Effects of Phyllanthus amarus on garlic-induced hepatotoxicity
HF Hunaleyo, LB Buratai, BM Mofio, HK Lawan, AA Abdulrahman

Nigerian Journal of Health Sciences 2017 17(2):53-58

Background: One of the most important organs that regulate various physiological processes in the body is the liver. The liver, if diseased or damaged by toxic agent (s) could contribute to the cause of morbidity and mortality globally. Phyllanthus amarus is highly valued in African traditional medicine for its hepatoprotective, anti-inflammatory and several related ailments. Aim: The aim of the present study was to investigate the effects of the administration of P. amarus on garlic-induced hepatotoxicity in rats. Settings and Design: Albino rats (n = 30) weighing 170-200 g were randomly divided into five Groups (I-V) of six. Group I (control) received orally 1 ml/kg body weight of distilled water while Groups II, III, IV and V were administered orally same volume of garlic homogenate corresponding to 5 g/kg body weight on a daily basis for 14 days to induce liver toxicity. Similarly, Groups III, IV and V were orally administered with 100, 200 and 400 mg/kg body weight of P. amarus aqueous leaf extract, respectively, for another 7 days. Materials and Methods: The levels of serum alkaline phosphatase (ALP), aspartate transaminase (AST), alanine transaminase (ALT) and total bilirubin (TB) were determined by standard methods. Histopathological analysis of the liver tissue was carried out as described by Druby and Wallington. Statistical Analysis: Results were expressed as mean ± standard errors of means. Statistical analysis was performed using one-way ANOVA and Bonferroni post hoc test was used to determine the difference between means at 95% level of significance. Results: The results showed that all the doses of the extract of P. amarus significantly decreased (P < 0.05) the levels of ALP, ALT and AST and TB relative to those administered 5 g/kg body weight of garlic only (Group II). The histopathological analysis of the liver samples also confirmed the hepatocurative potential of P. amarus against the hepatotoxicity caused by garlic. The ameriorative effect of P. amarus is suspected to be due to the presence of some antioxidants (phenols and flavonoids) as determined and quantified in the present work. Conclusion: It was concluded that P. amarus showed hepatocurative effect having ameliorated the lobular necrosis and inflammation of the liver induced by garlic homogenate in albino rats.

Diagnostic accuracy of rapid antigen test for malaria and determinants of heavy malaria parasitaemia in children at the Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
EI Nwaneli, C D I Osuorah, JC Ebenebe, N Umeadi

Nigerian Journal of Health Sciences 2017 17(2):59-65

Background: According to the United Nations Children's Fund, malaria kills a child every 30 s and about 3000 every year. Ninety per cent of the global burden of malaria occurs in sub-Saharan Africa. To reduce this burden, prompt recognition of risk factor, rapid diagnosis and immediate treatment are crucial. Objective: This study evaluated the diagnostic accuracy of rapid diagnostic test (RDT) used in the diagnosis of malaria. It secondarily sought to determine factors that are associated with heavy malaria parasitaemia in children. Methodology: This cross-sectional and descriptive study was conducted over a 5-month period. Children aged 6 months to 17 years, who had axillary temperature >37.4°C or history of fever in the past 48 h and who had not received a full course of artemisinin combination therapy were included. The patients were enrolled consecutively using purposive sampling methods. Blood samples for malaria parasite were collected from all participants using microscopy and RDT. Results: Of the 246 participants enrolled, 58 and 188 tested positive and negative for malaria parasite using blood film microscopy (BFM). Of the 58 positive and 188 negative blood samples, 49 and 157 participants, respectively, were reactive and non-reactive for malarial antigen when the RDT was done. This gave RDT sensitivity of 84.5% (95% confidence interval [CI]: 80.3-88.7), specificity of 83.5% (95% CI: 81.1-85.9), false-positive rate of 16.5% (95% CI: 3.8-29.2), false-negative rate of 15.5% (95% CI: 11.9-42.9), positive predictive value of 61.3% (95% CI: 52.4-70.2) and negative predictive value of 94.6% (95% CI: 93.8-95.4). The overall diagnostic accuracy of the RDT was 83.8% (95% CI: 81.7-85.9). None of the respondent's clinicodemographic factors such as age, place of residence, socio-economic status, degree and duration of fever were significantly associated with heavy malaria parasitaemia in surveyed children. Conclusion: The RDT is a good diagnostic tool and can be conveniently used in situation where rapid diagnosis of malaria parasitaemia is needed and/or where BFM is unavailable.

Prevalence and correlates of obsessive–compulsive symptoms in a sample of undergraduate clinical medical students in Osogbo, Southwestern Nigeria
T Opakunle, O Aloba, O Opakunle, A Oyewole, O Osokoya

Nigerian Journal of Health Sciences 2017 17(2):66-71

Background: Obsessive–compulsive symptoms (OCS) may be common, yet, under-recognised and under-reported among medical students. Their presence is associated with other mental disorders which could have negative impacts on the academic functioning of medical students. Objectives: The objective is to assess the prevalence and correlates of OCS in a sample of Nigerian clinical medical students. Methods: This is a cross-sectional descriptive study conducted among 209 Nigerian medical students in their clinical training years. They completed a sociodemographic questionnaire, the Obsessive-Compulsive Inventory-Revised, the Depression and Anxiety Stress Scale – 21 and the Rosenberg Self-Esteem Scale. Results: The prevalence of OCS was 32.1%. Depression, anxiety and stress were present in 13.9%, 27.8% and 35.4% of the respondents, respectively. The presence of OCS was associated with stress, anxiety, depression and low self-esteem among the medical students. Conclusions: OCS is relatively common among clinical medical students. Their presence may worsen the difficulties experienced among medical students in the course of their training. There may be a need to be screening clinical medical students for the presence of OCS.

The role of physicians' knowledge of guidelines in the usage of beta-blockers in heart failure
EJ Ogbemudia, AO Obasohan

Nigerian Journal of Health Sciences 2017 17(2):72-75

Background: Beta-blockers (BB) are recommended in the management of heart failure (HF), but its usage has been reported as low. The role of physicians' knowledge of guidelines in this observation has not been fully investigated. Objectives: The objective was to determine whether a gap in the physicians' knowledge of guidelines for the use of BB in HF is a reason for its low usage. Materials and Methods: Questionnaires were distributed to physicians in the Departments of Internal and Family Medicine. Multiple choice questions based on the 2016 European Society of Cardiology guidelines for the use of BB in HF were in the questionnaire. A physician was adjudged knowledgeable of the guidelines if he/she scored 50% or above. The proportion of physicians with inadequate knowledge was derived as a percentage of all respondents. Chi-square test was used to determine whether department, gender and cadre were associated with knowledge of guidelines. Results: A total of 70 physicians responded. Departments of Family and Internal Medicine, respectively. Fifty-five (78.6%) of them were not knowledgeable about the guidelines for the use of BB in HF, while only 15 (21.4%) were knowledgeable. Association between a physician's department, gender, cadre and knowledge of HF guidelines yielded P = 0.774, 0.144 and 0.227, respectively. Conclusion: There is a gap in the physicians' knowledge of the guidelines for BB use in HF. Measures to educate and regularly update physicians on HF guidelines should be institutionalised to ensure evidence-based practice, improved care and better outcomes.

Influence of pain intensity and difficulty on health-related quality of life of patients with knee osteoarthritis
OA Ojoawo, OO Falade, EB Arayombo

Nigerian Journal of Health Sciences 2017 17(2):76-81

Background: Knee osteoarthritis (OA) is one of the most common causes of pain and disability in the western world and it affects up to 80% of people over the age of 65. Aim: The objective of this study was to examine the influence of self-reported symptoms of knee OA (KOA) on the health-related quality of life (HRQoL) of patients with KOA. Materials and Methods: Seventy patients diagnosed with KOA were purposively recruited for the study. The Western Ontario and McMaster Universities OA Index was used to assess the pain intensity, functional difficulty and stiffness, whereas HRQoL form Short-Form 12 Health Survey was used to assess the quality of life of patients with KOA. The data collected were analysed using SPSS version 17. Descriptive and inferential statistics were used to summarise the data. Results: There was a statistically significant negative relationship between age and physical difficulty (r = −0.301 P < 0.001). There was a statistically significant negative correlation between health quality domain (Hex) and present pain intensity (r = −0.473 P < 0.01). There was a statistically significant negative relationship between Hex and total difficulty (r = −0.321 P < 0.05). Conclusion: It was concluded from the study that in patients with KOA, the higher the pain intensity and/or physical difficulty, the lower the patient's HRQoL.

Threatened abortion in a tertiary hospital in Nigeria: A 5-year experience
OO Sowemimo, CA Adepiti, OO Kolawole, OA Adeniyi, KO Ajenifuja

Nigerian Journal of Health Sciences 2017 17(2):82-85

Background: Threatened abortion usually precedes early pregnancy loss. Affected pregnancy may progress or result in eventual miscarriage. Understanding the risk factors and their management will continue to improve its outcome. Materials and Methods: Records of patients managed for threatened abortion at the OAUTHC, Ile-Ife over a period of 5 years from January 2009 to December 2013 were retrieved. Information about the sociodemographic characteristics, clinical presentation and outcome were collected and analysed using IBM, Armonk, NY, USA-SPSS version 20. Results: One hundred and eight records out of 118 patients admitted for threatened abortion over the period under review were retrieved. There were 2060 gynaecological ward admissions over the period. Threatened abortion accounted for 5.7% of all gynaecological ward admissions. The mean age of women admitted was 29.53 ± 4.47 years and majority (68.5%) had tertiary education. Seventy-five per cent were booked for antenatal care, 53.7% were nulliparous and 42.6% had previous first or second-trimester miscarriage(s). Sixty-two per cent were in the first trimester and the mean gestational age was 12.55 weeks ± 4.78. Malaria fever was the single most common risk factor (47.2%), urinary tract infection and other risk factors were identified in 28.7% and 24.1% had no identifiable risk factor. Half of the patients carried their pregnancy to term, whereas 25.9% had a complete miscarriage and the rest were lost to follow-up. Among those who proceeded to term, 74.1% were booked and 42% were unbooked patients (P value of 0.027). Conclusion: Threatened abortion remains a common complication in early pregnancy. It halves the chances of pregnancy continuation to term. In our environment, malaria fever was the most common risk factor and booking for antenatal care conferred better pregnancy outcome.

Incidental finding of uterine scar dehiscence at elective repeat caesarean section at term
OA Ijarotimi, OO Sowemimo, OA Dare, PO Ibuola

Nigerian Journal of Health Sciences 2017 17(2):86-88

The risk of adverse outcome for the mother and/or baby is high in the setting of uterine rupture and its possibility should be entertained in a pregnant woman with previous uterine surgery and recent onset lower abdominal pain in advanced gestation. In the absence of symptoms, uterine scar dehiscence may occur unnoticed until complications set in. Women with short inter-pregnancy interval, caesarean wound morbidity and classical caesarean section are at increased risk. Each case should be individualised and those at high risk of uterine rupture should be offered appropriate care. We report a case of antepartum scar dehiscence found incidentally at elective repeat caesarean section at term.