Severe idiosyncratic drug reaction (Lyells syndrome) after ingesting dihydroartemisinin

Lyells syndrome also called Toxic epidermal necrolysis is the extreme formof idiosyncratic drug reaction that is called Steven Johnsons Syndrome. The condition results in an extensive loss of the skin with mucous membrane involvement. Lyells syndrome has been induced by many agents. The commonest agent in the literature being sulphonamides. However, in our search of the medical literature there was no report of dihydroarthemisinin as a cause ofLyells syndrome.We report three patients seen at two tertiary health institutionswith Lyells syndrome after treatment formalaria with dihydroarthemisinin. This resulted from administration of dihydroarthemisinin with chloroquine in twopatients and dihydroarthemisinin withAmodiaquine in one patient. The first patientwas a seven year old child who developed90%cutaneous involvement and died fromhemorrhagic shock.The secondwas a 28 old female that developed a 76% body surface involvement and died from septicemia. The third patient was a pregnant 37year old woman that developed 52% body involvement and died from septic shock. In these patients the earliest symptomswere not recognized and therewas considerable delay before referral. In view of the recent WHO recommendation of Arthemisinin Combination Treatment (ACT) for malaria, we expect more cases of Steven Johnson Syndrome and Lyells syndrome from ACT treatment. The aim of this report is to raise the awareness of clinicians to this potentially fatal complication

Testicular Biopsies of Azoospermic Men at The Lagos State University Teaching Hospital

Objectives: This study was conducted to evaluate the histological findings from testicular biopsies in azoospermic men seen at the Lagos State University Teaching Hospital, Ikeja - Lagos, Nigeria.Patients and Methods: A retrospective study of testicular biopsies of azoospermic men who presented to our institution from 2005 to 2006 was performed. The patient’s age, type of infertility and histopathological diagnosis were evaluted. All biopsies were preserved in 10% formaldehydesolution.Results: Of the 51 azoospermic men (mean age 30 years, range 25 – 46 years) 25 (49.0%) had primary infertility, 11 (21.6%) had secondary infertility and 15 (29.0%) were not specified. Five (9.8%) patients had normal spermatogenesis. Abnormal histological parameters occurred in 46 (90.2%) patients: testicular atrophy in 30 (58.8%), maturation arrest in 14 (27.5%) and hypospermatogenesis in 2 (3.9%) patients.Conclusion: The presence of normal spermatogenesis in azoospermic men, which would suggest an obstructive lesion, is not common in our practice, in contrast to previous studies from our country. This may indicate a changing pattern in the aetiology of male infertility in our environment. Identification of the possible causes of testicular damage resulting in non-obstructive azoospermia in our environment may help to prevent male infertility.Key Words: Azoospermia, etiology, diagnosis, testicular biopsies, histopathology, infertility, environmen

Gingival Overgrowth and Associated Factors among Epileptic Patients of Lagos University Teaching Hospital, Lagos, Nigeria

Background: Gingival Hyperplasia (GH) may occur as a hereditary disorder or linked to certain factors such as drugs. Drug induced GH; now referred to as Gingival Overgrowth (GO) typically develops in a susceptible individual within 1-3 months of commencing medication. It is the most common oral side effect reported with the use of anticonvulsants and aesthetically displeasing. This study aims to evaluate the proportion of epileptic patients attending the Neurology Clinic of LUTH that present with GO and assess the associated factors. Patients and methods: 300 dentate subjects consisting of 150 epileptics and 150 controls matched for age and sex participated in this study. Bio-data and medical history were collected using a structured self-administered questionnaire and confirmed from patients’ case file. Oral hygiene was assessed using the Simplified Oral Hygiene Index (S-OHI) of Green and Vermillion and GO, the New Clinical Index for Drug-Induced Gingival Overgrowth (DIGO). Result: The age range was between 10 and 74 years. Male to female ratio for cases and control was 1:1.8 and 1:1.7 respectively. The mean S-OHI score in the cases was 1.89 ± 0.758. The proportion of epileptic patients who presented with GO was 32.7%. Conclusion: The proportion of patients who presented with GO was significantly higher among the epileptics.Keywords: Gingival Hyperplasia, Gingival Overgrowth, Epileptics, AnticonvulsantsNigerian Journal of Plastic Surgery Vol. 9, No 2, September 201

Report of hereditary gingival fibromatosis in two Nigerian siblings

Background: Hereditary Gingival Fibromatosis (HGF) is a rare condition with a prevalence of 1:750,000, and can present as an isolated disorder or more rarely as a syndrome component. It is characterised by a slow and progressive enlargement of both maxillary and mandibular 28rganiza with varying severity between individuals within the same family. This paper reports the occurrence of HGF in two young patients from the same parents.Materials: Detailed clinical evaluation revealed a positive history of generalised gingival swelling in the two patients, in the eldest child of the family, and an uncle. There was no history of intake of drugs that could predispose to the development of gingival hyperplasia. Intra oral examination showed generalised gingival hyperplasia involving thelingual and buccal regions of both maxillary and mandibular arches.Conclusion: Screening other siblings of patients who present with delayed eruption and gingival enlargement for HCF with the view of instituting early and effective plaque control in order to reduce severity of the enlargement is recommended

Catheter associated urinary tract infections; prevalence among admitted burn patients in the burn wards of the Lagos State University Teaching Hospital, Ikeja-Lagos, Nigeria

Introduction: Major burn is associated with significant change in intravascular fluid volume that requires fluid resuscitation. The resuscitation is monitored to ensure fluid balance. Urethral catheterization is essential to collect urine during the process. Catheterization promotes bacterial colonization of urethra. Catheter associated urinary tract infection (CAUTI) may thus complicate burn patient’s management. A prevalence study of CAUTI was carried out among the burns patients of Lagos StateUniversity Teaching Hospital to determine the morbidity burden.Methods: Urine samples were collected from catheterized burn patients on admission between 1st of July 2009 and 31st December 2010 and  processed in the microbiology laboratory. The demographic data were collected from the case notes and their descriptive analysis carried out using SPSS version 16 software.Results: A total of 1568 urine samples were collected from all units of the hospital including 32 (2%) from catheterized burn patients. The age range for patients with burn injury was from 2 to 45 years and male: female ratio of 1.5:1. Sixteen per cent of all urine samples yielded growth; 2% were from burn patients. The difference in the rates of CAUTI among burns patients and other hospitalized patients was not statistically significant. The predominant causative agent was Escherichia coli (60%) followedby Acinetobacter baumannii (20%) and Pseudomonas aeruginosa (20%). Resistance to the first line antibiotics was quite high. Conclusion: Efforts should be made towards reducing the incidence of CAUTI among cases with burns.Keywords: Urinary catheter, urinary tract infection, burns, Nigeria

Evaluation of Microbiology Request Forms at a Tertiary Health Institution in Lagos, Nigeria; an Audit of Incomplete Filling of Forms and the Impact on Results.

Laboratory analytical errors were hitherto believed to be responsible for inaccurate investigation results. Recent findings have shown that with advances in analytical techniques, preanalytic factors are now responsible for most of the errors. We audited the Laboratory Request Forms, which were sent for microbiological investigations at a tertiary hospital in Lagos, Nigeria for incomplete fillings and the effects on results. A retrospective study of all the request forms received at the Medical Microbiology and Parasitology Department of Lagos State University Teaching Hospital, Ikeja-Lagos, Nigeria between July 2011 and March 2012 was carried out. The forms were checked for the absence/presence and details of specific items and parameters. Frequencies and percentages were calculated from the data collected. A total of 1441 cases were reviewed. The ages were accurately filled in only 9.5%. The duration of hospital stay was not indicated in 95.2% of cases. Column for clinical summary was not filled in 56.3% cases. The working diagnosis was confusing to the Laboratory Physicians in 14.1% cases and non-informative in 18.4%. A total of 31.5% specimens were inappropriate for the requested investigations and investigations not relevant to the working diagnoses in 36.8 % cases. Multidrug resistant isolates were found in 6.2 % cases. The standard of filling of laboratory request forms in the environment of the study and others with similar situation need to improve.Keywords: Inaccurate laboratory investigation results, Audit, NigeriaNigerian Medical Practitioner Vol. 63, No. 5-6,201

Intussusception in Infants, Experience from Lagos, Nigeria

Worlwide, intussusception is a fairly common surgical emergency in infants. They often present in ways that mimmick dysenteric diarrheoa, and accurate diagnosis requires both an awareness of its modes of presentation and a healthy index of suspicion. We reviewed and analysed several epidemiologic and clinical parameters as well as management options in cases of intussusception in infants and children treated at the Lagos State University Teaching Hospital between January 2006 and December 2006. There were 33 cases in all. All of them had operativemanagement. The commonest type was ileo-colic intussusception (91%). There was no definite pathologic lead point but enlarged Peyer’s patches were noticed in 5 cases. Delay in diagnosis and referral from various centers was apparent as 23 cases (69.7%) presented beyond three days of onset of symptoms. Manual operative reduction was possible in 50% of cases who presented beyond 5 days of onset of symptoms. There was one unusual case of post operative jejuno-jejunal intussusception after an initial operative manual reduction of ileo-colic intussusception. 36% of the patients that presented more than 72hours after the onset of symptoms required bowel resections, on account of vascular compromise of the intussusception. Yet there was no mortality in this series. Late presentationof patients with intussusception is still quite common in our environment, increasing complications in these cases. However by a combination of aggressive fluid resuscitation and close monitoring prior to surgery, we have been able to manage these cases and achieve good results

Urinary albumin:creatinine ratio in postburn patients in Ikeja- Lagos, Nigeria; a point-of-care survey

Background: Chemical mediators are released after burns. They are responsible for the pathophysiological responses of microcirculation and fluid shift in patients with burns. The mediators also have direct damaging effects on tissues including the kidneys. Acute kidney disease is common in patients with burns.Patients/methods: A cross-sectional Point-of-Care survey of the urine of post-burn patients was done at the Lagos State University Teaching Hospital, Ikeja-Lagos, Nigeria to check for the prevalence of renal morbidity among them and study the predisposing factors. All consenting postburn cases that were seen at the Out-patient Clinic between May 1st and October 31st 2011 were studied. Urine samples were collected into sterile containers and tested for albumin and creatinine with MicroalbuPHAN(R) (Erba Lacherma Bmo CZ) Diagnostic Strips. The ratio of the urinary concentrations of albumin:creatinine was calculated.Results: Fifty-six cases were seen, 55(98.2 %) had urinary albumin: creatinine ratio within the microalbuminuria range, one proteinuria and were independent of the extent of burn injury.Conclusion: Post-burn renal morbidity is common in the study environment. Renal status of patients should be assessed during the acute, subacute and postburn phases of management to detect persisting renal injury and institute appropriate management.Key words: - Burns, point-of-care-testing, kidney injury, urinary albumin: creatinine ratio, Nigeria

Nutritional and haematological parameters of cleft lip and/or palate patients in Lagos, Nigeria.

Introduction: Cleft Lip and Palate (CLP) deformities are the most common congenital abnormalities of the orofacial structures. The deformity is associated with certain peculiar problems including feeding disorders and recurrent infections. These may combine to affect the nutritional status of the patients. This study was carried out to assess the prevalence of malnutrition among patients with CLP deformities in Lagos, review the prevalence of anaemia and the burden of bacterial infections.Materials/methods: Serum albumin levels of patients with CLP invited for surgical intervention in Lagos between 2006 and 2008 were assessed to determine the nutritional status, the Packed Cell Volume for the presence of anaemia and total White Cell Count (WBC) to screen for the possibility of bacterial infection.Results: Two hundred and twenty five patients were studied comprising of 112 males and 113 females. Mean age was 5.05 ± 7.73 years. One hundred and one (44.89%) patients had complete cleft of the lip and palate, 27.22% had cleft lip, 13.78% had cleft of the lip and hard palate, while 7.11% had cleft of the soft palate alone. Various types of rare cleft deformities occurred in 8.88% patients out of which macrostomia or lateral cleft constituted 6.67%. Forty-eight (21.3%)patients had malnutrition. The type of CLP deformities was found to have no significant effect on the serum albumin level (p = 0. 089). Sixty-eight (30.2%) patients had anaemia. There was an association between the types of CLP deformities and the PCV levels (P=0.001). Twenty-two (9.8%) patients showed haematologic evidences of on-going bacterial infections with raised total WBC count.Conclusion: The prevalence of anaemia in patients with CLP is however higher than that of the general population. Patients with CLP require nutrition support and continuous medical monitoring