The Medical Social Worker: A Neglected Ally in the Management of Patients with Burn Injuries

Burn injuries come with enormous challenges and devastation to the victims. The consequences get worse when multiple members of a family are involved. Social supports are necessary, especially where health financing is mainly through out-of-pocket expenditure. The use of Medical Social Workers (MSW) in burn care in our region is limited, and their roles are poorly or inadequately reported. This study appraises the role of MSW in the multidisciplinary management of burn patients. We report the management of an impoverished family of five who sustained varying degrees of burn injuries, and the role MSW played in their care. Beyond being a routine discharge planner, the MSW provided social support, psychotherapy and rallied community support, which translated to an improved outcome for the patients. Involving MSW in burn care provides great benefit to patients. Burn surgeons are therefore encouraged to use the added value of MSW on their teams. Keywords: Burn, Injury, Medical social worker, Healthcare financin

Breast cancer patients’ presentation for oncological treatment: a single centre study

Introduction: Breast cancer patients are presenting at advanced stages for oncological treatment in Nigeria and World Health Organization predicted developing countries’ breast cancer incidence and mortality to increase by year 2020. Methods: Prospective observational hospital based study that enrolled breast cancer patients from catchment area of an oncology service hospital in Nigeria between 2007 and 2013. Patients’ demographics, breast cancer burden and health care giver presentation variables were analysed for causal factors of seeking medical help and what determines commencement of effective oncological treatment. Results: Forty-six patients were enrolled, 19.6% of them presented primarily to oncologist while 80.4% presented secondarily for oncological treatment. There is a significant difference in presentation time for oncological treatment (t = -3.56, df = 42.90, p = 0.001) between primary (M =11.56 ± 5.21 weeks) and secondary presentation (M= 52.56 ± 10.27weeks) . Tumor burden of those that presented secondarily were significantly more advanced (U = 78.5, p = 0.011) and, univariate analysis reveals that: patients’ matrimonial setting, breast cancer awareness and mode of discovery of breast symptoms are patient related factors that determines their choice of health care providers and, determinant of effective oncological treatment is patient first contact health care provider. Conclusion: Patients’ bio-characteristics that determine their choice of health care provider should be incorporated into community breast cancer sensitization drives. Additionally, there is a need for a government agency assign the task of accrediting and defining scope of enterprise of health care institutions and their health care providers in our pluralist health system.Pan African Medical Journal 2016; 2

Childhood intussusception in Ile-ife: What has changed?

Background: Intussusception is one of the most common causes of intestinal obstruction in children. While the outcome has improved in the developed nations, the same cannot be said of the developing countries, more especially in the sub-Saharan region. This study aims to review our current experience in the management of childhood intussusception and factors affecting surgical outcome at the Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife. Patients and Methods: This was a retrospective study of 78 patients treated for intussusception at paediatric surgical unit of Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife between January 1993 and December 2011. The case notes of the patients were retrieved and the following information was recorded: Demographic characteristics, month of occurrence, clinical presentation, investigations, and management as well as the post-operative outcome. The patients were divided into two groups in terms of outcome. Results: There were 58 males and 20 females (M:F = 2.9-1). The age of most of the patients was between 3 months and 9 months with peak incidence at 6 months. Most patients 46 (58.9%) were seen during the dry season of December to April. Only six patients (7.7%) presented within 24 hours of onset of illness. More than half of the patients presented after 24 hours. Passage of red currant stool, vomiting, abdominal pain, fever, and abdominal distension, passage of watery stool, anal protrusion and palpable abdominal mass in various combinations were the clinical features. All the patients had surgical operations. The most common type of intussusception was ileo-colic type in 64 patients (82.1%). Intestinal resection rate was 41%. The overall mortality rate was 15.4%. Conclusion: There was a delay in presentation of children with intussusception with high post-operative mortality

Posterior urethral valves in children: Pattern of presentation and outcome of initial treatment in Ile-Ife, Nigeria

Background: The management of posterior urethral valves (PUV) and its sequelae is still a challenge to most pediatric surgeons in our environment due to late presentation and inadequate facilities for long-term evaluation and treatment. Despite initial successful treatment about 40% would develop chronic renal failure. The aim is to describe the presentation, management and outcome of the initial treatment in boys with PUV. Materials and Methods: It is a retrospective analysis of PUV in boys 8 years and below over a 17 years period. Demographic characteristics, clinical features, investigations, and treatment outcome were reviewed. Results: Thirty-seven cases were analyzed. The median age was 5 months (range from birth to 8 years). Three (8.1%) patients had prenatal ultrasound diagnosis. The most common presentation was voiding dysfunction 37 (100%). Part of the preoperative investigation included micturating cystourethrogram (n = 31: 83.8%) and abdomino-pelvic ultrasonography (n = 37:(100%). The mean serum creatinine value of those who presented within thefirst 30 days of life and those who presented afterwards were 325 (±251) µmol/L and 141 (±100) µmol/L respectively, P = 0.003. Surgical interventions included trans-vesical excision of valves (n = 9: 28.1%), valvotomy (n = 10: 31.3%), balloon avulsion (n = 8: 25.0%), vesicostomy (n = 4: 12.5%) and endoscopic valve avulsion (n = 1: 3.1%). Seventeen (56.7%) patients had serum creatinine >70.4 µmol/L after 1-month of valve excision. Five (13.5%) patients had postrelief complications and 5 (13.5%) died on admission. Ninety percentage (27/30) of patients had poor prognostic indices. Conclusions: The initial treatment outcome was good but most had poor prognostic factors

Management of Locally Advanced Breast Cancer: Challenges and Treatment Outcomes in an Emerging Tertiary Hospital in South-Western Nigeria

Introduction: Patients presenting with advanced breast cancer is a common phenomenon in Nigeria and many developing countries. At this stage, patients’ high expectations of survival conflict with the realities of the clinical outcome, thus creating enormous challenges to the attending surgeon practicing in a resource-poor setting. Aim: To evaluate patients who presented with Locally Advanced Breast Cancer (LABC), management challenges and treatment outcomes. Materials and Methods: This was a retrospective study of patients with LABC at Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti between January 2016 and December 2018. The variables of interest were patients’ demographics, findings of triple assessment, presentation, diagnosis, treatment intervals, the treatment received and follow-up outcomes. Results were presented using descriptive statistics mean±SD, median and Interquartile Range (IQR). Results: Seventy-eight patients had LABC in the study period. ages ranged from 24-94 years (mean 50.1±14.0). Total 77 (98.7%) were females and patients had breast lump ranging in size from 3-22 cm (mean 8.7±3.3, median 8, IQR 6-10). A vast majority of patients (84.6%) had tumour >5 cm in size. More than two-thirds (69.2%) were clinical stage IIIB. The duration of symptoms was 2-42 months (mean 10.1±7.8). The duration between presentation and cancer confirmation ranged from 7-140 days (mean 40.1±32.1, median 28.5, IQR 16.5-60.0). There was no facility to determine the receptor status of the tumours. Forty-six (59.0%) patients were routinely placed on tamoxifen (hormone therapy). Fifty-six (71.8%) patients had Modified Radical Mastectomy (MRM). Only 30 (38.5%) completed the chemotherapy schedules while the rest had them haphazardly, mainly due to financial reasons. Five out of 22 (22.7%) referred for radiotherapy received it after an average of 5.2 months. Postmastectomy, 7 had loco-regional recurrence at one year and 15 within three years. Overall, 40 were alive, 16 were dead while 22 were lost to follow-up at three years. There was significant difference in 3-year survival among those who had chemotherapy and mastectomy compared to those who had just one of the two (Fisher’s-exact p=0.002). Conclusion: Delayed presentation, diagnostic and treatment inadequacies are the common challenges of management of LABC. Early diagnosis, adequate provision of diagnostic facilities and subsidisation of all aspects of care will be a reasonable panacea to some of the challenges