Review of current concept in the management of pressure ulcers

Pressure ulcers are quite distressing, and they cut across all age groups. Aside from increasingmortality, it results in protracted hospital stay and an upsurge in the consumption of healthcare resourcesPressure ulcers are considered to be essentially preventable, but in order to prevent them it is important to identify the people most at risk and deliver timely preventative care. In case of severe acute respiratory distress syndrome (ARDS), as in coronavirus dis­ease 2019 (COVID-19) affected patients, prone position and invasive ventilation improve the clinical status of this group of patients. This form of therapy is associated with an increased risk of facial pressure ulcers. When pressure ulcer occurs, appropriate documentation of each ulcer and staging of the ulcer are essential for good wound assessment.Treatment involves, assessing the nutritional needs of the patient, management of infections, removal of necrotic tissue, maintenance of a moist environment for wound healing, and possibly surgery

Risk factors and perinatal outcome of umbilical cord prolapse in Sagamu, Nigeria

Background: Umbilical cord prolapse is an obstetric emergency that threatens the life and well-being of the fetus and also increases maternal morbidity. Fetal survival in umbilical cord prolapse can be enhanced by prevention where risk factors are identified and prompt diagnosis and decisive intervention.Objective: The aim of this study was to determine the incidence, identify the risk factors associated with umbilical cord prolapse and document the perinatal outcome of cases of cord prolapse.Methods: This was a 13-year retrospective case-control study of cases of umbilical cord prolapse seen at the OOUTH, Sagamu, Southwestern Nigeria between January 1, 2000 and December 31, 2012.Result: During the study period, the incidence of umbilical cord prolapse was 1 in 122 deliveries (0.82%). The umbilical cord prolapse occurred in association with breech presentation five times (33.3%) and transverse lie eleven times (18.5%). The occurrence of breech presentation among the control cases was 8.6% (p<0.001) and that of transverse lie was 1.9% (p<0.001). There were also significant statistical differences between the cases of cord prolapse and controls in terms of prematurity, low birth weight, unbooked status and multiparity. The perinatal rate was 222/1000 (22.2%) compared to the perinatal mortality of 68/1000 (6.8%) for the control group.Conclusion: It is suggested that pregnant women should be encouraged to register early in pregnancy for antenatal care as this will enhance early identification of the risk factors and appropriate management instituted to reduce perinatal mortality

Respiratory symptoms and pattern of lung functions among commercial motorcyclists in Sagamu, Nigeria

Background: The relationship between occupational exposure to air pollutants and poor respiratory health is known. The motorcyclists commonly seek medical care for respiratory diseases in Nigeria.Objective: To determine the prevalence of respiratory symptoms and the pattern of lung functions among commercial motorcyclists compared to control subjects.Method: The controlled cross-sectional study was conducted in Sagamu, an urban town in south-western, Nigeria. The commercial motorcyclists and the controls with similar age, non-smokers and same male sex were included in the study. The riders and controls recruited were non-smokers. A structured questionnaire approved by the British Medical Research Council/ATS (American Thoracic Society) was used. The pulmonary function tests were performed according to ATS recommendation.Results: A total of 200 subjects were studied: 100 were commercial motorcyclists and 100 were non-motorcyclist controls. Compared with the controls, the prevalence of cough (71% vs 21%) and sputum (67% vs 20%) was higher among the commercial motorcyclists. Twenty-one percent of the commercial motorcyclists had an obstructive ventilatory pattern compared to 13% of the control group.Conclusion: This study provides further evidence that commercial motorcyclists are exposed to occupational hazards which predisposed them to increased frequency of respiratory symptoms and impaired lung functions. Health education strategy may assist this group of workers and reduce the burden of respiratory disorders among them

RHEUMATOID ARTHRITIS ASSOCIATED WITH PULMONARY FIBROSIS IN NIGERIANS: TWO CASE REPORTS.

Rheumatoid arthritis may sometimes present with extra-articular involvement, pulmonary involvement is not common. Rheumatoid arthritis has been reported among Nigerians and extra-articular manifestations are rarely seen. One of the patients was misdiagnosed and mismanaged as a patient with pulmonary tuberculosis. The study is to demonstrate that rheumatoid arthritis is not as rare as previously reported in Nigeria and its pulmonary involvement can mimic tuberculosis or other granulomatous lung disorder. Clinical and serological acumen are necessary to distinguish between the two. Two diagnosed patients with rheumatoid arthritis and pulmonary involvement seen at Olabisi Onabanjo University Teaching Hospital (OOUTH), are hereby presented.

FEMALE GENITAL TRACT CANCERS IN SAGAMU, SOUTHWEST, NIGERIA.

OBJECTIVE: To describe pattern of female genital tract cancers seen at Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, Nigeria. DESIGN: This is a retrospective review of all cases of female genital tract cancers managed at the Gynaecology department of OOUTH, Sagamu, Nigeria. SETTING: OOUTH is a tertiary health institution of the State's university and it takes referrals from within and outside the State. SUBJECTS: Case records of all female genital tract cancers managed between January 2004 and December 2013 were retrieved and analysed using SPSS version 16.0. RESULTS: There were 2059 women treated forvarious gynaecologic conditions, 179 (8.7%) were cases of female genital tract cancers and 161 records were available for analysis. Cervical cancer constituted the commonest (51.6%), followed by ovarian (35.4%), endometrial (9.9%), and choriocarcinoma (1.9%). There were no cases of vaginal and fallopian tube cancers. The lowest mean age was found in choriocarcinoma (36.60 ± 4.50 years) and highest in vulvar cancer (70.00 ± 2.82 years). The mean ages for cervical, endometrial and ovarian cancers were (51.98 ± 12.39), (65.38 ± 7.24), and (54.42 ± 10.51) years respectively. Similarly the least mean parity was found in choriocarcinoma (2.33 ± 1.52), and the highest in vulvar cancer (6.00 ± 1.44). The mean parity for cervical, endometrial, and ovarian were (4.10 ± 1.49),(3.06 ± 1.48), and (3.72 ± 1.68) respectively. These differences are statistically significant, age; F = 7.61, p < 0.0001, and parity; F = 3.27, p= 0.013. CONCLUSION: Incidence of cervical, endometrial, and ovarian cancers remain high and presentations are at late stages. There is a need to improve on cervical cancer screening, and for the attending physicians to improve on their indices of suspicions as regards endometrial and ovarian cancers.

EFFECT OF PRE-OPERATIVE SUB-LINGUAL MISOPROSTOL VERSUS INTRAVENOUS OXYTOCIN ON CAESAREAN OPERATION BLOOD LOSS.

BACKGROUND: Caesarean operation remains the most common abdominal surgery in women and has immense benefits to both mother and baby when employed. Haemorrhage, however, remains the greatest challenge associated with its outcome. OBJECTIVE: To compare the effectiveness of pre-operative sub-lingual misoprostol with intravenous oxytocin administered after delivery of the neonate in minimising blood loss at Caesarean operation. DESIGN: A prospective study. RESULTS: The mean blood loss was significantly lower in misoprostol group compared to oxytocin group (517.32mls versus 621.22mls; p = 0.005). The drop in haematocrit was significantly lower in misoprostol group than the oxytocin group, (400 µg-misoprostol versus oxytocin: 1.88 versus 3.04; p = 0.0001). Side effects of chills, shivering and pyrexia were noted more with the use of misoprostol. CONCLUSION: Pre-operative sub-lingual misoprostol is more effective than intravenous infusion of oxytocin in reducing blood loss at Caesarean section operation. However, occurrence of transient side effects of chills, shivering and pyrexia were noted more with use of misoprostol.

Post-partum mental disorders in Sagamu.

BACKGROUND: Pregnancy and labour are sufficiently stressful to precipitate mental disorders in women after delivery. This may arise newly, as a recurrence or an exacerbation of previously existing mental illness in the individual woman. Postpartum mental disorders are under reported in our practices. OBJECTIVE: To determine the incidence of post-partum mental disorders in our practice, pattern of presentation and the commonly associated factors. DESIGN: A retrospective descriptive study. SETTING: Olabisi Onabanjo University, Sagamu, Nigeria. RESULTS: During the study period there were a total of 9085 deliveries and 27 cases of puerperal mental illness. This gave an incidence of 2.9 per 1000 births. The mean age and mean parity of patients were 27.3 (+/- 7.9 SD) and 2.3 (+/- 1.8 SD) respectively. The mean delivery-presentation interval and mean length of hospitalisation were 11.5 (+/- 7.15 SD) and 12.4 (+/- 5.8) respectively. CONCLUSION: Incidence of post-partum mental illness in our practice is 2.9 per 1000 births. There were preponderance of primiparity and young maternal age in the study group. Family history of psychiatric disorders and marital disharmony appear to play major role in the aetiology of these disorders in our practice.

Endometrial carcinoma following treatment for breast carcinoma in a Nigerian female. A case report and review of the literature.

Tamoxifen is the primary hormonal therapy for breast cancer as well as its chemoprevention. It is used in the management of breast cancer because of its anti oestrogenic effect. It is however an agonist on the endometrium with undesirable effects of endometrial proliferation with the risk of endometrial hyperplasia and carcinoma. Several authors have reported cases of endometrial hyperplasia and carcinoma following tamoxifen therapy for breast carcinoma. No such report has been made from Nigeria . This paper presents the first case of endometrial carcinoma following tamoxifen therapy for breast carcinoma in a 52 year old Nigerian female. It also highlights the recommended guidelines for the follow up of women with breast cancer on tamoxifen therapy.

Ruptured uterus at Sagamu, Nigeria.

Ruptured uterus, the largest contributor to maternal deaths in our center was reviewed to find ways of reducing it and improve the outcome. Sixty cases treated at Ogun State University Teaching Hospital, Sagamu between January 1988 and December 1997 were scrutinised. During the 10 year period, total deliveries were 5,214 giving an incidence of 11.5 per 1,000. 76.7% of cases occurred in patients aged 30 years and more; and 58.6% in para 4 and more. 88.3% were unbooked. The ruptures were spontaneous in 76.7% and lower uterine segment was the most common (80%). Uterine repair with sterilisation was carried out in 46.7%, sub total hysterectomy in 26.7% and repair only in 11.7%. Most of the aetiological factors were preventable by good antenatal care and the outcome improved by early referral and efficient blood transfusion system.