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   Table of Contents - Current issue
Coverpage
January-March 2019
Volume 6 | Issue 1
Page Nos. 1-53

Online since Friday, October 11, 2019

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ORIGINAL ARTICLES  

Complications of thyroidectomy at a tertiary health institution in Nigeria p. 1
Sani Ali Samuel, Sani Hauwa Rebecca
DOI:10.4103/ssajm.ssajm_33_18  
Introduction: Thyroid surgeries are the most common endocrine surgeries performed all over the world. The procedure has been through tremendous evolution to enhance patient safety. In spite improved techniques, every thyroid surgeon has come across complications with this operation. This is a retrospective study of complications of thyroidectomies at a tertiary health institution in Abuja, Nigeria. The study highlights some of the complications encountered at the University of Abuja Teaching Hospital, Gwagwalada, Abuja, following thyroid surgeries by General surgeons. Aim: This article aimed to determine the complication rates after thyroidectomies in our institution and proffer efficient methods of complication management, thus reducing postoperative morbidity and mortality. Material and Methods: A retrospective study of complications arising from consecutive thyroidectomies was carried out in the University of Abuja Teaching Hospital for over a 5-year period between January 1, 2012 and December 31, 2017. Clinical data on each case were extracted from patient folders using a structured questionnaire. Data was analyzed using SPSS, IBM version 21. Results: A total of 72 thyroidectomies were carried out during the period. There were seven males and 65 females with M:F ratio of 1:9. The median age of the patients was 38.5 years (range 18–75 years). Preoperative diagnoses included simple goiter (n = 6, 8.3%), nontoxic multinodular goiter (n = 51, 70.8%), toxic nodular goiter (n = 6, 8.3%), Grave’s disease (n = 2, 2.8%), toxic multinodular goiter (n = 5, 6.9%), simple multinodular goiter (n = 1, 1.4%), and others such as solitary thyroid cyst (n = 1, 1.4%) . The operations were total thyroidectomy (n = 15, 20.8%), subtotal thyroidectomy (n = 13, 18.1%), near-total thyroidectomy (n = 33, 45.8%), lobectomy (n = 10, 13.9%), and extended lobectomy (n = 1, 1.4%); 72.1% of the patients had no complications whereas 27.9% of the patients developed complications. The complications were temporary recurrent laryngeal nerve (RLN) palsy 9.7%, recurrent goiter 1.4%, hypothyroidism 1.4%, hypocalcemia 5.6%, hypertrophic scar formation 5.6%, and hematoma collection 4.2%. No patient developed wound infection, transient or permanent hypoparathyroidism, permanent RLN palsy, superior laryngeal nerve palsy, recessed scar, or mortality. All the patients were followed up for a period of 1 to 5 years. Conclusion: Thyroidectomy is safe in our institution. The complication rate of 27.9% is high, however, this is a summation of all complications recorded at the institution. Most of the complications were minor and resolved with conservative measures in 3 to 6 months. The dreaded complications of thyroidectomy such as permanent RLN injury, wound infection, and mortality is zero (0)% each. Careful patient selection and robust collaboration with cosmetic surgeons and endocrinologist in the management of goiters improved our outcome.
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Intraocular pressure negatively correlates with serum brain-derived neurotrophic factor in patients with primary open-angle glaucoma p. 10
Isyaku Umar Yarube, Ahmed Saidu, Sadiq Hassan
DOI:10.4103/ssajm.ssajm_28_18  
Introduction: Glaucoma is a blinding eye disease, the hallmark of which is elevation of intraocular pressure (IOP). Glaucoma is nearly impossible to diagnose and treat without expensive equipment and IOP reduction, respectively. Hence, the need for a biomarker is an aid in diagnosis and an alternative treatment option to IOP reduction. Brain-derived neurotrophic factor (BDNF) may serve as both a biomarker and a therapeutic option. However, the exact role of BDNF and its dynamics during glaucoma is not well demonstrated, especially in a Sub-Saharan African population. This study, therefore, examines the serum levels of BDNF and its relationship with IOP. Patients and Methods: Intraocular pressure (IOP) and serum BDNF were measured in 44 glaucoma patients and 41 controls. Results: Glaucoma patients had higher IOP compared to controls. They also had higher BDNF (2.578 ± 0.210) compared to controls (1.745 ± 0.111). Glaucoma patients on medications had higher BDNF (3.086 ± 0.180) compared to those not on medications (0.605 ± 0.116). Serum BDNF significantly correlated with IOP. Conclusion: In conclusion, glaucoma patients have higher IOP and serum BDNF concentrations compared to nonglaucoma controls. IOP negatively correlates with serum BDNF in patients with glaucoma. Untreated glaucoma appears to decrease serum levels of BDNF, whereas treatment of the condition increases it. Serum BDNF may serve as a potential therapeutic target and useful diagnostic and monitoring tool in the management of glaucoma.
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Intraoperative and postoperative effects of different doses of bupivacaine: a comparative and prospective study for lower limbs surgeries p. 16
Yunus A Gafar, Baffa Yusuf, Olagunju Ganiyat, Ali Yunus
DOI:10.4103/ssajm.ssajm_11_19  
Background Central neuraxial block is the gold standard for surgeries below the level of the umbilicus, especially for lower limb operations. Bupivacaine of different concentrations are used for regional blocks and the side effects are attributed to the concentration of the local anaesthetics used. Objective The aim of this study was to prospectively investigate the intraoperative and postoperative effects of different doses of bupivacaine in lower limb surgeries. Methodology A double-blind randomized controlled study was conducted on 120 patients scheduled for emergency lower limb surgeries at Ahmadu Bello University Teaching Hospital from January to December 2017. The patients were randomly grouped into two groups: 1 and 2. The patients in group 1 received 10 mg of 0.5% bupivacaine and 10 μg of fentanyl, whereas those in group 2 received 7.5 mg of 0.5% bupivacaine and 10 μg of fentanyl. Parameters considered included the hemodynamic indices, quality of intraoperative analgesia, onset time of sensory and motor blockade, level of sensory and motor blockade, and duration of the sensory and motor blockade. A P value less than 0.05 was considered statistically significant. Results There was no statistically significant difference (P < 0.05) in the demographic, American Society of Anesthesiologists (ASA) parameters, time of onset of sensory block, and duration of sensory block. There was statistically significant difference in duration of motor blockade, with time of first analgesic request, and more hypotension recorded in group 1 compared to group 2. Conclusion This study has established that 7.5 mg of 0.5% bupivacaine with 10 μg fentanyl has operative analgesia of equal efficacy as 10 mg of 0.5% bupivacaine.
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Circulating serotypes and antimicrobial susceptibility pattern of Vibrio cholerae isolates from insurgency-stricken Maiduguri, northeastern Nigeria p. 21
Musa A Garbati, Abubakar S Baba, Abubakar Mursal, Galadima B Gadzama
DOI:10.4103/ssajm.ssajm_12_19  
Background: Cholera has continued to be a global threat to public health largely due to lack of social development. In endemic areas, outbreaks usually occur when war or civil unrest disrupts public sanitation services contaminating food and water supplies. Extensive and injudicious use of antimicrobials has led to the emergence of Vibrio cholerae strains that are resistant to several antibiotics. Aim: This study aims to highlight the recent cholera outbreak in the northeastern Nigeria and its characteristics, regarding the circulating serotypes and the antibiotic susceptibility of the isolates. This information is important for the effective control of future outbreaks using vaccination and antibiotics. Materials and Methods: We retrospectively reviewed 102 consecutive fresh diarrheic stool samples at the University of Maiduguri Teaching Hospital, Maiduguri, Nigeria, from July to December 2018. All samples were analyzed by culture and serology according to standard procedures. Antimicrobial susceptibility testing was performed with the Kirby-Bauer disk diffusion method on Mueller-Hinton agar. Results: Stool samples from 102 suspected cholera cases were received in the medical microbiology laboratory department for evaluation. Males made up 54% of the study population, aged 3 months to 70 years. Most of the cases were from camps harboring large numbers of internally displaced persons. Serotyping revealed that the sero group Ogawa was responsible. The strains were 100% sensitive to amikacin, ciprofloxacin, and cefotaxime, with varying resistance to trimethoprim/sulfamethoxazole and tetracycline. Conclusion: Our study highlights the continuing social problems associated with cholera epidemics and the significance of regular serologic and antimicrobial resistance surveillance of V. cholerae strains in our environment for proper management of cases.
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Uterine artery Doppler indices in pregnancy-induced hypertension in North Western Nigeria p. 27
Mohammed K Saleh, Joseph Chawo, Idris S Kazaure, Abdulkadir M Tabari, Isyaku Kabiru
DOI:10.4103/ssajm.ssajm_21_18  
Background: Pregnancy-induced hypertension (PIH) is a syndrome of hypertension with or without proteinuria, occurring when systolic blood pressure is greater than or equal to 140 mmHg and diastolic blood pressure is greater than or equal to 90 mmHg at gestational age of 20 weeks and above in a woman who has been previously normotensive. Doppler ultrasound (DUS) is now routinely used for evaluation of accessible vessels, hence its clinical application in patients with PIH. Aims and Objective: To evaluate the usefulness of DUS of the uterine artery (UA) in women with PIH. Materials and Methods: This was a prospective case–control study in which ultrasound examination of the uterus of 400 patients (200 hypertensive and 200 normotensive pregnant women) was performed. The UA Doppler indices, resistivity index, and systolic/diastolic ratio (RI and SD/DV) were recorded. Results: The mean RI in the PIH group (0.64 ± 0.07) was significantly higher than the mean of 0.50 ± 0.06 among the control group (t = 19.922, df = 398; P < 0.0001). In addition, the mean SD/DV ratio was significantly higher in the PIH group (3.04 ± 0.67) than in the control group (2.09 ± 0.29) (t = 18.270, df = 398; P < 0.0001). The Doppler spectral waveform patterns of the UA in both the groups revealed the presence of diastolic notch in 81.5% of the patients with PIH but in none of the control patients (Fisher’s exact P < 0.0001). Conclusion: Doppler parameters of the UA are abnormal in PIH, and its predictive value in PIH would be useful in the management of such patients.
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Perception of antimicrobial resistance among clinical medical students in a Tertiary Nigerian Teaching Hospital p. 36
Abdulhakeem A Olorukooba, Mindiya H Isaaq, Bilkisu Nwankwo, Mary O Onoja-Alexander, Lawal Amadu, Khadeejah L Hamza
DOI:10.4103/ssajm.ssajm_31_18  
Background: Inappropriate use of antimicrobials worldwide contributes to antimicrobial resistance (AMR). The World Health Organization has identified education of medical students as an important aspect of AMR containment. Surveys from developed countries revealed that medical students recognize the importance of AMR but feel inadequately prepared and want more education on how to make antimicrobial choices. The perception of Ahmadu Bello University (ABU) medical students regarding AMR has never been evaluated. Aim: This article aims to determine the perception of AMR among medical students of ABU. Setting and design: We conducted a cross-sectional survey on clinical medical students in the fourth, fifth, and sixth year of ABU. Material/methods: Open Data Kit on android was used to administer the questionnaire. The questionnaires recorded basic demographic information, perception about AMR, and promoters of AMR. Bivariate and multivariate associations between categorical variables were tested using odds ratio and confidence intervals. Results: Most (98.4%) respondents strongly agree/agree that AMR was a significant problem nationally and is a significant problem in the hospital (84.6%). Better use of antimicrobials will reduce problems with AMR (98.4%), prescribing broad-spectrum antimicrobials when equally effective narrower spectrum antimicrobials are available increase AMR (77.3%). Most (98.9%) would like more education on AMR. Respondents pointed out that overuse of antimicrobials (97.3%) was one of the main promoters of AMR. Level of student was found to be significantly associated with the perception of AMR. Conclusion: It is recommended that incorporation of additional antimicrobial education into the medical school curriculum is necessary.
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Malnutrition in HIV: Are patients in early stages of disease and with high CD4 counts spared? p. 43
Reginald O Obiako, Iorhen E Akase, Abdulaziz Hassan, Aliyu Babadoko, Bolanle O.P Musa, Yemi Balogun, Lilian Okonkwo, Rasheed Yusuf, Haruna M Muktar, Michael Obadaki, Ibrahim Abdu-Aguye, Bilkisu B Maiha
DOI:10.4103/ssajm.ssajm_24_18  
Background High incidence of malnutrition have been reported in patients with a moderate and advanced HIV disease, but data on the nutritional status of patients with early and mild HIV infection are lacking. This study compared the nutritional status of antiretroviral therapy (ART)-naïve HIV-positive patients with high CD4 counts receiving care in Kaduna state to HIV negative controls. Materials and Methods Consecutive 90 consenting HIV-infected adults, who were ineligible for ART in the 2013 treatment guideline, were enrolled alongside 90 age-and-sex-matched HIV seronegative healthy individuals, and compared for body mass index (BMI), hemoglobin, serum albumin, vitamin B12, zinc, and copper. Results Majority (77%) of participants in both groups were females, slightly younger than the males (ages 39.0 ± 4.0 vs 40.0 ± 2.2 years, P > 0.05). HIV-negative persons had significantly higher nutritional indices (BMI, serum albumin, vitamin B12, zinc, and copper levels) than HIV-infected patients, whereas the indices were worse in WHO clinical stage II than WHO clinical stage I patients. HIV and marital status were significantly associated with malnutrition. Conclusion WHO clinical stage I/II HIV-infected persons have significantly lower nutritional indices than HIV-negative controls. Significant malnutrition therefore occurs in early HIV infection before the start of anti-retrovirals (ARVs) and the occurrence of opportunistic infections.
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CASE REPORT Top

Extranodal NK/T cell lymphoma: diagnostic challenges in a resource-constrained setting p. 49
Murtala Abubakar, Iliyasu Y Shuaibu, Dotiro Chitumu, Almustapha Aliyu Liman, Dauda E Suleiman
DOI:10.4103/ssajm.ssajm_37_18  
Introduction: Extranodal natural killer/T-cell lymphoma (NKTCL)- nasal type is a rare form of non-Hodgkin lymphoma. It mainly affects the midfacial structures (the nose, oropharynx, and hypopharynx). Prognosis is generally very poor and diagnosis is often delayed in Africans because of low index of clinical suspicion and resource constraints. Case report: The patient was a 30-year-old man who presented with a 5-month history of rhinorrhea associated with blockage of the left nasal cavity. Examination revealed a fleshy left nasal mass. Incisional biopsy of the mass was reported as nonspecific chronic inflammation but the diagnosis was reviewed to non-Hodgkin lymphoma after histologic examination of the excised mass. Subsequent immunohistochemical studies established a diagnosis of NKTCL 6 months after initial presentation. The patient was placed on chemotherapy and radiotherapy. He did not have access to radiotherapy because of financial constraints and defaulted from care after he has had three cycles of chemotherapy. The patient died 4 months after defaulting. Conclusion: It is very common to miss the diagnosis of the early phase of NKTCL before the appearance of the destructive facial lesion. Low index of suspicion and constraints of resources also play a role in the delayed diagnosis and poor outcome in Africa.
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