Dermatological Lesions of Cholesterol Embolization Syndrome and Kaposi Sarcoma Mimic Primary Systemic Vasculitis: Case Report Study

Primary systemic vasculitis can present with a wide spectrum of manifestations ranging from systemic non-specific features such as fever, malaise, arthralgia, and myalgia to specific organ damage. We describe two cases of cholesterol embolization syndrome and Kaposi sarcoma mimicking primary systemic vasculitis, both of which were characterized by features such as livedo reticularis, blue toe syndrome, a brown, purpuric skin rash, and positive p-ANCA associated with Kaposi sarcoma. Establishing the right diagnosis was challenging, and thus we aim in this study to highlight the possible ways to distinguish them from primary systemic vasculitis. Keywords: Dermatological lesions, Cholesterol embolization syndrome, Kaposi sarcoma, vasculitis mimic

The design and implementation of an Arabic pronunciation application for early childhood

Learning is not limited to a certain age group or a formal study environment.  However, the first eight years, and particularly the first three years, are most important, as the effects of the care and attention provided to the child during this period will continue throughout his or her life. A child’s early learning processes develop their educational abilities and skills, and fosters their academic achievements. Preschool can be very benefit to development and learning for children, but there are differences between countries in this area. It can reduce the repetition in the classroom and can raise achievement scores for students through the preschool programs of high quality (Jacobson and Linda 2008). There are many applications in the Middle East that teach kids, but there is didn't link between the vowels of the Arabic alphabet characters and verbally voice for each character and training to select correct format of Arabic alphabet like (fatha, dama and kasra).   This study aims to develop an educational application for children from the ages of 3 to 5 to help them improve their skills and abilities. The application will also prepare them for school by teaching them the Arabic letters, pronunciation and the short vowels (fatha, dama and kasra). The application also aims to help children communicate and interact more effectively with their external environment by employing several theories about learning skills, such as Piaget’s Theory of Cognitive Development, Edger Dale’s Cone of Learning and Bloom's Taxonomy of Cognitive Goals. The application will focus on the first three levels of Bloom's Taxonomy Pyramid which are ‘Remember’, ‘Understand’ and ‘Apply’. Furthermore, the application will be designed to aid children with their Arabic pronunciation, and aural and oral skills, and train and educate them in preparation for attending school. The expected result is that it will be considerably better than educational books for children’s education. Combining education and play in e-learning applications is an important way to attract children

Postoperative Pain Management in Emergency Surgeries: A One-year Survey on Perception and Satisfaction among Surgical Patients

Background: Postoperative pain varies from an individual to individual. It also varies with types and extent of surgery. In general, postoperative pain is inadequately managed in most centers worldwide, especially in developing countries. Therefore, this study presents the perception and satisfaction of postoperative pain management in emergency surgeries. Methods: A 1-year prospective study of the 891 patients who underwent emergency general surgeries at Ahmadu Bello University Teaching Hospital, from January to December 2018 is hereby presented. Pain scores and patient's satisfaction toward postoperative pain management were considered at 8 and 24 h postoperatively through a predesigned questionnaire. Numeric Pain Rating Scale was used to determine pain intensity and the level of satisfaction following postoperative pain management. Student's t-test was used to compare the pain scores and patient's level of satisfaction of the postoperative pain management. Results: A total of 891 patients were recruited for this study, with a mean age of 36.4 ± 8.9 years with a male-to-female ratio of 1.3:1. Postoperative pain management satisfaction score for patients (98%) who had pain 8-h postoperative period was 4.8 ± 1.6. Similarly, 96.4% of the patients who had pain 24 h postoperatively scored 2.8 ± 1.7. Majority of the patients 481 (54%) were of the American Society of Anesthesiologist physical Class II. Most of the patients underwent general surgery using the technique of general anesthesia. Conclusion: This study indicated that the perception and level of patient's satisfaction regarding postoperative pain management are inadequate. The health professionals and policy makers should be aware that postoperative pain management is suboptimal, as patients still have severe postoperative pain. Therefore, the need for improved postoperative pain management

Bilateral Absence of the Arcuate Artery on the Dorsum of the Foot: With anomalous origin of dorsal metatarsal arteries

Bilateral absence of the arcuate artery was observed during routine dissection of the lower limbs of a 60-year-old male cadaver. Running distally on the dorsal aspect of both feet and opposite the tarso-metatarsal joint, the dorsalis pedis artery diverged 2cm lateral to the tendon of the extensor hallucis longus. The 2nd dorsal metatarsal artery was found originating from the dorsalis pedis artery opposite the intermediate cuneiform bone. The 3rd and 4th dorsal metatarsal arteries originated from the lateral tarsal artery. Although absence of the arcuate artery has been previously described, the arterial variant described here is thought to be distinct from those previously reported. The variant 2nd dorsal metatarsal artery was found to originate from the dorsalis pedis artery. Knowledge of anatomical variations of arteries supplying the feet and toes has important clinical significance in reconstructive surgery and in determining associated pathology

Comparative study of 0.5mg/Kg and 1.0mg/Kg suxamethonium in achieving acceptable condition for endotracheal intubation

Background: Airway management is of utmost importance to the anaesthetist because failure to secure an adequate airway can result to morbidity and mortality. Endotracheal intubation is the cornerstone in airway management. This study investigated the effectiveness of lower dose of 0.5mg/kg suxamethonium in achieving acceptable condition for successful endotracheal intubation.Objective: To investigate the effectiveness of 0.5mg/kg suxamethonium in achieving the relaxation needed for successful endotracheal intubation.Methodology: A prospective double-blind study was done on 500 patients of ASA class I or II, undergoing elective surgery requiring general anaesthesia and endotracheal intubation. Patients were randomized into two: Group ‘A’ received 0.5mg/kg suxamethonium; Group ‘B’ received 1.0mg/kg suxamethonium intravenously. Anaesthesia was induced with propofol. Intubation conditions were assessed clinically one minute after suxamethonium administration by Viby-Mogensen scoring system.Result: Clinically acceptable intubation conditions were obtained in 91.6% and 96.4% of the patients after administration of 0.5mg/kg and 1.0mg/kg suxamethonium in groups A and B, respectively. The Mallampati classes of pharyngeal structures, Cormack grade, and laryngoscopy and intubation duration were of similar outcomes in the two groups. Intubation was successful in all (100%) patients. Twenty-one (8.4%) and nine (3.6%) patients in 0.5mg/kg and 1.0mg/kg group respectively required additional 0.5mg/kg of suxamethonium administration.Conclusion: Acceptable conditions for endotracheal intubation were achieved with lower dose (0.5mg/kg) suxamethonium.Keywords: Elective surgery, Muscle relaxant, Airway management, Balanced anaesthesi

Anaesthesia for Maxillofacial Surgeries: A 10 Year Review in ABUTH Zaria

Background: Maxillofacial surgeries pose lots of challenges to the attending anaesthetist especially as regards emergency airway management. The anaesthetist must be conversant with the techniques and appliances of managing both anticipated and unanticipated difficult airway.Objective: To present a retrospective review of the anaesthesia for 952 cases of maxillofacial surgeries treated over a period of ten years (2006 - 2015) in Ahmadu Bello University Teaching Hospital (ABUTH) Shika-Zaria, Nigeria.Methodology: After obtaining ethical approval from the hospital Ethics Committee, data were sourced from the clinical records of 952 cases of maxillofacial surgeries in ABUTH. All the patients had pre-anaesthetic assessment by the attending anaesthetist and informed consents were taken. Decision for the intubation technique was based on airway assessment by Mallampati classification, thyromental distance and atlanto-axial mobility. All patients were premedicated with intravenous atropine 10mcg/kg on the operating table.Results: Our findings identified fractures as the most common injury suffered by the patients, affecting 264 patients (27.7%), followed by ameloblastoma 168 patients (17.6%). Patients who had foreign body in the nostril were 10 (1.1%), while 165 (17.3%) were unclassified cases. Nasal intubation with direct visualization of vocal cords occurred most frequently (62.9%), followed by fibre-optic intubation (24.9%). Oral intubation was carried out in 44 (4.6%) patients, while tracheostomy was performed in 72patients (7.6%). In 281patients with anticipated difficult airway, fibre-optic intubation was attempted in all cases with asuccess rate of 84.7%.Conclusion: Difficult airway in maxillofacial surgeries is common anddemands special attention. Time of surgery should be carefully planned allowing reduction of anaesthetic morbidity and mortality.Key words: Difficult airway, Premedication, Anaesthetic plans, Fibre-optic intubation, Tracheostomy

Performance Evaluation of VANET Routing Protocols in Madinah City

Traffic management challenges in peak seasons for popular destinations such as Madinah city have accelerated the need for and introduction of autonomous vehicles and Vehicular ad hoc networks (VANETs) to assist in communication and alleviation of traffic congestions. The primary goal of this study is to evaluate the performance of communication routing protocols in VANETs between autonomous and human-driven vehicles in Madinah city in varying traffic conditions. A simulation of assorted traffic distributions and densities were modeled in an extracted map of Madinah city and then tested in two application scenarios with three ad hoc routing protocols using a combination of traffic and network simulation tools working in tandem. The results measured for the average trip time show that opting for a fully autonomous vehicle scenario reduces the trip time of vehicles by approximately 7.1% in high traffic densities and that the reactive ad hoc routing protocols induce the least delay for network packets to reach neighboring VANET vehicles. From these observations, it can be asserted that autonomous vehicles provide a significant reduction in travel time and that either of the two reactive ad hoc routing protocols could be implemented for the VANET implementation in Madinah city. Furthermore, we perform an ANOVA test to examine the effects of the factors that are considered in our study on the variation of the results

Comparison of the Qualities of Sevoflurane and Halothane in Paediatric Anaesthesia

Background: Inhalational anaesthetics are used for the induction and maintenance of general anaesthesia in children. More agents are evolving in an effort to discover the agent of choice in this age group, considering the safety margin, availability, affordability, and accessibility of the anaesthetics. Aim: The aim of our study was to compare the qualities of halothane and sevoflurane in paediatric patients. Materials and Methods: This was a prospective randomised study of 100 children within the age group of 5–12 years, scheduled for elective surgery in Ahmadu Bello University Teaching Hospital, Zaria, from January to October 2022, and satisfied the study inclusion criteria. The following variables (heart rate, blood pressure, arrhythmias, and complications) were recorded and analysed using IBM SPSS version 25 (Chicago) USA. P ≤ 0.05 was considered statistically significant. Results: The incidence of tolerability at induction of anaesthesia, hypoxaemia (SpO2 <90%), and airway responses (laryngospasm, coughing, and breath holding) was similar in both the groups. However, at induction of anaesthesia, the degree of muscle rigidity in the sevoflurane group was statistically significant compared with the halothane group (P = 0.028), but the difference was not statistically significant at the recovery period (P = 0.59). More so, the incidence of arrhythmias was higher in the halothane group than in the sevoflurane group. Conclusion: The overall qualities of halothane were commensurate with that of sevoflurane. However, where available and affordable, sevoflurane will be a better agent of choice in paediatric anaesthesia