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  Citation statistics : Table of Contents
   2012| January-March  | Volume 53 | Issue 1  
    Online since August 18, 2012

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Community participation and childhood immunization coverage: A comparative study of rural and urban communities of Bayelsa State, south-south Nigeria
Kalamawei Itimi, Paul O Dienye, Best Ordinioha
January-March 2012, 53(1):21-25
DOI:10.4103/0300-1652.99826  PMID:23271840
Background: Immunization coverage rates in Nigeria have remained very poor, in spite of numerous programs and strategies, specifically designed to improve coverage. This study was to assess the possible effects of greater community participation on immunization coverage, by comparing the immunization coverage in a rural community with a functional community health committee, with an urban community, with no distinct community structure. Materials and Methods: The study was carried out in Ondewari, a rural, riverine community, in Bayelsa State; and Yenagoa, the capital of Bayelsa State, south-south Nigeria; using a cross-sectional, comparative study design. The data were collected using a structured interviewer-administered questionnaire, administered on female head of households in both communities, with under-five children; and used to collect information on the socio-demographic characteristics of the respondents, the immunization status of children in the household below the age of 2 years, and reasons for none and incomplete immunization. Results: A total of 288 respondents were studied in the rural community, while 270 respondents were studied in the urban center. The respondents in the urban center were significantly younger (P<0.01), better educated (P<0.001), and had fewer number of children (P<0.01). The immunization status of children in the rural community was significantly better than those in the urban community (P<0.000). Only 11.46% of the children in the rural community were not immunized, compared to 47.04% in the urban community. However, the dropout rate in the rural community was much higher; with a DPT dropout rate of 77.34%, compared to 12.39% in the urban community. Most of the reasons given in the urban community for the incomplete immunization were linked lack of motivation, and include relocation (11.34%) and the adverse rumor about childhood immunization (17.23%), while the reasons in the rural community were mostly health facility related, and included the absence of the vaccinator (20.46%) and nonavailability of vaccines (26.64%). Conclusion: The immunization coverage in the rural community was surprisingly better than that of the urban community, which can be attributed to better mobilization and participation in the delivery of immunization services.
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Management of fascial space infections in a Nigerian teaching hospital: A 4-year review
Otasowie D Osunde, Benjamin I Akhiwu, Akinwale A Efunkoya, Adetokunbo R Adebola, Cornelius A Iyogun, Juwon T Arotiba
January-March 2012, 53(1):12-15
DOI:10.4103/0300-1652.99823  PMID:23271838
Background: Fascial space infections of the head and neck region, usually odontogenic in origin, are routinely treated as an out-patient procedure. Untreated or rapidly spreading odontogenic infections can be potentially life threatening. The present study is a review of patients with orofacial infections who required emergent incision and drainage in the maxillofacial unit of our institution. The need for early presentation is highlighted. Materials and Methods: This is a retrospective study of patients with orofacial space infections between January 2007 and December 2010. Patients' case files were retrieved and demographic as well as clinical characteristics were obtained and analyzed. A P value of <0.05 was considered significant. Results: A total of 53 patients with fascial space infection were seen over the period of study. Of the 41 patients reviewed, males accounted for 26 (63.4%) and females 15 (36.6%). Their ages ranged from 4 months to 80 years (mean 32.8± 18.3 years). There was no statistical difference between the mean age of male and female patients (t=-962, P=0.342). Submandibular space was the most frequently involved single space and accounted for 43.9% of the cases. This was followed by multiple space involvement (Ludwig angina) which accounted for 36.6%. Buccal space and submasseteric space infection represented 7.3% each. Sources of infections were of odontogenic origin in 92.7% of cases and were unknown in the remaining 7.3%. The outcome was satisfactory with complete resolution in 48.8% of cases. Resolution with some morbidities in the form of persistent limitation of mouth opening, orocutaneus fistula, and necrotising fascitis were seen in an almost equal proportion of 46.3% of cases. The outcome was observed to be significantly associated with the presence of underlying systemic conditions (χ2 =21.66; r=0.73; P=0.0001), time of presentation (χ2 =12.28; r=0.55; P=0.002), and age (χ2 =54.48; r=0.69; P=0.0001). Conclusion: Fascial space infections of the head and neck region, though potentially life threatening, can be prevented by regular dental visits. Early recognition and treatment of established cases are necessary to prevent considerable morbidity and mortality, especially in older patients with an underlying systemic condition.
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The effect of dietary habits on the development of the recurrent aphthous stomatitis
Bassel Tarakji, Kusai Baroudi, Yaser Kharma
January-March 2012, 53(1):9-11
DOI:10.4103/0300-1652.99822  PMID:23271837
Background: The aim was to assess the relationship between the dietary habits and development of recurrent aphthous stomatitis. Materials and Methods: Two groups (30 patients with RAS who have been following dietary habits and not associated with systemic disease or hematologic abnormalities, and the control group consist of 28 patients without recurrent aphthous stomatitis). Results: A Mann-Whitney test (P>0.05) shows no significance difference between the patients with RAS and the control group. Both groups eating similar food such as cheese, cow's milk, tea, lemon, coffee, orange, apple, yoghurt, and tomato, spicy food, but the patients with RAS ate specific foods containing (pH) like; oranges and lemons more frequently than the control group. Conclusion: Dietary habits have no important role in development of RAS but can lay a minor role in the pathogenesis of RAS either by causing hypersensitivity or by deficiency of some vitamins and minerals.
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Challenges of kidney care in a resource poor nation: A study of private kidney care centre in Nigeria
Umezurike H Okafor, I Ekwem, FS Wokoma
January-March 2012, 53(1):47-50
DOI:10.4103/0300-1652.99833  PMID:23271845
Background: Resource poor nations are froth with various confounding challenges in their social, political, financial, physical and healthcare needs. Care of patients with health problems', including those with kidney related disorders is associated with many challenges. This study is aimed to highlight the challenges of kidney care in a resource poor nation. Materials and methods: The activity of a private kidney care centre in Nigeria was reviewed from establishment to 6 months of operation. The details were documented and analysed. Result: The commencement of the kidney care centre was delayed as a result of financial and bureaucratic challenges. A total of 64 patients were seen during the period studied, 59.4% were male and the mean age was 48.2±5.5 years. 40.3% of the patients had chronic kidney disease. Twenty patients had haemodialysis however only 2 patients sustained the dialysis for the period studied. Most patients were unable to adhere to medication. The centre still depend on the parent hospital financially. Conclusion: The challenges of kidney care in resource poor nation are numerous and multifactorial.
  6 6,032 257
Colonization of peripheral intravascular catheters with biofilm producing microbes: Evaluation of risk factors
Monil Singhai, Abida Malik, Mohd. Shahid , Ashraf Malik, Vinita Rawat
January-March 2012, 53(1):37-41
DOI:10.4103/0300-1652.99830  PMID:23271843
Background: Biofilms often colonize catheters and contribute to catheter-related septicemia. However, predictors of catheter colonization by biofilms remain poorly defined. The aim of this study was to evaluate clinical factors that may be associated with biofilm colonization of catheters. Materials and Methods: A total of 54 isolates colonizing the peripheral intravascular catheters (IVCs) were studied and their biofilm production ability was analyzed by the tube method and antimicrobial susceptibility was also done. A detailed clinical history and examination was done of each subject to know age, sex, duration of use of IVCs, site of IVCs, swelling/purulence around the IVCs, number of attempts to install the catheter, and duration of hospital stay. Results: 44 (81.4%) out of 54 isolates colonizing the catheters showed biofilm formation. Biofilm formations were significantly associated with duration of hospital stay of more than 7 days [odds ratio (OR) = 6.6; 95% confidence interval (CI) = 1.3-34; P value (P) = 0.02], multiple attempts to install the catheter (OR=7; CI=1.5-31.8; P=0.01), and multidrug resistance (OR=9.5; CI=1.8 - 51.1: P=0.008). Klebsiella pneumoniae and Candida spp. comprised most of the biofilm-producing isolates. The overall susceptibility to antimicrobials was low among biofilm-producing compared to nonbiofilm-producing microbes. Conclusion: The results of this study suggest that evaluation of predictors of biofilm production is important in order to understand, prevent or manage biofilm colonization of IVCs.
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Posterior spinal decompression, stabilization and arthrodesis in Nigerian adults: Profile and outcome
OE Idowu, OA Adewole, AA Majekodunmi
January-March 2012, 53(1):42-46
DOI:10.4103/0300-1652.99832  PMID:23271844
Background: The availability of intraoperative fluoroscopy and improved access to varieties of spinal titanium implants has revived posterior spinal stabilization techniques with their distinct advantages. Our aim is to describe the profile of various spine pathologies requiring subaxial posterior spinal decompression, stabilization (using titanium implants), and arthrodesis, and to determine the rate of postoperative complications and factors affecting outcome. Materials and Methods: This is a prospective single institution study of consecutive adult patients seen during the study period. Data collected included the patients' demographics, radiological findings, indication for surgery, surgical procedure, operation time, intraoperative blood loss, and postoperative complications. Results: There were 26 patients (15 males and 11 females). Their ages ranged between 24 and 78 years (median = 42 years). The most common indications for surgery were spinal trauma and degenerative spine disease (24 patients). The region that was most commonly stabilized was the lumbar- 12 cases (46.2%). No patients experienced neural or vascular injury as a result of screw position; likewise no patient had screw loosening. There was a case each of superficial surgical site infection and transient cerebrospinal fluid leak but no case of implant failure was encountered. The outcome was significantly associated with the etiology (0.030) of the indication for surgery and preoperative power grade (0.000). Conclusion: Spinal trauma and degenerative spine disease are the two most common indications for posterior spinal decompression, stabilization and fusion in our center. It is associated with acceptable postoperative complication rate when done under fluoroscopic guidance. Outcome is related more to the preoperative neurological deficit and etiology of the indication for surgical stabilization.
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Evaluation of factors influencing intention to quit smokeless and cigarette tobacco use among Nigerian adolescents
Israel Agaku, Adisa O Akinyele, Uyoyo T Omaduvie
January-March 2012, 53(1):31-36
DOI:10.4103/0300-1652.99829  PMID:23271842
Background: Smokeless and cigarette tobacco use is becoming increasingly popular among Nigerian adolescents. This study aimed to evaluate predictors of intention to quit tobacco use among adolescents that currently use tobacco products in Nigeria. Materials and Methods: A total of 536 male and female high school students in senior classes in Benue State, Nigeria were enrolled into the cross-sectional study. The survey instrument was adapted from the Global Youth Tobacco Survey (GYTS) questionnaire. Results: Among adolescents with tobacco habits, 80.5% of smokeless tobacco users and 82.8% of cigarette smokers intended to quit tobacco use within 12 months. After adjustment, significant predictors of intention to quit cigarette smoking were parents' smoking status (P<0.01), peers' smokeless use status (P<0.01) and perception that smoking made one comfortable at social events (P<0.01). For intention to quit smokeless tobacco use, significant predictors after adjustment were parents' smokeless use status, (P=0.03) perception that smokeless tobacco use made one more comfortable at social events (P=0.04) and perception of harm from smokeless use (P=0.02). Conclusion: This study demonstrates that the intention to quit smokeless and cigarette tobacco use is significantly predicted by perception about the societal acceptance of tobacco use at social events, parents and peers' tobacco use status as well as the perception of harm from use of tobacco products. Providing social support may increase quit attempts among youth smokers.
  4 3,270 207
Operative stabilization of open long bone fractures: A tropical tertiary hospital experience
Adeleke O Ifesanya, Temitope O Alonge
January-March 2012, 53(1):16-20
DOI:10.4103/0300-1652.99825  PMID:23271839
Background: Operative treatment of open fractures in our environment is fraught with problems of availability of theater space, appropriate hardware, and instrumentation such that high complication rates may be expected. Materials and Methods: We evaluated all open long bone fractures operatively stabilized at our center to determine the outcome of the various treatment modalities as well as the determinant factors. Result: A total of 160 patients with 171 fractures treated between December 1995 and December 2008 were studied. There were twice as many males; mean age was 35.0 years. About half were open tibia fractures. Gustilo IIIa and IIIb fractures each accounted for 56 cases (45.2%). Fifty-three percent were stabilized within the first week of injury. Interval between injury and operative fixation averaged 11.1 days. Anderson-Hutchin's technique was employed in 27 cases (21.8%), external fixation in 21 (16.9%), plate osteosynthesis in 50 (40.3%), and intramedullary nail 15 cases (12.1%). Mean time to union was 24.7 weeks. Fifty-two complications occurred in 50 fractures (40.3%) with joint stiffness and chronic osteomyelitis each accounting for a quarter of the complications. Union was delayed in grade IIIb open fractures and those fractures treated with external fixation. Conclusion: A significant proportion of open long bone fractures we operatively treated were severe. Severe open fractures (type IIIb) with concomitant stabilization using external fixation delayed fracture union. While we recommend intramedullary devices for open fractures, in our setting where locking nails are not readily available, external fixation remains the safest choice of skeletal stabilization particularly when contamination is high.
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Rural dentistry: Is it an imagination or obligation in community dental health education?
Çoruh Türksel Dülgergil, Hakan Çolak
January-March 2012, 53(1):1-8
DOI:10.4103/0300-1652.99820  PMID:23271836
During the past two decades, epidemiologic studies in less developed or developing countries have clearly reported that caries prevalence shows the distinctive patterns over the word, even though it is declining in many developed countries. Due to huge rural districts where arrival is problematic and ineffective dental and preventive care centers in most suburban districts, there has been significant difference between the different parts of the communities to provide dental care service, and unfortunately the sole preventive measure has been limited with the advising of using the tooth brush and paste. The problems are usually arisen not only from the inadequacy of trained personnel but also from the absence of an effective economic and pragmatic system which aims to effectively dispense the dental service to all over the country. For this reason, the basic aim of dental care should be to carry out the many dental services in a multidisciplinary manner within the first appointment and to serve the people at their own homes and/or districts. Clearly, the needed multidisciplinary dental care system can lead to a new educational doctrine for rural dental practice. This versatile and practical training program based on specific perceived needs of a specific population(s) could need a new educational program. So, various preventive and/or restorative procedures included by this new doctrine could be named as "rural dentistry." In this review, with the examples from the many in vivo studies carried out under rural conditions over the world, the probable practices in this specific dental doctrine have generally been exemplified.
  1 1,642 212
Dipstick urinalysis should be documented prior to initiating antiretroviral therapy
Tubonye C Harry
January-March 2012, 53(1):51-51
DOI:10.4103/0300-1652.99834  PMID:23271846
  - 1,603 235
Modifying and increasing day-case procedures to solve local problems: Experience of a urology unit
Chukwudi O Okorie, Louis L Pisters
January-March 2012, 53(1):26-30
DOI:10.4103/0300-1652.99828  PMID:23271841
Background: Surgical ward congestion continues to be a problem across rural Africa. Day-case surgery has helped minimize this problem in most developed countries but remains underdeveloped across Africa. The objective of this study was to carefully expand day-case services within the framework of already existing hospital infrastructure. Materials and Methods: Seventy-one consecutive patients out of 149 mostly urologic patients that met the study criteria were treated and followed up on a daycase basis over a 15-month period. In the absence of a day surgery unit, these patients were prioritized and operated on urologic theater days while adequately utilizing the equipped preoperative holding area for patient recovery. Patients were all nonemergent, of American Society of Anesthesiologists' physical status (ASA-PS) classes 1 and 11 and accepting to undergo day-case procedure among other selection criteria. The main outcome measures were to determine the percentage reduction in admission rate and encountered complications. Results: Forty-nine (69%) of these 71 patients were treated using local anesthesia. The day-case surgery rate for the urology service was increased to 47.65% from a previous rate of 21.6%. Six patients (8.4%) felt that their postoperative pain was more significant than they had anticipated. Postoperative nausea and vomiting occurred in two patients (2.8%). There was one case of scrotal hematoma that resolved on observation. There was no mortality. Conclusions: In the absence of a dedicated day-case service, individual specialists should develop or increase safe lists of cases in their respective fields that can be done on a day-case basis in order to reduce demand for in-patient beds.
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