Perceived risk factors and preventive practices of Hepatitis B viral infection among pregnant women in Nigerian hospitals: A cross-sectional study

OBJECTIVE

The study assessed the perceived risk factors and prevention practices of HBV infection among pregnant women in Nigerian hospitals.

STUDY DESIGN

A descriptive cross-sectional study was conducted among 343 pregnant women attending antenatal clinics at two purposefully selected primary health care centers in Ile-Ife. Women were included in the study using systematic sampling. A structured researcher-administered questionnaire was used for data collection. Descriptive and inferential (Chi-square test and Logistic regression) statistical analysis were carried out.

RESULTS

More than half (53%) of the respondents had a low perceived risk for hepatitis. Majority (73.5%) had been screened for HBV during the index pregnancy but only 30% received complete doses of HBV vaccine. Respondents who underwent HBV screening during pregnancy (OR = 2.06, 95% CI = 0.94 - 4.5), who had completed Hepatitis B vaccination had reduced odds ratios for perceiving risk factors for Hepatitis B Viral Infection (OR = 0.224, 95% CI = 0.94 - 4.5).

CONCLUSION

Pregnant women had a low-risk perception of HBV infection. The low level of risk perception can serve as a basis for developing preventive interventions aimed at educating and empowering expectant mothers in order to prevent HBV infection and its transmission to their children.

The impact of non-closure of the platysma muscle layer on the cosmesis of thyroidectomy scar - a randomised double-blind controlled trial

BACKGROUND

The relevance of closing the platysma muscle layer after open thyroidectomy has received little interest in terms of research. The objective was to determine whether non-closure of the platysma muscle layer after open thyroidectomy impacts significantly on the cosmetic outcome of the resulting collar scar.

METHODS

In this prospective randomised controlled clinical trial, patients were assigned randomly to have the platysma muscle layer closed or not closed. The primary endpoint was the cosmesis of the collar scar six weeks after surgery assessed using the patient and observer scar assessment scale (POSAS). Additional endpoints included operation time and early postoperative wound complications.

RESULTS

Ninety-two patients were recruited, with 46 randomised to each group. The patient scar assessment subscale(PSAS) of the POSAS showed no significant difference in the scar cosmesis between the two groups six weeks after surgery (median PSAS: 16.5 vs 17.5; p = 0.514). The observer scar assessment subscale (OSAS) showed that the platysma muscle layer closure group had marginally better scars (median OSAS: 15 vs 17; p = 0.045). The size of the goitre did not make any significant difference in the scar cosmesis. There was no significant difference in the incidence of early postoperative wound complications as well as the median operation time.

CONCLUSION

Not closing the platysma muscle layer had no significant impact on the scar cosmesis six weeks after open thyroidectomy, with no significant difference in the incidence of early postoperative wound complications and the operation time.

A Fifteen Year Experience of Total Thyroidectomy for the Management of Simple Multinodular Goitres in a Low Medium Income Country

INTRODUCTION

Total thyroidectomy as a treatment for simple multinodular goitre is not well recognised in most centres in low middle income countries.

METHOD

This paper is a retrospective review of outcomes of total thyroidectomy for simple multinodular goitres in the last fifteen years in a tertiary hospital in Nigeria.

RESULTS

A total of 652 thyroidectomies were done from January 2001 to December 2015. Simple multinodular goitres were indication for a total thyroidectomy in 447 patients (68.6%) with a male to female ratio of 1:6. Postoperative complications were hypocalcaemia in 22 (4.9%), unilateral recurrent laryngeal nerve palsy in 13 (2.8%) and haemorrhage in 2 patients. Others were seroma and cellulitis. Tracheostomy was required in 35 (5.8%) patients but none was permanent.

CONCLUSION

Total thyroidectomy is a relatively safe treatment option for patients who have simple multinodular goitre. It provides a permanent cure with a low postoperative morbidity risk. The burden of replacement l-thyroxine needs to be discussed with the patients.

EXPERIENCE WITH MANAGING RETROSTERNAL GOITRES IN IBADAN, NIGERIA

BACKGROUND

There is no general consensus on the definition of retrosternal goitre (RSG) however thyroidectomy remains the gold standard of treatment with or without a sternotomy.

AIM

To review the outcome of surgical management of retrosternal goitres.

METHODOLOGY

Retrospective review of records of patients who had thyroidectomy for RSG over a 15-year period.

RESULTS

Out of a total of 45 patients, 34(76%) were females and 11(24%) were males with a male/female ratio of 3:1; while their age ranged between 28 and 72years with a mean of 57+15SD. All the patients were euthyroid and a quarter did not have symptoms apart from a neck mass. In all, 15% of the patients had recurrent goitre. CT scan of neck and chest was done in 31 (72%) patients; while 44 (98%) patients had cervical retrosternal goitres, 1(2%) patient had ectopic retrosternal goitre. A cervical incision was sufficient in 28 (62%) patients while 17 (38%) patients required additional sternotomy. Total thyroidectomy was done in all the patients. There were post-operative complications in 19 (42%) patients. Histopathology showed that 3(6.6%) patients had papillary thyroid carcinoma while 42(93.4%) had benign pathology findings.

CONCLUSION

Surgical removal is the treatment of choice. Most retrosternal goitres can be resected through a collar stud incision; however the possibility of a need for a sternotomy should always be planned. The simultaneous occurrence of cervical and ectopic retrosternal goitre should always be ruled out with a CT scan.

Diagnostic accuracy of tru-cut biopsy of breast lumps at University College Hospital, Ibadan

BACKGROUND

Tru-cut needle biopsies form an integral part of Triple assessment of breast cancer and include clinical assessment, mammography and core needle biopsy. No study has been done to evaluate the validity of the procedure in our environment. This study was done to evaluate the validity of core needle biopsies in our centre.

METHOD

A retrospective study of patients with tru-cut needle biopsies of breast lumps and follow-up excisional biopsy or mastectomy done in the Department of Surgery, University College Hospital, Ibadan over a ten year period was done. Fifty one patients who fulfilled the inclusion criteria had their records obtained from the Department of Pathology. The diagnosis was classified into benign and malignant with the excisional biopsy or mastectomy diagnosis used as the gold standard. The sensitivity, specificity and accuracy were calculated and kappa was also done to evaluate the degree of agreement.

RESULTS

A total of 51 cases were included in this study. The average age of the patients was 47 ± 13 years with a range from 19 to 81 years. Thirty of the biopsies (59%) had a definitive diagnosis of malignancy while twenty one (41%) were benign. The overall sensitivity, specificity and accuracy were 86%, 71% and 80.4% respectively. The specificity of malignant biopsies was 68% while benign was 35%. The level of agreement for malignant biopsies was higher than benign biopsies with a kappa of 0.39 for malignant diagnosis as against 0.29 for benign.

CONCLUSION

Tru-cut needle biopsies have a comparable sensitivity and specificity to excisional biopsies. Diagnostic accuracy can be further enhanced with the adoption of image guided biopsies.

The pattern of medical mortalities in a specialist hospital in north-central Nigeria

BACKGROUND

Review of causes of morbidity and mortality in health care facilities is an important exercise which gives a picture of the prevailing disease pattern in the particular community and at the same time looks out for any change in the disease pattern over time. This exercise is a necessary component for planning of the health care needs of the community.

OBJECTIVE

To determine the mortality pattern on the medical wards of the Kogi State Specialist Hospital, a tertiary center located in Lokoja, North-Central Nigeria.

METHODS

A retrospective review of medical records of all patients admitted to the medical wards of the hospital over a period of 18 months (December 2008 - May 2010) was carried out. The information recorded from these sources included the age and gender, diagnosis/ cause of death and the duration of admission.

RESULTS

A total of six hundred and eighty-four patients were admitted during the period being studied with a predominance of female patients (Female: Male Ratio = 1.07). There were seventy-six deaths (11.1%) during the period in question with HIV and related complications accounting for most recorded mortality (32.9%) closely followed by non-communicable cardiovascular conditions (hypertension, heart failure and CVD) - 28.9%.

CONCLUSION

This study clearly shows that HIV infection and its complications remains the leading cause of death despite the advent of HAART. Clearly there is a need to revisit the strategies of HIV prevention and control. Also there is an urgent need to focus on the prevention and treatment of non-communicable diseases like hypertension and diabetes.

Self medication amongst general outpatients in a nigerian community hospital

AIM

This study was designed to determine the proportion of general out patients who practice self medication, the drugs employed and the reasons for resorting to self medication.

METHODOLOGY

This study was conducted between June and December, 2007 at the General Outpatient Clinic of the Federal Medical Centre, Owo, Ondo State, Nigeria. Two hundred consenting respondents were selected by simple random sampling and interviewed with the aid of semi structured questionnaire by the authors with three assistants. Information regarding their bio-data, history of self medication, drugs used and the reasons for resorting to self medication were obtained.

RESULTS

Majority of the respondents (85%) admitted to self medication while the remaining proportion (15%) did not practice it. Drugs utilized could be single, usually analgesics (26.5%) and anti-malaria (15.9%) or in combinations, usually antimalaria-analgesics (22.4%), antimalariaanalgesic- antibiotic (15.3%) and antibiotic-analgesic (10.0%). The reasons cited by respondents for self medication were their perception of their complaints been minor enough to be amenable to self medication (54.7%) and financial constraint (22.4%).

CONCLUSION

Majority of the respondents practiced self medication using an array of drugs like analgesics, anti-malaria and antibiotics used either singly or in combination. The main reasons identified for self medication were that the ailments were minor and financial constraint.

Factors influencing the choice of surgery as a career by pre-registration interns

BACKGROUND

The dwindling interest in surgery and surgical specialties raises the fears that the surgical man-power requirements of the society may not be met adequately in coming years. There is a need to explore ways of stimulating interest in surgery in order to forestall this.

OBJECTIVE

To identify factors that influence or predict the choice of surgery as a career by interns.

METHODS

A descriptive cross-sectional study of 271 interns was conducted using structured self administered questionnaires. The data obtained included demographic details, details of internship rotations, choice of specialty, reasons for nonconsideration of surgery and if the interns had role models, staff advisers and first degree relatives who were surgeons. Data were analysed using descriptive and inferential statistics (SPSS software) with the level of significance at p < 0.05.

RESULTS

There were 163 (60.1%) males and 108 (39.9%) females with a mean age of 25.8 years. The majority (97%) wished to commence residency training soon after internship; surgery (37.6%), and internal medicine (22.4%) were the most popular choices. Reasons for non-consideration of surgery included: stressful (46.1%), future family plans (41.3%) and difficult training (18.1%). Males were more likely to choose surgery than females (52.1% vs. 13.0%, p < 0.001). Married interns were less likely to choose surgery compared to their single colleagues (0% vs. 37.5%, p = 0.042). Having surgeons as role models, staff advisers or first degree relatives were significantly associated with selecting a career in surgery.

CONCLUSION

Gender, marital status, having surgeons as role models, staff advisers or first degree relatives in medical school are significant factors influencing the choice of a career in surgery.

Clinical investigation of patient related factors in non carious cervical lesions

BACKGROUND

The majority of the studies on non carious cervical lesions (NCCLs) dealt with characteristics of NCCLs without identifying patient related factors associated with them.

OBJECTIVE

The basis of this study to identify these factors and to see if there are any association with the findings.

METHOD

This study was conducted among 34 patients referred to the conservative clinic of the Lagos University Teaching Hospital, Idi-araba, Lagos. Questions regarding patient's complaints, dietary habits and toothcleaning techniques were asked and correlated with the occurrence and severity of NCCLs clinically.

RESULT

Over a third, (41.2%) of the subjects presented with dentine sensitivity resulting in pain. Fifty percent (50%) of the patients were on one form of medication or the other. Out of this number, 50% habitually chewed vitamin C tablets. With respect to diet, 61.8%, 58.8% and 47.1% of the patients were on diet rich in fruits, soft drinks and fruit juices respectively. The degree of severity(extensiveness) of lesions significantly increases with age of patient (p = 0.001). Tooth cleaning habits played an important role in the occurrence, distribution and pattern of NCCLs. There was association between the tooth cleaning technique used and the extensiveness and distribution of the lesions. The horizontal technique accounted for 54.7% of lower jaw lesions while 63.7% and 55.8% of lesions found in the vertical and mixed (circular) techniques respectively were found in the upperjaw.

CONCLUSION

Awareness of the multifactorial etiology in noncarious cervical lesions may help the clinician to formulate an appropriate treatment plan and preventive strategies in the management of NCCLs.

Mirizzi syndrome: report of a case and the challenge of management in our environment

BACKGROUND

Mirizzi Syndrome is a rare complication of cholelithiasis reported to occur in 1% of all patients with gall stones and an incidence of 0.7-1.4% in all cholecystectomies. It is characterized by an impaction of a large calculus in the Hartman's pouch of the gall bladder (GB) or in the cystic duct, causing an extrinsic obstruction of the common hepatic duct. This can, with time, result in varying degrees of fistula formation between the duct and the GB. Types I, IIa, b and c have been described depending on the circumference of the duct involved in the cholecysto-choledochal fistula. This syndrome presents clinically as surgical jaundice. The preoperative diagnosis is difficult as well as the surgical management of the type II subtypes. The aim of this paper is to draw attention to this clinicopathological entity as it occurs with the same frequency in our environment as in the environment with high incidence of cholelithiasis.

METHOD

We report a case in our practice (Mirizzi Type IIa) and discuss the difficulties encountered in pre-operative diagnosis and subsequent management. The literature is also reviewed

RESULTS

The diagnosis of Type IIa Syndrome was made on the operating table. The on-table cholangiogram was inconclusive. A choledochoplasty was performed over a T-tube and this was removed after 12 weeks. Patient has done well thereafter.

CONCLUSION

The local surgeon is advised to have a high index of suspicion about this condition so as not to be caught unawares.

Lipid peroxidation in brain tissue following administration of low and high doses of arsenite and L-ascorbate in wistar strain rats

This study aimed at investigating the mechanism by which sodium arsenite induces brain injury and the role of L-ascorbate. Thirty adult (n=5) Wistar rats weighing between 140 and 160 g were used. Group 1 neither received sodium arsenite nor L-ascorbate (control), group 2 was administered low dose of arsenite only, group 3 received high dose of arsenite only, group 4 was administered L-ascorbate only, group 5 was administered low dose of arsenite and L-ascorbate, and group 6 received high dose of arsenite and L-ascorbate. M0 alon dialdehyde, MDA, levels were significantly increased in rats treated with high dose of arsenite when compared with those treated with low dose of arsenite. However, all treated groups except those treated with L-ascorbate only showed significant increase in MDA levels when compared with the control group. Rats treated with high dose of arsenite and L-ascorbate showed a significantly higher MDA level than those treated with low dose of arsenite and L-ascorbate. However, catalase activity, body weight gain, brain weight and mean food consumption were comparable across all groups. Brain tissue total protein was similar in all groups except in both groups treated with high dose of arsenite, where they were significantly reduced when compared with the control group. I0 n conclusion, sodium arsenite treatment induces brain injury via a mechanism associated with lipid peroxidation, but not catalase-dependent. However, L-ascorbate ameliorates arsenite-induced oxidative injury in the brain. L-ascorbate antioxidative potential in alleviating arsenite-induced brain injury is dependent on the concentration of arsenite.

Correlation of cag-A serological status with histological parameters of chronic gastritis among dyspeptic patients in south western Nigeria

BACKGROUND

The aim of this study was to determine the sero-prevalence of Cag-A strains of Helicobacter pylori in both dyspeptic and non-dyspeptic individuals and also correlate the serological status of Gag-A strain of H. pylori with the various graded histological variables of chronic gastritis in the dyspeptic patients.

METHODS

Using helicobacter p120 Cag-A enzyme linked immunosorbent assay, Cag-A serology test was carried out on 65 dyspeptic patients and 65 age and sex matched non-dyspeptic controls. The gastric biopsies of the patients were also histologically examined to ascertain the presence, nature and degree of the following histological variables of gastritis: colonisation by H. pylori; inflammation, intestinal metaplasia and mucosal atrophy. The CagA serological status was then correlated with the graded variables.

RESULTS

A prevalence of 46.2% and 58.8% seropositivity for Cag-A strain of H. pylori was found among dyspeptic patients and control individuals respectively. Cag-A seropositive patients accounted for nine(81.8%) of the 11 cases with moderate to severe activity and 75% of both cases with mucosal atrophy and cases with intestinal metaplasia.

CONCLUSION

Infection with Cag-A positive Helicobacter pylori was equally prevalent among both dyspeptic patients and control subjects studied. CagA seropositivity, however, appeared to be associated with higher inflammatory activity in the mucosa of patients with chronic gastritis and may be associated with intestinal metaplasia and mucosal atrophy in H. pylori-induced chronic gastritis.

Perception of dentine hypersensitivity and its management by a group of Nigerian dentists

BACKGROUND

Dentists need to be aware of the management of dentine sensitivity in view of its high prevalence.

OBJECTIVE

The study is to determine by questionnaire the perception of dentine hypersensitivity (DH) and its management by Nigerian Dentists.

METHOD

A structured questionnaire was used to collect data from 176 Nigerian Dentists who attended professional dental workshops in Lagos, Ife and Jos, Nigeria.

RESULTS

The majority (73.3%) of the responding dentists claimed to see patients with DH. Nearly half (45.1%) of the dentists mentioned cold as the commonest stimulus evoking pain in DH while 56.8% could correctly identified the hydrodynamic theory as the commonest theory of tooth hypersensitivity. Multifactorial aetiology identified as causing DH included tooth wear lesions, periodontal causes and bruxism. Treatment options suggested varies but non-invasive was mentioned more than the invasive techniques. Sensodyne toothpaste was the commonest desensitising paste mentioned. The knowledge of Nigerian Dentists was found to be associated with the specialty of the practitioners (p = 0.0004).

CONCLUSION

Dental Practitioners, especially the General Dental Practitioners should be enthusiastic in updating their knowledge of DH and the management. Prevention of DH by the Patients and the Dentists should be emphasised.

Correlation of serum anti-helicobacter pylori immunoglobulin a (IgA) with histological parameters of chronic gastritis in ibadan, Nigeria

BACKGROUND

The seroprevalence of anti-H. pylori IgA antibodies has been reported to vary among populations and in relation to strains of Helicobacter pylori bacterium. However, there has been conflicting reports on the association between IgA serological status and the histological variables of chronic gastritis. This study was therefore conducted to clarify this relationship.

METHOD

Using an ELISA based commercial kit, anti-H. pylori IgA antibody tests were performed on 65 dyspeptic patients and 65 age- and sex-matched controls. The gastric biopsies of these patients were also examined histologically for the degrees of inflammation, activity, intestinal metaplasia and atrophy. The CagA status of the patients had been determined previously.

RESULTS

There was an anti-H. pylori IgA antibody prevalence of 67.7% in dyspeptics and 56.9% in non-dyspeptic individuals. No correlations were observed between serum H. pylori IgA antibody and the graded parameters of chronic gastritis in dyspeptic patients, although twice more patients with mild gastric inflammation were found among IgA positive than among IgA negative patients. However, a statistically significant relationship was established between serum IgA positivity and the CagA status of the patients (p = 0.028).

CONCLUSION

The seroprevalence of anti-H. pylori IgA antibody is high in our environment. Serum IgA status may be associated with milder degrees of gastritis in our patients but a larger cohort of patients is needed to confirm this. There seems to be a good agreement between serum IgA and CagA statuses among dyspeptic patients.

Distribution and characteristics of non carious cervical lesions in an adult Nigerian population

BACKGROUND

Controversies rages in the literature as to the characteristics of non carious cervical lesions (NCCLs) in terms of the location and its severity.

OBJECTIVE

The study is to investigate the characteristics of NCCLs in adult patients who had a high incidence in them and to see if there are any association with the findings. Methods : The author examined 356 teeth with NCCLs in 34 subjects (male and female aged 22-75 years). The characteristics were based on the location of the lesion and the size (shape, extensiveness and depth).

RESULTS

In terms of the location, 61.2% were located on the posterior teeth, and 55.9% on the maxillary teeth. The first premolars (25.8%) and canines (19.4%) were affected most often, followed by the first molars (16.9%) and second premolars (13.8%). There was slight right side preponderance (50.3%) and more lesions in the male subjects (67.4%). Patients tended to be older, with 76.4% in the 40 years and older age group. In terms of the size of the lesion, 75.0% of the lesion had angular shape of < 135 (wedge), 70.2% had axial depth of 1-2 mm, and 51.7% had occlusogingival width (extensiveness) of 2-3.9mm (small). There was association between gender and the severity (extensiveness) of the lesion. The severity (shape and extensiveness) of NCCL was associated with age. There was strong association between the severity of NCCL and site of the lesion (jaws).

CONCLUSION

The authors found that NCCLs were significantly related to age. The posterior maxillary teeth especially the first premolars followed by the canines were the teeth commonly involved. No great difference in incidence was found between the right and left sides as a result of right or left hand dexterity. Awareness of a multifactorial etiology in noncarious cervical lesions may help the clinician to formulate an appropriate treatment plan for the patient. In addition, these characteristics help identify which teeth and patients that are more susceptible.

Intussusception and volvulus secondary to jejunal adenocarcinoma in an adult Nigerian male: a case report

A 31 year-old Nigerian man with jejuno-jejunal intussusception with the lead point being an adenocarcinoma complicated by small intestinal volvulus is presented. The subtle clinical features of an underlying small bowel malignancy were masked by the overwhelming clinical and radiological features of intussusception. rare case is reported to remind clinicians to have an increased index of suspicion of malignancy in patients who present with the usual features of chronic anemia, weight loss and loss of appetite with an intra-abdominal mass. The presentation of acute intestinal obstruction, with mesenteric vein thrombosis probably due to intussusception or volvulus should not however lower the suspicion. Histological evaluation of surgical biopsies is of immense importance.

Review of fine needle aspiration cytology in the management of goitres in Ibadan, Nigeria

OBJECTIVE

The use of Fine Needle Aspiration Cytology (FNAC) in the investigation of goitres was introduced into our practice more than a decade ago. This is a review of its diagnostic accuracy for thyroid carcinoma seven years after the first evaluation and following the establishment of the 'FNAC Clinic'.

METHOD

This is a retrospective study of patients who had FNAC of goitres and the histopathology of their thyroidectomy specimens between 1995 and 2004. The accuracy of the cytology reports were evaluated against the histology reports. The turnaround time of the patients for surgery was also determined.

RESULTS

There were 130 females and 21 males with an age range of 7-86 years. The diagnostic accuracy of the procedure for carcinoma was 89% with a sensitivity of 35%, specificity of 97%, positive predictive value of 64%, and a negative predictive value of 91%. The average turnaround time for surgery was 178.7 +/- 248.7 days with a range of five days to three and a half years.

CONCLUSION

The diagnostic accuracy of FNAC of goitre for carcinoma improved in the period under review. However, the long surgery turnaround time may reduce the usefulness of the procedure. The accuracy may be improved further by a protocol of ultrasound guidance, capillary collection with no-aspiration technique, on-site review of slides with a repeat of FNA as necessary.

Pattern and outcome of childhood intestinal obstruction at a tertiary hospital in Nigeria

BACKGROUND

Intestinal obstruction is a common cause of pediatric surgical emergency with a high morbidity and mortality in Africa.

METHODS

A retrospective review of cases managed from January 1996 to December 2005 at a teaching hospital in Southwestern, Nigeria was done to examine the pattern of causes of intestinal obstruction in children and the management outcome.

RESULTS

One hundred and thirty cases were seen over the study period with an age range of 2 hours to 14 years. Majority (61.24%) were infants, while 18.46% were neonates. Fifty-five cases (42.31%) were due to congenital causes while the rest were of acquired causes. The major causes of intestinal obstruction in the study were intussusception (29.23%), anorectal malformations (22.31%), obstructed inguinoscrotal hernia (16.92%) and Hirschsprung's disease (13.85%). Surgical site infection and sepsis were the commonest complications observed with an overall complication rate of 60.78%. The mortality rate was 3.08% and most (75%) occurred in neonates.

CONCLUSION

While mortality as an outcome of management is low, the morbidity was very high in this study.

Factors influencing the pattern of self-medication in an adult Nigerian population

BACKGROUND

Despite the growing research interest in self-medication, little information has been available about its major determinants especially in developing countries. This informed the conduct of this study to determine the major factors that influence the pattern of self medication in a population of market women in Ifako-Ijaiye area of Lagos, Nigeria.

METHODS

Interviewer administered pretested semistructured questionnaire was used to collect data from 205 market women selected by multistage sampling technique.

RESULTS

The patent medicine dealers were the commonest source of information on medications (31.4%) and where they were obtained (52.2%). The exceptions were the educated (62.5%) respondents who obtained theirs from hospitals and pharmacies. Trade and generic names (61.1%) were common means of drug recognition especially among the educated respondents (P<.05). Education of the respondents was the major factor influencing the practice of self-medication though the pattern was descriptively associated with the marital status and educational level of the respondents (P<.05). Benefits of the practice includes in the order: curing of ailments (58.0%), saving time and money (32.0%) and independence of care (7.0%).

CONCLUSION

Literacy and public health education were the major factors influencing the pattern of self-medication among market women. Recommendations on the role of education of market women, patent medicine dealers and the importance of community pharmacy were suggested.

Nonsteroidal gastropathy in dentistry--issues and controversies in patient's management

BACKGROUND

Nonsteroidal anti-inflammatory drugs (NSAIDs) provide excellent analgesia for mild to moderate pain and are therefore commonly prescribed in dental practice. However, they are not without side effects, most notably upper gastrointestinal toxicity. This article reviews the issues and controversies in managing dental patients especially those who present with acute pain in the light of introduction of preventive strategies to reduce such gastrointestinal complications.

METHODOLOGY

This review is primarily based on articles selected from Medline between 1997-2006 concerning upper gastrointestinal toxicity following NSAID use and introduction of preventive strategies to reduce them with particular reference to dental practice and developing countries.

RESULTS

Selective COX-2 inhibitors (coxibs) cause fewer gastrointestinal events than do non selective NSAIDs. However, they should be used with caution in the light of recent evidence linking them with adverse cardiovascular events.

CONCLUSION

Dental Practitioners need to be aware of notable side effects and the role of preventive strategies when prescribing NSAIDs.

HIV/AIDS and the surgeon

Human Immunodeficiency Virus and Acquired Immunodeficiency Disease (HIV/AIDS) are one of the most difficult challenges facing practicing surgeons worldwide. The challenge is more acute in sub-Saharan Africa as it currently has the highest prevalence of HIV infection in the world. Surgeons are at risk of occupationally acquired infection as a result of intimate contact with the blood and other body fluids of HIV patients requiring surgery. Patients also risk being infected by surgeons and other health care workers during surgical or dental procedures. The seropositive status of the majority of HIV positive patients may be unsuspected by the attending medical personnel who may not practice universal precautions against infection. The non-availability of relevant devices is however the most important factor militating against the use of universal precautions, especially in developing countries. There is therefore a need to increase the awareness about universal precautions and to provide the necessary devices to promote constant adherence to these procedures in order to reduce the risk of nosocomial HIV infection.

Familial thyrotoxicocis in five Nigerians

We describe the occurrence of thyrotoxicosis in four Nigerian families. Hitherto. the descriptions of familial thyrotoxicosis have been confined to the Caucasian population and only recently in a Chinese family. This is the first description of familial thyrotoxicosis in the Nigerian population. The mutation analysis of the genomic DNA of the TSH receptor of these patients is required to define the genetic mutations that caused the disease. We recommend that a high index of suspicion for familial thyrotoxicosis should be exercised in the clinical evaluation of patients who present with hyperthyroidism.

Bile duct stricture -- a sign of things to come?

OBJECTIVE

The aim of the report is to highlight this difficult to-treat condition hitherto uncommon in our environment and warn of the likelihood of more to come with the rising incidence of gallstone in our sub region.

PATIENT AND METHOD

A case report of an 18-year-old male undergraduate patient.

RESULT

A successful management with clinical, biochemical and radiological evidence (OTC and tubograms) despite inadequate investigative tool.

PRINCIPAL CONCLUSION

With the rising incidence of gall stones in our environment, it is imperative that the Trainee Surgeon must be schooled in common biliary surgery and help prevent this dreaded complication (bile duct stricture) and other sequelae of gall bladder surgery. A plea is also made for the provision of essential investigative tool to facilitate management of such cases in recognised centers.

Recurrent leg ulcers in a 16-year old Nigerian girl

This is a report of a 16-year old Nigerian girl who presented with recurrent leg ulcers associated with gastrointestinal symptoms. The management of this patient, who has ulcerative colitis manifesting with pyoderma gangrenosum, underlines the need for thorough evaluation of cutaneous ulcers in the tropics. The medical treatment of ulcerative colitis in childhood, with reservation of bowel resection for complications is preferred.

Bioavailability to rats of iron from fortified grain amaranth

In this study, fortified and unfortified grain amaranth seed flour diets and a FeSO4-fortified casein diet (used as a control) were evaluated for their iron (Fe) bioavailability. NaFeEDTA, ferrous fumarate, and FeSO4-fortified grain amaranth were fed to growing Sprague-Dawley weaning male rats. Iron intake, hemoglobin iron (HbFe) gain, Fe availability, total iron binding capacity (TIBC), serum iron, non-haem liver iron and red bloodcell volume (RBV) were determined, and the values were compared with those of the FeSO4-fortified casein diet control. Ferrous fumarate fortified diets gave consistently high values for all these parameters, compared with consistently low values for the amaranth diet without iron fortification. Relative biological values (RBVs) were 0.40, 1.55, 1.75, 1.67 and 1.00 for animals fed on an unfortified amaranth diet, and diets fortified with NaFeEDTA, ferrous fumarate, FeSO4 and casein fortified with FeSO4, respectively. Using FeSO4-fortified casein as control, ferrous fumarate gave a superior RBVs (1.75 vs. 1.00). The RBVs, of the unfortified cereal diets were 40% that of the control, perhaps suggesting low iron absorption from the amaranth cereal. Based on the results of this study, amaranth cereal can be considered an idea food vehicle for iron fortification. The iron fortification of choice is ferrous fumarate.