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   2009| June  | Volume 12 | Issue 2  
    Online since November 30, 2010

 
 
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ARTICLES
Case fatality among hypertension-related admissions in Enugu, Nigeria
EB Arodiwe, SO Ike, SC Nwokediuko
June 2009, 12(2):153-156
PMID:19764664
OBJECTIVE: To determine the case fatality rate and ultimate causes of death among patients with hypertension-related conditions admitted to an urban tertiary hospital, METHOD: A five-year review of hypertension-related admissions into the medical wards of the University of Nigeria Teaching Hospital, Enugu, between 1995 and 1999, was undertaken. RESULTS: 7220 patients were admitted into the medical wards during the period under review. Of these, 445 (6.2%) were due to hypertension-related causes. Of the later, 285 (64%) were males while 160 (36%) were females. One hundred and ninety one of the hypertension-related admissions died, giving a case fatality of 42.9%. The mean age at death was 54.8+/-15.8 years (53.5+/-15.9 years for males; 57.2+/-15.4 years for females, t=2.47, df=189, p=0.117). Sixty six percent of these were males while thirty four percent were females. Eighty six (45%) of the deaths occurred during acute hypertensive crises such as cerebrovascular accidents, hypertensive encephalopathy, and acute renal failure. Other important complications leading to death were congestive cardiac failure, accounting for thirty three cases (17.3%); and chronic renal failure 32 (16.8%). In twenty one (11%) hypertension-related admissions, the causes of death were not documented. CONCLUSION: Hypertension, with its related complications, constitute a major cause of morbidity and mortality in our medical wards. The case fatality rate is very high and often mostly avoidable complications were responsible. There is need to further study the determinants of these avoidable causes of death.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  590 0 5
Challenges of managing paediatric abdominal trauma in a Nigerian setting
EA Ameh, PM Mshelbwala
June 2009, 12(2):192-195
PMID:19764673
BACKGROUND: The management of abdominal trauma (particularly blunt trauma) has undergone tremendous revolution in the last 30 years with significant reduction in morbidity and mortality in developed countries. The aim of this report is to highlight the challenges of managing abdominal trauma in children in Nigeria based on our experience in Zaria, northern Nigeria. METHOD: This is a retrospective review of 82 children managed for abdominal trauma from 1991 2002 at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Information regarding demographics, mechanism of injury, haemodynamic status at presentation, clinical and radiologic evaluation, management, intraoperative findings and outcome, were extracted from case notes, operation notes and discharge summary notes. RESULTS: Fifty seven (69.5%) children had blunt trauma, mostly from traffic accidents (32, 57%) and falls (20, 36%), and 25 (30.5%) penetrating trauma mainly from falls onto sharp objects (7 of 18 patients) and animal-related injuries (5 of 18 patients). In the management of those with blunt trauma, advanced imaging modalities were usually not available and this resulted in an unnecessary laparotomy rate of 51% (laparotomy considered unnecessary because the patients remained haemodynamically stable after resuscitation and any intraperitoneal bleeding had stopped by the time oflaparotomy and no active operative measure was required to control bleeding). The management of penetrating trauma was more straightforward as this was guided by evidence of peritoneal penetration. Mortality from blunt trauma was 14.5% (8 of 55 patients) from exsanguinations before surgery 2, gastric perforation 3, hepatic laceration 2 and splenic injury one. Mortality from penetrating trauma was 12% (3 of 25 patients) from tetanus, overwhelming infection and haemorrhage respectively. The overall mortality from abdominal injury was 13.8% (11 of 80 patients) and were mostly avoidable if the patients presented early, and received some resuscitation before arrival at our hospital. CONCLUSION: The management of blunt abdominal trauma in children in Nigeria is faced with several challenges, which are mainly absence of an organised trauma system and lack of appropriate facilities. These need to be addressed in order to improve the care of these injuries.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  549 0 1
Relations of the neck of groin hernias to pubic tubercle
EA Agbakwuru, OI Alatise, AO Adisa, AA Salako, AR Adesunkanmi
June 2009, 12(2):157-161
PMID:19764665
OBJECTIVE: The traditional anatomical and surgical teaching is that any hernia with the neck above and medial to the pubic tubercle are inguinal. Present day surgical authors and teachers mostly adhere to this teaching but observe a difference in this relationship in clinical demonstrations. This confuses most medical students and surgical residents. This all-important clinical teaching should hence be revisited. Hence this study was to ascertain and validate clinically the true relationship of pubic tubercle and the neck of groins hernia. METHOD: DESIGN: Aprospective observational study. SETTING: Surgical Outpatient Clinic of Wesley Guild Hospital, Ilesa Unit of the Obafemi Awolowo University Teaching Hospital Complex, Nigeria. SUBJECTS AND MEASUREMENTS: Consecutive patients seen in the clinic with uncomplicated groin hernias were studied from January 1993 to December 2004. Examinations were done to ascertain the relationship of the groin hernias to the pubic tubercle. RESULTS: 96.8% of inguinal hernias have their necks above and lateral to pubic tubercle while all femoral hernia had their necks below and lateral to the pubic tubercle. CONCLUSION: Location above or below the pubic tubercle should be used as the sole difference between femoral and inguinal hernias in clinical demonstrations. More observations and inguinal dissections will be necessary for further clarification.
[ABSTRACT]   Full text not available     [PubMed]
  546 0 -
Prevalence of malaria parasitaemia and malaria related anaemia among pregnant women in Abakaliki, South East Nigeria
EU Nwonwu, PC Ibekwe, JI Ugwu, HC Obarezi, OC Nwagbara
June 2009, 12(2):182-186
PMID:19764671
BACKGROUND: Malaria currently is regarded as the most common and potentially the most serious infection occurring in pregnancy in many sub Saharan African countries. This study was undertaken to evaluate the prevalence of malaria parasitaemia and malaria related anaemia among pregnant women in Abakaliki, South East, Nigeria. MATERIALS AND METHODS: This is a cross sectional, descriptive study conducted in two tertiary health institutions in Abakaliki, South East, Nigeria (Ebonyi State University Teaching Hospital And Federal Medical Centre). Using systematic sampling method, 193 pregnant women were selected from the health institutions for the study. Their blood were analysed for haemoglobin status and malaria parasite. Data were also collected using an interviewer administered questionnaire. All the data were analysed using Epi info version 6 statistical software. RESULTS: Response rate was 100%. Twenty nine percent prevalence of malaria parasitaemia was detected, more common among primigravidae. Women with higher parity had higher frequency of anaemia in pregnancy. More than half of the pregnant women (51%) were in their second trimester at the time of booking. There was no case of severe anaemia requiring blood transfusion. CONCLUSION: Our pregnant women register late for antenatal care. Prevalence of malaria parasitaemia is high in our environment as well as anaemia in pregnancy, using the standard WHO definition. It is suggested that effort should be intensified to make our women register early for antenatal care in order to identify complications early. Intermittent preventive treatment for malaria should be incorporated into routine drugs for antenatal women.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  514 0 5
Lipid profile in pre-dialysis chronic kidney disease patients attending University of Maiduguri Teaching Hospital, Maiduguri-Nigeria
DS Mshelia, LB Buratai, YP Mamza
June 2009, 12(2):173-178
PMID:19764669
BACKGROUND/OBJECTIVES: Cardiovascular disease is a major cause of morbidity and mortality among patients with chronic kidney disease, and accounts for 50% of all deaths in them. Dyslipidaemia does not only accelerate atherosclerosis in these patients but also progresses the renal disease. This study therefore set to investigate the pattern of lipid profile in pre-dialysis chronic kidney disease patients. METHODS: This was case control study of 63 pre-dialysis chronic kidney disease patients attending University of Maiduguri teaching Hospital and 60 control subjects. All factors that may lead to dyslipidaemia were excluded in all subjects except hypertension. Lipid profiles were measured by standard methods. Data were analyzed using a statistical software SPSS version 11.0. Their observed differences in mean-SEM values were analyzed for statistical significance using Student's t-test andp-value <0.05 was considered significant. RESULTS: the mean+SEM of total cholesterol 4.50+0.14 mmol/L and triglycerides 2.18+0.10 mmol/L in patients were significantly higher than that of the controls 3.79+0.11 mmol/L and 1.19+0.06 mmol/L respectively, p<0.05. Similarly the mean+SEM of LDL 2.62+0.16 mmol/L and LDL/HDL ratio 3.53+0.12 in patients were significantly higher when compared to that of the controls 2.04+0.16 mmol/L and 2.04+0.08 respectively, p<0.05. However, although the mean+SEM HDL in patient 1.07+0.07 mmol/L, was lower than that of the controls 1.21+0.06 mmol/L, the difference was not statistically significant, p>0.05. The pattern of lipid profile did not change with severity of disease and dyslipidaemia in patients were more in triglycerides, 68.3% and HDL, 63.5% than in TC, 22.2% and LDL, 17.5%. CONCLUSION: Dyslipidaemia is common in pre-dialysis chronic kidney disease patients. It is pertinent to investigate and treat dyslipidaemia early in the course of the disease as it may prevent further progression of the renal damage.
[ABSTRACT]   Full text not available     [PubMed]
  507 0 -
Single versus two layer suturing for wound closure after inguinal hernia repair
EA Agbakwuru, JK Olabanji, OI Alatise, IA Katung, UU Onakpoya
June 2009, 12(2):162-164
PMID:19764666
OBJECTIVE: Method of skin-subcutaneous closure after inguinal herniorrhaphy affects the operation time and immediate outcome of the wound. The study was aimed to assess the effects of a single layer closure of the skin and subcutaneous wound of inguinal herniorrhaphy, in contrast to the conventional two layer closure. METHOD: DESIGN: Prospective randomized controlled trials. SETTING: Obafemi Awolowo University Teaching Hospital Ile-Ife, Osun State, Nigeria. PATIENTS AND METHOD: All adult patients attending surgical out patient clinic with uncomplicated inguinal hernia and had surgery, after randomization into two groups from June 2000 Dec 2005 were included in the study. One group had one layer - closure i.e. closure of skin and subcutaneous tissues together at once while the second group had two layer closure i.e. closure of skin and subcutaneous tissues separately. Duration of operation and complications were documented for comparison. RESULTS: One hundred and eighty wounds were studied in 160 patients; the extra wounds being from bilateral inguinal hernias. There were 93 wounds in group one (two layer closure) and 87 wounds in group two (one layer closure. There was no significant difference between healing of wounds and appearance of scars in both groups. The single layer closure group was, however, apparently quicker. (P= 0.006). CONCLUSION: The immediate outcome of the wound in both groups was similar. The medical personnel time was saved by closing the wound in single layer.
[ABSTRACT]   Full text not available     [PubMed]
  504 0 -
Stress and psychological health of medical students in a Nigerian university
AN Ofili, I Oriaifo, E Okungbowa, EU Eze
June 2009, 12(2):128-133
PMID:19764658
OBJECTIVE: Physician job satisfaction is one indicator of the overall health of our health care delivery system. Excellent but dissatisfied physicians could decide to leave the practice of medicine or highly talented students could opt for different careers if the perception that medicine is not a fulfilling career exists. This study aims to investigate the level of course satisfaction, its relationship to psychological disorder and presence/absence of stress among medical students. Physician job satisfaction is one indicator of the overall health of our health care delivery system. Excellent but dissatisfied physicians could decide to leave the practice of medicine or highly talented students could opt for different careers if the perception that medicine is not a fulfilling career exists. This study aims to investigate the level of course satisfaction, its relationship to psychological disorder and presence/absence of stress among medical students. MATERIALS AND METHODS: A cross-sectional study was conducted among 410 medical students of the University of Benin, Nigeria. The respondents completed a self-administered questionnaire and a standard instrument The General Health Questionnaire (GHQ 28). RESULTS: The response rate was 93.9%. Two hundred and forty four (63.4%) of respondents were satisfied with their course, 331 (86.0%) of them felt medicine was stressful. There was also a statistical significant difference in the level of stress among the various levels of medical students. One hundred and twenty three (31.9%) medical students indicated that they would not study medicine again if given a second chance. One hundred and twelve (29.1%) medical students had psychological disorder. More dissatisfied students had psychological disorder than satisfied students and this difference was found to be statistically significant. CONCLUSION: The level of perceived stress among medical students was found to be high and a significant number of students had psychological morbidity. There is a need to identify and correct the causes of dissatisfaction among these groups of students in order to improve on the psychological state of the students. Stress management training is also required as majority of the medical students found the course stressful.
[ABSTRACT]   Full text not available     [PubMed]
  495 0 -
An audit of deaths in the emergency room in the University College Hospital Ibadan
OO Afuwape, SO Ogunlade, T Alonge, OR Ayorinde
June 2009, 12(2):138-140
PMID:19764660
INTRODUCTION: Death rates in the accident and emergency department may be a reflection of the quality of care in the hospital. Trauma related mortality is a significant cause of preventable death. METHOD: A retrospective study was conducted in the accident and emergency department of the University College Hospital Ibadan (Nigeria) using the hospital records to determine the pattern of mortality over one year. RESULT: Five thousand one hundred patients attended the accident and emergency department in the year reviewed. One hundred and sixty eight (3.3%) mortalities were recorded .There were 97 males and 71 females with mean ages of 49+/-37.8 and 42+/-30.7 years respectively. 46% of the patients had medical (non-trauma non-surgical) related diagnoses. Trauma constituted 31% of the mortalities with an average probability of survival of 80% at presentation. Head injury and multiple long bone fracture were the commonest causes of trauma related mortalities. CONCLUSION: Trauma is a preventable cause of death. The poor outcome of the trauma patients underscores the need to equip the attending doctors in the emergency room with basic skills in trauma care.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  491 0 2
Millennium Development Goals : An assessment of awareness and perceptions of attainability by health workers in Owo, Nigeria
CO Omolase, AO Mahmoud, CO Fadamiro, BO Omolase, EO Omolade
June 2009, 12(2):134-137
PMID:19764659
AIM: To assess the awareness of the United Nations Millenium Development Goals (MDGs) by some Nigerian health workers and also their perceptions of the attainability of the goals. SUBJECT AND METHODS: Through the means of a structured questionnaire served on 92 consenting health workers selected by stratified sampling technique ,information regarding their bio data, awareness of the millennium development goals (MDGs), the duration and source of the awareness and their perception of attainability of the goals were obtained. The feasibility of attainment of the goals was rated as: very attainable, attainable, and not attainable. RESULTS: All the respondents were by then aware of the MDGs. Most of the respondents (57.6%) became aware within the preceding year, i.e., 2006; while only very few (2.2%) had been aware 6-7 years earlier (2000 and 2001). Some respondents (46.7%) got to know of MDGs through their colleagues while others (32.6%) got to know through the print and electronic media. The remaining others (20.7%) were informed through the sensitization efforts of the government and non-government agencies. The highest degree of optimism for the attainment ofMDGs were displayed largely for health related MDGs; i.e., the goals 4, 5 and 6. CONCLUSIONS & RECOMMENDATIONS: Majority of the respondents were aware of MDGs. Most adjudged the attainment of MDGs feasible. The government and other stake holders should sensitize the populace, strengthen the health system and ensure equitable access to health care.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  485 0 1
Audit of gynaecological laparoscopies in National Hospital Abuja, Nigeria
ER Efetie, JS Abubakar, SA Habeeb
June 2009, 12(2):149-152
PMID:19764663
CONTEXT: The scope oflaparoscopy is increasing in contemporary gynaecological practice. There is scanty data on gynaecological laparoscopy in Nigeria. OBJECTIVE: To determine the rate, indications, perioperative characteristics and complications of gynaecological laparoscopy at National Hospital, Abuja. STUDY DESIGN, SETTING AND SUBJECTS: A retrospective review of gynaecological laparoscopies performed at the National Hospital, Abuja, Nigeria over a four year period (2001-2004). RESULTS: There were 58 gynaecological laparoscopies during the study period, and a rate of 28.7 laparoscopies per 1000 gynaecological operations. The incidence is low due to occasional logistic problems with the equipment and multiple strike actions by health workers. The procedure was done wholly for diagnostic purposes, the major indication being infertility in 88.9% of the patients. Majority (54.9%) of the patients had the procedure performed during the luteal phase of their menstrual cycle, as opposed to the proliferative phase. The procedure was performed by consultants or senior residents in 50 (98%) of the patients. All the patients had general anaesthesia for the laparoscopies. There was no major complication or operative mortality in the patients whose case folders were analysed. CONCLUSION: The gynaecological laparoscopy rate is low, at 28.7 per 1000 gynaecological operations; it was done mainly for elective and diagnostic purposes, the major indication being infertility and it was generally safe with absence of major perioperative or postoperative complications.
[ABSTRACT]   Full text not available     [PubMed]
  473 0 -
Perception of neonatal jaundice among women attending children out patient and immunization clinics of the UPTH Port Harcourt
AU Eneh, RO Ugwu
June 2009, 12(2):187-191
PMID:19764672
BACKGROUND: Neonatal Jaundice (NNJ) is a common disorder worldwide. Early identification and proper management is needed to prevent the serious neurological complications associated with it. OBJECTIVE: To determine the knowledge of the women attending Children Outpatient (CHOP) and Immunization clinics on the causes, treatment and complications of neonatal jaundice. METHOD: Women who brought their children/wards to the immunization/children out patient clinics at the University of Port Harcourt Teaching Hospital Port Harcourt were interviewed using structured questionaire. RESULTS: There were 255 mothers who participated in the study. Of these 30 (11.8%) have never heard of neonatal jaundice while 225 (88.2%) have heard and only those who have heard were further analyzed. The age range was from 16 to 47 yrs (mean age 27.1 +/- 3.3 years). Median parity was 2. One hundred and twenty two (54.2%) women had tertiary education. One hundred and seventy four (77.3%) correctly defined neonatal jaundice, and in 114 (44.7%) source of information was from health talk in the clinic. Seventy five (33.3%), and 50 (22.2%) erroneously believed that eating too much groundnut in pregnancy and mosquito bite respectively were the main causes while 55 (24.4%) correctly answered that it is due to mismatch of mother and baby's blood. Only a few knew that use of dusting powder on baby's cord, prematurity, and storing baby's clothes in camphor were risk factors for NNJ. One hundred and fourteen (50.7%) and 60 (26.7%), wrongly believed that exposure to sunlight and use of glucose drinks respectively were the main forms of treatment and 50 (22.2%) knew brain damage as a possible complication CONCLUSION: There is still misconception on the causes and risk factors and treatment of neonatal jaundice among our women. Also only a few women are reached by the health talk in the clinics. There is therefore urgent need for massive health enlightenment campaign.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  473 0 3
Urinary tract infection in febrile children in Maiduguri north eastern Nigeria
AI Rabasa, MM Gofama
June 2009, 12(2):124-127
PMID:19764657
One hundred and forty five children aged 1 month to sixty months who had fever at presentation to the paediatric department of University of Maiduguri Teaching Hospital were investigated for urinary tract infection in this prospective study from November 2004 to October 2005. Prevalence of urinary tract infection was found to be 13.7 per cent. While the female sex and malnutrition were found to be significantly associated with urinary tract infection, height of temperature and symptoms referable to urinary system were not. Ninety per cent of the isolates were Gram negative; mainly coliform Spp, the remaining 10 per cent were due to staphylococcus aureus. Gentamicin was still found to be effective against most of the urinary pathogens. However, clavulinic acid potentiated amoxicillin, ampicillin, nalidixic acid and cotrimoxazole were found to be poorly effective. We therefore conclude that all ill children especially younger ones presenting with fever be screened for urinary tract infection. A regular surveillance of urinary tract infection pathogens and their antibiotic sensitivity pattern is recommended.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  472 0 3
Serum urea and uric acid concentration in pregnant women in sub-urban commercial community in Africa
JE Ahaneku, JI Adinma, GI Ahaneku, BO Nwosu, PC Nwofor, CC Okoli
June 2009, 12(2):216-218
PMID:19764679
Serum uric acid and urea levels were determined in 27 pregnant and 17 non-pregnant black African women. Uric acid levels for the pregnant women were significantly raised, and the relationship between uric acid elevation and gestational proteinuric hypertension was discussed. In conclusion, we recommend that uric acid estimation should be included during routine antenatal clinics in normal pregnancy. That the use of uric acid levels should be encouraged for the diagnosis and management of gestational proteinuric hypertension in African pregnant women. The above recommendation will help to reduce prenatal morbidity and mortality in African pregnant women.
[ABSTRACT]   Full text not available     [PubMed]
  470 0 -
Primary bone tumours in a tertiary hospital in Nigeria : 25 year review
DC Obalum, SO Giwa, AF Banjo, AT Akinsulire
June 2009, 12(2):169-172
PMID:19764668
BACKGROUND: Primary bone tumors remain a daunting challenge to orthopaedic surgeons. The challenge is heightened in developing countries due to limited diagnostic and therapeutic facilities and ignorance. The published literature on the subject is sparse in our environment. OBJECTIVE: To describe the pattern of primary bone tumors seen in a tertiary hospital in Nigeria. METHODS: This is a retrospective review of all the histologically confirmed primary bone tumours seen at Lagos University Teaching Hospital (LUTH) over a 25 year period. RESULTS: A total of 242 patients (aged 7.5 to 62 years) with a mean of 25.3 years were studied. One hundred and forty four patients (59.5%) were males and 98 (40.5%) were females. The peak age incidence was in the age group 11-20 years. One hundred and thirty (53.7%) of the tumors were benign. Among these Osteochondroma was the commonest accounting for 36 cases (27.7%) followed by Osteoclastoma, 28 cases (21.5%). Osteosarcoma accounted for 66 cases (58.9%) of all primary malignant tumours in the study. CONCLUSION: This study showed that primary bone tumours were mainly benign, occurred predominantly in the second decade of life with a male preponderance. Osteochondroma and Osteosarcoma were the most common benign and primary malignant bone tumours respectively.
[ABSTRACT]   Full text not available     [PubMed]
  466 0 -
Prevalence of human immunodeficiency virus in ophthalmic surgical patients
CU Ukponmwan, EE Egbagbe, AI Osahon
June 2009, 12(2):120-123
PMID:19764656
AIM: The aim of this study was to determine the incidence of human immunodeficiency virus in one hundred and sixteen (116) ophthalmic patients who had surgery over a two year period (July 2003 to June 2005) in the Department ofOphthalmology of the University ofBenin Teaching Hospital, Benin City. MATERIALS AND METHODS: A two year prospective study was carried out on 116 ophthalmic patients who had surgery between July 2003 and June 2005, A total of 116 patients were screened for HIV 1 & 2. An informed consent was obtained from all the patients. Patients who did not give their consent were excluded from the study. RESULTS: The total number of patients screened was one hundred and sixteen (116).There were 61 males and 55 females The age range was lyear to 78years with a mean age of 46 +/- 22.2 years (SD). The highest number of patients, 25 was found in the age group 61-70 years, comprising 21.6 of the total number of patients, followed by 24 patients in the 51 60 years age group. Three (3) patients comprising 2.6% were HIV positive. There were 2 females aged 25 and 50 years and a male aged 42years. The 25 year old female presented with squamous cell carcinoma of the conjunctiva, while the 57 year old woman had panophthalmitis. The male patient had herpes zoster ophthalmicus. He developed corneal opacities as complications of herpes zoster and had a peripheral iridectomy done to improve his vision. CONCLUSION: Although the HIV seropositivity rate of 2.6% is low, there is a need to do routine testing for HIV seropositivity in ophthalmic surgical patients who are billed for surgery as it gives them an opportunity to know their HIV status, thus enabling them to take appropriate preventive or treatment measures where necessary. HIV screening should be mandatory for high risk patients such as those with panophthalmitis, herpes zoster and squamous cell carcinoma of the conjunctiva that are markers for HIV.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  452 0 1
Day case adenoidectomy : Is it safe?
AD Dunmade, BS Alabi
June 2009, 12(2):145-148
PMID:19764662
OBJECTIVE: To document the Clinical outcome of Day Case Adenoidectomy in Children in a Nigerian tertiary health Institution and a private Ear, Nose and Throat Consultant Cinic. METHODOLOGY: This is a prospective study of twenty eight children without any co-morbid condition operated for adenoidectomy between June 2002 and May 2004. The patients were admitted on the day of surgery and discharged within 12 hours post surgery. RESULT: A total number of 28 patients were operated for adenoidectomy. 16 children were treated as planned day cases and 12 were treated as inpatients. 50% of the patients were in the age group of 2-4 years. There were 12 males and 4 females with a M:F ratio of 3: 1. All the parents of the patients had access to cars and 75% resided within 30 minutes of travelling time from the hospital. CONCLUSION: Day case adenoidectomy is relatively safe and may prove advantageous considering long surgical waiting lists, preventing Hospital acquired infection and minimizing cost of hospitalization.
[ABSTRACT]   Full text not available     [PubMed]
  450 0 -
Traumatic diseases of parotid gland and sequalae. Review of literature and case reports
BO Akinbami
June 2009, 12(2):212-215
PMID:19764678
Parotid gland injuries are accompanied by a large number of sequelae. The aim of this paper is to highlight the importance of thorough management of these parotid glandinjuries especially at initial presentation in order to minimize the complications that accompany these injuries. A review of the aetiology and management of the existing cases of parotid gland injuries obtained from published journals and internet search as well as a report of two cases managed in our centre is presented in this paper. A total of about 70 cases in the previous literatures were reviewed of which assault was responsible for almost 90% of the cases. Sialoceles and fistulae were the main sequelae of these injuries. More than half of the cases (54%) were managed by conservative methods. Surgical drainage was done in about 44% cases; where the Stenson's ducts were accessible, primary repair was done. Excision of the gland was done in very few cases. The two cases managed in our centre were due to assault from broken bottles and road traffic accident respectively and both were managed by conservative methods. The first patient was a case of sialocele following the injury, which resolved within 3 weeks after the cyst formation with reduction in food intake, aspirations and external surgical drainage; while the second patient was a case of persistent fistula which healed after about 5 weeks following the trauma. Follow-up of both patients for about 3 months revealed no further leakage or accumulation of saliva. Management of these injuries involves a thorough understanding of the structure and function of the parotid gland and closely related tissues.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  429 0 2
Small intestinal tubulovillous adenoma - Case report and literature review
OD Osifo, W Akhiwu, CA Efobi
June 2009, 12(2):205-207
PMID:19764676
Benign small intestinal tumour, though rare, have been reported. We report a case of sessile and extensive tubulovillous adenoma in a 13-year-old girl. She presented in a private hospital with three months history of abdominal pain, abdominal distension, vomiting, constipation, weight loss and anorexia. Significant findings on examination were weight loss, dehydration, and a huge smooth, not tender, mobile and indentable mass which extended from the left lumbar region to right iliac fossa. Visible peristalsis coursing from left to right was seen on the mass. Erect and supine plain abdominal x-rays revealed features of partial intestinal obstruction and abdominal ultrasound scan revealed dilated and hypertrophied bowel segment but could not say the bowel segment affected. The affected segment was found to be a 55cm portion of terminal ileum at operation which was resected due to hypertrophied proximal and collapsed distal segments, features in keeping with chronic intestinal obstruction, and ileo-ileal anastomosis done. Histology report was that of benign tubulovillous adenoma and the girl has enjoyed stable health for more than a year on close follow up in surgical outpatient clinic. This case highlights the unusual presentation and unusual gross nature of this small intestinal adenoma, which was found to be a benign adenoma on histological examination.
[ABSTRACT]   Full text not available     [PubMed]
  428 0 -
Fracture of the penis. A report of two cases
BT Ugwu, HU Liman, AA Sani, AM Mohammed
June 2009, 12(2):221-223
PMID:19764681
We present two cases of fracture of the penis in two young men at the extremes of the social strata the first an unemployed tailor while the other a practicing engineer. The first one was a bachelor while the other was married with children. In the first case, the fracture occurred during masturbation while in the second case it occurred during consensual intercourse with his wife on top. In the first case the fracture occurred at the base of the penis with associated rupture of the deep dorsal vein while in the second case it affected the mid-shaft with urethral rupture and blood at the tip of the penis at presentation. Both of them presented within two hours of their injuries with deformed, swollen and tender penis. Laubscher's subcoronal sleeve operation with evacuation of clots and repair of the tear with absorbable sutures to ensure a leak-proof repair was promptly performed with no complications. Both patients experienced spontaneous erection whilst in hospital even with indwelling catheter in place. The wife of the second case became pregnant six months after the repair. Counseling was successful with the engineer but was unsuccessful with the tailor-bachelor who continued with masturbation despite professional help. Though we published the first case of fracture of the penis in this centre almost a decade ago, we still found it necessary to report these new cases managed after we created awareness of this uncommon condition in our environment in order to highlight the presentations and the factors that influenced outcome.
[ABSTRACT]   Full text not available     [PubMed]
  427 0 -
Obstetric outcome in pregnant women subjected to domestic violence
N Ameh, SO Shittu, MA Abdul
June 2009, 12(2):179-181
PMID:19764670
OBJECTIVE: To determine the prevalence of domestic violence and its relationship to adverse obstetric outcomes amongst pregnant women who deliver at a tertiary level hospital in Zaria, Nigeria. METHOD: A cross-sectional study involving 310 women who delivered at the labour ward. Questionnaires were administered to parturient women. Details of their socio-demographic characteristics and obstetric outcome were compiled and the relationship to experiences of domestic violence studied. RESULTS: The prevalence of domestic violence was 28.4%. There was positive relationship between domestic violence during pregnancy, non-supervision of pregnancy and poor attendances to antenatal clinic (p<0.05). There was however, no statistically significant relationship between domestic violence, and complications of labour and neonatal outcome (p>0.05). CONCLUSION: The prevalence of domestic violence in pregnancy is high in this environment. Poor attendances to the antenatal clinic is a significant association.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  425 0 2
Myelomeningocoele in dizygotic twins
RO Ugwu, AU Eneh
June 2009, 12(2):196-199
PMID:19764674
BACKGROUND: Periconceptional use of folic acid can reduce a woman's risk of having a baby with a neural-tube defect and other congenital abnormalities. METHOD: Case reports of babies OO both males, who were delivered at term by emergency caesarean section by a 21 year old woman. At birth, both twins had neural tube defects, bilateral talipes equinovarusdeformity, bladder and bowel dysfunction. Twin one in addition had hydrocephalus and a ventriculoseptal heart defect (VSD). CONCLUSION: We advocate comprehensive neural tube defect (NTD) surveillance, a folic acidsupplementation program for high-risk women who have had a NTD-affectedpregnancy and a national folic acid education campaign for allwomen of reproductive age preconceptionally.
[ABSTRACT]   Full text not available     [PubMed]
  420 0 -
Are the symptoms of diabetic peripheral neuropathy in Nigerian patients objective? An evaluation using the United Kingdom Screening Test (UKST) and Bio-Thesiometry
OC Oguejiofor, JM Oli, CN Ajaero, CU Odenigbo, MA Odike
June 2009, 12(2):113-119
PMID:19764655
BACKGROUND: Symptoms suggestive of peripheral neuropathy (PN) in diabetes mellitus (DM) do not always indicate presence ofunderlying PN. OBJECTIVE: A pioneering study among Nigerian diabetic subjects to evaluate the objectivity of their symptoms of PN using two objective diagnostic instruments for PN the United Kingdom Screening Test (UKST) and Bio-Thesiometry. SUBJECTS AND METHODS: One hundred and twenty diabetic participants and a similar number of non-diabetic controls were screened for symptoms of PN using the UKST symptoms score and subsequently separated into two groups those with symptoms ofPN and those without. The "symptomatic" cases and controls were further evaluated with the UKST signs score and Bio-Thesiometry to assess the objectivity of the symptoms. RESULTS: Among 120 diabetic participants, 83(69.2%) had neuropathic symptoms (the symptomatic cases) while 10 (8.3%) of the 120 non-diabetic controls had neuropathic symptoms (the symptomatic controls). Among the cases, UKST signs score detected PN in 89.2% (74/83) and Bio-Thesiometry 71.1% (59/83), the difference in the ability of the two methods to detect PN in this group being statistically significant (X2 = 8.51, df = 1, p < 0.01). Among the controls, UKST detected PN in 100.0% (10/10) compared to Bio-thesiometry (50.0%; 5/10), the difference in the ability of the two methods to detect PN in this group also being statistically significant (X2 = 4.27, df = 1, p < 0.05, using continuity correction factor). The difference in the ability of both methods to detect PN between the cases and controls was however not statistically significant (X2 = 0.68, df = 1, p > 0.3) CONCLUSION: The symptoms of PN among Nigerian diabetic subjects when evaluated with a gold standard for scoring the symptoms (the UKST symptoms score) are real, objective and truly indicate presence of underlying PN. Diabetic subjects presenting to medical clinics with symptoms of PN should receive serious attention and evaluation using this gold standard to detect early those with genuine PN and are at risk of foot ulceration from PN.
[ABSTRACT]   Full text not available     [PubMed]
  412 0 -
Prevalence of HIV seropositivity in patients with lymphoid malignancies in a tertiary centre in southern Nigeria
CE Omoti, ON Adesuwa
June 2009, 12(2):141-144
PMID:19764661
OBJECTIVE: The human immunodeficiency virus (HIV) epidemic has a significant impact worldwide and infected subjects are at increased risk of developing cancer. We aim to determine the HIV seropositivity of lymphoid malignant patients in a tertiary centre in Southern Nigeria. METHOD: The course of disease in 275 patients with lymphoid malignant disorders at the University of Benin Teaching Hospital, Benin City, Nigeria, was analysed from 1996 to 2006. Blood specimens screened for antibody to HIV infection were confirmed by Western blot and the CD4+ lymphocyte count was measured by flow cytometry technique. RESULTS: A total of 275 patients aged 18-72 years were studied. Of the 275 lymphoid malignancies 11 cases were found to be HIV seropositive giving a seroprevalence of 4%. The most frequent lymphoid malignancy in association with HIV seropositivity was non-hodgkin's lymphoma (NHL) with a prevalence of 4.12% over the less frequent lymphoid neoplasms. The overall median CD4+ lymphocyte count was 185 microl with 9 cases seropositive for HIV below 200 microl (P<0.0001). CONCLUSION: We conclude that the seroprevalence of HIV infection in patients with lymphoid malignancies was 4% with NHL being the most common neoplasm associated with HIV infection in concordance with studies in the Diaspora.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  400 0 1
Severe idiosyncratic drug reaction (Lyells syndrome) after ingesting dihydroartemisinin
AO Ugburo, CA Ilombu, EO Temiye, IO Fadeyibi, OI Akinolai
June 2009, 12(2):224-227
PMID:19764682
Lyells syndrome also called Toxic epidermal necrolysis is the extreme form of idiosyncratic drug reaction that is called Steven Johnsons Syndrome: The condition results in an extensive loss of the skin with mucous membrane involvement. Lyells syndrome has been induced by many agents. The commonest agent in the literature being sulphonamides. However, in our search of the medical literature there was no report of dihydroarthemisinin as a cause of Lyells syndrome. We report three patients seen at two tertiary health institutions with Lyells syndrome after treatment for malaria with dihydroarthemisinin. This resulted from administration of dihydroarthemisinin with chloroquine in two patients and dihydroarthemisinin with Amodiaquine in one patient. The first patient was a seven year old child who developed 90% cutaneous involvement and died from hemorrhagic shock. The second was a 28 old female that developed a 76% body surface involvement and died from septicemia. The third patient was a pregnant 37 year old woman that developed 52% body involvement and died from septic shock. In these patients the earliest symptoms were not recognized and there was considerable delay before referral. In view of the recent WHO recommendation ofArthemisinin Combination Treatment (ACT) for malaria, we expect more cases of Steven Johnson Syndrome and Lyells syndrome from ACT treatment. The aim of this report is to raise the awareness of clinicians to this potentially fatal complication.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  393 0 5
Audit of the red cell units supply of a busy hospital blood bank in Nigeria
FA Fasola, TR Kotila, WA Shokunbi
June 2009, 12(2):165-168
PMID:19764667
BACKGROUND/OBJECTIVE: Blood bank audit embraces all procedures from blood procurement to the long -term consequences of transfusion which helps to identify opportunities for improvement. We have therefore looked at red cell transfusion in our hospital to identify areas that will require improvement. METHOD: Data was collected retrospectively from the hard copy record of the blood bank for a period of one month. RESULTS: Request was made for 1210 red cell units; crossmatch was made for 64% of the request. All units crossmatched were issued, of these 4.15% were returned unutilized. 5.1% were issued as uncrossmatched. The Obstetrics/Gynaecology unit recorded the highest blood usage and the medical unit the least. The use of blood by the emergency and paediatric were the same. The crossmatch:transfusion ratio for the hospital was 0.9:1. This study has shown that the crossmatch and transfusion rates are almost equal and only a small percentage was returned unused. CONCLUSION: This showed that there is inadequate supply of blood. There is a need to assess the reason for transfusion and establishing a blood transfusion advisory committee by the hospital. This will ensure interaction and collaboration between blood suppliers and users to improve the quality of transfusion practice. The new policy establishing a national transfusion service will also improve the transfusion service but emphasis has to be put on donor recruitment and donor care.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  386 0 1
Occurrence of anaplastic oligodendroglioma in a patient with Williams syndrome : a case report with analysis of mutational profile of tumor
BI Omalu, UH Nnebe-Agumadu
June 2009, 12(2):200-204
PMID:19764675
Williams syndrome is a rare congenital developmental disorder characterized by a constellation of distinctive facial dysmorphisms, mental retardation, cardiovascular anomalies, infantile hypercalcemia, delayed developmental milestones, dental and musculoskeletal anomalies and distinctive personality traits. A majority of patients with Williams syndrome exhibit a hemizygous micro-deletion of chromosome 7q11.23, which is the locus of some 20-30 genes including the ELN gene that encodes the structural protein elastin. Chromosome 7q contains putative tumor suppressor genes and is one of the chromosomes that are frequently involved in chromosomal aberrations in human malignancies. A paucity of tumors (three) has been reported in the literature to occur in patients with Williams syndrome. We report a case of anaplastic oligodendroglioma that occurred in a 31-year-old man with Williams syndrome. Mutational profiling by loss of heterozygosity analysis using a panel of polymorphic micro-satellite markers indicated combined deletion of chromosome 1p and 19q. We draw attention to this apparently rare or possibly under-reported occurrence of tumors in patients with Williams syndrome and suggest that Central Nervous System [CNS] tumors be considered as differential diagnoses in such patients when they present with unanticipated neurologic symptoms that are not attributable to those commonly associated with Williams syndrome.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  382 0 1
Primary papillary transitional cell carcinoma of the breast : A case report
IV Onyiaorah, DC Anyiam, SN Anyanwu, GU Chianakwana
June 2009, 12(2):219-220
PMID:19764680
BACKGROUND: Primary papillary transitional cell carcinoma of the breast is a rare occurrence worldwide and few cases ever have been reported. It may be mistaken for the benign intraductal papillary lesions or papillary adnexal neoplasms. CASE REPORT: A 66 year old woman who presented with a recurrent right breast mass. Histopathologic studies confirmed a diagnosis of Primary Papillary Transitional cell carcinoma. CONCLUSION: The need for a high index of suspicion of primary papillary transitional cell carcinoma of the breast must be considered, especially in suspected benign intraductal papillary lesions to facilitate adequate and timely diagnosis and management of this lesion.
[ABSTRACT]   Full text not available     [PubMed]
  381 0 -
Water beds for unconscious and bedridden patients necessary
PV Lofor
June 2009, 12(2):228-228
PMID:19764683
Full text not available     [PubMed]
  279 0 -
Congenital hypothyroidism--a delayed diagnosis in a neonate. A case report
TA Adesanmi, GN Adimora, BN Tagbo
June 2009, 12(2):208-211
PMID:19764677
Full text not available    [CITATIONS]  [PubMed]
  266 0 1
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