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   Table of Contents - Current issue
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July-September 2021
Volume 18 | Issue 3
Page Nos. 127-176

Online since Monday, August 23, 2021

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EDITORIAL  

Journal of clinical sciences now indexed in web of science p. 127
Adesoji Ademuyiwa
DOI:10.4103/jcls.jcls_27_21  
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ORIGINAL RESEARCH REPORTS Top

Pattern of congenital ocular anomailes among children seen at a West African tertiary eye care centre: A retrospective study p. 128
Kareem Olatunbosun Musa, Sefinat Abiola Agboola, Olapeju Ajoke Sam-Oyerinde, Salimot Tolani Salako, Chinwendu Nwanyieze Kuku, Chinyei Joan Uzoma
DOI:10.4103/jcls.jcls_48_20  
Background: The purpose of the study was to describe the pattern of presentation of congenital ocular anomalies (COAs) among children seen at the, Department of Ophthalmology (Guinness Eye Centre), Lagos University Teaching Hospital, Lagos, Nigeria). Methods: A retrospective chart review of children below the age of 16 years who were diagnosed of any type of congenital ocular anomaly at the Pediatric Ophthalmology Clinic of Lagos University Teaching Hospital, Lagos, Nigeria between January 2012 and December 2018 was done. Information concerning the age at presentation, gender, affected eye(s), visual acuity, and type of congenital anomaly was retrieved from the case files. Results: Seven hundred and forty-five eyes of 470 patients with congenital anomalies which constituted 13.6% of all the new pediatric ophthalmic consultations were studied. Two hundred and seventy-five (58.5%) children had bilateral ocular involvement, while 262 (55.7%) presented within the first year of life. The median age was 0.92 years with an interquartile range of 2.67 years. There were 255 (54.5%) males, with a male-to-female ratio of 1.2:1. Congenital cataract was the most common congenital ocular anomaly documented in 224 (30.1%) eyes of 133 patients. This was followed by congenital squint (131 eyes, 17.6%), congenital glaucoma (91 eyes, 12.2%), and corneal opacity (52 eyes, 7.0%). Overall, cataract, squint, glaucoma, corneal opacity, nasolacrimal duct obstruction, and ptosis accounted for 79.0% of the COAs documented in this study. Conclusion: COAs accounted for 13.6% of pediatric ophthalmic consultations in this study. Congenital cataract, squint, glaucoma, corneal opacity, nasolacrimal duct obstruction, and ptosis were the most common COAs observed.
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Risk factors for new-onset heart failure with reduced or preserved ejection fraction in patients with ischemic heart disease: A cohort study p. 133
Senbeta Guteta Abdissa
DOI:10.4103/jcls.jcls_79_19  
Background: Risk factors for heart failure (HF) with reduced ejection fraction (HFrEF) or HF with preserved ejection fraction (HFpEF) in Ethiopian and Sub-Saharan African patients with ischemic heart disease (IHD) is not well-known. Methods: This is a cohort study where 228 patients with IHD were recruited and followed retrospectively over 24 months period. Exclusion criteria were known HF at baseline and absence of echocardiography data. From baseline clinical and echocardiographic patient characteristics, risk factors for incident HFpEF and incident HFrEF were analyzed. Results: New-onset HF was diagnosed in 67.1% (153/228) of the patients. Median time to HF diagnosis was 12.02 (3.42–13.31) months in HFrEF and 12.06 (2.66–15.28) months in HFpEF. There was no significant difference between HFrEF and HFpEF in time to incident HF. On univariate regression analysis risk factors for incident total HF were age, diabetes, and left atrium (LA) size. Diabetes, systolic blood pressure (SBP), diastolic blood pressure, LA and diastolic left ventricular dimension (LVD) had significant association with HFrEF. Age, sex, hypertension, SBP, and diastolic LVD were significantly associated with HFpEF. On cox regression analysis diabetes and LA dimension were associated with total HF while diastolic LVD was associated with incident HFpEF and HFrEF. Age, diabetes, and dimension of LA were also associated with HFrEF. Conclusion: These data suggest a major role for age, sex, diabetes, bigger LA size, and diastolic LVD as predictors of HFrEF and HFpEF in patients with IHD. Strategies directed to prevention and treatment of diabetes, dilatation of left ventricle and LA may prevent a considerable proportion of HFrEF or HFpEF.
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An investigation of the relationship of the admission hyperglycemia to severity and 30-day outcome in acute ishemic and intracerebral hemorraghic stroke: A comparative cross sectional study p. 142
Osigwe Paul Agabi, Oluwadamilola Omolara Ojo, Mustapha Abudu Danesi, Frank Ibe Ojini, Njideka Ulumna Okubadejo
DOI:10.4103/jcls.jcls_81_20  
Background: Hyperglycemia is implicated as deleterious in acute stroke, although the impact may vary by stroke subtype. We sought to determine the frequency of admission hyperglycemia (subcategorized as diabetes related or reactive) and explore the relationship to stroke severity and functional motor outcome in acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH) stroke subtypes. Methods: This cross-sectional study recruited 170 stroke patients (85 AIS, 85 ICH) presenting within 72 h of onset. Baseline characteristics including stroke severity (National Institutes of Health Stroke Scale score), random blood glucose (RBG), and glycated hemoglobin (HBA1C) were documented. The outcomes were 30-day case fatality rate (CFR) and functional motor outcome. Results: The frequency of admission hyperglycemia was 24.7% in AIS and 22.4% ICH, with 18.8%/5.9% of AIS and 9.4%/12.9% of ICH presumed diabetes related and reactive, respectively. Stroke severity and infarct size were positively correlated with admission RBG and HBA1C (P = 0.000) in AIS but not ICH. Presumed mechanism of hyperglycemia did not relate significantly with either infarct size or hematoma volume (P > 0.05). Thirty days CFR was higher in AIS with hyperglycemia (42.9%) compared to normoglycemia (12.5%) (P = 0.003), but did not vary significantly in ICH (42.1% with and 36.4% without hyperglycemia; P = 0.65). There was no significant relationship of hyperglycemia to functional outcome in either stroke subtype. Conclusions: The association of admission hyperglycemia to stroke severity and short-term case fatality is evident in AIS. In ICH, hyperglycemia was not associated with significantly greater stroke severity and death at 30 days, even though case fatality was higher in those with hyperglycemia.
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Knowledge and Attitude toward Depression among Adolescents Attending Secondary Schools in an Urban Local Government Area of Lagos State, Nigeria: A cross sectional survey p. 148
Awujoola F Lesi, Mobolanle R Balogun, Temitope W Ladi-Akinyemi, Ugonnaya U Igwilo
DOI:10.4103/jcls.jcls_78_20  
Background: Globally, depression is the fourth leading cause of mental illness and disability among adolescents (15–19 years). This study aimed to assess knowledge and attitude toward depression among adolescents attending secondary schools. Methods: This was a descriptive cross-sectional study among 257 adolescents attending secondary schools in an urban area of Lagos State. Multistage sampling technique was used to identify appropriate schools, and a semi-structured self-administered questionnaire that contained a vignette depicting depression was used to collect data. Data were analyzed using SPSS version 20. Results: Overall, 257 students participated in the study. The mean age was 15.8 ± 1.3 years. Majority (91.5%) had prior knowledge about depression. The most common sources of information were from school (38.9%), family and friends (23.3%), and social media (20.6%). Majority (87.9%) correctly recognized depression in the vignette. Attempted suicide and social withdrawal from friends (71% and 67.3%, respectively) were less recognized as symptoms of depression. Similarly, only 36.2% recognized depression as a real medical condition. Students in science (76.9%) had better knowledge about depression than students in arts (43.5%) and commerce (43.8%) (P = 0.006). The teacher was considered as the primary access to care compared to the need for specialized care. Majority of the respondents had positive attitudes toward depression and 75.4% believed that people with depression should not be stigmatized. Conclusion: This study showed important gaps in knowledge of causes, symptoms, and the need for professional or psychiatric care of depression. It highlights the need to promote mental health literacy in schools.
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Medication nonadherence in Nigerian heart failure patients: A cross sectional study p. 155
Olagoke Korede Ale, Abdulwasiu Adeniyi Busari, Emmanuel S Irokosu, Akinwumi Akinyinka Akinyede, Sikiru O Usman, Sunday O Olayem
DOI:10.4103/jcls.jcls_1_21  
Background: Anti-failure therapy is vital to the reduction of morbidity and mortality associated with heart failure (HF). Medication nonadherence (MNA) has been identified as a major limiting factor for the attainment of therapeutic goals. This study aimed to determine the prevalence and characteristics of MNA in HF patients attending Lagos University Teaching Hospital (LUTH), Lagos. Methods: This was a descriptive cross-sectional study involving 202 previously diagnosed HF patients attending an outpatient clinic in LUTH. Data were obtained from patient's medical records and the use of an interviewer-administered questionnaire. Medication Adherence Report Scale 5-items was used to determine MNA. Results: Of the 202 HF subjects, 68% (n = 128) were aged 31–60 years, 65% (n = 132) were females, 58%, (n = 116) were taking ≤4 pills/day, 54.5% were taking pills twice daily, and 72.3% (n = 146) had comorbid conditions. The overall prevalence of MNA was 69.3% with ACE inhibitors having the highest MNA of 73.2% and angiotensin receptor blocker/neprilysin inhibitor having the least MNA of 0%. MNA was independent of age, gender, educational status, pill burden, duration of HF, history of HF admission, functional status, and specific comorbidities (P < 0.05). However, the presence of three comorbidities was associated with lower MNA (P < 0.05). Conclusion: There is a high prevalence of MNA in Nigerian HF patients. Measures aimed at improving adherence are imperative to improve outcomes in these patients.
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Training trends and practice pattern of intestinal anastomosis among Nigerian Postgraduate Trainees: A cross-sectional survey p. 161
Olanrewaju Samuel Balogun, Emmanuel A Jeje, Oluwole Ayoola Atoyebi
DOI:10.4103/jcls.jcls_2_21  
Background: The concept of mentor-mentee skills learning in surgical education has been the bedrock of training and knowledge acquisition over many years. Techniques of intestinal anastomosis are one of the fundamentals skills to be mastered in the early career of trainees in surgery. This study aims to evaluate the training trends and current practice of intestinal anastomosis amongst Nigerian postgraduate trainees. Methods: A cross-sectional survey using a self-administered questionnaire was conducted on surgical trainees who attended the 2020 annual revision course of the National Postgraduate Medical College in Lagos. Results: Response rate was 74.1%. The age range of respondents was 29–52 years with a mean 35.5 ± 4.6 years. Majority of the respondents had their future career interest in general surgery and were in the second (43.3%) and third (38.3%) postgraduate year in surgery. Nontraumatic emergency abdominal conditions (71.7%) were the most common indication for gastrointestinal anastomosis. Majority of the respondents practice prophylactic use of bowel preparation and nasogastric tube placement for elective colorectal procedures. Two-layer anastomosis using synthetic absorbable suture was favored by most respondents. This was the technique of choice regardless of the segment of the bowel involved in the anastomosis. Fifth postoperation day was the most preferred time for the commencement of oral intake. Twenty respondents gave an estimated anastomotic leak rate of 0%–10% and this was attributed to systemic factors by 71.7% of the respondents. Two-third of respondents rated their current anastomotic skills as good even though 86.7% of respondents desired further formal training in intestinal anastomosis. Conclusion: Nontraumatic emergency abdominal conditions were the most common indication for intestinal anastomosis. The traditional two-layer anastomosis with synthetic absorbable sutures was favored over other anastomotic techniques. Majority would commence oral feeding on 5th day postoperation. Self-rated anastomotic leak reported by a third of respondents was ≤10%.
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Effect of a nurse-led secondary stroke prevention intervention on medium-term stroke outcome in a teaching hospital in Nigeria: A quasi-experimental study p. 168
Iyabo Yewande Ademuyiwa, Njideka U Okubadejo
DOI:10.4103/jcls.jcls_6_21  
Background: Mortality and morbidity attributable to stroke remain high in developing countries. Secondary prevention of stroke can reduce recurrence using targeted interventions addressing modifiable risk factors. This study assessed the effect of a nurse-led secondary stroke prevention intervention on compliance to lifestyle, diet, clinic and physical therapy attendance, and drug compliance over the medium-term poststroke. Methods: The study utilized a case (interventional group)–control (noninterventional group) quasi-experimental design. Sixty consenting acute stroke patients surviving till discharge were consecutively recruited into the study and conveniently assigned to either group in a 1:1 ratio. Recruitment was conducted over the initial 3 months of the study. The intervention group received standardized intensive in-person counseling for cases and designated caregivers at discharge. This means that, apart from standardized intensive in-person counseling for cases and designated caregivers at discharge. There was additional telephone calls and weekly short messages to the intervention group in-order to reinforce information and communication during follow-up. The nonintervention group received discharge instructions provided by the managing physician only. Outcome assessment was conducted at 9 months post stroke. Results: The study recruited 39 (65%) males and 21 (35%) females. The mean age of participants in intervention group was 55.0 ± 14.5 years, while it was 56.0 ± 11.2 years in the nonintervention group. Other demographic parameters were similar between both the groups. At the end of the follow-up period of 9 months, compliance with lifestyle and diet modification, clinic and physical therapy attendance, and drug compliance was statistically significantly higher in the intervention compared to the nonintervention group (P < 0.05 for all comparisons). Conclusion: This study demonstrates the potential utility of a nurse-led intervention incorporating targeted lifestyle risk modification on compliance to strategies aimed at reducing stroke recurrence. Adoption of this task shifting/sharing strategy is recommended.
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CASE REPORT Top

Unexplained pulmonary thrombosis as a sole presentation of COVID-19: A case report p. 174
Ogochukwu A Ekete, Adewale S Ogundare, Nnaemeka C Ifediora, Obianuju B Ozoh
DOI:10.4103/jcls.jcls_70_20  
Recent reports have shown that thrombotic complications occur rather frequently among patients who have the novel coronavirus disease 2019 (COVID-19). Clinical presentation of pulmonary thrombosis is usually in association with moderate to severe symptoms of COVID-19 and manifests with worsening symptoms and features of atypical pneumonia on imaging. We report an unusual case of extensive pulmonary thrombosis in a young otherwise healthy adult without any typical COVID-19 symptom nor features of atypical pneumonia on imaging.
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