Background: The contribution of obesity to obstructive sleep apnea (OSA) is poorly described in Nigeria. We aimed to compare OSA risk between obese and nonobese adults in urban Nigeria. Materials and Methods: An analytic cross-sectional study was conducted. Participants were interviewed using the World Health Organization Non-Communicable Disease questionnaire. OSA risk assessment was performed using the STOP-BANG questionnaire. A total score of ≥3 on the STOP-BANG questionnaire indicated OSA risk, whereas a score ≥5 indicated high OSA risk. Obesity was defined as body mass index (BMI) >30 kg/m². Relationship between obesity and OSA was tested using chi-square and logistic regression models used to control for confounding factors. Results: There were 744 respondents, with a mean age of 44 (standard deviation 10) years. A total of 206 [27.7%, 95% confidence interval (CI) 24.46–30.9] respondents were obese (BMI ≥30 kg/m²). A total of 307 (41.3%, 95% CI 37.7–44.9) respondents scored ≥3 on the STOP-BANG questionnaire, whereas 37 (4.9%, 95% CI 3.6–6.7) scored ≥5. More number of obese than nonobese [57.8% (119/206) versus 34.9% (188/538)] respondents met the criteria for OSA risk (P < 0.001). Similarly, more obese persons [10.3% (21/206)] met the criteria for high-risk OSA compared to the nonobese [3% (16/538)]; P < 0.001. In logistic regression models adjusted for cigarette smoking and alcohol consumption, the odds for OSA risk was 15.76 (95% CI 7.44–33.9) in persons with BMI >35 kg/m² compared to those with a BMI range of 18.5–24.99. Conclusion: Obesity and OSA may be more prevalent in Nigeria than previously predicted. Obesity independently increased OSA risk in this population.

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Introduction: Tuberculosis (TB) kills, worldwide, about 1.5 million people infected by the disease per year according to the 2015 World Health Organization (WHO) Global TB report. In sub-Saharan Africa, Nigeria accounts for the highest absolute number of TB morbidity and the 4th among the six high-TB burden countries, which account for about 60% of all TB cases globally. Materials and Methods: This study is a retrospective, descriptive cross-sectional review of the facility TB registers of 4054 patients who accessed TB healthcare services at the 25 directly observed treatment short course (DOTS) Primary Health Care facilities in Zaria, Northwestern Nigeria, between January 1, 2007 and December 31, 2015. Results: Majority of the patients were males (2601; 64.2%), belonging to the age group <40 years (2837; 70%) The patients presented mainly with pulmonary TB (3591; 88.6%). Only half the number of patients (50.3%) had smear-positive results before the commencement of short-course chemotherapy with either 2RHZE/6EH or 2SRHZE/IRHZE/5RHE (1, 2 = 1 or 2 months intensive phase, 5 = 5 months continuation phase, R = rifampicin, H = isoniazid, Z= pyrazinamide, E = ethambutol, S = streptomycin). Human immunodeficiency virus (HIV) coinfection was reported in 774 (19.1%) patients. The treatment success rate was 80.2% (3253 patients); 278 (6.9%) of the patients were lost to follow-up, 176 (4.3%) were transferred out, and 235 (5.8%) died. The determinants of the unsuccessful treatment outcome were being a male, aged >40 years, TB and HIV coinfection, a greater degree of sputum smear positivity before treatment, located at far distances from DOTS centers, and being on retreatment or second-line regimen. Conclusion: The treatment success rate falls below the recommended 85% by the WHO. Recommendations: There is a need for the Nigeria government in collaboration with international agencies to intensify effort at TB surveillance, monitoring, and control activities in Nigeria. Effort should be directed at promoting TB/HIV awareness, the early recognition and diagnosis of TB, and strategies to expand and improve DOTS service at community level.

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Introduction: The human brain, as efficient as it is, cannot remember everything. It is legally required by law that healthcare providers maintain a record for each of their patients. In anaesthesia, every aspect of the anaesthetic care from preoperative to postoperative care needs to be documented. It is, therefore, essential to review the efficiency of manual record keeping and explore possible ways of improving it. Materials and Methods: This was a retrospective study of all patients of obstetrics undergoing caesarean section between 1st July, 2013 and 30th June, 2014. Study participants were identified from Institutional Anaesthesia record books and clinical record (case notes). With the aid of a questionnaire, relevant information concerning patients’ biodata, names of health personnel involved in the surgery and clinical information about vital signs and drug administration were documented from the records. Results: The chart completion rate was 63.88%. Emergency procedures had an average chart completion rate of 51.68% while the charts in elective procedures had a completion rate of 73.4%. The patients’ name was the most frequently recorded item. The Apgar score was not recorded in any of the charts reviewed. Critical incidents were poorly charted with a chart completion rate of 36.59%. Conclusion: Manual recording of anaesthesia information is unreliable and results in incomplete anaesthesia records. It is poorer in emergency surgeries as compared to elective ones. A comprehensive approach that would include structured teaching on the importance of chart completion and the use of automated information systems in recording may correct this anomaly.

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Wuchereria bancrofti, transmitted by mosquito, is endemic in Ghana and scrotal elephantiasis is a rare manifestation. Scrotal elephantiasis can assume a large size impacting negatively on the quality of life of patients. We present a case of a 47-year-old male, living in lymphatic filariasis endemic area of Ghana, with a 10-year history of giant scrotal swelling. The patient had subtotal scrotectomy done with preservation of both testes and penis. Surgery had satisfactory outcome, marking the end of the patient’s 10-year ordeal with the huge scrotal mass.

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Background: Lymphangiomas are the developmental defects of the lymphatic channels, and they are most commonly found in the head and neck regions. Late presentation, rejection of surgery, and traditional scarification result in fatal complications. Surgical excision often thought to give immediate relief and aesthetic results is associated with damage to contiguous structures and recurrence, hence, the need for less invasive treatment modality. Objective: To assess the effectiveness of bleomycin sclerotherapy of cervical lymphangiomas. Materials and Methods: This is a prospective study of patients with cervical lymphangioma treated with sclerosant injection between January 2008 and December 2016. Preinjection ultrasound scan and initial ultrasound-guided aspiration of the fluid in the swelling (which many times is multiloculated) using a 20G cannula into a 10 ml syringe were performed. The cannula tip is retained in the space and intralesional injection of double-diluted bleomycin 0.5 i.u./kg body weight was given as outpatient at 2–4-weekly interval. Postinjection events were documented. The clinical assessment of the pre- and postinjection of sclerosant was performed. Result: A total of 23 patients were recruited, and six were females and 17 were males. All swellings were noticed at birth but median time at presentation was 17 days. All patients but one (95.8%) had complete clinical resolution after 1–4 courses of sclerotherapy for 4–16 weeks. Only one patient had residual nodule that required surgical excision. Redundant skin and hyperpigmentation from skin wrinkle were the early effects noticed in three patients; however, these were cosmetically acceptable to the parents. No recurrence was recorded. Conclusion: The treatment of cervical lymphangiomas with intralesional bleomycin injection is shown to be effective. It is safe and associated with no complication. This treatment modality and outcome was found to be acceptable to the parents of these children.

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Background: Most of the preventive efforts in Nephrology are focused on hypertension and diabetes mellitus. Obstructive Nephropathy (ON) which is a relatively common cause of CKD in Nigeria has not received adequate attention. This study reviewed the clinical profile of patients with ON at a Kidney hospital with the aim of identifying areas where preventive strategy should be targeted. Materials and Methods: This was a 3 year retrospective study that reviewed records of patients managed for ON in a Kidney hospital in Southwest Nigeria. Results: Thirty patients managed during the review period had ON with a prevalence of 7.0%. The mean age of the patients was 63.4 ± 12.08 years. Twenty-three (76.7%) were males and 7(23.3%) were females. The mean packed cell volume, creatinine and estimated glomerular filtration rate at presentation were 25.17 ± 7.84%, 920.41 ± 642.79 micromol/l and 14.27 ± 15.45mls/min/1.72 m² respectively. Common aetiologies of ON were prostate cancer 13(43.3%), urolithiasis 6(20.0%), and cervical cancer 5(16.7%). Identified renal co-morbidities were hypertension 21(70.0%), diabetes mellitus 4(13.3%) and urinary tract infection in 11(36.7%). Anemia was present in 27(90.0%), hyperkalemia in 16(53.3%) and metabolic acidosis in 23(76.7%). Twenty-one (70.0%) had stage 5 CKD. A higher proportion of patients with malignancies had stage 4 and 5 CKD. Twenty-one (70.0%) had haemodialysis. Conclusion: Majority of patients with ON presented late and required hemodialysis. The common causes of ON were prostate cancer, stones, and cervical cancers which are largely preventable or treatable. Screening for prostate and cervical cancer and human papilloma virus vaccination of at risk population is highly recommended.

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Pyopericardium is an uncommon presentation of tuberculosis (TB) and has been reported in 6.98% of the cases of pyopericardium. Pyopericardium has been documented in <3% of the cases of large TB pericardial effusions, even in the high-prevalence areas of TB and human immunodeficiency virus infection. Pulmonary TB affects the pericardium in 1–2% of the cases, and pericardial TB is responsible for 7% of the cases of cardiac tamponade. Pericardial TB is usually an insidious illness and may present as acute pericarditis, chronic pericardial effusion, cardiac tamponade, or pericardial constriction; however, purulent pericarditis is rare. To the best of our knowledge, there are no previous case reports from India on acute pyopericardium with tamponade. Purulent pericarditis or pyopericardium is a rare entity and is associated with very high mortality. A 50-year-old woman was brought to the Emergency Department with respiratory distress and shock. Screening echocardiography suggested pericardial effusion with cardiac tamponade. The pericardial aspirate was frankly purulent, but she sustained a cardiac arrest, and resuscitative attempts were futile. The case is highlighted because of its rarity and fatal outcome, especially with late diagnosis and management. The following core competencies are addressed in this article: medical knowledge and patient care.

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Accidental exposure to chemicals and toxins is an important cause of acute kidney injury in the tropics. We report a case of a 26-year-old female who presented with acute kidney injury following a history of accidental ingestion of some white powder mistaken for table salt. Urine microscopy revealed the presence of calcium oxalate crystals. Because accidental poisoning was suspected despite normal 24-h oxalate excretion, renal biopsy was performed, which showed acute tubular injury with occasional refractile oxalate crystals. The patient improved symptomatically with conservative management and did not require haemodialysis. Subsequently, renal functioning showed an improving trend. Oxalic acid poisoning is relatively rare but is an emerging sporadic as well as epidemic poison in some regions.

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Objective: To ascertain the relationship between B-mode ocular ultrasound findings and standard autorefraction results of participants with refractive errors, with the aim of using B-mode ultrasound as a complementary technique to determine the refractive state of the eye. Materials and Methods: The study population consisted of 255 adult patients with refractive errors, aged 18–40 years. The ocular dimensions were measured using MINDRAY DC-7.0 real-time ultrasound machine with frequency probe of 5 and 7–12 MHz. The ocular shapes and other biometric measurements were then correlated with the results of the standard autorefraction. Results: The sensitivity for prolate ocular shape corresponding with myopia/astigmatism was 88.6%, whereas that of oblate ocular shape corresponding with hyperopia/astigmatism was 87.4%. The Pearson’s correlation coefficient between right axial length and right spherical equivalent was negatively strong at −0.79 (P < 0.001). In addition, the Pearson’s correlation coefficient was negatively strong at −0.76 (P < 0.001) between left axial length and left spherical equivalent. Conclusion: Real-time B-mode ocular ultrasound has a high sensitivity in determining ocular shape, which corresponded well with the refractive state of the participants’ eyes. Axial length (AL) was found to correlate strongly with spherical equivalent, and, thus, a regression equation can be used to predict the spherical equivalent from the AL measurements.

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Background: There was a dramatic decline of adolescents’ menarcheal age worldwide; Africa is witnessing a secular trend of this reducing menarcheal age among its black adolescents. A transition of overweight/obesity among adolescent is believed to be associated with reduced menarcheal age. Materials and Methods: It was a descriptive cross-sectional study that was conducted among female adolescent girls from January to December, 2016. Ethical approval was obtained from the management concerned. All consenting adolescents were recruited for the survey. Information was recorded on a structured, pretested questionnaire. Their respective weight and height were also measured. Body mass index (BMI) was calculated using the formula: BMI = weight (kg)/height (m²). The data obtained were analyzed using the Statistical Package for the Social Sciences version 18.0 (SPSS Inc., SPSS Statistics for Windows, Chicago, IL, USA). Fishers’ exact test was used, and the P ≤ 0.05 was considered statistically significant. Results: Two hundred and nineteen female adolescents participated in the survey. The mean age ± SD at menarche was 12.83 ± 1.312 years. The median and modal ages were both 13 years. There was no statistically significant association between the mean age at menarche and the ethnic groups (P(Fishers’) = 0.150). However, mean age at menarche was statistically associated with their BMI (P(Fishers’) = 0.00). Obesity was associated with reduced menarcheal age. Conclusion: The median and mean ages at menarche were 13.0 and 12.8 years respectively, which were in accordance with secular trend of reduced menarcheal age among black adolescents. Our study also showed an inverse association between the age at menarche and overweight or obesity among adolescents.

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Introduction: Scarlet fever and toxic shock syndrome are two major clinical entities caused due to the action of pyrogenic exotoxin. We screened the clinical isolates of Streptococcus pyogenes for the presence of major exotoxin encoding genes SpeA, SpeB and SpeC. Materials and Methods: Isolates of S. pyogenes obtained from clinical samples were characterised on the basis of pyrogenic exotoxin encoding genes SpeA, SpeB, and SpeC. The sample was cultured and identified by conventional biochemical test and further confirmed by latex agglutination test kit (Remel, USA). On confirmed group A streptococci isolates, deoxyribonucleic acid extraction and polymerase chain reaction were performed. Antimicrobial susceptibility testing and detection of inducible clindamycin resistance for all clinical isolates were performed using Clinical and Laboratory Standard Institute guidelines by Kirby–Bauer disk diffusion method. Results: Thirty-one confirmed isolates of S. pyogenes were tested; out of which, the respective prevalence values of SpeB and SpeC genes were 80.6 and 35.5%. SpeA gene was detected in only single isolate. All the isolates were susceptible to penicillin, but resistance was seen with erythromycin, tetracycline and levofloxacin. Inducible clindamycin resistance was seen in two isolates. Conclusion: The present study found that the genes encoding pyrogenic exotoxin is circulating in the S. pyogenes isolates present in north India and have the potential of causing scarlet fever that is not reported so far from the country. A significant percentage of drug resistance was noted for the alternative drugs required for the treatment of penicillin allergic patients. The recent upsurge in the cases of scarlet fever in south-east Asia warns us to keep a check on gene profile of these isolates in the community.

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Renal cell carcinoma (RCC) is the most common renal malignant tumour. Owing to its retroperitoneal location, RCC remains asymptomatic and non-palpable until advanced disease develops. Most cases are identified during radiological examination for other reasons. The management of RCC depends substantially on the effective use of imaging. This is true in all the stages of the RCC, from initial diagnosis to follow-up. This article sets to review the current knowledge about multidetector computed tomography (MDCT) scan and how it characterises the RCC. A search of PubMed database was made to locate the original and review articles in English that address the MDCT scan or RCC, without limit to publication date. Relevant articles and textbook chapters were reviewed, analysed and summarised. MDCT reveals the renal tumour, its extent, venous involvement, status of loco-regional lymph nodes as well as adrenal and liver extension. It is available and relatively affordable presently in some centres across the subregion. MDCT is an essential tool that has aided not only the early diagnosis of RCC, but also the staging and characterisation of the RCC.

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