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   Table of Contents - Current issue
Coverpage
January-March 2019
Volume 16 | Issue 1
Page Nos. 1-41

Online since Thursday, February 14, 2019

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ORIGINAL RESEARCH REPORTS  

A comparison of propofol - fentanyl with midazolam – pentazocine combination for sedation and analgesia during colonoscopy in Ibadan Nigeria p. 1
Tinuola Abiodun Adigun, Adegboyega Akere, Omobolaji O Ayandipo, Oludolapo O Afuwape
DOI:10.4103/jcls.jcls_38_18  
Background: Benzodiazepines, narcotics, and propofol in different combinations are administered to provide sedation and analgesia during colonoscopy. The study aimed to compare the efficacy and safety of midazolam-pentazocine with the propofol-fentanyl combination for sedation and analgesia during colonoscopy. Patients and Methods: This prospective randomized, double-blind study was conducted in 62 adults aged 18–82 years scheduled for colonoscopy. Patients were assigned into two groups, Group A (n = 31) received midazolam 2.5–5.0 mg with pentazocine 15–30 mg, whereas Group B (n = 31) received propofol 0.5 mg/kg with fentanyl 0.5ug/kg before the procedure. Efficacy was measured by the depth of sedation using Ramsay sedation score (RSS), pain score, and recovery from sedation, whereas safety was evaluated with heart rate, blood pressure (BP), and oxygen saturation. Results: There was no statistically significant difference between the two groups with respect to demographic and clinical data. The patients in Group B were more sedated with a mean RSS of 4.1 ± 0.79 compared with 2.07 ± 0.74 in Group A (P = 0.001). The mean pain score during the procedure was lower in Group B 3.19 ± 1.9 compared with 4.8 ± 1.9 in Group A (P = 0.001). The recovery time was faster in Group B compared with Group A, 24 versus 46 min, respectively (P = 0.001). The systolic BP at 5 and 10 min was lower in Group B (P = 0.024 and P = 0.001), respectively, as well as the diastolic BP at 5 and 10 min (P = 0.042 and P = 0.04), respectively. Hypotension was observed in six patients in Group B compared to two patients in Group A. There was no difference in the heart rates in both groups. Two patients in both groups had desaturation <90%, and oxygen was administered to maintain the oxygenation. No patient developed apnea that would have warranted endotracheal intubation. Conclusion: Propofol-fentanyl combination provided better sedation, less painful procedure, and shorter recovery time with minimal cardiorespiratory complication.
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Maternal knowledge, attitude and compliance regarding immunization of under five children in Primary Health Care centres in Ikorodu Local Government Area, Lagos State p. 7
Oluwatoyosi Adetola Adefolalu, Oluchi Joan Kanma-Okafor, Mobolanle Rashidat Balogun
DOI:10.4103/jcls.jcls_55_18  
Introduction: Immunization is one of the most successful and cost-effective public health interventions, saving the lives of 3 million children annually. One-third of the deaths among under-fives are preventable by vaccines. This study aimed to assess the knowledge, attitude, and compliance of mothers regarding immunization of under-five children in Ikorodu Local Government Area, Lagos State. Subjects and Methods: A cross-sectional descriptive study was carried out among 250 mothers of under-five children at health centers in Ikorodu selected by multistage sampling. An interviewer-administered questionnaire was used as the survey tool. Data were analyzed using Expanded Program on Immunization – Info Version 7.1.1.14. P < 0.05 was considered statistically significant. Results: All respondents were aware of immunization, more than half (72%) of them had good knowledge about the immunization of under-five children, all the mothers (100%) had a positive attitude toward immunization and a majority (86.4%) of the respondents had fully immunized their children. There was a statistically significant association between the mother's age, occupation, level of education, nature of the family and the level knowledge of the respondents. There was also a statistically significant association between the mothers' age and occupation and their compliance with the immunization of their children. Conclusion: Most mothers had good knowledge, a positive attitude and good practice towards immunization. Maternal age, education, and hence their occupation were important factors for good knowledge and practice towards childhood immunization. The education of women, thus delaying marriage, remains a key factor in ensuring child survival through immunization.
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Aortic aneurysm: A life-threatening condition in a low-resource nation p. 15
Ezekiel O Ogunleye, Oyebola Olubodun Adekola, Olufemi I.O. Dada
DOI:10.4103/jcls.jcls_44_18  
Background: Aortic aneurysm is said to be uncommon in the black population; however, with the modification in lifestyle of the dark-skinned people, and improved diagnostic facilities in Sub-Saharan African nations, a surge in its presentation is more likely. If undiagnosed, aortic aneurysm can be catastrophic. We determined the epidemiology pattern and outcome of aortic aneurysm at our institution. Materials and Methods: This is a retrospective analysis of patients who presented with aortic aneurysm from 2000 to 2017. A pro forma was designed to analyze the bio data, characteristics of the aneurysms, clinical manifestation, treatment, and outcome. The Crawford, Stanford, and DeBakey criteria were used to classify the aortic aneurysm. The surgical management of the aneurysm was resection and its replacement with synthetic polytetrafluoroethylene prosthesis with antibiotic prophylaxis under general anesthesia. Results: A total of 17 patients were recruited, with a mean age of 62.75 ± 20.92 years. A high proportion were above 65 years, i.e., 7 (41.2%), and male gender, i.e., 10 (58.8%). The most common location of aortic aneurysm using Crawford criteria was Type IV followed by Type I, with Stanford criteria being Stanford Type B (13) and with DeBakey being Type III (3). Five operated were fusiform in shape. A higher proportion of patients, i.e., 14 (82.4%), had coexisting hypertension, and a positive history of smoking, i.e., 7 (41.2%). The 30-day mortality was 64.7%, the operative mortality was 35.3%, and three patients (17.6%) were loss to follow-up. A positive history of smoking increased the risk of dead, relative risk 3.375, 95% confidence interval 0.677–5.909, P = 0.04. Conclusion: Aortic aneurysm, though uncommon, is not a rare disease among cardiovascular disorders in a low-resource environment. The most common shape and location were fusiform and Stanford Type B or DeBakey Type III, respectively. There was associated high 30-day mortality (64.7%).
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Iodine status in pregnant Nigerian women; Does Gestational age matters? p. 20
Oluwatosin O Kayode, Ifedayo A Odeniyi, Oluwarotimi B Olopade, Sandra O Iwuala, Oluwakemi O Odukoya, Olufemi A Fasanmade
DOI:10.4103/jcls.jcls_3_18  
Background: Iodine deficiency affects over 2.2 billion individuals globally. It is the most common cause of hypothyroidism in pregnancy and remains the leading cause of preventable infant intellectual deficits. This study set out to determine the relationship between gestational age and iodine status in Nigerian women. Methods: This was a prospective cross-sectional study with a total study population of 220 pregnant and 110 nonpregnant participants. Urinary Iodine Excretion (UIE) was performed using the Sandell–Kolthoff reaction. Pregnant women were grouped into three trimesters (0–13 weeks, 14–26 weeks, and ≥27 weeks.). Analysis of variance was used in comparison of means, Chi-square test used in analyzing proportions, while P ≤ 0.05 was considered statistically significant. Results: The median UIE was 135 μg/L in pregnant and 120 μg/L in the nonpregnant women. Among the pregnant women, 133 (60.5%) had insufficient iodine intake (UIE <150 μg/L) while 29 (27.3%) of the nonpregnant women had inadequate iodine intake (UIE <100 μg/L). The median UIE was 140, 139, and 120 μg/L in the first, second, and third trimesters, respectively (P = 0.13). The median UIE declined with advancing gestational age. The percentage of pregnant women with inadequate iodine intake was 53.6% in the first trimester and 59% and 72.6% in the second and third trimesters, respectively (P = 0.03). Conclusion: Three-fifths of the pregnant women had inadequate iodine intake. The median UIE decreased with advancing gestation. Iodine supplementation before and during pregnancy would help improve the iodine status in pregnancy.
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Impact of ophthalmology posting on the attitude and perception of senior medical students in a Nigerian medical school to ophthalmology as a specialty and a career choice p. 26
Kareem Olatunbosun Musa, Olufisayo Temitayo Aribaba, Adetunji Olusesan Adenekan, Olubanke Theodora Ilo, Monsurah Olabimpe Salami, Adeola Olukorede Onakoya
DOI:10.4103/jcls.jcls_84_18  
Background: Ophthalmology posting/clerkship is an integral part of the curriculum of medical schools globally. This provides ophthalmic educators an excellent opportunity to positively influence the medical students undergoing the posting. Materials and Methods: A pretest–posttest, noncontrolled, nonrandomized experimental study was conducted among 5th year medical students of the College of Medicine of the University of Lagos who underwent ophthalmology posting between November 2015 and February 2016. All respondents were requested to fill a semistructured questionnaire on the first and the last day of the posting. Information on sociodemographic data, perception and attitude toward ophthalmology, future practice plan, and a possibility of taking up a career in ophthalmology were obtained using a semistructured questionnaire. The data were analyzed using IBM Statistical Package for the Social Sciences version 20. Results: A total of 210 out of the 228 students participated in this study constituting a response rate of 92.1%. The mean age was 23.0 ± 2.3 years, and the male-to-female ratio was 1:1.1. There was a statistically significant improvement in the overall mean attitudinal scores after posting compared to the scores before posting (P < 0.01). Furthermore, there was a statistically significant improvement in the overall mean perception scores after posting compared to the scores before posting (P < 0.01). Although there was an increase in the mean score of disposition of respondents to ophthalmology as a future career from 2.18 before posting to 2.30 after posting, this was not statistically significant (P = 0.06). Conclusion: The 4-week ophthalmology posting impacted positively on the perception and attitude of respondents to ophthalmology as a discipline, but did not translate to a significant improvement in the consideration of ophthalmology as a future career.
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Use of imaging modalities and the effectiveness of radiation therapy on brain tumors in a tertiary hospital in Nigeria p. 33
Sandra C Nkamigbo, Omodele Abosede Olowoyeye, Muhammad Y. M. Habeebu, Anunobi Charles Chidozie, Oselumenosen David Omiyi, Omolola Salako, Victor I Edeh
DOI:10.4103/jcls.jcls_2_18  
Background: Brain neoplasia is of concern in our environment because there are no preventive measures or sufficient availability of definite treatment. With imaging, the disease can be detected and the treatment evaluated. Materials and Methods: In this retrospective study carried out at a tertiary hospital in Nigeria, diagnostic imaging modalities used for imaging brain tumors, the pattern of tumors identified at histology, and the response of brain neoplasia to radiation therapy were analyzed. Results: Out of the 147 patients included in the study, the mean age was 44.5 ± 2.3 years of age. For diagnostic imaging, 60% used only computed tomography (CT) scan, 24% used magnetic resonance imaging (MRI), while 16% used both CT scan and MRI. Histologically, primary tumors (54%) occurred more than metastasis (46%). Breast metastasis (33.3%) was the singular most common tumor, followed by astrocytoma (19%). For definitive management, almost half of the cases (49%) had radiotherapy alone. 25% had radiotherapy with surgery, 10% had both radiotherapy and chemotherapy while 16% had all three. Four weeks posttreatment, there was 78% positive response to therapy. Conclusion: In our environment, the radiological evaluation of brain tumors is often by CT scan, even though MRI offers better soft-tissue contrast. This may be ascribed to the relative affordability and availability of CT scan. Radiation therapy is effective in the treatment of brain tumors.
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CASE REPORT Top

Sezary syndrome in a 65-year-old schizophrenic patient p. 37
Abdullahi Umar, Tahir Turaki Mohammed, Maryam Shehu Ahmed, Modupeopla Omotara A. Samaila, Hadiza Sani
DOI:10.4103/jcls.jcls_50_18  
Sezary syndrome (SS) is the leukemic variant of cutaneous T-cell lymphoma characterized by a triad of erythroderma, peripheral lymphadenopathy, and the presence of circulating atypical lymphoid cells (Sezary cells) in the blood. We present a 65-year-old female with a recent-onset schizophrenia, presenting with a 3-year history of recurrent generalized pruritus, erythroderma, and a 2-month history of recent-onset, mushroom-like skin tumors. Examination revealed generalized erythroderma affecting more than 80% of total body surface area and significant peripheral lymphadenopathy. Peripheral blood buffy coat examination showed Sezary cells which constituted more than 18% of total circulating lymphoid cells, and histology report of the wedge biopsy of skin tumor confirmed mycosis fungoides. The patient was commenced on cytotoxic chemotherapy with some improvement in symptoms. However, she relapsed 2 months later, with development of new fungating tumors and died from overwhelming sepsis. We report this case to highlight the occurrence of two comorbidities together, each of which may negatively worsen the progression of the other, and to report a case of SS as one of the rare causes of generalized exfoliative dermatitis. Thus, there is a need for early skin biopsy and histology in any elderly patient presenting with recurrent generalized pruritus and erythroderma.
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