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   Table of Contents - Current issue
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April-June 2021
Volume 18 | Issue 2
Page Nos. 73-125

Online since Saturday, April 24, 2021

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EDITORIAL  

Leveraging on the faculty of clinical sciences capacity on cancer research p. 73
Adesoji O Ademuyiwa
DOI:10.4103/jcls.jcls_12_21  
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REVIEW ARTICLE Top

Roles and challenges of clinical microbiology laboratories in antimicrobial stewardship in resource-limited countries: A narrative review p. 74
Mohammed Ibrahim Tahir, Abdurrahman El-Fulaty Ahmad, Temidayo Oluwafemi Ige, Idris Nasir Abdullahi, Yahaya Usman, Ahmed Babangida Suleiman
DOI:10.4103/jcls.jcls_60_19  
Antimicrobial resistance (AMR) is a major global health challenge, especially in low- and middle-income countries (LMIC). Programs that appropriate antibiotic use such as antimicrobial stewardship, is a global health strategy adopted by the World Health Organization to contain threats posed by AMR. Unfortunately, many LMICs are at best left behind in the process of developing antimicrobial stewardship programs (ASP). We highlighted the roles of the clinical microbiology laboratory in antimicrobial stewardship and challenges associated with the program in LMICs. We further suggested ways forward in the adoption and implementation of existing programs in resource-limited settings. There is generally nonexistent or at best, fewer ASP in the LMICs. More efforts need to be channeled toward fighting the AMR scourge, primarily by adopting ASP while utilizing the little resources available.
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ORIGINAL RESEARCH REPORTS Top

Prevalence and pattern of dry eye symptoms among “okada” riders in Southwest Nigeria using the ocular surface disease index: A cross sectional study p. 81
Adetunji Olusesan Adenekan, Olubanke Theodora Ilo, Adegboyega Sunday Alabi, Olufisayo Temitayo Aribaba, Folasade Bolanle Akinsola
DOI:10.4103/jcls.jcls_37_20  
Background: Dry eye is a common disorder of the tear film that results in epithelial damage and the disruption of normal homeostasis at the ocular surface. It is a common ocular condition that is often missed in clinical diagnosis. The objectives of this study were to determine the prevalence and pattern of dry eye symptoms using the Ocular Surface Disease Index (OSDI) among commercial motorcyclists and also identify factors that may be responsible for dry eye symptoms in this population. Methods: This was a descriptive, cross-sectional, population-based study. Using a multistage random sampling technique, 422 commercial motorcyclists were surveyed from 10 units of registered commercial motorcyclists. Interviewer-administered OSDI questionnaires (face to face) were used, and visual acuity (VA) measurement was done. Results: The prevalence of dry eye symptoms in this study was 83.42%. Using the OSDI, the pattern of dry eye symptoms in this study showed that 21.56% had mild dry eye, 54% had moderate dry eye, and 7.82% had severe dry eye. Riders aged >50 years (86.90%), P < 0.05, 95% confidence interval: 0.012–0.021; nonuse of protective spectacles (87.46%), P < 0.05, 95% confidence interval: −0.235–−0.087; and use of helmets with face shields while riding (92.89%), P < 0.05, 95% confidence interval: −0.160–−0.062, were risk factors for dry eye symptoms. All respondents who had diabetes mellitus (P < 0.05, 95% confidence interval: 0.084–0.429) and a larger proportion (84.86%) of those not on topical medications (P < 0.05, 95% confidence interval: −0.365–−0.066) had dry eye. Visual impairment (VA <6/18) was observed in three respondents, with uncorrected refractive errors as the cause. Multivariate analysis showed that respondents aged <50 years, nonuse of protective spectacles, use of crash helmets with face shield, medical conditions, particularly diabetes mellitus, and nonuse of topical medications were significantly associated with dry eye symptoms. Conclusion: The prevalence of dry eye symptoms was high, and majority had moderate dry eyes based on OSDI grading. Furthermore, public health awareness program should be commenced to educate motorcyclists on the importance of using protective goggles in preventing dry eye disease.
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Surrogate markers and predictors of insulin resistance in Nigeria patients with Type 2 diabetes mellitus: A cross sectional study p. 90
Ifedayo Adeola Odeniyi, Ukamaka Beatrice Odife, Olufemi Adetola Fasanmade, Augustine Efedaye Ohwovoriole
DOI:10.4103/jcls.jcls_46_20  
Background: This study set out to identify and compare surrogate markers of insulin resistance (IR) in males and females and compare the prevalence of IR using different surrogate markers. Methods: The study was an analytical cross-sectional hospital-based study among Nigerians with Type 2 diabetes mellitus (T2DM). A total of 234 (131 T2DM and 103 healthy) persons were invited to participate in the study. One hundred and ninety-nine persons completed the study. The following anthropometric measurements were taken (height [m], weight [kg], waist circumference [cm], and hip circumference [cm]). IR score (IRS) was derived using these six measurements: fasting basal insulin, fasting C-peptide, glucose-insulin ratio, quantitative insulin sensitivity check index, homeostasis model assessment (HOMA-IR), HOMA-c-peptide. Results: Using an IRS of >11 as criteria for IR, 52 (41.6%) of T2DM, and 21 (28.4%) of the control group were found to have IR. Forty-five percent of the DM females and 36.4% of DM males had IR, respectively, whereas 31.8% of the control females and 23.3% of control males had IR, respectively. Visceral Adiposity Index (VAI) had the best predictive value with the highest area under the receiver operating characteristic curve (0.648). Conclusion: The prevalence of IR is nonsignificantly higher in females than males. VAI is the best surrogate marker to predict the presence of IR among the male study participants, while waist circumference is the best surrogate marker to predict the presence of IR among the female study participants.
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Gastrointestinal stromal tumor experience in a surgical oncological unit in sub-Saharan Africa: A retrospective analysis p. 98
Omobolaji O Ayandipo, Gabriel O Ogun, Oluwasanmi A Ajagbe, Omolade O Adegoke, Olalekan J Adepoju, Adam Rahman, Chioma M Ajuyah, Akintunde T Orunmuyi, Olayiwola B Shittu
DOI:10.4103/jcls.jcls_60_20  
Background: Gastrointestinal stromal tumors (GISTs) are characterized by specific immunohistochemical and genetic features. This study investigated the clinicopathologic features and surgical outcomes of 54 patients with GIST in a major referral hospital in sub-Sahara Africa. Methods: This retrospective cross-sectional single-center study describes 54 patients who underwent surgery for GIST between 1999 and 2019 in a Nigerian Tertiary Hospital. All cases were confirmed by immunohistochemistry and were analyzed for clinical characteristics, clinical management, and histopathologic data. The risk of recurrence was determined using the Fletcher National Institutes of Health criteria. Results: The mean age of the patients was 57.6 years ± 15.3 (11–81 years), and most patients (67%) underwent abdominal computed tomography scans preoperatively. The most common presentation was an abdominal mass (48%). The stomach was the most common site of GIST (37%). The mean tumor size was 8.9 cm (5–18 cm), and tumor morphology showed spindle cell type (75.9%), mixed spindled-epithelioid (20.3%), and epithelioid (3.7%) cell types. Overall, 51% had a high risk for recurrence. Conclusion: The clinicopathologic features of GIST in this study are consistent with reports in the literature. Slight variations in risk profile may be due to late presentation in our settings.
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Pattern of postchemotherapy-associated complicatioins in a paediatric oncology service in Lagos: An observational study p. 103
Adeseye Michael Akinsete, Ugonna Olaraiche Fakile, Emmanuella Ijeoma Nwobi, Opeyemi Mercy Awofeso
DOI:10.4103/jcls.jcls_54_20  
Background: Globally, there is an increase in the number of pediatric oncology cases with significant morbidity and mortality in the low to middle income countries (LMIC) despite improved survival in the resource endowed nations. The increase in survival is largely due to the revolutionary use of multi strategy therapeutic interventions like chemotherapy, immunotherapy, surgery and radiotherapy. These modalities are however fraught with several complications. AIM The aim of this study was to prospectively observe and document the common complications following treatment of childhood cancers in a tertiary pediatric oncology unit in a resource constrained setting. Methods: This was a longitudinal observational study over a three-year period involving children with various cancers. Ethical approval was obtained from the hospital's human, research and ethics committee. A questionnaire was used to obtain socio-demographic data as well as details of adverse events encountered. Results: A total of 100 children enrolled in the study with acute lymphoblastic leukaemia been the commonest cancer. Gastrointestinal adverse events were the most common in the study cohort with alopecia rarely reported. Conclusion: Increased awareness of the common complications in this environment and prophylactic medications may improve the care of children post chemotherapy thereby reducing overall morbidity and cost of care.
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Ranula: A retrospective clinicosurgical analysis of 29 cases from a tertiary health institution, Northwest, Nigeria p. 109
Mohammed Abdullahi, Abdurrazaq Olanrewaju Taiwo, Kurfre Roberts Iseh, Stanley Baba Amutta
DOI:10.4103/jcls.jcls_55_20  
Background: Ranula may grow into a considerable size as to cause obstructive symptoms, especially in infants when neglected. The aim is to describe the clinical presentation, treatment, and outcome of ranulas. Methods: This is a retrospective study of patients with ranulas that presented during the periods of January 2000 to December 2019 in the Department of Otorhinolaryngology, Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Northwest, Nigeria. Results: A total of 29 patients were seen during the review period: twelve (41.4%) males and 17 (58.6%) females. Age ranged from 3 days to 48 years (median 3 years). Most of the patients 19 (65.5%) were below the age of 10 years. Twenty-one (72.4%) patients had simple oral ranulas: 8 (38.1.6%) patients were congenital ranulas characterized by tongue protrusion and dysphagia. Plunging ranulas were seen in 8 (27.5%) patients, and 2 (25%) of these patients were HIV infected. Simple marsupialization was done for 10 (34.5%) patients, and one of these patients had an elective tracheostomy for difficult intubation. Sublingual gland excision and with the evacuation of the cyst were done for 16 (55.2%) patients. One of the patients with plunging ranula opted for conservative management. Only 12 (41.4%) patients came for follow up: a patient had recurrence 2 years after excision of plunging ranula. Conclusion: Ranula, when neglected can cause obstructive symptoms presenting as tongue protrusion in children. Inadequate follow up was seen in the majority of the patients. Adequate follow up to determine the recurrence, especially those who had marsupialization, is most desirable.
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Histopathological analysis of male breast cancer in Southwestern Nigeria: A single-center retrospective study p. 113
Mustapha Akanji Ajani, Segun Samson Odetola, Babatope L Awosusi, Ebenezer O Fatunla, Ayodeji A Salami
DOI:10.4103/jcls.jcls_66_20  
Background: Breast cancer in men is still an uncommon and largely understudied disease. It accounts for 1% of all breast cancers. The aim of this study was to review all the male breast cancer cases diagnosed at the tertiary medical institution in South West Nigeria over a 10-year period and to compare the findings with other similar studies done in Nigeria and globally. Methods: We retrospectively reviewed all histologically diagnosed cases of male breast cancers in the Department of Pathology, Tertiary Medical Institution in South West Nigeria over a 10-year period from January 1, 2009, to December 31, 2018. Clinicopathological parameters including patients' age, laterality, and specific histological sub-types were extracted from surgical day book and Cancer Registry of the Department. The data were analyzed using the IBM SPSS Statistics (version 22; IBM Corporation, Armonk, New York, USA). The results were subsequently presented in tables, relative frequencies, group percentages, and photomicrographs. Results: Forty-two cases of male breast cancer were seen accounting for 1.7% of all breast cancer cases. The age range was between 22 and 91 years with a mean age of 60.3 years, and a peak occurrence was in the 8th decade. The right breast was more affected than the left accounting for 52% of the total number of cases seen. The most common histological sub-type found was invasive ductal carcinoma accounting for 88% of all the cases. Conclusion: Male breast cancer is relatively uncommon compared to female breast cancer. It is more common in the older age group, and invasive ductal carcinoma is still the most common histological subtype.
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Evaluation of the use and effectiveness of telemedicine among the health professionals during the COVID 19 lockdown period: A cross sectional study p. 117
Olutayo James, Bolanle Oyeyemi Akinboboye, Kehinde Sharafadeen Okunade, Adeola Adegbayi Adekunle, Wasiu Lanre Adeyemo
DOI:10.4103/jcls.jcls_68_20  
Background: Telemedicine has been documented as a viable option in attending to patient's need where distance is a critical factor. The Federal Government of Nigeria on March 27, 2020, imposed a total lockdown in Lagos state in order to curb the spread of the coronavirus disease 2019 (COVID-19) pandemic. The restriction in movement prevented many patients from attending their regular clinics and physical consultations. The aim of this study was to evaluate the use and effectiveness of telemedicine among the hospital health professionals during the lockdown period. Methods: This was an online cross-sectional study among doctors at a tertiary health facility in Lagos. Ethical approval was obtained from the institutional ethical committee. A list of the telephone and WhatsApp contacts of doctors were obtained from the hospital directory; the SurveyMonkey tool was used as an online web-based structured questionnaire for data collection. The information obtained was analyzed to find means and averages. Results: A total of 104 doctors completed the survey. The proportion of participants who used telemedicine was 93.3%, with the most commonly used telemedicine option being phone call (27.1%) and WhatsApp video call (27.1%). The main management provided during this period was counseling (56.6%). Seventy-nine percent of the participants were satisfied with the result of the management provided through telemedicine options, but the major concern was that of ethical issues (36.2%). Majority (44.2%) of the respondents agree that telemedicine was effective during the COVID-19 lockdown period. There was no association found between gender, age, designation, and perceived effectiveness of telemedicine by respondents in this study (P = 0.88, 0.4, and 0.07, respectively). Conclusion: Telemedicine was found to be a useful tool for effective patient's management during the lockdown period although there exist ethical concerns. The formulation of policies guiding its use will ensure the security of information and patient's confidentiality.
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CASE REPORT Top

Intraperitoneal drain tip migration into the liver parenchyma following pancreaticoduodenectomy: A case report and review of literature p. 123
Thomas Olagboyega Olajide, Ayomide Makanjuola, Durojaiye Abiodun Adeuja, Oluwole Ayoola Atoyebi
DOI:10.4103/jcls.jcls_64_20  
Intraperitoneal drains are widely used in surgery for therapeutic or diagnostic purposes. The placement of drains following pancreaticoduodenectomy may decrease postoperative complications. Commonly reported complications of intraperitoneal drains include pressure necrosis with bleeding, viscus perforation, fistula formation, and mechanical bowel obstruction. We report a rare complication of drain tip migration and erosion into the liver parenchyma.
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