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   2012| January-March  | Volume 15 | Issue 1  
    Online since March 20, 2012

 
 
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REVIEW ARTICLES
Partograph as a tool for team work management of spontaneous labor
AAE Orhue, ME Aziken, AP Osemwenkha
January-March 2012, 15(1):1-8
DOI:10.4103/1119-3077.94087  
It is presently being debated whether the partograph is a useful tool for labor supervision and, if useful, where should the action line be located between 2, 3 or 4 h to improve the fetomaternal outcome. This review adduces facts to show that this debate is because there is a poor understanding of the essence and purpose of the partograph. The partograph is a form on which labor observations are recorded to provide an overview of labor, aiming to alert midwives and obstetricians to deviations in labor progress as well as maternal and fetal wellbeing. When deviations in labor progress are recognized early and corrected, complications are prevented and normal labor and delivery can occur. The earliest deviation in labor progress is slow labor progress, for which the partograph alert line is a prompt for early recognition by the midwives and other non-obstetric staff. The intervention to correct the deviation is at the action line by the staff with the requisite skill. In the circumstance in which the partogram was produced, the action to correct the deviation in labor progress was after 4 h, represented by the 4-h action line, but other workers have attempted with 2- and 3-h action lines and have had equally good results. However, in all these, the action at the action line was instituted by the staff with the appropriate skill, irrespective of whether the action line was 2, 3 or 4 h. As long as the action at the action line is by the staff with the requisite training, the deviation in labor progress will be corrected by either medical or surgical means irrespective of the action line location at 2, 3 or 4 h. In conclusion, the essence and purpose of the partograph is to ensure that labor progress is monitored to identify slow labor by the alert line but appropriate treatment must begin at the action line by the staff with the cognate skill, whether at 2, 3 or 4 h. The appropriateness of the intervention at the action line is the determinant of the outcome and not the delay.
  15,731 1,650 11
Review of hormonal treatment of breast cancer
IH Abdulkareem, IB Zurmi
January-March 2012, 15(1):9-14
DOI:10.4103/1119-3077.94088  
This critical review focuses on the role of steroid hormones and their receptors in the development and treatment of breast cancer, with special reference to estrogen receptors, as well as mechanisms of receptor-ligand interactions, response or resistance to hormonal therapy against breast cancer, in conjunction with other modalities like surgery and chemotherapy. Tamoxifen is used in hormonal treatment of breast cancer for up to five years, depending on the presentation. However, there have been recent developments in hormonal therapy of breast cancer in the last ten years, with the introduction of many different alternative therapies for this condition. A critical review of published articles in Pubmed/Medline, Athens, AJOL, NHS Evidence, Science Direct and Google, relating to hormonal treatment of breast cancer, was undertaken, in order to evaluate the mechanisms of estrogen receptor-ligand interactions, their involvement in the etio-pathogenesis of breast cancer, resistance of breast cancer cells to anti-hormonal agents, as well as ways of treating breast cancer using anti-hormone drugs like tamoxifen. Although tamoxifen is the established drug for hormonal treatment of breast cancer, cases of hormone resistance breast cancer have been described recently in the literature. This can happen from the beginning, or during treatment. Therefore, we aim to examine the causes of resistance to hormonal treatment with a view to understand the options of tackling this problem, and suggest other novel alternative hormonal therapies that can be tried, which may overtake tamoxifen in the future. We also seek to emphasize that hormonal therapy has a definite place in the treatment of breast cancer along with surgery, chemotherapy and radiotherapy, as the disease is often considered to be multi-systemic even from the beginning.
  8,556 2,387 14
CASE REPORTS
A clinical case report of Hashimoto's thyroiditis and its impact on the treatment of chronic periodontitis
BS Patil, GR Giri
January-March 2012, 15(1):112-114
DOI:10.4103/1119-3077.94113  
Periodontitis is a multifactorial disease with microbial dental plaque as the initiator of periodontal disease. However, the manifestation and progression of the disease is influenced by a wide variety of determinants and factors. The strongest type of causal relationship is the association of systemic and periodontal disease. Hashimoto's thyroiditis has also been considered as one of the causes of periodontal disease. This clinical case report highlights the impact of Hashimoto's thyroiditis on the outcome of periodontal therapy.
  8,103 810 1
ORIGINAL ARTICLES
Squamous papillomas of the conjunctiva: A retrospective clinicopathological study
OA Ogun, GO Ogun, CO Bekibele, EE Akang
January-March 2012, 15(1):89-92
DOI:10.4103/1119-3077.94106  
Background: There is very limited literature on squamous papillomas of the conjunctiva from Nigeria and sub-Saharan Africa. In an attempt to contribute to the literature on the subject, we studied the clinicopathological characteristics of patients histologically diagnosed with squamous papilloma of the conjunctiva in Ibadan, Nigeria. Materials and Methods: Clinical and pathological records of patients with histological diagnosis of squamous papilloma of the conjunctiva made in the Department of Pathology, University College Hospital, Ibadan, between January 1985 and December 2004, were reviewed. Results: There were totally 26 cases. Patients' ages ranged from 2 to 58 years with a mean age of 32 years. Male to female ratio was 1.4:1. Size of tumors ranged from 2 to 10 mm. Duration of presenting complaints was from 2 months to 10 years. The lesions in 10 cases were located in the medial canthus, at or close to the limbus in another 10 cases, and in the tarsal conjunctiva in a single case. Five cases had no documentation of location. Sixteen cases (61.5%) had multiple papillomas. Four cases had a history of chemical injury (alkaline based - hair relaxer in a single case, acid based - wet cell car battery fluid in two cases, and unknown chemical in a single case) preceding the lesion by at least 6 weeks. Fourteen cases had koilocytosis on histology suggestive of Human Papilloma Virus (HPV) etiology. HIV screening test was negative in the three patients who had the screening done. Preoperative clinical diagnosis was squamous papilloma in 16 cases, pterygium in 6 cases and squamous cell carcinoma in 2 cases. Conclusion: In the environment where we practice, conjunctival squamous papilloma occurs most commonly in the fourth decade of life. Only very few cases are submitted for histological diagnosis. HPV infection and chemical injury are the main etiology. We strongly advocate that all excisions of the conjunctiva, irrespective of the clinical impression, should be submitted routinely for histological assessment.
  6,616 545 4
CASE REPORTS
Scorpion sting pain: Which way to treat?
AO Amucheazi, BU Umeh
January-March 2012, 15(1):93-94
DOI:10.4103/1119-3077.94107  
The objective of reporting this case is to highlight the clinical usefulness of chloroquine in the management of scorpion sting pain with the hope of stimulating interest and research, especially in areas where local anesthetic agents may not be available. In this case reported here, lidocaine failed to provide sustained analgesia for pain relief following scorpion sting. Two milliliters of parenteral chloroquine was injected intradermally around the bite site. Chloroquine provided immediate pain relief within 3 minutes of injection. The pain relief was sustained beyond 24 hours. The use of local anesthetic agents should be continued while other agents such as chloroquine, which may also have relevant clinical usefulness, should be considered.
  6,246 500 1
ORIGINAL ARTICLES
Complication rates of open transvesical prostatectomy according to the Clavien-Dindo classification system
CK Oranusi, AME Nwofor, IO Oranusi
January-March 2012, 15(1):34-37
DOI:10.4103/1119-3077.94094  
Background: Traditional open prostatectomies either transvesical or retropubic remains the reference standard for managing benign prostatic enlargement in some centers, especially in developing countries. The comparison of complication rates between the various types of open prostatectomies is usually a source of significant debate among urologists, most times with conflicting results. The Clavien-Dindo classification system is an excellent attempt at standardization of reporting complications associated with surgeries. Materials and Methods: We reviewed retrospectively the records of patients who had open transvesical prostatectomy (TVP) in three specialist urology centers in Anambra state, Southeast Nigeria, over a period of 5 years (January 2004-December 2009), with the aim of documenting medical and surgical complications arising from open TVP. These complications were then categorized according to the Clavien-Dindo system. Results: A total of 362 patients had open TVP over the period under review. Of this number, 145 had documented evidence of complications. The mean age of the patients was 66.3 years (SD 9.4 years; range 49-96 years). The mean follow-up period was 27.8 months (SD 12.6 months; range 6-33 months). The overall complication rate for open TVP in this study was 40.1% (145/362). Complication rates for grades i, id, ii, iiia, and iiib were 0.8%, 0.6%, 35.1%, 0.6%, and 3.0%, respectively. Most complications of open TVP occur in the early postoperative period. Conclusion: Open TVP still remains a valid surgical option in contemporary environment where advanced techniques for transurethral resection of the prostate and laparoscopic prostatectomy are unavailable. Most complications occur in the early postoperative period, with bleeding requiring several units of blood transfusion accounting for the commonest complication. This should be explained to patients during the preoperative counselling.
  5,455 606 7
Therapeutic effect of a moderate intensity interval training program on the lipid profile in men with hypertension: A randomized controlled trial
S Lamina, GC Okoye
January-March 2012, 15(1):42-47
DOI:10.4103/1119-3077.94096  
Objective: Physical inactivity has been established as a major primary risk factor for the development of hypertension. Also, factors such as elevated total cholesterol (TC) and reduced high density lipoprotein cholesterol (HDL) have been implicated as risk factors for coronary events in hypertension. The purpose of the present study was to investigate the effect of interval training program on blood pressure and lipid profile of subjects with hypertension. Materials and Methods: A total of 245 male patients with mild-to-moderate hypertension (systolic blood pressure [SBP] between 140 and 180 mmHg and diastolic blood pressure [DBP] between 90 and 109 mmHg) were age matched and grouped into interval and control groups. The interval (n=140; 58.90 ± 7.35 years) group was involved in an 8-week interval training (60-79% HR max reserve) program of between 45 minutes and 60 minutes at a work/rest ratio of 1:1 of 6 minutes each, while the control hypertensive (n=105; 58.27 ± 6.24 years) group remained sedentary during this period. Cardiovascular parameters (SBP and DBP), VO 2 max, TC, HDL, and artrogenic index (AI) were assessed. Student's t-test and Pearson correlation test were used in data analysis. Results: Findings of the study revealed significant decreased effects of the interval training program on SBP, DBP, TC AI, and significant increased effects on VO 2 max and HDL level at P<0.05. There was also a significant correlation between changes VO 2 max and changes in AI. Conclusions: It was concluded that the interval training program is an effective adjunct nonpharmacological management of hypertension and a means of upregulation of HDL.
  4,253 1,121 8
CASE REPORTS
Ocular complications of malaria treatment
SNN Nwosu
January-March 2012, 15(1):95-97
DOI:10.4103/1119-3077.94108  
Malaria is endemic in Nigeria. With the emergence of chloroquine resistance various modes of treatment including parenteral quinine are employed with consequent untoward effects. This article reports two cases of severe ocular toxicity, including mimicry of intracranial space-occupying lesion, from treatment of malaria with various drugs including quinine. Medical practitioners are advised to exhaust other less toxic modes of therapy before using drugs with great potential for severe untoward effects such as quinine.
  4,798 470 -
Angiodysplasia of the colon: A report of two cases and review of literature
AB Olokoba, OA Obateru, SA Olatoke
January-March 2012, 15(1):101-103
DOI:10.4103/1119-3077.94110  
Angiodysplasias of the colon are enlarged and fragile blood vessels in the colon result in occasional loss of blood from the lower gastrointestinal tract. It may be observed incidentally at colonoscopy or patients may present with lower gastrointestinal bleeding. The objective of this case report is to highlight two cases of colonic vascular ectasia seen using a Pentax video colonoscope at the Endoscopy unit of Crescent hospital, Ilorin. The first patient is an 85-year-old man, who presented with constipation, left-sided abdominal pain, and weight loss of two weeks duration. There was no anorexia, abdominal swelling, diarrhea, or hematochezia. Abdomino-pelvic ultrasonography showed normal findings. Colonoscopy done, reaching the ileo-cecal valve and caecum, showed an area of dilated tortuous blood vessel (vascular ectasia) in the wall of the descending colon approximately 45 cm from the anal verge, with no features of bleeding. No ulcers or mass lesion was seen. Colonoscopy showed angiodysplasia of the colon. The second patient is a 30-year-old female trader who presented with two days history of massive hematochezia of about 7 episodes prior to presentation with an estimated blood loss per episode of about 300 ml. There were clinical features of shock. Packed cell volume at presentation was 14%. She was transfused with 4 units of fresh whole blood. Post stabilization, colonoscopy was done 5 days after bleeding had stopped, which revealed an area of erosion with mucosal blood clot about 27 cm from the anal verge. An area of angiodysplasia was seen. No hemorrhoids or mass lesion was seen anywhere in the colon. Angiodysplasia is an uncommon finding in Ilorin. These are the first reported cases of angiodysplasia of the colon from Ilorin, Nigeria.
  4,039 789 -
Hypohidrotic (anhidrotic) ectodermal dysplasia in female twins
GO Ogunrinde, RO Zubair, SO Ajike, SO Ige
January-March 2012, 15(1):98-100
DOI:10.4103/1119-3077.94109  
Autosomal recessive hereditary ectodermal dysplasia (HED) has not been described in sub-Saharan Africa. It is acknowledged to be rarer than the occasionally reported x-linked and autosomal dominant variants. We report a pair of Nigerian female twins with family history and clinical features suggestive of recessive HED, thereby showing the existence of this rare form in sub-Saharan Africa.
  4,366 390 2
ORIGINAL ARTICLES
Serum antioxidant vitamins and the risk of oral cancer in patients seen at a tertiary institution in Nigeria
AO Lawal, B Kolude, BF Adeyemi, JO Lawoyin, EE Akang
January-March 2012, 15(1):30-33
DOI:10.4103/1119-3077.94093  
Objectives: Tobacco and alcohol are major risk factors of oral cancer, but nutritional deficiency may also contribute to development of oral cancer. This study compared serum antioxidant vitamin levels in oral cancer patients and controls in order to validate the role of vitamin deficiencies in the etiology of oral cancer. Materials and Methods: Serum vitamin A, C, and E levels of 33 oral cancer patients and 30 controls at University College Hospital, Ibadan, Nigeria, were determined using standard methods. The data obtained were analyzed using the Student t-test, odds ratio, and logistic regression. Results: Mean vitamin A, C, and E levels were significantly lower in oral cancer patients (P=0.022, P=0.000, and P=0.013 respectively). Risk of oral cancer was 10.89, 11.35, and 5.6 times more in patients with low serum vitamins A, C, and E, respectively. However, on logistic regression analysis, only low serum vitamin E independently predicted occurrence of oral cancer. Conclusions: The lower serum vitamin A, C, and E levels in oral cancer patients could be either a cause or an effect of the oral cancer. Further studies using a larger sample size and cohort studies with long-term follow-up of subjects are desirable.
  3,715 613 4
CASE REPORTS
Esthetics with prosthetics in case of maxillary canine transposition: A clinical report
S Yadav, AK Sheorain, N Madan, P Bajaj
January-March 2012, 15(1):108-111
DOI:10.4103/1119-3077.94112  
Transposition is a dental anomaly manifested by a positional interchange of two permanent teeth. The maxillary permanent canine usually transposes with the first premolar and occasionally with the lateral incisor. These are mainly genetically governed and are treated orthodontically if complete segment of tooth is present; in case of missing teeth, participation of cosmetic dentist is must. The present case report describes a situation where left canine to lateral incisor complete transposition was present along with a missing left central incisor. Esthetic rehabilitation of the "smile zone" was the major concern. Scrupulous treatment planning to esthetically contour transposed teeth according to their normal positions, i.e., transposed left canine to lateral incisor and transposed left lateral incisor to canine with replacement of missing tooth, was a challenge.
  2,981 597 2
ORIGINAL ARTICLES
Pattern and presentation of spine trauma in Gwagwalada-Abuja, Nigeria
AA Kawu
January-March 2012, 15(1):38-41
DOI:10.4103/1119-3077.94095  
Objective: The objective was to demonstrate the correlations and effects of age, gender, and cause of accident on the type of vertebral fracture as well as on the likelihood to sustain neurological deficit following trauma in Nigeria. Background: Spinal column injury is a well-documented problem but literature has been mute on this problem in Nigeria unlike the many papers on spinal cord injury. Materials and Methods: A retrospective review of spinal cord injured (SCI) patients was performed. Age, sex, cause and level of injury, fracture pattern and distribution, and neurologic presentation of SCI patients from 1997 to 2007 were studied from case notes. Results: There were 202 patients with male preponderance and a mean age of 38.9 ± 11.4 years over the 11-year period. The most common cause of spine injury was road traffic injury (79.7%). Cervical spine injury (10.4%) accounted for the highest number of cases with complete neurologic deficit. The majority of patients, 119 (58.9%) sustained a type A fracture, 37 (18.3%) a type B fracture, and 41(20.3%) patients experienced a type C fracture. All patients had neurologic deficits. Age (P=0.032) and road traffic injury (P=0.029) were independently associated with type of fracture after multivariate analysis. Age (P=0.038), road traffic injury (P=0.027), and cervical spine fracture (P=0.009) were also independently associated with neurologic deficit. Conclusion: These data showed the correlation between trauma mechanism and the type of fracture seen, and also the type of fracture and the incidence of neurologic deficit. The predictors of fracture types are age and road traffic injury while age, road traffic injury, and cervical spine fractures predict neurologic deficit.
  3,062 463 -
Pattern of morphine prescription by doctors in a Nigeria tertiary hospital
TN Elumelu, AA Abdus-Salam, AA Adenipekun, OA Soyanwo
January-March 2012, 15(1):27-29
DOI:10.4103/1119-3077.94092  
Background: Morphine was reintroduced into Nigeria after a long period of absence due to technical problems relating to stock accounting. With this reintroduction, prescriber education was commenced in many centers including the University of Ibadan. Aims and Objective: The aim of this study is to review the morphine prescription habits of the medical doctors practicing at the University College Hospital, Ibadan, and to assess the level of conformity with international guidelines. Materials and Methods: All the prescriptions on oral morphine in the hospital's pharmacy records within a 6 months period were reviewed. Results: The results showed that more than half (51.7%) of all morphine prescriptions were from the Radiation Oncology Department, while the newly created Day Care Hospice Unit accounted for 31.8% of the prescriptions. No prescriptions were seen from the Labor ward. Only 1.1% of all the prescriptions conformed to international guideline as contained in the "Blue Book." Conclusion: The results showed that there is a need for more education and advocacy programmes to increase awareness among doctors about morphine prescriptions.
  3,061 404 5
Antioxidant status of type 2 diabetic patients in Port Harcourt, Nigeria
EP Odum, AA Ejilemele, VC Wakwe
January-March 2012, 15(1):55-58
DOI:10.4103/1119-3077.94099  
Context: Oxidative stress has been implicated in the pathogenesis of type 2 diabetes mellitus (T2DM) and its complications. Aims: This study was conducted to determine and compare total antioxidant status (TAS), vitamin C and E levels in T2DM patients and healthy control subjects. Settings and Design: Fifty-five previously diagnosed DM patients aged between 34 years and 70 years and 50 control subjects aged between 35 years and 69 years were consecutively recruited into this study. Materials and Methods: Blood pressure (mmHg), body mass index (kg/m 2 ), concentrations of plasma glucose (mmol/l), lipid profile (mmol/l), TAS (mmol/l), vitamins C (μmol/l), and E (μmol/l) were determined in all participants. Statistical Analysis Used: Statistical Package for Social Sciences (SPSS) version 11.0 was used for statistical analysis. Results: The mean plasma TAS (1.18 ± 0.27 mmol/l), vitamin C (26.59 ± 7.39 μmol/L) and vitamin E (15.33 ± 4.05 μmol/l) of T2DM patients were significantly lower (P=0.0001 for all) than those of controls (1.58 ± 0.28 mmol/l, 43.56 ± 6.86 μmol/l, 31.22 ± 6.20 μmol/l respectively). TAS had a positive correlation with vitamin E (r=0.588; P=0.013) but no correlation with vitamin C (r=−0.387; P=0.139) among diabetics. Conclusions: TAS, vitamin C and E levels are reduced in T2DM patients compared with those of controls.
  2,795 538 10
CASE REPORTS
Bilateral post-traumatic acute extradural hematomas: A report of four cases and review of literature
DO Udoh
January-March 2012, 15(1):104-107
DOI:10.4103/1119-3077.94111  
Bilateral extradural hematomas are rare and follow significant trauma. The mortality is higher than with unilateral single extradural hematomas and postoperative outcome depends on preoperative neurological status.
  2,867 426 4
ORIGINAL ARTICLES
Control to goal of cardiometabolic risk factors among Nigerians living with type 2 diabetes mellitus
CI Okafor, EN Ofoegbu
January-March 2012, 15(1):15-18
DOI:10.4103/1119-3077.94089  
Background : Cardiovascular risk factors contribute to morbidity and mortality among diabetic patients. National and international guidelines on management of diabetes therefore emphasize control to goals of blood glucose, blood pressure, dyslipidemia, and obesity so as to minimize the development of complications and enhance the patients' quality of life. Objective : To evaluate the status of control to goals of cardiometabolic risk factors among the diabetic patients attending the Diabetes clinic of University of Nigeria Teaching Hospital, Enugu. Materials and Methods : A survey of 233 type 2 diabetic patients recruited from the Diabetes clinic of our hospital was carried out. Standard procedures as described in the WHO STEP instrument were used to determine the waist circumference, weight, height, and systolic and diastolic blood pressure. Fasting blood glucose and lipid profiles were also assessed. Therapeutic goals used to define risk or poor control were values adopted by expert groups such as American diabetes association (ADA), National cholesterol education program (NCEP), American association of clinical endocrinologist (AACE) and International diabetes federation (IDF). Results : There were 98 males and 135 females with mean (SD) duration of diabetes mellitus (DM) of 6.7 (6.3) years. Suboptimal glycemic, blood pressure control and dyslipidemia were observed in 65.7%, 51.9%, 97.1% of the subjects respectively while 60.1% of the subjects were found to be overweight/obese. Comparing the mean indices of risk factors with the recommended therapeutic goals, status of control was optimal for HDL-cholesterol, waist circumference and triglycerides. All the other risk factors were suboptimal. Conclusion : Control to goals of cardiovascular risk factors is poor among the patients. There is the need to identify and tackle the possible contributing factors so as to reduce the morbidity and mortality in these patients.
  2,626 526 8
Epidemiology of armed robbery-related gunshot injuries in Maiduguri, Nigeria
AD Abbas, AA Bakari, AM Abba
January-March 2012, 15(1):19-22
Background and Objectives: Gunshot Injuries used to be rare in Nigeria until the civil war of 1967-1970. Unfortunately, it has become very rampant recently. The objective of this paper is to look at the epidemiology of armed robbery-related gunshot injuries as seen in the University of Maiduguri Teaching Hospital over a five-year period. Materials and Methods: Data on patients that presented with gunshot injuries within the study period (January 2002 to December 2006) were collected and analyzed retrospectively. Results: We studied 129 patients with gunshot injuries that were managed during the study period. This comprises of 117 males and 12 females (M:F=9.8:1). Eighty four (65.1%) were young males between 20 and 40 years. One hundred and fifteen (89.2%) of the 129 victims were shot by armed robbers, the remaining 14 (10.8%) were shot under other circumstances not related to armed robbery. Analysis of the time of attack revealed 72% of victims were attacked at night. Over 80% of victims were shot along the highway. The anatomical sites of gunshot entry wound show the extremities having the highest of 46.1%. Ninety one (79.1%) victims were treated operatively while 16 (13.9%) were treated nonoperatively. Conclusion: Armed robbery is the motive behind most gunshot injuries in Nigeria. Most of these attacks are preventable if the government would support and motivate the security apparatus responsible. There is also need for the government to support the victims by shouldering their treatment and subsequent rehabilitation.
  2,701 432 2
Psychiatric morbidity in hypertensives attending a cardiology outpatient clinic in West Africa
YO Oshodi, JD Adeyemi, DA Oke, S Seedat
January-March 2012, 15(1):84-88
DOI:10.4103/1119-3077.94105  
Objectives: To determine kinds of psychiatric morbidity among a sample of stable hypertensive outpatients in a teaching hospital. Materials and Methods: A cross-sectional study of 260 enrolled outpatients. Psychiatric morbidity was assessed using a 2-stage evaluation method with the General Health Questionnaire Version 12 (GHQ-12) and Structured Clinical Interview for DSM-IV (SCID) to assess for psychiatric diagnosis. Results: 28 (10.8%) of the 260 patients endorsed some psychological distress, with a mean GHQ-12 score of ≥2. At the second stage, 16.1% (N=13 of 81) interviewed had one or more psychiatric disorder on the SCID. The commonest psychiatric diagnosis made were mood disorders, with current major depressive disorder occurring at a rate of 6.2%. Other disorders found were past major depressive episode (2.5%), organic mood syndrome (3.7%), and somatoform disorder (3.7%). Conclusion: The relationship between hypertension and mood disorders should inform a higher index of suspicion among physicians and general practitioners in order to give patients appropriate treatments or referrals where necessary. It is recommended that collaboration with mental health service providers be encouraged.
  2,712 391 6
Some emerging issues in medical admission pattern in the tropics
OO Okunola, AA Akintunde, PO Akinwusi
January-March 2012, 15(1):51-54
DOI:10.4103/1119-3077.94098  
Background: There is a changing pattern in terms of medical admissions worldwide with an alarming increase in the prevalence of noncommunicable diseases, especially in the tropics over the last decade. The aim of this study was to describe the pattern of medical admission and highlight emerging issues of noncommunicable diseases in a Nigerian University Teaching Hospital. Materials and Methods: A retrospective review of medical admission at the Ladoke Akintola University of Technology Teaching Hospital, Osogbo, South Western Nigeria, over a 3 years period (January 2005 to December 2007). Data were retrieved from the medical records of all medical admission over the study period. Results: During the study period, 1786 patients were admitted into the medical wards. This consisted of 1089 males (61.0%) and 697 females (39.0%). Their ages ranged from 14 to 96 years with mean ages of 51 ± 16.89 years. Subjects ≥60 years of age accounted for 27.3% and 29.8% of total males and female admissions which were the largest age group. Noncommunicable diseases were responsible for 47.99% of total medical admissions. The indications for admission in order of frequency include cerebrovascular accidents 239 (13.4%), diabetes mellitus 194 (10.9%), tuberculosis 151 (8.5%), and chronic kidney disease 116 (6.5%). Hypertension was the underlying risk factor in majority of patients with CVD and CKD. Conclusion: Noncommunicable disease accounted for a significant number of admissions over 3 year duration. The elderly accounted for a major age group admitted for medical diseases. Therefore, preventive strategies against noncommunicable disease and effective geriatric care are advocated.
  2,639 405 4
Anesthetic equipment, facilities and services available for pediatric anesthesia in Nigeria
P Adudu
January-March 2012, 15(1):75-79
DOI:10.4103/1119-3077.94103  
Background: Facilities and equipment are known to contribute to improved patient care and outcome. Hospitals for sub-specialized pediatric anesthetic service are routinely available worldwide. In Nigeria, such hospitals now exist. It is therefore relevant to study the facilities and equipment available for pediatric anesthetic service to measure the quality of care in a health institution. Materials and Methods: A prospective study of the anesthetic equipment, facilities and services available for pediatric anesthesia was carried out in Nigerian hospitals using anonymously administered questionnaires from October, 2008 to October, 2009, after relevant ethics approval. Result: Ten of the 30 hospitals studied had intensive care unit facilities (33.3%) and only three of them had organized ambulatory anesthesia units for pediatric patients (10%). Facilities available for pediatric anesthetic care were service delivery oriented and not information technology based (automated anesthesia information management services - AIMS). A quarter of the hospitals studied (7) had their facilities and equipment updated recently. Also, there were no reception rooms nor post anesthetic care units specifically designed for pediatric patients. Equipment for acute pain service such as infusion pumps and patient controlled analgesia pumps (PCA pumps) and for capnography were found in only two hospitals (6.6%) at the time of the study. The anesthetic equipment used did not conform to the same standards (98%) even in the same hospital. Also, the use of disposable anesthetic equipment was low. Conclusion: We conclude that anesthetic services for pediatric patients should be based on the use of automated anesthesia information technology service. Anesthetic equipment should conform to the same standards and should be computerized. Disposable anesthetic equipment should also be used where applicable to minimize the incidence of nosocomial infections. This would result in improved peri-operative care in pediatric patients.
  2,560 400 3
Utilization of health care services by depressed patients attending the general out-patients department of the Jos University Teaching Hospital, Jos, Nigeria
SG Goar, A Obembe, MD Audu, MT Agbir
January-March 2012, 15(1):59-62
DOI:10.4103/1119-3077.94100  
Background: Depression is a common psychiatric disorder in primary health care throughout the world with increasing incidence and prevalence. It is often under-treated and under-diagnosed. Consequently, several studies have revealed that patients with depression are high utilizers of medical services. Objectives: The study was aimed at determining the frequency of consultation and the utilization of investigative procedures by the depressed and non-depressed patients in the last 12 months. Materials and Methods: This was a cross-sectional descriptive study among 200 consecutive patients attending the General Out-Patient Department of the Jos University Teaching Hospital between November 2006 and March 2007. A semi-structured questionnaire was used to collect socio-demographic data and health services utilization indices. Structured Clinical Interview for DSM-IV axis-1 Disorders (SCID) was used for diagnosis of depression. Results: The study found that 51(25.5%) of the respondents met DSM-IV criteria for the diagnosis of major depression while 149 (74.5%) did not. Depressed patients significantly had more number of consultations with their doctors (P=0.000), had consulted more number of hospitals (P=0.000), stayed longer on admission (P=0.000) and had consumed more types of medicine (P=0.005) in the last 12 months compared with the non-depressed. The depressed patients also had significantly higher mean of different types of investigations compared with non-depressed; urinalysis (1.69 vs 0.55, P=0.000), chest X-ray (0.57 vs 0.21, P=0.000) and Widal test (1.92 vs 0.39, P=0.000). Others are HIV screening (0.39vs0.11, P=0.000) urine mcs (0.94 vs 0.18, P=0.000), stool mcs (1.24 vs 0.20, P=0.000). Conclusion : The study demonstrated that patients who suffer from depression are higher utilizers of health care resources compared with the non-depressed. Therefore, it is recommended that general practitioners and other health workers need to be better equipped to deal with the diagnosis and management of depression.
  2,567 377 1
Relationships between hemoglobin A 1c and spot glucose measurements in Nigerians with type 2 diabetes mellitus
AE Edo, K Akhuemokhan
January-March 2012, 15(1):23-26
DOI:10.4103/1119-3077.94091  
Background: Glycosylated hemoglobin, HbA 1c is the most acceptable measure of chronic glycemia. It is not widely available and/or affordable in Nigeria. The mean of the monthly fasting plasma glucose (MFPG) of the preceding 3 months is often used as surrogate for assessing chronic glycemia. Objective: To determine the relationships among fasting plasma glucose (FPG), 2-hour post-prandial glucose (2-hPG), HbA1c, and MFPG. Materials and Methods: Hospital records were used to derive the MFPGs of diabetic subjects from the mean of their monthly FPGs of the preceding three months. Other data extracted included the patient's age, sex, body mass index (BMI), waist circumference (WC), and duration of diabetes mellitus (DMDU). FPG, 2- hPG and HbA 1c were determined during this index consultation. Results: Ninety five persons (65 males, 30 females) with type 2 were included in the study. Their mean age and DMDU were 54.7 ± 8.9 years and 8.1 ± 6.1 years, respectively. Their mean WC, BMI, FPG, 2-hPG, HbA1c, and MFPG were 100.2 ± 11.0 cm, 24.2 ± 4.3 kgm/2, 7.5 ± 2.4 mmol/l, 10.4 ± 4.1 mmol/l, 8.2 ± 2.2%, and 5.9 ± 2.2 mmol/l, respectively. The males were significantly older (57.5 ± 8.4 vs 49.3 ± 7.6, P<0.001) while the females had higher waist circumference and BMI than their male counterparts: 104.8 ± 11.6 cm vs 92.8 ± 10.1 cm, P<0.004; and 25.8 ± 4.9 kg/m 2 vs 23.3 ± 3.7 kg/m 2 , P<0.005, respectively. There were no significant differences in FPG, 2-hPG, MFPG and HbA1c levels between male and female subjects. There were significant positive correlations between FPG and HbA1c (r=0.45, P=0.05) and between 2-hPG and HbA1c (r=0.52, P=0.01), but there was no positive correlation between MFPG and HbA1c (r=−0.20, P=0.18). Conclusion: There is no positive correlation between MFPG and HbA 1c and thus MFPG may not be a good surrogate for HbA1c in assessment of chronic glycemia in our patients.
  2,386 398 1
The differential impact of two anesthetic techniques on cortisol levels in Nigerian surgical patients
AT Aggo, S Fyneface-Ogan, CN Mato
January-March 2012, 15(1):68-74
DOI:10.4103/1119-3077.94102  
Background: Surgical procedures are associated with a complexity of stress response characterized by neurohumoral, immulogic, and metabolic alterations. Aim: The aim was to compare the effects on the stress response by isoflurane-based intratracheal general anesthesia (ITGA) and bupivacaine-based epidural anesthesia (EA), using cortisol as a biochemical marker. Materials and Methods: Following the approval of the Hospital Ethical Board, informed written consent from patients recruited into this study was obtained. One group received general anesthesia with relaxant technique (group A) while the other group had bupicaine epidural anesthesia with catheter placement for top-ups (group B) for their surgeries. Both groups were assessed for plasma cortisol levels - baseline, 30 minutes after skin the start of surgery and at skin closure. Results: There was no statistically significant difference in the baseline mean heart rate, mean arterial pressure (mean MAP) and the mean duration of surgery between the two groups; the baseline mean plasma cortisol level was 88.70 ± 3.85 ng/ml for group A and 85.55 ± 2.29 ng/ml for group B, P=0.148. At 30 minutes after the start of surgery the plasma cortisol level in the GA group was 361.60 ± 31.27 ng/ml while it was 147.45 ± 22.36 ng/ml in the EA group, showing a significant difference, P=0.001. At skin closure the mean plasma cortisol value of 384.65 ± 48.04 ng/ml recorded in the GA group was found to be significantly higher than the value of 140.20 ± 10.74 ng/ml in the GA group, P<0.002. Conclusion: Using plasma cortisol as a measure, bupivacaine-based epidural anesthesia significantly reduces the stress response to surgical stimuli when compared with isoflurane-based tracheal general anesthesia.
  2,224 383 4
Perceptions of female sexual health and sexual dysfunction in a cohort of urban professional women in Abuja, Nigeria
OI Aisuodionoe-Shadrach
January-March 2012, 15(1):80-83
DOI:10.4103/1119-3077.94104  
Context: Data on sexual health behaviors, and the prevalence and risk factors for female sexual dysfunction (FSD) are rare, particularly from sub-Saharan Africa. Aims: This study was to briefly investigate the perceptions of a cohort of adult urban female professionals about female sexual health and sexual dysfunction awareness. Patients and Methods: Fifty female hospital staff attending an introductory seminar on FSD participated in this study by completing a 15-item questionnaire on some aspects of female sexual health. Questions asked ranged from sexual activity in the preceding 6 months, menopausal status, if they thought they had sexual dysfunction to their willingness to discuss an FSD with a sexual health physician if they had access to one. Results: Over 50% (n=28) of the respondents had an idea about what FSD was before the survey. These respondents further defined FSD as either the inability of a female to respond to sex, a lack of urge to engage in sexual activities, or inability to attain orgasm. About half of the respondents (n=21) did not know that FSD could be managed; however, 70% of them felt comfortable with discussing FSD symptoms with a sexual health practitioner.76.9% of the respondents who thought they had symptoms of FSD in this series (n=10) were willing to see a sexual health expert if they had access to one. Conclusions: This study provides a brief insight into FSD awareness amongst apparently healthy female workers of a health care facility and the need for further community-based studies on female sexual health issues in our society. Furthermore, it highlights the appropriateness of a comprehensive sexual medicine service in tertiary health care facilities in Nigeria for adequate screening and diagnosis of patients before appropriate treatment of FSD.
  2,161 373 5
LETTERS TO EDITOR
Simple hepatic cyst
KVS Hari Kumar, S Priya, D Mukherjee
January-March 2012, 15(1):115-115
DOI:10.4103/1119-3077.94114  
  2,152 352 1
ORIGINAL ARTICLES
Diagnosis of prostate cancer with needle biopsy: Should all cases be biopsied before treatment?
CK Oranusi, AI Ugezu, AME Nwofor
January-March 2012, 15(1):48-50
DOI:10.4103/1119-3077.94097  
Background: The triad of digital rectal examination (DRE), serum prostate specific antigen, and transrectal ultrasound-guided prostate biopsy is used in the detection of prostate cancer (PCa). It is recommended that all cases of PCa should be diagnosed with needle biopsy before treatment. The exclusion criteria for those that may not be suitable have not yet been defined. Materials and Methods: We reviewed all the patients diagnosed with PCa at the Nnamdi Azikiwe University Teaching Hospital Nnewi, Southeast, Nigeria, from January 2007 to December 2010. Relevant biodata and method of diagnosis of PCa before treatment were reviewed. Results: A total of 133 patients had bilateral orchidectomy over the period. 120 (90.2%) had their diagnosis confirmed by needle biopsy before bilateral orchidectomy (category 1), while 13 (9.8%) had bilateral orchidectomy before diagnosis was confirmed. The method of diagnosis for category 1 patients was with lower urinary tract symptoms (LUTS), abnormal DRE findings, elevated prostate-specific antigen (PSA), and transrectal needle biopsy. For category 11 patients, diagnosis of PCa was suspected based on LUTS, abnormal DRE findings, and elevated PSA. Of this number, 11 (84.6%) had, in addition, sudden onset paraplegia at presentation, while 2 (15.4%) had severe uncontrolled hematuria at presentation. All the patients in both categories had needle biopsy confirmation of their disease. The sensitivity of PSA was 99.2%. Conclusion: Needle biopsy of the prostate is the preferred method for the diagnosis of PCa in most cases before treatment is undertaken. There are valid reasons why all PCas will not be diagnosed in this fashion. Elevated PSA when combined with an abnormal DRE finding increases the predictive value for cancer. In areas where pathologists are lacking, abnormal DRE and elevated PSA results can be a guide to proceed to treatment especially, where there is severe compromise of patients' quality of life due to symptoms of advanced PCa while awaiting confirmation.
  1,974 403 2
Period of onset and lack of clinical manifestation of hepatotoxicity after commencing highly active antiretroviral therapy
RA Ugiagbe, EE Ugiagbe
January-March 2012, 15(1):63-67
DOI:10.4103/1119-3077.94101  
Aim: The period of onset of hepatotoxicity varies between cohorts as do their clinical manifestations. Clinical manifestations of hepatotoxicity that have been previously reported include fatal portal hypertension, dress syndrome, and lipodystrophy syndrome. The aim of this study was to determine the period of onset and clinical manifestation of hepatotoxicity after commencing HAART. Materials and Methods: This study was carried out on patients with HIV on HAART attending infectious disease clinic, gastroenterology clinic or admitted into the medical wards of University of Benin Teaching Hospital. Patients with HIV but not on HAART were used as controls. A clinical evaluation and relevant laboratory investigations were done. Hepatotoxicity was defined using a standardized toxicity grade scale. Results: A total of 84 cases and 42 controls were studied. The mean ages were 35.2 ± 9.9 years and 35.5 ± 9.0 years for the cases and the controls respectively. Over 70% of the study population and controls were females. The overall incidence of hepatotoxicity was 17.85% and severe hepatotoxicity occurred in 10.71% of the patients. Over 80% of liver enzyme elevations occurred within 3 months, most of which were asymptomatic. Conclusion: This study shows that over 80% of enzyme elevations occurred within 3 months and were mostly asymptomatic. There is a need for regular monitoring of liver function tests at short intervals in HIV patients starting HAART since most of the cases of hepatotoxicity found in this study occurred early and were asymptomatic.
  2,008 360 1
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