Jos Journal of Medicine https://www.ajol.info/index.php/jjm <p><em>Jos Journal of Medicine</em> is a peer-reviewed journal and editorially independent publication of the Association of Resident Doctors of Jos University Teaching Hospital. It seeks to provide a forum for the dissemination of research, review articles and information in all aspects of medical sciences among medical professionals in Africa</p><p>Other journals associated with this journal: <a title="http://www.josjournalofmedicine.com/" href="http://www.josjournalofmedicine.com/" target="_blank">http://www.josjournalofmedicine.com/</a></p> Association of Resident of Doctors en-US Jos Journal of Medicine 2006-0734 Copyright is held by the journal Rare Presentation of Florid Vulva Warts – A Case Report and Review of Literature https://www.ajol.info/index.php/jjm/article/view/260541 <p><strong>Background</strong>: Condyloma acuminata is an extremely common cutaneous sexually transmitted disease often diagnosed clinically, on the basis of its warty, cauliflower, and verrucous appearance. It is caused by the “low risk” Human papillomavirus types 6 and 11 in 90 percent of cases. The immune system plays a critical role in determining the course of viral infection, with immune-suppression and advanced age increasing the risk for long term wart persistence. Treatment options include the use of a wide variety of topical medications as well as surgical excision by cauterisation.</p> <p><strong>Patient</strong>: A rare case of florid vulvar warts in a 21-year old nulliparous immuno-competent woman is presented and the literature reviewed. She had a 7-month history of progressive vulva swelling with associated itching, contact bleeding, and malodorous discharge. It measured about 14 x 10 cm in dimensions, occupying the posterior two-thirds of the labia majora and minora and obliterating the <br>posterior commissure.</p> <p><strong>Intervention</strong>: There was no positive response to Podophyllin application, however, it was eventually excised and histologic analysis excluded malignancy.</p> <p><strong>Conclusion</strong>: Florid vulvar warts though rare in immune-competent patients, could occur. Patients with persistent and recurrent infection often require surgical procedures as was performed in our patient with the possibility of speedy recovery and restoration of normal anatomy and cosmesis.</p> K.C. Michael J. Musa D. Aboki N. Evule R. Simon E. Sagay J. Ameh Copyright (c) 2023 2023-12-04 2023-12-04 16 2 1 7 The Vital role of Cancer Registries in Cancer Control Program; Wake-up Call for Nigeria and Sub-Saharan Africa https://www.ajol.info/index.php/jjm/article/view/260543 <p><strong>Background</strong>: Cancer registry is an essential part of a balanced cancer control program that enables efficient&nbsp; planning and&nbsp; implementation of control program. Included as part of the resolution of World Health Assembly is&nbsp; a responsibility of Member States to&nbsp; establish population-based cancer registries. Africa particularly has sparse&nbsp; population-based cancer registration coverage. This paper&nbsp; aims to highlight cancer registries and the unique role&nbsp; it plays in cancer control and research, drawing attention to the need for an&nbsp; improved cancer registration in&nbsp; countries of Africa.</p> <p><strong>Methods</strong>: Relevant published literature on cancer registries in the past two decades were reviewed using different&nbsp; search methods.&nbsp;</p> <p><strong>Results</strong>: Cancer registration is essential for cancer control. It is cost-effective and assists countries of the world&nbsp; in setting priorities by&nbsp; identifying cancers with the highest burden, planning for emerging trends, focusing research&nbsp; where it is needed and allocating&nbsp; resources. Population-based cancer registries (PBCR) are the best option to&nbsp; measure and understand the cancer burden in the country&nbsp; by providing regional peculiarities and national&nbsp; estimates.</p> <p><strong>Conclusion</strong>: Countries in sub-Saharan Africa need a working cancer control&nbsp; program to help battle the ever increasing burden of cancer. Establishing and maintaining a population-based cancer registry is feasible&nbsp; in all&nbsp; populations, even in low-resource settings, as well as improving both the quantity and quality, particularly in sub Saharan Africa. It&nbsp; is critical for ensuring that cancer prevention and control interventions are making progress.&nbsp;&nbsp;</p> A.M.G. Omeaku O.C. Abanobi Copyright (c) 2023 2023-12-04 2023-12-04 16 2 8 16 Histological types of cervical malignancies seen at The Jos University Teaching Hospital: A five year restrospective review https://www.ajol.info/index.php/jjm/article/view/260544 <p><strong>Background</strong>: Cancer of the cervix is the most common gynaecologic malignancy and the fourth most frequent cancer in women worldwide.<br><strong>Objectives</strong>: To determine the pattern and histological types of cervical cancer in Jos University Teaching Hospital (JUTH).<br><strong>Material and Methods</strong>: This is a 5-year retrospective (January 2016 To December, 2020) study of all cervical cancers diagnosed at the Anatomical Pathology Department of JUTH. <br><strong>Results</strong>: Within the 5 years’ period (January 2016 To December, 2020), a total of 120 cases of cervical cancers were recorded in JUTH. Of these, Squamous cell carcinoma predominated with 95 (79%) of the cases, adenocarcinoma 14 (12%) cases, and adenosquamous 11 (9%) cases. Patients’ ages ranged from 20 to 90 years with highest occurrence in the 4th and 7th decades, with aa mean of 53.5 ± 10.1 years.<br><strong>Conclusion</strong>: Squamous cell carcinoma is the commonest gynaecological malignancy distantly followed by adenocarcinoma in our study. This is consistent with most studies in Nigeria and Africa but less common in the developed world and afflicts more of the older age group.</p> Cinjel P. Stephen Ajang F. Magaji Kwaghe V. Barka Da'ap I. Panan Joel Kaura Copyright (c) 2023 2023-12-04 2023-12-04 16 2 17 21 MRI visual rating of cognitive impairment in elderly patient https://www.ajol.info/index.php/jjm/article/view/260547 <p><strong>Background</strong>: Neurocognitive impairment is an acquired deficiency of cognitive abilities that significantly interferes with performance of daily activities. Early diagnosis is key in the management which is dependent on employing appropriate biomarkers. Cerebral atrophy is a valid neuroimaging biomarker. This study aims to correlate cerebral atrophy using standard visual assessment scales on Magnetic Resonance Imaging (MRI) with cognitive status using a standard cognition assessment tool in elderly patients at the University College Hospital, Ibadan Nigeria.</p> <p><strong>Methods</strong>: Patients over 60 years who presented for cranial MRI and met the inclusion criteria were recruited into the study which spanned a 10-month period. Relevant demographic and clinical information were obtained from the participants. Visual rating scores comprising Medial Temporal Atrophy (MTA), Fazekas, Koedam and Global Cortical Atrophy (GCA) of the images were entered into a standard proforma and the Statistical Package for the Social Sciences (SPSS) software version 20. Data was analyzed using chi square, student t-test, Spearman Rho test, Kruskal-Wallis test, Mann-Whitney Wilcoxon test, and logistic regression analysis.</p> <p><strong>Results</strong>: Spearman Rho test showed significant association between MTA and Fazekas scores and between Koedam and GCA scores. Significant association between MTA scores and severity of cognitive impairment by Mann-Whitney Wilcoxon test was shown. Kruskal-Wallis showed significant association between Fazekas scores and severity of cognitive impairment.</p> <p><strong>Conclusion</strong>: Medial temporal lobe atrophy is a useful marker of cognitive impairment and severity of cognitive impairment. White matter disease is significantly associated with the presence of and severity of cognitive impairment. Both can serve as useful neuroimaging biomarkers.</p> T.A. Olowolafe A.T. Adeniji-Sofoluwe A.O. Adeyinka A.O. Ogunniyi Copyright (c) 2023 2023-12-04 2023-12-04 16 2 22 38 Case report of a sickle cell disease patient with priapism triggered by Anti-Convulsant Therapy in Juth https://www.ajol.info/index.php/jjm/article/view/260548 <p><strong>Background</strong>: Priapism is defined as an abnormal persistent erection of the penis. It is usually painful and it is unrelated to sexual stimulation or unrelieved by ejaculation. Priapism results from a variety of possible etiological factors, including a number of pharmacological agents like anti epileptic medications.</p> <p><strong>Case summary</strong>: A 30-year-old man, a known sickle cell disease patient with background post cerebrovascular accident (CVA) seizure disorder, developed multiple episodes of priapism after commencement of a particular antiepileptic medication. The onset of priapism was noticed to coincide with the commencement of levetiracetam, an antiepileptic drug, and persisted while patient was on the medication. He had several conservative and surgical interventions for the twelve episodes of priapism he&nbsp; had over the two-year period&nbsp; following commencement of levetiracetam. These included corporal aspiration, Winter’s, T, Ebbehoj distal shunts with the last&nbsp; intervention being Al-Ghorab&nbsp; shunt. The withdrawal of the anticonvulsant, levetiracetam, however coincided with the cessation of&nbsp; priapism. He was subsequently commenced on Tab Epilin Chromo 200 mg bd, Meditriol 0.25&nbsp; mgdly, and Neurovite forte 1 dly. He also&nbsp; became seizure free subsequently.</p> <p><strong>Conclusion</strong>: A possible causative factor of priapism in this patient, namely levetiracetam, could&nbsp; have&nbsp; been masked by the background hemoglobinopathy but for a high index of suspicion. The&nbsp; withdrawal of this anticonvulsant coincided&nbsp; with the resolution of priapism in this patient.&nbsp;</p> O.I. Osunaiye S.I. Shuaibu C.G. Ofoha V.M. Ramyil N.K. Dakum I.C. Akpayak I.P. Umana B.J. Jila A.O. Oshagbemi Copyright (c) 2023 2023-12-04 2023-12-04 16 2 39 41 Determination of the predictive value of IPSS on the outcome of trial of voiding without catheter in BPH patients presenting with acute urinary retention https://www.ajol.info/index.php/jjm/article/view/260549 <p><strong>Background</strong>: Acute urinary retention is a common urological emergency. This study was to determine the value of storage IPSS, voiding IPSS and total IPSS in predicting the outcome of trial of voiding without catheter in patients with BPH presenting with acute urinary retention. <br><strong>Methods</strong>: This was a prospective observational study that included patients seen at the Accident and Emergency Unit of Jos University Teaching Hospital with acute urinary retention from benign prostatic hyperplasia. Each patient had clinical evaluation, and urethral catheter was passed to relieve the retention, then an International Prostate Symptom Score questionnaire was patient self- administered. The patients were all placed on Tamsulosin 0.4 mg daily for 3 days after which they had trial of voiding without catheter (TWOC). Statistical analysis was done using SPSS(R) version 23 and MedCalc Statistical software version 17.2. <br><strong>Results</strong>: Seventy-six patients with age range 52 - 82 years were enrolled in the study. The means of IPSS storage, IPSS voiding and IPSS total were 9.00, 10.64 and 19.55 respectively. IPSS storage (AUC = 0.768, p &lt; 0.0001), IPSS voiding (AUC = 0.760, p &lt; 0.0001), and IPSS total (AUC = 0.793, p &lt; 0.0001) predicted the outcome of trial without catheter (TWOC) with cut-off marks of 9, 10, and 20 respectively. <strong>Conclusion</strong>: IPSS storage, IPSS voiding, and IPSS total significantly predicted the outcome of trial without catheter in patients with BPH presenting with acute urinary retention.</p> Ayodele Olufikayo Oshagbemi Olutayo Israel Osunaiye Chimaobi Gideon Ofoha Idorenyin Cletus Akpayak Samaila Ibrahim Shuaibu Nuhu Kutan Dakum Venyir Mamzhi Ramyil Copyright (c) 2023 2023-12-04 2023-12-04 16 2 42 50 Management of penile fracture at Keffi, north central Nigeria-Case Series https://www.ajol.info/index.php/jjm/article/view/260550 <p><strong>Background</strong>: Fracture of the penis is a urological emergency. It is infrequent though increasing in our environment due to rise in over-zealous and vigorous sexual practices.</p> <p><strong>Patients</strong>: Four cases of penile fracture managed at our centre whose ages range between 25 - 45 years and who presented at three days, two weeks, one week, and three hours duration respectively. Diagnosis was made by clinical history and examination findings suggestive of penile fracture.</p> <p><strong>Intervention</strong>: All the patients had surgical repair of the rents in the tunica albuginea and a primary urethroplasty for the patient who had an associated urethral injury. The repairs were done using a vicryl suture.</p> <p><strong>Results</strong>: Two patients had penile fracture following sexual intercourse (one was from reverse coital position) and the other two had penile fracture from masturbation with one having associated urethral rupture. The four patients had surgical repair. Two of the patients had satisfactory sexual function and voiding post repair and two defaulted on follow-up.</p> <p><strong>Conclusion</strong>: Most patients with penile fracture still present late in our environment. Immediate surgical repair is advocated in order to ameliorate morbidity.</p> Olushola J. Ajamu John C. Onwukwe Oluwafemi Okedara Ogochukwu Egwuatu Onyekwere Agbaeze Copyright (c) 2023 2023-12-04 2023-12-04 16 2 51 57 Improvising a surgical drain with an infusion giving set and an empty saline container: An improvised surgical technology case report https://www.ajol.info/index.php/jjm/article/view/260551 <p><strong>Background</strong>: Improvisation is key to surmounting challenges of unavailability and prohibitive cost of surgical staff, stuff, space, and systems in Low- and Middle-Income Country contexts. We describe a step-by-step method for construction of an improvised surgical drain which has been used at our institution following thyroidectomies and mastectomies requiring drainage in a setting of resource constraints for over 20 years.</p> <p><strong>Patients</strong>: The drain has found use in surgical wound drainage following thyroidectomy, mastectomy, and laparotomy for patients with indications for drainage.</p> <p><strong>Intervention</strong>: In this surgical technology case report, we describe the 7-step process for fashioning and deploying this low-cost, low negative-pressure, closed tube surgical drain from an empty 500 mL normal saline collapsible plastic container, and an intravenous fluid giving set. The drain generates a calculated maximum opening negative pressure of 15.4 kPa calculated by Bernoulli equation and costs about 1.1 USD.</p> <p><strong>Conclusion</strong>: The technological simplicity of this low-cost improvised, negative pressure, closed tube drain for thyroid, breast, and abdominal surgeries in low resource settings constructed from a 500 mL infusion bag and an intravenous fluid giving set is apparent. The drain’s bio-mechanical efficiency and cost effectiveness must be validated against standard custom-made drains. Some randomised control studies are being carried out to that effect.</p> Barnabas Tobi Alayande Bashiru Omeiza Ismaila Emmanuel O. Ojo Mercy W. Isichei Augustine Zoomsen Sule Copyright (c) 2023 2023-12-04 2023-12-04 16 2 58 63 The response to intra-articular steroid injections in patients with osteoarthritis of the knee: Sonographic versus palpation technique https://www.ajol.info/index.php/jjm/article/view/260552 <p><strong>Background</strong>: Osteoarthritis is the most common chronic joint disease globally, intra articular&nbsp; steroid injection (IASI) is an option of&nbsp; treatment but has a huge variation in the response and&nbsp; duration of response. One of the reasons proposed for this variation is the extra-articular deposition of the steroid. This study is aimed at determining if there is any difference in response from traditional palpation-guided technique from the sonographic-guided technique.</p> <p><strong>Method</strong>: Fifty-four patients aged 30 to 80 years who have been diagnosed of osteoarthritis using American College of Rheumatology criteria, and have met the inclusion criteria were enrolled in the study. They were randomly divided into two cohort groups and had intra articular steroid injections into the knee either by palpation or sonographic-guided technique.</p> <p><strong>Results</strong>: The median age of the participants was 53.5 ± 10.1 years, there was a predominance of females, there was no significant difference between the sonography group and the traditional palpation technique group except in alcohol consumption with p-value of 0.025. In this study, palpation-guided methods responders are similar with the relative value of responders for the sonographic-guided&nbsp; method, 76.9% and 81.9%, respectively in 2 weeks using WOMAC&nbsp; score and 100% each using the VAS score. The WOMAC score in the&nbsp; group that had IASI under&nbsp; sonography had better pain reduction as seen in Figure 1, but the difference in response between&nbsp; the two&nbsp; groups was not statistically different.</p> <p><strong>Conclusion</strong>: In conclusion, palpation-guided intra articular steroid injection response is like the&nbsp; response from sonographic-guided intra&nbsp; articular steroid injection.</p> Femi O. Taiwo Courage U. Uhunmwangho David G. Mancha Shem B. Yilleng Idumagbodi Amupitan Icha I. Onche Yetunde F. Taiwo Charles C. Ani Copyright (c) 2023 2023-12-04 2023-12-04 16 2 64 72