OBSTRUCTED CONGENITAL HERNIA OF UMBILICAL CORD IN A NIGERIAN NEWBORN AND ITS DIAGNOSTIC CONUNDRUM

Background

Congenital Hernia of umbilical cord (CHUC) is a rare presentation. The failure of return of intestinal loops following physiological herniation has been postulated as the embryological basis of this condition. This is usually mistakenly termed as omphalocele minor. We aim to highlight this rare finding, the clinical features, diagnostic dilemma, and management of CHUC.

Case Presentation

He is a 4-day old male with obstructed CHUC. He had an oedematous umbilical stump, with circumferential normal abdominal wall skin folds in the form of a collar wrapping round the proximal aspect of the protrusion. The umbilical defect measured about 4 cm in diameter. Subsequently, surgical reduction and repair of defect was done, with resolution of symptoms.

Conclusion

CHUC though a rare entity and easily missed, accurate diagnosis and management offer good prognosis. Also, recognition will prevent iatrogenic bowel injury from careless clamping of the cord with associated morbidity and mortality. It also helps to prevent mis categorization and prevent unwarranted anxiety with misdiagnosis.

DEMOGRAPHICS OF COLLABORATORS INVESTIGATING THE NIGERIAN MEDICAL AND DENTAL INTERNS: A MEDICAL INTERNSHIP TRAINING IN NIGERIA (MINTING) STUDY COLLABORATION

Introduction

The internship period is a peculiar time in a doctor's career, and some have described it as a "nuisance year" during which the junior doctor assumes many roles at the same time. Junior doctors especially house officers are faced with many unique challenges; this is even more pronounced in poor resource settings like Nigeria. This study aimed to unravel and improve understanding of the challenges faced by medical and dental interns in Nigeria.

Methodology

A nine-member House officers Research and Statistics Committee (HRSC) was immediately set up to include three senior colleagues - Senior Registrars and Registrar. To carry out her responsibility efficiently the committee created the House Officers Research Collaboration Network (HRCN), a 103- member team comprising medical and dental interns from across Nigeria under a collaborative - Medical INternship Training in Nigeria (MINTING) study.

Results

Out of a total of the 103 House Officers Research Collaboration Network, 80 of them participated in this survey giving a 78% response rate. Ten of the intern Collaborators had additional qualification and seven of them had BSc as an initial degree. About 66 % of the Collaborators have never authored any publication. Of the 27 that have published an article; three collaborators are said to have published 15, 13, 16 articles respectively. Male collaborators where more likely to have published at least one article in the past. Thirty one of the 80 Collaborators have never been in a research collaborative group prior to this MINTING collaborative.

Conclusion

This commentary is set out to describe in detail Nigerian House Officers initiative in terms of the structure, functions, operational modalities, and to investigate the demographics of the HRCN collaborators which showed that over two third of collaborators have never authored any publication and about a third of them have never been involved in collaborative research. We also believe the findings will serve as policy guide and benchmark in training the critical medical health force.

AUDIT OF THE PRACTICE OF DAY CASE SURGERY IN THE DIVISION OF PAEDIATRIC SURGERY, UNIVERSITY COLLEGE HOSPITAL, IBADAN

Background

Paediatric day case surgery refers to planned procedures on patients on a non-resident basis but requires some facilities and time for recovery before discharge home on the day of surgery. This study was conducted to audit paediatric day case surgery practice at our centre, and to determine the outcome of day case surgeries.

Patients and Methods

This is a retrospective study of cases seen over a period of 12 years, 2010 to 2022. These patients' data were assessed from their case notes and information obtained for each of the patients included age, gender, diagnosis, type of operation, type of anesthesia and post operative complications. The data were analyzed using SPSS version 22.0 for windows.

Results

A total of 1,211 patients were recruited, with a M: F; 6: 1. The age of patients ranged from one week to 15 years with a median age of two years. A higher proportion of case load involved infants and toddlers compared to the other paediatric age groups. In this review, the largest volume of cases was seen in the last five years with the peak in 2018 (202). The right groin for an isolated diagnosis was operated in 381 (59 %) patients compared to the left 265 (41 %). The mean duration of surgery time was 40 minutes. Most of the patients had General Anesthesia (GA) with endotracheal tube, face mask, and laryngeal mask airway (LMA) using isoflurane, halothane and propofol at different times as anesthetic agents. There were no re admissions or mortality, however two of our patients had recurrence necessitating a re-do surgery.

Conclusion

Groin hernias are the most common day cases in children in our facility. Day case paediatric surgery is safe, and outcome is generally good, when well managed.

BIOCHEMICAL PREDICTORS OF ENTEROCOLITIS IN CHILDREN WITH COLORECTAL ANOMALIES POST COLOSTOMY AT UNIVERSITY COLLEGE HOSPITAL, IBADAN

Background

A large proportion of patients with preoperative enterocolitis still have enterocolitis persisting even after surgery while others resolve thereafter. Some researchers have studied Calprotectin, C-reactive protein (CRP), Blood and Plasma viscosity as markers of inflammation, hence, the choice of their use. The aim of the study is to determine the sensitivity and reliability of Calprotectin, C-reactive protein (CRP), Blood and Plasma viscosity as biochemical predictors of enterocolitis in children with colorectal anomaly post-surgery at University College Hospital Ibadan.

Patients and Methods

This is an observational analytic study of 32 patients with either Hirschsprung's disease or Anorectal malformation carried out over a year period. The demographic data of the patients, clinical condition and the preoperative and postoperative readings of the biochemical analytes were recorded in a chart. Statistical analysis were carried out using SPSS version 23 and test for statistical association done.

Results

The incidence of Hirschsprung associated enterocolitis is 12.5% and for Ano rectal malformation 6.3 %. Gender difference was not statistically significant even with the observed clinical difference. Plasma viscosity and blood viscosity correlate positively with each order. C-reactive Protein and Calprotectin did not predict enterocolitis in this study and the Sensitivity of blood viscosity at T1 and T2 is as low as 66% with a Positive Predictive Value of 25 %.

Conclusion

The incidence of Enterocolitis associated with Hirschsprung's disease and Anorectal malformation is 19 %. Calprotectin and C-reactive protein did not predict enterocolitis in this patients. The outcome of care was satisfactory in over 90 % of the patients.

OBSTRUCTED INGUINAL HERNIA IN CHILDREN: CASE-CONTROLLED APPROACH TO EVALUATE THE INFLUENCE OF SOCIO-DEMOGRAPHIC VARIABLES

BACKGROUND

Obstructed inguinal hernia in children is associated with high morbidity in developing countries due to delay in accessing care. Attempts made to reduce waiting time to herniotomy are not backed by a predictive model of disease occurrence and modeling obstructed inguinal hernia implies knowledge of factors associated with this complication.

AIM & OBJECTIVES

To determine the relationship between socio-demographic variables and obstructed inguinal hernia in children.

DESIGN

Case controlled.

SETTING

Paediatric surgery unit of a tertiary hospital.

MATERIALS AND METHODS

The study was prospective - all children presenting with obstructed inguinal hernia at University College Hospital, Ibadan, Nigeria between May 2009 and April 2014 were studied. For each case, two children with non-obstructed inguinal hernia were recruited consecutively as controls. Their demographics, clinical features, management and outcomes were obtained including the socio-demographic attributes of the parents. The data obtained were computed using SPSS; the p-value for significance was set at < 0.05.

RESULTS

A total of 81 consecutive patients (27 with obstructed inguinal hernia and 54 with non-obstructed inguinal hernia) were studied; they were aged between 2 weeks and 13 years with a mean of 25.9 ± 3.8 months. There were no differences between cases and controls based on gender, parents' religion, tribe, social status and side affected (p > 0.05). The mean age at presentation was 13.7 ± 5.6 months in the obstructed inguinal hernia vs. 32.0 ± 4.8 months in the non-obstructed inguinal hernia groups (p = 0.016). The duration of groin swelling before presentation was not significantly different (30.0 ± 7.7 vs. 28.3 ± 6.4 months, p = 0.893). Infants were three times more likely than older children to develop obstruction (OR = 3.33, CI: 1.20, 9.09, p = 0.020).

CONCLUSION

The age at presentation is the significant socio-demographic variable in this study that could predict obstruction in healthy children with inguinal hernia delivered at term.