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   2011| October-December  | Volume 52 | Issue 4  
    Online since March 13, 2012

 
 
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ORIGINAL ARTICLES
Hospital-acquired infections in a Nigerian tertiary health facility: An audit of surveillance reports
OK Ige, AA Adesanmi, MC Asuzu
October-December 2011, 52(4):239-243
Background: Hitherto efforts to implement data driven prevention guidelines for hospital-acquired infections (HAI) in Nigeria have been limited by the inadequate knowledge of the risks of these infections. This study evaluated the occurrence of HAI in a foremost tertiary health facility over a 5-year period for the purpose of reinforcing control efforts. Materials and Methods: A retrospective survey of records from the infection control unit of the University College Hospital, Ibadan, Nigeria, was done for the years 2005-09. For the 5 years studied 22,941 in-patients were reviewed and the data of those who developed infections during admission were retrieved and analyzed. The prevalence, types, and causative organisms of HAI were determined. The chi-square test was used to evaluate associations. Results: The prevalence of HAI over the 5-year period was 2.6% (95% CI: 2.4-2.8). Surgical and medical wards had the most infections (48.3%) and (20.5%) respectively. Urinary tract infection (UTI) and surgical site infection (30.7%) were the most prevalent (43.9%) HAI. UTIs were significantly higher in surgical and medical wards, surgical site infections in obstetrics and gynecology wards, and soft tissue infections and bacteremia in pediatric wards (P<0.05). Gram-negative infections occurred about four times as often as gram-positive infections with Klebsiella sp. and staphylococcus aureus being the predominant isolates (34.3%) and (20.1%) respectively. Conclusion: Efforts to limit HAI should be guided by local surveillance data if progress is to be made in improving the quality of patient care in Nigeria.
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Donor blood procurement and the risk of transfusion transmissible viral infections in a tertiary health facility in South-South Nigeria
Benedict Nwogoh, OD Ikpomwen, EM Isoa
October-December 2011, 52(4):227-229
DOI:10.4103/0300-1652.93793  
Background: Blood and blood products are scarce commodities. The demand often outweighs the supply. This study is directed at investigating the blood procurement sources and the risk of viral transfusion transmissible infection. Materials and Methods: The records of the blood transfusion unit of a tertiary health facility in south-south Nigeria were studied. The procurement and screening records from 1 January to 31 December 2009 were analyzed. Results: 7,552 donor records were analyzed, 6,931 were commercial donor and 621 replacement donors. 891 commercial donors were infected, 500 (7.2%) were HIV positive, 323 (4.7%) HBV positive, 42 (0.6%) had HIV and HBV co-infection, while 28 (0.4%) were HCV positive. Twenty-three replacement donors were infected, 16 (2.6%) were HIV positive, 6 (1%) were HBV positive, while 1 (0.2%) were HCV positive. None of the replacement donors had co-infection. The risk of infection was significantly higher with commercial donor procurement (X2=45.07, P<0.001, OD=3.845). Conclusion: Commercial blood donors are still the major source of blood to the hospital and they also have the highest prevalence of transfusion transmissible viral infections in this region thus constitute a major risk transmitting infections to potential recipients.
  5,068 284 5
Prevalence of intestinal parasites and bacteria among food handlers in a tertiary care hospital
DA Zaglool, YA Khodari, R. A. M. Othman, MU Farooq
October-December 2011, 52(4):266-270
DOI:10.4103/0300-1652.93802  
Objectives: The aim of this work is to determine the prevalence of intestinal parasites and bacteria among the food handlers. Materials and Methods: Two hundred food-handlers were subjected to a cross-sectional study working in the kitchen of a tertiary care hospital, i.e., Alnoor Specialist Hospital, Makkah, Saudi Arabia from February 2 to 27, 2009. The stool samples were examined for intestinal parasites following direct microscopic examination, formol ether concentration (Ritchie), and staining with modified acid fast staining techniques. For enteropathogenic bacteria samples were inoculated onto MacConkey's agar, deoxycholate citrate agar, xylose lysine deoxycholate agar as per the World Health Organization protocol. Fingernail materials were examined microscopically for enteropathogenic bacteria and parasites. Results: The majority (80%) of the food-handlers were young adults aged from 22 to 42 years. No intestinal parasites were detected from fingernail contents. Forty six (23%) stool specimens were positive for intestinal paraͼsites. Giardia lamblia 18 (9%) was most frequent among the 10 different types of detected intestinal parasites followed by Entamoeba histolytica 9 (4.5%). No pathogenic bacteria were detected in all stool samples, whereas finger nails showed isolation of microorganisms as coagulase-negative staphylococci 79 (39.5%), followed by Staphylococcus aureus 35 (17.5%). Conclusion: The findings emphasized the importance of food handlers as potential sources of infections and suggested health institutions for appropriate hygienic and sanitary control measures.
  4,918 374 24
Benign breast lesions in an African population: A 25-year histopathological review of 1864 cases
AN Olu-Eddo, Ezekiel Enoghama Ugiagbe
October-December 2011, 52(4):211-216
DOI:10.4103/0300-1652.93790  
Objective: The objective of this study was to delineate the prevalence and characterize the histologic pattern of benign breast diseases (BBDs) in the University of Benin Teaching Hospital, Benin City, Nigeria. Materials and Methods: A 25-year-old (1985-2009) retrospective study of all patients presenting with BBD. Results: During the 25-year-old study period, 1864 cases of BBD constituting 72.4% of all breast lesions were seen. The female to male ratio was 28.6:1. An increasing incidence of BBDs was observed. The overall mean age for BBD was 27.5 years, SD±11.3 with an age range of 9-84 years and a peak age occurrence in the third decade. The single most common lesion was fibroadenoma accounting for 43.1% of cases, followed by fibrocystic change (23.8%) with mean ages of 22.3 years and 30.2 years, respectively. Both lesions had a peak occurrence in the third decade. Other major lesions encountered were sclerosing adenosis (7.3%), atypical ductal hyperplasia (3.6%), and blunt duct adenosis (2.3%). Gynecomastia (2.1%) was the predominant lesion in males. Inflammatory lesions constituted 8.1% of cases while stromal and skin lesions accounted for 1.1% and 0.9% of cases respectively. Conclusion: BBDs constituted 70% of breast lumps and were mostly fibroadenoma and fibrocystic change. BBDs occurred predominantly in young females with a peak in the third decade. Though premalignant lesions of atypical hyperplasia were less common, biopsy of all BBDs should be done to exclude these lesions and routine mammographic screening of at risk individuals instituted to increase their detection.
  4,580 399 14
Elective caesarean section in a tertiary hospital in Sokoto, north western Nigeria
EI Nwobodo, AY Isah, A Panti
October-December 2011, 52(4):263-265
DOI:10.4103/0300-1652.93801  
Background: Elective caesarean sections have been considered safer for both mother and the fetus compared to their emergency counterpart. However, emergency caesarean sections have continued to form bulk of caesarean deliveries in our facility. Objective: The objective of this study was to determine the caesarean section rate together with the trend, indications, and maternal mortality associated with elective caesarean operation. Materials and Methods: A retrospective analysis of clinical records of all the patients that had caesarean section between January 2002 and December 2010 (9 years) at Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, Nigeria was conducted. Results: During the 9 year study period, 2284 caesarean sections were performed out of 22,985 total deliveries at UDUTH Sokoto, thus giving a caesarean section rate of 9.9%. Emergency and elective operations accounted for 1784 (78.2%) and 498 (21.8%) of the cases respectively. The rate of elective caesarean section increased from 1.7% in 2002 to 3.2% in 2007. Thereafter it declined gradually to 1.8% in 2010. Repeat caesarean section (30.7%) and malpresentation (17.1%) were the most common indications for elective caesarean operation. There were 18 maternal deaths from caesarean section and only one from the elective caesarean procedure. Conclusion: The rising trend in the elective caesarean section rate in this study underscores the need for better and improved patient selection together with counseling on its benefits and risks. This is because despite the fact that it is safer than emergency caesarean operation, it is not entirely devoid of complications. Routine use of spinal anesthesia in performing the procedure should be encouraged.
  3,617 290 1
Social determinants of alcohol use among drivers in Calabar
S Bello, A Fatiregun, WO Ndifon, A Oyo-Ita, B Ikpeme
October-December 2011, 52(4):244-249
DOI:10.4103/0300-1652.93797  
Objective: Hazardous use of alcohol is a public health problem which accounts for 4.0% of global disease burden. Although the prevalence of alcohol use among drivers of commercial vehicles in Nigeria has been documented, not much is known about its social determinants. This study was, therefore, aimed at assessing the social determinants of alcohol use among drivers of commercial vehicles in Calabar. Materials and Methods: A cross-sectional descriptive study was conducted among 360 male commercial drivers. A semistructured questionnaire, which included the World Health Organization Alcohol Use Disorders Identification Test, was administered at interview. Binary and multinomial logistic regression analyses were used to identify social determinants of any and hazardous alcohol use. Results: Determinants of any alcohol use (binary logistic) were history of use by parents (adjusted odds ratios (AOR)=2.7; 95% CI=1.1-6.3), friends (AOR=3.2; 95% CI=1.3-7.8) and ready availability (AOR=4.1; 95% CI=1.9-8.8) while determinants of hazardous use (multinomial logistic) were history of use by parents (AOR=5.8; 95% CI=2.0-16.9), siblings (AOR=7.0; 95% CI=2.6-16.9), friends (AOR=6.6; 95% CI=1.8-24.4), hostile upbringing environment (AOR=3.8; 95% CI=1.3-11.1), use of other drugs (AOR=55.6, 95% CI=14.5-200), and respondents who had fathers with a maximum of primary or no formal education (AOR=4.6; 95% CI=1.8-11.8). Conclusion: Alcohol use was associated with family use, friends' use, and use of other drugs. Multiple health education interventions are needed to tackle these challenges.
  3,645 238 3
Socioeconomic consequences of HIV/AIDS in the family system
P Taraphdar, T Guha Rray, D Haldar, A Chatterjee, A Dasgupta, B Saha, S Mallik
October-December 2011, 52(4):250-253
DOI:10.4103/0300-1652.93798  
Introduction: HIV/AIDS can lead to poverty affecting particularly women and young people and can halt or reverse socioeconomic development of a country. Objective: The objective of this study was to assess the socioeconomic consequences of HIV/AIDS within the family. Materials and Methods: A cross-sectional descriptive study was carried out among patients admitted in in-patient department and those attending integrated counseling and testing centre (ICTC) of School of Tropical Medicine, Kolkata. Data were gathered by interviewing the patients by using a predesigned questionnaire. Results: For prolonged duration and severity of disease, higher proportion of indoor patients reported loss of job, decreased family income, increased expenditure for care seeking, and faced greater economic consequences, reflected by selling assets. Loss of job was mainly due to illness (86.8%), disclosure of sero-status (13.2%), and predominantly among skilled workers. Assets were sold mainly to meet the cost of own illness for indoor patients, but more to meet the expenditure for husband's illness, in the case of ICTC patients. High school dropout seen in both groups was mainly due to economic reasons. HIV/AIDS status was known to other members of family for 84.8% of indoor patients out of which 15.4% experienced rejection by family members. Out of 72 ever married women indoor patients whose in-laws were aware of their HIV/AIDS status, 41.7%, 40.9%, and 33.33% reportedly were blamed for spouse's illness, and had strained relation with in-laws and spouse, respectively. Conclusion: Intensive behavior change communication and provision of care and support are required to curb AIDS-related stigma, discrimination, and to maintain physical, mental, and social wellbeing of people living with HIV/AIDS.
  3,576 255 9
EDITORIAL
Ethical dilemmas in dentistry
S Omer Sheriff, Dhastagir Sultan Sheriff
October-December 2011, 52(4):205-206
DOI:10.4103/0300-1652.93788  
  3,443 346 -
ORIGINAL ARTICLES
Rupture of the gravid uterus in a tertiary health facility in the Niger delta region of Nigeria: A 5-year review
TK Nyengidiki, DO Allagoa
October-December 2011, 52(4):230-234
DOI:10.4103/0300-1652.93794  
Background: Ruptured uterus is a major life-threatening condition encountered mostly in developing countries and is an index of failure of obstetric care at a point in time in a woman's reproductive career. With worsening economic condition, increasing caesarean section rates, and patients' aversion for operative delivery this condition would still remain a major obstetric matter for discussion. Objective: To identify the incidence, sociodemographic variables, clinical characteristics, causes, and outcome of ruptured uterus at the University of Port Harcourt Teaching Hospital. Materials and Methods: A 5-year retrospective study of cases of ruptured uterus at the University of Port Harcourt Teaching Hospital was carried out. The case notes of 40 patients with uterine rupture during the period 2003-2007 were analyzed. Data collected included sociodemographic characteristics, etiologic factors, clinical presentation, and outcome. Data were analyzed using Microsoft Excel version 2007 and SPSS 14.0 computer software. Results: The incidence of rupture of the gravid uterus was 1:258 deliveries. In patients with rupture of the gravid uterus, 65% (26) of patients were unbooked; 37.5% (15) were aged between 25 and 29 years. A total of 42.5% (17) of patients had secondary education and 21 (52.5%) were housewives. Rupture of a previous scar was the commonest etiologic factor accounting for 32.5% (11). The commonest presentation was abdominal pain in 92.5% of cases. Perinatal mortality and maternal mortality were 80% and 17.5% respectively. Conclusion: Rupture of the gravid uterus still remains a major cause of maternal mortality. Injudicious use of oxytocics should be discouraged in peripheral health facilities and reinforcement of the need for hospital based deliveries in patients with previous caesarean sections should also be intensified to improve outcome.
  3,458 306 8
Hydatidiform mole in Jos, Nigeria
Amaka N Ocheke, Jonah Musa, Alexander O Uamai
October-December 2011, 52(4):223-226
DOI:10.4103/0300-1652.93792  
Background: Hydatidiform mole is a relatively common gynecological problem which could present like spontaneous abortion, one of the commonest gynecological emergencies. It has the propensity to become malignant but can easily be identified and treated. The aim of this study was to determine the demographics, clinical features, treatment options and outcome of patients with hydatidiform mole in our environment. Materials and Methods: This was a retrospective review of all the cases of hydatidiform mole seen at the Jos University Teaching Hospital (JUTH), Jos, Nigeria over a 5-year period. Results: There were 34 cases of hydatidiform mole giving an incidence of 1 in 357 deliveries. However only 25 case notes were available for analysis and the mean age of patients was 28±3 years. Vaginal bleeding (92%), honeycomb appearance on ultrasound scan (84%), and passage of vesicles (60%) were the most common clinical findings while suction curettage was the mode of treatment for all the patients in this study. Twenty-eight percent of cases were confirmed by histology. No patient came for follow-up after the third month of diagnosis. Twenty percent of the patients booked for antenatal care within 9 months of diagnosis while 12% of patients presented as gynecological emergencies with features of malignant disease within six months of diagnosis. Conclusion: Hydatidiform mole is common in Jos, North Central Nigeria, and presents most commonly with vaginal bleeding with over 10% becoming malignant. Hence all patients who present with vaginal bleeding should be screened for HM. None of the patients completed the recommended duration of follow-up and only about ¼ had histology reports. Concerted efforts need to be made to address the challenges of patients adhering to recommended follow-up protocols and having to pay first before investigations are done.
  3,164 379 -
A comparison of axillary with rectal thermometry in under 5 children
BO Edelu, NC Ojinnaka, AN Ikefuna
October-December 2011, 52(4):207-210
DOI:10.4103/0300-1652.93789  
Background: Body temperature measurement is a crucial clinical assessment in the care of an acutely ill child, especially the under fives. Most temperature measurements in our hospital are done from the axilla. Objective: To study the relationship between temperatures taken in the axilla with those taken in the rectum in febrile and afebrile children less than 5 years. Materials and Methods: Rectal and axillary temperatures were taken concurrently in 400 febrile and 400 afebrile children aged less than 5 years using mercury-in-glass thermometers. Result: The rectal temperature measurements ranged from 38.0 to 41.4°C and 36.4 to 37.9°C in the febrile and afebrile groups of children respectively while the axillary temperatures ranged from 36.7 to 41.0°C and 35.9 to 37.5°C in the febrile and afebrile groups of children, respectively. There were significant differences between the temperatures measured at the two sites in all the age groups studied. There was good positive correlation between the rectal and axillary temperatures. A linear relationship between axillary and rectal temperatures was derived using the simple regression analysis. The equation is: rectal temperature = 0.94×axillary temperature+2.92. Conclusion: Although there's good correlation between axillary and rectal temperatures, significant difference exits between them that cannot be explained by the addition of any single value or any particular equation.
  3,011 368 2
Does concern about halitosis influence individual's oral hygiene practices?
CC Azodo, MI Onyeagba, CD Odai
October-December 2011, 52(4):254-259
Objective: The objective of this study was to assess whether the concern about halitosis influence oral health attitude and practices among young literate adults in Nigeria. Materials and Methods: This cross-sectional survey of 400 randomly selected temporary camp resident adults in Anambra state, South Eastern Nigeria was conducted using a modified version of the Hiroshima University-Dental Behavioral Inventory questionnaire. Results: Out of the 400 questionnaires distributed, only 294 were filled and returned giving an overall response rate of 73.5%. Half (50.0%) of the participants in this study expressed concern about halitosis. The participants that expressed concern about halitosis were mostly in the 25- to 27-year-old age group, females, known smoker, regular dental floss, and mouth wash users, had incorrect tooth brushing knowledge, brushed teeth more frequently and more forcefully, had no previous dental treatment, prefer symptomatic dental visit, experienced gingival bleeding, expressed worry about the color of their gingiva and teeth but were satisfied with the dental appearance. Conclusion: Data from this study showed that concerns about halitosis-triggered behavioral reaction in oral self-care practices namely tooth brushing frequency, tooth brushing force, mouth wash, and dental floss use. Also revealed were poorer oral health and lower preventive dental visit practices among participants concerned about halitosis. There is need for improved public knowledge and awareness about halitosis by the dentist in Nigeria.
  2,967 313 -
Histological study of smoke extract of Tobacco nicotiana on the heart, liver, lungs, kidney, and testes of male Sprague-Dawley rats
Adekomi Damilare Adedayo, AA Tijani, AA Musa, TD Adeniyi
October-December 2011, 52(4):217-222
DOI:10.4103/0300-1652.93791  
Background: Some of the effects of tobacco on man's health are well documented in many scientific reports. Whenever tobacco is used either in smoked or chewed form, nicotine is absorbed by the lungs and oral cavity and is spontaneously moved into the bloodstream where it is circulated throughout the body system. Materials and Methods: Ten male Sprague-Dawley rats were used for this investigation. The animals were randomly assigned into two groups, A and B, of five animals each. The animals in group B (treatment group) were exposed to smoke from a completely burnt 0.74 g leaf extract of Tobacco nicotiana, wrapped in 0.5 g of sterilized cotton wool for 5 minutes three times daily (7 am, 10 am, and 1 pm). The animals in group A (control group) were exposed to smoke from completely burnt 1.24 g of sterilized cotton wool with the same parameters as observed with the treatment groups. The duration of exposure was 5 days. Three hours after the last exposure, all the animals were killed by cervical dislocation. The heart, liver, lungs, kidney, and testes were carefully excised, blotted dry, and fixed in formol saline for histological analysis using Hematoxylin and Eosin stain. Results: Using the light microscope, it was observed that the histoarchitectural profiles of the studied organs in the sections obtained from the control animals were well preserved. Histopathological observations of the heart, liver, lungs, kidney, and testes in the treated animals showed a varying pattern of histological alterations, and distortions such as mild edema and occasional destruction of myocardial fibers, degeneration of the hepatocytes, reduction in the population of the germ cells, enlargement of the alveoli, alveolar hemorrhage, shrinkage of the glomerulus and glomerular hemorrhage were observed in the sections of the organs of the study of the animals in the treatment group when compared with the control group, hence showing that the smoke extract of Tobacco nicotiana has adverse and compromising effects on the heart, liver, lungs, kidney, and testes of male Sprague-Dawley rats. Conclusion: From these observations, it can be inferred that the exposure of male Sprague-Dawley rats to the smoke extract of Tobacco nicotiana may be associated with structural damage of some vital organs.
  2,771 375 1
Effect of interval training program on white blood cell count in the management of hypertension: A randomized controlled study
S Lamina, CG Okoye
October-December 2011, 52(4):271-277
DOI:10.4103/0300-1652.93803  
Objective: Elevated white blood cell (WBC) count is considered to be prospectively and positively associated with cardiovascular diseases, particularly hypertension. Also, the positive role of exercise in the management of hypertension has been well and long established. However the relationship between WBC count and hypertensive management particularly in the nonpharmacological technique is ambiguous and unclear. Therefore the purpose of the present study was to determine the effect of interval training program on WBC count and cardiovascular parameters in male hypertensive patients. Materials and Methods: A total of 245 male patients with mild to moderate (systolic blood pressure (SBP) between 140 mmHg and 179 mmHg and diastolic blood pressure (DBP) between 90 mmHg and 109 mmHg) essential hypertension were age matched and grouped into experimental and control groups. The experimental (n=140; 58.90±7.35 years) group involved in an 8-week interval training (60-79% HR max reserve) program of between 45 minutes to 60 minutes, while the age-matched controls hypertensive (n=105; 58.27±6.24 years) group remain sedentary during this period. Cardiovascular parameters (SBP, DBP, and VO 2 max) and WBC count were assessed. Student's t and Pearson correlation tests were used in data analysis. Results: Findings of the study revealed a significant effect of the interval training program on VO2max, SBP, and DBP and WBC count at P<0.05 and VO2max is negatively related to the WBC count (r=-0.339) at P<0.01. Conclusions: It was concluded that the interval training program is an effective adjunct nonpharmacological management of hypertension and the therapeutic effect of exercise programs may be mediated through suppression of inflammatory (WBC count) reaction.
  2,472 211 -
The role of prophylactic antimalarial in the reduction of placental parasitemia among pregnant women in Calabar, Nigeria
Emmanuel Columba Inyang-Etoh, Thomas Udagbor Agan, Saturday Job Etuk, Paul Columba Inyang-Etoh
October-December 2011, 52(4):235-238
DOI:10.4103/0300-1652.93795  
Introduction: Intermittent preventive treatment of malaria with sulfadoxine-pyrimethamine is a recommendation of the World Health Organization as part of the malaria control strategy in pregnancy in areas with malaria burden. Aim: This study set out to appraise the effectiveness of this regimen in the prevention of placental parasitemia among parturients in Calabar, Nigeria. Materials and Methods: Pretested, precoded questionnaires were administered to eligible women at the antenatal clinic and later updated at the labor ward. Intermittent preventive treatment was administered under direct observation at the clinic, while packed cell volume, placental parasitemia, and other laboratory tests were measured at the labor ward. Results: The gross presence of placental malaria in the intermittent preventive treatment (IPT)-treated and the control groups was 10.6% and 11.3% respectively (P=0.76). Anemia occurred in 3.1% of the IPT-treated group compared to 11.7% among the control group (P=0.000). Only 7.9% of the IPT-treated women had moderate to severe placental parsitemia whereas as many as 53.2% of women in the control group had moderate to severe parasitemia (P=0.000). Conclusion: Intermittent preventive treatment of malaria with sulfadoxine-pyrimethamine was associated with significant reduction in the degree of placental parasitemia among women in the IPT-treated group, although it did not completely eradicate placental malaria in the treatment group.
  2,137 206 1
An audit of 3859 preadmission chest radiographs of apparently healthy students in a Nigerian Tertiary Institution
OU Ogbeide, AA Adeyekun
October-December 2011, 52(4):260-262
DOI:10.4103/0300-1652.93800  
Background: Chest radiographs are routinely requested as part of the medical screening process prior to admission to institutions. Literature on the yield of such an exercise is sparse especially in the Nigerian setting. This study was therefore carried out to assess the usefulness of routine chest radiography for students at the time of admission. Materials and Methods: This was a prospective study of 3859 chest X-rays taken at the department of radiology, University of Benin Teaching Hospital for one admission screening for the 2008/2009 academic year. The age and sex of the subjects were also recorded. The heart, lung fields and bony thorax were examined for any abnormality. Results: Out of the 3859 pre-admission chest radiographs studied, there were 1951 males or 50.56% and 1908 females or 49.44% subjects. The mean age for males was 21.15±3. Conclusion: This study has shown that pre-admission routine chest radiography in asymptomatic patients remains a relevant screening tool for medical fitness during admissions into institutions. However because of dangers of exposure to ionizing radiation, we advise that a detailed medical history and physical examination be done to restrict its use to only those subjects with signs and symptoms suggestive of disease.
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LETTER TO EDITOR
Finding Maurice Pappworth
Allan Gaw
October-December 2011, 52(4):278-278
DOI:10.4103/0300-1652.93804  
  1,220 138 -
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