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ORIGINAL ARTICLES
Perception of primary school teachers on pupils’ eye health in the Ga West Municipality, Greater Accra Region, Ghana
Winston Ceesay, Imoro Z Braimah, Benjamin Abaidoo
July-September 2019, 9(3):15-20
DOI:10.4103/jwas.jwas_902_19  
Background: Eye health education is lacking in low- and middle-income countries due to limited availability of eye care personnel in the school setting. Teachers have been considered possible human resource for maintaining eye health in schoolchildren. Objective: The aim of this article is to determine the knowledge of teachers on the nature of eye problems among schoolchildren and their ability to recognize visual disorders. Materials and Methods: This was a descriptive cross-sectional survey among primary school teachers in the Ga West Municipality. Cluster sampling was used to select 140 teachers from 12 public and private schools. A structured questionnaire was used in assessing teachers’ knowledge about the features of a healthy and diseased eyes, common causes of visual impairment (VI) and blindness, and recognizing and preventing eye problems in the children. Aggregate scores were computed for correct responses concerning healthy and diseased eyes, and scores were categorized into poor (0–25%), fair (26–50%), good (51–75%), and very good (76–100%) knowledge. Results: Eighty-six (61.4%) of the teachers were females. The mean age was 33 ± 9.1 years. Most teachers were found to have good knowledge about healthy and diseased eyes (75.0% and 60.0%). Hypermetropia, red eye, allergy, and cataract were cited by 50.0–57.9% as the most common causes of VI and blindness. Between 27.1% and 92.1% of teachers identified difficulties seeing the writing board, inability to concentrate in class, holding the book close to the eye to read, and squinting as ways of recognizing eye problems. Most respondents, 132 (94.3%), were of the view that teachers should be involved in screening schoolchildren for ocular morbidities. Conclusion: Teachers in the Ga West Municipality had good knowledge of the characteristics of healthy eyes and a fair knowledge of the causes of VI in primary schoolchildren. Teachers require further training if they are to serve as focal persons for vision screening and eye health education in primary schools.
  1,362 114 -
Testicular cancer at the University of Port Harcourt Teaching Hospital: A 10-year retrospective review
V Abhulimen, EJ Raphael
July-September 2019, 9(3):21-26
DOI:10.4103/jwas.jwas_903_19  
Background: Testicular cancers are rare malignancies. They are however very common in males aged 15–40 years. Reports of increasing incidence of testicular cancer in western countries have been noted. Despite the increasing incidence, mortality has remained low in these countries. There are few publications on the management of testicular tumors in Nigeria. Aim: The aim of this study was to determine the hospital prevalence and highlight our experience in the management of patients with testicular cancer. Materials and Methods: This was a 10-year retrospective study on patients diagnosed with histologically confirmed testicular cancer from January 2009 to December 2018. The case records were retrieved. Data obtained included biodata, clinical presentation, investigations, treatment received and outcomes. Data analysis was carried out using SPSS version 20.0. Results: Eleven patients with testicular cancer were managed during the study period, constituting 0.01% of new cases seen in the hospital. Peak age was 20–29 years (54.55%), with a mean age of 29.27 ± 9.51yrs. The most common presentation was painless scrotal swelling, observed in nine (81.8%) patients. Nine (81.8%) patients presented six months or more after onset of symptoms with advanced disease. Distant metastasis was seen in two (18.2%) patients. Right sided disease was found in seven (63.6%) and left sided disease in four (36.4%). All had radical inguinal orchidectomy. The most common histological diagnosis was seminoma in 8 (72.7%) patients. All the subjects were offered four courses of chemotherapy with bleomycin, etoposide and cisplatin. However, only four (36.4%) completed the chemotherapy. A statistically significant association was observed between the duration of symptoms and the disease stage (P = 0.003), and between number of chemotherapy sessions and survival (P = 0.02). Conclusion: Testicular cancer was an uncommon condition in the catchment area of the University of Port Harcourt Teaching Hospital, affecting relatively young men. The commonest presenting complaint was painless scrotal swelling. Most patients presented with Stage II disease, with seminoma being the commonest histopathology. All had surgical treatment; adjuvant chemotherapy improved 5-year survival. Public education is necessary to surmount sociocultural barriers to effective management of testicular tumors in our environment.
  1,330 106 -
Clinical determinants of vaginal and abdominal hysterectomy for benign conditions at the University Teaching Hospital, Yaounde-Cameroon
Tebeu P M, Tayou R, Antaon J S S, Mawamba Y N, Koh V M, Ngou-Mve-Ngou J P
July-September 2019, 9(3):1-7
DOI:10.4103/jwas.jwas_900_19  
Background: Little is known about training and the practice of vaginal hysterectomy in many sub-Saharan Africa countries. Objective: The aim of this study was to identify the clinical determinants of choice of hysterectomy route for benign conditions at the University Teaching Hospital in Yaoundé, Cameroon (UTHYC). Methods: This was a retrospective cross-sectional study at the UTHYC from January 1, 2000 to December 31, 2008. Non-emergency hysterectomies for benign conditions were divided into two surgical approaches: vaginal and abdominal. Patients’ files and registers were used for data collection. Variables of interest were socio-demographic, reproductive health, and clinical characteristics, including indications and surgical route. Analysis was performed using Epi-Info version 3.5.1. Logistic regression analysis was conducted to determine the association between clinical variables and surgical routes. Odds ratios with their 95% confidence intervals (CI) were calculated. The level of significance was set up at P < 0.05. Results: One hundred and sixty-three women who underwent hysterectomy for benign conditions were included in the study. Thirty-seven (22.7%) were by vaginal route and 126 (77.3%) by abdominal route. Indications for hysterectomy were: cervical premalignant lesions, symptomatic uterine fibroids, prolapsed uterus, endometrial hyperplasia, recurrent cervical condyloma, and dysfunctional uterine bleeding.All 61 women with estimated uterine size of more than 12 weeks were operated on by abdominal route. At bivariate analysis, compared to women who had vaginal hysterectomy, factors associated with the choice of abdominal route were secondary/tertiary level of formal education, previous history of laparotomy/caesarean section, premenopausal status, age less than 50 years, and symptomatic uterine fibroids as surgical indication. At multivariate analysis, factors remaining independently associated with the choice of abdominal route were: age <50 years (AOR: 2.99 [1.9–4.71]), P < 0.001); previous laparotomy/cesarean section (AOR: 2.95[2.13–4.08], P = 0.001); premenopausal status (AOR: 1.55 [1.06–2.25]; P = 0.001); and myoma as surgical indication (AOR: 7.49.4[3.2–14.4]; P = 0.0001). Conclusion: Less than a quarter of hysterectomies for benign conditions were performed vaginally. All patients with uterine sizes larger than 12 weeks had laparotomy. The determinants of the choice of the abdominal route included age less than 50 years, previous laparotomy/caesarean section, premenopausal status, and fibroid as surgical indication.
  1,258 110 -
Prevalence of group B Streptococcus colonisation and antimicrobial susceptibility pattern among pregnant women attending a tertiary health facility in Ogun State, Southwest Nigeria
Oluwole Olutola Ojo, DO Awonuga, Iyabode Olabisi Florence Dedeke, Victor Ugochukwu Nwadike, Olaide Rufus Adenaya, Oluwaseyi Isaiah Odelola
July-September 2019, 9(3):8-14
DOI:10.4103/jwas.jwas_26_21  
Background: Genital colonisation by group B Streptococcus (GBS) in pregnant women in their third trimester has been shown to be a known risk factor for morbidity and mortality among newborns. Aim: The aim of the study was to determine the prevalence of GBS colonisation among pregnant women in Abeokuta, its associated sociodemographic factors, and the neonatal outcome among exposed babies. Design: Longitudinal cohort study. Setting: Department of Obstetrics and Gynaecology, Federal Medical Centre, Abeokuta, Ogun State. Methodology: One hundred sixty pregnant women presenting for routine antenatal care between 35 and 41 weeks were recruited consecutively. Swabs were taken from the vagina and then the rectum using a single swab. The samples were processed at the hospital’s Medical Microbiology Laboratory using standard microbiological methods. Babies whose mothers were positive had their bodies swabbed and the samples sent for GBS isolates. They were also screened for early-onset neonatal sepsis with C-reactive protein. Results: Prevalence of GBS vaginal colonisation was 4.3%. There was no significant association between GBS colonisation status and age, level of education, or occupation; however, women of parity ≤1 had significantly higher prevalence of GBS colonisation than those of parity ≥2. There was no incidence of GBS infection observed in the babies. The GBS isolates were 100% sensitive to cefuroxime and 83.3% resistant to ampicillin. Conclusion: The prevalence of GBS is low in our environment. The organisms were highly sensitive to cefuroxime, erythromycin, and ceftriaxone. Routine screening of all pregnant women may be unnecessary. However, women at risk of GBS who present in labour without a recent GBS screening should be offered intrapartum prophylactic cefuroxime.
  1,268 84 -
Effect of dental treatment on the quality of life of children with traumatic dental injuries in ibadan, Nigeria
Yewande Isabella Adeyemo, Olubunmi O Bankole, Timothy O Aladelusi, Obafunke O Denloye
October-December 2019, 9(4):1-7
DOI:10.4103/jwas.JWAS_11_21  
Background: Anterior dental trauma is known to be common in our environment as well as the complications that come with it. These injuries have been seen to impact the quality of life (QoL) of children significantly due to the fact that they compromise their dental health. This leads to aesthetic, psychological, social, and therapeutic problems impacting both the children and their parents. Treatment of these injuries has also been severely neglected possibly due to lack of awareness of where or how to access treatment as well as fear of dental treatment. However, treatment may on the other hand bring about a substantial improvement on the QoL of children in terms of their daily living. Aim: To assess the effect of dental treatment on the QoL of 12- to 15-year-old Nigerian school children previously identified as having had traumatized anterior teeth. Design: This is a follow-up study where secondary data were extracted from a cross-sectional study involving 1575 children attending public and private secondary schools in Ibadan, Nigeria. One hundred and ninety-six adolescents with evidence of dental trauma, previously identified as having their QoL negatively affected as a result of dental trauma, were called to take part in the follow-up study. The Child Perception Questionnaire (CPQ11-14) was used in assessing the QoL of participants with dental trauma before and after treatment. Data were analysed using the IBM® SPSS® Statistics version 20.0, and the effect of dental treatment on the QoL of the participants was assessed using the McNemar’s test. Statistical significance was set at P < 0.05. Results: Fifty-one (26.0%) out of the 196 invited children participated; there were 31 males and 20 females. The mean age was 13.4 years (standard deviation 1.1 years). Eighty traumatized anterior teeth were involved, with the maxillary centrals being the commonest (68, 85%). Twenty-three (45.1%) participants had more than one traumatized tooth. The commonest dental trauma was enamel fracture, which involved the dentine (39, 48.8%). The main treatments given were composite build-up (36, 45%) and root canal treatment (42, 52.5%). With the CPQ11-14, in the oral symptoms domain, the number adversely affected before treatment fell from 30 (58.8%) to 3 (5.9%) (P < 0.001); in the emotional well-being domain, the number dropped from 35 (68.6%) to 10 (19.6%) (P < 0.001); and in the social well-being domain, the number fell from 34 (66.7%) to 22 (43.1%) (P = 0.004). However, in the functional limitation domain, the number adversely affected increased from 24 (47.1%) before to 46 (90.2%) after treatment (P < 0.001). Conclusion: Treatment resulted in a significant improvement in the QoL of participants, especially regarding their oral symptoms, and emotional and social well-being. However, there was worsening in the functional limitation domain. There is the need to introduce oral health into the school curriculum in order to encourage early reporting and prompt treatment of traumatic dental injuries.
  1,253 86 1
Structured antenatal counselling and postpartum contraceptive uptake in South West Nigeria
Oluwaseyi Odelola, Adebayo Akadri
October-December 2019, 9(4):8-14
DOI:10.4103/jwas.JWAS_25_21  
Background: Antenatal clinic is an opportunity to counsel women on the need for postpartum contraception. This study was designed to determine the effect of structured antenatal counselling on postpartum contraceptive uptake. Materials and Methods: A prospective intervention study was conducted in the antenatal clinic of Olabisi Onabanjo University Teaching Hospital, Sagamu from July 15, 2018 to June 31, 2019. Two hundred antenatal attendees were randomly allocated to intervention and control groups. Women in the control group had routine antenatal counselling by the nurses/midwives, whereas those in the intervention group had well-structured antenatal contraceptive education sessions at each antenatal visit. A data capture sheet was used to obtain relevant information at presentation in labor and completed 6 months postpartum through phone conversation. Results: The overall contraceptive acceptor prevalence was 35.5%. Majority of the contraceptive acceptors (42.3%) opted for intrauterine contraceptive devices. The contraceptive prevalence among the intervention group was 45% when compared with 26% among the controls. This was statistically significant (χ2 =7.883, P = 0.005). However, after multivariate logistic regression analysis, the intervention (structured antenatal counselling) was not found to be a significant determinant of postpartum contraceptive uptake [adjusted odds ratio (AOR) 1.0; confidence interval (CI) 0.4–2.2; P = 0.941). Previous history of contraceptive usage, attending six or more antenatal visits, and Islamic religion were significant determinants of postpartum contraceptive uptake [(AOR 34.3; CI 7.1–164.6; P < 0.001) (AOR 8.0; CI 2.9–22.3; P < 0.001) (AOR 8.3; CI 3.3–10.0; P < 0.001), respectively]. Conclusion: Incorporation of structured antenatal contraceptives counselling was not significantly better than routine antenatal care in its effect on postpartum contraceptive uptake. There is need for deliberate efforts to encourage women to attend antenatal clinics in which contraceptive information would be provided during routine visits.
  1,184 85 -
Labor analgesia in South West Nigeria: Methods and self-reported effectiveness
Adebayo Akadri, Oluwaseyi Odelola, Akinmade Adepoju
October-December 2019, 9(4):15-20
DOI:10.4103/jwas.JWAS_30_21  
Context: Labor exposes many women to severe pain. Effective labor pain management is one of the prerequisites for a satisfying labor experience. Aim: The aim of this study was to assess the labor pain management practices and patients’ assessment of adequacy of pain relief in two tertiary hospitals in South West Nigeria. Materials and Methods: This was a cross-sectional study involving 132 pregnant women who had a noninstrumental vaginal delivery at the obstetric units of Babcock University Teaching Hospital and Olabisi Onabanjo University Teaching Hospital, between December 2017 and May 2018. A structured questionnaire was administered to women within 24 h of delivery to record details of labor and delivery, the form of labor analgesia administered and respondents’ perceived effectiveness of the analgesia. Data were analyzed using the IBM-SPSS statistics for Windows version 21.0 (IBM, Armonk, New York). Results: Sixty-six (50%) women rated labor pain to be severe. Thirty-eight women (28.8%) did not receive any pain relief during labor. Nonpharmacological pain management practices such as back massage, breathing exercises, and companionship were administered to 45(34.1%), 79(59.8%), and 45(34.1%) women, respectively. Nine women (6.8%) received intramuscular pentazocine (30 mg) for labor analgesia. There was a statistically significant association between use of back massage and severe labor pain perception (χ2 = 4.080; P = 0.043). Self-reported effectiveness was highest among users of back massage (82.2%) and companionship (77.8%). Conclusions: There is a large unmet need for labor analgesia in South West Nigeria. Nonpharmacological pain management practices were the most frequently used methods, and most patients experienced reduction in severity of pain. There is need for improvements in obstetric analgesia services in our maternity units.
  1,121 91 -
Dorsal corporoplasty techniques in the management of chordee associated with severe hypospadias at a teaching hospital in Yaoundé, Cameroon: A retrospective study
Tagang Ebogo Titus Ngwa, Landry Oriole Mbouche, Kamkui Laure Dadje, Tambo Faustin Mouafo, Fru Forbuzshi Angwafor
April-June 2020, 10(2):23-29
DOI:10.4103/jwas.jwas_64_21  
Introduction: The prevalence of hypospadias is 1 in 300 male births, of whom one in four will have some form of chordee. Correction of the chordee is imperative but presents a challenge with complications, including residual chordee, penile nodulations, and shortening. This study aimed at reporting the outcomes and at sharing our experience with the surgical correction of chordee associated with hypospadias at the Yaounde Gyneco-Obstetric and Pediatric Hospital (YGOPH). Patients and Methods: We carried out a retrospective cross-sectional study covering an eight-year period from 1 January 2010 to December 2017 at the Pediatric Surgery Service of the YGOPH. The study included all files of patients with severe hypospadias who underwent chordee correction using dorsal corporoplasty techniques and were reviewed for outcome evaluation. Results: A total of 40 patients met the inclusion criteria, of whom 22 (55%) had chordee corrected by the Nesbit corporoplasty technique, 13 (32.5%) by the Tunica Albuginia Plication (TAP) corporoplasty technique, and five (12.5%) by the Yachia corporoplasty technique. The median age at surgery was six (five to seven) years. The median follow-up period for the patients was five (three to six) years. Penile nodules were not observed in our series. Penile shortening was identified in four patients (18.2%) after Nesbit corporoplasty. Four patients had a residual chordee that was significant enough, requiring another correction. Conclusion: Irrespective of the technique of dorsal corporoplasty used in the correction of chordee associated with severe hypospadias, penile nodulation and shortening are not of concern, and residual chordee, if present, is usually mild and does not require any correction.
  1,140 52 -
CASE REPORT
The value of ultrasonography in the diagnosis of a rare congenital dermoid cyst of the anterior fontanelle in an infant
Peter T Adenigba, Taiwo A Lawal, Peter O Elemile, Francis Onakpoma, Ademola J Adekanmi
October-December 2019, 9(4):21-25
DOI:10.4103/jwas.JWAS_34_21  
A dermoid cyst is a benign lesion that may occur in different parts of the body. A dermoid cyst of the subgaleal space over the anterior fontanelle is rather uncommon. We present a case of congenital dermoid cyst of the anterior fontanelle in a 3-month-old male infant, underscoring the value of ultrasonography in the diagnosis and highlighting the classical clinical, sonographic, surgical, and pathological findings.
  1,104 85 -
REVIEW ARTICLE
Prevalence and epidemiological pattern of abdominal aortic aneurysms in Africa: A systematic review
Ngetich E, Ward J, Cassimjee I, Lee R, Handa A,   On behalf of the Oxford Abdominal Aortic Aneurysm OXAAA Group
January-March 2020, 10(1):3-14
DOI:10.4103/jwas.jwas_15_21  
Introduction: The incidence of abdominal aortic aneurysms (AAAs) in high-income countries has been declining in the last three decades. However, in most low-income and middle-income countries especially in Africa, little is known about its burden. The absence of screening services for AAA in African countries makes it difficult to detect and promptly manage AAA before rupture, which has significant implications for mortality. This study sought to systematically assess the prevalence of AAA amongst patients visiting hospitals in Africa and evaluate its epidemiological pattern. Materials and Methods: A systematic review was performed on the EMBASE, GLOBAL HEALTH, MEDLINE, and PUBMED databases. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement standards and protocol registered with PROSPERO (CRD42020162214). A data extraction tool was used to get relevant information from these studies. Quality assessment and risk of bias were performed using the Newcastle Ottawa Scale for cross-sectional studies. Results were summarised in tables, figures, and a forest plot. A narrative synthesis approach of the articles was taken. Results: Two hundred and sixty-one studies were identified and after the exclusion of 246, a final 15 were deemed suitable for analysis. A total of 4012 participants were screened for AAA and of these, 129 cases were identified. The prevalence of AAA in these studies ranged from 0.7 to 6.4%. Male participants accounted for 115 (89.1%) of the cases. There was a wide age range (31–72 years) reflective of both its possible infective and degenerative aetiology. AAA was reported to be associated with hypertension, smoking, advanced age, coronary artery disease, and HIV infection. There was no association between AAA and diabetes. Over 50% of cases were identified incidentally. About one-third (23–54%) of the participants presented aortic rupture with a mortality rate ranging between 65 and 72%. Conclusions: AAA prevalence in Africa is probably higher than the current thinking as there is no baseline data to compare with. Aetiologically, AAA was shown to be associated with hypertension, smoking, coronary artery disease, and possibly infectious pathologies like HIV. Large epidemiological studies would help better characterise AAA in this setting. Lastly, efforts targeting the reduction of the risk factors for AAA would go a long way in reducing the burden of AAA.
  1,040 68 -
CASE REPORTS
Peri-anal and genital localization of giant condyloma acuminatum or Buschke–Lowenstein’s Tumor: A report of two cases
Diop Balla, Papa Abdoulaye Ba, Ahmet Diouf, Baba NDiaye, Serigne Modou Sarre, Chekna Sylla
January-March 2020, 10(1):42-46
DOI:10.4103/jwas.jwas_5_22  
Buschke–Löwenstein’s tumor (BLT) is a skin tumor induced by a human papillomavirus (HPV) infection. HPV genotypes 6 and 11, which are of low oncogenic potential, are present in over 90% of condylomas. Genotypes 16 and 18 combine with factors related to immunosuppression and chronic irritation to promote exophytic and endophytic growth and malignant transformation. BLT is most common in men between the ages of 40 and 60, occurring most commonly in the genital area. Perianal localization is less frequent and raises the problem of adequate management to reduce morbidity and the rate of recurrence. We report the cases of two male patients aged 45 and 57 years, who presented with perianal and buttock BLT for which large excisions were performed with satisfactory outcomes. We discuss the epidemiological and therapeutic aspects.
  986 59 -
EDITORIAL
Abdominal aortic aneurysm—The African experience
Lily Wu
January-March 2020, 10(1):1-2
DOI:10.4103/jwas.jwas_2000_20  
  834 57 -
ORIGINAL ARTICLES
Relationship between sinonasal anatomical variations and symptom severity in patients with chronic rhinosinusitis
Yakubu Bababa Shirama, Auwal Adamu, Sa’idu Sule Ahmed, Kufre Robert Iseh, Sadisu Muhammad Ma’aji, Sule Muhammad Baba
January-March 2020, 10(1):20-25
DOI:10.4103/jwas.jwas_63_21  
Background: Anatomical variations are subtle structural abnormalities around the osteomeatal complex that might obstruct paranasal sinus drainage and ventilation. The role of these anatomical variants in chronic rhinosinusitis is still controversial and unclear. The aim of this study was to determine the prevalence of anatomical variations and their relationship with the severity of symptoms in patients with chronic rhinosinusitis. Materials and Methods: This was a cross-sectional study conducted among randomly selected patients with chronic rhinosinusitis. Sinonasal Outcome Test-20 (SNOT-20) was used to assess the patient’s severity of symptoms. Computed tomographic scan was used to determine the presence of anatomical variations. The relationship between anatomical variations and symptom severity was determined using the Statistical Products and Service Solution (SPSS) version 20.0. Results: There were 70(58.3%) males and 50(41.7%) females within the age range of 17–60 years. SNOT-20 scoring showed 6(5.0%) of the patients with mild symptoms, 69(57.5%) with moderate, 37(30.8%) with severe, and 8(6.7%) with profound symptoms. The prevalence of sinonasal anatomical variants was 26.7%, which comprised of septal deviation (10.8%), agger nasi (6.7%), concha bullosa (4.2%), Haller cells (3.3%), and Onodi cells (1.7%). There was a statistically significant relationship between the anatomical variations and symptom severity (P = 0.000). Conclusion: This study found a significant relationship between anatomical variations and severity of chronic rhinosinusitis. The prevalence of anatomical variants was found to be 26.7%.
  795 73 -
CASE REPORTS
Invasive pulmonary cryptococcal infection masquerading as lung cancer with brain metastases: A case report
Chidiebere Peter Echieh, Chimaobi Nwagboso, Stephen Ogbudu, John Eze, Ernest Ochang, Paul Jibrin, Anietimfon Etiuma, Okon Bassey
January-March 2020, 10(1):30-34
DOI:10.4103/jwas.jwas_47_21  
Cryptococcosis, a global disease problem, seen frequently in the immuno-suppressed, also affects patients without apparent immuno-suppression. Pulmonary cryptococcosis patients often present as cryptococcal pneumonia, whereas intracranial cryptococcosis presents with meningitis. We present a 33-year-old immunocompetent man, diagnosed with invasive pulmonary cryptococcal disease with spread to the brain. This case is unique because the patient was previously treated for tuberculosis and presented with typical bronchopulmonary thoracic, extra-thoracic as well as computed tomography (CT) scan features suggestive of lung cancer. Cryptococcosis was diagnosed by identification of oval thick-walled yeast on histology of lung biopsy specimen. The patient was treated with flucytosine and fluconazole initially and subsequently with Amphotericin B and fluconazole. He made clinical improvement with the resolution of symptoms but had residual radiological features. Invasive cryptococcosis affecting the lung and brain may present with a clinical picture similar to metastatic lung cancer. We recommend routine fungal stains and fungal culture in suspected cases.
  788 56 -
Gall bladder complications resulting from typhoid fever in children: Challenges of management and lessons learned
Akputa Aja Obasi, Arinze Aetelbert Igboanugo
January-March 2020, 10(1):35-38
DOI:10.4103/jwas.jwas_31_21  
Surgical complications of typhoid fever present commonly as gut perforation and very rarely as gall bladder gangrene or gall bladder perforation. Gall bladder complications are rare in children and when they occur they are often the result of an infective condition. Occasionally, typhoid fever causes concomitant gall bladder complications and gut perforation. The coexistence of both conditions accentuates morbidity and mortality.We present two cases of typhoid fever with gall bladder perforation and gall bladder gangrene, respectively. Challenges of diagnosis and treatment are highlighted. The need for surgeons in endemic areas to consider these conditions while evaluating children with peritonitis is emphasized. Ultrasound detection of thickened distended gall bladder with pericholecystic fluid in a child with typhoid fever may be a sign of impending gall bladder perforation. To reduce the high morbidity and mortality from surgical complications of typhoid fever, the implementation of proven preventive measures must be encouraged. In addition, public enlightenment of this scourge must be pursued with vigor.
  718 49 -
Central mini-tenotomy and environmental modifications to correct “macular diplopia” due to sickle cell retinopathy in a resource-limited setting
Niranjan Pehere, George Bornguoi, Unity Fahn
January-March 2020, 10(1):39-41
DOI:10.4103/jwas.jwas_17_21  
Epiretinal membrane causing binocular diplopia, also denoted “macular diplopia,” is a well-established entity, which is often difficult to treat. Mini-tenotomy is a surgical procedure to treat diplopia due to small-angle deviations. In this case report, we describe the successful management of a patient with “macular diplopia” secondary to sickle cell retinopathy using a central mini-tenotomy of the left superior rectus muscle and environmental adaptations to diminish peripheral retinal fusion.
  742 25 -
Mucoepidermoid carcinoma of the lacrimal gland: A case report
Alfin RJ, Alada JJ, Okwudire-Ejeh I, Mosugu O, Ramyil AV
January-March 2020, 10(1):26-29
DOI:10.4103/jwas.jwas_35_21  
Background: Mucoepidermoid carcinoma (MEC), a tumour previously believed to occur exclusively in the major salivary glands, was atypically recognized in the lacrimal gland. Few ophthalmologists are familiar with this rare neoplasm. Aim: This case is being reported for its rarity and the association with human immunodeficiency virus (HIV). Case Presentation: High-grade MEC of the lacrimal gland of the right eye was diagnosed in an orbital exenteration specimen of a 60-year-old HIV-positive man. He presented to the eye unit of a mission hospital in Jos, Nigeria with significant visual impairment in the right eye and a rapidly growing painful superolateral orbital mass. The tumour invaded and completely obliterated the anterior chamber. The lens, ciliary body, and iris were displaced posteriorly but were free from tumour infiltration. The tumour was exenterated, and the patient was subsequently referred for adjuvant radiotherapy. No evidence of recurrence or metastasis has been noted 15 months post-surgery. Conclusion: Early and decisive surgical intervention in a case of high-grade MEC of the lacrimal gland is crucial in forestalling local invasion as well as distant metastasis. Because of the possibility of local recurrence, adjuvant radiotherapy is required and close follow-up of the patient is warranted.
  696 60 -
ORIGINAL ARTICLES
Hormonal receptor expression in endometrial carcinoma: A retrospective immunohistochemical study in a Nigerian tertiary hospital
Segun Samson Odetola, Mustapha Akanji Ajani, Oluwadamilare Iyapo, Ayodeji A Salami, Clement Abu Okolo
April-June 2020, 10(2):1-4
DOI:10.4103/jwas.jwas_1_22  
Background: Endometrial carcinoma is the commonest genital tract malignancy in most developed nations, but it lags behind cervical carcinoma and ovarian cancers in most developing nations including Nigeria. Estrogen has been described as a promoter of endometrial carcinogenesis. Objectives: The aim of this study was to demonstrate the frequency of estrogen receptor (ER) and progesterone receptor (PR) expressions of endometrial carcinoma and to correlate it with tumour grade. Materials and Methods: Cases of endometrial carcinoma diagnosed in the Department of Pathology over a 10-year period were reviewed retrospectively. The paraffin-embedded blocks were retrieved, and immunohistochemistry for ER and PR was performed on them. Haematoxylin and eosin (H&E) slides were reviewed, and tumours were graded by three independent pathologists. Data were analysed using SPSS version 22. The level of significance was set at P ≤ 0.05. Results: There were 44 cases of endometrial carcinoma. ER and PR were positive in 29.5% and 18.2% of endometrial carcinoma, respectively. There was no significant association between ER (P = 0.361) and PR (P = 0.204) expressions and histological grade of the tumour. The most common histological grade was grade 3 with 70% of cases (36 cases), whereas 13 cases (26%) were grade 2 and only 2 cases (4%) were grade 1. Conclusion: The positive expressions of ER and PR in endometrial carcinoma suggest that steroid receptor studies may be of potential benefit in the management of some patients with endometrial carcinoma. Future studies employing larger sample size are therefore recommended.
  670 44 -
Epithelial lacrimal gland tumours in Nigeria: Clinicopathological features and treatment
Oluyemi Fasina, Adewunmi Oluseye Adeoye, Olanipekun Olalekan Aremu
April-June 2020, 10(2):5-11
DOI:10.4103/jwas.jwas_33_21  
Background: Epithelial lacrimal gland tumours are uncommon orbital tumours and are not widely reported among African populations. Objective: This study aimed to describe the clinicopathological features, treatment, and outcomes of epithelial lacrimal gland tumours in Nigeria. Design: Retrospective case series. Setting: Ocular Oncology Unit, Ophthalmology Department and Pathology Department of University College Hospital, Ibadan, Nigeria. Materials and Methods: A review of the medical records of all patients with histopathological diagnoses of epithelial lacrimal gland tumours managed at a tertiary health facility, southwestern Nigeria over 11.5 years was carried out. Results: Eighteen patients with equal numbers of men and women, and mean age at presentation of 42.2 ± 15.7 years (median 42 years, range 17–70 years) were managed. All patients presented with orbital swelling and had nonaxial proptosis with palpable firm to hard mass in the superotemporal quadrant of the orbit. The mean duration of symptoms was 42.2 ± 38.6 months (median 24 months, range 3–120 months). Visual acuity was <3/60 at presentation in eight (44.4%) of the affected eyes. Thirteen (72.2%) patients underwent orbitotomy and tumour excision, while five (27.8%) patients had orbital exenteration, and two of whom (11.1%) had combined orbital exenteration and craniotomy. Histopathological examination of the specimens revealed pleomorphic adenoma in nine (50.0%) patients, low-grade mucoepidermoid carcinoma in three (16.7%) patients, high-grade mucoepidermoid carcinoma in two (11.1%) patients, adenoid cystic carcinoma in three (16.7%) patients, and adenocarcinoma “not otherwise specified” in one (5.6%) patient. Mortality was reported in four (44.4%) of nine patients with malignant tumours, while no mortality was noted in the patients with benign pleomorphic adenoma. The mean follow-up period for the patients was 28.9 months (median, 4.5 months; range, 2–140 months). Conclusion: The main presenting symptom of epithelial lacrimal gland tumours in our patients was an orbital mass and the most common clinical finding, in addition to the orbital mass, was nonaxial proptosis. The tumours were equally divided into benign and malignant lesions in our studied population. Pleomorphic adenoma was the only benign tumour while mucoepidermoid carcinoma was the commonest malignant lesion. Orbital exenteration was performed in a high proportion of our patients and high mortality was noted among patients with malignant tumours.
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The impact of glaucoma on the mental health of primary open-angle glaucoma patients attending a teaching hospital in South East Nigeria
Chinemerem C Ubochi, Eberechukwu O Achigbu, Florence U Nkwogu, Onyinye E Onyia, Chiamaka J Okeke
April-June 2020, 10(2):17-22
DOI:10.4103/jwas.jwas_59_21  
Objective: To evaluate the effect of glaucoma on the mental health of primary open-angle glaucoma patients using Hospital Anxiety and Depression Scale (HADS)Materials and Methods: This was a hospital-based comparative study in which 180 glaucoma patients and controls 18 years and above who met the inclusion criteria were selected consecutively in the Eye Clinic of Federal Medical Centre, Owerri, Imo State, in 2017. Data were collected using a questionnaire and the HADS protocol. All the participants underwent comprehensive ocular examination, and glaucoma was graded using visual field perimetric indices and mean deviation. Results: The mean age for cases was 58.14 ± 13.88 years, whereas that of the control group was 57.19 ± 13.76 years. The majority of glaucoma respondents had the moderate form of the disease followed by the severe form. The glaucoma patients showed evidence of poor mental health with 59 (32.8%) of them anxious and 39 (21.7%) depressed compared to controls (P < 0.001). The mean scores for anxiety and depression were 6.02 ± 4.8 and 5.20 ± 4.5, respectively, for glaucoma patients, whereas those for the control group were 0.63 ± 1.8 and 0.64 ± 2.1, respectively (P < 0.001). There was no uniform correlation between the mental health of patients and the variables under study. Conclusion: Primary open-angle glaucoma affects the mental health of patients. This effect is worsened by the severity of the disease and influenced by the occupation and educational level of the patients. Multidisciplinary management of primary open-angle glaucoma patients is recommended.
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Dental Education With the COVID-19 Pandemic: Ghanaian Dental Students’ Experience
Sandra Ama Hewlett, Merley Afua Newman-Nartey, Kofi Osei-Tutu, Alexander Oti Acheampong, Nii Otu Nartey
July-September 2020, 10(3):8-14
DOI:10.4103/jwas.jwas_48_21  
Introduction: Due to the COVID-19 pandemic, all Ghanaian tertiary institutions were closed down and resorted to online teaching. This posed a challenge for dental education due to requirements of clinical tutoring and patient handling. This study explored the experiences of dental students with the change in teaching methods during the pandemic with the aim of assessing their effectiveness and explore measures for their improvement. Materials and Methods: This was an online survey involving undergraduate dental students in the two dental schools in Ghana. An e-questionnaire was sent out to all the students, exploring their knowledge of and response to the pandemic and assessing the impact of measures implemented during the pandemic to assist them complete their education. Results: Two hundred out of 412 students participated in the study giving a response rate of 48.5%; however, completed responses were available for 195 students, 123 (63.1%) from the University of Ghana Dental School and 72 (36.9%) from the Kwame Nkrumah University School of Medicine and Dentistry. There were 106 (54.4%) females;108 participants (54.4%) were pre-clinical students. One hundred and sixty-four (84%) respondents believed dental professionals had a higher risk of contagion because of proximity to patients during treatment and 115(59.0%) reported being fearful of performing clinical procedures. The students demonstrated adequate knowledge of the disease and a positive attitude towards the required changes instituted because of the pandemic. They however, highlighted technical obstacles and distraction as some of their challenges. The quality of internet was acceptable, but the volume of data was inadequate to meet their needs. Also, though both Universities had their own recommended learning management systems, Zoom was the preferred online learning platform. Conclusions: Generally, the students demonstrated a positive attitude towards the required changes. A blended educational approach may continue to be ideal for dental education as we adapt to this pandemic. Innovative ways may need to be sought to improve the online experience and the University approved online learning management systems enhanced to make them more user friendly.
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Retinitis pigmentosa in Onitsha, Nigeria
Sebastian N N Nwosu, Chikaodili U Ndulue, Oluchi I Ndulue, Chizoba U Uba-Obiano
April-June 2020, 10(2):30-35
DOI:10.4103/jwas.jwas_65_21  
Background: Retinitis pigmentosa describes a heterogenous group of progressive hereditary degeneration of the photoreceptor-retinal pigment epithelium complex with varying clinical manifestations. Although studies on the epidemiology of blindness and visual impairment in Nigeria have documented the contribution of retinitis pigmentosa, detailed study of the prevalence, incidence, and pattern of retinitis pigmentosa in Nigeria are few. Objectives: The aim of this study was to describe the relative frequency rate and pattern of retinitis pigmentosa among new patients at the Guinness Eye Center Onitsha Nigeria. Materials and Methods: Case files of new patients with clinical features of retinitis pigmentosa seen over a 6-year period were reviewed. Information on age, sex, and associated clinical features were extracted into a standard proforma and analyzed. Results: Thirty-seven (0.6%) of 5876 new patients had retinitis pigmentosa. There were 25 (67.6%) males and 12 (32.4%) females with an age range of 4–76 years; the median age was 33 years. Family history suggested autosomal dominant inheritance in 15 (40.6%) patients, autosomal recessive inheritance 4 (10.8%), X-linked inheritance 9 (24.3%), and 9 (24.3%) sporadic. Six (16.2%) patients were blind (acuity <3/60) and 22 (59.5%) patients had visual impairment (acuity <6/18). Eight (21.6%) patients had coexistent deafness (syndromic retinitis pigmentosa) including two (5.4%) cases of Usher syndrome. Conclusions: The relative frequency rate of retinitis pigmentosa among new patients in our hospital is low but the associated visual and otologic incapacitation are enormous. A prospective study incorporating molecular genetics would more exactly determine the inheritance pattern and the common genes of retinitis pigmentosa in Nigerians.
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An assessment of the correlation between tests of clinical competence and tests of cognitive knowledge amongst Nigerian resident doctors in surgery
Abdulrazzaq O Lawal, Abdul-Hakeem O Abiola, Muhammad Y M Habeebu, Rufus W Ojewola, Kehinde H Tijani
April-June 2020, 10(2):12-16
DOI:10.4103/jwas.jwas_45_21  
Background: Assessment of clinical competence involves the assessment of cognition and assessment of clinical performance (behaviour in practice). The limitations of the traditional long case examination (LCE) in the assessment of clinical performance led to its replacement with the objective structured clinical examination (OSCE) by many institutions. Aims: To determine and compare the abilities of the OSCE and LCE to predict candidates’ performance in the tests of cognitive knowledge in the fellowship examination of the National Postgraduate Medical College of Nigeria in the Faculty of Surgery. Materials and Methods: The results of the OSCE, LCE, written papers, picture tests (PTs), vivas, and the total clinical score (TCS) of surgical residents who took part in the fellowship examination over six consecutive examination periods were compared by using the Pearson’s correlation coefficient. A P-value less than .01 was considered as significant. Results: The OSCE had a weak but statistically significant positive correlation (.175) with the LCE. Both the OSCE and LCE had similar correlations with the total written papers (TWP) and PTs. The viva had a higher correlation with the OSCE than the LCE. The TCS when compared with either the OSCE or LCE alone had a higher correlation with most of the tests of cognitive knowledge. Conclusion: Neither the OSCE nor the LCE showed any superiority over the other in terms of the ability to predict performance in the tests of cognition. The TCS appears superior to either the OSCE or the LCE as a predictor of the candidates’ overall knowledge of surgery. Therefore, both the OSCE and the LCE should be retained as part of the examination.
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CASE REPORT
Localized pigmented villonodular synovitis of the knee co-existing with extra-articular nodular synovitis of the popliteus tendon sheath: A case report
Oladimejii Ranti Babalola, Bright Igbinoba, S Uwale Eyesan, Kolawole Olanrewaju Aramide, Malomo Oluwabusayomi Oghenerume, Adedamola D Onibonoje
July-September 2020, 10(3):45-48
DOI:10.4103/jwas.jwas_20_22  
Pigmented villonodular synovitis (PVNS) is a rare proliferative disorder affecting the synovial membranes of joints, bursae, and tendons. The knee joint is one of the most common locations for an intra-articular type of PVNS and this is usually of the diffuse type of PVNS or diffuse pigmented villonodular synovitis (DPVNS). DPVNS tends to be more associated with affectation of contiguous structures. We report a case of a localized form of the disease affecting the knee joint coexisting with an extra-articular lesion of the same nature involving the popliteus tendon sheath of the same knee. The clinical condition was managed with a combined surgical approach of arthroscopic marginal excision for the intra-articular lesion and excision biopsy for the extra-articular lesion.
  546 42 -
CASE REPORTS
An 8-month-old baby girl with slight drooping of left upper eyelid
Niranjan K Pehere, Gordon Neale Dutton
April-June 2020, 10(2):42-44
DOI:10.4103/jwas.jwas_18_21  
An 8-month-old baby girl, who accompanied her sister with an eye problem, was incidentally noticed to have smaller left eye compared to the right. The mother said that it had been present for 2 months. The child showed no detectable focal neurological deficits. Her vision was age appropriate in both eyes. A slight left-sided ptosis was present. Her eye movements were full in both eyes and there was no evidence of strabismus. Bilateral fundus examination was normal. The child had anisocoria (left pupil being smaller than the right one) and left hemifacial anhidrosis, which prompted the diagnosis of Horner’s syndrome. Magnetic resonance imaging of her chest showed a mass lesion in the apical region of the left lung which was later excised and found to be a neuroblastoma. This emphasizes the importance of having an eye on the siblings of children who come to the hospital.
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