FACULTY OF CLINICAL SCIENCES
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Item Quinolones for short-term treatment of uncomplicated urinary tract infection.(1999) Kadiri, S.; Ajayi, S.O.; Toki, R.A.Objectives: To investigate whether quinolones produce in vivo responses comparable to reported in vitro activity against the spectrum of organisms in uncomplicated urinary tract infection (UTI) in Nigeria, Design: Equal numbers of patients with urine culture positive UTI were randomised to oral quinolone, pefloxacin 400 mg Bd and ofloxacin 200 mg Bd for 5 days. Setting: Out-patient clinics and wards at the University College Hospital. Ibadan. Subjects: Sixty patients aged sixteen years and above with uncomplicated UTI. Main outcome measures: Number of isolates, number of patients with clinical and bacteriological cure one week after commencing therapy. Relative effectiveness and side effects of the drugs. Results: Sixty four bacterial isolates were obtained with the enterobacteriaccae comprising 86%. 62 (97%) were sensitive to both drugs in vitro. Clinical cure occurred in 57 patients (95%), being 28 (93%) in those taking perfloxacin and 29 (97%) in those taking ofloxacin. Bacteriological cure occurred in 55 patients (92%), being 27 (90%) in those taking perfloxacin and 28 (93%) in those taking ofloxacin. 59 of the 64 isolates (92%) were eliminated week, 30 of 33 (91 %) in those taking pefloxacin, and 29 of 31 (94%) in those taking ofloxacin; the difference was insignificant (p=1.16). The enterobacteriaceae were generally susceptible to both drugs. Side effects were minor and infrequent. Conclusion: Quinolones were highly active against the common urinary pathogens in these Nigerian patients and can be reliably employed in treatment when culture results are unavailable.Item Blood pressure changes in haemodialysis: the nigerian experience(1998) Salako, B.L.; Ajayi, S.O.; Kadiri, S.; Arije, A.; Osoba, O.A.The blood pressure changes in haemodialysis were assessed during 59 sessions in 21 patients. Blood pressure was measured with I he corresponding pulse before and subsequently hourly during dialysis, and the patients weights were measured before and after dialysis. The mean systolic blood pressure before dialysis was 170,22 + 29.64mmHg. This showed a statistically sig nificant decrease at l hour. being 167^31.79mmHg (P < 0.002 at 2 hours, being 164.83 + 40.26mmHgwith (P < 0.001). at 3 hours, being 166.84+ 36.94mm Hg (P< 0.001) intradialysis, and immediately after 4 hours of dialysis 166.28 ±35.70mmHg t P < 001). The mean diastolic blood pressure before dialysis of 109.90 + 20.SOmmHg also showed a significant decrease at 1 hour 106.07 + 22.84mmHg (P< 001) 2 hours 105.98+ 22.10mmHg (P < 0.001) and 3 hours intradialysis 107.81 + 25.39mmHg (P< 0.001). These findings suggest that blood pressure changes in haemodialysis are affected by drop in weight that invariably occurs in haemodialysis due to the accompanying process of ultrafiltrationItem Confusion and delirium in acute falciparum malaria infection(1996) Salako, B.L.; Ajayi, S.O.Item Socio-economic implications of the surgical treatment of hydrocephalus(1993) Afolabi, A. O.; Shokunb1, M. T.Between July 1987 and June 1991, 38 patients presented to our service for the surgical treatment of hydrocephalus. The average age at presentation was nine months and the sex ratio was M:F = 1:2: 1. Majority of the patients presented at advanced stage of the disease with gross head enlargement, psychomotor retardation and optic atrophy. Despite the willingness of the parents to have surgical treatment, there was an average delay of six weeks between confirmation of diagnosis and treatment, because of socioeconomic reasons.Item The efficacy of non-drug therapy in cancer pain management(1999-08) Onibokun, A.This study sort to examine the effects of cognitive-behavioural therapy (CBT) on pain intensity (PI), occurrence and control of negative thoughts in response to pain (OCNT) and quality of life (QOL) in breast cancer patients who were experiencing physical pain. A pretest post-test control group quasi- experimental research design was utilised. Ninety patients with breast cancer who were; experiencing physical pain were randomly assigned to three groups. Experimental group I received training in relaxation and guided imagery, white experimental group II had training in cognitive restructuring, in addition to relaxation and guided imagery. The control group received no CBT. The effects of CBT were tested on PI, OCNT and QOL, both among the three groups an between the two experimental groups, using Analysis of Variance and T-test, respectively. Subjects who received CBT experienced low PI than the control group. They perceived significantly fewer OCNT, and their health related QOL were better enhanced as compared with those who received no CBT. .The subjects in experimental group II who had an additional benefit of cognitive restructuring training experienced fewer OCNT than those in experimental group I. There was no significant difference in PI and QOL between experimental groups I and II. The results indicated that CBT plays a significant role in the control of cancer painItem Commonly reported gynecological morbidities and health-seeking behaviours among reproductive age women in urban Nigeria(1998-08) Uwnkwe, C. B. U.; Adoyomi, O. A.; Palayo, J.; Moronkola, O. A.; Onibokun, A.; Ogundiran, A.The present study investigated the commonly reported gynecological morbidities by reproductive age women in some/urban areas of south western Nigeria. Specifically the study attempted to determine the proportion of the reproductive age women surveyed reported the symptoms associated with obstetrics and gynecological morbidity, the perceived causes of such obstetrics and gynecological morbidity in the women, whether such women sought treatment or consultation for specific symptoms, and in what kind of health facilities., The Ex post facto research design was adopted in the study. The subjects used for the study were randomly selected from four health facilities located in the Ibadan metropolis, south western Nigeria. The findings from the study revealed that 91% of the respondents have had cause to report their problem to either government hospital, primary health center, private hospital, a sub-center or traditional hospital. Also, 55% of the respondents had their medium of information about health programmes through the radio, while the remaining 45% had been adequately informed about health programmes through the other media like television, magazines, workshops or seminars. About 80% claimed that they had menstrual disorders of heavy or light irregular bleeding, painful menstruation or spotting between periods, while79.6% claimed to have anaemia indicated by feeling excessively weak, tired or breathless during household activities. Some 60.4% of the respondents claimed to have lower reproductive tract infections while 30.7% stated that they have acute pelvic inflammatory disease, which is the lower abdomen pain or vagina discharge with fever. Also, about 58.4% was the percentage of women who sought or consultation for specific symptoms in the private hospital while the rest used the network of health centers and sub-centers available in their areas under the primary health care system. The implication of this findings were highlighted and discussedItem Psychotherapy in Africa: experience of the group psycho-educational support programme at Ibadan - a preliminary report(1995-11) Onibokun, A. C.; Ohaeri, J. U.; Campbell, O. B.; Adenipekun, A. AAfrica stem from the lack of an appropriate psychodynamic theory ori which to base the technique used. He suggested and experimented with the use of cosmologies (world view) native to the culture (e.g. - the Yoruba Ayanmo myth) in psychodynamic elaborations in therapy. Ohaeri (1989) believed that work along the lines suggested by Morakinyo (1982) be encouraged, but opined that the current socio-economic and cultural changes in Nigeria make it imperative to examine the need for formalized psychotherapy in the contemporary Nigeria. In view of the above coupled with the felt needs of the teaming number of oncology patients at the Cancer Registry of the University College Hospital (U.C.H.), Ibadan, the Lola Marinho Psycho-oncology Counselling Clinic (LMPOC2) was established in July 1992. The clinic now runs a formal psychotherapy programme. With the increased availability of modern methods for diagnosis and the treatment of cancer, our experience has shown that many more cases of cancer now report in hospitals in Nigeria, in particular, at the Radio-therapy Centre of the University College Hospital (U.C.H.), Ibadan, which is the only functioning radio-therapy centre in West Africa sub-region for now. This has offered us the opportunity to enquire into aspects of psycho-oncology. Our goals in this clinic are: 1. to assist the patients and heir family members in becoming more knowledgeable about the disease by providing them with all necessary information. 2. to give support by providing continuity of care. 3. to teach the patients and their family members the necessary skills to cope with the stress of living with cancer. It is an eight session progressive course, which we have developed and used for hundreds of patients at the Lola Marinho Psycho-oncology Counselling Clinic (LMPOC2). The programme is intended for people living with cancer who want to help themselves cope with and combat their disease. It is also meant for those who wish to conduct group teaching skills for people living with cancer and their family members. The paper deals with the efficacy of psychotherapy in improving the quality of life of oncology patients in Nigeria, judging from our experience with our clients at the Lola Marinho Psycho-oncology Counselling Clinic (LMPOC2) of the University College Hospital, Ibadan, Nigeria. The findings pose great challenges to all categories of health care providers, especially Nigerian psychologistsItem THE DEVELOPMENT OF A SCALE FOR PREDICTING MOTHERS COMPLIANCE IN THE EXPANDED PROGRAMME ON IMMUNIZATION (EPI)(1989-08) ADEMOLA, A. H.The apparent high drop out rate in Expanded Programme on Immunization (EPI) is constituting a major barrier in the break-through of the child survival programme especially in developing countries of the World (Alakija, 1986). This cross-sectional, descriptive and explorative study was carried out in Obokun Local Government Area (LGA), Oyo State of Nigeria between October, 1987 and July, 1988. The study population consists of mothers who attended EPI clinics for their children’s immunization under the Expanded Programme on Immunization. Respondents were mothers whose children bad taken the first doses of diphtheria, pertussis, tetanus and Oral polio vaccines (DPT/OPV) between October 1987, and January, 1988. These mothers were classified as compliers if by the end of July, 1988 they had completed the three doses of DPT/OPV schedules. Those who had not completed these three doses were termed non-compliers. Out of 121 mothers used in the study, 65 were compilers while 56 were non-compliers. Data gathering tools used included questionnaire to explore demographic, attitudinal and cognitive factors in these mothers which may affect compliance with EPI appointment schedules. In addition, observational check-list was used to probe into factors which may affect compliance due to clinic settings or arrangements. After analysis of the data, the identified compliance factors were scored to form a predicting scale that can be used to identify those that are likely not to comply with appointment schedules among mothers in EPI Programme so that measures that will make them comply can be instituted from the start. The result showed that the respondents in both compilers and non-compilers were similar in such demographic characteristics as age, marital status and parity. They however differ significantly in demographic characteristics such as educational levels, occupation, income and religion. Also, there were more compilers among mothers who attended orthodox form of ante-natal services, those who had institutionalized deliveries and mothers who brought their children to have first contacts of immunization within their six months of lives. The risk factors that can determine non-compliance with appointments in EPI based on the findings of the study are low- educational level, low income, semi-skilled and non-occupation, non attendance of Orthodox ante-natal services in pregnancy, no immunization during pregnancy, non-institutionalized deliveries, long distance from home to EPI centres, giving herbs as protection to children, delaying the first immunization till children reached ages six months and lastly religions of mothers in which case muslims can default more than Christians. Based on the findings from the study, it is recommended that the health education approach in EPI be modified to include local communication system for rural women since effective communication is the key to implementation of health education activities. In addition future studies should focus on production of predictor scale that will enable the identification of non- compliance among urban/cities mothers.Item CIRCULATING TUMOUR ASSOCIATED ANTIGENS AS AID TO EARLY DIAGNQSIS OF CARCINOMA OF CERVIX(1982-10) ADELUSI, B.Earlier studies by this author in 1976 provided evidence of an association between an infective, sexually transmitted agent, the Herpes Simplex Virus Type-2 (HSV—2) and human carcinoma of the cervix, irrespective of geographic location or ethnic origin of the individuals. Similarly, HSV-2 related antigens were demonstrated by the indirect immuno-fluorescent technique in desquamated cells of carcinoma of the cervix tissues from tumour bearing patients. To highlight the Potentials of the detection of tumour antigens in tumour-faearing patients as aid to early diagnosis of the cancer, Isolation and purification of the Tumour Associated Antigens (TAA) of human cancer of the cervix were attempted by immunological and physicochemical procedures in this study. Two antigen preparations, one the Soluble Antigens (SA), and the other, the Membrane Bound Antigens (MBA) were prepared from a pool of cancer of the cervix (CaCx) tissues. The soluble antigens were extracted by homogenization in Earle’s Balanced Salt Solution (EBSS) containing antibiotics, and the membrane-bound antigens were solublised by 3-molar potassiurn Chloride (3 Molar KCl). For isolation and purification of TAA, procedures for the purification of proteins were explored. These include physicochemical stepwise ammonium sulphate fractionation, sephadex ion exchange chromatography, sephacryl S-200 gel filtration, and affinity chromatography to eliminate the normal tissue components of the antigen fractions. Hyperimmune rabbit sera were then prepared against the partially purified TAA. Immunodiffusion studies, employing hyperimmune rabbit sera prepared against the partially purified TAA were used to demonstrate tumour associated antigens in the various cancer antigen preparations, and Circulating Tumour Associated Antigens (C-TAA) in the sera of tumour- bearing patients. The TAA in the cancer tissues showed lines of identity with the C-TAA in patients sera. Techniques involving adsorption by immuno-precipitation-in-gel with Normal Cervix (NCx) tissue antigen preparations, and pooled Normal Human Sera (NHuS) were utilized for the removal of antibodies to NCx and NHuS in the rabbit sera, after which there were no reactions with NCx indicating the specificity of TAA for CaCx. A comparison of the soluble and 3 Molar KCl extracts of the cancer antigens by immuno-precipitation reaction, using adsorbed hyperimmune rabbit sera prepared against the partially purified CaCx TAA, demonstrated three TAA (TAA-1, close to the central antisera well, TAA-2, intermediate and TAA-3, close to and curving towards the peripheral antigen well) in the soluble antigen preparation. Only one TAA (probably identical to the TAA-3 of the soluble antigen) was demonstrated in the 3 Molar KCl extract. Using the rabbit antisera against the partially purified CaCx TAA, adsorbed with NCx and NHuS, results of coded sera showed that immunodiffusion reaction was able to detect circulating TAA in 75.0 per cent of patients with cancer as compared with 5.6% in women with benign gynecological diseases, 1.4% in pregnant women and 0.0% in healthy control women. The result indicates that the test has great potential for immunodiagnosis of cancer of cervix. Although the sensitivity of the test method was low, the specificity was high, and could provide a means of early diagnosis of neoplastic changes in the cervix. The detection of Circulating-TAA as tumour markers in sera of patients, may someday become routine, and thus make earlier diagnosis of cancer possible. Indications are that immuno-diagnostic procedures can be designed in ways that are reproducible, simple and reliable. Such serological tests would extend our present ability for detection and monitoring of malignancies.Item HERPES TYPE-2 VIRUS AND CARCINOMA OF THE CERVIX UTERI IN NIGERIANS: IMMUNOVIROLOGICAL STUDIES(1976-03) ADELUSI, B.In the search for the etiology of carcinoma of the cervix uteri, various factors have been implicated by various workers. The disease has been shown to have a venereal origin, following on its significant association with coital characteristics. These include early Initiation into hetero-sexual acts and frequency of coitus, multiplicity of coital Partners, multiparity, low socio-economic standards, venereal diseases and circumcision. Extensive epidemiologic studies have indicated that a "venoreally transmitted factor" might be responsible for the introduction of the squamous cell variety of the malignant disease. Recently, a strain of Herpes Simplex virus, antigenically distinct from the strain commonly associated with oral lesions, and designated Genital Herpes or Herpes Type-2 (HT-2) virus, was shown to be venereally transmitted, and might have oncogenic potentialities on the cervix. At the time the present studies were contemplated, little was documented about the clinical and histopathologic presentation of Carcinoma of the cervix in Ibadan. There was also no knowlege of the prevalence of Herpes Type-2 virus antibodies in the population, nor of the precise relationship, if any, of the virus to carcinoma of the cervix uteri in Ibadan. It was clear however, as a result of the work Edington and Maclean (1965) that carcinoma of the cervix uteri is very common in Ibadan, where it was shown to form the commonest female malignancy. Clinical, cytologic, histopathologic and immuno-virologic studies were undertaken to see if indeed carcinoma of the cervix uteri has a venereal origin, and to ascertain whether or not there is any association between the malignancy and HT-2 virus infection in Ibadan. In addition, sero-epidemiologic studies were also undertaken to determine the prevalence of HT-2 virus antibodies in various sectors of the Population. Evidence was provided to show that coital practice was a significant correlate of carcinoma of the cervix in Ibadan. Furthermore, Imuno- fluorescence and complement fixation tests were two Parameters used to provide evidence that Herpes Type-2 virus is associated with the disease, in that carcinoma of the cervix patients possessed significantly levels of antibodies against HT-2 virus as compared with patients having extra-cervical pelvic, and extra-pelvic malignancies and healthy Controls. In addition, HT-2 virus antigens were detected by immunofluorescence tests in the exfoliative cervical cells from all patients with carcinoma of the cervix, whereas no such virus antigens were found in exfoliated cervical cells from healthy Controls. In was concluded, that the observed association between HT-2 virus and carcinoma of the cervix in agreement with other studies, and the fact that the virus was not associated with other extra-cervical malignancies in this environment, indicate a significant relationship. Even though this may not necessarily be an etiologic one, the precise relationship of the virus and the malignancy would have to await further investigation.