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   2017| October-December  | Volume 24 | Issue 4  
    Online since January 18, 2018

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Abstracts of papers presented at the 12th annual scientific conference of the national postgraduate medical college of Nigeria, Kano 2017

October-December 2017, 24(4):257-275
  4,556 200 -
Colour doppler sonography of the penis in the evaluation of erectile dysfunction: Our experience in Abuja, Nigeria
Joshua Oluwafemi Aiyekomogbon, Joseph Bako Igashi, Reuben Omokafe Lawan, Muftau Jimoh Bioku, Musa Ameadaji
October-December 2017, 24(4):210-216
DOI:10.4103/npmj.npmj_144_17  PMID:29355159
Background: Erectile dysfunction (ED) is an inability to achieve and maintain erectile rigidity sufficient for satisfactory sexual performance. It is either organic or psychogenic in origin. This study was aimed at establishing vasculogenic causes among patients being evaluated for ED using triplex Doppler Ultrasound. Patients and Methods: This study was conducted at the Department of Radiology, Federal Medical Centre, Abuja, Nigeria from July 2015 to January 2017. Thirty-five consecutive patients with the clinical diagnosis of ED were evaluated with colour Doppler ultrasound scan using a high-frequency linear transducer. The penile scan was done before and after intracavernosal injection of 10–20 μg prostaglandin E1. The waveforms of cavernosal arteries (CAs) were obtained alternately using angle of inclination ≤60°. The spectral waveforms and peak systolic velocities (PSV) of the CA were documented at 5-min intervals, from 5 to 50 min. Results: PSV of CA varied between 19.5 and 104.4 cm/s (mean: 42.4 ± 17.6) among the entire patients and between 19.5 and 24.7 cm/s (mean: 21.9 ± 1.7) among patients with arteriogenic ED. Arteriogenic ED was found in six patients (17%), while venogenic ED was observed in ten patients, which constituted 29% of the entire participants. None had combined arteriogenic and venogenic ED. Peyronie's disease was observed in seven patients, and none of these had vasculogenic ED. Conclusion: About 46% of the patients had vasculogenic ED. It is therefore imperative that patients with ED benefit from this safe, cheap and non-ionising diagnostic modality before initiating therapy as ED treatment is cause specific.
  3,985 313 1
Relationship between foetal haemoglobin and haematological indices in children with sickle cell anaemia from South Western Nigeria
Morenike Agnes Akinlosotu, Samuel Ademola Adegoke, Saheed Babajide Oseni, Oluwagbemiga Oyewole Adeodu
October-December 2017, 24(4):195-200
DOI:10.4103/npmj.npmj_107_17  PMID:29355156
Background: Foetal haemoglobin (HbF, α2γ2) retards polymerisation of haemoglobin (Hb) in sickle cell anaemia (SCA). In Nigeria, studies on the levels of HbF and its relationship with haematological indices are scanty. This study evaluated HbF concentrations of children with SCA from Southwestern Nigeria and correlated the levels with various haematological indices. Materials and Methods: HbF levels were quantified by high-performance liquid chromatography and haematological parameters determined with automated haemoanalyser. The relationship between steady-state HbF levels and blood parameters were assessed by statistical analyses. Results: The mean HbF of the 91 children with SCA (9.6% ± 5.9%) was significantly higher than 0.5 ± 0.7% for the 91 age- and sex-matched controls, P < 0.001. About two-third of children with SCA, sixty (65.9%) had low HbF levels (HbF of < 10%) whereas about one-third, 31 (34.1%) had high HbF level (HbF of ≥ 10%). The mean Hb concentration, haematocrit (Hct) and total red blood cell count were significantly lower amongst children with SCA, whereas the total white blood cell (WBC) counts, neutrophils, monocyte and lymphocyte percent, platelet counts, mean corpuscular Hb (MCH) and MCH concentration were significantly higher. HbF had a positive but weak correlation with Hct (r = 0.24, P = 0.014), Hb concentration (r = 0.21, P = 0.047) and red cell distribution width (r = 0.25, P = 0.015) and an inverse correlation with WBC count (r = -0.23, P = 0.038). Conclusion: Children with SCA had higher levels of HbF than matched controls. HbF had an inverse correlation with the WBC count and direct relationship with Hct and Hb concentration. It is recommended that routine determination of HbF and its induction are essential to maintain optimal haematological state of patients with SCD.
  3,030 1,144 -
Pre- and Post-ductal oxygen saturation among apparently healthy low birth weight neonates
Leo A Odudu, Beatrice N Ezenwa, Christopher I Esezobor, Ekanem N Ekure, Mathias T. C Egri Okwaji, Chinyere V Ezeaka, Fidelis O Njokanma, Jejelola Ladele
October-December 2017, 24(4):224-229
DOI:10.4103/npmj.npmj_164_17  PMID:29355161
Introduction: Reference values of oxygen saturation (SpO2) to guide care of low birth weight neonates have been obtained mainly from Caucasians. Data from African newborns are lacking. To determine the pre- and post-ductal SpO2values of low birth weight neonates within the first 72 h of life, compare SpO2values of moderate–late preterm and term low birth weight neonates and determine how mode of delivery affected SpO2in the first 24 h of life. Methodology: An observational descriptive study was carried out on apparently healthy low birth weight newborns weighing 1500 to ≤2499 g. Pre and post ductal SpO2values were recorded at the following hours of life: 10–24 h, >24–48 h and >48–72 h using a NONIN® pulse oximeter. Results: The ranges of pre- and post-ductal SpO2in the study were similar for both preterm and term neonates in the study (89%–100%). The mean (standard deviation [SD]) pre-ductal SpO2was 95.9% (2.3) and the mean (SD) post-ductal SpO2was 95.9% (2.1). There was a significant increase in pre-ductal SpO2from 10 to 24 h through >48–72 h of life (P = 0.027). The mode of delivery did not affect SpO2values within 10–24 h of life. Conclusion: The present study documented daily single pre- and post-ductal SpO2 values for preterm and term low birth weight neonates weighing 1500 g to <2500 g during the first 72 h of life. The overall range and mean pre- and post-ductal SpO2 were similar for both categories of stable low birth weight neonates in the study. There was no significant difference between SpO2ranges for late preterm compared to term low birth weight neonates. The results obtained could serve as guide in assessing SpO2of low birth weight neonates weighing between 1500 and 2499 g in the first 72 h of life.
  3,497 220 -
Predictive factors of management outcome in adult patients with mechanical intestinal obstruction
Adebambo Olalekan Bankole, Adedapo Olumide Osinowo, Adedoyin Adekunle Adesanya
October-December 2017, 24(4):217-223
DOI:10.4103/npmj.npmj_143_17  PMID:29355160
Background: Mechanical intestinal obstruction (MIO) is a common and potentially fatal surgical emergency, which constitutes about 20% of all admissions to the surgical emergency departments. Objective: To determine the predictive factors of morbidity and mortality in patients undergoing treatment for MIO at our tertiary hospital. Patients and Methods: This was a prospective study of consecutive patients, 18 years and above, that presented with features of MIO during a 1-year period (May 2014 to April 2015). Each patient had resuscitation, comprehensive clinical evaluation, appropriate investigations and definitive treatment. The data were analysed using SPSS version 22. Results: One hundred and five patients were studied. The age range was 18–86 years with a mean (standard deviation) of 45.6 (14.8) years. There were 54 males with a male to female ratio of 1.1–1. The common causes of MIO were post-operative adhesion (48.6%), tumour (25.7%), external hernia (15.2%) and volvulus (5.7%). Eighty-four patients (80%) had operative intervention while 21 patients (20%) had conservative management. Univariate analysis showed that dehydration, tachycardia (>90 bpm), pyrexia, abnormal levels of potassium, urea and creatinine, leucocytosis, American Society of Anesthesiologists (ASA) status >IIIE, bowel resection, intraoperative blood loss >500 ml and duration of surgery >2 h were significant predictors of mortality (P < 0.05). Multivariate analysis showed that elevated serum urea at hospital presentation and ASA status greater than IIIE were the independent predictors of mortality, but none of the factors could independently predict morbidity. The most common post-operative complication and cause of death were wound infection (29.6%) and sepsis (66.7%). The mortality rate was 14.3%. Conclusion: The most common cause of MIO was post-operative adhesion. Elevated serum urea and ASA status greater than IIIE were the independent predictors of mortality.
  2,929 367 2
Urinary schistosomiasis in school children of a southern nigerian community 8 years after the provision of potable water
Emmanuel Eyo Ekanem, Francis Michael Akapan, Michael Eteng Eyong
October-December 2017, 24(4):201-204
DOI:10.4103/npmj.npmj_136_17  PMID:29355157
Background: Urinary schistosomiasis, one of the neglected tropical diseases, is a major infection of public health importance in Nigeria. Control measures include the provision of potable water as the main strategy, population-based chemotherapy and health education. Aims and Objectives: The aim of this study was to determine the effect of the provision of potable water on the prevalence and intensity of infection with Schistosoma haematobium in Adim community, Cross River State, Nigeria. Subjects and Methods: A cross-sectional survey was carried out among school and children aged 5–14 years in Adim community in Cross River State using the polyamide millipore filter technique and ova detection and count compared with the situation that obtained 8 years earlier before the provision of potable water. The prevalence and intensity of haematuria and proteinuria by reagent strips were also compared between the two eras. Results: The prevalence of schistosomiasis was 14.5% compared to 51% in the prepotable water era (P = 0.001). The intensity of the infection was also significantly reduced between the two eras with 1.3% of the children having a severe intensity compared to 4.5% in the prepotable water era. Conclusions/Recommendations: The prevalence and intensity of S. haematobium have significantly reduced in this community though not yet eliminated. More boreholes need to be provided to make the water more accessible. This could be combined with other measures to eradicate S. haematobium from this community.
  2,869 337 -
Comparison of efficacy of cell block versus conventional smear study in exudative fluids
Sandeep S Matreja, Kamal Malukani, Shirish S Nandedkar, Amit V Varma, Anjali Saxena, Arpita Ajmera
October-December 2017, 24(4):245-249
DOI:10.4103/npmj.npmj_150_17  PMID:29355165
Introduction: Cytological examination of serous effusions helps in staging, prognostication and management of patients with malignancy. The method has disadvantage of lower sensitivity in differentiating reactive atypical mesothelial cells from malignant cells. Aim: The aim of this study is to compare the cytological features of pleural and peritoneal exudative fluids by conventional smear (CS) method and cell block (CB) method and also to assess the utility of a combined approach for cytodiagnosis of these effusions. Materials and Methods: One hundred and fifty-three pleural and peritoneal exudative fluid samples were subjected to evaluation by both CS and CB methods over a period of 2 years. Cellularity, architecture patterns, morphological features and yield for malignancy were compared, using the two methods. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for diagnosing malignancy were calculated by both methods, using histology as a gold standard. Results: CB method provided higher cellularity, better architectural patterns and additional yield for malignancy as compared to CS method (P < 0.005). Sensitivity, specificity, PPV, NPV, and accuracy by CS method were 69.2%, 95%, 56.25%, 97.08% and 92.8%, while by CB method were 92.30%, 99.2%, 92.30%, 99.28% and 98.6%. Conclusion: The present study shows that it is advisable to routinely make CBs before discarding specimens that are suspicious for malignancy by smear examination.
  2,298 316 3
Giant cell tumour of the clavicle: A rare presentation of a locally aggressive tumour
Adewole Tayo Akinsulire, Olakunle Olaleke Badmus, Suleiman Olayiwola Giwa
October-December 2017, 24(4):250-253
DOI:10.4103/npmj.npmj_133_17  PMID:29355166
We report a case of a 28-year-old female who presents with painless, progressively increasing left upper chest swelling of 6 months duration. Examination revealed a 20 by 10 cm firm mass arising from the clavicle. She was investigated and a diagnosis established based on the histological report. The tumour was excised with a wide margin and reconstruction done with an autogenous fibula graft. Full functional ability was restored in limb with the radiological union. After 5 years of regular follow-up, there was no evidence of recurrence and shoulder function remained excellent. The successful management of this patient shows wide local excision and reconstruction as an excellent surgical option in treating giant cell tumour of the clavicle.
  2,417 149 1
Effects of low-dose intravenous dexamethasone combined with caudal analgesia on post-herniotomy pain
Omotayo Felicia Salami, Simbo Daisy Amanor-Boadu, Olayinka Ranti Eyelade, Simeon Olugbade Olateju
October-December 2017, 24(4):230-235
DOI:10.4103/npmj.npmj_120_17  PMID:29355162
Background: Caudal analgesia for postoperative pain relief in paediatric day-case surgery has been found to be of short duration, hence the need for addition of adjuncts to prolong the analgesia. Objective: The objective of the study was to compare the analgesic effects of caudal block with or without low-dose intravenous dexamethasone in children undergoing day-case herniotomy. Patients and Methods: This was a prospective randomised controlled study conducted in male patients, aged between 1 and 7 years scheduled for herniotomy. A total of 94 patients were randomised into two groups. Group A received intravenous 0.25 mg/kg dexamethasone in 5 ml solution, whereas Group B received equivalent volume of intravenous normal saline. All the patients had a caudal block. Post-operative pain was assessed and recorded in post-anaesthesia care unit (PACU) using objective pain scale. Time to first analgesia request (TFA), pain scores and complications were documented. Data were analysed using Statistical Package for the Social Sciences version 21.0. Results: A total of 94 patients were analysed with a mean age of 3.30 ± 1.67 and 3.06 ± 1.50 years for Groups A and B, respectively. The TFA request was 654.18 ± 31.56 and 261.50 ± 10.82 min in Groups A and B, respectively, P = 0.0001. Postoperatively, in the PACU, there was statistically significant difference in pain score between the two groups at 0, 30, 60, 120, 180 and 240 min (P = 0.0001) all through. Conclusion: The use of low-dose intravenous dexamethasone (0.25 mg/kg) in combination with caudal block prolonged duration of analgesia, reduced pain scores and analgesic consumption postoperatively, in children undergoing day-case herniotomy.
  1,940 204 -
Histological types of soft-tissue sarcomas at the lagos university teaching hospital
Nzechukwu Zimudo Ikeri, Andrea Oludolapo Akinjo, Olugbende O Ajayi, Adekunbiola Aina Fehintola Banjo
October-December 2017, 24(4):205-209
DOI:10.4103/npmj.npmj_146_17  PMID:29355158
Objective: There is scanty data on histologically diagnosed soft-tissue sarcomas in the Nigerian literature. This is due to paucity of facilities for ancillary testing as well as a dearth of specialist soft tissue pathologists. Knowledge however of the common soft-tissue sarcomas is vital for the establishment of an effective sarcoma service. The aim of this study, therefore, was to determine the histological spectrum of soft-tissue sarcomas in Lagos, Nigeria. Materials and Methods: Archival haematoxylin and eosin (H and E)-stained slides were retrieved and reviewed by a team of soft-tissue pathologists at the Royal National Orthopaedic Hospital, London, UK. Immunohistochemistry and fluorescent in situ hybridisation studies were performed on cases without definitive diagnosis on routine H and E. Results: Fifty-two cases were studied. The male-to-female ratio was 1:1.3, with a median age of 33 years. Most sarcomas (57.5%) were of intermediate malignant potential according to 2013 World Health Organization classification. Kaposi sarcoma (37.5%), undifferentiated sarcomas (22.5%), dermatofibrosarcoma protuberans (15%) and myxofibrosarcomas (7.5%) were the most common sarcomas seen in adults. There was no case of liposarcoma. Sarcomas in the younger age group (<20 years) accounted for 23.1% of cases with embryonal rhabdomyosarcoma accounting for the majority. Conclusion: Soft-tissue sarcomas in adults in Lagos Nigeria show a different morphologic spectrum than those reported in Western countries.
  1,836 212 -
The role of transrectal ultrasound-guided fine-needle aspiration biopsy in the diagnosis of prostate cancer: Sextant versus extended protocol
Abisola E Oliyide, Kehinde H Tijani, Emmanuel A Jeje, Charles C Anunnobi, Adekunle A Adeyomoye, Rufus W Ojewola, Moses A Ogunjimi, Taiwo O Alabi
October-December 2017, 24(4):236-239
DOI:10.4103/npmj.npmj_131_17  PMID:29355163
Aim and Objectives: The aim of this study is to compare the prostate cancer detection rates of sextant and extended transrectal ultrasound (TRUS)-guided fine-needle aspiration biopsy (FNAB) protocols. Materials and Methods: This was a prospective study of 96 patients investigated for prostate cancer. An extended 10-aspiration TRUS-guided FNAB using a 22G Echotip Chiba needle was performed. Inclusion criteria included the presence of one or more of the following: Abnormal digital rectal examination (DRE) findings, persistently elevated prostate specific antigen, and abnormal prostatic imaging. A set of traditional sextant aspirations were carried out as well as four laterally guided aspirations taken from the middle base of the peripheral zone on either side. The cancer detection rates of sextant and extended (combination of sextant and lateral) FNAB protocols were determined and compared. The value of P < 0.05 was considered statistically significant. Results: The overall cancer detection rate was 24%. Benign cases were reported in 71.8% of patients and 4.2% reported as suspicious. Of the 23 patients' aspirations positive for malignancy, 16 (69.6%) were detectable by the sextant protocol while the lateral protocol detected 21 (91.3%). Two cancers were detected by the sextant protocol only (where the lateral technique was negative for malignancy), 7 cancers were detected by the lateral protocol only while 14 cancers were positive in both the sextant and lateral protocols. The extended protocol showed a statistically significant 30.4% increase in cancer detection over the traditional sextant (P = 0.007). Conclusion: The extended protocol rather than the sextant protocol should be offered to patients who require FNAB of the prostate as the optimum FNAB protocol.
  1,849 183 -
Serum level of prostate-specific antigen in diabetic patients in Basrah, Iraq
Jasim N Al-Asadi, Lamia M Al-Naama, Muhannad M Abdul-Kareem, Fawzi C Mashkoor
October-December 2017, 24(4):240-244
DOI:10.4103/npmj.npmj_174_17  PMID:29355164
Objectives: The aim of this study was to determine the effect of type 2 diabetes mellitus (DM) on the serum level of prostate-specific antigen (PSA) in men in Basrah, Iraq. Patients and Methods: A case–control study was done including 70 confirmed type 2 diabetic patients and 70 non-diabetic persons. Data about age and family history of diabetes were collected. For diabetic patients, data related to disease history were also enquired about. Weight and height were measured and body mass index (BMI) was calculated. Blood examination was done to estimate fasting plasma glucose and PSA. Results: The mean ages of diabetic and non-diabetic patients were 55.2 ± 10.5 and 55.9 ± 10.9 years, respectively. The mean total serum PSA was significantly lower among diabetic than non-diabetic men (1.97 ± 1.05 ng/ml vs. 2.60 ± 1.22 ng/ml, respectively, P = 0.001). The multivariate linear regression analysis showed that age, DM and BMI were independent predictors of serum PSA variation. Age was significantly related to PSA in non-diabetics, but not in diabetic patients. Conclusion: Serum PSA level is significantly lower and less age dependent in type 2 diabetic patients than in non-diabetics. Therefore, DM should be considered in setting of PSA threshold when screening for prostate cancer.
  1,794 207 -
Preoperative bowel preparation complicated by lethal hypermagnesaemia and acute nephropathy
Olumuyiwa A Bamgbade
October-December 2017, 24(4):254-256
DOI:10.4103/npmj.npmj_145_17  PMID:29355167
Hypermagnesaemia is an uncommon but serious disorder. An elderly woman presented with severe cardiovascular collapse, neurologic depression and acute nephropathy, following bowel preparation. Urgent laboratory tests revealed serum magnesium level of 7.5 mmol/L (normal = 0.75–1.05 mmol/L). Prompt resuscitation and treatment of the hypermagnesaemia included intravenous calcium chloride as a physiological antagonist, fluid infusion and frusemide to aid renal excretion of magnesium. There are few case reports of patients who survived hypermagnesaemia levels >7 mmol/L. This is a case report of near-fatal hypermagnesaemia which resolved following early diagnosis and treatment. Hypermagnesaemia may be difficult to diagnose because serum magnesium is not checked routinely and many clinicians are unfamiliar with this uncommon condition. It is a diagnosis of exclusion and may not be recognised as a cause of neurologic or cardiorespiratory depression. Hypermagnesaemia should be considered as a possible diagnosis in elderly or high-risk patients presenting with such symptomatology.
  1,567 123 1