Nigerian quarterly journal of hospital medicine最新文献

Introduction: The treatment of cervical carcinoma is dependent on many factors including histological types and degree of differentiation. Degree of differentiation is an important consideration in determining the prognostic outcome.

Objective: The study is to describe the histological pattern of cervicer cancer seen in our practice with emphasis on tumour differentiation.

Method: This retrospective study was carried out within Radiotherapy Department of University College Hospital, Ibadan. The records of patients diagnosed of cervical cancer seen between July 2008 and June 2010 were analysed. Data pulled out included age, disease stage at presentation, histological variant and degree of differentiation.

Results: 206 patients were seen during the period of which 196 had complete data. Squamous cell carcinoma (SCC) was seen in 178 patients (i.e. 90.8%) while 14 patients (7.1%) had adenocarcinoma. One patient each had adenoid cystic carcinoma, adenosquamous carcinoma, clear cell carcinoma and mucinous carcinoma. Majority of the patients, 99 (50.5%) had poorly differentiated tumours, 64 (32.7%) had well differentiated tumours, while the rest 33 (16.8%) had moderately differentiated tumours. Of the SCC tumours, 95 (53.4%) were poorly differentiated, 58 (32.6%) well differentiated while the remaining 25 (14%) were moderately differentiated. In comparison only 3 of the 14 adenocarcinoma cases (21.4%) were poorly differentiated, 5 cases (35.7%) were well differentiated, while 6 (42.9%) were moderately differentiated. The difference in the degree of differentiation between squamous histology and adenocarcinoma was statistically significant (p value = 0.002).

Conclusion: Poorly differentiated squamous cell carcinoma remains the leading variants of cervical cancer seen in our environment.

Background: Chronic ulcers are an important cause of morbidity among surgical and medical patients. Infection in ulcers may delay healing and cause septicemia resulting in mortality. Microbial studies are important for the appropriate management of these ulcers.

Methods: Details of all patients treated for ulcers that were investigated at the department of Medical Microbiology and Parasitology, Lagos State University Teaching Hospital, Ikeja-Lagos, Nigeria between July 1st 2009 and December 31, 2010 were retrieved from the computer database and transferred into the proforma designed for the study. Data collected were demography, date of onset of ulcer, mode of specimen collection, names of isolates and drug sensitivity patterns.

Results: A total of 329 cases were seen and reviewed during the study period. Males constituted 50.2%, females 38.3% and the gender of the remaining 11.6% were not indicated. There were 259 (78.7%) adults and 42 (12.8%) children. The ages of 28 cases were not indicated. Microbial growths were obtained in 217 (66.7%) patients. Gram negative (Gn) organisms were isolated in 181 (83.5%) and Gram positive (Gp) in 35 (16%). The most common isolates were Pseudomonas aeruginosa (19.1%) Staphylococcus aureus (9.7%), Proteus mirabilis (7.6%) and Escherichia coli (7.3%). There were widespread resistances by the isolates to the common antibiotics in the study environment.

Conclusions: The wide spread resistance may be due to lack of an antibiotic use policy. Certain antibiotics should be reserved for second line treatment in the emergency setting.

Background: lt is estimated that epilepsy affects approximately 50 million people worldwide and about 40 million of them live in developing countries. Studies have indicated high rates of poor knowledge, negative attitude and poor first aid management skills of students with epilepsy among practicing teachers. However, there is paucity of such studies on trainee teachers to ascertain any similarities or differences (if any) and the effect of educational interventions.

Objective: To determine the effect of a health education intervention on trainee teachers' knowledge, attitude and first aid management of epilepsy.

Methods: The effect of a health education intervention in first aid management of epilepsy was assessed among 226 trainee teachers, attending the Federal College of Education (Technical), Akoka. This was done using a quasi-experimental study design. Data were analyzed using the SPSS version 15.

Results: The respondents had a median age of 22 years with a range of 18 to 56 years. The majority of them were females (68.6%), single (79.2%), Christians (81.9%), Yoruba (70.4%) and in first year (100 level) of their study (69.9%). The highest proportion was from the Accounting department (46.0%). A consistent increase in responses to items on knowledge, attitude and first aid management of epileptic seizure items from baseline to post-intervention was observed. For instance, the proportion of responses that epileptic seizures originate from the brain significantly (p = 0.025) increased from 62.5% at baseline to 74.1% after intervention. Generally, slightly more than two-fifths (44.2%) and about two thirds (61.9%) of the respondents were observed to have poor knowledge and negative attitude to epilepsy respectively at baseline. Overall, giving health education on epilepsy led to a reduction in the proportion of respondents with poor knowledge by 15.5% (increase of good knowledge by 29.6%), decrease of negative attitude by 16.4% and increase of good first aid management skill by 25.0%. The knowledge scores were significantly associated with age (p = 0.001), marital status (p = 0.003) and department (p = 0.004) while the attitude scores were significantly associated with teaching duration (p = 0.020). The knowledge was predicted by department (p = 0.001) while the attitude was predicted by teaching duration (p = 0.036).

Conclusion: This study reveals that health education could improve the knowledge, attitude. and first aid management of students with epilepsy among trainee teachers. It is therefore proposed that an intervention programme on baseline knowledge of epilepsy and its first aid management be incorporated into the teacher-training curriculum, particularly those in health-related programmes, to address their deficiencies in knowledge, attitude and first aid management of students with epilepsy.

Background: Bryophyllum pinnatum Lam. Kurtz (Crassulaceae) is used in traditional African medicine in the treatment of diarrhoea.

Objective: To investigate the antidiarrhoeal action of the hydroethanolic leaf extract of Bryophyllum pinnatum (BP).

Methods: Normal intestinal transit, castor oil-induced intestinal transit, castor oil-induced diarrhoea, gastric emptying and enteropooling models in rodents were used to investigate antidiarrhoeal effect. The possible mechanism of antidiarrhoeal activity was investigated using prazosin (1 mg/kg, s.c; α1, adrenoceptor antagonist), yohimbine (1 mg/kg, s.c; α2 adrenoceptor antagonist), propranolol (1 mg/kg, i.p; α- adrenoceptor non-selective antagonist), atropine (1 mg/kg, s.c; muscarinic cholinergic antagonist), pilocarpine (1 mg/kg, s.c; muscarinic cholinergic agonist), and isosorbide dinitrate (IDN) (150 mg/kg, p.o; nitric oxide donor).

Results: BP (25-100 mg/kg, p.o) produced dose-dependent and significant (P < 0.001) decrease in intestinal propulsion in normal and castor oil-induced intestinal transit models in comparison to distilled water (10 ml/kg, p.o.) treated control. This antidiarrhoeal effect was inhibited by propranolol pretreatment but yohimbine, prazosin, or atropine pretreatment failed to block this effect. BP treatment reduced the increased peristaltic activity induced by pilocarpine, however, co-treatment with IDN significantly (P < 0.001) enhanced the antidiarrhoeal effect of the extract. In castor oil-induced diarrhoea test, the extract produced a dose-dependent and significant (P < 0.001) increase in onset of diarrhoea, decreased diarrhoea score, the number and weight of wet stools when compared to control. The in vivo antidiarrhoeal index (ADI(in) vivo)) of 53.52 produced by the extract (50 mg/kg, p.o.) was similar to 76.28 ADI(in vivo) produced by morphine (10 mg/kg, s.c.). The extract produced dose- dependent and significant (P < 0.05; P < 0.001) decrease in the weight and volume of intestinal content in the intestinal fluid accumulation model. In gastric emptying test, BP treatment reduced the quantity of test meal emptied in 1 h but not significant.

Conclusion: The results showed that the hydroethanolic leaf extract of Bryophyllum pinnatum possesses antidiarrhoeal activity possibly mediated by interaction with β adrenoceptor, muscarinic cholinergic receptor and nitric oxide pathway.

Background: Inflammatory markers have been widely implicated in Diabetes Mellitus (DM) and the metabolic syndrome (Mets). Data on the association of cytokines (pro inflammatory mediators) and components of the Mets are sparse in sub Saharan Africa.

Objective: We sought to document the pattern of distribution of cytokines in Nigerian subjects with type 2 DM and compare cytokine levels between DM subjects with and without the Mets.

Methods: 200 subjects with type 2 DM and 100 healthy sex and aged matched Controls were studied. Anthropometric indices, lipid parameters and cytokine levels, which included interleukin 10 (IL-10), tumour necrosis factor-alpha (TNF-α), interferon gamma (IFN-γ) and C reactive protein (CRP) were determined. Continuous variables were compared between subjects with type 2 DM and the controls and also between DM subjects with and without the Mets.

Results: The mean levels of all studied cytokines were significantly higher in the subjects with type 2 DM than the Control subjects, save for IFN-γ which was significantly lower in type 2 DM. The mean cytokine levels were comparable in the DM subjects with and without the Mets and also comparable in obese DM and non obese DM subjects. Of the Mets defining criteria, waist circumference (WC) and Triglyceride (TG) were found to be significantly associated with only two of the studied cytokines. The correlation coefficient and p values of these findings are as follows: WC vs TNF-α (r = 0.16, p = 0.001) and TG vs CRP (r = 0.15, p = 0.03). Multiple regression analyses showed that the cytokines were linearly associated with each other but not with other clinical and biochemical variables. The cytokines were found to be interrelated. IL-10 with a beta value of 0.14 predicted the presence of INF-γ with a 95% confidence interval of 0.000 - 0.109 and a p value of 0.05. TNF-α with a beta value of 0.17 predicted the presence of IL-10 with a 95% confidence interval of 0.004 - 0.034 and a p value of 0.01. IL-10 with a beta value of 0.17 predicted the presence of TNF-α with a 95% confidence interval of 0.3-0.590 and a p value of 0.01.

Conclusion: Cytokine levels are higher in DM than non DM subjects; however, the cytokine levels are not strongly associated with the Mets. Limited correlations were found between each of the cytokines and the parameters of the Mets. Further studies on this entity amongst Africans should be carried out to ascertain if these results are peculiar to DM subjects in sub- Saharan Africa.

Background: Computers have become an essential part of life particularly in industrially advanced countries of the world. Children now have greater accessibility to computers both at school and at home. Recent studies suggest that with this increased exposure, there are associated musculoskeletal disorders (MSDs) in both school-aged children and adults.

Objectives: To assess the posture assumed by secondary school students during computer use and its impact on the occurrence and severity of reported musculoskeletal discomforts.

Methods: Posture assumed during normal computer class, occurrence of discomforts, body parts involved and the intensity of discomforts were evaluated in 235 school aged children using Rapid Upper Limb Assessment (RULA) scale, Body Discomfort Chart (BDC) and Visual Analogue Scale (VAS) before and after normal computer class. Inferential statistics of t-test and chi-square were used to determine significance difference between variables, with level of significant set at p < 0.05.

Results: None of the participants demonstrated acceptable posture. Computer use produced significant discomforts on the neck, shoulder and low back. There was a significant relationship between participants height and posture assumed. Two hundred and eleven (89.8%) participants reported discomforts/pain during the use of computer. Weight and height were contributory factors to the occurrence of musculoskeletal discomfort/pain (p < 0.05) in some of the body parts studied.

Conclusion: Musculoskeletal discomfort was found to be a problem among the school-aged children during computer use. Weight and height were implicated as factors that influenced the form of posture and the nature of the reported discomfort. Creating awareness about the knowledge of ergonomics and safety for promotion of good posture was therefore recommended.

Background: Orofacial lesions are among the earliest clinical manifestations of HIV infections.

Objective: This study to investigate the oral lesions seen in HIV positive women with emphasis on the need for diagnosis of oral lesions by all health workers.

Method: A prospective cross-sectional study of HIV positive women attending the HIV/AIDS clinic (PEPFAR) of the University of Benin Teaching Hospital, Benin-city, Nigeria. The subjects were investigated for the presence of oral lesions, between the period January and March, 2011. The study was approved by the ethics committee of the hospital and a written informed consent was obtained from each subject that participated in the study. Determination of HIV related oral lesions was carried out clinically using the criteria proposed by the ECC/WHO, 1993. P values ≤ 0.05 were considered significant.

Results: A total of 107 HIV/AIDS infected women attending the HIV/AIDS Clinic were examined. The age ranged from 18 to 50 years with mean age of 36 ± 9.2 years. The age group of 21 to 30 was the most affected (n = 36, 33.6%). Sixty-one subjects (57.0%) presented with oral lesions. The most common observed oral lesion was pseudomembranous candidiasis (n = 37, 37.8%); followed by melanotic pigmentation (n = 11, 11.2%) and xerostomia (n = 11, 11.2%). Group 1 oral lesions accounted for 64.3%, group 2 accounted for 30.6%, while group 3 accounted for 5.1%.

Conclusion: Oro-facial lesions are among the earliest clinical manifestations of HIV infection. These were commonly observed in HIV infected Nigerian women. Oral candidiasis the most common oral lesion observed in the series may therefore be used as a clinical indicator of early immunodeficiency associated with HIV.

Background: The referral letter is a flexible means of transmitting information about the care of patients from one healthcare worker to another. In developing regions of the world like Africa, where it may serve as the only means of transferring patient's information, the referral letter has infrequently been studied.

Objective: The study is to assess the quality of referral letters to the Paediatric department of a tertiary hospital in Nigeria.

Methods: Referral letters sent to the Olikoye Ransome-Kuti Emergency Center (ORKCEC) and the Paediatric Outpatient Clinics of the Lagos University Teaching (LUTH) between December 2012 and February 2013 were reviewed for content of information. Letter sent to the emergency center were compared with letter sent from sources within LUTH.

Results: A total of 356 letters were reviewed, with 196 (55.1%) letters sent to the Emergency center. The majority of the referral letters (262; 73.6%) were from hospitals other than LUTH-(inter-hospital). Patient's name (99.7%), name of referring hospital (93.3%) and presenting complaints (91.1%) were the most consistently filled. Information relating to adverse clinical warning (1.7%), request for feedback (4.2%) and urgency of referral (8.4%), were the least filled. Only in 28.4% of the letters were the results of any or all the investigations done included. More interhospital letters had information on findings on physical examination, treatment, urgency of referral and request for feed-back from the receiving specialists. Referral letters to the clinics were more likely than letters to emergency centre to contain information on presenting complaints, history of the presenting complaints, and findings on physical examination.

Conclusion: Referral letters sent to the paediatric department of LUTH are poorly written with significant information about patient care frequently missing. Interhospital referral letters and letters sent to the clinics, though similarly low in quality, were more likely to contain information on physical findings and treatment received.

Background: Head circumference at birth is an important neonatal parameter in view of its association with perinatal and postnatal morbidity and mortality. It is an indicator of brain volume and a tool for assessing the development of the central nervous system. Being a complex hereditary trait, predicting baby's head circumference from parental anthropometrics could complement the already existing ultrasonographic method of prediction.

Objective: To identify the parental anthropometric determinants of baby's head circumference in Lagos, Nigeria, using a sample of patients attending a government hospital.

Methods: Parental anthropometric parameters were obtained from 250 couples. The baby's head circumference was measured immediately after birth. The data were subjected to multivariate analysis.

Results: The parental variables that were most predictive of babies' head circumference were mid-parental weight, maternal height, maternal weight gain during pregnancy and maternal age.

Conclusion: Assessment of these parental attributes can complement ultrasonographic data in predicting baby's head circumference for better perinatal outcome.

Background: Anemia is the world's second leading cause of disability and thus one of the most serious global public health problems. The World Health Organization (WHO) estimates that an average of 56% of pregnant women in developing countries, are anaemic.

Objectives: This study was conducted to. determine the knowledge, attitude and practices of prevention of anaemia in pregnancy amongst pregnant women attending the Antenatal Clinic at Ifako-Ijaiye General Hospital.

Methods: The design was cross-sectional descriptive study. Simple random sampling method was used to select two hundred and twenty respondents (220). A pretested, structured, interviewer administered questionnaires were used for data collection.

Results: Majority (95%) of the respondents was aware of anemia in pregnancy but the mean knowledge score was 56.5%. Less than half (46.3%) of the respondents thought that contraceptives could help prevent anemia in pregnancy by reducing closely spaced pregnancies. Only 31.8% were compliant with the use of iron supplements. About one third (33.2%) didn't combine drinking tea with meals while 47.3% of the respondents didn't use iron supplements with milk products.

Conclusion: The study showed that most of the respondents had a moderate level of knowledge, and positive attitude towards contraceptive use but a high proportion were not compliant with the daily use of iron supplements. It is recommended that health education of women as well as close family members should be reinforced to improve the compliance with supplements.