Showing papers in "Annals of Medical and Health Sciences Research in 2012"

Obstructive sleep apnea hypopnea syndrome

Abstract: Obstructive sleep apnea hypopnea syndrome (OSAHS) is an important medical condition which is on the increase in the past 50 years. It causes significant morbidity and mortality in both developed and developing nations of the world. To review the relevant literature on obstructive sleep apnea. Literature review was carried out on the pathophysiology, clinical presentation, complications, diagnostic modalities, and treatment using computerized search. Additional information was obtained by cross referencing and using texts and journals in the medical libraries of Federal Medical Centre Owerri and University of Nigeria, Enugu. Most of the literature was from developed countries, with very few reports from Africa. Comprehensive management plan was lacking in many textbooks. OSAHS is an increasing medical and, more importantly, respiratory condition across the world. Early recognition and prompt appropriate intervention measures will reduce the mortality and improve the quality of life in patients with such conditions.

An overview of female genital mutilation in Nigeria

Abstract: Nigeria, due to its large population, has the highest absolute number of female genital mutilation (FGM) worldwide, accounting for about one-quarter of the estimated 115–130 million circumcised women in the world. The objective of this review is to ascertain the current status of FGM in Nigeria. Pertinent literature on FGM retrieved from internet services [Google search on FGM in Nigeria, www.online Nigeria, PubMed of the national library of medicine www.medconsumer. Info/tropics/fgm.htm, Biomedcentral and African Journal Online (AJOL) (FGM)] and textbooks, journals, and selected references for proper understanding of the topic was included in this review. The national prevalence rate of FGM is 41% among adult women. Evidence abound that the prevalence of FGM is declining. The ongoing drive to eradicate FGM is tackled by World Health Organization, United Nations International Children Emergency Fund, Federation of International Obstetrics and Gynecology (FIGO), African Union, The economic commission for Africa, and many women organizations. However, there is no federal law banning FGM in Nigeria. There is need to eradicate FGM in Nigeria. Education of the general public at all levels with emphasis on the dangers and undesirability of FGM is paramount.

Surgical-site infection following cesarean section in Kano, Nigeria

Abstract: Objectives: To determine the prevalence, risk factors and common bacterial pathogens for surgical site infection (SSI), following cesarean section (CS). Materials and Methods: A retrospective case-control study of patients delivered by CS in Aminu Kano Teaching Hospital, Kano, Nigeria. The cases were the patients whose CS was complicated by SSI; they were matched by other patients delivered by CS who had had no SSI as controls. Hospital records of cases and controls were compared. Results: Four hundred and forty five hospital records were available for review, 44 (9.1%) had SSI. Statistically significant determinants of infection are: Long duration of labor before CS (P<0.001), Long operation time (P=0.009), heavy intraoperative blood loss and blood transfusion (P<0.001). Eleven (25%) of the cases had CS due to obstructed labor compared to 15.3% of controls. Staphylococcus aureus was isolated in 31.8% of the cases. Cephalosporins and quinolones were the most sensitive antibiotics. Conclusion: The incidence of SSI following CS in our unit was 9.1%. Most cases followed prolonged obstructed labor, with long operation time and heavy blood loss. Staphylococcus aureus sensitive to cephalosporins was the most frequently isolated pathogen. Strategies for preventing prolonged obstructed labor and appropriate antibiotic prophylaxis may prove effective.

Efflux pump-mediated resistance in chemotherapy

Abstract: Efflux pump mechanisms perform important physiological functions such as prevention of toxin absorption from the gastrointestinal tract, elimination of bile from the hepatocytes, effective functioning of the blood–brain barrier and placental barrier, and renal excretion of drugs. They exist in all living cells, but those in the bacterial and mammalian cells are more important to the clinician and pharmacologist, as they constitute an important cause of antimicrobial drug resistance, which contributes to treatment failure, high medical bills, and increased mortality / morbidity. This review was aimed at highlighting the role of efflux pump mechanisms in microbial resistance to chemotherapeutic agents. It was also aimed to elucidate their structure and mechanisms of action so as to integrate the efflux pump mechanisms in the design and development of novel antimicrobial agents.Findings from previous studies and research on this subject assessed through Google search, Pubmed, Hinari websites, as well as standard textbooks on chemotherapy, provided the needed information in the process of this review. Efflux pump inhibitors are promising strategies for preventing and reverting efflux‑mediated resistance to chemotherapeutic agents. They are usually employed as adjuncts in antimicrobial and cancer chemotherapy. Toxicity, more common with the older‑generation inhibitors such as verapamil and reserpine, constitutes the greatest impediment to their clinical applications. No efflux pump inhibitor has been approved for routine clinical use, as a result of doubtful clinical efficacy and unacceptably high incidence of adverse effects, particularly inhibition of the P‑450 drug metabolizing enzyme. At present, their applications are mainly restricted to epidemiological studies. Nonetheless, the search for efficacious and tolerable efflux pump inhibitors continues because of the potential benefits. There is a need to consider efflux pump substrate selectivity in the design and development of novel chemotherapeutic agents.

Ischemic stroke and neuroprotection

Abstract: Stroke is a major cause of morbidity and mortality in both developed and developing countries of the world. Greater understanding of the pathophysiology of neuronal damage in ischemic stroke has generated interest in neuroprotection as a management strategy. This paper aims to review the current concept and place of neuroprotection in ischemic stroke. An extensive search of all materials related to the topic was made using library sources including Pubmed and Medline searches. Current research findings were also included. The findings are as presented. Neuroprotection is an increasingly recognized management strategy in ischemic stroke that promises to assist clinicians in reducing stroke mortality rates and improving the quality of life of survivors.

Diagnosis, Prevention and Management of Postoperative Pulmonary Edema

Abstract: Postoperative pulmonary edema is a well-known postoperative complication caused as a result of numerous etiological factors which can be easily detected by a careful surveillance during postoperative period. However, there are no preoperative and intraoperative criteria which can successfully establish the possibilities for development of postoperative pulmonary edema. The aims were to review the possible etiologic and diagnostic challenges in timely detection of postoperative pulmonary edema and to discuss the various management strategies for prevention of this postoperative complication so as to decrease morbidity and mortality. The various search engines for preparation of this manuscript were used which included Entrez (including Pubmed and Pubmed Central), NIH.gov, Medknow.com, Medscape.com, WebMD.com, Scopus, Science Direct, MedHelp.org, yahoo.com and google.com. Manual search was carried out and various text books and journals of anesthesia and critical care medicine were also searched. From the information gathered, it was observed that postoperative cardiogenic pulmonary edema in patients with serious cardiovascular diseases is most common followed by noncardiogenic pulmonary edema which can be due to fluid overload in the postoperative period or it can be negative pressure pulmonary edema (NPPE). NPPE is an important clinical entity in immediate post-extubation period and occurs due to acute upper airway obstruction and creation of acute negative intrathoracic pressure. NPPE carries a good prognosis if promptly diagnosed and appropriately treated with or without mechanical ventilation.

Clinical presentation of uterine fibroids in Nnewi, Nigeria: A 5-year review

Abstract: Background: Uterine leiomyomas are the commonest benign tumors in women, with a higher preponderance amongst Africans. Several etiological factors have been suggested, with subtle variations in clinical presentation being reported in different studies. This may constitute a determinant for the management measures undertaken. Aim: To review the clinical presentation and management measures undertaken for uterine leiomyoma. Subjects and Methods: A retrospective study was conducted at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, from January 2002 to December 2006. A review of case records of patients with a diagnosis of uterine leiomyoma was done. The data were analyzed and presented in tables using comparative percentages. Results: Uterine leiomyoma constituted 117 of the 1094 gynecological admissions during this study period (10.7%, 117/1094). The mean (SD) age of presentation was 35.7 (6.1) years. Most of the patients were nulliparous (76.7%, 79/103) and 51.5% (53/103) were married. The commonest mode of presentation was lower abdominal mass (66.9%, 67/103) and the least was recurrent abortion (1%, 1/103). Surgery was employed in all cases, with myomectomy being the commonest modality used in 90.3% (93/103) of cases. The common postoperative complications were prolonged pain (49.5%, 51/103) and postoperative pyrexia (34.9%, 36/103). Conclusion: The symptom of lower abdominal mass correlates with late presentations in our setting. This makes the application of newer therapies like laparoscopic myomectomy difficult even when they are available. Other therapies which are independent of fibroid size (like uterine artery embolization) are not readily available in our environment. This further emphasizes the importance of myomectomy as the most important treatment modality in our environment

Childhood urinary tract infection in abakaliki: etiological organisms and antibiotic sensitivity pattern.

Abstract: Background: Urinary tract infection (UTI) is a common childhood infection in the Tropics which causes significant illness and is frequently missed, probably because of its non-specific presentation and similarity with other common illnesses. Objectives: To determine the prevalence, common etiological agents, and the susceptibility of these pathogens to the commonly available antimicrobial agents in this center. Materials and Methods: This was a retrospective study carried out at the Children’s Outpatient Clinic and Children’s Emergency Ward of Ebonyi State University Teaching Hospital Abakaliki (EBSUTH). The study was carried out between January 1, 2007 and December 31, 2009. Results: One hundred ten subjects of the 3625 children seen in the center during the period of study had UTI giving a case prevalence rate of 3.0%. Majority of the patients (59, 53.6%) were less than 2 years of age with a male:female ratio of 1:1.3. Fever was the commonest presenting symptom and the commonest organisms isolated in urine were Klebsiella (27, 24.5%), and Staphylococcus aureus (24, 21.8%). The drugs that were most sensitive to these organisms were Gentamicin (50, 45.5%), Ceftriaxone (49, 44.5%), and Ciprofloxacin (36, 32.7%). Conclusion: The study revealed a high prevalence of UTI among children. Klebsiella was the commonest causative organism isolated in the urine. Gentamicin, Ceftriaxone, and Ciprofloxacin were the antimicrobials with the highest sensitivity to all the isolated microorganisms.

Pattern and Determinants of Antenatal Booking at Abakaliki Southeast Nigeria

Abstract: Background: Antenatal care is one of the pillars of SAFE Motherhood Initiative aimed at preventing adverse pregnancy outcome. Early antenatal booking is recommended for this benefit. Aim: The objective of this study was to determine the antenatal booking pattern of pregnant women and its determinants. Subjects and Methods: A cross‑sectional survey of pregnant women attending the antenatal booking clinic at Federal Medical Centre Abakaliki Ebonyi State between April 6, 2011 to August 5, 2011 was undertaken. Epi info 2008 version was used for analysis. Results: The mean age of the respondents was 27.46 (5.81) years and the mean gestational age at booking was 24.33 (5.52) weeks. A total of 83.1% (286/344) of the pregnant women booked after the first trimester while the remaining 16.9% (56/344) booked early. Socio‑biological variables and past obstetrics history did not contribute significantly to the gestational age at booking while sickness in index pregnancy, personal wishes, and financial constraint were statistically significant reasons given for seeking antenatal care. Majority of the pregnant women 37.2% (128/344) suggested that the second trimester was the ideal gestational age for booking while 18.3% (63/344) did not know the ideal gestational age for booking. Most pregnant women 81.1% ( 279/344) knew the benefits of early antenatal care even though they booked late 83.1% (286/344). Conclusion: Most pregnant women access antenatal care late at Abakaliki because of misconception and poverty. Health education and subsidization of cost of medical services will help in reversing the trend of late antenatal booking.

Profile of Microvascular Disease in Type 2 Diabetes in a Tertiary Health Care Hospital in India

Abstract: Background: Diabetes mellitus (DM) is a metabolic disorder complicated by microvascular and macrovascular diseases. The clinical profile of these complications has not been adequately studied in many tertiary health care centers in India. Aim: The authors studied the clinical profile of microvascular diabetes complications [peripheral sensory neuropathy (PSN), diabetic retinopathy (DR), nephropathy] in patients attending a tertiary care hospital in India. Subjects and Methods: In this cross-sectional study, patients ( n = 1529) with type 2 diabetes mellitus (T2DM) were studied for the presence of complications. PSN was diagnosed when the vibration perception threshold of big toe was >25 V. Retinopathy was diagnosed using direct ophthalmoscopy (presence of microaneurysms, exudates, and hemorrhages), and nephropathy with microalbuminuria (≥30 mg/l albumin in a spot urine sample) or low creatinine clearance ( Results: PSN was present in 37% (565/1529), nephropathy in 20% (297/1529), and retinopathy in 17% (256/1529) of the study population. Microvascular complications are seen in 48% (734/1529) patients of the study population.Increasing age ( P P P = 0.036) were the common risk factors for all complications. Hypertriglyceridemia ( P = 0.016) and low body weight ( P = 0.039) predisposed to retinopathy over other microangiopathies. Overall, nephropathy was associated strongly with retinopathy ( P = 0.015). Conclusions: The data showed that neuropathy was the most common microangiopathy and coexisted with other complications in many patients. Old age, long duration of disease, and poor glycemic control are the common risk factors for microvascular complications.

High Burden of Protein–Energy Malnutrition in Nigeria: Beyond the Health Care Setting

Abstract: There is still a high burden of protein-energy malnutrition in Nigeria. The severe forms of the disease are usually associated with high level of mortality even in the tertiary health facilities. To review the cost-effective health promotional strategies at community levels that could aid prevention, early detection, and prompt treatment of protein-energy malnutrition. The strategy used for locating articles used for this review was to search databases like Google, Google scholar, relevant electronic journals from the universities' libraries, including PubMed and Scirus, Medline, Cochrane library and WHO's Hinari. We believe that strategies beyond the health care setting have potential of significantly reducing the morbidity and mortality associated with protein-energy malnutrition in Nigeria.

Prevention of mother to child transmission of human immunodeficiency virus: the nigerian perspective.

Abstract: Despite the proven effectiveness of the prevention of mother to child transmission (PMTCT) of human immunodeficiency virus (HIV) program, Nigeria currently has the highest burden of vertical transmission of HIV in the world due to poor coverage of the PMTCT program partly as a result of poor knowledge of PMTCT interventions amongst healthcare providers in the country. This paper aims at making information on PMTCT interventions more readily available to healthcare providers in developing countries. The internet was searched using Google and Google scholar. In addition, relevant electronic journals from the Universities library including PubMed and Scirus, Medline, Cochrane library, and World Health Organization (WHO)'s Hinari were used. There was paucity of published work on PMCT from Nigeria. Most of the information concerning PMCT in Nigeria was obtained from technical reports from the Federal Ministry of Health and WHO. It is expected that this article will help in improving healthcare providers' knowledge of PMTCT interventions and thus help in the urgently needed rapid scale-up of PMTCT services in Nigeria.

Emergency obstetric hysterectomy in a tertiary hospital in sokoto, Nigeria.

Abstract: Background: Emergency obstetric hysterectomy (EOH) is a life-saving procedure which is often performed to treat some obstetric complications, as a last resort, to prevent maternal mortality. Objectives: This study was designed to determine the rate, indications, and complications of the EOH procedure at Usmanu Danfodito University Teaching Hospital (UDUTH), Sokoto. Materials and Methods: This retrospective study involved all the patients who had EOH at UDUTH, Sokoto, Nigeria, between January 2005 and December 2010. The case records of these patients were retrieved from the medical record library and information relating to age, parity, booking status, indications, type of hysterectomy, cadre of the surgeon, type of anesthesia, and complications of the procedure were extracted. The data were processed via SPSS version 11.5 and the c2 test was used to analyze some of the results with the confidence limit set at 95%. Results: During the 6-year period, 83 EOH were performed out of 16,249 deliveries giving the rate of the former as 0.51%, i.e. 1 in 196 deliveries. However, the case records of only 74 patients (82.9%) were available for the study. The rate of EOH increased with advancing maternal age and increasing parity. The majority of the patients (89.2%) were unbooked for antenatal care, and the rate of the procedure among these patients (1.82%) was significantly higher than 0.07% observed amongst booked subjects (P<0.001). The main indication for the procedure was ruptured uterus (93.2%) and the majority of the patients (95.9%) had subtotal hysterectomy. Anemia (66.2%), excessive hemorrhage (35.5%), septicemia (18.9%), and wound infection (16.2%) were the leading complications. Excessive hemorrhage was significantly higher in the procedure performed by the senior registrars (51.2%) compared to those undertaken by consultants (16.2%); P=0.03. The case fatality rate of the EOH procedure was 12.1%. However, the case fatality rates in the procedure performed by consultants and senior registrars were 6.5% and 16.3%, respectively. Conclusion: The rate of EOH in the centre is relatively high and ruptured uterus is responsible for the majority of the procedure. Prevention of prolonged obstructed labor, and therefore uterine rupture, through antenatal care and supervision of labor will reduce the rate of EOH whereas performance of the procedure by the most experienced surgeon will minimize the maternal morbidity and mortality.

Limitations of Activities in Patients with Musculoskeletal Disorders

Abstract: Background: Musculoskeletal disorders (MSD) are the major cause of morbidity throughout the world, having a substantial influence on quality of life (QOL). We studied QOL ascertained by limitations of activities of daily living, impact on family and social relationships, and sleep disturbances among patients with MSD. Aim: Ascertain QOL in MSD. Materials and Methods: A cross-sectional study among 2633 randomly selected subjects. The study was carried out in the field practice area of D Y Patil Medical College, Pune, India. In the first phase of the study, patients of MSD were identified by house-to-house surveys, by face-toface interviews, and clinical examination carried out by trained interns in random samples of selected households. Subsequently, QOL in patients with MSD was elicited by measuring limitations of activities of daily living, impact on family and social relationships and sleep disturbances by structured instrument, using Likert/Dichotomous Scale. Statistical software EPI Info 2002 was used for estimation of sample size, data entry, and analysis. Data were summarized using proportions and percentages. Association of gender and rural–urban background with prevalence of musculoskeletal disorders was explored with odds ratio (OR) with 95% confidence intervals. Results: A total of 2633 subjects were examined. Out of these, 190 (7.2%) suffered from various types of MSD, with higher prevalence in females than males (OR=1.43, 95% CI=1.05 to 1.95). Prevalence was also higher in the rural population compared with urban (OR=2.02, 95% CI=1.45 to 2.83). However, the rural–urban difference may be due to the confounding effect of age, as prevalence was higher in the elderly (48.78%) and the mean age of the rural population was significantly higher than the urban population. Different degrees of limitations among patients of MSD in carrying out specific activities were: Dressing 9.5%, washing hair 11.6%, rising from bed 50%, feeding themselves 6%, walking 39%, taking bath 10%, toilet 37%, rising from chair 47%, rising from floor 55%, boarding bus 30%, and sleep disturbances 47%. These limitations also had impact on their family and social relationships. Conclusions: Patients of musculoskeletal disorders face appreciable limitations in their activities of daily living, which adversely impact their QOL.

Depression in Patients with Epilepsy: A Study from Enugu, South East Nigeria

Abstract: Background: Depression is a common psychiatric disorder in epilepsy patients. A bidirectional interaction is thought to be present between epilepsy and depression. There are few studies of this relationship in Nigerian Africans. Objectives: This was a cross-sectional study of the frequency and pattern of depression in a cohort of epilepsy patients in Enugu, South East Nigeria. Materials and Methods: Adult patients with epilepsy seen at the University of Nigeria Teaching Hospital, Enugu, from May to September 2009 were assessed for depression using the Becks Inventory for Depression. Informed consent was obtained from each patient. Clinical data obtained were analyzed using Statistical Package for the Social Sciences, version 15. The hospital’s ethical review committee approved the study. Results: In all, 83 subjects were studied (50 males and 33 females). They were aged from 18 to 75 years, with an average of 29.87 years. Most subjects were <25 years of age, single (53, 64%) and had at least secondary school education (65, 78%). Depression was present in 71 (85.5%) subjects – minimal 57 (68.7%), mild 10 (12%), and moderate 4 (4.8%). No case of severe depression was seen. Patients <25 years of age were the most affected. Depression was not significantly associated with age, gender, seizure type, or educational level. Conclusion: A significant proportion of Nigerian African epilepsy patients have depression, which may be easily overlooked, with far-reaching consequences on patients’ quality of life, morbidity, and mortality rates. There is need to regularly assess for and manage epilepsy-related depression in this population.

Hepatitis-B vaccination status among dental surgeons in benin city, Nigeria.

Abstract: Background: The development of success-oriented hepatitis-B vaccine uptake approach among dental surgeons is dependent on the availability of comprehensive baseline data. Objective: To determine the hepatitis-B vaccination status among dental surgeons in Benin City. Materials and Methods: This questionnaire-based cross-sectional study of dental surgeons in Benin City was conducted in May 2011. The questionnaire elicited information on demography, occupational risk rating of contracting hepatitis-B infection, hepatitis-B vaccination status, barriers to uptake of hepatitis vaccine, and suggestions on how to improve hepatitis-B vaccination rates among dental surgeons. Results: Participation rate in the study was 93.3%. More than half (51.4%) of the respondents were 20–30 years old and 52 (74.3%) were males. The occupational risk of contracting hepatitis-B infection among dental surgeons was rated as either high or very high by 51 (72.9%) of the respondents. Amongst the respondents, 14 (20.0%) had received three doses of the hepatitis-B vaccine, 34 (48.6%) either two doses or a single dose, and 22 (31.4%) were not vaccinated. The major barriers reported among the respondents who were not vaccinated were lack of opportunity and the fear of side effects of the vaccines. The suggested ways to increase the vaccination rate among the respondents in descending order include: Making the vaccine available at no cost (51.4%), educating dentists on the merits of vaccination (17.1%), and using the evidence of vaccination as a requirement for annual practicing license renewal (14.3%) and for the employment of dental surgeons (11.4%) and others (2.9%). Conclusion: This study revealed low prevalence of complete hepatitis-B vaccination among the respondents. Improvement in uptake following the respondents’ recommendations will serve as a template in developing success-oriented strategies among stakeholders.

Stillbirth rate in a teaching hospital in South-eastern Nigeria: a silent tragedy.

Abstract: Background: Stillbirths often are not seen as a major public health problem, for despite increasing attention and investment on maternal, neonatal, and child health, stillbirths remain invisible. Aim: The objective of this study was to determine the stillbirth rate at the Imo State University Teaching Hospital, Orlu. Subjects and Methods: Analysis of the case records of stillbirths that occurred in the institution over a 5‑year period from 1st July 2005 to 30th June 2010 was made. Data retrieved was analyzed for age of the women, parity, presumptive risk factor for the stillbirth, and booking status of the women. Also, the total births during the period of study were obtained. A P‑value of <0.05 is said to be significant at confidence level of 95% (95/100). Results: There were a total of 1,142 deliveries within the study period, out of which 206 resulted in stillbirths. This gave an institutional stillbirth rate of 18% (180/1000 deliveries). One‑hundred and fifty‑five 75.2% (155/206) of the stillbirths were macerated stillbirth. The age range of the women was 15-44 years. The modal age was 31 years. The age group of 26- 30 years had the highest prevalence rate of stillbirths of 79 (38.3%, 79/206), while age group of more than 40 years contributed the least with four stillbirths 4 (1.9%, 4/206). Conclusion: The stillbirth rate at the institution is too high and efforts must be made to reduce it.

Survey of the reasons for dental extraction in eastern Nigeria.

Abstract: Background: Extraction of teeth is the commonest surgical procedure carried out in the dental surgery setting. Aim: The purpose of this survey was to identify the causes of teeth extraction in Eastern Nigeria. Subjects and Methods: Record forms for entering data and a self‑addressed return envelope were distributed to 100 dental surgeons in Eastern Nigeria using a simple random selection. Results: Seventy‑one (71; 71/100) dentists responded to the request and the total extractions carried out were 3998. There were 1508 (37.7%) extractions in males and 2490 (62.3%) in females with male‑to‑female extraction ratio of 1:1.7. In both male and female gender, there were more teeth extractions between the ages of 11 and 30 years. Extractions were recorded more in the lower social class (47.6%; 1903/3998). There were more extractions in the permanent (85.0% ; 3398/3998) than deciduous (15.0%; 600/3998). The commonest reasons for teeth extraction were caries (55.2%; 2208/3998). Conclusion: The result of this study shows that dental caries is the commonest reason for tooth extraction in Eastern Nigeria. It is hoped that the study will facilitate the development of treatment and preventive procedures relevant to the problems observed in this part of Nigeria, thus minimizing the loss of teeth and its expected adverse consequences.

Prevalence of Human Immunodeficiency Virus Transmission among Transfused Children with Sickle Cell Anemia in Enugu Nigeria.

Abstract: Background: There are a number of routes for human immuno-defi ciency virus (HIV) transmission in children Blood transfusion-related HIV is still common in developing countries like Nigeria especially among high risk children such as those who require repeated blood transfusions Aim: The aim of this study was to find the prevalence of HIV among transfused children with sickle cell anemia in Enugu Subjects and Methods: This is a descriptive cross-sectional study conducted at the Sickle Cell Clinic of the University of Nigeria Teaching Hospital, Enugu Sixty-nine transfused children with SCA were enrolled after obtaining consent from their caregivers and assent from older children Non transfused children matched for age, sex, and social status with the subjects served as control Voluntary counseling and testing were then provided Relevant data were obtained using pretested questionnaire Statistical Package for Social Science (SPSS) version 11 (Chicago, IL) was used for data analysis The chi-square was used to test for significant association of categorical variables and a P -value of less than 005 accepted as significant Results: HIV antibodies were found in 29% (2/69) of the subjects and in 16% (1/64) of the control ( P = 0604) All the infected individuals among the subjects were males, had only been transfused once and were from the lower socioeconomic class The only infected child from the control group was a 7-year-old male and he probably acquired it through vertical transmission since the mother also tested positive to HIV antibody Conclusions: Blood transfusion is still a risk factor for HIV transmission among children with sickle cell anemia in Nigeria Strategies that will ensure improved blood transfusion safety at health facilities need to be strengthened

Low levels of some nutritional parameters of pregnant women in a rural community of South East Nigeria: implications for the attainment of the millennium developmental goal.

Abstract: Background: In developing countries, under nutrition is common, and this plays a crucial role in the pathogenesis of malaria and anemia. Indeed it has been associated with adverse pregnancy outcomes. Unfortunately, published evidence concerning the situation is lacking. Objectives: To evaluate some nutritional function indices of pregnant women in a rural Nigerian community. Subjects and Methods: This is a cross sectional study involving of 171 pregnant women from a rural area in South-eastern Nigeria. They included 72 and 99 women in their second and third trimesters respectively. The control group was of 60 women, matched in age, parity and socioeconomic conditions, non-pregnant, non-menstruating and non lactating apparently healthy women. The parameters measured by standard methods included serum iron, total proteins, albumin, globulin, packed cell volume and hemoglobin. Results: The results obtained from control group, second and third trimesters, recorded as Mean (SEM) were 134.60(3.12) μg/L, 101.20(4.48) μg/L and 91.87(3.42) μg/L respectively for iron; 69.12(0.80) g/L, 63.60(0.71) g/L and 57.74(0.75) g/L for total proteins; 42.95(0.92) g/L, 35.74(1.00) g/L and 35.26(0.64) g/L for albumin; 26.77(1.00) g/L, 27.78(1.07) g/L and 22.93(0.88) g/L for globulin; 32.80(0.36%), 27.92(0.37%) and 27.73(0.34%) for packed cell volume, and 11.25(0.11) g/L, 9.59(0.13) g/L and 9.57(0.14) g/L for hemoglobin respectively. These results showed that all the parameters decreased significantly in pregnancy (P<0.001) except globulin that did not show immediate, significant decrease. Conclusion: There is a general decrease in the nutrition parameters studied among the pregnant women from our study area, indicating under-nutrition. Urgent measures should be taken to improve the nutritional status of rural dwellers especially the antioxidant micronutrients.

Knowledge and Practice of Pulp Therapy in Deciduous Teeth among General Dental Practitioners in Saudi Arabia

Abstract: Background: It has been observed that the general dentists and pedodontists differ in their treatment recommendations for pulp therapy in deciduous teeth. Aim: To determine the knowledge and practice of pulp therapy in deciduous teeth by general dental practitioners (GDP) in two cities of southern Saudi Arabia. Subjects and Methods: Fifty GDP selected at random from government and private dental clinics were questioned about pulp therapy in deciduous teeth in Abha and Najran cities using a 10‑item questionnaire. The data were analyzed using IBM SPSS software version 11.0 and descriptive statistics were obtained. Results: All 50 participants responded to the survey. Pulpotomy was suggested as the first line of treatment for pulp‑exposed primary tooth by 32 respondents with 44 using Buckley’s formocresol and 32 applying it on the pulp for 5 minutes. 43 respondents squeeze dried the cotton pellet before application on the pulp. In pulpectomy procedure 44 respondents preferred zinc oxide eugenol as obturation material with 22 using handheld reamers and 15 using slow‑speed lentilospirals for obturation. 12 respondents used obturation techniques which had no scientific relevance. In order of preference Glass ionomer cement (GIC), silver amalgam, and stainless steel crowns were the materials of choice for final restoration of endodontically treated deciduous teeth. All 50 answered in the affirmative when asked if they would like to have additional information about pulp therapy in deciduous teeth. Conclusion: The study concluded that general dentists were regularly performing pulp therapy in decidous teeth and therefore need to be frequently updated about these procedures.

Surgical Resident Doctor’s Perspective of Their Training in the Southeast Region of Nigeria

Abstract: Background: There are several problems militating against satisfactory residency training in Nigeria. These problems may not be effectively identified and resolved if the opinion of the trainee doctors is ignored. Objectives: To review surgical residents’ perspectives of their training program in South-eastern Nigeria, with the aim of suggesting evidence-based innovative changes to enable the programs meet global trends and standards. Materials and Methods: A total of 90 semi-structured and pre-tested questionnaires were evenly distributed (30 per hospital) to the surgical residents at three tertiary healthcare facilities in South-eastern Nigeria. Information sought included sociodemographic variables, level in the residency training, rating of program and different aspects, learning environments/opportunities, and suggestions on ways to improve either part or overall program. Results: Analysis of 56 properly completed questionnaires (response rate=62.2%) shows that the respondents were aged 29 to 53 years [mean(SD) = 35.3(1.7)], mostly males (91.1%) and junior residents (75%). A significant majority of residents (47 or 83.8%) rated the surgical residency training in their respective centers as inadequate. Grand rounds were roundly criticized as having misplaced objectives and tending toward fault-finding by Consultants. Suggested interventions for improvement included enhanced supervision/mentoring/teaching by senior colleagues, inclusion of didactic lecture sessions, research trainings, and foreign postings. Conclusion: There exist gaps between expectations of surgical residents and the training offered. These create needed support for an evidenced-based review of surgical residency training program to enable it meet the aspirations of trainees and the ever-changing trend in Medicine. More studies on surgical residents covering other regions of Nigeria, and including the trainers (Consultants), will be of immense value.

Assessment of mild cognitive impairment with mini mental state examination among adults in Southeast Nigeria

Abstract: Background: Mild cognitive impairment is a recently described neuropsychiatric entity with the possibility of evolving into overt dementia. It has been found to respond to therapeutic intervention, thus halting or significantly retarding the progression to dementia. Resource‑poor countries like Nigeria can hardly afford to provide optimal care for dementia patients. Knowledge about mild cognitive impairment in Nigeria is limited. An appreciation of the probable burden may help stimulate and galvanize appropriate public health policies in response. Aim: This cross‑sectional, descriptive study sought to determine the frequency of subclinical mental state abnormalities in a cohort of apparently normal adult Nigerians. Subjects and Methods: One hundred and thirty‑five apparently normal adult Nigerians of both sexes seen at the University of Nigeria Teaching Hospital, Enugu, were interviewed. The Mini Mental State Examination (MMSE) of Folstein, Folstein, and McHugh was used to assess cognitive function in each subject at a single instance. The results obtained were analyzed using SPSS version 11.3 (Chicago, IL). Consent was obtained from each person and approval obtained from the hospital’s ethics review board. Results: A cut‑off score of ≥17 was obtained for normal cognitive function in this population using the MMSE. Minimum score obtained was 12, while the maximum score was 30. A mean (2SD) of 24.84 (7.94) was obtained on analysis of the overall MMSE scores of the 135 individuals. Cognitive impairment was identified in 5.93% (8/135) of the subjects examined. These persons thus represent otherwise normal functional individuals with unrecognized mild cognitive impairment who may be at risk of developing overt dementia in future. Conclusion: The concept of mild cognitive impairment needs further large‑scale studies in Nigerians with possible multi‑centre participation to fully elucidate the scope of the problem. Strategies for the appropriate management of dementia need to be strengthened.

Electromagnetic Energy Radiated from Mobile Phone Alters Electrocardiographic Records of Patients with Ischemic Heart Disease

Abstract: Background: Electromagnetic energy radiated from mobile phones did not show significant effect on the blood pressure, heart rate, and electrocardiographic (ECG) parameters in animals and humans. Aim: This study aimed to investigate the effect of radiofrequency of mobile phone on the electrocardiographic parameters in patients with history of ischemic heart disease, taking into consideration the gender factor . Subjects and Methods: A total number of 356 participants (129 males and 227 females) were admitted in this study. They were grouped into: subjects without cardiac diseases (Group I), patients with ischemic heart disease (Group II), and patients with history of cardiac diseases not related to myocardial ischemia (Group III). Electrocardiogram was obtained from each patient when the mobile phone was placed at the belt level and over precordium in turn-off mode (baseline) and turn-on mode for 40 sec ringing. The records of ECG were electronically analyzed. Results: Prolongation of QTc interval was significantly observed in male gender of Groups I and III ( P P = 0.01) and changes in the voltage criteria ( P = 0.001). These changes were not observed in female patients with ischemic heart disease. The position of mobile at the belt level or over the precordium showed effects on the heart. Conclusions: The radiofrequency of cell phone prolongs the QT interval in human beings and it interferes with voltage criteria of ECG records in male patients with myocardial ischemia.

Knowledge of Orthodontics as a Dental Specialty: A Preliminary Survey among LASUCOM Students.

Abstract: Background: Awareness of malocclusion and the need to make corrections has increasingly becomes prevalent among our population. However, very few patients have presented in the orthodontic clinics with referrals from medical practitioners, an indication that the primary caregivers may be deficient in the knowledge of orthodontic practice. Objective: To assess the knowledge of orthodontics and the awareness of the effects of malocclusion on the general wellbeing, among medical students at the Lagos State University College of Medicine (LASUCOM). Materials and Methods: This cross-sectional study was conducted using a self-administered questionnaire. A total of 85 medical students in the institution participated in the study. Data entry and analysis was done using Epi info version 3.5. Frequency counts were generated for all variables and measures of central tendency for numerical variables. Results: All participants were medical students. Majority (75.3%) were in their clinical years while 24.7% were in their preclinical years. Only 45.9% of the respondents had heard of the term “orthodontics” and only 20% correctly answered that orthodontics involves malocclusion and its management. Concerning the treatment procedures used in orthodontic clinics, 54.1% of them selected rearrangement of teeth. When asked to identify the appliances used in orthodontics, 49.4% selected dentures, 40% selected removable appliances, and 57.7% selected braces. Most of the respondents (81.2%) agreed that as medical doctors they would refer patients for orthodontic care, while 3.5% were undecided and 15.3% disagreed. Conclusion: The medical students surveyed had limited knowledge of orthodontics as a specialty and also knew very little about the impact of malocclusion on the well-being of the individual. They would, therefore, benefit from basic education in orthodontics to stimulate their interest in the specialty and improve their ability to refer patients appropriately.

Nigerian Clinical Level Medical Students Knowledge of Dental Specialty

Abstract: Background: The roles of physicians in oral healthcare delivery are very important due to the unequal distribution of the low oral health manpower as well as the lack of awareness of patients concerning the treatment of oral health problems by dentists in Nigeria. Aim: To assess the Nigerian clinical level medical students’ knowledge of dental problems and conditions in relation to the dental specialty that treat them. Subjects and Methods: This questionnaire‑based cross‑sectional study of clinical level medical students of University of Benin, Benin City, Nigeria, was conducted between May and June, 2010.The knowledge of the students was graded as good (16-20), fair (8-15), and poor (<8). Results: Out of the 350 questionnaires distributed, 279 were filled and returned giving an overall response rate of 79.7% (279/350). Of these, 47.0% (131/279), 50.2% (140/279), and 2.8% (8/279) of respondents showed poor, fair and good knowledge respectively. The trend showed a statistically significant increase in the mean level of knowledge of dental specialty with an ascent in the clinical level (P = 0.01). Conclusion: The level of knowledge of dental specialty in this survey was suboptimal and varied with different specialties which may have adverse implication in future patient care. The variation in the level of knowledge with different clinical level suggested gain in knowledge about dental specialty mainly through nonformal means among medical students.

The impact of a "Brief ECT Orientation Module" on the knowledge and attitudes of medical students towards ECT in India

Abstract: Background: Electroconvulsive therapy (ECT) continues to be an intervention that attracts controversy in spite of its proven efficacy. There is limited literature on attitude and knowledge of medical students towards ECT from Asian and African countries. Aim: The current study assesses the impact of a Brief ECT Orientation Module on the knowledge of and attitudes of Indian medical students towards modified ECT. Subjects and Methods: The study was conducted at a tertiary care multi-specialty hospital associated with a government medical college. The students were administered the study questionnaire on Day 1 of Psychiatry clerkship. Following this, they were administered the Brief ECT Orientation Module. Assessment was made using a questionnaire with items related to knowledge and attitude towards ECT before and after Brief ECT Orientation Module. Results: Fifty-nine students completed the study. There was a significant improvement in knowledge of medical students on all the three domains of the questionnaire for assessment of knowledge about ECT-related facts. A change in attitudes towards ECT was also observed following Brief ECT Orientation Module, especially among those who witnessed ECT administration. Conclusion: The findings of the current study suggest that the Brief ECT Orientation Module is effective in improving the knowledge and attitude of medical students towards ECT.

Clinical Presentation of Mucopolysaccharidosis Type II (Hunter's Syndrome).

Abstract: We present a rare case of mucopolysaccharidosis (MPS) with a typical presentation of mental retardation and absence of corneal clouding. The purpose of presenting this case report is to highlight the distinctive manifestation of MPS (Hunter's disease) and to provide a concise report of Hunter's disease for medical practitioners with the hope that such information will help identify boys earlier in the course of their disease. This report is of a 7-year-old boy who presented to the children outpatient through a referral with a history of inability to grasp objects, inability to express self, and coarse skin, which started 5 years ago. On examination, he was short statured, with a big head, protruding abdomen, coarse skin, swollen wrist joints, and clubbed fingers. There was mild mental retardation. Investigations revealed mucopolysaccharides in urine ad radiographic findings were in keeping with diagnosis. Based on the clinical features and radiological findings, one can diagnose a case of MPS. However, careful and critical approach is necessary to exactly diagnose the type of MPS as enzymatic studies are not available in most centers.

Triorchidism with torsion.

Abstract: Polyorchidism is a rare anomaly; triorchidism is the commonest type and is frequently associated with cryptorchidism, inguinal hernia, and testicular torsion. It is also reported as an increased risk of testicular malignancy. We report a case of 72-year-old man with left supernumerary testes in the left hemiscrotum. He presented with pain in his left hemiscrotum of short duration. Physical examination revealed tender hemiscrotum. Both ultrasound and MRI examinations revealed polyorchidism. One of the testes in the left hemiscrotum revealed features of torsion and hemorrhagic necrosis. Polyorchidism is a rare entity. In most cases, sonography alone is diagnostic of polyorchidism. Magnetic resonance imaging may provide additional information in complicated cases of polyorchidism.

A Telfairia Occidentalis seed-incorporated diet may be useful in inhibiting the induction of experimental andropause

Abstract: Background: Andropause, a prevalent pathology of men, results from an imbalance in steroid hormone concentrations that often is associated with aging, and reduces the quality of life of the sufferer. This study investigates the usefulness of a diet containing 15% Telfairia occidentalis seeds in the inhibition of the induction of experimental andropause. Materials and Methods: Twenty male rats were divided into four equal groups. Rats in the test group received dihydrotestosterone and estradiol valerate (ratio 10:1) subcutaneously every other day for 28 days and were placed on the test diet. Those in control I received the hormones, but not the test diet. Rats in controls II and III received olive oil (vehicle) and were placed on the test diet and normal diet, respectively. Testes weights and relative weights, serum testosterone concentrations, and testosterone concentration per gram of testicular tissue were measured or determined in all rats using standard protocols. Data were analyzed and differences between means separated using one-way analysis of variance. Results: Rats in the test group had slightly larger mean relative testes weights compared to those in control I, though both were significantly (P<0.001) smaller than the values obtained in controls II and III, respectively. Rats in the test group had significantly higher (P=0.034) serum testosterone concentrations relative to the control I group 6.9(0.3) ng/ml vs. 4.7(0.1) ng/ml, while the testosterone relative to testes weight values (ng/ml/g) of the test group was 16.8(3.4), and for controls I, II, and III the values were 12.3(1.4), 5.5(0.4), and 4.6(0.7), respectively. The differences between the test and control groups were all significant (P=0.04 in control I, and <0.001 in controls II and III). Conclusion: The test diet resulted in a modest reduction of biochemical castration and an improvement in secretory capacity of the testes of the test rats, relative to the control group that received the hormones but was placed on a normal diet. T. occidentalis seeds-incorporated diet may be useful in inhibiting the induction of experimental andropause.