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   2010| October-December  | Volume 17 | Issue 4  
    Online since May 3, 2016

 
 
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ARTICLES
Comparison of topical lidocaine [2% gel] and injectable lidocaine [2% solution] for incision and curettage of chalazion in Ilorin, Nigeria
OO Osayande, AO Mahmoud, BO Bolaji
October-December 2010, 17(4):270-276
AIMS AND OBJECTIVES: To compare the efficacy and side effects profile of topical 2% lidocaine gel with injectable 2% lidocaine solution as local anaesthetics for incision and curettage of chalazion. PATIENTS AND METHODS: Overa 12 month period, 61 patients with unilateral chalazia who were scheduled for incision and curettage surgery under local anaesthesia were randomized into 2 groups: A & B. Group A received 1.5 ml of injectable lidocaine as local anaesthetic while Group B received 1.5 ml of lidocaine 2% gel topically. The major outcome of interest was pain experienced during anaesthetic administration and surgery. RESULTS: Mean pain score from anaesthesia administration was significantly higher in the injection group (A = 4.46 vs. B = 0.57), (p = 0.000005). There was a statistically significant difference in mean pain score during incision and curettage with more pain in the gel group (A = 2.84 vs. B = 4.83), (p =0.0012). However, the mean total pain score (surgery plus anaesthesia) was more in the injection than the gel group (A = 7.3 vs. B = 5.4) (p = 0.0094). The proportions that had no fear for injection were 54.8% in A and 56.7 % in B. Group A had significantly more ptosis than Group B (2.2 vs. 1.4, p = 0.00003,). Bleeding occured in 93.5% in group A while none occurred in Group B (p = 0.000). CONCLUSION: Lidocaine 2% gel is an effective, safe and convenient alternative to injectable lidocaine 2% as local anaesthetic agent in incision and curettage for Chalazion in this study.
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Cardiovascular autonomic reflex function in sickle cell anaemia patients.
EO Sanya, A Soladoye, TO Olanrewaju, PM Kolo, I Durotoye
October-December 2010, 17(4):266-269
AIMS AND OBJECTIVES: Cardiovascular autonomic dysfunction (CAD) has been documented as part of neurological complications in sickle cell anaemia (SCA). There is little information on CAD from sub-Saharan Africa with 25-40% prevalence rate of sickle cell trait. This study therefore assessed cardiovascular autonomic reflex function in a group of Nigerians with SCA. SUBJECTS AND METHODS: Forty SCA and 44 controls (Hemoglobin AA) were studied. They were assessed using 6 non-invasive cardiovascular autonomic reflex (CAR) tests. Parasympathetic functions were assessed with heart rate variability (HRV) to deep breathing, Valsalva maneuver and lying-to-standing test while sympathetic blood pressure regulation was assessed by systolic and diastolic blood pressure responses to lying-to-standing position and isotonic handgrip test. RESULTS: Mean haemoglobin (Hb) concentration of SCA patients and controls were 8.4 +/- 2.4 g/dl and 13.1 +/- 0.9 g/dl, respectively. Baseline heart rate was significantly faster in the SCA patients (84 +/- 12 beats/minute) than in controls (76 +/- 11 beats/minute) [P < 0.05]. Eleven SCA compared to 2 controls had abnormal responses to deep breathing test (P = 0.003); 15 SCA and 6 controls had impaired Valsalva ratio (P = 0.01); 8 SCA and 4 controls had abnormal responses lying-to-standing test (P = 0.2). Although, more SCA patients compared to controls had abnormal responses to sympathetic mediated blood pressure tests the difference was insignificant (P > 0.05). Overall 21 (53%) SCA patients compared to 4 control subjects (9%) fulfilled the criteria for cardiovascular autonomic neuropathy (presence of e"3 CAR tests) with p < 0.05. CONCLUSION: CAN occur in Nigerians with SCA with relative preservation of the sympathetic blood pressure reflex control compared to parasympathetic heart rate regulation. Increase baseline heart rate associated with SCA in the presence of chronic anaemia could result in myocardial hypertrophy and dilatation. This is likely to be predispose sicklers to hypoxia-related arrhythmia.
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Determinants of mortality of preterm babies in the university of Ilorin Teaching Hospital, Ilorin Nigeria
BM Suleiman, OA Mokuolu, OO Adesiyun, A Adeniyi
October-December 2010, 17(4):291-296
AIMS AND OBJECTIVES: A prospective study to identify the determinants of mortality among 185 preterm babies at the University of Ilorin Teaching Hospital, Ilorin. SUBJECTS AND METHODS: Data on 185 preterm babies and their mothers were collected over a nine month period in a tertiary hospital to identify the determinants of mortality among these babies. RESULTS: Factors identified as significant determinants of mortality were severe perinatal asphyxia (p = 0.000; OR = 71.31; 95% CI = 17.63-308.24), apnoea (p = 0.000; OR = 178.20; 95% CI = 20.64-7709.02), necrotizing entero-colitis (p = 0.001) and resuscitation duration (p = 0.003; OR = 5.33; 95% CI = 1.62-19.02). CONCLUSION: The primary causes of death are severe perinatal asphyxia, respiratory distress syndrome and infection. In Nigeria, survival below 28 weeks gestation is less than 20%. The findings in this study highlight the need for prompt and effective resuscitation of these infants by a trained health worker with verifiable competence in newborn resuscitation. It also highlights the need for availability of functional facilities like ventilators and resources like surfactant.
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Comparison of normative and self-perceived dental needs among adolescents in Lagos, Nigeria
EA Akaji, SO Jeboda, FA Oredugba
October-December 2010, 17(4):283-286
AIMS AND OBJECTIVES: Professionally determined needs as well as self-perceived oral health needs play significant roles in the assessment of needs for dental care. The aim of this study was to compare the self-perceived oral health needs by the adolescents with professionally determined needs by the oral health-care giver. SUBJECTS AND METHODS: This was a community-based cross-sectional study involving 504 adolescents who were selected through multistage random sampling from secondary schools in Lagos State. Self-assessed oral health needs was measured by the participants' response to the question(s): How can you describe the condition of your teeth/gum? Their response was compared to the findings of an intra-oral examination of the participants (after an informed consent) carried out under field conditions by one examiner employing DMFT and CPITN indices for Dental Caries and Periodontal status respectively. RESULTS: The prevalence of Dental Caries was 11.9% while that of Periodontal disease was 60.4%. The Sensitivity, Specificity, Positive and Negative Predictive Values for Dental Caries were 30%, 85%, 21.4% and 89.9% respectively; and 21.7%, 80.9%, 63.4%, and 32.9% respectively for Periodontal status. CONCLUSION: Self-perceived oral health needs assessed by questionnaire among adolescents was found to be at variance with the clinically determined needs. Promotion of oral health awareness among adolescents with emphasis on recognition of signs and symptoms of common dental diseases using the school as a base is strongly advised.
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Knowledge and practice of family planning among antenatal care attendees at Nnewi, south east Nigeria
AO Igwegbe, JO Ugboaja, EN Monago
October-December 2010, 17(4):287-290
AIMS AND OBJECTIVES: Entrenching an effective family planning program has being a major challenge in Sub Saharan Africa. Determining the knowledge, attitude and practice of family planning among the women is very necessary in order to achieve success. The aim of this study iS to determine the knowledge, and practice of family planning among antenatal women in Nnewi, South East, Nigeria. A descriptive cross sectional study of 356 women attending antenatal clinic at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria was carried out over a 5-month period. MATERIALS AND METHODS: With the aid of pre-tested interviewer-administered semi structured questionnaires, information on biosocial characteristics, knowledge of, and practice of family planning as well as sources of information on family planning were obtained from the respondents. Data was analysis was done with Epi info statistical package, version 3.5.2 (2008) RESULTS: Three hundred and forty (95.5%) of the respondents knew about family planning out of which 260 (76.5%) had ever used a modern method. The male condom (256; 75.3%) and the natural method (Billings method) (150; 44.1%) were the commonly known methods. Also the commonest used methods were the male condom (144; 55.4%) and Billings method (96; 36.9%). Birth spacing (248; 72.9%) and limiting births (138, 40.6%) were mainly identified as the benefits of family planning and only 6 (1.7%) of the respondents identified family planning as being important in the reduction of maternal mortality. The major sources of information on family planning were health workers (224; 65.9%) and the radio (126; 37.1%). CONCLUSION: The knowledge and practice of family planning has improved among our women. However, the methods commonly used are those associated with high failure rates. Family panning program managers should recognize this limitation. There is need for public sensitization on the correct use of the Billings method and the male condom. Ultimately, our women should be encouraged to accept the more reliable methods of family planning.
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Awareness, practice of safety measures and the handling of medical wastes at a tertiary hospital in Nigeria
SO Samuel, OO Kayode, OI Musa
October-December 2010, 17(4):297-300
AIMS AND OBJECTIVES: The study is prompted by the significant public health impact of continuing rise in the emerging and re-emerging infectious diseases.and to determine the awareness and practice of safety measures in the handling of medical wastes among health workers in a teaching hospital. MATERIALS , SUBJECTS AND METHODS: Stratified sampling technique was used to choose 325 respondents from different professional groups and cadres of health workers and these included medical doctors, nurses/midwives, laboratory workers, ward attendants, porters, cleaners and laundry workers at the University of Ilorin teaching hospital between January and June 2008. Simple random sampling method by balloting was used to select subjects in each group. Data was collected using structured, self administered questionnaires which considered all the variables under study. Data collected were analyzed using Epi-Info computer software program. RESULTS: Three hundred and twenty five (325) questionnaires were administered, out of which 320 were returned giving a response rate of 98.5%. Respondents are nurses 128 (40.0%), doctors 107 (33.4%) and pharmacists 10 (3.1%). Years of work experience ranged from 3 to 27 years with respondents who had working experience between 11 to 15 years constituting over one quarter, 88 (27.5%) while those below 5 years were 8 (2.5'%). Two hundred and ninety eight (93.0%) respondents knew about hospital wastes while 193 (60.3%) only knew about general wastes. Majority of the health workers have appreciable knowledge of collection, minimization and personal risks associated with hospital wastes 299 (93.4%), 302 (94.4%) and 311 (97.2%) respectively. The most common routine safety practice is putting on protective clothing. CONCLUSION: This study revealed a high level of awareness of hospital wastes among health workers; however, the practice of standard safety measures was low. It is recommended that hospital wastes disposal and management policy be formulated and appropriate committee constituted to monitor compliance with the policy and create awareness among health workers on this policy and its implementation through training and re-training.
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Left ventricular systolic function in a Nigerian pre-dialysis patient population with chronic kidney disease
EB Arodiwe, IL Ulasi, CK Ijoma, SO Ike
October-December 2010, 17(4):301-307
AIMS AND OBJECTIVES: This study evaluates left ventricularsystolic function (LVSF) and factors affecting it in CKD patients at first presentation, using two dimensional echocardiography. PATIENTS AND METHODS: One hundred consecutive patients with CKD who were presenting to the medical outpatient and renal clinics of university of Nigeria teaching hospital, Enugu for the first time, who satisfied the study criteria were screened. Eighty six patients completed the study. Forty-eight sex matched hypertensive patients with normal renal function and forty-six age and sex matched subjects (with normal blood pressure and renal function) were selected as controls. Clinical and laboratory parameters and echocardiographic indices were measured. RESULTS: Left ventricular systolic dysfunction (LVSD) was present in 13 (15.1%) of CKD patients and 4 (8.3%) of hypertensive patients (p < 0.001). The mean fractional shortening in CKD patients (35.1 +/- 10.4%) was significantly lower than the hypertensive patients (40.1 +/- 9.8), p = 0.008. Positive correlation was found between fractional shortening (FS) and estimated glomerular filtration rate, haemoglobin level, CKD stage, diastolic blood pressure, serum albumin and systolic blood pressure.(r = 0.281, P < 0.001; r = 0.277, p < 0.001; r = 0.270, p = < 0.001; r = 0.237; P = 0.001; r = 0.230, p = 0.002; and r = 0.199, p = 0.007) respectively. Left ventricular mass index and mean arterial blood pressure, correlated negatively with LV systolic function (r = -0.315, P < 0.001; and r = -0.223, P Stepwise multiple regression analysis showed that of all the factors that correlated with LVSF. CONCLUSION: This study has shown that LVSF is impaired in a significant number of our CKD patients at presentation.
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Dysplasia epiphysealis hemimelica: a case report
AA Kawu, AO Salami, ME Ugbeye, K Olawepo, A Adesanya
October-December 2010, 17(4):313-315
AIMS AND OBJECTIVES: To report the clinical presentation, course, management and associated pathology of DEH seen at the National Orthopaedic Hospital Lagos. PATIENT AND METHODS: Case review was employed to report the association of an incidental radiologic finding of asymptomatic DEH with Blount disease. RESULTS: This case is an 11-year-old girl with asymptomatic DEH of both ankles associated with right unilateral Blount disease. The incidental pathology is conservatively managed following the surgical treatment of the Blount disease which is the symptomatic pathology. CONCLUSION: DEH is an uncommon pathology usually an incidental radiologic finding which may or may not be associated with other skeletal pathologies. The management is essentially conservative but surgery is an option when symptomatic.
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Microhardess and depth of cure of a spectrum of light-cure composite resins: a comparative study
AO Arigbede, K Baroudi, DC Watts
October-December 2010, 17(4):277-282
AIMS AND OBJECTIVES: To determine the proportion of composite resin materials that is capable of bulk or large incremental cure. MATERIALS AND METHODS: This study was carried out at the Dental Biomaterials and Biomechanics Laboratory, Dental School, University of Manchester, England. Six randomly selected composite resins and one experimental sample were employed for this study. The technique employed by Watts et al. was employed for the study. Knoop hardness number (KHN) was measured as a function of depth of the material at 0.2 mm intervals. One-Way ANOVA test and linear regression were used for statistical analysis. RESULTS: Clearfil Majesty Posterior has the highest value for microhardness and depth of cure while Els extra low shrinkage A3 has the lowest value for micro hardness and depth of cure. Estelite 0 and Clearfil Majesty Posterior (28.6%) have depths of cure greater than 3.0 mm and may, therefore, be capable of large incremental cure. Gradia Dentin and Els extra low shrinkage A3 (28.6%) have depths of cure lesser than 2.0 mm while Filtek Silorane (experimental material) has a depth of cure of 2.4 mm. NEUN and Els extra low shrinkage A2 have depths of cure of 2.3 and 2.5 mm respectively. CONCLUSIONS: It appears that Clearfil Majesty Posterior and Estelite 0 (28.6%) can effectively be cured in bulk or large increments. It is imperative to investigate the depth of cure of composite resin materials before using them in bulk or large increments.
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Assessment of interrelationship between poverty and blindness in Maiduguri, Nigeria
DY Ribadu, AO Mahmoud
October-December 2010, 17(4):308-312
AIMS AND OBJECTIVE: To assess the possible role of poverty as a cause and a consequence of blindness among blind individuals in Maiduguri, Nigeria. PATIENTS AND METHODS: Eighty-five consenting blind individuals living within 4 wards of Maiduguri had ocular examination to determine the cause of their blindness with a view to determining the avoidable nature (preventable and/or curable, were adequate resources available) of their blindness. A semi-structured questionnaire which captured their demographic data, antecedents of blindness and interventions (medical and rehabilitative) sought, access to welfare support services was also administered. Socio-economic status of the respondents was explored through information sought on educational attainment, employment status, means of livelihood, possession of personal assets, and estimates of monthly income. RESULTS: Blindness from the main causes were avoidable as they were either curable (cataract 41, 48%) or preventable (xerophthalmia 20, 23.5%; glaucoma 12, 14.1%; and trachoma 5, 5.1%). Only 8.2% of the subjects were employed, majority (75.3%) roamed the streets begging; and 69% lived on less than a dollar a day. Over three-quarters had no access to any form of welfare support. Majority (70.6%) did not have any personal asset. More than two-thirds had no formal education and over three-quarters had no access to health services. CONCLUSIONS & RECOMMENDATION: The avoidable nature of blindness in 78 (90%) of the subjects implicates poverty as a causative factor. In turn, the subjects' subsequent existence in poverty and destitution appear directly related to their blindness. We recommend an effective and comprehensive eye care service, and an intensification of poverty-alleviation measures.
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Myomectomy during second trimester pregnancy: a case report
P Isabu, J Eigbefoh, F Okogbo, S Okunsanya, R Eifediyi
October-December 2010, 17(4):324-326
The prevalence of leiomyoma during pregnancy is reported as approximately 2%. Although during pregnancy leiomyomas usually remain asymptomatic, they may complicate its course. The management of leiomyoma during pregnancy is medical, but in certain circumstances surgical intervention and myomectomy may be required. This 28-year-old primigravida presented with progressively worsening lower abdominal pain at 14 weeks gestational age. Ultrasonography demonstrated a large fundally sited multi lobulated fibroid extending up to the right hypochondrium. There was an intrauterine gestation compatible with her menstrual dates. Laparotomy confirmed a large leiomyoma showing benign degenerative changes. The operative procedure was successful, and the pregnancy progressed normally. She was admitted at 34 weeks gestation with a diagnosis of antepartum haemorrhage. She was managed conservatively in the ward until 37 completed weeks gestation when she had an elective caesarean section and delivered of a live male neonate with a birth weight of 2.7 kg. She had type III placenta praevia.
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Klippel-Feil syndrome: a case report
A Kawu Ahidjo, AO Salami Olayinka, O Ayokunle
October-December 2010, 17(4):320-323
OBJECTIVE: To report the clinical presentation and peculiarity of management of Klippel-Feil syndrome (KFS) at the University of Abuja Teaching Hospital, Gwagwalada. BACKGROUND: KFS is a rare pathology that has not been previously reported on in Nigeria. METHODS: Case review was employed to report this pathology. RESULT: This case is a 10 year old boy with KFS presenting with cosmetic blemish and scoliosis. Surgical treatment of the cosmesis was offered but patient defaulted because of fund due to their low income. CONCLUSION: KFS is an uncommon pathology in the male. The management is essentially conservative but surgery is an option if there was cervical spine instability, scoliosis and cosmetic blemish.
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Achalasia of the oesophagus in infancy: a case report
RA Arogundade, LC Abonyi, OF Ojo, EO Udo
October-December 2010, 17(4):316-319
BACKGROUND: Achalasia characteristically causes dismotility of the lower oesophageal sphincter and defective peristalsis of the body of the oesophagus, in response to the act of swallowing, as a result of ganglionic cells degeneration. The resultant oesophageal dilatation leads to food stasis and may cause oesophagitis and tracheobronchial aspiration. Achalasia is a rare occurrence in the paediatric age group and even more extremely rare in the neonate and young infant. Urgent radiologic evaluation of the underlying cause of persistent on-going vomiting in an infant is mandatory. OBJECTIVE: To emphasize the role of upper gastrointestinal imaging in infants with persistent on-going vomiting, severe dehydration and malnutrition through case illustration of a 9-month-old infant seen in a private medical outfit in Lagos. METHODS: Dilute barium oesophagogram, pre- and postoperatively, was performed in a 9-month-old infant and illustrative images were presented. Literature materials on achalasia of the oesophagus were reviewed and juxtaposed with findings in the illustrated case for discussion. RESULTS: Only 3 to 4 percent of achalasia is reported to occur in the paediatric age group with average duration of 28 months from onset of symptoms to diagnosis. Persistent vomiting and failure to thrive are common. Pneumatic dilatations and surgical myotomy are recommended treatment methods. CONCLUSION: Urgent upper gastrointestinal contrast study is appropriate in infants with suspected achalasia for successful management.
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