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   2011| July-September  | Volume 52 | Issue 3  
    Online since October 17, 2011

 
 
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ORIGINAL ARTICLES
Patterns and predictors of self-medication amongst antenatal clients in Ibadan, Nigeria
Folasade A Bello, Imran O Morhason-Bello, Oladapo Olayemi, Adeyemi O Adekunle
July-September 2011, 52(3):153-157
DOI:10.4103/0300-1652.86124  
Background: Self-medication is widely practiced in the study area, as many drugs are available over-the-counter, in addition to the use of local herbal preparations. Also, apprehension about the dangers of drug use in pregnancy appears to affect the compliance of prescribed medication. This study assess the drug use profile of an antenatal population. Materials and Methods: This was a questionnaire-based descriptive study of 410 antenatal clients attending primary, secondary and tertiary centers in Ibadan, Nigeria. The variables analysed were demographic data of respondents and level of health care received. Outcome measures were use of prescribed drugs, self-medication or herbal preparations. Chi-tests and logistic regression were used for statistical analysis. Results: All patients on prescribed medication for medical conditions claimed to be compliant with their drugs. Exactly 19.2% admitted to self-medication, mostly hematinics and pain-relieving pills (acetaminophen). No one admitted to alcohol or tobacco use, but 46.3%, especially attendees of the rural center (OR 5.79; 95% CI 2.56-13.10), ingested herbal concoctions while pregnant. Married women (OR 0.2; 95% CI 0.05-0.75) or those whose spouses had higher education (OR 0.43; 95% CI 0.21-0.89) were less likely to practice self-medication, while hypertensive women were more likely to practice it (OR 22.54; 95% CI 3.81-133.49). Conclusions: Social support has a role in safe drug use practices. This should be used to advantage by encouraging partners' attendance at antenatal sessions. Patients need counseling on the dangers of procuring their usual prescription drugs without consultation. Use of herbal concoctions needs to be explored in the community.
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Autoantibody profile and other immunological parameters in recurrent spontaneous abortion patients
U Shankarkumar, VD Pradhan, MM Patwardhan, A Shankarkumar, K Ghosh
July-September 2011, 52(3):163-166
DOI:10.4103/0300-1652.86126  
Background: An autoimmune cause and related immunological alterations resulting in recurrent spontaneous abortion (RSA) have been suggested in patients with unknown etiology. Materials and Methods: This study evaluated the autoantibody profile and other immunological parameters among RSA patients and normal pregnant women from Mumbai western India. Fifty RSA patients with unknown cause and greater than three consecutive abortions along with 50 normal pregnant women were studied for various auto antibodies such as ANA, anti-dsDNA, ANCA, AECA, 2 micro globulin, anti-HLA antibodies and ACLA using immunofluorescence microlymphocytotoxicity and ELISA. Immunological parameters such as HLA class I monoclonal antibody expression, CD3 (T cell), CD19 (B cell), and CD56 (NK cell) were estimated by flow cytometry. Results: The results revealed 34% positivity of all auto antibodies tested among patients. ANA(12%), ANCA (20%), AECA (24%), ACLA (8%), anti-dsDNA(0%), β2 microglobulin (14%), and anti-HLA antibodies(10%) among RSA patients were identified. An increased expression of HLA class I specific monoclonal antibody (10%) with HLA A3 (16%) specificity were found to correlate with shared HLA alleles among the RSA couples. Among normal pregnant (control) group ANA (2%), ANCA (2%), AECA (3%), ACLA (4%) and increased expression of CD56 with reduced HLA class I monoclonal were observed. Conclusion: Our findings suggest a possible role of various autoantibodies along with the related immunological parameters underlying RSA.
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Determination of normal dimension of the spleen by ultrasound in an endemic tropical environment
Ogbeide Ehimwenma, Marchie Tobechukwu Tagbo
July-September 2011, 52(3):198-203
DOI:10.4103/0300-1652.86141  
Background: To determine the normal dimensions of spleen by ultrasonography in our environment exposed to endemic tropical infection and infestation. Materials and Methods: A prospective study of normal spleen ultrasound-based measurements in 200 Nigerian adults at the University of Benin Teaching Hospital Benin, Nigeria. Results: There were 91 males and 109 females; their age ranged between 20 and 60 years. For the males the mean age was 32.4 years (± 9.2 SD), mean height was 175.0 cm (±7.3 SD), mean weight was 72.5 kg (±10.1 SD), and mean body mass index was 23.6 (±2.8 SD) and the females the mean age was 29.7 years (±9.0 SD) mean height was 164.6 cm (±5.8 SD), mean weight 64.1 kg (±12.9 SD), and mean BMI was 24.9 (±1.4 SD). For the males the mean splenic length, width, depth, and volume were 11.1 cm (±0.9 SD), 4.4 cm (±0.5 SD), 7.8 cm (±0.6 SD), and 202.7 cm 3 (±49.4 SD), respectively. For the females the corresponding values of splenic length, width, depth, and volume were 10.1 cm (±0.7 SD), 4.0 cm (±0.4 SD), 7.1 cm (±0.5 SD), and 153.7 cm 3 (±33.2 SD), respectively. Conclusion: Comparison between mean splenic dimension parameters for males and females (from unpaired t-test determination) showed a statistically significant difference (P<0.001 for splenic length, width, depth, and volume). There was also statistically significant increasing value correlation between subjects' weight and height (in favor of height) when compared to spleen length, width, depth, and volume. The other parameters show no significant correlation in both female and male. In particular there was also no statistically significant correlation of splenic measurements with age in either sex. This is similar to what was noted in other centers.
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The benefit of myomectomy in women aged 40 years and above: Experience in an urban teaching hospital in Nigeria
Jesse Y Obed, Babagana Bako, Saidu Kadas, Joshua D Usman, Abubakar A Kullima, Joel Y Moruppa
July-September 2011, 52(3):158-162
DOI:10.4103/0300-1652.86125  
Background: Abdominal myomectomy remains the mainstay of surgical management of uterine fibroids in our environment. However, its benefit in women aged 40 years and above remains debatable. Materials and Methods: An 11-year prospective study was conducted involving 98 women, aged 40 years and above, who had abdominal myomectomy for the treatment of uterine fibroid at the University of Maiduguri Teaching Hospital, Maiduguri. They were followed up regularly for 1-6 years to detect conception, resolution of symptoms and obstetrics performance. Data were analyzed using SPSS version 13. Results: The mean age of the patients was 42.6΁2.9 years and 77 (78.6%) of them were nulliparous. Lower abdominal swelling was the commonest clinical presentation and the mean uterine size was 18.6΁8.5 weeks. Infertility with uterine fibroids was the indication for myomectomy in majority of the cases [48 (48.9%)], while pregnancy complications accounted for 11.2% (11) of the cases Fertility restoration was 10.4% among the infertile patients. There was complete resolution of symptoms in 35.9% of those who required symptomatic relief, and term pregnancies were recorded in 72.7% of patients with pregnancy complications. Conclusion: Myomectomy is the recommended treatment of uterine fibroids in women aged 40 years and above with infertility and who wish to become pregnant. If there is no need for further fertility preservation, hysterectomy should be offered.
  8 7,569 389
A study evaluating the effect of mifepristone (RU-486) for the treatment of leiomyomata uteri
Sucheta Mukherjee, Somajita Chakraborty
July-September 2011, 52(3):150-152
DOI:10.4103/0300-1652.86123  
Background: To estimate the efficacy of daily administration of 25 mg mifepristone for the treatment of uterine leiomyoma. Materials and Methods: A total of 30 women were to receive 25 mg mifepristone daily for a period of 6 months. Abdominal ultrasonography was performed before treatment, at 3 months and after 6 months, to evaluate the leiomyoma size and uterine volume. Endometrial biopsy was done after the treatment. Efficacy was estimated by the reduction in leiomyoma size, uterine volume, and improvement in quality of life. Results: After 180 days of treatment, there was a 47% decrease in the leiomyoma volume and a 53% decrease in the uterine volume. Symptomatic improvement was noted. Twenty-three of 30 women (75.7%) became amenorrheic after the treatment. Endometrial biopsy after treatment revealed simple hyperplasia in two of 30 women. Conclusion: 25 mg mifepristone produces reduction in leiomyoma size and uterine volume and produces symptomatic improvement in women with fibroids.
  7 3,684 414
Effect of maternal dietary intake on the weight of the newborn in Aligarh city, India
Anisa M Durrani, Anjali Rani
July-September 2011, 52(3):177-181
DOI:10.4103/0300-1652.86132  
Background: This study aimed (1) To record the nutrient intake of the respondents and compare the same with the available recommended dietary allowances (RDA). (2) To assess the correlation between maternal dietary intake and the weight of newborn. Materials and Methods: Two hundred and ninety two pregnant women. Study Area: Five hospitals of Aligarh city, Uttar Pradesh. Study Tool and Data Collection: Interview schedule was administered to record information regarding dietary intake and weight of newborn. The data collection was initiated in April 2009 and was completed in March' 2010. Data Analysis: Statistical analysis was done by using version SPSS 17. Frequency distributions were calculated for all variables. Univariate and multivariate analysis were performed to determine the influence of the dietary intake on the birth weight of newborn. Results: Results revealed that the nutrient intake in all trimesters of pregnancy was lower as compared to RDA. There were significant correlations between the nutrient intake of the mothers and the weight of newborn in all trimesters of pregnancy (P=0.01). Conclusion: It was found that the dietary intake during all trimesters of pregnancy were significantly associated with the birth weight.
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Predictors of impaired renal function among HIV infected patients commencing highly active antiretroviral therapy in Jos, Nigeria
Oche O Agbaji, Adamu Onu, Patricia E Agaba, Muhammad A Muazu, Kakjing D Falang, John A Idoko
July-September 2011, 52(3):182-185
DOI:10.4103/0300-1652.86133  
Background: Kidney disease is a common complication of human immunodeficiency virus (HIV) infection even in the era of antiretroviral therapy, with kidney function being abnormal in up to 30% of HIV-infected patients. We determined the predictors of impaired renal function in HIV-infected adults initiating highly active antiretroviral therapy (HAART) in Nigeria. Materials and Methods: This was a retrospective study among HIV-1 infected patients attending the antiretroviral clinic at the Jos University Teaching Hospital (JUTH), between November 2005 and November 2007. Data were analysed for age, gender, weight, WHO clinical stage, CD4 count, HIV-1 RNA viral load, HBsAg and anti-HCV antibody status. Estimated glomerular filtration rate (eGFR) was calculated using the Cockcroft-Gault equation. Statistical analysis was done using Epi Info 3.5.1. Results: Data for 491 (294 females and 197 males) eligible patients were abstracted. The mean age of this population was 38.8΁8.87 years. One hundred and seventeen patients (23.8%; 95% CI, 20.2-27.9%) had a reduced eGFR (defined as <60 mL/min), with more females than males (28.6% vs. 16.8%; P=0.02) having reduced eGFR. Age and female sex were found to have significant associations with reduced eGFR. Adjusted odds ratios were 1.07 (95% CI, 1.04, 1.10) and 1.96 (95% CI, 1.23, 3.12) for age and female sex, respectively. Conclusions: Older age and female sex are independently associated with a higher likelihood of having lower eGFRs at initiation of HAART among our study population. We recommend assessment of renal function of HIV-infected patients prior to initiation of HAART to guide the choice and dosing of antiretroviral drugs.
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The evaluation of myomectomies performed during cesarean section in our clinic
Kadi Celal, Çiçek Hülya
July-September 2011, 52(3):186-188
DOI:10.4103/0300-1652.86135  
Background : We evaluated the data of patients who had applied myomectomy during cesarean section operation in our clinic between April, 2008 and December, 2010. Objective : I0 n this period, 3689 cesarean sections were done in our clinic, we analyzed their data retrospectively and determined 27 myomectomy cases during cesarean section operation. The age of the patients, the numbers of pregnancy, parities, the rates of abortus, indications of cesarean, pregnancy weeks, residential areas of myoms detected during the cesarean and their size, were recorded. Furthermore, pre-operative and post-operative hemoglobin (Hb) values, differences between hemoglobin values, whether there was bleeding or not, the need of blood transfusion if it occurred, the duration of operation and hospitaization and the pathological diagnoses of myomectomy materials, were examined. Materials and Methods: Retrospective study of myomectomies. Results : The mean age of patients was 29.6±5.9 (19-42) and mean gestational age was 39.2±1.0(37-42) weeks. The mean size of the fibroids was 5.94±6.29 cm 3 (0.96-26.50 cm3). Subserous myoms were the most frequently seen ones (24 of 27 patients=89%) with fundal, corporal localizations in most of the instances. T0 he pre-operative and post-operative values of Hb were 11.8±1.52 (8.6-10.5) and 10.3±2.6 (6.9-13.3) g/dl respectively and the difference was statistically significant (P<0.001). Blood transfusion was not necessary in any patient. The mean duration of the operation was found to be 40.7±13.9 (13-60) minutes. Conclusion: Myomectomies can be performed safely during cesarean section by experienced obstetricians and gynecologists, and myomectomy performed for fibroids in appropriate localizations does not increase post-operative bleeding or maternal morbidity or mortality.
  5 2,313 221
Indications and outcome of abdominal myomectomy in University of Maiduguri Teaching Hospital: Review of ten year
AD Geidam, ZM Lawan, C Chama, BG Bako
July-September 2011, 52(3):193-197
DOI:10.4103/0300-1652.86139  
Background: Abdominal myomectomy is a common modality of treatment for large and symptomatic uterine fibroid in women who wish to retain their fertility. Though frequently performed the procedure may still be associated with complications. Materials and Methods: A retrospective review of all patients who had abdominal myomectomy from January 1999 to December 2008 at the University of Maiduguri Teaching Hospital. Information on the Sociodemographic characteristics, indication for the myomectomy, uterine size, pre and post operative packed cell volume (PCV), intraoperative findings, cadre of surgeon, duration of hospital stay and complications were obtained. Results: The rate of abdominal myomectomy was 3.34%. Majority of the patients (79.8%) aged 30-49 years, and most (58.9%) were nulliparas. Abdominal mass (63.7%), menorrhagia (57.7%), and subfertility 55.2% were the leading indications for abdominal myomectomy. Complications were seen in 10.9% of the cases, 55.5 % of which were wound infections. Clinical and intra operative factors associated with complications included menorrhagia (P=0.003), estimated blood loss (EBL) ≥500mls (P=0.005) and post operative PCV of <30% (P=0.081). Conclusion: Complication rate after myomectomy was low with menorrhagia and EBL ≥ 500 mls being significantly associated with development of complication.
  3 3,929 225
Longstanding hydrocele in adult black Africans: Is preoperative scrotal ultrasound justified?
Chukwudi O Okorie, Louis L Pisters, Ping Liu
July-September 2011, 52(3):173-176
DOI:10.4103/0300-1652.86130  
Background: Longstanding hydrocele is very common among adult Black Africans. Preoperative scrotal ultrasound is widely used for adult patients presenting with hydrocele, with the main aim to rule out more serious underlying pathologies like malignancy or testicular torsion. This paper analyzes the findings and the necessity of automatic ordering of scrotal ultrasound in cases of longstanding hydrocele in adult Black Africans. Materials and Methods: 102 consecutive patients with longstanding scrotal hydrocele were investigated clinically and all patients also had routine preoperative scrotal ultrasound. Results: Overall, none of our patients had any serious underlying pathology associated with their hydrocele. 97% of the patients had simple hydrocele on ultrasound. Hydrocele is more common on the right (P=0.04) and is more bilateral in elderly patients (P=0.0002). Conclusions: Routine preoperative scrotal ultrasound does not seem to be justified in longstanding hydroceles. This is especially important considering the fact that most hydroceles are benign in origin and nature.
  2 3,896 192
Effect of anemia on hepatotoxicity of HAART in HIV patients in Benin city
Rose A Ugiagbe, Emeka U Eze
July-September 2011, 52(3):167-172
DOI:10.4103/0300-1652.86127  
Background: Hepatotoxicity is a relevant adverse effect of highly active antiretroviral Treatment owing to its frequency, and it can cause interruption of therapy, hepatitis, and death. There is dearth of information on hepatotoxicity arising from highly active antiretroviral therapy (HAART) in anemic patients. Anemia is the most common symptom in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome. We studied the effect of anemia on hepatotoxicity in HIV patients who were about to start HAART, attending clinic, or in the medical wards. Materials and Methods: This was a prospective study in which patients were recruited consecutively and followed up for 24 weeks. Results: In all, 84 patients were recruited and 42 were enrolled as controls. The mean ages of the cases and controls were 35.2΁9.9 and 35.5΁9.0 years, respectively. The age range of the cases was 18-68 years with a median age of 31.5 years, whereas the mean age of the controls was 20-57 years with a median age of 33.5 years. There was no difference (t=0.197, df=124, and P=0.844). There were 61 females (72.6%) and 23 males (27.4%) in the cases, whereas in the controls, there were 34 females (81.0%) and 8 males (19.0%). Among the cases, 30 (35.7%) were anemic, while 54 (64.3%) were not anemic. Six (20%) of the anemic patients had hepatotoxicity, and 9 (16.7%) of the patients with normal packed cell volume had hepatotoxicity. Among the controls, all 42 (100%) patients had normal packed cell volume. Four (9.5%) of the patients had hepatotoxicity. There was no association between hepatotoxicity and anemia (χ2 =3.243, df=2, P=0.198). Conclusion: Anemia did not affect hepatotoxicity of HAART in this study.
  1 2,905 260
EDITORIAL
Uterine fibroids: Which treatment?
Francis A Uba
July-September 2011, 52(3):149-149
DOI:10.4103/0300-1652.86122  
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ORIGINAL ARTICLES
Dentinal sensitivity among a selected group of young adults in Nigeria
Clement C Azodo, Awerosa C Amayo
July-September 2011, 52(3):189-192
DOI:10.4103/0300-1652.86136  
Background: There is paucity of data on the prevalence of dentinal sensitivity outside the hospital setting and impact of dentinal sensitivity among young adults in Africa. This study aimed to determine the prevalence and impact of dentinal sensitivity among young adults in Nigeria. Materials and Methods: A cross-sectional survey was conducted among the undergraduates of University of Benin in August, 2010. Self-administered questionnaire elicited information on demography, self-reported dentinal sensitivity, the trigger factor, action taken, functional, and psychological impact. Results: The prevalence of dentinal sensitivity was 211 (52.8%) among the participants and it was significantly higher in females than males (P=0.027). Participants experienced shocking sensation more on the left-side of the mouth. The most common trigger factor for the dentinal sensitivity was due to cold drink [169 (80.1%)]. Among the participants with dentinal sensitivity, majority [139 (65.9%)] have not taken any action and only 24 (11.4%) have visited the dentist because of the problem. Dentinal sensitivity exhibited psychological impact among the participants as 64 (30.3) reported unhappiness due to the shocking sensation. Eating and talking were disturbed, respectively, in 59 (28.0%) and 12 (5.7%) of the participants. Conclusion: The prevalence of dentinal sensitivity was high which was significantly higher in females than males. Despite the negative functional and psychological impact among the participants, only a few sought dental professional care. Screening for dentinal sensitivity at community level is required to proffer early treatment and ameliorate its impact on the populace.
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