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   2012| April-June  | Volume 15 | Issue 2  
    Online since June 16, 2012

 
 
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ORIGINAL ARTICLES
Obstetric outcome of teenage pregnancies at a tertiary hospital in Enugu, Nigeria
HU Ezegwui, LC Ikeako, F Ogbuefi
April-June 2012, 15(2):147-150
DOI:10.4103/1119-3077.97289  
Context: Maternal age, parity, and socioeconomic class are important determinants of obstetric outcome of pregnancy. Teenage pregnancy constitutes a high risk pregnancy with complications arising from a combination of physiological, anatomical, and socioeconomic factors Objective: The objective was to determine the current incidence of all teenage pregnancies and their obstetric outcomes at UNTH, Enugu. Materials and Methods: This was a retrospective review of all teenage pregnancies at University of Nigeria Teaching Hospital, Enugu over a 6-year period (2000--2005). A total of 74 teenage pregnancies were analyzed and compared with 105 controls (adult mothers). Results: Records of 74 teenage pregnancies were identified within the study period which constitutes 1.67% of 4422 deliveries within the period. Majority of the teenagers (78.3%) were nulliparous. There was statistically significant differences between the teenage mothers and older mothers in the rate of unemployment (75.7% vs. 24.8%, P = 0.000), booking status (41.9% vs. 100%, P = 0.000) anemia (32.4% vs. 24.8%, P = 0.001), unsure of last menstrual period (32.4% vs. 15.2%, P = 0.007), caesarean section (18.9% vs. 10.5%, P = 0.000), cephalopelvic disproportion as an indication for caesarean section (9.4% vs. 3.8%, P = 0.001), preterm delivery (18.9% vs. 11.4%, P = 0.001), low birth weight (23.0% vs. 10.5%, P = 0.005), episiotomy (61.7% vs. 28.7%, P = 0.001), instrumental delivery (6.8% vs. 2.9% P = 0.001), Apgar score at 1 minute (35.1% vs. 19.1% P = 0.005), and perinatal mortality (16.2% vs. 12.4%). There were no maternal deaths. Conclusion: Pregnant teenagers are at higher risk than their older counterparts. Female socioeducational development and proper use of contraceptive services will help reduce teenage pregnancy rate, while perinatal care will help to minimize it associated hazards
  15 7,917 1,225
Emergency peripartum hysterectomy in Nnewi, Nigeria: A 10-year review
NJA Obiechina, GU Eleje, IU Ezebialu, CAF Okeke, SU Mbamara
April-June 2012, 15(2):168-171
DOI:10.4103/1119-3077.97303  
Background: Emergency peripartum hysterectomy has remained a challenging and very life saving surgical procedure in obstetrics. Its indications are emerging. Aims: This was to determine the incidence, indications, and outcomes of emergency peripartum hysterectomy at a tertiary hospital in Nnewi, south-east Nigeria. Materials and Methods: A retrospective study of the case files of patients requiring an emergency peripartum hysterectomy between January 2000 and December 2009 was conducted. Emergency peripartum hysterectomy was defined as one performed for hemorrhage unresponsive to other treatment within 24 hours of delivery. The findings were analyzed using Epi info version 3.5.1. Results: During the 10-year period, there were 6,137 deliveries and 38 cases of emergency peripartum hysterectomies, giving an incidence of 6.2 per 1000 deliveries. Of the 38 hysterectomies, only 29 (76.3%) case files were available for analysis. The mean age of the patients was 28.1 ± 5.4 years and 22 (75.9%) patients were unbooked. There were four primigravidae (13.8%) while 25 (86.2%) were parous. The main indications for hysterectomy were placenta praevia 14 (48.3%) and uterine rupture 10 (34.5%). Subtotal hysterectomy was performed in majority (72.4%) of cases. The commonest postoperative morbidities were postoperative fever (37.9%), postoperative anemia (24.1%), and wound infection (20.7%). The maternal case fatality rate was 31.0%, while the perinatal mortality was 44.8%. The mean duration of hospital stay was 9.8 ± 2.4 days. Conclusion: The incidence of emergency peripartum hysterectomy was high and majority of patients were unbooked. Placenta praevia has emerged as its primary indication. Booking for antenatal care, anticipation, prompt resuscitation, and early surgical intervention by a skilled surgeon are crucial.
  11 3,158 549
Tooth loss: Are the patients prepared?
VN Okoje, OO Dosumu, TO Alonge, C Onyeaso
April-June 2012, 15(2):172-175
DOI:10.4103/1119-3077.97305  
Background and Aim: Tooth loss is associated with esthetic, functional, psychological, and social impacts on the life of individuals. This study was designed to find out how Nigerians feel about losing their teeth and what effects, if any, this has on their lives. Most of the problems presented to the dentist as difficult denture tolerance could be as a result of the emotional effects of tooth loss rather than problems from the denture itself. Materials and Methods: The study was carried using a self-administered questionnaire to consenting adult patients undergoing tooth extraction at the Oral and Maxillofacial Clinic, University College Hospital, Ibadan, Nigeria. The data collected were analyzed using SPSS, version 15.5. Results: A total of 90 respondents completed the questionnaires; 35 (27.6%) were males while 55 (43.3%) were females. The respondents were aged 0-70 years. Immediate acceptance of tooth loss was noted in 88 (69.3%) cases, but 6 (47%) accepted the loss only after 1 year, while 8 (6.3%) of the cases found it difficult to accept losing their teeth and incidentally, all of them were 30 years and above. Only 52 (40.9%) of the patients were prepared for the emotional effect of losing their teeth. A feeling of relief immediately following tooth extraction was expressed by 75 (43.9%) cases and of these 32 (47.8%) were females. The emotional effects following teeth loss were sadness 22 (12.9%) cases, depression in 11 (6.4%), feeling of losing body part in 24 (14%), feeling of aging in 4 (2.3%), while 13 (7.6%) respondents felt unconcerned. Conclusion: We observed that emotional effects of tooth loss are also experienced among our patients with a range of emotions quite similar to those observed by previous authors from the developed world. The significant number of patients that failed to come to terms with their tooth loss indicates that the effect of tooth loss on self-esteem and self-image is not short lived as it has been assumed.
  7 2,571 608
Experiences of mistreatment among medical students in a University in south west Nigeria
ET Owoaje, OC Uchendu, OK Ige
April-June 2012, 15(2):214-219
DOI:10.4103/1119-3077.97321  
Objective: This study was conducted to assess the experiences of mistreatment and harassment among final-year clinical students in a Nigerian medical school. Materials and Methods: A self-administered questionnaire was used to obtain information on the various forms of mistreatment experienced by 269 students in the 2007 and 2008 graduating classes of a medical school in Nigeria. Results: Almost all the respondents (98.5%) had experienced one or more forms of mistreatment during their training. The commonest forms experienced by the students were being shouted at (92.6%), public humiliation or belittlement (87.4%), negative or disparaging remarks about their academic performance (71.4%), being assigned tasks as punishment (67.7%), and someone else taking credit for work done by the student (49.4%). Religious or age discrimination was reported by 34.2%, sexual harassment and other forms of gender-based mistreatment by 33.8%, and threats of harm by 26.4%. These incidents were mainly perpetrated by physicians and occurred mostly during surgical rotations. The effects included strained relationships with the perpetrators, reduced self-confidence and depression. Conclusion: Most medical students experienced verbal forms of mistreatment and abuse during their training. Appropriate strategies for the prevention and reduction of medical student mistreatment should be developed.
  7 2,857 506
Determinants of cord care practices among mothers in Benin City, Edo State, Nigeria
BI Abhulimhen-Iyoha, MO Ibadin
April-June 2012, 15(2):210-213
DOI:10.4103/1119-3077.97320  
Background: Mothers care for their infants' umbilical cord stump in various ways. Different cord care practices have been documented; some are beneficial while others are harmful. Who and what influence the cord care practiced by mothers have, however, not been fully explored particularly in the study locale. Objective: The objective of this study was to determine the factors that influence cord care practices among mothers in Benin City. Materials and Methods: The study subjects included 497 mothers who brought their babies to Well Baby/Immunization Clinic at the University of Benin Teaching Hospital (UBTH), Benin City, Edo State, between July and August 2009. A structured questionnaire served as an instrument to extract information on their biodata and possible determinants of cord care practices. Results: Significantly older women (P=0.023), educated mothers (P=0.029), and those who had male babies (P=0.013) practiced beneficial cord stump care practices. Beneficial cord care practice increased with increasing maternal educational status. The best predictors of beneficial cord care practices are maternal level of education (P=0.029) and infant's sex (P=0.013). The use of harmful cord care practices was more common among mothers who delivered outside the Teaching hospitals. Most (71.2%) of the mothers were aware of hygienic/beneficial cord care. The choices of cord care methods eventually practiced by mothers were influenced mainly by the disposition of nurses (51.3%), participants' mothers (32.0%), and their mothers-in-law (5.8%). There was no significant relationship between cord care practice on one hand and maternal parity, tribe, and socioeconomic classes on the other. Conclusion/Recommendation: The need for female education is again emphasized. The current findings strongly justify the need for public enlightenment programs, using the mass media and health talks in health facilities, targeting not only women of reproductive age but also secondary audience like their mothers, mothers-in-law, nurses, and attendants at health facilities. Proper hygiene including proper hand washing techniques while caring for newborns along with vaccination of infants and their mothers will help prevent infections including tetanus while prompt health-seeking behavior is advised to improve outcome should such infections occur.
  6 6,508 780
CASE REPORTS
Heterotopic pregnancy following intrauterine insemination: Successful management with salpingectomy and continuation of intrauterine pregnancy
JI Ikechebelu, GU Eleje
April-June 2012, 15(2):241-243
DOI:10.4103/1119-3077.97338  
We report the first case of a heterotopic pregnancy (HP) following ovulation induction and intrauterine insemination (IUI) with resultant normal intrauterine pregnancy after salpingectomy. A 41-year-old para 0 +0 that presented with primary infertility due to azoospermia and polycystic ovaries after laparoscopic evaluation. She had induction of ovulation with Clomiphene citrate, gonadotropin stimulation (hCG), and intrauterine insemination using donor sperm. The resulting pregnancy was later diagnosed as heterotopic pregnancy following rupture of the tubal component at 8 weeks' gestation after an initial misdiagnosis as corpus luteum cyst of pregnancy. She had an emergency laparotomy and left salpingectomy, and the intrauterine pregnancy has continued subsequently to 25 weeks of gestation as at 01/04/2011.This report demonstrates that HP may occur after ovulation induction and IUI. The ectopic component could be misdiagnosed as corpus luteum cyst. It is recommended that pregnancies following this procedure be followed up with serial trans-vaginal ultrasound in the first trimester. Presence of corpus luteum cyst of pregnancy in early ultrasound should be an index of suspicious of a possible heterotopic pregnancy. Early diagnosis and prompt intervention is essential to salvage the intrauterine pregnancy and avoid maternal morbidity and mortality.
  5 6,288 540
ORIGINAL ARTICLES
Cardiovascular responses to treadmill exercise in Nigerian hypertensives with left ventricular hypertrophy
SA Ogunyemi, MO Balogun, AO Akintomide, RA Adebayo, OE Ajayi, PO Akinwusi, AT Oyedeji, EA Ajayi
April-June 2012, 15(2):199-205
DOI:10.4103/1119-3077.97318  
Background: Left ventricular hypertrophy (LVH) is an independent risk factor for adverse cardiac outcomes in hypertensive patients. Objective: This study is designed to assess the cardiovascular responses to treadmill exercise among Nigerian hypertensives with echocardiographically proven LVH. Materials and Methods: Fifty hypertensive patients with LVH (27 males and 23 females) between 30 and 65 years of age were studied in Nigeria. 50 hypertensive patients without LVH and 50 normal subjects who were age and sex matched served as controls. All patients and control subjects underwent M-mode, 2-D and Doppler ECHO-studies and the Bruce protocol treadmill exercise test. Results: The study showed that the estimated maximal oxygen consumption (MVO2) in MET reduced progressively from 8.39 ± 1.26 (normotensive control) to 7.62 ± 1.33 (hypertensive without LVH), 6.27 ± 0.99 (hypertensive with LVH) (P<0.0001ANOVA). The duration of exercise (s) was also reduced in that order from 455.4 ± 79.1 to 411.6 ±8 2.3, 315.8 ± 75.6 respectively (P<0.0001). The systolic blood pressure (SBP) and pressure rate product (PRP) during maximal exercise were also increased in hypertensives with LVH and hypertensive without LVH when compared to normotensive controls. The hypertensives with LVH and hypertensives without LVH also showed significant limitation to heart rate increase with exercise compared to normotensive controls (P<0.003). Conclusion: This study demonstrated significant impairment of exercise capacity in hypertensives with or without LVH compared to normotensive subjects. Both earlier recognition and improved understanding of LVH may lead to more effective therapeutic strategies for this cardiovascular risk factor.
  5 3,016 413
Prevalence and associated risk factors of ante-partum hemorrhage among Arab women in an economically fast growing society
A Bener, NM Saleh, MT Yousafzai
April-June 2012, 15(2):185-189
DOI:10.4103/1119-3077.97315  
Objective: The aim of this study was to determine the prevalence and associated risk factors of antepartum hemorrhage (APH) in the third trimester of Arab women residing in Qatar and their neonatal outcome. Design and Setting: A prospective hospital-based study was conducted in the Women's Hospital and Maternity Clinics. Materials and Methods: The study was based on pregnant women in the third trimester from the first week of January 2010 to April 2011. A total of 2,056 pregnant women, who had any kind of maternal complications, were approached and 1,608 women (78.2%) expressed their consent to participate in the study. The questionnaire covered variables related to socio-demographic factors, family history, medical history, maternal complications and neonatal outcome. Multiple logistic regressions were used to describe the association between socio-demographic factors and APH. Results: The overall prevalence of APH among Arab women residing in Qatar was 15.3% with 6.7% among Qatari's and 8.6% among non-Qatari Arab women; the difference in ethnicities was not significant. Among maternal socio-demographic characteristics, lower education (primary or below AOR 1.72; 95%CI 1.22-2.43, and intermediate education AOR 1.41; 95%CI 0.88-2.26; P=0.005) compared to university education was significantly associated with APH. As for maternal biological characteristics, family history of G6PD (AOR 1.87; 95% CI 1.18-2.95; P=0.007) and family history of Down's Syndrome (AOR 1.88; 95%CI 1.35-2.62; P=<0.001) were significantly associated with APH at the multivariable level; family history of hypertension (OR 1.78; 95%CI 1.30-2.44; P<0.001) was significant at the univariate level. Neonatal outcomes as a result of APH included increased risk of Apgar score at 1 minutes <7 (AOR 1.44; 95%CI 1.12-2.02; P=0.04) and minor congenital anomaly (AOR 2.82; 95%CI 1.39-5.71; P=0.004). Conclusion: Qatar has a high prevalence of APH. Poor education, family history of hypertension, G6PD and Down's syndrome were found to be significantly associated with increased risk of APH in Qatar. Neonates of APH are at significantly increased risk of adverse outcome. Thus it is essential that obstetricians are alerted to these risk factors for early detection and to decrease the negative effects of APH.
  4 6,654 770
Evaluation of design parameters of eight dental implant designs: A two-dimensional finite element analysis
SR Desai, MS Desai, G Katti, I Karthikeyan
April-June 2012, 15(2):176-181
DOI:10.4103/1119-3077.97308  
Aim: Implants could be considered predictable tools for replacing missing teeth or teeth that are irrational to treat. Implant macrodesign includes thread, body shape and thread design. Implant threads should be designed to maximize the delivery of optimal favorable stresses. The aim of this finite element model study was to determine stresses and strains in bone by using various dental implant thread designs. Materials and Methods: A two-dimensional finite element model of an implant-bone system is developed by using Ansys. An oblique load of 100 N 45° to the vertical axis of implant as well as a vertical load was considered in the analyses. The study evaluated eight types of different thread designs to evaluate stresses and strains around the implants placed in D1 bone quality. Results: Forty-five-degree oblique von Mises stresses and strains were the highest for the filleted and rounded square thread with an angulation of 30° (216.70 MPa and 0.0165, respectively) and the lowest for the trapezoidal thread (144.39 MPa and 0.0015, respectively). Conclusions: The findings in this study suggest that the filleted and rounded square thread with an angulation of 30° showed highest stresses and strains at the implant-bone interface. The trapezoidal thread transmitted least amount of stresses and strains to the cortical bone than did other models.
  4 4,519 967
Are we eliminating cures with antibiotic abuse? A study among dentists
SR Goud, L Nagesh, S Fernandes
April-June 2012, 15(2):151-155
DOI:10.4103/1119-3077.97291  
Context: The theme of "World Health Day 2011" is "combat drug resistance- No action today, No cure tomorrow" which is very pertinent. The present study emphatically demonstrates the current issues related to the overwhelming concerns regarding indiscriminate use of antibiotics, leading to a bleak tomorrow where cures may be few. Aim: To know the prescription pattern of antibiotics for various dental procedures by dental practitioners. Materials and Methods: A pretested questionnaire was used which contained two sections pertaining to prescription of antibiotics for healthy and medically compromised patients during various dental procedures, with therapeutic and prophylactic considerations. Results: Questionnaire response rate of 66.6% was observed. Amoxicillin emerged as the most preferred antibiotic for dental procedures both as a therapeutic and a prophylactic drug. 50% of the endodontists and 40% of the general dentists opted to prescribe antibiotics during root canal therapy where ideally operative intervention would have sufficed. Overuse of antibiotics for routine scaling and extraction was observed. Conclusion: The dental profession as a whole needs to acquire a deeper understanding of the global effects of superfluous antibiotic prescription. Antibiotics when judiciously used are precise life-saving drugs.
  4 2,649 636
Mandibular defect reconstruction with nonvascularized iliac crest bone graft
VN Okoje, OS Obimakinde, JT Arotiba, AO Fasola, SO Ogunlade, AE Obiechina
April-June 2012, 15(2):224-227
DOI:10.4103/1119-3077.97334  
Context: Reconstruction of mandibular defect is a challenge to the head and neck surgeon because of associated functional and esthetic problems. Our experience with the use of nonvascularized iliac crest bone graft is hereby reported. Aim: The aim was to report our experience with the use of nonvascularized iliac crest bone for mandibular defect reconstruction at University College Hospital, Ibadan. Nigeria. Settings and Design: A retrospective descriptive study was performed. Materials and Methods: Cases of mandibular reconstruction with iliac crest bone graft between January 2001 and December 2007 were included in this study. Grafts were secured with either a stainless steel wire or a titanium plate. Preoperative diagnosis, postoperative follow-up records including investigations, diagnosis of graft infection and subsequent treatment modalities were extracted from the available records. Statistical analysis used: Descriptive variables were analyzed with SPSS version 14. Results: A total of 47 patients had mandibular defect reconstruction with nonvascularized iliac crest block bone during the study period. Thirty-eight patients had graft secured with transosseous wire [NVIBw] while 9 had a titanium plate [NVIBp]. The male:female ratio was 26:21 while the mean age of the patients was 24.6±4.25 years. Ten patients (21.3%) developed persistent graft infection during the postoperative period. All cases of infection occurred in patients who had transosseous wiring and analysis showed that 60% of the infected grafts revealed mixed microbial isolates containing Klebsiela spp, Pseudomonas Aeurogenosa, and E coli. Six (60%) of the infected grafts were removed as a result of unabated infection while 4 (40%) were successfully treated by exploration and pus drainage. Conclusions: Nonvascularized iliac crest bone graft provides an affordable and less technical choice for mandibular reconstruction with minimal complications in a resource-limited economy.
  4 3,115 803
Outcome analysis of surgical treatment of Blount disease in Nigeria
AA Kawu, OOA Salami, A Olawepo, MA Ugbeye, W Yinusa, OO Odunubi
April-June 2012, 15(2):165-167
DOI:10.4103/1119-3077.97340  
Objective: The objective was to evaluate the results of surgery of Blount diseases using the postoperative metaphyseal-diaphyseal angle (MDA) at 2-year follow-up. Background: The goal of surgery in Blount disease is to restore the normal configuration of the articular surface of the proximal end of the tibia in proper relationship to the mechanical axis of the limb. Our hypothesis is that patients will demonstrate significant clinical improvements following surgery and predictive models can be developed. Materials and Methods: All patients who had surgery for Blount disease from January 2002 till December 2007 at the National Orthopaedic Hospital Lagos Nigeria and follow-up for 2 years were included. Data extracted were gender, affected limb, Blount's type, age when deformity was noted, and age at presentation, preoperative femoral tibial angle (TFA), Langenskiold score, preoperative MDA, and postoperative MDA. Linear regression was used to assess the predictive effect of selected clinical and radiographic measures on post-MDA. The model was adjusted for confounders: age deformity noted, age at presentation, affected limb, Blount's type, and gender. Variables in the adjusted model achieving significance at P < 0.05 were included in a multiple regression analysis. Results: Eighty-six knees in 57 patients were included. The mean preoperative and postoperative MDA at 2 years was 34.6° ± 8.9° and 10.6° ± 4.3°, respectively. Seventy-three knees (84.9%) have correction of ≤10° with recurrence in 13 (15.1%) knees at 2 years (P < 0.001). The postoperative MDA was graded into good outcome if ≤10°. There was a significant improvement between preoperative MDA and postoperative MDA (P < 0.001). The multilinear analysis demonstrated that the preoperative MDA was a significant predictor of the postoperative MDA. The postoperative MDA was predicted with a standard error of 0.92 with the following formula: post-MDA = 1.027 + 0.404 pre-MDA. Conclusion: The mean postoperative MDA of 84.9% of the knees operated at 2 years was 9.4° ± 3.1° with recurrence rate of 15.1%. Postoperative MDA is a good outcome measure for surgical treatment of Blount disease and surgical correction should aim at producing post MDA ≤10°.
  3 5,230 489
Bladder stones in catheterized spinal cord-injured patients in Nigeria
AA Kawu, A Olawepo, OOA Salami, SA Kuranga, H Shamsi, EA Jeje
April-June 2012, 15(2):156-158
DOI:10.4103/1119-3077.97294  
Objective: The objective was to determine the incidence of bladder stones in patients with spinal cord injury (SCI) and to assess if catheter encrustation or positive urinary culture of Proteus mirabilis is predictive of bladder stones. Background: Bladder stones are common urological complication in those with SCI managed with indwelling urinary catheter. Detection and removal of bladder stones are important to prevent possible further complications. Design : This was a prospective cohort study. Materials and Methods: Ultrasound scan was performed in persons with SCI seen from 1st January to 31st December 2009 who had indwelling urethral catheter for at least 3-month post-injury. Indwelling urethral catheters were examined for encrustation at the time of removal, urine culture taken specifically for P. mirabilis and ultrasound scan done to detect bladder stones. Results: There were 89 patients with spinal cord injury and 68 (76.4%) patients were evaluated during the review period. Twenty-nine (42.6%) patients had bladder stones and 22 (32.3%) patients had catheter encrustation. Of the 22 patients with catheter encrustation, 19 (86.3%) also had bladder stones. Forty-six (67.6%) patients had no catheter encrustation. Of these, 7 (14.7%) were found to have bladder stones. Thirty-seven (38.2%) urine cultures were positive for P. mirabilis. Of these 37 (54.4%) patients, 27 also had bladder stones. Catheter encrustation (P = 0.004) and a positive urine culture of P. mirabilis (P = 0.007) in patients with indwelling urinary catheter is highly predictive of the presence of bladder stone. Conclusions : This study shows that a large number of SCI patients have an indwelling urethral catheter and suggests that ultrasound scan for the presence of stone should be schedule in a catheterized SCI patient if catheter encrustation or a positive urine culture of P. mirabilis is noted.
  3 3,098 285
Prevalence of activated protein C resistance (Factor V Leiden) in Lagos, Nigeria
TA Adeyemo, A Adediran, AA Akinbami, AS Akanmu
April-June 2012, 15(2):136-141
DOI:10.4103/1119-3077.97287  
Objectives: Hereditary resistance to activated Protein C (Factor V Leiden) is the commonest genetic defect known to confer a predisposition to thrombosis. This study aims to determine the prevalence of activated protein C resistance (APCr) in Lagos, and to determine if any association exists between APCr and ABO, Rhesus blood types, and hemoglobin phenotypes. Materials and Methods: A functional APCr test was conducted on healthy adult volunteers to get a Factor-V-related activated protein C ratio (APC-V ratio). APCr due to Factor V mutation was indicated when the APC-V ratio is below a cut-off value that was determined by calibration. Subjects' hemoglobin, red cell ABO, and Rhesus phenotypes were determined by standard methods. Results: Six (2%) of 297 participants with normal baseline coagulation screening tests had functional resistance to activated protein C (APC-V ratio < 2). None of the six subjects with APCr had history of venous thromboembolism. One of the six subjects was a female but the male sex did not demonstrate a risk of inheritance of APCr (P = 0.39). Four (67%) of the six subjects with APCr were non-O blood group. Whereas only two (0.9%) of 226 non-A subjects (blood groups 0 and B) had APCr, 4 (6%) of 71 subjects with A gene (blood groups A and AB) had APCr. The inheritance of A gene appears to constitute a risk to inheritance of APCr (P = 0.03). No association was demonstrable between APCr and hemoglobin phenotypes. Conclusion: Only 2% of the studied population had resistance to APC. The inheritance of blood group A may be a predisposition to APCr.
  3 2,746 453
Testicular torsion: Needless testicular loss can be prevented
Gabriel E Njeze
April-June 2012, 15(2):182-184
DOI:10.4103/1119-3077.97311  
Background: The risk of losing the testis is an ever present threat in patients with testicular torsion, who delay before presenting to the surgeon. A retrospective study was carried out to audit patients with acute scrotal pain who came to the Trans Ekulu Hospital Enugu, the promptness of offering them surgical treatment and the results. Materials and Methods: Patients operated upon for suspected torsion of the testis at Trans Ekulu Hospital Enugu over a 10-year period (1993-2003) were studied. The intervals between the onset of scrotal pain and presentation at the hospital were recorded. The duration of scrotal pain, findings on examination of the scrotum, time of starting surgical operation, and the number of viable testes seen intraoperatively were documented. Results: Twenty-two patients were found to have undergone emergency scrotal exploration and their ages ranged from 10 to 38 years with a mean of 22.7 years. Eight of these patients came within 3 hours of onset of scrotal pain, one patient came within the 6 hours, and the rest came late. These patients were operated upon shortly after arrival at the hospital. Sixteen patients (72.7%) had testicular torsion, 12 testes were viable, and 4 nonviable. Conclusion: Majority of our patients presented reasonably early. Those who had testicular loss came late. However, some who came late still had viable testes.
  3 3,220 551
Sexual assault against women at Osogbo southwestern Nigeria
NA Adeleke, AS Olowookere, MB Hassan, JO Komolafe, EO Asekun-Olarinmoye
April-June 2012, 15(2):190-193
DOI:10.4103/1119-3077.97316  
Background: Sexual assault against women is common all over the world. However, reliable data on the subject in developing countries including Nigeria is not available. Objective: To review the patterns of sexual violence against women treated at the hospital over a 7-year period. Materials and Methods: Review of hospital records of victims of sexual assault who presented at the hospital from 1 January 2003 to 31 December 2009. Data obtained were analyzed using descriptive statistics and Chi squire test. Results: Sexual assault cases constituted 2.1% of female consultation outside pregnancy during the period under study while proportion of cases increased over the years under review. Mean age of the victims was 15.8 (SD 8.1) years ranging from 5 to 48 years. Most (73.7%) were less than 18 years while 93.2% were single (never married). About 81% of the victims less than 18 years were sexually abused in the day time. Majority (79.6%) knew their assailant. About 40% of the victims presented within 24 h of sexual abuse but none had postexposure prophylaxis. Conclusion: Sexual assault among women is an important health problem in this environment. There is need for hospital based management protocol.
  3 6,288 648
CASE REPORTS
Uncommon, undeclared oesophageal foreign bodies
MI Akenroye, AT Osukoya
April-June 2012, 15(2):244-246
DOI:10.4103/1119-3077.97339  
We report two cases of unusual and undeclared oesophageal foreign bodies. A small double-rounded calabash or bottle gourd Lagenaria siceraria, stuffed with traditional medicine designed to acquire spiritual power. A whole tricotyledonous kola nut Cola nitida also designed to make medicine to gain love from a woman after passing it out in stool. Each case presented with a sudden onset of total dysphagia and history of ingestion of foreign bodies was not volunteered by any despite direct questioning. Plain radiograph of the neck and chest in either case did not reveal presence of foreign body. Both were successfully removed through rigid oesophagoscopy.
  2 1,905 297
ORIGINAL ARTICLES
Use of insecticide-treated mosquito nets for children under five years in an urban area of Lagos State, Nigeria
IP Okafor, KA Odeyemi
April-June 2012, 15(2):220-223
DOI:10.4103/1119-3077.97325  
Background: Insecticide-treated nets (ITNs) have proven to be one of the most effective means of reducing malaria morbidity and mortality in children and pregnant women. This study is carried out to determine the practice and determinants of ITN use for children under five years among care givers in an urban area of Lagos State. Materials and Methods: A community-based, cross sectional study was carried out in Lagos State in April 2007 among three hundred and forty (340) care givers primarily responsible for child care at home. They were selected by a multi-stage sampling method using a pre-tested, interviewer-administered, structured questionnaire. Results: ITN use rate for under-fives was high (61.8%) and this was significantly determined by care giver's marital status (P < 0.001) and the number of children under five years in the household (P = 0.006). Educational level of care giver and occupation of head of the household were not significant determinants. Conclusion: There is need for health campaigns on ITNs targeted at unmarried care givers of young children. In addition, we also recommend social marketing of modern family planning methods to reduce family size, thereby increasing chances of ITN use among children less than five years to reduce malaria burden.
  2 4,841 548
The anterior chamber angle width in adults in a tertiary eye hospital in Nigeria
SNN Nwosu, AI Apakama
April-June 2012, 15(2):132-135
DOI:10.4103/1119-3077.97284  
Objective: The objective was to determine the anterior chamber angle width in adult Nigerian patients seen at the Guinness Eye Center Onitsha Nigeria. Materials and Methods: Consecutive new adult patients (aged ≥21 years) seen between March and July 2006 were the subjects of this study. Exclusion criteria included refusal to consent to the test, previous intraocular surgery that could distort the angle integrity and anterior segment pathology precluding the visualization of the angle. Each patient had visual acuity assessment, visual field analysis, ophthalmoscopy, intraocular pressure measurement, refraction, and gonioscopy. The angle grading was by the Shaffer method. Results: Of the 328 patients (648 eyes), aged 21-85 years (median age 59 years), 195 (59.5%) were females and patients older than 50 years constituted 64.9%. Gonioscopy showed that 245 eyes (37.8%) had wide open angles (grades III and IV); 227 (35.0%) had grade II angles; 176 (27.2%) had narrow angles (grade I or slit), 9 of which were deemed occludable. Of the 80 patients with chronic simple glaucoma, 20 (25%) had at least grade III angle; 34 (42.5%) had grade II angle; and 26 (32.5%) had grade I angle. Peripheral anterior synechiae were observed in three eyes. Compared with nonglaucomatous eyes, the angles of the glaucomatous eyes were significantly narrower (P <0.01). Similarly patients older than 50 years were more likely to have narrower angles (P < 0.001). However there was no significant difference between the angle width of male compared to female patients (P >0.05). Conclusions: A little more than a third of adult patients seen in our hospital have wide open angles; a third of the glaucoma patients usually taken as open angle cases actually have very narrow angles some of which are occludable. A population-based study is therefore recommended to clearly define the epidemiologic characteristics of glaucoma including the anterior chamber width in different parts of Nigeria.
  2 2,429 319
Pattern and determinants of newborn apnea in an under-resourced Nigerian setting
TA Ogunlesi, OB Ogunfowora
April-June 2012, 15(2):159-164
DOI:10.4103/1119-3077.97299  
Objective: To determine the prevalence, distribution and determinants of newborn apnea in a resource-constrained setting. Design: Retrospective study. Materials and Methods: Newborn babies who had apnea during hospitalization between January and December 2008 were studied. The sex, age and body weight, clinical conditions, etiologies of apnea and outcome were recorded. Babies with and without apnea were compared using bivariate and multivariable analysis. Results: Out of 402 babies seen during the review, 78 (19.4%) had apnea. They comprised 59 preterm and 19 term babies. Forty (51.3%) had apnea at the point of admission while the remaining 38 (48.7) developed apnea after a mean interval of 118.5 ± 101.1 hours. Thirty-seven percent of preterms had idiopathic apnea. Etiologies included respiratory distress (50.0%), hypothermia (42.3%), and asphyxia (28.2%). Multivariate analysis showed that weight <2.5kg, hypothermia, referred status and presence of respiratory distress were determinants of apnea. Case fatality rate was 82.2% among apneic babies. Conclusion: Apnea occurred commonly in this population of babies. Stringent efforts like ventilator supports for babies in respiratory distress, better perinatal care including thermoregulation are required to reduce the occurrence of the major risk factors for newborn apnea. The identified determinants can be used to draw up effective preventive measures in resource-poor settings.
  2 2,201 329
CASE REPORTS
Enucleation of the solitary epithelial cyst of pancreatic head in an adult: A case report and review of the literature
U Dalal, R Singal, AK Dalal, Y Kumar, S Gupta, P Mendiratta, R Garg
April-June 2012, 15(2):228-230
DOI:10.4103/1119-3077.97327  
Solitary true pancreatic cyst is a rare entity, and only a few cases are reported in the literature. We report a case of a 35-year-old woman who had a cyst in the head of the pancreas and gall stones and presented with complaints of pain in the epigastric region. The patient underwent open cholecystectomy with aspiration of the pancreatic cyst at some other private hospital. After 4 months, she presented to us with no relief in pain. Repeat contrast-enhanced computed tomography of the abdomen showed recurrence of the cyst. The patient underwent enucleation of the cyst at our hospital. During a 2-year follow-up after the enucleation, she remained asymptomatic.
  1 1,674 265
Histoplasmosis: An elusive re-emerging chest infection
M Nagoda, AE Uloko, M Babashani, M Maiyaki
April-June 2012, 15(2):235-237
DOI:10.4103/1119-3077.97336  
An immunocompetent patient presenting with disseminated histoplasmosis and superior vena cava obstruction. Features at presentation were in keeping with tuberculosis. Histology of bronchoalveolar lavage specimen clinches the diagnosis of histoplasmosis.
  1 1,919 342
Case report of traumatic abdominal wall hernia following blunt motorcycle handlebar injury and review of the literature
TO Ogundiran, HA Obamuyide, MA Adesina, AF Ademola
April-June 2012, 15(2):238-240
DOI:10.4103/1119-3077.97337  
A 25-year-old man, riding a motorcycle, rammed into a moving car at a T junction and sustained a blunt lower-right abdominal injury with the handlebar of his motorbike. He developed a swelling at the point of impact for which he presented in hospital 10 days later. Clinical assessment revealed a healthy young man with a soft, nontender reducible swelling over the lateral half of the right inguinal area. A diagnosis of acute traumatic hernia was made. Abdominal ultrasonography revealed a wide-necked defect in the anterior abdominal wall over the right inguinal area with protruding bowel loops beneath an intact skin. He was planned for herniorrhaphy but has defaulted since then.
  1 2,709 422
ORIGINAL ARTICLES
Pattern of head growth and nutritional status of microcephalic infants at early postnatal assessment in a low-income country
BO Olusanya
April-June 2012, 15(2):142-146
DOI:10.4103/1119-3077.97288  
Objective: To determine the pattern of head growth and the early postnatal nutritional status of microcephalic infants in a low-income country. Materials and Methods: A cohort study in Lagos, Nigeria in which the head growth of full-term singletons within the first postnatal check-up at 6-8 weeks was evaluated using the latest World Health Organization (WHO)'s Child Growth Standards (WHO-CGS) for head circumference. Nutritional status of microcephalic infants at follow-up was also determined after adjustments for potential confounders. Results: Of the 452 infants (male: 227) enrolled, microcephalic infants were 32 (7.1%) at birth and 34 (7.5%) at follow-up. However, while 401 (88.7%) remained normocephalic and 15 (3.3%) remained microcephalic at follow-up, 19 (4.2%) became microcephalic and 17 (3.8%) became normocephalic. Microcephalic infants were significantly underweight (P < 0.001), stunted (P < 0.001) and wasted (P < 0.001) at follow-up. Conclusions: Regardless of their status at birth, microcephalic infants at 6-8weeks are likely to be undernourished by all nutritional indices suggesting that head circumference may serve as a complementary or default screening tool for early detection of undernourished infants in resource-constrained settings.
  1 3,331 495
A cross-sectional study of cutaneous drug reactions in a private dental college and government medical college in eastern India
C Chattopadhyay, N Chakrabarti
April-June 2012, 15(2):194-198
DOI:10.4103/1119-3077.97317  
Background: Cutaneous drug reactions are a common impediment in therapy, the incidence ranging from 2% to 8%. This cross-sectional study was designed to compare different trends of cutaneous drug reaction in two different socio-economic groups of patients in the same region. Aims: The aim was to evaluate common drugs implicated in causing reactions, describe the adverse cutaneous drug reactions, study the characteristics of patients presenting with the reactions. Study Design: This is an observational study of cross-sectional type. Materials and Methods: The study was carried out in the department of Oral and Maxillofacial surgery in a Private dental College and department of General Medicine in a Medical College only on outdoor basis for 3 years. Out of 2000 patients observed in each college for their necessary treatment 75 patients in the dental College and 200 patients in the Medical College were reported to have various types of cutaneous drug reactions. Diagnosis was based on detailed history including temporal correlation between drug intake and onset of rash and thorough clinical examination Apart from history of drug intake, information regarding associated other allergy, comorbidity and severity (whether hospitalization was required or not) was recorded. Rechallenge with the drug was not possible due to ethical problem. Results: Out of 2000 patients observed in each college 75 patients in dental College and 200 patients in Medical College were documented to have different kinds of cutaneous drug reactions. A total of 30 were male and 45 female in dental college whereas 90 male and 110 female patients were enrolled in Medical College. The age group of the patients in both the colleges ranged from 18 to 75 years. Common culprits observed in this study were antibiotics and NSAIDs. They had contributed 53% and 40% of the total skin reactions respectively in dental college and 47.5% and 45% in Medical College. We encountered 6 patients of systemic lupus erythematosus (SLE), 20 patients with allergic rhinitis and 12 patients with bronchial asthma in the whole proceedings. The duration of drug intake varied from 15 minutes to 2 weeks. The most common reaction noted was maculopapular rash 37 (50.5%), urticaria 15 (20%), fixed drug eruption (FDR) 15 (20%), angioedema 6 (8%) in dental College whereas a little different trend was observed in the medical college. Hospitalization was required in two cases of Steven--Johnson syndrome caused by NSAIDS in the dental College whereas 11 patients were hospitalized for the same indication in the medical College. Except for maculopapular rash, all other skin reactions were observed more frequently with NSAIDS in dental College whereas Steven--Johnson syndrome is predominantly observed in Medical College with anticonvulsants. In all the cases causative drugs were withdrawn. A total 40% of the patients required only antihistaminic, 35% required antihistaminic and topical corticosteroid and rest required a combination of antihistaminic, oral and topical corticosteroids. Conclusion: Commonest drugs causing drug reactions are antibiotics mainly beta lactams and quinolones. Severe reactions were seen in our series with anticonvulsants and NSAIDS. Association with other diseases could not be inferred due to this modest patient pool.
  1 2,072 507
CASE REPORTS
Analgesic nephropathy as a cause of end-stage renal disease in a 55 year-old Nigerian
UH Okafor, EI Unuigbe, AC Onwuchekwa, P Emem-Chioma
April-June 2012, 15(2):231-234
DOI:10.4103/1119-3077.97335  
Analgesic nephropathy is a subtle but significant cause of chronic renal failure. There is paucity of data on analgesic nephropathy in Nigeria. This case presentation is to highlight the need to have high index of suspicion in patients at risk of developing analgesic nephropathy. In March 2009 a 55-year-old businessman was referred to the renal unit on account of azotemia by the hematologist who had hitherto managed the patient as a case of refractory anemia. The patient had osteoarthritis for over 10 years and was managed with several analgesic drugs over the same period. He was found to have features suggestive of analgesic nephropathy and had end-stage renal disease. He was commenced on appropriate therapy, and he had a live related kidney transplant six months later. Analgesic nephropathy is preventable and morbidity/mortality can be remarkably reduced with appropriate and prompt intervention.
  - 2,304 337
ORIGINAL ARTICLES
Declining uptake of HIV testing among tuberculosis patients in Enugu state of Nigeria: The need for a reappraisal of strategy
CC Dim
April-June 2012, 15(2):206-209
DOI:10.4103/1119-3077.97319  
Background: The prevalence of HIV in Enugu State is the highest in Southeastern Nigeria. Since HIV is associated with TB, it is important to assess the performance of the Enugu State TB program as regards HIV screening of TB cases. This study assesses the proportions of TB cases that are screened for HIV as well as the prevalence of HIV among individuals with TB at the Enugu State TB program of Nigeria. Materials and Methods: The study was a retrospective review of data from the Enugu State TB program, Nigeria, from 2008 to 2009. Analysis was both descriptive and inferential at 95% confidence levels. Results: A total of 3,286 TB cases were registered within the 2-year period. Out of these, 1,867 (56.8%) were new sputum smear positive (ss+). In all, 67.9% and 78.9% of all-TB cases were screened for HIV in 2009 and 2008 respectively [OR=0.57 (0.48-0.67)]. Also, 83.0% and 87.9% of new ss+ cases were screened for HIV in 2009 and 2008 respectively [OR=0.68 (0.52-0.88)]. The mean HIV prevalence for all TB cases was 34.5%. Conclusion: The performance of the State's TB program with respect to HIV screening of TB patients reduced significantly in 2009 when compared to 2008. Improved program monitoring and the opt-out approach of the provider initiated HIV testing and counseling are recommended.
  - 2,724 348
Correlation of interdental and interradicular bone loss in patients with chronic periodontitis: A clinical and radiographic study
SR Desai, HH Shinde
April-June 2012, 15(2):125-131
DOI:10.4103/1119-3077.97280  
Objective: The aim of this study was to investigate the correlation between interdental and interradicular bone loss and clinical parameters in patients with chronic periodontitis. Materials and Methods: One hundred-twenty intraoral periapical radiographs of first molars were obtained from patients with chronic periodontitis and were digitalized to record height and width of the bone defect in the interdental and interradicular region (furcation) and bone defect angle in the interdental region in vertical defects. Pocket depth (PD) and clinical attachment loss (CAL) was recorded at three sites. The data was divided into groups according to the pocket depth at each site. One-way ANOVA was used to compare three different pocket depths with respect to CAL, height and width at a particular site. This was followed by Tukeys HSD post hoc tests to know the significant difference between two groups of pocket depths. Lastly Karl Pearsson's co-efficient method was applied to find out the relationship among CAL, height and width for the particular site. Results: When the pocket depth groups were compared for CAL, height and width of the defect at all three maxillary and mandibular sites, the results were statistically significant. In maxillary molars, a radiographic bone defect height ranging from 3.4-7.1 mm at the mesiobuccal site and 3.6-7.2 mm at the distobuccal site was associated with 1.2-3.5 mm defect height in the interdental region. In mandibular molars, a radiographic bone defect height ranging from 2.9-7.0 mm at the mesiobuccal site and 3.2-6.8 mm at the distobuccal site was associated with 1.2-3.6 mm defect height in the interdental region. The mean bone defect angle was 36.3 ± 16.5 degrees. Conclusion: Treatment of interdental bone loss can prevent further bone loss in the interradicular region. Radiographic measurements combined with clinical findings can be useful for periodontal risk assessment.
  - 4,935 797
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