GOMBE MEDICAL JOURNAL

Magnetic Resonance Imaging of Pituitary Microadenoma: A Case Series

Dahiru Mohammed Yunusa, Umar Aminu Usman, Aishatu Ibrahim — Mon, 12 Aug 2024 00:00:00 -0600

Pituitary microadenoma is a benign tumour of the pituitary gland less than 10mm in diameter. Pituitary microadenoma pose a challenge in clinical practice as well as diagnostic imaging due to their silent clinical presentation and size. Magnetic Resonance Imaging (MRI) is the mainstay for the diagnosis of pituitary microadenoma. In developing countries, there is scarcity of Medical Specialist and more so, functional MRI machines are not readily available. Even where available, they are not affordable for the majority of the populace. These factors might be responsible for the delay and under reporting of pituitary microadenoma in developing countries. We presented two cases of microadenoma who have visited different health facilities with different symptomatology as well as the challenges encountered in their diagnosis.

Radiation Recall in Oropharyngeal Cancer with Background Retroviral Disease: A Case Report

Sunday AA, Gaddafi Y, Munir S — Mon, 12 Aug 2024 00:00:00 -0600

Radiation recall is not a common phenomenon in cancer patients but it can occur in any cancer patient who received radiation therapy prior to commencement of chemotherapy. It is caused by a tissue reaction that develops in a previously irradiated area precipitated by administration of certain drugs or triggering agents or disease conditions. This is a case report of a 30 years old patient with oropharyngeal cancer and background retro viraldisease who was managed in our facility. She initially had six cycles of chemotherapy using cisplatin and paclitaxel in 2015 followed by radiotherapy which she completed and certified disease free in 2016. Five years later in December 2021, she was diagnosed with recurrent disease with extension into nasopharynx. She was re-evaluated, properly optimized and commenced on another round of chemotherapy. Ten days after the first cycle, she developed radiation recall with erythema, dry desquamation and pruritus at the previously irradiated site in addition to mucositis, difficulty and pain on swallowing and xerostomia. The manifestation of radiation recall was successfully managed without worsening of prognosis. Patient is in her 9^thyear since diagnosis. This communication is aimed at contributing to existing body of knowledge, highlighting the possibility of radiation recall in cancer patients, for the purpose of continuous medical education and mentor-ship in residency training.

A Post-Marsupialisation Vulval Botryomycosis in Northeast Nigeria: A Rare Case Report

Mon, 12 Aug 2024 00:00:00 -0600

Abstract:

Botryomycosis is an uncommon chronic suppurative granulomatous infection that affects humans, usually involves the skin, and rarely viscera; it mimics other conditions like actinomycosis, mycetoma, and subcutaneous mycoses. We here report a unique case of a 42-year-old woman who is a known Human Immunodeficiency Virus (HIV) patient who had failed first-line anti-retroviral therapy, she presented with a 3-month history of post-marsupialization left labia multinodular swelling with discharging sinuses. Tissue biopsies for Microbiological and histologic diagnosis yielded Pseudomonas aeruginosa, Acinetobacter baumannii, and micro abscesses respectively. She was treated with Intravenous Amikacin for 10 days and later switched to oral levofloxacin for another 10 days based on the susceptibility result. This is the first reported case of Botryomycosis in Nigeria and the first case of Pelvic botryomycosis in the world.

Keywords: Botryomycosis, marsupialization, Nigeria

A Swallowed Foreign Object in Adult Psychiatric Patient: A Case Report

Mohammed Ibrahim, Michael Felix Shalzim, Udeh Clement Chukwudi, Ibrahim Shehu — Mon, 12 Aug 2024 00:00:00 -0600

ABSTRACT
Swallowing of foreign objects is rare among adults with few patients requiring intervention. We present a patient with psychiatric disorder who swallowed a foreign object and was complicated by peritonitis secondary to gastric perforation.
INTRODUCTION
Foreign objects can be swallowed accidentally or intentionally. Majority of swallowed objects occurs in children which is usually accidental, while adult cases are rare and occur mostly in psychiatric patients.1 There are about 80% of the patients who are asymptomatic with spontaneous passage of swallowed object, while about 20% are symptomatic and require intervention.2 The clinical presentation and management depends on the size, shape, nature and location of objects.2 There are guidelines for management of swallowed objects in
children which some of the principles can be applied to the adult patients.2,3
CASE REPORT
We present a 38-year-old lady who presented in surgical clinic at Modibbo-Adama University Teaching Hospital, Yola on account of recurrent abdominal pain of 6 months duration, generalized colicky, and worsens on feeding. Pain started a day after swallowing a cutlery
(Fork). (Figure 1). No associated emesis, abdominal distension and patient has normal regular bowel motions. She was treated using herbal medications. She is a known schizophrenic patient not regular on medical treatment. Clinical examination revealed a lady in mild painful distress, pale but a febrile, not dehydrated with normal vital signs. Abdomen was flat with tenderness at the epigastric and right hypochondrial region, no guarding and had normal bowel sounds.
An abdominal X-ray revealed the swallowed fork at the epigastric region and extends towards the right lower quadrant of the abdomen. The patient had routine haematological and biochemistry test which revealed a packed cell volume of 24%, blood grouping and cross match was done and patient transfused 2 units of blood.
The patient had laparotomy under general anaesthesia with intra-operative finding of the fork within the stomach and perforation along the lesser curvature of the stomach by the handle of the fork which was within the lesser sac. Gastrostomy and extraction of the cutlery was done (Figure 2), perforation repaired by simple interrupted sutures and gastric incision repaired in a similar fashion. The peritoneal cavity was lavage and peritoneal drain inserted via a stab incision at the right hypochondrium, and the peritoneal cavity closed en-mass. The post-operative period has been uneventful patient commenced oral sibs 3 days postoperative and was discharged 12th day post-operative. The patient was subsequently managed for the Psychiatric disorder in the out-patient clinic.
DISCUSSION
Swallowing of foreign objects is common among children especially between the age of 6 months and 6 years, it rarely occurs in adults and when it does it occurs mostly in patients
with mental retardation or psychiatric disorders.3,4,5 This is similar to the patient in this study who has an underlying psychiatric illness.
Swallowed foreign objects varies widely in size and shape with objects like fish bone,
dentures, pin, toothpick, impalements among the commonly swallowed objects.3,6 The Most common swallowed foreign object in the paediatric population globally is the coin, similarly in Nigeria it has been reported to be the commonest ingested foreign object in children,
however, in adults, swallowed objects are variable.5,7
The clinical presentation varies widely ranging from gastrointestinal, respiratory and non-specific symptoms. The majority of patients being asymptomatic with objects passed out in faeces, while only about 20% of the patients present with symptoms especially when it results in obstruction of the gastrointestinal tract. Swallowed objects that fail to pass through the gastrointestinal tract are usually impacted in the oesophagus. This is because the oesophagus is the narrowest part of the gastrointestinal tract, however, most swallowed objects that passes to the stomach usually passes out spontaneously, but large objects like the one swallowed by the index patient my fail to pass through the pylorus or negotiate the duodenum.2 The retention of objects in the stomach is not so common occurring in about 5%
of patients.6
The use of radiographs can confirm the diagnosis and help localize radio-opaque objects like in the case of this patient. Hand-held metal detectors could help localize metallic objects.12 Just as depicted in the radiographs above, the nature and position of a metallic object can be confirmed with radiographs. Negative radiographs do not rule out the presence of foreign objects. Non-radio-opaque objects can be localized using 3-dimensional computed tomography and, in addition, a contrast endoscopy can be valuable.8
The management of ingested foreign objects can be by observation, endoscopy and or surgical intervention.9 The choice of management depends on the anatomical location, size, shape and nature of ingested object and the competence of the endoscopist.10 There is no validated guideline in management of these patients especially in adults.11 The management of metallic foreign objects that result in perforation of the stomach with resultant sepsis are extremely rare and are associated with increased morbidity and mortality.12 Our patient who presented with peritonitis had laparotomy with removal of the retained object, repair of gastric perforation and irrigation of the peritoneal cavity with warm saline. Post-operatively the patient had remarkable improvement.
CONCLUSION
Swallowed foreign objects are rare in adults with majority being asymptomatic requiring only observation, while few patients are symptomatic and requiring endoscopic or surgical
intervention.
Consent
Written informed consent was obtained from the patient for the publication of this case report and the images
Financial Support and Sponsorship
Nil

Conflicts of Interest
There is no conflict of interest.
References
Boumarah DN, Binkhamis LS, AlDuhileb M. Foreign body ingestion: Is intervention always a necessity?. Annals of Medicine and Surgery. 2022 Dec 1; 84:104944.
Wyllie R. Foreign bodies in the gastrointestinal tract. Current opinion in pediatrics.
2006 Oct 1;18(5):563-4.
Ambe P, Weber SA, Schauer M, Knoefel WT. Swallowed foreign bodies in adults. Deutsches Ärzteblatt International. 2012 Dec 14;109(50).
Al-Salem AH, Qaisarrudin S, Murugan A, Hammad HA, Talwalker V. Swallowed foreign bodies in children: aspects of management. Annals of Saudi Medicine. 1995 Jul;15(4):419-21.
Kay M, Wyllie R. Pediatric foreign bodies and their management. Current
gastroenterology reports. 2005 May;7(3):212-8.
Erbil B, Karaca MA, Aslaner MA, İbrahimov Z, Kunt MM, Akpinar E, et al. Emergency admissions due to swallowed foreign bodies in adults. World journal of gastroenterology: WJG. 2013 Oct 10;19(38):6447.
Alabi BS, Oyinloye OI, Omokanye HK, Aremu SK, Afolabi OA, Dunmade AD, et al. Foreign bodies in the upper aerodigestive tract of Nigerian children. Nigerian Journal of Surgery. 2011;17(2):78-81.
Dorterler ME, Gunendi T. Foreign body and caustic substance ingestion in childhood.
Open Access Emergency Medicine. 2020 Nov 4:341-52.
Gracia C, Frey CF, Bodai BI. Diagnosis and management of ingested foreign bodies: a ten-year experience. Annals of emergency medicine. 1984 Jan 1;13(1):30-4.
Eisen GM, Baron TH, Dominitz JA, Faigel DO, Goldstein JL, Johanson JF, et al.
Guideline for the management of ingested foreign bodies. Gastrointestinal endoscopy. 2002 Jun 1;55(7):802-6.
Chen MK, Beierle EA. Gastrointestinal foreign bodies. Pediatric annals. 2001 Dec 1;30(12):736-42.
Au A, Goldman RD. Management of gastric metallic foreign bodies in children.
Canadian family physician. 2021 Jul 1;67(7):503-5.

Figure 1: Cutlery (fork) in plane X-ray Erect Figure 2: Postoperative cutlery (fork)

The Postoperative Outcomes Between Patients Who Had Modified Ferguson with Those Who Had Mitchell Bank’s Herniotomy

Adamu S, Nwosu CD, Abdurrahman L, Abdurrashid N, Bwalya KJ — Mon, 12 Aug 2024 00:00:00 -0600

ABSTRACT:

Background

The commonest inguino-scrotal ailments in children are hernia and hydrocele. Hence, herniotomy remains the commonest operative procedure performed by the Paediatric surgeons. The main objective is to compare early post operative complications especially scrotal oedema or haematoma following the modified Ferguson (incision of the external oblique) and Mitchell Bank ( non incision of the external oblique ).

Materials and methods

It’s a prospective and single blind study carried out between May 2017 and April 2018 at the University Ilorin Teaching Hospital Ilorin, Kwara state. A total of 70 patients were randomized into 2 groups ; modified Ferguson ( n=35 ) and Mitchell Bank ( n=35 ) methods of herniotomy. The patients were then followed up for 30 days to study the outcome. Data generated was analysed using SPSS software and 95% confidence interval was used, a p value <0.05 was considered statistically significant.

Results

The age range of the subjects was 2-15 years with a median of 4.13 years, majority had normal (71.4%) weight, while 20.6% were underweight. About 74.3% had right sided hernias/hydrocele. The mean duration of the surgery was 22.9±6.3 and 33.5±10.3 for MBH and MFH (P<0.001), length of surgical incision was longer in MFH (3.11 ± 0.55 cm) compared to MBH (2.22 ± 0.41 cm) (P< 0.001); There were 4 and 5 postoperative complications noted among those with MBH and MFH respectively, however, it was not statistically significant .(P=0.761)

Conclusion

The study showed that the incidence of post operative complications were similar between the 2 groups, however, the duration of surgery and length of incision was longer in MFH compared to MBH. Therefore, when there is time constraint MBH is preferred.

KEYWORDS: Modified Ferguson Herniotomy, Mitchell Bank Herniotomy, Scrotal Oedema, Haematoma

Risk Factors and Clinical Features of Malaria Among Newborns With Fever in Federal Teaching Hospital Gombe: A Cross-Sectional Study

Mon, 12 Aug 2024 00:00:00 -0600

Introduction

Malaria is a cause of fever in the neonatal period especially in malaria-endemic regions and it is important to recognize and treat it early. We set out to document the risk factors, clinical features and outcome in subjects with neonatal malaria in our setting

Methods

We conducted a prospective, cross-sectional study in which 131 newborns with fever were recruited. Malaria diagnosis was by use of direct microscopy following Giemsa staining. Maternal and newborn characteristics were documented. Data analysis was done using SPSS version 24 and p-value was considered significant when less than 0.05.

Results

A history of malaria in the mother regardless of the gestational age of occurrence, prematurity, Packed cell volume(PCV) less than 45, jaundice and a history of transfusion were significantly associated with malaria in the newborn. More deaths were recorded in newborns with malaria however the difference was not statistically significant.

Conclusion

Clinicians should have a heightened index of suspicion for malaria in neonates who present with fever and the features mentioned above in malaria-endemic regions.

Association between Foetal Umbilical Artery Waveforms and Foetal Outcomes in Patients with Pre-eclampsia: An Analytical Cross-sectional Study at Federal Teaching Hospital, Gombe, North-eastern Nigeria

Mon, 12 Aug 2024 00:00:00 -0600

ABSTRACT

Background: Globally, pre-eclampsia is a major cause of maternal and perinatal morbidity and mortality. In Nigeria, it is identified as the primary cause of maternal complications. The objective of this study is to examine the association between foetal outcomes in patients with pre-eclampsia and the Doppler waveform of the umbilical artery at Federal Teaching Hospital Gombe (FTHG). Studies have shown umbilical artery Doppler can predict adverse foetal outcome early than the other methods before delivery of the foetus by a means difference of 9.2 days plus or minus 4days

Materials and methods: A cross-sectional study was carried out at the antenatal clinic and gynecological emergency unit of Federal Teaching Hospital Gombe (FTHG), involving 96 patients who were diagnosed with pre-eclampsia. The samples were selected using convenience sampling techniques. The umbilical artery Doppler waveform was tested at the laboratory while the fetal outcome and maternal information/socio-economic information of the sampled women were collected from labor ward and semi-structured interviewer-administered questionnaire. Chi-square test was employed in analyzing the data collected with a significance level set at a p-value of less than 0.05.

Results: Of the 96 respondents studied, almost ¹/₃of the studied patients exhibited abnormal umbilical artery waveforms, which varied in severity. These abnormalities included reduced end diastolic flow in 27 accounting for about quarter of the studied cases, reversed end diastolic flow was observed in only 2 (2.1%) cases, and absent end diastolic flow in 1 (1.0%) case. It was observed that those with abnormal umbilical artery Doppler waveforms were seven times more likely to give birth to low birth weight babies (OR=7.09, p-value=0.008, 95% CI=1.494 – 14.041) and five times more likely to require admission to a special care baby unit (SCBU) (OR=5.06, p-value=0.024, 95% CI=0.088 – 0.846).

Conclusion: This study established a strong association between abnormal umbilical artery Doppler waveforms in women with pre-eclampsia and the likelihood of their babies being born with low birth weight and admission to SCBU. Therefore, the findings can serve as a guide in the timing of delivery for patients with pre-eclampsia. In addition, they can be used as an indication for referrals by facilities without SCBU and which cannot manage low birth weight babies in their hospital.

Keywords: foetal umbilical artery; pre-eclampsia; foetal outcome; Federal Teaching Hospital,

Gombe

Haematological Profile of Children with Sickle Cell Anaemia in Crises and Steady State: A Comparative Study in A Tertiary Hospital, North-Eastern Nigeria

Mon, 12 Aug 2024 00:00:00 -0600

Introduction

Sickle cell anaemia (SCA) is an inherited, most severe, and commonest form of sickle cell disease that results from the β-globin gene mutation. Complications of SCA are mostly dependent on the activation of blood indices. This study is aimed at evaluating haematological parameters needed for monitoring sickle cell anaemia children.

Materials and Methods

This was a comparative cross-sectional study conducted in a tertiary hospital where 198 sickle cell children were recruited using convenience sampling technique. The data was analysed using SPSS version 23.0. The complete blood count parameters of sickle cell anaemia children in crisis and steady states were compared. Haemoglobin (Hb), haematocrit, White blood cell (WBC), Mean corpuscular volume (MCV), Mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC) and platelet (Plt) were determined. Independent T-test and ANOVA were used to summarise the continuous variables. A p-value<0.05 was considered statistically significant.

Results

The mean Hb, MCV & MCH were significantly lower in children with crises compared with the steady state (p= <0.001, <0.001 and 0.046). The mean WBC was 20.58 ± 9.91 in crises and 14.29 ± 4.47 in steady state (p=<0.001). The Hct was lower in crises (21.76 ± 4.62) compared with steady state (22.41 ± 3.52) (p= 0.269) and the Plt was higher in crises (426.52 ± 219.67) compared with steady state (391.46 ± 182.63/mm³) (p=0.224).

Conclusion: Haemoglobin and Hb-dependent haematological indices in sickle cell anaemia were lower in crisis states especially in haemolytic crisis while WBC and platelets were higher. Close monitoring of Complete Blood Count, rather than the usual Hb value only, is highly necessary for SCA children with haemolytic crises.

Keywords: Sickle cell anaemia, Children, steady state, crisis state, Haematological profile,

Dexamethasone as an Additive to Heavy Bupivacaine in Unilateral Spinal Anaesthesia for Lower Limb Open Reduction and Internal Fixation

Ibrahim N, Panda SU, Bawa AI, Adamu S, Wakili IM, Adamu SA — Mon, 12 Aug 2024 00:00:00 -0600

Background: An ideal additive should shorten the speed of onset of action of the local anaesthetic drug and also reduce its dosage along with providing better hemodynamic changes. Therefore, the aim of this study was to determining the onset of action of unilateral spinal anaesthesia when intrathecal dexamethasone is added to heavy Bupivacaine for lower limb open reduction and internal fixation (ORIF).

Materials and methods: The study was carried out in Anaesthesia Department, Federal Teaching Hospital Gombe, Gombe State. It was a prospective experimental study in which patients were recruited using simple random sampling technique and balloted for the intervention given. The minimum sample size (n) for this study was calculate and resulted in a total number of 68 subjects for the entire study. Data was collected using modified questioner. Dependent variables; onset time, level of the block, HR, SBP, DBP, MAP and while the independent variables; height, age, weight. All the data obtained were analyzed using statistical package for social sciences (SPSS Chicago, USA). Student T test was used to compare the quantitative variables; age, height, weight, BMI, haemodynamic changes and the onset time. While Chi-squared (X²) test was used to compare the qualitative variables; sex, ASA. Results were presented in the form of tables and p < 0.05 was regarded as statistically significant.

Results: The mean onset time for sensory block were 4.48 ± 1.44 minutes and 4.44 ± 0.88 minutes in groups BA and BD respectively, p=0.92, while the mean onset time for the motor block were 7.24 ± 2.09 minutes and 6.59 ± 1.56 minutes for groups BA and BD respectively, p=0.16 which were all not statistically significant.

Conclusion: this study revealed that, addition of 4mg dexamethasone to 10 mg of 0.5% heavy Bupivacaine intrathecally does not affect both sensory and motor onset of action anaesthesia.

Key words: Unilateral spinal anaesthesia, heavy bupivacaine, dexamethasone