Management of undescended testes in children in Zaria, Nigeria

Objective: To study the presentation, management and outcome of undescended testes inchildren in a northern Nigerian population.Design: Retrospective study.Setting: Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.Subjects: Thirty six children aged £12 years with 43 undescended testes managed in 10 years.Interventions: Orchidopexy, orchidectomy , herniotomy.Results: The age at surgery was fourteen months to 12 years (median six years); four (11%) had correction before two years, 15 (42%) before five years and 21 (57%) at age ³ 5 years. Thirty two (74%) testes were palpable and eleven (26%) non-palpable. Evaluation wasmainly clinical. Ultrasonography was performed for three non-palpable testes but was not helpful. Laparoscopy was not used in any patient. The condition was unilateral in 29 (81%) and bilateral in seven (19%). Forty five per cent of the testes were in the inguinal canal, 31%at the external ring, and 12% each at the internal ring and abdomen respectively. Ten (24%) testes were macroscopically atrophic (canalicular five, abdominal four, internal ring one). Orchidopexy was performed for 37 undescended testes and orchidectomy for four. Groinand scrotal haematoma developed following one orchidopexy. Following orchidopexy, four (10%) testes retracted necessitating repeat surgery.Conclusion: There is a need to educate parents, traditional birth attendants, midwives and doctors in our environment to ensure earlier presentation and treatment

Urinary stones in children

Urinary stones were previously thought to be uncommon in the paediatric age however this may be due to differences in presentation and evaluation of children with stones. There are variations in the incidence worldwide; affected by diet and climate. Common aetiological factors are metabolic changes, urinary tract abnormality and urinary tract infections. The patho-physiological processes leading to stone formation are multifactorial involving interplay of increasing concentration of particles in urine, such as calcium, magnesium, phosphates, oxalates, alteration in urine pH and a decrease in the flow of urine or stasis. Presentation may be acute or non-specific and varied thus diagnosis is often difficult or delayed and a wide range of imaging techniques, urine and serum biochemical analysis are needed for evaluation. Treatment must also be directed towards removing the underlying cause(s) of the stone where this is identified as well as dealing with the pathological affects of the stone if recurrence is to be minimized. Nigerian Journal of Surgical Research Vol. 7(3&4) 2005: 238-24

Overcrowding of accident & emergency units: is it a growing concern in Nigeria?

Background: The inability of the Nigeria’s Accident and Emergency Departments (AED) to meet current demands is growing among the public and health care professionals. The data supporting perceptions of insufficient capacity are limited. Therefore, this study was intended to determine the prevalence, causes, and effects of overcrowding AEDs in Nigeria.Materials and Methods: This was a cross sectional, descriptive study carried out among AED staff of 3 referral teaching hospitals in Nigeria, using a pre-tested and validated structured questionnaire.Results: The analysis of the 267 AED staff revealed 20-56years (36.40+5.1 mean) age range. One hundred and twenty eight (47.9%) were males, 139 (52.1%) females. Two hundred and fifty nine (97%) agreed that an AED should have a bed capacity of 21-30. Agreement to AED overcrowding in Nigeria was quite considerable. The frequency of AED overcrowding per week was 4-7 times. The average bed occupancy level was 3.25. Agreed common causes of prolonged AED admissions were to be a high volume of critically ill patients, Delayed transfer of patients to the wards, delay in theatre operation, delay in radiological investigations and exceptionally high proportion of patients requiring admission in AED. Also, long pre-review waiting time and haematological delays were more causes. The average waiting time for victims to be seen was 29.7minutes.Conclusion: There are many causes of AED overcrowding in this environment. However, improving AED bed management, better organized and diligent discharge planning, and reducing access block should be a priority to reduce AED overcrowdingKeywords: Overcrowding, accident, emergency surgery, Nigeri

A Technique to Avoid the Marginal Artery During Divided Colostomy in Neonates

Colostomy is a frequently performed procedure in neonates presenting with anorectal malformation and Hirschsprungs disease. A divided colostomy is more commonly performed but has a definite risk of injury to the marginal artery during the procedure, leading to stoma necrosis. This is a description of a technique which identifies, displaces and preserves the marginal artery during colostomy construction and therefore ensures a safer colostomy in neonates without the danger of necrosis. Key words: Technique. Marginal artery, Colostom

Phytochemical Screening and Antibacterial Activities of Aframomum melegueta (K. Schum) Seed Extracts on Salmonella typhi and Klebsiella pneumoniae

The phytochemical screening and antibacterial effects of Aframomum melegueta (K. Schum)on Salmonella typhi and Klebsiella pneumoniae was carried out. The phytochemical screening revealed the presence of alkaloids, flavonoids, tannins, saponins, steroids, anthraquinones, terpenoids, glycosides and phenols in the seed extract. The susceptibility test showedzones of inhibition (ZOI) of S. typhi (11.0mm) and K. pneumonia (13.0mm) with methanolic seed extract (MSE), while the hot aqueous seed extract (HASE) recorded 3.0mmas ZOI for both test organisms. The Minimum inhibitory concentration (MIC) of 200mg/ml and 100mg/ml were recorded against S. typhi and K. pneumoniae respectively with MSE, while HASE indicated 400mg/ml and 200mg/ml MICs against S. typhi and K. pneumoniae respectively. The Minimum Bactericidal Concentration (MBC) obtained from MSE were 200 mg/ml and 25mg/ml for S. typhiand K. pneumoniae, while HASE had > 400mg/ml for test microbes. The effectiveness of different concentrations of the test plant extracts on the test organisms was significant (P<0.05). Further trials involving other clinical isolates and botanicals at different concentrations be conducted, to optimize theprocess

Adenocarcinoma arising in a cystic duplication of the small bowel: case report and review of literature

Enteric duplications are rare, but can occur anywhere along the digestive tract. Most of the patients become symptomatic in early childhood and only a few cases of adult patients have been reported in literature. Here we report a unique case of an adenocarcinoma arising in a coincidentally found cystic duplication of the small bowel

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction 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. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer