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   2014| January-February  | Volume 17 | Issue 1  
    Online since December 10, 2013

 
 
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CASE REPORTS
Rectal and genital prolapse in Nigerian newborns: Case reports and review of the literature
AA Folashade, OT Adetutu, FM Bolanle
January-February 2014, 17(1):119-121
DOI:10.4103/1119-3077.122873  PMID:24326821
Genital prolapse in the newborn is a rare clinical condition often times seen in association with congenital myelo-meningocele, or this could occur following shigellosis infection. We therefore report two neonates with rectal prolapse following diarrhea and utero-vaginal prolapse associated with congenital spinal bifida.
  14,015 418 1
ORIGINAL ARTICLES
Reducing maternal deaths in a low resource setting in Nigeria
EC Ezugwu, PU Agu, MO Nwoke, FO Ezugwu
January-February 2014, 17(1):62-66
DOI:10.4103/1119-3077.122842  PMID:24326810
Objective: To assess the impact of the adoption of evidence based guidelines on maternal mortality reduction at Enugu State University Teaching Hospital, Nigeria. Materials and Methods: A retrospective review of all maternal deaths between 1 st January, 2005 and 31 st December, 2010 was carried out. Evidence based management guidelines for eclampsia and post-partum hemorrhage were adopted. These interventions strategy were carried out from 1 st January, 2008-31 st December, 2010 and the result compared with that before the interventions (2005-2007). Main outcome measure: Maternal mortality ratio (MMR) and case fatality rates. Results: There were 9150 live births and 59 maternal deaths during the study period, giving an MMR of 645/100 000 live births. Pregnant women who had no antenatal care had almost 10 times higher MMR. There was 43.5% reduction in the MMR with the interventions (488 vs. 864/100 000 live births P = 0.039, odds ratio = 1.77). There was also significant reduction in case fatality rate for both eclampsia (15.8% vs. 2.7%; P = 0.024, odds ratio = 5.84 and Post partum hemorrhage (PPH) (13.6% vs. 2.5% P value = 0.023, odds ratio = 5.5. Obstetric hemorrhage was the most common cause of death (23.73%), followed by the eclampsia. Conclusion: Administration of evidence based intervention is possible in low resource settings and could contribute to a significant reduction in the maternal deaths.
  12,587 937 6
CASE REPORTS
Fatal scorpion sting in a child
OA Oyedeji, TL Musa, OJ Adebami, GA Oyedeji
January-February 2014, 17(1):112-114
DOI:10.4103/1119-3077.122866  PMID:24326819
Fatal scorpion stings are rare in Nigeria. Hitherto, there has been no report from Nigeria of death following scorpion stings. This report is that of a 2-year-old boy who was stung by a scorpion while playing outside his home environment in Osogbo, South West Nigeria. He subsequently presented to the Children Emergency Unit of Ladoke Akintola University of Technology Teaching Hospital, Osogbo, in pain and with features of shock. He died within 2 h of admission despite all treatment given to relieve pain and manage shock. The case is reported in order to share the important lessons learned.
  10,648 665 -
ORIGINAL ARTICLES
Treatment of unilateral giant fibroadenoma by breast reduction skin incision: The inverted "T" technique
JU Achebe, GE Njeze, OR Okwesili
January-February 2014, 17(1):43-46
DOI:10.4103/1119-3077.122835  PMID:24326806
Background: Giant fibroadenoma (GFA) has been defined as fibroadenoma greater than 5 cm in it's the widest diameter and/or weighing more than 500 g. A benign lesion, its size also raises the possibility of malignancy requiring differentiation from a malignant breast disease. When unilateral GFA presents with a severe breast asymmetry, due to its size, it is not correctable by simple enucleation alone. Postoperative asymmetry from volume and ptosis disparity results, which needs to be addressed at the primary surgery. The inverted "T" technique, which is effective in volume reduction and ptosis correction in breast hypertrophy, can be applied in the treatment of unilateral GFA. Aim: This is a retrospective review of all GFA treated by inverted "T" method. Materials and Methods: A retrospective review was carried out on all patients with GFA treated by inverted "T" skin pattern method over a period of 20 years (January 1988 to December 2007). The procedures were carried out at the University of Nigeria Teaching Hospital and the National Orthopedic Hospital, Enugu. Information, which included patients' demographics, pre-operative assessment, operative findings and outcome of surgery were obtained from the case files of the patients. The degree of ptosis was recorded for each patient. Diagnosis of GFA was made after clinical evaluation and pre-operative tissue biopsy. Immediate results of treatment were based on the patients' satisfaction, visual assessment of symmetry of size of breasts, correction of ptosis and position of nipple areola complex (NAC). Results: A total of 27 patients underwent inverted "T" technique for excision of GFA in their breasts. Their average age was 17.5 years (range 12-25 years) delay in presentation ranged from 2 months to 15 months. In 16 patients (59.2%), the left breast was involved in GFA whilst the tumor occurred on the right breast in 11 (40.7%). The tumor weighed on the average 1500 g (range 655-2200 g). Average diameter of the tumor was 15 cm (range 12-20 cm). All quadrants of the breasts were involved at presentation. The inferior glandular pedicle bearing the NAC was used in all patients. The length of the pedicle ranged from 8 cm to 14 cm whilst the width ranged from 6 cm to 8 cm. Lactation was reported by three patients who went on to successfully breast feed. Complications were minimal. Most were minor wound healing problems and minor breast asymmetry. Epidermolysis in 2, hypertrophic scar in 6,minor breast asymmetry in 3 and delayed healing at the "T" junction in the inframammary fold in 4 were the common complications. All patients were satisfied with the result obtained. Conclusion: In GFA with a significant breast asymmetry, excision through inverted "T" technique was successful in achieving postoperative symmetry with the opposite breast in these patients. Complications were minimal.
  8,044 609 4
Indications for tonsillectomy and adenoidectomy: Our experience
AO Ahmed, I Aliyu, ES Kolo
January-February 2014, 17(1):90-94
DOI:10.4103/1119-3077.122855  PMID:24326815
Background: Infection and obstruction are the most common indications for performing tonsillectomy and adenoidectomy. In the past, infection was the main indication for these procedures; however, in the last few decades obstruction is said to be more prominent as an indication when compared to infection. Objective: The objective of this study was to report our observations of indications for tonsillectomy and adenoidectomy. Materials and Methods: This is a 2 year retrospective analysis of case records of patients aged 0-18 years who have had tonsillectomy, adenoidectomy and adenotonsillectomy performed in a tertiary hospital. Statistical Analysis Used: IBM SPSS (for windows, version 19) software was used to analyze this data. Results: A total of 115 patient's records were reviewed. Moreover, 33.9% were children under 3 years, 60.0% were between 4 years and 10 years and 6.1% were between the ages of 11 years and 18 years. Obstruction accounted for a total of 68.7% while infection accounted for only 31.3% of the indication for these procedures. Conclusion: Obstruction as an indication is proportionally higher in younger children while infection is proportionally higher in older children.
  5,710 654 6
Outcome of primary posterior sagittal anorectoplasty of high anorectal malformation in well selected neonates
OD Osifo, TO Osagie, EO Udefiagbon
January-February 2014, 17(1):1-5
DOI:10.4103/1119-3077.122821  PMID:24326797
Background: Conventional posterior sagittal anorectoplasty (PSARP) for high anorectal malformation (ARM) involves initial colostomy creation with its attendant complications, but primary PSARP in neonates requires no initial colostomy. Objectives: To report on locally adapted inclusion criteria and outcomes of primary PSARP in neonates in Benin City. Materials and Methods: Babies who presented during the first week of life in clinically stable conditions, without cardiac anomaly, and had hemogram and blood chemistry within normal ranges, were included in this prospective study undertaken at the University of Benin Teaching Hospital in 2008-2011. Results: Fifty children with ARM comprising 19 (38%) low/intermediate and 31 (62%) high anomalies were treated during the period. Five (10%) singletons delivered via spontaneous vaginal delivery at term. Aged at operation between two and seven (mean 4) days and comprised three males and two females (ratio 1.5:1), met the inclusion criteria for primary PSARP. The procedure was well tolerated by all the babies; oral intake was commenced on the second post-operative day with nine days median hospitalization duration. No mortality was recorded on six months to four years follow-up. Apart from minor superficial perianal surgical site infection in one baby which responded to antibiotics, no post-operative sepsis or breakdown of repair was recorded. Continence and other anal functions were found excellent using the modified Wingspread scoring during follow-up. Conclusion: These outcomes showed that with meticulous selection, primary PSARP in neonates was feasible and safe in a developing country. Multicenter studies and long-term follow-up are advocated World-wide.
  5,612 724 5
CASE REPORTS
Multiple bilateral submandibular gland sialolithiasis
VS Sunder, C Chakravarthy, R Mikkilinine, S Mahoorkar
January-February 2014, 17(1):115-118
DOI:10.4103/1119-3077.122870  PMID:24326820
Sialolithiasis accounts for the most common etiology of salivary gland obstruction which leads to recurrent painful swelling of the involved gland which often exacerbates while eating. Stones may be encountered in any of the salivary glands but most frequently in the submandibular gland and its duct. Simultaneous sialolithiasis in more than one salivary gland is rare, occurring in fewer than 3% of cases. Seventy to 80% of cases feature solitary stones; only about 5% of patients have three or more stones, the case report which we are presenting here had three submandibular sialoliths involving both the submandibular glands which were removed by intraoral approach and no post-operative complications were noted.
  5,039 597 5
ORIGINAL ARTICLES
Oral misoprostol in the prevention of uterine bleeding after surgical evacuation of first trimester abortion: A comparative study of three uterotonic agents
TM Aramide, AK Olusegun, AC Akinfolarin, DF Oriola
January-February 2014, 17(1):10-13
DOI:10.4103/1119-3077.122823  PMID:24326799
Objective: This comparative study was aimed at determining the effectiveness of oral Misoprostol compared with intravenous Ergometrine and intravenous Oxytocin in reducing vaginal bleeding following surgical evacuation for first trimester abortions. Materials and Methods: This was a single-blind placebo-controlled study in which patients with first trimester uncomplicated abortions were divided into three groups using computer-generated randomization table. The first group was administered oral Misoprostol, the second group had intravenous Ergometrine, and the third group was administered intravenous Oxytocin. The uterotonic agents were administered before the surgical evacuation was carried out. Results: There was statistically significant reduction in blood loss after the evacuation in the Misoprostol group ( P < 0.000). There was also significant reduction in the number of days of bleeding in the Misoprostol group (2.00 ± 0.86) compared with 4.43 ± 0.92 and 4.64 ± 1.06 days in the Ergometrine and Oxytocin groups, respectively ( P < 0.000). There were, however, more gastrointestinal side effects in the Misoprostol and Ergometrine groups (60.7% and 57.1%, respectively) compared with the Oxytocin group. Conclusion: Oral Misoprostol appeared to demonstrate superior efficacy in reducing uterine bleeding after surgical evacuation, compared to the other commonly used uterotonic agents.
  4,672 621 2
Awareness, knowledge and attitude on cleft lip and palate among antenatal clinic attendees of tertiary hospitals in Nigeria
FJ Owotade, OK Ogundipe, VI Ugboko, VN Okoje, HO Olasoji, ON Makinde, EO Orji
January-February 2014, 17(1):6-9
DOI:10.4103/1119-3077.122822  PMID:24326798
Background: Adequate knowledge and awareness of cleft lip and palate (CLP) deformity may help to counter the negative beliefs and attitudes toward the condition. The objective of this study was to assess the level of awareness, knowledge and attitude of women attending antenatal clinics about CLP. Materials and Methods: A cross-sectional descriptive study with the aid of a structured interview administered questionnaire was conducted among 200 women attending antenatal clinics in three Federal Government Teaching Hospitals in the Northern and Southwestern regions of Nigeria. The main outcome measure was the level of awareness and the mean cumulative knowledge score. Results: The mean age of the subjects was 28.9 ± 5.1 years (age range: 16-42 years). Half of the women (50.5%) reported that they had seen or heard about CLP. The mean cumulative knowledge score was 6.9, with only 19.8% having adequate knowledge. Many respondents had neither read an article on CLP nor participated in any public enlightenment program, and 31.5% indicated that they would like to know more about the condition. Level of educational attainment had a statistically significant effect on the level of awareness and knowledge on CLP, as more educated respondents tend to be more aware and knowledgeable ( P < 0.001). Conclusion: There is need for increased public enlightenment/health education to increase awareness and subsequently help develop more positive attitudes toward children with CLP. Such programs should include distribution of pamphlets on CLP at clinics, especially antenatal clinics, media campaigns on radio, TV and newspaper as well as establishment of cleft support groups by the relevant governmental and professional organizations.
  3,935 606 5
Avascular necrosis in sickle cell (homozygous S) patients: Predictive clinical and laboratory indices
AJ Madu, AK Madu, GK Umar, K Ibekwe, A Duru, AO Ugwu
January-February 2014, 17(1):86-89
DOI:10.4103/1119-3077.122852  PMID:24326814
Background: Pathogenetic mechanism as well as laboratory and clinical correlates of osteonecrosis in sickle cell have not been fully investigated. The aim of this study is to investigate the predictive value of the steady state white cell and platelet count as well as the frequency of bone pain crisis per annum to detect sickle cell patients who will eventually develop avascular necrosis (AVN). Patients and Methods: A 5 year retrospective analysis of 122 homozygous S (HbSS) patients, aged 6-49 years (mean age 24.7 ± 7 years), out of which 16 patients (13.1%) had developed AVN within the years under review. Results: The prevalence of AVN in sickle cell patients was determined to be 13.1 per 1000. The steady state white cell count, platelet count, frequency of bone pain crisis and hematocrit, was compared in patients that develop AVN and those who had not over the period. Only the steady state platelet count was found to differ significantly ( P = 0.011) between these two patient groups and to correlate positively (Pearson correlation coefficient = −0.251) with development of AVN. The hematocrit, white cell count, and frequency of bone pain crisis were found neither to differ significantly nor correlate with the development of AVN. Conclusion: In conclusion, patients with a raised steady state platelet count may have a higher tendency to develop AVN and may require closer orthopedic review and prophylactic intervention.
  3,507 494 3
Comparative evaluation of root canal disinfection by conventional method and laser: An in vivo study
Shailendra Mashalkar, Mansing G Pawar, Swapnil Kolhe, Deepak T Jain
January-February 2014, 17(1):67-74
DOI:10.4103/1119-3077.122846  PMID:24326811
Objective: The aim of this study was to comparatively evaluate in vivo the disinfecting ability of conventional method and lasers in root canals. Materials and Methods: Study criteria included 60 single rooted teeth, which were indicated for root canal therapy followed to dental caries and trauma with intact crowns. Such selected patients were randomly divided into 2 groups, namely, Group A (30 teeth) and Group B (30 teeth). All clinical procedures were carried out under strict aseptic precautions. The teeth in Group A were subjected to biomechanical preparation followed by the treatment with the help of diode laser containing the gallium aluminum and arsenic, which emitted 980 nm wavelengths. The teeth in Group B were treated with routine method of biomechanical preparation along with irrigation using sodium hypochlorite and hydrogen peroxide. The microbiological samples were taken immediately after the access preparation and after the completion of the root canal disinfection and were sent for microbiological analysis. Results: The teeth in Group A showed presence of common strains of bacteria ranging from Streptococci, Staphylococci, Klebsiella, and Pseudomonas. Reduction in the growth of microorganisms was found for all types of microorganisms. Only 8 samples exhibited the growth after treatment with laser. Results of Group B also showed the presence of common strains of anaerobic and aerobic bacteria as shown in earlier studies, predominantly Staphylococcus, Streptococci, and Pseudomonas. Statistical analysis showed non-significant P values for the microorganisms; however, only 3 samples showed the growth after treatment with conventional technique using sodium hypochlorite and hydrogen peroxide. Conclusion: Conventional method by using sodium hypochlorite and hydrogen peroxide as irrigating solutions is highly effective in disinfecting the root canal. Lasers when used can also reduce the bacterial load of the infected root canal.
  3,207 725 2
Health education alone and health education plus advance provision of emergency contraceptive pills on knowledge and attitudes among university female students in Enugu, Nigeria
SU Arinze-Onyia, EN Aguwa, Ed Nwobodo
January-February 2014, 17(1):100-105
DOI:10.4103/1119-3077.122858  PMID:24326817
This was an intervention study to compare the effects of health education alone and health education plus advance provision of emergency contraception (EC) pills on the knowledge and attitudes to EC by female students of University of Nigeria in South-East Nigeria. Materials and Methods: A structured questionnaire was used to collect data in February, 2009 from 290 female students of a tertiary educational institution (140 in the study group and 150 from the control group) who were selected by multistage sampling. Subsequently, health education was conducted among all the students. In addition, a pack containing 2 tablets of EC pills (Postinor) was given only to the students in the study group. Three months after this intervention, its effects were assessed through a survey using the same structured questionnaire employed in the baseline survey. Results: knowledge of EC was significantly higher among the study group than the controls at post-intervention, P < 0.05. Attitudes to EC were also more favorable at post-intervention survey among the study group, P < 0.05 in most of the variables. Conclusion/Recommendation: Health education plus advance provision of EC pills effectively improved knowledge and attitudes to EC among female students of tertiary institutions more than health education alone and this should be promoted.
  3,083 438 -
Refractive errors in patients attending a private hospital in Jos, Nigeria
K Malu, C Ojabo
January-February 2014, 17(1):106-111
DOI:10.4103/1119-3077.122863  PMID:24326818
Objective: This study was carried out to determine the prevalence and pattern of refractive error in patients presenting to a private hospital. Materials and Methods: Records of all patients who presented at the hospital from 2000 to 2009 with visual acuity (VA) of 6/9 or less and showed improvement in distance vision of one or more lines with refraction were reviewed. The eye with the better presenting visual acuity was used for classifying the patient. The spherical equivalent refraction was used with the formula (sphere plus cylinder/2). Results: Two thousand eight hundred ninety eight patients were seen at the hospital for various eye problems. Six hundred one (20.7%) patients with distant VA which improved with refraction were considered for this analysis. Two hundred twenty one (36.8%) of patients with refractive error were visually impaired (VA <6/12-3/60). Blindness (<3/60 - none perception of light) was seen in 91 (15.1%) of the patients, seven of whom were aphakic. Best corrected visual acuity increased the number of patients with normal visual acuity from 289 (48.1%) to 579 (96.3%). Overall visual impairment (VI) (<6/12-3/60) was reduced from 221 (36.8%) to 22 (3.6%). Severe visual impairment and blindness were completely eliminated just with refractive correction. Of those with refractive error, there were 35.8% with myopia, 29.5% with hypermetropia and 34.8% with astigmatism. Males had slightly more myopia and astigmatism, and female more hypermetropia though the difference was not statistically significant. Refractive error was seen more among the students 207 (34.4%) and civil servants 189 (31.4%) and least among the artisans 7 (1.2%). Anisometropia of ≤ 1 D, >1-2 D, >2-3 and > 3 D were found in 76.5%, 11.8%, 5% and 5.0% respectively. Conclusion: The study shows that refractive error is a common cause of VI and myopia is the most common type. It confirms that most of the refractive error can be corrected with off-the-shelf spectacles.
  2,988 466 1
Non-third molar related pericoronitis in a sub-urban Nigeria population of children
MO Folayan, EO Ozeigbe, N Onyejaeka, NM Chukwumah, T Oyedele
January-February 2014, 17(1):18-22
DOI:10.4103/1119-3077.122826  PMID:24326801
Background: The study will report on the prevalence, clinical presentation, diagnosis, and management of non-third molar related pericoronitis seen in children below the age of 15 years who report at the Pediatric Dental Clinic, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife over a 4½ year period. Materials and Methods: This is a prospective study of cases of pericoronitis affecting any tooth exclusive of the third molar diagnosed in the pediatric dentistry out-patient clinic in Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife between January 2008 and June 2012. Pericoronitis was diagnosed using the criteria described by Howe. Information on age, sex, history malaria fever, upper respiratory diseases, tonsillitis, and evidence of immunosuppression were taken. Radiographs were taken in all cases to rule out tooth impaction and information on treatment regimen was also collected. Results: The prevalence of non-third molar related pericoronitis was 0.63%. More females (63.6%) were affected. Chronic pericoronitis was the most common presentation (73.3%). No case was reported in the primary dentition and the premolar. No case was associated with tooth impaction and the tooth most affected was the lower right second permanent molar (35.7%). Bilateral presentation was seen in 36.4% patients. Herpetic gingivostomatitis was reported in association with one case. Chronic pericoronitis resolved within 3 days of management with warm saline mouth bath (WSMB) and analgesics, while acute/subacute resolved within 10 days of management with antibiotics, analgesics, and WSMB. Conclusions: The prevalence of non-third molar related pericoronitis is the low. The most prevalence type is chronic pericoronitis affecting the lower right second permanent molar.
  2,919 456 1
Asymptomatic bacteriuria among pregnant women with sickle cell trait in Enugu, South Eastern Nigeria
CC Obiora, CC Dim, HU Ezegwui, EE Nwogu-Ikojo, C Okeudo
January-February 2014, 17(1):95-99
DOI:10.4103/1119-3077.122856  PMID:24326816
Context: Asymptomatic bacteriuria (ASB) in pregnancy is a major risk factor for developing acute cystitis and pyelonephritis, especially, among women with sickle cell disease. This study compared the prevalence, pattern, and microbiological characteristics of ASB in pregnancy between sickle cell trait (HbAS) and normal hemoglobin AA (HbAA) genotype subjects. Materials and Methods: Culture and sensitivity of mid-stream urine samples were collected from 300 HbAS women and 300 matched HbAA control at the antenatal clinic of University of Nigeria Teaching Hospital Enugu, Nigeria from August 2010 to December 2011. Analysis was both descriptive and inferential at 95% confidence levels. Results: Prevalence of ASB in HbAS and HbAA women were 32.7% (98/300) and 32% (96/300) respectively (odd ratio (OR) =1.03 [95% confidence interval (CI) 0.73, 1.45]). Escherichia coli was the most common organism isolated in both the HbAS group (56.1%, 55/98) and control group (61.4%, 59/96), (OR = 0.80 [95% CI 0.45, 1.42]). The antibiotics with the highest microbial sensitivity were ciprofloxacin 90.8% (89/98) and gentamicin 100% (98/98) for HbAS and HbAA women respectively. Conclusions: The prevalence of ASB in pregnant women with HbAS in Enugu, Nigeria was high and did not vary significantly from that of woman with HbAA. Therefore, pregnant women irrespective of their sickle cell status would benefit from routine screening for ASB.
  2,847 465 -
Effects of the topical hemostatic agent Ankaferd Blood Stopper on the incidence of alveolar osteitis after surgical removal of an impacted mandibular third molar
M Tek, I Akkas, O Toptas, F Ozan, I Sener, C Bereket
January-February 2014, 17(1):75-80
DOI:10.4103/1119-3077.122847  PMID:24326812
Background: Alveolar osteitis (AO) is a commonly seen post-operative complication during the wound-healing period after permanent tooth extraction or surgical removal of impacted third molar teeth. Objectives: The aim of this clinical study was to evaluate the effects of administration of the topical hemostatic agent Ankaferd Blood Stopper (ABS) into the socket on AO formation after impacted mandibular third molar extraction. Patients and Methods: Bilaterally, 100 half-impacted mandibular third molars were extracted in 50 patients. Then, 1.0 mL ABS was administered to achieve hemostasis in one half of the sockets and as a control, the other half was irrigated with 1.0 mL physiological serum after surgery. Results: There was no statistically significant difference in terms of AO formation ( P > 0.05) between the extraction sites. However, the postoperative pain in ABS administration sites was higher than in the other sites for the first 2 days after surgery ( P < 0.05). Conclusions: The results showed that ABS administration did not increase the incidence of AO formation. Thus, ABS can be used safely for hemostasis after impacted mandibular third molar surgery.
  2,425 659 3
Facial nerve palsy: Analysis of cases reported in children in a suburban hospital in Nigeria
MO Folayan, RI Arobieke, E Eziyi, EO Oyetola, J Elusiyan
January-February 2014, 17(1):23-27
DOI:10.4103/1119-3077.122828  PMID:24326802
Aim: The study describes the epidemiology, treatment, and treatment outcomes of the 10 cases of facial nerve palsy seen in children managed at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife over a 10 year period. It also compares findings with report from developed countries. Methodology: This was a retrospective cohort review of pediatric cases of facial nerve palsy encountered in all the clinics run by specialists in the above named hospital. A diagnosis of facial palsy was based on International Classification of Diseases, Ninth Revision, Clinical Modification codes. Information retrieved from the case note included sex, age, number of days with lesion prior to presentation in the clinic, diagnosis, treatment, treatment outcome, and referral clinic. Findings: Only 10 cases of facial nerve palsy were diagnosed in the institution during the study period. Prevalence of facial nerve palsy in this hospital was 0.01%. The lesion more commonly affected males and the right side of the face. All cases were associated with infections: Mainly mumps (70% of cases). Case management include the use of steroids and eye pads for cases that presented within 7 days; and steroids, eye pad, and physical therapy for cases that presented later. All cases of facial nerve palsy associated with mumps and malaria infection fully recovered. The two cases of facial nerve palsy associated with otitis media only partially recovered. Conclusion: Facial nerve palsy in pediatric patients is more commonly associated with mumps in the study environment. Successes are recorded with steroid therapy.
  2,500 471 1
Cardiac arrest during anesthesia at a university Hospital in Nigeria
A Rukewe, A Fatiregun, TO Osunlaja
January-February 2014, 17(1):28-31
DOI:10.4103/1119-3077.122829  PMID:24326803
Background: We assessed the incidence and outcomes of cardiac arrest during anesthesia in the operating room at our university hospital. A previous study on intraoperative cardiac arrests covered a period from 1994-1998 and since then; anesthetic personnel, equipment, and workload have increased remarkably. Materials and Methods: After obtaining institutional ethics approval, we retrospectively reviewed patients' hospital records such as anesthetic charts and register and ICU admission charts between 1 st July 2005 and 30 th June 2010. The cardiac arrests encountered during anesthesia was identified from anesthetic charts and followed-up in the intensive care unit (ICU) for the first 24 h postoperatively. We consider that cardiac arrest occurred in any patient under anesthesia with asystole or ventricular fibrillation requiring cardiac compression or electrical defibrillation. We define recovery as an alive and non-comatose patient 24-h after the cardiac arrest. Results: During the study period, a total of 12,143 surgeries were done; the median age of all the patients was 30 years (range: 1 day-119 years). A total of 31 cardiac arrests identified (frequency 25.5:10,000; 95% confidence interval (CI) 17.7-35.8) out of which 17 were nonfatal. Mortality related to anesthesia was 11.5:10,000 (95% CI 6.5-18.9). The median age of patients with cardiac arrests was 39 years (range: 2 months-78 years). Overall, 80.7% cardiac arrests occurred in the American Society of Anesthesiologists' (ASA) physical status 3-5. Cardiothoracic and neurosurgical operations accounted for 54.8% of the total cardiac arrests. The known risk factors identified among those who had cardiac arrest were, ASA physical status 3-5 (80.7%), procedures performed out-of-work hours (60%), and manually ventilating patients during general anesthesia (39%). Conclusion: Cardiac arrest during anesthesia is higher in poor risk patients (ASA 3-5) who are manually ventilated under general anesthesia and operated during out-of-work hours.
  2,037 536 4
The effect of orthodontic extraoral appliances on depression and the anxiety levels of patients and parents
T Topcuoglu, O Yildirim, M Birlik, O Sokucu, M Semiz
January-February 2014, 17(1):81-85
DOI:10.4103/1119-3077.122850  PMID:24326813
Background: Psychosocial consequences and post-operative anxiety in patients after fixed orthodontic treatment are important parameters that must be evaluated by clinicians not to effect patient and their parent's psychosocial mood negatively. Objective: The aim of this study was to evaluate the changes in depression and anxiety levels of orthodontic patients and their parents before the extraoral appliance therapy, and at a 1-year follow-up. Materials and Methods: Patients and one of their parents responded to a series of questionnaires and evaluation scales in order to assess depression and anxiety levels. Two groups of patients and their parents were surveyed; one group that had not yet embarked on the treatment and another that had commenced extra-oral appliance therapy 1 year prior to the study. Results: The 1-year-treatment group scored significantly higher than the pre-treatment group on the depression scale and the trait-anxiety scale. State-trait anxiety inventory scores did not differ significantly between the groups. The parents of the 1-year-treatment group also scored significantly higher on the Beck depression inventory than those of the pre-treatment group. Conclusion: The results of this study emphasize the need for due consideration of psychological parameters before and during treatment with extra-oral appliances, particularly with regard to depression and anxiety.
  2,186 379 3
Pattern of presentation of oral health conditions by children at University of Nigeria Teaching Hospital, Enugu: A retrospective study
N Folaranmi, E Akaji, N Onyejaka
January-February 2014, 17(1):47-50
DOI:10.4103/1119-3077.122836  PMID:24326807
Aim: The study aimed to determine the pattern of occurrence of oral conditions among children that attended the Child Dental Health clinic of the University of Nigeria Teaching Hospital (UNTH), Enugu over a 45 months period. Materials and Methods: Clinical records of 305 patients, aged 3 days to 16 years, who attended the Child Dental Health Clinic of the UNTH from April 2008 to December 2011 were retrieved and analyzed. Results: Out of a total of 305 children who visited the Child Dental Health Clinic within this period, there were 148 (48.5%) males and 157 (51.5%) females. The ages ranged from 3 days to 16 years with a mean age of 9.05 years, only 4.6% made asymptomatic visit while 95.4% made symptomatic visit. 68.2% had caries and its sequeale, with no significant difference across the gender ( P = 1.472). Nearly 91.1% had periodontal diseases, with a significant difference noted ( P = 0.020) 2% had tooth developmental anomalies, 10.5% had traumatic dental injuries, 12.1% had malocclusion and other esthetic problems, 15.1% had other oral pathologies, 14.4% had abnormalities of tooth eruption. Conclusion: A significant 95.4% of the children made symptomatic visit. Periodontal disease was the most prevalent finding followed by dental caries. There is an urgent need to increase dental health awareness among children through school based continuing dental education program and also among other pediatric care givers such as parents, teachers, and pediatricians.
  2,199 365 4
Pediatric cataract surgery in Madagascar
HCL Randrianotahina, HE Nkumbe
January-February 2014, 17(1):14-17
DOI:10.4103/1119-3077.122824  PMID:24326800
Background: Cataract is the main cause of blindness among children in Africa, having replaced vitamin A deficiency and measles. The management of childhood cataract in Africa, especially francophone countries, is inadequate. Aims and Objective: The objective is to study the age at presentation of children diagnosed with cataract, their visual outcomes, and follow-up patterns after surgery in Madagascar. Materials and Methods: This was a retrospective case series of children operated on for cataract in one of the busiest eye hospitals in Madagascar between September 1999 and July 2009. Data were obtained from theater logs and patient case notes and entered in a Microsoft Excel spreadsheet. Data entry was carried out using Microsoft Excel and analysis using Intercooled Stata version 9.0. Student t-test and Pearson's Chi-square were used to test associations where appropriate. Results: A total of 60.5 percent of the 86 children operated on during the study period were boys. The mean age at presentation was 6.9 years (±SD 4.3) for congenital cataract, 13.1 years (±SD 2.9) for developmental cataract and 9.4 years (±SD 4.0) for traumatic cataract. A total of 36 children (41.9%) came back for follow-up, while 72 children (83.7%) were lost to follow-up 5 weeks after surgery. The mean follow-up period was 5 weeks (±SD 17.9). Children, who were brought back for follow-up were younger than those who were not. Although 64 (74.4%) of children had refraction during their encounters with the eye care facility, only 3 (3.5%) were provided with glasses. At last documented follow-up, 2.7% of the children had 6/18 vision or better. Conclusions: In Madagascar, presentation for congenital and developmental cataract is very late, visual outcome poor and follow-up inadequate. There is an urgent need for a childhood blindness program to effectively deal with pediatric cataract, an avoidable cause of blindness and visual disability in children on the island nation.
  1,861 464 6
An in vitro study of the effect of design of repair surface on the transverse strength of repaired acrylic resin using autopolymerizing resin
H Mahajan, GS Chandu, SK Mishra
January-February 2014, 17(1):38-42
DOI:10.4103/1119-3077.122833  PMID:24326805
Statement of Problem: The fracture of complete denture is a common occurrence in the field of prosthodontics. Often if all other criteria are met such as good aesthetics, occlusion, and functionality; denture repair is acceptable. Once denture fractures, we would want the joint surface strength to be as good as original. Purpose: The purpose of this study was to determine the effect of different repair surface design on the transverse strength of repaired acrylic denture resin. Materials and Methods: Sixty specimens of heat-cured acrylic resin of dimension 65 mm × 20 mm × 2.5 mm were prepared using a special die. Transverse strength of 15 samples was calculated which serves as a control group. Three different types of joint surface contours were prepared each having 15 samples each as butt, round, and rabbet joint. Transverse strength of three joint contours was then compared with control group and also they were compared with each other and result was statistically analyzed with one-way analysis of variance (ANOVA) and Post-hoc ANOVA Tukey's HSD test at 5% level of significance. Z-test of proportion was also done for types of failures. Result: Transverse strength of original specimen was higher than that of repaired specimens. Transverse strength of round joint was higher than the butt and rabbet joint. Conclusion: Methods of repair have significant effect on strength of repaired denture. Round joint design of repair technique was far superior.
  1,760 392 -
CASE REPORTS
Multiple organ dysfunction caused by parathyroid adenoma-induced primary hyperparathyroidism
Q-Y Fu, L Ma, Z-B Yang, T Pao
January-February 2014, 17(1):122-124
DOI:10.4103/1119-3077.122874  PMID:24326822
We present a 27-year-old male with multiple organ dysfunction caused by parathyroid adenoma-induced primary hyperparathyroidism (PHPT). Initially, the patient experienced a sudden onset of gastrointestinal symptoms, polyuria, polydipsia, bone pain, renal dysfunction, nephrolithiasis, and acute pancreatitis, symptoms associated with hypercalcemia. Biochemical findings suggested PHPT. Renal biopsy showed an acute tubular injury and massive calcium deposits in the tubular epithelial cells and tubular lumina. Moreover, neck ultrasonography suggested the possibility of a parathyroid tumor. We excised his right parathyroid gland. Histopathological analysis revealed features of a parathyroid adenoma. Post-operatively this patient had normal serum calcium concentration, but was renally insufficient. A recent repeat biopsy showed chronic renal tubular injury. Our findings illustrate the complications of various systems that can occur in patients with PHPT caused by a parathyroid adenoma.
  1,667 344 -
ORIGINAL ARTICLES
Early results of two methods of posterior spinal stabilization in Nigerians
AA Adeolu, AA Oremakinde, EO Komolafe
January-February 2014, 17(1):51-55
DOI:10.4103/1119-3077.122838  PMID:24326808
Background: In this study, early outcomes of the spinous process wiring with vertical strut (SPWVS) were compared with that of standard pedicle screw and rod (PSR) in our patients. Materials and Methods: We obtained patients' bio-data, diagnosis, investigations, cost of implant, operative circumstances, complications, and outcomes from clinical documentation. Outcome measures, including postoperative infection and persistent/recurrent instabilities, implant related problems, operative blood loss and time and cost, were compared in the two groups of patients. Results: Forty one (M:F-0.9:1) patients had PSR and 35 (M:F-2.2:1) had SPWVS. There was no difference in the occurrence of post-operative instability ( P = 0.630), surgical site infection ( P ≥ 0.416), neurological deficits ( P ≥ 0.461) and implant related complications ( P ≥ 0.461) in the two groups of patients. Cost of implant in the PSR group range from N138,000 (for 2 level fusion) (1USD = N159) to N246,000 (for 4 level fusion) with an average of N192,000 (Standard deviation [SD] N44,090.81) depending on the number of level fused while the cost of implant for SPWVS was N8,000 irrespective of the number of level of fusion being carried out ( P = 0.000). Mean estimated blood loss intra-operatively was higher for PSR (761.33 [SD 396.24] ml) than SPWVS (524.58 [SD 504.70] ml) ( P = 0.005). Mean operation time was 397.17 (SD 122.183) min and 249.44 (SD 130.31) min PSR and SPWVS ( P = 0.000). Conclusion: SPWVS appears to be a good alternative to PSR, especially in our resource limited environment, in view of similar post-operative infection rate, implant complication, stability and post-operative neurological deterioration as well as shorter operation time, less estimated blood loss and much cheaper cost of implant in the former.
  1,505 333 2
Comparison of chemotherapy and hematopoietic stem cell transplantation pre and postterm DMFT scores: A preliminary study
ET Ertas, F Kurnaz, YO Zorba, I Koçyigit, Y Sisman, L Kaynar, AE Sekerci, H Ertas, M Cetin
January-February 2014, 17(1):32-37
DOI:10.4103/1119-3077.122831  PMID:24326804
Aims: Chemotherapy is frequently used as a conditioning regimen to destroy malignant marrow cells before transplantation. Xerostomia, dysphagia, altered taste perception, mucositis, soft-tissue ulceration, and infection are common adverse oral effects of chemotherapy. The study was aimed to compare decayed, missing, filled teeth (DMFT) scores before and after hematopoietic stem cell transplantation (HSCT) and chemotherapy. Materials and Methods: Thirty-six patients undergoing HSCT were included in the study. A pre-HSCT dental treatment protocol was implemented that consisted of restoration of all active carious lesions, treatment of periodontal infections, and extraction of all teeth with advanced periodontal disease. Upon completion of dental treatment, the importance of rigorous and effective oral hygiene was reemphasized, and patients were recalled 6 months later. DMFT scores were calculated prior to the initiation of HSCT treatment and 6 months after transplantation. Statistical Analysis Used: Regression analysis was used to evaluate the effects of HSCT and chemotherapy on DMFT scores. Results: Wilcoxon T test showed a statistically significant difference in DMFT scores before and after HSCT ( P < 0.001). Conclusions: DMFT scores were found to increase after chemotherapy and HSCT, suggesting that the risk of infection is higher among HSCT patients when compared to other individuals. The results emphasize the need for dental examinations as an integral part of examination and treatment planning for patients undergoing HSCT and chemotherapy.
  1,483 315 2
Effect of the number of portal area on modified histological activity index of viral hepatitis and histological findings
M Gurbuzel, G Saygi, F Ozyigit, AF Oguzoncül, HG Gulsen, S Basaran
January-February 2014, 17(1):56-61
DOI:10.4103/1119-3077.122840  PMID:24326809
Aim: Viral hepatitis is one of the most important causes of chronic hepatitis. Liver biopsy is used to verify clinical diagnosis and to evaluate necroinflammation and fibrosis. Biopsy is the guide for therapy and can be performed also after treatment to assess the effect of therapy on liver. This paper aimed to explore histopathological characteristics of biopsy samples, which had been referred to our department with the clinical diagnosis of chronic viral hepatitis, in reference to Ishak Modified Hepatic Activity Index (IMHAI), as well as to compare inflammatory scores and stages in the groups created according to the number of portal area (PA). Materials and Methods: The study included 107 patients that underwent liver biopsy in 2011 being diagnosed with chronic viral hepatitis. Age, gender and type of viral hepatitis were retrospectively reviewed and histological findings such as IMHAI inflammatory score and stage, hepatosteatosis and ground glass hepatocytes were re-assessed by two pathologists. Results: Of the present cases, 97 had chronic hepatitis B, 5 had chronic hepatitis C, and 5 had chronic hepatitis BDThe group with PA number of 2-4 consisted of 8 cases and the group with PA number of 11 and over consisted of 37 cases. Conclusion: Statistical analysis performed by comparing IMHAI inflammatory score and stage with PA revealed that score and stage were significantly higher in PA ≥ 11 groups as compared to PA 2-4 group.
  1,505 260 1
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