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   Table of Contents - Current issue
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October-December 2018
Volume 15 | Issue 4
Page Nos. 171-214

Online since Monday, December 3, 2018

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ORIGINAL RESEARCH REPORTS  

Pattern of presentation and outcome of management of acute appendicitis: A 10-year experience p. 171
Oludolapo O Afuwape, Omobolaji O Ayandipo, Oluwafunmilayo Soneye, Adegbolahan Fakoya
DOI:10.4103/jcls.jcls_105_17  
Background: Appendicitis is one of the most common indications for nonelective abdominal surgery. This is true in both developed and developing countries. The aim of this study was to describe the pattern of presentation and outcome of management in a large hospital in the developing world. Methods: All patients of the general surgery divisions who had appendicectomy for clinical preoperative diagnosis of acute appendicitis between July 2007 and June 2016 were included in the study. Patients who had incidental appendicectomy were excluded from the study. Data were collected retrospectively using a data collection instrument designed for the study. Results: The total number of appendicectomy operations performed within the stipulated period was 1081. Male:female ratio was 1.37:1. The age range was from 12 years to 80 years. The most common symptom and sign remain the right lower quadrant pain and right iliac fossa tenderness, respectively. The duration of symptoms before presentation ranged from 10 h to 96 h. Approximately 20% or a fifth of the patients had ruptured appendix. Tumor associated appendicitis constituted 2.2%. The negative appendicectomy rate was 9.5%. About 47% of the patients were discharged <72 h after surgery. There were five mortalities in all. Conclusion: The diagnosis of acute appendicitis in the developing world may still be done with acceptable levels of accuracy based on in-depth medical history and clinical examination.
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Neck dissection: Clinicosurgical appraisal of 21 cases in a sub-Saharan African tertiary referral hospital p. 176
Abdurrazaq Olanrewaju Taiwo, Ramat Oyebunmi Braimah, Adebayo Aremu Ibikunle, Olalekan Micah Gbotolorun, Terry Godwin Ndubuizu
DOI:10.4103/jcls.jcls_32_18  
Background: Neck dissection constitutes an essential part of overall management of cancer of the head-and-neck region. Once the tumor involves neck nodes, survival drops by almost 50%. The aim of this present study is to present our experience in neck dissections. Patients and Methods: This was a retrospective study of neck dissection carried out in the department of dental and maxillofacial surgery of a tertiary referral hospital. Information retrieved includes age, sex, diagnosis, type of primary surgery, type of neck dissection, complications, and prognosis. Data were stored and analyzed using IBM SPSS Statistics Version 20 (IBM Corp., Armonk, NY, USA). Results: A total of 21 neck dissections were carried out during the study period. The patients' age ranged from 23 to 72 years with a mean ± standard deviation of 55.1 ± 11.9. There are 12 (57%) males and 9 (42.9%) females with an M:F ratio of 1.3:1. Squamous cell carcinoma (14 [66.7%]) was the main indication for neck dissection. Modified radical neck dissection (RND) (Type 1) was the commonest type of neck dissection carried out (7 [33.3%]), while 4 (19.0%) cases and 3 (14.3%) cases of modified RND Type II and Type III, respectively, were performed. Three (14.3%) cases of selective neck dissection (SND) (Type III) and one (4.8%) case of SND (Type II) were performed. Extended neck dissections were carried out in three (14.3%) patients. Overall, 11 (52.4%) patients survived, while 7 (33.3%) were lost to follow-up and 3 (14.3%) passed away. Conclusion: Patient selection is essential in neck dissection in the overall management of oncologic head-and-neck diseases.
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Paranasal sinus mucoceles in a tertiary center, Southwestern Nigeria: A 10-year review of ophthalmic features, management, and outcome p. 183
Oluyemi Fasina, Sule Samuel Okoh
DOI:10.4103/jcls.jcls_34_18  
Background and Objective: Paranasal sinus mucoceles result from obstruction of the ostium of the affected paranasal sinus which becomes filled with secretions from the mucosal lining. We report the clinical features, management, and outcome of treatment in patients with paranasal sinus mucoceles in a tertiary health facility. Patients and Methods: Retrospective chart review of all patients with paranasal sinus mucoceles was conducted. Results: A total of 12 cases of paranasal sinus mucoceles were managed during the study period with equal gender distribution and mean age of 37.7 ± 5 years. The mean duration of symptoms before presentation was 2.5 ± 2.2 years, and all the patients presented with nonaxial proptosis, with 7 (58.3%) patients having orbital extension of the mucocele. The frontal and ethmoidal sinuses were most affected and frontoethmoidectomy was performed in 5 (41.7%) patients, while this was combined with medial orbitotomy in 5 (41.7%) patients and orbital exenteration in 2 (16.6%) patients. Conclusion: Paranasal sinus mucoceles are relatively uncommon in our region but still associated with significant ocular morbidity.
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Economic burden, impact, and consequence of adverse drug reactions among medical inpatients in clinical practice p. 186
Peter Ehizokhale Akhideno, Olumuyiwa John Fasipe, Ambrose Ohumagho Isah, Omagbemi Sampson Owhin
DOI:10.4103/jcls.jcls_64_18  
Background: An adverse drug reaction (ADR) is defined in this study as a response to a drug which is noxious and unintended that occurs at doses normally used for therapeutic purposes. Despite the extensive study and attention given to ADRs, they still represent a clinically significant problem and burden with high prevalence. Aim: The main aim of this study was to adequately evaluate the economic burden, impact, and consequence of ADRs among adult medical inpatients in clinical practice, to highlight the pattern of medications most frequently involved in ADRs, and to estimate the economic cost implication of treating ADRs in such clinical practice setting. Methods: The patients admitted into the adult medical wards of a Nigerian university teaching hospital over a 9-month period from December 2013 to August 2014 were prospectively recruited for the study and followed up till discharge. Results: Five hundred and seven patients were evaluated during the study, out of which 269 (53.1%) of them were male and 238 (46.9%) were female. The mean age of the study population was 48.9 ± 17.8 years (median: 46 years). Most ADRs were mild and moderate in 21 (41.2%) cases and 24 (47.1%) cases, respectively. Severe ADRs occurred in 2 (3.9%) cases, while four (7.8%) cases were fatal ADRs. The economic cost implication of treating ADRs was ₦ 161,668.00 ($1243.60), equivalent to about 1.9% of the total cost of all medications used by all admitted medical inpatients during admission. The cost of treating ADRs per patient with ADRs was ₦ 3169.96 ± ₦ 6348.77 ($24.38 ± $48.84), while the mean ADR treatment cost per admitted medical inpatient was ₦ 318.87 ($2.45). The most frequently affected body systems by ADRs were the central nervous system and the gastrointestinal system corresponding to the antidiabetic drug – insulin use causing neuroglycopenic symptoms and nonsteroidal anti-inflammatory drugs (NSAIDs) use causing NSAID-induced gastroenteritis/GIT bleeding, respectively. Conclusions: The economic burden, impact, and consequence of ADRs were significantly high among these adult medical inpatients. In this study, ADRs increase patients' morbidity, mortality, cost of health care, and length (duration) of hospitalization. Insulin and NSAIDs caused the highest number of ADRs which indicate that adequate caution, proper care, and continuous monitoring must be implemented during the course of treating patients with these drugs to optimize their clinical efficacy and prevent the occurrence of ADRs in them.
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Does the anesthetic technique influence the epinephrine and norepinephrine concentration during pelvic surgery? p. 194
Oyebola Olubodun Adekola, Adekunle O Durodola, Ibironke Desalu, Temitayo Olushola Kushimo, John Olutola Olatosi, Godwin O Ajayi
DOI:10.4103/jcls.jcls_52_18  
Background: Epinephrine and norepinephrine concentrations increase by up to ten-fold immediately after surgical injury depending on the severity of the injury. However, the plasma levels of epinephrine and norepinephrine do not necessarily increase concurrently. The plasma epinephrine levels increase for about 48 h, while the norepinephrine levels remain elevated for about 8-10 days after injury. The choice of anesthesia has been shown to influence the secretion of epinephrine and norepinephrine. Materials and Methods: We compared the effects of balanced combined spinal-epidural anesthesia (CSEA, n = 20) and general anesthesia relaxant (GAR, n = 20) on epinephrine and norepinephrine concentrations during major pelvic surgery in patients with uterine mass > 20 weeks gestation. Blood samples for epinephrine and norepinephrine were analyzed at preinduction and 1, 3, and 4 h after surgical incision using enzyme-linked immunosorbent assay technique. Results: The mean norepinephrine concentration differs significantly after incision; at 1 h, CSEA 230.11 ± 42.85 versus GAR 51.25 ± 29.15 pg/ml, P = 0.015; and at 3 h, CSEA 116.22 ± 39.91 versus GAR 27.00 ± 19.89 pg/ml, P = 0.045. The norepinephrine concentrations increased from preinduction values after incision; at 1 h, increased in CSEA by +168% but increased in GAR by +31.7%; at 3 h, increased in CSEA by +35.64% but decreased in GAR by -22.85%; while at 4 h, decreased in CSEA by −3.37% but increased in GAR by +38.94% , P = 0.04 [Figure 2]. The mean epinephrine was comparable during the study, P > 0.05, while the mean heart rate, mean arterial blood pressure, and estimated blood loss were significantly lower with CSEA. Conclusion: We have demonstrated that in patients with uterine mass >20 weeks gestation, CSEA when compared to general anesthesia resulted in an initial increase in mean norepinephrine concentration 1 h after surgical incision followed by gradual decrease toward preinduction values.
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Evaluation of the usefulness of plain radiography in the imaging of nontraumatic neck pain: A retrospective survey at a tertiary hospital in Lagos, Nigeria p. 201
Cletus Uche Eze, Christopher Chukwuemeka Ohagwu, Livinus Chibuzo Abonyi, Nicholas Kayode Irurhe, Titilope A Ayeni
DOI:10.4103/jcls.jcls_51_18  
Background: Plain radiography rather than magnetic resonance remains the first-line modality in the evaluation of patients with nontraumatic neck pain (NNP) in most hospitals in Lagos, Nigeria. Objective: The objective of the study is to determine the usefulness of plain radiography in the detection of causes of NNP. Subjects and Methods: A sample of 596 patients was evaluated in a retrospective study carried out at a tertiary hospital. Request forms were used to sort patients into the type of X-ray views requested by physicians while radiologists' reports were used to sort patients according to radiological findings, type of X-ray views, and type of imaging modality requested by radiologists for further evaluation of patients. Results: No abnormality detected was reported in 67.6% of patients while computed tomography or magnetic resonance imaging was requested for further evaluation in 74.6% of patients. Physicians requested anteroposterior (AP) and lateral views for most patients (71.1%) while AP, both oblique and lateral as well as AP, open-mouth, and lateral views were requested for 12.5% and 16.4% of patients, respectively. Radiologists requested either oblique or open-mouth view for 214 patients after film review. The mean age of patients was 46 ± 6 years; 39.3% of patients were men while 60.7% were women; pain was most common after the 5th decade of life. Conclusion: Plain radiography was useful in the evaluation of patients with NNP in the tertiary hospital studied although it was not totally done in line with any standardized pathway for imaging of patients with NNP.
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The competence of community pharmacists in Lagos, Nigeria, on correct inhaler techniques p. 207
Obianuju B Ozoh, Hilda Omogie, Daniel O Obaseki, Ayodeji O Dosu
DOI:10.4103/jcls.jcls_42_18  
Background and Objectives: Community pharmacists are in an excellent position to train asthma patients on inhaler techniques. Their competence in the use of these devices contributes to the effectiveness of their training. We aimed to evaluate the knowledge and competence in the use of various inhaler devices among community pharmacists in Lagos, Nigeria. Subjects and Methods: This was a cross-sectional study using standard checklists and dummy devices to evaluate the competence of pharmacists on the use of the metered-dose inhaler (MDI), Diskus, Turbuhaler, and the MDI with spacer. Results: There were 42 participants, 66.7% male and median age of 40.5 (interquartile range: 34.6–50.0) years. All were familiar with the MDI, 60%, 7%, and 5% were familiar with the Diskus, Turbuhaler, and the spacer, respectively. The mean checklist scores on the MDI and Diskus were 5.3 ± 3.0 and 2.3 ± 3.3 (maximum 11), respectively. One participant performed all the steps correctly on either device. Only one participant scored a point on the Turbuhaler, and the mean score for the spacer was 0.8 ± 2.9 (maximum 13). No participant performed all the steps correctly on either the Turbuhaler or the spacer. Previous training on inhaler technique was the only independent determinant of better performance on the MDI (odds ratio 0.44; 95% confidence interval 0.97–4.74). Conclusion: The competence of community pharmacists in Lagos, Nigeria, on inhaler techniques is poor. Their awareness of the Diskus, Turbuhaler, and spacer devices is also very low. Educational interventions are needed to improve competence in correct use of inhalers among pharmacists to enable them effectively play their role in asthma care.
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LETTERS TO EDITOR Top

Infantile hemangioendothelioma of the liver in a Nigerian newborn: A case report p. 213
Mahmood Dhahir Al-Mendalawi
DOI:10.4103/jcls.jcls_78_17  
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Infantile hypertrophic pyloric stenosis and bilious vomiting: An unusual presentation p. 214
Mahmood Dhahir Al-Mendalawi
DOI:10.4103/jcls.jcls_97_17  
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