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   Table of Contents - Current issue
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January-March 2023
Volume 13 | Issue 1
Page Nos. 1-113

Online since Wednesday, January 18, 2023

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ORIGINAL ARTICLES  

Presentation and management of orbito-ocular malignancies in a tertiary institution in Southwest Nigeria Highly accessed article p. 1
Adewumi Olabimpe Alabi, Adegboyega Sunday Alabi, Anthonia Chima Sowunmi, Kehinde O Ololade, Bolanle Comfort Adegboyega, Muhammad Yaqub M Habeebu, Omolara Amina Fatiregun, Folasade Bolanle Akinsola
DOI:10.4103/jwas.jwas_37_21  
Purpose: The aim of this study was to review the management of orbito-ocular malignancies in the Departments of Radiotherapy and Ophthalmology, Lagos University Teaching Hospital, between January 1997 and December 2011 in comparison to previous and recent studies globally. Materials and Methods: This was a retrospective study of orbito-ocular malignancies seen at the Departments of Radiotherapy and Ophthalmology, Lagos University Teaching Hospital from 1997 to 2011. Case files and treatment cards were retrieved through the Medical Records department and the information required was extracted with the aid of a data extraction form. Results: A total of 98 cases with histologically confirmed orbito-ocular malignancies seen during the 15-year study period were analysed. Retinoblastoma (51 [52.0%]) was the most common orbito-ocular malignancies seen in children, whereas squamous cell carcinoma of the conjunctiva (25 [25.5%]) was the most common in adults. Seventeen (17%) patients had a combination of radiotherapy, surgery, and chemotherapy. Thirty (33%) had enucleation, whereas 33 (36%) had exenteration. Thirty-six patients had chemotherapy, whereas 44 patients benefited from radiotherapy, and radical treatment was offered to 24 patients. Total radical treatment dose was 35–65 Gy in 20–35 fractions over 4–7 weeks. Most of the patients (84 [85.7%]) were lost to follow up. Five (5.1%) died from disease progression and four (4.1%) are still alive and on regular follow-up. Conclusion: This study showed that the use of multimodality treatment was implemented but did not improve survival because the majority of patients presented late. The need for a collaborative effort in early detection and prompt referral for treatment of cancer cases cannot be overemphasised.
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Difference in muscle strength and functional outcome in direct lateral approach versus posterior approach in total hip arthroplasty: A prospective cohort study Highly accessed article p. 6
Sajid Ansari, Sanny Kumar Singh, Anil Regmi, Tarun Goyal, Roop Bhushan Kalia, Raj Kumar Yadav, Aditya Koduvally Suresh Gowda
DOI:10.4103/jwas.jwas_258_22  
Background and Purpose: The choice between posterior approach (PA) and direct lateral approach (DLA) for total hip arthroplasty (THA) remains a contentious issue regarding clinical outcome optimization and restoring patient function. Previous studies have evaluated the postsurgical outcomes mostly in the form of Harris hip score (HHS), and the data to objectively measure the postoperative muscle power is scarce. We intend to objectively compare the hip abduction and extension strengths and other functional outcomes with a very simple tool in PA and DLA in the Indian population as most patients do not undergo as intensive rehabilitation in the postoperative period as in the western world. Materials and Methods: A total of 158 patients underwent THA during the study period, of which 48 met inclusion criteria and only 42 completed 6 months follow-up. Patients were evaluated preoperatively, postoperatively at 2 weeks, 6 weeks, 3 months, and 6 months follow-up. At each visit, muscle strength was tested using a customized sling device mounted on a pulling apparatus fitted on the wall, as well as a pain score (VAS), Harris hip score (HHS), and Short Form Survey (SF-36). Results: The study showed statistically significant better hip muscle strength at 2 weeks postoperative for leg press test and 2 weeks as well as 6 weeks postoperative for hip abduction strength in the PA. However, no differences were noted during the 3 or 6 months follow-up period among the DLA and PA. The surgical approach used has no effect on VAS, HHS, or SF-36 scorings. Conclusion: The weak abductor mechanism at 2 and 6 weeks and extension mechanism at 2 weeks in a cohort of DLA in contrast to the PA are seen in the early postoperative period and hence are short-lived muscle weakness. However, there is no effect on VAS, HSS, and SF-36 scores. Therefore, the surgical approach is to be chosen according to the surgeon’s expertise.
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The use of McGrath MAC video laryngoscope versus mccoy laryngoscope in adults with anticipated difficult airway undergoing elective surgery p. 15
Bilkisu Adamu, Saidu Yusuf Yakubu, Rabiu Isah Muhammad
DOI:10.4103/jwas.jwas_265_22  
Background: Difficult airway management remains one of the most challenging clinical situations encountered by anaesthetists. Aim: The study compared the effectiveness of the McGrath MAC video laryngoscope to the McCoy® laryngoscope in patients with difficult airway. Materials and Methods: Following the institution’s ethical approval, the randomised controlled trial was conducted involving 74 adults with American Society of anaesthesiologists’ physical status (ASA) grading of I-III scheduled for elective surgery. The Patients were randomised into either group MVL (McGrath MAC) or group MCC (McCoy) and intubated after preoxygenation with 100% oxygen and administration of IV propofol and suxamethonium. The Intubation Difficulty Score (IDS), success rate of intubation, time to intubation, number of optimising manoeuvres and complications was assessed. Statistical analysis was performed using the statistical Package for Social Sciences (SPSS) version 24.0 computer software (IBM SPSS Statistics, IBM Corp. NY, United States). Numerical and categorical data were compared using the student’s t-test and Chi square (χ2) test respectively. A value of P < 0.05 was considered statistically significant. Results: Lower IDS scores were noted in the McGrath group; 54.1% vs. 5.4% of patients had IDS score of 0 in the McGrath and McCoy groups respectively, (P < 0.001). Overall success rate was higher in the McGrath group (100% vs. 89.1%), P = 0.040. Conclusion: Lower IDS scores and improved intubation success rate was achieved with the McGrath compared with the McCoy laryngoscope in patients with predicted difficult airway. The McGrath has proved to be useful in managing patients with difficult airway.
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The use of preputial dartos flap in the primary repair of distal hypospadias: A single-centre experience p. 27
Partha Chakraborty, Kartik Chandra Mandal, Sourav Roy, Shashi Kant Tewary, Pankaj Kumar Halder, Anil Kumar
DOI:10.4103/jwas.jwas_252_22  
Background: An additional flap during the tubularization of incised urethral plate urethroplasty (TIPU) is believed to minimize the postoperative complications. It is still debatable whether using an additional flap is worth the risk given the hazards associated with doing so. This study aims to re-evaluate the benefits and drawbacks of TIPU with or without a preputial dartos (PD) flap. Materials and Methods: We assessed the results of patients with distal hypospadias who underwent surgery in our institute over the past 2 years. The urethral plate’s width, thickness, and depth, the periurethral tissue’s quality, and the width of the glans at the mid-glans level determined whether the neourethra was covered with a PD flap or left uncovered. Data on intra-operative blood loss, operating time, length of hospital stay, postoperative complications, and outcome were analysed. Results: There were 96 patients: 58 received an extra PD flap, whereas the other 38 did not. In the flap group, ventral skin necrosis was a prevalent problem, whereas meatal stenosis predominated in the no-flap group. Both the flap group (25.66%) and the no-flap group (23.86%) experienced comparable postoperative complications (P = 0.503). In comparison to the no-flap group, the flap group showed statistically significant differences (P<0.001) in intra-operative blood loss (22.10 ± 6.96 vs. 10.34 ± 3.02 mL), operating time (96.34 ± 6.661 vs. 71.39 ± 9.76 min), and hospital stay (10.04 ± 0.87 vs. 8.47 ± 1.64 days). Conclusion: The additional PD flap does not always affect the result of TIPU in terms of complications.
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A modified rectal mucosal biopsy for the diagnosis of Hirschsprung’s disease: Zaria experience p. 36
Tunde Talib Sholadoye, Halima Oziohu Aliyu, Philip Mari Mshelbwala
DOI:10.4103/jwas.jwas_241_22  
Background: Full-thickness rectal biopsy is often used for the diagnosis of Hirschsprung’s disease (where a suction biopsy kit is not available). This is associated with some challenges such as limited theatre space and the need for general anaesthesia. We aim to highlight the usefulness and sensitivity of a modification of the rectal mucosal biopsy without general anaesthesia in the diagnosis of Hirschsprung’s disease. Materials and Methods: This is a retrospective analysis of children with Hirschsprung’s disease who had rectal mucosal biopsy over a 16-year period (January 2004–December 2019). Research was approved with institutional number ABUTHZ/HREC/H22/2022. The patients had the biopsy with small, curved artery forceps, surgical blade, and dissecting scissors. Histological analyses of tissue were done. Clinical data and results were recorded on a structured pro forma, and the data were analysed. Results: There were 263 boys and 97 girls with a median age of 10.5 months. Only 37 (10.3%) of the rectal biopsies were done by consultants. Hirschsprung’s disease was confirmed in 279 (75.5%) of the partial-thickness biopsies, whereas 52 (14.4%) biopsies were inadequate specimens. Resident doctors were responsible for 92.2% (47) of inadequate biopsies (P = 0.63), although they did 89.7% of all biopsies. In one (0.3%) patient, the procedure ended as a full-thickness biopsy leading to a significant haemorrhage that required blood transfusion. Conclusions: The modified rectal mucosal biopsy is a simple, safe, and effective method for making the diagnosis of Hirschsprung’s disease. This is performed without general anaesthesia and is useful where a suction biopsy kit is unavailable.
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Chlamydia trachomatis seropositivity and associated risk factors among women attending a Northern Nigerian Tertiary Hospital p. 40
Rabi'at Muhammad Aliyu, Adebiyi Gbadebo Adesiyun, Umma Suleiman Bawa, Abdulhakim Abayomi Olorukooba, Shamsudin Aliyu
DOI:10.4103/jwas.jwas_240_22  
Background: Genital Chlamydia trachomatis (Ct) is the commonest bacterial sexually transmitted infection globally. Acquisition of Ct infection is affected by biological and behavioural factors. Aim: Determine the prevalence of Ct infection and identify risk factors associated with Ct infection in sexually active fertile women in Northern Nigeria. Materials and Methods: One hundred and fifty sexually active women presenting to the Obstetrics and Gynaecology department of Ahmadu Bello University Teaching Hospital, Zaria were studied. Socio-demographic characteristics and history of risk factors for acquisition of genital Ct were obtained from the participants using a questionnaire. Their sera were tested for the presence of Ct immunoglobulin G using Enzyme-Linked Immunosorbent Assay. Results: The mean ages ± standard deviation of seropositive and seronegative women were 29.1 ± 7.3 years and 28.9 (SD 6.7) years respectively (P = 0.438). The prevalence of Ct infection was 6.7% (10/150). Occupation was associated with Ct seropositivity (P = 0.02). Number of sexual partners, age at coitarche; duration of sexual exposure and previous history suggestive of sexually transmitted infection were not associated with Ct seropositivity (P > 0.05). Conclusion: A low prevalence of Ct was found among fertile women. Lack of regular source of personal income was associated with Ct infection but the sexual behavioural factors studied were not.
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The adequacy of hospital response to COVID-19 pandemic amongst surgical institutions in South-Eastern Nigeria p. 44
Kelechi Uzodinma Imediegwu, Chiamaka Q Onyebuchukwu, Jude C Abor, Edeani D Bobby, Ngozi JF Okoye, Chidera V Magbo, Emmnauel Izuchukwu Onyenagubo, Winifred U Omene
DOI:10.4103/jwas.jwas_239_22  
Background: The novel corona virus (COVID-19) was first diagnosed in Wuhan, China in December 2019. The healthcare specifically, departments of surgery in Southeastern Nigeria, are making modifications to cope and plan for the pandemic. Objectives: To evaluate how well surgical institutions in Southeastern Nigeria are prepared for the anticipated influx of Covid-19 patients, existing patients and to determine the adequacy of hospital provision of essential supplies and awareness creation. Materials and Methods: A cross-sectional online study of two hundred and one (201) surgery resident doctors in surgical institutions in South-eastern Nigeria was conducted. Questionnaires were designed and distributed using online platforms. The data obtained was analyzed using the Statistical Package for the Social Sciences (SPSS). Significance was set at P < 0.05. Consent was obtained from all respondents. Results: A total of 201 surgery resident doctors filled and submitted their questionnaires, response rate of 71.5%, out of which 50.1% agreed that hospital response to Covid-19 pandemic was inadequate, 78.3% agreed that the Personal Protective Equipment (PPEs) provided by hospitals were inadequate while about 53.8% agreed that the hospital workforce was poor and inadequate and incapable of adapting to the unstable workforce during the pandemic. About 46.2% agreed that the hospitals were conducting an adequate creation of awareness with regards to the pandemic while 25% agreed that the hospital compliance with the CDC (Center for disease control) preventive protocols/guidelines in surgical institutions were adequate. There was a statistically significant association (P = 0.019 (< 0.05); X2= 5.517) between hospital type and provision of adequate Personal protective equipment for surgical procedures. Only 19% of the government hospital employees felt that adequate amount of PPEs were provided compared to 41% of private hospital employees. Conclusion: The results from this study show that the hospital response to Covid-19 pandemic and awareness creation amongst surgical institutions in Southeastern Nigeria are inadequate. Recommendations: The government should equip the health sector by providing the necessary amenities to adequately combat the challenges of surgical practice in the Covid-19 pandemic.
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Impact of virtual resources and effect of COVID-19 pandemic on plastic surgery residency and training among residents in southern Nigeria p. 50
Kelechi Uzodinma Imediegwu, Chidera V Magbo, Ebube I Umeji, Emmnauel K Azumah, Chiamaka Q Onyebuchukwu, Kenechukwu Judah Okonkwo, Jude C Abor, Anthonia Uduezue
DOI:10.4103/jwas.jwas_238_22  
Background: Despite the increased usage of virtual, nonphysical resources for medical education during the coronavirus disease-2019 (COVID-19) pandemic, plastic surgical training still suffered adversely in some aspects. Objectives: The aim of this study was to explore the overall impact of virtual resources and effect of the COVID-19 pandemic on plastic surgery training among residents in Southern Nigeria. Materials and Methods: This was a cross-sectional study conducted among senior plastic surgery residents in southern Nigeria using a well-structured online questionnaire carried out over a 3-month period. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software program, version 25.0. Measures were taken to significantly minimise response, answer order, and other survey research errors/bias. A pilot study was done. Consent was obtained from all participants. Results: A total of 29 plastic surgery residents completed the questionnaire. Mean age was 35.15 years with standard deviation of 6.31. The response rate was 72.5%. According to a majority of the residents, there were no significant changes in the frequency of burn, hand, and facial injury cases during the pandemic; training courses on plastic surgery (44.3%) and operative cases decreased (48.3%), whereas there was a significant increase in intraoperative teaching (27.6%) as well as simulations and conferences (41.4%). Majority of the respondents also alluded to the significant financial and psychological impacts of the pandemic on residents and a significant decline in cases with general anaesthesia as compared with cases with local anaesthesia. Conclusion: The COVID-19 pandemic has caused a mixture of significant positive and negative changes in the plastic surgery training of residents.
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A comparative study between propofol-fentanyl versus propofol-suxamethonium for ease of endotracheal intubation in children p. 55
Alfa Mikailu, Mamuda Atiku, Ahmad Abdurrahman, Dalhat Salahu, Saheed Adesope
DOI:10.4103/jwas.jwas_229_22  
Background: Following propofol induction, suxamethonium tremendously improves intubating conditions in children and has been the gold standard agent for this purpose. However, suxamethonium could be absolutely contraindicated in some patients. Fentanyl, a short acting opioid, has been investigated as a suitable alternative with varying results. Aim and Objectives: This study compares the ease of tracheal intubation between propofol-suxamethonium (1.5 mg/kg) and propofol-fentanyl (3 mcg/kg) during general anaesthesia among children. Patients and Methods: In this double-blind randomised controlled study, 84 ASA I or II patients booked for elective surgery under general anaesthesia requiring tracheal intubation were randomised into two groups (F and S). Induction was with propofol 3 mg/kg over 30 s followed by either fentanyl 3 mcg/kg or suxamethonium 1.5 mg/kg. Two minutes later, there was an attempt at intubation and intubating conditions were assessed using Steyn’s modification of Helbo-Hansen’s score (ease of laryngoscopy, jaw relaxation, coughing, vocal cord position, and limb movement). Results: All patients in both groups had successful intubation at the first attempt. Patients in group S (suxamethonium) had significantly better overall intubating conditions compared to those in group F (fentanyl) (p=0.0001), 85.7% in group S compared to 21.4% in group F had excellent intubation condition. None of the patients in the two groups demonstrated fair or poor intubation condition. Conclusion: A combination of propofol-fentanyl can be used as an alternative to propofol-suxamethonium to ease intubation in paediatric patients.
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Factors responsible for the performance of final-year dental surgery students in their professional examinations in Nigeria p. 60
Kelechi U Imediegwu, Chidera P Chukwu, Ifeanyi E Nweze, Jude C Abor, Bassey Asuquo, Valentina I Ebisike, Ogechukwu T Ugwu, Ugwu I Hillary
DOI:10.4103/jwas.jwas_222_22  
Background: Little is known about the factors responsible for the academic performance of clinical dentistry/dental surgery students, particularly those in their finals in Nigerian universities. Objectives: The objectives of the study were to identify the subjective factors that may affect the performance of dental surgery finalists at the undergraduate level in Nigerian dental schools and to proffer realistic suggestions to improve dental surgery education. Materials and Methods: A cross-sectional survey of final-year dental surgery students in Nigeria was conducted using a well-structured validated online questionnaire distributed randomly through online platforms. Descriptive and inferential data analysis was done with Statistical Package for the Social Sciences (SPSS) version 21. Chi-squares and Fischer’s exact values were calculated. Significance was set at P < 0.05. Consent was obtained from all participants. Results: Sixty-nine final-year dental surgery students completed and submitted the questionnaire. The hours spent on clinical hands-on-dental practice, dental surgery lectures/clinics attendance, and impact of particular course lecturers were the top three most agreed factors influencing the performance of dental surgery students in their examinations. A significant relationship (P = 0.027 [<0.05]; X2 = 4.873) exists between gender and the perception in that the greater cumulative number of study hours was alluded to significantly influencing performance in examinations. More females unlike males indicated that the total number of hours studied does not affect performance. A statistically significant association (P = 0.004 [<0.05]; X2 = 13.274) was also found between age grades and the influence of repeating an examination on performance. A majority of the respondents across all age grades indicated that repeating students do not always perform better or even pass the examinations. A majority of the respondents across all age grades indicated that those that have completed a degree before medical school do not always perform better in examinations. This finding also had a statistically significant association (P = 0.048 [<0.05]; X2 = 7.886). Conclusions: There is a need to coordinate efforts in the management of dental institutions to ensure that adequate attention is given to the dental surgery students at every stage of their training. Creation of dental surgery mentorship programmes may also help in the overall quality of the programme.
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Clinicopathological features and treatment outcome of patients with gastric cancer in Lagos: Is the outlook getting better? p. 67
Adedapo Olumide Osinowo, Thomas Olagboyega Olajide, Olanrewaju Samuel Balogun, Ayomide Makanjuola, Adedoyin Adekunle Adesanya, Oluwole A Atoyebi
DOI:10.4103/jwas.jwas_219_22  
Background: Gastric cancer (GC) is an important cause of morbidity and mortality in Nigeria. Significant advances in the management of GC in South-West Nigeria occurred in the last three decades. Patients and Methods: This was a retrospective comparative study of patients with GC that presented at our tertiary hospital in the last three decades. Information on clinicopathological features and treatment outcome were analysed. Data of two consecutive periods; 1991–2004 (Group I) and 2005–2018 (Group II) were compared. Results: Ninety-one patients were studied; Group I (47 patients), Group II (44 patients). The mean age was 56.4 ± 12.7 years and male-to-female ratio was 1.8 to 1.0. The predominant symptoms were epigastric pain in 81(89.0%) (43 vs. 38) and weight loss in 63(69.2%) (32 vs. 31), whereas the signs were epigastric tenderness in 44(46.1%) (24 vs. 20) and epigastric mass in 42(46.1%) (26 vs. 16). The overall mean duration of symptom was 12.3 ± 16.9 months. Barium meal diagnosed GC in 29(61.7%) patients in Group I vs. 4(9.1%) patients in Group II. Conversely, endoscopy diagnosed GC in 23(48.9%) patients in Group I vs. 37(84.1%) patients in Group II. Operations undertaken included palliative subtotal gastrectomy 26(28.6%), potentially curative subtotal gastrectomy 15(16.5%) and non-resectional surgeries in 27(29.7%) patients. The overall incidence of major post-operative complications was 33%. Thirty-nine (42.8%) of the studied patients were lost to follow up. The median postoperative survival for Groups I and II patients was 22 weeks and 58 weeks, P = 0.012, respectively. Conclusion: The outcome of management of patients with GC at our tertiary hospital has improved modestly in the past three decades. Patients are still presenting late with very advanced disease.
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The correlation of sonographic and histopathologic findings in the diagnosis of palpable breast masses in Zaria p. 74
Nafisa Bello, Sefiya Adebanke Olarinoye-Akorede, Halima Mono Mohammed, Ibrahim Aliyu, Mubarak Zubair Abdullahi, Muhammad Zaria Ibrahim, Sulieman Lawal, Muhammad Haruna Rasheed
DOI:10.4103/jwas.jwas_218_22  
Introduction: Presently, histology is the gold standard in definite diagnosis of breast masses. Ultrasound is a relatively cheap, non-invasive, and non-ionizing imaging modality which is widely available in most hospitals. An assessment of its accuracy in diagnosing breast masses is necessary to minimize unwarranted biopsies. Aim and Objectives: This study aims to correlate the ultrasonographic and histopathologic findings in the diagnosis of patients with palpable breast masses. Materials and Methods: This was a cross-sectional hospital-based study, which involved 100 consecutive patients who presented with palpable breast masses in Zaria. This was carried out for a period of 7 months (November 2016–June 2017). They had a clinical breast examination to identify the mass, which was then imaged and biopsied via ultrasound-guided fine needle aspiration cytology. Results: The generated data were analysed using SPSS version 23.0 (Chicago, IL, USA). There were more benign masses (63%) than malignant masses (29%). On correlating the final diagnosis of ultrasound to that of histology, it was found to have a sensitivity of 89%; specificity of 94%; positive predictive value of 89%; negative predictive value of 94%; and accuracy of 92%. Conclusion: This study shows that there was a correlation between ultrasound and histology findings in differentiating between benign and malignant masses. This proves that ultrasound has a significant role to play in evaluating and diagnosing clinically palpable breast masses.
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Conjunctival fungal flora in a tertiary eye hospital in Nigeria p. 79
Benjamin U Adukwu, Sebastian N N Nwosu, Felix E Emele, Chizoba Uba-Obiano, Adaora A Onyiaorah
DOI:10.4103/jwas.jwas_216_22  
Objectives: The aim of this study is to determine the hospital incidence and pattern of conjunctival fungal flora in adult patients at the Guinness Eye Center Onitsha, Nigeria. Materials and Methods: New adult patients, without anterior segment disease, were randomly recruited. Using a sterile swab stick, specimen was taken from the inferior conjunctival fornix of each participant’s right eye and inoculated into Sabouraud dextrose agar slant in a test tube and incubated at 27°C. The specimens were examined for fungal growth every 48 h for 4 weeks. Specimens with fungal growth were further examined under a high power microscope for fungal identification and characterization. Results: A total of 225 patients (105 males, 120 females) were examined. The age range was 18–75 years; mean age was 41 ± 17.1 years; 62 (27.6%) were culture-positive: 25 (40.3%) were males and 37 (59.7%) were females (P >0.05). Both moulds and yeasts were isolated with moulds constituting 44 (74.2%). Aspergillus [26 (41.9%)] and Candida [16 (25.8%)] were the commonest organisms. Participants >60 years had the greatest burden. Pensioners (61.5%), traders (44.0%), farmers (30.1%), and artisans (27.3%) were occupational groups with significantly higher proportions of culture-positive specimens (P < 0.05). Conclusion: Over a quarter of new adult patients without anterior segment disease harbour fungi, some of which are pathogenic, in their conjunctival fungal organisms. While Aspergillus and Candida were the commonest isolates, older participants, pensioners, traders, farmers, and artisans had significantly higher proportion of culture-positive specimens. These findings should be considered when formulating pre-operative guidelines for ocular surgery in our environment.
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Neonatal burn injuries managed in a neonatal intensive care unit of a tertiary hospital in North-Central Nigeria p. 84
Simon J Yiltok, Akintunde J Akintayo, Bose Ozoiza Toma, Udochukwu Michael Diala, Atarang A Dafong, Christopher Y Karago, Joshua D Choji, Abdulquadri Idrisu
DOI:10.4103/jwas.jwas_214_22  
Introduction: Neonatal burn injuries are rare in clinical practice. This explains the many case reports of such injuries. This is a report of our experience in the management of neonatal burn injuries in our centre. Materials and Methods: This is a retrospective study of neonatal burn injuries that were managed over an eight year period (2014–2022). The information that was retrieved from the case notes included the socio-demographic data, birth weight, weight at admission, type of injury, total burn surface area (TBSA), depth of burn injury, type of treatment, length of hospital stay and outcome of care. The data were then entered into the SPSS version 25 (IBM Corp., United States) software and analysed. Results: We managed 11 neonates, five males and six females with a male: female (M: F) ratio of 1:1.2. Their age ranged from zero to 25 days with a median (IQR) of 2 (1 -15) days. Eight (72.7%) of them were one to two days old and eight (72.7%) were admitted as out born. Majority (81.8%) of the mothers were primiparous women. Nine (81.8%) of the injuries were as a result of hot water bath. Most (66.6%) of these baths were done by the grandmothers or mothers of the babies. The total burn surface area (TBSA) ranged from 1% to 62%, with a median (IQR) of 11 (7.5 – 19.0). None of the babies had skin grafting. The length of stay (LOS) ranged from six days to 25 days with a median (IQR) of 11.0 (7.0 – 16.0) days. Only one baby died giving a hospital mortality rate of 9.1%. Conclusions: The commonest cause of neonatal burn injury in this series is scald injuries from hot water bath. Providing education about safe bathing to caregivers should be included in routine antenatal and postnatal instructions in order to prevent burns.
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Conservative management of stable, minimally displaced pertrochanteric fractures: A case series p. 91
Matthew Mercouris, Schalk Klopper, Stefan Swanepoel, Sithombo Maqungo, Maritz Laubscher, Stephan Roche, Ntambue Kauta
DOI:10.4103/jwas.jwas_223_22  
Background: Hip fractures are common, and account for significant morbidity and mortality. While surgical intervention remains the gold standard, nonoperative treatment protocols are seldom analysed and may be of value in select settings. Objectives: We sought to review our conservatively treated pertrochanteric fractures and present a case series that outlined indications, treatment protocol and early outcomes. Materials and Methods: A retrospective review of medical records and radiographic imaging of all patients who presented with stable pertrochanteric fractures and were treated nonoperatively, from September 2017 to February 2021, at a Level 2 District Hospital in South Africa. Results: Of the 242 patients who were admitted with pertrochanteric fractures, 12 (4.9%) fractures were radiographically classified as AO 31A1.2 (stable, minimally displaced) and eligible for active nonoperative management. Within 6 weeks of injury, 10 (84%) of the patients who received active nonoperative treatment achieved union. Two patients (16%) failed the treatment protocol and required surgery, with one failing during the hospital phase of the treatment protocol and the other on follow up. In the group of united fractures, the neck shaft angle was on average within 3 degrees of the contralateral hip with a range of 0 to 5 degrees. At follow-up, two (16%) patients had a measurable shortening of 5 mm at union. There was no medical morbidity associated with this protocol. Conclusions: In our case series, the active nonoperative management protocol, involving early mobilisation and serial radiographs, in select cases of stable pertrochanteric fractures yielded acceptable outcomes. This is of relevance in low-middle income countries with limited surgical capacity.
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CASE REPORTS Top

Congenital palatal fistula with cleft of the soft palate p. 96
Johnson Uchechukwu Achebe, Obinna Remigius Okwesili, Okechukwu Oliver Onumaegbu
DOI:10.4103/jwas.jwas_253_22  
Congenital palatal fistula or perforation is rare, unlike the acquired form which commonly results from cleft palate repair. Congenital palatal fistulae are often associated with submucous cleft palate. Only a few of this fistulae are diagnosed shortly after birth. We present the case of a 3-year old girl with congenital palatal fistula coexisting with cleft of the soft palate that was noticed shortly after birth. The palate was repaired using Bardach’s palatoplasty and the client was subsequently referred to a speech therapist.
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Prosthetic rehabilitation following segmental maxillectomy confluent with an orbital defect using a hollow orbital prosthesis retained magnetically with an obturator: A case report p. 98
Manu Rathee, Sujata Chahal, Maqbul Alam, Prachi Jain, S Divakar, Sandeep Singh
DOI:10.4103/jwas.jwas_234_22  
Loss of a sense organ, such as an eye in situations of orbital involvement, or any other bodily part, such as the maxilla or palate, might make one more dependent on others for care and affect how they perceive themselves in society. The prosthetic rehabilitation of large mid-facial defects is a challenging task due to the varied size and shape of the defect. Confluent maxillary and orbital abnormalities are best restored with prosthetic means by creating a comfortable, aesthetically pleasing prosthesis that allows for the restoration of speech, deglutition, and mastication. The retention of any prosthesis is must for it to be successful. The hollow orbital conformer described in this case presentation aids in reducing the weight of the prosthesis, thereby enhancing the retention of the prosthesis. This clinical case presentation highlights the aesthetic and functional rehabilitation using a combined obturator-orbital prosthesis connected using intraoral magnets.
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Innovative customized pressure appliance as an adjuvant in presurgical management of bilateral multiple keloid: A case report p. 103
Manu Rathee, Sandeep Singh, Prachi Jain, Sujata Chahal, Santhanam Divakar, Sarthak Singh Tomar
DOI:10.4103/jwas.jwas_231_22  
Keloid is a benign, long-lasting fibroproliferative mass of dermal connective tissue that forms at the site of cutaneous injury as a result of an unregulated repair and healing process at specific anatomical locations, with a preference for the highly pigmented ethnic group. The use of clips or splints to apply pressure to the affected area is common treatment of keloids; nevertheless, controlling the volume and direction of the keloids might be challenging. The appliance’s unique design allows for more precise control over the amount and direction of pressure applied to the scar tissue.
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Biliary atresia splenic malformation: A case report from a tertiary centre in West Africa and the lessons learnt p. 106
Olumide A Elebute, Manuella Talla Timo, Felix M Alakaloko, Justina O Seyi-Olajide, Christopher O Bode, Adesoji O Ademuyiwa
DOI:10.4103/jwas.jwas_195_22  
Biliary atresia (BA) is a rare disease characterised by biliary obstruction of unknown origin that presents in the neonatal period. It is classified into syndromic with various congenital anomalies and non-syndromic (isolated anomaly). We present a case of syndromic BA associated with polysplenia and intestinal malrotation, discovered incidentally during the Kasai procedure. The small intestine was found to be non-rotated with the duodenojejunal junction to the right of the vertebral column. The presence of accessory spleens was noted. Kasai portoenterostomy and Ladd’s procedure were performed. The patient had an uneventful postoperative course with the passage of cholic stool from the third postoperative day. At the seventh-month follow-up, the stool remained cholic. A multidisciplinary approach in the care of babies with BA and long-term follow-up is crucial for a successful outcome.
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Post-dated breech pregnancy in a non-obviously communicating rudimentary horn of a bicornuate uterus requiring hemi-hysterectomy p. 111
Muhammad Baffah Aminu, Iffat Sania, Munni Khairunnaesa
DOI:10.4103/jwas.jwas_194_22  
Developmental anomalies of the Müllerian duct systems such as the bicornuate uterus are rare globally and hardly do term pregnancies occur in conjunction with these abnormalities. The occurrence of post-dated pregnancy is rarely associated with a bicornuate uterus. We present a 35-year-old un-booked multigravida with post-date pregnancy complicated by breech and intrauterine foetal death (IUFD) in a rudimentary uterine horn. She had caesarean delivery complicated by intractable postpartum haemorrhage (PPH). This together with the risks of poor uterine involution in the postpartum and obstetric outcome in the event that another pregnancy occurs in the same horn subsequently warranted a caesarean hemi-hysterectomy of the rudimentary uterine horn. Uterine bicornuate is an uncommon genital tract anomaly and a rare cause of post-date pregnancy. Postpartum bleeding warranting caesarean hemi-hysterectomy should be anticipated as the pregnant horn may not be responsive to conventional oxytocics.
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