West Africa Journal of Medicine

ORIGINAL: An Audit of Orthodontic Retention Protocol in a Tertiary Health Institution: A 3-Year Retrospective Study

2024-11-25T14:24:06+00:00

Background: The aim of this study was to determine the retention practices following orthodontic treatment in a tertiary health institution in Nigeria.

Methods: A retrospective study conducted in the Orthodontic Clinic of the Lagos University Teaching Hospital over a 3-year-period. Data on the type of retainers used and the retention practices in the upper and lower arches were obtained from case files of patients who had completed orthodontic treatment in the institution. Statistical analysis was performed using IBM SPSS software version 23.

Results: The demographic variables comprised of 136 subjects; 93 females (68.4%) and 43 males (31.6%). Their ages ranged from 9-44 years with a mean age of 18.96 ± 6.75. Class I malocclusion was the most common malocclusion pattern (84.6%), followed by Class II (10.3%) and Class III (5.1%). Removable retainers were more commonly used and accounted for retention carried out in 85.3% of the study population. There was a preference for the use of removable retainers in the upper arch; the Hawley retainer being the most used (79.4%). In the lower arch however, no form of retention was carried out for majority of the patients after orthodontic treatment (86.8%). However, when done, the fixed lingual retainer was the most frequently used (13.2%).

Conclusion: The Hawley retainer was the predominant retainer in this study. The fixed lingual retainer was the most frequently used in the lower arch. Longitudinal studies are required to determine efficacy of different types of retention following orthodontic treatment.

Keywords: Retention, Orthodontic Treatment, Orthodontics, Retainers.

ORIGINAL: Comparing Antenatal and Delivery Care Services in Public and Private Health Facilities: Evidence from 2018 Nigeria Demographic and Health Survey

2024-11-28T11:46:24+00:00

Background: There have been calls for privatisation of public health facilities to improve quality of care received. The study compared antenatal and delivery services received in public and private health facilities in Nigeria.

Methods: The study was based on 2018 Nigeria Demographic and Health Survey data collected from women aged 15-49 years, concerning their pregnancy and delivery. Data on those that attended antenatal clinic (ANC) in public or private facilities and had live births in the preceding five years was analysed. Simple logistic regression was used to test for association between type of facility for ANC and delivery and the care received.

Results: A total of 15,811 women attended ANC in public (12,921, 81.7%) and private (2,890, 18.3%) facilities, and 12,399 delivered in public (8,583, 69.2%) and private (3,817, 30.8%) facilities. Type of facility attended was associated with number of ANC visits (OR=3.89; p<0.001), blood sample taken (OR=1.16; p=0.029), iron supplementation (OR=0.49; p<0.001), deworming (OR=0.74; p<0.001), receiving all the components of ANC service (OR=0.79; p<0.001), and skilled birth attendance (OR=3.81; p<0.001). However, it was not associated with blood pressure measurement (OR=1.07; p=0.459), urine sample taken (OR=1.05; p=0.486), postnatal check (OR=0.94; p=0.171) and timing of postnatal check (OR=0.73; p=0.185).

Conclusion: While private facilities had more ANC visits and skilled birth attendance, overall provision of ANC services was better in the public facilities. Therefore, antenatal and delivery services were not necessarily better in private facilities. Beyond availability, further studies are needed to compare the quality of antenatal and delivery services in public and private facilities.

ORIGINAL: Determinants of Antimicrobial Use for Covid-19 Related Symptoms among Nigerians

2024-11-28T11:59:05+00:00

Background: Antimicrobial use plays a key role in development and spread of antimicrobial resistance. Following the global coronavirus disease 2019 (COVID-19) pandemic and the report of the first confirmed case in Nigeria, several states embarked on either a full or partial lockdown as a measure to prevent or curtail the spread of the virus with its attendant challenges. This survey was designed to provide a snapshot of public antimicrobial use and common perception related to antimicrobial use for COVID-19 related symptoms among Nigerian populace.

Methods: We developed and tested a 29-question electronic questionnaire with Google forms asking respondents about their antimicrobial use and perceptions regarding appropriate antimicrobial use for real or perceived symptoms during the outbreak period. Respondents aged 18 years and above were recruited through crowd sourcing and they received the link to the survey tool through emails and social media including WhatsApp, Twitter, Facebook, LinkedIn, and Instagram. All data analysis was performed using SPSS version 26.0.

Results: A total of 410 responses were received from the six geopolitical zones in Nigeria comprising 200 (48.8%) females and 210 (51.2%) males. Majority (62.9%) of the respondents had taken antimicrobials in the 3 months period preceding the survey, while less than half (46.8%) received prescription for it. Previous intake of antimicrobial for similar illness was a predictor of antimicrobial intake (OR: 0.55, 95%CI: 0.30-1.01). The most consumed antimicrobial was antimalarial drugs, specifically Artemisinin-based combination therapy (43.4%), followed by antibiotics [Ciprofloxacin (20.2%)].

Conclusion: There was high levels of antimicrobial use for COVID-19 related symptoms by the Nigerian public. This is likely to escalate the already high prevalence of antimicrobial use previously reported and may further fuel the emergence of antimicrobial resistance.

ORIGINAL: Evaluation of Foetal Haemoglobin Status among Nigerian Patients with Sickle Cell Anaemia Using High Performance Liquid Chromatography

2024-11-29T15:35:26+00:00

Background: Sickle cell anaemia (SCA, HbSS) is a genetic disorder of haemoglobin with marked variation in clinical manifestation. The aim of this study was to determine the foetal haemoglobin (HbF) status of patients with HbSS, compared with that of individuals with HbAS and HbAA control as well as to establish the relationship between HbF level and age and gender of the participants.

Methods: This was a cross-sectional study in which HbF values of known HbSS patients along with HbAS and HbAA controls were analysed using High Performance Liquid Chromatography. Socio-demographic and other information were obtained with the use of questionnaire. Data was analyzed using SPSS software, version 20.0. Ethical approval was obtained for the study.

Results: One hundred and two (102) participants were recruited for the study, comprising 60 patients with HbSS, 22 HbAS and 20 HbAA controls, with mean age of 11.0 years±9.6, 11.7 years ±8.8 and 12.3 years±8.1 respectively. There were 30 (61.2%) males and 30 (56.6%) females for HbSS group, 9 (18.4%) males and 13(24.5%) females for HbAS group and 10(20.4%) males and 10(18.9%) for HbAA group. Mean HbF level among HbSS participants was 8.0 ±6.1% and was significantly higher than that of HbAS (3.0 ±3.4%) and HbAA (2.2 ±4.1%) control (P<0.05). Mean HbF level was higher in children (<18 years) than adults (e"18 years) among HbSS, HbAS and HbAA participants, though not statistically significant (p >0.05). Mean HbF level was also higher among female HbSS, HbAS and HbAA groups compared to corresponding male groups, though only HbSS female group was significant (p = 0.031).

Conclusion: Patients with HbSS have significantly higher HbF level than individuals with HbAS and HbAA. Foetal haemoglobin level tend to decrease with advancing age and higher in females. Increased HbF level may play a compensatory mechanism in sickling in HbSS, thus the use of agent that increase HbF level may improve clinical outcome.

ORIGINAL: Hospital-Based Cross-Sectional Study of the Impact of Cutaneous Lichen Planus on the Quality of Life of Patients at a Tertiary Center in Lagos, Nigeria

2024-12-17T15:01:31+00:00

Background: Lichen planus is a darkly pigmented skin disease that impairs the quality of life of patients. The effect of lichen planus on patient's quality of life (QoL) is not widely documented. The study's objective was to determine QoL impairment of LP patients, determine what aspect of QoL is impaired, and correlate clinical and sociodemographic characteristics with QOL impairment.

Methodology: This was a cross-sectional descriptive study conducted from February 2018 to January 2019 at the outpatient dermatology clinic of the Lagos State University Teaching Hospital, Lagos, Nigeria. All consecutive newly diagnosed LP patients who gave their consent were recruited into the study. Socio-demographic data and QoL (using the dermatology life quality index, DLQI) was documented. The hospital's ethical committee gave ethical approval for the study. The patients were clinically examined. Statistical analysis was done using SPSS version 22. The level of significance of all tests was set at 5%.

Results: Quality of life was impaired in 95.5% of the patients. The mean DLQI score was 10±6.7. The minimum DLQI was one and the highest 24. Quality of life was mildly, moderately and severely impaired in 38.01%, 23.81% and 38.01% respectively. Pruritus was significantly associated with QoL impairment. Feelings of embarrassment (54.5%), itchy skin (54.5%), interference with being in public (54.5%), social life (50%) and having to deliberately choose clothes to cover the LP lesions (61.1%) were the main items impaired in the DLQI instrument.

Conclusion: Lichen planus affects QoL of patients negatively. The items of impairment are feelings of embarrassment, social functioning and choice of clothing.

ORIGINAL: Hypertension and its Clinical Correlates in a Rural Community in South Western Nigeria

2024-12-19T09:40:12+00:00

Background: Hypertension is the commonest cardiovascular risk factor globally and is a cause of untold morbidity and mortality. However, its clinical correlates at the community level have not been well elucidated.

Methods: History taking, anthropometric measurements, electrocardiograms and laboratory investigations were done for all the study subjects. Ethical approval was obtained from the institution's ethical body. Analysis was done using SPSS version 20. Two hundred people were recruited for the study. The prevalence of hypertension in the community was 58.5% with 31(15.5%) being newly diagnosed. The Body Mass Index [BMI] (28.2±6vs 25.6±5.3; P=0.003),Waist-Hip ratio (0.9±0.08 vs 0.86±0.06; p= 0.001), total cholesterol (5.675±1.8 vs 4.6±1.7, P=0.000), triglycerides (1.19±0.85 vs 0.91±0.59; p=0.019), LDL cholesterol (3.38±1.6 vs 2.66±1.5; p=0.002), heart rate (82.4±15.8 vs 76.8±11.2; p=0.018) QRS duration (84.8±13.4 vs 80.5±11.2; p=0.040), and QTc (0.423±0.041 vs 0.402±0.035; p=0.001) were higher in those with hypertension. NYHA functional class was worse in hypertensives (p=0.041). Prevalence of left ventricular hypertrophy (LVH) in hypertensives ranged from 2.6 to 48.2%, depending on the criteria used. Systolic blood pressure, pulse pressures, HDL levels and hip circumferences were higher in those with electrocardiographic LVH. Systolic blood pressure (OR:1.045, P=0.006; CI: 1.013-1.079) and a normal BMI (OR: 0.159, p= 0.004; CI: 0.045-0.559) were the independent predictors of LVH in this study.

Conclusion: The prevalence of hypertension is rising, even in rural populations, with accompanying LVH, higher QTc and florid cardiovascular risk factors. It is therefore imperative to tighten the reins of control of blood pressure and other cardiovascular risk factors before the cardiovascular morbidity and mortality explode in the rural communities.

ORIGINAL: Relevance of Rheumatic Valvular Heart Disease in the Aetiology of Heart Failure in Contemporary Times

2024-12-19T10:48:26+00:00

Background: Rheumatic valvular heart disease (RVHD) is one of the foremost causes of heart failure (HF) in our population, particularly among young adults, but a decline in the prevalence of RVHD has been observed. The effect of this decline on the relevance of RVHD among other causes of HF is not established in our setting.

Objective: To determine whether RVHD is still a leading cause of HF in our population or not.

Methods: This was a retrospective study of HF patients hospitalized between August 2018 and June 2020. The demographic features, blood pressure, aetiology of HF and ejection fraction were retrieved from the unit's HF register. Data were presented as frequencies and medians. Associations were tested as appropriate.

Results: RVHD accounted for 78 (35.5%) of HF, with a median age of 47 years. The young and middle- aged subgroups were 10(12.8%) and 48(61.6%), respectively. The affected valves were all regurgitant and 68 (77.2%) had definite RVHD. Isolated mitral valve, combined mitral and aortic valves were affected in 40 (51.3%) and 22 (28.2%), respectively. The median systolic blood pressure and ejection fraction were 110mmHg and 26% respectively. RVHD was associated with HF with reduced ejection fraction. (P value < 0.001).

Conclusion: RVHD remains one of the leading causes of HF (35.5%) among adults in our population. Young adults are now in the minority and most patients present late in the course of the disease. Valve surgery should be made readily accessible. Primary and secondary prevention of acute rheumatic fever should be reinforced.

ORIGINAL: Menstrual Characteristics of sub-Sahara Black African Women with and without Endometriosis

2024-12-19T11:05:21+00:00

Background: One gynecological disorder which is often a mystery to premenopausal women who are affected is endometriosis, a benign condition characterized by ectopic endometrium growing outside the uterus but behaving as if it is still within the uterus.

Materials and methods: Hospital records of 226 women who consulted for fertility management at Nordica Fertility Center were surveyed retrospectively. These women were stratified by age into <35 years and >35 years and by BMI into <18.5 (underweight), 18.5-24.9 (normal), 25.0-29.9 (overweight) and >30 (obese). There were 113 who had laparoscopic diagnosis of endometriosis and 113 without endometriosis but just infertility. STATA 13 statistical software was used for analysis of data.

Results: The mean (±sd) age of the women in the study was 34.3 (4.9) with no significant difference among those with (33.9 (4.3)) and without (34.6 (5.4)) endometriosis. There was a significant difference (t=-3.36, P-value=0.0005) in the mean BMI (Kg/m2) of women with endometriosis (25.8±4.9) compared to that of women without endometriosis (27.9±4.5). The probability of endometriosis among normal weight women was higher at age <35 years (OR=2.76, 95% Confidence Interval 1.33,5.73) than at age >35 years (OR=1.59, 95% Confidence Interval 0.62, 4.10). The mean (±SD) parity among those with endometriosis (0.13±0.34) was significantly lower (t-test=2.31; P-value=0.01) than that among women without endometriosis (0.28 ± 0.60). Primary infertility was more prevalent (62.0%) than secondary infertility (38.0%) among those with endometriosis while secondary infertility was more prevalent (55.8%) than primary infertility (44.3%) among those without endometriosis. The mean age (years) at menarche of women without endometriosis (13.3±1.6) was significantly higher (t-test=1.88, P-value=0.03) than that among those with endometriosis (12.9±1). Those with endometriosis were most likely to have dysmenorrhea alone, menorrhagia alone and both dysmenorrhea and menorrhagia concurrently than those without the disease.

Conclusion: Anthropometric and abnormal menstrual profile of patients presenting with pelvic pain, co-morbidity of dysmenorrhea and menorrhagia, infertility and low parity can guide clinicians and gynecologist to make early and proper diagnosis of endometriosis for better treatment outcomes.

ORIGINAL: Plasma Low-Density Lipoprotein Cholesterol Estimated by Friedewald Compared to Martin-Hopkins Equation in Nigerian Population

2024-12-20T16:32:49+00:00

Background: Friedewald equation for estimation of plasma low-density lipoprotein cholesterol (LDL-C) has recently been the subject of controversies. We investigated the agreement between LDL-C calculated with the Friedewald equation (LDLC F) and novel Martin-Hopkins formula (LDL-CMH), and the influence of sex, age, and triglyceride stratification on the level of biases.

Methods: We used convenience sample of data from records of 7151 adults who underwent test for plasma lipid profile from 2014 to 2017 at a tertiary Hospital in Nigeria. During the period automated standard enzymatic methods were used for determination of plasma lipids. The Bland-Altman plot was used to evaluate the agreement between the two equations.

Results: Participants were 2953 males and 4198 females. The age of the subjects ranged from 21 to 91 years with overall mean age of 54.2±12.1 years. The discrepancy between LDLC MH and LDL-CF ranged from -0.05 to 0.93 mmol/L (median = 0.16) with a mean value of 0.172 ±0.094 mmol/L. The BlandAltman analysis showed an estimated bias of 6.38% (95% CI = -5.02, 20.0). The bias in males and females was 8.3% (95% CI = -5.6, 22.2) and 6.9% (95% CI = -4.4, 18.3), respectively. At an average LDL-C less than 1.81 mmol/L, estimated bias became increased to 16.6% (95% CI = -6.1, 39.2). The calculated LDL-C MH were significantly higher than LDL-CF irrespective of the level of triglyceride.

Conclusion: Although both showed excellent reliability, the Friedewald equation resulted in a clinically lower LDL-C than the Martin-Hopkins formula. It may be necessary to pay attention to biological sex differences.

ORIGINAL: Prevalence and Correlates of Frailty Syndrome among Older Adults Attending Chief Tony Anenih Geriatric Centre, University College Hospital, Ibadan

2024-12-20T16:44:36+00:00

Background: Frailty has emerged as an important clinical measurement among older adults because of its negative health outcomes.

Objective: This study measured the prevalence and factors associated with frailty among older adults aged 60 years and above at a Geriatric Centre in Nigeria.

Methods: In this descriptive cross-sectional study, 971 older adults were recruited consecutively. Data on sociodemographics characteristics and clinical parameters were obtained using an interviewer-administered questionnaire and physical examination performed. The Frailty syndrome and Frailty Index were assessed using the Fried Frailty Criteria (FFC) and Canadian Study of Health and Aging (CSHA) scale respectively. Bivariate and multivariate analyses were carried out using SPSS version 21 at a p <0.05.

Results: The mean age of the participants was 71.3 (± 7.1) years with a female to male ratio of 2.4:1. Based on FFC scale, 498 older persons (51.3%) had frailty syndrome while only 148 (15.2%) were frail using the CSHA scale. The measure of agreement (Kappa statistics) was 0.22 (p<0001) indicating weak agreement between the two scales. Logistic regression analysis revealed increasing age (OR=1.948 [1.219-3.113]), multiple morbidities (OR= 1.584, [1.177-2.201]), depression (OR= 5.050, [2.501-9.442,]), imbalance or increased risk of fall (OR 1.623, [1.192-2.211,]), and inability to perform IADL (OR= 0.599 [0.535-0.670,]) to be the most significant determinants of frailty syndrome while obesity (OR=0.660, [0.449-0.971]), unusually appeared a deterrent.

Conclusion: The prevalence of frailty syndrome was high among the older adults. Targeted and timely interventions on the modifiable factors may delay progression into frailty and the eventual negative health outcomes.

ORIGINAL: The Evolving Application of DNA-Based Genotyping of Red Blood Cells in Blood Grouping: A Narrative Review

2024-12-23T11:11:51+00:00

Blood grouping system is made of diversities of inherited specific antigen markers located on the red cell membrane. Exposure to foreign antigens not present in individual genetic make-up stimulates the production of the corresponding alloantibodies which often times is detrimental to health. The high throughput, specific and cost-effective DNA-based red cell genotyping has improved health care delivery in blood transfusion science by enhancing our understanding of the genetic variations which control the expression of red cell antigens. It improves efficiency, accuracy of test, and enhances personalized therapy especially in transfusion dependent patients. This review aims to evaluate the evolving application of DNA-based red cell genotyping in determining blood group. It has helped to resolve discrepancies encountered with the conventional serological testing especially in difficult-to-type patients. Rare cell phenotypes with no commercially available antisera or weakly reacting antigens are easily detected. Furthermore, in-utero fetal DNA genotyping for identifying fetus at risk of haemolytic disease of fetus and newborn (HDFN), selection of donors for bone-marrow transplant and monitoring haemopoietic progenitor cells after ABO mismatch are other important applications of DNA-based genotyping.

ORIGINAL: Predictors of Bacterial Co-Infection and Outcome in Children with Severe Malaria in Ilorin, Nigeria

2024-12-23T11:28:49+00:00

Background: Severe malaria is a significant cause of morbidity and mortality in Nigeria and concomitant bacteraemia may potentially worsen clinical outcomes. (Duration of admission, Mortality, Fever clearance time and Coma recovery time).

Objectives: This study aimed at identifying the proportion of children with severe malaria who had concomitant bacteraemia, the pathogens implicated and their drug sensitivity pattern, predictors of bacterial co-infection and its effect on treatment outcome.

Methods: This was a hospital-based cross-sectional study at the Emergency Paediatric Unit of the University of Ilorin Teaching Hospital, Nigeria. The subjects were children aged 6 months to 14 years with severe malaria and microscopy confirmed parasitemia at admission. All subjects had blood culture samples drawn at admission for identification of bacterial isolates. Relevant clinical and laboratory parameters were recorded on case proformas.

Results: A total of 944 children were admitted into the Emergency Paediatric Unit during the study period with 176 (18.6%) managed for severe malaria. Of the 176 children with severe malaria, 41 (23.3%) had concomitant bacteraemia. Gram positive bacteria were the most common (70.7%) isolates with Staphylococcus aureus being the most predominant (65.9%). The bacterial isolates were mostly sensitive to Ciprofloxacin. Children with concomitant bacteraemia had a longer duration of admission (p = 0.028) and longer fever clearance time (p=0.015). Increasing duration of coma before presentation was the single independent predictor of bacteraemia (p= 0.010).

Conclusion: Severe malaria constituted a significant cause of admissions in UITH with approximately a fourth of the subjects having bacterial co-infection and this was associated with a worse prognosis (longer duration of admission and fever clearance time). Increased duration of coma prior to admission was the only predictor of the presence of bacteraemia in children with severe malaria. This highlights the importance of investigating for concomitant bacteraemia, especially in children presenting with coma.

EDITORIAL: Mitigating the Burden of Hypertension in Developing Nations and the Global Impact of Covid-19 Vaccine

2024-11-25T13:14:16+00:00

It is with great delight that I present this edition of the West African Journal of Medicine. I am particularly intrigued by the diversity of articles presented in this edition, cutting across numerous fields in Medicine and Surgery and reflecting the resourcefulness of our authors in their fields. I especially welcome the editorial by Prof. Otuyemi on A three-year audit of Orthodontic Retention Protocol in a Nigerian tertiary health institution. Future editions will expand the editorial column to accommodate many authors from diverse fields.

Hypertension continues to be a deadly disease despite preventive measures. It remains one of the most important risk factors for ischemic heart disease, stroke, and kidney disease.¹ Despite advances in management of hypertension over the years, the global prevalence is rising, especially in rural populations. This has been attributed to changes in lifestyle, population growth, and an aging population.² The impact of the disease on the populace cannot be over-emphasized as complications from hypertension continue to abound. Presently, it affects over 1 billion people globally and continues to be the highest single contributor to global burden of disease and mortality.³

About 75% of people with hypertension live in low- and middle-income countries with an estimated 74.7 million in Sub-Saharan Africa.⁴ Major issues affecting the rural populace are the gross unawareness of hypertensive status, poverty, poor drug and clinic compliance, lack of access to specialist care, and religious and traditional myths that foster poor health-seeking behaviours. More often than not, hypertension is diagnosed when patients present with complications at the hospital and this gives cause for concern. The article on ‘Hypertension and its clinical correlates in a rural community,’ in this edition, further sheds light on this rising scourge in our rural communities, as many of the patients presented with left ventricular hypertrophy and florid cardiovascular risk factors.

The lesson that is being learnt repeatedly is that we must increase awareness and tighten the reins of blood pressure control if we must mitigate the impact of disease. Studies on long-term awareness and trends in hypertension management has shown that even in highly developed best performing countries, treatment coverage was at most 80% and control rates were less than 70%.¹ Hence, the need for intensive and sustained awareness is paramount, if we must overcome this scourge. Training of healthcare professionals on current guidelines and adherence to the guidelines, ensuring patients compliance with medications, promoting regular blood pressure measurements, establishing a hypertension registry, reducing pill-burden by opting for single-pill therapy, and providing ready access to healthcare in rural communities, will also go a long way to ensure control and reduce prevalence of hypertension.

COVID-19 continues to be a deadly disease with multisystemic affectations and associated with various complications and co-morbidities. Renal involvement has been found to be a predictor of disease severity, prolonged hospitalization, need for intensive care admission, and mortality, with renal patients having a 2-fold risk of death. Histopathological findings on autopsy of patients reveals vacuolar degeneration, diffuse proximal tubular injury with loss of brush border, frank necrosis, and prominent erythrocyte aggregation obstructing capillary lumen on light microscopy. Clusters of coronavirus particles with distinctive spikes in tubular epithelium and podocytes can be seen on electron microscopy.⁵ This shows the multiorgan involvement seen in this disease.

In this edition, we had two case reports on the Impact of impaired kidney function on outcomes of Nigerians with COVID-19 infection. These two cases experienced acute deterioration of an existing CKD, had associated worsening respiratory failure, gross metabolic derangement and eventually resulted in mortality. The severity experienced in patients with impaired kidney function is high, emphasizing the need for strict infection prevention and control, early detection and prompt management in this cohort of patients.

The impact of the corona virus disease on lifestyle and health practices continues unabated as many people still live in morbid fear of contracting the virus. This has resulted in diverse preventive practices ranging from the use of traditional herbal medications to indiscriminate use of antibiotics and antimalarials.⁶ It has been noticed that the safety guidelines provided by the Centre for disease control of many nations are being neglected with many people seeking antiviral medications and immune boosters. In this edition, a study on Determinants of Anti-microbial Use for COVID-19 related symptoms among Nigerians found high levels of antimicrobial use among the populace. This is particularly worrisome as it could lead to the emergence of antimicrobial resistance in not-too-distant future. Health agencies at both private and public levels must join hands to provide correct and up-to-date information to the populace regarding the deleterious effect of indiscriminate antimicrobial use and proper infection prevention guidelines to follow in COVID-19.

The distribution of COVID-19 vaccine is spreading further. Globally, over 335 million doses of the coronavirus vaccines have been administered, in more than 100 countries.⁷ Some countries have gotten their shipments and vaccinated a large proportion of their population but many more are still awaiting their first shipments. The effect of the vaccine is becoming obvious on the global page as countries who have vaccinated large populations have started experiencing a drop in incidence and death rates. Low-and-middle income countries have started taking delivery of the vaccine in batches and some have started vaccinating their citizens. However, a number of concerns have been raised over the side effects of some of the vaccines being given. Reports of blood clots following vaccination have resulted in eight countries suspending the Astra Zeneca vaccine over safety concerns. The World Health Organization (WHO) and the European Medicines Agency (EMA) have said that there is no link between the vaccine and reports of blood clots. However, many countries are treading with caution while some are delaying roll-out until these reports are fully clarified. While minimal side effects such as fatigue, headache, muscle aches, chills, joint pain, and possibly fever may be easier to handle, life threatening ones such as blood clots need to be properly investigated.

COVID-19 has opened up a vast area of research and colleagues are encouraged to do quality research in this area, as it affects their field. WAJM remains one of the leading journals providing international exposure to research studies by researchers and clinicians in Africa. We encourage you to keep sending your manuscripts for review and subsequent publication in this vastly informative journal. You are assured of critical, unbiased, prompt and in-depth review of manuscripts and subsequent publishing, if found suitable.

REFERENCES

NCD Risk Factor Collaboration (NCD-RisC). Long-term and recent trends in hypertension awareness, treatment, and control in 12 high-income countries: an analysis of 123 nationally representative surveys. Lancet 2019; 394: 639–51
Dzau V. J., Balatbat C.A. Future of Hypertension - The Need for Transformation. Hypertension. 2019; 74:450–457
NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants. Lancet. 2017; 389:37–55
Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, Chen J, He J. Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries.Circulation. 2016; 134:441–450.
Oghenekaro Godwin Egbi et al. Coronavirus infection and kidney disease: a review of current and emerging evidence. Pan African Medical Journal. 2020;37:149. doi: 10.11604/pamj.2020.37.149.23655
Ngwewondo A, Nkengazong L, Ambe LA, Ebogo JT, Mba FM, Goni HO, et al. Knowledge, attitudes, practices of/towardsCOVID19 preventive measures and symptoms: A cross-sectional study during the exponential rise of the outbreak in Cameroon. PLoSNegl Trop Dis 2020; 14(9):e0008700

Covid vaccines: How fast is progress around the world? https://www.bbc.com/news/world-56237778

EDITORIAL: A 3-Year Audit of Orthodontic Retention Protocol in a Nigerian Tertiary Health Institution

2024-11-25T13:31:23+00:00

Orthodontic treatment outcome can be judged as successful when there is a long term post-treatment stability. Despite the use all treatment philosophies and appliance techniques, stability may not be guaranteed until the teeth are maintained in their orthodontically corrected positions following cessation of active treatment.^1,2 Retention of treatment results obtained after several months orthodontic treatment is one of the greatest challenges the orthodontist has to face apart from achieving their treatment objectives of correction of malocclusion. Relapse of orthodontic treatment is likely to take place within the first eight months of completion of treatment which is the time it takes for the gingival and periodontal ligaments to remodel. Relapse can also occur due to soft tissue pressures whenever the teeth are positioned in an unstable location.² In order to avoid relapse, there are generally two types of retention protocol viz: Removable and fixed appliances which are usually customized for each patient.

Removable retainers can be removed by the patient and they include: Hawley’s bite plate and thermoplastic retainer (Essix and Sta-Vac) while fixed retainers are passive wires bonded to the lingual surfaces of a patient’s teeth. CAD/CAM technique is now being used to fabricate a custom-cut NiTi retainer wire from a plain sheet of metal.

Previous studies^3,4 have shown that the preferred choice of retainer was the removable, clear thermoplastic/vacuum-formed retainer. However, fixed retainers were mostly used in the Netherlands and Switzerland and vacuum-formed retainers were mostly used in the United Kingdom, Ireland and Malaysia. A combination of a fixed and removable retainers (vacuum-formed retainer) was the most used in Norway^.

Majority of orthodontists prescribe that removable retainers be worn full-time for 6 months but

the standard retention procedure is for 1-2 years. At present, longer periods of retention is being advocated, so much that some orthodontists now advocate a life-long retention. A study showed that maintenance of post-treatment orthodontic stability 1 and 10 years post-retention was only achieved in 60 and 38 per cent of cases respectively.¹

Retention protocols vary from clinician to clinician and from country to country. Studies^3,4 have shown a general increase in the use of fixed retainers, however there was no consensus on the use of a particular approach.

In this 3-year audit of retention practices in a Nigerian tertiary institution, removable retainers were mostly favoured, probably because of ease of fabrication and the cost. It is worthy of note that fixed retainers were sparingly used in the upper and lower arches. This may create a major challenge in maintaining de-rotated teeth, and this may subsequently result in late incisor crowding. One limitation of this study however, is the retrospective nature, which did not provide any information on the duration of retention and post-retention stability results.

References

Otuyemi OD, Jones SP. Long term evaluation of treated Class II division 1 malocclusions utilizing the PAR index. Br J Orthod. 1995;22: 171-175.
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CASE REPORT: Rosai-Dorfman Disease in Cervical Lymph Nodes: The Challenges of Diagnosis in a Resource Limited Setting and Use of Immunohistochemistry in the Diagnosis

2024-12-23T11:48:21+00:00

We report a case of Rosai-Dorfman disease in a 28-year-old Nigerian woman with a 7-year history of painless prominent bilateral neck swelling which waxed and waned over the years. She had two misdiagnosis hence appropriate therapy was not initiated over the years. She was eventually referred for independent opinion and was diagnosed correctly with review of the histology sections and with the use of CD45, S100, CD 68, CD 15, CD 20, synaptophysin and AE1/AE3 immunohistochemistry markers. Classic features on Haematoxylin and eosin stained sections and positivity of the lesional cells for S100 and CD68 were diagnostic of Rosai-Dorfman disease. She was subsequently placed on oral steroids with minimal objective reduction in the neck circumference from 57 to 46 cm. After two months, she was managed with three courses of chemotherapy (cyclophosphamide, doxorubicin hydrochloride, vincristine and prednisolone) which resulted to a significant sustained reduction in her neck circumference to 36 cm. She has been on follow up for about a year without a recurrence.