Usmanu Danfodiyo University Teaching Hospital Research Articles

Assessing Lifetime Cancer Risk for Radiotherapists using the Excess Relative Risk (ERR) and Excess Absolute Risk (EAR) Models.

This research assesses the occupational radiation exposure of workers in the Radiotherapy Department at Usmanu Danfodiyo University Teaching Hospital, Sokoto, where ionizing radiation is frequently utilized. The study evaluates the annual effective dose, individual distribution ratios, and collective effective dose for the personnel. The obtained annual effective doses range from 0.25 to 2.75 mSv, and the collective effective doses range from 8.58 to 90.09 man-mSv for Administrative and Medical Physicists, respectively. No radiotherapist received an annual effective dose exceeding 5 or 10 mSv, ensuring that the lifetime cancer risk remains below 75%. This retrospective study relies on at least five years of thermoluminescent dosimetry (TLD) records to evaluate whole-body occupational exposure among personnel interacting with ionizing radiation. The TLDs were read using a Harshaw dual-4500 TLD reader on a quarterly basis over the five-year study period. The results indicate that no radiologist received an annual effective dose surpassing the 20 mSv limit recommended by UNSCEAR.

Comparative Analysis of Multiple Comparison Tests for Radiation Exposure Subgroups Among Dental Workers At Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria

Post-hoc analysis is a crucial statistical technique employed to identify specific group differences following a significant ANOVA result. This study delves into the comparative analysis of three commonly used post-hoc tests - Tukey's HSD, LSD, and Scheffe's method - to determine significant differences in radiation exposure levels among dental workers at Usman Danfodiyo University Teaching Hospital, Sokoto, Nigeria. Dental professionals are routinely exposed to ionizing radiation, primarily from X-ray machines. Excessive exposure can lead to various health risks, including cancer. Hence, accurate assessment and comparison of radiation exposure levels among different categories of dental workers are essential for effective radiation protection measures. In this study, the researchers calculated the critical values for each post-hoc test at a significance level of 0.05. The results indicated that the LSD method had the smallest critical value (0.674), followed by Tukey's HSD (1.304) and Scheffe's method (1.566). A lower critical value generally implies a higher sensitivity in detecting significant differences between groups. By conducting pairwise comparisons, the study found that the LSD method was the most effective in identifying statistically significant differences in radiation exposure levels among the dental workers. This suggests that the LSD method is a suitable choice for post-hoc analysis in this specific context. The findings of this study have significant implications for radiation protection practices in dental settings. By employing appropriate post-hoc analysis methods, healthcare institutions can accurately assess radiation exposure risks and implement targeted interventions to minimize exposure and protect the health of dental workers.

Knowledge, Attitude, And Perception Of Health Workers Towards Electronic Health Record System (A Case Study Of Uduth, Sokoto)

Background: Electronic Health Records System (EHRS) has shown a lot of advantages over the conventional paper based medical records. Its use has grown rapidly in the developed world and yet most African nations are still lagging behind. In Nigeria, the penetration of EHRS is low with less than 10.0% of hospitals embracing it.Factors responsible for this low penetration or use of EHRS in Nigeria include interoperability issues, epileptic power supply, cost of installation, resistance to change, health providers' and patients' poor orientation. This study aimed to assess level of knowledge, attitude and perception of health care workers on the use of EHRS in Usmanu Danfodiyo University Teaching Hospital, Sokoto. Methodology: Cross sectional study was conducted in June, 2023 among 132 healthcare workers that were randomly selected using stratified sampling technique. Pre-tested structured self-administered questionnaire was used for data collection. Data was cleaned and analyzed using IBM SPSS version 21.0. Univariate analysis to generate summary statistics, proportions and frequency tables was conducted. While Bivariate analysis was conducted to identify variables that were significantly associated with respondents knowledge, attitude and perception at a P-value of <0.05. Results: Majority (70%) of the respondents had good knowledge of EMR and 30% had bad knowledge. 84% of the respondents had positive attitude towards EHRS while 86% of them had positive perceptions on EHRS. Doctors were 85.0% less likely to be knowledgeable about EMR than other healthcare workers (aOR 0.150; 95% CI 0.030 - 0.748). Respondents that were computer literate were 30.0% more likely to be knowledgeable than those who were not (aOR 1.297; 95% CI 3.885 – 4.330) and those that had computer training were 13.0% more likely to be knowledgeable than those who were not (aOR 1.126; 95% CI 0.032 – 0.501). A greater proportion of respondents with good knowledge 90(96.8%) had a good attitude, the result was statistically significant (X2<37.85, p=0.01) A greater portion of the respondents with good attitudes had good perception 108(95.6%) as compared to respondents, with poor attitudes 16(46.2%) the association was statistically significant (χ2=77.39, p <0.01). A greater proportion of respondents with good knowledge had good practice compared to those with poor knowledge. However, the result was not statistically significant feχ2=2.330, p=0.169). Conclusion: majority of the respondents had good knowledge 92(70%), good attitude110 (84%) and good perception towards EHR 114(86%). As such government support and funding of electronic health system in health facilities is recommended.

Asymptomatic Group B Streptococcal infection, Antibiotic Sensitivity, Risk Factors and Pregnancy Outcome among Pregnant Women at the Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

Background Streptococcus agalactiae or group B streptococcus (GBS), although a normal commensal, it is a leading cause of both maternal and neonatal sepsis. Objectives The study assessed the prevalence and sensitivity pattern of Group B Streptococcus, as well as the risk factors for infection and pregnancy outcome among pregnant women at the department of Obstetrics and Gynaecology of the Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. Methods A prospective study among 152 pregnant women at the antenatal care clinic of Usmanu Danfodiyo University Teaching Hospital, Sokoto, selected by simple random sampling technique and relevant information was obtained using semi structured interviewer questionnaire. Swab samples were collected from the vagina and rectum for culture and further evaluation. The data was managed using SPSS software version 26 and the variables were analysed using descriptive and inferential statistics, and P- value < 0.05 was considered statistically significant. Result The prevalence of Group B Streptococcal infection among respondents was 4.6%. The mean age was 26.97± 5.6 with a range of 16 to 39 years. The organism was 100 % sensitive to Levofloxacin, Gentamycin and Clindamycin, but 57.1 %, 28.6 % and 14.3 % sensitive to Erythromycin, Augmentin and Penicillin respectively. The spousal educational status was statistically associated with GBS infection at a P- Value 0.04. There was 1(0.7%) each of spontaneous miscarriage and a preterm birth at 36 weeks’ gestation. Conclusion Group B Streptococcal infection is relatively common in our environment, with a contrary susceptibility pattern. It is association with spousal educational status.

An Audit of Post-neonatal Infant Morbidity and Mortality from Admissions in an Emergency Unit of a Tertiary Hospital in Sokoto, Northwest Nigeria

Background The first year of life is a critical period of adaptation for a young infant during which the child becomes exposed to a lot of infectious agents and other environmental problems as its immune systems and other organs are developing. Magnitude of deaths within the first year of life is a significant socioeconomic index of any population. Challenges can also be brought to the forefront which can be tackled by appropriate authorities. Objectives To assess the causes of morbidity and mortality amongst infants aged 29 days to 12 months admitted in the emergency Paediatric unit (EPU) of Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto over a 5- year period. Materials and Methods The admission records of children aged 29 days to 12 months were retrieved. Information extracted included socio-demographic data, diagnosis and outcome of admission. These were entered into a study proforma and analysed with SPSS version 23. Results Total admissions were 1776 in the five-year review. Majority were males accounting for 1030 (58%) with M:F ratio of 1.38:1. 972 (55.4%) were aged 6 to 12 months. Top causes of admissions were diarrhoea disease 328 (18.5%), pneumonia 280 (15.8%), sepsis 211 (11.9%), malaria 202 (11.4%) and malnutrition 154 (8.7%). Mortalities were 223 (12.6%). Highest fatalities out of 223 were from sepsis 47 (21.1%), pneumonia 40 (17.9%), malaria 27 (12.1%), malnutrition 25 (11.2%) and diarrhoea disease 20 (9.0%). Higher proportion of the mortalities were in females 14.5% vs 11.2% (X2 = 4.3; p=0.038). Sepsis mortality was high throughout likewise pneumonia but mortality pattern of other disease conditions varied throughout infancy. Conclusion Post-neonatal admissions were mainly due to infections, likewise mortality of which the top causes varied throughout infancy. Females were more proportionately affected by mortality. These insights on the morbidity and mortality patterns calls for more concerted efforts on child survival strategies and targeting this group of infants is imperative.

Peri-Ampullary Tumour; An Unusual Cause of Upper Gastrointestinal Bleeding

Periampullary tumors are cancers that arise in the region of the around the ampulla of Vater, where the bile duct and pancreatic duct converge and empty into the small intestine. This region is very critical for digestive enzyme and bile secretions. This may be associated with slow disease progression, age related changes delayed onset of symptoms and lack of screening and diagnostic facilities. These tumours can be challenging to diagnose and manage due to their proximity to several vital structures. Upper gastrointestinal bleeding may be a rare clinical presentation following tumoral ulceration, erosion into blood vessels or nearby structures or secondary complications like pancreatitis or portal hypertension. Identifying the anatomical origin of these malignancies is usually a herculean task. This will require prompt oesophagogastroduodenoscopy and imaging to determine the source and appropriate management. This is especially true given the region's transitional character, closeness to various structures, and overlapping features among them. We present periampullary tumour an unusual cause of upper gastrointestinal bleeding in a resource limited setting. A52 year old Nigerian male was admitted at the Usmanu Danfodiyo University Teaching Hospital, Sokoto for evaluation following a 3 months history of progressive weight loss, generalized body weakness and a burning and occasionally colicky, persistent, non-radiating epigastric pain, loss of appetite, easy fatiguability, occasional dizziness and recurrent non-projectile post-prandial non-billous vomiting. Though he had no hematemesis, he had history of passage of malaena. The patient was fully conscious on admission, pale, wasted with a markedly tender epigstric region. He was tachycardic with a minimal elevation in blood pressure level of 138/94mmHg. He had an international normalized ratio (INR) of 1.0. Oesophagogastroduodenoscopy was performed which showed a polypoid fungating mass at the1st extending to the 2nd part of the duodenum. A Computerized Tomogram scan of the abdomen showed a diffuse circumferential duodenal wall thickening of 1st and 2nd parts (more in 2nd part) with reduction in luminal calibre of duodenum and mildly dilated pancreatic, common bile, common hepatic ducts. Multiple biopsies were taken for histology which showed moderately differentiated aadenocarcinoma. Surface epithelium composed of columnar epithelial cells which can be seen in the top right of the image below with an invasive tumour, seen infiltrating the lamina propria in the lower left. He went on to have an exploratory laparotomy with triple bypass involving a side to side gastrojejunal anastomosis and cholecystojejunostomy and entero-enterotomy folowing which he went on to receive chemotherapy. As of the time of this write up the patient has recuperated well following his treatment.

Traumatic penile amputation managed at Usmanu Danfodiyo University Teaching Hospital Sokoto, Nigeria: a case series

BackgroundTraumatic penile amputation is a rare surgical emergency and a cause of anxiety and psychological distress to patients, spouses, or parents, especially when it occurs in children. Several mechanisms are involved in penile amputation and the management options also vary. We report two cases of penile amputation that our institution handled in the past year to draw attention to the risks associated with firearm confrontations and grinding machines as causes of genital injuries. In a similar vein, we look over the literature for management options.Case presentationIn the first case, a grinding machine resulted in an isolated total penile amputation of a 6-year-old boy. In contrast, the second patient was a 25-year-old man who had bilateral testicular injuries and near-total penile amputation as a result of gunshot injury as part of polytrauma. Both patients had a history of profuse bleeding from the penile stump associated with severe pain. Both patients were resuscitated and subsequently underwent emergency wound debridement and stump refashioning/meatoplasty. The first patient had a satisfactory outcome and was discharged home on follow-up visits while the second patient died from overwhelming sepsis with pulmonary embolism as a differential.ConclusionPenile injuries may increase in tandem with civilian firearm-related incidents. Similarly, grinding machines are an important cause of penile injuries. In emergencies, wound debridement followed by stump refashioning is an appropriate treatment option.

Pattern Of Admission And Outcome Among Neonates Admitted Into The Special Care Baby Unit Of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

Introduction: The neonatal disease pattern is a sensitive indicator of the availability, utilisation and effectiveness of mother and child health services in the community. Community based data are difficult to come by, so hospital based data most often is use to assess the burden of neonatal problems. Aim: To determine the pattern of morbidity, mortality and outcome of neonates admitted into the Special Care Baby Unit (SCBU) of the Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto from 1 st January 2022 to 31st December 2022. Methods: A hospital-based retrospective review of medical records of neonates admitted into the SCBU of UDUTH, Sokoto from 1 st January, 2022 to 31st December, 2022. Information retrieved included the biodata, place of birth, age at admission, diagnosis, duration of hospital stay and outcome. Data was analysed using SPSS version 22. Results: A total of 818 neonates were admitted during the study period, 393(48.0%) were males and 425(52.0%) were females giving a male to female ratio of 1:1.1. Most 606(74.1%) of the patients were out born. Birth Asphyxia 245(30.0%) was the main reason for admission, followed by prematurity 182(22.3%). Majority 653(79.2%) were discharged, 16(2.0%) left against medical advice, while 149(18.2%) of the admitted patients died. Prematurity related death 61(40.9%) and birth Asphyxia were the leading causes of death respectively. Majority 107(71.8%) of the deaths occur among the out-born. Conclusion: Birth asphyxia and prematurity related complications were the main reasons for neonatal admissions and the leading causes of death in this study. Most of the neonatal deaths were from preventable causes. Strengthening perinatal care, emergency obstetric services, facilities for improved preterm care should be provided in secondary and tertiary health facilities and improving the skills of health care providers on neonatal resuscitation are necessary to reduce neonatal mortality

Acute Kidney Injury Among Asphyxiated Neonates In Sokoto, North West Nigeria

Background: Birth asphyxia and its attendant complications remain a common problem in our neonatal intensive care units. Compelling evidence from various epidemiologic studies shows that Acute Kidney Injury (AKI) is indeed one of the commonest complications of birth asphyxia. The kidneys are sensitive to oxygen deprivation, renal insult may occur within few hours of hypoxic-ischemic episode, which if prolonged could lead to irreversible cortical and or tubular necrosis. Aim: To determine the prevalence and factors associated with AKI among asphyxiated term neonates in Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, Nigeria Materials and methods: One hundred and nineteen asphyxiated term neonates admitted into the special care baby unit of UDUTH Sokoto participated in the study. Birth asphyxia was defined as failure to initiate and sustain breathing at birth with Apgar scores ≤ 5 at 5 minutes in the presence of arterial cord blood pH < 7 and base deficit >12mmol. Blood samples were taken for arterial blood gas analysis within one hour of life. Moderately and severely asphyxiated neonates who satisfied the inclusion criteria were consecutively recruited into the study and serum creatinine assay was done on day 3 and day 5 of life. AKI was defined as a rise in serum creatinine ≥ 0.3mg/dl over 48 hours. Quantitative variables such as birth weight, length, occipitofrontal circumference (OFC) were expressed using mean, standard deviation and range, while qualitative variables like gender, mode of delivery and grade of asphyxia were summarised using frequency and percentages. Chisquare and fisher’s exact tests were applied to determine if any relationship exists between sociodemographic/clinical factors and AKI. A p-value of < 0.05 was considered statistically significant. Results: Of the 119 asphyxiated term neonates 74 (62.2%) were males while 45 (37.8%) were females giving a M:F ratio of 1.6:1. Majority 96 (80.7%) of the subjects had normal birth weight with a mean birth weight of 3.1 ± 0.6kg. The mean gestational age recorded was 38.2 ± 1.1 months The prevalence of AKI in the study subjects was 42.9%. The grade of birth asphyxia was significantly associated with AKI with a prevalence odds ratio of 7.2 (95CI 2.8-18). Conclusion: The prevalence of AKI in asphyxiated term neonates in UDUTH Sokoto was high and the grade of birth asphyxia was found to be significantly associated with AKI

Patterns and outcomes of Emergency Pediatric Unit admissions in Usmanu Danfodiyo University Teaching Hospital in Sokoto State, Nigeria: a five-year review

Children are susceptible to illnesses that often require urgent medical attention, with attendant high mortality rates, especially in resource-constrained settings. Periodic audits in tertiary care facilities can guide preventive and therapeutic policies. The aim was to determine the admissions pattern and outcome over five years in the Emergency Paediatric Unit (EPU) of Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, a major tertiary facility in North Western Nigeria. This was a retrospective study between January 2017 and December 2021. The admission records of children aged >1 month to 15 years were retrieved, relevant information extracted, and entered into a study proforma. Data was analyzed using SPSS version 23. There were 6088 admissions. Under-fives constituted 4448 (73.1%), and males were 3558 (58.4%). The median age was 24.0 months (Interquartile Range, IQR, 12, 60). Top admissions were severe malaria (1100; 18.1%), acute diarrhoeal disease (631; 10.4%), Sickle Cell Disease (SCD) (624; 10.2%), pneumonia (547;9.0%), Severe Acute Malnutrition (SAM) (438;7.2%), febrile convulsions (421;6.9%), pharyngotonsillitis (402;6.6%) and sepsis (398;6.5%). Total discharges were 2483 (40.8%), 2635 (43.3%) were transferred, and mortalities were 679 (11.2%). Case fatality rates of the top admissions were sepsis (19.6%), SAM (19.4%), severe malaria (13.7%), pneumonia (10.6%), febrile convulsions (5.0%), acute diarrhoeal disease (4.9%), pharyngotonsillitis (2.5%) and SCD (2.1%). SCD was the most common non-infectious morbidity and responsible for most re-admissions. Malaria was the top cause of mortality in all age groups except infancy, where sepsis and pneumonia predominated. In conclusion, malaria and other infectious diseases accounted for most admissions. Non-communicable diseases, like SCD, also constitute significant morbidity. Hence, policymakers need to scale up targeted preventive measures.

A Ten-Year Review of Neonatal Tetanus Seen in a Tertiary Health Facility in Sokoto North-Western Nigeria: Before and During the Covid-19 Pandemic

Background: Neonatal tetanus (NNT) remains among the leading cause of preventable morbidity and mortality among neonates in Nigeria. Nigeria remains among the countries carrying the global NNT burden. At the onset of the COVID-19 pandemic, reports have predicted that the pandemic will significantly impact on the health system globally, and low-resource countries where vaccination programs fared even worse are likely to see a surge in vaccine-preventable diseases during and after COVID-19 pandemic. Aims: To determine the prevalence, yearly trend, risk factors, and outcome of NNT cases seen in the Special Care Baby Unit (SCBU) of Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria over a ten year period: before and during COVID-19 pandemic. Methods: This was a retrospective study. Data was retrieved from all the case notes of neonates admitted with a clinical diagnosis of NNT into the SCBU of the UDUTH, Sokoto from 1st January, 2013 to 31st December, 2022. The data obtained was analyzed using SPSS version 21. Results: During the 10 years period of the study, NNT accounted for 0.4% of admissions. The majority 15(57.0%) of the mothers of the neonates with NNT were from rural areas, 15(56.0%) had no antenatal care (ANC), and only 10(37.0%) of the mothers received vaccination against tetanus. All the mothers were from lower socio-economic classes. Most 17(63.0%) of the neonates were delivered at home by traditional birth attendants. The umbilical cord was the portal of entry in 26(96.0%) of cases, while 1(4.0%) followed traditional uvulectomy. Cord care was done using hot water fermentation in more than half of the neonates 17(63.0%), while only 1(4.0%) of the mothers used chlorhexidine gel for cord care. The case- fatality rate was 6(22.0%). the yearly trend showed an increased incidence of NNT admissions in 2022. Conclusion: The study showed that NNT is still a public health problem, with an increased scourge during the COVID-19 pandemic, which can be tackled through health education of mothers via mass media, improving the quality and access to ANC services, tetanus toxoid vaccination, hospital delivery and avoidance of traditional uvulectomy particularly in rural areas by the Sokoto state government. Antenatal and vaccination services should be given priority in response to future pandemics to sustain gains of the SDG 3.

Evaluation of Co-production of Colistin Resistance and ESBL Genes among Gram-negative Clinical Isolates from Usmanu Danfodiyo University Teaching Hospital Sokoto, Nigeria

Study’s Excerpt/Novelty This study presents a comprehensive evaluation of colistin-resistant and extended-spectrum beta-lactamase (ESBL) gene co-production among Gram-negative clinical isolates from Usmanu Danfodiyo University Teaching Hospital in Sokoto. Notably, 13.9% of the isolates exhibited phenotypic co-production of colistin resistance and ESBL, with a significant presence of blaCTX-M and CTX-M 8 genes among ESBL producers, although no colistin resistance genes (mcr-1 and mcr-2) were detected via PCR. These findings highlight the necessity for integrated molecular and phenotypic investigations to fully elucidate resistance mechanisms in Gram-negative bacteria and underscore the need for further research to uncover alternative pathways contributing to observed resistance phenotypes. Full Abstract The emergence of antimicrobial resistance (AMR) is a major threat to global health. Its effects include high mortality and morbidity rates, treatment failure, and increased treatment costs. This study aimed to evaluate the co-production of colistin-resistant and extended-spectrum beta-lactamase (ESBL) genes among Gram-negative clinical isolates from Usmanu Danfodiyo University Teaching Hospital in Sokoto. Gram-negative bacteria were isolated from clinical specimens, including urine, feces, and wound aspirates. The Double-Disk Synergy Test and the Colistin Agar Test, respectively, were used to phenotypically validate the existence of colistin resistance and ESBL. Polymerase chain reaction (PCR) was used for molecular characterization. Primers were used to target genes linked to colistin resistance (mcr-1 and mcr-2) and ESBL genes (blaCTX-M, CTX-M 1, CTX-M 2, and CTX-M 8). The findings indicated that 13.9% of the isolates displayed co-production of Colistin and ESBL, and of these isolates, 60% had blaCTX-M genes, and 20% had CTX-M 8 linked to ESBL production. However, the presence of colistin resistance genes was not detected by PCR. Therefore, molecular analysis did not confirm the existence of the colistin resistance genes (mcr-1 and mcr-2) in these isolates. Consequently, the findings showed no molecular co-production of the ESBL and colistin resistance genes. This work emphasizes how crucial it is to look into molecular and phenotypic traits to completely comprehend how colistin resistance and ESBL genes coexist in Gram-negative isolates. More research is required to investigate other mechanisms behind the resistance phenotypes identified.

Impact of COVID Pandemic on Pattern and Outcome of Admissions in a Paediatric Emergency Unit in Sokoto, Nigeria

Background: The COVID pandemic had widespread impact on the world population, especially on health-care. This ranged from direct effects of the infection on populace, in addition to changing pattern of morbidity and mortality, children inclusive. Objectives: To compare the pattern and outcome of admissions during the COVID pandemic period (2020 – 2021) to the preceeding year (2019) in the emergency Paediatric unit (EPU) of Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto. Materials and Methods: This was a retrospective study. The admission records of children aged > 1 month to 15 years were retrieved, relevant information extracted, entered into a study proforma and analysed with SPSS version 24. Results: Total admissions were 3741. The 1st pandemic year (2020) had the lowest (1116, 29.8%) while 1406 (37.6%) and 1219 (32.6%) patients were admitted in 2019 and 2021. The lowest admission was between March and June 2020 coinciding with the lockdown, highest was in August 2020 when restrictions had been lifted. The topmost admissions yearly were malaria, acute respiratory infections and acute gastroenteritis. The trend showed that all cases reduced in the pandemic years (2020-2021) but respiratory infections increased. Mortality was highest in 2020 (p=0.001). Malaria was the highest cause of mortality for the 3 years, however, mortality rate from sepsis, cardiac and respiratory diseases rose sharply in the pandemic years. Three confirmed cases of COVID were seen with 1 mortality. Conclusion: Admission rates reduced during the pandemic year in 2020 however, with increased rate of mortality. There was increase rate of sepsis, cardiac and respiratory mortality following the pandemic.

Assessment of some biochemical parameters in chronic kidney disease (CKD) patients attending Usmanu Danfodiyo University Teaching Hospital, Sokoto

In chronic kidney disease (CKD), inadequate and poor nutrition are important factors affecting the outcome and recovery from disease and injury. This study was designed to assess some nutritional indices of patients with CKD attending UDUTH Sokoto. Seventy-five CKD patients and twenty-five controls were recruited, parameters such as serum albumin, total protein, haemoglobin, vitamin D, zinc and copper were determined using standard methods. A significant (P<0.05) increase in Urea, Creatinine, Uric acid, phosphate, copper and potassium was observed in the patients as compared to the controls. There was a significant (P< 0.05) decrease in sodium, chloride, calcium, bicarbonate and albumin of the patients when compared to the control. However, there was no significant difference (p>0.05) observed in the total protein levels of the patients and the control. Therefore, these assessed parameters plays important role for the screening of malnutrition in CKD patents and if this is established, nutritional intervention can be made to these patients to minimize or prevent the advances of malnutrition problems in the CKD patients.

CORRELATES OF MAJOR DEPRESSIVE DISORDER AND HEALTH CARE UTILIZATION AMONG PATIENTS WITH SICKLE CELL DISEASE.

BACKGROUND: The comorbidity between major depressive disorder (MDD) and sickle cell disease (SCD) has been documented in numerous literature sources, and there have been reports of an increase in both urgent and non-urgent healthcare utilization among individuals with both conditions compared to those with either of the conditions alone. AIM: To determine the correlates of major depressive disorder and health care utilization among patients with sickle cell disease MATERIALS AND METHODS: The study was conducted at the Usmanu Danfodiyo University Teaching Hospital (UDUTH) in Sokoto and involved SCD patients. A semi-structured questionnaire was used to gather data on sociodemographic, clinical, and healthcare utilization variables, at the same time the Patient Health Questionnaire-9 (PHQ-9) and the Mini International Neuropsychiatric Interview-7 (MINI) were employed to screen and diagnose MDD, respectively. RESULTS: SCD patients with comorbid MDD reported significantly more visits to primary care physicians (P = 0.041), underwent more laboratory tests (P = 0.007), received fewer prescribed medications (P = 0.004), and had more visits to other hospitals (P = 0.005). However, no significant association was found with hospitalization (P = 0.476), daycare visits (P = 0.102), or emergency department visits (P = 0.315). CONCLUSION: This study showed that comorbid SCD and MDD are associated with an increase in non-urgent healthcare utilization, such as outpatient visits, but did not find an increase in urgent healthcare utilization, including acute hospitalizations and emergency admissions.

Disrespect and abuse of women during childbirth in selected health facilities in Sokoto metropolis, Nigeria

Background: The promotion of respectful care during delivery is of utmost importance if the goals of attainment of quality health care and utilization of skilled birth attendants in our health facilities are to be achieved. This study sought to assess the prevalence, forms, and factors associated with Disrespect and Abuse (D&A) of women during childbirth in Sokoto metropolis of Sokoto state.
 Method: A descriptive cross-sectional design was used to study 290 women who had facility-based delivery within the past eight weeks in Sokoto metropolis and were attending childhood immunization or family planning clinics. Data was collected using a set of structured questionnaire and was analyzed using IBM SPSS version 23 computer software. Level of statistical significance was set at p<0.05 and approval for the study was obtained from the Research Ethics Committee of Usmanu Danfodiyo University Teaching Hospital, Sokoto while written informed consent was obtained from respondents after explaining the objectives of the study to them.
 Results: A total of 57 (19.7%) of the respondents had experienced at least one form of D &A with bad attitude accounting for 75.4%, followed by Physical abuse (50.9%). Nurses and Midwives ranked highest (78.9%) among the perpetrators of D&A. Emotional distress, injury and death of baby were some of the negative effects of D&A.
 Conclusion: The incidents of D&A have wider implications for the utilization of maternity services and maternal mortality. There is an urgent need for the training and re-training of health workers about respectful maternity care in Nigeria.

Conscious sedation in pediatric dental procedures: Experience from Usmanu Danfodiyo University Teaching Hospital, Sokoto, Northwestern Nigeria

Abstract Background: The management of fear and anxiety in children scheduled for dental procedures has been a great challenge to the operating dental surgeon. Despite several controversies regarding the effectiveness, and safety of conscious sedation in dental and minor oral surgical procedures, it is widely used nowadays in dental practice. This study aimed to present a retrospective analysis of pediatric dental patients managed under conscious sedation. Materials and Methods: This was a retrospective study conducted over 5 years. After obtaining ethical approval from the research and ethics committee of the institution, the case records of all patients from 15 years and below who had a dental procedure under conscious sedation were retrieved. The demographics, procedures performed, the drug and dosage used, and length of the procedure were also recorded. Data obtained were analyzed using a statistical package for social sciences (IBM SPSS) version 25. Results: A total of 196 patients were included, 92 (46.9%) males and 104 (53.1%) females in the age range of 1–14 years and mean ± SD of 6.79 ± 2.98 years. The age categories were analyzed against the gender which revealed more female children between 6 and 10 years with no statistically significant difference (χ 2 = 4.566; df = 2; P = 0.102). The conscious sedation was done with ketamine 1–2 mg/kg intravenously in 72 patients (36.7%) and 3–4 mg/kg intramuscularly in 124 patients (63.3%), and additional doses were given in 93 patients (47.4%). Pulpectomy only constitutes the highest procedure performed in 42 patients (21.4%). The range length of the procedures was 5–67 min. Multiple procedures were performed in 52 (26.5%) of the patients. All patients were monitored until complete recovery, and no complications were recorded. Conclusion: Conscious sedation with ketamine was found effective and safe during dental and minor oral surgical procedures. With good functional suction, conscious sedation can provide excellent patient cooperation in carrying out multiple procedures in pediatric dental patients.

Depressive Symptoms among Children with Sickle Cell Anemia in a Tertiary Health Facility in North-western Nigeria

Abstract Context: Sickle cell anemia (SCA) being a chronic debilitating condition places affected children at risk of depression. Aims: The aim of this study is to determine the prevalence of depressive symptoms in children with SCA, the perceived causes, intervention sought, and associated factors. Settings and Design: This was a cross-sectional survey involving children with SCA aged 7–15 years attending pediatric hematology clinic of Usmanu Danfodiyo University Teaching Hospital, Sokoto. Materials and Methods: Information on depressive symptoms was obtained using the short mood and feelings questionnaire for children and adolescents. Statistical Analysis Used: Data were analyzed using IBM-SPSS version 25.0. Results: Respondents consisted of 291 child–caregiver pair with M:F of the children 1.6:1 and mean age of 11.0 ± 2.7 years. Majority [239 (82.1%)] of the caregivers were females with mean age 38.4 ± 7.4 years. Most [217 (74.6%)] of the caregivers were Hausa by tribe, married (269, 92.5%), in a monogamous setting, 159 (58.5%) with 129 (44.3%) of them having low socioeconomic status. One hundred and forty-nine (51.2%) children had depressive symptoms. Requirement for daily drug intake (125, 83.9%), missed school days (119, 79.9%), recurrent illness (115, 77.2%), and stress (114, 76.5%) were the commonest perceived causes. Prayers (138, 94.5%) and use of distraction (100, 68.5%) were the commonest interventions adopted. Child age category (P = 0.002), caregiver’s gender (P < 0.001), family setting (P < 0.001), socioeconomic status (P = 0.008), comorbidity (P = 0.021), frequent painful crises (P = 0.001), and frequent hospital admission (P = 0.024) were associated with depressive symptoms and remained independent predictors of depressive symptoms on logistic regression. Conclusions: Depressive symptoms were common among the subjects and associated with some sociodemographic and medical factors.

Changing trend of airway management in patients with temporomandibular joint ankylosis; A 9 year retrospective appraisal in Sokoto, Northwest Nigeria

Study objectiveTemporomandibular joint ankylosis (TMJA) presents a serious airway management challenge as rigid laryngoscopy is not possible. Administration of anesthesia to these patients requires flexible fibreoptic bronchoscope, trained personnel and monitoring facilities. These equipment and trained personnel are not readily available in resource limited countries. The main objective of this article is to report the changing trends of airway management in patients with TMJA in our centre over the last 9 years. DesignThis was a retrospective study conducted from January 2014 to December 2022. The period of review was grouped into 3 yearly periods (2014–2016, 2017–2019 and 2020–2022). SettingDepartment of Oral and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital and Noma Children Hospital, Sokoto, Nigeria. Patients A total of 117 patients were studied. Data retrieved include gender, age, etiology of ankylosis, duration of ankylosis, type of airway management and complications. Interventions Type of airway management. Conducted includeBlind nasal tracheal intubation, awake flexible fibreoptics, sleeping flexible fibreoptics and tracheostomy. MeasurementsAnesthetic chart, age, duration and laterality of TMJA. Main resultsA total of 117 TMJA patients (56 males and 61females) were recruited into the study. Age ranged from 5 to 40 years. Mean ± SD 16.5(7.85). Bulk of the patients were between age 1–30 years. During the 2014–2016 review, tracheostomy was the main airway management procedure in 20 (17.1%) patients, while only 1 (0.8%) case of blind nasal tracheal intubation was observed. In the 2020–2022 review, most of the airway management was awake fibre-optics in 48 (41.0%) patients and sleeping fibre-optics in 27 (23.1%) patients. Only 2 (1.7%) cases of death was observed in the tracheostomy subjects. ConclusionAirway management in TMJA patients have evolved over the years in our centre. Surgical airway management which has many shortcomings is no longer encouraged because of improved facilities and personnel.

Demographic and clinical characteristics of central nervous system congenital anomalies: A one year review of cases managed at UDUTH Sokoto

Background: The spectrum of CNS congenital anomalies varies from one geographical location to another across the globe. This essentially can be solitary or multiple and can be cranial, spinal, combination of both cranial and spinal or others. The understanding of their distribution in each location could determine local workforce and facility needs and as well guide in the areas of sub specialization. Objective: The aim of this study is to document the pattern of CNS congenital anomalies cases that had surgical intervention, at the Usmanu Danfodiyo University Teaching Hospital, Sokoto. Methods: A cross-sectional, retrospective hospital based study from January, 2021 to December, 2021 of all patients with CNS congenital anomalies who had surgical intervention at the Neurosurgery Department, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. Results: A total of 49 cases presented to our facility and had surgical interventions for central nervous system congenital anomaly. Of those 49 cases with CNS Congenital anomalies, there were 25 (51.0%) males and 24(48.98%) females, with a male-to-female ratio of 1.04: 1. The median age was 185 days, with age range of 2– 364days. Overall, the most commonly diagnosed neurosurgical CNS congenital anomalies in order of decreasing frequency were Congenital hydrocephalus 20 (40.82%), Myelomeningocele 14 (28.57%), Encephalocele 10 (20.41%), combination of Hydrocephalus associated with myelomeningocele 8(16.33%), Meningocele 3(6.12%), Lipomeningocele 1( 2.00%), Dandy walker malformation 1( 2.00%) , and Dandy variant1(2.00%) . Conclusions: NTDs (Myelomeningocele, Meningocele and lipomeningocele) were the most common CNS anomalies (55.10%). However, congenital hydrocephalus, Myelomeningocele, Encephalocele, Hydrocephalus + MM, and Meningocele are common in our environment in decreasing frequency. Though, Lipomeningocele, Dandy walker malformation and dandy variant are relatively rare. Understanding of this distribution may guide service expansion and workforce needs, inspire sub specialization as well as direct research and government policy in this community.