Serial evaluation of iron stores in pregnant Nigerians with hemoglobin SS or SC

Iron status of nonpregnant and pregnant Nigerian patients with hemoglobin SS or SC were assessed using serial hematological parameters, measured by Coulter counter, and serial serum ferritin concentrations measured by radioimmunoassays. The median value of 393 micrograms/L (range, 175 to 900 micrograms/L) for serum ferritin in nonpregnant patients with Hb SS and SC was significantly higher than that found in nonpregnant patients with Hb AA (median, 89.8 micrograms/L; range, 13 to 250 micrograms/L). Apart from packed cell volume values, there were no other significant differences between patients with Hb SS or SC and Hb AA in the other parameters assessed: mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration. In both the normal pregnant patients (Hb AA) and pregnant patients with Hb SS and SC the serum ferritin values decreased as pregnancy advanced to 28 weeks and rose gradually thereafter. At similar stages of gestation serum ferritin values were significantly higher in patients with Hb SS or SC than in those with Hb AA. Pregnancy seems to have induced a significant rise in mean corpuscular volume and mean corpuscular hemoglobin values in the patients with Hb SS or SC, especially in the third trimester, than in patients with Hb AA. The pattern of change in mean corpuscular hemoglobin concentration values was similar in both groups of patients. From the data obtained, it seems the iron status in the patients with Hb SS or SC was good, and pregnancy did not push the patients into an iron deficiency state. The use of prophylactic iron supplementation in pregnant patients with Hb SS or SC appears unjustified.     

Intravascular volume expansion and fetal outcome in pregnant Nigerians with hemoglobin SS and SC

In a comparative study of physiological changes in pregnant Nigerians, plasma volume measurements were performed in 75 healthy Nigerian women. They comprised 40 women with hemoglobin genotype AA (20 pregnant and 20 nonpregnant) and 35 women with hemoglobin genotype SS or SC (15 pregnant and 20 nonpregnant). Plasma volume was determined in the left lateral position using the Evans blue dye dilution technique (described by Dacie and Lewis) in the nonpregnant, at 16 and 36 weeks of gestation, and at 8 weeks postpartum.     

Does the addition of cement improve the rate of local recurrence after curettage of giant cell tumours in bone?

We retrospectively compared the outcome after the treatment of giant cell tumours of bone either with curettage alone or with adjuvant cementation. Between 1975 and 2008, 330?patients with a giant cell tumour were treated primarily by intralesional curettage, with 84 (25%) receiving adjuvant bone cement in the cavity. The local recurrence rate for curettage alone was 29.7% (73 of 246) compared with 14.3% (12 of 84) for curettage and cementation (p = 0.001). On multivariate analysis both the stage of disease and use of cement were independent significant factors associated with local recurrence. The use of cement was associated with a higher risk of the subsequent need for joint replacement. In patients without local recurrence, 18.1% (13 of 72) of those with cement needed a subsequent joint replacement compared to 2.3% (4 of 173) of those without cement (p?=?0.001). In patients who developed local recurrence, 75.0% (9 of 12) of those with previous cementation required a joint replacement, compared with 45.2% (33 of 73) of those without cement (p = 0.044).     

Hoffa’s fat pad tumours: What do we know about them?

Purpose

We report on a group of patients with tumours in the Hoffa’s fat pad (HFP), their clinical presentation, histological type and treatment, including two synovial sarcomas with their clinical follow-up, which have not been described previously in the literature.

Methods

We performed a retrospective review of our prospectively collected database of 25 cases of HFP tumours with at least six months follow-up.

Results

The gender, age at presentation (over and under 16 years of age), clinical features, history of trauma, treatment chosen, and complications were recorded. The mean age of the patients was 32 years (three to 47). Six patients were under 16 years old. Pain was the most common symptom, present in 92 % (n = 23/25). The final diagnoses included 23 (92 %) benign tumours and two (8 %) malignant tumours. The most common benign tumour was pigmented villonodular synovitis (PVNS) (48 % n = 12). The two malignant tumours were synovial sarcomas and both presented in patients under 16 years old.

Conclusions

Hoffa’s fat pad tumours are an uncommon and rarely diagnosed group of lesions that can be misinterpreted as any knee pathology. Although the majority of HFP tumours are benign, malignant tumours should be considered in the differential diagnosis for the paediatric population.     

维吾尔医药学专著《阿日普验方》

《阿日普验方》为《木接热巴提阿日普》（Mujarribati Arip）的意译名，是由维吾尔医学家毛拉阿日普忽炭尼（Molla Arip Hotani），约于1620年以波斯文撰写的一部维吾尔医药学专著，现有2部察合台维吾尔文抄本，分别藏于新疆维吾尔医学专科学校和一位维吾尔医师家中。该书介绍维吾尔医学四大物质论、气质论、体液论、诊断知识、治疗法（食疗、药疗）及一些常用草药、成药，是一部具有经典著作地位和重要影响的维吾尔医药学专著，应当整理、出版，以广传播。     

Effect of psychological management techniques on specific item score change during the management of dental fear in children

The aim of the study is to determine how specific fear inducing items contribute to the overall dental fear level in Nigerian children. In addition, it looks at the specific changes that psychological management produces on each item and how variables like age, gender and type of treatment received contribute to these specific changes observed. The dental fear level of 75 children, who were attending the dental clinic for the first time were assessed pre and post-treatment using the short form of the dental subscale of the child fear survey schedule. During treatment, the children were managed using various forms of psychological management strategies. The effect of age and the gender of the children on the dental fear level were analyzed. The effect of the type of treatment received, categorized into either invasive or non-invasive, on the dental fear level was also determined. Results showed that with the use of psychological management strategies, dental fear level of the children decreased significantly post treatment (13.45 vs 12.59; p = 0.009). However, no statistically significant dijfference was noted in the dental fear scores based on age, gender and type of treatment received. On the other hand, the aggregate scores for each of the possible fear inducing items highlighted in the psychometric scale varied and so did the effectiveness of psychological techniques in significantly reducing dental fear scores for each of the items. Age, gender and type of treatment did have significant effect on the fear level changes that occur with specific items. It was concluded that although a significant change occurred in the dental fear level score of the child post management with psychological techniques, this does not necessarily translate to significant changes in the scores for each fear inducing item assessed by the psychometric scale. Age, gender and the type of treatment the child received also influence the change that could occur for each item. The dental fear level of the children decreased significantly post treatment (13.45 vs 12.59; p = 0.009).     

The flight of physicians from West Africa: views of African physicians and implications for policy

West African-trained physicians have been migrating from the sub-continent to rich countries, primarily the US and the UK, since medical education began in Nigeria and Ghana in the 1960s. In 2003, we visited six medical schools in West Africa to investigate the magnitude, causes and consequences of the migration. We conducted interviews and focus groups with faculty, administrators (deans and provosts), students and post-graduate residents in six medical schools in Ghana and Nigeria. In addition to the migration push and pull factors documented in previous literature, we learned that there is now a well-developed culture of medical migration. This culture is firmly rooted, and does not simply fail to discourage medical migration but actually encourages it. Medical school faculty are role models for the benefits of migration (and subsequent return), and they are proud of their students who successfully emigrate.     

A custom-made prosthesis attached to an existing femoral component for the treatment of peri- and sub-prosthetic fracture

Peri- and sub-prosthetic fractures, or pathological fractures below an existing well-fixed femoral component, with or without an ipsilateral knee replacement, present a difficult surgical challenge. We describe a simple solution, in which a custom-made prosthesis with a cylindrical design is cemented proximally to the stem of an existing, well-fixed femoral component. This effectively treats the fracture without sacrificing the good hip. We describe five patients with a mean age of 73 years (60 to 81) and a mean follow-up of 47 months (6 to 108). The mean overlap of the prosthesis over the femoral component was 7.5 cm (5.5 to 10). There have been no mechanical failures, no new infections and no re-operations. We suggest that in highly selected cases, in which conventional fixation is not feasible, this technique offers a durable option and avoids the morbidity of a total femoral replacement.