Nigerian Journal of Medicine

Ocular Morbidity in Children with Allergic Conjunctivitis: A Rural‑urban Survey

Valerie Nawem Ihinose Abiola — 2023-10-03

Background: Allergic conjunctivitis occasionally may result in some ocular morbidities. This ranges from innocuous to severe forms of ocular disorders. Aim: This study reports and compares ocular morbidities among children with ocular allergies living in an urban and rural community. Materials and Methods: A comparative cross‑sectional study conducted in urban and rural schools among children aged 5–15 years using a multistage sampling method. Sociodemographic data, past ocular history, history of ocular allergies, and treatment were collected with an interviewer‑based questionnaire and were analysed using the Statistical Package for the Social Sciences (SPSS) software version 25. Descriptive analyses of sociodemographic variables and associated ocular morbidity were carried out. The Chi‑square test was used to test associations between rural and urban groups. A P = 0.05 or less was considered significant. Results: Associated ocular morbidities were seen in 8% (19/238) of the children with allergic conjunctivitis. There was no statistically significant difference in the proportion of ocular morbidities observed between both locations (8.1 vs. 7.9 in the rural and urban location, respectively, with a P = 1.000). Children with mild forms of allergic conjunctivitis were 197 (82.8%), and only 1.7% had severe forms. The moderate and severe form of allergic conjunctivitis were more prevalent in the rural area (P = 0.002) while untreated allergic conjunctivitis was found in 168 (70.6%) of those affected. Conclusion: This study demonstrated a higher proportion of moderate‑to‑severe forms of allergic conjunctivitis among school children in the rural region with the majority being untreated.

Prevalence, Outcome, and Predictors of Placenta Migration among Pregnant Women with Placenta Praevia in Enugu Nigeria

Uchenna Anthony Umeh — 2023-10-03

Background: Placenta praevia is one of the leading causes of obstetric haemorrhages and a major contributor to maternal and fetal morbidity and mortality. Although low‑lying placentae are common during routine midtrimester anomaly scans, the incidence of placenta praevia at term remains low, probably due to placenta migration. It is important to follow‑up pregnant women with low‑lying placentae to identify the few whose placenta will remain in the lower segment and hence at risk of major obstetric haemorrhage. Aim: The objectives of this study were to determine the prevalence, predictors, and pregnancy outcome of low‑lying placenta diagnosed in the midtrimester. Materials and Methods: The study was a cohort study with longitudinal follow‑up of 416 pregnant women from the University of Nigeria Teaching Hospital, Enugu State University Teaching Hospital, and Mother of Christ Specialist Hospital who had an ultrasound diagnosis of low‑lying placentae between 16 weeks and 20 weeks of gestation. Data analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 22. P < 0.05 was considered statistically significant. Results: The prevalence of low‑lying placenta at 20, 24, 28, 32, and 36 weeks of gestation was 51%, 41.3%, 22.3%, 12.7%, and 10.5%, respectively. 87.3% of those with low‑lying placenta had normally situated placenta at term. Previous caesarean section and male gender were significant predictors of placenta praevia at delivery (P < 0.001 and P = 0.03, respectively). Conclusion: Despite the high prevalence of low‑lying placenta before 20 weeks of gestation, only a few of these placentas remain low‑lying at term. Previous caesarean section and male gender were significant predictors of placenta praevia at delivery. This study recommends a routine ultrasound scan in the second or third trimester for placenta localisation.

Health‑seeking Behavioural Practices of the Elderly in Rural Community of Ekiti State, Southwestern Nigeria

Kayode Rasaq Adewoye — 2023-10-03

Background: The aging process increases the risks of contracting a disease among elderly people. Health‑seeking behaviour is poor among the aged in sub‑Saharan countries like Nigeria, escalating the burden of noncommunicable diseases and the cost of health care which further impact the utilisation of orthodox medicine. Aim: This study aims to assess the health‑care‑seeking behavioural practices and associated factors among elderly people in Ido‑Ekiti. Materials and Methods: A descriptive cross‑sectional study was conducted among 420 elderly respondents in Ido‑Ekiti. An interviewer‑administered semi‑structured questionnaire was used to collect information. The data collected were analyzed using SPSS version 25 and results were presented in the form of tables and bar charts. Chi‑square tests were used to test for associations. All data analysis was done at a 5% level of significance. Results: The age range of respondents was between 65 and 95 years, with a mean age of 73.88 ± 6.84 years and 64.0% within the age range of 65–75 years. About 63.3% of the respondents have had an episode of illness in the last year preceding the study and only 35.3% consulted a doctor for treatment (good health‑seeking behaviour); however, 57.9% of the respondents admitted utilising any of the following: self‑medication, consult spiritualist, and use of herbal medicine (poor health‑seeking behaviour). The factors statistically significantly associated with respondents’ health‑seeking behavioural practices are employment status (P < 0.001), educational level (P < 0.002), cost of health care, access to the health facility, length of time before consultation, beliefs, and lack of support from relations (P < 001). Conclusion: This study shows that the majority of the elderly had poor health‑seeking behaviour due to educational and economic factors. Making the free or subsidized cost of health care for the elderly in rural communities and the provision of monthly financial support to the aged by the government will promote and encourage good health‑seeking behaviour of old people.

Pregnancy‑associated Plasma Protein‑A, Progesterone, and Oestriol Levels and Some Birth Outcomes in HIV‑seropositive Pregnant Women at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria

John Ekenedirichukwu Okwara — 2023-10-03

Background: Pregnancy is associated with biochemical alterations and may be compounded by human immunodeficiency virus (HIV) infection potentially affecting pregnancy outcome such as birth weight, Apgar score, and foetal viability (stillbirth or intrauterine foetal death [IUFD]). Aims: This prospective case–control study evaluated some biochemical parameters and their possible effects on pregnancy outcome in HIV‑seropositive subjects. Patients, Materials and Methods: The study involved 136 HIV seropositives on highly active antiretroviral therapy and 137 HIV‑seronegative pregnant women, recruited from the Antenatal Clinic of Nnamdi Azikiwe University Teaching Hospital, Nnewi. Pregnancy‑associated plasma protein‑A (PAPP‑A), oestriol (E3), and progesterone were analysed using an enzyme‑linked immunosorbent assay method, and the delivery outcomes were reported. Results: Progesterone was significantly higher (P = 0.002) in HIV‑seropositive individuals (59.3 ± 17.84 ng/mL) compared to controls (54.89 ± 8.24 ng/mL). There were no significant differences in the levels of E3 and PAPP‑A between the two groups. In HIV seronegatives, there were no significant changes in measured biochemical parameters between trimesters (P > 0.05). There were no significant differences in measured biochemical parameters between subjects with IUFD and subjects with live births (P > 0.05) for both the test and control groups. Subjects with significantly lower PAPP‑A in HIV seropositives had babies with higher Apgar score. The incidence of IUFD was 7.31% among HIV seropositives and 7.47% among HIV seronegatives. Conclusion: HIV infection affects some biochemical indices such as progesterone and PAPP‑A but does not adversely affect pregnancy outcomes in HIV seropositives under antiretroviral therapy.

Patient’s Perceived Satisfaction and Quality of Life with Fixed Partial Denture: A 10‑Year Retrospective Assessment in a Tertiary Institution, South‑West, Nigeria

Shakeerah Olaide Gbadebo — 2023-10-03

Background: Tooth loss is a disease of public health concern and defines the oral health status and quality of life of an individual. Aim: This study assessed the level of satisfaction and the oral health‑related quality of life (OHRQoL) of patients that received fixed partial denture (FPD), for the replacement of teeth, at a Nigerian tertiary health facility. Materials and Methods: A cross‑sectional retrospective evaluation of the clinical records of patients who received FPD within a period of 10 years was done. The eligible participants (44) were contacted by telephone and data on satisfaction and OHRQoL (using Oral Health Impact Profile [OHIP]‑14 questionnaire) were collected. Descriptive analysis was used to report satisfaction and OHRQoL. The association between categorical variables was tested with Chi‑square. P value was set at ≤ 0.05. Results: The conventional fixed–fixed prostheses supported mostly with porcelain‑fused‑to‑metal crowns were the most used. High satisfaction with the appearance was reported by 22 (48.9%) at delivery as against 14 (31.1%) after use. Decementation was the most recorded failure, (26, 57.8%) and the total OHIP‑14 score was 21.71 ± 9.47, indicating poor quality of life. Forty‑four participants (18, 40.9% males and 26, 59.1% females) underwent oral rehabilitation with FPD within the study period. The age range and mean age of the participants were 21–72 years and 46.8 ± 13.8 (standard deviation) years, respectively. Significantly higher aesthetic satisfaction was reported at delivery of FPD compared to the present time of assessment (P < 0.001) showing a decline in satisfaction. However, long‑term posttreatment satisfaction on aesthetics, masticatory ability, and phonetics was significantly higher compared to their pretreatment satisfaction (P < 0.001, 0.001, and P = 0.003, respectively). Furthermore, OHIP‑14 scores showed statistically significant (P < 0.05) improved OHRQoL posttreatment except for OHIP8 and OHIP12 subdomains with P > 0.05. Conclusion: A decline in satisfaction with aesthetics of FPD postdelivery was observed and the psychological domains of OHIP‑14 were mostly affected showing a better quality of life.

Outcome of Flexible Ureteroscopy and Holmium Laser Lithotripsy in the Management of Renal Stones: A two‑year Retrospective Study

Idorenyin Cletus Akpayak — 2023-10-03

Background: Over the decades, the management of renal stones has shifted from the undesirably invasive open nephrolithotomy to the more effective and less invasive approaches with lower morbidity. These less invasive options include extracorporeal shock wave lithotripsy, percutaneous lithotripsy, and flexible ureterorenoscopy (fURS). Aim: This study seeks to evaluate the outcomes of flexible ureterorenoscopy with holmium: yttrium‑aluminum‑garnet (holmium:YAG) laser lithotripsy for the treatment of renal stones <2.0 cm in our patients. Patients and Methods: Records of 23 patients who underwent flexible ureteroscopy and holmium: YAG laser lithotripsy between October 2020 and September 2022 were reviewed retrospectively. The patients who had the flexible ureteroscopy and laser lithotripsy for renal stones <2.0 cm for various indications were the subjects of this study. All patients had computed tomographic urography preoperatively to locate the stone. Stone‑free rate (SFR) was deduced from no stone detected on imaging and resolution of the patient’s preoperative complaints related to the renal stones at follow‑up. Data on patients’ demographics, indication for the surgery, location of the stone, size of the stone, preoperative double J (DJ) placement, postoperative DJ stent placement, intraoperative and postoperative complications, and the SFR were retrieved and subjected to the statistical analysis. Results: A total of 23 patients had fURS and laser lithotripsy during the two‑year study period. All the patients had solitary stone in the renal unit operated. The mean stone size for all the patients was 1.3 cm (range: 0.5–1.9 cm). Fifteen (65.2%) patients had DJ stent preoperatively. Postoperative DJ stent was placed in all our patients. Four (17.4%) patients had Grade 1 ureteric injury while none had high Grades (2, 3, and 4) ureteral injuries. Two (9.5%) patients had intraoperative bleeding, 1 (4.8%) had transient haematuria
postoperatively while 2 (9.5%) patients had urinary tract infection. The SFR was 91.3% in a single surgery. Two patients (8.7%) had residual fragments in the lower calyx. Conclusion: Flexible ureteroscopy and laser holmium lithotripsy give a satisfactory SFR, with few complications. It is a safe and effective treatment modality for the treatment of stones <2.0 cm in the renal pelvicalyceal system.

Sociodemographic Determinants of Overweight and Obesity in Adults Attending a Tertiary Hospital in Rivers State, Nigeria

Boma Oyan — 2023-10-03

Background: There has been an increase in the prevalence of obesity in developing countries with a concomitant rise in morbidity and mortality. The sociodemographic factors of an individual may play a role in his or her body weight. This study aims to determine the relationship between overweight/obesity and sociodemographic characteristics among adults attending the Family Medicine Clinic of a tertiary health centre in Nigeria. Materials and Methods: This was a descriptive, hospital‑based study. Interviewer‑administered questionnaires were used to obtain the sociodemographic variables (age, sex, social class, highest educational level attained, average monthly income, and marital status). A clinical examination was performed to assess the body mass index (BMI), waist circumference (WC), and waist/hip ratio (WHR). Fisher’s exact test was used to test for associations between overweight/obesity and the various sociodemographic determinants and the level of significance was set at P < 0.05. Results: With the BMI, overweight was present in 32.5% of the study population while 36.6% was obese. The WC was increased (>94 cm and >80 cm, respectively) in 43.5% of males and 92.8% of females. The WHR was increased (>0.90 and >0.85) in 52.2% of males and 80.8% of females. The only sociodemographic factor independently associated with being overweight or obese BMI in this study was the female gender (P = 0.011). Conclusion: No region of the world has been successful at reversing the obesity epidemic once it has begun. This study highlights how sociodemographic factors may influence obesity and measures to modulate this disease can be targeted to certain groups.

Hospital Prevalence, Delay in Diagnosis, and Sociodemographic Features of Hidradenitis Suppurativa in Nigeria: A Multicentre Retrospective Study

Ehiaghe Lonia Anaba — 2023-10-03

Background: Hidradenitis suppurativa (HS) is rare in Africans and so not commonly documented in this population. Aim: We aimed to document the hospital prevalence, sociodemographic factors, delay in diagnosis, and factors associated with a delay in diagnosis. Materials and Methods: This multicentre retrospective study of 64 HS patients was conducted across seven outpatient dermatology clinics in Nigeria. Data spanning 2017 and 2022 were retrieved following ethical approval. Extracted information included age at onset, age at diagnosis, delay in diagnosis, gender, family history of HS, body mass index, smoking history, socioeconomic status, and Hurley stage. Data were analysed using IBM Statistics version 26. For all statistical tests, P < 0.05 was considered statistically significant. Results: Thirteen thousand six‑hundred and two new patients composed of 5850 males and 7752 females attended the clinics and 64 of them had HS giving a hospital prevalence of 0.47% (64/13,602). Most of the HS (70.3%) were female. The median (interquartile range) age of the patients was 30 (24, 36) years and the age range was 12–59 years. Age at diagnosis was 20–39 years in 76.6%. There was a delay in diagnosis in 45.3%, a significant relationship between delay in diagnosis with duration and severity of HS with P < 0.001 and P < 0.005, respectively. Conclusion: HS is uncommon in Nigeria. Diagnosis is frequently delayed and patients present with a severe form of the disease. Furthermore, HS is rare among individuals with a low socioeconomic status. There is a need for more awareness and prompt referral of this debilitating disease at the primary health‑care level.

Personality Traits as Key Determinants of COVID-19 Vaccine Uptake among Healthcare Workers in Nigeria

Mohammed Yusuf Mahmood — 2023-10-03

Background: The coronavirus disease 2019 (COVID‑19) pandemic has posed a significant global challenge, necessitating the development and administration of vaccines to halt its spread. Nevertheless, there is limited information on the predictors, patterns, and personality variables influencing COVID‑19 vaccine uptake among Nigerian health‑care workers (HCWs). Aim: The study set to assess level of factors including personality factors that influence acceptance of the COVID-19 vaccines among.HCWs in Nigeria. Materials and Methods: From August 9 to October 11, 2021, a web‑based, cross‑sectional survey was conducted on 300 HCWs in Nigeria, aged 19 and above, with social media access and English language proficiency. Descriptive statistics, Chi‑square, and binary logistic regression were used to analyse the data on the SPSS version 20. Results: The findings revealed that while 64% of those who participated in the study received the first dosage of the COVID‑19 vaccine, only 48.3% returned for the second dose. The impression of heightened susceptibility to contracting COVID‑19 was the primary reason for vaccination uptake. Although education level was associated with vaccination uptake, it did not predict it independently. The age distribution, agreeableness, conscientiousness, and high vulnerability as a rationale for receiving a vaccine were all the independent predictors of vaccine uptake. Conclusion: This study reveals that despite their role as vaccination advocates, HCWs can exhibit hesitancy toward novel vaccines. To increase vaccine uptake among HCWs and the general population, it is crucial to recognise the factors that influence vaccine acceptance among them, including individual personality variables, and incorporate this understanding into vaccination promotion programs.

Assessment of Antinuclear Antibodies, Anti‑Beta 2‑Glycoprotein‑1, and Thyroid Peroxidase Autoantibody Levels in Human Immunodeficiency Virus Sero‑positive Pregnant Women at Nnamdi Azikiwe University Teaching Hospital, Nnewi Nigeria

John Ekenedirichukwu Okwara — 2023-10-03

Background: Pregnancy is associated with biochemical alterations and may be compounded by human immunodeficiency virus (HIV) infection potentially affecting pregnancy outcome. Aims: This study evaluated some biochemical parameters that could possibly affect pregnancy outcomes in HIV‑infected women. Patients, Materials and Methods: The study involved 136 HIV sero‑positive on highly active antiretroviral therapy (HAART) and 137 HIV sero‑negative pregnant women, recruited from the Antenatal Clinic of Nnamdi Azikiwe University Teaching Hospital, Nnewi. Antinuclear antibodies (ANAs), anti‑beta 2‑glycoprotein‑1 (βGP1), and thyroid peroxidase autoantibody (TPOab) were analysed using the enzyme‑linked immunosorbent assay methods. Results: TPOab in HIV sero‑positive subjects (104.9 ± 51.06 IU/mL) was significantly higher (P > 0.05) compared with controls (89.5 ± 33.5 IU/mL). ANA and βGP1 in test group (0.89 ± 0.31; 12.94 ± 8.9, respectively) did not change significantly (P > 0.05) compared with the controls (0.84 ± 0.27; 10.37 ± 9.6, respectively). There were no significant changes in measured biochemical parameters between trimesters (P > 0.05). Furthermore, there were no significant differences in measured biochemical parameters between subjects with different APGAR scores in all subject groups. Conclusion: HIV infection affected TPOab level but had no impact on ANA, βGP1, and APGAR score in HIV pregnancy under HAART.

Scalp Reconstruction following Excision of Malignant Tumors in Southeastern Nigeria

Obinna Remigius Okwesili — 2023-10-03

Background: Malignant scalp tumors are not common and constitute a small percentage of all scalp tumors. Reconstruction of the scalp defects following oncological resection presents peculiar challenges. Aim: The aim of the study is to report our experience in reconstructing scalp defect of varying sizes after the excision of malignant tumours using a variety of techniques. Materials and Methods: This was a retrospective review of patients who had scalp reconstruction after oncological resections from June 2010 to May 2014 (four years) at our teaching hospital in the South‑east of Nigeria. Data on the demographics, nature of the scalp tumors, site, size of the defects, mode of scalp reconstruction, and outcomes were collected and analyzed. Results: Of the 17 patients who had scalp reconstruction, 29.4% of them were men and 70.6% were women (M:F = 5:2). The mean age of the patients was 41.2 ± 4.98 years (range: 19–85 years). The majority of the patients (47.1%) were young adults between 20 and 40 years, and the least involved age group (11.8%) was 13–19 years. The most common etiology of malignant scalp tumors was squamous cell carcinoma (52.9%). The temporal region was the most common site (41.2%) affected. Most of the defects were between 6.1 and 9.0 cm in diameter, followed by defects that were <3 cm in diameter. Neurosurgical assistance was required in 5 (29.4%) patients where the tumor had involved the skull bone. Tumor recurrence was noted in 3 (17.6%) patients within one year of follow‑up. Conclusion: Scalp reconstruction after oncological resection presents a peculiar esthetic challenge due to the hair‑bearing skin of the scalp and the need to maintain the hairline. The use of local flaps from the scalp remains the first and the best option. For very large scalp defects, free flap through microvascular surgery is the preferred option.

Analysis of p21 Expression in Cervical Carcinoma at a Tertiary Institution in Ghana: An Immunohistochemical Study

Babatunde Moses Duduyemi — 2023-10-03

Background: Cervical cancer is one of the leading causes of female mortality worldwide. About 85% occur in low‑income countries with 13.8% incidence and 14% death in Ghana. p21 has been overexpressed in many cancers. Its overexpression in cervical cancer is linked to tumor growth and a bad prognosis. Aim: The expression profile of p21 in our setting is largely unknown, therefore, the necessity to evaluate p21 expression in cervical cancer. Materials and Methods: A retrospective and descriptive study design was employed to investigate p21 expression in association with demographic and clinicopathological features on formalin‑fixed paraffin‑embedded cervical cancer tissues. The age, histologic type, and tumor grade of patients were abstracted from the hospital records between January 1, 2015, and December 31, 2016. Tissue microarray of suitable blocks was constructed, and immunohistochemistry was performed. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 26. Results: One hundred and thirty‑five cases were used for the study with an age range of 31–115 years and mean age of 58.93 years (standard deviation ± 17.88). Majority of the cases were postmenopausal (40–59 years). Squamous cell carcinoma (SCC) was the most common histological type (96.3%) with the nonkeratinizing variant having the highest frequency (53.1%). Majority of the cases were high grade; Grade 2 (33.3%) and Grade 3 (49.6%). Majority of the cases (66.7%) stained positive for p21 antibody. The associations between p21 and the clinicopathological characteristics were not statistically significant (P > 0.05). p21 was more overexpressed in SCC (64.8%) than adenocarcinoma. Conclusion: An overexpression of p21 in this study suggests that it may contribute to antiapoptosis in cervical cancer leading to tumor progression, aggressive behavior, and poor prognosis.

Usability of Surveillance Outbreak Response Management and Analysis System for Coronavirus Disease among Epidemiology Officers in Delta State Nigeria

Olise Ozakpo — 2023-10-03

Introduction: Nigeria recently used electronic surveillance tools for epidemic diseases, one such tool is the Surveillance Outbreak Response Management and Analysis System (SORMAS); no readily available study has assessed the use of SORMAS in Nigeria. The title of this study is the usability of SORMAS for coronavirus disease among epidemiological officers in Delta State; it explored the ease of use, the effectiveness of SORMAS, its applicability, and the challenges with its use. Materials and Methods: This descriptive qualitative study involved disease surveillance and notification officers (DSNOs) and their assistants DSNOs in the year 2022; 25 of them were interviewed using two audio tape recorders after consent was obtained. Ethical clearance was obtained from the appropriate body. Thematic content analysis, with the help of Analysis of Qualitative Data software, was used to analyze data. Results: The findings showed that SORMAS was difficult to use for 100% of the respondents, particularly at the initial time, and subsequent use was relatively easy. About 100% of users found SORMAS to be effective for coronavirus disease 2019 surveillance and claimed it could be applied to other health diseases. About 100% of the respondents had challengesp which included network problems, unavailability of adequate airtime, low technological know‑how, software glitch, and hardware issues, among others. Conclusion: This study helped to outline the factors affecting SORMAS use, demonstrated that SORMAS was relatively easy to use after repeated training, was deemed effective by all respondents; applied to other health diseases, and its use was affected by several challenges.

Immunization of Children in Africa: Strides and Challenges

Dimeji Abdulsobur Olawuyi — 2023-10-03

Background: The African continent is behind by a wide margin in the childhood vaccination race which contributes significantly to the high childhood morbidity and mortality rate from vaccine‑preventable diseases in the continent. Some African countries are still struggling to achieve routine immunization coverage for all recommended expanded program on immunization vaccines. Aim: In this study, we aimed to identify the barriers hindering childhood immunization in Africa and to identify the remarkable progress made so far. Materials and Methods: Peer‑reviewed articles published in English that focused on the barriers to childhood immunization in Africa and the progress made so far was reviewed. This was achieved by searching relevant search terms in PubMed, Google Scholar, Wiley Online Library, and CINAHL databases dating back from January 2000 to June 2022. Result: A total of 30 papers were reviewed. The barriers include parents’ education status, economic status, and gender/age; place of birth and place of residence; cultural beliefs and religious affiliations; fear of contracting diseases and lack of trust in health public institutions; vaccine awareness and delivery; and dose‑specific delays. The achievements include international support and oriented actions, plans for technological integration and its implementation, and domestic immunization‑oriented actions and research work. Conclusion: Childhood immunization is still low in Africa with the majority of the countries yet to realize the global immunization targets. Technologies and immunization‑related interventions have been implemented to support Africa but more concerted effort and aid are required to reduce vaccine‑preventable deaths to the bare minimum.

COVID‑19 in Renal Transplant Patients – A Narrative Review

Jayesh Valecha — 2023-10-03

The World Health Organisation declared the novel coronavirus known as severe acute respiratory syndrome coronavirus 2 a pandemic in March 2020. This virus has led to the deaths of more than 6 million people worldwide. Besides causing pneumonia, COVID‑19 is linked to multiple organ dysfunction, including the kidneys, especially in individuals whose immune systems are already compromised. Consequently, individuals who are currently on a waiting list for a kidney transplant or who have recently received a kidney transplant are at a significantly increased risk for developing acute kidney injury and are severely impacted by the COVID‑19 infection. The pandemic has negatively affected the transplantation process and led to a decrease in the number of organ donations as well as the volume of renal transplants. This review summarises the outcomes of COVID‑19 infection in renal transplant patients, its pathophysiology, the challenges faced by the transplant community, and the management of immunosuppression.

Case Series: Uterine Rupture with a Life Baby after Two Previous Caesarean Sections: An Incidental Finding at Elective Caesarean Sections at Term

Obiora Asiegbu — 2023-10-03

We present three cases of the absence of lower uterine segment (LUS) muscles with a life baby covered by the fetal membrane after two previous caesarean sections (CS) at elective CSs at term. The first case was a 30‑year‑old booked multipara with bad obstetrics history andu two previous CS at a secondary facility on account of unexplained three serial stillbirths at term. There were no histories of maternal obesity, hypertension, or diabetes mellitus. She then had an elective CS at 37 weeks on account of two previous CS. Intraoperatively, it was noted that the LUS was covered by the fetal membranes with visceral peritoneum and no muscle layer. The second case was a 33‑year‑old booked G4P2 + 1A2 with two previous CSs on account of fetal distress and breech presentation with one previous scar at term, respectively. Pregnancy was uneventful till the presentation. At presentation, there was no history or examination finding suggestive of uterine rupture. She had an elective CS at 39 weeks on account of two previous CS. Intraoperatively, a thin membrane at the LUS with no muscular tissue exposing the fetal membranes was seen, with good fetomaternal outcomes. The third case was a 30‑year‑old booked G3P2 + 0A2 with two previous elective CSs on account of primigravida with breech presentation and placenta praevia, respectively. The course of the pregnancy was uneventful. At presentation, there was no clinical sign or symptom suggestive of uterine rupture. She had an elective CS at 37 weeks on account of two previous CS. Intraoperatively, a thin membrane at the LUS with visceral peritoneum and no muscular tissue was seen. The pregnancy outcome was favorable. Silent scar rupture as seen in our case series is one of the common complications of previous CS. Early detection with the introduction of imaging techniques, although not done for our cases and prompt intervention reduces morbidity and mortality.

Bilateral Giant Juvenile Fibroadenoma of the Breast Developing Metachronously in a 10‑Year‑Old Girl

Babatunde Moses Duduyemi — 2023-10-03

Giant juvenile fibroadenoma (GJF) is very rare and represents about 0.5% of all fibroadenomas. We describe a case of a 10‑year‑old premenarche girl that presented with huge bilateral GJFs. The right breast mass appeared first and was managed accordingly. The left mass developed rapidly within three months necessitating a second subtotal mastectomy.

Management of Metastatic Paratesticular Tumour in a Resource‑Poor Setting

Benjamin O. Ayogu — 2023-10-03

Paratesticular tumours are tumours that arise from the testicular tunics, spermatic cord, epididymis, or vestigial remnants. The tumours are rare and account for approximately 5% of intrascrotal neoplasms. About 75% of these tumours arise from the spermatic cord. Paratesticular tumours most commonly manifest as painless scrotal masses. Alternatively, the tumour may be incidentally noticed when a scrotal ultrasound scan is done for another intrascrotal pathology such as hydrocele, inguinoscrotal hernia, epididymo‑orchitis, or suspected testicular tumour. We present a case of metastatic paratesticular tumour in a 21‑year‑old Nigerian male, who presented at the University of Nigeria Teaching Hospital, Ituku‑Ozalla, Enugu, in September 2018 at the age of 19 years with a painless right hemiscrotal mass. The patient was clinically evaluated with scrotal ultrasonography, testicular tumour markers, and liver function test. Biopsy specimen obtained was ignorantly discarded by the patient who was subsequently lost to follow‑up. Histologic diagnosis of mesenchymal tumour (myxoid liposarcoma) was made two years after his initial presentation when he developed both inguinal and retroperitoneal lymph node metastasis at the age of 21 years. He was evaluated as clinical stage IV disease and then commenced on chemotherapy after baseline investigations. Our objective of presenting this report is to highlight the effect of delayed diagnosis in the management outcome, challenges in the provision of resources in low‑ and middle‑income countries, and to emphasise the rarity of the tumour in our subregion.

Case Report of Ectopic Pregnancy Occurring in the Tubal Stump after a Previous Salpingectomy

Maradona E. Isikhuemen — 2023-10-03

Tubal stump ectopic pregnancy is rare but a potentially life‑threatening condition. A high index of suspicion is required for early diagnosis and effective treatment, thereby minimising morbidity associated with this type of abnormal pregnancy. The aim of this report was to document a rare case of repeat ectopic pregnancy in the tubal stump following previous salpingectomy. We report a 35‑year‑old para 1+1 with one living child who had one previous right salpingectomy for ruptured right ectopic pregnancy. She presented with complaint of abdominal pain of one‑day duration following a five‑week history of absent menstruation. On presentation, she was in shock and there were features of intra‑abdominal fluid (blood) collection. Abdominopelvic ultrasound scan demonstrated intraperitoneal fluid collection with floating loops of bowel. She was resuscitated, had salpingectomy for ruptured tubal stump ectopic pregnancy, and remained stable on follow‑up. In conclusion, tubal stump ectopic pregnancy is a rare but possible complication of a previous salpingectomy. A high index of suspicion is required for early diagnosis and effective management.

Complex Adult Congenital Heart Disease: A Rare Case of Dextrocardia with Double‑outlet Right Ventricle

Adeola Olubunmi Ajibare — 2023-10-03

Double‑outlet right ventricle (DORV) is a complex and rare congenital heart disease (CHD), which is usually symptomatic early in childhood and thus diagnosed early. Dextrocardia is another rare CHD that can occur either as an isolated cardiac abnormality or may be associated with other complex cardiac defects. However, the co‑occurrence of DORV and dextrocardia is rare, especially in adult life. We present a 35‑year‑old Nigerian lady with situs inversus totalis and complex CHD, which included dextrocardia with multiple congenital intracardiac shunts, DORV occurring with L‑malpositioning of the great vessels, atrial septal defect, and ventricular septal defect with partial anomalous pulmonary venous drainage, persistent left superior vena cava as well as severe pulmonary stenosis.