Annals of Clinical Sciences

Micronutrients and Immune Response in COVID-19: A Case-Control Study in Nigeria.

ADEBUSOLA SHAKUNLE — 2025-01-12

Background: As a result of insufficient knowledge, the significance of the immunological and nutritional status of SARS-CoV-2 patients has received very little attention in Nigeria. This study's primary goal is to compare the micronutrients and immunological indicators between SARS-CoV-2 patients (case) and controls in tertiary hospitals in southwestern Nigeria.

Methodology: This is a case-control study involving 160 participants attending two tertiary institutions in the south-west of Nigeria, grouped into two: (80) cases, COVID-19-positive patients, and (80) COVID-19-negative individuals (46 males and 34 females; 28 men and 52 females) were included. COVID-19 individuals were recruited from Olabisi Onabanjo Teaching Hospital in Sagamu and the Holding Bay of Lagos State University Teaching Hospital in Ikeja. The nasopharyngeal swab was collected into viral transport media, and COVID-19-positive and negative participants were confirmed using the polymerase chain reaction technique. Plasma from the patients was used in the assay, and levels of interleukin-6, vitamin D, ferritin, and high-sensitivity C-reactive protein were estimated by the enzyme-linked immunosorbent method. At the same time, the spectrophotometry technique was used for the plasma estimation of zinc.

Results: The mean (± SD) age was 51.53 (±1.86) and 54.21 (±1.89) in COVID-19 positive and negative subjects, respectively. The results of biochemical parameters revealed that plasma interleukin-6, high-sensitivity C-reactive protein, and ferritin were significantly raised (264.36±20.74; 10.39±0.23), (31.84±1.21; 5.98±0.42), and (245.08±15.18; 95.25±5.30), while vitamin D and zinc were reduced in COVID-19 subjects compared with the control (18.30±1.64; 69.00±3.21), and (31.26±5.44; 46.13±2.96) (p=0.001).

Conclusion: A low plasma level of vitamin D and zinc, as well as a statistically significant elevated plasma interleukin-6, high-sensitivity C-reactive protein, and ferritin, were found amongst COVID-19-positive patients. It is not clear whether these are predisposing factors or consequential to the COVID-19 infection.

Audit of Cardiology Specialty Referrals in a Nigerian Tertiart Hospital

Folasade Daniel — 2025-01-12

Background: Referrals to cardiology specialists are common, but many are inappropriate, potentially straining resources and delaying care for patients with true cardiac pathology. This study audited referrals to a cardiology service to assess the yield of confirmed cardiac diagnoses and identify patterns of referral appropriateness.

Methodology: The study was conducted over one month at the Cardiology Unit of the Lagos State University Teaching Hospital (LASUTH). Data on patients’ demographics, referral sources, cardiovascular risk factors, provisional and final diagnoses were collected. Descriptive statistics, including means and percentages, were used to analyse categorical data, while non-parametric data were analysed with Student’s t-test and ANOVA.

Results: A total of 121 patients (67 males and 54 females; mean age: 53.9 ± 15.7 years) were referred. Nearly half (49.5%) of referrals were from within the Department of Medicine, with 45.5% from other departments and 5% from external facilities. Hypertension was the most prevalent risk factor (62.8%), followed by diabetes mellitus (3.3%) and obesity (1.7%). The highest diagnostic yield was observed for arrhythmias, heart block, and thromboembolic diseases. However, 19.8% of referrals resulted in no identifiable cardiac disease. Incorrect provisional diagnoses were most common for coronary artery disease (60% error rate).

Conclusion: The rate of inappropriate referrals to the cardiology service is high, with significant proportions originating from within the same department. Arrhythmias and thromboembolic diseases yielded the highest rates of appropriate referrals, while coronary artery disease had the lowest. Targeted training for referrers on cardiovascular disease evaluation, particularly ECG interpretation, is recommended to optimise cardiology service utilisation.

ASSESSMENT OF SERUM LEVELS OF HIGH SENSITIVITY C-REACTIVE PROTEIN AND LIPOPROTEIN (a) AND THEIR CORRELATION IN HYPERTENSIVE PATIENTS IN SOUTHERN PART OF NIGERIA

Augustine Onovuakpo Eguvbe — 2025-01-12

Background: Globally, hypertension is the main preventable risk factor for cardiovascular disease and overall mortality. Low-grade inflammatory processes in vascular tissue have been implicated in the pathophysiology of hypertension. Both high-sensitivity C-reactive protein (HSCRP) and lipoprotein (a) (Lp [a]) have been associated with cardiovascular disease. This study was to evaluate the serum levels of HSCRP and Lp (a) and their correlation in hypertensive patients.

Methodology: This was a cross-sectional study carried out in the hospital between October 2022 and January 2024 at the Delta State Central Hospital, Warri, Nigeria. The study enrolled three hundred participants composed of two hundred hypertensive and one hundred normotensive individuals. The study used a structured interviewer-administered questionnaire to collect data, which was then analysed using SPSS version 23.

Results: The mean HSCRP was 4.23 ± 3.31 vs. 1.50 ± 1.49 mg/L in the hypertensive and control groups, respectively. The difference in the two groups was statistically significant (<0.001). It was observed that 6.7% vs. 50.0% had low HSCRP in the hypertensive and control groups, respectively; 54.1% vs. 38.3% had intermediate HSCRP in the hypertensive and control groups, respectively; 39.2% vs. 11.7% had high HSCRP in the hypertensive and control groups, respectively. The difference in the two groups was statistically significant (P-value <0.001). The mean Lp (a) were 32.77 ± 16.61 vs. 16.88 ± 13.85 mg/dl in the hypertensive and control groups, respectively. The difference in the two groups was statistically significant (<0.001). It was observed that 43.3% vs. 81.7% had normal Lp (a) in the hypertensive and control groups, respectively, while 56.7% vs. 18.3% had elevated Lp (a) in the hypertensive and control groups, respectively. The difference in the two groups was statistically significant (P-value <0.001). There was a positive correlation between HSCRP and Lp (a) in the hypertensive group (P-value = 0.028).

Acquired Hair and Scalp Diseases in School-Age Children and in Adolescents.

Ehiaghe Anaba — 2025-01-12

Background: Acquired Hair and Scalp Disease (AHSD) occurs globally, affects all ages and. the type of AHSD differs between school-age children and in adolescents. The objectives were to determine the prevalence and types of and, to compare types of acquired hair and scalp disorders (AHSD) between adolescents and school-age children as well as between genders.

Methodology: A multi-center cross-sectional descriptive study of 509 students over a four-month period was conducted in 2023: three schools. In this study, a school-age child was defined as aged ≤ 12 years and adolescents as ≥13 years. In Nigeria, school-age children (primary school children) are aged ≤ 12 years.¹⁷Diagnosis was clinical. Data was analyzed using the IBM statistics version 26.

Results: The mean age of the students was 13.6 ±3.4 years. The prevalence of hair and scalp disease was 17.3%. Traction alopecia (TA), tinea capitis (TC) and seborrheic dermatitis (SD) were observed in 47.3%, 25.3% and 24.2% respectively. TC occurred more in school-age students, p<0.001, SD occurred more in the adolescents, p= 0.011. TC occurred more in males, p=<0.001, TA occurred more in females, p=<0.001 and acne folliculitis nuchae occurred only in males.

Conclusion: Acquired hair and scalp disease is not uncommon is children and the prevalent ones are traction alopecia, tinea capitis and seborrheic dermatitis. There is no age nor gender based difference in the occurrence of AHSD rather there is a significant difference in the type of AHSD based on age and gender.

RELATIONSHIP OF SERUM ZINC TO INSULIN RESISTANCE IN METABOLIC SYNDROME PATIENTS IN SOUTH WEST NIGERIA

ADEYEMI DADA — 2025-01-12

Background: Metabolic syndrome (MetS) is a growing concern not only in developed countries but also in the developing countries owing to increasing urbanisation. The coexistence of insulin resistance (IR), obesity, atherogenic dyslipidaemia, and hypertension defines MetS. Serum zinc has been reported to play a central role in the onset and progression of IR. This study aimed to determine levels of serum zinc in participants with MetS.

Methodology: Two hundred and seventy participants, comprising 180 MetS and 90 healthy controls, were recruited for this study in southwest Nigeria. Anthropometric indices, fasting plasma glucose (FPG), triglyceride (TG), high-density lipoprotein cholesterol (HDL-c), serum fasting insulin (FI), and zinc were measured. IR was assessed using Homeostatic Model Assessment for IR (HOMA-IR) cut off >2. Normally distributed data was presented as mean, while data not normally distributed as median. SPSS version 23 was used for statistical analysis and set at p < 0.05.

Results: Mean age of MetS participants was 61.2(±9.3) vs controls 60.7(±8.9) yrs; results of MetS to control participants include mean FPG 138.7(±35.4) vs 75.6(±14.0)mg/dL, p <0.001; TG 94.0(±22.0) vs 73.1(±22.0)mg/dl, p<0.001; mean HDL-c of 23.5 (±8.5) mg/dL vs 52.3 (±17.1)mg/dL, p <0.001; Median FI 9.6(5.5-16.2) vs 7.5(5.8-8.6)uU/mL p <0.001 ; HOMA-IR was 2.9(1.4-5.4) vs 1.3(0.9-1.8), p <0.01; and Zinc 45.0(25.2-59.1) vs 101.4(74.1-144.4)ug/dL, p <0.01.

Conclusions: Low serum zinc in MetS has a direct relationship with the development of IR as well as increasing BMI, FPG, and FI and IR. This implies that zinc supplementation may play a significant role in the management of MetS patients in Southwest Nigeria.

Diagnostic value of beta-HCG versus placental alpha microglobulin-1 in the diagnosis of prelabour rupture of membranes in an Urban Hospital Population

Nimat A. Amisu — 2025-01-12

Background: Prelabour Rupture of Membranes (PROM) is a global health challenge imposing a great risk to both the mother and the foetus The diagnosis of PROM can be challenging in instances where there is no obvious leakage of fluid from the cervix. Although some tests have been documented to have high diagnostic accuracy, there is as yet a universally accepted "gold standard" diagnostic test. This study aimed to assess the diagnostic value of the qualitative detection of beta human chorionic gonadotropin (HCG) in cervicovaginal fluid in PROM and to compare its accuracy with the immunoassay of placental alpha microglobulin-1 (PAMG-1).

Methodology: This comparative analytic study involved pregnant women at gestational ages ≥ 28 weeks with suspected PROM. Cervicovaginal β-HCG was assayed qualitatively using a standard pregnancy test strip, while PAMG-1 immunoassay was done with the Amnisure ROM® 2012 kit (International LLC, Boston, USA). The presence of 2 lines (control and test) in either kit was interpreted as positive. It was considered negative if only the control line was present and invalid if no lines were observed. The definitive diagnosis of PROM was made following the review of the case notes for the clinical course and outcomes of each patient.

Results: Among the 136 women examined, 88 tested positive for PAMG-1, while 87 tested positive for β-HCG. The final diagnosis of PROM was made in 90 women. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 97.8%,100%, 100%, 95.8%, 98.5% and 96.7%, 100%, 100%, 93.9%,97.8% for PAMG-1 and β-HCG, respectively. There was no significant difference between the detection ability of both tests (p-value=0.899).

Conclusion: While PAMG-1 may offer slightly higher diagnostic accuracy, β-hCG could be a comparable and more cost-effective alternative, especially considering the context and specific circumstances.

SPECTRUM OF LUMBOSACRAL MRI FINDINGS IN PATIENTS WITH LOW BACK PAIN IN A TERTIARY HOSPITAL IN NIGER DELTA REGION OF NIGERIA

Ifeanyichukwu Nwajei — 2025-01-12

Background: Low back pain (LBP) is a common musculoskeletal condition in clinical practice and one of the most common causes of disability in the developed nations, as well as one of the most frequently reported chronic health problems affecting the adult population. Of all the imaging modalities, Magnetic Resonance Imaging (MRI) has been found to be very useful in evaluating the abnormalities in the lumbosacral spine due to its excellent soft tissue resolution.

Methodology: A hospital-based, cross-sectional, prospective study of one hundred and fifty (150) adults with low back pain was carried out using a 1.5 Tesla MRI scanner (Toshiba excelart vantage March 2015). Picture Archiving and Communication System (PACS), was utilized for data collection. Analysis of the collated data was done using Statistical Package for Social Sciences version 25.0 (SPSS Inc. IL USA).

Results: Findings on MRI included abnormalities in 141(94%) of participants while 9 (6.0%) participants had normal findings. Degenerative disease of the spine was the most common finding and was present in 126(84%) of the participants, and this was more common at the L4/L5 level.

Conclusions: Lumbar disc degeneration was the most common cause of low back pain. L4/L5 disc level affectation was more common.

Chronic Myeloid Leukaemia in Pregnancy; a case report of Anaesthetic Management.

Folayinka Ogunmuyiwa — 2025-01-12

Chronic Myeloid Leukaemia (CML) is a myeloproliferative disorder marked by the Philadelphia (Ph) chromosome, a genetic mutation present in about 95% of cases. This mutation leads to uncontrolled proliferation of granulocytes and often progresses through chronic, accelerated, and blast phases. CML is uncommon, with an incidence of 1–2 cases per 100,000 people annually, and is rare in pregnancy, occurring in approximately 1 in 75,000 pregnancies. However, when CML does coincide with pregnancy, it presents complex challenges due to the impact on feto-maternal health.

The standard treatment for CML involves tyrosine kinase inhibitors (TKIs), which target the BCR-ABL1 protein. Due to the teratogenic risks associated with TKIs, alternative treatments such as hydroxyurea or interferon-alpha are often preferred in pregnancy, though these also carry risks like intrauterine growth restriction (IUGR). Leukapheresis is another option to manage high white blood cell counts, especially in the first trimester when medication options are limited.

Anaesthetic management for caesarean delivery in CML patients requires careful planning, as both regional and general anaesthesia have potential risks, including bleeding and increased likelihood of postpartum haemorrhage. A multidisciplinary approach involving haematology, obstetrics, and anaesthesia is essential to optimise outcomes.

This case report describes the anaesthetic and clinical management of a pregnant patient with CML undergoing emergency caesarean section, emphasising individualised care and interdisciplinary coordination.