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   2008| June  | Volume 11 | Issue 2  
    Online since December 1, 2010

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Placenta praevia at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife. A ten year analysis
O Loto, TG Onile
June 2008, 11(2):130-133
CONTEXT: Placenta preavia is one of the obstetric emergencies associated with maternal mortality and morbidity. It is also a major cause ofprematurity. With prompt and appropriate management the complication can be drastically reduced. OBJECTIVE: The objective of this study is to document the pattern of presentation, mode of management and the outcome of the management of placenta praevia at Obafemi Awolowo Teaching Hospitals Complex (I.H.U.), Ile-Ife between January, 1996 to December, 2005. The outcome will help in identifying the women at risk and offer suggestions to reduce the associated complications. MATERIALS AND METHODS: The study involved a ten-year retrospective analysis of the data collected from the case records of all the cases diagnosed as having placenta praevia during the period under review. RESULTS: During this period there were 7515 deliveries and a total of 128 cases of placenta praevia giving an incidence of 1.65% i.e. 3 in 200 births. Majority (58.2%) of patients with placenta praevia were unbooked and 77.4% of them were multiparous. Only 20.2% were accessible for diagnosis by ultrasound scanning, while 25.8% of them were delivered before 36 weeks of gestation. The perinatal mortality rate was 177 per 1000 births. CONCLUSION: Placenta praevia is still a major cause of obstetric morbidity and mortality. The diagnosis can be made with routine ultrasound scanning which then allows patient identification and institution of appropriate and comprehensive treatment aimed at minimizing complications. The role of good referral system, 24 hours blood banking services and facilities for caesarean section and adequate neonatal backup in preventing morbidity and mortality associated with the condition can not be over emphasized.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  862 0 1
Retained products of conception in a utero cutaneous fistula : a case report
O Okoro, S Onwere
June 2008, 11(2):170-171
This is a case report of a patient with utero-cutaneous fistula following Caesarean Section and criminal abortion. Her case was further complicated by the discovery of products of conception within the fistula. At laparotomy, adhesiolysis with the freeing of the uterus and fistulectomy were performed. She had an uneventful recovery.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  692 0 1
Health effects of night shift duty on nurses in a university teaching hospital in Benin City, Nigeria
EC Isah, OA Iyamu, GO Imoudu
June 2008, 11(2):144-148
OBJECTIVE: This study is aimed at identifying the effects of night shift duty on the health and wellbeing of nurses in order to make recommendations on ways of ameliorating them. METHODS: The study was ofa cross sectional descriptive type using a total sample of nurses in the hospital. Data collection was by means of a semi-structured self-administered questionnaire and the analysis by the computer Programme for Epidemiologists (PEPI). RESULTS: The response rate was 79.3% with a total of 211 (68.1%) having one or more health complaints, which included muscle ache and pains (58.7%), frequent headaches (21.9%), lack of concentration (21.3%) and a negative effect on social life (66.1%). The younger nurses disliked night shift more than the older ones (2 = 57.5, df=6, p = 0.000) and 57.7% felt they were less productive during night shift. The shorter the period of sleep after the night shift, the lesser the level of productivity and the more the manifestation of health symptoms (2 = 45.5, df = 4, p = 0.000 and 2 = 29.0, df = 2, p = 0.000 respectively). CONCLUSION: Night shift duty caused both medical and psychological problems on the nurses. There is a need for medical surveillance, educational programme and the application of sleep hygiene techniques for shift working nurses.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  665 0 1
Overview of contraceptive use in Jos University Teaching Hospital, north central Nigeria
JT Mutihir, VC Pam
June 2008, 11(2):139-143
BACKGROUND: Modern contraceptive methods accepted by 17,846 new clients in Jos University Teaching Hospital, a tertiary health institution, over two decades are presented. METHODS: This was a review of the contraceptive trend in new clients who used the various methods of contraception over an 18-year period, 1985-2002. RESULTS: The accepted methods were the intrauterine device (26.1%), oral contraceptive pills (23.5%), female sterilization (21.7%), the Injectable (14.2%), male condom (9.5%), Norplant implants (4.9%) and vasectomy (0.1%). Reversible methods were used by 78.2% and the permanent forms by 21.8%. The women were the acceptors of the methods in 90.5%, while men contributed only 9.5% of the new acceptors. Ten men only had vasectomy over the period of study. CONCLUSION: The Intrauterine device was the leading method of contraception accepted by the women and male vasectomy was the least accepted by men. There is the need for increased male involvement in contraceptive issues.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  655 0 2
Cervical plexus block for thyroidectomy : experience with a giant goitre : case report
GA Rahman, IK Kolawole
June 2008, 11(2):158-161
Local or regional anaesthesia has long been recognised as a useful anaesthetic option for thyroidectomy. A few authors have reported the successful use of local infiltration anaesthesia for thyroidectomy in our environment. The technique is said to be particularly suitable for simple giant goitres. Cervical plexus block has also been found useful for this operation in other parts of the world. However, we are unaware of any report on the use of cervical plexus block for thyroidectomy in our environment. We used bilateral superficial cervical plexus block for thyroidectomy in a 20-year old girl with a simple multinodular goitre. Surgery was performed with the patient in the classical thyroidectomy position. Though the patient was lightly sedated during the operation, the anaesthetist maintained communication with her throughout the procedure. Anaesthesia was generally effective, except for minor complaints of pressure symptoms during mobilization of the gland and postural aches. These, the patient described as tolerable. Surgery, which lasted 2 hours 45 minutes, was uneventful. The patient was allowed oral fluid intake within 2 hours postoperatively. Superficial cervical plexus block is simple, safe, effective and cheap for thyroidectomy for Simple Giant Goitre.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  582 0 2
Changing trends in maternal mortality in a developing country
JU Onakewhor, EP Gharoro
June 2008, 11(2):111-120
OBJECTIVE: To have a 5-year review of the maternal mortality ratio in the largest centrally located Mission hospital in Benin City where a large proportion of women deliver yearly. METHOD: This was a 5-year (January 1, 1996 through December 31, 2000) review of the causes of maternal mortality at the Saint Philomena Catholic Hospital, Benin City. The case notes of those that suffered maternal mortality were retrieved and thoroughly perused. Information on all cases of maternal mortality were extracted from the patients' case-notes; the labour ward Registers; the antenatal, postnatal, the female ward and the theatre registers. The midwifery/nurses' reports were also examined. The duplicate copies of the death certificates were examined and the necessary information was also extracted. The total deliveries for the period were extracted from the delivery registers. RESULTS: There were 7055 women who gave birth during the 5-year period. There were 32 maternal deaths; Maternal Mortality Ratio (MMR) of 454/ 100,000 live births. Unbooked emergencies accounted for 68.7% of all deaths, and were more than doubled the booked women. The MMR increased progressively from 325 in 1996 to peak at 765 in 1999 (P < 0.0001) with an insignificant drop in 1998 (P > 0.06). It was lowest in 2000 (241) (P < 0.0001). Paradoxically, as the number of deliveries decreased progressively from 1530 in 1996 to 1247 in 2000, the MMR increased progressively from 327 in 1996 to 675 in 1999. There were no postmortem examinations and no coroner's inquests. More than 76% of the women spent 48 hours or less from time of admission to death and majority of them were of low parity. Nulliparity was 37.5%. The mean parity was one. Young women 20-39 years old accounted for 81.3% with 9.4% teenage deaths due to illegally induced abortions. Eclampsia (34.4%), hemorrhage (25.0%), Infections (18.8%) and abortions 12.5%) were the four leading causes of death. Puerperal deaths were 56.3%. Five short case scenarios were presented to highlight the tortuous pathway the women passed to end in maternal mortality. CONCLUSION: The MMR ratio was still unacceptably high. The causative factors were largely preventable. The puerperium was the most dangerous period. Women empowerment, free or highly subsidized universal antenatal care services, and provision of adequate emergency obstetric services with effective contraceptive backup is suggested. Re-orientation of care givers and community leaders to enhance awareness and early recognition of the danger signs and risk factors associated with pre-eclampsia and eclampsia with prompt and adequate management or referral is emphasized.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
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Adult nephrectomy : our experience at Ile-Ife
TA Badmus, AA Salako, AA Sanusi, FA Arogundade, GO Oseni, BM Yusuf
June 2008, 11(2):121-126
OBJECTIVES: To determine indications for adult nephrectomy in our community and the outcome of the procedure in our Institution. MATERIALS AND METHOD: Records of adult patients scheduled for nephrectomy at Obafemi Awolowo University Teaching Hospital from January 1993 to December 2004 were reviewed. Information extracted and analysed included age of patient, sex, presentation, investigations, indication, type and outcome of nephrectomy, histopathology result and duration of follow up. RESULTS: During the period, thirty adult patients mean age 42.73 yrs (range 16-80 yrs, M:F = 2:1) were scheduled for nephrectomy. Indications included suspicion of malignancy in 19 (63.3%) patients, protracted loin pain in non-functioning kidney in 2 (6.7%), uncontrollable bleeding in a patient with bilateral polycystic kidney (3.3%), pyonephrosis with septicaemia in a patient (3.3%), kidney injury (grade 5) in 2(6.7%) and kidney donation for transplantation in 3(10%). Ultrasound and intravenous urography were useful in the patients' evaluation. Twenty-seven (90%) patients were operated upon, but only 25 (83.3%) had nephrectomy. Sixteen (53.3%) had radical nephrectomy, 5 (16.7%) had simple nephrectomy, 3 (10%) had nephro-ureterectomy, and one (3.3%) had partial nephrectomy. Major surgical complications included wound sepsis (18.5%) and primary haemorrhage (7.4%). The overall morbidity and mortality rates were 7.4% and 3.7% respectively. Postuninephrectomy, patients' renal function remained stable after an average of 34.05 months follow-up. CONCLUSION: Renal tumours constitute the main indication for adult nephrectomy in our community. Kidney injury, kidney donation, and pyonephrosis are relatively uncommon indications. Open nephrectomy, which remains our local practice, is safe and unilateral nephrectomy is compatible with normal life.
[ABSTRACT]   Full text not available     [PubMed]
  563 0 -
Hydatidiform mole in gombe : a five year Histopathological review
AA Mayun
June 2008, 11(2):134-138
OBJECTIVE: The purpose of this study is to do a histopathological review of all cases ofhydatidiform moles seen in pathology department of Federal Medical Centre, Gombe between June 2000 and May 2005. METHODS: All the relevant request forms, slides and paraffin embedded tissue blocks were retrieved. The slides stained with routine Haematoxylin and Eosin were then reviewed. RESULTS: Thirty four cases of hydatidiform moles were studied and these formed 7.5% of all products of conception seen during the review period. There were 18 cases of complete hydatidiform mole and 16 cases of partial hydatidiform mole. No invasive or tubal mole was seen during this period. The frequency of hydatidiform moles was 1 in 166 delivaries. The age range for all the molar pregnancies was 15-44 years with vaginal bleeding as their leading mode of presentation between 11-18 weeks ofgestatation. CONCLUSION: Molar gestation was found to be a common gynaecological problem in Gombe affecting women mainly in their third decade of life.
[ABSTRACT]   Full text not available     [PubMed]
  561 0 -
Glaucomatocyclitic crisis in Edo State, Nigeria : report of two cases
AE Omoti, ME Enock
June 2008, 11(2):162-165
OBJECTIVE: To report two classical cases of glaucomatocylitic crisis in tertiary Health Centres in Edo State, Nigeria. METHOD: Two cases of glaucomatocylitic crisis seen at Irrua Specialist Teaching Hospital, Irrua, and University of Benin Teaching Hospital, Benin City, both in Edo State, Nigeria are reported. Diagnosis was based on typical history and findings on examination. RESULTS: The first was a female who presented in December 2002 at Irrua Specialist Teaching Hospital and the second was a male who presented at the University of Benin Teaching Hospital, in March 2004. Both presented with blurring of vision in the affected eye and seeing halos around light. The intraocular pressures in the affected eyes were markedly elevated, there were fine keratic precipitates in the corneal endothelium of the involved eyes and the optic discs and visual fields were normal. Repeated episodes of the symptoms confirmed the diagnosis ofglaucomatocyclitic crisis. CONCLUSION: This report shows that typical cases of glaucomatocylitic crisis occur in Nigerians but require a high index of suspicion for the diagnosis.
[ABSTRACT]   Full text not available     [PubMed]
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The relationship between gallstone disease and gall bladder volume
AB Olokoba, BJ Bojuwoye, LB Olokoba, KW Wahab, AK Salami, KT Braimoh, AK Inikori
June 2008, 11(2):89-93
BACKGROUND: The role of a large gallbladder volume with regards to a predisposition to gallstones is unknown. It is likely that an increase in gallbladder volume could result in impaired gallbladder motility and bile stasis which may encourage gallstone formation. This study is therefore to determine the relationship between the presence of gallstone disease and gall bladder volume. METHODOLOGY: One hundred type 2 diabetic patients and 100 age and sex-matched controls underwent real time ultrasonography to determine the relationship between the presence of gallstone disease and gallbladder volume. Their demographic characteristics were recorded and compared. The ultrasound examinations was done in the morning following an overnight fast (to prevent gall bladder contraction) without sedation. Longitudinal and transverse scans of the right upper quadrant was done in both the supine and left lateral positions The gallbladder volume was measured. RESULT: The mean gallbladder volume in diabetic patients with gallstone disease 28.4 +/- 18.6 ml was higher than in those without gallstone disease 27.4 +/- 14.8 ml p = 0.844. The mean gallbladder volume in the controls with gallstone disease 26.5 +/- 14.7 ml was also higher than in those without gallstone disease 24.1 +/- 12.7 ml p = 0.189. CONCLUSION: The fasting gallbladder volume tended to be larger in patients with gallstones (i.e. both diabetic patients and controls).
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  528 0 1
Knowledge, use and promotion of insecticide treated nets by health workers in a suburban town in south western Nigeria
CA Iyaniwura, A Ariba, T Runshewe-Abiodun
June 2008, 11(2):149-154
BACKGROUND: Morbidity and mortality associated with malaria can be significantly reduced by widespread use of insecticide treated nets. Health workers can increase acceptability of ITN by promoting its use and serving as role model. OBJECTIVE: To assess the knowledge, use and promotion of insecticide treated bed-net by health workers. METHOD: This descriptive, cross sectional study was carried out among health care workers in Sagamu (Ogun State) between November 2004 and January 2005. Data was collected from 263 health workers using a pretested, structured questionnaire. RESULT: Two hundred and forty six (93.5%) were aware of insecticide treated bednets (ITN) but many did not have adequate knowledge about it, only 52 (20.9%) knew that ITN should be retreated every 6 months. Sixty (22.8%) were currently using ITN. In the homes where they were currently using ITN, children were the main users (59%). The major reasons given for not using an ITN were that it had not occurred to them (23.2%), 13.3% were satisfied with the method they were using and 12.1% felt it was not convenient to use. Less than one-third (32.3%) indicated that ITN was available in their health facility. Fifty-seven percent (56.7%) had recommended it for patients before. The main reasons given by those who had not recommended it before were: lack of knowledge about it (52.5%), while 20% indicated that they were not familiar with it. CONCLUSION: Awareness about ITN is high among the health workers but the knowledge about it is inadequate. The major challenges to use and promotion of ITN by health workers are lack of conviction about the unique benefits of ITN, inadequate knowledge and poor access to the nets.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  516 0 2
Improving the safety of room air pneumoperitoneum for diagnostic laparoscopy
JI Ikechebelu, CA Okeke
June 2008, 11(2):127-129
BACKGROUND: Laparoscopic examination is a useful investigation in the evaluation of infertile women. To perform this test, pneumoperitoneum is required to distend the abdomen, improve visibility and displace the intestines out of the pelvis. Several gases have been used to achieve this purpose including Nitrous Oxide (N2O), Carbondioxide (CO2), Helium, Xenon andAir. STUDY DESIGN AND METHOD: This was a prospective study in a private fertility centre in Nnewi, Nigeria aimed at reducing the morbidities inherent in the use Room Air pneumoperitoneum for diagnostic laparoscopy. This was sequel to an earlier study, which revealed that women who had Room Air pneumoperitoneum had a higher port wound infection rate, abdominal discomfort (feeling of retained gas in the abdomen) and shoulder pain with resultant delayed return to normal activity than women who had Co2 pneumoperitoneum. RESULTS: This study demonstrated that the use of soda lime to purify the Room Air and a low pressure suction pump to evacuate the air after the procedure significantly reduced the wound infection rate and virtually eliminated the abdominal discomfort and shoulder pain associated with Room Air pneumoperitoneum. This was followed by early return to normal activity. CONCLUSION: Therefore, use of Room Air for pneumoperitoneum is safe and affordable. It is recommended for low resource settings.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  509 0 2
High voltage electrical injuries in the University of Calabar Teaching Hospital
IA Ikpeme, ME Asuquo, I Okereke-Okpa
June 2008, 11(2):166-169
BACKGROUND: Burn injuries are a common presentation in Nigerian hospitals and result from a variety of causes. Recently, many have resulted from Petroleum related fire incidents. High voltage electrical injuries are relatively rare; lightning strikes even rarer. In traditional societies where Traditional medicine practitioners are usually the first to be contacted and where late presentation to hospitals is the rule, complications such as the wet gangrene necessitating amputation are common. Even when patients present relatively early and are resuscitated and treated, complete prosthetic rehabilitation is difficult because of poverty and lack of social support systems. CASE REPORT: This review presents three cases of high voltage electrical burns resulting from typical 11KVA burns as well as lightning strike. It also highlights the role of prompt presentation in a health facility with appropriate resuscitation in determining good treatment outcomes.
[ABSTRACT]   Full text not available     [PubMed]
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Reasons for preference of delivery in spiritual church-based clinics by women of south-south Nigeria
EJ Udoma, AD Ekanem, AM Abasiattai, EA Bassey
June 2008, 11(2):100-103
OBJECTIVES: To investigate the various reasons for patronizing the spiritual church-based clinics by women from South-South Nigeria. DESIGN: Forty seven spiritual church-based clinics were studied between 1st February 2003 and 31st July 2003. SETTING: Forty seven spiritual church-based clinics in both Akwa Ibom and Cross River State in South-South Nigeria. PATIENTS: Two thousand and sixty three pregnant women who were regular attendants of the spiritual church-based clinics. RESULTS: Various reasons for preferring church delivery included: Spiritual protection against satanic attacks and safe delivery in 975 (36.8%) lack of funds in 629 (30.5%), harsh attitude of health workers in 249 (12.1%), convenience in 212 (10.3%), faith in God and previous delivery in church 83 (4.0%) each help and good care guaranteed in 48 (2.35). CONCLUSION: It is suggested that the spiritual churches with interest in obstetric care establish properly staffed and well equipped health clinics as an annex to the church.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  468 0 3
Early postnatal growth of preterm low birth weight, appropriately-sized infants
OF Njokanma, MT Egri-Okwaji, JO Babalola
June 2008, 11(2):104-110
BACKGROUND: Postnatal growth monitoring is useful in assessing the health ofpreterm babies but their growth patterns have not been sufficiently studied in Africans. AIM: To describe the growth achievements ofpreterm, low birth weight, appropriately-sized, Nigerian infants. STUDY DESIGN: The subjects were prospectively recruited from two centers Olabisi Onabanjo University Teaching Hospital (January 1994 to June 1995) and Havana Specialist Hospital (June 1995 to June 1997). The weight, length and occipito-frontal circumference of 89 preterm, low birth weight, appropriate-for-dates infants were monitored from birth until 53 post-conceptual weeks. Growth velocities were compared with 46 term infants. RESULTS: Initial weight loss, age at regaining birth weight and growth rate in the early postnatal weeks were inversely related to gestational age. Subsequent weight gain was directly related to gestational age. Between birth and 40 weeks post conception, growth rates for different gestational age groups were 129 to 207 g/week (weight), 0.78 to 0.93 cm/week (length) and 0.62 to 0.65 cm/week (head circumference). After 40 weeks, the corresponding rates were 188 to 238 g/week, 0.86 to 0.96 cm week and 0.48 to 0.50 cm/week, respectively. Head growth demonstrated a faster catch-up than weight and body length in that order. The observed growth rates were slower in some respects than Caucasian figures but faster than reported for the Japanese. CONCLUSION: Study subjects had growth patterns within previously defined ranges. The better profile of western babies is probably related to better infrastructure while the advantage over Asian babies is probably racial.
[ABSTRACT]   Full text not available     [PubMed]
  461 0 -
Hepatitis C virus infection in Nigerians with diabetes mellitus
SC Nwokediuko, JM Oli
June 2008, 11(2):94-99
BACKGROUND/AIMS: Studies from mainly Caucasian populations have shown epidemiological evidence of an association between diabetes mellitus and Hepatitis C virus (HCV) infection. The aim of this study was to determine whether any such association exists in a blackAfrican population with diabetes mellitus. METHOD: This was a cross sectional study of consecutive diabetic patients seen at the diabetes clinic of the University of Nigeria Teaching Hospital Enugu, Nigeria between September 1, 2004 and April 30, 2005. Patients who underwent upper gastrointestinal endoscopy during the same period for dyspeptic symptoms were used as controls after matching for age and sex. Structured questionnaire on risk factors for HCV infection was administered to the participants. Blood test for HCV antibodies was carried out on the diabetic patients as well as the control subjects. RESULTS: Out of 191 diabetic patients, 27(14.1%) were HCV antibody positive compared to the control group in which 5 out of 134 (3.7%) subjects had HCV antibodies (p = 0.0046). CONCLUSION: Hepatitis C virus infection is more common in Nigerian patients with diabetes mellitus than in control subjects. The nature of the association between diabetes mellitus and HCV infection remains to be elucidated.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
  459 0 3
Salvaging twin 2 after abortion of twin 1 : a case report
JU Onakewhor, O Ohiosimuan, AN Onyiriuka
June 2008, 11(2):155-157
We present intentional delayed delivery of twin 2 after a spontaneous membrane rupture and abortion oftwin1 in a dichorionic twin pregnancy at 14 weeks. As signs of infection were missing, we adopted a conservative (not expectant) management. The pregnancy was prolonged to 35 weeks' gestation. In the absence of additional risk factors, the role of conservative management of multiple pregnancies after loss of one fetus in prolonging the pregnancy to fetal viability in resource-poor setting is highlighted. The gained gestational age of 20 weeks and 4 days (144 days in all), for the remaining fetus and the healthy mother and child pair after delivery at 35 weeks are discussed. The perinatal, economic and psychological implications are highlighted. The importance of good clinical assessment in the diagnosis of cervical incompetence and using ultrasound scan as a complimentary instrument is emphasized.
[ABSTRACT]   Full text not available     [PubMed]
  451 0 -
Antibiotic-associated pseudomembraneous colitis in a Nigerian--case report
JA Otegbayo, OA Oluwasola, A Akere, SO Lawal
June 2008, 11(2):172-173
Full text not available    [CITATIONS]  [PubMed]
  325 0 1
Use and misuse of mobile phone in hospitals
GA Rahman
June 2008, 11(2):174-175
Full text not available     [PubMed]
  282 0 -
Strategies to improve patients follow-up in developing countries
B Ekele
June 2008, 11(2):176-176
Full text not available    [CITATIONS]  [PubMed]
  201 0 1