University Of Maiduguri Teaching Hospital Research Articles

One-point evaluation of children exposed to rubella infection In Utero in Maiduguri, North-Eastern Nigeria: A follow-up Study

Background: Rubella is a disease caused by a virus, rubella virus. Major obstetrics concerns are profound effects of the virus on developing fetuses, which may result in multiple congenital malformations. Although vaccination has reduced the incidence of rubella virus substantially; the World Health Organization (WHO) estimated that more than 100,000 cases of congenital rubella syndrome occur each year worldwide, most of them in developing countries. Diagnosis of rubella cannot be made on clinical grounds alone due to lack of specific symptoms or signs that are unique to the disease. Women infected with rubella during pregnancy are at increased risk of developing complication for the women and their fetuses. Some of these complications may not present at birth, but several years during childhood and later in life. Methodology: The main rubella sero-prevalence study was conducted in 2013, at the Department of Obstetrics and Gynaecology of the University of Maiduguri Teaching Hospital (UMTH), Maiduguri, Borno State, North-Eastern Nigeria. This is a follow-up descriptive study. The children of women who had significant titres of Immunoglobulin M antibodies, and who were negative for Immunoglobulin G antibodies were followed during their pregnancies and childbirth. The children born to these women who acquired rubella virus infection in mid pregnancy were reviewed at 10-11 years of age, and their current state of health is reported. Their biodata, educational status, rubella serostatus, state of health, and history of vaccination with measles were obtained. Results: There were 459 pregnant women who consented and participated in the main sero-prevalence study. Four hundred twenty-one women (91.7%) women tested positive for rubella-specific IgG antibodies, and of the remaining 38 women, 6 (15.8%) were positive for IgM rubella-specific antibody. All the patients with positive IgM antibodies were followed up till birth. All the pregnancies were carried to term and delivered in hospital. None of the neonates was found to have any congenital malformation at birth. At 10 years review of the six (6) children, 1 (16.7%) child developed cataract. None of the children developed cardiac, ear, or other complications of rubella. Five (5) children (83.3%) tested positive for both IgG, one (1) was negative (the child with cataract) for rubella antibodies. None had IgM rubella antibodies. All the children were enrolled in schools and their performance is at least average of their peers. Conclusion: None of the known types of congenital rubella syndrome was found in this study, this may be as a result of smaller number of infected pregnancies. It is recommended that inclusion of rubella vaccination in the National programme on Immunization protocol will be cost effective in the prevention of rubella-associated complication in children.

Sero-prevalence of rubella-specific antibodies in pregnant women attending antenatal care in Maiduguri, north-eastern Nigeria

Context: Rubella is a disease caused by a virus –rubella virus. Major obstetrics concerns are profound effects of the virus on developing fetuses, which may result in multiple congenital malformations. Although vaccination has reduced the incidence of rubella virus substantially; the world health organization (WHO) estimated that more than 100,000 cases of congenital rubella syndrome occur each year worldwide, most of them in developing countries. Diagnosis of rubella cannot be made on clinical grounds alone due to lack of specific symptoms or signs that are unique to the disease. Laboratory confirmation of suspected cases is done based on the detection of the presence of immunoglobulin M (IgM) during the acute illness or a significant rise in rubella – immunoglobulin G (IgG) antibody titres in the serum of previously infected individuals. Methodology: This is a descriptive cross-sectional study conducted at the antenatal clinic of the Department of Obstetrics and Gynaecology of the University of Maiduguri Teaching Hospital (UMTH), Maiduguri, Borno State, North-Eastern Nigeria. Eligible women who presented for booking for antenatal care at the hospital were recruited. Their bio-data, educational status, and history of vaccination with measles and previous obstetrics outcomes were obtained. Five milliliters of venous blood was taken and the serum obtained from the sample was analyzed for anti-rubella IgG antibodies. The samples that were negative for IgG were tested for IgM antibodies. Data obtained analyzed using the statistical package for social science SPSS v16.0.0 (Sept 13, 2007) Inc, Illinois, USA. Results: There were 459 pregnant women who consented and participated in the study. Their age range is 17-43 years (mean= 25.8±5.3). There were 280 (61.0%) patients who were multiparous (mean=3.5±2.1) and women with secondary education accounted for 39.4%. Four hundred twenty-one women (91.7%) women tested positive for rubella-specific IgG antibodies, and of the remaining 38 women, 6 (15.8%) were positive for IgM rubella-specific antibody. Most of the patients (98.1%) with positive IgG had serum titers in the range of 51-150U/mL. All the patients with positive IgM antibodies were followed up till birth, all the pregnancies were carried to term and none of the neonates was found to have any congenital malformation. None of the socio-demographic characteristics were found to be significantly associated with presence of IgG antibodies. Past history of abortions and congenital cataracts were significantly associated with IgG sero-positivity. Conclusion: The sero-prevalence of anti-rubella IgG sero-positivity is high in Maiduguri and this indicates high herd immunity. The number of pregnant women requiring rubella vaccination postpartum in also large. It is recommended that inclusion of rubella vaccination in the National programme on Immunization protocol will be cost effective in the control of rubella and CRS.

Prevalence of Immunoglobin G and M among children infected with Plasmodium falciparum in some Hospitals in Maiduguri, Borno State

The threat of Malaria to the public health especially in Sub-Saharan Africa is enormous and Nigeria in particular is considered a bit hotspot. The diseases are transmitted by Plasmodium species with severe disease outcome children under 5 years. In this study, we undertook a cross-sectional study using representative cohort of children in Maiduguri aged 5 59 months to determine the seroprevalence and risk factors associated with infection with P. falciparum in this vulnerable aged group. A cross-sectional study was conducted on participants from four hospitals in Maiduguri, Borno State. In total, plasma was collected from 182 and 91 participants for the detection of IgG and IgM antibodies, respectively using Enzyme Linked Immunosorbent Assay for the measurement of IgG and IgM antibody production against P. falciparum. The result indicates that the overall seroprevalence was (75.3%; 137/182) and (86.8%; 79/91) corresponding to IgG and IgM respectively. Based on gender, male 24(13.2%) and 8(8.8%) were positive with respect to IgG and IgM while 21(11.5%) and 4(4.4%) of the females were positive to IgG and IgM antibodies respectively. Additionally, both University of Maiduguri Teaching Hospital and State Specialist Hospital Maiduguri, recorded the highest prevalence of 15 (8.2%) for IgG while only UMTH recorded the highest prevalence of 5(5.5%) to IgM antibodies. In conclusion, the overall seroprevalence was found to be low for both IgG and IgM. However, our study observed differences in the seroprevalence of P. falciparium in children according to age and study locations for IgM and IgG respectively. Also, males have high seroprevalence for both IgG and IgM.

Histochemical Demonstration of Fungi in Breast Diseases at University of Maiduguri Teaching Hospital-North Eastern Nigeria

Breast disease is a global public health concern, and recent research suggests that fungal infections may be linked to its development and progression. This study aims to investigate the presence of fungi in formalin-fixed paraffinembedded (FFPE) breast tissue samples diagnosed with various breast diseases, including breast cancer, using histological staining techniques. The study design was a retrospective cross-sectional study that used convenience sampling to retrieve 49 breast tissue blocks diagnosed with various breast diseases from the Histopathology archive of the University of Maiduguri Teaching Hospital, Nigeria. The samples were re-embedded with paraffin wax, sectioned, and stained using Haematoxylin and Eosin and Grocott Methanamine Silver Stain. The data collected was analyzed descriptively and using chi-square tests. Fibroadenoma was the most common diagnosis in the study (69.3%), followed by Chronic Granulomatous Mastitis (18.4%) and breast cancer (12.2%). The highest frequency of Fibroadenoma diagnosis was in the age range of 30-39, whereas the highest frequency of breast cancer diagnosis was in the age range of 20-29. The study found that fungal infections were present in breast tissue samples, and the highest percentage of positive Gomori Methenamine Silver (GMS) stain test results were found in breast disease cases with breast cancer with a significant p value of 0.0175. This study provides evidence of a potential association between fungal infections and breast diseases in North Eastern Nigeria. Further research is needed to fully understand the mechanisms underlying this association and its implications for breast cancer prevention and treatment.

Determinants of splenic preservation among patients with sickle cell disease in North-Eastern Nigeria.

In patients with sickle cell disease (SCD), the spleen commonly enlarges during early childhood, but undergoes reduction in size and fibrosis from repeated episodes of vaso-occlusion and infarction. The rate of progression of this process varies markedly among these patients. The aim of current study was to explore clinical and laboratory factors associated with the preservation of the spleen among these patients. Two hundred four patients with SCD (103 females; age 1-45 years) underwent abdominal ultrasonography at the University of Maiduguri Teaching Hospital, Nigeria between October 2020 and November 2021 to assess for splenic visualisation and echotexture. Steady-state clinical parameters and blood samples for full blood count, serum chemistry, high-performance liquid chromatography and malaria parasitemia were obtained from all the patients. The spleen was visualised in 107 (52.4%; 95% confidence interval [CI], 46%-59%) patients with SCD on ultrasonography. While the spleen was visualised in all children less than 5 years of age, it was visualised in only 23.5% of those aged 15 years and older. Visualisation of the spleen was significantly associated with low mean corpuscular haemoglobin concentration and high haemoglobin F (HbF) in those younger than 10 years. The odds of visualisation of the spleen on ultrasonography increased by a factor of 1.17% for every 1% increase in HbF level. Only 32 (15%) patients were on regular hydroxyurea therapy. The HbF level was significantly higher among patients on hydroxyurea (median 12.7 vs. 7.4; p < 0.0001). In patients with SCD, failure to visualise the spleen was not found in children less than 5 years old. Patients with visualised spleens had a higher level of HbF than those with non-visualised spleens. HbF was significantly associated with visualisation of the spleen before 10 years of age. Since early administration of hydroxyurea will increase HbF level, we expect that it would help to preserve the spleen.

Molecular Detection of Influenza A(H1N1)Pdm09 Virus Among Chronic Kidney Disease Patients: A Peripheral Blood Sample Approach and Assessment of the Associated Risk Factors

Introduction: Chronic kidney disease (CKD) is a progressive loss of functional nephron characterized by various risk factors. Influenza virus has been found to cause rhabdomyolysis, which is toxic to the kidneys and can initiate or worsen CKD. This study aims to investigate the frequency and molecular detection of Influenza A(H1N1)Pdm09 Virus gene among CKD patients attending University of Maiduguri Teaching Hospital, Nigeria.Materials and Methods: Peripheral blood samples were collected from 150 CKD patients. One-step RT-PCR was performed for detection of influenza virus using the Centers for Disease Control and Prevention protocol. Relevant clinical data were collected in standardized questionnaires from each patient, and medical history was obtained from their hospital records.Results: Conventional PCR analysis revealed that 16% of the CKD patients tested positive for Inf A/Pdm H1N1. The virus frequency was found to be higher among patients in CKD stage 5 (end-stage CKD) and lower in CKD stage 3 (moderate CKD). Additionally, female CKD patients and those in the age group of 55-64 years showed a higher susceptibility to Inf A/Pdm H1N1 infection.Discussion: The study provides evidence of the presence of Inf A/Pdm H1N1 in CKD patients, aligning with previous research showing its involvement in kidney disease aggravation. CKD patients often exhibit immune dysregulation, which might facilitate the virus's invasion and persistence. Conclusion: This study provides evidence of an association between Influenza A(H1N1)Pdm09 viraemia and decreased kidney function among CKD patients. The findings highlight the importance of monitoring and preventing influenza infection in CKD patients to prevent further kidney damage.

Asymptomatic Bacteriuria and Foetomaternal Outcome at the University of Maiduguri Teaching Hospital

Asymptomatic Bacteriuria and Foetomaternal Outcome at the University of Maiduguri Teaching Hospital

Abstract 29: Detection of Protein Kinase C Isoenzymes in Patients at Risk of Schistosoma Haematobium Induced Bladder Cancer

Abstract Purpose: The Detection of Protein Kinase C Isoenzymes in Patients at risk of Schistosoma haematobium induced Bladder Cancer attending University of Maiduguri Teaching Hospital (UMTH) was carried out. The study comprised of fifty six (56) patients aged ten to fifty six (10-56) years with clinical features of schistosomiasis and confirmed for the presence of S .haematobium eggs in urine samples. Methods: Twenty milliliters (20ml) of urine was centrifuged at 1000 rpm for 10 min to obtain the sediment. The supernatants were then discarded and the sediment (pellet) re-suspended for S. haematobium. A drop of the sediment were transferred to a glass slide, covered with a cover slip and examined using × 40 objective lens. The urine samples were observed for red blood cells and deposits that might contain proteins. The extraction of total urine template RNA was carried out according to Bioneer Specification and protocol; fifty six (56) of the S. haematobium samples of the patients were used. AccuPrep® Universal RNA Extraction Kit (K-3141) from Bioneer Corporation was used and one page protocol was followed for RNA Extraction. Pre- Denaturation was done for 5min at 94oC, Denaturation for 30sec at 94oC, Annealing for 30sec at 52oC, Extension for 1min at 72oC 35 cycles, Final extension for 5min at 72oC. Results: Result was run on 2% agarose gel. The study was able to investigate and detect the putative involvement of different PKC isoforms (alpha, beta, and delta) in patient with risk of schistosoma related bladder cancer. Out of the fifty six (56) Multiplex PCR Amplification of PKC Alpha, PKC Beta and PKC Delta from cDNA of extracted RNA template of S. haematobium infected urine sample investigated, only twenty seven (27) showed detection base pairs predicted size from Lane 1-9; of which PKC Alpha (325bp) has two (2) lane; PKC Beta (490bp) has seven (7) lane; and PKC Delta (404bp) has eighteen (18) lane of predicted base pair according to the cDNA size marker, some empty-zero (0) bands lanes and Unpredicted base pair band size were also seen. Conclusion: The major findings in the present study were the detection of PKC isoenzymes base pairs (band) which indicated the risk level of schistoma induced bladder cancer and stages of the patients using the analysis that proves Isoenzymes are detected by electrophoresis. Snail control, sanitation, avoid contacts with bullinus species and focus on early detection and diagnosis of patients infected with S. haematobium. Citation Format: Zanna Abdulsalam, Adamu Inuwa, Sambo Bello Zailani. Detection of Protein Kinase C Isoenzymes in Patients at Risk of Schistosoma Haematobium Induced Bladder Cancer [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 29.

Pattern of anaemic crises in Paediatric Sickle Cell Anaemic Patients seen at the University of Maiduguri Teaching Hospital, North-eastern Nigeria

Background: Sickle cell anaemia (SCA) is the commonest haemoglobinopathy worldwide. The main presentation is chronic anaemia often exacerbated during periods of rapid destruction of red blood cells, marrow failure, or acute sequestration. Blood transfusion is often needed to save lives; unfortunately, this is often not available. Objectives: This study aimed at identifying the pattern of anaemic crises, the age group with the highest frequency and associated morbidities. Methodology: This was an analytical observational study that examined patterns of anaemic crises in children with SCA. Patients who that fulfil the inclusion criteria were recruited consecutively. Standard laboratory methods as described by Dacie and Lewis were employed in the evaluation of specimens. Results: One hundred patients in anaemic crisis, comprised 53 males and 47 females, given an M: F ratio of 1.1:1, and 100 SCA patients age and sex-matched in steady state. The mean ± SD age of cases was 7.2 ± 3.5 while that of controls was 6.82 ± 3.98, there was no difference between the ages p = 0.53. The highest incidence of anaemic crisis was seen among those aged 10 to 16 years. Malaria was the commonest morbidity among all types of anaemic crises. There was no association between types of morbidity and anaemic crisis p = 0.42. Conclusions: Haemolytic crisis was the most common anaemic crisis; acute splenic sequestration was commoner in the under-fives. Children older than 10 years were at greatest risk of anaemic crisis. Malaria was the commonest associated morbidity.

A 10-year review of records of patients managed for pelvic organ prolapse at a University Teaching Hospital, in Northeast Nigeria

Background: Pelvic organ prolapse (POP) is an important gynaecological condition as is associated with the deterioration of the quality of life of the patients. The aetiology is multifactorial and most women do not seek medical attention until symptoms become unbearable. Objective: To determine the prevalence of POP and assess the clinical presentation and management of patients with POP in our hospital. Methodology: A retrospective review of surgically managed cases of POP at the University of Maiduguri Teaching Hospital from 1 January 2010 to 31 December 2019. Data analysis was done using SPSS version 25 and the results were expressed as percentages Results: The prevalence of surgery for POP was 4.3% of major gynaecological surgical surgeries. The majority of the patients were at least 40 years old (56.8%) and grandmultiparas (72.9%). The most common presenting complaint was something coming down the vagina (93.2%) and the commonest risk factor was unsupervised home delivery (83.8%). The most common type of POP was UV prolapse (67.6%), and the most common surgical treatment offered was a vaginal hysterectomy and pelvic floor repair. Conclusion: Advanced maternal age, grandmultiparity and unsupervised home delivery were some of the risk factors for POPin this study. Supervision of delivery by a skilled birth attendant with the use of a partograph can prevent this important gynaecological condition.

Seroprevalence of Influenza A/H1N1 virus among patient with Chronic Kidney Disease in North-Eastern Nigeria

Introduction: Influenza A H1N1 infection can cause respiratory and multiple organ failure, which can lead to fatality. The prevalence of circulating Influenza A H1N1 viral IgG antibodies among patients with Chronic Kidney Disease (CKD) is not well understood. This study aimed to investigate the prevalence of circulating Influenza A H1N1 viral IgG antibodies among patients with CKD. Methods: The study was conducted at the University of Maiduguri Teaching Hospital (UMTH) from January to November 2020. Ethical approval was obtained from the University of Maiduguri Teaching Hospital Ethical Committee, and informed consent was obtained from participants. Patients with a Glomerular Filtration Rate (GFR) of less than or equal to 90mL/min with associated CKD risk factors and proteinuria were included, while patients with a GFR of 90 mL/min without CKD risk factors and patients with a GFR greater than 90 mL/min were excluded. One hundred and sixty consented subjects had their blood samples collected and analyzed for H1N1 IgG antibodies using ELISA technique. Other sociodemographic and health information were obtained from patient health records. Data analysis was carried out using the statistical package for social sciences (SPSSTM) version 20.0. Results: Out of 160 CKD blood samples tested, 23 (14.4%) were seropositive for circulating influenza A (H1N1) IgG antibodies. The seroprevalence of influenza A/H1N1 circulating antibodies was higher in the age groups of 35-44 years and 55-64 years (8 or 34.8%). The seroprevalence was higher among females (17 or 73.9%) than males (6 or 26.1%). Most of the study subjects had a normal body mass index (10 or 43.5%). Chronic Kidney Disease stage 3 patients had the highest number of patients with circulating H1N1 antibodies (10 or 43.5%) with a P value &gt; 0.594. Conclusion: This study suggests that H1N1 virus may be considered as an additional risk factor in CKD patients, particularly CKD Stage 5 - End Stage Renal Disease

Management of rare ectopic teeth eruption: case series

An ectopic tooth is a rare eruption of a tooth out of the normal dental apparatus and occurs commonly with the third molar. Thus, in this study, we reported a case series of ectopic teeth in rare jaw locations and highlight the associated pathology and our experience in the surgical management. Patients and. All cases of ectopic tooth managed at the Department of Oral and Maxillofacial Surgery, University of Maiduguri Teaching Hospital from January 2011 to December 2020 were reviewed. The information retrieved includes biodata, location of the ectopic tooth, signs, symptoms, type of tooth and associated pathology, surgical approach and complications. Ten cases of ectopic teeth were identified over the study period. This comprised 80.0% males with a mean age was 23.3 years. The antrum and lower border of the mandible accounted for 50.0% and 40.0% of the ectopic locations, respectively. Dentigerous cyst was the most associated pathology (70%) and usually presented with pain and swelling. Surgical intervention predominantly via the intraoral route was performed if indicated. Ectopic teeth are rare and not always associated with pathology. A high index of suspicion and radiological investigation are necessary for diagnosis. A more extensive multi-center study is however recommended to determine the prevalence of ectopic teeth other than the third molar.

Assessment of hs –CRP in Patients with Hypothyroidism at University of Maiduguri Teaching Hospital, Maiduguri Borno State

Introduction: High sensitive c-reactive protein (hs-CRP) is an important sensitive inflammatory marker, but not a routine laboratory investigation for diagnosis of hypothyroidism. However, many thyroidal conditions involve inflammation in the present study, the level of hs-CRP and its link with hypothyroidism was assessed. Materials &amp; Methods: A total of 60 males and 50 females aged 20-55 years were assessed for the study. Evaluation of hs-CRP was done on SD biosensor standard F200 fluorescent immunoassayauto analyser in serum was also assayed for FT3 FT4 and TSH by enzyme linked immunosorbent assay (ELISA) technique using Stat-fax-2100. Result: In our study, we have found the values of FT3 in cases as 1.21+0.89 pg/ml lower than control values of 1.92+ 0.66 pg/ml, values of FT4 in cases is 0.60+ 0.53 ng/dl as compared to control group value of 1.40 +0.39 ng/dl, values of TSH as 2.07+ 1.19 miu/l higher than the control group of 0.48+1.67 miu/l. The mean values of hs-CRP for cases as 7.85+0.72 higher than the control group with 3.50+0.54. Conclusion: Our study findings suggest that patients with hypothyroidism also have elevated hs-CRP which can have implication related to cardiovascular disease.

5613357 ULTRASONOGRAPHIC SPLENIC INDICES AND AGE-RELATED CLINICAL AND LABORATORY PARAMETERS IN PATIENTS WITH SICKLE CELL DISEASE IN NORTH-EASTERN NIGERIA

Background: The spleen is one of the organs affected by sickle cell disease (SCD) early in life (1-3); repeated episodes of vaso-occlusion and infarction result in a reduction in both the spleen’s structure and function (4). The rate of progression of this process varies markedly among individuals with SCD. The aim of the current study was to evaluate spleen sizes using abdominal ultrasound in children and adults with SCD in an African setting and to explore baseline clinical and laboratory variables associated with the presence or absence of the spleen. This information could be used for early monitoring and aid management among these patients. Methods: Two hundred and four sickle cell disease patients (SCD) (101 males and 103 females; age range, 1.1 to 45 years) underwent abdominal ultrasound scans at the University of Maiduguri Teaching Hospital, Nigeria between October 2020 to November 2021. One hundred and eleven age-matched healthy persons were enrolled as controls (69 males and 42 females: age range 1.5 years to 34 years). Imaging was performed by a single radiologist who assessed and measured the spleen length, depth, and width, and calculated the volume. Results: The spleen was visualized in 107 SCD patients (52.4%; 95% CI, 46% - 59%; SE 0.035) on ultrasound and was absent in 97 patients. There was a progressive increase in spleen absence with increasing age; while the spleen was present in all the under-fives, it was present in less than 24% (n = 20/85) of those 15 years and above (Fig.1). The pattern of spleen size growth with age among the SCD patients is shown in Fig.2; the median spleen length remained relatively stable at 6.5cm throughout early childhood, increasing only slightly to 7.0 cm in the 10 -14 years before reaching the adulthood size of 8.8cm from 15 years and above. Factors that were significantly associated with the presence of the spleen on the univariate analysis included high HbF and haemoglobin, low levels of platelets, HbA2, red cells indices (MCH, MCHC), positive malaria parasitemia, and history of intake of hydroxyurea. Multivariable logistic regression analysis showed only high HbF (12.2% vs 7.5%; OR, 1.17; 95% CI, 1.05 -1.29. P = 0.003) and low mean corpuscular haemoglobin concentration (MCHC) (34.1pg vs 35.1pg; OR, 0.69; 95% CI, 0.47 – 0.99. P = 0.049) were significantly associated with persistence of the spleen among SCD patients (Table 1). Only 32 (15%) patients were on regular hydroxyurea therapy, however, the HbF% level was significantly higher among patients on hydroxyurea (median 12.7; IQR 9.4) compared to their counterparts not on hydroxyurea (median 7.4; IQR 8.0) (P = 0.000). Sex and clinical parameters including frequencies of hospitalization, painful crises, febrile episodes, and total lifetime transfusion had no association with the presence of spleen on ultrasound Conclusion: In patients with SCD, the spleen persisted up to five years before any evidence of autosplenectomy occurred. Patients with persistent spleens had a higher level of HbF compared to those with absent spleens. Early determination of HbF may be of value in identifying patients who will benefit from HbF-inducing therapy such as hydroxyurea. Table 1 - Adjusted odd ratios for associations with spleen present or absent on ultrasound Parameter OR (95% Confidence interval) P value Hb, g/dl 1.07 (0.78 - 1.46) 0.675 MCH, g/dl 0.86 (0.72 - 1.02) 0.077 MCHC, pg 0.69 (0.47 - 0.99) 0.049* Platelets, ×106/µL 0.99 (0.99 -1.00) 0.274 HbF, % 1.17 (1.05 -1.29) 0.003* HbA2, % 0.75 (0.35 - 1.58) 0.447 Malaria parasite positive 2.55 (0.96 - 6.75) 0.060 Regular intake of hydroxyurea 1.84 (0.42 - 7.99) 0.418 Hb haemoglobin; MCH mean corpuscular haemoglobin; MCHC mean corpuscular haemoglobin concentration; SD standard deviation. CI con

Evaluation of Wound Infection by Resistant Strains of Pseudomonas aeruginosa in Maiduguri, Northeastern Nigeria

Following a loss of skin integrity (wound), the subcutaneous tissue is exposed, creating a moist, warm, and nutrient-rich environment that is favorable for microbial colonization and growth. The colonization of wound by pathogenic bacteria could be a source of localized or systemic infection and impair the wound healing process. Here, we report the incidence of infection by antibiotic resistant strains of Pseudomonas aeruginosa in wounds of patients attending hospitals in Maiduguri. Four hundred and twenty (420) wound swab samples were collected, using the Levine technique, from patients presenting with wounds in four (4) selected hospitals in Maiduguri (UMTH: University of Maiduguri Teaching Hospital; SSH: State Specialist Hospital; USH: Umaru Shehu Ultra-Modern; and MSH: Mohammed Shuwa Memorial Hospital). Wound swab samples were cultured on Blood agar, MacConkey agar and Cetrimide agar. Suspected colonies of Pseudomonas aeruginosa were further confirmed by biochemical tests and subjected to Kirby Bauer Disc Diffusion technique to ascertain their resistivity profile. Isolates were further classified as Multidrug resistant based on criteria set by European Centre for Disease Prevention and Control (ECDC) and the Centers for Disease Control and Prevention (CDC). Sixty eight (68) out of the four hundred and twenty (420) wounds analyzed yielded positive growth of P. aeruginosa. This gives a recovery rate of 16.2%, which was highest among male patients (10.7%) and patients between the ages of 21-40 years (6.0%) (p&lt; 0.05). Hospital based prevalence was found to be highest in UMTH (20.8%) and least in MSH (6.0%) (p&gt;0.05). All isolates were resistant to Ceftazidime (100%) and prevalence of multidrug resistance was 44.1%, where patients attending SSH recorded the highest rate of 20.6%. Efficient care must be given to wounds from initial onset to the time of healing so as to prevent infection by pathogenic microorganisms

Pattern of gout and its association with chronic kidney disease in Maiduguri, northeastern Nigeria.

Gout is considered uncommon among Black Africans. It is commoner in men and associated with obesity, hypertension, and chronic kidney disease (CKD). This study aims to determine the pattern and frequency of gout and its associated factors in Maiduguri, north-eastern Nigeria. A retrospective study of gout patients managed at the rheumatology clinic of the University of Maiduguri Teaching Hospital (UMTH), Nigeria, from January 2014 to December 2021. Diagnosis of gout was made using the Netherlands 2010 criteria, and CKD was defined as an estimated glomerular filtration rate (eGFR) of < 60ml/min/1.73m2 using the 2021 CKD-epidemiology collaboration (CKD-EPI) creatinine equation. A P-value of < 0.05 was considered statistically significant. Out of 1409 patients seen during the study period, 150 (10.7%) had gout. They comprised 57.0% males, mostly presented with mono-articular disease (47.7%) with the ankle predominantly involved (52.3%). First metatarsophalangeal and knee joint involvement were commoner among males than females (59% vs 39%, p = 0.052 and 55.7% vs 34.8%, p = 0.05 respectively). The mean serum uric acid (SUA) level was 557.6 ± 176.2mmol/l, and the levels did not differ between gender (p = 0.118, CI [- 126.6 to 14.5]). Ninety (84.1%) had CKD with 20.6% in end-stage renal disease (eGFR < 15ml/min/1.73m2). Polyarticular involvement and tophi were commoner among patients with CKD (21.1% versus 11.8% p = 0.652 and χ = 4.364, p = 0.022 respectively) Serum uric acid levels positively correlated with serum creatinine (p = 0.006) and negatively correlated with eGFR (p = 0.001). The best predictor of SUA level was the eGFR (B = - 2.598, p < 0.001). Gout in north-eastern Nigeria constitutes about 11% of all rheumatic diseases and is typically monoarticular; however, polyarticular form and tophi were commonly seen in patients with CKD. Further studies will be needed to evaluate the relationship between the pattern of gout and CKD in the region. Key Points • Gout in Maiduguri is commonly monoarticular; however, polyarticular presentations and tophi are commoner among gout patients with chronic kidney disease (CKD). • The increase in the burden of CKD might have resulted in the increase in the number of females with gout. • The use of the validated and simple Netherlands criteria for the diagnosis of gout is useful in developing countries to overcome the challenges associated with the use of polarized microscope and thereby allowing further research on gout. • There is a need for further research on the pattern and prevalence of gout and its relationship with CKD in Maiduguri, Nigeria.

HIV infections averted at PEPFAR-APIN clinics in Nigeria: a ten-year retrospective evaluation of the clinical outcomes of post-exposure prophylaxis services

Introduction: Nigeria contributes a high fraction to the global burden of HIV infections. Post-exposure prophylaxis (PEP) is a proven strategy to prevent transmission of the virus. The aim of this study was to determine the clinical outcomes of PEP in Nigeria at four clinics funded by United States President's Emergency Plan for AIDS Relief and AIDS Prevention Initiative in Nigeria (PEPFAR-APIN): Ahmadu Bello University Teaching Hospital (ABUTH), Jos University Teaching Hospital (JUTH), University of Maiduguri Teaching Hospital (UMTH) and University College Hospital (UCH). Methods: This study adopted a multisite retrospective design using the site's databases (2006-2016). Retrieved data was exported into SPSS version 25 for statistical analysis. Outcomes were measured as a proportion of HIV infections averted after PEP. Frequencies and percentages were used to describe the findings, while binary logistic regression was used to determine the sociodemographic predictors of clinical outcomes. Results: The average age of the 575 PEP patients whose data were retrieved was 30.45 (SD ±9.50 years), with 344 (59.8%) being females. Out of 545 patients,157 (28.8%) indicated their job status as students. Out of 273 patients, 198 (72.5%) reported their exposure type was non-occupational. The HIV status of 129 (22.4%) patients was negative after completing PEP. Prescribed regimen (β = -0.048, 95% CI -0.095 to -0.001, p = 0.045) and type of exposure (β = 0.351, 95% CI 0.042-0.660, p = 0.027) were predictors of post-PEP HIV status in JUTH and ABUTH respectively. Conclusion: There was a high rate of lost-to-follow-up among the PEP patients, but the incidence of seroconversion was low in those who were tested after PEP. The right choice of regimen and presenting with non-occupational exposure affected the outcome of the service.

Evaluation of the Effect of Surgical Repair on Lip-Nose Morphometric Parameters of Patients with Unilateral Cleft Lip using Two-Dimensional Photogrammetry: A Comparative Study between the Cleft and the Non-Cleft Side.

This prospective, comparative study was carried out to evaluate the effect of cleft lip repair on lip-nose morphometric characteristics of subjects with complete unilateral cleft lip/palate at the University of Maiduguri Teaching Hospital, Borno State, Nigeria. The study population consisted of a total of 29 subjects. Lip repair was done using Millard's rotation advancement technique by a single consultant. Standardised photographs were taken; preoperatively and during different postoperative periods; immediately, 1 week, 3, and 6 months. Indirect measurements of eight linear distances were carried out using Rulerswift software application. For all statistical analyses of mean difference, a P-value of less than 0.05 was accepted as being statistically significant. A total of 52% were women, whereas 44% were men. There are considerable disparities between the cleft and non-cleft sides of complete unilateral cleft patients before surgery; statistically significant differences of 1.4 mm, 6.3 mm, and -17.6 mm in vertical lip height, philtral height, and nasal width respectively. Six months after repair, statistically significant differences in lip height between the cleft and the non-cleft side were observed in vertical lip height, nasal width, and philtral height (mean difference of -1.28 ± 0.78, 2.02 ± 2.86, 1.22 ± 1.83 mm; P < 0.001, P = 0.016, P = 0.022, respectively). Horizontal lip height was maintained with no statistically significant difference (mean difference of -0.12 ± 2.19 mm). Following cleft repair, using Millard's rotation advancement technique, differences in lip-nose morphometric parameters were found to be reduced, however, not always eliminated by treatment.

Trends in the incidence of Rifampicin resistant Mycobacterium tuberculosis infection in northeastern Nigeria

Mycobacterium tuberculosis is a respiratory bacterial pathogen that causes Tuberculosis. About one-quarter of the global population is infected, most of which are asymptomatic with a 5–15% risk of developing active disease across their lifespan. The progression of the disease has been enhanced by HIV coinfection and the emergence of Mycobacterium tuberculosis strains that are resistant to first-line anti-TB drugs, especially Rifampicin. Rifampicin resistance is brought about by mutation in the gene coding for beta-subunit of the enzyme RNA polymerase (rpoB) and is a surrogate marker for multidrug-resistant Tuberculosis (MDR-TB). Herein, using the GeneXpert MTB/RIF molecular technique, we examined the incidence of Mycobacterium tuberculosis infection and evaluate rpoB gene mutation among Mycobacterium tuberculosis isolates identified from presumptive pulmonary tuberculosis (PTB) and extra-pulmonary tuberculosis (EPTB) patients attending the directly observed treatment short-course (DOTS) clinic, University of Maiduguri Teaching Hospital, Nigeria. A total of two thousand four hundred and fifty-one (2451) presumptive TB cases (PTB = 2279, EPTB = 172) were analyzed from January 2018 to July 2019. The incidence of Mycobacterium tuberculosis infection was 22.68% (Mean±S.E = 46.33 ± 15.41). The incidence of Rifampicin-resistant Mycobacterium tuberculosis was 4.50% (Mean±S.E = 2.08 ± 1.02). The incidence of Mycobacterium tuberculosis and HIV co-infection was 16.59%, while the incidence of Rifampicin-resistant Mycobacterium tuberculosis and HIV co-infection was 4.23%. The peak incidence of M. tuberculosis infection was observed during the first quarter of each year and this variation was observed to be statistically significant (f = 9.34606; p < .05; CI95; p = 0.000068). Incidence of Rifampicin-resistant Mycobacterium tuberculosis was observed to be more prevalent among female patients that are 15 years or older (Fischer's exact test = 0.533; p < .05; CI95; p = 0.465348). The incidence rates reported herein are higher than the WHO-reported national average. By this report, it can be affirmed that the incidence of Mycobacterium tuberculosis infection in northeastern Nigeria is increasing and the rate of infection follows a seasonal trend.

The Accuracy of Rapid Urine Tests in Detecting Asymptomatic Bacteriuria in Pregnancy at University of Maiduguri Teaching Hospital, Maiduguri, Nigeria

Background: Asymptomatic bacteriuria (ASB) is the most prevalent Urinary tract infection (UTI). The gold standard for detecting ASB is urine culture, which requires trained personnel who are not always readily available in some parts of the world. Quick office-based tests such as urine microscopy and reagent strip testing are also used as screening tests at points of care, reserving culture for positive and symptomatic cases. Objectives: This study determined the risk factors for ASB and the accuracy of reagent strip testing and microscopy in detecting ASB among pregnant women. Methods: A cross-sectional study of 150 women attending the antenatal clinic of the University of Maiduguri Teaching Hospital (UMTH) in Maiduguri, Nigeria, was conducted from 3rd October to 13th December 2010. Demographic and clinical variables were obtained. Midstream urine specimens were collected from each patient and used for reagent strip testing, microscopy, culture and antibiotic susceptibility testing. The performance of the various tests alone and in combination was evaluated using urine culture as the standard. Results: Sickle cell trait, history of UTI before index pregnancy and anaemia at booking were significant risk factors for the development of ASB. A combination of positive leucocyte esterase and nitrite tests had specificity and a positive predictive value of 100% each. Similarly, the combination of pus cell count and gram stain, termed enhanced urinalysis had specificity and positive predictive values of 99.1% and 95.0%, respectively. Conclusion: Sickle cell trait, UTI before index pregnancy and anaemia at booking are significant risk factors for ASB. A combination of negative dipstick leucocyte esterase, nitrite, and negative enhanced urinalysis effectively rules out ASB. Urine culture can be restricted to positive and symptomatic patients.