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   Table of Contents - Current issue
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January-March 2021
Volume 11 | Issue 1
Page Nos. 1-37

Online since Wednesday, June 22, 2022

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ORIGINAL ARTICLES  

Factors affecting the outcome of traumatic brain injured patients with acute epidural haematoma in National Hospital, Abuja p. 1
Obinna Mmadukaku Ayogu, Daniel Efeomo Onobun, Kenechukwu Kizito Igbokwe, Charles Ugochukwu Ugwuanyi, Chizim Otitodilichukwu Mordi, Sandra A Ibeneme
DOI:10.4103/jwas.jwas_16_22  
Objective: The objective is to determine the prognostic factors affecting the surgical outcome of patients surgically treated for acute epidural haematoma. Materials and Methods: A retrospective review of 71 consecutive patients who underwent neurosurgery for acute epidural haematomas over a 5-year period (from January 2015 to December 2019) was conducted. Clinical characteristics and the time intervals were investigated to determine the interactions between all these factors and the outcome. The outcome was graded according to the Glasgow Outcome Scale (GOS) at subsequent follow-up clinic visits. Results: The severity of traumatic brain injury using the Glasgow Coma Scale score (chi-square test, P = 0.033) had a statistically significant relationship with the outcome. The patients’ age, gender, and total length of time until surgical intervention (P > 0.05) were of no statistical significance in relation to the outcome. The mortality rate of patients presenting at our centre is 16.9%. Overall, after surgery, 47 of 71 with epidural haematoma had good recovery (GOS 5). Twelve of 71 patients had GOS of 2–4. Twelve patients died. The median duration from injury to presentation was 15 hours with an interquartile range of 15 hours. Conclusion: Our results indicate that the severity of brain injury is an independent risk factor in determining the outcome of epidural haematoma in traumatic brain injury.
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Correlation of quantitative MRI parameters with neurological outcome in acute cervical spinal cord injury p. 5
Mesi Mathew, Wilfred C Mezue, Mark C Chikani, Abdullahi O Jimoh, Enoch O Uche, Musa B Mathew
DOI:10.4103/jwas.jwas_52_22  
Background: The unbearable morbidity and significant mortality associated with traumatic cervical spine injuries (T-CSIs) have been complicated by difficulties in outcome prediction. Objectives: This study aims to determine the correlation between quantitative magnetic resonance imaging (MRI) parameters and neurological outcome among patients with acute T-CSI. Materials and Methods: This is a prospective study in which patients with T-CSI were recruited over a 12-month period. ASIA Impairment Scale (AIS) at admission, 6 weeks, and 3 months was assessed. Mean spinal cord compression (MSCC), mean canal compromise (MCC), and length of lesion (LOL) were calculated from MRI at admission, and correlation with neurological severity and outcome was determined. The data were analysed using SPSS version 21. A P-value of less than 0.05 was considered significant for associations. Results: Sixty-nine patients were enrolled comprising 55 males and 14 females giving a male-female ratio of 4.9:1. Their ages ranged from 18 to 74 years with a mean age of 40.2 ± 15.1 years. Injuries were ASIA A in 55.1% and ASIA E in 7.2% on admission. The mean MSCC, MCC, and LOL were higher for ASIA A and B and lowest in ASIA E injuries. Patients with good AIS (D and E) had significantly lower MSCC on admission (P = 0.032) and at 6 weeks (P = 0.000), and the LOL was also lower on admission (P = 0.000), at 6 weeks (P = 0.006), and at 3 months (P = 0.007). None of MRI parameters predicted outcome. Conclusion: The MSCC, MCC, and LOL correlate with T-CSI severity but were not sufficient to predict outcome.
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Neonatal hearing screening, with otoacoustic emission, among normal babies in a northeastern Nigerian hospital p. 11
Amina Abdullahi, Nurudeen Adebola Shofoluwe, Adamu Abubakar, Mala Bukar Sandabe, Hamman Ibrahim Garandawa, Mohammed Ibrahim Babatunde, Raheem O Quadri
DOI:10.4103/jwas.jwas_32_22  
Background: Hearing is necessary for speech and language development, children with bilateral hearing loss often have impaired speech and language abilities thus limiting educational attainment. Early detection and intervention will help minimize such effects. Therefore, neonatal hearing screening program has been advocated in developing countries. Objective: TThe objective of this study is to determine the prevalence of hearing loss and risk factors among full-term inborn neonates delivered in a University Teaching Hospital with transient evoked otoacoustic emission (TEOAE). Materials and Methods: All full-term neonates delivered in a University Teaching Hospital were included in this prospective cross-sectional study. The hospital’s ethical committee gave approval. The researcher obtained informed consent from the parents and administered a questionnaire for demographic, prenatal, and postnatal data. A comprehensive head and neck examination preceded the preliminary otoscopy. With the help of a hand-held otodynamic otoport, Neonatal Hearing Screening Program otoacoustic emission (OAE), each ear’s hearing was assessed. Statistical Product and Service Solutions (SPSS) version 22.0 was used to analyse the data. Results: 150 full-term neonates were screened, of which 72 (48%) were males and 78 (52%) were females. Neonates that failed the TEOAE in both ears were 12 (8%). 18 (12%) neonates had a refer in right ear only, while 24 (16%) had a refer in the left ear only. The only significant risk factor with a referral outcome of TEOAE was family history of childhood hearing loss (23.1%). Conclusion: This study found a high prevalence (8%) of failed TEOAE of full-term neonates delivered in our hospital with a significant risk factor of family history of childhood hearing loss.
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Management of chondrosarcomas of the jaws in a Nigerian tertiary hospital p. 15
Benlance Ekaniyere Edetanlen, Jovana Ivie Ehizonaga, Osawe Omoregie
DOI:10.4103/jwas.jwas_22_21  
Background: There is a dearth of literature on the diagnostic characteristics and treatment outcomes for chondrosarcomas of the jaws in our environment due to the rarity of the lesion. Objectives: The aim of this study was to review the demographic data, presenting symptoms, location, radiographic findings, histological findings, treatment, and outcomes in chondrosarcoma of the jaws. Materials and Methods: A retrospective medical record review was undertaken of all patients diagnosed with chondrosarcoma of the jaws at our center between 2000 and 2020. Results: Ten patients (3%) were identified among 333 patients with orofacial neoplastic lesions. The mean age was 26.6 years (standard deviation [SD] 20.6 years, range 14–82 years). The male-to-female ratio was 1:1. Eight (80.0%) patients had jaw swelling and the average duration of symptoms on presentation was 18 months. Maxillary location occurred in six (60.0%) patients. Radiographically, all the lesions appeared radiolucent without clearly defined borders. All patients had only radical resection, except one who had adjuvant chemotherapy as well. Recurrence occurred in three (30.0%) patients and one of the patients died. The mean follow-up was 3 years (range 1–5 years). Conclusions: Chondrosarcomas in this study affected relatively young patients, with painless jaw swelling being the most common presenting symptom. Men and women were equally affected. Radiolucent lesions and conventional histological types were the most common. Radical surgery alone was the most common modality of treatment and the outcomes were good.
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Cryptorchidism in Dalhatu Araf Specialist Hospital, Lafia, Nigeria: Presentation, management, and outcome p. 21
Christian A Agbo, Joseph T Godwin, Musa Y Muhammad
DOI:10.4103/jwas.jwas_36_22  
Objective: To determine the presentation, management, and outcome of cryptorchidism in Dalhatu Araf Specialist Hospital, Lafia, Nigeria. Materials and Methods: This is a retrospective study conducted at Dalhatu Araf Specialist Hospital, Lafia, Nigeria. Information of patients who presented with cryptorchidism to the hospital from January 2015 to January 2020 was retrieved from the folders and analysed. Results: A total of 37 patients were studied during the study period. Only three (8.1%) presented and had correction before/at the age of two. A majority of patients (91.9%) presented after the age of two; 78% of the testes were palpable. The condition was unilateral in 30 patients (81.1%) and bilateral in seven patients (18.9%). Laparoscopy was used in one (2.7%) patient. A majority (51.4%) of the testes were in the inguinal canal, 29.7% at the external ring, 13.5% at the internal ring, and 5.4% within the abdomen. Orchidopexy was performed for 41 undescended testes and orchidectomy for three atrophic testes. There was a good outcome in 93.2% of the surgical corrections. Scrotal haematoma developed following two orchidopexies and one (2.2%) testis retracted. Conclusion: Cryptorchidism is a common anomaly in urology. The correction of cryptorchidism at the appropriate age is indicated to optimise testicular function, potentially reduce and/or facilitate the diagnosis of testicular malignancy, provide cosmetic benefits, and prevent complications such as a clinical hernia or torsion. Education of parents, traditional birth attendants, midwives, and doctors in our environment is required to ensure earlier presentation and treatment.
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Prevalence of revision adenoidectomy in a tertiary otorhinolaryngology centre in Nigeria p. 23
Jamila Lawal, Hassan Iliya Dadi, Rasheedat Sanni, Nurudeen Adebola Shofoluwe
DOI:10.4103/jwas.jwas_61_22  
Introduction: Remnants or the regrowth of adenoid tissue after adenoidectomy may present with clinical symptoms that could warrant a revision surgery. Aim and Objectives: This study aims to determine the prevalence and risk factors of revision adenoidectomy in our centre. Materials and Methods: This is a retrospective case–control study conducted in a tertiary otorhinolaryngology centre over a 10-year period. Cases of revision adenoidectomies were identified and matched with controlled cases of single-stage adenoidectomies within the same period. All information was entered into the Statistical Package for the Social Sciences (SPSS) version 25 and analysed using descriptive and cross-tabulation analysis. Results: A total of 1249 adenoidectomies were performed during the period of review with 26 being revision cases. The prevalence of revision adenoidectomy was found to be 2.1% with the mean interval between surgeries being 2.1 years. Age ≤ 2 years (odds ratio (OR) = 95.25, P < 0.0001), allergy (OR = 0.09, P < 0.0001), recurrent tonsillitis (OR = 0.79, P = 0.006), recurrent/chronic middle ear infections (OR = 7.5, P < 0.0001), and the primary surgeon being a junior registrar (OR = 11.5, P < 0.0001) were significantly associated with revision adenoidectomy. The performance of adenoidectomy without tonsillectomy also carries a significant odd (P = 0.04). Conclusion: Revision adenoidectomy is low in our setting. Young age at primary surgery, the presence of allergy, surgeon’s designation, the extent of surgery, and recurrent middle ear and tonsil infections are factors associated with revision adenoidectomy. These should be considered in risk stratification and surgery planning.
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CASE REPORTS Top

Tropical diabetic hand syndrome—Report of 2 cases p. 29
Innocent E Abang, Joseph Asuquo, Chukwuemeka Anisi, Pius U Agweye, Ngim E Ngim, Iya Eze Bassey
DOI:10.4103/jwas.jwas_46_22  
Tropical diabetic hand syndrome (TDHS) is not a commonly reported complication of diabetes mellitus. It was first reported in Nigeria in 1984[1] but prior to that time, in 1977, it was described in the United States of America.[2] Several other cases are now being reported in other countries of Africa and India. It is termed TDHS because it affected patients with diabetes mellitus in the tropics. It presents with cellulitis, ulceration, and fulminant sepsis of the hand, which may progress to gangrene, and many have lost the digits as seen in one of our patients or sometimes the whole hand. Many of these patients present very late as the onset of the condition is usually due to minor trauma to the hand like a pin prick or little scratches, which result in cellulitis are treated by patent medicine dealers until the sepsis and possibly gangrene in some cases sets in.
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Post-operative vesicoenterocutaneous fistula with multiple intestinal knotting: A case report p. 33
Abdullahi Khalid, Ahmed Mohammed Umar, Abdullah Abdulwahab-Ahmed, Abubakar Sadiq Muhammad, Ngwobia Peter Agwu, Ismaila A Mungadi
DOI:10.4103/jwas.jwas_78_22  
Herein is a case of a 51-year-old farmer who presented to our facility with initial leakage of urine but later urine mixed with faeces from the lower abdomen after two previous abdominal surgeries. He had an open transvesical prostatectomy due to benign prostate enlargement complicated by leakage of urine from lower abdominal wall scar. A repeat surgical intervention to correct the urine leakage was followed by recurrence of urine leakage and later by leakage of feculent urine from the lower anterior abdominal wall.At our facility, he had exploratory laparotomy with manual unknotting of ileal loops, fistula tracts excision, resection, and end-to-end ileoileal anastomosis. The bladder wall was repaired with suprapubic cystostomy. Although the finding of asymptomatic multiple small bowel knotting was incidental in the index case, its timely management averted a sitting timed bomb that may lead to a diagnostic dilemma with catastrophic consequences.
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