Pyramid Journal of Medicine <p>The <strong>Pyramid Journal of Medicine</strong> (PJM) is an online Open Access, peer-reviewed scholarly journal in the broad field of clinical and bio-medical sciences.</p> <p>The journal aims to publish in all areas of clinical practice including, but not limited to, Internal Medicine, Pediatrics, Obstetrics and Gynecology, Surgery and their sub-specialties. Also included are issues related to public health, health economics, medical geography, medical sociology, health policy, global health, bio-medical engineering, translational medicine and topics of general interest to biomedical sciences. The journal will accept manuscripts in form of <em>Original Articles</em>, <em>Case Reports</em>, <em>Case Series</em>, <em>Mini Reviews</em>, <em>Reviews</em>, <em>Short Communications</em>, <em>Perspectives Systematic Reviews</em>, <em>Meta-Analysis</em>, <em>Book Reviews</em> and <em>Letter to the Editor</em> in all aspects of clinical sciences and bio-medical sciences.</p> PAGEPress srl Scientific Publications, Pavia, Italy en-US Pyramid Journal of Medicine <p><strong>PAGEPress</strong> has chosen to apply the&nbsp;<a href="" target="_blank" rel="noopener"><strong>Creative Commons Attribution NonCommercial 4.0 International License</strong></a>&nbsp;(CC BY-NC 4.0) to all manuscripts to be published.<br><br> An Open Access Publication is one that meets the following two conditions:</p> <ol> <li>the author(s) and copyright holder(s) grant(s) to all users a free, irrevocable, worldwide, perpetual right of access to, and a license to copy, use, distribute, transmit and display the work publicly and to make and distribute derivative works, in any digital medium for any responsible purpose, subject to proper attribution of authorship, as well as the right to make small numbers of printed copies for their personal use.</li> <li>a complete version of the work and all supplemental materials, including a copy of the permission as stated above, in a suitable standard electronic format is deposited immediately upon initial publication in at least one online repository that is supported by an academic institution, scholarly society, government agency, or other well-established organization that seeks to enable open access, unrestricted distribution, interoperability, and long-term archiving.</li> </ol> <p>Authors who publish with this journal agree to the following terms:</p> <ol> <li>Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</li> <li>Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li> <li>Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.</li> </ol> Pattern and outcome of admissions at the Emergency Pediatric Unit of Federal Medical Centre Nguru, Yobe State, Nigeria <p>Emergency care involves the care of patients with acute illnesses or injuries that require immediate medical attention. Periodic evaluation of emergency unit generally provides an excellent means of auditing hospital performance and assessing the quality of services in the hospital. The aim was to determine the pattern and outcome of Pediatrics admissions at the emergency Pediatrics unit of Federal Medical Centre Nguru, Yobe State, Nigeria. This is a retrospective review of case notes of all children admitted into emergency unit at the Pediatrics Department of Federal Medical Centre Nguru between November 2015 and October 2017. The data was entered into SPSS version 20 soft-ware and a descriptive analysis was used for analysis of the data. A total of 3289 patients aged from 1 month to 192 months (16 years) were seen. The mean age was 52.1± 46.3 months. There were 57.8% males and 42.2% females. Underfive children admitted were 62.2%, children 5 years and above were 37.8%. The common indications for admission were malaria (24.8%), diarrhea (11.1%), sickle disease (9.8%) and sepsis (7.4%). Most (50.0%) of the patients were transferred to the ward, while 35.0% discharged home from the EPU. Mortality was 11.6%, while 0.8% of the patients were discharged against medical advice and 1.2% absconded from admission. Infections especially malaria, pneumonia and diarrhea diseases are the most prevalent causes of childhood morbidity and mortality in emergency pediatric unit of the hospital, and children less than 5 years of age are commonly affected.</p> <p>&nbsp;</p> Umar Isa Umar Isyaku Lawal Muhammed Garba Dayyabu Gwarzo ##submission.copyrightStatement## 2018-12-12 2018-12-12 1 1 Diabetes mellitus in patients with mental disorders: Prevalence and associated factors <p>People with mental disorders have comorbid physical illnesses, particularly an increased risk of diabetes mellitus (DM), found in many psychiatric disorders; schizophrenia, major depression and bipolar disorder. This elevated risk is associated with increased mortality, more so, as treatment of such medical conditions is not easily accessible by people with mental disorders. The aim of the paper is to determine the prevalence and associated factors for DM in patients with mental disorders in Kano, northwest Nigeria. In this cross-sectional study, one hundred and fifty-seven consecutive patients, aged 18 years and above, attending the outpatient psychiatry clinic of Aminu Kano Teaching Hospital were recruited. Sociodemographic and clinical characteristics questionnaires were completed. Height, weight and blood pressure were measured. Subsequently 3 mL of blood was taken using aseptic venepuncture technique and glycated hemoglobin (HbA1c) levels were detected, with a cutoff point of 6.5% used for diagnosis of DM. The age of the patients ranged between 18-79 years with a mean (SD) of 35.5 (±10.6) years. Majority of the patients 91 (58%) were female. Schizophrenia was the most common diagnosis (37.6%) The prevalence of DM was 24.2%. A statistically significant association was found between DM and age (P=0.021), duration of illness (P=0.016) and diagnosis of schizophrenia (P=0.027). DM is common in patients with mental disorders. Associated factors for DM in people with mental disorders include increasing age, prolonged duration of illness and a diagnosis of schizophrenia, the latter being an independent predictor of DM in people with mental disorders.</p> Desola Shakirah Owolabi Baffa Adamu Gwaram Femi Lukman Owolabi Musa Usman Umar Muhammad Murtala Umar Abdullahi Musbahu Abdullahi Shehu Suleiman Yahaya Isah ##submission.copyrightStatement## 2018-12-12 2018-12-12 1 1 Outcome of breech deliveries in Aminu Kano Teaching Hospital, Kano State, Nigeria: A 2-year study <p>Breech presentation is defined as polar alignment of fetus in which the fetal buttocks or feet present at the maternal pelvic inlet. Breech is the most common malpresentation in pregnancy, incidence is high before term but occur in 3-4% of term pregnancies. There is increased perinatal morbidity and mortality with breech presentation which has been linked to the prematurity, birth asphyxia due to cord accidents, congenital abnormalities, birth trauma and mode of delivery. This study was aimed at determining the incidence and outcome of breech deliveries at Aminu Kano Teaching Hospital, Nigeria. It was a retrospective analysis of breech deliveries at Aminu Kano Teaching Hospital over a 2-year period. Information was obtained from the labor ward register, theatre register and the case notes of the mothers. There were 6658 deliveries during the period of the study, out of which 154 had breech deliveries. The incidence of breech deliveries during the period under study was 2.31%. The age of the patients ranged from 17-45 years. Parity ranged between 0-11. There were more breech deliveries in the multipara (59.5%) than in primigravidae (14.9%) and primipara (25.6%).However, there was no significant difference in the perinatal outcome between the groups (P=0.054). Deliveries were mostly through caesarean section (62%), while 38% were through assisted vaginal breech. There were 113 live births and 8 still births. This study has shown that the incidence of breech is slightly lower than in many studies, and breech deliveries were mostly unplanned and more among multiparae. The neonatal outcomes in the planned breech deliveries were excellent. Birth asphyxia and stillborn were found more in the unplanned and unbooked cases with breech.</p> Zainab Datti Ahmed Haruna Usman Natalia Adamou Hadiza Shehu Galadanci ##submission.copyrightStatement## 2018-12-12 2018-12-12 1 1 Assessment of the perception of service recipients about the quality of work in health care professionals in the Children Emergency Room of a Tertiary Hospital in Nigeria <p>The children emergency room (ER) is regarded as an essential section of hospitals and other healthcare settings where immediate medical and surgical care is given to children in need of urgent care. The conditions of the emergency room and the quality of service by the emergency room staff has been described as a major determinant of the socio-medical outcome of patients and their relatives. This is a hospital based cross-sectional carried out in the Children Emergency Room (CHER) of the Enugu State University Teaching Hospital, Enugu Nigeria. Parents and care-givers that presented with their sick children to the ER department were successively enrolled after obtaining consent. Information on their assessment of certain aspects of the emergency room environment and quality of service received from medical and administrative personnel working in the emergency room was obtained using a 5-point Likert assessment scale. Results were reported using frequencies, percentages and chisquare were applicable. Statistical significance was set at P≤0.05. Over half (59%) of the 83 respondents that presented to the emergency room during the study period were self-referrals and all (95.2%), but four respondents noted a significant improvement&nbsp;in the condition of their sick children following management in the emergency room. In all parameters assessed, most respondents rated the emergency room conditions as moderate in noise level 69 (83.1), crowdedness 65 (78.3), comfort 49 (59.0) and cleanliness 41 (49.4) with an overall point score of 2.97±0.33 out of a possible five. Doctors were on average rated better than nurses and record clerk staff in politeness (P=0.001), patience (P=0.002), efficiency (P=0.002), and adequate explanation of procedures (P=0.001) while nurses were rated better than record staff in explanation of procedures to their patient (P=0.05) but not in politeness (P=0.894), patience (P=0.505) and efficiency (P=0.982). The rating of record clerks was significantly affected by the socio-economic class of respondents (P=0.036) but not by gender (P=0.252) or age of respondents (P=0.123). None of the respondents’ socio-demographic factors significantly determined their rating for the emergency room conditions and the quality of service by doctors or nurses. There is a need for a continued review of emergency room conditions in addition to training and re-training of staff in the children emergency room. This not only helps improve health outcomes but may also significantly reduce the duration of stay in the emergency room that in turn reduces congestion and the burden on the healthcare system.</p> Chidiebere DI. Osuorah Ikenna Kingsley Ndu Ogechukwu F. Amadi Uchenna Ekwochi Obinna C. Nduagubam Onukwuli V. Ozoemena Chinawa J. Maduabuchi Ogechukwu H. Azionu ##submission.copyrightStatement## 2018-12-12 2018-12-12 1 1 Assessment of satisfaction and utilization of health-care services by National Health Insurance Scheme enrolees at Aminu Kano Teaching Hospital, Kano, Nigeria <p>The National Health Insurance Scheme (NHIS) aims at universal health coverage through access to high-quality health-care to all enrolees. To achieve this goal, it is necessary to incorporate feedbacks from periodic patient-surveys into service improvement plans. This study therefore, assessed satisfaction and utilization of health-care services by enrolees of a Nigerian tertiary hospital. This was a crosssectional study of 399 respondents randomly selected from enrolees attending the NHIS-clinic of Aminu Kano Teaching Hospital, Kano. Using an intervieweradministered questionnaire, it assessed their sociodemographics, medical history, number of and reason for clinic visits, satisfaction with- access to care, patient-provider relationships and hospital facilities/environment. Respondents’ mean age was 38.3 ± 9.2 years and females accounted for 55.9% of respondents. Most respondents (60.4%, 69.8%, 96.0%) were satisfied with the ease of accessing care, waiting-time and hospital facilities/environment respectively. Most respondents (94.8%, 81.1%, 73.3%, 74.5%, 83.1%, 91.1%) were satisfied with their relationship with physicians, nurses, laboratory staff, pharmacists, record officers and other hospital-staff respectively. Overall, 80.5% of respondents were satisfied with the hospital’s services. All respondents had visited the clinic at least once in the preceding 12-weeks. Although 49.1% visited for&nbsp;non-communicable diseases, more respondents who were for antenatal-care (followed by non-communicable and communicable diseases) had had ≥ 2 clinic visits (c2 =15.5%, df=2, P=0.0001). This study observed a high utilization of and overallsatisfaction with the hospital’s services; however, there is a need for service improvement plans to address the challenges of patient access to care and waitingtime.</p> Abubakar Yusuf Abubakar M. Jibo Sanusi Abubakar Bukar A. Grema Auwal U. Gajida Godpower C. Michael ##submission.copyrightStatement## 2018-12-12 2018-12-12 1 1 Effect of malaria on the outcomes of sickle cell phenotypes in a semi-nomadic population <p>Studies have shown that malaria contribute significantly to mortality among infants and children with Sickle Cell Anemia (SCA). The nomadic lifestyle of the Fulanis make access to health care difficult and exposure to malaria high. We conducted a cross sectional study among consenting members of a semi-nomadic Fulani population in Nigeria to determine the impact of malaria on the outcome of SCA. On-the-spot malaria rapid diagnostic test (RDT) and hemoglobin electrophoresis were done. A total of 229 subjects participated, 100 (43.7%) females. Median age was 35 years (yrs) with range of 15-80 yrs. Hemoglobin AS phenotype was found among 53 (23.1%) subjects; none had hemoglobin SS. A positive malaria RDT was found among 24 (10.5%) individuals. The FGD revealed that majority of the respondents considered malaria as an important cause of ill-health but were not aware of SCA as an important disease. The high prevalences of malaria, hemoglobin AS phenotype, and absent of hemoglobin SS in the community implies the potentially fatal effect of malaria on individuals with hemoglobin SS. A comprehensive intervention to reach this vulnerable population is thus recommended.</p> Baffa A. Gwaram Mahmood M. Dalhat Muhammad Hamza Zaiyad G Habib Musa M. Bello Ahmad M. Yakasai Aisha H. Sadauki Hauwa Aliyu Zira G. Vandi Faruk Sarkin-Fada Kamilu M. Karaye Abdulrazaq G. Habib ##submission.copyrightStatement## 2018-12-12 2018-12-12 1 1 Cushing syndrome secondary to late onset adrenal hyperplasia: presentation and challenges of management <p>Cushing’s syndrome is a clinical disorder caused by overproduction of cortisol. Adrenal adenoma is the cause in 5% of cases of Cushing syndrome. ACTH-independent Cushing’s syndrome in 90% is caused by unilateral adrenal tumors. Of these, adenomas are the cause in 80% of the cases, while the others are adrenocortical carcinoma. Rare causes of Cushing’s syndrome include adrenal hyperplasia. Overproduction of cortisol results in weakened protein structures leading to protuberant abdomen and poor wound healing, glucose is converted to fat and deposited in the abdomen, supraclavicular fossa and cheeks. Other presentations are diabetes, hypertension, osteoporosis, fractures, impaired immune function, glucose intolerance, and psychosis. We report a 21-year-old female who presented with clinical symptoms of newly diagnosed hypertension and diabetes mellitus which after poor response to treatment she was evaluated and diagnosed to have Cushing syndrome. She subsequently had left adrenalectomy and did very well with resolution of patients’ symptoms. The histology came out to be diffuse adrenal hyperplasia.</p> Muzzammil Abdullahi Mamuda Atiku Imam Mohammed Ibrahim ##submission.copyrightStatement## 2018-12-12 2018-12-12 1 1 Malignant histiocytosis of lungs and chest wall: A case report of diagnostic conundrum and treatment challenges in a resource-poor setting <p>Malignant histiocytosis is a rare condition with variable clinical presentation and prognosis. Its diagnosis requires high index of suspicion and further evaluation. Thus, it poses a diagnostic as well as management challenges especially in resource poor setting. The objective is to highlight the diagnosis and treatment challenges in the management of malignant histiocytosis so that physicians can diagnose it early and initiate appropriate treatment. Our patient is a 35-year-old man who presented with chest wall mass, dyspnoea and right cervical lymphadenopathy He was initially being evaluated for lymphoma. Biopsy of the lymph nodes was done twice in different hospitals and that of the chest wall mass done once. Histological diagnosis was arrived at with the aid of immunohistochemistry three months after his first presentation to the hospital. The patient was then commenced on chemotherapy and showed remarkable improvement on the short-term basis. Malignant histiocytosis is a rare disease laden with management challenges. Despite that, its diagnosis and treatment can be achieved even in resource poor setting with high index of suspicion, team work and good laboratory support.</p> Jameel Ismail Ahmad Ismail Mohammed Inuwa Dalha Gwarzo Haliru Imam Mohammed Ibrahim ##submission.copyrightStatement## 2018-12-12 2018-12-12 1 1 Asymptomatic thoracic aortic aneurysm in a resource limited hospital in a 70-year-old man <p>Aortic aneurysm is a term used to describe more than 50% dilatation of a segment of the aorta (artery) from its original diameter. The etiological factors include hypertension, artherosclerosis, trauma, congenital syphilis, mycotic bacterial dissection, inflammation etc. A case of a 70-year-old man with well-controlled long-standing hypertension whose check chest X-ray showed aortic aneurysm as an incidental finding which latera ruptured was discussed. The case report discusses the importance of follow up imaging in a hypertensive patient even with regular medication as absence of routine medical checkup including X-ray may lead to missing important complication like aortic aneurysm that can rupture if untreated. This is what prompted this case report so as to underscore the importance of at least check chest radiograph in a hypertensive patient.</p> Mohammad A. Suwaid ##submission.copyrightStatement## 2018-12-12 2018-12-12 1 1