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   Table of Contents - Current issue
Coverpage
April-June 2019
Volume 6 | Issue 2
Page Nos. 55-109

Online since Tuesday, November 5, 2019

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REVIEW ARTICLE  

Integration of traditional birth attendants (TBAs) into the health sector for improving maternal health in Nigeria: a systematic review p. 55
Sulayman Hajaratu U, Adaji Sunday E
DOI:10.4103/ssajm.ssajm_25_17  
This work tries to look at how the integration of traditional birth attendants (TBAs) into the health sector in Nigeria can be a strategy for reducing maternal deaths. Skilled birth attendance in Nigeria is below 40% and most deliveries are with unskilled personnel like the TBAs. In the light of current evidence that training of TBAs can have some positive effect on neonatal outcome and with inconclusive evidence on their role in maternal health, this “birthing workforce” can be harnessed by the Nigerian government by re-defining their roles as health promoters with the overall aim of improving skilled attendance at deliveries and the reduction of maternal morbidity and mortality.
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ORIGINAL ARTICLES Top

Effects of clonidine-bupivacaine combination on the onset and duration of brachial plexus block in upper extremities surgeries: a preliminary report p. 63
Suleiman Zakari A, Kolawole Israel K, Opeyemi Abe, Adegboye Kazeem A, Aminudeen Abdulrahman
DOI:10.4103/ssajm.ssajm_4_19  
Objective Delayed onset of action and incomplete anaesthesia are often observed after brachial plexus block. Efforts have been made to hasten the onset of sensory and motor blocks as well as prolonging the duration of anaesthesia by combining several adjuvants to local anaesthetic agents for brachial plexus block. This study determined the onset of sensory and motor blocks and the duration of analgesia when clonidine was added to bupivacaine in patients who had upper extremities surgery under brachial plexus block. Methods This prospective comparative single blind study involved randomization of 40 ASA I-II patients scheduled for upper extremities surgery under periclavicular brachial plexus blocks into two equal groups. Group CB received 1 mL of clonidine (100 µg) and 29 mL of 0.5% bupivacaine while group B received 1 mL of water for injection and 29 mL of 0.5% plain bupivacaine. The onset of sensory block, motor block, duration of analgesia, and first request to rescue analgesia were assessed in the two groups. Results The onset of sensory and motor blocks was significantly faster in group CB compared with group B, 8.55 ± 3.0 versus 14.75 ± 5.7 min (P = 0.000) and 5.05 ± 1.1 versus 11.5 ± 4.6 (0.000), respectively. Similarly, the duration of sensory and motor blocks were 461 ± 94.2 versus 364 ± 39.1 min (P = 0.000) and 540 ± 81.3 versus 441.5 ± 41.5 min (P = 0.000), respectively. The time to request for rescue analgesia was longer in group CB in comparison with group B, 9.7 ± 2.3 versus 8.8 ± 2.5 hr but the difference was not statistically significant, P = 0.244. Conclusion Brachial plexus block with bupivacaine/clonidine reduced the onset time of sensory and motor blocks and prolonged the duration of analgesia and time to request for rescue analgesia.
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Palatal Flap Mobilization in Cleft Palate Repair: A Simplified Technique p. 68
Akinwale A Efunkoya, Olusola I Amole, Uchenna K Omeje, Benjamin I Akhiwu, Otasowie D Odunde
DOI:10.4103/ssajm.ssajm_35_18  
Background: Closure of the cleft palate defect without tension is frequently a challenge. Many surgical techniques exist for cleft palate repair. These techniques mostly inculcate some form of palatal flap mobilization. Adequate mobilization of the palatal flaps can achieve closure without tension, thereby reducing the incidence of palatal fistulae. Aim: This article aims to describe and illustrate a simplified technique of palatal flap mobilization in cleft palate repairs. Materials and method: A descriptive narrative of cleft palatal repair was done with emphasis on a simplified technique for palatal flap mobilization. Variations of this technique for von Langenbeck, Bardach, and isolated soft palatal repairs are also described with illustrations. Conclusion: A simplified technique of palatal mobilization can enhance palatal cleft closure without tension, thereby reducing incidence of palatal fistulas.
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Pharyngoesophageal foreign bodies: clinical presentation and treatment outcome in a tertiary health center p. 72
Abdulrazak Ajiya, Abdullahi Hamisu
DOI:10.4103/ssajm.ssajm_17_19  
Background: Foreign body (FB) ingestion is a commonly encountered problem in both children and adults in emergency departments. Aim and Objective: This study reviewed the pattern and outcome of rigid esophagoscopic management of pharyngoesophageal FBs in our center. Materials and Methods: The records of patients managed for impacted pharyngoesophageal FBs at the study center over a period of 10 years were reviewed. Information obtained was collated and analyzed using SPSS version 18. Results: A total of 153 patients were reviewed. Among these, 96 (62.7%) were males with sex ratio (M:F) of 1.6:1. The mean age was 23.5 ± 2.3 years. The main presenting complaint was dysphagia 127 (83%). Coin was the most common FB, 33 (21.6%). The most common site of impaction was at the cricopharyngeal sphincter, 58 (37.9%). Complication was encountered in 43 (28.1%) patients. The most common complication encountered during rigid esophagoscopy was mucosal tear, 35 (22.9%). Most patients [97 (63.4%)] stayed for 1 to 3 days on admission; 151 (98.7%) had successful rigid esophagoscopic removal of their FBs. There is a statistically significant correlation between type of FB and duration of impaction with development of complication following rigid esophagoscopy (P value = 0.006 and 0.014, respectively). Conclusion: Rigid esophagoscopy was highlighted in this study as an effective method of removal of pharyngoesophageal FBs; however, ion disc battery and artificial denture are relatively associated with increased complications.
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Prevalence and associated risk factors of intestinal parasitic infections among school children in Bamo no. 2 primary school, Adele town, East Arsi, Ethiopia p. 77
Mulumebet Tadesse, Beyene Dobo, Melese Birmeka
DOI:10.4103/ssajm.ssajm_36_18  
Introduction: Intestinal parasitic infection (IPI) is one of the major and serious medical and public health problems in developing countries including Ethiopia. Effective prevention and control of IPIs require the identification of local risk factors, particularly among school children. Objective: This article assesses the prevalence of IPIs and associated risk factors among school children in Bamo no. 2 primary school in Adele town, East Arsi in southeast Ethiopia. Materials and Methods: Study participants were selected by using multistage sampling technique. A total of 417 school children were enroled in Bamo no. 2 primary school in Adele town, East Arsi. Structured questionnaires were used to identify environmental, sociodemographic, and behavioral factors. Stool specimens were collected and examined for parasites using direct smear and formal–ether concentration technique. Data were analyzed using SPSS Version 20. A bivariate and multivariate logistic regression analysis was done. P value less than 0.05 was considered as statistically significant. Results: The overall prevalence of IPIs in the present study was 113/417 (27.1%), for at least one intestinal parasite. A total of six parasites were detected; the most prevalent were Ascaris lumbricoides [50 (12.00%)], Entamoeba histolytica/dispar [43 (10.3)], Trichuris trichiura [35 (8.4%)], Giardia lamblia [31 (7.4%)], Hymenolepsis nana [13 (3.1%)], and Teania saginata [12 (2.9%)]. In addition to these, single [49 (15.45%)] and multiple [64 (20.18%)] infections were identified. In this study, the most significantly associated risk factors for the occurrence of IPIs were grade level, water type used, hand washing habit before meal and after defecation, defecation habit, and eating unwashed/uncooked vegetable (P < 0.05). Conclusion: Intestinal parasites were prevalent in varying magnitude among the school children. Therefore, the Woreda health office, school community, and nongovernmental organizations need to give education on personal hygiene and environmental sanitation, and treatment should be taken into account to reduce the prevalence of IPIs.
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Retrospective analysis of anesthesia for hypertensive disorders in pregnancy at University of Ilorin Teaching Hospital, Kwara State p. 86
Adegboye M Babajide, Kazeem A Adegboye, Christianah I Oyewopo, Josiah Chikamnario, Isreal K Kolawole
DOI:10.4103/ssajm.ssajm_6_19  
Background: Hypertensive disorders are one of the most common medical complications of pregnancy. It is a major cause of fetomaternal morbidity and mortality. Objectives: This article compares the clinical outcome of anesthetic techniques for parturients with hypertensive disorder undergoing cesarean section. Methods: We conducted a retrospective review of the medical records of patients with hypertensive disorders in pregnancy, who underwent cesarean section from January 2016 to December 2017. Data collected included demographic profiles, specific hypertensive disorders, anesthetic techniques, and maternal and neonatal outcome. Result: Over the reviewed period, 1294 cesarean sections were done, out of which 95 (7.3%) patients had hypertensive disorders in pregnancy. Preeclampsia was the most common hypertensive disorder (45.3%) and it was more common among the multiparus patients. Eight-two patients (86.3%) underwent subarachnoid block with 0.5% heavy bupivacaine, 10 patients (10.5%) had general anesthesia with relaxant technique using isoflurane as the volatile agent, whereas three patients (3.2%) had epidural block with 0.5% plain bupivacaine. Eighty-six patients (90.5%) were done as emergency whereas nine patients (9.5%) were done as elective. A total of 82 (86.3%) neonates had good APGAR score of >7. There was no significant difference between the anesthetic techniques and neonatal outcome, P = 0.642. The proportion of blood loss was more during emergency surgeries. There was no statistical significant difference between the nature of surgery and estimated blood loss, P = 0.691. Out of the 95 parturient, 12 (12.6%) had hypotension that necessitated use of vasopressor (ephedrine), out of which 11 cases were done as emergency whereas one was done as elective. There was no significant difference between the nature of the surgery and the use of vasopressor, P = 0.942. Conclusion: The choice of anesthesia did not have a significant difference on maternal and neonatal outcome following cesarean section in parturient with hypertensive disorders in pregnancy.
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Levels of interleukin 6 and 10 and their relationship to hematological changes in HIV treatment-naïve and treatment-experienced patients p. 90
Iorhen E Akase, Reginald O Obiako, Bolanle O. P Musa, Adefolarin Opawoye, Alani S Akanmu
DOI:10.4103/ssajm.ssajm_8_19  
Introduction: Human immunodeficiency virus (HIV) infection is characterized by excessive and dysregulated production of both proinflammatory and antiinflammatory interleukins, which produces various hematological changes. This study described hematological changes in HIV-positive patients in Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Methods and Materials: This was a cross-sectional study involving 88 consecutive patients. They included 44 newly diagnosed antiretroviral treatment (ART)-naïve patients (as the test group), and 44 ART- experienced patients (as the control group). All 88 patients were evaluated for full blood count and CD4+ T-cell count as well as interleukins 6 and 10 assays. Results: The mean packed cell volume in the ART-naïve and the ART-experienced participants were 32.6 ± 5.7% and 38.6 ± 6.0% (P = 0.01). Mean hemoglobin were 10.8 ± 1.80 and 12.8 ± 1.66 g/dL in the ART-naïve and the ART-experienced participants (P = 0.01), whereas the mean corpuscular volume among the ART-naïve patients was 83.9 fL ± 7 and 99.3 fL ± 12 among the ART-experienced patients (P = 0.01). The median total white cell count among the ART-naïve and the ART-experienced patients were 5.6 × 109 and 3.1 × 109 (P = 0.04), whereas their total platelet counts were 227 × 109 ± 116 and 252 × 109 ± 95 (P = 0.29). Conclusion: Use of ART reduces inflammatory response to HIV, thus lowering levels of interleukins 6 and 10 ultimately improving hematological outcomes, except in a few patients who use zidovudine.
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Timeliness of surgical pathology results: a departmental audit of histopathological services p. 96
Charles Nwafor Chukwuemeka, Dan Ekpo Memfin
DOI:10.4103/ssajm.ssajm_30_16  
Aim To determine the turnaround time (TAT) for surgical pathology specimens (SPS) seen in our department and to identify the various determinants (variables) that affect it. Materials and method This is a cross-sectional descriptive study (prospective) of all SPS that were sent to the histopathology laboratory of University of Uyo Teaching Hospital (UUTH). A special proforma/questionnaire was designed for this study taking into account the various stages of converting a histopathological request to a result. Results Following specimen accessioning, the mean number of days before grossing was 1.65 ± 0.97 days. Tissue processing took a mean of 2.30 ± 2.05 days. Many of the processed SPS (histopathological slides) were reviewed and reported by histopathology resident doctors and consultant histopathologists within second and third days after processing in the laboratory (24.1% and 23.2% respectively), with a mean of 5.18 ± 13.07 days. Typing of result and verification of result took a mean of 2.99 ± 13.16 days. The shortest time interval to transform a histological request to a standard result was four days while the mean TAT was 8.47 ± 3.34 days. There was a significant correlation between the histological diagnosis and TAT. Conclusion Overnight fixation should be limited to large operating room specimens and not generalised. Provision of automated tissue processor, multi-headed and projecting microscopes will improve the TAT. All laboratory staff should be made to know that each stained glass slide represents a living patient and that the results are awaited.
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Sonography of scrotal abnormality among subfertile and fertile males in Abuja, Nigeria p. 101
Kolade-Yunusa Hadijat Oluseyi, Thairu Yunusa
DOI:10.4103/ssajm.ssajm_47_16  
Background Male factor infertility in Nigeria accounts for up to 50% of all infertility cases, most of which happen as a result of abnormalities of testicular function and infection. Male factor can be assessed by seminal fluid analysis; however scrotal ultrasound is now increasingly being used to evaluate males with infertility. Objectives The objective of this study is to determine the spectrum of scrotal abnormalities on ultrasound in sub-fertile and fertile men. Patients and method This was a prospective study which spanned for a period of eight months (January–August 2016). A total of 270 patients were included in the study comprising of 180 consecutive males who were being evaluated for sub-fertility and 90 apparently normal fertile adults who underwent a scrotal scan at the radiology department of University of Abuja Teaching Hospital using 7.5 MHz of EMP G70, China scan machine with Doppler facility. All patients were scanned in supine and upright position in both B and Doppler modes and any scrotal abnormalities were recorded. Result The mean age of sub-fertile and fertile subjects studied was 29 ± 11.4 years and 34 ± 16.3 years, respectively. Scrotal abnormalities were commoner in the sub-fertile group compared to the fertile group with a prevalence rate of 45.0% and 32.2%, respectively. Varicocele was the most common finding in both groups with a higher prevalence rate of 50.6% in the sub-fertile group compared to 48.3% in fertile group. This distribution was statistically significant (P = 0.000). Varicocele was observed more on the left. Hydrocele was the second most common finding in both groups. Conclusion The role of scrotal scan in evaluating infertility cannot be overemphasized. In this study, ultrasound scan was used to evaluate 45.0% of sub-fertile subjects with scrotal abnormalities. Ultrasound being non-invasive and readily available should be considered as an important investigation in accessing cases of infertility.
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CASE REPORT Top

Unusual foreign bodies in the aerodigestive tract p. 106
Aluko AA, Ajiya A, Tukur AR
DOI:10.4103/ssajm.ssajm_28_19  
Background Foreign body impaction in the airways is usually accidental in adults and deliberate insertion is rare. Magicians and other traditional healers perform various forms of magic, which are dangerous and could sometimes fail. This report conveys our recent experience with the aspiration of needles by magicians following failed magic. Case Summary Two male magicians aged 19 and 24years presented with the aspiration of 2 needles each while performing magic to sell their traditional medicines. Both had similar symptoms of dysphagia, odynophagia and neck pain. Plain radiograph of the soft tissue neck confirmed long sewing needles in the Pharynx and larynx respectively. Both patients had their foreign bodies successfully removed under general anaesthesia. Conclusion Dangerous forms of magic could fail and may lead to life-threatening emergencies. Fatal outcomes are only avoided if facilities and expertise are readily available.
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