mobile teeth for smokers was 0.15 ± 0.49 while that of nonsmoker was. 00 ± 0.00 and this was not statistically significant (P = 0.178). One-quarter (25%) of smokers had score 3 and 4 while only 5% of nonsmokers had were found Shallow and deep pockets were found score 3 and 4. About half (45.0%) of the smokers had low-moderate nicotine dependency among the smokers revealed that. Participants with higher nicotine dependence had nonsignificantly poorer oral hygiene, gingival, and periodontal status than their counterparts. Conclusion: Smokers generally had poorer oral hygiene, gingival, and periodontal status as compared to the nonsmokers. Smokers with higher nicotine dependence did not have poorer oral hygiene, gingival, and periodontal status than their counterparts.
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Urinary tract infections and antimicrobial susceptibility pattern among female students in a tertiary institution in southwest Nigeria - A cross sectional study p. 131
Tinuade Adesola Ajani, Charles John Elikwu, Victor Ugochukwu Nwadike, Babatunde Tayo, Opeoluwa Akinleye Shonekan, Celen Chika Okangba, Chinenye Gloria Anaedobe, Tunde Ehimen Thompson, Azubuike Chidiebere Omeonu, Faluyi Bibitayo, Mustapha Akanji Ajani, Nkadinma Florence Nkwogu, Joseph Emejuru, Kelechi Okangba, Obinna Mark Ugwa, Marvelous Afolabi, Abisola Atere, Temidola Kalejaye, Timothy A Oluwasola, Olusegun Akintoye Coker
DOI:10.4103/jcls.jcls_47_19  
Background: Urinary tract infections (UTIs) is a common medical problem that affects all age groups but with significant morbidity in females because of the nature of their anatomy and physiology. This study was aimed to identify the common causative organisms of UTI and their antimicrobial susceptibility pattern among female students in Babcock University. Methods: A cross-sectional study, in which 200 female participants with symptoms of UTI were recruited. Mid-stream urine was collected from them and processed using the standard microbiological procedures. Antimicrobial susceptibility testing was performed on isolates from the samples with significant bacteriuria. Sociodemographic and risk factors were obtained using standard questionnaires, and statistical analysis was performed using SPSS version 23.0. Results: UTIs were confirmed in 14.5% (29/200) participants. Of the pathogens isolated, Escherichia coli was predominant 30.6% (11/36). Most of the pathogens isolated were susceptible to ofloxacin and gentamicin, while ceftriaxone had the least susceptibility (18.2%). The majority of the participants, 165 (82.5%) though symptomatic, did not have bacteriuria. The participants aged 15–20 years were mostly infected [24 (13.4%)]. No significant association was found between the sociodemographic factors and UTI. Conclusion: The prevalence of UTI from this study was 14.5%. E. coli was the predominant bacteria pathogen isolated, and ofloxacin and gentamycin were the most active antibiotics on susceptibility pattern. The majority of the patients though symptomatic, had no pathogens isolated from their urine. Therefore, caution should be applied on the use of antibiotics when managing UTI based on symptoms alone, to prevent antibiotic resistance
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Perception and practice of handwashing among public secondary school students in Somolu Local Government Area, Lagos, Nigeria - A cross-sectional study p. 136
Esther O Oluwole, Abisola S Ajayi, Tolulope A Olufunlayo
DOI:10.4103/jcls.jcls_5_20  
Background: Hand hygiene is a simple and effective means of preventing the spread of communicable diseases, and the promotion of hand hygiene is an important public health measure. This study assessed knowledge, attitude, and practice of and barriers to handwashing among secondary school students in Somolu Local Government Area (LGA), Lagos, Nigeria. Methods: The study was a descriptive cross-sectional, conducted in selected secondary schools in Somolu LGA, Lagos State. Multistage sampling method was employed to select 420 respondents from the selected public secondary schools. Self-administered and pretested questionnaires were used to collect data. Analysis was done using IBM SPSS version 22. Descriptive and bivariate analyses were conducted with level of significance (P) at ≤0.05. Results: The mean ± standard deviation age of the respondents was 14.09 ± 2.06 years. Less than two-third (64.0%) of the respondents had good knowledge, almost all (99.5%) had positive attitude, while about 71% had good practice of handwashing. Forgetfulness (49.8%) and laziness (33.8%) were the major reasons for not practicing handwashing at home as opposed to unavailability of soap (50%) and lack of nearby water supply (46.2%) in schools. A statistically significant association was found between class of respondents, parent's level of education, and handwashing practices (P < 0.05). Conclusion: Although majority of the respondents had positive attitude toward handwashing, knowledge and practice of handwashing, which is a key to infection control, was not at par with their attitudes. We recommend targeted health education sessions on handwashing and provision of handwashing facilities in secondary schools.
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Base excess and pH as predictors of outcomes in secondary peritonitis in a resource limited setting - A prospective study p. 145
O Oludolapo Afuwape, Omobolaji Ayandipo, Samuel Aroso
DOI:10.4103/jcls.jcls_18_20  
Background: Estimation of the serum pH and base excess as determinants of the adequacy of resuscitation may predict the patient outcome in peritonitis. Materials, Patients and Methods: This was a prospective study conducted in University College Hospital, Ibadan, on patients from 18 years and above with diagnosis of secondary peritonitis who had exploratory laparotomy over a 4-month period (January to April 2017). The patients' biodata, pulse rate, blood pressure, and clinical diagnosis were documented. At presentation, the patients were resuscitated with intravenous normal saline and broad-spectrum antibiotics. Each patient had measurements of acid-base status, and pH analyzed at presentation and in the immediate postoperative period (within 1 h) using the I-STAT point of care device. They were followed up for 48 h after the surgery. The changes in base excess and serum pH in survivors and nonsurvivors were described at 48 h after surgery. This was statistically compared using SPSS version 20 (Chicago, IL, USA). Results: A total of 45 patients were recruited comprising 37 males and 8 female patients. The mean age was 40.86 ± 15.45 years. The mean admission base excess was −4.76 ± 5.41. The mean admission pH was 7.41 ± 0.07. There were 28 (62%) survivors and 17 (38%) mortalities. The pH on admission and base excess values and after surgery demonstrated statistical significance in survivors and nonsurvivors. Conclusion: Changes in base excess and serum pH values are plausible outcome markers in patients with peritonitis resuscitated with early goal-directed therapy.
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CASE REPORTS Top

The role of olecranon autograft as a void filler in the surgical management of enchondroma of the phalanx- A case report p. 150
Mruthyunjaya Mruthyunjaya, Supreeth Nekkanti, V Sheshagiri, Arunodhaya Siddartha, T Pramod, CS Likhit, Mohammed Ameen
DOI:10.4103/jcls.jcls_59_19  
Enchondromas of the phalanx are common benign tumours. They exhibit a monostotic or polyostotic pattern of presentation.These lesions are symptomatic and are usually diagnosed coincidentally. We report a 56-year-old female patient who presented to us with complaints of pain and swelling of the left-hand fourth finger when it was jammed in a gate. Plain radiograph of the hand confirmed the diagnosis of an enchondroma. A surgical curettage and olecranon bone graft was performed in this patient. In this article, the authors attempt to highlight the advantages of olecranon bone harvesting and the good functional results associated with this graft. Our patient had a good functional outcome with no evidence of recurrence at the end of one year.
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A case series of harmful eye practices following trauma seen at Lagos University Teaching Hospital p. 154
Olubanke T Ilo, Adetunji O Adenekan, Olufisayo T Aribaba, Femi C Oduneye
DOI:10.4103/jcls.jcls_65_19  
A case series which highlights the different harmful eye practices which are still being practiced by individuals even following an initial ocular trauma in an Urban City like Lagos in Nigeria. Three cases of patients with vision loss/blindness, following instillation of harmful substances into the eyes, are presented. The first is a 24-year-old female undergraduate who applied her urine and “holy water” into both eyes, following an initial bilateral blunt ocular injury with resultant bilateral corneal abscess. The second is a 54-year-old male auto-electrician who applied his urine and then alum solution into his left eye, following trauma to the eye with resultant anterior staphyloma. In the third case, olive oil and kerosene were applied into the right eye of a 5-year-old male pupil, following accidental application of super glue into the eye, with resultant ankyloblepharon and vision loss. Harmful eye practices and poor health-seeking behavior still remain a challenge in the 21st-century Nigeria. There is a need for more awareness and information dissemination programs, which can be instituted to help reduce needless vision loss/blindness resulting from harmful eye practices.
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