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   Table of Contents - Current issue
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October-December 2016
Volume 6 | Issue 4
Page Nos. 191-240

Online since Friday, December 8, 2017

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REVIEW ARTICLES  

Transverse testicular ectopia: What surgeons must know; Insights in embryology and management Highly accessed article p. 191
Advait Prakash, Suraj Jain, Manoj Kela, Chandrajeet Yadav, Rajat Lohiya, Tanmay Maheshwari
DOI:10.4103/ais.ais_1_17  
Transverse testicular ectopia (TTE) is a rare congenital anomaly, in which both gonads migrate toward the same hemiscrotum. It is usually associated with other abnormalities such as persistent Müllerian duct syndrome (PMDS), true hermaphroditism, inguinal hernia, hypospadias, pseudo-hermaphroditism, and scrotal anomalies. Most of the reported cases are in children with very few reported cases in adults. We report a case of 30-year-male, who presented with right reducible inguinal hernia and left undescended testis. Diagnosis was confirmed preoperatively by ultrasound followed by diagnostic laparoscopy and open inguinal exploration for orchiopexy. Bilateral transseptal orchiopexy and hernioplasty were performed. He had an uneventful recovery. Due to lack of awareness most of these cases are diagnosed accidentally intraoperatively. Preoperative diagnosis can be achieved by proper knowledge and imaging techniques (ultrasonography and magnetic resonance imaging). Surgeons who frequently repair inguinal hernias should be aware of disease and appropriate surgical management options available to them when this condition is unexpectedly identified during inguinal exploration. The embryology, clinical features and management algorithm are discussed herewith with review of pertinent literature.
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ORIGINAL ARTICLES Top

Acceptability of clinical teaching by mentorship among medical students in Nigeria p. 195
Marliyya S Zayyan, Hawwau N Madugu, Nkiru Ameh, Olarenwaju A Oguntayo, Adebiyi G Adesiyun, Ahmed A Saad
DOI:10.4103/2278-9596.220328  
Background: Mentoring is “a process whereby an experienced, highly regarded, empathetic person guides another individual in the development and reexamination of their own ideas, learning, and personal and professional developments.” We determine the acceptability of mentoring by undergraduate medical students in obstetrics and gynecology and the challenges of mentoring as perceived by the mentees. Patients and Methods: All undergraduate students of obstetrics and gynecology for 2009/2010 sessions were assigned to a mentor according to their admission numbers for clinical teaching. Guidelines were drawn for the scope, mode of teaching as well as the timing of contact for 16 weeks. Structured questionnaires were administered to assess their acceptability of the scheme as well as the problems of mentoring. The data were analyzed by the statistical package for social sciences. Results: One hundred and twenty 5th year medical students were interviewed. They were aged 22-32 years with a mean of 25.7 years. There were 82 (73.2%) males and 30 (26.8%) females. The students were in medical schools for an average of 6.1 years. Eighty-two students (73.2%) assessed the scheme as good while 4 (3.7%) assessed it as poor. The teaching objectives were judged to be satisfactorily met by 99 (88.6%) students and 91 (81.3%) assessed contact with teachers as satisfactory. The clinic facilities were thought to be good for learning by 102 (91.1%) and 79 (70.5%) considered the facilities provided to be conducive for individual private learning. Facilities for research were considered to be adequate by 53 (47%). The main drawback of the scheme was lack of uniformity in standard by the mentors, as reported by 87 (77.6%). Conclusion: Mentoring in clinical medicine is both convenient and acceptable by medical students.
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MAGPI technique for distal penile hypospadias; modifications to improve outcome at a single center p. 201
Arvind K Shukla, Aditya P Singh, Pramila Sharma, Jyotsna Shukla
DOI:10.4103/ais.ais_37_16  
Background: Hypospadias is the most common congenital anomaly of urogenital organs in boys. We reviewed our experience with modification in the meatal advancement and glanuloplasty incorporated (MAGPI) technique of hypospadias repair. We point out some modifications and outcomes of this technique in this study. Patients and Methods: We identified all patients who underwent modified MAGPI repair of the distal hypospadias by a single surgeon over a 10-year period. We performed a retrospective chart review by outdoor assessment postoperatively. We assessed parents' satisfaction with functional and cosmetic outcomes. Decision to undergo this type of repair was intraoperative, depending on position and mobility of the meatus, and the quality of periurethral tissue. We made some modifications in the original technique of the MAGPI including no trimming of the edge of the glans in granuloplasty, incorporation of the collar in the granuloplasty; leading to glans augmentation and taking stay suture over the ventral wall of the urethra with some perimeatal tissue. Results: Our study was a retrospective analysis. We collected data retrospectively and outcomes were assessed by the outpatient department visits in follow-up. We identified 150 patients, with a median age of 6 years (3–8 years). Position of meatus was glanular 90 (60%) or coronal 60 (40%). Chordee was minimal in our study and was corrected by only penile degloving. Urethral stenting was required in all patients for 3–4 days. There was no case of fistula, meatal regression, stenosis, mucosal prolapse, or second procedure. Cosmetic outcome was deemed satisfactory in 98% (147/150). Conclusion: In selected cases, our modifications in the MAGPI hypospadias repair provide excellent functional and cosmetic outcomes with minimal complications.
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HIV infection: Prevalence and seroconversion in a cohort of antenatal attendees at the Benue State University Teaching Hospital, Makurdi, Nigeria p. 206
PO Eka, AO Ojabo, SK Hembah-Hilekaan, BT Utoo, O Audu, JO Ben-Ameh
DOI:10.4103/ais.ais_48_16  
Background: Human immunodeficiency virus (HIV) testing of pregnant women and their partners is an important step in access to prevention of mother-to-child transmission (MTCT) services; pregnant women are at a high risk of seroconversion, which is associated with a high rate of MTCT. Repeat HIV testing in late pregnancy or in labor is worthwhile in areas with high HIV prevalence. This study aimed at determining HIV prevalence and seroconversion in a cohort of antenatal attendees at the Benue State University Teaching Hospital. Patients and Methods: This was a prospective cross-sectional study involving 432 cohorts of antenatal attendees. The HIV status of these women were determined at booking using rapid HIV kits: Determine ½, Stat-Pak, and Unigold Recombigen. Repeat testing was performed during labor among women who were HIV negative at booking to determine the seroconversion rate. Results: Overall HIV prevalence among this cohort of women was 8.6%. The seroconversion rate during labor was 2.5% among women who were seronegative at booking. Majority of the participants were young (modal age = 26–29 years, 36%), belonged to middle class (60.9%) and upper class (17.6%), and had secondary (50.0%) or tertiary education (38.0%). Conclusion: HIV prevalence and seroconversion rates are rather high. There is need for more aggressive PMTCT awareness advocacy and intervention to reduce the incidence of pediatric acquired immunodeficiency syndrome in our setting. Further studies to differentiate seroconversion from new infections in pregnancy are worthwhile PMTCT strategies.
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Challenges in complete surgical resection of giant cystic hygroma Highly accessed article p. 210
Amit K Sinha, Bindey Kumar, Anil Kumar, Prem Kumar, Zaheer Hasan, Chandni Sinha
DOI:10.4103/ais.ais_49_16  
Background: Giant cystic hygroma is a benign cystic lesion that is disfiguring and a life threatening lymphatic malformation. Surgical resection is the main modality of treatment. Complete surgical resection of giant cystic hygroma is difficult and challenging. Patients and Methods: We discuss 10 cases of giant cystic hygroma wherein complete surgical resection was done. These cases were operated between 1996 and 2015. The preparation of patients, challenges, and outcome of the procedure were evaluated and recorded. Results: The age of the 10 cases we evaluated ranged from 1 month to 10 years. Five patients less than 1 year in age presented with respiratory embarrassment and feeding problems. Older children (5 patients) presented with disfigurement of face including visible non-tender mass. All children had some degree of feeding difficulties. One case had mediastinal involvement and presented with respiratory distress. Postoperatively, 6 patients had blood transfusion, while 5 required mechanical ventilation. Conclusion: This article focuses on difficulties encountered during surgical resection of giant cystic hygroma due to its varied clinical presentation, which is unique to the large size of the mass. These include anesthetic difficulties, operative difficulties in terms of identifying vital structures, bleeding, and cosmesis, and operative sequel and complications.
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Ultrasound determination of gall bladder size and wall thickness in normal adults in Abuja, North Central Nigeria p. 214
Kolade-Yunusa Hadijat Oluseyi
DOI:10.4103/ais.ais_50_16  
Background: Diseases of the gallbladder (GB) do affect its size and wall thickness. GB diseases are common pathology frequently encountered in medical practice and presents as right upper quadrant pain. Ultrasound is a relatively safe, inexpensive, and reproducible imaging modality for assessing normal or diseased GB. It is the first method of choice when GB disease is suspected. Objective: The aim of this study is to determine a referential value of normal GB size and thickness which can be used as baseline in this environment to determine GB disease and for follow-up of these patients. Materials and Methods: This is a cross-sectional study conducted on 400 normal adults aged 15–70 years at the radiology department over a period of 10 months. Subjects had their GB scanned with 3.5 MHz transducer after fasting overnight. The length, width, and height were measured and the volume obtained using the ellipsoid formula. GB thickness was also recorded. Results: The overall mean age was 40.70 ± 14.97. Mean age of males and females were 46.32 ± 15.64, and 36.61 ± 12.33 respectively. The mean values for length, width, height, volume, and wall thickness of the GB was 6.40 ± 1.06 cm, 2.38 ± 0.77 cm, 2.77 ± 0.25 cm, 23.46 ± 8.14 cm3 and 0.27 ± 0.08 cm respectively. The mean values for, length, width, height, volume, and wall thickness of GB for males were 6.36 ± 1.03 cm, 2.46 ± 0.87 cm, 2.81 ± 0.29 cm, 24 ± 8.66 cm3 and 0.28 ± 0.76 cm and for females were 6.44 ± 1.10 cm, 2.30 ± 0.67 cm, 2.75 ± 0.22, 22.98 ± 7.63 cm3, and 0.26 ± 0.27 cm. Mean GBV was higher in males than females. Conclusion: Normal values of GB dimensions have been established in the north central Abuja using ultrasound. These values can be used as reference values in management of GB disease.
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CASE REPORTS Top

Optimum management of invasive cervical cancer in HIV/AIDS patients and impact on survival: Case series from a resource-limited setting and literature review p. 219
A Adamu, DA Dawotola, IM Mohammed, TA Olasinde
DOI:10.4103/ais.ais_4_17  
With the lengthening of life expectancy among HIV-positive subjects related to the use of highly active antiretroviral (HAART) treatments, an increased risk of cancer has been reported in this group of patients. The clinical management of cancers, including cervical cancer in HIV-positive patients has challenges mainly due to the concerns on immune status. At present, their mode of management is similar to HIV-seronegative patients and involves the use of chemotherapy and radiotherapy concurrently, as indicated. This becomes more challenging because HIV infection, cancer, radiotherapy, and chemotherapy lower immunity through reduction in CD4 cell counts, which is further complicated with low-resource setting of late presentation, poor access to HAART, lack of accessible radiotherapy facilities, and poverty.
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Abdominal myomectomy is safe in the first trimester pregnancy: A Case Report p. 224
Umma S Bawa, Muhammad A Abdul, Nana H Madugu, Zulaihatu Sarkin-Pawa
DOI:10.4103/ais.ais_28_16  
Uterine myoma is the most common gynecological tumor in women of the reproductive age group. The incidence of myoma in pregnancy ranges from 0.3% to 2.6%, of which approximately 10% leads to complications. The management of uterine myoma during pregnancy in most of the cases is expectant, and its surgical removal is generally delayed until after delivery. In the last two decades, there have been increasing reports of successful myomectomy during caesarean section and even fewer cases in the first and second trimester. We report a case of huge uterine fibroids presenting to the booking clinic at approximately 13 weeks of gestation with a large for date uterus and severe lower abdominal pain. She was admitted and managed conservatively for the presumptive diagnosis of red degeneration in pregnancy. She had myomectomy on account of the distressing abdominal pain. She had an uneventful postoperative period and was discharged home on the 7th postoperative day on hematinics. She was eventually delivered a live baby weighing 2.6 kg by an emergency caesarean section following rupture of membranes prematurely at 37 weeks of gestation. We can therefore say that in carefully selected cases, particularly in cases of subserous fibroids, myomectomy in pregnancy may be safer than previously thought.
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Spontaneous regeneration of a wide mandibular defect following segmental mandibulectomy for ameloblastoma: A case report and review of the literature p. 228
Davis S Adeola, Ekene P Onyebuchi, Rowland Agbara, Albert U Okeke
DOI:10.4103/ais.ais_45_16  
Mandibular defects may be congenital or arise from a number of causes including surgery, infections, and trauma. Sporadic cases of spontaneous regeneration of jaw defects have been reported in the literature, however, the exact mechanism of this occurrence has not been fully understood. Some of the suggested factors that have been advanced for this phenomenon include age, periosteum, and genetics. Further studies are needed to elucidate the molecular basis of this phenomenon. We report a case of spontaneous regeneration of the mandible in a 14-year-old Nigerian boy following segmental mandibulectomy for ameloblastoma.
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Complete uterine didelphys: An incidental finding at emergency cesarean section p. 233
F Bakari, AG Adesiyun, EP Ochogwu, H Umar-Sulayman, N Ameh, US Bawa
DOI:10.4103/ais.ais_46_16  
Uterine didelphys is a rare form of Mullerian duct abnormality. Women with this developmental anomaly are often asymptomatic although pregnancy complications are common. We present a 23-year-old para 0+1 that registered for antenatal care at 31 weeks gestation and in whom an ultrasound scan revealed a suspected huge cervical mass that turned out to be an undiagnosed ipsilateral nonpregnant half of a double uterus at emergency cesarean section, which was indicated because of preterm labor and a coexisting suspected huge cervical mass.
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Postpartum urinary retention mimicking Fowler's syndrome: A case report p. 237
M Awaisu, M Ahmed, CM Taingson, AT Lawal, Sudi A
DOI:10.4103/ais.ais_3_17  
Urinary retention (UR) is relatively uncommon in women; however, it may occur following childbirth and is termed as postpartum urinary retention (PPUR). PPUR has been variably defined as the abrupt onset of painful or painless inability to completely micturate, requiring urinary catheterization, over 12 hours after giving birth or unable to void spontaneously within 6 hours of vaginal delivery. This is a case of a 22-year-old woman presenting with 12 days history of intractable UR following spontaneous vaginal delivery and repair of episiotomy. The UR persisted despite repeated trial without catheter (TWOC) and bladder training. The absence of an identifiable cause and the failure of the bladder neck to open on micturating cystourethrogram (MCUG) lead to the suspicion of Fowler's syndrome thus the patient was referred to our urology unit. She was seen with an indwelling urethral catheter and there was no significant finding on evaluation except the presence of hard, impacted feces in the rectum. She had rectal enema with evacuation of feces and was able to void spontaneously without catheter. Normal voiding was maintained at 2 months of follow-up.
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LETTER TO EDITOR Top

Granulomatous lobular mastitis p. 240
Vipul Yagnik
DOI:10.4103/ais.ais_2_17  
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