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   Table of Contents - Current issue
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July-September 2019
Volume 9 | Issue 3
Page Nos. 57-92

Online since Wednesday, September 23, 2020

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ORIGINAL ARTICLES  

Obstetric brachial palsy: Challenges of management in a developing country p. 57
Lawuobah Gbozee, Mohammed Kabir Abubakar, Samuel S Hennings
DOI:10.4103/ais.ais_1_20  
Background: Obstetric brachial palsy is not common in the presence of satisfactory Obstetric practice. The objective of this study was to highlight the challenges in the management of Obstetric brachial palsy (OBP) in Liberia. Patients and Method: The study was carried out at John F Kennedy (JFK) Memorial Hospital Monrovia Liberia, the largest tertiary institution in Liberia, between October 2018 and June 2019. Records of all patients with OBP that presented to the orthopedic outpatient clinic were used for the study. All the patients were less than 3 months old. The follow-up status at 8–12 weeks and as at June 2019 were recorded. Phone numbers provided on the charts were used to trace the parents of the patients or care givers. Results: Records of 10 patients were analyzed. There were seven males and three females. Birth weight ranged 2.6–4.5 kg, the gestational ages at birth was 36–40 weeks. Parity of the mothers were 1–3. Five patients had Erbs Palsy, three patients had Klumpkes paralysis, and two patients had global deformity. All 10 patients had right upper limb involvement. All the patients were referred for physiotherapy. At 8–12 weeks of presentation, three patients came for follow-up, seven were lost to follow-up. A follow-up phone call in June 2019 revealed improvement in four patients, some improvement in one patient, whereas five patients could not be reached. Conclusion: OBP is not uncommon in our setting and usually occurs on the right upper limb. Majority of the patients that present soon after birth would have significant improvement on physiotherapy.
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An alternative to DJ-stenting for ureteroneocystostomy: Experience at a tertiary health facility p. 61
Ngwobia Peter Agwu, Abdullahi Khalid
DOI:10.4103/ais.ais_6_20  
Background: Stenting of the ureters is an established principle of ureteral surgery. This can be achieved using conventional double-J (DJ) stents, ureteric catheter or improvised infant feeding tubes. In routine urological practice, our choice is influenced by availability, cost, and the availability of urethrocystoscopic equipment for device retrieval. We described an alternative surgical technique and review the outcomes of this procedure. Patients and Method: This is a 10-year retrospective study from October 2007 to November 2017 of patients who had an alternative to DJ-stenting using infant feeding tube for ureteroneocystostomy following ureteric injury in the urology unit of a tertiary health facility. The records of socio-demographic, clinical and therapeutic characteristics and complications in patients who had alternative to DJ-Stenting inserted for ureteroneocystostomy following ureteric injury were extracted from patient's case notes. Data was analyzed using SPSS version 20. Results: Out of a total of 26 female patients with ureteral injuries who had ureteroneocystostomy with alternative to DJ-stenting, complete records of 12 (46.2%) patients were available. Mean age of patients was 37.42 ± 13.69 years with a range of 20-58 years. Majority of the patients were between the ages of 30 to 39 years (33.3%). The alternative to DJ-stent specific complication was stent dislodgement noted in 12.5% of patients. Conclusion: The alternative to DJ-stenting for ureteroneocystostomy is associated with low procedure-specific complications. It is a useful tool especially for patients from low socio-economic background presenting with ureteral complications after gynecological or obstetric surgeries.
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Pattern of computed tomographic findings in patients referred with head injury secondary to road traffic accident in a Nigerian otolarhyngologic center p. 67
Tokan S Baduku, Abdulkadir M Tabari
DOI:10.4103/ais.ais_5_20  
Background: Head injuries are common causes of morbidity and mortality in trauma patients. Computed tomography (CT) is an important imaging modality in the management of patients with a head injury. This study aimed at documenting the pattern of CT findings among patients with a head injury who presented to the Radiology Department of a tertiary hospital which has neither a Neurology nor a Neurosurgical unit. Patient and Methods: This is a one-year retrospective study carried out on 127 patients seen at the National Ear Care Centre (NECC), a premier Ear Nose and Throat health institution, which serves as a referral center for cities and towns within Nigeria. Radiology request cards, duplicate copy of radiology reports, and soft copy of their CT images were analyzed. All patients with a history of head trauma from other causes were excluded from the study. Results: A total of 127 patients were recruited from January 2017 to December 2017 and had cranial CT done. Their mean age was 35.5 (range 1–70 yrs) with M: F of 3:1. The most frequently involved age group was 21–30 years, accounting for 26.7%. Referrals from secondary and primary health centers accounted for 22% and 28%, respectively. Thirty-seven (29%) patients had normal brain CT findings. The most common abnormal findings were skull fractures and intracerebral hemorrhage in 63 (26%) and 55 (18.8%) patients, respectively. Less common findings include midline shifts, intracranial pneomocoeles, metallic foreign bodies, ventricular hemorrhages, effacements, and compressions. Conclusions: The patronage of CT imaging modality by primary and secondary health centers is significant, constituting 50% of the referrals. This suggests that medical personnel in the secondary and primary health centers are maximizing the use of CT as a diagnostic modality. Also, skull fracture still dominates the CT findings.
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Effect of flap-fixation on seroma formation after mastectomy among African patients: A single centre randomized study p. 73
Ibrahim U Garzali, Amina I El-Yakub, Abdulrahman A Sheshe
DOI:10.4103/ais.ais_10_20  
Background: Breast cancer is the most common in female malignancy world-wide with about 1 million new cases per year. Surgeons play a major role in the management of breast cancer with mastectomy constituting the most common and important surgical intervention needed for these patients especially in our setting. Seroma constitute most common complication of mastectomy with some surgeons now considering it a side effect of the surgery rather than a complication. The objective of this study was to determine the role of flap-fixation on seroma formation after mastectomy in Aminu Kano Teaching Hospital. Patients and Methods: This was a single Centre prospective study carried out from August 2017 to September 2018 with the studied population being women with breast cancer undergoing mastectomy. Recruitment was at the surgical outpatient clinic. The patients were randomized into two groups with group A having flap fixation after mastectomy and group B having conventional closure with no flap fixation. Seroma formation was then compared within the two groups. Results: A total of 60 patients were involved in the study with 30 patients per group. The mean age of patients is 44.2 ± 6.1 for group A and 46.3 ± 7.4 in group B. Majority of the patients had modified radical mastectomy with prolongation of the surgery by up to 20 min in group A. The duration of drainage, amount of fluid drained and incidence of seroma was higher in group B. Conclusion: Flap fixation to pectoralis major significantly reduces seroma formation after mastectomy for breast cancer.
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Effect of diabetes mellitus on operative outcome following laparoscopic cholecystectomy: A one year cross sectional study at tertiary care hospital p. 78
Kiran S Mahapure, Shrishail C Metgud
DOI:10.4103/ais.ais_3_20  
Background: Diabetes is reported to be a risk factor for gallstone formation. Diabetic patients are more prone to operative and post-operative morbidities. This study was aimed to find intra-operative difficulties and complications during laparoscopic cholecystectomy in diabetic and non-diabetic patients Patients and Method: This is a one year cross-sectional study carried out in a tertiary health center. Operative difficulties and complications studied in a total of 60 patients (30 diabetics + 30 non-diabetics) undergoing elective laparoscopic cholecystectomy from January 2014 to December 2014. Statistical analysis consisted of Chi-square test or Fisher's exact test, “p” value of less than or equal to 0.05 at 95% confidence interval considered as statistically significant. Results: Pre-operative characteristics including clinical presentation, duration of symptoms and vitals were comparable in diabetic and non-diabetics patients (p > 0.050). Significantly higher number of patients in diabetic group underwent open pneumoperitoneum (40% versus 16.67%; P = 0.045). Statistically significant difference noted in appearance of gall bladder, adhesions, dissection of Calot's triangle, releasing adhesions, intra operative bleeding, grasping of gallbladder, removal of gallbladder from liver bed, extraction of specimen, drain placement, and conversion (p < 0.050). The operative time was significantly higher in patients with diabetes mellitus (p < 0.050). Conclusion: Diabetes mellitus is significantly associated with operative difficulties and prolonged surgical time during laparoscopic cholecystectomy.
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Management of blunt liver trauma: Observational hospital-based study p. 84
Ajinkya J Kasekar, Anant N Beedkar, Sarojini P Jadhav, Pankaj S Tongse
DOI:10.4103/ais.ais_35_19  
Background: Conservative management of blunt liver trauma is being recommended based on evidence from research studies. The present study describes the observations concerning the management of blunt liver trauma from a tertiary care centre in Marathwada region of Maharashtra. Patients and Methods: This observational hospital-based study included hemodynamically stable patients with confirmed blunt liver trauma, admitted at our tertiary care hospital. Patients who were not hemodynamically stable on admission; but later became hemodynamically stable after resuscitation were also included in the study. Hemodynamic stability was assessed based on systolic BP >90 mmHg; Pulse rate <100, and transfusion requirements <2 units. Diagnostic tools used were routine laboratory tests, Ultrasound imaging and CECT abdomen and pelvis. The AAST classification was used for grading the liver injury in patients in whom CT scan was done. Patients were assessed for clinical and hemodynamic status. Resuscitation, was done by using crystalloid solution and blood. The patients were then transferred to the intensive care unit for monitoring of vitals like pulse rate, systolic BP and abdominal distension. Regular observations and documentation of vital signs abdominal distension and haemoglobin were done, and once there is a change in the hemodynamic status patient was scheduled for surgical intervention. Patients were followed at 1, 2, 3, and 6 months interval. Results: Total 31 (29 males, 2 females) blunt liver trauma patients were included. In total 26 patients (83.9%) were managed conservatively. Five patients (16.1%) were operated based on hemodynamic parameters. Most of the patients with grade II, III and IV liver trauma were managed conservatively with satisfactory results. Conclusion: Study findings favour nonoperative management of blunt liver trauma in hemodynamically stable patients and also in patients who are responsive to resuscitation.
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CASE REPORT Top

Single-stage debridement, decompression, and circumferential reconstruction for lumbar tuberculous spondylitis: A posterior-only approach p. 89
Adetunji M Toluse, Taofeek O Adeyemi, Adeniyi S Ogunsakin, Asi-Oqua E Bassey
DOI:10.4103/ais.ais_18_20  
Spinal tuberculosis accounts for almost 50% of all skeletal involvements. Global reconstruction with adequate debridement and decompression, all through posterior approach alone, is one of the surgical treatment modalities in the management of this disease. A 33-year-old female presented to our facility with lumbar tuberculous spondylitis; had 8-month history of low back pain and 4-month history of progressive low back swelling with associated fever, drenching night sweat, and progressive weight loss. She had a single-stage debridement and instrumented fusion via a posterior-only approach. She is ambulant with normal gait and gaining weight by the 1-year follow-up visit, with radiologic evidence of fusion. The posterior-only approach for 360° instrumented fusion is quite rewarding in the operative care of spinal tuberculosis.
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