Aetiological profile of facial nerve palsy in north central Nigeria

Background: Facial nerve abnormalities represent a broad spectrum of lesions which are commonly seen by the otolaryngologist. The aim of this paper is to highlight the aetiologic profile of facial nerve palsy.Methods: A retrospective study of patients with facial nerve palsy seen in the Ear, Nose and Throat clinic for 5 years.Results: The study comprised of 25 patients, made of 16(64%) males and 9(36%) females (M:F = 1.7:1). The age ranged between 6months and 80years, mean of 32.1years (SD=16.38), with peak presentation seen in the 30-40years age group. Bell’s palsy 13(52%), road traffic injury 5(20%) and chronic suppurative otitis media 3(12%) are the commonest cause. The others are stroke 2(8%), measles infection 1(4%) and middle ear tumor 1(4%). Spontaneous recovery was observed in 40%.Conclusion: Bell’s palsy was the commonest cause of facial nerve palsy, however aetiologies cut across all age groups. male slightly more affected. This serves as data base for clinical evaluation of facial palsy in our environment

Biochemical and histological changes associated with treatment of malaria and diabetes mellitus in mice with extracts of Mormodiaca charantia

Diabetes and malaria are prevalent diseases in the tropics. In spite of the availability of various independent therapies for each of these diseases, treatments of patients with both diseases have been quite challenging. Mormodiaca charantia is used in Nigeria separately to treat malaria and diabetes. This present study was aimed at investigating the effects of the methanolic extract of Mormodiaca charantia leaves (100 mg/kg body weight) on diabetic mice infected with malaria. Animals were infected with malaria and induced with diabetes by intraperitoneal injection of 1 x 107 Plasmodium berghei and 100 mg/kg body weight alloxan monohydrate respectively. Animal subjects were treated with 5 mg/kg body weight of chloroquine phosphate, 10mg/kg body weight of glibenclamide and 100 mg/kg body weight of the extract daily for five days. Parasitemia, packed cell volume (PCV) and blood glucose level were monitored in the course of the treatment: Antioxidant status, kidney function test and histology of the kidney and pancreas section were examined. There was a decrease in the parasitemia level with a concomitant increase in the PCV, heamoglobin (Hb) and red blood cell count (RBC) level in groups treated with M. charantia and chloroquine. Blood glucose of all the treated groups decreased significantly (p<0.05) at the end of the experiment. The creatinine, uric acid and urea values in the group treated with the plant extract was significantly increased with values 1.23 mg/dl, 2.68 mg/dl and 30.15 mg/dl respectively, however, the group treated with both standard drugs had the highest urea value (51.55 mg/dl). Photomicrograph of the section of the pancreas and kidney of the infected group showed treated with 100 mg/kg of the plant extract showed mild degeneration of the islet of langerhan and mild atropy of the glomeruli respectively. These results support further studies on the use of Mormodiaca charantia as a single treatment for both diseases

Nodular hidradenoma of the breast: A case report

Nodular hidradenoma is a rare benign skin adnexial lesion of the breast. It is often located in the nipple areolar region and presents as a slow growing painless lesion.We report a case in a 62 yr old male who had a slowly growing left breast lesion of 10 yrs duration. Physical examination revealed an 8 cm superficial, spherical, mobile non tender lump in the nipple areolar region. Excision biopsy with clear margins was performed and histologic examination was nodular hidradenoma after wide consultations.Nodular hidradenoma of the breast is a differential diagnosis of sub areolar masses that must be considered by both pathologist and surgeons to avoid misdiagnosis and overtreatment.Keywords: Nodular hidradenoma, Male breast, Nipple areolar regio

Peripheral vestibular vertigo: clinical spectrum and review of Aetiological factors.

Vertigo constitutes a significant proportion of specialist otorhinolaryngological (ORL) outpatient practice although management may be multidisciplinary. Accurate diagnosis remains a challenge, often depending on clinical/neurootological examination, often with limited availability of costly and sophisticated diagnosticfacilities, the yields of which are often low.This report aims at creating a reference database formanagement of vertigo in the (ORL) Clinic. This is a retrospective chart review of vertigo patients seen in ORL outpatient clinic through 2001 to 2006. Clinical/neuroo-otological examination, radiology and audiometry were the major modalities of investigation. The prevalence of vertigo in the Oto- Rhino-Laryngology outpatient Clinic was 15% (134). There were 79 males and 55 females with peak age at presentation between the 3 and 4 decade of life. Benign paroxysmal positional vertigo 33 (25%), Labyrinthitis 23(17%), menieres disease 19(14%) and cervical spondylosis 14(10.5%) were the leading clinical diagnoses. Trauma accounted for 35% of the aetiological factors while17%was idiopathic. Clinical examination remains the prime technique in accurate diagnosis of vertigo although contemporary diagnostic facilities may help. The spectrum of the non-traumatic and idiopathic cases suggest a need for immunogenetic study in the diagnosis.Keywords: Vertigo, clinical diagnosis, aetiology, outpatient revie

Aetiological Profile of Facial Nerve Palsy in North Central Nigeria

Background: Facial nerve abnormalities represent a broad spectrum of lesions which are commonly seen by the otolaryngologist. The aim of this paper is to highlight the aetiologic profile of facial nerve palsy. Methods: A retrospective study of patients with facial nerve palsy seen in the Ear, Nose and Throat clinic for 5 years. Results: The study comprised of 25 patients, made of 16(64%) males and 9(36%) females (M:F = 1.7:1). The age ranged between 6months and 80years, mean of 32.1years (SD=16.38), with peak presentation seen in the 30-40years age group. Bell’s palsy 13(52%), road traffic injury 5(20%) and chronic suppurative otitis media 3(12%) are the commonest cause. The others are stroke 2(8%), measles infection 1(4%) and middle ear tumor 1(4%). Spontaneous recovery was observed in 40%. Conclusion: Bell’s palsy was the commonest cause of facial nerve palsy, however aetiologies cut across all age groups. male slightly more affected. This serves as data base for clinical evaluation of facial palsy in our environment

Otorhinolaryngologic Emergencies In Nigeria, Sub-Saharan Africa: Implication for Training.

Background: The anatomy and function of the ear, nose and throat (ENT) make pathologies potentially catastrophic. Reports on the epidemiology of otolaryngologic emergencies put the prevalence at between 30 and 80%. There are however very few studies from the developing countries. This study was aimed at determining the magnitude and spectrum of otolaryngologic emergencies in a teaching hospital in a developing country in sub-Saharan Africa. Methods: This was a two year retrospective review done at the Department of Otorhinolaryngology in the University College Hospital, Ibadan, Nigeria. The clinical records of patients managed as emergencies between July 31, 2001 and 30 June, 2003, were reviewed and the biodata, diagnosis and treatment were extracted and analysed. Results: Emergencies constituted 22% of the 2544 cases reviewed. The top five diagnoses were recurrent otitis media (24%), foreign bodies in the orifices (21.0%), head and neck trauma (20%), epistaxis (16%) and chronic sinusitis (8.8%). Children accounted for over 40% of the study population, although there was a peak in the third decade due to trauma. More than 80% of the cases were referred by general practice doctors. Only 41% of the cases were managed surgically, the rest required only conservative treatment. Conclusion: The greater proportion of the cases referred as emergencies did not require surgical intervention and could have been managed conservatively by the referring doctors. It is recommended that the curriculum of otolaryngology posting for general practice trainees should be reviewed so as to increase the duration of exposure from the present one month. This will enable general practitioners to be more adept at instituting the conservative management of otolaryngologic emergencies

Otogenic Tetanus: Continuing Clinical Challenge in the Developing Country

Background: Otogenic tetanus is a vaccine preventable disease which continues to be of public health significance.Objectives: To evaluate patients with otogenic tetanus and identify the factors that predisposes patients to it.Methodology: This is a 16-year retrospective review of all patients managed for otogenic tetanus at the Department of Otorhinolaryngology, University College Hospital, Ibadan. The essential clinical data collected include demographic data, clinical presentations, tetanus immunization history, duration of hospital admission, management and outcome.Results: There were 66 subjects made up of 45 (68.2%) males and 21 (31.8%) females. Their age ranged between 2 and 65years, mean of 7.7 years but the under 5years constituted the majority, 56.1%. All patients presented with ear discharge, lock jaw and spasms. The onset of symptoms ranged between 3 and 8 days with a mean of 4.3 ± 3.3days. Only 21.2% had history of completed childhood tetanus immunisation. No patient had booster shots. About 98% had history of use of herbs, charcoal, honey, cigarette, methylated spirit or deodorant in the discharging ear. All were managed with antibiotic ear dressing, tetanus toxoid, human tetanus immunoglobulin, antibiotic therapy and sedative but only 3% had airway management. The duration of hospital admission ranged from 18 days to 105 days and there were 12.1% death.Conclusion: Otogenic tetanus is still a major problem in developing countries and this can be prevented if recommended childhood tetanus vaccination and booster shots regimen are properly taken. Health education on ear hygiene and care of the ear may prevent this disease

Biochemical and histological changes associated with treatment of malaria and diabetes mellitus in mice with extracts of Mormodiaca charantia

Diabetes and malaria are prevalent diseases in the tropics. In spite of the availability of various independent therapies for each of these diseases, treatments of patients with both diseases have been quite challenging. Mormodiaca charantia is used in Nigeria separately to treat malaria and diabetes. This present study was aimed at investigating the effects of the methanolic extract of Mormodiaca charantia leaves (100 mg/kg body weight) on diabetic mice infected with malaria. Animals were infected with malaria and induced with diabetes by intraperitoneal injection of 1 x 107 Plasmodium berghei and 100 mg/kg body weight alloxan monohydrate respectively. Animal subjects were treated with 5 mg/kg body weight of chloroquine phosphate, 10mg/kg body weight of glibenclamide and 100 mg/kg body weight of the extract daily for five days. Parasitemia, packed cell volume (PCV) and blood glucose level were monitored in the course of the treatment: Antioxidant status, kidney function test and histology of the kidney and pancreas section were examined. There was a decrease in the parasitemia level with a concomitant increase in the PCV, heamoglobin (Hb) and red blood cell count (RBC) level in groups treated with M. charantia and chloroquine. Blood glucose of all the treated groups decreased significantly (p<0.05) at the end of the experiment. The creatinine, uric acid and urea values in the group treated with the plant extract was significantly increased with values 1.23 mg/dl, 2.68 mg/dl and 30.15 mg/dl respectively, however, the group treated with both standard drugs had the highest urea value (51.55 mg/dl). Photomicrograph of the section of the pancreas and kidney of the infected group showed treated with 100 mg/kg of the plant extract showed mild degeneration of the islet of langerhan and mild atropy of the glomeruli respectively. These results support further studies on the use of Mormodiaca charantia as a single treatment for both diseases

Improvised Venous Canula Myringostomy in Acute Otitis Media: Analysis of outcome in Nigeris

Background : This case control study was based on the hypothesis that myringostomy done on an a bulging but inflamed tympanic membrane before perforation might improve healing of the middle ear and tympanic membrane, thus reducing the probability of progression to chronic suppurative otitis media. Our objective was to compare outcome of tympanic membrane healing in acute otitis media (AOM) patients who had myringostomy and those presenting with perforation and suppuration. In this study we also examined the suitability of a venous canula as an improvisation in the absence of conventional myringostomy tube. Methods :This prospective study, carried out in the Otolaryngology Unit, Department of Surgery, Federal Medical Center, Lokoja between February 2006 and August 2008, included consecutive AOM patients who presented with excruciating otalgia and bulging, hyperaemic tympanic membrane and another group with ruptured tympanic membrane both within 2 weeks duration. The patients with bulging tympanic membrane had venous canula myringostomy done in the local anaesthesia and the canula was kept in situ until the ear became dry and until the myringostomy site closed up. While the group with tympanic membrane perforation at presentation had ear suction toileting and daily ear dressing, until ear became dry. The 2 groups were followed up daily to determine duration of stay of the improvised myringostomy tube and the closure of the myringostomy site or tympanic membrane perforation and they were compared using Pearson’s correlation test at 0. 05 significance. Results : Subjects comprised of 42 AOM (15 males and 27 females (M: F = 1.7:3) and 26 with tympanic membrane perforation (11 males and 15 females), aged between 3 years to 48 years (mean+ SD = 13+ 6 years). Relief of otalgia was seen all the subjects in the myringostomy group (100%). The mean number of days to achieve dry ear after myringostomy tube was 3 days after myringostomy while it was 3 weeks in the perforation group (P = 0.002). The mean number of days to achieve closure of the myringostomy was 3.7 days after dryness while among the perforation group, it was 3 months (P= 0.000). Conclusion : Venous canula, which is cheap and readily available, could be an improvisation for myringostomy in AOM; and this aided early relief of otalgia, resolution of disease and significant reduction in treatment durations

Phytochemical composition, cytotoxicity and in vitro antiplasmodial activity of fractions from Alafia barteri olive (Hook F. Icon)-Apocynaceae

The ethanolic extract of Alafia barteri (Hook F. Icon) was dissolved in distilled water and successively partitioned in n-hexane, chloroform, ethyl acetate and n-butanol. The fractions were evaluated for phytochemical composition, lethality against brine shrimp larvae and in vitro antiplasmodial activity against Plasmodium falciparum strain. The obtained results revealed that the roots and leaf extracts of A. barteri exhibited broad spectrum of antiplasmodial activity (IC50 1.5 ± 0.7–6.2 ± 0.80 μg/mL). The aqueous leaf fractions displayed the most potent antiplasmodial activity with an IC50 value of 1.5 ± 0.7 μg/mL, which is comparable to reference antimalarial drug (IC50 value of 1.3 ± 0.2 μg/mL). The leaf fractions displayed higher activity than the root extracts. The highest minimum lethal concentration (105.2 ± 0.8 ppm) was exhibited by the aqueous leaf extract followed closely by the root extract (120.2 ± 1.1 ppm). The leaf extracts contained higher polyphenols (45.3 ± 0.85 mgGAE/g) and flavonoids (18.10 ± 0.2 mgCTE/g) than the root extracts. The n-hexane and EtOAc extracts/fractions displayed lower activity on brine shrimp larvae