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   Table of Contents - Current issue
Coverpage
July-September 2018
Volume 5 | Issue 3
Page Nos. 65-105

Online since Monday, July 29, 2019

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ORIGINAL ARTICLES  

Can preoperative haemoglobin concentration and patients’ age predict American Society of Anesthesiologists’ scores? p. 65
Saidu Y Yakubu, Sani Awwalu, Livingstone G Dogara, Aliyu D Waziri, Lawal I Ibrahim, Kasim M Pindiga, Aisha I Mamman
DOI:10.4103/ssajm.ssajm_22_18  
Introduction The latest version of the American Society of Anesthesiologists (ASA) score approved by the ASA House of Delegates in 2014 is used preoperatively to assess patients’ physical status (PS) before administration of anaesthesia and surgery. The ASA score does not take into consideration the patients’ age, gender or results of laboratory investigations. This study was to determine any relationship between preoperative haemoglobin (Hb) concentration, age and ASA scores. Materials and Methods Clinical records of 205 patients who had elective surgeries in a tertiary hospital for more than a period of six months were analysed for patients’ ages, gender, Hb concentrations and ASA scores, retrospectively. Data were analysed using SPSS version 20.0 with level of significance set at P ≤ 0.05. Results There were 205 patients who had surgeries during the period under review with females making up 110 (53.7%). The mean Hb and ages were 12.0 ± 1.7 g/dl and 32.2 ± 19.0 years, respectively. The median (interquartile range [IQR]) ASA-PS score was 2 (0). Most of the patients were anaemic (N = 105, 51.2%), whereas 12 (5.9%) were ≥65 years. The distribution of ASA-PS scores varied significantly across age categories (KWH statistic = 25.313, df = 4, P = <0.001). Post hoc analyses revealed that ≥65-year-olds had comparable ASA-PS scores to the ≤1 year category but higher scores compared to the 2–12-, 13–18- and 19–64-years categories. Anaemic patients had higher mean rank ASA-PS scores compared to those without anaemia (111.50 vs. 94.07, MWU statistic = 4357.000, P = 0.013). Spearman correlation analyses for ASA/Hb and ASA/age were ρ = –0.161, P = 0.021 and ρ = 0.257, P = <0.001, respectively. Multiple ordinal regression analyses to predict ASA-PS scores from Hb and age were negative with Hb (estimate = –0.261, P = 0.004) but positive with age (estimate = 0.036, P = <0.001). Conclusion Higher preoperative Hb is associated with lower ASA-PS score; older patients are more likely to have higher ASA-PS scores.
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Central corneal thickness measurement of non-glaucomatous adults in Ahmadu Bello University Sick Bay, Samaru, Zaria p. 69
Kehinde Oladigbolu, Hauwa Abdullahi, Halima Abdulsalam, Olutayo Gana, Nachafiya Kadala, Victoria Pam
DOI:10.4103/ssajm.ssajm_30_18  
Background: Central corneal thickness (CCT) is the measurement of the center of the cornea and also a parameter for assessing the corneal health status. Normal mean values for CCT range between 521 μm and 554 μm due to racial and age differences; this is an important factor to consider when measuring intraocular pressure (IOP). The CCT is supposed to influence the IOP measurement in the cornea with overestimation of IOP in thicker corneas and an underestimation in thinner corneas. Objectives: To determine the mean CCT of nonglaucomatous adults in the Eye Clinic of Ahmadu Bello University (ABU) Sick Bay Samaru, Zaria, and the correlation between CCT and IOP, age, gender, and refractive error. Materials and Methods: Consenting adults who met the inclusion criteria were selected using simple random sampling. The participants had visual acuity assessment for both distance and near and detailed ocular examination. IOP and CCT were measured with Perkins handheld applanation tonometer and PacScan 300AP ultrasonic pachymeter, respectively. Data were entered in a pretested questionnaire and analyzed using Statistical Package for the Social Sciences (SPSS) version 23.0. Results: More female participants were recorded in the study, 55 (67.9%). The mean age of all participants was 40.01 years (SD ± 13.86). The combined mean CCT for both eyes was 531.18 µm (95% CI, 522.65–539.71). A moderate inverse correlation shows the CCT decreases with increasing age (r = –0.42, P < 0.001) and a weak linear correlation with presbyopia was significant (r = 0.23, P = 0.03). No significant correlation was found between CCT and IOP, gender, and other types of refractive error. Conclusion: The mean CCT of nonglaucomatous adults in this study is comparable to those of other Nigeria and African figures. There is a very significant inverse correlation between CCT and age.
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Comparing Frozen and Paraffin Section in the Detection of Metastases in Sentinel Lymph Node in Breast Cancer in Aminu Kano Teaching Hospital, Kano, North-Western, Nigeria p. 74
Abdurrahman A Sheshe, Abubakar B Muhammad, Amina El-Yakub, Ibrahim Suleiman
DOI:10.4103/ssajm.ssajm_14_18  
Background: Sentinel lymph node biopsy is an effective diagnostic procedure to determine the need to treat the axilla or otherwise in patients with early breast cancer to avoid its inherent complication and further morbidity. Frozen section is one of the acceptable methods of scrutinizing sentinel lymph nodes to enable decision be made intraoperatively. This study is aimed to determine the sensitivity of frozen section biopsy in the diagnosis of positive sentinel lymph nodes in patients with early breast cancer. Materials and Methods: The study was conducted in the Surgery and Pathology Departments of Aminu Kano Teaching Hospital, Kano, from September 2015 to March 2017. Consecutive patients diagnosed with early breast cancer, who met the inclusion criteria, were recruited into the study after obtaining informed consent. Early breast cancer in this study was defined as stage I (T1, N0, M0) or stage IIA (T2, N0, M0). Additional information included age, sex, menopausal status, surgical procedures, duration of surgery, and the histopathological types. Statistical and comparative analysis was made. Result: A total of 117 patients with breast cancer were seen at the General Surgery Outpatient Department during the study period. Out of these patients, 40 met the inclusion criteria and were recruited for the study. The age range of 28 to 70 years and mean age of 47.4 ± 11.6 years were recorded. Twenty-two (55%) patients were premenopausal. Eighty-two sentinel lymph nodes were harvested and analyzed. Twenty-eight (34.1%) sentinel nodes were found to be positive by frozen section, whereas 54 (65.9%) were negative. The paraffin section analysis showed that 44 (53.7%) out of 82 sentinel nodes were positive for malignancy, whereas 38 (46.3%) were negative. The sensitivity, specificity, and accuracy of frozen section were 70.8%, 100%, and 82.5%, respectively. The false-negative rate was 29.2% (P = 0.292, confidence interval = 90%). Conclusion: Frozen section biopsy of sentinel lymph node is not as effective as routine staining technique in detecting malignant cells in patients with early breast cancer.
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Prevalence and pattern of bacterial isolate in febrile children with sickle cell anemia in a tertiary hospital in Northern Nigeria p. 80
Abdullahi Musa, Olufemi Gboye Ogunrinde, Aisha Indo Mamman, Yauba Muhammad Saad, AbdulRasul Ibrahim, Alhassan Mela Yakubu
DOI:10.4103/ssajm.ssajm_1_19  
Context: Bacterial infections constitute a major cause of morbidity and mortality in children with sickle cell anemia (SCA). These children have increased susceptibility to bacterial infections, the pattern of which varies with place and time. Knowledge of local pattern of bacterial infection in SCA will facilitate empirical management. Aims: This article aims to determine the prevalence and pattern of bacterial isolates and their in vitro antibiotic sensitivities in febrile children with SCA. Settings and Design: A comparative cross-sectional study was conducted at Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Methods and Material: Two hundred and thirty-two febrile children with SCA between 6 months and 15 years and another 232 febrile children with AA phenotype were investigated for bacterial infections. Blood and urine cultures were done in all the patients and other cultures were performed based on the patients’ clinical presentation. Statistical Analysis Used: Data was analyzed using Epi Info statistical software. Results: Bacterial cultures were positive in 34 (14.7%) of children with SCA and 40 (17.2%) of the controls. The three most frequently isolated pathogens among both children with and without SCA were Staphylococcus aureus (23.5%; 25.0%), Escherichia coli (23.5%; 20.0%), and Klebsiella spp. (14.7%; 17.5%). Bacterial infection was significantly more common in children less than 5 years with SCA (χ2 = 3.98, df = 1, P = 0.046). Most of the organisms isolated were sensitive to third-generation cephalosporins. Conclusions: Gram-negative bacteria were the most common isolates in febrile children with SCA. Boys less than 5 years have higher positivity rates. In children with SCA admitted with suspected bacterial infection, third-generation cephalosporins should be the antibiotic of choice for empirical treatment.
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Knowledge of antibiotic resistance among healthcare workers in primary healthcare centers in Kaduna North local government area p. 86
Maria A Garba, Fatima Giwa, Aisha A Abubakar
DOI:10.4103/ssajm.ssajm_23_18  
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Prevalence and pattern of medical disorders in pregnancy at the time of delivery at Lagos University Teaching Hospital, Lagos, Nigeria p. 93
Ochuwa Adiketu Babah, Emmanuel Owie, Ephraim O Ohazurike, Opeyemi Rebecca Akinajo
DOI:10.4103/ssajm.ssajm_32_18  
Objective To determine the prevalence and pattern of various medical conditions in pregnancy and also determine their impact on fetal and maternal outcome. Study Design A cross-sectional analytic study was conducted using labor ward data obtained over a period of 5 years (2013–2017). All women delivered at Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria, with or without medical condition complicating pregnancy at the time of admission to labor ward were included in the study. Their sociodemographic parameters, nature of medical condition, fetal weight, fetal outcome, APGAR scores, and maternal outcome were extracted from the delivery register. Data analysis was done using SPSS version 23. Results The prevalence of medical conditions complicating pregnancy was found to be 24.5%. The five commonest medical conditions complicating pregnancy are hypertensive disorders of pregnancy, human immunodeficiency virus (HIV) infection, sickle cell disease, diabetes mellitus, and hepatitis. The trend has remained relatively constant in the last 5 years. Maternal mortality rate in affected women was 0.4% compared to 0.3% for women without medical disorder in pregnancy, p = 0.298; while perinatal mortality rate was 6.4 and 7.1%, respectively, p = 0.850. Conclusion Despite the high prevalence of medical disorders in pregnancy, which puts pregnancy at high risk, the maternal and perinatal outcome is comparable to that of women without any medical disorder complicating pregnancy if managed in a tertiary hospital with adequate facility for emergency obstetric care and good neonatal facility.
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Patterns of significant and unexpected, and critical findings in surgical pathology practice in a university hospital in Nigeria: a 5-year retrospective survey p. 99
Almustapha A Liman, Balarabe Kabir, Murtala Abubakar, Shehu Abdullahi, Sani M Shehu
DOI:10.4103/ssajm.ssajm_2_19  
Critical values or significant and unexpected findings were introduced in anatomic pathology only recently; after showing immense success in clinical pathology practice; and it still is a subject of variation according to the differences in geographical or work setting and among pathologists and clinical specialists. It has been demonstrated that customizing the list at a given institution to address all potential diagnoses and results necessary and when framed into a policy can serve as important measures for optimizing patients’ safety. This study was conducted to demonstrate the prevalence and distribution patterns of these findings and to raise the awareness of the local pathologists and other clinicians to the evolving concept and practice of significant and unexpected values in surgical pathology. We studied the prevalence of significant and unexpected findings in surgical pathology through a retrospective review of 14,696 surgical pathology reports seen in a large tertiary hospital over a five-year period. Based on literature and our experience, we selected 10 categories of possible surgical pathology results that can justify an urgent communication with the clinician for immediate action and extracted them from the pool; they were analyzed and presented in descriptive tabular format. The study established a prevalence of 3.15% and outlined the distribution and frequency ratios of the 10 specific categories of results. The prevalence as established here was comparatively high, hence, the need for institutionalizing critical diagnoses guidelines in our surgical pathology practice as a patient safety initiative.
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OBITUARY Top

Obituary: Dr. Adeola Davis p. 104
Abdullah A Abba
DOI:10.4103/ssajm.ssajm_21_19  
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Obituary: Dr. Fatai Kunle Salawu p. 105
Abdullah A Abba
DOI:10.4103/ssajm.ssajm_20_19  
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