Editorial: Times are Changing: the Great Cholesterol Con

No Abstract

Editorial: COVID-19: The Odds against Resource-poor Countries

No Abstract

Editorial: Nigeria’s Worsening Financial Crisis: Whither the Health of the Nation

No Abstrac

The Effect of Service Compact (SERVICOM) on Service Delivery in Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria

This study examined the effect of service compact (Servicom Service delivery) in Nnamdi Azikiwe University Teaching Hospital Nnewi. Questionnaire and face-to-face interviews were used in the collection of data. The hypotheses were tested using descriptive statistics. The study discovered among other things that with the inauguration of the SERVICOM Charter by the Federal Government of Nigeria, the Management of Nnamdi Azikiwe University Teaching Hospital Nnewi identified key areas that required re-evaluation and attention based on the submissions of every service unit and department, after an analysis of the Strengths, Weaknesses, Opportunities and Threats (SWOT) of each of the service areas. A pre-SERVICOM Charter workshop which was supervised by the Federal Government was held in the various institutions nationwide to enable care providers enumerate their current service capacity and identify their impediments. In the light of the foregoing, some of the recommendations proffered are that the SERVICOM Charter project should be sustained and supervision and control of the SERVICOM Charter project should be intensified in order to ensure that the Nigerian factor of service-fatigue would not supervene in care delivery in the near future

The burden of motorcycle-related neurotrauma in

Neurotrauma or cranio-spinal trauma is the most common pathology in multiple injuries, causing significant morbidity and mortality. Majority of cases result from road traffic accidents. In one of Nigeria’s centres for neurosurgery, we evaluated our local etiological patterns to ascertain the impact of motorcycles, the most commonly used mode of intra-city transportation, on neurotrauma. This is a retrospective study of all consecutive neurotrauma patients presenting in our unit in the first 30 months after the commencement of neurosurgical services. The data were collected for each patient with a structured proforma, and were analyzed. A total of 1055 neurosurgical cases were attended to in our service in the period under study, out of which 138 had congenital anomalies and 917 had acquired diseases. Among the acquired cases, 785 had trauma but only 748 (95.3%) of them had complete records, with 658 (88%) cases of head injury, 61 (8.1%) cases of spinal injury, and 29 (3.9%) concomitant head and spinal injuries. These are distributed thus: road traffic accidents 537 (71.8%), falls 120 (16.0%), assaults 47 (6.3%), missiles 20 (2.7%), falling objects 11 (1.5%), de-celeration/acceleration injuries 7 (0.9%), sports/recreational activities 3 (0.4%) and birth trauma 3 (0.4%). Majority were males 569 (76.1%), and in the 15-40year age group 376 (50.3%). Of the 537 cases of road accidents, those related to motorcycles were 367 (68.3%), motor vehicles 169 (31.5%) and bicycle 1 (0.2%); and none of th

Does improvised waterbed reduce the incidence of pressure ulcers in patients with spinal injury?

Background: Pressure ulcers are lesions caused by unrelieved pressure over bony prominences, resulting in damage to underlying tissues. The etiology is multifactorial including prolonged immobility. They usually complicate spinal cord injuries with long periods of bed confinement. The use of bed replacements markedly reduces the incidence of pressure ulcers, but the unaffordability of these replacements in low-income countries has necessitated the need to explore cheaper alternatives. Aim and Objective: The aim of this study was to ascertain whether the use of our cheap and locally improvised waterbeds would reduce the incidence of pressure ulcers in patients on prolonged bed confinement due to spinal injury. Methodology: Over a 16-month period, 51 patients (age range 1-80 years) with spinal injuries were managed conservatively in our service using improvised waterbeds in 21 (41.2%), while using the regular hospital bed/foam in 30 (58.8%). Biodata, the time interval between injury and presentation to the hospital, nature of the injury, use of improvised waterbed and development of pressure ulcer, were collected, collated, and analyzed. Statistical significance was calculated with the Chi-square test. Results: Most were males (98%), in the age range of 21-30 years (25.5%), and due to fall from heights (35.3%). Of 21 patients who were managed on improvised waterbeds, 6 (28.6%) had pressure ulcers, and of the 30 who did not use the waterbed, 17 (56.7%) developed ulcers. The c2 = 3.9381, while P = 0.0472. This difference was statistically significant. Conclusion: The improvised waterbed, which is much cheaper than the standard waterbed, was observed to have significantly reduced the incidence of pressure ulcers among our patients. Nonetheless, further studies would still be needed to confirm this observation

Incidence of undetected spina bifida occulta in patients presenting for other neurosurgical conditions in the emergency room of a tertiary health facility

Background: Spina bifida occulta are the most common spinal dysraphisms, yet, the least diagnosed. It is estimated that as much as 30–50% of normal healthy people could harbour this defect.Objectives: To evaluate the incidence of spina bifida occulta and tell-tale signs amongst consecutive patients presenting to a tertiary health facility, under emergency conditions, who had no previously known congenital spinal dysraphisms.Methodology: The study was conducted at the Accident and Emergency Room of Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi, Anambra State, Nigeria over a 12-month period. The cohort of patients at the Emergency Room were preferred, in order to reduce the interference from overt dysraphisms. Consecutively, consenting patients, were recruited, and data were presented in charts, tables and graphs, and analysed by comparative evaluations with literature.Results: There were 109 recruited subjects, within the age range of 9 to 85years, and most were males 80 (73.4%). Occult dysraphisms were detected in 8 (7.34%) of cases, 6 (5.5%) of whom were males. The affected spinal regions were: cervical 1 (0.92%), thoracic 1 (0.92%), lumbar 5 (4.6%) and sacral 1 (0.92%); a pre-morbid deficit of unilateral foot drop was found in 2 (1.83%). At presentation, most of the subjects came with neurological deficits; however, their dysraphisms were only discovered at routine imaging. There was no family history of spinal dysraphism amongst them. The tell-tale signs were abnormal hair growth 7 (6.42%), and dermal sinus 1 (0.92%). Spinal magnetic resonance imaging (MRI) and computed tomography (CT) were each employed for 2 (1.83%) cases, respectively.Conclusion: Occult spinal dysraphisms were discovered in 7.3% of our emergency patients, and most had abnormal bands of hair growth. The non-diagnoses of these cases by relatives and healthcare personnel, prior to their presentation, calls for concern

Clinical outcomes of surgical management of paranasal sinus mucocoeles in South-East Nigeria

Paranasal sinus mucocoeles are uncommon, benign clinical entities. They result from obstruction of the sinus drainage ostium with accumulation of secretions within the cavity and slow progressive expansion, resulting in adjacent tissue displacement. The clinical features demonstrated are therefore dependent on the prominent direction of its expansion. Treatment is by surgical intervention to drain the mucocoele with or without extirpation of the sinus mucosa to prevent re-accumulation. Complications result from tissue damage following delay in surgical intervention. We present four cases with sinonasal mucocoeles who underwent surgical drainage and mucosal extirpation in two tertiary eye centres in South-East Nigeria. The first had lost vision prior to surgery from exposure keratopathy and globe perforation. Two had no impairment of vision. Proptosis, diplopia, chronic discharging sinus and cosmetic blemish were the prominent presenting complaints. All complaints were fully resolved following surgery. There has been no report of recurrence of symptoms during the limited follow-up period

A case of retroperitoneal malignant triton tumor in a Nigerian boy

Malignant peripheral nerve sheath tumor is a rare tumor occurring in 5%–10% of all malignant soft tissues sarcomas and triton tumor arising from neurofibromatosis type 1 (NF-1) is even rarer with associated high rate of mortality. No case of triton tumor has been reported in Nigeria to the best of our knowledge. We seek to report a case of lately detected retroperitoneal triton tumor presenting in a 12-year-old Nigerian child who was brought with bilateral lower limb weaknesses, weight loss, and a right lumbar mass. There were multiple café au lait spots on the body. Abdominal computerized tomographic scan revealed a huge right retroperitoneal mass crossing the midline, compressing adjacent structures with multilevel intraspinal extensions. Core needle biopsy performed and both histology and immunohistochemical studies confirmed the diagnosis, but patient demised in the course of care. The aim is to heighten suspicion of this extremely very rare malignant tumor in children with NF-1