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   2020| July-September  | Volume 17 | Issue 3  
    Online since July 4, 2020

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Diuretic resistance in patients with heart failure: Clinical characteristics and predictors of outcome
Mesfin Tasew, Tamirat Moges Aklilu, Senbeta Guteta Abdissa
July-September 2020, 17(3):66-73
Background: Our aim was to study the clinical characteristics and predictors of mortality in heart failure (HF) with diuretic resistance. Methods: We conducted a 5-year retrospective study on 119 HF patients with diuretic resistance at Tikur Anbessa Specialized Teaching Hospital. The primary endpoint was mortality. We compared baseline characteristics and assessed association in patients who received high-dose (≥120 mg) versus low-dose (<120 mg) furosemide. Bivariate and multivariate logistic regression analyses were done. Results: Patients receiving high-dose diuretic had significantly higher mean values for age and in New York Heart Association Class IV HF and received a larger dose of hydrochlorothiazide than low-dose patients. They also had significantly higher mean values for systolic blood pressure (SBP), hemoglobin, and serum creatinine. There was no significant difference in mortality between the two groups. On multivariate analysis, association with the high-dose diuretic group remained significant for the higher mean value for SBP and serum creatinine. Independent predictors of mortality were anemia (adjusted odds ratio [AOR]: 4.1, 95% confidence interval [CI]: 1.1–15.2, P = 0.04), infective endocarditis (AOR: 4.9, 95% CI: 2.1–25.7, P = 0.01), and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) (AOR: 3.1, 95% CI: 1.1–9.9, P = 0.04). The use of digoxin was associated with lower mortality (AOR: 0.21, 95% CI: 0.06–0.78, P = 0.01). Conclusions: In HF patients with diuretic resistance, anemia, infective endocarditis, and the use of NSAIDs were independently associated with increased mortality, whereas the use of digoxin was associated with reduced mortality. Early identification and treatment of the risk factors could play a role in reducing mortality.
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Return to work during the epidemic – Implications for surgical care: Caution is the word
Adesoji O Ademuyiwa
July-September 2020, 17(3):51-51
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The relationship between grip styles and musculoskeletal injuries in table tennis players in Lagos, Nigeria: A cross-sectional study
Ayoola Aiyegbusi, Mayowa Oduntan
July-September 2020, 17(3):52-56
Background: Table tennis is a high skill sport that requires athletes to make accurate judgments. It involves explosive, repeated movements that involve hitting the ball, thus subjecting the musculoskeletal system to risks of overuse injuries. Grip styles in table tennis, which is the way players hold the racquet has been reported to affect injury predisposition. Aims: The aim of this study determine the dominant grip styles among table tennis players in Nigeria and how they predispose to musculoskeletal injuries. Setting and Design: This was cross-sectional study. Materials and Methods: This study involved 108 professional and recreational male and female (M = 71, F = 37) table tennis players with at least 6 months playing experience from selected sports clubs in Lagos state, Nigeria. An adapted questionnaire from the Badminton Injury Questionnaire and the Tennis Injury Questionnaire was used to collect data. Data were analyzed using descriptive statistics, and the association between variables was determined using Chi-square and the level of statistical significance was set at P < 0.05. Results: The Shakehand grip was the predominant style (90.7%) among the players and had the highest prevalence of injury (94.2%). Although other grip styles in relative terms predisposed less to injuries, they appear not to be popular among the players. There was no significant association (P > 0.05) between the different grip styles and the prevalence of injury. The personal grip style was, however, significantly (P < 0.05) associated with dislocation and bruises. Conclusion: The Shakehand Grip was the predominant Grip style among Table Tennis players in Lagos and had the highest prevalence of injury.
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Neoplasms of the appendix: An experience of a tertiary hospital in Southwestern Nigeria
Mustapha Akanji Ajani, Sebastian A Omenai, Oluwadamilare Iyapo
July-September 2020, 17(3):57-60
Background: The appendix is a vestigial tube-like organ. Its exact physiological function is unknown. Appendectomies are done usually following a clinical diagnosis of acute appendicitis. Neoplasms can arise from this organ as well. Carcinoids are the most common neoplasms arising commonly at the tips. This retrospective review of neoplasms of the appendix was aimed at identifying the incidence and describing the histological variants of neoplasms of the appendix in our environment. Materials and Methods: This study was a 10-year retrospective review of all appendectomy specimens submitted to the Department of Pathology, University College Hospital, Ibadan, Nigeria, from January 1, 2009, to December 31, 2018. Microscopy was done examining the longitudinal sections from the tip to the base of the appendix. The histological diagnosis was extracted from the records in the department and classified using the WHO classification of tumors of the appendix (2019). Patients' biodata such as age and sex were also extracted. The data were analyzed for frequency distribution using SPSS 23. Results: The incidence of neoplasms in the appendix was 0.84% of the 1071 appendectomies received in our department over the study period. Low-grade appendiceal mucinous neoplasm (LAMN) was the most common histological variant accounting for 55.5% of neoplasms, followed by metastatic carcinoma at 22.2% and carcinoids at 11.1%. There was a female preponderance of 77.8%. Conclusion: Neoplasms of the appendix are rare in our environment, and LAMN was the most common neoplasm of the appendix in our institution. There is a female preponderance among patients with appendiceal neoplasms.
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Experience with the management of pediatric laryngopharyngeal reflux in an Indian teaching hospital
Santosh Kumar Swain, Jasashree Choudhury
July-September 2020, 17(3):61-65
Aim: Laryngopharyngeal reflux (LPR) is the retrograde flow of gastric content to the larynx and pharynx where these materials come in contact to the upper aerodigestive tract. This clinical entity is less studied among the pediatric population. The objective of this study is to evaluate the impact of LPR in the pediatric population. Materials and Methods: This retrospective study was done in between December 2016 and January 2019. Clinical data such as associated symptoms, endoscopic findings, laboratory testing, therapeutic interventions, and outcome were analyzed. Endoscopic findings were considered to be consistent with LPR in the pediatric age included: Lingual tonsil hypertrophy, postglottic edema, true vocal fold edema and congested and swollen arytenoids, congested inter-arytenoids area. Results: There were 212 children evaluated for dysphonia. There were 38 girls (52.77) and 34 boys (47.22%), and mean age at presentation was 9.32 years with a male-to-female ratio of 0.89:1. Out of 212 children who underwent endoscopy, 72 had shown LPR disease. Five children (6.94%) showed vocal nodules, 3 (4.16%) showed vocal fold cyst, and 2 (2.77%) children showed subglottic edema along with LPR. All the children were treated with anti-reflux measures. By second follow-up visit on 1 month, 68 children (94.44%) had improved symptomatically. Conclusion: LPR appears to cause laryngeal manifestations more commonly in children. In this study, all the children were presenting dysphonia, intermittent cough, foreign-body sensation in throat, and throat-clearing habit. All of them showing congested arytenoids and inter-arytenoid membrane. Early diagnosis and treatment often result in the improvement of hoarseness of voice and prevent complications. LPR in the pediatric population is almost a new diagnosis.
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Clinical and microbiological profile of enteric fever among pediatric patients in a tertiary care center in South India: A cross-sectional study
A Malini, C Barathy, NS Madhusudan, C Johnson
July-September 2020, 17(3):74-79
Introduction: Enteric fever, which is endemic in India, is a significant cause for morbidity, particularly among young children. Enteric fever is associated with high fever, abdominal pain, diarrhea, and splenomegaly. Recently, there have been increasing reports of enteric fever due to Salmonella enterica serovar Paratyphi A and multidrug resistance among Salmonella species. Objectives: The objective of this study was to know the relative occurrence of Salmonella Typhi and Salmonella Paratyphi A from blood cultures of enteric fever cases, to study the sensitivity pattern of Salmonella species isolated, to compare the clinical profiles in typhoid and paratyphoid fever, and to know their treatment outcome. Materials and Methods: It was a prospective hospital-based cross-sectional study. The demographic, clinical, and laboratory data were recorded for all cases included in the study. All clinically suspected cases of enteric fever were confirmed by blood culture and/or the Widal test. Antibiotic sensitivity was tested by the Kirby–Bauer disc diffusion method. Results were analyzed using SPSS version 21. Results: One hundred and nineteen cases were confirmed enteric fever. Their clinical profile is discussed. Out of 119 cases, 24 showed blood culture positivity. Salmonella Paratyphi A and Salmonella Typhi were isolated in the ratio of 3:1. The isolates were sensitive to ampicillin, co-trimoxazole, ceftriaxone, and azithromycin. Ceftriaxone was the most commonly used antibiotic for treatment. All patients recovered, and no mortality was encountered. Complications were seen in 33 children (27.7%), which included subclinical hepatitis, bronchitis, and pneumonia. Conclusion: Considering the blood culture results, enteric fever due to S. Paratyphi A was more common in our study. Multidrug resistance was not seen among Salmonella species. The duration of illness and complications were more with typhoid than paratyphoid cases.
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Prospective study on acute toxicities of external beam radiotherapy in the management of pelvic malignancies in Lagos University Teaching Hospital
Bolanle Comfort Adegboyega, Habeebu Y Muhammad, Adedayo O Joseph, Babatunde M Alabi, Francis A Durosinmi-Etti
July-September 2020, 17(3):80-85
Introduction: Radiation therapy is key to the management of pelvic malignancies. It not only induces cellular death in target organs but also results in adverse effects on the surrounding structures. These side effects are classified as acute or late toxicities based on the timing of its occurrence from the treatment time. The aim of this study was to describe the pattern and management of radiation side effects in pelvic cancer patients treated with external beam radiotherapy (EBR) at Lagos University Teaching Hospital. Methodology: This study was carried out on pelvic cancers patients treated with curative intent over 6 months. The weekly review of treatment related toxicities were graded using the National Cancer Institute Common Toxicity Criteria and analyzed. Results: A total of 106 patients aged between 32 and 83 years were studied. Mean age was 59.2 years and M: F of 3:7. The most common pelvic malignancy seen was cervical cancer in 50.9% of cases; prostate cancer in 17.0%, and endometrial cancer in 15.1%. The most common acute adverse event was perineal skin desquamation in 73.5% patients, genitourinary toxicities in 66% of patients, hematological derangements in 41.5% patients, and gastrointestinal toxicities in 37.7%. Grades 1 and 2 toxicities were the usual complaints in 62.1% patients and severe toxicities (G3 and 4) in 37.9%. Conclusion: Mild-to-moderate acute radiation induced toxicities is a common occurrence following EBR of pelvic cancer. Conservative management of these toxicities makes EBR tolerable and prevents treatment interruption.
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An interesting story of intravascular hemolysis but normal haptoglobin and bilirubin levels
Kriti Chauhan, Nikhil Shandilya
July-September 2020, 17(3):86-88
Multiple bee stings are associated with intravascular hemolysis (IVH), rhabdomyolysis, hypotension, renal tubule injury, and all causing acute kidney injury. Evidence in support of hemolysis includes anemia, hyperbilirubinemia, hemoglobinemia, hemoglobinuria, low haptoglobin (Hp) levels, elevated lactate dehydrogenase, and Coomb's test (if antibody mediated). However, under certain circumstances, hemoglobinemia and hemoglobinuria may be the only evidence of IVH depending on the etiological factors in association with the environment inside the body. Bee venom is known to have deleterious actions on different tissue types (neurotoxin, muscle paralytic, hematotoxic, epithelial damage, etc.). Altogether, they determine the outcome and presentation. Apart from this, there are several conditions that determine the binding of oxygen and Hp to hemoglobin (Hb). Arterial blood gases (ABGs) play a very important role in this. Hence, it is important for the pathologists to have an understanding of ABG as well to know how even simple tests (Hb, bilirubin, and Hp) can get affected by them. We describe one such occurrence in a patient with multiple hornet bee stings and formulate the likely causes and pathogenesis.
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