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   2013| October-December  | Volume 16 | Issue 4  
    Online since August 23, 2013

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The end of the road for prostate specific antigen testing?
E Nna
October-December 2013, 16(4):407-417
DOI:10.4103/1119-3077.116871  PMID:23974730
Many candidate biomarkers for diagnosis of prostate cancer have been investigated, but prostate-specific antigen (PSA) testing remains the frontline test for both mass screening and individual clinical testing. Although the PSA test is cost-effective, analytically reliable, and flexibly high throughput, it has a very weak correlation with prostate malignancy. This has resulted in over-diagnosis and over-treatment of patients leading to costly economic, social, and psychological impacts. PSA testing lacks the ability to molecularly characterize prostate diseases and define aggressiveness and lethality, which are necessary to influence choice of treatment. Therefore, newer molecular tests are beginning to replace the PSA tests. The prostate cancer antigen 3 test has shown superiority and is now widely used. The recently reported sarcosine urine test, the already delineated TMPRSS2: ETS fusion genes, the glutathione-S-transferase P1 serum marker, and enhancer of zeste homolog 2 biomarker may also help improve diagnosis and prognostication of prostate cancer. The analytical trend is toward a multiplex testing format using molecular and/or proteomic techniques that are reliable, accurate, reproducible, and ensure rapid quantitation. Therefore, validation of these newer biomarkers and their assays are necessary for both large-scale clinical trials and clinical utility.
  6,014 8,972 2
Factors affecting utilization of University health services in a tertiary institution in South-West Nigeria
GO Obiechina, GO Ekenedo
October-December 2013, 16(4):454-457
DOI:10.4103/1119-3077.116888  PMID:23974738
Background: Most university health services have extensive health infrastructures, for the provision of effective and efficient health services to the students. In this study, we have tried to determine student's perception of factors affecting their utilization. Objective: To determine students' perception of health care services provided in a tertiary institution and assess students' attitude towards utilization. Materials and Methods: Simple random sampling technique was used to select 540 respondents, comprising of 390 males and 150 females. A structured and self-administered questionnaire was the instrument used to collect data for the study, while data collected was analyzed using descriptive statistics of frequency count and percentage. Results: High cost of drugs (72.0%), non availability of essential drugs (54.8%), time spent waiting for treatment (67.2%), inadequate referral services (81.7%), and satisfaction with services (60.6%) were considered by the respondents as factors affecting the utilization of university health services. Students-medical staff relationship and accessibility to health facility (77.6% and 74.3% respectively) were, however, not considered as factors that affect utilization of university health services. Conclusion: It is recommended that to improve utilization and cost of care, government should make necessary efforts to incorporate tertiary institution into National Health Insurance scheme so that students above the age of 18 years can benefit from free treatment.
  9,921 1,019 2
Relationship among expression of basic-fibroblast growth factor, MTDH/Astrocyte elevated gene-1, adenomatous polyposis coli, matrix metalloproteinase 9,and COX-2 markers with prognostic factors in prostate carcinomas
H Erdem, U Yildirim, AK Uzunlar, K Çam, A Tekin, MA Kayikçi, C Sahiner, M Oktay, H Ankarali, LY Aydin
October-December 2013, 16(4):418-423
DOI:10.4103/1119-3077.116873  PMID:23974731
Background: The etiopathogenesis of prostate cancer (PC) is still not clear, but hormonal, genetic, and environmental factors are thought to play a role in the tumor pathogenesis. Astrocyte elevated gene-1(AEG-1) as a novel transmembrane protein is predominantly located in the perinuclear region and endoplasmic reticulum. It has been found that AEG-1 upregulation increases the invasive ability of glioma and prostate cancer. Basic fibroblast growth factor (bFGF), matrix metalloproteinase-9 (MMP-9), cyclooxygenases-2 (COX-2), and adenomatous polyposis coli (APC) are very important in tumor progression as well. Materials and Methods: This study included 97 radical prostatectomy specimens. IHC stains for bFGF, MMP-9, COX-2, APC, and AEG-1 were performed on the tissue microarray using standard procedures. For each patient, the age, Gleason score, tumor volume, lymphovascular invasion, lymph node metastasis, surgical margin, and the invasion of vesiculoseminalis areas were assessed. Analyses were performed using the statistical PASW (ver. 18). Results: Statistically significant positive relationships were found MMP-9 and COX-2 (r = 0.242 and P = 0.017), between MMP-9 and APC (r = 0.207 and P = 0.043), and between bFGF and AEG-1 (r = 0.295 and P = 0.004). However, the relationships between age and staining results and tumor volume and staining results were not found to be significant. Although a positive correlation was found between the Gleason score and tumor volume and the Gleason score and age (r = 0.415 and P = 0.0001; r = 0.246 and P = 0.015, respectively), we did not find a statistically significant relationship between other stains and other prognostic parameters (lymphovascular invasion, lymph node metastasis, surgical margin, or vesiculoseminalis invasion). Conclusion: The relationships we found between MMP-9 and COX-2, between MMP-9, and APC and between bFGF and AEG-1 as independent prognostic parameters could be helpful in the development of new therapeutic procedures.
  5,969 2,225 6
Clinical significance of low serum magnesium in pregnant women attending the University of Benin Teaching Hospital
NO Enaruna, ABA Ande, EE Okpere
October-December 2013, 16(4):448-453
DOI:10.4103/1119-3077.116887  PMID:23974737
Objective: Magnesium level is known to decline during pregnancy. A suggested role for magnesium deficiency in conditions like pre-eclampsia and pre-term birth has prompted studies with conflicting evidence. The primary objective of this study was to determine the prevalence of hypomagnesemia in pregnancy, while the secondary objectives attempted to define maternal and fetal outcome due to hypomagnesemia. Subjects and Methods: A pilot study was performed to determine the mean serum magnesium level for the population of female patients attending the University of Benin Teaching Hospital. The result of the pregnant population in the pilot study was used as a reference for hypomagnesemia in this study. Thereafter, a prospective cohort study of antenatal women recruited in the second trimester and followed-up till delivery and 1 week post-partum was done. Serum magnesium estimates were done with samples collected at recruitment and delivery. The magnesium levels determined at recruitment were used to divide the subjects into two groups of hypomagnesemic and normomagnesemic patients. Their sociodemographic and clinical characteristics were used to generate a database for analysis. Results: The prevalence of magnesium deficiency was 16.25%. Hypomagnesemia was significantly correlated with the occurrence of pre-eclampsia ( P = 0.011), leg cramps ( P = 0.000) and pre-term birth ( P = 0.030). A logistic regression analysis showed that hypomagnesemia had an Odds ratio of 22 for pre-eclampsia. There was no maternal mortality or early neonatal death. Conclusion: Pre-eclampsia and pre-term birth are associated with hypomagnesemia in pregnancy; hence, magnesium supplementation or magnesium-rich diet consisting of green leafy vegetables, soy milk and legumes may improve outcome.
  5,563 969 12
Pregnancy outcome and factors affecting vaginal delivery of twins at University of Nigeria Teaching Hospital, Enugu
TO Nwankwo, UU Aniebue, E Ezenkwele, MI Nwafor
October-December 2013, 16(4):490-495
DOI:10.4103/1119-3077.116895  PMID:23974745
Objective: The study aims to determine the differences in maternal and perinatal outcomes between caesarean and vaginal deliveries and the factors affecting vaginal delivery in twin pregnancy. Materials and Methods: An observational study to audit twin pregnancies delivered at the University of Nigeria Teaching Hospital between 2002 and 2008. Clinical observations were entered into a questionnaire immediately after the delivery of the women and the mothers and their babies were followed up until the end of the puerperium. Results: There were 5298 deliveries within the study period, out of which 117 were twin deliveries. This gives a twinning rate of 22 per 1000 deliveries. The mean age of the mothers was 30 ± 5.9 years. Twenty-five (21.4%) women were admitted into the hospital for preterm labor. The average gestational age of admission was 32 ± 5.8 weeks and the average duration of hospital stay for preterm labor was 12.6 ± 9.1 days. Other pregnancy complications observed were severe hypertension (14.5%, anemia (9.4%), postpartum hemorrhage (8.5%), puerperal fever (5.1%), abruptio placentae, and diabetic mellitus (2.7%). Fifty-nine women (50.4%) had vaginal deliveries, 5 (4.3%) had vaginal delivery of the leading twin and caesarean delivery of the retained second twin while 53 women (45.3%) were delivered by caesarean section. Forty-eight (41%) women had preterm delivery. Vaginal deliveries were more common than caesarean section among patients that were unbooked than booked P = 0.047 (OR 2.26, 95%CI:0.93-5.53) and those that had cephalic presentation of the leading twin, P = 0.0002 (OR = 4.7 95% CI:2.6-8.2). Vaginal delivery tended toward statistical significance when the fetal weight of the leading twin was 1.5 to 2.5 kg, P = 0.09. The commonest indications for caesarean section were abnormal lies and presentations and hypertension in pregnancy.Two-hundred and seventeen (92.7%) out of a total of 234 fetuses that were delivered in this study were live births and 17 (7.3%) still births. The rate of new born admissions in twin 1 was however higher in those delivered by Caesarean section (39.6%) than those delivered vaginally (29.7%). Indications for admissions into the special baby care units were; prematurity 33 (40.2%), birth asphyxia 15 (18.3%), low birth weight 12 (14.6%), neonatal jaundice 10 (12.2%), and twin-twin transfusion 4 (4.9%). There was a higher rate of early neonatal death in both vaginally delivered twin 1 (9.4%) and twin 2 (11.9%) than those delivered by Caesarean section, 3.8 and 3.5%, respectively. Conclusion: Cephalic presentation of the leading twin, birth weight less than 2.5 kg, and unbooked women presenting in advanced labor predisposed to vaginal delivery in twin pregnancies. There was however increased risk of still birth and early neonatal deaths especially for the leading twin in vaginal deliveries in unbooked women.
  5,413 690 3
Dry socket following surgical removal of impacted third molar in an Iranian population: Incidence and risk factors
M Eshghpour, AH Nejat
October-December 2013, 16(4):496-500
DOI:10.4103/1119-3077.116897  PMID:23974746
Introduction: Dry socket (DS) is the most common post-surgical complication following extraction of impacted molar teeth. Various risk factors have been mentioned for this complication including gender, age, amount of trauma during extraction, difficulty of surgery, inappropriate irrigation, infection, smoking, and oral contraceptive use. The aim of the current study was to evaluate the incidence of DS among surgical removal of impacted third mandibular molar in an Iranian Oral and Maxillofacial Clinic and also identifying the background risk factors. Materials and Methods: A total of 189 patients with a total of 256 surgeries entered this study. Surgeries to remove impacted third mandibular molar teeth between April 2009 and August 2010 were included in this study. A questionnaire containing two sections was designed; in the first section demographic data along with smoking status, oral contraceptive use, menstrual cycle phase, systemic disorders, and use of antibiotics prior to surgery collected; in the second section data regarding difficulty of surgery according to radiograph and surgeon perception after surgery, length of surgery, and number of anesthetic carpules along with data regarding cases returning with DS recorded. Data were reported descriptively and analyzed with Fisher's exact test and Chi-square with the confidence interval of 95%. Results: The incidence of DS was 19.14%. Age, gender, systemic disorder, and antibiotics use prior to surgery revealed no significant associations with DS ( P > 0.05). However, incidence of DS was significantly relevant to smoking, oral contraceptive use, menstruation cycle, difficulty of the surgery according to pre-surgery radiograph evaluation and perception of surgeon post-surgery, length of surgery, and number of carpules used to reach anesthesia ( P < 0.05). Conclusion: It is recommended to identify high risk groups when performing extraction surgeries to consider measures in order to reduce postoperative complications.
  4,950 1,088 12
Morphological spectrum of non-neoplastic lesions of the uterine cervix in Warri, South-South, Nigeria
FN Nwachokor, GC Forae
October-December 2013, 16(4):429-432
DOI:10.4103/1119-3077.116883  PMID:23974733
Background: The uterine cervix is a gateway to several non-neoplastic and neoplastic gynecological lesions. Most of these non-neoplastic lesions are commonly found in women of reproductive age. These lesions constitute a source of morbidity and mortality in women worldwide hence the need to analyze them to provide a baseline data of the pattern of these lesions in our local environment. Objective: The purpose of this study is to determine the frequency and morphological patterns of non-neoplastic cervical lesions at the central hospital, Warri, Nigeria. Materials and Methods: All uterine cervical biopsies received at the Department of Pathology, Central Hospital, Warri over a 7 year period (January 2005-December 2011) were the specimens for this study. Slides were retrieved from the archives of the Department of Pathology. Where necessary, new sections were made from formalin fixed, paraffin embedded blocks. Results: A total of 176 cervical specimens were received in the Pathology Department during this period. Of these, 56.3% were benign lesions while 43.7% were malignant. Among the benign cases, non-neoplastic lesions accounted for 92.9% of benign cervical lesions. The age range of non-neoplastic cervical lesions was 20 to 89 years with a mean age of 54.9 ± 4.6 years. The peak age incidence of non-neoplastic cervical lesion was 40-49 years which accounted for 33.7%. Inflammatory lesions and tumor-like lesions accounted for 59.8% and 40.2% of non-neoplastic cervical lesions respectively. Among the inflammatory lesions, chronic non-specific cervicitis was the most commonly encountered lesion constituting 72.2% of all inflammation. Human papilloma virus (HPV) cervicitis with koilocytic changes accounted for 14.5% of all inflammatory lesions. Conclusion: Inflammatory lesions were the most frequent non-neoplastic cervical lesions. These lesions therefore account for significant amount of gynecological problems in our environment. Adequate cervical screening with follow up histological biopsies is a relevant tool in diagnosing them to enhance early detection of premalignant and malignant cervical lesions.
  5,407 592 2
A 20 year retrospective analysis of medicolegal deaths in a tertiary hospital setting in Nigeria
WO Akhiwu, CC Nwafor, AP Igbe
October-December 2013, 16(4):535-539
DOI:10.4103/1119-3077.116910  PMID:23974754
Objective: To determine and classify the various types of medicolegal deaths as seen at University of Benin Teaching Hospital (UBTH), Benin City, Nigeria. Materials and Methods: This is a retrospective study of all the medicolegal deaths seen in the Department of Histopathology, (UBTH, Benin City over a 20 year period (January 1990-December 2009) as recorded in the autopsy registers of the department. Result: A total of 5035 autopsies were done during the period, 89% of which were coroner cases. Four thousand, four hundred and eighty-one coroner cases representing 12.5% of all bodies received by the mortuary during the period were studied. The male to female ratio was 1.9:1, with an overall mean age of 38.3 years. The ages ranged from 1 day to 101 years with a peak incidence in the 25-44 years age group. A total of 553 children and 3928 adults were involved. The commonest indication for coroner's autopsy was sudden unexpected natural deaths (SUNDs) which accounted for 65.5% of the cases. Other causes of death were accidents, homicide, suicide, and undetermined causes representing 28.6, 5.0, 0.5, and 0.4%, respectively. Commonest cause of SUND was cardiovascular diseases with complications of hypertension being the most common CVS disease (26.9%). Road traffic accident was the commonest form of accident causing death (88.7%). Public enlightenment and health education about routine medical screening will help to reduce causes of natural deaths. Conclusion: This study shows the pattern of medicolegal autopsies in UBTH and this preliminary data will provide a baseline for future research and help in formulating policies to help in reduction of preventable causes of death.
  4,890 638 4
Risk factors for surgical site infections following clean orthopaedic operations
UOE Ikeanyi, CN Chukwuka, TOG Chukwuanukwu
October-December 2013, 16(4):443-447
DOI:10.4103/1119-3077.116886  PMID:23974736
Background: Surgical site infections can follow clean orthopaedic operations and can cause serious morbidity, mortality and increased resource utilization. Despite this, there are few studies on risk factors for surgical site infections in the Nigerian orthopaedic literature. We conducted a prospective study to determine the host and environmental risk factors for surgical site infections following clean orthopaedic operations. Materials and Methods: Consecutive patients who satisfied the inclusion criteria and were to undergo clean orthopaedic operations performed at the National Orthopaedic Hospital, Igbobi, Lagos from January 2007 to July 2008 were included. Patient's biodata, duration of preoperative hospitalization and other risk factors were analyzed. The risk factors for surgical site infection were determined with Chi square test. Results: The overall rate of surgical site infection during the 18 months of the study was 9.9% (12 of 121). Independent risk factors for this were: Prolonged duration of preoperative hospital stay greater than 13 days (21% infection rate), increasing age greater than 60 years (31% infection rate), and use of implants and drains (only one un-drained wound was infected). Conclusion and Recommendations: Patient's age, duration of preoperative hospitalization, type of surgery (implant or non-implant), and use of drains were the most significant risk factors affecting surgical site infection. It is recommended that preoperative hospital stay should be as short as possible and extra care/precautions taken when working on the elderly, using implants or requiring drainage.
  4,708 817 11
Effectiveness of data collection and information transmission process for disease notification in Anambra State, Nigeria
CC Nnebue, CN Onwasigwe, CC Ibeh, POU Adogu
October-December 2013, 16(4):483-489
DOI:10.4103/1119-3077.116894  PMID:23974744
Background: Disease surveillance and notification (DSN) has been shown to be weak in Nigeria, thus, its inability to promptly detect and control epidemics. Objective: To examine the completeness and timeliness of data collection and information transmission process for DSN in the Anambra state. Materials and Methods: The study was of cross-sectional design and employed the multistage sampling method to select 270 health workers who are involved in DSN in Anambra state. Data were collected by a mix method of interviewer administered questionnaire and observational checklist preceded by key informant interviews and desk review. Results: One hundred (43.9%) health workers reported regular supply of Integrated Disease Surveillance and Response (IDSR) forms, 25% and 16.2% reported it was irregular and usually out of stock, respectively. Most facilities (81.5%) returned completed forms monthly. Secondary health facilities were less likely to submit completed forms, while majority of primary health facilities submitted theirs monthly ( X 2 = 4.42, P = 0.035). With respect to correctness of records, Health Management Information System records (55.6%) were the least correct, while out-patient register (88.9%) was the most correct. Only 10.0% of health facilities submitted completed forms 5 days after completion, 88.9% of them submitted completed IDSR002 forms within 2 days of completion, while the remainder was submitted 4 days later. Conclusion: The health workers were not operating the DSN system in the State to optimal functionality. Recommendations were therefore made for the periodic training-retraining of health personnel on DSN, improved funding, provision of logistics, improved supervision, and feedback of information.
  4,408 451 4
A comparative study of heart rate variability tests and lipid profile in healthy young adult males and females
A Roy, D Kundu, T Mandal, U Bandyopadhyay, E Ghosh, D Ray
October-December 2013, 16(4):424-428
DOI:10.4103/1119-3077.116882  PMID:23974732
Background: Coronary Heart Disease (CHD) is the leading cause of death in many developed countries. The relation between heart rate variability (HRV) and CHD was recently explored after the development of HRV techniques. Lower HRV was proven to be associated with a greater risk for developing hypertension among normotensive men, and hypertension is one of the major risk factors of CHD. Acute myocardial infarction is accompanied by decreased HRV, which is due to reduced vagal or increased sympathetic outflow to the heart. Aim: This study was designed to test the hypothesis of influence of gender and lipid profile difference on heart rate variability tests. Materials and Methods: Thirty healthy adult male and thirty healthy adult female subjects in the age group of 18- 25 years without any addictions and gross systemic disease were selected. Heart rate variability tests during Valsalva maneuver, deep breathing and 30:15 R-R intervals ratio were carried and lipid profile of the subjects were analyzed. Results: We found a decrease in values of HRV tests during the Valsalva maneuver, deep breathing in male individuals as compared with age- and Body Mass Index, BMI-matched females. VHeart Rate Variability tests during 30:15 R-R intervals Ratio in male individuals were significantly decreased as compared with females. Values of total cholesterol, Low Density Lipoprotein, LDL cholesterol were found to be significantly increased and High Density Lipoprotein, HDL cholesterol significantly decreased in males. Conclusion: Healthy adult males may be at a higher risk of developing acute myocardial infarction and CHD due to decreased HRV and atherogenic lipid profile. Lower level of serum estrogen may be the cause of this difference in HRV among males. The difference in HRV tests among males and females disappears after menopause.
  3,947 827 4
Pediatric HIV in Kano, Nigeria
PN Obiagwu, F Hassan-Hanga, M Ibrahim
October-December 2013, 16(4):521-525
DOI:10.4103/1119-3077.116905  PMID:23974751
Background: Pediatric human immunodeficiency virus (HIV) infection is still an important public health issue despite a decrease in global, national, and local seroprevalence rates. Design: A prospective, hospital-based study was conducted. Materials and Methods: One-hundred and sixty children presenting for the first time to the hospital were studied. Each child had a detailed physical examination and initial double rapid HIV antibody tests. A virological confirmatory test was done for those aged less than 18 months of age with positive results. Mothers of HIV-infected children also had HIV testing. HIV-infected children were enrolled into HIV care and followed up for 6 months. Data were analyzed using the SPSS 16.0 for Windows. Results: Twenty-two (13.8%) children were confirmed HIV-infected. The mean age was 26.9 ± 30.8 months. Male to female ratio was 1.1:1. Probable modes of transmission were mother-to-child in 63.6%, group circumcision in 22.7%, sexual transmission in 9.1% and unscreened blood transfusion in 4.5%. The most frequent symptoms on presentation were fever in 95.4% of patients, cough and weight loss in 77.3% and diarrhoea in 59.1%. The most common signs were hepatomegaly in 77.3%, pyrexia and crepitations in 72.7%, and pallor in 40.9%. Commonly diagnosed conditions were undernutrition, diarrheal disease, oral thrush, and pneumonia. Tuberculosis co-infection was diagnosed in 18.2% of children. Fourteen (63.6%) children had advanced and severe immunodeficiency. Mortality rate over 6 months was 18.2%. Conclusion: Early diagnosis of pediatric HIV and prompt institution of treatment in children would go a long way in reducing the scourge of the disease.
  4,063 569 7
Observational assessment and correlates to blood pressure of future physicians of Bengal
P Das, M Basu, K Chowdhury, S Mallik, G Dhar, A Biswas
October-December 2013, 16(4):433-438
DOI:10.4103/1119-3077.116884  PMID:23974734
Intoduction: Hypertension is a modern day epidemic and growing public health problem. A sizable proportion of world populations suffer from prehypertension or hypertension. Objectives: The present study was carried out to detect the prevalence of undiagnosed hypertension among undergraduate medical students and to identify the associated risk factors. Materials and Methods: The study was observational in nature and was done in medical colleges of Bengal. Study tool was a predesigned, pretested, validated, and semi-structured questionnaire containing both open-ended and close-ended questions. Data were collected through self-administration, clinical, and anthropometric examination. The data were then tabulated, analyzed and interpretation was done by using percentage and Chi-square test. Results: Most of the students (63%) were young adults, predominantly males (67%) and day scholars (71%). Almost one-third of them either suffered from hypertension or at risk of hypertension. Hypertension was found higher among male students. Family history of hypertension or diabetes mellitus was not associated with hypertension. Vegetarian or nonvegetarian diet or extra-salt consumption was also not associated with hypertension. Smoking was shown positively associated with hypertension but alcohol consumption was not. Higher per capita monthly income and overweight or obesity were shown positively associated with hypertension. Conclusion: The overall prevalence of hypertension in this study was 13% and there were positive association of hypertension with multiple socio-demographic factors like age, sex, type of family, per capita monthly income, residence, BMI, smoking, etc.
  3,611 455 2
Sacrohysteropexy with synthetic mesh in Aba, South-Eastern Nigeria: A report of three cases and review of the literature
F Massey, CC Umezurike, KC Eguzo
October-December 2013, 16(4):554-557
DOI:10.4103/1119-3077.116917  PMID:23974760
The surgical treatment of uterovaginal prolapse in women who wish to preserve their uteri for fertility presents a challenge to a gynecologist. This is particularly more challenging in Nigeria and the rest of Africa where there is not only a strong cultural aversion to hysterectomy but women also prefer large family size and male babies. This underscores the need for fertility friendly, uterus-preserving procedures. Three young women under the age of 40 presented with uterovaginal prolapse. They were of low parity and wanted to preserve their uteri for future reproductive function. They had open abdominal suspension of their uteri to the sacrum using a synthetic polypropylene mesh. A pus-string suture was also used to obliterate their pouch of Douglas to prevent future enterocele. Pelvic anatomy was restored and normal vaginal axis was achieved. They had uneventful post-operative period. In resource-limited settings, open abdominal (rather than laparoscopic) sacrohysteropexy with synthetic mesh is an effective and safe alternative to Manchester operation and other vaginal procedures in women who desire to preserve the uterus for future reproductive function.
  3,540 371 1
The histopathological pattern of liver biopsies at the University of Benin Teaching Hospital
EE Ugiagbe, MO Udoh
October-December 2013, 16(4):526-529
DOI:10.4103/1119-3077.116906  PMID:23974752
Objective: Microscopic examination of liver tissues remains an essential part in the diagnostic work-up of patients with liver diseases. The aim of this study is to determine the histopathological pattern of liver diseases at the University of Benin Teaching Hospital, Benin City, Nigeria. Materials and Methods: This is a retrospective study of all cases of liver biopsies between January 2005 and December 2011. The appropriate data was obtained from the Surgical day book of the department of histopathology. The data was analyzed to reflect age, sex, and pathological diagnosis of the lesions. Results: A total of 80 cases of liver biopsies were reported during the 7-year period. There were 50 males and 30 females with a male:female ratio of 1.7:1. The age ranged from 4 months to 69 years with a mean age of 38.4 ± 13.3 years. The highest incidence was in the 4 th decade. The three common histopathological diagnoses were inflammatory lesions, 63.8%; malignant neoplasms, 22.5%, and liver cirrhosis in 6.3% of cases. Other less common lesions were alcoholic liver disease and steatosis. This peak age incidence of chronic hepatitis precedes that of hepatocellular carcinoma by about two decades. Conclusion: The preponderance of chronic hepatitis, hepatocellular carcinoma, and liver cirrhosis in this study is similar to those already established in the African literature, with hepatitis B and/or C being the most incriminated risk factors due to their endemicity in our environment. Public enlightenment programs, widespread implementation of hepatitis B virus vaccination, and surveillance of individual at-risk are essential for the control of hepatitis infection and its late complications.
  3,376 361 3
Tobacco use and oral health of inmates in a Nigerian prison
EA Akaji, N Folaranmi
October-December 2013, 16(4):473-477
DOI:10.4103/1119-3077.116892  PMID:23974742
Objectives: To determine the effect of tobacco use on oral health status of inmates of a federal prison in Enugu, Nigeria. Materials and Methods: The study involved 230 inmates of the Nigerian Prison in Enugu. An interviewer-administered questionnaire was used to collect data on the demographic characteristics of the participants, oral hygiene methods, and smoking habits. An intra-oral examination to determine their oral health status was done using simplified oral hygiene index (OHI-S) for the oral hygiene status, the modified decayed missing and filled teeth (DMFT) index for caries status, and community periodontal index of treatment needs (CPITN) for the periodontal needs. Statistical Package for Social Sciences software, version 15 was used to analyze data. Results: One hundred and twenty participants (52.2%) were current smokers. Mean DMFT of smokers and nonsmokers were 2.38 ± 0.71 and 2.25 ± 0.83 respectively ( P = 0.508) while mean Community Periodontal Index (CPI) scores of smokers and nonsmokers were 4.71 ± 1.26 and 2.27 ± 0.86, respectively ( P = 0.276). Oral soft tissue lesions such as mucosal burn, oral leukoplakia-like lesions were found mainly in the tobacco users. Conclusion: Tobacco use had a negative effect on the oral health of the participants as smokers had worse oral health profile than non-smokers. They may benefit from counseling programs with the view to educate them on the effect of tobacco use on oral health and by extension, the general health. The full implementation of the Framework Convention on Tobacco Control (FCTC) treaty in Nigeria could help in curtailing these unwanted consequences of tobacco use.
  3,077 492 7
Pattern and clinical profile of children with complex cardiac anomaly at University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria
JM Chinawa, HA Obu, CB Eke, JC Eze
October-December 2013, 16(4):462-467
DOI:10.4103/1119-3077.116890  PMID:23974740
Background: Complex congenital cardiac abnormalities are rare among children and contribute to mortality and morbidity. The prevalence and pattern of presentation vary from place to place. Materials and Methods: The objective of this study was to determine the clinical profile and pattern of presentation of complex congenital cardiac malformations among children attending a tertiary hospital in Enugu State. A cross-sectional retrospective study in which a review of the records of children who attended the children outpatient clinic of University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu State over a 5-year period (January 2007-June 2012) was undertaken. Results: Thirty one thousand seven hundred and ninety-five (31,795) children attended the outpatient clinic of the hospital over the study period, of these, 65 had cardiac diseases, from which 16 were found to have congenital complex cardiac abnormalities of various types, giving a prevalence of 0.05%. Complex abnormalities seen in these children are Tricuspid atresia with various associations, cor triatriatum, single ventricle, and large ASD (atrio-septal defect) with complete AVCD, cor triatriatum sinistrum with cardiomyopathy, DORV (double outlet right ventricle) with left sided aorta, hypoplastic tricuspid valve with a PDA (patent ductus artriosus), TOF (tetralogy of fallot), prolapse of aortic valve, and pulmonary regurgitation. One of these complex cardiac anomalies presented with Turner's syndrome and another with VACTERAL association. Conclusions: The results of this study show that 0.05% of children who presented at cardiology clinic of a teaching hospital in Enugu State had congenital complex cardiac abnormalities and that the commonest forms seen were those with cor triatriatum and TOF.
  3,000 379 5
CT-guided percutaneous transthoracic lung biopsy: First experience in Ibadan, Nigeria
GI Ogbole, PO Adeoye, CA Okolo, K Iseko
October-December 2013, 16(4):544-547
DOI:10.4103/1119-3077.116911  PMID:23974756
Percutaneous lung biopsy had been described in the nineteenth century by Leyden, but image- guided needle chest biopsy only gained widespread acceptance in the 1970s. Currently, tissue sampling of a thoracic lesion is indicated when the diagnosis cannot be obtained by the non-invasive techniques and cytological diagnosis will modify the stage of the disease or influence the therapeutic strategy. Cytology obtained by small-gauge needle aspiration biopsy confirms the nature of the lesion in 80 - 95% of cases and carry a low incidence of major complications. The purpose of this report was to provide information on our first experience with CT-guided biopsy and show that with some innovativeness much can be achieve with limited resources and good team work. We performed a CT of the thorax using appropriately placed improvised metal markers, which determined the optimal cutaneous entry point. We then re-checked the location of the lesion scanning intermittently at 5mm slice thickness; we marked the entry point with a pen and cleaned the surface with methylated spirit. A local anaesthetic was subcutaneously injected around marked area. We used a 21G aspiration needle to obtain cytology sample then 18G Trucut biopsy needle to obtain histology specimen. The length of the needle was chosen based on predetermined distance of the target lesion from the skin estimated from the CT images. Our patient was a 51-year-old Nigerian female with a peripherally located nodule in the posterior aspect of the right lung. She had CT-guided biopsy of the nodule. The procedure was well tolerated with no complication of pneumothorax. The histology report provided the basis for treatment regimen. Our experience indicates that percutaneous transthoracic CT-guided needle biopsy is feasible and a safe procedure in our hospital for evaluation of undetermined lung lesions.
  2,811 367 1
Intra-cardiac masses in adults: A review of echocardiogram records at two echocardiographic laboratories in Enugu, South-East Nigeria
EC Ejim, BC Anisiuba, SO Ike, NI Oguanobi, C Ubani-Ukoma, I Essien, U Nwaneli, B Onwubere, P Njoku
October-December 2013, 16(4):468-472
DOI:10.4103/1119-3077.116891  PMID:23974741
Background: Transthoracic echocardiography (TTE) is an excellent initial diagnostic technique used to evaluate and diagnose cardiac masses, even though transoesophageal echocardiography (TEE) provides superior image resolution and better visualization of cardiac masses, especially in patients with suboptimal transthoracic echocardiographic studies. TTE is the clinical procedure of choice for identification of left ventricular thrombi. TTE has greater than 90% sensitivity and greater than 85% specificity for detection of left ventricular thrombi and is probably superior to the sensitivity and specificity of TEE, especially for apical thrombi. Aims: The study aimed to identify the common types of cardiac masses and their commonest locations in the heart. Materials and Methods: We did a retrospective review of our echocardiogram reports from May 2003 to July 2012 to identify the frequency of intra-cardiac masses in adults, as well as the gender distribution and commonest location of these masses. Results: There were 2,814 echo examinations in adults over this period, comprising 1,661 males (59.1%) and 1,153 females (40.9%). Intra-cardiac masses were found in 20 of these patients representing 0.7% of the study population. Thrombi were the commonest masses noted in our study, and there were more masses in the atria than in the ventricles. The left heart chambers also had more masses than the right heart chambers. There was no sex difference in the frequency of cardiac masses. Conclusion: Intra-cardiac masses are rare, and transthoracic echocardiography is still valuable in the diagnosis and initial characterization of cardiac masses.
  2,856 261 -
Pattern of cancer deaths in the medical wards of a teaching hospital in South East Nigeria
EB Arodiwe, SO Ike, SC Nwokediuko, CK Ijoma, II Ulasi
October-December 2013, 16(4):505-510
DOI:10.4103/1119-3077.116901  PMID:23974748
Background: Cancers are emerging public health problems in developing countries like Nigeria. The epidemiological shift and aging population make cancers a challenge. Objective: We set out to describe the pattern of death due to cancer in our medical ward. The hospital is one of the premier hospitals covering the South East zone of Nigeria. Materials and Methods: We retrospectively reviewed the case notes and death certificates of all who died of cancer in our adult medical wards for 16 years (January 1995 to December 2010). Statistical Analysis Used: Statistical Package for Social Sciences (SPSS Inc. Chicago, IL) version 17.0 was used. Results: Twenty seven thousand, five hundred and fourteen patients were admitted into the medical wards. Six thousand, two hundred and fifty died. Out of the 6250 deaths, cancers accounted for 7.6%. Male to Female ratio was 2.4:1. The mean age at death was 43.7 ± 17.4 years. The mean age at death in both sexes was similar (42.9 ± 17.5 for men and 45.7 ± 17.0 years for women), P = 0.109. Primary liver cell carcinoma was the most common cause of death among men (40.8%), while cancer of hematopoietic organ was the most common in women (48.7%). The overall fatality rate was 1.7% (477/27 514) of medical admissions. Younger and middle age groups were most commonly affected in both sexes. Conclusion: Since the most productive age groups were affected, governments in developing countries should as a matter of urgency put in place adequate cancer preventive and curative services.
  2,690 296 1
Hepatic transaminase and alkaline phosphatase enzyme levels in HIV/HBV co-infected and HIV mono-infected patients in Maiduguri, Nigeria
BW Goni, H Yusuph, SK Mustapha, MA Sahabi, SA Gwalabe, A Tahir, B Bakki, IM Kida
October-December 2013, 16(4):530-534
DOI:10.4103/1119-3077.116908  PMID:23974753
Background: Studies have shown that HIV-HBV co-infected patients have an increased risk of liver-related morbidity and mortality compared to their HIV-mono-infected counterparts. Furthermore, it has been reported that HIV-HBV co-infected patients have a significantly high incidence of drug-induced hepatotoxicity following commencement of HAART than HIV-mono-infected patients. Objectives: To compare the levels of aspartate amino transferase (AST), alanine amino transferase (ALT) and alkaline phosphatase (ALKPO 4 ) enzyme levels between HAART naïve HIV-HBV co-infected patients and their HIV-mono-infected counterparts. Materials and Methods: A cross-sectional descriptive study in which 142 newly diagnosed HIV/HBV co-infected and HIV mono-infected adults were investigated for alkaline aminotransferase, aspartate aminotransferase and alkaline phosphatase enzyme levels. Results: The study subjects comprised of 80 (56.3%) females and 62 (46.7%) males. The age range of the study population was 15-65 years. The mean ages of male and female subjects were 45.5 ± 10.5 years and 39.1 ± 7.5 years respectively ( P < 0.05). Sixty-three (44.4%) study subjects were HIV/HBV co-infected while 79 (55.6%) were HIV mono-infected. The mean ALT enzyme level of HIV/HBV co-infected subjects was significantly higher than that of HIV mono-infected ones i.e., 42.12 IU/l vs. 27.86 IU/l, ( P = 0.038). However, there was no statistically significant difference in the mean AST (30.14 IU/l vs. 29.09 IU/l, P = 0.893) and ALKPO 4 (55.86 IU/l vs. 60.97 IU/l, P = 0.205) enzyme levels between HIV-HBV co-infected and HIV mono-infected subjects albeit the two enzymes were moderately elevated in both categories of subjects. Conclusion: The significantly elevated ALT enzyme levels amongst HIV-HBV co-infected subjects suggest that HIV-HBV co-infected patients may have an increased risk of liver-related morbidity and mortality than their HIV mono-infected counterparts. Screening for serological markers of chronic HBV infection, as well as hepatic transaminase enzyme levels in all newly diagnosed HIV-positive patients is therefore recommended before commencement of HAART.
  2,478 435 2
The relationship between vertical cup-disc ratio and body mass index in Port Harcourt, Nigeria
CN Pedro-Egbe, EA Awoyesuku
October-December 2013, 16(4):517-520
Background: Glaucoma is the leading cause of irreversible blindness in the world and risk factors to developing glaucoma must be determined early to prevent blindness from the disease. Aim: To determine the relationship between vertical cup disc ratio (VCDR) and body mass index (BMI) in a population screened for glaucoma in Port Harcourt, Nigeria Materials and Method: This study was part of a one-day screening exercise for glaucoma at the University of Port Harcourt. Demographic data included age, sex, race and occupation. Height was measured with a wall-mounted tape and weight with a bathroom scale. Intraocular pressure was measured with Perkins applanation tonometer and funduscopy was with direct ophthalmoscope. BMI was calculated as weight in kilograms divided by the square of height in meters (Weight/Height2). Results: A total of 491 subjects were screened; consisting of 230 males (46.8%) and 261 females (53.2%). The mean age was 35±13.29 years. About 28%(n=141) of the participants were overweight while 17.7%(n=87) were obese. The mean BMI was 25.39 ± 4.82 kg/m 2 and the mean VCDR for both eyes was 0.38±0.13mmHgratios have no units. Most participants (n=864; 89.4%) had normal VCDR. Only 102 (10.6%) had cupped discs. There was no statistically significant relationship between BMI and VCDR (P= 0.947; R2 = 0.01). Conclusion: Obesity was not associated with a larger VCDR.
  2,486 308 -
Mesenteric lipoma causing recurrent intestinal obstruction
MO Enyinnah, CC Umezurike
October-December 2013, 16(4):551-553
DOI:10.4103/1119-3077.116914  PMID:23974758
Although lipoma is a common tumor found in almost all parts of the body, that occurring in the mesentery of the gut is a rarity. A 29-year-old man presented in our center with a 10-year history of recurrent central colicky abdominal pain, vomiting, constipation, and central abdominal mass. Exploratory laparotomy revealed a huge smooth yellow mass in the mesentery of the mid ileum. Resection of the affected segment of the ileum and end to end ileal anastomosis were carried out. Histology report confirmed lipoma. He had uneventful post-operative recovery. Mesenteric lipoma should be considered as a possible differential diagnosis in a patient with recurrent features of intestinal obstruction and a mobile abdominal mass. A high index of suspicion and improvement on the pre-operative diagnosis and treatment are needed in secondary health facilities in Africa.
  2,482 290 1
Clustering of cardiovascular disease risk-factors in semi-urban population in Northern Nigeria
T Dahiru, CL Ejembi
October-December 2013, 16(4):511-516
DOI:10.4103/1119-3077.116903  PMID:23974749
Introduction: Non-communicable diseases (NCDs) are major causes of morbidity and mortality particularly for developing countries. Large proportion of all NCDs deaths are occurring in low- and -middle-income countries are estimated to occur in people under 70-years-old. These low- and middle-income are undergoing epidemiological transition which allows the concomitant occurrence of both communicable and NCDs due to adoption of western life-style that predisposes them to development of these diseases. It is also known that there are risk-factors that tend to cluster in individuals and make them more susceptible to NCDs especially cardiovascular diseases (CVDs). Among NCDs, CVDs constitute the largest share responsible for 48% of all deaths due to NCDs. To determine extend of clustering of these risk-factors in a semi-urban community in northern Nigeria, a population-based study was carried out. Materials and Methods: This study was conducted in Dakace, a semi-urban settlement near Zaria. A simple random sampling of 199 eligible respondents out of 424 was adopted to select study participants. An interviewer-administered questionnaire was used to collect socio-demographic information, smoking habits, alcohol consumption as well as level of physical activity. The following measurements were carried out on these respondents: Blood pressure (BP), fasting blood glucose, serum lipids, weight, and height to calculate body mass index (BMI). Results: There were of 199 participants: 94 males (47.2%) and 105 females (52.8%) with an overall mean age of 39.9 ± 15.6 years. About 20% had no risk factor; more females than males had risk-factors. Proportion of subjects with risk-factors increase with increasing BMI, particularly high BP; physical activity does not protect subjects from developing risk-factors. Conclusion: This study clearly shows that CVD risk-factors are prevalent even in segment of the population that hitherto may be considered free and the prevalence of these risk-factors are high compared to some obtained from other part of Nigeria.
  2,327 433 4
Perception of patients attending a tertiary hospital in Nigeria about good dental practice: A pilot study
IO Oketade, O Osiro, ST Ibiyemi, O Ibiyemi
October-December 2013, 16(4):478-482
DOI:10.4103/1119-3077.116893  PMID:23974743
Background: Criteria for a good dental practice as expressed by patients have influence on their behavior in terms of compliance with clinical advice, less pain and anxiety and more utilization of dental care. Objective: To assess the opinion of patients attending the dental clinic of a tertiary hospital Southwestern, Nigeria about their perception of a good dental practice. Materials and Methods: A 16 item semi-structured bi-lingual interviewer-administered questionnaire comprising socio-demographic characteristics and 24 criteria of a good dental practice generated by clinicians and patients was administered to 156 patients who were blinded from knowing which criteria were clinicians' or patients' criteria. Patients were then asked to pick 12 criteria out of the 24 criteria that they considered of greater priority. Frequency of the most picked criteria in a descending order was determined. Student's t-test was used to compare mean scores at P < 0.05. Results: The mean age of study participants was 36.7 ± 13.8 years. The majority 139 (89.1%) of the study participants ranked ''clinician's procedure should be as painless as possible'' as the most important clinician determined criteria of a good dental practice while 31 (19.9%) of them ranked hotlines available for emergencies as the least. The majority 133 (85.2%) of the study participants ranked ''sterile procedure and proper handling of equipment'' as the most important patient determined criteria of a good dental practice while 30 (19.2%) of them ranked patients being attended by just one clinician as the least. There was a statistically significant difference between mean scores of clinicians' criteria and patients' criteria ( P = 0.00001), participants ranked more patients' criteria than clinicians' criteria. Conclusion: In determining the criteria for a good dental practice, clinicians' perspective as well as patients' perspective should be considered.
  2,326 346 2
Presence of chaperones during pelvic examinations in southeast Nigeria: Women's opinions, attitude, and preferences
PO Nkwo, CO Chigbu, S Nweze, OS Okoro, LO Ajah
October-December 2013, 16(4):458-461
DOI:10.4103/1119-3077.116889  PMID:23974739
Objectives: To assess the opinions, attitude, and preferences of Nigerian women to the presence of chaperones during pelvic examinations. Materials and Methods: A cross-sectional survey of first time gynecology clinic attendees on their opinions, attitudes, and preferences with respect to the presence of chaperones during their pelvic examinations. The interview was conducted with the aid of semi-structured, researcher-administered questionnaires. Results: One hundred and nineteen (51.7%) of the respondents preferred female physicians for pelvic examination, 23 (10%) preferred male physicians and 88 (38.3%) had no gender preference. When the examining physician is a male, 124 (53.9%) respondents would like to have chaperones during pelvic examinations while 106 (46.1%) would not. Eighty-three percent of respondents preferred nurse chaperones. Age, level of education, and parity did not have any significant relationship with the attitude of the respondents toward the presence of chaperones ( P = 0.503, 0.525, and 0.605 respectively). Conclusions: We conclude that most southeastern Nigerian women would prefer their pelvic examinations to be done by a female physician or to be attended by a nurse chaperone if the examining physician is a male. We recommend a routine offer of chaperones during such examinations while respecting the patients' right to refuse the offer.
  2,184 269 1
Metallic sewing needle ingestion presenting as acute abdomen
S Misra, V Jain, F Ahmad, R Kumar, N Kishore
October-December 2013, 16(4):540-543
DOI:10.4103/1119-3077.116879  PMID:23974755
We reported an unusual case of a 26-year-old man presenting to surgical emergency as generalized peritonitis following an ingestion of multiple metallic sewing needles. The X-ray of his abdomen showed pneumoperitoneum and multiple metallic foreign bodies in the abdominal cavity. An ultrasonogram of his abdomen showed multiple metallic foreign bodies in the abdominal cavity and urinary bladder. Emergency exploratory laparotomy was performed. On laparotomy, gastric and duodenal perforation was found through which metallic sewing needles were protruding out. A peritoneal lavage was done, and all the sewing needles were extracted from the perforation site, paracolic gutter, liver parenchyma, and urinary bladder. The primary repair of the perforation with omental patching was done with the drainage of subhepatic space and pelvic cavity. These multiple ingested sewing needles led to the perforation of the stomach and the duodenum, which resulted in perforation peritonitis.
  2,017 295 1
Takayasu arteritis in young male
BS Patil, UG Rajoor
October-December 2013, 16(4):548-550
DOI:10.4103/1119-3077.116913  PMID:23974757
Hypertension is one of the common diseases affecting general population. The World Health Organization has concluded that hypertension is the major factor responsible for the most deaths worldwide, 12.8% per year or more than seven million. Additionally hypertension is rated third on the list of factors responsible for the burden of disease during life, as measured by disability-adjusted life-years. The study, diagnosis and treatment of hypertension in the young constitute one of the major health challenges today, because of high percentage of potentially curable chance if the cause could be found. Indeed intensive study and investigations are required to unravel the underlying cause. Here we present a case of typical Takayasu arteritis presented with swelling in the right neck and hypertension.
  1,903 359 -
Weekend versus weekday hospital deaths: Analysis of in-patient data in a Nigerian tertiary healthcare center
BO Nwosu, NO Eke, A Obi-Nwosu, OJ Osakwe, CO Eke, NP Obi
October-December 2013, 16(4):501-504
DOI:10.4103/1119-3077.116900  PMID:23974747
Aim: This study aims at comparing weekday deaths to weekend deaths of in-patients of a tertiary hospital in Nigeria. Materials and Methods: This is a 10-year retrospective survey conducted at the Nnamdi Azikiwe University Teaching Hospital in which the death records of the hospital were accessed from the various wards and health records department to extract relevant data pertaining to the time of hospital death. Tests of statistical significance were done using Chi-square test at 95% confidence intervals. Results: A total of 3934 deaths were recorded during the period of study. The ages ranged from a few hours to 94 years with a mean age of 38.5 years. The male to female ratio was 1.2:1. An average of 547 weekend deaths and 568 weekday deaths were recorded, giving a ratio of 0.96:1. A ratio of weekend to weekday death rate of 0.99:1 and 0.93:1 for the males and females, respectively was noted. The labor ward, followed by the intensive care unit (ICU) had the highest weekend to weekday death ratio of 1.72:1 ( P = 0.0461) and 1.41:1 ( P = 0.1440), respectively. Weekend deaths were less in the other wards, with the gynaecological ward having the least ratio of 0.63:1 ( P = 0.7360). Conclusion: The rate of hospital deaths was generally found not to vary significantly over the weekends and weekdays in the hospital except for the labor ward which had significantly higher weekend to weekday death rates of 1.72:1. There is therefore need for confidential enquiry into the causes of hospital deaths, especially in the labor ward, in order to identify and prevent avoidable deaths.
  1,735 272 6
Physician heal thyself
Akoria Obehi Aituaje, Arhuidese Isibor James
October-December 2013, 16(4):558-558
DOI:10.4103/1119-3077.116876  PMID:23974761
  1,638 197 -
The frequency of various indications for plain chest radiography in Nnamdi Azikiwe University Teaching Hospital Nnewi (Nauth)
OC Okpala, C Okafor, ME Aronu
October-December 2013, 16(4):439-442
DOI:10.4103/1119-3077.116885  PMID:23974735
Background: With soaring advances in the field of medicine, the place of older radiologic imaging modalities is being reduced to basic screening tools. Yet the modern imaging modalities like computerized tomography (CT), magnetic resonance imaging (MRI), ultrasound and nuclear medicine are hardly available. Study Objectives: To study the frequency of various indications of plain chest radiography, remind us of its uses and to enhance the preparedness of the department to maximally accomplish the ideals of this investigation. Methodology: A total of 1476 consecutive patients for chest radiography in the department of radiology, NAUTH, Nnewi from the period of February 2009 and whose request form contain adequate data were recruited for this study. These data were analyzed using SSPS. Results: A total of 1476 patient were included in this study. There was female preponderance with male to female ratio of 1.3:1. Mean Age of the patients is 39.32 years (std19.56). The most frequent indication for chest radiography is certain infections and parasitic diseases (40.9% and the greatest source of referral for this study is General outpatient (GOPD)/family medicine department. Conclusion: The most frequent indications for chest radiography in the study are certain infection and parasitic diseases. Chest Radiography is the most frequent plain radiography study in our environment where infectious diseases are still very rampant. This makes chest radiography an important study for screening patient for possible diagnosis and classifying the need for further radiographic investigation of our patients.
  1,490 210 -

October-December 2013, 16(4):553-553
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