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   2008| December  | Volume 11 | Issue 4  
    Online since December 1, 2010

 
 
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ORIGINAL ARTICLES
Relationship between epistaxis and hypertension : a study of patients seen in the emergency units of two tertiary health institutions in Nigeria
SA Isezuo, S Segun-Busari, E Ezunu, A Yakubu, K Iseh, J Legbo, BS Alabi, AE Dunmade, FE Ologe
December 2008, 11(4):379-382
PMID:19320416
BACKGROUND: Both epistaxis and hypertension are common in the general population. OBJECTIVE: This study aimed at determining the prevalence of hypertension among epistaxics, and the relationship between epistaxis and hypertension. METHODS: Retrospective analysis of 62 adults comprising 31 each of males and females with a mean age of 41.4 +/- 16.6 years (range: 18-90 years) that presented in the emergency units of two tertiary health institutions seen over 11 years was done. Main outcome measure was the prevalence of hypertension amongst epistaxics. Seventy-six age and sex-matched patients with bleeding from sites other than the nostrils with no record of epistaxis were selected by simple random sampling as controls. RESULTS: Peak prevalence of epistaxis occurred during the months of January and March. Compared to the controls, the epistaxics had significantly higher blood pressures: (146.1 +/- 40.7 mmHg versus 123.2 +/- 16.3 mmHg systolic, P=0.001), and (91.3 +/- 24.8 mmHg versus 78.2 +/- 12.8 mmHg diastolic, P=0.001), and higher proportions of patients with previous history of hypertension (32.3% versus 7.9%; p<0.001) and family history of hypertension (12.9% versus 2.6%; p<0.02). The proportion of subjects with blood pressure elevation at presentation that remained sustained was significantly higher among the epistaxics than the nonepistaxics (87.5% versus 47.6%, chi2=8.1, P=0.005). The epistaxics had significantly higher prevalence of hypertension than the non-epistaxics (45.2% versus 13.2%, chi2=17.5, p=0.001). Univariate analysis demonstrated association between epistaxis and hypertension (OR=5.4, 95% CI=2.4-12.5, P=0.001), and between epistaxis and age (OR=0.9, 95% CI=1.3-12.5, P=0.02). On multivariate analysis using logistic regression the association between epistaxis and hypertension persisted, after adjusting for age, sex, season and causes of epistaxis (OR=5.6, 95% CI=1.7-15.6, P=0.01). CONCLUSIONS: Our findings support an association between epistaxis and hypertension in the study population.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  548 0 6
CASE REPORTS
Closed drainage of liver abscesses : the 'UNICAL' drain as an efficient and cost saving device in a tropical setting
R Ndoma Egba, M Asuquo, GU Ugare, I Udoh
December 2008, 11(4):396-399
PMID:19320422
INTRODUCTION: Liver abscesses occur in both the developed and developing countries. Up to the time of this study lever abscesses in our centre were drained with open laparotomy, because of the lack of standard equipment for percutaneous drainage. We present a preliminary report of six cases of liver abscesses drained percutaneously using the 'UNICAL' closed drainage system. METHODOLOGY: Six patients all males aged 23 54 years were treated for liver abscesses using the 'UNICAL' drain (a locally devised active drain system), under ultrasound guidance. Five of the patients had amoebic abscesses, all located in the right hepatic lobe. The sixth patient had multiple pyogenic abscesses involving both hepatic lobes. The six patients had pre and post-drainage antimicrobial therapy for a total of two weeks. RESULTS: One patient, who was a diabetic, had a recollection of pus within a week after the initial drainage. He was redrained with the same device with complete cure. Full blood count and liver function tests showed anaemia (haemoglobin < 10 g/dl), leucocytosis and hyperbilirubinaemia in five patients. CONCLUSION: We conclude that the 'UNICAL' drain is an effective and cheap device for percutaneous drainage of liver abscess under ultrasound guidance in a'resource poor environment'.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  525 0 2
ORIGINAL ARTICLES
Prevalence of hypertension and associated variables in paid workers in Ilorin, Nigeria
EK Oghagbon, AB Okesina, SA Biliaminu
December 2008, 11(4):342-346
PMID:19320407
BACKGROUND: The enormous burden of hypertension worldwide and in Africa, informed the decision to measure the blood pressure pattern in salaried workers in Ilorin, Nigeria. These were selected, as they resemble closely those that are likely to be affected by western style living. METHODS: It was a cross-sectional study that involved staff of both government and a private organisation in Ilorin, Nigeria. Two hundred and eighty one subjects, comprising of 211 males and 70 females were recruited into the study. Systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI) and fasting plasma glucose (FPG) were determined. RESULTS: The prevalence of hypertension was 27.1% in the population, being 28.4% in males and 22.9% in females. Mean SBP and DBP were significantly higher in females (SBP; 139.59 mmHg +/- 20.84, DBP; 86.92 mmHg +/- 10.96) than in males (SBP; 127.39 mmHg +/- 19.55, DBP; 82.16 mmHg). P < 0.05. The prevalence of hypertension increased with age and BMI. Age was correlated to SBP, (r = 0.355, P < 0.01) DBP, (r = 0.322, P < 0.01) and BMI (r = 0.143, P < 0.05). Obesity prevalence was 13.2% consisting of males (5.3%) and females (7.8%). Prevalence of diabetes mellitus was similar in both sexes at 1.5%. CONCLUSION: There is a high prevalence of hypertension among salary earners in Ilorin, Nigeria and this is commoner among males. The degree of increase in BP is worse in female workers. Obesity is on the upward climb in our society and should be addressed early in order to curtail its associated morbidities.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  493 0 6
Correlating antibiotic consumption with antimicrobial resistance of uropathogens in a university teaching hospital in Lagos, Nigeria
OO Oduyebo, IA Onwuezobe, SO Olayemi, AS Akintunde
December 2008, 11(4):305-308
PMID:19320399
OBJECTIVE: This study was carried out to correlate the antibiotic consumption rates with the antibiotic resistance rates of uropathogens in Lagos University Teaching Hospital. METHODOLOGY: Urine specimens obtained over 18 months (between January 2005 and June 2006) were processed for microscopy culture and sensitivity, and records of antibiotics dispensed during the same periods were reviewed. Significant bacteriuria was performed by the standard loop method. Isolation and identification of organisms was by standard laboratory methods. The antibiotic consumption calculator of Monnet (ABC calc version 3) was used to classify the antibiotics into ATC classes and to calculate the numbers of daily defined doses. The 6-monthly antibiotic resistance and consumption rates were compared using Pearson's correlation coefficient. For analysis, the period of study was divided into three. RESULTS: Except for co-trimoxazole the rates of consumption of all antibiotics were higher in the second period than the first period of the study and highest in the 3rd period for ciprofloxacin, and ceftazidime. This correlated with an increase in the rates of resistance for some antibiotics during the 2nd and 3rd periods. While a steady increase in consumption of ciprofloxacin correlated with a steady increase in the resistance rates from the 1st to the 3rd periods, a steady increase in consumption of ceftazidime was associated with an increased resistance rate from the 2nd to 3rd periods. CONCLUSION: Increased consumption of the antibiotics tested, most noticeably, ciprofloxacin and ceftazidime correlated with increased resistance rates. There is need for urgent interventions like formulation of antibiotic policies and education of staff on the appropriate use of antibiotics to reduce the development of resistance.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  487 0 1
Pattern of intestinal obstruction in a semiurban Nigerian hospital
AO Oladele, AA Akinkuolie, EA Agbakwuru
December 2008, 11(4):347-350
PMID:19320408
INTRODUCTION: Intestinal obstruction remains one of the commonest causes of acute abdomen worldwide. The pattern of intestinal obstruction varies from one place to another. We report the pattern of intestinal obstruction observed in a semi urban Nigerian hospital over a 5 year period. MATERIALS AND METHODS: Records of patient admitted and managed for intestinal obstruction between April 2001 and April 2006 at the federal medical centre, Owo, Southwestern Nigeria, were reviewed. Demographic data as well as parameters relating to the symptoms, duration, onset, type, diagnosis, intraoperative findings, as well as postoperative outcomes were retrieved. All data was entered into a personal computer and analyzed using SPSS for windows version 11. RESULTS: A total of 95 patients were managed during the period. The mean age was 39 years. The male:female ratio was 1.8:1. Adhesive intestinal obstruction was the commonest cause of symptoms in 44%, followed by volvulus in 14% and external hernias in 11% of the patients. A correct preoperative diagnosis was made in over 70% of the patients. Out of those with adhesive obstruction, 75% had a previous abdominal or groin operation while 57% had surgical exploration for failed conservative management. The mean duration of hospital stay was 6 days and the overall mortality rate was 20%. CONCLUSION: Adhesive intestinal obstruction is the commonest cause in this semi-urban population which was studied. Obstructed hernia is becoming increasingly less common as a cause of intestinal obstruction.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  481 0 3
An audit of rejected repeated x-ray films as a quality assurance element in a radiology department
KC Eze, N Omodia, B Okegbunam, T Adewonyi, CC Nzotta
December 2008, 11(4):355-358
PMID:19320410
OBJECTIVES: To find out the causes, number, percentage and sizes of rejected radiographic films with a view of adopting measures that will reduce the rate and number of rejected films. SETTING: Radiology Department of a University Teaching Hospital. MATERIALS AND METHODS: Over a two-year period (1st April 2002 to 31st March 2004), the total number of x-ray films utilized for radiographic examinations, rejected films and sizes of rejected films were collected retrospectively from the medical record of radiology department. All the rejected films were viewed by a radiologist and three radiographers for the causes of the rejects which was arrived at by consensus. The data was analysed. RESULT: A total of 15,095 films were used in the study period and 1,338 films (8.86%) were rejected or wasted. The rate of rejected films varied from 7.69% to 13.82% with average of 8.86%. The greatest cause of film rejects was radiographers' faults 547 (40.88%), followed by equipments faults 255 (19.06%), and patients' faults 250 (18.90%). The highest reject rate (13.82%) was for films used for examination of the spine (15 x 30) cm size. This is followed by 9.92% for skull (18 x 24) cm films and 8.83% for small sized films (24 x 30) cm used for paediatric patients. Of a total of 1,338 rejected films, 1276 (95.37%) additional exposure were done to obtain the basic desired diagnostic information involving 1151 patients; 885 (76.89%) of these patients needed at least one additional hospital visit to take the repeat exposure. CONCLUSION: Rejected films are not billable; patients receive additional radiation and may even come to hospital in another day for the repeat. Radiographer's work is increased as well as that of the support staff. The waiting room may be congested and waiting time increased. The cost of processing chemical and films are increased, thus if work is quantified in monetary terms, the cost of repeats is high. Rejected-repeated film analysis is cheap, simple, practicable, easy to interpret and an effective indictor of quality assurance of radiology departments.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  456 0 1
Emergency contraceptive knowledge and practice among unmarried women in Enugu, southeast Nigeria
SN Obi, BC Ozumba
December 2008, 11(4):296-299
PMID:19320397
BACKGROUND: With a high incidence of unwanted pregnancies and unsafe abortion especially among unmarried women in developing countries, there is need to promote emergency contraception (EC). OBJECTIVE: To assess the unmarried women's knowledge, attitude and practice of EC. METHODS: A random sample of a cross-section of 594 unmarried women in Enugu, southeast Nigeria, was surveyed with questionnaire between January and April 2004. RESULTS: Of the 1,160 unmarried women interviewed initially, 51% had heard of EC. One hundred (16.9%) knew the correct meaning of EC and these were mainly those with higher educational qualification, previous unwanted pregnancy, or had used modern contraception (p<0.05). Other respondents mentioned vaginal douching, application of traditional remedies to the vagina as effective emergency contraceptives. Although sixty percent (n=354) of respondents had used regular modern contraception, only 20% (n=119) had ever used EC. Few respondents knew correctly how EC function and the recommended timeframe for use. The two most common sources of information about EC were mass media (49.2%) and friends (28.8%). Seventy three percent (n=87) of emergency contraceptive users had some difficulties obtaining EC due to non-availability (n=42), attitude of health service providers to unmarried women demanding contraception (n=28) and cost (n=17). The attitude of the health service providers may have accounted for the dearth of information on EC even among users. Sixty-seven percent of respondents favored the use of EC by unmarried women. Opposition to the use of EC by unmarried women is because ofbeliefthat it has some health effect (n=72), induces abortion (n=80) and for religious reasons (n=42). CONCLUSION: Provision of appropriate information and access to EC, better service providers' attitude towards unmarried women is advocated.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  441 0 3
Outcome of urethroplasty for urethral stricture at Jos Universitry Teaching Hospital
NK Dakum, VM Ramyil, CO Amu
December 2008, 11(4):300-304
PMID:19320398
BACKGROUND: The treatment of urethral stricture disease has remained a challenge over the years. The outcome has also been varied, with recurrent stricture being a major concern. We determined the outcome of urethroplasty with particular reference to the complications. METHODOLOGY: This was a retrospective study over 10 years (1995 to 2005) done at the Jos University Teaching Hospital, a tertiary health institution in the middle belt region of Nigeria. RESULTS: There were a total of 32 patients whose ages ranged from 0.06 to 75 years (mean 25 yrs, SD 18.8 yrs,). Eleven patients had had one form of stricture treatment or the other. Stricture aetiology was traumatic in 21 (66%) and inflammatory in 6 (19%) patients. Of the 24 patients in whom the stricture length at operation was specified, six, 11 and seven were <2 cm, 2-4 cm and >4 cm respectively. The stricture was located in the anterior urethra in 18 (58.1%), posterior urethra in 2 (6.4%) and bulbomembranous in 11 (35.5%) of patients (unspecified in one). The bulbar urethra was the single most involved region, occurring in 12 (38.7%) patients. Resection and end to end anastomosis was done in 16 patients and replacement urethroplasty in 16 others (Quarteys in 12, Swinney in 3 and Orandi in 1). Complications observed were urinary tract infection in 12 (37.5%) patients, recurrent stricture 11 (34.4%) wound infection 10 (31.3%), oedema of genitalia 7 (21.9%), urethrocutaneous fistula 4 (12.5%), impotence 3 (9.4%), wound haematoma 2 (6.3%) and urinary incontinence in 1 (3.1%) patient(s). CONCLUSION: Urinary tract infection, recurrence of the stricture and wound infection remain our major challenges. We recommend that in order to improve outcome, surgeons should regularly audit their practice and make necessary adjustments. In addition, urethroplasty should preferably be carried out by those with the cognate experience, while not compromising the need to teach younger colleagues.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  430 0 1
Umbilical cord prolapse in Kaduna, northern Nigeria : a study of incidence
PI Onwuhafua, G Adesiyun, I Ozed-Williams, A Kolawole, A Ankama, A Duro-Mohammed
December 2008, 11(4):316-319
PMID:19320402
CONTEXT: Prolapse of the umbilical cord is a live threatening obstetric emergency for the fetus-infant. OBJECTIVE: To determine, the incidence of cord prolapse in the hospital. METHODS AND MATERIALS: A-12 1/2 year retrospective study of all women who presented with cord prolapse in labour at a university teaching hospital. RESULTS: During the period there were 16633 deliveries and 34 women presented with cord prolapse, giving an incidence of 2.0 per 1000 (1 in 504 deliveries). Highest incidence occurred in women of 35 years and above (5.0 per 1000); in the 25-29 years group 2.3 per 1000 and in those less than 20-years-old 1.3 per 1000. The highest incidence of cord prolapse was in the para 5 and over, 2.4 per 1000; para 0, 2.0 per 1000 and paras 14, 1.9 per 1000. The incidence of cord prolapse in the unregistered women was 5.2 per 1000, and in the registered 1.5 per 1000. The highest incidence was in the Hausa/Fulani ethnic group 3.4 per 1000; the Yoruba ethnic group, 2.1 per 1000; the Northern minority ethnic group, 2.0 per 1000; the Ibo ethnic group, 1.0 per 1000. No case of cord prolapse was recorded among women of Southern minority ethnic group. The incidence of cord prolapse among preterm births was, 62.7 per 1000, breech, 32.5 per 1000; shoulder, 133.3 per 1000, twin births. 16.8 per 1000 and cesarean births, 11.4 per 1000. CONCLUSION: Cord prolapse is an uncommon obstetric complication, the incidence of which is determined by the influence of various factors acting individually or in synergy.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  414 0 1
Prevalence of dyslipidaemia in apparently healthy professionals in Asaba, South South Nigeria
CU Odenigbo, OC Oguejiofor, UM Odenigbo, CC Ibeh, CN Ajaero, MA Odike
December 2008, 11(4):330-335
PMID:19320405
BACKGROUND: Hypercholesterolaemia is a major risk factor for coronary heart disease (CHD) especially in industrialized societies. Coronary heart disease is becoming an increasing cause of death even in the developing world. OBJECTIVE: To determine the prevalence of dyslipidaemia in apparently healthy professionals in a developing economy. METHOD: One hundred apparently healthy professionals were recruited from several professions by stratified random sampling. This population was believed to be at higher risk of dyslipidaemia considering their more likely "western diet" lifestyle. Total cholesterol, LDL-cholesterol, HDL-cholesterol and Triglycerides were determined using standard cholesterol LDL precipitating reagents/kits. RESULTS: The mean age of the subjects was 41.59 +/- 8.22 years (range 29 to 58 years) with male to female ratio of 1:1.2. Mean total cholesterol was 180.69 +/- 36.248 mg/dl (4.67 +/- 0.94 mmol/L), LDL cholesterol 122.68 +/- 44.42 mg/dl (3.17 +/- 1.15 mmol/L), HDL-cholesterol 37.47 +/- 9.91 mg/dl (0.96 +/- 0.26 mmol/L) and Triglyceride 83.139 +/- 66.888 mg/dl (0.94 +/- 0.76 mmol/L). Using the Third Report of the NCEP Expert Panel on Detection. Evaluation and Treatment of high blood cholesterol in Adults (ATP III) definition and risk classification, 5% of the study population had hypercholesterolaemia, 23% elevated total serum cholesterol, 51% elevated LDL-cholesterol and 60% low HDL-cholesterol, with females recording better overall lipid profile. CONCLUSION: Dyslipidaemia was highly prevalent in the population studied, with low HDL-cholesterol being the most frequent lipid abnormality. Dyslipidaemia is becoming a serious health problem in the developing world also, even among the apparently healthy, and necessitates periodic lipid profile screening.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  413 0 5
Prognostic significance of QT interval prolongation in adult Nigerians with chronic heart failure
PM Kolo, OG Opadijo, AB Omotoso, IA Katibi, MO Balogun, MA Araoye
December 2008, 11(4):336-341
PMID:19320406
BACKGROUND AND OBJECTIVES: Prognostic survival studies for heart-rate corrected QT interval in patients with chronic heart failure are few; although these patients are known to have a high risk of sudden cardiac death. This study was aimed at determining the mortality risk associated with prolonged QTc in Nigerians with heart failure. MATERIALS AND METHOD: Ninety-six consecutive patients with heart failure were recruited with 90 age and sex-matched controls. All the subjects had a 12-lead electrocardiogram at a paper speed of 25 mm/sec and a rhythm strip (lead II) at 50 mm/sec. The latter was used to calculate the QTc using the Bazett's formula. Left ventricular systolic and diastolic functions were assessed using 2D guided M-mode and Doppler echocardiogram respectively. They were followed-up for six months. RESULTS: Ninety-one patients and 90 controls completed the study. Five patients were lost to follow-up. The mean age (51.9 +/- 16 years) of the patients was similar to that of the controls (50.3 +/- 15) (P = 0.475). Twenty-eight (30.8%) patients died after 6 months of follow-up against none of the controls. The mean QTc was significantly longer in the non-survivors (0.494 +/- 0.027) than in the survivors (0.462 +/- 0.035) (P = 0.0001). The percentage mortality in patients with prolonged QTc against those with normal QTc was 41% and 14% respectively (P = 0.001). In the stepwise regression analysis, QTc was an independent predictor of mortality (R = 0.412, R2 = 0.17, P= 0.001). CONCLUSION: QTc prolongation is a predictor of mortality in CHF and may be an important adjunct in risk stratification of patients with heart failure.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  408 0 1
CASE REPORTS
Laparoscopic retrieval of perforated intrauterine device
JI Ikechebelu, SU Mbamara
December 2008, 11(4):394-395
PMID:19320421
We present a case of successful laparoscopic retrieval of a perforated intrauterine device (Lippes loop). The Lippes loop was inserted after manual intrauterine adhesiolysis as a treatment of uterine synaechia presenting as secondary amenorrhoea of 20 months duration. The uterine perforation in this patient did not occur at the time of insertion but possibly during the attempt at transcervical removal of the missing IUD by manipulation with the retrieval hook. Double puncture laparoscopic technique under ketamine general anaesthesia was performed to remove the IUD without complication and patient went home the same day.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  388 0 3
Tuberculous ileal perforation in a HIV positive patient : a case report and review of literature
D Dogo, AA Bakari, BM Gali, AG Ibrahim
December 2008, 11(4):386-388
PMID:19320418
BACKGROUND: Tuberculosis is prevalent worldwide. Even in developed countries there is a resurgence of tuberculosis mainly due to increasing HIV infection. Tuberculous ileal perforation is uncommon. It is, however, a potentially fatal complication of intestinal tuberculosis especially in HIV/AIDS patient. AIM: To highlight tuberculous ileal perforation as an underestimated complication of intestinal tuberculosis in an HIV patient presenting with acute abdomen. METHOD: A 42-year-old HIV positive long distance truck driver with tuberculous ileal perforation is presented and related literatures reviewed. CONCLUSION: Intestinal perforation due to abdominal tuberculosis is an aetiological factor in acute HIV abdomen. High index of suspicion remains the key to diagnosis.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  381 0 1
ORIGINAL ARTICLES
Computed tomography study of complicated bacterial meningitis
KC Eze, TA Salami, CU Eze, SO Alikah
December 2008, 11(4):351-354
PMID:19320409
OBJECTIVE: To monitor the structural intracranial complications of bacterial meningitis using computed tomography (CT) scan. DESIGN: Retrospective study of medical and radiological records of patients who underwent CT scan over a 4 year period. SETTING: A University Teaching Hospital in a developing country. SUBJECTS: Thirty-three patients with clinically and laboratory-proven cases of bacterial meningitis who had clinical features of central nervous system complication of the disease. OUTCOME MEASURES: Only patients with available complete records were studied with material obtained from the medical records and radiology departments of the hospital. RESULTS: Persistent headache (30.3%), persistent fever (18.18%), seizures (15.5%) and torticollis (12.12%) were the most common presenting features that necessitated the request for CT scan. Communicating hydrocephalus (36.36%), cerebral abscess (12.12%), multiple areas of cerebral infarction (12.12%) and subdural empyema (9.09%) were the most common CT scan findings. The complications were more common in children aged less than 15 years. CONCLUSIONS: Computed Tomography is an accurate and useful means of diagnosing intracranial complications of bacterial meningitis. Early and effective diagnosis of treatable lesions such as hydrocephalus, cerebral abscess and subdural empyema will help improve prognosis of the patients. There appears to be no alternative to prevention, adequate and early treatment of this condition to reduce its long-term neurological sequelae.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  368 0 1
CASE REPORTS
Ectopic (tubal) molar gestation : report of two cases
AJ Randawa, SM Shehu, MA Abdul
December 2008, 11(4):392-393
PMID:19320420
BACKGROUND: Ectopic molar gestation is a rare event. Its malignant potential is similar to that of an intrauterine molar pregnancy. OBJECTIVE: To document two cases of tubal molar gestations seen over a 10-year period. STUDY DESIGN: Case series. RESULTS: Two young Nigerian undergraduates presented with features of ruptured tubal pregnancy. They had total salpingectomy and histopathological analysis of the tubal specimens revealed complete hydatidiform mole. HCG level normalized in both cases within three weeks of treatment. CONCLUSION: Ectopic molar gestation does occur occasional in our setting. It is pertinent that clinicians in this part of the world be aware of this and to take routine histological examination of tubal specimens in ectopic pregnancy very seriously in order to diagnosed cases of ectopic molar gestations early and mount appropriate post treatment surveillance.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  353 0 2
ORIGINAL ARTICLES
Experience with the management of urethral stones presenting with urinary retention at Gusau
A Ahmed, NM Saeed
December 2008, 11(4):309-311
PMID:19320400
BACKGROUND: Urinary tract stones are increasing in our societies. Similar to the finding in developed countries, majority of our patients have upper urinary tract stones. Urethral stone is an uncommon cause of acute urinary retention. It presents with an emergency management scenario which is compounded by lack of endoscopic facilities in our hospitals. We present the management of urethral stones presenting as acute urinary retention in our centre. PATIENTS AND METHOD: This prospective study was conducted between January 1998 and June 2006. All patients who presented with urethral stones were included. Following the diagnosis, 2% xylocaine jelly was instilled into the urethra after which a Foley catheter was gently inserted to dislodge the stone back into the bladder. Thereafter, the stone was removed by cystolithotomy after complete evaluation of the patient. RESULT: There were 7 patients. Their ages ranged between 8 and 45 years. All patients presented with acute urinary retention and pain at the glans. One patient had a history of previous passage of stone in urine. Five stones were located in anterior urethra. All stones were easily pushed back into the bladder. The stones sizes ranged between 0.6 x 1.5 cm and 3.0 x 3.5 cm. There was no urethral injury in any patient. CONCLUSION: Urethral stone is a rare cause of acute urinary retention. In the absence of urethral pathology, urethral stone can be easily and safely pushed back into the bladder from where they can be removed by cystolithotomy.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  345 0 3
Implanon sub-dermal implants : a 10-month review of acceptability in Jos, North-Central Nigeria
JT Mutihir, PH Daru
December 2008, 11(4):320-323
PMID:19320403
OBJECTIVE: To determine the acceptance of Implanon so far, the group of women accepting it, insertion complications and immediate post insertion problems, if any, and report our initial experience with the method. METHODOLOGY: This was a retrospective review study of all cases of Implanon acceptors between 1st May and 28th February 2007. Demographic and social factors were collated. Insertion and post-insertion complications were evaluated. RESULTS: A total of 2,608 clients accepted contraceptive methods out of which 350 clients had Implanon capsules inserted within the study period (13.4%). One hundred and ninety-one (54.6%) of the acceptors desired more children, and therefore using it to space pregnancies, 154 (44.0%) would not want more children, but opted for the temporary long term method, and 5 (1.4%) were uncertain whether to have more children in the future or not. The mean age and parity of acceptors were 32.4 years and 3.6 respectively. The mean number of living children to the women was 3.4. All the women were married. About three-quarters (75.8%) of the women had secondary and tertiary education. Seventy-two (20.6%) of the women were taking a modern contraceptive method for the first time. The rest 278 (79.4%) had used one or more methods of contraception, and were only switching over to Implanon sub-dermal implants. The patients weighed between 40 and 122 kg with an average of 62.4 kg. Post-insertion complications like infection, expulsion, bruising and induration were not reported. Four women discontinued the method for varying reasons. CONCLUSION: Women are accepting the new method. Over three-quarters of the clients are switching from other methods to Implanon. The method appears to have good continuation rate and therefore a promising long term sub-dermal contraceptive method amongst our women.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  337 0 1
A decade of hysterectomy in a tertiary hospital in urban Niger-Delta region of Nigeria
E Abe, LO Omo-Aghoja
December 2008, 11(4):359-363
PMID:19320411
BACKGROUND: Hysterectomy is a very common gynaecological procedure which has a significant place in optimizing the reproductive health outcomes of women. OBJECTIVES: To document the indications, the type of hysterectomy commonly performed, the difficulties encountered and complications of the procedure at the Central Hospital, Benin City. MATERIALS AND METHODS: This was a retrospective review of the service delivery records of patients that had hysterectomy in the gynaecological unit between January, 1994 and December, 2003. RESULTS: There were 1216 major gynaecological operations during the study period. Of these, 131 (10.8%) hysterectomies were done. Total abdominal hysterectomy accounted for 80.4% of the procedures performed and most were done by consultants (94.4%). The mean age of the patients was 45.7 years with a median of 46 years and they were commonly grandmultiparous (71.0%). The commonest indication for the procedure was symptomatic uterine fibroid (62.3%) followed by urogenital prolapse (13.1%). The crude morbidity rate was 30.3% and the mortality rate was 1.6%. CONCLUSION: Hysterectomy in this centre is a fairly safe procedure. There is paucity of skills for vaginal and radical procedures. Training is advocated with a view to reducing the presently high morbidity rate as well as achieving our aim of optimizing the reproductive health outcomes of our women.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  335 0 2
CASE REPORTS
Metastatic carcinoma of the breast with inguinal lymph node involvement : a report of two cases
NJ Jebbin, JM Adotey
December 2008, 11(4):383-385
PMID:19320417
BACKGROUND: Metastatic carcinoma of the breast may display varied clinicopathological patterns. Lymphatic spread to the inguinal lymph nodes is, however, very rare. OBJECTIVE: To report two cases of advanced breast carcinoma with metastases to the inguinal lymph nodes in two Nigerian women. SETTING: The University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. CASE REPORT: Two Nigerian women, one aged 40 years with an invasive lobular carcinoma of the right breast, and the other aged 48 years with an infiltrating ductal carcinoma of the left breast, presented with metastases to their corresponding inguinal lymph nodes diagnosed by open biopsy. RESULTS: The first had a right simple mastectomy done and was lost to follow up before any adjuvant therapy could be administered. The second died before any definitive treatment could be offered. CONCLUSION: Metastasis to the inguinal nodes is rare and signifies an advanced disease. The pathogenesis is speculative, probably from retrograde embolisation.
[ABSTRACT]   Full text not available     [PubMed]
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ORIGINAL ARTICLES
Factors affecting the visual outcome in hyphema management in Guinness Eye Center Onitsha
LO Onyekwe
December 2008, 11(4):364-367
PMID:19320412
BACKGROUND: This study aims of determining the complications, outcome of hyphema treatment and recommend ways of enhancing good visual outcome. METHOD: The records of all cases of hyphema seen from 1st January 2001 to 31st December 2005 were reviewed retrospectively. The variables analyzed were the biodata of all the patients, the agents causing hyphema, associated injuries and complications. Visual acuity at presentation, discharge and last visit was analyzed. RESULTS: Seventy four patients that had hyphema were reviewed. The male:female ratio was 3.5:1. Trauma was predominantly main cause of hyphema. The common agents of injury include whip (23.2%) and fist (18.8%). The common complications were secondary glaucoma (52.5%), corneal siderosis (30.0%) and rebleeding (10%). Visual outcome is related to time ofpresentation, complications and treatment. Significant improvement was achieved following treatment. CONCLUSION: Hyphema is a common complication of eye injuries. It is commonly associated with other eye injuries like vitreous haemorrhage and cataract. Common complications include secondary glaucoma, corneal siderosis and rebleeding. Visual outcome is dependent on time of presentation, severity and nature of complications. Visual outcome can be improved by early presentation and detection of complications and appropriate treatment.
[ABSTRACT]   Full text not available     [PubMed]
  334 0 -
Effect of highly active antiretroviral therapy on CD4 count and weight in AIDS patients seen at the UITH, Ilorin
HO Olawumi, PO Olatunji, AK Salami, L Odeigah, JO Iseniyi
December 2008, 11(4):312-315
PMID:19320401
OBJECTIVE: To determine the response on treatment-naÔve HIV/AIDS patients to the Highly Active Antiretroviral Therapy (HAART) in terms of CD4 Count and Weight gain over a period of 2 1/2 years. METHODS: Patients with Acquired Immunodeficiency Syndrome (AIDS) were recruited under the Federal Government Highly Active Antiretroviral Therapy (HAART) programme at the University of Ilorin Teaching Hospital. The treatment regimen included Lamivudine, Starvudine and Nevirapine. The patients' responses were evaluated with respect to CD4 count and weight over the period of treatment. The diagnosis of HIV/AIDS was made on the basis of reactivity with two different ELISA reagents, and CD4 count was done with Dynal T4 Quant method. The weights (kg.) of the patients were taken at monthly visit. RESULTS: The duration of treatment for the patients analysed ranged from 1 month to 14 months. Analysis of CD4 count was possible in 105 patients. The mean post treatment CD4 count and weight were significantly higher than the pre-treatment values (p < 0.001 and p < 1.01) respectively. There were significant positive correlations (p < 0.05 and p < 0.001) between increases in CD4 count and weight respectively, and duration of treatment. In eight (8) patients, CD4 Count reduced or remained the same in spite of treatment. CONCLUSION: The HAART regime is associated with increase in CD4 Count and weight gain. While increases in CD4 Count and weight correlated with duration of therapy, there was no correlation between CD4 Count increase and weight gain.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
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CASE REPORTS
Case report : Acute fatty liver of pregnancy in a 30-year-old Nigerian primigravida
AO Ajayi, MO Alao
December 2008, 11(4):389-391
PMID:19320419
Acute fatty liver of pregnancy is an uncommon, potentially fatal disorder that usually occurs in the third trimester of pregnancy or in the early post partum. We present here a 30-year-old Nigerian primigravida with acute fatty liver of pregnancy. She was successfully managed and discharged.
[ABSTRACT]   Full text not available     [PubMed]
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ORIGINAL ARTICLES
Visual outcome of traumatic cataract surgery in Ibadan, Nigeria
CO Bekibele, O Fasina
December 2008, 11(4):372-375
PMID:19320414
OBJECTIVE: To review the visual outcome of traumatic cataracts operated at the University College Hospital, Ibadan with the view to making recommendations for improved outcome. METHODS: All patients operated at the University College Hospital Ibadan, Nigeria between May 1999 and April 2004 with traumatic cataract were reviewed retrospectively to determine visual outcome and main causes of poor visual outcome <6/18, using a structured data entry form and information obtained from the operation register and case notes of patients RESULTS: 32 patients, age range 2 to 71 years, mean age 25.6 +/- SD 16.1 years were reviewed. 22 (68.8%) were males while 10 (31.2%) were females. Causes of traumatic cataract included wood/stick splinters in 7 (21.9%), cane/whiplash injury 6 (18.8%), and propelled missile injuries, 5 (15.6%). Less important cause of injuries were gun shot, road traffic accident and fist injuries. 11 (35.6%) of the patients had best corrected post operative visual acuity of >6/18, 10 (32.2%) <6/18-3/60, while 32.2% of the cases reviewed remained blind or had vision <3/60 in the affected eye. Cause of poor post operative visual acuity (less than 6/18) in 64.4% of the subjects included cornea opacity 12.5%, posterior capsule opacity 12.5%, retinal detachment 9.4%, and glaucoma 6.9%. CONCLUSION: Useful vision can be restored in a proportion of traumatic cataracts through surgery, although sight-limiting complications, which may be related to the severity of the trauma or prolonged post op inflammation may be present, many are potentially treatable with further intervention. The need for adequate health education to prevent ocular injuries and preoperative diagnosis of associated posterior segment complications that may prevent optimal post-operative visual acuity is also noted.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
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Attitude and practice of antenatal HIV screening among pregnant women attending a secondary health facility in Benin-city
VO Omuemu, FM Akemokwe, IE Ahanmisi
December 2008, 11(4):324-329
PMID:19320404
OBJECTIVE: To assess the awareness, attitude and practice of HIV testing among antenatal clients in Benin-city. METHODOLOGY: A cross-sectional, descriptive study was carried out among 200 pregnant women. Respondents were selected at the weekly booking clinic using systematic sampling technique. Pre-tested, semi-structured and researcher-administered questionnaire was tool for data collection. RESULTS: All the respondents were aware of HIV testing. Majority (85.5%) supported antenatal HIV testing with a higher proportion supporting mandatory testing (51.0%). About 25.0% of the respondents had undergone HIV testing and only 27.5% of them were counseled. Previous HIV testing was associated with higher educational status (p = 0.0443) and a higher parity (p = 0.0191). About 59.1% of those who had not been tested were willing to undergo the test. Predictors of willingness to test were a positive reaction to a positive test result (p = 0.0015) and support for mandatory testing (p = 0.0021). Age, educational status and parity were not associated with willingness to test. (p > 0.05) CONCLUSION: The practice of HIV testing was low and indicates the need to increase public enlightenment programmes on voluntary HIV testing and its benefits.
[ABSTRACT]   Full text not available     [PubMed]
  319 0 -
Neuro-ophthalmic manifestation of nasopharyngeal carcinoma at Ilorin : a five year review
AD Dunmade, DS Ademola-Popoola
December 2008, 11(4):376-378
PMID:19320415
BACKGROUND: Patients with Nasopharyngeal Carcinoma (NPC) may present with neuro-ophthalmic symptoms including visual loss. Involvement of the cranial nerves have been found to impact significantly on the individual's 5 year survival rate, which makes an early diagnosis of this condition of great importance in the management of NPC. MATERIAL AND METHODS: A retrospective review of all patients with clinical and histological diagnosis of NPC over a five year period between 1999 and 2003 was carried out. Information retrieved from the records include their age, symptoms and signs with emphases on neuro-ophthalmic at presentation. Data were analysed using SPSS statistical package. RESULT: Twenty records out of the 23 patients with a diagnosis of NPC seen during this period were available for review. The age range was between 20 and 60 years, the Mean was 38.9 years, SD 11.62. Sixty percent of the patients had neuroophthalmic manifestation with symptoms such as ocular pain, double vision, loss of vision and eye protrusion and signs such as ophthalmoplegia, exposure keratopathy and proptosis in various combinations. CONCLUSION: Neuro-ophthalmic manifestations were commonly found among patients diagnosed as NPC at Ilorin. A high index of suspicion of NPC whenever a patient presents with neuro-ophthalmic signs and symptom is advocated.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
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Neurosurgery in Nigeria--an evaluation of the perception of health personnel in a new centre and a comparison of the Nigerian situation with that of other African states
JK Emejulu
December 2008, 11(4):291-295
PMID:19320396
BACKGROUND: Neurosurgery has become endangered species in Nigeria. We have only 15 practising neurosurgeons for our population of 150 million, giving a ratio of one neurosurgeon to 10 million Nigerians. Of the 26 accredited medical schools, only 6 offer neurosurgery. This study is a preliminary evaluation of the perceptions about neurosurgery before the commencement of neurosurgical services in a tertiary health institution, and a comparison with the situation in other African countries. METHODOLOGY: A questionnaire designed after the 5-point Likert rating scale was distributed to doctors, nurses, final-year medical/nursing students, paramedics and administrative staff of the 350-bed health institution. The completed questionnaires that were returned, were collated and data analysis done. RESULTS: Out of 200 questionnaires distributed, 164 were completed and returned. Most of the respondents were females 59.1%, and most were in the 20 30 year age group, 57.3%; more than 96% stated that they have heard of neurosurgery previously, but rated the available services in Nigeria as inadequate 50.6%, and quality of services as fair 39.6% or poor 36.6%, respectively. In their opinion, political and administrative lapses rather than funding are responsible for the poor state of affairs, culminating in unavailability of adequate manpower and facilities. Health policy changes and provision of facilities with manpower training were suggested by 78% of respondents as the solution to the problem. Most, however agree that neurosurgery has good prospects 78%, in the institution. CONCLUSION: Neurosurgical service in Nigeria is grossly inadequate both in availability and quality, and these have resulted from bad government policies. It is therefore of utmost necessity that services and training be urgently provided in this specialty, at least in the tertiary institutions in Nigeria.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
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Primary caeserean section in grandmultiparae at Mater Misericordiae Hosptial Afikpo : a 5 year retrospective study
EC Ojiyi, EI Dike, AU Idrissa
December 2008, 11(4):368-371
PMID:19320413
OBJECTIVES: To identify the common indications and the outcome of primary caesarian section in grandmultiparae at Mater Misericordiae Hospital Afikpo. MATERIALS AND METHODS: The case notes of 69 grandmultiparae who had primary caesarean section at Mater Misericordiae Hospital Afikpo between January 1999 to December 2003 inclusively. The information obtained included age, parity, occupation, height, educational status, booking status, indication for caesarean section, operative and post-operative complications, types of anaesthesia, types of uterine incision, mean blood loss, associated pelvic findings and foetal outcome. RESULTS: Eighty nine percent (89%) of 69 primary caesarean sections were done emergency procedure. The commonest indications for a caesarean section were dystocia (76.8%), antepartum haemorrhage (17.4%), essential hypertension (10.1%) Puerperal pyrexia (24.6%), haemorrhage (7.2%) wound dehiscence (4.3%) and anaemia (2.9%), were the commonest intra- and post operative complications encountered. The perinatal mortality rate was 153/1000. There were two maternal deaths (29 per 1000). CONCLUSION: Health education of the population coupled with better utilization of comprehensive maternity care and family planning facilities are advocated.
[ABSTRACT]   Full text not available     [PubMed]
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LETTERS
Research training should be emphasized for Nigerians postgraduates in the medical specialties
EP Laabes
December 2008, 11(4):401-401
PMID:19320424
Full text not available    [CITATIONS]  [PubMed]
  192 0 1
Is condom use the answer to preventing HIV transmission through sexual intercourse?
PV Lofor
December 2008, 11(4):400-400
PMID:19320423
Full text not available     [PubMed]
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