African Journals On-line
Journal of College of Medicine

Fundamental Function of Reprints in Scientific Studies

Wilson I B Onuigbo, FRCP (Glasgow), FRCPath

Medical Foundation and Clinic, Enugu, Nigeria.

Correspondence to : Prof. Wilson I.B. Onuigbo, Medical Foundation and Clinic, 8 Nsukka Lake, P.O. Box 1792, Enugu Nigeria 400001.

Aim:To study whether librarians request for reprints.

Methods: A 15 years retrospective analysis was carried out as regards reprint requests received by me from all over the world with special reference to those made by librarians.

Results: During 1970-1982, I published 69 scientific papers. These elicited 2,053 requests of which 29 (42%) interested librarians. The Libraries were located in 10 countries, USA leading with 17 requests. Of these American requests, only 9 of the 55 states featured. There was a tendency for a particular library to dominate the picture in the individual country. The importance of the reprint as an instrument for promoting research was illustrated with my paper on melanoma in Igbo patients. Though published in Britain, the work was requested thus; “I would be most grateful if you could let us have 2 copies of this most interesting article for our reference libraries at the Westminster and St George’s Hospitals in London”.

Conclusion: Using other parameters, it is clear that librarians themselves do request for reprints. Accordingly, the reprint request (RR) is a tracer tool in scientific studies which should stand the test of time unless displaced by e-mail or any other future invention.

Key Words: Reprint Request, Librarians.

Priapism: A Review.

Fred O. Ugwumba, Aloy E. Aghaji

Urology Unit, Department of Surgery, College of Medicine, University of Nigeria, Enugu Campus.

Correspondence to: Dr. Fred Ugwumba, Department of Surgery, UNTH, Enugu.

Aim: To explore the aetiological factors, pathogenesis and management of priapism and highlight its peculiar features in Nigerians.

Materials & Methods: A literature search was carried out using MEDLINE –, these were reviewed in line with the aims for meaningful findings and case reports.

Results: Priapism is currently classified into low flow (Ischaemic) and high flow (nonischaemic) priapism, with low flow being commoner, in all communities and in association with sickle cell disease. Hypoxia associated with low flow priapism is usually associated with varying degress of erectile dysfunction [ED]. High flow priapism is usually associated with trauma and is a non-ischaemic painless event.

Low flow priapism also associated with drug treatment of erectile dysfunction, psychiatric disorders and malignant infiltration of the penis. Management ranges from conservative to a spectrum of surgicalinterventions. In Nigeria some patients are noted to have developed priapism following ingestion of oral herbal aphrodisiacs.

Conclusion: Priapism is an emergency with dire effects on erectile function when treatment is delayed. A clear understanding of the aetiological factors and pathogenesis is useful in aiding rapid diagnosis and treatment. Preventive strategies need to be established where possible.

Key Words: Priapism, Low flow, High flow.

Women’s Assessment of Intra- and Post-Partum Care at the University of Nigeria Teaching Hospital, Enugu, Nigeria.

H.E. Onah

Department of Obstetrics & Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria

Correspondence to: Dr. H.E. Onah, Dept of Obs & Gynae, UNTH, Enugu.

Objectives: To: 1. determine the proportion of parturients attending a Nigerian tertiary care facility who are satisfied with the intrapartum and postpartum care they receive; 2. detemine the reasons for, and factors associated with dissatisfaction and 3. seek parturients’ views on certain intrapartum practices e.g shaving of public hair, enema, pain relief etc, which may impact upon their overall satisfaction.

Methods: A survey of women who had normal deliveries or caesarean section after a period of labour in the hospitalfrom 30^th September 1998 to 30^th June 1999 using a structured pre-tested questionnaire.

Results: Six hundred and seventy-one parturients were interviewed. Their overall rating of care was as follows: very good (58.9%), good (35.2%), mixed (4), bad (0%), very bad (1.9%). Factors that were satisfying to the parturients who rated the care as good or very good (94.1% of the parturients) were: easy availability, competence and caring attitude of labour ward personnel; shaving of public hair on admission, use of intravenous drip without oxytocin and baby care. Despite their overall favourable rating, the following were dissatisfing to the majority of this group: enema on admission, poor pain relief, oxytocic use in labour, the infrequent or non-attendance to the labour ward by consultants, the attendants not seeking their views when making decisions about them, restriction to bed during labour, high cost of care and the restriction of visitors to the wards. For the minority of patients (5.9%) who rated the care as mixed, bad or very bad, the following were dissatisfiers: poor attitude of staff, bad toilet facilities, and intermittent shortage of working materials such as water, linen and oxygen.

Conclusions: Although the majority of the parturients in the hospital studied were satisfied with their intrapartum and postpartum care, they identified several deficiency area with important medico-legal implications.

Key Words: Assessment, intrapartum, postpartum, clients, Enugu, Nigeria

An Analysis of Spectacle Malingering in Nigerian Children

E.N. Onwasigwe FMCOphth

Department of Ophthalmology, University of Nigeria Teaching Hospital, Enugu.

Correspondence to: Dr. E.N. Onwasigwe, Dept. of Ophthalmology, UNTH Enugu.

Aim: To verify the appropriateness and moral justification for the selective prescription of a pair of plain lenses for spectacle malingerers.

Patients and Methods: The study was undertaken over a 5-years period, (May 1996 to April 2001). Patients were selected based on the premise that symptoms of refractive error were verified and found to be feigned, added to the fact that symptoms disappeared with prescription of plain lenses. One hundred and twenty children were recruited.

 Results: The study population of 120 children had 18 males (15.0%) and 102 females (85.0%), given a male to female ratio of 1:6. The mean age was 13.6 ± 2.3 years. The peak age group was 14-16 years. It was observed that most of these patients manifested intense behavioral disorder that adversely affected their personality and general performance in school. The commonest presenting symptom was defective vision. Other attendant symptoms were headache, photophobia, ocular pain, watering and diplopia.

Conclusion: It is highlighted that children who do not respond to counselling may selectively be treated with plain lenses.

Key Words: Spectacle malingering, Selective plain glasses.

Femoral Venous Blood pH Changes in Response to External Graduated Leg Compression and its Relationship to Deep Vein Thrombosis.

G.C Okoye, M.B. B.S., PhD.,

Bioengineering Unit, University of Strathclyde, Glasgow, UK.:

Correspondence to: Dr. G.C. Okoye, Department of Medical Rehabilitation, Faculty of Health Science and Technology, College of Medicine, University of Nigeria, Enugu Campus. Nigeria.

Aim: To measure in vivo the femoral venous blood pH in response to external lower limb compression in cardiac catheterization patients.

Patients and Method: The pH was measured in discrete samples of blood withdrawn from the femoral vein before, during and after insertion of the catheterized leg into the graduated elastic stockings (T.E.D. Kendall).

Result: There was a reduction of the mean pH of the blood obtained from the femoral vein at one minute after insertion of the stocking onto the leg.

Conclusion: The changes observed might reflect the localized acidaemia in the valve cusps that may be the first part to initiate thrombus formation. The localized acidaemic condition, which although is under a powerful homeostatic mechanism, may indeed reflect one of the haemodynamic variables that are important in the homeostatic balance between thrombogenesis and fibrinolysis and therefore the pathogenesis of deep venous thrombosis.

Keywords: Ph Response, Localized Acidaemia, External Lower Limb Compression, Deep Vien Thrombosis

A comparison of Glycosylated Haemoglobin (GHL) in Obesity and Diabetes Mellitus in Enugu Metropolis.

J.C. Onyeanusi*, S.O. Ureme*, E.N. Ofoegbu**, C. Ndiokwelu***, I.G. Maduka****, Z. Okwuowulu*

*Department of Medical Lab Sciences, UNEC, **Department of Medicine UNEC, ***Department of Dietetics, UNTH, Enugu, ****Department of Chemical Pathology, UNTH, Enugu.

Correspondence to: J.C. Onyeanusi, Dept of Medical Lab Sciences, University of Nigeria, Enugu Campus.

Aim: To compare the blood concentation of Glycosylated haemoglobin in obesity and diabetes mellitus in Enugu metropolis.

Materials and Method:A total of seventy-five patients (male and female) that attended medical Clinic of University of Nigeria Teaching Hospital Enugu were recruited for the study. Fifteen patients were obese, seventeen were obese-diabetics, forty-three were non-obese –diabetics while twenty were non-obese-diabetics with various complications. Twenty apparently healthy subjects served as controls. Fasting blood samples were collected with fluoride-oxalate bottles from both test and control groups. Glycosylated haemoglobin (GHb) and fasting blood sugar (FBG) were determined by the spectrophotometric method while the haematocril (PCV) was determined by microhaematocril method.

Results: In obese subjects, the following results were obtained GHb 55.40±3.9 mm0l/L fructose, FBG 6.3±1.07 mmol/L, PCV 0.38±0.03 L/L while in obese-diabetics, the following results were recorded GHb 093.45± 6.06 mmol/L fructose, FBG 12.30±5.62 mmol/L, PCV 0.39±0.02 L/L. In non-obese-diabetics the results were GHb 95.05. 9mmol/L fructose, FBG 4.90±0.34 mmol/L and PCV 0.41± 0.03 L/L.Statistical comparison of mean results for GHb and FBG showed no significant differences between obese and control groups (P>0.05) while significant differences were recorded between obese-diabetics non-obese diabetics and control groups respectively, (P<0.05). In addition, when the results of the test groups were compared with one another, significant differences were obtained in obese vs non-obese-diabetics (P<0.05) with regard to FBG and GHb. No Conclusion: This study has shown that elevated glycosylated haemoglobin and hyperglycaemia may not be regular features of obesity significant differences were obtained with PCV in all test and control groups whereas they are consistently documented in diabetes.

Key words: Gycosylated haemoglobin, obesity diabetes.

Significant Bacteriuria in Pregnancy in Enugu, Nigeria.

*N.F. Onyemelukwe, **S.N. Obi, ***B.C. Ozumba

*Department of Medical Laboratory Sciences, University of Nigeria, Enugu Campus, **Department of Obstetrics and Gynaecology, Federal Medical Centre, Abakaliki, ***Department of Obstetrics and Gynaecology, University of Nigeria, Enugu Campus.

Correspondence to: Dr. S.N. Obi, Dept of Obs & Gynae, Federal Medical Centre, PMB 102, Abakaliki. E-mail: [email protected] 

Objective: To determine the prevalence, demographic characteristics and microbiological assessment of the causative agents of significant bacteriuria in healthy pregnant women and its effect on pregnancy in women in Enugu, Eastern Nigeria.

Materials and Methods: A prospective study based on data obtained from healthy pregnant women seen at antenatal clinic of University of Nigeria Teaching Hospital (UNTH) and three primary health centers in Enugu, between 15^th February 1995 and 14^th August 1996. Seven hundred and fifty-eighty healthy pregnant women were seen during the review period.

Results: The prevalence of bacteriuria in this study was 12.7 percent. Escherichia coli was the commonest organism (36.5%) isolated. Antimicrobial susceptibility test revealed that 98.9% of the organisms were sensitive to cephalexin and 93.8% to nitrofurantoin. The organisms were resistant to ampicillin and co-trimoxzole. The prevalence of preterm delivery, hypertension, diabetes mellitus and anaemia were higher in the study group than the control, but the difference was not statistically significant (p>0.05). Patients in the lower socio-economic class and those with pre-pregnancy history of urinary tract infection were more at risk of asymptomatic bacteriuria.

Conclusion: All pregnant women should be screened for bacteriuria and those with significant bacteriuria treated with antibiotics.

Key Words: Significant bacteriuria, pregnancy, Enugu, Nigeria.

Adipose Tissue Tumours in Port Harcourt (A ten year review)

D. Seleye-Fubura FMCPath, FWACP, E.N. Etebu FMCPath, FICS

Department of Anatomical Pathology University of Port Harcourt Teaching Hospital Prot Harcourt Nigeria.

Correspondence to: Dr. D. Seleye-Fubura, Dept of Anatomical Pathology, UPTH, Port Harcourt.

Aim: To review the characteristics of adipose tissue tumors in Port Harcourt.

Method: A ten year (January 1990 – December 1999) retrospective study of 160 adipose tissue tumors was carried out by the authors which was made up of 153 benign and 7 malignant tumors occurring at various anatomical sites of the body. All the histological slides previously stained with hematoxylin and eosin stains were retrieved to confirm previous diagnosis. Special stains was also used for the confirmation of some cases. Variables considered include tumor location, age and sex which were extracted from the request forms and daily specimen record books.

Results: Adipose tissue tumors accounted for 2.4% of total tumors diagnosed during the study period. Majority (82=51.3%) occurred in females and 78 (48.7%) occurred in males giving a sex ratio of 1.1:1. Benign and malignant tumors accounted for 95.6% and 4.4% respectively giving a ratio of 22.1. The ages varies from 36 to 69 years and the highest frequency of occurrence was the upper arm.

Conclusion: Adipose tissue tumors are one of the commonest soft tissue tumors. Though not given much attention in medical practice and in literature, it posed cosmetic problems. The location and size of the tumor determined the symptoms which ranges from dyspnea to a feeling of fullness and discomfort on motion.

Key Words: Adipose tumors, Age, Sex, Site, UPTH.

Anthropometrical Profile, Skinfold Tickness and Subcutaneous Fat Depositions in Adolescents of Southeastern Nigeria

*C.I.P. Anibeze PhD, **A.O.C. Akpa MD, M.Sc, **A. Etudo M.Sc

*Department of Anatmy, College of Medicine, Abia State University, Uturu.

**Department of Anatomy, Ebonyi State University College of Medicine, Abakaliki.

Correspondence to: Dr. C.I.P. Anibeze, Dept of Anatomy, Abia State University Uturu.

Background: The threatening health problems resulting from excess subcutaneous fat depositions have been reported by the world Health Organization. Also noteworthy is that childhood obesity is a pointer to adult obesity. This necessitated a study on the anthropometrical profiles of adolescents of Southeast Nigeria using different methods of determination of adiposity patterns.

Methods: Subcutaneous fat depositions in adolescents of Southeastern Nigeria were studied from anthropometrical data generated between 1998 and 2000 on 857 adolescents. The methods used were the Body Mass Index (BMI), the Triceps Skinfold Thickness (TST) and Subscapular Skinfold Thickness (SST).

Result: Results in the three methods were positively correlated (r=0.81) in establishing adiposity patterns of subjects. However, the TST and SST showed more accuracy in reliability of data related to fat content of body while the BMI relates to total body weight.

Conclusion: The paper established the fact that for measurements of growth for adolescents of Southeast Nigeria, the BMI provides enough information on growth of subjects but for quick anthropometrical fat content determinations in clinical examinations, the TST and SST appear to provide more accuracy.

Key Words: Body Mass Index, Skin fold, Thickness, Adolescents.

Discordant HIV-1 Infection in Dizygotic Twins: Case Report and Review of Literature.

Ifeoma J. Emodi MB Bch, FMCPaed

Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu.

Correspondence to: Dr. I.J. Emodi, Dept of Paediatrics, UNTH, Enugu.

First-born twins are at a four-fold risk of acquiring HIV infection if delivered by caesarean section. A female second twin delivered by caesarean section presented at the age of 14 months with features of HIV/AIDS. She died four months later of full blown AIDS. The first twin, a male, who was delivered vaginally, is asymptomatic and negative for HIV-1 at 18 months of age. He is growing normally. Their father died of AIDS a month before the demise of twin two. Discussion focuses on factors influencing perinatal transmission of HIV and strategies available to minimize the risk.

Key Words: HIV, transmission, dizygotic twins.

Occupational Exposure to the Risk of HIV Infection Among Surgeons at a University Teaching Hospital in Enugu, Nigeria.

T.A. Okeke. DPH, FMCPH

Department of Community Medicine, University of Nigeria Teaching Enugu.

Correspondence to : Dr. T.A. Okeke. Dept of Community Medicine, UNTH Enugu.

Aim: To determine the various factors that predispose surgeons to needlestick injuries, with a view to making recommendations for prevention and control.

Materials and Methods: A cross-sectional study was conducted at the University Teaching Hospital in Enugu, between March and April 2002. The study population comprised of all 135 doctors working in the surgical department at the time of the study. Data was collected using self-administered structured questionnaire.

Results: The mean age of respondents was 32.4 years. More than half (53%) of the surgeons reported having sustained a needlestick injury in the preceeding 3 months. Majority of these injuries occured during intravenous catheterization and the most frequently reported circumstances associated with needlestick injuries were re-capping of needles. Washing with soap and water was the main method of aftercare used and it is noteworthy that none of the doctors received post-exposure prophylaxis. Less than half used double gloving as a protective measure and 13% did nothing to protect themselves. The majority (97%) incorrectly estimated the sero-conversion rate with exposure to a patient with HIV. The most popular recommendation was availability of surgical gloves followed by health education to raise the level of awareness of medical personnel.

Conclusion: The high rate of needlestick injuries among surgeons in this hospital could be reduced by the introduction of a comprehensive needlestick prevention programme.

Keywords: Needlestick injury, surgeons, HIV.

Assessing Payment and Community Based Distribution Issues in Establishing Demand-Responsive Systems for Community –Based Distribution of Insecticide Treated Nets in South East Nigeria.

Obinna Onwujekwe MBBS, PhD^1,2, Douglas Nwagbo MSc³, Elvis Shu PhD¹, Samuel Ghasi MSc¹, Benjamin Uzochukwu MBBS, FWACP³, Angus Onyido PhD⁴, Obiora Onwuamaeze MBBS¹.

1.Health Policy Research Unit, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu Campus.

2. Gates Malaria Partnership, London School of Hygiene and Tropical Medicine, London.

3. Department of Community Medicine, University of Nigeria, Enugu Campus.

4. National Arbovirus and Vector Research Division, Federal Ministry of Health, Enugu.

Correspondence to: Dr. Obinna Onwujekwe, Dept ofPharmacology and Therapeutics, University of Nigeria, Enugu Campus. E-mail: [email protected]. 

Objectives: To assess the payment of pricing factors necessary for achieving optimal community-based distribution of insecticide nets (ITNs) re-treatment services.

Methods: Questionnaire interviews were conducted with randomly selected household heads or their representatives in five malaria holo-endemic communities of Southeast Nigeria. Interviews were also held with community leaders before and after ITNs sales. The sale of ITNs was based on the communities’ distribution and payment preferences.

Findings: While payment by installment was preferred for ITNs, it was one-off mechanism for net re-treatment. Most of the respondents that bought the nets paid by a maximum of two fourth-nightly installments, and some of them determined the mark-up price of ITNs over that for untreated nets before buying. The major problems encountered were cases of non-adherence to the payment modality and return of after use. A community-based system was able to sell the nets.

Conclusion: The payment preference of communities should be incorporated in

implementing community-based ITNs sales. Appropriate pricing should involve ITNs programme managers being aware of the price movements in local markets for untreated nets, as a basis for dynamic reasonable price setting for ITNs

Key words: Demand responsive, malaria, insecticide-treated nets, financing, community-based.

Conjunctival Pyogenic Granulomas

Wilson I.B. Onuigbo and Nwabueze O. Magulike

Medical Foundation & Clinic, Enugu and Department of Ophthalmology, University of Nigeria Teaching Hospital, Enugu.

Correspondence to: Dr. N.O.Magulike, Dept of Ophthalmology, UNTH, Enugu.

Aim:To study the excised pyogenic granuloma (PG) of the conjunctiva in Igbos.

Methods: During a 30-years period, conjunctival biopsy specimens submitted for histological opinion were studied retrospectively with special reference to PG.

Results: There were 21 cases, all being unilateral. The male: female ratio was 3:1. The males peaked in the 31-40 range while the few females showed wide scatter. Most patients presented within 6 months of noticing their lesions which usually measured up to 1 cm across. Trauma was documented in some cases. Whereas two ophthalmologists submitted 4 specimens each, one sent three, another provided two, and 8 forwarded single examples.

Discussion: This series was typical in manifesting the rapid evolution characteristic of PG in other parts of the body. Such rapidity differentiates PG from longer lasting lesions, e.g cancers, whose own treatment is more invasive. The combined frequency of maleness and youngness among the sufferers may be appreciated as being due proneness to injury of the occupational type. In conclusion, if ophthalmologists provide these data in Laboratory Request Forms, epidemiological researches would be facilitated.

Key Words: Conjunctiva, Pyogenic granuloma, Igbos

Torsion of the Spermatic Cord: Is Bilateral Orchidopexy Really Necessary?

*Anselem O. Obi FWACS, **Aloy E. Aghaji FRCS

*Federal Medical Centre, Abakaliki. **Urology Unit, Department of Surgery, UNEC.

Correspondence to: Dr. A.O. Obi, Federal Medical Centre, Abakaliki, Ebonyi State.

Aim: To evaluate the rationale for bilateral orchidopexy as treatment for unilateral torsion of the testis, by determining how frequently the contralateral testis shows an abnormal pathology in unilateral testicular torsion.

Patients and Methods:This is a retrospective study using adult urology patients treated for both acute and intermittent torsion of the testes in UNTH Enugu and a private Urology clinic in Enugu from January 2000 to May 2002. The study relies on information obtained from patients case notes. Most of the cases were treated by the authors.

Results: Fifty cases (100 testes) were studied. Ages ranged between 14 to 45 years with a mean of 22.5 years. Peak incidence was in the 20-29 years age group: 25 patients (50%). Testicular pain was the chief presenting symptom (87.2% of cases). Commonest findings were horizontal lie (27%) and clapper bell deformity (23%). The pathology causing torsion was unilateral in 23 (46%) of cases and bilateral in 25 (50%) of cases.

Conclusion: The observed incidence of bilateral abnormality 25 patients (50%) was found to be statistically significant (P<0.05) thus buttressing the need for bilateral orchidopexy as standard treatment for unilateral torsion of the testes.

Key words: Torsion, spermatic cord, orchidopexy.