A Review on Effectiveness of Marine Pollution Control and Management in Nigeria

This study reviews the successes and limitations of agencies saddled with marine pollution control and management in Nigeria using secondary data. The agencies investigated include Nigerian Port Authority (NPA), National Oil Spill Detection and Response Agency (NOSDRA), and Nigerian Maritime Administration and Safety Agency (NIMASA). The study shows that NIMASA has been at the frontline of marine pollution control and has been dynamic and effective in marine pollution control and management in Nigeria. Port reception facilities by NPA for ship waste collection within stipulated time to encourage turn-around time of vessels is encouraging. For NOSDRA, the review highlights some statutory impediments affecting the effective functioning of the agency. It is important to de-bottleneck all statutory issues threatening the smart performance of NOSDRA. Delay in attending to oil pollution, for instance, is a huge control failure with multiplying consequences for the environment. The effort in the development of an action plan referred to as National Oil Spill Compensation Rate (NOSCR) which stipulates compensation to affected or host communities from facility operators is not a control measure and may even be misused by criminal minds to intentionally cause spills and pollution in other to seek financial gain. Grassroots operators should be sensitized to more effective ways to control and handle marine pollutants. This can be achieved with the simple truth that harms to the marine environment are an invitation to the end of the existentialism of life itself. It is believed that once the attitudinal change by the marine operators and especially the grassroots is achieved, marine pollution control and management can be made more effective. &nbsp

Safety of the surgeon: ‘Double-gloving’ during surgical procedures

Background. In the face of increasing HIV/AIDS prevalence in subSaharan Africa, we evaluate the effectiveness of ‘double-gloving’ during surgery as a means of protecting the surgeon operating on patients with a known or unknown HIV status.Methods. A prospective study was conducted to determine the rate of glove puncture and intraoperative injury in categories of patients with known positive, known negative or unknown HIV status.Results. The surgeon and the first assistant double-gloved in all the 1 050 procedures performed between 2009 and 2013, and a total of 8 400 surgical gloves were used. Sixty-nine patients (6.6%) were HIV-positive, 29 patients (2.8%) were HIV-negative, and the HIV status was unknown for the remaining 952 patients (90.7%). The overall glove puncture rate in the study was 14.5%. The glove puncture rate was 0%, 31% and 15% for HIV-positive, HIV-negative and HIV status unknown, respectively, and this difference was statistically significant. The mean operating time in the group with glove punctures was 148 min (95% confidence interval (CI) 135 - 161), while mean operating time in the group without glove puncture was 88 min (95% CI 84 - 92). Conclusion. Double-gloving offers protection against intraoperative injury. Knowing the HIV status of the patient offers additional protection to the operating surgeon. While we recommend routine double-gloving for surgeons working in HIV-prevalent patient populations, we also advocate for the routine screening for HIV in all surgical patients

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Synergistic typhoid and ascarid intestinal perforation

No AbstractThe Nigerian Medical Practitioner Vol. 52 (5&6) 2007: pp. 109-11