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   2013| July-September  | Volume 16 | Issue 3  
    Online since June 14, 2013

 
 
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ORIGINAL ARTICLES
Adherence counseling and reminder text messages improve uptake of antiretroviral therapy in a tertiary hospital in Nigeria
O Maduka, CI Tobin-West
July-September 2013, 16(3):302-308
DOI:10.4103/1119-3077.113451  PMID:23771450
Context: Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) is one of the world's most challenging pandemics. For treatment with Highly Active Anti-Retroviral Therapy (HAART) to be effective, high rate of adherence is essential. Aim: To demonstrate the effect of adherence counseling and text message reminders in improving patients' adherence to HAART. Settings and Design: A randomized control trial among non-adherents was carried out in a tertiary hospital in Nigeria between March and July, 2011. Materials and Methods: A total of 104 patients: 45 males (43.3%) and 59 females (56.7%) participated in the study. They were randomized into intervention and control groups. The intervention group received monthly adherence counseling and twice weekly short message reminders for four months, while the control group received only standard care. Self-reported adherence and CD4+ cell counts were measured pre- and post-intervention. Statistical Analysis Used: Data was analysed using Statistical Package for Social Sciences (SPSS) version 18. Risk rates, Chi-square, Mann-Whitney U test and Cohen's effect size were calculated. Level of significance was set at P = 0.05. Results: At post-intervention, 76.9% of the intervention group and 55.8% of the control group achieved adherence (χ2 = 5.211, P = 0.022, RR = 0.75 (0.55-0.96), Cohen's w = 0.224). Also, median CD4+ cell count of the intervention group increased from 193 cells/ml to 575.0 cells/ml against 131.0 cells/ml to 361.5 cells/ml in the control group (P = 0.007). Conclusion: Adherence counseling and text message reminders improved adherence among HIV patients. Its adoption for HIV patient management is advocated.
  72,017 1,186 40
Utilization of insecticide treated nets among pregnant women in Enugu, South Eastern Nigeria
EO Ugwu, PC Ezechukwu, SN Obi, AO Ugwu, TC Okeke
July-September 2013, 16(3):292-296
DOI:10.4103/1119-3077.113449  PMID:23771448
Background: The goal of roll back malaria partnership is to achieve universal coverage for all populations at risk using appropriate interventions for prevention and case management. Objective: The objective of this study is to determine the use of insecticide treated nets (ITNs) and other anti-vector measures among pregnant women in an area hyper-endemic for malaria. Materials and Methods: Questionnaires were administered to a cross-section of 832 consecutive pregnant women attending antenatal care in three hospitals in Enugu, Nigeria that have high client flow for maternity services. Data collected were analyzed using descriptive and inferential statistics by means of the Statistical Package for Social Sciences (SPSS) version 16. P-value of less than 0.05 was considered statistically significant. Results: The mean age of the women was 33.2 ± 2.9 (range: 15-45) years. Three hundred and fifty nine (43.1%) women owned insecticide treated nets (ITNs), however 325(90.5%) slept under the nets during the index pregnancies; equivalent to 39.1% utilization rate among the 832 women studied. Out of the 325 (39.1%) women that used ITNs; 236 (28.4%) used it singly, while 89 (10.7%) used it in combination with other anti-vector measures. Educational status and social class of the women had strong association with the use of ITNs (P < 0.0001). Women who used ITNs were significantly less likely to have acute malaria, anaemia and babies with low birth weight than women who did not use ITNs (P < 0.05). Conclusion: The use of ITNs is poor among pregnant women in Enugu, but associated with favorable maternal and feto-neonatal outcome. Future measures to increase its use should consider improvement in educational level and social class of our women.
  9,128 843 10
Pattern of liver disease admissions in a Nigerian tertiary hospital
SC Nwokediuko, PC Osuala, UV Uduma, AK Alaneme, CC Onwuka, C Mesigo
July-September 2013, 16(3):339-342
DOI:10.4103/1119-3077.113458  PMID:23771457
Objective: Liver disease is an important cause of morbidity and mortality globally. Its pattern varies in different geographical locations. This study aimed to determine the pattern and risk factors of liver disease in a Nigerian tertiary hospital. Study Design: Retrospective Study Site: University of Nigeria teaching hospital Ituku/Ozalla, Enugu state, Nigeria. Materials and Methods: Case notes of patients admitted with a diagnosis of liver disease were reviewed and information relating to demographics, risk factors for liver disease and results of relevant investigations extracted. Results: Liver diseases accounted for 7.9% of medical admissions, with primary liver cancer and liver cirrhosis accounting for 44.3% and 20.4%, respectively. The main risk factors were alcohol consumption (52.1%), hepatitis B virus infection (49.4%), ingestion of herbs and roots (45.5%) and cigarette smoking (30.1%). Conclusion: Liver cirrhosis and primary liver cancer account for two thirds of liver disease in hospitalized patients in a Nigerian tertiary hospital. The major putative risk factors are alcohol consumption, hepatitis B virus infection, use of herbs and roots and smoking.
  8,508 881 5
Prevalence and pattern of sickle cell disease in premarital couples in Southeastern Nigeria
GA Nnaji, DA Ezeagwuna, IJF Nnaji, JO Osakwe, AC Nwigwe, OW Onwurah
July-September 2013, 16(3):309-314
DOI:10.4103/1119-3077.113452  PMID:23771451
Context : Premarital haemoglobin screening is an important strategy for the control of Sickle Cell Disease. Aims: To determine the prevalence and pattern of sickle cell disease among premarital couples and to assess their attitude to the risk of sickle cell anaemia in their offspring. Settings and Design: A cross sectional descriptive study using interviewer administered questionnaire and haemoglobin screening to collect data. Materials and Methods: Systematic sampling of every third premarital couples attending the General outpatient Clinic of Nnamdi Azikiwe University Teaching Hospital, Nnewi, between November 2010 and October 2011 was used to select the subjects for the study. Statistical Analysis Used: SPSS version 16 was used for statistical analysis of data from 212 premarital couples or 424 subjects. Results: The prevalence of HbAA and HbAS were 72.64% or 308/424 and 26.4% or 112/424, respectively, while HbSS was 0.94% or 4/424. In 95.3% of the couples there was no risk of offspring inheriting sickle cell anaemia. An equal percentage of males (χ2 = 24.704; df = 6; P = 0.000) and females (χ2 = 12. 684; df 6; P = 0.048) (67.9% or 144/212) would call-off their marriage if there was risk of their offspring being HbSS. Conclusions: Three quarters of the premarital couples had HbAA, while one quarter had Sickle cell trait. A very low percentage of the couples (2.8%) had 1:4 risk of their offspring inheriting SCA (HbSS). About 2/3 of the subjects would call-off the marriage if there was risk of their offspring inheriting SCA.
  8,450 793 3
REVIEW ARTICLE
Urinary free cortisol in the diagnosis of Cushing's syndrome: How useful?
AO Ifedayo, AF Olufemi
July-September 2013, 16(3):269-272
DOI:10.4103/1119-3077.113445  PMID:23771444
Cushing's Syndrome results from chronic exposure to excessive circulating levels of glucocorticoids. To confirm the clinical suspicion, biochemical tests are needed. These biochemical tests include the measurement of excess total endogenous cortisol secretion assessed by 24-hour urinary free cortisol (UFC), loss of the normal feedback of the hypothalamo-pituitary-adrenal axis assessed by suppressibility after dexamethasone testing, and disturbance of the normal circadian rhythm of cortisol secretion assessed by midnight serum or salivary cortisol. We searched the Medline, Pubmed, journal articles, WHO publications and reputable textbooks relating to Cushing's syndrome using publications from 1995 to 2011. UFC has been the classic screening test used to confirm hypercortisolemia as the first step in diagnostic work-up of Cushing's syndrome. Its long-term use in clinical practice has led to emergence of significant evidence regarding the utility of UFC in the diagnosis of Cushing's syndrome. UFC would have been a simple diagnostic tool to use but for the drawbacks in the sample collection, different laboratory methods of assay, not easily determined normal range. UFC use as a screening test is not strongly favoured because cortisol is not uniformly secreted during the day, and the increased prevalence of mild, preclinical or cyclic Cushing's syndrome. A very high level of UFC negates the need for other test procedures in patients with obvious symptoms and signs of Cushing's syndrome. We therefore suggest that UFC should be used with other screening tests for Cushing's syndrome to increase diagnostic yield.
  7,846 1,173 2
CASE REPORTS
Rare malformation of glans penis: Arteriovenous malformation
Y Akin, M Sarac, S Yucel
July-September 2013, 16(3):389-391
DOI:10.4103/1119-3077.113471  PMID:23771468
Pediatric glans penis malformations, especially arteriovenous malformations (AVM), are very rare. Herein, we report two rare cases. A 14-year-old boy attended our outpatient clinic with chief complaints of purple swelling and rapidly growing lesion on the glans penis. The lesion was excised surgically after physical and radiological evaluations. Pathology reported AVM and the patient is being followed up. The second case is a 2-year-old boy who was admitted with a big lesion involving glans penis and genital area that has been present since birth. In physical and radiological evaluations, lesion on the glans penis was pulsatile. Parents of the patient did not want any surgery and patient has been in follow-up. Diagnosis of the vascular lesions on glans penis is very easy by physical and radiological examinations today. Long-term follow-up is very important for AVM. Clinicians must make a careful effort to document new glans lesions in the pediatric population and decrease anxiety in the parents of affected children.
  5,653 356 1
ORIGINAL ARTICLES
Accuracy of Prader orchidometer in measuring testicular volume
TU Mbaeri, JC Orakwe, AM Nwofor, KC Oranusi, OO Mbonu
July-September 2013, 16(3):348-351
DOI:10.4103/1119-3077.113460  PMID:23771459
Background: Seminiferous tubules comprise 80-90% of testicular mass. Thus, the testicular volume is believed to be an index of spermatogenesis. Therefore, accurate testicular volume is one way to assess testicular function. Objective: To determine the accuracy of Prader orchidometer for measuring the testicular volume by comparing the resultant measurement with the actual testicular volume in humans. Materials and Methods: The testicular volumes of 121 testes from 62 patients with prostate cancer (mean age 72.74 ± 9.38 years) were measured using Prader orchidometer before therapeutic bilateral orchidectomy. The actual testicular volumes were then determined by water displacement of the testis. Results: The mean testicular volume of the 121 testes was 10.60 ± 3.5 ml and13.26 ± 5.2 ml for water displacement and Prader orchidometer measurements, respectively. A strong correlation was found between the actual testicular volume and volumes obtained by Prader orchidometer ( r = 0.926, P = 0.0001). The Prader orchidometer however, over-estimated the mean actual testicular volume by 2.66 ± 2.37 ml (25.10%). Conclusion: The result of this study has shown that measuring the testicular volume by Prader orchidometer overestimates the actual testicular volume.
  5,265 492 4
Gender difference on patients' satisfaction and expectation towards mental health care
Abdulbari Bener, Suhaila Ghuloum
July-September 2013, 16(3):285-291
DOI:10.4103/1119-3077.113448  PMID:23771447
Background: Recognizing patient satisfaction and expectation is considered as important components of assessing quality of care. Aim: The aim of this study was to determine the gender difference on the patient satisfaction with psychiatrists and explore their expectation from physicians to mental health care needs. Design: This is a prospective cross sectional study conducted during the period from April 2009 to July 2009. Setting: Psychiatry hospital of the Hamad Medical Corporation. Subjects: A total of 1300 psychiatry patients aged 18 to 65 years were approached and 1054 (81.1%) patient's participated in this study. The study sample included only Qatari and other Arab nationals. Materials and Methods: The study was based on a face to face interview with a designed Patient Doctor Relationship Questionnaire (PDRQ). A standard forward-backward procedure was applied to translate the English version of the PDRQ to Arabic. The main outcome measures of the study were 13-item patient doctor relationship questionnaire (PDRQ) score and other 11 items assessing what patients need from psychiatrists. Also, Socio-demographic data of the patients were collected. PDRQ was administered by qualified nurses among the psychiatry patients. Results: Of the studied patients, 50.9% were males and 49.1% were females. Male patients (55.5%) were more satisfied with the treatment of psychiatrists than females (44.5%). A significant association was observed between male and female patients in terms of marital status (P = 0.02), number of children (P < 0.001), education level (P = 0.001) and monthly household income (P = 0.03). The satisfaction level significantly increased with higher education in both the groups (P = 0.001). The satisfaction level of male patients was significantly higher than female patients in most of the satisfaction areas (P ≤ 0.001). Male patients had significantly high expectations from psychiatrists than females (P < 0.001). Both the groups had different attitude in assessing mental health needs. Conclusion: The study findings revealed that in general, psychiatry patients were quite satisfied with the services provided by the psychiatrists and the study found a gender difference in their satisfaction level with the mental health care. Male patients had significantly greater expectations from psychiatrists than females. The individuals of lower socio-economic status and less education tend to be less satisfied with the mental health care.
  4,305 656 13
Accuracy of impressions with different impression materials in angulated implants
S Reddy, K Prasad, H Vakil, A Jain, R Chowdhary
July-September 2013, 16(3):279-284
DOI:10.4103/1119-3077.113447  PMID:23771446
Purpose: To evaluate the dimensional accuracy of the resultant (duplicative) casts made from two different impression materials (polyvinyl siloxane and polyether) in parallel and angulated implants. Materials and Methods: Three definitive master casts (control groups) were fabricated in dental stone with three implants, placed at equi-distance. In first group (control), all three implants were placed parallel to each other and perpendicular to the plane of the cast. In the second and third group (control), all three implants were placed at 10° and 15 o angulation respectively to the long axis of the cast, tilting towards the centre. Impressions were made with polyvinyl siloxane and polyether impression materials in a special tray, using a open tray impression technique from the master casts. These impressions were poured to obtain test casts. Three reference distances were evaluated on each test cast by using a profile projector and compared with control groups to determine the effect of combined interaction of implant angulation and impression materials on the accuracy of implant resultant cast. Results: Statistical analysis revealed no significant difference in dimensional accuracy of the resultant casts made from two different impression materials (polyvinyl siloxane and polyether) by closed tray impression technique in parallel and angulated implants. Conclusion: On the basis of the results of this study, the use of both the impression materials i.e., polyether and polyvinyl siloxane impression is recommended for impression making in parallel as well as angulated implants.
  3,680 956 3
Malaria diagnosis and treatment amongst health workers in University of Nigeria Teaching Hospital Enugu, Nigeria
MD Ughasoro, HU Okafor, CC Okoli
July-September 2013, 16(3):329-333
DOI:10.4103/1119-3077.113456  PMID:23771455
Background: Confirmation of malaria and appropriate treatment are keys to malaria control. Objective: To determine the practice of malaria diagnosis and treatment in a Nigerian tertiary hospital. Materials and Methods: Retrospective review of patients' records at the Children's Clinic in UNTH. Results: Out of 6,684 children seen within the one year reviewed period, children diagnosed with malaria were 35.8 percent. Males were 60 percent and females were 40 percent. Children under five years were 72.6 percent of the total. Folders successfully traced were 1012; in 92 percent investigations for malaria were requested while 32 percent had differential diagnosis. Out of the 931 malaria investigations requested, 30percent did the tests and positive results were 94.9 percent. Presumptive treatment was 98 percent. Majority (83.3%) received ACTs. Conclusion: The practice of presumptive treatment was high and few cases had a differential diagnosis. Training of health workers on the need to confirm malaria cases is required.
  3,322 466 5
Teachers' knowledge and attitudes towards seizure disorder: A comparative study of urban and rural school teachers in Akwa Ibom State, Nigeria
MU Akpan, EE Ikpeme, E-OE Utuk
July-September 2013, 16(3):365-370
DOI:10.4103/1119-3077.113465  PMID:23771463
Background: Knowledge and attitude of school teachers with regard to seizure disorder has an important impact on continuation of schooling of children with seizure disorder. Though school teachers in both rural and urban settings are exposed to the same training, their perception of seizure disorder could be influenced by the environment in which they reside. Objectives: To determine the knowledge and attitudes of school teachers towards children with seizure disorder, and the influence of urban residence on perception of seizure disorder by the teachers. Materials and Methods: A self-administered questionnaire on knowledge and attitudes to seizure disorder were filled by school teachers drawn from both urban and rural settings in Akwa-Ibom State, Nigeria. Results: One-hundred and thirty-two urban school teachers and an equal number of their rural counterparts completed the questionnaire. There were significantly more female teachers in the urban schools whereas the rural schools were dominated by male teachers with male to female ratio of 1:5.6 and 1.2:1, respectively. Majority of the urban (60.6%) and rural (57.6%) school teachers were National Certificate of Education holders. Thirty-eight (28.8%) of urban respondents versus eight (6.1%) of rural respondents thought seizure disorder was caused by evil spirits whereas 60 (45.5%) urban respondents compared to 80 (60.6%) of rural respondents felt seizure disorder was infectious. Majority of the respondents from both urban and rural schools (68.2% and 63.6% respectively) believed that the foam from the mouth of a convulsing child with seizure disorder is the infecting agent. However, 62.1% of urban respondents as well as 45.5% of rural respondents would advise that children with seizure disorder be admitted into special schools. There was no significant difference in the mean overall knowledge and attitudes of school teachers to seizure disorder in the two settings ( P = 0.33 for knowledge and 0.28 for attitudes). Teachers' high level of education however, had a positive influence on their knowledge and attitudes towards children with seizure disorder. Conclusion: School teachers in both urban and rural schools exhibited poor knowledge and negative attitudes towards children with seizure disorder. Residing in the urban setting did not have a positive impact on teachers' perception of seizure disorder. Massive health education on seizure disorder is therefore advocated for teachers in both urban and rural schools.
  3,258 503 10
The value of international prostate symptom scoring system in the management of BPH in Jos, Nigeria
OC Amu, EI Udeh, AI Ugochukwu, NK Dakum, VM Ramyil
July-September 2013, 16(3):273-278
DOI:10.4103/1119-3077.113446  PMID:23771445
Objective: To determine the value of international prostate symptom scoring (IPSS) system in management of patients with benign prostatic hyperplasia (BPH) in Jos, Nigeria. Materials and Methods: This was a prospective study of 104 newly diagnosed patients with BPH from June 2006 to July 2007. Patients' symptoms were initially evaluated by administering a pretreatment IPSS/Quality of Life Score (QOLS). This categorized patients into mild, moderate, and severe symptom groups. The mild symptom group had watchful waiting as mode of management. The moderate symptom group received doxazosin, an alpha blocker, while the severe symptom group had prostatectomy. A post-treatment IPSS/QOLS was administered 3 months after. Mean changes in IPSS/QOLS was calculated and subjected to paired student's t- test for significance in changes. Spearman's correlation coefficient was used to test significance between correlations. Results: Mean age of patients was 64.3 years. 3 patients (2.9%), 53 patients (51.0%), and 48 patients (46.1%) fell into the minor, moderate, and severe symptom categories, respectively. The QOLS correlated with IPSS. There was a mean change in symptom scores of +2.3 for the minor symptom category, -8.1 (P < 0.001) for IPSS and -1.7 (P < 0.001) for QOLS in the moderate symptom category, and -24.6 (P < 0.001) for IPSS and -4.0 (P < 0.05) for QOLS in the severe symptom category. Conclusion: The study has shown that IPSS is a valuable tool in management of patients with BPH.
  3,171 469 -
A prospective clinical evaluation of the longevity of resorbable sutures in oral surgical procedures
B Fomete, BD Saheeb, AC Obiadazie
July-September 2013, 16(3):334-338
DOI:10.4103/1119-3077.113457  PMID:23771456
Introduction : The objectives of this prospective randomized study were to clinically evaluate the longevity of resorbable sutures (chromic catgut and vicryl) and determine the effect of chlorhexidine mouth wash on their absorption time in oral surgical procedures. Both sutures were of size 3/0 with round body needle and were placed using the standard technique. Methods and Materials : One hundred patients selected for the study were divided into two groups of 50 patients each (vicryl and chromic catgut groups). Each group was subsequently subdivided into chlorhexidine (17 cases); warm saline mouth wash (17 cases) and warm water mouth wash (16 cases (control). Results: The sutures were placed during various minor surgical procedures e.g. third molar surgery (65 cases), incisional biopsy (7 cases), excisional biopsy (8 cases), sutured lacerations (10 cases) and malar elevations through intraoral upper buccal sulci approach (8 cases) and 2 cases of cystic enucleations. The mean longevity of chromic catgut for chlorhexidine was 11.4 days with a range of 5-16 days. The patients, who used warm saline mouth wash, had a mean longevity of 11.7 days with a range of 7-24 days. The mean longevity of vicryl in patients that used chlorhexidine was 22.7 days, with a range of 14-36 days and that of warm saline mouth wash was 24.5 days with a range of 14-47 days. Conclusion : The resorbable sutures investigated have a mean longevity, which was slightly shorter than the figure stated by the manufacturer. Chlorhexidine was found to have no appreciable effect on absorption time of the sutures.
  2,740 622 2
Cranial bony decompressions in the management of head injuries: Decompressive craniotomy or craniectomy?
WC Mezue, C Ndubuisi, SC Ohaegbulam, M Chikani, U Erechukwu
July-September 2013, 16(3):343-347
DOI:10.4103/1119-3077.113459  PMID:23771458
Objective: Decompressive surgery is one of the available options in dealing with traumatic brain injury (TBI) when clinical and radiological evidence confirm that medical treatment may be insufficient. This can be achieved either by complete removal of the bone or by allowing it to float, but the indications and utility of these are yet to be resolved. This study examines the indications and outcome for both procedures. Materials and Methods: Review of all cases of bony decompression done at the Memfys Hospital for Neurosurgery, Enugu, Nigeria from August 2002 to May 2010. Prospectively recorded data of CT, MRI, operating room, clinics and wards were utilized. Results: There were 38 patients out of whom 35 were males and 3 females. The mean age was 36 years (range 15-80). The causes of the predisposing TBI were road traffic accidents (RTA) (79%), gunshot (10.5%), and assault (7.9%). Decompressive surgery was unilateral in 36 and bi-frontal in 2. Decompressive craniectomy with bone stored in anterior abdominal wall pocket was done in 8 patients and decompressive craniotomy with bone left in situ in 30. Of the latter, bone was unsecured and allowed to float in 13 and the craniotomy was lightly anchored with sutures in 17 patients. Surgery was performed within 24 h in 68.4% of cases. Mortality was 21.1% overall but was up to 25% in the more severely injured patients who had craniectomy. Conclusion: Bony decompression is useful in the management of head trauma. Careful selection of cases and appropriate radiological assessment are important and will guide decision for either craniotomy or craniectomy.
  2,687 582 5
Measurement of normal ocular volume by the use of computed tomography
BO Igbinedion, OU Ogbeide
July-September 2013, 16(3):315-319
DOI:10.4103/1119-3077.113453  PMID:23771452
Background: Reduction or increase in ocular volume may indicate ocular pathology. Unfortunately the reference values utilized for ocular volume had been that of non-Africans. It is therefore pertinent to have a reference value of normal for Africans. Objective: To document the computer tomography (CT) scan measured ocular volume in Benin City, which may serve as a reference for African. Materials and Methods: The ocular volume of 200 consecutive 'normal' patients (400 eyes) who had CT scan done (using Somatom AR.T, CT scanner, and Siemens) was calculated. The dimensions were obtained at mid-ocular axial slices with maximum anterior-posterior dimension and maximum size of the eye lens. Result: The mean (mean ± 2 SD) ocular volume for both eyes was 5282.23 mm 3 ± 1755.13 mm 3 (right eye was 5264.26 mm 3 ± 1781.12 mm 3 ; left eye was 5300.20 mm 3 ± 1771.57 mm 3 ). The mean ocular volumes was different for either eyeball and sex (in males the right eye was 5289.80 mm 3 , left eye was 5224.31 mm 3 ; while in females the right eye was 5338.18 mm 3 , left eye was 5240.79 mm 3 ). Ocular volume correlated with the patients' ages P = 0.006 for the right eye, P = 0.008 for the left eye and P = 0.006 for total eyeball volume. Conclusion: Ocular volume correlated positively with the age of the patients to about 50 years after which some reduction was observed. We noted that males had slightly larger eyeballs in comparison to females, although not at statistical significant level.
  2,801 406 6
Viral infections among couples for assisted reproduction in a fertility clinic in Nigeria
AB Ajayi, A Oladokun, FA Bello, IO Morhason-Bello, MO Ogundepo
July-September 2013, 16(3):352-355
DOI:10.4103/1119-3077.113461  PMID:23771460
Context: The risk of laboratory cross-contamination may limit the availability of assisted conception for couples infected with chronic viruses. However, assisted conception is the standard of care for people living with human immunodeficiency virus (HIV) to minimize risk of transmission or reinfection. Aims: To assess the burden of viral infection among couples that present for assisted reproductive technology (ART) with a view to evaluating implications for their care. Settings and Design: A cross-sectional descriptive study carried out among 138 couples at a private fertility clinic in Nigeria. Materials and Methods: Screening for HIV, hepatitis B virus (HBV) and hepatitis C virus were carried out among these clients. The males' seminal parameters were analyzed according to World Health Organization (WHO) criteria. Statistical analysis Used: Statistical Package for Social Sciences was employed. Analysis was by Chi-square test; statistical significance was set at 0.05. Results: Viral infections were found in 10/138 women (7.2%) and 15/138 (10.9%) men. The most prevalent infection was HBV. Twenty-one couples were sero-discordant. Two couples had concordant HIV and HBV infections, respectively. There was no significant association between sperm quality and chronic hepatitis infection. Conclusion: Nearly a fifth of the couples had at least one partner infected with a chronic virus - a proportion significant enough to demand attention. Apart from separate laboratory and storage facilities, basic principles to minimize transmission are recommended: HBV vaccination in sero-discordant partners of HBV carriers (and immunoprophylaxis for the baby) and antiretroviral therapy for HIV-positive partners to reduce the viral load before fertility treatment is commenced.
  2,741 432 -
CASE REPORTS
Unusual foreign bodies in the orofacial soft tissue spaces: A report of three cases
SB Aregbesola, VI Ugboko
July-September 2013, 16(3):381-385
DOI:10.4103/1119-3077.113469  PMID:23771466
The ingestion and inhalation of foreign bodies with their associated morbidity and mortality have been widely reported in the literature. However, reports on foreign body impaction in the orofacial region are comparatively fewer. Three unusual cases of foreign body impaction into the buccal and submasseteric spaces are presented. The three patients were adults and they presented with history of painful facial swelling associated with limited mouth opening. Plain skull radiographs revealed the foreign bodies within the facial soft tissue spaces in two patients while it was not helpful in the third patient. Surgical explorations of the left buccal, left submasseteric and the right buccal spaces led to the retrieval of the foreign bodies. Prompt diagnosis and surgical removal of such foreign bodies will greatly minimize the associated complications which may include; cellulitis, facial abscess, allergic reactions, necrotizing fasciitis and osteomyelitis.
  2,638 449 3
ORIGINAL ARTICLES
Relationship between admission serum C-reactive protein and short term outcome following acute ischaemic stroke at a tertiary health institution in Nigeria
SA Abubakar, NU Okubadejo, OO Ojo, O Oladipo, FI Ojini, MA Danesi
July-September 2013, 16(3):320-324
DOI:10.4103/1119-3077.113454  PMID:23771453
Background: There is evidence of an association between mediators of inflammation, particularly C-reactive protein (CRP), and outcome of acute ischaemic stroke. This provides a potential opportunity for interventions aimed at improving outcome. There is sparse data exploring the role of inflammatory markers such as CRP and stroke outcome in Africans. The study objective was to determine the association between admission serum CRP levels and short-term outcome in the Nigerian patient presenting with acute ischaemic stroke. Materials and Methods: Consecutive patients hospitalized for first-ever acute ischaemic stroke at the Lagos University Teaching Hospital, Lagos, Nigeria, were prospectively enrolled between October 2007 and June 2008. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS). Serum CRP was determined on samples obtained within 7 days of stroke onset. All stroke patients were followed up till day 30 post-stroke. Outcome measures were 30 day Glasgow outcome scale score and functional impairment on the modified Rankin Scale (mRS). An age- and gender-matched healthy control group had serum CRP determined at inclusion. Elevated CRP was defined as any level above the cutoff (mean +2 x standard deviation of CRP level of controls). Results: Eighty patients with acute ischaemic stroke (47 men and 33 women) and 40 controls (27 male and 13 female) (P = 0.47) were studied. Mean age in cases was 59.1 ± 15.0 years. Mean CRP was significantly higher in stroke cases than controls (17.7 ± 14.4 mg/L versus 1.1 ± 1.7 mg/L respectively) (P < 0.00001). The frequency of elevated CRP (>4.5 mg/L) was 76.3% in stroke (N = 61) and 5% (N = 2) in controls (P < 0.0001). The case fatality rate in stroke with elevated CRP (32.8%) was significantly higher than stroke with normal admission CRP (0%; P = 0.015). The association of higher admission CRP with fatality () was statistically significant (P < 0.0001). Amongst survivors, mean CRP levels were markedly higher in the patients with unfavorable motor outcome (moderate/severe disability; n = 22; 21.5 ± 11.1) compared to those with favorable outcome (mild disability; n = 38; 6.5 ± 6.2) (P < 0.00001). In multivariate regression analysis, only high NIHSS score (P = 0.004) and admission CRP (P = 0.008) were independently associated with case fatality. Conclusions: Elevated admission CRP and high NIHSS score are independent predictors of short-term case fatality and adverse functional outcome following acute ischaemic stroke in Nigerians.
  2,462 564 6
C-reactive protein a better indicator of inflammation after third molar extraction
PM Chander, FM Ali, V Aher
July-September 2013, 16(3):297-301
DOI:10.4103/1119-3077.113450  PMID:23771449
Purpose: The purpose of this study was to evaluate the relation between pre-operative pain and pre-operative levels of C-reactive and post-operative pain and swelling in impacted third molar surgery. Materials and Methods: In this prospective study subjects were patients indicated for mandibular third molar extraction. Patients were assessed for certain inclusion and exclusion criteria's. A standard surgical extraction procedure was followed to reduce the bias. Hematological investigation of C-reactive protein levels were recorded pre-operatively and post-operatively. Pain, swelling and trismus in patients were assessed pre-operatively and post-operatively in an interval of 24 hours, 48 hours and 7 days. Pain and swelling were measured using verbal analogue scale and thread length measurement respectively. The mouth opening was recorded, too. Results: Post-operative C-reactive protein levels were seen consistency raised in those cases which showed high pre-operative levels. Peak levels of C-reactive protein were seen at 48 hours post operatively. It was observed that pre-operative pain swelling and mouth opening were seen to be variable in all the cases having high C-reactive protein levels. Conclusion: C-reactive protein was found to be a better indicator of inflammation than pre-operative pain, swelling and mouth opening for post-operative discomfort.
  2,507 493 2
Anatomic study of the pterion in Nigerian dry human skulls
U Ukoha, CK Oranusi, JI Okafor, OO Udemezue, AE Anyabolu, TC Nwamarachi
July-September 2013, 16(3):325-328
DOI:10.4103/1119-3077.113455  PMID:23771454
Background: The pterion is a point of sutural confluence seen in the norma lateralis of the skull. The site is an important landmark in surgical approaches to the anterior and middle cranial fossa. Objective: This study was designed to determine the frequency of pterion types and anatomic positions of the pterion in dry human skulls of Nigerians in the South Eastern Zone. Materials and Methods: Specific measurements were taken on both sides of 56 Nigerian human skulls of unknown sex, obtained from the Department of Anatomy, Nnamdi Azikiwe University, Nnewi Campus, Nnewi, Nigeria. Results: All the four types of the pterion were present, i.e. sphenoparietal, frontotemporal, stellate, and epipteric. The study showed that the sphenoparietal type was 75% on the right side, 76% on the left side, the frontotemporal type was 19.6% on both sides, the stellate type was 1.8% on the right side and absent on the left side. The epipteric type was 3.6% on both sides. The distances from the centre of pterion to the frontozygomatic suture were 2.74 ± 0.07 cm on the right side and 2.74 ± 0.06 cm on the left side. The pterion was 4.02 ± 0.05 and 4.01 ± 0.03 cm above the midpoint of the zygomatic arch on the right and left sides, respectively. Conclusion: These findings are important for the surgeon as the pterion junction is a common extracranial landmark in neurosurgical and surgical approaches.
  2,671 305 2
CASE REPORTS
Dicephalus dipus tetrabrachius conjoined twins of Zaria: Case report and literature review
PO Ibinaiye, PM Mshelbwala, N Abdulgafar, AK Lawal
July-September 2013, 16(3):395-397
DOI:10.4103/1119-3077.113473  PMID:23771470
One of the most interesting congenital malformations to manage is a conjoined twin. Conjoined twins are rare occurrences in obstetric/pediatric practice. More commonly known as Siamese twins, this phenomenon is shrouded in mystery and considered a curiosity by general public. Current technology is lending a helping hand in the early diagnosis of these conditions. Frequently, the twins are born dead, but there are few cases in which the twins survive. We presented a case of dicephalus dipud conjoined twins; a rare type of conjoined twins.
  2,458 331 -
ORIGINAL ARTICLES
Prevalence of β thalassemia carrier state in Sindhi community of Wardha and evaluation of risk factors for β thalassemia trait
R Rakholia, P Chaturvedi
July-September 2013, 16(3):375-380
DOI:10.4103/1119-3077.113468  PMID:23771465
Objective: To determine the prevalence of β thalassemia in Sindhi community of Wardha and evaluation of risk factors. To give genetic counseling to those diagnosed as carriers. Study Design: Cross-sectional (prevalence study). Setting: Sindhi community residing in and around Wardha. Study Period: 18 months. Materials and Methods: A total of 578 individuals belonging to Sindhi community residing in and around Wardha in India were selected by systemic randomization. Those who fulfilled the inclusion criteria and voluntarily gave consent were subject to Naked Eye Single Tube Rapid Osmotic Fragility Test (Nestroft). Those found positive by Nestroft were labeled carriers and advised to undergo Hemoglobin A 2 (HbA 2 ) quantification for confirmation of carrier status. Carriers thus identified were given genetic counseling. Result: The mean age of study population was 15.06 years with a range of 3-28 years. The largest group consisted of those between 12 and 18 years. The prevalence of β thalassemia carrier state as diagnosed by Nestroft is 36.36% (200/550) and incidence of carrier state by HbA 2 quantification in the study population was 17.2% (95/550). Conclusion: Prevalence of β thalassemia in the Sindhi community of Wardha is higher than in other studies and equal to the highest prevalent communities in India. Thus, we recommend that urgent measures to increase awareness and control the disease be taken.
  2,228 442 1
Short term results of pterygium surgery with adjunctive amniotic membrane graft
O Okoye, NC Oguego, CM Chuka Okosa, M Ghanta
July-September 2013, 16(3):356-359
DOI:10.4103/1119-3077.113463  PMID:23771461
Objective: The objective of this study is to present the 3 months results of pterygium excision with adjunctive amniotic membrane graft. Materials and Methods: In a non-comparative case series study, the medical records of all patients who had pterygium excision with adjunctive amniotic membrane transplant on bare sclera from December 2009 to August 2010 were reviewed. All the patients were followed up for 3 months. The data collected were sex, age, occupation, type of pterygium (primary or recurrent), extent of pterygium, post-operative complications and recurrent pterygium growth. Results: Thirty eyes of 30 consecutive patients were operated on. There were 14 males and 16 females (M:F =1:1); age range 25 to 70 years (mean: 48.3 SD + 12.01). Twenty-six eyes had primary and 4 recurrent pterygia. Stage 3 pterygium accounted for most of the cases (53.3%) followed by stage 2 (36.7%) and stage 4 (10%). Nineteen patients (63.3%) had occupations with considerable exposure to actinic damage. Of these, manual laborers accounted for the highest number contributing 13 (43.3%) out of the 19 cases. Of the 30 patients 2 had a reoccurrence giving a recurrence rate of 6%. One patient developed dellen 1 week post-operatively with complete resolution following conservative large soft contact lens application. Conclusion: Short term results suggests that adjunctive amniotic membrane transplant with pterygium excision is effective and safe. A larger randomized clinical trial with a longer follow-up period is however recommended.
  2,088 454 2
LETTERS TO EDITOR
Transabdominal ultrasonographic assessment of prostate size and volume in Nigerians with clinical diagnosis of benign prostatic hyperplasia
SM Ma'aji, B Adamu
July-September 2013, 16(3):404-404
DOI:10.4103/1119-3077.113476  PMID:23771473
  2,307 209 -
CASE REPORTS
Intraosseous acinic cell carcinoma
V Hiremath, N Mishra, SG Patil
July-September 2013, 16(3):386-388
DOI:10.4103/1119-3077.113470  PMID:23771467
Acinic cell carcinoma is an uncommon low-grade malignant tumor of salivary glands. It was first described by Nasse in 1892, arising in parotid salivary gland. Salivary gland tumors are also known to develop within jaw bones, arising within the jaw as a primary central lesion, and are extremely rare with only a few cases reported. We present a rare case report of 65-year-old woman with intraosseous acinic cell carcinoma of left side of the mandible.
  2,025 460 -
Isolated gallbladder rupture following blunt abdominal trauma
BM Gali, N Ali, AA Bakari, IE Suleiman
July-September 2013, 16(3):398-400
DOI:10.4103/1119-3077.113474  PMID:23771471
The gallbladder is a relatively well-protected organ; consequently its rupture following blunt abdominal injury is rare and usually associated with other visceral injuries. Isolated gallbladder rupture is extremely rare. We report a healthy Nigerian adult male who sustained isolated gallbladder rupture following blunt abdominal injury from riding a motor cycle (Okada). A high index of suspicion with positive bile aspirate might lead to early diagnosis. Open cholecystectomy is a safe option of treatment in a resource poor centre especially in delayed presentation and has a good outcome.
  2,159 259 2
ORIGINAL ARTICLES
Common echocardiographic abnormalities in Nigerians of different age groups
EC Ejim, CB Ubani-Ukoma, UC Nwaneli, BJ Onwubere
July-September 2013, 16(3):360-364
DOI:10.4103/1119-3077.113464  PMID:23771462
Background: Transthoracic echocardiography (TTE) is one of the most commonly performed cardiac investigations. It can provide comprehensive information about cardiac structure and function, helping to establish a diagnosis and guide therapy, and it is no longer the preserve of the specialist cardiology department. Previous studies on echocardiographic findings in our environment had documented valvular heart disease, hypertensive heart disease and congenital heart diseases as the commonest echocardiographic findings in Nigerians. Aims: The study aimed to provide an update on the common echocardiographic findings in different age groups in this part of the world, since some of the previous similar studies were done over a decade ago. Materials and Methods: We reviewed the echocardiogram reports of 608 consecutive patients done from July 2009 to October 2011 at a private echocardiographic laboratory in Enugu, South-East Nigeria. Data was analyzed for age, gender and echocardiographic findings. Results: The age range of the patients was from 3 days to 98 years with a mean age of 46.4 ± 21.4 years. The mean age of the males was 47.6 ± 21.3 years, while the mean age of the females was 45.2 ± 21.1 years. The commonest echocardiographic abnormality in children was atrial septal defect, while rheumatic heart disease was the commonest in adolescents and young adults. Left ventricular diastolic dysfunction and degenerative valvular diseases respectively were the commonest in the middle-aged and elderly populations in this study. Conclusion: This study has reaffirmed rheumatic heart disease (predominantly mitral valve regurgitation) as the commonest cardiac abnormality in adolescents and young adults. Degenerative valvular diseases, left ventricular diastolic dysfunction, and atrial septal defects were the commonest abnormalities in the elderly, middle-aged population and children, respectively.
  2,017 290 4
Trend in asthma severity in steroid naive asthmatic children in Benin city, Nigeria
O Oviawe, WO Osarogiagbon
July-September 2013, 16(3):371-374
DOI:10.4103/1119-3077.113466  PMID:23771464
Background: Asthma imposes heavy health burden on children and families worldwide. It is a chronic inflammatory airway disease and as such, treatment of the asthmatics is aimed at relieve of bronchoconstriction and inflammation. Until about a decade ago, emphasis was on the bronchoconstriction rather than the inflammation. Objective: To determine the trend in severity of asthma in steroid naive children, in an era when steroid use in the treatment of asthma was uncommon. Materials and Methods: Case notes of patients managed for asthma from 1985 to 1995 and age 5 - 16 years were retrieved and reviewed (these case notes are usually stored in Prof. O. Oviawe's office). Information extracted included age of onset of asthma, severity of asthma and drug medication at presentation and at 1 year. The GINA Guideline (2006) was used in classifying the asthma severity. Results: A total of 77 patients satisfied the criteria for the study. Of these, 53 were males and 24 females. Males: Female ratio was 2.3:1; age range 5 - 16 years; mean age ± SD (8.5 ± 3.13 years). At presentation, 48 (62.3%) patient had intermittent, 29 (37.7%) had persistent asthma, of these, 25 (86.2%) had mild persistent and 4 (13.8%) had moderate persistent. None had severe persistent asthma. At 1 year follow-up, 29 (37.7%) now had intermittent asthma, while 44 (57.1%) had persistent asthma, of these, 23 (52.3%) had mild persistent, 20 (45.5%) had moderate persistent, while 1 (2.3%) had severe persistent. Medication therapy was β2-agonist in 72 (93.5%) patients. Conclusion: The study supports progressive pathologic process possibly inflammatory in origin. It is opined that steroid naivity led to the trend seen in this study and judicious use of corticosteroids would have arrested the trend.
  1,871 308 -
CASE REPORTS
Congenital granular cell lesion in newborn mandible
O Gupta, R Arora, K Gupta, U Sharma
July-September 2013, 16(3):401-403
DOI:10.4103/1119-3077.113475  PMID:23771472
Congenital granular cell lesion (CGCL) is a rare non-neoplastic lesion found in newborns also known as Neumann's tumor. This benign lesion occurs predominantly in females mostly as a single mass. The histogenesis and natural history of the lesion remains obscure. It arises from the mucosa of the gingiva, either from the maxillary or mandibular alveolar ridge. The lesion is more common in the maxillary alveolar ridge than the mandibular.The present report describes a case of congenital granular cell lesion in an eight-day-old female child who was born with a mass on the anterior mandibular alveolar ridge. The mass was protruding from her mouth and compromised feeding. A clinical diagnosis of teratoma was suggested. Histologically, cells of this lesion are identical to granular cell tumor (neuroectodermal type) and show intense diastase-resistant Periodic Acid Schiff positivity. Immunohistochemically, cells are positive for vimentin but negative for S-100 and desmin, thus suggesting that CGCL is possibly derived from primitive gingival mesenchymal cells rather than having schwannian origin.
  1,837 313 1
LETTERS TO EDITOR
Ante-partum bleeding: Is determination of its risk factors clinically significant?
Shigeki Matsubara
July-September 2013, 16(3):405-405
DOI:10.4103/1119-3077.113477  PMID:23771474
  1,918 163 -
CASE REPORTS
Isolated gallbladder perforation following blunt abdominal trauma: A missed diagnosis
CN Ekwunife, JI Ofoegbu
July-September 2013, 16(3):392-394
DOI:10.4103/1119-3077.113472  PMID:23771469
This is a case of a 21-year-old man who presented with history of abdominal pain following blunt abdominal trauma. Although the initial ultrasound scan showed mild free peritoneal fluid, the patient was managed conservatively as a probable case of splenic injury and was discharged in satisfactory condition after 6 days of admission. He presented again 7 days later with recurring epigastric pain and had exploratory laparotomy on the presumptive diagnosis of peritonitis, probably due to peptic ulcer perforation. Intraoperatively, he was then discovered to have an isolated gallbladder perforation. This is a rare condition in which the diagnosis is often delayed or missed as was the case in our patient. To the best of our knowledge, this is the first reported case of isolated gallbladder perforation in Nigeria, and it behooves the clinician to be aware of the likelihood of this condition in patients with blunt abdominal injury.
  1,574 246 -
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