BINGHAM JOURNAL OF MEDICINE

Bingham Journal of Medicine Vol. 1, No. 1, January–June, 2017

BINGHAMJOURNAL OFMEDICINE

PUBLISHED BY

BINGHAM JOURNAL OF MEDICINE

Volume 1 Number 1 January–June 2017

ISSN XXXXXXXXX

(See full Table of Contents in English on Page i)

MEMORANDUMServe the Lord Truly by Serving HumanityEldryd H. O. Parry

RESEARCH ARTICLESDysglycaemia among Adult Outpatients in Banjul, The GambiaB. C. Nkum, F. B. Micah, T. C. Ankrah, O. Nyan, A. E. Ohwovoriole

Relaxative Effect of Cold Water Stem-Bark Extract of Erythrophleum suaveolens on Frog Rectus AbdominisT. O. Ogundeko, M. I. Builders, E. A. Ogbole

Hepatitis B and C Viral Infections among Clinical Medical Students in Jos, North Central NigeriaY. J. Peters, S. Ramyil, D. D. Freeman, A. H. Isa, A. S. Anzaku, M. I. Builders, A. M. Yakubu

CASE REPORTSevere Acute Maternal Morbidity Associated with Septic Abortion: A Case ReportA. Mustapha, S. David, A. G. Adebiyi, A. Bashir

LETTER TO THE EDITORRenal Failure and Haemolysis in a Two-Year-Old Child due to Black Water Fever Or Naphthalene PoisoningY. Mava, A. L. Ohadike, A. M. Yakubu



TABLE OF CONTENTS

GENERAL INFORMATION v

INFORMATION FOR AUTHORS vii

EDITORIAL ........................................................................................................................................................................................... 1

MEMORANDUM

Serve the Lord Truly by Serving Humanity...................................................................................................................................... 3Eldryd H. O. Parry

RESEARCH ARTICLESDysglycaemia among Adult Outpatients in Banjul, The Gambia .......................................................................... 8B. C. Nkum, F. B. Micah, T. C. Ankrah, O. Nyan, A. E. Ohwovoriole

Relaxative Effect of Cold Water Stem-Bark Extract of Erythrophleum suaveolens on Frog Rectus Abdominis ............... 15T. O. Ogundeko, M. I. Builders, E. A. Ogbole

Hepatitis B and C Viral Infections among Clinical Medical Students in Jos, North Central Nigeria ................................. 19Y. J. Peters, S. Ramyil, D. D. Freeman, A. H. Isa, A. S. Anzaku, M. I. Builders, A. M. Yakubu

CASE REPORT

Severe Acute Maternal Morbidity Associated with Septic Abortion: A Case Report .............................................................. 23A. Mustapha, S. David, A. G. Adebiyi, A. Bashir

LETTER TO THE EDITOR

Renal Failure and Haemolysis in a Two-Year-Old Child: Black Water Fever Or Naphthalene Poisoning? ........................... 26Y. Mava, A. L. Ohadike, A. M. Yakubu

INDEX TO VOLUME 1, NO. 1, 2017

Author Index ................................................................................................................................................................................. 29Subject Index ................................................................................................................................................................................ 29

COLLEGE NEWS ...................................................................................................................................... xiii

i

Cover Picture:The Unique Riyom Rock Formation, one of the several wonderful rock formations of JosModified from Source: http://omgvoice.com/lifestyle/rock-formations-jos-plateau-state/

Bingham Journal of Medicine Vol. 1, No. 1, January–June, 2017ii


TABLE DES MATIÈRES

INFORMATION GÉNÉRALE v

INFORMATION POUR AUTEURS vii

NOTES DE RÉDACTION.......................................................................................................................................................................... 1

MÉMORANDUM

Serve the Lord Truly by serving Humanity; Graduation Ceremony, Bingham University, Karu, Nasarawa ....................... 3Eldryd H. O. Parry

ARTICLES DE RECHERCHE

Dysglycémie chez les Adultes Externes à Banjul, Gambie ........................................................................................................ 8B. C. Nkum, F. B. Micah, T. C. Ankrah, O. Nyan, A. E. Ohwovoriole

Effet relaxant de l’eau froide Extrait de la tige-écorce d’Erythrophleum suaveolens sur le Rectus Abdominus de lagrenouille ............................................................................................................................................................................................. 15T. O. Ogundeko, M. I. Builders, E. A. Ogbole

Infections virales des hépatites B et C chez les étudiants en médecine clinique de Jos, Centre-Nord du Nigeria ........... 19Y. J. Peters, S. Ramyil, D. D. Freeman, A. H. Isa, A. S. Anzaku, M. I. Builders, A. M. Yakubu

RAPPORT DE CAS

Morbidité Maternelle Aiguë Sévère Associée à l’Avortement Septique: Rapport de cas ..................................................... 23A. Mustapha, S. David, A. G. Adebiyi, A. Bashir

LETTRE À L’ÉDITEUR EN CHEF

Insuffisance Rénale et Hémolyse chez un Enfant de 2 ans: Fièvre de l’eau Noire ou Empoisonnement auNaphtalène? ......................................................................................................................................................................................... 26Y. Mava, A. L. Ohadike, A. M. Yakubu

INDEX TO VOLUME 1, NO. 1, 2017Index d’auteur ............................................................................................................................................................................... 29Index des matières. ....................................................................................................................................................................... 29

COLLEGE NEWS ............................................................................................................................................................................... xiii


BINGHAM JOUNRNAL OF MEDICINE

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EDITORIAL LEADERSHIP

The Editor-in-ChiefProfessor Augustine Efedaye Ohwovoriole

Editorial CommitteeA. E. Ohwovoriole

S. AnzakuM. I. Builders

Y. MavaJ. ShuaibuA. Shehu

BINGHAM UNIVERSITY

Vice-Chancellor – Prof. Samuel K. L. FwaDeputy Vice-Chancellor – Prof. O. LadejiAg Registrar – Mr. David OlowolaUniversity Librarian – Pastor J. O. ArosanyinAg University Bursar – Mr. Alianda Watoseninyi

COLLEGE OF MEDICINE

Provost – Professor A. M. YakubuDean, Faculty of Clinical Sciences – Dr. Amos BassiAg. Dean, Faculty of Basic Medical Sciences – Dr. Nuhu AdehDean, Faculty of Health Sciences – Prof. M. T. C. Egri-OkwajiCollele Librarian – Allahde Shehu


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Editor-in-Chief and Editorial OfficeDepartment of Internal MedicineCollege of Medicine and Health SciencesBingham UniversityJos CampusPMB 2172, JosPlateau State, Nigeria.Tel: +234-8032470758


Assistant Editor-in-ChiefSteven Anzaku

Associate EditorsProf. Robinson WammandaProf. Elizabeth Ogboli-NwaforDr. Mustapha BelloDr. Victoria OkojieDr. Samuel Timothy YerimaProf. Barnabas MandongDr. Peter OgedemgbeProf. Victor EmeProf. Samuel AbayomiProf. Amos GadzamaProf. Christian O. IsicheiProf. Solomon S. DanbauchiProf. Lofta B. ChirdanProf. J.P. AmbeProf. O.E. Babalola

Editorial AdvisersDr. Ezra GbajeDr. S.A AdewuyiProf. Alhassan M. YakubuProf. Ayuba I. ZoakaProf. C.A ChamaProf. E.N. SokombaProf. Fidelia Bode-ThomasProf. G.O. OgunrindeProf. Mathias T.C. Egri-OkwajiProf. Oladapo S. Shittu

Editorial CommitteeA. E. OhwovorioleS. AnzakuM. I. BuildersY. MavaJ. ShuaibuA. Shehu

Journal Administrative StaffMusa Eve Aikeh

TypesettingMrs. Lucy O. Ogundepo

Journal and Business OfficeBingham Journal of MedicineCollege of Medicine and Health SciencesBingham University, Jos CampusPMB 2172, JosPlateau State, NigeriaTelephone: +234-8032470758


Liaison OfficeBingham Journal of Medicine Office,Faculty of Basic Medical SciencesBingham University,Karu, Nasarawa State, Nigeria.

THE JOURNALBingham Journal of Medicine ispublished by the College of Medicine andHealth Sciences Bingham University and theBingham Medical Society. The Journalaccepts articles in English.

NOTICE TO SUBSCRIBERSAnnual individual subscription rates inUS Dollars inclusive of postage are asfollows for 2017:

West Africa – $100.00Rest of the world – $150.00

Annual Institutional Rates inclusiveof postage:

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Cheques should be made to BinghamJournal of Medicine and sentto the Editor-in-Chief.

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NOTICE TO ADVERTISERSRequests for information aboutadvertising in BJM should be addressedto the Editor-in-Chief, BJM. Furtherinformation may be found at the websiteof the Journal or from the EIC,bjmedicine @yahoo.com.

NOTICE TO AUTHORSEditorial matters including submission ofarticles for publication written in theVancouver style should be addressed to:

The Editor-in-Chief, BJM,College of Medicine and Health SciencesBingham UniversityJos CampusPMB 2172, JosPlateau State, NigeriaE-mail: bjmedicine @yahoo.com

COPYRIGHT © 2017 BY BJMAll rights reserved. No part of this BJMpublication may be reproduced/stored ina retrieval system, or transmitted in anyform or by any means, mechanical,electronic, photocopying, recording orotherwise without the prior permissionof the Editor- in- Chief of BJM.

DISCLAIMERBingham Journal of Medicine is notliable for statements or claims made byany contributor or advertiser in theJournal. Statements or opinions ofcontributors /advertisers reflect theirown views and do not represent thepolicy of the Journal, its owners or itspublishers. The publication of anadvertisement does not implyendorsement of such a product by BJM, its owners or publishers.

MISSIONThe Bingham Journal of Medicine (BJM),a publication of the College of Medicineand Health Sciences and the BinghamMedical Society, is for clinicians,scientists andothers interested in the fieldof medicine and other biomedicalsciences. The Journalwhich acceptsarticles in English aims to educateclinicians, improve the life and careofpatients, stimulate and disseminatefindings from research in medicine andallied biomedical sciences and relatedareas and provide a forum for thedocumentation and exchange ofinformation in the clinical and biomedicalsciences.

MANUSCRIPTSThe Journal accepts only articles thathave neither been published nor are beingconsidered for publication by any otherjournal. BJM publishes reports of

GENERAL INFORMATION

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experimental and clinical work on allaspects of research in medicine, andrelated subjects and disciplines.Manuscripts must be written in the formsuggested in the Uniform Requirementsfor Manuscripts Submitted to BiomedicalJournals: Writing and Editing forBiomedical Publication by theInternational Committee of MedicalJournal Editors. http://www.icmjc.org/urm_full

A detailed general write-up on“Information for Authors” is given at theICMJE reference (….) . This site/articleshould be consulted by all potential BJMauthors. BJM will publish contributionsdealing with all aspects of medicine andrelated disciplines. Articles submitted toBJM should fall into one of the followingcategories:(a) Original research article(b) Brief communications and case

reports(c) Medical education matters and

issues(d) Reviews and meta-analysis(e) Conference and Workshop reports(f) Supplements(g) Editorials and commentaries(h) Correspondence (Letters)(i) Patient vignettes and quizzes(j) Book Reviews(k) Medical and Health News(l) Miscellaneous (memoranda, prose,

poetry, socio-political issues, etc.).The full manuscript, which should be inUK English (with abstract in both Frenchand English and of no more than 250words), is to be submitted electronicallyincluding full set of tablesand figures.Authors should submit an electronicversion of the manuscript (using pointsize 12 of New Times Roman) andillustrations to [email protected] should be typed double-spaced throughout (including referencesand tables) and sent to the Editor-in-Chief at the above address.

The manuscript should be organisedunder the following sections:(1) Title page; (2) Abstract; Keywords(using MeSH of Index Medicus); (3)Abbreviations; (4) Introduction; (5)Subjects/Participants, Materials andMethods; (6)Results; (7) Discussion;(8)Acknowledgements; (9) Conflict ofInterest (if applicable); (10)

References;(11) Tables; (12) Figures;(13) Legends to Figures.

Appropriate variations from this outlineapply to such contributions asmemoranda, editorials, commentaries,prose and poetry etc. Abstracts oforiginal contributions including casereports should be structured intoBackground; Objectives; Methods;Results, Conclusions, and keywords.

The title page should contain the title ofthe article, the names, highest degree,appointments and affiliations of theauthors as well as a suggested runningtitle and the details of the correspondingauthor.

References citing journal titles shouldbe spelt out as in Pubmed/Medline.Tables and legends should be providedin line with the “Uniform requirements formanuscripts submitted to BiomedicalJournals.” (1)

MANUSCRIPTS STYLEBingham Journal of Medicine publishesreports of experimental and clinical workon all aspects of research in medicine andrelated subjects and disciplines.Manuscripts must be written in the formsuggested in the Uniform Requirementsfor manuscripts submitted to BiomedicalJournals” and as modified by the Journal.A word count must be provided both forabstracts (a maximum of 250 words) andthe main text (exclusive of references,tables and figure legends).

Data are not to be sliced to the size ofthesmallest publishable unit but should bea complete documentation of a study.Contributors are requested to discloseany conflicts of interest that mightbias their work. They shouldacknowledge in the manuscript allfinancial support for the work and otherpersonal connections.

SUBMISSION CHECKLIST FORAUTHORSCorresponding authors should ensurethat:1. The article is typed in Microsoft

Word or other application softwarewidely accessible.

2. All parts of the manuscript are typeddouble-spaced using Times NewRoman with point size 12.

3. Each of the sections is begun on anew page

4. The following sequence is followed:(1) Title page, (2) Abstract,Keywords, (3) Abbreviations, (4)Introduction, (5) Subjects, Materialsand Methods, (6) Results, (7)Discussion, (8) Acknowledgements,(9) Conflict of Interest, (10)References, (11) Tables, (12) Figures,and (13) Legends to Figures.

5. Abstract is structured in no morethan 250 words, (include a wordcount) and if unstructured (videsupra) a maximum of 150 words.

6. Four to ten keywords (from IndexMedicus MeSH) are provided.

7. References, figures, and tables arecited consecutively in text.

8. A set of illustrations clearlynumbered and labelled fororientation is provided.

9. They have included permission toreproduce previously publishedmaterials or permission to useillustration that may identify humansubjects.

10. A cover letter stating the followingis included:i). Originality of workii) Type of article (vide supra)iii) Approval of final copy of

manuscript by all authors. Ifpossible all authors should sign.

iv) Name, postal and e-mailaddresses, telephone and faxnumbers of correspondingauthor.

11. They acknowledge potential conflictof interest and financial support.

12. They keep for their own use a copyof everything being submitted.

13. When finally accepted, they enclosea signed transfer of copyright andother forms.

14. They have submitted an electroniccopy by email to the Editor-in-Chief.

REFERENCEInternational Committee of MedicalJournal Editors uniform requirements formanuscript submitted to BiomedicalJournal. http://www.icmjc.org/urm_full

General Information

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DETAILED INFORMATION FOR CONTRIBUTORS

BINGHAM JOURNAL OF MEDICINE (BJM)

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Mission and ScopeThe Bingham Journal of Medicine (BJM)publishes contributions of professional,scientific and educational interest tomedical practitioners and researchersand those in related disciplines, withspecial focus on medical practice andresearch in Africa and its people. Theaim of the Journal is to provide a mediumfor the dissemination of researchfindings in Africa and elsewhere and topromote co-operation amongst andbetween medical researchers in Africaand the rest of the world. The Journal ispublished in UK English with abstract inboth English and French.

Information about previous publicationManuscripts are considered on theunderstanding that they have neitherbeen published nor are underconsideration for publication by anotherjournal. However, publication of theabstract of the paper elsewhere does notdisqualify the paper from consideration.When there is doubt about possibleduplicative publication, authors shouldattach a copy of the published paper tothe manuscript on submission.

Submission of ManuscriptsThe Journal welcomes papers in theform of original research articles,commentaries, editorials, reviews andeducational materials as well as scientific,socio political and economiccontributions in matters that impact onmedical care, education and research. Anelectronic copy of the manuscript shouldbe sent to:

The Editor-in-Chief, BJM,Professor Augustine Efedaye OhwovorioleDepartment of Internal MedicineCollege of Medicine and Health SciencesBingham UniversityJos CampusPMB 2172, JosPlateau State, NigeriaTelephone: +234-8032470758


Revised manuscript: When revising amanuscript at the request of the Editor-in-Chief, authors should provide acovering letter detailing the response toeach of the points raised by the assessorsor the editors.An electronic proof of the editedmanuscript may be sent to thecorresponding author for corrections onrequest. Such proofs must be returnedto the Editor within three days ofdespatch by the Editorial office.Typographical corrections only shouldbe effected when correcting galleyproofs.

Manuscripts should be prepared inaccordance with the “UniformRequirements Submitted to BiomedicalJournals” (1). The paper should be typedwith 3 cm margins and double spacedthroughout, including illustrations andreferences. Pages should be numberedand word-counts provided for theabstract and the complete paperexcluding the references, tables andlegends. Point size 12 using Times NewRoman should be used throughout themanuscript, using Microsoft Word orother commonly available wordprocessing application.

All contributions are peer reviewed byassessors. Accepted manuscripts maybe copy edited according to the Journalstyle. The authors are responsible for allstatements and claims made in their workand such claims and statements are notnecessarily shared by the editors or thepublisher or owners of the Journal.Similarly, neither the Editors nor thePublishers guarantee any claims madeconcerning advertised products orservices.

The manuscript should be accompaniedby a covering letter, which identifies thecorresponding author and signed by allco authors. Only those who havecontributed significantly should be

included as authors (vide infra). Allauthors should also sign the declarationand copyright when the contribution isfinally accepted. The senior authorshould provide an explanation for any ofthe authors unable to sign.

OffprintsOffprints are obtainable from the Editor-in-Chief at advertised rates. Theseshould be paid for at the time of the finalacceptance of a contribution.

TYPES OF CONTRIBUTIONS

Indicate the type of contribution in thecovering letter as follows (sections A toH):

Section A: Original Research Articles

An original research should concernitself with aetiology, pathogenesis,pathology, diagnosis, management andprevention of medical disorders. Animalresearch contributions which impact onhuman health care are equally welcomein this section. This type of manuscriptshould have a maximum of 4,000 wordsand a maximum total of eight illustrations(Tables and Figures) and no more than30references.

Section B: Brief Communications andCase Reports

Examples of these include unique casereports, clinical experiences, reports ofadverse drug effects, and short reportsof original research. The text should notexceed 1,500 words, with a total of threefigures and/or tables or less; and no morethan 15references. The format should beas for a standard paper.

Section C: Medical Education

Included here are important innovationsin medical education for clinicians as wellas continuing professional improvement.The text length and other requirementsare as for an original research publication.


Information for Contributors

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Section D: Reviews and Meta-AnalysesDetailed systematic and criticalevaluation and meta-analysis of theliterature on clinical practice topics, drugtherapy, mechanisms of disease, currentconcepts on clinical topics, or othertopics of scientific or clinical interest.These will normally be submitted onrequest but the EIC will also entertainunsolicited contributions. The maximumlength should be 5,000 words and shouldcontain sub headings (maximum threesub-sub heads). Maximum number of 60references and 10 Tables/illustrations.

Section E: Conference and WorkshopReports and SupplementsConference and workshop reports shouldnot exceed 5,000 words, and should beedited before submission. Proceedingsof grand rounds are also welcome in thissection. The Journal will also publishspecial issues as supplements upon aproposal having been accepted by theJournal.

Section F: Editorials and CommentariesEditorials and commentaries are normallycommissioned. However, unsolicitedones are welcome and subject to routineassessment. The theme should betopical or on papers published in theJournal. The maximum length should be1,000 words with no more than 20references.

Section G: CorrespondenceLetters to the Editor should contain amaximum of 600 words, five referencesand no more than two illustrations and/or tables. Letters may be on mattersconcerning clinical observations, othermatters of clinical relevance or reactionsto articles published in the Journal.Correspondence should be typed double-spaced and submitted in duplicateby e-mail. Accepted letters may be editedbefore publishing.

Section H: MiscellaneousThese include book reviews, prose (100words) and poetry (60 lines), sociopolitical issues related to medical careand personal opinion or issues for debate(maximum 2,000 words).

MANUSCRIPT FORMAT AND PRE-PARATIONType the manuscript in UK English withdouble spacing all throughout . Thepaper should be set out as follows: (a)Title page, (b) Abstract, (c) Keywords,(d) Abbreviations (d) Text [Introduction;Subjects/Participants, Materials andMethods; Results and Discussion], (e)Acknowledgement, (f) Duality ofInterest, (g) References, (h) Tables, (i)Figures, and (j) Legends to figures andTables.Number the manuscript pagesconsecutively starting from the title pagethrough the tables. Each of thesesubsections should be started on a newpage in the sequence given above.

Title PageThe title page should contain (i) the titleof the manuscript, (ii) initial(s) andsurname of each author, and theiraffiliation; (iv) name, postal and e-mailaddresses of corresponding author, (v) arunning title of not more than 40characters , (vi) financial supportinformation (e.g. agency, grant number).Avoid use of abbreviations in the title.Provide a word count of both the abstractand the main text at the bottom of thetitle page.

Abstract PageThe abstract should either be structured(maximum 250 words) or unstructured(150 words or less) depending on the typeof article. Articles that need structuredabstracts include original researchpapers, case reports, reviews and metaanalyses and brief reports. Othercontributions may be provided only witha 150-word summary in the conventionalmanner. In any event the abstract shouldinclude the purpose, methods, resultsand conclusions. Editorials,correspondence, commentaries, proseand poetry and similar contributionsshould not carry abstracts.

Structured abstracts should be providedas follows:(i) abstract for original contributions,

case reports and brief reportsshould consist of the followingsections: (a) Background andobjectives, (b) Methods which

should include design, participants,materials, setting and measurements(c) Results and (d), Conclusions.

(ii) A review article abstract (includingmeta-analysis) should be organisedinto the following sections: (a)Background/Purpose, (b) Datasourcem (c) Study selection, (d) Dataextraction, (e) Results, and (f)Conclusions.

Keywords: Provide four – ten keywordsor short phrases that can be usedfor indexing, immediately followingthe abstract. Use terms from IndexMedicus Medical Subject Headings(MeSH).

GUIDELINES ON STYLE

Headings in Text: Use a maximum of theelevels of sub-headings.

Abbreviations should be sparingly usedand only to save space and avoidrepeating long names or regimes usedmore than once. In a figure or table, definethe abbreviation in a foot note. List in analphabetical order all non-standardabbreviations (with definitions) containedin the text after the keywords. Acceptedabbreviations can be used withoutdefinition. Avoid abbreviations can beused without definitions. Avoidabbreviations in the title, running title,titles of illustrations, and at the start of asentence.

Drugs should be indicated by theirgeneric names but not trade names exceptfor drugs showing adverse reaction orthose used in comparison of differentpreparations of the same agent. In thelatter case give the generic name followedby the proprietary name and themanufacturer in brackets.

Tables should be submitted one each ona separate page, typed doubled line-spaced, and numbered and referred to inthe text by Arabic numerals. Theirapproximate positions in the text shouldbe indicated. A brief title describing thecontent in the table should be supplied atthe top. Tables should be created usingthe tables function of the word processing



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software Microsoft Word, not aspreadsheet.

Give each column of the table a shortheading. The units in which results areexpressed should be given in brackets atthe head of each column. Placeexplanations in the footnotes but not inthe heading. For footnotes, use thefollowing symbols in the given sequencein order from left to right or from top tobottom in the body of the Table *, †, ‡, §,¶, **, ††, ‡‡, §§ etc. No internal horizontalor vertical rules should be used in thetable. If a table must extend beyond apage, repeat the title followed by “contd”and repeat the column headings.

Illustrations or photographs should beblack and white glossy prints of veryhigh quality. However, professionallymade line drawings are acceptable asphotographic prints. Original drawings,X ray films etc. are not acceptable.Illustrations should not be larger than anA4 size. Letters, numbers and symbolsshould be even and clear throughout andof sufficient size that when reduced forpublication each item will still be legible.Illustration title and explanatory notesshould be in the respective legend andnot in the figures themselves.

Provide photomicrographs with stainingtechniques, internal scale markers and/or a statement of magnification.Symbols, arrows, or letters used in thephotographs should contrast with thebackground.

Figures should be numberedconsecutively in Arabic numeralsaccording to the order in which theyhave been cited in the text. Patientsshown in photographs should have theiridentity concealed or should have giventheir written consent for publication.Materials taken from other sources mustbe accompanied by a written permissionfor reproduction by the publishers orcopyright holder.

Colour Figures will only be published atthe expense of the authors. Authorsshould write to inquire from the Editor-in-Chief.Pertaining to each figure,authors should write the figure number,

the name of the senior author, the runningtitle and an arrow to indicate the top edge.Footnotes are only allowed on the titlepage and in tables, but not within the text.Footnote symbols should be used in thefollowing order, horizontally and/orvertically: *, †, ‡, §, ¶,**, ††, ‡‡, §§ etc.Use of numbers or letters is notacceptable.

Legends for Figures: Type each legendfor an illustration double-spaced, startingon a separate sheet, with Arabicnumerals corresponding to the figure.This should start with a short title,followed by a short, cryptic descriptionof the legend. All abbreviations andsymbols should be explained in thelegend. Magnification and stain for anymicrophotograph should be given at theend of the legend for the figure, whereappropriate.

UNITS OF SCIENTIFICMEASUREMENTSPresent units of scientific measurementsin the units in which the research wasconducted (with the conventional or SIequivalents in parentheses) in the text.In a table or figure, a conversion factorshould be provided as a footnote

ACKNOWLEDGMENTSAcknowledgement of general, financialand material support or technical andsecretarial help etc. should be indicatedat the end of the main text. It is theresponsibility of the authors to obtainconsent of those being acknowledged.

REFERENCESThe references should be numbered assuperscripts in the order in which theyappear in the text, tables, or legends.References should be in the Vancouverstyle, as laid down in the “UniformRequirements for manuscripts submittedto Biomedical Journals (1)”.

At the end of the article the full list ofreferences should give the surname andinitials of all authors unless there are morethan six, when only the first six shouldbe given, followed by et al. The author’sname should be followed by the title ofthe article, the title of the Journal

abbreviated as in Medline, the year ofpublication, the volume number and thefirst and last pages. For books, thereferences should follow the followingformat: the author, title of book, place ofpublication, the publisher, the year andthe relevant pages. Journals not listed inMedicine should be spelt out in full.

Examples of ReferencesI. Journals: List all authors when six orfewer; when seven or more, list first sixand add et al1. Standard article:Adeja M, Moses J,

Emuh P. Effect of Exercise onGlycaemic Control in Patients withType 2 Diabetes Mellitus. Bing J Med2016; 1: 45 –49.

2. Standard article: Adeja M, Moses J,Emuh P, Williams MK, Odjede YT,Okums GK, et al. }revalence ofhypertension among SecondarySchool Students in Jos Metropolis.Bing J Med 2016; 2: 67–71.

3. Books: List all authors or editorwhen six or fewer: when seven ormore, list the first six and add et al.

1. Author of a BookMakamer EN. Diabetes mellitusfor Medical Students. 6th ed.Nairobi. Princess Publisher;1990.

2. Chapter in a BookPhillips SI, Whisnant JP.Hypertension and stroke . In:Laragh JH. Brenner BM, editors.Hypertension: pathophysiology,diagnosis and management. 2nded. New York. Raven Press; 1995.p. 465 – 78.

4. Volume with SupplementShen HM, Zhang QF. Riskassessment of nickel carcino-genicity and occupational lungcancer. Environ Health Perspect1994;102 (Suppl ): 1275–82.

5. Issue with supplementPayne DK, Sullivan MD, MassieMJ. Women’s psychologicalreactions to breast cancer. SeminOncol 1996; 23(1 Suppl 2): 89–97.



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6. Volume with partOzben T, Nacitarhan S, Tuncer N,Plasma and urine sialic acid innon-insulin dependent diabetesmellitus. Nig Ann ClinBiochem2014; 32(Pt.3):33–56.

7. Type of article indicated as neededEnzensberger W, Fischer PA.Metronome in Parkinson’s disease(letter). Lancet 1996; 347:1337.

8. Personal author(s)Ringsven MK, Bond D. Gerontologyand leadership skills for nurses,2nd ed. Albany (NY). DelmarPublishers; 1996.

9. Editor(s), compiler(s) as authorNorman IJ, Redfern SJ, editors.Mental health care for elderlypeople. New York. ChurchillLivingstone; 1996.

10. Conference proceedingsKimura J, Shibasaki H, editors.Recent advances in clinicalneurophysiology. Proceedings ofthe 10th International Congress ofEMG and ClinicalNeurophysiology. 1995 Oct 15-19,Kyoto, Japan. Amsterdam: Elsevier,1996.

11. Conference paperBengtsson S, Solheim BG.Enforcement of data protection,privacy and security in medicalinformatics. In: Lun KC, DegouletP. Piemme TE, Rienhoff O, editors.MEDINFO 92. Proceedings of the7th World Congress on MedicalInformatics 1992 Sep 6-10: Geneva,Switzerland. Amsterdam: NorthHolland, 1992. p.1561 – 5.

12. DissertationChaplain SJ. Post-hospital homehealth care: the elderly’s accessand utilization (dissertation). StLouis (MO): Washington Univ.1995.

13. The Holy Bible. King Jamesversion. Grand Rapids (MI):Zondervan Publishing House;1995. Ruth 3:1 – 18. 1973.

Electronic Material13. Journal article in electronic format

Morse SS. Factors in theemergence of infectious diseases.Emerg Infect Dis (serial online)1995 Jan-Mar (cited 1996 Jun 5);(1):(24 screens); Available from:URL: http/www.cdc.gov/ncidod/EOD/eid.htm.

14. Monograph in electronic formatCDI, clinical dermatologyillustrated (monograph on CD-ROM), Reeves JRT, Maibach H.CMEA Multimedia Group,producers. 2nd ed. version 2.0 SanDiego. CMEA: 1995.Hemodynamics III the ups anddowns of hemodynamics (computerprogram). Version 22. Orlando(FL). Computerized EducationalSystems, 1993.

15. Journal article on theInternet[Edited 12 May 2009]Amos BM. Quality improvementinitiative in nursing homes: the ANAacts in an advisory role. Am J Nurs[Internet]. 2002 Jun [cited 2002 Aug12];102(6):[about 1 p.]. Availablefrom: http://www.nursingworld.org/A J N / 2 0 0 2 / j u n e /Wawatch.htmArticle

For full reference information seeReference 1 given below. It is theresponsibility of authors to ensure theaccuracy of cited references.

ETHICAL CONSIDERATION1. Consent:All manuscripts reporting

experiments in human beings mustbe accompanied by a statement inthe method section that the authorshave complied with the requirementsof the local ethical committee. Ifinvestigators have no access to anethics committee, the principlesoutlined in the Helsinki Declaration(2) should be followed. Avoid usingpatient’s names, initials or hospitalnumbers. If full-face photographsare to be used, such photographsmust be accompanied by a signedor thumb printed informed consentof the person. Animal experimentersmust also follow the institution’sguidelines on the use of laboratoryanimals in research.

2. Criteria for AuthorshipThe criteria for authorship are asexpressed in the UniformRequirements (1) which state that“authorship credit should be basedonly on substantial contribution to”:

(a) conception and design, oranalysis and interpretation ofdata;

(b) drafting the article or revising itcritically for importantintellectual content;

(c) final revision of the version tobe published.

Authors should meet conditions a,b, and c. Collecting and assemblingdata reported in a paper are not, bythemselves, qualifications forauthorship. The corollary alsoshould not be over looked i.e. thosewho meet criteria for authorshipshould not be excluded.

3. Conflicts of InterestAuthors should list all financialsupport, including equipment anddrugs on the title page. Details offinancial interest that mightinfluence the conduct or reportingof the study should be given in thecovering letter. Referees (assessorsof articles) should also inform theeditor of any possible conflict ofinterest.

4. Previous and RedundantPublicationsManuscripts that overlapsubstantially with previouspublications should not besubmitted for consideration.Publication of the abstract arisingfrom a conference does notdisqualify the paper. Authors shouldsubmit a copy of potential duplicatepapers to the editor.

5. CopyrightOn acceptance, the copyright of thepaper will be vested in the Journal/Publisher. All authors of themanuscript are required to sign the“Statement to be signed by allauthors” and the transfer of thecopyright.


DOCUMENTS CITED1. International Committee of Medical

Journal Editors. Uniform require-ments for manuscript submitted toBiomedical Journals.http://www.icmjc.org/urm_full

2. 41st World Medical Assembly.Declaration of Helsinki’s recom-mendations guiding Physicians inBiomedical Research and involvinghuman subjects Bulletin Pan-American Health Organisation.1990;24: 606–9.

The Editor-in-Chief, BJM,Professor Augustine Efedaye Ohwovoriole

Department of Internal MedicineCollege of Medicine and Health SciencesBingham University, Jos CampusPMB 2172, Jos, Plateau State, NigeriaTelephone: + 234-8035378642E-mail: bjmedicine @yahoo.com

http://icmje.org/recommendations/browse/manuscript-preparation/sending-the-submission.htmlThe titles of journalsshould be abbreviated according to thestyle used for MEDLINE(www.ncbi.nlm.nih.gov/nlmcatalog/journals

Style and FormatReferences should follow the standards

summarized in the NLM’s InternationalCommittee of Medical Journal Editors(ICMJE) Recommendations for theConduct, Re-porting, Editing andPublication of Scholarly Work inMedical Journals: Sample References( w w w . n l m . n i h . g o v / b s d /uniform_requirements.html) webpageand detailed in the NLM’s CitingMedicine, 2nd edition (www.ncbi.nlm.nih.gov/books/NBK7256/).Dinyain A,Omoniyi Esan GO, Olaofe OO, SabagehD, Komolafe AO, Ojo OS. Autopsycertified maternal mortality at Ile Ife,Nigeria. Int J Womens Health 2013; 6:41 6.


xi


Editorial

1


We are most delighted to introduce toyou the maiden edition of the BinghamJournal of Medicine (BJM), a publication ofthe College of Medicine and Health Sciencesof the Bingham University and the BinghamSociety of Medicine.

Our mission is to provide a forum forthe dissemination and sharing of researchfindings that will enable all serve humanitybetter. In so doing, we would be bringing thefruits of “studying for excellence and wisdom”to the calling of our profession.

In this maiden edition, Professor Parryaddresses our first medical graduates, the coremessage of which is the need to serve theLord through service to humanity. Nothingcould be more apt for any academic orpractising christian doctor.

The birth of BJM coincided with theinduction of our first set of doctors. It wasworth celebrating. However, the celebrationswere almost marred by the death ofProfessor Felix Idowu Anjorin, the idefitigablepioneer Provost of our Medical School and

a former Vice-Chancellor of the BinghamUniversity. His loss could not have come at amore difficult time, a few days to theemergence of his first set of medicalstudents.

Diffult to question why the Lord calls ata particular time. Professor Anjorin did andsacrificed everything to ensure the take-offand sustainance of the Medical School. Aswe mourn his departure in the manner goodchristians do, we are consoled that Felixfought a good fight. He accomplished hismission. The rest – knowing him – is to beat peace with his maker, having servedhumanity and the Lord.

We can use the Bingham Journal ofMedicine to serve our Lord through servinghumanity. Join us in this unique service to theLord through studying for excellence and wis-dom by sharing your research findings withus.

We invite you to submit your learnedarticles to BJM as we set out to make adifference.

Professor Augustine E. OhwovorioleEditor-in-Chief, BJM

PAYINGTHROUGH BJM BANKACCOUNT

ACCOUNT NAME: BINGHAM JOURNAL OF MEDICINE

ACCOUNT NUMBER: 0058392738

NAME OF BANK: DIAMOND BANK OF NIG. PLC.

BRANCH: DIAMOND BANK PLC,

13, COMMERCIAL AREA,

JOS, PLATEAU STATE

SWIFT CODE: CITIGB2L



invites

Researchers to submit the reportsof their

findings for publication in theBJM.

BJM is peer-reviewed,uses the Vancouver guidelines.

Turn-around from submission to publicationwill be optimum.

Professor Augustine E. OhwovorioleEditor-in-Chief, BJM


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Serve the Lord Truly by Serving HumanityAn Induction Address to the First Medical Graduates of the College of Medicine and

Health Sciences by Professor Sir Eldryd H. O. Parry, Founder of Tropical Health andEducation Trust on 19th March 2015, at

Bingham University, Karu, Nasarawa State, Nigeria


Mr. Vice-Chancellor, Provost College of Health Sciences,Registrar Nigeria Medical Council, friends, colleagues; I amdeeply honoured by your invitation to give an address at thishistoric occasion and to share with you the triumph whichyour University celebrates today, yet while it is a time ofcelebration it is also a time for reflection for all of us. Many ofyou will know the reason for this statement. My invitation toaddress you today was sent, on behalf of the University, by mydear friend, my colleague and my former student, but also mybrother in Christ, Professor Felix Anjorin. His earthly race hasbeen run, he now enjoys the invitation to enter the joy of hisLord, welcomed with wonderful words, “Well done, good andfaithful servant”. We celebrate the University which hestruggled to develop, we celebrate you, the graduates whomhe and many others have laboured to educate and equip. Henow joins the great cloud of witnesses before whom we whoremain are called to run the race set before us with endurance,the race which Professor Anjorin has now run, and the racewhich, with his example, we must run, as the writer to the Hebrewsurges us, “looking unto Jesus”.

Professotr Anjorin’s invitation to me gave an outline ofwhat he wanted me to say in my address; I quote his words -“to challenge our young graduates to ensure that they servethe Lord truly by serving humanity in ways that bring glory toour Lord and Saviour Jesus Christ and dignifying tohumanity.” I shall now try to do this and to put his instructionsinto words which you will remember and which I hope will helpand guide you in the years of professional life which stretchout before you.

First this morning, I should like to congratulate those whohad the vision to dream of the possibility of Bingham Universityproducing its own medical graduates, and who then had thecourage and the resolve to put their shoulders to the task. Iknow well the demands of a new medical school, I know wellthe difficulties, I know well the disappointments, but I alsoknow the delight of success, the celebration of achievementand the exultation of the community which surrounds the firstgroup of graduates. We celebrate today not only the graduates,but their proud mothers and fathers and their families.

My address has three parts, first what it means to be adoctor, second what must characterize a Christian in the twentyfirst century and third, how the graduates of Bingham can beexamples of service to the people of Nigeria in the years ahead,by marrying the chief lessons of the first two parts.

Our Secondment to UCH IbadanI want, however, before we consider these critically

important matters, to tell you a little about my experience ofyour country.

In 1960, two weeks before the Nigerian flag was raisedover a newly independent Nigeria, my wife of a little less thanthree weeks and I disembarked at Apapa wharf after sailingfrom Liverpool in the United Kingdom. We came to thedepartment of medicine at University College Hospital, Ibadan,on secondment from my post at the Hammersmith Hospital,Royal Postgraduate Medical School, London. UCH Ibadan hadall the intensity of a fine teaching hospital and, before the endof that year, it enjoyed all the wonder of producing the firstindigenously trained Nigerian doctors. We practised classicalclinical medicine with a strong scientific base and so,unconsciously, we set a standard for all subsequent medicalschools in Nigeria.

We came to Nigeria expecting to stay for only one yearbut l loved our teaching hospital work and, although thesecondment was officially for one year, it became two and ahalf years. Those years irrevocably changed our lives and sentus back to my post in London with the hope perhaps of returning.Then, in our second year in London, when I was putting thefinal touches to my doctoral thesis on Endomyocardial Fibrosis,I was asked whether I would be interested in taking a teachingpost in the new Haile Sellassie I University Medical School inAddis Ababa, Ethiopia. After a prospective visit to the country,and with the support of the Wellcome Trust, we accepted theinvitation to leave a career in the United Kingdom; our littlefamily flew to Ethiopia in January 1966.

It was the very beginning of Ethiopia’s own medical school,just as Ibadan had been. All that we did was new, and yet ourmodel was the classical model of a scientifically based modernmedial school. There was little space for innovation, ourresponsibility was to establish a medical school which wouldprovide the country with the doctors that it so desperatelyneeded. Those who have not had to go through the prolongedlabour of a new medical school may assume that innovation iseasy; it is never easy, primarily because the medical professionresists change and because statutory bodies, which have toapprove new ideas because they are responsible for nationalstandards, prefer safety and convention over risk andinnovation.

Academic medicine in those cooler highlands was

3

MEMORANDUM


intensely interesting and, importantly, wealso thrived as a family. The ancientculture, the raw disease, and theopportunity to shine the light of clinicalscience on historic plagues such aslouse-borne relapsing fever, provided aclinical and cultural feast.

Invitation to ZariaWe had always wondered whether

we might return to Nigeria, not leastbecause we had seen a note in the Lancetabout a new medical school in Zaria.Then, to our astonishment, in the middleof our third year in Ethiopia, I had a letterfrom the Vice Chancellor of Ahmadu BelloUniversity, Zaria, Dr Ishaya Audu, apaediatrician whom I had met in Londonwhen he was doing postgraduate training;his letter invited me to come to Zaria asProfessor of Medicine. It was a dark time,war raged and Lagos was empty ofvisitors when I flew from Addis Ababa inJuly to see Dr Audu in Zaria. It did nottake us long to accept the invitation and,although it was very hard indeed to saygood bye to so much in Addis Ababa, weflew directly across Africa to Lagos andthen on to Kaduna in February 1969.

While we celebrate new graduatestoday, we should at the same timecelebrate that great Nigerian, that finepaediatrician, that single-mindedChristian, Professor Ishaya Audu. AsVice-Chancellor of ABU he insisted thatthe University would serve areas of thecountry which desperately needed skilledand trained people. I was a member ofthe Admissions Committee of the Facultyof Medicine, which often sat late into theevening as we grappled with dis-advantage and as we tried to find fair andpractical solutions for admission. I hadto learn the map of Nigeria intimately andparticularly the minority areas of muchof the country. It was our policy thatthose with less privilege and withoutearly advantages could gain admissionand would not be crowded out bystudents who had enjoyed goodsecondary education at the many goodschools from which they could choose.At no stage did we compromise minimumand basic standards. It was a necessary,humane and strategic policy. Amongstthose early students in the MedicalFaculty in Zaria were some of the pioneer

teachers here at Bingham University. Thepioneer students in Zaria proved that theproducts of a new medical school set thetone for its future and for the reputationwhich it may acquire. It is they, not theirteachers, who are its ambassadors andwho will thus be used by outsiders tojudge whether it is successful. Binghamwill be judged by you, by today’sgraduates.

The Zaria Pattern of EducationI emphasise that the training at

UCH, Ibadan, was the best that a classicalclinical training could be; while we weredetermined to do this also at ABU, wealso resolved to consider our patients inthe context of their home, their family,their village. When clinical teaching waswell established, Oxfam gave us aPeugeot pick up which we modified totake students so that on Fridayafternoons I was able to go with a load ofstudents to the home of a patient, or wewould take a patient who was ready toleave hospital to their home. I wanted ourstudents to try to understand, and insome cases even to cost, the burden onthe patient of their disease, or the burdenof having to return to hospital. For somestudents this was a new experience ofrural reality, indeed one student once saidto me when we were in a remote village,“I did not know that there were all thesepeople here”. In those days we did nottalk about poor people, we just servedthem, whereas now, the business ofdevelopment both numbers and measurespoverty and its obliteration within itstargets.

I have given you this short historyso that you can put your own trainingand education here at Bingham in thecontext of the wider development ofrelevant medical education in Nigeria.

Essential Values for a DoctorAllow me to ask you a question;

how in your practice in the twenty-firstcentury, can you put your ideals as a newmember of our ancient and I hope, stillrespected, profession?

Let me give you some absoluteessentials; I have not set them in theirorder of importance, but they have alogical sequence, yet they are still justmy list.

First, you will work hard andconscientiously; you will not look forevery little opportunity to cut corners, tobe less than thorough, to scribblesomething in a case note folder insteadof writing carefully and legibly.

The Health TeamSecond, you will work with yourcolleagues as a member of a team, andnot just as an individual. Medicine ischanging all over the world; the era ofthe unchallenged individual has passed.In any forward looking and scientificmedical school there is no place for asenior physician, for example, who speaksdogmatically, who goes unchallenged,and who denies his students theopportunity to think. Today’s physicianmust now bring evidence to support whathe says, or to refute what someone elsehas proposed. This leads to a healthyenvironment of enquiry and learning, aquestioning and critical approach toclinical evidence, which is an ideal culturemedium for tomorrow’s doctors.

In the medicine of today, howeversenior an individual may be, that man orwoman is no more than one member of ateam, of which they may or may not bethe leader. You will have to workalongside others in a clinical orcommunity team and you will have tolearn to respect the other members of theteam and the parts that they play. Let meillustrate this from my current experiencein Ethiopia where, based upon two ruralteaching hospitals, my colleagues DrYoseph Mamo and Dr Shitaye Alemuhave pioneered the rural care of patientswith chronic disease, for examplerheumatic heart disease, epilepsy,diabetes. This decentralized programmeis revolutionary for poor village patients;they are saved the cost and thedisruption of travel to a health centre,thus their follow up improves and theylearn to trust the health team at their localhealth centre. The programme is led by ateam and not by an individual and theoverall supervision and training of thestaff at the health centres are givenprimarily by our managing nurse. I havesat with him in a health centre clinic andhave been amazed at his clinicalantennae, his understanding of thediseases, and his good relationship with

Eldryd H. O. Parry To serve humanity is to serve the Lord


his patients and colleagues. Through thetraining given to them by this nurse, thenurses, pharmacists and health officersat health centres have become part of anessential clinical team. If each of youcould have seen such a professionalindividual, you would have needed nopersuasion that you could learn withinthat team. I hope that all of you are readyto learn from such people.

Third, if you are the leader of a team, youwill do all you can to bring the best outof everyone in the team. Thus you willnot exercise hard authority over theothers, rather you will encourage itsmembers, you will help each one tocontribute their part, you will make eachone feel valued. Then and only then willthey in their turn give of their best.

Let me tell you a story: when I wasworking at ABU Hospital, Zaria, I was toohard on some of the juniors and too readyto be critical of them. I still have to becareful as I can find myself being toocritical of colleagues even now. One day,two of my junior colleagues came to meand said that I should not be too hard onthem. It was brave of them to warn me; Iwas deeply humbled by their approachand I went away, like Peter, and weptbitterly. They did me a great service, theywere not angry, rather they just wantedto help me to relate to them and the otherjuniors in a positive and good way.

Fourth, you will treat your patients withthe same courtesy whoever they are, adaily paid labourer or a high rankingofficial. Allow me to ask you, are you abig enough person to be able to relate toa really poor patient? Will you be readyto give dignity to the weak andinsignificant, will you treat them as realpeople, mothers, fathers, orphans,whoever they are?

Let me give you an example; in thefirst few years at ABU we took ourstudents across the country to Adamawa,from Zaria to the leprosy hospital inGarkida, to learn from the great Dr RoyPfaltzgraff. I only remember one patient;he had lost the fingers of both hands toleprosy, he was illiterate, the sort ofperson who could be quietly forgottenand disregarded. But Dr Pfaltzgraff had abetter way, he saw this poor and deeply

disabled man as a precious person, a manfor whom Christ died, a man who couldbe served and whose humanity could bedignified through such service, if I mayagain use Professor Anjorin’s words.Pfaltzgraff gave the man without fingers,poor and insignificant as he was, a jobwhich he could do, of which he could beproud, and through which he would havehis own part to play in the economy ofthe leprosy hospital. He was made thebell ringer; unable to hold the ropewithout fingers, he could bend his armand hold the bell’s rope in the bend ofhis elbow. Now he was a person whocould hold his head high; what medicine,what humanity, what dignity!

Continue to LearnFifth, you will recognise that yourlearning has only just begun; do not stopyour reading and your study. Learn tolove your work, get excited aboutlearning, about meeting new andinteresting clinical problems, aboutgrowing up as a young enquiring doctor.As a more mature learner, you will takeresponsibility for your own learning. Donot wait to be taught by others, set asidetime to learn. Much of medicine is visual,and there is no short cut for clinicalexperience. As part of this learning, youwill be ready to admit your mistakes,which will be difficult if, in your culture,you will expect to be respected andadmired. It will be difficult for those ofyou who like to be right and who like toshow others that you are right, this maybe a very troublesome part of yourlearning.

As you learn, so you will want tocontribute academically to yourprofession, and practically to the care forwhich you are responsible

EnduranceSixth, you will have to learn not to giveup when the going is hard, when youseem to be stuck, both because there isso much work to do and because youfeel burdened by its demands on yourtime, on your mind and on your leisure,and when circumstances are against you,whatever these may be. Last week I rereada letter that I received from Dr IshayaAudu only two years before he died; hewrote that very few Christian preachers

warned that believers would, in thistransient world, endure tribulation. Hewas lamenting the unhealthy teachingabout success and prosperity in Nigeriaat that time; he denounced this pros-perity teaching as it was diametricallydifferent from the tribulation which waspromised by the Carpenter of Nazareth.Audu wanted to warn those who wouldlisten to him against the distorted valueswhich excluded endurance and thedetermination to go through difficultiesand overcome them.

Seventh, you will follow the high ethicalstandards of behaviour and of decision-making that have been set out by theNigeria Medical Council and otherassociated bodies.

Responsibility of the Christian DoctorAll that I have just outlined I would

be ready to present at any medical school,but yours is not just any medical school,the Christian foundation of Bingham hasto be the foundation of your practice;your professional values will be Kingdomvalues and your professional compasswill be set for the glory of God.

This is not an easy path as I havejust suggested from Professor Audu’sletter.

In whatever society you are livingyou will have to be ready to be known asa Christian, this may be difficult and evenlonely; you are certain to have to swimagainst the tide, to deal with a clash ofvalues. Let me give you a recent personalexample; I was a member of a MedicalAssociation which, in a dispute overmoney with Government, said that itwould call its members out on strike andthey would therefore withdraw theirservices. Some friends and I reckonedthat this was immoral, how could werefuse to treat someone as would happenif we withdrew our services? So weresigned from the Association.

You may be challenged in a differentway, perhaps related to personal gain.This is the lot of every Christian in anysociety. In some parts of the world now,as you well know, genuine faith is testedto the very limit.

It is now 2015 and you mayreasonably ask me who do I think that Iam, a foreigner, bature? Who am I, a

5



visitor who has not lived in Nigeria forthirty five years, who am I to set out apattern for you?

I do so because I have been invitedto give this address today, a preciousopportunity to tell you what I believe,and to pronounce again the Kingdomvalues which we share, you and I, asbrothers and sisters in Christ primarily,and as those who are colleagues in ourprofession secondarily, and also to tellyou how we should live and work withinmedicine.

The New Testament is rich in itspractical guidance for every day livingas a Christian. In the early Church,Christians were described as those whobelonged to the Way, they weredistinctive. They had exchanged thevalues of a classical, Roman and Greekculture for the values of One Who hadlately been numbered with those who hadbroken the law, the transgressors, OneWho had been despised and rejected,One who had nowhere to lay His head,One Who was called the Friend ofsinners. Here is your role model.

Some years ago I was gripped bythe title of a book Christian CounterCulture. The author was one of the mostdistinguished practical Bible teachers ofthe last century, the Reverend Dr JohnStott. His book applies to today’s worldthe matchless truths of Christ’s Sermonon the Mount.1 This is where you canstart. Time and again Dr Stott emphasized,so that no reader could be in any doubt,time and again he comes back to histheme, the new way - “you have heardthat it was said, when the law of Mosesshaped the culture of the community andthe behaviour of the people of God, but Itell you…” where His law of love andHis deeply countercultural teachingwould challenge values and set a whollynew level of Kingdom values. In thatsermon, You have heard that it was said,Love your neighbour and hate yourenemy, but I tell you “Love your enemiesand pray for those who persecute you”2

This is the radical realm of behaviourwhere all those who call themselvesChristians belong. These are Kingdomvalues. These are the values, this is theethical culture, this is the fulcrum for yourlife and behaviour, and therefore this hasto be the fulcrum for your clinical practice.

There is enough in that great sermonfor you and for me; it was dramaticallycounter cultural, love for enemies, givingto those in need, attitudes to personalpossessions and wealth; there is enoughto challenge our conformist andcomfortable Christianity; there is enoughto make one ask questions about howcan a vibrant personal faith be shown in2015? There is enough for us to examinethe practice and the rewards of medicineto day. Where will your faith give you awider horizon?

I described above some of the basiccharacteristics which must be evident inany doctor; but there is more for you andfor me if we call ourselves Christian. Iknow of no passage of Scripture whichexpresses quite simply what this more is.The apostle Paul had been teaching in abusy metropolis, a commercialcrossroads, a port and town withadvanced worship of the goddess Diana;it was Ephesus. He called together theelders of the small Christian community,he had come to say goodbye. He said,“you know how I lived the whole time Iwas with you, I served the Lord withgreat humility…… you know that thesehands have supplied my own needs andthe needs of my companions; ineverything I showed you that by thiskind of hard work, we must help theweak, remembering the words the LordJesus Himself said,” it is more blessed togive than to receive”3

First, he was consistent I lived the wholetime; consistent day in, day out.

Second, he did not push himself, he didnot boast of himself yet he was a man ofmassive learning; he did not stand onrank, yet he was a man of the privilegedbirth of a Roman citizen, who served theLord with great humility among ordinarydockworkers and merchants.

Third, he expressed his humility by doingordinary everyday labour.

Fourth, having given of himself, so thathe would not be a burden on the membersof the church at Ephesus, hedemonstrated practical giving.

Fifth, he sought to help thedisadvantaged, the weak, whether inbody, mind or position in society it doesnot matter; he did it for the weak.

Now let us bring this example intoNigeria 2015.

First, wholeheartedness; Scripture is richin its commands that, whatever one’shand finds to do, one should do it withall one’s strength. Paul’s conscience wasclear, not only had he lived and taughtamong them but he was so determined totake nothing from them and thus not totake advantage of them, so that what hesaid is a model for all of us here today.

Wholehearted hard work, but morethan that, he did the sort of thing that aneducated privileged man in his positionwould not be expected to do. This is noeasy road, it is so countercultural, soagainst the image of the big man, of theimportant woman. But what a wonderfultestimony to a man’s character, to awoman’s dignity, what wonderful wordsto be said of someone, he helped theweak; that is royal behaviour, how muchmore distinguished, how much morerelevant, how much more telling than allthe boasted pomp and show of affluenceand power, of prosperity and of rank.

Second, transparency of behaviour; theshining light of integrity searches outmotives. Is this not needed throughoutNigeria today?

Third, and this is peculiarly Christian,humility. Be glad not to push yourselfforward, be ready to acknowledge thecontribution of others, rather than yourown, take every opportunity to take thehumble part. This leads naturally into themodel for all Christian health careprofessionals, humility expressed inservice. Be glad just to serve; there is nofiner verse of Scripture than I am amongyou as One who serves.4

The servant king is well known as amodern song. It links the greatness ofmajesty and of Kingship, with thegreatness of service.

There is no frenzied rush forrecognition here, there is no seeking ofpersonal gain; instead there is a deeplyservant attitude. I talked about the



Sermon on the Mount being acountercultural statement; this servantbehaviour of Paul was commandinglycounter cultural. In the terminology oftoday here was a big man doing manuallabour, a big man serving the weak.

Is this the pattern today in thiscountry? It was once. I have been readingDr Walter Miller, who came to Kano in1899 and who described in his importantbook, Reflections of a Pioneer, the lifeand work of the Reverend W. A.Thompson a West Indian clergyman whocame to Nigeria to serve in Kano and Zariaunder the Church Missionary Society.Thompson was a man of sterling worthand great love of the people. No manhas done more spiritually for the Hausapeople than this African brother oftheirs. No man known to me socompletely won their respect andconfidence.

Such an attitude must also havegripped the mind and the life of a fifteenthCentury Spanish Nobleman, a soldier,who became known as Saint Ignatius ofLoyola; he wrote a prayer which distilsinto a few simple words the sort ofbehaviour and the set of mind whichthose, who have worked so hard to makethis day possible, hope will be manifestin the graduates of Bingham. Your familyand friends, your teachers andcolleagues, are justifiably proud of youtoday; your test will be that they shouldbe more proud of you in the years aheadas you strike out in the sort of medicalservice which the poor and the weak arelonging to receive.

This is Igantius’ prayer:5

Teach us good Lord,To serve you as you deserve,To give and not to count the cost,To fight and not to heed the woundTo toil and not to seek for rest,To labour and not to ask for any reward, Except to know that we do your will.

This is your servant doctor. Thisembodies all the historic values of ourprofession within its own distinctiveChristian frame.

I must emphasise that in my practicein this country, it was my privilege towork alongside people who did notnecessarily share my Christian faith andyet were good people who worked withinthe classic ethical and practical limits ofour profession.

While you will thus follow in theirsteps, there will be times when the verycentre of your values will be underscrutiny, when you feel the pressure ofwhat is currently done, but which maybe contrary to the meaning and theapplication of the words “but I tell you”.This will be difficult, particularly whenthe needs and demands of your family oryour friends apparently clash with whatyou believe to be right. Misunder-standings may follow, and you may beconfronted with the need to forgive; youwill learn not to insist on your own way.

These occasions will undoubtedlyarise, be ready to dig deep into a firmfoundation of faith, for example, if youare well founded you will rejectbehaviour which refuses a patienturgently needed care because the patientdoes not have sufficient money.

Pause to ask yourself, will you beprepared to put service before self, willyou be prepared to disregard cash anddemonstrate compassion, will you beready to be countercultural towardsrewards?

As each one of you starts out onyour professional journey, you have achoice.

In today’s Nigeria, you are called toa new level of faithfulness. Never beforewas such bravery needed. After IshayaAudu’s public service he opened aprivate hospital which he calledSavannah Polyclinic, in Dogon Yaro,Samaru, Zaria. A newspaper reporter

wrote that “it was more or less amissionary hospital. It was a placewhere the poor and the down troddenflocked for medical services which werelargely free. In fact, when any of hispatients needed surgery, Audu would usehis personal funds to get an externalsurgeon. Profesor Ozigi described hisvirtues as simplicity, humility, absoluteintegrity, self discipline, courage,steadfastness, firmness, straight-forwardness as reported by Taiwo Obe,in the Guardian Sunday; his daughter,Hussaina, said that he taught her the truemeaning of meekness. Intrinsic to itsdefinition is love and gentleness, and anability to value the weak and thevulnerable and make them feel important.Premium Times 20th June 2014.

Serve the Lord Truly by ServingHumanity

I want to finish this address as Ibegan with the charge which the LateProfessor Anjorin gave me to challengeour young graduates, that is you, toensure that they, that is you, serve theLord truly by serving humanity in waysthat bring glory to our Lord and SaviourJesus Christ and dignifying to humanity.

I celebrate with Bingham Universityon this academic milestone, Icongratulate you and your families, Isalute those colleagues who have trainedyou, and I wish you all fulfilledprofessional lives of exemplary service.

REFERENCES1. Stott J. The Message of the Sermon on

the Mount: Christian Counter -CultureDowneis Grove: Intervasity Press.www.ivpress.com.

2. Matthew 5: 43–44. The Holy Bible,New International Version.

3. Acts 20 : 19, 24. The Holy Bible, NewInternational Version.

4. Luke 22 : 27,. The Holy Bible, NewInternational Version.

5. Prayer for Generosity (St. Ignatius ofLoyola). wwwprayerfoundation. org/prayerofignatius ofloyolahtml

7



Departments of †Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana‡Edward Francis Small Teaching Hospital, The Gambia and Medical Research Council Laboratories, Fajara, The Gambia, §Medicine,College of Medicine and Health Sciences , Bingham University, Jos Campus, Nigeria*Correspondence: Dr B.C. Nkum, Departments of Medicine, School of Medical Sciences, Kwame Nkrumah University of Science andTechnology, Kumasi, Ghana. Email: [email protected]:Abbreviations: 2HPG, Two Hour Plasma Glucose; BMI, Body Mass Index; BP, Blood Pressure; DM, Diabetes Mellitus; FHx, Family History;FPG, Fasting Plasma Glucose; GI, Glucose Intolerance; HTN, Hypertension; IFG, Impaired Fasting Glycaemia; IGT, Impaired Glucose tolerance;MRC, Medical Research Council; NGT, Normal Glucose Tolerance; RF, Risk Factor; SBP, Systolic Blood Pressure WC, Waist Circumference;WHR, Waist-Hip Ratio.

RÉSUMÉCONTEXTE: L’intolérance au glucose, est un facteur de risque majeurde maladie cardiovasculaire. Outre quelques études épidémiologiquessur le diabète sucré, il existe peu d’informations sur l’intolérance auglucose en Gambie. Les quelques études qui ont eu lieu il y a plusieursannées.OBJECTIF: Déterminer la prévalence et les facteurs de risque associésà la dysglycémie parmi les patients ambulatoires à Banjul, en Gambie.Méthodes: Dans une étude transversale, 308 patients adultes ont étéinscrits dans les cliniques externes de l’hôpital Edward Francis Petithôpital d’enseignement et les laboratoires du Conseil de recherchesmédicales à Fajara, Banjul. Les données recueillies comprenaient descaractéristiques sociodémographiques, antheropométriques etcliniques, ainsi que la tolérance au glucose. L’état de tolérance auglucose a été évalué au moyen d’un test de tolérance au glucose oralestandard de l’OMS. Les données récapitulatives sont présentées sousforme de moyenne ± écart-type et de proportions en pourcentage.L’association entre les variables est présentée comme étant des oddsratios. L’analyse des données a été effectuée à l’aide de SPSS version20. La signification statistique est fixée à p <0,05Résultats: Un total de 296 participants avaient des données complètespour l’analyse, dont 101 (34,1%) étaient des hommes. L’âge moyendes participants était de 53,2 ± 12 ans. . Le glucose plasmatiquemoyen à jeun était de 5,3 ± 0,8 mmol / l alors que le glucose moyen ±SD à 120 minutes après la charge de glucose était de 7,7 ± 2,3 mmol /l. Environ 56% des participants avaient une tolérance normale auglucose, 8% avaient une glycémie à jeun altérée, 26% avaient unetolérance au glucose altérée et 10% avaient un diabète de type 2précédemment non diagnostiqué. Les principaux facteurs de risque dedysglycémie étaient l’âge, l’hypertension, la masse corporelle idex, letour de taille, le rapport taille-hanche, la pression artérielle systoliqueet diastolique.CONCLUSION: La prévalence de diabète sucré et de prediabète nondiagnostiqués auparavant chez les patients fréquentant des cliniquesà Banjul, en Gambie, semble être élevée. Les taux d’inhibition de latolérance au glucose semblent plus élevés que dans de nombreusesautres études menées en Afrique. Les facteurs de risque de dysglycémiedans les cliniques gambiennes sont l’âge, l’hypertension et l’obésité.La raison des taux particulièrement élevés de tolérance au glucosealtérée chez les Gambiens est peu claire et méritent d’être étudiéesplus avant. BJM 2017; 1 (1): 8–14.

Mots-clés: Hypertension artérielle essentielle, glycémie à jeun altérée,Tolérance au glucose altérée, diabète sucré, test oral de tolérance auglucose, Gambie, facteurs de risque.

BINGHAM JOURNAL OF MEDICINERESEARCH ARTICLE

Dysglycaemia among Adult Outpatients in Banjul, The Gambia

Dysglycémie chez les Adultes Externes à Banjul, Gambie

B. C. Nkum*†, F. B. Micah†, T. C. Ankrah†, O. Nyan‡, A. E. Ohwovoriole§

ABSTRACTBACKGROUND: Glucose intolerance is a major risk factor forcardiovascular disease. Besides a few epidemiological studieson diabetes mellitus, there is limited information on glucoseintolerance in the Gambia. The few studies that have been wereseveral years ago.OBJECTIVE: To determine the prevalence of, and associatedrisk factors for, dysglycaemia among outpatients in Banjul,The Gambia.METHODS: In a cross-sectional study, 308 adult patients wereenrolled at the Outpatient clinics of Edward Francis SmallTeaching Hospital and Medical Research Council Laboratoriesin Fajara, Banjul. Data gathered included socio-demographic,anthropometric ,and clinical features as well as glucosetolerance status. Glucose tolerance status was assessed using aWHO standard oral glucose tolerance test. Summary data arepresented as mean±(SD) and proportions as percentages.Association between and among variables are presented as oddsratios. Data analysis was performed using SPSS version 20.Statistical significance is set at p<.0.05RESULTS: A total of 296 participants had complete data foranalysis, of which 101(34.1%) were males. The mean age of theparticipants was 53.2 ± 12 years. . The mean fasting plasmaglucose was 5.3 ± 0.8 mmol/l while the mean ± (SD) plasmaglucose at 120 min after glucose load was 7.7 ± 2.3 mmol/l.About 56% of the participants had a normal glucose tolerance,8% had impaired fasting glycaemia, 26% had impaired glucosetolerance, and 10% had previously undiagnosed type2 diabetesmellitus . The main risk factors for dysglycaemia were age,hypertension, body mass index, waist circumference, waist-hipratio, systolic and diastolic blood pressure.CONCLUSION: The prevalence of previously undiagnoseddiabetes mellitus and prediabetes in patients attending clinicsin Banjul , the Gambia appears to be high. Rates for impairedglucose tolerance appear higher than in many other reportrdstudies from Africa. The risk factors for dysglycaemia in theGambian attending clinics include age, hypertension, andobesity. The reason for the particularly high rates of impairedglucose tolerance among the Gambians are unclear and deservefurther studies. BJM 2017; 1(1): 8–14.

Keywords: Essential Hypertension, Impaired FastingGlycaemia, Impaired Glucose Tolerance, Diabetes Mellitus, OralGlucose Tolerance Test, The Gambia, Risk factors.

Bingham Journal of Medicine Vol. 1, No. 1, January–June, 2017 9

B. C. Nkum and Associates Dysglycaemia among Gambian Adult Outpatients

INTRODUCTIONGlucose intolerance (GI) also

referred to as dysglycaemia, consists ofany one of diabetes mellitus (DM),impaired fasting glycaemia (IFG), andimpaired glucose tolerance (IGT). It isassociated with significant morbidity andmortality especially with increasedcardiovascular disease.1, 2 Reportedstudies of glucose intolerance or dys-glycaemia in The Gambia are few. Anationwide survey for diabetes mellitus(DM) in 1996 found a prevalence rate of0.3% for DM while later communitystudies reported a rural DM prevalencerates of 0.8–2.2% and an urban prevalenceof about 8%.3–8

Thus there is limited information onGI in the Gambia as several risk factorswere not reported. As part of our studieson the risk factors for cardiovasculardiseases in the Gambian, we determinedthe prevalence and types of glucoseintolerance and its risk factors amonghypertensive and non hypertensiveGambians.

SUBJECTS, MATERIALS, ANDMETHODS

In a cross-sectional studyconducted at the Medical ResearchCouncil (MRC) Laboratories, Fajara andthe Royal Edward Francis Small TeachingHospital (REFTH), Banjul, The Gambia,participants without a known history ofDM were recruited from the HypertensionClinic of REFTH and the Gate Clinics ofthe MRC. Three hundred and sixteen (209female and 107 male) consecutive patientsseen during the period of study acceptedto participate in the study.

Inclusion criteria included being anadult of age > 25 years and freelyconsenting to participate in the study.Patients with major diseases (other thanhypertension), severe inter-currentillness, systemic or metabolic diseasesand/or morbid obesity (BMI > 35 kg/m2)were excluded from the study.

The study was approved by TheGambia Government / MRC EthicalCommittee. All the participants gavewritten informed consent

Research ProceduresUsing the appropriate local

language, an assistant gathered informa-

tion on socio-demographic data, family,social and past medical history.Anthropometric measurements thatincluded weight, height, waist and hipcircumferences, using standardtechniques were taken. 9 Measurementsof height as well as body circumferenceswere made to the nearest 0.5 cm whilebody weight was recorded to the nearest0.5 kg. A digital blood pressure (BP)machine (Omron r HOM – 705 CP, Japan)was used to measure blood pressure onthe left arm. Three BP readings weretaken; the mean of the last two readingswas used for the analysis.

A standard oral glucose tolerancetest (OGTT) was performed using 75 ganhydrous glucose.10 Venous plasma wasdrawn for glucose levels at 0, 30 and 120minutes and other analytes at 0 minute.Venous blood glucose was determinedimmediately upon taking the samplesusing a Haemocue analyser (HaemocueAB, of Sweden). For the purposes ofanalysis and interpretation, venouswhole blood glucose concentrationswere converted to venous plasma glucoseconcentrations (PGC) following theinstruction accompanying theHaemocue® Manual.

Definition of Terms and Criteria.The operational definition of terms

and criteria adopted for this study areshown in Table 1.

Data Management and StatisticalAnalysis

The data obtained were managedusing Microsoft Excel 2007 and analysedusing Stata version 8.0 statisticalpackage (Stata Corporation, CollegeStation, Texas, USA). Percentages whichwere calculated for discrete variableswere compared using Pearson chi-squaretest. Average values are presented asmeans and standard deviation forcontinuous variables and comparedusing student t-test. Summary results ofnonparametric data were compared usingPearson Chi-square test. P-values of lessthan 0.05 were taken as statisticallysignificant while clinical significance wasdetermined using odds ratio or effect size.

RESULTSQuality of Data and ClinicalCharacteristics of Participants

Three hundred and sixteenoutpatients were recruited into the study.Twenty of the participants (twelvefemales and eight males) had incompletedata and were excluded from furtheranalysis. Thus the completion rate of thestudy was about 94%. The performanceof the plasma glucose assay wassatisfactory. Tthe intra-assay coefficientswere 1.3% at 5.4 mmol/L and 1.6% at 16.1mmol/L and the inter-assay coefficientsof variation were 1.2% at 5.2 mmol/L and2.5% at 14.8 mmol/L.

Characteristics of Study ParticipantsThe study had more women than

men (65.9% v 34.1%). Male and femaleparticipants were similar with regards toage, weight, and fasting plasma glucose.About three quarters of the participantswere in the middle age group of 45-64years. The females had higher values of

Table 1: Operational Definition of Termsand Diagnostic Criteria

Entity Definition / Criteria

SystemicHypertension Systolic blood pressure

> 140 and / or diastolicblood pressure> 90.mmHg or use ofa n t i h y p e r t e n s i v emedications11

Global Adiposity Normal, overweight andobesity respectively:BMI < 25, 25–29.9 and> 30 kg / m 2. 12

Central Obesity Waist Hip Ratio > 0.9(males) and > 0.8(females). OR WC > 88cm (Female), > 102 cm(male). 12

Diabetes Mellitus Fasting venous plasmaglucose > 7.0 mmol/L andor 2h post glucose PGL> 11.1 mmol/L 1, 2

Impaired FastingGlycaemia Fasting venous plasma

glucose > 6.1 mmol/L and< 7.0 mmol/L. 1, 2

Impaired GlucoseTolerance Fasting venous plasma

blood glucose < 7.0mmol/L and 2h postglucose load > 7.8 mmol/L and < 11.1 mmol/L.1, 2


commonest risk factors for diabetesmellitus in the males aside hypertensionwere increasing age, smoking, and centralobesity. Among the female participantsthe three leading risk factors (excludinghypertension) were central obesity,overweight / obesity, and age >45 years.All anthropometric indices of propensityto develop DM were more common in thefemale than in the male participants. Theleast common risk factor for DM was IFGfollowed by a low rate of positive familyhistory of diabetes mellitus.

Frequency and Types of DysglycaemiaFigure 1 shows the distribution of

participants by the type and frequencyof glucose tolerance status they had atassessment. Overall, 131(44.3%) of thepatients had dysglycaemia, about 23%of which were undiscovered type 2 DM.Prediabetes was the commonest class ofGI, affecting 37.6% of the males and36.9% of the females. About a third ofthe participants and three quarters of allthose with GI had prediabetes. . Impairedglucose tolerance (IGT) was significantlymore common than either IFG or DM inboth males and females. Prediabeteseither as IFG or IGT was more prevalentin the males than in females(p > 0.05) butundiscovered DM was more commonamong the females than males.

Relationship Between GlucoseTolerance Status and Risk Factors

Table 4 shows a comparison of theparticipant characteristics by the variousdegrees of glucose metabolism, fromnormal glucose tolerance to diabetesmellitus. Generally the patients with GIwere older and fatter by BMI or waistcircumference. All other indices ofproneness to developing DM werehigher in the participants with GI thanthose who were glucose tolerant. Theparticipants with DM had the highestmean or frequency of all the risk factorsexcept age which was highest amongthose with prediabetes. The mean ofvalues and / or prevalence rates ofanthropometric risk factors progressivelyincreased from NGT subjects throughprediabetes to type 2 diabetes.


Table 3: Distribution of Participants by Risk Factors for Type 2 Diabetes Mellitus

Number (%)

RF for T2DM All Participants Male Female P value

Global obesity 77 (26.0) 13 (12.9) 64 (32.8) <0.001Overweight 81(27.4) 26(25.7) 55 (28.2) >0.05 WC 216 (74.3) 34 (33.72) 182 (93.3) <0.001 WHR 220 (74.3) 41 (40.6) 179 (91.8) <0.001FHx of DM 44 (14.9) 10 (9.9) 34 (17.4) 0.08HTN 208 (70.3) 70 (69.3) 138 (70.7) 0.66Smoking 73 (24.7) 58 (53.2) 15 (7.7) <0.001IFG 14 (4.7) 5 (4.9) 9 (4.6) 0.92IGT 90 (28.5) 34 (30.4) 56 (28.7) 0.44Age >45 years 227(76.7) 83 (82.1) 144 (73.8) 0.345

DM, diabetes mellitus; FHx, family history; IFG, imaoired fasting glycaemia; IGT, impairedglucose tolerance; HTN, hypertension; RF, risk factor; WC, increased waist circumference; WHR. increased waist-hip ratio.T2DM, type 2 diabetes mellitus

Table 2: Characteristics of Study Participants

Characteristic Mean (SD) or N (%)

All Male Female

Mean SD

N (%) 296 (100) 101 (34.1) 195 (65.9)Age (years) 53.2 (12.0) 54.4 (10.6) 52.5 (12.6)SBP mmHg 136.2 (27.8) 139.5 (28.3) 134.5 (27.45)DBP mmHg 83.2 (15.6) 83.3 (13.8) 83.3 (14.5)FPG mmol/L 5.27 (0.84) 5.26 (0.82) 5.26 (0.85)2hPGL mmo//L 7.73 (2.25) 7.54 (1.85) 7.82 (2.43)

Number (%)Age (years)

< 45 69 (23.3) 18 (17.8) 51 (26.2)45–64 173 (58.4) 63 (62.4) 109 (56.4)> 65 55 (18.6) 20 (19.8) 35 (17.9)

Overweight/Obesity 158 (53.3) 39 (38.6) 119 (59.5)Normal BMI (<25) 138 (46.6) 62 (61.4) 76 (38.5)Overweight (25–29.9) 81 (27.4) 26 (25.7) 55 (28.2)Obese, BMI (>30) 77 (26.0) 13 (12.9) 64 (32.8)Cigarette Smoking 65 (22.0) 51 (50.5) 14 (7.2)

2hPGL = Two Hour Plasma Glucose, BMI = Body Mass Index, DBP = Diastolic BloodPressure, FPG = Fasting Plasma Glucose, SBP = Systolic Blood Pressure

body mass index,_BMI), waistcircumference (WC), waist to hip ratio(WHR) and frequency of overweightand/or obesity. Smoking was muchsignificantly commoner among the menthan among the female participants (50%v 7%). Table 2 shows a summary of thecharacteristics of the study participants.

Prevalence of risk factors for Type 2Diabetes Mellitus

The prevalence of risk factors fortype 2 diabetes mellitus (T2DM) amongthe study participants is shown in Table3. Overall the commonest risk factors forT2DM were central obesity, age > 45years, and global obesity. The three

Bingham Journal of Medicine Vol. 1, No. 1, January–June, 2017 11

Association Between Type 2 DiabetesMellitus Versus its Principal RiskFactors among Study Participants

Table 5 shows the univariateanalysis of the relationship betweenT2DM and its principal RFs among thestudy participants presented as oddsratios (ORs). The Table shows that inthe males the risk factors stronglyassociated with T2DM (OR >3) were apositive family history of DM, global andcentral forms of obesity, and a history ofcigarette smoking. In the females agemore than 45 years, central obesity (highWC and high WHR) and IFG were theleading risk factors. In the females obesitybut not overweight (BMI of 25–29.9) wasmoderately associated with havingdiabetes mellitus.

DISCUSSIONThe purpose of this work was to

determine the prevalence of glucoseintolerance and its associated riskfactors among Gambians attendingoutpatient clinics. The quality of data wasgenerally satisfactory. The response ratewas of good quality at about 94% whilethe precision of the glucose assays wereboth satisfactory with intra- and inter-assay repeatabilities of less than 5%.

The distribution of the participantsby sex was skewed towards the womenbut both sexes had sufficient participantsto undertake a meaningful sub-analysis.The preponderance of females may reflectthe differences between African men andwomen in their health-seeking behavoiur.The female participants were generallyheavier and smoked less. Concerningother variables, including baseline serumanalytes and clinical features, the menand women were generally comparable.

Prevalence of and Types DysglycaemiaAbout 40% of the participants had

one form or the other of dysglycaemia.The prevalence of previouslyundiagnosed Type 2 DM in adultGambians of 10% found in this study washigh but similar to the reports from aprevious Gambian study. That studyreported a prevalence of 0.3%.3,4 In anurban Banjul community study however,the prevalence of DM (both diagnosedand undiagnosed) was 8% in men and9% in women.5 Relatedly, the prevalence

Fig. 1: Frequency of Dysglycaemia Subtypes Among Gambians at a RoutineOutpatient Clinic. Overall, about 45% of the patients had dysglycaemia, about 23%of which were undiscovered type 2 diabetes DM. Prediabetes was the commonestclass of dysglycaemia, affecting about 37% of both the males and of the females.DM, diabetes mellitus IFG, impaired fasting glycaemia, IGT, impaired glucosetolerance. JFG DM IGT


30

25

20

15

10

5

0

Per

cen

tag

e

Table 4: Comparison of Participants by Glucose Tolerance Status and Risk Factors

Risk Factor NGT Prediabetes DM AllDysglycaemia

Mean (SD)

Age (Years) 51.5(10.8) 55.6(12.4) 53.3(9.9) 55.2(11.9)BMI(Kg/m2) 26.0(6.0) 26.16(6.2) 29.2(6.9) 26.8(6.5)WC (cm) 91.0(13.2) 92.7(12.7) 98.94(12.7) 94.08(17.9)WHR 0.867(0.068) 0.884(0.056) 0.897(0.07) 0.887(0.060)SBP(mmHg) 132.84(26.7) 139.52(29.2) 144.7(5.8) 141.13(38.5)FPG (mmol/l) 4.0(0.53) 5,4(0.77) 6.6(1.10) 5.7(0.96)2HPG(mmol/l) 6.3(0.83) 8.64(1.16) 12.3(2.7) 9.5(2.2)

Number (%) with Factor Present

N 165 101 30 131

Males 56(33.9) 38(37.6) 7(23.3) 45(34.1)Females 109(66.1) 63(62.4) 23(76.7) 85(65.9)FHx 24(14.5) 10(9.9) 7(23.3) 17(13.0)Cigarette Smoking 30(18.2) 28(27.7) 7(23.3) 35(26.7) WHR 116(70.3) 72(71.3) 27(90.0) 99(75.6)BMI > 25 86(52.1) 52(51.5) 20(66.7) 72(55.0) WC 78(47.3) 49(48.5) 23(76.7) 72(55.0)HTN 60(36.4) 65(64.3) 17(56.7) 97(82.8)

2HPP = Two Hour Plasma Glucose,; BMI, body mass index kg/m2; DM. diabetes mellitus; ;FPG = Fasting Plasma Glucose ; FHx, family history; IFG, imaoired fasting glycaemia; IGT,impaired glucose tolerance; HTN+, hypertension; WC, increased waist circumference; WHR. increased waist-hip ratio.T”DM, type 2 diabetes mellitus



12

of hypertension was high at 17% and19% in men and women respectively.3–8

These discrepant higher prevalence ratesfound in the Banjul studies compared tothe rural areas may be partly due tourbanization and adoption of westernlifestyle as has been reported by others.13

Reports from other parts of Africahave shown a similar trend.14-18 In urbanGhana, Amoah et al reported a DMprevalence of 6.3% (1.9% diagnosed and4.4% undiagnosed),14,15 a rate very muchlower that reported ( 1.5%) in the Ashantiregion.16 A hospital based study inKumasi found 18% previouslyundiagnosed Type 2 DM among thesepatients.17 The National NCD survey inthe 1990s in Nigeria recorded a nationalDM prevalence of 2.2% but middle agedparticipants from urban Lagos had ahigher prevalence of 7%.18 Other Nigerianstudies have reported varyingprevalence rates19–22 Sabir et al found aprevalence of about 5% undiagnosedDM in urban Fulanis in NorthernNigeria.23 These DM prevalence ratesfrom West Africa are either similar to orlower than those reported from a Chinesepopulation.24

Prevalence of Prediabetes MellitusPre-diabetes may manifest as IFG

and or IGT. Prediabetes is not a clinicalentity per se but represents a risk factorfor DM and some cardiovasculardiseases.28–30 In this study the prevalenceof IFG was 8% when the WHO criterion

was applied. This Gambian prediabetesrate is quite low compared to several otherstudies.14,15,23–26,30–32

Using the WHO criterion for IFG ,Sabir et al reported a higher prediabetesprevalence of 16.9% from NorthernNigeria.30 Similarly in the Accracommunity studies the prevalence of IFGwas higher than ours at 10.7%.14, 15 Onthe other hand studies from Australiaand China have reported prevalencerates similar to ours.24,31 In the US theprevalence of IFG was reported to behigher in men than women a phenomenonwhich is attributed to the higher fastingplasma glucose in US men.25–27 This sexdifference trend which appears to be atvariance with our results was alsoreported in the Australian study.31

This study found an IGT prevalenceof 26% which appears high but is similarto reports from other studies.25 Theprevalence of IGT was higher in the malesthan in he females, a finding that is similarto several others including the Gambianreports.3–8, 26, 28 An IGT prevalence of 28%was reported in the community study inThe Gambia, with about 25% inparticipants with normal BMI and 50% inthe obese participants.3–8 Reports fromseveral African centres indicate muchlower IGT prevalence rates than wefound in this study, most being about15%.14,15,22,33 Sabir et al reported aprevalence of 15% from northernNigeria,22 Amoah reported a prevalenceof 15.8% from Accra, Ghana14, 15 while

Elbagir et al reported a lower prevalenceof 7.9% from northern Sudan.33 Theprevalence rates of IGT from other con-tinents show similar differences to ourfindings. The NHANES survey in 1988 –1994 recorded a crude prevalence of15.6% with similar findings in men andwomen while in the 2005–2006 survey aprevalence of 5.4% isolated IGT and 9.8%combined IFG and IGT werereported.26–27 Other studies have IGTprevalence rates varying from 10% to24%.31,34-36 The reason for the muchhigher IGT prevalence in our studycompared to other reports is not obviousfrom our study and deserve furtherstudies.

Risk factors for Diabetes Mellitus andPrediabetes Mellitus

In this study, the main risk factorsfor DM were age, hypertension, BMI,WC, WHR, and BP . Previous Gambianstudies had showed that the prevalenceof hypertension was higher in DMpatients than in the general populationand that among the urban Gambianparticipants there was frequent co-existence of obesity, hyperlipidaemia,physical inactivity, hypertension andDM.3-8 The earlier study also had 3.3% ofthe participants reporting a family historyof DM. Though our study found amoderate proportion of participants witha family history of DM, this was notassociated with DM and pre-diabetes.Sabir et al identified age and obesity asthe major risk factors for dysglycaemiain the northern Nigerian population30

while in Ghana, Amoah reporteddysglycaemia to be associated withincreasing age, SBP, DBP and BMI.14, 15

ConclusionThe major strength of this study

was the performance of a standardOGTT in a large number of participantswith no history of DM in The Gambia . –

The main weakness of this study was thefact that it was a hospital based cross -sectional study which was likely to befraught with some biases.

The prevalence of prediabetes andpreviously undiagnosed Type 2 DM inthe urban adults attending outpatientclinics in Banjul in the Gambia appears tobe high and much higher than previously

Table 5: Univariate Analysis of the Relationships Among Risk Factors and the Oddsof Undiagnosed Type 2 Diabetes Mellitus

Risk Factor OR(95%CI)

Males Females

Age 1.29 0.15 – 11.48 9.04 2.68 – 30.47*FHx DM 4.97 0.81 – 30.43* 1.56 0.53 – 4.70Cigarette Smoker 2.61 0.48 – 14.12 1.39 0.29 – 6.73BMI >25 3.67 0.67 – 20.05* 0.79 0.28 – 2.25BMI >30 3.05 0.53 – 12.69* 1.45 0.60 – 3.50 WC 4.67 0.94 – 23.31* 9.52 2.76 – 32.82* WHR 3.68 0.68 – 19.98* 10.32 1.31 – 81.37*HTN 1.81 0.38 – 8.56 1.99 0.83 – 4.79IFG 3.02 0.57 – 17.49* 5.35 1.87 – 15.33*

*, Clinically significant association; BMI, body mass index (kg/m2). DM. diabetes mellitus;FHx, family history; IFG, impaired fasting glycaemia; IGT, impaired glucose tolerance; HTN,hypertension; RF, WC, increased waist circumference; WHR. increased waist-hip ratio.



reported. The most common form ofdysglycaemia among the Gambiansstudied was prediabetes with IFG beingpredominant. The risk factors associatedwith dysglycaemic states are increasingage, hypertension and obesity. Thisincreasing trend of dysglycaemia is likelyto be the result of the change in lifestyleof urban Gambians. There is thereforethe need to increase screening, manage-ment and control of these factors. Furtherlarger and prospective studies may yieldmore robust data to support or refute ourresults and our therefore called.

ACKNOWLEDGEMENTSWe are grateful to the Medical

Research Council (MRC), UK for fundsto BCN to pursue the study and the RoyalVictoria Teaching Hospital (RVTH), thestudy participants, the field workers andthe support from MRC Support Service.

We are also thankful to thefollowing individuals who contributed invarious ways to the success of the work:Dr. Hilton Whittle, Dr. T Corrah, Dr. S.Allen, Dr. K. McAdam, Dr. Alieu GayeDr. Aliu O. Akano, Mr. Winston Banyaand Ben Sam. .

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diagnosis and classification of diabetesmellitus and its complications. Part 1:diagnosis and classification of diabetesmellitus provisional report of a WHOconsultation. Diabet Med. 1998; 15:539–53.

2. World Health Organisation. Definitionand diagnosis diabetes mellitus andintermediate hyperglycaemia: Report ofa WHO/IDF Consultation, Geneva,Switzerland. 2006.

3. van der Sande MA, Bailey R, Faal H,Banya WA, Dolin P, Nyan OA et al.Nationwide prevalence study ofhypertension and related non-communicable diseases in The Gambia.Trop Med Int Health. 1997; 2: 1039–48.

4. van der Sande MA, Walraven GE,Milligan PJ, Banya WA, Ceesay SM,Nyan OA et al. Family history: anopportunity for early interventions andimproved control of hypertension,obesity and diabetes. Bull World HealthOrgan. 2001; 79: 321–8.

5. van der Sande MA, Ceesay SM,Milligan PJ, Nyan OA, Banya WA,Prentice A et al. Obesity and

undernutrition and cardiovascular riskfactors in rural and urban Gambiancommunities. Am J Public Health. 2001;91: 1641–4.

6. van der Sande MA, Milligan PJ, NyanOA, Rowley JT, Banya WA, CeesaySM et al. Blood pressure patterns andcardiovascular risk factors in rural andurban gambian communities. J HumHypertens. 2000; 14: 489–96.

7. van der Sande MA, Walraven GE, BaileyR, Rowley JT, Banya WA, Nyan OAet al. Is there a role for glycosuriatesting in sub-Saharan Africa? Trop MedInt Health. 1999; 4: 506–13.

8. van der Sande MA, Milligan PJ,Walraven GE, Dolmans WM, NewportM, Nyan OA et al. Geographicalvariation in prevalence of hypertensionwithin The Gambia. J Hum Hypertens.2001; 15: 733–9.

9. World Health Organisation. WHOSTEPS surveillance manual : the WHOSTEPwise approach to chronic diseaserisk factor surveillance / Non-communicable Diseases and MentalHealth, World Health Organization.2005.

10. World Health Organisation. Definition,diagnosis and classification of diabetesmellitus and its complications. Part 1:diagnosis and classification of diabetesmellitus. Report of a WHOconsultation. 1999.

11. Chalmers J, MacMahon S, Mancia G,Whitworth J, Beilin L, Hansson L et al.1999 World Health Organization-International Society of HypertensionGuidelines for the management ofhypertension. Guidelines sub-committee of the World HealthOrganization. Clin Exp Hypertens.1999; 21: 1009–60.

12. Clinical Guidelines on the Identification,Evaluation, and Treatment ofOverweight and Obesity in Adults—The Evidence Report. NationalInstitutes of Health.Obes Res. 1998; 6:51S–209S.

13. Schulz LO, Bennett PH, Ravussin E,Kidd JR, Kidd KK, Esparza J et al.Effects of traditional and westernenvironments on prevalence of type 2diabetes in Pima Indians in Mexico andthe U.S. Diabetes Care. 2006; 29:1866–71.

14. Amoah AG. Undiagnosed diabetes andimpaired glucose regulation in adultGhanaians using the ADA and WHOdiagnostic criteria. Acta Diabetol. 2002;39: 7–13.

15. Amoah AG, Owusu SK, Adjei S.Diabetes in Ghana: a community based

prevalence study in Greater Accra.Diabetes Res Clin Pract. 2002; 56: 197–205.

16. Plange-Rhule J.A study of the riskfactors for cardiovascular disease in theAshanti region of Ghana. FWACPDissertation 2007.

17. Micah FB, Nkum BC. Lipid disordersin hospital attendants in Kumasi,Ghana. Ghana Med J. 2012 ;46:14-21.

18. Akinkugbe OO, Final report of theNational Expert Committee on NonCommunicable Diseases in Nigeria.1997 (Federal Ministry of Health andSocial Services, Series 4): 64–90.

19. Ohwovoriole AE, Kuti JA, Kabiawu SI.Casual blood glucose levels and preva-lence of undiscovered diabetes mellitusin Lagos Metropolis Nigerians. DiabetesRes Clin Pract. 1988; 4: 153–8.

20. Erasmus RT, Fakeye T, Olukoga O,Okesina AB, Ebomoyi E, Adeleye Met al. Prevalence of diabetes mellitus ina Nigerian population. Trans R Soc TropMed Hyg. 1989; 83: 417–8.

21. Puepet FH, Ohwovoriole AE.Prevalence of risk factors for diabetesmellitus in a non-diabetic population inJos, Nigeria. Niger J Med. 2008; 17:71–4.

22. Owoaje EE, Rotimi CN, Kaufman JS,Tracy J, Cooper RS. Prevalence of adultdiabetes in Ibadan, Nigeria. East Afr MedJ. 1997; 74: 299–302.

23. Sabir AA, Isezuo SA, Ohwovoriole AE.Dysglycaemia and its risk factors in anurban Fulani population of northernNigeria. West Afr J Med. 2011; 30: 325–30.

24. Gu D, Reynolds K, Duan X, Xin X,Chen J, Wu X et al. InterASIACollaborative Group. Prevalence ofdiabetes and impaired fasting glucosein the Chinese adult population:International Collaborative Study ofCardiovascular Disease in Asia(InterASIA). Diabetologia. 2003; 46:1190–8.

25. International Diabetes Federation atlas.Available at http://www. diabetesatlas.org/contact and accessed on 3rdMay, 2015.

26. Cowie CC, Rust KF, Byrd-Holt DD,Eberhardt MS, Flegal KM, EngelgauMM et al. Prevalence of diabetes andimpaired fasting glucose in adults in theU.S. population: National Health andNutrition Examination Survey 1999–2002. Diabetes Care. 2006; 29: 1263–8.

27. Karve A, Hayward RA. Prevalence,diagnosis, and treatment of impairedfasting glucose and impaired glucose

13



tolerance in nondiabetic U.S. adults.Diabetes Care. 2010; 33: 2355–9.

28. Nathan DM, Davidson MB, DeFronzoRA, Heine RJ, Henry RR, Pratley R,Zinman B; American DiabetesAssociation. Impaired fasting glucoseand impaired glucose tolerance:implications for care. Diabetes Care.2007; 30: 753–9.

29. American Diabetes Association.Diagnosis and classification of diabetesmellitus. Diabetes Care. 2006; 29: S43–8.

30. Sabir AA, Isezuo SA, Ohwovoriole AE.Dysglycaemia and its risk factors in anurban Fulani population of northernNigeria. West Afr J Med. 2011; 30: 325–30.

31. Dunstan DW, Zimmet PZ, Welborn TA,

De Courten MP, Cameron AJ, SicreeRA et al. The rising prevalence ofdiabetes and impaired glucose tolerance:the Australian Diabetes, Obesity andLifestyle Study. Diabetes Care. 2002;25: 829–34.

32. Genuth S, Alberti KG, Bennett P, BuseJ, Defronzo R, Kahn R et al. ExpertCommittee on the Diagnosis andClassification of Diabetes Mellitus.Follow-up report on the diagnosis ofdiabetes mellitus. Diabetes Care. 2003;26: 3160–7.

33. Elbagir MN, Eltom MA, Elmahadi EM,Kadam IM, Berne C. A high prevalenceof diabetes mellitus and impairedglucose tolerance in the Danaglacommunity in northern Sudan. DiabetMed. 1998; 15: 164–9.

34. Sekikawa A, Eguchi H, Tominaga M,Igarashi K, Abe T, Manaka H et al.Prevalence of type 2 diabetes mellitusand impaired glucose tolerance in a ruralarea of Japan. The Funagata diabetesstudy. J Diabetes Complications. 2000;14: 78–83.

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36. Chen KT, Chen CJ, Gregg EW,Williamson DF, Narayan KM. Highprevalence of impaired fasting glucoseand type 2 diabetes mellitus in PenghuIslets, Taiwan: evidence of a rapidlyemerging epidemic? Diabetes Res ClinPract. 1999; 44: 59–69.

14



Relaxative Effect of Cold Water Stem-Bark Extract of Erythrophleumsuaveolens on Frog Rectus Abdominis

Effet relaxant de l’eau froide Extrait de la tige-écorce d’Erythrophleum suaveolens sur leRectus Abdominus de la grenouille

T. O. Ogundeko, M. I. Builders*, E. A. Ogbole

ABSTRACTBACKGROUND: Erythrophleum suaveolens is a folkloricplant claimed to be a muscle relaxant. The frog rectusabdominus muscle is a tissue that is apt for the study ofneuromuscular junction activities.OBJECTIVE: To determine the muscle relaxant effect ofErythrophleum suaveolens on the isolated frog rectusabdominis muscle in the presence of acetylcholine.MATERIALSAND METHODS: Dose- response relationships(DRC) of cold water bark extract of Erythrophleum suaveolens,acetylcholine (Ach) only in the presence of E. suaveolens atvarying concentrations and volumes from given stocks of 1x10-

4 in each case were studied. Responses were obtainedisotonically and recorded via a dynamometer.RESULTS: Stem-bark water extract of E. suaveolens blockedthe contracture effect of acetylcholine. The relaxing effect ofthe extract on the isolated rectus abdominis muscle was slow,though blockade effect on the acetylcholine-inducedcontractions decreased with increasing dose of acetylcholine.However, the effect of Ach on frog rectus abdominis musclewas dose-dependent. Effective concentrations (EC50) of Achand E. suaveolens plus Ach were 3.16 x10-9and 2.58 x10-7g/mlrespectively.CONCLUSION: Erythrophleum suaveolens is a skeletalmuscle relaxant,which appears to be a potent non-depolarizingneuromuscular blocker. BJM 2017; 1(1): 15–18.

Keywords: Erythrophleum suaveolens, Frog rectus Abdominis,Acetylcholine, Inhibition, Muscle Relaxant.

Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, Bingham University, Jos Campus.*Correspondence: Dr. Modupe Builders. Pharmacology and Therapeutics, College of Medicine and Health Sciences, Bingham University,Jos Campus. Private Mail Bag 2172, Jos, [email protected]: Ach, Acetylcholine; DRC, Dose-response curve; EC50

, Effective concentration at 50%; NMJ, Neuromuscular junction.

ABSTRAITCONTEXTE: Erythrophleum suaveolens est une plantefolklorique prétendu être un myorelaxant. Le rectus grenouilleest abdominus muscle est un tissu qui est apte pour l’étudedes études de jonction neuromusculaire.OBJECTIF: Déterminer l’effet myorelaxant de Erythrophleumsuaveolens sur la grenouille isolé rectus abdominis muscle enprésence d’acétylcholine.MATÉRIELS ET MÉTHODES: relation dose-réponse (RDC)de froid extrait d’écorce de l’eau de Erythrophleum suaveolens,acétylcholine (Ach) seulement en présence de E. suaveolens àdes concentrations et des volumes variant de stocks de donnéesde 1x10-4 dans chaque cas ont été obtenus avec réponsesisotonique enregistrées (1mm / sec) par l’intermédiaire d’undynamomètre.RÉSULTATS: Stem écorce extrait de l’eau de E. de l’extraitbloqué l’effet de contracture de Ach. L’effet relaxant de l’extraitisolé sur le muscle droit de l’abdomen a été lente, bien quel’effet de blocage sur les contractions induites parl’acétylcholine a diminué avec l’augmentation de la dosed’acétylcholine. Cependant, l’effet de l’Ach sur le rectusabdominis muscle grenouille est dose-dépendante. Lesconcentrations efficaces (CE50) de Ach et E. suaveolens ainsiAch étaient 3.16 x10-9and 2,58 x10-7g / ml, respectivement.CONCLUSION: Erythrophleum suaveolens est un relaxantmusculaire squelettique, et semble être un non-dépolarisantsbloquant neuromusculaire puissant. BJM 2017; 1(1): 15–18.

Mots-clés: Erythrophleum suaveolens, grenouille rectusabdominis, acétylcholine, Inhibition, Relaxation.

RESEARCH ARTICLE


T. O. Ogundeko and Associates Effect of E. suaveolens on Rectus Abdominis

INTRODUCTIONThe rectus abdominus muscle of the

frog though striated does not behave likenormal voluntary muscle and respondsto acetylcholine (Ach) by giving a slowcontraction. It is an extremely usefulpreparation for showing the actions ofthose compounds that blocktransmission at the neuromuscularjunction (NMJ) by acting the same wayas an excess of Ach. Such compoundswill also block transmission in the ratphrenic nerve diaphragm and stimulatethe slow fibres of the frog rectus.1–2

Drugs like diltiazem and verapamilhave been reported to inhibit contrac-tions of frog rectus abdominus musclesin the presence of Ach.3 The relaxingeffect of cold water stem-bark extract ofE. suaveolens is evident on skeletalmuscle such as the rat phrenic nerve-diaphragm. An observed relaxation-pattern of E. suaveolenson rats phrenicnerve diaphragm preparation showed itas closely related with that ofhexamethonium thus suggesting as anexplorable potent- muscle relaxant asclaimed by traditional healers.4 Thedetermination of LD

50on albino mice gave

an insight into the safety margin of E.suaveolens (223.8±0.05mg/kg bodyweight) falling within the very toxic rangeas defined by Hodge and Sternercategorization.5 Investiga-tions carriedout on isolated ileum tissue of the guinea-pig (Caviaporcellus) and smooth muscleof the rabbit jejunum (Oryctolagus-cuniculus) by running a dose-responserelationship of agonist test drugs(acetylcholine, histamine, and bariumchloride; isoprenaline and adrenaline) inthe presence of the cold water crudeextract of stem-bark of Erythrophleumsuaveolens showed an antagonist effectwith a right shift and inhibitory nature ofErythrophleum suaveolens.6

Detailed investigations on plantmaterials especially such that are alreadyin use especially by trado-medicalpractitioners should not be taken withlevity. Erythrophleum suaveolens isused for diverse purposes: as drinks, thebark is used as alcoholic and stimulantas well as laxative, abortifacient,antibiotics, and in the treatment ofoedema, gout, rheumatism amongstothers in the area of medicine.7 – 9

This study aimed to further confirmthe muscle relaxant effect ofErythrophleum suaveolens on theisolated frog rectus abdominis muscle inthe presence of acetylcholine.

MATERIALS AND METHODSThr stem-back of Erythrophleum

suaveolens was collected from BurukuLocal Government Area, Benue Statecentral Nigeria. This was identified andclassified by Professor Hussaini(Botanist with the University of JosNigeria) and Dr Okonkwo (Taxonomistwith the College of Forestry, Jos, Nigeria).Plant sample was dried in thePharmacology Laboratory of BinghamUniversity, Jos while the process ofextraction was done as describedearlier.4–7

Freshly-prepared isolated frogrectus abdominis muscle was attachedto a lever (0.5–1g load) and mounted onan organ bath (50–100ml) containingfreshly prepared frog ringer solution(NaCl–6.50g, KCl –0.75g, CaCl

2 –1.00g,

NaHCO3–0.40g – Sigma Chemical

Company, Louis, USA, Kernel Chemicals,Germany). Contraction and relaxationresponses were isotonically recorded(1mm/sec) via a dynamometer(UgoBasile, Comerio, Italy) (5volts),frequency (0.5Hz), pulse width (1.4mls),(1). pH (7.4), aeration (air) andtemperature (320C). Acetylcholine -Sigma Chemical Company, Louis, USAwas used as the reference drug.

Dose- response of relationships(DRC) of cold water bark extract ofErythrophleum suaveolens, Acetyl-

choline and Ach in the presence of E.suaveolens at varying concentrationsand volumes from given stocks of 1x10-4

in each case were obtained. Responseswere isotonically recorded (1mm/sec) viaa dynamometer.

RESULTSErythrophleum. suaveolens extract

produced no response on the isolatedtissue of frog rectus abdominis muscle,thus no amplitude of response wasobserved (Table 1). Tissue in thepresence of Ach exhibited contractileresponse with threshold and maximumheights response of 1.5cm and 3.2cmrespectively, at 4.0x10–7 g/ml, percentagemaximum response was 100 as shown inTable 2.

Table 3 indicates that E. suaveolensextract in the presence of Ach reducedtissue response (lowest height–0.6cm) at2.2 x10–8g/ml with percentage maximumresponse of 70 and (highest–0.9cm) at1.0x10–6g/ml with percentage maximumresponse of 100.

A dose-dependent graph indicatingeffective eoncentration (EC

50) of Ach and

E. suaveolens plus Ach 3.16 x10–9 and2.58 x 10–7g/ml was obtained by plottingpercentage maximum responses againstlog concentrations (Figure 1). The curveshowed a shift to the right in compliancewith the characteristics of an agonist inthe presence of Ach (percentagemaximum response = 100). However, thecurve obtained from that of Ach in thepresence of E. suaveolens extract(percentage maximum response = 100)also produced a shift to the right.

Table 1: Dose Effect of E. suaveolens Extract on Frog Rectus Abdominis Muscle

Ach (g/ml) ESE FBC Log MR Responses MedR MMR(g/ml) FBC (cm) (cm) %

1 x 10–4 0.2 4.0 x 10–6 –6.0 0.0 3 0.0 0.0

1 x 10–4 0.4 8.0 x 10–6 –9.0 0.0 3 0.0 0.0

1 x 10–4 0.6 1.2 x 10–5 –7.9 0.0 3 0.0 0.0

1 x 10–4 0.8 1.6 x 10–5 –2.0 0,0 3 0,0 0,0

1 x 10–4 1.0 2.0 x 10–5 –3.0 0.0 3 0.0 0.0

1 x 10–4 2.0 4.0 x 10–7 –7.4 0.0 3 0.0 0.0

Ach, Acetylcholine; ESE. E. suaveolens extract (ml); FBC, final bath concentration; MedR,median response (cm); MMR, Mean Maximum Response (%) ; MR, Mean Response (cm).



17

DISCUSSIONThe fact that muscle relaxants are

very powerful drugs which may producenegative effects has left one to explorethe use of Erythrophleum suaveolens forsame purpose in traditional medicinepractices. This is also useful for drugdevelopment.

Erythrophleum suaveolens extractalone: Erythrophleum suaveolens extractblocked the nicotinic actions ofendogenous ligand acetylcholine by wayof inhibiting flow of nerve impulseswithin the tissue.10 Acetylcholine is anatural endogenous ligand and one ofthe synaptic transmitters. Theacetylcholine receptor transmits itssignal across the plasma membrane,increases transmembrane conductanceof the relevant ion and thereby alteringthe electrical potential across itmembrane. Acetylcholine causes theopening of the ion channel in thenicotinic acetylcholine receptor (Ach R),which allows Na+ ions to flow down itsconcentration gradient into cells,producing a localized excitatorypostsynaptic potential- a depolarization,and excitation. 10

Erythrophleum suaveolens in thepresence of acetylcholine: The inhibitoryeffect of the extract of Erythrophleumsuaveolens may be due to blockage ofthe receptor and thus preventing theentry of ions during depolarization ofskeletal muscle by acetylcholine. Theresults of the present investigationsuggest that an extract of Erythrophleumsuaveolens may exert an inhibitory effecton skeletal muscle contraction and thismay be due to inhibition of the effect ofacetylcholine at the receptor site.10

Neuromuscular blocking drugsinhibit neuromuscular transmission fromnerves to muscles by competitivelyblocking the binding of acetylcholine toits postsynaptic receptors at the motorend plate, thereby causing paralysis ofthe muscle.11 E. suaveolens extractexhibited non-depolarizing musclerelaxation by preventing access ofacetylcholine to the receptor protein.This results in no depolarization andprevents a change in resting potential ofthe motor end-plate. The result is lack ofmuscular contraction or paralysis.12

Table 2: Effect of Acetylcholine Concentration on Frog Rectus Abdominis Muscle


1 x 10–4 0.2 4.0 x 10–7 –6.40 1.5 3 1.5 46.91 x 10–4 0.4 8.0 x 10–7 –6.1 2.0 3 2.0 62.51 x 10–4 0.6 1.2 x 10–7 –5.92 2.7 3 2.7 84.41 x 10–4 0.8 1.6 x 10–6 –5.80 2.8 3 2.8 87.51 x 10–4 1.0 2.0 x 10–5 –3.01 3.2 3 3.2 100.01 x 10–4 2.0 4.0 x 10–7 –7.4 3.2 3 3.2 100.0

Ach, Acetylcholine; ESE. E. suaveolens extract (ml); FBC, final bath concentration;MedR,Median response; MMR, Mean Maximum Response; MR, Mean Response.

Table 3: Dose-response Relationships of Acetylcholine in the Presence ofE. suaveolens extract on Frog Rectus Abdominis Muscle


1 x 10–4 0.2 + 0.5 1.4 x 10-8 –7.85 0.0 3 0.0 0.01 x 10–4 0.4 + 0.5 1.8 x 10-8 –7.74 0.0 3 0.0 0.01 x 10–4 0.6 + 0.5 2.2 x 10-8 –7.70 0.63 3 0.63 70.01 x 10–4 0.8 + 0.5 2.6 x 10-8 –7.60 0.7 3 0.7 77.81 x 10–4 1.0 + 0.5 3.0 x 10-8 –7.52 0.8 3 0.8 88.91 x 10–4 0.5 + 0.5 1.0 x 10-6 –6.0 0.9 3 0.9 100.0

Ach, Acetylcholine; ESE. E. suaveolens extract (ml); FBC, final bath concentration; MedR,Median response; MMR, Mean Maximum Response; MR, Mean Response.

L o g F B C

Maximumresponse(%)

1 0

2 0

3 0

4 0

5 0

6 0

7 0

8 0

9 0

1 0 0

- 4- 6- 8- 1 0 - 2

*

*

**

**

***

*

Fig. 1: Maximum Response against Log Final Bath Concentration of Acetylcholinealone and Acetylcholine in the presence of E. suaveolens. Acetylcholine alone Acetylcholine + E. suaveolens.

7

100

90

80

70

60

50

40

30

20

10

Maxim

um R

esponse (%)



Erythrophleum suaveolens extractblocked the contracture effect of Ach.The relaxing effect of the extract on theisolated rectus abdominus muscle wasslow, though blockade effect on theacetylcholine-induced contractionsdecreased with increased dose ofacetylcholine. Paralysis is increased whenusing either non-depolarizing ordepolarizing relaxants by substancessuch as halogenated volatile anestheticagents, ether, lidocaine, digitalisglycosides, quinidine, diuretics, andprocaine. Also non-depolarizing blocksare increased by additional non-depolarizers.13

Muscle relaxation is the mainstay ofmodern anaesthesia and intensive care.Through manipulation of the traditionalstructure-action relationships, many newand improved muscle relaxants have beencreated, and several have been broughtto clinical use.14 Research in the field ofneuromuscular-blocking drugs such asthe isolation of tubocurarine andMalouetiabe quaertiana throughimproved understanding of thephysiology of neurons and receptorsover the years15–16 suggests similarcompounds may also be responsible fornon-depolarizing blocking activity ofE. suaveolens.

ConclusionThe cold water stem-bark extract of

E. suaveolens exhibited antagonizingeffect on the Ach-induced contraction ofthe isolated frog rectus abdominismuscle. This study corroborates the factthat E. suaveolens is a skeletal musclerelaxant. There is therefore need to

proffer better approach to the use ofE. suaveolens as skeletal a musclerelaxantin tradio-medicine as well as indrug development.

Conflicts of interest:No conflict of interest.

AcknowledgementThe authors thankfully acknowl-

edge the support of Prof. AlhassanYakubu, Prof Felix Anjorin, Miss JoyceBabatunde and Mr. Isaiah Idyu.

REFERENCES1. Bikhazi GB, Leung I, Flores C, Hassan

MJ, Mikati MD, Foldes FF.Potentiation of neuromuscular blockingagents by calcium channel blockers.Anesth Analg.1988; 67: 1–8.

2. Chattopadhyay RN, Roy RK, Das AK.Comparative studies of the effect ofcalcium channel blockers on isolatedskeletal muscle preparation. Indian JPharmacol. 1992; 24: 233–234.

3. Ogundeko TO, Idyu II, Ojo MT, IdyuVC, Ogbole EA, Builders MI, et al.Investigation of relaxative effect ofstem-bark extract of Erythrophleumsuaveolens on rat phrenic nerve-diaphragm muscle. J Advances MedicalPharmasci. 2015; 3: 24–30.

4. Idyu II, Kela SL, Idyu VC, AkinyedeA, Builders MI, Ogbole EA, et al. Acutetoxicity studies of Erythrophleumsuaveolensin Albino Mice (Mus-musculus). Int J Sci Res. 2014; 3: 366–371.

5. Idyu II, Olaoye TO, Sokomba EN, IdyuVC, Ramyil MS, Ogbole EA, et al. ThePharmacological evaluation of coldwater stem-bark extract of Erythro-phleumsuaveolens on gastrointestinalmuscle of guinea pig (Caviaporcellus)ileum. Int J Sci Res. 2014; 3: 602–607.

6. OgundekoTO, Ramyil MS, Idyu CV,Idyu II. Comparative effect of coldhydro stem-bark extract of Erythro-phleumsuaveolens on gastrointestinalmuscle of rabbit jejunum (Oryctola-guscuniculus). Ame J Pharmac Sci 2014;2: 52–55.

7. Akinpelu BA, Dare CA, Adebesin FI,Iwalewa EO, Oyedapo OO. Effect ofstem-bark of Erythrophleumsua-veolens (Guill. & Perri.) saponin onfresh water snail (Lanisteslybicus)tissues. Afr J Environmental SciTechnol. 2012; 6: 446–451.

8. Burkill H. The Useful Plants of WestTropical Africa.1985; 3: 116–120.

10. Kavimani S, Elango R, Gupta M,Majumdar UK. The effect of aqueousextract of Orthosiphonthymiflorus onisolated skeletal muscles. Ant Sci life.1998; 18: 46–49.

9. Grosse-Sundrup M, Henneman JP,Sandberg WS, Bateman BT, Uribe JB,Nguyen NT, et al. Intermediate actingnon-depolarizing neuromuscularblocking agents and risk of post-operative respiratory complica-tions:prospective propensity score matchedcohort study. Bri Med J. 2012; 345 10:1–14.

10. Crna MA. Neuromuscular blockingagent: A review. J AmeAssoc NurseAnaesth. 1981: 159–165.

11. Lee C. Conformation, action, andmechanism of action of neuromuscularblocking muscle relaxants. J PharmacolTherap. 2003; 98: 143–169.

12. Raghavendra T. Neuromuscular blockingdrugs: discovery and development2002; 95: 363–367.

13. McKenzie AG. Prelude to pancuroniumand vecuronium. Anaesth 2002; 55:551–556.

14. Bowman WC. Neuromuscular block. BriJ Pharmacol. 2006; 147: S277–S286.


Departments of †Medical Microbiology and Parasitology, ‡Haematology and Blood Transfusion, §Obstetrics and Gynaecology,¶Pharmacology and Therapeutics, **Paediatrics, College of Medicine and Health Sciences, Bingham University Teaching Hospital,Jos.*Correspondence: Dr. Y. J. Peter, Department of Medical Microbiology and Parasitology, College of Health Sciences, Bingham University,[email protected]: HBV, hepatitis B virus; HCV, hepatitis C virus, HBsAg, hepatitis B surface antigen; HBeAb, hepatitis B antobody.

Hepatitis B and C Viral Infections among Clinical Medical Students in Jos,North Central Nigeria

Infections virales des hépatites B et C chez les étudiants en médecine clinique de Jos,Centre-Nord du Nigeria

Y. J. Peters*†, S. Ramyil†, D. D. Freeman†, A. H. Isa‡, A. S. Anzaku§, M. I. Builders¶, A. M. Yakubu**

ABSTRACTBACKGROUND: The people most at risk of hepatitis B virus(HBV) and hepatitis C virus (HCV) infection by mucocutaneousexposure are healthcare and public safety workers who areexposed to blood and body fluids. Medical students who arebeing trained to practise within the healthcare environmentare also at risk of contracting these viruses.OBJECTIVES: The objective of this study was to determine theprevalence of HBV and HCV infection among clinical medicalstudents in Jos and vaccinate those who were hepatitis Bsurface antigen (HBsAg) seronegative.METHODS: We conducted a cross sectional study of clinicalmedical students. All clinical medical students of BinghamUniversity were targeted. A structured questionnaire wasadministered to obtain demographic data on risk of exposureto HBV and HCV infections. Laboratory analysis of hepatitisvirus antibodies from blood sample collected from each studentwas undertaken. The prevalence rate and test of associationbetween variables were appropriately determined.RESULTS: Of a total of 116 students enrolled, 51(44%) weremales and 65 (56%) were females. Six (5.2%) students wereHBsAg seropositive, none was previously immunized againstHBV infection, among them, four (3.5%) had detectable serumHBeAb levels. None of the students who previously had HBVvaccination was seropositive for HBsAg. Two (1.7%) studentshad detectable serum anti-HCV, one from each gender.CONCLUSION: We conclude that the prevalence rates of HBVand HCV infections are relatively low among the clinicalmedical students. All HBsAg seronegative students should beoffered HBV vaccine. BJM 2017; 1(1): 19–22.

Keywords: Hepatitis B virus, hepatitis C virus, medicalstudents, Jos.

ABSTRAITCONTEXTE: Les personnes les plus à risque de virus de l’hépatiteB (VHB) et le virus de l’hépatite C (VHC) par l’expositionmucocutanée sont les travailleurs de la santé et de la sécurité publiquequi sont exposés au sang et les fluides corporels. Les étudiants enmédecine sont formés et se pratiquer dans le milieu des soins desanté; ils sont à risque d’exposition à ces virus.OBJECTIFS: L’objectif de cette étude était de déterminer laprévalence du VHB et du VHC chez les étudiants en médecine cliniqueà Jos et vacciner ceux qui étaient HBsAg séronégatifs.Méthodes: Nous avons mené une coupe, étude descriptivetransversale d’étudiants en médecine clinique. Tous les étudiants enmédecine clinique de l’Université Bingham ont été ciblés. Unquestionnaire structuré a été administré pour obtenir des donnéesdémographiques sur le risque d’exposition au VHB et du VHC.L’analyse en laboratoire des anticorps du virus de l’hépatite del’échantillon de sang prélevé sur chaque sujet a été entreprise. Le tauxde prévalence et le test d’association entre les variables a été déterminéeen utilisant le test de chi carré de Pearson.RÉSULTATS: Sur un total de 116 sujets inscrits, 51 (44%) étaientdes hommes et 65 (56%) étaient des femmes. Six (5,2%) sujets étaientHBsAg séropositifs, aucun n’a été préalablement immunisé contrel’infection par le VHB, parmi eux 4 (3,5%) avaient Ac anti-HBesérique détectable. Aucun des sujets qui avaient auparavant vaccinationcontre le VHB était séropositif pour HBsAg. Deux (1,7%) des sujetsavaient antiHCV sérique détectable, un de chaque sexe.CONCLUSION: Nous avons conclu que la prévalence du VHB etdu VHC sont relativement faibles chez les étudiants en médecineclinique. Tous les sujets séronégatifs HBsAg devraient être offertsvaccin contre le VHB. BJM 2017; 1(1): 19–22.

Mots clés: VHB, VHC, étudiants en médecine, Jos.


RESEARCH ARTICLE


Y. J. Peters and Associates Viral Hepatitis in Clinical Students

INTRODUCTIONHepatitis due to hepatitis B virus

(HBV) and hepatitis C virus (HCV) areoa a major global public health concernbecause of worldwide distribution of theviruses and significant attendantmortality and morbidity.1,2 They are alsothe leading cause of liver cirrhosis andcancer around the world.3 The personsat most risk for hepatitis infection bycutaneous or mucosal exposure arehealthcare and public safety workers whoare reasonably anticipated to be exposedto blood and body fluids.4 Hepatitis Bvirus is a prototype for the hepadna-viridae family of hepatotropic partiallydouble stranded DNA viruses, while HCVis a single stranded RNA virus belongingthe family, Flaviviridae.7 Although verydifferent at the molecular level, HBV andHCV share may similarities as pathogens.

Perinatal and sexual exposures toviral pathogens are highly efficientmodes of transmission and person-to-person spread of viral hepatitis. Thisinfection occurs among householdcontacts of a chronically infected person,likely as a result of non-intact skin ormucous membrane contact withsecretions containing blood.8

Percutaneous exposures that haveresulted in transmission of hepatitisinclude contaminated equipment , illegalinjection drug use, and needle sticks orother injuries from sharp instrumentssustained by hospital personnel.9 Inaddition, occasional outbreaks of HBVinfection have been associated withtattooing and acupuncture.10 Indeveloping countries, donor testing forHBsAg is not universal. Transmissionthrough unsafe therapeutic practices,including inadequately sterilized needlesand medical instruments, and the reuseof disposable needles and syringesremains a significant problem.11 Rarely,transmission has followed bites frominfected persons and it has beensuggested that most horizontaltransmission within families and amongyoung children is due to inapparentparenteral exposure to saliva or blood.12

Health education is the cornerstone inthe prevention of these viralinfections.13–15 Immunization remains themost effective way to control HBVinfection.16 This stresses the importance

of HBV vaccination among all health careworkers including clinical medical andnursing students. Hepatitis B vaccinationis recommended for healthcare personnelat risk for occupational exposure to thisblood borne pathogen.

Bingham University medicalstudents who would come to the hospitalfor clinical training to be trained in ahospital will be at risk of HBV and HCVinfections. We conducted a crosssectional, descriptive study of freshintake of clinical medical students ofBingham University Teaching Hospital.The aim of this study was to determinethe HBV and HCV status of all medicalstudents coming to Bingham UniversityTeaching Hospital for training and toimmunize those students who were foundto be HBsAg seronegative.

SUBJECTSAll the clinical medical students of

Bingham University were targeted. The123 clinical medical students who wereeligible to be recruited included all medicalstudents who started clinical training inthe years 2012, 2013 and 2014. Eachstudent was enrolled within two weeksof reporting to the hospital for clinicaltraining. Only clinical medical studentswho accepted to participate by signingthe informed consent form were recruited.Ethical clearance for the study wasobtained from the Bingham UniversityTeaching Hospital, human research andethics committee (BHUTH/HREC/SNO/00033).

Pretest counseling was given toeach student in confidence and aninformed consent obtained. A structuredquestionnaire was administered to obtaindemographic risk of exposure to HBV andHCV infection data from each student.The questionnaire included questions onsocio-demographics, medical history,and exposure to sexual activity, jaundicedpatients and socio-cultural activity thatinvolved blood. Each student was thenregistered with a unique study numberwhich was used to track their bloodsample.

A blood sample of 4-5 ml wascollected from each student into an EDTAvacutainer bearing the unique subjectnumber. Each sample was centrifuged at2500 rpm for five minutes and plasma

obtained. The plasma was divided andheld in duplicate vials stored at –20oC untilneeded. A stored sample was thawed andbrought to room temperature just beforeit was analysed. Each sample wasscreened for HBsAg using ABON(HBsAg) and anti-HCV using ABON(antiHCV) rapid test strips (AbonBiopharm, China). All the samples thatwere found positive for HBsAg were alsotested for anti-HBsAb and HBeAb by asecond test using One step HBV (Biotec,Middlesex UK) rapid test strips. Bloodsamples from students previouslyvaccinated against HBV were also testedfor anti-HBsAb and HBeAb.

The data was analysed using SPSS(SPSS Inc., Chicago IL.U SA) version 17.The Pearson’s Chi square test at 95%confidence with statistical significantlevel set at p<0.05 was used to test thedata obtained.

RESULTSA total of 116 students were

recruited, of which 51 (44%) were malesand 65 (56%) females. The mean age formales was 23.4 years and for females 23.6years with a range of 19–51 years. Onehundred and eleven (95.7%) of thestudents lived in a city rather than townor village; 99 (85.3%) of the students weredomiciled in Plateau state.

Twenty-one (18.1%) students werepreviously immunized against HBVinfection, 13(11.2%) of whom were malesand eight (6.9%) were females. Thirty-six(31.0%) students were previouslyhospitalized or had surgery, 14 (12.0%)were males, 22 (18.9%) were female. Forty-four (37.9%) had contact with jaundicedpatients, 18(15.5%) were males, 26(22.4%) were females while 46(39.7%)students had dental proceduresperformed on them (Table 1). Sixteen(13.8%) shared sharp objects with others,6(5.2%) were males, 10 (8.6%) werefemales. Eleven (9.5%) had tattoo marks,5(3.0%) were males, 9 (7.7%) werefemales. Six (5.2%) female studentssuffered jaundice another 3 (2.6%) femalestudents had traditional surgery liketattoo, scarifications and circumcisions.Three students (2.6%) had bloodtransfusion, two (1.7%) were males, one(0.9%) was female.



21

No socio-demographic variable wassignificantly associated with HBV orHCV infection. There was no co-infectionfor the two viruses in any subject.

DISCUSSIONthis study, we examined the

occurrence of HBsAg and anti HCVamong clinical students in Jos. A commonsocio-demographic risk of exposureassociated to HBV and HCV infectioncould not be determined from thisstudy.11 Significantly however, is thatnone of the students who previously hadaccepted HBV vaccine intervention wasseropositive for HBsAg in this study, thismay be an indication of efficiency of thevaccine given. All the HBsAg positivestudents were male, this was surprising;the reason for this bias if determinedwould be a significant finding.

We found HBsAg prevalence of5.2% and anti HCV prevalence of 1.7%among our students. This HBsAgprevalence of about 5% is low comparedto findings from other parts of Nigeria17,18

and Africa19 as well as earlier studies fromJos.20–22 The relatively low HBsAgprevalence in these students comparedto the prevalence in the generalpopulation is not surprising. Thesestudents, who were undergraduates,were more likely to be from families withbetter education and health awareness.These students were likely to be lessexposed to the negative risk of exposureand unsafe practices associated withHBV and HCV infections compared to thegeneral population.

The prevalence of HBV and HCVinfections are relatively low among theseclinical medical students compared to theprevalence of the general population.However, there is a need to screen allclinical medical students atcommencement of their clinical studyyears so as to vaccinate those who areseronegative against HBV, to protectthem from future risk of infection by thevirus.

Conflict Of InterestI declare no conflict of interest that

might have led to bias in this work.

REFERENCES1. Alta MJ. Epidemiology of viral hepatitis

and HIV co-infection. J Hepatol. 2006;44: 6–9.

2. Kane A, Llyod J and Zaffaran M.Transmission of hepatitis B, hepatitis Cand human immunodeficiency virusesthrough unsafe infections in thedeveloping world. Model-basedregional estimates. WHO Bull. 1999;27: 801–807.

3. CDC. Morbidity and mortality weeklyreport. MMWR. 2/7/2012; 61: 545–64.

4. Paul K N, Bradley M M, Benjamin C,Holly H, Don D J, Danielle H andLouisa D. Global epidemiology ofhepatitis B and hepatitis C in peoplewho inject drugs: results of systematicreviews. The Lancet. 2011; 378: 571–83.

5. Sarra E, Lamya OAMS, Sahar IM,Shima EEA, Nazik FEM, Ekram HH etal. Staff Knowledge, adherence toinfection control recommendations andseroconversion rates in hemodialysiscenters in Khartoum. AJANT. 2011; 4:13–19.

6. Egesie JO, Joseph ED, Egesie UG andOdeh CI. Trends in the Incidence ofHepatitis B, C and Human Immuno-deficiency Virus (HIV) among BloodDonors in a Tertiary Hospital inNigeria. J Med Trop. 2011; 13: 79–81.

7. Karl-Dimiter B, Stefan F W, Pu T,Masanori I, Tam T. L, Francis V. C, andInder M. V. Human liver chimeric miceprovide a model for hepatitis B and Cvirus infection and treatment. J ClinInvest. 2012; 120: 924–30.

8. Destang JL. Hepatitis B Virus infection.N Engl J Med. 2008; 359: 1486-1500.

9. Henderson DK. SHEA Guideline forManagement of Healthcare WorkersWho are Infected with Hepatitis BVirus, Hepatitis C Virus and/or Human

Six (5.2%) male students wereHBsAg seropositive, none of whom waspreviously vaccinated against HBV. TheChi square output revealed that theprevalence of Hepatitis B virus infectionfor male and female respondents differedsignificantly (p<0.05). There was a riseof HBV infection with increasing agestarting at age 21 years (Figure 2). Amongthe seropositive students, four (3.5%)had detectable HBeAb, only nine (7.8%)out of the 21(18.1%) previouslyvaccinated students had detectableserum antiHBsAb. None of thosepreviously vaccinated against HBVinfection however, was seropositive forHBsAg.

Two (1.7%) students wereseropositive for HCV infection, one eachfrom either gender (p>0.05). This gave aHCV prevalence of 1.7% in our studysubjects.

Table1: Distribution of Medical Students by Risk Factors for Viral Hepatitis

Risk Factor Number (%)

Male Female Total

N 51 65 106

Immunization 13(25.5) 8(12.3) 21(19.8)Hospitalization 14(27.5) 22(33.8) 36(33.3)Dental procedure 17(33.3) 29(44.6) 46(43.3)Blood Transfusion 2(39.2) 1(1.5) 3(2.8)Shared sharps 6(11.3) 10(15.4) 16(15.1)Suffered jaundice 0 6(7.2) 6(5.7)Contact Jaundice 18(35.3) 26(40.0) 44(41.5)Scarification mark 5(9.8) 6(9.2) 11(10.4)Traditional Surgery 0 3(4.6) 3(2.8)

0

5

10

15

20

25

30

35

<21 21-23 24-26 27>

Num

ber o

f sub

ject

s

Age group in years

Reactive

Non-reactive

Fig. 1: Distribution of Participantsby Age and HBsAg Serum Reaction Reactive Non-reactive.



22

Immunodeficiency Virus. Infect ControlHosp Epidemiol. 2010; 31: 204–232.

10. Ali M, Idrees M, Ali L, Abrar H,Rehman IU, Saleem S, Afzal S and ButtS. Hepatitis B virus in Pakistan: Asystematic review of prevalence, riskfactors, awareness status andgenotypes. Virol J. 2011; 102: 1–9.

11. Iroezindu MO, Daniyam CA, Isa ES,Edith NO, and Oche OA. High riskbehavior among hepatitis B virusinfected patients in a Nigerian tertiaryhospital. J Med Trop. 2012; 6: 8–12.

12. Ado A, Alhassan S, Chonoko UG,Samaila AU. Sero-prevalence ofhepatitis Ba surface antigen (HBsAg)among Blood Donors attending AhmaduBello University Teaching Hospital(ABUTH), Zaria, Nigeria. Bajopas2010; 3: 20–22.

13. Gadour MO and Mohammed BET.HBV, HCV and HIV among patientswith hemophilia in Khartoum-Sudan.SJMS. 2011; 6: 50–51.

14. Emechebe GO, Emodi IJ, Ikefuna AN,Ilechukwu GC, Igwe WC, Ejiofor OS

and Ilechukwu CA. Hepatitis B virusinfection in Nigeria – a review. NMJ.2009; 50: 42–49.

15. Hassan A, Nur H A, Christian R andothers. Prevalence and risk factors ofhepatitis B and C virus infections in animpoverished urban community inDhaka, Bangladesh. BMC infectiousdisease. 2010; 10: 23–33.

16. Ndako J A, Echeonwu GON, OlabodeAO et al. Seroprevalence of HepatitisB Surface Antigen (HBsAg) amongchildren of Primary school age in acommunity, North Central Nigeria.Sierra Leone J Biomed Res. 2010; 2:32-37.

17. Balogun TM, Emmanuel S and OjerindeEF. HIV, Hepatitis B and C viruses co-infection among patients in a Nigeriantertiary hospital. Pan Afr Med J. 2012;12: 2–3.

18. Mabayoje V.O, Akinwusi P.O., OpaleyeO.O, Aboderin O.A, Egbewale B. E, andFagbami A.H. Prevalence of hepatitisB surface antigen, hepatitis C andhuman immunodeficiency virus

antibodies a in a population of studentsof tertiary institution in Nigeria. Afr JCln Exper Microbiol. 2010; 11: 68–74.

19. Komas NP, Bai-Sepou S, ManirakizaA, Leal J, Béré A and Faou A. Theprevalence of hepatitis B virus markersin a cohort of students in Bangui,Central African Republic. BMCInfectious Diseases. 2010; 10: 1–7.

20. Egah DZ, Banwat EB, Audu ES, Iya D,Mandong BM, Anele AA, et al.Hepatitis B surface antigen, hepatitisC and HIV antibodies in a low-riskblood donor group, Nigeria. EastMediterr Health J. 2007; 13: 961–6.

21. Chukwuedo AA, Eze NCO, NimzingL, Okwori AEJ. Prevalence of hepatitisB virus surface antigens (HBsAg) andHepatitis C virus antibodies in blooddonors at Jos, Plateau State, Nigeria.Inter J Nat App Sc. 2009; 5: 398–401.

22. Jombo GTA, Egah DZ, Banwat EB.Hepatitis B virus and HumanImmunodeficiency Virus co-infection inZawan community of Plateau State.J Med Trop. 2005; 7: 21–26.


Department of Obstertrics and Gynaecology, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria, †Gastroenterologyunit, Department of Internal Medicine, ABUTH, Zaria.*Correspondence: Dr. Aisha Mustapha. Department of Obstertrics and Gynaecology, Ahmadu Bello University Teaching Hospital, Shika, Zaria,Nigeria [email protected]: DIC, Disseminated intravascular coagulation; MVA, Manual vacuum aspiration; NSAIDs, Nonsteriodal anti-inflammatory drugs;PCV, Packed cell volume; SAMM, maternal near-miss or severe acute maternal morbidity; UGIH, Upper gastrointestinal haemorrhage.

Severe Acute Maternal Morbidity Associated with Septic Abortion:A Case Report

Morbidité Maternelle Aiguë Sévère Associée à l’Avortement Septique: Rapport de cas

A. Mustapha*, S. David†, A. G. Adebiyi, A. Bashir

ABSTRACTBACKGROUND: Massive upper gastrointestinal haemorrhage(UGIH) is a common surgical emergency. It is howeveruncommon for it to present as the only site of bleeding in apatient with septic abortion.OBJECTIVE: To report a case of the occurrence of non-steroidalanti-inflammatory drug (NSAID)-induced gastropathy as acause of massive UGIH in a patient with septic abortion.CASE REPORT: A 19-year-old woman presented with fever andbleeding per vaginam and haematemesis about two weeks afteran unsafe abortion. Examination revealed a young woman inshock. She was fully investigated and successfully resuscitatedRESULTS: She had intractable haematemesis which wasinitially suspected to be due to disseminated intravascularcoagulopathy. She was rhesus negative. The haematemesis wassubsequently found at endoscopy to be due to acute uppergastrointestinal ulceration following non-steroidal anti-inflammatory drug abuse. She had, among other treatments,13 units of rhesus negative blood transfused, intensive careand triple therapy for the UGIH, anti-D immunoglobulinadministration and manual vacuum aspiration for retainedproducts of conception. She recovered fully.CONCLUSION: Severe acute maternal morbidity can be due toseveral causes. A high index of suspicion for unusual causessuch as non-steroidal anti-inflammatory induced gastropathyand prompt appropriate multidisciplinary approach tomanagement are key to a favourable outcome. BJM 2017;1(1): 23–25.

Keywords: Gastrointestinal haemorrhage, NSAID-inducedgastropathy, septic abortion, maternal near-miss, severe acutematernal morbidity

ABSTRAITCONTEXTE: hémorragie digestive haute Massive (UGIH) estune urgence chirurgicale commune. Il est cependant rare, pourprésenter, comme le seul site de saignement chez un patientprésentant un avortement septique.OBJECTIF: Rapporter un cas de l’apparition d’un médicamentanti-inflammatoire non-stéroïdien (AINS) gastropathie induitecomme une cause de UGIH massives chez les patients présentantun avortement septique.RAPPORT DE CAS: A 19 ans, la femme a présenté de la fièvreet des saignements PV et hématémèse environ deux semainesaprès l’avortement à risque. L’examen a révélé une jeune femmeinstinct. Elle a été entièrement étudiée et réanimée avec succèsRÉSULTATS: Elle était rhésus négatif, elle avait hématémèseintraitable qui a été initialement soupçonné d’être due à unecoagulopathie intravasculaire disséminée. Le hématémèse adécouvert par la suite à l’endoscopie soit due à l’ulcérationgastro-intestinale supérieure aiguë suite à l’abus de droguesnon-stéroïdiens anti-inflammatoire ; une histoire qui a étédifficile d’obtenir d’elle. Elle avait, entre autres traitements, treizeunités de sang rhésus négatif transfusés, les soins intensifs etla triple thérapie pour le UGIH, anti-D administrationd’immunoglobuline et l’aspiration manuelle pour les produitsde conception retenus. Elle est complètement rétablie.CONCLUSION : la morbidité maternelle aiguë sévère peut êtrefait à plusieurs causes. Un indice élevé de suspect pour descauses inhabituelles telles que la gastropathie induite anti-inflammatoire non stéroïdien dans les cas et l’approchemultidisciplinaire appropriée invite à la gestion sont essentiellesà une issue favorable. BJM 2017; 1(1): 23–25.

Mots-clés: Hémorragie massive gastro-intestinale, gastropathieinduite par les AINS, l’avortement septique, maternelle quasi-accidents, graves de morbidité maternelle aiguë



A. Mustapha and Associates Maternal Near-miss from Abortion

INTRODUCTIONIn Nigeria, an estimated 20–40% of

maternal deaths result from abortioncomplications1 with much more sufferingdisability.Massive upper gastrointestinalhemorrhage (UGIH) which be defined asbleeding from the upper gastrointestinaltract is associated with haemodynamicinstability, acute anemia and/or the needfor blood transfusion of at least four unitsof blood.2

Non-steroidal anti-inflammatorydrugs (NSAIDs) are the most highlyprescribed drugs for pain, inflammationand fever but they are associated withsevere side effects including gastro-intestinal injury and peptic ulcerationwhich can lead to gastrointestinalhaemorrhage.4,5

A maternal near-miss or severe acutematernal morbidity (SAMM) can bedefined as a woman who nearly died butsurvived a complication that occurredduring pregnancy, childbirth or within 42days of termination of pregnancy. Criteriafor identifying near misses could beclinical, intervention-based, or organ-system dysfunction-based criteria.3

Massive UGIH may present inrelation to septic abortion but usually asa component of disseminated intra-vascular coagulopathy (DIC).3 We didnot find any report on massive uppergastrointestinal hemorrhage in patientswith septic abortion that were not due toDIC.

We report a rare presentation ofmassive upper GI bleeding from NSAID-induced gastroduodenal ulcerations in ateenager with septic abortion who was amaternal near-miss.

HistoryThe patient was a 19-year old para

0+1 who presented to us with a 13-dayhistory of unsafe induced abortion at 10weeks of gestation, a 7-day history offever, bleeding per vaginam and an 8-hour history of haematemesis. Abortionwas carried out using manual vacuumaspiration (MVA) at the home of thepractitioner. Pain subsided same day withuse of some tablets but spottingcontinued. Six days post abortion,bleeding per vaginam worsenednecessitating use of 24–30 pad strips perday as against her premorbid use of two-

three pad strips during menses. She hada repeat MVA four days prior topresentation at the same place and bythe same person. Bleeding subsided butshe developed copious foul smellingvaginal discharge, low back pain, fever,and coffee ground vomitus. Eight hoursprior to presentation, she had fourepisodes of frank haematemesis of about500ml per episode. She then developedsevere body weakness and dizziness afterthe fourth episode. Other relevantaspects of the history were that she wasblood group B-negative, had never usedcontraceptives, was not aware of papsmear, and had one sexual partner whobroke up with her on discovering theindex pregnancy.

Physical ExaminationOn examination at presentation, she

was lethargic, severely pale, febrile(axillary temperature was 38.20C), withcold clammy extremities, sweating,tachydyspnoeic with impalpable radialpulses. The carotid pulse was 136 beatsper minute and the blood pressure was80/50 mmHg. The saturated partialpressure of oxygen was 62%. She hadtwo bouts of frank haematochezia ofabout 150 ml/bout while being examined.There was marked suprapubictenderness but no ascites. Her perineumwas soiled with foul smelling purulentdischarge seen trickling from the cervicalos, No product of conception was seen.The anal area was bloodstained, and therectum was roomy and empty.

An initial impression of septicabortion with massive uppergastrointestinal bleeding in a rhesusnegative single student secondary toDIC was made.

ManagementShe was resuscitated including

intravenous fluids, passage of anasogastric tube and urethral catheter.Intravenous ceftriaxone and metroni-dazole were commenced as well as.

Her admitting packed cell volume(PCV) was 16% . Two units of fresh Bnegative blood were transfused threehours after presentation. The clottingprofile showed no laboratory evidenceof DIC. Indirect Coombs test wasnegative. Urgent ultrasound scan (USS)

done showed retained products ofconception. Full Blood count showed aleucocytosis of 22x10 9/L withneutrophilia of 98%, toxic granulationsand left shift. The platelet count wasnormal.

Further Management ChallengesHaematemesis and haematochezia

continued with the average blood lossof 2–3l/day and syncopal attacks afterbouts. Transfusion of rhesus negativeblood continued with intermittent calciumgluconate administration after every fourunits. Additional history revealed shewas taking four tablets of ibuprofen fourto six times daily in addition to ampicillincapsules in the preceding four days. Adiagnosis of NSAID-induced gastro-pathy was then entertained.

The gastroenterologists and thegeneral surgeons were invited. She wasplaced on nil per oral, and wascommenced on intravenous ranitidine.She was slated for oesophago-gastroduodenoscopy but her PCV haddropped to 13% after six units of blood.There was difficulty procuring Rhesusnegative blood for transfusion and aletter was written to the National BloodTransfusion Service at Kaduna forassistance with prompt response.Endoscopy done on the fourth day ofadmission revealed a huge ulcer in thefirst part of the duodenum that measuredabout 2cm x 2cm, with a visible vesseland thick adherent blood clot on theulcer. There were also multiple areas ofgastric erosion in the body and antralparts of the stomach.

On the fifth day of admission, shevomited two litres of fresh blood withassociated clots and she developedaltered sensorium, with systolic bloodpressure of 60 mmHg, un-recordablediastolic blood pressure, and saturatedpartial pressure of oxygen of 35%–60%even after four hours of resuscitation.Anesthetists reviewed for intensive careand she was given intravenousephedrine, oxygen therapy, intravenousfluids and blood transfusion.

After two days of intensive care, shewas improving, UGIH was subsiding, andher vital signs were normalizing. She wascommenced on clarithromycin,rabeprazole, and amoxicillin and she


A. Mustapha and Associates Maternal Near-miss from Abortion

made some clinical improvement. Shedeveloped hypokalaemia of 2.5 mmol/L,which was corrected. She had a total of13 units of blood transfused with posttransfusion PCV of 28%.

Repeat USS showed retainedproducts of conception with destructiveendometrial changes. She had cervicalstenosis, which was dilated and manualvacuum aspiration was done. Anti-Dimmunoglobulin was administered. After12 days on admission, she developedfeatures of malaria fever, which wasconfirmed on blood film and treated.

She thereafter maintained steadyprogress. Both the patient and herparents were adequately counseled. Shewas referred to the reproductive healthclinic for post abortion care includingpapanicolaou smear. She was dischargedafter 13 days on admission.

DISCUSSIONMassive UGIH can occur with

septic abortion as well as in patients withstress-induced gastrointestinal ulcera-tion, ingestion of caustic substances,NSAIDs, in intensive care unit patientsand patients with severe burns. Reportedcases of massive UGIH in septic abortionare due to DIC.3 Other authors havereported melena.7 We didn’t find anypublication on massive UGIH in septicabortion attributable to concurrent useof NSAID and subsequent developmentof NSAID induced gastropathy. Theclosest case was that following soap-induced abortion.8 A high index ofsuspicion may help in the diagnosis, asmost patients who undergo inducedabortion will be on analgesics mostlyNSAIDs.

The cause of her massive UGIH wasdue to NSAID induced gastroduodenalulceration, which was confirmed at adiagnostic endoscopy. Althoughdifferent endoscopic therapies areavailable to secure haemostasis includ-ing injection and thermal therapies, at thetime the patient presented to our facility,none of these techniques was operational

though a surgical consult was obtainedin the event of failure of medicalmanagement. The decision to give tripletherapy to the patient for Helicobacterpylori eradication without a urea breathtest was based on the fact that the patientwas weak at presentation and we wouldnot have been able to wait for 10 days towean her off the previous antibiotics shewas on and also for her to have anovernight fasting and breathing into thebreath card would not be possible

Severe Acute Maternal MorbidityAn analysis of cases of SAMM or

near-misses has the potential to highlightthe deficiencies (as well as the positiveelements) in the provision of obstetricservices in any health system. The higherfrequency of near misses compared tomaternal deaths allows a more rapid,comprehensive and statistically reliablequantitative analyses that are valuableto clinical audit. Also, compared tomaternal deaths, survivors could tell theirown stories. This patient was one out ofthe numerous women who sufferedSAMM. For every maternal death, atleast 30 women suffer SAMM.5

The diagnosis of SAMM in ourpatient was based on clinical,intervention-based and organ-systemdysfunction-based criteria . The clinicalcriterion she had was in the form of severehaemorrhage with blood loss of over 2.4L.The intervention-based criteria weretransfusion of over 2L of blood and alsoadmission into intensive care unit. Theorgan-system dysfunction-based criteriawere a systolic blood pressure <90mmHglasting more than 60 minutes despiteaggressive fluid replacement of greaterthan two litres and oxygen saturation lessthan 90% for greater than 60 minutes.Prompt multidisciplinary approach wasparamount to successful treatment.

CONCLUSIONUnsafe induced abortions are

common in Nigeria despite restrictiveabortion laws. Massive UGIH can

complicate septic abortion. A high indexof suspicion is needed to ascertain if thisis due to NSAID-induced gastropathyand not the commoner presentation ofDIC. A past history of use of NSAID andother related drugs should be sought inevery patient with upper GI haemorrhageirrespective of the clinical presentation.

REFERENCES1. Okonofua FE. Preventing unsafe

abortion in Nigeria. Afr J ReprodHealth. 1997; 1: 25–36.

2. Farris S. Massive gastrointestinalbleeding CDEM self-study moduleavailable at www.org/ssm/gi/gib/gib.phb accessed on 6/12/14

3. Buka NJ, Whelton JA, Tenney B.“Upper gastrointestinal hemorrhageafter septic abortion.” Am J ObstetGynecol 1965; 91: 504–508.

4. Nuki G, Pain control and the use ofnon-steroidal anti-inflammatorydrugs. British Medical Bulletin,1990; 46: 262–278.

5. Smalley WE, Ray WA, DaughertyJR, Griffin MR, Non-steroidal anti-inflammatory drugs and theincidence of hospitalizations forpeptic ulcer disease in elderlypersons. AM J Epid. 1995; 141: 539–45.

6. Say L, Souza JP, Pattison RC. WHOWorking Group on MaternalMortality and MorbidityClassifications. Maternal near-miss– towards a standard tool formonitoring quality of maternal healthcare. Best Pract Res Clin ObstetGynaecol. 2009; 23: 287–96.

7. Rana A, Pradhan N, Gurung G, SinghM. Induced septic abortion: A majorfactor in maternal mortality andmorbidity. Journal of Obstetrics andGynaecology Research. 2004;30: 3–8.doi: 10.1111/j.1341-8076.2004.00146.x

8. Smith R, Smith L, Tenney B. SoapInduced Abortion: report of 5 cases.Obstet Gynecol. 1962; 20: 211–5.

25


Renal Failure and Haemolysis in a Two-Year-Old Child due to Black WaterFever Or Naphthalene Poisoning

Insuffisance Rénale et Hémolyse chez un Enfant de 2 ans: Fièvre de l’eau Noire ouEmpoisonnement au Naphtalène?

WEST AFRICAN JOURNAL OF MEDICINE

LETTER TO THE EDITOR

Malaria remains a major publichealth problem in the world, with sub-Saharan Africa accounting for about80% of malaria cases.1 Black waterfever (BWF) is one of the severeforms of malaria. 2, 3 It is a clinicalsyndrome characterized by severeintravascular haemolysis, haemo-globinuria and acute renal failure,commonly seen after receivingquinine. 2, There have been reportsof haemolysis occurring in patientstreated with artemether-lumefantrinecombination therapy.3 There is also astrong association of haemolyticanaemia with naphthalene poisoning,first described in 1949,4 . In this initialreport four Negro infants withmothballs poisoning, presented amongothers with severe intravascularhaemolysis, haemoglobinuria andacute renal failure.

Our patient, BJK, a 2-year- oldmale child presented with complaintsof fever, diarrhoea, vomiting andpassage of dark coloured urineassociated with reduced urine outputfor three days. Child was treated withartemether–lumefantrine andparacetamol. His mother gave ahistory of accidental mothballingestion, for which vomiting wasinduced by administering palm oil,peak milk and abdominal compression;the child vomited one ball of thenaphthalene. Examination revealedan acutely ill looking child who wasconscious with a temperature of38.5oC. He was pale and jaundiced

but other vital signs were stable. Hisurine coca-cola coloured.

A diagnosis of severe malariapresenting as severe anaemia andblack water fever was made. Thedifferential diagnosis was haemolyticanaemia secondary to naphthalenepoisoning. The patient’s packed cellvolume (PCV) was 18% and malariaparasite was positive. Urinemicroscopy showed no red blood cellsor red cell cast. Urine culture showedno bacterial growth. The results of afull blood count were as follows:haemoglobin, 5.8 g/dl; WBC,

9.0×109/L; platelets, 220×109/L;reticulocytes, 1.5%; neutrophils,61%; lymphocytes, 30%; monocytes,2%; and eosinophils 7%. His G6PDactivity was within normal limits. Theliver function tests were normalexcept for high bilirubin. The patientwas also negative for hepatitis B andC screening. Serial serum electro-lytes and urinalysis results are shownin the Table. The index patientimproved tremendously after he wastransfused with blood and was placedon artesunate.

Table 1: Serial Results of Serum Biochemistry and Urinalysis

Day 1 Day 3 Day 5

Serum ElectrolytesSodium mmol/l 145 150 140Potassium mmol/l 5.8 5.l 4.2Chloride mmol/l 110 100 100Bicarbonate mmol/l 15 20 25Urea mmol/l 20 8.8 3.8Creatinine μmol/l 135 87 44

UrinalysisSpecific Gravity 1.030 1.020 1.020pH 6.5 7.0 8.0Glucose Negative Negative NegativeProtein +++ ++ +Ketone +++ Negative NegativeHaemoglobinuria ++ + NegativeNitrite Negative Negative NegativeLeucocyte esterase Negative Negative NegativeBilirubin + + Negative

Protein +, 30 mg/dl; bilirubin +, 15 mg/dl; haemoglobinuria +, 10 mg/dl.


Y. Mava and Associates Letter to the Editor

The clinical presentation of BWFis typically with intravascularhaemolysis2 associated with fever,headache, vomiting, malaria parasi-taemia and later passage of coca-colacoloured urine, jaundice and renalfailure. Our patient had similarpresentation except that he never hadquinine, halofantrine or mefloquine.The most likely trigger in our patientmight be the artemether-lumefantrinehe was given on outpatient basis. Thiscorroborates with a report by Aloniet al3 where haemolytic crisis ofBFW followed artemether-lumefatrine intake.

The index patient improvedtremendously after he was transfusedwith blood and was placed onartesunate. Oguche et al 2 hadsimilarly treated their patients withBWF using artesunate. Our patient’searly signs of renal failure werereversed by renal challenges. It isconceivable that other drugs andchemicals can trigger intravascularhaemolysis with subsequentdevelopment of haemoglobinuria,jaundice and renal failure especiallyif they are G6PD deficient.4, 5 Thismay be the case in our patient, sincehe had ingested naphthalene ball, buth i s G

6PD activity was within normal

limit. However, the laboratory report

suggesting normal G6PD activity maynot be unusual in the black Africantype G

6PD deficiency where, false

negative G6PD assay may occur.

The challenge here is that we hadno reagents to do the susceptibilitytest of the blood of index patient tonaphthalene to see wither thehaemolysis could be attributed tonaphthalene or not. Massivehaemolysis and haemoglobinuria hadbeen reported in a patient with SCA,5 however the index patient’sgenotype was AA. Haemoglobinprecipitation in the kidney can lead torenal impairment. This might havebeen the case in the index patient.

It is very important for physicianswho manage cases of malaria to beaware that severe intravascularhaemolysis can follow artemether-lumefanthrine administration; and thatnaphthalene poisoning may mimicBWF and G6PD deficiency.

ACKNOWLEDGEMENTWe are grateful to all the Nursing

Staff and the assistance of Dr. JatauE.O. of the Department of Haema-tology, Jos University TeachingHospital is hereby acknowledged. Weare also grateful to the patient’smother for her high degree ofcooperation.

REFERENCES1. WHO: World Health Organization;

2011. http://www.who.int/malaria/world_malaria_report2011/en/website

2. Oguche S, Mava Y, Watila IM, MoltaNB. Black Water Fever (BWF)? ACase report from the Semi-arid NorthEastern Nigeria. Nig J Clin Pract.2010; 13: 103–105.

3. Aloni M, Nsangu M, Kunuanuna T,Kadima B, Manda F. HaemolyticCrisis of Black water fever followingAntemether-Lumefatrine intake. BullSoc Pathol Exot 2010; 103: 296–298.

4. Zuelzer WW, Apt L. Acutehaemolytic anaemia due toNaphthalene Poisoning. JAMA 1949;141: 185.

5. Djibo A, Souna-Adamou A, BrahBouzou S. Black water fever in adultswith sickle cell anaemia. Two fatalcases. Med Trop. 2000; 60: 156–8.

Y. Mava*, A. L. Ohadike,A. M. Yakubu

Department of Paediatrics, College of Medicine and Health Sciences,

Bingham University, Jos Campus,Jos.

*Correspondence: Dr Y MavaEmail:[email protected]

27


AAbortion, septic, resulting in maternal near-miss, 23Acetycholine, effect on rectus abdominis muscle, 15Adiposity, categories of , 8Antibody, to hepatitis C virus, 19

BBlack water fever, in a child,

causing haemolysis, 26Body mass index, among Gambian outpatients, 8

CCase report,

maternal near-miss, 23Central obesity, categories of, 8Ceremony, for doctor induction, speech at, 3

Christian Counter- Culture, John Scott, 3Christian Doctor, their responsibility, 3Cigarette smoking, prevalence among Gambians , 8

DDiabetes mellitus, type 2,

prevalence among Gambians, 8risk factors for, among Gambian outpatients, 8

Dose-response relationship,of Erythrophleum extract, 15

Dysglycaemia, prevalence among Gambian outpatients, 8

EEffective concentration,

of acetycholine and Erythrophleum, 15

28

AUTHOR INDEX TO VOLUME 1, NO. 1, 2017


A

Adebiyi, A. G., 23

Ankrah, T. C., 8

Anzaku, A. S., 19

B

Bashir, A., 23

Builders, M. I., 15 ,19

D

David, S., 23

F

Freeman, D. D., 19

SUBJECT INDEX TO VOLUME 1, NO. 1, 2016

I

Isa, A. H., 19

MMava, Y., 26

Micah, F. B., 8

Mustapha, A., 23

NNkum, B. C., 8

Nyan, O., 8

OOgbole, E. A., 15

Ogundeko, T. O., 15

Ohadike, A. L., 26

Ohwovoriole, A. E., 8

P

Parry, Eldryd H. O., 3

Peters, Y. J., 19

R

Ramyil, S., 19

Y

Yakubu, A. M., 19

Yakubu, A. M., 26


SUBJECT INDEX TO VOLUME 1, NO. 1, 2017


29

Erythrophleum bark extract, effect on muscle, 15Essential hypertension,

as risk factor for diabetes mellitus, 8

FFamily history, of diabetes mellitus, among Gambians, 8Frog, rectus abdominus muscle of, effect of extract on, 15

GGambia, dysglycaemia among outpatients, 8

HHaemolysis, black water-fever-induced, 26Haemorrhage, upper gastrointestinal associated with

abortion, 23Health team, learning from team members, 3Hepatitis B surface antigen,

positivity among clinical students, 19Hepatitis B Virus, in medical students, 19Hepatitis Be antibody, positivity in clinical students, 19Hepatitis C Virus, in medical students, 19Hypertension, essential, associated with dysglycaemia, 8

IIgnatius, Saint, prayer of, 3Immunisation against viral hepatitis,

rate among clinical students, 19Impaired fasting glycaemia, prevalence among Gambians, 8Impaired glucose tolerance, among Gambian outpatients, 8Induction, of doctors, 3

JJos, medical students, viral hepatitis in, 19

KKing, serving as told by St. Luke, 3

LLetter to the Editor, Black water fever in a child, 26

MMaternal near-miss, associated with septic abortion, 23Muscle, rectus abdominis, of frog, relaxant, 15

NNaphthalene poisoning, possibly causing haemolysis, 26

Non-steroidal anti-inflammatory drugs, causinggastrointestinal haemorrhage in septic abortion, 23

NSAID, causing haemorrhage, 21

OObesity, global, categories of, 8Oral glucose tolerance test,

in diagnosis of dysglycaemia, 8Outpatients, Gambian, occurrence of dyglycaemia in, 8

PPrediabetes, occurrence among Gambian outpatients, 8Prevalence, of antibodies to hepatitis virus, 19

RRectus abdominus, of frog, effect of Erythrophleum extract

on, 15Reflections of a pioneer, by Rev. W. A. Thompson, 3Relaxant, on rectus abdominis, 15Renal failure, in a child caused by black water fever or

naphthalene poisoning, 26Risk factors, for dysglycaemia among Gambian outpatients,

relation to glucose tolerance, 8

SStott, John, author Christian Counter Culture, 3Septic abortion, resulting in maternal near-miss, 23Severe acute maternal morbidity,

associated with septic abortion, 23Stem bark, extracts, of Erythrophleum,

effect of frog rectus abdominis, 15Students, clinical, viral hepatitis among, 19

TThompson, W. A, Reverend, 3

VValues, essential for a Christian doctor, 3

WWaist circumference, of Gambian outpatients, 8Waist-hip-ratio, of Gambian outpatients, 8

ZZaria, pattern of education, 3


CM&HS Bingham University: Historical PerspectivesThe College of Medicine and Health Sciences of Bingham

University, Karu took off in 2006 in Jos with 44 medical studentsbefore moving to Karu, Nasarawa State the Faculty of BasicMedical Sciences of the Bachelor of Medicine, Bachelor ofSurgery (MBBS) programme is currently located. The firstprovost of the college was late Professor F.I Anjorin whopioneered the progress of the college and the vision is beencarried on by the current provost Professor A.M Yakubu. Outof the 44 students admitted, 20 arrived Jos in April 2011 for theirclinical training at Bingham University Teaching Hospital, Jos(Former Evangel Hospital, Jos). The clinical section of theCollege currently based in Jos has two faculties; Faculty ofBasic Clinical Sciences and Faculty of Clinical Sciences with 16departments.

The college’s MBBS program has full accreditation by theMedical and Dental Council of Nigeria (MDCN) and interimaccreditation by National University Commission (NUC).

Pioneer Medical GraduatesThe College has proudly contributed 64 medical doctors

to the health system of Nigeria. The first batch of 19 doctorswas inducted by the Registrar of the Medical and DentalCouncil of Nigeria in March 2015 consisted of the following:

COLLEGE NEWSby Dr. Stephen A. Anzaku, Department of Obstetrics and Gynaecology

xii

1. Dr ACHEMA, Timothy Ataguba

2. Dr ACHIMUGU, Glory Ojonugwa

3. Dr AGELAGA, Dooshima Deborah

4. Dr BAMSA, Emmanuel Gbenga

5. Dr CHINYIO, Damai

6. Dr DIDAMSON, Pfongkazah Daniel

7. Dr Dike, Boniface Obinna

8. Dr DOMA, Sophia Sheamui

9. Dr EVBOROKHAI, Ezra Ojeikhoba

10. Dr IKECHUKWU,Iwuchukwu

11. Dr JEREMIAH, Olushola Emily

12. Dr MUSA, Gloria Danladi

13. Dr OLAYEMI, Victor Olushola

14. Dr OLOGUN, Olufemi M. D.

15. Dr ONUWE, Adavize Adinoyi

16. Dr SAMUELSON, Keneolisa Chibuzor

17. Dr TIZHE,Nuhu Wankwanje

18. Dr UBANYI, Tina Onyekachukwu

19. Dr ZORTO, Nanisi Umare

The First Set of Doctors from the College of Medicine &Health Sciences, Bingham University.To the left, Professor A. M. Yakubu, Provost of the College administering the Oath of Office to the Graduants.

The Second Set of Doctors from College of Medicine & Health Sciences, Bingham University


The second set of 45 doctors consisted ofthe following medical graduants:1. Dr ABAYA, Jummai Grace2. Dr ABO, I. Isabella3. Dr ABUNIKE, Sarah Adamma4. Dr ACHUKOH, Chioma Princess5. Dr ADEYEFA, Adewole Ameh6. Dr AGUIYI, Ivan Okechukwu7. Dr AJAH, Ekene Simon8. Dr AKANDE, Eunice Opeoluwa9. Dr ALELE, Jolomi Yvonne10. Dr ALU, Vivian Ojoma11. Dr AMUTA, Wilson Ehi12. Dr ANOM, Ogisa Ibia Timothy13. Dr ATTAH, Benjamin Ugbede14. Dr AYENI, Victoria Emike15. Dr CHIKEREZE, Collins Chukwuebuka16. Dr DAVID, Abraham Enejoh17. Dr DUROJAIYE, Justina Ayobola18. Dr EDION, Sandra Omozele19. Dr EJIMADU, Ifeatu Amanda20. Dr EMODI, Chukwuemeka Chinweikpe21. Dr EVBUOMWAN, Osasumwen Vanessa22. Dr HARUNA, Musa Kereng23. Dr ICHEME, Ojogbane David24. Dr IDI, Ishaku Ishaya25. Dr IKO, Alamce Gladys26. Dr IPINERA, Abayomi27. Dr JAMES, Kurgnam Pisagih28. Dr JIMBA, Matayebi Ruth29. Dr KANTIYOK, Jesse Peter30. Dr MUSA, Naomi Shepuya31. Dr MUSA, Ojone32. Dr ODUNAIKE, Ibukunoluwa Mary33. Dr OFFIAH, Nneka Valeria34. Dr OGHENEJIVWE, David Ese35. Dr OGU, Ivy Arikpi36. Dr OKEKE, Francis Chibueze37. Dr OLABODE, Opeyemi Oluwaseun38. Dr OLAOSEBIKAN, Oluranti Mojisola39. Dr OLORUNFUNMI, Joshua Seye40. Dr OMALE, Ojonide D.41. Dr SAM-MBOK, Nenkang42. Dr SOLANKE, Anuoluwapo Opeyemi43. Dr SOLA-OJO, Obabusiyimi44. Dr TULE, Teryima Ikyaan45. Dr UMEANAEDOBE, Nonso Arinze Professor Felix Idowu Anjorin

Participants at the workshop on Performance-based Trainee Assessment under the auspices of the College in June 2016.

xiii

Death of Foundation Provost and Former Vice-Chancellor,Professor F. I. Anjorin

On a sad note the College lost its first Provost and former Vice-Chancellor ofBingham University, Professor Felix Idowu Anjorin in March 2015. The deathcreated a huge vacuum in the acade-mic and pofessional progress of the MedicalSchool. He was exteremely dedi-cated to the cause and growth of the College.He was passionateabout mentoring they o u n gprofessionally aswell as spiritually.May his soul restwith his maker.

MedicalEducationWorkshop

The Collegehas as one of itsprincipal goalsexcellence in medicaleducation. To thisend it organized amedical educationworkshop in Jos withthe theme“Workshop onPerformance-basedTrainee assessmentusing OSCE, OSPE& PACES” from 2nd

– 6th June 2016.The workshop

was directed byP r o f e s s o rOhwovoriole andwas attended byparticipants frommedical schools inthe Northern part ofNigeria.

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