Nigerian quarterly journal of hospital medicine最新文献

Background: The incidence of diabetes mellitus in older adults is increasing in Lagos and other parts of Nigeria but there is paucity of information on the use of medicines in this group of patients.

Objective: A survey was therefore carried out to determine the prevalence of potentially inappropriate prescribing of antidiabetic medications to older diabetes adults in Lagos, Nigeria.

Methods: A convenient sample of physicians working in seven health care facilities in Lagos were surveyed using a self-administered pre-tested questionnaire to determine the medications they often prescribed for diabetes patients older than 50 years, whether they consider dosage reduction in these patients, and the counselling information they provide to the patients. AGS 2012 Beer's criteria were used to determine potentially inappropriate medication (PIM) for the patients. Factors associated with the tendency to prescribe inappropriately were then evaluated using logistic regression analyses.

Results: Glibenclamide, metformin, and metformin/glimepiride combination were regularly prescribed by 45.64-87.25% of the physicians but gliclazide, pioglitazone, pioglitazone/metformin and pioglitazone/glimepiride combinations were prescribed occasionally by 41.61-61.74% of them. Majority of the physicians (87.25%) prescribe glibenclamide to the older patients and do not also always consider dosage reduction on account of older age. Some of these (30.2%) of these physicians equally prescribed chlorpropamide to the patients. Postgraduate qualification was the only significant factor associated with prescription of chlorpropamide (p < 0.05).

Conclusion: Inappropriate use of chlorpropamide and glibenclamide, and failure to consider dosage reduction on account of older age have been reported by physicians treating older diabetes patients in Lagos. This calls for continuous education of physicians in Lagos as well as in other parts of Nigeria to promote rational use of antidiabetic medications in the country.

Background: The frequency of prescriptions for ciprofloxacin use in children is high despite the caution recommended.

Objective: To assess frequency of ciprofloxacin prescriptions in a pediatric unit and review the literature on use of ciprofloxacin in children.

Methods: Patient case notes in a pediatric general ward of a tertiary hospital were reviewed. Electronic databases were searched for articles published in English between January2001 and December2011.

Results: Ciprofloxacin was prescribed for 20% of the children in our preliminary study. In all the studies reviewed ciprofloxacin was used as a second line treatment in life-threatening cases and only for organisms that were susceptible on culture. Adverse events such as arthralgia, gastro intestinal disturbances and CNS reactions were recorded; they were reversible and often did not warrant discontinuation of therapy.

Conclusion: Ciprofloxacin may be used in children as second line treatment, in life-threatening cases, for susceptible organisms when the benefit outweighs the risk.

Background: Dermatophytes are the commonest organisms causing superficial fungal infections. Earlier epidemiologic studies in Nigeria revealed dermatophyte infection as one of the top three reasons for visiting the dermatologists.

Objective: To determine the frequency, characteristics and predisposing factors to dermatophyte infections at the dermatology outpatient clinic of the Lagos University Teaching Hospital (LUTH) from March 2003 to September 2009.

Methods: The clinic records and case notes of patients were reviewed. Patients' data which includes demographic details, characteristics of disease, predisposing factors and clinical presentation findings were entered on Excel spreadsheets and analyzed using SPSS 15. Results were displayed using frequency tables.

Results: Dermatophyte infections were found in 8.39% of patients attending the dermatology outpatient clinic of LUTH. Tinea pedis was the most frequently seen, occurring in 33.6% of patients; followed by tinea corporis (20%), tinea manuum (18.6%) and tinea capitis (14.8%). Dermatophyte infection was most frequently seen in the 3rd and the 4th decades of life, except tinea capitis seen predominantly in the 1st decade of life and tinea intertrigo in the 5th decade.

Conclusion: Dermatophyte infections occur at all age groups, although frequency of occurrence differs with age group and site of the body affected.

Background: Injury is the leading cause of death and disability and the third most common cause of death Little attention has been given to the concomitant injuries associated with maxillofacial fractures in scientific literatures.

Objectives: For effective planning and efficient management of the patients, there is need to study the pattern ofthese injuries.

Methods: Consecutive patients who sustained one or more facial bone fractures over a period of 2 years were prospectively studied.

Results: There were 103 patients out of which 96 sustained concomitant injuries giving an incidence of 93.2%.There were 75 (78.1%) males and 21 (21.9%) females with a M:F of 3.6:1. The mean + (SD) age was 30.8 +13.0 with a range of 2.0 to 68.0 years. Road Traffic Crashes was the commonest (n = 81, 84.4%) cause of injury. Soft tissue of the face, with an incidence of 62.1% (n = 64) was the commonest concomitant injury. It was followed by neurologic injury (n = 51, 49.5%) and ophthalmic injury (n = 38, 36.9%) while abdominal injury (n = 2, 1.9%) was the least common. Majority (87.5%) of the ophthalmic injury patients sustained midfacial fracture while 12.5% of the them sustained mandibular fractures. Pulmonary and cervical injuries were found to be associated more with mandibularfractures.

Conclusion: Concomitant injuries occur commonly with maxillofacial fractures and they were found to have significant effect on the management of the fractures. A multidisciplinary approach will bring about a very efficient management of patients.

Background: HIV infection is the highest cause of death worldwide and presenting eventually with ENT regions.

Objective: This study is to determine the prevalence of hearing loss and hearing patterns among adults Nigerians with HIV and causal relationships between CD4+ counts with the degree of hearing impairments.

Methods: This prospective study was carried out among all consecutive HIV positive patients attending the clinic at the University of Ilorin teaching hospital (U.I.T.H.), Ilorin, Nigeria between January and July, 2008. They all had audiological assessments with a pure tone audiometer within the frequency range 250 to 8,000 Hz to determine their hearing thresholds together with their CD+ counts estimations.

Results: 89 were evaluated in the age range of 18 to 56 years (Mean 36.4 years, SD of 8.82) and the modal age group was 21-39 years (59.6%), 40-56 years (38.2%).There were 51 males (57.3%) and 38 females (42.7%) with a male/female ratio of 1.3:1.0. Otological symptoms included tinnitus (15.7%), vertigo (15.7%), otalgia (14.6%) and hard of hearing (10%). Examinations showed bilateral serous Otitis media (glue ear) in 58 patients (65.1%) with no affectation of the facial nerves. PTA showed mixed, conductive and SNHL in 32 patients (36%), 20 patients (22.5%), 9 patients (10.1%) respectively and only 15(16.9%) had normal hearing thresholds. The CD4+ counts ranged between 12 to 616. CD4 counts with hearing loss mostly < 300mm3.

Conclusion: The prevalence of hearing loss is 87% among HIV infected patients, mostly mixed HLwith causal relationships between reduced CD4+ counts of less than 300/mm3 with severity of hearing loss. The hearing loss can interfere with the communication and specific knowledge vital to the development of best practices towards ensuring the inclusion of hearing impaired in HIV/AIDS prevention and treatment programmes.

Background: The appeal of the white coat to both the doctors and the public is waning. In most developing countries such as Nigeria doctors' view of the white coat is not known.

Objective: To determine the proportion of interns which supported wearing of white coat by doctors.

Methods: A 10-item questionnaire was distributed to medical interns undertaking mandatory pre-registration training in a tertiary hospital. Characteristics of interns who were supportive of doctors wearing the white coat were compared to those who did not support or were indifferent to it.

Results: Two hundred and thirty three interns returned completed questionnaires. About 54% (126) and 52% (107) of the participants were males and graduates of the College of Medicine, University of Lagos respectively. The majority of interns (167; 71.7%) supported the wearing of white coats by doctors when attending to patients; 22 (9.4%) were opposed to it while 44 (18.9%) were indifferent. Older interns, females and interns who had not rotated through Paediatrics were more likely to support the wearing of white coats by doctors. The commonest reason for wearing the white coat was for identification.

Conclusion: The majority of medical interns supported the wearing of white coat by doctors. Prevention of infection is no longer the major reason for wearing the white coat. There is need to document the public's perception of the white coat.

Corneal scarring is the fourth largest cause of blindness globally, and a much more prominent factor in developing countries. Blindness from corneal scarring is largely a preventable phenomenon, and is capable of causing significant morbidity that can last for a lifetime. A significant proportion of these cases are caused by the use of harmful traditional eye medicines/remedies, and are used and prescribed by friends, relatives and traditional healers, with widespread use especially in developing countries. Use of traditional remedies can also cause harm indirectly by causing delays before seeking medical treatment. Reducing corneal scarring from the use of harmful traditional medicine is through a combination of approaches with the key strategies being community diagnosis, education, participation, and intervention, with provision of basic eye care integrated into the primary health care of the community. Collaboration with traditional healers in the community is also another approach that has been found to be useful.

Background: Lead is an environmental toxicant, occupational and environmental exposures remain a serious problem in developing and industrializing countries.

Objective: This study is designed to investigate the effects of L-ascorbic acid and L-tryptophan on the neurotoxicity and neurobehavioural alterations in lead exposed male Sprague Dawley rats.

Methods: Experimental animals were exposed to oral doses of lead (Pb), L-ascorbic acid, and L-tryptophan at 75 mg/kg body weight, 40 mg/kg body weight, and 20 mg/kg body weight respectively, while control animals received 0.90% saline solution. Oral administration spanned for four weeks after which changes in neuro-behaviour, organ weight, blood deposition of Pb, brain serotonin, tryptophan and neuronal redox status were determined. Changes in organ weight, blood lead levels, neuro-behavioural characteristics, brain serotonin and tryptophan contents, and brain redox status were determined.

Results: The results indicated that Pb exposure increased blood lead, organ-weight index, and behavioural signs of anxiety and aggression. The sub-chronic exposure to Pb also decreased brain serotonin, while causing oxidative stress by decreasing reduced glutathione levels, antioxidant enzyme activity and increasing lipid peroxidation and brain protein contents. L-ascorbic acid attenuated both Pb induced neuronal oxidative stress, and abnormalities in behaviour. But L-tryptophan ameliorated Pb altered neurobehaviour with no significant effect on Pb induced oxidative stress in the brain. Co-administration of L-ascorbic acid and L-tryptophan on Pb exposed rats showed a reversal in all indices assessed towards the physiological state of control.

Conclusion: This suggests that L-ascorbic and L-tryptophan can be used to compliment chelating therapy in lead neurotoxicity.