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   Table of Contents - Current issue
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Jan-Jun 2021
Volume 10 | Issue 17
Page Nos. -

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REVIEW ARTICLES  

Diabetes and sleep p. 1
RS Reng, GA Onwuegbuzie
DOI:10.4103/nnjcr.nnjcr_24_20  
Sleep has often been thought of as a “restorative” process for the mind and the body; however, it has been shown that it also directly affects many metabolic and hormonal processes. Sleep which is a key factor in physiological restitution also modulates the metabolic, endocrine, and cardiovascular systems and thus has medical implications which include decreased glucose tolerance and insulin sensitivity. Reduction in the time available for sleep is a hallmark of modern society which has developed during the past few decades with increase in the time available for work and leisure, often viewed as harmless and efficient. In normal, healthy individuals, glucose tolerance varies across the day, with total sleep loss or even a 2-h reduction of sleep/night for 1 week there is increased levels of proinflammatory cytokines and low grade inflammation, a condition known to predispose to insulin resistance and diabetes. Sleep deprivation is associated with disturbances in the secretion of the counter regulatory hormones such as growth hormone and cortisol. Elevated evening cortisol levels can lead to morning insulin resistance, while the sympathetic nervous system inhibits insulin release while the parasympathetic system stimulates it, thus leading to elevated glucose levels. Adults are sleeping less and less in our society. Yet sleep is no longer thought of as strictly a restorative process for the body. The importance of sleep for metabolic function and specifically glucose homeostasis is now widely accepted, as many studies have shown a correlation between sleep deprivation or poor sleep quality and an increased risk of diabetes.
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A synopsis of human pandemics p. 7
Esther L Ismaila, Bashiru Omeiza Ismaila, Simeon Omale, David M Umar, David Danjuma Shwe, Nathan Yakubu Shehu
DOI:10.4103/nnjcr.nnjcr_27_20  
Pandemics have been an important part of human history and have caused widespread morbidity and mortality as well as economic devastation in their wake. As the world struggles to contain its latest pandemic coronavirus disease 2019, it is important to look at all the human pandemics that have been recorded. The PubMed and Google Scholar databases were searched for, all in English language literature, using the search words “pandemics” and “history of pandemics.” Further references were obtained through cross-referencing the bibliography cited in each work. Available literature showed pandemics are a recurrent feature in human existence globally. Detailed description of effects of pandemics in Africa were few. The pandemics were classified according to the periods they occurred. From 430BC to 2020AD, different epidemics largely caused by bacteria and viruses have affected the human. With the recurrent patterns of earlier pandemics and advances in international travel, it is obvious that for the foreseeable future, pandemics will remain a global health challenge.
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ORIGINAL ARTICLES Top

Evaluation of hysterosalpingographic findings of patients presenting with infertility in Kano, Northern Nigeria p. 14
Jamilu Tukur, Safiya Usman Zahradeen, Idris Usman Takai, Mohammed Abba Suwaid, Usman Muhammad Ibrahim
DOI:10.4103/nnjcr.nnjcr_13_20  
Background: Hysterosalpingography (HSG) is a minimally invasive tool with reasonable specificity and sensitivity which is effective in diagnosing tubal factor infertility. Objective: This study determines the pattern of infertility, the risk factors for infertility in women presenting for HSG, and documented HSG findings among women with infertility at Aminu Kano Teaching Hospital (AKTH), Kano. Materials and Methods: This was a retrospective study of HSG findings among infertile women who presented for HSG between January 2016 and December 2018 in AKTH. The register for HSG was reviewed at the Radiology Department, and information obtained from the record included the age, file number, and the outcome of HSG. The corresponding files of the patients were then retrieved from the Central Medical Records Department. Information obtained from the case notes were age, parity, type of infertility, and risk factor for infertility. Results: During the study period, there were 400 cases of infertility who presented to the gynecological clinic, out of which 250 patients presented for HSG. One hundred and forty-four case notes were retrieved giving a retrieval rate of 57%. Majority of the women who had HSG during this study were aged between 26 and 30 years. Secondary infertility was predominant over primary infertility which occurred in 86 (59.7%) of the patients. Among the 144 patients who were examined, 71 (49.3%) of the women had an abnormal finding. Bilateral tubal blockage was the predominant abnormal finding on HSG, found in 27 (18.7%) patients. Right tubal blockage occurred more than left tubal blockage, which was seen in 15 (10.4%) and 13 (9.0%) patients, respectively. Regarding uterine pathology, uterine fibroid occurs most in the women accounting for 11 (7.6%) when compared to uterine adhesions which were found in only 4 (2.7%) women. Conclusion: Even though uterine adhesions were significant findings, bilateral tubal blockage and uterine fibroid were the main HSG findings in AKTH within the study period.
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Lifestyle and risk factors associated with threatened miscarriage in elsaudi maternity hospital, Khartoum, Sudan (2018) p. 19
Mohammed Eltayeb, Eltayeb A Mustafa
DOI:10.4103/nnjcr.nnjcr_11_20  
Background: Threatened miscarriage is a relatively common complication during pregnancy, occurring in approximately 20% of all pregnancies. Objectives: The objective of this study is to determine the risk factors associated with threatened miscarriage at Elsaudi Maternity Hospital, Sudan in 2018. Materials and Methods: This is nonmatched single center, case–control study. Results: Overall, of 139 women were enrolled in our study distributed as 68 controls and 63 cases with vaginal bleeding. Risk factors for threatened miscarriage were age <20 (odds ratio [OR] 1.7), age over 40 (OR 1.4), rural residency (OR 1.3), first pregnancy (OR 1.6), unplanned pregnancy (OR 1.6), smoking (OR 2.2), mobile phone usage of more than 6 h (OR 2.4), having high stress level (OR 1.6), being a work in women (OR 1.3), having pre-existing medical condition (OR 1.5), nausea and vomiting during current pregnancy (OR 5.8), having previous miscarriage (OR 2.2), and using oral contraception (OR 1.3). Education and normal body mass index reduce the risk of having threatened miscarriage. Conclusion: Identifying risk factors for threatened miscarriage may aid in the prevention and treatment. We should raise awareness among women about the importance of prepregnancy counseling to identify pregnancies at risk.
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Coronary atherosclerosis in diabetics: A postmortem teaching hospital experience in South-South Nigeria p. 25
Akhator Terence Azeke, Dele Eradebamwen Imasogie
DOI:10.4103/nnjcr.nnjcr_5_20  
Context: Diabetes mellitus (DM) is a risk factor for the development of coronary artery disease. It is plausible that there is no significant association in the grade/severity of coronary atherosclerosis in diabetics in comparison with nondiabetics. Aims: The aim of this study, therefore, was to test this hypothesis by assessing the association of DM on the grade of coronary atherosclerosis. Settings and Design: This study was carried out at the Department of Morbid Anatomy, University of Benin Teaching as a prospective postmortem study. Subjects and Methods: This study employed consecutive sampling technique for recruiting the study population from June 1, 2012, to May 31, 2013. At postmortem, the coronary artery of each subject was graded into one of four grades on the basis of the percentage of cross-sectional area stenosis. Statistical analysis used: the data obtained were analyzed with Chi-square, Mann–Whitney U-test, Spearman's correlation, and multinomial logistic regression to determine the association/relationship between DM and coronary atherosclerosis. Results: Fifty-two cases constituted the study population. Their age ranged from 23 to 82 years with a mean age of 50.35 years (standard deviation = 16.62), median age of 50 years and modal age of 36 years. The severity of the grades of coronary atherosclerosis increased with age. There was a statistically significant association between the atherosclerotic grades of those participants with DM in comparison with those without the disease. Conclusion: The null hypothesis is therefore rejected as there is a statistical significant association in the grades of atherosclerosis in the study population with and without DM.
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Orthodontic problems in repaired cleft lip and palate patients seen in a Federal Teaching Hospital in Gombe, North Eastern Nigeria p. 30
Elfleda Angelina Aikins, Olugbemi Benedict Akintububo
DOI:10.4103/nnjcr.nnjcr_7_20  
Background: Clefts of the orofacial complex are the second most prevalent birth defects anomalies. Management of children born with clefts is multidisciplinary with oral surgeons and orthodontists playing major roles. Objective: The aim of this study was to ascertain the occlusal anomalies in patients who had undergone cleft lip and palate repair. Methods: Data was collected from participants using a pretested anonymous structured questionnaire. An examination of their occlusions was carried out on the same day. All findings were recorded on a data sheet. Data were analyzed using the Statistical Package for the Social Sciences 20.0, and frequency tables of variables were generated. Significance was determined at a 95% confidence interval, and statistical significance was set at P < 0.05. Results: Twenty-four (75.0%) patients presented with at least one incisor with a positive overbite, 21 (65.63%) with a positive overjet, 16 (50.0%) with anterior tooth rotations, 13 (40.63%) had crossbite and edge-to-edge bite, and 8 (25.0%) had anterior tooth displacements. There was no recorded crossbite among patients with repaired cleft palate only. More than half of the participants 17 (53.8%) with anterior crossbite had repaired cleft lip and palate. Conclusion: Almost all the patients had untreated occlusal anomalies, and we are, therefore, recommending that an orthodontist be included in all Smile Train Teams in Nigeria to ensure total rehabilitation of cleft lip and palate patients.
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Efficacy of preincisional versus post incisional unilateral ultrasound-guided transversus abdominis plane block in patients undergoing appendectomy under subarachnoid block p. 34
Uwadia Tony, Hanson Osazuwa Idehen, Charles Olumese Imarengiaye
DOI:10.4103/nnjcr.nnjcr_17_20  
Background: Transversus abdominis plane (TAP) block produces effective postoperative analgesia and reduces postoperative opioid consumption after abdominal surgeries. It could be instituted preoperatively or postoperatively. Objectives: This study determined which period of institution of TAP block is more efficacious in postoperative analgesia in patients undergoing open appendicectomy. Patients and Methods: Eighty patients undergoing open appendicectomy were randomized, of which eight were excluded for various reasons (these were; three for protocol violations, four declined further participations, while one for prolonged surgery). A total of 72 patients received SAB, of which half received (n = 36) TAP block with 20 ml of 0.375% plain marcaine before skin incision (preoperative TAP block group) while the other half (n = 36) received same volume and concentration of TAP block at the end of surgery (postoperative TAP block group). Pain was evaluated postoperatively at rest and on movement by numerical rating scale (NRS) over 24 h. Results: Pain scores were significantly lower in the preoperative TAP block group than in the postoperative TAP block group, especially in the first 6 h (P < 0.001) postoperatively; although, both demonstrated lower pain score. Furthermore, total analgesic consumption (paracetamol and tramadol) was significantly higher in the postoperative TAP block group (P = 0.001 and P = 0.002). Conclusion: Preoperatively, administered TAP block increases time to first analgesic request, provides a longer duration of analgesia and reduces total analgesic requirement in comparison to postoperative TAP block in patients undergoing open appendicectomy.
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Intravenous tranexamic acid for reducing blood loss during cesarean delivery: A double-blind, randomized-controlled trial p. 40
Ibrahim Salihu Halifa, Timothy Abiola Olusesan Oluwasola, Bukola Fawole, Adesina Oladokun
DOI:10.4103/nnjcr.nnjcr_25_20  
Background: Cesarean delivery (CD) has been associated with an increased risk of postpartum hemorrhage (PPH) and maternal mortality. Tranexamic acid (TXA) has proven effective in managing hemorrhage, but its overall effect on blood loss during CD when given before skin incision is yet to be evaluated. Materials and Methods: We recruited 154 consenting pregnant women, scheduled for CDs at the University College Hospital, Ibadan, between October 1, 2015 and March 31, 2016. Participants were randomly allocated to receive either 1 g of TXA or placebo given intravenously, 10 min before skin incision. All participants had intravenous oxytocin postdelivery. Operative blood loss, as the primary outcome, was measured by weight and volume at entry into the peritoneal cavity, at the end of the surgery, and 2 h postsurgery. Results: Both groups, with 77 women each, had similar baseline characteristics, obstetrics history, and blood loss from skin incision to the peritoneal cavity. Blood loss from uterine incision to 2 h postsurgery was significantly lower among the TXA group (613.05 ± 195.63 ml vs. 751.17 ± 250.66 ml; P < 0.001). Neonatal outcomes and the need for additional uterotonics were similar in the two groups. Conclusion: TXA significantly reduced blood loss during CD with no adverse events. Routine use of TXA during CDs will further reduce the impact of PPH.
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Pediatric ear, nose, and throat emergencies: An experience from a tertiary center in Northwestern Nigeria p. 47
Mohammed Aminu Usman, Iliyasu Yunusa Shuaibu, Mohammed Ibrahim Babatunde, Abdulrazak Ajiya, Nurudeen Adebola Shofoluwe, Dotiro Chitumu
DOI:10.4103/nnjcr.nnjcr_16_20  
Background: Ear, nose, and throat (ENT) emergencies constitute a significant presentation at the pediatric emergency room worldwide. Often times, the management of these emergencies may be challenging, especially if the appropriate instruments/expertise are not available. Objectives: This study aims to present our experience in the management of pediatric ENT emergencies. Methodology: The record of pediatric patients managed for otorhinolaryngologic emergencies over 3 years between January 2015 and December 2017 was reviewed. Demographic and clinical data were retrieved and analyzed using the Statistical Product and Service Solution version 23.0 software (SPSS Inc., Chicago, Illinois, USA). Results: A total of 402 emergencies were reviewed. There were 206 (51.2%) boys and 196 (48.8%) girls with male-to-female sex ratio of 1.05:1 and mean age ± SD of 4.86 ± 3.9 years. Acute otitis media was the most common otologic pediatric emergency, accounting for 102 (25.4%). Ear foreign bodies (FBs) were the second most common otologic condition seen in 48 (11.9%) children. Nasal FBs were the most common pediatric nasal emergencies seen in 74 (18.4%) children. Obstructive adenoiditis was the most common throat condition in this study accounting for 37 (9.2%). There was a significant association between patient's ages and outcomes. Age < 5 years is a significant positive predictor of poor outcomes. Conclusion: Most of the emergencies are inflammatory diseases, followed by FBs of the ear, nose, and throat, and the majority of the cases can be managed on an outpatient basis. The provision of appropriate instruments and experts will greatly help in the successful management of such cases.
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Diagnostic mammography in Sokoto: A review of 123 cases p. 53
Muhammad Baba Sule, Ibrahim Haruna Gele, Sule Ahmed Sa'idu, Sadisu Mohammed Ma'aji, Yakubu Bababa Shirama, Abacha Mohammed
DOI:10.4103/nnjcr.nnjcr_52_19  
Background: Diagnostic mammography is a radiographic examination of the breast to detect the palpable and nonpalpable lesions. More than 1.15 million women are diagnosed of breast cancer yearly worldwide. Objective: This study is aimed at evaluating the mammographic outcomes among 123 Nigerian females who had the sign and symptoms of breast diseases. Materials and Methods: This is a cross-sectional study (retrospective in nature) of 123 adult females who came for diagnostic mammography between December 2010 and November 2012 at the mammographic suite of radiology department UDUTH. MLO and CC views were done for the breast examination though compression views were occasionally employed. Results: One hundred and twenty-three females had diagnostic mammography, with a minimum age of 30 years. The prevalence of diagnostic mammography within the stated period is 61.5%. The mammographic findings were normal in 62 (50.4%) and abnormal in 61 (49.6%) of the subjects. The abnormal mammographic findings were masses in either or both breasts in 45 participants (36.6%), architectural distortion in either or both breasts in 10 participants (8.1%), isolated calcification in either or both breasts in 4 participants (3.3%), left retracted nipple in 1 (0.8%) participant while another subject (0.8%) had a retracted right nipple. Conclusion: Diagnostic mammography can detect the various forms of breast pathologies which were mostly breast masses, calcifications, and architectural distortions. These findings affirmed the need of routine early screening so that breast diseases can be detected early.
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CASE REPORTS Top

Two-year follow-up of platelet-rich fibrin-reinforced and modified coronally advanced flap: Pinnacle of the regeneration milieu: Case series p. 58
Sumit Munjal, Seema Munjal, Dhoom Singh Mehta
DOI:10.4103/nnjcr.nnjcr_23_20  
Root coverage (RC) is a sine qua non for the restoration of periodontal vigor altered by the gingival recession (GR). The objective of this study was to clinically evaluate platelet-rich fibrin + coronally advanced flap (P-CAF) and novel platelet-rich fibrin + laterally slided coronally advanced flap (PLSCAF) procedures. RC is done using an assortment of biomaterials, even though they are overpriced and technique sensitive. The success of any autograft depends upon the survival of the same, which is determined by conducive healing. PRF has an edge for being autogenous, angiogenic, immunogenic, inexpensive, easily available, and lacks donor-site morbidity. This study was conducted on three middle-aged systemically healthy patients, one female and two males who had sufficient width, length, and thickness of keratinized tissue adjacent to isolated Miller's I or II GR. A significant improvement in recession width, depth, and gingival thickness was clearly delineated at the second year follow-up. We evinced expected positive outcome on all patients, besides a 100% RC with PLSCAF prowess. Within the limitation of this case series, P-CAF and PLSCAF demonstrated to be promising techniques when treating Miller's I or II GR. Nonetheless, embracing a four-pronged strategy for rapid healing is veritably demonstrated here.
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Excision of solitary neurofibroma of the palate using diode laser p. 62
Vineet Bansal, Aravinda Konidena, Amrit Kaur Mann, Nirvana Yumnam
DOI:10.4103/nnjcr.nnjcr_41_19  
Oral physicians may encounter tumors of neural origin in the orofacial region. Solitary neurofibroma is a rare benign nonodontogenic tumor which may present either as a solitary lesion or as part of the generalized syndrome of neurofibromatosis or von Recklinghausen's disease of the skin. Clinically, oral neurofibromas present as pedunculated or sessile slow-growing painless nodules. Due to their benign, painless, slow-growing nature, they resemble various other lesions and can present a diagnostic challenge. We present a case of neurofibroma of the palate presenting as a sessile nodule in a 38-year-old female that was treated by excision using diode laser along with a relevant review of the literature.
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