Knowledge of Hepatitis B Vaccine among Operating Room Personnel in Nigeria and Their Vaccination Status

Background. Hepatitis B virus (HBV) infection is a well recognised occupational health hazard preventable by vaccination. Objectives. To determine the knowledge of operating room personnel (ORP) in Nigeria about the Hepatitis B vaccine, their perception of Hepatitis B vaccination and vaccination status against HBV. Methods. Four university hospitals were selected by simple random sampling. A structured questionnaire was administered to 228 ORP after obtaining consent. Result. Only 26.8% of ORP were vaccinated against HBV. The primary reason for not being vaccinated or for defaulting from vaccination was lack of time. Differences in age, sex, duration of practice and respondent's institution between vaccinated and unvaccinated ORP were not significant (P > 0.05). The majority (86.8%) had the awareness of the existence of Hepatitis B vaccine. 83.8% of respondents believed that the vaccine should be given to the ORP as part of work place safety measures. The majority were aware of the modes of transmission of HBV infection. 78.9% of respondents believed that Hepatitis B vaccine is safe and 81.1% would recommend it to another staff. Conclusion. Despite a good knowledge about HBV infection and vaccine, most of ORP are still not vaccinated. Hepatitis B vaccination should be a prerequisite for working in the theatre, hence putting surgical patients at reduced risk

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Crohn’s disease in a developing African mission hospital

BACKGROUND: We report a case of innocuous intestinal obstruction requiring surgical intervention which was confirmed to be Crohn’s disease histopathologically in a resource-constrained rural mission hospital in the Cameroon. CASE PRESENTATION: The clinical presentations of a 70-year male of Kumbo origin from Northwestern region of Cameroon with a history of crampy right lower quadrant abdominal pain, non-bloody, non-mucoid diarrhea alternating with constipation. Abdominal examination revealed an ill-defined mass in the right iliac fossa and visible peristalsis. Abdominal CT scan and Barium enema study confirmed a complex ascending colonic and caecal tumor. He had exploratory laparotomy and intraoperative finding was a huge complex inflammatory mass involving the caecum, terminal ileum and the sigmoid colon. He subsequently had sigmoidectomy with end to end sigmoido-rectal anastomosis, a caecal resection and the proximal ascending colon exteriorized as end mucoid fistula and terminal ileostomy were performed. The histopathological diagnosis confirmed Crohn’s disease. He subsequently had adjuvant chemotherapy consisting of Azathioprine, Methotrexate, Mesalamine and Methyl-prednisolone. The patient had complete disease remission and presently on maintenance dose of mesalamine and omeprazole treatment. He has been followed- up two monthly in the surgical outpatient clinic over the last 16months with satisfactory clinical outcome. CONCLUSIONS: Crohn’s disease is uncommon in Africa yet we come across this entity sparingly. The signs and symptoms of Crohn’s disease overlap with many other abdominal disorders like tuberculosis, ulcerative colitis, irritable bowel syndrome etc. Several literature submit that it is difficult to make an accurate diagnosis of this disease, despite the fact that many diagnostic armamentaria are available to suggest its presence. Most of the patients with Crohn’s disease are treated conservatively and a few may require surgical intervention especially presenting with complications like intestinal obstruction, perforations, and abscess as well as fistula formations as seen in this index patient. Crohn’s disease is considered by many as a very rare disease in Africa. It is interesting to know that Crohn’s disease which affects mainly young adults may debut at any age. Rarity and clinical curiosity of this entity suggest reporting of this case. The author also documented an evidence-based up-to-date information on Crohn’s disease. Keywords: Crohn’s disease; Autoimmune disorder; Granulomatous colitis; Regional enteritis</p

EPIDEMIOLOGIC FEATURES OF ACUTE APPENDICITIS IN A TROPICAL AFRICAN POPULATION

BACKGROUND: The true incidence rate of appendicitis in Cameroon and the magnitude of etiological factors in appendicitis are unknown. AIM: To describe the epidemiology of acute appendicitis in the Northwestern region of Cameroon. MATERIALS AND METHODS: A retrospective population-based cohort study was conducted to assess the demographic features, incidence and seasonal variation of acute appendicitis using the medical database of two Mission Hospitals in the Northwestern Region, Cameroon from January 2006 to January 2016. The National Institute of Statistics, Bamenda Regional Office, Bui-Division -Population Data of Cameroon in 2016 was used to estimate the standardized annual incidence of appendicitis in the locality. Hospital A is a 200-bed Mission Hospital (with 50 surgical beds), while Hospital B is a 250-bed Mission Hospital (with 70 surgical beds). Pathologically confirmed specimens of appendicitis were analyzed against demographic data of the patients. Data analysis was done using simple percentages, Student t or Chi-square tests and calculations were also aided with the Number Cruncher Statistical (NCSS, LLC Kaysville) software where applicable. RESULTS: During the decade, a total of 772 out of 784 cases of appendicitis recorded during the observed period were confirmed histologically from both hospitals (56% from Hospital A and 44% from Hospital B). With a local population whose disease or specimens would most probably end up in this hospital pathology department estimated at 1,753,460 the standardized incidence rate of appendicitis was 3.85 per 100,000 per annum. Fifty-two percent were males and 48% were females. The appendicitis cases were made up 0.94%, 1.53%, and 2.86% of the total hospital admissions in 2006, 2007, and 2010, respectively. There has been an increasing incidence in both sexes almost in a similar pattern. The overall mean age was 28.64 years (M 28.94 and F 28.43 years) with 6% below the age of ten and 1.5% above 60 years. The highest incidence in males and females occurred in the second and third decades, respectively. Incidences were higher during the rainy season (April to September) 68%, P < 0.05), with peaks from June to August, when 42.5% of all cases presented. CONCLUSION: Appendicitis is very uncommon in northwest Cameroon. The increasing incidence of the disease in both sexes in this region may be due to the change to a Western lifestyle. The age distribution has a similar pattern in both sexes and 85% are 40 years or less, although the incidence is marginally higher in males. Higher prevalence of infections and allergens from pollens in the rainy season could contribute to a higher incidence of appendicitis.</p

Crohn’s disease in a developing African mission hospital: a case report

Abstract Background A case is reported of innocuous intestinal obstruction requiring surgical intervention that was confirmed to be Crohn’s disease histopathologically in a resource-constrained rural mission hospital in Cameroon. Case presentation A 70-year man of Kumbo origin from Northwest region of Cameroon with a history of crampy right lower-quadrant abdominal pain, non-bloody, non-mucoid diarrhea alternating with constipation presented to my institution. Abdominal examination of the patient revealed an ill-defined mass in the right iliac fossa and visible peristalsis. An abdominal computed tomographic scan and barium enema study confirmed a complex ascending colonic and cecal tumor. The patient underwent exploratory laparotomy. The intraoperative finding was a huge complex inflammatory mass involving the cecum, terminal ileum, and sigmoid colon. He subsequently had sigmoidectomy with end–to-end sigmoidorectal anastomosis and a cecal resection, and the proximal ascending colon was exteriorized because end mucoid fistula and terminal ileostomy were performed. The histopathological diagnosis confirmed Crohn’s disease. The patient subsequently received five courses of adjuvant chemotherapy consisting of azathioprine, methotrexate, mesalamine, and methylprednisolone. He had complete disease remission and subsequently had closure of ileostomy with satisfactory postoperative status. The most recent follow-up abdominal computed tomographic scan and colonoscopy revealed disease-free status. The patient is also currently receiving a maintenance dose of rectal mesalamine and oral omeprazole treatment. He has been followed every 2 months in the surgical outpatient clinic over the last 16 months with satisfactory clinical outcome. Conclusions Crohn’s disease is uncommon in Africa, and this entity is encountered sparingly. The signs and symptoms of Crohn’s disease overlap with many other abdominal disorders, such as tuberculosis, ulcerative colitis, irritable bowel syndrome, and others. Several publications in the literature describe that it is difficult to make an accurate diagnosis of this disease, despite the fact that many diagnostic armamentaria are available to suggest its presence. Most of the patients with Crohn’s disease are treated conservatively, and a few may require surgical intervention, especially those presenting with complications such as intestinal obstruction, perforations, and abscess as well as fistula formations, as seen in this index patient. Crohn’s disease is considered by many to be a very rare disease in Africa. It is interesting to know that Crohn’s disease, which affects mainly young adults, may debut at any age. The rarity and clinical curiosity of this entity suggested reporting of my patient’s case. Evidence-based up-to-date information on Crohn’s disease is also documented

INTEROBSERVER VARIABILITY IN ULTRASOUND SCAN FOR SUSPECTED ACUTE APPENDICITIS

BACKGROUND: There is a global resolve among Clinicians towards adoption of imaging modalities in the evaluation of appendicitis because clinical algorithms have been disappointing. We sought to determine the authenticity of interobserver variability in ultrasound scan in a resource-constrained mission hospital settings, northwestern region of Cameroon. METHODS: In this study, we reviewed the standardized diagnostic approach in acute appendicitis and also performed prospective cross observational qualitative testing using sensitivity, specificity, positive predictive value, negative predictive value, and accuracy to determine the interobserver variability of ultrasonography using the medical database of the two Mission Hospitals, northwestern region of Cameroon from January 2012 to December 2016. A sequential non-randomized convenient sampling was used and data was analyzed using the Statistical Package for the Social Sciences version 22. RESULTS: A total of 103 patients who had pre-operative evaluation with Ultrasound scan and subsequently underwent surgery with histo-pathological examination of the removed appendix were analyzed. Their ages ranged from 15 to 65 years with a mean age of 30.6±18. There were 62 males and 41 females with a ratio of 1.5:1. Of the 103 patients, (n=90; 87.4%) cases were diagnosed as AA by histopathology while (n= 9; 8.7%) cases were negative. Ultrasound was positive in (n=75; 72.8%) cases, equivocal in (n=16; 15.5%), and negative in (n=10; 10.4%) cases. Sensitivity of ultrasound from this study when compared with ultrasound as the gold standard was 90.2% with a specificity of 85.6%; while Overall accuracy was 72.4%. Age and gender had no significant relationship with the accuracy of ultrasound in this study (p value=0.2 and 0.7 respectively). CONCLUSION: Ultrasound scan is more useful in detecting than in ruling out appendicitis. The radiological criteria for acute appendicitis, the accuracy of various imaging modalities and the limitations of the available research are described in this series. The interobserver variability in the ultrasonography evaluation of appendicitis is of significant impact in resource- limited surgical emergency settings like ours, which is a rural tropical population in the developing country.</p

Typhoid ileal perforation in Shisong, Northwestern Cameroon

Background: The study aims to provide an overview of the spectrum of perforated typhoid fever cases and their outcome that were managed in resource constrained rural mission hospital, Northwestern of Cameroon. Methods: This was a retrospective observational study which was conducted in St Elizabeth Catholic General Hospital, Shisong, Northwestern region of Cameroon over a two year period covering January 2016 and December 2018. The patients included were those admitted and diagnosed of typhoid ileal perforation. Data collected were analyzed using SPSS computer software version 22. Results: During the study period, thirty-eight patients underwent surgery for typhoid ileal perforation. They included 26 (68.43%) males and 12 (31.57%) females with Male to Female ratio of 2.2: 1. Sixty -five percent of cases occurred between the months of July and September. The most common presentations were with abdominal pains (92.11%), and abdominal distention (92.11%). X-ray abdomen revealed pneumo -peritoneum in 26 (68.4%) cases, while ultrasound detected free peritoneal collection in 34 (90%) cases. Perforations were surgically treated depending upon the number of perforations, general health status of patient and degree of fecal contamination. Perforated typhoid still carries dismal prognosis. The mortality was associated with duration of delay in obtaining blood pre - operatively for patients requiring transfusion (p=0.018) and duration of presentation to operation time interval (p=0.026). Conclusion: Typhoid intestinal perforation is still endemic in our setting with dismal prognosis. Urgent public health concerted effort is required with emphasis on preventive measures such as safe drinking water, appropriate sewage disposal, and typhoid vaccination. Educating the populace on early and prompt diagnosis, adequate resuscitation as well as early surgery in patients with typhoid ileal perforation to keep the mortality low.</jats:p