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   2005| June  | Volume 8 | Issue 1  
    Online since January 11, 2011

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Mortality patterns in the accident and emergency department of an urban hospital in Nigeria
AU Ekere, BE Yellowe, S Umune
June 2005, 8(1):14-18
OBJECTIVE: The accident and emergency (A & E) department of any hospital provides an insight to the quality of care available in the institution. The University of Port Harcourt Teaching Hospital (UPTH) is a foremost institution in the South-South geopolitical region of Nigeria, servicing a core population of about 5 million people. The aim of this review was to highlight the demographic patterns of mortality, time spent before death in the emergency room. METHODS: A 3 year retrospective review, covering April 2000 - March 2003, of patients attended to in the Accident & Emergency department of University of Port Harcourt Teaching Hospital was carried out. Casualty records including attendance registers, Nurses' report books and death certificates were used to extract demographic indices, causes of death and time from arrival to death in the Accident and Emergency Unit. Multiway frequency tables were used for analysis. RESULTS: Of the 22,791 patients seen during the study period, 446 died, giving a crude mortality rate of 2 percent. The male to female ratio was 1.5:1; the trauma subset and the non-traumatic subset being 4.6:1 and 1.2:1 respectively. Most of the cases were of non-traumatic origin (79.8%), with the 20-49 age group being the most affected when all the cases were taken into consideration. However, the overall mean age was 33+/-9.4 years. The peak age in trauma deaths was 20-29 year, while that in non-traumatic deaths was 40-49 years. Some of the deaths (3.4%) could not be traced to any cause. Probably due to incomplete records or ignorance to the cause of death. Road traffic accidents and assaults were the commonest causes of traumatic death, accounting for 57.8% and 11.1% respectively. Bulk of the non traumatic deaths (25.2%) was from cardiovascular diseases. Most of the patients (70.9%) died within six hours of arrival in the accident and emergency, while 3.6% (16) were dead on arrival. The average time in the casualty before death was about 22.0 hours. Contributing factors to theses deaths might include poor infrastructures on ground, inadequate transportation to hospital, delay in presentation and inadequate clinical exposure by the first line physicians in the accident and emergency department. CONCLUSION: Improvement in management techniques might unravel the mysteries of death of unknown origin. Management of medical emergencies should be emphasized in the training of accident and emergency workers.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
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Epidemiological risk factors for breast cancer--a review
MN Okobia, CH Bunker
June 2005, 8(1):35-42
The rising global incidence, morbidity and mortality from breast cancer has led to intensified efforts in the search for etiological factors of the disease. While international variations in the incidence of the disease may implicate a role for environmental factors, available evidence indicates that lifetime estrogen exposure may be a critical factor in breast carcinogenesis. While increasing age and the female sex are well-recognized risk factors, reproductive characteristics such as age at menarche and menopause, menstrual irregularity, age at first and last childbirth, parity and breastfeeding have also been linked to breast carcinogenesis. Early menarche and late menopause are associated with increased lifetime exposure to estrogens. In addition, a long period from Tanner stage breast-2 to onset of ovulatory cycles and a long period of luteal inadequacy and anovulatory cycles characteristic of the perimenopausal years creates long estrogen windows favorable for tumor induction. The intense differentiation of the terminal duct lobular unit associated with each full term pregnancy and release of various hormones, autocrine and paracrine growth factors during lactation may explain the protective effects of early age at first full term pregnancy, parity and lactation of breast cancer risk. A protective role for xenoestrogens has been postulated and evidence is emerging in support of an increased breast cancer risk with abortion and prolonged use of postmenopausal hormone replacement therapy. Appreciating relevant risk factors for breast cancer in the population is central to any preventive and control program aimed at reducing the burden of the disease through the design and implementation of culturally sensitive interventions.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  803 0 14
A review of the choice of therapy in primary open angle glaucoma
AE Omoti
June 2005, 8(1):29-34
We are in the midst of a therapeutic revolution and the choice of therapy in the management of glaucoma can no longer be based on long-held beliefs. The choice between medical, surgical and argon laser trabeculoplasty as primary therapy for glaucoma has been a matter of debate and research for many years. Arguments are based mainly on 3 factors: efficacy, safety and cost. In Africa, other factors that must be considered include acceptability of surgery, compliance with medical therapy, scarcity and expense of modern drugs, absence of laser facilities among others. It is generally accepted that trabeculectomy surgery is the most acceptable form of therapy in Africans mainly because of its efficacy, late presentation and problems encountered during medical therapy. However many African patients are reluctant to have surgery for glaucoma mainly because of fear and the fact that there will be no visual improvement after the surgery. There are now several potent modern drugs, which though expensive have acceptable safety profile, and fewer problems with compliance. The decision on the choice of therapy should be individualized and not be based on long-held beliefs.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
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Knowledge and attitudes of terminally ill patients and their family to palliative care and hospice services in Nigeria
A Adenipekun, A Onibokun, TN Elumelu, OA Soyannwo
June 2005, 8(1):19-22
BACKGROUND: A palliative care and Hospice service is a neglected aspect of medical discipline especially in a developing country like Nigeria. With the global increase in incidence of cancer and HIV/AIDS and 70% of them presenting late, coupled with limited resources, for effective symptom control, palliative care therefore remains the only option left to improve the quality of life of the patients. OBJECTIVE: To assess the knowledge and attitudes of patients and their relations to palliative care and hospice services {PC&H} and to fashion out appropriate services for the patients. MATERIALS AND METHODS: A total of 130 participants were studied using a questionnaire which comprised of three parts: Socio-demographic variables, Information about Knowledge and Attitudes towards PC&H. RESULTS: Sixty nine were patients while 61 were family members. Ninety four [72.3%] had no knowledge of PC&H regardless of level of education and social status. 109 [84%] agreed that symptoms of the terminally ill patients should be treated to improve their quality of life and 75% of the participants agreed that this will be better done in a Hospice. 106 [83%] participants desire to have hospice established in every community, this again was regardless of tribe CONCLUSION: There is a gross lack of knowledge about PC&H in our community as evidenced among the participants studied. However, there is a positive attitude towards PC&H suggesting a general acceptance, since there is presently no well established Hospice in Nigeria; we recommend that government and Non governmental organizations should assist in this area. A hospital based Hospice might be a starting point.
[ABSTRACT]   Full text not available     [PubMed]
  607 0 -
Radiologic management of impacted coin in the oesophagus--a case report
IJ Okoye, AO Imo, V Okwulehie
June 2005, 8(1):56-59
The incidence of swallowed foreign body is high in children and young adults. The common age of occurrence is below 10 years of age. It is a well known paediatric emergency often requiring urgent oesophagoscopy. Majority of swallowed foreign bodies (FBs) are impacted at sites known conventionally as constrictions. The commonest FB swallowed by children is coins; by adults - bones, fish bones and large bolus of meat, and in the older age group - dentures. The most common presenting symptoms are drooling of saliva, dysphagia and odynophagia. The anatomic proximity of the upper airway and oesophagus permit the development of respiratory symptoms like cough and stridor. Long standing foreign body impaction with weight loss, consolidated lungs and failure to thrive are documented presentations of FB in the oesophagus. We present a case of a 20 year old male who inadvertently swallowed a coin which got impacted at the thoracic inlet - one of the conventional areas of constriction. He presented late with cough, stridor, odynophagia and weight loss. The presentation of weight loss that could arise from unduely prolonged odynophagia rather than from complications like fistula, empyema thoracis or ominous predisposing lesions like malignancy was noted. The case highlighted the oddity of an adult swallowing a coin, its impaction in the, oesophagus of an apparently healthy adult and the non-surgical retrieval of the FB by fluoroscopic guidance.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  591 0 3
Carcinoma of the gallbladder at the Nnamdi Azikiwe University Teaching Hospital--a 5-year retrospective study
GU Chianakwana, PI Okafor, SN Anyanwu
June 2005, 8(1):10-13
BACKGROUND: Carcinoma of the gallbladder is often missed because of the low index of suspicion. AIMS AND OBJECTIVES: To review the incidence, pattern and outcome of carcinoma of the gallbladder in our center and to highlight the need for early diagnosis. DESIGN: Retrospective survey of all cases of carcinoma of the gallbladder. SETTING: Nnamdi Azikiwe University Teaching Hospital serving rural, semi-urban and urban communities. PATIENTS AND METHODS: Patients who had histologically confirmed carcinoma in the general surgical units of the Nnamdi Azikiwe University Teaching Hospital over a 5-year period were reviewed and, from their case notes, the following information on sex, age, mode of presentation, time of diagnosis, stage of disease, treatment given and outcome were extracted. RESULTS: Twenty-one cases of gallbladder carcinoma were seen out of a total of 692 cases of different types of cancers seen in the general surgical units, giving an incidence of 3.04%. Six were males and 15 were females, age ranged between 39 and 72 years, a mean of 55; with the peak age in the 7th decade of life. Eleven patients (52.4%) presented with features of chronic cholecystitis and had cholecystectomy. Ten patients presented with obstructive jaundice in a stage too advanced for any form of palliative surgical treatment. The outcome was good in patients who presented with features of cholecystitis but who turned out to be cases of early carcinoma of the gallbladder because after five years of follow-up, none of them has shown any features of recurrence. There was no mortality in this group and the patients have remained in good health. However, the prognosis was poor in those patients who presented with obstructive jaundice. They remained very ill, with worsening general condition. They were discharged home on request of their relations and were lost to follow-up. CONCLUSIONS: Carcinoma of the gallbladder may present as cholecystitis. It is advisable for clinicians to have this in mind before, during and after cholecystectomy. Early presentation to hospital by patients would avert delay and improve early diagnosis, early treatment, and better outcome.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  588 0 3
Conservative management of third trimester cervical spinal cord injury using Gardner-Wells tongs traction
AO Malomo, JC Emejulu, AA Odukogbe, WA Shokunnbi, MT Shokunbi
June 2005, 8(1):46-50
Spinal cord injury, though an important cause of morbidity appears to be uncommon in pregnant women or perhaps, has not been accurately documented among them. Superimposed on the many impairments resulting from spinal cord injury is the presence of the foetus in the womb which in itself normally brings about intense physiological alterations in the patient. Despite the complexities, neither the pregnancy nor the spinal cord injury needs jeopardize the optimal care of the other as long as the standard protocols are followed. In the past 10 years, the University college Hospital, Ibadan, Nigeria treated approximately 900 spinal cord injury patients, and only 3 of these were pregnant-an incident of 0.30 per 90 patients per year, or 0.33%. We report here, the conservative management of one of these pregnant patients using the Gardner-Wells' tongs traction, resulting in normal parturition and full neurological recovery.
[ABSTRACT]   Full text not available     [PubMed]
  551 0 -
Co-morbid psychiatric disorders in Nigerian patients suffering temporomandibular joint pain and dysfunction
BD Saheeb, AN Otakpor
June 2005, 8(1):23-28
OBJECTIVES: To determine the prevalence of psychiatric morbidity among Nigerian patients with temporomandibular joint pain and dysfunction (facial arthromyalgia). to delineate the specific types of comorbid psychiatric disorders and identify the socio-demographic characteristics of the patients with psychiatric disorders. DESIGN: A two-stage design was adopted to study the prevalence and types of co-morbid psychiatric disorders of identified 24 patients with temporomandibular joint pain and dysfunction over a period of 5 years. SETTING: Pain and Psychiatric clinics of the University of Benin Teaching Hospital, Benini City, Nigeria. METHODS: The patients were controlled for age gender, and marital status. The State-Trait Anxiety Inventory. 28-item General Health Questionnaires and the Hospital Anxiety and Depression Scales were used for first stage screening while the second stage interview utilised the Psychiatric Assessment Schedule. RESULTS: The prevalence of psychiatric morbidity was 37.5% and 12.5% in the study and control groups respectively. Generalised anxiety disorder and dysthmia were the main forms of psychiatric disorders identified. Temporomandibular joint pain and dysfunction patients with co-morbid psychiatric disorders were significantly older (P<0.0001), had the illness for shorter periods before presentation (p<0.001) and were non-professionals. CONCLUSION: The findings highlight the need for multi-disciplinary approach to the assessment and management of patients with temporomandibular joint pain and dysfunction.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  522 0 4
The use of herbal products in dementia : experience of Kippo in four Nigerians
R Uwakwe, F Olebuezie
June 2005, 8(1):51-55
Modern neuroimaging and other investigative techniques have provided a lot of new information on the neurobiology of the dementias. Unfortunately no permanent cure has been found for this debilitating disease, giving rise to continuing trial of various products. Alternative and herbal medicine has become popular in neuropsychiatric disorders including dementia. In this report, we present our experience with Kippo - a Japanese herbal product - in 4 Nigerians with dementia. Two of the patients fully completed the study. The ten word list learning test, community screening interview for dementia (CSI -D), structured dementia interview (SIDAM) and the Geriatric Mental State schedule (GMS) were used to identify dementia according to ICD -- 10 diagnostic criteria. Dementia behaviour disturbance scale (DBD) and modified 22 - item mini - mental state examination (MMSE) were used to evaluate the product efficacy over 8 weeks. One patient showed some initial improvement on the DBD without effect on the MMSE and the other patient showed some initial improvement on the MMSE without effect on the DBD. Both patients had worsening on the clinical Global Impression Scale (CGI) within the study period. There were no demonstrable adverse effects as shown by physical examinations and laboratory tests. No definite conclusion could be drawn on the efficacy and safety of Kippo in dementia in this short study. We recommend a well controlled larger scale investigation of the effect of Kippo on well defined different subtypes of dementia.
[ABSTRACT]   Full text not available     [PubMed]
  514 0 -
Tuberculin reaction among healthy BCG vaccinated primary school, children in Nnewi, south eastern Nigeria
CC Ifezulike, CC Ezechukwu, I Egbonu, JO Chukwuka
June 2005, 8(1):4-9
OBJECTIVE: To assess the Mantoux test reaction pattern in healthy BCG vaccinated Primary School Children aged 6 -10 years in Nnewi, South -East Nigeria. MATERIALS AND METHODS: Four primary schools were randomly selected out of 43 government owned primary schools in the town. The entire BCG vaccinated pupils in each school were the sample frame. Mantoux test was administered in 662 pupils that met the inclusion criteria and had their results read 72 hours later. RESULTS: Three groups of children were identified: First group of 470 (75.6%) were negative, 76 (12.2%) had intermediate reaction, while 76 (12.2%) had positive Mantoux test. Increasing age, sex, presence of BCG scar and age at vaccination did not affect the pattern of Mantoux test reaction. CONCLUSION: The result indicates that the use of Mantoux test in the diagnosis of Tuberculosis may not be affected by BCG vaccination at birth and therefore, BCG vaccination at birth should be continued.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  511 0 6
Term abdominal pregnancy misdiagnosed as abruptio placenta
JI Ikechebelu, DN Onwusulu, CN Chukwugbo
June 2005, 8(1):43-45
A 37 year old multiparous woman at 37th week gestation presented with an undiagnosed abdominal pregnancy and acute abdomen following forceful reduction of an associated utero-vaginal prolapse. She had an urgent laparotomy with delivery of a live female baby lying in the left broad ligament. The baby weighed 2.6 kg with Apgar scores of 2 and 6 at first and fifth minutes respectively. The partially detached placenta was easily delivered complete with membranes. Haemostasis was secured by ligation and excision of the left adnexum (broad ligament with the pregnancy sac and uterine appendages). She was transfused with two units of whole blood. This case highlights the importance of excluding pregnancy in any woman of reproductive age with undiagnosed abdominal mass and utero-vaginal prolapse before any manipulation. It also underscores the importance of ultrasound scan in early pregnancy by a competent sonologist.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  504 0 3
Drug treatment of common childhood symptoms in Nnewi : what mothers do?
CC Ezechukwu, I Egbuonu, JO Chukwuka
June 2005, 8(1):1-3
OBJECTIVES: To determine how mothers treat common childhood symptoms before hospital attendance in Nnewi. MATERIALS AND METHODS: Information was obtained from 211 consecutive mothers on their children's presenting symptoms, drugs administered, source of the drugs, persons who prescribed the drugs, number of drugs administered, prior to hospital attendance through a structured questionnaire administered by the authors. RESULTS: A combination of fever, cough and catarrh topped the list of presenting symptoms in 87 (41%) of the patients while fever and diarrhea had the least frequency of 16 (7.6%). One hundred and five or 52% of the mothers decided on the drugs that were administered followed by patent medicine dealers who accounted for 59 or 29.2%. Trained health professionals whom mothers consulted before bringing their children to hospital were responsible for 28 (13.8%) of the prescriptions. Patent medicine stores were the sources of 90.6% of the drugs while health facilities accounted for 8.4%. The frequency chart of prescribed drugs were analgesics 166 (34.9%), hematinics 88 (18.5%), antibiotics and antimalarials 81 (17.1%) and 74 (15.6%) respectively while antidiarrheoals and ORT were least administered with 7 (1.5%) and 1 (0.2%) respectively. The children received an average of 2.7 drugs per prescription. CONCLUSION: With the high prescription rate of mothers for sick children at home, there is need for effective methods to educate mothers on the use and potential dangers of home medication.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  489 0 6
Incomplete uterine rupture, following blunt trauma to the abdomen : a case report
CA Enakpene, OA Ayinde, AO Omigbodun
June 2005, 8(1):60-62
Full text not available     [PubMed]
  241 0 -
Acute breathlessness as a presenting feature of gastroesophageal reflux disease--case report
A Akere, JA Otegbayo
June 2005, 8(1):63-64
Full text not available     [PubMed]
  209 0 -