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   Table of Contents - Current issue
Coverpage
January-March 2023
Volume 28 | Issue 1
Page Nos. 1-80

Online since Tuesday, December 13, 2022

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ORIGINAL ARTICLES  

Healthcare workers’ willingness to report to work during a pandemic in southeastern Nigeria: A hypothetical case using Ebola virus disease p. 1
Ntat Ibiok, Chioma A Onyedinma, Olanike R Agwu-Umahi, Chukwukasi W Kassy, Ifeoma M Obionu, Onyinye H Chime, Ifeoma J Ogugua, Casmir N Ochie, Susan U Arinze-Onyia, Anne C Ndu, Emmanuel N Aguwa, Adaeze T Okeke
DOI:10.4103/ijmh.IJMH_63_22  
Background: The Ebola virus disease (EVD) outbreak of 2014–2016 in West Africa was the world’s deadliest to date, and the World Health Organization declared it an international health emergency. It adversely affected the health system with many healthcare workers (HCWs) being worried about going to work. Objective: This study therefore aimed at determining the willingness of HCWs to report to work in an outbreak of EVD. Materials and Methods: A semi-structured, self-administered, questionnaire-based cross-sectional study was conducted among 360 doctors, nurses, and medical laboratory workers in public and private health facilities in Enugu Metropolis. Results: Seventy-three percent (73%) of our respondents were willing to report to work during an outbreak of EVD. Nurses were about five times more likely to be willing to work than other categories of staff [odd ratio (OR) = 4.999; confidence interval (CI)= 2.15–11.597; P < 0.001] and female HCWs were about 1.3 times more likely to be willing to work than males during an EVD outbreak (OR =1.275; CI=0.743–2.815; P = 0.049). Availability of vaccination for healthcare staff (88.6%) and family members (79.2%) were the greatest personal and family-related motivating factors for willingness to work, whereas the provision of antiviral treatment for staff with unprotected exposure to an ill patient (78.1%) was the greatest work motivating factor. However, passion for work surpassed increased remuneration (61.4%) as a personal motivating factor for HCWs willingness to report to work during an EVD outbreak. Conclusion: Our study showed that HCWs were largely willing to work during an EVD outbreak. Personal vaccination for staff and family members and provision of antivirals were the major motivating factors.
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Renal biomarkers in pre-eclampsia and their associations with severity of pre-eclampsia p. 7
Paschalina C Ezechukwu, Emmanuel O Ugwu, Samuel N Obi, George U Eleje, Polycarp U Agu, Emeka I Iloghalu, Kingsley C Obioha, Chidinma I Onwuka, Angela O Ugwu, Obinna D Onodugo, Benjamin C Ozumba
DOI:10.4103/ijmh.IJMH_11_22  
Background: Preeclampsia is one of the leading causes of maternal and perinatal morbidity and mortality in Nigeria and worldwide. It is not yet concluded as to whether or not elevated levels of serum creatinine and/or uric acid could be regarded as a predictive indicator for the severity of the disease. Objectives: To compare the mean serum levels of uric acid and creatinine in preeclamptic and normotensive pregnant women and assess for any associations between these renal biomarkers and the severity of preeclampsia in Nigeria. Materials and Methods: It was a cross-sectional analytical study of 132 women with preeclampsia (n = 61) and normotensive pregnant women (n = 61). The study group comprised eligible consecutive women diagnosed with preeclampsia, whereas the control group comprised appropriately matched normotensive pregnant women. Main outcome measures included the mean serum levels of uric acid and creatinine in both groups, and their levels in cases with mild and severe degrees of preeclampsia. Results: The mean serum levels of uric acid and creatinine were significantly higher in women with preeclampsia than in normotensive pregnant women (7.67 ± 2.9 versus 4.56 ± 1.1; P < 0.001, and 0.76 ± 0.3 versus 0.53 ± 0.1; P < 0.001, respectively). There was no significant difference in the mean serum levels of uric acid and creatinine in women with mild and severe degrees of preeclampsia (6.66 ± 2.3 versus 7.77 ± 2.9; P = 0.37, and 0.56 ± 0.2 versus 0.79 ± 0.4; P = 0.12, respectively). Conclusions: This study has demonstrated that serum uric acid and serum creatinine levels are elevated in pregnancies complicated by preeclampsia. However, there is no significant association between serum levels of these renal biomarkers and the severity of preeclampsia. The studied renal biomarkers are therefore important in the diagnostic workup of preeclampsia but of limited value in the disease prognostication.
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Assessment of relationship between anthropometric measurements and reproductive hormonal profiles, among females of childbearing age at a tertiary health facility in Nigeria p. 12
Waliu O Oladosu, Adewale M Alayo, Aminat O Ahmed, Olanrewaju S Jimoh, Sekinat T Olarinoye-Raji, Basirat A Egbeyemi, Taofeek A Ajadi
DOI:10.4103/ijmh.IJMH_47_22  
Background: Increasing prevalence of overweight and obesity has profound impacts on health generally, including the reproductive system. Traditionally, pear body shapes, from narrow waist and wide hip circumferences, have been associated with high fecundability among females. Although this has been scientifically demonstrated by a number of researches only a few of these investigations were conducted with black women in Africa who were of reproductive age. Objectives: The objectives of the study were to compare the mean reproductive hormone levels between the different waist-to-hip ratio (WHR) and body mass index (BMI) categories and also to determine the correlations between the two anthropometric measurements and the reproductive hormones in a black African population. Materials and Methods: It was an analytical cross-sectional study of 180 females of a childbearing age. The WHR and BMI were measured as per standard recommendations. Serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, estradiol, day-21 progesterone, and testosterone were assayed. Results: A majority of the research participants were within the age group 21–30 years. Thirty three percent (33%) and 28.9% of participants were overweight and obese, respectively, using BMI compared with 26.7% and 20%, respectively, using WHR. Seventy six point nine percent (76.9%) of participants with an optimal BMI range ovulated with 61.5% having adequate luteal phase support compared with 75% and 54.2%, respectively, using WHR. Day-21 serum progesterone and serum estradiol were significantly negatively correlated with WHR and BMI (P < 0.05). BMI, however, showed a better correlation than WHR (r = -0.535 vs. -0.397; P = 0.001 vs. 0.008, respectively). Gonadotropins were significantly lower among overweight and obese groups for both BMI and WHR (P < 0.05), but only WHR showed moderately positive significant correlation with gonadotropins (LH: r = 0.050 vs. r = 0.215, P = 0.003, respectively; FSH: r = 0.159 vs. r = 0.431, P = 0.001, respectively), same as serum testosterone (r = 0.580 vs. r = 0.611, P = 0.002, respectively). Conclusions: Anthropometric measurements can serve as objective clues to functionality and optimal concentrations of reproductive hormones. Weight control should therefore aid the optimization of reproductive hormones and fertility among females of reproductive age.
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Assessment of resilience in the second wave of the COVID-19 pandemic: A snapshot of experiences of adolescents secondary school children in southeast Nigeria p. 19
Awoere T Chinawa, Edmund N Ossai, Ann E Aronu, Josephat M Chinawa
DOI:10.4103/ijmh.IJMH_40_22  
Background: The second wave of the COVID-19 pandemic has created much psychological burden on the adolescent child. Resilience is an intertwine of risk and protective factors that may help the adolescent child in growth and development. Objectives: This study aimed to determine the factors that influence resilience among adolescents attending secondary schools in southeast Nigeria. Materials and Methods: This is a cross-sectional study of 496 adolescent students who attend six secondary schools in Enugu city. Results: The majority of the respondents, 79.4%, feel safe when they are with their families. A high proportion of the respondents, 61.5%, were resilient. A comparable proportions of male (59.9%) and female (62.9%) respondents were resilient. (χ2=0.476, P = 0.490). A significantly higher proportion of respondents who were in junior secondary three class, 70.5%, were resilient when compared with those in senior secondary three class, 59.4% (χ2=4.050, P = 0.044). The highest proportion of respondents who had strong social support, 75.8%, were resilient, whereas those who had poor social support were the least, 36.6%. The observed difference was statistically significant (χ2=39.995, P < 0.001). The respondents who had poor social support were about six times less likely to be resilient when compared with those who had strong social support [adjusted odds ratio (AOR)=0.177, 95% confidence interval (CI): 0.099–0.317]. Also, the respondents who had moderate social support were about three times less likely to be resilient when compared with those who had strong social support (AOR=0.369, 95%CI: 0.261–0.601). Conclusion: Resilience in adolescents is enhanced by education, being in junior secondary class, good family structure, and strong social support.
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Anthropometric effect of a personalized food avoidance dietary approach to stop hypertension p. 25
Chioli P Chijioke, Micheal T Okafor, Uzoamaka A Okoli, Imelda N Nubia, Bridget Nwokolo, Ifeoma C Onah, Clinton Ide, Chika Effiong-Essieng, Genevieve Obiefuna, Chikere Anusiem
DOI:10.4103/ijmh.IJMH_56_22  
Background: Body anthropometries are indicators of health and disease. It is universally accepted that it is a useful tool for assessing health status. Objective: The aim of this article is to determine the effect of a personalized food avoidance dietary approach to stop hypertension (PFADASH) on anthropometric parameters: body mass index (BMI), triceps skin fold thickness (TSFT), and abdominal circumference (AC) on study participants. Materials and Methods: This was a longitudinal study and part of an open controlled clinical trial of a PFADASH approved by the University of Nigeria Teaching Hospital Ethics Committee. Anthropometric parameters were compared between study participants with good and poor dietary compliance to a PFADASH. Results: There was no significant difference in the anthropometric parameters: BMI, TSFT, and AC among participants with good and poor dietary compliance to a PFADASH (P > 0.05). Conclusion: There was no negative effect of a PFADASH on anthropometric parameters, despite not being a calorie-restrictive dietary intervention.
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Effectiveness and safety of vaginal versus sublingual misoprostol for cervical ripening and induction of labor: A randomized controlled trial p. 31
Rasmus I Okonkwo, Augustine D Onyeabochukwu, Emmanuel O Izuka, Onyema A Onyegbule, Chukwunonyerem P Duke-Onyeabo, Chinelo E Obiora-Izuka, Uchenna I Nwagha
DOI:10.4103/ijmh.IJMH_59_22  
Background: Vaginal misoprostol is a highly effective method of cervical ripening and induction of labor; however, it is associated with some complications. Therefore, there is need to explore other routes of administration that may be safer, acceptable, and also effective. Objective: The aim of this study was to compare the effectiveness and safety of vaginal versus sublingual misoprostol for cervical ripening and induction of labor. Materials and Methods: This was a randomized controlled trial conducted among booked antenatal women in Owerri, South-East Nigeria. The eligible participants were randomized to receive either 25 μg of misoprostol vaginally (n = 90) or 25 μg sublingually (n = 90). Outcome measures included delivery within 24 h, induction to delivery interval, cesarean section rate, side effects of misoprostol, Apgar Score at birth, and admission into the Neonatal Intensive Care Unit. Results: There was no significant difference in the effectiveness and side effects of both routes of administration (p > 0.05). The results were comparable in both groups, except for the time to reach the active phase of labor (vaginal route 16.64 ± 9.12 vs. sublingual route 13.78 ± 7.47, P = 0.023) and the number of doses of misoprostol used (vaginal route 2.81 ± 1.53 vs. sublingual route 2.34 ± 1.49, P = 0.040). Conclusion: The effectiveness of cervical ripening and induction of labor is comparable in both groups and the side effect profile is also similar. Hence, the sublingual route is as effective and as safe as the vaginal route but with added advantage of shortening the duration of active phase of labor and requiring less doses for induction of labor.
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Maternal and perinatal outcomes of abruptio placenta at the Lagos University Teaching Hospital: A five-year retrospective review p. 39
Ayodeji A Oluwole, Aloy O Ugwu, Opeyemi R Akinajo
DOI:10.4103/ijmh.IJMH_52_22  
Background: Abruptio placentae is a form of antepartum hemorrhage that occurs when there is a partial or complete separation of the placenta before the delivery of the fetus. In addition to vaginal bleeding, it is often associated with abdominal pain, uterine tenderness, fetal heart irregularity, and hypertonic uterine contraction. It is a significant cause of maternal and perinatal morbidity and mortality. It is therefore important to review this obstetrics emergency with a view to creating more awareness on its complications. Objectives: The study was aimed to determine the prevalence as well as the perinatal and maternal outcomes of abruption placentae at the Lagos University Teaching Hospital (LUTH), Nigeria. Materials and Methods: This was a retrospective review of records of pregnant women managed in the labor and postnatal wards of LUTH, Idi-Araba, Nigeria, over a 5-year period from January 2015 to December 2019. Relevant data retrieved were entered and analyzed using the IBM Statistical Package for Social Sciences (SPSS Statistics), version 23. Results: A total of 80 pregnancies were complicated with abruptio placentae giving a prevalence of 0.96% of all admissions during the study period. Several maternal complications recorded included acute renal failure (6.25%), disseminated intravascular coagulation (2.08%), postpartum anemia (37.5%), and postpartum hemorrhage (54.7%). Forty six percent (46%) of the neonates had no complication, 11.3% had early neonatal death, 20% had fresh stillbirth, and 22.5% had birth asphyxia. Conclusion: Abruptio placentae contributed a sizeable proportion to maternal morbidity and perinatal morbidity and mortality in the study population.
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Evaluation of the incidence of central venous catheter-associated infections in patients admitted in the intensive care unit of a tertiary hospital in Nigeria p. 43
Onyekachi V Okafor, Adaobi O Amucheazi, Fidelis A Onyekwulu
DOI:10.4103/ijmh.IJMH_1_22  
Background: Presence of a central venous catheter (CVC) though useful may lead to CVC-associated bloodstream infections (CVCBSIs), resulting in increased morbidity and mortality. Objectives: The objectives of the study were to determine the incidence of CVCBSIs, the predominant causative microorganisms, the antibiotic sensitivity pattern of the microorganisms, and the associated risk factors. Materials and Methods: This prospective observational study evaluated the incidence of CVCBSIs in patients who had the catheter inserted on admission into the intensive care unit (ICU) of a tertiary hospital in South-East, Nigeria. Sixty-eight patients were recruited for the study. Blood samples were collected aseptically from a peripheral vein on admission, 72 h after the insertion of CVC, and at removal of CVC for blood culture. The distal 5 cm of the CVC was also collected at removal for microscopy, culture, and sensitivity testing. Results: Six out of all the patients recruited developed CVCBSIs, giving an incidence rate of 9.2%, whereas 48% (n = 31) developed catheter bacterial colonization. Over one-fifth (22.7%) of the patients with catheter duration beyond 5 days had CVCBSIs. Patients whose CVC duration was beyond 5 days had a higher risk of CVCBSIs (P = 0.015) than others. The commonest microorganism isolated was Staphylococcus aureus, whereas the most susceptible antibiotic was aminoglycoside (gentamycin). Conclusion: The incidences of CVCBSIs and CVC colonization were 9.2% and 48%, respectively. The duration of catheterization was found to be a major risk factor for CVCBSIs. The most predominant organism isolated was S. aureus. The most sensitive antibiotic agent was the aminoglycoside (gentamycin). It is therefore recommended that catheter care bundle which includes hand hygiene, use of chlorhexidine for skin preparation during insertion, use of barrier precautions during insertion, and the removal of unnecessary central lines should be strictly adhered to. Gentamycin should be used as empirical antibiotics in the ICUs.
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Determinants of female health workers’ attitude toward spouses’ use of vasectomy for family planning p. 50
Ifeanyi E Menuba, Eric E Asimadu, Sylvester O Nweze
DOI:10.4103/ijmh.IJMH_54_22  
Background: Vasectomy is an effective and safe surgical method of male contraception. It is simpler than female tubal ligation and has fewer complications. Objective: The aim of this study was to determine the effect of selected demographic characteristics on female health workers’ attitudes to spouses’ use of vasectomy for birth controlMaterials and Methods: This was a cross-sectional study of female health workers in two tertiary health institutions in Enugu, Southeast Nigeria. Data were collected using a pretested structured self-administered questionnaire. Data were collected on sociodemographic characteristics and attitudes toward vasectomy. Results: Two hundred and ninety female health workers completed the questionnaire. The mean age of participants was 32.26 ± 9.39 years. Approximately 66.6% of the women were less than 35 years and 53.1% were married. Only 21.0% of the respondents would encourage their spouses or partners to undergo vasectomy after they have had their desired number of children. Half of the women (50.0%) would prefer to have their tubes tied (tubal ligation) and 63.1% had never discussed vasectomy with their spouses or partners. Younger women (<35 years) were significantly more likely to encourage their spouses/partners to have a vasectomy (odds ratio [OR] 2.1289; P = 0.0231). However, ever-married women (OR 0.1296; P = 0.0000) and women who have had children (OR 0.1767; P = 0.0000) were significantly less likely to do the same. Nurses were more likely to encourage their spouses to undertake vasectomy compared to doctors (OR 2.4750; P = 0.0041). Conclusion: Vasectomy is not widely accepted among our female health workers; only a fifth of them would encourage their spouses/partners to have a vasectomy.
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Management of melanoma of the foot in our subregion: Is preliminary biopsy always required? p. 54
Obinna R Okwesili, Emmanuel C Nnadi, Johnson U Achebe
DOI:10.4103/ijmh.IJMH_51_22  
Background: Majority of patients with melanoma of the foot in our subregion present late. After preliminary excision biopsy for these patients, many of them do not come back for further excision when there is an indication to do so following biopsy result. A better result could be achieved by using wider margins for excision biopsy in patients with low socio-economic status. Objectives: We assessed the role of excision of melanoma of the foot without preliminary biopsy as an option in the management of melanoma of the foot in our subregion. Materials and Methods: This was a 5-year retrospective review of patients with melanoma of the foot that presented to a tertiary health institution in Nigeria from December 1, 2014 to November 30, 2019. Results: Half of the patients with lesions that have not advanced locally (35.3%) had wide local excision with 2–3 cm margin without preliminary biopsy, relying on clinical diagnosis of melanoma. Another 35.3% of same number as those mentioned above were managed by doing a preliminary biopsy. Incision biopsy was employed for those with distant metastasis or lesions where amputation of any form was indicated (29.4%). Conclusion: Melanoma of the foot can be diagnosed clinically with a high degree of accuracy in majority of patients. Preliminary biopsy is essential for lesions requiring amputation or very large lesions. For small lesions, excision biopsy with wider margins than is used for preliminary biopsy is beneficial especially for poor patients who tend to delay having a second surgery that is definitive due to financial constraint, ignorance, or other reasons.
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Histopathological evaluation of benign soft tissue lesions at Nnamdi Azikiwe University teaching hospital, Nnewi, south-east Nigeria: A 9-year review p. 59
Ifeoma F Ezejiofor, Olaniyi O Olaofe, Ogochukwu I Ezejiofor, Nnamdi S Ozor, Nonyelum C Osonwa
DOI:10.4103/ijmh.IJMH_49_22  
Background: Soft tissue lesions are remarkably diverse and range from inflammatory, self-limited lesions to neoplasm. The diversity of these lesions frequently poses a diagnostic challenge to pathologists and remains a subject of interests. Lack of research on soft tissues in our setting has prompted the need to study them. Objectives: The aim of this study was to determine the benign lesions of soft tissues with respect to age, sex, anatomic site, and histologic types. It also aimed to determine the baseline data of benign soft tissue lesions in Nnewi, Nigeria. Materials and Methods: This study reviewed all histologically diagnosed benign soft tissue lesions at the Histopathology Department of Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria from 2011 to 2019 and classified the tumors using the 2020 WHO Classification of Soft Tissue Tumours. Results: A total of 351 cases of soft tissue lesions were diagnosed during the study period, out of which 251 were benign lesions and accounted for 71.5% (251/351) of all soft tissue lesions, whereas 28.5% (100/351) of the cases were malignant. The benign lesions included inflammatory and benign neoplasm, of which neoplasm accounted for the majority of the cases with a frequency of 94.0% (236/251), whereas inflammatory lesions accounted for 5.9% (15/251). The 236 benign soft tissue tumors diagnosed had a male-to-female ratio of 1: 1.4 with a mean age (SD) of 37.5 (19.5) years. The most frequent occurrence of benign tumors was seen in the fourth decade with 52 cases (21.0%), followed by fifth decade with 42 cases (16.7%). Adipocytic tumors were the commonest with a frequency of 54.0% (135/251), followed by peripheral nerve sheath tumors (PNSTs) with 12.4% (31/251) and then vascular and fibroblastic/myofibroblastic tumors with 10.8% (27/251) and 5.6% (14/251), respectively. Lipoma is the most common histologic type of benign soft tissue tumor and the only benign adipocytic tumor. This is followed by hemangioma 9.6% (24/251) and then neurofibroma 7.6% (19/251). Lipoma accounted for 37.09% (135/351) of all soft tissue lesions and the majority of them were seen in the fourth decade, whereas hemagioma and neurofibroma occurred more at the first decade. The most common anatomic distributions of these benign tumors were lower extremities with 23.5% (n = 59/251), followed by trunk 21.1% (n = 53). The major inflammatory lesions were tuberculoid granulomatous inflammation and panniculitis with 2.3% (6/251) of cases each. Others were necrotizing fasciitis (n = 2) and eosinophilic myositis (n = 1). Conclusion: Benign soft tissue tumors had a slight female preponderance. Lipoma is the single most common benign soft tissue neoplasm, whereas tuberculosis and panniculitis were the two most common inflammatory soft tissue lesions. Histopathological evaluation of these lesions still stands as a gold standard in their diagnosis.
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CASE SERIES Top

Adenomatoid odontogenic tumors: Rare cases in Enugu, Eastern Nigeria p. 67
Mark C Nwoga
DOI:10.4103/ijmh.IJMH_32_22  
Adenomatoid odontogenic tumors (AOTs) are very rare. We present a case series of eight AOTs seen and managed at University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu State, Nigeria over a 10-year period, from 2012 to 2021. Their epidemiological data and clinic-pathological information were obtained from the biopsy forms, histopathology reports, and case files archived in the Records Department of the hospital. The AOTs were diagnosed in 8 patients out of the 225 odontogenic tumors seen during the period giving a prevalence of 3.6%. Five patients (62.5%) were males, whereas three (37.5%) were females giving a male-to-female ratio of 1.7:1. The mean (SD) age at onset of lesion was 12.4 (5.4) years with a range of 5–21 years. The location of the tumors was anterior in 62.5% of the jaw cases. A maxillary location was observed in 62.5% of the cases. Pain complaint was reported in 25% of the subjects. Tumor fluid was aspirated in 75.0% (n = 6) of the lesions: straw aspirate (83.3%),and dark-brown aspirate (16.7%). A tooth was associated with the tumor in 87.5% (n = 7) of the cases, with the canine impacted in 85.7% (n = 6) of these. Only one case (12.5%) was extrafollicular. The AOTs are uncommon and differed from other Nigerian studies by exhibiting a male gender prevalence, lower mean age, and frequent straw aspirates.
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CASE REPORTS Top

Successful pregnancies after vaginal reconstruction following acquired gynatresia with pudendal thigh (Singapore) flaps p. 73
Johnson U Achebe, Obinna R Okwesili, Charles O Adiri, Eric E Asimadu
DOI:10.4103/ijmh.IJMH_57_22  
Acquired gynatresia resulting from traumatic vaginal delivery is rare. The use of bilateral pudendal flaps for reconstruction provides sensate tissue for a functional neovagina. Reconstruction of the vagina after complete stenosis from birth trauma has not widely been reported. We present a 29-year-old woman who developed vaginal stenosis within 2 months after vaginal delivery of a stillbirth baby. There was a failure of coitus for approximately 5 months before presentation. She had successful vaginal reconstruction with pudendal flaps and became pregnant twice through coitus after surgery. Her baby was delivered via Caesarean section. We have reported a case where the vagina was successfully reconstructed with bilateral pudendal thigh flaps which resulted in subsequent spontaneous (unassisted) pregnancies.
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Multiple subcutaneous nodules leading to a diagnosis of metastatic neuroblastoma in an infant: A case report p. 77
Dauda E Suleiman, Zainab A Adamu, Abdullahi Mohammed
DOI:10.4103/ijmh.IJMH_64_22  
Neuroblastoma is a childhood malignancy with protean clinical manifestations. One rare presentation is multiple cutaneous nodules, especially in infants. We present a case of multiple cutaneous nodules as the initial presentation in an infant with metastatic neuroblastoma. The patient received chemotherapy with good response and is alive and well 5 years post diagnosis.
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