Penetrating abdominal injuries in children: a study of 33 cases

Background: Trauma is gradually becoming a major cause of disability and it can be of any form, physical or emotional. For the surgeon the physical form is of major interest, especially its causes and incidence, which can be influenced by environmental or social factors.Aim: The aim of this work was to study the incidence, etiology, principles of management and outcome of children with penetrating abdominal injuries.Materials and methods: This was a 2-year prospective study of 33 children aged 0–15 years with penetrating abdominal injuries at the University of Maiduguri Teaching Hospital in northeast Nigeria. Information obtained included the following: the patient’s biodata, mechanism of injury, time of presentation to the Accident and Emergency Department after the injury, haemodynamic status at presentation, presence or absence of abdominal organ evisceration, presence or absence of associated injuries, the timing of surgery, intraoperative findings, the type of surgical procedure and outcome.Results: Thirty-three (31.4%) children [of whom 24 (i.e. 72.7%) were from the rural areas] of 105 children with trauma-related injuries had penetrating abdominal injuries. The male : female ratio was 3 : 1, and the mean age ± SD was 2.30± 0.81 years. There were 15 (45.4%) children with gunshot wounds, 11 (33.3%) with bomb blast wounds, three (9.1%) with impalement injuries and two (6.1%) with arrow injuries. Fourteen (42.4%) patients had abdominal organ evisceration; of them, nine were as a result of gunshot injuries. Routine exploratory laparotomy was carried out in all 33 patients. Seven (21.2%) were operated on with simultaneous resuscitation in the immediate laparotomy group, and 26 (78.8%) underwent delayed laparotomy. There was a negative laparotomy in four (12.1%) patients, two of whom had only omental evisceration with no other accompanying visceral injuries, and two without evisceration. Three (9.1%) patients died after developing enterocutaneous fistula, compartment syndrome and sepsis.Conclusion: There were more cases of penetrating abdominal injuries among boys and children from the rural areas than in those from urban areas.Keywords: evisceration, exploratory laparotomy, penetrating abdominal injur

Wilms’ tumour: an 18-year treatment outcome and challenges faced in managing this tumour in developing countries

Background: The survival rate of nephroblastoma (Wilms’ tumour) has significantly improved, but the outcome of managing it in developing countries leaves much to be desired, mortality and morbidities still are high.Objectives: The aim of this study is to review the treatment outcome of nephroblastoma in Nigerian children and to identify factors that play a role in the poor outcome in our setting.Materials and Methods: This is an 18-year retrospective study of children aged 15 years with Wilms’ Tumour (WT) in two federal tertiary hospitals in northeast Nigeria. Data was obtained from patients’ medical records and the operating registers. Kaplan- Meier test was used to estimate the 2- and 5-year survival rate and the Log Rank analysis employed for the significance of survival rate according to the stage of the tumour.Results: There were 44 children, 25 (56.8%) boys and 19 (43.2%) girls in a ratio of 1.3:1 with a median age of presentation of 4 years, and only 3 (6.8%) patients presented in less than 2 months of onset of symptoms. Painless abdominal swelling was the most prominent symptom in 35(79.5%) children followed by weight loss in 15(34.1%). All the patients were managed according to the International Society of Paediatric Oncology (SIOP) protocol. Twenty-five patients (25, 60.9%) had a full course of post operative chemotherapy out of whom 11 (44.0%) of them were referred for radiotherapy. Eight (19.1%) patients defaulted post-operative chemotherapy. Twentyone (47.7%) patients died; 14(66.7%) of their tumour, and 7(33.3%) from treatment related complications. Thus the overall survival rate was 52.3% after a median follow up of 24.5 months. Two- and 5-year survival rates were 43.2% (CI 28.5-57.8%) and 11.4% (CI 2.0-20.7%) respectively.Conclusion: Our study revealed poor treatment outcome from WT, probably because of associated late presentation and incomplete treatment

Knowledge of Hepatitis B Vaccine among Operating Room Personnel in Nigeria and Their Vaccination Status

Background. Hepatitis B virus (HBV) infection is a well recognised occupational health hazard preventable by vaccination. Objectives. To determine the knowledge of operating room personnel (ORP) in Nigeria about the Hepatitis B vaccine, their perception of Hepatitis B vaccination and vaccination status against HBV. Methods. Four university hospitals were selected by simple random sampling. A structured questionnaire was administered to 228 ORP after obtaining consent. Result. Only 26.8% of ORP were vaccinated against HBV. The primary reason for not being vaccinated or for defaulting from vaccination was lack of time. Differences in age, sex, duration of practice and respondent's institution between vaccinated and unvaccinated ORP were not significant (P > 0.05). The majority (86.8%) had the awareness of the existence of Hepatitis B vaccine. 83.8% of respondents believed that the vaccine should be given to the ORP as part of work place safety measures. The majority were aware of the modes of transmission of HBV infection. 78.9% of respondents believed that Hepatitis B vaccine is safe and 81.1% would recommend it to another staff. Conclusion. Despite a good knowledge about HBV infection and vaccine, most of ORP are still not vaccinated. Hepatitis B vaccination should be a prerequisite for working in the theatre, hence putting surgical patients at reduced risk

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

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care