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   2009| September  | Volume 12 | Issue 3  
    Online since November 30, 2010

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Emergency obstetrics care in a Nigerian tertiary hospital : A 20 year review of umblical cord prolapse
B Bako, C Chama, BM Audu
September 2009, 12(3):232-236
CONTEXT: Umbilical cord prolapse is an obstetric emergency associated with high perinatal morbidity and mortality unless prompt delivery by the fastest and safest route is carried out. OBJECTIVES: To determine the incidence of umbilical cord prolapse, predisposing factors, and fetal outcome. STUDY DESIGN, SETTING AND SUBJECTS: A 20 year retrospective study of all women who presented with umbilical cord prolapse at University of Maiduguri Teaching Hospital, Maiduguri, North-Eastern Nigeria. RESULTS: During the study period there were 27,753 deliveries and 75 women had cord prolapse, giving the incidence of 1 in 370 deliveries (0.27%). Significantly more patients with non vertex presentation, twins and preterm delivery had cord prolapse. The highest occurrence was in those with unengaged presenting part (65.2%), spontaneous rupture of membrances (62.1%) and grandmultiparous women (57.6%). Caeserean section was carried out in 50% of cases, with mean decision-delivery interval of 77.1 +/- 21.7 minutes and 28/33 (84.9%) of babies delivered within 60 minute had normal Apgar scores. The Knee-chest position was most commonly used method of alleviating cord compression while arrangement for caesarean section was being made. The perinatal mortality was 27.3%. CONCLUSION: umbilical cord prolapse is a brisk obstetric emergency with high perinatal morbidity and mortality unless prompt delivery is undertaken. Better communication and prompt response to emergency by the theatre team to reduce the decision-delivery interval would improve the perinatal outcome.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
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A study of the pattern, management and outcome of penetrating colon injuries in Sagamu
AO Tade, LO Thanni, BA Ayoade
September 2009, 12(3):284-288
BACKGROUND: Colon injuries are increasingly being treated safely by primary repair in spite of the high risk of septic complications. OBJECTIVE: This is a retrospective study of the pattern, management and outcome in patients treated for penetrating colon injuries at Olabisi Onabanjo University Teaching Hospital, Sagamu over a 7 year period (January 1995-December 2001). PATIENTS AND METHODS: Records of thirty-two patients were studied. RESULTS: Gunshots (75 percent) and knife stabs (18.75 percent) accounted for ninety-four percent of penetrating colon injuries. Associated intra-abdominal injuries were present in 22 patients (68.8 percent). Eight (twenty-five percent) patients presented in shock. Moderate to major faecal contamination was present in 30 (93.8%) patients. Severe colon injury occurred in nine patients. The eighteen patients with right colon wounds were managed by primary repair. All the fourteen patients with left colon wounds had a diverting colostomy alongside repair or resection. Complications included wound infection (56.7 percent) and septicaemia (31.7 percent). Eleven patients died, giving an overall mortality rate of 34.4 percent. Mortality was significantly associated with shock on admission (p<0.02), degree of faecal contamination (p<0.05) and severity of colon injury (p<0.01). Colostomy did not affect mortality. (P<0.1). CONCLUSION: In this study primary repair was employed in 56% of patients with penetrating colon injuries. The routine use of diverting colostomy for all left colon injuries can no longer be justified in current surgical practice as colostomy did not affect mortality.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
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High caesarean section rate : a ten year experience in a tertiary hospital in the Niger Delta, Nigeria
GO Igberase, PN Ebeigbe, BO Andrew
September 2009, 12(3):294-297
BACKGROUND: Caesarean section rate is rising worldwide and Nigeria is no exception. METHODS: This was a descriptive study. The data from case notes, antenatal and theatre records of patients who had caesarean delivery over a ten year period in the Baptist medical center, Eku were extracted and analysed. RESULTS: The total delivery for the period under study was 5,153 and the total number of caesarean deliveries was 1,777 giving a caesarean section rate of 34.5%. There was no definite trend in the yearly caesarean section rates. Majority of the cases were aged 25-29 (32%). Grandmultipara constituted 26.4% of the patients while 70.1% of cases presented at a gestational age range of 37-42 weeks. Majority of the patients (59.5%) where unbooked for antenatal care. Dystocia (27.1%) was the commonest indication for caesarean section. Emergency abdominal delivery constituted 63.3% of cases while the common complications included wound breakdown, anaemia and endometritis. There were a total of 25 maternal deaths giving a case fatality rate of 1.4%. The leading causes of deaths were haemorrhage (36%), infections (24%), severe preeclampsia/eclampsia (24%), cardiac arrest (12%) and anaesthesia related complication (4%). CONCLUSION: This study found a very high caesarean section rate with majority of cases presenting as unbooked emergency cases. High caesarean section rate in this region was due to increase in primary caesarean delivery for dystocia, elective repeat caesarean deliveries and caesarean deliveries for preeclampsia/eclampsia. Future studies should be extended to rural areas and be targeted at determining whole population Caesarean section rates.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
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Maternal and fetal outcomes of jaundice in pregnancy at the University College Hospital, Ibadan
A Oladokun, JA Otegbayo, AA Adeniyi
September 2009, 12(3):277-280
OBJECTIVE: This study is aimed at determining pregnancy outcome of cases of jaundice in pregnancy over a 10 year period at the University College Hospital, Ibadan. METHODOLOGY: All case records of patients with jaundice in pregnancy over a 10-year period from 1st January 1992 through 31st December 2001 were retrieved from the medical records office of the hospital and analysed. RESULTS: During the ten-year study period, there were 16,566 registered pregnancies in the hospital, and 52 cases of jaundice in pregnancy were seen, giving an overall incidence of 0.3% or 1 in 318 deliveries. However, 48 case records were retrievable. Viral hepatitis was the commonest cause accounting for 58.3% of cases. It was followed by malaria and sickle-cell anaemia with 20.8% and 16.7% respectively. Other causes include sepsis 14.6%, cholestasis 6.3%, and Pre-eclampsia 2.1%. Preterm delivery occurred in 39.6%, while intrauterine fetal death (IUFD) occurred in 8.3% of cases, all occurring in the third trimester. A case of early neonatal death was recorded. There was no maternal death and the mean hospital stay was 18 days (range 4-45 days) during admission. CONCLUSION: Viral hepatitis, malaria and sickle-cell anaemia are the leading causes of jaundice in pregnancy. These should be promptly diagnosed, investigated and appropriate management instituted as most of the perinatal deaths can be avoided by close fetal monitoring especially in the third trimester and with recourse to early delivery before fetal demise occurs.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
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Experience with rigid esophagoscopy in Jos, north-central Nigeria
AA Adoga, AS Adoga, OG Nwaorgu
September 2009, 12(3):237-239
OBJECTIVE: Esophagoscopy which may be done for either a therapeutic or diagnostic reason has remained useful in the management of esophageal diseases. This study evaluates our experience with rigid esophagoscopy with special emphasis on esophageal foreign bodies in our unit. METHOD: This is a six-year (January 2000-December 2005) retrospective review of cases of rigid esophagoscopy in the Ear, Nose and Throat Unit of our center. RESULTS: Fifty-seven patients with ages ranging from 10 months 75 years were studied. There were 35 (61.4%) males and 22 (38.6%) females. Fifty-three of the patients (93%) had varying foreign bodies in the esophagus, 3 (5.2%) patients had carcinoma of the esophagus while 1 (1.8%) had pharyngeal pouch. The 0-10 year age group had the highest prevalence of esophageal foreign bodies (66.0%) with the middle third of the esophagus been the commonest site of impaction (58.5%). There was no fatality recorded. CONCLUSION: Rigid esophagoscopy is a relatively safe procedure in trained hands and ideal environment with the necessary facilities in place.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
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Male involvement in family planning : women's perception
AR Nte, N Odu, CE Enyindah
September 2009, 12(3):306-310
OBJECTIVES: To assess the knowledge of mothers of under-five children brought to immunisation centres of contraceptive methods applicable by males and their perceptions of the roles of males in family planning. SUBJECTS AND METHODS: This cross-sectional descriptive study involved a questionnaire interview of mothers who came to immunise their children at five public immunisation centres in Port Harcourt. Data entry and analysis employed EPI-Info version 6. RESULTS: Amongst the 558 mothers interviewed, the contraceptive prevalence rate was 5.6% and 85.6% of them knew at least a family planning method for males. About 15.8% would depend on their spouses for choice of contraceptive methods and 52.7% would discontinue family planning if their spouses objected. About 33.5% of the spouses had used some form of contraception while only 22.1% of the females recognised that male involvement could impact on the acceptance rate of family planning services. Despite their knowledge of safe child spacing, about 53% of the respondents delivered within shorter intervals and had significantly more pregnancies/children that they would have had if they were in 'control' of their reproductive health decisions. The spouses, despite being significantly older, more educated, with higher level jobs, and in-charge of the reproductive health decision in the home, did not contribute to the knowledge of the women and their practices of family planning. CONCLUSION: Despite the advantaged position of males in family matters, their roles in family planning remains largely unutilised. If the acceptance of family planning must improve, males should also be targeted by family planning programmes.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
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Papillary adenocarcinoma of thyroid in a patient with right submandibular mass--a rare case of 'lateral aberrant thyroid'
JM Adotey
September 2009, 12(3):333-334
BACKGROUND: Ectopic thyroid is a rare entity in the study of thyroid disease. The occurrence of ectopic thyroid tissue as a mass in the submandibular region is even rarer. AIM: To report a case of papillary adenocarcinoma of thyroid within a right submandibular mass in a 67-year-old man. Additionally this is to alert doctors on the possibility of the condition and re-emphasize the need for proper and thorough histologic investigation. METHOD: The case notes of the patient, who had presented a year earlier with right submandibular mass, were retrieved and studied. At the initial presentation chest radiograph and assessment of the oropharynx by an otorhinolaryngologist were carried out. Full blood count, erythrocyte sedimentation rate (ESR) and fine needle aspiration biopsy (FNAB) were done at the second presentation. An ultrasound scan of the neck and repeat chest radiograph were also performed. RESULTS: The right submandibular mass had increased in size about 10-fold by the time the patient was seen 13 months later. The chest radiograph and oropharyngeal examination were normal. The neck ultrasound scan demonstrated the presence of a solid right submandibular mass. The FNAB showed papillary adenocarcinoma of the thyroid. He declined a near-total thyroidectomy and demanded nonsurgical treatment. Low dose L-thyroxine (0.1 mg) daily was started and referred to another centre for possible radioactive iodine treatment. This latter treatment could not be given because of lack of facilities. Follow-up review in 3 months showed that the patient was only on L-thyroxine therapy and his clinical condition had deteriorated. He was subsequently lost to follow-up. CONCLUSION: This patient illustrates the even rarer case of a 'lateral aberrant thyroid' presenting as a malignant submandibular mass. It is probably the latest addition to the rather rare number of such cases in the literature. Doctors should be aware of the possibility of the condition and the need for proper an d thorough histologic investigation is re-emphasized.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
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Indications for spirometry at a tertiary hospital in south east, Nigeria
CC Onyedum, CJ Chukwuka
September 2009, 12(3):229-231
BACKGROUND: Spirometry evaluation of ventilatory functions plays a critical role in the diagnosis, differentiation and management of respiratory illness such as asthma, chronic obstructive pulmonary disease and restrictive lung disorders. It appears to be underutilized especially by most primary care physicians. AIM: This study was aimed at determining the indications for spirometry at a tertiary health institution in Nigeria and to determine the source of referral of the patients. METHODS: Clinical and anthropometric data of all subjects who underwent spirometry at the University of Nigeria Teaching Hospital, Enugu, Nigeria over a three year period were retrieved from the records book and analyzed to determine the sex distribution, age distribution, indication for the procedure, and source of referral. RESULTS: A total of fifty two patients had the procedure over a three year period (Jan 2004-Dec 2006). The male to female ratio was 1: 1.08. Their ages ranged from 5 to 85 years of age with a mean age of 42.3 +/- 20.50 years. The commonest indication for spirometry during the study period was Bronchial asthma followed by Chronic Obstructive Pulmonary disease (COPD). Most of the patients were referred by the respiratory unit performing the procedure followed by the surgical units and no referral came from the neighbouring peripheral hospitals. CONCLUSION: Bronchial Asthma is the commonest indication for the use of spirometry. There is poor referral from the peripheral primary care centers. Primary care general physicians and surgeons should be encouraged to use of spirometry.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
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Giant fibrosarcoma prostuberans of abodominal wall : Management problems in resources-constrained country
TO Chukwuanukwu, SN Anyanwu
September 2009, 12(3):338-340
BACKGROUND: Abdominal wall sarcomas represent less than 1% of adult malignancies. Dermatofibrosarcoma protuberans can grow to very large sizes and the recommended resection 2-3 cm from the macroscopic tumour margin can produce very large full thickness defects of the abdominal wall. Reconstruction of such defects can be quite challenging in resource constrained areas where patients present late with giant lesions. OBJECTIVE: To highlight the presentation and management challenges faced by the surgical oncologist and reconstructive surgeon in a resource constrained country when faced with giant Dermatofibrosarcoma protuberans of the abdominal wall. METHODS: Prospective study of patients with abdominal wall soft tissue sarcoma presenting to the authors. Cases of giant dermatofibrosarcoma protuberns who underwent surgery were analysed. RESULTS: Seven cases managed over an eight year period (January 2000 to December 2007). Age ranged from 27-70 yrs with slight female preponderance 1.5:1 F:M. Three presented with recurrent fungating masses. Only one could be reconstructed with prolene mesh. One recurrence was noted during the period under study. CONCLUSION: Poverty, ignorance and lack of necessary working tools are major challenges faced by the surgical oncologist and reconstructive surgeon in resource constrained areas and pose a major obstacle to the control of cancer in these areas.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
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Knowledge and practice of cervical cancer screening using Pap smear among women attending antenatal clinic at Aba, south-eastern Nigeria
S Onwere, O Okoro, B Chigbu, A Onwere
September 2009, 12(3):341-342
Full text not available    [CITATIONS]  [PubMed]
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Daycase laparoscopic gynaecological procedures--current trends in anaesthetic management
BO Onajin-Obembe
September 2009, 12(3):311-318
Laparoscopy for gynaecological procedures is minimally invasive and is mostly performed as a daycase. The advancement of laparoscopy and minimal access surgery has greatly influenced the evolution of anaesthetic techniques. Preoperative assessment can be simplified by the use of questionnaires in pre-assessment clinics. Intraoperative intravenous fluid administration improves patient well being while airway management can be by the age-old, tried and trusted orotracheal tube or by the newer laryngeal mask airways. The use of propofol as an induction agent, a short acting non-depolarizing muscle relaxant e.g. mivacurium, an inhalational anaesthetic agent with a fast wake up time e.g. sevoflurane or desflurane, and short acting opioids e.g. fentanyl guarantees quick recovery of patients. The trend towards a multimodal approach to postoperative pain and prevention of postoperative nausea and vomiting (PONV) improves postoperative profile of day case gynaecological patients. Expertise in providing a pneumoperitoneum with carbon dioxide is desirable even as other options for lifting the abdominal wall are being investigated.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
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Complications of unsafe abortion : case reports and the need for curriculum review in Nigeria
AV Umoh, AJ Umoiyoho
September 2009, 12(3):321-323
Unsafe abortion remains a major reproductive health problem in Nigeria. These are 2 case reports of unsafe abortion, one performed by a patent medicine dealer where a false passage was created in the substance of the cervix to evacuate the uterus using a cannula. A piece of the cannula was left in situ for five years leading to chronic infection and infertility. The second case was performed by a medical practitioner for a second trimester abortion. He deliberately created a false passage in the substance of the cervix to evacuate the uterus leading to severe haemorrhage. We conclude that there is a need to review and improve the training of medical practitioners in termination of pregnancies to avoid unsafe abortion.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
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Heterotopic pregnancy at term masquerading as intrauterine twin gestation, a case report
JH Kigbu, AS Sagay, PM Chingle
September 2009, 12(3):324-326
A case of combined intrauterine and abdominal pregnancies in a 29-year-old primigravida occurring in a natural cycle is presented. She booked for routine antenatal care in the obstetric unit of the hospital. An early scan at 10 weeks showed a twin gestation (diamniotic, dichorionic placentation). She was admitted between 10-21 weeks on account of severe hyperemesis gravidarum and anaemia in pregnancy. She was managed with antiemetics, intravenous fluids and two units of blood transfused before discharge for follow up in the antenatal clinic. Pregnancy was uneventful between 22 weeks to 38 weeks when she had elective Caesarean section on account of twin gestation, primigravida and borderline pelvis. At Caesarean section a combined intrauterine and abdominal pregnancies were found. She was delivered of first twin (intrauterine), a baby boy weighing 2.5 kg with Apgar scores of 8 and 9 in 1 and 5 minutes respectively; second twin (abdominal) a baby boy weighing 2.7 kg with Apgar scores of 8 and 9 at 1 and 5 minutes respectively.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
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Upper gastrointestinal tract bleeding in Ilorin, Nigeria - A report of 30 cases
AB Olokoba, LB Olokoba, AA Jimoh
September 2009, 12(3):240-244
BACKGROUND: Upper gastrointestinal tract bleeding refers to blood loss within the intraluminal gastrointestinal tract from any location between the upper oesophagus to the duodenum at the ligament of Treitz. The onset and severity of blood loss varies widely. Acute gastrointestinal bleeding is a potentially life-threatening abdominal emergency that remains a common cause of hospitalization. There is no local data on the clinical presentation, endoscopic findings and the risk factors for upper gastrointestinal tract bleeding in Ilorin. This study was therefore to review the cases of upper gastrointestinal tract bleed in Ilorin. AIM: To review the cases of upper gastrointestinal tract bleeding seen in Ilorin. METHODOLOGY: A retrospective review of the cases of upper gastrointestinal tract bleeding who had upper gastrointestinal tract endoscopy as part of their workup was undertaken to cover a eighteen month period from June 2006 to November 2007. Their clinical presentation, endoscopic findings, and the risk factors which predisposed them to bleeding were evaluated. The endoscopy register and the request forms were reviewed. RESULTS: A total of thirty patients had upper gastrointestinal tract bleeding for which upper gastrointestinal tract endoscopy was performed during the period under review. Twenty-three of the patients were males (76.7%) while seven were females (23.3%). Sixteen patients (53.3%) presented with malaena only; eleven patients (36.7%) with malaena and haematemesis only; while three patients (10.0%) presented with malaena, haematemesis and haematochexia. However all the patients presented with malaena, haematemesis or haematochexia. The commonest clinical presentation of patients with upper gastrointestinal tract bleeding passage of malaena (53.3%). The commonest endoscopic finding was multiple sources of bleeding (66.7%) while the commonest risk factor for upper gastrointestinal tract bleeding was NSAID use (36.7%). CONCLUSION: The passage of malaena, multiple source of bleeding, and NSAID use are the commonest clinical presentation, endoscopic findings and risk factors respectively in patients with upper gastrointestinal tract bleeding in Ilorin. The spectrum of clinical presentation, endoscopic findings and risk factors for upper gastrointestinal tract bleed found in this study is similar to that found by other workers.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
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Family planning practice in a tertiary health institution in north-western Nigeria
AY Isah, EI Nwobodo
September 2009, 12(3):281-283
BACKGROUND: Family planning in our environment had remained a delicate issue that is still reluctantly being accepted based on religious belief and the perception that it is synonymous with population control. OBJECTIVE: This study was carried out with the objectives of identifying the characteristics of contraceptive acceptors in our family planning unit, their source(s) of information and methods of preference among others. MATERIALS AND METHODS: The record cards of all clients who attended the family panning clinic between January 1st 1998 and December 31st 2002 as well as the theatre records of patients that had bilateral tubal ligation (BTL) during the study period were reviewed. Relevant information on biodata, reasons for family planning, methods of choice and reasons for discontinuation were extracted and analysed. Comparative percentage was used for the analysis. RESULT: A total of 839 clients requested and were served with contraceptives during the study period with an acceptor rate of 167.8/annum.Over 75% of the acceptors were Muslims. The main reason for selecting family planning services was for child spacing (84.9%) with only 12% requiring the service to end the reproductive carrier. Antenatal/postnatal clinics were their main source(s) of information about family planning services. CONCLUSION: The study revealed that the practice rate of family planning in this community is still low. Female education, use of religious/traditional leaders along with improved dissemination of information using the mass media may go along way to increase contraceptive up take.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
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A baseline study of drug prescribing practices in a Nigerian military hospital
ET Adebayo, NA Hussain
September 2009, 12(3):268-272
BACKGROUND: In many developing countries, drug costs form an important portion of government and household expenditure. Also, improper use of drugs is a major health hazard and increases treatment costs. However, while the problem of irrational use of drugs is worldwide, it has not been adequately studied especially in developing countries such as Nigeria. Military facilities provide health care services to an important segment of both the military and civil population. METHODS: The aim of this study was to evaluate drug prescribing practices at a Nigerian military hospital (Military Hospital, Ikoyi, Lagos) and to make recommendations for its improvement. Using WHO rational drug use (RDU) criteria, prescribing and facility care indicators were studied using case notes of general out patients seen between March 2006 and February 2007. Also, a knowledge, attitude and practice (KAP) study of prescribers and dispensers at the hospital to complement the study of indicators was also undertaken. RESULTS: Based on systematic sample of 180 case notes collected over the study period, the average number of drugs per encounter was higher (3.0 +/- 1.5) than other African values. Also, 43.8% of drugs were prescribed using their generic names which is low. A high number of patients were prescribed antibiotics (27.8%) and injections (23.9%). From the KAP study of 29 respondents, only one (3.4%) was not aware of the existence of the Essential Drug List (EDL) while 50.0% claimed ownership of a copy of the EDL. Few (13.9%) respondents, could accurately detail the 5 steps in issuing a prescription. CONCLUSION: This study revealed gaps between the actual level of knowledge of prescribers/dispensers about RDU and actual practice. The need for further studies and focused interventions are outlined.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
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Relationship between age and serum lipids in malnourished and well-fed pre-school children in Zaria, Nigeria
SA Akuyam, HS Isah, WN Ogala
September 2009, 12(3):273-276
OBJECTIVE: The objective of this study was to evaluate the relationship between age and serum total cholesterol (TC) and triglyceride (TG) in malnourished and well-fed pre-school Nigerian children in Zaria, northern Nigeria. MATERIALS AND METHODS: Serum total cholesterol (TC) and TG concentrations were measured in 115 malnourished and 115 age- and gender-matched well-fed children aged one (1)-three (3) years. These consisted of 25, 30, 30 and 30 children with kwashiorkor, marasmic-kwashiorkor, marasmus and underweight, respectively with their corresponding age- and gender-matched well-fed children. There were 60 males and 55 females each of malnourished and well-fed children. Concentrations of TC and TG were measured by enzymatic colorimetric method using reagent kits supplied by HUMAN, Gesel Für Biochemical Und Diagnostica mbH (Wiesbaden, Germany). RESULTS: There was no correlation between age and serum TC in malnourished children (r = 0.0101, p = 0.9250), while the correlation was negative and significant in well-fed children (r = 0.3599, p = 0.3110). Similarly, there was no correlation between age and serum TG in malnourished chidren (r = 0.0605, p = 0.4623) but negative and significant correlation in well-fed children (r = 0.3210, p = 0.0001). CONCLUSION: The findings of this study demonstrate that in well-fed pre-school children, serum lipids decrease with advancing age and that this pattern was abolished in malnourished children. This contribution should be noted and considered when interpreting serum lipid results in children.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
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Mortality predictors in community-acquired pneumonia
MO Tanimowo
September 2009, 12(3):298-301
OBJECTIVE: To determine mortality predictors among patients admitted for community-acquired pneumonia to the medical wards of Ladoke Akintola University of Teaching Hospital between Jan. 2003 and Dec. 2005. METHODS: The case notes of 65 patients admitted for community-acquired pneumonia were studied with respect to their admission Pneumonia Severity Index (PSI) (Score) and functional class. The duration of admission, side of lung affected on chest X-ray, co-morbid illness and outcome were also noted. RESULTS: The mean Pneumonia Severity Index score for patients who were discharged and those who died was 65.48 +/- 32.6 and 95.47 +/- 32.9 respectively (P<0.05). Bedridden patients have higher mortality than patients who walked without problems on admission (P<0.05). The mean duration of admission of discharged patients was 9.5 +/- 8.9 days while that of patients who died was 4.82 +/- 2.7 days (P<0.05). The side of lung involvement of chest X-ray does not seem to affect mortality (P>0.05). Sixteen co-morbid illnesses were identified. CONCLUSION: The Pneumonia Severity Index score remains an important mortality predictor in patients with community-acquired pneumonia, but there is need to widen its scope to include functional class, duration of admission, and locally important co-morbid illnesses.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
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Sensitivity pattern of bacterial isolates in childhood sepsis in clinical practice at Onitsha
EO Obidike, G Anigbo, C Igbodo
September 2009, 12(3):302-305
OBJECTIVE: To determine the commonest organism cultured from the blood of children suspected to have bacterial sepsis and their antibiogram sensitivity using the commonly used antibiotics in a private practice and see if there are differences from established data from other areas. METHOD: Children beyond neonatal age presenting to a children's specialist hospital in southeast Nigeria over a 2 year period with fever and other features of systemic inflammatory response syndrome (SIRS) thought to be due to bacterial infection (but without focal point of infection) had their blood cultures done. A review of their case notes and an analysis of their blood culture and antibiogram sensitivity results was done. RESULTS: Fourteen cases fitted the criteria and were analysed. Staphylococcus aureus was the commonest organism and of the profiled antibiogram the sensitivity pattern showed that ciproxin, gentamycin, chloramphenicol and erythromycin were the best. CONCLUSION: Staphylococcus aureus is still a major cause of childhood bacterial sepsis. Gentamycin and erythromycin are safe and useful antibiotics in their treatment and are recommended.
[ABSTRACT]   Full text not available    [CITATIONS]  [PubMed]
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The cervical smear pattern in patients with chronic pelvic inflammatory disease
MA Abdul, SO Shittu, JA Randawa, MS Shehu
September 2009, 12(3):289-293
BACKGROUND: Cancer of the cervix is the commonest malignancy of the genital tract in Nigeria. In an atmosphere of opportunistic screening due to lack of a national screening programme, studies are needed to determine patients at risk of premalignant lesions of the cervix. GOAL: To determine cervical smear pattern in patients with chronic pelvic inflammatory disease and investigate the potential of chronic pelvic inflammatory disease as a risk factor to cervical dysplasia. STUDY DESIGN: Case-control study. SETTING: Department of Obstetrics and Gynaecology, Ahmadu Bello University Teaching Hospital Zaria, Nigeria. SUBJECTS: Three hundred and sixty-nine premenopausal women attending the gynaecologic and family planning clinics of Ahmadu Bello University Teaching Hospital Zaria, Nigeria from January to December 2000. RESULTS: Of the 369 women that had cervical cytology by Pap smear, 163 (44%) had chronic pelvic inflammatory disease (cases) while 206 (56%) were non chronic PID patients (control). There was no statistical significance in the mean age between the two groups. The mean age at first coitus and marriage of all the women were 17.92.7 years and 18.5 3.4 years respectively. There were 52 dysplastic smears encountered, giving a prevalence rate of 140/1,000 or 14% for Cervical Intraepithelial Neoplasia. There were higher cases of dysplasia in the chronic PID group than in the control and this differences was statistically significant (p<0.05). Other risk factors to dysplasia identified include high parity (>4) and age of first coitus less than 20 years. Only 10% of all the women screened were aware of both cervical cancer and Pap smear. CONCLUSION: Women with chronic pelvic inflammatory disease are probably at higher risk of developing cervical dysplasia than women without chronic pelvic inflammatory disease. Cervical cancer screening programmes should be intensified in chronic pelvic inflammatory disease patients. However, further studies are needed in our setting to verify the association between pelvic inflammatory disease and cervical dysplasia.
[ABSTRACT]   Full text not available     [PubMed]
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Limb amputations in adults in an Ivorian teaching hospital
JB Sié Essoh, M Kodo, V Djè Bi Djè, Y Lambin
September 2009, 12(3):245-247
OBJECTIVE: To determine the pattern of limb amputations and preventable indications. DESIGN: Aretrospective study. SETTING: Department of orthopaedic surgery, Yopougon Teaching Hospital, Abidjan, Côte d'Ivoire. PATIENTS AND METHODS: One hundred fifty-six patients with amputations over a 11-year period were studied. There were 111 men and 45 women with a mean age of 42 years. MAIN OUTCOME MEASURES: Indications, level of amputation, morbidity, and mortality. RESULTS: A total of 160 limb amputations were performed in the 156 patients. Trauma (49.9%), diabetic foot sepsis (31.4%), and peripheral vascular disease (13%) were the main indications. Below knee (46.9%) and below elbow (11.2%) amputations were the most common procedures performed. Wound infection was the commonest complication occurring in 42 (26.9%) patients. There were 25 (16%) deaths, out of which 22 were due to sepsis. CONCLUSION: Majority of amputations in our environment are preventable by education, early presentation and appropriate management of the common indications.
[ABSTRACT]   Full text not available     [PubMed]
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A review of caesarean sections associated with perinatal mortality at the University of Ilorin Teaching Hospital, Ilorin, Nigeria
OM Abiodun, OR Balogun
September 2009, 12(3):248-251
OBJECTIVES: To determine the perinatal mortality rate among women who delivered through caesarean section in a tertiary health institution in Nigeria and evaluate how various social and obstetric factors influence the perinatal deaths. METHODS: A review of the clinical records of patients who had caesarean section associated with perinatal death over a 5-year period in the University of Ilorin Teaching Hospital was performed. Socio-demographic and obstetrics data were collected from the record of the patients and their infants for analysis. RESULTS: During the period under review, there were 122 perinatal deaths associated with 923 caesarean sections giving perinatal mortality rate of 132 per 1000 births. Majority (86.1%) of the patients were unbooked and 77.9% had no or low level of education. Nulliparae and grandmultiparae accounted for 88 (72.1%) of the perinatal deaths. Obstructed labour was the indication for caesarean sections in 64.8% of the cases. The stillbirth and early neonatal mortality rates were 80 and 52 per 1000 respectively. Seventy eight per cent of the stillbirths were identified prior to surgery. CONCLUSION: Perinatal mortality rate among patients who were delivered through caesarean section is still high in our center and the women were mostly unbooked, in the extremes of parity, and had no or low level of education. Preventive measures should aim at adequate female education and effective and efficient antenatal coverage.
[ABSTRACT]   Full text not available     [PubMed]
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Potential toxicity of chlorpheniramine plus chloroquine for the treatment of childhood malaria
AD Adedapo, OG Ademowo, KS Adedapo, K Demissie, OY Osinubi
September 2009, 12(3):252-257
OBJECTIVES: To compare the adverse effects of two regimens of chlorpheniramine plus chloroquine (CP+CQ) in children who live in a country where chloroquine resistant malaria is endemic. METHODS: 99 children with acute uncomplicated malaria were randomised into two treatment groups. Group I received high dose chlorpheniramine (6 mg +12 mg/day for 7 days in children = 5 years; 8 mg + 18 mg/day for 7 days in those >5 years) plus chloroquine 10 mg/kg daily for 3 days. Group II received a 50% higher dose of chlorpheniramine plus chloroquine 10 mg/kg daily for 3 days. Outcome measures were vital signs, clinical response and parasite clearance on days 0-7 and day 14. RESULTS: Parasite clearance, fever clearance and cure rate were comparable for the two groups. Drowsiness occurred in 66.7% of high dose and 86.3% of higher dose CP+CQ subjects (p = 0.05). Compared to children treated with high dose, those treated with higher dose CP+CQ had significantly lower respiratory rates on day 2 (p = 0.001), day 6 (p = 0.015), and on day 14 (p = 0.003). CONCLUSION: The higher rates of drowsiness and lower respiratory rates in children treated with higher dose CP+CQ calls for caution in the clinical application of the higher dose combination. The higher dose has no additional benefit and may in fact be dangerous.
[ABSTRACT]   Full text not available     [PubMed]
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Mothers' perception of excessive crying in infancy in south eastern Nigeria
NS Ibeziako, RC Ibekwe, BC Ibe
September 2009, 12(3):258-261
BACKGROUND: Excessive infant crying, though usually benign, can be very troublesome to parents with unwanted consequences on the child. Previous reports had shown cultural and racial differences in it's perception by mothers. We undertook this study to determine the prevalence of excessive crying in our area of practice and also determine associated factors. METHOD: This was a cross sectional, questionnaire based descriptive study on mothers' perception of their infants' crying. Subjects were mother/infant pairs attending the well baby clinics at the Institute of Child Health, University of Nigeria Teaching Hospital, Enugu, Mother of Christ Specialist Hospital, Enugu and the Ebonyi State University Teaching Hospital, Abakaliki. RESULT: Four hundred and eighty mother/infant pairs participated in the study. Seven point nine percent of the mothers reported excessive crying in their infants. There was no significant diurnal variation in the rate of excessive crying among these infants. Educated mothers (P = 0.008) reported excessive crying less frequently than the uneducated ones. Other maternal and infants demographic factors did not have any influence on mothers' perception of excessive crying in their infants. CONCLUSION: Excessive crying among infants is more commonly perceived by uneducated mothers. This group should be identified and counselled about excessive crying to prevent untoward consequences.
[ABSTRACT]   Full text not available     [PubMed]
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Some haematological reference values for pre-primary and primary school aged children in Port Harcourt, Nigeria
DV Dapper, CA Nwauche, IM Siminialayi
September 2009, 12(3):262-267
BACKGROUND: Published reports of haematological reference values for pre-primary and primary school aged residents of Port Harcourt, Nigeria are relatively scanty. AIM: To determine the reference ranges of some haematological parameters for pre-primary and primary school aged children resident in Port Harcourt, Nigeria. METHODS: A total of 250 pre-primary school subjects consisting of 124 males and 126 females aged between 1 to 5 years and 536 primary school children consisting of 262 males and 274 females aged between 6 and 13 years resident in Port Harcourt, Nigeria were randomly recruited into the study. 3-5 ml of venous blood was collected with minimum stasis and the values of the following haematological parameters determined by the indicated methods: Haematocrit was determined using Hawksley micro-capillary tubes centrifuged at 3000 rpm for 10 minutes. Red blood cells, white blood cells [including a differential count] and platelet cells were counted manually using the improved Neubauer counting chamber. Erythrocyte Sedimentation Rate (ESR) was determined using the Westergren method. Haemoglobin concentration was determined by the cyanmethaemoglobin method. RESULTS: The reference ranges for haematocrit, total white blood cell, differential neutrophils and lymphocyte counts, platelet cell counts and erythrocyte sedimentation rates; haemoglobin concentration and red cell counts are presented for male and female pre-primary and primary school children in Port Harcourt. There were no significant gender variations in the values of these parameters in both pre-primary and primary school children. However, primary school subjects, irrespective of sex, were found to have significantly higher values of lymphocyte differential counts and erythrocyte sedimentation rates and significantly lower platelet counts and total white cell counts and differential neutrophils counts compared to their pre-primary school counterparts [p<0.05]. There were no significant differences in the values of haematocrit between the two subject groups; though the values in primary school subjects were marginally higher. CONCLUSIONS: The present study reports values and reference ranges of some haematological parameters for pre-primary and primary school aged children in Port Harcourt, Nigeria; no significant gender variations were observed in these parameters. The results indicate that significant differences exist in the values of some of the haematological parameters under investigation between pre-primary and primary school subjects. This suggests a distinction in the haematological parameters of both populations.
[ABSTRACT]   Full text not available     [PubMed]
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Unsuspected pregnancy at hysterosalpingography : A case report and outcome
AO Akhigbe, O Oyobere, UR Ukah
September 2009, 12(3):327-329
Full text not available     [PubMed]
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Penile fracture at LAUTECH Teaching Hospital, Osogbo
AO Aderounmu, AA Salako, SA Olatoke, AK Eziyi, O Agodinrin
September 2009, 12(3):330-332
BACKGROUND/OBJECTIVE: We have seen three cases of penile fracture presenting in diverse ways in our teaching hospital. We want to highlight the difficulties of management when patients present late. PATIENTS AND METHODS: Three case reports of young men whose ages range between 22-32 years and who presented at 1 year 6 months, four weeks, and 3 hours respectively, following penile fracture. RESULTS: The patient that presented within 3 hours had immediate exploration and primary repair with good results while the one that presented after four weeks is still being followed up. The patient that presented very late has been lost to follow up after he was told that he would require surgery. CONCLUSION: Early surgical intervention in penile trauma still gives the best result and is hereby advocated. Decision to operate or not should also be based on the empirical finding of size of tear if there is no associated urethra injury.
[ABSTRACT]   Full text not available     [PubMed]
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Fatal massive haemoptysis in an African child
MA Alhaji, H Ahmed, HA Umdagas
September 2009, 12(3):319-320
Full text not available     [PubMed]
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Gangrene of the limb complicating Salmonella typhi septicaemia in a Nigerian child
MA Bugaje, LW Umar, MO Ogirima, L Hassan
September 2009, 12(3):335-3377
We report an unusual case of lower limb gangrene in a pubertal boy following a typical clinical presentation of septicaemia due to Salmonella typhi. After an initial response to presumed appropriate antibiotic and supportive therapy, the patient developed tissue ischaemia in both feet. There were no clinical or laboratory evidence suggestive of DIC or coagulopathy. Following conservative management which included oral administration of vitamin C, there was gradual regression of ischaemic changes, progressive healing and recovery of function of the left foot while the condition of the right foot deteriorated with extensive tissue necrosis and dry gangrene that extended to the distal one third of the foot. This necessitated surgical disarticulation of the metatarsophalangeal joints two months after admission. This report is to alert clinicians about this rare complication of a common curable disease with a view to anticipating the possibility of it occurring as well as considering appropriate preventive measures.
[ABSTRACT]   Full text not available     [PubMed]
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Errors on which doctors in Nigeria need to be educated about
MC Asuzu
September 2009, 12(3):343-344
Full text not available     [PubMed]
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