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   2014| May-June  | Volume 17 | Issue 3  
    Online since April 9, 2014

 
 
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ORIGINAL ARTICLES
Accuracy of clinical and ultrasound estimation of fetal weight in predicting actual birth weight in Enugu, Southeastern Nigeria
EO Ugwu, PC Udealor, CC Dim, SN Obi, BC Ozumba, DO Okeke, PU Agu
May-June 2014, 17(3):270-275
DOI:10.4103/1119-3077.130208  PMID:24714001
Background: Estimation of fetal weight is important for antenatal and intrapartum management of pregnant women. Sonographic methods are not readily accessible in under-resourced settings, it is therefore necessary to study the accuracy of a clinical method of estimating fetal weight where this limitation (unavailability of ultrasound) exists. Objective: To compare the accuracy of clinical and ultrasound methods of fetal weight estimation at term. Materials and Methods: Clinical and ultrasound fetal weights were estimated on 200 consecutive term pregnancies (37 completed weeks of gestation - 41 weeks and 6 days) at the University of Nigeria Teaching Hospital, Enugu, Nigeria from 1 st April to 30 th November 2012. Accuracy was determined using percentage error, absolute percentage error, and proportion of estimates within 10% of actual birth weight. Results: Actual birth weight had strong positive correlation with both clinical and ultrasound estimated fetal weights (r = 0.71, P < 0.001 and r = 0.69, P < 0.001, respectively). Overall, both the clinical and ultrasound methods systematically overestimated the actual birth weight. The proportion of the clinical estimated weights that were within 10% of the actual birth weight was significantly lower than that of ultrasound method for babies of all birth weights (35.0 vs. 67.5%; P < 0.001) and for macrosomic babies (76 vs 100%, P = 0.009). For babies with normal birth weights (2.5-3.9 kg), ultrasound method error values were significantly lower than those of clinical method for both the mean % error (5.4 vs 19.6%; P < 0.001) and the mean absolute % error (9.97 vs 20.6%; P < 0.001). Conclusion: The ultrasound method is generally a better predictor of the actual birth weight than the clinical method, and thus should be used in estimating the actual birth weight when accessible.
  10,403 833 9
An evaluation of school health services in Sagamu, Nigeria
OA Oyinlade, OO Ogunkunle, DM Olanrewaju
May-June 2014, 17(3):336-342
DOI:10.4103/1119-3077.130236  PMID:24714013
Context: School health services (SHS) have been shown to be suboptimal in Nigeria. The paucity of data on the status of SHS in Sagamu makes it even more challenging for instituting corrective action. Aim: To evaluate SHS in public and private schools in Sagamu. Settings and Design: This was a cross-sectional study carried out on private and public nursery/primary and secondary schools in Sagamu, Ogun State. Materials and Methods: A total of 91 schools, randomly selected from 182 available, comprising 53 private nursery/primary schools, 22 public nursery/primary schools, 11 private secondary schools and 5 public secondary schools, were inspected for availability of the components of the SHS and evaluated using the SHS Evaluation Scale (SHSES). Statistical Analysis Used: Data were analyzed using SPSS version 15.0. Categorical variables were analyzed using Chi-square test. Level of significance was taken to be P < 0.05. Results: Only one (1.1%) school benefited from the services of a school doctor. Essential drugs and materials for first aid services were available in 85 (93.4%) of the schools, while only 26 (28.6%) had a sick bay. Screening tests for disabilities were performed in only 10 (11%) of the schools visited. Although school midday meals were available in all the schools, they were not free. Private secondary schools had the highest percentage of good school health evaluation scores (63.6%), while 96.2% of the private primary schools had poor health service evaluation scores. Conclusions: SHS are unsatisfactory in Sagamu. It is therefore necessary for all stakeholders in Sagamu schools (private and public) to provide the materials and manpower needed to achieve effective SHS in the area.
  10,288 866 2
Single visit root canal treatment: A prospective study
JI Edionwe, OP Shaba, DC Umesi
May-June 2014, 17(3):276-281
DOI:10.4103/1119-3077.130210  PMID:24714002
Objectives: The aim was to determine the success rate of single visit root canal treatment (RCT) and thus encourage clinicians to offer this treatment option appropriately. Materials and Methods: This was a longitudinal clinical study involving all teeth of the secondary dentition except third molars in the upper and lower jaws. Teeth having irreversible pulpitis, pulp necrosis or periapical periodontitis were included in the study. RCT and obturation was done at a single visit. The patients were monitored over 6 months. Results: Forty-five teeth were treated in 21 females and 24 males, aged 18-56 years (34.4+/-12.7). Preoperatively, pain was present in 84.4%, tenderness to percussion in 53.3%, and periapical radiolucency in 24.4% teeth. Forty percent had irreversible pulpitis and 60% had apical periodontitis. Post-operatively, pain reduced to 51.1% on day 1, 15.5% at 1 week, and 0% for the rest of the period. Tenderness to percussion reduced to 15.6% at 1 week and 0% by 1 month. Periapical radiolucency reduced to 9.5% at 6 months. Favorable outcome of 33.3% was recorded on day 1 and increased to 90.5% at 6 months. Six months success rate for teeth which had irreversible pulpitis was 100% and 83.3% for apical periodontitis. The mean time needed to complete a single visit RCT ranged from 77 min for a tooth having one canal to 132 min for one having four canals. C onclusion : Single visit RCT is a viable treatment option for teeth having irreversible pulpitis or apical periodontitis irrespective of tooth type or number of canals. Clinical Significance: A lot of patients are lost to follow-up visits for teeth requiring RCT once the pulp is extirpated at the first visit due to cessation of pain, subsequently leading to treatment failure. Single visit endodontics eliminates the need for follow-up visits and improves treatment prognosis.
  5,341 905 1
Pattern of morbidity and mortality of newborns admitted into the sick and special care baby unit of Enugu State University Teaching Hospital, Enugu state
U Ekwochi, IK Ndu, IC Nwokoye, OU Ezenwosu, OF Amadi, DIC Osuorah
May-June 2014, 17(3):346-351
DOI:10.4103/1119-3077.130238  PMID:24714015
Background: Being the highest contributor to under-5 mortality, neonatal mortality and morbidity has great impact to the attainment of millennium development goals 4 (MDG 4). In Nigeria and other developing countries, this indicator strongly poses a major challenge in achieving this goal. Objectives: To determine the morbidity and mortality pattern of admitted babies in the special care baby unit (SCBU) of Enugu State University Teaching Hospital (ESUTH). Materials and Methods: This is a comparative and descriptive longitudinal study of causes of morbidity and mortality between babies born within (inborn) and outside our hospital facilities (outborn) based on information on place of birth, APGAR scores, age on admission, diagnosis on admission, duration of hospital stay, and outcome of newborns admitted into the sick and SCBU over a 1 year period. Results: A total of 261 neonates were admitted during the period under review. The common causes of admissions seen from the study were perinatal asphyxia (80, 30.7%), low birth weight (64, 24.5%), neonatal sepsis (44, 16.9%), and neonatal jaundice (16, 0.06%). A total of 37 (14.2%) deaths were recorded during the period. The leading causes of deaths were severe form of perinatal asphyxia (18, 52.9%), neonatal sepsis (10, 29.4%), and very low birth weight (two, 0.06%). Fifty-five percent of all the deaths occurred within 24 h of admission. Death due to asphyxia was more in babies born outside the hospital (outborn) than in babies born within the hospital (inborn). Equal number of outborn and inborn babies died from neonatal sepsis. The age at presentation to the sick baby unit was significantly lower in inborn (P = 0.004), while age at death was not different in both group of newborns (P = 0.876). Conclusion: The neonatal mortality rate and the causes of death in this study are similar to those documented by other studies in Nigeria and are largely preventable. Strengthening perinatal care, emergency obstetric services, and enhancement of neonatal resuscitation skills to traditional birth attendants (TBAs) and other community health workers are necessary to reduce the neonatal mortality in our setting and other rural settings across developing countries.
  5,148 940 10
CASE REPORTS
Keratocystic odontogenic tumor: Treatment modalities: Study of 3 cases
B Roopak, M Singh, A Shah, G Patel
May-June 2014, 17(3):378-383
DOI:10.4103/1119-3077.130251  PMID:24714022
Management of the keratocystic odontogenic tumor has been one of the most controversial entities of the maxillofacial surgery. It can become quite large because of its ability for significant expansion, extension into adjacent tissues and rapid growth and also has high reccurence rate as it shows a thin, friable wall, which is often difficult to enucleate from the bone in toto, and have small satellite cysts within the fibrous wall. There are various treatment modalities suggested from conservative to radical approach, but studies have shown even with conservative approach good results are achieved. In this paper we are presenting various treatment modalities and 3 cases have been discussed.
  4,848 743 1
ORIGINAL ARTICLES
Intrathecal tramadol versus intrathecal fentanyl for visceral pain control during bupivacaine subarachnoid block for open appendicectomy
JM Afolayan, TO Olajumoke, FE Amadasun, NP Edomwonyi
May-June 2014, 17(3):324-330
DOI:10.4103/1119-3077.130234  PMID:24714011
Context: Profound side-effects following intrathecal use of local anesthetics as the sole drugs of choice make spinal anesthesia for open appendicectomy uncommon. Aim: The aim of this study was to evaluate the effectiveness of intra-operative analgesia produced by intrathecal tramadol and fentanyl during bupivacaine spinal anesthesia for open appendicectomy. Settings and Design: A prospective randomized study was performed. Materials and Methods: A total of 186 American Society of Anesthesiologists 1 or 11 patients scheduled for emergency open appendicectomy were analyzed. Group FB ( n = 62) received intrathecal fentanyl 25 μg plus 3 ml of 0.5% hyperbaric bupivacaine, Group SB ( n = 62) received 0.5 ml normal saline plus 3 ml of 0.5% hyperbaric bupivacaine and Group TB ( n = 62) received intrathecal tramadol 25 mg plus 3 ml of 0.5% hyperbaric bupivacaine. Visual analog scale scores and frequency of subjective symptoms among patients in the three groups formed the primary outcome measure of this study. Results: Effective intraoperative sensory block was achieved in 100% of patients in group FB and TB while 29 (46.8%) patients in group SB had ineffective sensory block ( P = 0.0001). The pain free period was significantly longer in patients in Group FB than Group SB and TB. Mean time for Group FB with regard to first analgesic request was 304.73 ± 67.91 min, Group SB was 146.59 ± 36.62 and Group TB was 238.39 ± 61.28 min. Incidence of complications were comparable among the three groups. Conclusion: This study showed that intrathecal tramadol (25 mg) can safely replace intrathecal fentanyl (25 μg) in the management of visceral pain and discomfort during subarachnoid block for appendicectomy.
  4,589 908 2
Facial soft tissue changes after orthodontic treatment
S Aksakalli, A Demir
May-June 2014, 17(3):282-286
DOI:10.4103/1119-3077.130226  PMID:24714003
Objectives: To successfully meet expectations on facial esthetics, it is important to understand normal craniofacial growth and the impact of orthodontic treatment thereon. To date, there have been few studies documenting changes in facial esthetics through photography. The objective of this study was to compare facial soft tissue esthetics before and after orthodontic treatment by means of photographic analysis. Materials and Methods: The 45 children were divided into 3 groups according to Angle's classification: Groups I, II, and III comprised children with class I, II, and III malocclusion, respectively. Photographs were analyzed with a software. Twenty-one soft tissue landmarks were identified on profile and frontal photographs, ratios and angles were calculated. Results: For group I, there was no difference between pre- and post-treatment facial analysis. For group II, there were significant changes in 5 values. The most significant changes were observed for A-N-B and Al-Me/Ch-Me. For group III, we noted significant changes for 5 values. The most significant change was observed for N-Pn-Pog. Conclusion: There were significant changes in facial soft tissue esthetics after orthodontic treatment for class II and III cases. Changes in A-N-B and nose tip angle (N-Pn-Cm) were observed for class II and class III subjects.
  4,326 1,034 3
Right colon interposition in corrosive esophageal long segment stricture: Our local experience
JC Eze, N Ezemba, FA Onyekwulu, IA Nwafor, K Etukokwn, O Orakwe
May-June 2014, 17(3):314-319
DOI:10.4103/1119-3077.130232  PMID:24714009
Background: Aim of our study is to highlight technical details in pedicled right colon interposition locally in cases of long segment corrosive esophageal stricture. Lesion results from cicatrization of burns wound inflicted by chemicals. Restoration of swallowing is of paramount importance. Materials and Methods: It was a retrospective study involving adult and adolescent patients who had surgery because of corrosive esophageal stricture between January 2001 and December 2010. Hospital records were reviewed for age, sex, radiological findings, detail of anesthesia, operative procedure, and follow up. The steps which included mobilization of colon with intact marginal blood supply, safeguarding the middle colic artery that forms the pedicle, and doing three anastomoses that were leak proof were ascertained. Result: There were 12 males (70.5%) and six females (29.4%) and age ranged from 14 to 45 years. Caustic soda caused the problem among 10 (58.8%) patients while liquid acid battery was involved in three (17.6%) patients. The rest were distributed equally between native concoction and unknown substance. All were done under general anesthesia and mean duration of the procedure was 306.8 ± 54.6 min with an average intra operative blood loss of 823.1 ± 428.5 m. Sixteen (94.1%) had successful pedicle isolation and 15 (82.3%) patients had neither dysphagia nor reflux at follow-up. Conclusion: Securing a pedicled right colon based on middle colic artery was a critical step. This surgical technique should be used to restore swallowing among patients with long segment esophageal stricture.
  4,752 485 2
Nephrotic syndrome among children in Kano: A clinicopathological study
PN Obiagwu, A Aliyu, AT Atanda
May-June 2014, 17(3):370-374
DOI:10.4103/1119-3077.130247  PMID:24714020
Objective: To evaluate the clinicopathological features of children with nephrotic syndrome seen in a pediatric nephrology unit in northern Nigeria. Materials and Methods: All children less than 15 years of age who had nephrotic syndrome and who had been subjected to renal biopsy at Aminu Kano Teaching Hospital, Kano, were studied. Their histologic diagnoses were evaluated alongside clinical and other laboratory parameters. Results: Twenty children, 17 males and three females, were studied. These represented 55% of all children with nephrotic syndrome seen in the pediatric nephrology unit during the study period, the rest of which have never had renal biopsies. Peak age was 7-8 years (range 2.5-13 years). Fourteen of the 20 children (70%) had previously been on steroid treatment. Of these, 11 (55%) were classified to be steroid resistant and three (15%) were frequent relapsers. Six (30%) children were newly diagnosed with nephrotic syndrome and had not commenced steroid treatment. Hypertension was found in seven (35%) children. Sixteen children (80%) had microscopic hematuria on presentation. The most common histopathological diagnosis was focal glomerulosclerosis in nine (45%) children (segmental = 8; global = 1). Minimal change disease was found in four children (20%), membranoproliferative glomerulonephritis in three children (15%), membranous nephropathy in three children (15%), and diffuse mesangial hypercellularity in one child (5%). Of the six children who had renal biopsy before commencement of steroid treatment, three (50%) were found to have glomerulosclerosis. Conclusion: Focal segmental glomerulosclerosis was the most common histological subtype diagnosed in Kano among children with nephrotic syndrome in this study.
  3,358 650 2
Randomization of two dosing regimens of vaginal misoprostol for cervical ripening and labor induction in a low resource setting
AA Adeniyi, AA Odukogbe, A Olayemi, O Oladokun, AO Adeniji, CO Aimakhu, C Enakpene
May-June 2014, 17(3):287-291
DOI:10.4103/1119-3077.130227  PMID:24714004
Objectives: To compare the effectiveness of two dosing regimens of vaginal misoprostol for cervical ripening and induction of labour. Materials and Methods: Pregnant women with singleton low risk pregnancy at term scheduled for elective induction of labour were randomized to receive either 25 μg or 50 μg of vaginal misoprostol for pre-labour cervical ripening. All the patients received antenatal care and delivered at the University College Hospital (UCH) from January 1 st to May 31 st 2006. A total of 128 patients were randomized; 65 patients received 25 μg and 63 patients received 50 μg of vaginal misoprostol. Results: Significantly higher number of patients in the 50 μg group progressed to active labour as compared with the 25 μg group (95.2% versus 84.6%, P < 0.05). The need for oxytocin augmentation of labour was higher among the 25 μg as compared with 50 μg (39.7% versus 16.4%, P = 0.007). There was higher proportion of patients in the 50 μg group delivering vaginally within 24 hours as compared with the 25 μg group (98.2% versus 90.0%, P = 0.063). However, the mean interval between the first dose of misoprostol and vaginal delivery was not statistically different in the two groups (754 ± 362 minutes and 885 ± 582 minutes, P = 0.152). The incidence of caesarean section was similar in the two groups (7.7% versus 11%, P = 0.580). Labour complications, such as precipitate labour, tachysystole and abnormal fetal heart rate patterns were greater in the 50 μg group. Conclusion: Twenty-five microgram of misoprostol appears to be as effective as 50 μg for pre-induction cervical ripening and labour induction. Though 50 μg of vaginal misoprostol resulted in relatively faster delivery and less need for oxytocin augmentation, it was associated with more labour complications as compared with 25 μg of misoprostol.
  3,264 616 2
Assessment of burnout among health workers and bankers in Aba south local government area, Abia state, South East Nigeria
EN Aguwa, I Nduka, SU Arinze-Onyia
May-June 2014, 17(3):296-302
DOI:10.4103/1119-3077.130229  PMID:24714006
Aim: To determine the prevalence of burnout among health workers and bankers in Aba South Local Government Area in Abia State. Materials and Methods: A cross-sectional, descriptive study was carried out in 2013 among health workers and bankers in Aba metropolis. By multistage sampling method, proportionate number of the health workers and bankers were selected. The study instrument was Freudenberger Burnout Scale. Results: A total of 327 health workers and bankers were studied: 253 (77.4%) were health workers while 74 (22.6%) were bankers. The age range was 21 to 59 years, and 229 (70.0%) were females. Most (48.3%) had worked for 5 years or less and had burnout scores within 0-25. There was significant difference between gender ( P = 0.017), level of education ( P = 0.038), and type of occupation ( P = 0.002) to burnout score. Age ( P = 0.956), marital status ( P = 0.461), and years of work ( P = 0.247) did not significantly affect burnout score. Female health workers were significantly more at risk of burning out compared to their male counterparts. Among bankers, however, though females were more at risk, this was not significant. Sex, level of education and type of work were the greatest contributors to burnout score. Conclusion: The prevalence of burnout risk among health workers and bankers is high. More female health workers are at risk of burnout than male health workers. There should be policies aimed at identifying those most at risk and reducing the prevalence.
  3,359 503 4
Bilateral pelvi-ureteric junction obstruction: Our experience in a developing country
AG Ibrahim, S Aliyu, N Ali
May-June 2014, 17(3):267-269
DOI:10.4103/1119-3077.130205  PMID:24714000
Background: Bilateral pelvi-ureteric junction (PUJ) obstruction is rare and causes high morbidity and mortality. Recent advances have led to its diagnosis and management in the perinatal period. However, open surgery is still the mainstay of treatment in less endowed nations where late presentation is the norm. Materials and Methods: All patients with PUJ obstruction diagnosed and managed at the University of Maiduguri Teaching Hospital between January 2006 and December 2011 were retrospectively reviewed. All had open surgery and all repairs were stented with double J stents or appropriate size feeding tube. Results: A total of 18 patients were analyzed, 11 males and 7 females with a ratio of 1.57:1 and mean age of 27.5 years (age range 2-38). The main clinical features were loin pain (72.22%) and fever (72.22%); while the main complications at presentation were hydronephrosis (55.56%), impaired renal function (61.11%) and pyelonephritis (50%). The causes of obstruction were mainly congenital (50.0%) and due to schistosomal fibrosis/stricture (22.2%). Preliminary double J stents, tube nephrostomies and hemodialysis were used to recover renal function before surgery. Anderson-Hynes (41.7%) and Heineke-Mirhulicz (19.4%) pyeloplasty were the main procedures performed. The main post-operative complications were urinary tract infections (67.67%) and leakage (11.11%). The mean duration of symptoms was 23.72 months and the mean hospital stay was 13 days. The mortality rate was 5.56%. Conclusion: Bilateral PUJ obstruction is uncommon in Maiduguri, with congenital causes and schistosomal fibrosis as the most common etiologies. Aggressive treatment aimed at recovering renal function is necessary before open pyeloplasty if morbidity and mortality is to be reduced. Open pyeloplasty remained the best treatment option with favorable outcome.
  3,351 485 1
Prevalence of hematological abnormalities and malnutrition in HIV-infected under five children in Enugu
BU Ezeonwu, AN Ikefuna, T Oguonu, HU Okafor
May-June 2014, 17(3):303-308
DOI:10.4103/1119-3077.130230  PMID:24714007
Background: Hematological abnormalities such as anemia, neutropenia, and thrombocytopenia occur in children infected by the human immunodeficiency virus (HIV). These abnormalities are due to myelosuppression caused by the HIV and contribute to the morbidity and mortality of HIV-infected children. Malnutrition is prominent in HIV-infected children due to associated conditions such as oropharyngeal candidiasis, diarrhea, and cytokine production which result in poor intake, nutrient loss, and increased metabolic rate, respectively. Objectives: To determine the prevalence of hematological abnormalities (using the World Health Organization (WHO) case definitions) and malnutrition in HIV-infected children receiving care at the University of Nigeria Teaching Hospital, Enugu. Materials and Methods: The hematological and anthropometric indices of HIV-infected children between 18 and 59 months were assessed. Their hemoglobin level, neutrophil, and platelet counts were the hematological profiles evaluated using the WHO case definitions in HIV clinical staging. The weight-for-height z-score index was used to assess the nutritional status of subjects using the WHO reference ranges. The t-test, Chi-square, and Pearson correlation coefficient were used for statistical analysis. Results: There were 67 HIV positive children: 34 males and 33 females, aged 18-59 months. The mean hematological levels of subjects were hemoglobin (Hb) 10.4 ± 1.2 g/dl, neutrophil count 3,031 ± 1,039 cells/mm 3 , platelets count 294 ± 78 × 109/L. Two children (3.0%) had anemia (hemoglobin < 8 gm/dl) and were severely immunosuppressed, on highly active antiretroviral therapy treatment and had advanced HIV disease (clinical stage 3). Children who were malnourished were 15 (22.4%). Conclusion: Hematological abnormalities and malnutrition occur in HIV positive children.
  2,781 593 1
Comparison of intravenous colloid and colloid-crystalloid combination in hypotension prophylaxis during spinal anesthesia for cesarean section
HO Idehen, FE Amadasun, IT Ekwere
May-June 2014, 17(3):309-313
DOI:10.4103/1119-3077.130231  PMID:24714008
Context: Many studies comparing different intravenous fluid types usually do not use equipotent volumes of three to one crystalloid to colloid ratio in such comparisons. Conflicting results emanate from such studies. Aim: This study was designed to compare the efficacy of equipotent volumes of colloid and crystalloid-colloid combination in spinal anesthesia-induced hypotension prophylaxis during cesarean section. Settings and Design: A prospective randomized double blinded experimental study carried out in a tertiary hospital in Nigeria. Materials and Methods: Pregnant women scheduled for elective cesarean section were prospectively randomized into two groups to receive either 1000 ml of crystalloid/colloid (750/250 ml) combination or 500 ml colloid intravenous fluid preload, before spinal anesthesia. Hemodynamic variables were monitored till the end of surgery. The results were collated, analyzed, and rational conclusions deduced. Statistical Analysis Used: Data collected and analyzed with Statistical Package for Social Sciences (SPSS) version 16 and rational deductions derived. Results: In the first 10 min, the crystalloid-colloid combination showed better efficacy in hypotension prophylaxis over the colloid only regimen. In the next 30 min; however, there was no significant difference between both groups in hemodynamic parameters. Conclusion: Beyond 10 min the crystalloid-colloid combination has no advantage over colloid alone in hypotension prophylaxis, as used in this study.
  2,596 768 2
Health services utilization and costs of the insured and uninsured under the formal sector social health insurance scheme in Enugu metropolis South East Nigeria
FA Ujunwa, O Onwujekwe, JM Chinawa
May-June 2014, 17(3):331-335
DOI:10.4103/1119-3077.130235  PMID:24714012
Background: Health insurance is a social security system that aims to facilitate fair financing of health costs through pooling and judicious utilization of financial resources, in order to provide financial risk protections and cost burden sharing for people against high cost of healthcare through various prepayment methods prior to falling ill. It is still unclear how the Federal Social Health insurance program for federal civil servants has affected the insured and uninsured civil servants in terms of health services cost and utilization in Enugu metropolis. Objectives: The aim of the study was to compare the health services utilization and cost of insured with that of the non-insured federal civil servants with a view to generate information for policymaking on improving services of the National Health Insurance Scheme. Materials and Methods: A comparative, descriptive, cross-sectional survey of both the insured and uninsured federal civil servants was conducted in Enugu metropolis. Respondents were purposively enrolled and were grouped according to their insurance status after signing the informed consent form. Comparative analysis of health services utilization, satisfaction, and health services cost which include total cost, average cost, and catastrophic expenditures were done using SPSS version 17.0. Results: There were 809 respondents; this comprised 451 insured and 358 uninsured respondents. There were 420 males (51.9%) and 389 females (48.1%). It was found that 657 respondents had at least easy access to health; this comprised 369 (56.7%) insured and 288 (43.3%) non-insured respondents while 70 (46%) of the non-insured and 82 (54%) of the insured civil servant had difficult access to health care ( P = 0.620). Conclusion: There are still federal civil servants yet to enroll into the formal sector social insurance program. The NHIS-insured civil servants have no appreciable advantage in terms of access to and cost of health services in Enugu metropolis.
  2,674 524 2
Falls among pregnant women in Enugu, Southeast Nigeria
TC Okeke, EO Ugwu, LC Ikeako, CO Adiri, CCT Ezenyeaku, KE Ekwuazi, OS Okoro
May-June 2014, 17(3):292-295
DOI:10.4103/1119-3077.130228  PMID:24714005
Background: Falls during pregnancy are major public health issues and a common cause of maternal injury during pregnancy. There is paucity of data on prevalence and risk factors of falls during pregnancy in African population including Nigeria. Objective: To determine the prevalence and risk factors associated with falls during pregnancy in Enugu, Nigeria. Materials and Methods: This was a cross-sectional study of 332 consecutive pregnant women presenting in labor for delivery at the University of Nigeria Teaching Hospital Enugu, Nigeria between 1 st May and 31 st December, 2012. Results: The mean age of the women was 32.2 ± 2.7 (range: 20-42) years. One hundred and eight women (32.5%) reported falling at least once during the index pregnancy. Women aged ≤ 30 years had twofold risk of falling during pregnancy than women aged > 30 years [41.1% (69/168) vs. 23.8% (39/164); odds ratio (OR): 2.23; 95% confidence interval (CI): 1.39-3.58; P < 0.001)]. Similarly, women ≥ 160 cm in height had significantly higher risk of falling during pregnancy than women < 160 cm in height [43.5% (70/161) vs. 22.2% (38/171); OR: 0.37; 95% CI: 0.23-0.60; P < 0.0001)]. Furthermore, primigravidae had almost threefold risk of falling during pregnancy than multigravidae [45.3% (63/139) vs. 23.3% (45/193); OR: 2.73; 95% CI: 1.70-4.37; P < 0.0001)]. Conclusion: Falls during pregnancy is common in Enugu, Nigeria. It is, therefore, recommended that women should be counseled during pregnancy on this public health problem and the above-identified risk factors emphasized in order to reduce the prevalence and morbidity.
  2,808 258 2
A retrospective comparison of dental treatment under general anesthesia on children with and without mental disabilities
ME Sari, B Ozmen, AE Koyuturk, U Tokay
May-June 2014, 17(3):361-365
DOI:10.4103/1119-3077.130243  PMID:24714018
Purpose: The purpose of this study is to determine the properties of the dental procedures performed on children with dental problems under general anesthesia and compared between the patterns of dental treatment provided for intellectual disability and non-cooperate healthy child. Materials and Methods: In this retrospective study, the records of patients between the ages of 4 and 18 who were treated under general anesthesia were evaluated. Patients were divided into two groups: Those with intellectual disability and healthy patients who had difficulty cooperating. A statistical analysis of the mean standard deviation was conducted with a focus on two factors: Age and dental treatment methods. Results: In this study, it was observed that restorative treatment and tooth extraction was generally higher in intellectual disability children than in their healthy children. When evaluating the health status of teeth, the value of decayed missing and filled teeth (dmf-t) was observed to be close in healthy and intellectual disability individuals in the 4-6 age groups; it was higher in individuals with intellectual disability in the 7-12 age groups. There was no significant difference in terms of periodontal treatment and fissure sealants in the 12-18 age groups. Conclusions: By comparing the different patient groups who received dental treatment under general anesthesia, both the number of teeth extracted and DMF-T indices were higher in the disabled group. Therefore, especially more efforts should be made at encouraging these patients to visit the dentist earlier and receive primary preventive care.
  2,261 684 9
CASE REPORTS
Proximal migration of a 5 French pancreatic stent during bile stone extraction: A successful retrieval using mini-snare
Yu-Sheng Liao, Qiu Zhao, Yan Fan, Jie Wu
May-June 2014, 17(3):384-386
DOI:10.4103/1119-3077.130253  PMID:24714023
Pancreatic stents are used for a variety of conditions during therapeutic endoscopic retrograde cholangio pancreatography (ERCP). Pancreatic duct stenting reduces the incidence of post-ERCP pancreatitis and facilitate bilitary cannulation in difficult cases. Proximal migration of a pancreatic stent during bile duct stone extraction is an infrequent event, but its management can be technically challenging. We present a case that a double flanged pancreatic stent (5 French (Fr), 5 cm) was placed to facilitate the bilitary cannulation during the bile duct stone extraction. The pancreatic duct stent migrated into the proximal pancreas duct at the end of the bile duct stone clearance. After two unsuccessful attempts to remove the impacted stent with a balloon catheter and forceps, wire-guided endoscopic snare retrieval was conducted. Firstly, a guide wire was placed in the pancreatic duct and a soft mini-snare was passed over the guide wire. Then, the mini-snare was advanced into the proximal pancreatic duct over the guide wire and the proximally migrated stent was removed successfully with the mini-snare. Wire-guided endoscopic snare retrieval of proximally migrated pancreatic stents is safe and effective. The successful case of the retrieval with mini-snare provides another option for proximal migration retrieval of pancreatic stent retrieval. Further studies are needed to confirm its effectiveness and elucidate its associated complications.
  2,549 341 2
Hurthle cell tumor of the thyroid gland: Report of a rare case and review of literature
PCN Okere, DB Olusina, MO Enyinnah
May-June 2014, 17(3):375-377
DOI:10.4103/1119-3077.130249  PMID:24714021
This article presents a case of Hurthle cell adenoma (HCA) of the thyroid gland with a review of literature on Hurthle cell tumors. This case presented is that of a 57-year-old woman with a recurrent thyroid swelling. She previously underwent a right hemithyroidectomy for thyroid mass 10 years prior. A left lobectomy was done and microscopic examination revealed a HCA of the thyroid. The patient was discharged on thyroid replacement therapy and has remained healthy after more than 24 months of follow-up. The literature review highlights the criteria for diagnosis, the role of imaging and fine needle aspiration cytology (FNAC) in preoperative diagnosis.
  2,449 406 1
ORIGINAL ARTICLES
On the use of drains in orthopedic and trauma
YZ Lawal, MO Ogirima, IL Dahiru, K Abubakar, A Ajibade
May-June 2014, 17(3):366-369
DOI:10.4103/1119-3077.130246  PMID:24714019
Introduction: The use of drains in trauma and Orthopaedic practice has been affected by the concept of evidence based medicine that has become accepted as standard of care for all surgical or medical practice, which questions all care processes that cannot be backed by evidence to be beneficial to the patient. There have been a large number of multi centre meta-analytical studies that found drains to be of little or no benefit in trauma and Orthopaedic operations. Because of these studies, there are few situations where drains are routinely used e.g. Calcaneal fractures in developed countries. Even major procedures like total knee and arthroplasties are being performed without drains. We set to find out whether such evidence can be found in our practice. Materials and Methods: Between 2004 and 2012, eighty six patients matched for sex and type of injury and operative procedures to be done were prospectively selected and assigned to use or no use of drains in their operations. Complications like haematoma, drain migration, infection, inadvertent drain stitching were observed in the two groups. Results: Eighty six major orthopaedic operations were studied. There was no evidence of occurrence of complication arising from non use of drains in the undrained group. Those patients whose wounds were drained had no need for drain change thus making the wound care less eventful Conclusion: Postoperative wound drains make for neat postoperative period with less tissue swelling. There was no statistically significant differences between the drained and undrained wounds in terms of infection rates, haematoma or seroma formation.
  2,458 358 4
Effects of N-acetyl cysteine on lipid levels and on leukocyte and platelet count in rats after splenectomy
M Sit, EE Yilmaz, M Tosun, G Aktas
May-June 2014, 17(3):343-345
DOI:10.4103/1119-3077.130237  PMID:24714014
Introduction: Many of studies have shown that increased lipid levels play a significant role in the pathogenesis of atherosclerosis after splenectomy. We investigated the effects of N-acetyl cysteine (NAC) on lipid parameters and leukocyte and platelet (PLT) levels following splenectomy. Materials and Methods: 32 Sprague-Dawley rats weighing from 200 to 250 g were placed into four experimental groups. For 42 days post-operatively, all rats were fed standard rat food and water and the rats in the first group ( n = 8) received no intraperitoneal infusion. Rats in the second group ( n = 6) were given a 50 mg/kg saline solution (SF); those in the third group ( n = 8) received 50 mg/kg NAC and the rats in the fourth group ( n = 8) were administered a 100 mg/kg NAC infusion intraperitoneally. Results: All parameters other than white blood cell count were significantly different between the four groups. There were no significant differences between the control and SF groups in terms of total cholesterol and PLT levels. Triglyceride (TG), very-low-density lipoprotein (VLDL) and high-density lipoprotein (HDL) levels were significantly elevated in the SF group compared with the control rats. There was no statistically significant difference between the SF and NAC 50/100 groups in terms of low-density lipoprotein levels. Total cholesterol, TG, HDL and VLDL levels were significantly reduced and the PLT level was significantly elevated in the NAC 50 and NAC 100 groups compared with the SF group. Conclusion: Serum VLDL and TG levels should be monitored in patients after splenectomy. For reduction in these lipid parameters, early NAC treatment should be initiated. More prospective larger studies are needed to confirm our results.
  2,200 284 3
Evaluation of oxidative stress using exhaled breath 8-isoprostane levels on chronic kidney disease
BS Tiryaki, T Tasliyurt, BM Yelken, S Sahin, F Kutluturk, HI Koseoglu, B Ozturk, A Yilmaz, S Sahin
May-June 2014, 17(3):356-360
DOI:10.4103/1119-3077.130240  PMID:24714017
Background: There have been limited numbers of studies on patients with chronic kidney disease (CKD) to determine oxidative stress in exhaled breath condensate (EBC). Those two studies have been carried out on hemodialysis patients, and hydrogen peroxide and nitric oxide have been studied in order to show oxidative stress on EBC. Aims: We investigated oxidative stress in EBC evaluating 8-isoprostane levels on different stages of CKD. Materials and Methods: A total of 81 patients with 2-4 CKD stages have been evaluated prospectively. The patients have been categorized into three groups according to their CKD stages. For biochemical analysis, blood and breathing air samples were taken. 8-isoprostane has been measured using immunoassay method as the indicator of oxidative stress in EBC. Results: 8-isoprostane values were 8.19 ± 4.56, 13.89 ± 8.70, and 14.20 ± 10.68 pg/min group 1, 2, and 3, respectively; and the EBC 8-isoprostane levels increased significantly as CKD stages advanced (P0 = 0.018). There was a statistically significant reverse correlation between 8-isoprostane and glomerular filtration rate (GFR; r = −0.275; P = 0.014), but not between 8-isoprostane and C-reactive protein (r = −0.183; P = 0.177). Conclusions: We determined the level of 8-isoprostane in EBC of patients with different stages of CKD and showed that the level of 8-isoprostane significantly increased through the progress of CKD. We consider that our study is important because there have been limited number of studies that evaluate oxidative stress in CKD using EBC which is a noninvasive method.
  2,047 392 1
The impact of the duration of admission to the emergency room on the mortality of intensive care patients
MK Erkuran, A Duran, T Ocak, V Citisli, H Kaya
May-June 2014, 17(3):320-323
DOI:10.4103/1119-3077.130233  PMID:24714010
Objective: There are many factors affecting the mortality of patients admitted to the intensive care unit (ICU). Among these are the patients' age, diagnosis, and concomitant pathology. The aim of this retrospective study was to investigate whether there is an adverse effect of the time between admission to the Emergency Room (ER) and admission to the ICU on the mortality of these patients. Materials and Methods: The medical records of the patients who were admitted to the Emergency Department (ED) of the Bolu Izzet Baysal State Hospital and subsequently were admitted to the ICU between December 2009 and August 2011 were analyzed in terms of the time of admission, the season of admission, and the waiting and the stand-by times in the ER. Results: A total of 2380 patients, who were admitted to the ED of the Bolu Izzet Baysal State Hospital and subsequently to the ICU, were included in the study. The median waiting time in the ER was 1.23 h (10 min to 10.02 h). After completion of the admission procedures, the median hospitalization time in the ER was 0.16 h (3 min to 2.58 h). There was no statistically significant difference between the patients who died after admission to the ICU and the ones who survived, in terms of the waiting and the stand-by times in the ER ( P > 0.05). Conclusion: The waiting times at the ED did not affect the mortality of the ICU patients.
  2,103 314 2
CASE REPORTS
Leukemoid reaction associated with transitional cell carcinoma: A case report and literature review
H He, Z Zhang, J Ge, W Zhou
May-June 2014, 17(3):391-394
DOI:10.4103/1119-3077.130256  PMID:24714025
The goal of this article was to investigate the diagnosis, treatment and mechanisms of the leukemoid reaction (LKR) 14 15 associated with transitional cell carcinoma. A 64-year-old male patient presented with anuria. Color ultrasound imaging 15 16 revealed a large bladder tumor. Digital radiography and computerized tomography of the chest, abdomen and pelvis 16 17 revealed only bilateral hydronephrosis, but did not reveal any metastasis. The pre-operative white blood cell count in 17 18 the peripheral blood consistently increased to 58,400/mm3 while neutrophil granulocyte count was 54,900/mm3, without 18 19 fever. Radical cystectomy and construction of bilateral cutaneous ureterostomy was performed. The histological diagnosis 19 20 was transitional cell carcinoma, Grade 3. Granulocyte colony-stimulating factor (G-CSF) staining was positive in tumor 20 21 cells. Results: After surgery, the leukocyte value became nearly normal. At 3 months later, patient was admitted to our 21 22 hospital with the complaints of the left leg edema, diagnosed as pelvic lymph node metestasis. Patient died of systemic 22 23 metastasis within 6 months after the cystectomy. Bladder cancer associated with LKR, though rare, is considered highly 23 24 malignant, difficult to diagnose and as having poor prog.
  1,831 348 1
ORIGINAL ARTICLES
Central region morphometry in a child brain; Age and gender differences
I Otag, H Tetiker, MI Kosar, A Otag, M Atalar, M «imen
May-June 2014, 17(3):352-355
DOI:10.4103/1119-3077.130239  PMID:24714016
Background: Data on central region morphometry of a child brain is important not only in terms of providing us with information about central region anatomy of the brain but also in terms of the help of this information for the plans to be applied in neurosurgery. Objective: In the present study, central region morphometry of a child brain in mid-sagittal MR images was analyzed in age and gender groups. Materials and Methods: Different points determined previously, commissura posterior0 (PC) and the distances between cerebral cortex point (VCS) vertical to commissura anterior- commissura posterior line, sulcus centralis (CS), sulcus marginalis (MS), and the angle (α) between CS-PC-MS were determined and measured together with difference of gender in three different age groups (aged 6-9, 10-13, and 14-17). Results: Central region measures of the brains of boys aged 6-17 are higher than girls except for MS-PC distance. While VCS-PC, CS-PC, and MS-PC measures display a significant difference in the girls aged 14-17 when compared to the other age groups of 6-9 and 10-13 (P < 0.05), angle α is not significantly different in age and gender groups (P > 0.05). However, while VCS-PC, CS-PC and MS-PC distances show a significant increase in girls beginning from the age of 14, this increase is limited in boys. Conclusion: Morphometric differences observed in different age groups in boys and girls shall contribute our evaluation of the alterations in brain development in both of genders and shall be useful in preparation of surgical operation plans to be applied to the central region.
  1,895 196 -
CASE REPORTS
Thrombotic microangiopathies and acute kidney injury induced by artificial termination of pregnancy
H Wu, HB Zou, Y Xu, L Zhang
May-June 2014, 17(3):387-390
DOI:10.4103/1119-3077.130255  PMID:24714024
Thrombotic microangiopathy (TMA) is a rare, but potentially lethal condition requiring rapid recognition, diagnosis and initiation of therapy. Here, we present two cases of women with hemolytic anemia, thrombocytopenia and acute kidney injury shortly after surgical termination of pregnancy. Histological examination of their kidneys revealed endothelial cell swelling and luminal stenosis or fibrin-containing thrombi in the glomeruli and arterioles, which support the diagnosis of TMA. The patients were treated with hemodialysis, plasma infusion and corticosteroids with or without immunosuppressive agents. Three weeks after treatment, one patient was cured and symptoms of the other patient markedly improved. Reporting of more cases of TMA associated with surgical termination of pregnancy will provide further insights into this rare disease, possibly aiding in identifying risk factors and improving time to clinical diagnosis, treatment and prognosis.
  1,568 356 1
BOOK REVIEW
Radiology for medical students
Abdulkadir Musa Tabari
May-June 2014, 17(3):395-396
  1,689 226 -
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