Radiographic assessment of endodontic accidents at a Nigerian tertiary health institution: a one-year retrospective study

Introduction: Dental treatment can produce iatrogenic injury to the tooth with endodontic procedural errors occurring during the various stages of endodontic treatment. This study determined the prevalence and pattern of endodontic accidents in clinical practice at a tertiary health center in Nigeria. Methodology: This was a retrospective study of teeth treated with conventional hand-held file systems. Digital peri-apical working length, pre-obturation and post obturation radiographic images of teeth which received root canal treatment, were assessed for the presence or absence of errors. All errors present were recorded and data analysis was done using IBM SPSS version 22.0. Results: The prevalence of procedural errors was 31.3% with ledges being the most prevalent error followed by transportation while gouging was the least encountered error. Majority (83.8%) of the errors occurred during root canal instrumentation. A higher proportion of molars had errors compared to the other types of teeth with the prevalence of errors increasing from incisors to premolars and then to molar teeth. The mandibular molars were found to be most frequently involved in procedural errors. Conclusion: The prevalence of procedural errors seems high. Practitioners should show greater care during the canal preparation stage and to maintain the accuracy of the working length throughout the procedure, as errors which occur during canal preparation accounted for the vast majority of errors seen in this study. Special care should be taken when working on molars, which had a significantly higher error rate when compared to anterior teeth or premolars

Rituximab-induced acute thrombocytopaenia in an African lupus patient: a case report

Drug-induced acute thrombocytopaenia (DITP) is a complication of various medications resulting in a platelet count <50 x 109/L from prior normal levels. It typically occurs within 1-2 weeks postadministration but can occur rapidly within 1-3 days with previous exposure. Rituximab (an anti-CD20 antibody) used to treat many autoimmune cytopaenias, has been reported to cause thrombocytopaenia mostly in lymphoma patients. Reports in lupus are rare possibly because of off-label use. We hereby highlight the case of a 39-year old African lady who developed acute thrombocytopenia 12 days post-rituximab. Frequent monitoring of blood counts will enhance identification and treatment of this complication

Treating complexity in the older adult - the role of the geriatric giants

As people age, they accumulate medical conditions. Geriatric giants comprise a group of conditions that lead to significant mortality and morbidity and contribute to the complexity in treating geriatric patients. They are common and rarely occur in isolation. The 5 Is of geriatric giants are: iatrogenesis, immobility, instability, incontinence and impaired cognition. Consequences for the patient and their caregivers include loss of functional independence, institutionalisation and caregiver burnout. Primary care practitioners are often the first port of call for geriatric patients in South Africa and by asking a few key questions and performing a thorough examination; these conditions can be recognised early. Whilst there are often limitations to cure, the main aim is to maintain the older adult's functional independence as much as possible, and by following an organised management approach to each of these conditions, the quality of life of patients can be improved

Hypoglycaemia Unawareness : Practical Avoidance and Management : Review

In diabetic patients requiring insulin; hypoglycaemic events are inevitable and severe hypoglycaemia is one of the most feared complications of the disease. It is associated with not only physical discomfort; cognitive dysfunction and loss of personal control; but sometimes more severe consequences; including coma and death. In comparison with conventional glucose targets; iatrogenic hypoglycaemia is up to six times more common with intensive therapy and remains the most important barrier to sustained good glucose control. Neural tissue is dependent on a continuous supply of glucose for maintenance of function. Consequently; the development of symptoms in response to low glucose levels is essential for recognising impending neuroglycopenia and to provoke timeous corrective measures to restore glucose balance. Unawareness of hypoglycaemia and failure to develop warning symptoms therefore increases the risk of severe hypoglycaemia and its associated morbidity

Knowledge of Blood-Borne Transmission Risk is Inversely Associated with HIV Infection in Sub-Saharan Africa

Introduction: Accurate; comprehensive knowledge of an infectious pathogen's modes of transmission helps people to avoid infection. Growing evidence suggests that blood-borne HIV transmission is widespread in sub-Saharan Africa. Methodology: I examined the association between knowledge of blood-borne HIV risk and prevalent HIV infection in Demographic and Health Survey data from 16 sub-Saharan African countries. I also searched three online databases for evidence of public education campaigns focused on blood-borne HIV risks in these countries. Results: Knowledge was moderately to strongly inversely related to HIV prevalence at the national level (i.e.; countries in which many respondents were aware of blood-borne risk had lower HIV prevalence than countries in which few respondents were aware of such risk). At the individual level; respondents who knew about blood-borne HIV risks were modestly less likely to be infected than those who did not show awareness of this risk; independent of demographic and sexual behavior variables. This relationship was stronger in southern Africa than in west; central; and east Africa. In parallel analyses; knowledge of condom use as a way to prevent HIV was positively associated with prevalent HIV infection at both the national and individual levels. West; central; and east African countries with low to moderate HIV prevalence had implemented public education campaigns that included a focus on blood-borne transmission risks. Such campaigns were absent from high prevalence countries in southern Africa. Conclusion: These findings suggest that knowledge of blood-borne HIV risk protects against HIV infection and that public education campaigns are important for spreading that knowledge

Iatrogenic ureteric and bladder injuries in obstetric and gynaecologic surgeries

Objective: To review iatrogenic ureteric and urinary bladder injuries from obstetric and gynaecological surgeries treated in the urology department analysing; ureteric anatomy; aetiologicfactors; diagnosis; treatment and outcomes. Design: A retrospective study. Setting: Institute of Urology; Kilimanjaro Christian Medical Center (KCMC); Moshi; Tanzania. Subjects: Twenty three women were treated for iatrogenic ureteric and bladder injuries secondary to obstetric and gynaecological procedures in the department of urology between June 1994 and July 2004. Results: Hysterectomy was the leading cause of ureteric injuries contributing to nine (47.4

Les complications uro-génitales de la chirurgie pelvienne et du canal inguinal : au sujet de 15 observations

Objectif: La chirurgie pelvienne et du canal inguinal expose à des complications parmi lesquelles les lésions iatrogènes urogénitales. Le but de ce travail était de rapporter notre expérience de ces complications. Patients et méthodes: Il s'agit d'une étude retrospective des complications uro-génitales survenues au cours de cette chirurgie entre le 1er janvier 1997 le 31 décembre 2001. Elle comprend 15 patients (10 hommes et 5 femmes dont l'âge moyen est de 35,5 ans) opérés en programme opératoire réglé de hernie inguino-scrotale (n=4), de fibrome utérin (n=3) ou en urgence de hernie inguino-scrotale étranglée (n=4), de volvulus du côlon sigmoïde (n=1), de cancer du rectum en occlusion (n=1), de rupture utérine (n=1) et de pyoannexe gauche (n=1). Résultats: Les lésions étaient des sections ou plaies urétérales (n=7), des plaies ou em-brochages vésicales (n=6) et des lésions artérielles testiculaires (n=2). Six lésions ont été découvertes immédiatement tandis que neuf ont été méconnues et se sont manifestées par un syndrome péritonéal (n=7) et par une atrophie testiculaire (n=2). Le traitement réalisé était une cystorraphie sur sonde (n=7), une suture urétérale sur catheter (n=6), une réimplantation urétérale (n=1) et une orchidectomie (n=2). La morbidité pour les réinterventions était nulle. Un patient est décédé à J12 post-opératoire - il s'agit du patient opéré pour cancer du rectum en occlusion. Conclusion: La prévention des lésions urogénitales passe par l'application rigoureuse de techniques bien apprises par des chirurgiens expérimentés