Comparative effects of ethanol extract of Talinum triangulare and ascorbic acid on Di-2-ethylhexyl phthalate induced undescended testis in Wistar rats

This study compared the effects of Talinum triangulare extract and Ascorbic acid on the oxidative stress caused by Di-2-ethylhexyl-phthalate (DEHP) induced undescended testis (UDT) in Wistar rats. Twenty-four pregnant rats were randomly divided into six groups of four animals each. Group 1(Control) received 2.5ml/kg corn oil for 21 days, Group 2 received 750mg/kg DEHP on gestational days (GD) 14-18, Group 3 received 200mg/kg ascorbic acid for 21 days and 750mg/kg DEHP from GD 14-18 and Group 4 received 200mg/kg Talinum triangulare extract for 21 days and 750mg/kg of DEHP from GD 14-18. The dams were delivered, the resulting pups weighed and sacrificed on postnatal day (PND) 28. Gross examination of the pups, biochemical and histological changes were recorded. Data were analyzed using One-way ANOVA. Group 2 pups had UDT and low birth weight compared to other groups. The mean testicular weight and anogenital distance (AGD) were low in Group 2 pups compared to pups in Groups 3 and 4. The mean values of all the antioxidant enzymes and serum testosterone were low in Group 2 pups compared to other groups. Histological examination of the testes of Group 2 pups revealed moderate vascular congestion within the tunica albuginea and severe atrophy of seminiferous tubules with degenerated Sertoli cells compared to normal findings in other Groups. Although the ameliorative effects of Talinum triangulare is not as potent as that of Ascorbic acid, preconceptional and continuous intake of this vegetable by pregnant women would help to prevent UDT and other associated problems.Keywords: Oxidative stress, Talinum triangulare , testosterone, Undescended testis, Ascorbic aci

Solitary colonic neurofibroma in an African child

Neurofibromas are a group of heterogeneous neurocutaneous disorders. They are benign neoplasms consisting of neural and connective tissue components affecting any organ system. Gastrointestinal involvement in neurofibromatosis type 1 (NF1) are rare and are late manifestations of the disease, but in exceptional cases they can be the initial sign of neurofibromatosis in patients who have no external stigmata that arouse suspicion. Neurofibromatosis of the colon as a part of the NF1 is rare. Isolated colonic neurofibromatosis without other features suggestive of NF1 is rarely encountered in clinical practice. We report the case of a 12-year-old boy with an isolated colonic neurofibromatosis presenting with a right hypochondrial mass with no external features of NF1. We report this case as its presentation in children may give a diagnostic dilemma and the probability of malignant digestive disease associated with NF1 should be kept in mind, regardless of the age of the patient.Keywords: children, colonic, neurofibroma, rare, solitar

Histoarchitectural studies of gonads of rat pups following brief exposure to hyperthermia in-utero

This study investigated the effect of hyperthermia on the gonads of the pups of Wistar rats following maternal exposure to brief hyperthermia during pregnancy. Twenty-five pregnant adult female Wistar rats were randomly selected into two groups: Group A (Control) which consisted of 10 female rats and Group B (Experimental) which had 15 female rats. The pregnant dams in the experimental group were exposed to brief hyperthermia for 15 minutes twice daily at 8.00am and 4pm on gestational day (GD) 12-18. The pups produced by the rats were weighed, examined and sacrificed at 35days of post-natal life. Recorded were the microscopic appearances of the gonads while the luminal diameter and thickness of the gonadal vessels were measured and recorded. Data was analysed, mean and standard deviation were generated with student t-test, and p< 0.05 was taken as significant. Maternal exposure to brief hyperthermia during pregnancy significantly reduced the birth weight of the pups in Group B (3.86 ± 0.26g) compared to Group A (4.71 ± 0.18g). The luminal diameters of the testicular and ovarian arteries of the pups in Group B were significantly increased whereas the gonadal vascular arterial wall thicknesses were significantly reduced in comparison with the Group A. Histological examination of the gonads revealed fewer cell population with degeneration and damage to the germinal epithelium of the gonads of the pups in Group B which was more severe in the testes. Maternal exposure to brief hyperthermia during pregnancy has deleterious effects and subsequent destruction of the gonads of pups of Wistar rats and this may interfere with fertility of the pups later. Key Words: brief hyperthermia, gonads, maternal, pregnancy, wistar rat

Typhoid Caecal Perforation in a Two-Year Old Child: A Case Report

BACKGROUND: Typhoid fever afflicts people of low socioeconomic status in developing nations. Although ileal perforation is a common complication of typhoid fever in tropical Africa, caecal perforations related to typhoid fever are uncommon. They present atypically in children under of five years old. Such presentation could include cough and caecal perforation.CLINICAL DESCRIPTION: We report a two-year old girl with intraoperative and histopathological evidence of a perforated typhoid caecitis who had right hemicolectomy.CONCLUSION: Caecal perforations may occur in children as young as two years of age following enteric fever. High index of suspicion is needed for early detection.

Measurement of penile size in healthy Nigerian newborns using conventional penile length measurement technique

Objectives We attempted to establish a standard penile length for male newborn Nigerians using the conventional penile length measurement technique.Summary Defining the normal penile size in the neonate is paramount to making accurate diagnosis of abnormalities of the penis and the medical and surgical management of these anomalies.Patients and methods We carried out a prospective cross-sectional study of all term male neonates within 72 h of birth from April 2013 to March 2014 in the three largest obstetric centres (University College Hospital, Adeoyo Maternity Hospital and Our Lady of Apostles Catholic Hospital) in Ibadan, Nigeria. They underwent clinical examination, and their penile sizes were measured using the conventional penile length measurement technique.Results A total of 675 male Nigerian newborns were studied. The mean penile length was 3.14 ±0.65 cm, and the mean penile width was 0.97± 0.15 cm.Conclusion The penile dimensions obtained are comparable with reported values in previous studies in other parts of the world

The role of fluoride on eruption of mandibular molar of albino rats

Eruption of the tooth is a complex and highly regulated process which can be influenced by genetic, environmental and systemic factors. Fluoride is found naturally in water as well as in foods and dental products. The first mandibular molar is the first molar to erupt and it is essential for  mastication of food. We studied the effect of fluoride on the eruption of the first mandibular molar in albino rats. Fluoride at different  concentrations was added to the water of pregnant albino rats while sterile water without fluoride was given to the control pregnant dams. The pregnant dams were allowed to deliver, and the heads of their pups carefully decapitated, and mandibles dissected out on days 10, 12, 15 and 18 for assessment of eruption pattern of the first molar while also measuring the mandibular length and breadth. The mandibles were then processed for hematoxylin and eosin staining. On gross examination, some of the teeth developed intraosseously while others were located mucosally, pre-occlusally or occlusally. There was significant reduction in both the birth weight and mandibular length as the fluoride concentration increased compared to the control but a significant increment in the mandibular breadth between the experimental groups in comparison with the control group on day 15 (p value <0.05). These findings suggest that high concentrations of fluoride could delay mandibular molars’ eruption and also cause low birth weight. Key Words: fluoride, mandibular molar, tooth eruptio

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Childhood intussusception: A prospective study of management trend in a developing country

Background: The management of intussusception has evolved universally from the use of hydrostatic reduction through operative reduction to the use of pneumatic reduction for the acute and uncomplicated cases and surgical reduction for the complicated cases. However, the process of evolution has been very slow in the developing countries, especially sub-Saharan Africa, due to lack of requisite facilities and expertise to manage these patients nonoperatively. This study examined the trends in the management of childhood intussusception in a developing country, compared operative and nonoperative modalities of treatment, and assessed the impact of delayed presentation on the outcome of management. Patients and Methods: This was a prospective study of the management of children with intussusception at the University College Hospital, Ibadan, Nigeria. Results: Fifty-five consecutive cases of intussusception that presented to the Children Emergency Unit of the University College Hospital between January 2005 and December 2011 were prospectively studied. Details of sex, age of the patients, clinical presentation, duration of symptoms, mode of treatment, and incidence of recurrence were recorded and analyzed. The median age was 7 months. Moreover, the duration of symptoms varied from 1 to 21 days with a mean of 4 days. Twenty-two patients (40%) had attempted hydrostatic reduction; this was successful in 14 patients (63.6%), whereas 8 patients (36.4%) had failed reduction. In all, 41 patients (74.6%) had operative management of intussusceptions; primary operative intervention was carried out in 33 patients (60%) and secondary surgical management in 8 patients (14.5%) with failed hydrostatic reduction. At surgery, manual reduction of intussusception was carried out on 17 patients (30.9%) and resection of devitalized bowel with end to end anastomosis was carried out on the remaining 24 patients (43.6%). The incidence of surgical intervention for intussusception was 74.6%, mortality was 3.6%, and recurrence rate was 3.6%. Conclusions: Nonoperative management of intussusception should be adopted in carefully selected cases of intussusception in this subregion as it will help to reduce the financial burden on the parents while surgical management should be reserved for the complicated cases

Childhood intussusception: Impact of delay in presentation in a developing country

Background: The classical cases of intussusception are readily diagnosed clinically, and despite recent improvements in radiological techniques, the diagnosis of intussusception and success in its nonoperative reduction has been suboptimal, thus making operative management a veritable backup. This study examined the impact of delays in presentation on the rate of bowel resection, length of hospital stay, and appraised the outcome of operative treatment. Patients and Methods: This was a retrospective study of consecutive children admitted and treated surgically for intussusception between January 2002 and December 2011 at the University College Hospital, Ibadan, Nigeria. Results: The mean age at presentation was 13.4 months with a male: female ratio of 1.8:1. Fourteen patients (25.5%) presented within the first 24 h of onset of symptoms with majority (36.4%) presenting between 2 and 3 days of onset of symptoms. The primary surgical intervention was performed on 47 patients (85.5%), and the secondary operative intervention was performed on eight patients (14.5%) who had failed initial nonoperative management of intussusception. Manual reduction of intussusception was performed on 27 patients (49.1%), 26 patients had resection of gangrenous bowel with end-to-end anastomosis while two patients (3.6%) had spontaneous reduction of intussusception which was discovered at laparotomy. The mean duration of hospital stay was 12.1 days (range 3–60 days). The overall mortality was 5.5% (three patients), and three patients (5.5%) had recurrence of intussusception. Conclusion: Although mortality is reducing, a high rate of bowel resection is a consequence of delayed presentation and effort should be made to make an early diagnosis of intussusception and make prompt referral to improve outcome