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Neovascular glaucoma in a nigerian African population
No full textObjective: To determine the ocular and systemic factors associated with neovascular glaucoma (NVG) in an African population.Design: Hospital based cross sectional study.Setting: Eye clinic, Department of Ophthalmology, University College Hospital, Ibadan, Nigeria.Subjects: Sixty one consecutive patients with clinical diagnosis of NVG seen between January 1995 and December 1999 had a complete ocular evaluation.Results: Among the 61 subjects studied with an identifiable aetiological factor presumably causing neovascular glaucoma, 82% had associated posterior segment diseases producing ischaemia. These were retinal venous obstruction (78.7%), retinal arterial occlusion (1.6%). Those with no identifiable vaso-occlusive disease had couching (11.5%), aphakia with vitreous loss (3.3%) and chronic uveitis (1.6%). Systemic arterial hypertension was present in 62.3% while diabetes mellitus was presentin only 8.3% of the subjects studied. Chronic uveitis and penetrating eye injury were infrequently diagnosed. Chronic open angle glaucoma was present in the other eye of 37.7% of subjects.Neovascular glaucoma was unilateral in 95.1% of subjects. 84.4% of affected eyes were blind on presentation. Males outnumbered females among subjects with NVG above 40 years, while females outnumbered males in the subjects below 40 years of age. Eyes of that were couched constitute a significant proportion of subjects with neovascular glaucoma.Conclusion: Medical conditions such as systemic hypertension, diabetes and ocular conditions like retinal vein, retinal artery occlusion, couching and glaucoma were associated with NVG. Most of these ocular and systemic associations should be identified early and treated to preventneovascular glaucoma in the other eye of the subject
PARTNER NOTIFICATION IN THE MANAGEMENT OF SEXUALLY TRANSMITTED INFECTIONS IN NAIROBI, KENYA
No full textABSTRACTObjective: To assess utilization of partner notification as a tool in prevention and controlof Sexually transmitted infections in Nairobi City Council clinics.Design: A cross-sectional study carried out between April and September 2000.Setting: Nairobi City Council health clinics were stratified into eight administrativedivisions and a total of 16 out of 54 primary health clinics with at least four STIs patientsper day were selected. A standard questionnaire was administered to every fourth patientwith clinical diagnosis of STIs who gave consent on exist. Sexual partners referred byindex cases during the five day period from each clinic were also enrolled into the study.An additional questionnaire was administered to HCP who were managing STIs patientsand their sex partners.Results: Of 407 STIs patients recruited between April and September 2000, 20.6% wereprimary and 2% were secondary referrals giving an average referral rate of 23%.Respondents with multiple sex partners were less likely to refer their partners comparedto those who had one partner (17.9% vs 82.1%, p<0.005). Counseling of STI patientson the importance of partner referral was more effective than issuing referral cardsalone (72.8% vs 56.8% % p= <0.006). Barriers to partner notification included partnersbeing out of town (44.6%) fear of quarrels and violence from partners (32.5%) andcasual partners (15.1%) whose sex partners were unknown.Conclusion: Counseling and understanding of STIs patients on the need to treat all sexualpartners is pivotal to the success of partner referral
MALIGNANT OROFACIAL NEOPLASMS IN LAGOS, NIGERIA
No full textObjectives: To analyse general differences in age, gender, anatomic location of the various histological types of malignant neoplasm involving the oral and maxillofacial region at a tertiary referral centre in Nigeria and to compare this with reports in the literature.Design: Retrospective analysis.Setting: A tertiary referral centre in Lagos, Nigeria.Subjects: All patients with a histological diagnosis of malignancy were included provided the final surgical histology reports as well as the biopsy reports were available for review.Results: Squamous cell carcinoma (SCCA) with a peak age incidence in the 6th decade of life and a male to female ratio of 1.65 to 1 was the most common cancer (42.8%). Males with SCCA (mean = 48.7 years) were relatively younger than females (mean = 58. 8 years). Eighteen percent of patients with SCCA were below 40 years at presentation and males were predominantly affected at a ratioof 5.2:1. Majority of the SCCA (75%) were well /moderately well differentiated. However, in patients below 40 years, 45.9% had poorly differentiated SCCA.The Most commonly affected sites for SCCA were the maxillary antrum (36.7%), mandibular gingiva/alveolus (23.0%) and tongue (12.04%). Patients who presented with antral SCCA were relatively younger (mean = 48.9 years) than those who had SCCA involving the mandibular gingiva/ alveolus (mean = 57.l years) as well as floor of mouth (mean = 56.3 years). Furthermore, males withantral SCCA were younger than their female counterparts. Similarly, males who had mandibular gingiva/ alveolus SCCA (mean = 48.4 years) were younger than their female counterparts (mean = 62.8 years). Majority of the glandular carcinomas (GLDCAs) arose from minor salivary glands (63.0%). Thirty seven per cent of these patients were below 40 years at presentation. Females whohad antral GLDCA (mean = 32.4 years) were relatively younger than their male counterparts (mean = 49 years). Most of the patients who presented with sarcoma were below 40 years (77.4%) and males were younger (22. 8 years) than females (mean = 35.4 years).Conclusions: The proportion of orofacial cancers that is SCCA in Nigerians is relatively low because of a relatively high proportion of GLDCA and Burkitt’s lymphoma. A relatively high proportion of patients with SCCA were below 40 years at presentation. They were predominantly males who presented with poorly differentiated tumours
MOLLUSCICIDAL ACTIVITY OF SOME CAMEROONIAN PLANTS ON BULINUS SPECIES
No full textObjective: To evaluate some locally available plants for their molluscicidal activity on Bulinus camerunensis and B. truncatus (slender form).Design: Experimental studies.Setting: Ndongo stream near the University of Buea and the University of Buea Life Sciences Laboratory.Subjects: Evaluation of molluscicidal activity on snails of Bulinus camerunensis and B. truncatus (slender form).Main outcome measures: Plant extracts with molluscicidal activity determined. Determination of LC50, LC90 and LC100 of the potent plant extracts. Application of the extracts on aquaria-reared snails. Semi-field application of extracts.Results: A preliminary screening test using 10,000ppm solution of the water extracts of thirteen plants revealed that 61.5% (8/13) of the plants investigated had molluscicidal properties, with snail mortality rates above 90%. Extracts of Nicotiana tabacum, Aframomum citratum, A. melegueta, Curcuma domestica and Solanum scabrum killed 100% of the snails after twenty four hours exposure.B. camerunensis was more susceptible to the water extracts than B. truncatus. The LC50, LC90 and LC100 of the different plant extracts against B. camerunensis were generally lower than those against B. truncatus. The concentrations that produced 50%, 90% and 100% snail mortalities were lowerwith the methanol extracts than with water extracts, indicating that the methanol extracts were more toxic to the snails than the water extracts. Generally, the eggs were more susceptible to the extracts than the young and adult snails. Application of the water extracts at LC 100 on snails reared in aquaria and under semi-field conditions revealed that N. tabacum could kill up to 100% of the snails in aquaria and 61.25% under semi-field conditions.Conclusion: Eight plant species with molluscicidal activity were identified, among which Nicotiana tabacum, Aframomum citratum, A. melegueta, Solanum scabrum and Curcuma domestica presented the highest activity. B. camerunensis was more susceptible to all the plant extracts tested than B.truncatus, and the methanol extracts proved more toxic than the water extracts. Semi-field testing of potent extracts showed promise, with N. tabacum having the highest effects on the snails
RACHS - l SYSTEM IN RISK STRATIFICATION FOR CONGENITAL HEART DISEASE SURGERY OUTCOME
No full textBackground: The Risk Adjustment in Congenital Heart Surgery (RACHS-1) system has been used as a benchmark to compare surgical results in developed countries. Its ability to stratify postoperative mortality risk has been validated in several developed countries, however, this has not been examined in a developing country.Objectives: To assess the ability of the RACHS-1 system to stratify postoperative mortality risk in a developing country.Design: Retrospective study over a five year period between 1st January 2002 and 31st December 2006.Setting: Kenyatta National Hospital, a teaching and referral hospital in Nairobi, Kenya.Subjects: Three hundred and seventeen consecutive operations were performed on 313 patients aged between 0.25 and 204 months.Results: Operations were performed in RACHS-1 categories 1, 2, 3 and 4 with hospital mortalities of 2.5%, 16.9%, 29.4% and 50% respectively. The difference in mortality between categories 1 and 2 was significant (p-value of 0.0003), however, the difference in mortality between categories 2 and 3 and categories 3 and 4 was not significant (pvalues 0.193 and 0.67 respectively).Conclusions: The RACHS-1 system did not adequately stratify risk in a low case load setting. The use of the RACHS-1 method as a benchmark to compare surgical results of paediatric cardiac surgery services in developing countries may be limited
Schistosomiasis presenting as acute appendicitis
No full textBackground: Schistosomiasis is a chronic granulomatous inflammation that affects many systems in the body including the gastrointestinal tract. This study was carried out by reviewing all cases of schistosomal appendicitis, and documents any association with acute appendicitis.Objective: To review all cases of schistosomal appendicitis and document any possible asspciation with acute appendicitis.Design: A retrospective study.Setting: Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, 1991 to 2004.Subjects: Eight hundred and three specimen of appendicectomy were reviewed. Thirty five of them were diagnosed as schistosomal appendicitis.Results: The involvement of the vermiform appendix by schistosomiasis found in 35/843 (4.2%) cases of all the appendicectomy specimen received in our histopathology laboratory between 1991 and 2004 shows that 23 of the cases (65.7%) had histologically proven acute appendicitis while the remaining 12 cases (34.3%) were schistosomiasis without active inflammation. The appendiceal wall oviposition is associated with submucosal fibrosis, narrowing of the lumen and subsequent acute suppurative inflammation in 17 cases while there were active granulomas with tissue eosinophilia in six cases.Conclusion: This finding has demonstrated that though the frequency of appendix involvement is low considering the endemicity of schistosomiasis in our environment, however acute appendicitismay be caused by schistosomiasis
Stakeholders perception of HIV sero-discordant couples in western Kenya
No full textObjective: To describe the perceptions of key stakeholders regarding the counselling needs of HIV sero-discordant couples as part of preparation for a clinical trial involving HIV sero-discordant couples.Design: Qualitative study using key informant and couple interviews.Setting: Moi Teaching and Referral Hospital (MTRH).Subjects: A purposive sample of nine key informants and 31 couple interviews totaling 71 participants. The couple interviews consisted of HI V untested, HI V concordant (positive and negative) and discordant couples.Results: Seventy one individuals participated in nine key informant and 31 couple interviews. The responses identified the following as key issues in counselling HIV discordant couples:(i) The need for education on the meaning of HI V sero-discordancy including potential sourcesof infection(ii) Assistance in disclosing HIV test results to one’s partner(iii) Discussion of the stigma surrounding formula feeding. Overall, the participants supported safer sexual practices in discordant partnerships.Conclusions: Psychosocial support of HI V sero-discordant couples should include messages about the meaning, mechanisms and implications of sero-discordancy. Culturally appropriate HI Vdisclosure and safer sex messages are also needed to support these partnerships
WANDERING SPLEEN PRESENTING AS A RIGHT HYPOCHONDRIAL MASS AND INTESTINAL OBSTRUCTION
No full textThis is a case report of a 23 year old multiparous woman who presented with intestinalobstruction and a right hypochondrial mass. Laparatomy revealed an infarcted 1.4Kgspleen in the right lumbar region compressing the ascending colon. There was also ilealvolvulus around the splenic pedicle. This is probably the first documented case ofwandering spleen in the right hypochondrium, presenting as right large bowel obstruction,to be reported in our region. Wandering spleen is a rare condition, often asymptomatic,but may present as an acute abdomen. Pre-operative diagnosis is difficult and rarelymade. Laboratory tests are seldom useful, but imaging studies do assist. Up to 1971only 350 cases had been reported in the western literature. Review of English literaturefrom 1900 to 1991 reported only 51 cases in children. In our region 11 cases werereported in Uganda between 1968 and 1971. No other literature is available from ourregion. Clinical presentation, aetiology, investigation, and management of wanderingspleen is discussed
MATERNAL MORTALITY AT THE STATE SPECIALIST HOSPITAL BAUCHI NORTHERN NIGERIA
No full textObjective: To analyse and document our experiences with maternal mortality with the view of fi nding the trends over the last seven years, common causes and attributing socio-demographic factors. Design: A prospective analysis of maternal mortality Setting: State Specialists Hospital Bauchi, Bauchi Northeastern Nigeria Main outcome measures: These include maternal mortality ratio for the period under review and the annual trends, age and party most affected the direct and indirect causes of maternal mortality in our environment. Results: The maternal mortality ratio (MMR) for the period under review was 1, 732 per 100, 000 live births. Six hundred and twenty one of the deaths (81.0%) occurred in 12,067 unbooked deliveries giving a maternal mortality ratio of 5,146 per 100,000 for unbooked mothers. This ratio is approximately eleven times that obtained in booked live deliveries. Age range was 14-44 years and the mean age was 27.8 years. The highest maternal death was in the adolescent mothers. The primigravidas had the highest maternal mortality of 28.9%. The direct obstetric causes of maternal death accounted for 79.4% of the deaths. The major causes of deaths were eclampsia 31.9%, haemorrhage 19.2% and sepsis 10.4%. Amongst the indirect causes of maternal death, anaemia was the leading cause accounting for 12.1%. The annual MMR was highest for the year 2006 (2,586 per 100,000). Conclusion: Maternal mortality is unacceptably high in our environment. The provision of more health facilities where basic and comprehensive antenatal care are provided, skilled attendants at birth, community mobilisation to improve antenatal attendance and the use of TBAs as a link between the pregnant women, families and communities providing important messages for a healthy pregnancy, and safe birth remain the bedrock of containing maternal mortality in our environment