Nigerian journal of clinical practice (Niger J Clin Pract)

Publications in this journal

• Article: Experience with diagnostic laparoscopy for gynecological indications.

  J I Ikechebelu
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  ABSTRACT: Context: Diagnostic laparoscopy is an endoscopy procedure, which has become indispensable in the evaluation of the female reproductive organs especially in infertility. Aim: Experience with conversion to open laparotomy is presented and ways of averting this complication are discussed. Settings and Design: A retrospective study was performed. Materials and Methods: All the 1654 diagnostic laparoscopies performed at a private fertility center over a 10-year period (January 2000 to December 2009) were analyzed for indications, cases of conversion to open laparotomy, and measures taken to prevent this complication. Statistical Analysis Used: Simple percentage method was used. Results: Infertility was the commonest indication for 1627 (98.4%) procedures, while primary amenorrhoea and chronic pelvic pain were responsible for 20 (1.2%) and 7 (0.4%) procedures, respectively. There was no mortality in this series. There was conversion to open laparotomy due to hemorrhage in only 2 (0.12%) procedures and this happened at the first year of practice. Conclusions: The low rate of conversion was attributed to the surgeons experience, proper patient selection, and the use of Palmers point for insufflation in some patients with previous pelvic surgeries and use of supraumbilical access in patients with pelvic masses. Diagnostic laparoscopy for gynecological indications is safe and wider application of this modern technology is recommended for our practice.
  Nigerian journal of clinical practice 04/2013; 16(2):155-8.
• Article: Neonatal hypothermia in sub-Saharan Africa: A review

  R Onalo
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  ABSTRACT: Background: Hypothermia is a major factor in neonatal morbidity and mortality in developing countries. High prevalence of hypothermia has been reported widely even from warmer tropical countries. In spite of the World Health Organization’s recommendation of maintenance of warm chain in newborn care, hypothermia continues to be a common neonatal condition which has remained under-recognized, under-documented, and poorly-managed. Objective: This review aims at providing the incidence of and risk factors for neonatal hypothermia as well as provides a pathophysiological overview and management options for neonates with the condition in sub-Saharan Africa. Materials and Methods: All available published literature on neonatal hypothermia was searched electronically and manually. The principal electronic reference libraries and sites searched were PubMed, Embase, Ajol, Cochrane Reference Libraries and Google Scholar. The search terms used included ’neonatal hypothermia,’ ‘Cold stress in newborn’ ‘thermal care of the newborn,’ ’neonatal thermogenesis,’ ‘neonatal cold injury,’ among others. Pertinent books and monographs were accessed. Data in formats inaccessible to the reviewer were excluded. Result and Conclusion: Neonatal hypothermia is a major condition of public health importance in countries of sub- Saharan Africa. Awareness of the burden of the disease is still low in some communities. Risk factors for neonatal hypothermia in the region include poverty, home delivery, low birthweight, early bathing of babies, delayed initiation of breastfeeding and inadequate knowledge among health workers. Low-tech facilities to prevent heat losses and provide warmth are available in sub-Saharan Africa and are thus recommended as well as continuous efforts at sensitizing caregivers on the thermal needs of newborns.
  Nigerian journal of clinical practice 04/2013; 16(2):129-138.
• Article: Paediatric Maxillofacial Injuries at a Nigerian Teaching HOspital: A 3year Review

  Olushola Amole
  Nigerian journal of clinical practice 04/2013; 16(2):149-154.
• Article: Association between blood pressure and urinary electrolytes in a population of non-urban-dwelling Nigerians

  Ejike C.E.C.C, Ugwu C.E
  Nigerian journal of clinical practice 09/2012; 15(3):258-264.
• Article: Prevalance of self-reported dentine hypersensitivity among university students in Turkey

  Colak H, Hamidi MM, Aylikci BU, Uzgur R
  Nigerian journal of clinical practice 01/2012;
• Article: jejunoileal atresia: a 2year preliminary study on outcome and management

  OH Ekwunife, IC Oguejiofor, VI Modekwe, AN Osuigwe
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  ABSTRACT: Background/Aim: Intestinal atresia is a common cause of neonatal intestinal obstruction. Jejuno-ileum is the commonest site of intestinal atresia. Reports on Jejunoileal atresia in developing countries are still few. The purpose of this study is to determine the presentation and management outcomes of neonates with Jejunoileal atresia treated in our hospital. Materials and Methods: Detailed data on all babies that presented and were treated within the study period (November2008-November, 2010) were kept and analyzed. A management protocol was put up and maintained. Result:A total of 9 babies (7males and 2 females) were treated. They were aged 2hours to 13days. Their weight ranged from 1.7kg to 3.3kg. Apart from one baby which presented within 2hrs with prenatal ultrasound diagnosis, others had bilious vomiting from the first day of birth, abdominal distension and delayed or absent passage of meconium. Even though symptoms developed on the first day of birth, presentation to the surgical unit was delayed 72hours and beyond in most patients.Type I atresia is commonest (no=4).There is associated gut malrotation in 2 babies. Five babies had complications which included surgical site infection, sepsis, prolonged vomiting post operatively, aspiration, rupture of dilated proximal segment after membrane excision, entero-cutaneous fistula and malnutrition. Three babies died giving a mortality of 33.3%. Mortality is commoner in types IIIb and IV. Conclusion: Mortality is higher in complex atresia which most times will require neonatal intensive care and parenteral nutrition facilities. These are still lacking in our institution. Providing these facilities will further improve outcome.
  Nigerian journal of clinical practice 08/2011; Niger J Clin Pract 2012(15):354-7..
• Article: A review of current management of cancer of prostate

  Adegun PT
  Nigerian journal of clinical practice 03/2011; 9(1):34-40.
• Article: 26)Probable autoimmune causal relationship between periodontitis and Hashimoto’s thyoiditis:A systemic review BS Patil.,S Patil.,T.R.Gururaj.,Nigerian Journal of Clinical Practice.,July-September 2011 Vol 14,Issue 3.,pages 253-261.

  patil, gururaja rao
  Nigerian journal of clinical practice 03/2011; 14(3):253-261.
• Article: Krukenberg tumour simulating uterine fibroids and pelvic inflammatory disease.

  B U Ezem, C C Osuagwu, I V Onyiaorah
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  ABSTRACT: To report a case of cancer of the colon which presented as secondaries to the ovaries. Case report. The case presented is that of a 39-year-old female who presented with lower abdominal pain and a multinodular pelvic mass which led to an initial diagnosis of multiple uterine fibroids and pelvic inflammatory disease. The presence of a colonic mass was first suggested by ultrasound. Laparotomy revealed carcinoma of the colon with bilateral krukenberg's tumour and an insignificant fibroleiomyoma. This case is reported to alert practitioners that all multinodular pelvic masses should not be assumed to be multiple fibroids.
  Nigerian journal of clinical practice 09/2010; 13(3):336-7.
• Article: Congenital orbital teratoma.

  L O Onyekwe, A N Onwuegbuna, J K C Emejulu
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  ABSTRACT: Congenital orbital teratoma though rare is available in this environment. This is a case report of a baby with a protruding orbital mass in the left eye with all classical clinical features of teratoma. Though the histopathological report fell short of confirming the diagnosis the clinical features and outcome of management strongly suggest that the lesion is a teratoma. Multidisciplinary approach to the management not only saved the life of the baby in question but also enhanced the outcome of treatment. Good and compliant follow up for six months was experienced. Cytological test is mandatory for any suspected cases ofteratoma.
  Nigerian journal of clinical practice 09/2010; 13(3):338-40.
• Article: Demographic and sociocultural characteristics of sickle anaemia children with positive hepatitis B surface antigenaemia in a tertiary health facility in Enugu.

  G O Emechebe, I J Emodi, A N Ikefuna, G C Ilechukwu, W C Igwe, O S Ejiofor, C A Ilechukwu
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  ABSTRACT: Hepatitis B virus) infection is contracted through contact with body fluid of infected persons. Patients with sickle cell anaemia (SCA), a common haematological disorder in Nigeria, have tendencies to visit traditional healers who administer scarifications and ritual marks that may expose them to HBV infection. To determine the demographic and socio-cultural characteristics of children with SCA infected with HBV at the University of Nigeria Teaching Hospital Enugu. Two hundred and twenty one children aged 6 months to 17 years with SCA were recruited consecutively from October 2004 to April 2005. They were screened for HBsAg using ELISA method. There was no statistically difference in hepatitis B surface antigenaemia among different age group (P = 0.907). Social class did not significantly influence the prevalence of HBsAg among subjects (p = 0.887). Socio-cultural practices like circumcision and scarification did not influence the prevalence of HBsAg, (p = 0.636) (p = 0.771) respectively. Significantly higher number of people from lowest socioeconomic class practice scarification (p = 0.0001). Demographic and sociocultural factors do not appear to influence the prevalence of HBsAg among children with SCA in Enugu, Nigeria.
  Nigerian journal of clinical practice 09/2010; 13(3):317-20.
• Article: Review of obstetrics genito-urinary fistulae in the University of Calabar Teaching Hospital Calabar, Nigeria.

  E I Ekanem, A D Ekanem, J E Ekabua, S J Etuk, A Essiet
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  ABSTRACT: Obstetric fistulae with Urinary incontinence are one of the most distressing maternal morbidities. It is associated with physical and social deprivation such as wife abandonment and violent reactions against the victims particularly in the developing countries of the world. To study the demographic and reproductive profiles as well as management of patients with obstetric fistulae in UCTH, Calabar, Nigeria. A five-year retrospective study of case records of 37 patients managed in Maternity Annex of University of Calabar Teaching Hospital, Calabar Nigeria for obstetric genito-urinary fistulae was carried out. One in every 122 parturients during the period had fistula. Eleven (29.7%) were teenagers. Many patients were married (54.1%), nulliparous (59.4%), come from low socioeconomic class (72.9%) and did not utilize modern obstetric facilities properly. Many cases resulted from prolonged obstructed labour (51.4%) and 70.2% presented with total incontinence of urine. Eighteen (48.7%) were diagnosed within 6 month of delivery. The main types encountered included were vesico-vaginal (34.4%) or complex (10.8%) fistulae who were manage conservatively (21.6%) or with bladder repairs. Majority (29.7%) were referred for further treatment. Parturient in Calabar still suffer from this age long obstetric morbidity mainly due to poor utilization of modern obstetric care facilities. Results of treatment are largely unsatisfactory; therefore resources should be channeled towards prevention.
  Nigerian journal of clinical practice 09/2010; 13(3):326-30.
• Article: Gastrointestinal stromal tumours at the University of Nigeria Teaching Hospital Enugu, Nigeria: an immunohistochemical study of GIT mesenchymal tumours.

  E R Ezeome, D B Olusina, U O Igbokwe
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  ABSTRACT: Mesenchymal tumours of the gastrointestinal tract (GIT) are uncommon. Recent progress in the understanding of the biology and origin of these tumours has led to their reclassification. A new subclass designated Gastrointestinal Stromal Tumours (GIST) is diagnosed based on the presence of a mutational over expression of c-kit protein that is thought to be critical in the pathogenesis of these tumours. This new class oftumours may form the majority of gastrointestinal mesenchymal tumours. Even though the diagnosis of GIST is mainly based on positive staining with CD117, a minority of tumours with histological characteristics of GIST are CD117 negative and are classified as CD117 negative GIST. In this first review of mesenchymal GIT tumours from Nigeria, we present 11 cases ofmesenchymal tumours of the gastrointestinal tract seen within a six-year period at our centre. Immunohistochemistry was performed on 7 of them in which histological appearances suggested GIST. Only two cases had all the criteria defined in the consensus conference on the diagnosis of GIST. Our findings, albeit in a very small sample, contrasts with what obtains in developed countries in the proportion of GIT mesenchymal tumours that are truly GIST. This raises a question to be answered on the true nature and proportion of gastrointestinal strumal tumours among GIT tumours in Nigerian patients.
  Nigerian journal of clinical practice 09/2010; 13(3):306-10.
• Article: Safety, efficacy and acceptability of implanon a single rod implantable contraceptive (etonogestrel) in University of Benin Teaching Hospital.

  A O Aisien, M E Enosolease
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  ABSTRACT: The study evaluated the safety, efficacy and acceptability of Implanon (etonogestrel) subdermal implant contraceptive amongst its acceptors. This was part of an on going prospective longitudinal study that involved 32 women out of 46 sexually active healthy informed volunteers recruited from our family planning clinic between February and March 2007. All the subjects received the single rod subdermal implant Implanon which contains 68 mg etonogestrel. Data on socio-demographic characteristics, menstrual pattern, haematological indices, weight, blood pressure, side effects and user's satisfaction were collected and analysed. The subjects served as their own control. The mean age and parity were 33.9 +/- 5.2 years and 3.1 +/- 1.7 respectively. The mean weight was 71.4 +/- 12.0 kg at pre-insertion. At 6 months the weight reduced to a non significant (p < 0.13) mean value of 70.0 +/- 10.5 kg and increased to a non significant (p < 0.88) mean value of 71.5 +/- 11.6 kg at 12 months. The mean systolic and diastolic blood pressures did not show statistical significant changes at 6 months follow up (p < 0.17/0.64). However at 12 months there were significant but within normal reductions (p < 0.003/0.05) in the systolic and diastolic blood pressures. The side effects were menstrual abnormalities. Eighteen (56.3%), 1 (3.1%) and 13 (40.6%) reported reduced, increased and combinations of bleeding patterns respectively. No participant had normal cycle. Other experiences were headache, 4 (12.5%) and reduced libido 3 (9.4%). The mean packed and white blood cell concentrations did not show statistical significant changes at 6 and 12 months follow up. At 12 months there was statistical significant increase (p < 0.04) in the mean +/- SD platelet count (205312.5 +/- 75694.8 per ul) when compared with the pre-insertion mean value (176343.8 +/- 52945.3 per ul). One acceptor had thrombocytopenia without any untoward effect. Two subjects discontinued method on account of menorrhagia and headache. The efficacy and continuation rate were 100% and 93.8% respectively. All the clients received adequate information about the method and most of them were satisfied with it at follow up. Implanon was an effective, safe and acceptable method of contraception amongst its acceptors. Menstrual abnormalities were the major side effects which most of the subjects found tolerable with adequate counseling. The reduced platelet concentration of the one acceptor would require follow up to ascertain the trend.
  Nigerian journal of clinical practice 09/2010; 13(3):331-5.