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   2014| March-April  | Volume 55 | Issue 2  
    Online since March 31, 2014

 
 
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ORIGINAL ARTICLES
Perception of quality of maternal healthcare services among women utilising antenatal services in selected primary health facilities in Anambra State, Southeast Nigeria
Obiageli F Emelumadu, Ugochukwu Uchenna Onyeonoro, Andrew Ugwunna Ukegbu, Nkiru N Ezeama, Chigozie Ozoemena Ifeadike, Obasi Kanu Okezie
March-April 2014, 55(2):148-155
DOI:10.4103/0300-1652.129653  PMID:24791050
Background: This is a cross-sectional descriptive study aimed at assessing antenatal care service attendees' perception of quality of maternal healthcare (MHC) services in Anambra State, southeast Nigeria. Materials and Methods: A total of 310 pregnant women utilising antenatal care (ANC) services in three purposively selected primary health centres (PHCs) in rural communities in Anambra State were studied. Reponses were elicited from the participants selected consecutively over a 4-month period, using a pre-tested, semi-structured interviewer-administered questionnaire on socio-demographic characteristics, utilisation and perception of MHC services. Data collected were analysed using SPSS version 17. Results: Findings showed that utilisation of facility for both antenatal (97.0%; 95% CI, 94.4-98.4%) and natal services (92.7%; 95% CI 89.2-95.2%) were quite high. Generally, most of the women were satisfied with MHC services (89.7%). Most of them were satisfied with the staff attitude (85.1%), waiting time (84.1%) and cost of services (79.5%). Being ≥30 years (X2 = 4.61, P = 0.032), married (X2 = 9.70, P = 0.008) and multiparous (X 2 = 9.14, P = 0.028), as well as utilisation of formal health facility for antenatal (X2 = 26.94, P = 0.000) and natal (X2 = 33.42, P = 0.000) services were associated with satisfaction with maternal health services. Conclusions: The study showed high level of satisfaction with quality of maternal health services among antenatal attendees and highlights the need to strengthen interventions that increase uptake of formal MHC services.
  13,350 301 25
Study of proportion and determinants of depression among college students in Mangalore city
Sarah Naushad, Waseem Farooqui, Satish Sharma, Mukthi Rani, Rajashree Singh, Supreet Verma
March-April 2014, 55(2):156-160
DOI:10.4103/0300-1652.129657  PMID:24791051
Background: Onset of depression is occurring earlier in life today than in past decades. Adolescence being transitional period from childhood to adulthood is a stage of emotional instability resulting from demand for separation and independence. Evidence suggests that early intervention for depression in children can improve long-term outcomes. Materials and Methods: This cross-sectional study was done in January 2010 to find out the prevalence of depression among pre university students in Mangalore city. Prevalence of depression was assessed using Beck's Depression Inventory II. Data was collected using a self-administered questionnaire. Results: Out of 308 participants, depression was seen among 79.2% students. A majority (41.2%) were found to be suffering from moderate followed by mild (26.6%) depression. Prevalence of depression (P = 0.027) and severity of depression (P = 0.0357) was found to significantly increase with age of the participants. Students of commerce were found to be significantly more depressed than students of science stream (P = 0.002). No association of depression with gender of participants or with the type of college they were studying in was observed. Conclusion: There is a need for college students to be educated about depression in order to improve recognition and diagnosis. Also student counselling service offering mental health assistance needs to be established at colleges.
  10,169 167 11
Allergic conjunctivitis in Jos-Nigeria
Keziah N Malu
March-April 2014, 55(2):166-170
DOI:10.4103/0300-1652.129664  PMID:24791053
Background: Allergic conjunctivitis (AC) may follow seasonal or perennial pattern. There are climatic and racial risk factors involved in some types of AC. It is more prevalent in warm climatic conditions and among Afro-Caribbeans, Arabs and Asians and less among the White populations. Clinical presentations also seem to follow climatic and genetic predisposition. The purpose of this study is to determine the prevalence of AC and its clinical presentations in a hospital setting in this region in people of all ages. Materials and Methods: This is a hospital-based retrospective study of new patients seen at Adoose Specialist Hospital, Jos the capital city of Plateau State in North Central Nigeria with clinical diagnosis of AC from 2000 to 2009. Results: There were 972 subjects, 474 (48.8%) males and 498 (51.2%) females with M:F ratio of 1:1.05. The most common symptom was itching followed by redness, pains, watery/mucoid discharge, sticky eyes, puffy eyes and photophobia. The presence of papillae in the upper tarsal or lower conjunctiva, a discrete or confluent gelatinous hypertrophy of the limbal conjunctiva (Trantas dots), hyperpigmentation, hyperemia/chemosis of the conjunctiva were the common signs. AC was more prevalent in those aged 1−16 years 38.4% decreasing to 4.9% in the age group above 50 years. The presentation followed perennial pattern, with a peak around July. The most prevalent ocular comorbid condition was refractive error (distant RE and presbyopia) in 15.4%, followed by pterygium/pinguecula 3.6%, bacterial conjunctivitis in 2.2%, glaucoma 2.1% and eyelid disorders 1.7%. Cataract was present in1.3%, and keratopathy1.1%. Other conditions such as episcleritis, dry eye, vitamin A deficiency and posterior segment disease were also present in decreasing order. Systemic association were few with generalised body atopy in 0.3%. Conclusion: The prevalence of AC was 32% and is similar to what pertains in some of the African hospital studies, but differs in presentation from the Caucasians.
  9,384 202 24
REVIEW ARTICLE
Kidney injury, fluid, electrolyte and acid-base abnormalities in alcoholics
Adebayo Adewale, Onyekachi Ifudu
March-April 2014, 55(2):93-98
DOI:10.4103/0300-1652.129631  PMID:24791039
In the 21 st century, alcoholism and the consequences of ethyl alcohol abuse are major public health concerns in the United States, affecting approximately 14 million people. Pertinent to the global impact of alcoholism is the World Health Organisation estimate that 140 million people worldwide suffer from alcohol dependence. Alcoholism and alcohol abuse are the third leading causes of preventable death in the United States. Alcohol dependence and alcohol abuse cost the United State an estimated US$220 billion in 2005, eclipsing the expense associated with cancer (US$196 billion) or obesity (US$133 billion). Orally ingested ethyl alcohol is absorbed rapidly without chemical change from the stomach and intestine, reaching maximum blood concentration in about an hour. Alcohol crosses capillary membranes by simple diffusion, affecting almost every organ system in the body by impacting a wide range of cellular functions. Alcohol causes metabolic derangements either directly, via its chemical by-product or secondarily through alcohol-induced disorders. Many of these alcohol-related metabolic disturbances are increased in severity by the malnutrition that is common in those with chronic alcoholism. This review focuses on the acute and chronic injurious consequences of alcohol ingestion on the kidney, as well as the fluid, electrolyte and acid-base abnormalities associated with acute and chronic ingestion of alcohol.
  7,747 365 19
ORIGINAL ARTICLES
An audit of paediatric mortality patterns in a Nigerian teaching hospital
Gerald Dafe Forae, Obiora Jude Uchendu, Alex Payim Igbe
March-April 2014, 55(2):130-133
DOI:10.4103/0300-1652.129644  PMID:24791046
Background: The 4 th millennium development goals (2002) reported that sub-Saharan Africa countries including Nigeria have a persistently high childhood mortality rates in-spite of all the preventive and interventional measures to reduce this ugly trend. Patients and Methods: Childhood mortality data was obtained from the medical records department and post-mortem records of the pathology departments over a 5-year period from January 2007 to December 2011. The selection criteria include all case notes with mortality records involving children admitted into the paediatrics department through the labour ward and the obstetrics theater, children emergency unit (CHER), paediatric out-patient clinic. Results : A total of 12,442 children were admitted during this period. Of this, 711 paediatric deaths were documented accounting for 17.5%. The male to female mortality ratio was 1.4:1. The age range was from birth to 17 years. Neonatal deaths accounted for the most common cause of death constituting 344 (48.4%) of all deaths. Among the neonatal mortality patterns, severe birth asphyxia/perinatal asphyxia was the most common cause of early neonatal deaths accounting for 97 (28.2%). Septicaemia accounted for the most frequent cause of infant mortality accounting for 28 (21.8%). Among the under-5 age group, severe malaria constituted the most common cause of death accounting for 52 (36.6%) cases while malignancy topped the list of 5-17 years mortality rate constituting 15 (15.4%) cases. Conclusion: Perinatal and neonatal deaths constitute the vast majority of death in our environment with most of the deaths resulting from severe birth asphyxias, prematurity. Again in the post-neonatal period, infections and other preventable diseases constitute the most common cause of death in children of under age group of five years. Above 5 years childhood malignancies constitutes the highest mortality pattern.
  7,285 175 8
A comparison of Simplified Acute Physiology Score II, Acute Physiology and Chronic Health Evaluation II and Acute Physiology and Chronic Health Evaluation III scoring system in predicting mortality and length of stay at surgical intensive care unit
Mahryar Taghavi Gilani, Majid Razavi, Azadeh Mokhtari Azad
March-April 2014, 55(2):144-147
DOI:10.4103/0300-1652.129651  PMID:24791049
Background: In critically ill patients, several scoring systems have been developed over the last three decades. The Acute Physiology and Chronic Health Evaluation (APACHE) and the Simplified Acute Physiology Score (SAPS) are the most widely used scoring systems in the intensive care unit (ICU). The aim of this study was to assess the prognostic accuracy of SAPS II and APACHE II and APACHE III scoring systems in predicting short-term hospital mortality of surgical ICU patients. Materials and Methods: Prospectively collected data from 202 patients admitted to Mashhad University Hospital postoperative ICU were analyzed. Calibration was estimated using the Hosmer-Lemeshow goodness-of-fit test. Discrimination was evaluated by using the receiver operating characteristic (ROC) curves and area under a ROC curve (AUC). Result: Two hundred and two patients admitted on post-surgical ICU were evaluated. The mean SAPS II, APACHE II, and APACHE III scores for survivors were found to be significantly lower than of non-survivors. The calibration was best for APACHE II score. Discrimination was excellent for APACHE II (AUC: 0.828) score and acceptable for APACHE III (AUC: 0.782) and SAPS II (AUC: 0.778) scores. Conclusion: APACHE II provided better discrimination than APACHE III and SAPS II calibration was good at APACHE II and poor at APACHE III and SAPS II. Use of APACHE II was excellent in this post-surgical ICU.
  6,843 202 30
Prevalence of pulmonary hypertension in sickle cell anaemia patients of a tertiary hospital in Nigeria
Adedoyin O Dosunmu, Taiwo M Balogun, Olufunke O Adeyeye, Folashade A Daniel, Rachael A Akinola, Josephine A Josephine, Akinsegun A Akinbami, Aba O Sagoe, Babatunde O Onadeko
March-April 2014, 55(2):161-165
DOI:10.4103/0300-1652.129661  PMID:24791052
Background: Sickle cell disease (SCD) is an inherited haemoglobinopathy characterised by recurrent organ hypoxia-reperfusion cycles which may result in repeated organ damage including the lungs and heart. In SCD, pulmonary hypertension is a known complication that may precede or complicate acute chest syndrome which is often fatal. This study seeks to know the prevalence of pulmonary hypertension and its relationship with clinical and laboratory parameters in sickle cell disease patients attending a tertiary hospital in Lagos. Materials and Methods: This was a case - control study involving patients with sickle cell disease recruited from adult sickle cell clinic of Lagos State University Teaching Hospital, Ikeja and HbAA controls matched for age and sex from a tertiary educational institution in Lagos. Both the patients and controls were subjected to echocardiography and pulmonary hypertension was deduced from their cardiac tricuspid regurgitant jet velocity. Other parameters measured were age, body mass index, full blood count, red cell indices, foetal haemoglobin, chest X-ray, liver function tests, lactate dehydrogenase and pulmonary function tests. Consenting patients were 56 HbSS in steady state and 28 HbAA controls matched for age and sex. Data was analysed using SPSS version 16.0. Results: The mean age of patients was 22 ± 6 years. In two 2 of 56 (3.6%) of the participants with sickle cell disease, the pulmonary artery pressure was > 25mmHg and there was significant difference in the mean of the pulmonary artery pressure of the control and that of the patients (P-value 0.013). Also, using the appropriate correlation tests, there was significant relationship between the pulmonary artery pressure and lactate dehydrogenase, aspartate transferase and haematocrit in patients with sickle cell disease. Conclusion: Sickle cell disease is an independent cause of pulmonary artery hypertension. Variation in cardiovascular reactions to recurrent hyperhaemolysis and hyperdynamic state in sickle cell disease may explain differences in the development of cardiac complications. Exploration of these reactions may reveal other therapeutic measures to prevent complications in sickle cell disease. Clinical assessment of adult patients with sickle cell disease should include echocardiography.
  6,699 198 14
SYMPOSIUM
Biomedical techniques in translational studies: The journey so far
Imran Haruna Abdulkareem
March-April 2014, 55(2):99-105
DOI:10.4103/0300-1652.129634  PMID:24791040
Biomedical techniques have wide clinical application in many fields of medicine such as oncology, rheumatology, immunology, genomics, cardiology and diagnostics; among others. This has been made possible with the use of genetic engineering and a number of techniques like Immunohistochemistry (IHC), Fluorescent Microscopy, Cell Culture, Genetically Modified (GM) Cells, Monoclonal Antibodies (MAbs), Polymerase Chain Reaction (PCR) and Western blotting. The aim of this literature review is to explore the foundations and bases of the commonly used biomedical techniques, as well as their applications in biomedical research and clinical medicine in general. This review also aims to shed some light on more recent advances in genetic engineering, especially in relation to genetically modified cells and use of monoclonal antibodies which have found more increasing use and relevance in genomics, oncology, rheumatology, immunology, cardiology as well as diagnostics, and have revolutionised patient care, while at the same time resulting in improved standard of health care. Unfortunately, some of these new techniques are associated with unwanted side effects which may pose a risk to the people they are actually intended for. Therefore, there is need for strict regulations and guidelines to control the use and implementation of some of these novel techniques.
  6,020 209 -
ORIGINAL ARTICLES
A survey on doctors' knowledge and attitude of treating chronic pain in three tertiary hospitals in Nigeria
Emmanuel O Sanya, Philip M Kolo, Muhammadu A Makusidi
March-April 2014, 55(2):106-110
DOI:10.4103/0300-1652.129635  PMID:24791041
Background: Chronic non-cancer pain (CP) is one of the most common complaints that bring patients to the hospital. When pain persists, people move from doctor-to-doctor seeking for help, thus the burden of CP is huge. This study, therefore was aimed at assessing attitude and knowledge of doctors in three teaching hospitals in Nigeria to CP. Materials and Methods: Structured questionnaire was administered to doctors practicing at the University of Ilorin Teaching Hospital, Usmanu Danfodio University Teaching Hospital and University of Maiduguri Teaching Hospital. Responses were graded on maximum scale of five. Results: Of the 410 doctors who participated in study, 79.7% were men. Their years of practice varied from 1 year to 20 years (mean SD = 4.5 ± 1.7 years). Close to 58% of participants were resident doctors, 36.4% medical officers and 8.6% consultants. Only 23.3% of participants had basic medical or postgraduate training on pain management. The physicians' mean goal of treating CP in patients was 3.7 ± 1.1, compared to 4.0 ± 1.1 in close relative and 4.1 ± 0.9 for doctors'-self pain. Only 9.5% of doctors use opioids for CP compared to 73% who use Nonsteroidal anti-inflammatory drugs (NSAIDs). Few doctors (23%) use ≥2 drugs to treat CP. Doctors were indifferent on the appropriateness of patients with CP to request for additional analgesics (mean score = 3.1 + 1.4). Doctors' self-rated knowledge of CP was 1.8 ± 0.7 compared to 4.1 ± 0.9 for acute and 0.8 ± 0.3 for cancer pains (P = 0. 003). Conclusion: Incorporation of pain management into continuing medical education could help improve observed deficiency in doctors' knowledge of pain treatment which resulted from lack of basic medical education on pain.
  5,813 188 -
The effect of new emergency program on patient length of stay in a teaching hospital emergency department of Tehran
Z Talleshi, SM Hosseininejad, Goli Khatir, F Bozorghi, AM Heidari Gorji, MA Heidari Gorji
March-April 2014, 55(2):134-138
DOI:10.4103/0300-1652.129645  PMID:24791047
Background and Aim: Ideally, the period of patients admitting in the Emergency Department (ED) should not exceed 6 hours. Prolonged of the patients admitting time affects the ED overcrowding, quality of patient care and patient satisfaction. To evaluate the efficacy of new programs and suggest new strategies to reduce the overcrowding in a typical overcrowded ED of general teaching hospital in Tehran city. Materials and Methods: In this descriptive case study, charts of patients held over 24 hours, in Imam Hossein Hospital affiliated to the Shaheed Beheshti Medical University, were reviewed from April 21 rd on August 23 rd , 2008. Results: Of 15,477 patients, 151 (1%) have been held in the ED over 24 hours. Reasons for this long-stay included:lack of available bed in Intensive Care Unit (ICU) (125 patients), lack of available bed in related wards (18 patients), poor final decision - making by physician (eight patient) Conclusion: Long-term stay of patients in ED of teaching hospital is a major problem. The most frequent cause is a limitation of inpatient beds. The long stay time had not been affected by paraclinic procedures, multispecialities involvement or the lack of obvious diagnosis. The following solution is proposed: (1) creation of a holding unit, (2) active inter-facility transfer and (3) governing admittance of patients who need ICU care to related wards.
  5,735 157 4
Primary hip spica with crossed retrograde intramedullary rush pins for the management of diaphyseal femur fractures in children: A prospective, randomized study
Mohammad Ruhullah, HR Singh, Sanjay Shah, Dipak Shrestha
March-April 2014, 55(2):111-115
DOI:10.4103/0300-1652.129638  PMID:24791042
Background: Femoral fractures are common in children aged between 2 and 12 yearsand 75% of the lesions affect the femoral shaft. Traction followed by a plaster cast is universally accepted as a conservative treatment. We compared primary hip spica or traction followed by hip spica with closed reduction and fixation with retrogradely passed crossed Rush pins for diaphyseal femur fracture in 25 children of the age group 3-12 years, randomly distributed in each group. Materials and Methods: Fifty children (age: 3-13 years, mean; 9 years) with femoral fractures were evaluated; 25 of them underwent the conservative treatment using immediate hip spica (group A) and 25 underwent treatment with crossed retrograde Rush pins (group B). Results: Mean duration of fracture union was within 15 weeks in group A and 12 weeks in group B. Mean duration of weight bearing was 14weeks in group A and 7 weeks in group A. Mean hospital stay were 4 days in group A and 8days in group B. The man follow-up period was 16 months in group A and 17 months in group B. Complications like angulation, shortening and infection were compared. Bursitis and penetration of pins at the site of Rush pin insertion is a complication associated with this method of treatment. Conclusion: Closed reduction and internal fixation with crossed Rush pins was a superior treatment method in terms of early weight bearing and restoration of normal anatomy.
  5,577 145 4
Cluster of differentiation 4+ cell count mean value, reference range and its influencing factors in Human Immunodeficiency Virus-seronegative pregnant women in Lagos
AA Akinbami, AO Dosunmu, A Adediran, AA Adewunmi, KA Rabiu, V Osunkalu, S Ajibola, EI Uche, A Adelekan
March-April 2014, 55(2):116-120
DOI:10.4103/0300-1652.129640  PMID:24791043
Background: Immunity in pregnancy is physiologically compromised and this may affect cluster of differentiation four (CD4) count levels. It is well established that several factors affect CD4 count level in pregnancy. This study aims to determine the effects of maternal age, gestational age, parity and level of education as they influence CD4 count in pregnancy and also to determine the mean and reference range of CD4 count in pregnancy in Lagos, Nigeria. Materials and Methods: A descriptive cross-sectional study was carried out at Ante-natal clinics in Lagos State, Nigeria. About 5 mls of blood was collected into Ethylene Diamine Tetracetic Acid (EDTA) bottles from HIV-negative pregnant women in various gestational ages of pregnancy. CD4+ cell count and full blood count of all samples were done within 3 hours of collection. The descriptive data was given as means ± standard deviation (SD). Pearson's chi-squared test and correlation were used for analytical assessment. Results: A total of 74 pregnant women were recruited. The age range was 19-41 years and a mean age of 30.42 ± 5.34 years. The CD4+ cell count was not statistically significant when compared with participants ages P = 0.417, neither with gestational ages P = 0.323, nor with parity P = 0.247 nor level of education P = 0.96. An overall mean CD4+ cell count was 771.96 ± 250 cells/μl and the range was 193-1370 cells/μl. Conclusion: Maternal age, gestational age, parity and level of education had no significant effects on CD4+ cell count levels in pregnancy. The mean CD4+ cell count of HIV-negative pregnant women in Lagos is 771.96 ± 250 cells/μl.
  5,200 147 1
Long-term smoking results in haemostatic dysfunction in chronic smokers
Soronnadi Clara Ngozi, Neboh Emeka Ernest
March-April 2014, 55(2):121-125
DOI:10.4103/0300-1652.129641  PMID:24791044
Background: Smoking has been known to cause endothelial dysfunction and bronchial carcinoma and duration of smoking has been implicated in the effects of smoking on regular smokers. This study evaluated the effects of long-term smoking on some coagulation markers in chronic smokers. Materials and Methods: A total of 78 chronic smokers (age, 41 ± 20 years) where grouped according to duration of time they have smoked (2-6 years, 7-11 years, 12-16 years and 17-21 years), and included in the study. Bleeding time (BT), whole-blood clotting time (WBCT), total platelet count (TPC), prothrombin time (PT) and activated partial thromboplastin time with kaolin (APTTK) were estimated in the subjects using standard operative procedures. Statistical Analysis used: Graph pad prism software (Statmate) version 2.0 and SPSS version 20.0 were used for the statistical analysis and the test of significance was calculated using paired Student's t-test. Results: There was an inverse correlation between the durations of smoking and BT, WBCT, PT and APTTK coagulation markers and a linear correlation between the different durations and TPC, in the chronic smokers. The strongest effects was in the 12-16 years and 17-21 years duration (P < 0.05). Conclusion: The study revealed that long-term chronic cigarette-smoking can lead to haemostatic dysfunction in chronic smokers. Smoking should be generally discouraged as it could have far-reaching medical implications on this group of subjects, especially in bleeding emergency cases.
  5,108 164 4
CASE REPORTS
A case report of complete mole with co-existent exaggerated placental site reaction and review of the literature
Ozhan Ozdemir, Mustafa Erkan Sari, Vefa Selimova, Bunyamin Ugur Ilgin, Cemal Resat Atalay
March-April 2014, 55(2):180-182
DOI:10.4103/0300-1652.129670  PMID:24791057
Exaggerated placental site (EPS) is defined as a non-neoplastic trophoblastic lesion, which intermediate trophoblasts infiltrate exaggeratedly into endometrium and myometrium. These lesions may occur following normal pregnancy, ectopic pregnancy, abortus or molar pregnancy. Herein we share a case of EPS detected after evacuation due to molar pregnancy. We also review the related literature, where only a few reports exist describing the clinical course, histopathology and differential diagnosis of EPS.
  5,045 159 3
Disseminated intravascular coagulation in malaria: A case report
Laltanpuii Sailo, Debasis Pradhan, Rakesh Nongthombam, Prithwis Bhattacharyya
March-April 2014, 55(2):171-172
DOI:10.4103/0300-1652.129665  PMID:24791054
Disseminated intravascular coagulation (DIC) is seen in <5% of patients with severe Plasmodium falciparum malaria and is more common in cerebral malaria. Here, we report the diagnosis and management of a case of severe P. falciparum malaria with DIC.
  5,030 141 5
ORIGINAL ARTICLES
Gestational thrombocytopaenia among pregnant women in Lagos, Nigeria
Sarah Oluwatayo Ajibola, Akinsegun Akinbami, Kabiru Rabiu, Adeniyi Adewunmi, Adedoyin Dosunmu, Adediran Adewumi, Bodunrin Osikomaiya, Kamal Ismail
March-April 2014, 55(2):139-143
DOI:10.4103/0300-1652.129647  PMID:24791048
Background: Thrombocytopaenia is a common haematologic abnormality during pregnancy. Pregnant women with thrombocytopenia have a higher risk of bleeding excessively during or after childbirth, particularly if they need to have a caesarean section or other surgical intervention during pregnancy, labour or in the puperium. The aim of this study was to determine the prevalence of gestational thrombocytopaenia among pregnant women reporting for antenatal care at tertiary health care centres in Lagos. Materials and Methods: Platelet count was analyzed in 274 consecutive pregnant women who gave informed consent and 70 non-pregnant female staff of the hospitals. Platelet count was performed on each sample using the Sysmex KN-21N automated haematology analyzer. The study design was cross-sectional, proportions were analyzed for statistical significance with the chi-square, and Odds ratio was also calculated. Thrombocytopaenia is classically defined as a platelet count of less than 150 × 10 [9] /L. [3],[4] Counts from 100 to 150 × 10 [9] /L are considered mildly depressed, 50 to 100 × 10 [9] /L are moderately depressed and less than 50 × 10 [9] /L are severely depressed. Results: Thirty-four (13.5%) pregnant women were thrombocytopaenic compared with three (4.3%) non-pregnant women. This was statistically significant; P = 0.03; Odds ratio: 3.5 (95% CI 1.03-11.82). Out of the 37 pregnant women who were thrombocytopaenic, most of them (78%) had mild thrombocytopenia, only 6% had severe thrombocytopaenia. Conclusion: The prevalence of gestational thrombocytopaenia in this study was 13.5%. Although majority of the pregnant women had mild thrombocytopaenia, healthcare providers should screen all pregnant women routinely for thrombocytopaenia to avoid excessive bleeding during or after childbirth.
  5,002 144 6
Atrial septal defects: Pattern, clinical profile, surgical techniques and outcome at Innova heart hospital: A 4-year review
Daberechi K Adiele, Josephat M Chinawa, Ijeoma O Arodiwe, V Gouthami, KS Murthy, John C Eze, Egbuna O Obidike, Fortune A Ujunwa
March-April 2014, 55(2):126-129
DOI:10.4103/0300-1652.129642  PMID:24791045
Background: Atrial septal defect (ASD) is a congenital heart defect that leads to shunting of blood between left and right atria. It may be asymptomatic and sometimes may present with heart failure. Surgical repair is definitive, but currently non-surgical procedure is used to close the defect. Materials and Methods: It is a retrospective study of patients who underwent transcatheter closure of ASD at Innova Heart Hospital, Hyderabad, India. Echocardiography was repeated at intervals of 24 hours, then at 1, 3 and 6 months after the procedure to assess complications. The morphological characteristics of the ASD, including its diameter, location, shape and the width of surrounding septal margins, were also evaluated. Results: From April 2007 to June 2011, 69 consecutive children (29 males, 40 females) with a median age of 9.0 years (range = 3.2-19 years) registered with diagnosis of ASD. The median weight was 31.5 kg (range = 7.5-39.0 kg). Five patients (7.2%) were young children aged 3-5 years. Forty-four (63.8%) of these children presented with symptoms of heart failure, whereas 47 (68.1%) of the cases repaired with device were large-sized ASD. The most common interventional procedures done were Searcare Heart® and Amplatzer® technique with a highest success rate obtained in 2010. Conclusions: ASD is a common congenital heart disease with a high success rate for those who undergo intervention.
  4,835 162 3
CASE REPORTS
Dyskeratosis congenita in a Nigerian boy
Aliyu Ibrahim, Kabir Halima
March-April 2014, 55(2):173-175
DOI:10.4103/0300-1652.129667  PMID:24791055
Dyskeratosis congenita is a rare hereditary disease. It mainly affects males and manifest between 5 years and 12 years. Its classic manifestation consists of skin pigmentary changes, nail dystrophy, oral leukoplakia, bone marrow failure and predisposition to malignany. We report the case of a 9-year-old boy who presented with hyperpigmentation of the skin, palms and soles, leukoplakia of the tongue, dystrophy of the nails, epiphoria and recurrent epistaxis with gum bleeding. Full blood count showed pancytopenia and bone marrow biopsy showed hypocellular marrow with no abnormal cells. He was transfused with pack red blood cells, platelets concentrate and was commenced on co-trimoxazole prophylaxis and anabolic steroid. He is currently on follow-up in the paediatric clinic.
  4,633 109 2
The 8p12 myeloproliferative syndrome
O John-Olabode Sarah, A Oyekunle Anthony, A Adeyemo Titilope, S Akanmu Alani
March-April 2014, 55(2):176-179
DOI:10.4103/0300-1652.129669  PMID:24791056
The occurrence of a myeloproliferative disorder in association with an aggressive lymphoproliferative disorder is a distinctly unusual phenomenon. We report a case of concurrent leukaemia-lymphoma syndrome characterized by a BCR/ABL-negative myeloproliferative disease, eosinophilia and a lymphoma. The bone marrow chromosome analysis showed the karyotype 46, XY, t(8;9) (q12; p33), which indicated presence of FGFR1 gene translocations. 8p12 myeloproliferative syndrome (EMS) / stem cell leukaemia-lymphoma syndrome (SCLL) belongs to the tyrosine kinase fusion genes chronic myeloproliferative diseases. The patient was managed conservatively with hydroxyurea, allopurinol and blood component therapy. The patient eventually died of intracerebral haemorrhage due to severe thrombocytopaenia. Based on our experience the overlap in the clinical presentation of this disease with lymphomas, can lead to a delay in diagnosis of EMS/SCLL. Given the aggressive nature of this disease, an accurate clinical and molecular diagnosis of this entity has become increasingly important.
  4,606 96 3
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