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   2012| April-June  | Volume 53 | Issue 2  
    Online since November 17, 2012

 
 
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REVIEW ARTICLE
Healthcare - associated infections: A public health problem
Angela Revelas
April-June 2012, 53(2):59-64
DOI:10.4103/0300-1652.103543  
Disinfection and sterilization in hospitals, is of increasing concern. Nosocomial infections can be defined as those occurring within 48 hours of hospital admission, 3 days of discharge or 30 days of an operation. They affect 1 in 10 patients admitted to hospital. Nosocomial infections are associated with a great deal of morbidity, mortality, and increased financial burden
  47 7,520 263
ORIGINAL ARTICLES
How are our medical students using the computer and internet? A study from a medical college of north India
Khan Amir Maroof, Pawan Parashar, Rahul Bansal
April-June 2012, 53(2):89-93
DOI:10.4103/0300-1652.103549  
Background: In today's world, use of Internet has become indispensable. Medical students have much to gain from the Internet technology that has revolutionized the medical field. There is a very rapid change in the way communication technology is being handled and our medical students should also be ready to embrace it. Very few studies have been done on this topic in India. The aim was to find out the knowledge, practice, and barriers of Internet use among the medical undergraduates of Subharti Medical College, Meerut. Materials and Methods: A cross-sectional study was conducted among the MBBS students belonging to the first, second, third, and fourth years of their course during August to October 2009. A pretested questionnaire was used collecting information on their Internet usage patterns, knowledge about information technology, and barriers to using it. Data were entered in Microsoft Excel and appropriate statistical tests were applied for analysis. Results: The proportion of respondents having a laptop were more in cohort of students belonging to the admission year 2009 (65.8%) followed by 2008 (54.7%), 2007 (53.0%), and 2006 (38.0%), i.e., a gradual increase in newer cohorts. About half (57.4%) of the students had some sort of formal training in computer and Internet use. Knowledge about Internet was more among the junior cohorts compared to the senior cohorts (P<0.0001). Only about one-fifths of the respondents used Internet for searching literature for projects from medical journals on the Internet. Majority of the respondents accessed Internet for less than 3 hours per week. About one-tenth (8.0%) of the students felt that Internet is totally useless in medical field. The major barrier (54.4% of the respondents) to using Internet was lack of time. Conclusions: Further research should focus on designing and implementing computer and Internet training for medical students.
  9 2,796 206
The relationship between the weight of the placenta and birth weight of the neonate in a Nigerian Hospital
Abubakar A Panti, Bissala A Ekele, Emmanuel I Nwobodo, Ahmed Yakubu
April-June 2012, 53(2):80-84
DOI:10.4103/0300-1652.103547  
Background: There have been several publications from different countries on the relationship between the placental weight and birth weight of the neonate. However, such reports from Nigeria are lacking in literature. The objective of this study was to determine the relationship between the placental weight and birth weight of the neonate at term pregnancy in a Nigerian hospital. Materials and Methods: It was a cross-sectional study conducted at Usmanu Danfodiyo University Teaching Hospital Sokoto between 1 st October 2008 and 31 st March 2009. Data gestational age at delivery (in weeks), parity, mode of delivery, fetal birth weight, placental weight, fetal gender, presence or absence of maternal medical diseases were obtained from 1009 singleton term deliveries who met the inclusion criteria for the study. The data was processed using EPI-INFO version 2005 and statistical analysis performed using one-way analysis of variance. A probability of 0.05 was set for statistical significance. Results: The placental birth weight ranged from 300 to 890 g with a mean of 590±82 g while the birth weight of the neonate ranged from 2030 to 5020 g with an average of 3275±469 g. The mean gestational age at delivery was 38.8±1.1 weeks while the mean placental birth weight ratio was 18.2±2.4 Increase in birth weight of the neonate was associated with corresponding increase in placental weight. However, as the gestational age at term advances the proportion of increase in the former was greater than that of the latter. Conclusions: There is a positive correlation between placental weight and birth weight of the neonate. However, the ratio of the placental and neonatal birth weights at term decreases with advancing gestational age. Thus, prolongation of pregnancy at term may adversely affect the fetus.
  8 4,511 243
Clinical evaluation of posterior canal benign paroxysmal positional vertigo
Titus S Ibekwe, C Rogers
April-June 2012, 53(2):94-101
DOI:10.4103/0300-1652.103550  
Background: Benign paroxysmal positional vertigo (BPPV) is a mechanical peripheral vestibular disorder which may involve any of the three semicircular canals but principally the posterior. In as much as the literature has described theories to explain the mechanism of BPPV and also contains scholarly works that elucidate BPPV; its management remains an enigma to most clinicians. To this end, this work was aimed at outlining an evidence-based best practice for most common form of BPPV. Materials and Methods: A systematic review of the literature was conducted between 1948 and June 2011 in PubMed, Embase, Ovid, and Cochrane database through the online Library of the University of Cape Town. Seventy-nine worthy articles that addressed the study were selected on consensus of the two authors. Conclusion: There is consensus for the use of canalith repositioning procedures as the best form of treatment for posterior canal canalolithiasis. However, successful treatment is dependent on accurate identification of the implicated canal and the form of lithiasis. Furthermore, clinicians should note that there is no place for pharmacological treatment of BPPV; unless it is to facilitate repositioning.
  5 7,875 350
CASE REPORTS
Right atrial myxoma as a possible cause of hemorrhagic stroke and sudden death
Donatus Sabageh, Oluwole Olaniyi Odujoko, Akinwumi Oluwole Komolafe
April-June 2012, 53(2):102-104
DOI:10.4103/0300-1652.103551  
Right atrial myxomas are rare primary tumors of the heart. They may remain asymptomatic or eventually cause constitutional signs and symptoms. Less frequently, obstruction of the tricuspid valve occurs, resulting in exertional dyspnea, syncope, or sudden death. Neurological manifestation as initial presentation of atrial myxomas is rarely, if ever, associated with right atrial myxomas and may be secondary to cerebral infarction, cerebral hemorrhage and, more rarely subarachnoid hemorrhage. We review the case of a previously unknown, middle-aged Nigerian man who presented to hospital with severe headache and sudden loss of consciousness. A clinical diagnosis of hypertensive hemorrhagic cerebrovascular accident was made. The patient died suddenly a few hours after presentation. Post-mortem examination revealed a small intracerebral hemorrhage in the left superior temporal lobe as well as a large right atrial myxoma, a ventricular septal defect in the muscular septum, and right ventricular hypertrophy. The liver showed fatty change while the kidneys showed evidence of benign nephrosclerosis. Right atrial myxomas may, therefore, be remotely considered as a cause of intracranial hemorrhage, especially in the presence of predisposing cardiac anomalies such as a ventricular septal defect. Similarly, being a known cause of right heart failure, sudden death, and other constitutional derangements, it may contribute significantly to disease outcome. Hence, it should be given due consideration in the differential diagnosis of cerebrovascular accidents.
  4 2,764 160
ORIGINAL ARTICLES
Frequency of cognitive impairment and depression in Parkinson's disease: A preliminary case-control study
Oluwadamilola O Ojo, Njideka U Okubadejo, Frank I Ojini, Mustapha A Danesi
April-June 2012, 53(2):65-70
DOI:10.4103/0300-1652.103544  
Background: This study aimed to determine the frequency of cognitive impairment and depression in our Parkinson's Disease (PD) and their relationship with disease severity and disability. Patients and Methods: A total of 40 PD patients and 40 age-, sex-, and educationally matched controls were studied. The Unified Parkinson Disease Rating Scale (UPDRS) Motor and Activities of Daily Living (ADL) scores and the Hoehn and Yahr (HY) stage were documented. Depression was assessed using the Zung Self-Rating Depression Scale (ZSDS), while cognition was evaluated using a composite score of the mini-mental state examination (MMSE) score and category fluency score. Results: A total of 55% (22/40) of PD and 10% (4 of 40) of controls had depression (P<0.001). A total of 60% of PD (24/40) and 5% of controls (2/40) had cognitive impairment (P<0.001). Both NMS coexisted in 16 of 40 PD (40%) compared with none of the controls (P<0.001). UPDRS (motor and ADL) scores and HY stage were significantly worse with impaired ZSDS scores - P 0.001. UPDRS ADL was significantly impaired by the presence of cognitive impairment. Coexisting depression and cognitive impairment were associated with significant worsening of all scores of severity and disability. Conclusion: Cognitive impairment and depression accompany our PD and are related to disability and worsening disease severity.
  4 2,995 189
Non-trauma related paediatric abdominal surgical emergencies in Lagos, Nigeria: Epidemiology and indicators of survival
Adesoji O Ademuyiwa, Chris O Bode, Opeoluwa A Adesanya, Olumide A Elebute
April-June 2012, 53(2):76-79
DOI:10.4103/0300-1652.103546  
Background : Pediatric surgical emergencies are associated with higher morbidity and mortality. The aim of this study is to describe the epidemiology of non-trauma related pediatric abdominal surgical emergencies in our centre and determine the indicators for survival in a cohort of patients. Patients and Methods : A retrospective study of children aged 1 day to 15 years who presented with non-trauma related abdominal emergencies at the Lagos University Teaching Hospital (LUTH). Results : There were 129 children. The median age at presentation was 5 months (range: 1 day-15 years). There were 104 males and 25 females. Sixty-four (49.6%) patients presented within 48 hours of the onset of the symptoms while 65 (50.4%) presented after 48 hours. Intestinal obstruction is the commonest indication for pediatric emergency surgery in our centre accounting for 76 patients (58.9%). Appendicitis is the second most common indication for emergency surgery with 13 patients (10.1%). Thirteen patients (10.1%) had postoperative complications. There were 13 deaths in all (10.1% mortality rate). Eleven out of 43 (25.6%) neonates died compared with 2 (2.3%) out of 86 patients in the other age groups (P=0.002). Seven out of 107 (6.5%) patients that had surgery within 72 hours died while 5/22 (22.7%) patients died who had surgery after 72 hours (P=0.003). There were 4 mortalities (28.6%) among patients with postoperative complications compared with 9 (7.8%) mortalities among 116 patients without any postoperative complications (Pp=0.001). Conclusion : Intestinal obstruction is the commonest pediatric surgical emergency seen in LUTH. Neonatal age, admission to surgery intervention time >72 hours, and severe postoperative complications are associated with high mortality.
  4 2,964 173
CASE REPORTS
Advanced sickle cell associated interstitial lung disease presenting with cor pulmonale in a Nigerian
Ademola Emmanuel Fawibe, Philip Manman Kolo, James Ayodele Ogunmodede, Olufemi Olumuyiwa Desalu, Kazeem Alakija Salami
April-June 2012, 53(2):105-107
DOI:10.4103/0300-1652.103552  
Previous studies have reported abnormal pulmonary function and pulmonary hypertension among Nigerians with sickle cell disease, but there is no report of interstitial lung disease among them. We report a Nigerian sickle cell patient who presented with computed tomography proven interstitial lung disease complicated by pulmonary hypertension and cor pulmonale.
  1 2,574 119
ORIGINAL ARTICLES
The accuracy of 2D ultrasound prenatal sex determination
Blessing Ose-Emenim Igbinedion, Theophilus Oriazo Akhigbe
April-June 2012, 53(2):71-75
DOI:10.4103/0300-1652.103545  
Background: Pregnant women have been curious about the sex of their unborn child. The advent of ultrasound, its application into medicine, and the revolutionary changes in its resolution and function has led to the ability to assign a sex to these unborn children, thereby allaying the anxiety of these women but with consequent emergent ethical, moral, psycho-social, and medico-legal issues. The objectives were to determine the accuracy of sonographic prenatal sex determination, perform binary classification test, and the impact it has, including mis-diagnosis. Materials and Methods: A prospective prenatal sonographic sex determination study on 205 consecutive consenting pregnant women aged 20-40 years in a private hospital in Benin between August 2010 and October 2011. Questionnaires were administered to these women before and after the scan and the women were told the sex of the fetuses and their feelings on the determined sex recorded. The sex at birth was confirmed and compared to the scan determined gender by their case note and telephone. Relevant discussions during the scan and later on were recorded on the questionnaires. The statistical package used was SPSS version 17 and binary classification tests were performed. Results: The sensitivity (98.2%) and binary classification components values of prenatal sex determination were high with the sensitivity of detecting a female higher than that of males. Two males were misdiagnosed as females. Most of the women were happy even when the sex differed from that which they desired. Conclusion: Prenatal sonographic sex determination has a high sensitivity index. Consequently we advocate its use prior to more invasive sex tests.
  1 18,640 232
Management of intractable postpartum haemorrhage in a tertiary center: A 5-year experience
Hüseyin Cengiz, Levent Yasar, Murat Ekin, Cihan Kaya, Sema Karakas
April-June 2012, 53(2):85-88
DOI:10.4103/0300-1652.103548  
Background: The purpose of this study is to describe treatment alternatives to prevent postpartum hysterectomy after failure of conventional therapies. Prevention of hysterectomy was the main outcome studied. Materials and Methods: This is a retrospective study of 19 patients diagnosed to have intractable postpartum hemorrhage and not managed with medical treatment who were subsequently treated with operative interventions in our unit between January 2004 and January 2009. The cases were identified by review of medical records. Results: In the period under review, a total of 17,341 deliveries were conducted, out of which 19 women were managed for intractable PPH. The incidence of severe PPH unresponsive to standard medical treatment was 0.1%. The mean maternal age was 33.5±3.4 years (range 27-39 years). The mean gestational age was 38.3±1.3 weeks (range 37-41 weeks). Organ preserving surgery methods were utilized in all the patients with a success rate 78.9%. The mean duration of surgery was 95 minutes (range 50-130 minutes) and the mean hospital stay was for 5 days. The mean transfused blood volume was 2.4 units as packed red cells. Among these 19 cases, 4 cases were resorted to hysterectomy. Conclusions: In the presence of uncontrolled hemorrhage, this simple procedure should be tried before other complex treatment alternatives are undertaken. Our case series suggests that the combination of uterine artery ligation with B-Lynch sutures might be the best surgical approach because it preserves future fertility better than other methods and avoids high operative risks and morbidity.
  - 3,683 307
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