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   Table of Contents - Current issue
Coverpage
October-December 2019
Volume 16 | Issue 4
Page Nos. 105-151

Online since Tuesday, October 22, 2019

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REVIEW ARTICLE  

Submitral left ventricular aneurysm: Characteristics, diagnosis, management, and outcome p. 105
Berhanu Nega, Dejuma Yadeta Goshu, Senbeta Guteta Abdissa
DOI:10.4103/jcls.jcls_99_18  
Left ventricular (LV) aneurysm (LVA) is an uncommon cardiac disorder. There is no documented report from Ethiopia. Our objective was to discuss a case of LVA we encountered and analyze the clinical characteristics, diagnosis, management modalities, and outcome of patients with LVA from published studies over the last 200 years. in addition to the case we encountered, we searched PubMed for publications on patients with LVA and analyzed those reported since 1816. We identified 369 patients with LVA. The mean age at diagnosis was 31.7 ± 21.7 years, and 52.3% of them were males. It was more frequently reported from Africa (32.0%) and Europe (31.4%). The inferior part of the left ventricle including the submitral area is the most frequently (51.8%) reported location for LVA. Diagnosis was made coincidentally in most (40.1%) of the patients. The presenting features in those symptomatic patients were dyspnea or heart failure (HF) (23.8%), rhythm disturbances (18.2%), chest pain (10.6%), syncope (8.4%), thrombus (10.8%), or embolic events (5.4%). The universally used diagnostic modality was echocardiography. Electrocardiography (61%), chest X-ray (31.2%), cardiac catheterization (42.8%), computed tomography (1.3%), and magnetic resonance imaging (1.6%) were used as confirmatory or complementary imaging tests. During the follow-up period, death from cardiac causes occurred in 13.1% of the patients, with the leading cause of the cardiac death being congestive HF (51.9%). LVA has varied clinical features with potentially deleterious outcomes. While close follow-up with echocardiography in such patients is necessary, building the local expertise in surgical management of such patients is recommended as it has implications on individual patient, proper health-care utilization, and health-care costs.
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ORIGINAL RESEARCH REPORTS Top

Sociodemographic correlates and management of breast cancer in Radiotherapy Department, Lagos University Teaching Hospital: A 10-year review p. 111
Temitope Olatunji, Anthonia Chima Sowunmi, Kingsley Kayode Ketiku, Oladapo B Campbell
DOI:10.4103/jcls.jcls_82_18  
Background: Worldwide, breast cancer is the most frequently diagnosed life-threatening malignant disease in women. Aim: The aim of the study was to determine the sociodemographic correlates and management of breast cancer in a tertiary hospital. Patients and Methods: Case notes of histologically confirmed breast cancer patients were retrieved, and data extracted were analyzed using the Statistical Package for the Social Sciences version 20 (SPSS Incorporation, Chicago, Illinois State, United States of America). Results: A total of 1141 cases were analyzed, of which 1132 (99.2%) were female and 9 (0.8%) were male, with a ratio of 1:126. The range was between 9 and 20 years. The mean age was 46.8 ± 12.2 years, whereas most of the cases were between 50 and 59 years (23.0%). The mean age at menarche was 14.7 ± 2.2 years, whereas less than two-third of the patients were between 13 and 16 years (63.4%). The mean age at first pregnancy was 24.3 ± 4.7 years, whereas majority of them were between 20 and 29 years (71.4%). The mean age at menopause was 49.0 ± 5.7 years, whereas more than a third of the patients were between 45 and 49 years (37.5%). The median number of children ever born was 4 (interquartile range [IQR]: 3–5). Majority of the patients are married (84.1%). The median duration of breastfeeding of the patients was 12 (IQR: 12–18) months. The mean body mass index was 28.6 ± 6.5, whereas about a third of them are obese (34.7%). Majority of the patients have unskilled occupation (51.1%). The test of association between sociodemographic characteristics and histology status revealed a significant association between age of patients (P = 0.013**), marital status (P = 0.027**), age at menarche (P = 0.009**), and number of children (P = 0.034**). The test of association between sociodemographic characteristics and stage of disease revealed a significant association between age at menarche (P = 0.018**), age at menopause (P = 0.041**), age at pregnancy (P = 0.036**), and body mass index (P = 0.028**). A total of 213 (30.9%) cases had combined treatment, 289 (59.4%) had a mastectomy, and 294 (71.6%) had radiotherapy. The treatment outcome revealed that 549 (48.1%) were lost to follow-up, 447 (39.2%) were dead, and 145 (12.7%) were alive after 2 years posttreatment. Conclusion: Sociodemographic characteristics such as age of patients, age at menarche, and marital status had a significant association with histology, whereas age at menarche, age at menopause, age at pregnancy, and body index mass had a significant association with stage of disease, therefore influencing health outcomes for breast cancer.
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Teenage pregnancies: A few years wait until young adulthood is worthy of advocacy p. 120
Omololu Adegbola, Mojisola Modupe Sanusi
DOI:10.4103/jcls.jcls_32_19  
Background: Teenage pregnancies are health problems of global importance attributed to restrictions of sexually active teenagers access to contraception. It is therefore important to study the impact of pregnancy on teenagers for better care and avert adverse pregnancy outcome. Objectives: The main objective of the study is to compare the pregnancy outcome (early pregnancy loss, preterm delivery, birth weight, live and stillbirths, and other perinatal outcomes) among teenagers (aged 15–19 years) and young adult women (aged 20–24 years). Materials and Methods: This was a comparative study of 74 teenage pregnancies and 690 young adult pregnancies managed at the Lagos University Teaching Hospital over a period of 5 years from May 1, 2008 to April 30, 2013. Results: The teenagers had more miscarriages and more preterm deliveries than young adults (P < 0.0001). Teenagers had more emergency cesarean deliveries and less spontaneous vaginal deliveries (P < 0.0001). Although teenagers had more low birth weight babies compared with young adults (33.3% vs. 22.8%), this was, however, not statistically significant (P = 0.0652). The perinatal mortality rate was 218/1000 total births among teenagers as compared to 90/1000 in young adult women, and this was statistically significant (P = 0.0049). Conclusion: Preventing teenage pregnancies or delaying pregnancy until adulthood results in a better fetomaternal outcome.
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Do we meet up with the standard blood demand, usage, and availability levels in State Specialist Hospital, Akure, Ondo State, Nigeria? p. 125
Patrick Olanrewaju Osho, Matthew Temitope Oluwole, Olumuyiwa John Fasipe, Salewa Evelyn Osho, Victor Olusesan Koledoye, Oluwatosin Idowu Oni, Akinwumi Akinbodewa
DOI:10.4103/jcls.jcls_26_19  
Aim: The aim of this study is to determine the extent of blood usage during blood transfusion procedures with evaluation of blood transfusion prescription practices in view of optimal and efficient utilization of blood transfusion services (BTSs). Materials and Methods: We prospectively analyzed all the blood orders between May 2015 and April 2017 from the Blood Bank of Hematology Laboratory in State Specialist Hospital, Akure, Ondo State, Nigeria. The indices used were in compliance with the international blood transfusion clinical practice guidelines. Results: Out of 1536 blood units ordered and crossmatched in this study, 62.57% units were transfused to patients and 37.43% were not transfused. This indicates judicious blood usage during transfusion procedure to saving lives. The overall blood transfusion indices for crossmatch-to-transfusion ratio (C/T), transfusion probability (%T), and transfusion index (TI) were 1.60, 62.57, and 1.00, respectively. This implied that blood at the point of utilization within the hospital, enjoyed a favorable status of blood prescription practice compare to the standard reference values (that is, C/T ratio ≤2.5, %T ≥30, and TI ≥0.5) in most of the departments under study. Departments such as Obstetrics and Gynecology (CT = 2.45, %T = 25.45, TI = 0.41) and General Theater (C/T = 3.8, %T = 16.44, TI = 0.26) exhibited inappropriate order of excessive crossmatched blood by junior medical officers which may be subsequently canceled by senior colleagues on later review of the patients were common. Conclusion: This study showed a reliable and efficient clinical practice in the management of BTSs from the point of order to the point of need which amount to a more appropriate, prudent, and conserved utilization of blood products, resources, and services.
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Two component preparation of fibrin glue and its clinical evaluation in split skin grafting p. 133
AP Pavan, Guru Prasad Reddy Gorla
DOI:10.4103/jcls.jcls_33_18  
Background: Fibrin glue is an alternative to conventional suturing and stapling of skin grafts and has several advantages. It acts as a sealant and a hemostatic agent with an added adhesive property that has been reportedly used in many specialties with better outcomes. Objective: The objective was to study the effectiveness of fibrin glue in anchoring the split skin graft to the wound bed and to analyze the advantages, disadvantages, and outcome of using fibrin glue compared to suturing and stapling. Methodology: A total of 60 patients undergoing split skin grafting for various indications were studied. Each patient was used as both case and control, where fibrin glue was applied on one half and sutures and/or staples were applied on the other half of the same ulcer. Examination of the wound was conducted by two observers independently from the 3rd postoperative day at regular intervals onward and included inspection for the graft uptake, soakage, and infection and graded accordingly based on the three parameters. Results: Overall, graft uptake was better in fibrin glue study group. Furthermore, soakage and infection were less in fibrin glue study group when compared to the conventional suturing/stapling. No difference in infections rate was found among burns and postsurgical raw area patients. Conclusion: The use of fibrin glue is a simple, safe, and cost-effective method, with a rapid technique to fix the skin graft, avoid peroperative bleeding and postoperative collection, better uptake of graft, and better overall results.
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Medication adherence and influencing factors in patients with type 2 diabetes attending a tertiary hospital in South-West Nigeria p. 138
Ebele Eugenia Onwuchuluba, Rebecca Oritsmeje Soremekun, Olubukola Olusola Oyetunde
DOI:10.4103/jcls.jcls_40_19  
Background and Objectives: Adherence to antidiabetic medications represents a huge hurdle that needs to be overcome for patients to gain maximum clinical benefits from their therapies. Several factors have been associated with patient adherence. This study assessed adherence to antidiabetic medications and evaluated the influence of pill burden on adherence. Materials and Methods: This is a cross-sectional study of 418 consenting patients with established type 2 diabetes attending the endocrinology Outpatient Clinic of a Tertiary Hospital. Patients were approached consecutively and surveyed using a questionnaire comprising information on demographics, medication adherence, and factors affecting adherence. Data on medication regimen and comorbidities were extracted from participants' case records. The study lasted for 15 months. Data were analyzed and summarized using descriptive and inferential statistics. Results: Nearly 27.5% of the participants were adjudged nonadherent to antidiabetic medications. The average number of antidiabetics was 1.56 ± 0.617. Of the number of participants that are adherent, nearly 33% and 35% of them were on one and two antidiabetic medications, respectively. However, been on three or more medications is associated with poorer adherence. Participants on metformin had better adherence compared to those on insulin alone or insulin plus oral antidiabetics. Short duration of diabetes (P = 0.048), older age (P = 0.024), and high educational level (P = 0.002) are associated with better adherence. Conclusion: A substantial number of patients were non-adherent to their antidiabetic medications. Been prescribed 3 or more antidiabetic medications was associated with poor adherence. The association between adherence to medication and glycemic control is not significant. High Pill-burden, young age, low educational level are potential targets for interventions.
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Oral characteristics of children with seizure disorders in a tertiary health institution p. 144
Chioma L Nzomiwu, Aderonke O Oluwo, Folakemi A Oredugba, Foluso E. A. Lesi
DOI:10.4103/jcls.jcls_42_19  
Background: Children with seizure disorders are faced with different oral conditions from lack of personal care, side effects of medications, and injuries from poor neuromuscular controls. Aims: This study aims to assess the oral health characteristics of children diagnosed with seizure disorders. Settings and Design: A cross-sectional survey was carried out among children aged 0–16 years who attended the outpatient neurology clinic of the Department of Paediatrics, Lagos University Teaching Hospital and an age- and gender-matched control group. Materials and Methods: Data were collected through interviewer-administered questionnaires to their parents/caregivers and oral examinations of the children. Statistical Analysis Used: Data entry was done using Statistical Package for Social Sciences version 20, and statistical analysis was performed using Chi-square test, and the level of significance was set at P < 0.05. Results: Two groups of 101 children each with seizure disorders and without seizure disorders aged between10 months and 16 years participated in the study. Majority of the participants with seizures –92 (91.1%) had never visited the dentist. The Decayed, Missing, Filled Teeth for participants with seizure disorders and control were 0.56 + 1.89 and 0.15 + 0.50, respectively. With regard to gingival hyperplasia, anterior open bite, proclined teeth, and fractures of teeth, patients with seizures showed significantly worse conditions compared with the control group. Conclusions: Result from this study showed that children who have seizures had poorer oral health and dental visit behavior than those without seizures. There is therefore a need for oral health care to be incorporated into recommended health care of these groups of patients to improve their quality of life.
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CASE REPORT Top

Sonographic diagnosis of fetal meningomyelocele in an obese patient: Report of a case p. 148
Ernest Ruto Upeh, Olaolopin Ijasan, Cletus Uche Eze
DOI:10.4103/jcls.jcls_53_19  
Meningomyelocele and meningocele are common neural tube defects in developing countries. Risk factors include poor sensitization of intending mothers on preconception folic acid use, maternal obesity, hyperthermia from malaria, and high pollution levels. Some of the problems associated with this condition include lack of dedicated spinal bifida clinics, expensive treatment, the social stigma associated with the condition, and poor awareness about the condition among local physicians. This has led to poor management outcomes. A multidisciplinary approach involving neonatologists/pediatricians, obstetricians, neurosurgeons, radiologists, psychologists, and physiotherapists is necessary to optimize patient outcome.
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