Grandmultiparity in Lagos, Nigeria

The case-notes and records of grandmultiparous patients delivered at the Lagos University Teaching Hospital between 1st January, 1994 and 31st December, 1996 were analysed. The incidence of grandmultiparity was 4.11%. There were no cases of extreme grandmultiparity. The mean age +/- SD was 33.26 +/- 1.8 years, and the mean parity +/- SD 5.57 +/- 0.38. No patient was under 20 years and none had a parity greater than 9. Fifty-seven (42.22%) were booked patients and 78(57.78%) were unbooked. Anaemia and malpresentation were commonest in the antenatal period, whilst hypertension and disproportion were commonest intrapartum. Fifty per cent of the patients had a spontaneous vaginal delivery. The Caesarean section rate was 30.37%. The incidence of intrapartum complications, cephalopelvic disproportion, obstructed labour and Caesarean section, were found to be higher in the unbooked patients. There was an increased incidence of twin pregnancy and placenta praevia. The maternal mortality ratio was 44.4/1000 amongst the grandmultipara which was not statistically more significant than in the general obstetric population. The perinatal mortality rate was 169/1000 deliveries.     

HIV seroprevalence in emergency department patients: Lagos University Teaching Hospital, Lagos, 1999

The emergency department patients represent a cross-section of the entire population and values of HIV seroprevalence in them have been used to assess the general trends of HIV surveillance in other countries. The objectives of this study is to determine 1. Whether seroprevalence of HIV antibodies in patients attending emergency departments could serve as a marker of prevalence of HIV antibody in the general population. 2. The degree of clinical suspicion or knowledge of the medical personnel to the status o the HIV seropositive patients is also evaluated. A total of 312 emergency department patients of Lagos University Teaching Hospital (LUTH) had their blood samples screened for antibodies against Human Immunodeficiency Virus (HIV) types I and II by ELISA based techniques: Immunocomb II HIV I & II Bispot Kits. Repeatedly reactive samples were confirmed by another ELISA based technique using Immunocomb I & II Combfirm kits. The attending medical doctor was asked whether there was any suspicion or knowledge that the patient being attended to, was HIV seropositive. The seroprevalence of HIV antibodies was 5.77% with no significant difference in sex incidence. The age groups 20-29 and 30-39 years were most affected. The seropositive nature of affected patients was unsuspected by medical personnel in 55.56% of the HIV antibodies seropositive patients. The Federal Ministry of Health in 2000, estimated the National prevalence rate of HIV to have been 5.4% in 1998. This figure is comparable to that obtained in this study and revalidates the fact that emergency department patients may be used for disease surveillance in the population. The seropositive status of majority of the HIV positive patients was unsuspected by the attending medical personnel. Thus, strict adherence to universal safety precautions is essential for all medical personnel. Post exposure prophylaxis should be made readily accessible to all medical personnel.     

Fungi causing dermatophytosis in Lagos, Nigeria

Dermatophytes of the genera Trichophyton, Microsporum and Epidermophyton were isolated from 162 (41%) of 395 patients with clinical manifestations of ringworm infection reporting at the Lagos University Teaching Hospital, Lagos, Nigeria between January 1986 and December 1987. Of the 162 strains of fungi isolated, 120 (74.1%) were Microsporum species and 7 (4.3%) were Epidermophyton floccosum. Superficial mycosis was most prevalent on the skin (59.3%), followed by that of the hairs (27.2%). Infection of the nails (13.6%) was the least common. Infection occurred in all the age groups with the age group (20 years old and above) having the highest rate of isolation (68.5%) while the age group (5 years and below) had the lowest isolation rate (3.7%).     

Experience in oesophageal substitution in Lagos, Nigeria

This is an audit of five years work (1996 - 2001), in oesophageal substitution at the Cardiothoracic Surgery Unit of Lagos University Teaching Hospital, Nigeria. The study aimed at highlighting the current trends in indication and methods of oesophageal substitution in the context of our experience. We did a retrospective study of all who required oesophageal substitution during the period of study. We studied the various aspects of the patients' care including the indications for oesophageal substitution, the substituting organs and the results of surgery. We saw fifty-nine patients comprising 19 patients oesophageal carcinoma, 31 corrosive strictures of the oesophagus, 4 peptic strictures and 3 achalasia cases. Two patients had oesophageal substitution because of mediastinitis. Fifty-five patients underwent oesophageal substitution. The substituting organs were stomachs in 36 patients and colon in 19 patients. There were three anastomotic strictures, two grafts failed, and five cases of anastomotic leaks. In all, operative mortality was 9.1% . We concluded that oesophageal substitution was done more for benign reasons in our centre. We also emphasised the positive aspects of colon interposition and the prospects of doing more of it in the near future.     

Prevalence of serological markers of chronic hepatitis B virus infection in diabetics in the Lagos University Teaching Hospital,Lagos

Hepatitis B virus (HBV) infection, a major world health problem, is hyper endemic in South-East Asia and sub-Saharan Africa including Nigeria. Being a major cause of morbidity and mortality, prophylaxis using the highly efficacious hepatitis B vaccine is recommended for those at risk. The prevalence of serological markers of chronic HBV infection was determined in a population of 100 outpatient diabetics and 80 non-diabetic controls at the Medical Outpatient Department of the Lagos University Teaching Hospital Idi-Araba between January and July 1992. Twenty diabetic patients [20%] and 14 controls [17.5%] had serological markers (HbsAg and antiHBc) indicating ongoing chronic HBV infection. The difference between diabetics and non-diabetic controls was not statistically significant (P>.05). None of the HbsAg and antiHBc positive diabetics [45%] and 8 control patients [57%] were HbeAg positive. The presence of serological markers was not related to the duration, type of diabetic treatment and degree of diabetic control. Our findings suggest that diabetics in Lagos appear not to be more predisposed to chronic HBV infection than the rest of the population, and therefore would require no special antiHBV prophylaxis.     

Prevalence of HIV-related autoimmune haemolytic anaemia in Lagos,Nigeria

Background:

Despite a high frequency of anaemia, a positive direct antiglobulin test (DAT) and bone marrow hyperplasia HIV-infected patients, lack of reticulocytosis may cause underdiagnosis autoimmune haemolytic anaemia (AIHA) in them. This study was carried out to determine the prevalence of autoimmune haemolytic anaemia in HIV-infected patients and to compare the haematological/immunological characteristics of subjects with anaemia and those without.

Materials and Methods:

A total of 350 HIV-infected subjects attending the Lagos University Teaching Hospital who consented were recruited for the study. This included 250 subjects with anaemia (haemoglobin concentration <10 g/dl) as cases and 100 subjects without anaemia as controls. Five milliliters of venous blood drawn from each subject was used for the full blood count, reticulocyte count and DAT.

Results:

Subjects with anaemia had lower mean CD4 cell count (284.3 cells/μl) and higher mean reticulocyte per cent (1.5%) than the non-anaemic subjects. The frequency of reticulocytosis was higher in female subjects than in males. Only 0.8% (2 of 250) of the study group screened positive to DAT, p = 0.0339. None of the subjects in control group screened positive to DAT.

Conclusion:

Autoimmune haemolytic anaemia is a rare complication of HIV infection in our geographical location.     

Pattern of extremity injuries in polytrauma in Lagos, Nigeria

BACKGROUND: Extremity injuries are common in polytrauma, which remains a leading cause of death, long hospitalisation and disability for all ages. There are few research works on the pattern of these extremity injuries in Lagos, Nigeria. OBJECTIVE: To describe the pattern of extremity (limb) injuries in polytraumatised patients. PATIENTS AND METHODS: This was a prospective study carried out at the Lagos University Teaching Hospital, between 1st November 2004 and 31st October 2006. RESULTS: A total of 291 patients presented with multiple injuries between November 2004 and October 2006. All of them had extremity injuries. The studied patients were aged 2 to 76 years with a mean of 31.2 +/- 16.4. Two hundred and twenty two (76.3%) of the patients were aged 40 years or less. There were 219 males and 72 females showing a male to female ratio of 3:1 Road traffic accident was the most common aetiology (73.2%). The most frequently seen fractures were tibia 27.8%, femur and fibula 24.7% each. An overwhelming majority (88.8%) had multiple fractures. The commonest fracture combinations were tibia/ fibula 24.7% and radius/ulna 19.6%. The most frequently associated injury was head injury 26.8%. Others were spinal and abdominal injuries 13.4% each. Hip dislocation accounted for a majority (56%) of all dislocations seen in this study. CONCLUSION: Lower extremity injuries were commoner than upper extremity injuries in polytrauma. Majority of them had multiple fractures especially among bones that have close anatomical location. Head injury was the most commonly associated injury.     

One year of EEG unit at psychiatric hospital, Yaba, Lagos

To show the continuous investigative value of electroencephalography (EEG) in the management of neuro-pathological disorders such as epilepsy in Nigeria. The limitation against this, especially lack of adequate fund to procure the EEG machine was highlighted. A prospective study over the first twelve months of setting up the EEG unit at the psychiatric hospital, Yaba, Lagos. Subjects included all the patients that had EEG recording in the unit during the study period. Awake EEG was done on each subject using 10-20 system of electrode placement with metal disc electrodes on the 24-channel medelec computerised EEG machine. Majority of the cohort (71.3% ) were aged < 30 years. Seizure disorder constituted the largest clinical reason for EEG request. The EEG findings were normal in close to 44% of the cohort, but abnormal in 56% with 'epileptiform activities' as the most common abnormalities. Despite the notable constraints involved, EEG continues to be of immense value in the management of neuro-pathological disorders in Nigeria.     

Assessment of radiation protection practices among radiographers in Lagos,Nigeria

Background:

Use of ionising radiation in diagnostic radiography could lead to hazards such as somatic and genetic damages. Compliance to safe work and radiation protection practices could mitigate such risks. The aim of the study was to assess the knowledge and radiation protection practices among radiographers in Lagos, Nigeria.

Materials and Methods:

The study was a prospective cross sectional survey. Convenience sampling technique was used to select four x-ray diagnostic centres in four tertiary hospitals in Lagos metropolis. Data were analysed with Epi- info software, version 3.5.1.

Results:

Average score on assessment of knowledge was 73%. Most modern radiation protection instruments were lacking in all the centres studied. Application of shielding devices such as gonad shield for protection was neglected mostly in government hospitals. Most x-ray machines were quite old and evidence of quality assurance tests performed on such machines were lacking.

Conclusion:

Radiographers within Lagos metropolis showed an excellent knowledge of radiation protection within the study period. Adherence to radiation protection practices among radiographers in Lagos metropolis during the period studied was, however, poor. Radiographers in Lagos, Nigeria should embrace current trends in radiation protection and make more concerted efforts to apply their knowledge in protecting themselves and patients from harmful effects of ionising radiation.     

Beta-lactamase detection in nosocomial bacterial pathogens in Lagos,Nigeria

Beta-lactamase production was investigated in 1033 bacterial pathogens--262 gram-positive bacteria, 482 Enterobacteriaceae, 289 non-fermenting bacilli. These were isolated from nosocomial infections in paediatric patients. Beta-lactamase was detected using chromogenic cephalosporin and starch paper methods. More than 80% of the isolates produced the enzyme, which was not detected in enterococci and streptococci. There was no appreciable difference ([symbol: see text] 2 = 5.31, P > 0.05) in the number of Beta-lactamase producers obtained using the two methods. Great caution must be exercised in the therapeutic use of Beta-lactam drugs for nosocomial bacterial infections.     

Occlusal features of sickle cell anaemia patients in Lagos, Nigeria

One hundred and four sickle cell anaemia patients aged 10-45 years and attending the out patients' clinic of the Lagos University Teaching Hospital as part of a routine check-up were seen. They were in a steady state of health. By means of a structured questionnaire the Biodata of each consecutive eligible patient was obtained and physical examination was carried out. Oral examination was done with emphasis on occlusal variables including Angle's Classification of occlusion, overjet, overbite, tooth: bone ratio, lip competence and skeletal pattern. Results showed that the majority of the patients 92 (88.5%) seen presented with Angle's Class 1 malocclusion. Increased overjet was observed in 50 (48.2%) of the sample population while an overbite depth of 2 was most frequently seen in these patients. Spacing in the anterior segment of the upper and lower arches was a fairly common occurrence, occurring in 51 (49.0%) and 39 (30.8%) of the patients seen respectively. Normal dental base relationship (Skeletal 1) was observed in 72 (69.2%) while lip incompetence was seen in 41 (39.4%) of the patients examined. Occlusal anomalies vary from mild to severe and may be attributable to hyperplastic maxillary bone and the resultant skeletal discrepancy.