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   Table of Contents - Current issue
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January-June 2019
Volume 16 | Issue 1
Page Nos. 1-78

Online since Tuesday, March 5, 2019

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ORIGINAL ARTICLES  

The estimation of effective radiation dose following computed tomography urography at Aminu Kano Teaching Hospital, Kano Nigeria p. 1
Idris Garba, Aisha R Abdullahi, Mansur A Yahuza, Muhammad A Suwaid, Yusuf Lawal
DOI:10.4103/njbcs.njbcs_20_18  
Background: Computed tomography urography (CTU) is an efficient radiological examination for the evaluation of urinary system disorders. However, the procedure exposes patients to a substantial amount of radiation dose associated with increased cancer risks. Objectives: To determine computed tomography (CT) dose index following CTU and to evaluate organs equivalent doses and cancer-induced risks. Materials and Method: A prospective cohort study was carried out at a tertiary health facility in Kano, Northwestern Nigeria. Ethical approval was sought and obtained. Patients Demographics scan parameters and CT radiation dose data were obtained from patients that had CTU procedure. Effective dose (ED), organ equivalent doses, and cancer risks were estimated using SPSS statistical software version 16 and CT dose calculator software. Results: A total of 56 consented patients were included in the study, consisting of 29 males and 27 females. Radiation dose data for CTU was estimated as follows: dose length product (2,320 mGy*cm), computed tomography dose index (9.67 mGy), and ED (34.5 mSv). The probability of cancer risks was also estimated to be 600 per a million CTU examinations. Conclusion: The study revealed that the radiation dose for CTU is considerably high with increase in cancer risks probability. Variations in ED between studies suggest that optimization is not fulfilled. Patient radiation dose estimate should be taken into consideration when imaging protocols are planned for CTU.
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Computed tomographic evaluation of pediatric head injury in Aminu Kano Teaching Hospital, Kano, Nigeria p. 5
Abdu Hamisu Dambatta, Mohammed Sidi
DOI:10.4103/njbcs.njbcs_15_18  
Objective: To describe the computerized tomographic findings in children with head trauma who presented at the Aminu Kano Teaching Hospital, Kano, Nigeria. Methods: It is a retrospective review of patients aged 9 month to 12 years with suspected head injury following head trauma, who presented for CT scan at Aminu Kano Teaching Hospital, Kano, Nigeria from January 2016 to December, 2017. Results: Sixty eight cases were reviewed retrospectively. They ranged from 9 months to 12 years with the mean age of 5 years. Fifty four (79.4%) were males. Fourteen were females (20.6%). Thirty five (51.5%) had head injury secondary to RTA. Twenty four (35.3%) had a history of fall from height. Four (5.9%) had a history of fall into a well. Four (5.9%) had a history of assault. Only one had a history of gun shot (1.5%). Twenty one patients (30.9%) had normal findings. Five (7.4%) of them had a frontal bone fracture. Seven (10.3%) had a parietal bone fracture. Two (2.9%) had fracture of base of the skull. Seventeen (25%) had intracerebral haematoma. Three had brain oedema (4.4%). One had epidural haematoma (1.5%). Eight (11.8%) had subdural haematoma. Six (8%) had combined fracture with cerebral contusion. Conclusion: RTA is a major cause of head injury in the most paediatric age group in our environment with CT scan as a valuable imaging tool in the investigation and management of these patients.
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A descriptive study of the etiology and outcome of peripheral vascular injuries at the Aminu Kano Teaching Hospital p. 9
Tunde N Oyebanji, Ismail M Inuwa, Jameel Ismail Ahmad, Shamsuddeen Muhammad, Abdulrahman A Sheshe, Lofty John C Anyanwu
DOI:10.4103/njbcs.njbcs_23_18  
Background: Peripheral vascular injuries (PVIs) are infrequent but their management could be hampered by delayed presentation and fraught with untoward morbidity or death. Herein, we describe the factors contributing to the morbidity and mortality of PVIs in this environment. Materials and Methods: Data relating to patients with PVIs between March, 2012 and March, 2018 were retrospectively collected from case folders and analyzed. Results: The records of 16 patients were analyzed. There were 13 (76.9%) males and 3 (23.1%) females. The male/female ratio was 4.3:1. The median age was 30 years (range, 10–52). The median duration between injury and presentation was 2.5 days. Nine (56.3%) PVIs were secondary to stab wounds; two (12.5%) occurred in intravenous drug abusers while the others were each of different etiologies. The superficial femoral artery was the most frequently injured vessel (six cases; 37.6%). Fourteen (87.5%) patients required surgery ranging from patch arterioplasty to reversed saphenous vein interposition graft. Two (12.5%) patients were managed conservatively. The mean length of stay for the overall patient population was 11.7 days. Ten patients (62.5%) had surgical site infections (SSIs) causing prolonged hospital admission. There were three deaths (18.8%), all occurring in patients with co-morbidities like chronic kidney disease (CKD) and sepsis. Conclusion: PVIs were infrequent in this environment and presentation is delayed. Reasonable limb salvage rates are possible depending on the severity of ischemia. SSIs may suggest prolonged hospital stay. Mortality appears to be heightened if there are underlying co-morbidities. More patients would however be required to statistically correlate these findings.
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Management of clavicle fractures and adjacent clavicular joint dislocations in a Tertiary Health Center, North West, Nigeria p. 15
Friday Samuel Ejagwulu, Yau Zakari Lawal, Inuwa Mohammed Maitama, Kenneth Ezenwa Amaefule, Siyaka Simpa Audu
DOI:10.4103/njbcs.njbcs_34_17  
Background: Fractures of the clavicle are known to be common and occur in all ages and genders. It is commoner in the young and elderly, especially postmenopausal women. The mechanism of injury is either direct resulting in transverse fracture or indirect resulting in oblique fracture. The results of treatment are more favorable in the younger age groups because of their inherent healing potentials compared with the elderly. Aims and Objectives: To assess the incidence of clavicle injuries, treatment modalities with their outcomes, and to evaluate the X-ray union of the pathology. Patients and Methods: The patients were recruited over a period of 4 years (2009–2012) with informed and duly signed consent obtained. Fractures or dislocations were confirmed clinically and radiologically. One group of the patients was managed conservatively and the other operatively with various surgical options. Results: A total of 49 patients comprising 34 males (69.4%) and 15 females (30.6%) were studied. The age range was 2 weeks (0.6 years) to 62 years (mean- 32.1 years). Middle third shaft fractures were the commonest (77.6%), while medial third shaft fractures and acromioclavicular joint dislocation were the least common (2.0% each). Thirty-three (67.3%) and 16 (32.7%) of the patients were managed conservatively and operatively, respectively. The average X-ray healing duration was 16.2 and 14.6 weeks for those managed conservatively and surgically, respectively. Conclusion: Middle third clavicle fractures constitute the commonest variety, and both conservative and operative treatment modalities are applicable.
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A pilot study of the maximum interincisal distance among adult Northern and Southern Nigerians p. 24
Fadekemi Olufunmlayo Oginni, Janet Oluwatosin Akinyemi, Babatunde O Bamgbose, Bamidele Adetokunbo Famurewa, Oluwaseun Caleb Oginni, Mohammad Abubakar Kaura, Junichi Asaumi
DOI:10.4103/njbcs.njbcs_44_17  
Objective: To study the average maximum interincisal distance (MID) and its association with individual physical parameters and dietary pattern in a representative convenient sample of healthy adult Nigerians from two ethnic groups. Materials and Methods: This was a pilot cross-sectional study of healthy adults, free of temporomandibular joint (TMJ) disorders, aged 18–58 years in Ile-Ife (Southwest Nigeria) and Kano (Northwest Nigeria). MID, body weight, and height were determined using a clean wooden spatula on a transparent plastic linear gauge, calibrated body weight electronic scale, and wall-mounted height scale, respectively. Dietary habits and history were assessed using a validated structured questionnaire. MID was compared in each group and related to subjects' age, sex, height, and weight. Results: Of 853 subjects screened, 794 (93.1%), aged 18–58 years, met the inclusion criteria. About 393 (49.5%) and 401 (50.5%) subjects were from the Northwest (Kano City) and Southwest (Ile-Ife), respectively. The mean age of the subjects from the Northwest and Southwest Nigeria was 35.4 years and 26.7 years, respectively, and M:F ratio was 1:1.02. Female subjects recorded higher body mass index (BMI) and were slightly older than the males. Mean MID (SD) values in millimeters were 45.68 (6.7), 47.60 (7.73), and 46.69 (7.29) in the Southwest, Northwest, and combined groups, respectively. MID was significantly higher in males than females, peaked at age 33 years in both the sexes and, thereafter, decreased with increasing age. Conclusion: The MID vary with ethnic origin, weight, height, age, and BMI. A peak MID in adult appears to exist at about 33 years.
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Female sexual dysfunction among women attending the family planning clinic at Aminu Kano Teaching Hospital: A cross-sectional survey p. 32
Hauwa Musa Abdullahi, Aisha Abdurrahman, Zainab Datti Ahmed, Jamilu Tukur
DOI:10.4103/njbcs.njbcs_8_18  
Background: Female sexual dysfunction (FSD) is a multifactorial condition in which individuals fail to experience satisfaction from sexual activity. Discussion on sexual function has been the subject extreme secretiveness due to cultural and religious reasons. There is paucity of data on the prevalence and risk factors of FSD in our environment. Objectives: To determine the prevalence, pattern and risk factors for FSD at Aminu Kano Teaching Hospital, Kano. Methods: It was a cross-sectional study of 342 women attending the family planning clinic at AKTH. The FSFI questionnaire was used to determine the prevalence and pattern of FSD among the patients. A section was added to the questionnaire to obtain information on the sociodemographic characteristics of the patients and the risk factors. The data was analysed using SPSS version 20.0. Chi square test and Fisher's exact test were used to test for association, a p-value of less than 0.05 was considered statistically significant. Results: The prevalence of FSD was found to be 86.0%. The most prevalent type of disorder was that of desire occurring in 91.8%, followed by disorders of lubrication (84.8%), arousal (80.7%), pain (66.4%), orgasm (41.5%) and satisfaction (31.6%). Only coital frequency (P <0.001) and chronic pelvic pain (P <0.001) were found to be significantly associated with FSD, while there was no significant association between FSD and number of years married, marital setting, hypertension, diabetes, previous abdominal or pelvic surgery, previous diagnosis of a mental or psychiatric disorder, smoking, pelvic or vaginal infection and pelvic organ prolapse. Conclusion: There is a high prevalence of FSD in our environment with disorder of desire, lubrication and arousal being the most common. Coital frequency and chronic pelvic pain were significantly associated with FSD.
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Nasopharyngeal cancer in Kano – A histo pathologic review p. 38
Ochicha Ochicha, Abdullahi M Ahmad
DOI:10.4103/njbcs.njbcs_27_18  
Background: Nasopharyngeal cancer (NPC) represents the most common head and neck malignancy in most Nigerian centers. Although it is uncommon among all cancers, it has significant morbidity and mortality associated with it. There has been no specific study on NPC in our locality. This review, therefore, endeavors to document and evaluate the pattern in our center. Materials and Methods: This was a retrospective review of all nasopharyngeal cases diagnosed at the pathology department of our hospital between 1st January 2005 and 31st December 2014. The biodata and histopathological findings were reviewed. Results: NPC accounted for 1.3% of all cancers during the study period and was twice as common in males than females (M: F = 2.1:1). Patients' age ranged from 16 to 70 years with median of 38 years and bimodal peaks in the 3rd and 5th decades. Squamous carcinoma was the most frequent histologic type (97.1%), followed by adenoid cystic and papillary adenocarcinoma each comprising 1.4%. The prevalent squamous carcinoma subtypes were non-keratinizing (80%) and keratinizing (17%). Conclusion: Our findings were broadly similar to other Nigerian centers, but slightly at variance with other low incidence zones in Western world.
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Hemodialysis outcome at Rasheed Shekoni Hospital p. 42
Alhaji Abdu, Ademola Babatunde Lawrence, Awwal Tijjani Shuaibu, Tahir Sani
DOI:10.4103/njbcs.njbcs_30_18  
Introduction: The growing number of patients with Chronic Kidney Disease (CKD) is alarming. This is particularly so in developing countries where glomerulonephritis and unknown causes are common in addition to the rising incidence of hypertension and diabetes. Hemodialysis is the common Renal Replacement Therapy (RRT) modality worldwide; however, many ESRD patients in developing countries cannot sustain hemodialysis beyond few months. We review the experience of a new hemodialysis center in a developing country to highlight the indications and outcome of hemodialysis. Materials and Methods: We retrospectively reviewed the case files and dialysis charts of all patients that had hemodialysis at Rasheed Shekoni Specialist Hospital over the first two years. Result: A total of 96 patients were dialyzed in the center during the two years. Fifty-seven were males and 22 were businessmen. The mean age was 39.19 ± 16.9 years, females were slightly younger. Seventy one of the patients had CKD while 25 had Acute Kidney Injury (AKI). Males had significantly higher serum urea and calcium, while the females had significantly higher serum albumin. More than half of the patients with CKD could not afford hemodialysis beyond the first 6 weeks. At the end of two years only one patient was still on dialysis, 3 patients were referred for kidney transplantation while the remaining patients had discontinued dialysis after an average of 8 weeks. Conclusion: The discontinuation rate of hemodialysis due to ESRD is high in developing countries. This is mostly due to the high cost of hemodialysis and relatively few centers that are concentrated in urban areas. The government has to develop policy to subsidize hemodialysis as well as develop other RRT modalities such as peritoneal dialysis and transplantation.
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Platelet count and indices in acute uncomplicated Malaria in Kano, Nigeria p. 46
Aminu Abba Yusuf, Sharif Alhassan Abdullahi, Ibrahim Musa Idris, Yusuf Dan'Asabe Jobbi
DOI:10.4103/njbcs.njbcs_21_18  
Background: Quantitative and qualitative abnormalities of platelets are common among patients with malaria infection, and these correlate with severity. Few studies documented platelet changes in uncomplicated malaria in the endemic regions. This study aimed to describe the changes in platelet counts (PLTs) and automated platelet indices in uncomplicated malaria infection in a Nigerian population. Materials and Methods: This is a comparative cross-sectional study of 152 patients presenting with symptoms of uncomplicated malaria to the general outpatient Department of Aminu Kano Teaching Hospital, Kano, Nigeria. Malaria diagnosis was made using gold-standard microscopy of Giemsa-stained thick blood smear, while PLTs and indices (mean platelet volume [MPV], plateletcrit [PCT], platelet distribution width [PDW] and platelet-large cell ratio [P-LCR]) were determined using automated haematology analyser. Data were analysed using STATA v13 and results presented in descriptive terms. P =0.05 was considered statistically significant. Results: There were more female 8 (51.3%) than male 74 (48.7%) patients. A total of 84 patients (55.3%) were malaria positive. The prevalence of malaria-positive smears was higher in males 48 (31.6%) and among the age groups of 5–14 and 15–24 years (13.8% each). Thrombocytopenia was seen in 15 (19.7%) and 2 (2.6%) of malaria-positive and malaria-negative individuals, respectively, and the difference was statistically significant (P = 0.001). Platelet indices reveal significant differences in the MPV (P = 0.0016) and P-LCR (P = 0.0265) between malaria-positive and malaria-negative patients. Although both lower mean PLT and PCT, and higher PDW were found in malaria-positive than in malaria-negative individuals, this difference was not statistically significant (P > 0.05). Conclusion: This study showed that abnormalities in PLT and indices are more common among patients with an acute febrile illness who are malaria positive than those who are malaria negative.
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Association of ABO neo-maternal incompatibility and neonatal jaundice in Nguru, Nigeria Highly accessed article p. 51
Hadiza Tikau Idi, Sani Awwalu, Usman Abjah, Ahmadu Aliyu Babadoko, Abdulaziz Hassan, Baba M Mohammed, Ishaku Ibrahim
DOI:10.4103/njbcs.njbcs_28_18  
Context: ABO blood group antigens are inherited and specific to an individual. In pregnancy, active immunisation occurs when the foetus is of a different ABO blood group from the mother and may result in neonatal jaundice (NNJ). Therefore, monitoring and evaluation of mothers at booking and throughout pregnancy and the postpartum period is important in management. Aim: The aim of this study is to determine the prevalence of neo-maternal ABO blood group incompatibility and to assess any relationship with NNJ among mother-neonate pairs in Nguru, Northeast Nigeria. Subjects and Methods: This was a cross-sectional descriptive study of 200 pregnant women at Federal Medical Centre, Nguru, Yobe State, Nigeria in 2015. ABO blood group antigens of both mothers and neonates were determined while direct Coomb's test (DCT), full blood counts, reticulocyte counts and bilirubin assays were determined for neonates of ABO-incompatible neo-maternal pairs. Data were analysed using SPSS Version 20, and a P ≤ 0.05 was considered as statistically significant. Results: The mean age of the mothers was 26.4 ± 6.2 years. Blood group O had the highest frequencies among mothers and neonates 58% and 57.5%, respectively. Although 28% of the mother-neonate pairs were ABO blood group incompatible, only 12.5% of the incompatible neonates had a positive cord blood DCT, and only 6% of the neonates developed jaundice. There was a strong and positive association between ABO neo-maternal blood group incompatibility and NNJ P = 0.007 (Fishers' exact test), odds ratio = 8.52, 95% confidence interval; 1.665, 43.591. Conclusion: ABO neo-maternal incompatibility is common, and it has a strong positive association with NNJ. There is a need for routine neonatal ABO screening, especially where jaundice exists.
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Association between cognition and peripheral brain-derived neurotrophic factor in a sample of normal adults in Kano, Nigeria p. 55
Isyaku U Yarube, Tasneem M Hassan, Rufa'i Y Ahmad, Lawan M Umar, Bello M Musa, Saleh M A Ibrahim
DOI:10.4103/njbcs.njbcs_46_17  
Introduction: Cognition is an important physiological and social element for both humans and animals. There is paucity of literature on cognitive function in Africans. Furthermore, the molecular mechanisms involved in cognition have not been fully elucidated. Brain-derived neurotrophic factor (BDNF) has a role in neuronal plasticity and cognition. However, the relationship between cognitive performance and serum BDNF levels has not been demonstrated in an African population. This study aimed to assess cognition and BDNF level and determine their relationship in a population of healthy adult Africans. Materials and Methods: Cognitive function and BDNF were determined using Mini Mental State Examination and enzyme-linked immunosorbent assay kit, respectively. SPSS statistics was used to process data. Results: Thirty male and female volunteers with a mean age of 48.7 ± 11.32 years were studied. The median cognitive score was 24.00 (21 and 28) with no sex variation (U = 107, P = 0.833). The median value of serum BDNF concentration was 2.09 ± 0.15 ng/L and statistically the same in males and females (t = 1.276, P = 0.213). Cognitive score correlated moderately with BDNF level (r = 0.369, P = 0.045), but not with sociodemographic or anthropometric characteristics. Conclusion and Recommendation: It was concluded that the population studied had normal cognitive function, which was not affected by sociodemographic and anthropometric characteristics. BDNF was a mediator of global cognitive function and was positively associated with registration and negatively associated with language domains of cognition. Peripheral levels of BDNF may potentially serve as a biomarker and index of cognitive evaluation in clinical settings.
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Risk factors for intestinal parasitosis among Almajiri pupils in Zaria, North Western Nigeria p. 60
Rabilu Iliyasu Yandoma, S Yohanna
DOI:10.4103/njbcs.njbcs_47_17  
Context: Intestinal parasitosis is an infection by intestinal parasites and is of important public health concern in the tropics and subtropics. The Almajiri pupils have peculiar characteristics in the community that predispose them to intestinal parasitosis. Aim: To assess the risk factors for intestinal parasitosis among Almajiri pupils in Zaria, North Western Nigeria. Settings and Design: The study was undertaken in Zaria town of Kaduna State, North Western Nigeria. Cross-sectional analytical design was used for this study. Subjects and Methods: A structured questionnaire was used to obtain data on 262 consented participants drawn by multistage sampling technique. Sociodemography, risk factors for intestinal parasitosis, and stool examination findings of the study participants were assessed. Statistical Analysis Used: Descriptive and inferential statistics were used to analyze the data. P values <0.05 were considered significant. Results: The prevalence of intestinal parasitosis among the pupils was 83.2%. Statistically significant relationships were found between having intestinal parasitosis and being an older pupil (P = 0.008), poor hand washing practices after defecation (P = 0.042), habit of biting finger nails/thumb sucking (P = 0.003), two or more pupils eating together from the same bowl (P = 0.003), and belonging to a polygamous family (P = 0.009). Conclusion: There was a high prevalence of intestinal parasitosis with many of its risk factors such as poor personal hygiene identified among the Almajiri pupils in Zaria. It is recommended that public health promotion, improved personal hygiene, and including the Almajiri pupils in mass deworming exercises are emphasized.
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Urinary tract infection in children with protein-energy malnutrition in Aminu Kano Teaching Hospital Kano, Northwest Nigeria p. 64
Umma Abdulsalam Ibrahim, Henry A Aikhionbare, Ibrahim Aliyu
DOI:10.4103/njbcs.njbcs_5_18  
Background: Determining the antimicrobial sensitivity pattern of urinary tract infection (UTI) in malnourished children in a community will help the clinician in decision-making regarding suitable first-line antibiotics. Materials and Methods: We performed a prospective cross-sectional study from July to November 2011 at the Aminu Kano Teaching Hospital to determine the prevalence of UTI and evaluate the antibiotic sensitivity pattern of organisms isolated from the urine of children with protein-energy malnutrition (PEM) and normal controls. In total, 169 children with PEM aged 6–59 months were enrolled consecutively as subjects and 169 well-nourished age and sex-matched children as controls. Results: The prevalence of UTI was found to be 16.0% in the subjects; this was significantly higher than 2.4% in the controls. The most common isolate was E. coli in both the subjects and controls. All isolates were sensitive to gentamycin and ciprofloxacin, whereas about half of the isolates were resistant to commonly used antibiotics such as amoxicillin, cotrimoxazole, and cefuroxime. The antibiotic sensitivity pattern of the organisms differs from other reports. Conclusion: There is high a prevalence of antibiotic resistance to the commonly used antibiotics for UTI. It is recommended that ciprofloxacin or gentamycin be considered as empirical antibiotic of choice in children with PEM and proven UTI. It is advised that regular surveillance of urinary tract pathogens should be carried out to evaluate antibiotic sensitivity pattern to guide empirical treatment.
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CASE REPORTS Top

A case report: A rare presentation of mandibular condylar fibrous dysplasia p. 70
Moshood Folorunsho Adeyemi, Moninuola Adebusola Ernest, Ehigie Igben, Habib Ayodeji Adeyemi
DOI:10.4103/njbcs.njbcs_4_18  
Fibrous Dysplasia is a fibro-osseous lesion characterized by the progressive replacement of normal bone by fibrous connective tissue resulting from arrest of bone maturation from woven bone to lamellar bone by a missense mutation. We report a 33-year old patient who presented with inability to open her of a month duration. On examination, patient had facial assymetry, anterior and posterior crossbite but scissors bite on the contralateral side, mouth deviation to the left on mouth opening associated with limited mouth opening, and there was no apparent swelling at the right preauricular region. The patient subsequently underwent surgery under general anesthesia following computed tomography (CT) scan. Fibrous dysplasia is a rare occurrence of the mandibular condyle, and its possibility in this location should be considered, pending a histopathologic report and the clinical importance of CT scan in the evaluation of temporomandibular joint lesions should be emphasized.
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Huge vulvar edema in a primigravida with severe preeclampsia – Emergency caesarean section and spontaneous resorption: A case report p. 75
HM Abdullahi, MM Suleiman, MM Abdullahi
DOI:10.4103/njbcs.njbcs_10_18  
Vulvar edema refers to accumulation of fluid within the interstitial space of the vulvar. It can result from inflammatory conditions, infections, infestations, trauma, pregnancy, tumours and iatrogenic causes. It is an unusual complication of pregnancy and is difficult to determine the cause. It may occur due to underlying systemic pathology and has also been associated with preeclampsia. It has the potential to interfere with vaginal delivery and compromise tissue integrity and has been associated with maternal mortality postpartum. We present a case of huge vulvar edema in a 23 years old primigravida woman that was managed elsewhere as a case of vulvar edema with elevated blood pressure and subsequently discharged home. She presented to us with severe preeclampsia and worsening massive vulvar edema at 32 weeks of gestation. Conservative management failed because of worsening symptoms. Caesarean section was performed with regressing of symptoms within few days. It is important for the clinicians to note that vulvar edema complicating preeclampsia could be a poor prognostic sign.
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