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   Table of Contents - Current issue
Coverpage
April-June 2020
Volume 17 | Issue 2
Page Nos. 11-50

Online since Thursday, May 14, 2020

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EDITORIAL  

Looking for sunrise in the horizon in the face of world pandemic p. 11
Adesoji O Ademuyiwa
DOI:10.4103/jcls.jcls_31_20  
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ORIGINAL RESEARCH REPORTS Top

Evaluation of prophylactic intravenous hydrocortisone for the prevention of postdural puncture headache following spinal anesthesia for cesarean section p. 13
Alaba Olusola Ogunsiji, Babatunde Babasola Osinaike, Simbo Daisy Amanor-Boadu, Gbolahan Oladele Obajimi
DOI:10.4103/jcls.jcls_71_19  
Context: Postdural puncture headache (PDPH) is a common complication following spinal anesthesia. No medication is currently used on routine basis for its prevention despite its high incidence. Aims: This study evaluated the efficacy of prophylactic intravenous (IV) hydrocortisone 100 mg in reducing the incidence and severity of PDPH among obstetric patients who had spinal anesthesia for cesarean delivery. Study Design: This study is a double-blind, randomized controlled trial in which 400 consenting parturients having cesarean section under spinal anesthesia were randomized into two groups; hydrocortisone and control groups. Following delivery, patients in the hydrocortisone group received IV hydrocortisone 100 mg diluted to 2 ml while those in the control group received the same volume of 0.9% saline. Patients were reviewed for the occurrence of PDPH over 5 days and headache severity assessed using the numerical rating scale. Intraoperative and postoperative side effects of single-dose hydrocortisone were also documented. Statistical Analysis: Data were analyzed using SPSS 20 software. A P < 0.05 was considered statistically significant. Results: A total of 197 and 194 patients completed the study in the hydrocortisone and control groups, respectively. In the hydrocortisone group, 46 patients (23.4%) developed PDPH compared to 48 patients (24.7%) in the control group (P = 0.813). Both the mean maximum NRS scores as well as headache severity grades were similar between both groups with P = 0.930 and 0.714, respectively. The duration of PDPH averaged 2.87 ± 1.44 days in hydrocortisone group compared with 2.73 ± 1.38 days in control group (P = 0.630). Conclusions: Prophylactic IV hydrocortisone 100 mg does not reduce the incidence or severity of PDPH following spinal anesthesia for cesarean section.
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Childhood intussusception in Abeokuta, South-west Nigeria p. 20
Opeoluwa Adetola Adesanya, Anuoluwapo Aremo, Olufunmilola Opeyemi Adesanya
DOI:10.4103/jcls.jcls_39_19  
Background and Objective: While significant progress has been made in the management of childhood intussusception globally, many centers in the developing world still grapple with the challenges of late presentation and attendant high morbidity and mortality. This study aims to review the pattern of presentation and the treatment outcome of children treated for intussusception at a semiurban tertiary hospital in Abeokuta, South-west Nigeria. Patients and Methods: A retrospective study of forty consecutive children aged 15 years old and below, who were managed for intussusception between April 2013 and March 2018 was done. The bio data, clinical presentation, operative findings, and outcome were obtained from the operating theater records and patient case notes. The data were analyzed using the SPSS software version 23. Results: There were forty patients, of which 20 were male and 20 were female. Their age ranged from 4 months to 5 years, with a median age of 7 months. Thirty -five (87.5%) patients were aged less 1 year. The duration of symptoms ranged between 6 h and 9 days (median = 3 days). Majority (57.5%) of patients presented after 48 h of the onset of symptoms. The patients were treated by the operative manual reduction in 67.5%, whereas 32.5% had bowel resection and anastomosis. Seven children (17.5%) died while postoperative complications occurred in 27.5% of patients. Factors associated with poor outcome included late presentation, bowel resection, and severe sepsis. Conclusion: The management of intussusception in Abeokuta is associated with high morbidity and mortality, which can be improved if affected children present earlier.
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Clinical correlates of tobacco use among hospitalized psychiatric patients p. 24
Sujita Kumar Kar, Pritha Roy, Pronob Kumar Dalal
DOI:10.4103/jcls.jcls_95_18  
Introduction: Recently concluded the National Mental Health Survey found the prevalence of tobacco use disorder to be 20.9% in adults (male = 32.8% and female = 9.8%). The burden of tobacco use disorder is higher in patients with mental illnesses, which significantly affects the treatment outcome. The aim of the study was to estimate the prevalence of tobacco use in psychiatry in-patients of a tertiary care hospital in North India and to compare sociodemographic and clinical parameters between tobacco users and nonusers. Methods: This is a cross-sectional, observational study conducted on psychiatric in-patients of a tertiary care hospital in North India. Retrospective chart review of patients with age ≥ 15 years was done. Data were extracted in a semi-structured pro forma. Comparison of sociodemographic and clinical parameters between tobacco users and nonusers was done using an appropriate statistical tool. Results: The study sample consisted of 303 psychiatric in-patients, of which 121 (39.9%) of patients were tobacco users (males = 58.85% and females = 7.21%). Among tobacco users, 52% were primarily suffering from severe mental disorders, 29% from common mental disorders. Tobacco users had a higher number of psychiatric comorbidities and comorbid other substance use disorders than tobacco nonusers. Comorbid alcohol use (38%) and cannabis use (34%) were also high in the tobacco user group. Those using tobacco were significantly less adherent to treatment.Conclusion: Tobacco use is seen in 2/5th of the psychiatric in-patients. High psychiatric comorbidity and poor treatment adherence are more common among tobacco users.
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Side effects of radiotherapy on breast cancer patients in the Department of Radiotherapy, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria p. 30
Anthonia C Sowunmi, Peace C Onuoha, Adewunmi O Alabi, Uchenna Samuel Okoro
DOI:10.4103/jcls.jcls_79_18  
Background: Side effects of radiotherapy (RT) could be temporary or permanent, can be severe, and affect quality of life. An investigation into the side effects of RT on breast cancer patients would help evaluate the incidences and associated risk factors in the low-income countries for patients undergoing RT in order to ensure maximum treatment with very minimal side effects. Objective: To assess the side effects of RT in patients with breast cancer undergoing RT in Lagos University Teaching Hospital. Materials and Methods: This was a descriptive, cross-sectional study. Self-administered questionnaires were distributed to breast cancer patients on RT that have received treatment for at least 2 weeks at the RT Department between March and August 2016. A total of 146 questionnaires were distributed, whereas 139 were completely filled and returned for the evaluation and analysis, given a response rate of 95.2%. Results: The common side effects noticed from the analysis of this research work included skin erythema (87.1%), fatigue (74.1%), telangiectasia (69.1%), pain (89.9%), breast swelling (45.3%), and loss of hair in the armpit and chest area (87.1%), and the less common ones were breast shrinkage (20.1%), lymphedema (41.0%), cardiac complications (30.9%), lung problems (12.9%), sore throat (7.9%), brachial plexopathy (24.5%), and damage to the bones (ribs; 3.6%). Management of the side effects by patients revealed that 30 (21.6%) used analgesics, 28 (20.1%) used steroidal cream, 27 (19.4%) avoided deodorants and antiperspirant, 22 (15.8%) exercised, 15 (10.8%) took antibiotics, 10 (7.2%) took herbs, and 7 (5%) had to stop treatment temporarily for minimum of a week due to severe morbidity. Conclusion: A large percentage of breast cancer patients undergoing RT experience painful side effects (89.9%), of these 87% experience skin erythema, 74% experience fatigue, and 69% experience telangiectasia.
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Risk behaviors for road traffic crashes among commercial motorcyclists in a semi-urban area of Ogun State, Nigeria p. 38
Kolawole John Sodeinde, Oluwakemi O Odukoya, Titilope O Charles-Eromosele, Tolulope F Olufunlayo
DOI:10.4103/jcls.jcls_15_19  
Background: Over the past three decades, there has been an increase in the use of motorcycles as a means of transportation in Nigeria. Motorcycle-related crashes have also been on the rise, with human error accounting for up to 90% of traffic accidents in Nigeria. This study aimed to identify risky behaviors for road traffic crashes among commercial motorcyclists in Ikenne local government of Ogun State, Nigeria. Methods: This descriptive cross-sectional study was carried out among 400 commercial motorcyclists selected using multistage sampling method. A semi-structured, interviewer-administered questionnaire was used to elicit data about respondents' awareness of certain risky behaviors as causes of motorcycle crashes and their attitude toward and practice of such risky behaviors. Data were analyzed using SPSS version 16 and presented as chart and tables. Results: The mean age of the respondents was 33.7 ± 9.5 years. Only few (4.0%) had tertiary education. All of them were males. Awareness of risky behaviors was good with an average of 85.9%. Attitude to causes of accidents was also good, with 90.4% of the respondents having good attitude. However, most (95.5%) of the respondents demonstrated accident-related risky behavior(s). Risk behavior was statistically associated with younger age (P < 0.001), lower levels of education (P < 0.01), and training before commencement of trade (P < 0.05). Conclusion: Despite good awareness and attitude, most respondents demonstrated one risky behavior or the other. Younger age and poor educational status were statistically associated with risky behaviors. There is need for strict enforcement of traffic codes to ensure compliance.
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Correlation of neutrophil–lymphocyte ratio with disease activity in rheumatoid arthritis p. 46
Saif Quaiser, Ruhi Khan
DOI:10.4103/jcls.jcls_16_18  
Background: Neutrophil–lymphocyte ratio (NLR) is reported to be increased in various inflammatory conditions, but its significance in RA remains unclear. The aim of this study was to evaluate whether NLR can be used as a simple tool for disease activity assessment in rheumatoid arthritis (RA). Aim: The aim was to assess the NLR in RA patients and compare between active cases and those in remission. Materials and Methods: The study enrolled 150 diagnosed RA patients. Disease activity was determined with the Disease Activity Score (DAS-28), and the correlation of NLR with disease activity was analyzed. Results: NLR, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were found to be significantly high in RA patients. Further, NLR correlated positively with CRP, ESR, and worsening DAS score. Conclusion: Our study concludes that NLR can become a readily available and cost-effective tool for disease assessment in RA in future.
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SHORT COMMUNICATION Top

Preventing the progression of coronavirus disease 2019 pandemic to community transmission stage in the Western Pacific region p. 49
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jcls.jcls_20_20  
The pandemic of Corona Virus Disease-2019 (COVID-19) has resulted in the loss of lives of thousands of people, socioeconomic commotion, and overwhelmed health care facilities. In the Western Pacific region, despite of the significant decline in the number of reported cases in China, the region accounted for 943 cases and 20 deaths in a single day and it is an indication that the disease continues to spread. The nations in the region have begun the task of scaling up of all essential activities with an aim to ensure that they are ready and well-equipped with facilities to facilitate quick detection and subsequent actions against the disease. In conclusion, like the global community, the Western Pacific region has to step up their efforts to fight against the COVID-19 pandemic. We have to ensure that we are ready with our capacity building and resource before the emergence of the outbreak in the region and this will essentially require a coordinated and concerted approach from all the involved stakeholders.
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