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   2012| October-December  | Volume 15 | Issue 4  
    Online since December 12, 2012

 
 
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ORIGINAL ARTICLES
Characteristics of clients accessing HIV counseling and testing services in a tertiary hospital in Sagamu, Southwestern Nigeria
AA Salako, OA Jeminusi, OA Osinupebi, OO Sholeye, AO Abiodun, OT Kuponiyi
October-December 2012, 15(4):391-396
DOI:10.4103/1119-3077.104509  
Introduction: Client-initiated HIV testing and counseling has helped millions of people learn their HIV status. Nevertheless, global coverage of HIV testing and counseling programs remains low. This study describes the characteristics of clients who accessed HIV counseling and testing (HCT) services in Olabisi Onabanjo University Teaching Hospital, (OOUTH) Sagamu. Materials and Methods: A retrospective study of the clients accessing HCT services in OOUTH. Data was collected from clients using a client intake form. Pre-test counseling, HIV screening and post-test counseling were carried out. Informed consent and confidentiality were ensured. Data obtained were analyzed using SPSS 10.0. Results: A total of 2607 clients accessed our HCT services between May 1 st 2008 and April 30 th 2010. The clients were between the ages of 1 year and 90 years. The mean age was 33.3 ± 15.26. The median age was found to be 32.0 years, with the modal age being 30.0 years. 73.7% (1828) were non-reactive (negative result), 25.9% (643) were reactive (positive result), while 0.3% (8) were indeterminate. Among the reactive results, 9.3% (242) were males while 15.1% (394) were females. Conclusion: A fair uptake of HCT services was noted. More females accessed services than males. More positive results were seen among females than males (P<0.05). Recommendations: Upscale of HCT services to involve Sexually transmitted infections clinics and free-standing, client-initiated testing centers is necessary. Continuous AIDS education and risk reduction should be promoted.
  13,052 416 1
Evaluation of patients' satisfaction with quality of care provided at the National Health Insurance Scheme clinic of a tertiary hospital in South- Eastern Nigeria
GUP Iloh, JN Ofoedu, PU Njoku, FU Odu, CV Ifedigbo, KD Iwuamanam
October-December 2012, 15(4):469-474
DOI:10.4103/1119-3077.104529  
Background: The umpteenth threats to change of healthcare provider by dissatisfied patients on formal sector health insurance are well known and can be a proxy indicator for the need for quality improvement in service delivery. Objective: This study was aimed at evaluating patients' satisfaction with quality of care provided at the National Health Insurance Scheme (NHIS) clinic of a tertiary hospital in South-Eastern Nigeria. Materials and Methods: This was a descriptive study carried out on 400 NHIS patients from April 2011 to October 2011 at the general outpatient department of Federal Medical Centre, Umuahia. Patients were selected by simple random sampling using every second NHIS patient that registered to see the clinicians and who met the selection criteria. Data were collected using pretested, structured interviewer-administered questionnaire. Each satisfaction item was scored in a five-point Likert scale ordinal response, which was converted to percentage scale response. Satisfaction was measured from the following domains: accessibility, patient waiting time, patient-provider communication, patient-provider relationship, hospital bureaucracy, and hospital environment. Operationally, patients who scored 50% and above in the assessed domain were considered satisfied while those who scored less than 50% were dissatisfied. Results: The overall satisfaction score of the respondents was 66.8%. Specifically, the respondents expressed satisfaction with patient-provider relationship (81.5%), patient-provider communication (79.9%), accessibility (74.2%), and hospital environment (68.2%) and dissatisfaction with hospital bureaucracy (48.8%) and patient waiting time (48.3%). Conclusion: This study has shown that the overall patients satisfaction with the services provided was very good with patient-provider relationship rated highest and patient waiting time the lowest. There is need to improve on the current level of patients satisfaction while effort should be made to address the identified domains of dissatisfaction.
  11,814 1,158 10
The prevalence of Rhesus negativity among pregnant women in Enugu, Southeast Nigeria
TC Okeke, S Ocheni, UI Nwagha, OG Ibegbulam
October-December 2012, 15(4):400-402
DOI:10.4103/1119-3077.104511  
Background: Hemolytic disease of the newborn, secondary to rhesus D (Rh D) iso-immunization, contributes significantly to perinatal morbidity and mortality. Prevalence data in Nigeria, and Southeast Nigeria in particular, is very scanty. This study was carried out to provide our experience in this preventable clinical condition in Enugu, Southeast Nigeria. Objective: To determine the prevalence and trends of Rh D negativity among pregnant women in Enugu, Southeast Nigeria. Materials and Methods: A 5-year retrospective study of rhesus negative women was carried out at the University of Nigeria Teaching Hospital, Enugu, Nigeria, between 1 st January 2000 and 31 st December 2004. Result: The prevalence rate of Rh D negative women in Enugu, Nigeria, is 4.5%. Out of 6306 women who booked for antenatal care, 282 (4.5%) were Rh D negative women. One hundred and eighty-two (182) (64.5%) of the Rh D negative women were of blood group O followed by blood group A 20%, blood group B 12.1%, and blood group AB 3.2%, respectively. Conclusion: There is a need for adequate counseling of pregnant women on the importance of Rh D negative factor during the antenatal period in order to prevent hemolytic disease of the newborn.
  8,271 837 2
Assessment of respiratory symptoms and lung function among textile workers at Kano Textile Mills, Kano, Nigeria
M Nagoda, JU Okpapi, M Babashani
October-December 2012, 15(4):373-379
DOI:10.4103/1119-3077.104505  
Background: The number of textile industries in Nigeria with large work force is on the rise. There is thus the need to assess medical challenges of its workers, one of which is respiratory ailments. Although much has been written about the subject globally, only few studies have been done in Nigeria. This study aims to address this gap. Objective: A cross-sectional study was undertaken to determine the prevalence of respiratory symptoms and pulmonary functions among Textile Workers in Kano, Nigeria. Materials and Methods: A cross sectional study was done, Two hundred male workers exposed to raw cotton dust and its end products in a Textile Company and 200 unexposed workers with similar age- and gender-matched were investigated. Their forced vital capacity (FVC), forced expiratory volume in one second (FEV11), and peak expiratory flow rate (PEFR) were determined with a flow-sensing spirometer and Wright's peak flow meter. Results: Exposed workers generally complained of cough, phlegm production, rhinitis, wheezing, chest pain, and breathlessness. Unexposed worker has a significant lower frequency (P < 0.001) of symptoms as well as higher (P < 0.001) forced vital capacity (FVC), forced expiratory volume in one second (FEV11), and peak expiratory flow rate (PEFR) than exposed workers. The reduction in ventilatory function of exposed from predicted values for Nigerian men was significantly higher (P < 0.001) than unexposed workers. The smokers among the exposed and unexposed workers had significantly lower lung function values than nonsmokers. Conclusion: Respiratory symptoms were more prevalent among workers in most dusty sections of the factory. Use of protective mask should be enforced. Workers in the spinning and weaving sections of the company compared with workers in other sections had the lowest lung function indices.
  3,393 5,149 6
An analysis of uterine rupture at the Nnamdi Azikiwe University Teaching Hospital Nnewi, Southeast Nigeria
SU Mbamara, NJA Obiechina, GU Eleje
October-December 2012, 15(4):448-452
DOI:10.4103/1119-3077.104524  
Objective: Uterine rupture is a preventable condition which has persistently remained in our environment. The aim of this study therefore is to ascertain the incidence of uterine rupture, examine the predisposing factors and maternal and fetal outcome of patients managed of uterine rupture in a tertiary hospital. Materials and Methods: This descriptive case series was conducted at the department of Obstetrics and Gynaecology, Nnamdi Azikiwe, University Teaching Hospital Nnewi from March 2004 to February 2009. Results: The incidence of uterine rupture was 6.2 per 1000 deliveries. The commonest age range of occurrence was 30-34 years. Uterine rupture occurred predominantly among women of low parity. Previous caesarean section with concurrent use of oxytocics was the commonest risk factor documented.The maternal and perinatal mortality ratio was 94 per 100,000 deliveries and 6 per 1000 births respectively. Surgery was the main stay of treatment and the commonest procedure carried out was uterine repair only. Conclusion: Rupture of the gravid uterus is still a significant cause of maternal mortality and morbidity in our environment. The causes are commonly preventable. The provision of maternal care by skilled personnel, proper antenatal care, update training programmes for health care providers and appropriate legislation on maternal care will significantly reduce the incidence of uterine rupture and improve its prognosis.
  4,826 629 6
Parity related changes in obesity and some antioxidant vitamins in non-pregnant women of South-Eastern Nigeria
UI Nwagha, EE Iyare, FE Ejezie, SO Ogbodo, CC Dim, BU Anyaehie
October-December 2012, 15(4):380-384
DOI:10.4103/1119-3077.104506  
Background : The delivery of many children at short interval is associated with micronutrient depletion and weight gain. However, the relationship between the levels of the micronutrients and the body weight is yet to be ascertained. Objectives : To determine the relationship between parity, body weight and some antioxidant vitamins in non-pregnant Nigerian women. Patients and Methods : Randomly recruited 200 non-pregnant women, comprising 82 primiparous and 118 multiparous women completed the study. Their age, parity, mid-arm circumference (MAC), waist circumference (WC), weight, height and body mass index (BMI) were determined. The serum levels of vitamins A, C and E were assayed using standard methods. Results : The mean BMI, WC and MAC of the multiparous subjects (parity = 3.0 ± 0.58) were significantly higher than that of the primiparous subjects (parity = 1), (P < 0.05, P < 0.01 and P < 0.01 respectively). Furthermore, there were statistically significant decrease in the vitamin A, vitamin C and vitamin E in multiparous compared with the primiparous women (P < 0.005, P < 0.05 and P < 0.005), respectively. Conclusion: Multiparty enhances weight gain, but depletes antioxidant vitamin micronutrients in non-pregnant Nigerian women.
  3,549 1,743 -
Predictors of disclosure of sero-status to sexual partners among people living with HIV/AIDS in Ogun State, Nigeria
OE Amoran
October-December 2012, 15(4):385-390
DOI:10.4103/1119-3077.104507  
Introduction: Disclosure may reduce the transmission of HIV by raising awareness and decreasing risky behavior, thus status disclosure is an issue to be addressed for HIV prevention and treatment. The objective of this study was to determine the prevalence and determinants of HIV status disclosure to sexual partners among People Living with HIV/ AIDS (PLWAs) in Ogun state, Nigeria. Materials and Methods: This study is an analytical cross-sectional study. A sample of people living with HIV/AIDS attending secondary health facilities in Ogun State were recruited into the study. Results: Of the total 637 interviewed, 324 (50.9%) indicated that they have disclosed to their main sexual partner. About 44.6% of the respondents reported that they do not know their partner's HIV status, while 30.3% had a negative partner and 25.1% with HIV-positive partners. Among the participants who disclosed their HIV status, 17.3% disclosed on the day of receiving test result, 15.5% within two weeks, 9.7% in 2 to 4 weeks, 8.3% in 1 or more months. Predictors of disclosure were individuals who were married [OR = 4.52, CI = 2.06-9.92] living within monogamous family [OR = 1.67, CI = 1.10-2.53], had anticipation of partner's support before disclosure [OR = 3.68, CI = 2.36-5.76] with knowledge of partner's sero-status either positive [OR = 4.08, CI = 2.62-6.35] or negative [OR = 2.49, C.I = 1.59-3.90] and had a low self-esteem [OR = 0.61, CI = 0.42-0.89]. Conclusion: Disclosure rate was low in this African population. The study implies that PLWAs especially those having a difficult family life should be supported to make effective decisions to disclose their status. HIV sero-status should be addressed in behavioral interventions like counseling on positive living and a multidisciplinary approach to develop positive self-esteem through follow-up counseling.
  3,858 973 17
Poor cataract surgical output: Eye care workers perspective in north central Nigeria
FG Adepoju, BJ Adekoya, AA Ayanniyi, V Olatunji
October-December 2012, 15(4):408-414
DOI:10.4103/1119-3077.104513  
Background: Cataract remains a disease of priority being the leading cause of blindness globally. Although surgically curable, cataract surgical output has remained low in Nigeria, Kwara state inclusive. A study was carried out to investigate the perception of eye care workers (ECW) on low surgical output and their adjudged reasons; this has hitherto not being evaluated. Materials and Methods: A cross-sectional quantitative survey with the aid of pretested structured questionnaire of all ECW and qualitative survey using in-depth interview on selected workers in Kwara State, Nigeria was done. Results: A total of 142 out of the 157 ECWs (90.5%) working in the 14 surgical eye centers in the state were interviewed with a mean age of 40.37 years, SD ± 8.67. There were 94 (66.2%) females, with a female to male ratio of 2:1. 91 (64.1%) participants were of the opinion that the numbers of cataract surgeries in the state were inadequate. Hospital-based and human resource efficiency-related issues such as long clinic waiting time, multiple paying and procedural sites, poor staff mix, and gaps in available human resource were the major reasons given for low cataract output. Others reasons were high cost and fear of surgery, distance of eye clinics from patients. Conclusions: Regular operational researches, proper deployment, and efficient use of human and material resources in addition to subsidized cost and appropriate health education to allay fear of surgery are steps that could enhance cataract surgical output.
  3,669 363 1
Psychiatric sequelae of traumatic brain injury: Retrospective analysis of 75 subjects from Kaduna, Nigeria
FT Nuhu, AJ Yusuf
October-December 2012, 15(4):397-399
DOI:10.4103/1119-3077.104510  
Objective: Traumatic brain injury (TBI) is a public health problem and is associated with many complications. However little is known about the psychiatric sequelae of TBI in Nigeria. This study described the pattern and determinants of psychiatric sequelae among subjects with TBI. Materials and Methods: The study is a retrospective review of cases of subjects referred to Federal Neuropsychiatric Hospital, Kaduna on account of TBI or its complications from 2001 to 2008. Information obtained included the socio-demographic characteristics, type of injury, durations of unconsciousness (LOC) and posttraumatic amnesia (PTA), psychiatric and psychoactive substance use history. Psychiatric diagnosis was based on the criteria of the 10th edition of the International Classification of Diseases (ICD-10) Results: Mean age of the subjects was 32.2 ± 35.8 years, mean duration of unconsciousness was 6.88 ± 9.40 days, mean duration of PTA was 5.45 ± 8.78 days, 90.7% were males, 69.3% had road traffic accident (RTA), 28.0% had psychosis, 25.3% had cognitive impairment while 17.3%, 8.0%, and 6.7% had epilepsy, personality change and depression respectively. About 15% had no complications yet. Only 30.7% did cranial CT scan. Long duration of LOC and PTA were significantly associated with psychiatric complications (P value <0.05). Conclusions: Psychiatric sequelae are common after TBI. Long periods of LOC and PTA are predictive of such sequelae. Efforts should be made to prevent RTA, communal clashes and other activities that can lead to TBI.
  3,289 537 1
Metabolic syndrome in newly diagnosed type 2 diabetes mellitus using NCEP-ATP III, the Nnewi experience
CU Osuji, BA Nzerem, CE Dioka, EI Onwubuya
October-December 2012, 15(4):475-480
DOI:10.4103/1119-3077.104530  
Background and Objectives: Type 2 diabetes is becoming epidemic and several studies have shown that diabetes is associated with increased co-morbidities and impaired functional health in the general adult population. Type 2 diabetes is one of the co-morbidities associated with metabolic syndrome that carries with it increased risk of cardiovascular disease and death. The purpose of this study is therefore to determine the prevalence of metabolic syndrome in newly diagnosed type 2 diabetes mellitus subjects seen at Nnewi South East Nigeria. Design and Setting: This is a cross-sectional study in newly diagnosed diabetics attending a private hospital-Hope Specialist Hospital, Nnewi. Materials and Methods: One hundred and eighteen (118) newly diagnosed diabetic patients were recruited into the study consisting of those who on routine screening were found to have elevated blood glucose or were symptomatic of the disease and presented for treatment. Statistical Analysis: Statistical analysis was carried out using SPSS version 13. Student's t-test was used for continuous variables, and a χ2 test was used for categorical variables. In the analyses a P- value of <0.05 was considered statistically significant. Results : Of the 118 subjects, 25 were removed from the study because their samples were lost as a result of prolonged power outage leaving 93 subjects consisting of 47 males and 46 females. The mean (SD) and the range of age was 55.27 (12.55) years, 24-84 years; SBP 153.52 (29.83) mmHg,100-230 mmHg; DBP 94.23 (15.42) mmHg, 60-140 mmHg; TC 5.17 (1.4) mmol/L, 2.0-11.12 mmol/L; LDL-C 2.06 (1.55) mmol/L, 0.1-9.4 mmol/L; HDL-C 1.28 (0.48) mmol/L, 0.15-2.8 mmol/L; TG 1.75 (0.85) mmol/L, 0.50-5.0 mmol/L; BMI 30.30 (6.23) kg/m 2 , 17.84-49.12 kg/m 2 ; and WC of the general population mean (SD) 96.86 (7.16) cm, range 84-112 cm; for men 101.40 (3.88) cm, range 85-108 cm and for women 92.22 (6.77) cm, 84-112 cm. Metabolic syndrome was found in 62 (66.7%) subjects of which 26 (41.9%) were males and 36 (58.1%) were females (P < 0.019). The prevalence of different components of metabolic syndrome was as follows: hypertension was found in 75 (80.6%): 37 males and 38 females (P = 0.635), dyslipidemia in 31 (60.8%): 19 males and 12 females (P = 0.572). Obesity was found in 23 (45.1%): 8 males and 15 females (P < 0.014). Of the study subjects 33 had hypertension prior to the diagnosis of diabetes mellitus (DM). Seventeen males had hypertriglyceridemia against 11 females (P = 0.357). Equal number of males and females (11 each) had low HDL--C (-C (P = 0.603). Conclusion: The study shows that metabolic syndrome is highly prevalent in newly diagnosed type 2 diabetes patients and the most common risk factor is hypertension.
  3,051 724 9
Pattern of presentation and management of lip injuries in a Nigerian hospital
WL Adeyemo, OA Taiwo, MO Adeyemi, RA Adewole, OM Gbotolorun
October-December 2012, 15(4):436-441
DOI:10.4103/1119-3077.104520  
Aim: Human lip injuries, although uncommon, present major challenges in terms of reconstructive options and the outcome of surgical management. The reconstructive techniques are usually varied but the ultimate objectives of treatment are to achieve healing, function, and aesthetics. The aim of this study was to report the etiology, pattern of presentation, and surgical management of lip injuries in Lagos University Teaching Hospital (LUTH). Materials and Methods: A prospective study of consecutive cases of lip injury was conducted at the Oral and Maxillofacial Surgery Clinic of the Lagos University Teaching Hospital. Data collected included age and sex of patients, etiology, pattern of presentation, and surgical techniques of repair. Results: A total of 13 patients with lip injury to the lip were included in the study (M = 6, F = 7). Human bite (11 cases) was the most common cause of injury followed by electric burns (2 cases). The most (81.8%) frequently affected site was the lower lip. Most patients presented within 72 hours after injury with infected wound. Treatment offered included thorough debridement and primary repair using various surgical techniques. A one-stage surgical technique was employed in all cases. Healing was uneventful in all cases and satisfactory. Conclusion: Most of the lip injuries in the present study were due to human bites with almost equal sex distribution. Lower lip was most commonly affected. All cases were successfully treated by debridement, broad spectrum antibiotic coverage, and one-stage surgical repair with a favorable outcome.
  3,039 334 4
Prevalence of ototoxicity in University of Benin Teaching Hospital, Benin city: A 5-year review
G Obasikene, PROC Adobamen, P Okundia, FO Ogusi
October-December 2012, 15(4):453-457
DOI:10.4103/1119-3077.104527  
Background : Ototoxicity refers to damage of the cochlea and/or vestibular apparatus from exposure to chemical substances, resulting in hearing impairment and or disequilibrium. An earlier study carried out at University of Benin Teaching Hospital (UBTH) in 2000 implicated chloramphenicol as the commonest ototoxic drug, followed by antimalarials (Quinine). Aim: To identify the commonly implicated drugs in patients diagnosed with ototoxicity in Ear, Nose and Throat (ENT) Clinic of UBTH. Materials and Methods: One-hundred and three patients' case notes, diagnosed as having ototoxicity, between June 2005 and July 2010 at the ENT Clinic of UBTH were reviewed. Seventy-nine cases met the criteria for diagnosis of ototoxicity in this study. Results: Intravenous quinine (19.0%) was the commonest implicated drug, followed by oral chloroquine (6.3%), antihypertensive drugs (nifedipine, moduretics, artenolol [6.3%]), native herbal medicine (13.9%), chloramphenicol (1.3%), and unidentifiable drugs accounted for 53.2%. Most patients had severe to profound hearing loss at 4000 Hz and at 8000 Hz. Tinnitus was found in 84.8% of the patients. Conclusion: Quinine is still the commonest implicated ototoxic drug in this part of the country.
  2,861 401 6
Plasma concentrations of water-soluble vitamins in metabolic syndrome subjects
EP Odum, VC Wakwe
October-December 2012, 15(4):442-447
DOI:10.4103/1119-3077.104522  
Context: Vitamins B1 (thiamine), B3 (niacin), B6 (pyridoxine), and C (ascorbic acid) are vital for energy, carbohydrate, lipid, and amino acid metabolism and in the regulation of the cellular redox state. Some studies have associated low levels of water-soluble vitamins with metabolic syndrome and its various components. Aims: This study aims to determine the plasma concentrations of vitamins B1, B3, B6, and C in Nigerians with metabolic syndrome and in healthy controls. Settings and Design: One-hundred subjects with metabolic syndrome were recruited into the study. One-hundred controls were age - and sex-matched. Materials and Methods: Blood pressure, body mass index, waist circumference, concentrations of plasma glucose, lipid profile, and vitamins B1, B3, B6, and C were estimated. Statistical analysis used: Statistical Package for Social Sciences (SPSS) version 11.0. Results: The mean plasma vitamins B1, B3, B6, and C concentrations of subjects were significantly lower than that of controls (P = 0.001, 0.05, 0.045, 0.001 respectively). Fourteen percent and 32% of subjects had inadequate vitamins B1 and C status, respectively. Vitamin B6 was lower (P = 0.001) and vitamin C was higher (P = 0.012) in female than in male subjects. Conclusions: Thiamine, niacin, pyridoxine, and ascorbic acid levels were lower in subjects than in controls. Pyridoxine was also lower and ascorbic acid was higher in female than in male subjects.
  2,697 563 13
The magnitude of abdominal adiposity and atherogenic dyslipidemia among geriatric Nigerians with arterial hypertension in a rural hospital in South-eastern Nigeria
GUP Iloh, AN Amadi, PU Njoku, JN Ofoedu, J Awa-Madu
October-December 2012, 15(4):462-468
DOI:10.4103/1119-3077.104528  
Background: As the case detection rate of arterial hypertension increases daily in rural Nigeria, screening for its associated abdominal obesity and dyslipidemia is an important healthcare challenge. Of great concern in rural Nigeria is that most geriatric hypertensives with abdominal obesity and dyslipidemia are not routinely diagnosed and therefore do not receive appropriate management. Objective: This study was aimed at describing the magnitude (prevalence and pattern) of abdominal adiposity using waist circumference (WC) index and dyslipidemia among geriatric Nigerians with arterial hypertension in a rural hospital in South-eastern Nigeria. Materials and Methods: A descriptive hospital-based study was carried out from June 2008 to June 2011 on 122 consecutive geriatric patients with systemic hypertension who met the selection criteria at St. Vincent De Paul Hospital, Amurie-Omanze, a rural Mission General Hospital in Imo state. Abdominal obesity was defined as WC ≥102 cm and ≥88 cm for men and women, respectively. Dyslipidemia was defined using the third report of National Cholesterol Education Panel in adult (ATP III). The data collected included basic demographic variables, blood pressure, waist circumference, fasting lipid profile, and blood sugar. Results: The prevalence of abdominal obesity was 50.8% and was the most common pattern of abdominal adiposity. Fifty-four (44.3%) out of 122 patients had at least one dyslipidemia with the most frequent being low high-density lipoprotein cholesterol (HDL-C, 38.5%). There was statistically significant difference between male and female gender based on abdominal adiposity (X 2 = 5.406, P value = 0.04) while their mean lipid differentials were not statistically significant. Conclusion: This study has shown that abdominal adiposity and dyslipidemia exist among geriatric hypertensives in the study area with abdominal obesity being the most common abdominal adiposity and low HDL-C being the most frequent lipid abnormality. This study therefore urges the necessity to consider abdominal obesity and dyslipidemia in geriatric hypertensives in rural Nigeria alongside the complex of other cardiovascular risk factors.
  2,787 364 6
Antimicrobial sensitivity pattern of organisms causing urinary tract infection in children with sickle cell anemia in Maiduguri, Nigeria
Y Mava, M Bello, JP Ambe, SB Zailani
October-December 2012, 15(4):420-423
DOI:10.4103/1119-3077.104515  
Background: Patients with sickle cell disease have increased tendency to develop frequent and severe infections, especially of bones and urinary tract. Objective: The knowledge of antimicrobial sensitivity pattern of common etiological agents will serve as a guide to empiric treatment while results of urine culture and sensitivity are being awaited. Materials and Methods: Antimicrobial sensitivity test was carried out on bacterial isolates from the urine of febrile children with sickle cell anemia (SCA) and children with HbAA in Maiduguri. Urine specimens were collected and cultured by standard methods. Sensitivity to 15 antimicrobials (based on availability of sensitivity disc) was tested using the disc-diffusion technique of stokes. Results: Significant bacteriuria was obtained from 65 (26%) of the 250 children with SCA and 51 (20.4%) of the 250 controls. The isolates were E. coli, Klebsiella, Coliforms, Proteus, Staph aureus and Salmonella. Sensitivity was highest to 3 rd generation cephalosporins, followed by the quinolones: ciprofloxacin (86.2%), ofloxacin (83.1%), and peflacine (73.8%). Sensitivity of the organisms to some of the commonly used antibiotics like ampicillin, cotrimoxazole, and nalidixic acid was generally low. In general, the pattern of bacteriuria and their sensitivity in the SCA group was similar to the pattern in the control group. Conclusion: Etiological agents of childhood urinary tract infections (UTI) in this environment are resistant to most of the drugs commonly recommended for its treatment. Amoxicillin/clavulanic acid, cefuroxime, and gentamicin, are recommended as first-line drugs for treatment of UTI while awaiting results of culture and sensitivity. Ceftriaxone and ceftazidime should be reserved for case of non response to first-line drugs and severe infections.
  2,401 563 2
Adolescent and adult cleft lip and palate, in Ile-Ife, Nigeria
AO Oladele, JK Olabanji, OO Awe
October-December 2012, 15(4):403-407
DOI:10.4103/1119-3077.104512  
Introduction: Congenital cleft lip and palate (CLP) defects usually present in childhood, especially in places with available and affordable care. In Nigeria, their incidence is low but late presentation in Adult life have been reported. This article aims at reviewing adolescent and adult CLP patients in our center, with the advent of free and available care, and to document the patterns and management outcomes of these patients as an addition to existing literature on the subject of adult CLP. Materials and Methods: A retrospective review of adolescent and adult CLP patients managed from May 2006 to April 2010. Demographic data as well as clinical information were retrieved from the hospital records and include the type of cleft deformity, surgical intervention prior to presentation, the type of surgery performed and postoperative outcomes. Some pertinent clinical photos were also reviewed. Results: Adolescent and adults constituted 24% of the 137 patients, their age ranged from 13 to 76 years, with a mean, median and modal age of 28, 22 and 20 years respectively. Unilateral cleft of primary palate was commonest with female preponderance. Most never had surgery, others desired revision surgery or secondary procedures. The outcomes were satisfactory in the 37 procedures performed on 33 patients. Conclusion: A relatively high ratio of adolescent and adult clefts is observed. Most of them have never had surgical intervention. Some had failed surgical intervention prior to presentation. Satisfactory outcomes were achieved despite late intervention but failed initial intervention was associated with poorer outcomes.
  2,562 359 -
CASE REPORTS
Reconstruction of the chest wall after excision of a giant malignant peripheral nerve sheath tumor
SA Edaigbini, IZ Delia, MB Aminu, A Ibrahim, MOA Samaila, K Abdullahi, AA Liman
October-December 2012, 15(4):484-486
DOI:10.4103/1119-3077.104533  
Primary chest wall tumors are uncommon and constitute 0.2-2% of all tumors. Metastatic tumors and tumors of local extension are more common. Malignant peripheral nerve sheath tumor (MPNST) of the chest wall is even rarer and its incidence on the chest wall not stated in the literature. The incidence in the general population is 0.0001% while the risk is approximately 4600 times higher in patients with type I neurofibromatosis and 3-13% of them will finally develop into MPNST, usually after latent periods of 10-20 years. Clinically, these tumors are aggressive, locally invasive, and highly metastatic. Excision of giant chest wall tumor leaves a defect that is reconstructed using musculocutaneous flaps with or without a mesh. We report the case of a 24-year-old man who presented at the surgical outpatient clinic with 7 months history of persistent left sided chest pain minimally relieved by analgesics, 5 months of cough and worsening dyspnoea, and 3 months history of anterior chest swelling on the left side of the manubrium. Following evaluation and investigations, the tumor was excised and the residual defect closed with methylmetacrylate sandwiched between two prolene meshes and overlaid with both pectoralis major muscles. The histology of the excised mass revealed MPNST He made an uneventful postoperative recovery, but died barely 3 months later from widespread pulmonary metastases. A review of the literature revealed that such tumors hardly ever reach such large-size as in our case.
  2,530 298 2
Ruptured tubal molar pregnancy
IA Yakasai, N Adamu, HS Galadanchi
October-December 2012, 15(4):491-493
DOI:10.4103/1119-3077.104537  
Molar pregnancies in most instances develop within the uterine cavity, but may occur at any site. Ectopic molar pregnancy is a rare event. The objective of this study was to present a case of ruptured tubal molar gestation, discuss its clinical features and ways to improve diagnostic accuracy. A 35-year-old woman presented with features suggestive of ruptured tubal ectopic pregnancy. There was neither any evidence at the time of presentation to suspect a molar gestation, nor β human chorionic gonadotrophin (βhCG) hormone estimation was done, but only a clearview pregnancy test was carried out. She had total left salpingectomy and histological evaluation of the specimen revealed complete hydatidiform mole. The hCG level normalized within 3 weeks of follow-up. Clinical features of ectopic molar pregnancy may be indistinguishable from non-molar ectopic pregnancy. We recommend βhCG estimation as well as histological examination of the surgical specimen for all patients coming with features suggestive of ectopic pregnancy.
  2,373 446 1
Negative pressure dressing combined with a traditional approach for the treatment of skull burn
N Gümüs
October-December 2012, 15(4):494-497
DOI:10.4103/1119-3077.104539  
Deep burns of the calvarium due to high-voltage electrical current present serious therapeutic challenges in the healing. In this study, as an alternative approach to the treatment of burned skull, negative pressure dressing is used to facilitate separation of the necrotic bones from healthy margins of the cranium, and to encourage rapid granulation tissue formation after trephination of the bone. A 36-year-old male patient, who had been seriously injured on his head with high-voltage electrical current, is presented. On the fifth day after injury, necrosis of the scalp became clearly significant, thereby necessitating extensive debridement. Under general anesthesia, necrotic scalp was removed, leaving the calvarial bone exposed, and while devitalized calvaria was left in place, exposed bone was drilled. A vacuum-assisted dressing was then applied to the wound and set to 125 mmHg continuous pressure. Some granulation tissue developed in the holes and margins of the wound, but it was not sufficient to allow successful closure of the wound with skin grafting. Therefore, the patient underwent another operation in which devitalized outer table of the skull was easily removed from viable bone by using a little force. Elevation of the necrotic outer bony layer revealed profuse granulation tissue formation over the inner layer. When dealing with this experience, vacuum-assisted dressing seems to be a useful tool in acceleration of the separation of necrotic bones and stimulation of granulation tissue formation in burned calvarium.
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ORIGINAL ARTICLES
Blood transfusion, antibiotics use, and surgery outcome in thyroid surgery: Experience from a suburban center in Nigeria
J Kpolugbo, O Uhumwangho, G Obasikene, U Alili
October-December 2012, 15(4):458-461
DOI:10.4103/1119-3077.104525  
Background: Edo North, which is a known goiter belt in Nigeria, is within the catchment area of this hospital. Although thyroid disease is prevalent in the communities, the fear and cost of surgery have been limiting factors for sufferers who should otherwise seek expert care. Aim: To review all thyroid surgeries at Irrua Specialist Teaching Hospital, to determine pathological diagnosis of goiters, and to evaluate the outcome and necessity or otherwise of antibiotic therapy and routine cross-matching of blood. Results: There were 80 patients in the study, with 75 (93.75%) females and 5 (6.25%) males, giving female-to-male ratio of 15:1. People in the 4 th and 5 th decade of life constituted a dominant 32.5% and 26.7%, respectively, while the 1 st and 2 nd decades combined constituted only 7.5% of the study population. Two patients (2.5%) had blood transfusion while a similar number had wound infection. Conclusion: Thyroidectomy is a safe surgery with minimal risk of complications. Grouping and cross-matching of blood in elective thyroidectomy is not an essential pre-operative preparation for all patients just as antibiotic therapy/prophylaxis made no difference in patient outcome. Simple multinodular goiter is the commonest histological diagnosis.
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CASE REPORTS
Chylous ascites due to signet ring cell gastric adenocarcinoma
RA de Mello, T Gregório, T Cardoso
October-December 2012, 15(4):487-490
DOI:10.4103/1119-3077.104536  
"Chylous ascites is a rare presentation of peritoneal effusion. The signet ring cell gastric adenocarcinoma is also relatively rare presentation of gastric cancer. We present a quite rare case of chylous ascites associated with signet ring cell gastric adenocarcinoma. Case report: a 47-years-old Caucasian man presented to our emergency department with abdominal distention. The abdominal ultra-sound showed high volume ascites and the diagnostic paracentesis revealed milk-like peritoneal fluid rich in triglycerides. He was underwent to medium chain triglycerides based diet, total parenteric diet and treatment with somatostatin without response. Due to presented digestive hemorrhagic events, upper digestive endoscopy was performed and revealed signet ring cells gastric adenocarcinoma on biopsy. The patient died in disseminated intravascular coagulation context. Conclusion: chylous asicites is a rare presentation of ascites and it may be associated with abdominal neoplasm. The prompt diagnosis is important for optimize the etiology evaluation and therapeutically approach."
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ORIGINAL ARTICLES
Cardiovascular responses to blood transfusion in children with anemic heart failure
WE Sadoh, AE Sadoh, M Okposio
October-December 2012, 15(4):424-429
DOI:10.4103/1119-3077.104517  
Introduction: This study evaluated the cardiovascular responses to blood transfusion in children with anemic heart failure using mostly clinical parameters. Materials and Methods: Consecutive patients with anemic heart failure presenting to a children's emergency room and requiring blood transfusion were assessed for heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), liver size, and oxygen saturation (O 2 sat) pre-transfusion, 1-2 h into transfusion (intra-transfusion), immediate post-transfusion, and at late post-transfusion (24 h later). Results: A total of 75 patients were recruited of which 46 (61.3%) were males. Their mean age was 43.8 ± 40.3 months while their mean PCV at presentation was 15.0 ± 4.5%. There was a significant mean net reduction of 10 beat per minute (bpm) between the pre (139.7 ± 25.2 bpm) and intra-transfusion (129.6 ± 22.0 bpm) HR, P = 0.0004. The mean net reduction of 4 cycles/ min between the pre and intra-transfusion RR was also significant, P = 0.0033. The two parameters declined in values subsequently. Conclusion: The HR and RR are two easily measurable indices with reduction in HR and RR by 10 bpm and 4 cycles/min, respectively, from pre-transfusion to intra-transfusion observations.
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CASE REPORTS
Omentoplasty as an effective surgical modality for managing a high risk patient with deep sternal wound infection
KE Okonta, M Anbarasu
October-December 2012, 15(4):481-483
DOI:10.4103/1119-3077.104531  
Poorly managed diabetes and hypertensives are risk factors for deep sternal wound infection (DSWI) following cardiac surgery; leading to increased morbidity and mortality. To reappraise the effectiveness of omental flap in the management of High risk patient with DSWI. A middle aged man with extensive mediastinitis following cardiac surgery (from outside referral). He was a known Diabetic and Hypertensive who was poorly compliant on medications. The history, physical examination, gycosylated Haemoglobin (HbA1c) and microbiological analyses showed high blood pressure, poor glycaemic control, septicaemia with staphylococcal DSWI. Resuscitation was achieved with the use of oral antihypertensives, Human insulin and antibiotics respectively. The DSWI was managed with serial debridement and subsequent wound cover with omental flap. The hospital stay was shorter and outcome was good. The management of DSWI with omental flap may be an effective surgical modality that reduces morbidity and mortality even in high risk patients.
  1,914 320 1
ORIGINAL ARTICLES
Prevalence of dentine hypersensitivity among university students in Turkey
H Çolak, BU Aylikçi, MM Hamidi, R Uzgur
October-December 2012, 15(4):415-419
DOI:10.4103/1119-3077.104514  
Background and Objective: Dentine hypersensitivity (DH) is a common clinical finding with a wide variation in prevalence values. There is lack of data on the prevalence of dentinal sensitivity in Turkish population. The aim of this study was to establish the prevalence of DH and to examine some associated factors such as initiating stimuli among university students in Kırıkkale, Turkey. Materials and Methods: A cross-sectional survey was conducted among undergraduates of University of Kırıkkale, Turkey. An electronic questionnaire was developed and distributed via e-mail to undergraduate students in Kırıkkale University. Self-administered questionnaire elicited information on demography, self-reported dentinal sensitivity, the trigger factor, professional treatment taken, and duration time. Test of significance was done with Chi square statistics. P<0.05 was considered as significant. Results: A total of 1463 responses were evaluated in this study. One hundred and twenty-four students were diagnosed as having DH, giving a prevalence figure of 8.4%. The prevalence of DH in females was significantly higher than that in males. The most common initiating factor was cold drinks. Tooth sensitivity was found to be common among hard toothbrush users. About 46% of patients reported that they had not undergone any treatment for the discomfort and 35% reported having had some sort of treatment. Among the participants with dentinal sensitivity, 58.8% of the respondents reported that they use soft drinks occasionally. Approximately 64.2% of the patients claimed that DH was present for 1-6 days and the majority (87%) of the patients with hypersensitive teeth experienced pain occasionally. Conclusion: The prevalence of DH among university students was 8.4%. DH is not a common problem in undergraduate university students.
  1,910 315 5
LETTER TO EDITOR
Unusual presentation of renal tuberculosis in type 2 diabetes
KVS Hari Kumar, I Pandey, K Singh, D Mukherjee
October-December 2012, 15(4):498-499
DOI:10.4103/1119-3077.104540  
  1,776 346 1
ORIGINAL ARTICLES
Comparative analysis of case screening with varying cough duration and sputum samples for diagnosis of tuberculosis in patients attending the OPD at a tertiary care hospital at Srinagar, India
S Hamid, SA Hussain, I Ali
October-December 2012, 15(4):430-435
DOI:10.4103/1119-3077.104519  
Research Question: Can we minimize cough duration and number of sputum samples in chest symptomatic patients for screening of TB? Objective: To evaluate cough of 3 weeks versus 2 weeks duration using two sputum samples versus three samples in chest symptomatic patients attending the OPD. Study Design: Hospital-based cross-sectional study. Materials and Methods: Outpatients (2810) with H/O cough of 3 weeks and 2 weeks duration were screened by subjecting them to sputum microscopy for tuberculosis using two sputum samples as well as three samples following standard procedure for sputum collection, staining and acid-fast bacillus (AFB) identification. Those on drugs were not included. Results: Using ≥2 weeks cough, sputum positivity rate was 12%, nearly as high as the sputum positivity among patients with ≥3 weeks cough, i.e. 14%. First sputum smear alone on an average could detect 91.8% cases, while the first two sputum smears could detect on an average 96% cases. The study showed that maximum number of cases was diagnosed by only two sputum smears and added diagnostic value of third specimen was small, i.e. 4%.High sputum positivity rate using ≥2 weeks cough with two sputum samples was seen. Conclusion: The sensitivity analysis of the study showed that using ≥2 weeks cough with two sputum samples gives almost similar values as ≥3 weeks cough with three sputum samples, but this needs further confirmatory results of culture sensitivity. Hence, using ≥2 weeks cough with two sputum samples as the diagnostic criteria for screening of cough patients for TB should be recommended as one way of improving efficient use of scarce resources.
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