African
Journals Online
Nigerian Quarterly Journal of
Hospital Medicine
VOLUME 9 NUMBER 2
APRIL-JUNE'99
A Study of Some Aetiological
Factors in 41 Cases Of Cancer Of The Cervix Uteri
In Zaria
ABSTRACT
A prospective study of some aetiological factors in 41
patients with histologically confirmed cancer of the
cervix seen in Zaria. Questionnaires were administered to
all the patients seeking the following information - age,
menarche, age at first marriage, whether polygamous or
monogamous, parity, circumcision in husband/partner and
smoking habit. Histological classification was attempted
using mucin and routine stains.
The age range was 27 to 72 years with an average of
49.4 years. All the women were married except for one
widow, all their spouses were circumcised and there were
only three smokers. Twenty four were from a polygamous
home. The average age of first marriage was 14 years.
They had a mean number of 7.2 children and were married
for an average of 1.9 times.
Our findings confirm similar observations by workers
from Ibadan, Zaria, and Tanzania, but circumcision and
smoking in our patients do not appear to play a similar
role as in patients from developed countries.
Prevalence Of Hepatitis B
Surface Antigen Among Tertiary Health Workers in Ilorin
ABSTRACT
A total of 181 tertiary hospital staff at the
University of Ilorin Teaching Hospital were screened for
the presence of Hepatitis B surface antigen (HBsAg) in
their Sera. They were made up of 128 nursing staff, 36
doctors, and 17 laboratory staff, with a mean length of
service of 12.3+7.6 years, and who actively work in
contact with patients and laboratory specimens.
Screening for HBsAg was carried out using the
enzyme-linked immunosorbent assay (ELIZA) method.
Fourteen (7.7%) of the staff were found to be positive
for HBsAg. This was significantly lower than the
percentage positives of 21.7% and 16.0% obtained among
the blood donors and antenatal clinic patients
respectively. The positivity rate was not affected by
sex, age or length of service. The possible reasons for,
and inferences from our findings are discussed.
Ectopic Pregnancy: Lagos
University Teaching Hospital Experience Over A
Five-Year Period
ABSTRACT
Ectopic pregnancy remains one of the commonest
gynaecological emergencies in developing countries. In a
retrospective study of ectopic pregnancy carried out at
Lagos University Teaching Hospital (LUTH), Lagos,
Nigeria, over a five year period, 272 cases were managed
with an incidence of 43.8/1000 deliveries. 85.7% of the
196 patients evaluated were found to be in the active
reproductive age group (20 - 34 years) and 65% were of
low parity (para 0-1). Previous abortions, pelvic
inflammatory disease and pelvic adhesions were the common
associated risk factors. 99% of the patients presented in
the ruptured state. Accurate diagnosis was made in 89% of
the patients within 24 hours of presentation.
Misdiagnosis occurred in only 11% of the patients and
correct diagnosis was made later with laparoscopy and/or
ultrasonography. Abdominal pain or tenderness, pallor and
amenorrhoea constituted the commonest clinical features.
Paracentesis abdominis and/or culdocentesis gave positive
result in 83% of our patients and no false positive
result was recorded. Immediate Laparotomy with total
salpingectomy or segmental partial salpingectomy was the
commonest surgical procedure. Only 2.7% of the patients
had conservative surgery. Anaemia was the commonest post
operative complication (77%). Ten deaths occurred giving
a case fatality rate of 3.7%. An intensive health
education programme towards reducing the risk factors and
avoidance of delay in diagnosis/management were suggested
as means of reducing the associated morbidity and
mortality in ectopic pregnancy.
Neuroimaging in Selected
Nigerian Epileptic Patients: A Decade of
Experience
ABSTRACT
Background: There is currently a general agreement
that in the evaluation and management of epilepsy brain
computed tomography-CT and nuclear magnetic resonance
imaging-MRI complement the clinical and
electrophysiological information obtained. Most of the
studies on CT and epilepsy are from elsewhere. The study
sets out to highlight the relevance of neuroimaging in
the management of epilepsy in selected Nigerian patients.
Objective: This study examines the incidence of
cerebral abnormalities using optiminsed brain CT scanning
in Nigerian patients with intractable epileptic seizures
and relates these to clinical and electroencephalographic
localisation of seizures.
Methods. A prospective descriptive study was
undertaken on 344 consecutive Nigerian patients with
various epileptic syndromes of whom only 238 (173
children and 65 adults) completed a follow-up of between
0.5 to 8.8 years. Of these, 87 (64 children and 23
adults) satisfied the defined selection criteria for
neuroimaging, but only 33 patients were able to obtain
the investigation which consisted of CT scan in 31 and
MRI in 2 patients. The neuroimaging was done in various
centres in Nigeria and abroad. For CT scanning, the
Somatom-AR. T (Siemens system) total body scanner and its
varieties were used, and for MRI, done in the United
Kingdom, a 1.5 Tesla Siemens system with a 25cm
circularly polarised head coil used as both transmitter
and receiver was employed. All electroencephalography
(EEG) was recorded with 8,12 or 16 channel EEG machines.
Results. Altropic changes dominated with neurimaging
abnormalities in one-third of the patients scanned. The
vast majority of patients with generalised tonic-clonic
seizures (9 out of 12) had no demonstrable abnormalities,
and the reverse was the case in complex partial seizures
in which 9 out of 13 patients had demonstrable structural
lesions on CT.
Conclusion: This study further supports the relevance
of CT scanning whenever partial seizures are associated
with abnormal neurological signs during the interictal
period. Though CT abnormalities may not always be
amenable to surgical correction or alter significantly
clinical management, CT findings can definitely alter the
initial clinical or EEG classification of type of
epilepsy in a few patients leading to alteration of drug
therapy with rewarding results. In additon, brain tumour,
brain abscess and obstructive hydrocephalus are known
conditions that are amenable to surgical correction and
are detectable on CT. Computerised tomography is
expensive and must be justifiable on clinical grounds,
and reserved for patients whose epilepsy is unresponsive
to drug treatment rather than for all patients at
presentation.
Are We Meeting The Calorie
Needs Of Hospitalized Children?
ABSTRACT
For the past four decades, nutrition has assumed its
pride of place on the list of advances in surgery and
general patient care. We prospectively reviewed the
effect of hospitalisation on the nutritional status of 28
children admitted for various surgical and medical
conditions at the Lagos University Teaching Hospital.
Parameters studied were admission weights, calorie intake
and weight lost or gained within the first one week of
admission.
The mean Daily Calorie Intake among the 16 children
admitted for infective medical conditions was 68.8% of
ideal while the corresponding figure for those who had
major surgeries was only 27.0% of ideal. Although the 12
surgical patients had admission weights satisfactorily
suitable for their ages, they lost a mean 11.8% of
admission weights at the end of the first week of
hospitalisation and surgery. The medical group had a
modest weight gain of 2.6% within the same period.
It was concluded that hosplitalisation is deleterious
to the nutritional status of children in our institution
and various modes of nutritional support are recommended
for ameliorating this undesirable side effect of hospital
admission in this group of patients.
Psychiatric Morbidity in Private
General Practice in Lagos, Nigeria
ABSTRACT
Two hundred and ninety-eight consecutive patients
referred to the author by general practitioners working
in a private general hospital in Lagos were studied.
Sixty eight percent of the patients were less than 40
years old. 88% of them presented with somatization
symptoms mostly of chronic nature. Internal heat was the
commonest somatization symptom. Anxiety and depressive
disorders were most commonly diagnosed. At least 58% of
the patients reported important psychosocial stresses
most of which were related to physical illnesses and
financial difficulties.
Private general hospital setting might be having a
fairly heavy load of psychiatric disorders particularly
those with physical symptoms presentation. The importance
of early identification of psychiatric disorders in
primary care centres has been emphasized.
Managing Health Information
System
ABSTRACT
The effective planning, management monitoring and
evaluation of health services, health resources and
indeed the health system requires a wealth of health
information, with its simultaneous effective and
efficient management.
It is an instrument used to help policy-making,
decision making and day to day actions in the field. The
objectives of the paper are to create awareness on health
information system (HIS); to highlight the importance of
operational and management information systems and to
examine policy designs of health management information
system.
First, this paper through literature search gives a
broad meaning of the word SYSTEM. highlighting its
general characteristics. Secondly it clarifies the
meaning of health information system (HIS), and health
management and health information system (HMIS). The
general characteristics, problems and various types and
sources of information are discussed. Thirdly it examines
three basic policy designs of health management
information system (HMIS) - Papua New Guinea's and Suva's
and Nigeria's.
Human Red Cells With
Paroxysmal Nocturnal Haemoglobinuria Phenotype Are
Competent For The Growth Of Plasmodium falciparum
ABSTRACT
Paroxysmal nocturnal haemoglobinuria (PNH) is an
acquired blood disorder characterised by acute
intravascular haemolysis, due to increased susceptibility
of red cells to complement -mediated lysis. Any red cell
abnormality that would affect the invasion and growth of
Plasmodium falciparum would serve as a useful tool for
the future intervention of malaria infection in humans.
The aim was to find out whether P. Falciparum can invade
and infect these abnormal human red cells, and whether
the parasite depends on the host cell for the synthesis
of its GPI anchors.
Patients with the PNH condition have a mixture of
normal and abnormal red blood cells (RBCs) in their
blood. In order to obtain a homogenous sample of abnormal
(PNH) cells, PNH red cells were purified from patients
with this condition by the process of 'panning'. The
purified cells were used as hosts for the culture of
P.falciparum in vitro.
Results show that GPI-linked molecules on the red cell
surface are not required for the efficient entry of the
parasites, and that the PNH red cells are competent to
sustain the growth of P.falciparum.
Chronic Toxicity Of Enantia
Chlorantha in Animal Model
ABSTRACT
Enantia chiorantha (Annonaceae) bark, a traditional
medicinal plant often used in the treatment of
P.falciparum infections has been indiscriminately
ingested by individuals especially in this part of the
world.
The present study was conducted to determine the
cumulative effects of E. chlorantha in the body tissues.
The bark after procurement was sun-dried and chopped into
tiny pieces. A 150g sample was boiled in 1.5L distilled
water and the resultant aqueous extract was administered
ad - libitum to 5 groups of rats consisting of 10 animals
each for a period of 16 weeks. The animals were
thereafter sacrificed and the important body
organs/tissues were excised for histopathological study.
The aqueous extract of E.chlorantha was found to
produce certain pathological changes in most of the
animals studied. Among the parts affected were the lungs,
liver, heart, tongue and pancreas. The kidney, however
showed mild pathology.
This therefore suggests that specific recommended
regimen be ingested by users.
The Impact Of
Community-Directed Administration Of Various Formulations
Of Pre- Packaged Chloroquine In Umuahia South Local
Government Area Of Abia State Nigeria
ABSTRACT
The high patronage of Patent Medicine Vendors (PMV's)
to the detriment of Primary Health Centres (PHCs), the
uncontrollable habit of home treatment and
self-medication by rural dwellers, have necessitated the
need to improve on the knowledge and awareness of malaria
exhibited by these target groups. A community-directed
intervention programme to effect prompt and adequate
treatment of presumptive episodes of clinical malaria in
a rural community (Ubakala, population 15,600) in
Ummuahia South Local Government Area (L.G.A.) of Abia
State, Nigeria has therefore been studied. The
instruments of implementation were based on (a) training
the rural dwellers, 3 Community Malaria Committees
(CMC's) and the Patent Medicines Vendors (PMVs) in the
community and (b) supplying the CMCs and PMVs with the
essential antimalarial drug, chloroquine (CQ) packaged in
various age-specific plastic bottles, compartmentalized
polythene bags and blister packs. Of the 3,000 pre-packs
delivered in 4 instalments from January to November 1998,
2503 were sold under a subsidized cost-recovery scheme.
The progress of 510 patients was followed up 4 days after
treatment and 250 mothers/carers of children under 6
years in each of the test and control (Olokoro,
population: 11,800) communities were interviewed
in-depth. Results showed a significant increase
(P<0.001) in knowledge, awareness drug consumption
(without misuse) and compliance amongst PMVs and rural
dwellers in the test compared with the control community.
Analysis of cases of malaria which were recorded as
"severe" by the PHCs highlighted a reduction in
the test community. These results showed that the
strategy is feasible and sustainable and could lead to
continued reduction of malaria-specific morbidity and
mortality in the community. The protocol could also be
extended to other communities in Nigeria.
Effect Of Nicotine And
Tobacco Consumption On Brain Acetyl Cholinesterase And
Serum Alkaline Phosphatase In Rats
ABSTRACT
The effect of nicotine and tobacco consumption on
brain acetyl cholinesterase and serum alkaline
phosphatase in rats was studied.
Rats were divided into three groups and the first
group was fed rat chow and water ad libitum and an oral
administration of 2ml of 0.1%(v/v) nicotine per 100g body
weight of rats per day. The second group of rats was fed
0.5% (w/w) tobacco rat chow with water and while the
third group was fed rat chow with water ad libitum for 30
days.
The rats were sacrificed by decapitation after
starving them overnight, blood was collected by cardiac
puncture and their brains were quickly excised. The
specific activities of the brain AChE and serum alkaline
phosphatase were determined.
Results of the study showed that the specific activity
of brain AChE in the nicotine - fed rats and in tobacco -
fed rats were significantly higher than in the control.
Data indicate that nicotine and tobacco consumption may
have excitatory effect on brain AChE activity and serum
alkaline phosphatase. However, nicotine consumption
produced a more pronounced excitatory effect that in
tobacco when fed to rats. Our findings suggest that
nicotine and tobacco consumption affect the regulation of
brain functions medicated by the cholinergic
neurotransmission.
The Latex Of Jatropha
Curcas Linn (Euphorblaceae): A Prospective Haemostatic
Agent
ABSTRACT
The latex of Jatropha curcas Linn (Euphorbiaceae) has
been investigated as a prospective haemostatic agent.
The latex reduced clotting and bleeding times
significantly (P<0.0001) compared to Tincture of
Benzoin Co (TBC); Iodine tincture, Tannin and 90%v/v
Ethanol. There was a significant positive correlation
between the clotting times of normal volunteers of blood
groups A, AB, B and O with various concentrations of the
latex of J. curcas (r=0.9684, P<0.0001). Increased
concentrations of the Latex decreased the clotting and
bleeding times to a critical point of maximum
clotting/bleeding activity. The concentration of latex
that gave maximum clotting activity was 4.7%w/v and 100%
v/v while 2%w/v and 25%v/v latex were minimum effective
concentrations of the latex. The latex also showed
anticoagulant antagonist activities, reversing the
effects of EDTA, Sodium citrate, and Heparin in normal
blood samples (P<0.0001). All anticoagulants used in
the study enhanced the clotting activity of the latex by
an average factor of six.
Vasoconstrictor effect (Styptic action) of the latex
was evident as 0.2ml fresh latex containing equivalent of
0.0022mM Ca2+ stimulated similar response (7.80cm) to
2.5mM CaCI2 on an isolated guinea pig taenia coli smooth
muscle.
Probable mechanism of haemostatic activity of the
latex are protein precipitation, vasoconstriction
(Styptic action), and temporary haemostatic plug
formation via platelet adhesion.
Contraceptive Promotion And
Utilization: SolutionTo Problem Of Illegally Induced
Abortion in Countries With Restrictive Abortion Law
ABSTRACT
This study examined the contraceptive utilisation
among patients treated in a University Teaching Hospital
for complications of illegal abortion aimed at utilizing
such information to proffer solution to the problems of
unwanted pregnancy and induced abortion.
In this study, 93.3% of patients had never used
contraceptive and of this patients 31.1% have had
previous induced abortion. Also 94.7% of the patients who
have had previous induced abortion had never used
contraceptive.
Contraceptive promotion and utilization were proffered
as solution to the problem of unwanted pregnancy and
induced abortion.
Estimation Of Measles
Sero-conversion in Children Vaccinated Against
Measles in Edo State of Nigeria
ABSTRACT
A study of seroconversion of 115 children between 9
months to 5 years vaccinated against measles was
conducted in Oriowon local government area of Edo State.
This has to establish the immune status of the children
against measles after immunisation. Haemagglutination
inhibition technique was used.
Prevaccination immune status was conducted and 89.6%
of the children studied especially among the older ones
between 2-5 years were found with protective measles
antibody. The highest of the titre attained was 1.256.
Exposure to endemic environment was attributed to this
cause.
In the postvaccination assessment of the immune
status, 94.7% developed protective measles antibody with
a minimum titre level of 1:16, while 5.27% was not
protected against measles. Among the highly protected
children, 84.9% had a titre range between 1.64 and
1.1024.
The high measles antibody titre detected in the
children before vaccination was thought could affect the
measles vaccination, instead there was increase in
measles antibody titre. This could indicate the
potentiation of antibody development by the immunization.
Children were observed to have been vaccinated at
older age than the scheduled age of vaccination. This was
attributed to the attitude of the mothers.
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