Megaloblastic Anemia Associated with Small Bowel Resection in an Adult Patient

Megaloblastic anemia is characterized by macro-ovalocytosis, cytopenias, and nucleocytoplasmic maturation asynchrony of marrow erythroblast. The development of megaloblastic anemia is usually insidious in onset, and symptoms are present only in severely anemic patients. We managed a 57-year-old male who presented at the Hematology clinic on account of recurrent anemia associated with paraesthesia involving the lower limbs, 4-years-post small bowel resection. Peripheral blood film and bone marrow cytology revealed megaloblastic changes. The anemia and paraesthesia resolved with parenteral cyanocobalamin. Keywords: Bowel resection, megaloblastic anemia, neuropathy, paraesthesi

Determining Factors for the Choice of Medical Career among the Final Year Medical Students of a Private University in Nigeria

Background: Medical education worldwide is more expensive compared to other university courses due to the structure of the training into two phases: basic medical sciences and clinical sciences, each with extensive syllabuses and involves an array of professionals in various specialties. The burden of medical education was largely borne by the government in Nigeria until recently when the private sector forayed into the provision of tertiary education including medical education. Methods: The study was a cross‑sectional survey study. All 94 final year medical students of Afe Babalola University, Ado‑Ekiti, a private sector‑owned university in South Western Nigeria, were invited to participate in the study. The institutional ethical approval was sought and obtained (ERC/2020/04/07/364A). Structured self‑administered questionnaires were used to collect relevant data. Participation in the study was voluntary and confidential. The data obtained were analyzed using SPSS version 20.0 (SPSS Inc., Chicago, IL, USA). Results: Eighty‑three (88%) final year medical students participated and returned completed questionnaires out of 94 students. Further analyses  were on the number of the respondents (n = 83). Fifty‑seven (68.7%) of the respondents were female, whereas 26 (31.3%) of the respondents were male. The mean standard deviation age was 23 (1.6) years, and the age ranges between 20 and 30 years. Parental influence and personal interest were the two most important factors that influenced the decisions for medical education. Fifty‑seven (68.7%) of the respondents prefer to practice outside Nigeria, 25 (30.1%) respondents will like to practice in Nigeria but in urban areas, whereas only 1 (1.2%) of the respondents will prefer to practice in a rural area. Conclusion: The choice of medical education and future specialty is multifactorial but the most important factors are personal interest and parental influence. The choice of where to practice is mostly determined during the undergraduate program, and it tends toward continuous emigration of doctors to developed countries. Keywords: Medical education, medical students, Nigeria, postgraduate specialty, private universit

Posterior Cerebral Artery Ischemic Stroke in a Patient with Hypoplastic P1 Segment of the Posterior Cerebral Artery

Posterior circulation stroke usually presents with clinical challenges, and symptoms may include blindness. Hypoplastic or atretic cerebral artery may be a risk factor for future ischemic stroke. We present a 75‑year‑old male patient with posterior cerebral artery ischemic stroke who presented with sudden visual deterioration, and brain magnetic resonance angiography showed hypoplastic right P1. Keywords: Hypoplastic artery, ischemic stroke, posterior circulation, visual impairmen

Pattern of Blood Component Request and Utilization in a Tertiary Hospital in Nigeria

Background: Blood transfusion being a life‑saving procedure plays a vital role in the management of patients in the clinical practice. The challenges of inadequate voluntary blood donors and poor storage facilities made availability of sufficient safe blood difficult in developing countries. All efforts should therefore be put in place to ensure judicious use of the available blood by separating each unit of blood donated into components and giving individual patient only the required blood component rather than giving whole blood. Aim: This study was conducted to look into the pattern of blood components request and utilization in a tertiary hospital in Nigeria to assess its effectiveness in reducing blood wastage. Materials and Methods: This is a hospital‑based retrospective study. Blood Bank registers for blood component request and utilization were analyzed over a period of 20 months. Units of blood products requested and units used were considered during this period with emphasis on request to transfusion ratio. Results: Highest blood product request was from pediatrics ward. Total blood product request for male was higher than for female. Highest blood product request was packed cell with request to transfusion ratio of 1.01, followed by fresh‑frozen plasma, request to transfusion ratio 1.0 and platelet, request to transfusion ratio 1.14. Conclusion: Appropriate blood product request maximizes utilization, minimizes wastage, thereby increasing efficiency of the blood bank staff by reducing the unnecessary workload of cross matching, issuing of blood and wastage of reagents

Surgical Outreach as a Tertiary Hospital’s Corporate Social Responsibility: Shall we do more?

Introduction: The underserved populations of the rural and suburban communities of developing countries are challenged by the twin hurdles of low-income earning and out-of-pocket payment for surgical care services. This study aims at appraising the process, outcome, and impact of a free surgical outreach programme carried out by a Federal Teaching Hospital in South-western Nigeria. Methods: A free day-case surgical outreach programme was announced through a popular radio jingle for a period of 1 week to attract would‐be beneficiaries of the programme. A 2-day screening exercise was conducted by the concerted efforts of various specialists in the department of surgery and ophthalmology to select those who are suitable for day-case surgery. Across-sectional survey of patients who participated in the 5-day surgical outreach programme was carried out. A structured questionnaire was used to obtain information on biodata, diagnosis, surgical operations, complications, and level of satisfaction. A 3‐point bipolar satisfaction outcome scale was used to assess the level of satisfaction. The data obtained were analyzed using the SPSS software version 20.0. Results: One hundred and fifty‐eight patients were screened, but only 124 participated. Ophthalmic cases constituted 60.5%, whereas the rest (39.5%) were non-ophthalmic cases. Patients with cataract were 73 (58.9%) of all the surgical lesions operated during the outreach programme. Two (1.6%) patients with pterygium were the other ophthalmic cases, whereas the non-ophthalmic cases were mainly hernias. A total of 129 surgical operations were performed in the 124 patients, with 5 (0.4%) of them having bilateral cases. One hundred and seventeen patients (94.4%) expressed satisfaction with their experience of the programme. Conclusions: Optimal corporate social responsibility of tertiary hospitals can be performed effectively and satisfactorily through a properly organized surgical outreach

Determination of Gestational Age by Tibial Length using Ultrasound in A Nigerian Tertiary Hospital

BACKGROUND: Determining fetal gestational age accurately is important to good obstetric care and outcome. Methods like measurement of symphysio-fundal height have been used but not accurate. With the advent of ultrasound, various fetal biometric parameters e.g. BPD, FKL, and fetal limbs are now being used. AIMS AND OBJECTIVES: The aim of this study is to ultrasonographically evaluate the usefulness of fetal tibial lengths as an alternate to femur lengths in predicting gestational age from the second to third trimesters. MATERIAL AND METHODS: A total of 500 pregnant Nigerian women between the GA of 13 to 41 week had ultrasound scan evaluation done at the fetal assessment unit of a Teaching Hospital. Fetal biometric parameters BPD, FL, and TL were measured and recorded against the calculated gestational age from the last menstrual periods. RESULTS: There was a strong relationship between TL and EGA with a significant positive linear correlation (r= 0.915 P<0.05). For FL, r= 0.900 and for BPD r=0.906, all related to GA. The study has also shown a good correlation between TL and the other measured variables. For TL and FL, r=0.889 while TL and BPD r=0.867, making TL a substitute limb for limb measurement and as a pointer to a skeletal anomaly or delayed bone growth or dwarfs. The mean TL ranged from 13.47 mm at 13 week to 74.64 mm at 41 weeks of gestation. CONCLUSION: This study has been able to justify the tibia as an important substitute for femur in the prediction of GA especially where the femur is susceptible to errors. (Int J Biomed Sci 2019; 12 (4): 104-111

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Chance Fracture in an Unbelted Rear Seat Passenger

Chance fracture occurs from flexion-distraction injury in motor vehicle road crash usually when the patient is on a seat belt. It is often associated with intra-abdominal injuries. We managed a 22-year old female unbelted rear seat passenger of a bus which was involved in a lone accident. We highlighted the possible mechanism of chance fracture in an unbelted passenger and satisfactory spinal stability on conservative care with neither internal nor external fixation

Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

OBJECTIVES: Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs. DESIGN: A multicentre, international, collaborative cohort study. SETTING: 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020. PARTICIPANTS: Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, Wilms' tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer. MAIN OUTCOME MEASURE: All-cause mortality at 30 days and 90 days. RESULTS: 1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001). CONCLUSIONS: The COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally