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   Table of Contents - Current issue
Coverpage
October-December 2018
Volume 8 | Issue 4
Page Nos. 153-187

Online since Monday, February 10, 2020

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ORIGINAL ARTICLES  

Limb ulcerations in patients who abuse pentazocine: A demographic and clinical study of an under-recognized etiology of hard-to-heal ulcers in Zaria, Northwest Nigeria p. 153
Abdulrasheed Ibrahim, Muhammad Lawal Abubakar, Abdulghaffar Adeniyi Yunus, Ismail Lawal Dahiru, Kenneth E Amaefulae, Malachy Eneye Asuku
DOI:10.4103/ais.ais_33_19  
Background: Pentazocine-induced ulcerations are characterized by an indolent and intractable course. They constitute in their prolonged form a severely debilitating condition and require long-term multidisciplinary care. The purpose of this study was to analyze the sociodemographic and clinical profile of patients with pentazocine-induced ulcerations and highlight the unique set of challenges in their management. Patients and Method: This is a retrospective study of the clinical records for all patients with pentazocine-induced ulcerations from June 2002 to November 2013. The diagnosis was established by a past history of pentazocine abuse and the finding of chronic nonhealing ulcers on physical examination. Study variables included clinical presentation and outcome. The outcome was classified as healing following ulcer excision and skin grafts, healing following debridement and dressings, amputation, and loss to follow-up. Results: There were 8 males and 10 females with a mean age of 41 (range: 22–68 years). Employment in the health care profession was noted in eight patients: three were physicians and five were nurses. The time interval from the start of pentazocine injection to cutaneous changes ranged from 2 to 13 months. Ulcers were asymmetrical and deep with irregular shapes. The forearm and the thighs were the commonest locations of the ulcers. Split thickness skin graft after ulcer excision was done for two patients and skin grafts after repeated debridements in four patients. Two patients had above-elbow amputations and one patient had an above-the-knee amputation. Fifty percent (9 of 18 patients) refused surgical intervention and left the hospital against medical advice. Conclusion: In this study, there was a preponderance of pentazocine-induced ulcerations among middle-aged, college-educated medical or paramedical professionals. The majority of the ulcers were large, deforming, and indolent. Ulcer excision and split-thickness skin graft as well as treatment for drug dependence and social support are mandatory for an optimal outcome.
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Neurosurgical operative interventions in a new neurosurgical centre in resource-limited settings: A hospital-based study in Nigeria p. 159
David O Udoh, George A Akpede, Emmanuel C Obeta, Uyiosa Osazuwa, Sampson Tudjegbe, Dafe Akpodoado
DOI:10.4103/ais.ais_12_19  
Background: Neurosurgical operations commenced in this institution (which was established in 1973) in 2006. Serving populations of 10 to 12 million, it was, until 2014, the sole neurosurgical facility in the mid-western regions of the country where the demand for neurosurgical care - especially neurotrauma, congenital anomalies, intracranial tumour and degenerative diseases - is very high. We undertook an audit of neurosurgical operations highlighting limitations to effective care and factors influencing outcome. Patients and Method: We studied retrospectively the demographic data, the indications for and nature of operations, as well as outcomes, in neurosurgical patients at our teaching hospital between June 2006 and August 2014. Results: A total of 1,184 patients (51% of all neurosurgical admissions) underwent operative procedures during the eight-year period. Male to female ratio was 2.4 to 1. Most operations were performed in patients aged 0-10 years (25.4%); this was followed by patients aged 21-30 years (17.5%) and >60 years (17.14%). Among patients operated in their first decade of life, those aged 2 years and under accounted for the vast majority (208 i.e. 17.6%). The leading indications were traumatic brain injury (28%), hydrocephalus (16%), chronic subdural haematoma (14%), intracranial tumours (12%) and spinal canal stenoses (10.7%). However, in children 2 years and below, congenital anomalies were the commonest indication for surgery. Operative mortality was 6.25%; this was higher in operations for brain tumours and in the elderly. Conclusion: The profile of central nervous system surgery in Benin City, Nigeria over eight years underscores the need for improvement in the available neurosurgical services, personnel training and facility to meet the escalating society demands.
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Thoracostomy tube in trauma surgery: Does position really matter? p. 166
Jerry G Makama, Nuhu Yusuf, Sunday Edaigbini, Eyo E Ekpe
DOI:10.4103/ais.ais_17_19  
Background: In chest trauma, the conditions that compromise breathing very fast include hemothorax (HTx), pneumothorax (PTx), or both (HPTx). Fortunately, these conditions can be managed with tube thoracostomy (TT). This study was performed to determine whether TT position affects the rate of secondary intervention. Patients and Method: We studied adult trauma patients who underwent TT placement over a period of one year (from March 2017 to March 2018) in 3 Nigerian teaching hospitals. Classification of tube placement by radiologist was considered as ideal when the tube was apically directed and placed in the pleural cavity. Non-ideal TT was defined within the fissure or supradiaphragmatic position. The primary outcome was defined as TT replacement, additional TT tube insertion, or surgical intervention. Results: Ninety seven chest trauma patients who underwent TT placement. Indications for placement were HPTx (43.2%), HTx (26.8%), and PTx (30.0%). Majority of patients were male (66%), median age of 40.8 years (IQR 16–55 years), and blunt (71.1%) trauma. Ideal TT positioning was found in 76 (78.4%) and non-ideal 21 (21.6%). Secondary intervention rate was 4 (19.0%) including 3 (14.25%) replaced TT and 1 (4.75%) thoracotomy. Rate of secondary intervention for ideal and non-ideal TT position was 1 (1.0%) and 19.0% (P = 0.009), respectively. The difference in rate of secondary intervention was not significant (25.1% vs 34.1%, P = 0.09). Conclusion: Position of a non-kinked TT with the sentinel hole within the thoracic cavity does not affect secondary intervention rates. Given over 20% of individuals with additional TT placement required operative intervention for definitive management, early operative intervention in the setting of non-kinked TT provides ideal patient care.
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Preventing pregnancy among women with chronic illnesses: A study of the roles of non-gynecologists practicing in Zaria, Nigeria p. 171
Afolabi K Koledade, Sunday E Adaji, Nana H Madugu
DOI:10.4103/ais.ais_29_19  
Background: Women all over the world suffer from chronic illnesses such as hypertensive diseases, cardiac diseases, diabetes mellitus, mental illnesses, cancers, and HIV/AIDS. Unprotected sex in the presence of preserved fertility could lead to unplanned pregnancies that could pose additional challenges to the ongoing chronic morbidities especially in low-resource settings. We assess the knowledge of non-gynecologists on contraceptive requirements for women with chronic and debilitating illnesses and how these requirements are met within their practice. Patients and Method: A cross-sectional descriptive study using a structured pretested and self-administered questionnaire, administered to non-gynecologists physicians providing care to chronically ill patients in Zaria, northern Nigeria. Data were collected, cleaned, and analyzed using IBM SPSS v19.0. Results: The response rate was 71% (85). Most respondents (88.2%) practice in the teaching hospital and 77.8% (66) had at most 10 years of medical practice. The majority (92.9%) manage women of the reproductive age group (WRAG) with debilitating illnesses. Up to 95.3% (84) agreed that pregnancy affects the management of chronic or debilitating diseases, and 91.8% agreed that these women can benefit from modern contraceptive methods to delay or prevent pregnancies. 74.1% had diagnosed pregnancy among women they managed for chronic or debilitating diseases. Sixty six (76.6%) referred their patients to a contraceptive provider while 9.4% offered them contraception. Up to 51.8% are willing to be trained as counselors in contraception to improve their practice. Conclusions: Training on counseling, especially in the form of Continuous Medical Education can help improve the capacity of non-gynecologists to offer contraceptive services in the context of chronic disorders among WRAG.
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CASE REPORTS Top

Long-term survival in a patient with bilateral metachronous triple negative breast cancer: A case report and literature review p. 176
Ismail Hadi Zubairu, Sunday Adeyemi Adewuyi
DOI:10.4103/ais.ais_19_19  
The incidence of bilateral metachronous breast cancer is rare in our environment. We report the rare case of a 44-year-old woman who has survived for 12 years after she was first diagnosed with stage 3B medullary right breast cancer. She had a positive family history of breast cancer in her paternal grandmother. She was treated with mastectomy and axillary clearance, six cycles of combination chemotherapy and external beam radiotherapy. She was also placed on tamoxifen. She developed a second primary breast cancer in the contralateral breast; triple negative, 10 years after her first diagnosis. She was treated with modified radical mastectomy and six cycles of Docetaxel with excellent response. She completed her chemotherapy about 2 years ago and has been on follow-up with no evidence of loco-regional recurrence.
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Primary intradural liposarcoma of the cervical spine: Case report p. 180
Abdullahi Onimisi Jimoh, Okwunodulu Okwuoma
DOI:10.4103/ais.ais_9_19  
Liposarcoma is the commonest soft tissue sarcoma. It accounts for up to 20% of soft tissue sarcoma. Liposarcoma of the central nervous system is very rare. Pleomorphic liposarcoma (PLS) variant is a rare malignant soft tissue tumor comprising 5%-15% of liposarcomas. It is characterized by its high invasiveness. Few cases have been reported in the literature. We report a case of a pleomorphic variety of cervical spinal cord in a male that was operated with good outcome. The clinical presentation, management, and outcome in a case of primary PLS of the cervical spine, and a review of the literature, are presented. A 42-year-male presented with insidious upper back pain. Magnetic resonance imaging revealed an intradural, extramedullary lesion compressing the spinal cord adjacent to C3/C4. Urgent decompressive laminectomy with gross total resection was performed. Histopathology revealed high-grade PLS. The patient was followed-up to one year and has remained stable symptomatically. Surgical resection is a modality of treatment with adjuvant therapies. Of the few reported cases ours has a good outcome up to the one year follow-up. It should be considered in intradural cord lesion with the characteristic MRI finding.
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Late presenting foreign body and spontaneous exhalation in children: Myth vs reality p. 184
Rashi , Amit Kumar, Amit K Sinha, Bindey Kumar
DOI:10.4103/ais.ais_23_19  
Foreign body (FB) inhalation is frequent in infant and children. Prompt treatment is needed to avoid further complications. We here report two cases of FB right bronchus with delayed presentation. The children had history of FB inhalation which was not properly evaluated initially by their primary physicians. The children were brought to us due persistence of cough, vomiting and difficulty in breathing. Following evaluation, chest x-ray revealed FB in the airway of each of the patients, In both, there was accidental dislodgement of the FB before the specific intervention.
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