Otolaryngological practice in developing country: A profile of met and unmet needs

Background: There has been a significant advance in the practice of otorhinolaryngologic surgery from the simple excisional surgery to minimally invasive functional endoscopic techniques, reconstruction and the use of laser. In this review we present our experience of the otolaryngologic practice in NigeriaMethods: A retrospective review of clinical record chart of the spectrum of patients seen in the otorhinolaryngology department in 5 years (2004-2004). We reviewed the 708 patients seen at the outpatient clinic and the 111 surgical procedures done in one of the top otolaryngologic centres in Nigeria.Results: Chronic suppurative otitis media accounted for 22% outpatient consultation, followed by sensorineural hearing losses 12% and Inflammatory disorders of the sinuses and larynx 16%, head and neck cancers was lowest 1.3%. In contrast to the spectrum in the clinic, laryngologic/head and neck surgery accounted for 47 (42%), rhinologic 31 (28%), otologic 29 (26%) and minimal invasive / endoscopic surgeries 4 (4%).Conclusion: The contrast between the high prevalence of CSOM and high number of laryngologic surgery suggest the limitations faced by otolaryngolgists in the tropics in terms of unavailability and inability to afford sophisticated diagnostic and operating equipment particularly in otologic practice. This will be useful for formulating exchange of training and fellowship with otolaryngologists in other parts of the globe and improvement of clinical practice

Dysplastic Papilliferous Basaloid Ameloblastoma: Report of a Case

Papilliferous ameloblastoma is an uncommon histologic variant of ameloblastoma. About five cases have been reported in the English literature till date. All five showed squamous differentiation with keratin formation and were diagnosed as papilliferous keratoameloblastoma. The present lesionshows basaloid differentiation and mild dysplasia in addition to papilliferous projections, thus termed dysplastic papilliferous basaloid  ameloblastoma.  Ameloblastoma, the most common odostoma has not ceased to intrigue pathologists with its diverse histomorphological patterns. Therefore, we present this uncommon lesion in a 50 year old man with right mandibular swelling. Key words: Papilliferous, Basaloid, Ameloblastoma, Dysplastic, Nonhealing socket

Comparative Effects of Isometric Quadriceps Training, Glucosamine and Chondroitin Sulphate Iontophoresis on Pain Intensity and Physical Functions of Patients with Knee Osteoarthritis

This study was with a view to comparing the effective means of alleviating pain and improving physical functions in patients with knee osteoarthritis using quadriceps strengthening exercises, glucosamine and chondroitin sulphate iontophoresis. Seventy-eight participants with grade II knee OA were purposively selected and randomly assigned to three groups using fish bowl technique. Group one participants received 1g of glucosamine sulphate (GS) through iontophoresis while group two received 1g of chondroitin sulphate (CS) iontophoresis (40mA- min as dosage) using trans-arthral electrode placement technique twice a week, for 12 weeks. Group three participants had intervention in the form of quadriceps muscle strengthening exercise (1RM, 10 reps and 3 sets), which was a baseline treatment for all the groups. Pain intensity, active knee range of motion and physical function were assessed. Descriptive statistics, ANOVA and Kruskal-wallis test were used to analyze the data. Alpha level was set at p ≤ 0.05. The three modes of interventions significantly alleviated pain (p = 0.001), improved the Functional Activity Level and active ranges of motion (p = 0.001) in the groups after 12 weeks. Although, the administration of Quadriceps strengthening exercise alone, significantly improved the Functional Activity Level than Chondroitin sulphate iontophoresis and Glucosamine sulphate (H = 19.89, p = 0.001). However; there was no significant difference in the active range of motion across the 3 groups. In conclusion, Quadriceps strengthening exercise, Glucosamine and Chondroitin sulphate iontophoresis were effective in alleviating pain, enhancing range of motions and improving physical functions. However, Quadriceps strengthening exercise showed higher efficacy compared to others

Otolaryngological Practice in Developing Country: A Profile of Met and Unmet Needs

Background: There has been a significant advance in the practice of otorhinolaryngologic surgery from the simple excisional surgery to minimally invasive functional endoscopic techniques, reconstruction and the use of laser. In this review we present our experience of the otolaryngologic practice in Nigeria Methods: A retrospective review of clinical record chart of the spectrum of patients seen in the otorhinolaryngology department in 5 years (2004-2004). We reviewed the 708 patients seen at the outpatient clinic and the 111 surgical procedures done in one of the top otolaryngologic centres in Nigeria. Results: Chronic suppurative otitis media accounted for 22% outpatient consultation, followed by sensorineural hearing losses 12% and Inflammatory disorders of the sinuses and larynx 16%, head and neck cancers was lowest 1.3%. In contrast to the spectrum in the clinic, laryngologic/head and neck surgery accounted for 47 (42%), rhinologic 31 (28%), otologic 29 (26%) and minimal invasive / endoscopic surgeries 4 (4%). Conclusion: The contrast between the high prevalence of CSOM and high number of laryngologic surgery suggest the limitations faced by otolaryngolgists in the tropics in terms of unavailability and inability to afford sophisticated diagnostic and operating equipment particularly in otologic practice. This will be useful for formulating exchange of training and fellowship with otolaryngologists in other parts of the globe and improvement of clinical practice

Hearing outcome after canal wall down mastoidectomy and Wullstein type III tympanoplasty

Objective: This is to report the hearing outcome in patients who had CSOM, with ossicular erosion, treated with Canal Wall – Down Tympanomastoidectomy and the classical Wullstein type III tympanoplasty (CWDT) in which the graft was applied directly on the stapes footplate.Methods: This was a retrospective review of record charts of patients’ hearing status before surgery and between 18 – 24 months after surgery using the pure tone average derived according to the guidelines of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology Head and Neck Surgery (AAO-HNS). All the patients had audiometry done with a computer audiometer BA 20 Kamplex in a sound - proof (acoustic) booth. Calibration: SO/DP 389 – 1983.Result: CWDT was done in 21 patients, 13 females and 8 males, aged 5 - 64 years, mean 30(SD = 15.59). All the patients had CSOM with mastoid abscess and partial or complete erosion of the malleus and incus and intact footplate of the stapes. Additional findings included foreign body in the middle ear 2, polyp 6 and meningitis 3. The duration of CSOM was 3 – 35 years, mean 17.5(SD = 8.9) and there was correlation with pre-operative air conduction (AC) (r =0.580, P = 0.006) and preoperative air- bone gap (r = 0.610, P = 0.003). The mean hearing gain was 5dB (with a range between - 5 and 25dB), and hearing gain between 10 – 25dB was achieved in 5/21(24%). The pre-operative AC was 30 – 60dB, mean 45dB (SD = 9.08) and bone conduction (BC) was 10 - 30dB, mean 20.7 dB (SD = 4.55). While the postoperative AC was between 25 and 55dB, mean of 39.29(SD = 9.5), the BC was 15 - 35dB, mean 20.23(SD = 4.9). The preoperative air – bone gap was 10 – 40 dB, mean 24.29(SD = 8.8) while post-surgery it was 10 – 35 dB, mean 19.29(SD = 7.8).Conclusion: Hearing benefit from CWDT is minimal, a second look surgery and ossiculoplasty, bone – anchored hearing aid or a hearing aid may be expedient for further hearing augmentation

Effect of Spinal Anaesthesia on Hearing Threshold

Background: Hearing loss following spinal anaesthesia is a known yet uncommonly reported complication. This study was aimed at determining the incidence and type of hearing loss (HL) following spinal anaesthesia (SA) and the relationship with the size of spinal needle. Methods: A prospective study of patients scheduled for spinal anaesthesia for surgery at the Operating room and Otorhinolaryngology department in a tertiary centre was undertaken. The audiometry was done and the pre- and post - anaesthesia results were compared. Results: Ninety - four ears of 47 patients, 16 males and 31 females, age range between 21 and 63 years (mean ± SD= 41 ± 5) were included. The duration of anaesthesia was between 90 and 150 minutes (mean ± SD= 116 ± 9). HL was seen in 9 ears of 7 patients (15%) and tinnitus in 14 ears. The preoperative and postoperative BC PTA were 10 - 45dB (mean ± SD= 26 ± 5) and 25 - 65dB (mean ± SD=38 ± 5) respectively, (P= 0.02) while the preoperative and postoperative AC PTA in the early frequency range (0-100Hz) were between 5 - 45dB (mean ± SD= 20 ± 5) and 25 - 50dB (mean ± SD=25 ± 7) respectively, (P= 0.08). There was significant difference in the mean BC PTA between those who had procedure less than 1 hour, 37.2dB and those greater than 1 hour 38.4dB, (P=0.004). According to the Quincke needle sizes, the mean BC PTA among those who had 26G and 27G were 37.4dB and 38.1dB respectively (P=0.2). Conclusion: HL complicating SA is significant and associated with duration of procedure thus should be included in informed consent for medico-legal and ethical reasons and measures must be taken to avoid the leak of cerebrospinal fluid

Development of a Solar Dryer Incorporated with a Thermal Storage Mechanism

This work presents the development and performance evaluation of a solar crop dryer for drying agricultural products. The dryer consists of three major parts; the drying chamber (630 mm by 610 mm by 210 mm), a solar collector (630 mm by 590 mm by 50 mm) and a heat storage device (630 mm by 590 mm by 50 mm). The dryer was designed for crops weighing a maximum of 15 kg with an ambient temperature of 33oC. The performance evaluation was carried out using unripe plantain and okra. The results of the performance evaluation for no-load test showed that the average temperatures for the drying chamber, collector and ambient without the heat storage system and the boaster mirror were recorded as 47, 69 and 32oC respectively and 55.5, 71.5 and 32oC with heat storage, while 73oC, 83.5oC, 32oC respectively with both the heat storage and boaster mirror. The boaster mirror introduction recorded a higher temperature of 73oC in the drying chamber as against 55.5oC when it was not installed. The results of the on-load test shows that the rate of moisture removal was faster in the dryer (1 to 0.24) kg after drying for four days fro plantain and (1 to 0.21) kg after drying for three days for okra as against (1 to 0.35) kg for plantain and (1 to 0.49) kg for okra with direct/open sun drying. The products were evaluated for physicochemical properties for the fresh, solar dryer dried and open sun-dried samples and results shows that solar-dried plantain and okra recorded higher percentage of nutrients over open sun-dried samples in Fibre, protein, ash content (1.89, 1.17, 0.39), (1.63, 1.14, 1.53) respectively, while the percentage of fat content was significantly higher in sun-dried samples with plantain having (0.32%) and okra (0.1%) as against solar-dried samples

The Association of Maternal Social Factors and Antenatal Care with Cord Serum Zinc in Full – Term Neonates

Zinc is a crucial micronutrient in early childhood survival and the development of innate and acquired immunity. The objective is to determine the relationship between of maternal social class and antenatal care to serum zinc level in newborns in a tertiary and a rural hospital. It is prospective study using questionnaires on consecutive mothers with normal pregnancy(excluding sepsis and chronic illneses) and cord serum level of Zinc estimation in newborns using flame atomic absorption spectrophotometry. There were 106 mothers and neonates; were made up of 57 females and 49 males. The ages of the mother ranged between 21 years to 39 years, with a mean of 26 years; while the gestational age of the neonates ranged between 30 weeks and 45 weeks with a mean of 37.3. The range of the serum Zinc was 0.14μg/L – 0.92μg/L, with a mean of 0.64μg/L (SD=0.17) and median value of 0.63μg/L. The social classes of the mothers were low 66, middle 23 and high 17 with mean neonatal serum zinc of 0.62μg/L, 0.68μg/L and 0.72μg/L. The mean serum Zinc in 17/86 neonates of mothers with inadequate tetanus vaccination was 0.53μg/L, (below the median value) compared to 0.66μg/L in 89/106 neonates of mothers with complete vaccination. The serum zinc in the neonates of mothers <25 years of age was 0.68μg/L compared to 0.61μg/L in the neonates of mothers >25years. Fever in pregnancy was seen in 31/106; with mean neonatal serum Zinc of 0.63μg/L compared with those without fever 0.65μg/L. There were 94 neonates with normal weight (>2.5kg) and 12 low birth weight (<2.5kg) with mean serum Zinc of 0.69μg/L and 0.66μg/L respectively. Antenatal care was complete in 81 and incomplete in 25 with mean neonatal serum Zinc of 0.66μg/L and 0.56μg/L respectively. Univariate analysis revealed significant correlation between the mean serum Zinc and the socioeconomic class (P = 0.022), but there was no correlation with maternal age (P=0.327), sex (P=0.566), gestational age (P=0.100), birth weight (P=0.365), vaccination (P=0.954), malaria fever (P=0.875) and antenatal care (P=0.97), We concluded that low social status of the mothers and inadequate vaccination in pregnancy were major factors associated with low neonatal serum zinc. The control of these factors may impact on optimal neonatal nutrition

Hearing loss following spinal anaesthesia among obstetric patients at the University College Hospital Ibadan

Background: Sensorineural hearing loss (SNHL) is a rarely reported complication of subarachnoid block and may go unnoticed unless audiometric test is performed.Objective: The aim of this study was to determine the prevalence of sensorineural hearing loss following spinal anaesthesia in obstetric patients.Patients and Methods: Seventy patients of ASAphysical status classes I and II scheduled for elective Caesarean section were randomized into two groups (A&amp; B). Lumbar puncture was performed using 25 gaugepencil point spinal needle type in group Aand 25 gauge Quincke cutting tip type in group B. Spinal anaesthesia was achieved in both groups with 12.5mg (2.5ml) of 0.5% hyperbaric bupivacaine subarachnoid injection in the sitting position. Each patient had a preoperative pure tone audiometry (PTA) test done before spinal anaesthesia as a baseline; this was repeated on the first and third days after the surgery for each patient.Results: Twelve (34.3%) patients in group Aand 24 (68.6%) in group B had more than one attempt at lumbar puncture; and 5[1 (2.9%) from group Aand 4 from group B (11.4%)] developed Post Dural Puncture Headache(PDPH), p= 0.36. Of the 4 patients in group B who developed PDPH, 2 had associated transient sensorineural hearing loss.Conclusion: This study shows that spinal anaesthesia may lead to transient hearing loss among few obstetric patients without long term sequelae. Use of Quincke spinal needle type was more likely to cause PDPH and transient hearing loss.Keywords: Caesarean section, Spinal anaesthesia, Hearing loss, Spinal needle

New triterpene isovanniloyl and antibacterial activity of constituents from the roots of Paullinia pinnata Linn (Sapindaceae)

In addition to lupeyl steryl ether (1) and 3-oxo-11α-hydroxyl-20 (29) lupen (2), a new lupeol-3-isovanniloyl ester (3) was isolated from Paullinia pinnata. Using detailed 1D and 2D NMR spectra and comparison with the published data, the new compound was characterised as 3-O-isovanilloyl-3R,5R,8R,9R,10R,13R,14S,17S,18R,19R-lup-20(29)-en, for which the trivial name Paullinoyl was proposed. Compound 3 demonstrated significant antibacterial activity on the tested strains (MIC 15.2–30.20 μg/ml). The antibacterial activities obtained in this study confirmed the use of P. pinnata in traditional medicine for treating bacterial infections