FACULTY OF CLINICAL SCIENCES

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Start date: 2000End date: 2009

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    Hypertensive patient in the surgical ward - what the Surgeon should do
    (2004) Akute, O. 0; Olubowale, 0. 0|; Aghahowa, M. E; Afolabi., A. 0
    Two cases of hypertension are presented to emphasize the need for the surgeons to pay adequate attention to these purely medical conditions that may have a devastating adverse effect on the outcome of surgery. The article also highlights the serious constraints that still characterize the management of these patients in this part of the world. The ideal situation is a multi-disciplinary approach involving the Surgeon, the Physician and the Anaesthetist. The surgeon must not confine himself to the technical aspect of the surgery alone. The hypertension must be controlled whether the patient presents with an elective or emergent surgical condition and anti-hypertensive medication must be continued up till the time ofsurgery and at times intra-operatively. It is not only unnecessary hut also potentially dangerous to withdraw anti-hypertensives before anaesthesia. The main goal of the surgically amenable secondary hypertension is to remove the cause ofter adequate control of the hypertension in preparation for surgery. Patient however must be made to understand that the hypertension may not be "cured" and the anti-hypertensive medication may have to be continued post-operatively particularly if the hypertension is long established before patient presents. Local and/or regional blocks are to be preferred to general anaesthesiafor peripheral lesions and even then it is still preferable to have the hypertension controlled.
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    Recurrent leg ulcers in a 16-year old Nigerian girl
    (2003) Afolabi, A.O
    This is a report of a 16-year old Nigerian girl who presented with recurrent leg ulcers associated with gastrointestinal symptoms. The management of this patient, who has ulcerative colitis manifesting with pyoderma gangrenous, underlines the need for thorough evaluation of cutaneous ulcers in the tropics. The medical treatment of ulcerative colitis in childhood, with reservation of bowel resection for complications is preferred.
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    Penetrating abdominal injuries in children
    (2002) Idowu, O. E.; Ogunsanya, W. F. O; Afolabi, A. O; Olapade-Olaopa, E.O
    Traumatic injuries are leading causes of morbidity and mortality in children. The ubiquity of various types of weaponry (which is culturally and geographically dependent) has created an epidemic of violence that is spreading into all walks of life, and affecting all ages. The abdomen is the third most commonly injured region in children; 20% of the abdominal injuries are of the penetrating variety, the small intestine being the most commonly injured organ. In this article two illustrative cases of penetrating abdominal injury (PAI), causes, mechanism and pathophysiology of PAI, resuscitation and evaluation are presented. Treatment options with particular reference to the four commonly injured viscera and experience are also discussed.
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    Emergency obstetric patients in a developing country and prevalence of HIV infection
    (2009) Awolude, O. A.; Oladokun, A.; Adesina, O. A.; Mutiu, W. B.; Adewole, I. F.
    The availability of VCT for HIV for booked antenatal patients offers a unique opportunity for best obstetrics practice but not for patients presenting with emergencies and unknown HIV status. Health workers who attend to such patients are at higher risk of acquiring HIV infections. Between 1st March 2005 and 30th September 2007, unbooked emergency obstetric patients in the labour ward of a teaching hospital who consented were tested using double rapid immunodiagnostic technique and confirmed by Western Blot. HTV positive patients were post-test counselled and offered single dose nevirapine tablet (200mg) in labour with syrup given to the baby at birth at 2mg/kg followed by syrup zidovudine for 6 weeks: The results showed that 275 (89.0%) of the 309 women pre-test counselled agreed to testing. The mean age of clients was 27.7 years (± 4.4 SD). The mean gestational age at presentation was 36.4 weeks (± 4.2 weeks). Primigravidae constituted 37.5% of the patients. Twenty-one (7.6%) of these consenting patients were H3V positive. In conclusion, the HIV prevalence of 7.6% among these unbooked obstetric patients is higher than the 4,7% among our booked antenatal patients and National prevalence of 4.4%. This poses substantial risk of transmission of HIV to attending health workers considering the readiness with which needle prick accident can occur in emergency situations.
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    Pregnancy outcome in diabetic patients at University College Hospital, Ibadan
    (2003-04) Oladokun, A.; Aimakhu, C. O.; Aimakhu, C. O.; Awolude, O. A.; Olayemi, O.; Adeleye, J.
    Context: Diabetes mellitus is one of the common medical complications in pregnancy, which if not properly controlled, can lead to significant perinatal and maternal morbidity and mortality. Objective: To determine the incidence of diabetes mellitus in pregnancy in this centre, and to assess the effect of maternal glucose control on the obstetric performance as well as perinatal outcome of pregnant diabetics managed at the University Collage Hospital, Ibadan. Study Design: A review of the obstetric outcome for 49 diabetic women who delivered at the University College Hospital, U.C.H, Ibadan, Nigeria during a 1 0-year period (January, 1991 t o D ecember 2 000) i s presented. Results: The incidence rate of diabetes in pregnancy was 0.74 per 1000 deliveries per year. Most patients (89.8%) booked for antenatal care and delivery in this centre. Good control was achieved in 77.6% of patients and the mean birth weight was 3.37 ± 1.52kg. There was no significant difference in the birth weight and fetal outcome if a patient had pre-existing or gestational diabetes. However, the outcome was significantly related to the level of control. With good control there was a better Apgar score at 5 minutes, which was prognostic for fetal outcome. The perinatal mortality rate was 98/1000 births and this was significantly associated with poor control when compared with good control (p < 0.05). There was no maternal death. Conclusion: Further improvement in the management is needed. Preconception control, early antenatal booking and good control in pregnancy are strongly advocated as means of achieving good pregnancy outcome.
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    The challenges of single-short spinal anaesthesia for caesarean section in a morbidly obese patient: a case report
    (2005-10) Danladi, K. Y.; Sotunmbi, P. T.; Awolude, O. A.; Obisesan, K. A.
    An unusual case of morbid obesity, severe hypertension and twin gestation at 36weeks in an unbooked multigravid patient was presented for cesarean section. She was referred from a private clinic to the obstetric emergency unit of the University College Hospital, Ibadan with history of hypertension in pregnancy. She was a known hypertensive for ten years and her blood pressure was poorly controlled due to non-compliance with medications and medical check-up. She had been having progressive visual loss over the ten year period and had lost three, previous pregnancies. Following comprehensive clinical and radiological evaluation, she had a carefully planned single-shot spinal anaesthesia for cesarean delivery of a set of twin which was performed on a double operation table. She remained stable throughout the procedure and post operative period.
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    Complete hydatidiform mole co-existing with a twin live fetus
    (2001) Obisesan, K. A.; Adesina, O. A.; Awolude, O. A.
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    Rectovaginal and vesicovaginal communications following coital injury
    (2001) Odukogbe, A. A.; Onifade, R. A.; Adewole, I. F.; Adesina, O. A.; Awolude, O. A.
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    Screening for premalignant lesion of the cervix: determinants of patients’ practices
    (2005) Awolude, O. A.; Adesina, O. A.; Oladokun, A.; Adewole, I. F.
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    The role of ethnicity on pain perception in labour among parturients at the University College Hospital
    (2009-04) Olayemi, O.; Morhason-Bello, I. O.; Adedokun, B. O.; Ojengbede, O. A.
    Aims: In developing countries, the major mechanism by which parturients cope with labor pain is psychological. This study aims to assess the effect of ethnicity on the perception of pain by parturients in labor at the University College Hospital, Ibadan. Materials and Methods: The study was conducted between the 1 November 2006 and the 30 March 2007 at the University College Hospital Ibadan. The main outcome measure was pain perception assessed by the Box Numerical Scale (BNS). Univariate analysis was by t-test for continuous variables and c2 test for categorical variables. The multiple linear regression method was utilized for multivariate analysis. The level of statistical significance was set at P < 0.05. Results: The lowest adjusted mean BNS score was found in theYoruba ethnic group: they had scores lower than the mean scores for the other ethnic groups (-0.636 [95% confidence interval (CI) -0.959, -0.313]). The presence of a doula also reduced the mean BNS scores significantly (-0.533 [95% CI -0.844, -0.222]. Increasing parity also reduced pain scores (-0.182 [95% CI -0.342, -0.022]). Increasing educational attainment increased pain scores in labor (0.189 [95% CI 0.017, 0.361]). The influence of increasing age was not statistically significant in this model. In conclusion, ethnicity of the parturient relative to that of the predominant ethnicity in the place of birth has a significant effect on the perception of labor pain by the parturient. In our resource-challenged environment, trained doulas may help make labor less painful for the parturient