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   2011| April-June  | Volume 18 | Issue 2  
    Online since November 24, 2015

 
 
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ARTICLES
An overview of Cleft care in Nigeria
A Butali, WL Adeyemo
April-June 2011, 18(2):151-153
This is an overview of the present state of cleft lip and palate care in Nigeria. The aim is to stimulate further discussions on the need to improve standard of care and quality of life in patients with cleft lip and palate deformities. The number of cleft surgeries and surgeons involved in cleft repairs across Nigeria is increasing due to availability of free treatment grants provided by non-governmental organisation; therefore, it has become imperative to assess the quality of surgery and quality of cleft care. It is expected that as the number of repaired cleft lip/ palate increases, more patients will require secondary repair, speech therapy, and orthodontics therapy and orthognathic surgery. The following recommendations are made to improve the standard of cleft care in Nigeria: establishment of multidisciplinary team approach, formulation of policy on quality control, establishment of fellowship training in cleft care and establishment of regional specialised cleft care centre.
[ABSTRACT]   Full text not available  [PDF]
  634 97 -
Bowel preparation for colonoscopy: Enema versus Sodium Phosphate
OI Alatise, AO Arigbabu, OO Lawal, DA Ndububa, EA Agbakwuru, OS Ojo, O Adekanle
April-June 2011, 18(2):134-140
Background: Colonoscopy is considered to be the gold standard investigation for assessing the colonic mucosa. Good bowel preparation is essential in order to achieve optimal visualisation of the mucosa. Traditionally water enema is used for bowel preparation in most centres in Nigeria. This prospective study was performed at the Gastrointestinal Endoscopy Unit of Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria between July 2008 and June 2009. Aims and objectives: This study compared patients' tolerability, adverse effects, efficacy and mean duration of colonoscopy of water enema and sodium phosphate (NaP) for bowel preparation toward colonoscopy. Patients and Methods: Standard structured questionnaire was completed by 64 patients and the colonoscopist assessing tolerability, adverse effect, efficacy and mean duration of the procedure. Results: There were sixty four patients aged between 22 to 86 years. The mean age was 58.16 ΁ 15.790. Thirty eight (59.4%) patients were in patients and 26 (40.6%) were out patients. Forty one (64.1%) patients had water enema while 23 (35.9%) patients were included in the NaP group. The median age for patients in both groups was 62.0 years. Patients in NaP group rated their bowel preparation as more tolerable and found the dietary restriction much easier than those in water enema group (p<0.0001). Better colon cleansing score was found in patient in NaP group as compared with those in water enema group in all region of the colon. The procedure took significantly longer time in patients in water enema group as compared with those in NaP group (p<0.0001). Conclusion: NaP has a better bowel cleansing score for colonoscopy than water. It has better tolerability, side effect profile, efficacy and gives a shorter mean duration for the procedure.
[ABSTRACT]   Full text not available  [PDF]
  584 126 -
Prevalence of Chronic Bronchitis and Tobacco Smoking in some Rural Communities in Ekiti State, Nigeria
OO Desalu
April-June 2011, 18(2):91-97
Aims and objectives: The objective of this study was to determine the prevalence of chronic bronchitis (CB) and its association with sociodemographic factors and tobacco smoking in some rural communities in Ekiti state, Nigeria. Subjects and methods : This is a cross sectional study among adults aged e" 35 years in the three selected rural communities in Ekiti state, South West, Nigeria from January 2009 to March 2009.The subjects were selected by multistage cluster sampling method .The European Coal and Steel Community (ECSC) questionnaire was adapted and administered by trained health workers to obtain sociodemographic information, respiratory symptoms, history of tobacco smoking, occupational exposure to dust and housing. Results: Of the 391 subjects that participated in the study, 135(34.5%) were males and 256(65.5%) were females; the mean age of the subjects was 55.5΁ 10.2 year. Twenty two subjects (5.6%) met the case definition of CB. Nine (6.7%) of the 22 were males and 13(5.1%) were female. None of the current smokers had CB, while 36.4% of those with CB were former smokers. The multivariate logistic regression analysis showed that aged 65-74 (OR= 9.66, 95% C.I 3.43-27.20), aged e"75 years (OR= 3.88, 95% C.I 1.08-13.98) and tobacco smoking (OR= .37 95% C.I 2.12-19.14) had the strongest association with CB. Poor housing (OR=1.80; 95% C.I 0.56-6.51), occupational exposure to organic and inorganic dust (OR= 1.74; 95% C.I 0.67-4.60) and Low socioeconomic status (OR=1.72; 95% C.I 0.29-10.88) were also independently associated with CB. Sex and level of education were not associated with CB. Conclusion: The prevalence of chronic bronchitis in this study was 5.6 % and is comparable to previous studies worldwide. Apart from old age which is not modifiable, other associated factors with CB like tobacco smoking, low socioeconomic status, poor housing and exposure to dusts can be modified to prevent the disease.
[ABSTRACT]   Full text not available  [PDF]
  583 101 -
Observations on Early and Delayed Colostomy Closure
AO Tade, BA Salami, BA Ayoade
April-June 2011, 18(2):118-119
Background: T raditional treatment of a variety of colorectal pathologies had included a diverting colostomy that was closed eight or more weeks later during a readmission. Aims and objectives: The aim of this retrospective study was to determine the outcomes of early colostomy closure and delayed colostomy closure in patients with temporary colostomies following traumatic and non-traumatic colorectal pathologies. In this study early colostomy closure was the closure of a colostomy within three weeks of its construction, while delayed colostomy closure referred to closure after 3 weeks. Patients and methods: Complete records of the 37 adult patients who had temporary colostomy constructed and closed between Jan. 1997 December 2003 for various colorectal pathologies were studied. Results: Fourteen patients had early colostomy closure while 23 had delayed closure. In the early colostomy closure group there were 10 men and 4 women. The mean age of the patients was 28yr with a range of 18 - 65yr. Colostomies were closed 9 - 18days after initial colostomy construction. There was no mortality. Morbidity rate 28.6% (4 out of 14). There were two faecal fistulas (14.3%). Twenty-three patients had delayed colostomy closure 8 weeks to 18 months after initial colostomy construction. These were patients unfit for early surgery after initial colostomy construction because of carcinoma, significant weight loss, or sepsis. There was no mortality. Morbidity rate was 26.1%. There were 3 faecal fistulas (13.2%). Conclusion: Outcomes following early colostomy closure and delayed closure were comparable. Patients fit for surgery should have early closure whilst patients who may have compromised health should have delayed closure.
[ABSTRACT]   Full text not available  [PDF]
  597 65 -
Awareness and Practice of Safety Precautions among Healthcare Workers in the Laboratories of two Public Health Facilities in Nigeria
A Fadeyi, A Fowotade, MO Abiodun, AK Jimoh, C Nwabuisi, OO Desalu
April-June 2011, 18(2):141-146
Aims and objectives : To determine the level of awareness and practice of SP among laboratory workers at two tertiary public health facilities in Nigeria. Methods : A semi-structured, self-administered questionnaire was used to assess the awareness, attitude and adherence to SP among laboratory workers. Information on the availability of safety equipment was also sought. The laboratory safety practice of respondents was assessed based on self-reported observance of basic principles of universal precautions in clinical settings. Results : Study participants were 130, mean age: 28.2 years (SD΁6.6), number of years in hospital employment: 3.7 years (SD΁2.4) and the male to female ratio was 1.8:1. Many (41.5%) were unaware and 25.4% do not observe SP. Participants attest to availability of various safety devices and equipment including hand gloves (86.2%), disinfectants (84.6%), HBV immunisation (46.2%) and post exposure prophylaxis (PEP) for HIV and HBV (79.6%). Attitude to safety is unsatisfactory as 60.0% eat and drink in the laboratory, 50.8% recap needles and 56.9% use sharps box. Even though 83.1% are willing to take PEP, only 1.5% will present self following laboratory injury. Conclusion : This study shows the deficit in the awareness of SP among laboratory personnel and demonstrates that attitude and practice of safety rules are unsatisfactory. Training and re-training on SP is therefore desired. Counselling to induce a positive attitudinal change on HBV immunisation and PEP is similarly necessary.
[ABSTRACT]   Full text not available  [PDF]
  579 75 -
Prostate diseases in Lagos, Nigeria: A histologic study with tPSA correlation
CC Anunobi, OR Akinde, SO Elesha, AO Daramola, KH Tijani, RW Ojewola
April-June 2011, 18(2):98-104
Objective: To present a 10year retrospective histologic study of prostate diseases in Lagos, Nigeria. The aim is to document the prevalence, histologic pattern, age distribution and PSA values of prostatic diseases. Materials and methods : The materials consisted of slides, paraffin embedded tissue blocks, patients case files and histology request forms of all prostatic biopsies received at the Morbid Anatomy department of Lagos University Teaching Hospital Idi-Araba, Lagos from 1999 to 2008. Each sample represents a different patient. Results: Prostatic biopsies comprised 3.6 % of all biopsies in LUTH. BPH was the commonest prostatic lesion and accounted for 70.9% of all cases. The age range was 40 to 94 years with a mean of 67 years and a peak age group at 60-69 years. Stromoglandular pattern was the most common histological type of BPH accounting for 72.2 %( 393) of the cases. Malignant tumours constituted 28.9% of all prostatic biopsies. Most (93.7%) of these malignancies were seen in trucut biopsies. Adenocarcinoma accounted for 99.1% of the total 222 malignant tumours. It showed an age range of 40 to 98 years, a mean age of 66 years and peak prevalence in the 60-69 year age group. Gleason score nine was the most frequent (16.8%) in occurrence. Most adenocarcinomas were poorly differentiated (40%). Incidental carcinoma was seen in 4.2% of prostatectomy samples. High grade PIN was seen in 19.1% of adenocarcinoma cases. The most common inflammatory lesion was chronic non-specific prostatitis accounting for 76.4% of all inflammatory lesions. Malignant and benign lesions were accountable for PSA levels of 1 to 49.9ng/ml while values of 50ng/ml and above were seen exclusively in malignant lesions. . Conclusion : Prostatic lesions constitute a significant source of morbidity among adult males in Lagos. Adenocarcinoma is the commonest histologic subtype of prostatic cancer and most are of poorly differentiated variety. Elevated levels of tPSA in Nigerian males may be as a result prostate cancer, BPH or BPH with prostatitis. PSA should in our opinion be used as a component of a strategy integrating multiple diagnostic approaches for prostate cancer screening and not to be used alone in our environment.
[ABSTRACT]   Full text not available  [PDF]
  576 77 -
Stroke Mimics which complicate the Clinical Management of 'Stroke Patients'
BI Ogungbo, FI Ojini, D Okor, OB Bankole
April-June 2011, 18(2):147-150
Not all patients presenting as 'stroke patients' have cerebrovascular disease, as some conditions mimic stroke clinically. A significant degree of misdiagnosis of stroke has been documented. Clinical presentation of patients with stroke mimics can confound emergency care physicians and lead to significant morbidity and mortality for the patient, if unrecognised. We highlight some conditions that can mimic stroke emphasising ways in which these stroke mimics can be differentiated from stroke. Correct identification and management of these conditions can reduce morbidity and mortality in 'stroke patients'.
[ABSTRACT]   Full text not available  [PDF]
  583 66 -
Effect of the Aqueous extract of entandrophragma utile Bark on gastric acid secretion in Ghosh and Schild rat preparations
Theresa A John, AO Onabanjo
April-June 2011, 18(2):111-117
Aims and objectives: The reduction of aggressive factors such as gastric acid is considered a key target of gastrointestinal protection. We investigated the antisecretory effect of the aqueous bark extract of E. utile, a Nigerian traditional medicinal preparation used for ulcers. Methods: Male rats were anesthetized and cannulated for intragastric perfusion of saline and test agents as well as for infusion of histamine into the jugular vein. Gastric effluents were collected every 30 min and 10 ml aliquots were titrated against 0.01 N NaOH using phenol red indicator. Gastric acidity was deduced from titre values. Histamine in saline was infused for 2 h at a rate of 1 x 10-4 g kg- 1 min -1 to stimulate acid secretion. In one set of animals, cimetidine in saline was simultaneously perfused intragastrically for 2 h at the rate of 2.5 x 10-3 g kg-1 h-1. Similarly, rats in other sets were simultaneously perfused intragastrically with either the aqueous fresh bark extract of E.utile or the decolorized extract for 2 h at a rate of 1.5 x 10-3 g kg-1 h-1. The extract was also perfused in rats that had established peak gastric acid output with prior infusion of histamine. Results: Mean basal acid output per 0.5 h was 20.2 ΁ 1.9 mEq. Peak measurement fluctuated within a range of 114 - 117 mEq 0.5h-1 and was maintained for more than 5 h. Cimetidine or E. utile prevented the rise to peak output that histamine produces. Using the 2-tailed paired t-test, the inhibitory effects of either cimetidine or E. utile was significant (p<0.05) at 60 min. E. utile significantly caused greater inhibition of histamine stimulated gastric acid output than cimetidine at 120 min (p<0.05). When the extract was given after establishment of peak output, the gastric acidity dramatically fell to below the basal level. Conclusion: The aqueous bark extract of E. utile contains one or more active component(s) that can be developed as antisecretory medication for hypersecretory states or for protection of the compromised gastrointestinal mucosa.
[ABSTRACT]   Full text not available  [PDF]
  572 58 -
Symphysiotomy- A Dying Art: The Experience at Federal Medical Centre Umuahia Nigeria
GC Nkwocha, CC Umezurike
April-June 2011, 18(2):126-129
Aims and objectives: To review the indications, outcome and complications of symphysiotomy done in Federal Medical Centre Umuahia during the study period. Patients and methods: This study is a 5-year review of all women who had symphysiotomy at Federal Medical Centre Umuahia. The total number of the procedure performed, and all the deliveries conducted at the hospital in the study period were obtained from the labour ward register. The case notes of the patients were then retrieved and their biodata and other relevant information were obtained and summarized in frequency tables and percentages. Results: Ten (10) symphysiotomies were performed among 3702 deliveries conducted during the period under review giving a rate of 0.27%. per cent of the patients were aged 30 years and below, mean age was 26 (΁ SD4.9) years. Most of the patients were multiparous women, only one was grandmultiparous. All were for mild to moderate cephalopelvic disproportion (CPD). In one particular case, the patient also presented with retained second twin. They were all unbooked patients. Main complication was pelvic and leg pain but there were two cases of vesicovaginal fistula which may be a complication of obstructed labour since leakage of urine did not start immediately after the procedure. The birth weight of the babies ranged from 3kg to 4.2kg. There was no maternal mortality but two fresh stillbirths were recorded giving a perinatal mortality rate of 200 per 1000 total births. Conclusion: Symphysiotomy if done by a trained person, in well selected patients is still safe and can be life saving in environments where caesarean delivery is not well accepted and late presentation is common.
[ABSTRACT]   Full text not available  [PDF]
  566 63 -
Migrating Foreign Body in the Tracheobronchial Tree of Children: Report of Two Cases
O Oviawe, BI Abhulimhen-Iyoha, DE Obaseki
April-June 2011, 18(2):154-157
Tracheobronchial foreign bodies (FBs) especially in infants and children can cause respiratory obstruction and can lead to death if intervention is delayed. Two cases of migrating FBs in the tracheobronchial (T-b) tree with fatal outcome are reported: Case 1 was an 11-year-old girl with a ten-week history of episodes of fever, cough, breathlessness and progressive weight loss. No positive history of FB aspiration. She was cachetic and febrile with short attention span, dyspnoeic, a flattened left upper hemithorax, mediastinal shift and evidence of atelectasis. Case 2, a 5-year-old girl with a three-month history of aspiration of a tiny toy. She developed fever, cough and marked weight loss, developed severe respiratory distress three days prior to presentation. She was febrile, had grade II finger clubbing, markedly dyspnoeic, left mediastinal shift, and evidence of left sided atelectasis. X-ray films in Case 1 showed evidence of FB at various locations in the T-b tree, and complete opacification and atelectasis of left hemithorax in Case 2. Planned bronchoscopy could not be done as both patients were adjudged to be too severely ill for the procedure. Both patients died after 9 days and 8 hours of hospital stay, respectively. Postmortem revealed FB in right main bronchus in both patients (tooth and toy, respectively) and evidence of tuberculosis in Case 2. Fatal outcome is attributed to inappropriate healthcare seeking behaviour, lack of medical expertise and material resources in our health facilities.
[ABSTRACT]   Full text not available  [PDF]
  557 67 -
Non puerperal Uterine inversion due to Submucous Fibroid: A Case Report
Olufemi M Omololu, Kabiru A Rabiu, Mustapha A Quadri, Muyideen O Oyedeko, Yejide M Fatogun
April-June 2011, 18(2):158-160
An unusual case of non-puerperal uterine inversion is presented. The patient, a 37 year old multipara who had been earlier diagnosed with uterine fibroids, subsequently developed a protrusion from the vagina having declined surgery. The mass had become necrotic and infected at the time of presentation. Uterine inversion was diagnosed clinically and further confirmed at surgery where a vaginal hysterectomy was carried out. Uterine inversion is a rare condition not encountered by most gynaecologists. Diagnosis and treatment could thus be challenging. The literature on non-puerperal uterine inversion regarding the evaluation and management is reviewed.
[ABSTRACT]   Full text not available  [PDF]
  559 64 -
Prophylaxis Versus pre-emptive Antibiotics in third Molar Surgery: a randomised control study
AA Olusanya, JT Arotiba, OA Fasola, AO Akadiri
April-June 2011, 18(2):105-110
Objectives: This study was carried out to compare the efficacy of preoperative single bolus antibiotics with a 5 day- postoperative antibiotic regimen in reducing pain, swelling, and trismus, surgical site infection (SSI) and alveolar osteitis (AO) after third molar surgery. Patients and methods: A randomised experiment was done involving eighty-four patients. The patients were divided into two groups consisting of 42 patients each. A preoperative group was given an oral bolus of 2g amoxycillin capsules and 1g metronidazole tablets one hour before extraction, while those in the postoperative group were given a five-day regimen oral 500mg amoxycillin capsules thrice daily and 400mg metronidazole tablets thrice daily. The occurrence of postoperative pain, swelling, trismus, SSI and AO were compared between the groups. Results: Seventy-nine patients completed the study; 38 patients in the preoperative group and 41 patients in the postoperative group. There was no difference between the groups in respect of the inflammatory complications. The four cases of AO occurred in the preoperative group. Conclusion:Single bolus antibiotic prophylaxis should be adequate for most cases of third molar surgery as the degree of degree of postoperative pain, swelling and trismus was similar in both groups. The use of single bolus antibiotic prophylaxis would also help reduce the cost of treatment in developing countries as well as reduce the risk of development of resistant strains. However, a five-day postoperative antibiotic regimen is advised in patient with risk factors for AO.
[ABSTRACT]   Full text not available  [PDF]
  539 84 -
Bacterial Isolates in Blood Cultures of Children with Suspected Septicaemia in Kano: A Two -Year Study
SI Nwadioha, E Kashibu, OO Alao, I Aliyu
April-June 2011, 18(2):130-133
Aims and Objective : Septicaemia is a common condition in children with a resultant high morbidity and mortality. The gold standard for diagnosis of septicaemia is the isolation of bacterial agents from blood cultures. The study was done to determine the common aetiology of septicaemia in children and their antibiotic susceptibility pattern in Kano, Nigeria. Materials and Methods : A retrospective study with a review of blood culture reports of paediatric patients aged 0-15 years, suspected of septicaemia, from October 2006 to October 2008 in the Medical Microbiology department of Aminu Kano Teaching Hospital Kano. Kano. Nigeria was carried out. Results : Out of a total of 3840 blood culture samples, only 18.2% (n=700) was culture positive. Gram - negative and gram - positive bacteria constituted 69.3% (n=2661) and 30.7% (n=1179) respectively. The most prevalent bacterial isolates were Escherichia coli with 44.3% (n=310/700) and Staphylococcus aureus 30.7% (n=215/700). Escherichia coli were sensitive to ceftriaxone, ciprofloxacin, gentamicin and clavulinate - amoxyl . Conclusion : The commonest bacterial isolate from blood culture of children with suspected septicaemia in Kano is Escherichia coli. The most sensitive and preferable among the tested antibiotics is ceftriaxone. Rational use of antibiotics with regular antibiotic susceptibility surveillance studies is recommended to maintain high antibiotic therapeutic profile.
[ABSTRACT]   Full text not available  [PDF]
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Knowledge and Attitude of PLWHA concerning Oral lesions of HIV/AIDS among patients of PEPFAR Clinic in Lagos University Teaching Hospital (LUTH) Lagos, Nigeria
GA Agbelusi, HA Adeola, PO Ameh
April-June 2011, 18(2):120-124
Introduction: Oral manifestations in Human Immunodeficiency virus/Acquired Immunodeficiency Disease Syndrome (HIV/AIDS) are associated with adverse effects on quality of life such as pain, difficulty in eating, bad breath, altered taste and sometimes altered appearance. There is also a predisposition to poor nutrition which confers an additional burden on the body's immune defences and the ability to fight off infections. Knowledge of the oral lesions will enable People Living with HIV/AIDS (PLWA) to seek dental treatment on time. Aims and objectives: To assess the general knowledge of HIV/AIDS, its oral manifestations and willingness to know more about its oral lesions among people living with HIV/AIDS (PLWHA) in Lagos, Nigeria. Patients and methods: A structured questionnaire was administered to two hundred and thirty-five patients (235) who were randomly selected from attendees at an NGO clinic supporting PLWHA in Lagos. Results: Majority of the participants exhibited poor knowledge of the oral manifestations of HIV/AIDS although many of them had fair knowledge of the general symptoms of HIV/AIDS. The high educational status of the subjects seemed to play little role in awareness of oral manifestations in HIV/AIDS as only 45(21.4%) of the participants had good overall knowledge having a range of 25- 31 correct answers out of 210 participants. Many of the respondents (145, 69%) wish to know more about oral lesion of HIV/AIDS. Conclusion: Although there is a high awareness of the general symptoms of HIV/ AIDS in the study group, there is poor awareness of the oral manifestations, their presentations and management. The study also showed that PLWHA would be willing to know more about the oral manifestations of HIV/AIDS and seek dental care for their management.
[ABSTRACT]   Full text not available  [PDF]
  539 68 -