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   Table of Contents - Current issue
Coverpage
Jul-Dec 2019
Volume 8 | Issue 14
Page Nos. 45-121

Online since Friday, October 4, 2019

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REVIEW ARTICLE  

Neurological manifestation of human immunodeficiency virus/Aids p. 45
GA Onwuegbuzie, RS Reng
DOI:10.4103/nnjcr.nnjcr_20_19  
Neurologic complications occur in human immunodeficiency virus (HIV)-infected patients, but only a few of these complications are directly related to HIV infection of the central nervous system (CNS). The virus can affect virtually every aspect of the central and peripheral nervous system, directly or indirectly with the major target being the immune system, including lymphocytes, microglia, and macrophages. Common neurologic manifestations include meningitis, minor and major cognitive impairment, stroke, seizure, immune-mediated effects and opportunistic infection. Diagnosis usually involves a detailed clinical evaluation, including mini-mental scale, as well as lumbar puncture for serology and culture, nerve conduction studies, electromyogram, and neuroimaging. Treatment is usually targeted at the HIV using highly active antiretroviral therapy (HAART) and specific disease entities. CNS side effects of HAART may be transient, while others may require withdrawal of the antiretroviral drug.
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ORIGINAL ARTICLES Top

Alcohol use among secondary school students in Nigeria: A worrisome trend p. 54
Adewoyin Adejoke Osonuga, Bola Deborah Ogunmoroti, Ayokunle Osonuga, Adebayo Da'costa
DOI:10.4103/nnjcr.nnjcr_40_18  
Background: Alcohol abuse is a global health problem, resulting in a spectrum of biopsychosocial and medical consequences. In recent times, there has been a surge in the number of adolescents who have been exposed to alcohol abuse and its attending consequences. This study aimed at identifying the reasons for alcohol abuse and assessed the knowledge of students about the harmful effects of alcohol. Materials and Methods: The study was a cross-sectional study involving 384 students who were selected by convenience sampling after ethical approval and consent was granted. A pretested questionnaire was administered to get basic biodata. This questionnaire also had five-scale questions to elicit other variables of interest. Data were analyzed using Microsoft Excel and SPSS. Results: 66% of respondents reported to have taken alcohol before, at ceremonies or while hanging out with friends. Alcohol caused problems with the law and family problems in about half of the respondents. Assault and high-risk sexual behaviors were not uncommon (5% and 12%, respectively). Most respondents knew of the consequences of alcohol abuse but gave reasons for taking alcohol; social media (96.2%), fun (94.8%), coping with stress of school (73.9%), and adolescence (93.8%) were common among other reasons. Conclusion: Alcohol problems are common in our secondary schools, stakeholders should be aware of this. We recommend expert support for students, especially in secondary schools, so that we can save the next generation from self-destructing.
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Incidence of skeletal-related events in advanced and metastatic prostate cancer patients treated with androgen deprivation therapy in a low- and middle-income country p. 60
Oseremen Inokhoife Aisuodionoe-Shadrach, Sadiq Abu
DOI:10.4103/nnjcr.nnjcr_12_17  
Context: Skeletal-related events (SREs) occur in men with prostate cancer (CaP) and may result from androgen deprivation therapy (ADT). Aims: The purpose of this study was to determine the incidence of SREs in patients with CaP treated with HT while highlighting the burden of advanced and metastatic CaP in a low- and middle-income country practice. Settings and Design: Eligible cases were newly diagnosed patients with CaP seen at the University of Abuja Teaching Hospital, Abuja, Nigeria between January 2012 and December 2015 with bone metastases and treated with ADT. Subjects and Methods: Data compiled from patient's medical records showed tumor diagnosis, laboratory and radiology results. SREs included spinal cord compression, surgery to bone, pathologic fracture, and radiation to bone. Statistical Analysis Used: The data were analyzed using SPSS version 20 for windows (SPSS INC: Chicago Illinois). Results: Two hundred and nineteen cases of CaP were seen over the period of which 142 (64.8%) cases were first diagnosed as American Joint Committee on Cancer Stage IV CaP and commenced on ADT. More than half the patients on ADT were older >65 years with a mean (standard deviation [SD]) of 68.3 (±9.5) years. Serum prostate-specific antigen range was 1.4–2461.58 ng/ml with a mean (SD) of 113.7 (±288.9) ng/ml. Twenty nine patients (20.5%) had one or more SREs with spinal cord compression (19.1%), pathological fractures (1.4%), and radiotherapy to the affected bone (1.4%) being the most common SREs. ADT was orchiectomy, LHRH, anti-androgens, and complete androgen blockade (orchiectomy plus antiandrogens) in 14 (9.8%), 3 (2.1%), 44 (30.9%), and 81 (57%) patients, respectively. Conclusions: Sixty-five percent of the cases in this series were either advanced or metastatic CaP at first diagnosis majority of whom went on to orchiectomy plus antiandrogens as ADT. This lends credence not only to late presentation and increased morbidity and mortality of CaP in our environment but also to significantly low penetration of radiotherapy services and access to LHRH.
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Biting preferences of blackfly in two endemic communities of ose local government area, Ondo state, Nigeria p. 64
Olajide Joseph Afolabi
DOI:10.4103/nnjcr.nnjcr_38_18  
Context: Blackflies are hematophagous dipterans who transmit Onchocerca volvulus; the pathogen of onchocerciasis. Aims: The study was undertaken in Imeri and Idogun to evaluate the knowledge of respondents on the biting preferences of blackflies. Settings and Design: The design is an observational study in epidemiology which involves the use of structured questionnaire to obtain useful epidemiological information from the respondents. Materials and Methods: Structured questionnaire was administered during personal interview and focus group discussion to obtain useful epidemiological information. Statistical Analysis Used: Data obtained were analyzed using Carl Pearson Chi-square at P < 0.05 level of significance. Results: The results showed that only 193 of the 578 respondents interviewed in the two communities had adequate knowledge of the cause and mode of transmission of onchocerciasis. This group knew that the disease is transmitted by the bite of infected blackflies. Other respondents (66.6%) had wrong perception about the cause and mode of transmission of the disease. The wrong perceptions observed in the communities include transmission by sexual intercourse, stepping on charms, and transmission from infected parent to offspring. The knowledge on the biting preference of the blackflies as tested among 193 respondents that were knowledgeable about the disease varied significantly (P = 0.05). Some respondents believed the fly bites in the farm (48.7%) and others believed the fly bites by the riverside (36.3%), in the village (5.2%), whereas 9.8% of the respondents believed the fly bites both on the farm and the riverside. Similarly, others believed the fly bites on the exposed legs (54.4%), hands (9.9%), and face (6.7%). Meanwhile, 29% of respondents believed the fly bites on any exposed part of the body. Conclusions: The results revealed that ignorance on the bioecology of the vector is still very high in these communities.
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Relationship between ABO blood group phenotypes and hypertensive disorders of pregnancy: A hospital-based cross-sectional study in Kano, North-West Nigeria p. 68
Isyaku Gwarzo Mukhtar, Aisha A Yakubu, Bashir Wada Yakasai, Salisu Ibrahim Ahmed, Shamsuddeen Mansur
DOI:10.4103/nnjcr.nnjcr_28_19  
Background: Hypertensive disorders of pregnancy (HDP) complicate an estimated 5%–10% of pregnancies globally. Studies have linked non-O blood group with the development of HDP, especially preeclampsia (PE). However, these reports have not been consistent. This study aimed to determine the relationship between ABO blood group and HDP among pregnant women attending antenatal clinic at Murtala Muhammad Specialist Hospital, Kano, Nigeria. Materials and Methods: Two hundred and ten pregnant women with clinically diagnosed HDP and an equal number of age-matched normotensive controls were recruited for the study. Blood pressure was measured using a mercury sphygmomanometer and a Littman's stethoscope which was positioned on the medial aspect of the right arm at sitting position. Urinalysis was performed using a urine dipstick (Medi-Test Combi 9®). ABO blood groups were determined by tile agglutination method using potent monoclonal anti-A, anti-B, and anti-D reagents (Plasmatec Lab., Bridport, UK). Data were analyzed using Statistical Package for Social Sciences version 23.0. Chi-square test of association, Student's t-test, and logistic regression were used as statistical tools, and results were presented as frequencies, percentages, mean ± standard, odds ratio (OR), and confidence interval (CI); P ≤ 0.05 was considered statistically significant. Results: The mean age of the cases and controls was 26.20 ± 6.96 and 25.90 ± 6.37, P = 0.65, respectively. The mean gestational age of the cases and controls was 32.30 ± 4.15 and 29.06 ± 4.25, P = 0.01, respectively. The mean systolic and diastolic blood pressure of the cases and controls in mmHg were 176.62 ± 32.62 and 123.08 ± 6.40, P = 0.01, and 114.20 ± 20.08 and 76.43 ± 5.07, P = 0.01, respectively. Of the 210 individuals in the HDP group (cases), 90 (42.86%) had gestational hypertension (GH), 50 (23.81%) had PE, and 70 (33.33%) had eclampsia. Type O blood group was the most common group in both cases (93 [44.3%]) and controls (98 [46.7%]). This was followed by groups A (40 [19.0%] and 45 [21.45]), B (58 [27.6%] and 53 [25.2%]), and AB (19 [9.0%] and 14 [6.7%]) for cases and controls, respectively. There was no statistically significant difference in the frequencies of ABO blood group between the cases and controls (χ2 = 1.41, P = 0.70, df = 3). Compared to type O blood group individuals, non-O blood group individuals had 1.106 times odd of developing HDP than the controls (OR: 1.106, 95% CI: 0.753–1.625, P = 0.61). Similarly, types A, B, and AB blood group individuals had 1.292, 1.492, and 1.882 times odds of developing GH compared to blood Group O and controls (OR: 1.292, 95% CI: 0.670–2.490, P = 0.45; OR: 1.492, 95% CI: 0.813–2.740, P = 0.20; and OR: 1.882, 95% CI: 0.746–4.748, P = 0.18), respectively. Equally, types A, B, and AB blood group individuals had 1.243, 0.990, and 1.699 times odds of developing PE compared to blood group O individuals and controls (OR: 1.243, 95% CI: 0.561–2.754, P = 0.59; OR; 0.990, 95% CI: 0.442–2.217, P = 0.98; and OR: 1.699, 95% CI: 0.546–5.281, P = 0.36), respectively. Compared to type O blood group individuals, types A, B, and AB blood group individuals had 0.463, 0.690, and 0.901 times odds of developing eclampsia compared to controls (OR: 0.463, 95% CI: 0.199–1.079, P = 0.74; OR: 0.960, 95% CI: 0.505–1.825, P = 0.90; and OR; 0.901, 95% CI: 0.301–2.695, P = 0.85), respectively. Primiparity (OR: 2.320, 95% CI: 1.451 – 3.711, P = 0.01, for HDP) and gestational age (OR: 1.078, 95% CI: 1.013 – 1.148, P = 0.02 – gestational hypertension; OR: 1.328, 95% CI: 1.212 – 1.456, P = 0.01 – preeclampsia; OR: 1.467, 95% CI: 1.333 – 1.614, P = 0.01 – eclampsia) were identified as pregnancy related risk factors for HDP. Conclusion: The frequencies of ABO phenotypes in women with HDP are similar to that of normotensive pregnant women. There is no relationship between ABO phenotypes and HDP as observed in this study. However, nulliparity and gestational age were identified as risk factors for HDP. Similar hospital-based and population-based studies should be conducted to further evaluate this phenomenon in this environment.
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A comparative evaluation of the role of cone beam computed tomography (CBCT) imaging and orthopantomography (OPG) in sinus augmentation procedures: An original study p. 75
S Girish Rao, Sushma Mehta, Abhishek Singh Nayyar
DOI:10.4103/nnjcr.nnjcr_8_17  
Background and Aim: Radiology and higher imaging modalities have their own advantages and disadvantages. The present study was designed to do a comparative analysis of the role of cone-beam computed tomography (CBCT) and orthopantomography (OPG) for preoperative planning and postoperative evaluation of treatment outcomes in implant therapy in combination with sinus augmentation procedures. Materials and Methods: Pre- and postoperative assessment of maxillary sinuses was done in 17 patients who underwent implant therapy in combination with sinus augmentation procedures using CBCT and OPG. Statistical analysis was performed using IBM SPSS statistics 20 (Chicago, USA). Paired and unpaired t-tests were used to do a comparative analysis of the two modalities used. Results: There was a concordance between the treatment type based on pre- and postoperative CBCT assessments. The assessment of sinus morphology revealed a significantly higher detection rate of aberrations in the form of sinus mucosal hypertrophy and septa on CBCT which were imperceptible on orthopantomographs undermining the role of routine radiography in these procedures. The results obtained, also, revealed that vertical alveolar bone height could be measured more precisely with CBCT. Conclusion: Based on the findings of the above study, it could be concluded that CBCT increased the accuracy of both the sinus morphology assessment and the estimation of gain in vertical alveolar bone height, in addition to bone density, which remains unassessed by the conventional radiological techniques including OPG.
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Pattern of utilization of dental services and oral self-care practices of people living with HIV/AIDS in two tertiary health institutions in Nigeria p. 84
Kehinde Adesola Umeizudike, Opeyemi Daramola, Babatope Bamidele Osagbemiro, Titilope Adenike Adeyemo
DOI:10.4103/nnjcr.nnjcr_35_18  
Background: People living with HIV/AIDS (PLWHA) have a high risk of oral health problems. However, little is known about their utilization of oral health services in Nigeria. Objectives: The aims of this study were to determine utilization of dental services and oral hygiene practices among PLWHA attending two tertiary health institutions. Materials and Methods: This was a descriptive, cross-sectional study among PLWHA attending HIV clinics in two teaching hospitals in South West and South South Nigeria. Information obtained using self-administered structured questionnaires included questions on pattern of dental services' utilization and oral hygiene behavior. P < 0.05 was considered as statistically significant. Results: Three hundred and fifty-two (352) PLWHA participated. Mean age was 42.5 ± 9.4 years, 64.2% were females, and 36.9% were of middle socioeconomic status (SES). Previous dental visits (36.9%) were associated with perception of dental need, center of study, and SES (P < 0.05). Odds of utilizing dental health services were higher among those who perceived they needed dental care (odds ratio: 4.12; 95% confidence interval: 2.13–7.96). Eighty-eight (25%) had visited the dentist in the preceding 12 months and received dental treatment in the form of extraction (64.4%), routine dental check (13.8%), and scaling and polishing (5.8%). Lack of perceived dental need and financial limitations were the main barriers for lack of dental visits. Twice daily tooth brushing was practiced by 40.1% of the respondents. Conclusion: Utilization of the dental services among PLWHA was low and influenced by self-perception of dental need, study center, and higher SES. Oral hygiene practices were less than optimal.
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Adherence to isoniazid preventive therapy for tuberculosis among HIV patients in Kano, Nigeria p. 91
Ibrahim Rabiu Jalo, Usman Muhammad Ibrahim
DOI:10.4103/nnjcr.nnjcr_14_19  
Background: Tuberculosis (TB) is the most common opportunistic infection among human immunodeficiency virus (HIV)-infected individuals. It is a major cause of mortality among patients with HIV and poses a risk throughout the course of HIV disease. Adherence to isoniazid preventive therapy (IPT) is a critical factor that needs to be considered in scaling up services in developing countries. Objectives: The study aimed to assess adherence and associated factors to IPT among HIV patients in Kano. Methods: Using a cross-sectional study design, interviewer-administered questionnaire was used to collect information from 320 HIV patients from two comprehensive health centers (CHCs). Results: Up to two-third, 211 (65.9%) of the participants were aware of the use of isoniazid for the prevention of TB among HIV/AIDS patients, but only about half 172 (53.8%) of the respondents interviewed were currently using IPT for TB prevention. Up to 158 (89.5%) of the 172 respondents interviewed had good level of adherence to IPT and the main reasons to enhance adherence were disclosure of HIV status to partner/relatives (77.9%), adequate counseling about IPT (62.8%), and awareness of IPT for TB prevention (65.9%). Conclusion: Good level of adherence to IPT from this study implies that the need for improve strategies to ensure IPT scale up as adherence to IPT among HIV clients in Kano is optimal, but uptake remains low.
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Willingness to pay for antipsychotic medications in two tertiary health institutions in Nigeria p. 97
Wednesday Joshua Edefo, Stella F Usifoh, Waka Anthony Udezi
DOI:10.4103/nnjcr.nnjcr_23_19  
Objectives: Antipsychotic medications availability and affordability enhance patients' compliance and consequently improving their productivity. In Nigeria, where about half the number of her population is impoverished, and health-care cost burden is mostly out of pocket of patients. The study objectives are to determine patients' preference in three antipsychotic medications with different attributes and side/adverse effects and a hypothetical antipsychotics medication with highest efficacy and highest risk, which of the drug's willingness to pay (WTP) price is closer to the actual amount of the medication, as well as the demographic factors that influence WTP of antipsychotic medications. Methods: WTP instrument was administered to 706 consenting patients. The characteristics ranging from efficacy, duration of administration, and possibility of eliciting side/adverse effects of the drugs was provided. A contingent valuation method was used where a virtual market scenario of 20 payment options was presented to the patients with different prices ranging from N 100 ($ 0.33) to NGN5000 (USD16.67). As at the time of this study, $1 (USD) was equivalent to N300.00 (NGN). A linear multivariate analysis was employed to determine the influence of sociodemographic factors on WTP. Results: At most of the given prices, more patients were willing to pay for the hypothetical antipsychotic D. The WTP for all the medications except haloperidol indicated by most of the respondents were above their reference prices. Longer duration of previous treatment, higher educational status, higher income, and stable marital status gave P = 0.001, P = 0.015, P < 0.001, and P = 0.002, respectively. Conclusion: Patients preferred the medication that has the highest efficacy and attendant risk; majority of the patients are willing to pay at a lower price than the prevailing price for all medications used except haloperidol. The duration of previous drug treatment, income, age, education, and marital status significantly affected the WTP of drugs.
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A 5-year prospective review of postoperative pain management in Ahmadu Bello University Teaching Hospital Zaria: Challenges and way forward p. 104
Yunus Adeniyi Abdulghaffar, FS Ejagwulu, B Fomete, AB Obidike, SO Abdullahi, TS Akande
DOI:10.4103/nnjcr.nnjcr_32_18  
Background: Perception of postoperative pain varies. It depends on the type of surgery and the individual involved, which is influenced by race. Postoperative pain, in general, is inadequately managed in developing countries. This study prospectively reviewed the challenges of postoperative pain management in our center, the incidences and other options available for effective postoperative pain management. Methods: Following hospital ethics approval and informed consent, a 5-year prospective review of postoperative pain management was carried out on 3623 patients operated in Ahmadu Bello University Teaching Hospital under subspecialty of general, maxillofacial, orthopedic, and obstetrics and gynecology surgeries, from January 2013 to December 2017. Following the enlightenment of patients about numeric pain score scale, pain scores of the patients that met the inclusion criteria were determined 24 h postoperatively through a predesigned questionnaire. Numeric pain scale was used to ascertain pain intensity and the level of satisfaction following postoperative pain management. The surgeons' and the anesthetic review, as well as the anesthetic chart of the 3623 patients managed, were studied. The incidence of the degree of pain scores was calculated for the different patient's populations. Techniques of anesthesia were also computed. Data were analyzed using Chi-square statistical package. Results: High rate of severe pain incidences was observed. Out of the overall 3623 patients managed within the study period, 42.1% (1525) of the patients reported severe pain. About 43.8% (1587) of patients had moderate pain and only 14.1% (511) of the patients recorded mild pain. Most of the patients [56.1% (2033)] had general anesthesia, while 41.5% (1503) had regional anesthesia. Around 2.4% (87) of the patients had both general and regional anesthesia. Conclusion: Postoperative pain is inadequately managed. There is need for the policymakers to provide intensive intervention on postoperative pain management by considering adequate supply of strong opioids regularly. More so, knowledge of the anesthetists and physicians involved in postoperative pain management need to be improved and updated, especially on the techniques for managing postoperative pain.
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Stress response associated with elective cesarean delivery: A comparison of the effect of general versus subarachnoid anesthesia p. 109
Olumide Adeleke Akitoye, Mamuda Atiku, Nathaniel David Adewole
DOI:10.4103/nnjcr.nnjcr_37_18  
Context: Pregnancy, surgery, and anesthesia are identified forms of stress to the body. Sustained response to stress has been associated with increased morbidity and mortality. Aim: The aim of the study is to determine the effect of anesthetic techniques on the response to the stress of surgery and anesthesia. Study Design: This was a prospective, randomized, double-blind study. Subjects and Methods: One hundred and forty patients scheduled for elective cesarean section were recruited and randomized into two groups: general anesthesia and subarachnoid anesthesia. Heart rate (HR), blood glucose, and cortisol levels were used to evaluate the body response to stress. Blood samples to estimate glucose and cortisol levels were taken the night of the day before surgery, just before induction, 30 min after induction, 60 min after induction, and 24-h postsurgery. The Statistical Package for the Social Sciences Version 23 was used for analysis to find the mean and standard deviation of both categorical and noncategorical variables. The Independent t-test and two-tailed test were used to show the differences in the HR, blood glucose, and cortisol levels within and between the general anesthesia and subarachnoid anesthesia groups. Results: The two groups were comparable in terms of age, height, weight, and American Society of Anesthesiologists status. The changes in HR and blood glucose were similar in both groups. However, a statistically significant difference was noted in the level of cortisol between the two groups at 60-min postskin incision with 494 ± 161 nmol/L in the general anesthesia group as opposed to 347 ± 161 nmol/L in the subarachnoid anesthesia group with a P = 0.01. Conclusions: The study demonstrated that subarachnoid anesthesia offers an advantage over general anesthesia in terms of the reduction to stress response to surgery and anesthesia. However, patient's choice and the urgency in the delivery of the fetus should be considered in choosing a mode of anesthesia.
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CASE REPORTS Top

Cervical cystic teratoma of the neck in a neonate: A case report and literature review p. 115
Aditya Pratap Singh, Ramesh Tanger, Vinay Mathur, Arun Kumar Gupta
DOI:10.4103/nnjcr.nnjcr_45_16  
Cervical teratoma is very rare. We are presenting here a case of cervical immature teratoma in a neonate with review of literature. A 17-day-old male baby with huge cervical teratoma and oral extension presented to us with feeding difficulties. We completely excised the tumor. The infant was discharged after 7 days with mild facial palsy. Uneventful recovery followed without recurrence. Histopathology suggested immature cystic teratoma. There was huge cervical teratoma with oral extension in the neonate. It was located at the cervical region which is very rare, and it was present in the male baby. We completely excised the tumor with mild facial palsy without recurrence. It should be kept in mind in case of neck swelling in a neonate. Cervical teratoma is a rare variety.
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Palpitation in a known hypertensive patient, looking beyond the obvious: A case of pheochromocytoma coexisting with hypothyroidism p. 118
Akolade O Idowu, Andrew O Mene, Omotayo F Salami, Theophilus O Ajiro, Daniel E Ezuduemoih, Clement G Inyang
DOI:10.4103/nnjcr.nnjcr_1_19  
Pheochromocytoma is an uncommon tumor arising from the chromaffin cells of the adrenal medulla. It is a potential life-threatening endocrine disorder. We report a case of a 56-year-old woman who presented on account of recurrent episodes of palpitation with frontal headache that was associated with visual flashes and episodic sweating. Abdominopelvic computed tomography scan showed a well-circumscribed homogeneous mass within the left adrenal gland. The urinary metanephrine and normetanephrine were markedly raised, with an assessment of pheochromocytoma made. Pheochromocytoma should be strongly considered in any patient presenting with palpitations and other neurological symptoms after ruling out cardiac abnormalities. It is important to screen for secondary cause of hypertension in a newly diagnosed hypertensive with ultrasound, which is cheap and readily available. Likewise, ambulatory blood pressure monitoring is highly recommended in any patient with strong suspicion of pheochromocytoma but with normal blood pressure to demonstrate the lability in the pattern.
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LETTER TO THE EDITOR Top

Primary B-Cell jejunal maltoma in a young adult male: A case report and review of literature p. 121
Mahmood Dhahir Al-Mendalawi
DOI:10.4103/nnjcr.nnjcr_15_18  
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