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   Table of Contents - Current issue
Coverpage
July-December 2016
Volume 17 | Issue 2
Page Nos. 31-67

Online since Wednesday, November 16, 2016

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EDITORIAL  

Emerging rare causes of lower gastrointestinal bleeding p. 31
Jerry Godfrey Makama
DOI:10.4103/1595-1103.194216  
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ORIGINAL ARTICLES Top

Thromboelastography parameters versus classical coagulation profile in trauma patients: Retrospective study p. 33
Abdulraouf Y Lamoshi, Alison M Wilson
DOI:10.4103/1595-1103.194214  
Background: Thrombelastography (TEG) assesses the viscoelastic properties of the whole blood and it is more comprehensive and capable to detect any coagulation abnormalities in comparison to classical coagulation tests (CCTs). On this ground, TEG can be more efficient in acute settings. Therefore, the primary aim was to compare TEG parameters of traumatic brain injury (TBI) versus non-TBI (NTBI) patients. The secondary aim was to identify TEG versus CCT parameters associated with outcome. Methods: A cross-sectional retrospective observational study of 142 patients admitted to a university-based, Level 1 trauma center. TEG and CCT were collected on admission. Institutional Review Board approval was obtained for this study. SAS was used for categorical data were analyzed using Chi-square or Fisher's exact test. A comparison of continuous variables between TBI and NTBI patients was performed using the independent-sample t-test. Results: In a total of 142 patients, 48 patients had TBI and 94 patients did not. Overall, mortality was 20.4% (45.8% TBI vs. 7.4% NTBI). There were no significant associations between TEG or CCT parameters and studied variables some of which are injury severity score, abbreviated injury scale, craniotomy/ectomy, type of brain injury, discharge status, and blood pressure. There was no difference between the TBI and NTBI groups regarding TEG or CCT parameters. Maximum amplitude (MA) was the only parameter (TEG or CCT) associated with need for transfusion of packed red blood cell (PRBC) (P = 0.0377). PRBC transfusion was given in 94% of patients with an MA <57.4. Platelet transfusion was given in 89% of patients who have MA < 58.1. Fresh-frozen plasma (FFP) transfusion was given in 80% of patients who have R ≥5.8. PRBC transfusion was given in 77% of 18 patients with α <62.9. Conclusions: TEG parameters are potentially useful as means to rapidly diagnose coagulopathy and predict transfusion in trauma patients. Independently, the presence of TBI does not cause a detectable coagulopathy. TEG analysis is more efficient than the classical parameters in detecting patients who will need PRBC and FFP transfusion.
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Airway management with submental orotracheal intubation in maxillofacial surgery: Our experience and literature review p. 38
Abdurrazaq Olanrewaju Taiwo, Adebayo Aremu Ibikunle, Ramat Oyebunmi Braimah
DOI:10.4103/1595-1103.194218  
Background and Aim: The challenge of the “shared airway” is a recurring predicament in maxillofacial surgeries. The need to have unfettered access to the nasal pyramid and oral cavity without jeopardizing the integrity of the airway during maxillofacial surgeries is vital. The use of submental intubation has been reported as an excellent adjunct in maxillofacial trauma surgery; however, few, if any, report exists on its use for massive facial tumors. This is a report of its use in varied scenarios including traumatic and neoplastic conditions. The aim of this study was to review the indications, complications, and outcomes of airway management using submental intubation in maxillofacial surgery at a tertiary hospital in Nigeria. Patients and Methods: Records were retrieved retrospectively over a period of 28 months (June 2013–October 2015). Data recorded included demographics, indications, and intraoperative and postoperative complications. Results: A total of eight patients were evaluated, all of whom had surgery under general anesthesia. All of them had conventional orotracheal intubation initially, which was then converted into the submental route. Two of them had intraoperative complications of raised airway pressure, however no postoperative complication was observed. Conclusions: Although it requires some surgical skill, submental intubation provides a reasonable substitute to other airway management techniques in certain patients. Its importance in patients with massive maxillofacial tumors was also highlighted along with other indications.
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Prevalence and attitude of self-ear cleaning with cotton bud among doctors at aminu Kano teaching hospital, Northwestern Nigeria p. 43
Mukhtar Gadanya, Sanusi Abubakar, Abdulazeez Ahmed, Amina Zangina Maje
DOI:10.4103/1595-1103.194215  
Background: The use of cotton bud for self-ear cleaning is a common practice among many people despite its attendant ill-effects. This study examined the prevalence, attitude toward the use of cotton buds, and reasons for the use of cotton buds and problems or ill-effects associated with its use among medical doctors working at Aminu Kano Teaching Hospital. Materials and Methods: A descriptive cross-sectional study was carried out among a randomly selected sample of 130 medical doctors working in Aminu Kano Teaching Hospital spread across several departments in the hospital using a self-administered semi-structured questionnaire. Data were analyzed using MINITAB statistical software and the results summarized using measures of central tendency while Chi-square test was used to assess for associations between categorical variables. Results: The respondents' age ranged from 25 to 55 years with a mean age of 33.6 ± 5.4 years. Most of the respondents were males (68.0%) The prevalence of cotton bud use was found to be 76.3% and for many, the frequency of use of cotton buds was once daily, and both ears were frequently cleaned. A common problem encountered with cotton bud use was retention of the bud as a foreign body. There was an association between owning a cotton bud and using it (χ2 = 38.317, P= 0.001). There was also a significant association between the use of cotton buds and the department where the respondent works (χ2 = 19.28, P= 0.0001). Conclusion: The use of cotton buds for self-ear cleaning is surprisingly prevalent among medical doctors working at Aminu Kano Teaching Hospital. There is a need for health education and promotion strategies for health workers in the hospital community that ear cleaning is best done by trained personnel.
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Improvisation of surgical equipment in the surgical services of a developing country p. 48
Adeyinka Ayodele Adejumo, Oluseyi A Adeosun, Paul O Omoregie, Barnabas Alayande
DOI:10.4103/1595-1103.194217  
Background: The perennial scarcity of surgical equipment in Nigeria has given room for improvisation of such items using locally available materials. Aim: This publication aims to appraise the ingenious methods employed by surgeons to overcome their challenges in clinical practice. Methods: An in-depth research into relevant literature about the functionality of various surgical devices was carried out using selected texts and relevant articles. Results: Many surgeons have come up with various techniques to make do with local resources in overcoming the limitations imposed by scarcity of certain equipment/device. Conclusion: Surgical practitioners in resource-limited regions have been able to surmount the challenges of scarcity of required items using different methods and materials from the local environment.
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Pattern of traumatic spinal cord injury in Makurdi, Nigeria p. 53
Williams Terhemen Yongu, Cornelius Itodo Elachi, Daniel Demesugh Mue, Joseph Aluetse Kortor
DOI:10.4103/1595-1103.194219  
Objectives: To study the pattern of presentation and outcome of conservative treatment of traumatic spinal cord injury (TSCI) in our institution. Setting: Benue State University Teaching Hospital, Makurdi, Benue State. Materials and Methods: A 3-year retrospective review (June 2012 to May 2015) of TSCI was done. Demographic data, cause, associated injuries, time interval to presentation, level of injury, American Spinal Injury Association (ASIA) classification at presentation and at 6 weeks were obtained from case notes. The patients were all managed conservatively and had bed rest on air or water mattress. Results: There were 45 patients mean age 33.26 ± 1.55 (range 8–77 years) with TSCI comprising 37 males and 8 females giving a male: female ratio of 4.6:1. Students were mostly affected (n = 11, 24%) while motor vehicular accident was the cause of injury (n = 18, 40%). Cervical spine was the most injured (n = 24 53.3%). Majority had the ASIA Class A (n = 22 48.9%) at presentation. Thirteen (48.1%) of them improved, two were referred, six remained the same, eight deteriorated, and 16 were discharged against medical advice. Period of hospitalization was 1–65 days. Conclusion: TSCI affects mainly young males involved in motor vehicular accident. Conservative treatment can be used in resource-constrained centers.
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CASE REPORTS Top

Utero-cutaneous fistula following cesarean section p. 58
Matthew Chum Taingson, Joel A Adze, Stephen B Bature, Amina Mohammed Durosinlorun, Mohammed Caleb, Abubakar Amina
DOI:10.4103/1595-1103.194212  
Utero-cutaneous fistula is an extremely rare entity, and only a few case reports have been published. Most Utero-cutaneous fistulas are secondary to postpartum or postoperative complications. A 23-year-old woman, para 1+0, not alive, noticed bleeding through her abdominal incision scar, following a cesarean section for retained second twin 5 years before presentation. A fistulous tract was demonstrated at examination under anesthesia with a probe, between the uterus and wound. The patient had laparotomy with excision of the fistulous tract and uterine repair; she did well postoperatively. Although our patient had a successful surgical treatment, prevention of utero-cutaneous fistula by meticulous technique during the primary surgical procedure and measures to prevent postoperative sepsis would have spared this patient the distress, cost, and risk of a second operation.
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Simultaneous bilateral femoral neck fractures following electroconvulsive therapy p. 61
Ismail Lawal Dahiru, Kenneth Ezenwa Amaefule, Yau Zakari Lawal, Maitama Muhammad Inuwa, Yunus Adeniyi Abdulgafar
DOI:10.4103/1595-1103.194211  
Fracture neck of femur occurs commonly among elderly people with osteoporosis being the risk factor favoring its occurrence. Its occurrence among young adults, though uncommon, follows high-energy trauma with multisystem affectation. Fracture neck of femur poses a management challenge to the surgeon in deciding on the best option of treatment, in achieving accurate reduction and fixation, and in dealing with complications which may be inevitable. Fracture neck of femur following electroconvulsive therapy is rare. Simultaneous bilateral femoral neck fractures following electroconvulsive therapy are even rarer. Simultaneous bilateral femoral neck fractures management is technically demanding, requiring considerable experience, appropriate instrumentation, and equipment. It is also associated with high morbidity which includes nonunion and avascular necrosis. These fractures can be prevented by the use of modified electroconvulsive therapy. This case seeks to reemphasize the rarity of simultaneous bilateral femoral neck fractures following electroconvulsive therapy, highlight the challenges of managing this condition and proffer ways of avoiding its occurrence.
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Caudal regression syndrome with a solitary kidney: A case report and review of the literature p. 64
Abdulkadir Abubakar, Babagana Mustapha Abubakar
DOI:10.4103/1595-1103.194213  
Caudal regression syndrome (CRS) is a rare, congenital anomaly that is often complicated by a neurogenic bladder. Congenital anomalies of the kidney and urinary tract in aforesaid patient present an added challenge in the management. The aim and objective of this study is to report a rare case of CRS with neurogenic bladder and right solitary hydronephrotic kidney. The patient was a 3-year-old female infant with burdensome lower urinary tract symptoms and congenital back and lower limbs deformities. Her examination unveiled vertebra and lower limbs anomalies. The computed tomography scan showed lumbosacrococcygeal agenesis with a right solitary hydronephrotic kidney. She was treated for urinary tract infection at presentation, after which cystometry confirmed high-pressure neurogenic bladder. She did well to the initial continuous bladder drainage and the ensuing oxybutynin with clean intermittent catheterization. Instantaneous management of the bladder dysfunction prevents potentially permanent solitary renal dysfunction and the secondary bladder malfunction in a patient with CRS and neurogenic bladder.
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