Clinicopathological report of children and young adults with nephrotic syndrome undergoing renal biopsy at workshops in Port Harcourt, Nigeria

Background: Kidney biopsy is a procedure that is not commonly performed in Nigeria. This study reports the clinical and pathological findings in children who underwent renal biopsies during nephrology workshops held in Port Harcourt in 2014 and 2015.Methods: The native kidney biopsies were processed and evaluated with light microscopy only.Results: Nineteen patients (10 females) were biopsied. The mean age was 11.0 ± 6.5 years and the range was 1.8 to 21 years. Eleven patients had steroid-dependent  nephrotic syndrome (SDNS) while eight were steroid-resistant (SRNS). Hypertension and haematuria were present more often in SDNS. There were 11 cases (57.9%) with non-proliferative lesions, including minimal change disease (4 cases), focal segmental glomerulosclerosis (4 cases) and collapsing glomerulopathy (3 cases). The proliferative lesions (8 cases) included membranoproliferative (mesangiocapillary) glomerulonephritis (MPGN, 5 cases), mesangial proliferative glomerulonephritis (2 cases) and MPGN with collapsing glomerulopathy (1 case). Overall, the most common pathologic diagnosis was MPGN (26.3%). Hypertension was more common with proliferative than non-proliferative lesions (62.5% versus 36.4%).Conclusions: Although MPGN was the most common morphologic lesion among children with nephrotic syndrome, bigger studies are necessary to confirm this. Efforts should be intensified in acquiring the expertise and infrastructure for performing and interpreting renal biopsies in Port Harcourt order to optimize patient management

Severity of malcircumcisions and circumcision-related complications in three tertiary health facilities in Southern Nigeria

Background: Complications following circumcision are well recognized. In our environment, it is relatively common and frequently encountered in pediatric surgical practice. While some may be easily corrected others may be more tasking and even life threatening. There is need to identify the serious complications, and to proffer ways of preventing them or managing them when they occur. We aimed to evaluate the spectrum of malcircumcision and circumcision related complications in our region and to identify the major challenging ones.Patients and methods: Data was prospectively obtained from all male children presenting with malcircumcisions or circumcision related complications in three tertiary health facilities in southern Nigeria between June 2006 and May 2013. Data included complication presented, age, circumcisionist, method of circumcision, treatment offered, outcome.Results: A total of 126 male children with 143 malcircumcisions or complicated circumcisions were seen within the period. The spectrum ranged from minor glandular adhesions to penile amputation and lifethreatening excessive bleeding. Procedures Included: manual removal of plastibell, suture ligation of bleeding vessel, adhesiolysis, preputial trimming, meatoplasty, urethroplasty, fistuloplasty, glanuloplasty and penile repair. Most tasking were urethral loss, fistula closure and glanular amputation. There were no deaths.Conclusion: Circumcision related complications are common in our region. Penile amputation, urethral loss, and fistulae are the most challenging complications. There is need to educate the health workers and general public on the hazard of untrained circumcisionists.Keywords: circumcision, complications, severity, managemen

Short hospital stay versus day-care Mathieu hypospadias repair

Objective: This study compared the outcome of Mathieu repair between patients who went home within 24 hours on catheter and dressing and patients who were managed in hospital for 48 hours and had their catheters and dressings removed before going home. Patients and Methods: A retrospective study of Mathieu hypospadias repair performed by the same surgeon for 11 years. Outcome measures were catheter and dressing related problems/complications. Results: Sixty five patients were included in the study; 43(66.2%) were managed in-hospital for the first 48 hours (Group A), while 22(33.8%) were managed as day-care cases (Group B). Complication rate was 6(14.0%) and 3(13.6%) respectively, with fistula rate of 2(4.7%) in Group A and 1(4.5%) in Group B. Conclusion: Day care Mathieu repair of hypospadias does not increase the occurrence of complications

Pattern, outcome and challenges of neonatal surgical cases in a tertiary teaching hospital

Background: Globally, the major causes of neonatal deaths are birth asphyxia, prematurity and severe infections. Little attention is paid to deaths contributed by surgically amenable conditions. This study was undertaken to determine the burden and types of surgical problems encountered in the neonatal period, their outcome and challenges encountered. Patients and Methods: This was a retrospective study. The case notes of all neonates admitted into the newborn unit of our centre between April 2002 and March 2010 with surgical conditions were retrieved and the following information extracted: Sex, diagnosis, age at presentation, surgical intervention and outcome. Results: Out of 7,401 neonates admitted within the study period, 460 (6.2%) had a surgical condition. Of the 1,657 babies that died within the same period, 196 (11.8%) of them were those with surgical conditions. Congenital abnormalities accounted for 408 (88.7%) of all the surgical cases. Intestinal obstruction 129 (31.6%), neural tube defects 101 (24.8%) and anterior abdominal wall defect 58 (14.2%) were the commonest congenital abnormalities, while fracture of the long bones following birth trauma 15 (28.8%) and perforated NEC 14 (26.9%) were the commonest acquired conditions. Surgery was performed in 166 (36.1%) and 98 (59%) had postoperative complications. Significantly, more deaths occurred in preterms than in term babies (P = 0.003) and in those delivered outside the hospital than in in-born babies (P = 0.02). The major cause of death was infection in 92 (47%). Conclusion: Neonatal surgical conditions contributed significantly to both neonatal admissions and overall neonatal mortality and thus highlights the need for investments in newborn surgical care in developing countries

Knowledge and use of biostatistics among resident and junior doctors at the university of port harcourt teaching hospital, Port Harcourt

Background: The place of research in the generation of facts and evidence on which contemporary medicine can be based cannot be overemphasized. Medical and surgical research is now more crucial than ever before for advancement of clinical practice and career progression for medical professionals. This requires good understanding and application of biostatistics among clinicians. Aim: To assess the knowledge and use of biostatistics among resident doctors at the University of Port Harcourt Teaching Hospital, Port Harcourt. Subjects and Methods: This was a questionnaire-based study carried out in the University of Port Harcourt Teaching Hospital. Completed questionnaires were retrieved immediately after completion. The data were entered into an Excel spreadsheet, cleaned, and subjected to statistical analysis. Results: There were a total of 109 respondents. Sixty-nine (63.3%) respondents were included in the study. Fifty-five (79.7%) respondents indicated that they understood the basic concepts of biostatistics, and only 16 (23.2%) respondents can apply their knowledge practically in research. Conclusion: The level of appreciation and use of biostatistics among resident doctors in the University of Port Harcourt Teaching Hospital is inadequate. This may be a reflection of the situation with resident doctors in other institutions in the country. There is a need for a curriculum review both at the undergraduate and postgraduate levels to prepare medical professionals for the task of high-quality research and advancement of knowledge

Childhood burns in south eastern Nigeria

Background: Burns injuries are recognized as a major health problem worldwide. In children and, particularly, in our environment where poverty, ignorance and disease are still high, they constitute significant morbidity and mortality. Previous studies on this topic in parts of Nigeria either lumped adults and children together or were retrospective. We, therefore, prospectively studied the current trends in burns in children. Patients and Methods: This prospective study of burns spanned over a period of 18 months (June 2006-December 2007) at the Paediatric Surgery Units of the Imo State University Teaching Hospital, Orlu, and the Federal Medical Centre, Owerri, Imo State. Data were collected and analysed for age, sex, cause/type of burn, place of burn, presence or absence of adult/s, initial prehospital intervention, interval between injury and presentation, surface area and depth of burn and treatment and outcome. Results: Fifty-three patients were studied, 31 (58.4%) were male and 22 (41.6%) were female (M:F = 1.4:1). Patients mostly affected were aged 2 years and below. The most common cause of burns was hot water in 31 (58.5%) patients. The vast majority of these injuries happened in a domestic environment (92.5%) and in the presence of competent adult/s (88.7%). Outcome of treatment was good: there were two (3.8%) deaths and 46 (86%) patients had complete recovery. Conclusion: Burns is still a major health problem among children in south eastern Nigeria. Fortunately, outcome of appropriate treatment is good. However, we think that poor safety consciousness among parents is a major predisposing factor. Public enlightenment on measures to ensure safe home environment may be necessary to avoid or limit childhood burns

Time of passage of first stool in newborns in a tertiary health facility in Southern Nigeria

Introduction: The first stool passed by the newborn, the meconium, is different from the ordinary stool both in its nature and its implication. Delayed or non-passage of the meconium may represent a number of clinical conditions. In this study, we sought to identify what should be considered delayed passage of meconium in our babies. Aims and Objectives: To investigate the timing of passage of first stool in Nigerian neonates and whether it is influenced by gender, birth weight, maternal age, and parity. Materials and Methods: A proforma was designed to obtain the following data: Maternal age, parity, mode of delivery, Apgar score at 1 min, birth weight, gender, and interval between delivery and passage of first stool among normal newborn babies delivered at the obstetrics department of our center in August and September 2010. Results: One hundred babies out of 393 delivered during the period of the study were included in the study. There were 63 (63%) males and 37 (37%) females. The interval between delivery and passage of meconium ranged from 0.5 to 54 h; mean, 16.2 (SD = 10.57). This was not influenced by gender, weight, maternal age, and parity. Conclusion: Non-passage of meconium beyond 48 h of life could be considered delayed. We therefore, recommend that clinicians should re-evaluate newborns, for hitherto unrecognized conditions, if after 48 h they have not passed first stool

Knowledge and Use of Biostatistics among Resident and Junior Doctors at the University of Port Harcourt Teaching Hospital, Port Harcourt

Background: The place of research in the generation of facts and evidence on which contemporary medicine can be based cannot be overemphasized. Medical and surgical research is now more crucial than ever before for advancement of clinical practice and career progression for medical professionals. This requires good understanding and application of biostatistics among clinicians. Aim: To assess the knowledge and use of biostatistics among resident doctors at the University of Port Harcourt Teaching Hospital, Port Harcourt. Subjects and Methods: This was a questionnaire-based study carried out in the University of Port Harcourt Teaching Hospital. Completed questionnaires were retrieved immediately after completion. The data were entered into an Excel spreadsheet, cleaned, and subjected to statistical analysis. Results: There were a total of 109 respondents. Sixty-nine (63.3%) respondents were included in the study. Fifty-five (79.7%) respondents indicated that they understood the basic concepts of biostatistics, and only 16 (23.2%) respondents can apply their knowledge practically in research. Conclusion: The level of appreciation and use of biostatistics among resident doctors in the University of Port Harcourt Teaching Hospital is inadequate. This may be a reflection of the situation with resident doctors in other institutions in the country. There is a need for a curriculum review both at the undergraduate and postgraduate levels to prepare medical professionals for the task of high-quality research and advancement of knowledge

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways