Annals of African Medicine
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   2014| April-June  | Volume 13 | Issue 2  
    Online since April 2, 2014

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A retrospective analysis of acute organophosphorus poisoning cases admitted to the tertiary care teaching hospital in South India
M Rajesh Kumar, GP Vignan Kumar, P Ramesh Babu, S Satish Kumar, BV Subrahmanyam, M Veeraprasad, P Rammohan, M Srinivas, Amit Agrawal
April-June 2014, 13(2):71-75
DOI:10.4103/1596-3519.129876  PMID:24705111
Objectives: We have herein reported our experience with the pattern of presentation of cases of acute organophosphorus (OP) poisoning cases in a tertiary care hospital. Materials and Methods: This retrospective study evaluated the hospital records of patients with acute OP poisoning. In a pre-structured proforma, data regarding age, sex, time elapsed after intake, circumstances of poisoning, duration of hospitalization, severity, complications, and outcome of the patients were recorded. The data were presented as mean ± standard deviation, entered in the open office datasheet, and analyzed with PSPP software. Results: A total 101 patients were included in the study. Young adult males were more commonly involved than females (M:F 2.5:1). The mean age of the patients was 28 years (range 2-72 years, SD ± 14.3 years). Mean time to receive treatment was 5.2 ± 7.4 (range 1-48 h). About 45.5% patients received first aid before coming to the hospital. The reason was suicide in 88.1% cases and accident in 12 (11.9%, all children). Seventy-nine patients received pralidoxime (PAM) and the mean duration was 1.7 ± 1.1 (range 1-4 days). Atropine was given in all patients. Mean duration was 5.1 ± 3.1 (range 1–19 days). Mean hospital stay was 7.5 ± 4.7 days (range 1–26 days). Mortality was 9.9% in the present series. Conclusion: Although the present study contribute substantial information regarding the epidemiology and outcome of acute OP poisoning in a tertiary care teaching hospital at a district level, its relatively small sample size and the retrospective record-based nature are the major limitations of the present study. There is a further need for prospective studies to understand the underlying socio-economic factors responsible for acute OP poisoning in our population, and, accordingly, address the problems to reduce the incidence of acute OP poisoning cases.
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A retrospective review of snake bite victims admitted in a tertiary level teaching institute
M Rajesh Kumar, M Veeraprasad , P Ramesh Babu, S Satish Kumar, BV Subrahmanyam, P Rammohan, M Srinivas, Amit Agrawal
April-June 2014, 13(2):76-80
DOI:10.4103/1596-3519.129879  PMID:24705112
Objective: Snake bite remains major public health problem worldwide. We present our experience with cases of snake bites managed in our tertiary care teaching center of South India. Materials and Methods: The details of all patients with snake bite admitted to a tertiary teaching care hospital from 2010 to 2012 were retrospectively retrieved and reviewed. The details regarding age, gender, first aid received or not, time elapsed between the bite, emergency care management and ASV (Anti Snake Venom) administration, site of snake bite, clinical features at the time of presentation, local examination findings at the site of bite, duration of hospital stay, need for elective ventilation, details of investigations and outcome were reviewed. The data were analyzed in PSPP software (Free Software Foundation, Inc.) for window for statistical analysis, while standard deviation (SD) was applied for the continuous variables, and proportions were applied for the categorical variables. Results: Mean age was 38.4 ± 14.8 years (range 4-70 years). Majority [72 (82.8%)] were farmers. In 86.2% patients, the site of bite was in lower limbs. Snake could be identified in only 20 cases [Cobra-12 (60%), Krait-2 (10%), and Viper-6 (30%)]. Mean time to reach to hospital was 12.1 ± 21.4 hours (range 1-120 hours). Mean anti-venom therapy duration was 3.2 ± 2.0 days (range 1-14 days). Mean hospital stay was 4.7 ± 3.1 days (range 1-15 days). Majority (72.4%) made good recovery; mortality was in 4.6% cases, and 20 (23%) patients left against medical advice. Conclusions: This study identified major epidemiological and management variables related to snake bite. There is a need for a well-planned data collection and information dissemination system to avoid this potentially preventable disease.
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Cervical spondylosis in South West Nigerian farmers and female traders
SA Oguntona
April-June 2014, 13(2):61-64
DOI:10.4103/1596-3519.129857  PMID:24705109
Background: Neck pain is a common pain syndrome in the clinical practice. It may or may not be associated with the radiculopathy or myelopathy. Load carrying on the head is believed to be associated with an increased incidence of cervical spondylosis. Radiographic spondylosis is noticeable in 25-50% of people of 50 years of age and in 75-90% by the age of 65 years. Materials and Methods: Plain cervical radiograph were obtained in all farmers and female traders above 45 years of age who complained of neck pain. Those who met the radiological diagnostic criteria were enlisted in the study. The study was carried out over a 3 year period (July 2009-June 2012) in a private rheumatology clinic. Results: Thirty six cases of cervical spondylosis were seen, representing 10.7% of a total rheumatology cases seen over the study period. There were 23 males (63.9%) and 13 females (36.1%), giving a male : f0 emale ratio of 1.8:1. There were 18 male farmers, 5 female farmers, and 5 female traders. Eight males and 6 females showed severe degenerative changes in the cervical spine. Mostly affected were C4-C7 cervical spine levels. Conclusion: Load carrying, as earlier documented in literature may be a significant contributory factor to the degenerative process of the cervical spine.
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A rare presentation of cervical fibroid in pregnancy
Animesh C Gandhi, Hemant I Dugad, Yatin Shah
April-June 2014, 13(2):88-90
DOI:10.4103/1596-3519.129889  PMID:24705114
Pregnancy in a fibroid uterus is not rare. However cervical fibroid is rare in pregnancy and has unique management challenges. We report a case of cervical fibroid in a Gravida2 Para1 patient that was found incidentally in a routine ultrasound in the second trimester. The fibroid grew in pregnancy till term, caused obstructed labour, a Cesarean section was required for the baby. Post surgery the fibroid prolapsed out of the introitus. Conservative management was decided to prevent surgical complications, delayed consequences of surgery and to preserve future child bearing. The case shows that conservative management over surgery is sometimes the appropriate choice.
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Assessment of the sexual functions of males with chronic liver disease in South West Nigeria
Olusegun Adekanle, Dennis A Ndububa, Ernest O Orji, Oluwasegun Ijarotimi
April-June 2014, 13(2):81-86
DOI:10.4103/1596-3519.129884  PMID:24705113
Background: Patients with chronic liver disease (CLD) have been reported to have sexual dysfunction irrespective of etiology. There is little or no report from Nigeria on this disorder. This study looked at sexual dysfunction among male patients with CLD. Materials and Methods: Patients with chronic viral hepatitis B, liver cirrhosis (LC) and hepatocellular carcinoma (HCC) were interviewed using the international index of erectile function questionnaire. Their responses were compared with an age and sex matched healthy controls. Bio-data and body mass index were obtained for both groups and liver disease severity was graded for patients using the Child-Pugh score. Analysis was done using SPSS (SPSS Inc., Chicago, IL, USA, 2004) for frequencies and means while comparison of means was done using Student's t-test. Significance level was put at P < 0.05. Results: There were 120 subjects consisting of 60 patients aged from 28 to 71 years; mean (SD) 45. 3 ± 9.4 and 60 controls aged from 29 to 79 years with mean (SD) 45.5 ± 10.1 years. Sexual dysfunctions were seen in patients with HCC and LC in the domains of sexual desire and sexual satisfaction respectively when compared with controls. When patients were divided into the various liver disease severities, patients in Child-Pugh Grade B scored low in the domain of arousal, whereas the domains of erectile functions, orgasm, resolution and satisfaction were affected in patients in Grade C when compared with controls. Conclusions: Male patients with CLD have significant sexual dysfunctions when compared with controls. The dysfunctions are more pronounced in those with Grade C liver disease. Sexual concerns of CLD should be inquired of in those with advanced liver disease.
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Pattern of arthralgia in an urban community in Southwestern Nigeria
Mathew Sunday Jenyo, James Olusegun Bamidele, Wasiu Olalekan Adebimpe
April-June 2014, 13(2):65-70
DOI:10.4103/1596-3519.129863  PMID:24705110
Background: Arthritis is a common presentation among Nigerians, most especially in the elderly population. Easy access to over-the-counter drugs, paucity of data, and non-orthodox medical practice have underscored the need to examine the magnitude of the problem toward morbidity reduction risk factors. The objective of the study was to determine the pattern of arthralgia in Osogbo community in Southwestern Nigeria. Materials and Methods: This was a descriptive cross-sectional study conducted between September 2010 and August 2011. Respondents were serially recruited as they presented to the randomly selected healthcare facilities. Interviewer administered questionnaires, and modified checklist were used for collecting clients information, physical examination, X-ray, and laboratory results. Data were analyzed using the SPSS software. Results: A total of 90 cases were screened, with a male to female ratio of 1:1.5 and age range of 50-59 years. Females were more affected among the studied respondents, and this was statistically significant (p < 0.05). About half (48.9%) used non-steroidal anti-inflammatory drugs (NSAID) for the pain, while about 17.8% used traditional herbs. Osteoarthritis of the knee was the most common radiological finding, constituting about 86.7% of the 30 respondents that had X-ray done. Only one case tested positive to rheumatoid factor in high-dilution titer. Notable complication of arthralgia in this study was loss of time off work in 46.6% of the respondents. Conclusion: Arthralgia of the knee joint was most common in the studied area, followed by that of hip and the ankle. Weight reduction strategies and prompt diagnosis and treatment were advocated. Since about half of the respondents used NSAID, the use of enteric-coated NSAID tablets would go a long way to minimize the unwanted side effects of NSAID, notably peptic ulceration and erosion.
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Metastatic papillary carcinoma of the thyroid in a patient previously treated for Graves' disease
Garba H Yunusa, Tessa Kotze, Anita Brink
April-June 2014, 13(2):91-94
DOI:10.4103/1596-3519.129891  PMID:24705115
Incidental papillary carcinoma of the thyroid in patients treated surgically for benign thyroid diseases including Graves' disease is a known phenomenon. However, the management of these patients remains an issue of concern and controversy for those who care for them. We report a case of metastatic paillary carcinoma of the thyroid in a patient previously treated for Graves' disease. The subject of this presentation is a 50-year-old lady who was diagnosed with Graves' disease at the age of 29, for which she had a subtotal thyroidectomy following failure of medical and radioactive iodine treatment. Three years later, the patient was referred to our nuclear medicine department with a clinical diagnosis of suspected metastatic lymph nodes presumably from a thyroid malignancy.She had an 123I diagnostic whole body scan that showed 123I avid areas in the thyroid bed as well as left cervical lymph nodes, which later turned out to be metastatic papillary carcinoma of the thyroid on histology. She was treated with therapeutic doses of 131I. Follow-up radioactive iodine scans and serum thyroglobulin assays showed no evidence of malignant thyroid tissue. The occurrence of papillary carcinoma of the thyroid after a subtotal thyroidectomy for Graves' disease is hereby reported. The need for vigilance and regular follow-up in patients who receive all forms of treatment for benign thyroid diseases is emphasized.
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Abdominal lump with intestinal obstruction: Prior history of abdominal surgery is a clue to diagnosis
Debajyoti Mohanty, Pankaj Kumar Garg, Anjay Kumar, Bhupendra Kumar Jain
April-June 2014, 13(2):95-96
DOI:10.4103/1596-3519.129893  PMID:24705116
  1 3,320 25
Sexual function of males with chronic liver disease
Kasonde Bowa
April-June 2014, 13(2):86-87
  - 2,961 12
Do not forget to see the linear hyperdense sign on CT
Binit Sureka, Aliza Mittal, Mahesh Kumar Mittal, Brij Bhushan Thukral
April-June 2014, 13(2):96-97
DOI:10.4103/1596-3519.129895  PMID:24705117
  - 4,477 17