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   Table of Contents - Current issue
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July-September 2020
Volume 23 | Issue 3
Page Nos. 141-200

Online since Wednesday, October 7, 2020

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ORIGINAL ARTICLES  

Obstetric outcome of pregnancies complicated by hypertensive disorders of pregnancy p. 141
Robinson C Onoh, Kanario A Onyebuchi, Johnbosco E Mamah, Bonaventure O Anozie, Ekwedigwe C Kenneth, Esike O U. Chidi
DOI:10.4103/smj.smj_48_19  
Background: Hypertensive disorders of pregnancy are of significant public health concern due to associated maternal and perinatal morbidity and mortality. Objective: To determine the trend and obstetric outcome of pregnancies complicated by hypertensive disorders in a tertiary hospital in South-East Nigeria. Materials and Methods: Patients managed for hypertensive disorders from January 1, 2012, to December 31, 2017 were recruited for the study. Case files of patients were retrieved, and information on sociodemographic variables, risk factors, and fetomaternal outcome were extracted using a pro forma. Data analysis was done using International Business Machine-Statistical Package for the Social Sciences Version 20 (IBM-SPSS Version 20, New York, USA ). Ethical clearance was obtained from the ethics and research committee of the institution. Results: During the study period, there were a total of 14,181 deliveries, of which 785 women were managed for hypertensive disorders of pregnancy, thus giving a prevalence of 5.5%. Preeclampsia accounted for 62% (487) while chronic hypertension was 4.3% (34). There was a rising trend from 2012 with a peak in 2017. About 60% (181) of the patients were not booked for antenatal care. The predominant risk factors were advanced maternal age 14.2% (43) and previous history of hypertensive disorder 13.6% (41). Almost half of the patients had caesarean section (46.4%, 140). Preterm births were recorded in 56.6% (171) of the patients. Maternal and perinatal deaths were recorded in 0.7% (2) and 16.2% (941) of the patients, respectively. Conclusion: This study showed that hypertensive disorders of pregnancy remain a significant cause of adverse maternal and perinatal outcomes in pregnancy. Adequate antenatal coverage, early diagnosis, and improved emergency obstetric care services are needed to reverse the trend.
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Relationship between microalbuminuria and glomerular filtration rate in children with sickle cell anemia in steady state p. 147
Rasaki Aliu, Jalo Iliya, Patience Ngozi Obiagwu, Adamu Sani
DOI:10.4103/smj.smj_25_19  
Background: Microalbuminuria (MA), a common phenomenon in children with sickle cell anemia (SCA), is defined as an increased urinary albumin–creatinine ratio of 30–300 mg/g of creatinine in an early morning or random urine specimen. Whereas some studies have shown that MA reflects early kidney damage, other studies have documented that it is a manifestation of advanced nephropathy. The reports about the relationship between glomerular filtration rate (GFR) and MA in children with SCA are conflicting. Materials and Methods: This was a longitudinal study. Serum creatinine, GFR, and albumin–creatinine ratio were determined at baseline. The individuals were followed up over 3 months during which albumin–creatinine ratio and GFR were assayed monthly, and the relationship between them was determined. Results: One hundred and seventy children aged 1–18 years with SCA and MA were studied. The mean albumin–creatinine ratio was 120.9 ± 66.8 mg/g, 138.32 ± 101.79 mg/g, 117.12 ± 78.09 mg/g, and 106.73 ± 38.82 mg/g at baseline, 1, 2, and 3 months, respectively, whereas the mean GFR was 121.7 ± 33.0 ml/min/1.73 m2, 117.69 ± 29.70 ml/min/1.73 m2, 117.56 ± 35.77 ml/min/1.732 m2, and 116.22 ± 30.28 ml/min/1.73 m2 at baseline, 1, 2, and 3 months, respectively. There was no significant relationship between MA and GFR in the participants throughout the study period (Pearson's correlation coefficients: 0.050, 0.250, 0.268, and 0.143 and corresponding P: 0.95, 0.88, 0.15, and 0.36). Conclusions: GFR is normal in SCA children with MA. There is no significant relationship between MA and GFR in children with SCA.
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Relationship between sociodemographic characteristics of stroke survivors and poststroke motor performance p. 153
Adamu Ahmad Rufai, Aisha Zannah Mustapha, Adewale Luqman Oyeyemi
DOI:10.4103/smj.smj_2_19  
Background: Motor impairment is a frequent presentation of stroke leading to partial or total loss of function of a body part usually limbs. Objective: This study investigated poststroke motor performance and its association with sociodemographic and clinical characteristics of stroke survivors. Materials and Methods: Ninety-four stroke survivors from two selected physiotherapy clinics in Maiduguri participated in this study. Data form was used to obtain information on sociodemographic and clinical characteristics of the participants while the Short-Form Fugl Meyer scale was used to obtain the information on motor performance of the participants. Descriptive statistics of mean, standard deviation, frequency, and percentage were used to summarize the data. Chi-square test of association was used to analyze motor performance and its association with sociodemographic and clinical characteristics of the participants. Results: The mean age and poststroke duration of the participants were 52.65 ± 12.70 years and 26.32 ± 32.70 months, respectively. Of the entire participants, 55 (58.5%) were male, 49 (52.1%) were employed, and 33 (35.1%) had Qur'anic education. Forty (42.6%) had a duration of stroke between 3 and 12 months. Gender (χ2 = 12.72, P = 0.002) and educational level (χ2 = 17.77, P = 0.023) were significantly associated with motor performance. Age, employment status, and duration of stroke showed no significant association with motor performance. Conclusion: The outcome of this study suggests that female gender and “no educational” attainment were associated with poor motor performance among stroke survivors in Maiduguri. Gender and educational level can influence motor impairment after stroke and should represent an essential part of assessment during stroke rehabilitation.
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Histopathological characteristics of carcinoma of the uterine cervix in a tertiary hospital in southern Nigeria p. 158
Sebastian A Omenai, Mustapha Akanji Ajani, Clement Abu Okolo
DOI:10.4103/smj.smj_60_19  
Background: Carcinoma of the uterine cervix is the fourth-most common cancer among women worldwide, and the leading cause of cancer-related death for women in developing countries. Objective: Cervical carcinoma is a major cause of mortality in a developing nation such as Nigeria. This study provides an update on the prevalence of pathological variants of cervical carcinomas seen at the University College Hospital, Ibadan, Southwestern Nigeria. Materials and Methods: This is a retrospective study involving the review of all the histologically diagnosed cervical carcinoma in the Department of Pathology, University College Hospital, Ibadan between January 2012 and December 2016. The histologically diagnosed cancers and the relevant clinical and histopathological information relating to these tumors were extracted from the records of the department. All cases were treated as anonymous with strict confidentiality. The cases were classified using the World Health Organization histological classification of tumors of the cervix (2014). The obtained data were analyzed using the Statistical Package for the Social Sciences version 23. Results: A total of 294 cases were included in this study. The peak age of diagnosis was in the 6th decade. Two hundred and fifty-two cases (86.0%) were squamous cell carcinoma, 18 cases (6.1%) were adenocarcinomas, 16 cases (5.5%) were adenosquamous carcinomas, and 6 cases (2.2%) were adenoid cystic carcinomas, and one representing 0.3% was a neuroendocrine carcinoma. The most common histological grade was moderately differentiated (Grade 2). The large cell nonkeratinizing squamous cell carcinoma was the most common histological variant.Conclusion: A majority of cervical carcinomas are squamous cell carcinomas and are majorly the large cell nonkeratinizing variant.
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Computed tomographic scan utilization in the diagnosis of otorhinolaryngological diseases p. 164
Festus Oghanina Ehigiamusoe, Eloho Benedicta Obi-Egbedi-Ejakpovi
DOI:10.4103/smj.smj_47_19  
Background: Having an audit of common otorhinolaryngological diseases diagnosed on computed tomography (CT) scan in our environment is important as it will help elucidate the sociodemographics and pattern of referral for CT scan from an ear, nose, and throat (ENT) clinic as well as CT findings. Materials and Methods: The request forms as well as the CT scan reports of 203 patients who were referred from the ENT clinic between 2006 and 2014 and had CT scan were retrieved from our records. All CT scans were done using a four-slice BrightSpeed helical GE CT scan machine. Out of the 214 patients recruited for this study, only 203 patients were unanimously agreed upon by the authors as the remaining 11 patients had incomplete data. Results: There were 124 males (61.1%) and 79 females (38.9%). The mean age of patients with nasopharyngeal tumor was 40.67 ± 26.01 years, laryngeal tumor was 57.47 ± 15.64 years, antrochoanal carcinoma was 46.05 ± 22.95 years, and sinusitis was 44.96 ± 17.19 years, while that of otitis media was 43.33 ± 23.60 years. A total of 177 patients representing 87.2% of the study population had one or two pathological findings on CT scan. Sinusitis accounted for most findings on CT scan (12.8%), followed by laryngeal tumor (10.7%) and antrochoanal carcinoma (10.2%). Others were choanal polyp (9.7%), nasopharyngeal tumors (9.2%), rhinitis (6.1%), mastoiditis (5.1%), and mucocele of the sinuses (4.6%). Juvenile angiofibroma (1.0%) and palatal masses (1.0%) were the least in terms of occurrence of all ENT conditions. Conclusion: Common findings on CT scan of the ENT in our environment have been documented.
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Histological spectrum of soft-tissue tumors in a tertiary hospital p. 170
Raymond Akpobome Vhriterhire, Joseph Aondowase Ngbea, Isaac Onah Akpor
DOI:10.4103/smj.smj_39_19  
Objective: The objective of this work was to determine the histological pattern of soft-tissue tumors diagnosed in our hospital and compare findings with those of other places. Background: A comprehensive record of the pattern of histologically diagnosed tumors is a fundamental requirement for good cancer screening policies, effective therapeutic decisions, and developing a regional cancer registry. The objective of this work was to determine the histological pattern of soft-tissue tumors diagnosed in our hospital and compare findings with those of other places. Materials and Methods: A retrospective audit of soft-tissue samples submitted in the histopathology laboratory of a tertiary hospital in Makurdi, North Central Nigeria, was carried out. Results: One hundred and eighty-eight soft-tissue tumors were diagnosed in the study period, and they had a male: female ratio of 1:1.2, with a mean age of 35.05 ± 18.9 years, and the most frequent occurrence in the fourth decade. Benign tumors were more common, 67.0% (n = 126), than malignant ones, 33.0% (n = 62). Lipoma accounted for the largest proportion of the tumors accounting for 38.9% (n = 49) of benign and 26.1% (n = 49/188) of all the soft-tissue tumors. Embryonal rhabdomyosarcoma was the most frequent malignant tumor, with peak occurrence in the first decade, and comprised 25.8% (16/62) of the malignant soft-tissue tumors and 8.5% (n = 16/188) of all soft-tissue tumors. Kaposi sarcoma, a tumor of intermediate malignancy, consisted of 24.2% (n = 15/62) of the malignant soft-tissue tumors. The remaining malignant soft-tissue tumors found in this study included pleomorphic rhabdomyosarcoma, alveolar rhabdomyosarcoma, liposarcoma, angiosarcoma, pleomorphic sarcoma, malignant fibrous histiocytoma, and hemangiopericytoma. Conclusion: Lipoma was the single most common soft-tissue tumor. Half of all the malignant tumors consisted of embryonal rhabdomyosarcomas, most frequent first decade of life, and Kaposi sarcoma, a tumor of intermediate malignancy.
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Pattern of fatal unintentional injuries in an urban setting in a developing nation Highly accessed article p. 179
Obiora Jude Uchendu, Nkadi Francis Nwachokor, Eseroghene Arthur Ijomone
DOI:10.4103/smj.smj_23_19  
Background: Epidemiologic survey in most countries show a shift from infectious disease to noncommunicable diseases and injuries as major causes of death. Fatal nonintentional injuries constitute a significant but preventable cause of death in sub-Sahara Africa. Objective: The objective of this study is to describe the age, sex, and causes of fatal unintentional deaths from autopsies performed in Warri, Delta State. Materials and Methods: This is a descriptive retrospective study, based on coroner's autopsies performed in Warri, Delta State, from 2003 to 2016. Information on age, sex, and causes of fatal nonintentional injuries was extracted from autopsy reports and analyzed using SPSS version 21. Results: A total of 236 fatal unintentional death victims, composed 190 (80.5%) male and 46 (19.5%) female, with a mean age of 33.08 years and peak incidence in the fourth decade were studied. Major causes of accidental deaths in this investigation include road traffic accident (RTA) (48.7%), drowning (15.5%), burns (12.3%), electrocution (10.2%), falls (4.7%), and poisoning (3.4%). Fatal RTA victims consist of 87 (75.7%) male and 28 (24.3%) female, with motorcycle-related death accounted for 52 (45%) deaths, whereas pedestrian and vehicle users each accounted for 32 (27.8%) cases. Conclusion: Unintentional deaths are relatively common but highly preventable through education and enforcement of safety practices; and safety-targeted engineering and infrastructural designs.
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Knowledge and attitude on neonatal jaundice among women of reproductive age group in rural community in northern Nigeria p. 184
Chinedu John-Camillus Igboanusi, Awawu Grace Nmadu, Istifanus Anekoson Joshua, Mary Ojonema Onoja-Alexander, Benjamin Olatubosun
DOI:10.4103/smj.smj_43_18  
Background: Neonatal jaundice (NNJ) is a common cause of hospitalization in the 1st week of life and a significant cause of neonatal morbidity and mortality worldwide. Objectives: The aim of this study was to assess the knowledge and attitude related to NNJ among women of reproductive age group in Basawa community, Zaria, Nigeria. Materials and Methods: The cross-sectional descriptive study was carried out in January 2017 among mothers aged 15–49 years. One hundred and seventy-two structured, pretested, interviewer-administered questionnaires were used to collect data. Data were analyzed using SPSS software version 21. Results were presented in tables and charts. Results: The mean age of respondents was 34 ± 6.98 years; 158 (92%) of them were aware of NNJ and predominant sources of information from relatives (35%) and hospital (33.1%). Ninety-one percent had poor knowledge of NNJ. Only 76 (46%) and 36 (21%) respondents, respectively, identified infection and breast milk as causes of NNJ. Complications of NNJ mentioned included serious illness (56.4%) and disability (21.5%). Majority of respondents (106, 62%) had poor attitude to NNJ. About 132 (77%) believed that NNJ had an effect on neonates and was curable while only 66 (38%) believed that health education during antenatal care was a preventive measure for NNJ. A statistically significant association was found between income and level of knowledge of respondents about NNJ (P = 0.043). Conclusion: This study highlighted inadequate knowledge, poor attitude, and misconceptions about NNJ. It underscores the importance of health education programs and campaigns in addressing the gaps in knowledge.
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CASE REPORTS Top

Hemoperitoneum complicating venomous snakebite: A case report p. 191
Abdulmumini Yakubu, Y Musa, AS Maiyaki, SH Tambuwal
DOI:10.4103/smj.smj_62_19  
Herein, we report a case of hemoperitoneum complicating venomous snakebite from a carpet viper in a young Nigerian who survived it. Review of the literature indicates that it is a rare presentation and from the available evidence, the first from Nigeria. A peculiar feature was the late presentation. Management has been discussed while highlighting some of its limitations.
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Blistering erysipelas in a black patient p. 195
Hayatu Umar, Femi Akindotun Akintomide, Aliyu Abdullahi, Jamila Muhammed, Abubakar Sadiq Maiyaki
DOI:10.4103/smj.smj_63_19  
Blistering erysipelas bullosa constitutes a rare and severe variant of erysipelas, which is rarely reported in the medical literature. It is an acute inflammation of the epidermis and superficial lymphatics. The diagnosis is usually clinical. We report the case of blistering erysipelas of the lower limb complicated by sepsis in a young immunocompetent obese female. To the best of our knowledge, this is the first case being reported from sub-Saharan Africa. We recommend a high index of suspicion of this rare disease in a patient with suspected skin lesions and predisposing factors.
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Recurrent urinary tract infection due to large urinary bladder calculus in a 6-year-old child p. 198
Ibrahim Haruna Gele, SB Muhammad, SA Sa'idu, SM Ma'aji
DOI:10.4103/smj.smj_56_19  
Urinary bladder calculus is an uncommon presentation in the tropics, especially in children. Large (>2.5 cm) or giant bladder stones are rare and are more common in males due to higher incidence of lower urinary tract obstruction. Ultrasonography and plain radiography play an important role in the diagnosis of urinary bladder stone as well as evaluation for complications that may be associated with this condition. A 6-year-old boy presented with a 3-month history of abdominal pain and dysuria. He was treated with antibiotics on several occasions in a rural health center with no satisfactory improvement of his symptoms. Ultrasound and intravenous urography showed a huge oval urinary bladder calculus measuring 4.5 cm × 4.2 cm × 4.0 cm with moderate bilateral hydronephrosis. We presented a rare case of large bladder calculus in a 6-year-old boy with recurrent urinary tract infection highlighting the role of ultrasonography and excretory urography in the management.
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