Annals of Ibadan postgraduate medicine最新文献

Background: Clinical and histopathologic observations have indicated that psoriasis is not rare in our population as previously thought. The initial rarity also led to paucity of studies on the disorder including histopathologic features in our practice setting. To date, there is no report on the histopathologic features of psoriasis indigenous to our practice environment.

Objective: To evaluate the frequency of occurrence of the various histopathologic features of psoriasis in patients from this environment and identify any peculiarities that exist in black African patients.

Methods: A cross-sectional study of patients diagnosed clinically with psoriasis at the University College Hospital, Ibadan between January 2015 and October 2016. After baseline sociodemographic data, all patients had baseline clinical examination and were offered skin biopsy after obtaining informed consent. The biopsy specimen was examined for histopathologic features of psoriasis after routine processing and staining using a pretested proforma with the frequencies of each diagnostic feature reported in percentages.

Results: Forty-four patients with plaque psoriasis were analyzed. The mean age of the patients studied was 39.84 ± 20.97 years with a male to female ratio of which was almost equal. The most consistent epidermal changes in decreasing other of frequency were acanthosis, hypogranulosis, hyperkeratosis followed by elongation of rete ridges while dermal features were dermal infiltration by inflammatory cells, and dilatation of superficial dermal vessels. Munro's microabscesses were found in less than half of the patients biopsied. Some of the patients were found to have atypical changes.

Conclusion: Histopathological features of psoriasis in the study is similar to what has been previously established universally but typical features such as Munro's micro abscesses and Kogoj's spongiform pustules are less frequently seen than expected. Atypical changes such as dermal melanophages and periadnexal infiltration by inflammatory cells may also be seen.

Background: Bilateral end-stage knee osteoarthritis is a common presentation. The decision facing both patient and surgeon is whether to undertake the replacement of both knees in one sitting i.e. simultaneous bilateral total knee replacement (SMTKR) or to undertake this as a staged bilateral total knee replacement (STTKR). The decision is made harder by the presence of severe coronal and sagittal plane deformities and associated bone loss. We present our results of treating such patients with a focus on a trilogy of cost, complication and functional outcome following SMTKR.

Methodology: A retrospective review of 31 patients who presented with bilateral knee arthritis. 19 underwent SMTKR and 12 underwent STTKR. Data on the trilogy of complication, cost and functional outcome were collected and analysed.

Results: Our cohort of patients was overwhelmingly female in both groups at overall F/M = 30/1. Patients in the SMTKR group were slightly younger at a mean of 65 years compared to 69 years in the STTKR group. Mean Oxford Knee Score (OKS) improved significantly in all groups, mean of 54 in SMTKR and 56 in the STTKR groups. There was one fatality in the STTKR from upper GI bleeding and 1 revision for bone graft failure. The overall cost is less with SMTKR.

Summary: SMTKR is a safe and effective undertaking in properly selected patients with bilateral end-stage knee arthritis with severe deformities. Significant experience is however needed to successfully tackle complex deformities and such procedures should be undertaken by experienced arthroplasty surgeons.

Background: Fluoride concentration (F conc) in water is a major determinant for the occurrence of dental caries and dental fluorosis. In most homes of rural communities, especially in developing countries, there is a major reliance on sachet water as an alternate low-cost drinking water. This study aims to determine the fluoride concentrations of common commercially packaged sachet water in Ibarapa land, Southwestern, Nigeria.

Methods: An observational study was conducted using convenience sampling of all commercially packaged sachet water for drinking in Ibarapa land, Southwestern, Nigeria. Thirteen samples of sachet water were obtained from Ayete (2), Igboora (6) and Lanlate (5). F conc of the sachet water was determined in triplicate using the Fluoride Ion-Selective Electrode by direct analysis. Temperature and pH of water were also measured. Results were analysed using SPSS version 23.

Results: The F conc, temperature and pH range were 0.03 mgF/l - 2 mgF/l, 26.4°C - 27.2°C and 6.90 - 8.19 respectively. The minimum F conc in all samples was 0.03ppm at pH 6.90 while maximum was 2ppm at pH 7.78. F conc in 2 (15.4%), 8 (61.5%) and 3 (23.1%) water samples were 0.5-0.6 mgF/l, <0.5 mgF/ l and >0.6 mgF/l respectively. No sachet water had fluoride levels printed on their labels.

Conclusion: F conc of the sachet water varied, with the majority of samples having low concentrations. Attention needs to be paid to both low levels and high levels of fluoride in drinking water to ensure safety and protective benefit.

Background: Skin sepsis is a pyodermal infection caused by Lancefield's group streptococci and Staphylococcus aureus . It is characterized by discolored and mottled skin, cellulitis, impetigo and multi-systemic collagen muscularitis and can be transmitted from person to person.

Objective: This study sampled the skin of consented abattoir workers in Moniya Ibadan, for clinical sepsis, with a view to establishing a causal relationship between the infection obtained and the abattoir workers examined.

Methodology: A total of 100 meat handlers' hands and forearms were examined. Swabs were taken from lesions which appeared clinically to be infected and then propagated on selective culture media designed for staphylococci and streptococci. Conventional biochemical tests and Lancefield determination were carried out as considered appropriate.

Results: Of the 100 swabs from the categories of abattoir workers examined, 43 streptococci (35 from lesion 8 from wound) and 36 Staphylococcus aureus (20 from lesion and16 from wound) were obtained. The regression analysis from the grouping of gender, causative agents and specific infection as a predictor of infection were recorded to be significant (b = 0.18; t = 1.74; p < 0.05) for the nature of but non-significant (b = -0.067; t = -0.649; p > 0.05) for the gender.In-vitro antigen antibody reaction on StreptexM kit elicited varied reactions to Lancefield's serological grouping (A (56%), B (9%) C (7%) G (22%) and L (7%). Resistance of Staphylococcus aureus in varying percentages (Tetracycline and gentamicin 62%, meropenem and ceftriaxone 100%, amikacin, 10%, and vancomycin 80%) to conventional antibiotics were observed.

Conclusion: From this study point of view, the causal relationship between the infection and the infected has been established, from the pathogens of pyodermal origin contacted from cows, that causes sepsis across all the category of abattoir workers studied. There is a need to provide an ideal functioning abattoir fully equipped with required facilities for safety and ease of execution of duties.

Samuel Omokhodion was born to Pa Jacob Avblimen and Madam Victoria Edewede Omokhodion of Emuhi Ekpoma, Esan West Local Government of Edo State on 9^th March 1953, in Ondo state while his father was working in the Civil Service of the old Western Region of Nigeria. Samuael Omohodion attained the illustrious age of 70 years in December 2022. This edition of chronicles examines his biography - early life, career in paediatric cardiology, number of publications, professional affiliations, and priestly calling.

Background: Depression is one of the most common and devastating consequences among stroke survivors. In spite of the availability of treatment for depression, the non- or under-detection precludes patients from benefiting from it.

Objectives: This study sought to validate the Patient Health Questionnaire (PHQ- 9) as a tool for detecting depression among patients with stroke.

Methodology: A cross-sectional design comprising of adult patients diagnosed with stroke, who were attending the Neurology out-patient clinic of the University of Port Harcourt Teaching Hospital was employed in the study. The Receiver Operator Characteristics (ROC) curve and validity tests were performed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID-DSM IV) as the gold standard. The optimal PHQ-9 cut-off was determined using Youden Index. Kappa statistics was performed at p<0.05.

Results: The study had a total of 197 stroke cases with PHQ-9 and SCID-DSM IV findings. The median age was 54 years (range: 35-76 years). ROC Curve for PHQ-9 revealed an Area under the Curve (AUC) value of 0.93(95% CI: 0.88- 0.98). The optimal cut off value of six was obtained based on Youden Index. Sensitivity, specificity, positive predictive and negative predictive values at the optimal cut-off were 88.7%, 93.1%, 82.5% and 95.7% respectively. The Kappa statistics yielded 0.80 (95% CI: 0.68-0.86).

Conclusion: PHQ-9 is a useful screening tool for identifying depression among patients with stroke. An optimal cut-off score of six for PHQ-9 should be adopted for patients with stroke in Nigeria to identify depression, and the provision of holistic care.

Background: Existing literature suggests inequalities in nutritional and feeding practices for children in rural communities compared to their urban counterparts. However, with increasing urbanization and changing social norms, re-assessment of rural-urban differences in feeding practices for under-five children is essential. This study therefore aimed to assess the feeding practices and nutritional status of children in a peri-urban setting in Ibadan.

Methods: We conducted a community-based cross-sectional comparative study in peri-urban LGA (Lagelu) in Ibadan. Participants were 617 caregivers of underfive children identified, from wards typical of rural and urban settings, through a multistage sampling technique. Caregivers' sociodemographic details, 24-hour dietary recall of the child's feeding, and anthropometric measurements were obtained.

Results: Nearly half of the children were 2 years or older (rural: n=142, 47.2%; urban: n=147, 46.2%). There was significant difference between settings in terms of maternal age and education, father's education, caregiver's occupation and socioeconomic status. In total, 611 children (99.0%) were breastfed. Of those breastfed, 45% and 39% in rural and urban settings respectively were initiated within an hour of delivery. Children in rural setting had longer duration of breast feeding. However, they are less likely to be exclusively breast fed for 6 - months compared with children whose caregivers are urban dwellers. Dietary diversity was similar in both settings but higher among males. (20.3% male, 11.7% female in rural; 17.3% male and 15.5% female in urban). Overall, 108 (22.3%), 107 (21.9%), 152 (30.6%) and 34 (7.0%) of children aged 6-59 months were cachetic, underweight, stunted, and overweight respectively but commoner among children in rural settings.

Conclusion: Feeding and nutrition programmes need to apply a gender lens if sustained behavioural interventions on child nutrition are to reach equitable outcomes.

Background: A large proportion of patients with preoperative enterocolitis still have enterocolitis persisting even after surgery while others resolve thereafter. Some researchers have studied Calprotectin, C-reactive protein (CRP), Blood and Plasma viscosity as markers of inflammation, hence, the choice of their use. The aim of the study is to determine the sensitivity and reliability of Calprotectin, C-reactive protein (CRP), Blood and Plasma viscosity as biochemical predictors of enterocolitis in children with colorectal anomaly post-surgery at University College Hospital Ibadan.

Patients and methods: This is an observational analytic study of 32 patients with either Hirschsprung's disease or Anorectal malformation carried out over a year period. The demographic data of the patients, clinical condition and the preoperative and postoperative readings of the biochemical analytes were recorded in a chart. Statistical analysis were carried out using SPSS version 23 and test for statistical association done.

Results: The incidence of Hirschsprung associated enterocolitis is 12.5% and for Ano rectal malformation 6.3 %. Gender difference was not statistically significant even with the observed clinical difference. Plasma viscosity and blood viscosity correlate positively with each order. C-reactive Protein and Calprotectin did not predict enterocolitis in this study and the Sensitivity of blood viscosity at T1 and T2 is as low as 66% with a Positive Predictive Value of 25 %.

Conclusion: The incidence of Enterocolitis associated with Hirschsprung's disease and Anorectal malformation is 19 %. Calprotectin and C-reactive protein did not predict enterocolitis in this patients. The outcome of care was satisfactory in over 90 % of the patients.

The paper chronicles the life and times of Professor Alexander Brown, the Foundation Professor and Head of the Department of Medicine at the University of Ibadan. The official opening of the University College Ibadan, Nigeria on 20 November 1957 as well as the graduation of the first set of clinical students in 1960 were glorious moments for Alexander Brown who laboured for 12years to witness these. He was also instrumental to the creation of the Department of Paediatrics (1962), Department of Radiology (1963) and the Medical Illustration unit of the hospital. Paediatrics and Radiology were initially units in the Department of Medicine. He played significant role in the development of postgraduate programmes in Cardiology, neuropsychiatry and nephrology units of the hospital and substantial role in the development of nursing education in the hospital. He was the brain behind the famous Ibarapa Community Health Project.