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   Table of Contents - Current issue
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January-June 2021
Volume 19 | Issue 1
Page Nos. 1-43

Online since Saturday, June 26, 2021

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REVIEW ARTICLE  

Pediatric epilepsy care in Nigeria: A management approach for the primary care physicians p. 1
Wilson Chukwuneke Igwe, Ann Ebele Aronu
DOI:10.4103/NJGP.NJGP_15_20  
Epilepsy is a neurologic disorder of the brain characterized by an enduring predisposition to recurrent unprovoked seizures. It is the most common childhood neurologic disorder world-wide. Poor management often impacts negatively on the child's neurodevelopmental, emotional, physical, and social well-being. In resource-poor countries, the majority of children with epilepsy are managed by primary care physicians who are not sufficiently trained to offer effective care in pediatric epilepsy. Many low income countries do not have nationally approved guideline on management of pediatric epilepsy. Access to specialist care is costly and may involve long distance travels from rural areas to the cities. This often leads to a huge treatment gap. Efforts aimed at increasing the management skills of primary-care physicians in diagnosing and giving appropriate treatment is necessary in ensuring reduction in treatment gap. This review article is based on the authors' clinical experience and a review of 20 published works from review articles, recommendations, and guidelines sourced from PubMed and Google using the search terms “Paediatric epilepsy, management, primary care.” In the absence of any approved national guideline, a simplified approach to the clinical diagnosis, appropriate use of available diagnostic facilities, and cheap but cost-effective drugs will lead to better management of childhood epilepsy in resource-constrained settings.
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ORIGINAL ARTICLES Top

A review of the sociodemographic characteristics of children immunized with the rotavirus vaccine in adonai hospital, karu local government area, Nasarawa state, north-central Nigeria p. 6
Godwin Adakole Obute, Esther David, Kehinde Kazeem Kanmodi
DOI:10.4103/NJGP.NJGP_17_20  
Introduction: There is a dearth of literature on existing rotavirus immunization services offered in Nigeria; with only very little information has been documented about it. This study aims to conduct a clinical audit of all children immunized with rotavirus vaccine in Adonai Hospital, Karu Local Government Area, Nasarawa State, north-central Nigeria. Materials and Methods: This study was a hospital-based study which adopted a retrospective study design. The population included in this study was children who had received rotavirus vaccine at Adonai Hospital. The study instrument was a data extraction form which obtained information about the sociodemographic data and clinical data of the children registered in the child immunization register. Only the data of all children immunized with rotavirus vaccine at the facility were obtained. Statistical Analysis Used: Data collected were analyzed using SPSS version 20 software. Results: A total of 111 children had been immunized with rotavirus vaccine in the health facility, 51.4% of them were males, 20.7% were from Igbo ethnicity, 86.5% came from Christian families, and all were residing in urban areas. All the children were within the age of 6 weeks to 40 weeks as the time of rotavirus vaccination. The dropout rate for rotavirus vaccine among the immunized children was 17.1%. Only 2.7% of all the children that received the vaccine developed an adverse event following immunization (AEFI), of which all were minor AEFIs. Conclusions: This study recorded a low rate of AEFI among children immunized with rotavirus vaccine in Adonai Hospital. Furthermore, the observed dropout rate in our facility is relatively very low when compared with the general dropout rate observed among children receiving immunization services in Nigeria. Notwithstanding, we recommend that investigations need to be done to explore the reasons why some children have dropped out of the rotavirus vaccination program at the surveyed facility.
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Microbial isolates and sensitivity patterns among antenatal patients with asymptomatic bacteriuria in a tertiary hospital in north-central Nigeria p. 11
Gerald Tochukwu Igwemadu, Samuel Pam, Samson J Ayanwuyi, Maimako Martins Yakubu, Uche Augustine Akunaeziri, Abayomi Ibukun Alao
DOI:10.4103/NJGP.NJGP_16_20  
Introduction: Asymptomatic bacteriuria (ASB) in pregnancy is defined as the presence of at least 105 colony-forming units per milliliter of a bacteria species in clean-catch urine in the absence of obvious symptoms of urinary tract infection during pregnancy. It is associated with obstetric complications such as preeclampsia, pyelonephritis, preterm labor, low birth weight, and prematurity. Determining the microbial isolates and sensitivity patterns of ASB among pregnant women locally will aid the management of ASB in pregnancy and prevention of complications associated with it. Objective: The aim of the study was to determine the microbial isolates and sensitivity pattern among antenatal patients with ASB at the Federal Medical Center (FMC), Keffi, Nasarawa state. Materials and Methods: This is a cross-sectional study among pregnant women attending the antenatal clinic at the FMC, Keffi, with ASB. Clients who met the selection criteria were recruited for the study. A structured pro forma was administered, and midstream urine samples were collected and processed. Result was analyzed using the Statistical Package for the Social Sciences version 20. Chi-square at a significant level of 0.05 and confidence level of 95% was used to determine significance. Results: A total of 184 consented women presenting for their first antenatal visit were screened for ASB, of which 82 were positive for significant bacteriuria, giving a prevalence of 44.6%. The ages of the participants ranged from 18 to 43 with a mean age of 29.58 ± 5.42 years. The common uropathogens isolated were Staphylococcus aureus 43 (52.4%), Klebsiella spp. 14 (17.1%), and Escherichia coli 13 (15.9%). The isolates were most sensitive to amoxicillin-clavulanate (85.4%), nitrofurantoin (82.9%), and gentamicin (79.3). Conclusion: The prevalence of ASB among the study participants was high. S. aureus, Klebsiella spp., and E. coli were the predominant organisms cultured while most of the isolates were sensitive to amoxicillin-clavulanate, nitrofurantoin, and gentamicin.
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“primary care physicians” perspective on placebos in clinical practice: Attitudes, beliefs, and prescribing habits p. 16
Syed Irfan Karim
DOI:10.4103/NJGP.NJGP_10_20  
Background: Global patterns in the clinical use of placebos differ due to physicians' conceptual differences, culture, region, and setting. This study aimed to evaluate the attitudes, beliefs, and prescribing habits of primary care physicians toward the use of placebos. Methods: This was a cross-sectional study. An anonymous web-based survey questionnaire was used to collect the information of primary care physicians (2017–2018). Descriptive statistics and frequency distributions were calculated using the Chi-square and Fisher's exact tests. Results: The mean age of the participants was 41.3 ± 12 years. Male physicians (67%) outnumbered their female counterparts. There were 87/108 (80.5%) physicians who responded. Minority of the physicians (21%, n = 18) had used a placebo in clinical practice, and only 25% indicated placebo prescription to be ethically acceptable. The most common reasons for placebo use were to satisfy a complaining patient (27.6%), calm the patient (23%), and as a supplemental treatment to other medicines (20.7%). A significant association was found between the age (P = 0.03) and years of experience (P = 0.01) with the placebo prescribing practice. Majority (43.8 %) of non-Saudis compared to 15.5% of Saudi respondents reported using placebos (P = 0.01, odds ratio = 6.35). Majority (75%) of the respondents believed that placebos can be used in clinical practice without giving prior information to the patient. Conclusion: Minority of the physicians used placebos in clinical practice. Clinical experience and cross border variation were seen among physicians in placebo prescribing practices. Physicians used placebos primarily for psychological benefit.
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Measurements of Rates and Parameters in Newborn Babies Fit for Discharge at a Tertiary Hospital in North-Western Nigeria p. 23
Jamilu Abdullahi Faruk, Yakubu Abubakar, Niyi Mustapha Adebiyi, Isa Abdulkadir
DOI:10.4103/NJGP.NJGP_18_20  
Introduction: The arrival of a newborn brings a mixture of excitement and anxiety, due to a wide variation in physical and physiologic findings. Neonatal morbidity and mortality remain alarmingly high in North-western Nigeria, and failure to recognize a sick neonate that needs medical attention contributes to these dire statistics. Therefore, an understanding of the variations of newborn parameters allows health-care personnel to address families' concerns and support parents. Materials and Methods: The study was a retrospective descriptive review of birth records, of live neonates delivered at a tertiary hospital who were referred for a pediatrician's assessment and subsequently certified stable and fit for discharge. Their parameters were described, and sub-groups were compared. Results: There were 224 newborns examined, with a male:female ratio of 1:1.1. Majority (99.1%) of the babies were examined within 24 h of life, and the mode of delivery was through cesarean section in 70.1% of the newborns. Their mean gestational age was 39.3 (±1.2 standard deviation [SD]) weeks, with 37 (16.5%) late preterm and 187 (83.5%) term babies. They had birth weight 3.1 kg (±0.6 SD) and 2.6 (±0.6 SD), P = 0.0001; length 49.2 cm (±2.9 SD) and 47.0 (±3.0 SD), P = 0.017; occipitofrontal circumference 34.6 cm (±1.7SD) and 33.6 (±1.3 SD), P = 0.001; respiratory rate 52 (±12 SD) and 54 (±14 SD), cycles (cpm) P = 0.291; heart rate 141 (±13SD) and 145 (±15SD) beats (bpm), P = 0.129; for the term and late preterm babies, respectively. Conclusions: Referred newborns who were assessed and certified stable and discharged, had comparable parameters, with average respiratory rate of 51 cycles, and heart rate of 140 beats. There were no statistical differences in the vital signs between late preterm and term newborns.
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The use of virtual media in postgraduate medical training during the COVID-19 pandemic: Experience from a resource-constrained setting p. 27
Jamilu Abdullahi Faruk, Yakubu Abubakar, Hafsat Rufai Ahmad, Abdulkadir Isa
DOI:10.4103/njgp.njgp_19_20  
Context: The novel coronavirus disease 2019 (COVID-19) pandemic brought about public health safety measures of social distancing and avoidance of crowded gatherings. These led to widespread disruptions in activities of daily living, as well as routine health-care services and learning activities. There has been a noticeable move to the online domain as the platform for teaching and learning. Aims: The present study aimed to describe the online learning and teaching experiences of postgraduate medical doctors in Nigerian hospitals. Subjects and Methods: The study was a cross-sectional online survey sent to medical doctors across social media platforms, and it sought to find out the current number of hours utilized and modalities of their online educational media use. Results: A total of 116 doctors responded and completed the survey, with 74 (63.8%) and 104 (89.6%) of them having some webinar experience before and during the pandemic, respectively. At least 82 (70.4%) had 1–5 h of online learning activities each week, and an overwhelming 114 (98.2%) used a personal Internet data subscription to access online educational material. In addition, 56 (48.3%) felt that online learning was less rewarding than in-person interactions even though 93 (80.2%) found the online learning activities to be quite convenient. Poor Internet connectivity was cited as a major challenge to a successful online learning experience in 80 (68.9%). Conclusion: Although the COVID-19 pandemic restricted face-to-face human contact including learning activities, postgraduate medical education has filled the void by increasing online learning activities, resulting in an admixture of experiences and reactions.
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An evaluation of the effectiveness of preemptive ketamine for postoperative analgesia in elective thyroidectomy p. 32
Joshua Olayinka Oni, Benjamin Olusomi Bolaji, Israel Kayode Kolawole, Olufemi Adebayo Ige, Olanrewaju Olubukola Oyedepo, Majeed Babajide Adegboye
DOI:10.4103/njgp.njgp_2_21  
Background: The use of preincision low-dose ketamine as a preemptive analgesic modality has been widely suggested. However, findings from previous studies have remained inconclusive. Materials and Methods: Eighty-two patients scheduled to have elective thyroidectomy under general anesthesia were recruited. The patients were randomly allocated into one of two groups, to receive either 0.5 mg/kg of ketamine intravenously or an equal volume of normal saline, 10 min before surgical incision. At the end of surgery, pain scores, time to first request for analgesic and total opioid requirement in 24 h postoperatively were recorded. Results: There was no significant difference in the postoperative pain scores, time to first requirement for analgesic, postoperative opioid consumption and satisfaction with analgesia between the two groups. The median pain scores at recovery, 2, 6, 12, and 24 h postoperatively for the ketamine and saline groups were not significantly different (P values 0.208, 0.185, 0.412, 0.590, and 0.854 respectively). The times to first request for analgesic were 86.00 ± 56.58 min in the ketamine group and 79.90 ± 68.05 min in the saline group (P = 0.357). The 24-h opioid (morphine) consumptions were 11.00 ± 3.16 mg in the ketamine group and 13.21 ± 5.87 mg in the control group (P = 0.275). Conclusion: This study concluded that the administration of preincision low-dose ketamine (0.5 mg/kg) did not produce a preemptive analgesic effect in patients who had an elective thyroidectomy.
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CASE REPORT Top

Variceal banding: Experience with two cases in nauth, Nnewi – A resource-limited environment p. 38
Chiemelu D Emegoakor, SN Chukwurah, HC Nzeako
DOI:10.4103/NJGP.NJGP_14_20  
Esophageal varices can present with life-threatening hemorrhage and can be managed by surgery or medically. Banding is an endoscopic treatment for variceal bleeding and is a known management option for variceal bleeding but is not widely available in Nigeria due to lack of expertise and equipment. Previously, patients relied on medical management and surgery for treatment; however, these were not effective as mortality rates were high. Few centers in the country are known to offer this procedure to their patients and none has been reported in Southeast Nigeria, hence the justification for reporting our experience managing two cases of bleeding esophageal varices. We report two cases of variceal bleeding on the background of decompensated liver cirrhosis of alcohol and viral etiology, respectively. The first patient was on propranolol, but it was not effective in preventing variceal bleeding. The second patient was not on prophylaxis. Both the patients had variceal banding in NAUTH, Nnewi, and no complications were reported. Variceal banding is a safe procedure and is an effective measure in control of bleeding varices.
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LETTER TO EDITOR Top

Social media posts: A key influencer of health-related behavior among Nigerians p. 42
Kehinde Kazeem Kanmod, Njideka Jacob Nwafor, Babatunde Abiodun Amoo, Abdullahi Adamu Hundeji
DOI:10.4103/njgp.njgp_3_21  
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