Uncommon complications of Otitis media in a tertiary center: A Case Series

Background: The aim is to report cases of unusual and infrequent complication of otitis media in North-central Nigeria, as well as evaluate their outcome. We present 7 case reports of patients with unusual complications from otitis media in our setting.Case 1: A fifteen year old Yoruba girl presented at the Accident and emergency of our hospital with a 2 week history of left sided ear ache, 10 day history of left sided ear discharge and 3 day history of jaw and neck stiffness. There was a positive history of use of ‘Turari’ locally prepared perfume and application of an ear drop from a local chemist. Caregiver said patient was fully immunized. Examination revealed a young girl, conscious and alert, not pale, anicteric with stiff neck, positive and rigid joints on movement.Case 2: An 8 year old Yoruba girl presented first to the eye clinic with 2 days history of swelling of the right eye, associated pain, reduction in vision and eyelid swelling without eye discharge or itch. There was a of purulent ear discharge 8 days prior to eye symptoms. No history of trauma was obtained. Examination revealed proptosis with zygomatic abscess extending to the post-auricular. She had incision and drainage with systemic and topical antibiotics for ear dressing. Outcome was uneventful.Conclusion: The unusual complication of otitis media still occurs in our environment usually due to late presentation and contamination of wound. Prevention is still the best option.  Keywords: Otitis Media, Complications, Otogenic Tetanus, Ophthalmic, Proptosi

Hysterosalpingogram findings among women with infertility in Ogun State, Nigeria

Background: Infertility is a relatively common health challenge in the society with social and psychological consequences. Hysterosalpingogram (HSG) is traditionally used to ascertain some of the causes of infertility. The use of ionizing radiation and contrast media injection with the possibility of complications, make new imaging modalities preferable, especially when in-vitro fertilization is being considered as a management option. Objective: To describe the pattern of the cervical, uterine, tubal and adnexial abnormalities causing infertility as detected by HSG in a tertiary health care institution, and demonstrate the prospects of retaining Hysterosalpingography in the investigation of female infertility. Methods: The HSG and reports of 124 patients referred to the Radiology Department of a tertiary health facility between January, 2013 and June, 2014, at a tertiary healthcare institution, were reviewed for abnormalities in the cervix, uterus, the fallopian tubes and adnexial structures. Results: Secondary infertility was the commonest indication for the procedure among in 66 of the 124 HSG reviewed. Pathologies in the cervix were found in 66 (51.6%) cases, of which the most frequent abnormality was cervical fibrosis in 59.4% (36/66) cases. Uterine abnormalities were found in 71.7% (89/124) cases, with uterine fibroid occurring in 82% (73/89) of these cases. Pathologies in the Fallopian tube occurred in 68 (54.8%) cases, with bilaterally blocked tubes occurring most frequently in 32.4% (22/68). Twenty-seven of the 68 cases (39.7%) with tubal abnormalities were aged 20-29 years. Conclusion: Secondary infertility was the commonest indication for HSG in the study, while uterine fibroid, cervical fibrosis and bilaterally blocked tubes were the most prominent findings in descending order of frequency. Therefore, caution should be exercised in managing pelvic infections, inflammations, diagnostic dilation and curettage and post-abortal and post-surgical periods in order to reduce the risk of fibrosis

Recurrent Galactorrhoea: A consequence of unheeded primary hypothyroidism

Background: Primary hypothyroidism can lead to hyperprolactinemia through several mechanisms in both men and women, manifesting as galactorrhoea, loss of libido, and infertility in both sexes, as oligomenorrhea/amenorrhea in women, and as gynecomastia and erectile dysfunction in men. Case presentation: Here presented is a 28-year-old Nigerian woman with a history of recurrent bilateral painless galactorrhoea of 12 years’ duration and persistent low mood. Physical examination was unremarkable. The hormonal assay revealed elevated thyroid-stimulating hormone, elevated serum prolactin, low thyroxine, and low triiodothyronine levels. Magnetic resonance imaging of the brain revealed normal findings. A diagnosis of hyperprolactinemia secondary to primary hypothyroidism was made. Pharmacological therapy began with thyroid hormone replacement therapy and a dopamine agonist: 75 micrograms of levothyroxine daily and 0.5 micrograms of cabergoline twice weekly for 8 weeks. After 8 weeks of pharmacological therapy, hormonal assay revealed values within the reference range with significant symptomatic improvement evidenced by cessation of galactorrhoea and low mood. Conclusion: Primary hypothyroidism has been proven to be one of the numerous causes of hyperprolactinemia and it could be unheeded in a patient who does not present with the typical signs and symptoms of primary hypothyroidism

Diabetic foot care: Self reported knowledge and practice among patients attending three tertiary hospital in Nigeria

Background: Diabetes Mellitus (DM) foot complications are a leading cause of mortality in developing countries and the prevalence of diabetes is expected to increase in the next decades in these countries. Theaim of this study was to determine the knowledge and practice of foot care among diabetes patients attending three tertiary hospitals in Nigeria.Methods: This is a cross-sectional study carried out from November 2009 to April 2010. Pre-tested structured questionnaires were administered by medical officers to diabetes patients. The outcome variables were knowledge and practice regarding foot care. The knowledge and practice scores were classified as good if score .70%, satisfactory if score was 50-69% and poor if score was < 50%.Results: Of 352 diabetes patients, 30.1% had good knowledge and 10.2 % had good practice of DM foot care. Majority (78.4%) of patients with poor practice had poor knowledge of foot care. With regard toknowledge, 68.8% were unaware of the first thing to do when they found redness/bleeding between their toes and 61.4% were unaware of the importance of inspecting the inside of the footwear for objects. Poor footpractices include; 89.2% not receiving advice when they bought footwear and 88.6% failing to get appropriate size footwear. Illiteracy and low socioeconomic status were significantly associated with poor knowledge and practice of foot care.Conclusion: This study has highlighted the gaps in the knowledge and practice of foot care in DM patients and underscores the need for an educational programme to reduce of diabetic foot complication

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Information needs of small ruminant rearers in Peri-Urban areas of Southwest Nigeria

The study aimed at recognizing the information needs of small ruminant rearers within households in three peri-urban areas of Oyo state and Ile-Ogbo in Osun state. The respondents were purposively selected and snowball technique was used to identify them. Focus group discussion and questionnaire/interview schedule were used to collect information for the study. It was discovered that 51.3% of respondents were aged 50years and above indicating that the rearing of small ruminants was also suitable for the more settled and slower citizens and that 73.6% of the respondent had some form of education. Majority of the respondents (87.6%) earned less than N5,000.00 monthly from small ruminants and 94.2% of them think rearing small ruminants is profitable. In addition, 77.7% of them reared small ruminants primarily for income generation. The study also revealed that the most important constraints to small ruminant production were theft, death from vehicles and pests and disease infestations and that the respondents needed information on small ruminant rearing in areas like feeding, management system, housing, disease identification and record keeping

Awareness and use of natural growth promoters among poultry farmers in Oyo state, Nigeria

The study investigated the awareness and use of natural growth promoters (NGPs) among poultry farmers in Oyo state. Purposive sampling was used to select 11 local government areas based on the concentration of the poultry farms and 13 respondents were randomly selected from each local government. Structured questionnaire was used to elicit information from respondents. The study revealed that 69.6% of poultry farmers were males and 82.7% were within the age range of 21-50 years. Most (67.4%) of the farmers were married, 72.3% were Christian,92.8% were educated and 46.8% practice farming as major occupation. Majority (60.4%) had flock size of less than 1,000 birds and they were aware of NGPs, with feed enzymes having highest percentage (89.3%) of awareness. Feed enzymes and probiotics have the highest utilization with 87.1% and 55.0% respectively. Major constraints to utilization of NGPs are lack of extension agents,lack of knowledge of natural growth promoters,lack of technical know-how and cost of NGPs. Significant relationship was found between farmers’ educational qualification (χ2;= 38.762, p= 0.010, flock size; χ2=42.078, p= 0.043 and the awareness of NGPs. Significant relationship also existed between farmers’ monthly income (χ2= 22.744, p= 0.004), flock size χ2= 48.184, p= 0.010) and utilisation of NGPs. There is high level of awareness but utilization is low. NGPs should be subsidized and distributed through poultry farmers group.Key words: Awareness, Utilisation, Natural Growth Promoters, Poultry, Farmer

A review of stroke admissions at a tertiary hospital in rural Southwestern Nigeria

Background: Stroke is a common neurological disorder and is the third leading cause of death and a major cause of long-term disability. The disease is expected to increase in low- and middle-income countries like Nigeria. There is no information on stroke in rural Nigeria. Objectives: To review the clinical patterns, risk-factors, and outcome of stroke in a tertiary hospital in rural Nigeria and examine the rural-urban variation of stroke hospitalization in Nigeria. Materials and Methods: We carried out a retrospective study of patients who had a clinical diagnosis of stroke at the Federal Medical Centre, Ido-Ekiti, South-western Nigeria between November 2006 and October 2009. Results: A total of 101 patients who had stroke were admitted during this review period, accounting for 4.5% of medical admission and 1.3% of total hospital admission. Women accounted 52.5% of cases, with a male to female ratio of 1 : 1.1. Their mean age was 68 ± 12 years. Stroke occurrences increased with age, as almost half (49.5%) of the cases were aged ≥70 years and majority (84.2%) of them were in low socioeconomic class. The mean hospital stay for stroke treatment was 12 ± 9 days, Glasgow coma score on admission was 11 ± 4. Ischemic stroke was 64.4%; hemorrhagic stroke, 34.7%; and indeterminate, 1.0%. Hypertension (85.2%), diabetes mellitus (23.8%), and tobacco smoking (22.8%) were the common identifiable risk factors for stroke. Of all the patients, 69% had ≥2 risk factors for stroke. Thirty-day case fatality was 23.8%; it increases with age and was higher among men than women (29.2 vs 18.9%) and in patients with diagnosis of hemorrhagic stroke (34.3 vs 18.5%). The numbers of identifiable risk factors of stroke has no effect on the 30-day case fatality. When compared with stroke in urban areas of Nigeria, we found no differences in frequency of hospitalization (1.3 vs 0.9 - 4%) and the major risk factor (hypertension). Hemorrhagic stroke was more common in urban than in the rural community (45.2 - 51 vs 34.7%) and the 30-day case fatality was lower in the rural community (23.8 vs 37.6 - 41.2%). Conclusion: Stroke is also a common neurological condition in rural Nigeria, in view of the fact that almost 70% of the patients had ≥2 risk factors of stroke. We recommend that, sustainable, community-friendly intervention programmes are incorporated into the health care system for the early prevention, recognition, and modification of the risk factors in persons prone to the disease.DOI: 10.4103/1596-3519.8206

Studies of synthetic chalcone derivatives as potential inhibitors of secretory phospholipase A2, cyclooxygenases, lipoxygenase and pro-inflammatory cytokines

Ibrahim Jantan,1,* Syed Nasir Abbas Bukhari,1,* Olayiwola A Adekoya,2 Ingebrigt Sylte3 1Drug and Herbal Research Centre, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; 2Department of Pharmacy, Faculty of Health Science, UiT The Arctic University of Norway, Troms&oslash;, Norway; 3Department of Medical Biology, Faculty of Health Science, UiT The Arctic University of Norway, Troms&oslash;, Norway *These authors contributed equally to this work Abstract: Arachidonic acid metabolism leads to the generation of key lipid mediators which play a fundamental role during inflammation. The inhibition of enzymes involved in arachidonic acid metabolism has been considered as a synergistic anti-inflammatory effect with enhanced spectrum of activity. A series of 1,3-diphenyl-2-propen-1-one derivatives were investigated for anti-inflammatory related activities involving inhibition of secretory phospholipase A2, cyclooxygenases, soybean lipoxygenase, and lipopolysaccharides-induced secretion of interleukin-6 and tumor necrosis factor-alpha in mouse RAW264.7 macrophages. The results from the above mentioned assays exhibited that the synthesized compounds were effective inhibitors of pro-inflammatory enzymes and cytokines. The results also revealed that the chalcone derivatives with 4-methlyamino ethanol substitution seem to be significant for inhibition of enzymes and cytokines. Molecular docking experiments were carried out to elucidate the molecular aspects of the observed inhibitory activities of the investigated compounds. Present findings increase the possibility that these chalcone derivatives might serve as a beneficial starting point for the design and development of improved anti-inflammatory agents. Keywords: anti-inflammatory, tumor necrosis factor-alpha, lipopolysaccharides, molecular dockin