FACULTY OF CLINICAL SCIENCES
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Item Impact of metabolic Acidosis on the dialysis dose: findings from a two center cross-sectional study in a low income population setting.(2021) Uduagbamen, P.K.; Ajayi, S.O.; Soyinka, F.O.; Kadiri, S.Background: Metabolic acidosis (MA) still remains a very common finding in patients with end stage kidney disease (ESRD) despite the increasing volume of research on dialysis treatment that have resulted in improved haemodialysis delivery. Its occurrence increases the risk of dialysis termination and inadequate dialysis dose that is associated with poor treatment outcome. The study endeavored to study metabolic acidosis and to determine its relationship with the dialysis dose (Kt/V). Materials and Methods: This was a two centre cross-sectional study involving 298 participants with ESKD who had 1642 sessions of maintenance haemodialysis. Serum electrolytes were analyzed by the Ion-Selective Electrode method and haematocrit was determined using a Hematocrit Centrifuge Results: Two hundred and ninety eight (192 males and 106 females) participants took part with a mean age of 51.44 + 7.31 years (males, 51.18 + 4.62 years, females, 52.14 + 2.93 years), P=0.04. The mean serum bicarbonate concentration, post dialysis (20.61 ± 6.26 mmol/L) was significantly higher than the pre dialysis, 18.41 ± 3.63 mmol/L (P<0.001) concentration. The prevalence of pre and post dialysis metabolic acidosis were 79.0% and 38.3% (P<0.001) There was a significant reduction in the mean anion gap following dialysis (P<0.001). The mean dialysis dose was significantly higher in males than females (P=0.03) and in participants with normal PSBC than participants with low PSBC (P<0.001) Risk factors for metabolic acidosis were advancing age, elevated Body Mass Index and blood pressure. Metabolic acidosis was negatively related to glomerular filtration rate and haematocrit. Aging, lesser dialysis frequency, independently predicted metabolic acidosis Conclusion: Metabolic acidosis is quite common in patients on maintenance dialysis, more common in females, advancing age and in less frequent dialysis treatment. Its occurrence increased the risk of inadequate dialysis.Item Resistivity index in the diagnosis and assessment of loss of renal function in diabetic nephropathy.(2021) Jinadu, Y.O.; Raji, Y.R.; Ajayi, S.O.; Salako, B.L.; Arije, A.; Kadiri, S.Objective: The aim of this study was to determine the haemodynamics of the intrarenal arteries from the relationship between resistivity index (RI) and kidney function, and to identify the predictors of high RI among patients with diabetic nephropathy (DN) and those with diabetes mellitus (DM) without DN. Methods: This was a cross-sectional survey of 133 participants, comprising 40 subjects with DM without DN, 53 with DM with DN and 40 healthy controls. Information obtained was demographics, lifestyle, medical and medication histories, while anthropometric and blood pressure measurements were taken. Albuminuria and estimated glomerular filtration rate were determined and RI was measured using a Doppler ultrasound scan. Results: The mean intrarenal artery RIs were higher among the patients with DM without DN (0.60 ± 0.04) and the group with DM with DN (0.61 ± 0.04) than in the controls (0.56 ± 0.04) (p = 0.02). Glycated haemoglobin (HbA1c) predicted high RI in the DM without DN group (OR 2.81; CI: 1.73–9.03) while hypertension (OR 3.60; CI: 1.06–12.22) predicted high RI in the DM with DN group. Conclusion: Elevated intrarenal artery RI was prevalent among patients with DM without DN and those with DM with DN, while elevated HbA1c level and hypertension predicted elevated RI in subjects with DM without DN and those with DM with DN.Item Pattern of congenital hand anomalies at a tertiary plastic surgery service in south-western Nigeria: a 10-year, cross-sectional retrospective review(2020) Michael, A.I.; Ademola, S.A.; Olawoye, O.A.; Iyun, A.O.; Oluwatosin, O.M.Context: Although congenital hand anomalies are among the more common musculoskeletal anomalies worldwide, we do not know its prevalence in our practice. Aims: The aim of the study was to determine the pattern of congenital hand anomalies presenting to our tertiary plastic surgery outpatient service in South-Western Nigeria. Materials and Methods: This is a cross-sectional retrospective analysis of outpatient cases of congenital hand anomalies presenting over a 10-year period. Descriptive and inferential statistics were performed using frequencies, Student’s t-test and Chi-square as appropriate. The data were analysed using IBM SPSS Statistics 23.0. The statistical significance value was set at P < 0.05. Results: One hundred and twenty-two cases were identified. The highest number of cases was seen in the year 2012, 23 patients (19.3%). There was a male preponderance of 66 patients (55.1%). Thirty-two patients (26.2%) presented as neonates and 36 (29.5%) as infants. Bilateral anomalies were seen in 67 patients (54.9%). The most common anomaly was failure of differentiation, 88 patients (72.1%) followed by duplication, 26 patients (21.3%). Syndactyly with 43 patients (35.2%) was the most common anomaly under failure of differentiation. No significant associations were found between the type of anomaly and gender or laterality. Conclusions: Syndactyly was the most common congenital hand anomaly in this study. There was a preponderance of bilateral involvement in both syndactyly and polydactyly.Item Impact of impaired kidney function on outcomes of Nigerians with COVID-9 infection: report of two cases from the University College Hospital, Ibadan(2021) Raji, Y.R.; Ajayi, S.O.; Abiola, B.I.; Augustine, T.; Adekanmbi, O.; Arije, A.Covid-19 infection predominantly affects the respiratory system; however, other systems and organs are also affected. The kidneys are among the organs commonly affected by SARS-CoV-2 and this has been reported to be a predictor of increased severity, need for intensive care (ICU), admission, and death. We presented two cases of COVID-19 that were associated with co-morbidities that include diabetes mellitus, systemic hypertension and impaired kidney function. The relationship of the multiple co-morbidities particularly the impaired kidney function with the outcomes of COVID-19 infection and the challenges of offering dialysis for patients with COVID-19 infection with kidney failure were discussed. The two cases presented also highlighted the state of preparedness for the management of COVID-19 and its various complications and co-morbidities, particularly kidney failure in a tertiary hospital in Nigeria at onset of the COVID-19 outbreak. WAJM 2021; 38(3): 292–296.Item Time to return to school in child and adolescent burn for patients from a sub-saharan tertiary hospital(Elsevier Ltd, 2019) Michael, A.I.; Ademola, S.A.; Olawoye, O.A.; Iyun, A.O.; Arowojolu, O.; Oluwatosin, O.M.Background: Africa, with the largest number of paediatric burns needs to focus more attention on paediatric burn survivors. Burn injury truncates schooling in child and adolescent burn patients. The aim of this study was to determine the time to return to school and factors influencing this in child and adolescent burn patients. Methodology: A cross-sectional study of child and adolescent patients aged one to nineteen years that had been managed for bun injuries. Demographic variables were obtained from archived computerized data. Phone interviews were conducted to obtain time to return to school variables using a questionnaire. Descriptive statistics, students t test, fishers exact test and Chi square test were uses as appropriate for analysis on data on SPSS version 23. A p value <0.05 was considered statistically significant. Results: Thirty-one patients were recruited for the study. There was a female preponderance, 19 (61.3%). The mean age of the patients was 7.2 (±5.3) years. Scald injuries were the commonest [N = 14 (45.2%)] cause of burn. The mean Total Burn Surface Area (TBSA) was 14.1 (±12.0)%. The mean length of hospital stay was 30 (±59) days. The mean time to return to school after discharge from the hospital was 8.4 (±8.7) weeks. The occurrence of burns on the trunk was significantly (p = 0.048) associated with an earlier time to return to school. Conclusion: Time to return to school from burn injury and from discharge in child and adolescent burn survivors in this study are at least three times longer than previous studies. The burn care team needs to consider school re-entry programs for these children.Item Impact of impaired kidney function on outcomes of Nigerians with COVID-9 infection: report of two cases from the University College Hospital, Ibadan(2021) Raji, Y.R.; Ajayi, S.O.; Abiola, B.I.; Augustine, T.; Adekanmbi, O.; Arije, A.Covid-19 infection predominantly affects the respiratory system; however, other systems and organs are also affected. The kidneys are among the organs commonly affected by SARS-CoV-2 and this has been reported to be a predictor of increased severity, need for intensive care (ICU), admission, and death. We presented two cases of COVID-19 that were associated with co-morbidities that include diabetes mellitus, systemic hypertension and impaired kidney function. The relationship of the multiple co-morbidities particularly the impaired kidney function with the outcomes of COVID-19 infection and the challenges of offering dialysis for patients with COVID-19 infection with kidney failure were discussed. The two cases presented also highlighted the state of preparedness for the management of COVID-19 and its various complications and co-morbidities, particularly kidney failure in a tertiary hospital in Nigeria at onset of the COVID-19 outbreak. WAJM 2021; 38(3): 292–296.Item Latex glove conduit as improvised blood vessel model for microvascular anastomosis training(Elsevier Ltd, 2020) Aderibigbe, R.O.; Ademola, S.A.; Michael, L.A.; Olawoye, O.A.; Iyun, A.O.; Oluwatosin, O.M.Background: In the growing need of microvascular surgery in modern-day plastic surgery, financial burden on surgeon or institution can discourage acquisition of skill particularly in the initial phase of laboratory simulation. This article describes the construction of a cheap, easy-to-make blood vessel model. Materials and method: The model was made using infusion giving set, latex glove, scissors, tape measure and Swan glue CD 308. A cut sheet from the latex glove was rolled twice over two glue- painted segment of the infusion giving set stent. The stents were gently pulled out, turning the sheet into a conduit. The blood vessel model was then allowed to dry. Discussion: The use of latex glove for initial training in microvascular anastomosis has been for long. Previously described productions into a conduit are cumbersome. This model is easy to construct and is useful in an office or dry laboratory setting. Conclusion: The latex glove blood vessel model described in this article is a useful material in the training of budding microsurgeons. Residents in our institution have reported a very good learning experience with its use.Item Management of lower extremity soft-tissue sarcoma in a sub-saharan african teaching hospital: case reports(2019) Ayandipo, O.O.; Ademola, S.A.; Afuwape, O.O.; Michael, A.I.; Elemile, P.O.; Udonsak, N.S.Background: Soft-tissue sarcomas are relatively rare tumors and can occur in many parts of the body. When they affect the body extremities, their management can be challenging, often leading to limb amputation. Recent advances in surgery, adjuvant therapy, and better collaboration among different surgical specialists, medical and radiation oncologists, coupled with management in specialized centers have led to an upsurge in limb preservation. However, this is not obtainable in many centers in the developing countries. We report cases of soft-tissue sarcoma of the lower limb in two patients managed in a tertiary center in sub-Saharan Africa and the challenges encountered in their management. Case Reports: Two patients presented to our hospital with progressive painless masses on the lower third of their legs. Evaluation suggested that the masses were malignant. They both had wide local excision. The first patient had reconstruction with island sural artery fasciocutaneous flap, whereas the second had reconstruction with freestyle propeller flap. The postoperative periods were uneventful, and timely adjuvant therapy was commenced. Limb function was preserved in the two patients. Conclusion: Treatment of soft-tissue sarcomas of the limbs could be tasking, but multispecialty surgical intervention and adequate adjuvant therapy could give favorable result and a functional limb postoperatively.Item Otitis media with effusion and hearing loss in childen with orofactial clefts.(2019) Olije, T.; Fasunla, A.J.; Onakoya, P.A.; Ademola, S.A.; Adeosun, A.A.Background: Little or no attention is given to hearing health of children with orofacial cleft. This study was carried out to determine the prevalence of otitis media with effusion (OME) and evaluate hearing thresholds of children with orofacial cleft in Nigeria. Methodology: Eighty-three consecutive children with orofacial cleft comprising, 12 (14.5%) cleft lip alone, 32 (38.5%) cleft lip and palate and 39 (47.0%) cleft palate alone, and 83 healthy controls participated in the study. Structured questionnaire was used to collect socio-demographic and relevant medical information. Participants had ear, nose and throat examinations, visual reinforcement or condition play audiometry and tympanometry tests done. Statistical analysis was done with appropriate statistical tools, level of significance was set at p<0.05. Results: Mean age of cases was 22.83 ± 2.71 months and controls was 23.34 ± 2.54 months. Hearing loss was found in 28 (16.9%) ears of cases and 14 (8.5%) ears of controls (p=0.021). There was a significant difference between mean hearing thresholds of cleft palate ± lip and control (p<0.05). OME was present in 80 (48.2%) ears of cases and 17 (10.2%) ears of the controls (p=0.001). There was a statistically significant association between cleft palate ± lip and OME (p=0.0001, OR = 4.520 [2.353-8.681]). Conclusion: Otitis media with effusion and hearing loss were more prevalent among children with orofacial cleft palate than non-cleft children. Hence, routine early hearing and middle ear evaluations are recommended for inclusion in their management plan.Item State distribution of new patients presenting with cleft lip and palate to the university college hospital: a pilot study.(2018) Michael, A.I.; Olusanya, A.A.; Olawoye, O.A.; Ademola, S.A.; Iyun, A.O.; Akinmoladun, V.L.; Oluwatosin, O.M.Background: The UCH/Smile Train partnership, which offers free cleft surgeries to patients provides succor. Objective: The objective of the study was to determine the state distribution of new patients presenting with cleft lip and palate, to The UCH. Method: A retrospective review of all new cleft patients presenting to The UCH between January 2012 and June 2015. The data obtained were their local government area of residence, age of the patients, gender of the patients and the type of cleft. Descriptive statistics was used to analyze the distribution of patients seen while Chi square test was used to analyze the influence of gender and laterality on the type of cleft. Results .'Sixty-seven eligible patients were seen within the study period. Majority (83.6%) of patients seen were from 14 of the 33 Local Government Areas (LGA’s) in Oyo state. Patients were seen from LGA’s in proximity to UCH. A few (16.4%) of the patients came from outside the state. Iwajowa, the LGA with the least number of patients (1.8%) was furthest from UCH. Left sided clefts were significantly more than bilateral or right-sided clefts (p=0.001). Most of the patients from Oluyole LGA had CP while no patient with CP was seen from Lagelu and Akinyele LGA’s. Conclusion: There is the need to intensify cleft awareness programs. Further studies into the health habits, cultural beliefs and genetic profile of communities may explain some regional distribution of cleft types seen.