Day case surgery and developing countries- A review

Day case surgery (DCS) is increasingly practiced all over the world but with a lag between the developed and developing continents. While it has witnessed a boom in the continents of America and Europe culminating in the establishment of Freestanding and autonomous units, the developing countries still largely practice hospital based day cases with relatively limited scope and utilization. This article reviews the evolution, scope, safety, organisation including the standard necessary for establishing and practicing day case surgery and examines the practice in the developing world. Electronic literature search combined with review of both local journals and relevant texts. There is increasing need, applicability, potentials and relevance of day case surgery in the developing world with potential huge economic and social benefits. As modern day case surgery practice requires dedicated services with meticulous attention equal to that given to in-patients, efforts should be focused on providing efficient services, in well structured centres, ploughing back resources to improve infrastructural/organisational deficiencies and acquiring relevant technology with skills in the developing world

Nigeria’s Nascent Democracy and ‘WAR’ Against Corruption: A Rear View Mirror

One of the problems facing the nascent democracy in Nigeria which is morepressing than economic development is the high rate of brazen corruption invirtually all facets of the polity’s national life. Thus, the thrust of this paper isa review of the recent ‘WAR’ against corruption in Nigeria. The papersurveys a number of manifestations of corruption in the body politik and thecountry’s woes. The paper however infers that unless the institutionalmechanisms put in place are rejuvenated coupled with political will on thepart of the political actors, the so-called war may be a mirage after all.Key words: Corruption, Kleptocracy, Constitutionalism, Integrity, Poverty

Photobioreactor Technologies for High-throughput Microalgae Cultivation

The evaluation and optimisation of microalgae cultivation process for biomass, lipid and high value chemicals production requires experimental investigation of several interacting variables. This thesis addresses the development of a range of small-scale photobioreactor technologies and shows how they can be applied for rapid, early stage evaluation and scale-up of microalgae cultivation processes. In particular, the work focuses on the engineering evaluation of a novel shaken miniature photobioreactor (mPBr) and a single-use photobioreactor (SUPBr) that can be adapted for both phototrophic and heterotrophic cultivation. A prototype twin-well mPBr was initially designed and fabricated with light provided from cool white light emitting diodes (LED). This was scaled-out to a 24-well mPBr system (4 mL working volume) on a novel shaken platform. High power warm white LEDs provided a maximum light intensity of 2000 µmolm‾²s‾¹. In both systems, surface aeration (via a semipermeable membrane) and mixing were provided by orbital shaking. Real-time control of temperature, relative humidity and CO2 levels was achieved via incubator level control. Amongst the tested geometries of the mPBr, round base and pyramid base gave the best performance. The mass transfer coefficient (kLa) values in the 24-well were measured between 20 – 88 h‾¹ and visual observation of fluid hydrodynamics showed an increase in total surface area with increased shaking frequency. Negligible evaporation was observed at 90% relative humidity for light intensity of < 400 µmolm‾²s‾¹ and at 32 °C, while light intensity variation across the platform is in the range ± 20 µmolm‾²s‾¹. Evaluation of phototrophic culture kinetics of Chlorella sorokiniana in both mPBr designs showed good reproducibility between wells. The best culture performance occurred at 380 µmolm‾²s‾¹, 300 rpm and 5% CO2, where final biomass concentration and total lipid concentration achieved were 9 ± 0.2 gL‾¹ and 55% w/w respectively. The SUPBr comprised a transparent polymeric CultiBagTM operated on the illuminated rotary shaken platform described above. Mixing time values were determined over the range 40 - 220 rpm and were generally less than 40 s. Hydrodynamic studies showed three distinct flow regimes at various shaking frequencies: in-phase, transitional and out-of-phase. Under optimal flow regime, the highest cell concentrations achieved was 6.7 gL‾¹ ± 0.3. Doubling the total working volume resulted in 35 - 40% reduction in biomass concentration due to an increase in the light path length. Phototrophic scale-up criteria from mPBr to SUPBr was successfully achieved based on light–path length and kLa values. Comparison of final biomass concentrations showed similar performance of 6 ± 0.2 gL‾¹ and comparable total lipid production of 25 – 30% by weight at a light intensity of 180 ± 20 µmolm‾²s‾¹. Furthermore, application of the shaken 24-well system for heterotrophic cultivation of microalgae and scale-up to a 7.5 L stirred tank bioreactor was also shown. Cells were cultured in 24 parallel wells, shake flasks and a 7.5 L bioreactor with working volumes of 4 mL, 100 mL and 4000 mL respectively using glucose (10 gL‾¹) as the main carbon source. Constant k(L)a was chosen as scale-up criteria and the values range between 30 – 60 h‾¹. Final biomass concentrations showed good agreement in the range of 4.5 ± 0.5 gL‾¹ and total lipid production of 43 – 50% by weight for the three systems. Overall, the results show the utility of the mPBr and SUPBr technologies for the rapid evaluation and scale-up of both phototrophic and heterotrophic microalgae cultivation conditions

The Politics of States\', Local Governments\' Creation and Nigeria\'s Search for Geo-Political Balancing

Undoubtedly, one of the major absurdities of Nigerian federalism well noted in the extant literature which has also been responsible for her convoluting character is structural imbalance. This paper took a cursory look at this anomaly in line with Mill's law of federal stability. The paper reviewed all previous attempts at both state and locality creation exercises till date. The paper however inferred that it is imperative that the challenge of geo-political balancing is resolved if the polity will be stabilized. Keywords: Federalism, Ethnic-minorities, Geo-politics, State Creation, Local-Government.African Research Review Vol. 2 (3) 2008: pp. 334-36

Pancreatic Pseudocyst in Federal Medical Centre, Gombe and Review of Literature

Pseudocyst arises from pancreatic inflammation or ductal disruption and is the commonest cystic lesion of the pancreas. Although spontaneous resolution is common particularly in its early phase, progression of the cyst may culminate in grave consequences for the patient.The aim of the study is to highlight the presentation, management and outcome of pseudocyst in an environment where it is reportedly uncommon.Case series with review of literature. Although pancreatic pseudocyst is not very frequently seen in this environment, it is not entirely rare but is frequently misdiagnosed. Non specific symptoms in the early stage and subsequent confusion with various intra abdominal pathologies are among the reasons for late diagnosis and delayed intervention.Pseudocyst is amenable to surgical treatment. Early recognition is imperative in preventing complications and in defining the true incidence of this disease entity in our locality. Clinical suspicion in every setting of pancreatitis complemented by serum amylase estimations and early ultrasound scan will improve the diagnosis

Design and parallelisation of a miniature photobioreactor platform for microalgal culture evaluation and optimisation

Miniature photobioreactors (mPBr) represent a potential platform technology for the high-throughput, phototrophic cultivation of microalgae. This work describes the development and characterisation of a novel orbitally shaken twin-well mPBr, and its scale-out to a 24-well microplate format, suitable for optimisation of microalgae culture conditions. Fluid hydrodynamics, oxygen mass transfer coefficient (kLa) and light intensity distribution in the mPBr were first investigated as a function of orbital shaking frequency. High speed video analysis of the shaken wells indicated rapid fluid flow and good mixing while measured kLa values varied between 20 and 80 h−1. Light intensity variation across the scaled-out platform was in the range ±20 μmol m−2 s−1. The use of the mPBr platform was demonstrated for optimisation of conditions for the batch cultivation of Chlorella sorokiniana. Using a modified tris-base phosphate (TBP) medium, the highest biomass concentration and productivity achieved were 9.2 g L−1 and 2.5 ± 0.2 g L−1 d−1 respectively at 5% CO2 with a light intensity of 380 μmol m−2 s−1. In general, cell growth rate and yield increased with increasing shaking frequency (up to 300 rpm) while culture conditions had limited impact on pigment production. Overall, these results demonstrate the application of the mPBr for rapid optimisation of phototrophic culture conditions and establishment of high cell density cultures

Perineo-penile Degloving Exposure in Quartey's Urethroplasty: A Preliminary Report

Objective: To present a technique of stricture exposure in Quartey's urethroplasty. Methods: A retrospective analysis of case files of seven patients that underwent perineo-penile degloving (PPD) exposure for Quartey's urethroplasty was done and formed the basis of this communication.The perineo-penile degloving exposure involves a midline perineal incision to expose the bulbar urethral and a circumcising incision to deglove the penis which is later delivered to the perineum through the retro-scrotal tunnel. The urethroplasty is then done in a single operation field. Results: Seven patients with long segment urethra stricture were repaired using PPD exposure during the study period. The age ranged from 35 to 70 years with a mean of 48.6±11.1 years. The peno-bulbar site was involved in six (85.7%) of the patients. The mean intra-operative length of the stricture is 7.6±1.5cm. All the patients had Quartey's flap for their reconstruction under spinal anaesthesia with mean operation time of 3.16±0.50 hours (range 2.30 – 4.00 hours). They all had ventral on-lay repair except for one patient who had tubularization of the flap and anastomosis. Three of the patients had excellent short-term outcome. However, one patient developed slight distal penile skin necrosis, two patients had perineal wound infection and one patient could not void despite patent urethra postoperatively. Of the patients, only one had extravasation of contrast on pericatheter urethrogram which warranted leaving the urethral catheter for one more week. The mean follow-up period was 8.3±4.5 months with a range of 3 to 14 months. There has being no evidence of recurrence clinically or urodynamically thus far. Conclusion: PPD is convenient and allows tension-free, water-tight reconstruction in a single operation field with a comparable short-term outcome. Key words: urethral stricture, Quartey's urethroplasty, perineo-penile degloving, exposure

Reasons for cancellations of urologic day care surgery

Objective: The numerous economic and social benefits associated with the practice of day care surgery could be eroded by frequent cancellations. We therefore determined the reasons for such cancellations in a tertiary care centre in Nigeria.Patients and Methods: This was a prospective study of all consecutive urologic day cases seen at Jos University Teaching hospital, Nigeria from January 2003 to December 2004.Results: A total of 270 patients were seen during the study period with ages from 2 weeks to 100 years (median 55 years) and male to female ratio of 14:1. The procedures carried out were mainly urethroscopy/urethrocystoscopy in 103 (38.2%) patients, visual internal urethrotomy in 48 (17.8%) and trucut prostatic biopsy in 33 (12.2%) patients. Sixteen (5.9%), 16(5.9%), 9(3.3%) and 8(3.0%) patients had examination under anaesthesia / bladder biopsy for suspected bladder carcinoma, urethral dilatation, testicular biopsy and total orchidectomy for carcinoma of the prostate respectively.There was a cancellation rate of 15.6% (n=42) mainly due to the inability of the patients to come (24 patients, 57.1%), inadequate materials in the theatre (9 patients, 21.4%), power failure (4 patients, 9.5%), strike action (3 patients, 7.1%) and financial difficulties (2 patients, 4.8%).Conclusion: We are still faced with a high cancellation rate of urologic day cases and these are mainly due to avoidable reasons. Patient as well as physician education and provision of adequate materials andinfrastructural development are recommended to reduce these; so as to gain maximally from urologic day surgery practice

Variability of the lateral ligamentous complex of the knee

The current study examined the prevalence and morphometric values of three extracapsular ligaments on the lateral aspect of the knee namely lateral collateral ligament, anterolateral and triradiate collateral ligaments in human cadavers. Twenty knees were used. The lateral collateral ligament, anterolateral and triradiate collateral ligaments were present in 70%, 5% and 25% of the cases respectively. The triradiate collateral ligament had three parts namely femoral, tibial and fibular arms with average lengths of 20.03mm, 18.14mm and 16.20mm respectively. The lateral collateral ligament was attached on the lateral condyle of femur and the apex of head of fibula. The anterolateral ligament was attached on the lateral epicondyle of femur anterior to the origin of the lateral collateral ligament and both posterior to the Gerdy’s tubercle and on the lateral meniscus. The triradiate collateral ligament attached on the lateral condyle of femur, descends as the femoral arm and divides at the joint line as the tibial arm (anteriorly) and fibular arm (posteriorly). The tibial arm was attached on the posterior aspect of the Gerdy’s tubercle while the fibular arm was attached on the anterior aspect of head of fibula. The triradiate collateral ligament and the anterolateral ligaments possessed internal attachment to the lateral meniscus and could potentiate meniscal damage. There are considerable ligament variations at the lateral side of knee which should be brought to the knowledge of surgeons and radiologists.Keywords: Knee, Lateral complex, lateral collateral ligament, anterolateral ligament, triradiate collateral ligamen

Engineering characterisation of a shaken, single-use photobioreactor for early stage microalgae cultivation using Chlorella sorokiniana.

This work describes the characterisation and culture performance of a novel, orbitally shaken, single-use photobioreactor (SUPBr) system for microalgae cultivation. The SUPBr mounted on an orbitally shaken platform was illuminated from below. Investigation of fluid hydrodynamics indicated a range of different flow regimes and the existence of 'in-phase' and 'out-of-phase' conditions. Quantification of the fluid mixing time (tm) indicated a decrease in tm values with increasing shaking frequency up to 90 rpm and then approximately constant tm values in the range 15-40 s. For batch cultivation of Chlorella sorokiniana, the highest biomass concentration achieved was 6.6 g L(-1) at light intensity of 180 μmol m2 s(-1). Doubling the total working volume resulted in 35-40% reduction in biomass yield while shaking frequency had little influence on culture kinetics and fatty methyl esters composition. Overall this work demonstrates the utility of the SUPBr for early stage development of algal cultivation processes