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   Table of Contents - Current issue
October-December 2021
Volume 24 | Issue 4
Page Nos. 145-187

Online since Friday, February 11, 2022

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Relations of plasma homocysteine to left ventricular geometry and functions p. 145
Obiageli Uzoamaka Agbogu-Ike, Bilkisu Bello Maiha, Lilian Okwubenata Okonkwo, Mohammed Aliyu, Albert Imhoagene Oyati
Background: Hyperhomocysteinemia is a risk factor for heart failure commonly in females. The study aimed at determining Hcy's association with left ventricular (LV) remodeling. Materials and Methods: A cross-sectional study evaluating the relationship of plasma Hcy to echocardiographic LV structure and function in 65 apparently healthy Nigerians (Mean age 41.87 ± 12.90 years, 52.2% females) without cardiovascular disease. Results: The mean Hcy level was 10.76 ± 2.69 μmol/L with no significant (P = 0.89) sex difference and 50.8% of the subjects had Hcy levels within the fourth quartile (hcy: 10.3–17.5 μmol/L). Plasma Hcy showed no significant (P > 0.05) relationship to LV mass (LVM), wall thickness (WT), relative WT, systolic/tissue-Doppler-derived diastolic function, and left atrial dimension in both sexes. Hyperhomocysteinemia (hcy >10.3 μmol/L) was significantly (P < 0.007) correlated to LVM indexed to height2.7 in all subjects but showed no such association in the unadjusted and adjusted binary logistic regression models. The odd of hyperhomocysteinemic patients having thicker LVM trended more toward females (odds ratio: 1.44, 95% confidence interval, 0.59–3.50) than males. Conclusion: Plasma hyperhomocysteinemia found in healthy Nigerian-Africans shows no relationship to LV remodeling, echocardiographic LV structural and functional parameters.
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Evaluation of peripheral arterial disease in type 2 diabetic patients using computed tomography angiography p. 154
Mohamed Salih, Moawia Gameraddin, Mohamed Yousef, Bushra Abdel Malik, Qurain Turki Alshammari, Dalia Bilal
Background: Peripheral artery disease (PAD) in patients with Type 2 diabetes mellitus (T2DM) has broad characteristics and various complications. Aim: The purpose of this study is to evaluate PAD in T2DM and their association with age, gender, and the duration of T2DM. Materials and Methods: This study is a prospective cross-sectional one conducted at the radiology department in Royal Care International Hospital, Khartoum, Sudan, over 3 years. A total of one hundred and ten patients, 69 males and 41 females, were examined using MDCT. A binary logistic regression test was applied to identify independent predictors of PAD. Results: PAD in T2DM is found to be 50.91% atherosclerosis, 43.64% plaques, 29.09% stenosis, and 14.55% thrombosis (mean age 65.84 ± 9.57 years; mean duration of T2DM 29.37 ± 6.7 years). The prevalence of PAD was common in patients over 60-year-old. Atherosclerosis is significantly higher in males than females (59.4% vs. 36.6%, 95% confidence interval = 1.092–5.600, P = 0.03%). Plaques and stenosis of lower-extremity arteries were higher in males than females 44.9% vs. 41.5% and 29.0% vs. 29.3%) respectively. The incidence of thrombosis was higher in femoral arteries than lower distal arteries, and the prevalence was higher in females than males (22% vs. 10.1%, odds ratio = 2.228), respectively. Conclusion: Atherosclerosis, plaques, stenosis, and thrombosis were the most common PAD findings in patients affected with T2DM. Age, gender, and duration of diabetes, relatively risk factors associated with PAD. Thrombosis is more prevalent in the femoral artery than lower distal arteries.
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Have our strictures changed: A study of the current characteristics and management of urethral stricture disease in Zaria, Nigeria p. 160
Nasir Oyelowo, Muhammed Ahmed, Ahmad Bello, Ahmad Tijani Lawal, Bola Biliaminu Lawal, J Olagunju, Abdullahi Sudi, Mudi Awaisu, Musliu Adetola Tolani, Hussaini Yusuf Maitama
Introduction: Urethral stricture is a common cause of lower urinary tract symptoms in middle-aged and elderly men. Its presentation and management are closely linked with its etiology and this varies across geographical regions of the world as well as overtime. We hereby review the etiology, characteristics, and presentation of men with urethral strictures in a tertiary hospital in northern Nigeria over a year and compare it with previous studies in the region. Patients and Methods: The study was a prospective study from January-December 2016, all patients with urethral strictures and who consented to the study were enrolled in the study. Data was collected using a structured study proforma and analyzed using SPSS version 23. Results: The mean age was 44.1 years with a range of 13-71 years. The age interval 30 – 39 years accounted for most of the patients 24 (28.6%). 43% of the patients had short segment urethral strictures (<2cm) while 57% had long segment strictures (>2cm). The bulbar urethra was the site of most strictures with a frequency of 65%. Strictures were found in the penile and peno-bulbar urethra in 25% and 21% respectively. Only 10% of patients studied had multiple strictures. The etiology was an infection in the majority of the patients with a frequency of 53.3%. Post-traumatic strictures occurred in 33.3% while iatrogenic and catheter –Induced strictures were seen in 7.1% and 6% respectively. 8.3% had recurrent strictures, 1.2 % had previous dilations and 2.4 % had previous DVIU. 88% had no previous intervention for the stricture before the presentation. The complications from urethral strictures observed in the patients were acute urinary retention in 83.4% urethrocutaneous fistulae in 2.4% and urosepsis in 1.2% of the patients. 11% presented with no complication. 68% of these patients were managed by excision and end to end anastomosis, 15 % had a penile pedicled flap 12%, a buccal mucosa graft urethroplasty and 5% with staged urethroplasty. Conclusion: Though there is a gradual rise in post-traumatic and iatrogenic strictures in our environment, Post-inflammatory strictures still predominate. It is however infrequently accompanied by fistulae as seen decades ago. These strictures are mostly long segments single bulbar strictures.
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Incidental sinus findings in brain MRI for suspected intracranial disease p. 165
Joyce Ekeme Ikubor, Nekwu E Okolugbo, Oghenetejiri D Ogholoh, Nicholas Kogha, Amenaghawon P Bemigho-Odonmeta
Introduction: The incidental finding of a paranasal sinus (PNS) abnormality on imaging may lead to early detection of sinus pathologies. Brain magnetic resonance imaging (MRI) is a valuable tool for evaluation of the PNSs. Objectives: The objectives were to determine the prevalence, site, and type of abnormalities in the PNSs of a Nigerian population who had brain MRI for suspected intracranial disease and unrelated sinus disease. Materials and Methods: A cross-sectional design was adopted for this study. Radiology request forms, images, and reports of consecutive patients referred for brain MRI for suspected intracranial disease from January 2018 to December 2019 were studied. Abnormalities detected were complete mucosal opacification, mucosal thickening, collection with air–fluid level, and retention cyst/polyp. Statistical Analysis Used: Data were analyzed using Statistical Package for the Social Sciences for Windows version 22.0 (SPSS Inc. Chicago, IL, USA). Results: Four hundred and seventy-nine patients were referred for brain MRI between January 2018 and December 2019. The prevalence of sinus abnormality detected incidentally was 26.7%. The maxillary sinus was the most frequently involved sinus. Fluid collection with air–fluid level was the most common abnormality. There was no significant relationship between the sinus abnormalities with age and sex. Conclusions: The prevalence rate of abnormal sinus findings on brain MRI is 26.7% in this study, buttressing that morphological changes in the PNSs are frequently encountered incidentally on imaging; hence, there is a need to obtain a relevant history of sinus pathology from patients undergoing brain imaging to aid prompt diagnosis of subclinical sinus disease and achieve optimal therapeutic outcomes.
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The use of excel spread sheet and printer in marking medical science objective questions: An alternative to manual marking method p. 172
Raymond Ugochukwu Okolo, Olorunshola Victor Kolawole
Background: Multiple-choice question (MCQ) is an effective form of written assessments for knowledge acquisition. Optical mark reading scanner is used for grading MCQs. Major setback in the use of scanner is the cost of acquiring it. Consequently, several manual methods such as conference making and stencil overlay are used to mark MCQ. This paper highlights the use of Microsoft Excel Spreadsheet and printer to mark MCQ and compares the method with other manual methods of marking. Materials and Methods: Five sets of 100 stems of objective questions (true or false, one in five, and matching types) were administered to students. Answer script was designed using Excel Spreadsheet. Three groups of marking were done: directly on the question paper, use of stencil for marking on the answer script, use of Microsoft Excel soft copy. At the end of the marking process, mean marking time, mean collation time, mean counting time, and mean marking error were collated and compared. The instant computer statistical software was used to calculate means, standard deviations, and ANOVA.A P < 0.05 was regarded as statistically significant. Results: Results showed a statistically significant low mean marking time of 0.68 h (P < 0.0001) for the spreadsheet/printer marking method. Marking error was significantly low with this method (P < 0.001) as compared with other manual marking methods. The collation time and counting time were not significantly different across the groups. Conclusion: It is concluded that Excel Spreadsheet and printer marking method significantly reduced marking time and marking errors in marking MCQs.
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Hospitalization and discharge against medical advice underpinned by elder mistreatment p. 178
Obehi Aituaje Akoria, Imuetinyan R Edeki, Ejemen A Dawodu
This clinical vignette is that of an 82-year-old woman who was admitted into a geriatrics unit in Nigeria, with acute heart failure and multiple decubitus ulcers. She was subsequently discharged against medical advice after 27 days on account of financial constraints and her children's inability to achieve a unified front for her care provision. The clinical scenario illustrates that medical presentation of disease may be a manifestation of elder mistreatment. It also highlights how discharge against medical advice may be the culmination of mistreatment of hospitalized older adults. We review the literature on types and important features of elder mistreatment and how it may be diagnosed in clinical settings. We also discuss challenges that clinicians in Nigeria may face in diagnosing and managing elder mistreatment as a result of a dearth of training in geriatrics and the absence of a national framework to tackle elder mistreatment.
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The rodent ulcer: Report of two cases p. 185
Husain Yahya
A rodent ulcer refers to the slowly growing, ulcerated, locally invasive basal-cell carcinoma (BCC) which is the most common cutaneous malignancy in Caucasians but is rare in people with dark skin. We report two morphologically different presentations of nodular BCC in Nigerian patients. The first was a large, slowly growing ulcer on the right side of the face which had been present for many years, with the diagnosis not being made despite visits to various health centers, whereas the second was a much smaller ulcerated nodule on the right alar nasi and dorsum of the nose. We highlight the need for vigilance to make the correct diagnosis early and institute appropriate treatment.
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