Nigerian quarterly journal of hospital medicine最新文献

Background: Calotropis procera is a species of flowering plant which belongs to the Asclepiadaceous family. Its other names are Apple of Sodom, Giant Milkweed and Swallow-wort. It's native to Africa and Asian countries where they exist as a spreading shrub or small tree with height of about 4m. They. exude copious milky sap when cut or broken. It has a broad grey-green leaves with a pointed tip, two rounded basal lobes and no leaf stalk. Their flowers are waxy white. The different part of this plant has been used for different medicinal purposes such as cure of leprosy, eczema, inflammation, cutaneous infections, syphilis, malarial and low hectic fevers, and as abortifacient.

Objective: The extract of the bark of the plant Calotropis procera used locally by people in Sokoto to treat ringworm infection was investigated for the claimed activity by subjecting the extract collected to both phytochemical and antifungal screening.

Methods: The extracts of water, n-hexane, petroleum ether and chloroform of the bark of the plant Calotropis procera were evaluated for the presence of alkaloids, tannins, glycosides, saponins, steroids and flavonoids. And the water extract which is often used by the local people was tested for antifungal activity using Sabouraud Dextrose Agar (SDA) in Kirby-Bauer disc diffusion method developed by Kirby et al. Fulcin tablet was used as a standard and two petridishes that does not contain the extracts were used as control.

Results: In the phytochemical study using extracts of n-hexane, petroleum ether, chloroform and water, the presence of alkaloids, tannins, saponins and steroids (cardiac glycoside) were confirmed. Also, for the antifungal activity of the plant, there was a complete inhibition of Microsporum specie and Trichophyton specie in the sample after 10 days of inoculation when water extract at different concentrations (i.e. 20 mg/L, 30 mg/L and 40 mg/L) were applied. The tablet only completely inhibited Trichophyton specie. Epidermophyton specie was not found in the sample. The inhibitory effect of this extract was significant (p < 0.05) when compared with fulcin tablet.

Conclusion: The research confirmed that the extract of the bark of the plant Calotropis procera has some antifungal activity.

Background: The consistent use of male latex condom significantly reduces the risk of HIV infection among men and women.

Objective: This study was designed to assess the prevalence and pattern of male and female condom use among antiretroviral therapy naïve people living with HIV (PLHIV) in Lagos, Nigeria.

Methods: This was a cross-sectional descriptive study. Interviewer administered questionnaires were used to collect demographic data of age, gender, marital status, rate, pattern of and reasons for not using condoms among PLHIV.

Results: Four hundred and forty three respondents were interviewed with age rangefrom 14 to 75 years and a mean of 35 ± 9 years. There were 175 (39.5%) males and 268 (60.5%) females in the study. Overall, 71 (16.0%) of respondents used condom consistently. Only 55 (12.4%) of the respondents were aware of female condom while 9 (2%) used it.

Conclusion: This study reveals that there is a low consistent use of male condoms and a very low awareness and use of female condoms among studied PLHIV.

Background: Increase in QT dispersion (QTd) is associated with an increased risk of cardiovascular morbidity and mortality.

Objectives: This study sought to (i) determine the mean QTd and (ii) characterise QTd in a healthy Nigerian population.

Methods: One hundred healthy Nigerian adults were studied. Healthy status of the subjects was determined by history and physical examination. A resting 12- lead ECG was obtained from all subjects for determination of QTc, QTd and ECG left ventricular hypertrophy (LVH) using Sokolow Lyon (SL) and Araoye's codes. Echocardiography was used to determine LV systolic function, LVM and LVMI for 60 subjects.

Results: The QTd ranged from 15-70ms with a mean value of 38.5 ± 11.2ms. QTd was independent of age (p = 0.86), sex (p = 0.97), heart rate (p = 0.22), blood pressure (p > 0.05), BMI (p = 0.81), QTc (p = 0.41), LVH (ECG and echo) and LV systolic function (p > 0.05).

Conclusion: QT dispersion is independent of demographic parameters, LV systolic function and LV hypertrophy in healthy adult Nigerians.

Injury to male external genitalia is very rare because of some intrinsic factors like location, strong investing tunica albuginea and cremasteric muscles. However, when it occurs it is considered a urological emergency. Child labour with poor understanding of risks and safety precautions, especially under harsh supervision, surely poses major challenges. This case illustrates degloving injury of the penis and avulsion of the scrotum in a young boy while operating a roller type machine used in palm trees plantation. The penis was primarily regloved and avulsed skin primarily repaired. A good cosmetic outcome was observed from this treatment. This case also illustrates the importance of early presentation and emergency intervention in this condition.

Events associated with severely injured victims are common occurrences. These injured patients should be properly managed to achieve good outcome. Trauma algorithm protocols are known to improve therapeutic process and outcome. However, most hospitals in our subregion that attend to severely injured patients are yet to develop an algorithm treatment protocols for the management of these patients. The ambulance system in Nigeria is still un-coordinated and unsupervised. Most of the existing ambulances are not well equipped and usually not manned by experienced paramedics. Therefore, transfer of severely injured victims is fraught with danger during transit. Communication link to inform the trauma centres ahead of transfer is virtually non-existent. Upgrading of the trauma systems in Nigeria is necessary to prevent unnecessary mortality among the resourceful age group that are mostly affected by events causing severely injured patients .

Congenital lobar emphysema (CLE) is a notable cause of respiratory distress in neonates, however it remains a diagnostic challenge due to inadequate facilities and low level of experience. The management of this condition also is a bigger challenge due to paucity of expertise and relatively non-existent well-equiped neonatal intensive care unit in this part of the world. Here we present the case of a 5- day old baby who presented at Lagoon Hospital, Apapa with history of severe respiratory distress since birth. CT scan of the chest confirmed an emphysematous left upper lobe with contralateral mediastinal shift. The baby had a left posterolateral thoracotomy with left upper lobectomy and thereafter was electively ventillated for forty eight hours in the neonatal intensive unit. He had an uneventful postoperative course and was discharged from the hospital within one week forfollow-up in the clinic.

Background: 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 investigates the histological pattern and grades of cervical cancer tumours seen at a radiotherapy centre in Ibadan, Nigeria.

Patients and 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: Depression is caused as a result of combination of genetic, biochemical, environmental, and psychological factors. Citalopram and fluoxetine are antidepressants which are considered the current standard for depression treatment. There are little or no reports as to whether these antidepressants affect blood chemistry and haematological parameters in humans.

Objective: The effects of citalopram and fluoxetine on blood chemistry, hematology and brain serotonin in rats were investigated.

Methods: Forty-five Sprague Dawley male albino rats (140.69 +/- 5.86g) were divided into 3 equal groups. The first group of rats were orally administered 2 ml of 0.25 mg/ml of citalopram, the second group was administered 2 ml of 0.25 mg/ml of fluoxetine and the third group was administered 2 ml of saline (0.89% NaCl) daily for 4 weeks. The body weights and feed intake of rats were recorded every other day throughout the duration of drug administration. Five rats from each group were sacrificed by cervical dislocation after 7, 14, 21 and 28 days of drug administration. Blood was taken intravenously into lithium heparinized tubes and brain excised. Blood chemistry and hematology were determined by auto analyzer, while brain serotonin levels were determined using High Performance Liquid Chromatography. Serum levels of creatinine, urea, albumin, protein, glucose and activities of aspartate aminotransferase (AST) and alanine amino transferase (ALT) were determined in rats administered citalopram, fluoxetine and saline. The packed cell volume, white blood cells, red blood cells and platelets of rats administered the respective drugs were determined.

Results: There was no significant (P > 0.01) difference in the mean body weight of rats administered fluoxetine, citalopram or saline for 2 weeks. There were no significant differences in the hematological parameters of rats. The results of the study showed that citalopram increase the body weight of rats in the third and fourth week and was reduced in fluoxetine administered rats. The drugs also affected brain serotonin level, lipid profile of rats and increased levels of albumin, glucose and activities of liver enzymes; aspartate aminotransferase and alanine aminotransferase.

Conclusion: Data of the study indicate that oral administration of citalopram and fluoxetine in rats for 4 weeks daily affected blood chemistry and do not affect haematological parameters.

Background: There is growing burden of cardiovascular disease in developing countries and the pathogenesis of artherosclerotic damage starts in childhood

Objective: The study is to examine the prevalence of hyperlipidaemia in schoolchildren in Lagos, as it relates to both socio-demographic and anthropometric correlates

Methods: A cross-sectional study was carried out among urban and rural adolescent schoolchildren aged between 10 and 19 years in Eti-Osa Local Government Area (EOLGA) of Lagos State. A structured questionnaire was used to get information relating to socio-demographic characteristics, family history of cardiovascular disease, lifestyle habits and socio-economic class, and the students were examined for height, weight and cholesterol levels.

Results: Two hundred and eighty eight subjects in the urban region and 72 subjects in the rural region of Eti-Osa LGA participated in the study. The mean age was 15.6 +/- 2.2 years with a range of 10 to 18.9 years. The mean serum total cholesterol was 148.1 mg/dl with a range of 100 to 254 mg/dl. There was significant correlation between serum cholesterol and gender only in the 12-13.9 year group. Neither place of residence nor age had any significant correlation to serum cholesterol. Thirteen (3.6%) students had elevated serum total cholesterol of e"200 mg/dl. Four subjects had BMls above the 95th centile, giving a prevalence rate of 1.1%. They were females, living and schooling in the urban area and three-quarters were of high socio-economic class.

Conclusion: Strengthening pre-enrollment medical and physical examinations, regular measurement of weight, height and BMI and laying emphasis on important lifestyle modifications early in the formative years are important to prevent development of non-communicable disease later in life.

Background: Oral health care imparts on the quality of life and general health outcomes, therefore essential for the knowledge of graduating medical students

Objective: To assess the knowledge of graduating medical students on child and maternal oral health

Methods: A cross sectional survey was undertaken among the graduating medical students of the University of Port Harcourt using an anonymous structured questionnaire with open and closed ended questions. Participants' knowledge about aetiology of dental caries, gingivitis and preventive oral health care and behaviours associated with early childhood caries (ECC) were assessed. Information gathered was collated and analyzed using a statistical software-SPSS Version 17.

Results: There were 166 participants with a mean age of 25.4 (+/- 3.0) years, range 20-45 years. Over 80% knew the roles of diet and bacteria in aetiology of dental caries. Regarding ECC, 59% agreed that breast milk and infant formula may be harmful to the teeth and 41.4% were aware that a mother can transmit cariogenic bacteria to the child. The importance of dental check up in pregnancy and the association between oral diseases in pregnant women and infant health was known by 63.3% and 51.8% respectively. Also, the importance of age at first visit and frequency of routine dental visits in a child was known to 40.4% and 54.8% respectively. Only 12.7% of participants knew that a carious primary tooth should be restored. Over 90% agreed that they needed to increase their knowledge on child oral health.

Conclusion: The knowledge base of graduating medical students on the subject of maternal and child oral health was inadequate. A curriculum review that accommodates clinical exposure to child and maternal oral health during undergraduate and postgraduate medical residency training in Paediatrics is advised to increase their knowledge.