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   Table of Contents - Current issue
Coverpage
March-April 2017
Volume 58 | Issue 2
Page Nos. 53-85

Online since Monday, November 27, 2017

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ORIGINAL ARTICLES  

The incidence, risk factors and determinants of perinatal outcome of umbilical cord prolapses in Lagos, Nigeria p. 53
Omololu Adegbola, Olufemi Ayanbode
DOI:10.4103/0300-1652.219344  
Background: Umbilical cord prolapse is an obstetric emergency which is associated with significant perinatal mortality and morbidity as well as long-term handicap. Objectives: The objective of this study was to determine the incidence of cord prolapse, elucidate the risk factors as well as the fetal outcome at the Lagos University Teaching Hospital (LUTH). Design and Setting: A retrospective study at a tertiary care center in Lagos, Nigeria. Materials and Methods: A descriptive retrospective study of all pregnancies complicated by prolapse of the umbilical cord in LUTH from January 1, 2001 to December 31, 2010. Results: A total of 13,592 deliveries were conducted during the study period and 52 of which were complicated by cord prolapse at various cervical dilatations, thus giving an incidence of 3.8/1000 deliveries. Umbilical cord prolapses occurred commonly in women with multiple parities (51.9%), pregnancies with abnormal presentations (breech precisely) in 42.3%, abnormal lie in 30.8% with majority of the cord prolapse occurring after spontaneous membrane rupture (73.1%) while 26.9% occurred following amniotomy. Twenty-nine (55.8%) cases occurred outside the hospital setting; 69.2% of the children affected were term. The mean diagnosis–delivery interval was 53.3 ± 25.5 min, and cesarean section was the mode of delivery in 84.6%. Twenty-five percent of the children had Apgar score of ≥7 at the 1st min of life increasing to 69.2% at 5 min. The perinatal mortality was however 19.2%. Conclusion: Umbilical cord prolapse is associated with a significant perinatal mortality in this study, especially in those with spontaneous rupture of membranes that occurred outside the hospital setting.
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Diagnostic accuracy of spot albumin creatinine ratio and its association with fetomaternal outcome in preeclampsia and eclampsia p. 58
Rekha Sachan, Munna Lal Patel, Pushpalata Sachan, Radhey Shyam, Pratima Verma, Soniya Dheeman
DOI:10.4103/0300-1652.219345  
Introduction: Hypertensive disorders in pregnancy are one of the leading causes of maternal and perinatal mortality. Proteinuria is one of the common and important features of preeclampsia. To evaluate the diagnostic accuracy of albumin-creatinine ratio (ACR) in woman with preeclampsia and eclampsia and examine the association between ACR and fetomaternal outcome. Materials and Methods: Prospective study carried out over a period of 1 year in the Department of Obstetrics and Gynaecology, after informed consent and ethical clearance total ninety pregnant women from gestational age 20 to 40 weeks were enrolled, including, thirty preeclampsia, thirty antepartum eclampsia, considered as cases and thirty normotensive pregnant women as controls. Preeclampsia was defined as per National High Blood Pressure Education Program 2000 working group. All patients were asked for a spot midstream urine sample, followed by 24 h urine collection. Urinary protein was estimated by the sulfosalicylic acid method and creatinine by the Jaffe's method. The urinary ACR was determined by automated analyzer. Results: Mean value of urinary ACR of controls was significantly lower (0.103 ± 0.037) as compared to both groups. On comparing between groups the difference was significant (<0.001), a strong correlation between urinary ACR levels and 24 h urinary proteins was observed. Conclusion: In our study, an association of raised ACR values with severity of disease as well as with adverse fetomaternal outcome was observed.
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Effects of atorvastatin on proteinuria of type 2 diabetic nephropathy in patients with history of gestational diabetes mellitus: A clinical study p. 63
Fatemeh Abbasalizadeh, Parviz Saleh, Rana Dousti, Reza Piri, Mohammad Naghavi-Behzad, Shamsi Abbasalizadeh
DOI:10.4103/0300-1652.219348  
Background: Gestational diabetes is known as one of the diseases through pregnancy. In the present study, changes in proteinuria after atorvastatin administration among patients with history of gestational diabetes were studied. Materials and Methods: In this randomized clinical trial, 42 patients were included in the study. Atorvastatin was administered for 21 patients, and 21 patients were designated as control group. Lipid profile, protein, and 24 h urine creatinine (uCr) levels were determined in the beginning and 3 months after intervention. P < 0.05 was considered statistically significant. Results: Lipid profile in intervention group was enhanced; low-density lipoprotein (LDL) had decreased while triglyceride had not changed and high-density lipoprotein had been increased. There was no statistically significant change in serum Cr, serum urea, estimated glomerular filtration rate, uCr, urine volume, 24-h urine protein level, or urine protein/Cr ratio on both groups during the study; also, there was no statistically significant difference between groups. Conclusions: Although LDL level decreased after atorvastatin therapy, atorvastatin therapy had no effect on the level of proteinuria or other parameters related to kidney function.
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Clinical feature and management of immune thrombocytopenic purpura in a tertiary hospital in Northwest Nigeria p. 68
Abdulaziz Hassan, Adeshola Adebayo, Abubakar Umar Musa, Aishatu Maude Suleiman, Ismaila Nda Ibrahim, Ibrahim Usman Kusfa, Mohammed Sirajo Aminu
DOI:10.4103/0300-1652.219343  
Background: Immune thrombocytopenic purpura (ITP) is a rare bleeding disorder that may remit spontaneously. Life-threatening bleeding may require transfusion support, steroids, and other immunosuppressive therapy or splenectomy. Objective: To review the clinical presentation and laboratory features of ITP at Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria. Subjects and Methods: A retrospective analytic study of case notes and bone marrow (BM) records of patients diagnosed with ITP at Haematology Department, ABUTH, Zaria, from January 1, 2004, to December 31, 2012. Results: There were nine cases (six females, three males), aged 6–20 (mean 11.11) years. The presentations were epistaxis 8 (88.9%), purpura 4 (44.4%), gum bleeding 4 (44.4%), menorrhagia 2 (22.2%), and intracranial hemorrhage (ICH) 1 (11.1%). Only 1 (11.1%) had clinical splenomegaly. Platelet count of <20 × 109/L was found in 4 (44.4%) while 6 (66.7%) had packed cell volume of <25%. All the nine cases had BM megakaryocytic hyperplasia. Six patients had blood transfusion support while 7 (77.8%) patients received oral prednisolone therapy with time to cessation of bleeding of 12–16 (mean of 8) weeks. One case had spontaneous remission while another had anti-D due to relapse after steroid therapy; this resulted in transient rise in platelet counts. None had other immunosuppressive therapy or splenectomy. Six (66.7%) cases were lost to follow-up after achieving remission and one died of ICH. Conclusion: ITP is not common in our center though its clinical presentations are varied. However, prednisolone and blood transfusion therapy are central to the management of these patients with favorable outcome.
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Are semen parameters worsening? Comparing semen parameters 10 years apart p. 72
Abayomi Bolaji Ajayi, Victor Dayo Ajayi, Ifeoluwa Oyetunji, Oluwafunmilola Biobaku, Happiness Aikhuele, Atiba Adedamilola, I Ibukun Ayelehin, Bamgboye M Afolabi
DOI:10.4103/0300-1652.219350  
Background: Semen parameters, especially sperm count and motility have been said to be diminishing over time with implications for fertility and infertility treatment. Objective: The objective of this study was to study semen parameters 10 years apart and describe any observed change. Design: A retrospective study carried out at Nordica Fertility Centre, Lagos, Nigeria. Semen parameters of 100 consecutive men who sought fertility treatment on account of infertility in 2003 and semen parameters of 100 consecutive men who also sought fertility treatment at the center in 2013 on account of infertility were analyzed and compared. A paired t-test was performed to ascertain whether sperm counts have diminished over the last decade. The World Health Organization semen values were used as standard. Main Outcome Measures: They are sperm count, motility, and mean progressive motility. Results: The mean sperm count in the 2003 group was 34.6 × 106/ml (range: 0.1–105.0 106/ml) compared with 21.8 × 106/ml (range: 0.1–80.0 × 106/ml) in the 2013 group. The mean motility was 47.9% in the 2003 group and 45.3% in the 2013 group. The mean progressive motility in the 2003 group was predominantly graded as good (50% good, 44% fair, 2% poor, 4% no motility) while in the 2013 group, the predominant grade of mean progressive motility was fair (15% good, 81% fair, 4% poor). Normal morphology was more commonly seen in the 2013 group compared to the 2003 group. Mean semen volume was 2.7 and 2.6 ml in 2003 and 2013 groups, respectively. The mean difference in sperm count (mean = 12.8, standard deviation = 31.6, n = 100) was significantly >0 providing evidence that sperm counts have diminished in the last decade. Conclusion: There was a statistically significant 37% drop in mean sperm count and mean progressive motility worsened in the last decade. These may have far-reaching effects on infertility and its treatment.
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Etiology, clinical characteristics, and management of pleural effusion in Ilorin, Nigeria p. 76
Peter Oladapo Adeoye, Wahab Rotimi Johnson, Olufemi Olumuyiwa Desalu, Chima Pascal Ofoegbu, Ademola Emmanuel Fawibe, Alakija Kazeem Salami, Abayomi Fadeyi, Akingbade Adebayo Akin-Dosumu, Ibraheem M Rasheedat
DOI:10.4103/0300-1652.219349  
Background: Pleural effusion (PE) is a primary manifestation or secondary complication of many disorders. This study reviews the pattern and management of PE in a Nigerian hospital. Materials and Methods: The medical records of 213 patients with clinical diagnosis of PE over a period of 3 years were reviewed. Results: PE accounted for 0.5% of the total hospital admissions. The most common cause of PE was tuberculosis (TB) (32.9%), followed by malignancy (29.1%) and pneumonia (15.0%). The male to female ratio was 1.3:1. TB was the leading cause of effusion in males, while it was malignancy in females. Pneumonia accounted for 61.9% of PE in preschool age and 66.7% in school age. Breathlessness (50.0%), cough (39.4%), and chest pain (24.9%) were the common presentations. Most (90.1%) of them were exudative effusion and with half in the right lung. Chest radiography (91.6%), pleural fluid for Ziehl–Neelsen stain (74.7%), cytology (59.2%), and tissue biopsy (57.8%) were the common diagnostic investigations. The majority (92.0%) had closed thoracostomy tube drainage, while 9.9% had chemical pleurodesis. The intra-hospital mortality was 10 (4.7%). Conclusion: TB, malignancy, and pneumonia are the leading causes of PE. A multidisciplinary approach is needed for optimal management.
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CASE REPORT Top

Secundum atrial septal defect with Eisenmenger syndrome: A scarcely reported disease in Nigeria p. 81
Nnamdi I Nwosu, Emeka Omejua, Nneka Udora, Ezinne Nwosu
DOI:10.4103/0300-1652.219346  
Atrial septal defect (ASD) may be rarely associated with Eisenmenger syndrome (ES), the most advanced form of pulmonary vascular disease to complicate a congenital heart disease. In spite of availability of pediatric cardiologists and two-dimensional-echochardiography in many tertiary health care centers in Nigeria, late referral and late diagnosis of ASD still occur leading to the development of ES. We describe a case of a 19-year-old male with ASD who presented late with ES.
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LETTER TO EDITOR Top

Ileoileal intussusception caused by the metastasis of cutaneous malignant melanoma to the small bowel 6 years after its excision presenting with small bowel obstruction p. 84
Gachabayov Mahir
DOI:10.4103/0300-1652.219347  
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