Outpatient burden of adult respiratory diseases in University of Ilorin Teaching Hospital, Nigeria.

Background: Respiratory diseases constitute a significant cause of morbidity globally. There is limited information on the epidemiology of respiratory diseases in North Central Nigeria particularly with the changing trend in risk factors. Aim: This study aimed at evaluating the pattern and morbidity related to respiratory diseases among adult outpatients attending a chest clinic in a tertiary healthcare facility, especially with increasing environmental pollution and biomass exposure globally. Patients And Methods: This was a retrospective review of the case records of 338 newly referred patients seen in the chest clinic of the University of Ilorin Teaching Hospital (UITH) with respiratory illnesses over a 2-year period (January 2017-December 2018). Results: The mean age of the recruited patients was 47.6 ± 19.8 years with a male to female ratio of 1.1:1. Microbiologically confirmed tuberculosis (30.2%), chronic obstructive pulmonary disease (COPD) (24.3%), and bronchial asthma (17.8%) were the commonest conditions managed in the clinic. Overall, noncommunicable respiratory diseases (61.2%) constituted a larger proportion of cases when compared to infective respiratory conditions. Almost 90% of the patients were never smokers. Systemic hypertension (15.1%) and human immunodeficiency virus infection (3.6%) were the commonest comorbid illnesses. Conclusion: Although tuberculosis constituted the most observed single condition, noncommunicable respiratory diseases predominated cumulatively among the new cases seen in the chest clinic of UITH, Ilorin. This raises the need for significant attention in terms of prevention and management of noncommunicable respiratory diseases, which appear to be on the uprising.

Spinal Malignant Peripheral Nerve Sheath Tumours in Nigerians.

BACKGROUND: Spinal Malignant peripheral nerve sheath tumours (MPNSTs) are very rare aggressive tumours with poor prognosis. Little is known about these tumours in sub-saharan Africa. OBJECTIVES: This study aims to evaluate the clinical profile and outcome of management of these tumours in a resource limited country. METHODS: We retrospectively analysed data from the records of patients who had surgery for spinal MPNSTs at our center between January 2004 and December 2018. RESULTS: There were four patients in this study (M:F= 1:1). The ages ranged from 27-53 years with a mean of 43.25 ± 11.84 years. The tumour was located in the thoracic region in 2 of the patients (50%), the lumbar region in one (25%) and thoracolumbar in the 4th patient. Three patients (75%) presented with back pain while limb weakness, sensory deficit and sphincteric dysfunction were present in all patients at presentation. The duration of symptoms were 2 months in 2 patients (50%) and 3 months in the other 2. None of the patients had neurofibromatosis. Gross total tumour excision was achieved in 2 patients (50%) and subtotal resection in the other 2. The tumours were high grade in three patients (75%) and low grade in one. Two patients had adjuvant radiotherapy. Two of the patients were dead within 6 months of the diagnosis, another one within 18 months while one patient is still alive 3 years after. CONCLUSIONS: MPNSTs are very rare in our practice. Most of the tumours were high grade tumours and ran an aggressive course.

Assessment of Post-Treatment Health-Related Quality of Life among Patients with Pulmonary Tuberculosis in Ilorin, Nigeria.

BACKGROUND: A lot of attention has generally been given to the microbiology and treatment of pulmonary tuberculosis with relatively limited consideration on its impact on the physical, psychological and social domains of the individual especially after successful drug treatment. AIM AND OBJECTIVES: This study aimed at assessing the health-related quality of life (HRQoL) and related factors among individuals who had successfully completed treatment for pulmonary tuberculosis (PTB) in Ilorin. METHODS: This was a hospital based cross-sectional study at the pulmonary outpatient clinics of the University of Ilorin Teaching Hospital and Kwara State Specialist Hospital, Sobi, Ilorin. HRQoL assessment was conducted in 308 consenting patients who had been certified microbiologically cured for bacteriologically confirmed PTB in the preceding three years using the validated St. George's Respiratory Questionnaire (SGRQ). All subjects also had plain chest radiograph done for assessment of the presence and extent of lung parenchymal damage. RESULTS: The overall total median percentage HRQoL score was 18.5 (7.9-28.2) with the highest score in the activity component [33.7 (18.3-41.8)] and least scores in the impact component [10.0 (0.0-21.9)]. The independent predictors of impaired HRQoL were age > 40 years (p= 0.007), absence of formal education (p=0.004), mMRC score >1 (p= 0.002), PTB retreatment (p=<0.001) and radiographic scores >3 (p= <0.001). CONCLUSION: There is impaired HRQoL following treatment for PTB in Ilorin. Hence, there is a need to incorporate HRQOL assessment as an adjunct outcome measure after PTB treatment especially in those with the above identified risk factors.

Clinicopathological Pattern and Management of Primary Lung Cancer in Ilorin, Nigeria.

BACKGROUND: Lung cancer incidence and mortality rates have increased in some low and medium-resourced countries. OBJECTIVES: This study aimed to describe the clinicopathological pattern and management of lung cancer seen in our setting. METHODS: We reviewed cases of pulmonary neoplasm diagnosed and managed at the University of Ilorin teaching hospital over eight years. Cases with tissue diagnosis were enrolled in the study and relevant clinical data were collected from the medical record using a proforma. DESIGN: Hospital-based retrospective study. RESULTS: Out of the 71 cases of primary lung cancer reviewed, 44(62%) were males and the male to female ratio was 2:1. The mean age was 62±14 years and the occurrence was highest in aged 50-69 years. Thirty (42.3%) with histories of tobacco smoking were males. Adenocarcinoma accounted for 34(54.9%), 23(32.4%) were squamous cell carcinoma, 2(2.8%) were large cell carcinoma and 6(8.5%) were other histological variants. The majority (82.7%) presented at stage III-IV lung cancers, 56.3% had malignant pleural effusion and 74.6% received palliative care. Thirty-eight (53.3%) had chest tube drainage, 19(26.7%) underwent chemical pleurodesis and 22(31.0%) received Cisplatin-based systemic chemotherapy. One patient had curative surgery and none received radiotherapy. At 12 months, 4 (5.6%) were still alive, 14(19.7%) cases had medical records of their death and 53(74.7%) were lost to follow up. CONCLUSION: This study has highlighted the clinicopathological trend, high rate of mortality and late presentation of lung cancer in our setting. There is a need to increase the awareness of the warning signs and risk factors to ensure early detection and facilitate curative therapy.

CONTEXTE: L'incidence du cancer du poumon et les taux de mortalité ont augmenté dans certains pays à faibles et moyennes ressources. OBJECTIFS: Cette étude visait à décrire le modèle clinicopathologique et la prise en charge du cancer du poumon observé dans notre milieu. MÉTHODES: Nous avons passé en revue les cas de néoplasme pulmonaire diagnostiqués et pris en charge à l'hôpital universitaire de l'Université d'Ilorin pendant huit ans. Les cas avec diagnostic tissulaire ont été inclus dans l'étude et les données cliniques pertinentes ont été collectées à partir du dossier médical à l'aide d'un formulaire. CONCEPTION: étude rétrospective en milieu hospitalier. RÉSULTATS: Sur les 71 cas de cancer du poumon primitif examinés, 44 (62%) étaient des hommes et le ratio homme / femme était de 2:1. L'âge moyen était de 62 ± 14 ans et la fréquence était la plus élevée chez les 50 à 69 ans. Trente (42,3%) ayant des antécédents de tabagisme étaient des hommes. L'adénocarcinome représentait 34 (54,9%), 23 (32,4%) étaient des carcinomes épidermoïdes, 2 (2,8%) étaient des carcinomes à grandes cellules et 6 (8,5%) étaient d'autres variantes histologiques. La majorité (82,7%) des cancers du poumon de stade III-IV, 56,3% ont eu un épanchement pleural malin et 74,6% ont reçu des soins palliatifs. Trente-huit (53,3%) ont eu un drainage par sonde thoracique, 19 (26,7%) ont subi une pleurodèse chimique et 22 (31,0%) ont reçu une chimiothérapie systémique à base de cisplatine. Un patient a subi une chirurgie curative et aucun n'a reçu de radiothérapie. À 12 mois, 4 (5,6%) étaient encore en vie, 14 (19,7%) cas avaient un médical de leur décès et 53 (74,7%) étaient perdus de vue. CONCLUSION: Cette étude a mis en évidence la tendance clinicopathologique, le taux élevé de mortalité, et la présentation tardive du cancer du poumon dans notre milieu. Il est nécessaire d'accroître la sensibilisation aux signes avant-coureurs et aux facteurs de risque pour assurer une détection précoce et faciliter la thérapie curative. MOTS CLÉS: Clinico-pathologique, modèle, prise en charge, cancer du poumon, néoplasme, Nigéria.

Neoadjuvant chemoradiation versus adjuvant chemotherapy for locally advanced adenocarcinoma of the rectosigmoid junction.

AIM: The optimal treatment approach for adenocarcinoma of the rectosigmoid junction remains unclear. The aim of this work was to compare outcomes of neoadjuvant chemoradiation (NCR) and adjuvant chemotherapy (AC) treatment for cancer of the rectosigmoid junction. METHOD: This was a nationwide, retrospective cohort study (2004-2015) using hospital-based cancer outcomes data (National Cancer Database). All patients who underwent resection with curative intent for locally advanced [American Joint Committee on Cancer (AJCC) Stages II and III] adenocarcinoma of the rectosigmoid junction were included. Exclusion criteria were age less than 18 or over 75 years, Charlson-Deyo score > 2, AJCC Stages I and IV and unstaged tumours. Treatment with NCR was compared with treatment with AC, the primary outcome being overall survival. Other end-points were resection margin status, the presence of lymphovascular invasion and postoperative length of stay. RESULTS: A total of 2828 patients were included in this study, of whom 1701 (59.7%) received NCR. NCR was more frequently utilized in patients who were black (10.3% vs 7.6%, P < 0.05) and underwent treatment at academic institutions (37.9% vs 22.5%, P < 0.05). Treatment with NCR did not differentially influence survival following risk adjustment (hazard ratio 1.17, CI 0.98-1.40; P = 0.085). NCR was independently associated with a decreased likelihood of a positive resection margin (OR 0.44, CI 0.33-0.58; P < 0.001) and lymphovascular invasion (OR 0.51, CI 0.40-0.67; P < 0.001). However, treatment with NCR was associated with the need for prolonged hospitalization compared with AC (7.3 days vs 6.5 days; P = 0.015). The study was limited by its retrospective design, external validity and risk of tumour misclassification. CONCLUSION: NCR currently seems to be favoured over AC for the management of locally advanced adenocarcinoma of the rectosigmoid junction. This approach may not be justified as NCR is associated with prolonged hospitalization needs without a clear survival benefit when compared with AC. Prospective studies are warranted to definitively compare outcomes of NCR and AC in this patient population.

Air Quality Index and Respiratory Symptoms among Garri Processing Workers in Ogbomoso, Nigeria.

BACKGROUND: Epidemiological studies have linked morbidity and mortality of individuals to exposure to atmospheric gaseous and particulate matter especially fine particles (PM2.5) and coarse particles (PM10).The process of garri (cassava crisps) production (frying with firewood) is associated with production of gaseous and particulate matter which contribute to ambient particulate matter air pollution. The objective of this study was to determine the impact of air quality indices on the prevalence of respiratory symptoms among the garri processing workers in Ogbomoso. METHODOLOGY: A comparative cross-sectional study was carried out among 351 garri processing workers in Ogbomoso as subjects and 351 residents of Ogbomoso metropolis as controls that were age, sex and height-matched. A semi-structured questionnaire was used to obtain sociodemographic profiles and respiratory symptoms of participants and document physical examination findings. Particulate matter counter was used for air quality sampling. RESULTS: The mean age of subjects was 41.7 ± 14.9 years and that of controls was 41.6 ± 14.7 years (p =0.960). The two groups were also matched for socioeconomic status, sex and height. Prevalence of respiratory symptoms was higher at 48.4% among the garri workers than the control group which was 29.1% (p<0.001). Cough was the predominant symptom with a prevalence of 29.3% and 10.5% among the subjects and controls respectively. The mean count of PM1.0 in garri processing locations was significantly higher than that recorded in Ogbomoso metropolis; 73.77±42.08 vs 15.04±6.66mg/m3 (p<0.0001). CONCLUSION: Garri processing work is associated with significant increase in ambient air pollution and increased prevalence of respiratory symptoms among the workforce compared to the control population. Effective preventive strategies including education and provision of safety masks may reduce the occupational hazards associated with garri processing factory workers in Nigeria.

Outcomes of octogenarians with esophageal cancer: an analysis of the National Cancer Database.

The optimal treatment of esophageal cancer in octogenarians is controversial. While the safety of esophagectomy has been demonstrated in elderly patients, surgery and multimodality therapy are still offered to a select group. Additionally, the long-term outcomes in octogenarians have not been thoroughly compared to those in younger patients. We sought to compare the outcomes of esophageal cancer treatment between octogenarians and non-octogenarians in the National Cancer Database (2004-2014). The major endpoints were early postoperative mortality and long-term survival. A total of 107,921 patients were identified [octogenarian-16,388 (15.2%)]. Compared to non-octogenarians, octogenarians were more likely to be female, of higher socioeconomic status, and had more Charlson comorbidities (p < 0.001 for all). Octogenarians were significantly less likely to undergo esophagectomy (11.5% vs. 33.3%; p < 0.001) and multimodality therapy (2.0% vs. 18.5%; p < 0.001), a trend that persisted following stratification by tumor stage and Charlson comorbidities. Both 30-day and 90-day mortality were higher in the octogenarian group, even after multivariable adjustment (p ≤ 0.001 for both). Octogenarians who underwent multimodality therapy had worse long-term survival when compared to younger patients, except for those with stage III tumors and no comorbidities (HR: 1.29; p = 0.153). Within the octogenarian group, postoperative mortality was lower in academic centers, and the long-term survival was similar between multimodality treatment and surgery alone (HR: 0.96; p = 0.62). In conclusion, octogenarians are less likely to be offered treatment irrespective of tumor stage or comorbidities. Although octogenarians have higher early mortality and poorer overall survival compared to younger patients, outcomes may be improved when treatment is performed at academic centers. Multimodality treatment did not seem to confer a survival advantage compared to surgery alone in octogenarians, and more prospective studies are necessary to better elucidate the optimal treatment in this patient population.

Acute Oxygen Therapy on Hospital Wards in Low Middle-Income Country: Experience from a Referral Centre in Ilorin, Nigeria.

BACKGROUND: Oxygen is like any other medication that can cause severe consequences if administered inappropriately. OBJECTIVE: To audit the pattern of acute oxygen therapy on regular hospital wards of a referral centre in Ilorin, Nigeria. METHODS: We reviewed 150 patients that received or had a prescription for acute oxygen therapy in three months and extracted relevant information using a proforma. RESULTS: About one-third of the patients (30%) were >65 years of age and the male to female ratio was 1:1. The commonest indication and medical condition for acute oxygen administration were hypoxemia (70.7%) and pneumonia (26.0%), respectively. Pneumonia accounted for most (41.2 %) of the oxygen therapy in childhood. The majority of patients (88.0%) had written order for oxygen prescription, 40.7% had a prescription to target oxygen saturation and only 31.3% achieved their target saturation. Oxygen prescription was adequate (documentation of delivery device, flow rate of oxygen, and target oxygen saturations) in 40.7% of patients. The assessment, monitoring and titration of oxygen therapy were adequate in 92.7%, 65.3% and 28 % of patients respectively. Overall mortality was 27.3% in patients receiving acute oxygen supplementation. Eleven patients had unstable COPD, and 63.6 %, 54.5 % and 45.6 % of them had adequate oxygen prescription, monitoring and titration respectively. The challenges to oxygen use were faulty delivery devices, emptied oxygen cylinders, inability to routinely do arterial blood gas analysis and lack of hospital oxygen protocol. CONCLUSION: The current practice of acute oxygen therapy is not satisfactory and interventions are advocated to improve the healthcare providers' administration of oxygen.

Profile of patients with chronic obstructive pulmonary disease in Ilorin who were never-smokers.

BACKGROUND: The most recognized risk factor for chronic obstructive pulmonary disease (COPD) worldwide is cigarette smoking. However, recent surveys have revealed an increasing trend from nonsmoking causes especially from biomass exposure. This study, therefore, aimed to determine the proportion of patients and the clinical pattern of COPD among never-smokers in Ilorin. SUBJECTS AND METHODS: This is a retrospective study in which case records of patients with clinical diagnosis of COPD from January 2013 to December 2017 were reviewed. Data were collected with respect to their sociodemographic characteristics, clinical details, comorbid illnesses, and severity of the disease. RESULTS: A total of 135 case records of patients with COPD were reviewed, of which 66 had spirometric confirmation of the disease. In all, 38 (57.6%) of them were never-smokers with a male-to-female ratio of 1:1.1. The mean age of the subjects was 64.5 ± 11.7 years. Cough and exertional dyspnea were the most common symptoms (89.5% each), and systemic hypertension was the most common comorbid illness. Firewood exposure constituted the most common nonsmoking risk factor (47.4%), and the majority of the patients had mild COPD. When compared with ever-smokers, the mean post bronchodilator lung function parameters were found to be significantly better in never-smokers. CONCLUSION: Over half of COPD cases in Ilorin were never-smokers with firewood exposure as the main risk factor. This study has further highlighted the need for increased awareness of the hazards of biomass fuel exposure in our setting.

Evaluation of immune response in challenged chickens vaccinated with Newcastle disease vaccine using gums from Cedrela odorata and Khaya senegalensis as delivery agents.

Immune response of challenged chickens following previous vaccinations with Newcastle disease vaccine using gums from Cedrela odorata and Khaya senegalensis as delivery agent were evaluated. Two hundred and fifty-two one-day old chickens were divided into vaccine-gum oral (GVOR), vaccine-gum ocular (GVOC), vaccine oral (VOR), vaccine ocular (VOC), gum oral (GOR), gum ocular (GOC), No-gum-no-vaccine/challenged (NGNV/C), and No-gum-no-vaccine/unchallenged (NGNV/U) groups. They were vaccinated at days 21 & 42 and challenged at day 84. Trachea and intestinal washings were collected at intervals as well as weekly serum samples. These were analyzed using enzyme-linked immunosorbent assay (ELISA) and haemagglutination inhibition (HI) test for mucosal and systemic IgG response (MA and SA). Statistical analysis was done using Omnibus one-way ANOVA. MA and SA were not different (P > 0.05) post first and second vaccination although gum-vaccine groups were marginally higher post second vaccination. Post Infection (PI), there was an early and sustained spike in both MA and SA for the GV groups especially GVOR (P < 0.05). MA and SA for the Gum alone (especially GOR) groups also spiked PI (P < 0.05). Therefore, phytogenic polymers used could be said to possess immunopotentiating property with a possible induction of immunologic memory mechanism.

Structural echocardiographic abnormalities seen in HIV/AIDS patients are independent of cd4 count.

INTRODUCTION: The human immunodeficiency virus (HIV) infection remains one of the most daunting public health challenges today. Cardiac involvement in HIV/acquired immune deficiency syndrome (AIDS) is frequent and has been recognized on autopsy since the emergence of the pandemic. The objective of the study was to assess the pattern of structural echocardiographic (echo) findings in HIV/AIDS patients and compare this to the echo findings in apparently healthy HIV-negative controls. MATERIALS AND METHODS: One hundred and fifty HIV-positive patients were recruited consecutively from the HIV patients attending the University of Ilorin Teaching Hospital, Ilorin, North Central, Nigeria. One hundred and fifty age- and sex-matched controls were also recruited from the surrounding community. All the individuals had clinical examination, electrocardiography (ECG) and echocardiography (echo) done. RESULTS: ECG abnormalities were seen in 55.3% of the HIV-positive patients compared with 2.7% of controls (P < 0.001). The overall prevalence of echo abnormalities among the patients was 54%, against 15.3% (P < 0.001) of the controls. All the structural dimensions of the cardiac chambers were significantly greater than the cardiac chamber dimensions in the controls except for left atrial dimension (LAD). When the patients were considered in two groups of those with CD4 count less than 200 cells/mm3 than those with CD4 count more than 200 cells/mm3, the structural chamber dimensions were similar between both groups. CONCLUSIONS: Echo is an important tool for detecting cardiac abnormalities in HIV/AIDS patients. There is a high prevalence of echo abnormalities among HIV patients seen in our centre. The HIV infection was associated with increased structural dimensions of cardiac chambers compared with HIV-negative controls. This however did not seem to be related to disease severity as the chamber dimensions were similar between those with CD4 count below and above 200 cells/mm3.

How does hybrid bridging core modification enhance the nonlinear optical properties in donor-π-acceptor configuration? A case study of dinitrophenol derivatives.

This study spotlights the fundamental insights about the structure and static first hyperpolarizability (ß) of a series of 2,4-dinitrophenol derivatives (1-5), which are designed by novel bridging core modifications. The central bridging core modifications show noteworthy effects to modulate the optical and nonlinear optical properties in these derivatives. The derivative systems show significantly large amplitudes of first hyperpolarizability as compared to parent system 1, which are 4, 46, 66, and 90% larger for systems 2, 3, 4, and 5, respectively, at Moller-Plesset (MP2)/6-31G* level of theory. The static first hyperpolarizability and frequency dependent coupled-perturbed Kohn-Sham first hyperpolarizability are calculated by means of MP2 and density functional theory methods and compared with respective experimental values wherever possible. Using two-level model with full-set of parameters dependence of transition energy (ΔΕ), transition dipole moment (µ(0)) as well as change in dipole moment from ground to excited state (Δµ), the origin of increase in ß amplitudes is traced from the change in dipole moment from ground to excited state. The causes of change in dipole moments are further discovered through sum of Mulliken atomic charges and intermolecular charge transfer spotted in frontier molecular orbitals analysis. Additionally, analysis of conformational isomers and UV-Visible spectra has been also performed for all designed derivatives. Thus, our present investigation provides novel and explanatory insights on the chemical nature and origin of intrinsic nonlinear optical (NLO) properties of 2,4-dinitrophenol derivatives.

Diagnostic accuracy of tru-cut biopsy of breast lumps at University College Hospital, Ibadan.

BACKGROUND: Tru-cut needle biopsies form an integral part of Triple assessment of breast cancer and include clinical assessment, mammography and core needle biopsy. No study has been done to evaluate the validity of the procedure in our environment. This study was done to evaluate the validity of core needle biopsies in our centre. METHOD: A retrospective study of patients with tru-cut needle biopsies of breast lumps and follow-up excisional biopsy or mastectomy done in the Department of Surgery, University College Hospital, Ibadan over a ten year period was done. Fifty one patients who fulfilled the inclusion criteria had their records obtained from the Department of Pathology. The diagnosis was classified into benign and malignant with the excisional biopsy or mastectomy diagnosis used as the gold standard. The sensitivity, specificity and accuracy were calculated and kappa was also done to evaluate the degree of agreement. RESULTS: A total of 51 cases were included in this study. The average age of the patients was 47 ± 13 years with a range from 19 to 81 years. Thirty of the biopsies (59%) had a definitive diagnosis of malignancy while twenty one (41%) were benign. The overall sensitivity, specificity and accuracy were 86%, 71% and 80.4% respectively. The specificity of malignant biopsies was 68% while benign was 35%. The level of agreement for malignant biopsies was higher than benign biopsies with a kappa of 0.39 for malignant diagnosis as against 0.29 for benign. CONCLUSION: Tru-cut needle biopsies have a comparable sensitivity and specificity to excisional biopsies. Diagnostic accuracy can be further enhanced with the adoption of image guided biopsies.

Comparison of Parental Satisfaction with Three Tooth-Colored Full-Coronal Restorations in Primary Maxillary Incisors.

OBJECTIVES: To evaluate and compare the parental satisfaction among resin composite strip crown, preveneered stainless steel crown (PVSSC) and the newly introduced pre-fabricated primary zirconia crown for restoring maxillary primary incisors. STUDY DESIGN: A prospective clinical study on 39 children with carious or traumatized primary maxillary incisors. They were randomly and equally distributed in three groups and received one of the full-coronal restorations. Children were recalled to evaluate and compare parental satisfaction about performance of crowns after one year through a questionnaire. RESULTS: Parents were satisfied with all three tooth colored full-coronal restoration techniques. A significant relationship was found between colour of PVSSC (p=0.003) and durability of resin strip crowns (p=0.009) with the overall parental satisfaction levels. Parents who gave poor ratings in these two variables however rated their overall acceptance levels as being satisfied. CONCLUSION: Parental overall satisfaction was highest for zirconia primary crowns followed by resin composite strip crowns and lowest satisfaction was reported for pre-veneered SSCs. Parents were least satisfied with durability of resin composite strip crowns and colour of pre-veneered stainless steel crowns. However, this did not affect their overall satisfaction with these crowns.

[Post-dental extraction tetanus. About an observation]. / Tétanos post-avulsion dentaire. A propos d'une observation.

UNLABELLED: The authors report a case of tetanus diagnosed in the aftermath of tooth extraction, in the absence of any other front door. OBSERVATION: A patient showed a persistent trismus several days after the extraction of tooth 38 performed at the dental office. The diffusion of tension and the appearance of paroxysms allowed the diagnosis of tetanus. DISCUSSION: The possibility of occurrence of tetanus after a tooth extraction should be kept in mind before a persistent trismus with rapid expansion in the neck and limbs. The dentist should be aware of the symptoms of tetanus to refer the patient to a specialized department.

RISK FACTORS AND SERO-PREVALENCE OF HEPATITIS B SURFACE ANTIGEN AMONG BLOOD DONORS IN UNIVERSITY OF ILORIN TEACHING HOSPITAL, ILORIN, NIGERIA.

BACKGROUND: Availability of safe blood and blood products for transfusion is increasingly difficult globally, especially in developing countries because of high prevalence of Transfusion Transmissible Infections. OBJECTIVES: To determine the prevalence of HBsAg among blood donors and to evaluate the socio-economic, demographic and medical factors associated with its infection. DESIGN: A prospective study. SUBJECTS: Three hundred and fifty consecutive blood donors were recruited. 2 ml of venous blood was collected aseptically from the ante-cubital vein and subjected to serological test for HBsAg. RESULTS: High prevalence rate 10.9% was recorded. All the donors reactive to HBsAg were males (38,100%) with a mean age of 30.7 ± 8.02 years, while 55.3%, 44.7%, 5.3%, 42%, 47.4%, 5.3% of them were single, married, primary school graduate, secondary school graduate, tertiary school graduate and illiterate respectively with 36.8%, 23.7%, 39.5% and 0% been unemployed, civil servants/professionals, skilled artisans and business/petty traders. The most common risk factor was multiple sexual partners 55.3%, followed by extra marital affairs 13.2%, tattooing 10.5%, previous blood transfusion 5.2%, previous surgery 2.6% and sex trading 2.6%. CONCLUSION: Active public enlightenment programmes and strict blood donation selection criteria need to be put in place in order to provide safe blood and blood products for transfusion.

A randomised controlled trial of three aesthetic full-coronal restorations in primary maxillary teeth.

AIM: This randomised clinical trial (RCT) compared the clinical outcomes of three aesthetic full-coronal restorations (composite strip crowns, pre-veneered stainless steel crowns (SSCs) and pre-fabricated primary zirconia crowns) in carious and traumatised primary maxillary incisors. MATERIALS AND METHODS: One hundred and twenty nine teeth in 39 children aged between 3 to 5 years were included. Children were randomly assigned to one of three treatment groups using a permuted block randomisation technique with a total of 43 teeth in each group. After trainee calibration, restorations were placed and evaluated after 6 months. Outcomes evaluated were restoration failure, tooth wear of opposing teeth and gingival health. RESULTS: The retention rate was highest for zirconia crowns (100%) followed by pre-veneered SSCs (95%). Strip crowns were the least retentive (78%). Zirconia crowns showed low grade abrasion in four opposing teeth. Teeth restored with resin composite and pre-veneered SSC showed an increase in mean gingival index score, while corresponding values decreased in zirconia crowns. CONCLUSION: Resin composite strip crown is a highly sensitive technique leading to lower retention rate. Pre-veneered stainless steel crowns showed increased incidence of facial veneer fracture. Zirconia crowns are highly retentive and biocompatible but cause low grade of abrasion of their opposing natural dentition at the 6-month follow-up.

Neuroprotective effect of Lannea egregia Alkaloid-rich leaf extracts in streptozotocin-induced diabetic rats.

Background: Studies suggest that medicinal plant extracts can help reduce the neuron degeneration associated with diabetes. In this study, the neuroprotective effect of the alkaloid-rich extract from the leaves of Lannea egregia was assessed in rats with diabetes induced by streptozotocin (STZ). Methods: Lannea egregia alkaloid-rich analysis was carried out via a known procedure. The rats were randomly assigned into five treatment groups (n = 8): normal control, diabetic-induced rats (45 mg/kg STZ), and diabetic rats treated with low doses of Lannea egregia leaf alkaloid-rich extract (50 mg/kg b.w, LEL) and high (100 mg/kg b.w, LEH) (300 mg/kg and 150 mg/kg), and metformin (200 mg/kg). On 22nd day of the experiment, animals were sacrificed, and their blood and brains were collected for neuro-biomarker analysis. Results: Diabetic-induced rats that received metformin, LEL and LEH exhibited considerably reduced levels of dopamine, serotonin, norepinephrine, NO, MDA, and AChE, BChE activities when compared to untreated diabetic animals. Additionally, rats with diabetes that received treatment with metformin, LEL and LEH displayed a noticeable increase in ENTPDase, Na/K ATPase, GST, CAT, GPx, and SOD activities when compared to the untreated diabetic rats. Histological examination revealed improved brain architecture in the treated groups in contrast to those in diabetic-induced rats. Conclusion: The alkaloid-rich extracts of Lannea egregia might be effective in normalizing brain damage caused by complications of diabetes mellitus.

BODY STALK ANOMALY: CLINICAL AND HISTOPATHOLOGIC FINDINGS OF THIS RARE ANOMALY IN A NIGERIAN NEWBORN.

Introduction: Body stalk anomaly (BSA) is a rare and severe congenital malformation in which the exact pathophysiology is still unknown. The possible causes of body stalk anomaly include early amnion rupture with direct mechanical pressure and amniotic bands, vascular disruption of the early embryo, or an abnormality in the germinal disk. Case presentation: We report a case of sonologically delayed diagnosis of BSA which was confirmed post-delivery following histopathological examination and we reviewed relevant literature regarding this phenomenon. Sonographic features of the foetus included a wide anterior abdominal wall defect (omphalocele) with protrusion of the liver into the amniotic cavity. The umbilical arteries show normal calibre, flow, velocimetry, and spectral waveform. Conclusion: Body stalk anomaly is accepted as a fatal anomaly, so it is important to differentiate it from other anterior abdominal wall defects prenatally and this could guide the management options.