The Undescended Testes in Children: a Prospective Epidemiological Study

Background: The management of undescended testes remains a topical issue. This study was aimed at determinining the presentation and outcome of children presenting with undescended testes at the Lagos University Teaching Hospital (LUTH).Methods: This was a prospective cross-sectional study that included all male children aged 1-15 years with undescended testes who were treated by the paediatric surgery unit in LUTH from January 2010 to December 2011Results: A total of 56 boys with 73 undesecended testes were surgically treated during the study period. The median age at operation was 3.0 years (range: 1 to 11years). Seventeen (30.4%) boys had bilateral undescended testes while 39 (69.6%) boys had unilateral undescended testes . Associated anomalies were present in 6 (10.7%) boys- hypospadias in 5 (8.9%) boys and vertebral anomaly in 1 (1.8%) boy.. Open orchidopexy was performed in 59 (80.8%) cases while stagedorchidopexy was done in 11 (15.1%) cases. There were 4 (5.4%) post operative complications -3 cases of postoperative hematoma and 1 case of wound dehiscence.Conclusion: Children with undescended testes present late in Lagos. About a third of patients with undesended testes in our centre have bilateral undescended testes while about 10% have associated congenital anomalies.Key words: Undescended, Testis, Children, Epideniolog

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

Urethral length and its relationship with anthropometric parameters in adult male Nigerians

This contains data from 450 adult men who required urethral catheterization for various therapeutic and diagnostic reasons. All of them had their ages documented and anthropometric parameters measured. And their urethral lengths were measured by substracting the unsed catheter length from total usable cathether length.THIS DATASET IS ARCHIVED AT DANS/EASY, BUT NOT ACCESSIBLE HERE. TO VIEW A LIST OF FILES AND ACCESS THE FILES IN THIS DATASET CLICK ON THE DOI-LINK ABOV

The efficacy of procin-x and celloid-s in the management of benign prostatic enlargement

Background and Objective: Despite a decent efficacy and safety profile, α1 - blockers (A1B) and the 5α - reductase inhibitors (5ARI), the conventional drugs used in the treatment of the symptoms of Benign Prostatic Hyperplasia (BPH), are commonly associated with adverse effects including sexual dysfunction and postural hypotension. Phytotherapy for the treatment BPH symptoms has been used for centuries. However, scientific data on their efficacy are sparse. Procin-X and Celloid-S (PC) are powdered plant material products with acclaimed anti- BPH properties. This study assessed their usefulness in the management of BPH. Materials and Methods: This was a single blind, randomized, placebo-controlled study conducted at our hospital involving 80 patients (divided in to 2 equal groups) with the clinical diagnosis of BPH. The study group were given PC while the controls were given multivitamin Capsules daily for a period of 14 weeks. All patients were evaluated at intervals for severity of symptoms, flow rates, prostate size, prostate specific antigen (PSA) and possible adverse effects including erectile function. Test of significance between the means was done using the Students Paired t-test. A P < 0.05 was considered significant. Results: At the end of 14 weeks there was an reduction in symptom score by 5.7 and 1.6 in subjects and controls respectively (P < 0.05) and an increase in flow rate by 4.0mls/s and 1.1mls/s respectively (P < 0.05). There was a 60% and 14% reduction in PSA in the subjects and control respectively. There was also statistically significant increase in the erection score in the subjects. Conclusion: PC appear to be effective and in the management of the symptoms of BPH. The positive effects of PC on erectile function may however give them an advantage over the A1B and 5ARI drugs while the reduction in PSA may also give it a role in chemoprevention of prostate cancer. A large scale cohort study is needed to confirm these findings

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit