COMPUTER VISION SYNDROME: PREVALENCE AND ASSOCIATED RISK FACTORS AMONG UNDERGRADUATES IN A TERTIARY INSTITUTION IN NORTH WESTERN NIGERIA

Background: Computers and other visual display devices have become essential in the present era and have led to a rise in computer-related health problems. Using computers in homes, universities and other institutions has increased output greatly but has also led to an increased risk of developing Computer vision syndrome (CVS). Objectives: To determine the prevalence and risk factors associated with computer vision syndrome among undergraduates. Methodology: A cross-sectional study was conducted among153 respondents who were selected using a multi-stage sampling technique. A pretested, structured, interviewer-administered questionnaire was used to collect data. SPSS version 23 was used to analyze the data. A Chi-square test was used to determine the relationship between CVS and associated risk factors at a P-value of <0.05. Results: The mean age of respondents was 22.4 ± 3.4 years. The prevalence of CVS in this study was 83 (54.3%). The common symptoms experienced among the respondents were headache (51, 61.4%), eye strain (48, 57.8%) and blurred vision (42, 50.6%). The risk factors significantly associated with CVS in this study were duration of computer use, hours of computer use per day, level of a computer screen and taking breaks during computer use. Conclusion: About half of the students in this study had at least one symptom of CVS. Therefore, awareness of CVS should be created by the institution during which students would be educated on CVS and its prevention.

EVALUATION OF GLOMERULAR FUNCTIONS IN PATIENTS WITH SCA IN MAIDUGURI NORTH-EASTERN NIGERIA: A RECOMMENDATION FOR EARLY ASSESSMENT AND DETECTION OF DYSFUNCTION IN A RESOURCE-POOR SETTING.

Background: Sickle cell anaemia (SCA) is a disorder of Mendelian autosomal recessive inheritance, characterised by abnormal haemoglobin synthesis resulting in multi-systemic manifestations. The kidneys are largely affected by this disorder, but overt features of kidney disease mostly manifest after the second decade, even though insult and sub-clinical features may occur during childhood. Unfortunately, investigating these sub-clinical features is not routinely done in resource-scarce settings, partly due to the low socioeconomic status of most of our patients and the overwhelmed health care workers. Objectives: To investigate glomerular dysfunction in children with SCA in the context of the resource-poor setting. Methodology: This cross-sectional study was conducted at the University of Maiduguri Teaching Hospital (UMTH), over 6 months. One hundred and ten SCA (Hb SS) children aged 3 – 14 years in steady-state constituted the cases, while 110 non-SCA (Hb AA) age and sex-matched, apparently healthy children formed the control. Anthropometry, blood pressure, urinalysis and serum creatinine of the subjects was done. Glomerular filtration rate (GFR) was estimated using the Schwartz formula. Results: The mean systolic blood pressure (SBP) ± SD of the cases and controls were 96.8±9.34mmHg and 99.14±13.44mmHg respectively, (p = 0.13). The mean diastolic BP ± SD of the cases and controls were 60.18±6.85mmHg and 64.35±8.23mmHg respectively, (p = 0.0001). Glomerular filtration rate was significantly higher among the cases than the controls, 126±32ml/min/1.73m2 and 93±16ml/min/1.73m2 respectively (p <0.001). Proteinuria was higher among the cases (8.2%), with one (0.9%) having nephrotic range proteinuria. Conclusions: The proteinuria and hyperfiltration found in some of the children with SCA in this study suggest that renal function abnormalities can be detected early in this group of children when appropriately and timely investigated.

KNOWLEDGE, ATTITUDE AND PRACTICE OF EMERGENCY CONTRACEPTION AMONGST HEALTHCARE WORKERS IN IDP CAMPS AND HOST COMMUNITY CLINICS IN JERE AND MAIDUGURI METROPOLITAN LOCAL GOVERNMENT AREAS, BORNO STATE

Background: Emergency contraception (EC) offers women a second chance to avoid unintended pregnancy after unprotected sexual intercourse. Besides its availability, requisite knowledge and positive attitude of the healthcare works will encourage its utilization by the Internally Displaced Persons (IDP) and host community. Objectives To determine the knowledge, attitude and practice of EC by healthcare workers (HCWs) in IDP camps and host community clinics in Jere and Maiduguri metropolitan local government areas (LGAs) of Borno state, Nigeria. Methodology: Self-administered questionnaires were issued to HCWs attending a workshop on child spacing counselling and service organized by the Society of Gynaecology and Obstetrics of Nigeria, North-East sector (SOGON-NE). The questionnaire inquired about knowledge, attitudes and practice of emergency contraception. Results: Eighty-nine (89.0%) of the respondents were aware of EC and 88.0% have approved of its provision. The most common indication for the EC was unprotected sexual intercourse (91.0%), followed by rape, failed contraception and missed pills. Sixty-five (84.4%) of Nurse/Midwives and CHEWs were willing to provide EC for prospective clients and 59(76.6%) of them had provided EC in the past. The commonest form of EC known to the respondents was Levonorgestrel (Postinor 2), followed by oral contraceptive pills (OCP) and intrauterine device (IUCD). Mifepristone and ulipristal were known to only 23.6% and 11.2% of the respondents respectively. Majority (79.6%) will give EC immediately after intercourse. Only 46.1% of the respondent would institute EC within 7 days of unprotected intercourse and among them, 50% were Nurse/Midwives and 46.4% were CHEWs. Conclusion: Both the knowledge and approval of EC among the HCWs in the IDP camps and host community clinics in Jere and Maiduguri metropolitan LGAs of Borno state are high. This can be harnessed to encourage the wide utilization of the EC by adolescents and other vulnerable womenin the IDP camps and Host communities.

CIPROFLOXACIN AND STREPTOMYCIN AS DRUGS OF CHOICE IN TREATMENT OF SURGICAL SITE INFECTIONS IN MAIDUGURI

Background: Surgical site infections (SSIs) are medical events that have direct unintended consequences on patients. They often result in increased hospitalization and a greater number of diagnostic and therapeutic procedures. In Maiduguri, they are a major source of post-operative illness among hospitalized patients. Hence, it is important to determine the scope of bacteria involvement and identify suitable antibacterial agents for effective treatment. Objectives: The study was designed to determine the prevalence of SSIs in patients with surgical wounds, determine the antibiogram of the bacteria involved and drug of choice in the treatment of SSIs. Methodology: The study design was cross-sectional using the qualitative approach. Patients with surgically created wounds infected (>30 days post-surgery) were enrolled between April and May 2018 at UMTH following informed consent. Swab samples were aseptically collected from the patients. The isolation and identification of bacterial isolates were done by cultural, microscopic and biochemical characterization. The antibiogram of the bacterial isolates was determined using disc diffusion method. Appropriate statistical tools were used. Results: A total of 70 patients with surgically created wounds were enrolled. The prevalence of SSIs in patients with surgically created wounds was 95.7% (67/70). Three bacterial species were identified with S. aureus accounting for the highest proportion of 68.7% (46/67) while Klebsiella spp was (19.4 %, 13/67) and E. coli was (11.9 %, 8/67) [p<0.05]. Ciprofloxacin had the highest proportion of sensitivity against S. aureus isolates with a value of 87 %. Streptomycin is the most sensitive drug against the Gram negative organisms isolated with a sensitivity of 87.5 % and 85 % for E. coli and Klebsiella spp., respectively. Conclusions: These findings suggest that there is a high prevalence of SSIs in patients with surgically created wounds seen at UMTH. Ciprofloxacin and streptomycin are suitable antibacterial agents in the treatment of the condition and this could contribute to effective treatment of patients with SSIs.

BRAIN COMPUTED TOMOGRAPHIC FINDINGS OF STROKE PATIENTS IN MAIDUGURI, NORTH-EASTERN NIGERIA.

Background: Stroke is a major neurological condition with high disability and mortality rates in developing countries including Nigeria. Computed tomography (CT) scan is an important imaging modality in confirming the diagnosis of stroke, classifying stroke subtypes and ruling out stroke mimics. Objectives: To determine the CT findings of patients with stroke in Maiduguri, North-eastern Nigeria. Methodology: A retrospective hospital-based study conducted at the Department of Radiology, Federal Neuro-psychiatric Hospital, Maiduguri, North-eastern Nigeria over four-year period from January 2015 to December 2018. All patients were clinically diagnosed with stroke and referred to the department for a brain CT scan. The request forms and CT reports were retrieved from the Archive and analysed. All patients were examined with a 16-slice General Electric CT scanner. Data were analysed using SPSS statistical software version 23. Results: There were 138 patients and out of which, 83 (60%) were males and 55 (40%) females with a male to female ratio of 1.5:1. The mean age was 51.6 ± 16.6 years with an age range of 5-85 years and the majority of the patients were middle-aged group. The CT findings showed 88 (64%) were confirmed stroke cases and the remaining 50 (36%) were misdiagnoses of stroke, with normal finding in 23% and stroke mimics in the remaining 13%. Brain infarction was the most common stroke subtype accounting for 64% of the patients, followed by intracerebral haemorrhage of 33% and 3% had subarachnoid haemorrhage. The left cerebral hemisphere was the most commonly involved. Cerebral atrophy and brain tumours were the two most common stroke mimics in this study and they were mostly seen in females than males. Conclusion: In this study, the accuracy rate of clinical diagnosis of stroke was low. Therefore, CT scan is the 'gold standard’ in the diagnosis of stroke and it is strongly recommended in the management of all stroke patients.

CLINICAL AND HISTOPATHOLOGICAL CHARACTERIZATION OF LUPUS NEPHRITIS IN A TERTIARY HEALTH CENTRE, NORTH-EASTERN NIGERIA: REPORT OF FIVE CASES.

Background: Lupus nephritis (LN) is an immune complex glomerulonephritis that complicates up to 40% of SLE patients. A kidney biopsy is required for diagnosis and staging of the disease. Case report: We report a cohort of five patients with LN from a tertiary health facility in northeastern Nigeria. The five patients were all women with age ranging from 26 to 55 years, and eGFR of between 6 to 154ml/minute. Four patients had normal kidney size and were biopsied whereas 1 patient had contracted kidney. Diffuse proliferative LN (Class IV) was seen in two patients while the other two patients had glomerular sclerosis (Class VI). Patients were given induction with methylprednisolone and mycophenolate mofetil (MMF). At one year follow up 2(40%) patients were in remission, 1(20%) was on maintenance hemodialysis and 2(40%) patients had died. Conclusion: Lupus nephritis is a common complication of SLE in northeastern Nigeria. Patients have features of advanced kidney disease at presentation.

A RARE CASE OF COLORECTAL CARCINOMA WITH BONY METASTASES.

Colorectal cancer is one of the most common malignancies in the world. Bone metastasis is rare, and data are lacking. Here we report a case of colorectal carcinoma with bony metastasis.

BRAIN COMPUTED TOMOGRAPHIC FINDINGS OF STROKE PATIENTS IN MAIDUGURI, NORTH-EASTERN NIGERIA.

Background: Stroke is a major neurological condition with high disability and mortality rates in developing countries including Nigeria. Computed tomography (CT) scan is an important imaging modality in confirming the diagnosis of stroke, classifying stroke subtypes and ruling out stroke mimics. Objectives: To determine the CT findings of patients with stroke in Maiduguri, North-eastern Nigeria. Methodology: A retrospective hospital-based study conducted at the Department of Radiology, Federal Neuro-psychiatric Hospital, Maiduguri, North-eastern Nigeria over four-year period from January 2015 to December 2018. All patients were clinically diagnosed with stroke and referred to the department for a brain CT scan. The request forms and CT reports were retrieved from the Archive and analysed. All patients were examined with a 16-slice General Electric CT scanner. Data were analysed using SPSS statistical software version 23. Results: There were 138 patients and out of which, 83 (60%) were males and 55 (40%) females with a male to female ratio of 1.5:1. The mean age was 51.6 ± 16.6 years with an age range of 5-85 years and the majority of the patients were middle-aged group. The CT findings showed 88 (64%) were confirmed stroke cases and the remaining 50 (36%) were misdiagnoses of stroke, with normal finding in 23% and stroke mimics in the remaining 13%. Brain infarction was the most common stroke subtype accounting for 64% of the patients, followed by intracerebral haemorrhage of 33% and 3% had subarachnoid haemorrhage. The left cerebral hemisphere was the most commonly involved. Cerebral atrophy and brain tumours were the two most common stroke mimics in this study and they were mostly seen in females than males. Conclusion: In this study, the accuracy rate of clinical diagnosis of stroke was low. Therefore, CT scan is the 'gold standard’ in the diagnosis of stroke and it is strongly recommended in the management of all stroke patients.

EVALUATION OF GLOMERULAR FUNCTIONS IN PATIENTS WITH SCA IN MAIDUGURI NORTH-EASTERN NIGERIA: A RECOMMENDATION FOR EARLY ASSESSMENT AND DETECTION OF DYSFUNCTION IN A RESOURCE-POOR SETTING.

Background: Sickle cell anaemia (SCA) is a disorder of Mendelian autosomal recessive inheritance, characterised by abnormal haemoglobin synthesis resulting in multi-systemic manifestations. The kidneys are largely affected by this disorder, but overt features of kidney disease mostly manifest after the second decade, even though insult and sub-clinical features may occur during childhood. Unfortunately, investigating these sub-clinical features is not routinely done in resource-scarce settings, partly due to the low socioeconomic status of most of our patients and the overwhelmed health care workers. Objectives: To investigate glomerular dysfunction in children with SCA in the context of the resource-poor setting. Methodology: This cross-sectional study was conducted at the University of Maiduguri Teaching Hospital (UMTH), over 6 months. One hundred and ten SCA (Hb SS) children aged 3 – 14 years in steady-state constituted the cases, while 110 non-SCA (Hb AA) age and sex-matched, apparently healthy children formed the control. Anthropometry, blood pressure, urinalysis and serum creatinine of the subjects was done. Glomerular filtration rate (GFR) was estimated using the Schwartz formula. Results: The mean systolic blood pressure (SBP) ± SD of the cases and controls were 96.8±9.34mmHg and 99.14±13.44mmHg respectively, (p = 0.13). The mean diastolic BP ± SD of the cases and controls were 60.18±6.85mmHg and 64.35±8.23mmHg respectively, (p = 0.0001). Glomerular filtration rate was significantly higher among the cases than the controls, 126±32ml/min/1.73m2 and 93±16ml/min/1.73m2 respectively (p <0.001). Proteinuria was higher among the cases (8.2%), with one (0.9%) having nephrotic range proteinuria. Conclusions: The proteinuria and hyperfiltration found in some of the children with SCA in this study suggest that renal function abnormalities can be detected early in this group of children when appropriately and timely investigated.

9. CLINICAL AND HISTOPATHOLOGICAL CHARACTERIZATION OF LUPUS NEPHRITIS IN A TERTIARY HEALTH CENTRE, NORTH-EASTERN NIGERIA: REPORT OF FIVE CASES

Background: Lupus nephritis (LN) is an immune complex glomerulonephritis that complicates up to 40% of SLE patients. A kidney biopsy is required for diagnosis and staging of the disease. Case report: We report a cohort of five patients with LN from a tertiary health facility in northeastern Nigeria. The five patients were all women with age ranging from 26 to 55 years, and eGFR of between 6 to 154ml/minute. Four patients had normal kidney size and were biopsied whereas 1 patient had contracted kidney. Diffuse proliferative LN (Class IV) was seen in two patients while the other two patients had glomerular sclerosis (Class VI). Patients were given induction with methylprednisolone and mycophenolate mofetil (MMF). At one year follow up 2(40%) patients were in remission, 1(20%) was on maintenance hemodialysis and 2(40%) patients had died. Conclusion: Lupus nephritis is a common complication of SLE in northeastern Nigeria. Patients have features of advanced kidney disease at presentation.