Malnutrition among Children with Non-syndromic Cleft Lip and Palate: A Case – Control Study in Ile – Ife, Nigeria.

Background: Children with cleft lip and palate (CLP) face lots of difficulties in the society. They tend to suffer malnutrition due to lack of standard care especially from their parents and society at-large. The potential risk of malnutrition is particularly high during early childhood. There is paucity of indigenous data on the prevalence of malnutrition in children with CLP. The aim of the study was to assess the influence of non sydromic CLP on the nutritional status of children. Methods: Anthropometric parameters weight for age z score (WAZ), height for age z score (HAZ), weight for height z score (WHZ) of children with CLP were compared with age matched controls. Results: Prevalence of underweight, wasting and stunting for cleft group were 26%, 18% and 14% respectively compared to 18%, 14% and 10% for the control. Differences in the underweight, wasting and stunting between the two groups were not statistically significant (p value = 0.334, 0.585, and 0.538 respectively). There was significant difference in the bottlefeeding and breastfeeding rates of the two groups. (p= 0.000 and 0.000 respectively). Conclusion: There is no statistically significant difference in the occurrence of malnutrition in children with non- syndromic Cleft lip and Palate compared with control.

Laryngeal carcinoma: experience in Ile-Ife, Nigeria

Objectives: This study aimed to determine the prevalent age; pattern of presentation; histopathology type; and outcome of management of laryngeal carcinoma in our environment. Design and Setting: This was a 10-year retrospective study carried out at a teaching hospital. Materials and Methods: Records of patients managed for laryngeal carcinoma from January 1994 to December 2004 were reviewed. Only 13 cases with tissue diagnosis were included in this review. The age; sex; occupation; presentation; use of cigarette and alcohol; investigations; histology; outcome of management; and duration of follow-up were extracted and analyzed. Results: The patients had a mean age of 69.9 years (range 38-88 years) and a male-to-female ratio of 12:1. Histopathology was squamous cell carcinoma in all. Symptoms included hoarseness in voice and breathlessness in all; cough in 7 (53.8); weight loss in 7 (53.8); and otalgia in 6 (46.2). Two patients indulged in alcohol and two were also regular cigarette smokers. All the patients presented with stage IV disease and in respiratory distress necessitating emergency tracheostomy. Seven (53.8) patients had total laryngectomy plus postoperative radiotherapy while 2 (15.4) had pharyngolaryngectomy; thyroidectomy; radical neck dissection plus postoperative radiotherapy and thyroxine supplement. Surgical complications included pharyngocutaneous fistula in 2 (15.4) patients; pharyngeal stenosis; stomal stenosis; and hypocalcemia with hypothyroidism in 1 patient each. The fistulae were managed conservatively and prognosis was good despite late presentation. Conclusion: Laryngeal carcinoma mainly occurs in males. Presentation is late with hoarseness in voice and breathlessness in our community. Soft-tissue neck x-ray is a useful diagnostic tool. Scarce radiotherapy centers; ignorance; local taboo; poverty; and poor recognition by primary healthcare providers have a negative impact on its management. Laryngeal carcinoma should be excluded when managing elderly patients for bronchial asthma

Incisional Hernia in Women: Predisposing Factors and Management Where Mesh is not Readily Available

Background:Aim: Incisional hernia is still relatively common in our practice. The aim of the study was to identify risk factors associated with incisional hernia in our region. The setting is the Obafemi Awolowo University Teaching Hospitals Complex; Ile-Ife; Nigeria during a period when prosthetic mesh was not readily available. Patients and Methods: All the women who presented with incisional hernia between 1996 and 2005 were prospectively studied using a standard form to obtain information on pre-hernia (index) operations and possible predisposing factors. They all had open surgical repair and were followed up for 18-60 months. Results: Forty-four women were treated during study period. The index surgeries leading to the hernias were emergency caesarian section 26/44 (59.1); emergency exploratory laparotomy 6/44 (13.6); and elective surgeries 12/44 (27.3). Major associated risk factors were the use of wrong suture materials for fascia repair; midline incisions; wound sepsis; and overweight. Conclusion: For elective surgeries; reduction of weight should be encouraged when appropriate; and transverse incisions are preferred. Absorbable sutures; especially chromic catgut; should be avoided in fascia closure. Antibiotics should be used for complicated obstetric cases

Predictive factors for birth trauma in southwestern Nigeria

Birth trauma is a significant cause of neonatal morbidity and mortality. This prospective study determined the predictive factors for birth trauma as seen in a Nigerian university teaching hospital. This was a prospective descriptive evaluation of birth trauma at Wesley Guilds Hospital, Ilesa over three years. Semi-structured questionnaire was used to collect data on the age, gender, pattern of presentation, place and mode of delivery, level of birth attendants, and treatment offered. Outcome measures were factors predisposing to birth trauma. A total of 137 neonatal hospital admissions with birth related complaints were recorded between 10th December, 2002 and 9th December 2005, out of which 119(86.8%) patients had 121 birth injuries (Males: Females= 1.4: 1). The mean age was 6 ± 4.1 (range: 1-31) day. Non skeletal injuries included cephalohaematoma 30(24.8%), genital bruises/abrasion 4(3.3%), subconjuctiva haemorrhage 2(1.7%), subdural haemorrhage 1 (0.8%), nasal necrosis 1(0.8%), Erb`s`palsy 31(25.6%) and Klumpke`s palsy 2(1.7%). Skeletal injuries were mainly bone fractures 50(41.3%)with 2(1.7%)mortality. Ante natal care/delivery, level of birth attendants, mode of delivery, fetal distress, and emergency caesarian section were among the factors that determined birth trauma. The prevalence of birth trauma is high in southwestern Nigeria. The predictive factors are easily identifiable in the perinatal period; early recognition could reduce significantly birth trauma