The Use of Unripe Pawpaw for Wound Bed Preparation Following Radiation‑Induced Sacral Ulcer: A Case Report and Review of Literature

Radiation wounds are very difficult to manage due to poor vascular status, excessive matrix metalloproteinases, and abnormal  myofibroblast function. Such wound beds do not adequately support conventional resurfacing as do nonradiate beds. We present a 46‑year‑old female with a sacral radiation ulcer, which had earlier failed to support flap cover on two instances after bed preparation with conventional honey dressing and negative pressure dressing, but was subsequently successfully managed with unripe pawpaw wound bed preparation. Are‑elevation of the right gluteal myocutaneous flap proved successful and satisfactory. The finding may have resulted from both enzymatic properties of unripe pawpaw and its ability to break the biofilms and to locally supply the ascorbic acid necessary for collagen synthesis and granulation tissue formation. Keywords: Case report, radiation wounds, unripe pawpaw, wound bed preparatio

Open Inguinal Hernia Repair: Our Experience with Tertiary Institution-Based Surgical Outreach

Background: Inguinal hernia afflicts the low socioeconomic class mostly in resource‑poor settings. The surgical outreach option greatly reduces this burden. Tertiary health institutions will be a good base for surgical outreaches in hernia repairs. Aim: The aim of this study was to determine the outcome of using a tertiary health‑care facility for a surgical outreach program. Methods: This was a prospective clinical study conducted among 195 patients who underwent open groin hernia repair in Alex‑Ekwueme Federal University Teaching hospital Abakaliki. Data were collected from admission, till discharge from hospital, and up to 3 months follow‑up after the surgery. Results: Out of 206 recruited, a total of 195 patients underwent open groin hernia repair with a male: female ratio of 6.5:1. Their age ranged from 0 to 88 years with a mean age of 33.94 ± 23.40 years. Among the patients, 69.2% of the hernias occurred in ages below 50 years, 58.4% had right, 38% left and 3.6% had bilateral hernias. Open hernia repair was performed in 63.1% and herniotomy in 36.9%. In those that had an open hernia repair, majority 91.8% had tissue repair, whereas 8.2% had mesh repair. Postoperative complication rate was 9.2%. Conclusion: Surgical outreach in a tertiary health facility offers standard care with skilled surgical personnel offering a better outcome with complication rate similar to what obtains in a conventional tertiary health care. Tertiary hospitals where available should be preferred in the surgical outreach for hernias in a low‑resource setting. Keywords: Low‑resource setting, Nigeria, open hernia repair, surgical outreach, tertiary health‑care facility&nbsp

Containing COVID-19 in Nigeria: An Appraisal of Lockdown and Surveillance at Inter‑State Borders to Control Disease Spread

Introduction: The outbreak of coronavirus disease 2019 (COVID‑19) in Nigeria prompted decision‑making at the various levels of  governance. Ebonyi State Government in South‑east Nigeria closed her borders with neighboring states as a preventive measure for the spread of the pandemic. This study was an assessment of the effectiveness and challenges of border closure and surveillance activities in controlling the dispersion of the disease across states. Materials and Methods: The five major borders of Ebonyi State with her neighboring States of Enugu, Cross River, and Abia were visited. Information was collected about movement restrictions and surveillance at the borders using an observation checklist and key informant interviews. Data collected were analyzed using IBM‑SPSS and thematic interpretation. Results: Commuters on essential duty were enforced to wear face masks, perform hand hygiene, and undergo screening for the  symptoms of COVID‑19 before entering the State. All the first 13 COVID‑19 confirmed persons in the State were from those picked up as suspected cases by surveillance at the State borders. People who travelled hundreds of kilometers across several States were stopped from entering Ebonyi State. However, movement restriction at the borders was undermined by some security personnel who were bribed by commuters to allow them crossover during night hours. Conclusion: The lockdown and surveillance activities at the borders were effective in controlling the spread of COVID‑19, but alternative routes of entry and corrupt act during odd hours constituted serious risks. Uniformity of movement restriction across all the states borders with vigilante groups manning inter‑community boundaries may control the disease spread across regions. Keywords: Coronavirus disease 2019 surveillance, infection control, inter‑state borders, lockdown, suspected case

Patterns of Antimicrobial Use in a Specialized Surgical Hospital in Southeast Nigeria: Need for a Standardized Protocol of Antimicrobial Use in the Tropics

Background: Antimicrobial resistance remains a growing global health menace. One of the key actions to curb this menace by the World Health Organization is antimicrobial stewardship (AMS). A prescription protocol is one of the cost‑effective AMS interventions in surgery. This study determines the patterns of antimicrobial usage in a hospital specialized in orthopedic and plastic surgeries care in Nigeria. Methods: A cross-sectional survey was carried out at National Orthopaedic Hospital Enugu, a tertiary hospital specialized in orthopedic and plastic surgeries in Southeast Nigeria in May 2019. All the inpatients were included in the study. A standardized tool for point prevalence survey was used to collect data. Data were analyzed using Epi Info version 7.2.4. Results: A total of 127 inpatients  participated in the survey with 387 antimicrobial encounters. The most common reasons for antimicrobial use were for the treatment of community-acquired infections (65.0%) and prophylaxis (29.4%). The decision for their use was made majorly on an empirical basis (92.4%). The reasons for antimicrobial prescriptions were documented in the majority (97.5%) of the cases and stop review dates in all (100%) of the prescriptions. Ceftriaxone (25.7%), tinidazole (21.9%), and metronidazole (14.6%) were the commonest antimicrobials prescribed among the patients. Conclusion: Orthopedic and plastic surgery practices require tailored prophylactic antibiotic regimens in the tropics due to peculiarities of both the specialties and the subregion. The claim that existing protocols in the temperate regions may apply in the tropics has been questioned due to the microbial profile on the tropics. Keywords: Antimicrobial protocol in surgery, antimicrobial resistance, antimicrobial stewardship, prophylactic antibiotic

Clinical Outcome of Nonoperative Treatment of de Quervain’s Disease with Local Corticosteroid Injection in Nigerian Setting

Background: The goal of treatment of de Quervain's disease, pain relief and restoration of hand functions, is achievable with local corticosteroid injection. However, published reports indicate variations in its cure rate and efficacy from and within subregions. This study aimed to determine the outcome of this treatment modality in Nigerian setting. Patients and Methods: Fifty-one cases of de Quervain's disease in 41 consecutive eligible patients were enrolled between January 2011 and December 2016, treated with local methylprednisolone acetate injection and followed up prospectively in orthopedic clinics of Federal Teaching Hospital, Abakaliki, and Mater Miserere Cordiae Hospital, Afikpo, Nigeria. Results: Eight weeks post initial injection, 94% of the cases were signs and symptoms free. The recurrence rate post initial injection (19.6%) correlated directly with pain intensity (P < 0.001) and was significantly (P = 0.018) higher in subacute compared to acute and chronic presentations. At the end of a follow-up period that ranged from 24 to 84 months with a mean of 54 months, 47 (92.2%) cases were cured with either single injection (78.4%) or multiple injections (13.7%) of corticosteroid, 3 (5.9%) had incomplete resolution but were satisfied, and in 1 (2%) there was no beneficial response. There was no serious adverse reaction; 14 (27.5%) cases had localized skin depigmentation. Conclusion: In our setting, local corticosteroid injection as a treatment modality for de Quervain's tenosynovitis has short- and long-term success rates of over 90%, and is rarely associated with serious adverse reaction. It is recommended as the initial treatment of choice in de Quervain's disease.&nbsp

Comparing hospital stay and patient satisfaction in a resource poor setting using conventional and locally adapted negative pressure wound dressing methods in management of leg ulcers with split skin grafts: a comparative prospective study

Introduction: chronic leg ulcers cause a prolonged hospital stay with devastating effects on the patients. Several modifiable factors are taken care of to reduce the duration of stay. A further measure to hasten wound bed preparation pre-grafting and to hasten graft healing post-grafting is with negative pressure dressing. Methods: sixty-two patients were placed in two groups of 31 cases each. The wound beds were prepared with negative pressure apparatus locally adapted with suction machine for group A and with conventional gauze dressing using 5% povidone iodine soaks for group B. Grafted wound was also dressed similarly for the respective groups. Grafts were inspected on the 5th post-operative day and were determined with planimeter grid. Grafts were monitored until completely healed and patients were discharged. Satisfaction and length of stay were determined at discharge. Results: the mean hospital stay pre-grafting and post-grafting were 12.2 (±8.64) days and 13.6 (±2.03) days respectively for the negative pressure dressing and 28.8 (±30.9) days and 21.8 (±21.97) days respectively for the traditional dressing group. These differences with p values of 0.038 for the pre-grafting stay and 0.006 for the post-grafting stay were statistically significant. The patients managed with negative pressure dressing also recorded greater satisfaction with the process and the outcome. Conclusion: negative pressure dressing contributes significantly to reducing the length of hospital stay in chronic leg ulcers both in wound bed preparation and in graft healing resulting to better patient satisfaction than in patients treated with conventional gauze dressing and 5% povidone iodine soaks

Determinants and outcomes of elective and emergency caesarean section at a tertiary hospital in Abakaliki, Southeast Nigeria: A 6‑year review

Background: Despite its increasing acceptance as a safe alternative to vaginal delivery, caesarean section (CS) in developing countries continue to be associated with maternal and fetal morbidity and mortality.Objectives: This study was aimed at evaluating the indications, outcomes and factors associated with increased CS at the Federal Teaching Hospital, Abakaliki.Methods: This was a six year retrospective study covering 2012 to 2017. Case notes of patients were identified and retrieved from the records unit of the hospital. Information extracted include sociodemographic variables, indications and types of CS performed and the complications. These data were entered into a personal computer and analysed with Epi Info version 7.Results: These were presented using tables and percentages. A p-value of 0.05 was considered significant. In 6 years, 11,215 women were delivered, 2405 (21.4%) had emergency CS while 1445 (12.9%) had elective CS; giving a CS rate of 34.3%. The most common indication for emergency CS was cephalopelvic disproportion (22.0%) while previous caesarean section (27.7%) formed the major indication for elective CS. Severe birth asphyxia was recorded in 17.2% and 4.2% of babies delivered by emergency and elective CS respectively. Booking status, parity and patient’s age had statistically significant association with the chance of having a CS. Maternal and perinatal deaths were recorded in 2.6% and 5.0% for emergency CS compared to 1.0% and 0.2% for elective CS. Although lifesaving, CS, due to an existing condition or complication in the patient, may be associated with an increase in maternal and fetal morbidities and mortalities.Conclusion: There was a higher burden of complication with emergency CS due to its associated determinants. Adequate training of healthcare personnel on ways of minimizing complications against the backdrop of an existing problem and an efficient referral system will help reduce these morbidities and mortalities.Keywords: Abakaliki; caesarean section; determinants; Nigeria; outcome

Abdominoplasty for male truncal obesity: case report

Truncal obesity and its associated health risk is an enormous burden. The traditional surgical treatment modality is liposuction or lipoabdominoplasty. An uncommon mode of the treatment is the use of abdominoplasty alone or as a surgical component. The aim of this report is to show a satisfactory outcome of abdominoplasty as the only surgical component in the management of severe truncal obesity in elderly male patient. We report a 75 year old Nigerian trader who had truncal obesity with gross abdominal asymmetry and cardiovascular and diabetes mellitus co-morbidities as well as bilateral knee osteoarthritis and social isolation due to truncal disfigurement. He was offered abdominoplasty as a sole surgical option for correction of anterior abdominal wall asymmetry. Apart from post operative wound complications and blood transfusion reactions, the patient had a good recovery and improved quality of life. Abdominoplasty is a rewarding treatment when used as a sole surgical option in centrally obese patients with anterior abdominal wall asymmetry and significant subcutaneous fat thickness

Birth Preparedness and Complication Readiness among Pregnant Women in a Secondary Health Facility in Abakaliki, Ebonyi State, Nigeria

Background. Birth preparedness and complication readiness (BP/CR) concept is based on the premise that preparing for birth and being ready for complications reduce all three phases of delay to a bad obstetric outcome. Objectives. To determine the knowledge of BP/CR with its determinants and BP/CR index among pregnant women in Abakaliki, southeast Nigeria. Methods. A cross-sectional survey was done between 1st March 2019 and 31st July 2019 among 450 randomly selected antenatal attendees at Mile Four Hospital, Abakaliki, Nigeria. The data were obtained using a pretested interviewer-administered structured questionnaire adapted from the maternal and neonatal health program handbook of the Johns Hopkins Program for International Education in Gynaecology and Obstetrics (JHPIEGO). The data obtained were analyzed using percentages, chi-square, and odds ratios. The level of significance is at P value 0.05). However, only booking in the 1st or 2nd trimester was a significant determinant of the respondent’s adequate knowledge of BP (AOR=0.63, 95% CI 0.40-0.98) and CR (AOR=0.62, 95% CI 0.39-0.97). Identification of transport and saving of money was the commonest birth plan while the commonest danger sign known to the participants was bleeding. Conclusion. This study revealed that knowledge of BP/CR is suboptimal. The determinant of this knowledge is antenatal booking. It is recommended that women should have adequate antenatal care education to improve their knowledge of BP/CR. This will help to increase the low BP/CR index seen in our study