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   Table of Contents - Current issue
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January-March 2019
Volume 22 | Issue 1
Page Nos. 1-45

Online since Thursday, March 28, 2019

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ORIGINAL ARTICLES  

Effect of oral midazolam in preventing postoperative emergence agitation in children p. 1
Atiku Mamuda, Mustapha Ibrahim Gudaji
DOI:10.4103/smj.smj_32_17  
Introduction: Emergence from general anaesthesia can be complicated by the presence of agitation in children and thus presents a challenging situation for postanesthesia care providers. Several factors are associated with emergence agitation (EA). These include pain, preoperative anxiety, young age, poor adaptability, short time to recovery, among others. Objective: This study aimed to determine the effect of oral midazolam in preventing postoperative EA in children. Materials and Methods: This was a case–control study carried out among 80 healthy children aged 1–10 years scheduled for day-case surgery. The children were randomly assigned to receive either a syrup of paracetamol 10 mg/kg with injectable midazolam 0.5 mg/kg added to the syrup (Group A) or a placebo in the form of paracetamol syrup (Group B) at a dose of 10 mg/kg 30 min before induction of anesthesia. Patients' state of agitation was assessed every 5 min for the 1st h by means of an EA scale. Children with an agitation score of 3 or 4 were classified as agitated. Prolonged agitation was defined as a score of ≥3 lasting 15 min after arrival in the recovery room. Data were analyzed using the Statistical Software for Social Sciences version 20. Results: Eighty children aged 1–10 years were enrolled in the study. Majority of the procedures were circumcisions (48.75%), while urethral dilatation, examination under anesthesia, and tongue release were the least (1.25%). There was no statistically significant difference in the agitation state of the two groups (P = 0.60). Conclusion: Premedication with oral midazolam 0.5 mg/kg administered 30 min preoperatively does not prevent EA in all cases.
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Major extremity amputations: Indications and post surgery challenges in a Nigeria tertiary institution p. 8
Oni Nasiru Salawu, OM Babalola, JO Mejabi, AA Fadimu, BA Ahmed, GH Ibraheem, DM Kadir
DOI:10.4103/smj.smj_49_17  
Background: Amputation is an ancient procedure which has been practiced for centuries for a variety of indications. The goal of the procedure is to eliminate potential threat to the patient while producing a viable stump for easy rehabilitation. Objective: To identify the indications, postoperative complications and peculiarities of patients with amputation in a native African population. Materials and Methods: This was a prospective study carried out on all consenting patients who had extremity amputation at Federal Medical Centre, Birnin Kebbi, from June 2015 to May 2016. Results: During the study period, there were 47 amputations in 47 patients (34 males and 13 females). The mean age of the patients was 35.73 ± 19.43 years. The most common indication for amputation was traditional bone setter's (TBS) gangrene accounting for 44.7% of cases, followed by diabetic foot syndrome at 25.5%. Camel bites accounted for 6.4% of the amputations. The most common type of amputation was below-knee amputation (46.8%), followed by above-knee amputation (25.5%). Five (10.7%) patients had surgical site infection and only 2.1% of the patients developed phantom limb sensation. None of these patients was fitted with a prosthesis due to the high cost or nonavailability of the prosthesis. Conclusion: Complications of TBS intervention were the leading cause of amputation in this study. Gangrene following camel bites was also found to be a peculiar cause for amputation in this environment. Appropriate public health interventions are necessary to reduce the incidence of preventable gangrene. Provision of prosthesis with adequate technical support is essential to proper rehabilitation of the amputees.
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Ocular comorbidities in children with strabismus in Benin City p. 13
Valentina Winifred Okeigbemen, Nanaishat Momoh
DOI:10.4103/smj.smj_41_17  
Background: Strabismus is the misalignment of the visual axis. Certain comorbidities have been found to be associated with strabismus. These must be identified and treated. Objective: The aim of this study was to determine the ocular comorbidities associated with strabismus in children 15 years and below presenting to the eye clinic of University of Benin Teaching Hospital, Benin City, from January 2014 to December 2014. Patients and Methods: This is a prospective hospital-based observational study of consecutive patients seen in the eye clinic. Results: Fifty-five children presented with strabismus accounting for 2.6% of the total number of 2112 new cases. There were 30 males (54.5%) and 25 females (45.5%) giving a male-to-female ratio of 1:0.83. The age range was from 5 months to 14 years. The mean age was 4.7 years with a standard deviation of ± 3.4 years. Thirty-seven (67.3%) of the patients were under 5 years of age. Forty-seven (85.5%) patients had esotropia, six (10.9%) had exotropia, and two (3.6%) had hypertropia. Vision-impairing comorbidities included refractive error in 33 (64.7%) patients, cataract in 9 (17.6%) patients, corneal opacity in 1 (2.0%) patient, and retinopathy of prematurity in 1 (2.0%) patient. Nonvision-impairing disorders were microcornea, conjunctivitis, and nasolacrimal duct obstruction. The relationship between ocular comorbidity and types of strabismus was not statistically significant (P > 0.05). Conclusion: Detailed assessment to identify the comorbidities associated with strabismus is recommended. This could improve the management of this condition.
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Morphologic patterns of testicular lesions in Uyo: A university hospital experience p. 18
Chukwuemeka Charles Nwafor, Nkem Nnenna Nwafor
DOI:10.4103/smj.smj_33_17  
Background: The testis can be biopsied either for a diagnostic or therapeutic purpose. Objective: The aim of this study is to characterize the common indications for testicular biopsy and determine the pattern of testicular lesions. Materials and Methods: This was an 8-year retrospective study of all testicular and paratesticular specimens that were histologically diagnosed in the Department of Histopathology in University of Uyo Teaching Hospital between January 2008 and December 2015. Results: Sixty-four cases of testicular specimens were received in the histopathology laboratory, accounting for 1.3% of all received specimens. The youngest patient was 4 years, while the oldest patient was 86 years with a mean age of 54.4 ± 21.62. The most common presenting complaints seen in the nonfertility, nonprostate cancer-related cases were testicular swelling, pain, and small-sized testis as seen in 50%, 31.3%, and 12.5% of cases, respectively. In 60.9% of cases, the clinical diagnosis was prostatic cancer, while primary and secondary infertility accounted for 12.5% and 1.6%, respectively, with testicular/paratesticular tumor been the clinical diagnosis in 7.8% of cases. The mean ages for surgical castration patients, male infertility patients, and malignant lesion patients were 68.9, 41.7, and 46.5 years, respectively. Hypospermatogenesis was the most common histopathologic diagnosis of testicular biopsies in infertile men (33.4%). Four malignant lesions were seen, with embryonal rhabdomyosarcoma accounting for 50% of cases. Conclusion: Benign neoplastic lesions of the testis are very rare in study population, while embryonal rhabdomyosarcoma is the most common malignant lesion seen. Most men do not present to health facility for infertility management.
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Mammographic screening patterns in Sokoto, Northwestern Nigeria p. 23
Sule Baba Muhammad, Sule Ahmed Saidu, Sadisu Mohammed Ma'aji, Abubakar Musa, HG Ibrahim, Sama'ila Bello Gusau, Yakubu Bababa Shirama
DOI:10.4103/smj.smj_44_16  
Background: Screening mammography is a radiographic examination of the breast performed for early detection of breast cancer in asymptomatic women. The American College of Radiology recommends that women should have mammography at the age of 40 years and annually thereafter. However, those who are at increased risk of breast cancer should start screening mammography earlier. These include patients with a strong family history of breast cancer or those who had radiotherapy to the chest wall. Objective: This study is aimed at evaluating the mammographic outcomes among 77 Nigerian females who had screening mammographic breast examination. Materials and Methods: From December 2010 and November 2012, 77 females had routine screening mammography in the department with the general electric alpha-RT machine with model number MGF-101 (manufactured 2010). All the participants had to fill a mammographic form consisting of variables such as age, sex, occupation, family history of breast cancer, tribe, contraception, parity and caffeine consumption, history of surgical intervention (lumpectomy, biopsy, and/or mastectomy), previous mammography, and last childbirth. Mediolateral-oblique and cranial-caudal views were done for the breast examination though additional were occasionally employed. Results: Seventy-seven females had screening mammography. The minimum age recruited was 40 years. The mammographic outcome for those who had screening was normal in 51 (66.2%) and abnormal in 26 (33.8%) participants. The abnormal mammographic outcomes were architectural distortion in either or both breasts in 13 (16.9%) participants, masses in either or both breast in 11 (14.3%) participants, while isolated calcification in either or both breast among 2 (2.6%) participants. Two (18.2%) of the subjects with masses had associated macrocalcification. No masses with malignant features were seen. Conclusion: Screening mammography was found out to be useful in detecting various forms of breast pathologies which were mostly breast masses, calcifications, and architectural distortions. Screening mammography is, therefore, advised yearly and routinely for women age 40 years and above.
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Clinico-microbial profile of diabetic foot infections in Zaria, North-West Nigeria p. 28
Kenneth Ezenwa Amaefule, Ismail Lawal Dahiru, Innocent Onoja Okpe, S Aliyu, AA Aruna
DOI:10.4103/smj.smj_44_17  
Background: Diabetic foot infection (DFI) is a dreaded complication of diabetes mellitus, which usually occurs following foot ulceration. It may starts as a monomicrobial infection and end up as a polymicrobial infection. Antimicrobial regimens are usually selected empirically initially, based on local epidemiological and antimicrobial susceptibility pattern. Objective: The aim is to investigate the microbiological profile of patients admitted with DFIs in our institution and determine the antimicrobial susceptibility pattern of the isolates. Materials and Methods: A 2-year retrospective observational study of patients admitted with DFI into our institution. The microbiological culture and antimicrobial susceptibility results of swab specimens from the patients were retrieved and reviewed. These were correlated with the clinical stage of the disease. Results: Fifty-six patients' medical records were reviewed. There were 35 males and 21 females. The mean age of the patients was 56.2 years (range 48–75 years). Three patients had bilateral lesions. The Wagner grades of the lesions were Grades II–V, with Grade IV being predominant. Eight bacteria species and a fungus were isolated from the 59 swab specimens studied. Four specimens yielded no growth, whereas 7 specimens yielded contaminants. Monomicrobial cultures were predominant, with Gram-negative bacteria being preponderant. Staphylococcus aureus was the most common isolate, followed by Proteus species. The isolates showed greater susceptibility to levofloxacin and ciprofloxacin. Conclusion: The findings suggest that either levofloxacin or ciprofloxacin should be the anchor antimicrobial agent in empirical treatment of DFI in our locality.
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Knowledge, attitude, and perception of pregnant women toward anesthesia for cesarean section at Aminu Kano Teaching Hospital p. 33
Ayyuba Rabiu, Idris Sulaiman Abubakar, Alhasan Datti Muhammad
DOI:10.4103/smj.smj_58_16  
Background: Anesthesia is regarded as an integral part of cesarean section due to its elimination of pain and discomfort. Pregnant women need to have awareness of anesthesia for cesarean section. Objectives: The aim of this study was to determine the knowledge, attitude, and perception of pregnant women toward anesthesia for cesarean section. Materials and Methods: This was a cross-sectional study among consenting pregnant women at Aminu Kano Teaching Hospital. A structured pretested questionnaire was used to obtain information from the participants. Ethical approval was obtained from the hospital ethics committee. Data obtained was analyzed using SPSS version 18 (SPSS Inc., Chicago, Illinois, 2012, US). Fischer's exact test was used for categorical data and P ≤ 0.05 was considered statistically significant. Results: The mean age ± standard deviation was 28.71 ± 5.635 years. Two hundred and thirty-two (68.8%) had knowledge of anesthesia for surgical procedures, and in up to 221 (65.5%), the anesthesia known to them was for cesarean section. Main sources of knowledge were from the clinic (195, 44.5%) and previous experience/exposure (180, 41.1%). The main anesthetic side effects were headache (24, 64.9%) and delayed recovery (11, 29.7%). Regional anesthesia was preferred (246, 73.0%) over general anesthesia (91, 27.0%) because of safety (258, 44.3%), fear of death (240, 41.2%), and the desire for being awake during the procedure (85, 14.5%). Knowledge of anesthesia was statistically associated with the age groups of the respondents (P = 0.027) and their occupation (P = 0.003). Conclusion: The study revealed high knowledge and awareness of anesthesia for cesarean section among pregnant women and regional anesthesia was preferred over general anesthesia.
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CASE REPORTS Top

Permanent pacemaker implantation: our initial experience with Two cases reported p. 38
Ismail Mohammed Inuwa, Jameel Ahmad, Ibrahim Aliyu, Tunde Oyebanji, Nasir Ahmad Ishaq, Kana Shehu
DOI:10.4103/smj.smj_43_17  
Permanent pacemaker implantation is a lifesaving procedure. Complete heart block is one of the most common indications in our environment. Diagnosis is often missed and treatment is not readily available. These reasons account for the low turnover of cases. Two cases were successfully conducted in our center using the VVIR type of pacemaker, and no significant complications were recorded afterword. All patients presented with typical symptoms of complete heart block and were symptoms free after the procedure.
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Pancreatic pseudocyst in a 4-year-old child p. 42
Mohammad Abba Suwaid, L Yusuf
DOI:10.4103/smj.smj_61_17  
Pancreatic pseudocyst is a localized fluid collection that is rich in amylase and other pancreatic enzymes and is surrounded by a wall of fibrous tissue. Pseudocysts are connected to the pancreatic ductal system, through the pancreatic parenchyma. It is caused by pancreatic ductal disruption either due to stenosis, calculi, or protein plugs obstructing the main pancreatic ductal system or as a result of pancreatic necrosis following an attack of acute pancreatitis. Pseudocysts are a common clinical problem and complicate the course of chronic pancreatitis in 30%–40% of patients but rarely seen in children. A case of a 4yr old who presented with abdominal swelling and vomiting. His initial diagnosis after a barium meal study was retrogastric mass such as duplication cyst/mesenteric cyst. However, ultrasound scan confirms a diagnosis of pancreatic pseudocyst. The case is here presented with a literature review.
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