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   2016| September-October  | Volume 57 | Issue 5  
    Online since September 14, 2016

 
 
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ORIGINAL ARTICLES
Nigeria's National Health Act: An assessment of health professionals' knowledge and perception
Osahon Enabulele, Joan Emien Enabulele
September-October 2016, 57(5):260-265
DOI:10.4103/0300-1652.190594  PMID:27833244
Background: Nigeria's National Health Act 2014 (NHA 2014) was signed into law on October 31, 2014. It provides a legal framework for the regulation, development, and management of Nigeria's Health System. This study assessed the knowledge and perception of the NHA 2014 by health professionals. Materials and Methods: This was a descriptive, cross-sectional, questionnaire-based study conducted in December 2015, in Ota, Ogun State, Nigeria. Data entry and analysis were done using the Statistical Package for the Social Sciences version 16 (IBM SPSS, Chicago, IL, USA) statistical software, with Pearson's Chi-square, which is used to determine the associations between variables. Statistical significance was set at a P < 0.05. Results: The study population comprised 130 health professionals (medical doctors/dentists, nurses, pharmacists, laboratory scientists, and other health-related professionals) in attendance at a medical conference. The respondents' age ranged from 21 to 75 years with a mean age of 44.53 ± 12.46 years. Medical practitioners accounted for 82.3% of the respondents. Although most (79.2%) respondents had a good perception of the NHA 2014 with majority (86.2%) claiming they were aware of the act, majority (73.8%) exhibited poor knowledge of the act. A little more than half (53.1%) of the respondents believed that the NHA 2014 will help to reduce strike actions in the health sector. Conclusion: Although health professionals in Nigeria have good awareness and perception of the NHA 2014, their knowledge of the Act is poor.
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Quality of life and associated factors among poststroke clinic attendees at a University Teaching Hospital in Nigeria
Osunwale Dahunsi Oni, Olatunji F Aina, Francis I Ojini, Victor O Olisah
September-October 2016, 57(5):290-298
DOI:10.4103/0300-1652.190602  PMID:27833249
Background: Quality of life (QOL) measures are effective in quantifying disease burden after stroke, more so than levels of debility. The objective of this study is to determine QOL and associated factors of stroke survivors in Lagos, Nigeria. Materials and Methods: Seventy stroke survivors (study sample) and seventy stable hypertensive patients (control sample) attending clinics at a Nigerian hospital were recruited for the study. Respondents were assessed using sociodemographic/clinical questionnaires, modified mini-mental state examination, modified Rankin Scale, schedule for clinical assessment in neuropsychiatry, and World Health Organization-QOL-BREF. Results: Mean ages of the study and control respondents were 57.43 (±9.67) years and 57.33 (±9.33) years, respectively. Each sample comprised 38 male and 32 female respondents. Stroke survivors were significantly more likely to: be unemployed (P= 0.001), pay more for healthcare (P = 0.001), consume alcohol (P = 0.02), and have physical impairments (P = 0.001) compared with control. The mean QOL scores of stroke survivors were significantly lower than controls across all spheres. Stroke survivors who were unemployed, younger, female, paying more for healthcare, more disabled, with right stroke lateralization, having comorbidities, and sexual dysfunction had significantly poorer QOL specific grades. Depression or anxiety poststroke was also associated with reduced QOL means scores. Conclusion: Besides, clinical variables such as levels of disability and stroke lesion lateralization, other factors such as unemployment, health costs, age, gender, and emotional problems influenced QOL after stroke.
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Malignant tumors of the larynx: Clinicopathologic profile and implication for late disease presentation
Ayotunde James Fasunla, Oluwole Agboola Ogundoyin, Paul Adekunle Onakoya, Onyekwere George Nwaorgu
September-October 2016, 57(5):280-285
DOI:10.4103/0300-1652.190596  PMID:27833247
Background: Malignant laryngeal tumors are uncommon. Late presentation of the disease may worsen management outcomes. We described the epidemiologic, clinicopathologic profile, and management outcomes of laryngeal tumors in a tertiary health institution in Nigeria. Materials and Methods: An 11-year retrospective review of medical records of patients managed for malignant laryngeal tumor at the University College Hospital, Ibadan, Nigeria, was performed. Results: There were 97 patients comprising 74 (76.3%) males and 23 (23.7%) females with a mean age of 60.48 ± 12.15 years. The mean duration of illness was 7.3 ± 3.8 months. History of cigarette smoking and alcohol consumption was in 2.1% and 14.4% patients, respectively. The most common clinical presentations were hoarseness, cough, and dyspnea. Transglottis (91.8%) was the most common anatomic tumor location and 92.8% patients presented in advanced disease stage. Four histologic types were identified with squamous cell carcinoma accounting for 96.9%. About 92% patients had emergency tracheostomy and 56 (57.7%) patients had total laryngectomy. The postoperative complications were pharyngocutaneous fistula (5.2%) and peristomal recurrence (3.1%). The 5-year survival rate was 52.5%. Conclusions: Malignant laryngeal tumors are uncommon, but more females are getting the disease. Squamous cell carcinoma is the most common histologic variant. Late stage disease presentation and initial wrong diagnosis contributed to the poor management outcome.
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Effect of submucosal or oral administration of prednisolone on postoperative sequelae following surgical extraction of impacted mandibular third molar: A randomized controlled study
Adebayo Aremu Ibikunle, Wasiu Lanre Adeyemo, Akinola Ladipo Ladeinde
September-October 2016, 57(5):272-279
DOI:10.4103/0300-1652.190599  PMID:27833246
Background: The aim of the study was to evaluate the effect of preoperatively administered submucosal and oral prednisolone on postoperative pain, facial swelling, and trismus following third molar surgery. Patients and Methods: This was a randomized controlled trial in which subjects were randomly distributed into three groups. Group A consisted of subjects who received 40 mg oral prednisolone; Group B consisted of subjects who received 40 mg submucosal injection of prednisolone while Group C consisted of subjects who did not receive prednisolone. Each group had 62 subjects. Measurements for facial width/facial swelling, pain, and mouth opening were recorded preoperatively and postoperatively. The postoperative evaluation points were postoperative days 1, 3, and 7. These measurements were compared with the preoperative values both within and among the groups. Results: Most of the subjects were in their third decade of life. A considerable increase in the mean postoperative values for pain, facial width and trismus was observed. Notably, subjects who did not receive prednisolone showed comparatively higher values for the measured parameters throughout the postoperative evaluation period. Subjects who received submucosal injection of prednisolone showed overall lower values compared to those who received oral prednisolone. Conclusion: The results of this study indicate that the administration of prednisolone has a significantly beneficial effect in ameliorating the postoperative sequelae of the third molar surgery. In addition, the effect of submucosally injected prednisolone is comparable to the orally administered prednisolone; indeed it shows superiority to the latter in a number of dimensions. Submucosal injection of prednisolone offers a simple, effective, easy, safe, and minimally invasive option to existing therapeutic methods of reducing these postoperative sequelae.
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Genital prolapse: A 5-year review at Federal Medical Centre Umuahia, Southeastern Nigeria
Obinna Izuchukwu Oraekwe, Maduabuchi Amagh Udensi, Kelechi Chiemela Nwachukwu, Uka Kalu Okali
September-October 2016, 57(5):286-289
DOI:10.4103/0300-1652.190601  PMID:27833248
Background: Genital prolapse is an important cause of morbidity among postmenopausal and multiparous women especially in our environment where a high premium is placed on large family size. This study was done to determine the prevalence, risk factors, clinical presentation, and management options of genital prolapse. Patients and Methods: Data of those diagnosed with genital prolapse were retrieved from records in the clinic, wards, theater, and from patients' folders in the medical records department. Statistical Analysis Used: Data were analyzed using Statistical Package for Social Sciences version 20 with P < 0.05. Results: Genital prolapse accounted for 0.8% of gynecological clinic attendances and 5.2% of major gynecological operations. The mean age of patients was 56.7 ± 15.5 years. Farmers constituted 60.7% of the patients while 72.1% and 70.5% were postmenopausal and grandmultiparous women, respectively. The sensation of something coming down the vagina was the most common symptom noted in 98.4% of the patients. Most (23.0%) of the patients had unsupervised delivery at home. Uterovaginal prolapse was the most common (70.5%) type of genital prolapse, and third-degree uterovaginal prolapse was its most frequent presentation. Majority of the patients (44.4%) were managed expectantly while the most common surgery performed was vaginal hysterectomy with pelvic floor repair (33.3%). Conclusion: Widespread availability of antenatal services especially in the rural communities and limitation on family size can significantly reduce the burden of this disease.
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Buccal mucosal graft urethroplasty for proximal bulbar urethral stricture: A revisit of the surgical technique and analysis of eleven consecutive cases
Irekpita Eshiobo, Esezobor Ehizomen, F Omosofe, V Onuora
September-October 2016, 57(5):266-271
DOI:10.4103/0300-1652.190603  PMID:27833245
Background: Urethral stricture disease is prevalent, and many surgical techniques have been developed to treat it. Currently, urethroplasty for bulbar strictures implies ventral or dorsal stricturotomy and a buccal mucosa graft (BMG) patch. Objective: To describe the surgical approach of the ventral patch BMG urethroplasty for proximal bulbar urethral stricture and to analyze 11 consecutive cases for whom the technique was used. Patients and Methods: The diagnosis of urethral stricture was confirmed with a combined retrograde urethrography and micturating cystourethrography. A single team exposed the urethra, harvested, and planted the BMG in the lithotomy position under general anesthesia. The oral preoperative preparation was done with oraldene (hexetidine) mouth wash three times daily beginning from the 2nd preoperative day. The buccal mucosa was harvested from the left inner cheek in all the patients. The donor site was left unclosed but packed with wet gauze. Data related to age, preoperative adverse conditions, stricture length, urine culture result, perineal/oral wound complications, postoperative residual urine volume, and duration of hospital stay were recorded. Results: Eleven patients with proximal bulbar urethral stricture had BMG urethroplasty from August 2013 to October 2015. Stricture length ranged from 2 to 5 cm. In six (54%) of the men, the stricture resulted from urethritis thereby constituting the most common etiology of urethral stricture in this study. The preoperative adverse conditions were age above 70 in three, diabetes mellitus in two, severe dental caries in one, and recurrent stricture in two. All of them were able to resume reasonable oral intake 72 h postoperatively. One (9.2%) had perineal wound infection, while two (18.2%) still had mild pain at donor site 4 weeks postoperatively. Ten (90.9%) of the 11 patients had <30 ml residual urine volume at 2 months of follow-up. Conclusion: Urethritis is still a common cause of urethral stricture in this rural community. Ventral onlay buccal mucosal graft urethroplasty for proximal bulbar urethral stricture is safe, even in certain adverse preoperative conditions. Buccal mucosa from the cheek is however now preferred.
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Short-term effects of lovastatin therapy on proteinuria of type 2 diabetic nephropathy: A clinical trial study
Alireza Sadighi, Javid Safa, Amir-Mansour Vatankhah, Sona Ghorashi, Aida Aharilahagh, Sina Davari-Farid, Ourmaan Nezami-Nargabad, Mohammad Naghavi-Behzad, Reza Piri, Parinaz Pishahang, Savalan Babapoor-Farrokhran, Sanam Fakour, Nastaran Ghodratnezhad-Azar
September-October 2016, 57(5):253-259
DOI:10.4103/0300-1652.190600  PMID:27833243
Background: Diabetic nephropathy (DN) is characterized by albuminuria, hypertension, and a progressive decline in glomerular filtration rate. The 3-hydroxy-3-methylglutaryl coenzyme A is a well-known agent that is active in lowering total plasma and low-density lipoprotein cholesterol (LDL-C) levels in cases with hypercholesterolemia. Hence, in this study, proteinuria changes at the beginning and after the withdrawal of lovastatin in patients with type 2 DN (T2DN) were studied. Materials and Methods: Lovastatin was administered for thirty male patients with T2DN and then was withdrawn. Twenty-four hours, urine creatinine and protein levels were determined. Results: The mean levels of total cholesterol and LDL-C were reduced without any change in the triglyceride (TG) level while the high-density lipoprotein cholesterol (HDL-C) level was increased. There was a reverse linear correlation between the changes in the level of HDL-C and the changes in the level of 24 h urine protein after 90 days of lovastatin therapy (P = 0.007, r = −0.484). Conclusions: Short-term 3-month lovastatin therapy has no effect on proteinuria levels in patients with T2DN despite the antihyperlipidemic effects and reverse correlation of proteinuria with HDL-C.
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Cytohistological discordance on gastrointestinal brushings: Facts unfolded
Ruchita Tyagi, Jagpal Kaur, Gursheen Kaur, Pavneet Kaur Selhi, Harpreet Kaur Puri, Neena Sood
September-October 2016, 57(5):299-302
DOI:10.4103/0300-1652.190597  PMID:27833250
Introduction: Brush cytology is a rapid, cost-effective, and reliable tool to diagnose gastrointestinal tract (GIT) lesions in low-resource settings. Most of the studies on GIT brushings have focused on upper GI lesions. We have studied the diagnostic accuracy of brush cytology in the entire length of GIT and correlated the cytological diagnosis with histopathology. The aim of this study is to study diagnostic utility of brush cytology of GIT lesions in the context of correlation with biopsy and study the factors responsible for cytohistological discordance. Materials and Methods: A retrospective analysis of 101 cases of prebiopsy brush cytology samples of GIT lesions was done over a period of 1 year (June 2014 to May 2015). The cytological diagnosis was compared with histopathological diagnosis and percentage of correlation was calculated. The reasons for discordance were noted and studied. Results: The cytological diagnosis of 79 (78.2%) correlated with histopathological diagnosis. There was discordance in cytological and histological diagnosis in 22 cases (21.8%). Inadequacy of cytological sample and overlap of nuclear atypia caused by regenerative changes and malignancy were significant factors for cytohistological discordance. Conclusion: The diagnostic accuracy of brush cytology can be improved by taking appropriate measures to eliminate factors responsible for fallacies in cytological diagnosis.
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Cross-sectional study on the obstetric performance of primigravidae in a teaching hospital in Lagos, Nigeria
Kehinde Sharafadeen Okunade, Halimat Okunola, Lawal Oyeneyin, Fatimah N Habeeb-Adeyemi
September-October 2016, 57(5):303-306
DOI:10.4103/0300-1652.190595  PMID:27833251
Background: A woman carrying her first pregnancy is starting a new life, and this is a crucial time in her obstetric career. This study was aimed to compare the obstetric performance of primigravidae to that of the multigravidae with a view to suggesting ways of preventing the associated complications. Patients and Methods: The study was a cross-sectional case-control study carried out among women who delivered in the study center over a year period. Relevant data of primigravid parturients who delivered in the hospital were retrieved from the labor ward register, and an equal number of multigravidae who delivered during the same study were selected by simple random sampling as the control group. Results: Primigravidae constituted 15.3% of the total number of parturients seen during the study period. The age range of the primigravidae was 20–48 years and with a mean age of 28.24 ± 4.28 years. The obstetric complications seen in statistically significant proportion among the primigravidae case group include hypertensive disorder (P = 0.048), prolonged pregnancy (P = 0.039), prolonged labor (P = 0.006), oxytocin augmentation (P = 0.022), cephalopelvic disproportion (P = 0.001), obstructed labor (P = 0.008), instrumental delivery (P = 0.035), cesarean delivery rates (P = 0.011), and increased neonatal unit admission rate (P = 0.002). Conclusion: Primigravidity is a high-risk pregnancy with several associated obstetric complications. Primigravidae should, therefore, be managed by specialists in well-equipped hospitals that will provide comprehensive antenatal and intrapartum care which will eventually result in a satisfactory obstetric outcome.
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