Oral Disorders and Serum Oestrogen Levels in Postmenopausal Women in Lagos, Nigeria.

BACKGROUND: Changes in hormonal levels during puberty, pregnancy, menstruation, and menopause have varying effects on the oral cavity. Several mucosal disorders manifest in the oral cavity of postmenopausal women partly due to a decrease in oestrogen and progesterone level which are significant. The aim of this study was to determine the oral disorders associated with serum blood oestrogen levels in Nigerian postmenopausal women. MATERIALS AND METHODS: A cross-sectional analytical study at the Oral Diagnosis and Oral Medicine clinics in a large tertiary hospital in Lagos, Nigeria between June 2019 and December 2019 involving 35 postmenopausal and 35 premenopausal women within the ages of 40 to 60 years. The prevalence of oral disorders such as hyposalivation, burning mouth sensation, and periodontitis in pre and postmenopausal women was determined, likewise the association between oral disorders and blood oestrogen levels. RESULTS: The mean age of the postmenopausal women was 53.2 ± 5.6 years and premenopausal women was 46.4 ± 4.0 years. Chronic periodontitis was the most prevalent oral disorder in 19(54.3%) postmenopausal women followed by hyposalivation 5(14.3%) compared with 13(37.1%) and 2(5.7%) respectively in premenopausal women. All postmenopausal women who had chronic periodontitis 19(100%) had relatively high oestradiol levels compared with 5(38.5%) premenopausal women. CONCLUSION: There was no statistically significant association between oral disorders and blood oestrogen levels.

CONTEXTE: Les changements des niveaux hormonaux pendant lapuberté, la grossesse, la menstruation et la ménopause ont des effets variables sur la cavité buccale. Plusieurs troubles des muqueuses se manifestent dans la cavité buccale des femmes ménopausées, en partie à cause d'une baisse significative des taux d'œstrogènes et de progestérone. L'objectif de cette étude était de déterminer les troubles bucco-dentaires associés aux niveaux d'œstrogènes dans le sang sérique chez les femmes ménopausées nigérianes. MATÉRIEL ET MÉTHODES: Une étude analytique transversale dans les cliniques de diagnostic oral et de médecine bucco-dentaire d'un grand hôpital tertiaire à Lagos, au Nigeria, entre juin 2019 et décembre 2019, impliquant 35 femmes ménopausées et 35 femmes préménopausées âgées de 40 à 60 ans. La prévalence des troubles bucco-dentaires tels que l'hyposalivation, la sensation de bouche brûlante et la parodontite chez les femmes pré et post-ménopausées a été déterminée, de même que l'association entre les troubles buccodentaires et les niveaux d'œstrogènes dans le sang. RÉSULTATS: L'âge moyen des femmes ménopausées était de 53,2 ± 5,6 ans et celui des femmes préménopausées de 46,4 ± 4,0 ans. La parodontite chronique était le trouble bucco-dentaire le plus répandu chez 19 (54,3 %) femmes ménopausées, suivie par l'hyposalivation 5 (14,3 %), contre 13 (37,1 %) et 2 (5,7 %) respectivement chez les femmes préménopausées. Toutes les femmes ménopausées qui souffraient de parodontite chronique 19(100%) avaient des taux d'œstradiol relativement élevés par rapport à 5(38,5%) femmes préménopausées. CONCLUSION: Il n'y a pas d'association statistiquement significative entre les troubles bucco-dentaires et les taux d'œstrogènes dans le sang.

Clinical Significance of Elevated Levels of Cardiac Troponin T in Patients with Chronic Kidney Disease at Lagos University Teaching Hospital, Lagos.

BACKGROUND: This is an observational study of pre-dialysis patients with Chronic Kidney Disease (CKD) attending nephrology clinic at Lagos University Teaching Hospital to determine the clinical significance of elevated levels of Cardiac Troponin T (CTT) and possible associated factors. METHODS: One hundred and forty-three (143) patients with CKD and no prior history of myocardial infarction were recruited and their serum levels of CTT were determined within 3 months of sample collection and storage at -80° C. ECG findings and clinical variables were compared. The 99 percentile cut-off value was derived using healthy individuals that met the inclusion criteria. RESULTS: Mean blood CTT level was significantly higher in CKD patients compared to the general population. The 99th percentile value derived in the reference sample population was 48.02pg/ml. Statistical analysis showed significant association of CTT elevation with left ventricular hypertrophy, decreased renal function and age. CONCLUSION: CTT is generally elevated in pre-dialysis patients with CKD and a single elevated blood level of CTT above the 99th percentile may suggest asymptomatic Acute Coronary Syndrome. Serial rising levels of CTT and other clinical features will be of diagnostic significance in the diagnosis and management of asymptomatic acute coronary syndrome in patients with CKD.

CONTEXTE: Étude observationnelle de patients prédialysés atteints d'une maladie rénale chronique (MRC) fréquentant une clinique de néphrologie de l'hôpital universitaire de Lagos afin de déterminer la signification clinique des niveaux élevés de troponine cardiaque T (TTC) et des facteurs associés possibles. METHODESS: Cent quarante-trois (143) patients atteints de MRC et aucun antécédent d'infarctus du myocarde ont été recrutés et leurs taux sériques de TTC ont été déterminés dans les 3 mois suivant le prélèvement et le stockage de l'échantillon à -80 °C. Les résultats de l'ECG et les variables cliniques ont été comparés. La valeur seuil du 99e centile a été calculée à partir de personnes en bonne santé qui répondaient aux critères d'inclusion. RESULTATSS: Le taux moyen de TTC dans le sang était significativement plus élevé chez les patients atteints de MRC que dans la population générale. La valeur du 99e centile calculée dans la population de l'échantillon de référence était de 48,02pg/ml. L'analyse statistique a montré l'association significative de l'altitude de TTC avec l'hypertrophie ventriculaire gauche, la fonction rénale diminuée et l'âge. CONCLUSION: Le CTT est généralement élevé dans les patients de pré-dialyse atteints de MRC et un taux sanguin élevé simple de CTT au-dessus du 99ème centile peut suggérer ACS qui n'a pas été remarqué. Les niveaux ascendants périodiques de CTT et d'autres dispositifs cliniques seront d'importance diagnostique dans le diagnostic et la gestion de ces patients atteints de MRC mais asymptomatique pour le syndrome coronaire aigu. MOTS-CLÉS: Troponine cardiaque T, Syndrome coronarien aigu, Maladie rénale chronique, hypertrophie ventriculaire gauche.

Oxidative stress markers and genetic polymorphisms of glutathione S-transferase T1, M1, and P1 in a subset of children with autism spectrum disorder in Lagos, Nigeria.

BACKGROUND: The role of oxidative stress has been identified in the development of autism spectrum disorder (ASD), and polymorphisms of glutathione S-transferase have been associated with some diseases linked to oxidative stress. Hence, we evaluated the serum levels of oxidative stress markers and investigated genetic polymorphisms of glutathione S-transferase associated with autism. MATERIALS AND METHODS: Forty-two children clinically diagnosed with ASD using the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) criteria and a clinical interview were included in the study. Twenty-three age-matched controls without any known genetic/developmental disorder were also recruited. Oxidative stress markers along with the genetic polymorphisms of glutathione S-transferase were determined. RESULTS: Reduced glutathione in ASD patients was significantly lower than the control (P = 0.008), whereas other oxidative stress markers measured were not significantly different in both the control and case populations. The frequencies of GSTT1 and GSTM1 null genotypes were lower among the controls compared with the cases, however, no association risk was observed. The observed risk of carrying Val/Val genotype among the cases was approximately six times that of the controls. CONCLUSION: Individuals with ASD showed a significant diminished level of reduced glutathione, however, the distribution of GSTT1, GSTM1, and GSTP1 polymorphisms was not found to be associated with autism in this study population.

The effect of a membrane dialyzer during hemodialysis on the antioxidant status and lipid peroxidation of patients with end-stage renal disease.

Renal failure is accompanied by oxidative stress, which is caused by enhanced production of reactive oxygen species (ROS) and an impaired antioxidant defense. We studied 73 hemodialysis (HD) patients (39 males and 34 females) aged 24-75 years; the patients were randomized into two subgroups according to the type of hemodialysis membrane (35 patients were dialyzed on cellulose and 38 patients on polysulfone F7/F9 membrane dialyzers) and we assessed their antioxidant and lipid peroxidation status levels. The total antioxidant status (TAS) levels including whole blood levels of malondialdehyde (MDA) and glutathione (GSH); glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), and catalase (CAT) activities were measured, before and after hemodialysis. The MDA levels significantly increased 52.0% and 16.9% post dialysis among the cellulose and the polysulfone dialyzer users, respectively, (P<0.05). The TAS levels significantly decreased, 22.0 and 16.5% in the cellulose and polysulfone dialyzer users, respectively, (P<0.05). The erythrocyte SOD activity decreased 25.1 and 19.1% in the cellulose and the polysulfone dialyzer users, respectively, (P<0.05). The GSH concentrations, post dialysis, decreased 49.9 and 6.8% in the cellulose and polysulfone dialyzer users, respectively, (P<0.05). In contrast, the erythrocyte activity of CAT, post dialysis, increased 15.0 and 37.3% in the polysulfone and the cellulose dialyzer users, respectively, (P<0.05). We conclude that the type of the dialysis membrane affects the oxidative status after HD with possible consequences on patient morbidity and mortality.

The incidence of electrolyte and acid-base abnormalities in critically ill patients using point of care testing (i-STAT portable analyser).

BACKGROUND: Electrolytes and acid-base disorders are common challenges seen in the intensive care unit (ICU) resulting in difficulty in weaning patients off the ventilator, prolonged admission periods, preventable cardiac arrhythmias and cardiac arrest. These require prompt lab results most of which are done serially, ideally a point of care test (POCT), as most central hospital lab result's turnaround time (TAT) sometimes might not meet up with the urgency of clinical decision making in the ICU. OBJECTIVE: To determine the incidence of electrolytes and acid-base abnormalities using i-Stat portable analysers in the ICU of the Lagos University Teaching Hospital (LUTH). METHOD: The i-STAT Portable Clinical Analyzer, a POCT system consisting of a hand-held analyzer and single-use cartridges that measure different panels of analytes in 65-100 microl of blood using an EC8+ cartridge type analyzer for sodium, potassium, chloride, urea, glucose, pH, blood gases [TCO2, pO2, pCO2]) and heamatocrit was used. RESULTS: Over 66.78% of the patients had multiple electrolytes and acid-base abnormalities. Azotemia in 20%, hypoglycaemia in 13.33%, and hyperglycaemia in 53.33% of patients. CONCLUSION: it is concluded from this study that electrolyte and acid base abnormalities is not uncommon in the intensive care unit of LUTH and the i-STAT Portable Clinical Analyzer was helpful in facilitating early diagnosis and treatment.

Primary aortoappendicular fistula arising from an infected, chronic, contained, ruptured abdominal aortic aneurysm.

Gastrointestinal bleeding can be caused by a variety of pathologies. Primary aortoappendicular fistula is rare and, in our case, arose in addition to a chronic contained rupture sac of an abdominal aortic aneurysm. Clinical diagnosis is difficult. Aortic aneurysmorrhaphy along with extensive debridement and emphasis on antibiotic therapy is curative.

Management of co-existing intra-abdominal disease in aortic surgery.

OBJECTIVES: the treatment of abdominal aortic aneurysms more than 5 cm in diameter is well accepted, but controversy surrounds the management of concomitant serious intra-abdominal lesions diagnosed in the perioperative period. This study was undertaken to demonstrate that synchronous surgery is feasible and safe in this group of patients. DESIGN: in 1978 a decision was made to undertake combined operations on all patients with an aortic aneurysm of 5 cm or more in diameter and a significant non-vascular intra-abdominal lesion requiring surgery. METHODS: the case records of 676 patients who had aortic grafting for aneurysmal disease or the urgent management of occlusive disease between 1978 and 1998 were analysed retrospectively. SETTING: district general hospital. RESULTS: fifty-six (8%) patients had co-existing intra-abdominal disease treated at the time of aortic graft surgery. There were three (5%) hospital deaths and seven patients required early reoperation. One patient developed a subphrenic abscess and there were three superficial wound infections. There has been no clinical evidence of aortic graft infection in this series. CONCLUSION: this single centre experience with synchronous surgery demonstrates that it is safe and does not appear to predispose to an increased risk of graft infection.

The influence of total knee arthroplasty on lower limb blood flow.

Ischaemic complications of total knee arthroplasty (TKA) are unusual and tend to occur in patients with peripheral vascular disease (PVD). A prospective study was undertaken to investigate the effect of TKA on blood flow in patients without clinical evidence of PVD. Ankle brachial index (ABI) did not alter post-operatively and no changes in arterial waveforms were found. Unless there is clinical evidence of PVD, TKA under tourniquet control is therefore very unlikely to cause ischaemic complications.

Uncomplicated penetrating colonic injury.

The case of a patient with an air gun pellet injury to the right colon is reported. This was treated conservatively, and the pellet was passed per rectum 12 hours after the injury. Gunshot wounds to the abdomen do not necessarily warrant immediate laparotomy. Sieving of bowel motions may identify if the foreign body has been passed.

Contamination of evacuated pneumoperitoneum air following laparoscopic cholecystectomy: preliminary results from a prospective study.

A prospective microbiological analysis of evacuated pneumoperitoneum air in 20 patients following laparoscopic cholecystectomy for benign gallbladder disease is reported. In six patients (30%) a positive culture was obtained, out of which five had bowel derived organisms. Bile specimens taken at the same time as the air specimens were similarly cultured but failed to yield any organisms. There were no post-operative septic complications. There were no deaths. The initial results suggest that the evacuated peritoneal air is a potential source of contamination to the theatre staff and environment. This must be borne in mind when advocating laparoscopic procedures for treatment of high-risk patients.

Flush saphenofemoral ligation and multiple stab phlebectomy preserve a useful greater saphenous vein four years after surgery.

PURPOSE: Flush saphenofemoral ligation, with multiple cosmetic stab phlebectomy, successfully treats saphenofemoral reflux and superficial varicosities. The long-term effect on the residual greater saphenous vein (GSV) requires evaluation. METHODS: Noninvasive triplex ultrasound assessment of the residual GSV for potential use as a vein graft was used. We evaluated the independent objective and subjective cosmetic outcomes. We also used analysis to determine the correlation between GSV reflux, symptoms, and cosmetic outcome. RESULTS: Seventy-two limbs were assessed at a median follow-up of 4 years (interquartile range 3 to 5 years). Fifty-nine limbs had patent GSVs above and below the knee. The mean length patent was 51 cm, and the mean internal diameters above and below the knee were 3.6 and 2.8 mm, respectively. In 65% of cases the vein had suitable ultrasonic characteristics, suggesting that it would be suitable for use as a conduit for a vascular bypass graft. Sixty-two limbs were considered a symptomatic success and 61 an objective cosmetic success. There was no correlation between the symptomatic and cosmetic outcome and the presence of superficial GSV reflux (linear regression analysis). CONCLUSIONS: These findings support the effectiveness of the procedure of flush saphenofemoral ligation and multiple stab phlebectomy with regard to cosmetic and symptomatic outcome and may preserve the GSV for use as an autologous bypass graft.

Exploration of the common bile duct for stones: the influence of the flexible choledochoscope and perioperative antibiotic prophylaxis.

A retrospective study of 110 patients, out of a total of 743 open cholecystectomies, who have undergone common bile duct (CBD) exploration for stones between 1985 and 1990. CBD exploration was performed in the presence of abnormal peroperative cholangiogram in 86 (78%) patients. The remaining 24 patients were known to have either an abnormal preoperative ERCP or palpable ductal stones at the time of surgery. Post exploratory choledochoscopy was performed as an additional completion procedure in 58 (53%) patients and it identified further stones in 28 (48.3%) of these patients. There were three patients in whom no stones were identified on exploration of the CBD. Documented evidence of peroperative antibiotic prophylaxis was obtained in 78 (71%) patients. A total of 27 (24.5%) patients developed complications including seven (6.4%) patients with retained stones. In four of these patients with retained stones, flexible choledochoscopy was undertaken as an additional completion procedure to ensure ductal clearance. Cardiorespiratory and septic complications were the next most common problems occurring in 6.5% and 5.4% respectively, of patients reviewed. In conclusion, the retained stone rate has fallen from 14% in 1987 to 6.4% in this study. The choledochoscope has influenced this as it identified further residual stones following conventional exploration. The sepsis rate has also fallen from 19.5% to 4.5% in this study. We believe this is due to the use of antibiotic prophylaxis.