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   2006| April-June  | Volume 9 | Issue 2  
    Online since December 22, 2014

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Severe anaemia in childhood in Sokoto, Nigeria
NM Jiya, T Yusuf, KI Airede
April-June 2006, 9(2):52-55
Background: Blood transfusion still remains the standard treatment of severe anaemia despite the dangers or risk of transmission of HIV and Hepatitis B and C viruses asso iated with it. Objectives : To determine the prevalence, aetiology, presentation, severity and outcome of severe anaemia among the children admitted into Emergency Paediatrics Unit (E.P.U.) of our Teriary Hospital in Sokoto, Nigeria . Methods : This was a 3-year prospective study conducted in Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, of severe anaemia cases admitted into E.P.U. (i.e. between January, 2000 and December, 2002). Information from the study proforma included date of admission, age, gender, symptoms and signs at presentation , complication(s) developed, haemotocrit (PCV), causes of anaemia, haemoglobin (Hb) electrophoresis and outcome of treatment. Severe anaemia was defined according to WHO criterion of Hb concentration of less than 5gm/dl or PCV :S 15%. Results: One hundred and twenty seven (127) of the 4,717 (2.7%) patients were diagnosed with severe anaemia over the study period. The M:.F ratio identified was 1.8:1; with a significant male preponderance. The mean age ΁ (SD) was 4.6 ΁ (2-95) years (ranges, 3 months- 15 years) . The majority (73.3%) of cases were under 5 year of age. Also, majority of the cases presented during the rainy season (May to September) , with an annual rise in prevalence rates; 28.3%, 2000; 29.1%, 2001 and 42.6%, 2002. The main symptoms at presentation was fever (88.2%) whilst the physical sign of pallor was seen in all patients. The PCVs (degree of anaemia) were :S 5% in 6/127 (4.7%); 6- 10% in 48 (37.8%) and 11 - 15% in 73 (57.5%) of our cases. Malaria was the leading cause; with malaria parasite being present in 80 (62.9%) cases. Hb electrophoresis pattern revealed 70 (55·% ) as AA; 42 (33.1%), SS; 6 (4.7%), SS + F and 8 (6%), AS. Anaemic heart failure and convulsion were the main complications encountered in this study. 110 (86.6%) of the patients were transfused with fully screened packed red cells blood. 99 (77.9%) of them were discharged home and to be seen at out-patient clinic, 8 (6.3%) signed against medical advice, and 20 of them died; yielded a case-fatality rate of 15.7% . Conclusion: The increasing incidence of severe anaemia in childhood necessitating blood transfusion, with the associated risk of HIV and Hepatitis B and C transmission, is a major health problem. Therefore, more aggressive measures at prevention and early detection, and appropriate treatment of malaria , as the leading cause of severe anemia in our environment, should be vigorously pursued promoted , supported and sustained.
[ABSTRACT]   Full text not available  [PDF]
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Lupus anticoagulant in adult sickle cell anaemia patients
E Olayemi, NKD Halim, MA Durosinmi,
April-June 2006, 9(2):64-68
Background and Objectives: The lupus anticoagulant (LA) is an antiphosphollpid antibody (APLA), which prolongs phospholipid - dependent coagulation tests by interfering with coagulation reactions dependent on protein- phospholipid complexes in vitro. LA has been described in patients with beta-thalasaemia and children with SCD. This study was designed to determine the frequency of LA in adult SCA patients and if present in some patients to compare the frequency of crises, complications, blood transfusion, packed cell volume (PCV) and platelet count among SCA patients with LA and those without LA. Methodology: One hundred and forty nine SCA patients were screened for the presence of LA using the KCT. Kaolin clotting time index (KCTI) was calculated to determine the presence of LA; a ratio equal to or greater than 1.2 was taken to signify the presence of LA. Results: Seventeen patients had LA with KCTI >1.2, two of these had a prior history of transient ischemic attacks. Comparisons of the means of estimated number of bone pain crises per year, age at first complication of SCA, number of admissions in the previous year before the study and PCV In SCA patients with and without LA were not statistically significant. Conclusion: KCT provides a sensitive method to screen SCA patients for LA so that those with LA can be closely monitored and treatment offered where indicated.
[ABSTRACT]   Full text not available  [PDF]
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Fever in children: Reliability of measurement by mother's touch
EAD Alikor
April-June 2006, 9(2):42-45
OBJECTIVES: To determine the reliability of touch as a method of detection and measurement of fever in children. Specifically, the study is undertaken to determine the sensitivity, specificity and predictive values of touch as in detecting fever in children. METHODS: This was a prospective hospital-based study of 207 mother/infant pairs seen as outpatients in the University of Port Harcourt Teaching Hospital, Port Harcourt , Nigeria. The 3 minute timed rectal temperature of each child was taken using the mercury-in-glass clinical thermometer. The mother was asked to check an answer whether the child was febrile "NOW". Demographic and medical information was obtained through a structured questionnaire administered to the mother by face-to-face · interview. A child was taken as having fever if the temperature was 37.5΀C or above. Temperature below 37.5΀C is taken as afebrile. RESULT: Thirty seven percent of 202 mothers who participated in the study identified their children as having fever by the touch method, whilst the rest 63% felt that their children did not have fever. With the use of the thermometer, 146 (70% ) of 207 children were identified as having temperature of 37.5΀C or above. Sixty one (29.5%) had temperature below .5΀C . Sensitivity, specificity, positive and negative pre'dictive values were calculated as 45.5%, 84.2%, 88% and 37% respectively. The -sensitivity was higher in the moderate to high grade fever than in the mildly febrile group. The specificity increased to 58.6% and 65.3% when temperatures of 37.8 and 38.0 were used as cut-off points in the definition of fever. CONCLUSIONS: From this study and the review of other works on the subject, it is concluded that detection and measurement of fever by mother's touch in our setting , although useful, need to be supplemented with measurement with a thermometer.
[ABSTRACT]   Full text not available  [PDF]
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Abdominal pregnancy presenting with antepartum haemorrhage: A case report
BN Ejikeme, OUJ Umeora, JO Mbazor, VE Egwuatu
April-June 2006, 9(2):69-70
Mrs. EC presented post term , with antepartum haemorrhage at a Nigerian Teaching Hospital. Ultrasound studies suggested Placenta Praevia type IV and intrauterine fetal death. She was planned for Emergency Caesarean Section but eventually had a laparotomy. Intra operative findings were the macerated stillborn lying in the peritoneal cavity and placenta adherent to the omentum and guts. The fetus was delivered and placenta completely excised. Post operative condition of Mrs. EC was satisfactory and was discharged 7 days later .
[ABSTRACT]   Full text not available  [PDF]
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An audit of diagnostic cytology in a teaching hospital in Sokoto, Nigeria
SA Malami, BA Ojo
April-June 2006, 9(2):56-59
Background: An audit of the pattern of utilization of the diagnostic cytology service at UDUTH, Sokoto, was done to highlight perceived shortcomings and establish Its cost effectiveness. Materials and Methods: A retrospective descriptive review of cytology tests done in 495 patients were evaluated. Results: These were principally fine needle aspirations (334) followed by voided urine (55), ascitic fluid taps (38) and others (68). Among the aspirations; breast and lymph node swellings predominated. There were no significant complications with fine needle aspiration (FNA) in our experience. The overall sensitivity of cytology for the five commonest sites in this study was 90.0% and the specificity was 77.3%. This is comparable with results obtained in previous studies. Conclusion: Diagnostic cytopathology is a useful adjunct to histology and could significantly improve the quality of patient care in our own environment. It is hoped that these simple investigations would be used more often In the future for the diagnosis of tumours and common inflammatory conditions.
[ABSTRACT]   Full text not available  [PDF]
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Human immunodeficiency virus nephropathy in children- A review
OM lbadin, OP Okunola
April-June 2006, 9(2):33-41
Background: Human immunodeficiency virus associated nephropathy (HIVAN ), was first introduced into the medical lexicon in late 1980s following the advent of HIV/AI DS . Initially thought to be peculiar to homosexuals with HIV/AIDS, it Is now known to be a com plication of HIV-1/AID.S. Objectives : To review the subject within the context of rapidly expanding literature but with emphasis on children thus drawing attention to the budding subjects. Review: The prevalence of HIVAN varies from 5-85% amongst HIVIAI DS cohorts but majority of these are in adult males drawn largely from black/Hispanic populations. HIVAN is less frequent and less fulminant in children as compared to adults. Its rate of progression to End Stage Renal Disease (ESRD) Is slower in children who commonly have varied histological pattern other than focal segmental glomerulonephrosis (FSGS) that is typical of adult type. HIVAN is characterized by massive proteinuria, azotaemia, normal blood pressure, normal to large echogenic kidneys resulting from microcyst formation and typical histologic pattern(s). The most frequent clinical expression is nephrotic syndrome, which readily progresses to ESRD. The current pandemic of HIV!AIDS worldwide would tend to suggest a parallel increase in prevalence of HIVAN . Currently it accounts for about 10% of adult cases of ESRD in the United States of America. Conclusions: HIVAN complicates mainly HIV-1 infection. In West Africa, however , substantial cases of HIV/AIDS are due to HIV -2. It remains to be seen how the AIDS pandemic and undue representation of HIV-2 as co-founding factors would affect the prevalence of HIVAN in children. Such issues and others bothering on treatment options, prognosis and histological pattern In the emerging childhood HIV /AIDS in Nigeria are discussed.
[ABSTRACT]   Full text not available  [PDF]
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Site distribution and histopathological study of extra-nodal lymphoma in Ilorin, Nigeria
EAO Afolayan
April-June 2006, 9(2):60-63
Aims: The histopathological .findings and site distribution of 44 primary extra-nodal lymphomas (ENL) diagnosed at the department of Morbid Anatomy and Histopathology of University of llorin Teaching hospital (UITH) from January 1985- December 1998 were received. The study was designed to determine the occurrence, distribution and histologic type of ENLs in study area of Nigeria. Methodology: Routine retrospective histopathologic review of case specimens. Results: There were 20 males and 24 females. Eighteen (40.9%) cases were from the gastro-intestinal tract (GIT) while 11 (25%) and 7 (15.4%) cases occurred in head and neck and the ovary respectively. sites were soft tissue 2, breast 2 and others 4 cases. Histologically, all were diffuse non-Hodgkin's lymphoma (NHL). 's lymphoma accounted for 54.5% of the cases. by histological grade, using working formulation for clinical usage were: Low grade (LG) 9.1% Intermediate grade (IG) 27.3% and High grade (HG) 63.6% Conclusion: Extra-nodal non-Hodgkin's lymphoma is common and should form part of the differential diagnoses in the neoplastic disorders of various organs and tissues to avoid wrong diagnosis and consequent mismanagement.
[ABSTRACT]   Full text not available  [PDF]
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Uterine rupture in a primigravida: A case report
Nnadi Daniel, Nwobodo Emmanuel, Ukwu Aaron, Airede Lydia
April-June 2006, 9(2):71-73
This is a report of a case of uterine rupture in an un-booked primigravida following neglected obstructed labour. Overzealous application of fundal pressure and intrauterine manipulation contributed to the uterine rupture. The main findings at surgery were incomplete anterior lower segment uterine rupture and a severely asphyxiated male baby that weighed 3200grams. Repair of the uterine rupture without bilateral tubal ligation was performed. Her post operation recovery was uneventful
[ABSTRACT]   Full text not available  [PDF]
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Prevalence of HIV sero-discordance in a resource - Constraint country
JUE Onakewhor, OJ Erhabor
April-June 2006, 9(2):46-51
Background: The management of HIV in pregnancy is a "couple's issue" and no one in the relationship takes HIV risks alone. Standard medical care for HIV/AIDS in medical appointments and health education programmes often exclude the patient's "significant others" for reasons of confidentiality. Partners' involvement in HIV management is beneficial. The determination of partners' serostatus and implementation of preventive strategies in situations of serodiscordance is essential. Objective: To determine the magnitude of serodiscordance of HIV infection among spouses of HIV positive pregnant women in Benin City, Nigeria and the level of response by partners to voluntary counseling and testing . Design: A retrospective analysis of the Partner Registers , Laboratory records of the spouses of HIV positive pregnant women and the electronic database of the PMTCT + Programme from January 1, 2003 to December 31 , 2005. Method: The study was conducted at the Department of Obstetrics and Gynecology and the Federal Government of Nigeria HIV Laboratory of the University of Benin Teaching Hospital, Benin City. Using the Double/ Triple Algorithm of rapid serological test, the HIV serostatus of spouses of HIV- positive women were determined after counseling. Results: 130 male spouses were screened. 30(23.0%) were seropositive. 100(77.0%) were seronegative. The overall Male: Female seropositive ratio was 1:4. Conclusion: HIV infection serodiscordance in our married population is large suggesting high preponderance of premarital female infections. The challenges of meeting the future reproductive needs of serodiscordant couples is highlighted.To prevent partner infection, more pragmatic ways including legislative backup is suggested. Ways of mitigating the 'feminization of the epidemic' is suggested.
[ABSTRACT]   Full text not available  [PDF]
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Integrating voluntary confidential counseling and testing {vcct) for immunodeficiency virus/acquired immunodeficiency syndrome (hiv/aids) into the national programme on immunisation: A vehicle for providing accelerated access to mother s and babies with unmet needs for prevention of mother-to-child transmission of hiv/aids
JUE Onakewhor, KI Airede
April-June 2006, 9(2):29-32
Full text not available  [PDF]
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