Surgical gastrointestinal endoscopy in Ibadan, Nigeria

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Malignant Diseases of the Stomach in Ibadan, Nigeria: A 19-year appraisal

Background: Malignant lesions of the stomach have a wide geographical variation in prevalence. This study was aimed at determining the pattern of gastric malignancies in Nigeria, a developing country like and compares this to what obtains in the developed countries. Methods: a retrospective study utilizing case-files, histopathology reports and cancer registry data of patients who have been operated on for a pre-operative diagnosis of carcinoma of the stomach in the University College Hospital Ibadan, Nigeria from 1990 to 2008; a period of 19 years. Results: There were 286 patients with a male to female ratio of 1.4: 1. The age range was 24 to 99 years with an average age of 55.35 years. The yearly average was approximately 15 patients annually. There were 18% of the total who were 40 years and below. Majority of the cases were adenocarcinoma (89%) with a few other cases of Carcinoid tumour, Squamous cell carcinoma, Leiomyosarcoma, lymphomas and Gastrointestinal Stromal tumour (GIST). Conclusions: Incidence rates of malignant disease of the stomach in Nigeria affect the 50-70 years age-group, have a slight male predominance and do not seem to be increasing or decreasing. There seems to be no role at present for Helicobacter pylori in the aetiology of gastric carcinoma in Nigeria

Ward Round-An acute abdominalemergency

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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

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

Adult abdominal wall hernia in Ibadan

Background: Abdominal wall hernias are very common diseases encountered in surgical practice. Groin hernia is the commonest type of abdominal wall hernias. There are several methods of hernia repair but tension-free repair (usually with mesh) offers the least recurrent rate.Aim: To describe the clinical profile of anterior abdominal wall hernias and our experience in the surgical management of identified herniasMethods: The project was a retrospective study of all patients with abdominal wall hernia presenting into surgical divisions of University College Hospital Ibadan during a 6 year period (January 2008 to December 2013). Relevant information was retrieved from their case notes and analysed.Result: The case records of 1215 (84.7%) patients out of 1435 were retrieved. Elective surgery was done in 981(80.7%) patients while 234 (19.3%) patients had emergency surgery. There were 922 (84.8%) groin hernias and post-operative incisional hernia accounted for 9.1% (111) of the patients. About half (49.1%) of those with incisional hernia were post obstetric and gynaecologic procedure followed by post laparotomy incisional hernias 16 (14%) and others (23.5%). The ratio of inguinal hernia to other types in this study is 3:1. Hollow viscus resection and emergency surgery were predictors of wound infection statistically significant in predicting wound infection (P < 0.001). Peri operative morbidity/mortality at 28 days post operation was documented in 113 patients (12.1%). One year recurrence rate of groin hernia was 2.1%.Conclusion: The pattern of presentation and management of anterior wall hernias are still the same compared with the earlier study in this hospital. New modality of treatment should be adopted as the standard choice of care. Abdominal wall hernias are very common clinical presentation. Modified Bassini repair was the preferred method of repair due to its simplicity. Mesh repair is becoming more common in recent time but high cost and initial non-availability of the mesh limit its use in our centre.Keywords: Hernia, Mesh, Bassini, Ibada

Review of fine needle aspiration cytology in the management of goitres in Ibadan, Nigeria

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Clinical Ethics in Gabon: The Spectrum of Clinical Ethical Issues Based on Findings from In-Depth Interviews at Three Public Hospitals

Introduction Unlike issues in biomedical research ethics, ethical challenges arising in daily clinical care in Sub-Saharan African countries have not yet been studied in a systematic manner. However this has to be seen as a distinct entity as we argue in this paper. Our aim was to give an overview of the spectrum of clinical ethical issues and to understand what influences clinical ethics in the Sub-Saharan country of Gabon. Materials and Methods In-depth interviews with 18 health care professionals were conducted at three hospital sites in Gabon. Interview transcripts were analyzed using a grounded theory approach (open and axial coding),giving a qualitative spectrum of categories for clinical ethical issues. Validity was checked at a meeting with study participants and other health care experts in Gabon after analysis of the data. Results Twelve main categories (with 28 further-specified subcategories) for clinical ethical issues were identified and grouped under three core categories: A) micro level: "confidentiality and information","interpersonal, relational and behavioral issues","psychological strain of individuals",and "scarce resources";B) meso level: "structural issues of medical institutions","issues with private clinics","challenges connected to the family",and "issues of education, training and competence";and C) macro level: "influence of society, culture, religion and superstition","applicability of western medicine","structural issues on the political level",and "legal issues". Discussion Interviewees reported a broad spectrum of clinical ethical issues that go beyond challenges related to scarce financial and human resources. Specific socio-cultural, historical and educational backgrounds also played an important role. In fact these influences are central to an understanding of clinical ethics in the studied local context. Further research in the region is necessary to put our study into perspective. As many participants reported a lack of awareness of ethical issues amongst other health care professionals in daily clinical practice, we suggest that international organizations and national medical schools should consider infrastructure and tools to improve context-sensitive capacity building in clinical ethics for Sub-Saharan African countries like Gabon

Learning health professionalism at Makerere University: an exploratory study amongst undergraduate students

<p>Abstract</p> <p>Background</p> <p>Anecdotal evidence shows that unprofessional conduct is becoming a common occurrence amongst health workers in Uganda. The development of appropriate professional values, attitudes and behaviors is a continuum that starts when a student joins a health professional training institution and as such health professionals in training need to be exposed to the essence of professionalism. We sought to explore undergraduate health professions students' perceptions and experiences of learning professionalism as a preliminary step in addressing the problem of unprofessional conduct amongst health workers in Uganda.</p> <p>Methods</p> <p>Eight focus group discussions were conducted with 49 first to fifth year health professions undergraduate students of the 2008/2009 academic year at Makerere University College of Health Sciences. The focus group discussions were recorded and transcribed, and were analyzed using content analysis with emergent coding.</p> <p>Results</p> <p>The difference in the way first and fifth year students of Makerere University College of Health Sciences conceptualized professionalism was suggestive of the decline in attitude that occurs during medical education. The formal curriculum was described as being inadequate while the hidden and informal curricula were found to play a critical role in learning professionalism. Students identified role models as being essential to the development of professionalism and emphasized the need for appropriate role modeling. In our setting, resource constraints present an important, additional challenge to learning universal standards of health professionalism. Furthermore, students described practices that reflect the cultural concept of communalism, which conflicts with the universally accepted standard of individual medical confidentiality. The students questioned the universal applicability of internationally accepted standards of professionalism.</p> <p>Conclusions</p> <p>The findings call for a review of the formal professionalism curriculum at Makerere University College of Health Sciences to make it more comprehensive and to meet the needs expressed by the students. Role models need capacity building in professionalism as health professionals and as educators. In our setting, resource constraints present an additional challenge to learning universal standards of health professionalism. There is need for further research and discourse on education in health professionalism in the Sub-Saharan context of resource constraints and cultural challenges.</p