Training and Confidence Level of Junior Anaesthetists in CPR- Experience in A Developing Country

Training in resuscitation is done worldwide by a dedicated council who is responsible for training and frequent recertification. Nigeria has no Resuscitation council and training is the responsibility of individual health institutions. There is no mandatory law on resuscitation training or recertification. This study sought to investigate how much training in CPR occurs, how effective this training is and how confident our anaesthetic trainees are in implementing present guidelines. A detailed questionnaire was anonymously filled by trainee anaesthetists who attended a revision course prior to postgraduate examinations. They answered questions on their length of training in anaesthesia, CPR training re-ceived, confidence in implementing existing guidelines and suggestions for improvement. Thirty -six trainees responded. Mean length of anaesthetic training was 3.55 ±2.39 years. 55.6% of trainees had received some CPR training. 75% of this was conducted by their anaesthetic department. Eleven trainees (30.6%) were confident in their ability to perform CPR according to 2005 guidelines, twelve (33.3%) had ever defibrillated a patient and only ten (27.8%) were confident in their ability to interpret ECG There is low confidence among junior anaesthetists in Nigeria in performance of CPR, poor knowledge of ECG interpretation of cardiac arrest rhythm and little practice in defibrillation. The establishment of a Resuscitation council would ensure adequate and frequent training which would improve knowledge, boost confidence and result in better patient care

Awareness of the Warning Signs, Risk Factors, and Treatment for Tuberculosis among Urban Nigerians

Objectives. To determine the awareness of the warning signs, risk factors, and treatment of tuberculosis among urban Nigerians. Methods. This was a cross-sectional survey among 574 adults in Ilorin, Nigeria. Semistructured questionnaire was administered by trained interviewers to obtain information about awareness of tuberculosis warning signs, risk factors, and treatment. Results. Majority of the subjects (71.4%) were aware of at least one warning sign of tuberculosis. Cough (66.2%), weight loss (38.0%), and haemoptysis (30.7%) were the most identified warning signs. The predictors of awareness of warning sign were increasing age (), higher family income (), higher level of education (), and belonging to Christian faith (). Awareness of risk factors for tuberculosis was higher for tobacco smokers (77.0%) and history of contact with a case of TB (76.0%). Less than half were aware of HIV infection (49.8%), alcohol consumption (42.5%), chronic kidney disease (40.4%), extremes of ages (39.4%), cancers (36.9%), and diabetes mellitus (27.5%) as risk factors for TB. Tuberculosis was reported to be curable by 74.6% of the subjects and 67.9% knew that there are medications for treatment of tuberculosis, while 11.5% knew the duration of treatment. Conclusion. This study has revealed that the awareness of HIV and noncommunicable diseases as risk factors for TB is poor. This study has therefore demonstrated the need for health education programs that will emphasize recognition, identification, and modification of risk factor for TB

Oral fetus-in-fetu: A case report

Fetus-in-fetu is a rare condition, less than 200 cases have been reported. Its embryopathogenesis is linked to a monozygotic, diamniotic parasitic twin. The presence of a calcified vertebral column and other body parts are key to the diagnosis, and differentiate it from a teratoma. We report a case of a neonate who was admitted immediately after delivery by Caesarian section following a prolonged obstructed labor caused by a huge mass projecting from the hard palate. The mass had identifiable malformed body parts but was anencephalic. Intraoperative findings were a short stalk and cleft of the soft palate. He had excision of the mass and did well post operatively. Persistent mouth breathing and difficult nasal cannulation lead to request for post operative magnetic resonance imaging which showed patent nostrils and absent residual mass. Prompt and skillful anesthesia and surgical intervention assisted in the survival of this patient

Postoperative pain management in children: A survey of practices of pediatric surgeons in Nigeria

Background: Postoperative pain has a negative effect on the process of recovery. There is paucity of literature on the postoperative pain management practice in children in developing countries. We sought to determine the current practice of postoperative pain management in children among pediatric surgeons in Nigeria. Methods: A cohort of 43 pediatric surgeons/trainees attending two annual meetings of Association of Paediatric Surgeons of Nigeria (2011 and 2013) were surveyed with a questionnaire enquiring about the practice of postoperative pain management in children and their perceptions. Results: Thirty-seven respondents had completed the survey (86% response rate). Of these respondents, 27 (73.0%) were consultants and 10 (27.0%) were trainees. Only 2 (5.4%) respondents used any guidelines, and 8 (21.6%) respondents had an established institutional protocol for the pediatric postoperative pain management. Almost half of the respondents (18, 48.6%) used clinical judgments for assessing postoperative pain, followed by crying, requires oxygen to maintain saturation > 95%, increased vital signs, expressions, and sleeplessness scale (13, 35.1%); alertness, calmness, respiratory response/crying, physical movement, muscle tone, and facial tension behavioral scale (11, 29.7%); and verbal rating (10, 27.0%). In neonates, 89% of the respondents used paracetamol and 32% used pentazocine for routine postoperative analgesia. None of the respondents used morphine for neonatal postoperative analgesia. In older children, commonly used analgesics include paracetamol (35, 94.6%), pentazocine (30, 81.1%), and nonsteroidal anti-inflammatory drugs (28, 75.7%). More than half of the respondents (20, 54.1%) were not satisfied with their current practice of postoperative pain management. Conclusion: Pain was infrequently assessed, and analgesic therapy though multimodal was largely not protocol based and therefore subject to inadequate pain relief. Postoperative pain should be more visible in our hospitals, and efforts should be made to improve its assessment and management

Pediatric laparoscopic surgery in North-Central Nigeria: Achievements and challenges

Background and Objective: Advances in laparoscopy are making the service accessible even in resource-poor countries where adaptations are made to meet local challenges. We report our experience in the provision of laparoscopy service to children at a tertiary health center in North-central Nigeria. Methods: A team of pediatric surgeons, anesthetists, and nurses collaborated to provide service and train other personnel. A prospective collection of data on biodata, diagnoses, procedure, and outcome over an effective period of 36 months of laparoscopy intervention of the 54 months between September 2009 and February 2014 was done. Consent, which also included the possibility of conversion to open was obtained from the parents of the patients. Results: A total of 73 patients aged 2 weeks to 16 years with a male: female ratio of 3 to 1 had laparoscopy done during the period. Fifty-two (71.2%) procedures were therapeutic, and 21 (28.8%) cases were done as emergency. Laparoscopic appendectomy was the most commonly performed procedure 25 (34.3%), followed by laparoscopic orchidopexy 17 (23. 3%), and diagnostic laparoscopy for disorders of sexual differentiation in 13 (17.8%). The length of stay in hospital postoperative was 1-3 days with a mean of 1.34 ΁ 0.45 days. The complications recorded included hemorrhage, in a case of infantile hypertrophic pyloric stenosis due to failed electrocautery, one port site burns injury from diathermy dissection, and two periport pain postoperation. There was no mortality recorded. Conclusion: Pediatric laparoscopic service is gaining recognition in our practice in spite of poor resources, incessant industrial actions, and apathy from support staff. The outcomes are encouraging as the patients had minimal morbidities. Skills are improved through practice and retraining and manpower, and instruments are being expanded through our collaboration and training

Development and validation of a questionnaire to assess the doctors and nurses knowledge of acute oxygen therapy.

BACKGROUND:Prescription and administration of oxygen in emergencies by healthcare providers are reported to be inappropriate in most settings. There is a huge gap in the knowledge of health care providers on various aspects of oxygen therapy, and this may be a barrier to optimal oxygen administration. Hence, it is essential to ascertain providers' knowledge of acute oxygen therapy so that appropriate educational interventions are instituted for better delivery. There is no available validated instrument to assess knowledge of acute oxygen therapy. The study aimed to develop, validate and evaluate the test-retest reliability of a questionnaire to determine the doctors and nurses understanding of acute oxygen therapy. METHODS:This study involved the development of the questionnaire contents by a literature review, assessment of face validity (n = 5), content validity, using a panel of experts (n = 10), item analysis and test-retest reliability among a sample (n = 121) of doctors and nurses. RESULTS:Face validity indicated that the questionnaire was quick to complete (10-15 min), most items were easy to follow and comprehensible. The global content validity index (S-CVI) was 0.85. The test-retest reliability statistics showed a kappa coefficient of 0.546-0.897 (all P<0.001) and percentage agreement of 80-98.3% indicating high temporal stability in the target population. In total, 90% of the items fulfilled the reliability acceptance criteria. Item discrimination analysis showed that most questions were at an acceptable level. The final questionnaire included 37 item questions and eight sections. CONCLUSION:The designed questionnaire is a reliable and valid tool for assessing knowledge of acute oxygen therapy among doctors and nurses