Recurrent Galactorrhoea: A consequence of unheeded primary hypothyroidism

Background: Primary hypothyroidism can lead to hyperprolactinemia through several mechanisms in both men and women, manifesting as galactorrhoea, loss of libido, and infertility in both sexes, as oligomenorrhea/amenorrhea in women, and as gynecomastia and erectile dysfunction in men. Case presentation: Here presented is a 28-year-old Nigerian woman with a history of recurrent bilateral painless galactorrhoea of 12 years’ duration and persistent low mood. Physical examination was unremarkable. The hormonal assay revealed elevated thyroid-stimulating hormone, elevated serum prolactin, low thyroxine, and low triiodothyronine levels. Magnetic resonance imaging of the brain revealed normal findings. A diagnosis of hyperprolactinemia secondary to primary hypothyroidism was made. Pharmacological therapy began with thyroid hormone replacement therapy and a dopamine agonist: 75 micrograms of levothyroxine daily and 0.5 micrograms of cabergoline twice weekly for 8 weeks. After 8 weeks of pharmacological therapy, hormonal assay revealed values within the reference range with significant symptomatic improvement evidenced by cessation of galactorrhoea and low mood. Conclusion: Primary hypothyroidism has been proven to be one of the numerous causes of hyperprolactinemia and it could be unheeded in a patient who does not present with the typical signs and symptoms of primary hypothyroidism

Prescribing Pattern of Non-Steroidal Ant­‐inflammatory Drugs at the Outpatient Pharmacy Department of Lagos University Teaching Hospital, Nigeria

Background: Non-steroidal Anti- inflammatory Drugs (NSAID), are among the most widely used and misused of all drugs. Though they provide symptomatic relief from pain and swelling in chronic joint diseases, they may cause renal impairment, especially in combination with other nephrotoxic agents.Objectives: This study aimed to investigate the prescription pattern of NSAID in the Out-patient Pharmacy Department of Lagos University Teaching Hospital (LUTH), Nigeria.Design: A total of 3800 prescriptions containing NSAIDs were analyzed for information on drug name, the number of NSAIDs per prescription, the presence of ACE inhibitors and diuretics alongside NSAIDs and NSAIDs prescribed in generic or brand names.Results: The results showed that Aspirin was the most frequently prescribed NSAID (62.2%) and 68.4% of the NSAIDs prescriptions studied were written in generic names. The total number of drugs per prescription was in most cases 3 or greater (84.6%). There were statistically significant (p ≤ 0.05) associations between the individual NSAID prescribed and whether they were prescribed in generics or brand names; individual NSAID prescribed and the frequency of co-prescription with an ACE inhibitor and a diuretic; types of NSAID prescribed and the cost in Naira.Conclusion: Though most of the prescribers complied with WHO standard in their prescriptions vis a vis generic prescription, avoidance of polypharmacy and avoidance of drug interactions and contraindications, there is obvious need for interventional measures or strategies to improve rational prescribing for some of the prescribers tailored towards rational prescription and use of drugsKeywords: NSAID, Prescription, Outpatient, Adverse reaction, Aspirin

Autoamputation of the Breast in Invasive Ductal Carcinoma: A Case Report

Autoamputation is the spontaneous detachment from the body and elimination of an appendage or abnormal growth. Autoamputation of an organ due to malignancy has been reported in various organs, although its aetiopathogenesis has not been fully explained. Autoamputation of the breast is associated with late presentation and slow desmoplastic reaction in breast cancer. The patient was a 43- year- old Nigerian woman who presented with a one-year history of left breast mass diagnosed as triple negative invasive ductal carcinoma. She defaulted from hospital care but represented after autoamputation of the left breast. The case is reported to showcase the variations in the clinical course of breast cancers

Diabetic foot care: Self reported knowledge and practice among patients attending three tertiary hospital in Nigeria

Background: Diabetes Mellitus (DM) foot complications are a leading cause of mortality in developing countries and the prevalence of diabetes is expected to increase in the next decades in these countries. Theaim of this study was to determine the knowledge and practice of foot care among diabetes patients attending three tertiary hospitals in Nigeria.Methods: This is a cross-sectional study carried out from November 2009 to April 2010. Pre-tested structured questionnaires were administered by medical officers to diabetes patients. The outcome variables were knowledge and practice regarding foot care. The knowledge and practice scores were classified as good if score .70%, satisfactory if score was 50-69% and poor if score was < 50%.Results: Of 352 diabetes patients, 30.1% had good knowledge and 10.2 % had good practice of DM foot care. Majority (78.4%) of patients with poor practice had poor knowledge of foot care. With regard toknowledge, 68.8% were unaware of the first thing to do when they found redness/bleeding between their toes and 61.4% were unaware of the importance of inspecting the inside of the footwear for objects. Poor footpractices include; 89.2% not receiving advice when they bought footwear and 88.6% failing to get appropriate size footwear. Illiteracy and low socioeconomic status were significantly associated with poor knowledge and practice of foot care.Conclusion: This study has highlighted the gaps in the knowledge and practice of foot care in DM patients and underscores the need for an educational programme to reduce of diabetic foot complication

An audit of Cancer in the Surgical Wards of a Tertiary Healthcare facility in a resource-limited setting

Background: In Africa, cancer is an emerging public health concern. In Sub-Saharan Africa, data on cancer epidemiology and survival which are necessary for the planning of treatment and control of cancers are scarce. Methods: A retrospective study of all patients who were admitted to the surgical wards in a Nigerian tertiary facility between January 2012 and December 2016 was done. The retrieved data included demographic features, presenting symptoms, mode of presentation, duration of illness, diagnosis, stage of disease, treatment modalities, treatment intention, compliance with treatment, survival, and current status. Result: The 279 patients studied comprised 81 (29.0%) males and 198 (71.0%) females. Cancer of the female breast was the leading malignancy occurring in 59% (165/279) patients; this was followed by colon cancer in19% (54/279) and prostate cancer in 10% (29/279). The commonest cancer among the females was breast cancer while prostate cancer was the commonest among the males. The stage of the disease was classified as early in 14.7% (41/279), locally advanced in 61.6% (172/279) and metastatic in 23.7% (66/279). Treatment goal was palliative for 57% (159/279) of the patients, curative in 26%while 13.6% (38/279) of the patients received no anti-cancer treatment. Ninety-six patients (34.5%) refused treatment or defaulted from treatment after the commencement of therapy. Although 53 (19%) patients died within the first month of admission, the overall mean duration of survival was 12.71 ± 13.0 months (range of 1- 84 months). Conclusion: Late presentation of patients, high treatment default rate, inappropriate management plan and overall poor survival were identified as daunting issues in cancer management in a resource-limited setting

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Comparative study of neonatal clitoral length measurement using calliper and spatula

Background:&nbsp;When standard instruments are unavailable for clitoral length measurement, improvisation with locally available tools could be of diagnostic value. Objective: The objective of this study was to determine how the clitoral length measured with a wooden spatula compared to that measured with a caliper. Methods:&nbsp;This was a comparative cross-sectional study. Three hundred and five term female infants were recruited from multiple health facilities in Sagamu, Ogun State, Nigeria. The clitoral length was measured with a sliding digital caliper and a wooden spatula (tongue depressor). All the measurements were taken within the first 72 hours of life and comparative analysis was carried out. Results:&nbsp;The mean (± SD) clitoral length using the sliding digital caliper and the spatula were 6.7 ± 1.6 mm and 6.5 ± 1.8 mm respectively. There was no statistically significant difference between the mean values of both measurements (t = 1.369, p = 0.171). Pearson’s correlation showed that both variables were significantly correlated (r = 0.693, p &lt; 0.001) and the spatula length was a moderate predictor of the caliper length (Coefficient of determination [R2] = 0.48 and p &lt; 0.001). Conclusion:&nbsp;The findings of this study suggest that the determination of clitoral length using a spatula, commonly found in all community settings, is similar to determination of clitoral length using a digital caliper, most often used for clinical research