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   Table of Contents - Current issue
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October-December 2022
Volume 19 | Issue 4
Page Nos. 111-150

Online since Wednesday, November 9, 2022

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EDITORIAL  

World Health Organization medical product alert N°6/2022: A clarion call for eternal vigilance p. 111
Adesoji O Ademuyiwa
DOI:10.4103/jcls.jcls_71_22  
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ORIGINAL RESEARCH REPORTS Top

Breast cancer heterogeneity: Comparing pre- and postmenopausal breast cancer in an African population p. 112
Faustin Ntirenganya, Jean Damascene Twagirumukiza, Georges Bucyibaruta, Belson Rugwizangoga, Stephen Rulisa
DOI:10.4103/jcls.jcls_47_22  
Background: Breast cancer (BC) is the most prevalent cancer in women and the leading cause of women's cancer-related deaths and morbidity worldwide. Conventionally considered as a single disease, recent advances suggest that BC is rather a heterogeneous disease with different molecular subtypes exhibiting distinct clinical presentation, anatomo-pathological features, response to treatment and survival outcomes. The purpose of this study was to compare tumor characteristics and epidemiologic risk factors associated with premenopausal versus postmenopausal BC and to assess heterogeneity by menopausal status. Methods: This was a comparative cross-sectional study. A total of 340 patients were included in the study (170 premenopausal vs. 170 postmenopausal BC). Patients' and tumor characteristics were compared in both populations. Percentages and means have been used for descriptive statistics. For categorical variables with comparison groups not exceeding 2, Fischer's exact test was used, otherwise, Chi-square test was used. For continuous variables, Mann–Whitney U-test has been used to compare the numerical ranked variables. A value of P = 0.05 or less was considered statistically significant. Odds ratio (OR) and 95% confidence interval (CI) was estimated using logistic regression analysis. Results: The median age of patients was 49 years (range: 18–89 years), with premenopausal median age of 41 years (range 18–50 years) and postmenopausal median age of 58 years (range 48–89 years). Factors associated more with the occurrence of premenopausal BC than postmenopausal BC were obesity/overweight in adolescence/early adulthood (OR = 0.29 95% CI 0.18–0.49, P < 0.001) and history of benign breast disease (OR 0.34 95% CI 0.14–0.83, P = 0.014), while factors associated more with postmenopausal than premenopausal BC included alcohol intake (OR = 2.47 95% CI 1.54–3.98, P < 0.001), history of breastfeeding (OR = 2.75 1.12–6.78, P = 0.036). However, sports activities (OR = 0.33 95% CI 0.16–0.65, P = 0.0015) and contraceptive use (OR = 0.19 95% CI 0.12–0.32, P < 0.001) seem to be protective for postmenopausal BC. In premenopausal period, patients presented more at advanced stages (Stage III and IV) (51.2% of premenopausal vs. 44.7% for postmenopausal, P = 0.0246), reported more intermediate-to-rapid disease progression (92% in premenopausal vs. 81.1% in postmenopausal (P < 0.001), had more invasive ductal carcinoma (98% in premenopausal vs. 93.5% in postmenopausal (P = 0.053) and had more poorly differentiated tumors (72% compared to 19.4% of postmenopausal BC patients (P < 0.0001). There was no statistically difference in molecular subtypes distribution between premenopausal and postmenopausal women (P = 0.062). However, progesterone receptor (PR) positivity was more associated with postmenopausal BC (P = 0.0165). Conclusion: BC is a heterogeneous disease. Premenopausal BC seems to be more aggressive than postmenopausal BC, with a relatively high prevalence of poorly differentiated and high-grade tumors with rapid progression. However, pre- and postmenopausal BC have similar molecular subtypes with different PR expression but similar ER and human epidermal growth factor receptor 2/Neu oncogene expression.
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Analysis of spirometric variables with increasing body mass index in normal and overweight healthy individuals p. 119
Ilham Jaleel, Haja Nazeer Ahamed
DOI:10.4103/jcls.jcls_41_22  
Background: The relationship between the parameters of body mass index (BMI) and lung function has been established by numerous studies done earlier. Those studies have been done mainly on obese individuals, but only a very few studies have been done in people with normal BMI or overweight group. Our aim is to analyze the various spirometric variables, namely forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), forced expiratory flow (FEF 25%–75%), and peak expiratory flow rate (PEFR), with respect to increase in the BMI in otherwise normal healthy subjects. Methods: The present study design is a randomized experimental parallel-group study. Sixty individuals who were otherwise healthy without any respiratory illness were selected for this study. Their anthropometric measurements were taken. Based on WHO classification, the subjects were grouped as follows: Group I with a BMI of 18.5–24.9 as a normal weight group and Group II with a BMI of 25–29.9 as the overweight group. Using Medispiror, the spirometric variables were determined. Analysis of spirometric variables, namely FEV1, FVC, FEF 25%–75%, and PEFR, were all done using the appropriate statistical method. Results: The results showed that there was a significant decrease in all spirometric variables except PEFR with an increase in BMI. However, the decrease in FVC was relatively more than the decrease in FEV1. Conclusion: This study can be concluded that there is a significant decrease in spirometric variables, namely FEV1, FVC, and FEF 25%–75%, as the BMI increases even in normal individuals who are not obese.
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Anemia in pregnancy: Prevalence among clients attending antenatal clinics in Chikun LGA, Kaduna, Nigeria p. 123
Bilkisu Nwankwo, Sarah Joseph, Nafisat Ohunene Usman, Adegboyega Moses Oyefabi
DOI:10.4103/jcls.jcls_42_22  
Background: Despite concerted global efforts to reduce the burden of maternal anemia, it remains a major public health issue. Over 40% of pregnant women worldwide are anemic; low- and middle-income countries (especially those in sub-Saharan Africa) make a disproportionately higher contribution to the global burden. The condition can lead to undesirable outcomes for the mother and child. This study was conducted to determine the prevalence of anemia in pregnancy among women attending antenatal clinics in Chikun LGA, Kaduna. Methods: This study was conducted among 145 women attending antenatal clinics in Chikun LGA. Data were collected using a pretested, semi-structured interviewer-administered questionnaire. Hemoglobin (Hb) level was determined and anemia was defined using the World Health Organization-recommended cutoff of <11 g/dl. The results were presented in frequency tables. Data were analyzed using IBM SPSS Statistics version 26. Statistical significance was set at P < 0.05. Results: Fifty-five (37.9%) of the respondents were between the ages of 25 and 29 years. The mean age of the respondents was 28.61 ± 5.5 years. The majority, 107 (73.8%), had a household size of 2–4. Only 16 (11.0%) respondents were aware of anemia. Pregnant women were identified by half (50.0%) of the respondents as being more at risk of anemia. Only a quarter (25.0%) of respondents had good knowledge of anemia. Over two-fifth (42.8%) of the respondents were anemic. There was a statistically significant relationship between household size and anemia in respondents. Conclusion: A large proportion of the respondents were anemic; this underscores the need to strengthen the nutritional counseling and routine hematinics given during the antenatal period. Social drivers should also be addressed in terms of favorable public policies.
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Correlation between Lund-Mackay CT scan score and Sinonasal Outcome Test-20 symptoms score in the evaluation of chronic rhinosinusitis p. 130
Yakubu Bababa Shirama, Auwal Adamu, Kufre Robert Iseh, Sa'idu Sule Ahmed, Sule Muhammad Baba, Sadisu Muhammad Ma'aji
DOI:10.4103/jcls.jcls_54_22  
Background: Computed tomographic (CT) scan is important in the evaluation of chronic rhinosinusitis (CRS). The usefulness of CT scan in predicting the severity of symptoms is still debatable. The aim of this study is to determine the correlation between a CT scan scoring and the severity of clinical symptoms in patients with CRS. Methods: A cross-sectional study of patients with clinically diagnosed CRS. Their symptoms severity was assessed using the Sinonasal Outcome Test-20 (SNOT-20) scoring system. All eligible patients had CT scans using BrightSpeed (GE) computed tomographic scanner. The CT scan findings of each subject were scored according to the Lund-Mackay scoring system. The correlation between the CT score and the SNOT-20 symptom score was determined. Results: There were 120 participants comprised 70 (58.3%) males and 50 (41.7%) females with male: female ratio of 1.4:1. The mean and standard deviation of SNOT-20 were 38.9 ± 17.5 (range: 6–81) and that of Lund-Mackay score were 9.8 ± 5.5 (range: 0–24). There was statistical significant correlation between Lund-Mackay score and SNOT-20 score (r = 0.653 P = 0.000). The correlation was strongest in relation to nasal symptom domain (r = 0.746, P = 0.000), but it was weak with the facial symptom domain (r = 0.225, P = 0.013). Conclusion: This study found a strong positive correlation between the Lund-Mackay score and SNOT-20 symptoms score among patients with CRS.
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Epidemiological and radiological patterns of paediatric fractures in an elite community in South West Nigeria p. 136
Olubukola T. A. Omidiji, Olasode Israel Akinmokun, Omodele A Olowoyeye
DOI:10.4103/jcls.jcls_55_22  
Background: Fracture remains a common cause of morbidity, mortality, and disability in childhood. The etiology of fractures varies between and within countries and depends on the socioeconomic and environmental conditions. Etiology of fractures from the elite and high socioeconomic class community has not been documented and this study aimed to document such, including the radiographic features. Methods: A prospective, descriptive, cross-sectional study conducted on 38 children below 17 years that presented with injured limb between July 1, 2018, and June 30, 2020, to a private facility located within a highbrow location in Lagos, Nigeria. Ethical approval was obtained from the Health Research and Ethics Committee, Lagos University Teaching Hospital, Idi-Araba. Data were collected with pro forma. Data analysis was done using the Microsoft excel and Statistical Package for the Social Sciences software (SPSS) for Windows version 21. Results: Thirty-eight children were recruited. The mean age was 8.78 ± 4.35 years. The male-to-female ratio was 3.2–1. Fall was the most common cause of the fracture. Injury occurred most within the school environment followed by the home environment. All the injured presented with pain and swelling of the affected parts. The upper limbs were more injured. Transverse fractures were the most common radiographic findings. Moderate-to-severe displacement of fracture edges was seen in 55.3%, with severe angulations of fracture edges in 23.4%. Majority of the fractures were managed conservatively. Conclusion: Majority of the fractures were due to falls. Most are complete and transverse fractures. A higher percentage was displaced. The management was mostly conservative.
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CASE REPORTS Top

Rhabdomyolysis: A rare and often-missed complication of diabetic ketoacidosis p. 142
Khadijah Omobusola Oleolo-Ayodeji, Helen Olubunmi Salako, Olaolu Aziza Moronkola, Elizabeth Eberechi Oyenusi, Abiola Olufunmilayo Oduwole
DOI:10.4103/jcls.jcls_46_22  
A 19-year-old male with type 1 diabetes mellitus (diagnosed at 12 years of age) was brought to the emergency room with fever and altered sensorium. His compliance with his insulin regimen was questionable. Examination revealed a Glasgow Coma Scale of 5/15, sluggishly-reacting pupils, severe dehydration, and fever (temperature 38.8°C). Vital signs at the upper limit of normal, urethral catheter drained dark red urine with output of 1–2 ml/kg/hr. Laboratory investigations showed hyperglycemia (250 mg/dL), ketonuria (+) hematuria (+++) and proteinuria (++), and glycated hemoglobin (HbA1C) – 9.6%. Full blood count showed leukopenia, neutrophilia, and thrombocytopenia. Deranged electrolytes included hypernatremia, metabolic acidosis, and hypophosphatemia with elevated urea and blood urea nitrogen. Serum creatinine kinase (CK) was elevated. A diagnosis of diabetic ketoacidosis (DKA) with rhabdomyolysis (RM) and raised intracranial pressure was made and he was managed with adequate fluid resuscitation, osmotic diuresis, glycemic control, platelet transfusion, and antibiotics with clinical improvement. Normal CK levels were documented 3 months later. RM is a rare complication of DKA. High index of suspicion should be maintained for prompt detection and management to prevent potential complications, especially acute kidney injury.
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Use of guidewire in assisted urethral catheterization and urethral dilatation with Cook's S dilators: A viable option in resource limited setting p. 146
Adedeji Lukman Fatuga, Abisola Ekundayo Oliyide, Oyedele Jamiu Hassan, Emmanuel A Jeje
DOI:10.4103/jcls.jcls_35_22  
Difficult urethral catheterization (DUC) is a commonly encountered emergency by urologists. A review of literature describes many techniques which are not readily accessible in resource-limited settings. We present our recent experience with the use of Terumo hydrophilic guidewire in the management of DUCs and planned elective management of urethral strictures presenting this as a viable option in reducing the frequency of emergency suprapubic catheterization with its attendant risks and costs.
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