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   Table of Contents - Current issue
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April-June 2021
Volume 24 | Issue 2
Page Nos. 65-98

Online since Tuesday, July 13, 2021

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ORIGINAL ARTICLES  

Computerized tomographic brain findings of CNS manifestations in HIV/AIDS patients receiving HAARTS treatment p. 65
Philip Oluleke Ibinaiye, Sefiya Adebanke Olarinoye-Akorede, Suleiman T Sa'ad, Nasiru M Tahir, Aminu U Usman, Abubakar Ali-Gombe, Sani Garko, Dahiru M Yunsa, Timothy Y Umoru, Bello O Usman, Abdulaziz Umar
DOI:10.4103/smj.smj_68_17  
Background: Despite current availability of highly active antiretroviral therapy (HAART) in our hospital, neurologic complications of HIV are common. Aim: The aim of this study was to document brain computed tomography (CT) findings in HIV patients receiving HAART who developed neurological complications and to examine the relationship of these findings with CD4 cell counts. Materials and Methods: Twenty patients with central nervous system symptoms out of 200 HIV/AIDS patients receiving HAART at the HIV Clinic of Federal Teaching Hospital, Gombe, were retrospectively studied. The findings were reviewed alongside their clinical features, CD4 + count, and HAART history. Results: CT findings were positive in 12 (60%) of the patients, while no abnormality was seen in 8 (40%). The most common brain abnormality was atrophy (35%). Two out of five patients (40%) with CD4 counts >200 had abnormal CT findings compared with 9 out of 14 patients (64%) with CD4 counts <200 cells who had CT abnormalities. This finding was statistically significant (R = 0.864, P = 0.00). Conclusion: There is high incidence of neurological complications and positive brain CT scan among the patients who defaulted from HAART treatment and with CD4 cell counts of <200 cells/microliter.
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Asymptomatic malaria parasitaemia among HIV infected children and adolescents p. 70
Surajudeen Oyeleke Bello, Esther Solomon Audu, Ikrama Hassan, Efe Abolodje, Ishaku Bako
DOI:10.4103/smj.smj_20_19  
Background: Malaria manifests with life-threatening manifestations resulting in hospital admissions and sometimes death may ensue. This is more devastating among children due to high susceptibility resulting from impaired immune system following severe malaria. Human immunodeficiency virus (HIV) coinfection with malaria further compromises the immune system and increases the vulnerability. The effect of co-trimoxazole prophylaxis in curtailing malaria has not being well evaluated in our environment where both malaria and HIV are endemic. This study sets out to determine the magnitude of asymptomatic malaria among HIV-infected children and adolescents receiving care at our facility. Study Design: This was a descriptive cross-sectional study. Materials and Methods: A prospective study among HIV-infected children aged 2–18 years was enrolled in our care. Nonprobability convenience sampling was used to recruit individuals who fulfilled the criteria. Questionnaire and patients' medical records were used to gather some data. A sample was taken for malaria parasite microscopy. The analysis was done using the Statistical Package for the Social Sciences version 20. Categorical variables were presented as percentages and association assessed using Chi-square test, whereas continuous variables were presented as mean and standard deviation, and the association between two means was checked using Student's t-test. Results: The mean age of the study population is 7.02 ± 2.97 years. Of the 420 participants in this study, 92 (45.7%) had confirmed malaria. There was no significant difference in the gender, age groups, and viral loads of patients with malaria. Conclusion: There is a high prevalence of malaria coinfection with HIV in this study.
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Association of local anesthetic method and prostate volume with the occurrence of prostate biopsy complications p. 75
Musliu Adetola Tolani, Muhammed Ahmed, Babatunde Kolapo Hamza, Muhammad Salihu Muhammad, Ahmad Bello, Hussaini Yusuf Maitama
DOI:10.4103/smj.smj_23_20  
Background: Due to the invasive nature of prostate biopsy, it is associated with various complications. The study aimed to determine the association of local anesthetic method and prostate volume with the occurrence of these prostate biopsy complications. Materials and Methods: It was a prospective study carried out in 106 patients with indications for prostate biopsy. They were randomized into two equal groups receiving either intrarectal lidocaine gel or periprostatic nerve block. Prostate volume was determined using transrectal ultrasound, and patients were further divided into three prostate volume classes (20-40 ml, 40-100 ml, and ≥100 ml). Systematic sextant prostate biopsy was done, and the occurrence of complications (pain, bleeding, infection, and urinary retention) was documented. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software. Results: The pain scores of patients were similar irrespective of their prostate volume even with the use of different types of anesthesia. There was no significant tendency for the occurrence of bleeding, infection, and voiding complications when periprostatic nerve block or intrarectal lidocaine gel was used for pain relief. Postbiopsy cystourethritis was, however, significantly associated with the volume of the prostate (P = 0.006). Conclusion: The choice of local anesthesia does not affect the occurrence of complications following transrectal prostate biopsy. There is, however, a significant potential for the development of postbiopsy cystourethritis in patients with larger prostates.
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A cadaveric study of thoracic paravertebral spaces from the point of view of paravertebral block p. 80
Moiz Junaid Dayer, Vaishaly Kishore Bharambe
DOI:10.4103/smj.smj_44_19  
Background: Paravertebral block (PVB) is a regional anesthetic technique, in which a local anesthetic is injected into the thoracic PVS, resulting in ipsilateral somatic and sympathetic nerve blockade. Objectives: The present study aimed at observing the extent of thoracic paravertebral space (TPVS) at the levels of T1–2, T6–7, and T11–12 by measuring the horizontal and vertical spread of the dye in the Indian population. Materials and Methods: Methylene blue dye was injected into the TPVS at the levels of T1–2, T6–7, and T11–12 and its spread observed. Results: A total of 25 cadavers were studied. The extent of horizontal the spread was average of 83.0 mm at the level of T1–2, 103.0 mm at the level of T6–7, and 88.2 mm at the T11–12 level. The average vertical spread in the intercostal space at the level of T1–2 was found to 48.1 mm, at the level of T6–7 was found to be 44.6 mm, and at the level of T11–12 was found to be 55.04 mm. The maximum vertical spread of dye was over three intercostal spaces. Sixty-four percent of the cadavers studied showed a spread of dye from TPVS to lumbar paravertebral space. In 20% of the cadavers, a contralateral spread of injected dye was observed. The average depth of the needle to reach the TPVS was observed to be 36.8, 35.7, and 36.1 mm for T1–2, T6–7, and T11–12, respectively. Conclusions: A paravertebral block (PVB) has immense potential in regional anesthetic techniques involving thoracic and lumbar dermatomes. The present study will be helpful for surgeons and anesthesiologists to reduce uncertainties of the spread of anesthetic agents in thoracic PVB and its complications.
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CASE REPORTS Top

Dextrocardia with situs inversus: An incidental finding in a 9-year-old child p. 90
Muhammad Baba Sule, Sadisu Mohammed Ma'aji, Sule Ahmed Sa'idu, Amina M B. Shamaki
DOI:10.4103/smj.smj_13_20  
Dextrocardia is a cardiac positional anomaly, in which the heart is located in the right hemithorax with its base to apex axis directed to the right and caudad. The malposition is intrinsic to the heart and not caused by extracardiac abnormalities. This is a 9-year-old Nigerian female child who was referred for plain radiograph of the chest on account of recurrent episodes of cough and upper respiratory tract symptoms. The chest and upper abdominal radiograph showed dextrocardia with a right placed heart and gastric fundal gas beneath the right diaphragm. Complimentary abdominal ultrasound showed displaced spleen and stomach to the right with the liver displaced to the left, confirming the diagnosis of dextrocardia with situs inversus.
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Localized tetanus: A case report p. 93
Mamman Na'uzo Aliyu, Lawson Amagiya, Zainab Abdullahi
DOI:10.4103/smj.smj_133_20  
Tetanus is a vaccine-preventable disease caused by a potent neurotoxin released following infection with the obligate anaerobic bacterium, Clostridium tetani. Of the four clinical forms of the disease, generalized tetanus accounts for the most common form of the disease. This is a case report of localized tetanus involving the thigh muscles in a 12-year unimmunized girl following a wound sustained around the right groin area initially thought to be an acetabular fracture. The child had antibiotics, antitetanus serum, sedatives, and wound care. She was unable to have full treatment because of parental decision to seek traditional treatment at home. The case is reported because of the rarity of localized tetanus, the diagnostic dilemma presented by the case, and the cultural interplay and understanding of the disease process by the patient/caregivers. It is also reported to highlight the gap in routine immunization and the need for booster doses in this age group.
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Neonatal lower limb gangrene: Effect of local cosmetic agent p. 96
Oni Nasiru Salawu, GH Ibraheem, JO Mejabi, C Nwosu, BA Ahmed, AK Suleiman, OM Babalola
DOI:10.4103/smj.smj_2_20  
Limb gangrene is a common orthopedic emergency in this part of the world, but neonatal limb gangrene is a rare pathology. Sepsis is a common complication of limb gangrene which can lead to mortality if not managed early. Here is a case of left leg gangrene in a 16-day-old female neonate following the application of local cosmetic agent ("lele") by the mother prior to naming ceremony. The patient presented with features of septicemia; she was resuscitated, and left below-knee amputation was done for her. Harmful and unnecessary cosmetics should be avoided in neonates.
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