Outcome of neonatal surgeries in Nnewi, Nigeria

Background: A surgical neonate is a challenge, especially in developing countries such as Nigeria, where neonatal surgical practice is still evolving. Mortality is still high compared with developed nations. Data from developing countries on this emerging aspect of paediatric surgery, however, are scarce. We reviewed all neonatal surgical cases that were managed at the Nnamdi Azikiwe University Teaching Hospital Nnewi, a tertiary institution located in the South Eastern region of Nigeria, with a view of determining the outcome.Patients and methods: This was a retrospective review of Hospital records of infants aged 0–28 days who were treated at the Special Baby Care Unit of the hospital from January 2009 to June 2012.Results: Out of 1863 babies admitted to the Special Care Baby Unit of the hospital, 147 (8%) were surgical cases. There were 91 males and 56 females (M: F=1.6 : 1). The mean weight of the babies was 2.5 kg (range=0.1–4.3 kg). Thirty-two babies (16.9%) were premature. The most frequent indication for admission is gastrointestinal conditions, accounting for 78.2% of all neonatal surgeries. The most common procedure carried out was intestinal anastomosis and repair (36%). One hundred and thirteen neonates (76.9%) presented beyond 48 h of onset of symptoms. Of the delayed cases, 65% sought medical attention early at the primary and secondary health centres, but referral was delayed from periods ranging from 2 to 21  days (mean=5 days). Only 15 of the neonates had a valid prenatal ultrasound diagnosis. In only three of the cases were the mothers referred for planned delivery and specialist care. Infective conditions (sepsis, surgical site infection, respiratory tract infections) accounted for 45.4% of morbidity. Mortality was higher in the late presenters, premature babies, babies with weight less than 2.5 kg and in thoracic surgeries. Overall, 41 neonates died, yielding a mortality of 27.9%.Conclusion: The high morbidity and mortality from neonatal surgeries still persists. Factors that negatively affect the outcome include late presentation, prematurity, low birth weight and thoracic surgeries. Enhanced prenatal diagnosis,early patient referral, further personnel training and improvement in facilities will improve outcome.Keywords: late presentation, mortality, neonatal surgery, Nigeria, outcom

Anti-plasmodial and anti-inflammatory activities of cyclotide-rich extract and fraction of Oldenlandia affinis (R. & S.) D.C. (Rubiaceae)

Background: Oldenlandia affinis, commonly called ‘kalata-kalata’, a versatile plant used locally to treat malaria fever in some parts of sub-Saharan Africa was investigated for anti-plasmodial and anti-inflammatory activities.Objective: The study was designed to evaluate the antiplasmodial as well as anti-inflammatory activities of whole extract and cyclotide-rich fraction of Oldenlandia affinis.Method: The dichloromethane-methanol extract (ODE) of the plant, O. affinis was investigated for suppressive and curative antiplasmodial activities against Plasmodium berghei in mice. ODE and the cyclotide-rich fraction (CRF) was investigated for chronic and acute anti-inflammatory activities in rat models of inflammation. Inhibition of pro-inflammatory mediators was studied in RAW264.7 macrophages.Results: ODE exhibited significant (p<0.05) reduction in mean parasitaemia in both the suppressive and curative models of Plasmodium berghei infection in mice.Administration of ODE(100, 200, or 400 mg/kg) and CRF (100, 200, or 400 mg/kg) produced significant inhibition of rodent models of acute and chronic inflammation . This observation is supported by the significant (P<0.05) inhibition of pro-inflammatory mediators, inducible nitric oxide (iNO) and tumour necrosis factor-alpha (TNF-α), and the reactive radical scavenging activities in RAW264.7 macrophages.Conclusion: These findings could explain, at least in part, the successes reported in the use of the herb, Oldenlandia affinis in the traditional treatment of malaria feverKeywords: Oldenlandia affinis, Reactive oxygen/nitrogen species, Plasmodium berghei, pro-inflammatory mediators, parasitemi

Anti-plasmodial and anti-inflammatory activities of cyclotide-rich extract and fraction of Oldenlandia affinis (R. & S.) D.C. (Rubiaceae).

Background: Oldenlandia affinis, commonly called \u2018kalata-kalata\u2019, a versatile plant used locally to treat malaria fever in some parts of sub-Saharan Africa was investigated for anti-plasmodial and anti-inflammatory activities. Objective: The study was designed to evaluate the antiplasmodial as well as anti-inflammatory activities of whole extract and cyclotide-rich fraction of Oldenlandia affinis Method: The dichloromethane-methanol extract (ODE) of the plant, O. affinis was investigated for suppressive and curative antiplasmodial activities against Plasmodium berghei in mice. ODE and the cyclotide-rich fraction (CRF) was investigated for chronic and acute anti-inflammatory activities in rat models of inflammation. Inhibition of pro-inflammatory mediators was studied in RAW264.7 macrophages. Results: ODE exhibited significant (p<0.05) reduction in mean parasitaemia in both the suppressive and curative models of Plasmodium berghei infection in mice.Administration of ODE(100, 200, or 400 mg/kg) and CRF (100, 200, or 400 mg/kg) produced significant inhibition of rodent models of acute and chronic inflammation . This observation is supported by the significant (P<0.05) inhibition of pro-inflammatory mediators, inducible nitric oxide (iNO) and tumour necrosis factor-alpha (TNF-\u3b1), and the reactive radical scavenging activities in RAW264.7 macrophages. Conclusion: These findings could explain, at least in part, the successes reported in the use of the herb, Oldenlandia affinis in the traditional treatment of malaria fever

Association between serum vitamin D status and uterine leiomyomas: a case-control study

Objective Uterine leiomyoma is a common gynecological condition that negatively affects women’s quality of life. Vitamin D plays an important role in tumor development and progression. However, clinical studies comparing serum vitamin D levels between women with and without uterine leiomyomas are limited and inconclusive. This study aimed to compare serum vitamin D levels in women with and without uterine leiomyomas. Methods This hospital-based case-control study included 150 women who visited a gynecological clinic. The cases included 75 women with uterine leiomyoma, whereas the controls included 75 age-and parity-matched participants without uterine leiomyoma. Serum vitamin D levels were measured in each participant and volumes of the uterine leiomyomas were determined using the water displacement method following myomectomy. The statistical significance was inferred at P<0.05. Results The mean serum vitamin D level was 15.26±4.96 ng/mL and 22.45±6.93 ng/mL for the case and control groups, respectively. The difference was statistically significant (t-value −7.302 and P<0.001). Within the fibroid group, nine (12.0%), 49 (65.33%), and 17 (22.67%) participants had vitamin D deficiency, insufficiency, and sufficiency, respectively; and in the control group, two (2.67%), 24 (45.33%), and 39 (52.0%) participants had vitamin D deficiency, insufficiency, and sufficiency, respectively. There was significant negative correlation between the fibroid volume and the serum vitamin D level (r=−0.591, P<0.001). Conclusion Women with uterine leiomyoma had lower vitamin D levels than women in the control group. Lower vitamin D levels were associated with larger fibroid masses. Therefore, vitamin D supplementation may reduce fibroid growth and development

Patient safety culture in the operating room: a cross-sectional study using the Hospital Survey on Patient Safety Culture (HSOPSC) Instrument

Abstract Background Credible evidence has established a link between the level of patient safety culture in healthcare environments and patient outcomes. Patient safety culture in the operating room has received scant attention despite the burden of adverse events among surgical patients. We aimed to evaluate the safety culture in our operating rooms and compare with existing data from other operating room settings. Methods We investigated the patient safety culture in the operating rooms of our hospital as perceived by the surgeons, nurse anaesthetists and perioperative nurses using the Hospital Survey on Patient Safety Culture (HSOPSC) instrument. IBM Statistical Package for Social Science software, version 25, was used for data entry and analysis. Differences were considered significant when p < 0.05. Results Only 122 completed surveys were returned out of a survey population of 132 frontline staff, yielding a response rate of 92.4%. The overall average composite score was 47%. The average composite scores ranged from 17–79.6% across the 12 dimensions of the HSOPSC, with teamwork within units being the only dimension with demonstrable strength. Non-punitive response to error, communication openness, feedback and communication about error”, frequency of events reported”, handoffs and transition and staffing need improvement. The perceived safety culture varied according to work areas and professional roles with nurse anaesthetists having the highest perception and the surgeons the least. Conclusion Patient safety culture in our operating rooms is adjudged to be weak, with only one of the twelve dimensions of HSOPSC demonstrating strength. This is notwithstanding its comparative strengths relative to other operating room settings

A multicentre observational study of HIV, TB and risk of chronic lung disease in urban west Africa

OBJECTIVE: HIV and TB are risk factors for non-communicable chronic lung disease (CLD). Despite the high prevalence of these infections in west Africa, there are no studies that compare CLD between people living with HIV (PLWH) and HIV-negative populations in this setting. This study sought to quantify the contribution of HIV and TB infection in addition to conventional CLD risk factors, such as tobacco and biofuel exposure, to CLD in urban west Africa. DESIGN: A multi-centre cross-sectional study was conducted in three community clinics in Lagos, Nigeria between 2018 and 2019. METHODS: Spirometry, questionnaires and clinical records were used to estimate prevalence of CLD and association with risk factors. RESULTS: 148 HIV-negative individuals and 170 HIV-positive individuals completed the study. Current cigarette (11/318, 3.5%) and lifetime domestic biofuel (6/318, 1.8%) exposures were low. Airway obstruction (33/170, 19.4% vs 12/148, 8.1%, p = 0.004) and CLD (73/170, 42.9% vs 34/148, 23%, p < 0.0001) were more prevalent in PLWH compared to the HIV-negative group. HIV infection (OR 2.35 (1.33, 4.17), p = 0.003) and history of TB (OR 2.09 (1.04, 4.20), p = 0.038) were independently associated with increased risk of CLD. CONCLUSIONS: HIV and TB far outweigh conventional risk factors, including tobacco and domestic biofuel exposure, as drivers of non-communicable CLD in urban west Africa. Current global policy for CLD may have limited impact on CLD in this setting. Enhanced prevention, diagnosis and management strategies for incident HIV and TB infections are likely to have a significant impact on long-term lung health in sub-Saharan Africa (SSA)

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

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality