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   2005| January-March  | Volume 12 | Issue 1  
    Online since January 29, 2016

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Basic trauma life support: knowledge of medical students
O Akiode, AA Musa, A Shonubi, FE Lesi
January-March 2005, 12(1):14-17
BACKGROUND: The first hour of management (golden hour) of any trauma patient might be the determining factor if he/she will survive. The first contact most patients have in an emergency room is with a young medical graduate. The knowledge of basic trauma life support (BTLS) by all doctors therefore becomes important. AIMS AND OBJECTIVES: This study set out to assess how much knowledge medical students had about BTLS in their final year compared with their knowledge at the beginning of clinical postings. METHOD: A cross-sectional study of fourth and sixth (final) year medical students to evaluate their knowledge of BTLS using a test of 30 questions under examination conditions. One hundred and twenty-three fourth year students were given a test after a lecture on the care of injured patients. The same test was administered on 41 sixth year students without prior lecture on day of test, having had a similar lecture 2 years before. Data analysis was performed using the SPSS 11.0 for Windows statistical software and EPI INFO version 6.04. RESULT: Mean scores were 25.8 +/- SD1.91 for the 4th year students and 21.0 +/- SD2.93 for the 6th year students. There was a statistically significant difference between scores of the 4th year and the 6th year (P < 0.000001). CONCLUSION: Knowledge was imparted in the 4th year but was forgotten by the 6th year. It is essential that courses in BTLS be given periodically to all medical graduates and all personnel involved in care of the traumatised patient.
[ABSTRACT]   Full text not available   
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Destructive ophthalmic surgical procedures in Onitsha, Nigeria
SN Nwosu
January-March 2005, 12(1):53-56
OBJECTIVES: to determine the incidence, trend and causes for surgical removal of the eyeball at the Guinness Eye Center Onitsha, Nigeria. PATIENTS AND METHODS: Case files and theatre records of all patients who had eviscreration, enucleation or exenteration at the Guinness Eye Center Onitsha between 1995 and 2001 were reviewed. Information on age, sex, disease duration before hospital presentation, indication for surgery and the type of surgery were analysed. RESULTS: 56 eyes of 56 patients were surgically removed. Patients including some with penetrating eye injuries presented late for treatment; 37.5% and 53.5% had used traditional eye medicines (TEM) and eye drops possibly containing steroids, respectively, prior to hospital consultation. The indications for surgery were severe ocular infections, especially panophthalmitis; severe penetrating eye injuries and orbito-ocular tumours. The annual incidence ranged from 1.9 - 4.2% with an average of 3.4% . The downward trend observed in the later part of the study was associated with reduced incidence of ocular gunshot injuries, which in turn coincided with a reduction in violent crime in Onitsha and its environs. CONCLUSIONS: In spite of the observed downward trend in the rate of destructive eye surgery, the incidence of such procedures could be reduced further by timely intervention with modern microsurgical techniques; intraocular antibiotics and radiotherapy. The public should be educated on the harmful effects of TEM and abuse of eye drops. Those with eye problems should seek early hospital treatments.
[ABSTRACT]   Full text not available   
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The effect of training on the reporting of notifiable diseases among health workers in Yobe State, Nigeria
SB Bawa, EA Olumide
January-March 2005, 12(1):1-5
The generation of data through disease surveillance and notification system is critical to appropriate planning and implementation of disease control programmes, outbreak investigation, emergency preparedness and response. Health workers therefore need to be trained, retrained and updated on the principles and practice of disease surveillance and notification. This quasi-experimental study compared a study and control group "before and after" an intervention (training programme) in the study group. The Experimental and control LGA's were selected using a multistage, stratified random sampling technique. Overall, three LGA's were selected and enrolled in each of the groups. In each of the selected LGA's, all functional health facilities and personnel that fulfilled the inclusion criteria were then included in the study. The total number of participants in the experimental and control groups were 73 and 71 respectively at baseline. The proportion of personnel who were aware of the surveillance system increased from 35.6% to 91.9% (p=0.00) and the mean knowledge score increased from 0.85+/-1.38SD to 6.152.64SD (p=0.00) post intervention in the experimental group. The percentage completeness was 2.3% before and 52.0% after (p-0.00), while the percentage timeliness was 0.0% before and 42.9% after (p=0.00) in the experimental group. These statistically significant differences were however not demonstrated in the control group. Training therefore had a positive effect on health personnel knowledge, reporting requirement and the timeliness and completeness of the disease surveillance and notification system.
[ABSTRACT]   Full text not available   
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Arteriovenous fistula for patients on long term haemodialysis in jos, Nigeria
SJ Yiltok, KS Orkar, EI Agaba, OO Agbaji, JN Legbo, EA Anteyi, A Jenrola
January-March 2005, 12(1):6-9
BACKGROUND: The introduction of haemodialysis has prolonged the lives of patients with end-stage-renal disease (ESRD). To maintain them on long-term dialysis, vascular access procedures are required. OBJECTIVES: To describe the experience with arteriovenous fistula (AVF) from a developing country. METHODS: Eighty-two AVF were created in 74 patients on maintenance haemodialysis. They all had side-to-end AVF using prolene 7/0 monofilament suture for anastomoses. RESULTS: There were 55 males and 19 females with a male: female ratio of 2.9:1. The ages ranged from 18 to 70 years with a mean of 43.4 "12.1 years. Most of the AVF created were on the left upper limbs with the radio-cephalic and brachio-cephalic accounting for more than 70% . Eight patients developed thrombosis of the veins used for the AVF and one developed a pseudo aneurysm. CONCLUSIONS: Arteriovenous fistula makes long-term haemodialysis feasible. It can be created easily and has a low rate of complications.
[ABSTRACT]   Full text not available   
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Limb gangrene following treatment of limb injury by traditional bone setter (Tbs): a report of 15 consecutive cases
OE Nwankwo, AU Katchy
January-March 2005, 12(1):57-60
This study is done to evaluate cases of limb gangrene resulting from treatment of limb injury by traditional bonesetter.METHOD: This is a prospective study in which patients with limb gangrene are evaluated as each presents. Data extracted for evaluation include history of having been to a traditional bonesetter, the original injury, type of treatment given by the traditional healer, progression of condition while on treatment and reason for not coming to orthodox orthopaedic centre ab initio for treatment. RESULTS: 15 cases were seen during the 5-year of study spanning June 1997 to May 2002. Upper limbs were involved in 4 cases while 11 involved the lower limbs. The original injuries were 3 cases of soft tissue injury to the joints, 7 closed fractures and 5 open fractures of type I and II. There was associated sepsis and toxemia in all except one. All the cases were treated by amputation. There were 4 deaths. CONCLUSION: Limb gangrene was not a justifiable end-result of treatment in all the cases judging by the nature of the original injury. Reasons for this end result were adduced. The need to avert unnecessary limb loss from mismanagement of limb injury by education of public in general and enlightenment of the traditional bonesetters of the harmful procedures in their practice is highlighted.
[ABSTRACT]   Full text not available   
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A review of the radiological diagnosis of small bowel obstruction using various imaging modalities
AT Kidmas, JE Ekedigwe, AZ Sule, SD Pam
January-March 2005, 12(1):33-36
Radiological investigation is an important tool in the diagnosis of small bowel obstruction (SBO). While plain abdominal radiograph remains the commonest investigation done in SBO, contrast gastrointestinal radiography, ultrasonography (US), computerised tomography (CT) scan -- with or without contrast enhancement are increasingly being advocated particularly in equivocal cases of SBO. We conducted manual, medicine and internet search for relevant literature on diagnosis of SBO using radiological investigations. Plain abdominal radiograph has a diagnostic accuracy for SBO that varies widely from 50 - 92% . Contrast gastrointestinal radiograph in equivocal cases of adhesive SBO can readily differentiate between complete and partial obstruction. Abdominal ultrasound is cheap and readily available. Accuracy of as high as 89% has been reported in experienced hands. CT scan has an added advantage of predicting the site and cause of obstruction. In developing countries like ours, plain abdominal radiography still remains an important diagnostic tool. The role of abdominal ultrasonography needs further evaluation since it is safe, readily available and affordable.
[ABSTRACT]   Full text not available   
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Permanent hypoparathyroidism developing post-thyroidectomy
SA Adebisi, GA Rahman, AK Jimoh, FG Adepoju, OO Goodman
January-March 2005, 12(1):41-44
A case of permanent hypocalcaemia following a subtotal thyroidectomy for a simple multinodular goiter in a 35 year -- old married teacher is presented. This further confirms the need for utmost precaution during thyroid surgery to prevent the damage or inadvertent removal of the parathyroid glands and its consequential complications. It also throws more light on the problem faced in the management of hypocalcaemia vis a vis patient compliance and availability of proper medications in this environment.
[ABSTRACT]   Full text not available   
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Death from ingestion of removable partial denture: a case report
VJ Ekanem, ON Obuekwe, A Unuigbe
January-March 2005, 12(1):65-66
OBJECTIVE: to illustrate the danger of using acrylic denture as removable partial denture in a developing country. METHOD: post mortem examination was performed on a man who died after ingesting removable partial denture. RESULTS: A removable partial denture was seen seated in the mid portion of the oesophagus with its lateral wings deeply embedded in the wall of the oesophagus causing laceration and severe haemorrhage. CONCLUSION: The radiolucent nature of acrylic denture may prevent early diagnosis and intervention when it is ingested or aspirated. There is need for proper education of patients wearing partial denture in especially the acrylic type.
[ABSTRACT]   Full text not available   
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Bile duct stricture -- a sign of things to come?
OO Akute, AO Afolabi
January-March 2005, 12(1):37-40
OBJECTIVE: The aim of the report is to highlight this difficult to-treat condition hitherto uncommon in our environment and warn of the likelihood of more to come with the rising incidence of gallstone in our sub region. PATIENT AND METHOD: A case report of an 18-year-old male undergraduate patient. RESULT: A successful management with clinical, biochemical and radiological evidence (OTC and tubograms) despite inadequate investigative tool. PRINCIPAL CONCLUSION: With the rising incidence of gall stones in our environment, it is imperative that the Trainee Surgeon must be schooled in common biliary surgery and help prevent this dreaded complication (bile duct stricture) and other sequelae of gall bladder surgery. A plea is also made for the provision of essential investigative tool to facilitate management of such cases in recognised centers.
[ABSTRACT]   Full text not available   
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Gene therapy in the management of oral cancer: a review of recent developments
AL Ladeinde, MO Ogunlewe, WL Adeyemo, BO Bamgbose
January-March 2005, 12(1):18-22
AIMS: This article reviews the present body of knowledge regarding the principle, transfer techniques, therapeutic strategies, clinical applications and limitations of gene therapy in the management of oral squamous cell carcinoma. MATERIALS AND METHODS: Scientific publications on gene therapy between 1990 and 2003 were selected for the purpose of the review. These include clinical articles, experimental studies and review articles. RESULTS: Viruses are the commonly used transfer system for the delivery of gene therapy. The viral vectors commonly used are: retroviruses, adenoviruses, herpesviruses, and adenoassociated viruses (AAV). Transfection of cancer cells in vivo with gene therapy is done by intralesional injection, and sometimes by topical application. Phase I and II clinical trials have established the safety and clinical efficacy of gene therapy in the treatment of oral squamous cell carcinomas in humans, especially in combination with chemotherapy or radiotherapy. Phase III clinical trials and studies of the use of gene therapy as an adjuvant following surgery are presently underway. CONCLUSIONS: Gene therapy represents a new and innovative approach to the treatment of oral cancer especially in recurrent disease and adjuvant treatment. Oral squamous cell carcinoma is especially an attractive tumour target due to its frequent genetic mutations and accessibility for intra-tumoural administration of gene therapy. However, gene therapy has not yet been shown to be suitable for systemic delivery in cancer patients, hence the control of regional and metastasis is presently difficult.
[ABSTRACT]   Full text not available   
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Childhood parapneumonic pleural effusion in Enugu
O Tagbo, O Uchenna, H Anthony
January-March 2005, 12(1):28-32
OBJECTIVES: To review the epidemiological pattern and clinical features, management and outcome of childhood parapneumonic pleural effusion in Enugu. METHODS: The records of the children with diagnosis of pleural effusion admitted at the University of Nigeria Teaching Hospital, Enugu between January 1995 and February 2001 were reviewed. RESULTS: Forty out of forty two patients reviewed were analysed. There were 20 males, and 20 females (ratio of 1: 1), with age range of 3 months to 156 months (13 years) and the mean age of 4.99 years. The presenting symptoms were fever in 40 patients (100% ), cough in 38 (97.40% ), dyspnea in 36 (90.00% ), breathlessness in 27 (67.5% ), while, the most common physical sign was pallor. Thirty six children had diagnostic thoracocentesis. Twenty four (55.81% ) yielded pus, out of which, 10 grew organisms on culture; Streptococcus Pneumonia in 3, Staphylococcus aureus in 2, coliforms in 2, Haemophilus influenzae in 1, Proteus mirabilis in 1, Pseudomonas aeruginosa in 1. Nine patients received ampicillin/cloxacillin combination alone; 31 received ampicillin/cloxacillin with other antibiotics, including anti- tuberculous drugs in four children. Thirty-five of the children had thoracotomy, and one later had thoracotomy and decortication. Thirty-seven (92.5% ) were discharged home on recovery. The average admission duration was 24 days. Mortality rate was 7.50%. CONCLUSIONS: In this review, there appears to be an evolving change in epidemiological pattern in comparison with the previous study from this center. There is need to improve on the diagnostic procedure and treatment modalities in order to establish definite criteria for antibiotic use and surgical intervention.
[ABSTRACT]   Full text not available   
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Extramedullary presentation of multiple myeloma in the parotid gland as first evidence of the disease -- a review with case report
ON Obuekwe, NN Nwizu, MA Ojo, PI Ugbodaga
January-March 2005, 12(1):45-48
Myeloma is a neoplasm of plasma cells that causes painful, bone-destructive lesions. It may present as a solitary lesion (plasmacytoma), or involve multiple sites (multiple myeloma). Myeloma may occur in an extraosseous location as a solitary lesion, or less commonly, in combination with multiple myeloma. Oral manifestations may be the first sign or symptom of the disease. Soft tissue plasmacytomas of the head and neck tend to involve the nasal cavity or nasopharynx, rather than the oral cavity. Its occurrence in the parotid gland is rare. We present an unusual case of multiple myeloma with extramedullary involvement involving the parotid gland as first evidence of the disease. Multiple myeloma should be considered in the differential diagnosis of salivary gland swellings.
[ABSTRACT]   Full text not available   
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Effect of acute uncomplicated malaria on platelet counts
MO Kehinde, AE Ohwovoriole, OJ Ekanem, K Odusote, AT Abegunde, A Adeniji, AN Okechukwu, AE Esoimeme
January-March 2005, 12(1):10-13
OBJECTIVE: To determine the effect of uncomplicated malaria on platelet count. PATIENTS AND METHODS: Adult Nigerians (residing in the Lagos metropolis) who were diagnosed as having uncomplicated malaria were treated with a standard regime of chloroquine. Platelet counts were obtained before treatment, Day 0, and again on day 14 when parasitaemia had been cleared in the patients. There were 40 (21 males, 19 females) patients enrolled for the study. Their ages ranged from 15 years to 56 years with a mean +/- SEM of 27. 4 +/- 1.8 years. 28 (14 males, 14 females) patients had both day 0 and 14 platelet counts. RESULTS: The malaria parasite counts ranged from 1020 /mm(3) to 72,000 /mm(3) at day 0 with a mean +/-SEM of 15,638.0 +/- 3,727.0/mm(3) and zero on day 14. The mean platelet count on day 0 was 137.0 +/- 58.4x 10(9)/L while the day 14 mean platelet count was 234.0 +/- 96.9 x 10(9)/L. Comparison of mean platelet counts on day 0 with those on day 14 showed a highly statistically significant difference (p < 0.001). The degree of malaria parasitaemia was not significantly related to the level of platelet count. Transient thrombocytopenia is very common in uncomplicated malaria in semi -immune adults. The mechanism, aetiology, and clinical relevance of the phenomenon deserve further studies.
[ABSTRACT]   Full text not available   
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Neurofibromatosis with malignant transformation presenting as an emergency in a nigerian child: a case report
CN Okoromah, TA Adegbola, OI Ojuola
January-March 2005, 12(1):49-52
Neurofibromatosis is a rare disease, and malignant transformation of this otherwise benign tumor is extremely rare in childhood. In this case report, attention is drawn to childhood neurofibromatosis presenting as a life-threatening triad of malignant transformation, visceral metastasis and upper airway obstruction leading to death in a 9-year-old female Nigerian child. This case report is purposed to draw attention to this condition, mostly reported in adults and to review literature on the disease.
[ABSTRACT]   Full text not available   
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Zygomatic arch reconstruction with autogenous rib bone graft in a post irradiated patient -- a case report
AL Ladehinde, MO Ogunlewe, MO Thomas
January-March 2005, 12(1):61-64
Reconstruction of zygomatic arch using an autogenous free non-vascularised bone graft is presented. The zygomatic arch was resected along with the masseter and part of temporalis muscle following a histologically diagnosed case of chondrosarcoma. She received radiotherapy 3 weeks post-operatively to the site. The resultant facial asymmetry was unacceptable to the patient. She was therefore rescheduled for reconstruction of the zygomatic arch despite the anticipated attendant risk of avascular bed for the graft. Bone grafting was done 44 months post irradiation and the patient had been followed up for 38 months without evidence of rejection. We evaluated other sites of possible bone of similar contour and thickness to the zygomatic arch; we found the rib most suitable, despite the poor quality of rib as graft material, because it is a dense, thick bicortical bone with low proportion of cancellous bone, although it is the second most favoured donor site for free bone graft. The advantages of the rib as a graft are that it presents a contour that could be shaped to fit many defects, it is available in sufficient length up to 12-18 cm to fit large defects, the donor site regenerates when the periosteum is preserved.
[ABSTRACT]   Full text not available   
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Helminthiasis in selected children seen at the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria
VA Wagbatsoma, MS Aisien
January-March 2005, 12(1):23-27
OBJECTIVES: Illiteracy, poverty with associated poor environmental sanitation practices have been implicated in the heavy burden of helminthiasis among children. The objective of this cross-sectional survey is to determine the impact of parents' level of education on the intestinal helminthic status of children. PATIENTS, MATERIALS AND METHODS: All patients, 0-15 years totaling 1030 who visited the communicable disease clinic of the University of Benin Teaching Hospital, Benin City, from October, 2001 to March 2002 were included in this study. However, only 207 of the enlisted patients submitted faecal samples for examination and constituted the study population. Tool for data collection was structured questionnaire that was researcher administered to mother/caregivers after informed consent was obtained. Information sought in the questionnaire included sex and age of the subjects and level of education of their parents. Formol ether concentration method was used for stool examination while intensity was estimated using McMaster counting chamber technique. RESULTS: Of the 207 faecal samples examined 46(22.2% ) had ova of helminths while 161(77.85% ) had none. More school children, 40(19.3% ), than pre-school children, 6(2.9% ) had helminth ova in their faecal samples and the difference was found to be statistically significant (P < 0.05). More females, 28(13.5% ) than males, 18(8.7% ) were infected but the difference was however not statistically significant (P > 0.05). Intestinal helminth ova seen in order of prevalence include A. lumbricoides, 23(11.1% ); hookworm, 12(5.8% ); T. trichiuria, 8(3.8% ); Schistosoma mansoni, 2(1.0% ); Strongyloides stercoralis, 1(0.5% ) while multiple infection was recorded in 11(5.3% ) patients. Intensity of infection was low. The difference between the means for A. lumbricoides, T. trichiuria and multiple infection by age were found to be statistically significant P < 0.001; P < 0.05; P < 0.001, respectively. Mother's level of education more than father's level of education seemed to influence the pattern of intestinal helminthiasis among the children but the association was not found to be statistically significant (P > 0.05). CONCLUSION: Prevalence and intensity of infection was low probably due to periodic antihelminthic treatment offered by the health authorities. Improvement in mother's level of education brought about decrease in prevalence of intestinal helminthiasis among the children. Therefore, improvement in female education should be encouraged to reduce the incidence of communicable disease in the family.
[ABSTRACT]   Full text not available   
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