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   Table of Contents - Current issue
Coverpage
July-December 2021
Volume 19 | Issue 2
Page Nos. 45-75

Online since Saturday, December 18, 2021

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REVIEW ARTICLE  

Medical and nonmedical fainting: Separating the sheep from the goats p. 45
Justus Uchenna Onu, Sunday Onyemaechi Oriji, Richard Uwakwe
DOI:10.4103/njgp.njgp_11_21  
In recent times, the Nigerian public space has been awash with various incidences of “fainting” during investigations seeking to unravel issues surrounding alleged financial mismanagement in public institutions. A critical question is, to what extent do these apparent fainting behaviors represent a true illness-related event? Feigning of medical symptoms for external gains is well-described phenomenon with enormous cost to both forensic and nonforensic settings. Separating the sheep from the goats in these situations is a task many clinicians are not familiar with. This article aims to articulate the current models of malingering and to highlight the various ways of detecting deception in clinical settings. The authors opine that an integrative strategy, which involves the combination of various approaches with emphasis on the verbal and nonverbal signals during clinical interviews coupled with psychological testing and perhaps neuroimaging techniques, may improve the detection of deception in the clinical setting. We recommend that clinicians should not shy away from employing any of these “malingering diagnostic” approaches when there is a reasonable suspicion to the veracity of patients' symptoms such as fainting during a panel inquiry.
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ORIGINAL ARTICLES Top

The use of telemedicine in mitigating the effects of reduced antenatal care visits during the COVID-19 infection lockdown in Nigeria p. 50
Ikechukwu Innocent Mbachu, Samson Dayo Ejikunle, Chioma Ngozichukwu Pauline Mbachu, Jude Ehiabhi Okohue, Osita Samuel Umeononihu, Chukwuemeka Ojiyi, Hilary Obiagwu, Marcel Chukwuemeka Ukah, Ihechinyerem Kelechi Osuagwu
DOI:10.4103/njgp.njgp_13_21  
Aims and Objectives: The study evaluated the use of telemedicine in the management of pregnant women during the COVID-19 in Nigeria. Subjects and Methods: This was a cross-sectional study conducted among medical practitioners that care for pregnant women and a self-administered online questionnaire (google form) was used to obtain relevant information from the respondents. Data were analyzed using Stata software version 16. Results: A total of 138 medical practitioners participated in the study. The mean age of the participants was 41.30± 7.5 years. Seventy (51.47%) work in national public tertiary health institutions while 27(19.85%) work in-state public tertiary and 19(13.97%) in private specialist hospitals. There was a significant reduction in the number of patients seen during the period when compared to the number before the pandemic(p=0.013). Fifty-one (36.96%) of the medical practitioners said they practiced telemedicine, with the majority 41(80.39%) using audio calls. Conclusion: The use of telemedicine was poor among the medical practitioners despite the drop in antenatal attendance.
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Technical notes on high-frequency ultrasound duodenography and colonography imaging of giardial lesions p. 54
Philip C Njemanze, Josephine T Njemanze, Clara C Ofoegbu, Esther Nneke, Ijeoma A Onweni, Uchechi V Ejiogu, Chinenye U Mgbenu, Nneoma E Ukeje, Anthonia C Amadi, Doris C Amaefule
DOI:10.4103/njgp.njgp_8_21  
Background: Worldwide G. lamblia is the third most common agent of diarrheal disease with over 300 million cases annually. Simple technical notes for clinicians are presented on use of high-frequency ultrasound imaging for duodenography and colonography in patients with Giardia lamblia infection. Methods: Ultrasound images were obtained from 100 consecutive patients with symptomatic giardiasis and 40 healthy controls. High-frequency annular array transducer of 7.5 MHz was used to obtain B-mode ultrasound grayscale and color images of the duodenum and colon with and without water contrast. The diagnosis of G. lamblia was based on clinical presentation, serial stool microscopy, and finding of flagellates in duodenal aspirates. Results: We demonstrated normal duodenum and colon echoanatomy in control subjects. In patients with giardiasis, the lesions of the duodenum and colon were associated with increased dimensions and wall thickness compared to healthy controls (P < 0.05). The ultrasound features of giardial lesions were characterized by increased wall echogenicity, flattening or loss of duodenal folds and/or colonic haustration, hyperechoic floating foci demonstrating chaotic motility, increased perilesional tissue echogenicity, and altered colonic peristalsis. Conclusion: In conclusion, high-frequency B-mode ultrasound imaging with and without water contrast demonstrated the details of duodenal and colonic echoanatomy in normal subjects and patients with giardiasis. The technique could be applied in the clinical setting of rural practitioners.
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Factors associated with nonadherence to antiretroviral therapy among children with HIV/AIDS in Ahmadu Bello University Teaching Hospital, Zaria, Nigeria p. 61
Abdullahi Musa, Kabiru Sabitu, Idris Hadejia Suleiman, Aishat Bukola Usman, Yakubu Abubakar
DOI:10.4103/njgp.njgp_12_21  
Background: The advent of antiretroviral (ARV) treatment in combined therapy has transformed HIV/AIDS into a chronic treatable condition and significantly improved the prognosis and quality of life of patients with HIV/AIDS. However, to achieve this, patients have to maintain strict adherence which has been shown to be affected by several factors. This study, therefore, aimed to estimate and identify factors associated with adherence to ARV drugs among children attending Paediatric ARV Clinic at Ahmadu Bello University Teaching Hospital, Zaria. Subjects and Methods: Sociodemographic and clinical information of the children and their caregivers was collected using a semi-structured questionnaire. Bivariate and multivariate analyses were done to examine the odds of adherence and nonadherence to ARV therapy with respect to the various factors. P = 0.05 was considered statistically significant. Results: A total of 167 children and their caregivers were studied. The children were aged between 2 and 17 years with a mean age of 9.1 ± 3.4 years, while the caregivers were aged between 20 and 70 years with a mean age of 37.6 ± 10.7 years. The estimated adherence in the past 30 days was found to be 76.6%. Caregivers' forgetfulness and traveling were reported as the major reasons for missing medications. Caregivers' age <35 years was significantly associated with poor adherence (odds ratio = 2.35 [95% confidence interval: 1.09–5.06]). Conclusion: Caregiver factors were the main factors associated with poor adherence in children with HIV. We recommend regular adherence counseling at every visit with emphasis on the use of reminder methods to improve adherence.
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Cerebral vasospasm, intracardiac clot, wellens syndrome, and popliteal vein aneurysm in a hypercoagulable state in lassa fever p. 68
Philip Chidi Njemanze, Chinwendu C Darlington, Clara C Ofoegbu, Esther C Nneke, Ijeoma A Ohaegbulem, Joy E Onuchukwu, Chinenye U Mgbenu, Nneoma E Ukeje, Chidimma O Ukaegbu, Amuchie Marvis, Clinton O Mezu, Juliet Chizoma Anaele, Doris C Amaefule, Ogechi Uzoma, Chinonso Mbara
DOI:10.4103/njgp.njgp_17_21  
Background: Lassa fever could precipitate a condition of hypercoagulable state with multiple organ involvement. We report an unusual presentation of cerebral vasospasm, intracardiac clot, Wellens syndrome, and popliteal vein aneurysm in a case of Lassa fever. We demonstrate the use of noninvasive imaging in the diagnosis and management of hypercoagulable state in a first case presentation in Lassa fever. Methods: We present a 53-year-old Nigerian woman, with a high-grade fever (39°C) that was associated with chills, headaches, insomnia, anxiety, chest pain, diaphoresis, palpitation, general weakness, muscle aches in all extremities, muscle cramps, dizziness spells, hyperacusis, nausea, vomiting, diarrhea, hematochezia, and abdominal pain. She admitted that her home is infested with rodents. Physical examination revealed severe anemia. Laboratory tests including blood sample analysis and biochemistry were conducted. Lassa fever was confirmed using Lassa virus-reverse transcription-polymerase chain reaction tests. Electrocardiography (ECG), two-dimensional echocardiography, venous duplex ultrasound of the leg veins, and transcranial Doppler ultrasound were performed. Results: Blood tests showed electrolyte imbalance and hypertriglyceridemia. Ultrasound tests revealed intracardiac clots with dyskinetic apical septal wall motion abnormality, saccular aneurysm with popliteal venous thrombosis of the right leg popliteal vein, and cerebral vasospasm of the right internal carotid artery due to cardiogenic microemboli. ECG demonstrated Wellens syndrome. The patient was successfully treated with intravenous ribavirin, whole blood transfusion, broad-spectrum antibiotics, isosorbide dinitrate, pentoxifylline, metronidazole, antimalarial, dexamethasone, erythropoietin, anticoagulants (low-molecular-weight heparin and warfarin), and supportive care. Conclusion: Noninvasive ultrasound modalities were useful for early detection and treatment of hypercoagulable state in Lassa fever.
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LETTER TO EDITOR Top

COVID-19 in old-age p. 74
Muhammed Jasim Jalal
DOI:10.4103/njgp.njgp_15_21  
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