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THE SUB-PUBIC ANGLE IN ADULT INDIGENOUS MALAWIAN SUBJECTS
No full textBackground: A number of parameters are used to assess the pelvis for clinical, physical and forensic anthropological reasons. When it is adequately assessed within any population group, the pelvis displays wide variations. Although the sub-pubic angle is one of the three forensically important angles of the pelvic outlet, literature is scanty or lacking on East and Central Africans, and no published report is available on indigenous Malawian subjects.Objectives: To determine the sub-pubic angle in indigenous Malawians and compare them with angles from other population groups previously reported.Design: A cross-sectional study.Setting: Queen Elizabeth Central and Blantyre Adventist hospitals in the city of Blantyre.Subjects: One hundred and nineteen antero-posterior radiographs of pelves of adults indegenous Malawians aged 20-84 years to determine their sub-pubic angle.Results: Women showed significantly wider sub-pubic angles than men (129.07 ± 14.19° SD women and 99.16 ± 15.73° SD men; P < 0.001), confirming similar results previously studied in other population groups. We have demonstrated that the sub-pubic angle alone could accurately assign sex to 67.12% of males and 63.04% of females, and race could be accurately assigned to 21.92% of men and 89.96% of females. Malawiansshowed significantly wider angles than Amerindians, Black and White Americans (P < 0.001).Conclusion: This study documents sexual and racial differences and for the first time (on comparison) the sub-pubic angles indicate geographical variations, underpinning the need to establish normal ranges of these angles in any given population. We recommend the establishment of local references of the sub-pubic angle to other countries in the sub-region
ROLE OF CHILD HEALTH CLINICS IN PROMOTING USE OF INSECTICIDE-TREATED NETS AMONG CHILDREN UNDER FIVE YEARS IN NYAMIRA, DISTRICT, KENYA
No full textBackground: Maternal child health clinics are the ideal places to meet and sensitise all the mothers with children under five years on the use of insecticide-treated nets in the prevention of malaria.Objective: To determine whether child health clinics are promoting the use of insecticide-treated nets in malaria prevention among children.Design: Cross-sectional, descriptive study.Setting: Eight health centres in Nyamira District.Subjects: Four hundred mothers bringing their children aged five years and below to the child health clinics between August and October 2003.Results: Two hundred and eighty four mothers (71%) had not received any information on the use of insecticide-treated nets while at the MCH clinics. Only 50% of the clinics had bed nets/ITNs posters mounted on their premises. Out of those clinics with posters, only in 50% of them had bed net posters seen. Very few mothers (36.2%) had seen the bed net/ITNs posters. None of the healthcareproviders used bed net/ITNs posters to educate the mothers. None of the insecticide-treated net leaflets were issued.Conclusion: Despite the fact that maternal child health clinics were well placed in promoting the use of insecticide-treated nets to the mothers who brought their under five year children, very little was being done to this effect. MCH clinics need to be more aggressive in motivating mothers to use insecticide-treated nets
PNEUMATOSIS CYSTOIDES INTESTINALIS ASSOCIATED WITH ASCITES AND PYLORIC STENOSIS SECONDARY TO A CHRONIC DUODENAL ULCER: CASE REPORT
No full textA thirty eight year old female with a long standing history of a chronic duodenal ulcerpresented at the Nyeri Provincial General Hospital with vomiting, abdominal pain andabdominal distension. Oesophago-gastro-duodenoscopy revealed a tight pyloric stenosiswhile abdominal ultrasonography showed ascites. At laparatomy, she was coincidentallyfound to have pneumatosis cystoides intestinalis(PCI). The recent literature is reviewedand this case of PCI associated with ascites and pyloric stenosis secondary to a chronicduodenal ulcer is reported
Demographic study of nasopharyngeal carcinoma in a hospital setting
No full textObjectives: To highlight demographic pattern of nasopharyngeal carcinoma and determine mode and stage of presentation.Design: Prospective analytical study.Setting: Kenyatta National Hospital (KNH)/University of Nairobi, Kenya.Subjects: One hundred and twenty five patients seen at the ENT department of KNH. These were either referred from other peripheral hospitals or first seen at KNH and satisfied the inclusion criteria. Patients with open neck biopsy were excluded (among other criteria).Results: Age range of the patients was 13-85 years. Male: Female ratio was 2.2:1 with the highest frequency in the 31-40 years. Most patients presented in late disease (stages III and IV) which carry a poor prognosis. Majority of the patients had neck swelling as the first symptom followed bynose blockage. Several patients referred from peripheral major hospitals and open neck biopsy.Majority of the patients seen were from poor social-economic background.Conclusion: Nasopharyngeal carcinoma is a common malignancy at KNH. Diagnosis is usually made in late stages of the disease when prognosis after full treatment is poor. There is need to make early diagnosis by heightening the index of suspicion among health professionals and probably health education in the community on the need to seek treatment for persistent neck masses
PRESENTATION OF PRIMARY MEDIASTINAL MASSES IN IBADAN
No full textABSTRACTObjective: To determine clinical features, anatomic location and histological types of primarymediastinal masses diagnosed and treated in a black African population.Design: A retrospective study of clinical data collected from patients case notes, thecardiothoracic unit’s and pathology records between June 1975 and May 1999.Setting: University College Hospital, Ibadan, Nigeria which hosts a major cancer center inthe West African sub-region, and serves community clinics.Patients: All patients with primary mediastinal masses referred for evaluation and treatment.Main outcome measures: Excluded metastatic, oesophageal and vascular- lesions. All patientshad radiological evalulation and tissue biopsies. The anatomic subdivision of the mediastinuminto anterosuperior, middle and posterior section was used.Results: One hundred and five consecutive patients were evaluated and treated. The meanage was 34.0 ± 20.4 years. There were 75 males and 30 females. Eighty one (77.1%) weresymptomatic, 24 (22.9%) were asymptomatic. Thirty seven (45.7%) of the symptomaticpatients had malignant disease while 44 (54.3%) had benign disease. Forty five patients(43%) and 60 patients (57%) had malignant and benign diseases respectively. Incidence ofsymptoms, was 82.2% for malignant and 73.3% for benign diseases. This difference inincidences is statistically insignificant (p=0.283). Majority of asymptomatic patients (70.8%)had benign disease while 29.2% of patients with malignancy were asymptomatic. Thisdifference in incidence was statistically significant (p=0.0039). The frequency of mediastinalmasses were anterosuperior, in 67 patients (63.8%), posterior mediastinal, 24 patients(22.9%) and middle mediastinal in 14 patients (13.3%). Lymphoma 23 (21.9%), thymusglands tumours 19 (18.1%) and endocrine tumours (goiters) 18 (17.1%) were the commonesttypes of primary mediastinal masses treated.Conclusion: Majority of our patients with mediastinal masses (whether benign or malignant)are symptomatic and the absence of symptoms is more associated with benign disease.Majority of lesions are situated in the anterosuperior mediastinum. Lymphoma is the mostfrequent primary mediastinal mass
EXPERIENCE WITH ROAD TRAFFIC ACCIDENT VICTIMS AT THE NAIROBI HOSPITAL
No full textObjective: To evaluate the clinical and epidemiological data on automobile injuries and toassess the adequacy of road trauma documentation at the Nairobi Hospital.Design: A retrospective descriptive study.Setting: The Accident and Emergency Centre of the Nairobi Hospital.Subjects and method: Medical records of randomly selected road trauma patients whopresented at The Accident Centre between 1st July 1997 and 31st August 1998 wereanalysed.Results: The mean age was 32 years with a peak incidence in the 21-30 year age group. Malescomprised 63.1 % of the injured. The predominant category of the road user injured was thevehicle occupant (70%). Pedestrians only constituted 21.3%. Major city roads or highwayswere the commonest scenes of injury (38.3%). Most of the responsible vehicles were smallpersonal cars (65.8%). The public service minibuses (popularly known as matatu) caused20% of the injuries. Most of the injuries were mild and transport of the injured to hospitalwas uniformly haphazard. A quarter of the injuries were severe enough to warrantadmission. Trauma documentation was poorwith less than 30% accuracy in most parameters.Conclusion: The pre-hospital and initial care of the injured is not systematized. The studycalls for re-orientation of trauma care departments to the care of the injured
GOLDENHAR’S SYNDROME: CASE REPORT
No full textA case of Goldenhar’s Syndrome (oculoauriculovertebral dysplasia) in a 3-day-oldNigerian neonate with right anophthalmos and lipodermoid, left Iimbal dermoid,bilateral preauricular appendages and mandibular hypoplasia is presented. Thelipodermoid was attached to the tarsal conjunctiva of the lower lid of the anophthalmicside. The causative factor was presumably maternal drug (traditional medicine) ingestionat three months gestation. No similar case has been reported previously. The literatureon Goldenhar’s Syndrome is briefly reviewed
BIOCHEMICAL AND MOLECULAR DIAGNOSIS OF GLUTARIC ACIDURIA TYPE 1 IN A BLACK SOUTH AFRICAN MALE CHILD: CASE REPORT
No full textGlutaric aciduria type 1 (GA-1) is an inborn error o C metabolism caused by a deficiency ofthe mitochondria1 enzyme glutaryl-Co enzyme A d:hydrogenase. GA-1 is not uncommonamongst Caucasians but to the best of our knowledgt :, it has previously not been reported inblack African children. We present a case of GA-1 in a black South African boy who wasreferred to hospital at the age of five years and ten 1 D months with dyskinesia and dystoniaaccompanied by chorea and athetosis. Radiologica examination revealed enlarged basalcisterns with bilateral fluid collection around the sylvian fissures suggestive of GA-1.Analysis of urine showed raised levels of glutaric acic 1 at 520 pmoUmmol creatinine (normal< 2.0), 3-hydroxyglutaric acid at 113 pmoUmmol crc:atinine (normal ~3.0) and a low bloodcarnitine level of 31.5 pmoM (normal 35-84). A definitive diagnosis was reached throughDNA analysis which revealed homozygosity for ar A293T mutation in the glutaryl-CoenzymeA dehydrogenase (GCDH) gene
METABOLIC CONTROL OF TYPE-2 DIABETIC PATIENTS COMMONLY TREATED WITH SULPHONYLUREAS IN A DEVELOPING COUNTRY
No full textABSTRACTBackground: Previous reports suggest that currently available drugs used in the treatmentof type 2 diabetes do not sustain glycaemic control.Objective: To assess metabolic control in type 2 diabetic patients predominantly treated withsulphonylurea drugs at primary care clinics in a developing country.Design: Descriptive.Setting: Two primary care clinics in Trinidad, West Indies.Subjects: One hundred and seventy nine (117 females and 62 males), randomly selected, type2 diabetic patients.Protocol: Body weight, height, blood pressure (BP), waist and hip circumferences weremeasured and fasting blood samples taken for glycated haemoglobin (HbAlc, glucose, insulinand lipids determinations. Fasting insulin and glucose concentrations were used to assessinsulin resistance and sensitivity (%S) using Homeostasis model assessment (HOMA)method.Results: Of the 179 patients studied, 87% of male and 92% of female patients were treatedwith sulphonylurea drugs whereas 13% and 9% of male and female patients respectivelywere managed on diet and/or exercise. Female patients had significantly higher prevalenceof obesity than males, and despite similar fasting glucose and HbAlc, levels, the females andpatients of East Indian ethnic group had significantly higher prevalence rates of insulinresistance, hypercholesterolaemia, hypertriglyceridaemia and reduced HDL-cholesterolthan the males and patients of African origin respectively.Conclusion: Consistent with previous reports, the results showed indications of poormetabolic control among the patients particularly females and patients of East Indian ethnicgroup