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   2014| October-December  | Volume 23 | Issue 4  
    Online since December 9, 2020

 
 
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COMMENTARY
An appraisal of ethical issues in end-of-life care

October-December 2014, 23(4):358-364
Caring for patients at the end-of-life period could involve a number of situations and incidents that pose moral dilemma for both the health workers and the patients' family members or loved ones. Some of these issues include shared decision-making, the right to refuse medical treatment, medical futility, and euthanasia versus assisted suicide, information disclosure (truth-telling), substitute decision-making, and confidentiality. They may seem improbable or remote, until one is confronted with them real-time. Providing good care for dying patients requires that physicians and other members of the health care team be knowledgeable of ethical issues pertinent to end-of-life care.
[ABSTRACT]   Full text not available  [PDF]
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CASE REPORTS
Human cysticercosis of the breast mimicking breast cancer: A report of a case from Ile-Ife, Nigeria

October-December 2014, 23(4):351-354
BACKGROUND: Human cystericosis is the infection caused by the larvae of pork tapeworm Taenia solium.The infection commonly affects the muscle, the central nervous system and subcutaneous tissues.The involvement of the breast is unusual. OBJECTIVE: To present a 54 years old postmenopausal woman, a petty trader and a Jehovah witness who presented with a painless lump in the right breast which was increasing in size.The mass was clinically diagnosed by the Surgeon who examined her as a case of right breast cancer and an excisional biopsy was done. METHOD: A review of the case note, autopsy findings including gross and microscopic examinations and literature was done. RESULTS: A histopathological appraisal of biopsy revealed the presence of the typical cysticercus larva and a definitive diagnosis of right breast Cystericosis was made. The diagnosis of cysticercosis in unusual sites such as breast may be clinically difficult and this supports why all biopsies must be sent to the pathologists for definitive diagnosis. CONCLUSION: Human cystericosis of the breast is rare, nevertheless, this should be considered as a differential diagnosis for a mass in the breast particularly in the tropics and developing countries.To the best of our knowledge, this is the first case from our centre.
[ABSTRACT]   Full text not available  [PDF]
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Carcinoma head of the pancreas masquerading as hepatocellular carcinoma: A case report

October-December 2014, 23(4):355-357
BACKGROUND: Cancer of the pancreas is the primary malignant tumour of the pancreas commonly seen in the elderly. Hepatitis B virus infection is not a known marker of the disease, but patient with carcinoma head of the pancreas presenting with epigastric mass with positive hepatitis B infection in the region of the world with high endemicity for hepatitis B virus infection may cause diagnostic pitfall. OBJECTIVE: To present a case of carcinoma head of the pancreas masquerading as hepatocellular carcinoma. METHODS: A review of the case note, autopsy findings including gross and microscopic examinations and literature was done. RESULTS: An elderly woman with history of weight loss and cigarette smoking.There was an epigastric mass and the liver was enlarged.The serum hepatitis B antigen was positive. Autopsy revealed an ill-defined mass in the head of the pancreas with metastasis to the liver. CONCLUSION: Things are not always what they seem.
[ABSTRACT]   Full text not available  [PDF]
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ORIGINAL ARTICLES
Pattern of neurological admissions in the tropics: Experience at Abakaliki South-Eastern Nigeria

October-December 2014, 23(4):302-305
Background: The pattern of neurological admissions varies amongst different regions of the world and this depends on many factors including the regional burden of neurological disorders. This study determined the pattern of neurological admissions in a tertiary health centre in Abakaliki South Eastern Nigeria and compared it with that from other parts of the country. Methodology: A review of admissions into the medical wards of the Federal Teaching Hospital Abakaliki southeastern Nigeria from July 2012 to June 2013 was done using the register of admissions and discharges. Results: Out of 1247 patients admitted in medical ward over the study period, 267 (21%) had neurological disorders with mean age of 55.1±20.2years.There were 154(58%) males and 113(42%) females, with a sex ratio of 4:3. Seventy two percent of the patients were between 30 and 69years. Stroke accounted for 62% (166) of the neurologic admissions. Others were central nervous system (CNS) infections, seizure disorders, hypertensive encephalopathy, myelopathies,CNS tumors and neurodegenerative disorders in descending order of frequency. Conclusions: The burden of neurological disorders is high with male preponderance in Abakaliki south-eastern Nigeria affecting mainly the productive population. Stroke and CNS infections were the most prevalent neurological disorders identified which are both largely preventable.There should be good health planning that will address the enormous neurological disease burden with emphasis on preventive health.
[ABSTRACT]   Full text not available  [PDF]
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Fetomaternal outcome of twin gestation in Port Harcourt, South-South, Nigeria

October-December 2014, 23(4):282-287
Background: Twin pregnancy is a high risk pregnancy with significant implications for both mother and baby.This study is to assess the current status of twin gestation in Port Harcourt in view of the rising incidence worldwide. Objective: To determine the prevalence, fetal and maternal outcomes of twin gestation at the University of Port Harcourt Teaching Hospital (UPTH). Materiais and Method: This was a 5-year retrospective analysis of hospital records of mothers who had twin gestation and delivered at UPTH between January 1st 2008 and December 31st 2012. Results: The prevalence of twin gestation was 16 per 1000 deliveries.The Mean age and parity were 29.63±4.1 and 1.65±1.3 respectively. Premature delivery occurred in 30.8% of cases. Antenatal complications were observed In 66.0% with anaemia being the commonest complication. Caesarean section was performed for 51.06% while 47.34% had successful vaginal delivery and discordant delivery accounted for 1.6%.The commonest intrapartum complication was fetal distress in 42.86%.There was no significant difference in the mean birthweight between first and second twin. Unbooked status was significantly associated with birth asphyxia (x2=8.25,p=0.004) and perinatal mortality (x2=5.04,p=0.02).Monochorionic placentation was also significantly associated with perinatal mortality (x2=5.52,p=0.018).The perinatal mortality rate was 55.85/1000 total birth while the maternal mortality ratio was 281.09/100,000 live birth. Conclusion: Twin gestation in Port Harcourt is still associated with significant maternal and perinatal morbidities and mortality. Early initiation of specialist care in the management of twin gestation and improvement in neonatal care facilities will improve the outcome of twin gestation in Port Harcourt.
[ABSTRACT]   Full text not available  [PDF]
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Trauma admissions into the intensive care unit and outcome of care in a tertiary health facility

October-December 2014, 23(4):296-301
Background Trauma remains a leading cause of morbidity and mortality in resource challenged economies 1. In Nigeria, the number of deaths due to trauma-induced injuries is on the rise. Major trauma victims are usually from road traffic accidents and are managed at the accident and emergency unit while the severe ones are admitted into the intensive care unit Methodology All trauma admissions to the intensive care unit (ICU)of LAUTECH Teaching Hospital Osogbo over a 5year period (2008-2012) after ethical approval from the ethical unit of the hospital were reviewed. Results During the study period, 112 trauma patients were admitted to the ICU, representing 68% of total ICU admissions. The male: female ratio of ICU trauma cases was 3:1.Out of the trauma admissions 83(74.1%) of the cases came as emergency from the accident and emergency unit while 2.4% and 1.6% respectively came from operating theatre and the general ward respectively. 83(74.1%%) of trauma cases admitted were road traffic accidents, while 20(17.9%) were burns not related to RTA and the remaining 8(9%) were due to falls, fight/assault. Most of the road traffic accidents related trauma patients admitted to the intensive care unit had head injuries (66.3%) while 7% and 12% had multiple fractures and chest injuries respectively. The mean patient age was 35 years and the mean duration ofICU stay was 6.3±8.4 days. Survivors had a longer ICU stay Conclusion: Trauma is a major cause of hospitalization and intensive care utilization. It also consumes a significant amount of the health care budget. In most instances it is preventable.Trauma prevention, the most effective management strategy, should include increased public education, improved security, better implementation of legislative measures to ensure safety for all road users,control of firearms,and minimizing domestic and intentional violence.Appropriate, aggressive intensive care in combination with efficient communications, rapid medical evacuation, and an organized emergency multidisciplinary trauma care team will further improve outcome in trauma patients.
[ABSTRACT]   Full text not available  [PDF]
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REVIEW ARTICLES
Permanent neurological damage after spinal anaesthesia

October-December 2014, 23(4):330-334
The use of subarachnoid block for various surgeries is becoming common and it is without complications.There many complications of spinal anaesthesia but one of the devastating of such complications that can lead to permanent disability and psychological trauma for the anaesthetist is permanent neurological damage. METHOD: This is a review article of various works on neurological damage following spinal anaesthesia using different search engines such as PubMed and Google. CONCLUSION: Permanent neurologic damage can occur after spinal anaesthesia but its incidence is low.
[ABSTRACT]   Full text not available  [PDF]
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ORIGINAL ARTICLES
The prognosis of acute stroke in a tertiary health centre in South-East Nigeria

October-December 2014, 23(4):306-310
Background: Stroke is a common neurologic disorder and it is the third leading cause of mortality worldwide after ischaemic heart disease and cancer.This study determined the prognosis of acute stroke in Federal Teaching Hospital Abakaliki (FETHA) South-East Nigeria. Methodology: It was a retrospective, descriptive and hospital based study conducted in a tertiary health centre in Abakaliki south-east Nigeria. The stroke register of the neurology unit was reviewed and relevant data were extracted and analyzed. Results: Stroke accounted for 12% of medical death with 24hour, 7day and 30day mortality rates of 5%, 10% and 15% respectively. Factors associated with stroke mortality include advanced age, female sex, extremes of blood pressure, loss of consciousness and haemorrhagic stroke. Conclusion: There should be regular health education with emphasis on primary prevention of stroke. Also, stroke patients should be referred early to a stroke unit for adequate management.
[ABSTRACT]   Full text not available  [PDF]
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Evolving pattern of Spinal anaesthesia in stable eclamptic patients undergoing caesarean section at University of Benin Teaching Hospital, Benin, Nigeria

October-December 2014, 23(4):288-295
Background: Eclampsia is still associated with high maternal and perinatal and perinatal morbidity and mortality, especially in resource poor countries with limited access to perinatal and critical care facilities.The ideal method of anaesthesia for caesarean section in eclamptics is not generally agreed upon. Methods: Review of the patients' case notes as well as records of the institutions Labour WardTheatre, Intensive Care Unit and Postnatal Ward was carried out between January 2011 and December 2012. Patients’ clinical and demographic data, anaesthetic management methods, maternal and perinatal outcome measures were evaluated and analysed. Results: Ninety-nine cases of eclampsia were reviewed, of which 87 had Caesarean section.After excluding five patients who had intercurrent medical ailments, 82 patients were finally analyzed. Of these, 65 (79.3%) had spinal anaesthesia while 17 (20.7%) had general anaesthesia. Out of the 19 (23.2%) who were transferred to the intensive care unit, 12 (70.6%) had general anaesthesia while 7 (10.8%) had spinal anaesthesia. Of the 17 patients who had general anaesthesia. 10 (58.8%) were ventilated post operatively versus only 2 (3.1%) in spinal anaesthesia. Nine of the 17 general anaesthesia patients (52.9%) versus only 1 of 65 spinal anaesthesia (1.5%) died in ICU. Apgar was two fold better in the spinal anaesthesia group at 5 minutes.There was a higher risk ratio for stillbirths in the general anaesthesia patients. Conclusion: maternal and perinatal survival and well being are better in eclamptics who had spinal anaesthesia for caesarean section compared to those who had general anaesthesia.
[ABSTRACT]   Full text not available  [PDF]
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Uterine packing in the management of complete placenta praevia

October-December 2014, 23(4):321-324
Background: Complete (type 4) placenta praevia is a major cause of haemorrhage in Obstetrics. Uterine packing is an effective but underutilized life-saving intervention in situation of uncontrolled haemorrahage due to major placenta praevia. Objectives: To reappraise the effectiveness of uterine packing in the management of complete placenta praevia in order to popularize the practice. Methods: Seven case series of complete placenta praevia were managed with uterine packing in Enugu, Nigeria between January 2, 2012 and February 28, 2013. Results and Interpretation: Previous Caesarean delivery (85.71%) was the commonest identified risk factor for complete placenta praevia. Uterine packing was effective in preventing blood transfusion in 57.14% of the cases,and further post-operative intervention in 85.71%.Peripartum hysterectomy and maternal death were 100% avoidable. Conclusion: Uterine packing is an effective life-saving intervention in management of complete placenta praevia. The technique should be considered whenever there is uncontrollable haemorrage following complete placenta praevia.
[ABSTRACT]   Full text not available  [PDF]
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Pregnancy, parturition, parity and position in the family. Any influence on the development of paediatric inguinal hernia/hydrocele?

October-December 2014, 23(4):311-314
Aim: To see if pre-partum factors have a relationship to the development of inguinal hernia in children. Method: A prospective study on children with hernia. On first contact, the affected child was examined and data like the age,sex, weight, blood group, the diagnosis,side of the lesion and other co-morbid conditions was recorded. The mother filled a questionnaire about her age, parity, illness during pregnancy, her mode of delivery and the patient's position in the family. Results: There were 104 patients from 103 mothers, their ages ranged from 13days to 14 years with the highest incidence in the 1-4 age group. The sex ratio was overwhelmingly male (M:F ratio was 38:1). Right sided hernias were predominant. Only 7% had a family history.The peak: age group of the mothers was 26-32 years and about 33% of the mothers had some illness during pregnancy.The birth positions of the patients showed that majority of them were either 1st or 2nd born children. Conclusion: Women of ages 26-32 likely to have children with inguinal hernia. Malaria during pregnancy is unlikely to have a role to play. 1st and 2nd born male children have a higher chance of having inguinal hernia.
[ABSTRACT]   Full text not available  [PDF]
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Case series of child sexual abuse: Abia State University Teaching Hospital experience

October-December 2014, 23(4):325-329
Background : Child sexual abuse remains a serious infringement on the rights of the child.Though it appears to be viewed less seriously among adolescents, the consequences may be more severe and less obvious for the younger child.Age of the child appears not to be a deterrent.There is paucity of local data in the sub-region on this important social problem.The circumstance surrounding child sexual abuse in our environment needs to be reviewed.This study sets out to evaluate the characteristics of victims of child sexual abuse and to proffer solutions on how to stem the tide of the crime. Objective: To examine the characteristics of sexually abused children presenting to the paediatrics department of Abia State University Teaching hospital, Aba. Method: The case records of 10 consecutive cases of sexually abused children that presented to the Children Outpatient Department of Abia State University Teaching Hospital (ABSUTH) Aba,from January to June 2006 were prospectively reviewed and the parents/child/abuser interviewed where possible. Results: All the victims were females aged 3 – 11 yrs, while all the abusers were males 14-29yrs.Both parties were of low socio-economic Cass. 50% of the victims reported the incident. Mental and psychological state of the perpetrators appears to be a factor. Physical injuries to the vulva-vaginal areas were common Conclusions: This study shows that child sexual abuse may not be uncommon in our environment. The exact prevalence remains unknown. The perpetrators of child sexual abuse should be prosecuted as a deterrent and rehabilitated whenever possible.
[ABSTRACT]   Full text not available  [PDF]
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Case histories of brain fag syndrome in Nigerian University undergraduates

October-December 2014, 23(4):315-320
Background: Brain fag syndrome since the 1960s was identified as a medical problem among Nigerian students and till date there are varying opinions on its aetiology and classification. Recently it was grouped among the culture bound syndromes in the Diagnostic and Statistical Manual of Diseases (IV).This is a critical report on the clinical presentations of the brain fag syndrome in Nigerian undergraduate students. Method: Previous literatures on brain fag syndrome were carefully reviewed and related to the syndrome presentations in the presently reported cases. Results: The clinical findings indicate underlying primary memory problems in the students and secondary other manifestations like depression, anxiety,and varying somatic complaints. Conclusion: Brain fag syndrome might be a primarily reversible dysfunction of the working memory circuitry with multiple predispositions and precipitants
[ABSTRACT]   Full text not available  [PDF]
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REVIEW ARTICLES
Adverse effects of nickel in transosseous wires and surgical implants: Literature review

October-December 2014, 23(4):335-343
Introduction: Transosseous wires used in the management of fractures are stainless steel alloys which contain nickel 14.5%, chromium 17.6%, Iron 62.5% and m olybdenum 2.8%. Gradual disintegration of the transosseous wires release nickel into the blood leading to increase nickel concentration in the blood. Nickel has been found to have some adverse systemic effects on the body.The aim of this paper is to discuss the sources of Nickel in the body as well as the systemic adverse effects of Nickel as a degradation product of stainless steel surgical implants. Methods: A study of pertinent literature on nickel asa content of stainless steel a lloy used in implant surgery was done, taking note also of other sources of nickel in the body, the toxicokinetics of nickel and the related adverse effects of this metal and its compound in humans. Result: Asouto ome, the sources of human exposure to nickel, distribution a nd metabolism of nickel in the body, host response to stainless steel wires and the adverse effects of nickel in the body are presented. Conclusion: It may be necessary to discourage the use of wires or implants containing nickel in the management of fractures. The need for removal of these implants after they have served their purposes is emphasized.
[ABSTRACT]   Full text not available  [PDF]
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CASE REPORTS
Excision of a giant anterior chest wall neurofibroma and chest wall reconstruction with methlymethacrylate and vertical rectus abdominis musculocutaneous flap: Case report

October-December 2014, 23(4):344-350
INTRODUCTION Plexiformneurofibromas (PNFs) are benign nerve tumours resulting from aberrant growth of cells of nerve sheath. PNFs are generally painless, slow growing neoplasms. Although most neoplasms are asymptomatic, they can be particularly debilitating due to their potential to grow to very large sizes. They have potential for transformation into highly malignant peripheral nerve sheath tumours which occur in approximately 5% of patients.They can affect most parts of the body. When they occur in the chest wall, they are amenable to excision. Following excision, a surgeon is faced with a large skeletal and soft tissue defects which pose functional and cosmetic challenges. CASE PRESENTATION We present a 24-year-old farmer that presented with a giant anterior chest wall plexiformneurofibroma that was noticed since childhood. He had excision of the mass and skeletal reconstruction with methylmethacrylate sandwiched in prolene mesh and soft tissue coverage with vertical rectus abdominismusculocutaneous flap. CONCLUSION We conclude that the use of methylmethacrylate and myocutaneous flaps give both good functional and cosmetic outcome following excision of large chest wall tumours.
[ABSTRACT]   Full text not available  [PDF]
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