Recently, there have been notices of drug recalls by different pharmaceutical companies. This is based on the finding of high level of N-nitrosodimethylamine (NDMA) in such medications. These medications are useful in the management of some diseases which affect a significant percentage of the population. It is therefore necessary to evaluate the chemical substance (NDMA), the sources, mechanisms, and the effects it can pose on the users of implicated medications. It is also important to consider the possible ways to avert the entry of NDMA into the medications. The substance, NDMA, has been found to be present as an impurity in high concentration in certain drugs, especially metformin slow release, valsartan and ranitidine. The approved healthy daily intake of NDMA by Food and Drug Administration (FDA) is about 96 ng. However, the concentrations of NDMA found in these drugs were exceptionally high which led to their recall. The high level of NDMA may arise from contamination, direct synthetic process, or from the degradation process of the medicine. Chromatography is the best detection modality of NDMA. The carcinogenic risk is the most feared effect of accumulated NDMA beyond the acceptable limit. On the basis of the frequent recalls of these medications, it is therefore imperative that pharmacists, pharmacologists, and physicians are acquainted with the sources of NDMA. This is in view of the serious risk it can pose to patients’ safety and quality of life. These concerns have given rise to this review article.

Background: Although Bacillus Calmette Guerin (BCG) vaccine remains one of the most important public health preventive measures against tuberculosis (TB), the presence of a BCG scar may not imply an immune response. Tuberculin reactivity after BCG vaccination has been the most common measure of the effect of the BCG vaccine. Post-vaccination BCG-induced tuberculin reactivity ranges from no induration to an induration diameter of 15 mm. However, tuberculin conversion in infants is usually about 10 mm in more than 90% of infants tested at 12 weeks post-vaccination age. Objective: This study sought to assess the tuberculin conversion rate after BCG vaccination. Materials and Methods: It was a hospital-based cross-sectional study. Two hundred and eighty (280) infants aged 13 to 15 weeks who received BCG vaccination within one month of birth were enrolled. The BCG scar diameter was measured, and Mantoux test was done. Data were analyzed by using the Statistical Package for Social Sciences (SPSS), version 20 (Chicago Il). Results: Among the 280 BCG-vaccinated infants, tuberculin conversion rate was 64%, whereas scar failure rate was 28.9%. Overall, 75.9% of infants with a BCG scar had a positive Mantoux test. The BCG-vaccinated infants with a BCG scar were about six times more likely to have a tuberculin conversion than those without a BCG scar (OR =5.641, 95% C.I = 3.227 to 9.859). Conclusion: There was a 64% conversion rate among the BCG-vaccinated infants. The presence of the BCG scar correlated well with the tuberculin conversion rate.

Background: Information obtained from the “brought in dead” (BID) cases is important in understanding the challenges in seeking health care and help in policy making. Objective: This study was conducted to describe the characteristics of children presenting to Enugu State University Teaching Hospital (ESUTH), Enugu as BID and probable causes of death. Materials and Methods: This descriptive study was conducted in the Children Emergency Room (CHER) of ESUTH. Information from all cases of BID children presenting to the CHER of ESUTH between May 2016 and April 2020 was recorded in a register after the confirmation of death. A probable diagnosis was made by verbal autopsy. Data were entered and analyzed with Statistical Package for Social Sciences (SPSS) version 20 (Chicago, IL). Results were presented as tables, bar chart, and prose. Results: There were 124 cases of BID, accounting for 2.2% of the total presentations and 43.1% of the mortalities. Their ages ranged from one month to 192 months, with a median age of 12 months. Majority (61, 49.2%) of the dead children were infants. There was an almost equal sex distribution with 63 males and a male-to-female ratio of 1:1. Probable causes of death included acute gastroenteritis (AGE), severe anemia, sepsis, acute encephalitic syndrome, and aspiration. None of the cases was referred from a health facility. There was a bimodal peak for the annual presentation (January and October). Most of the presentations were during the day (86, 69.4%). None of the parents gave consent for autopsy. Conclusion: The rate of children dying before receiving health care in our hospital is high; there is an urgent need for continuous mass mobilization within the communities to improve the health-seeking behaviors, and also to teach them to recognize danger signs in children.

Background: Multiple myeloma (MM) is a very common hematological malignancy and constitutes about 10% of hematological malignancies. Laboratory investigations including haematological, biochemical, and molecular studies play an important role in the diagnosis, monitoring of response, and relapse in patients with MM. Objectives: The objectives of this article were to assess the initial clinical features, hematological profile, and biochemical parameters of newly diagnosed patients with MM. Materials and Methods: This was a retrospective study of MM patients seen from February 2010 to January 2020 at a tertiary hospital in Nigeria. A total of 51 patients’ case notes were retrieved from the Medical Records Department of the hospital. The socio-demographic data were collected using a Microsoft Excel Sheet. Data on age, sex, hematological parameters, presence of bone lesions (fractures, and osteolytic findings from radiographs), and biochemical parameters were extracted and analyzed. Results: The median age was 60.5 years, and the mean age was 59.6 ± 9.3 with a range of 35–89 years and a male-to-female ratio of 1.7:1. Only 1 (2.0%) patient was aged below 40 years, and the rest 50 (98.0%) were above 40 years of age. The 61–70 age group had the highest number of cases, 31 (60.8%). The mean hemoglobin, white cell count, and platelet count were 7.96 ± 2.2; 6.76 ± 0.6; and 213.50 ± 98 respectively. Serum protein was >80 g/L in 33 (64.7%) and <80 g/L in 18 (35.3%) patients. Two-thirds of the patients, 34 (66.7%) had albumin level <35 g/L. The mean albumin and globulin levels were 36.2 ± 10.9 and 59.2 ± 1.9 respectively, giving an albumin–globulin ratio (AGR) of 0.611. The mean calcium level was 2.6 ± 0.29 mmol/L. The overall mean urea and creatinine levels were 8.02 ± 3.2 (mmol/L) and 169.5 ± 89.4 (μmol/L), respectively. The most common clinical presentations were weakness, pallor, and bone pains with a proportion of 49 (96.1%), 47 (92.2%), and 45 (88.3%), respectively. Conclusion: The physicians should be alerted on the possibility of MM when an elderly patient presents with weakness and bone pains. The AGR is commonly low, connoting a poor prognosis.

Background: Dyslipidemia is an established risk factor for cardiovascular disease (CVD). Different schools of thought hold different opinions regarding the use of statins in the perioperative period for cardiac surgery patients. There seems not to be a consensus yet on when to commence statin therapy for cardiac surgery patients not yet on treatment for dyslipidemia, but the beneficial effects of dyslipidemia management are not in doubt. Objectives: The objective was to characterize the pattern of dyslipidemia and atherogenic indices present in cardiac surgery patients. Materials and Methods: The study was a retrospective record review of patients who presented for open heart surgery between 2013 and 2017. Results of pre-operative lipid profile of patients were extracted and analyzed using SPSS version 22. Atherogenic risk was determined using three different risk ratios: atherogenic plasma index and Castelli’s risk indices-I and II. Results: The study included a total of 51 adult patients with the age range 18–75 years and male: female ratio of 1:1.4. Dyslipidemia observed in participants was majorly in the form of low high-density lipoprotein 24 (49.0%) and elevated low-density lipoprotein 11 (22.5%). Using atherogenic plasma index, more than one-quarter of participants 15 (30.6%) were found to be in the high- and medium-risk groups. Conclusion: Incidental findings of dyslipidemia made in this group of patients have its associated health implications. Hence, it buttresses the importance of assessing for and adequate management of the medical condition, particularly in a group of patients already burdened with CVD.

Background: The World Health Organization (WHO) has made recommendations for breastfeeding. These recommendations are to promote proper breastfeeding practices, which are essential for improved child health and survival. Objectives: The study intended to determine the level of awareness of WHO breastfeeding recommendations among nursing mothers in Enugu and how awareness translates into practice. Materials and Methods: A questionnaire was used to assess the awareness of WHO recommendations on breastfeeding and breastfeeding practices of mothers in Enugu, Nigeria. Results: Most (254; 64.1%) mothers have not heard about the WHO recommendation on breastfeeding; majority (81.1%) were aware of exclusive breastfeeding. Antenatal clinics are the commonest source of information on breastfeeding. Only 2.5% mothers intend to breastfeed for the duration recommended. Awareness of WHO recommendations was not associated with decision to breastfeed or frequency of breastfeeding. Younger mothers were less likely to be aware of the recommendation (P = 0.007, OR = 0.559, 95% CI = 0.366–0.851), while antenatal care attendance was associated with increased awareness (P = 0.002, OR = 10.389, 95% CI = 2.439–44.262). Maternal education affected breastfeeding frequency only. Conclusion: Significant gaps exist in awareness of the WHO recommendations on breastfeeding among mothers in Enugu, Nigeria.

Introduction: The association of headache and epilepsy has long been recognized in clinical practice. Primary headache, especially migraine, is episodic and shares common genetic and pathologic pathways. Current definition of epilepsy underscores the impact of other neurologic comorbidities such as headache in the burden of epilepsy. There is a paucity of data on seizure-related headache in Nigeria. Objectives: The objectives of this study were to describe the pattern and correlates of seizure-related headache among people with epilepsy (PWE) attending medical outpatient clinics in Enugu, Southeast Nigeria. Materials and Methods: Data were collected from the epilepsy register of PWE attending medical outpatient clinics in two teaching hospitals in Enugu. Data were analyzed using the SPSS statistical software. Results: The overall prevalence of headache among PWE was 48% (73/152). A history of migraine was reported in 3 (2%) of the patients. The commonest form of headache was postictal headache 24 (15.8%). Preictal headache was reported by 16 (10.5%), out of which 4 (4.5%) were reported as possible auras. Headache pain was mainly aching 44 (60.3%) and generalized 41 (56.2%). Seizure-related headaches correlated with medical history of alcohol use (P = 0.04). Positive history of head injury and epilepsy-related head injury weakly correlated with having headache (P = 0.07), respectively. Conclusion: PWE often have seizure-related headaches. Such headaches occur mainly after seizures. Careful evaluation of PWE should include the burden and impact of headache in the lives of these patients.

Background: Health-related quality of life (HRQOL), a patient-sensitive outcome globally, has become the clinician’s primary goal of care. Evidence suggests that diabetes mellitus (DM) and its treatment/care impair patients’ HRQOL, which varies depending on patient population/factors. Diabetics’ HRQOL in South-South Nigeria is largely unknown. Objectives: This study assessed and compared the HRQOL of patients with type 2 diabetes attending the outpatient diabetic clinic at a tertiary hospital in Port-Harcourt, Rivers State, South-South Nigeria with age-/gender-matched nondiabetics living within the same environment. Materials and Methods: This descriptive cross-sectional comparative study recruited 200 respondents, respectively those with type 2 diabetes (cases) and nondiabetics (controls). Data were collected by using the World Health Organization Quality of Life–BREF (WHOQOL-BREF) questionnaire and analyzed by using descriptive and inferential statistics at P≤ 0.05 level of significance. Results: The two groups (200 each) had no significant differences (P = 0.35 - P = 0.98) in terms of their demographic variables. The diabetic group mean scores were significantly (P = 0.00) lower than that of the non-diabetics in terms of WHOQOL-BREF overall, health satisfaction, physical, psychological, and social domains. Diabetics with tertiary education (58%) had a significantly higher mean score (P = 0.012) in terms of overall WHOQOL-BREF than those with secondary and primary education (42%). Ninety-two patients (46%) with diabetes had comorbidities that increased significantly with age (P = 0.00) and expressed less satisfaction with their health (P = 0.04). Conclusion: Patients with diabetes had lower HRQOL scores than non-diabetics, implying the negative impact of diabetes and its treatment/care on their life. Diabetics’ HRQOL should be routinely evaluated and enhanced by empowering diabetic self-care activities that aid diabetes control and retard complications.

Background: Driving requires good vision for safe and effective execution. Eye examination is required before issuance of drivers’ license, but seldom conducted. Aim: The study aimed to evaluate the visual status of drivers in the Enugu state government house and to determine the adequacy of their vision for the job. Materials and Methods: Case files of drivers working in the government house that came for eye check in May 2015, at Enugu State University of Science and Technology, Teaching hospital were retrieved. Sociodemographic data, relevant history, and clinical ophthalmic findings were reviewed. Descriptive and inferential statistics were done using the Epi-info (version 7.2.4.0). A value of P ≤ 0.05 was considered statistically significant. Results: Fifty drivers’ case files were selected, of which 47 (94%) had complete information and 3 (6%) case files were grossly inadequate and were thus discarded. All were men aged 27–59 years. The mean age was 49.787 ± 7.3 years. Three (6%) underwent a visual test before obtaining their first drivers’ license. None had a comprehensive eye examination at employment. Eye tests are not regularly conducted. Forty-one (87.23%) had mild, 4 (8.51%) moderate, and 2 (4.26%) had severe visual impairment. Refractive errors accounted for 76.60% of ocular morbidities. Thirty-five (81.40%) of the 43 (91.49%) drivers who were above 40 years had presbyopia. Four (8.51%) were below 40 years, and only one was presbyopic (odds ratio [OR] 11.333; 95%; confidence interval [CI] 1.049–122.393; P = 0.0459). Glaucoma accounted for 10.64%. Esterman’s efficiency score showed 91.49% with scores of 96–100. Conclusion: Uncorrected refractive errors were quite common among the drivers. Periodic eye tests should be performed on drivers. This should be enforced to ensure safer road travel.

Background: Bacterial contamination of operating theaters is a major contributory factor to the high prevalence of post-operative nosocomial infections. The detection of changing trends of microbial counts and micro-flora is key to reducing microbial contamination and good antibiotic stewardship. Objective: The objective of this study was to identify bacterial colonization of surfaces and equipment in Enugu State University Teaching Hospital’s operating theater. It also aimed at determining the sensitivity patterns of the colonized surfaces. Materials and Methods: This cross-sectional study was conducted in the Main Theater of Enugu State University Teaching Hospital (ESUTH), Parklane, Enugu, Nigeria. Samples were collected from equipment, operating room surfaces, and cleaning solutions. Results: Out of 92 samples collected from various sites, bacterial growth was observed in 47 (51.1%) specimens. Coagulase-negative Staphylococcus (CoNS) was the most common isolate (36.2%), followed by Staphylococcus aureus (34%). Among S. aureus isolates, 43.8% were methicillin-resistant S. aureus (MRSA), and the remaining were methicillin-susceptible S. aureus (MSSA). There was high Gram-negative resistance to meropenem. All the Gram-negative isolates were susceptible to imipenem. Conclusion: CoNS and S. aureus were the commonest isolates. Increased efforts are needed to reduce the rate of healthcare-associated and surgical site infections in operating theaters.

Background: COVID-19 pandemic has had a severe impact on the global economy and the public health systems of all affected countries. Objectives: To understand the challenges (health, cognitive, economic, and psychological) posed by the lockdown for the COVID-19 pandemic on caregivers of children with chronic neurological disorders in Enugu, Nigeria. Materials and Methods: A focused group discussion was done with seven caregiver-patient pairs while observing all precautionary measures. The responses of the participants were recorded, transcribed, and analyzed. Results: There was limited access to physicians to review the children’s health, lack of money for medications with worsening of symptoms in some cases. Some children had forgotten what they had learnt during the previous academic period whereas others had torn their books. The policy imposed hunger on the households. Caregivers lost their jobs, and others had their businesses locked down and were unable to provide food. Children had access to cloth face masks but seldom adhered to its use. The participants were well adapted to handwashing. One participant had access to a hand sanitizer. The lockdown of worship centers conferred a sense of anger, frustration, and hopelessness among some of the participants. Conclusion: The lockdown affected access to health services, interrupted learning, superimposed hunger, and affected the social well-being of the study participants. It is recommended that locally adapted strategies be developed to mitigate unintended effects of health policies on sick children and their caregivers.

Background: Adolescent risky sexual behavior is of a public health concern as most outcomes have long-term negative consequences on adolescents’ health and development. Objectives: This study was undertaken to assess the prevalence and sociodemographic determinants of risky sexual behavior among unmarried adolescents in Nigeria. Materials and Methods: A quantitative cross-sectional study was undertaken in Ebonyi state, Nigeria, using a pre-tested structured interviewer-administered questionnaire. Data were collected from 1045 adolescent boys and girls. Descriptive, bivariate, and multivariate analysis were performed using STATA software. Results: A total of 372 (35.6%) adolescents in the survey ever had a boyfriend or girlfriend. About, 369 (36.0%) had been pressurized by others to have sex, 73 (7.0%) had engaged in multiple sexual partnering, 3.0% had engaged in age-disparate sex, 27 (2.6%) had a one-night stand, and 37 (2.4%) reported they had engaged in nonconsensual sex. Lifestyle risky behaviors that were reported include partying/night clubbing 399 (38.1%), the use of mood-enhancing drugs 319 (30.5%), and alcohol consumption 316 (30.2%). Some sociodemographic factors were significantly associated with multiple sexual partnering, age-disparate sex, nonconsensual sex, and other lifestyle risky behaviors. In logistic regression analysis, gender was a predictor of multiple sexual partnering, age-disparate sex, and nonconsensual sex (odds ratio [OR] = 0.43, confidence interval [CI] = 1.40–3.71; OR = 10.0, CI = 0.03–0.29; OR = 3.0, CI = 0.01–0.14, respectively), while type of place of residence (OR = 1.75, CI = 0.35–0.92) and schooling status (OR = 3.70, CI = 0.13–0.41) were predictors of multiple sexual partnering. Conclusion: Risky sexual behaviors were prevalent among adolescents highlighting the need for strategic SRH interventions that pay close attention to identified drivers that predispose adolescents to unhealthy sexual behaviors.

Background: The causes of upper urinary tract (UUT) obstruction vary from one geographical location to another, and across gender and age. Similarly, the site of obstruction along the ureter varies with the nature of the obstructing lesion. Data in this regard from southeast Nigeria are deficient. Objective: To determine the causes of symptomatic UUT obstruction in southeast Nigeria. Materials and Methods: The medical records of individuals with confirmed UUT obstruction presenting from January 2011 to November 2017 were reviewed for information on the cause and location of obstruction. In addition, the pattern of the obstructions caused by UUT stones was compared across the gender and age of individuals. All statistical analyses were done using SPSS^® version 21. Results: The medical reports of 267 individuals are included for analysis. Overall, urinary stone is the most prevalent cause of UUT obstruction, with a male-to-female ratio of 1.25. From 50 years of age onward, obstructing UUT stones are commoner in females (χ² = 5.03; P = 0.03). In addition, obstructing UUT stones are more common on the right (55.1%) and in the upper ureter (48.9%) in univariate analyses. Congenital pelvi-ureteric junction (PUJ) obstruction is observed to be the most prevalent congenital cause of UUT obstruction. Uterine fibroids in females and advanced prostate cancer in males are also notable causes of ureteric obstruction. Conclusion: Beyond urinary stone and congenitally defective PUJ, uterine fibroids and prostate cancer are other notable causes of ureteric obstruction in southeast Nigeria.

Background: Sickle cell disease (SCD) is an autosomal recessive blood disorder characterized by multiple-organ involvement including the gallbladder. Subjects with SCD are prone to developing pigment gallstones due to chronic red blood cell hemolysis, increased bilirubin levels, cholecystitis, and biliary sludge.Ultrasonography is a noninvasive, readily available, and permits a fast evaluation of the gallbladder. It is useful in establishing the various patterns of gallbladder disease and volume abnormalities. Objectives: The objectives of this study were to sonographically evaluate cholelithiasis and gallbladder volume in patients with SCD and correlate the findings with age and gender. A comparison of the above parameters in sickle cell patients was also made with apparently healthy controls. Materials and Methods: This was a prospective study of 150 patients with SCD and an equal number of apparently healthy control subjects in Benin City. Each subject was sonographically evaluated for possible gallbladder stones and its volume using a 3–5 MHz curvilinear array transducer with a SonoaceX4 ultrasound machine (Medison, Seoul, South Korea). Result: The prevalence of cholelithiasis among subjects with SCD in this study was 10%. Patients with SCD had a significantly higher mean gallbladder volume (34.50 ± 20.43 cm³) compared with apparently healthy control subjects (20.39 ± 10.71 cm³; P = 0.000). Conclusion: The prevalence of cholelithiasis in SCD was shown to increase with age. There was a positive linear correlation between the incidence of cholelithiasis and gallbladder volume with age of the patient.

Background: Preeclampsia (PE) is a pregnancy-specific condition, with a serious impact on the health and quality of life of both mother and child. PE is a multisystem progressive disorder that occurs following placental and maternal vascular dysfunction and resolves postpartum over a variable period of time. Objectives: The study was aimed to determine the incidence as well as the perinatal and maternal outcomes of PE at the Lagos University Teaching Hospital (LUTH), Nigeria. Materials and Methods: This was a retrospective review of patients managed in the labor and postnatal wards of the LUTH, Idi-Araba, Nigeria, over a 5-year period. A study proforma was used to collect relevant data which were entered and analyzed using the IBM Statistical Package for Social Sciences (SPSS Statistics) Version 23. Results: A total of 426 pregnancies were complicated with PE giving an incidence of 10.2% of all deliveries during the study period. Several maternal complications recorded included: acute kidney injury (1.9%), abruptio placentae (2.1%), postpartum hemorrhage (2.4%), maternal mortality (3.8%). The perinatal mortality rate was 16.7%, and 35.4% of the live births required neonatal intensive care unit admission. Conclusion: PE contributed a sizeable proportion of deliveries in LUTH, Nigeria during the study period. It also played a significant role in maternal and perinatal complications.

Mammary ductal ectasia (MDE) is both rare and benign in children. Less than 50 cases have so far been reported in the literature. It often presents as bloody nipple discharge (BND) and results in significant parental anxiety. Although mostly thought to be developmental in origin, the practice of pressing breast swellings in neonates and infants could potentially predispose the breast tissues to infection. Lack of awareness of MDE among healthcare providers may result in unnecessary, expensive, and even invasive investigations. We report a case of MDE presenting as BND and subclinical mastitis in a 5-month-old girl.

Winged scapula is most commonly caused by injury of the long thoracic nerve which results in paralysis of the serratus anterior muscle. Scapular osteochondroma is uncommon and rarely presents as winged scapula in the skeletally matured patients. We report a 9-year-old female with progressive winging of the left scapula due to osteochondroma on its costal surface. The clinical diagnosis of the cause of the scapular winging was difficult because the tumor was non-palpable, mainly cartilaginous, and not visible on a plain radiograph but was unraveled with ultrasonography. Diagnosis of osteochondroma in a pre-teen is unusual but should be considered in the differential diagnosis for static-winged scapula in a child.