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   Table of Contents - Current issue
Coverpage
January-June 2021
Volume 28 | Issue 1
Page Nos. 1-30

Online since Thursday, April 22, 2021

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ORIGINAL ARTICLES  

Patients' perspective of one-stop breast clinic, Lagos University Teaching Hospital Highly accessed article p. 1
Bolanle C Adegboyega, Kayode N Irurhe, Caleb Yakubu, Adebola M Bashir, Adedoyin O Ogunyemi, Adewumi O Alabi
DOI:10.4103/wajr.wajr_21_20  
Introduction: The complex nature of cancer diagnosis and treatment, with the pressing need for individualized patient care, has led to the services being organized into multidisciplinary teams (MDTs), also called tumor boards or cancer conferences. MDTs are beneficial as they provide coordinated, consistent, expert-driven, and cost-effective care that is delivered in a timely fashion to the patient. This study is aimed to assess the level of impact of a one-stop breast clinic on the management of breast cancer among breast cancer patients in Lagos University Teaching Hospital (LUTH). Methodology: A cross-sectional descriptive study was carried out among patients who attended the MDT breast clinic on referral from within and outside Lagos University Teaching Hospital LUTH. Results: The mean age ± standard deviation of the respondents was of 33.4 ± 7.62 years. More than half of the respondents (66%) felt satisfied about the workings of the MDT clinic, with less than a quarter of respondents reporting that were very satisfied with the clinic. Almost all the respondents (90%) were of the view that it allowed for a more expert opinion. Problems faced by the clinic in the MDT Clinic included filled up booking times (6%) and not taking enough time to attend to patients (2% each). Conclusion: The study revealed a good level of satisfaction among respondents about the MDT clinic; however, reservation on issues such as booking time, better patient to doctor relationship, and availability of more doctors were still of concern to patients. Addressing these issues are vital in achieving an all-round great experience in the multidisciplinary setting.
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Effect of topical xylocaine for pain relief during hysterosalpingography among infertile women in Zaria, Nigeria: A randomized controlled trial p. 8
Anisah Yahya, Nafisa Bello, Hajara Umaru-Sule, Aminatu Makarfi Umar, Halima Mono Muhammad, Philip Oluleke Ibinaiye
DOI:10.4103/wajr.wajr_9_20  
Background/Aim: Hysterosalpingography (HSG) is a radiological procedure that is used to assess the patency of the female genital tract. It is a routine procedure for evaluating female factor infertility in our environment where the incidence of tubal factor infertility is high. It is associated with varying degrees of discomfort and pain. The study aimed at comparing the efficacy of topical analgesia to a placebo for providing pain relief in women undergoing HSG as workup for infertility. Subjects and Methods: The study was a double-blind, parallel group randomized controlled trial of 117 infertile women who had HSG at the Ahmadu Bello University Teaching Hospital, Zaria, from February to December 2019. The intervention group (n = 59) and the control (n = 58) had 15 ml of 2% xylocaine gel and 15 ml of K-Y jelly (placebo) applied directly on their uterine cervical lip, respectively. The primary outcome measure was the mean Visual Analog Scale (VAS) for pain perception on each group during HSG at the point of cervical manipulation and uterine filling with contrast. Results: The mean VAS scores for pain perception in the xylocaine group during cervical manipulation and uterine filling were 2.3 (0.24) and 3.5 (0.35), respectively, while the scores for the placebo group during cervical manipulation and uterine filling were 7.1 (1.8) and 5.5 (0.32), respectively. The observed difference was statistically significant (P ≤ 0.001). Conclusion: During HSG of infertile women in Zaria, Nigeria, the use of topical xylocaine on the uterine cervix was associated with decreased pain perception during cervical manipulation and uterine filling with contrast when compared to placebo. “Trial registry: Www.clinicaltrials.gov, Identifier NCT03802032.”
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CASE REPORTS Top

Inguinal masses in pregnancy: A case of round ligament varicosty in Ghana p. 15
Gilbertson Allorsey
DOI:10.4103/wajr.wajr_12_20  
Round ligament varicosities (RLVs) are noted to present diagnostic difficulties for clinicians and are often mistaken to be inguinal hernias. Very few of such cases have been reported globally. To the best of my knowledge, no case on RLV has been reported in Ghana and as such, this case study is likely to be the first reported case in Ghana. A 27-year-old pregnant woman reported to the hospital with complains of bilateral inguinal swelling accompanied with intermittent excruciating pain. The swellings are visible with the woman in the standing position but disappear with the woman lying supine. The swellings are however prominent in the supine position on Valsalva maneuver. The woman was diagnosed with bilateral inguinal hernia and was scheduled for possible surgery after delivery. Dilatation of the vasculature of the round ligament presents as a bulging mass within the inguinal canal, mimicking inguinal hernias when examined physically. The distinction between the two, thus, the RLV and inguinal hernia is established with ultrasound scan examination. Diagnosing RLVs require the use of a color/power Doppler ultrasound machine and also well-trained clinical personnel with sonographic expertise. Ultrasound scan has been recognized to diagnose RLV effectively and to produce a clear-cut distinction from inguinal hernia. Accurate diagnosis of RLV is also essential to avoid unnecessary surgical interventions since the condition is noted to mostly resolve by itself after delivery.
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Hemothorax or not: Use of extrapleural fat sign p. 18
Rajat Dahiya, Thaker Nirav, Jaggi Sunila, Talwar Inder
DOI:10.4103/wajr.wajr_33_19  
Extrapleural hematoma is a collection located between the chest wall and the parietal pleura and is usually associated with rib fractures. Computed tomography is an excellent modality to diagnose extrapleural hematoma and rib fractures as well as differentiate it from a pleural collection. Extrapleural hematoma needs to be differentiated from a hemothorax for appropriate management. We hereby report a case of a large extrapleural hematoma and associated pleural effusion following trauma being managed as a hemothorax based only on chest radiograph appearance.
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Testicular microlithiasis seen in primary infertility p. 21
John Sheyin, Nuhu D Chom
DOI:10.4103/wajr.wajr_31_19  
Testicular microlithiasis (TM) is rare and usually asymptomatic. It is usually bilateral but has been reported on single testis. TM is defined as five microliths on a single sonogram; it is divided into classical TM and limited TM. There is association between TM and neoplasm. A 34-year-old male presented with a history of primary infertility. Investigations done were normal, except for semen analysis and scrotal ultrasound. The scrotal scan showed multiple hyperechoic foci in both testes. The patient did not come for follow-up in the clinic. Ultrasound is used to diagnose TM in a case of infertility
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Portal biliopathy in a Nigerian: A pictorial case report of a rare finding p. 24
Aderemi O Oluyemi, Sumedh K Waghmare, Raymond A Kuti
DOI:10.4103/wajr.wajr_16_20  
Portal biliopathy (PB) was well delineated as a distinct clinical entity in the 1990s. Since then, science has much improved in diagnosing and managing this condition. Currently, magnetic resonance imaging and cholangiopancreatography have largely replaced endoscopic retrograde cholangiopancreatography as the most important tool in PB diagnosis. Our resource-limited environment has not allowed for optimal availability and uptake of this tool in general but when it is deployed, as in this index case, it can yield great and accurate dividend. This report is the first such scientific documentation of PB in a Nigerian adult. It seeks to show the striking radiological image appearances upon which diagnosis is based. We hope that the article will help increase the index of suspicion for such a rare diagnosis in our locality and that it will encourage the more widespread deployment of such essential and beneficial radiological tools in disease diagnosis.
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Kartagener's syndrome in a young female: A rare diagnosis in a resource-limited facility p. 27
Yusuf Lawal, Muhammed Abba Suwaid, Mansur Adamu Yahuza, Hadijat Oluseyi Kolade-Yunusa
DOI:10.4103/wajr.wajr_24_20  
Kartagener's syndrome (KS) is a subset of a larger group of ciliary motility disorders called primary ciliary dyskinesia. It is a genetic disease with an autosomal recessive inheritance characterized by inefficient or absent mucociliary clearance. It is a very rare congenital malformation comprising a classical triad of situs inversus, bronchiectasis, and sinusitis. A 22-year-old single female Nigerian came to our health facility with complaints of recurrent productive, non-foul-smelling cough, nasal discharge, and occasional shortness of breath since early childhood. She had a positive history of recurrent hospital visitations and chronic use of antibiotics but with few hospitalizations for recurrent chest infection. Chest examination revealed a maximally audible apex beat on the right side of her chest. Chest radiograph showed dextrocardia, while a chest computer tomography scan revealed cystic and varicose bronchiectatic changes with peribronchial thickening and multiple tiny interstitial nodules, mainly in the bilateral middle and lower lung fields. The patient had a fair response on inhaled steroids, nasal steroid spray, antibiotics, mucolytics, and bronchodilators. She is on follow-up clinic visits and close monitoring for potential complications. Patients with KS exist in resource-poor settings like northern Nigeria, largely being managed as cases of chronic sinusitis, pneumonia, or asthma. Although there is no rapid, reliable, non-invasive diagnostic test for KS, accurate diagnosis is crucial if the risks of complications from advanced disease and reduced quality of life are to be averted.
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