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   Table of Contents - Current issue
Coverpage
January-June 2019
Volume 4 | Issue 1
Page Nos. 1-29

Online since Tuesday, October 15, 2019

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ORIGINAL ARTICLES  

An audit of breast lumps detected during cancer screening: A report from Southwest Nigeria p. 1
Babatunde Adeteru Ayoade, Henry O Ebili, Olubunmi M Fatungase, Collins C Nwokoro, Babatunde A Salami, Adeleke O Adekoya, Abimbola A Oyelekan, Bolanle O Adefuye, Ayodeji A Olatunji
DOI:10.4103/archms.archms_2_19  
Background: In low-Human Development Index countries, population-based screening programs for breast cancer are virtually nonexistent, but there are occasional screening programs organized by nongovernmental organizations in these countries. This study aims to describe the clinical and histopathological characteristics and the prevalence of breast diseases detected by clinical breast examination (CBE) in a cohort of women who participated in a community-based breast screening program. Methodology: This is a retrospective cross-sectional study of women who were referred for assessment in our Breast Clinic following CBE during a breast cancer screening program. Palpable lesions were subjected to biopsy and histopathological examinations. Results: Of the 2450 women screened, 102 had breast biopsy. Twenty-one were malignant (20.6%) and 79 were benign (77.5%). The mean age for benign breast disease was 32 ± 14 years, whereas that for women with malignant breast lesions was 57 ± 11 years (P < 0.001). Sixty-three women (61.8%) were married, 59 (57.8%) had tertiary education, and 27 (26.5%) were petty traders. The mean lump size was 3.8 ± 3.9 cm for benign lumps and 6.2 ± 4.2 cm for malignant lumps (P = 0.014). Histopathological examination revealed that 20.6% of the lumps were malignant, 50% were benign neoplasm (fibroadenoma,) 17.6% were fibrocystic change and related conditions (fibroadenosis), 5.9% were sclerosing lesions, 2% were inflammatory lesions, 2% were benign proliferative breast disease, and 2% were inadequate sample. Two of the 12 breast lumps (16.6%) were detected for the first time at screening, of which two were malignant. This constitutes 1.9% (2/102) of all the lumps biopsied and 0.081% of all the women who had CBE. Conclusion: This study has demonstrated that CBE as a tool for early detection of breast cancer should be encouraged and applied. It confirms that fibroadenoma is the most common cause of clinically obvious breast lumps.
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Necrotizing fasciitis of the breast in Ahmadu Bello University Teaching Hospital, Zaria, Northwestern Nigeria p. 7
Peter Pase Abur, Lazarus M Yusufu, Vincent I Odigie
DOI:10.4103/archms.archms_4_19  
Context: Necrotizing fasciitis of the breast is rare globally. There is an observed increase in the number of cases seen in our hospital. Moreover, there is no previous documentation on the disease from this center. Aims: The aim was to highlight the clinical features, predisposing factors, complications, treatment, and outcome of necrotizing fasciitis of the breast. Settings and Design: It was a 5-year prospective study from January 2012 to December 2016. Subjects and Methods: The biodata, clinical features, predisposing factors, complications, treatment, and outcome of necrotizing fasciitis of the breast were documented. Statistical Analysis Used: The results were analyzed using SPSS software version 21 and presented as percentages and charts. Results: Thirty-nine out of 163 women with infective breast disease had necrotizing fasciitis of the breast. Majority of the patients (28 [71.8%]) were <31 years. Most of the patients had low educational status (33 [84.6%]). The most common clinical features were foul-smelling discharging ulcers/sinuses and necrosis of the skin of the breast in all patients. Majority of the patients (29 [74.4%]) were lactating mothers. Poorly treated mastitis/breast abscess was the predominant predisposing factor. Culture revealed polymicrobial organisms in 20 (51.3%) patients. Thirty-six (92.3%) patients had serial wound debridement, 25 (64.1%) had split-thickness skin grafting, and 3 (7.7%) had toileting mastectomy. Mortality rate was 10.3%. Conclusions: Necrotizing fasciitis of the breast is not uncommon in our center. Majority of the patients were illiterate with low socioeconomic status. Poorly treated mastitis/breast abscess in lactating women was the major predisposing factor.
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Gastric outlet obstruction in adults in the University of Benin Teaching Hospital: A 5-year prospective study p. 10
Peter Ikponmwosa Agbonrofo, Omorodion O Irowa, Vincent I Odigie
DOI:10.4103/archms.archms_22_19  
Background: Gastric outlet obstruction (GOO) is a contemporary surgical challenge. It is due to mechanical pyloroduodenal obstruction of gastric emptying. In Africa, cicatrizing duodenal ulcer or antral tumors are common causes; resultant inanition, fluid, electrolyte, and nutritional derangements could be life-threatening. Definitive therapy aims at relieving the obstruction. Aim: To highlight causes, clinical features, and outcome of management of GOO in the University of Benin Teaching Hospital. Patients and Methods: This was a 60-month prospective study from July 1, 2013, to June 30, 2018. Consecutive adult patients with GOO were studied. Diagnosis was confirmed using barium meal, esophago-gastro-duodenoscopy, biopsy, and operative findings. Preoperative optimization required nasogastric tube suctioning/warm saline lavage, intravenous fluids, antibiotics, and blood transfusion. Results: There were 52 GOO patients, constituting 7.9% of 659 gastrointestinal conditions requiring surgery during the study period. Operative intervention occurred in 50 (96.2%) patients. The male:female ratio was 1.7:1. The age ranges from 32 to 89 years, with a mean age of 63.5 ± 15.3 years. Most patients were in the 7th-8th decades of life (33 patients, 63.5%). Nonbilous vomiting and epigastric pain occurred in 50 (96.2%) patients, while 49 (94.2%) patients had weight loss. Mean duration of symptoms 10.5 ± 12.1 weeks. Malignant obstructions were 63.5% (33 patients). Palliative by-pass was effected in 58.0% (29 patients). Hospital stay was 16–23 days. Mortality rate was 3.8% (2 patients). Conclusions: GOO is a disease of the elderly in our region. Presentation is late. Most require surgical intervention. The most common cause is malignant obstruction. Most patients require prolonged, adequate preoperative resuscitation/optimization. We advocate early referral, routine endoscopy, and biopsy for patients with epigastric pain in the subregion.
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Effectiveness of sweeping of membranes in reducing the incidence of elective induction of labor for postdate pregnancies p. 15
MG Nyamzi, DA Isah, RA Offiong, AY Isah
DOI:10.4103/archms.archms_36_18  
Introduction: Prolonged pregnancy is a high-risk pregnancy that is associated with increased maternal morbidity and increased perinatal morbidity and mortality. Objectives: The objective was to evaluate the effectiveness of sweeping of the fetal membranes to reduce the incidence of elective induction of labor for postdate pregnancy and to compare pregnancy outcome among women who had sweeping of membranes at 40 weeks with those who did not have sweeping of membranes. Subjects and Methods: This was a randomized, controlled study conducted from September 2017 to June 2018. One hundred and ninety-four consenting participants with no contraindication to vaginal delivery were randomized into two groups, those who had membrane sweeping at 40–41 weeks' gestation and a control group who had vaginal examination to assess Bishop score only at recruitment. Participants were followed up to delivery. Results: Sweeping of membranes effectively reduced the incidence of elective induction of labor. The proportion of those that had spontaneous labor in the treatment group was 85 (87.6%) compared to the control group that had 67 (62.9%). This was statistically significant with P < 0.001. The incidence of induction of labor was significantly lower in the membrane sweeping group compared with the control group (12.4% vs. 37.1%; P < 0.001). There was a significant higher mean time interval from recruitment to admission (recruitment admission interval) among the control group (5.76 ± 2.75 days) compared with those that had membrane sweeping (3.35 ± 2.55; P < 0.001). Conclusion: Sweeping of the membranes appears an effective and safe procedure in reducing the incidence of elective induction of labor and duration of pregnancy at term in low-risk population.
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Pattern of referral before and after referral intervention among primary health centers in North-Western Nigeria p. 22
Sunday Asuke, Kabir Sabitu, Muhammed Sani Ibrahim
DOI:10.4103/archms.archms_9_19  
Introduction: The revised Nigerian National Health Policy and the WHO Expert Committee on the Role of Hospitals as the First Referral Level both recognize primary health care (PHC) as the entry point in the referral system. This study was carried out to assess the effect of training of PHC workers on referral and instituting referral focal person among PHCs on key referral indicators in Zaria and Giwa local government areas, North-Western Nigeria. Methodology: The study was a quasi-experimental study with pre- and postinterventional components carried out among seventy participants in the intervention and 62 participants in the control groups who were selected through a multistaged sampling technique. Data were collected using a structured self-administered questionnaire containing close-ended questions. Data were analyzed with SPSS software version 20.0. Results: Preintervention, majority of the respondents (74.3%) in the intervention and (67.7%) control groups had not received training on referral process. Postintervention, increase was noted in mean referral rate from 0.18 ± 0.28 to 0.52 ± 0.34, which was statistically significant, and mean counter referral rate from 0 ± 0 to 40.34 ± 45.53 in the study group, but there was no statistically significant change in the control group. Conclusion: Postintervention, significant increases were noticed in two of the practice indicators; referral rate and counter-referral rate in the study group only. The other practice indicators did not record a significant increase.
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CASE REPORT Top

Tetanus following a lion attack p. 28
Sani Hadiza, Yakubu Peter Dodo, Yusuf Nuhu, Abubakar Abdulhameed Balarabe, Yakasai Adam Bashir
DOI:10.4103/archms.archms_13_19  
Lion attacks are rarely seen even in hunters. However, there are few reported cases affecting mainly zookeepers. Most patients usually die from injuries sustained and never survive long enough to develop tetanus. We present a case of tetanus complicating lion attack in a 42-year-old zookeeper, who presented with multiple puncture wounds and quadriplegia after being attacked by a lion in the zoo and subsequently developed signs of tetanus 3 days after the bite.
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