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   2016| May-June  | Volume 57 | Issue 3  
    Online since June 15, 2016

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Typhoid fever in a Tertiary Hospital in Nigeria: Another look at the Widal agglutination test as a preferred option for diagnosis
Osahon Enabulele, Simeon Nyemike Awunor
May-June 2016, 57(3):145-149
DOI:10.4103/0300-1652.184057  PMID:27397952
Background: Single Widal agglutination test rather than blood culture, is commonly employed to diagnose typhoid fever in Nigeria. We took another look at the Widal agglutination test as a preferred option for diagnosis of typhoid fever by determining the specificity and sensitivity of Widal agglutination test in febrile adult patients. Materials and Methods: Two hundred and seventy-one blood samples from consecutive adults (>18 years) with febrile illness attending the General Practice Clinic of the University of Benin Teaching Hospital were tested using the Widal agglutination test, blood culture, and malaria parasite test on each sample to establish the diagnosis of typhoid fever. Results: Of the 271 blood samples 124 (45.76%) were positive following a Widal agglutination test, 60 (22.10%) blood samples grew Salmonella organisms on blood culture while 55 (20.29%) blood samples showed a co-infection of typhoid fever and malaria. A sensitivity of 35%, specificity of 51%, positive predictive value of 17%, and a negative predictive value of 73% were observed for Widal agglutination test as a diagnostic modality for typhoid fever infection. Conclusion: A single Widal agglutination test is not a valid diagnostic option for typhoid fever while co-infection with malaria parasite is the preponderant microbiological finding in typhoid fever infections. The severity of malaria parasitemia is associated with positive titers on Widal test.
  15,401 38 3
An assessment of hand hygiene practices of healthcare workers of a semi-urban teaching hospital using the five moments of hand hygiene
Emmanuel Olushola Shobowale, Benjamin Adegunle, Ken Onyedibe
May-June 2016, 57(3):150-154
DOI:10.4103/0300-1652.184058  PMID:27397953
Background: Hand hygiene has been described as the cornerstone and starting point in all infection control programs, with the hands of healthcare staff being the drivers and promoters of infection in critically ill patients. The objectives of this study were to access healthcare workers compliance with the World Health Organization (WHO) prescribed five moments of hand hygiene as it relates to patient care and to determine the various strata of healthcare workers who are in default of such prescribed practices. Methods: The study was an observational, cross-sectional one. Hand hygiene compliance was monitored using the hand hygiene observation tool developed by the WHO. A nonidentified observer was used for monitoring compliance with hand hygiene. The observational period was over a 60-day period from August 2015 to October 2015. Results: One hundred and seventy-six observations were recorded from healthcare personnel. The highest number of observations were seen in surgery, n = 40. The following were found to be in noncompliance before patient contact - anesthetist P = 0.00 and the Intensive Care Unit P = 0.00 while compliance was seen with senior nurses (certified registered nurse anesthetist [CRNA]) P = 0.04. Concerning hand hygiene after the removal of gloves, the following were areas of noncompliance - the emergency room P = 0.00, CRNA P = 0.00, dental P = 0.04, and compliance was seen with surgery P = 0.01. With regards to compliance after touching the patient, areas of noncompliance were the anesthetists P = 0.00, as opposed to CRNA P = 0.00, dental P = 0.00, and Medicine Department P = 0.02 that were compliant. Overall, the rates of compliance to hand hygiene were low. Discussion: The findings however from our study show that the rates of compliance in our local center are still low. The reasons for this could include lack of an educational program on hand hygiene; unfortunately, healthcare workers in developing settings such as ours regard such programs as being mundane. Conclusion: The observance of hand hygiene is still low in our local environment. Handwashing practices in our study show that healthcare workers pay attention to hand hygiene when it appears there is a direct observable threat to their wellbeing. Educational programs need to be developed to address the issue of poor hand hygiene.
  10,555 34 13
Chronic kidney disease in Nigeria: Late presentation is still the norm
Oluseyi A Adejumo, Ayodeji A Akinbodewa, Enajite I Okaka, Oladimeji E Alli, Ifedayo F Ibukun
May-June 2016, 57(3):185-189
DOI:10.4103/0300-1652.184072  PMID:27397961
Background: Chronic kidney disease (CKD) has become a public health problem in Nigeria. Efforts are being geared toward early diagnosis and prevention of CKD. This study involved the evaluation of the referral pattern and mode of presentation of CKD patients at first contact in a tertiary health institution. Patients and Methods: Patients' records over an 18 month period were retrieved and the following information extracted: Sociodemographic data, referral hospital, mode of presentation, etiology of CKD, packed cell volume, blood pressure, and estimated glomerular filtration rate (GFR) at first presentation. Results: There were 202 CKD patients with a male: female ratio of 1.7:1 and a mean age of 48.15 ± 16.69 years. The median estimated GFR of the patients at presentation was 3.17 ml/min/1.73 m [2] . The common etiologies of CKD were chronic glomerulonephritis, hypertension, diabetes mellitus, obstructive nephropathy in 69 (34.2%), 47 (23.3%), 38 (18.8%), and 21 (10.4%) respectively. Among these patients, 111 (55%) and 98 (48.6%) had moderate to severe hypertension and anemia, respectively, 173 (85.6%) presented in CKD Stage 5, 101 (50%) required urgent hemodialysis whereas 123 (60.9%) required in-hospital admission. Only (18) 9% of these CKD patients presented by self-referral while (103) 51% were referred from secondary and private health facilities. Conclusion: Most Nigerian CKD patients still present very late to nephrologists implying that the present preventive strategies have not yielded desired results. Early diagnosis and referral of CKD patients could be better achieved through regular education of the public and retraining of health workers especially those in primary and secondary health institutions.
  7,124 33 5
Effect of olive oil massage on weight gain in preterm infants: A randomized controlled clinical trial
Mahnaz Jabraeile, Alehe Seyyed Rasooly, Mahni Rahkar Farshi, Jamileh Malakouti
May-June 2016, 57(3):160-163
DOI:10.4103/0300-1652.184060  PMID:27397955
Background: Despite the fact that effect of massage with or without oil on the baby's weight gain is not clear, but recent studies have shown that massage with essential oils make lipid absorption through the skin. The aim of this study was to evaluate the effect of olive oil massage on weight gain in preterm infants. Materials and Methods: This study was a single-blind, randomized controlled clinical trial. In this study, infants who met inclusion criteria for the study were divided into two groups by using random numbers table. Newborns in intervention group were under massage for 10 days and 3 times for 15 min daily; the mother of these newborns had been trained already using olive oil. Moreover, the infants of the control group were under massaging without oil same as the above-mentioned method. Researchers weighed babies daily during 10 days and recorded it at the checklist. Data from the study were reviewed and analyzed by descriptive statistics and repeated measure test using the statistical software SPSS/13. Results: This study showed that the neonatal weight gain in the infants with the oil massage was 21 g daily in average, whereas the increase in infant massage without oil was 7 g. This difference was statistically significant (P < 0.001). Conclusion: Considering the positive effect of infant massage on weight gain in premature infants with olive oil, it is recommended that nurses use oil in infant massage in the neonatal units.
  5,921 45 11
An assessment of serum prolactin levels among infertile women with galactorrhea attending a gynecological clinic North-West Nigeria
Emmanuel Ajuluchukwu Ugwa, Adewale Olufemi Ashimi, Mohammed Yusuf Abubakar, Idris Usman Takai, Okunade Taiwo Lukman, Hamzah Abdurrahman Lawal, Muhammed Abubakar Also, Amadi Ngozi Gift, Halimat Muhammed Kiri
May-June 2016, 57(3):178-181
DOI:10.4103/0300-1652.184068  PMID:27397959
Background: Galactorrhea is a common manifestation of hyperprolactinemia but may not always be present in women with hyperprolactinemia. This study was, therefore, undertaken to assess the serum prolactin levels of infertile women presenting with galactorrhea and to determine the prevalence of hyperprolactinemia among them. Materials and Methods: This was a retrospective study of serum prolactin levels of 63 female partners of infertile couples attending the gynecological clinic of Federal Medical Centre, Birnin Kudu, Jigawa State, Nigeria, who were found to have galactorrhea from January 1, 2012, to December 31, 2013. Ethical clearance was obtained. Solid phase enzyme-linked immunosorbent assay was used to measure serum prolactin. Sociodemographic characteristics were determined. The data obtained were analyzed using SPSS version 17.0 statistical software. Absolute numbers and simple percentages were used to describe categorical variables. Similarly, quantitative variables were described using measures of central tendency (mean, median) and measures of dispersion (range, standard deviation) as appropriate. Results: The average age of the women was 27.9 ± 5.6 years. In half of the cases (50%), galactorrhea was associated with menstrual disturbances, mainly amenorrhea (23.3%). Although most (63.3%) of the clients had normal serum prolactin level despite being galactorrheic, averagely there was a marked elevation in serum prolactin of as high as 40.3 ± 52.3 ng/mL. Conclusion: We conclude, therefore, that the prevalence of hyperprolactinemia in this study was low when compared with other studies and that galactorrhea does not always indicate raised serum prolactin levels.
  5,284 32 1
Cycloplegic effect of atropine compared with cyclopentolate-tropicamide combination in children with hypermetropia
Rabi Yahaya Sani, Sadiq Hassan, Saudat Garba Habib, Ebisike Philips Ifeanyichukwu
May-June 2016, 57(3):173-177
DOI:10.4103/0300-1652.184065  PMID:27397958
Background: Cycloplegic refraction is important in assessing children with hypermetropia. Atropine, though the gold standard cycloplegic agent for refraction in children, has a long duration of action and more severe side effects compared to short-acting cycloplegic agents. The aim of the study was to compare the cycloplegic effect of atropine with cyclopentolate and tropicamide combination in children with hypermetropia. Subjects and Methods: This was a crossover interventional study in children with hypermetropia. Cycloplegic refraction using two separate regimens of cycloplegic drugs was done on all subjects. Data were analyzed using the statistical software SPSS version 22.0. The mean spherical equivalent values of regimen 1 (atropine 1%) and regimen 2 (cyclopentolate 1% and tropicamide 1%) were presented as mean and standard deviation. A P ≤ 0.05 was considered statistically significant. Results: One hundred and twenty-six eyes of 63 subjects aged 5-12 years were examined. The mean spherical equivalent values for regimen 1 and regimen 2 for the right eyes were 4.73 ± 2.1 DS and 4.54 ± 1.9 DS, respectively (P = 0.59). The mean spherical equivalent values for regimens 1 and 2 for the left eyes were 4.74 ± 2.0 DS and 4.54 ± 1.8 DS, respectively (P = 0.56). Conclusion: The combination of 1% cyclopentolate and 1% tropicamide could be a useful alternative to atropine 1% for cycloplegic refraction in children with hypermetropia.
  5,198 31 5
Postoperative complications from primary repair of cleft lip and palate in a semi-urban Nigerian teaching hospital
Oluwafemi Adewale Adesina, Akinwale Adeyemi Efunkoya, Kelvin Uchenna Omeje, Paul Ikhodaro Idon
May-June 2016, 57(3):155-159
DOI:10.4103/0300-1652.184059  PMID:27397954
Background: This paper seeks to investigate the incidence of short-term postoperative complications in children and adult patients undergoing primary surgery of cleft lip and palate. Patients and Methods: One hundred and fifteen patients consisting of children (below 12 years) and adult (12 years and above) who were operated for both cleft lip and palate within a 2-year period at the University of Maiduguri Teaching Hospital were reviewed postoperatively at 1 week, 2 weeks, 1 month, 3 months, 6 months, and 1 year intervals, respectively. The complications encountered within the periods of the review were recorded. Results: One hundred and twenty surgeries were performed on 115 patients (85 children 30 Adults). A total of 43 complications (31 in children and 12 in adults) were recorded over the study period. Eighteen (41.9%) of these complications were noticed in unilateral cleft lip repair, while 12 (27.9%) and 13 (30.2%) complications were observed in bilateral cleft lip and cleft palate surgeries, respectively. A higher complication rate (72.0%) was recorded in children compared with adults. Major complications (13.9%) were, however, observed more in adults than children. Conclusion: Although every surgeon attempts to prevent complications during surgery, they may still occur. The high complication rate observed in our study may be due to a small sample size. General complications observed among children are due to cross infection during a hospital stay, contributing immensely to the higher rate of complications in children. Moreover, this may be reduced by short hospital stay following surgery. We also advocate early contact with children with cleft, and early surgical intervention in other to prevent some of the major complications encountered in adult patients.
  4,194 31 9
Childhood ovarian neoplasms in Ibadan, South-western Nigeria
Mustapha Akanji Ajani, Kolawole Olanrewaju Aramide, Tinuade Adesola Ajani, Ayodeji A Salami, Clement Abu Okolo
May-June 2016, 57(3):164-166
DOI:10.4103/0300-1652.184061  PMID:27397956
Background: Childhood ovarian neoplasms are very rare. Little information is available on the relative pattern and frequency of these tumors in Nigerian children. Earlier study done in Ibadan involved ovarian neoplasms in children and adolescents. The aim of this study is to review cases of ovarian neoplasms in children <15 years over a 22΍ years period. Materials and Methods: This was a retrospective study. Twenty-four cases of childhood ovarian neoplasms were seen in patients <15 years of age. These cases were classified using the current World Health Organization histological classification of ovarian tumors. Results: Childhood ovarian neoplasms accounted for 2.8% of all cases of ovarian tumors seen in this period. Fourteen (58.3%) cases of childhood ovarian neoplasms were benign, and 10 (41.7%) were malignant. Mature cystic teratoma occurring in 13 (54.2%) was the most common childhood ovarian neoplasm and was most prevalent between 10 and 14 years of age. Burkitt lymphoma was the most common 4 (40%) malignant childhood ovarian tumor and prevalent between 5 and 14 years of age. Conclusion: Mature cystic teratoma remains the single most common childhood ovarian neoplasms, and Burkitt's lymphoma is the most malignant childhood ovarian tumor in Ibadan, South-western Nigeria.
  3,587 31 2
Environmental factors related to the occurrence of oral clefts in a Brazilian subpopulation
Ana Thereza de Saboia Campos Neves, Luiz Evaristo Ricci Volpato, Mariano Martinez Espinosa, Andreza Maria Fabio Aranha, Alvaro Henrique Borges
May-June 2016, 57(3):167-172
DOI:10.4103/0300-1652.184064  PMID:27397957
Background: A cross-sectional study was conducted at the Craniofacial Rehabilitation Center in the General Hospital of the University of Cuiabα, Cuiabα city, Mato Grosso, Brazil. Materials and Methods: Poisson regression model was used to analyze the relationship between antenatal factors and the occurrence of oral clefts in 116 patients. Results: Oral clefts were more common in males (64.66%) and White race (46.02%). The mean age of the children was 21.91 months. The most common type of cleft was cleft lip and palate (CLP, 55.17%). Maternal and paternal smoking in the first trimester of pregnancy and parity were significantly associated with the occurrence of CLP. Parent's age, educational level, and occupation did not interfere in the occurrence of oral clefts. There was also no significant association between maternal illness, medication use, alcohol consumption, and maternal exposure to chemicals in the first trimester of pregnancy and the occurrence of clefts in this population. Conclusion: The analysis of the environmental factors present during the pregnancy of children with oral clefts revealed a significant association between parity (second onward), maternal smoking, and paternal smoking and the occurrence of CL and/or palate in this population.
  3,580 31 6
Serum copper and zinc levels in preeclamptic Nigerian women
AO Onyegbule, CC Onah, BC Iheukwumere, JN Udo, CC Atuegbu, NO Nosakhare
May-June 2016, 57(3):182-184
DOI:10.4103/0300-1652.184071  PMID:27397960
Background: The exact etiology of preeclampsia remains unknown even though several studies have been done. Some studies have shown that supplementation of zinc (Zn) and copper could ameliorate the effects of preeclampsia while other studies did not establish the beneficial role of these elements in preeclampsia. The objective of this study was to compare the Zn and copper levels in the serum of Nigerian women with or without preeclampsia. Materials and Methods: In this study, serum Zn and copper levels were determined using atomic absorption spectrometry in 54 patients and 48 healthy normotensive pregnant women. The mean, standard deviation, Student's t-test, and Pearson correlation were employed. Results: Serum Zn was significantly lower in patients than controls (8.27 ± 0.60 vs. 12.16 ± 1.83 μmol/l. P <0.001) (t-test). Serum copper was also significantly lower in patients than controls (8.14 ± 1.80 vs. 16.62 ± 3.17 μmol/l, P < 0.001). Conclusion: There was a significant reduction in the levels of Zn and copper in patients with preeclampsia. Dietary supplementation of these trace elements may help to prevent preeclampsia.
  3,494 36 2
Effect of automated red cell exchanges on oxygen saturation on-air, blood parameters and length of hospitalization in sickle cell disease patients with acute chest syndrome
John C Aneke, Nancy Huntley, John Porter, Perla Eleftheriou
May-June 2016, 57(3):190-193
DOI:10.4103/0300-1652.184073  PMID:27397962
Background: Red cell exchanges (RCEs) lead to improvement in tissue oxygenation and reduction in inflammatory markers in sickle cell disease (SCD) patients who present with acute chest syndrome (ACS). The aim of this study is to evaluate the effects of automated-RCE (auto-RCE) on oxygen saturation (SpO 2 ) on-air, blood counts, the time to correct the parameters and length of hospitalization after the exchange in SCD patients presenting with ACS. Subjects and Methods: This was 2 years study involving five SCD patients; the time for SpO 2 on air to increase to ≥95% and chest symptoms to resolve, postprocedure, as well as the length of in-patient hospitalization was recorded. All data were entered into Statistical Package for Social Sciences Version 20.0 (SPSS Inc., Chicago, IL, USA) computer software for analyses. Results: The study involved 4 (80%) hemoglobin (Hb) SS and 1 (20%) HbSC patients. The median time of SpO 2 recovery was 24 h, ranging from 6 to 96 h. About 60% (3/5) of patients achieved optimal SpO 2 within 24 h post-RCE, while discharge from intensive care unit was 24 h after auto-RCE in one patient. The Hb concentration was significantly higher, while the total white cell and absolute neutrophil counts were significantly lower at the time of resolution of symptoms, compared to before auto-RCE (P < 0.05). The average post auto-red cell transfusion symptoms duration was 105.6 (24-240) h while mean inpatient stay was 244.8 (144-456) h. Conclusion: Auto-RCE could reverse hypoxia in ACS within 24 h.
  2,887 31 5
Management of a blinding orbital apex cyst in a 14-year-old girl
Kator Chaha, Dominic Chinda, Mustapha Abubakar Waziri, Emmanuel Raphael Abah
May-June 2016, 57(3):194-197
DOI:10.4103/0300-1652.184074  PMID:27397963
This study was conducted to highlight the diagnostic and management challenges of orbital apex lesions. It is a retrospective report of a 14-year-old female who presented with no perception of light vision in her left eye following a 1-year history of left unilateral axial proptosis. Her computed tomography scan revealed a mass surrounding the optic nerve which was reported to be an optic nerve glioma. She had lateral orbitotomy and a cystic mass was dissected and excised. Systemic steroids and antibiotics were administered. Visual recovery was achieved in the immediate postoperative period. At discharge, her visual acuity was counting finger in the left eye. Visual recovery in the orbital apex lesions is possible if the patient is diagnosed early and managed promptly but delayed presentation and diagnostic challenges could lead to irreversible blindness.
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