Nigerian Tertiary Health Center Research Articles

HBME-1 expression by thyroid neoplasms in a Nigerian tertiary health Centre

Aim: The aim of this study is to review the histopathological diagnosis of thyroid neoplasms seen in OAUTHC Ile Ife using HBME-1 immunohistochemical marker.
 Materials and methods: We studied all thyroid neoplasms diagnosed in the Department of Morbid Anatomy and Forensic Medicine OAUTHC, Ile-Ife from 1st July 1996 to 30th June 2016. We noted the age, sex of the patients, nature of histological diagnosis (benign and malignant) and the specific histologic diagnosis. We evaluated HBME-1 immunostain grade (0, 1+, 2+, 3+, 4+) for all the tumours.
 Results: We studied only fifty-six cases (all neoplastic thyroid diseases). Sixteen (28.6%) and forty (71.4%) cases of the cases were benign and malignant, respectively. The Malignant thyroid neoplasms were 2.5 times more frequent than the benign thyroid lesions. There is a significant statistical relationship between HBME-1 expression and the nature of the neoplastic cases (p = 0.001). The sensitivity of HBME-1 in distinguishing benign from malignant thyroid neoplasms in this study was 77.5%, the specificity was 87.5%, the positive predictive value (PPV) was 93.3% and the negative predictive value (NPV) was 60.1%. 
 Conclusion: There is a significant statistical association between HBME-1 and the nature of thyroid neoplasms. HBME-1 can be used as an added tool in distinguishing malignant thyroid neoplasms from the benign tumours.

Cytokeratin 19 (CK19) expression by thyroid neoplasms in a Nigerian tertiary health centre.

despite the observed appreciable sensitivity and specificity of the use of CK19 in predicting thyroid malignancies, there is still a paucity of information about its uses in Nigeria. Current information across the world is also scarce. This study was to review the histopathological diagnosis of thyroid neoplasms seen in Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile Ife, using cytokeratin 19 immunohistochemical marker. a retrospective study of fifty-six cases of thyroid neoplasm seen over a period of twenty years was conducted. The tissue samples were subjected to immunohistochemical staining for CK19 using monoclonal antibodies. The expression of the markers on the various thyroid neoplasms was assessed histologically. the expression of CK19 was significantly higher in malignant thyroid neoplasms compared to benign neoplasms (p<0.05). The sensitivity and specificity for cytokeratin 19 were 90.0% and 75.0% respectively. diffuse immunohistochemical expression of CK19 is a strong indicator of thyroid malignancy. This biomarker can help in the diagnosis of thyroid neoplasms especially those with incomplete or equivocal histomorphology features.

Lung function abnormalities in patients with sickle cell disease in a Nigerian tertiary health centre

ABSTRACT Introduction Pulmonary complications with the subsequent lung function abnormalities occur commonly among sickle cell disease (SCD) patients even while at their steady states. This study, therefore, aimed to determine the prevalence and pattern of lung function abnormalities and its associated factors among SCD patients. Methods This was a hospital-based cross-sectional study in a Nigerian tertiary hospital involving 113 SCD participants and age- and gender-matched non-SCD controls. Spirometry, transthoracic echocardiography, oxygen saturation, complete blood count, serum urea and creatinine were done for the participants. Results The forced vital capacity, forced expiratory volume in 1 second and the peak expiratory flow rate of the SCD participants were significantly lower than that of the control group with p-values of 0.004, 0.000 and 0.000 respectively. Of the SCD participants; 40.7% recorded abnormal lung function with the restrictive pattern occurring most commonly with a prevalence of 28.3%. There was a statistically significant relationship between age and lung function of the SCD participants (p = 0.044). Conclusion Lung function abnormalities occur frequently among people with SCD with the restrictive pattern being the most common abnormality and these abnormalities occur more frequently as these patients age.

Mortality review in a maxillofacial center in Northern Nigeria

Context: Mortality pattern is an essential component in health delivery globally. It is an important medical appraisal that should be made regularly. Mortality in maxillofacial patients often results from co-morbidity from others diseases as seen in Ludwig's angina and advanced stage malignancies. Aim: To document the causes of maxillofacial mortalities during a 12-year period. Materials and Methods: An analysis of all cases of death recorded in the Department of Oral and Maxillofacial Surgery of a Nigerian tertiary health Centre from January 2006 to December 2018. Results: A total of 3255 oral and maxillofacial patients were seen during 12-year period. About 65 deaths were recorded accounting for 2.0% of all cases of which 69.2% were males, whereas 30.8% females. The age group most affected was 30 to 39 with 23.1% closely followed by 20 to 29 with 21.5%. Conclusion: Cervicofacial infection was the commonest causes of mortality in oral and maxillofacial surgery in our environment.

Serum Micronutrients as related to Childhood Pneumonia Severity and Outcome in a Nigerian Health Facility.

Micronutrients are essential minerals and vitamins needed for optimal health. There are however conflicting reports about the roles of micronutrients in severity and outcomes of childhood pneumonia. This study aims to determine the socio-demographic and serum micronutrients - Zinc (Zn), Selenium (Se), Vitamins (Vit) A, C and E status of Nigerian children with or without pneumonia and relate these to pneumonia severity and outcome. Children aged two months to 14 years with severe and non-severe pneumonia were recruited with age and sex-matched controls over 12 month period in a Nigerian tertiary health centre. Relevant history and serum micronutrients were compared in the two groups and related to pneumonia severity and length of hospitalisation (LOH). One hundred and forty-four children (72 for each group) were recruited with median (IQR) age 1.6 (0.6 - 4.0) years and fifty-six (38.8%) had severe pneumonia. Pneumonia incidence was associated with undernutrition, inappropriate immunisation and Zn deficiency (p < 0.05). Hypovitaminosis A [60.8(22.2)µg/dl vs. 89.5(34.7)µg/dl; p < 0.001], low serum Zn [71.6(32.5)µg/dl vs. 92.6(24.6)µg/dl; p=0.019] and indoor air pollution (IAP) were associated with pneumonia severity. However, only IAP (OR = 4.529; 95%CI 1.187-17.284; p=0.027) and Zn deficiency (OR=6.144; 95%CI 1.157-32.617; p=0.033) independently predicted severe pneumonia. No significant correlation between serum micronutrients and LOH. Exposure to IAP and low serum micronutrients particularly Zn and Vit A were associated with pneumonia incidence and severity in Nigerian children. Routine micronutrient supplementation may assist to reduce the burden of childhood pneumonia in developing countries.

Family Functioning of People Living with HIV/AIDS Accessing Care at a Nigerian Tertiary Health Centre

Aims: To assess the family functioning and identify its determinants among adult PLWHA at Bowen University Teaching Hospital, Ogbomoso.&#x0D; Study Design: The study is a descriptive cross-sectional study.&#x0D; Place and Duration of the Study: The study was conducted in the Antiretroviral (ARV) Clinic of the Bowen University Teaching Hospital, Ogbomoso, Nigeria from January 2014 to March 2014.&#x0D; Methodology: Sixty-one HIV-infected patients aged 18 years and older were selected using the systematic random sampling. Data were collected using a pre-tested, structured, researcher-administered questionnaire which had a section on respondents’ socio-demographic characteristics and incorporated the General Functioning scale of the Family Assessment Device to assess their family functioning. The data were analysed using SPSS and presented as descriptive and inferential statistics.&#x0D; Results: The mean age of the 61 respondents was 37.1±8.1 years and 43 (70.5%) of them were females. Most of the respondents were married (65.6%) and the proportion of those with primary education (37.7%) was highest. A mean General Functioning (GF) score of 1.8±0.6 indicated an overall healthy family functioning. The proportion of respondents with healthy family functioning was highest for the married among all marital categories and decreased with increasing level of education. These associations of marital status and level of education with family functioning were statistically significant (P = 0.02 and 0.04, respectively) based on the result of Fisher’s exact test.&#x0D; Conclusion: The fact that larger proportions of the respondents were married and had low education level was found to have influenced the finding of a high rate of healthy family functioning in this study. Therefore, regular family functioning assessment as part of routine evaluation of PLWHA is suggested, and interventions that can temper the dysfunctional influences of formal education on family functioning should be incorporated into HIV/AIDS care.

Musculoskeletal Tumors of the Extremities: Challenges and Outcome of Management in a Nigeria Tertiary Hospital

Background: Patients with musculoskeletal tumors in developing countries often present late to the hospital and this poses serious challenges to the management, especially for malignant tumors. This study aims to highlight the various types of musculoskeletal extremity tumors seen in a Nigerian tertiary health center during the study period, the challenges encountered in managing them, and the outcome of the management. Materials and Methods: A prospective study in which all consenting patients with musculoskeletal extremity tumors who presented to the center from April 2015 to March 2017 were recruited. Results: Seventy‑two patients were managed during the study period. The mean age was 22.1 ± 4.5 years and the age group most affected was the 11–20 years group, n = 22 (30.6%). Male‑to‑female ratio was 1.6:1. The femur was the most commonly involved bone. Forty tumors were benign while 32 were malignant tumors. Osteochondroma was the most common benign tumor while osteosarcoma was the most common malignant tumor. The challenges encountered during the management were a late presentation, poverty, and traditional bonesetter intervention before the presentation. Patients with benign tumor had excision with good outcome in all. Twenty (62.5%) of the patients with a malignant tumor had the ablative procedure, two of these 20 patients died within 6 months of treatment, while 12 (37.5%) of the patients with malignant tumor refused the treatment. Conclusion: Management of musculoskeletal extremity tumors is highly challenging in this part of the country, especially the malignant types, due to the challenges mentioned. There is a need for more awareness about the disease, the Government should subsidize the cost of management of this disease, and more specialty training of personnel is necessary for appropriate management of the diseases. Keywords: Extremity, musculoskeletal, tumor.

Musculoskeletal tumors of the extremities: Challenges and outcome of management in a Nigeria Tertiary Hospital

Background: Patients with musculoskeletal tumors in developing countries often present late to the hospital and this poses serious challenges to the management, especially for malignant tumors. This study aims to highlight the various types of musculoskeletal extremity tumors seen in a Nigerian tertiary health center during the study period, the challenges encountered in managing them, and the outcome of the management. Materials and Methods: A prospective study in which all consenting patients with musculoskeletal extremity tumors who presented to the center from April 2015 to March 2017 were recruited. Results: Seventy‑two patients were managed during the study period. The mean age was 22.1 ± 4.5 years and the age group most affected was the 11–20 years group, n = 22 (30.6%). Male‑to‑female ratio was 1.6:1. The femur was the most commonly involved bone. Forty tumors were benign while 32 were malignant tumors. Osteochondroma was the most common benign tumor while osteosarcoma was the most common malignant tumor. The challenges encountered during the management were a late presentation, poverty, and traditional bonesetter intervention before the presentation. Patients with benign tumor had excision with good outcome in all. Twenty (62.5%) of the patients with a malignant tumor had the ablative procedure, two of these 20 patients died within 6 months of treatment, while 12 (37.5%) of the patients with malignant tumor refused the treatment. Conclusion: Management of musculoskeletal extremity tumors is highly challenging in this part of the country, especially the malignant types, due to the challenges mentioned. There is a need for more awareness about the disease, the Government should subsidize the cost of management of this disease, and more specialty training of personnel is necessary for appropriate management of the diseases. Keywords: Extremity, musculoskeletal, tumor.

Correlation between placental malaria parasitaemia at delivery and infant birth weight in a Nigerian tertiary health centre

Background: Untreated malaria during pregnancy is detrimental to the health and survival of the mother, foetus and neonate due to its great potential to cause maternal anaemia, foetal death and intrauterine growth restriction leading to low birth weight. The foetal complications are due to impaired placental function that results from placental malaria parasitaemia as well as impaired foetal oxygenation from maternal anaemia. This study was conducted to determine the influence of placental malaria parasitaemia on infant birth weight. Methodology: This was a prospective cross-sectional analytical study of 205 parturients recruited consecutively as they presented for delivery at the Federal Medical Centre, Yenagoa. An interviewer-administered questionnaire was used to collect data. After delivery, the neonates were weighed and placental blood was collected for microscopy to detect malaria parasites. Data was analysed using SPSS version 22. Results: The prevalence of placental malaria parasitaemia was 13.7% and Plasmodium falciparum was the only parasite species detected. Placental malaria parasitaemia was associated with a reduction of the mean infant birth weight by 335 grams ( P = 0.01). Conclusion: Malaria during pregnancy is still an important public health problem among our obstetric population, with a high prevalence of placental malaria parasitaemia and a significant negative effect on the birth weight of neonates. To enable the developing foetus achieve its full genetic growth potential, pregnant women should be encouraged to register early for antenatal care and utilize all the recommended malaria preventive measures. Keywords: Placenta, malaria infestation, birth weight

A study on shotgun injuries to the craniomaxillofacial Region in a Nigerian Tertiary Health Center.

Short-range shotgun wounds of the craniomaxillofacial region are life-threatening and are as devastating as military rifle wounds. This study aimed to evaluate the pattern of presentation of craniomaxillofacial shotgun injuries, types of shotgun injuries, and the outcome of treatments in our environment. This is a prospective observational study. Materials and Methods: This is a prospective observational study conducted from February 2006 to March 2012. All patients with shotgun wounds to the craniomaxillofacial region were included in the study by convenient sampling method. Glezer's shotgun classification scheme was used to categorize the patients into short-, intermediate-, and long-range shotgun wounds. Data collected were analyzed using SPSS version 16. Descriptive statistics were used to calculate the data. Mean and standard deviation (SD) were calculated for all quantitative variables such as age. Frequency and percentages were presented for qualitative variables. A total number of 28 patients were seen. Ages ranged from 19 to 64 years with a mean (±SD) of 32.7 (±11.4) years. The two most commonly used shotguns were locally made pistol (25, 42.9%) and the cut-size gun (10, 35.7%) and the least commonly used was Dane gun (1, 3.6%). Close-range injury to the face was 17 (60.7%) while that of intermediate- and long-range injuries were 6 (21.1%) and 5 (17.9%), respectively. Wounds sustained from close-range shotguns to the face were the most common in this environment. The outcome of treatment was satisfactory when treated with conservative debridement and early reconstruction.

Cognitive function in newly diagnosed patients with HIV infection in a Nigerian Tertiary Health Centre: assessment using Community Screening Interview for Dementia (P2.302)

Cognitive function in newly diagnosed patients with HIV infection in a Nigerian Tertiary Health Centre: assessment using Community Screening Interview for Dementia (P2.302)

Mycobacterium tuberculosis and HIV Co-infections among Patients Attending a Nigerian Tertiary Health Center

Mycobacterium tuberculosis and HIV Co-infections among Patients Attending a Nigerian Tertiary Health Center

An appraisal on antibiotic susceptibility of common bacterial pathogens in urinary tract infections at a Nigerian Tertiary Health Center

Background: Urinary tract infections (UTIs) with concomitant rise in antibiotic resistance among uropathogens remained a major health problem. A periodic appraisal of the microbial agents responsible for UTIs with their antimicrobial susceptibility is, therefore, fundamental for a fitted empirical antimicrobial intervention. This study determined the range of bacterial species in patients with suspected UTI and their antibiotic susceptibility pattern at a tertiary care center in Nigeria. Patients and Methods: This was a retrospective review of urine samples subjected to microscopy, culture, and sensitivity from patients with suspected UTI in 2015. Bacterial isolates were identified by biochemical profiling. The antibiotics susceptibility of the culture-positive isolates was achieved by disk diffusion method as recommended in the Clinical Laboratory Standard Institute guidelines. Results: There were 1,096 urine samples subjected to microscopy, culture, and sensitivity during the study period; 1,001 met the inclusion criteria. Urine microscopy yielded significant pyuria in 23.2% and sterile pyuria in 8%. Urine culture was positive in 43% of the specimens and yielded Escherichia coli in 28%, Staphylococcus aureus was seen in 6.1%, and Klebsiella in 4.8%. Out of the positive cultures, 35.3% specimens have significant pyuria. The most sensitive antibiotics were Streptomycin, Ciprofloxacin, and Gentamycin. Resistance was predominantly to Nalidixic acid, Ceftriaxone, and Ampicillin. Conclusion: Periodic appraisal of the uropathogens and evaluation of their sensitivity is a needed guide in empirical antibiotic interventions. In this appraisal, E. coli was the commonest agents in patients with UTI. Most of the microbes were sensitive to Aminoglycoside and Ciprofloxacin but often resistant to Nalidixic acid and Ceftriaxone.

Management of tracheobronchial foreign bodies in a Nigerian tertiary health center

Background: Airway foreign bodies present as emergencies, are not uncommon in developing countries like Nigeria, and can occur in all age groups. They present great difficulties for both parents and medical practitioners in general and the otorhinolaryngologist in particular. Tracheobronchial foreign bodies may endanger the life of the patient depending on the type, size, and location of the foreign body in the airway tract. We aim to look at the management of tracheobronchial foreign bodies and present a maiden article on the management of tracheobronchial foreign bodies in our center. Patients and Methods: This was a retrospective review of all patients seen at the Emergency Unit and Consultant Clinics of the National Ear Care Centre, Kaduna, Nigeria, with diagnosis of foreign bodies in the airway (the tracheobronchial area). Medical records of patients seen between January 1, 2012, and December 31, 2016, were reviewed. Data generated from the case files were analyzed descriptively. Results: Thirty-four patients presented with foreign bodies in the airway. This comprises 25 males and 9 females in a ratio of 2.8:1. Age at presentation ranged between 11 months and 27 years; the mean age was 7.02 ± 5.46 years. The predominant age group affected was 0–9 years. Twelve patients had a preliminary tracheostomy before endoscopic removal of the foreign body. Twenty-seven patients had rigid bronchoscopy and foreign body removal while 3 patients had flexible bronchoscopy, 1 patient had direct laryngoscopy, and 3 patients had tracheoscopy and foreign body removal. Majority of the foreign bodies were plastic in origin. Conclusion: Airway foreign bodies are acute emergencies, especially in pediatric age groups, and the best modality of treatment is endoscopic removal under general anesthesia.

Hemoglobinopathy- The Old and New Eras in a South-Eastern Nigerian Tertiary Health Center

BACKGROUND: Hemoglobinopathy is the commonest genetic defect worldwide and sub-Saharan Africa bears the second largest burden of this disorder. The challenges confronting management of hemoglobinopathy in resource-limited settings in Africa are diagnosis, monitoring and prognostication. The old conventional hemoglobin protein electrophoresis test (HbPE) lacks the capacity to make definitive diagnosis of hemoglobin variants (genotype) of an individual, hence, so many diagnosis of hemoglobinopathy have been missed as a result of this defect. This necessitated the need for more reliable technique for screening, diagnosis, monitoring and evaluation of Hemoglobinopathy (High Performance Liquid Chromatography,(HPLC)).AIMS: This study aimed to compare the old conventional HbPE and the new chromatographic methods (HPLC) of determining variant Hemoglobin in a south-eastern tertiary health institution in Nigeria.METHODOLOGY: A one-year prospective study of Eight thousand four hundred and seventy eight (8,478) consecutive patients who presented at the Department of Hematology, Federal Medical Centre, Umuahia for HbPE from January to December 2013 (old era) and seventy (70) patients among them who used HPLC to determine their variant hemoglobin (new era). Biomedical data, electrophoretic and chromatographic patterns of their variant hemoglobin were obtained using the conventional alkaline cellulose acetate HbPE machine and the D-10TM HPLC [Bio-Rad Laboratories] respectively. Statistical analysis was done using SPSS.RESULT:A total of 8,478 patients made up of 1,505(17.8%) males and 5,013(59.1%) females were seen within the study period. The study included both children ( ≥7months) and adult with majority of them (25%) between age of 20-30 years. Three hemoglobin variants were identified viz: [(AA(6447/76%),AS(1876/22.12%),SS(159/1.88%)] using alkaline cellulose acetate HbPE machine in the old era. In the new era, four Hb variants [AA,AS,SS(5.7%) and SD(1.3%)] were obtained using the HPLC. There was a linear increment in quantitative HbF [(AA(31/37),AS(13/20),SS(0/5) had HbF <1%,while AA(0/37),AS(0/20),SS(2/5) had HbF>10%,(Table 1)] and HbA2 [(AA(45/45),AS(8/20),SS(0/5) and AA(0/45),AS(3/20),SS(2/5) had HbA2<3.5% and >10% respectively,(Table 2)] as you move from AA, AS ,to SS Hb variants. The S-window for all HbSS (4/5) was >70% while that of AS and SD ranged between 40-70%.CONCLUSION: A critical comparison of the old and new methods of diagnosis of hemoglobinopathy showed that the later (HPLC) was superior to the former (HbPE) in the early detection, diagnosis, quantification, monitoring and prognostication of Hemoglobinopathy. Therefore, HPLC is strongly recommended in the policy guidelines for Hemoglobinopathy screening in health institutions in developing countries such as Nigeria where the prevalence is high.KEYWORDS: Diagnosis, Hemoglobin variants, HbPE, HPLC, Hemoglobinopathy. [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Retrospective Survey of Sickle Cell Disease in Pregnancy in a Niger-Delta Nigerian Tertiary Health Center

Background: The number of sickle cell disease (SCD) females with pregnancy is increasing worldwide today because of better care for sickle cell patients and an increase in life expectancy for these people. This however poses obstetric complications if pregnancy progresses without adequate care and follow-up. This study aimed at determining the prevalence and challenges of SCD among pregnant women seen in ante-natal clinic in a Niger-delta Nigerian tertiary health center.Methodology: This was a-ten-year retrospective study of thirty five thousand, nine hundred and seventy six pregnant women seen at the antenatal clinic of Braithwaite Memorial Specialist Hospital (BMSH) (2003-2013). Biomedical data and hemoglobin (Hb) electrophoresis were obtained using hypothesis generation questionnaires and conventional hemoglobin electrophoretic machines respectively. Data analysis was obtained using SPSS version 16.Result: A total of 35,976 pregnant women registered in the ante-natal clinic within the study period out of which 28,815 (80.09%) were Hb AA, 7,109 (19.77%) were Hb AS, and 52 were Hb SS (prevalence of 1.4 per 1000 pregnant women). The average booking gestational ages of 22.6 and 29.1 weeks were recorded for SCD and non-SCD participants respectively. The higher level of education (Post-secondary and post-graduate) recorded was relatively higher among the SCD (60%) compared to non-SCD (58.05%) population, although this was not statistically significant (Table 1). Hemoglobin concentration below 11 g/dl were recorded by 39.4 % and 80.8% of non-SCD and SCD participants respectively (P=0.001) (Table 2a). The study population recorded 20.8% as Hb AS (Table 2b).Conclusion: The prevalence of sickle cell disease in pregnancy is on the increase in this region. Anemia, late ante-natal booking, and poor educational empowerment rank among the greatest challenges confronting management of sickle cell disease in pregnancy in Nigeria. Therefore, awareness creation and national policies that will scale up the care of sickle cell disease in pregnancy should be topmost priorities in improving their life expectancies in Nigeria.Table 1Levels of Education: SCD Pregnant women compared to Non-SCD PregnantLevels of EducationFrequency n (%)Total n (%)p-valueNon HbSSHbSSPrimary (1-6)71 (0.2)- (0)71 (0.2)<0.05JSS (1-3)810 (2.4)1 (2)811 (2.4)>0.05SS (1-3)13,308 (39.4)19 (38)13,417 (39.7)>0.05Post-Secondary (Tertiary)19,419 (57.5)28 (56)19,447 (57.2)>0.05Post-graduate (Masters, Ph.D.)188 (0.55)2 (4%)190 (0.5)<0.05Total33,756 (100)50 (100)33,806 (100)Table 2(a) Pattern of Hemoglobin Concentration in HbSS and Non-HbSS Pregnant womenHb Conc. (g/dl)Frequency n (%)Total n (%)p-valueNon-HbSSHbSS<1113,276 (39.2)42 (80.8)13,318 (39.3)<0.05≥1120,554 (60.8)10 (19.2)20,564 (60.7)<0.05Total33,830 (100)52 (100.0)33,882 (100)Chi-square: 188.78, p-value = 0.001Note: Hb Concentration <11.0 g/dl is termed "Anemia in pregnancy" [1],[2]. 34,020 of the registered women had their Hemoglobin concentration documented.

Assessment of Position and Symmetry of the Chin Following Reconstruction of Mandible with Autogenous Iliac Bone Grafts and Non Pre-Shaped Titanium Reconstruction Plates: A Comparative Pilot Study of Visual Perception and Computer Analyzed 2D Photo Image

Aim: To restore acceptable facial profile after avulsion or ablation, the missing portions of the mandible must be adequately reconstructed. The purpose of this study was to compare the perception of individuals on mandibular chin dimensions and computer analyzed images following reconstruction of the mandible in a Nigerian tertiary health center. Method: Ten patients with tumors involving the anterior part of the mandible were included. There were 2 groups of assessors. Patients were seated on the dental chair with back rest reclined at 90 degrees. Position of the chin was assessed from the side and symmetry was assessed from the front. Images were transported to computer for analysis. The coronal images were segmented into two halves with a vertical midline. On both sides to the midline, a vertical line was drawn. For the sagittal images, a vertical line was drawn to pass through the nasal sill. Result: From the objective analysis, 5 of the patients had their chin in normal or very close to normal positions, 4 had mild retrusions (≤ 2 mm) and 1 had moderate retrusion (≥ 2). When evaluations were compared, more clinicians graded more accurately than para-clinicians in all the patients. Objectively, 8 patients had less than 2 mm, 1 patient had 2.5 mm and one had 5.5 mm (severe asymmetry). When evaluations were compared, 5 or more assessors in both groups graded correctly in 6 patients. Conclusion: Chin positions were normal based on objective evaluation in half of the cases, while symmetry was very close to normal in only one case.

Prevalence, clinical characteristics and outcome of pulmonary hypertension among admitted heart failure patients

There is paucity of data in Africa on the prevalence of pulmonary hypertension (PHT) and its impact on morbidity and short-term mortality in heart failure (HF) patients. The aim of this study was to assess the prevalence of PHT, its clinical characteristics and in-hospital mortality among HF patients admitted to a referral hospital in Nigeria. The study was carried out on serially-admitted HF patients who satisfied the inclusion criteria, in a Nigerian tertiary health center. PHT was defined as the presence of mean pulmonary artery pressure (mPAP) of ≥25 mmHg, assessed using Doppler echocardiography and Chemla formula. A total of 80 admitted HF patients were studied serially. 53 of them (66.25%) had PHT while the remaining 27 (33.75%) had normal mPAP. mPAP was 38.31 ± 12.23 mmHg and 16.39 ± 5.48 mmHg (P < 0.001) for subjects with and without PHT, respectively. The most common cause of HF was hypertensive heart disease (HHD) (28 patients; 35%). Subjects with PHT had relatively lower systolic blood pressure (SBP) (P = 0.044), and larger left atrium (P = 0.036) and left ventricle (LV) at both end-diastole and end-systole (P = 0.036 and P = 0.008, respectively), and a trend toward lower LV ejection fraction (LVEF) (P = 0.053). There was no relationship between mPAP and N-terminal pro-B type natriuretic peptide (P > 0.05). A total of 12 HF patients (15.0%) died, out of whom 8 (66.7%) had PHT. Cardiogenic shock (P = 0.044) and trans-mitral flow velocities ratio (P = 0.023) were the independent determinants of in-hospital mortality. PHT was common among the admitted HF patients, and was associated with worse morbidity indices, and a trend toward higher mortality. We recommend that HF patients be screened for PHT, and its presence should be taken into consideration in the management and prognostication of affected patients.

Pattern of presentation and management of orofacial and neck soft tissue tumors in a Nigerian tertiary health center a preliminary study

Introduction The overlying soft tissues of the head and neck comprise mainly of subcutaneous fat, neurovascular tissues, fascia and muscles covered by skin and lined by mucosa. Parenchyma organs, glands, glia and lymphoreticular tissues are not classified as soft tissues [1]. Tumors arise from any part of the soft tissues and

Isolated postprandial hyperglycemia in type 2 diabetic patients in a Nigerian Tertiary Health Center.

Background:Postprandial hyperglycemia has been shown to be an independent cardiovascular risk factor. Some studies have reported that postprandial hyperglycemia is common and can occur even in patients with normal fasting glucose levels. This has been referred to as isolated postprandial hyperglycemia.Objectives:This study sets out to estimate the prevalence of isolated postprandial hyperglycemia in a cohort of patients with type 2 diabetes and to identify their clinical characteristics.Materials and Methods:Ninety patients being managed for type 2 diabetes were recruited consecutively as they attended the diabetes clinic for follow-up. The patients were assessed with questionnaires, to obtain the demographic data. Their body mass index (BMI) was calculated. Fasting blood samples were collected for analysis of fasting plasma glucose (FPG). Patients were given their usual drugs and then served a standard meal calculated to contain 50 g of carbohydrate, providing 500 kcal. Blood samples were collected two hours after the start of the meal for postprandial glucose levels.Results:The mean age of the patients was 57.7 ± 10.8 years with a male : female ratio of 2 : 3. The mean duration of diabetes was 6.77 ± 6.53 years. The mean BMI was 27.54 ± 6.01 kg / m2. The mean FPG and two hour postprandial glucose were 7.51 ± 3.39 mmol / l and 11.02 ± 4.03 mmol / L, respectively, and the mean HBA1c was 9.0 ± 2.5%. The prevalence of isolated postprandial hyperglycemia was 24.4%. Elevated postprandial glucose was seen in 41.7% of the patients at target glycated hemoglobin levels. The patients with isolated postprandial hyperglycemia tended to be older and less obese.Conclusion:There was poor glycemic control in the patients generally; however, a significant proportion of patients, with apparently good glycemic control, had isolated postprandial hyperglycemia.