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   Table of Contents - Current issue
April-June 2023
Volume 13 | Issue 2
Page Nos. 1-129

Online since Monday, March 20, 2023

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Feedback culture among Nigerian orthodontic medical educators p. 1
Sylvia Simon Etim, Abiodun O Arigbede
Background: Feedback is central to a quality medical and dental education in promoting self-directed learning and enhance progressive sharpening of trainees’ skills, which are applicable in orthodontics. Hence, orthodontic educators must be conversant with the subject of feedback. There is insufficient information concerning this at the moment. Aim and Objectives: To determine the prevalence, quality, and barriers to feedback culture among Nigerian orthodontic educators. Design of the Study: Cross sectional. Setting: Nigerian orthodontists in training institutions. Materials and Methods: A descriptive study involving orthodontic educators in Nigeria, was done using a 26-item structured questionnaire distributed face-to-face or through google forms. Simple descriptive data analysis was done to address the study objectives. Results: Twenty-five orthodontic educators participated. Sixteen (60%) alluded to existence of a formal feedback culture in their centers, and 10, that is, 40% of the educators were comfortable giving feedback by themselves. Over half, 13, that is, 52% of the educators gave feedback as the need arises, and a few educators (18, 72%) rated the quality of feedback given as “good.” In contrast, 11, that is, 44% of the educators always sought feedback from trainees, and 8, that is, 32% among them never sought feedback from colleagues. Feedback execution was preferred at different times including after teaching (10, 40%), after assessment (3, 12%), during practical (7, 28%), and on observations relating to attitude and professionalism (7, 28%). Feedback was mainly verbal and based on reports/observations. Time constraint was the barrier identified by the majority (13, 52%) of the participants. Conclusion: The scope and quality of feedback practice among orthodontic educators in Nigeria were inadequate. Time constraint was the most common barrier to feedback alluded to by the participants. There is a need to improve on feedback culture in orthodontics training in Nigeria.
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Immunohistochemical profiling of HER-2/neu, steroid hormone receptors and KI-67 biomarkers in a cohort of Nigerian women with breast cancer p. 7
Omobolaji O Ayandipo, Gabriel O Ogun, Olalekan J Adepoju, Oludolapo O Afuwape, Ebenezer O Fatunla, Akintunde T Orunmuyi
Background: Progressive improvement in the accuracy of profiling of hormone receptors in breast cancer provides the basis for targeted endocrine therapy, a major pillar of multimodal breast cancer treatment. However, the disparity in findings from comparatively smaller sample-sized studies in West Africa has led to somewhat conflicting conclusions and recommendations. Objectives: This study investigates the immunohistochemical (IHC) profile of breast cancer specimens for estrogen receptor (ER), progesterone receptor (PR), human epidermal receptor-2 (HER2)/neu, and Ki-67 in a tertiary hospital in Ibadan, Nigeria over 12 years. Materials and Methods: We reviewed 998 IHC reports, documented clinicopathologic parameters, computed patterns of biomarkers, and stratified them based on the American Society of Clinical Oncology/College of American Pathologists recommendations. Descriptive analysis including frequency, mean, and median were generated from the data extracted. Results: Out of the 998 cases, 975 (97.7%) were females and 23 (2.3%) were males. The mean age was 48.84 ± 11.99 years. Open biopsies were the most common types of specimens (320, 41.6%): lumpectomy and incisional biopsy of ulcerated, fungating or unresectable tumours. In those cases, 246 (32.0%) were samples of breast-conserving or ablative surgical extirpation (mastectomy/wide local excision/quadrantectomy), and 203 (26.4%) were obtained by core needle biopsies. Invasive ductal carcinoma was the most common histopathological type (673, 94.5%). The majority of graded tumours were intermediate grade (444, 53.5%). Four hundred and sixty-nine (48.4%) were ER positive, 414 (42.8%) were PR positive, and 180 (19.4%) were HER2/neu positive. Three hundred and thirty-four (34.0%) were triple-negative. Eighty-nine cases had Ki-67 staining done, and of these 61 (68.5%) had positive nuclear staining. Conclusion: Steroid hormone receptors and HER-2/neu proportions in our cohort are likely to be more representative than the widely varied figures hitherto reported in the sub-region. We advocate routine IHC analysis of breast cancer samples as a guide to personalized endocrine therapy.
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Ultrasonographic intravesical prostatic protrusion in men with benign prostatic hyperplasia in Southwest Nigeria p. 16
Tolulope Adebayo Okedere, Bukunmi Michael Idowu, Stephen Olaoluwa Onigbinde
Objectives: To study the relationship between sonographically measured intravesical prostate protrusion and international prostate symptoms score (IPSS), as well as prostate volume, in men with benign prostatic hyperplasia at a single health facility. Materials and Methods: This was a cross-sectional observational study of one hundred men (age >40 years) diagnosed with benign prostatic hyperplasia. Their International Prostate Symptoms Score (IPSS) was assessed using the standardised IPSS instrument. Abdominal ultrasound was done to measure the intravesical prostatic protrusion (IPP), while prostate volume was estimated transabdominally and transrectally. Correlations between parameters were quantified with Spearman’s correlation test. P ≤ 0.05 was statistically significant. Results: The mean age was 62.84 ± 9.0 years (Range =42–79 years). The mean IPSS was 20.99 ± 6.42 (range of 5–30). Seventy-three percent of the men in this study had intravesical prostatic protrusion on ultrasound. The mean IPP was 13.0 ± 4.0 mm. Of the 73 men with IPP, 17 (23.3%), 29 (39.7%), and 27 (37%) had grade I, grade II and grade III IPP, respectively. The mean transabdominal prostate volume (TPVA) and transrectal prostate volume (TPVT) were 71 ± 14 ml and 69 ± 13 ml, respectively. IPP had a statistically significant positive correlation with all the other parameters. The strongest correlation (very high correlation) was with the TPVA (r=0.797, P < 0.0001), followed by a moderate correlation with the IPSS (r =0.513, P < 0.0001). TPVT, transition zone volume, transition zone index, presumed circle area ratio, and quality of life score yielded slightly weaker moderate correlation with IPP, while IPP correlated weakly with age. Conclusion: IPP correlated well with multiple clinical and sonographic parameters. It correlated better with TPVA than TPVT.
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Abdominal trauma imaging in a Nigerian tertiary hospital—Our experience with 87 adult patients p. 23
Adedire Timilehin Adenuga, Ademola Adeyeye
Introduction: Abdominal trauma is a major cause of morbidity and mortality in low- and medium-income countries (LMICs). Abdominal trauma imaging is important in determining the location and severity of organ injury, the need for surgery, and the identification of complications. The choice of imaging in abdominal trauma in LMICs is influenced by peculiar problems, which include the availability of imaging modality, expertise, and cost. There are few reports on options of trauma imaging in LMICs, and this study aimed to identify and characterise the type of imaging done for patients presenting with abdominal trauma at the University of Ilorin Teaching Hospital. Materials and Methods: This was a retrospective observational study of patients with abdominal trauma who presented at the University of Ilorin Teaching Hospital from 2013 to 2019. Records were identified, and data were extracted and analysed. Results: A total of 87 patients were included in the study. There were 73 males and 14 females. The abdominal ultrasound was the commonest modality done in 36 (41%) patients, whereas abdominal computed tomography was done in five (6%) patients. Eleven patients (13%) had no imaging done, and 10 of these patients proceeded to having surgery. In patients with intraoperative finding of perforated viscus, the sensitivity of radiography was 85% and specificity was 100%, whereas that of the ultrasound was 86.7% and 50% for sensitivity and specificity, respectively. The ultrasound scan was the commonest imaging done for patients who presented with features of haemorrhage (P = 0.04), odds ratio (OR) = 1.29 (95% confidence interval [CI] = 1.08–1.6), and patients with severe injury, P = 0.03, OR = 2.07 (95% CI = 1.06–4.06). Gender (P = 0.64), shock at presentation (P = 0.19), and mechanism of injury (P = 0.11) did not influence the choice of imaging. Conclusions: Abdominal trauma imaging in this setting was majorly via ultrasound and abdominal radiographs. Factors suggested to influence the pattern of abdominal trauma imaging in LMICs include the availability of specific imaging modality, cost, lack of standardisation and definite abdominal trauma protocols.
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Comparative accuracy and complications of palpation-guided versus ultrasound-guided core needle biopsy of palpable breast lumps in Ahmadu Bello University Teaching Hospital, Zaria p. 28
Stephen Gboya Gana, Lazarus Yusufu, Peter Pase Abur, Sefiya Adebanke Olarinoye-Akorede, Nafisa Bello
Background: Breast lumps are a common complaint by women. Palpable breast lumps are accessible to core needle biopsy (CNB) with the aim of obtaining tissue for histologic diagnosis. CNB is achievable either by palpation guidance or image guidance. The superiority of either technique in returning an accurate diagnosis has not been demonstrated in our centre. Aim: This study aimed to compare the diagnostic accuracy and complications of palpation-guided versus ultrasound-guided CNB techniques in palpable breast lumps. Materials and Methods: This was a randomised, controlled, comparative study. Consenting patients were randomised into either a palpation-guided or an ultrasound-guided group. All patients subsequently had open surgical biopsy, which represented the control group. Data analysis was done using SPSS, version 21. Results: Each CNB group had 40 patients. In the palpation-guided group, 24 (54.55%) lumps were benign and 13 (29.55%) were malignant, whilst seven (15.90%) were inconclusive. In the ultrasound-guided group, 31 (65.96%) lumps were benign and 15 (31.91%) were malignant, whilst one (2.13%) was inconclusive. The sensitivity and specificity for palpation-guided CNB were 92.9% and 100%, respectively. The sensitivity and specificity for ultrasound-guided CNB were 100% each. There was no statistically significant difference in sensitivity between the two groups (P value of 0.4828). One patient (2.5%) in the ultrasound-guided CNB group had a hematoma. Conclusions: This study has shown that CNB has high diagnostic accuracy and low complications in the management of breast lumps, either by palpation-guided or ultrasound-guided techniques. There was no significant difference in accuracy or complications of CNB using either technique.
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Comparison of ocular biomery in primary open angle glaucoma and non-glaucoma in South West Nigeria p. 37
Ajibola Toyin Oluwaniyi, Olusola Olawoye, Tarela Frederick Sarimiye, B G K Ajayi
Background: Glaucoma is a public health problem in Nigeria. The number of individuals affected by glaucoma in Nigeria is much higher than the individuals known to have the disease. Ocular parameters such as intraocular pressure, central cornea thickness, axial length and refractive error have all been documented as risk factors of glaucoma especially among Caucasians and African Americans, with little documentation in Africa where there’s an alarming rate of blindness. Aim and Objectives: To compare central cornea thickness (CCT), intraocular pressure (IOP), axial length (AL) and refractive state in participants with primary open angle glaucoma (POAG) and non-glaucoma in South-West Nigeria. Materials and Methods: This hospital-based case-control study was carried out among 184 newly diagnosed POAG and non-glaucoma adult participants attending the outpatient clinic of Eleta eye institute. The CCT, IOP, AL and refractive state were measured in each participant. Test of significance between proportions in categorical variables were assessed using chi square test (χ2) in both groups. The means were compared using independent t-test while correlation between parameters were analyzed using Pearson correlation coefficient. Results: The mean age of the POAG participants was 57.16 + 13.3 years and the mean age of the non-glaucoma participants was 54.15 + 13.4 years. The mean IOP in the POAG group was 30.2 + 8.9mmHg while non- glaucoma group was 14.2 + 2.6mmHg (P < 0.001), other ocular parameters were not significantly different in both groups. In the POAG group, decreased spherical equivalent refractive error (i.e increasing myopia) was significantly associated with increased axial length (r= -0.252, P = 0.01), but not significant in the non- glaucoma group. However, in the non-glaucoma group, central cornea thickness increased with increasing intraocular pressure (r= 0.305, P = 0.003), which was not significant in the glaucoma group. Conclusion: Patients with POAG had much higher IOP and thus, IOP remains a significant risk factor in its development. There was a significant relationship between refractive state and axial length in the POAG group while a significant relationship was identified between central cornea thickness and intraocular pressure in the non- glaucoma group.
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Urinary catheter documentation in a Nigerian teaching hospital: Are we recording enough? p. 45
Chike John Okeke, Moses Adebisi Ogunjimi, Emmanuel Ajibola Jeje, Anselm Okwudili Obi, Chukwuebuka Uzoma
Background: Urinary catheters are an important armamentarium of urologic practice. Several indications for their use exist. A good knowledge of the details surrounding every urinary catheter inserted is necessary for the proper management of the patients. Inadequate documentation can lead to complications such as urinary tract infection or even forgotten catheters. Objectives: This study aimed at auditing the practice of documentation of urinary catheter parameters in our hospital as a means to improving the standard of care and aligning with international best practices with respect to the use of urinary catheters in our hospital. Materials and Methods: This study was a 3-month audit on the quality of documentation on the parameters of each urinary catheter use in Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria. The parameters included the indication for catheterisation, route of catheterisation, staff who catheterised, size of catheter, type of catheter, volume of water used for inflating catheter balloon, volume of urine drained, if aseptic technique was followed during catheterisation, informed consent and complications encountered. Data were summarised as frequencies and means. Statistical significance was pegged at P < 0.05. Results: Seventy-four patients were men, whereas two were women. The mean age of the patients was 67.29 ± 15.17 years. Overall, sex (76 [100%]), age (76 [100%]) and route of catheterisation (68 [89.5%]) were the three most commonly documented information. The documentation on complications and volume of fluid instilled to inflate the catheter balloon were the least-documented parameters (6 [7.9%] and 11 [14.5%], respectively). The following parameters were better documented in the SPC arm: The staff who passed the catheter p = 0.000), the type of catheter passed (p = 0.004), asepsis (p = 0.001) and acquisition of informed consent (p = 0.043). Conclusions: Documentation following urinary catheter use was noted to be poor in this study. Documentation of catheter parameters was noted to be higher in patients who had SPC than those who had urethral catheterisation.
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Clinical profile and predictors of early outcome in patients with traumatic spinal cord injury in Jos, North-Central Nigeria p. 49
Jeneral Dumura Alfin, Danaan Joseph Shilong, Gyang Markus Bot, Onyemaechi Ereke Nwibo, Nanpan Isa Kyesmen, Shina Abidemi Olalere, Nenkimun Dirting Bakwa
Background/Objectives: Spinal cord injury is a devastating condition and has been recognised so since antiquity with evolving pattern of presentation and outcome. This study aimed to review the clinical profile and determinants of early outcome in patients with traumatic spinal cord injury (TSCI) in Jos, Nigeria. Materials and Methods: This retrospective cohort study, reviewed the health records of all patients with TSCI that were managed, based on the neurosurgical unit protocol for the management of TSCI in our institution from 2011 to 2021. Relevant data were retrieved into a preformed pro forma, analysis was done for determinants of outcome using SPSS and presented in tables and figure. Results: A total of 296 patients, aged 20–39 years, with male to female ratio of 5.2:1 were studied. The median time from injury to presentation was 96 h, and the cervical spine was the most (139, 47.0%) affected region. Most of the patients (183, 61.8%) had complete injury (ASIA A) at presentation, the average, first week mean arterial blood pressure (MAP) of 89.98 ± 8.86. Mortality was 73 (24.7%) at 6 weeks post injury and complete TSCI, cervical spinal cord segment and the average “first week” MAP were, independent predictors of mortality. The admission ASIA impairment scale (AIS) and injury to presentation interval were predictive of AIS improvement at 6 weeks and length of hospital stay (LOHs). Conclusions: We also found that AIS at admission, level of spinal cord affected and the average first week MAP were early predictors of mortality, while the injury to presentation interval and admission AIS, predicted improvement of AIS at 6 weeks. The LOHs was seen more in patients with severe AIS at admission and those who had delayed presentation.
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Preoperative intravenous dexamethasone and postoperative analgesia following breast surgery: A prospective, randomized double-blind trial at a Tertiary Healthcare Facility in Ghana p. 59
PapaKobina Gyakye Degraft-Johnson, Robert Djagbletey, Henry K Baddoo, Ernest Aniteye, George Aryee, Raymond Essuman, Faustina Amable, Ebenezer Owusu Darkwa
Introduction: Breast surgery may be associated with significant postoperative pain and if not adequately treated, may lead to the development of chronic post-surgical pain. This necessitates the use of effective management, involving the use a multimodal analgesia regimen for the management of post breast surgery pain. The analgesic effect of perioperative use of dexamethasone has been explored but findings have been inconsistent. Aim: The aim of this study was to determine the postoperative analgesic enhancing effect of a single preoperative dose of dexamethasone on patients undergoing breast surgery at a tertiary hospital in Ghana. Materials and Methods: This was a prospective, double-blind, placebo-controlled study involving 94 consecutively recruited patients. Patients were randomized into two groups: dexamethasone (n = 47) and placebo (n = 47). Patients in the dexamethasone group had 8mg (2 mL of 4 mg/mL) dexamethasone and those in the placebo group had 2 mL of saline administered intravenously just before induction of anaesthesia. All patients received a standard general anaesthesia with endotracheal intubation.The numerical rating score (NRS), time to first analgesic request and the total opioid consumed in the first 24 h were recorded. Results: Patients receiving dexamethasone had lower NRS scores at all measured time points but this was significant only at 8 h post-surgery (P = 0.037). The time to first rescue analgesia was significantly prolonged in the dexamethasone group (339.26 ± 312.90 min vs. 182.10 ± 166.72 min; P = 0.020).However, the mean total opioid (pethidine) consumed in the first 24 h postoperatively was not significantly different between the dexamethasone and control groups (113.75 ± 51.35 mg vs. 100.00 ± 60.93 mg; P = 0.358). Conclusion: A single preoperative dose of 8mg dexamethasone given intravenously, reduces postoperative pain compared to placebo, significantly reduces the time to first analgesia but not the total opioid consumed in the first 24 h post breast surgery.
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Auditing the findings of computed tomographic angiographic examinations using 160-slice scanner: Analysis of 5-year experiences from Northwestern Nigeria p. 66
Anas Ismail, Yusuf Lawal, Adamu Abba Adamu, Isa Hassan Muhammad, Tahir Sani, Saadatu Hassan Jaafar, Zainab Hayatu, Mohammed Kabir Saleh
Background: Computed tomographic angiography (CTA) is a promising tool for the rapid characterisation of the anatomy and structural lesions of the vascular system. Aim/Objectives: The aims/objectives of the study were to determine the frequency and pattern of vascular lesions in northern Nigeria. We also set to determine the agreement between clinical and CTA diagnosis of vascular lesions. Materials and Methods: We study patients that had CTA studies over a 5-year period. In total, 361 patients were referred for CTA, but only the records of 339 of them were retrieved and analysed. The information about patients’ characteristics, clinical diagnosis, and the findings on CTA was also retrieved and analysed. The categorical data results were expressed as proportions and percentages. The Cohen’s kappa coefficient (κ statistic) was used to determine the agreement between the clinical and CTA findings. A P value of <0.05 was considered statistically significant. Results: The mean (standard deviation) age of the subjects was 49.3 (17.9) years with a range of 1–88 years, consisting of 138 (40.7%) females. Up to 223 patients had various abnormalities on CTA. There were 27 (8.0%) cases of aneurysms, eight (2.4%) cases of arteriovenous malformations, and 99 (29.2%) cases of stenotic atherosclerotic disease. There was a significant agreement between the clinical diagnosis and corresponding findings on CTA showed for intracranial aneurysms (k = 15.0%; P < 0.001), for pulmonary thromboembolism (k = 4.3%; P < 0.001), and for coronary artery disease (k = 34.5%; P < 0.001). Conclusions: The study found that close to 70% of the patients referred for CTA have abnormal findings, out of which stenotic atherosclerosis and aneurysm are the common findings. Our findings highlighted the diagnostic value of CTA variety of clinical conditions and underscored the prevalence of many vascular lesions in our environment, which hitherto were regarded as uncommon.
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Evaluation of the effect of surgical repair on lip–nose morphometric parameters of patients with unilateral cleft lip using two-dimensional photogrammetry: A comparative study between the cleft and the non-cleft side p. 73
Mohammed Adam Sheikh Abdullahi, Olutayo James, Hector Oladapo Olasoji, Wasiu Lanre Adeyemo
Background: This prospective, comparative study was carried out to evaluate the effect of cleft lip repair on lip–nose morphometric characteristics of subjects with complete unilateral cleft lip/palate at the University of Maiduguri Teaching Hospital, Borno State, Nigeria. Materials and Methods: The study population consisted of a total of 29 subjects. Lip repair was done using Millard’s rotation advancement technique by a single consultant. Standardised photographs were taken; preoperatively and during different postoperative periods; immediately, 1 week, 3, and 6 months. Indirect measurements of eight linear distances were carried out using Rulerswift software application. For all statistical analyses of mean difference, a P-value of less than 0.05 was accepted as being statistically significant. Results: A total of 52% were women, whereas 44% were men. There are considerable disparities between the cleft and non-cleft sides of complete unilateral cleft patients before surgery; statistically significant differences of 1.4 mm, 6.3 mm, and –17.6 mm in vertical lip height, philtral height, and nasal width respectively. Six months after repair, statistically significant differences in lip height between the cleft and the non-cleft side were observed in vertical lip height, nasal width, and philtral height (mean difference of –1.28 ± 0.78, 2.02 ± 2.86, 1.22 ± 1.83 mm; P < 0.001, P = 0.016, P = 0.022, respectively). Horizontal lip height was maintained with no statistically significant difference (mean difference of –0.12 ± 2.19 mm). Conclusion: Following cleft repair, using Millard’s rotation advancement technique, differences in lip–nose morphometric parameters were found to be reduced, however, not always eliminated by treatment.
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Endoscopic septoplasty: A retrospective analysis of indications and outcome p. 78
Yusuf Bukar Ngamdu, Abdullahi Musa Kirfi, Auwalu Adamu, Adamu Abubakar, Kingsley Paul Edem, Babagana Muhammad Ahmad
Background: Endoscopic septoplasty is a minimally invasive surgical procedure for the correction of nasal septal deformity. Globally, nasal septal surgeries are rarely performed, and in our country these procedures are even more scarcely undertaken, partly due to dearth of facilities and to some extent, the expertise of embarking on this specialised surgical procedure. Therefore, we aimed to document the indications and the outcome of endoscopic septoplasty in our environment. Materials and Methods: This was a retrospective study of all consecutive patients that had endoscopic septoplasty at a state tertiary hospital over three years period. Ethical approval was obtained before commencement of the study. Patients’ medical records were retrieved. Biodata, clinical presentation, operative procedure and outcome were extracted and analyzed descriptively. Results: Fourteen patients had endoscopic septoplasty over the period under review, constituting 11 (78.6%) males and 3 (21.4%) females. Predominant clinical features were nasal obstruction (100%) and nasal septal deviation (100%). The main indication for procedure was deviated nasal septum. The outcome of the surgery was good, 2(14.3%) of the patients had nasal adhesions but no major complication was recorded. The length of hospital stay ranged between 3 and 5 days with a mean of 3.7 ± 0.9 days, and all the patients were discharged successfully. Conclusions: Endoscopic septoplasty is a safe surgery. The main indication for the procedure was deviated nasal septum, and the procedure has a favourable outcome among the operated patients.
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Correlation between serum prostate-specific antigen and testosterone following bilateral total orchidectomy for patients with advanced prostate cancer in Jos, Nigeria p. 82
Olutayo Israel Osunaiye, Venyil Mamzhi Ramyil, Nuhu Kutan Dakum, Idorenyin Cletus Akpayak, Samaila Ibrahim Shuaibu, Chimaobi Gideon Ofoha, Ayodeji Olushola Ogunmola, Christian Agbo Agbo, Adedayo Stephen Oyedeji
Background: Prostate cancer is a common malignancy affecting men beyond the middle age. Monitoring of treatment of the disease using serum testosterone and prostate-specific antigen (PSA) offers an index of treatment efficacy and a reflection of disease progression, respectively. The objective of this study was to determine the relationship between changing values of serum PSA and serum testosterone in patients with advanced prostate cancer following bilateral total orchidectomy (BTO). Materials and Methods: This was a prospective longitudinal study carried out over a 1-year period among patients who met the inclusion criteria. Each patient underwent detailed clinical evaluation including history, as well as physical examination with digital rectal examination of the prostate. Also, samples of serum PSA and testosterone were obtained and sent to the same chemical pathology laboratory before intervention with BTO, then at 2, 4, and 6 months. The values of serum PSA and testosterone were obtained and changes over this period were compared for both parameters. The analyses included independent inferential analysis of serum testosterone and serum PSA over a period of 6 months and a correlation of the two parameters over the same period. Results were analysed using SPSS version 23. P value of <0.05 was regarded significant. Charts and tables were used for data expression. Kruskal–Wallis and Wilcoxon tests were used for individual inferential analysis of serum testosterone and PSA. The Spearman ranked correlation coefficient test was used to determine the degree of correlation of serum testosterone and serum PSA levels while Pearson correlation coefficient test was used to determine the degree of correlation between the percentage changes in serum testosterone and PSA measured over the period of the study. Results: A total of forty-two men with mean age of 68.49 ± 8.86 years who had advanced prostate cancer were recruited. The histologic type of prostate cancer diagnosed for all the patients was adenocarcinoma. The mean Gleason score was 7.98 ± 1.09, while the modal Gleason grade group represented was grade group 5. There were statistically significant changes in serum testosterone and PSA levels in response to bilateral total orchidectomy with P value of <0.001. However, there was no statistically significant correlation between serum testosterone and serum PSA levels following bilateral total orchidectomy with p values of 0.492, 0.358, 0.134, and 0.842 at baseline, 2, 4, and 6 months, respectively. There was a significant correlation between the percentage changes in serum testosterone and PSA measured between baseline and 2 months with P value of <0.001. However, there was no statistically significant correlation between the percentage changes in serum testosterone and PSA measured between baseline measured against 4 months and 6 months with P value of 0.998 and 0.638, respectively. Conclusion: The study showed that reduction in serum levels of testosterone and PSA following BTO was significant. It also revealed no statistically significant correlation between serum testosterone and serum PSA measured over 6 months following bilateral total orchidectomy.
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Amsler grid versus 10-2 test in primary open angle glaucoma p. 92
Temitope Mariam Gbadegesin, Olusola Olawoye, Tarela Frederick Sarimiye, Oluwatobi Olalekan Idowu, Benedictus G K Ajayi
Background: Glaucoma is the leading cause of global irreversible blindness. The goal of management in glaucoma lies in its early detection and treatment to prevent further optic neuropathy. Available equipment for early glaucoma detection is not cost-effective or readily available in resource-scarce settings such as Nigeria. Thus, there is a need for a simple cost-effective tool to detect glaucomatous central visual field (CVF) defects in all the stages of glaucoma within the community in resource scarce-settings. Aims and Objectives: The aim of this article is to determine the validity of the Amsler grid in detecting central glaucomatous visual field defects in primary open angle glaucoma (POAG). Materials and Methods: This was a cross-sectional study of follow-up glaucoma patients at a secondary eye care hospital in Nigeria. All patients had detailed ophthalmic examination in addition to 24-2 and 10-2 CVF tests and Amsler grid test. POAG was classified using the Hodapp–Parrish–Anderson criteria into mild, moderate, and severe on 24-2 CVF. The diagnostic validity of the Amsler grid was calculated using the 10-2 CVF as a reference standard. Regression analyses were performed between the Amsler grid scotoma area and 10-2 CVF parameters [mean deviation (MD), scotoma extent (SE), and scotoma mean depth (SMD)]. Results: A total of 150 eyes of 150 patients were enrolled. The sensitivity, specificity, and positive predictive value and negative predictive value of the Amsler grid compared with the 10-2 CVF was 49.5%, 95.9%, 96.2%, and 47.9%, respectively, with an area under curve of 0.7. Sensitivity increased with increasing severity (P < 0.001) from 20.0%, 31.0%, and 76.6% in mild, moderate, and severe POAG, respectively. The Amsler grid scotoma area had the strongest relationship with the 10-2 MD, followed by 10-2 SE and 10-2 SMD with a quadratic R2 of 0.579, 0.370, and 0.307, respectively. Conclusion: The Amsler grid has a low sensitivity in mild-to-moderate POAG. However, it may serve as an adjunctive tool in resource-scarce settings for detection of severe POAG in the community by primary eye care providers.
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Single dose versus 72-hour course of ceftriazone for antibiotic prophylaxis in preventing post-caesarean wound infection: A randomized control trial p. 100
Usman Danjuma Zubairu, Mohammed A Abdul, Umma Suleiman Bawa, Nana Hauwa Madugu
Background: Single dose antibiotic prophylaxis has been established as the standard for prevention of post-caesarean wound infection in most developed centers across the world. However, this is not the case in most developing countries including Nigeria where various multiple dose regimens are still being used due to paucity of locally generated evidence, and anecdotal suggestions of a higher risk of infectious morbidity in our environment. Objectives: This study was aimed to determine whether there was a significant difference in the incidence of post-caesarean section wound infection between a single dose and a 72-hour course of intravenous ceftriazone for antibiotic prophylaxis in selected patients undergoing both elective and emergency caesarean section. Materials and Methods: A randomized controlled trial was carried out among 170 consenting parturients scheduled for elective or emergency caesarean section who met a set out selection criteria, between January and June 2016. They were divided randomly into two equal groups, A and B, of 85 each using the Windows WINPEPI software version 11.65 (Copyright J.H. Abrahamson, 22 Aug 2016) for randomization. Group A patients received a single dose of 1 g, whereas Group B patients were given a 72-hour course (1 g daily) of intravenous ceftriazone. The primary outcome measure was the incidence of clinical wound infection. The secondary outcome measures were the incidences of clinical endometritis and febrile morbidity. Data were collected using a structured proforma and analyzed using Statistical Package for Social Sciences version 21. Results: The overall incidence of wound infection was 11.2%; Group A had 11.8%, and Group B had 10.6%. Endometritis was 20.6%; Group A had 20% and Group B had 21.2%. Febrile morbidity was 4.1%; Group A had 3.5% and Group B had 4.7%. There was no statistically significant difference in the incidence of wound infection (relative risk [RR] = 1.113; 95% confidence interval [CI] = 0.433, 2.927; P = 0.808), endometritis (RR = 0.943; 95% CI = 0.442, 1.953; P = 0.850), and febrile morbidity (RR = 0.745, 95% CI = 0.161, 3.415; P = 0.700) between the two groups. Group A showed similar risk of developing wound infection compared to Group B (P > 0.05). Conclusion: There was no significant difference in post-caesarean wound infection and other infectious morbidity between patients that received a single dose, and those that received a 72-hour course of ceftriazone for antibiotic prophylaxis. This suggests that single dose antibiotic prophylaxis with ceftriazone is similar to multiple dose regimens in efficacy with likely cost-effective advantage.
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Prevalence and predictors of anxiety among surgical patients in the preoperative holding area of National Orthopaedic Hospital, Enugu, Nigeria: A cross-sectional study p. 105
Edmund N Ossai, Arinze D G Nwosu, Okechukwu Onwuasoigwe, Kenneth Ubboe, Johnson Ameh, Lawrence Alu
Background: High preoperative anxiety in surgical patients impacts anesthetic management, postoperative pain scores, patient satisfaction, and postoperative morbidity. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) offers an attractive option for the assessment of preoperative anxiety on account of its brevity and validity. Aim: Our aim was to determine the prevalence and predictors of preoperative anxiety in our surgical patients. Materials and Methods: We conducted a cross-sectional study among surgical patients by means of interviewer-administered structured questionnaire. The questionnaire incorporated both the APAIS and numeric rating scale for anxiety instruments, with the patients’ demographic and clinical details. The data collection was carried out from January 2021 to October 2022. Data entry and analysis were done using IBM Statistical Product and Service Solutions, statistical software version 25. Continuous variables were summarized using mean and standard deviation, while categorical variables were presented using frequencies and proportions. Chi square test, Student t test, correlation analysis, and multivariate analysis using binary logistic regression were used in the analysis. Statistical significance was determined by a P value of <0.05. Results: A total of 451 patients participated in the study, with a mean age of 39.4 ± 14.4 years. The prevalence of clinically significant anxiety was 24.4% (110/451). The predictors of high preoperative anxiety in our cohort were female gender, tertiary education attainment, lack of previous surgical experience, ASA grade 3, and patients scheduled for major surgery. Conclusion: A substantial proportion of the surgical patients experienced clinically significant preoperative anxiety.
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Intramedullary tuberculoma of the conus medularis in an immunocompetent young adult with no pulmonary tuberculosis, the challenges of diagnosis and management: A case report and review of literature p. 113
Jeneral Dumura Alfin, Philip Ojile Akpa, Danaan Joseph Shilong, Gyang Markus Bot, Onyemaechi Ereke Nwibo, Nanapan Isa Kyesmen, Shina Abidemi Olalere, Nenkimum Dirting Bakwa, Innocent Emmanuel
Background and Objective: Intramedullary tuberculoma (IMT) of the conus medullaris is an extremely rare tumour that constitutes a diagnostic and management challenge in a resource-limited setting. We report a case of conus medullaris, IMT in a young immunocompetent, patient with no prior clinical features of pulmonary or extra-pulmonary tuberculosis. Case Summary: The patient presented with six months history of progressive and persistent mid back pain and slight weakness of both lower limbs of 3 months duration. Physical examination revealed a well-nourished man with power of 3/5 and hyperreflexia on both lower limbs. Chest radiograph and other investigations for tuberculosis were negative. Magnetic resonance imaging (MRI) of the lumbosacral spine showed fusiform expansion of the conus medullaris, with a well circumscribed, ring enhancing, intramedullary mass straddle between T12 and L1. Patient had gross total resection with no intraoperative monitoring assistance and no post-operative worsening of neurological function. Histology showed granulomatous lesion with central caseation in keeping with a tuberculoma. Patient was commenced on post-operative anti-tuberculous therapy with physiotherapy, with full motor recovery at six months post-surgical intervention and anti-tuberculous therapy. Conclusion: Intramedullary tuberculoma can be considered as one of the differential diagnoses of intradural, intramedullary tumour of the conus, even in immunocompetent individual with no clinical features of tuberculosis.
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Bilateral self-enucleation of the eyes: Case report and literature review p. 118
Sebastian N N Nwosu, Victoria O Nwosu, Cyriacus Ugochukwu Akudinobi, Adaora Amaoge Onyiaorah, Chizoba Udoka Uba-Obiano
Self-removal of the eyeball is an extreme form of self-harm, which is rare especially in a society ill-disposed to self-maiming. We report the case of a 75-year old man who plucked out his own two eyes in obedience to a voice urging him to do so. According to his wife, the patient had been exhibiting symptoms suggestive of a psychiatric disorder just before the incident. But this was overlooked. This case report draws attention to the devastating ophthalmic consequences of neglected psychiatric disorders in the elderly. We recommend greater attention to the mental health of the elderly. Prevention and management of auto-enucleation requires a collaboration between psychiatrists and ophthalmologists.
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Hydatid disease of tibia reconstructed with allograft: A rare case report and literature review p. 122
Bishwa Bandhu Niraula, Anil Regmi, Shivam Bansal, Mohit Dhingra, Ravi Hari Phulware, Saroj Kumar Bhagat
Background: Hydatid disease of bone shows a well-defined, multiloculated lytic lesion with the appearance of a bunch of grapes. The presenting symptoms are pain and swelling with or without pathological fracture. The treatment options include surgery followed by a long duration of albendazole. Removal of the involved bone is required to decrease the chances of recurrences. Case Report: In our study, we have included a case of 28-year-old woman presented with complaints of pain and difficulty in weight bearing over her right lower limb for 2.5 months. Radiograph suggested an eccentric lytic lesion in midshaft of tibia and biopsy revealed granulosus cyst wall, nucleate germinal layer, the brood capsule, and protoscolices with visible hooklets. Patient was subjected to surgery with the excision of cyst along with extended curettage of bone creating a bone defect around the lesion and with anterolateral platting with coverage of bone defect by allogenic bone grafting. Patient was kept on above knee slab with non-weight-bearing mobilization for 6 weeks. Postoperative chemotherapy with Albendazole was given for 3 months. Patient was followed up every 6 weeks for 3 months and every month thereafter on outpatient basis. Return to work and patient satisfaction were excellent. Conclusion: Definitive Surgical management with Preoperative and postoperative chemotherapy seems to be effective to avoid recurrence. The bone defect caused by the disease or surgery can be managed with a bone graft either of autograft or allograft.
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