Demography and management outcome of neural tube defects in a Nigerian tertiary health institution

Background: Neural tube defects (NTD) are a group of congenital anomalies of the central nervous system (CNS). Its management is very challenging. A recognised leading cause is a folic acid deficiency, therefore prevented by taking a preconception folic acid. This study looked at the demographic features and management outcome of neural tube defect, a fairly common preventable condition with the need to raise awareness on its preventive measures. Methods: The study was conducted on 82 patients with NTD that were managed in federal medical centre Yola, in North-Eastern Nigeria. It was a retrospective study over a 4-year period, from January 2016 to December 2019.Results: Ages at presentations ranged from 1 to 93 days with a mode of 3 days. There were 29 males and 53 females with a male to female ratio of 1:1.8. Spina bifida constituted 74.4%, encephalocele (20%), Anencephaly (5%). Types of spina bifida managed were myelomeningocele (63.5%), meningocele (33.3%), and lipo-myelomeningocele (3.2%). Two had a 2-level meningocele. Syndromic associations of myelomeningocele were with hydrocephalus (78.1%), foot deformity (22.2%), cardiac (2.5%), and anorectal malformation (2.5%). Ninety-five-point one had various surgeries with 30.8% developing postoperative complications. commonest was post excision of myelomeningocele and encephalocele hydrocephalus (29.1%) in 7 patients. Post-operative Mortality was reported in 2 patients (8.3%).Conclusions: Myelomeningocele was the commonest NTD, and its syndromic association with hydrocephalus was common. A large number of patients had surgical interventions with a good outcome. Post-op mortality was minimal.

Clinical findings and surgical outcomes of encephalocoeles

Background: Encephalocoeles are herniation of the brain and its meninges via a midline cranial vault defect or at the base of the skull, at the site of local mesenchymal disruption. It accounts for 10% to 20% of all the cranial and spinal dysraphisms found in 1/5000 live births.Method: It is a 5 year retrospective study on 42 cases of encephalocoele managed in a Nigerian Tertiary Medical Centre. We extracted the clinical findings and surgical management outcomes from the patient's case notes.Result: Ages at presentation were Neonates (24, 57.1%), ≤3 months (35, 83.3%), with mode of 2 days. Males (12, 28.6%), females (30, 71.4%), with M:F=1:2.5.  Posterior (occipital) lesions (36, 85.7%), anterior (6, 14.3%). Variable size lesions (33, 78.6%), giant encephalocoeles (9, 21.4%). Hydrocephalus (16, 38.1%) included pre-excision HCP (12, 75% of 16) and post excision HCP (4, 25% of 16). Available neuroimaging was TFUSS (all, 100%), CT Scan (20, 47.6%), MRI (2, 4.8%). Surgery of excision and repair (36, 85.7%), combined craniofacial repair (6, 14.3%), additional ventriculoperitoneal shunt (16, 38.1%). Post-operative complications included CSF leak (2, 4.8%), superficial surgical site infection (3, 7.1%), meningitis (1, 2.4%), shunt infection (4, 9.5%), shunt obstruction (7, 16.7%). Outcomes were good (38, 90.5%), blind (3, 7.1%), vegetative (1, 2.4%), death (1, 2.4%).Conclusions: Encephalocoeles are an uncommon congenital type of neural tube defect containing herniated brain tissue. Posterior (occipital) lesions are commoner (and maybe of giant size) than anterior lesions (Sincipital). Surgical outcomes are generally good

Comparative phytochemical and in vitro antimicrobial activities of the leaf extracts of two medicinal plants growing in North-East, Nigeria

Introduction: The use of plants as medicine is as old as chemistry and common to all societies including the African, notably some parts of Northern Nigeria. Infectious diseases are among the causes of mortality and morbidity in rural areas endemic with hygienic problems in most developing countries including Nigeria. Two plant species with similar ethnomedical reports from different families were used in this study against some microorganisms. Their phytochemicals were also evaluated. Methods: The leaf samples of Punica granatum and Waltheria indica were prepared and independently extracted with 80% methanol using maceration technique. The extracts were concentrated to dryness at reduced pressure and then subjected to phytochemical evaluation. Antimicrobial activities were evaluated using hole-in-plate disc diffusion technique. Results: The phytochemical results of both extracts revealed the absence of anthraquinones. However, both extracts showed the presence of cardenolides, cardiac glycosides, flavonoids, saponins, tannins and terpenoids; while alkaloids were found in W. indica. The antimicrobial susceptibility study showed dose-dependent pattern with the highest dose (80 mg/hole) showing inhibition zone of 23.67±0.47 and 23.33±0.47 mm, respectively by P. granatum and W. indica against Streptococcus pyogenes while at 20 mg/hole inhibition was noted as 8.67±0.47 and 7.00±0.00 mm against Escherichia coli for P. granatum and W. indica, respectively. Conclusion: The findings of this study scientifically support the use of P. granatum and W. indica in folklore medicine for the cure of infections by microbes

Assessment and Evaluation of Bris Soil and its Implication on Maize Crop in Merang- Terengganu Region of Malaysia

The research objectives focus on the evaluation of the physical properties of BRIS soil; to investigate the limiting factors for maize crop; also to create the awareness of the farmers as to the fertility and soil characteristics for better maize production and the effort to increase maize crop production.        Soil fertility status of soil series are classified as very low to low, except Base Saturation because the soils are strongly influenced by sea movement. The soil suitability was S3-twrne for Baging and Rhu Tapai, S3-twrnx for Rudua, and S3-twrn for Jambu with the soil productivity of around < 1, 1-2 and 2-3 tons dried maize per ha per year respectively. The needed efforts to improve soil capability from actual to potential soil suitability for maize cultivation are i.e. cover the soils with mulch, make sprinkle irrigation, make dam for water holding and retention, give and maintain organic matters in the soils and do not burn biomass, fertilize soils with NPK and organic fertilizers, do wash elements of Na and H and break down shallow spodic horizons, make terraces and mix mineral subsoils to BRIS soil to improve CEC. Keywords: Assessment, Evaluation, Bris Soil Series, Physiography, Maize, Terengganu,

BRIS Soil Suitability Assessment on Sweet Potato in Merang- Terengganu Region of Malaysia

The research objectives focus on the evaluation of the physical properties of BRIS soil; to investigate the limiting factors for sweet potato crop; also to create the awareness of the farmers as to the fertility and soil characteristics for better sweet potato production and the effort to increase sweet potato crop production. Soil fertility status of soil series are classified as very low to low, except Base Saturation because the soils are strongly influenced by sea movement. Soil fertility status of soil series are classified as very low to low, except Base Saturation because the soils are strongly influenced by sea movement. However, Baging and Rhu Tapai soil suitability in terms of nutrient where mostly M/nU/d, with SU at the slope; for Rudua and Jambu they are mostly S with no trace of some soil criteria. However the needed efforts required in improving the soil capability from actual to potential soil suitability for sweet potato cultivation can be seen in the agronomic requirement table above. Hence, cover the soils with mulch, make sprinkle irrigation, make dam for water holding and retention, give and maintain organic matters in the soils and do not burn biomass, fertilize soils with NPK and organic fertilizers. Keywords: Suitability, assessment, Bris soil series, Soil Profile, Terenggan

Review of patients with chronic suppurative otitis media in the National Ear care centre, Kaduna Nigeria.

Chronic suppurative otitis media (CSOM) is the most common condition presenting to Otolaryngological clinics, often patients present late with consequent complications that require surgical intervention. This study aimed to review the mode of clinical presentation, modality and outcome of treatment of CSOM seen at NECC Kaduna. Methodology:This was a retrospective study carried out in the National Ear Care Centre, Kaduna for a period of 3 years; from January 2016 - December 2018. Results: Two hundred and thirty-four patients with CSOM were studied. There were 127 males and 107 females making M: F =1.2:1. The age range was from 8-60years with a mean age of 26.5±12.6years. The age group 11-20 (31.2%) had the highest number. Majority presented with hearing loss and ear discharge 228(97.4%) and 182(77.8%) respectively. Other symptoms were otalgia, tinnitus, vertigo and nasal symptoms. Eleven (4.7%) had complications at presentation. Ninety-two (39.3%) had surgery, 64 had only aural toileting and dressing with topical antibiotic with recorded success as majority achieved dry ear, while 38 patients were lost to follow up. Postoperative complications include; loss of taste sensation, facial nerve palsy, recurrent/persistent ear discharge, persistent dizziness, and infection of the donor site and no mortality was recorded. Conclusion: One-third of the patients who benefitted from surgery had a good outcome and for those with conservative treatment, the majority achieved dry ear. Early presentation is advised to avoid complications

Review of urological cancers in Damaturu, Nigeria

 Background: Urological cancers (UC) remain a major global burden and a significant cause of high morbidity and mortality. In other to plan and tackle this burden, there is need to audit the pattern of these malignancies in our locality which is currently lacking.  Hence, the objectives of our study were to describe the histological pattern, frequency and demographic characteristics of urological cancers seen in Damaturu.Methods: The reports of all the urological specimens that were histologically diagnosed as malignant between November 2017 to October 2019 in the histopathology department of Yobe state university teaching hospital, were analyzed. The department keeps newly established cancer registry for the state.Results:  Fifty-five UC were diagnosed, with male to female ratio of 13.8:1. These UC constitute 34.1% of the 161 urological specimens assessed and 26.4% of all types of medical cancers diagnosed in the period of study. Prostate cancer dominates the UC (41; 73.8%), followed by bladder cancers (11; 19.8%) and the remaining kidney, penis and testicular cancers (1; 1.8%) each.Conclusions: Urological cancers are very common in our region, particularly prostate cancers in which majority were poorly differentiated. This report though analyzed few cancers, the proportion of UC is high. Urothelial cancer of the bladder is now more frequent than squamous cell carcinoma. This study can serve as basis for future epidemiologic studies targeting at the risk factors, awareness and prevention of UC

Geochemical assessment of toxic metals stocking in top-soil within the area of limestone quarry in Gombe of North-eastern Nigeria

This work presents an assessment of geochemical toxic metal stocking in top-soil within the area of a limestone quarry in Gombe State. Samples of topsoil from the area of a limestone quarry in Gombe (North-eastern Nigeria) were collected to analyse levels of hazardous substances such as of Hg, Fe, Zn, Ni, Mn, Cu, Cr, Cd and Pb. A total of 24 topsoil samples were collected around the radius of 0.5 km from the blasting arena. Additionally, six background samples were also collected from an unexploited reserved area that was ~6 km far from the main sampling location. Two rocks of limestone samples from blasting area were also collected and analysed for heavy metals as a reference. All the samples were processed and extracted with nitrate acid solution and analysed using smart spectrophotometer methods. The results suggested varying organic contents in soil, sand, silt, clay and pH. All these parameters are correlated with those of unexploited samples. Limestone rocks samples displayed a high concentration of Fe and Mn improvement. Toxic metals concentrations (mg/kg) in top-soil with background levels were discovered in Hg, Fe, Mn, Ni, Zn, Cd, Cu, Cr and Pb. Residual phases exhibited the lowest enrichment for most metals possibly, because of high loamy sand content. The situated enrichment advocates influence from mining activities. The results especially geoaccumulation index assessment exhibit below detected limit to 0.20 mg/kg for Pb which is uncontaminated by Lead when compared with the USA threshold limit of particulate metal concentration. Conversely, the other hazardous metals ranged from 1 to 2, indicating the area is contaminated moderately. The exposure to dust containing high silica in quarry workers leads to deterioration of pulmonary function and hence suggesting a need for protective measures of the quarry workers.Key words: Top-soil, heavy toxic metal, limestone quarry, air pollution

Preeclampsia and COVID-19: results from the INTERCOVID prospective longitudinal study

Background: It is unclear whether the suggested link between COVID-19 during pregnancy and preeclampsia is an independent association or if these are caused by common risk factors. Objective: This study aimed to quantify any independent association between COVID-19 during pregnancy and preeclampsia and to determine the effect of these variables on maternal and neonatal morbidity and mortality. Study Design: This was a large, longitudinal, prospective, unmatched diagnosed and not-diagnosed observational study assessing the effect of COVID-19 during pregnancy on mothers and neonates. Two consecutive not-diagnosed women were concomitantly enrolled immediately after each diagnosed woman was identified, at any stage during pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed until hospital discharge using the standardized INTERGROWTH-21st protocols and electronic data management system. A total of 43 institutions in 18 countries contributed to the study sample. The independent association between the 2 entities was quantified with the risk factors known to be associated with preeclampsia analyzed in each group. The outcomes were compared among women with COVID-19 alone, preeclampsia alone, both conditions, and those without either of the 2 conditions. Results: We enrolled 2184 pregnant women; of these, 725 (33.2%) were enrolled in the COVID-19 diagnosed and 1459 (66.8%) in the COVID-19 not-diagnosed groups. Of these women, 123 had preeclampsia of which 59 of 725 (8.1%) were in the COVID-19 diagnosed group and 64 of 1459 (4.4%) were in the not-diagnosed group (risk ratio, 1.86; 95% confidence interval, 1.32–2.61). After adjustment for sociodemographic factors and conditions associated with both COVID-19 and preeclampsia, the risk ratio for preeclampsia remained significant among all women (risk ratio, 1.77; 95% confidence interval, 1.25–2.52) and nulliparous women specifically (risk ratio, 1.89; 95% confidence interval, 1.17–3.05). There was a trend but no statistical significance among parous women (risk ratio, 1.64; 95% confidence interval, 0.99–2.73). The risk ratio for preterm birth for all women diagnosed with COVID-19 and preeclampsia was 4.05 (95% confidence interval, 2.99–5.49) and 6.26 (95% confidence interval, 4.35–9.00) for nulliparous women. Compared with women with neither condition diagnosed, the composite adverse perinatal outcome showed a stepwise increase in the risk ratio for COVID-19 without preeclampsia, preeclampsia without COVID-19, and COVID-19 with preeclampsia (risk ratio, 2.16; 95% confidence interval, 1.63–2.86; risk ratio, 2.53; 95% confidence interval, 1.44–4.45; and risk ratio, 2.84; 95% confidence interval, 1.67–4.82, respectively). Similar findings were found for the composite adverse maternal outcome with risk ratios of 1.76 (95% confidence interval, 1.32–2.35), 2.07 (95% confidence interval, 1.20–3.57), and 2.77 (95% confidence interval, 1.66–4.63). The association between COVID-19 and gestational hypertension and the direction of the effects on preterm birth and adverse perinatal and maternal outcomes, were similar to preeclampsia, but confined to nulliparous women with lower risk ratios. Conclusion: COVID-19 during pregnancy is strongly associated with preeclampsia, especially among nulliparous women. This association is independent of any risk factors and preexisting conditions. COVID-19 severity does not seem to be a factor in this association. Both conditions are associated independently of and in an additive fashion with preterm birth, severe perinatal morbidity and mortality, and adverse maternal outcomes. Women with preeclampsia should be considered a particularly vulnerable group with regard to the risks posed by COVID-19

Comparative phytochemical and in vitro antimicrobial activities of the leaf extracts of two medicinal plants growing in North-East, Nigeria

Introduction: The use of plants as medicine is as old as chemistry and common to all societies including the African, notably some parts of Northern Nigeria. Infectious diseases are among the causes of mortality and morbidity in rural areas endemic with hygienic problems in most developing countries including Nigeria. Two plant species with similar ethnomedical reports from different families were used in this study against some microorganisms. Their phytochemicals were also evaluated. Methods: The leaf samples of Punica granatum and Waltheria indica were prepared and independently extracted with 80% methanol using maceration technique. The extracts were concentrated to dryness at reduced pressure and then subjected to phytochemical evaluation. Antimicrobial activities were evaluated using hole-in-plate disc diffusion technique. Results: The phytochemical results of both extracts revealed the absence of anthraquinones. However, both extracts showed the presence of cardenolides, cardiac glycosides, flavonoids, saponins, tannins and terpenoids; while alkaloids were found in W. indica. The antimicrobial susceptibility study showed dose-dependent pattern with the highest dose (80 mg/hole) showing inhibition zone of 23.67 ± 0.47 and 23.33 ± 0.47 mm, respectively by P. granatum and W. indica against Streptococcus pyogenes while at 20 mg/hole inhibition was noted as 8.67 ± 0.47 and 7.00 ± 0.00 mm against Escherichia coli for P. granatum and W. indica, respectively. Conclusion: The findings of this study scientifically support the use of P. granatum and W. indica in folklore medicine for the cure of infections by microbes