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   Table of Contents - Current issue
January-June 2020
Volume 17 | Issue 1
Page Nos. 1-75

Online since Saturday, May 30, 2020

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Indication and outcome of endoscopic sinus surgery among patients with chronic rhinosinusitis with or without nasal polyps in the national ear care centre, Kaduna p. 1
Abdulrahman O Afolabi, Garba Mainasara Mohammed, Mustapha Yaro Abubakar, Hassan Dadi, Tsamiya B Gazali, Rashida Sanni, Mohammed Sani, Saheed Nasir
Context: Endoscopic sinus surgery is a minimally invasive and currently the treatment of choice for acute/intermittent and chronic/persistent rhinosinusitis (RS) unresponsive to conservative medical treatment. Aims: To evaluate the indications and outcomes of treatment of RS with or without nasal polyps. Methods and Material: This was a retrospective review of all cases of endoscopic sinus surgery done at the National Ear Care Centre. The information extracted from the case notes of patients included the demographic profile, clinical radiologic and endoscopic findings, the surgery offered and outcome of surgery. Statistical analysis used: All information was entered into SPSS version 20.0. Results: Out of 116 patients had endoscopic sinus surgery, only 107 (92%) had complete information for the analysis. Their age ranged from 9 to 72 years with a mean age of 35.9 ± 1.9 years. Up to 105 of the patients presented nasal discharge alternating with nasal obstruction while 65% (70) of them had bilateral disease. Computed tomography scan revealed abnormalities in 66.4% (71) patients. The preoperative diagnosis of chronic RS (CRS) with simple nasal polyp was made in 66 patients, had functional endoscopic sinus surgery with polypectomy in 64.5% (69) patients and intraoperative findings revealed a mixture of mucosal diseases with sinonasal polyps in 73.8% and fungal sinus diseases in 18 (16.8). Majority of the patients (53.3%) were discharged home on the 2nd postoperative day. About 71% of the patients had resolution of their disease after months of followup. Conclusion: Endoscopic sinus surgery is higher among young adult in third and fourth decades of life. There is female preponderance and preoperative radiology assessment and the intraoperative findings revealed strong relationship. The outcome of treatment revealed recurrent disease in 10.5% with nasal adhesion, epistaxis and excessive nasal crust formation.
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Morphological spectrum of excised conjunctival lesions in a tertiary hospital in North-Western Nigeria p. 7
Sadiq Hassan, Saudat Garba Habib, Imam Ibrahim Muhammad, Philip Ifeanyichukwu Ebisike, Abdu Lawan
Context: Conjunctiva is a transparent membrane lining the inner surface of the eyelids and the globe up to the corneoscleral limbus. It is a common site for the growth of lesions in the eye. Depending on their origin, conjunctival lesions could be non-neoplastic and neoplastic. The neoplastic lesions are either benign or malignant. These lesions can be distinguished based on the patient's history, clinical presentation and histopathological features. Aims: In this study, the pattern of excised conjunctival lesions was determined. Methods and Material: This was a 6-year (2010–2015) retrospective study of all excised conjunctival lesions diagnosed at the Pathology Laboratory of Aminu Kano Teaching Hospital. Statistical analysis used: Data were analysed with Statistical Package for Social Sciences (version 20.0; SPSS, Chicago, IL, USA). Results: A total of 198 conjunctival lesions were diagnosed during the period. The male patients were 136 (68.70%), whereas the females were 62 (31.30%) with male-to-female ratio of 2.2:1, with a mean age ± standard deviation of 37.69 ± 16.39 years. The neoplastic nature of the lesions was as follows: 54 (27.3%) were malignant, 61 (30.8%) were pre-malignant and 83 (41.9%) were benign. The most common lesions observed were conjunctival squamous cell carcinoma, dysplasia and squamous papilloma with frequencies of 50 (25.30%), 46 (23.20%) and 24 (12.10%), respectively. Conclusions: Benign lesions are the most common conjunctival lesions, whereas squamous papilloma and squamous cell carcinoma are the most common benign and malignant lesions, respectively.
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Radio-pathological findings of male breast lesions in the sub-Saharan African population p. 11
Halimat Jumai Akande, Bola Bamidele Olafimihan, Olayide Sulaiman Agodirin, Rasheed Wemimo Mumini, Abdulrafiu Ayinde Abdulmajeed
Context: Globally, information about male breast lesions is scarce. Focus is often on clinical presentation with less emphasis on radiological characteristics. Aim: To document and highlight the imaging and pathology findings of male breast diseases in a Sub-Saharan Africa. Materials and Methods: Male patients who had breast ultrasound and/or mammography in a tertiary hospital over a 10year period were reviewed retrospectively. Biodata of the patients, symptoms, and imaging findings with pathology reports were documented and analyzed. Breast ImagingReporting and Data Systems lexicon was used. Results: Fiftyfive male patients were seen and constituted about 1.82% of the total number of breast cases. Their age range was 12–85 years, with a mean of 35.89 ± 18.45 years. Four of these patients had mammograms only, 49 had breast ultrasound scan alone, whereas 2 had a combination of both modalities. The most common clinical indication and radiological findings were breast swelling (60%) and gynecomastia (72.7%), respectively. Gynecomastia was the most common finding pathologically (67.6%), whereas malignancy constituted 14.7%. The lesions were observed more in the right breast (40.7%). Conclusions: Imaging plays a significant role in the evaluation of male breast diseases. Ultrasound has high accuracy in the detection of benign lesions. This study found gynecomastia as the most common benign male breast disease. Breast cancer, although rare cancer among males was observed in a 35yearold young male.
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Does the presence of micronuclei in cervicovaginal smears help diagnose cancer early? p. 17
Özgen Arslan Solmaz, Gülcan Kahraman
Context: The presence of micronuclei is an indicator of chromosomal instability, which may be associated with cancer. Cervical smears, which are commonly used in cervical carcinoma screening, are non-invasive samples of exfoliated epithelial cells, such as buccal mucosa cells. Aims: We aimed to demonstrate the association between micronucleus frequency and cancer if any was present. Settings and Design: This retrospective study was performed in our laboratory. A total of 4500 conventional cervical smears screened in the past 3 years (January 2015–2018) were included in the study. Materials and Methods: Cervical smear samples of 4000 patients, all of cytologic samples, were analysed using light microscopy under oil immersion (×1000) for the determination of micronuclei. The health information of patients with micronuclei was viewed in the hospital information system, and we investigated whether they had malignant tumours. Statistical Analysis Used: The Chi-square test was performed. Results: One hundred and forty-seven patients had micronuclei, and 3853 had none. Malignant tumours were detected in 29 of the 147 patients, no tumour was detected in 118. A statistically significant correlation was found between the presence of micronuclei and the presence of malignant epithelial tumours in the body and in the presence of micronuclei in cervical smears (P < 0.05). Conclusions: We found that the incidence of malignant epithelial tumours was 108.58-fold higher in cases with micronucleus than those without micronucleus. We believe that we can detect both cervical pathologies and epithelial tumours in other organs using the same test and that this finding should be transferred to pathology reports.
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Evaluation of the computed tomography number for water, field uniformity, image noise and contrast resolutions in Kano Metropolis, Nigeria p. 21
Mohammed Sidi, Usman Yahaya Hussain, Anas Ya'u, Idris Garba
Context: Quality control (QC) tests for computed tomography (CT) scanners are primarily concerned with the maintenance of CT scanner at the optimum operational conditions for providing the required diagnostic information at the least possible exposure to ionising radiation. Aims: The study was aimed at evaluating a CT number for water, field uniformity, image noise and contrast resolutions in Kano metropolis using phantom and assuring optimum operational condition of the equipment. Materials and Methods: A prospective, crosssectional design was employed. Four scanners tagged CT scanner I–IV were included in the study. CT number for water, field uniformity, noise, as well as highcontrast resolution (HCR) and lowcontrast resolution were tested using head CT water phantom. Results: CT scanner I, III and IV have passed a CT number for water and field uniformity tests (0.3, −0.48 and − 1.36), but scanner II failed the test (−4.38). However, the entire scanners failed noise (4.5, 8.75, 4.90 and 4.93); while only scanner III passed the HCR QC test (bars were countable at the 3rd bar pattern), scanners I, II and IV failed HCR test (bars were countable at 5th, 6th and 4th bar patterns). All the studied scanners failed lowcontrast resolution test (margins appear sharp at the 4th hole) in scanners I, II and IV and the hole was not demonstrated in the phantom image of scanner III. Conclusion: Majority of the CT scanners in Kano metropolis passed the tests for the CT number for water and field uniformity but revealed some inadequate levels of noise, HCR and lowcontrast resolution tests.
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Sonographic evaluation of renal changes among drug-dependent and drug-naive adult patients with human immunodeficiency virus/acquired immunodeficiency syndrome in Kano, Nigeria p. 26
Mohammed Sidi, Anthony C Ugwu, Abdu Hamisu Dambatta, Mohammed Kabir Saleh, Umar Jibo, Muhammad Abdullahi Jega, Aminu Abubakar Aminu, Anas Ya'u, Umar Mansur
Context: Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) remains a major challenge globally. HIVassociated nephropathy is the third most common cause of endstage renal failure and more prevalent among AfricanAmericans with HIV compared with other races. Aims: This study evaluated sonographic renal changes in drugdependent and drugnaive patients with HIV/AIDS in Kano, Nigeria.Materials and Methods: A prospective and comparative study involving 190 each of drugdependent and drugnaïve patients were conducted. Renal sonography was performed using digital ultrasonic diagnostic imaging system, equipped with a 3.5 MHz curvilinear transducer. Statistical analysis used: An independent ttest and Mann–Whitney Utest were used to compare the renal volume and mean rank of the renal parenchymal echogenicity between drugdependent and drugnaïve patients. Statistical significance was considered at P < 0.05. Results: The mean values of the CD4 counts were 573.20 ± 222.441 cells/mm3 for drugdependent and 252.43 ± 215.22 cells/mm3 for drugnaïve patients. The drugdependent and drugnaïve patients had mean right renal volumes of 118.12 ± 27.75 cm3 and 128.48 ± 37.73 cm3, whereas the left renal volumes were 114.84 ± 24.14 cm3 and 123.35 ± 28.22 cm3, respectively. The drugdependent patients had 6.3% and 4.7% increased renal parenchymal echogenicity on the right and left, whereas the drugsnaïve patients had 45.3% and 43.7%, respectively. There was a statistically significant difference in the right and left renal volume between drugdependent and drugnaïve patients (P = 0.003 and P = 0.002). There was a significant statistical difference in the right and left renal parenchymal echogenicity between drugdependent and drugnaïve patients (P = 0.00). Conclusions: There was a significant statistical difference in the renal volume and parenchymal echogenicity between drugdependent and drugnaïve patients.
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Sonographic assessment of carotid arteries in adults with radiographic features of hypertensive cardiomegaly at Kano, North Western Nigeria p. 33
Mohammed Kabir Saleh, Mohammed Usman, Kabiru Isyaku, Mohammad Abba Suwaid, Anas Isma'il, Mansur Yahuza Adamu, Abdu Hamisu Dambatta, Idris Sule Kazaure
Context: Hypertension is a chronic medical condition in which there is elevation of arterial blood pressure (s). Hypertensive cardiomegaly is a complication and effect of long standing systemic hypertension on the heart. Aims: This study is to relate a component of hypertensive heart disease with sonographic changes found in the carotid arteries of these patients, as they are directly linked to atherosclerotic effect of hypertension. Materials and Methods: In this prospective crosssectional study, four hundred (400) subjects with primary hypertension were recruited. The study group (200) is having cardiomegaly on PA chest radiograph. The carotid arteries of all participants were insonated on both gray scale and Doppler modes. Demographic characteristics, CIMT, and Doppler velocimetric indices (PSV, EDV, and RI) were generated and subjected to statistical analysis. Results: The mean age for the study group was 48.91 ± 10.0, consisting of 110 (53.9%) males and 90 (45.9%) females. Cardiothoracic ratio was seen to increase with age (P < 0.0001) and not associated with gender (P = 0.110). The mean carotid intimamedia thickness (CIMT) in the right and left was 1.3 ± 0.13 mm and 1.50 ± 0.18 mm, with the highest CIMT of 1.70 ± 0.25 mm seen at higher systolic readings (P = 0.002). Mean PSV of right common carotid artery (CCA) was 66.20 ± 21.81 cm/s and left CCA was 59.54 ± 22.75 cm/s, EDV of right CCA was 17.85 ± 5.97 cm/s and left CCA was 16.56 ± 6.44 cm/s, RI of right CCA was 0.72 ± 0.07 cm/s and left CCA was 0.72 ± 0.06 cm/s. Positive correlation was seen between age and CIMT (P = 0.001). 7.5% had echogenic smooth plaques. Conclusions: Carotid artery abnormalities continue to relate with severity of hypertension among patients with chest radiographic findings.
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Knowledge of rotavirus gastroenteritis and its current preventive strategies in children, among healthcare providers in Ilorin, North-Central Nigeria p. 42
Mohammed B Abdulkadir, Sunday Adedeji Aderibigbe, Rasheedah M Ibraheem, Abayomi Fadeyi
Context: Rotavirus is a leading cause of severe gastroenteritis in children aged less than 5 years. Healthcare providers are responsible for implementing strategies for control of rotavirus gastroenteritis. Aims: To determine knowledge of healthcare providers regarding rotavirus gastroenteritis, its burden, management, and prevention. Materials and Methods: The study was a crosssectional descriptive survey of healthcare providers working in facilities caring for children. A selfadministered questionnaire was given to subjects containing questions on demographics and knowledge covering burden of rotavirus gastroenteritis, modes of transmission, age of occurrence, prevention, and rotavirus vaccines. Statistical analysis used: Data analysis was carried out with SPSS version 20. Results: Questionnaires were issued to 75 participants of which 65 (response rate = 86.7%) returned filled questionnaires. Majority (70.8%) of the subjects were females. Subjects included medical doctors (33.8%), nurses (32.3%), community health extension workers (27.7%), and laboratory scientists (4.6%). Most [39, 60.0%] subjects identified rotavirus as the commonest cause of diarrhea and only 21 (32.3%) indicated rotavirus contributed over 30% to the burden of diarrhea in these children. Fecooral route was recognized as a route of transmission by most subjects (95.4%) and 67.7% identified vaccination as a modality for prevention. Only six (9.2%) respondents could name any rotavirus vaccine. None of the demographic or occupational characteristics of the subjects was significantly related to awareness of effective rotavirus vaccines (all P > 0.05). Conclusions: Healthcare providers were aware of rotavirus as a cause of gastroenteritis in underfive children but most had poor understanding regarding its burden, prevention, and existing vaccines.
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Learning style preferences of medical students in Kano, Northwestern, Nigeria p. 46
Auwal Sani Salihu, Aliyu Ibrahim, Shakirat Desola Owolabi, Natalia Adamou, Umar Musa Usman, Musa Muhammed Bello, Ibrahim Inuwa
Context: The current literature posited that the knowledge of learning styles can be useful to both teachers and students. This study sets out to investigate and compare the learning style preferences of medical students (2nd year–5th year). Aims: The aim of the study was to investigate learning style preferences of medical students (2nd year–5th year) and compare those styles across years in the medical school (preclinical to clinical). Settings and Design: This study was carried out in the Faculty of Clinical Sciences, College of Health Sciences, Bayero University, Kano, Nigeria. It was a descriptive cross-sectional study. Subjects and Methods: A descriptive cross-sectional study was conducted in Kano, Northwest Nigeria. The Visual, Aural, Read/Write, and Kinesthetic (VARK) questionnaire, a self-administered instrument, was administered to 206 preclinical and clinical years' medical students in 2016. Statistical Analysis Used: Percentages, proportions, frequency tables, and charts were used in the analysis. Results: The response rate was 87.7%. The mean age of the study sample was 21.9 years. There were 124 (60.2%) males and 82 (39.8%) females. The mean score of each VARK item revealed that kinesthetic, auditory, read/writing, and visual modalities have 6.607 (standard deviation [SD] 2.265), 5.369 (SD 2.436), 4.984 (SD 2.621), and 4.345 (SD 2.468), respectively. The most common preferred learning style for both preclinical and clinical years' medical students was multimodal learning style. Conclusions: The findings in this study indicate that multimodal learning style is the most preferred, while other preferences are also common. Therefore, this has important implications on how educators deliver teaching and support students' learning.
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Economic evaluation of cerebral palsy in a resource-challenged setting p. 50
Umar Isa Umar, Halima Adamu, Ali Abdulkareem
Context: Cerebral palsy is a problem with a high prevalence in Africa and requires a life-long care. It is associated with high treatment cost and disruptions in the social life of caregivers. Aims: To evaluate the costs of care among some selected children with cerebral palsy in the resource-challenged setting. Settings and Design: A cross-sectional study. Materials and Methods: Prevalencebased costs were stratified by patients' socio-demographic characteristics and socioeconomic scores (SES).The “bottom-up” and “human capital” approaches were used to generate estimates on the direct and indirect costs of 100 patients with cerebral palsy. Statistical analysis used: All estimates of the financial burden of cerebral palsy were analyzed from the “patients' perspective” using IBM SPSS statistics software, version 23. Results: Onehundred children aged between 6 and 180 months were recruited, 62.0% males and 38.0% females with a male to female ratio of 1.6:1. The majority (79.0%) resides in an urban setting and 45.0% are within low socioeconomic class (Ogunlesi SES IV and V). The total cost of cerebral palsy care per month was ₦3,702,612.6 ($10,285.04) with a mean cost per patient per month of ₦37,026.1 ($102.85). The total direct cost of care per month was 77% of the total monthly cost, while the indirect cost per month was 23%. Medications/drugs are the principal cost drivers, comprising approximately 45.0% of the total direct costs per month. The total annual cost was ₦44,431,351.2 ($123,420.42) with a mean yearly cost per patient of ₦444,313.5 ($1,234.20). Conclusions: The study provided a preliminary estimate of the high cost of care borne by the family in the treatment of childhood cerebral palsy. The indirect cost is the principal cost driver of the total cost incurred by the family..
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Uptake of isoniazid preventive therapy for tuberculosis among HIV patients in Kano, Nigeria p. 57
Rabiu Ibrahim Jalo
Context: Despite convincing data on its efficacy and recommendation by the World Health Organisation that isoniazid preventive therapy (IPT) be included as part of the minimum package of care for people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome, IPT has not been widely implemented. Aims: The study assessed uptake and predictors of IPT among HIV patients in Kano, Nigeria. Methods and Material: Using a cross-sectional study design, an interviewer-administered questionnaire was used to collect information from 320 HIV patients from 2 primary health-care centres using systematic sampling technique. Statistical analysis used: Data were analysed using SPSS version 20.0. Results: Majority of the respondents (309; 96.9%) believed that tuberculosis (TB) poses a threat to health and well-being of HIV patients and up to 307 (95.9%) knew that TB is preventable, but slightly over a half (172; 53.8%) of the respondents were using IPT for prevention of TB. Age, education, awareness and disclosure were found to be independent predictors of IPT uptake. Respondents who were 30 years or older (adjusted odds ratio [AOR] = 2.46, 95% confidence interval [CI] = 1.16–5.24) and those who disclosed their HIV status to partner/family (AOR = 1.52, 95% CI = 1.15–3.68) had higher odds of IPT uptake, whereas respondents with informal education (AOR = 0.46, 95% CI = 0.14–0.93) and those who lack awareness of IPT were less likely to uptake IPT (AOR = 0.23, 95% CI = 0.08–0.68). Conclusions: IPT is being underutilised for the prevention of TB among HIV patients in Kano. This implies the need for health-care workers to introduce strategies to improve counseling and disclosure.
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Vaginal delivery of a giant submucous fibroid: A case report p. 64
Zainab D Ahmed, Suleiman A Gaya, Natalia Adamou, Ali B Umar
Uterine fibroid is a benign neoplasm that arises from uterine smooth muscles and is the most common tumor of the female reproductive tract. They could be intramural, subserous, or submucous depending on the location in the uterus. The main definitive form of management is surgical, which is myomectomy, hysterectomy, or hysteroscopic excision of small subserous nodules. Rarely, submucous fibroids could extrude through the cervical os, which can make vaginal hysterectomy possible. We present the case of a 40-year-old multipara who presented with menorrhagia, vaginal discharge, and a large mass protruding through the vagina. She had vaginal myomectomy of a mass measuring 25 cm in diameter and weighing 2.3 kg. She did well postoperatively. Vaginal hysterectomy for huge pedunculated submucous fibroid is safe, short, simple, definitive, and rarely associated with discomfort or complication to patients.
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Squamous cell carcinoma of the kidney: A consequence of longstanding staghorn calculus p. 68
Nasiru Raheem, Muzzammil Abdullahi, Haruna A Nggada
Squamous cell carcinoma (SCC) of the kidney is a rare and an aggressive tumor with a 5-year survival rate of <10%. They are usually associated with staghorn calculi and diagnosed at an advanced stage due to the rarity and inconclusive clinical and radiological features. We present a case of 54-year-old man histologically diagnosed of SCC of the kidney following nephrectomy. He had antituberculous drugs for 4 months on account of history of chronic cough, weight loss, and intermittent fever of 1-month duration. This case merits being reported because this aggressive cancer would have been prevented if the stone had been detected and removed early with biopsy taken from renal pelvis or calyceal wall.
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Congenital vaginal agenesis, davydov procedure: A case report and review of literature p. 71
Ayyuba Rabiu, Zainab Datti Ahmed, Ibrahim Garba, Mutiat O Balogun, Maryam Lawal
Congenital vaginal agenesis, also called Müllerian agenesis or Rokitansky–Mayer–Küster–Hauser syndrome, is a rare anomaly of the female genital tract. The affected individuals present with primary amenorrhea, varying degree of uterovaginal anomalies, infertility, and other associated renal, spine, and skeletal malformations. Embryologically, the vagina is formed from the fusion of the two embryonic structures: the upper part from the Müllerian duct system and the lower third from the urogenital sinus. Müllerian agenesis is caused by embryologic underdevelopment of the Müllerian duct, with resultant agenesis or atresia of the vagina, uterus, or both. We report the case of a 25-year-old woman who presented with complaints of delayed onset of menses and inability to have sexual intercourse with her partner. She had well-developed secondary sexual characteristics. She had never experienced penetrative sexual intercourse despite being married for 2 years. A general physical examination revealed a young woman of normal stature. She had well-developed breast (Tanner stage 5). The clitoris and pudendal cleft were normal. There was normal external urethral meatus with blind ended vagina of 2 cm long. A digital rectal examination revealed good sphincteric tone with no uterus or cervix palpated. A diagnosis of congenital uterovaginal anomaly was made. A buccal smear done revealed XX karyotype. She was counseled about her condition. Consents for surgery and media release were sought and obtained. A Davydov procedure for neovaginal construction was made and her postoperative condition was satisfactory. Congenital vaginal agenesis is a rare condition with profound effects on the affected individuals. Therefore, proper counseling on future fertility options and the need for neovaginal construction for improved sexual satisfaction should never be overemphasized among others.
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