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   2013| July-September  | Volume 20 | Issue 3  
    Online since September 9, 2015

 
 
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ARTICLES
Torsion of the Testis and factors that determine the choice of Orchidectomy and unilateral Orchidopexy
AO Takure, OB Shittu, SA Adebayo, LO Okeke, EO Olapade-Olaopa
July-September 2013, 20(3):197-202
Aims and Objectives: To determine the age group affected by testicular torsion and the relationship with orchidectomy and unilateral orchidopexy. To determine if seasonal variation affects the incidence of torsion of the testis. Materials and methods: Data of confirmed patients with testicular torsion from July 1998 to June 2010 were retrieved. They were divided into two, group I (age < 21 years) and group II (age e"21 years). The indices analyzed were the relationship of age group, occupation on orchidectomy and unilateral orchidopexy and seasonal variation and torsion. Cases of acute epididymo- orchitis, torsion of appendix testis, and testicular tumor were excluded from the study. Results: A total of 169 confirmed cases of testicular torsion were analysed.The estimated incidence was 12.1 cases per 100,000 populations. Their age range from 9 months to 45 years and mean age 23.8΁7.6 (SD). 62.1% of torsion occurred at e" 21 years. One hundred and twenty patients (71%) had bilateral orchidopexy, 32 (18.9%) had orchidectomy and 17 (10.1%) had unilateral orchidopexy. In group II; unilateral orchidopexy was significant (p<0.03) and there was a correlation between the occupation and orchidectomy (p < 0.02). There was no statistical correlation between total torsion and humidity (r=0.321, p=0.309), or ambient temperature (r=0.248, p=0.437). Conclusions: Testicular torsion was commoner in men age e" 21 years and more students lost their testes. Unilateral orchidopexy should be considered in some cases. There was no relationship between torsion, orchidectomy, ambient temperature and relative humidity. The need for rigorous pre-school and pre- employment health education is advocated.
[ABSTRACT]   Full text not available  [PDF]
  789 186 -
Relationship between liver function tests and thyroid hormones in thyroid disorders
MO Ajala, PS Ogunro, OA Fasanmade
July-September 2013, 20(3):188-192
Aims and Objectives: To evaluated the effect of thyroid dysfunction on liver function tests and if there is any correlation between them. Materials and methods: A total of 68 subjects (40 hyperthyroid and 28 hypothyroid) between the ages of 20-60 years old and 40 healthy euthyroid volunteers of the same age groups were studied. Plasma albumin, bilirubin (total and conjugated), thyroxine (T4), triiodothyronine (T3), thyroid stimulating hormone (TSH); activities of aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP) and gamma glutamyltransferase (GGT) were estimated in the plasma of the participants. Results: Plasma concentration of Total .bilirubin and liver enzyme activities increased significantly in both hyperthyroid and hypothyroid subjects. The positive correlations between thyroid hormones and liver enzymes in hyperthyroid subjects were negative in hypothyroid subjects and vice - visa. Conclusion: It can be concluded that both hyperthyroidism and hypothyroidism altered liver function tests. It is thus recommended that liver function tests interpretation in thyroid dysfunction should be with caution.
[ABSTRACT]   Full text not available  [PDF]
  822 100 -
Pattern of dermatoses among inmates of Ilesha Prison, Nigeria
OA Oninla, O Onayemi, OA Olasode, SO Oninla
July-September 2013, 20(3):174-180
Aims and Objectives: Dermatoses are common health problems in prisons and environmental conditions influence their prevalence and pattern. Hot and humid environment as obtains in the tropics, stress, and overcrowding are conditions that facilitate development of. The aim of this study was to determine the prevalence and pattern of dermatoses in a prison located in a tropical environment. Materials and Methods: The study was done in May-July 2006 in a South-West Nigerian prison. Using a purpose designed questionnaire, information on sex, age, prison status, and number in rooms was obtained and inmates were clinically examined. Results: Inmates studied were 305 (296 males and 9 females). Dermatoses were found in 221 inmates with overall prevalence of 72.5% (221/305). Infectious disorders were seen in 67.9% (150/221) and non-infectious in 32.1% (71/221). The diseases occurred in 72.9% (167/229) of awaiting trial persons and 72.9% (51/70) convicted persons. Overcrowding was more in cells (average sleeping area was 9.5 sq feet). Skin diseases affected 80.3% (61/76) of inmates in cells and 69.9% (160/229) in dormitory rooms.. About 71.2% (94/132) of inmates affected stay in five highly overcrowded dormitory rooms with infectious disorders in 48.5% (64/132). Dermatophyte infections were 34.3% of 332 dermatoses seen, pityriasis versicolor 14.5%, acne vulgaris 12.3%, dandruff 10.5%, 28.4%. A significant relationship was found with overcrowding and place where dermatoses were first noticed. Conclusion: Dermatoses are common health problem of prisoners, and prison conditions facilitate these problems.
[ABSTRACT]   Full text not available  [PDF]
  793 84 -
Stroke recurrence in Nigerian children with sickle cell disease treated with hydroxyurea
IA Lagunju, BJ Brown, OO Sodeinde
July-September 2013, 20(3):181-187
Aims and Objectives . To compare the outcome after a first clinical stroke, following treatment with and without hydroxyurea (HU). Subjects and Methods . A retrospective review of a cohort of Nigerian children with SCD, who had suffered a first stroke, was carried out. Outcomes in the group of children who received and did not receive HU were compared. Results . Thirty two children presented with stroke and one died of haemorrhagic stroke at presentation. All the children had haemoglobin SS phenotype, and ischaemic stroke was the predominant form seen. Mean age at first clinical stroke was 7years, 7 months (SD= 2years, 4months). Thirteen children received HU while 18 declined HU therapy. Maximum dose of HU ranged from 20-25 mg/kg/ day. The secondary stroke incidence of 7/100 person years in the HU group was significantly lower than the 28/100 person years in the non-HU group (P= 0.001, OR 3.808, 95% CI 1.556, 9.317). Children who did not receive HU were more likely to drop out of school and to have moderate-severe motor disabilities requiring caregiver assistance for daily living. Conclusion . In settings where facilities for chronic blood transfusion are not accessible or feasible, HU therapy should be considered for secondary stroke prevention in children with SCD.
[ABSTRACT]   Full text not available  [PDF]
  781 95 -
Late life depression among elderly hypertensive patients
AJ Yusuf, MS Isa, MA Amedu, FT Nuhu, SB Garko
July-September 2013, 20(3):208-213
Aims and Objectives: To determine the correlates of late life depression among elderly hypertensive patients as seen in Zaria Northern Nigeria. Subjects and methods: Elderly hypertensive patients attending the cardiac clinic of Ahmadu Bello University Teaching Hospital Zaria were recruited for the study. They were interviewed using socio-demographic Questionnaire, Consortium to Establish Registry for Alzheimer's Disease (CERAD), Geriatric Depression Scale -30 and Stick Design Test. Patients that had a score of 11 and above in the GDS-30 were further interviewed using the Geriatric Mental State Schedule(GMSS) AGECAT. Data obtained from the study was analyzed using Statistical Package for Social Sciences windows version 15. All tests of significance were carried out at 5% level of probability Results: A total of 179 patients participated in the study out of which 110(65.1%) were females. The mean age of the subject was 68.23΁ 5.72 years. The rate of late life depression based on International Classification of Diseases (ICD), 10th edition and Geriatric Mental State Schedule AGECAT (GMSS-AGECAT) diagnoses were 17. 88% (32) and 20.11 %( 36) respectively. There was very good agreement between diagnoses based on ICD-10 criteria and GMSS-AGECAT (kappa=0.82, p<.001). Late life depression was significantly associated with recent bereavement (OR=11.04, p=.001), poverty (OR=4.39, p=.036) and lower diastolic blood pressure (7.04, p=.008). Conclusion The rate of late life depression in this study is comparable to that of other studies reported in the literature. Poverty and bereavement but not high blood pressure, are important factors associated with depression in the elderly
[ABSTRACT]   Full text not available  [PDF]
  791 79 -
Health status of children in institutionalised homes in South West Nigeria
BJ Brown, RE Oladokun
July-September 2013, 20(3):168-173
Aims and Objectives : to determine the nutritional and immunisation status as well as morbidity pattern of children in institutionalised care in south -western Nigeria. Subjects and methods : The study was cross sectional and involved children under the age of fifteen years in seven institutions in Oyo and Ogun states, south western Nigeria. Children admitted into these homes were either orphans or those separated from their parents through child abandonment, illness and juvenile delinquency. A history of current and recent illnesses in the preceding one month as well as immunisation was obtained for each child. Physical examination including growth assessment was then performed after which blood specimens were collected for haematocrit estimation, haemoglobin electrophoresis and examination for malaria parasites. Results: A total of 161 children were studied comprising 74 (46.0%) males and 87 (54.0%) females. Their ages ranged from 1.12 to 168 months with a mean (standard deviation) of 94.5 (47.0) months. Only 24.5 % of the children were reported to have completed the immunisation schedule. Fifty five (34.2%) of the 161 children were reported to have been ill in the preceding period of one month, the leading symptoms being fever (14.9%), cough (10.3%) and diarrhoea (3.9%). Forty six (28.6%) of the children were stunted, 34 (21.1%) underweight and 106 (65.8%) anaemic. Conclusion : The health status of children in institutionalised care is poor and needs better supervision and support to facilitate growth and wellbeing.
[ABSTRACT]   Full text not available  [PDF]
  777 81 -
Perioperative considerations in orthopaedic patients with Diabetes Mellitus: A Review
DC Obalum, SU Eyesan, F Fiberesima, CN Ogo, C Nzewi, M Mijinyawa
July-September 2013, 20(3):223-227
Patients with diabetes mellitus are predisposed to a host of orthopaedic problems which may require surgery and many patients with orthopaedic conditions may have unrecognised hyperglycaemia presenting for the first time at surgery. This group of patients are also prone to adverse surgical outcomes like post-operative infections and poor wound healing. The control of hyperglycaemia in orthopaedic patients with diabetes mellitus is the key in optimising surgical outcome in these patients. Peri-operative insulin is the main antihyperglycaemic agent of use. The risk of hypoglycaemia with tighter peri-operative glucose control outweighs its potential benefits. Blood glucose control with insulin infusion is better than sliding scale insulin. Control of infections and promotion of wound healing are necessary adjuncts in the management to optimise surgical outcome.
[ABSTRACT]   Full text not available  [PDF]
  770 86 -
Angiomyolipoma presenting as renal abscesses: a consideration for further evaluation of renal abscess
AA Popoola, OO Komolafe
July-September 2013, 20(3):241-243
Aims and Objectives : This is to describe an usual presentation of renal angiomyolipoma as renal abscess Case report : This is a case report of a 51 year old man with clinical and radiological features suggestive of renal abscess. The patient had exploratory laparatomy and a simple nephrectomy for a non functioning kidney which was more like a bag of pus. The histological report however revealed renal abscess coexisting with angiomyolipoma supporting previous reports that renal abscess may be a harbinger of other renal pathologies. Conclusion: Abscesses are usually managed by drainage and the dictum of wherever there is pus let it out' holds generally but this does not always suffice in renal abscesses because renal abscesses are often found in the background of other diseases which may be of more clinical importance.
[ABSTRACT]   Full text not available  [PDF]
  771 74 -
Prostatic tumours among Nigerian males: A private practice experience in Benin-City, South-South, Nigeria
JU Aligbe, GD Forae
July-September 2013, 20(3):193-196
Aims and objectives : To highlight the frequency and histological types of prostatic tumours seen in a private practice setting in Benin-City, South-South Nigeria. Materials and Methods : Haematoxylin and eosin stained-slides of prostatic biopsies diagnosed at the Ashamas Foundation Diagnostic Centre, Benin-City for 10 years were archived and studied. Histological request forms were analysed for clinical bio-data, type of biopsies and diagnosis. Results : A total of 908 prostatic tumours comprising of 468 open prostatectomies, 378 transurethral prostatectomies, 60 needle biopsies and 2 unspecified biopsy types were diagnosed. The peak age incidence of prostatic tumours was 60-69 years accounting for 37% of all prostatic tumours. Nodular prostatic hyperplasia (NPH) was the most common tumour accounting for 74.9%. Prostatic cancer was the second most common tumour accounting for 22.1% of all prostatic tumours. Six cases (1.3%) of incidental carcinoma were diagnosed out of the 680 cases of NPH. Transitional cell carcinoma and metastatic carcinoma constituted 0.2%, 0.1% of prostatic tumours respectively. In all, carcinosarcoma and fibrosarcoma accounted for 0.1% each of the prostatic tumours. High grade prostatic intraepithelial neoplasm accounted for 0.2% while 1.1% was inadequate for histopathological diagnosis. Conclusion: Nodular prostatic hyperplasia accounted for vast majority of all prostatic tumours in this study. However a significant percentage of prostatic adenocarcinoma was also encountered. Health education and population based screening modalities are advocated to reduce prostatic tumour morbidity and mortality in the Nigerian adult male population.
[ABSTRACT]   Full text not available  [PDF]
  766 75 -
Congenital long-QT Syndrome in a Nigerian child: A Case Report
R Onalo, IB Babaniyi
July-September 2013, 20(3):237-240
Case report : We describe the clinical manifestation and the challenges of diagnosing Long QT syndrome, type 1 (LQTS1), in an 8-year old girl who presented at the Paediatric Cardiology Clinic with syncopal attacks following dancing and excitement. Her initial ECG showed normal QT interval of 380msec (QTc = 440 msec), but later, increased to 410 msec (QTc = 520 msec) following epinephrine challenge test. Conclusion : The challenges with the diagnosis of LQTS1 in children in resource- constrained setting and the need for vigilance in children with syncopal attacks and other cardiac events with normal QT intervals on an electrocardiogram are thus highlighted.
[ABSTRACT]   Full text not available  [PDF]
  758 76 -
Cost of epilepsy care in a Nigerian tertiary hospital
EO Sanya, PM Kolo, A Adekeye, K Mustapha, BA Ademiluyi, K Ajayi
July-September 2013, 20(3):218-222
Aims and Objectives : The economic impact of epilepsy is enormous in terms of use of health care resources and loss of productivity. There is presently scanty data on economic impact of epilepsy in Nigeria,which necessitated this study. Subjects and Methods : This cross-sectional study is on epilepsy patients age e"16years who attended Neurology clinic at UITH Ilorin. Data collected included clinical characteristics, utilisation of resources and cost of care. Direct medical costs included recurring costs like consultation, hospitalisation, medication and investigation fees. Indirect costs were number of days lost due to seizure attack and travelling to clinic by patients and relatives. Results: Sixty-five patients (32 males, 33 females) participated in the study with age range of 16 to 74 years and mean (SD) of 35΁17years. Total clinic attendance was 314 days and 53days were spent on admission. Close to 25 % of patients resided outside Ilorin metropolis and distance traveled to attend clinic varied from 4 to 200km (mean=47΁30.6km). The total annual cost per patient was 41,878 ($279.2 USD). It consisted of direct cost [DC] of 33,616 (80%) and indirect cost [IC] of 8262 (20%). The three leading consumptive items in DC were: antiepileptic drugs (AEDs) - 24,138, investigations - 5373 and transportation - 2387. Majority (76.9%) of the patients were on carbamazepine. Self-estimated monthly family income varies from 3000 to 200,000 (median of 25,000). Only 23 patients (35.4%) bore the cost of care themselves. Of the IC, lost earnings due to absenteeism from work amounted to 6177. Equivalent of 1 USD was 150 at time of study. Conclusion . AEDs accounted for a significant proportion of TC. Increase in availability of generic drugs could help bring down the cost of care within affordable reach of indigent patients.
[ABSTRACT]   Full text not available  [PDF]
  765 68 -
Initial experience with Spinal Stabilisation with Pedicle Screws and Rods in Nigerians: Indications and outcome of surgery
AA Adeolu, OC Akinbo
July-September 2013, 20(3):203-207
Aims and Objectives :To provide an initial experience in performing the procedure of the use of pedicle screws and rods for stabilisation of the spinal column in Nigerians with highlights on indications and outcome of surgery. Materials and Methods: The hospital records of all the patients who had the procedure were retrieved. Biodata, presentation, neuroimaging findings, surgical procedure and postoperative outcomewere extracted from records. Evidence of recurrent spinal instability, change in neurological status, wound infection and implant related complications postoperatively were used as outcome measures Results: Twenty seven procedures were performed in 26 patients [male: female was 1:1]. The age range was 26 to 77 years (mean=52.9, SD= 13.7). Seventeen (65.4%) patients had degenerative spinal disease, while 9 (34.6%) had trauma. Five patients (19.2%) had thoracic spinal lesions and these were secondary to trauma, while there were 21 (80.8%) patients with lumbar spinal lesions. The indications for surgery were spinal instability in trauma cases and/or anticipated instability for degenerative cases. Two spinal segments were fused during 11 (40.7%) procedures, 3 in 10 (37.4%), 4 in 4 (14.8%) and 5 segments in 2 (7.4%) procedures. Post operatively, the Frankel grading improved in 6 (23.1%) patients, while it remained the same in 20 (76.9%). Back pain resolved in all but 1 (96.2%) patient. One (3.9%) patient each had screw fracture, recurrent instability andsymptomatic redundant rod lengthwhile 2 (7.7%) peri-operative mortalities occurred due to cardiac events. Conclusion: The most common indication for posterior spinal stabilisation with pedicle screws and rods in this study is established or anticipated instability from degenerative lumbar spinal disease.Immediate stabilisation was achieved in majority of the patients without postoperative neurological deterioration.
[ABSTRACT]   Full text not available  [PDF]
  764 67 -
Clinical correlates of women requesting labour epidural analgesia in a tertiary hospital in Nigeria
CO Imarengiaye, BN Olagbuji, MC Ezeanochie, II Akhideno
July-September 2013, 20(3):214-217
Objectives: To evaluate the clinical correlates of women who received pain relief in labour with lumbar epidural analgesia and also investigate the labour outcome. Materials and Methods: A hospital -based case-control study conducted in a tertiary care facility in Nigeria. The clinical characteristics and delivery outcome of women who had epidural analgesia in labour were compared to those without. Results: The utilisation rate of labour epidural analgesia during the study period was 13/1000 women. Tertiary education was significantly higher among women who had epidural analgesia in labour (22.7% vs 3.4%, p=0.0009). There were no statistically significant differences between women who had labour epidural analgesia and the controls in terms of labour and delivery by caesarean section. The second stage of labour was prolonged in women who received epidural for pain relief in labour (p = 0.005). The neonatal indices (Mean birth weight or Apgar score <7 in first minute) were similar. Conclusion: This study suggests that labour epidural analgesia is not associated with increased caesarean section and adverse foetal outcome. This is of value inincreasing the acceptance of this service by pregnant women in Nigeria.
[ABSTRACT]   Full text not available  [PDF]
  723 101 -
Natal tooth and cultural impact on its management in a tropical neonatal unit: A Case Report
EE Eseigbe, SJ Adama, JT Amuda, P Eseigbe
July-September 2013, 20(3):231-233
The incidence of natal tooth is uncommon and its management could be fraught with challenges. A 3 day old female presented with features of sepsis and a natal tooth. Treatment for sepsis was permitted and successfully instituted but definitive management of the natal tooth was deferred, for cultural reasons, by the parents. The case documents the occurrence of natal tooth and highlights the impact of cultural beliefs on management of some medical conditions. It underscores the need to develop the relationship between orthodox medical care and cultural beliefs, in susceptible communities, with a view to achieving optimal health care delivery.
[ABSTRACT]   Full text not available  [PDF]
  743 63 -
H-Type tracheo-oesophageal fistula: A diagnostic challenge in a resource- poor country. A Case report
OA Elebute, AO Ademuyiwa, JO Seyi-Olajide, CO Bode
July-September 2013, 20(3):234-236
H-type fistula is a rare form of congenital tracheo-oesophageal fistula accounting for 4% of all cases of Tracheo-oesophageal fistula. The typical picture is that of recurrent chest infection due to both missed and delayed diagnosis as well as cyanosis and choking during feeds. In resource poor countries this problem is further exaggerated by ignorance, poverty and lack of access to basic investigative modalities.
[ABSTRACT]   Full text not available  [PDF]
  742 58 -
Fatal haemorrhage from an Ultrasound Guided Fine Needle Aspiration of the liver in a patient with Primary Hepatocellular Carcinoma: Case report
O Adekanle, DA Ndububa, O Ijarotimi, OA Komolafe, EA Omonisi, SO Ojo
July-September 2013, 20(3):228-230
A case of fatal haemorrhage is reported among 72 ultrasound (US) guided percutaneous fine-needle aspiration liver biopsies (FNAB) performed in the gastro- intestinal unit of Medicine Department in a tertiary hospital. The patient had primary hepatocellular carcinoma (PHCC) with advanced hepatic cirrhosis. Death was due to bleeding from liver nodule resulting in intra-peritoneal haemorrhage. Pre-procedure laboratory tests did not reveal the existence of major bleeding disorders in the patient. This event is our first experience, but colour flow Doppler ultrasound guidance has been reported to prevent its occurrence. The use of FNAB for the diagnosis of PHCC should therefore be guided with colour flow Doppler ultrasound scan to prevent haemorrhage. In addition, there should be proper selection of patients for FNAB especially in areas where there are no colour flow Doppler ultrasound scans.
[ABSTRACT]   Full text not available  [PDF]
  693 57 -