Nigerian quarterly journal of hospital medicine最新文献

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.

Objective: The study investigates on eighteen month review of infecting bacterial agents and susceptibility pattern in chronic ulcers in Lagos, Nigeria.

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 coil (7.3%). There were widespread resistances by the isolates to the common antibiotics in the study environment.

Conclusion: 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: Exercise is a physical activity that maintains physical fitness and optimum health of an individual.

Objective: The objective of this study was to determine changes in redox-oxidative status, lipid profile, cortisol, testosterone and fasting blood glucose (FBG) in trained and untrained male subjects during a programmed exercise session.

Methods: Twenty (20) trained and twenty (20) untrained young healthy male subjects (age 21.75 +/- 1.15 years, height 1.74 +/- 0.02 m and weight 65.25 +/- 1.46 kg) participated in the study. Their weights, heights, waist and hip circumferences were measured. Subjects who have fasted for 12 hours exercised on the treadmill for 20 minutes at 1.5 km/hr after a warm-up period of exercising at 0.5 km/hr. for 3 minutes. Blood samples (1.5 ml) were withdrawn from the cubital vein before and immediately after the exercise session. Blood samples were analyzed for FBG, lipid profile, testosterone, cortisol and oxidative enzymes activities. Blood pressure and pulse rate were also measured before and after the exercise.

Results: There was a significant decrease in rate of glucose disappearance in the trained subjects compared with the untrained subjects. The low density lipoprotein (bad cholesterol), TC, TC:HDL and LDL:HDL ratios were significantly higher in the untrained subjects both before and after the exercise while the trained subjects recorded significantly low cholesterol level. Testosterone and cortisol were significantly higher in untrained subjects before the exercise while its level balanced up with that of the trained subjects after the exercise. There was a significant increase in pulse pressure and diastolic pressure in untrained subjects after the exercise compared with trained subjects. Results of antioxidant assay showed that basal GPx and catalase were significantly higher in the trained subjects while GSH and SOD significantly increased in untrained subjects after the programmed exercise. Trained subjects expressed efficient energy utilization with better preparedness to handle oxidative stress better than untrained subjects.

Conclusion: Exercise improves body lipid profile, cardiovascular system and antioxidant status, thus providing better accommodative adjustment to changes without any significant change to blood pressure parameters during exposure to exercise training.

Background: Detection and treatment of asymptomatic bacteriuria (ASB) in pregnancy is important to avert the attendant maternal and fetal morbidity. Other than urine culture, no other screening test is unequivocal.

Objective: The use of enhanced urinalysis test to detect ASB in pregnancy was investigated.

Methods: This was a prospective observational study which compared enhanced urinalysis with dipstick tests and urine culture. Clean catch midstream urine specimen was collected from 150 consecutive asymptomatic pregnant women. Tests of validity were used for comparison.

Results: Enhanced urinalysis detected bacteriuria as much as urine culture (4% vs. 4.7%). Itwas 57.1% sensitive and 98.6% specific. It had a false negative rate of 42.9% and was 96.7% accurate when compared to urine culture. Enhanced urinalysis took 1-2 hours to be done and required skills to use the microscope and was more expensive than dipstick urinalysis.

Conclusion: The accuracy of enhanced urinalysis and its ability to detect ASB as much as urine culture connotes that it can be used to detect asymptomatic bacteriuria in pregnancy albeit only in secondary and tertiary health centres because of the cost and technicality involved.

Background: Tooth bleaching (whitening) is a conservative and cost effective treatment of discoloured teeth.

Objectives: The purpose of this study was to evaluate the clinical efficacy and safety of 16% and 35% carbamide peroxide as in-office bleaching agents.

Methods: Thirty adult subjects who desired to whiten their discoloured teeth were enrolled in the study. Carbamide bleaching agents, in concentrations of 16% and 35%, were used to whiten their teeth employing the spilt-arch technique/half-mouth design using vacuum formed half-arch matrix seated over the maxillary teeth for a one-hour session per week for two weeks. Outcome was monitored with Vita shade guide and photographs.

Results: Twenty females and ten males, ages 18-43 years, with mean age 27.83 years, participated in the study. Tooth whitening was obtained in all subjects. Shade tab movement of 2-4 shades and 4-6 shades was recorded at first sessions then 3-5 and 5-9 shades at second sessions for 16% and 35% concentrations of carbamide peroxide respectively. The bleaching outcome was significantly better with the 35% concentration of carbamide peroxide while transient tooth sensitivity was observed in both concentrations ofthe bleaching agents.

Conclusion: Carbamide peroxide in 16% and 35% concentration are effective and safe for bleaching discoloured vital teeth, however, 35% concentration gave significantly more lightening effect without additional side effects compared to 16% concentration.

Objective: To evaluate the effectiveness of ultrasound guided tranvaginal probe placed on the anterior abdominal wall for oocyte retrieval in a patient whose ovaries were not visible trans-vaginally.

Design: A case report

Setting: Medical ART Center, Nigeria- Private IVF clinic with an academic setting

Patient(s): A 35 yr old woman undergoing IVF treatment with ovaries difficult to visualize trans-vaginally having ovarian stimulation pressure effect.

Intervention(s): Ultrasound guided oocyte aspiration through the abdominal wall using the trans-vaginal probe.

Main outcome measures: Number of oocytes retrieved.

Results: 9 oocytes were successfully aspirated using the ultrasound scan guided probe placed over the anterior abdominal wall.

Conclusion: Successful oocyte retrieval can be achieved via the abdominal puncture with the aid of a trans-vaginal ultrasound probe placed on the abdominal wall.

Background: The majority of the studies on non carious cervical lesions (NCCLs) dealt with characteristics of NCCLs without identifying patient related factors associated with them.

Objective: The basis of this study to identify these factors and to see if there are any association with the findings.

Method: This study was conducted among 34 patients referred to the conservative clinic of the Lagos University Teaching Hospital, Idi-araba, Lagos. Questions regarding patient's complaints, dietary habits and toothcleaning techniques were asked and correlated with the occurrence and severity of NCCLs clinically.

Result: Over a third, (41.2%) of the subjects presented with dentine sensitivity resulting in pain. Fifty percent (50%) of the patients were on one form of medication or the other. Out of this number, 50% habitually chewed vitamin C tablets. With respect to diet, 61.8%, 58.8% and 47.1% of the patients were on diet rich in fruits, soft drinks and fruit juices respectively. The degree of severity(extensiveness) of lesions significantly increases with age of patient (p = 0.001). Tooth cleaning habits played an important role in the occurrence, distribution and pattern of NCCLs. There was association between the tooth cleaning technique used and the extensiveness and distribution of the lesions. The horizontal technique accounted for 54.7% of lower jaw lesions while 63.7% and 55.8% of lesions found in the vertical and mixed (circular) techniques respectively were found in the upperjaw.

Conclusion: Awareness of the multifactorial etiology in noncarious cervical lesions may help the clinician to formulate an appropriate treatment plan and preventive strategies in the management of NCCLs.

Background: Diabetic retinopathy is an important complication of diabetes mellitus, which may lead to blindness.

Objective: The study is to analyze posterior segment lesions in Diabetes Mellitus patients seen in Guinness Eye Centre, Lagos University Teaching Hospital in relation to the number, duration and severity.

Methods: All the case files of Diabetes Mellitus patients seen during the period of study were retrieved and data extracted from them were analyzed. Such information included age, sex, duration of Diabetic Retinopathy and its severity.

Results: A total of 84 case files were reviewed. There were 47 males and 37 females with a male to female ratio of 1.3:1. No diabetic patient was seen in the age group 30 years and below. Fifty-five (65%) patients who presented themselves did so very late. Of the 35 patients found to have diabetic retinopathy at presentation, 16 had the disease bilaterally. The most common form of Diabetic Retinopathy was clinically significant macula oedema. The study shows that a high proportion of the patients (41.6%) had Diabetic Retinopathy.

Conclusions: Patients with DM should be referred early for eye examinations. Physicians Residents should be made to rotate through eye Departments for a period of at least 2 weeks so they can learn fundoscopy. Diabetic patients should be educated on the eye complications that may arise from their condition. Regular eye screening with fundus camera and laser therapy should be part of the routine management of Diabetics in Nigeria as is done in advanced countries.

Eventration of the diaphragm can have varied symptomatology. We present three cases that presented with features suggestive of gastric outlet obstruction, productive cough of acute onset, and traumatic diaphragmatic rupture respectively. They were successfully treated with plication of affected hemidiaphragm. We also reviewed existing literature on the subject with presentation of our findings.

Background: While intact long bones are most ideal in estimation of the stature of unidentified individual, in forensic cases as may occur when natural or man-made disasters present bone fragments, regression equations derived from measurements of these bone fragments have been used to determine the length of the intact long bone.

Objective: The study reports on the morphometry of the humerus and the estimation of its length using regression equations in a Nigerian population.

Methods: The maximum length of the humerus was measured using an osteometric board while theAnatomical neck circumference (ANC), Anatomical neck diameter (AND), mid shaft diameter (MSD), olecranon vertical diameter (OVD), olecranon transverse diameter (OTD), transverse diameter of the inferior articular surface (IASD), transverse trochlea diameter (TTD) proximal point of the caput humeri and collum anatomicum (CHCAD), proximal edge of the fossa olecrani (PEFO) and the most distal point of trochlea humeri (FOTHD) and the biepicondylar width (BEW) of the distal segment were measured using a digital vernier caliper. Partial correlation and Persian regression were used to derive the linear regression equations for the measured parameters that showed correlation with the humeral length.

Results: Estimation of the maximum length of the humerus from the measures of its ANC, FOTHD, and MSD was achieved with relative accuracy. In deriving regression equations for the length of the humerus of the right and left sides, irrespective of side, the ANC and MSD were both significant in estimating the maximum length of the humerus; on the right side only the ANC exhibited significant correlation, while on the left side both the ANC and FOTHD exhibited significant correlation.

Conclusion: These previously unreported findings may help in anthropometric, forensic, and archaeological investigations for the estimation of the stature of the remains of unknown bodies by using regression equations in a Nigerian population.