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   Table of Contents - Current issue
Coverpage
March-April 2019
Volume 60 | Issue 2
Page Nos. 47-97

Online since Wednesday, July 31, 2019

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ORIGINAL ARTICLES  

Fallopian tube epithelial changes in ovarian serous tumors compared with control group: A single-center study p. 47
Fatemeh Sari Aslani, Mona Maleknasab, Mojgan Akbarzadeh-Jahromi
DOI:10.4103/nmj.NMJ_27_19  
Background: Recent studies have hypothesized that distal end of fallopian tube is a possible origin of ovarian serous carcinoma. This study investigated histopathological changes in fallopian tube epithelium (FTE) of the patients with ovarian serous tumors compared with control group. Materials and Methods: In a prospective cross-sectional study, fallopian tubes (right and left) of 34 cases with ovarian serous tumors were collected from patients who underwent surgery in two major gynecological centers affiliated to Shiraz University of Medical Sciences, Shiraz, Iran (2012–2015). They are composed of 21 (61.8%) high-grade serous carcinomas (HGSCs), 5 (14.7%) borderline ones, and 8 (23.5%) benign serous tumors. As control group, fallopian tubes of 72 hystrectomy cases without ovarian tumor were added to the study. Both tubes of all of the cases were submitted entirely, according to the protocol of sectioning and extensively examining the fimbriated end. The results were statistically analyzed using SPSS-PC windows and Chi-square tests. Results: Significant differences were found between the cases and control group in tubal epithelial cell stratification (especially >3 cell layers thickness), atypia, mitosis, glandular complexity, tufting, and detached epithelial cells (P < 0.05). These findings particularly atypia and mitosis were more frequently seen in the ampulla and fimbriated end of high-grade ovarian serous carcinomas. Conclusion: Our results showed that premalignant epithelial changes of the ampulla and the distal end of FTE were seen in some of the patients with ovarian HGSCs. Therefore, FTE could be one of the sources of ovarian serous carcinoma.
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Components and risk factors of metabolic syndrome among rural Nigerian workers Highly accessed article p. 53
Rufina N. B Ayogu, Chikodili Nwajuaku, Elizabeth A Udenta
DOI:10.4103/nmj.NMJ_53_19  
Background: Metabolic syndrome (MetS) is a serious public health risk predisposing the workforce to cardiovascular diseases and diabetes. Aim: The aim of this study was to determine the components and risk factors of MetS among Nigerian teachers and bank workers (BWs). Settings and Design: The cross-sectional study was conducted in Idemili South Local Government Area, Southeast Nigeria. Materials and Methods: The study involved 427 teachers and 66 BWs in 14 secondary schools and 5 microfinance banks, respectively. Data collection methods included questionnaire, lipid profile, fasting plasma glucose (FPG), weight, height, waist circumference, and blood pressure (BP) measurements. Inferential statistical analysis involved Pearson correlation and Chi square with Cochran–Mantel–Haenszel test. Significance was accepted at P < 0.05. Results: Most (73.3%) of the teachers were 40–60-year-olds; 75.8% of BWs were 19–39-year-olds (P < 0.01). Underweight (7.7%), overweight (26.8%), obesity (17.2%), impaired FPG (IFPG) (14.0%), hypertriglyceridemia (38.0%), and hypertension (40.0%) were prevalent with similarity (P > 0.05) between occupations, age, and gender. Females were more likely to have abdominal obesity (P < 0.01) than males. MetS prevalence was 20%. MetS was more likely among females (odds ratio [OR] =0.63, 95% confidence interval [CI] =0.471–0.841); workers with abdominal obesity (OR = 1.67, 95% CI = 1.210–2.295), IFPG (OR = 0.05, 95% CI = 0.008–0.347), raised diastolic BP (OR = 12.00, 95% CI = 2.177–66.134), and hypertriglyceridemia (OR = 1.55, 95% CI = 1.931–5.600); and those who often drank fluids other than water (OR = 0.11, 95% CI = 0.013–0.961). Conclusion: MetS was a problem of public health significance among the workers with higher prevalence among teachers, 40–60-year-olds, and females. Abdominal obesity was the strongest risk factor of metabolic syndrome among the workers.
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Prevalence and pattern of thyroid disorders among patients attending University of Nigeria Teaching Hospital, Enugu, Southeastern Nigeria p. 62
Edwin Nkemjika Okafor, Martin C Ugonabo, Ekene E Chukwukelu, Innocent N Okonkwo, Enyuche Ezigbo, Obiageli Odurukwe
DOI:10.4103/nmj.NMJ_34_19  
Introduction: Thyroid disorders (TDs) remain the second-most common endocrine disease after diabetes worldwide. Recently, there has been increased interest in the prevalence and pattern of TD based on the fact that it accelerates cardiovascular complications. However, there are limited data on the prevalence and pattern of TDs in the University of Nigeria Teaching Hospital (UNTH) Enugu, Southeast Nigeria. Objectives: We studied prevalence and pattern of TDs as seen in patients attending UNTH, Enugu, Nigeria. Methods: This study was conducted in the Outpatient Department of UNTH Enugu from January 2016 to January 2019. Demographic and clinical data collected include age, gender, anthropometrics, clinical features, and associated complications of TDs. The patients were grouped as hyperthyroidism, hypothyroidism, and euthyroid sick syndrome (ESS) according to symptoms, signs, thyroid function test, liver function test, fasting blood sugar, and cholesterol. Results: A total of 260 patients (210 females and 50 males) with a mean age of 49.22 ± 9.79 years reflected overall prevalence rate of 2.4%. The prevalence of hyperthyroidism 150 (58%), hypothyroidism 100 (39%), and (ESS) 10 (3.9%) was 1.4%, 0.9%, and 0.09%, respectively. Hypertension 34.3%, heart failure 26.7%, and atrial fibrillation 20% seen in Grave's disease were the most common cause of hospitalization and death. Conclusion: Grave's disease is the most common cause of TDs and occurs more in females than males in this study. We observed that hypertension, heart failure, and atrial fibrillation are promoters of complication in TDs. Health system facilities need to be strengthened in this area to improve the detection and management of TDs.
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Determinants of choice of place of delivery among women attending two referral hospitals in Kano North-West Nigeria p. 68
Ogonna N. O Nwankwo, Oluchukwu Emmanuel Ani, Michael Akpoke, Emmanuel Ajuluchukwu Ugwa
DOI:10.4103/nmj.NMJ_14_19  
Background: Women are often unable to choose for themselves when, where, and from whom to seek care. This study was undertaken to determine factors that influence a woman's choice of place of delivery among women attending immunization clinics in two referral hospitals in Kano, Nigeria. Materials and Methods: A hospital-based cross-sectional descriptive study conducted among 314 women who delivered in Kano, Nigeria. Stratified random sampling was done. Pretested, interviewer-administered questionnaires were used to obtain responses about sociodemographic characteristics, choice of place of delivery, and factors that influenced their choice of place of delivery. Ethical approval was obtained from an ethical committee. Women who gave birth within the past 12 months and gave informed consent were recruited. The data were analyzed using SPSS statistical software version 22. Results: About 218 (69.4%) women had their previous delivery in the health facility, whereas 96 (30.6%) had theirs outside the health facilities. The level of satisfaction in health facility care was also high. For those who had their deliveries outside the health facility, 37 (38.5%) of the deliveries were monitored by a nurse/midwife. The respondents level of education (P ≤ 0.001), spouse level of education (P < 0.001), spouse occupation (P ≤ 0.015), human influence (P = 0.025), and total cost of each visit (P = 0.010) were associated with the choice of place of delivery; however, at multivariate logistic regression, only human influence and respondents level of education were determinants of the choice of place of delivery. Conclusion: Most of the respondents had their previous deliveries in the health facilities and had a high level of satisfaction with the health facilities where they delivered compared to other studies. Utilization of the health facilities for childbirth may increase if there is involvement of relations, especially husbands and mothers and if the clients' level of education is improved.
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Awareness of papanicolaou smear and visual inspection with acetic acid as screening tools for cervical cancer among women attending the general outpatient clinic of a Tertiary Institution in North Central Nigeria p. 76
Ezekiel Agu Tomen, Stephen Yohanna, Rose Ezioma Obilom
DOI:10.4103/nmj.NMJ_16_19  
Background: Cervical cancer is the second most common cancer in women worldwide and the leading cause of cancer deaths in developing countries. Knowledge and awareness of the disease in Africa are very poor, and mortality from the disease is still very high. Screening in most developing countries is mainly opportunistic. This study was undertaken to determine the level of awareness of Papanicolaou (Pap) smear and visual inspection with acetic acid (VIA) as screening methods for cervical cancer to assist in the early diagnosis of the disease. Materials and Methods: This hospital-based, descriptive, cross-sectional study involved women aged 21–65 years who attended the general outpatient clinic of Dalhatu Araf Specialist Hospital, Lafia, either as patients or patients' relatives during the study period. A simple random sampling technique was used to recruit 239 participants using the Leslie Kish formula. Data collected about the participants included sociodemographic background, gynecologic and other relevant medical histories, awareness of cervical cancer, and awareness of Pap smear and VIA as screening tests for cervical cancer. The results were reported as frequencies and percentages only. Results: Only 28 (11.7%) study participants had heard about cervical cancer and only 10 (4.2%) were aware of Pap smear as a screening test for cervical cancer. None of the participants were aware of VIA as a screening test for cervical cancer. Conclusion: This study revealed that the level of awareness about cervical cancer among the study participants was low. No participant was aware of VIA as a screening method for cervical cancer, but a small percentage of the participants were aware of Pap smear test. It is recommended that efforts should be intensified to improve the awareness of population at risk of cervical cancer.
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In what ways might stories and anecdotes impact upon the quality of small group teaching in obstetrics and gynecology? p. 80
Onome Ogueh
DOI:10.4103/nmj.NMJ_32_19  
Objectives: The aim of this study was to find out how stories and anecdotes might improve the quality of the daily morning obstetrics and gynecology (O and G) teaching and determine if the emotions generated by the stories and anecdote deepened the understanding of medical topics. Materials and Methods: The overarching approach to this study was action research. On two occasions, I told stories using PowerPoint presentation during the morning teaching in the O and G seminar room to 10 and 11 learners instead of the traditional factual presentation of a medical topic. The learners ranged from the 3rd-year medical students to 4th-year specialist trainees in O and G and a consultant anesthetist. Each learner completed a feedback questionnaire at the end of the teaching session. I noted the learners' comments and analyzed written feedback. Results: More than 90% of the learners agreed or strongly agreed that the stories were appropriate for their level of training, and on both occasions, every single learner agreed or strongly agreed that the stories improved the quality of the morning teaching. On both days all but one learner agreed or strongly agreed that the stories improved their understanding of the medical topics, and a senior O and G trainee wrote that the story was: “useful – improved my understanding of situation involved.” The stories generated a lot of emotion in the learners, emotions that deepened their understanding of the topic covered. Conclusion: Stories and anecdotes appear to improve the quality of teaching, and this was the case regardless of level of training and experience of the learner. Hence, stories and anecdotes may be an excellent teaching tool in a setting like the morning teaching where the learners are quite varied.
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Health status of persons with hemophilia: A pilot survey from a resource-constrained Country p. 87
Helen C Okoye, Benedict Nwogoh, Megan Adediran, Theresa U Nwagha
DOI:10.4103/nmj.NMJ_33_19  
Background: Most resource-poor countries are yet to develop standard hemophilia treatment center (HTC) despite improved outcome of health status of persons with hemophilia (PWH). Aim: This study aimed to evaluate the health status of PWH in Nigeria. Methodology: In this descriptive, cross-sectional study, modified prevalidated and pretested questionnaire (National health and Nutrition examination survey (NHANES) 2013 Health Status questionnaire (HSQ)) was consecutively administered to consenting PWH (pediatric and adult) attending the 2018 Annual General Meeting of the Haemophilia Foundation of Nigeria. The study's measurable outcome variables were calculated health status and its determinants. Association between the outcome variables and clinical characteristics of PWH was done using SPSS software version 22, and P < 0.05 was considered statistically significant. Results: Of the 36 PWH who participated in the survey, 50% had good health status, 38.9% had poor health status, while only 11.1% had excellent health status. A majority (88.9%) had access to HTC with <6 consultations in the past year. Nearly 47.2% were hospitalized for disease-related problem in the past year. There was nonsignificant difference between health status and disease type (P = 0.751) and severity (P = 0.086), treatment plan (0.496), type of treatment facility (P = 0.152), and access to a doctor (P = 0.67).Conclusion: Several PWH in resource-poor settings still suffer serious morbidity that impacts negatively on their health status. More robust (multicenter) research is needed to ascertain the true picture of health status of PWH in resource-poor countries.
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CASE REPORTS Top

Stump appendicitis due to retained fecalith after laparoscopic surgery p. 92
Olanrewaju Samuel Balogun, Adedapo O Osinowo, Ayomide A Makanjuola, Samuel O Nwokocha
DOI:10.4103/nmj.NMJ_39_19  
Stump appendicitis is a rare cause of right iliac fossa pain in patients with a previous history of appendectomy for acute appendicitis. The presentation is often delayed and may pose a clinical diagnostic challenge to the surgeon. More often, a high index of suspicion backed with relevant radiologic investigations is required for diagnosis. Open and laparoscopic appendectomy may be complicated by stump appendicitis. We report our experience in a 49-year-old Nigerian who presented to us with recurrent right iliac fossa pain and abdominal distension of 2 weeks' duration. The patient had laparoscopic appendectomy 1 year prior to presentation to us. A diagnosis of stump appendicitis with small-bowel obstruction was made with an abdominal computed tomography scan. He had an open stump appendectomy and small-bowel adhesiolysis with a good postoperative outcome.
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Keystone flaps in urethroplasty: Reconstruction in a complex case of panurethral stricture disease p. 95
Sidhartha Kalra, Lalgudi Narayanan Dorairajan, Ketan Mehra, Ramanitharan Manikandan
DOI:10.4103/nmj.NMJ_30_19  
Panurethral strictures are a surgical challenge for a reconstructive urologist more so in situations where local tissue for reconstruction is deficient. Two-stage urethroplasty is the preferred option in such cases. In some complex stricture diseases where patients are not willing for multiple procedures, permanent perineal urethrostomy can give a good functional outcome. Keystone flaps have been used as a simple and effective method of wound closure in other areas of the body that would otherwise have required complex flap closure and skin grafting. We describe, for the first time, a case of inflammatory panurethral stricture disease complicated by Fournier gangrene with extensive penile, scrotal, and perineal skin deficit managed with a perineal urethrostomy, with the help of keystone design perforator island flaps with successful outcome.
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