FACULTY OF CLINICAL SCIENCES

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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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    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.
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    Evaluation of histopathology examination of routine tonsillectomy and adenoidectomy specimens in developing countries
    (2011) Adeyemo, A. A.; Okolo, C.; Ogunkeyede, S. S.
    Objective: Healthcare costs are usually borne directly by patients or relations in developing countries; therefore reducing waste in the system is very important. This study aims to determine the necessity of full histopathology examination in routine tonsillectomy and adenoidectomy in children. Methods: A retrospective chart review of patients 18 years and younger who underwent tonsillectomy and/or adenoidectomy between January 1986 and December 2006 at the University College Hospital, Ibadan, Nigeria was done. The age, sex, surgical procedure and pathology results were recorded. Histology reports were broadly classified into: non-neoplastic and neoplastic pathologies. Charts of neoplastic pathologies were pulled and the medical history reviewed. Results: A total of 244 patients met the inclusion criteria with a mean age of 5.3 ±4.7 years. There were 150 males (61.5%) and 94 females (38.5%). Tonsillectomy and adenoidectomy were performed together on 74 patients (30.3%) while tonsillectomy and adenoidectomy alone were performed on 60 (24.6%) and 110 (44.7%) patients, respectively. Review of the pathology reports revealed two cases of malignancies with an incidence of 0.82%. Conclusion: Medico-legal factors will suggest the review of all surgical specimens. Therefore it is important to identify innovative approaches to reduce costs of histopathology examination in routine tonsillectomies and adenoidectomies
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    Metastatic cervical lymphadenopathy masquerading as extrapulmonary tuberculosis
    (2012) Adeyemo, A. A.
    Introduction: Cervical lymphadenopathy can be due to various pathologies especially in the young. A high index of suspicion is required in the management of cervical lymphadenopathy to prevent misdiagnosis and wrong treatment. Case report: Here present the diagnostic challenge in the case of a young lady with nasopharyngeal carcinoma who initially presented solely with cervical lymphadenopathy. Previous fine needle aspiration cytology had suggested tuberculosis (TB) and she was commenced on anti-TB drugs. However failure of improvement and worsening symptoms led to another review in ENT clinic. A subsequent nasopharyngeal biopsy confirmed nasopharyngeal carcinoma. She subsequently improved after commencement of appropriate treatment. Conclusion: In regions with a high prevalence rate of tuberculosis, care must be taken to exclude malignancy in patients with cervical lymphadenopathy even when cytology suggests a granulomatous infection
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    Knowledge of caregivers on the risk factor knowledge factors of otitis media
    (2012-10) Adeyemo, A. A.
    Introduction: Otitis media (OM) is common in children. In developing countries, it is the most common cause of hearing impairment. Many factors predispose to OM, some of which are modifiable through lifestyle changes. This study aimed to determine the knowledge of caregivers on the risk factors (RFs) associated with OM and their willingness to modify their lifestyle to reduce the risk of OM. The impact of socioeconomic status (SES) on the knowledge and willingness in lifestyle alteration was also assessed. Materials and Methods: This is a prospective study using a modifi ed Ear Infection Survey questionnaire. The SES of caregivers/mothers was determined, and they were interviewed to determine their knowledge of RFs for OM and their willingness to undergo lifestyle modifi cations. Results: One hundred caregivers (96 females) were interviewed, majority of whom (81%) were in the higher SES. There were signifi cant differences between low and high SES in day care attendance, siblings and parents with history of OM. Apart from daycare attendance and household smokers, all other RFs were higher among the lower SES. Individuals from low SES background had poorer knowledge of the RFs for OM. A strong willingness to modify behavior to avert a surgical procedure for OM is seen in both groups. Conclusion: Caregivers in both SES groups were willing to undergo behavioral modifi cations in reducing the risk of OM; utilizing this knowledge in educational programs will help to reduce the prevalence of OM in children. This must be coupled with training and encouragement of health workers to disseminate information on RFs of OM
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    Pediatric head and neck malignancies in sub-Saharan Africa
    (2012) Adeyemo, A. A.; Okolo, C. A.
    Introduction: Cancers are relatively rare in children however recent reports suggest that malignancies are becoming a major source of pediatric deaths. Method: Using the database of the cancer registry of the University College Hospital, Ibadan we reviewed all newly diagnosed cases of head and neck cancers in children under 19years old at the hospital between 1981 and 2008. Results: A total of 1,021 cases of Head and Neck cancers were seen in children. The hospital based incidence of pediatric head and neck cancers is 36 cases per year. There were 627 males and 394 females [M:F ratio of 1.6:1] with mean ages of 8.21 and 7.70 years respectively. Boys were more affected than girls in all years of life while the peak age of onset for both sexes is the third year of life. The commonest anatomical site involved is the eye/orbit; other common sites were the nasopharynx, paranasal sinuses, nasal cavity and thyroid gland. Neural malignancies constitute the commonest malignancies seen (35.3%), other are lymphomas (33.1%), squamous cell carcinoma (9.1%) and soft tissue sarcoma (8.6%). Retinoblastoma is the commonest lesion seen among the patients with a slight male preponderance [M:F ratio of 1.2:1] Burkitt lymphoma (BL) is seen in all age groups but there is greater frequency in the older ages. The incidence of carcinomas is higher in the older age groups, relatively rare lesions like Hodgkins lymphoma and thyroid malignancies are almost exclusive to older children. Conclusion: The pattern of head and neck malignancies in children in sub-Saharan Africa is changing; dominant lesions like lymphomas are being gradually replaced by other malignancies such as neural malignancies, soft tissue sarcomas and squamous cell carcinoma
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    Asynchronous video-otoscopy with a telehealth facilitator
    (Mary Ann Liebert , Inc, 2013-04) Biagio, L.; Swanepoel, D. W.; Adeyemo, A. A.; Hall, J. W.; Vinck, B.
    Objective: The study investigated whether video-otoscopic images taken by a telehealth clinic facilitator are sufficient for accurate asynchronous diagnosis by an otolaryngologist within a heterogeneous population. Subjects and Methods: A within-subject comparative design was used with 61 adults recruited from patients of a primary healthcare clinic. The telehealth clinic facilitator had no formal healthcare training. On-site otoscopic examination performed by the otolaryngologist was considered the gold standard diagnosis. A single video-otoscopic image was recorded by the otolaryngologist and facilitator from each ear, and the images were uploaded to a secure server. Images were assigned random numbers by another investigator, and 6 weeks later the otolaryngologist accessed the server, rated each image, and made a diagnosis without participant demographic or medical history. Results: A greater percentage of images acquired by the otolaryngologist (83.6%) were graded as acceptable and excellent, compared with images recorded by the facilitator (75.4%). Diagnosis could not be made from 10.0% of the video-otoscopic images recorded by the facilitator compared with 4.2% taken by the otolaryngologist. A moderate concordance was measured between asynchronous diagnosis made from videootoscopic images acquired by the otolaryngologist and facilitator (j = 0.596). The sensitivity for video-otoscopic images acquired by the otolaryngologist and the facilitator was 0.80 and 0.91, respectively. Specificity for images acquired by the otolaryngologist and the facilitator was 0.85 and 0.89, respectively, with a diagnostic odds ratio of 41.0 using images acquired by the otolaryngologist and 46.0 using images acquired by the facilitator. Conclusions: A trained telehealth facilitator can provide a platform for asynchronous diagnosis of otological status using video-otoscopy in underserved primary healthcare settings
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    Traumatic brain injuries in children: a hospital-based study in Nigeria
    (2013-06) Udoh, D. O.; Adeyemo, A. A.
    Background: Traumatic Brain Injury (TBI) is a significant cause of morbidity and mortality worldwide. Our previous studies showed a high frequency of motor vehicle accidents among neurosurgical patients. However, there is a dearth of data on head injuries in children in Nigeria. Aims: To determine the epidemiology of paediatric traumatic brain injuries. Setting and Design: This is a prospective analysis of paediatric head trauma at the University of Benin Teaching Hospital, a major referral centre for all traumatic brain injuries in Nigeria between October 2006 and September 2011. Materials and Methods: We studied the demographic, clinical and radiological data and treatment outcomes. Data was analysed using statistical package for the social sciences (SPSS) 16.0. Results: We managed 127 cases of paediatric head injuries, 65 boys and 62 girls representing 13% of all head injuries managed over the 5-year period. They were aged 3 months to 17 years. The mean age was 7.4 years (median 7 years) with peak incidence occurring at 6-8 years i.e. 31 (24.4%) cases. Motor vehicle accidents resulted in 67.7%, falls 14% and violence 7%. The most frequent computed tomography finding was intracerebral haemorrhage. Mean duration of hospitalization was 18 days (median 11 days). Eleven patients died, mortality correlating well with severity and the presence of intracerebral haematoma. Conclusion: Head injuries in children are due to motor vehicle and motor vehicle-related accidents. Hence, rational priorities for prevention of head injuries in children should include prevention of vehicular, especially pedestrian, accidents in developing countries