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   2007| July-September  | Volume 14 | Issue 3  
    Online since April 14, 2016

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Comparison of the therapeutic efficacy of phonophoresis and iontophoresis using dexamethasone sodium phosphate in the management of patients with knee osteoarthritis
SR Akinbo, CB Aiyejusunle, OA Akinyemi, SA Adesegun, MA Danesi
July-September 2007, 14(3):190-194
BACKGROUND AND OBJECTIVE: Many treatment options, including non-pharmacological and pharmacological measures, have been recommended in the management of osteoarthritis (OA). Among the non-pharmacological approach is physiotherapy, which involves the use of physical modalities like, heat therapy, exercise therapy, electrical stimulation, therapeutic ultrasound, iontophoresis, and phonophoresis. This study was therefore designed to compare the effectiveness of 0.4% Dexamethasone sodium phosphate (DEX-P) phonophoresis (PH) with 0.4% DEX-P iontophoresis (ION) therapy in the management of patients with knee joint OA. METHODS: Fifty patients (19 males and 31 females) with a mean age of 53.6 +/- 8.9 years were randomly assigned to PH or ION groups with 25 patients in each group. Ultrasound waves of 1 MHz frequency was applied for 5 minutes to the target knee, so also was the direct current for 10 minutes for 10 sessions treatment period. Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores, 20 meters ambulatory time, and knee range of motion (ROM) were evaluated before and after therapy as the outcome measures. RESULTS: At the end of two weeks, significant improvement in total WOMAC scores was observed in 15 (60%) and 16 (64%) patients in the PH and ION groups respectively, indicating no significant difference in the improvement rate. Twenty (20) metres ambulatory time and knee range of motion also improved significantly in both groups, yet these variables showed no significant difference between the two groups. CONCLUSION: Both therapeutic modalities were found to be effective and generally well tolerated after 10 treatment sessions. DEX-P phonophoresis was not superior to DEX-P iontophoresis in the treatment of patients with OA of the knee.
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Visual standards in commercial driving
CO Adeoti, JN Ubah, MA Isawumi, AO Ashaye, IO Oluwatimilehin, RA Raji
July-September 2007, 14(3):199-203
OBJECTIVES: The study was carried out to review the ocular factors involved in road traffic accidents (RTA) in order to reduce associated injuries and possibly suggest a standard for driving. MATERIALS AND METHODS: The study was carried out in the eye clinic of Ladoke Akintola University of Technology Teaching Hospital, Osogbo between May and June 2004. A stratified random sample technique was used to select 99 drivers (198 eyes) from 6 motor park units. Information obtained included age, sex, past history of road traffic accident (RTA), visual acuity and field, colour vision and ability to read number plate tests. RESULTS: Six drivers (6.1%) were visually impaired. There were 5 cases of monocular blindness. Twenty (20.20%) drivers had accidents in the past, 24(24.24%) could not read number plate at 20.5meters, 6 (6.1%) were colour blind while 36 had visual field loss within 120 degrees horizontally. All the six drivers that had visual field loss encroaching within 20 degrees of fixation had accidents in the past. CONCLUSION: This study has shown that there is need to improve on the standard of vision testing before licenses are issued or renewed. Where visual acuity alone is used, it must be done properly by testing one eye at a time. However, a comprehensive eye test using a battery of tests comprising visual acuity, colour vision, visual field and number plate test at 20.5 meters before first issue of driving license and at renewals will be better. Drivers with visual impairment or inability to read number plate test at 20.5 meters should be disqualified from driving commercial vehicles. Drivers with monocular blindness or visual field loss encroaching within 20 degrees of fixation must also not be allowed to drive commercial vehicles. However, further large scale studies will be necessary in order to prove all these propositions scientifically.
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A rapid situation assessment of sexual risk behaviour of alcohol users in Lagos, Nigeria
RA Lawal, JD Adeyemi, AA Akinhanmi, AA Haruna, LB Bassey, RO Coker, OO Ogunsemi, M Ekpo, M Mwansa, S Saxena
July-September 2007, 14(3):180-189
BACKGROUND: National sentinel surveys of HIV/AIDS among pregnant women in Nigeria have shown steady rise in prevalence from 1991 (1.8%) to 2001 (5.8%), which may reflect the pattern in the adult population in the country. The roles of known potential risk factors of the HIV/AIDS scourge in Nigeria deserve elucidation. This work aims to study the relationship between alcohol use and sexual risk behaviour. PATIENTS AND METHODS: Rapid assessment technique involving qualitative and quantitative methods was employed. A multi-site design which made it possible to compare samples recruited in high and low density settings was used. RESULTS: One hundred and nine of the alcohol users were recruited in the Low Density Area (LDA), while 130 were recruited in the High Density Area (HDA). In the HDA, 49 (53%) of the beer users used alcohol before sex either most or all of the time 21 (22.6%), or occasionally 28 (29.1%). Unlike the beer users less than half, 8 (42.1%), of Palm wine drinkers drank alcohol before sex. Beer users in the HDA used beer after sex with casual partners significantly more than the Palm wine drinkers (P = 0.036). Alcohol users in the LDA were more inclined to casual sex and they (54, 56.8%) believed that it had some or major role in their desire as well as performance of sex compared with users in the HDA (P = 0.005). CONCLUSION: Irrespective of their socioeconomic class, ethnicity, religion and educational attainment alcohol users in the country indulge in high risk sexual behaviours that predispose them to infection with HIV and other sexually transmitted diseases.
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Some malignant tumours in HIV -infected individuals in Benin City Nigeria
OC Osime, AN Onunu
July-September 2007, 14(3):195-198
AIM AND OBJECTIVES: The aim of the study was to report the cases of some malignancies seen in Human Immune Deficiency Virus (HIV) - positive patients seen at the UBTH between January 1999 and December 2003. PATIENTS AND METHODS: All patients that presented to the medical and surgical units of the UBTH within the period of the study and who had histologically confirmed malignant conditions and also tested to HIV were included in the study. RESULTS: The male: female ratio of HIV-seropositivity within the period of study was 1:1.2. The highest incidence of HIV-seropositivity was in 2003 (65.1%). Of the patients that tested positive for HIV, Hodgkin's lymphoma was the commonest form of malignancy while leukaemia was the least common. CONCLUSION: We conclude that Kaposi's sarcoma is not now so common in HIV-positive patients as previously reported by other studies, while Hodgkin's lymphoma has become rather more prevalent.
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A comparative study of marital status on the academic performance of the female medical undergraduate in a Nigerian university
VE Egwuatu, OU Umeora
July-September 2007, 14(3):175-179
OBJECTIVE: To examine the effect of marriage, pregnancy and child bearing on the academic performance of the Nigerian female medical student. METHOD: Self administered cross sectional questionnaires were distributed to female and male medical students of Ebonyi State University, Nigeria. Academic records were examined, and data obtained analysed using the Epi info statistical software package. RESULTS: Sixteen (19.3%) of the female students were married, thirteen after admission into the Faculty. Fourteen of these had children and mean parity was 2. The married female students were older, had more resit examinations than their male and single female counterparts. The difference was statistically significant. CONCLUSION: Marriage and child bearing which play a central and prominent role in the traditional African culture, may serve as an additional burden on the Nigerian female medical student, affecting her academic performance. The specific problems associated with marriage, pregnancy and childbirth need to be recognised, addressed and reflected in a modern medical curriculum.
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Plasma total and ultrafiltrable calcium in normal pregnancy, hypertension in pregnancy and pre-eclampsia
OO Oladipo, BB Afolabi, AO Okorodudu
July-September 2007, 14(3):213-216
OBJECTIVE: To measure the ultrafiltrable and total plasma calcium in normal pregnancy and pregnancies complicated with hypertension and pre-eclampsia. PATIENTS AND METHODS: Total and ultrafiltrable calcium concentrations were measured in maternal plasma from non-pregnant (35), normal pregnant (35), Pregnancy induced hypertension (35) and pre-eclamptic (20) women. Plasma total calcium level was measured by the o'cresolphthalein method. Ultrafiltrate of plasma was obtained using the Amicon MPS-1 micro-partition device. RESULTS: There was no significant difference in the plasma total calcium level between the non- pregnant group and the pregnant group (normal, hypertensive and pre-eclamptic). However there was a significant reduction in the ultrafiltrable (protein free and complexed) calcium level in the pregnant group compared to the non-pregnant group (1.15mmol/L +/- 0.23 Vs 1.25mmol/L +/- 0.13) p<0.05. CONCLUSION: Measurement of the ultrafiltrable calcium in addition to total calcium assay may be more useful in assessing calcium status in normal and complicated pregnancies.
[ABSTRACT]   Full text not available     [Mobile Full text]  [EPub]
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Aortic aneurysm in a young Nigerian man
RA Akinola, PO Soeze
July-September 2007, 14(3):269-271
A 22year old man with aortic aneurysm is presented. The diagnosis was incidental on abdominal ultrasound, as the pathology was not suspected. This case is presented because of the rarity of this pathology in this age group and race. The significance of ultrasound scan in the diagnosis of aortic aneurysm is emphasised. The various modalities of investigation and diagnostic difficulties in developing countries are highlighted.
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Multi-disciplinary (MDT) approach in the management of head and neck cancers in Nigeria
BS Alabi
July-September 2007, 14(3):173-174
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Informed consent in a tertiary hospital in Nigeria: how involved is the nurse?
MD Dairo, MO Oyetunde, PB Olaitan
July-September 2007, 14(3):209-212
INTRODUCTION: We reviewed the nurse's involvement and role perception on informed consent in LAUTECH Teaching Hospital, Osogbo, Osun State, Nigeria OBJECTIVES: The study aimed at determining the nurses' knowledge, attitude and perception of role in informed consent and the level of participation in the procedure. METHODS: A descriptive cross sectional study of the nurses in the medical and surgical units of LAUTECH Teaching Hospital was carried out using semi structured questionnaire. RESULTS: Sixty five nurses participated in the study. A high proportion - 60 (92.3%) had heard of informed consent but only 26(40%) had correct and adequate knowledge of informed consent. Forty (61.5%) had participated as witnesses to the procedure of seeking informed consent. Participation was only sometimes in 38 (58.5%) of respondents. Forty seven (86.2%) nurses wanted nurses to be involved in obtaining informed consent because it improves quality of patient care while 38(58.5%) nurses believed that involvement of nurses should be because it is the nurses' statutory responsibility. CONCLUSION: It would appear that the knowledge of informed consent among nurses was inadequate and nurses were not adequately carried along in the process. Training of nurses in this important procedure would greatly enhance the quality of patient care.
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An overview of the socio-cultural and psychiatric aspects of women's reproductive health in West Africa
OF Aina
July-September 2007, 14(3):231-237
The challenges associated with women reproductive health in West African sub region have over the years become a source of concern to relevant world bodies such as WHO, UNFPA, World Bank etc. Some of these challenges include Infertility, Family Planning and Female Genital Mutilation (FGM). However, of greater concern is the scourge of Sexually Transmitted Diseases (STDs) most especially HIV/ AIDS and the unacceptably high maternal mortality in the sub region where Nigeria alone accounts for the highest percentage (10%) of the global 60,000 maternal deaths annually. Significant psychiatric complications such as anxiety and depression are associated with menstruation and menopause. However, the postpartum period is the most vulnerable with significant proportion of women developing such psychopathologies as Puerperal (maternity) blues, Postpartum Depression (PPD) and Acute Organic Brain Syndrome. Sociocultural factors, the dearth of psychiatrists in West Africa coupled with the poor or non-recognition of the psychiatric complications by the obstetric staff have not allowed enough clinical attention to be paid to these problems. It is thus advocated that improvement in the maternal and child health care component of the primary health care (PHC) services will go a long way to attenuate the psychiatric complications associated with childbirth.
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Preoperative staging of rectal carcinoma using transrectal ultrasonography (Trus): experience with 30 Nigerians
GA Rahman, KT Braimoh
July-September 2007, 14(3):226-230
BACKGROUND AND OBJECTIVE: Colorectal cancer is the second most common malignancy; accounting for approximately 155,000 new diagnosed cases each year in the United States. It is about the commonest Gastrointestinal Malignancy in Nigeria. For cancers specifically located in the rectum, various therapeutic options are available including local excision, total mesorectal excision, preoperative radiotherapy etc. These treatment modalities vary in morbidity and chance for cure. The choice of surgery as well as possible outcome largely depends on the depth of tumour infiltration of the rectal wall as well as extent of perirectal tissue involvement. The aim of this study was to assess local fixity clinically and also to assess the ability of transrectal ultrasound (TRUS) to fulfil staging requirements in patients with rectal cancer. The results of these findings were compared with findings at operation and subsequent findings at pathological examination. This is with the aim of evaluating the usefulness of transrectal ultrasound in selecting patients for surgical intervention especially with respect to resectability. MATERIALS AND METHODS: Thirty consecutive patients with histologically confirmed rectal carcinoma at UITH, Ilorin from January 1998 to December 2002 who underwent preoperative TRUS were prospectively studied. After clinical examination including digital rectal examination they all had TRUS, proctoscopy and sigmoidoscopy. Result of findings on clinical examination, TRUS, findings at surgery and histological findings were compared and analysed using SPSS 10.0. RESULTS: There were 30 patients reviewed. Twenty per cent of patients who were thought to have fixation of the tumour on clinical examination were not confirmed on TRUS and at surgery. All the patients that TRUS diagnosed as fixed and therefore not resectable were confirmed at surgery and histopathology. Digital Rectal Examination (DRE) identified four patients with peri-rectal lymph nodes but TRUS picked six; though only five were histologically positive. CONCLUSION: TRUS is a useful preoperative imaging technique especially where CT and MRI are not readily available. This can assist the surgeon in preoperative decision taking as to the resectability of the tumour and possible prognosis.
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Knowledge and management of malaria among non-medical Nigerian undergraduates
EO Agbaje, DO Aphia
July-September 2007, 14(3):221-225
AIMS AND OBJECTIVE: The present work investigated knowledge and management of malaria among non-medical students in two tertiary institutions in Lagos State, Nigeria, and aimed at evaluating the possible roles played by the human host in perpetuating the deadly disease, malaria, especially among those outside the health-sector. METHODS: Two tertiary institutions within Lagos metropolis were selected as study fields and a total population of 400 non-medical students was studied through random distribution of fixed-end and self-administered questionnaire. RESULTS: The study showed that most of the informants did not know much about malaria, in terms of its transmission, symptoms, prevention, management, morbidity and mortality, which could explain the disappointments that have been suffered in the fight against the parasite and its carrier even in the face of highly efficacious anti-malarias, since such individuals would not be able to manage the disease adequately. Some of the correct responses were found to be significant when compared with the incorrect options. Lastly, drugs other than anti-malarials were employed to treat the disease and conversely, most fevers were thought by the students to be due to malaria. CONCLUSION: The present work shows the massive gap in the knowledge of malaria between the health sector and other members of the society. If there must be any clue to the long-standing problems facing malaria therapy, it will come as a consequence of bridging the gap.
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Dental implant education in Nigeria: a curriculum guide
WL Adeyemo, PA Akeredolu, HO Oderinu, BO Olorunfemi
July-September 2007, 14(3):247-251
AIM: Anecdotal evidence suggests that the practice of implant dentistry, "gold standard" for edentulism is presently very low in Nigeria. This article proposes a model for teaching dental implant education and also emphasises the need for inclusion of standardised dental implant education in the dental curriculum in Nigeria. METHODS: A literature search using the MEDLINE was conducted on various models for teaching of dental implant education worldwide. RESULTS: Implant dental education for undergraduate and postgraduate programmes has 3 components namely: didactic educational programme, laboratory hands-on experience, and clinical hands-on experience. In addition, dentists and dental educationists can gain proficiency in basic and advanced implant dentistry through implant dental education organised by recognised universities, private and international implant organisations, manufacturer-sponsored educational programmes as well as training and courses organised by dental associations. CONCLUSIONS: Dental implant education should be given a priority and be included in both the undergraduate and postgraduate dental curriculum in Nigeria. In addition, a standardised implant dentistry programme should be formulated and developed for all dental schools in Nigeria.
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A review of bilateral tubal ligation at caesarean section in Jos, Nigeria
JT Mutihir, AO Aisien, IA Ujah
July-September 2007, 14(3):252-255
CONTEXT: The advent of minilaparotomy under local anaesthesia has revolutionalised the performance of bilateral tubal ligation for permanent contraception in Jos. Female sterilisation has however continued to be performed during caesarean section mainly for obstetric or surgical reasons. OBJECTIVE: To determine the incidence of bilateral tubal ligation during caesarean section, and the trend over the years in Jos, Nigeria. METHODOLOGY: This was a retrospective analysis of the register of all bilateral tubal ligations including those performed at caesarean section, between January 1985 and December 2000 (16 years). RESULTS: A total of 3,585 female sterilisations were performed, and 533 (14.9%) were at caesarean section. The rest were through minilaparotomy under local anaesthesia (84.3%) and laparoscopy (0.7). The yearly rate of tubal ligation at caesarean section declined from 33.8% in 1985 to 16.3% in 2000. The commonest indication for the tubal ligation during caesarean section was repeat caesarean section, and accounted for 55.5%. The mean age and parity of the women were 32.1 years and 5.0 respectively. The mean of the number of children of the women at the time of the caesarean section was 4.5. There was a significant difference in age, parity and number of living children of the women compared with those that had bilateral tubal ligation at times other than during caesarean section. There was no complication specific to the tubal ligation at caesarean section. CONCLUSION: About 15% of all female sterilisations were performed at caesarean section. The trend demonstrated a decline, probably influenced by the advent of minilaparotomy under local anaesthesia in Jos, Nigeria.
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Low cost methods for secondary prevention of cervical cancer in developing countries
RI Anorlu, ER Ola, OO Abudu
July-September 2007, 14(3):242-246
BACKGROUND: Cervical cancer is both a preventable and a curable disease- preventable because the pre-invasive stage can be detected by screening and curable because the very early stage can be cured. It is the commonest genital cancer among females in Nigeria. The incidence and mortality from this disease in developing countries is very high. This is due to the unavailability of organised screening programmes. To address this problem, effective and practical alternatives to cytology are being investigated in many studies. OBJECTIVE: To examine the strengths and limitations of new methods currently undergoing evaluation for secondary prevention of cervical cancer in developing countries. MATERIAL AND METHODS: We conducted a computerised literature search for published articles. Mesh phrases used for the search were cervical cancer screening, cervical cancer screening in developing countries, cervical cancer screening- new techniques. Hand searches of journals and the proceedings of major conferences were also done. RESULTS: The visual tests for screening for cervical cancer was found to be highly sensitive and can be performed by not only physician but also other trained health care providers. The "single visit approach" to prevention of cervical cancer also referred to as "see and treat" has been tried in some countries in Asia and Africa and found to be effective and acceptable to women and their partners. CONCLUSION: Several studies conducted in many developing countries have shown that low cost methods for cervical cancer prevention do have a place in reducing the incidence of this deadly disease.
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Knowledge, attitude and practices of Nigerian anaesthetists in HIV infected surgical patients- a survey
OT Kushimo, SG Akpan, I Desalu, NA Merah, IU Ilori
July-September 2007, 14(3):261-265
In the light of increasing prevalence of the human immunodeficiency virus (HIV), anaesthetists are likely to see more patients with this virus in their practice. This study evaluated, using a questionnaire format, the knowledge, attitude and practices of anaesthetists in the management of HIV infected surgical patients. The questionnaire sought demographic information, the knowledge of risks involved as well as attitude and practices. One hundred (66.7%) out of 150 questionnaires distributed amongst members of the Nigerian Society of Anaesthetists were completed and returned. Fifty-five per cent (55%) of the respondents confirmed their willingness to be screened but only 45% had had a personal HIV screening test. Even though 23% of all the respondents will transfuse unscreened blood in an emergency, only 1(8.3%) of the consultants will do so. This trend was also reflected in gloving behaviour as 11(91.6%) of consultants will routinely wear gloves whilst only 12(70.5%) of the senior house officers will routinely glove for venepuncture despite the availability of gloves. Other precautionary facilities such as goggles, sharp disposal bins, routine screening of all surgical patients were more available in private than in government hospitals. Ninety- six per-cent of all respondents will initiate an action after a needle stick injury whilst 4% will ignore. General Anaesthesia was the choice of anaesthetic in an HIV/AIDS infected patient by 43% of respondents whilst 22% of respondents would choose regional technique. However, only 85% of respondents were willing to anaesthetise an infected patient. This study suggested a dearth of knowledge and perception of risks of HIV/AIDs amongst Nigerian Anaesthetists. Appropriate training and greater education is highly recommended. Rigorous infection control policy is imperative and hospital authorities must ensure availability of protective facilities.
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Marjorlin's ulcer presenting as pathological fracture
ME Asuqo, V Nwagbara
July-September 2007, 14(3):266-268
The objective of this case report is to sensitise attending medical practitioners of the morbidity and mortality associated with chronic cutaneous ulcers thus emphasising the surgical importance of its management. Chronic ulcers, scars and osteomyelitic sinuses are common but malignant transformation though uncommon poses a threat to function and life. Chronic ulcers exposed to chronic topical applications by trado-medical practitioners may undergo malignant transformation from chronic irritation and pursue an aggressive course with significant morbidity and mortality as illustrated in the patient with pathological fracture and a huge matted ipsilateral inguinal lymphadenopathy. We present this case of posttraumatic Marjolin's ulcer with pathological fracture to illustrate the surgical importance of chronic ulcers and possible role of chronic irritation from topical application by trado-medical practitioner in malignant transformation of ulcer.
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Pathology of maternal deaths in Rivers state (a ten year autopsy review) in a referral hospital
DS Fubara, J Ikimalo, CT John
July-September 2007, 14(3):256-260
BACKGROUND: Most of the maternal death studies in this environment based their statistics on clinical cause with no reference to autopsy records. This gap of knowledge would be filled with autopsies performed on the victims. OBJECTIVES: To highlight the importance of autopsy in the study of maternal mortality. DESIGN/SETTING: A ten year (1st January 1991 - 31st December 2000) retrospective autopsy study of maternal deaths in University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt. METHODOLOGY: The coroner's autopsy report and hospital autopsy records on maternal deaths were retrieved and re-evaluated for this study. Variables considered were the ages of the victims, primary place of antenatal care/management and the cause of death at autopsy. RESULTS: A total of 60 maternal autopsies were performed during the period under review. Forty eight (80%) cases were direct maternal deaths of which haemorrhagic shock from ruptured ectopic pregnancy was the most common 21(35%). The highest frequency of direct maternal death occurred in the age group 20 - 29 years. Indirect (fortuitous) maternal deaths accounted for 20% cases of which cardiovascular disorders was the most common cause of death 4(7.1%) and the age group 40-49 years were most affected 4(6.7%). Majority of the deaths occurred at the traditional birth attendants (TBA) centres 26(43.3%) of which 25(41.7%) were direct or obstetric maternal deaths. The indirect maternal death was highest in the general hospitals 4(6.7%). CONCLUSION: Maternal mortality is a common obstetric problem in this environment. As the death toll was highest in the TBA centers, they should be trained and be integrated to the health care delivery system. There should be an established referral system and improved emergency obstetric services including blood transfusion in our local health centres. These will drastically reduce the mortality rate.
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Prospective case-control study of interictal depression and suicidal ideation in Nigerians with epilepsy
NU Okubadejo, MA Danesi, OF Aina, FI Ojini, JD Adeyemi, DA Olorunshola
July-September 2007, 14(3):204-208
BACKGROUND: Co-morbid depression and suicidal ideation in people with epilepsy (PWE) in developing countries are under-recognised, and so may be consequently undertreated. This study was designed to determine the frequency and clinical correlates of interictal depression and suicidal ideation in PWE. PATIENTS AND METHODS: Using a prospective design, we evaluated 96 PWE and two groups of controls (103 age- and sex-matched population controls and 13 persons with DSM - IV diagnosis of major depression (controls with depression - CWD) without epilepsy. Depression was assessed using Zung Self-rating depression scale (scores =40 indicating depression). RESULTS: Depression was more prevalent in PWE (25/96 i.e. 26.0%) than normal controls (10/103 i.e. 9.7%) (P = 0.004). Suicidal ideation scores were similar for depressed PWE and depressed normal controls (1.7 +/-1.0 v. 1.5 +/- 1.0; P>0.05), but significantly higher in CWD (2.61.3; P=0.04). Among PWE, mean duration of epilepsy (years) was the only variable significantly related to depression (i.e. 12.7 8.8 in depressed PWE v. 8.3 6.6 in non-depressed PWE (P=0.01). CONCLUSION: Depressive symptomatology is a frequent co-morbidity in our tertiary care population of PWE. However, suicidal ideation is less common in contrast to persons with major depression.
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Hypnosis and its place in modern pain management - review article
FE Amadasun
July-September 2007, 14(3):238-241
This is an evidence-based review of the efficacy of hypnosis in pain management. Hypnosis is as old as mankind. It is reported in the Ebers Papyrus in ancient Egyptian cures. It went into decline in the Middle Ages with the rise of Christianity, being erroneously associated with witchcraft. There was resurgence of interest in the 19th century. In the early 1950s, the British Medical Association endorsed the teaching of hypnosis in all medical schools. The literature is replete with anecdotal and controlled studies of the efficacy of hypnotherapy in pain management. Not much is found of the effectiveness in acute pain conditions. Nevertheless, in spite of some methodological flaws in many reports, there seems to be sufficient clinical evidence of sufficient quality, to conclude that hypnosis has demonstrable efficacy in the treatment of chronic pain.
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Avascular necrosis of the femoral head in sickle cell disease in Nigeria: a retrospective study
AL Akinyoola, IA Adediran, CM Asaleye
July-September 2007, 14(3):217-220
BACKGROUND: Avascular necrosis (AVN) especially of the femoral head, has long been recognised as a manifestation of sickle cell disease (SCD). Despite this knowledge the actual prevalence of this complication among sickle cell patients in Nigeria is not known. OBJECTIVE: To determine the prevalence and patterns of presentation of avascular necrosis of the femoral head in sickle cell disease. PATIENTS AND METHODS: A retrospective study carried out at the Orthopaedic and Haematology clinics of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. Four hundred and sixteen patients with sickle cell disease seen over a 15-year period. RESULTS: Of the 416 patients with sickle cell disease 340 (81.7%) had haemoglobin SS genotype while 76(18.3%) had SC genotype. Sixty-six (15.9%) patients 35 males (53%) and 31 females (47%) had clinical and radiologic features of avascular necrosis (AVN) of the femoral head. Fifty-three of them (80.3%) had Hb SS while 13 had Hb SC. The peak age incidence in both Hb SS and Hb SC was 21-30 years. Forty patients (60.6%) presented with stage IV disease (Ficat and Arlet Staging) while 21.2% had stage III and 18.2% had stage II. No patient was diagnosed in stage 1 or 0. CONCLUSION: The prevalence of AVN of femoral head in Hb SC and HbSS is similar i.e. the difference is not statistically significant (P=0.48). Most of our patients present late with advanced diseases. Considering the paucity of facilities available for total hip replacement in Nigeria and the young age group affected we recommend regular screening of patients with sickle cell disorder for AVN and regular community educational programmes for early diagnosis.
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