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   2013| January-February  | Volume 54 | Issue 1  
    Online since March 16, 2013

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The human health implications of crude oil spills in the Niger delta, Nigeria: An interpretation of published studies
Best Ordinioha, Seiyefa Brisibe
January-February 2013, 54(1):10-16
DOI:10.4103/0300-1652.108887  PMID:23661893
Background: The health hazards created by oil exploration and exploitation are covert and slow in action. They are not given the deserved attention in official documents in Nigeria, even as they can be major contributors to the disease burden in oil-bearing communities. This study is an interpretation of the data reported in several published studies on crude oil spills in the Niger delta region, Nigeria. Materials and Methods: A manual and Internet search was conducted to extract quantitative data on the quantity of crude oil spilled; the concentrations of the pollutants in surface water, ground water, ambient air and plant and animal tissue; and the direct impact on human health and household food security. Results: An average of 240,000 barrels of crude oil are spilled in the Niger delta every year, mainly due to unknown causes (31.85%), third party activity (20.74%), and mechanical failure (17.04%). The spills contaminated the surface water, ground water, ambient air, and crops with hydrocarbons, including known carcinogens like polycyclic aromatic hydrocarbon and benxo (a) pyrene, naturally occurring radioactive materials, and trace metals that were further bioaccumulated in some food crops. The oil spills could lead to a 60% reduction in household food security and were capable of reducing the ascorbic acid content of vegetables by as much as 36% and the crude protein content of cassava by 40%. These could result in a 24% increase in the prevalence of childhood malnutrition. Animal studies indicate that contact with Nigerian crude oil could be hemotoxic and hepatotoxic, and could cause infertility and cancer. Conclusions: The oil spills in the Niger delta region have acute and long-term effects on human health. Material relief and immediate and long-term medical care are recommended, irrespective of the cause of the spill, to ensure that the potential health effects of exposures to the spills are properly addressed.
  12,885 628 33
Barriers to utilisation of maternal health services in a semi-urban community in northern Nigeria: The clients' perspective
Suleman Hadejia Idris, Mohammed Nasir Sambo, Muhammed Sani Ibrahim
January-February 2013, 54(1):27-32
DOI:10.4103/0300-1652.108890  PMID:23661896
Background: Low level of utilisation of maternal health services is a major factor responsible for high maternal mortality in northwestern region of Nigeria. This study was aimed at determining the barriers to utilisation of maternal health services from the perspective of mothers in northwestern Nigeria. Materials and Methods: A cross-sectional study of 150 mothers, selected through multistage technique, was conducted. Data were collected using a structured interviewer-administered questionnaire, and analysed using SPSS statistics 17.0. Results: Only 2.7% utilised preconception service, 98.7% antenatal care service (ANC), 24.0% delivery, 35.3% postnatal care and 14.0% utilised family planning service. Major reasons for non-utilisation of delivery service were not having a delivery complication in the past (57% (CI = 47.4-66.1)) and negative provider attitude (23.7% (CI = 16.4-32.7)). For non-utilisation of postnatal care, the major reasons were also not having a postnatal complication in the past (60.8% (CI = 50.4-70.4)) and negative provider attitude (27.8% (CI = 19.4-38.0)). As for non-utilisation of family planning service, the major reason was desire to have more children (32.6% (CI = 24.7-41.4)). Reasons for non-use of preconception care and ANC were not computed because respondents to these questions were not enough; only 6 (4.0%) were aware of preconception care in the first place and only 2 (1.3%) were not using ANC. Conclusion: Despite living near a health facility, most of the mothers were not using maternal health services. It is recommended that while there is the need to raise awareness on the utilisation of maternal health services, bring it closer to the mothers and make it more affordable, there is a more pressing need to improve its quality, especially through the alleviation of negative attitude of health care providers.
  11,810 431 32
Helicobacter pylori eradication therapy: A review of current trends
AB Olokoba, OA Obateru, MO Bojuwoye
January-February 2013, 54(1):1-4
DOI:10.4103/0300-1652.108884  PMID:23661891
Helicobacter pylori has been implicated in the formation of chronic gastritis, peptic ulcer disease, mucosa-associated lymphoid tissue lymphoma and gastric cancer. Eradication of H. Pylori has been recommended as treatment and prevention for these complications. This review is based on a search of Medline, the Cochrane Database of Systemic Reviews, and citation lists of relevant publications. Subject heading and key words used include H. Pylori, current treatment and emerging therapy. Only articles in English were included. There has been a substantial decline in the H. pylori eradication rates over the years, despite the use of proton pump inhibitor and bismuth salts for triple and quadruple therapies respectively. The reasons for eradication failure are diverse, among them, antibiotic resistance is an important factor in the treatment failure. Primary resistance to clarithromycin or metronidazole significantly affects the efficacy of eradication therapy. This has led to the introduction of second line, third line "rescue," and sequential therapies for resistant cases. Subsequently, new antibiotic combinations with proton-pump inhibitors and bismuth salts are being studied in the last decade, to find out the antibiotics that are capable of increasing the eradication rates. Some of these antibiotics include Levofloxacin, Doxycycline, Rifaximin, Rifampicin, Furazolidone based therapies. Studies are ongoing to determine the efficacy of Lactoferrin based therapy.
  7,942 581 12
Risk factors, ulcer grade and management outcome of diabetic foot ulcers in a Tropical Tertiary Care Hospital
Andrew E Edo, Gloria O Edo, Ignatius U Ezeani
January-February 2013, 54(1):59-63
DOI:10.4103/0300-1652.108900  PMID:23661901
Background: The objective was to determine the risk factors, ulcer grade, and management outcome of patients with diabetic foot ulcers (DFU) managed in a tropical tertiary hospital. Materials and Methods: This is a prospective observational study of all consecutive diabetes mellitus (DM) patients with DFU admitted in the University of Benin Teaching Hospital, Benin City, Nigeria over a 26-month period. Data documented included age, gender, type of DM, duration of DM, risk factors of DFU, duration of DFU, Wagner's ulcer grade, and the blood glucose at presentation and management outcome. Results: Thirty-four (55.7%) of the 61 study subjects were females. Their mean age was 56.29±12.71 years. 85.2% had type 2 DM. 13.1% of the patients were newly diagnosed diabetic at presentation. The mean duration of DM was 7.8±6.98 years. The mean duration of DFU was 46.09±47.82 days and the casual blood glucose level at presentation was 18.41±9.31mmol/l. Risk factors of DFU included spontaneous blisters (52.46%), peripheral vascular disease (44.3%), peripheral neuropathy (42.6%), and visual impairment (21.3%). The common ulcer grades were IV (44.3%) and III (36.1%).The amputation rate was 52.2% while the mortality rate was 14.3%.The baseline ulcer grade was significantly associated with the risk of lower extremity amputation, and the odds ratio was 2.36 (95% 1.06-5.21). Conclusions: Spontaneous blisters, peripheral vascular disease, peripheral neuropathy,and visual impairment are common risk factors of DFUs. Many of our patients with DFUs presented with grade IV and V ulcers with the resultant high rate of lower extremity amputations (LEAs). Early presentation and treatment of DFUs will reduce LEAs.
  6,220 348 13
Barriers to postnatal care and exclusive breastfeeding among urbanwomen in southeastern Nigeria
Joseph O Ugboaja, Nwosu O Berthrand, Anthony O Igwegbe, Amaka L OBI-Nwosu
January-February 2013, 54(1):45-50
DOI:10.4103/0300-1652.108895  PMID:23661899
Background: Available evidence shows that only a small proportion of Nigerian women access postnatal care and practice exclusive breastfeeding. Given that both interventions are critical to the survival of both the mother and the new born, it is important to identify factors that militate against an effective postnatal care and exclusive breastfeeding in the country, in order to scale up services. The aim was to determine the major barriers to postnatal care and exclusive breastfeeding among urban women in southeastern Nigeria. Materials and Methods: A cross-sectional survey of 400 urban market women using semistructured questionnaires and focus group discussions. Results: Out of 400 women interviewed, 365 (91.7%) attended postnatal clinic. Lack of knowledge about postnatal care services (42.2%; n = 14), distant location of the hospitals (36.4%; n = 12) and feeling that postnatal visits was not necessary (21.1%; n = 7) were the main reasons for non-attendance to postnatal clinic. With respect to exclusive breastfeeding, 143 (35.9%) of the women practiced EBF. The main reasons for nonpractice of EBF were that EBF was very stressful (26.2%; n = 67), mother's refusal (23.5%; n = 60), and the feeling that EBF was not necessary (18.1%; n = 46). Thirty five (13.7%) of the women were constrained by time while the husband's refusal accounted for 1.5% (n = 3) of the reasons for nonpractice of exclusive breastfeeding. Conclusion: Poor knowledge and inaccessibility to health facilities were the main obstacles to postnatal care while the practice of exclusive breastfeeding was limited by the stress and mothers refusal.
  6,095 383 17
The impact of seat-belts in limiting the severity of injuries in patients presenting to a university hospital in the developing world
Olumuyiwa Joshua Ogundele, Adeleke O Ifesanya, Sylvester A Adeyanju, Samuel O Ogunlade
January-February 2013, 54(1):17-21
DOI:10.4103/0300-1652.108888  PMID:23661894
Background: Road traffic injuries are major public health problems and a leading cause of death and injury around the world. Approximately 1.2 million people are killed each year in road crashes worldwide, with up to 50 million more injured. Over 95% of these deaths and injuries occur in the low- and middle-income countries of the world. The aim of this study is to evaluate the impact of the use of seat-belts in reducing the severity of injuries from road traffic crashes and to determine the compliance and awareness of the importance of the use of seat-belts among Nigerian motorists. Patients and Methods: The injury patterns and outcome of care in 140 patients who were seen at the emergency department of our tertiary hospital were evaluated. Initial care and resuscitation was carried out on all patients using the advanced trauma life support protocol. Results: A total of 81 (57%) patients used seat-belts, while 59 (42.1%) did not. Nineteen (13.6%) patients died as a result of their injuries; 4 (21.1%) of these had used seat-belts, while 15 (79%) had not ( P = 0.001). The mortality rate of 79% for patients who did not use seat-belt was statistically significant. Conclusions: The seat-belt is an effective safety tool that not only saves lives, but also significantly reduces the severity of the injury that a vehicle occupant may have sustained if they were not wearing the device. More public enlightenment is needed to increase the awareness and compliance of use of seat-belts among Nigerian motorists.
  5,689 238 5
Childhood acquired heart diseases in Jos, north central Nigeria
Fidelia Bode-Thomas, Olukemi O Ige, Christopher Yilgwan
January-February 2013, 54(1):51-58
DOI:10.4103/0300-1652.108897  PMID:23661900
Background: The patterns of childhood acquired heart diseases (AHD) vary in different parts of the world and may evolve over time. We aimed to compare the pattern of childhood AHD in our institution to the historical and contemporary patterns in other parts of the country, and to highlight possible regional differences and changes in trend. Materials and Methods: Pediatric echocardiography records spanning a period of 10 years were reviewed. Echocardiography records of children with echocardiographic or irrefutable clinical diagnoses of AHD were identified and relevant data extracted from their records. Results: One hundred and seventy five children were diagnosed with AHD during the period, including seven that had coexisting congenital heart disease (CHD). They were aged 4 weeks to 18 years (mean 9.84΁4.5 years) and comprised 80 (45.7%) males and 95 (54.3%) females. Rheumatic heart disease (RHD) was the cause of the AHD in 101 (58.0%) children, followed by dilated cardiomyopathy (33 cases, 18.9%) which was the most frequent AHD in younger (under 5 years) children. Other AHD encountered were cor pulmonale in 16 (9.1%), pericardial disease in 15 (8.6%), infective endocarditis in 8 (4.6%) and aortic aneurysms in 2 (1.1%) children. Only one case each of endomyocardial fibrosis (EMF) and Kawasaki Disease were seen during the period. Conclusions: The majority of childhood acquired heart diseases in our environment are still of infectious aeitology, with RHD remaining the most frequent, particularly in older children. Community-based screening and multicenter collaborative studies will help to better describe the pattern of AHD in our country. More vigorous pursuit of the Millennium development goals will contribute to reducing the burden of childhood acquired heart diseases in the country.
  5,606 263 7
Application of queuing theory to patient satisfaction at a tertiary hospital in Nigeria
Nkeiruka Ameh, B Sabo, MO Oyefabi
January-February 2013, 54(1):64-67
DOI:10.4103/0300-1652.108902  PMID:23661902
Background: Queuing theory is the mathematical approach to the analysis of waiting lines in any setting where arrival rate of subjects is faster than the system can handle. It is applicable to healthcare settings where the systems have excess capacity to accommodate random variations. Materials and Methods: A cross-sectional descriptive survey was done. Questionnaires were administered to patients who attended the general outpatient department. Observations were also made on the queuing model and the service discipline at the clinic. Questions were meant to obtain demographic characteristics and the time spent on the queue by patients before being seen by a doctor, time spent with the doctor, their views about the time spent on the queue and useful suggestions on how to reduce the time spent on the queue. A total of 210 patients were surveyed. Results: Majority of the patients (164, 78.1%) spent 2 h or less on the queue before being seen by a doctor and less than 1 h to see the doctor. Majority of the patients (144, 68.5%) were satisfied with the time they spent on the queue before being seen by a doctor. Useful suggestions proffered by the patients to decrease the time spent on the queue before seeing a doctor at the clinic included: that more doctors be employed (46, 21.9%), that doctors should come to work on time (25, 11.9%), that first-come-first served be observed strictly (32, 15.2%) and others suggested that the records staff should desist from collecting bribes from patients in order to place their cards before others. The queuing method employed at the clinic is the multiple single channel type and the service discipline is priority service. The patients who spent less time on the queue (<1 h) before seeing the doctor were more satisfied than those who spent more time ( P < 0.05). Conclusion: The study has revealed that majority of the patients were satisfied with the practice at the general outpatient department. However, there is a need to employ measures to respond to the suggestions given by the patients who are the beneficiaries of the hospital services.
  4,028 276 8
Cord blood haemoglobin and ferritin concentrations in newborns of anaemic and non-anaemic mothers in Lagos, Nigeria
Adewumi Adediran, Abidoye Gbadegesin, Titilope A Adeyemo, Akinsegun Akinbami, Vincent Osunkalu, Ann Ogbenna, Alani S Akanmu
January-February 2013, 54(1):22-26
DOI:10.4103/0300-1652.108889  PMID:23661895
Background: Pre-delivery haemoglobin and serum ferritin concentrations of anaemic and non-anaemic mothers were determined, and cord blood haemoglobin and serum ferritin concentrations of their newborns were compared. This is to establish the mean values for pre-delivery haemoglobin and serum ferritin concentrations of anaemic and non-anaemic mothers and the cord blood haemoglobin and serum ferritin concentrations of their newborns at term. Materials and Methods: A case-control study was done involving 142 pregnant women and their newborns. They were divided into two groups - the anaemic group ( n = 65) and the non-anaemic ( n = 77) group. Five millilitres of blood was collected from each woman and 2 ml was collected from the cord of their newborns into ethylenediaminetetraacetic acid (EDTA) bottle and plain bottle for full blood count analysis and ferritin assay, respectively. Results: The mean pre-delivery haemoglobin concentrations of the women in anaemic group and non-anaemic group were 9.5 ± 1.01 g/dl and 12.15 ± 1.07 g/dl, respectively, and their mean serum ferritin concentrations were 64.45 ± 138.76 μg/l and 32.83 ± 35.36 μg/l, respectively. The mean cord blood haemoglobin concentrations for anaemic and for non-anaemic groups were 12.54 ± 2.54 g/dl and 13.44 ± 2.23 g/dl ( P = 0.02), respectively, and the mean cord blood serum ferritin concentrations (non-anaemic, 69.38 ± 78.88 μg/l; anaemic, 7.26 ± 115.60 μg/l) ( P = 0.00) were higher in the newborns of non-anaemic than of anaemic mothers. Significant association was found between maternal anaemia and cord blood ferritin concentrations ( P = 0.025). Conclusion: Maternal anaemia has significant effects on cord blood haemoglobin and serum ferritin concentrations.
  3,325 250 3
Attitude, perception and feedback of second year medical students on teaching-learning methodology and evaluation methods in pharmacology: A questionnaire-based study
Uma A Bhosale, Radha Yegnanarayan, Gauri E Yadav
January-February 2013, 54(1):33-39
DOI:10.4103/0300-1652.108891  PMID:23661897
Background: To assess the student's attitude, perception and feedback on teaching-learning methodology and evaluation methods in pharmacology. Materials and Methods: One hundred and forty second year medical students studying at Smt. Kashibai Navale Medical College, Pune, were selected. They were administered a pre-validated questionnaire containing 22 questions. Suggestions were also asked regarding the qualities of good pharmacology teachers and modification in pharmacology teaching methods. Descriptive statistics were used and results were expressed as percentage. Results: Majority of the students found cardiovascular system (49.25%) as the most interesting topic in pharmacology, whereas most of the students opined that cardiovascular system (60.10%), chemotherapy (54.06%) and central nervous system (44.15%) are going to be the most useful topics in internship. 48.53% students preferred clinical/patient-related pharmacology and 39.13% suggested use of audiovisual-aided lectures. Prescription writing and criticism of prescription were amongst the most useful and interesting in practical pharmacology. Students expressed interest in microteaching and problem-based learning, whereas seminars, demonstrations on manikin and museum studies were mentioned as good adjuvants to routine teaching. Multiple Choice Question (MCQ) practice tests and theory viva at the end of a particular system and periodical written tests were mentioned as effective evaluation methods. Students were found to have lot of interest in gathering information on recent advances in pharmacology and suggested to include new drug information along with prototype drugs in a comparative manner. Conclusion: There is a need of conducting few microteaching sessions and more of clinical-oriented problem-based learning with MCQ-based revisions at the end of each class in the pharmacology teaching at undergraduate level.
  3,259 262 3
Serum lipid profile in alcoholic cirrhosis: A study in a teaching hospital of north-eastern India
Jyoti Prakash Phukan, Anuradha Sinha, Jatindra Prasad Deka
January-February 2013, 54(1):5-9
DOI:10.4103/0300-1652.108886  PMID:23661892
Background: Alcoholic cirrhosis is often associated with impaired lipid metabolism. However, there are only a few studies regarding lipid profile in alcoholic cirrhosis that have been undertaken in India. The aim of the study is to assess the degree of alteration of serum lipid profile in alcoholic cirrhotic patients and also to detect its relationship with the age of the patients and the alcohol consumption pattern. Patients and Methods: This cross-sectional study was conducted in a teaching hospital of north-eastern India for 1 year with 100 patients with alcoholic cirrhosis (cases) and 50 healthy individuals (controls) without history of alcohol consumption. A questionnaire of personal characteristics including history of alcoholism was completed for each patient. Serum lipid profile (total, low-density lipoprotein (LDL), high-density lipoprotein (HDL) cholesterol and triglyceride) was recorded for each case and control. t test of significance was applied for statistical analysis. Results: Majority of the cases were in the 41-50 years age group. There was no relationship of cirrhosis with the type of alcoholic beverage, but a definite relationship was observed with the quantity and the duration of alcohol consumption. In patients with cirrhosis, the total serum cholesterol level was decreased. There was a significant decrease in serum HDL and LDL cholesterol compared with the control group ( P < 0.001). However, the serum triglyceride levels were significantly increased in alcoholic cirrhotic patients compared with the control group ( P < 0.001). Conclusion: In this study, we found that there was marked alteration of serum lipid profile values in patients with alcoholic cirrhosis compared with normal, non-cirrhotic individuals. Therefore, a search for lipid profile abnormality should be performed in every cirrhotic patient.
  2,854 248 8
Primary neuroendocrine carcinoma of the thymus
Gajanan S Gaude, Virupakshi Hattiholi, Prakash R Malur, Jyothi Hattiholi
January-February 2013, 54(1):68-71
DOI:10.4103/0300-1652.108904  PMID:23661903
Primary neuroendocrine tumors of the thymus, previously known as carcinoid tumors of the thymus, are unusual and rare tumors, and prognosis for these patients has been difficult to predict. We hereby report a case of primary neuroendocrine tumor of the thymus that had an aggressive and fatal course in spite of surgical resection and adjuvant chemotherapy. These tumors must be regarded as a malignant neoplasm that is prone to metastasize to distant sites, even after total excision.
  2,453 179 2
Is there any relationship between Chlamydophila pneumoniae and coronary atherosclerosis among Iranians?
Mohammad Hadi Sadeghian, Seyed Abbas Tabatabaee Yazdi, Hossein Ayatollahi, Mohammad Reza Keramati, Kiarash Ghazvini, Ali Reza Rezai, Nasrin Heidari, Maryam Sheikhi, Gohar Shaghayegh
January-February 2013, 54(1):40-44
DOI:10.4103/0300-1652.108894  PMID:23661898
Background: Atherosclerosis is a coronary heart disease, andis the most common cause of death in the industrialized world. Some studies suggested that atherosclerosis may be triggered by infectious agents, mostly Chlamydophila pneumoniae. However, the role of C. pneumoniae in the pathogenesis of coronary atherosclerosis is still controversial. Objectives: This study was performed to evaluate whether there is a significant association between coronary artery atherosclerosis and C. pneumoniae by the polymerase chain reaction (PCR) method. Materials and Methods: This case-control study was carried out on formalin-fixed paraffin-embedded tissue biopsies of the coronary arteries obtained from 30 patients with coronary atherosclerosis and 30 subjects without atherosclerosis living in Northeast of Iran. All subjects' weight and height were determined, and the body mass index was calculated. We also reviewed the medical history and previous laboratory reports of patients. Deoxyribonucleic acid (DNA) was extracted, and C. pneumonia DNA was amplified and detected using PCR assay. Results: The age of the patients in the study group was from 18 to 50 years, and the male to female ratio was 5:1. Only oneout of the 30 coronary tissue samples had positive PCR for C. pneumoniae (3.3%), while it was negative for patients in the control group. Conclusions: This study showed that C. pneumoniae infection is not strongly associated with coronary artery atherosclerosis in Northeast of Iran.
  2,205 152 1