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   2007| October-December  | Volume 14 | Issue 4  
    Online since April 14, 2016

 
 
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ARTICLES
A three-year review of mortality patterns in the medical wards of Aminu Kano Teaching Hospital, Kano, Nigeria
MU Sani, AZ Mohammed, A Bapp, MM Borodo
October-December 2007, 14(4):347-351
BACKGROUND: The pattern of morbidity and mortality reflects the burden of disease in a particular community. This pattern shows geographic variations between communities and countries. The knowledge of the pattern of diseases and their contribution to mortality in a given country is very important in evaluating its health care delivery system. Such knowledge is important for health planning and for improving the healthcare services in that particular nation. We set out to study the mortality pattern in our medical wards. MATERIALS AND METHODS: This is a retrospective study that reviewed the causes of death in the medical wards of Aminu Kano Teaching Hospital (AKTH) Kano between January 2001 and December 2003 (three years). The data were obtained from the admission and discharge/death register, patients' case records, the weekly as well as quarterly mortality reviews. The SPSS version 10 was used to analyse the data. RESULTS: A total of 3369 patients were admitted over the 3 year study period. Of these 2518 (74.7%) were discharged or referred and 851 patients died, giving an overall mortality rate of 25.3%. The male to female admission ratio was 1.6:1. Majority of deaths, 714 (83.9%) occurred after 24 hours of admission. The most important causes of death were infectious diseases other than HIV/AIDS (17.9%), cerebrovascular disease (17%), HIV/AIDS (13.6%), chronic renal failure (12.5%) and diseases of the circulatory system (11.9%). CONCLUSION: Mortality in the medical wards reflects the emerging trend of mixed disease spectrum burden comprising communicable and non communicable diseases. Public health education, raising the socio-economic status of our people as well as improving the standards of our health care facilities and personnel would prevent a large proportion of deaths from medical wards.
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Factors influencing non-compliance with anti-hypertensive drug therapy in Nigerians
CO Amira, NU Okubadejo
October-December 2007, 14(4):325-329
BACKGROUND: Non-compliance with antihypertensive drug therapy can have a negative impact on cardiovascular outcome. The objective of this study was to determine compliance rate with anti-hypertensive therapy and factors affecting compliance among patients attending a Nigerian tertiary hospital. METHODS: A cross sectional study was conducted on 225 black hypertensive patients attending a tertiary clinic in Lagos, Nigeria. Demographic data, current anti-hypertensive therapy, compliance with prescribed therapy, factors affecting compliance and BP were documented via an investigator administered questionnaire and open-ended interviews. RESULTS: In this study, 77(34.2%) of the hypertensive patients were non-compliant. Blood pressure control was significantly better among compliant patients (45.9%) than in non-compliant patients (27.3%) (x(2) = 7.35 p=0.007). Gender, age, number of drugs used, educational level and presence of co-morbidities did not affect compliance. The major reasons for non-compliance were miscellaneous factors (60%) related to both patient's attitudes and beliefs (reflecting ignorance),and consultation failure on the part of clinicians. Lack of finances and side effects of medications accounted for 23.8% and 16.2% of non-compliances respectively. CONCLUSION: Although lack of finances is the single most self reported reason, miscellaneous factors related to patients' attitudes and belief contribute frequently. Incorporating patient education and counselling in routine follow-up may improve compliance, BP control, and ultimately impact positively on cardiovascular outcome.
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Intestinal parasitism in Magama Gumau rural village and Jos township in north central Nigeria
EI Ikeh, MO Obadofin, B Brindeiro, C Baugherb, F Frost, D Vanderjagt, RH Glew
October-December 2007, 14(4):290-295
OBJECTIVE: To determine the prevalence of intestinal parasitosis in one rural village and one urban centre in North Central Nigeria. METHODS: A total of 111 single stool specimens from all the volunteered rural dwellers and 93 specimens from randomly selected urban dwellers were examined using Formol-ether and modified Ziehl-Neelsen techniques; during the months of June and July 2005. A questionnaire was completed for each subject and the nutritional status of the adults was assessed using the anthropometric measurements (weight and height for age and Biomass index). RESULTS: The results suggest very high prevalence rates of intestinal parasitosis of 72.1% and 69.9% for the rural and urban populations respectively. All the age groups were infected. The males in the rural area had a prevalence of 69.2% as against 74.6% in females (P>0.05); while in the urban area, the males were more significantly infected (77.4%) compared with the females with 66.1% (P< 0.05). Those with normal BMI (18.5-24.9 kg/m2) had the highest prevalence of 79.3% and 72.4% for the rural and urban populations respectively. The prevalence of the parasites in the rural and urban populations respectively were: Entamoeba coli (16.2% and 9.7%); E. histolytica (18.9% and 18.3%); E. hartmani (1.8% ad 0.0%); Endolimax nana (16.2% and 18.3%); Iodamoeba butschlii (0.0% and 1.1%); Giardia lamblia (7.2% and 4.3%); Schistosoma mansoni (9.9% and 0.0%); Strongyloides stercoralis (0.9% and 0.0%); Hookworm (4.5% and 5.4%); Ascaris lumbricoides (1.8% and 0.0%); Enterobius vermicularis (0.0% and 1.1%); Cryptosporidium parvum (29.7% and 19.4%); and Enterocytozoon bieneusi/Encephalitozoon intestinalis (39.6% and 47.3%). Polyparasitism was recorded in 48.6% of the rural subjects and 36.6% of the urban subjects. CONCLUSION: The study has shown a very high prevalence of intestinal parasitosis in both the rural and urban populations and that C. parvum and E. bieneusi/E. intestinalis are harboured by apparently healthy individuals.
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Endometrial carcinoma following treatment for breast carcinoma in a Nigerian female. A case report and review of the literature
EK Abudu, O Musa, PO Adefuye, FB Abdul Kareem, AO Agboola, AA Banjo
October-December 2007, 14(4):355-357
Tamoxifen is the primary hormonal therapy for breast cancer as well as its chemoprevention. It is used in the management of breast cancer because of its anti oestrogenic effect. It is however an agonist on the endometrium with undesirable effects of endometrial proliferation with the risk of endometrial hyperplasia and carcinoma. Several authors have reported cases of endometrial hyperplasia and carcinoma following tamoxifen therapy for breast carcinoma. No such report has been made from Nigeria . This paper presents the first case of endometrial carcinoma following tamoxifen therapy for breast carcinoma in a 52 year old Nigerian female. It also highlights the recommended guidelines for the follow up of women with breast cancer on tamoxifen therapy.
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Pattern of the cases seen in the accident and emergency department in a Nigerian Tertiary Hospital over a period of twelve months
OO Afuwape, TO Alonge, VM Okoje
October-December 2007, 14(4):302-305
INTRODUCTION: There is a dearth of information on emergency medical services in Nigeria. This study was conducted to determine the age, sex distribution and the pattern of patient presentation in the Accident and Emergency Department of a Nigeria teaching hospital. METHODS: A retrospective study of all cases seen at the accident and emergency department of the University College Hospital in 2003 was carried out. The information extracted from the records includes age, sex, and diagnosis, department to which the patient was referred, the month of presentation and the outcome within the first twenty four hours of presentation. RESULTS: A total of 4674 patients attended the casualty, with a male: female ratio of 1.2:1. The third decade was the peak age distribution. There was a predominance of surgical cases (61%). In the treatment outcome, 52.1% were referred to other departments while there were ten (0.2%) mortalities. Trauma related cases constituted 45.1%. Road traffic accidents were the commonest cause of trauma. CONCLUSION: The largest proportion of patient were in the active third decade of life. Trauma is the commonest cause of presentation in the Accident and Emergency Department. A significant proportion of patients do not require admission. The doctor in the Accident and Emergency Department must be skilled in basic trauma care.
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Comparison of clinical, microscopic and rapid diagnostic test methods in the diagnosis of Plasmodium falciparum malaria in Enugu, Nigeria
O Tagbo, UO Henrietta
October-December 2007, 14(4):285-289
OBJECTIVE: To compare the use of clinical, microscopic and immunochromato-graphic methods in the diagnosis of Plasmodium falciparum malaria. METHODS: Children with history of fever were consecutively recruited. Information on personal characteristics, and clinical features were obtained with the parental consent before enrolment. Malaria parasite density was done with quantitative microscopy, as well as specie identification in both local and reference laboratories. Rapid diagnostic test (RDT) kits were also used for parasite detection. RESULTS: Eighty three children had clinical diagnosis of malaria, while the remaining 6 had other diagnoses. On microscopy 89 and 26 patients had parasitaemia by the local and reference laboratories respectively. With the RDT, 15 patients had parasitaemia with corresponding minimum densities of 1200 and 716 parasites per ul from the local and reference laboratories. The sensitivity and specificity of the RDT to the reference laboratory were 42.31% and 93.65% respectively, while concordance was 57.69% for RDT, 30.49% for clinical diagnosis (all symptoms), 43.75% for clinical diagnosis (fever alone), and 29.21% for local laboratory. CONCLUSION: There was a significant deficiency in malaria diagnosis using any of the methods alone. For reliable diagnosis of malaria a combination of the methods of diagnosis is recommended. Degradation of the RDTs might have contributed to its low sensitivity. Training and better quality assurance should be established for the medical and laboratory workers in order to improve malaria diagnosis.
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Patients' perception of quality of emergency care in a Nigerian teaching hospital: The influence of patient-provider interactions.
AJ Ariba, LO Thanni, EO Adebayo
October-December 2007, 14(4):296-301
BACKGROUND: Attention is rarely given to patients' opinions regarding the quality of care they received, which is an important feedback to healthcare providers, planners and policy makers. AIM: To assess how patients who survived life-threatening/emergency conditions percieved the quality of care they received. METHOD: This prospective study was carried out among adult patients who had received emergency care at the Accident & Emergency (A & E) unit of Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, between March and December 2004 using a semi-structured questionnaire. RESULTS: There were 1129 respondents, 81 males and 48 females. Their mean age was 35.3 years. 62% were treated for surgical, and 37.2% for medical emergencies. The mean duration of stay at A & E was 2.4 days. Although 91% of the respondents regarded available equipments as very adequate, 38.8% perceived the overall quality of care as sub-optimal. Many of the patients were displeased with their interactions with care providers. They longed for urgent improvement in waiting time, speed of issuing drugs, imterpersonal relationship with health workers and attending to emotional distress of emergency victims. They also wished to have free treatment during emergencies CONCLUSION: Majority of the patients who received care in A & E of this tertiary hospital perceived the quality of care received as satisfactory. However, a substantial proportion regarded the quality of care as sub-optimal. Although most thought equipments were adequate, many of them expressed displeasure with their interactions with care providers. To improve patient's satisfaction with emergency care, greater emphasis needs to be placed on enhancing the interpersonal relationships between health workers and patients than is currently done.
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Triplet pregnancy as seen in the Jos University Teaching Hospital
JT Mutihir
October-December 2007, 14(4):281-284
BACKGROUND: Triplet pregnancies are high-risk pregnancies and fortunately the prevalence is low. They are associated with high perinatal morbidity and mortality. DESIGN: All the records of the 16 triplet pregnancies managed in Jos University Teaching Hospital, North Central Nigeria, were retrieved and analysed. RESULTS: There were a total of 41,159 deliveries and 16 triplet pregnancies giving a prevalence of 1 triplet pregnancy in 2,572 deliveries. Over 60% of the mothers were above the age of 24 years, and about 94% were multipara. The female to male sex ratio was 1:0.85, that is, 1 female in 0.85 males. The pre-term delivery rate was 68.7% of the total triplet pregnancies. Booked patients had better foetal and maternal outcome compared with unbooked patients. Most (81.3%) of the women were allowed vaginal delivery. There was no significant difference between the average Apgar scores of babies delivered by caesarean section and vaginal delivery. All the patients had postpartum haemorrhage (a blood loss of 500 ml and above), but none of them required blood transfusion. CONCLUSION: Triplet pregnancies are not managed often in Jos University Teaching Hospital probably because they do not occur commonly on the Jos Plateau, Nigeria
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Spermatoprotective activity of the leaf extract of Psidium guajava Linn
OB Akinola, OS Oladosu, OO Dosumu
October-December 2007, 14(4):273-276
BACKGROUND: The leaves of Psidium guajava Linn. (guava) contain several natural antioxidants. We therefore designed the present study to evaluate the effect of ethanol extract of guava leaves on gossypol-associated sperm toxicity in Wistar rats. METHODS: Animal groups 1, 2, and 3 (n=6 each) were treated orally with crude cottonseed oil to provide 14 mg/kg/d of free gossypol for 53 d. Besides, groups 1 and 2 rats were supplemented orally with 250 mg/kg/d and 500 mg/kg/d respectively of guava leaf extract (GLE) for the same period. Group 4 animals (control, n=6) received normal saline. RESULTS: No significant difference (P>0.05) occurred in the sperm count of group 1 rats compared to control. In animal group 2, significant increase (P<0.05) in sperm count occurred, as opposed to group 3 animals, where this parameter decreased significantly (P<0.05). Besides, mean values of 78 %, 82 %, 30 %, and 65 % respectively were obtained for sperm motility in animal groups 1, 2, 3, and 4. CONCLUSION: Our findings suggest that ethanol extract of guava leaves possesses beneficial effect on gossypol-associated sperm toxicity, and may therefore enhance male fertility, possibly owing to its rich constituents of natural antioxidants.
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Congenital malformations in singleton and twin births in rural Nigeria
I Sunday-Adeoye, PI Okonta, VE Egwuatu
October-December 2007, 14(4):277-280
BACKGROUND: The presence of a congenital malformation at birth is a cause of anxiety at an otherwise joyous occasion. Congenital malformations are a significant contributor to perinatal mortality. STUDY DESIGN: A retrospective study of external congenital abnormalities in singleton and twin births in rural eastern Nigeria over a 20 year period. RESULT: The incidence of congenital defects for all deliveries was 110.8/10,000 births. Of 1453 twins and 32206 singleton births, there were 58 and 315 congenital abnormalities, with incidence of 97.8/10,000 births and 399.2/10,000 births respectively. Twins were significantly (x(2) =115.22; p< 0.0000) more likely to have a congenital malformation than singletons (RR 4.08, 95% CI 3.10 - 5.7). The pattern of defects was similar for singleton and twin births and the leading system affected was the musculo-skeletal system, distantly followed by the central nervous system. For both groups the commonest malformation was ulnar polydactyly, followed by hydrocephaly and ankyloglossia. Surprisingly no conjoined twins were recorded and there were only 7 cases of congenital umbilical hernia, abnormalities previously considered to be very common in Nigerians and Africans respectively. CONCLUSION: Twins are about four times more likely to have congenital malformations than singletons. The overall prevalence of congenital malformations recorded is comparatively low. There is need for more detailed routine documentation of all birth defects including post-mortem report and the conduct of prospective population-based epidemiological surveys of birth defects in Nigeria.
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Pattern of abnormal liver enzymes in HIV patients presenting at a Nigerian Tertiary Hospital
AA Ejilemele, CA Nwauche, OA Ejele
October-December 2007, 14(4):306-309
AIM: To demonstrate the pattern of abnormal liver enzymes in HIV patients presenting at the University of Port Harcourt Teaching Hospital, Port Harcourt. BACKGROUND: Abnormalities of liver function tests (LFT) have been shown to be common in HIV/AIDS in developed countries. Studies have shown that these abnormalities may be due to direct inflammation induced by the HIV virus on the liver cell. It may also be due to gall bladder disease and infection with bacterial, viral or other opportunistic agents. PATIENTS AND METHODS: We reviewed the clinical notes and biochemistry results of HIV positive patients presenting at the HIV clinic from January 2003 to October 2003. Efforts were made to elicit symptoms suggestive of hepatobiliary disease. Their hepatitis B surface antigen status and their hepatitis C status were obtained. Attempts were made to determine the pattern of liver injury in each patient seen. RESULTS: A total of one hundred and twenty -nine (129) cases were recruited. The mean age was 35.6 +/- 9.0 years with a male to female ratio of 1.1 : 1. One hundred and thirteen patients (87.6%) had abnormalities of their LFT'S. Sixteen of these (14.5%) were classified as cholestatic liver injury while ninety-four (85.5%) were classified as having hepatocellular injury. Three patients (2.3%) were HbSAg positive while one (0.8%) was hepatitis C antibody positive. None of the patients was on anti retroviral drugs at the time of recruitment. CONCLUSION: We therefore conclude that abnormalities of liver enzymes are common in patients with HIV in this environment. It is therefore important to characterise the nature of this abnormality and to institute appropriate management. However further studies are required in this field of HIV related liver disease in our locality.
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Problems of management of primary congenital glaucoma in Benin City, Nigeria
AE Omoti, OM Uhumwangho
October-December 2007, 14(4):310-313
OBJECTIVES: To determine the problems encountered in the management of primary congenital glaucoma in developing countries. METHODS: A prospective study of new patients with a diagnosis of primary congenital glaucoma attending the eye clinic of the University of Benin Teaching hospital, Benin City, Nigeria over a 5 year period, from July 2001 to June 2006. The age, sex, presenting complaints and duration were recorded. They were examined by the aid of a pen torch, hand-held slit lamp and direct ophthalmoscope. Intraocular pressure and corneal diameter were measured under anaesthesia. The patients were followed up till June 2006 and the problems encountered in management were recorded. RESULTS: Eight children comprising 5 males (62.5%) and 3 females (37.5%) with primary congenital glaucoma were seen. All the patients (100%) presented with buphthalmos and 7 (87.5%) had corneal opacity. Four (50%) accepted surgery but only 2 (25%) eventually had surgery. Maximum follow-up was 7 months. CONCLUSION: Presentation with features of advanced disease, poor acceptability of surgery, poor follow-up and low surgical rate are problems associated with the management of congenital glaucoma in Benin City, Nigeria.
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The views of some selected Nigerians about mental disorders
R Uwakwe
October-December 2007, 14(4):319-324
AIM: To determine the views of sampled subjects about mental disorders and their treatment recommendations of such disorders. METHODS: This is a cross sectional descriptive study. The subjects were asked to list the causes of mental disorders they know, explain what they think the role of evil spirits in mental disorders is, if any, and to name the treatment options available for these disorders. Medical students who participated in the survey were also re-administered the study questionnaire following their completion of four week's rotation in Mental Health. RESULTS: Medical students (30), nurses (20), medical records officers (20) and 64 others including 10 religious ministers participated in the study. Thirty-eight- (28.4%) respondents thought that evil spirits cause mental disorders, and 88 (65.7%) would recommend prayer houses for the treatment of mental disorders. Medical students, even after their 4 weeks of rotation in mental health, did not differ in their beliefs from the rest of the groups. CONCLUSION: The knowledge of most interviewees about mental disorders is based on religious beliefs without scientific foundation. Adequate training in psychiatry for medical students, interaction of psychiatrists with their non-psychiatrist counterparts, public enlightenment about mental disorders may be necessary to raise the level of awareness/general knowledge of, and reduce superstitious beliefs about psychiatric disorders.
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Acute renal impairment following use of intravenous contrast agent: A case report and reminder for increased awareness of the problem
EI Unuigbe, AA Adeyekun, CO Azubike, CO Oladele
October-December 2007, 14(4):358-361
OBJECTIVE: Contrast-induced nephropathy is one of the adverse reactions to the use of radiocontrast media. Its incidence can be reduced if preventive measures are instituted. This report presents a case of acute renal impairment following use of radiocontrast media. PATIENT, METHOD AND RESULTS: We report a case of an elderly hypertensive diabetic who developed acute renal impairment within 24 hours of undergoing an intravenous urography. He was not a known asthmatic and had no previous history of allergy. His renal function improved subsequently with hydration, diuretics and strict input/output monitoring. He was discharged after 23 days in hospital and renal function returned to pre-morbid state 3 months after discharge. CONCLUSION: The report is a reminder of the possibility of nephropathy associated with the use of intravascular contrast media. There is need for extra care to be taken to identify risk factors in patients that are to undergo intravascular contrast studies and adequate attention paid to these.
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Non-cirrhotic portal vein thrombosis, an uncommon cause of portal hypertension - a case report
BM Tijjani, MM Borodo, AA Samaila, M Tabari, SU Alhassan
October-December 2007, 14(4):362-364
Most cases of portal hypertension follow chronic liver disease (cirrhosis) while non cirrhotic causes are occasionally seen. A case of portal hypertension secondary to non-cirrhotic portal vein thrombosis is reported. The patient was managed at the Aminu Kano Teaching Hospital Kano, Nigeria in the year 2006. She presented with recurrent massive upper gastrointestinal bleeding and was resuscitated, followed by clinical, radiological and endoscopic evaluation. She had massive splenomegaly and grade four oesophageal varices with evidence of recent bleed. There were, however, no other stigmata of chronic liver disease or portal hypertension. Abdominal computed tomography scan confirmed portal vein thrombosis. Splenectomy and ligation of short gastric veins was performed and the patient has not had any repeat episode of haematemesis or malaena six months post surgery.
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Early childhood caries: experience in Nigerian children at Lagos
CA Sowole, EO Sote
October-December 2007, 14(4):314-318
Objective of the paper was to assess the prevalence of Early Childhood Caries among Nigerian children aged 6 months to 5 years, describe the pattern and relate it to the socioeconomic status of their parents/guardians. METHODS: It was a descriptive study carried out in three randomly selected local government areas in Lagos State. Questionnaires designed to provide information on the socio-economic status of the parents were completed by one of the authors. All the children were examined using sterile instruments for the presence of early childhood caries. RESULTS: The prevalence of early childhood caries amongst the children was 10.5%, among them 4.8% had severe early childhood caries. Early childhood caries was observed in children as early as 13 months. The primary incisors were most affected. Only 17 (4.4%) had visited the dentist. CONCLUSION: There was a tendency towards higher caries level in children of higher socio-economic status. Preschool children had great demand for restorative care.
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Mass casualty incidents and disasters in Nigeria: The need for better management strategies
IP Ehiawaguan
October-December 2007, 14(4):341-346
AIMS AND OBJECTIVES: The aim of this article is to discuss principles involved in disaster management, disasters in Nigeria, examine the current level of preparedness in the country and make recommendations for improvement. METHODS: An overview of various disaster events in the country coupled with review of the literature. RESULT: Fatality figures for disaster in Nigeria are high. CONCLUSION: There is need for a strong political will from government at all levels regarding disaster management in order to mitigate its occurrence and impact.
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Perception of Nigerian internal medicine residents on the diagnosis and management of heart failure
AC Mbakwem, JN Ajuluchukwu
October-December 2007, 14(4):336-340
AIM: To evaluate the perception of internal medicine residents on diagnosis and management of heart failure in Nigeria. METHOD: A modified version of the Euro-F study questionnaire was administered to internal medicine residents (IMRs) from Nigeria who were attending the pre part I Fellowship examination of the Faculty of Internal Medicine of the National Postgraduate Medical College. Responses were compared with data from the Nigerian primary physicians (PCP) survey and the Euro-HF study. RESULTS: The commonest symptoms used by the IMRs in heart failure diagnosis were exertional dyspnoea 68.85%(42), pedal oedema 63.93%(39) and orthopnoea 50.82%(31), while the signs included elevated jugular venous pressure 50.82%(31), basal crepitations 47.50%(29) and a gallop heart rhythm 39.34%(24). Categorisation using the Framingham criteria for diagnosis showed that 52% of the IMRs knew three or more major signs of heart failure. The IMRs use of investigations in diagnosing heart failure was fair to good and was significantly higher than results from the Euro-F study and the primary care physicians (PCPs) in Lagos study; echocardiogram, (p=0.007and <0.00001); electrocardiogram, (p= 0.0002 and p=0.001); chest x-ray (p=0.05 and 0.5) respectively. However the mean proportion of IMRs that would rely on investigation to make a diagnosis was significantly lower than in the Euro-F study (p=0.0001) and in the PCPs (p = 0.02). Although the mean proportion of the IMRs patients using ACE-inhibitors was significantly higher than in the Euro-F survey (p<0.001) and the PCPs (p <0.00001), majority (93.94%) of the IMRs were using less than half the trial doses for treatment. On the other hand, the knowledge of survival benefits with the use of b-blockers was very poor in the all the groups, p>0.05. CONCLUSION: A substantial knowledge gap still exists among the IMRs as regards the diagnosis and management of heart failure and this need to be addressed by the trainers.
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Severe gastrointestinal haemorrhage due to primary intestinal Kaposi's sarcoma - a case report
AA Salako, AO Adisa, OS Ojo, AO Arigbabu
October-December 2007, 14(4):352-354
Kaposi's sarcoma (KS) was previously a relatively rare disease. With the advent of HIV/AIDS pandemic however, AIDS-related KS has been on the increase and so has interest in the disease. Ninety per cent of patients with KS present with skin lesions. While the gastrointestinal tract is a fairly common site of metastatic KS, primary gastrointestinal KS is uncommon. The presentation of gastrointestinal KS with severe gastrointestinal bleeding is rarer still. In this report, we present a 56yr old HIV-negative patient who presented with severe gastrointestinal bleeding without any skin lesions. Multiple haemorrhagic polypoidal lesions were found on the walls of the jejunum and ileum as well as the liver at exploratory laparotomy and these were found to be KS on histopathologic examination. We also discuss the diagnostic and therapeutic challenges we had with this rare cause of severe GI bleeding.
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The use of thromboembolic prophylaxis by surgeons: A multicentre Nigerian study
VI Akinmoladun, JT Arotiba, OA Fasola, TO Alonge, FO Oginni, ON Obuekwe
October-December 2007, 14(4):330-335
BACKGROUND: Despite the well known contributions of deep vein thrombosis and pulmonary embolism to perioperative deaths, these major causes of morbidity and mortality appear not to be given adequate attention by surgeons in our environment. OBJECTIVE: To study the practice of thromboembolic prophylaxis among surgeons in some sub-specialties in three Nigerian tertiary institutions. MATERIALS AND METHODS: A structured questionnaire was used to collect information from consultants in the surgical sub-specialties on the use of thromboembolic prophylaxis in their practice. RESULTS: Fifty nine adequately completed questionnaires were returned. Of this, only 28 (47.5%) used prophylaxis routinely in major surgeries. Use was most frequent in orthopaedics and least in ophthalmology and otorhinolaringology. Subcutaneous heparin was the most commonly employed agent and the most important indication for prophylaxis was a previous history of thromboembolism. CONCLUSION: The results obtained suggest low use of prophylaxis. Evidenced-based guidelines are available on antithrombotic and thrombolytic therapy with the benefits outweighing risks, burdens and costs. Therefore greater attention should be paid to antithrombotic measures by all the surgical sub-specialties and patients stratified according to risk.
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