Pattern of Patient Presentation to the General Surgery Unit of a Tertiary Health Care Centre in a Developing Country

Background: Not much has been published on the surgical burden in Africa. This study describes the pattern and distribution of surgical  conditions treated by the general surgery division in a Nigerian tertiary hospital.Method: This was a retrospective study over thirty months. All patients treated by the general surgery divisions of the hospital were included in this study.Results: A total of 5631 new patients were seen over the period. Male: Female sex ratio was 1: 1.35 with a mean age of 39.6 years. malignant conditions accounted for 22.7% while 74.6% were benign. Breast carcinoma was the commonest malignancy in females. The commonest malignancyin males was abdominal (gastrointestinal, hepatobiliary and  retroperitoneal).Conclusion: Patients are getting increasingly educated. Appropriate manpower training is required so that tertiary hospitals are not encumbered by mundane surgical conditions .Specialty clinics for hernias, breast, gastrointestinal malignancy and anorectal conditions should beconsidered.Key words: Breast, Colon, Epidemiolog

An Audit of Perforated Peptic Ulcer Disease in a Tropical Teaching Hospital

Background: Perforated peptic ulcer (PPU) is associated with high  morbidity and a mortality rate. Thus it requires urgent surgical  intervention. Recently a reduction in the rate of peptic ulcer perforation in young men with a relative increase in the elderly and in women has been documented. This study is an audit of perforated peptic ulcer surgical emergencies treated by the gastrointestinal surgery division of a teaching hospital in Nigeria. It also reviews the early complications and the average duration of admission of these set of patients.Method: This was a retrospective five-year audit of patients admitted by the gastrointestinal surgery division of a tertiary teaching hospital in Ibadan Nigeria. The data extracted from the patients’ records included the bio-demographical data, the duration of symptoms prior to admission, thepatients’ vital signs at presentation and the results of the haematological investigations. Other information includes the duration from admission to surgery, the intra-operative findings and the outcome of the treatment.Results: Forty patients consisting of thirty three male and seven female were treated. The ages ranged from 20 years to 70 years. The peak incidence was in the fifth decade. None of the patients was seen within 6 hours of the onset of symptoms however fifteen patients were seen within twenty four hours of the onset of symptoms. Twelve patients (30%) had history of significant ingestion of non-steroidal anti-inflammatory drugs, nine (22.5%) had a significant history of alcohol ingestion, while one (2.5%) had a recent history of fasting prior to the onset of symptoms. The distribution of the sites of perforation, revealed a pattern of 9(22.5%), 21(52.5%) and 10(25%) in the body of the stomach, pre-pyloric region and the first part of the duodenum respectively. There were six mortalities.Conclusion: The outcome is excellent when prompt and adequate resuscitation and surgical repair of perforation are done. Health education  may increase patient awareness which may translate to early presentation. Risk scores may be helpful in predicting the outcome but an experienced clinical opinion is still essentia

Laparoscopic Appendectomy in a Developing African Country

Background: The wide spread introduction of laparoscopic surgery to  surgical practice in Nigeria is a relatively new development. The benefits of laparoscopic appendicectomy are controversial. Laparoscopic  appendicectomy (LA) has always generated controversy due to its cost and time consuming nature and the multiple trocar points required which  arguably approximates to the length of the incision in open  appendicectomy. The purpose of this study is to describe the unit experience in a developing country.Method: This is a retrospective study conducted by the laparoscopic  surgery unit of the department of surgery. The study includes all patients who consented to laparoscopic appendicectomy over a period of eighteen months.Results: Thirty patients out of a hundred consented to laparoscopic appendicectomy with a male female ratio of 1:1.5.The mean operating time was 62 minutes. The duration of postoperative admission ranged from 1 to 7 days with a mean of 2.2days.There was 1(3.3%) conversion and 1(3.3%) pelvic collection. There was no readmission over three  months of follow up.Conclusion: Laparoscopic appendicectomy is safe and allows early  discharge. The low incidence of cholecystectomy in Nigeria compared with the high incidence of appendicitis in Nigeria supports the adoption of  surgery for a different disease entity apart from cholecystectomy for  training (hand and eye coordination). The level of safety demonstrated in the initial cases of laparoscopic appendicectomy supports adopting LA as a procedure of choice in acquisition of basic laparoscopic surgery skills

Traumatic splenic rupture in pregnancy with favourable pregnancy outcome: Case report

Trauma complicating pregnancy is one of the causes of deaths that are not captured in the maternal mortality ratio, yet it occurs in about 1 in 15  pregnancies. This is a report of a case of splenic rupture occurring after a vehicle hit a pregnant woman who was a pedestrian. Splenectomy was done and, in spite of having a hemoperitoneum of about 2 litres, she recovered without further complication and was able to sustain the pregnancy to term, with the delivery of a healthy female infant. Clinicians should seek to exclude splenic rupture in cases of blunt trauma to the abdomen during  pregnancy because of the risk of severe haemorrhage, shock, and possibility of pregnancy loss. Key words: Haemoperitoneum; Pregnancy; Splenectomy; Trauma

Utilization of Palm Fruit Fibers as Constituent Materials for Hand Mould Clay Bricks

The production process of palm oil generates a huge amount of waste. As Nigeria is one of the largest producing countries, the fruit fiber wastes from palm oil processing have received a low level of waste management and have been a long-term environmental concern. This study is focused on recovery of the palm fruit fibers and its utilization as a constituent material for locally hand mold clay bricks. Varying percentages (1% to 3%) of palm fruit fiber was introduced into local hand mold clay. The bricks produced were tested for optimum moisture content and dry density. Some preliminary tests such as natural moisture content determination (wet and dry), Specific gravity test, Particle size distribution test (Sieve analysis), Atterberg limit test, Compaction test (Standard Proctor), Water absorption test, and Compressive strength test was carried out. The results show a decrease in optimum moisture content as the percentage of the palm fruit fibers increased from 1% to 3% in the soil sample while the maximum dry density increased. With the addition of 1% to 3% of the palm fruit fibers and the mix sun-dried, noticeable improvement in the compaction characteristics of the soil sample was observed. It can be deduced from the results that for a good construction clay soil, the lower the moisture content, the higher the dry density and the better the quality of bricks. Production of clay bricks with palm fruit fibers could serve as an economic substitute for the growing cost of sandcrete blocks

Stage-specific five-year survival outcomes in women treated for early stage breast cancer in Ibadan, Nigeria

Background: The disparity between the overall survival of breast cancer between high-income countries (HICs) and low- and middle-income countries (LMICs) has been majorly attributed to the high rate of diagnosis of Early Stage Breast Cancer (ESBC) in HICs, with about three-quarters and one-fifth of the total breast cancer patients diagnosed with ESBC in HICs and LMICs respectively. The median 5-year survival rate of ESBC in HICs is 86% while it is about 72% in Sub-Saharan Africa.Objectives: To determine stage-specific five-year survival outcomes in women treated for ESBC.Methods: We conducted a longitudinal, cohort study to assess the treatment and outcome of ESBC in a Nigerian tertiary hospital. Patients diagnosed and treated for ESBC over 5 years were recruited and followed up for a minimum of 5 years after treatment. Clinicopathologic parameters, disease progression and known vital status, were retrieved. A 5% level of significance was used.Results: 67(9.6%)patients of 694 new cases of breast cancer seen over the study duration was treated for ESBC, of whichsixty- three (63) were followed up over the specified follow-up period. The mean age was 43(10) years. Based on the American Joint Committee on Cancer staging, 9 patients were stage IA, 16 stage IB, 16 stage IIA and 26 stage IIB respectively. The overall 5-year survival was 77.8%.Conclusion: The survival pattern of our cohort fairly compares with reports in HICs, despite the challenges faced in the multimodal treatment protocol received by our patients. Keywords: early breast cancer,survival, survival analysis, stage-specifi

Characteristics and outcome of road traffic injured patients in the emergency department of a tertiary teaching hospital in Nigeria

Background: The exit modes from the emergency department (ED) for road traffic injury patients are namely planned discharge; admission to the wards/intensive care unit or transfer to the operating theatre; discharge against medical advice (DAMA). The aim of this study was to assess the characteristics and outcomes of non-poly-traumatized road traffic injury (RTI) related ED admissions of a tertiary health care facility in a developing country and the exit pattern from the ED.Methods: This was a retrospective hospital data-based study of outcome of RTI patients seen in the ED of a tertiary teaching hospital in Nigeria from January to December 2017.Results: 1120 RTI patients were recruited consisting of 774 males and 346 females with a male: female ratio of 2.24:1. The age range was 1 to 94 years with a mean age of 37.5±17.5 years.  Peak ages were in the fourth (24.2%) and third (20.4%) decades of life respectively.  85.5% of the patients were commercial vehicles passengers. Motorcycle accidents constituted 44% of the patients while 41.8% were in cars. The commonest injuries were head injuries (31% m:f 2.7) and fractures (21% m:f 3). There were 11.5% DAMA and 7.1% deaths. Motorcycles injuries had the highest mortality rate while the motorized tricycles injuries had the highest DAMA rates.Conclusions: Motorized tricycles may be considered as a safer means of commercial mode of transportation compared to motorcycles despite its own limitations. There is a need to educate patients against the common practice of discharge against medical advice

ULTIMATE BOUNDEDNESS RESULTS FOR SOLUTIONS OF CERTAIN THIRD ORDER NONLINEAR MATRIX DIFFERENTIAL EQUATIONS

Abstract. We present in this paper ultimate boundedness results for a third order nonlinear matrix differential equations of the form where A, B are constant symmetric n × n matrices, X, H(X) and P (t, X,Ẋ,Ẍ) are real n × n matrices continuous in their respective arguments. Our results give a matrix analogue of earlier results of Afuwape [1] and Meng 2010 Mathematics Subject Classification: 34C11, 34D20

A 12-month prospective study of intra-abdominal hypertension and abdominal compartment syndrome incidence and outcomes at a tertiary hospital in Nigeria

Background: Peritoneal sepsis is a life-threatening emergency, more so in the low- and middle-income countries (LMICs) where immediate hospital presentation for much needed urgent surgical care is the exception rather than the norm. Continued research into the multifactorial aetiopathogenesis responsible for the high level of morbidity and mortality is necessary. We aimed to determine the incidence of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in patients presenting with generalized peritonitis in a tertiary hospital in Nigeria. Methods: We conducted a prospective study involving recruitment of consenting patients managed for generalized peritonitis over 12 months. Results: Fifty-seven consenting and appropriate patients were recruited over the course of the study and managed as per study protocol. The duration of symptoms ranged between 11 hours and 7 days. All patients had varying degrees of IAH and ACS at presentation with generalized peritonitis. A laparotomy with definitive surgery was done in 51 patients (89%), with 6 patients (11%) having only a bedside peritoneal drain inserted for decompression. Significant improvement of the respiratory rate (P < 0.001), oxygen saturation (P = 0.041), and urinary output (P = 0.021) only occurred after decompression by laparotomy or tube drainage. The consecutive mean ± standard deviation (SD) intra-abdominal pressures measured, respectively, at presentation, immediately postsurgery, then postoperatively at 6 h, 24 h, and 72 h reflected significant improvement at each point (respectively in cmH2O: 11.4 ± 6.03, 6.58 ± 5.58, 5.78 ± 3.29, 4.73 ± 2.86, 6.72 ± 5.18; P < 0.001). Conclusions: IAH and ACS are not uncommon in our setting, and ACS at presentation is a significant predictor of mortality in patients with peritoneal sepsis. Surgical decompression invariably leads to an improvement in all clinical variables investigated. Keywords: intra-abdominal hypertension; abdominal compartment syndrome; peritonitis; laparotomy; percutaneous catheter decompression; Nigeria

Association of Body Composition with Odds of Breast Cancer by Molecular Subtype: Analysis of the Mechanisms for Established and Novel Risk Factors for Breast Cancer in Nigerian Women (MEND) Study

BACKGROUND: The association between obesity and breast cancer (BC) has been extensively studied among US, European and Asian study populations, with often conflicting evidence. However, despite the increasing prevalence of obesity and associated conditions in Africa, the continent with the highest age-standardized BC mortality rate globally, few studies have evaluated this association, and none has examined in relation to molecular subtypes among African women. The current analysis examines the association between body composition, defined by body mass index (BMI), height, and weight, and BC by molecular subtype among African women. METHODS: We estimated odds ratios (ORs) and 95% confidence intervals (95% CI) for the association between measures of body composition and BC and molecular subtypes among 419 histologically confirmed cases of BC and 286 healthy controls from the Mechanisms for Established and Novel Risk Factors for Breast Cancer in Women of Nigerian Descent (MEND) case-control study. RESULTS: Higher BMI (aOR: 0.79; 95% CI: 0.67, 0.95) and weight (aOR: 0.83; 95% CI: 0.69, 0.98) were associated with reduced odds of BC in adjusted models, while height was associated with non-statistically significant increased odds of BC (aOR: 1.07, 95% CI: 0.90, 1.28). In pre/peri-menopausal, but not post-menopausal women, both higher BMI and weight were significantly associated with reduced odds of BC. Further, higher BMI was associated with reduced odds of Luminal A, Luminal B, and HER2-enriched BC among pre/peri-menopausal women, and reduced odds of triple-negative BC among post-menopausal women. CONCLUSIONS: Higher BMI and weight were associated with reduced odds of BC overall and by molecular subtype among West African women. Larger studies of women of African descent are needed to definitively characterize these associations and inform cancer prevention strategies