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   Table of Contents - Current issue
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July-December 2020
Volume 17 | Issue 2
Page Nos. 77-161

Online since Friday, October 9, 2020

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REVIEW ARTICLE  

Cancer aetiology and progression: The crucial link between genome, epigenome and metabolome Highly accessed article p. 77
Salihu Ismail Ibrahim, Fakhradden Yahya Muhammad
DOI:10.4103/njbcs.njbcs_2_20  
Genomic and metabolic profiles of cancer cells differ significantly from normal cells. Cancer cells utilise nutrients with an impaired metabolic process to maintain their high metabolic demands to adapt and proliferate. Metabolic rewiring in cancer cells has profound effects on the regulation of gene expression and vice versa. Genomic and metabolomic interactions are highly intertwined in both normal and cancer cells. Genomic components affect the metabolomic activities by modulating the expression of genes that regulate the metabolome. Inversely the metabolome, in turn, coordinates and provide a favourable microenvironment for genomic expression of metabolome regulating enzymes. The review aims to understand the link between genomic and metabolomic processes, their point of interaction, shared process, including dependent and independent networks in understanding cancer aetiology and progression. We systematically searched PubMed, Hinari, Google scholar and Nature journals to identify potentially relevant articles. We included reports that met the following criteria: (1) current knowledge on the cause of cancer as explained by genetic mutation, and (2) examine to what extent the mutation is determined by the metabolome. We also reviewed epigenetic aberration as hallmark of cancer aetiology. We discussed that the interaction between the genomic and metabolomic components is indispensable for the normal metabolic processes. Anything that alters the interplay of these processes will definitely cause impairment in the interaction and overall compromise in the entire genomic, metabolic, and cellular processes. Understanding the complex interaction between genome, epigenome, and metabolome is crucial to gain a greater insight into unravelling cancer pathogenesis and in the onset and progression of cancers and the potential of designing novel therapeutic strategies.
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ORIGINAL ARTICLES Top

Quality of nursing care assessment in the context of coronavirus disease (COVID-19) pandemic in the University of Benin teaching hospital, Benin-City, Nigeria: Patients' perspectives Highly accessed article p. 84
Ngozi Rosemary Osunde, Olaolorunpo Olorunfemi, Lucy Chukwuka, Oluwatosin Mary Oyewole, Mojolaoluwa Omolade Olawale
DOI:10.4103/njbcs.njbcs_23_20  
Context: Quality of nursing care is the extent to which nursing health-care services provide an improved desired health outcome. Thus, using patients' perception as a proxy in measuring the quality of nursing care is highly recommended. Aims: The aim is to assess the quality of nursing care in the context of Coronavirus diseases (COVID-19) pandemic in the University of Benin Teaching Hospital (UBTH) from patients' perspectives. Materials and Methods: A cross-sectional descriptive study on the quality of nursing care: patients' perspective. Self-administered questionnaires were distributed to selected patients who had been on admission for not <2 weeks from the onset of the pandemic. A multistage sampling technique was used to select the sample size of 200 patients. Data collected were analysed using tables, percentages, means, standard deviation and Chi-square test; at 0.05 level of significance, through the Statistical Package for the Social Science software. Results: The findings revealed that patients had poor perception in some areas of nursing practice, and this is attributed to the shortage of nurses on the wards for patients' care. It also showed that nurse-patient relationship, and nurse-patient communication were significantly related to patients' perception of quality of nursing care (χ2 = 3.84, P ≤ 0.001) and (χ2 = 17.61, P = 0.003), respectively. Conclusion: The patient's perception of nursing care in UBTH was not perfect and this they attributed to the shortage of nurses on the wards for patients 'care, therefore the hospital management and the government should ensure more nurses are employed in the hospital so that the nurses can implement the standard ratio of nurse–patient relationship.
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Cataract surgical coverage and visual outcome using RAAB in birnin gwari local government Area, North West Nigeria p. 91
Saudatu Umar Madaki, Alhassan Mahmoud Babanini, Saudat Garba Habib
DOI:10.4103/njbcs.njbcs_7_20  
Context: Cataract is the leading cause of blindness worldwide. It is responsible for 51% of blindness and accounting for 65.2 million blind people worldwide. Cataract surgery has been shown to be one of the most cost effective health care interventions. Aims: To determine the cataract surgical coverage (CSC) and visual outcome using RAAB in Birnin Gwari Local Government Area, North West Nigeria. Setting and Design: Population based cross sectional study. Materials and Methods: Rapid method of assessing avoidable blindness was used (RAAB) in the study. A total of 2162 out of 2530 registered eligible subjects were examined. Two stage cluster random sampling was used to select 59 clusters in 40 villages, and in each cluster, 50 subjects aged 40 years and above were selected using probability proportional to the size. Biodata of all eligible subjects were registered followed by visual acuity (VA) testing. Subjects with VA of <6/18 were examined further to determine the cause of poor vision. Statistical analysis used: The data were recorded in a modified RAAB questionnaire form and were analysed using SPSS version 16.0 program (SPSS Inc., Illinois, USA). Results: Cataract surgical and couching coverage were found to be 31.9% and 19.9%, respectively. Visual outcome for cataract surgery was poor in 37% of the subjects; this was worst in those who had couching. Conclusions: In view of the low CSC, there is a need to provide quality and affordable cataract surgical services in the community.
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An appraisal of anaesthesia for ectopic pregnancy in a tertiary institution North-central Nigeria p. 97
Adegboye Majeed B, Oyewopo Christianah I, Oni Olayinka J
DOI:10.4103/njbcs.njbcs_30_19  
Context: Ectopic pregnancy is a life threatening gynaecological emergency; it is a significant cause of maternal morbidity and mortality, thus poses various anaesthetic challenges. Aims: To determine the profile of women that present with ectopic gestation, their mode of presentation, the anaesthetic technique used, complications and outcome. Settings and Design: This was a retrospective review of ectopic pregnancy at the University of Ilorin teaching hospital from 1st January 2015 to 31st December 2018. Materials and Methods: Data were obtained from operating theatre records, anaesthetic records regarding modes of anaesthesia, complications and outcomes were extracted. Statistical analysis used: Analysis was done IBM SPSS version 22. Results: There were 89 cases of ectopic pregnancies that were managed during the period of review. The incidence of ectopic pregnancy in this study was 0.9% of all deliveries. A total of 69 (77.5%) of the case file were available and were retrieved and analysed. The age range was 25–29 years, with mean age of 27.5 ± 5.4 years. Most of the patients presented with ruptured ectopic 57 (82.6%). All the patients had general anaesthesia, and ketamine 47 (68.2%) was the predominant induction agent (P = 0.007). The most common surgical intervention performed was open laparotomy with unilateral salpingectomy 60 (87%). Fifty three (76.8%) of the patients required intra operative blood transfusion. All patients with the American Society of Aanesthesiologists (ASA) IVE had ruptured ectopic, while 88% of patients with ASA IIIE presented with ruptured ectopic. Ninety per cent of the patient that were ASA IVE had an immediate post operative complication. While the least complication was seen in patients with ASA IE 3 (37.5%). No patient required intensive care admission, and no mortality was recorded. Conclusion: The most common form of presentation of ectopic pregnancy in this study was ruptured unilateral ectopic, and general anaesthesia for laparotomy was the most common intervention.
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Dental caries experience and molar-incisor hypomineralisation in children: Pattern and severity Highly accessed article p. 103
Titus Ayodeji Oyedele, Nneka Maureen Chukwumah, Yewande Isabella Adeyemo
DOI:10.4103/njbcs.njbcs_8_20  
Context: While efforts have been directed at reducing caries prevalence and its consequences by increasing access to fluoride in developed countries, its prevalence in developing countries is still on the increase. This study determined caries experience, pattern and severity in children with and without molar-incisor hypomineralisation (MIH). Materials and Methods: This was a cross-sectional, hospital-based study in children aged 3–16 years whose parents/legal guardians consented to participate in the study. They were recruited when they presented at the Paediatric dental clinic in a tertiary institution in Nigeria where assessments of their caries status (using the Decayed, Missing and Filled Teeth/decayed, missing and filled teeth [DMFT/dmft] index), restorative status (F/f + D × 100) and caries severity (using the visible pulpal involvement, ulceration as a result of displaced tooth fragments, fistula and abscess [PUFA/pufa] index) were carried out. Results: A total number of 391 children participated in the study; 58.8% were female and 41.2% were male with their mean age being 9.99 (±0.18) years. The DMFT for the study population was 1.71, while dmft was 1.81 and 51.4% of the participants had MIH; generally, the restorative index for the population was low (3.2). Children with MIH had a higher number of decayed teeth compared to children without MIH (P = 0.001); Overall, DMFT was higher in MIH-affected children. There was a significant difference in teeth with pulpal involvement (P = 0.01) and teeth with abscess formation (P = 0.02) in children with MIH compared to children without. Conclusion: Children with MIH had higher prevalence of caries and was more severe, compared to children without MIH.
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Relationship between age, gender and low back pain in patients referred for magnetic resonance imaging of lumbosacral spine at ahmadu bello university teaching hospital, Zaria p. 108
Usman Bello O, AF Oyewole, ND Chom
DOI:10.4103/njbcs.njbcs_36_19  
Context: Low back pain (LBP) is a symptom of many lumbosacral spine abnormalities which are prevalent in all occupational groups in our environment. Its frequency and severity are significantly related to age and gender. Aims: To determine the relationship between age, gender and LBP in patients referred for magnetic resonance imaging (MRI) of lumbosacral spine. Settings and Design: A cross sectional study at Ahmadu Bello University Teaching Hospital, Zaria. Materials and Methods: The study was conducted within 4 years at the MRI suite of the Department of Radiology, on 200 patients who had LBP who had MRI scan. Statistical analysis used: Data from the questionnaires were sorted and entered into Microsoft Excel. Analysis was performed using the Statistical Package for Social Sciences Version 22.0. Results: There is male preponderance, with a male to female ratio of 1.6:1. The ages ranged from 11 to 80 years, with a mean of 47.8 + 1.4, and the peak incidence (55 [27.5%]) is in the fourth and fifth decades of life. A statistically significant association (χ2 = 33.9; P < 0.001) was also found between the severity of LBP and ageing. Majority of the patients (172 [86%]) had intervertebral disc prolapse/herniation, out of which 104 (60.5%) were males and 68 (39.5%) were females. Conclusion: Patients with lumbar disc prolapse had early age incidence with male preponderance. The incidence of lower level disc involvement was more, and there was no significant decadal difference in presentation, when both protruded and extruded types of disc prolapse were compared to age and gender.
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The relationship between cost of treatment and cognitive deficit in schizophrenia p. 115
Michael A Amedu, Shehu Sale
DOI:10.4103/njbcs.njbcs_9_20  
Context: Schizophrenia is not only a complex and disabling illness, but also costly. Cognitive impairment is a major determinant of functional outcome of patients. Aims: To determine the relationship between the direct cost of treatment and the cognitive impairment in schizophrenia. Settings and Design: This is a longitudinal study at a tertiary mental health facility in northern Nigeria. Materials and Methods: This study involved 270 patients with schizophrenia aged 15–64 years. Instruments used included Schizophrenia Cognition Rating Scale (SCoRS), the Mini International Neuropsychiatric Interview PLUS and a modified cost of illness (COI) questionnaire. Statistical analysis used: All tests of statistics were carried out at 5% level of probability. Results: A total of 270 participated in this study with a male: female ratio of almost 1. The mean age of participants 33.04 years. Majority were unemployed (51.5%), single (45.6%) and of low socioeconomic class (88.5%). Lower SCoRS for stable patients was significantly associated with higher educational attainment, occupational and marital status, high socioeconomic status and absence of caregiver. SCoRS had a significant correlation with duration of untreated psychosis, COI, age at onset, duration of illness, length of caregiving and number of caregivers. Conclusion: Cognitive impairment experienced by patients with schizophrenia are numerous, not only by the suffering and limitations it imposes on them, but also the enormous cost and burden that comes with caregiving. Efforts geared toward early detection and presentation of schizophrenia patients, and subsidizing cost of drug by government will go a long way in reducing cognitive impairment among patients.
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Pattern of diabetes mellitus complications and co-morbidities in ughelli north local government area, Delta State, Nigeria p. 123
Otovwe Agofure, Oghenenioborue Rume Okandeji-Barry, Patience Ogbon
DOI:10.4103/njbcs.njbcs_37_18  
Context: Diabetes mellitus (DM) is a metabolic disorder associated with reduced life expectancy, microvascular complications, increased risk of macrovascular complications and diminished quality of life. Aims: To assess the pattern of DM complications and co morbidities in Ughelli North Local Government Area, Delta State, Nigeria. Settings and Design: This was a 7 year retrospective study conducted in General Hospital Ughelli Delta State, Nigeria. Materials and Methods: A designed pro forma was used to collect the basic information from patients who presented themselves from the year 2010–2017. Statistical analysis used: The collected data were entered into the computer and analysed using the SPSS software version 20.0. The data were presented in simple percentages and charts, whereas Pearson correlation was used to test for correlation among variables of interest at the level of significance (P < 0.05). Results: The total number of patients was 53,421, of which 19,391 (36.29%) were females, 18,559 (34.75%) males and 15,435 (28.95%) children. The overall prevalence of diabetes was 25.46% with the prevalence among males 46.63% and females 53.37% at (P = 0.000), respectively. The pattern of diabetes complications was kidney failure (27.87%), heart attack (27.27%), erectile dysfunctions (21.0%) and cardiovascular diseases (10.0%). Prevalent diabetes comorbidity recorded were hypertension (54.0%), peptic ulcer (7.0%) and asthma (4.0%). Conclusion: The present study showed the prevalence of DM and the presence of complications among the patients.
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Correlation of anthropometric indices with fasting blood glucose and blood pressure among university students in Kano, Nigeria p. 128
Isyaku Mukhtar Gwarzo, Mabaruka Nasir Adam, Nafisa Yusuf Wali, Salisu Ahmed Ibrahim
DOI:10.4103/njbcs.njbcs_38_19  
Context: Studies have suggested superiority of measures of central obesity over body mass index (BMI) in predicting cardiovascular risk. This multiplicity of anthropometric indices has led to inconsistency in their correlation with fasting blood glucose (FBG) and blood pressure. Aim: The aim of this study was to determine the prevalence of obesity using different anthropometric indices and their correlation with FBG and blood pressure among university students in Kano, Nigeria. Materials and Methods: One hundred and forty-eight participants were randomly selected for the study. Anthropometric indices, FBG and blood pressure were measured following standard protocols. Data were analysed using IBM SPSS version 23.0. Pearson's correlation coefficient was used to determine the relationship between quantitative variables. P ≤ 0.05 was considered statistically significant. Results: The mean age of the participants was 22.09 years ± 4.03. The prevalence of obesity was: BMI – 4.8%, waist circumference (WC) – 23.1%, waist–hip ratio (WHR) – 31.76% and waist–height ratio (WHtR) – 31.76%. BMI was positively correlated with diastolic blood pressure (DBP) and mean arterial pressure (MAP). WC was positively correlated with systolic blood pressure (SBP), DBP and MAP. WHtR was positively correlated with SBP, DBP and MAP among female participants only. WHR was negatively correlated with DBP and MAP in male participants only. WC, WHtR and WHR were positively correlated with FBG among female participants only. Conclusion: The prevalence of obesity among undergraduate students in Kano is high. There was a wide variation in the correlation between anthropometric indices and FBG and blood pressure.
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Knowledge, attitude and preferred method of family planning among men living in an Urban Slum in Kano, Nigeria p. 135
Auwal Umar Gajida, Idris Usman Takai
DOI:10.4103/njbcs.njbcs_17_19  
Context: Male involvement in family planning (FP) has a direct influence on their spouse's attitude towards the use of modern contraceptives. Aims: The aim was to determine the knowledge, attitude and preferred methods of FP among men living in an urban slum of Kano, Nigeria. Materials and Methods: A cross-sectional design was used to study 110 married men living in Dorayi Quarters in Kano. Data were obtained using interviewer-administered questionnaire. Descriptive statistics were used to describe categorical variables. P <0.05 was considered statistically significant. Results: The mean age was 39 ± 11.01 years. Majority (64%) were among 22–41 age groups. Most (97.22%) of the respondents were Muslims, whereas the remaining 2.78% were Christians. Majority of the respondents (96%) were married and 62 (57.41%) had secondary education. Up to 44.4% of the respondents had good knowledge of FP, with oral contraceptive pills as the most widely known methods (80%), followed by injectable (75%), male condom was known by 73% of the respondents, withdrawal by 55% and (IUCD) intrauterine contraceptive device by 25% in that order. Almost two-third of the respondents believed that FP practice is a good practice. Respondent's family structure and educational status were also noted to significantly influence their knowledge of and attitude towards FP (P < 0.05). Conclusions: FP knowledge, attitude and preferred method among men in Dorayi is relatively higher than popular assumptions. However, health education needs to be intensified to encourage the practice of FP.
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Evaluation of respiratory health among refuse management and sanitation board workers in Kano metropolis p. 140
Yunusa Muhammad, Rufai Yusuf Ahmad, Abdullahi Sule Dambatta, Yakubu Abubakar
DOI:10.4103/njbcs.njbcs_1_20  
Context: Kano State Refuse Management and Sanitation board workers are constantly exposed to bioaerosol inhalation, including toxins and biotoxins that are been released from the waste. Aims: The aim of this study is to evaluate and determine the respiratory health status of Workers. Methodology: The study was a cross-sectional survey with 129 participants recruited using a convenience sampling technique. Forced vital capacity, forced expiratory volume in 1 s and St. George questionnaire were used to collect data and the result was analysed using descriptive statistics of frequencies, percentages and graphs, while the differences and relationships were obtained using one-way ANOVA and Spearman rank correlation co-efficient, respectively. Results: The mean age of the participants was 34.2 years. Up to 75.2% of the participants were male, whereas 24.8% were female. Up to 40% of participants did not have any respiratory symptoms, 35% had mild symptoms, 14% had moderate symptoms and 11% had severe respiratory symptoms. The symptoms include dyspnea, coughing, excessive mucus secretion and breathlessness. Respiratory symptoms was positively related to the length of exposure (P = 0.029). There was no significant difference in respiratory symptoms between waste collectors, sweepers and drivers. Furthermore, no relationship was found between the age of the workers and respiratory symptom (P = 0.056). Significant difference (P = 0.003) was observed between gender of the participants and respiratory health. Conclusions: Waste disposal work has significant impact on respiratory health. The provision of health education for safety and proper use of personal protection is necessary to reduce the impact of pollutant on respiratory health.
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CASE SERIES Top

Early outcome of endoscopic trans-nasal trans-sphenoidal pituitary surgery in Kano, Nigeria p. 145
Emmanuel Sara Kolo, Ismail Hassan, Musa Ibrahim, Ahmad Haruna Misbahu, Auwal Adamu, Nasiru Jinjiri Ismail, Dalhat Salahu, Mansur Ramalan
DOI:10.4103/njbcs.njbcs_17_2  
Endoscopic trans-nasal trans-sphenoidal hypophysectomy is a minimally invasive surgical procedure aimed at resection of pituitary tumors. This technique is widely practiced in developed countries but is presently gaining popularity in our environment. This study was aimed at presenting our preliminary outcomes as it relates to the technique of endoscopic trans-nasal trans-sphenoidal pituitary surgery in Kano, Nigeria. This was a retrospective study of patients with pituitary tumors that presented at a government tertiary and private specialist health institutions from October 2018 to December 2019. They all had excision of varying degrees of pituitary tumors via endoscopic trans-nasal trans-sphenoidal approach under general anesthesia. There were 4 females (66.7%) and 2 males (33.3%) and their ages ranged between 25 – 60 years. They presented with varying degrees of clinical symptoms such as gynaecomastia, galactorrhea, irregular menstruation, infertility, intermittent headache and visual impairment. Four (66.7%) had complete tumor excision and 2 (33.3%) had incomplete excision. Four (66.7%) had complete symptom relief and 2 (33.3%) had significant improvement in symptoms. The complications of surgery were nasal septal adhesion 1(16.7%), CSF leak 1(16.7%) and transient diabetes insipidus 2(33.3%). All complications were resolved during admission and at follow up visits. Histopathological analysis of specimens confirmed 5 cases of pituitary adenoma and a case of pituitary Rathkes cleft cyst. Endoscopic trans-nasal trans-sphenoidal pituitary surgery is feasible and has a favorable outcome in our setting with prospects for improvement to ensure safety. Keywords: Nasal endoscopy, Sinus surgery, Pituitary tumors, Skull base, Hypophysectomy.
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Ebstein's anomaly amongst adults with chronic heart failure: A case series and review of the literature p. 151
Muhammad Nazir Shehu, MU Sani
DOI:10.4103/njbcs.njbcs_31_19  
Ebstein's anomaly (EA) is a rare, congenital cardiac malformation-associated apical displacement of the tricuspid valve (TV) leaflets (commonly septal), leading to atrialisation of the right ventricle and dilatation of the right atrium. Clinical presentation depends on the degree of the displacement of TV leaflets and other associated cardiac malformations. Echocardiography is the standard criterion for the diagnosis of EA. We present a series of three cases of EA who all presented with features of chronic heart failure at the General Amadi Rimi Specialist Hospital and Federal Medical Centre, Katsina State, Nigeria.
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CASE REPORTS Top

Twin gestation: An unusual intrauterine contraceptive device failure outcome p. 155
Afolabi Korede Koledade, Zubaida G Abdullahi, Tokunbo O Adeoye, Oladapo Sunday Shittu
DOI:10.4103/njbcs.njbcs_24_19  
The copper-T intrauterine contraceptive device is an effective long-acting reversible contraceptive option. However, there exists a slim chance of failure. The Copper T 380A has a 1 year failure rate of 0.8% and a 12 year cumulative failure rate of 2.2%. On long-term basis, the cumulative life failure rate for Copper T 380A is 22/1000 long-acting contraceptives after a single application from the 1st to 10th year of insertion, comparable to 18.5 for all tubal sterilisation procedures. When failure happens, the patient is usually at the crossroads of either to terminate the pregnancy or continue with the unplanned pregnancy. Therefore, the patient ought to be adequately counselled on management options, which includes termination of pregnancy where there are no restrictive laws, intrauterine contraceptive device (IUCD) removal if accessible otherwise leave in situ with risks of miscarriage, pre-labour rupture of membrane, and pre-term delivery. The patient's choice is usually laden with emotional and psychological adjustments, especially if the IUCD failed with twin gestation, as seen in this case of a 39-year-old multipara who had Copper-T IUCD inserted 6 months after her last delivery. She opted to carry on with the pregnancy despite associated medical conditions. Attempt at IUCD removal failed at 19 weeks gestational age (GA), and she subsequently drained liquor and was delivered of live pre-term babies at 32 weeks GA. The IUCD was picked up extra chorion and not embedded close to the cervical internal os. Her gestational diabetes and hypertension were co-managed with physicians, while the neonatologists managed the pre-term babies before they were all discharged.
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Unilateral absence of musculocutaneous nerve with bilateral variation in the formation of the median nerve p. 159
Shabina Anjum
DOI:10.4103/njbcs.njbcs_33_19  
Anatomical variations of the brachial plexus and its nerves are common. In this case, during a routine cadaver dissection, we encountered different variations of the brachial plexus. On the right side, there was an absence of musculocutaneous nerve (MCN) and the two roots of the median nerve (MN) united in the upper arm despite the axilla. Flexor muscles of the right arm, i.e., coracobrachialis, biceps brachii and brachialis, were innervated directly by the two different branches from the lateral cord. On the left side, the MCN was present and distributed as usual, but the MN received additional contributions from the lateral cord. Variations in the peripheral nerves are usually prone to iatrogenic injuries and brachial plexus block failure. Precise knowledge of such variations helps clinicians in the correct interpretation of unusual clinical findings, nerve conduction tests and imaging. This case report also shows the importance of vigilant anatomical dissection.
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