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   2013| July-September  | Volume 16 | Issue 3  
    Online since November 22, 2013

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Childhood diabetes mellitus in sokoto, north-western Nigeria: A ten year review
Omoshalewa Ugege, Paul Kehinde Ibitoye, Nma Mohammed Jiya
July-September 2013, 16(3):97-101
Background : There is paucity of literature on childhood diabetes mellitus (DM) from developing countries, especially North-Western Nigeria. We describe the clinical presentation and outcome of childhood DM as seen in Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, Nigeria. Materials and Methods : This was a 10-year retrospective review of case files of children aged 15 years and below with childhood DM seen between September 1 st 2001 and August 31 st 2011. The age, gender, presenting features, complications, laboratory features, and outcome of the patients were extracted and analyzed. Results: Eight out of the 23,931 children admitted during the study period were diagnosed with type 1 (T1) DM, giving a case prevalence rate of 0.33/1000 (3/10 000). The male-to-female ratio was 1:1. The mean age at presentation was 11.8 ± 3.1 years. The mean duration of symptoms before presentation was 6 ± 4.9 weeks (range 1.2-12 weeks). The most prevalent symptoms were polyuria and weight loss, 7 (87.5%) each, polydipsia, 6 (75%), polyphagia, 5 (62.5%), and weakness, 4 (50%). Five (62.5%) patients presented with diabetes ketoacidosis (DKA). The mean random blood sugar (RBS) was 22.6 ± 12.01 (range 13-49.5) mmol/L. Five (62.5%) patients were discharged while three (37.2%) left against medical advice. Four (80%) of the discharges were lost to follow up. Conclusion: Childhood DM is relatively uncommon in UDUTH, Sokoto. There is a high frequency of DKA, late presentation, and default to follow up. We recommend increased awareness campaigns and health education on childhood DM.
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Morphological variation of third ventricle using computerized tomography among different gender and age groups: A 5-year retrospective study in Usmanu Danfodiyo University Teaching Hospital, Sokoto, North - West Nigeria
JD Usman, AD Zagga, AA Tadros, G Yunusa, SA Saidu, H Ahmed, SS Bello, A Abdulhameed, SM Bello, A Bello
July-September 2013, 16(3):83-86
Background: Many methods have been described for measurements of the third ventricle as a means of evaluating brain atrophy during the normal aging process and disease. Enlargement of the cerebral ventricles is one of the most frequently replicated neurobiological findings in schizophrenia. The aim of this morphological study was to examine the range in the normal size of the third ventricle of individuals living in Sokoto and to assess its association with gender and age. Materials and Methods: All available brain CT in the Radiology Department of the Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, Nigeria, from 2007 to 2012 (a 5-year period) and reported as normal by the radiologist were recruited for the study. Films were viewed on the computer monitor. Measurements were made with Dragon V 3.1.1 Philips and Neusoft Medical System Company Limited software; the software provides a meter rule with which measurements were done. Results: A total of 252 CT scan images where used in the study. Of this number, 156 (61.9%) were CT scan images of males and 96 (38.1%) were CT scan images of females. The mean width was 8.38 mm and mean anteroposterior length was 12.16 mm. These differences were statistically significant, P = 0.0209 < (0.05). Conclusion: Our findings provide a base line data for the measurement of the third ventricles using CT scans in our environment and this may be applied in various clinical conditions involving the third ventricle.
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Bacterial isolates from the bronchoalveolar lavage fluid of patients with pneumonia not responding to initial antimicrobial therapy
Rahul Magazine, Bharti Chogtu, Shobitha Rao, Kiran Chawla
July-September 2013, 16(3):102-106
Background: Patients with community-acquired pneumonia (CAP) who are admitted in a hospital but do not respond to initial antimicrobial therapy pose a challenge to the attending physician. The knowledge of the likely pathogens and their sensitivity pattern can help the clinicians to better manage such cases. Aims and Objectives: To study the spectrum of the bacterial isolates and to determine the antimicrobial sensitivity pattern obtained from the bronchoalveolar lavage (BAL) fluid of CAP patients who did not respond to initial antimicrobial therapy. Setting and Design: A retrospective study of 87 patients who were admitted in the medical wards of a tertiary care teaching hospital in South India with the diagnosis of CAP and were not responding to initial antimicrobial therapy. Materials and Methods: The patient-related data were obtained from the case records and entered on a pre-designed proforma. This included demographic characteristics and reports of relevant clinical tests. The BAL culture and sensitivity results were also noted on the proforma. Results: The mean age of the patients was 49.28 ± 16.61 years (mean ± SD, range 17-80 years). Fifty-seven patients (65.5%) of were male. Also, 98 bacterial isolates were obtained from the BAL fluid of 87 patients. The most prevalent bacterial isolates included Pseudomonas aeruginosa (n = 35, 35.7%), Klebsiella pneumoniae (n = 19, 19.4%), Staphylococcus aureus (n = 15, 15.3%) and Acinetobacter species (n = 11, 11.2%). Most bacterial isolates tested showed 100% sensitivity to meropenem except Acinetobacter species (25%). Conclusion: P. aeruginosa and K. pneumoniae were the most common bacterial pathogens isolated from the BAL fluid. The isolates tested showed 100% sensitivity to meropenem except Acinetobacter species. All the methicillin-resistant S. aureus isolates displayed sensitivity to vancomycin, linezolid and teicoplanin.
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Epistaxis in Ido Ekiti, Nigeria: A 5-year review of causes, treatment and outcome
Olajide Toye Gabriel, Afolabi Oluwasesan Bamidele
July-September 2013, 16(3):107-110
Background: Epistax is a common otorhinolaryngological emergencies worldwide. This study determined the pattern, causes/risk factors, treatment and outcome of nasal bleeding in Ido Ekiti, Nigeria. Materials and Methods: This was a retrospective study of patients managed for epistaxis in the Federal Medical Centre, Ido Ekiti, Nigeria, from January 2005 to December 2010. Information on demographic characteristics, clinical presentation and management of epistaxis was obtained from the hospital medical records . Results: A total number of 69 patients with epistaxis were seen out of which 57 with complete data was studied. The male to female ratio was 1.7:1. Their ages ranged from 2 to 81 years, with a mean age of 44.1 years ± 20.9 SD. There were bimodal peak age groups at 21-30 and 61-70 years. Idiopathic causes of epistaxis accounted for 42.1% followed by trauma, associated hypertension, tumors, septicemia and anticoagulant therapy. The right nasal cavity was involved in 57.9%. Anterior bleeding accounted for 43 (75.4%). Majority of our patients were managed with anterior nasal packing. Surgical measures carried out included resection/clearance of nasal tumors. About 8.8% of patients had blood transfusion. Conclusion: Idiopathic and trauma from road traffic injuries were the most common causes/risk factors for epistaxis in this study. Majority of our patients were managed conservatively with anterior nasal packing.
  1 2,857 194
Pharyngeal fibromatosis presenting as adenoid hypertrophy: A case report and review of literature
Segun Segun-Busari, Adekunle David Dunmade, Biodun Sulyman Alabi, Kayode Adebamiji Adeniji, Olushola Abdulrahman Afolabi, Habeeb Kayodele Omokanye, Isaac Olarewaju Ajayi
July-September 2013, 16(3):121-123
A 10-year-old girl presented with a noisy breathing noticed from birth and failure to thrive. Examination revealed a huge lobulated firm mass in the oropharynx (toward the left side). Plain radiography of the neck showed a huge circumscribed pharyngeal mass extending from the base of the tongue to the level of the fourth cervical vertebrae. The mass measuring 6 cm Χ 5 cm was excised through a left lateral pharyngotomy. Histological examination showed sections of highly cellular interlacing bundles of fibroblast with moderate hyalinization extending to the surrounding fibro-fatty tissue. The cells have spindle nuclei with tapering ends. Occasional mitosis and in some areas myxoid degeneration were seen. A diagnosis of pharyngeal fibroma was made. Patient had an uneventful post-operative recovery with complete resolution of symptoms for the past 6 years. This rare benign tumor has not previously been reported at this site and may thus give rise to difficulty in diagnosis or to a misdiagnosis.
  - 1,208 110
Diagnosing linear immunoglobulin - A dermatosis of childhood in a resource-constrained area: Case report and review of literature
Muhammad S Mijinyawa, Shehu M Yusuf, Aminu Z Mohammed, Aisha M Nalado
July-September 2013, 16(3):124-126
Linear immunoglobulin A (IgA) dermatosis (LAD) of childhood is a self-limiting blistering eruption. At histology, the blisters are subepidermal and may be reported as resembling dermatitis herpetiformis or bullous pemphigoid. Direct immunofluorescence (DIF) of normal or perilesional skin shows a linear band of IgA at the basement membrane. Many of the patients also have a circulating IgA antibody against the basement membrane. Diagnosis of this condition in a resource constrainedcenter, where immunofluorescence is unavailable, may pose diagnostic challenges, and may therefore require high index of suspicion. We describe a case of LAD of childhood in a 7-year-old boy in this report.
  - 1,251 117
Bilateral massive corpus leteum cysts in a human immunodeficiency virus positive singleton pregnancy at term
Panti Abubakar Abubakar, Nasir Sadiya, Bilal Suleiman, Omenbelede Joel
July-September 2013, 16(3):127-129
Corpus luteum cyst at term is a rare occurrence. It is unusual for these cysts to be bilateral. We report a case of massive bilateral corpus luteum cysts in a term singleton pregnancy. A 32-year-old gravid 2, para 1, known human immunodeficiency virus positive patient on highly active antiretroviral therapy had an elective cesarean section at term on account of a low CD4 count and ovarian cysts. At surgery, she was found to have massive bilateral ovarian cysts. Each of the cysts was about the size of a 20-week size gravid uterus, (Left side 20 cm × 23 cm×15 cm; Right side 22 cm × 24 cm ×10 cm). After the 3.4 kg male baby was delivered in a good condition, a bilateral cystectomy was performed. Subsequent histopathology confirmed the diagnosis of corpus luteum cyst of pregnancy.
  - 3,072 112
Ebstein's anomaly with severe aortic stenosis and syncope: Implications in management
Vijayakumar Subban, Anitha Lakshmanan, Latchumanadhas Kalidoss, Ulhas M Pandurangi, Ajit S Mullasari
July-September 2013, 16(3):130-132
Ebstein's anomaly is a rare congenital heart disease involving the right side of the heart with typical malformations of the tricuspid valve and the right ventricle. Associated left heart anomalies, particularly aortic valve disease, are extremely rare. We report here an unusual case of Ebstein's anomaly of the tricuspid valve and severe aortic stenosis who presented to us with recurrent syncopal episodes. The patient needed to undergo electrophysiological evaluation before aortic valve replacement to rule out arrhythmic causes of syncope.
  - 1,382 121
Juvenile ocular myasthenia gravis in association with thymolipoma
Kavita Mardi, Neha Bakshi
July-September 2013, 16(3):133-135
Thymolipomas are uncommon tumors of anterior mediastinum. Their association with juvenile ocular myasthenia gravis is extremely rare. A 14-year-old boy presented with ptosis of 2 years and left-sided diplopia of 19 months duration. On examination external ophthalmoplegia and ptosis were present. Generalized muscle weakness was absent. On a neostigmine challenge test, the boy showed improvement in symptoms after 20 minutes of neostigmine injection. Anticholinesterase antibodies and antinuclear antibodies were negative. Chest CT revealed a soft tissue mass in the anterior mediastinum. Histopathological examination of the excised mass was diagnostic of thymolipoma.
  - 1,203 126
Post-traumatic cerebrospinal fluid leak: Challenge for cranio-maxillofacial surgeons
Mohammad Akheel, Suryapratap Singh Tomar
July-September 2013, 16(3):136-137
  - 1,751 173
Nigerian dentists and oral health-care of pregnant women: Knowledge, attitude and belief
Agnes O Umoh, Clement Chinedu Azodo
July-September 2013, 16(3):111-115
Background: Pregnant women seek preventive, interventional and rehabilitative oral health-care for their oral health and protection of their fetus and babies after delivery. The objective of the study was to determine the Nigerian Dentist's knowledge, attitude and belief pertaining to the oral health-care of pregnant women. Materials and Methods: This cross-sectional of Nigerian dentist was conducted between June and December, 2011 using Huebner et al., modified dentist's attitude to the pregnant women questionnaire Results: The overall response rate of 92.5% (149/160). Receipt of continuing medical education (CME) was reported among the participants on periodontal disease of pregnant patients (22.1%), oral hygiene of pregnant patients (20.1%), early childhood caries (35.6%) and general dental problem (51.0%). The majority (92.6%) agreed that Dentists have the skill to counsel pregnant patients, But only 73.8% of them provided oral hygiene instruction frequently to pregnant patients and even fewer (6.0%) were involved in educational advice on oral health for young women. Many of the participants agreed that counseling pregnant patients about periodontal disease and its effect on the developing baby is of utmost importance. Participants also dominantly agreed that dental treatment should be part of prenatal care and 97.3% of them opined that physician recommendation will increase the likelihood of pregnant seeking dental care. More than half (56.4%) of the participants reported that Dentists should be concerned about being sued if something goes wrong with the pregnancy. The recommended ways to improve oral health-care of pregnant women among the participants were through CME (92.6%), provision of educational materials on oral health-care of pregnant women (93.3%) and information on ways to counsel pregnant women (98.0%). Conclusion: Data from this study revealed high preparedness, positive attitude and favorable disposition in dental care provision for pregnant women among the studied Nigerian Dentists.
  - 2,041 242
Socio-demographic profiles and outcome of motorcycle related head injury in a Nigerian Tertiary Health Institution
Ayodeji Salman Yusuf, Timothy Olugbenga Odebode, Adekunle Ganiyu Salaudeen, Mustapha Faiz Alimi, James Olaniyi Adeniran
July-September 2013, 16(3):116-120
Background: Motorcycle increasingly has been used for commercial transportation in many Nigerian cities with attendance increase in the rate of motorcycle crashes. Head injury is responsible for high morbidity and most mortality following such crashes. The aim of this study is to determine the socio-demographic characteristics of head injured victims of motorcycle crashes, severity of head injury and management outcome. Materials and Methods: A 1 year prospective study of head injured motorcyclists and pedestrians knocked down by motorcycle were carried out at University of Ilorin Teaching Hospital using a pre-designed proforma. Information collected included the age, gender, literacy level, alcohol consumption, license status, crash helmet use, Glasgow coma score and Glasgow outcome score. The IBM statistical package for social sciences (version 15.0) statistical package was used for statistical analysis. Results: A total of140 patients with the median age of 30 years (ranged 3-90 years) were studied. They comprised 115 (82%) males and 25 (18%) females. Most patients (66%) had at least secondary education. People of varying occupations were involved in a motorcycle crash. All riders were males and most (71.8%) were unlicensed. Only 5.8% of riders wore crash helmets at the time of the crash and they all had a favorable outcome. At both extremes of age (<10 years and >70 years) more patients were involved as pedestrians. The only socio-demographic variable that influence outcome of head injury was the patient age. Outcome was better in younger age group (P = 0.004). There was 26.4% mortality. Most, 23 (88.4%), of patients with severe head injury died and none of them had good recovery (P < 0.0001). Conclusion: Our findings demonstrated high mortality among non-crash helmet wearing motorcyclists with motor cycle related head injury. The outcome was significantly influenced by age and head injury severity.
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Ear, nose, and throat foreign bodies in a tertiary health institution in Sokoto, Nigeria
Stanley B Amutta, Kufre R Iseh, D Aliyu, M Abdullahi, Goshi A Abdulrahaman
July-September 2013, 16(3):87-92
Background: Otorhinolaryngeal foreign bodies are common in ear, nose, and throat (ENT) practice. The objective of this study is to determine the pattern of otorhinolaryngeal foreign bodies in a Tertiary Health Institution in Sokoto, North-Western Nigeria. Materials and Methods: This is a 2 year retrospective study using the records of all cases of ENT foreign bodies at Usmanu Danfodiyo University Teaching Hospital, Sokoto, from January 2009 to December 2010. Data analysis was carried out using the SPSS for windows version 13.0. Results: A total of 90 cases were analysed. Ear foreign bodies 48 (53.3%) were commonest, followed by nasal foreign bodies 16 (17.8%), bronchial foreign bodies 15 (16.7%), and esophageal foreign bodies 11 (12.2%). Age range was 9 months to 64 years. High frequency of the foreign bodies was noted in the younger age group. The foreign bodies varied according to the site with plant seed being more common in the ear and the nose while meat bolus is more common in the esophagus. Bronchial foreign bodies were seen exclusively in children less than 14 years old with beads and valve of plastic toys being the most common. Conclusion: Otorhinolaryngeal foreign bodies remain frequent occurrence particularly in the younger age group 9 years old or less and high index of suspicion suggested and early intervention to prevent the morbidity and mortality from complications.
  - 5,078 330
Contraceptive choices among women attending the fertility research unit of Usmanu Danfodiyo University Teaching Hospital, Sokoto
Constance E Shehu, Ahmed T Burodo
July-September 2013, 16(3):93-96
Background: One of the most sensitive and intimate decisions made by any individual or couple is that of fertility control . The knowledge of the factors which influence contraceptive choices may increase its acceptance and uptake. This study determines the choice and reason for contraception among new clients attending the Fertility Research Unit of Usmanu Danfodiyo University Teaching Hospital, Sokoto. Materials and Methods: In this prospective study a structured questionnaire was administered to 251 consecutive clients, who attended the Fertility Research Unit of Usmanu Danfodiyo University Teaching Hospital, Sokoto between 1 July 2008 and 31 December 2008. Results: Most (58.2%) of the clients were between 21 and 30 years of age. Many (42.6%) were grand multipara. Majority (76.9%) of the clients were married. The main source of knowledge of contraception and referral (45.8%) was the physicians. Child spacing (87.7%) was the most common reason given for contraceptive use. Majority (55.8%) of the clients chose Implanon and the least preferred method of contraception was the condom (2.0%). Conclusion: Our data shows that the most commonly chosen contraceptive method in the study population was the Implanon. Child spacing was the main reason for seeking family planning while the source of contraceptive knowledge was the physicians.
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