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   Table of Contents - Current issue
Coverpage
July-December 2019
Volume 25 | Issue 2
Page Nos. 139-240

Online since Thursday, September 19, 2019

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ORIGINAL ARTICLES  

Laparoscopic versus open sigmoid loop colostomy: A comparative study from a cohort of 62 patients requiring temporary faecal diversion at a tertiary care center in North India p. 139
Navjot Singh, Parvez David Haque, Shekhar Upadhyay, Navneet Kumar Chaudhry
DOI:10.4103/njs.NJS_13_19  
Background: Over decades, colostomies have been done through open method, but laparoscopic creation of an intestinal stoma is safe, feasible and has distinct advantages over conventional techniques in specific procedures. The aim of this study compares operative and short-term outcomes of laparoscopic and open sigmoid loop colostomy formation for temporary fecal diversion. Subjects and Methods: A single institution, comparative study conducted in the department of surgery for patients who underwent either laparoscopic or open sigmoid loop colostomy. The 2 years' study was from December 1, 2013, to November 30, 2015. Subjects were prospectively enrolled in the study after informed consent, both genders of >12 years of age. Data analysis was done using Statistical Package for Social Sciences version 21.0. Variables were tested by Kolmogorov–Smirnov test, compared using unpaired t-test/Mann–Whitney Test, Chi-square test/Fisher's exact test. P < 0.05 was considered statistically significant. Results: Sixty-two patients were enrolled; laparoscopy group – 29 patients (46.77%) versus open group – 33 patients (53.22%). Laparoscopic group/open surgery group showed less blood loss (20.69 + 17.71 ml / 121.97 + 35.29ml, P-value 0.0005), lower requirement of analgesics (4.28 ± 1.76 days/6.88 ± 2.75 days), shorter hospital stay (8.79 ± 5.57 days and 11.73 ± 6.61 days, P = 0.001), early return of the bowel function and tolerance to diet. Complications and readmission requirement for any complication was lower in the laparoscopic group. Conclusions: Laparoscopic sigmoid loop colostomy is a simple alternative to open sigmoid loop colostomy with respect to postoperative pain, earlier return of bowel function, lower analgesic requirement, and lesser hospital stay.
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Clinical outcome of nonoperative treatment of de Quervain's disease with local corticosteroid injection in Nigerian setting p. 146
Njoku Isaac Omoke, Ugochukwu Uzodimma Nnadozie
DOI:10.4103/njs.NJS_10_19  
Background: The goal of treatment of de Quervain's disease, pain relief and restoration of hand functions, is achievable with local corticosteroid injection. However, published reports indicate variations in its cure rate and efficacy from and within subregions. This study aimed to determine the outcome of this treatment modality in Nigerian setting. Patients and Methods: Fifty-one cases of de Quervain's disease in 41 consecutive eligible patients were enrolled between January 2011 and December 2016, treated with local methylprednisolone acetate injection and followed up prospectively in orthopedic clinics of Federal Teaching Hospital, Abakaliki, and Mater Miserere Cordiae Hospital, Afikpo, Nigeria. Results: Eight weeks post initial injection, 94% of the cases were signs and symptoms free. The recurrence rate post initial injection (19.6%) correlated directly with pain intensity (P < 0.001) and was significantly (P = 0.018) higher in subacute compared to acute and chronic presentations. At the end of a follow-up period that ranged from 24 to 84 months with a mean of 54 months, 47 (92.2%) cases were cured with either single injection (78.4%) or multiple injections (13.7%) of corticosteroid, 3 (5.9%) had incomplete resolution but were satisfied, and in 1 (2%) there was no beneficial response. There was no serious adverse reaction; 14 (27.5%) cases had localized skin depigmentation. Conclusion: In our setting, local corticosteroid injection as a treatment modality for de Quervain's tenosynovitis has short- and long-term success rates of over 90%, and is rarely associated with serious adverse reaction. It is recommended as the initial treatment of choice in de Quervain's disease.
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Preoperative predictors of level of difficulty of laparoscopic cholecystectomy p. 153
Prem Chand, Manpreet Kaur, Sumit Bhandari
DOI:10.4103/njs.NJS_3_19  
Background: Laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic gallbladder stone disease. This is due to its safety, reliability, cost-effectiveness, negligible mortality, shorter duration of hospitalization (early return to work), better cosmesis, minimal wound complications, and temporary paralytic ileus. In spite of these, conversion to open cholecystectomy which is sometimes required in difficult cases could be challenging. Aims and Objectives: The aim of the present study is to aid the prediction of difficult cases undergoing LC, thereby better selection of patients with the least conversion rates. Materials and Methods: This prospective study was conducted on 100 consecutive patients with cholecystitis, over a 2-year period from January 1, 2017, to December 31, 2018, having undergone LC. Various preoperative parameters, including age, sex, previous attacks of cholecystitis, deranged liver functions, and ultrasonographic findings, were analyzed for their effects for predicting the level of difficulty during LC. Results: Twenty-five percent of the cases were correctly predicted as difficult in the age group of >65 years. Cholecystitis was more common (79%) in females, but difficulties were encountered more frequently while performing LC in males. Abnormal serum hepatic and pancreatic enzyme profiles were associated with difficulties during surgery as about 83.3% of the patients predicted as moderately difficult peroperatively had deranged liver functions. The preoperative ultrasonography findings were helpful for predicting the degree of difficulty involved in the procedure. About 33.3% of the patients that had pericholecystic fluid on ultrasound preoperatively were correctly predicted to have moderately difficult surgeries. The Chi-square test and P value were used to determine statistical significance. Conclusions: Females, the absence of previous repeated attacks of cholecystitis and hospitalizations, no upper abdominal surgery in the past, normal liver function tests, normal amylase levels, nondistended and uncontracted gallbladder, absence of pericholecystic collection, afebrile, and single stone are positive preoperative predictors of safe LC in symptomatic gallbladder stone disease.
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Histopathological pattern of testicular lesions in Kano, Northwestern Nigeria p. 158
Abubakar Abdulkadir, Haruna Muhammad Sanusi, Sule Alfa Alhaji
DOI:10.4103/njs.NJS_44_18  
Background: The global distribution of testicular disorders differs conforming with differences in demographic denominators. The diagnostic dictum for these disorders customarily adheres to findings at clinical assessment, relevant imaging, and laboratory evaluation. Histopathological confirmation remains the ultimate for the diagnosis of testicular malignancies and many testicular dysfunctions. The epidemiological review of the histological outcomes among Kano populace, however, is deficient. Objective: The aim of the study was to analyse histological pattern of testicular lesions in Kano, Nigeria. Methodology: The study is a 14-year retrospective review of testicular specimens subjected to histology in Kano from January 2003 to December 2016. The variables obtained were the age of patients, laterality, and histological diagnoses. These were collated and analyzed; the findings were presented as mean, patients' age range, and laterality ratio with frequency tables. Results: Three hundred and forty-three testicular tissues were assessed. The nonneoplastic lesions were 79.2% with patients' age range of 3–90 years. Atrophies and maturation arrests formed 29.4% and 18.0%, respectively. Specimens from the right were more with a ratio of 1.6:1. Neoplastic lesions were 3.5% and patients' age range from 3 to 65 years. Seminomas were the predominant neoplastic lesion and constituted 66.7%. The right testes were more commonly affected and have a ratio of 1.4:1. Conclusion: This appraisal affirms that testicular lesions could be found across a wide age range and majorities are nonneoplastic. The findings in this study concur with the published African and Asian conclusions.
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Outcome of management of neonatal intestinal obstruction at a tertiary center in Nigeria p. 163
Olakayode Olaolu Ogundoyin, Dare I Olulana, Taiwo A Lawal, Akinlabi E Ajao
DOI:10.4103/njs.NJS_11_19  
Background: Intestinal obstruction in a newborn remains a significant emergency in pediatric surgery. Clinical presentation is often subtle with sudden deterioration of their clinical states. Clinical outcome in the developing countries is poor owing to a variety of factors. Objective: The objective of this study is to identify the factors affecting the management outcome in our environment. Patients and Methods: Data on clinical presentation, management, and outcome of all neonates managed for intestinal obstruction over a 13-year period at a tertiary center in Nigeria were retrospectively reviewed. Analysis of factors affecting the management outcome was also performed. Results: One hundred and seventeen neonates comprising 85 (72.7%) boys and 32 (27.3%) girls were managed for intestinal obstruction. The age at presentation ranged from 0 to 29 days, with a mean of 6.86 ± 8.4 days. Seventy-five (64.1%) patients presented within a week of onset of symptoms and 42 (35.9%) patients later. Eighty-five patients (72.6%) presented with symptoms from birth. The most common causes of intestinal obstruction included anorectal malformation in 62 (53%) neonates and Hirschsprung's disease in 16 (13.7%) neonates. Other causes included obstructed inguinoscrotal hernias, duodenal atresia, jejunoileal atresia, malrotation, and annular pancreas. Eleven patients died with a mortality rate of 9.4%. The age at presentation (P = 0.001) and the presence of postoperative complications (P = 0.009) were significantly related to the duration of hospital stay. Furthermore, the presence of postoperative complications (P = 0.012) was significantly associated with postoperative mortality. Conclusion: Early presentation and postoperative complications significantly affected the morbidity and mortality associated with the management of neonates with intestinal obstruction.
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Determinants of outcome of abdominal trauma in an urban tertiary center p. 167
Solomon Agbroko, Adedapo Osinowo, Emmanuel Jeje, Oluwole Atoyebi
DOI:10.4103/njs.NJS_2_19  
Background: Abdominal trauma constitutes a significant cause of potentially preventable mortality. Therefore, knowledge of the determinants of outcome facilitates the development of rational treatment protocols for improving outcome. Objective: To identify the determinants of outcome in patients with abdominal trauma managed in a tertiary health center. Patients and Methods: This is a prospective study of consecutive patients presenting with abdominal trauma to our tertiary health center over a 12-month period. Data regarding patient demographics, injury mechanisms, type of organ injuries, treatment modalities, injury-to-intervention time, and outcomes were documented. The Injury Severity Scores and Revised Trauma Scores were determined. The data were analyzed using the Statistical Package for the Social Sciences version 20. Results: There were 76 patients, 66 males and 10 females, whose ages ranged from 15 to 66 years (mean of 32.9 ± 10 years). Thirty-one (40.2%) patients had blunt abdominal trauma whereas 45 (59.8%) patients had penetrating trauma. There was a mortality rate of 8% predominantly from blunt trauma as compared to penetrating abdominal trauma (12.9% vs. 4.4%). There was a statistically significant difference between survivors and nonsurvivors as regards the means of injury-to-intervention time (25.4 ± 36.4 vs. 67.5 ± 58.2, P = 0.007), the means of Injury Severity Scores (15.1 ± 27.9 vs. 23.7 ± 9.8, P = 0.008), and the presence of brain injury (50.0% vs. 5.6%, P = 0.029). Conclusion: This study has shown that delayed intervention, high Injury Severity Score, and associated significant brain injury were determinants of poor outcomes. Prompt intervention and postoperative management in intensive care definitely improve outcome.
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Survey of basic laparoscopic training exposure of Nigerian postgraduate trainees p. 172
Olanrewaju Samuel Balogun, Adedapo Olumide Osinowo, Christopher O Bode, Oluwole A Atoyebi
DOI:10.4103/njs.NJS_38_18  
Background: The practice of laparoscopy involves the use of training models that are different from conventional open surgery. These concepts are not captured in the traditional models of surgical residency training. Residency training in surgery has been seen as an ample opportunity for early introduction and training in laparoscopy. Objectives: This study aimed to assess the level of exposure and training experience of some surgical resident doctors in accredited training institutions in Nigeria on laparoscopy. Methodology: A cross-sectional survey was conducted among the resident doctors undergoing revision course in surgery at the National Orthopaedic Hospital, Igbobi, Lagos, and Lagos University Teaching Hospital, Lagos, in March 2018. Using the quantitative method of data collection, a pre-tested structured questionnaire was used to collect information on the demography and training exposure of the residents in laparoscopy. Results: A total of 54 of 96 residents surveyed returned the questionnaire, giving a response rate of 56%. There were 53 (98.1%) males and 1 (1.9%) female. The age range of the respondents was between 30 and 46 years, with a mean of 34.2 ± 3.96 years. Thirty-two (59.3%) respondents had spent at least 2 years training in surgery. Thirty-six (66.7%) respondents had not participated in more than four laparoscopic procedures during their rotation. Forty-six percent of respondents reported that their experience in laparoscopy was mainly by observation of the procedures. Forty-nine (90.7%) of respondents surveyed had not attended any training program in laparoscopy. Eighty-one (81.0%) of respondents had a strong motivation and desire for future practice of laparoscopy. Conclusion: This study revealed that few Nigerian postgraduate trainees sampled in the survey were exposed and had training experience in laparoscopy.
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Is final histopathological examination the only diagnostic criteria for xanthogranulomatous cholecystitis? p. 177
Anshuman Pandey, Dinesh Kumar, Shakeel Masood, Smita Chauhan, Suneed Kumar
DOI:10.4103/njs.NJS_1_19  
Background: Xanthogranulomatous cholecystitis (XGC) is an uncommon inflammatory disease of gallbladder (GB) and can mimic GB cancer in extensive form. This study aims to assess the predictability of XGC on the basis of clinical presentation, laboratory tests, and radiological or intraoperative findings on frozen section analysis. Materials and Methods: This is a retrospective study, conducted over a period of 4 years from October 2013 to November 2017. In this study, all patients with histopathological reports of XGC, who underwent cholecystectomy or a radical cholecystectomy, were included. Clinical records of these patients were reviewed for clinical features, laboratory tests, and findings on radiological imaging. Results: Out of 700 consecutive cholecystectomies reviewed, 34 had histologically proven XGC (4.85%). Two patients had simultaneous presence of GB carcinoma with XGC. The most common presenting symptoms were right upper quadrant pain in 32 (94%) patients, jaundice in 9 (36%) patients, and fever in 5 (14%) patients. The most common radiological finding was cholelithiasis in 85.2% of cases. Thick-walled GB was present in 79.4% of patients; irregular wall thickening was present in 20.5% of patients. Intramural nodule was present in two patients, whereas hepatic invasion was observed in 11% and pericholecystic infiltration was present in 8.8% of patients. Regional lymphadenopathy was present in 9 (26.4%) patients. Conclusion: Clinical presentation and laboratory parameters were unequivocal due to considerable overlap. Despite recent advances in radiology, none have significant sensitivity and specificity to accurately diagnose XGC preoperatively. Intraoperative frozen section can add to the diagnosis with limited accuracy. The diagnosis of XGC can be confirmed only on histopathological examination.
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Management of deep neck space infections in a tertiary center in North West Nigeria p. 183
Saheed Babatunde Nasir, Iliyasu Yunusa Shuaibu, Solomon Abimuku Labaran, Abdulrahman Inusa
DOI:10.4103/njs.NJS_19_19  
Background: Deep neck space infection (DNSI) is a potentially fatal condition that more commonly results from dental and tonsillar infections. Timely intervention is, therefore, crucial when such patients present to the managing physician. Objective: The objective of this study is to review the etiology, clinical presentation, and treatment outcome of patients managed for DNSIs over a period of 7 years at National Ear Care Centre, Kaduna. Methodology: The record of patients managed for DNSIs over a 7-year period between January 2010 and December 2016 was reviewed. Data obtained included demographic characteristics such as age, sex, occupation, level of education, main presenting symptoms, duration of symptoms, etiology of the DNSI, location of the infection, comorbidity, bacteriology, duration of hospital stay, and type of treatment given. The data were analyzed using the Statistical Package of the Social Sciences version 23.0. Results: A total of 55 patients presented with DNSIs, and there were 34 (61.8%) females and 21 (38.2%) males, with a sex ratio of 1.6:1. The age range of the patients was 1–71 years, with a mean age of 30.7 years (standard deviation of 18.1). The most common etiologic factor among these patients was tonsillar-related infection which accounted for 24 (43.6%). The most common symptom at presentation was fever (96.4%), followed by odynophagia (60%). Peritonsillar space infection as seen in 25 (45.5%) patients was the most common region affected, followed by submandibular space infection. Of the 35 (64%) patients who had incision and drainage, Staphylococcus aureus was the most common organism isolated in 16 (45.7%), followed by Streptococcus pneumoniae (11, 31.4%). Majority (38, 69.1%) of the patients spent <5 days on admission. Conclusion: This study shows that oropharyngeal and orodental infections are the most common causes of DNSIs. Educating the populace about orodental health may help in reducing cases of DNSIs in Nigeria.
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Introduction of suturing skills acquisition into undergraduate surgical education: Early experience from Ile-Ife, Nigeria p. 188
Adewale Abdulwasiu Aderounmu, Funmilola Olanike Wuraola, Olalekan Olasehinde, Oludayo A Sowande, Adewale Oluseye Adisa
DOI:10.4103/njs.NJS_5_19  
Background: Undergraduate medical students of the Obafemi Awolowo University, Ile-Ife, Nigeria, had over the years acquired various skills informally without structured training in basic skills in wound closure. The Department of Surgery introduced suturing skills acquisition workshop into the curriculum of the Final-Year Medical Students in 2016. This study describes the preliminary experience and the perception of the participants. Methods: All students undergoing the senior rotations in surgery and surgical specialties were taken through a day suturing skills workshop at the surgical skills laboratory. Skills were demonstrated using validated narrative videos followed by practical sessions supervised by senior registrars and consultant surgeons. All participants were requested to complete a feedback form after the workshop. Results: One hundred and eighty students were trained in six workshop sessions per year over two academic sessions. There were 128 (71.1%) male and 52 (28.9%) female students trained by 9 consultants and 13 senior registrars with 15–17 students in each session. Self-assessment feedback after the workshop revealed that all but 3 (1.7%) students felt very confident in handling basic instruments, 102 (56.7%) were confident of their proficiency in basic suturing, 68 (37.8) were less confident, whereas 10 (5.6%) were not confident looking ahead and 82 students (46.1%) wanted additional skills to attain proficiency in some common surgical procedures prior to graduation. Conclusion: The department achieved the aim of introducing suturing skills acquisition into undergraduate surgical education. In the future, other surgical skills acquisition workshops may be considered as desired by the students.
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Role of perioperative surgical safety checklist in reducing morbidity and mortality among patients: An observational study p. 192
Ashish Chhabra, Amandeep Singh, Pushpinder Singh Kuka, Haramritpal Kaur, Amarjeet Singh Kuka, Honey Chahal
DOI:10.4103/njs.NJS_45_18  
Background: Safe Surgery Saves Lives. Patient safety is a fundamental of good quality health care, and complications due to the health-care system are well-documented and constitute an important public health problem. Implementation of the checklist in medicine and surgery can help to decrease the risk of adverse events thus can improve patient safety. Materials and Methods: After the Institutional Ethical Committee clearance, a total of 500 patients were enrolled and divided into two equal groups. In Group 1 (n = 250), patients underwent surgery before regular implementation of the World Health Organization (WHO) surgical safety checklist (SSC), whereas in Group 2 (n = 250), patients underwent surgery after the WHO SSC was regularly implemented. All the patients were followed up after the surgery, and patients were looked for and compared for the postoperative complications. Results: We found that 27 patients (10.8%) in Group 1 and 13 patients (5.2%) in Group 2 developed major wound disruption (P < 0.05). There were 73 patients (29.2%) in Group 1 and 34 patients (13.6%) in the Group 2 who developed an infection of the surgical site (P < 0.05). There were five patients (2%) in Group 1 while none of the patients in Group 2 developed sepsis during the study (P < 0.05). Conclusions: We found that implementation of the WHO SSC significantly reduces surgical site infections, major disruptions of the wound, and sepsis.
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Red cell distribution width: A surrogate biomarker to predict tumor burden in carcinoma gallbladder p. 198
Amit Gupta, Sweety Gupta, Ashish Gupta, Arvind Gupta, Bela Goyal, Saumya Agrawal, L Manoj Joshua, Utkarsh Kumar, Bina Ravi, Ravi Kant
DOI:10.4103/njs.NJS_22_19  
Aim: To assess the role of red cell distribution width as a marker to predict tumor burden in gallbladder cancer (GBC). Methods: One hundred and twenty-eight patients with newly diagnosed GBC were included in the study. Peripheral blood samples were obtained, and red cell distribution width (RDW) was assessed. Tumor markers and other biochemical parameters were also recorded. Statistical Analysis: Quantitative variables were summarized using mean and standard deviation or median and interquartile range based on the normality of the distribution. The association of RDW with stage of tumor was analyzed using Chi-square test. All statistical tests were interpreted for significance using a cutoff value of P < 0.05. Results: RDW showed a positive correlation with total bilirubin, total leukocyte count, and erythrocyte sedimentation rate (P < 0.002), but not with platelet count (P < 0.643). RDW showed a significant correlation with tumor markers CA 19-9 (P < 0.003), carcinoembryonic antigen (P < 0.003), and CA 125 (P < 0.002). In Stage IVB, there were significantly more patients with high RDW (78%) than normal RDW (21.8%). However, the results were not statistically significant (P < 0.073). Conclusion: In the present study, we have utilized RDW for correlation with tumor markers in carcinoma gallbladder and as a predictor of stage. We demonstrated higher levels of RDW with advanced stages of GBC. Overall, the study suggested that RDW may be utilized as a surrogate biomarker to predict tumor burden and disease in patients with GBC.
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Can increased metabolic status be a grading tool for oral squamous cell carcinoma? A glucose transporter 1 immunoexpression study Highly accessed article p. 203
Abikshyeet Panda, Alokenath Bandyopadhyay, Gouse Mohiddin, Malvika Raghuvanshi, Sanjay Kumar Sahoo, Lipsa Bhuyan
DOI:10.4103/njs.NJS_17_18  
Background: Glucose transporter-1 (GLUT-1) is a GLUT protein whose expression is upregulated in malignant cells where enhanced uptake of glucose is observed. Aim: The aim of this study is to evaluate the expression of GLUT-1 protein in oral squamous cell carcinoma (OSCC) tissue sections using immunohistochemistry and to describe the relationship between increased metabolic status and the grades of OSCC. Materials and Methods: This is cross-sectional study with 76 formalin-fixed paraffin-embedded tissue blocks of OSCC, obtained from the archives of the department. All the cases were scored using Bryne's grading system by three oral pathologists independently. The tissue sections were then stained using immunohistochemistry with anti-GLUT-1 rabbit monoclonal antibody. Results: Staining intensity and localization of positively stained slides were evaluated. Overall, a significant correlation between Bryne's histopathological grading system for OSCC and GLUT-1 immunohistochemical expression was observed. Thus, high GLUT-1 expressions are observed with increasing grades of OSCC. Conclusion: This study shows that a significant positive correlation exists between GLUT-1 immunoexpression and histological grading of OSCC. Thus, GLUT-1 expression can be used as a diagnostic adjunct and prognostic marker for OSCC patients.
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Clinical examination among medical students: Assessment and comparison of the strengths and weaknesses of objective structured clinical examination and conventional examination p. 208
Tunde Talib Sholadoye, Musliu Adetola Tolani, Muhammad Balarabe Aminu, Hussaini Yusuf Maitama
DOI:10.4103/njs.NJS_16_19  
Background: Traditional clinical examination is perceived to be biased and to overcome this, objective structured clinical examination (OSCE) was introduced. Aims: The aim was to assess the students' exposure and perception of OSCE as well as its strengths and weaknesses in comparison to conventional clinical examination. Subjects and Methods: A cross-sectional study of students who had surgical OSCE was conducted from July 2018 to October 2018 in Ahmadu Bello University, Zaria. Using a structured questionnaire, exposure and perception of OSCE as well its strength and weaknesses in comparison to the conventional clinical examination were assessed with dichotomous questions and a 5-point Likert scale. Data were analyzed with SPSS Version 20. Results: One hundred and thirty-four students responded, mean aged 24.1 ± 4.3 years, with a male-to-female ratio of 2.5:1. Although 64.7% of them strongly agreed that OSCE is the standard mode of examination, only 36.1% strongly agreed that it was easier to pass. More than half of the students perceived that the content of the OSCE was appropriate, wide-scoped, unbiased, and brought out specific areas of weakness. Some students (38.1%), however, felt that there was a need for improvement in the OSCE process, especially in time allocation, but most of them (89.5%) prefer it and agree that it was superior to conventional clinical examination. Conclusions: The perception of the process and structure of OSCE among the medical students was good. Compared to conventional clinical examination, students found OSCE was easier and fairer, had a better examination of structure and level of coordination, and induced lesser anxiety and fatigue. However, the entire process of OSCE can be improved.
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CASE REPORTS Top

Duodenal rupture after blunt abdominal trauma by bicycle handlebar: Case report and literature review p. 213
Fernando Mendoza-Moreno, Isabel Furtado-Lobo, Marina Perez-Gonzalez, Maria Del Rocio Diez-Gago, Carlos Medina-Reinoso, Manuel Diez-Alonso, Francisco Hernandez-Merlo, Fernando Noguerales-Fraguas
DOI:10.4103/njs.NJS_31_18  
Blunt abdominal trauma is most frequent in the pediatric population. Duodenal lesions after abdominal trauma in children are infrequent and tend to be secondary to traffic accidents. It is up to five times more frequent in males, with an average age between 16 and 30 years. Bicycle accidents continue to lead to morbidity and mortality in children, representing between 5% and 14% of total blunt abdominal injuries. The diagnosis of duodenal injuries after trauma is difficult and requires a high index of clinical suspicion. We present the case of a 17-year-old patient seen in the emergency room after falling off his bicycle and presented a blunt trauma in the epigastric region. On physical examination, there was a swelling in the upper right abdominal quadrant and epigastrium with tenderness on deep palpation. He presented with hematemesis without hemodynamic repercussion. A contrast abdominal computed tomography was performed and he was diagnosed with third-part duodenal rupture. A resection of the perforated third-part duodenal rupture was performed, and the transit was reconstructed using a Roux-Y duodenojejunostomy. The postoperative period was uneventful and the patient was discharged after 16 days of stay.Duodenal injury is very rare, produced by high-energy trauma. They rarely present as single lesions as other visceral lesions are usually associated. The early diagnosis is important to reduce the morbidity and mortality.
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Submental dermoid cyst mimicking double chin p. 217
Suresh Babu Bommaji, Md Yousuf Qureshi, G Santosh Reddy, Sandhya Rampati
DOI:10.4103/njs.NJS_36_18  
Dermoid cysts are developmental cysts, arising from entrapped midline ectodermal tissue lined by epidermis, with skin appendages present in the fibrous wall when the 1st and 2nd branchial arches of each side fuse and the entrapped tissues then undergo proliferation and cystic transformation. A 27-year-old male reported with a single large swelling in the submental region of 1-year duration, which was diagnosed as dermoid cyst after surgical excision using extraoral approach.
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Large abdominal wall defect reconstruction: Revoking and modifying the old technique p. 220
Singaravelu Viswanathan, Souparna Manjunath, BA Ramesh, Mohan Jagannathan
DOI:10.4103/njs.NJS_29_18  
The risk factors for abdominal wall hernia after surgery are an increase in body mass index, midline incision, incisional surgical-site infection, preoperative chemotherapy, blood transfusion, increasing age, female sex, and increasing thickness of subcutaneous tissue. Reconstructing the abdominal wall defect becomes a challenge in multiple risk factor patients. Many new mesh implants have been invented, but all fail in case of infections. We modified and re-evoked an old technique of fascia lata free graft reinforced with tensor fascia lata pedicled flap.
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Avulsion injuries of right hemidiaphragm: Report of two case scenarios with different outcomes p. 223
Nupur Aggarwal, Priyansh Jariwala, Shaban Kamal, Navneet Kaur
DOI:10.4103/njs.NJS_41_18  
Avulsion injuries of domes of the diaphragm are rare injuries and may occur following lateral thoracoabdominal trauma. We share our experience of two cases of avulsion injuries of the right dome of the diaphragm. Our first case presented within a week following blunt trauma to the abdomen, and on thoracotomy, an effective repair was performed by restoring attachment of the diaphragm to the parietes. Our second case presented with severe respiratory distress, 1½ months after sustaining blunt injury chest and abdomen in a road traffic accident and on thoracotomy was found to have a completely necrosed right hemidiaphragm, and hence, no repair could be performed. However, the patient could not be weaned off ventilator and died after 3 months of primary injury. These cases highlight the importance of early diagnosis and repair of diaphragmatic injuries for a favorable outcome.
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Abstract of papers presented at the nigerian surgical research society meeting, Bida, Nigeria, July 2019 p. 226

DOI:10.4103/1117-6806.267109  
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Abstracts of papers presented at the joint surgical oncology congress of the association of surgeons of Nigeria and the Nigerian chapter of the American College of surgeons held in partnership with senologic international society p. 233

DOI:10.4103/1117-6806.267111  
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