Nigerian quarterly journal of hospital medicine最新文献

Neonatal diabetic ketoacidosis is a rare condition that may occur in the first few weeks of life as a complication of neonatal diabetes mellitus. The prominent clinical features are hyperglycaemia and dehydration. It could also mimick an infection. The danger of inappropriate diagnosis is increased morbidity and mortality. To prevent this, we advocate routine testing of blood glucose levels in neonates and infants who present at the emergency rooms. We report a case of neonatal diabetic ketoacidosis in a female who presented at our facility.

Background: Croton penduliforus (Euphorbiaceae) is a tropical evergreen plant widely distributed in Africa. Its seeds are used in folklore medicine as laxative, as well as a major component of herbal contraceptive and antifibroid decoction.

Objective: This study is to investigate the oral acute toxicity and histological effects of Croton penduliflorus seed oil in mice.

Methods: Croton penduliflorus seed oil (CPSO) was prepared by Soxhlet extraction of shelled, oven dried, ground seed sample with 40-60 degrees C petroleum ether. Albino mice of both sexes aged 6-7 weeks old were randomly divided into seven groups of five. Graded doses of 200, 400, 600, 800, 1000 and 1200 mg/kg body weight of the extract were administered orally to groups 2-7 respectively. The control group was administered with 0.1 ml of Tween 20. The numbers of deaths over a period of 24 hours were recorded. Acute toxicity (lethal dose) was estimated from the graph of % cumulative death against log dose of the extract. The animals that survived after 24 hours were monitored daily for 14 days for appearance of delayed toxicity signs. At the end of 14 days all the animals were sacrificed and blood sample were collected from each animal into a plain sterilized bottle. Internal organs namely kidney, liver, heart and lungs were isolated and fixed in 10 % formal saline for histopathological examination.

Results: The LD50 was estimated to be 570 mg/kg body weight. CPSO caused weight loss at doses greater than 600 mg/kg with significant increases in AST and ALP activities and fluctuation of serum electrolytes.

Conclusion: Croton penduliflorus seed oil is toxic to the kidney and liver of mice.

Forensic investigations have been embraced in many developed countries to help investigate homicidal cases in their legal system amongst others. It is however still in infancy state in many developing countries, including Nigeria, making the use of this very vital tool very limited to prosecute cases. Some of the reasons include the low knowledge base of the investigating officers, to the dearth of Forensic personnel and the inability to use the findings to prosecute the offenders. The few cases where proper investigation is done, anatomic pathologists and sometimes medical officers are usually called to provide the forensic evidence. Often this involves exhumation of corpse. Exhumation of corpses for death investigation is not a common occurrence in Nigeria and we present the findings seen in these cases.

Background: Data on the utilization of the available oral health facilities by university undergraduates is scarce in Nigeria.

Objectives: To determine the level of utilization of oral health care services and to identify the barriers to seeking treatment among University of Lagos students.

Methods: A cross-sectional survey was carried out among University of Lagos undergraduates. Systematic sampling was used to select participants after randomly selecting a male and female hostel. Self-administered questionnaires were distributed to participants and collected immediately. The data was analyzed using Epi info version 6.04 software. Statistical significance was evaluated with chi square test and p-value <0.05 was regarded as significant.

Results: About half (50.9%) of the respondents had visited the dentist previously while only 42.7% respondents had utilized dental services in the past 12 months. There was no significant association between the age, gender, year of undergraduate education, and the faculty of these students and their level of utilization of oral health care services. A high proportion of respondents that had attended the dental clinic went for dental checkup (33.6%) and extractions (30.9%).The major barriers to receiving dental treatment was a lack of perceived need for dental treatment (53.1%) followed by lack of time (27.1%), fear/anxiety (18.2%) and cost of treatment (18.2%).

Conclusion: The low level of utilization among the undergraduates in Lagos, Nigeria shows that there is need for greater oral health awareness among the students, thereby increasing the use of oral health care facilities.

Health literacy is the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make an appropriate decisions concerning their health. It is one of the link by which the health status of individual and the health indices and statistics of our country can be improved upon. Factors influencing health literacy in Nigeria include the culture and belief system, poor and ineffective communication, lack of education and low educational level, and low socioeconomic status Low health literacy predisposes to poorer health status, poorer disease outcome, lack of understanding in the use of preventive services, frequent hospital visitations amongst others. Factors influencing health literacy must be identified and modified to help improve the health literacy level of the populace. This will invariably improve the health status of the populace with a resultant improvement in the health indices of our country. This is a call for the Government and Health Care Professionals to acknowledge low health literacy as a problem and, therefore, be willing to play their roles in tackling this problem to achieve a healthy Nation

Background: Subclinical hypothyroidism has been documented to have a positive effect on the clinical presentation and outcome in acute ischemic stroke.

Objective: To determine the prevalence of subclinical hypothyroidism in first ever ischemic strokes and to evaluate its effect on the clinical presentation.

Methods: Using a cross-sectional study design, 138 patients diagnosed with first ever ischemic stroke within 7 days of onset were included in the study. Each participant had documentation of demographic data, followed by a detailed neurological examination. Stroke severity on admission was recorded using the National Institute of Health Stroke Scale (NIHSS) and blood samples for free thyroxine (T4) and thyroid stimulating hormone (TSH) were taken within 24h of onset of symptoms. For analysis, the patients were divided into two groups: those who had elevated TSH level (> 2.5 mlU/L) with normal FT4 level were assigned to the sub-clinical hypothyroidism group whilst those with normal thyroid function were assigned to the control group. All values were compared between the two groups.

Results: The study population comprised of a total number of 138 participants with mean age of 63.4 +/- 12.9 years. The females were 56 (40.6%) and the males were 82 (59.4%). A total number of 11 (7.9%) had subclinical hypothyroidism whilst 127 participants (92%) had normal thyroid functions. The mean NIHSS score of cases with SCH on admission was significantly lower than that of those with normal thyroid functions (6.73 +/- 3.6 vs. 11.1 +/- 6.3, p=0.025). A significantly higher proportion of patients in the SCH group had mild neurologic deficits on admission compared with the group with normal thyroid functions (81.8% vs 24.4%, p < 0.001).

Conclusion: Our study has suggested that subclinical hypothyroidism appears to confer a neuroprotective effect in acute ischemic stroke.

Background: We have earlier reported the antinociceptive and anti-inflammatory effects of Alafia barteri Oliver (Apocynaceae) in rodents but its mechanism of actionsare yet to be elucidated.

Objective: This study sought toinvestigate the involvement of monoaminergic, nitric oxide-cyclic GMP-K+ channel and opioidergic pathways in its mechanism of actions.

Methods: methanol root extract of Alafia barteri (ALA) (100-400 mg/kg, p.o.) was given 1 h before administration of chemical or thermal-induced nociception andhistamine/serotonin-induced inflammation. The mechanism of the antinociceptive effect was investigated through intraperitoneal injection of prazosin (62.5 pg/kg; alpha1-adrenoceptor antagonist), yohimbine (1 mg/kg; alpha2 adrenoceptor antagonist) N(G)-nitro-L-arginine (L-NNA) (20 mg/kg; nitric-oxide-synthase inhibitor), c y p r o h e p t a d i n e (10 mg/kg; 5-HT2R antagonist), glibenclamide (10 mg/kg; ATP-sensitive K+ -channel inhibitor), or naloxone (5 mg/kg; opioid-receptor antagonist) before the nociceptive models.

Results: ALA(100-400 mg/kg)treatment produced dose and time dependent (P<0.001; 87.11%)increase in pain threshold in acetic acid-induced-writhing, inhibition of neurogenic (50.96%), and inflammatory (70.02%) phases of formalin test, and 41.75% maximum possible effect (MPE) in tail immersion testat 400 mg/kg in comparison with vehicle-treated control. The antinociceptive-effect was blocked by pretreatmentof mice withprazosin, yohimbine or L-NNA, (P<0.001) in writhing-assay. Similarly, naloxone pretreatment blocked the inhibition of neurogenic- and inflammatory-pain induced by ALA in formalin test. Interestingly, ALA produced dose related time course inhibition (P<0.05) of histamine and serotonin-induced paw inflammation with peak effects (57.89, and 81.82%), respectively, at 400 mg/kg.

Conclusion: Findings from these studies suggest central and peripheral arralgesic effect of A. barteri through interaction with L-arginine-nitric-oxide pathway, alpha(1/2)-adrenoceptors, and/or, opioidergic pathway, while, the anti-inflammatory effect involves marked inhibition of histamine and serotonin release.

Background: Glaucoma is the commonest cause of irreversible blindness in Nigeria and raised intraocular pressure (IOP) is the only modifiable risk factor. Selective laser trabeculoplasty (SLT), one of the treatment modalities, has been reported to have a cross-over effect on the fellow untreated eyes.

Objectives: To determine the lOP lowering effect of SLT on the contralateral untreated eyes in patients with primary open angle glaucoma.

Methods: This was a retrospective chart review of patients who underwent SLT at Guinness Eye Centre, Lagos from June 2011-June 2012. Information on bio-data, diagnosis and modality of treatment were retrieved. Excluded were patients who had glaucoma surgery or needed additional medications. Each patient had SLT in one eye either as primary or adjunctive treatment. IOPs were measured post-operatively in both treated and untreated eyes at various time points using the Goldmann applanation tonometer. Data was analysed using paired and unpaired two-tailed t-test for comparison of means with level of significance set at p<0.05.

Results: Forty eyes of twenty subjects were included. 60% (12) were males and 40% (8) were females. The mean age was 48.9 +/- 17.0 years (range, 23-74 years). Reduction in IOP from baseline was found in both the treated and the fellow untreated eyes at the various time points. Mean IOP reduction was maximal at 3 months; 8 mmHg or 26% (p=0.024) in the treated eyes and 7 mmHg or 25.9% (p=0.097) in the untreated eyes. Mean IOP reduction from baseline-were 1.3 +/- 5.9mmHg or 6.3% (P=.624) in the treated eyes and 2.9 +/- 7.5 mmHg or 9.7% (P=.418) in the untreated eyes at 6 months.

Conclusion: This study shows that there is a sustained IOP reduction in the fellow untreated eyes following SLT in patients with POAG. In view of the retrospective nature of the study, small sample size, non-randomization and lack of control definite conclusions cannot be drawn from the findings.

Background: A significant proportion of patients seeking dental care may present with one or more medical conditions. Information on medical history, drug used and attitude to medical recall visit is vital for planning dental treatment in this group of patients.

Objectives: To study the attitude of dental patients with medical condition toward their medication and medical recall visits.

Methods: This prospective study was conducted among consecutive new patients presenting to the Dental centre, UMTH, Maiduguri, between January and December 2012. The data were collected through a structured questionnaire.

Results: Of 566 new patients seen during the study period, 92 patients (16.3%) had medically compromised conditions. Male Female ratio was 1:1.4 and a mean age 43.3 +/- 16.1 years. Hypertension 91(5.7%) was the most prevalent medical problem. Forty-four (47.8%) kept regular medical recall appointments while 15 (16.3%) only visited their physician when they have perceived symptoms of their ailment. Fifty-three (57.6%) take their medications regularly as prescribed by their physician while 14.1% of the patients had on their own stopped their medication.

Conclusion: Appreciable number of the patients showed good drug compliance and regular recall visit to their physician, however there is still some level of poor drug compliance and irregular observance of medical recall appointments among the subjects. Oral health awareness instructions should include counselling and motivation on drug compliance and adherence to medical visit.