Fitness to drive among commercial intercity drivers in Benin-City, Edo State

Background: Unfit drivers are prone to road traffic accident, therefore their health is paramount in ensuring the safety of road users. To determine the fitness to drive among commercial intercity bus drivers in Benin City, Edo StateMaterial and methods: A descriptive cross-sectional study was conducted among 194 commercial intercity drivers. The respondents were selected using systematic random sampling technique. Data was collected with the aid of an interviewer-administered questionnaire. Estimation of the alcohol level, visual acuity, blood pressure and body mass index was done for respondents using an Alcomate breathalyzer, Snellen’s chart, sphygmomanometer, measuring tape/weighing scale, respectively. IBM SPSS version 21 software was utilized for data analysis. Level of significance was set at p < 0.05.Results: The mean age of respondents was 40.5 ± 7.3 years. Eighty-seven (44.8%) of the respondents had blood alcohol level greater than the legally acceptable limit, 12 (6.2%) were observed to be visually impaired while 4 (2.1%) were hypertensive. Based on these indices, 95 (49.0%) of the respondents were unfit to drive.Conclusion: Almost half of the drivers were unfit to drive based on their abnormal blood alcohol level, visual acuity and high blood pressure. This emphasizes the need for proper pre-medical and periodic medical examination of drivers to ensure their fitness to drive. This will minimize the occurrence of road traffic accidents and their sequelae.Keywords: Fitness to drive; Commercial intercity drivers; Benin Cit

Global Perspectives on Task Shifting and Task Sharing in Neurosurgery.

BACKGROUND: Neurosurgical task shifting and task sharing (TS/S), delegating clinical care to non-neurosurgeons, is ongoing in many hospital systems in which neurosurgeons are scarce. Although TS/S can increase access to treatment, it remains highly controversial. This survey investigated perceptions of neurosurgical TS/S to elucidate whether it is a permissible temporary solution to the global workforce deficit. METHODS: The survey was distributed to a convenience sample of individuals providing neurosurgical care. A digital survey link was distributed through electronic mailing lists of continental neurosurgical societies and various collectives, conference announcements, and social media platforms (July 2018-January 2019). Data were analyzed by descriptive statistics and univariate regression of Likert Scale scores. RESULTS: Survey respondents represented 105 of 194 World Health Organization member countries (54.1%; 391 respondents, 162 from high-income countries and 229 from low- and middle-income countries [LMICs]). The most agreed on statement was that task sharing is preferred to task shifting. There was broad consensus that both task shifting and task sharing should require competency-based evaluation, standardized training endorsed by governing organizations, and maintenance of certification. When perspectives were stratified by income class, LMICs were significantly more likely to agree that task shifting is professionally disruptive to traditional training, task sharing should be a priority where human resources are scarce, and to call for additional TS/S regulation, such as certification and formal consultation with a neurosurgeon (in person or electronic/telemedicine). CONCLUSIONS: Both LMIC and high-income countries agreed that task sharing should be prioritized over task shifting and that additional recommendations and regulations could enhance care. These data invite future discussions on policy and training programs

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Variation in postoperative outcomes of patients with intracranial tumors: insights from a prospective international cohort study during the COVID-19 pandemic

Background: This study assessed the international variation in surgical neuro-oncology practice and 30-day outcomes of patients who had surgery for an intracranial tumor during the COVID-19 pandemic. Methods: We prospectively included adults aged ≥18 years who underwent surgery for a malignant or benign intracranial tumor across 55 international hospitals from 26 countries. Each participating hospital recorded cases for 3 consecutive months from the start of the pandemic. We categorized patients’ location by World Bank income groups (high [HIC], upper-middle [UMIC], and low- and lower-middle [LLMIC]). Main outcomes were a change from routine management, SARS-CoV-2 infection, and 30-day mortality. We used a Bayesian multilevel logistic regression stratified by hospitals and adjusted for key confounders to estimate the association between income groups and mortality. Results: Among 1016 patients, the number of patients in each income group was 765 (75.3%) in HIC, 142 (14.0%) in UMIC, and 109 (10.7%) in LLMIC. The management of 200 (19.8%) patients changed from usual care, most commonly delayed surgery. Within 30 days after surgery, 14 (1.4%) patients had a COVID-19 diagnosis and 39 (3.8%) patients died. In the multivariable model, LLMIC was associated with increased mortality (odds ratio 2.83, 95% credible interval 1.37–5.74) compared to HIC. Conclusions: The first wave of the pandemic had a significant impact on surgical decision-making. While the incidence of SARS-CoV-2 infection within 30 days after surgery was low, there was a disparity in mortality between countries and this warrants further examination to identify any modifiable factors

Clinical characteristics of dermatophytosis among children in a Nigerian population: role of HIV/AIDS

Background: Dermatophytosis is a common superficial mycosis. It affects virtually every child at one stage or the other, but the disease may be more frequent in individuals with immunocompromising conditions. The typical characteristic of the rash is an annular, popular rash with a healing centre and an active periphery that may have an erythematous base and it occurs in different parts of the body. Aims: To elicit the clinical characteristics of dermatophytosis among children with HIV/AIDS. Methods: Two hundred each of HIV sero-positive and sero-negative children were evaluated for dermatophytosis (and its clinical types) and the possible role of HIV was examined. Results: Thirty-two (16%) seropositive and 24(12%) sero-negative children had dermatophytosis (P = 0.086). Tinea capitis was the most prevalent among the sero-positive and was the only type seen among the sero-negative subjects. Dermatophytosis was significantly more prevalent among those with more advanced clinical stage of HIV (p = 0.000). Children in 5 – 12 year age bracket were more affected in both groups. Conclusion: Tinea capitis was the most frequent type of dermatophytosis in the study, followed by tinea corporis. Children in 5 – 12 year age bracket were more affected in both groups. Occurrence of dermatophytosis was significantly influenced by the stage of HIV disease but not by HIV status. Keywords: Characteristics dermatophytosis HIV/AIDS children in Nigeri

HIV - sero Positivity and Intestinal Helminthiasis among Children in a Tertiary Health Facility in Benin-City, Nigeria.

To determine the effect of HIV sero - positivity on the prevalence of intestinal helminthiasis. Descriptive, crossectional study design was undertaken. A cross sectional study among 496 HIV sero- positive (cases) and 490 HIV sero- negative (controls) children 1 – 15 years attending paediatrics clinic were surveyed for intestinal helminthiasis. Faecal samples were collected and examined for the presence of characteristic helminth ova using formol ether concentration method while intensity of infection was determined using McMaster counting chamber. Overall prevalence of intestinal helminthiasis was 15.4%. Prevalence was higher among the cases, 21.4% than the control, 9.5% and the difference in rate of infection was found to be statistically significant (PÂ 0.0000). The prevalence of helminthiasis is significantly higher among the cases than the controls. It is likely that in the cases, HIV status could have accentuated their susceptibility to helminthiasis. Regular deworming of cases alongside improved personal hygiene should be practiced to reduce infection burden.Key words: HIV sero - positive, intestinal helminth, children, health facility

Qualitative research methods in neurosurgery: an unexplored avenue.

OBJECTIVE: Explore the value and potential of qualitative research to neurosurgery and provide insight and understanding to this underused methodology. BACKGROUND: The definition of qualitative research is critically discussed and the heterogeneity within this field of inquiry explored. The value of qualitative research to the field of neurosurgery is articulated through its contribution to understanding complex clinical problems. DISCUSSION: To resolve some of the misunderstanding of qualitative research, this paper discusses research design choices. We explore approaches that use qualitative techniques but are not, necessarily, situated within a qualitative paradigm in addition to how qualitative research philosophy aids researchers to conduct interpretive inquiry that can reveal more than simply what was said by participants. Common research designs associated with qualitative inquiry are introduced, and how complex analysis may contribute more in-depth insights is explained. Approaches to quality are discussed briefly to support improvements in qualitative methods and qualitative manuscripts. Finally, we consider the future of qualitative research in neurosurgery, and suggest how to move forward in the qualitative neurosurgical evidence base. CONCLUSION: There is enormous potential for qualitative research to contribute to the advancement of person-centred care within neurosurgery. There are signs that more qualitative research is being conducted and that neurosurgical journals are increasingly open to this methodology. While studies that do not engage fully within the qualitative paradigm can make important contributions to the evidence base, due regard should be given to immersive inquiry within qualitative paradigms to allow complex, in-depth, investigations of the human experience