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   Table of Contents - Current issue
Coverpage
April-June 2017
Volume 7 | Issue 2
Page Nos. 41-72

Online since Wednesday, April 4, 2018

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ORIGINAL ARTICLES  

First trimester body mass index and pregnancy outcomes: A 3-year retrospective study from a low-resource setting p. 41
Idris U Takai, Ifesinachi J Omeje, Aliyu S Kwayabura
DOI:10.4103/ais.ais_7_17  
Background: Extremes of body mass index (BMI) are associated with adverse pregnancy outcomes. This study was conducted to determine the prevalence of obesity and underweight among women in their first trimester and evaluate the impact of first trimester BMI on pregnancy outcome. Patients and Methods: Pregnant women who booked in the first trimester of pregnancy in Aminu Kano Teaching Hospital, and met the inclusion criteria, were studied retrospectively for a 3-year period from January 2012 to December 2014. Their booking BMIs were calculated and categorized using WHO classes. Pearson's Chi square test was used for all categories. Results: A total of 649 pregnant women booked in the first trimester during the study period, out of which 502 were eligible for the study. Of this, 99 women were obese and 57 were underweight giving the prevalence of obesity and underweight in first trimester of pregnancy as 15.3% and 8.8% respectively. Maternal outcomes mostly associated with obesity and overweight were hypertensive disorders in pregnancy (42.0%), gestational diabetes mellitus (41.3%), increased abdominal and instrumental delivery (38.6%), as well as third and fourth degree perineal tears (71.4%). Neonatal outcomes were low birth weight and fetal macrosomia (57.8%), preterm delivery and prolonged pregnancy (46.0%). The underweight group had a favorable outcome in majority of the outcomes assessed. Conclusion: Obesity in pregnancy is relatively common in our environment and is associated with adverse fetomaternal outcome when compared to the underweight subjects. There is a need for preconception care and further research to identify and possibly mitigate the risk factors of obesity.
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Tubularized incised plate urethroplasty with dorsal dartos flap cover and asymmetrical prepucial flaps: A valuable option in hypospadias repair? p. 48
Yogender S Kadian, Kajal Pradeep, Mahavir Singh
DOI:10.4103/ais.ais_16_17  
Background: Snodgrass or tabularized incised plate (TIP) repair is the most common technique for distal penile hypospadias cases. However different variations of this procedure have been tried in attempts to reduce the complications. The variations reported are for the cover of the neourethra and creations of prepucial flaps In this study the authors report another variation devised by them in which there is dorsal prepuce is divided into two unequal parts. Patients and Methods: We have managed 35 patients of distal hypospadias without chordee with hypospadias were managed wherein the neourethra was created by incised urethral plate and it was covered by a dorsal dartos flap taken from 1/3rd portion of asymmetrically divided prepuce after discarding its outer layer and rest 2/3rd of the two layered prepuce used to cover the penile shaft. Results: Three (8.57 %) patients developed a fistula at the coronal level, of which one closed spontaneously within three months of repair while two healed after a surgical repair. There was retraction of the meatus in one patient. All the remaining patients had acceptable cosmetic and functional outcome. Conclusion: The tubularized incised plate repair with suggested modification of asymmetrical division of dorsal prepuce and use of dartos flap to cover the neourethrais a good option in select patients of hypospadias without chordee. The advantage is that there is no overlapping of suture lines of the neourethra and skin and it takes care of glanular tilt. However the cosmesis is not as good as in cases where there is symmetrical division of prepucial flaps.
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Experience with tubularized incised plate urethroplasty in distal and mid penile hypospadias p. 52
Tausif A Khan, Reyaz Ahmad, Shehtaj Khan, Rajendra S Chana
DOI:10.4103/ais.ais_26_17  
Background: Whilst hypospadias is a common congenital defect in boys its aetiology largely remains unknown. The objective of this study was to evaluate the results of tubularized incised plate (TIP) urethroplasty in distal and mid-penile hypospadias repair. Patients and Methods: This was a prospective clinical study conducted in the Department of Pediatric Surgery over a period of 42 months (January 2012 to June 2015). All patients with distal and mid shaft hypospadias who underwent TIP urethroplasty in our department were studied. The patients were followed up for a period of 1 year after surgery. Results: Fifty eight patients (N = 58) with hypospadias (29 distal and 29 mid penile) were included in the study. The mean age at presentation was 4.5 years (range 3–7 years). The mean operative time was 70 min (range 55–90 min). The mean duration of postoperative stay was 11 days (range: 10–14 days). Overall 15 patients (25.86%) developed complications. Urethrocutaneous fistula (UCF) developed in 10 (17.24%) patients. Meatal stenosis occurred in six (10.34%) patients. Five patients (8.62%) developed flap necrosis and dehiscence of glans occurred in two patients (3.44%). The difference in complication rate between different types of hypospadias was not statistically significant (P > 0.05). There was no statistically significant difference in cosmetic and functional outcome between two groups operated by TIP urethroplasty. Conclusion: TIP urethroplasty is a simple and effective technique of repair for distal and mid-penile hypospadias in properly selected patients. It offers good functional and cosmetic results.
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An appraisal on antibiotic susceptibility of common bacterial pathogens in urinary tract infections at a Nigerian Tertiary Health Center p. 56
BM Abubakar, A Abubakar, UM Tela, MN Gabchiya, MJ Isah, HM Dogo, AA Panti, TT Ogunyele
DOI:10.4103/ais.ais_17_17  
Background: Urinary tract infections (UTIs) with concomitant rise in antibiotic resistance among uropathogens remained a major health problem. A periodic appraisal of the microbial agents responsible for UTIs with their antimicrobial susceptibility is, therefore, fundamental for a fitted empirical antimicrobial intervention. This study determined the range of bacterial species in patients with suspected UTI and their antibiotic susceptibility pattern at a tertiary care center in Nigeria. Patients and Methods: This was a retrospective review of urine samples subjected to microscopy, culture, and sensitivity from patients with suspected UTI in 2015. Bacterial isolates were identified by biochemical profiling. The antibiotics susceptibility of the culture-positive isolates was achieved by disk diffusion method as recommended in the Clinical Laboratory Standard Institute guidelines. Results: There were 1,096 urine samples subjected to microscopy, culture, and sensitivity during the study period; 1,001 met the inclusion criteria. Urine microscopy yielded significant pyuria in 23.2% and sterile pyuria in 8%. Urine culture was positive in 43% of the specimens and yielded Escherichia coli in 28%, Staphylococcus aureus was seen in 6.1%, and Klebsiella in 4.8%. Out of the positive cultures, 35.3% specimens have significant pyuria. The most sensitive antibiotics were Streptomycin, Ciprofloxacin, and Gentamycin. Resistance was predominantly to Nalidixic acid, Ceftriaxone, and Ampicillin. Conclusion: Periodic appraisal of the uropathogens and evaluation of their sensitivity is a needed guide in empirical antibiotic interventions. In this appraisal, E. coli was the commonest agents in patients with UTI. Most of the microbes were sensitive to Aminoglycoside and Ciprofloxacin but often resistant to Nalidixic acid and Ceftriaxone.
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CASE REPORTS Top

Giant omphalocele in a toddler: Patronage for single-layer primary closure p. 62
Amit K Sinha, Neeti Neha, Bindey Kumar, Prem Kumar
DOI:10.4103/ais.ais_25_17  
Omphalocele represent the commonest abdominal wall defects. Giant omphalocele is one of its subtypes, containing liver in its entirety. Due to various syndromic and non-syndromic associations and gross viscero-abdominal disproportion, post-operative outcome poses a challenge. There have been a lot of disparities among surgeons deciding the operative technique. We pluck the courage to report a yet another method of successful single layer primary closure of a giant omphalocele in our institute, well equipped with intensive care facilities.
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Giant lipoma of posterior neck p. 65
Junaid Alam, Mohammad Aslam, Sandeep K Varshney, Aditya Varshney
DOI:10.4103/ais.ais_38_17  
Lipoma is one of the most common benign mesenchymal tumors and is found almost in all sites where fat exists. This lesion is often asymptomatic except in cases of enormous masses compressing neurovascular structures. They are found relatively rarely on the posterior part of the neck. Surgical intervention in these tumors is very challenging because, sometimes, extension to the spinal cord and malignant transformation may occur especially in old age. Precise knowledge of the anatomy and meticulous surgical techniques are needed while operating such giant lipomas.
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Chronic myeloid leukemia with an initial presentation as ischemic priapism: A case report and review of literature p. 68
Abubakar U Musa, Muhammad A Ndakotsu, Sani B Abubakar, Peter N Agwu
DOI:10.4103/ais.ais_18_17  
Chronic myeloid leukemia (CML) is one of the myeloproliferative disorders accounting for 15–20% of adult leukemia. Priapism is a rare initial presentation of CML occurring in 1–2% of cases. It is a urologic emergency requiring urgent multidisciplinary management as delay in initiating treatment may lead to erectile dysfunction. Combined treatment modalities are usually employed in its management including surgery, chemotherapy, therapeutic leukapheresis, and local intracavernous therapy. We report an 18-year-old male who presented with a 12-day history of priapism. Further evaluation with peripheral blood film revealed CML in chronic phase with ischemic prolonged priapism. At presentation patient refused consent for surgical intervention and subsequently had cytoreductive therapy with oral hydroxyurea. He achieved complete detumescence after 4 weeks of cytoreduction and by the 5th month during follow-up, he developed erectile dysfunction.
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