A five-year review of nephrectomies at the Lagos State University Teaching Hospital (Lasuth) Ikeja Lagos

Background: Nephrectomies are performed for various reasons ranging from benign to malignant renal diseases. The surgical approach for a nephrectomy also varies with location. In Nigeria and many other developing countries, the major technique of performing a nephrectomy is an open approach.Objective: The objective of the study was to evaluate the cases of nephrectomies performed over a 5-year period at the Lagos State University Teaching Hospital, Ikeja and compare the findings with those from other institutions in our region.Materials and Methods: This was a retrospective study. The clinical records of consecutive patients who had nephrectomies done over a 5-year period between January 2009 and December 2014 were reviewed. The data extracted from their record included age, sex, indication for  nephrectomy, laterality (whether right or left), surgical approach, duration of surgery, the incidence of blood transfusion, histological findings and treatment outcome.Results: The records of a total of 40 patients were available. There were 16 males (40%) and 24 females (60%) with a M:F ratio of 1:1.5. The mean age was 44.75 ± 17.16 years (range: 3-70 years). The indication in the majority of the patients was renal malignancy (n = 30, 75%) while the remaining 10 (25%) were benign cases ranging from non-functioning hydronephrotic kidneys from pelviureteric junction obstruction to staghorn calculi. A total of 25 cases (62.5%) were on the right, while 15 (37.5%) were on the left. The imaging study done for diagnosis was majorly an abdominopelvic CT scan in 32 patients (80%). Twenty-one patients (52.5%) had a flank approach, while 19 patients (47.5%) had an anterior approach for their surgery. The mean duration of surgery was 140 ± 53.2 minutes (range 60-270 minutes). 27 patients (67.5%) were transfused perioperatively. The majority (n = 14, 46.7%) of the patients with renal malignancy had a histological diagnosis of the papillary variant of renal cell carcinoma. 32 patients (80%) were followed up for at least 3 years, while the rest were lost to follow up. The quantity of blood transfused correlated with the duration of the surgery.There was no perioperative mortality.Conclusion: Renal malignancies are the most common indication for nephrectomy in our centre. Though associated with a high transfusion rate, open nephrectomy (even when performed for a malignant condition) remains a safe procedure with a good outcome. Keywords: Nephrectomy, Renal malignancies, Blood transfusio

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Compton scattering tomography for agricultural measurements

This paper presents a new approach in tomographic instrumentation for agriculture based on Compton scattering, which allows for the simultaneous measurements of density and moisture of soil samples. Compton tomography is a technique that can be used to obtain a spatial map of electronic density of samples. Quantitative results can be obtained by using a reconstruction algorithm that takes into account the absorption of incident and scattered radiation. Results show a coefficient of linear correlation better than 0.81, when comparison is made between soil density measurements based on this method and direct transmission tomography. For soil water contents, a coefficient of linear correlation better than 0.79 was found when compared with measurements obtained by time domain reflectrometry (TDR). In addition, a set of Compton scatter images are presented to illustrate the efficacy of this imaging technique, which makes possible improved spatial variability analysis of pre-established planes

Volume of intersection of two cones

Radiation measurements utilising collimated source and detector systems invariably result in a target volume described by the overlap of their fields of view. When these collimators are cylindrical, this is derived from the volume of intersection of two cones. In general, analysis of this volume does not lend itself to a direct analytical process. Here, numerical methods of estimating the common volume of two intersecting right cones are presented. These include methods which employ, (a) a sequential scanning of an elemental volume with a predetermined size across a defined space containing the volume of interest and (b) a Monte Carlo technique. The accuracy obtainable and the execution time in the first type of algorithm depend on the size of the elemental volume (bin-size). On the other hand, these two parameters are independent of the bin-size but dependent on the number of histories sampled, for the Monte Carlo technique. At 0° angle of inclination, where an analytical estimation is easily obtained, the three algorithms considered here resulted in values with a precision better than 0.1% when compared to the analytically calculated one

90° Compton and Rayleigh measurements and imaging

A simple apparatus for measurement and imaging of objects using scattered X-rays was designed and constructed. This is composed of a well-collimated photon beam from an X-ray tube, a CZT thermoelectrically cooled semiconductor detector and an (x, y, θ) translation-rotation table containing the object to be studied. First, the output beam was monochromatized; studies on Compton and Rayleigh scattered radiation were then carried out, including the Compton profile. Then direct bremsstrahlung radiation of proper energy was employed, and energy intervals are selected where Rayleigh or Compton effects largely prevail. Compton images were finally obtained

Activities of Amodiaquine, Artesunate, and Artesunate-Amodiaquine against Asexual- and Sexual-Stage Parasites in Falciparum Malaria in Children

The activities of amodiaquine, artesunate, and artesunate-amodiaquine against asexual- and sexual-stage parasites were evaluated in 360 Nigerian children with uncomplicated Plasmodium falciparum malaria randomized to the standard dose regimens of the three drugs/combination. Clinical recovery from illness occurred in all children. There were no significant differences in fever clearance times. Patients treated with artesunate or artesunate-amodiaquine had significantly shorter parasite clearance times (1.4 ± 0.5 days or 1.4 ± 0.6 days versus 3.2 ± 2.3 days, P = 0.0001) and lower gametocyte carriage rates (3.3 or 1.7% versus 11.7%, P = 0.001) than those treated with amodiaquine alone. Gametocytemia was detected in 62 patients (11.7% before treatment and 5.6% after treatment). The pretreatment gametocyte sex ratio, which was female biased, increased significantly during the course of treatment with amodiaquine but not with artesunate and artesunate-amodiaquine. These results suggest that artesunate and artesunate-amodiaquine reduce gametocyte carriage and may reduce transmissibility in P. falciparum malaria by accelerating asexual clearance and influencing gametocyte sex ratio

Numerical investigation and sensitivity analysis of turbulent heat transfer and pressure drop of Al2O3/H2O nanofluid in straight pipe using response surface methodology

In this paper, investigation of the effect of Reynolds number, nanoparticle volume ratio, nanoparticle diameter and entrance temperature on the convective heat transfer and pressure drop of Al2O3/H2O nanofluid in turbulent flow through a straight pipe was carried out. The study employed a computational fluid dynamic approach using single-phase model and response surface methodology for the design of experiment. The Reynolds average Navier-Stokes equations and energy equation were solved using k-ε turbulent model. The central composite design method was used for the response-surface-methodology. Based on the number of variables and levels, the condition of 30 runs was defined and 30 simulations were performed. New models to evaluate the mean Nusselt number and pressure drop were obtained. Also, the result showed that all the four input variables are statistically significant to the pressure drop while three out of them are significant to the Nusslet number. Furthermore, sensitivity analysis carried out showed that the Reynolds number and volume fraction have a positive sensitivity to both the mean Nusselt number, and pressure drop, while the entrance temperature has negative sensitivities to both

Trace Element Analysis of Cancerous and Non-cancerous Breast Tissues of African Women in Southwest Nigeria Using Particle-Induced X-ray Emission Technique

In this study, we applied particle-induced X-ray emission (PIXE) spectroscopy to investigate the levels of trace elements in breast tissues and whole blood (cancerous and non-cancerous) of selected African women in Ile-Ife, Southwest Nigeria. Freeze-dried and homogenized specimens obtained through mastectomy from clinically diagnosed patients were made into 11-mm-diameter pellets. The pellets were irradiated with 2.5 MeV proton beam energy from a 1.7 MV 5SDH Tandem accelerator. The PIXE analytical system was calibrated with certified reference matrices of Bovine Liver and Animal Blood: NIST 1577a and IAEA-A-13, respectively. A total of 23 elements: Na, K, Ca, Cl, S, Al, P, Si, Zn, Pb, Br, Rb, Zr, Se, Sr, Mn, V, Ti, Cu, Fe, Ni, Cr, and Mg were detected. The results indicated that the levels were within 0.9-5288 and 0.6-2320 ppm in breast tissues and 0.3-17228 and 2.0-2475 ppm in the whole blood of cancerous and non-cancerous subjects, respectively. At the .05 level of significance, significant differences exist between these levels in the cancerous and non-cancerous breast tissues ( t  = 0.008) as well as the whole blood ( t  = 0.041). The results gave the baseline concentration of the observed trace elements in the normal and malignant subjects and indicated PIXE as a powerful tool for such investigation

Waiting Times for Prostate Cancer Diagnosis in a Nigerian Population

Background. Prostate biopsy remains an important surgical procedure in the diagnostic pathway for prostate cancer, but access to prostate biopsy service is poorly studied in the Nigerian population. While there has been a well-documented delay in patient presentation with prostate cancer in Nigeria, little is however known about how long patients wait to have a histological diagnosis of prostate cancer and start treatment after presenting at Nigerian hospitals. Method. This was a descriptive retrospective study to document the specific duration of the various timelines in getting a diagnosis of prostate cancer at the Lagos State University Teaching Hospital, Ikeja, Nigeria. Results. There were 270 patients. The mean age was 69.50±8.03 years (range 45-90). The mean PSA at presentation was 563.2±1879.2 ng/ml (range 2.05-15400), and the median PSA was 49.3 ng/ml. The median waiting times were (i) 10 days from referral to presentation; (ii) 30 days from presentation to biopsy; (iii) 24 days from biopsy to review of histology; (iv) 1 day from histology review to discussion/planning of treatment. The median overall waiting time from referral to treatment was 103 days. The mean time from presentation to biopsy was significantly shorter for patients with PSA of ≥50 ng/ml compared to those with PSA<50 ng/ml. p=0.048. Overall, the median time from biopsy to histology was significantly shorter for patients whose specimens were processed in private laboratories (17 days) compared to those whose specimens were processed at the teaching hospital laboratory (30 days), p≤0.001. Conclusion. There is a significant delay within the health care system in getting a prostate cancer diagnosis in the Nigerian population studied. The major points of the identified delay were the waiting time from patient presentation to having a biopsy done and the histology report waiting time