A 10-year review of colonoscopy at aminu kano teaching hospital, Kano Nigeria.

BACKGROUND: Colonoscopy is an investigation modality used for colorectal examination; it is the most accurate technique for the diagnosis and surveillance of important colorectal diseases such as cancers (colorectal cancer) and polyps. Aims: Most studies on colonoscopy in Nigeria were conducted in southwest such as Ilorin, Ife, Ibadan, and Lagos. We therefore feel the need to get information from other regions such as northwest, the area of this study. The aim of this study was to identify the common indications as well as colonoscopic findings among patients who had colonoscopy in Aminu Kano Teaching Hospital, Kano. METHODOLOGY: It was a 10-year retrospective descriptive study of patients who had colonoscopy between January 2008 and December 2017 at the study center. Colonoscopy register was used to extract information concerning the patient's age, gender, symptoms that necessitated the request for the procedure, and the endoscopic findings. RESULTS: A total of 839 patient records were reviewed, males constituted 62.2% of the patients. The mean age ± standard deviation was 43.86 ± 18.36 years, with a range of 8-96 years. The 30-39 years constituted the modal age group, followed by 40-49 years and 50-59 years. The commonest indications for the procedure were rectal bleeding (52.4%), chronic abdominal pain (51.3%), and diarrhea (48.8%). The cecal intubation rate was 98.2% with hemorrhoids as the commonest finding (42.3%) followed by suspected inflammatory bowel disease lesions (18.1%) and suspected colorectal tumors (16.2%). CONCLUSION: The commonest reason for colonoscopy was rectal bleeding while the commonest colonoscopic finding was hemorrhoids.

Historical epidemiology of hepatitis C virus in select countries-volume 4.

Due to the introduction of newer, more efficacious treatment options, there is a pressing need for policy makers and public health officials to develop or adapt national hepatitis C virus (HCV) control strategies to the changing epidemiological landscape. To do so, detailed, country-specific data are needed to characterize the burden of chronic HCV infection. In this study of 17 countries, a literature review of published and unpublished data on HCV prevalence, viraemia, genotype, age and gender distribution, liver transplants and diagnosis and treatment rates was conducted, and inputs were validated by expert consensus in each country. Viraemic prevalence in this study ranged from 0.2% in Hong Kong to 2.4% in Taiwan, while the largest viraemic populations were in Nigeria (2 597 000 cases) and Taiwan (569 000 cases). Diagnosis, treatment and liver transplant rates varied widely across the countries included in this analysis, as did the availability of reliable data. Addressing data gaps will be critical for the development of future strategies to manage and minimize the disease burden of hepatitis C.

Strategies to manage hepatitis C virus infection disease burden-Volume 4.

The hepatitis C virus (HCV) epidemic was forecasted through 2030 for 17 countries in Africa, Asia, Europe, Latin America and the Middle East, and interventions for achieving the Global Health Sector Strategy on viral hepatitis targets-"WHO Targets" (65% reduction in HCV-related deaths, 90% reduction in new infections and 90% of infections diagnosed by 2030) were considered. Scaling up treatment and diagnosis rates over time would be required to achieve these targets in all but one country, even with the introduction of high SVR therapies. The scenarios developed to achieve the WHO Targets in all countries studied assumed the implementation of national policies to prevent new infections and to diagnose current infections through screening.

The present and future disease burden of hepatitis C virus infections with today's treatment paradigm: Volume 4.

Factors influencing the morbidity and mortality associated with viremic hepatitis C virus (HCV) infection change over time and place, making it difficult to compare reported estimates. Models were developed for 17 countries (Bahrain, Bulgaria, Cameroon, Colombia, Croatia, Dominican Republic, Ethiopia, Ghana, Hong Kong, Jordan, Kazakhstan, Malaysia, Morocco, Nigeria, Qatar and Taiwan) to quantify and characterize the viremic population as well as forecast the changes in the infected population and the corresponding disease burden from 2015 to 2030. Model inputs were agreed upon through expert consensus, and a standardized methodology was followed to allow for comparison across countries. The viremic prevalence is expected to remain constant or decline in all but four countries (Ethiopia, Ghana, Jordan and Oman); however, HCV-related morbidity and mortality will increase in all countries except Qatar and Taiwan. In Qatar, the high-treatment rate will contribute to a reduction in total cases and HCV-related morbidity by 2030. In the remaining countries, however, the current treatment paradigm will be insufficient to achieve large reductions in HCV-related morbidity and mortality.

Prevalence of hepatitis B virus infection in Nigeria, 2000-2013: a systematic review and meta-analysis.

Vaccination against the hepatitis B virus (HBV) in the West African nation of Nigeria is lower than many Sub-Saharan African countries. In Nigeria, HBV is reported to be the most common cause of liver disease. However, the extent of HBV exposure among Nigerians at average risk is unknown. Our aim, therefore, was to accurately estimate the HBV prevalence for the country and the prevalence for specific subgroups. We used electronic databases to select systematic reviews and meta-analyses from 2000 to 2013. Forty-six studies were included (n = 34,376 persons). We used a random effects meta-analysis of cross-sectional and longitudinal studies to generate our estimates. The pooled prevalence of HBV in Nigeria was 13.6% (95% confidence interval [CI]: 11.5, 15.7%). The pooled prevalence (% [95% CI]) among subgroups was: 14.0% (11.7, 16.3) for blood donors; 14.1% (9.6, 18.6) for pregnant women attending antenatal clinics; 11.5% (6.0, 17.0) for children; 14.0% (11.6, 16.5) among adults; and 16.0% (11.1, 20.9) for studies evaluating adults and children. HBV prevalence in Nigeria varied by screening method [% (95% CI)]: 12.3% (10.1, 14.4) by using enzyme-linked immunosorbent assay; 17.5% (12.4, 22.7) by immunochromatography; and 13.6% (11.5, 15.7) by HBV DNA polymerase chain reaction. HBV infection is hyperendemic in Nigeria and may be the highest in Sub-Sahara Africa. Our results suggest that large numbers of pregnant women and children were exposed to HBV from 2000 to 2013. Increased efforts to prevent new HBV infections are urgently needed in Nigeria.

Prevalence of Hepatitis B Virus Infection in Nigeria; 2000-2013: A Systematic Review and Meta-Analysis

Vaccination against the hepatitis B virus (HBV) in the West African nation of Nigeria is lower than many Sub-Saharan African countries. In Nigeria; HBV is reported to be the most common cause of liver disease. However; the extent of HBV exposure among Nigerians at average risk is unknown. Our aim; therefore; was to accurately estimate the HBV prevalence for the country and the prevalence for specific subgroups. We used electronic databases to select systematic reviews and meta-analyses from 2000 to 2013. Forty-six studies were included (n = 34;376 persons). We used a random effects meta-analysis of cross-sectional and longitudinal studies to generate our estimates. The pooled prevalence of HBV in Nigeria was 13.6 (95 confidence interval [CI]: 11.5; 15.7). The pooled prevalence ( [95 CI]) among subgroups was: 14.0 (11.7; 16.3) for blood donors; 14.1 (9.6; 18.6) for pregnant women attending antenatal clinics; 11.5 (6.0; 17.0) for children; 14.0 (11.6; 16.5) among adults; and 16.0 (11.1; 20.9) for studies evaluating adults and children. HBV prevalence in Nigeria varied by screening method [ (95 CI)]: 12.3 (10.1; 14.4) by using enzyme-linked immunosorbent assay; 17.5 (12.4; 22.7) by immunochromatography; and 13.6 (11.5; 15.7) by HBV DNA polymerase chain reaction. HBV infection is hyperendemic in Nigeria and may be the highest in Sub-Sahara Africa. Our results suggest that large numbers of pregnant women and children were exposed to HBV from 2000 to 2013. Increased efforts to prevent new HBV infections are urgently needed in Nigeria

Relationship between ABO blood group and ABH secretor status in Kano, north-western Nigeria.

BACKGROUND: The determination of ABO Blood groups and ABH secretor status in blood and body fluid antigens respectively may have certain structural and disease related genetic linkages, hence the need to establish relationship between blood group and secretor status in the population. METHOD: A total of 256 subjects comprised of blood donors and healthy pregnant women at Aminu Kano Teaching Hospital, Kano were studied. Their ABO Blood groups and secretor status were determined by standard tile/tube and haemaglutination inhibition methods respectively. RESULTS: The result of this study shows that blood group B had the highest percentage ofsecretors (85.33%) followed by blood group AB (83.33%). Blood group O had a value of 64.18% while blood group A had the lowest prevalence of secretors of 61.9% in Kano metropolis. CONCLUSION: Blood groups A and O have lower prevalence of secretors compared to blood group B and AB, in Kano metropolis. There is need for further study to identify risk predisposition of these groups to cancer of the stomach and duodenal ulcer disease respectively; as reported in other parts of the world.

Relationship between duration of diagnosis and neuromusculoskeletal complications of middle-aged type 2 diabetes patients.

BACKGROUND: Patients with Type 2 Diabetes (T2D) often present with complications involving the neuromusculoskeletal system which creep in as the condition advances in years. Hence there is a need to further understand how the duration of diagnosis of diabetes (DD) relates to the neuromusculoskeletal complications in order to design timely preventive programmes. OBJECTIVE: To investigate the relationship between the duration of diabetes and neuromusculoskeletal complications in type 2 diabetes. METHODS: This was a cross-sectional survey involving 139 consenting T2D patients and 139 age and sex-matched nondiabetic individuals. The participants were assessed for the DD and selected neuromusculoskeletal complications including muscle weakness, ranges of motion (ROM), pain and foot ulceration. RESULTS: The mean DD was 7.82 ± 2.41 years. There were significant differences (p < 0.01) between the clinical variables of both groups. In the diabetic participants, significant inverse relationships (P<0.05) were obtained between the DDD and each of muscle strength {{lbow flexors (r =-0.57), knee extensors (r=-0.63), handgrip (r=-0.82)}; ROM {wrist extension (r=-0.64) and ankle planterflexion (r=-0.63)}. Significant and direct relationships were obtained between the DDD and each of pain (r=0.62) and ulcerative grading (r= 0.81). CONCLUSIONS: Type 2 Diabetes patients have poorer neuromusculoskeletal variables and longer duration of diabetes is associated with reduced muscle strength, diminished ROM, gradual ulceration of skin of the feet and higher level of foot pain. Immediate therapeutic exercises against these complications soon after diagnosis of diabetes may help to decelerate their progression.

Neuromusculoskeletal disorders in patients with type 2 diabetes mellitus: outcome of a twelve-week therapeutic exercise programme.

BACKGROUND AND OBJECTIVES: Usual line of management of diabetes patients is drug and diet with their physical needs usually receiving minimal attention. Among the physical needs, requiring attention is their neuromusculoskeletal disorders. This study was designed to investigate the effect of a twelve-week therapeutic exercise on neuromusculoskeletal disorders of Type 2 Diabetes (T2D) patients. METHODS: Forty-three participants from the Diabetes Specialty Clinic of Aminu Kano Teaching Hospital, Kano completed the study. Selected neuromusculoskeletal disorders including pain, dermatological foot grades, disorders of ranges of motion and strength of selected joints and muscles were assessed before and after a period of twelve weeks of therapeutic exercises. Participants were followed up for another twelve weeks without therapeutic exercises. RESULTS: Baseline assessment revealed poor neuromusculoskeletal status. Significant improvements (P < 0.05) were obtained for pain, Severity of Dermatological Foot Grading, Muscle strength (One Repetition Maximum) and Range of Motions at the end of the exercises except that of right wrist extension (P > 0.05). CONCLUSIONS: T2D patients presented with neuromusculoskeletal disorders at baseline. Therapeutic exercises however assisted in the improvement of these disorders but relapsed when exercises were suspended. Engagement in therapeutic exercises enhanced neuromusculoskeletal health, while withdrawal from the exercise contributed to a decline. T2D patients should be encouraged to participate in therapeutic exercises in order to promote their health and function.

Lipid Profile in Sickle Cell Disease Patients with Chronic Kidney Disease

Background: Dyslipidaemia is reported to occur in patients with sickle cell disease as well as patients with chronic kidney disease irrespective of the haemoglobin genotype. This study aimed at evaluating lipid profile in subjects with sickle cell anaemia (HbSS); sickle cell trait (HbAS) and normal haemoglobin genotype (HbAA); and comparing the lipid parameters between sickle cell disease patients with and those without chronic kidney disease. Methods: A total of 66 patients with chronic kidney disease: 26 HbAA; 24 HbAS and 16 HbSS and 60 apparently healthy controls were recruited for the study. Lipoproteins; urea; creatinine; estimated glomerular filtration rate and electrolytes were determined using standard procedures in both patients and controls. Results: The mean total cholesterol; low density lipoproten cholesterol and high density lipoproten cholesterol in stable HbSS subjects were significantly lower (p

Relationship between duration of diagnosis and neuromusculoskeletal complications of middle-aged type 2 diabetes patients

Abstract. BACKGROUND: Patients with Type 2 Diabetes (T2D) often present with complications involving the neuromusculoskeletal system which creep in as the condition advances in years. Hence there is a need to further understand how the duration of diagnosis of diabetes (DD) relates to the neuromusculoskeletal complications in order to design timely preventive programmes. OBJECTIVE: To investigate the relationship between the duration of diabetes and neuromusculoskeletal complications in type 2 diabetes. METHODS: This was a cross-sectional survey involving 139 consenting T2D patients and 139 age and sex-matched nondiabetic individuals. The participants were assessed for the DD and selected neuromusculoskeletal complications including muscle weakness, ranges of motion (ROM), pain and foot ulceration. RESULTS: The mean DD was 7.82 ± 2.41 years. There were significant differences (p < 0.01) between the clinical variables of both groups. In the diabetic participants, significant inverse relationships (P<0.05) were obtained between the DDD and each of muscle strength {elbow flexors (r = -0.57), knee extensors (r = -0.63), handgrip (r = ­0.82)}; ROM {wrist extension (r = -0.64) and ankle planterflexion (r = -0.63)}. Significant and direct relationships were obtained between the DDD and each of pain (r = 0.62) and ulcerative grading (r = 0.81). CONCLUSIONS: Type 2 Diabetes patients have poorer neuromusculoskeletal variables and longer duration of diabetes is associated with reduced muscle strength, diminished ROM, gradual ulceration of skin of the feet and higher level of foot pain. Immediate therapeutic exercises against these complications soon after diagnosis of diabetes may help to decelerate their progression

Neuromusculoskeletal disorders in patients with Type 2 Diabetes Mellitus: outcome of a twelve-week therapeutic exercise programme

ABSTRACT. Background and Objectives:Usual line of management of diabetes patients is drug and diet with their physical needs usually receiving minimal attention. Among the physical needs, requiring attention is their neuromusculoskeletal disorders. This study was designed to investigate the effect of a twelve-week therapeutic exercise on neuromusculoskeletal disorders of Type 2 Diabetes (T2D) patients. Methods: Forty-three participants from the Diabetes Specialty Clinic ofAminu KanoTeaching Hospital, Kano completed the study. Selected neuromusculoskeletal disorders including pain, dermatological foot grades, disorders of ranges of motion and strength of selected joints and muscles were assessed before and after a period of twelve weeks of therapeutic exercises. Participants were followed up for another twelve weeks without therapeutic exercises. Results: Baseline assessment revealed poor neuromusculoskeletal status. Significant improvements (P<0.05) were obtained for pain, Severity of Dermatological Foot Grading, Muscle strength (One Repetition Maximum)and Range of Motions at the end of the exercises except that of right wrist extension (P>0.05). Conclusions: T2D patients presented with neuromusculoskeletal disorders at baseline. Therapeutic exercises however assisted in the improvement of these disorders but relapsed when exercises were suspended. Engagement in therapeutic exercises enhanced neuromusculoskeletal health, while withdrawal from the exercise contributed to a decline. T2D patients should be encouraged to participate in therapeutic exercises in order to promote their health and function

Sociodemographic determinants of attrition in hospital based therapeutic exercise programme for type 2 diabetes patients.

BACKGROUND: Abandoning research programmes by participants may impose disadvantages on the participant, the research and the researcher. This study investigated the contributions of sociodemographic characteristics to the attrition of Type 2 Diabetes (T2D) patients who enrolled into a 12-week therapeutic exercise programme. METHODS: In the 12-week, thrice weekly hospital-based therapeutic exercise programme, the contributions of age, gender, duration of diagnosis, marital status, cohabitation, urbanization, educational and employment status to two sources of attrition (inability to locate and decline to commence or complete) were studied. RESULTS: Participants were aged 48 +/- 9.62 years. Out of the 152 participants who agreed to participate, only 93 (61.18%) actually commenced the exercise programme, while 69 (74.19%) of those who commenced the programme completed it. Risk of attrition due to inability to locate participants was higher in females (OR = 3.25, 95% CI = 2.96-3.91), single or divorced and living in the rural area (OR = 1.37, 95% CI = 1.12-1.52). Risk of decline to commence or complete was higher with increasing age, living alone, longer duration of diagnosis and being in paid employment while this was less likely in individuals who were married and more educated. CONCLUSION: We recorded 25.81% attrition for those who actually commenced the programme. Sociodemographic characteristics contributed to attrition in the 12-week, thrice weekly hospital-based exercise programme and we suggest closer monitoring (based on these sociodemographic characteristics) of T2D patients scheduled for therapeutic exercises in order to minimize attrition, maximise attendance and ensure higher retention.

Anaemia and its response to treatment with recombinant human erythropoietin in chronic kidney disease patients.

BACKGROUND: The introduction of erythropoietin has transformed the management of anaemia in CKD, with considerable benefits which includes enhanced quality of life, increased exercise capacity and improved cardiac function. There is paucity of data on the beneficial effects of this treatment from this environment. OBJECTIVE: The aim of this work was to study the pattern and response of anaemia and its response to treatment with recombinant human erythropoietin(r-HuEpo) in CKD patients in Nigeria. METHODS: This was a prospective study in which 20 CKD patients who satisfied the inclusion criteria were recruited consecutively. Subcutaneous r-HuEpo was administered to each of the study patients, starting with a weekly dose of 50 iu per kg and titrated according to haemoglobin (Hb) response, which was monitored fortnightly throughout the study period with the aim of achieving a target Hb of 11g per dl. RESULTS: The patients studied were anaemic with mean Hb of 7.36(1.05) g/dl. The anemia was normocytic normochromic in 85% of the patients. All the patients responded to treatment with r-HuEpo with the mean Hb rising from 6.74(0.70)g per dl to 11.64(0.37) g/dl and 7.64(1.19) to 11.98(0.45) g/dl in those on maintenance haemodialysis and pre-dialysis patients respectively. The patients reached the target Hb of 11g/dl within 8 weeks in predialytic CKD patients and within 10 weeks in those on maintenance haemodialysis. CONCLUSION: Anaemia is mostly normocytic normochromic in CKD patients in our environment and r-HuEpo therapy is effective in correcting the anaemia.

Blood pressure control among treated hypertensives in a tertiary health institution.

BACKGROUND: Goal blood pressure (BP) was defined by the JNC VI and the World Health Organization-International Society of Hypertension (WHO/ISH) as <140 mm Hg systolic and <90 mm Hg diastolic for the general and <130 mm Hg systolic and <85 mm Hg diastolic for special high-risk populations. It is well established that adequate BP control characterizes only a fraction of treated hypertensive patients. The importance of tight BP control has been established in preventing cardiovascular morbidity and mortality METHODS: We performed cross-sectional studies on the current status of BP control among treated hypertensive in our center. One hundred consecutive patients with essential hypertension who have been attending the out patient hypertension clinic and have been on treatment for at least 6 months were recruited. The pre treatment BP and BP records in the previous 2 visits were noted. Patients were said to have good BP control if their BPs are < 140/90 mmHg (<130/80 mmHg for high risk patients) at the time of the study and in the last visit. RESULTS: There were 49 males and 51 female (M: F; 1:1), aged 26 to 85 (mean 52.33 +/- 12.29) years. The duration of hypertension ranged 6 months to 30 (mean 7.37 +/- 7.1) years. The duration of treatment in our centre was 6 months to 10 (mean 3.22 +/- 2.23) years. Blood pressure was controlled in 33 (33%) of the patients. Pre-treatment mean blood pressure was significantly higher than the BP value at the time of the study (155.87 +/- 26.02/97.81 +/- 11.89 mmHg versus 143.40 +/- 24.14/86.53 +/- 12.71 mmHg) (p<0.05). Diuretics were the commonest antihypertensive prescribed either alone or in combination (69%), followed by a calcium antagonist (56%) and centrally acting drugs (38%). Twenty seven were on single antihypertensive, 43 (43%) on 2, 25(25%) on 3 and 5 (5%) on 4 classes of antihypertensive. Blood pressure control was associated with taking more than one antihypertensive medication and compliance. CONCLUSION: Control of BP in patients receiving antihypertensive drugs is still far from optimal in the study population in Nigeria just as in other countries. Many patients had multiple cardiovascular risk factors. Adherence to medication should be encouraged.

Prevalence of hypertension among teenage students in Kano, Nigeria.

BACKGROUND: Hypertension has been reported among young people worldwide. It is known to track from youth to adulthood, which makes it a useful predictor of essential hypertension in adulthood. This study determined the prevalence of hypertension and associated cardiovascular risk factors among secondary school teenagers in Kano, Nigeria. METHODS: A questionnaire was administered on a cross section of 1000 teenage students to inquire about cardiovascular risk factors. Participants' blood pressure, height and weight were measured. Relevant investigations were done for those with raised blood pressure. RESULTS: The participants' ages ranged from 13 to 19 years with a mean of 15.91.62 years. Seventy of the students had systolic blood pressure 140mmHg and/or diastolic blood pressure 90mmHg giving a prevalence rate of hypertension of 7.2% [95% CI = 5.6-8.9%]. Specifically, 32 (6.7%) of the 476 males were hypertensive compared to 38 (7.7%) of the 492 female participants. This difference was not statistically significant (2 =1.6 df = 1 p > 0.05). The prevalence rate of hypertension rose from 4.3% (among the younger participants) to 11.8% among the oldest students. Of the 70, a majority (88.5%) had grade 1 hypertension, 10.0% had Grade 2 hypertension and 1.5% had Grade 3 hypertension. The hypertensives were about twice more likely to have a family history of hypertension compared to their normotensive counterparts. This difference was statistically significant [OR = 2.1, 95% CI = 1.12-3.83] (2 = 6.4 df = 1 p = 0.01). CONCLUSION: Hypertension exists among teenage students in Kano, Nigeria. Early detection can reduce risk of cardiovascular changes and end organ damage.

Post kidney transplant tuberculosis in Nigeria: a case report.

BACKGROUND: Tuberculosis has been reported to be one of the most serious bacterial infections after transplant and occur up to 20 times more frequently in transplant recipients than in the general population. Renal transplant is available in few centers in the country and the post transplant population is increasing, but to our knowledge no case of post transplant tuberculosis has been reported in this environment. METHOD: The case report of a 35 year old Nigerian who had live related kidney transplant and later developed post transplant disseminated Tuberculosis is presented and the relevant literature is reviewed. RESULTS: A 35 year old university graduate had a live related kidney transplant in our center. He had stable allograft function on immunosuppressive regimen consisting of Cyclosporin, Azathioprine and Prednisolone, and presented with features of disseminated tuberculosis involving the cervical lymph nodes and chest with associated deterioration of allograft function. He was successfully treated with 2 months initial phase of quadruple anti tuberculosis drugs including Isoniazid, Rifampicin, Pyrazinamide and Ethambutol and four months continuation phase with Isoniazid and Rifampicin. He showed remarkable clinical improvement and reversal of the allograft dysfunction. CONCLUSION: This case illustrates one of the post transplant infectious complications seen in our environment and its successful treatment, and highlighted the need for Tuberculosis prophylaxis in transplant recipients in countries with high incidence of tuberculosis.

Prevalence of hypertension among teenage students in Kano, Nigeria

BACKGROUND: Hypertension has been reported among young people worldwide. It is known to track from youth to adulthood, which makes it a useful predictor of essential hypertension in adulthood. This study determined the prevalence of hypertension and associated cardiovascular risk factors among secondary school teenagers in Kano, Nigeria. METHODS: A questionnaire was administered on a cross section of 1000 teenage students to inquire about cardiovascular risk factors. Participants' blood pressure, height and weight were measured. Relevant investigations were done for those with raised blood pressure.RESULTS: The participants' ages ranged from 13 to 19 years with a mean of 15.91.62 years. Seventy of the students had systolic blood pressure 140mmHg and/or diastolic blood pressure 90mmHg giving a prevalence rate of hypertension of 7.2% [95% CI = 5.6-8.9%]. Specifically, 32 (6.7%) of the 476 males were hypertensive compared to 38 (7.7%) of the 492 female participants. This difference was not statistically significant (2 =1.6 df = 1 p > 0.05). The prevalence rate of hypertension rose from 4.3% (among the younger participants) to 11.8% among the oldest students. Of the 70, a majority (88.5%) had grade 1 hypertension, 10.0% had Grade 2 hypertension and 1.5% had Grade 3 hypertension. The hypertensives were about twice more likely to have a family history of hypertension compared to their normotensive counterparts. This difference was statistically significant [OR = 2.1, 95% CI = 1.12-3.83] (2 = 6.4 df = 1 p = 0.01). CONCLUSION: Hypertension exists among teenage students in Kano, Nigeria. Early detection can reduce risk of cardiovascular changes and end organ damage

Rhinocerebral Mucormycosis in a Patient with Type 1 Diabetes Mellitus: Case Report

Background: Rhinocerebral mucormycosis is one of the severe forms of infections in persons with diabetes mellitus. Its occurrence is rare and is reported little in our environ- ment. We report a case of rhinocerebral mucormycosis in a patient with type 1 diabetes mellitus (DM) with the aim of drawing the attention of physicians to its existence in our nvironment and the need for aggressive management. Method: The case notes of a patient with type 1 DM presenting with features of rhinocerebral mucormycosis and the rele- vant literature of the subject was reviewed. Result: An eighteen-year old senior secondary school man with a one-year history of type 1 DM was admitted to the male medical ard of Aminu Kano Teaching Hospital (AKTH) with features of diabetic ketoacidosis (DKA); facial rashes involving the medial canthus of the right eye extending to the right para- nasal area and right nostril. The facial rashes which started initially as blisters later progressed to form ulcers with necroses. There was progressive deterioration in level of consciousness with a right hemiparesis. Magnetic resonance imaging (MRI) revealed multiple brain abscesses with dilatation and engorgement of the sphenoidal and maxillary sinuses. He was managed with broad-spectrum antibiotics; antifungals and wound debridement. He continued to deteriorate and died seven weeks later. Conlusion: Rhinocere- bral mucormycosis though rare; does occur especially in the setting of DM and requires an aggressive and a multidisciplinary approach to management

A three-year review of mortality patterns in the medical wards of Aminu Kano Teaching Hospital, Kano, Nigeria.

BACKGROUND: The pattern of morbidity and mortality reflects the burden of disease in a particular community. This pattern shows geographic variations between communities and countries. The knowledge of the pattern of diseases and their contribution to mortality in a given country is very important in evaluating its health care delivery system. Such knowledge is important for health planning and for improving the healthcare services in that particular nation. We set out to study the mortality pattern in our medical wards. MATERIALS AND METHODS: This is a retrospective study that reviewed the causes of death in the medical wards of Aminu Kano Teaching Hospital (AKTH) Kano between January 2001 and December 2003 (three years). The data were obtained from the admission and discharge/death register, patients' case records, the weekly as well as quarterly mortality reviews. The SPSS version 10 was used to analyse the data. RESULTS: A total of 3369 patients were admitted over the 3 year study period. Of these 2518 (74.7%) were discharged or referred and 851 patients died, giving an overall mortality rate of 25.3%. The male to female admission ratio was 1.6:1. Majority of deaths, 714 (83.9%) occurred after 24 hours of admission. The most important causes of death were infectious diseases other than HIV/AIDS (17.9%), cerebrovascular disease (17%), HIV/AIDS (13.6%), chronic renal failure (12.5%) and diseases of the circulatory system (11.9%). CONCLUSION: Mortality in the medical wards reflects the emerging trend of mixed disease spectrum burden comprising communicable and non communicable diseases. Public health education, raising the socio-economic status of our people as well as improving the standards of our health care facilities and personnel would prevent a large proportion of deaths from medical wards.