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   2013| July-August  | Volume 54 | Issue 4  
    Online since October 9, 2013

 
 
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ORIGINAL ARTICLES
Experience with rubber band ligation of hemorrhoids in northern Nigeria
MA Misauno, BD Usman, UU Nnadozie, SK Obiano
July-August 2013, 54(4):258-260
DOI:10.4103/0300-1652.119654  PMID:24249953
Background: Treatment of hemorrhoids in Nigeria is usually done by the traditional open method that requires hospital admission; anesthesia and is associated with high morbidity. Rubber band ligation is a suitable alternative to open hemorrhoidectomy and has the potential to reduce the need for hospital admission. Patients and Methods: This was a prospective analysis of consecutive patients presenting with hemorrhoids that were suitable for surgical treatment to the Jos University Teaching Hospital and the Federal Medical Centre Gombe from January 2008 to December 2010 (24 months). Results: A total of 232 rubber band ligations were performed on 40 patients whose ages ranged from 20 to 54 years with a mean age of 37.1 ± 12.2 years. There were 24 males and 16 females (M:F::2:3). Thirty-nine patients (97.5%) were cured of their symptoms following the procedure, and 1 patient (2.5%) had severe pain as complication of the treatment. Another patient had recurrence that was treated by repeat rubber band ligation. Conclusion: We conclude that rubber band ligation is a safe and reliable way for outpatient treatment of hemorrhoids in Nigeria.
  14,371 152 2
Knowledge of diabetes and its associated ocular manifestations by diabetic patients: A study at Korle-Bu Teaching Hospital, Ghana
Godwin O Ovenseri-Ogbomo, Samuel Abokyi, GA Koffuor, Eric Abokyi
July-August 2013, 54(4):217-223
DOI:10.4103/0300-1652.119602  PMID:24249945
Background: Diabetes mellitus is a significant cause of visual impairment, hence adequate knowledge on this condition and its ocular manifestations is of immense importance to diabetic patients. Aim: To assess the knowledge of diabetic patients on the disorder and its ocular manifestations, and their attitude towards ocular examinations. Materials and Methods: A cross-sectional survey involving the use of a structured interview was conducted among diabetic patients attending the Diabetic Clinic of the Korle-Bu Teaching Hospital. Using Fishers Exact Chi-square (χ2 ) and Odds Ratios (ORs), data obtained was analyzed. Results: Only 103 (26.4%) patients knew the type of diabetes mellitus they were suffering from. Knowledge on ocular effects of diabetes mellitus was low and only 15 (3.8%) knew that it could affect the ocular refraction with no patient mentioning that diabetes mellitus could cause cataract or diabetic retinopathy. Attitude to routine eye examination was poor. As much as 135 (34.6%) had never had an eye examination since being diagnosed of diabetes. Knowledge of the type of diabetes mellitus the individual had or any ocular complication of this disorder was significantly related (OR: 4.22; P < 0.001 and OR: 2.55; P < 0.001) respectively to their attitude to seeking eye care. Conclusion: Diabetic patients' knowledge on diabetes mellitus and its ocular manifestations, and the attitude of diabetic patients towards eye examination were poor. Intensive health education by diabetes care givers and leaders of the Ghana Diabetic Association for diabetic patient is therefore required to improve attitude towards eye care to prevent visual impairment.
  12,851 188 20
Body mass index, pain and function in individuals with knee osteoarthritis
Adewale L Oyeyemi
July-August 2013, 54(4):230-235
DOI:10.4103/0300-1652.119610  PMID:24249947
Background: Obesity is a risk factor for progression of knee osteoarthritis (OA), and high body mass index (BMI) may interfere with treatment effectiveness on pain and function in individuals with knee OA. This study investigated the effects of BMI on pain and function during a four-week exercise programme in patients with knee OA. Materials and Methods: Forty-six (31 women and 15 men) participants with knee OA of different BMI categories (15 normal weight participants, 13 over weight participants and 18 obese participants), received standardised exercise therapy programme twice a week for 4 weeks. Outcome included a 10-point pain rating scale for pain-intensity and the western Ontario and McMaster university osteoarthritis index (WOMAC) for physical function. Results: Two-way repeated measure analysis of variance (ANOVA) on pain assessment score revealed a significant effect of time (F = 1049.401, P < 0.001) and group (F = 9.393, P < 0.001) on pain. Similar significant effect of time (F = 595.744, P < 0.001) and group (F = 5.431, P = 0.008) was obtained for WOMAC score on function. Post hoc analysis revealed significant difference between the normal weight and overweight group (t = 2.472, P = 0.016) and between normal weight and obese group (t = 3.893, P = 0.005) on pain outcome at the 4 th week post treatment. No significant difference was found at 4 th week post treatment on WOMAC scores (F = 2.010, P = 0.146). Conclusion: Exercise improved pain and function scores in OA patients across the BMI groups. Overweight independent of obesity may interfere with effectiveness of pain control during the symptomatic treatment of knee OA patients.
  7,117 298 13
High-risk of obstructive sleep apnea and excessive daytime sleepiness among commercial intra-city drivers in Lagos metropolis
Obianuju B Ozoh, Njideka U Okubadejo, Maxwell O Akanbi, Michelle G Dania
July-August 2013, 54(4):224-229
DOI:10.4103/0300-1652.119607  PMID:24249946
Background: The burden of obstructive sleep apnea among commercial drivers in Nigeria is not known. Aim: To assess the prevalence of high risk of obstructive sleep apnea (OSA) and excessive daytime sleepiness (EDS) among intra-city commercial drivers. Setting and Design: A descriptive cross-sectional study in three major motor parks in Lagos metropolis. Materials and Methods: Demographic, anthropometric and historical data was obtained. The risk of OSA and EDS was assessed using the STOP BANG questionnaire and the Epworth Sleepiness Scale, respectively. Statistical Analysis: The relationship between the OSA risk, EDS risk and past road traffic accident (RTA) was explored using the Pearson's chi square. Independent determinants of OSA risk, EDS risk and past RTA, respectively, were assessed by multiple logistic regression models. Result: Five hundred male commercial drivers (mean age (years) ±SD = 42.36 ± 11.17 and mean BMI (kg/m 2 ) ±SD = 25.68 ± 3.79) were recruited. OSA risk was high in 244 (48.8%) drivers and 72 (14.4%) had EDS. There was a positive relationship between OSA risk and the risk of EDS (Pearson's X 2 = 28.2, P < 0.001). Sixty-one (12.2%) drivers had a past history of RTA but there was no significant relationship between a past RTA and either OSA risk (X 2 = 2.05, P = 0.15) or EDS risk (X 2 = 2.7, P = 0.1), respectively. Abdominal adiposity, regular alcohol use and EDS were independent determinants of OSA risk while the use of cannabis and OSA risk were independent determinants of EDS. No independent risk factor for past RTA was identified. Conclusion: A significant proportion of commercial drivers in Lagos metropolis are at high risk of OSA and EDS.
  7,229 185 20
CASE REPORTS
An interdisciplinary approach to treat crown-root-fractured tooth
Ying Chun Sun, Ying Li, Jian Tong, Ping Gao
July-August 2013, 54(4):274-277
DOI:10.4103/0300-1652.119664  PMID:24249958
Restoration of a crown-root subgingival fractured tooth, especially at anterior aesthetic zones is still a great challenge for restorative dentists. Crown lengthening procedure alone has the disadvantage of high gingival curve of the final restoration, which was not discontinuous to adjacent teeth and thus compromise cosmetic outcomes. The objective of this report is to display a new interdisciplinary approach which combining endodontic root canal treatment, orthodontic extrusion, periodontal crown lengthening surgery and prosthodontic post-core-crown restoration procedures to restore a crown-root subgingival fractured maxillary central incisor and achieved a satisfied cosmetic result. Computer-based spectrophotometer was also used to accurately select colour without objective interference to achieve ideal cosmetic effects.
  6,628 252 4
ORIGINAL ARTICLES
Pain perception among parturients at a University Teaching Hospital, South-Western Nigeria
Olusola Peter Aduloju
July-August 2013, 54(4):211-216
DOI:10.4103/0300-1652.119597  PMID:24249944
Introduction: Labour pain is a universal experience. Relief of labour pains and companionship in labour are important aspects of quality of care in labour. Objectives: To evaluate perception of labour pains among parturients, their knowledge and awareness of pain relief during labour, the types of obstetric analgesia available and the outcome of their labour at the Ekiti State University Teaching Hospital, Ado-Ekiti. Materials and Methods: A cross-sectional study using questionnaire administered to pregnant women between 37 and 42 weeks gestational age in labour ward of the hospital. Results: The study revealed that 75.2% of the parturients experienced severe labour pains and 35.3% of them received analgesia in labour with Pentazocine injection being the only analgesic used. Only 18.3% had maximum relief of their pains. Parturients with increasing parity, higher social class and educational attainment and who had antenatal education on labour pains were associated with severe perception of labour pains with P values of 0.03, 0.03, 0.02 and 0.01, respectively. Parturients who were given Pentazocine injection for pains and had relief in labour had more spontaneous vaginal deliveries, P = 0.030 and better outcome for their babies, P = 0.028. Majority of the women reported that the practice of companionship and back rubbing in labour helped them to cope better with the labour process. Conclusion: Most women desire relief of pains of labour but the practice is still suboptimal in this centre. Efforts should be made towards developing the practice of obstetric analgesia and companionship in labour in this environment.
  6,438 179 7
Knowledge and attitude towards child adoption among women in Zaria, northern Nigeria
Solomon Avidime, Nkeiruka Ameh, Adebiyi Gbadebo Adesiyun, C Ozed-Williams, Nathaniel Isaac, Yakubu Aliyu, Kokori Sullyman, Hadiza Idris, Austin Ojabo
July-August 2013, 54(4):261-264
DOI:10.4103/0300-1652.119657  PMID:24249954
Background: The success of marriages has largely been premeditated on child bearing in most African society and oftentimes women are at the receiving end of childlessness with possible psychological and physical torture. Objective: To assess the knowledge and attitude of women of reproductive age towards child adoption in Zaria, Northern Nigeria. Methodology: A cross-sectional descriptive study, structured closed and open ended questionnaires was administered to 200 consenting consecutive women aged 15-49years to obtain information on socio-demographic characteristics, reproductive profile, knowledge and attitude towards child adoption. Data was analysed using SPSS V17 with p value set at 0.05. Results: The majority 89.4% of respondents have heard and are aware of child adoption and 77% agreed it is a good practice. The most prevalent source of information is the Mass media in 35.0% of respondents. The female gender is preferred by majority 64.2% of respondent if they will adopt. There is a strong association between numbers of living children and willingness to consider child adoption with P value < 0.05. Conclusion: There is a high level of knowledge and acceptability of child adoption practices in our environment. Child adoption institutions should therefore be supported to meet the need of the infertile couples.
  6,372 147 3
CASE REPORTS
Intraoral malignant melanoma
Suresh Babburi, RV Subramanyam, V Aparna, P Sowjanya
July-August 2013, 54(4):278-281
DOI:10.4103/0300-1652.119667  PMID:24249959
Primary oral mucosal melanoma is a rare aggressive neoplasm and accounts for only 0.2-8% of all reported melanomas. It is a malignant neoplasm of melanocytes that may arise from a benign melanocytic lesion or de novo from melanocytes within normal skin or mucosa. It is considered to be the most deadly and biologically unpredictable of all human neoplasms, having the worst prognosis. In this article, we report a case of oral melanoma in a 52-year-old female patient with a chief complaint of black discolouration of the maxillary gingiva and palate.
  6,023 166 7
ORIGINAL ARTICLES
Assessment of the risk factors for hearing loss in adult Nigerian population
Olusola Ayodele Sogebi
July-August 2013, 54(4):244-249
DOI:10.4103/0300-1652.119648  PMID:24249950
Background: A reduction in hearing sensitivity is common in adults and was previously considered to be normal as age increases. However, other health variables may play a role in the sensory changes. This prospective, comparative, hospital-based study assessed the risk factors (RFs) associated with sensorineural hearing losses (SNHL) in adult patients in a specialized tertiary hospital clinic in South-western Nigeria. Materials and Methods: Patients with clinical diagnosis of hearing impairment (bilateral SNHL) were the test subjects and age and sex-matched comparable group without SNHL were the Controls. Using a structured questionnaire, variables assessed included current and past medical history, family and social history, use of medications including ototoxic drugs, and prolonged medications. Results: One hundred and twenty-seven patients participated in the study comprising of 76 test subjects with SNHL (including 14 with suspected ARHL) and 51 controls. 59.8% of the participants were males. Univariate analysis revealed statistically-significant differences in family history, alcohol consumption, smoking, exposure to noise, previous ear discharge, previous head injury, hypertension, diabetes, osteoarthritis, ototoxic drugs usage, prolonged medication and obesity between the two categories of subjects. Logistic regression analysis revealed family history, smoking, noise exposure, head injury, hypertension had significantly increased odds of developing SNHL. Conclusion: It was concluded that the RFs for SNHL in adult Nigerians were multifactorial while some of the RFs may be amenable to primary prevention. Legislation and public health education could facilitate reduction of SNHL in our community.
  6,039 137 10
Hearing results in adults after stapedotomy
Emmanuel Sara Kolo, R Ramalingam
July-August 2013, 54(4):236-239
DOI:10.4103/0300-1652.119617  PMID:24249948
Background: Although clinical otosclerosis is considered a rare disease, it is the common cause of hearing loss in patients with an intact tympanic membrane. Also, the hearing loss is amenable to other non-surgical remedies. However, stapes surgery is currently the preferred treatment modality. This study aimed to assess the short-term hearing results in adults after primary stapedotomy, and find, if any, the effects of some variables on post operative hearing. Materials and Methods: This was a retrospective review of the clinical records of all consecutive patients who had primary stapedotomy for otosclerosis at the K. K. Ramalingam Ear, Nose and Throat Hospital and Research institute, Chennai, India between October 2011 and December 2011. Results: A total of 31 adults were studied; 19 (61.3%) were males and 12 (38.7%) were females. Their ages were between 21 years and 69 years; the mean age was 43.67 years, standard deviation (SD) 11.859 (95% CI; 39.24-48.10). The mean duration of symptom was 5.96 years; SD 6.188 (95% CI; 3.65-8.27). The commonest presenting symptoms were hearing loss (96.5%) and tinnitus (48.4%). The overall mean pre-operative pure tone average was 56.54 dB, SD 10.866 (95% CI; 52.55-60.52), while the overall mean post operative pure tone average was 33.75 dB, SD 15.577 (95% CI; 28.03-39.46). This difference was found to be statistically significant (Z = −4.454; P = 0.000). The overall mean pre-operative air bone gap was 43.14 dB; SD 6.824 (95% CI; 40.64-45.64) and the overall mean post operative air bone gap was 19.17 dB; SD 12.368 (95% CI; 14.63-23.70). This difference was found to be statistically significant (Z = −4.701). Nineteen patients (61.3%) had post operative air bone closure within 15 dB. The patient's age significantly correlated with the post operative pure tone average (r = 0.443; P = 0.023). There was no significant correlation between the duration of disease and the post operative pure tone average (r = −0.034; P = 0.870). Conclusions: Primary stapedotomy was effective in improving short term hearing outcome in adults with clinical otosclerosis. In addition, the post operative hearing outcomes were not affected by the duration of the disease; but by an increase in the patient's age.
  5,824 176 8
Diseases mortality patterns in elderly patients: A Nigerian teaching hospital experience in Irrua, Nigeria
OJ Uchendu, GD Forae
July-August 2013, 54(4):250-253
DOI:10.4103/0300-1652.119636  PMID:24249951
Background: Currently, in developing countries, there is a paradigm shift in the mortality patterns from communicable to non-communicable diseases. Objective: This study is aimed at providing a broad spectrum on the mortality patterns in elderly within a 5-year-period in a tertiary healthcare provider in Nigeria. Materials and Methods: This study is a retrospective review of mortality patterns of elderly patients from January 2007 to December 2011 occurring in Irrua specialist teaching hospital, (ISTH), Irrua and its environs. Information derived from the request cards include age, sex, clinical history, diagnosis, duration and cause of death. Results: During this period a total of 3,002 elderly (>65 years) admissions were seen. Of this, 561 patients were confirmed dead. Among this, 317 and 244 cases were elderly male and female patients, respectively. Hence the ratio of male to female was 1.3:1.0. The peak age group was 65-70 years accounting for 147 patients (26.2%). The age range of patients was 65-104 years while the modal and mean ages were 69 years and 74 years ΁ 4.2 standard deviation (SD), respectively. The most commonly encountered cause of mortality was cerebrovascular accident constituting 141 (25.1%) cases. The 2 nd and 3 rd majority of mortality cases were malignancies and diabetes mellitus (metabolic disorder) accounting for 85 (15.2%) and 45 (8%) cases, respectively. Others include congestive cardiac failure 35 (6.2%), Septicaemia 29 (5.2%), trauma 26 (4.6%) while chronic renal failure and chronic obstructive pulmonary disease consist of 22 cases (3.9%) each. Conclusion: Non-communicable diseases particularly cerebrovascular diseases and malignancies were the most commonly encountered cause of elderly mortality in our environment. Notwithstanding a large percentage of mortality patterns also results from communicable diseases with sepsis as the leading cause of mortality.
  5,533 119 3
Endocrine-related diseases in the emergency unit of a Tertiary Health Care Center in Lagos: A study of the admission and mortality patterns
AC Anyanwu, IA Odeniyi, OA Fasanmade, AJ Adewunmi, O Adegoke, AC Mojeed, KE Olofin, AE Ohwovoriole
July-August 2013, 54(4):254-257
DOI:10.4103/0300-1652.119651  PMID:24249952
Introduction: Non-communicable diseases are emerging as an important component of the burden of diseases in developing countries. Knowledge on admission and mortality patterns of endocrine-related diseases will give insight into the magnitude of these conditions and provide effective tools for planning, delivery, and evaluation of health-care needs relating to endocrinology. Materials and Methods: We retrieved medical records of patients that visited the emergency unit of the Lagos University Teaching hospital, over a period of 1 year (March 2011 to February 2012) from the hospital admissions and death registers. Information obtained included: Age, gender, diagnosis at admission and death, co-morbidities. Diagnoses were classified as endocrine-related and non-endocrine related diseases. Records with incomplete data were excluded from the study. Results: A total of 1703 adult medical cases were seen; of these, 174 were endocrine-related, accounting for 10.2% of the total emergency room admission in the hospital. The most common cause of endocrine-related admission was hyperglycaemic crises, 75 (43.1%) of cases; followed by diabetes mellitus foot syndrome, 33 (19.0%); hypoglycaemia 23 (13.2%) and diabetes mellitus related co-morbidities 33 (19.0%). There were 39 endocrine-related deaths recorded. The result revealed that 46.1% of the total mortality was related to hyperglycaemic emergencies. Most of the mortalities were sepsis-related (35.8%), with hyperglycaemic crises worst affected (71.42%). However, the case fatalities were highest in subjects with thyrotoxic crisis and hypoglycaemic coma. Conclusion: Diabetic complications were the leading causes of endocrine-related admissions and mortality in this health facility. The co-morbidity of sepsis and hyperglycaemia may worsen mortality in patients who present with hyperglycaemic crises. Hence, evidence of infection should be sought early in such patients and appropriate therapy instituted.
  4,891 133 4
A comparative study of the oral hygiene status of smokers and non-smokers in Ibadan, Oyo state
Modupe O Arowojolu, Olufunmilayo I Fawole, Elizabeth B Dosumu, OI Opeodu
July-August 2013, 54(4):240-243
DOI:10.4103/0300-1652.119627  PMID:24249949
Aims: The aim of this study was to assess the effect of tobacco smoking on gingival health and the oral hygiene status of respondents. Materials and Methods: A cross-sectional survey of 213 adults from three communities in the Ibadan North local government was carried out. Respondents were divided into two groups comprising of 117 smokers (cases) and 96 non-smokers (control). Intra oral examination was done using the Simplified Oral Hygiene Index (OHI-S) and Gingival index (GI). Results: The mean age of the smokers was 31.2 ± 12.6 years and that of the non-smokers 32.8 ± 9.5 years. The mean Simplified Oral Hygiene Index (OHI-S) was 1.15 ± 0.51 for the non-smokers and 2.19 ± 0.62 for the smokers (P < 0.05). The mean GI was 1.06 ± 0.55 for the non-smokers and 1.62 ± 0.58 for the smokers (P < 0.05). Conclusion: The study shows that smoking is associated with increased severity of gingival disease. It is, therefore, recommended that smokers should be encouraged to visit a dentist for preventive procedure more regularly than the non-smokers and better still, smokers should be encouraged to quit smoking as gingival disease is not without consequences if allowed to persist.
  4,723 121 8
CASE REPORTS
Familial dysbetalipoproteinaemia presenting with cauliflower xanthoma
Akbar Aliasgarzadeh, Maryam Ghorbanian, Mohammad Naghavi-Behzad
July-August 2013, 54(4):268-270
DOI:10.4103/0300-1652.119661  PMID:24249956
Familial dysbetalipoproteinaemia (FDL) is an inherited disorder in which both cholesterol and triglycerides are elevated in the plasma, pre-disposing the people to coronary artery disease and peripheral vascular disease. The disease is mostly manifested by xanthomas, which have variable forms according to lipid amounts in the plasma of the blood. Hereby, we report a 43-year-old man with FDL, presenting with a rare form of xanthomas calling "Cauliflower xanthoma" all over the body.
  4,716 92 -
Cervical intramural pregnancy: Report of a rare case
Abhishek Sharma, Ranapratap Ojha, Soumit Mondal, Sarbani Chattopadhyay, Parama Sengupta
July-August 2013, 54(4):271-273
DOI:10.4103/0300-1652.119670  PMID:24249957
Cervical pregnancy is an extremely rare condition of ectopic pregnancy with potential grave consequences if not diagnosed and treated early. A case of intramural pregnancy in the cervix is being reported for its rarity. Early diagnosis is imperative to preserve fertility, otherwise if the pregnancy is disturbed, it may precipitate massive haemorrhage, which may require hysterectomy to save the patient.
  4,363 130 3
LETTERS TO EDITOR
Familial dextrocardia in a Nigerian family
Aliyu Ibrahim
July-August 2013, 54(4):282-283
DOI:10.4103/0300-1652.119656  PMID:24249960
  4,057 77 2
CASE REPORTS
A multidisciplinary approach for ocular rehabilitation following surgical treatment of retinoblastoma: One year follow-up
Himanshi Aggarwal, Pradeep Kumar, Raghuwar D Singh, Varun Baslas, Habib A Alvi, Sunit Jurel
July-August 2013, 54(4):265-267
DOI:10.4103/0300-1652.119659  PMID:24249955
Retinoblastoma is a highly malignant neoplasm. Most of the cases are usually advanced at the time of detection, requiring enucleation to salvage the child's life. Just treating the patient for cancer is not enough; the cosmetic rehabilitation of these patients is equally important and it should always be an integral part of their treatment, to help them re-integrate in the aesthetic conscious society. Rehabilitating such patients require a multidisciplinary approach involving the combined and timely efforts of an ophthalmologist, paediatric oncologist and a skilled maxillofacial prosthodontist. This paper presents a case of 3½-year-old girl who had enucleation of her right eye due to retinoblastoma along with chemotherapy and radiotherapy at the age of 3 years. The patient was recalled regularly for follow-up at 3 month intervals for ophthalmic examinations and she was rehabilitated cosmetically with customised ocular prosthesis during the various stages of her developmental growth.
  3,974 101 -
LETTERS TO EDITOR
Hypokalemia- induced myopathy and massive creatine kinase elevation as first manifestation of Conn's syndrome
Serdar Olt, Selcuk Yaylaci, Lacin Tatli, Yasemin Gunduz, Tayfun Garip, Ali Tamer
July-August 2013, 54(4):283-284
DOI:10.4103/0300-1652.119658  PMID:24249961
  3,675 121 -
Single transducer technique: A novel and cost effective approach
Sachidanand Jee Bharati, Tumul Chowdhury
July-August 2013, 54(4):285-285
DOI:10.4103/0300-1652.119660  PMID:24249962
  3,677 68 -
Leucocytoclastic vasculitis: A complication after streptokinase therapy for acute myocardial infarction
Manisha Makkar, Neha Garg, Nek Chand Mahajan
July-August 2013, 54(4):286-287
DOI:10.4103/0300-1652.119663  PMID:24249963
  3,214 96 -
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