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   Table of Contents - Current issue
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Jul-Dec 2020
Volume 9 | Issue 16
Page Nos. 39-96

Online since Thursday, November 26, 2020

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ORIGINAL ARTICLES  

Histological pattern of breast diseases in children and adolescents in North Central Nigeria p. 39
Solomon Raphael, Kevin Nwabueze Ezike
DOI:10.4103/nnjcr.nnjcr_10_20  
Background: Breast lesions are said to be rare and predominantly benign in the pediatric population. However, several case reports of malignant breast lesions in this demography exist, hence, the need to carefully examine breast masses when seen in children and adolescents to ascertain their nature. Aim: The aim of this study is to document the frequency, sex, and age distribution of the histologic subtypes of breast diseases seen in children and adolescents in a district hospital. Patients and Methods: Data were collated retrospectively from patients' request forms and duplicate copies of histology reports of all cases of breast lesions seen over a 5-year period at the pathology unit of Asokoro District hospital, Abuja, North Central Nigeria. Data were analyzed using Microsoft Excel, expressed using measures of central tendencies and percentages, and displayed using simple tables. Results: One-hundred and thirty-six cases of breast lesions were seen in the children and adolescent population (≤19 years), representing 16% of all the breast specimens during the study period. Females accounted for 97% with female-to-male ratio of 33:1. Their ages ranged from 10 to 19 years with modal age at presentation of 16 years. One (0.74%) case of invasive cribriform carcinoma was seen in a 17-year old boy. They presented as unilateral breast lesions in 88.6%, bilateral lesions in 9.6%, and unstated in 5.8% of patients, respectively. The most common lesion was fibroadenoma (74.3%), followed by fibrocystic change (10.3%). Conclusion: Breast lesions are common among older children and adolescents in our environment, mostly benign in nature and strikingly affect females. Fibroadenoma was the most common histologic lesion seen.
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Pathologic findings in prostate gland at autopsy with topographic distribution of these diseases within the prostatic zones: Eleven-month prospective study in Oauthc, Ile-Ife, Nigeria p. 44
Ifeoma Florence Ezejiofor, Williams Olufemi Odesanmi, Oluwole Olaniyi Odujoko, Akinwumi Oluagbenga Komolaefe, Tosin O Alade, Rinde O Olaofe, Ibeh Charles Ibe
DOI:10.4103/nnjcr.nnjcr_20_20  
Introduction: Different zones of prostate harbor different prostatic pathology. The peripheral zone shows majorly prostatic adenocarcinoma, which is among the common causes of cancer death in men in sub-Saharan Africa. Aim: The study aimed to determine the spectrum of prostate pathologies in routine autopsies of adult male 30 years and above whose death was unrelated to prostate diseases. Methods: A total of eighty cases of prostate glands were harvested over an 11-month period. These glands were fixed for 48 h, grossed, and processed. The hematoxylin- and eosin-stained slides were examined using multiheaded microscope. Results: The age range of patients was 30–85 years with a mean age of 41.84 ± 12.63 years standard deviation. The most common cause of death in these patients was trauma secondary to road traffic accident followed by cardiovascular diseases. The most common lesions in each prostatic zone as observed in this study were chronic prostatitis 26.3% in the central zone; nodular hyperplasia 16.3% in the transitional zone; prostatic atrophy (13.8%) and adenocarcinoma (8.3%) in the posterior peripheral zone (one of the cases (1.3%) showed multiple carcinomatous foci); and chronic prostatitis 15.0% in the anterior fibromuscular zone. Four patients' ages 30, 31, 32, and 48 years had Schistosoma haematobium infections observed in the seminal vesicles, whereas patient aged 48 years had in addition adenocarcinoma of prostate gland and prostatic atrophy (PA). A case (1.3%) of prostatic calculi and simple cyst of the prostate was seen in ages 56 and 85 years, respectively. Conclusion: Different zones of the prostate are associated with different disease entities, and S. haematobium show an association with adenocarcinoma of prostate in one individual
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Premalignant and malignant lesions of the esophagus: A single-institutional experience p. 50
Mustapha A Ajani, Omolade O Adegoke, Ifeanyichukwu D Nwanji, Sebastian A Omenai, Kolawole O Akande
DOI:10.4103/nnjcr.nnjcr_22_20  
Background: Esophageal malignancy is a highly aggressive tumor with a poor prognosis. A number of lesions occurring in the esophagus are associated with a high risk of malignant transformation. While the patterns of esophageal cancers have been documented in a number of African countries, there is a limited data on the Nigerian situation. This study was aimed at reviewing the histological patterns of premalignant and malignant lesions of the esophagus. Methods: This was a 10-year retrospective study of histologically confirmed premalignant and malignant lesions of the esophagus seen at the University College Hospital, Ibadan, between January 2009 and December 2018. Data retrieved from the departmental records were analyzed using the SPSS computer software version 20.0. Results: There were 45 cases diagnosed with premalignant lesions and 32 cases diagnosed with malignant lesions out of the 363 biopsies during the study period. The most common premalignant lesion was Barret's esophagus (68.9%). Premalignant lesions were more common in males (64.4%). The mean age for patients with a diagnosis of premalignant lesions was 55 years. The mean age at the diagnosis for esophageal cancer was 61.5 years. Squamous cell carcinoma was the predominant histological subtype seen (65.6%) with adenocarcinomas accounting for the remainder of cases (35.4%). Conclusion: Squamous cell carcinoma is the most common malignancy of the esophagus in our study. Adenocarcinomas of the esophagus were not as rare as documented in previous African studies. This finding may imply a changing pattern in esophageal malignancies in tandem with the pattern in Western countries.
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A histopathological study of 752 female lesions of the breast with benign biological behavior p. 54
Innocent Emmanuel, Olufunmilayo Abobarin, Samuel Abaniwo, Patrick Nzekwe, Samuel Kelechi Richard, Barnabas Mafala Mandong
DOI:10.4103/nnjcr.nnjcr_3_20  
Introduction: Lesions of the breast with benign biological behavior (LBBBB) are nonmalignant pathologies. They underlie the most common cause of symptomatic breast problems. It is estimated that 30% of women at sometimes in their lifetime are afflicted with LBBBB that requires treatment. The objective of this work is to study the histological pattern of LBBBB in females at the Jos University Teaching Hospital, Nigeria, between January 2010 and December 2020, relating this finding to age and site, and comparing this with reports in published literature. Methodology: This is a descriptive retrospective research of consecutive cases of LBBBBs diagnosed at the Jos University Teaching Hospital, Nigeria, between January 2010 and December 2020. The records at the department were used to obtain the lesions so diagnosed. Results: A total of 1122 female cases of breast lesions were diagnosed during the period of the study: 370 (32.98%) malignancies and 752 (67.02%) benign (malignancy-to-benignity ratio, 1:2.03). Of the 752 cases of female LBBBB, 382 (50.80%) were on the right, whereas 370 (49.20%) were on the left. The five most common LBBBB were fibroadenoma, 382 (50.79%); fibrocystic change, 126 (16.76%); acute mastitis/abscess, 38 (5.05%); intraductal papilloma, 29 (3.86%); and fat necrosis, 21 (2.79%). The age range was 4–85 years, with mean, median, and mode of 30.60 ± 12.0 years, 28 years, and 23 years, respectively. Conclusion: Two-third of breast lesions in the female breast in our environment are benign and slightly more common on the right. Fibroadenoma is the most common histological type constituting more than half of cases and together with fibrocystic change (the second most common lesion) makes up two-third of all cases. The reproductive age is overwhelmingly the commonly affected group. We recommend increasing research in this field to help predict the risk of subsequent malignancy in affected women with LBBB in our environment.
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Comparative efficacy of core strengthening and stretching exercises on systemic and quality-of-life symptoms in adolescent college students with primary dysmenorrhea p. 59
Ayoola Ibifubara Aiyegbusi, Caleb Adewunmi Adeagbo, Sonia Idara Uwem-Umoh
DOI:10.4103/nnjcr.nnjcr_36_19  
Background: Dysmenorrhea is one of the most common complaints among adolescents affecting the quality of life (QoL) of many women in their reproductive years resulting in absenteeism and missed classes. Prior studies had concluded that various forms of exercises are effective non-pharmacological methods of managing the pain associated with primary dysmenorrhea (PD). There is however a dearth of studies on the effect of these exercises on systemic symptoms. This study investigated the effect of core strengthening and stretching exercises on pain and systemic symptoms in undergraduate college students with PD. Materials and Methods: Thirty female college students aged 16 years and above participated in the study. The respondents' pain, systemic, and QoL symptoms were assessed using a self-administered standard questionnaire pre- and postintervention of core strengthening and stretching exercises. Data were analyzed using descriptive statistics (bar chart, pie chart, frequency, mean, standard deviation, and percentage) and inferential statistics (Mann–Whitney U-test and Wilcoxon signed-rank test) at statistically significant difference (P = 0.05). Results: There were no statistically significant (P > 0.05) differences in the values of the frequency and severity of symptoms between the two groups. There were however significant (P < 0.05) differences in the pre- and postintervention values of the systemic and QoL symptoms in the core strengthening group unlike the stretching group. Conclusion: It is concluded from this study that though both forms of exercises were effective in significantly reducing pain, core strengthening exercises appeared to have better effects in managing the systemic and QoL symptoms associated with PD.
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Prevalence of endometriosis among women undergoing diagnostic laparoscopy at a tertiary hospital in North-Western Nigeria p. 65
Natalia Adamou, Usman Aliyu Umar, Faiza Lawan Mohammed
DOI:10.4103/nnjcr.nnjcr_43_19  
Background: Endometriosis is a complex gynecological disease in its physiopathological aspects and clinical implications. Signs and symptoms include pain and subfertility. The most common sites are pelvic organs and peritoneum. This study evaluated the prevalence of endometriosis among women undergoing diagnostic laparoscopy for chronic pelvic pain and infertility at a tertiary hospital in North-Western Nigeria over a 3-year period (from January 1, 2015, to December 31, 2017). Materials and Methods: A retrospective study of women who had diagnostic laparoscopy for chronic pelvic pain and infertility in our hospital was conducted. Theater operation register records and files of women who had laparoscopy for the same indications were retrieved and reviewed. Information on sociodemographic and reproductive characteristics as well as laparoscopic findings were extracted and reviewed. Results: The total number of women who had laparoscopy for the above indications over the study period was 92, of which 74 files were retrieved and analyzed. The prevalence of endometriosis was found to be 8.1%. Endometriosis was found to be more common in women whose complaint was chronic pelvic pain and/or dysmenorrhea. Conclusion: Endometriosis is a common, underreported gynecologic condition among women of reproductive age group presenting with infertility and chronic pelvic pain.
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Health-seeking behavior of obstetric fistula patients p. 69
Ibrahim Garba, Idris Sulaiman Abubakar, Mahmoud Kawu Magashi, Ayyuba Rabiu
DOI:10.4103/nnjcr.nnjcr_44_19  
Background: Obstetric fistula (OF) is one of the most dehumanizing diseases on the earth. It is a disease that reduces the female species of humans to a subhuman level where a woman continuously leaks urine and/or feces through her vagina. This birth complication is devastating to our women folks, particularly those living in the rural areas. Objectives: We aimed to look at the health-seeking behaviors of women who suffered from this condition with emphasis of identifying modifiable indices that could lead to reduction and/or eradication of the condition. Methodology: This was a descriptive, cross-sectional study where OF patient's health-seeking behavior was analyzed. All OF patients were recruited during the study period. Results: Fifty-two OF patients were interviewed during the study period. The mean age of the participants was 22.7 ± 7.6 years. Thirty-six participants (69.2%) had no formal education, and more than half of their husbands (57.7%) had no formal education. Majority (82.7%) of the participants were residing in the rural areas. More than half of the respondents (61.5%) had no source of income. Forty-seven (90.4%) attended antenatal care (ANC), and most of them (63.5%) had at least 4 ANC visits. Majority (76.9%) labored for more than 24 h and 35 (67.3%) had delay in reaching health facility. More than one-third (38.5%) were delivered through cesarean section. Forty-two respondents (80.8%) noticed urine leakage 2 days after delivery. Conclusion: Most of the findings here corroborated with the findings of earlier studies except for increased ANC attendance which might be due to increased awareness. The study clearly brought out the need to have deliveries conducted under skilled birth attendants to reduce/eradicate the menace of OF in our communities.
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Uterine exteriorization versus In situ repair of the uterine incision at cesarean delivery p. 74
Malachy Emeka Ayogu, Teddy E Agida, Yabaji Aliyu Isah, BI Adeka, Nathaniel Ketare
DOI:10.4103/nnjcr.nnjcr_46_19  
Background: Opinion appears divided on uterine exteriorization for uterine repair at Cesarean delivery. The available evidence appears insufficient to aid policy pronouncement of routine uterine exteriorization for repair of the lower segment incision. Aim: To evaluate the effect of extra-abdominal versus intra-abdominal repair of the uterine incision at Cesarean delivery. Materials and Methods: One hundred and seventy women were randomly assigned to groups; Group “A” had their repairs after exteriorization while Group “B” had in situ repair. It compared the effects of exteriorization of the uterus and in situ repair during Cesarean delivery. Outcome measures included: Intraoperative blood loss, postpartum anemia, transfusion rate, mean operative time, postoperative wound infection rate, nausea and vomiting, The data were analyzed using Statistical Package for the Social Sciences, version 20. Results: A data were available for analysis in 169 women that completed the study (exteriorization group [n = 85] and in situ repair group [n = 84]).Except for the statistically higher incidence of nausea/vomiting among the women that had exteriorization when compared with their counterpart whose uteri were repaired in situ(10.6% vs. 2.4%; P = 0.031). There were no statistically significant differences between the two groups in terms of the mean preoperative hematocrit (34.8% vs. 35.7%), P = 0.830; the mean postoperative hematocrit level (30.8 ± 4.7 vs. 30.8 ± 4.9), P = 0.958; the mean estimated blood loss (575 ml vs. 577 ml), P = 0.942; the postpartum anemia (35.3% vs. 26.2%), P = 0.200; transfusion rate was (15.3% vs. 17.9%), P = 0.518; operation time (57.5 vs. 53.2 min), and the surgical site infection rate (1.2% vs. 1.2%), P = 0.993. Conclusion: Exteriorization and in situ repair of uterine incisions had similar outcome but, the former is associated with significant higher incidence of nausea/vomiting.
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A 10-year review of progestogen-only injectable contraceptive use at a private facility in Lagos, Southwest Nigeria p. 81
Olaolopin Ijasan, Ernest Ruto Upeh
DOI:10.4103/nnjcr.nnjcr_50_19  
Background: Progestogen-only injectable contraceptives are affordable, long acting, and reversible. It can be administered by a trained nonmedical staff and does not require storage, making it specifically suitable for use in developing countries where contraceptive prevalence rates are low. Aim: This study aims to determine the sociodemographic characteristics of clients at the family planning clinic who accepted progestogen-only injectable contraceptives, their side effects, and discontinuation rates. Materials and Methods: In the retrospective study, clients who accepted and used progestogen-only injectable contraceptives at the Family Planning Clinic for over 10 years between August 1, 2008, and July 31, 2018, had their data collected using a structured pro forma. Results: Of the 197 clients who used progestogen-only injectable contraceptives during the study period, medical records of 181 (91.8%) of them were available and retrieved, while medical records of 16 were missing. The total number of contraceptive users during the same period was 1690, giving an acceptance rate of 11.7% for progestogen-only injectable contraceptives. The mean age of clients was 32.8 ± 6.2 years. Most (34.8%) of the participants were in the age group of 30–34 years. Most (95.6%) of the participants were married and 92.2% had at least a secondary school education. The majority (55.8%) of the participants used it for child spacing, while 44.2% used it to limit their families. The discontinuation rate at 1 year was 72.4%. Of the 181 participants, 65 (35.9%) reported side effects. The most common side effect was menstrual disorders (30.9%). No pregnancy was reported during use. Conclusion: Progestogen-only injectable contraceptives are effective and safe. Sociodemographic characteristics of users, side effects, and efficacy are similar to other local studies. However, the acceptance rate is low and the discontinuation rate at 1 year is higher than in other centers.
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Predictors of treatment outcome among adult patients with multi-drug resistant tuberculosis in Kano, Nigeria p. 86
Adamu Muhktar Mubarak, Fatimah Isma'il Tsiga-Ahmed, Rabiu Ibrahim Jalo, Aminatu Kwaku Ayaba, Usman Muhammad Ibrahim, Rabi Adamu Sufi, Ibrahim Aliyu Umar, Imam Wada Bello, Nura Musa Shuaib, Yusuf Ahmed Mustafa, Isa Muhammad Daneji, Aliyu Aminu
DOI:10.4103/nnjcr.nnjcr_53_19  
Background: Emergence of multidrug-resistant tuberculosis (MDR-TB) continues to threaten global tuberculosis (TB) treatment, care, and prevention, and it remains a major global health problem in many low- and middle-income countries with high morbidity and mortality. Objectives: The present study assessed MDR-TB treatment outcome and its predictors among adult patients in Kano, Nigeria. Methods: We conducted a secondary data analysis involving 283 adult patients treated for MDR-TB using routine data for MDR-TB programme in Kano State between August 2014 and September 2018. Results: The mean age (±standard deviation) of the respondents was 33.4 ± 11.6 years and up to 40% of them were within the age group of 25–34 years. About three-quarters of the participants 72.4% (205) were males; up to 63.6% (180) of the patients live in the urban areas, and mean duration of treatment initiation was 21 days after the diagnosis. Up to 66.8% (95% confidence interval [CI] = 61.1–72.4), patients had successful treatment, (cured) while 33.2% (95% CI = 27.6–38.9) died. After adjusting for confounding, gender and HIV status were found to be independent predictors of MDR-TB treatment outcome among MDR-TB patients in Kano. Male patients (adjusted odds ratio aOR = 0.38, 95% CI = 0.22–0.66, P = 0.001) and HIV-negative patients (aOR = 0.49, 95% CI = 0.28–0.87, P = 0.015) were less likely to die from MDR-TB. Conclusion: The study found a moderate treatment success rate for MDR-TB in Kano. Early initiation of treatment, control of HIV epidemic, and enhanced treatment supervision would likely improve treatment outcome.
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CASE REPORTS Top

Cervical spondylotic amyotrophy mimicking amyotrophic lateral sclerosis p. 91
S Sheetal, P Byju
DOI:10.4103/nnjcr.nnjcr_42_19  
Cervical spondylotic myelopathy refers to compressive myelopathy resulting from degenerative changes of the spine. Some patients present with “myelopathic hand” characterized by loss of motor strength, sensory changes, and spasticity. However, cervical spondylosis with muscle atrophy of the upper extremities without sensory disturbance or pyramidal signs is called cervical spondylotic amyotrophy. Cervical spondylotic amyotrophy is a rare condition, usually reported as unilateral disorder, though occasionally, it may be bilateral. Due to the gross wasting and absence of sensory signs, it may be mistakenly diagnosed as amyotrophic lateral sclerosis. Since cervical spondylotic amyotrophy is similar to motor neuron disease, and yet is treatable, it is important to recognize and treat this condition.
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True knotting of umbilical cord resulting in sudden unexpected fetal demise p. 94
Deazee M Saywon, Ayyuba Rabiu
DOI:10.4103/nnjcr.nnjcr_45_19  
Knotting of the umbilical cord is a significant cause of perinatal morbidity and mortality. It could be loose or tight. Tightening of the knot rarely occurs and when present can cause fetal demise. Antenatal features of the knotting of the umbilical cord are not only difficult to elicit but also usually do not conclusively establish the diagnosis. We report a case of true knotting of the umbilical cord in a 32-year-old female, who suddenly experienced decreased fetal movement and within 60 min had a fetal demise at 39 weeks of gestation. Intraoperative findings showed a stillborn female fetus, with no sign of maceration or congenital abnormality. The umbilical cord was relatively long and tightly knotted. To the best of our knowledge, this was the first case report of the true knotting of the umbilical cord in Liberia. Obstetricians and general practitioners should take caution that it remains an unseen cause of sudden intra-uterine fetal death during the antenatal period.
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