Palliative surgery for cancer in southwest Nigeria

Background: Most patients with cancer in the low-income environment present late, when the chances of cure are remote. Palliative care which includes surgery is needed to improve quality of life and minimize suffering and emotional disturbances associated with end of life.Methodology: Retrospective study of palliative surgery cases over five years. Data extracted included demographic features, diagnosis, procedure carried out, clinical status at 30 days postoperative, and survival.Results: 1,581 patients were operated over the study period. 227 patients were operated for malignancies; of these 91 patients (40%) had palliative procedures. The diagnoses in palliative surgery cases: prostate cancer 50 patients (54.9%), breast cancer 14.3%, stomach cancer 9.9%, and others. Indications for surgery were: urinary bladder outlet obstruction 46.1%, pleural effusion 14.3 %, obstructive jaundice 13.2%, and others. Bilateral total orchidectomy was performed in 50.5%, tube thoracostomy in 14.3%, laparotomy and biopsy in 11%. Thirteen patients (14.3%) died postoperatively; 57 patients (62.6%) were alive and well at 30 days after surgery. Survival period was <1 to 53 months with a mean of 8 months.Conclusion: Palliative surgery is useful in some patients with cancer. Facilities for less invasive procedures should be improved.Keywords: Palliative surgery, Cancer, Outcom

Large penile plexiform neurofibroma in an 11-year old boy

BackgroundNeurofibromatosis is a genetically inherited disorder of the nervous system (brain and spinal cord) which mainly affects the development of nerve (neural) cell tissues, causing tumors (neurofibromas) to develop on nerves. It is the most common single gene disorder of the nervous system and inheritance is through autosomal dominance. They are usually classified into types 1 and 2, the type 1 is the commoner type and also known as superficial neurofibroma. Plexiform neurofibromas are the next most common type of tumor in individuals with type 1 neurofibroma.   Plexiform neurofibromas are histologically benign tumors that are made up of a variety of cell types including neuronal axons, Schwann cells, fibroblasts, mast cells, macrophages, perineural cells and extracellular matrix materials such as collagen.  They can occur in any part of the body and can grow throughout the person’s lifetime, often becoming disfiguring, disabling or deadly via compression of vital structures or conversion to a malignant sarcoma or malignant peripheral nerve sheath turmor. The aim of this report is to present a large penile plexiform neurofibroma which required extensive dissection for complete excision and reconstruction of the phallus and glans penis.ObjectivesTo present a huge penile plexiform neurofibroma and the mode of surgical treatment.MethodsThe huge penile plexiform neurofibroma was completely excised and the penile defect resulting from the excision was repaired.ConclusionPlexiform neurofibromas are congenital tumors of peripheral nerve sheaths which may also develop near nerve roots deep within the body. They are usually benign but carry a malignant potential in 5-10% of patients. Plexiform neurofibromas are commoner in the face, chest and limbs but the index case occurred on the penile shaft.

Cloud computing: narzędzie do skutecznego zarządzania dokumentacją i informacjami w nigeryjskich bibliotekach akademickich

Akademische Bibliotheken haben im Rahmen ihrer traditionellen Aufgaben die Sammlung und Generierung von Daten und Aufzeichnungen unterschiedlicher Sensitivität und Nützlichkeit übernommen. In dieser Studie wurde die Bedeutung von Bibliotheksdokumentation untersucht, und es wurde die Einführung von Cloud-Computing-Technologie als realistische Alternative zu anderen Speicherungsmethoden für Dokumentation befürwortet. Das Cloud-Computing als Werkzeug zur Dokumentenverwaltung kann dazu beitragen, die unzähligen Aufzeichnungen, die im Rahmen des täglichen Bibliotheksbetriebs generiert werden, aufzubewahren. In dem Artikel wurde auch auf die Gefahr hingewiesen, die mit der papierbasierten oder elektronischen Speicherung von Informationen verbunden ist. Es wurde argumentiert, dass Informationen, die in diesem Format gespeichert sind, anfällig für Verluste durch Diebstahl, Feuer oder Computerviren, Festplattenausfälle und die Zerstörung des lokalen Bibliotheksservers aufgrund schlechter Wartungskultur des Personals sind. Neben der Funktion der Datensicherung ist der Fernzugriff auf diese Aufzeichnungen ein weiterer wichtiger Faktor, der bei der Verwendung von Cloud-Computing-Werkzeugen zur Verwaltung von Bibliotheksdokumenten berücksichtigt werden sollte. Aufgrund des erheblichen Potenzials, insbesondere in Bezug auf flexible Speichermöglichkeiten, wird dies insbesondere allen akademischen Bibliotheken im Land empfohlen. Es wurde jedoch festgestellt, dass Kosten für Daten und unregelmäßige Stromversorgung nur einige der Herausforderungen sind, die der Einführung von Cloud-Computing in Nigeria im Wege stehen, sowie die Anfälligkeit für Cyberangriffe, die zu teilweisem oder vollständigem Datenverlust führen können. Daher wird empfohlen, dass Cloud-Computing im Sinne einer Plattform für Dienste als Backup-Plattform, und nicht als das einzige Werkzeug zur Verwaltung von Dokumenten und Daten in akademischen Bibliotheken verwendet wird.Academic libraries, as part of their traditional responsibility, engage in the collection and generation of data and records with a various degree of sensitivity and usefulness. This study examined the importance of library record and advocates for the implementation of cloud computing technology as a viable alternative to other mode of record storage. Cloud computing as a record management tool will help preserve the myriad of records generated from the daily activities of  libraries. The paper also identified the danger of paper or electronic method of information storage. It argued that information stored in this format is susceptible to loss by theft, fire or computer viruses, hard drive collapse as well as the destruction of local library internet server due to poor maintenance culture on the part of the personnel. Apart from the data backup function, remote accessibility of these record is another key consideration for cloud computing utility in library record management. In view of the vast potential, especially in the area of its elastic storage capability, it is highly recommended for all academic libraries in the country. However, it is observed that the cost of data and irregular power supply are some of the challenges facing its adoption in Nigeria, as along with the vulnerability to cyber-attacks which may lead to a partial or total loss of record. In these regards, it is further recommended that cloud computing, as a service platform, is adopted as a backup platform rather than a sole tool for record and data management in academic libraries.Biblioteki akademickie w ramach swoich tradycyjnych zadań, angażują się w gromadzenie i generowanie danych i dokumentów o różnym stopniu wrażliwości i użyteczności. W badaniu tym zbadano znaczenie zapisów bibliotecznych i opowiedziano się za upowszechnieniem technologii przetwarzania w chmurze jako realnej alternatywy dla innego trybu przechowywania rekordów. Chmura obliczeniowa jako narzędzie do zarządzania rekordami pomoże zachować ich niezliczoną ilość generowaną podczas codziennej działalności bibliotek. W artykule zidentyfikowano również niebezpieczeństwo związane z papierową lub elektroniczną metodą przechowywania informacji. Zastosowano argument, że informacje przechowywane w tym formacie są podatne na utratę w wyniku kradzieży, pożaru lub wirusów komputerowych, uszkodzenia dysku twardego, a także zniszczenia lokalnego serwera internetowego biblioteki z powodu złego sposobu konserwacji ze strony personelu. Oprócz funkcji tworzenia kopii zapasowych danych, zdalny dostęp do tych rekordów jest kolejnym kluczowym czynnikiem dla narzędzia przetwarzania w chmurze w zarządzaniu rekordami bibliotecznymi. Ze względu na ogromny potencjał, szczególnie w zakresie możliwości elastycznego przechowywania, jest wysoce zalecany dla wszystkich bibliotek akademickich w kraju. Obserwuje się jednak, że koszt danych i nieregularne zasilanie to niektóre z wyzwań stojących przed jego przyjęciem w Nigerii, razem z podatnością na cyberataki, które mogą prowadzić do częściowej lub całkowitej utraty danych. W związku z tym zaleca się ponadto, aby chmura obliczeniowa jako platforma usługowa została przyjęta jako platforma kopii zapasowych, a nie jako jedyne narzędzie do zarządzania dokumentacją i danymi w bibliotekach akademickich

Chest Compression Only Cardiopulmonary Resuscitation (CCO-CPR) in out-of-hospital cardiac arrest and low resource setting - a case report

Statement of the problem: Out-of-hospital cardiac arrest (OHCA) often occurs in our population, but is rarely reported. Chest compression only (CCO) has been emphasized to manage such conditions by the lay rescuers and not by the trained expert who is unwilling to give mouth-to-mouth rescue breathing.Objective: To demonstrate the usefulness of Chest Compression Only Cardiopulmonary Resuscitation (CCO-CPR) by a bystander rescuer and potentially a CPR expert, who was not willing to give mouth-to-mouth rescue breathing in out-of hospital cardiac arrest.Summary: We report the case of a 50-year-old woman with cardiac arrest in out-of-hospital setting. She was hit by a moving vehicle at her road-side shop. Coincidentally, a bystander rescuer (an Anaesthetist) who witnessed the accident attended to the victim and diagnosed cardiac arrest. CCO-CPR was commenced by the rescuer who had no CPR adjuncts or drugs. The rescuer was also unwilling to give mouth-to-mouth rescue breathing. The patient's respiratory efforts and carotid pulsations returned after about 7 minutes of commencement of CCO-CPR although the patient was still unconscious. She was thereafter rushed to a nearby hospital where she was admitted and treated definitively. She fully regained her consciousness few minutes after admission. She was observed for 24 hours and discharged home in good clinical condition.Conclusion: This case is reported to sensitize health-care givers that Chest compression only CPR could be life saving in the hand of a bystander rescuer who is not willing to give mouth-to-mouth respiration

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London