Nigerian quarterly journal of hospital medicine最新文献

Background: Diseases of the prostate are common among adult Nigerians with some, clinically asymptomatic during life.

Objective: The study is to determine the prostatic weight and document the histopathologic patterns, frequency, and age distribution of clinically asymptomatic prostatic lesions seen at autopsy in LUTH, Lagos, Nigeria over a 12 month period (January to December 2009).

Methods: Consisted of hospital case files and prostate glands harvested en bloc from all autopsies in men aged 20 years and above who died of other causes other than clinically diagnosed prostate disease in LUTH within the study period. After en block removal, the prostate glands were fixed in formalin, weighed, sectioned at 3-5mm intervals, processed and embedded in paraffin. Whole mount serial sections were stained with H& E and examined.

Results: Only 145 prostate glands were suitable for histological evaluation. There was an increasing prostatic weight with age. The distribution of identified prostatic lesions showed 75 (51.7%) having no histological diagnosis. Acute and chronic prostatitis accounted for 2 (2.9%) each, benign prostatic hyperplasia alone, 52 (74.2%) while benign prostatic hyperplasia (BPH) associated with chronic prostatitis accounted for 7 (10%). Latent prostate cancerwas found in 7 (10%) of the cases.

Conclusion: Prostate weight increased with age. Acute prostatitis was found to be commoner in the younger age groups, particularly below 50 years while chronic prostatitis was seen more in the older men and was largely associated with BPH. BPH was found to be the commonest lesion. Latent carcinoma showed a prevalence of 10%, which is significant and in keeping with similar studies done elsewhere.

Background: Sickle cell disorder is the most important genetic hematological disease that affects people of black African descent. The years of young adulthood present a good opportunity for screening and counseling for this genetic blood disorder.

Objectives: To assess effect of health education and provision of free sickle cell haemoglobin screening on knowledge of sickle cell disorder, attitude towards sickle cell haemoglobin screening, and uptake of sickle cell haemoglobin screening among students of a School of Nursing.

Methods: Study design was a quasi-experimental noncontrolled study. Self-administered questionnaire was used for pre- and post-intervention data collection. Implemented interventions were seminar on sickle cell disorder combined with free sickle cell haemoglobin screening. The data was analyzed with Epi-info version 3.5.1 statistical software package.

Results: Respondents who participated in all the study phases were 104. Mean knowledge score (%) was high (80.9 +/- 22.8%) at baseline and improved significantly to 91.8 +/- 9.4% (p < 0.001) at post intervention. 91.3% were willing to screen fiancée before getting married while 72.1% were willing not to go ahead with marriage if self and fiancée are carriers of sickle cell haemoglobin. Phenotype of the respondents that volunteered to be screened for sickle cell haemoglobin were: A (70.5%), AC (6.8%) and AS (22.7%).

Conclusions: Implemented interventions, seminar on sickle cell disorder combined with free sickle cell haemoglobin screening service yielded significant impact on respondents' knowledge, attitude and uptake of sickle cell haemoglobin screening.

Background: Film rejects analysis (FRA) as part of quality assurance tests in radiography services, is carried out periodically to identify causes of film rejection and to proffer solutions to ameliorate such problems.

Objective: The study was carried out to estimate film rejection rate in a tertiary health facility in Benin, Nigeria and also to identify causes of film rejection in the centre.

Methods: This prospective study was carried out within 6 months. Ethical approval was obtained from the local committee on research and ethics before the study commenced. Only routine x-ray procedures were included in the study. Four x-ray rooms and four radiographers with equal training and job experience were selected for the study. Different boxes labeled for each room were used to daily collect rejected films.

Results: Overall rejection rate was 6.7%. Improper exposure caused the highest rate of repeats (> 12% in the old x-ray rooms). Highest rejection rates (31%) were found in the old x-ray rooms. Paranasal sinuses examination accounted for highest rejection rate (25%) among all routine x-ray investigations considered.

Conclusion: Rejection rate found was within recommended limits.Obsolete but poorly maintained x-machines layed major roles in overall film rejection rate in the centre. X ray of paranasal sinuses was challenging to radiographers observed. Radiographers should embrace CPD while obsolete x-ray equipments found in the centre should be scrapped to further reduce film reject rate in the centre.

Background: The critically ill patient undergoes rapid changes in the internal milieu requiring quick intervention. Point of care testing has been shown to be valuable in the early diagnosis and management of such patients.

Objective: This study determined the agreement between I-STAT Abbot point of care testing with standard laboratory testing in the analysis of electrolytes and glucose concentrations in critically ill patients.

Methods: The study was performed in a Sub-Saharan Tertiary Teaching Hospital in critically ill patients. Electrolyte and glucose analysis were measured with I-STAT Abbot Analyzer unit with parallel blood specimens (n = 30) tested in the laboratory on an ion-selective electrode, SFRI analyzer ISE 6000.

Results: There was no significant difference in mean sodium, potassium, chloride and glucose between I-STAT POCT and standard laboratory measurements. The agreement between POCT and laboratory glucose was good p(c) = 0.967, mean difference of 0.79 and 95% limit of agreement from -3.83 to +5.107 mmol/L, p = 0.733. Bicarbonate was moderate (p) = 0.637, mean difference of 1.95 and 95% limit of agreement from -4.294 to +0.394 mmol/L, p = 0.101. There was moderate agreement for sodium (p(c)) = 0.32, mean difference of 5.8 and 95% limit of agreement from -0.378 to +11.98 mmol/L, p = 0.064. Agreement for potassium was moderate (p(c)) = 0.439, mean difference of 0.15 and limit of agreement from -0.401 to +0.701 mmol/L, p = 0.588. There was, however, a significant difference in mean chloride, and BUN values; chloride (p(c)) = 0.0796, mean difference of 13.8 and 95% limit of agreement from -7.55 to + 20.015 mmol/L. Blood urea nitrogen (p(c)) = 0.064, mean difference of 18.55 and 95% limit of agreement from -30.126 to +6.974 mmol/L.

Conclusion: The mean sodium, potassium, glucose and bicarbonate were comparable with moderate to good agreement between I-STAT POCT and ISE 6000 Analyzer. Though, the mean BUN and chloride levels between the analytical methods differ significantly.

Background: Tuberculosis (TB) is the world's greatest infectious killer of women of reproductive age and the leading cause of death among people with HIV/AIDS. The major problem militating against the management of tuberculosis is the lack of compliance to medication by the infected patients as a result of multidrug needed to be taking daily leading to resistance. Occurrences of hepatic toxicity, teratogenicity, sperm quality damage, haematotoxicity and meningeal congestion of individual anti-tuberculous agents have been reported.

Objective: The study is aimed to determine the reproductive and haematological toxicity of combined antituberculous agents and the modulatory role of antioxidants using animal model.

Methods: Fifty rats (10 per group) were randomly allotted to five groups, consisting of the control, the fixed dose combined anti TB agents treated group, the fixed dose combined anti TB agents plus vitamin C treated group, the fixed dose combined anti TB agents plus vitamin E treated group and the fixed dose combined anti TB agents plus vitamin C plus vitamin E treated group. Therapeutic doses of the fixed dose combined anti TB agents (25 mg/kg/day), vitamin E (5 mg/kg) and vitamin C (8 mg/kg) were administered to the animals via oral gavage, daily over 28 days. After 28days, rats were sacrificed for internal macroscopic and histological examination of the organs, sperm analysis and haematological investigations were carried out.

Results: The results showed a significant increase (p < or = 0.05) in the levels of white blood cells (WBC), red blood cell (RBC) and haemoglobin (HB) of the combined anti-TB plus vitamins C or E treated groups compared with combined anti-TB treated group alone (56.34 +/- 0.11) that decreased the haematological parameters. A significant decrease (p < or = 0.05) in the sperm counts (22.26 +/- 0.02; 35.40 +/- 0.02) and motility (77.03 +/- 0.02; 94.50 +/- 0.01) of the combined anti-TB treated rats as compared with the control group were observed. The combined anti-TB plus vitamin C treated rats demonstrated a significant increase (p < or = 0.05) in the sperm motility (90.23 +/- 0.01) as compared with the control group. There was also a remarkable decrease in the abnormal morphology of the sperm in the combined anti-TB plus vitamins E and C treated rats (0.05 +/- 0.02) as compared with the combined anti-TB group alone (1.10 +/- 0.02).

Conclusion: Vitamins C and E positively modulated the sperm quality and haematological damage produced by the Fixed Dose Combined Anti-Tuberculous agents.

Anterior knee pain is a common presentation in Orthopaedic out patient practice. However anterior superior patellar spur is an uncommon cause.This case presentation is to highlight an anterior superior patellar spur with quadriceps tendonitis. The patient is a 52 year old man who presented with a recurrent anterior knee pain. The radiographic study revealed an anterio-superior patellar spur. The patient had a depo steroid injection as an adjunct therapy to physiotherapy and has been pain free.

Background: Children with obstetrical brachial plexus injury often present with relative reduction and deficit (discrepancies) in length, girth and functional performance in their affected upper-limb. However, the relationship between these discrepancies and the functional deficit is still unclear.

Objective: This study evaluated discrepancies in upper-limb of children with obstetrical brachial plexus injury, and find the relationship between these discrepancies and the functional performances in the affected upper-limbs.

Methods: This study involved 50 children with obstetrical brachial plexus injury undergoing rehabilitation at selected secondary and tertiary health institutions in Lagos state, Nigeria. Upper-limb-length, arm-girth and forearm-girth were measured using broad-blade anthropometer and inelastic tape measure. Modified Mallet-Scale was used to assess functional performances of the upper-limbs while joints' range of motion was assessed using a full-circle goniometer. Data was analysed using Pearson's Correlation Coefficient, paired and independent t-test.

Results: Participants were aged 47.86 +/- 124.50 months. Discrepancies in upper-limb length and arm and forearm girth were 2.17 +/- 3.19 cm, 0.21 +/- 0.78 cm and 0.73 +/- 0.73 cm respectively. There was significant discrepancy in lengths, girths and functional performance between affected and unaffected upper-limb. The age of commencement of treatment ranged between one day and 2555 days with a mean of 2224.52 +/- 469.30 days. Time of commencement of treatment was significantly related with lengths, girths and functional performance of the affected upper-limbs.

Conclusion: There are significant discrepancy in lengths, girth and functional performance between affected and unaffected upper limb of children with obstetrical brachial plexus injury. There is negative significant relationship between time of commencement of treatments and the discrepancies that occurred in the affected upper-limb of children with obstetrical brachial plexus injury.

Background: Haemorrhage is a leading cause of maternal mortality worldwide and hysterectomy may become necessary to save life. This procedure is associated with significant morbidity and mortality.

Objective: To determine the, indications, risk factors and the management outcome for the procedure in our unit.

Methods: A retrospective case controlled study of 34 cases of emergency obstetric hysterectomy (EOH) performed at the Lagos University Teaching Hospital over a period often years was carried out.

Results: The incidence of EOH was 2.56 per thousand deliveries. Increasing parity, history of previous caesarean section, placenta praevia and current delivery by caesarean section were significant risk factors for the procedure. The indications were ruptured uterus (61.8%), intractable haemorrhage during caesarean section (32.4%), and uterine atony (5.9%). Majority (73.5%) of the patients had subtotal hysterectomy but the outcome indices were similar for the total and subtotal procedures. The case fatality rate was 11.8%. Post-operative complications included anemia (100%), urinary tract infection (UTI) (14.7%) and wound infection (11.7%).

Conclusion: The incidence of EOH in our unit has increased since the last study published in 1983, but the associated mortality has decreased. The indications differed in proportion from those in developed countries although the risk factors were similar. The outcome indices were similar for the total and the subtotal procedures. EOH is still associated with considerable maternal morbidity and mortality which can be reduced by provision of better obstetric care for the population.

Background: Ageratum conyzoides (AC) is unique for its antioxidant activity and protective role to tissues. However this property is yet to be demonstrated in animals administered toxic alcohol concentrations.

Objective: To determine the effect of AC extract on the oxidative stress, liver enzymes and histology.

Methods: Twenty four male rats (190-230 g) were divided into three groups of eight rats. Group A (control) administered distilled water. Group B (ethanol group) received 10 g/kg body weight of ethanol. Group C (ethanol + AC group) were treated with ethanol (as above) and AC (250 mg/kg body weight) concurrently. Total experimental duration was 35 days at the end of which animals were euthanized by cervical dislocation. Liver and blood samples were taken and processed for: microscopic studies, estimation of activities of liver enzymes [alanine aminotransferase (AST), aspartate aminotransferase (ALT) and alkaline phosphatase (ALP)], Malondialdehyde (MDA) and antioxidants [Superoxide dismutase (SOD), Glutathione peroxidase (GSH-Px) and Catalase (CAT)] respectively.

Results: Compared to control, the rats treated with ethanol had significantly increased liver enzymes and MDA levels but these were decreased in ethanol + AC group compared to the ethanol group. The histologies of concurrent ethanol + AC treated group were similar to control groups.

Conclusion: AC protects the liver against alcohol induced damage.

Background: The peak age prevalence of otitis media with effusion (OME) is in early childhood. Day care attendance has been established by various studies as a risk factor for the development of OME.

Objective: This study is aimed at evaluating the prevalence of OME among children aged 6 - 24 months, and the impact of day care center (DCCs) attendance on the OME occurrence.

Methods: A prospective cohort study conducted in children recruited from DCCs and immunization clinics in Surulere, Lagos state, Nigeria. They were matched mainly on their place of care, at home or at day care center and presence or absence of OME using pneumatic otoscopy and tympanometry.

Results: A total of 152 children were studied. Based on their place of care, they were divided into day care attendees 64 (42.1%), and non day care attendees 88 (57.9%). The prevalence of OME was 37.7% overall, 43.7% in the day care attendees and 33.4% in the non day care attendees. Factors found to positively influence the prevalence of OME in this study include: young age 6-12 months, female gender and day care attendance.

Conclusion: OME is common in Nigerian children at young age. Day care facility attendance significantly increased OME prevalence.