Medical and Dental Consultants’ Association of Nigeria
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   2013| April-June  | Volume 16 | Issue 2  
    Online since April 6, 2013

 
 
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ORIGINAL ARTICLES
Neonatal jaundice and its management: Knowledge, attitude, and practice among expectant mothers attending antenatal clinic at University of Benin Teaching Hospital, Benin City, Nigeria
BA Egube, AN Ofili, AR Isara, JU Onakewhor
April-June 2013, 16(2):188-194
DOI:10.4103/1119-3077.110147  
Introduction: Neonatal Jaundice (NNJ) is a common disorder worldwide and one of the important contributors to the high neonatal morbidity and mortality in Sub-Saharan Africa. Severe neonatal jaundice leads to brain damage or even death in otherwise healthy newborns. The objective of the study was to assess the knowledge, attitude and practice of expectant mothers about neonatal jaundice and its management. Materials and Methods: The study was descriptive cross-sectional, carried out among 389 expectant mothers who were attending the antenatal clinic at the University of Benin Teaching Hospital. A structured, Pre-tested, researcher administered questionnaire was used to interview the respondents. Data was analysed using SPSS version 15. Results: The mean age of the expectant mothers was 30.5 (SD 4.9) years. Fifty-five (14.1%) of respondents had previous experience with NNJ, 8 (2.1%) lost babies due to NNJ. 334 (85.9%) were aware of the condition, 381 (77.4%) knew how to recognize the symptoms of NNJ, 279 (71.7%) knew a correct method of treatment of NNJ. A large proportion of the expectant mothers 261 (67%) knew some complications of NNJ. Two hundred and five (52.7%) did not know any danger sign of complications of NNJ. Three hundred and fifty five (91.3%) had good attitude towards its management. Majority of expectant mothers whose previous babies had NNJ took the babies to the hospital for treatment. A large proportion also expressed their willingness to seek medical attention if their babies were to develop the condition. Their knowledge of neonatal jaundice was significantly influenced by their level of education and the number of their previous babies who had NNJ. Conclusion: This study revealed that expectant mothers attending antenatal clinic at UBTH had good knowledge of the treatment and complications of NNJ but inadequate knowledge of the causes and danger signs of the condition. Their attitude and practice towards the management of NNJ was good. It is therefore recommended that Health care providers should give more health education on NNJ to the expectant mothers during antenatal visits.
  17,214 1,868 13
The knowledge attitude and practice regarding diabetes and diabetic retinopathy among the final year medical students of King Faisal University Medical College of Al Hasa region of Saudi Arabia: A cross sectional survey
FA Al Wadaani
April-June 2013, 16(2):164-168
DOI:10.4103/1119-3077.110133  
Purpose : The purpose of the study was to assess the knowledge attitude and practice of the final year medical students of king faisal university medical college towards diabetes and diabetic retinopathy. Materials and Methods: A cross sectional survey was conducted in King Faisal university Medical college of Al Hasa province of Saudi Arabia in May 2012. The student population was the Final Year students of MBBS. All 96 students of final year MBBS were included in this study. The data were collected by means of filling up of pre-tested specially designed questionnaires focused on Knowledge, Attitude and practice towards Diabetes Mellitus and Diabetic retinopathy. The answers were scored by assigning marks. A SPSS 17 was used for statistical analysis. Results: The mean of overall KAP score (±SD) for all the respondents were 64.75 ± 11.17 (Maximum 100). Male students scored better than the females students (65.30, P = 0.02 vs. 64.18, P = 0.02). The male student scored better in the knowledge (35.83 vs. 34.05, P = 0.018) and practice (13.63 vs. 12.95, P = 0.045) category while the attitude score of female student (17.16 vs. 15.83, P = 0 .020) was significantly higher than the male students. The main weakness of knowledge was on epidemiology of Diabetes Mellitus (DM), the follow up of the diabetic patient for the screening of diabetic retinopathy and the relation of duration of diabetes with the development and progression of diabetic retinopathy. Many students believed that diabetes is more prevalent among the uneducated people. Ninty percent students did not know the proper angle of insulin injection. Conclusion : This survey highlights some of the lacuna in the teaching system of the medical students and identified the need for improvement in their knowledge, attitude and practices for treating the patients with diabetes and diabetic retinopathy. This can be done by incorporating special syllabus focusing on diabetes and diabetic retinopathy in their teaching programme.
  12,975 1,058 3
Knowledge and utilization of malaria preventive measures among pregnant women at a tertiary hospital in Nigeria's federal capital territory
GO Akaba, JAM Otubu, ET Agida, O Onafowokan
April-June 2013, 16(2):201-206
DOI:10.4103/1119-3077.110162  
Objective: To determine the knowledge and utilization of malaria preventive measures as well as barriers to the utilization of these measures by pregnant women. Materials and Methods: The study was a prospective cross-sectional survey involving pregnant women at the booking clinic of the University of Abuja Teaching Hospital between May and August 2010. Close-ended pre-tested structured questionnaires were administered by interviewer method to 403 consecutive consenting women. Results: The knowledge of malaria and its preventive measures in pregnancy was 71.5%. There was a statistically significant association between knowledge of malaria and educational status (X2 = 16.053, P = 0.035). Intermittent preventive treatment was used by 15.9% of the respondents. Insecticide-treated net ownership was 42.6%; however, its use declined from 28.5% before pregnancy to 24.6% during pregnancy. Conclusion: There is adequate knowledge about malaria and its preventive measures in pregnancy, but the utilization of these measures is poor. There is need for concerted efforts at addressing the barriers to utilization of these effective interventions.
  12,677 1,213 13
Mothers' perception and management of abdominal colic in infants in Enugu, Nigeria
JM Chinawa, AC Ubesie, GN Adimora, HA Obu, CB Eke
April-June 2013, 16(2):169-173
DOI:10.4103/1119-3077.110135  
Background: Abdominal colic is common in infants but generally harmless. The exact aetiology is unknown but it has been associated with vicious cycle of crying and swallowing of air by the infant. The excessive crying associated with it can result in a lot of distress for family members creating unnecessary panics. We sought to find the perception and management of abdominal colic by mothers in Enugu. Objective: Objective of this study is to determine the perception and 'home management' of abdominal colic in infants by mothers in Enugu, south-east Nigeria and the factors associated with them. Materials and Methods: A cross-sectional survey involving 177 mothers that presented with their infants at the pediatric outpatient clinic of the University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu between June and November 2011. A pretested questionnaire was used after obtaining their consent. Results: A total of one hundred and seventy-seven mothers participated in this study. They were aged 20 to 60 years with mean age of 34 ± 7.3 years. Most of them (99.4%) believed that babies can have abdominal colic. While 41.3% attributed no problems to colic, the rest believed that it causes loose/greenish stools (12.4%), fever (16.4%) and vomiting (9.6%) etc. Most of the mothers (87.7%) do apply medications for colic which range from paracetamol (33.1%), Gbomoro (16.2%), teething powder (15.4%), salt water (13.2%), Buscopan (7.7%) and gripe water (4.6%). Conclusions : Mothers attribute symptoms of childhood illnesses to abdominal colic. This may have led to unnecessary and sometimes harmful management. There is need for health education of mothers and potential mothers.
  8,521 450 -
REVIEW ARTICLES
Neonatal hypothermia in sub-Saharan Africa: A review
R Onalo
April-June 2013, 16(2):129-138
DOI:10.4103/1119-3077.110120  
Background: Hypothermia is a major factor in neonatal morbidity and mortality in developing countries. High prevalence of hypothermia has been reported widely even from warmer tropical countries. In spite of the World Health Organization's recommendation of maintenance of warm chain in newborn care, hypothermia continues to be a common neonatal condition which has remained under-recognized, under-documented, and poorly-managed. Objective: This review aims at providing the incidence of and risk factors for neonatal hypothermia as well as provides a pathophysiological overview and management options for neonates with the condition in sub-Saharan Africa. Materials and Methods: All available published literature on neonatal hypothermia was searched electronically and manually. The principal electronic reference libraries and sites searched were PubMed, Embase, Ajol, Cochrane Reference Libraries and Google Scholar. The search terms used included 'neonatal hypothermia,' 'Cold stress in newborn' 'thermal care of the newborn,' 'neonatal thermogenesis,' 'neonatal cold injury,' among others. Pertinent books and monographs were accessed. Data in formats inaccessible to the reviewer were excluded. Result and Conclusion: Neonatal hypothermia is a major condition of public health importance in countries of sub- Saharan Africa. Awareness of the burden of the disease is still low in some communities. Risk factors for neonatal hypothermia in the region include poverty, home delivery, low birthweight, early bathing of babies, delayed initiation of breastfeeding and inadequate knowledge among health workers. Low-tech facilities to prevent heat losses and provide warmth are available in sub-Saharan Africa and are thus recommended as well as continuous efforts at sensitizing caregivers on the thermal needs of newborns.
  6,779 1,041 14
ORIGINAL ARTICLES
Comparison of IVF/ICSI outcome in patients with polycystic ovarian syndrome or tubal factor infertility
JE Okohue, SO Onuh, JI Ikimalo
April-June 2013, 16(2):207-210
Background: One of the recognized treatment options for patients with polycystic ovarian syndrome (PCOS) is in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Fears are however sometimes raised concerning the likely outcome of treatment in such patients compared with their counterparts with tubal factor infertility. Objective: To compare the IVF/ICSI performance in women with PCOS and those with tubal factor infertility. Materials and Methods: A retrospective analysis. Case notes of 30 patients, 35 years and below, with PCOS and who underwent 33 IVF/ICSI cycles and those of 42 age-controlled patients with tubal factor infertility and who had 43 cycles between December 2004 and April 2008 were retrieved. Data including duration of down-regulation, dose of human Menopausal Gonadotropin (hMG), number of cancelled treatments, endometrial thickness, number of oocytes retrieved and fertilization rate, in addition to the number of embryos transferred with resultant pregnancy outcome were compared between the two groups. The main outcome measures were response to gonadotropin stimulation, fertilization rate and clinical pregnancy rate. Results: There was no significant difference between the PCOS group and the tubal factor infertility group in the hMG dose (2.7 vs. 3.4 vials, respectively), endometrial thickness (10.5 vs. 10.1 mm, respectively) and embryos transferred (3.1 vs. 2.9, respectively). The fertilization rate was significantly higher in the tubal factor infertility group, which was 81.48% as against 63.24% for the PCOS group ( P < 0.0001). While more cases of ovarian hyperstimulation syndrome (OHSS) occurred in the PCOS group ( P = 0.049), overall clinical pregnancy rate per embryo transfer was similar (45.45% vs. 42.85%; P = 1), with similar miscarriage rates. Conclusion: IVF/ICSI performance in patients with PCOS is probably similar to their counterparts with tubal factor infertility with, however, a reduced fertilization rate and higher incidence of OHSS.
  6,908 718 -
Home births and postnatal practices in Madagali, North-Eastern Nigeria
M Bukar, YS Jauro
April-June 2013, 16(2):232-237
DOI:10.4103/1119-3077.110151  
Background: Home births are common in resource poor countries and postnatal practices vary from one community to the other. Objective: To determine the proportion of home births, reasons for home delivery, and evaluate postnatal practices in Madagali, north-eastern Nigeria. Materials and Methods: This was a cross-sectional descriptive study of 400 women of reproductive age, who had put to birth in the past 1 year. The study was carried out over a period of 8 weeks from April to June 2010. The multistage method of sampling was used to select respondents. In the first stage, four of the five health districts were chosen randomly, namely, Gulak, Madagali, Sukur, and Duhu. The questionnaires were evenly distributed among the four health districts. In the second stage, from each district, two villages were chosen by simple random sample. In the third stage, two wards were selected in each village by simple random sampling. Result: Of the 400 respondents interviewed, 289 (72.2%) were aged between 20 and 39 years, and most, 374 (93.5%) were married. Only 14 (3.5%) had tertiary education. Most respondents, 224 (56.0%) were farmers and grandmultiparae, 187 (46.7%). A total of 196 (49.0%) women delivered at home, whereas 204 (51.0%) delivered at the hospital. Of the 196 respondents who delivered at home, the bedroom 142 (72.4%), was the preferred place of birth. The most common reason for home birth was short duration of labor in 71 (36.3%) cases. Delivery was conducted by untrained persons in 50, (25.4%), whereas 99 (50.8%) and 31 (15.5%) deliveries were supervised by Traditional Birth Attendants (TBAs) and Midwives/Nurses, respectively. Postpartum, the majority, 235 (58.7%) respondents used sanitary pads to stanch lochia, whereas 140 (35%) used rags. Conclusion: A significant number of births take place in the home and supervised by unskilled persons. Against the backdrop of poor education and low socio-economic status of respondents, perineal hygiene can be adjudged satisfactory. There is the need to increase on the number of hospital birth and also trained TBA who conduct most of home deliveries.
  7,064 516 5
Determinants of undernutrition among primary school children residing in slum areas of a Nigerian city
CI Ndukwu, I Egbuonu, TO Ulasi, JC Ebenebe
April-June 2013, 16(2):178-183
DOI:10.4103/1119-3077.110142  
Background: Undernutrition remains the largest contributor to the global disease burden. Different factors affecting the nutritional status of children need to be studied to determine those to be targeted in a country like Nigeria, characterized by widespread poverty and inequitable distribution of wealth. Objective: This study was aimed at ascertaining the relationship between prevailing socioeconomic and environmental factors, and the nutritional status of children residing in a typical urban slum. Materials and Methods: A cross-sectional descriptive study of 788 children aged 6-12 years selected by stratified, multistage random sampling method from public primary schools in slum and non-slum areas of Onitsha was carried out. Their nutritional status was determined using anthropometric measures. The socioeconomic and environmental variables of interest were analyzed to determine their relationship with undernutrition in the children. Results: Socioeconomic status was the major determinant of nutritional status in this study. Poor housing also affected the nutritional status of the slum children who were significantly from poorer families than those residing in non-slum areas (χ2 = 66.69, P = 0.000). Conclusion: This study highlights the need for an effective nutrition program targeted at school children in urban slums surrounded by factors predisposing them to undernutrition.
  6,439 837 5
Enterocutaneous fistula: A review of 82 cases
GE Njeze, UJ Achebe
April-June 2013, 16(2):174-177
DOI:10.4103/1119-3077.110140  
Objective: Enterocutaneous fistula is an unpleasant and troublesome complication of abdominal operations. The objective was to review the outcome of treatment of patients treated for enterocutaneous fistula. Materials and Methods: This is a retrospective study of 82 teenage and adult patients, who suffered from enterocutaneous fistula, seen over an 11 year period, in the University of Nigeria Teaching Hospital, Enugu. Patients' charts were reviewed for biodata, etiology of the fistula, volume of the fistula output, and result of treatment. Majority of the fistulas occurred after abdominal operations; many by general practitioners. After treatment for correction of fluid and electrolyte deficits, they were all tried on conservative therapy with enteral nutritional support as the main stay of management. Those, whose fistulas did not close, underwent surgical treatment. Total parenteral nutrition, octreotide, fibrin glue, and wound vacuum assisted closure (VAC) were not used for treating these patients. Results: Spontaneous healing of fistulas occurred in 26 patients (31.7%), whereas 42 patients out of 50 (84%) healed after definitive operation. Fourteen patients (17%) in this study, died. Conclusion: Proper management of fluid and electrolyte imbalances, enteral nutritional support, control of sepsis and correctly timed surgical therapy, resulted in this good healing rate and acceptable mortality, without the use of parenteral nutrition, biologic fibrin glue injection or VAC. Suggestions are offered about steps that may help in eradicating some of these enterocutaneous fistulas.
  4,929 1,305 2
CASE REPORTS
Surgical management of Stenson's duct injury using epidural catheter: A novel technique
Sheetal R Kumar, V Hiremath, AG Patil, S Aparna
April-June 2013, 16(2):266-268
DOI:10.4103/1119-3077.110130  
Stenson's duct of parotid gland is a major duct which drains saliva into the oral cavity. Deep penetrating wound in the form of cut or crush injury to the buccal area carries the risk of parotid duct injury. It is in the form of ductal exposure, laceration, total severing, or crushing of the duct. These conditions are difficult to diagnose because of complex anatomy and variable nature of injury. Successful management of parotid duct injury depends on early diagnosis and appropriate intervention, failing of which may lead to complications like sialocele or salivary fistula. Many techniques have been proposed for diagnosis and management of parotid duct injuries. This article presents an easy and novel technique to diagnose and manage the parotid duct injuries using an "epidural catheter" which is often used for inducing spinal anesthesia. The technique of epidural catheter usage, its advantages, and limitation over other techniques proposed for the management of parotid duct injury are discussed.
  5,431 584 5
ORIGINAL ARTICLES
Acceptability of human papilloma virus vaccine and cervical cancer screening among female health-care workers in Enugu, Southeast Nigeria
EO Ugwu, SN Obi, PC Ezechukwu, II Okafor, AO Ugwu
April-June 2013, 16(2):249-252
DOI:10.4103/1119-3077.110141  
Background: Cervical cancer, a leading cause of cancer deaths in women in developing countries can be prevented primarily by vaccinating adolescent girls and women against infection by the human papillomavirus (HPV) before their first sexual exposure, and secondarily through screening and treatment of identified precancerous lesions. Aim: To determine the awareness and acceptability of the HPV vaccine and screening for cervical cancer among female health-care workers in Enugu, southeastern Nigeria. Materials and Methods: Questionnaires were administered to a cross-section of 177 female health-care workers selected systematically from the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria. Statistical analysis was both descriptive and inferential at 95% confidence level using the Statistical Package for Social Sciences (SPSS) computer software version 16. A P value of less than 0.05 was considered statistically significant. Results: The awareness of screening for cervical cancer (91%) was significantly higher than that of the HPV vaccine (62.7%) [odds ratio (OR): 0.17; 95% confidence interval (CI): 0.09-0.30]. However, the acceptability rate of the HPV vaccine (91.0%) was significantly higher than that of cervical screening (71.4%) (OR: 4.04;95% CI: 1.94-8.42)]. Only 25 (14.1%) of the health-care workers had done cervical screening, but 30 (49.2%) of the 61respondents with adolescent daughters had immunized their daughters with the HPV vaccine. Although no reason was given for the low participation in cervical screening, cost and availability of HPV vaccine was a major deterrent for the latter. Conclusion: With more public enlightenment, available and affordable HPV vaccine appears to hold the key for prevention of cervical cancer in developing countries where the burden is high.
  4,552 875 15
Intestinal helminthiasis and nutritional status of children living in orphanages in Benin City, Nigeria
DU Nwaneri, VO Omuemu
April-June 2013, 16(2):243-248
DOI:10.4103/1119-3077.110144  
Background : Intestinal helminths are often associated with poor growth and reduced physical activities, and may worsen already compromised nutritional status of children living in orphanages. Aims: To determine the relationship between intestinal helminthiasis and nutritional status of children living in orphanages in Benin City, Nigeria. Setting and Design: A cross sectional study carried out from January to April 2011 in orphanages in Benin City, Nigeria. Materials and Methods: Fresh stool samples from 140 children (0-17 years) living in 10 orphanages in Benin City, were analyzed using the Kato-Katz technique for the detection of ova of helminths between January and April 2011. Physical growth of the children was classified as stunted, wasted, and under-weight using height for age Z-score, weight for height Z-score, and weight for age Z-score below -2 standard deviation of the reference median, respectively, in the World Health Organization growth chart. Statistical Analysis: The data obtained was entered into spread sheet using the Microsoft Excel 2007 and the analysis was done using the Statistical Package for Social Sciences (SPSS) software versions 11.0 and 16.0 (SPSS Inc Chicago, IL, USA). Results: Prevalence of intestinal helminthiasis was 20.7% and was observed highest in children aged 12-17 years. Ascaris lumbricoides and Trichuris trichiura were the intestinal helminths isolated. Nearly all infected subjects had significant stunted growth ( P = 0.014) and another one-quarter were significantly under-weight ( P = 0.021) when compared with noninfected subjects. Conclusion: Intestinal helminthiasis is associated with under-weight and stunted growth.
  4,649 714 6
Relation of microalbuminuria to glycosylated hemoglobin and duration of type 2 diabetes
D Kundu, A Roy, T Mandal, U Bandyopadhyay, E Ghosh, D Ray
April-June 2013, 16(2):216-220
DOI:10.4103/1119-3077.110159  
Background: Nephropathy is one of the complications of type 2 diabetes mellitus that could lead to end-stage renal disease. Persistent microalbuminuria is the best predictor of high risk of developing diabetic nephropathy. The relation between HbA 1c and microalbuminuria with the duration of diabetes is not clear. Objectives: To determine microalbuminuria levels in type 2 diabetics and to correlate changes in microalbuminuria levels to glycosylated hemoglobin level and duration of diabetes. Materials and Methods: Study was conducted at Medical College, Kolkata. Fifty both male and female type 2 diabetics of age groups 30-60 years, without any complications were taken as cases and 50 healthy (male and female) subjects of comparable age were taken as controls. Cases with anemia, any other diseases or person using drugs that could affect HbA 1c levels and microalbuminuria were excluded from the study. Fasting and postprandial blood glucose, HbA 1c serum urea and serum creatinine were analyzed. Urine was analyzed for microalbuminuria. The Statistical Software SPSS 15.0 were used for the analysis of the data. Results: Urinary microalbumin, HbA 1c levels were significantly higher in the cases. Microalbumin levels were linearly correlated to the duration of diabetes and HbA 1c. Conclusions: Impaired glycemic control is associated with significant elevations in urinary microalbumin levels. Furthermore, there is an increased urinary microalbumin levels with increased duration of diabetes, which suggests that the detection of increased urinary microalbumin levels at the initial stage can avert, reduce the clinical and economic burden of diabetic complications in future.
  4,288 834 6
CASE REPORTS
Paraphenylenediamine poisoning
SC Chaudhary, KK Sawlani, K Singh
April-June 2013, 16(2):258-259
DOI:10.4103/1119-3077.110138  
Hair dye containing paraphenylenediamine (PPD) is widely used in India because of its free availability and low cost. PPD produces local as well as systemic toxic effects when applied topically and/or ingested. It is highly toxic when taken by mouth and the outcome depends mainly on the dose taken. Important clinical manifestations are angioedema leading to dysphasia and respiratory distress, rhabdomyolysis, intravascular hemolysis, acute renal failure and hepatic necrosis. Myocarditis or fatal arrhythmia may also occur in PPD poisoning. Mainstay of management is early recognition and supportive measures as there is no specific antidote. We hereby report a young female who presented to us with features of angioedema, cardiac manifestation and hepatic dysfunction after ingesting PPD, which was treated successfully. In the absence of laboratory facilities, clinical features like angioedema and chocolate brown-colored urine could be suggestive of PPD poisoning.
  4,336 657 4
ORIGINAL ARTICLES
Low birthweight delivery: Prevalence and associated factors as seen at a tertiary health facility
HAA Ugboma, CN Onyearugha
April-June 2013, 16(2):184-187
DOI:10.4103/1119-3077.110145  
Background: Low birth weight deliveries are major causes of a huge health burden on poor economies around the globe. It is even more worrisome in developing countries. Materials and Methods: The obstetric records of all low birth weight (LBW) deliveries were reviewed from 1 st June 2005 to 30 th May 2009. Results: The prevalence of LBW deliveries was 8.3%. Of the LBW babies, 68.4% were preterm, 53.6% were small for gestational age (SGA) and 12.6% were products of multiple gestations. Predominant factors associated with LBW delivery included nulliparity, low parities (1 and 2), parturient aged 25-35 years (80.6%), hypertensive disorders of pregnancy, and short birth spacing (84.4%). Conclusion: Most LBW babies were preterm delivered by low parity parturient aged 25-35 years with short inter-pregnancy intervals. Effective family planning and antenatal services provided particularly for these categories of potential parturient could help to curb the incidence.
  3,908 702 5
Could conscious sedation with midazolam for dental procedures be an alternative to general anesthesia?
E Silay, C Candirli, F Taskesen, I Coskuner, KT Ceyhanli, H Yildiz
April-June 2013, 16(2):211-215
DOI:10.4103/1119-3077.110160  
Aim: The aim of our study was to evaluate the likelihood that conscious sedation (CS) with intravenous midazolam could become an alternative modality to general anesthesia (GA) for dental procedures. Materials and Methods: In our study, 58 and 47 American Society of Anesthesiologists (ASA)-1 pediatric patients, aged 2-12 (mean 6) years, underwent dental procedures and minor oral surgical procedures under GA and CS with intravenous midazolam, respectively. The two groups were evaluated in terms of vital signs, duration of the treatment procedure, patient behavior, and the treatment comfort experienced by the physicians. Results: The oxygen saturation level was significantly lower (GA: 99.0 ± 0.30, CS: 98.4 ± 1.02; P < 0.001) and the duration of the treatment procedure was significantly shorter (P < 0.001) in the sedation group compared with the GA group. The physicians encountered various difficulties during implementation of the treatment strategy in cases where they used CS. Minor oral surgical procedures and tooth extraction processes requiring no saline irrigation, however, could be performed successfully under CS. Conclusions: In cases requiring multiple dental management issues, the sedation method was not found to be a useful alternative to GA.
  2,974 719 4
Coagulation profile of children with sickle cell anemia in steady state and crisis attending the university of Nigeria teaching hospital, Ituku-Ozalla, Enugu
JM Chinawa, IJ Emodi, AN Ikefuna, S Ocheni
April-June 2013, 16(2):159-163
DOI:10.4103/1119-3077.110132  
Background: Sickle cell anemia is associated with a hypercoagulable state that may lead to alterations in a coagulation profile. Measurements of coagulation factors are known to have some predictive value for clinical outcome. Objectives: To determine the coagulation profile of children with SCA in steady state and crisis and compare it with those with normal HbAA genotype. Materials and Methods: This is a prospective observational study involving 50 children with SCA in steady state, 50 in crises, and 50 with HbAA genotype, carried out from June to October 2009. All the values of coagulation profile were matched for age and sex. Results: The mean Prothrombin time (PT) (12.5 ± 1.2 secs), Activated partial thromboplastin time (aPTT) (41.6 ± 1.0 secs), and Thrombin time (TT) (12.3 ± 1.2 secs) of subjects with SCA in steady state as well as those during crises [PT (12.6 ± 1.8 secs), aPTT (45.6 ± 1.3 secs), TT (12.5 ± 1.7 secs)] were significantly prolonged compared to those of subjects with HbAA genotype. The mean bleeding time (BT) of 3.4 ± 1.0 mins was significantly shorter in children with SCA in steady state compared to those with HbAA genotype (3.7 ± 1.1 mins), (P < 0.038). Conclusion: Coagulation profile of patients with SCA is prolonged both in steady state and during crisis and when compared to those with HbAA genotype, though all values are within normal range.
  3,230 462 1
Depression among people living with human immunodeficiency virus infection/acquired immunodeficiency syndrome in Benin City, Nigeria: A comparative study
UE Chikezie, AN Otakpor, OB Kuteyi, BO James
April-June 2013, 16(2):238-242
DOI:10.4103/1119-3077.110148  
Background: Depression is a common co-morbidity among persons living with human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) (PLWHAs). It is associated with poor treatment adherence and higher mortality rates. Few reports have, however, emanated from developing countries where socioeconomic factors may confound this association. Materials and Methods: We conducted a cross-sectional comparative study of PLWHAs and apparently healthy staff of three LGA's. The depression module of the Schedule for the Clinical Assessment in Neuropsychiatry (SCAN) and the Beck Depression Inventory (BDI) was used to diagnose depression and depression symptom severity, respectively. Results: Depression was commonly co-morbid among individuals with HIV/AIDS. It was five times more common in PLWHAs than in apparently healthy populations (29.3% vs. 7.3%, OR: 5.25, 95% CI: 2.50-11.76). A similar trend was observed for depression symptom severity. Among PLWHAs, depression was significantly more likely among females (OR: 7.91, 95% CI: 1.83-71.00, P < 0.01), those unemployed (OR: 2.94, 95% CI: 0.18-1.82, P < 0.04), and with an illness duration >3 years (OR: 7.90, P < 0.0001). Having at least one child (OR: 2.79, 95% CI: 1.25-6.16, P < 0.001) and living with others (OR: 4.71, 95% CI: 1.51-15.52, P < 0.003) significantly reduced depression risk. Conclusion: Depression was commonly co-morbid among PLWHAs studied. Clinicians should be aware of risk factors for depression among PLWHAs in order to improve treatment outcomes.
  3,088 539 10
REVIEW ARTICLES
Biohazards associated with materials used in prosthodontics
S Padmaja
April-June 2013, 16(2):139-144
DOI:10.4103/1119-3077.110122  
Dental materials for permanent restorations are manufactured with the intent to be stable and insoluble, but they do not fully achieve this goal. The amount of dissolved components is small and their detection sometimes requires sophisticated analytical equipment. The minute amounts of components that leach out of permanent dental restorative materials are most unlikely to cause toxic reactions, locally or systemically. Reliable research information using robust methodology is thus needed to clarify the various safety issues and frequency of adverse reactions in general dentistry, including prosthodontic treatment.
  2,964 561 1
ORIGINAL ARTICLES
Comparison of the maternal and neonatal effects of bupivacaine plus fentanyl and ropivacaine plus fentanyl during cesarean delivery
Un Canan, D Örnek, O Kilci, F Dönmez, M Gamli, B Dikmen
April-June 2013, 16(2):195-200
DOI:10.4103/1119-3077.110154  
Purpose: The aim of the present study was to compare the anesthetic efficacy, and fetal and maternal effects of 7.5 mg (1 ml) intrathecal 0.75% hyperbaric ropivacaine + 25 μg (0.5 ml) fentanyl versus 5 mg (l ml) intrathecal 0.5% hyperbaric bupivacaine + 25 μg (0.5 ml) fentanyl in elective cesarean delivery. Materials and Methods: The study included 40 ASA I-II cases scheduled for cesarean delivery that were randomized into two groups of 20 cases each. Cases in the RF group were administered 0.75% hyperbaric ropivacaine + 25 μg (0.5 ml) fentanyl and those in the BF group were administered 5 mg (l ml) hyperbaric bupivacaine + 25 μg (0.5 ml) fentanyl into the spinal space. The time until spinal anesthesia in the T4 dermatome, overall duration of analgesia, hemodynamic parameters, Apgar score of newborns at 1-5 min, fetal blood gas values (pH, PO2, PCO2, HCO3−, and BE), maternal side effects, the degree of motor block, maternal need for ephedrine, objective pain scale score, and patient satisfaction were recorded in each group. Results: There were no significant differences between the groups in terms of the parameters evaluated (P > 0.05). Conclusion: In elective cesarean delivery, the combinations of bupivacaine + fentanyl or ropivacaine + fentanyl exhibited similar anesthetic efficacy, and fetal and maternal effects.
  2,596 691 2
Experience with diagnostic laparoscopy for gynecological indications
JI Ikechebelu
April-June 2013, 16(2):155-158
DOI:10.4103/1119-3077.110129  
Context: Diagnostic laparoscopy is an endoscopy procedure, which has become indispensable in the evaluation of the female reproductive organs especially in infertility. Aim: Experience with conversion to open laparotomy is presented and ways of averting this complication are discussed. Settings and Design: A retrospective study was performed. Materials and Methods: All the 1654 diagnostic laparoscopies performed at a private fertility center over a 10-year period (January 2000 to December 2009) were analyzed for indications, cases of conversion to open laparotomy, and measures taken to prevent this complication. Statistical Analysis Used: Simple percentage method was used. Results: Infertility was the commonest indication for 1627 (98.4%) procedures, while primary amenorrhoea and chronic pelvic pain were responsible for 20 (1.2%) and 7 (0.4%) procedures, respectively. There was no mortality in this series. There was conversion to open laparotomy due to hemorrhage in only 2 (0.12%) procedures and this happened at the first year of practice. Conclusions: The low rate of conversion was attributed to the surgeons experience, proper patient selection, and the use of Palmers point for insufflation in some patients with previous pelvic surgeries and use of supraumbilical access in patients with pelvic masses. Diagnostic laparoscopy for gynecological indications is safe and wider application of this modern technology is recommended for our practice.
  2,784 420 4
Patterns of presentations at a free eye clinic in an urban state hospital
MB Hassan, SA Olowookere, NA Adeleke, CA Akinleye, EG Adepoju
April-June 2013, 16(2):145-148
DOI:10.4103/1119-3077.110124  
Background: Provision of affordable eye care is one of the cardinal programs of the Osun State Government of Nigeria. Objective: The objective of this study was to assess the pattern of eye diseases presenting in a secondary health care facility based at Osogbo the State Capital. Materials and Methods: We reviewed the hospital records of all patients that were cared for at the eye clinic of the State Hospital, Osogbo, Osun State, Nigeria from January 2009 to December 2010. Results: A total of 1018 patients were attended to at the eye clinic during the period of review. Mean age of these patients was 49.4 ± 23.2 years. There were 408 (40.1%) males and 610 (59.9%) females with a female-male ratio of 1.5 : 1. Most of them were traders (28.1%) and married (32.1%). Vernal conjunctivitis (21.1%), cataract (14%), glaucoma (11.1%), and refractive errors (20.7%) were the main eye diagnoses. Conclusion: Preventable causes of blindness were quite common among the patients. There is a need for community education to reduce the prevalence of these diseases in the general population.
  2,675 433 1
Effects of user experience and method in the inflation of endotracheal tube pilot balloon on cuff pressure
AB Ozer, I Demirel, G Gunduz, OL Erhan
April-June 2013, 16(2):253-257
DOI:10.4103/1119-3077.110139  
Context: Endotracheal tube cuff pressure (ETCP) is recommended to be maintained between 20-30 cm H2O limits. While insufficient inflation of ETC may cause aspirations, over-inflation of it may lead to damage in tracheal epithelium. Aims: We planned to investigate the effects of user experience and cuff pressure inflation method differences following endotracheal tube cuff pressure and complaints about it. Patients and Methods: Two hundred and fifty patients planned for general anaesthesia were included in this study. ETC was inflated by users with different experience according to leakage or pilot balloon palpation techniques. ETCPs were measured by manometer at three periods (5 and 60 minutes after endotracheal intubation, and before extubation). Complaints about it were recorded in post anaesthetic care unit and 24 hours postoperatively. Results: Though we found experience of user had significant effect on the ETCP regulations, we observed inflation methods did not have any effect. However we found ETCP was higher than normal range with experienced users. A correlation was observed between cuff pressure and anaesthesia duration with postoperative complaints. Conclusions: Our study concluded that the methods used do not have any significant advantage over one another. While ETC inflated at normal pressure increases as user's experience increases, experience alone is not enough in adjusting ETCP. A manometer should be used in routine inflation of ETC instead of conventional methods. CP and anaesthesia duration have correlations with some postoperative complaints.
  2,507 572 7
Presentation, distribution pattern, and management of diverticular disease in a Nigerian tertiary hospital
OI Alatise, AO Arigbabu, OO Lawal, VA Adetiloye, EA Agbakwuru, DA Ndububa
April-June 2013, 16(2):226-231
DOI:10.4103/1119-3077.110152  
Background: Colonic diverticular disease is one of the most common and costly gastrointestinal disorders among industrialized societies, which have recently been described among Africans. Presentations and distribution pattern of the disease among Africans appeared to be different from that described among the Western population. We embark on this study aimed at evaluating the presentation, distribution pattern, and the management of diverticulosis in our tertiary health facility. Materials and Methods: A prospective descriptive study of the cases of diverticular disease seen between January 2007 and December 2011 at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria. Results: During the 5-year study period, 40 cases were seen. The patients were aged 41-85 years with a median age of 64 years. There were 29 (72.5%) male and 11 (27.5%) female with an average male to female ratio of 3:1. The most common presentation was bleeding per rectum in 28 (70%) patients, which mostly needed transfusion. Ten (25%) patients presented with recurring abdominal pain, whereas one (2.5%) patient presented with abdominal mass and features of intestinal obstruction. Thirty patients were diagnosed on colonoscopy, eight on barium enema, and two on computerized tomography scan. Thirty-four (85%) patients had a pancolonic disease. All the patients were placed on high fiber diet and antibiotics namely ciprofloxacin and metronidazole. Five patients had recurrence within 6 months of follow up, of which one had emergency colectomy. Conclusion: Diverticular disease is no longer a rare disease in Nigeria. It is a common cause of lower gastrointestinal bleeding in elderly patients. High index of suspicion for diverticular disease of the colon and its complications should increase in the country.
  2,593 337 1
Pediatric maxillofacial injuries at a Nigerian teaching hospital: A three-year review
OO Daniel, AI Olushola , Ver-or Ngutor, AB Idemudia, AR Adetokunbo, IA Cornelius, EA Akinwale
April-June 2013, 16(2):149-154
DOI:10.4103/1119-3077.110126  
Aim: To determine the nature of pediatric maxillofacial injuries, according to etiology and characteristics of patients. Materials and Methods: The records of patients aged 15 years and below who presented with maxillofacial trauma to the Maxillofacial Clinic of Aminu Kano Teaching Hospital, Kano, Nigeria over a 3-year period were retrospectively examined. Patients' demographic and etiologic factors were obtained and analyzed. A P value of <0.05 was considered significant. Results: A total of 160 patients comprising males, 102 (63.8%) and females 58 (36.2%), were seen over the period of study. The age of patients range from 4 months to 15 years, mean 7.07 ± 4.52 years. There was no gender difference in terms of age (P < 0.05). Road traffic accident (RTA) was the most common etiologic factor accounting for 45.0% of cases. This was followed by fall (40.6%). Animal related injury and violence accounted equally for 3.8%. Soft tissue injuries in the form of abrasion, laceration and avulsion accounted for 70.0% of cases. Other anatomical sites included the mandible (16.3%), dento-alveolar fractures(12.5%), and midface (1.3%). Conclusion: Road traffic accident and falls still remains the leading cause of maxillofacial injuries in children in this part of the globe. There is a need to reinforce existing traffic laws that aimed at minimizing the menace of RTA-related accidents.
  2,117 481 4
The serological study of cystic echinococcosis and assessment of surgical cases during 5 years (2007-2011) in Khorram Abad, Iran
M Zibaei, A Azargoon, M Ataie-Khorasgani, K Ghanadi, SM Sadjjadi
April-June 2013, 16(2):221-225
DOI:10.4103/1119-3077.110156  
Background: Echinococcus granulosus is a cestode whose larval stage causes cystic echinococcosis in wild animals, livestock, and human. Objective: The aim of this study is to highlight the seroepidemiology of E. granulosus infection and surgical cases in the general population of Khorram Abad district, southwest of Iran. Materials and Methods: Anti-E. granulosus antibodies were tested in 617 inhabitants in Khorram Abad by enzyme-linked immunoassay and antigen B. The surgical cases of cystic echinococcosis were investigated in Shohaday-e-Ashayer Hospital of Khorram Abad (as a referral center) from 2007 to 2011. Results: In total, 95 (15.4%) of the 617 participants (mean age 39.6 ± 17.6 years) had anti-E. granulosus antibodies. Prevalence of infection was more in males (60%) than females (40%), and showed statistical significance (P < 0.001). High-titer antibodies were most prevalent among the subjects aged 20-29 years. There was significant association between the presence of Echinococcus antibodies and the sector of residence, education of volunteers, and occupation (P < 0.05). According to hospital records, 58 cystic echinococcosis cases were referred to the hospital during the 5 years. Among the cases, 28 (48.3%) were men and 30 (51.7%) were women. They were between 4 and 74 years of age (36.6 ± 18.9 years). The liver was the organ where most of the hydatid cysts (51.7%) were located, followed by lungs (20.7%). Conclusion: This is the first report of the seroprevalence and contributing factors for E. granulosus infection in the general population in Khorram Abad. The findings confirm the importance of diagnosing human cystic echinococcosis in these regions, given the prevalence rates of surgical cases during the last 5 years, and need further evaluation of the risk factors present.
  1,914 457 9
CASE REPORTS
Giant fibrous tumours of the pleura with mucus secretion
L Huang, Y Chai
April-June 2013, 16(2):260-262
DOI:10.4103/1119-3077.110136  
Solitary fibrous tumors of the pleura (SFTP) are rare. We report a case of giant SFTP treated by surgical resection. We found that many soft tumors were separated by fibrous cords and creamy white mucus in our case. Among them, one great mass measured 23 cm × 18 cm × 10 cm. These tumors weighed 3750 g. The patient had no postoperative complications and received a good prognosis.
  1,797 223 1
New-onset diabetes after renal transplantation: A case series as seen in a Nigerian kidney transplant population
B Adamu, AE Uloko, A Aliyu, N A'isha
April-June 2013, 16(2):263-265
DOI:10.4103/1119-3077.110134  
New-onset diabetes after transplantation (NODAT) is an important metabolic complication of transplantation because of its associated morbidity and mortality. Risk factors for NODAT include those known to cause diabetes mellitus in non-transplant patients as well as transplant-specific factors. This study was aimed at illustrating the presentation and management of NODAT in three kidney transplant recipients in our center and reviewing the literature. To our knowledge, this is the first report from Nigeria. Two of the patients were males of ages 60 and 36 years, respectively, while the third was a female aged 25 years. They were all receiving prednisolone, two were on tacrolimus, and one was on cyclosporine as part of their immunosuppressive regimens. They developed NODAT at varying times post transplant, ranging from 3 months to 6 years. Two patients were managed with oral hypoglycemic agents and one with insulin. One patient died of hemorrhagic stroke. We conclude that NODAT occurred in our kidney transplant recipients and recommend that physicians should have a high index of suspicion in order to make an early diagnosis and institute appropriate management to reduce morbidity and mortality.
  1,475 337 -
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