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   2014| November-December  | Volume 17 | Issue 6  
    Online since November 11, 2014

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Pattern of mandibular third molar impaction: A cross-sectional study in northeast of Iran
M Eshghpour, A Nezadi, A Moradi, R Mahvelati Shamsabadi, NM Rezaei, A Nejat
November-December 2014, 17(6):673-677
DOI:10.4103/1119-3077.144376  PMID:25385900
Objectives: Impacted teeth, if left untreated, have a potential to induce various complications. The aim of the current study was to determine the prevalence and pattern of impacted mandibular third molar in the Iranian population. Study Design: This cross-sectional study was performed in patients who were referred to the Department of Oral Radiology between July 2009 and October 2010 to obtain an orthopantomogram (OPG). Data were collected regarding age and gender, prevalence of impacted mandibular third molars, angulation of impacted teeth (Winter's classification), level of impaction (Pell and Gregory classification), and relationship of the mandibular third molar with the ramus (Pell and Gregory classification). The collected data were analyzed using SPSS software version 11.0 with a confidence interval of 95%. Results: Among the 1433 patients included in the study, 489 (34.12%) patients were male and 944 (65.88%) were female. Of the total OPGs performed, 871 (60.78%) OPGs demonstrated at least one impacted mandibular third molar. In addition, of the 2866 mandibular third molars investigated, 1397 (48.74%) were found to be impacted. A significant association was observed between gender and the number of impacted teeth or the presence of impaction of any mandibular tooth (or teeth) (P < 0.05). The most common type of tooth angulation was mesioangular (48.67%). In addition, the most prevalent type of impaction level and ramus relationship was level B (63.85%) and Class II (48.46%), respectively. There were no significant differences between the two sides of the mandible for the prevalence of impacted third molar (P > 0.05). Conclusion: The pattern of mandibular third molars in the Northeast region of Iran revealed a high prevalence of impaction, which was mostly mesioangular, level B, and Class II with a gender predilection for females.
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Comparative evaluation of the fracture resistances of endodontically treated teeth filled using five different root canal filling systems
T Sandikci, RF Kaptan
November-December 2014, 17(6):667-672
DOI:10.4103/1119-3077.144375  PMID:25385899
Aim: The aim of this study was to compare the fracture resistances of teeth filled using different root canal sealers and rials. Materials and Methods: One hundred and twenty single rooted mandibular human incisor teeth with single canals were divided into 5 experimental groups of 20 teeth with 2 control groups of 10 teeth each. After root canal shaping using K3 rotary instruments, root canals were filled as follows: Group 1: (−) control, Group 2: (+) control, Group 3: Gutta-percha/AH Plus, Group 4: Thermafil/AH Plus, Group 5: Resilon/Epiphany self-etch (Epiphany SE), Group 6: Gutta-percha/Epiphany SE ve Group 7: EndoREZ sealer/EndoREZ cone. After the root canal sealers set, the apical 4 mm. portions of the specimens were embedded in cold curing acrylic and a fracture resistance test was applied in a universal testing machine. The load at which fracture occurred was recorded for each group and statistically analyzed using one-way ANOVA and Tukey's honestly significant difference tests. Results: Resilon/Epiphany SE ve EndoREZ sealer/EndoREZ cone groups had lower fracture resistances compared with the negative control group consisted of teeth without root canal shaping (P < 0.05). Gutta-percha/AH Plus, Thermafil/AH Plus and Gutta-percha/Epiphany SE groups showed similar fracture resistances (P > 0.05). The fracture resistance of the instrumented, but unfilled positive control group was significantly lower compared with (−) control, Gutta-percha/AH Plus, Thermafil/AH Plus (P < 0.01) and Gutta-percha/Epiphany SE (P < 0.05) groups. There were no significant differences between the fracture resistances of the Resilon/Epiphany SE and EndoREZ sealer/EndoREZ cone and positive control groups (P > 0.05). Conclusions: Root canal shaping procedures decrease the fracture resistance of teeth, and lateral condensation performed with AH Plus sealer and Gutta-percha and the Thermafil technique were found to be more successful.
  2,492 8,765 4
Traumatic penile injuries: Mechanisms and problems of treatment in a tertiary institution in Nigeria
CK Oranusi, AME Nwofor
November-December 2014, 17(6):763-766
DOI:10.4103/1119-3077.144392  PMID:25385916
Background: Penile injuries are uncommon. The more severe injuries are often difficult to manage. Objectives: We report our experience with penile injuries from different causes and treatment options available. Patients and Methods: We analyzed retrospectively 23 cases of penile injuries presenting to the Urology Unit of a tertiary hospital in the Southeastern part of Nigeria from January 2007 to December 2012. Results: The management for each patient varied depending on the nature and extent of the injury. The mean age of the patients was 28.9 ± 14.4 years (range 3 weeks to 43 years). The mean duration before presentation was 22.7 ± 17.8 h (range 1-168 h). The causes of penile injuries were categorized as follows: Postcircumcision 3 (13.0%), genital mutilation (self-inflicted injury/attacks by assailants) 6 (26.1%), accident 4 (17.4%), penile fracture 8 (34.8%), and gunshot injury 2 (8.6%). Isolated blunt injuries to the corporal tissues as occurs in penile fractures was managed successfully with early exploration and closure of the tunical tear, while injuries to the penile skin was managed with dressing and secondary closure. Severe penile injuries resulting in partial or total phallic loss presented the most challenge to treatment. Conclusion: Traumatic penile injuries are not common. Severe penile injuries could be challenging because of the nature of the injuries, delayed presentation and unavailability of modern technological tools and experience required for the treatment of such severe injuries. Expertise in the use of flaps for a neophallus are still been developed, and penile prosthetic devices are not readily available in our setting.
  8,684 375 2
Effect of chronic kidney disease on serum resistin level
S Dan, P Aditya, P Banerjee, C Bal, H Roy, I Banerjee
November-December 2014, 17(6):735-738
DOI:10.4103/1119-3077.144387  PMID:25385911
Background: Chronic Kidney Diseases (CKD) of all etiologies are usually associated with Insulin Resistance (IR). Resistin is also a protein associated with IR. Some studies conducted abroad have shown that resistin level is higher among CKD patients. Objective: To test if serum resistin level is significantly higher in CKD patients compared to normal individuals. Patients and Methods: 96 CKD patients and 97 normal individuals were included in the study. Written informed consent was obtained from every individual. Results: Serum resistin level was higher in CKD patients compared to control subjects. The difference in serum resistin level between two groups was statistically significant. Conclusion: Our study is probably the first study in India comparing serum resistin levels of CKD patients vis-à-vis control subjects. Further cellular research may be needed to explore this relation.
  8,615 280 5
Obesity, overweight, and underweight among urban Nigerians
CI Okafor, ID Gezawa, AA Sabir, TH Raimi, O Enang
November-December 2014, 17(6):743-749
DOI:10.4103/1119-3077.144389  PMID:25385913
Background: Disease burden from communicable and noncommunicable diseases is a significant health challenge facing many developing nations. Among the noncommunicable diseases, is obesity, which has become a global epidemic associated with urbanization. Objective: The aim was to evaluate the prevalence of weight abnormalities, their pattern of distribution and regional differences among apparently healthy urban dwelling Nigerians. Methods: A cross-sectional community-based descriptive survey was carried out in five urban cities, each from one geo-political zone of Nigeria. Multistage sampling procedures were used to select participants using the World Health Organization STEPS instrument. Ethical approval and consents were duly and respectively obtained from the Ethics Committee in the tertiary centers and participants in each of these cities. Analysis was performed using SPSS version 20 (IBM Corp., Amonk, NY; released 2011) with P value set at < 0.05. Results: A total of 5392 participants were recruited; of which, 54.5% and 45.5% were males and females respectively. Mean (standard deviation) age and body mass index (BMI) were 40.6 (14.3) years and 25.3 (5.1) kg/m 2 . Obesity, overweight, and underweight were found in 17%, 31%, and 5% of participants respectively. Significantly, while underweight declined with increasing age, overweight, and obesity increased to peak in the middle age brackets. Age of ≥ 40 years was found to confer about twice the risk of becoming overweight. The prevalence of obesity and mean BMI were significantly higher both among the females and the participants from southern zones. Conclusion: Obesity and overweight are common in our urban dwellers with accompanying regional differences. Attainment of middle age increases the likelihood of urban dwelling Nigerians to become overweight/obese. There is therefore the need to institute measures that will check development of overweight/obesity early enough, while improving the nutritional status of the few who may still be undernourished.
  5,939 645 10
Knowledge, attitude, and infection control practices of two tertiary hospitals in Port-Harcourt, Nigeria
SFA Brisibe, B Ordinioha, PK Gbeneolol
November-December 2014, 17(6):691-695
DOI:10.4103/1119-3077.144379  PMID:25385903
Background: Surgical site infections (SSIs) are a significant cause of morbidity, emotional stress and financial cost to the affected patients and health care institutions, and infection control policy has been shown to reduce the burden of SSI in several health care institutions. This study assessed the effects of the implementation of the policy in a tertiary hospital in Port Harcourt, Nigeria. Materials and Methods: A cross-sectional, comparative study design was used for the study, with data collected using a structured questionnaire and guided observation of doctors and nurses involved in the management of patients that had caesarean sections in two comparable tertiary hospitals in Port Harcourt-the University of Port Harcourt Teaching Hospital (UPTH) and the Braithwaite Memorial Specialist Hospital (BMSH). Results: There were no statistically significant differences in the designations and length of practice of the respondents in both hospitals (P = 0.77). However, 63.64% of the respondents in UPTH were aware of the infection control committee, compared with none in BMSH. The appropriate timing for the administration of prophylactic antibiotics, and for the removal of the hair at the incision site were observed by 57.58% and 69.69% respectively of the respondents in UPTH, compared with 22.86% (P = 0.00) and 0.00% (P = 0.02) in BMSH. The reasons given by the respondents in UPTH for nonadherence to the infection control policy include poor supervision (39.39%) and lack of in-service training (21.21%), while the respondents in BMSH gave reasons that include inadequate supply of consumables (34.29%) and absence of a hospital's policy on infection control (22.88%). Conclusion: The implementation of the infection control policy resulted in some improvements in certain infection control practices.
  5,656 694 7
Medical causes of death in a teaching hospital in South-Eastern Nigeria: A 16 year review
EB Arodiwe, SC Nwokediuko, SO Ike
November-December 2014, 17(6):711-716
DOI:10.4103/1119-3077.144383  PMID:25385907
Background: Most developing regions of the world are undergoing gradual epidemiological transition resulting in high burden of both communicable and noncommunicable diseases. This affects the pattern of death in this region. Objective: The objective of this study is to determine the causes of death in the medical wards of the University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, South-East Nigeria from 1995 to 2010. Materials and Methods: Data were collected retrospectively from January 1995 to December 2010. Statistical Analysis Used: Statistical Package for Social Sciences (SPSS Inc. Chicago, IL, USA) version 17.0 was used. Simple descriptive statistics were done. Student's t-test was used to compare means of continuous variables, while Chi-square test was used to test significance of differences between two proportions. Results: The mortality rate was 22.8% (6250/27,514) admissions. The male to female ratio was 1.7:1. Infections (20.2%) were the most common cause of death. However, chronic kidney disease was the single most common disease entity causing death (12.3%). Other important causes of death in order of prevalence were cerebrovascular accident (10.5%), acquired immune deficiency syndrome and tuberculosis either alone or as co-infection (10.3%), heart failure (8.8%), chronic liver disease (7.0%), septicemia (6.5%), respiratory failure (5.3%), diabetes mellitus (4.6%), cardiac arrhythmias (2.9%), and primary liver cell carcinoma (2.7%). There were few deaths from tetanus, malaria, typhoid fever, and coronary artery disease. Conclusion: Mortality is high in our medical wards and reflects the emerging trend of mixed disease spectrum comprising communicable and noncommunicable diseases.
  5,218 596 2
Determinants of timely initiation of complementary feeding among children aged 6-24 months in Sagamu, Nigeria
TA Ogunlesi, VA Ayeni, AF Adekanmbi, BM Fetuga
November-December 2014, 17(6):785-790
DOI:10.4103/1119-3077.144399  PMID:25385920
Background: Poor breastfeeding and complementary feeding practices may contribute to childhood malnutrition in the developing world. Objective: The objective was to examine the determinants of timely initiation of complementary feeding among Nigerian children. Materials and Methods: Using a cross-sectional design, children aged 6-24 months were surveyed in a Nigerian Teaching Hospital. Children with timely initiation of complementary feeding (6-8 months) were compared with children with untimely initiation of complementary feeding early (<6 months and >8 months) for clinical and social characteristics using both bivariate and multivariate analysis. Results: Of 156 children, 41%, 53.8%, and 5.1% had timely, early and delayed initiation of complementary feeding. Complementary feeding was initiated with processed cereals (44.8%), locally prepared maize gruel (32.1%) and mashed family diet (23.1%). Bivariate analysis showed significant association between timely initiation of complementary and orthodox maternity care, no prelacteal feeding, exclusive breastfeeding, no siblings and first birth order. Parental education was not associated with timely initiation of complementary feeding. Multivariate analysis identified orthodox maternity care, exclusive breastfeeding and no siblings as independent predictors of timely initiation of complementary feeding. Conclusion: Complementary feeding is most frequently initiated earlier than 6 months in this population. Good breastfeeding practices may influence timely initiation of complementary feeding. Interventions should be targeted at the entire population irrespective of educational and socioeconomic status.
  3,673 672 4
Experiences from polio supplementary immunization activities in Anambra State, Nigeria
IN Onyeka, AL Ilika, FN Ilika, DC Umeh, RI Onyibe, CJ Okoye, G Diden, CU Onubogu
November-December 2014, 17(6):808-813
DOI:10.4103/1119-3077.144406  PMID:25385924
Background: Routine immunization coverage is low in some States in Nigeria and contributes to the transmission of wild poliovirus. Anambra State has been polio-free since 2004. However, the risk of importation of poliovirus from travelers and migrants is a public health concern due to the commercial nature of the State. This paper reported experiences and lessons from supplementary immunization activities (SIAs) conducted in the State that will be useful to other settings experiencing low uptake of routine immunization. Materials and Methods: The SIAs were conducted simultaneously in the 21 local government areas (LGAs) in Anambra State during January, March, and November 2010. Data were entered and analyzed in Excel spreadsheet and findings were summarized as frequencies and proportions. Results: A total of 1,187,866 children were vaccinated in January, 1,260,876 in March and 1,225,187 in November 2010. The State's cumulative coverage exceeded the target coverage of >90% in the three SIAs. All LGAs met the >90% target in January and March, but one LGA achieved 79% coverage in November. The proportion of zero-dose children decreased from 6% to 4.7%, and the vaccine wastage rate ranged from 6% to 6.6%. In that same year, the state did not achieve the target coverage of >80% for routine oral polio vaccine (OPV 3 ) immunization in any of the months and only 29% of the LGAs exceeded the routine OPV 3 target. Conclusion: The State achieved high polio vaccination coverage through the SIAs, but coverage through routine immunization was low. Adopting proper planning and supervision, financial and political support, community involvement, improved vaccine logistics, and other measures utilized during the SIAs could help to improve routine immunization.
  3,877 348 4
Relationship between obesity and oral diseases
MA Sede, AO Ehizele
November-December 2014, 17(6):683-690
DOI:10.4103/1119-3077.144378  PMID:25385902
Objective: The aim of this study was to determine the relationship between obesity and periodontal status and dental caries experience of a group of Nigerian dental patients. Materials and Methods: Participants were selected from patients attending dental outpatient clinics of the University of Benin Teaching Hospital, Benin City, Nigeria. Their weight and height were measured and body mass index (BMI) estimated in kg/m 2 , gingival health assessed using bleeding on probing index, oral hygiene estimated using the simplified oral hygiene index (OHI-S), periodontal health estimated using the basic periodontal examination (BPE) and caries experience was estimated with the decayed, missing, and filled teeth (DMFT) index. Results: A few participants (3.8%) were underweight, 52.6% fell within the normal BMI range, 28.2% preobese, 12.2% obese class I and 3.2% obese class II. The mean OHI-S score was 2.16 ± 1.13 among the overweight participants and 2.05 ± 1.13 among those who are not (P = 0.543). The mean DMFT score was 3.03 ± 4.25 among the overweight participants and 2.32 ± 3.01 among those who are not (P = 0.223). Sixty-five percent of participants with BPE score of 0, considered to signify periodontal health, had normal BMI while all the participants with the worst BPE score recorded belong to the obese 1 group (P = 0.070). The binary logistic regression revealed that the likely predictor of gingival bleeding in the study is BMI between 35.0 and 39.9 (obese class 2) (P = 0.046, odds ratio = 0.07, 95% confidence interval = 0.01-0.96). Conclusion: It can be concluded from this study that there is no statistically significant relationship between obesity and periodontal status and dental caries experience in the studied group of dental patients. Increased BMI may however be a predictor of gingival bleeding.
  3,434 687 7
Prevalence of sexual dysfunction among females in a university community in Enugu, Nigeria
UI Nwagha, TC Oguanuo, K Ekwuazi, TO Olubobokun, TU Nwagha, AK Onyebuchi, PO Ezeonu, K Nwadike
November-December 2014, 17(6):791-796
DOI:10.4103/1119-3077.144401  PMID:25385921
Background: Female sexual dysfunction is a common, condition that significantly reduces the quality-of-life of the affected persons. Unfortunately, because of the veil of secrecy that shrouds discussions on human sexuality, there has been limited research on this topic in some sociocultural settings. Aim: The aim was to determine the prevalence and some sociodemographic factors associated with sexual dysfunction in females in a university community at the University of Nigeria, Enugu Campus, Enugu State, Nigeria. Subjects and Methods: This is a cross-sectional study involving 500 females recruited randomly in a tertiary institution in Nigeria. A self-administered structured pretested questionnaire on sexual activity was administered (the Female Sexual Function Index [FSFI]). Statistical analysis was performed using SPSS software package (Version 17.0, Chicago, IL, USA). Multiple logistic regression was used to determine the relationship between the sociodemographic factors, and the total FSFI scores dichotomized as normal and reduced sexual function. In addition, multiple linear regression was used to determine the relationship between the six different domains scores and the continuous values of the total score. For all, calculations, P < 0.05 was considered as statistically significant at 95% confidence interval (CI). Results: The prevalence of female sexual dysfunction (FSFI score ≤ 26.50) was 53.3%. The highest prevalence occurred in the 41-50 years age group (73.3%; 66/90), married and living together 56.4% (123/218) and had postsecondary education (56.1%; 137/244). Only age significantly predicted female sexual function (P = 0.007; 95% CI; 0.691-0.943). Marital status, religion, ethnic group, and educational qualification had no significant effect (P < 0.05). The total FSFI significantly increase as desire increases (P = 0.002; 95% CI = 0.817-3.573). Conclusion: Female sexual dysfunction is common in the university environment, with the highest prevalence occurring in 41-50 years age group.
  3,581 414 6
Transvesical prostatectomy in the management of benign prostatic hyperplasia in a developing country
FO Ugwumba, OF Ozoemena, AD Okoh, KN Echetabu, OM Mbadiwe
November-December 2014, 17(6):797-801
DOI:10.4103/1119-3077.144402  PMID:25385922
Context: The surgical management of benign prostatic hyperplasia (BPH) is evolving away from open surgery. In developing countries however majority of cases are managed by transvesical prostatectomy (TP). Aims: This study aims to describe our experience regarding the efficacy, complication profile and outcome of TP in the management of BPH in Nigeria. Settings and Design: A descriptive, retrospective study carried out in three tertiary centers. Subjects and Methods: Two hundred and ninety-seven patients were studied. Parameters examined included age, clinical features, investigations, type of postoperative bladder irrigation, prostate gland volume, duration of hospital stay, complications and outcome. Statistical Analysis Used: Simple means and percentages with SPSS 16. Results: Mean age was 65.2 ± 6.8 years (range 47-93 years). Presentation with severe lower urinary tract symptoms only occurred in 76 patients (25.7%); acute urinary retention was seen in 106 patients (35.7%). Chronic urinary retention, impaired renal function and haematuria occurred in 47 (15.8%), 37 (12.5%), and 31 patients (10.4%) respectively. On comorbidity, 63 patients (21.2%) were hypertensive and 24 patients (8.1%) had diabetes mellitus. Two hundred and twenty three patients (75%) had indwelling catheters at the time of surgery. Preoperative urinary catheter duration was 1 week-35 months. Mean duration of hospital stay was 8.8 days. Complications were transient urinary incontinence 33 patients (11.1%), urinary tract infection 38 patients (12.7%), and acute epididymoorchitis 15 patients (5.1%). Clot retention occurred in 40 patients (13.5%). Mortality rate was 1%. Conclusions: TP remains useful in developing climes. There is a need to emphasize effective preoperative workup so as to limit morbidity. Emphasis on variety of techniques for hemostasis is necessary.
  3,351 412 4
Mistreatment among undergraduate medical trainees: A case study of a Nigerian medical school
AO Oku, ET Owoaje, OO Oku, E Monjok
November-December 2014, 17(6):678-682
DOI:10.4103/1119-3077.144377  PMID:25385901
Background: Several international studies have shown that abuse or mistreatment is a regular phenomenon faced by medical students. However, there is limited information on medical student abuse/mistreatment in Nigeria. The study was therefore conducted to assess the prevalence and patterns of mistreatment experienced by Medical Students in the University of Calabar. Materials and Methods: A descriptive cross-sectional study was conducted among 451 undergraduate medical trainees in the University of Calabar. Systematic sampling was used in recruiting participants into the study. A self-administered questionnaire was then employed to obtain information on patterns of mistreatment experienced by medical undergraduates. Data were analyzed using Statistical Package for Social Scientists version 19 and level of significance set at <0.05. Results: More than a third (35.5%) of all respondents interviewed had experienced one or more forms of mistreatment during their training, with 38.5% of them experiencing it weekly. The most common form of mistreatment experienced was verbal abuse (52.5%), and the main perpetrators of these incidents were medical consultants, (18.6%) other cadre of doctors (17.3%) and lecturers (14.4%). Being in the clinical level of study and aged above 25 years were significantly associated with experiencing mistreatment in this study (P < 0.05). However, only 8.8% reported these incidents. Conclusion: With more than a third of undergraduate medical trainees experiencing mistreatment, development of appropriate strategies for the prevention and reduction of these incidents are strongly recommended.
  2,501 1,127 4
Prevalence of traditional cardiovascular risk factors among staff of Ladoke Akintola University of Technology, Ogbomoso, Nigeria
AA Akintunde, AA Salawu, OG Opadijo
November-December 2014, 17(6):750-755
DOI:10.4103/1119-3077.144390  PMID:25385914
Aim: The aim was to describe the frequency of occurrence of traditional cardiovascular (CV) risk factors among selected university workers in Ladoke Akintola University of Technology (LAUTECH) Nigeria. Materials and Methods: A cross-sectional study of 206 staff of LAUTECH, Ogbomoso, Nigeria had an assessment for nine traditional CV risk factors. Demographic and clinical parameters were taken. Blood sample was taken to determine the random blood sugar and lipid profile. 12-lead resting electrocardiography (ECG) was done for all participants. Statistical analysis was performed with the aid of Statistical Package for Social Sciences (SPSS) version 17.0 (Chicago Ill., USA) Results: The study population included 96 males (46.6%) and 110 females. The mean age was 45.3 ± 7.9 years (range 27-73 years). The prevalence of CV risk factors were as follows: Hypertension 84 (40.8%), visceral obesity 92 (44.7%), generalized obesity 79 (38.3%), low high density lipoprotein 113 (54.9%), impaired blood glucose 16 (7.8%), diabetes mellitus 3 (1.5%), hypercholesterolemia 102 (49.5%), left ventricular hypertrophy-ECG 24 (11.7%), elevated low density lipoprotein-cholesterol 99 (48.1%). About - (72.3%) had two or more CV risk factors clustered together. Females had a higher prevalence of CV risk factors and its clusters than their male counterparts. Of those diagnosed with hypertension in this study, more than half had never been told they were hypertensive 48 (57.1%). Conclusion: This study suggests a very high prevalence of CV risk factors among University Staff in LAUTECH, Ogbomoso, Nigeria. Clustering of CV risk factors is more prevalent among women. Appropriate preventive strategy in terms of education and modification of risk factors are important to reduce the burden of CV diseases among this population.
  3,046 446 8
The efficacy of chewing gum on postoperative ileus following cesarean section in Enugu, South East Nigeria: A randomized controlled clinical trial
OV Ajuzieogu, A Amucheazi, HA Ezike, J Achi, DS Abam
November-December 2014, 17(6):739-742
DOI:10.4103/1119-3077.144388  PMID:25385912
Background: Postoperative ileus (POI) is a common complication following caesarean section. It impairs patients comfort; delays wound healing and prolong duration of hospital stay. Several methods have been used in the management of this condition with varying efficacy. Chewing gum postoperatively is a recent concept in the western world being advocated as a cost effective and comfortable management of POI. Aim: The aim was to evaluate the efficacy of gum-chewing in reducing POI following caesarean section in Enugu. Materials and Methods: One hundred and eighty women booked for elective caesarean section were randomized into gum-chewing group (n = 90) or control group (n = 90) The subjects chewed sugarless gum three times daily from 6 h postoperatively until the first passage of flatus. Each chewing session lasted 30 min. Elective cesarean section was carried out with a Pfannenstiel incision. Groups were compared primarily for time to first bowel sound, and first flatus. Secondary endpoints of comparison were time of operation to first defecation, and patient satisfaction concerning postoperative gum chewing. The Student's t-test and Pearson Chi-square test and multiple linear regression were used for statistical analysis. Results: The groups were comparable in age, body mass index (BMI) and duration of surgery. The mean time to first bowel sounds (21.9 ± 8.0 vs. 26.1 ± 10.0), mean time to first flatus (24.8 ± 6.4 vs. 30.0 ± 10.0) and mean time to defecation (30.7 ± 5.9 vs. 40.0 ± 9.0) were significantly reduced in patients that chewed gum compared with controls. P =0.02, 0.01, and 0.01, respectively. Patients were satisfied with gum chewing and no side-effect was recorded. Previous surgery and duration of surgery were predictors on duration of POI, while age, BMI and parity had no effect. Conclusion: Gum-chewing has a beneficial effect on early return of bowel function following cesarean section and should be included in the postoperative management protocol.
  2,730 612 5
Awareness and practice of breast screening and its impact on early detection and presentation among breast cancer patients attending a clinic in Lagos, Nigeria
TO Olajide, AO Ugburo, MO Habeebu, AO Lawal, MO Afolayan, MO Mofikoya
November-December 2014, 17(6):802-807
DOI:10.4103/1119-3077.144404  PMID:25385923
Background: Breast cancer is the most common malignancy among females in Nigeria. The concept of breast screening (BS) is that it would result in presentation at earlier stages. We evaluated the impact of BS on early detection and presentation of breast cancer and determined the aspects BS need improvement. Patients and Methods: All patients with a diagnosis of malignant breast lump attending clinics at a tertiary hospital in Nigeria were recruited into the study over a 2-year period. Self-administered questionnaires were given to patients. Data collected were demographics, knowledge about BS, practice of BS, the motivation to practice BS and the source of information on BS. Results: Of 218 patients seen, 147 (67.4%) patients presented at the surgical outpatient clinic and 71 (32.6%) at the radiotherapy clinic, with age 48.01 ± 0.80 years. A total of 156 (71.6%) were aware of BS, while 62 (28.4%) were not aware. A logistic regression analysis showed that only the level of formal education predicted awareness of BS, P = 0.001 Nagelkerke's R2 = 0.126. Awareness of BS was mainly from electronic media 87 (55.7%). There was no significant difference in the ages of those aware and practicing BS 48.03 ± 1.05 years, and those not practicing BS 46.32 ± 1.94 years, P = 0.446. There was no significant difference in presentation for those practicing BS 7.41 ± 1.30 months, and those not practicing BS 11.38 ± 2.91 months, P = 0.175, with 64% practicing BS presenting late, while 77% not practicing BS presenting late, χ2 = 2.432, P = 0.488. A logistic regression analysis did not show any demographic or clinical parameters as predictive P = 0.225 Nagelkerke's R2 = 0.126. Conclusion: The high level of awareness and practice of BS was not translated into the presentation with early breast cancer.
  2,543 356 7
Polyp prevalence at colonoscopy among Nigerians: A prospective observational study
OI Alatise, AO Arigbabu, AE Agbakwuru, OO Lawal, OA Sowande, OO Odujoko, O Adegoke, O Ojo
November-December 2014, 17(6):756-762
DOI:10.4103/1119-3077.144391  PMID:25385915
Background: This study was aimed at identifying the prevalence, distribution, and clinicopathologic characteristic of colonic polyps among Nigerians undergoing colonoscopy at the Obafemi Awolowo University Teaching Hospitals complex, Ile-Ife, Nigeria. We also determined the polyp detection rate (PDR), polyps per colonoscopy (PPC) and adenoma detection rate (ADR). Materials and Methods: This is a prospective study of all colonoscopy examinations performed at the endoscopy unit of our hospital from January, 2007 to December 2013. The patient demographics, indications for colonoscopy, colonoscopic findings, number of the polyps, their sizes, possible risk factors in the individual case histories, and histopathological characteristics of the polyps. Results: During the study period, a total of 415 patients met the inclusion criteria and only 67 out of these had colonic polyps. The overall PDR was 16.1%. The age ranged was 2-87 years with a median of 57 years. Forty-three (64.2%) patients were 50 years or above and there were 40 (59.7%) males. Thirty-three (49.3%) patients were referred as a result of lower gastrointestinal bleeding, 14 (20.9%) for colorectal cancer (CRC) and 13 (19.4%) for routine screening. Thirty-nine (58.2%) patients had the polyps at the rectosigmoid region of the colon, 17 (25.4%) had the polyps located proximal to sigmoid colon and 11 (16.4%) patients had multiple polyps involving both segments. Adenomatous polyps was the most common (28 [47.5%]) histopathological finding of which two patients had adenomatous polyposis. Other findings include inflammatory polyps in 17 (18.8%) patients, 5 (8.5%) patients each had hyperplastic and malignant polyps, while 4 (6.8%) patients had juvenile polyps. The ADR was 6.8 and the PPC was 0.2. Statistically, patients 50 years and older were more likely to have adenomatous and hyperplastic polyps than those younger than this age (P = 0.010). Conclusion: We conclude that polyps are probably not as rare among black Africans especially when they are above 50 years. Our histopathological finding of adenomatous change in a good proportion of the detected polyps show that they are likely to be associated with CRCs in our compatriots and as such we would recommend a routine screening colonoscopy for Nigerians aged 50 and above.
  2,437 356 7
Making a difference with Vision 2020: The Right to Sight? Lessons from two states of North Western Nigeria
N Muhammad, MD Adamu
November-December 2014, 17(6):723-728
DOI:10.4103/1119-3077.144385  PMID:25385909
Settings and Aim: The World Health Organization launched in 1999 an initiative to eliminate the global avoidable blindness and prevent the projected doubling of avoidable visual impairment between 1990 and 2020 (Vision 2020: The Right to Sight). The World Health Assembly (WHA) adopted resolutions WHA 59.25, WHA 56.26 urging member states to adopt the Vision 2020 principles. More than 90 nongovernmental development organizations, agencies, and institutions, together with a number of major corporations, are now working together in this global partnership. Two neighboring states in North Western Nigeria provide eye care services using different approaches; one state uses the principles of Vision 2020, the other uses a different strategy. The aim of the study was to assess awareness and utilization of eye care services in two Nigerian states. Design: A population-based cross-sectional interview of households was conducted in two neighboring states using a structured questionnaire. Data analysis was performed using SPSS version 21 and a P < 0.05 was considered as significant. Findings: Participation rate was 97% in the two states. The population in the Vision 2020-compliant state were significantly more aware about general eye care services (80% vs. 44%, P < 0.0005); had less proportion of households unaware of any eye care service (55% vs. 69%, P < 0.0005); and have a significantly higher felt the need to utilize eye care services (47% vs. 5.9%, P < 0.0005). The service utilization rate was however low in the two states. Conclusion: The principles of Vision 2020: The Right to Sight is adaptable to different cultures/societies and has demonstrated a potential to increase awareness and a felt need for eye care in poor resource settings.
  2,438 274 2
Investigation of biofilm formation on contact eye lenses caused by methicillin resistant Staphylococcus aureus
MA Khalil, FI Sonbol
November-December 2014, 17(6):776-784
DOI:10.4103/1119-3077.144398  PMID:25385919
Objective: The objective was to investigate the biofilm-forming capacity of methicillin resistant Staphylococcus aureus (MRSA) isolated from eye lenses of infected patients. Materials and Methods: A total of 32 MRSA isolated from contact lenses of patients with ocular infections were screened for their biofilm-forming capacity using tube method (TM), Congo red agar (CRA), and microtiter plate (MtP) methods. The effect of some stress factor on the biofilm formation was studied. The biofilm-forming related genes, icaA, icaD and 10 microbial surface components that recognize adhesive matrix molecule (MSCRAMM), of the selected MRSA were also detected using polymerase chain reaction. Results: Of 32 MRSA isolates, 34.37%, 59.37%, and 81.25% showed positive results using CRA, TM or MtP, respectively. Biofilm production was found to be reduced in the presence of ethanol or ethylenediaminetetraacetic acid and at extreme pH values. On the other hand, glucose or heparin leads to a concentration dependent increase of biofilm production by the isolates. The selected biofilm producing MRSA isolate was found to harbor the icaA, icaD and up to nine of 10 tested MSCRAMM genes, whereas the selected non biofilm producing MRSA isolate did not carry any of the tested genes. Conclusions: The MtP method was found to be the most effective phenotypic screening method for detection of biofilm formation by MRSA. Furthermore, the molecular approach should be taken into consideration for the rapid and correct diagnosis of virulent bacteria associated with contact eye lenses.
  2,186 416 -
Assessment of physicians' knowledge of Glasgow coma score
JKC Emejulu, SPU Nkwerem, OC Ekweogwu
November-December 2014, 17(6):729-734
DOI:10.4103/1119-3077.144386  PMID:25385910
Background: Glasgow Coma Scale (GCS) is the most commonly used tool in assessing comatose patients. It is simple, easily communicable, and useful in prognostication and determination of the treatment modality in head injury. Unfortunately, a high percentage of clinicians who are not in the emergency or neurological services are not conversant with this life-saving tool. Objective: The objective of this study was to assess the level of knowledge of GCS among physicians practicing in a tertiary institution in South-East Nigeria, and to evaluate the call for a new and simpler scoring system. Materials and Methods: This study was carried out using the instrument of a structured-questionnaire in Nnamdi Azikiwe University Teaching Hospital Nnewi, a federal government tertiary health institution in South-East Zone of Nigeria, which is a 350-bed facility employing about 550 medical doctors of different cadres. Results: A total of 139 questionnaires were distributed to the doctors practicing in the institution who consented to participating in the study. The questionnaires were completed at the point of their administration and completed questionnaires were retrieved on the spot, and data were collated, and analyzed with the Statistical Package for Social Sciences, SPSS version 17.0. Statistical significance was calculated with the chi square, P ≤ 0.5. The modal age group was 20-30 years 66 (48%), and most were resident doctors 99 (66.2%). One week prior to the questionnaire distribution, 56 (42.1%) had been actively involved in emergency care of patients, and 41 (30%) could not recall what GCS stood for. Medical and house officers showed a better knowledge of GCS. Conclusion: There was a poor knowledge of GCS among a good number of physicians practicing in our setting and hence, continuing medical education on GCS is strongly advocated.
  1,988 310 2
Nonoperative treatment of acute traumatic spinal injuries: A prospective study
MON Nnadi, OB Bankole
November-December 2014, 17(6):767-771
DOI:10.4103/1119-3077.144395  PMID:25385917
Background: Traumatic spinal injury is a major cause of morbidity and mortality worldwide. There is no agreed method of care. Neurological recovery in complete injury has been dismal. Aims and Objectives : The aim of this study is to determine the neurological recovery at discharge in traumatic spinal injury patients managed nonoperatively in our center. Materials and Methods: This was a prospective descriptive study carried out on traumatic spinal injury patients managed by neurosurgical unit in our center from August 2010 to July 2013. The unit started in July 2010 with virtually no available facilities for surgical care for these patients. All patients were managed nonoperatively. The unit recorded data of the patients in accident and emergency, intensive care unit, and wards using structured proforma. Data were analyzed using Epi Info 7 software. Results: There were 76 patients studied of which 57 were males and 25 were females. Fifty three were caused by road traffic accident. Nineteen were complete injury. Patients with incomplete injuries did well at discharge. Completeness of injury significantly affected the outcome. Conclusion: The neurological recovery in incomplete spinal injuries in our study was good, but poor in complete injury. Conservative treatment should be adopted in developing countries in patients with poor resources and in centers where facilities are not available for adequate imaging and surgical care. Trauma system is imperative in our country.
  2,019 207 -
Evaluation of radiographic features of embedded primary molar roots in adult Turkish population
ME Ciftci, E Hastar, AM Aktan
November-December 2014, 17(6):772-775
DOI:10.4103/1119-3077.144396  PMID:25385918
Background: The roots of primary molars were found in the permanent dentition without symptoms on the clinical or radiographic examination. However, their incidence could not be achieved on the current literature. Objective: The aim of this study is to evaluate the radiographic features of the embedded primary molar roots in adult dentulous patients in Turkey. Materials and Methods: The data, from 5000 adult patients, including panoramic radiographs and demographic information, were evaluated retrospectively. The prevalence and location of the primary molar roots in the jaws were determined, as well as the prevalence and location of the primary molar roots in the adjacent permanent root levels. Results: Among 5000 Turkish population dentulous patients, 20 retained primary molar roots (0.38%) were found in 19 ones. Conclusions: The prevalence of the primary molar roots in the present study was found to be lower than that of the previous study. This finding may result from the larger amount of patient data that was evaluated in this study, which used panoramic radiographs.
  1,951 207 -
In vitro comparison of four different electronic apex locators to determine the major foramen using the clearing technique
D Altunbas, A Kustarci, D Arslan, K Er
November-December 2014, 17(6):706-710
DOI:10.4103/1119-3077.144382  PMID:25385906
Objectives: The aim of this study was to evaluate the accuracy of four electronic apex locators (EALs) (DentaPort ZX, Raypex 5, Endo Master and VDW Gold) in detecting the major foramen using the clearing technique. Materials and Methods: Forty-eight extracted single-rooted extracted teeth with mature apices were used for the study and divided into four groups of 12 teeth each. All teeth were embedded in an alginate model. Electronic measurements were taken using a size 15 K-file attached to the holder. Then, the teeth were cleared and photographed under a stereomicroscope with a digital camera. The distance between the tip of the file and the major foramen was measured by using an image analysis software program. Positive and negative values were recorded when the file tip was beyond or short of the major foramen and zero value when the file tip and the major foramen coincided. Statistical analysis was performed using the Kruskal-Wallis and Chi-square tests at a significance level of 0.05. Results: Mean distance from the file tip to the major foramen were 0.302 ± 0.202, 0.065 ± 0.293, 0.117 ± 0.475, and 0.258 ± 0.160 mm in the DentaPort ZX, Raype 5, Endo Master, and VDW Gold groups, respectively. There were no statistically significant differences among the devices (P > 0.05) . Conclusion: Under the experimental conditions, all EALs showed an acceptable determination of the major foramen.
  1,763 318 1
Mental disorders frequency alternative and complementary medicine usage among patients with hypertension and type 2 diabetes mellitus
Ahmet Keskin, Ugur BIlge
November-December 2014, 17(6):717-722
DOI:10.4103/1119-3077.144384  PMID:25385908
Objectives: Diabetes mellitus (DM) and hypertension (HT) are chronic disorders with which mental disorders may coexist and for which patients may resort to alternative medicine use. Alternative and complementary medicine is a treatment option that patients tend to use. This study is to determine the prevalence of mental disorders among patients diagnosed with DM and HT and their use of alternative medicine methods. Materials and Methods The study was conducted in a primary care setting. The data were collected from the Family Health Center No. 4 at Ηankaya, Ankara, Turkey. It involved patients aged between 18 and 65, who were on follow-up treatment for DM and HT. Patients accepted to participate in the study were administered the sociodemographic data form, the Primary Care Evaluation of Mental Disorders (PRIME-MD) questionnaire and the alternative medicine inquiry form. Participants: One hundred and sixteen patients with HT and 119 patients with DM (type 2) were recruited for the study. Results: In this study, 47.4% of HT patients and 53.8% of the DM patients were diagnosed with a PRIME-MD. The most commonly encountered disorder was mood disorders, in 37.1% of the HT patients and 45.4% of the DM patients. In this study, four HT patients (0.3%) and no DM patients stated that they resorted to complimentary medicine, which can use be used alongside conventional medical treatment and may help to feel better and cope better with any chronic condition. All four HT patients were using multivitamin combinations to support the treatment. As the alternative medicine usage was described as treatment used instead of conventional medical treatment we did not find any patient using alternative medicine. Conclusions: Mental disorders may coexist with HT and DM. Some of the HT and DM patients suffering from a mental disorder seek psychiatric support, while others do not. We believe that it is important to examine patients for mental disorders, while being followed-up for a chronic disease.
  1,605 318 2
An ectopic hamartomatous thymoma compressing left jugular vein
L Huang, L Zhao, Y Chai
November-December 2014, 17(6):814-816
DOI:10.4103/1119-3077.144407  PMID:25385925
Ectopic hamartomatous thymoma (EHT) is an extremely rare benign neoplasm. It is usually found at the root of the neck (frequently on the left) and does not usually impact adjacent tissues in clinically significant ways. While EHT manifests distinct pathological features, the lesion is either asymptomatic or may show nonspecific clinical features. We report one case of EHT which was assumed to be of low malignant potential since it severely compressed the inlet of left internal jugular vein as seen by computed tomography scan. To the best of our knowledge, this clinical finding of EHT is very rare. After the diagnosis and treatment of this patient, we believe that EHT or suspected EHT should be treated less invasively.
  1,595 251 2
Comparison of anaesthetic cost in open and laparoscopic appendectomy
I Demirel, AB Ozer, M Kilinc, MK Bayar, OL Erhan
November-December 2014, 17(6):696-700
DOI:10.4103/1119-3077.144380  PMID:25385904
Context: Appendectomy is generally conducted as open or by laparoscopic surgical techniques under general anesthesia. Aims: This study aims to compare the anesthetic costs of the patients, who underwent open or laparoscopic appendectomy under general anesthesia. Settings and Design: The design is retrospective and records of 379 patients who underwent open or laparoscopic appendectomy under general anesthesia, falling under the category of I-III risk group according to the American Society of Anesthesiologists (ASA) classification between the years 2011 and 2013, and aged 18-77. Subjects and Methods: Open (Group I) or laparoscopic (Group II) appendectomy operation under general anesthesia were evaluated retrospectively by utilizing hospital automation and anesthesia observation records. This study evaluated the anesthesia time of the patients and total costs (Turkish Lira ₺, US dollar $) of anesthetic agents used (induction, maintenance), necessary medical materials (connecting line, endotracheal tube, airway, humidifier, branule, aspiration probe), and intravenously administered fluids were evaluated. Statistical Analysis Used: We used Statistical Package for the Social Sciences software (SPSS version 17.0) for statistical analysis. Results: Of the patients, 237 were males (62.53%) and 142 were females (37.47%). Anesthesia time limits were established as 70.30 ± 30.23 minute in Group I and 74.92 ± 31.83 minute in Group II. Mean anesthesia administration cost per patient was found to be 78.79 ± 30.01₺ (39.16 ± 14.15$) in Group I and 83.09 ± 26.85₺ (41.29 ± 13.34$) in Group II (P > 0.05). A correlation was observed between cost and operation times (P = 0.002, r = 0.158). Conclusions: Although a statistical difference was not established in this study in terms of time and costs in appendectomy operations conducted as open and laparoscopically, changes may occur in time in market conditions of drugs, patent rights, legal regulations, and prices. Therefore, we believe that it would be beneficial to update and revise cost analyses from time to time.
  1,582 258 1
A rare cause of blepharoconjunctivitis: Phthiriasis palpebrarum
Ceyda Baskan, Rahmi Duman, Mehmet Balci, Sibel Ozdogan
November-December 2014, 17(6):817-818
DOI:10.4103/1119-3077.144419  PMID:25385926
  1,439 211 2
Self-perceived seizure precipitants among patients with epilepsy in Middle-belt of Nigeria
EO Sanya, K Mustapha, A Ademiluyi, A Bello, O Alaofin
November-December 2014, 17(6):701-705
DOI:10.4103/1119-3077.144381  PMID:25385905
Aim: Patient's perception of seizure precipitant is crucial in epilepsy management, but it is often overlooked by physicians. This may be due to neglect and underestimation of its importance. This study looked at frequency and nature of self-perceived seizure precipitants among patients with epilepsy. Materials and Methods: A close-ended questionnaire-based study. Patients with active epilepsy (≥2 attacks/year) were recruited from the neurology clinic of the University of Ilorin Teaching Hospital (UITH), Ilorin. Result: A total of 89 patients participated in the study and of these 41 (46.1%) were males. Their median age was 30 (21-52) years and median age at seizure onset was 22 (15-46) years. The median seizure duration was five (2-14) years. More patients (46.1%) had less than secondary school education and 12 (13.5) were uneducated. Generalized epilepsy was the predominant (68.6%) seizure type. A total of 33 (37.1%) subjects had ≥4 attacks/year, 29 (32.6%) had 5-12 attacks/year, and 27 (30.3%) >12 attacks/year. A total of 16 (18%) subjects did not mention any seizure precipitant, whereas 73 (82.2%) reported at least one specific seizure precipitant; of these, 62 (85%) patients reported ≥2 precipitants. Stress (41%), inadequate sleep (27%), and head trauma (26%) were the three leading seizure precipitants mentioned. Subject's age, sex, level of seizure control, and place of abode did not influence reported seizure precipitants. However, the more educated (>12 years education) patients significantly reported stress as seizure precipitant (P < 0.05). Most (80%) patients rightly indicated that antiepileptic drug was the best treatment for their seizure control. Conclusion: The result of this study showed that the leading perceived seizure precipitants among epilepsy patients attending the neurology clinic of UITH were stress, inadequate sleep, head trauma, and demonic attacks and spells.
  1,390 217 -