Emergence and spread of two SARS-CoV-2 variants of interest in Nigeria.

Identifying the dissemination patterns and impacts of a virus of economic or health importance during a pandemic is crucial, as it informs the public on policies for containment in order to reduce the spread of the virus. In this study, we integrated genomic and travel data to investigate the emergence and spread of the SARS-CoV-2 B.1.1.318 and B.1.525 (Eta) variants of interest in Nigeria and the wider Africa region. By integrating travel data and phylogeographic reconstructions, we find that these two variants that arose during the second wave in Nigeria emerged from within Africa, with the B.1.525 from Nigeria, and then spread to other parts of the world. Data from this study show how regional connectivity of Nigeria drove the spread of these variants of interest to surrounding countries and those connected by air-traffic. Our findings demonstrate the power of genomic analysis when combined with mobility and epidemiological data to identify the drivers of transmission, as bidirectional transmission within and between African nations are grossly underestimated as seen in our import risk index estimates

Trans-hiatal oesophagectomy as a palliative treatment for carcinoma of the oesophagus

Objective: To determine the role of palliation with trans-hiatal oesophagectomy in Nigerian patients with carcinoma of the oesophagus. Design: Prospective case series. The first series was from February 1986 to September 1987 (Series A) while the second series was from March 1989 to November 1996 (Series B). Setting: Cardiothoracic Surgery Unit (CTSU) of the University College Hospital, Ibadan, Nigeria. Subjects: First series consisted of 10 consecutive operable patients with carcinoma of oesophagus seen over the period of study. The second series consisted of 21 consecutive patients with same disease. Intervention: All patients had transhiatal oeosphagectomy by a two team approach and immediate placement of the freed stomach in the posterior mediastinum and cervical oesophagogastrostomy. Results: Patients in both series had a comparable age range of 43 - 80 years for series A and 40 - 82 years for Series B. The duration of symptoms were 2 - 6 months and 2 - 12 months respectively, for series A and B. In series A, nine patients had carcinoma of the middle-third (M1/3) of the thoracic oesophagus and one patient had carcinoma of lower-third (L1/3) of the thoracic oesophagus. In series B, 18 patients had M1/3 and three patients had Ll/3 lesions. Average blood loss in series A was 1,067 mls, corresponding value for series B was 852 mls. Postoperatively, all cases were classified as stage III or stage IV disease. There were 18 complications in eight patients in series A and 22 complications in 10 patients in series B. The commonest complications in series A were pleural enteries in six patients, haemorrhage four patients (three intraoperative, one post-operative) and respiratory failure (two patients). The commonest in series B were pleural enteries in nine patients, anastomotic leaks and stenosis in four patients and respiratory failure in three patients. Hospital mortality was 50% in Series A and 14.3% in series B. The causes of death were haemorrhage and respiratory failure in series A, respiratory failure in series B. Survival period in series A of the five patients discharged was for a median of 8.4 months, for series B, four patients were alive at 18 months post-operative, one patient attended follow-up clinic 24 months after surgery. No other adjunctive therapy was offered to the patients. Conclusion: Trans-hiatal oesophagectomy is a procedure suitable for patients with carcinoma of the oesophagus and affords palliation at an “acceptable price” among carefully selected patients with advanced carcinoma of the oesophagus. (East African Medical Journal: 2002 79(6): 311-316

Palliation for transposition of great arteries

Background: At the University College Hospital Ibadan we have no facility for total surgical correction of transportation of the great arteries (TGA). This prospective study reviews the palliative procedures we have used in the management of TGA. Method: Patients with the diagnosis of TGA were evaluated for morphological type. The choice of palliative procedure was made in some of the patients with morphological type in mind. No fixed criteria were used for allocating patients to Blalock-Hanlon (B-H), atrial septectomy while pulmonary banding (PB) and Blalock-Taussig (B-T) shunt have definite indications. Results: Fourteen consecutive patients with TGA were palliated. The ages of these patients ranged between 3 to 11 months (6.8 ± 2.4 months), there were 8 males to 6 females (1.3:1). Six patients had B-H atrial septectomy and 2(33.3%) died within 48 hours, 4 patients had B-T shunt and there were no mortality, 4 patients had PB and 2 (50.0%) died within 72 hours. The overall operative mortality was 28.6%. All the 10 survivors had improvement of their clinical features and fall in packed cell volume during the period of follow-up, which lasted 5 to 13 months (mean 9.3 ± 1.2 months). All patients had delayed wound healing. Conclusion: Appropriate and timely palliative surgery has a place in patients with TGA as an interim care. Key Words: Palliative surgery, transposition, great arteries Nigerian Journal of Surgical Research Vol.5(1&2) 2003: 129-13

PRESENTATION OF PRIMARY MEDIASTINAL MASSES IN IBADAN

ABSTRACTObjective: To determine clinical features, anatomic location and histological types of primarymediastinal masses diagnosed and treated in a black African population.Design: A retrospective study of clinical data collected from patients case notes, thecardiothoracic unit’s and pathology records between June 1975 and May 1999.Setting: University College Hospital, Ibadan, Nigeria which hosts a major cancer center inthe West African sub-region, and serves community clinics.Patients: All patients with primary mediastinal masses referred for evaluation and treatment.Main outcome measures: Excluded metastatic, oesophageal and vascular- lesions. All patientshad radiological evalulation and tissue biopsies. The anatomic subdivision of the mediastinuminto anterosuperior, middle and posterior section was used.Results: One hundred and five consecutive patients were evaluated and treated. The meanage was 34.0 ± 20.4 years. There were 75 males and 30 females. Eighty one (77.1%) weresymptomatic, 24 (22.9%) were asymptomatic. Thirty seven (45.7%) of the symptomaticpatients had malignant disease while 44 (54.3%) had benign disease. Forty five patients(43%) and 60 patients (57%) had malignant and benign diseases respectively. Incidence ofsymptoms, was 82.2% for malignant and 73.3% for benign diseases. This difference inincidences is statistically insignificant (p=0.283). Majority of asymptomatic patients (70.8%)had benign disease while 29.2% of patients with malignancy were asymptomatic. Thisdifference in incidence was statistically significant (p=0.0039). The frequency of mediastinalmasses were anterosuperior, in 67 patients (63.8%), posterior mediastinal, 24 patients(22.9%) and middle mediastinal in 14 patients (13.3%). Lymphoma 23 (21.9%), thymusglands tumours 19 (18.1%) and endocrine tumours (goiters) 18 (17.1%) were the commonesttypes of primary mediastinal masses treated.Conclusion: Majority of our patients with mediastinal masses (whether benign or malignant)are symptomatic and the absence of symptoms is more associated with benign disease.Majority of lesions are situated in the anterosuperior mediastinum. Lymphoma is the mostfrequent primary mediastinal mass

Coarctation of the Aorta: Experience at the University College Hospital, Ibadan

Between May 1977 and June 1998, 697 patients with congenital heart diseases were admitted to the cardiothoracic surgical unit (CTSU) at the University College Hospital, Ibadan. Eighteen (2.6 per cent) of the patients with 19 coarctations of the aorta (CoA) were retrospectively studied. The age range of all the patients with CoA was 18 days to 30 years (mean 7.2±8.2 years), but for the 15 patients who underwent surgery, it was one month to 30 years (mean 8.6±8.3 years). Three patients died preoperatively of congenital cardiac anomalies associated with infantile CoA. There were 16 thoracic and two abdominal CoA, while one patient had recurrent CoA. Resection and end-to-end anastomosis was performed in four patients, dacron tube interposition graft in three, and dacron patch graft in four patients. Other procedures were employed in five patients. Operative mortality was 25 per cent. Operative deaths occurred in two infants with isolated CoA, a neonate who had associated pulmonary hypertension and a 17-year old who had surgery for re-coarctation. Complications of surgery included post-operative haemorrhage in two patients, intra-operative hemorrhage in one and hoarseness of the voice in four patients. Paradoxical hypertension occurred in three patients, graft occlusion and wound dehiscence occurred together in one patient and two patients had chylothorax. It is concluded that CoA is a surgically correctable congenital anomaly which is probably less frequently diagnosed locally.Nigerian Journal of Paediatrics 2002;29:27-33