A COMPARISON OF RAPID DIAGNOSTIC TEST AND MODIFIED ZIEHL-NEELSEN METHOD IN THE DIAGNOSIS OF CRYPTOSPORIDIOSIS.

Background: Cryptosporidium parvum as a leading cause of persistent diarrhoea in developing countries causes a more severe illness in patients infected with human immunodeficiency virus (HIV). The intermittent shedding of Cryptosporidium parvum oocysts in stool, even in patients with massive diarrhoea, makes diagnosis difficult. This study evaluated the validity of Crypto-Strip test in comparison to the modified Ziehl-Neelsen for the diagnosis of Cryptosporidium infection using polymerase chain reaction (PCR) as gold standard. Methods: This was a hospital based cross-sectional study of 100 HIV positive patients with diarrhoea at a tertiary health facility in Jos, Nigeria. We collected 15mls of stool sample and relevant information from patients who gave informed consent. The oocytes of Cryptosporidium parvum were identified in the stool samples using modified Ziehl-Neelsen stain and Rapid diagnostic test (Crypto-Strip). We also ran all samples using polymerase chain reaction (PCR). Statistical analysis was with statistical package for Social Sciences (SPSS) version 21. Result: Out of the 100 stool samples analysed, 13 (13%) were positive for cryptosporidiosis by PCR. Crypto- Strips recorded 12 (12%) positive with one (1) being false negative as compared to PCR. Conversely, eight (8%) of the 100 samples collected were positive for Cryptosporidium oocysts using modified Ziehl Neelsen (mZN) stain. Out of the eight positives by mZN stain, two were false positive as both tested negative by the PCR. The Crypto-Strip test kit had a sensitivity of 92.3% and a specificity of 100.0% and also positive and negative predictive values of 100.0% and 98.9%, respectively. Whereas, the modified Ziehl Neelsen stain had a sensitivity of 46.2% and a specificity of 97.7% with a positive and negative predictive value of 75.0% and 92.4%, respectively. Conclusion: In this study, we have shown that Crypto-Strip test was a better diagnostic method for the diagnosis of crypto

AWARENESS OF INTERVENTIONAL RADIOLOGY AMONG MEDICAL STUDENTS IN A NIGERIAN UNIVERSITY

Introduction: Interventional radiology (IR) is an emerging specialty which is more established in the western nations but yet to take root in Nigeria. It involves the use of radiological imaging modalities to perform minimally invasive procedures for patients. The specialty can only grow and be sustained when there is continuous supply of manpower which starts by engendering the interest of medical students. Objective: To assess the level of awareness of IR among medical students following exposure to radiological posting. Methods: This was a cross sectional prospective questionnaire based study carried out at the University of Benin. Subjects were final year and penultimate final year medical students of the school of medicine of the University of Benin. The questionnaires consisted of 16 questions that assessed the students' awareness of interventional radiology. Data analysis was done using Statistical Package for Social Science, SPSS statistics (Version 23; IBM Corp., Armonk, NY, USA). Results: Eighty six of the students (90.5%) knew the definition of IR. Sixty five of the students (69.4%) had poor knowledge of IR. Sixty six students (69.5%) knew that IR patients can be admitted into the hospital while 74 students (77.9%) knew that IR doctors can conduct ward rounds in the hospital. Seventy nine (83.2%) of the students knew that IR outpatients' clinic can be conducted. Many (63.2%) knew the pathway of training for interventional Radiologists in Nigeria. Only 24 of the students (25.3%) were interested in IR in the future. The most common reason for not considering a career in IR in the future was lack of interest (46). Conclusion: There is an abysmally low level of awareness of IR among students in this centre, although this may not be true reflection of the whole country. Hence, a nationwide study may need to be conducted.

PREVALENCE AND PATTERN OF ADOLESCENT MALNUTRITION IN A COMMUNITY IN SOKOTO, NORTHWESTERN NIGERIA

Background: Adolescence is accompanied by increase in nutritional requirements due to the rapid growth and development associated with it. Adolescent nutritional status extends to adulthood and a predisposing factor to childhood malnutrition and non-communicable diseases in adulthood. Objective: To determine the prevalence and pattern of malnutrition among adolescent in a semi-urban community in Sokoto. Materials and Methods: A cross sectional study carried out between January and June, 2018 at Gwuiwa community, Wamakko LGA, Sokoto State. The demographics, weight, height and BMI were documented. Nutritional status was determined using the WHO BMI tables for appropriate age and gender. The socio-economic class of the participants was determined the Ogunlesi's classification. Data were analyzed using the SPSS 22.0. A p-value of <0.05 was considered significant. Results: Respondents' mean age was 12.6 (±2.3) about two-thirds of the respondents were aged 10-13 years. There were 84 (42.4%) males with M:F ratio of 1:1.4. One hundred and eight (54.6%), 63(31.8%) and 27(13.6%) were from lower, middle and upper socio-economic classes respectively. About a third (30.3%) of the respondents were stunted, 33 (16.7%) wasted and 3(1.5%) were overweight. Age (p=0.008) and socio-economic status (p= 0.04) were the correlates of adolescent malnutrition. Conclusion: Undernutrition is commoner among adolescents; with emerging overnutrition in the study area. There is need for concerted efforts on prevention at all levels to reduce its impact on non-communicable diseases and the nutritional status of future generations of our community.

PREVALENCE OF RIFAMPICIN-RESISTANT TUBERCULOSIS AND ITS ASSOCIATED FACTORS IN A TERTIARY HEALTH CARE CENTRE, SOUTH-WEST NIGERIA: A 5-YEAR REVIEW

Background: Tuberculosis is a chronic disease with associated high morbidity and mortality. In recent decades, there has been an increase in resistance to drugs used in the treatment of tuberculosis. This is a major stumbling block in the global fight against tuberculosis. This study was to demonstrate the current prevalence of rifampicinresistant tuberculosis and its associated predisposing factors in a Teaching Hospital in Nigeria. Methods: This was a cross-sectional retrospective study involving 359 consecutive patients with bacteriologically confirmed tuberculosis seen between January 2015 and December 2019. Drug susceptibility testing was performed for rifampicin using GeneXpert MTB/RIF assay. Relevant information was obtained from the clinical records of the patients with the use of a well-structured proforma. The data obtained were analysed using the Statistical Package for Social Sciences (SPSS) version 23.0. Results: There were a total of 359 patients out of which the majority, 235 (65.5%) were males. The mean age was 39.78+16.31 (range 1 - 90 years). A larger percentage of the subjects were new cases of tuberculosis (n=312, 86.9%), 49(13.6%) were HIV positive. The overall prevalence of rifampicin resistance found was 2.5% (n=9/359). There was a significant association between gender (p=0.005) and re-treatment (p=0.003). There was no significant association between rifampicin resistance and other factors including age and HIV. Conclusion: Male gender and patients on re-treatment for tuberculosis are more at risk of developing resistance to rifampicin in our environment. There is a need to ensure compliance with all guidelines in the management of tuberculosis to prevent an increase in drug resistance.

GILLES DE LA TOURETTE SYNDROME (GTS)- A RARELY DIAGNOSED AND UNDER REPORTED DISORDER IN NIGERIA

Background: Tourette Syndrome (TS) is an uncommon neuropsychiatric disorder and less frequently diagnosed. The population prevalence estimate of TS in children was 0.3% to 0.9%. In Nigeria, this suggests that approximately 100,000 people are affected considering the estimated population of 200,000,000. Objective: To present a case report of a teenager with a diagnosis of Gilles de la Tourette Syndrome. Case Report: This is case report of a 15-year-old female secondary school student who presented to psychiatric department of a Nigerian Teaching Hospital with 3 years history of verbal and physical aggression towards parents and siblings. She was abusive and sometimes beats her siblings and parents for no obvious reason. She talks repeatedly to imaginary person, saying “leave me alone, I am not killing your child, you do not have respect” She sometimes hits the imaginary person. She blinks, hisses, grunts and shouts. These behaviours are repetitive, usually last for about 3 minutes. Tourette syndrome diagnosis was made after comprehensive evaluation using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Conclusion: The appropriate referral of this patient is of great benefit in the course of her illness. She achieved significant improvement to enable her continue education.

EVALUATING THE EFFECT OF INTERVENTIONS ON BREAST SELF-EXAMINATION KNOWLEDGE AND PRACTICE AMONG ADOLESCENT FEMALE SECONDARY SCHOOL STUDENTS IN DELTA STATE, NIGERIA

Background: Adolescent females have reduced ability to self-detect breast abnormalities early. Improving their knowledge and practice of breast self-examination (BSE) will reverse this trend. Objective: This study evaluated the effect of two interventions on BSE knowledge and practice among in-school adolescent females in Delta State, Nigeria. Methods: A quasi-experimental research was conducted among ninety female secondary school students selected using a multistage sampling technique from three public secondary schools in the state. There were three groups: two experimental groups and a control. Experimental groups had BSE educational pamphlet alone (BPAM), and a combination of BSE pamphlet and BSE training (BPAME). The control group had a cervical cancer educational pamphlet. Participants were followed-up for eight weeks after the study implementation. Data analysis was done using SPSS version 23.0. Results: Mean age of respondents was 15.64 ± 1.33years. There was a significant difference in the respondents' level of BSE knowledge between baseline and 8 weeks follow-up (BPAM=5.20±2.28 to 21.56±1.85, t =29.44, 29 p<.05; BPAME=7.03±1.13 to 21.73±1.26, t =31.77, p<.05), and a significant difference in the level of BSE practice 29 between baseline and 8 weeks follow-up (BPAM 0.33±1.21 to 4.90± 1.56, t =13.25, p<.05; BPAME= 32.76±4.66 29 to 63.83±2.80, t =18.99, p<.05). Both interventions had same impact on BSE knowledge (Effect size ES=0.97, 29 p=0.000) but BPAME had a higher impact on BSE practice [(BPAM: ES=0.87, p=0.000) and (BPAME: ES=0.92, p=0.000)]. Conclusion: Both interventions had significant influence on the respondents' knowledge and practice of BSE but combined BSE pamphlet and training had more impact on BSE practice.

PAEDIATRIC ACUTE PERITONEAL DIALYSIS IN SOKOTO: REVIEW AND OUTCOME

Background: Renal replacement therapy (RRT) in form of peritoneal dialysis (PD) is an important treatment procedure in Paediatric Acute Kidney Injury (AKI) management. It is cost effective and materials are easily sourced for in the developing countries. There is paucity of sub-Saharan Africa data on the use of PD in paediatric AKI, hence this study. Methods: This was a retrospective and descriptive study of cohort of children who were admitted into Emergency Paediatrics Unit of Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, and had PD done between July 1st, 2007 and July 31st, 2019. Age, gender, cause of AKI, indication for dialysis, type of dialysis fluid and peritoneal access used, duration, complication and outcome were documented. Results: A total number of 11 children who had acute PD due to AKI during the duration were studied with male preponderance of 8 (72.7%) and majority (81.8%) belonging to lower social class (IV and V). Their ages ranged between 5 months and 12 years with a mean age of 4.8±3 years. Acute glomerulonephritis (AGN) (n = 5), severe acute diarrhoeal disease (n = 4) and obstructive nephropathy (n =2) were causes of AKI. Peritoneal dialysis was performed manually using percutaneous commercial PD catheters (n=10) and adapted catheter (n=1). Duration of PD ranged from 3 to 17 days (mean: 8.1±4.1 days). The main complications were peri-catheter leakage (n = 6), and catheter obstruction (n = 3), exit wound (n=2) and acute bacterial peritonitis (n = 1). Of the 11 patients, 7 (63.6%) were discharged home alive and well, 3 (27.4%) died and 1(9.1%) left against medical advice. Conclusion: With meticulous attention to aseptic procedure and use of improvised dialysis fluids and catheters or semi-rigid PD catheters where available, PD is an affordable choice of RRT in management of paediatric AKI. Complications are bound to occur and are better anticipated and planned for.

INCIDENTAL FINDING OF PITUITARY MACROADENOMA IN A PATIENT WITH CHRONIC SUBDURAL HAEMATOMA: A CASE REPORT

Background: With the advent of modern radiologic imaging there is increase in the detection of pituitary lesions in imaging done for others non-related lesion. The aim of this review is to report our first case of pituitary incidentaloma in a patient who was evaluated for chronic subdural haematoma Case Presentation: A 65-year-old known hypertensive presented initially to the internal physicians with severe headache, change in sensorium and right sided weakness. He has had history of a fall 6 weeks prior to presentation. His Glasgow coma scale score was 14/15 (E4V4M6). The power on his right upper and lower limbs was 3/5 and on the left limbs was 5/5. He had global exaggerated reflexes and hypertonia. Computerized Tomographic (CT) Scan of the brain done showed massive left subdural haematoma and 14 by 12 by 15 sellar mass. (Figure 1) Pituitary hormonal assay showed decrease in cortisol and other pituitary hormones with slight increase in prolactin. He subsequently had unilateral double burr hole and drainage. He did very well and was discharged 2 days after surgery. At his first follow up visit he was offered the option for further evaluation and treatment of the pituitary lesion but he declined due to financial constraints. Conclusion: Incidental finding of pituitary tumour is a reality in our setting. A lot need to be done to make modern radiological imaging readily available and affordable to increase yield.

KNOWLEDGE, ATTITUDE AND PRACTICE OF STIMULANT USE AMONG SECURITY PERSONNEL IN USMANU DANFODIYO UNIVERSITY, SOKOTO, NIGERIA

Background: The use and abuse of stimulants has become a serious public health problem resulting into both health and psycho-social negative effects. Objectives: The study assessed the knowledge, attitude and practice of stimulants use among security personnel. Methods: A cross sectional study conducted among 180 security personnel at Usmanu Danfodiyo University Sokoto, North-west Nigeria. Data was collected using a set of pretested, semi- structured, interviewer-administered questionnaire to obtain information on the socio-demographic characteristics of the study subjects, knowledge, attitude and practice of stimulants use. Data was analyzed using IBM SPSS version 20. Results: Majority (96.1%) had ever heard of stimulant use. Most of the respondents (87.8%) had adequate knowledge of stimulant use. A large proportion of them new that its abuse can be harmful (74.4%). Majority (73.6%) have negative attitude toward the use of stimulants. Less than a quarter (19.4%) use stimulant daily, 77.2% strongly agree that a colleague has ever been involved in the use of stimulants. Conclusion: Majority of the respondents demonstrated adequate knowledge of stimulant use and a large proportion of them new that when abused, it could be harmful. Majority have negative attitude towards use of stimulants. Security Personnel should be well informed on both the short and long term adverse effects of stimulants use.

PRESENTATION AND OUTCOME OF PREECLAMPSIA: A FIVE –YEAR REVIEW IN UDUTH, SOKOTO

Background: Hypertensive disorders in pregnancy are multi-organ, heterogeneous disorder of pregnancy associated with significant maternal and neonatal morbidity and mortality. Pre-eclampsia is a condition which typically occurs after 20 weeks of gestation and is characterized by high blood pressure and significant proteinuria. Objective: The aim of the study was to find out the outcome of pregnancies complicated by pre-eclampsia in the teaching hospital in Sokoto, North-West Nigeria. Methods: A five-year retrospective study on the presentation and outcome of management of pre-eclampsia carried out in Usmanu Danfodiyo University Teaching Hospital (UDUTH) between 1st January 2010 and 31st December 2014.