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   Table of Contents - Current issue
Coverpage
July-December 2019
Volume 4 | Issue 2
Page Nos. 31-55

Online since Monday, January 20, 2020

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ORIGINAL ARTICLES  

Pattern of visceral metastasis from breast cancer patients in Ahmadu Bello University Teaching Hospital, Zaria, North Western Nigeria p. 31
Peter Pase Abur, Lazarus M Yusufu, Vincent I Odigie
DOI:10.4103/archms.archms_15_19  
Background: Visceral metastasis from breast cancer usually results in high tumor burden with poor prognosis. Aim: This study aimed to document the pattern, treatment, and outcome of breast cancer patients with visceral metastasis in our hospital. Patients and Methods: This is a 5-year prospective study of breast cancer patients with visceral metastasis from January 2011 to December 2015. All patients had tru-cut biopsy to establish diagnosis. Chest X-ray, abdominopelvic ultrasound, and computed tomography of the thoracoabdominal region were done to establish the extent of visceral organ involvement. Information documented included patients' biodata, histology, site of visceral metastasis, treatment, and outcome. Results: Two hundred and fourteen out of 1087 patients with breast cancer had visceral metastasis (19.7%). Their age ranged 15–83 years. Eighty-four (39.4%) patients had metastasis to the lungs. Thirty-nine (18.3%) patients had metastasis to the liver. Fifty-eight (27%) patients had metastasis to two or more visceral organs. One hundred and eighty-one (84.6%) patients had chemotherapy, 158 (73.8%) had hormonal therapy, whereas 103 (49.1%) had surgery. The mortality at 3-year follow-up was 58.4%. Conclusion: The lungs were the most common organ of visceral metastasis followed by the liver in this study. A significant percentage had metastasis to two or more visceral organs. Early presentation will reduce the incidence of visceral metastasis and the high mortality associated with it.
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Effect of gestational age at booking on feto-maternal outcome at a Nigerian tertiary hospital p. 35
J Zaman, DA Isah, AY Isah
DOI:10.4103/archms.archms_37_18  
Background: Antenatal care (ANC) is one of the pillars of safe motherhood initiative aimed at preventing adverse pregnancy outcome. Early initiation of ANC may provide avenue for early identification and management of many medical illnesses in pregnancy with the resultant better feto-maternal outcome. The objective of the study was to determine the average gestational age (GA) at booking and to determine the effect of GA at booking on the feto-maternal outcome. Materials and Methods: This was a prospective cohort study of 414 women consecutively recruited at the booking clinic of the Teaching Hospital from September 2016 to July 2017. This was divided into two arms, early and late booking. However, only 186 and 189 women in the early and late booking women, respectively, completed the study and their data were available for analysis, and they were followed up to delivery. Results: The mean GA at booking in the study was 19.4 ± 8.14 weeks. The incidence rate of low-birth-weight was 8.3%. The recorded incidence rate of low-birth-weight of 7.8% among early attendees was similar to 8.8% recorded among those that booked late in pregnancy (P = 0.373). The overall stillbirth rate in this study was 29.33/1000 birth. The cumulative incidence of hypertensive disorders in pregnancy in the study was 12.8%. The overall mean packed cell volume (PCV) at booking was 33.6 ± 3.2 and similar to the respective PCV at booking in both early and the late booking women. The PCV at delivery was, however, significantly higher among those women that booked early when compared with those that booked late. Conclusion: The mean GA at booking in our unit is 19.4 ± 8.14. Early booking and access to routine hematinics may guarantee sustenance of this recorded higher PCV at delivery. Furthermore, educated and less parous women tend to book early from this study.
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Factors affecting uptake of natural family planning methods among clients at the reproductive health clinic of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria p. 42
Hauwa Shuaib Umar, Nkeiruka Ameh, Umma Bawa Suleiman, Fadimatu Bakari
DOI:10.4103/archms.archms_14_19  
Background: The use of natural family planning (NFP) methods is low worldwide with few existing data. Aim: The aim of the study is to determine the factors affecting the use and discontinuation of NFP methods in our setting. Methodology: In this descriptive cross-sectional study, 302 clients who presented at the Reproductive Health Clinic of Ahmadu Bello University, Zaria, were interviewed, with the aid of pretested questionnaires. Sociodemographic variables, reasons affecting the use, and discontinuation of NFP methods were recorded and analyzed using SPSS software version 15. Results: Among the 302 clients interviewed, 88.1% (266) had used a form of family planning method: 38.4% (116) used NFP, 49.7% (150) used artificial methods, whereas 37.1% (43) discontinued the NFP methods. Major factors hindering the use of an NFP method include lack of awareness (24%), been single (17%), unknown reason (17%), irregular menstrual cycle (10%), and fear of method failure (8%). Major factors for discontinuing the NFP methods include high failure rates (21%), irregular menstrual cycle (18%), introduction to other methods (14%), want of conception (12%), and fear of pregnancy (12%). Conclusion: The most common factor affecting the uptake of NFP was lack of awareness. Failure rates and irregular menstrual cycles were the common denominators, affecting both the use and discontinuation of NFP methods.
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Clinicopathological features, treatment, and outcome of pregnancy-associated breast cancer in Ahmadu Bello University Teaching Hospital, Zaria, Northwestern Nigeria p. 46
Peter Pase Abur, Lazarus M Yusufu, Vincent I Odigie
DOI:10.4103/archms.archms_5_19  
Background: Pregnancy-associated breast cancer (PABC) is breast cancer diagnosed during pregnancy or within 1 year of delivery. It is the most frequent malignancy diagnosed during pregnancy or lactation. There is a paucity of information on PABC in our hospital. Aim: The aim of the study is to highlight the clinicopathological features, treatment, and outcome of PABC in the center. Materials and Methods: It was a 6-year prospective study of PABC from January 2007 to December 2012 at our hospital. Information documented included patient's biodata, clinical features, pathological types, receptor status, staging, treatment, and outcome of PABC patients. Results: A total of 1344 patients had breast cancer during the study period. 31 patients (2.3%) had PABC. Age ranged 20–43 years, median 31 years. Common clinical features were: breast lump/mass – 27 (87.1%) patients, skin thickness – 10 (32.3%), nipple retraction – 9 (29.0%), and inflammation – 6 (19.4%). 19 (61.3%) patients were diagnosed in pregnancy: first trimester – 4 (12.9%), second trimester – 7 (22.6%), third trimester – 8 (25.8%), while 12 (38.7%) were within 1 year of delivery. Twenty-two patients (71.0%) had advanced disease. Twenty-four (77.4%) patients had invasive ductal carcinoma. Thirteen (59.1%) patients were ER/PR positive, 6 (27.3%) were triple negative, and 3 (13.6%) were HER2 positive. Twenty-four patients (77.4%) had vaginal delivery. Three patients (9.7%) had spontaneous abortion and 1 patient (3.2%) had still birth. 25 babies (80.6%) were alive and well. 17 patients (54.8%) had modified radical mastectomy (2 patients in second trimester and 15 patients after delivery), 25 (80.6%) had chemotherapy, 14 (45.2%) had radiotherapy, and 1 (3.2%) received trastuzumab. Mortality was 8 (25.8%). Conclusion: PABC constituted 2.3% of all breast cancer patients in our hospital. Majority (71%) presented with advanced disease. 3 out of every 4 were invasive ductal carcinoma, while 1 in 4 were triple negative. The mortality was 25.8%.
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CASE REPORTS Top

Aortic arch aneurysm presenting as ortner's syndrome p. 49
Peter Dodo Yakubu, Narendra Nath Khanna, Emmanuel Auchi Edafe, Suparna Rao, Abdulhameed Bala Abubakar
DOI:10.4103/archms.archms_17_18  
Ortner's syndrome is defined as left recurrent laryngeal nerve palsy resulting from cardiovascular disease. Though it was first reported in patients with dilated left atrium in mitral stenosis, many cases have been associated with other cardiovascular diseases such as thoracic aortic aneurysm, enlarge pulmonary artery, abberent subclavian artery etc. We report a case of 45 year old presented with hoarseness and dyspnea who was confirmed to have aortic arch aneurysm. His symptoms resolved completely after transthoracic endovascular aortic repair (TEVAR)
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Symptomatic Müllerian cyst in the retroperitoneum of an adult male: Case report and review of the literature p. 53
Musliu Adetola Tolani, Ahmad Bello, Muhammed Ahmed, Hussaini Yusuf Maitama
DOI:10.4103/archms.archms_19_19  
Retroperitoneal cysts of Müllerian origin are quite uncommon, and most of the cases reported in the literature are in females. This report details the case of a 20-year-old male who presented with recurrent right flank pain and right flank swelling. Imaging investigations revealed a simple cyst posterior to the right kidney. He subsequently had retroperitoneal exploration and excision of an ovoid cystic mass which was histologically confirmed as a Müllerian cyst. Thus, Müllerian cyst should be kept in mind in the differential diagnosis of retroperitoneal cysts.
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