Sickle cell disease (SCD) is characterized by recurrent vaso-occlusive crisis (VOC). VOC is an important index of disease severity and has been shown to correlate with the risk of multi-organ damage and early death. Although the vulnerability to VOC among patients with SCD may be genetically predetermined on the basis of genotype and haplotype variability, nonetheless, VOC is usually triggered by a wide spectrum of etiologic risk factors, which range from physiological to nonphysiological factors on the one hand, and from psychological to physical factors on the other hand. An understanding of these risk factors and their pathophysiologic mechanisms is important for the hematologist to accurately identify potential etiologic risk factors for VOC. Thus taking preemptive action that will prevent undue exposure of patients to the risk factors and/or prepare the patient to uneventfully withstand the risk factors if exposure is unavoidable. This will ultimately obviate frequent VOC with its attendant risk of organ damage and early death in patients with SCD. Hence, in this study we conducted a broad and comprehensive review (using “sickle cell painful vaso-occlusive crisis” and relevant sub-terms in PubMed, Google Scholar, and other search engines) of various etiologic risk factors for VOC and the pathophysiologic mechanisms through which they trigger pain in patients with SCD.

Turning around to interact with the environment is a common activity of daily living. Coordination of body segments during turning is very important for the maintenance of upright posture. The aim of this review was to provide information about coordination of body segments during turning in health adults to serve as a yardstick for identifying turning problems in patients with neurological problems. Literature search was conducted through CINHAL, EMBASE, MEDLINE, and Google Scholar from inception to 2012 using the following search terms: coordination and turning, onset latency and turning, and peak velocity and turning. The present review has shown that turning to predictable targets results in a separate top to bottom sequence of onset of rotation of body segments, while turning to predictable targets results in a more simultaneous onset of rotation of the segments. On the contrary, the angle or direction a person turns to does not affect the sequence of rotation of body segments during turning. The peak velocity of the head was shown to be higher than that of the shoulder and pelvis when turning on-the-spot. The head was also shown to reach its peak velocity earlier than the shoulder and pelvis. However, the effect of the predictability of a target, turn angle, and turn direction on either the peak velocity or the time to reach the peak velocity has not been reported. The onset of rotation of body segments during turning while walking was shown to be in a top to bottom sequence. Alteration of the normal sequence of rotation of segments during turning could challenge the balance of an individual and may subsequently result into falls.

Background: The classification of generalized epilepsy is characterized by conflicting tendencies on what purpose a classification should serve. It has evolved over the years to reflect these conflicting needs. Objective: We aim to review the various classifications of generalized epilepsy to evaluate their respective rationale, strengths, and weaknesses. Materials and Methods: A literature search of electronic databases supplemented by a search of cross-references was conducted. The search results were subjected to a narrative review. Results: Epilepsy classification is based primarily on the type of seizure, as well as evidence from clinical, neurological, electrophysiological, and neuroimaging evaluations. The main challenge of epilepsy classification is to balance the pragmatic needs of the clinician with the varied needs of the researcher. Various classifications of generalized epilepsy have been proposed but the most important are those proposed by the International League Against Epilepsy. Conclusions: We are a long way from an ideal classification that is grounded in evidence, flexible enough to accommodate new findings, and versatile enough to classify individual patients.

Background: Early detection is an essential step in decreasing the mortality and morbidity related to prostate cancer. Serum prostate-specific antigen (PSA) testing is a proven effective tool for early detection of prostate cancer. It has high sensitivity but low specificity and remains an important screening tool. Objectives: This study aims at finding a local reference sensitivity and specificity level of serum PSA in Kano, Northwestern Nigeria. Materials and Methods: A cross-sectional descriptive study of 93 patients who had lower urinary tract symptoms and digital rectal examination (DRE) findings suggestive of cancer of the prostate and/or raised PSA who presented to urology outpatient clinic of Aminu Kano Teaching Hospital, Kano over the period of one year (January to December 2012). All patients had transrectal ultrasound-guided biopsy for histological evaluation. The sensitivity and specificity of PSA were then analysed. Results: A total of 93 patients participated in the study with age range from 50 to 96 years and mean age of 68.086 ± 9.368 years. The sensitivity of PSA was found to be 91.4% but dropped to 47.3 when the reference ranged were considered at 0–4.0 ng/ml and 0–10.0 ng/ml, respectively. Also, the specificity was found to be 22.4% but raised to 77.0% at the other reference range. The diagnostic accuracies for 0–4 and 4.1–10 ng/ml were 48.0% and 59.1%, respectively. Conclusions: PSA testing still has a role to play in the diagnostic pathway and is relatively non-invasive, inexpensive with a high sensitivity. However, it has a low specificity. The reference range in our environment remains the international range of 0–4 ng/ml.

Introduction: Sickle cell anemia (SCA) is a chronic disease presenting with acute and painful exacerbations with multi-organ affectation. An alteration in the components of hemostasis such as the fibrinolytic system is observed among patients with SCA. Routine care of patients with SCA rarely involves the investigation of this component, and little attention is paid to the role of this system in the evaluation of patients with vaso-occlusive crisis. Objectives: To determine the D-dimer levels and some hematological parameters of adult patients with sickle cell anemia in steady state attending the hematology clinic of Ahmadu Bello University Teaching Hospital (ABUTH) Zaria, Nigeria. Materials and Methods: We conducted a case-control study involving 50 patients with SCA (HbSS) in steady state and 25 healthy volunteers with normal hemoglobin (HbAA) as controls. Steady state refers to absence of acute painful crisis or any changes due to therapy for at least four consecutive weeks after a previous painful crisis. Hemoglobin concentration (Hb), white blood cell count (WBC), and platelet count were determined by hematology analyzer. D-dimer levels were determined by ELISA method using Microplate Reader (Rayto RT-2100C), calibrated to a wavelength of 450 nm. Results were summarized as frequencies, proportions, and median with interquartile range (IQR) where appropriate and the level of significance was set at ≤0.05. Results: The mean age of the patients was 23.80 ± 7.46 years while that of the controls was 24.28 ± 4.8 years (P = 0.76), respectively. The mean hematological parameters of both groups were Hb (8.57 ± 1.33 vs 13. ± 1.29 g/dL, P value <0.0001), WBC (10.63 ± 3.19 vs 5. 76 ± 1.21 × 10⁹/L, P value <0.0001), platelet count (494.38 ± 213.88 vs 220.83 ± 75.26 × 10⁹/L, P value <0.0001), respectively. The median and IQR of D-dimer levels of the patients and the controls was 1730.25 ng/mL (12359.2–36.2 ng/mL) and 324.00 ng/mL (1034.0–127.8 ng/mL), respectively. Conclusion: Marked increase in D-dimer levels in patients with sickle cell anemia in this study suggested that multiple sites were involved in thrombi formation and this requires extensive fibrinolytic activity to dissolve these thrombi.

Background: This is an analysis of axillary masses to determine the spectrum of diseases that are commonly encountered in the axilla. Materials and Methods: Ten years' consecutive analysis axillary biopsies sent to the pathology laboratory of a tertiary hospital were formalin fixed, paraffin embedded, and stained with hematoxylin and eosin (H and E). Stains such as Ziehl–Neelsen, vermentin and CD5, CD20, and CD23 were also employed in further differentiation of diseases. Results: Fifty-nine axillary lesions were analyzed from 21 males and 38 females. The ages ranged from 2 months to 80 years and peaked in the third decade of life. There were eight developmental (congenital) lesions (13.6%), seven infectious (12.0%), 12 reactive (20.3%), and 31 neoplastic lesions (52.5%). All the congenital lesions were aberrant breast tissues. There were 19 non-neoplastic lymph nodes and 12 of them (63.2%) were reactive hyperplasia remaining (35%) being granulomatous inflammations of which four were tuberculous. A case of hematoma in a 2-month-old male child was seen. The neoplastic diseases were dominated by lipoma; five cases (16.1%), non-Hodgkin's lymphoma; 11 cases (35.5%), and metastatic carcinoma; 5 cases (16.1%). Conclusion: The most common tissue of affectation in the axilla was the lymph node. Malignant neoplastic diseases were the commonest pathology with female predisposition; the peak age of presentation was the third decade of life was the third decade. Histologic evaluation of axillary masses will aid in the prompt and appropriate treatment of diseases to reduce attendant morbidity and mortality.

Introduction: Salivary gland lesions present with varied clinical features because of the complex architecture of the glands. A good understanding of the distribution, natural history, epidemiology, and etiopathogenesis is essential for diagnosis and management. Materials and Methods: A retrospective cross-sectional study of all salivary gland lesions seen between January 2007 and December 2016 at the Biopsy Service of Lagos University Teaching Hospital was conducted. Results: There were 224 salivary gland lesions over the 10-year study period; 115 (51.3%) females and 109 (48.7%) males (M/F 1:1.05). The age range was 2 months to 86 years with a mean age of 37.07 years. Salivary gland lesions were more common in the third and fourth decades (18.8% and 18.3%, respectively). There were 55 (24.6%) cystic lesions, 55 (24.6%) benign neoplasms, 84 (37.5%), malignant neoplasms, and 29 (12.9%) inflammatory salivary gland lesions. The ratio of malignant tumors to benign tumors was 1.5:1. Conclusion: Salivary gland lesions are more prevalent in the third and fourth decades of life; malignant tumors were more prevalent than benign tumors. Malignant tumors and inflammatory lesions were more common in males whereas benign and cystic lesions were more common in females.

Background: Stroke has been a global burden, with increasing morbidity and mortality. Several risk factors have been identified, which are the target of preventive strategies, they include hyperhomocysteinemia, hypovitaminosis B_12, and low zinc levels. There is paucity of data on the biochemical risk factors in our environment which necessitated this study. Objective: To evaluate the serum levels of homocysteine, vitamin B₁₂, and zinc in patients with acute ischemic stroke in Zaria. Patients and Methods: This is a case-control study conducted over 13 months in ABUTH Zaria. One hundred patients with clinical diagnosis of ischemic stroke diagnosed, confirmed by brain CT-scan and Siriraj stroke score of less than -1, and equal number of apparently healthy age, and sex-matched were recruited. Their fasting serum homocysteine and vitamin B₁₂ were measured using enzyme-linked immunosorbent assay, while zinc was measured using direct colorimetric method. Stroke severity was determined using National Institute of Health Stroke Score (NIHSS), patients with NIHSS score of 1–4, 5–15, and 16–42 were classified as mild, moderate, and severe stroke respectively. Results: Mean serum homocysteine for patients was significantly higher than that of controls (P < 0.05) and mean serum zinc and vitamin B₁₂significantly lower compared to that of controls (P < 0.05). There was no association between hyperhomocysteinemia, low vitaminB₁₂, and low zinc concentrations with the severity of stroke using NHISS Score. Conclusion: Elevated serum homocysteine, low vitamin B₁₂, and zinc were found to be significant risk factors associated with ischemic stroke.

Background: Stroke often comes with a spectrum of constraints to lifestyle. This study investigated these constraints using a 24-hour lifestyle assessment among 6 stroke survivors. Objectives: The objective of this study was to provide an understanding of the ways in which stroke survivors are experiencing stroke, along with the opportunities and challenges of everyday life. Materials and Methods: Six stroke survivors were recruited to participate in this qualitative study. The study participants were 3 males and 3 females. Participants were engaged in in-depth interviews to generate information regarding the objective of this study. The interview was recorded on audiotape and transcribed. The generated data were analysed by thematic framework analysis. Results: Findings showed that 5 out of the 6 stroke survivors faced challenges in everyday life, in reconstructing their identity and depended on their family members to take care of them. All the stroke survivors reported some form of functional restrictions, with 4 out of the 6 responents indicating that their movement was restricted to their immediate compound and 5 out of the 6 respondents indicating that they were unable to do most of their house-hold chores; and one respondent said that he 'barely could do anything for self'. Conclusion and Recommendations: Among the 6 respondents, stroke has several manifestations on patients' mobility and indepdence. These have significant bearing on their wellbeing. Studies with larger sample sizes incorporating quantitative methods and longitudinal follow-up are recommended to shed more light on these findings.

Background: Malnutrition and malaria are common in sub-Saharan Africa, and understanding the relationship between protein-energy malnutrition (PEM) and malaria is of great public health importance. Findings from studies evaluating associations between various forms of malnutrition and malaria have been contradictory. This study aimed to determine the prevalence of malaria parasitemia among malnourished children and its various determinants studied. Materials and Methods: This was a cross-sectional study. Ninety febrile children with severe PEM aged 6–59 months (44 males and 46 females) based on modified Wellcome classification were enrolled as subjects and; 90 febrile well-nourished children age and sex matched children as controls. Both subjects and controls were enrolled consecutively in the emergency pediatrics unit of Aminu Kano Teaching Hospital from May to October 2013. The diagnosis of malaria parasitemia was based on the identification of asexual parasites on microscopy after Giemsa staining. Results: The prevalence of malaria parasitemia was 72.2% in the subjects, this was significantly higher than 37.8% in the controls (OR = 4.28, CI = 2.29–8.02). Parasite density was 2122 μL (400–1821). Age, sex, and type of PEM had no significant effect on the prevalence of malaria parasitemia and parasite density (P > 0.05). Plasmodium falciparum (P. falciparum) was seen in all the positive slides. Conclusion and Recommendation: Malnourished children experience more malaria than well-nourished children. Based on the findings of this study malnourished children should have access to the use of insecticide treated nets (ITN) and commence on malaria chemoprophylaxis.

Background: Over 200,000 babies die yearly in Nigeria, of which about 26% is due to birth asphyxia. Effective neonatal resuscitation (NR) using basic equipment is capable of preventing up to 30% of deaths associated with perinatal asphyxia. However, NR is only effective where caregivers have sufficient knowledge and required skills. The frequent industrial actions by health workers in the public sector have brought to the fore the importance of private health facilities in healthcare delivery. Thus, there is a need to assess training of health workers and availability of basic equipment in private health institutions in Kano. Aim: To assess availability of trained providers on NR and resuscitation equipment in private health facilities in Kano. Materials and Methods: This is a cross sectional survey of 85 conveniently sampled private institutions that provide obstetric care as part of their services in Kano metropolis. A semi-structured self-administered questionnaire was used to collect data from each facility. Results: Seventy eight filled questionnaires were retrieved and analyzed. There were 25 specialist clinics, 44 general practice facilities, and nine maternity homes/primary healthcare (PHC). Only 29 (37.2%) of the facilities have caregivers trained on NR in attendance during normal deliveries. Thirty four (43.5%) facilities have written protocol on NR. Only two (22.2%) of the maternity homes/PHC have functional ambu bags; the corresponding figures for specialist and general practice clinics are 16 (64%) and 24 (54.5%) respectively. Conclusion: There is insufficient number of trained personnel on newborn resuscitation, and low availability of newborn resuscitation equipment in private health institutions in Kano metropolis.

Background: Peptides of the renin angiotensin aldosterone system (RAAS) have been implicated in the pathogenesis of malaria infection; however, available data are limited. Thus, this study was aimed at determining the association between hypertension and activity of angiotensin converting enzyme (ACE) in malaria patients attending Sheikh Muhammad Jiddah General Hospital, Kano State, Nigeria. Materials and Methods: Four hundred and fifty consenting adults (300 malaria positive and 150 control participants) were evaluated. Data on sociodemographic characteristics were obtained using a questionnaire. ACE level was determined as described by Cushman and Cheung (1971) and blood pressure (BP) was evaluated using standard methods. Statistical Analysis: ACE activity and BP were expressed as mean ± SEM. Comparison between groups was carried out using one-way analysis of variance. Pearson's Chi-square (χ²) test was employed to establish association between Plasmodium infection, hypertension, sex, age, educational, and occupational status. P <0.05 was regarded as statistically significant. Results: A total of 300 (66.6%) patients tested positive for malaria, of which 60 (20%) were hypertensive. The prevalence differed significantly by gender, age group, and occupational status. The serum ACE activity was significantly lower in male (1.54 ± 1.04 μmol/min/ml) and female (2.01 ± 1.29 μmol/min/ml) patients with malaria compared to controls (7.09 ± 2.42 and 7.48 ± 2.42 μmol/min/ml, for males and females, respectively); and this further decreased with severity of infection. Moreover, the ACE activity of malaria patients with hypertension (11.67 ± 0.5 and 10.60 ± 0.40 μmol/min/ml) was significantly higher than nonhypertensive (3.20 ± 1.31 and 3.16 ± 0.74 μmol/min/ml) male and female patients, respectively. Conclusions: There was a significant association between the activity of ACE and hypertension in malaria infection, showing that ACE might play a significant role in the outcome of malaria.

Background: Rheumatic heart disease (RHD) remains a major public health problem in developing countries. Anecdotal reports across Africa show that the disease is coming less prevalent in the cities and the patients are surviving longer, although with a lot of morbidity. Between 2002 and 2006, 9.8% of 1312 patients were found to have RHD from our echocardiographic registry, with a mean age of 24 years. Therefore, we set out to review our current data for RHD to see if there are any changes in patterns of presentation in our center. Materials and Methods: This is a retrospective analysis of a prospectively collected echocardiography data between August 2010 and July 2012. The study was conducted at the Aminu Kano Teaching Hospital, Kano Nigeria. The procedure was performed with Aloka SSD 4000. The standard techniques for depicting the anatomical structures of the heart were employed. All echocardiographic procedures were performed by a cardiologist. Information obtained from the records included the age, gender, clinical diagnoses, and echocardiographic diagnoses. Prevalence and patterns were compared with previous findings. Results: During this period, a total of 1496 echocardiographic examinations were done. One hundred and four (7.0%) had RHD. There were 69 females (66.3%) and 35 males (33.7%) aged 30.7 + 14.0 years (range 12–70 years). Forty (38.5%) were aged 15–24 years. The commonest lesions were mixed mitral valve disease and aortic regurgitation (26.9%) followed by combination of mitral and aortic regurgitation (25%), and pure mitral regurgitation in 17.3%. Complications of RHD observed included secondary pulmonary hypertension (50%), left ventricular dysfunction (40.4%), atrial fibrillation (AF) (8.7%), infective endocarditis (1.9%), and intra cardiac thrombus (1.9%). Conclusion: RHD is still an important cause of cardiac morbidity. Although there is a reduction in prevalence compared to previous finding in the same center, while the patients are a bit older, they had more severe disease and still had complications at diagnosis.

Background: Estimated costs of seizure disorder care are overall high due to its high frequency in the general population, especially in developing countries. Considerable variability exists between seizure disorder patients, which poses significant socioeconomic burden to the society. Materials and Methods: A cross-sectional descriptive study with a “bottom-up” design from the societal perspective where information on the costs associated with seizures disorder was evaluated. The direct (medical and non-medical) and indirect (using the “human capital” approach) costs per month for adult outpatients with seizure disorder was estimated. All data were analyzed using IBM SPSS statistics software, version 20.0. Results: The mean healthcare cost per patient per month was ₦11,096.03 ($58.33). The direct and indirect cost of care per patient per month was ₦9,004.73 ($45.71) and ₦2091.30 ($10.62) respectively. The principal direct cost drivers were drugs and other medications amounting to ₦4041.68 ($20.52) per patient and a total of ₦371,835.00 ($1887.49) per month for all the patients in the study. The estimated healthcare cost per patient when annualized was found to be ₦133,152.39 ($675.90), while the total annual healthcare cost for all the patients in the study per year was ₦12,250,020.00 ($62,182.84). Conclusions: On the background of poor remunerations, high unemployment, and out-of-pocket payments the high costs of care among adults may lead to catastrophic societal expenditures for seizure disorder care, which significantly contribute to poor adherence and secondary treatment gap.

Background: Faking and counterfeiting occurs throughout the world with claims that it is more common in some developing countries with weak regulatory programs. It is estimated that more than 10% of drugs worldwide are counterfeit, with up to 50% in some countries. Heightening vigilance and awareness of counterfeiting is one measure for combating faking. Rationale: The aim of this study was to document perceptions of various healthcare providers regarding the problem of drugs faking/counterfeiting including perceived levels, affected drugs, implications, and measures to control; thus, this study aims to provide empirical data on the perception of healthcare providers regarding counterfeit drugs and their effect on public health/safety. Materials and Methods: Ethical approval was obtained and pretested questionnaires were administered to consenting healthcare providers in six local government areas in Lagos. The collected data was sorted and entered into Microsoft Excel, following which analysis was carried out. Results are presented as tables and charts. Results: Respondents believed that the problem of fake/counterfeit drugs is common with a modal faking range of 41–50% of drugs in the country. Anti-infectives, anti-malarials, and analgesics were reported to be the most implicated drugs. Many believed that faking/counterfeiting of drugs can be surmounted by the promulgation and enforcement of appropriate legislation and closure of open drug markets. Conclusions: It can be concluded that respondents are aware of the challenges posed by counterfeit drugs and if empowered can serve as a tool in its eradication. It is recommended that appropriate modalities to review the existing laws and close open drug markets be put in place.