Femoral Anteversion Angles in Dry Bones of Adult Nigerians: A Comparison of Two Methods.

BACKGROUND: Version describes the angle in the axial plane subtended by the femoral neck and the femoral shaft. Femoral version varies among various major geographic and racial populations. Femoral version plays a role in some orthopaedic operations. This study documented femoral version among Nigerians comparing two methods on dry femoral bones. METHODOLOGY: This was a prospective descriptive study that involved measurements of femoral anteversion and retroversion angles on dry femoral bones using the Kingsley Olmsted (KO) method and digital measurement using a free software, IC Measure® from imaging source (The imaging source, Europe GmbH, Uberseetor 18, 28217 Bremen. Germany) Forty-eight (48) adult dry femoral bones were measured. The results obtained from these measurements were analyzed using Stata 13 (StataCorp, Texas, USA) RESULTS: The average value of anteversion angle using the Kingsley Olmsted (KO) method was 20.50 ± 5.50. The average anteversion angle using IC measure was 21.30 ± 6.00. The observed agreement was 16.67%. (Expected agreement was 5.21 %.) The measurements obtained from both KO method and digital photograph using IC measure showed high correlation with each other (r = 0.89, P < .0001). CONCLUSION: The mean anteversion angle from this study was 20.50 ± 5.50 and 21.30 ± 6.00 using the KO and digital measurements respectively. These values further elaborated that the average anteversion angle is higher in Africans compare to other racial groups. Orthopaedic surgeons should be aware of this fact during surgical operations that involve proximal femur, such as femoral derotation, hemiarthroplasty and total hip replacement in Africans.

Body Size Perceptions and Weight Status of Adults in a Nigerian Rural Community.

BACKGROUND: Overweight and obesity are now recognized worldwide as increasing public health problems throughout the life course and wrong perception of one's body size may reduce the motivation for an overweight person to lose weight. AIM: This study was conducted to investigate how Nigerian rural dwellers perceive their body size and how their perception agrees with their body mass index (BMI). SUBJECTS AND METHODS: A cross-sectional sample of 183 adults living in a rural community, South-West Nigeria was randomly recruited into the study. Their verbal and visual body size perceptions were assessed through structured questions and body images. Descriptive and inferential statistics were used to analyze the data. RESULTS: Thirty-five percent (64/183) of participants were classified as either overweight or obese by BMI. More than half of the participants perceived themselves as normal weight. More women perceived themselves to be obese than men in both verbal and visual perceptions. Based on BMI classification, 43% (79/183) and 54% (98/183) of participants misperceived themselves in verbal and visual perception, respectively. Underestimation of body size was higher in men (38.3%, 36/94) while overestimation was higher in women (9.0%, 8/89). Men had consistently higher values of kappa coefficient which indicate greater agreement than women in both types of perception. CONCLUSION: We found considerable gender differences in body weight perception of adults in the Nigerian rural community. A large proportion of these rural dwellers could not appropriately classify their weight status; and over 30% (64/183) and nearly 50% (92/183) of them underestimated their own body weight in verbal and visual perceptions respectively.

Sexual dysfunction in Nigerian stroke survivors.

BACKGROUND: Over three-quarters of stroke survivors experience disruption of sexual functioning. Studies reporting poststroke sexual function of Nigerian patients are few. OBJECTIVES: This survey reports sexual dysfunction in Nigerian stroke survivors, and determines the influence of sociodemographic, clinical and psychological factors on the dysfunction. METHODS: Participants were 77 stroke survivors (60 males; 17 females) recruited consecutively from a teaching hospital. Participants completed the Beck Depression Inventory, Stroke Specific Quality of Life Scale and post-stroke sexual function questionnaire. Participants' motor ability was rated on the Modified Motor Assessment Scale. Data were analysed using Chi square test and Mann-Whitney U test (alpha level set at 0.05). RESULTS: Participants were aged 55.2 ± 10.8 (28-79) years. Most (94.8%) participants reported a dysfunction in sexual function. Decline in libido and coital frequency were reported by >70% and in erection, ejaculation and orgasm by >60% of participants. Participants' with erectile dysfunction were significantly older than those without (U=267.0; p=0.02). Depression, quality of life, willingness to have sex, general attitude to sex and ability to express sexual feelings had significant influence on sexual dysfunction reported by participants (p<0.05). CONCLUSION: Our findings suggest that sexual dysfunction is common among Nigerian stroke survivors and it is mostly associated with psychological factors.

Effects of aerobic exercise and drug therapy on blood pressure and antihypertensive drugs: a randomized controlled trial.

BACKGROUND: Although aerobic exercise has been shown to lower blood pressure (BP) in human beings, its additive BP-reducing effect on antihypertensive drug therapy seems to have been investigated in only laboratory animals. OBJECTIVES: This study investigated the effects of aerobic dance combined with antihypertensive drugs on BP and number of antihypertensive drugs in individuals with hypertension. METHODS: This open label randomised-controlled trial involved new-diagnosed male and female individuals with mild-to-moderate essential hypertension after at least four weeks of treatment. They were randomly assigned to drug therapy (Normoretic: Hydrochlorothiazide + amiloride hydrochloride, and Amlodipine) (control: n=33) and aerobic dance combined with drug therapy (exercise: n=30) groups. Intervention in each group lasted 12 weeks. BP was measured at baseline and during and pos-intervention. Number of antihypertensive drugs was recorded post-intervention. RESULTS: There were significant reductions in SBP at some periods of the intervention in the exercise group (p=0.000 to 0.002) and control group (p=0.001 to 0.002), and significant difference in DBP at some periods of the intervention in exercise group (p=0.000 to 0.003) and control group (p=0.000 to 0.001). SBP (p=0.066) and DBP (p=0.100) did not differ between the two groups post-12-week intervention. The BP control rates were similar between the exercises (56.7%) and control (35.5%) groups (p=0.075). Similarly, between-group difference in the number of drugs was not significant (p=0.511). CONCLUSION: This preliminary report demonstrates the tendency of aerobic dance to enhance BP control in individuals on two antihypertensive drugs without BP control.

Ibadan knee/hip osteoarthritis outcome measure: process of development.

The development of instruments for the assessment of therapeutic intervention has been an age long practice. However, many of the published instruments do not have detailed information on how the instruments were developed. It is necessary for authors to provide detailed (step by step) information on how measuring scales/instruments are developed. The Ibadan Knee/Hip Osteoarthritis Outcome Measure (IKHOAM) was developed as a Nigerian-environment and culture-friendly instrument for the assessment of the effectiveness of therapeutic interventions in individuals with osteoarthritis of the knee and/or hip. This article outlines the steps involved in developing an outcome measure using IKHOAM as a template.

Perceived body image and weight: discrepancies and gender differences among University undergraduates.

BACKGROUND: Body image (BI) is a multidimensional construct that includes perceptual, attitudinal, behavioural components, and feedback from other people's perception of oneself. The feedback from others and the degree to which one accepts or rejects it can determine self evaluation and perception. Body weight perception is a strong determinant of nutritional habits and weight management among adolescents. One of the barriers to reducing rise in obesity prevalence could be its cultural acceptability in some developing countries. OBJECTIVE: To explore the gender influences on perception of self- and opposite-sex body images (BI), perceived body weight and the actual body weight categories at which discrepancies occur among the perceived BIs in undergraduates. METHODS: This was a survey of perceptual dimension of BI, perceived body weight and actual body weight carried out in 121 undergraduates aged 21-29 years. RESULTS: Discrepancies occurred between self-perceived BI and each of actual body weight (p= 0.00 at 0.00-0.02 confidence interval (CI)), perceived body weight (p= 0.01 at 0.000-0.02 CI) and self-ideal BI (p= 0.03 at 0.000-0.05 CI) of normal-weight males. Self-perceived BI and perceived body weight also differed in normal-weight females (p= 0.02 at 0.000-0.04 CI). Discrepancies (p= 0.02 at 0.00-0.04 CI) occurred between self-perceived BI and self-ideal BI, and between self-perceived BI and desired BI (p= 0.02 at 0.00-0.04 CI) in overweight females. Gender differences occurred for self-ideal BI (p= 0.00 at 0.00-0.02 CI), ideal image for the opposite sex (IBIOS) (p= 0.02 at 0.00-0.04 CI) and desired BI (p= 0.00 at 0.00-0.02 CI). CONCLUSION: Normal-weight males perceived their BI differently from their actual body weight, perceived body weight and self-ideal BI whereas normal-weight females perceived their BI differently from only their perceived body weight. Discrepancies occur between self-ideal BI and self-perceived BI, and between self-perceived BI and desired BI in overweight females. There are differential perceptions of self-ideal BI, IBIOS and desired BI between males and females.

Validation of a Yoruba translation of the World Health Organization's quality of life scale--short form among stroke survivors in Southwest Nigeria.

The World Health Organization's quality of life scale - short form (WHOQOL-BREF) is a well-validated, cross-cultural tool for measuring quality of life (QOL) of patients with chronic diseases. It has been translated into over 20 languages, none of which is an indigenous Nigerianlanguage. The aim of this study was to investigate the validity of a Yoruba translated version of the WHOQOL-BREF Yoruba is the indigenous language of southwestern Nigeria. The English version of the WHOQOL-BREF was translated into Yoruba and it went through two rounds of back-translation. The English and Yoruba versions of WHOQOL-BREF were completed by 41 stroke survivors, literate in both languages. Participants were recruited through purposive sampling method from physiotherapy clinics of all tertiary health institutions in southwestern Nigeria between April and August, 2004. Data was analyzed using Spearman rank order correlation and paired t- test with the alpha level set at 0.05. Participants (24 males, 14 females) were aged 55 +/- 10.7 years and have had stroke for 28.4 +/- 6.7 months. Participants' domain scores on the Yoruba translated version of WHOQOL-BREF correlated significantly with those on its English version (r = 0.695-0.859; p = 0.000). This Yoruba version is a valid translation of the English WHOQOL-BREF and may be used for assessing QOL of stroke survivors in southwestern Nigeria.

Validity and internal consistency of a Yoruba version of the Ibadan knee/hip osteoathritis outcome measure (Yoruba IKHOAM).

The Ibadan Knee Hip osteoarthritis Outcome measure (IKHOAM) was developed for patients with Knee/Hip Osteoarthritis in the Nigerian and similar environments. The Yoruba Version was developed to encourage its use in the Southwestern region of Nigeria. The IKHOAM was translated into Yoruba in four separate processes of translation, back translation, committee review and pre-testing. It was administered to a cohort of 164 outpatients with symptomatic OA of the knee and or Hip who attended physiotherapy units in selected hospitals from Southwestern region of Nigeria. The IKHOAM (English Version) was correlated with the Yoruba version and Visual analogue scale (VAS). The Validity of the Yoruba IKHOAM was found to be satisfactory and comparable to the original version (r = 0.67, p = 0.005) for the criterion-related validity and r = -0.31 (p = 0.005) for construct validity. The items in the Yoruba IKHOAM correlated well with each other with Cronbach's alpha coefficient ranging between 0.69 and 0.99. The correlation on the different parts of the Yoruba IKHOAM was satisfactory (alpha = 0.52-0.87). The Yoruba IKHOAM like the original version is a reliable consistent and valid instrument that can be considered for use in the Nigeria environment for evidence based quality healthcare promotion in Knee/Hip OA patients.

Nigerian back school model: development and effect on industrial workers' knowledge of back pain and back care.

Back schools are health education programmes on back pain. Many back schools have been developed for different populations since 1969 when the first one was developed in Sweden, but none for the Nigerian setting. The need to develop a back school that would be appropriate for the Nigerian environment was therefore identified. As a step towards its development, this preliminary study was carried out to determine the effect of a back school model (BSM) on some Nigerian industrial workers' knowledge of low back pain and back care. The subjects were 110 workers of a soap industry in Lagos, Nigeria. Apre-test, post-test quasi-experimental design was used. The BSM consisted of two 45 minute teaching sessions on structure and functions of the back, epidemiology and causes of back pain, correct postures and demonstration of exercises that may prevent/alleviate back pain. Data on demographic information, low back pain (LBP) experience, knowledge of back structure and back care were collected using a questionnaire with closed ended questions, which was completed before, immediately after and 8-weeks after BSM administration. The results showed that the subjects' mean knowledge score increased significantly from an initial value of 16.1 + 5.3 to 24.0 + 5.6 (p < 0.05) immediately after and 23.1 + 3.9 (p < 0.05) 8 weeks after BSM administration. Educational attainment had no influence on subjects' knowledge scores before or 8 weeks after BSM administration. Reported experience of LBP and duration on the job had no significant influence on subjects' knowledge scores before, immediately or 8-weeks following BSM administration. It was concluded that the BSM was effective in improving the workers' knowledge of LBP and back care. We believe that this findingjustifies the effort to develop the Nigerian model of back school.

Normal values of knee angle, intercondylar and intermalleolar distances in Nigerian children.

There is little data on the range of variation of knee angle, intermalleolar and intercondylar distances in African children. Such measurements are needed to assist determining whether a child legs are normal or not. Knee angle intermalleolar and intercondylar distances were measured in 2166 Nigerian children aged one year to 10 years to establish normal values for these measurements. In the study we discovered that knees were maximally bowed at ages 1-3 years and reduced to neutral of 0 degrees at age five (5 years) in girls and age seven (7) in boys. Both sexes had no bowing after age (7 years) in boys. Both sexes had no bowing after age of 7 years. The valgus angle was found to be constant at about 11 degrees between ages 1-10 years in both sexes. Mean intercondylar distance was 0.2 cm at 1 year of age and did not vary significantly at 10 years of age. The greatest intermalleolar distances of 2.5 cm and 2.2 cm were noted between the ages of 2 and 4 years. Normograms of these measurements are presented as diagnostic aids in clinical settings.

Correlative study of 3 pain rating scales among obstetric patients.

The relationship between pain scores obtained on the Visual Analog Scale (VAS) the Box Numerical Scale (BNS) and Verbal Rating Scale (VRS) was studied. The subjects were 35 volunteer female patients who had their babies through caesarian section 1-3 days prior to the study. Demographic data and pain scores were collected through a questionnaire, which was available in both English and Yoruba, the two most commonly spoken languages in Ibadan where the study was carried out. Data were analysed using Pearson Product, Moment Correlation Coefficient, and One-way Analysis of Variance. Results indicated that there was no significant difference between the pain scores obtained on the 3 pain rating scales. Significant correlations existed between pain scores obtained on the VAS and VRS (r = 0.48, p = 0.003); VAS and BNS (r = 0.74, P = 0.000); BNS and VRS (r = 0.74, P = 0.000). High educational attainment improved correlation between the scales in this study. It was concluded that the three pain rating scales measure the same construct, and could be used for pain measurement in obstetrically related conditions in this environment.

The use of ultrasound in the management of bells's palsy: case studies

Four cases of bell's palsy were managed using low intensity continous ultrasonic energy. Two cases reported for treament within two weeks of the onset; one case within one week of onset while the last case was about six months old. Average of five treatments were given over a two week period; using 0.5 -0.8 watts/cm2 for five minutes over the mestoid process region. Feldene gel was used as couplant. All cases recovered spontaneously

Responses of the African hypertensive to exercise training: preliminary observations.

The aim of the study was to investigate the effect of exercise on blood pressure in hypertension. Ten hypertensives served as study subjects, and ten as controls. The study subjects (mean age 55.7 years) exercised for 42 minutes, three times a week for 12 weeks. The training intensity was 60-70% of heart rate reserve. Controls (mean age 57.2 years) were not subjected to exercise training. Blood pressure was measured at rest and during submaximal exercise test on the bicycle ergometer. The exercise heart rate of the study subjects was significantly reduced after exercise training. There were small but significant reductions in resting and exercise systolic blood pressure and exercise diastolic blood pressure of the study group following the exercise training. There was no significant change in the resting and exercise blood pressure of the control group. The significant blood pressure reductions in the study group were attributed to the exercise training programme. The response of the African hypertensive is similar to those reported in other racial groups, notably Caucasians.

Range of lumbar flexion in chronic low back pain.

Thirty low back pain (LBP) patients, and thirty normal controls without any back pain or disease were the subjects for this study. Lumbar flexion was measured using the skin-marking method, a MacRae and Wright's modification of Schober's method. The mean lumbar flexion for the LBP patients (5.25 +/- 2.12 cm) was significantly lower (P 0.05) than that for normal subjects (6.96 +/- 2.0 cm). The normal males had higher value of lumbar flexion than the females. There is also the tendency for lumbar flexion to decrease with advancing age. Measurement of lumbar flexion using skin-marking technique is therefore an objective method of monitoring patients with low back pain.