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   Table of Contents - Current issue
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April-June 2022
Volume 12 | Issue 2
Page Nos. 1-118

Online since Monday, August 29, 2022

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ORIGINAL ARTICLES  

Is blood transfusion justified during soft tissue surgery in Noma patients? A one-year appraisal at Noma Children Hospital, Sokoto, Nigeria Highly accessed article p. 1
Mujtaba Bala, Olalere Omoyosola Gbolahan, Abdurrazaq Olanrewaju Taiwo, Ramat Oyebunmi Braimah, Adebayo Aremu Ibikunle, Muhammad Kaura Abubakar
DOI:10.4103/jwas.jwas_55_22  
Background: Non-utilization of blood and inappropriate blood transfusion are common in surgical operations. Some surgical procedures are associated with minimal bleeding that does not warrant blood transfusion. No previous study has looked at the pattern of blood loss in noma defect repair to determine the possible need for blood transfusion. Aim/Objectives: This study aimed to determine the total amount of blood loss, the number of units of blood transfused, and the correlation between estimated blood loss and total operating time in patients who had surgical correction of noma defects. Materials and Methods: This is a hospital-based cross-sectional study of 35 patients who underwent surgical correction of noma defects. Age, sex, pre- and post-operative haemoglobin (Hb), number of requested blood units, total operating time, and total estimated blood loss were recorded. The methods used for the blood loss estimation were gauze swabs, Abdo-packs, drapes, and suction bottles. Results: Comparison of the mean pre- and post-operative Hb did not yield any statistically significant difference. The total estimated blood loss in these surgeries was in the range of 65–209 mL, with a mean of 117.20 ± 35.88 mL. No correlation between estimated blood loss and total operating time was noted (P = 0.940). No blood was transfused in any of the subjects. Conclusion: This study observed minimal blood loss in surgical corrections of the soft tissue noma defect. Apart from blood grouping, there may be no need for routine cross-matching of blood pre-operatively for surgical repair of noma defect. However, more studies are needed to buttress this finding.
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Eye health-seeking behaviour of traders in rural Nigeria p. 7
Adaora Amaoge Onyiaorah, Nkiru Kizor-Akaraiwe, Sebastian N N Nwosu
DOI:10.4103/jwas.jwas_62_22  
Aim: The aim of this article was to determine the healthcare provider first sought, reasons for the choice, and symptom duration before hospital presentation among traders in rural Nigeria. Materials and Methods: This was a cross-sectional study of traders at a rural Nigerian market, selected by systematic random sampling. A structured questionnaire was used to obtain information on sociodemographics, eye disease symptoms, eye care provider first sought, and reasons for choice. The analysis was carried out with Statistical Package for Social Sciences using descriptive and inferential statistics with an alpha level at 0.05. Results: Of the 177 traders, 88 (49.7%) were males and 89 (50.3%) were females. The mean age was 46.5 ± 13.75 years (range 19–72). Of the 83 traders who had ocular symptoms 23 (27.7%) never sought any care. The eye care providers first sought were patent medicine vendors 22 (26.5%), orthodox hospital 17 (20.5%), eye glass vendors 3 (3.6%), and traditional healers 3 (3.6%). The median symptom duration before presentation to an eye health facility was 83 days. Reasons for not seeking orthodox eye care first included cost 33 (39.8%), ‘ailment not serious’ 22 (26.5%), and advice from friends 7 (8.4%). Females were more likely to seek orthodox care (χ2=4.22, P=0.04), whereas males were more likely to feel that their ailment was not serious. Traders aged >50 years were less likely to seek any care for eye ailment (χ2 =8.41, P=0.04). Conclusion: Traders with eye disorders seek care late and most first seek care outside the orthodox hospital. Cost and feeling that ailment was not serious are barriers to seeking orthodox eye care. Eye health education and cost reduction would improve uptake of orthodox eye care services.
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Fibreoptic laryngoscopic assessment of patients with hoarseness: A cross-sectional analysis Highly accessed article p. 12
Auwal Adamu, Emmanuel Sara Kolo, Abdulrazak Ajiya, Ahmad Mahmud, Iliyasu Yunusa Shuaibu, Onyekwere George B Nwaorgu
DOI:10.4103/jwas.jwas_75_22  
Background: Hoarseness is a common clinical manifestation of laryngeal diseases. The cause of hoarseness may not always be a simple inflammatory disease, but it can be from other serious life-threatening conditions such as laryngeal cancer, for which a delay in diagnosis of such condition may compromise treatment, resulting in poor prognosis and a decreased survival rate. Against this background, we evaluated the causes of hoarseness using fibreoptic laryngoscopy in our environment. Materials and Methods: This was a cross-sectional study of patients with hoarseness attending ENT clinic of our institution. Ethical clearance and consent were obtained. A questionnaire was used to collect relevant clinical data, fibreoptic laryngoscopy was carried out, and the data was analysed using the Statistical Products and Service Solution version 20.0. Results: The study recruited 90 patients with hoarseness. The age of the patients ranged between 18 and 70 years with a mean of 40.1 ± 14.8 years. There were 51 (56.7%) males and 39 (43.3%) females. About 46 (51.2%) of the patients had intermittent hoarseness, whereas 44 (48.8%) had persistent hoarseness. Most of the patients, 49 (54.4%), had hoarseness for less than 6 months before presentation. The fibreoptic laryngoscopic findings were non-specific laryngitis 49 (54.5%), laryngeal tumor 20 (22.2%), vocal cord polyp 7 (7.7%), laryngeal papilloma 6 (6.7%), vocal cord palsy 5 (5.6%), and others 3 (3.3%). Conclusion: Laryngeal tumour constituted a significant percentage of fibreoptic laryngoscopic findings in patients with hoarseness after nonspecific laryngitis. Therefore, fibreoptic laryngoscopy is recommended for all patients with hoarseness in order to detect sinister pathology early.
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Pit pattern analysis of colorectal polyps using Storz professional image enhancement system (SPIES) endoscopy: A pilot study p. 17
Emeka Ray-Offor, Fatimah Biade Abdulkareem, Nze J Jebbin
DOI:10.4103/jwas.jwas_96_22  
Background: Endoscopic management of colorectal polyps includes detection, characterization, and therapeutic strategies. Pit pattern analysis is a useful tool when differentiating neoplastic and non-neoplastic colorectal polyps. Aim: To correlate pit pattern characterization of colorectal polyps using SPIES endoscopy and the histopathology. Materials and Methods: Total colonoscopy was performed on 189 patients by same endoscopist from January 2020 to September 2021 using Image 1 Connect (TC200), Image 1 H3-Link (TC300) and video-colonoscope (Karl Storz, Tuttlingen, Germany). Identified polyps were classified using Paris classification for mucosal lesions and the pit pattern according to Kudo’s modified criteria using SPIES endoscopy. All lesions were diagnosed by histopathological examination. Kappa index (κ) was used to evaluate the agreement of SPIES endoscopy Kudo’s pit classification with the histopathological diagnosis. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were independently determined. Result: Thirty-four polyps were detected in twenty-nine patients with twenty-one (61.8%, 21/34) polyps histologically confirmed as neoplastic. SPIES endoscopy characterized seventeen (50%, 17/34) of the polyps as neoplastic, four (1.8%, 4/34) as non-neoplastic (false negative) and four (1.8%, 4/34) as false positives. The sensitivity and specificity of SPIES endoscopy were 81.0% and 69.2% respectively and same values for PPV and NPV. The diagnosis of neoplastic polyps by SPIES endoscopy was in moderate agreement with histopathological diagnosis (κ = 0.502)Conclusion: SPIES endoscopy is a useful, rapid, and non-invasive tool in the endoscopic assessment of colorectal polyps.
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Day case anterior cruciate ligament reconstruction surgery – A study of early treatment outcomes in a regional orthopaedic centre p. 23
Oladimeji Ranti Babalola, Shopekhai E Itakpe, Tale Olajire Oladunjoye, James Imeh Akpan, Christian C Madubueze, Temitayo Koyejo
DOI:10.4103/jwas.jwas_125_22  
Background: Day-case anterior cruciate ligament reconstruction has the potential benefit of reduced hospital stay and reduced cost of care. The goal of this preliminary report was to compare the outcome of day-case arthroscopic anterior cruciate ligament reconstruction with those of in-patient care in terms of pain control and short-term functional outcome. Materials and Methods: This was a prospective comparative study involving patients who had anterior cruciate ligament reconstruction performed in our unit between January 2019 to July 2021 for isolated anterior cruciate ligament rupture. The patients were offered the option of in-patient and day-case anterior cruciate ligament reconstruction. All cases were isolated anterior cruciate ligament ruptures with no other ligament injury. Results: A total of twenty-one-day case and twenty-five in-patient anterior cruciate ligament reconstruction were managed during the period of the study. The median numeric pain scores at day 2 and 7 in the day case group was 8.0 (IQR=2.0) and 5.0 (IQR= 3.0) respectively and in-patient group was 7.0 (IQR =1.5) and 4.0 (IQR= 2.0) respectively. The international knee documentation score (IKDC) at 6 months in the day case and in-patient groups were 68.6 (IQR= 9.3) and 67.2 (IQR= 25.0) respectively. The Mann-Whitney U test indicated that patients who had ACL reconstruction on in-patient care basis had statistically significant lower visual analogue scale pain scores on the second (z=-2.58, P = 0.01) and seventh (z=-3.41 P = 0.001) post-operative days compared to patients who had ACL reconstruction on day case basis. There was no statistically significant difference in the median IKDC scores of both groups at 6 months. The cost of care in the day case group was 40% lower than those of the in-patient group. Conclusion: Although the cost of care in the day case group appeared lower as compared to the in-patient group, the day case group had higher post-operative pain scores compared to the in-patient group. Although the post-operative functional scores were similar in both groups, this was not statistically significant
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A comparison of the effect of isoflurane and propofol on liver enzymes p. 28
Motunrayo Adebukunola Oladimeji, Ibironke Desalu, Oyebola Olubodun Adekola, Olanrewaju Akanmu, Adeniyi Abiodun Adesida
DOI:10.4103/jwas.jwas_69_22  
Background: Isoflurane and propofol are routinely used for the maintenance of general anaesthesia. However, recently, they have been implicated in hepatotoxicity resulting in acute liver failure. Objective: We compared the effects of isoflurane and propofol on liver enzymes; aspartate transaminases (AST), alanine transaminases (ALT), alkaline phosphatase (ALP) and total bilirubin (Tbil) following general anaesthesia. Materials and Methods: This randomized, controlled clinical trial involved 60 ASA I and II patients aged 18–64 years scheduled for elective surgery requiring general anaesthesia. Anaesthesia was induced with intravenous sodium thiopentone 5 mg/kg and atracurium 0.5 mg/kg, and maintained in group I with isoflurane (MAC, 0.8%-1.5%) and in group P with (propofol infusion, 100–200µg/kg/minute). Blood samples were taken pre-induction, immediate- and 24 hours post operatively. The serum levels of AST, ALT, ALP, Tbil were analyzed and compared in both groups. Risk factors for post operative hepatotoxicity were determined. Result: Propofol caused a significant reduction in ALP (P = 0.005) but increase in Tbil (P = 0.010) 24 hours postoperatively. Though isoflurane had consistently higher values of AST, ALP and Tbil than propofol, only the mean AST values at 24 hours post-operative was significantly higher (P = 0.045). There was a significant increase in the 24 hours post-operative Tbil following massive blood loss; [odd ratio 23.91, 95%, CI (1.685–339.315)], P = 0.019. Conclusion: Both agents had a varied effect on liver enzymes. Isoflurane resulted in a significantly higher increase in 24 hours post-operative serum AST than propofol. Propofol caused a significant increase in 24 hours post-operative total bilirubin. Caution is therefore recommended in their use in patients with altered liver enzymes.
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Are the aetiologies of traumatic injuries changing in Nigeria? Evidence from the emergency department of a referral hospital in southwest Nigeria p. 34
Dele Owolabi Ojo, Kehinde Sunday Oluwadiya, Saheed Olatunde Akanni
DOI:10.4103/jwas.jwas_104_22  
Background: Traumatic injuries are a serious public health problem. The burden of these injuries is increasing globally, and there is evidence that the pattern is changing. Objective: The study had two objectives. The first was to determine the aetiology and clinical spectrum of trauma in a teaching hospital. The second was to determine whether these have changed compared with previous reports from the region. Materials and Methods: Between September 2017 and August 2018, data from injured patients who presented consecutively to the accident and emergency department at the Federal Teaching Hospital Ido-Ekiti, Nigeria, were prospectively collected using a trauma data form and analysed. Results: Road traffic crashes (RTCs) caused 75.6% of the injuries, and motorcycle crashes accounted for more injuries than all the other major causes of injuries combined. Compared with previous studies from the same hospital, assault has risen to the second position, whereas falls have fallen to the third position as causes of traumatic injuries. The Injury Severity Scores (ISS) of the patients ranged from 1 to 75, with a mean score of 7.01. The mortality rate was 2.5%. Time to treatment: odds ratio (OR) = 3.25 (1.1–10.0), ISS: OR = 1.172 (1.07–1.28), age: OR = 1.097 (1.013–1.188), and systolic blood pressure: OR=1.07 (1.106–1.025) were the significant predictors of mortality. No patient was transported to the hospital in an ambulance. Conclusion: The pattern of trauma in the subregion is changing as the proportion secondary to RTCs and motorcycle crashes is higher than previously reported studies from the area. The implication of this finding for the prevention of RTCs is discussed.
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Early functional outcome of hemiarthroplasty in the elderly with neck of femur fracture: A single centre’s experience p. 40
Muhammad Musa Chiroma, Mustapha Usman Ibrahim, Muhammed Nuhu Salihu, Francis Olusoji Awonusi, Abdul Rahman Alhaji Mamuda, Muhammad Kabir Abubakar, Kabir Musa Adamu, Shamsuddeen Muhammad, Bashir Bello
DOI:10.4103/jwas.jwas_109_22  
Introduction: Neck of femur fractures in the elderly population are common and often a devastating condition. The optimal treatment has been a subject of debate. Arthroplasty has been shown to be the most viable treatment option. The high cost of total hip replacement makes hemiarthroplasty a suitable option in our environment. Materials and Methods: This study was designed to measure the outcome of hemiarthroplasty after femoral neck fracture using Harris hip score in patients aged 60 and above at the National Orthopaedic Hospital, Dala, Kano, Nigeria. Results: Twenty-five consecutive patients 60 years and above with femoral neck fracture who met the inclusion criteria and gave consent were enrolled into the study. The mean Harris hip score at the pre-operative period was 16.92. Fourth week after the surgery, the mean Harris hip score was 69.96. The score rose further to 75.24 and 80.96 at 12 weeks and 6 months post-operatively. The difference between the mean pre-operative and post-operative scores at 4th week, 12th week, and 6th month was statistically significant. During the pre-operative period, all patients had a poor Harris hip score grade. Six months after the surgery, 7 patients (28%) had an excellent Harris hip score grade, 12 patients (48%) had good grades, and 1 patient (4%) had a fair Harris hip score grade. Five patients (20%) had a poor Harris hip score grade at 6 months. Conclusion: From the findings of this study, it can be concluded that early functional outcomes of hemiarthroplasty for femoral neck fracture in the elderly are good and satisfactory.
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Bilateral female inguinal hernia repair in Margaret Marquart Catholic Hospital and review of literature p. 47
Mahamudu Ayamba Ali, Emmanuel Abedi, Israel Hagbevor, Mathew Y Kyei
DOI:10.4103/jwas.jwas_10_21  
Background: Bilateral inguinal hernias are relatively rare in females compared to men. The management outcome of bilateral nylon darn, a method predominantly used in sub-Saharan Africa for same time repairs in complicated or elective hernia surgeries is largely unknown. Aims and Objectives: Our aim is to report a rare case of same time bilateral inguinal hernia obstruction and review the outcome of bilateral nylon darn posterior wall repairs after herniotomy. Design of the Study: This was a retrospective analysis of bilaterally operated inguinal hernia female patients data that was retrieved for the past 6-year period. Settings: All complete records of female patients who had same time bilateral inguinal hernia repairs at the Margaret Marquart Catholic Hospital (district hospital), for the period January 2015 to December 2020 were included in the study. Materials and Methods: Patient biodata, clinical notes on diagnosis, surgical management, postoperative care, and complications were extracted from hospital records and analysed. Results: A total of 14 patients aged between 40 and 87 years which represented 1.85% of the total hernia repairs were female with same time bilateral inguinal hernia repairs. Seven (50%) patients presented at the emergency with hernias detected over a year. Surgical site infection and pains after surgery were the predominant complications and occurred more common after emergency repairs. Conclusion: Emergency bilateral inguinal hernia repairs were three times associated with surgical site infection compared to elective repairs.
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Management of traumatic diaphragmatic injury—A peep into bowel repair via thoracotomy p. 53
Kelechi E Okonta, Christopher N Ekwunife, Emeka M Okonta, Martin A C Aghaji
DOI:10.4103/jwas.jwas_94_22  
Background: Traumatic diaphragmatic injury (TDI) is a relatively rare condition, and there is a high tendency for it to be missed if thorough clinical assessment and imaging review are not carried out. The surgical approach for TDI can be challenging, especially with bowel perforation. Materials and Methods: This is a retrospective case series of all consecutive patients with TDI from two tertiary hospitals in the southern part of Nigeria between January 2013 and December 2019. The demographic data of the patients, type, cause, and clinical diagnosis, intraoperative findings, Injury Severity Score, and outcome were noted. The descriptive statistics were presented in percentages and fractions. Results: Fourteen (4.3%) of the 326 chest trauma patients had TDI with 57.1% from penetrating causes and 42.9% from blunt causes. The causes of the TDI were gunshot injuries (42.9%), road traffic crashes (35.7%), stab injury (14.3%), and domestic accidents (7.1%). The preoperative method of diagnosis was mainly by massive haemothorax necessitating open thoracotomy (42.9%) and mixed clinical evaluation, chest radiograph, and upper gastrointestinal contrast studies (35.7%), and the drainage of intestinal content following the insertion of a chest tube to initially drain haemothorax (21.4%) and other modality of diagnoses (7.1%). The operative finding was mainly intestine content in the chest (50%) and only diaphragmatic injury (35.7%). The major complication after surgery was empyema thoracis (14.3%) and the mortality rate (14.3%). Conclusion: Penetrating injury of the chest was the major factor responsible for the TDI, and even with bowel perforation and acute TDI, thoracotomy offered an effective surgical approach for all the patients.
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The pain control efficacy of zolpidem versus melatonin after intervertebral disc herniation surgery under general anaesthesia: A randomised clinical trial p. 58
Hesameddin Modir, Esmail Moshiri, Alireza Mohammadi, Seyed Vesal Aghdasi
DOI:10.4103/jwas.jwas_105_22  
Background: Postoperative pain management has been linked with multiple clinically relevant complications such as thromboembolism, myocardial ischaemia, and cardiac arrhythmias. Objectives: The present study moves towards an evidence-based approach to the therapeutic efficacy of zolpidem and melatonin in a better clinically meaningful pain relief following intervertebral disc herniation surgery under general anaesthesia. Materials and Methods: Undertaking a randomised, parallel-group, double-blind, clinical trial, 60 patients meeting eligibility (mean age ≈ 39, 50% female and 50% men) were offered intervertebral disc surgery at the Arak-based Valiasr Hospital and stratified into two interventional arms by block randomisation. Data including (i) pain (visual analog scale) and sedation (Ramsay sedation scale) scores during recovery and at all five initial 24-h time points (two, four, six, 12, 24); (ii) adverse events inclusive of mild nausea and dizziness, pethidine consumption; and (iii) ongoing haemodynamic parameters, including heart rate, blood pressure, and oxygen saturation were collected. Data were analysed at a significance level of P = 0.05 (SPSS 20.0, IBM Corp). Results: Our results showed no perceived statistically significant between-arm difference in three functional haemodynamic parameters, duration of surgery, and adverse events, as well as in sedation and pain scores (P < 0.05). Our results showed no between-arm difference in analgesia and sedation, haemodynamic changes, and postoperative adverse events. Conclusion: The findings taken together lent a strong support for the highly encouraging efficacy of both drugs in affording adequate analgesia at 24 postoperative hours without any adverse events needing to be thought of. Therefore, both zolpidem and melatonin were promising postoperative pain relievers, while no drug is demonstrably superior to the other.
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Comparative study of the umbilical artery Doppler indices of healthy and growth-restricted foetuses in Lagos p. 63
Abayomi Ayyuub Adedo, Rasheed Ajani Arogundade, Adeyemi Adebola Okunowo, Bukunmi Michael Idowu, Latifat Tunrayo Oduola-Owoo
DOI:10.4103/jwas.jwas_63_22  
Aim of the Study: This study compared the umbilical artery Doppler indices (UADI) in normal and foetal growth-restricted (FGR) foetuses to determine the relationship between the UADI and pregnancy outcomes. Materials and Methods: This was a case-control study that recruited one hundred and eighty pregnant women comprising 90 with FGR pregnancies and 90 with normal pregnancies. Foetal biometric parameters and UADI were measured in all the participants. The UADI and clinical outcomes (preterm delivery, birth weight, perinatal death, etc.) of the normal and FGR foetuses were compared. Results: The mean estimated foetal weights of the FGR pregnancies (subjects) and normal pregnancies (controls) were 2.76 ± 0.66 kg and 3.62 ± 0.37 kg, respectively (P < 0.0001). The mean APGAR score at 5 min was 6.93 ± 1.72 for subjects and 8.03 ± 0.94 for controls (P < 0.0001). Abnormal umbilical artery Doppler waveforms were detected: decreased end-diastolic flow in 25 (27.8%), absent end-diastolic in 7 (7.8%) and reversed end-diastolic flow in 4 (4.4%) of the FGR pregnancies. There were 74 (82.2%) preterm deliveries among the subjects, while only 7 (7.8%) of the controls had preterm deliveries. Six deaths (two perinatal and four neonatal deaths) were recorded among the subjects, while no death occurred among the controls. Conclusion: Foetuses with FGR showed significantly higher quantitative Doppler indices (increased RI, PI, SD ratio), and a higher prevalence of abnormal umbilical artery waveform pattern (qualitative) than the healthy foetuses (controls).
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Pattern of emergency presentation of patients with breast cancer at the University of Benin Teaching Hospital p. 70
Oghenevwegba Dominic Akpoghor, Attah Raymond Eghonghon, Odigie C Osime
DOI:10.4103/jwas.jwas_124_22  
Background: Breast cancer is the most common malignancy affecting women in Nigeria. Presentation is usually elective. However, some patients present as an emergency with complications of the disease and its treatment. This study aimed to capture the features of this population of patients with breast cancer presenting as an emergency. Materials and Methods: The study was a prospective cross-sectional study conducted between March 2021 and February 2022. All the patients with histologically diagnosed breast cancer presenting as an emergency were recruited into the study. Relevant information was retrieved and analysed. Results: Over the study period, 34 patients were recruited. They were all females and ages ranged between 27 and 74 years of age (mean: 45.56 ± 11.71 years), and the highest incidence was in the fifth decade of life. The first symptom in all patients was a breast lump, and the duration of disease ranged between 3 and 84 months (mean: 29.21 ± 22.38 months). The right breast was most commonly involved, and invasive ductal carcinoma (no specific type) was the commonest histologic type in 88.24% of cases. Over half of the patients seen had received no treatment after establishing the diagnosis of breast cancer. For those who received treatment, radiotherapy was the least accessed form of treatment. The most common symptoms were difficulty breathing and jaundice (29.41% each), and metastatic disease was the most common diagnosis. The duration of admission ranged between 1 and 35 days, and a mortality rate of 45.45% was recorded. Conclusion: The most common indication for emergency presentation in patients with breast cancer was metastatic disease.
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A cross-sectional study of determinants of exclusive breastfeeding among working mothers in Enugu p. 75
Chidinma Ifechi Onwuka
DOI:10.4103/jwas.jwas_102_22  
Introduction: The practice of exclusive breastfeeding (EBF) has remained low despite its benefits. This is worsened when the woman has to combine breastfeeding with work in order to support her family. Objective: The objective was to determine the factors influencing EBF among working mothers in Enugu, South-eastern Nigeria. Materials and Methods: This was a questionnaire-based study of 315 nursing mothers in postpartum period, attending the immunisation centres of the Institute of Child Health of both University of Nigeria Teaching Hospital and Enugu State University Teaching Hospital. The information obtained was analysed using SPSS version 22. A P value of less than 0.05 was considered statistically significant. Results: Although 82.5% (n = 260) of the respondents were aware of EBF recommendation, only 69% (n = 217) practised EBF. A majority of the mothers (87%) initiated breastfeeding within 1 h of delivery. Ninety-nine percent of the mothers did not have workplace facilities (such as breastfeeding rooms, nursery, refrigerator, and privacy) that support breastfeeding practice. The main reasons for not practising EBF were pressure of work (40.8%, n = 40/98) and medical conditions (32.7%, n = 32/98). Low parity (P = 0.018) and registration for antenatal care in the hospital (P = 0.009) were significantly associated with EBF. Conclusion: The prevalence of EBF among working mothers in Enugu South-Eastern Nigeria is still suboptimal; thus there is a need for policy change in order to remove or mitigate associated factors. A multi-institutional national survey on the determinants of EBF among working mothers across the six geopolitical zones of the country may be necessary.
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Magnetic resonance imaging of ankle disorders in adult Nigerians in Lagos p. 81
Bukunmi Michael Idowu, Babalola Ishmael Afolabi, Stephen Olaoluwa Onigbinde, Oghenetejiri Denise Ogholoh, Nkem Nnenna Nwafor
DOI:10.4103/jwas.jwas_134_22  
Objectives: The aim of this study was to establish the frequency, distribution, and spectrum of abnormalities on ankle magnetic resonance imaging (MRI) in adult Nigerians. Materials and Methods: A retrospective analysis of ankle MRI of 50 adult patients was conducted at a single health facility. All adult Nigerians with complete clinical data, MRI images, and radiologists’ reports were included. The clinical history and ankle MRI findings were recorded and analysed. The threshold for statistical significance was established at P≤0.05. Results: There were 50 subjects comprising 27 males (54%) and 23 females (46%) aged 25–66 years (mean age = 42.84 ± 9.63 years). The right ankle was evaluated in 27 subjects (54%), while the left ankle was studied in 23 (46%). There was a history of trauma in 40 subjects (80%; 27 right ankles and 13 left ankles). Ankle joint effusion was the most common abnormality—seen in 50% of all subjects and in 62.5% of those with antecedent trauma. Achilles tendinosis and Kager (pre-Achilles) fat pad oedema (8–12%), deltoid ligament tear (8%), and medial malleolar fracture (4%) were the other frequently detected pathologies. The other pathologies detected were posterior tibial tendinosis (2%), plantar fasciopathy (2%), and talar contusion (2%). Joint effusion was significantly more prevalent in post-traumatic ankles than in the non-traumatic ankles and in the right ankles than the left ankles. There was no significant difference in the frequency of ankle abnormalities between the male and female subjects and between subjects younger than and older than the mean age. Conclusion: Joint effusion, deltoid ligament tear, and Achilles tendinopathy were the prevalent derangements in evaluated ankle joints. Trauma was the main indication for ankle MRI in this study.
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Ultrasonographic study of the effects of essential hypertension on the luminal diameter and doppler velocimetric indices of the abdominal aorta in adults p. 88
John Oluwafemi Adetokunbo, Bolanle Olubunmi Ibitoye, Anthony Olubunmi Akintomide, Bukunmi Michael Idowu
DOI:10.4103/jwas.jwas_136_22  
Objective: To investigate the effects of essential hypertension on the luminal diameter (caliber) and Doppler velocimetric indices of the abdominal aorta (AA) in adult patients with systemic hypertension. Materials and Methods: This was a prospective descriptive comparative study of 254 participants (127 with essential hypertension and 127 age/sex-matched controls). Their anthropometric parameters, fasting blood pressure, lipid profile, fasting blood sugar, and triplex sonography of the suprarenal and infrarenal abdominal aorta (Peak systolic velocity, PSV; End-diastolic velocity, EDV; Resistive Index, RI; and luminal diameter) were evaluated. Results: The mean age of the male subjects was 64.02 ± 10.02 years, while the mean age of the male controls was 63.14 ± 10.52 years (P > 0.05). The mean age of female subjects was 61.23 ± 10.09 years, while the mean age of the female controls was 61.76 ± 10.26 years (P > 0.05). The age group 60 – 69 years had the highest number of subjects and controls. The mean duration of hypertension in the subjects was 12.5 ± 5.2 years. The suprarenal and infrarenal abdominal aortic diameters (AAD) were higher in males than age-matched female counterparts. AAD increased with age mostly in hypertensive male subjects. PSV (in males) and RI (in both sexes) were elevated in hypertensive subjects compared to controls, while EDV (in both sexes) was significantly lower in subjects than controls. Multivariate linear regression showed that age and diastolic blood pressure were significant independent predictors for both suprarenal and infrarenal AADs. Conclusion: Systemic hypertension causes structural and hemodynamic changes in the abdominal aorta which are detectable on triplex sonography.
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The therapeutic antiemetic and hemodynamic effects of dexmedetomidine, ephedrine, and dexamethasone in combination with midazolam on laparoscopic cholecystectomy patients: A randomised clinical trial p. 96
Dorsa Dalaei, Hesameddin Modir, Shirin Pazoki, Amir Reza Naimi
DOI:10.4103/jwas.jwas_133_22  
Objective: The objective was to compare the hemodynamic and antiemetic effects of the combination of midazolam with ephedrine, dexamethasone, and dexmedetomidine in laparoscopic cholecystectomy surgical patients. Materials and Methods: This randomised, parallel-group, double-blind clinical trial was conducted by enrollment of 96 patients who were referred for laparoscopic cholecystectomy. Patients assigned into three equal-sized intervention arms having received anaesthesia induction with midazolam-ephedrine, midazolam-dexamethasone, and midazolam-dexmedetomidine using a block randomisation method. Frequency and severity of nausea and vomiting were observed from recovery to 24 h later, adverse events, and sedation on Ramsay sedation scale at recovery, 1, 2, and 4 h postoperatively. Data were recorded and analysed at a significance level lower than 0.05 in SPSS software. Results: The clinical parameters including mean blood pressure at all times and heart rate in 60–90 min were lower in the dexmedetomidine group when compared with other groups. The lowest severity of postsurgery nausea occurrence was observed in the midazolam-dexamethasone group and those receiving midazolam-dexmedetomidine from 4 to 24 h. In addition, vomiting scores were lower throughout recovery up to postoperative 4 h in the dexamethasone and dexmedetomidine groups (all P < 0.05). The highest sedation score was observed in the dexmedetomidine group during recovery up to 2 h (P = 0.001), reflecting a more clinically superior effect than dexamethasone (P = 0.01). Conclusions: A positive implication of dexmedetomidine was observed in attenuating postoperative nausea and vomiting and potentiating sedation. Nevertheless, it is providing a drop in the blood pressure and heart rate. Lending support to the potent adjuvant efficacy of dexamethasone following dexmedetomidine, consequently, a hypothesis can be put forward, stating that the dexmedetomidine and dexamethasone as adjuvants to midazolam are expected to bring the advantages of avoiding the adverse events and improving postoperative sedation.
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REVIEW ARTICLES Top

The cost of setting up an ENT endoscopic practice in lower middle-income countries of Sub-Saharan Africa p. 104
Samuel Oluyomi Ayodele, Shuaib Kayode Aremu
DOI:10.4103/jwas.jwas_57_22  
Ear, nose, and throat (ENT) surgeons in developing countries are constrained to practicing with lower technology, lower cost surgery, and reliance on outdated surgical techniques carried out with improvised instruments when compared with their counterparts in the developed world. In this review, we planned to lay open the bottle necks militating against setting up an ENT endoscopy practice in our setting with possible outcomes. The literature search was carried out to retrieve relevant published articles, books, and guidelines. Unpublished literatures were excluded. The search was limited to articles in English. ENT clinical practice in lower middle-income countries (LMICs) where there are limited or no ENT endoscopic setup due to high cost of procurement and maintenance, human resources, lack of subspecialty training, and inadequate funding by policy makers poses major challenges that can militate against the provision of adequate and effective surgical management. A continually improved management practices will positively affect the organisational structure, efficiency, and safety of a system. That is, an affordable and standard ENT endoscopic setup will go a long way to improve the access to training and practice for both ENT clinical and surgical purposes. The expansion of ENT endoscopic specialist training will improve both the diagnostic and therapeutic acumen in ENT practice in LMICs. The budget for health and the health-funding systems of our institutions must receive special and specific attentions tailored towards putting our health facilities in better shapes, subspecialty training, and procurement of state-of-the-art endoscopic equipment with proper plans on maintenance culture.
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Correlation of sonographic findings and histopathological diagnoses in women presenting with breast masses p. 109
Hafsat Oluwatosin Akinnibosun-Raji, Sule Ahmed Saidu, Zainab Mustapha, Sadisu Muhammad Ma’aji, Mohammed Umar, Farouk Umar Kabir, Uzoma Glosson Udochukwu, Kwefi Joshua Garba, Mansur Olayinka Raji
DOI:10.4103/jwas.jwas_84_22  
Background: Breast lumps have been reported as the most common breast symptom among adult females in Western Nigeria and are benign in 60% of cases. In South-Eastern Nigeria, fibroadenoma has been reported as the most common breast disease (47.5%), followed by carcinoma (30.4%) and fibrocystic disease. The aim of this study was to determine the correlation between sonographic and histopathologic findings in women who presented with breast masses. Materials and Methods: This was a cross-sectional study conducted among 160 consecutive female patients who presented with breast masses. A breast ultrasound scan was carried out to categorize the masses using the American College of Radiology Breast Imaging Reporting and Data System classification, and the histopathological diagnoses of the masses were obtained. The correlation of the sonographic findings and histopathological diagnoses was determined using the Statistical Package for Social Sciences (SPSS) IBM version 23.0. Results: Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were found to be 79.5%, 98.3%, 93.9%, 93.7%, and 93.8%, respectively. There was a positive correlation between the sonographic findings and histopathological diagnoses of the breast masses, which was statistically significant (P = 0.000, r = 0.846). Conclusion: This study found a statistically significant positive correlation between sonographic findings and histopathological diagnoses of breast masses.
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CASE REPORT Top

Role of platelet rich fibrin in the closure of oronasal fistula. A case report p. 115
Abdurrazaq Olanrewaju Taiwo, Ramat Oyebunmi Braimah, Bruno Oludare Ile-Ogendengbe, Abdullah Mohammed Farouk
DOI:10.4103/jwas.jwas_41_22  
An oronasal fistula is an abnormal opening connecting the oral cavity and the nose. They could occur as complications of oral and maxillofacial procedures. Oronasal fistulas (ONF) are challenging to repair optimally. The repair of a recurrent ONF is more of an enigma in cases where a small defect often requires an extensive surgery to close. Platelet rich fibrin (PRF) was described by Choukroun as a platelet concentrate from autologous blood which forms a single fibrin biomaterial after centrifugation. This haemostatic plug rich in growth factors is easy to prepare, manipulate; and adapt for soft and hard tissue healing. It has been utilized in the various fields of dentistry especially oral and maxillofacial surgery. Reports of role of PRF in the repair of ONF closure are scarce in literature especially in conjunction with other soft tissue flaps. This case report highlights that PRF can be used with success as an adjunct for the closure of ONF fistulas.
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