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   2008| January-March  | Volume 11 | Issue 1  
    Online since November 29, 2014

 
 
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ORIGINAL ARTICLES
Histopathological findings in liver biopsies and clinical correlation at Kano, Nigeria
AA Samaila, AZ Mohammed, MM Borodo, BM Tijjani
January-March 2008, 11(1):20-23
Background: Proper evaluation of liver disease requires histological diagnosis of liver biopsy specimens which form the basis for rational treatment and monitoring, as well as assessment of disease severity and progression. We report the histological findings in liver biopsy specimens obtained by percutaneous blind needle biopsy in Kano, Nigeria over a two year period (February 2002-April 2004). Materials and methods: Percutaneous blind needle liver biopsy (PBNLB) was performed in 37 consecutive patients with clinical, laboratory and ultrasonographically established liver disease using the Menghini suction needle after observing necessary precautions. Liver tissues obtained were processed and stained with Haematoxylin and Eosin (H&E), reticulin and Masson's trichrome stains before being reported on by a Histopathologist. Results: Adequate liver tissues were obtained in 36 patients with one reported as inadequate sample for histological assessment giving a failure rate of 0.027% for this study. The Commonest histological finding was chronic hepatitis accounting for 15 (40.5%) followed by PLCC in 10 (27%) of the patients. The other findings were cirrhosis in 5 (13.5%), extra hepatic biliary obstruction in 2 (5.4%) normal histology in 2 (5.4%), cholestatic hepatitis in 1 (2.7%), while reactive changes and inadequate sample were each reported in 1(2.7%) of the patients. Thirty two (86.5%) and 1 (2.7%) of the patients were positive for HBV and HCV respectively. The prevalence of HBV in cirrhosis, PLCC and chronic hepatitis were 100%, 90% and 86.7% respectively. One patient (2.7%) who was a case of PLCC tested positive for HCV antibody and this patient was positive for HBV as well. Conclusion: HBV related liver diseases (chronic hepatitis, cirrhosis and PLCC) are prevalent in this environment despite the almost totally preventable nature of the virus. It is therefore recommended that screening and vaccination for HBV should be encouraged and that those found positive for HBV be referred to a specialist early for proper evaluation and follow up. These measures will no doubt reduce the morbidity and mortality associated with HBV infection in this environment.
[ABSTRACT]   Full text not available  [PDF]
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The clinical spectrum of paediatric neurological disorders in Aminu Kano Teaching Hospital, Kano
RO Belonwu, GD Gwarzo
January-March 2008, 11(1):12-14
Background: Neurological disorders have been noted to account for more than 20% of global disease burden and that poor countries are disproportionately affected. The aim of this review was to highlight the clinical spectrum of neurologic disease seen in Kano as there had been no previous report from the center. Materials and methods: The medical records of all children who attended the paediatric neurologic clinic over 8-year period were examined and all relevant data were extracted and analysed. Results: Three hundred and fifty six patients were reviewed. There were 222 males and 134 females with ratio of 1.7:1. Age range was 2 months - 12years. Some patients had multiple morbidities. The predominant neurologic morbidities included: cerebral palsy (42.4%), epilepsy (27.8%), febrile seizure (6.5%), mental retardation(6.2%), microcephaly (5.6%), behavioral problems (5.6%), poliomyelitis (4.5%), hydrocephalus (4.2%), visual impairment (2.8%), down syndrome (1.7%), and attention deficit hyperactivity disorder (1.4%). A few others occurred infrequently. Birth asphyxia featured prominently in aetiology of cerebral palsy and epilepsy. Conclusion: It is suggested that preventive measures through health education and improved perinatal health services will greatly help in reduction of neurologic morbidities in Kano.
[ABSTRACT]   Full text not available  [PDF]
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Neural tube defects: Epidemiologic factors, clinical presentation and outcome in North Eastern Nigeria
M Bello, AM Abubakar, RT Akuhwa, SJ Yahaya, S Adamu, Y Mava
January-March 2008, 11(1):34-37
Background: Neural tube defects (NTDs) are important factors in fetal and infant morbidity and mortality with variations in incidence and ethnic distribution. This study was carried out to determine the epidemiologic factors, clinical presentation, types and immediate neonatal outcome of neural tube defects. Methods: The clinical records of all babies admitted with NTDs into the Special Care Baby Unit (SCBU) of the University of Maiduguri Teaching Hospital (UMTH) were prospectively reviewed over a 5-year period. Results: A total of 103 babies were admitted with NTDs. The overall incidence of NTDs in this study was 43/1000 admission with a yearly admission rate of between 2.3 - 8%. The age of the mothers ranged from 15 to 38 years. There were 56 (54.4%) males and 47 (45.6%) females. Of the 103 babies, 87 (84.5%) had spina bifida cystica, 15 (14.6%) had occipital encephalocele, while 1 (0.9%) had anencephaly and died within 8 hours of delivery. All the 87 patients with spina bifida cystica were ruptured and infected at presentation, with seven of them dying from overwhelming sepsis. Most of the babies (58.3%) were delivered at home. Only 2 of them were delivered at the University of Maiduguri Teaching Hospital, Maiduguri. Conclusion: The incidence of NTDs in this study was high and on the increase with many of the mothers booking late for antenatal care and delivering at home. There is the need for improvements in all factors that will encourage women attend antenatal clinic and deliver in the hospital. The need for folic acid supplementation in women of childbearing age and fortification of foodstuff with folic acid is highlighted.
[ABSTRACT]   Full text not available  [PDF]
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REVIEW ARTICLE
Carcinoma of the uterine cervix in nigerian women: The need to adopt a national prevention strategy
LR Airede, JUE Onakewhor, ME Aziken, ABA Ande, JU Aligbe
January-March 2008, 11(1):1-11
Background: Cervical cancer is the second most common type of cancer affecting women, and was responsible for over 250,000 deaths in 2005, approximately 80% of which occurred in developing countries. Without urgent action, deaths due to cervical cancer are projected to rise by almost 25% over the next 10 years. Prevention of these deaths will contribute to the achievement of the Millennium Development Goals. In Nigeria, carcinoma of the cervix is the commonest malignancy of the female genital tract, with an estimated incidence of 32 per 100,000 females. As a result of extremely poor knowledge and attitude towards cervical screening, and limitations posed by lack of facilities and human resources for its control, many women are presenting with, and dying from, complications of advanced stages of this preventable disease. Unfortunately, there are only five major functional radiotherapy facilities in Nigeria at present culminating in very long waiting queues for treatment. Consequently, many women never benefit from treatment before they die in despair. The subject of this review is to explore how this situation can be reversed. Objective: To determine the magnitude of, and social factors associated with, cervical cancer in Nigeria and the efforts being made to reduce the disease burden in Nigerian women. To proffer cost-effective strategies for intervention. Method: The review of previous strategies employed in targeted, hospital-based cervical screening programs in Nigeria and literature search in Medline, PubMed and Google. Results: There is poor public awareness of cervical cancer and strategies for its prevention. The utilization of hospital-based prevention programs (cervical screening) is extremely poor leading to a minute percentage of the population at-risk being reached. Many women present with advanced stages of the disease that require radiotherapy, which many can neither access nor afford. Conclusion: The number of Nigerian women with unmet need for cervical cancer screening is large. We recommend the augmentation of current prevention strategies with three pragmatic models viz the "Hub and Spoke Model", the "Mobile Van Cervical Cytology Clinic (MV3C) Model" and the "Screen and Treat Model" to reach the larger rural population who are the predominant victims of this disease.
[ABSTRACT]   Full text not available  [PDF]
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ORIGINAL ARTICLES
Clinical pattern of male breast cancer in Ile-Ife, Nigeria
AO Adisa, OA Arowolo, OI Alatise, OO Lawal, ARK Adesunkanmi
January-March 2008, 11(1):24-27
Background: Carcinoma of the breast in males is of interest because it is relatively uncommon and because presentation of the disease in hospitals is usually late owing to poor awareness and neglect. This study aimed to describe the pattern of the disease in our hospital. Method: Consecutive cases of male breast cancer presenting at the Ife Hospital Unit of the Obafemi Awolowo University Teaching Hospitals Complex, lle-lfe, Nigeria between January 1993 and December, 2003 were studied noting the manifestation, duration of symptoms, diagnoses, treatment and outcome in the patients. Results: Of 249 histologically proven cases of breast cancer managed during the study period, 8(3.2%) were males, giving a male to female ratio of 1:31. They were aged 51-80 years with a mean of 64.7 +SD9.7 years. Mean duration of symptoms before presentation was 9 months. Painless breast mass and ulceration were the commonest symptoms. All patients presented in the late disease stage, 3(37.5%) in AJCC stage III and 5(62.5%) presented with stage IV disease. Histopathology in 6(75%) confirmed invasive ductal carcinoma, the two others had only fine needle aspiration cytology diagnosis. Three of the patients had simple mastectomy while others due to advanced disease could only be offered adjuvant chemotherapy and radiotherapy. After 2 years of follow-up, 3(37.5%) patients had died, one patient had re-presented with recurrence at the site of operation while the other 4 patients (50%) had been lost to follow up. Conclusion: The study underlined the uncommon occurrence of male breast cancer and late presentation, low survival rate and poor follow up of cases in our environment.
[ABSTRACT]   Full text not available  [PDF]
  444 51 -
BRIEF REPORT
Slow progression of paediatric HIV disease: Is it a chance phenomenon or selective adaptation?
SI Adeleke
January-March 2008, 11(1):38-40
Background: Disease progression in human immunodeficiency virus / Acquired immunodeficiency syndrome (HIV/AIDS) is affected by several factors both external and internal to the human hosts. The European populations the chemokine-cell receptor variant CCR5 "Delta 32" is the genetic determinant of HIV disease progression that is believed to have been selected for the general population by exposure to antigens closely interlinked to HIV like Yersina pestis or small pox virus. It is thought 1 that among the African population, the selection is induced by HIV over time. Objective: To present two cases of mother to child transmitted HIV highlighting the possible increasing prevalence of slow disease progression. Results: Both patients were female, had lost one parent more than 10years earlier but had the other surviving parent exhibiting slow HIV disease progression. A possible inheritance of the genetic factors associated with slow disease progression in a recessive x-linked mendellian pattern and role of the high prevalence of HIV within the Sub-Saharan setting as the selective pressure favoring the establishment of the currently known immunologic and genetic factors influencing HIV disease progression was postulated. Conclusion: The cases have shown that there are slow progressors among the HIV patients and, therefore, there is the need for clinicians to be aware of these groups of patients. It is important to have an in depth of immunologic and genetic approach to examine the prevalence and possibility of adaptive selection for immunogenetic protectors of HIV progression in the region.
[ABSTRACT]   Full text not available  [PDF]
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ORIGINAL ARTICLES
The value of high dose frusemide in the management of 350 open prostatectomies
IO Ntia
January-March 2008, 11(1):28-33
Background: The use of frusemide in open and closed prostatectomy has provided a distinct advance over osmotic diuretics. Objective: To report our experience in the use of high dose infusion of frusemide in the postoperative management of 350 open prostatectomy and discuss its benefits. Patient and Methods: The study included 350 consecutive patients with benign prostatic enlargement who were managed with open prostatectomy and high dose frusemide infusion for bladder irrigation. The age ranged between 49 and 90; the mean age was 61 years. 330 (94.0%) patients presented with urine retention. Other associated medical and surgical conditions were adequately treated before, during and after prostatectomy. Suprapubic prostatectomy was performed on 319 (91.1%) patients while retropubic prostatectomy was on 31 (8.9%) patients. General anaesthesia was administered on 196 (54.6%), spinal analgesia on 139 (39.7%) and epidural analgesia on 15 (4.3%) patients. Blood transfusion, intravenous fluid and frusemide were given during and after operation to replace losses and maintain urine flow. A group of 100 consecutive prostatectomy were given Darrows solution, 1 litre in the first day and 1 litre in the second day following operation. Patients were carefully monitored during the 48 hours of intravenous fluid and frusemide infusion regime. Fluid intake, urine output, sodium and potassium losses in urine were studied in both group of patients. Frusemide infusion regime was carefully followed. Fluid intake regulated to be at least 500mls ahead of urine output during the infusion regime. Frusemide administration was discontinued at the end of the first 24 hours following operation and oral fluids commenced. Results: Intraoperatively, 268 (76.6%) patients were transfused with one unit of blood each; 40 (11.4%) patients received 2 units of blood each while 42 (12.0%) patients did not require blood transfusion. The average daily urinary electrolyte losses were 450 mmol of sodium and 32 mmol of potassium. The levels of serum sodium and potassium remained within the normal range in all patients. In the first 24 hours fluid intake ranged between 5.5 and 8.5 litres while urine output ranged from 3.8 to 6.4 litres. 28 (8.0%) patients complained of nausea and 10 (2.9%) vomited each once following the bolus intravenous injection of 40mg of frusemide. Two patients died on the 6 th and 8 th postoperative days respectively. Mortality was 0.6 percent. Conclusion: The use of high dose frusemide infusion in open prostatectomy is simple to administer, safe, cost effective and not associated with significant potassium depletion.
[ABSTRACT]   Full text not available  [PDF]
  419 44 -
Splenic operations in a teaching hospital, South-Western Nigeria
AS Oguntola, AOA Aderonmu, ML Adeoti, SA Olatoke, RO Bello, TB Rabiu
January-March 2008, 11(1):15-19
Background/Objective: To review all Splenic operations performed at LAUTECH Teaching, Hospital (LTH) over a four year period- highlighting the indications, associated injuries in trauma patients, complications, outcome of management and follow up care. Patients and Methods: Information including demographic data, indications for operation,, treatment and follow up care were obtained from case notes, theatre records and histology laboratory records; these were analyzed by simple percentage. Result: Twenty-six cases (M: F-18.8) with ages ranging between two and fifty-two years (mean 24.8 years) were treated. Eighty-eight percent were done as emergencies, 95% of these were for blunt abdominal injuries. Road traffic accident was the cause in above 50% of all patients with injuries while other indications included TSS, haematological, etc. Four (17%) of trauma patients had splenic preservation procedures done. Patients with wound infection, wound dehiscence and acute gastric dilatation were seven, five and one, respectively. No case of overwhelming post-splenectomy sepsis was seen. Mortality was 15.4%. Conclusion: As trauma is the most common indication for operations on the spleen, spleen conservation should be practiced more often where open procedures are indicated.
[ABSTRACT]   Full text not available  [PDF]
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