Wound bed preparation using nonsurgical methods: A prospective comparative study of honey versus unripe papaya (Carica papaya)

Background

The rapidity of wound bed preparation is determined in part by the type of dressing agent employed. The extension phase in which the wound is characterized by the presence of sloughs and eschar and microbial invasion could be managed nonsurgically.

Objective

The objective of this study was to compare the rapidity of wound bed preparation using unripe papaya versus honey.

Materials and Methods

Sixty-four patients were assigned into two equal groups, each dressed, respectively, with unripe papaya or honey. All selected patients were monitored for eschar separation and bacterial clearance time. Data obtained with a pro forma were analyzed with SPSS version 25.

Results

Unripe papaya dressing had a mean eschar separation time of 5.53 ± 2.20 days and bacterial clearance time of 6.81 ± 3.64 days compared to the honey group which had an eschar separation time of 30.09 ± 27.90 days and bacterial clearance time of 15.33 ± 13.62 days. P <0.001 and P < 0.001, respectively, in comparing both outcome measures between the two groups. There was a statistically significant difference in both eschar/slough separation time and bacterial clearance time both in favor of the group prepared with unripe papaya.

Conclusion

The use of unripe papaya was superior to honey in wound bed preparation with respect to eschar/slough separation, bacterial clearance ultimately resulting in reduced length of hospital stay.

Urological Surgeries in a West African Teaching Hospital

Introduction

Urological surgeries are a significant part of surgical services. The need for these services varies regionally and globally. Knowledge of the local need is important for prioritisation of resources.

Objectives

To describe the urological procedures done in our hospital for effective utilisation of the already scarce resource in this region.

Patients and Methods

This was a retrospective one-year study of the urosurgical cases done in a Nigerian Teaching Hospital. The main theatre register was used to collate data. Data collected included age, sex, operation done and anaesthesia employed.

Results

One hundred and twenty-two male and three female patients were included with a male-to-female ratio of 41:1. The mean age of the patients was 56.6 ± 19.89 years. Elective cases accounted for 102 (81.6%) of surgeries. Regional anaesthesia was the most common form of anaesthesia accounting for 105 (84%) followed by local anaesthesia in 16 (12.8%). Day cases accounted for 77 (61.6%) of procedures. More than 80% of the study population was 50 years and older. Overall, the three most common performed surgeries were digital-guided prostate biopsy 47 (37.6%), suprapubic cystostomy 16 (12.8%) and open prostatectomy 9 (7.2%). In male patients, the three most common procedures were prostate biopsy 47 (38.5%), suprapubic cystostomy 16 (13.1 %), open prostatectomy 9 (7.4%) whereas nephrectomy, pyeloplasty and stent removal each accounted for 33.3% each of procedures in female patients. Endourological procedures accounted for 5 (4%) of cases.

Conclusion

Open surgeries accounted for the majority of these cases done with prostate-related procedures being the most common procedures. Few endourological procedures were performed.

Outcome of transurethral resection of the prostate (TURP) using 5% dextrose water as irrigant

Background

TURP remains the gold standard for simple prostatectomy presently. Different fluids have been used for irrigation while performing monopolar TURP. The choice of irrigation fluid depends on a lot of factors.

Aim

We sought to find out if the outcome of monopolar TURP using 5% dextrose water in our setting compares with findings in other studies using different fluids as irrigation fluid in monopolar TURP.

Materials and Methods

This was a prospective study of 220 patients who had monopolar TURP using 5% dextrose water as irrigation fluid from 2015 to 2020.

Results

The study was completed by 220 patients. The mean age was 66.25 yrs. The mean weight of prostate was 53.2 g, and mean resected weight was 30.10 g using a mean irrigation volume of 45.35 liters, 5% dextrose water over a mean resection time of 66.08 mins. The mean changes in International Prostate Symptom Score/quality of life score (IPSS/QOLS) were statistically significant. Early complications recorded were postoperative hematuria with clot retention (1.4%), urinary tract infection (UTI) (13.2%), and secondary hemorrhage (10%). TURP syndrome was not recorded. Late complications seen within 2 years follow-up were transient urinary incontinence (6.4%), urethral stricture (4.1%), and bladder neck contracture (2.3%). There was no repeat TURP for residual adenoma within this period.

Conclusion

TURP using 5% dextrose water has comparable outcomes to other irrigation fluids for monopolar TURP. It is a good alternative to any other irrigation fluid.

Unusual case of bladder stone with an embedded scalpel blade

ME is an 84-year old man who presented with a 3-year history of storage urinary symptoms associated with strangury. He had an open radical prostatectomy and direct visual internal urethrotomy 10 years prior to presentation for early prostate cancer and partial urethral stricture, respectively. A plain abdominal X-ray revealed a bladder stone in which there was an opaque foreign body embedded within the stone. A cystolithotomy was done, and the retrieved stone was cracked open, revealing a surgical blade.The patient had an uneventful recovery postoperatively.

Physical Activity among Healthcare Workers in a Major Tertiary Hospital, Southeast Nigeria

BACKGROUND

Physical inactivity (PIA) is the fourth leading risk factor in an estimated global death of 3.2 million annually. To reverse this negative impact of PIA, there is a need to increase physical activity (PA). This could be achieved through creation of awareness, promotion, and good practice of PA by healthcare workers.

OBJECTIVE

To evaluate physical activity among healthcare workers (HCW) in a major tertiary hospital, southeast Nigeria.

METHODS

The Global Physical Activity Questionnaire (GPAQ) was researcher-administered to investigate PA level among consenting HCW who met the inclusion criteria. Participants were recruited from their workstations in the hospital. The questionnaire recorded age, anthropometrics, demographics, and physical activity. Data were summarized with descriptive statistics of frequency and percentages. The spearman rank correlation test was used to assess for the relationship between PA and socio-demographic factors.

RESULTS

There were 209 participants with 93 (44.5%) males and 116 (55.5%) females. The mean age was 34.32±9.88 years. Amongst different professions, Nurses were 53(25.3%), Doctors, 31 (14.8%), and Dietitians, 21 (10%), Accountants, 19 (9.1%). The majority of the participants 100 (47.8%) had physical activity level that was high (extra sufficient), 31 (14.8%) had a moderate PA level while 78 (37.3%) had a low physical activity level. There was a significant negative relationship between PA and age, marital status, number of children, and other dependents respectively, whereas there was no significant relationship between PA and gender, income, and family type.

CONCLUSION

HCWs have the minimum required PA in a week. About 63% met the minimum required PA in a week. Age, marital status, and having children or dependents reduce participation in PA. However, there is a need for conscious awareness and practice of PA among HCW in the hospital.

The Impact of Co-Morbidities on the Pattern of Blood Pressure Control in Elderly Hypertensives in Nigeria

INTRODUCTION

The elderly hypertensive patients often have increased prevalence of cardiometabolic risk factors and their attendant co-morbidities. The aim of this study was to determine the prevalence of cardiometabolic risk factors and blood pressure control among elderly hypertensive patients, and to determine the influence of modifiable cardiometabolic risk factors on the control of hypertension among elderly hypertensive patients.

SUBJECTS AND METHODS

A case-control comparative and hospitalbased study involving a total of 190 consenting elderly (>65 years), hypertensive patients (subjects) (n=100) and normotensive controls (n=90) was carried out over a period of ten months. Using interviewer-administered questionnaire, biodata and information regarding their lifestyle was obtained. Standard protocols were used to measure blood pressure, weight, height, waist circumference, fasting plasma glucose and fasting lipid profile of the subjects. Body mass index was derived from weight and height.

RESULTS

The mean age of the subjects was 71.5 ± 6.3 years and the controls was 72.3 ± 7.2 years. Forty-eight percent (48%) and 47.8% of the subjects and controls were females (p = 0.651). The level of control of hypertension was poor in over two-thirds (68%) of the elderly hypertensive patients. The prevalence of modifiable cardiometabolic risk factors burden was higher in the hypertensive subjects when compared with the controls. Prevalence of Dyslipidaemia was 76% in the subjects and 51% in the controls (p = 0.004). Prevalence of Diabetes Mellitus was 40% among the subjects and 17.8% in the controls (p = 0.0001); prevalence of Obesity was 24% in the subjects and 4.4% in the controls (p=<0.001); prevalence of excess alcohol intake was 49% in the subjects and 14.4% in the controls (p=<0.001). Prevalence of sedentary life style was high in both the subjects (53%) and controls (50%), p=0.679. Poor blood pressure control was predicted by dyslipidaemia and central obesity.

CONCLUSION

The level of control of hypertension was poor among the elderly and modifiable cardiometabolic risk factors were relatively prevalent. Central obesity and dyslipidaemia were predictive of poor control of hypertension. Addressing these factors may therefore improve blood pressure control.

Posture-induced intraocular pressure changes among patients with primary open angle glaucoma in a Nigerian Tertiary Hospital: Any implication for management

Background and Aim

To determine the effect of postural changes on intraocular pressure (IOP) among newly diagnosed patients with primary open-angle glaucoma (POAG).

Patients and Methods

This was a cross-sectional observational study of 55 consecutive newly diagnosed patients with POAG attending Glaucoma clinics at a Federal Teaching Hospital in Abakaliki, Ebonyi state, from July to September 2017. Patients IOPs were measured in the sitting position, supine without a pillow, and supine with pillow positions using Perkin's handheld applanation tonometer. All data were analyzed with SPSS version 20.0.

Results

A total of 55 subjects were recruited comprising 30 (54.5%) males and 25 (45.5%) females, with a mean age of 50.13 ± 9.97 years and an age range of 30-79 years. The mean intraocular pressure was 27.54 ± 3.98 mmHg in the sitting position, 30.15 ± 4.41 mmHg in the supine with pillow position, and 35.22 ± 4.61 mmHg in the supine without pillow position. The mean difference of mean IOP of sitting compared to supine without the pillow was 7.68 ± 2.08 mmHg (P-value < 0.001, 95% CI: 7.12-8.24); sitting compared to supine with the pillow was 2.61 ± 1.49 mmHg (P-value < 0.001, 95% CI: 3.01-2.21), whereas supine without the pillow compared to supine with the pillow was 5.07 ± 2.24 mmHg (P-value 0.001, 95% CI: 4.47-5.68).

Conclusion

IOP was lowest in the sitting position and highest in the supine without pillow position. There was a statistically significant reduction in IOP on the assumption of supine with pillow position compared to supine without pillow position. The use of thick pillows in supine positions (such as during sleep or relaxations) rather than lying supine without pillows may reduce IOP spikes in POAG patients. This may have a positive effect as regards treatment and progression of glaucoma.

Anesthesia for inguinal hernia repair: Experience with a tertiary hospital-based surgical outreach in a developing world

Background

The dearth of adequate facilities and anesthetists limits the number and extent of surgical cases that can be attended to in surgical outreach programs. Inguinal hernia remains a common health burden in the developing world. Tertiary hospitals provide good anesthetic complements to safe surgeries and will be a veritable tool in surgical outreaches.

Objectives

The objective of the study is to assess the types/techniques of anesthesia used in uncomplicated open inguinal hernia repair in a tertiary hospital-based surgical outreach program.

Materials and Methods

This study was a prospective analysis of anesthetic techniques used in all uncomplicated inguinal hernia repairs performed in outreach program over 1 week in May 2018. Data were collected with a pro forma, analyzed with SPSS, and presented in tables and figures.

Results

One hundred and ninety-five patients with uncomplicated inguinal hernias were recruited for the study. The patients' age ranged from 0 to 89 years, with a mean age of 33.62 ± 22.75 years. Most cases occurred in children. The male-to-female ratio was 7:1, and the majority were primary hernia repairs. Eighty-seven (44.6%) patients had local anesthesia (LA), 65 (33.3%) had general anesthesia (GA), while 43 (22.1%) had spinal anesthesia (SA). One hundred and sixty-two (83.1%) patients needed intraoperative analgesic augmentation. One hundred and sixty-nine (86.7%) patients were operated as day-case surgeries, while 26 (13.3%) patients were discharged the day after surgery. The failure rate of LA and SA put together was 74.6%, but there was no conversion to GA. Anesthetic complication was observed in 3.4% of cases.

Conclusion

Organizing inguinal hernia repair outreach in a tertiary hospital offers the benefit of a full complement of anesthesia, which ensures safe and smooth surgery with low anesthetic complications. Most cases were done as daycare surgeries despite the high failure rate of LA and SA.

Résumé

Contexte

Le manque d'installations adéquates et d'anesthésistes limite le nombre et l'étendue des cas chirurgicaux qui peuvent être traités dans les programmes de proximité chirurgicale. La hernie inguinale reste un fardeau de santé courant dans les pays en développement. Les hôpitaux tertiaires fournissent de bons compléments anesthésiques aux chirurgies sûres et seront un véritable outil dans les interventions chirurgicales.

Objectifs

Évaluer les types / techniques d'anesthésie utilisés dans la réparation de hernie inguinale ouverte non compliquée dans un programme de proximité chirurgicale en milieu hospitalier tertiaire.

Méthode

Une analyse prospective des techniques d'anesthésie utilisées dans toutes les réparations de hernie inguinale non compliquées effectuées dans le cadre d'un programme de sensibilisation sur une semaine en mai 2018. Les données ont été recueillies à l'aide d'un formulaire, analysées avec SPSS et présentées sous forme de tableaux et de figures.

Résultats

Cent quatre-vingt-quinze patients atteints de hernies inguinales non compliquées ont été recrutés pour l'étude. L'âge des patients variait de 0 à 89 ans avec un âge moyen de 33,62 + 22,75 ans. La plupart des cas sont survenus chez des enfants. Le ratio homme / femme était de 7: 1 et la majorité était des réparations primaires de hernie. Quatre-vingt-sept (44,6%) des patients ont eu une anesthésie locale (LA), 65 (33,3%) une anesthésie générale (AG), tandis que 43 (22,1%) une anesthésie rachidienne (SA). Cent soixante-deux (83,1%) patients ont eu besoin d'une augmentation analgésique peropératoire. Cent soixante-neuf (86,7%) patients ont été opérés en garderie tandis que 26 (13,3%) patients ont obtenu leur congé le lendemain de la chirurgie. Le taux d'échec de LA et SA réunis était de 74,6%, mais il n'y a pas eu de conversion en GA. Une complication anesthésique a été observée dans 3,4% des cas.

Conclusion

l'organisation de soins de proximité pour la réparation de la hernie inguinale dans un hôpital tertiaire offre l'avantage d'un complément complet d'anesthésie qui garantit une chirurgie sûre et en douceur avec de faibles complications anesthésiques. La plupart des cas ont été pratiqués en garderie malgré le taux d'échec élevé de l'anesthésie locale et rachidienne.

Mots-clés

Réparation de hernie inguinale, chirurgie de jour, anesthésie générale, anesthésie locale, anesthésie rachidienne.

Malament stitch and increased risk of bladder neck stenosis: any association following open prostatectomy in Enugu Southeast Nigeria

Background

Malament stitch is one of the effective techniques employed to minimize bleeding in simple open prostatectomy but concerns about possibility of increased risk of bladder neck stenosis has limited its routine use.

Aim

We studied patients who had open prostatectomy with Malament stitch to determine the incidence of bladder neck stenosis amongst them.

Material and methods

This was a prospective study of 72patients who had simple open prostatectomy in which malament stitch was applied from 2010 to 2020. A proforma was designed to collect data. Pretreatment variables were transrectal ultrasound (TRUS) volume of prostate, pretreatment IPSS value, postvoidal residual urine volume before surgery, weight of enucleated prostate adenoma, time to removal of Malament stitch. Outcome measures were done with post treatment IPSS and PVR at 6 weeks, 3 months and 6 months. Cystoscopy was done at 3 months or 6 months for patients with rising outcome measures to determine presence of bladder neck stenosis.

Results

The mean age of patients in this study was 68.3 years (SD = 7.1, range 52–82). The mean of the pretreatment score for IPSS was 30.7 (SD = 3.9, range 18–34) and 5.9 (SD = 0.2) for QOLS. The mean weight of prostate estimated with ultrasound was 169.5 g and mean weight of enucleated adenoma of the prostate was 132.5 g. The mean time of removal of Malament stitch was 23.1 h. Only 3 (4.2%) patients required cystoscopy because of increasing IPSS and PVR at 3 months postprostatectomy. 2 (2.8%) patients out of 72patients were confirmed to have bladder neck stenosis at cystoscopy.

Conclusion

Malament stitch did not lead to significant incidence of bladder neck stenosis in this study.

Splenic injuries in native Africans: Presentation, limitations of management, and treatment outcomes in a civilian trauma service in Southeast Nigeria

Background

Splenic trauma has emerged as a major global health burden, especially in developing nations with limited diagnostic and therapeutic facilities. The current trend toward nonoperative management (NOM) and adoption of splenic salvage whenever feasible calls for local evaluation of our current practice. The aim of this study was to document the epidemiology and outcomes of management of splenic injuries in our setting.

Patients and Methods

This was a multicenter, prospective study of epidemiology and outcomes of patients with splenic injuries recruited over 10 years in southeast Nigeria.

Results

Approximately 66% of all patients with abdominal injuries sustained splenic trauma. A total of 313 patients with splenic trauma were recruited; 226 (72.2%) were managed operatively (OM) and 87 (27.8%) conservatively (NOM). Majority (75.7%) had blunt abdominal trauma (BAT), while 24.3% sustained penetrating injuries. Sonographic grading showed that 46 (14.7%), 58 (18.5%), 79 (25.2%), 106 (33.9%), and 24 (7.7%) patients had grades I, II, III, IV, and V injuries, respectively. Isolated splenic injuries occurred in 172 (55%) patients, and the rest (141, 45%) had associated intra-abdominal injuries. Two-thirds (67.1%) were aged 16-45 years. In the OM group, 178 (78.7%) had total splenectomy, while 48 (21.3%) had splenic salvage. There was a statistically significant difference (P = 0.022) in the rate of postoperative complications between the splenectomy and splenorrhaphy groups. The overall mortality rate was 4.5%. Major predictors of morbidity and mortality were high-grade splenic injuries, total splenectomy, multiple injuries, advanced age, and comorbidities.

Conclusion

Splenic injuries complicate approximately two-thirds of all abdominal injuries in our environment and majority of these injuries were due to BAT. In this study, majority had OM and splenic salvage rate was relatively low.

Prophylactic role of ciprofloxacin and ceftriaxone in prostate biopsy-related infection: randomized comparative study of bacterial spectrum and antibiotic sensitivities

Background

The mainstay for the diagnosis of prostate cancer is transrectal ultrasound-guided prostate biopsy. However, prostate biopsy is associated with a significant risk of complications including urinary tract infection. This study aims to compare the bacterial profile and antibiotic susceptibility pattern in urinary tract infection after prostate biopsy between patients on 2 different antimicrobial prophylactic regimens.

Methods

This was a comparative cross-sectional study done at the urology unit of our institution, over 13 months. Fifty-six patients who met the inclusion criteria made up the study population and were randomly assigned to two groups. Those in group 1 (28) received intravenous ciprofloxacin (Juhel) 400 mg at induction of anesthesia, while those in group 2 (28) received intravenous ceftriaxone (Rocephin) 1 g at induction of anesthesia. All patients received bisacodyl (dulcolax) rectal suppositories 20 mg nocte starting 2 nights before the procedure as well as intravenous metronidazole (Juhel) at induction of anesthesia. Urine samples were taken for urine culture and sensitivity three days after biopsy. Isolated organisms and their antibiotics sensitivities were documented. Statistical analysis was done using SPSS version 21.0 with the level of significance set at P < 0.05.

Results

In group 1 the prevalence of urinary tract infection was 61%. Escherichia coli was isolated in 11(64.71%) cases, Klebsiella species in 3(17.65%), staphylococcus aureus in 1(5.88%), Proteus species in 1(5.88%), and non-hemolytic streptococcus species in 1(5.88%). In this group, all isolated bacterial organisms were resistant to ciprofloxacin. In group 2 the prevalence of urinary tract infection was 43%. Klebsiella spp was isolated in 6(50%) cases, Pseudomonas aeruginosa in 3(25%), E. coli in 2(16.67%), Staphylococcus in 1(8.33%). In group 2 all isolated bacterial organisms were resistant to ceftriaxone.

Conclusion

Ciprofloxacin and ceftriaxone are both associated with a high rate of urinary tract infection when used as prophylaxis for prostate biopsy. The bacterial etiology of prostate biopsy-related urinary tract infection is dependent on the prophylactic antibiotics used. Based on the high rate of urinary tract infection associated with the use of either ciprofloxacin or ceftriaxone, we recommend a combination of both drugs as prophylaxis for prostate biopsy.

Distribution pattern and prevalence of haematological cancers among adults in Abakaliki, South-Eastern Nigeria

Background

Haematological cancers are clonal diseases of the blood and blood-forming organs, with the distribution pattern not known in our locality. This study aimed to describe the distribution pattern and prevalence of haematological cancers among adults in Abakaliki, Nigeria.

Materials and Methods

This was an 8-year retrospective study in which the hospital records/case notes of adult patients diagnosed and managed for haematological cancers from May 2012 to April 2020 were reviewed. Data obtained were analysed with the SPSS software, version 20.

Results

One hundred and thirty-five cases of haematological cancers were included in the study, with 72 (53.4%) males and 63 (46.6%) females and male-to-female ratio of 1.1:1. The age range was 18-82 years, with a mean age of 49 ± 17 years. Lymphoid malignancies predominate more than myeloid (101 [74.8%] vs. 34 [25.2%]). The leukaemias were more predominant than the lymphomas and myeloma accounting for 48.2%, 36.3% and 7.4%, respectively. Chronic leukaemias were more common than the acute leukaemias with chronic lymphocytic leukaemia (CLL) being the most common accounting for 24.4% of haematological cancers. In general, non-Hodgkin's lymphoma (NHL) was the most common haematologic cancer accounting for 35 (25.9%), followed by CLL 33 (24.4%), chronic myeloid leukaemia (CML) 17 (12.6%), Hodgkin's lymphoma (HL) 14 (10.4%) and multiple myeloma (MM) 10 (7.4%). Others include acute lymphoblastic leukaemia (ALL) 9 (6.7%) and acute myeloblastic leukaemia (AML) 6 (4.4%). Myelodysplastic syndrome (MDS) and polycythaemia vera (PV), each contributed 3% while myelofibrosis (MF) and essential thrombocythaemia (ET) contributed 1.5% and 0.7%, respectively.

Conclusion

This study has shown that haematological cancers are not uncommon in our locality with NHL being the most common, followed by CLL, CML, HL, MM, ALL, AML, MDS, PV. MF and ET in that order. The burden of haematological cancers in Ebonyi State, Nigeria is therefore significant and should be prioritised in health-care policy formulation and management.

Feeding behavior among health-care workers in a tertiary health institution Southeast Nigeria

Background

Feeding behavior is an important factor in the prevention and management of noncommunicable diseases, which are the leading cause of death globally.

Objective

This study is aimed to investigate the feeding behaviors among health-care workers in a tertiary hospital in southeast Nigeria.

Materials and Methods

The study was a cross-sectional survey. A total of 418 participants (186 males and 232 females) were involved in the study. The instrument is a sociodemographic questionnaire and a modified form of the British Heart Foundation's questions to assess the nutritional value of individuals. The participants were consecutively recruited from their workstations. Data were collected using self-administered questionnaires, which were hand distributed and collected back on the same day after completion.

Results

The study showed that health workers in the teaching hospital had an overall "fair" feeding behavior (86.13 ± 8.52 out of 140). It also showed that females had a significant (P < 0.05) overall better feeding behavior (88.15 ± 9.00) compared to males (83.62 ± 7.18). The studied participants had poor feeding behavior in carbohydrates and fats and oil consumption and just fair behavior in fruits and vegetables, salt intake, and water consumption. The feeding behavior was inadequate, and there was no significant gender or profession-related differences in the overall behavior of the participants.

Conclusion

The health-care workers in the tertiary health institution in southeast Nigeria have inadequate feeding behavior. They should join in the global call and awareness on healthy feeding behavior to prevent and reduce the burden of noncommunicable diseases.

Evaluation of Foetal Haemoglobin Status among Nigerian Patients with Sickle Cell Anaemia Using High Performance Liquid Chromatography

BACKGROUND

Sickle cell anaemia (SCA, HbSS) is a genetic disorder of haemoglobin with marked variation in clinical manifestation. The aim of this study was to determine the foetal haemoglobin (HbF) status of patients with HbSS, compared with that of individuals with HbAS and HbAA control as well as to establish the relationship between HbF level and age and gender of the participants.

METHODS

This was a cross-sectional study in which HbF values of known HbSS patients along with HbAS and HbAA controls were analysed using High Performance Liquid Chromatography. Socio-demographic and other information were obtained with the use of questionnaire. Data was analyzed using SPSS software, version 20.0. Ethical approval was obtained for the study.

RESULTS

One hundred and two (102) participants were recruited for the study, comprising 60 patients with HbSS, 22 HbAS and 20 HbAA controls, with mean age of 11.0 years±9.6, 11.7 years ±8.8 and 12.3 years±8.1 respectively. There were 30 (61.2%) males and 30 (56.6%) females for HbSS group, 9 (18.4%) males and 13(24.5%) females for HbAS group and 10(20.4%) males and 10(18.9%) for HbAA group. Mean HbF level among HbSS participants was 8.0 ±6.1% and was significantly higher than that of HbAS (3.0 ±3.4%) and HbAA (2.2 ±4.1%) control (P<0.05). Mean HbF level was higher in children (<18 years) than adults (e"18 years) among HbSS, HbAS and HbAA participants, though not statistically significant (p >0.05). Mean HbF level was also higher among female HbSS, HbAS and HbAA groups compared to corresponding male groups, though only HbSS female group was significant (p = 0.031).

CONCLUSION

Patients with HbSS have significantly higher HbF level than individuals with HbAS and HbAA. Foetal haemoglobin level tend to decrease with advancing age and higher in females. Increased HbF level may play a compensatory mechanism in sickling in HbSS, thus the use of agent that increase HbF level may improve clinical outcome.

Penopubic testicular ectopia with bilateral cryptorchidism presenting as obstructed inguinal Amyand's hernia

Testicular ectopia is an aberrant deviation of the migration of the testis from its usual path of descent into the scrotum. Of the forms of ectopic testis, the penopubic (also called pubopenile) type is one of the least common; in this case, presented as an obstructed hernia. We report a rare case of penopubic testicular ectopia with bilateral cryptorchidism in a 17-year-old boy who presented to the emergency room with right obstructed inguinal hernia. Intraoperative findings included bilateral cryptorchidism, hernia sac with right undescended testis and normal vermiform appendix, a left penopubic testis abutting the hernia sac. Both testes had separate epididymides and adequate length of vasa deferentia and were transposed into their respective hemiscrotum via an open inguinal approach. The patient had an uneventful recovery.

Penopubic testicular ectopia can present as obstructed Amyand’s hernia. Early open groin exploration with orchidopexy was satisfactory.

Correlates of patients' satisfaction with antenatal care services in a tertiary hospital in Abakaliki, Ebonyi State, Nigeria

Introduction

antenatal care is a specialized pattern of care organized for pregnant women to improve their chances of a safe delivery. Assessment of patients' perception of healthcare services is one of the ways of measuring the quality of healthcare as satisfied patients are likely to come back for the services they need and to recommend the services to others.

Methods

this is a cross-sectional study. Two hundred and eighty-four booked antenatal attendees were randomly selected at the antenatal clinic of Federal Teaching Hospital, Abakaliki in November 2016 and interviewed using semi-structured questionnaire. Items in the questionnaire included sociodemographic and obstetric variables, assessment of amenities, total time spent, services and level of satisfaction. Data obtained were analyzed using Epi info TM 7.1.3.10 and presented with a simple percentage and chi-square. Main outcome measure: satisfaction with antenatal care.

Results

the mean age of the respondents was 28.2 ± 4.2 years, majority 130 (45.8%) were within the 25-29 age bracket. Most had tertiary education (146, 51.4%) and less than 10% are grand multipara. In general, 89.4% of the respondents were satisfied with the quality of antenatal care services. Majority of the respondents 170 (59.9%) were unsatisfied with the water supply while 128 (45.1%) were unsatisfied with cervical cancer prevention discussion during the health talk. The mean total time spent in the antenatal clinic was 4.1 hours ± 1.2 hours (range 2-7 hours). Being married and multiparous significantly affected satisfaction with the quality of antenatal care services as represented by P-value of 0.015 and 0.005 respectively.

Conclusion

majority of pregnant women were satisfied with the care they received. Health providers should, however, improve the state of sanitary facilities and ensure the provision of adequate information on cervical cancer screening during health talks.

Attitude and Practice of Aesthetic Surgery among Plastic Surgeons in Nigeria

BACKGROUND: Aesthetic surgery in developed countries is growing at an exponential rate. There is an increasing demand for cosmetic procedures in Nigeria but still, the practice is at a slow pace. Significant clients from Nigeria seek for these procedures outside Nigeria. OBJECTIVE: This study aimed at determining the attitude and practice of aesthetic surgery among plastic surgeons in Nigeria METHOD: We conducted a cross-sectional study among the attendees of the annual conference of the National Association of Plastic Reconstructive and Aesthetic Surgeons held at Calabar, Nigeria, using a questionnaire on consented participants. RESULTS: A total of 73 out of 84 Plastic surgeons participated in the study with a response rate of 86.9%. The mean age of the respondents was 45.4&plusmn;7.2 years. Only 14 (19.2%) had undergone extra training in cosmetic surgery. Most respondents 53.4% prefer Nigerian over foreign hospitals for cosmetic surgery for various reasons. Poor awareness (42.5%) and religious beliefs (42.5%) contributed most to the poor acceptability of cosmetic surgery in Nigeria. The vast majority (97%) of Nigerian plastic surgeons want the public to be engaged in awareness sensitization on cosmetic surgery and their preferred mode of sensitization was through internet / social media (80.8%), television (74%), and radio (65.8%). Scar revision (78.1%) abdominoplasty (69.9%) and breast reduction (67.1) were the common cosmetic procedures performed by Nigerian plastic surgeons. CONCLUSION: The attitude of Plastic surgeons in Nigeria to cosmetic surgery is influenced by the low acceptance of cosmetic surgery procedures by Nigerians. Attitudinal change programs, especially through social and other mass media, are desired to increase awareness and acceptance of cosmetic surgery in Nigeria.

Anterior abdominal wall reconstruction with mesh implants: indications and limitations in a developing tropical economy

INTRODUCTION

the role of surgery in managing massive midline abdominal wall defects has continued to rise, leading to higher demand for more effective techniques in order to limit recurrences. There is paucity of data on this subject in Southeast Nigeria. The aim of this study is to document the indications and challenges of treatment of complex, midline abdominal wall defects in our centre.

METHODS

this was a cross-sectional study of adult patients with complex, midline abdominal wall defects managed with mesh implants over a five-year period.

RESULTS

a total of 182 adult patients, predominantly females 160(87.9%), received mesh implants for complex abdominal wall defects. The common indications were incisional hernia 128(70.3%), abdominal wound dehiscence 16(8.8%) and divarication of recti 16(8.8%). About one-third 62(34.1%) of the patients required additional abdominoplasty procedure. Delay towards prompt surgical repair was noted in 168(92.3%) patients, notably due to financial constraints 32(17.6%) followed by comorbidities requiring serial assessments 24(13.2%). Superficial wound infection rate was 5.5% while deep (mesh) infection was noted in two (1.1%) patients. Recurrence and perioperative mortality rates were 1.1% and 1.6% respectively. Diabetes mellitus in obese female patients was an independent predictor of perioperative death (p=0.000).

CONCLUSION

the most common indication for abdominal wall reconstruction in our environment is incisional hernia. The use of prosthetic meshes to repair complex abdominal wall defects is largely safe and effective in our practice, but timely reconstruction is commonly hampered by multi-faceted economic, clinical and pathological barriers.

Abdominoplasty for male truncal obesity: case report

Truncal obesity and its associated health risk is an enormous burden. The traditional surgical treatment modality is liposuction or lipoabdominoplasty. An uncommon mode of the treatment is the use of abdominoplasty alone or as a surgical component. The aim of this report is to show a satisfactory outcome of abdominoplasty as the only surgical component in the management of severe truncal obesity in elderly male patient. We report a 75 year old Nigerian trader who had truncal obesity with gross abdominal asymmetry and cardiovascular and diabetes mellitus co-morbidities as well as bilateral knee osteoarthritis and social isolation due to truncal disfigurement. He was offered abdominoplasty as a sole surgical option for correction of anterior abdominal wall asymmetry. Apart from post operative wound complications and blood transfusion reactions, the patient had a good recovery and improved quality of life. Abdominoplasty is a rewarding treatment when used as a sole surgical option in centrally obese patients with anterior abdominal wall asymmetry and significant subcutaneous fat thickness.

Antibiotic use among surgical inpatients at a tertiary health facility: a case for a standardized protocol for presumptive antimicrobial therapy in the developing world

Background

Indiscriminate antimicrobial use is one of the greatest contributors to antimicrobial resistance. A low level of asepsis in hospitals and inadequate laboratory support have been adduced as reasons for indiscriminate use of antimicrobials among surgical patients. At present, there are no guidelines for presumptive antibiotic use in Nigeria and sub-Saharan Africa.

Aim

Surgical inpatients at the study hospital were surveyed to determine the level of antimicrobial use and degree of compliance with prescription quality indicators.

Methods

A cross-sectional survey was conducted among all surgical inpatients in May 2019 using a standardized tool developed by the University of Antwerp to assess the point prevalence of antimicrobials. Inpatients who were admitted from 08:00 h on the day of the survey were included. Data on patients' demographics, indication for antimicrobial use, reason for antimicrobial use, stop/review date, adherence to guidelines and laboratory use were collected. The prevalence of antimicrobial use in the surgical department was estimated.

Results

Eighty-two inpatients were included in the survey. Of these, 97.6% were receiving at least one antimicrobial agent. Only 5.4% of the prescriptions were targeted, and 37.6% of prescriptions were for empirical treatment of infections. Approximately half (50.7%) of the patients were receiving presumptive antibiotics, and 6% were receiving prophylactic antibiotics. In total, 58.7% of prescriptions were administered parenterally, and 98.2% of patients had documentation of a stop/review date. Metronidazole (P=32.3%, T=29.2%), ceftriaxone (P=28.4%, T=19.8%) and ciprofloxacin (P=14.2%, T=14.6%) were the most common antimicrobials used.

Conclusions

There is a high rate of antimicrobial use among surgical inpatients, and the rate of indiscriminate antimicrobial prescribing among these patients needs to be reduced. This can be achieved by developing antimicrobial guidelines for presumptive antimicrobial therapy.

Comparing hospital stay and patient satisfaction in a resource poor setting using conventional and locally adapted negative pressure wound dressing methods in management of leg ulcers with split skin grafts: a comparative prospective study

Introduction

chronic leg ulcers cause a prolonged hospital stay with devastating effects on the patients. Several modifiable factors are taken care of to reduce the duration of stay. A further measure to hasten wound bed preparation pre-grafting and to hasten graft healing post-grafting is with negative pressure dressing.

Methods

sixty-two patients were placed in two groups of 31 cases each. The wound beds were prepared with negative pressure apparatus locally adapted with suction machine for group A and with conventional gauze dressing using 5% povidone iodine soaks for group B. Grafted wound was also dressed similarly for the respective groups. Grafts were inspected on the 5^th post-operative day and were determined with planimeter grid. Grafts were monitored until completely healed and patients were discharged. Satisfaction and length of stay were determined at discharge.

Results

the mean hospital stay pre-grafting and post-grafting were 12.2 (±8.64) days and 13.6 (±2.03) days respectively for the negative pressure dressing and 28.8 (±30.9) days and 21.8 (±21.97) days respectively for the traditional dressing group. These differences with p values of 0.038 for the pre-grafting stay and 0.006 for the post-grafting stay were statistically significant. The patients managed with negative pressure dressing also recorded greater satisfaction with the process and the outcome.

Conclusion

negative pressure dressing contributes significantly to reducing the length of hospital stay in chronic leg ulcers both in wound bed preparation and in graft healing resulting to better patient satisfaction than in patients treated with conventional gauze dressing and 5% povidone iodine soaks.

Breast necrotizing fasciitis following stillbirth managed with nipple areola conservation in a resource-poor setting: a case report

Breast necrotizing fasciitis is a rare condition that has a tendency to rapidly progress with untoward morbidity and potential mortality. Its rarity often results to misdiagnosis and the fulminant course of the disease. We wish to present a case managed with nipple areola conservation following early intervention. We report a 28-year-old woman managed for unilateral right breast necrotizing fasciitis following stillbirth and resultant breast congestion in a background hypoalbuminemia. Early intervention ensured nipple-areola salvage. Wound was covered with split-thickness skin grafting. Early aggressive intervention in necrotizing fasciitis of the breast in a post-stillbirth lady with congestion contributed to preservation of nipple areola complex with eventual satisfactory management using split-thickness skin grafting.

Clinical Presentation and Management Outcome of Emergency Adolescent Gynecological Disorders at Federal Teaching Hospital, Abakaliki, Nigeria

Background:

Gynecological emergencies which affect the adolescents may pose a serious challenge to both the patient and the gynecologist.

Objectives:

The objective of this study is to determine the clinical presentations and management outcomes of emergency adolescent gynecological disorders at Federal Teaching Hospital, Abakaliki.

Materials and Methods:

This is a retrospective review of all cases of adolescent gynecological emergencies managed at Federal Teaching Hospital Abakaliki between January 1, 2012, and December 31, 2014. Data obtained from their case notes were analyzed using the IBM statistics version 20 (IBM Corp., Armonk, NY, USA). Data were presented using percentages and pie chart.

Results:

The prevalence of adolescent gynecological emergency disorders was 5.1%. The majority (82%) of the patients belong to the age bracket 15–19 with a mean age of 16.7 (2.4) years. About 90% of the patients were nulliparous. Unmarried patients comprised 80% of the study group. Vaginal bleeding was the most common clinical presentation (86%). The two most common diagnoses were abortion (60%) and sexual assault (26%). Only 10% of sexually active adolescent were using any form of contraception. Care received includes manual vaccum aspiration, laparotomy, and antibiotics. Blood transfusion was given in 18% of the cases. No death was recorded in all the cases.

Conclusion:

Abortive conditions and sexual assault were the most common clinical diagnosis among adolescents in the study. The percentage of adolescent assaulted in our study is unacceptable and should be prevented and efforts should be made to reduce the high unmet need for contraception seen in the study.

Clinical Outcome of Nonoperative Treatment of de Quervain's Disease with Local Corticosteroid Injection in Nigerian Setting

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.

CLEFT LIP, ALVEOLUS AND PALATE IN AFRICAN NATIVES: AN UPDATE ON DEMOGRAPHICS AND MANAGEMENT OUTCOME

BACKGROUND

Development of craniofacial structures is a complex process and disruption of any of the numerous steps can lead to development of oro-facial clefts. This is a surgically amenable anomaly as from early life that has had conflicting pattern of demographics reported by various researchers globally. There are several factors that are critical to the surgical outcome.

OBJECTIVE

Study the demographics and the management outcome of cleft lip, alveolus and palate and highlight factors responsible for improved care in recent time.

DESIGN

Descriptive cohort study.

SETTING

Tertiary health institution.

METHOD

All consecutive patients managed for cleft lip, alveolus and palate (CLAP) over 7years and 10months were studied.

OUTCOME

Cleft lip, alveolus and palate repair was performed on 149 patients, January 1, 2001- December 31, 2008 with an incidence of 2.1/1000 live births. From this, 27 patients, averaging 4.5 patients per year were operated for the first 6 1/3 years while the remaining 122(81.9%) the next 1 1/2 years, averaging 81.6 patients yearly. Their ages ranged from 3 months - 60 years with 77 (51.7%) males and 72 (48.3.0%) females. Cleft lip was the main presentation in 108(72.5%) of which 72(66.7%) were left sided. Bilateral cleft lip were14 (9.4%). Five (3.4%) patients had associated anomalies out of which 3(60.0%) had CLAP while 2(40.0%) isolated cleft lip or palate. The technique for cleft lip repair was Millard's and Noordhoof's while palatal cleft was the two-flap palatoplasty with intravelar veloplasty. Success was recorded in 142(95.3%) with complication observed in 7(4.7%) patients.

CONCLUSION

The rarity of cleft lip, alveolus and/or palate in the African native documented previously may no longer be tenable as observe in this study. Management outcome has improved owing to the collaboration with SmileTrain, USA, along with multidisciplinary approach.

Experience with rubber band ligation of hemorrhoids in northern Nigeria

Background:

Treatment of hemorrhoids in Nigeria is usually done by the traditional open method that requires hospital admission; anesthesia and is associated with high morbidity. Rubber band ligation is a suitable alternative to open hemorrhoidectomy and has the potential to reduce the need for hospital admission.

Patients and Methods:

This was a prospective analysis of consecutive patients presenting with hemorrhoids that were suitable for surgical treatment to the Jos University Teaching Hospital and the Federal Medical Centre Gombe from January 2008 to December 2010 (24 months).

Results:

A total of 232 rubber band ligations were performed on 40 patients whose ages ranged from 20 to 54 years with a mean age of 37.1 ± 12.2 years. There were 24 males and 16 females (M:F::2:3). Thirty-nine patients (97.5%) were cured of their symptoms following the procedure, and 1 patient (2.5%) had severe pain as complication of the treatment. Another patient had recurrence that was treated by repeat rubber band ligation.

Conclusion:

We conclude that rubber band ligation is a safe and reliable way for outpatient treatment of hemorrhoids in Nigeria.

Pattern of urological malignancies seen at Federal Medical Centre Gombe North Eastern Nigeria

BACKGROUND

The incidence of urological malignancies is on the increase globally like most other malignant tumours. There is generally poor documentation of urological malignancies in Nigeria attested to by the paucity of literature on this subject matter. This study was carried out to document the pattern and distribution of urological malignancies seen at Federal Medical Centre, Gombe, North Eastern Nigeria.

MATERIALS AND METHODS

This was a retrospective analysis of all pathologically proven urological malignancies seen at this centre from January 2000 to December 2007. All records of patients with the diagnosis of urological malignancies were retrieved from the histopathology registers, operation registers and patients' case notes. The patients' biodata including their ages, sex and tumour site were extracted and analysed.

RESULTS

A total of 118 cases of urological malignancies were recorded during the 8 years under review. Ninety-nine (83.9%) ocurred in males while the remaining 19 (16.1%) were in females giving a male: female ratio of 5:1. Children comprised of nine 9 (7.6%) and adults 109 (92.4%) of the population. The organ specific frequency of occurrence of the tumour in descending order comprised of prostate 63 (53.4%) bladder 33 (28.0%), kidney 17 (14.4%), testes 3 (2.5.%) penis 2 (1.7%) ureter and urethra (0%).

CONCLUSION

We concluded that prostate, urinary bladder and renal carcinomas are the three most common urological malignancies in North Eastern Nigeria.

Congenital amputation involving the hands and feet: a case report

BACKGROUND

Congenital amputation of the limbs is not uncommon. However, it is very rare when this involves both the upper and lower limbs.

METHOD

This is a case report of a child who presented with congenital amputation involving both the upper and lower limbs.

RESULTS

The patient was a 10-day-old baby girl that was delivered by a 21-year-old woman. She is the first and only child of the woman, whose pregnancy was uneventful and was carried to term. There is no family history of congenital anomalies. The findings on examination were: amputation of the index, middle and ring fingers at the level of metacarpophalangeal joints on both hands and a partial amputation (at the level of the middle phalanx) of the left little finger. There were forefoot amputations on both lower limbs. Scars were noticed over the amputation stumps with no associated congenital anomaly.

CONCLUSION

Congenital amputation involving all limbs as an isolated entity is a rare condition; the cause of which is probably as a result of congenital amniotic bands.