Smokers and Non Smokers: A Comparison of Oral Health Practices and Effect of Non Surgical Periodontal Therapy on their Periodontium.

AIMS AND OBJECTIVES: To assess the oral hygiene measures and self report oral symptoms of smokers and non smokers, as well as evaluate and compare the effect of non-surgical periodontal therapy on their periodontium. MATERIALS AND METHODS: This was a quasi experimental study conducted on smokers and non smokers. Adult patient smokers were recruited into the study group and matched with age and sex controls (non-smokers). Data was collected on oral hygiene measures and self reported oral symptoms. The patients were examined and evaluated using oral indices. Each patient had scaling and root planing done and was re-examined after six weeks. Data was analysed using SPSS. RESULTS: Seventy-two patients completed the study with age ranging from 20 to 65 years and a mean age of 43.7 (± 17.8) years. Twenty-one percent (21%) of smokers and 42% of the non smokers reported experiencing gum bleeding, p = 0.041. Sixty percent of the smokers reported stains on their teeth compared to 29.7% of non smokers, p = 0.028. The baseline gingival and calculus indices were lower in smokers compared to non smokers while the plaque index was higher among the smokers. The response to scaling and root planing was worse among smokers comparing their gingival and calculus indices but better in terms of the plaque indices, however, these were not statistically significant. CONCLUSION: There were no significant differences between the response of smokers and non smokers to non surgical periodontal therapy although smokers experienced gingival bleeding less often and have lower gingival index.

Comparing Oxygen Saturation of Normal Children with that of Children with Adenotonsillar Hypertrophy.

To compare the nocturnal oxygen saturation profiles of children with adenotonsillar enlargement with that of normal children. A 1 year comparative study. The study was carried out at the Otorhinolaryngology Ward of the University College Hospital Ibadan. These comprise of 60 children (1-9 years) with clinically confirmed adenotonsillar enlargement admitted for adenotonsillectomy and 60 normal children matched for age and sex. The biodata and common clinical presentations of the study group were acquired with a structured proforma. The severity of nasopharyngeal obstruction was determined by the adenoidal-nasopharyngeal ratio while the degree of tonsillar enlargement was graded by the Brodsky's classification. The nocturnal oxygen saturation of all the participants were recorded with a wrist worn pulse oximeter. Recording was for at least for 4 h. Oxygen saturation <92 % was regarded as desaturation. The oximetric values of the study and control group were compared. The mean nocturnal SPO2 (peripheral saturation of oxygen) profiles of children with adenotonsillar enlargement were as follows: basal = 96.86 %, minimum = 84.99 %; maximum = 99 % and average SPO2 <92 % = 87.74 % while the saturation profiles of the control group were as follows; basal = 97.88 %, minimum = 89.71 %; maximum = 99 %, average SPO2 <92 % = 90.82 %. Normal children have better nocturnal saturation profiles than children with adenotonsillar enlargement.

Evaluation of the perioperative analgesic effects of caudal block for herniotomy in children at the University College Hospital Ibadan, Nigeria.

INTRODUCTION: Caudal block is a commonly performed day case anaesthetic procedure in children for most infraumbilical surgeries worldwide [1] as it provides good analgesia in the perioperative period. In Nigeria there is paucity of data on caudal block hence the justification for this study. METHODS: This study compared the perioperative analgesic effects and safety profile of caudal block using 0.5 ml/kg body weight of 0.25% plain bupivacaine with light general anaesthesia (GA) versus inhalational GA alone in 60 children aged 2-10 years that had herniotomy using behavioural pain scale to access pain [2]. RESULTS: Showed a mean duration of surgery +/-standard deviation (SD) of 17 +/- 2 minutes for caudal, 51 +/- 6 minutes for GA (t = 60, p < 0.05, df = 59). Mean recovery times postoperatively was 6 +/- 2 minutes for caudal, 14 +/- 3 minutes for the GA (t =14, P < 0.05, df = 59). Mean postoperative pain scores was 2 +/- 0.6 for caudal, 5 +/-1 for the GA (t = 4, p < 0.05, df = 9). Time to first analgesic requirement was 170 +/- 19 minutes, 39 +/- 4 minutes for caudal and GA groups respectively (t = 37, p < 0.05, df = 59). Postoperatively 60% and 0% of patients in GA and caudal groups required opioid analgesic respectively. CONCLUSION: Children who had herniotomy under caudal block with 0.5 ml/kg of 0.25% plain bupivacaine had good analgesia with minimal complications. Caudal block in children is easy to perform and it's suitable for most day case infraumbilical surgeries.

Analgesic effect of intrathecal neostigmine combined with bupivacaine and fentanyl.

BACKGROUND: The spinal route of analgesia has consolidated its place as a major modality in the management of both acute and chronic pain. The search for ideal additives to local anaesthetic agents to prolong the analgesic effects poses a challenge to the anaesthetists. Neostigmine, an anticholinesterase, presents a novel approach to providing analgesia. Neostigmine, when given intrathecally, inhibits breakdown of an endogenous spinal neurotransmitter, acetylcholine, thereby inducing analgesia. We aimed to determine the analgesic and adverse effects of intrathecal neostigmine combined with hyperbaric bupivacaine and fentanyl. METHOD: Sixty male adults, ASA I-II requiring lower abdominal surgical procedures under spinal anaesthesia were randomly allocated to 2 groups: Neostigmine group, received intrathecal (IT) 0.5% hyperbaric bupivacaine 15 mg, fentanyl 25 microg and preservative-free neostigmine 25 microg while saline group, received same dose of bupivacaine and fentanyl plus 0.5 ml saline. The duration of analgesia, time to use first rescue analgesics and the incidence of adverse effects were recorded. RESULTS: The mean duration of effective analgesia was 485.6 +/- 37.6 minutes in neostigmine group compared with saline group, 316.0 +/- 49.15 minutes, p < 0.001. Total analgesic consumption 12 hours post-intrathecal injection was also less in the neostigmine group. The incidence of adverse effects such as hypotension, bradycardia, nausea and vomiting were not statistically significant in both groups, p > 0.05. CONCLUSION: This study showed that spinal neostigmine 25 microg added to hyperbaric bupivacaine and fentanyl provided a significantly longer surgical analgesia and insignificant adverse effects in male adults who had lower abdominal surgery under spinal anaesthesia.

Preventable trauma deaths in Ibadan: a comparison of revised trauma score and panel review.

BACKGROUND: The proportion of preventable trauma-related deaths may be a reflection of the quality of trauma care in a health institution. OBJECTIVE: To classify mortality in trauma patients in the emergency room and to determine the proportion of preventable trauma related mortality in a teaching hospital. METHODS: The records of patients who died in the emergency room following trauma from January 1996 to December 2005 were reviewed. Data extracted from the patients' records included the demographics, the mechanism of injury; and the duration of injury prior to presentation. The Probability of Survival (Ps) was calculated for each patient using the Revised Trauma Score (RTS). The RTS includes three physiologic parameters namely the Glasgow Coma Score [GCS], systolic blood pressure and respiratory rate which were recorded soon after the patient' presentation at the emergency department. RESULTS: There were 286 patients who died following trauma from January 1996 to December 2006. There was a male: female ratio of 3.4:1. Eighty-one percent were preventable deaths based on the revised trauma score while the panel review considered approximately 22% as preventable. Fifty-nine percent or 168 of the patients arrived in the hospital within six hours of sustaining injury. CONCLUSION: Despite access to emergency care within the first six hours (golden hours) the overall survival of our trauma patients is poor. The severity of the injuries, inadequate resuscitation, and missed injuries by medical personal are some of the factors associated with poor outcome of trauma care.

Day case adenotonsiletomy: experience of two private clinics in Nigeria.

BACKGROUND: adenoidectomy and tonsillectomy are among the common surgeries perform in children in otorhinoryngological practice. It was the aim of this study to evaluate the post operative mobility in patients undergoing day-case adenoidedtomy/tonsillectomy or adenotonsillectomy. METHODOLOGY: All pediatrics cases requiring adenoidectomy, tonsillectomy or both who presented at HANSA clinics Enugu (January 1990 to June 2004) and GENIKS specialist clinics Ibadan (January 2000 to June 2004) were counseled for day case surgery. The inclusion criteria were: Patients certified fit for surgery-ASA grade I or II for general anaesthesia and had no intercurrent CVS disease or bleeding diathesis among others. RESULTS: A total number of 144 patients requiring adenoidectomy Tonsillectomy or both were seen at the study centers with only sixty six (45.8%) meeting the inclusion criteria. Adenoidectomy constituted 47% of the surgeries with over 80 of the patient age less than 7 years reactionary haemorrhage was noted in 3 (4.5%) of the patient, the other complications were non-persistent vomiting 13 (19.7%), low grade fever 5 (7.6%) and pain at time of discharge 23 (34.8%). There were no fatalities. CONCLUSION: The complication rates were low. Day-case Adenoidectomy/tonsillectomy or adenotonsillectomy is safe and the presence or closeness of the family members contributed greatly to patients/post recovery as this as this had a soothing/calming effect on the patient/s.

Comparison of the therapeutic efficacy of phonophoresis and iontophoresis using dexamethasone sodium phosphate in the management of patients with knee osteoarthritis.

BACKGROUND AND OBJECTIVE: Many treatment options, including non-pharmacological and pharmacological measures, have been recommended in the management of osteoarthritis (OA). Among the non-pharmacological approach is physiotherapy, which involves the use of physical modalities like, heat therapy, exercise therapy, electrical stimulation, therapeutic ultrasound, iontophoresis, and phonophoresis. This study was therefore designed to compare the effectiveness of 0.4% Dexamethasone sodium phosphate (DEX-P) phonophoresis (PH) with 0.4% DEX-P iontophoresis (ION) therapy in the management of patients with knee joint OA. METHODS: Fifty patients (19 males and 31 females) with a mean age of 53.6 +/- 8.9 years were randomly assigned to PH or ION groups with 25 patients in each group. Ultrasound waves of 1 MHz frequency was applied for 5 minutes to the target knee, so also was the direct current for 10 minutes for 10 sessions treatment period. Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores, 20 meters ambulatory time, and knee range of motion (ROM) were evaluated before and after therapy as the outcome measures. RESULTS: At the end of two weeks, significant improvement in total WOMAC scores was observed in 15 (60%) and 16 (64%) patients in the PH and ION groups respectively, indicating no significant difference in the improvement rate. Twenty (20) metres ambulatory time and knee range of motion also improved significantly in both groups, yet these variables showed no significant difference between the two groups. CONCLUSION: Both therapeutic modalities were found to be effective and generally well tolerated after 10 treatment sessions. DEX-P phonophoresis was not superior to DEX-P iontophoresis in the treatment of patients with OA of the knee.

Benefit of modified plasmapheresis in the management of myasthenia gravis: a case report.

BACKGROUND: Myasthenia gravis is an autoimmune disease condition caused by the generation of antibodies against the acetylcholine receptor sites at the neuromuscular junction. The treatment modalities include anticholinesterase drugs, corticosteroids, immunotherapy, thymectomy and plasmapheresis. However, because of the poor financial state of our patients and the dearth of appropriate equipment in our centres modifications are made to standard treatment modalities including plasmapharesis. METHOD: We report a case of myasthenia gravis who was on various occasions on neostigmine, pyridostigmine and prednisolone. After about 18 months of treatment, he developed myasthenic crises on two occasions. He was admitted in the ICU for respiratory support where he also had modified plasmapheresis. RESULTS: The patient had remarkable improvement following the modified plasmapheresis with reversal of symptoms of the myasthenic crises. CONCLUSION: In the absence of facilities for standard plasmapheresis in this environment, the use of modified plasmapheresis is hereby recommended.

The influence of westernisation on pain perception in labour among parturients at the university college hospital Ibadan.

Pain perception as perceived by the parturient is determined by physical and psychological factors. The interplay of these factors is important to the healthcare professional who will be managing these women in labour. We therefore set out to assess the influence of educational attainment as a proxy for westernisation on pain perception by parturients. This was a cross-sectional study conducted among 765 parturients using a questionnaire with the Box Numerical Scale to assess pain score within 48 h of delivery. We studied women in labour at the University College Hospital Ibadan Nigeria from August 2003 to July 2004. A total of 1,000 consecutive parturients were enrolled into the study but 765 were included in the analysis after excluding women requiring caesarean section. Multiple linear regression with robust estimation of the Standard Error of the Mean (SEM) was utilised. The main outcome studied was the pain score obtained within 48 h of delivery using the Box Numerical Scale (BNS). The pain scores were highest among ethnic groups other than the predominant ethnic group (Yoruba) 9.13 (95% CI 8.13 - 9.33), it was lowest among those with no formal education. Multivariate analysis revealed educational attainment as a significant predictor of BNS. An interaction between age and educational attainment; only women between the ages of 25 - 30 had lower mean pain scores when educated compared with those without formal education -3.56 (95% CI -4.28, -2.87). In conclusion, findings in this study support the hypothesis that westernisation through education tends to increase perception of pain by parturients in this environment.

Malignant schwannoma of the nasal cavity and paranasal sinuses in a Nigerian.

An unusual case of malignant schwannoma with involvement of the forehead, external nose, right nasal cavity, paranasal sinus system (bilateral frontal sinus, right ethmoidal sinus), right orbit and anterior cranial fossa is reported in a Nigerian. Malignant schwannomas of the paranasal sinus are extremely rare, as only 20 well-documented cases have been previously published in English literature. No report in black Africans has been found in extant literature. The clinical features of this tumour are presented with detailed management. The patient had a wide surgical resection of the lesion with reconstruction of the resultant fronto-nasal defect using forehead musculofascial flap plus full thickness skin graft and adjuvant radiotherapy with satisfactory outcome. The good result of combined surgery and radiation regimens in this case demonstrates the usefulness of adjuvant radiation therapy in this condition.

Determinants of pain perception in labour among parturients at the University College Hospital, Ibadan.

This cross-sectional study of one thousand parturients aims to evaluate the factors, which are associated with pain perception in labour and to identify women who will benefit most from analgesia in labour. The instrument applied was a structured questionnaire incorporating the Box numerical scale (BNS) for pain assessment. Patients who delivered by elective or emergency caesarean section and women who did not give informed consent were excluded from the study. Spearman's and Pearson's correlational analyses were applied. Pain scores showed significant correlation with age (r=- 0.087, p<0.01), parity (r=- 0.226, p<0.01), gestational age at delivery (r=- 0.074, p<0.05), onset of labour (rho=0.195, p<0.01), mode of delivery (rho=0.160, p<0.01), booking status (rho=- 0.070, p<0.05) and educational status (rho=0.182, p<0.01). Certain groups of patients would benefit from obstetric analgesia. These patients include, nulliparous patients, young patients, patients who have had labour induced, those with preterm deliveries and those with an assisted vaginal delivery especially if they are well educated.

Ketamine anaesthesia for young children undergoing radiotherapy.

Young children with radiosensitive malignant tumours often require sedation or anaesthesia to provide immobility for radiotherapy sessions lasting several days. This paper describes the use of repeated intramuscular ketamine anaesthesia for radiotherapy in children age 1.5 to 5 years. Intramuscular ketamine 5-13mg/kg body weight was administered on 280 occasions to 15 children, the highest number of sessions per child being 30 and the least 9. The airway and cardiovascular parameters were well maintained. The time to complete recovery varied from 15 to 90 minutes (mean 52.5+/-31.7 S.D.). Involuntary movements of the tongue, mouth and limbs were observed in 8 patients (52.3%) during 63 sessions (22.5%) but only necessitated interruption of radiotherapy on 6 occasions (2.1%). Ketamine was found to be safe and effective for sedation of young children in the radiotherapy suite and minimal aneasthetic facilities were required.