Tropical Journal of Medical Research

Ultrasound evaluation of the uterine size and endometrial changes in a normal menstrual cycle

2013-07-22T15:48:38+00:00

Background: The endometrium is one of the most dynamic structures in the body and during the reproductive years of a normal female, the uterus undergoes ultrasonographically detectable alterations characterised by cyclical changes in the echopattern of the endometrium. The aim of this study is to assess the changes in the uterus and endometrium during the menstrual cycle of females in South-East and South-South Nigeria by ultrasound assessment, and also to establish the mean and normal ranges for uterine size and endometrial thickness during the cycle.
Methods: A prospective ultrasonographic study of cyclical endometrial and uterine changes in 300 women in two Nigerian tertiary hospitals.
Results: There was progressive increase in uterine dimensions from menstrual phase (early cycle) to secretory phase (late cycle),
progressive increase in endometrial thickness from menstrual phase (early cycle) to secretory phase (late cycle), with a greater increase observed from menstrual phase to the proliferative phase than from proliferative phase to secretory phase. The menstrual phase endometrium was mostly hyperechoic; the proliferative phase mostly hypoechoic and the secretory phase mostly hyperechoic. The mean values for the endometrial thickness and the antero-posterior length and width of the uterus for this study were 3.2±1.1mm, 4.0±3.2cm, 7.0±0.7mm and 5.2±4.2cm respectively for menstrual phase, 7.5±1.9mm, 4.1±0.6cm, 7.4±2.7cm and 5.3±2.0cm
respectively for proliferative phase and 9.4±1.9mm, 4.2±0.4cm, 7.9±4.5cm and 5.9±3.4cm respectively for the secretory phase. The
normal sonographic appearances of the uterus study were a thin hyperechoic endometrium at the menstrual phase, a thicker triple
layer endometrium at the proliferative phase, and a very thick hyperechoic endometrium with no midline echo at the secretory phase.
Conclusion: This study established that the normal thickness of endometrium in our population group is 2–3mm during the menstrual
phase, 6– 9mm during the proliferative phase and 8–11mm during the secretory phase.

Key words: Uterine and endometrial changes, ultrasonography, Nigeria

Birth preparedness and emergency readiness of pregnant women in Amaku general hospital Awka, Nigeria

2013-07-22T15:48:38+00:00

Background: Birth preparedness and emergency readiness constitute a comprehensive strategy to improve the use of skilled providers at birth and a key intervention to decrease maternal mortality. Complications can arise at any time during pregnancy, childbirth, and post-partum period. These emergencies can be life-threatening requiring urgent intervention to mitigate their effects. This study assessed the birth preparedness and emergency readiness of antenatal clinic attendees in Amaku General Hospital Awka, Nigeria.
Method: The study design was cross sectional and it employed systematic sampling technique to recruit consenting 100 antenatal
clinic attendees from whom socio demographic and knowledge data were obtained using interviewer administered questionnaire. The
data were analyzed with the statistical package of social sciences (SPSS).
Result: Their mean age was 27.9+4.5 years. Half of the respondents registered for ANC before 20 weeks gestational age while 93%
identified a health facility for delivery. As many as 78(78%) of the respondents had started buying materials and supply needed for
delivery, and 65(65%) were already saving money for the same purpose. Although 70(70%) of the subjects had arranged for
emergency transportation, only 6(6%) had made arrangement for a blood donor.
Conclusion: Despite efforts to provide fully equipped health facilities for basic and emergency obstetrics care, pregnant women need
re-orientation to anticipate and plan for untoward events.

Key words: Plan, birth, emergency readiness, pregnant women, Awka.

Emergency transvesical prostatectomy: A review of fifty cases

2013-07-22T15:48:38+00:00

Objective: To retrospectively study patients with benign prostatic enlargement who had emergency transvesical prostatectomy in order to determine the patterns in their presentation, management and outcome. This may guide future decisions in the management of such cases in a resource poor environment.
Patients and Method: Fifty patients who presented to the authors with benign prostatic enlargement and who had emergency transvesical prostatectomy over a fifteen-year period were studied retrospectively. The data collected included age, indications for surgery, associated medical conditions, investigations done, perioperative blood transfusions, weights and configurations of the enucleated prostate adenomata, duration of postoperative hospital stay, and postoperative complications.
Result: The indications for the emergency transvesical prostatectomy were severe prostatic haematuria which was refractory, and recalcitrant clot and urinary retention from prostatic haematuria. The peri-operative blood transfusion was 3.40 (SD 0.49) units per patient. There were postoperative complications in 40% of patients, and 62% had associated medical conditions
Conclusion: Emergency transvesical prostatectomy is expedient when precisely indicated and properly done. There is rarely an added risk when compared with elective operation.

Keyword: Emergency, Tranvesical prostatectomy, Prostatic Haematuria

Compliance with clinic appointments by hypertensive patients after discharge in a tertiary hospital, South East Nigeria

2013-07-22T15:48:38+00:00

Objective: Compliance with clinic appointment is one of the several ways to assess patients' adherence to treatment with varying rates of compliance with scheduled visits being reported. This study was carried out with the aim of assessing the level of compliance with clinic appointments of our hypertensive patients after discharge from the ward.
Method: This is a retrospective study. The case notes of consecutive patients admitted into the medical wards over a 2-year period, from 1st January 1996 to 31st December 1997, were reviewed. Those admitted with hypertension, or with its associated complications like heart failure, cerebrovascular accident (stroke), were studied for their compliance with clinic appointments after discharge, from 1st January 1998 to 31st December 1999. Compliance was divided into 4 categories: a) those who did not attend outpatient clinic at all after discharge; b) those who attended less than six times before dropping out; c) those who attended more than six times but dropping out before the end of 1999; and d)
those who kept regular appointments up to the end of 1999. Analyses was done using SPSS. Means and the respective standard deviations and proportions were used to describe the distribution of the data. The chi-square test was used to determine the statistical significance of the difference between the proportions, and the student t-test was used to compare means. A p-value of <0.05 was considered statistically significant.
Results: A total of 211 patients were studied, 105(49.8%) were males and 106(50.2%) females. The mean age (SD) of the population was 58.46±12.23 years, with a range of 24–88 years. There was no statistically significant difference in the ages of the female and male subjects (p= 0.309. Ninety-eight (46.4%) of the 211 patients did not attend clinic at all after discharge, 65(30.8%) attended a few times, 16(7.6%) had moderate attendance and 32 (12.2%) had full clinic attendance for the duration of the study.

Conclusion: The findings showed a poor compliance to follow-up appointments in clinics by hypertensive patients admitted into Nnamdi Azikiwe University Teaching Hospital, Nnewi.

Key-words:, Clinic, Appointment, Attendance Compliance, Hypertension,

Comparative effects of different walking aids on selected cardiovascular parameters, energy cost and walking speed among elderly patients with knee osteoarthritis

2013-07-22T15:48:38+00:00

Objective: This study aims at comparing the effects of cane, Rollator, and Zimmer's frame ambulations on selected cardiovascular parameters, energy cost and walking speed in elderly patients with knee osteoarthritis (OA).
Method: Twenty-five (25) elderly patients participated in this randomized cross-over designed study. Participants' systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse rate were measured before ambulation. Each participant performed a 6-minute walk test (6-MWT) using each of the three walking aids (WA) on three separate days. Immediate post-ambulation SBP, DBP, pulse rate, energy cost and walking speed were determined. Repeated measures ANOVA were used to compare the WA on all the selected variables at p<0.05 level of significance.
Results: The mean age of the participants was 65.1±3.9 years. SBP, DBP, pulse rate and walking speed were significantly different (p<0.05) for the three WA after 6-MWT. Participants' SBP (149.9±1.5 mmHg), DBP (87.4±1.1 mmHg) and pulse rate (89.1±1.1 bpm) after Zimmer's frame ambulation were signicantly higher than for the cane (145.3±7.9 mmHg; 83.7±5.5 mmHg; 83.20 ±5.8 b.p.m) and Rollator (147.48±7.1 mmHg; 85.9±0.9 mmHg; 86.2±1.4 bpm) ambulations respectively. Walking speed with cane ambulation (0.55±0.11m.sec-1) was significantly higher than for Zimmer's frame (0.40±0.1 m.sec-1) and Rollator (0.47± 0.10 m.sec-1)
ambulations. There was no significant difference in the energy cost of the participants during ambulation with the three WA.
Conclusion: Zimmer frame ambulation elicited comparatively high blood pressure and pulse rate while cane ambulation was accompanied by relatively high walking speed. The choice of WA by elderly patients with knee OA should therefore be based on the observed variations.

Keywords: Walking Aids; Elderly Patients; Cardiovascular parameters; Energy cost; Walking speed; Knee osteoarthritis

Sex difference and relationship among peak grip strength, grip strength and arthropometric measures in dominant and non-dominant hands of children aged 4-16 in Southeast Nigeria

2013-07-22T15:48:38+00:00

Objective: Hand dominance is a term that describes a preference to use one hand more than the other for everyday tasks. It could be described as the phenomenon that occurs when one hand is preferred to the other for fine motor skills tasks. Hand grip strength is a physiological variable that is affected by a number of factors including age, gender and body size. The aim of this study was to obtain relationship among Peak grip strength, grip strength and anthropometric measures in the dominant and non-dominant hands of Children in Nnewi, Southeast Nigeria.
Method: A total of 575 children, aged 4-16, were studied. Each child’s weight, height, age, and hand length were recorded. Their peak grip strength and grip strength were measured on the dominant and the non-dominant hand with the participants seated on a chair with elbow flexed at 900, and forearm in a semi-prone position using Woliobiao hand-held dynamometer.
Result: The results showed that grip strength increased with age except in age 13 in boys and age 15 in girls, where the grip strength in age 12 was higher than at 13 in boys, and the grip strength of 14 years was higher than that of 15years in girls in the dominant hands. In the non-dominant hand, the grip strength increased with age except in age 5 and age 15 in girls where the grip strength at 4 years and 14 years respectively were higher. The anthropometric traits correlated positively with grip strength on both dominant and nondominant hands. Boys also show more strength in their Peak and Grip strength on both dominant and non-dominant hands more than females. Peak grip strength in dominant hands was higher than those of the non-dominant hands across gender. Strong relationship
existed between grip strength, peak grip strength and the anthropometric measures-weight, height and in particular hand length.
Conclusion: Strong relationship exists between grip strength, peak grip strength, and the anthropomrtric measusures (weight, height, and in particular hand length) in children and adolescents of Southeast Nigeria

Keywords: Peak grip strength, Grip strength ,Dominant hand, Non-dominance hand

Casual blood pressure in Port Harcourt, Nigeria

2013-07-22T15:48:38+00:00

Background: Both dietary and lifestyle changes, as well as pharmaceuticals, can improve blood pressure control and decrease the
risk of poor outcome. Casual blood pressure measurement is necessary in poor resource countries like Nigeria because of lack of enough health facilities and personnel.
Method: This is a cross sectional study at the Sharks' Football Stadium, Port Harcourt, Nigeria, conducted in 2008. Blood pressures of subjects were measured using a mercury sphygmomanometer during a self-empowerment exhibition.
Results: One hundred and fourteen (114) subjects' participated in the study. The mean age of subjects was 38.90+0.52 years. Known hypertensives were 7 made of 3 females and 4 males. Three of the known hypertensives had elevated blood pressure.

Conclusion: Casual blood pressure measurement is necessary for early detection of hypertension especially in low resource areas where people do not readily have access to health facilities because of poverty. The high prevalence rates of non-communicable diseases, particularly hypertension, in developing countries is giving much concern.

Key Words: Casual, Blood Pressure, Hypertension, Subjects

Peculiar demographic and risk factors in traumatic brain injury in a tertiary institution in Nigeria: 4-year study

2013-07-22T15:48:38+00:00

Background: Trauma to the head has lately become more important, mostly, when there is associated brain injury, and the incidence is not decreasing. The Accident and Emergency Unit, being the first point of contact in the hospital for these cases, remains a reliable data pool for evaluating them. This study aims at reviewing the peculiar demographic and risk factors of traumatic brain injuries presenting in the Emergency Unit of our institution in order to compare them with previous publications.
Cases and Methods: This is a retrospective study of all cases diagnosed with traumatic brain injury in the Accident and Emergency Unit of our institution during a 4-year period; January 2007– December 2010. Data was collected from the Accident and Emergency records, collated and analyzed.
Results: A total of 14,332 cases presented within the study period, and 1,094 had traumatic brain injury. Most (77.8%) were male, and peak age incidence (31.1%) was in the >21-30year group, with motorcycle related accidents accounting for 57.7%, and mortality rate of 5.4% representing 103 per 100,000 per year.
Conclusion: The major demographic and risk factors in our environment include the male gender, motorcycle riding, young active age and active daytime period. Most of these factors correlated with findings from previous studies, but the incidence and mortality rates in our environment remain much higher than in developed countries.

Keywords: Active age, daytime, head trauma, male, motorcycle riding.