An Unusual Foreign Body in the Ear of an Elderly Nigerian Patient

This was a case of an incidental finding of an unusual foreign body in the right ear of an elderly Nigerian patient. The mode of presentation, the manner of discovery and how it was managed successfully were highlighted. We reported this case to create awareness, and encourage physicians to always observe effluents obtained from irrigation of body cavities for confirmation of diagnosis and documentation. KEY WORDS: Ear syringing, elderly, foreign body, locust bea

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Amputation Surgery in a Secondary Healthcare Facility in Nigeria – A Ten Year Review

Amputation is a common surgical procedure which is practiced world-wide, although for varied indications. Amputation rate in Britain is put at 1 to 1.5 per 10,000 population,(1) whilst that of Nigeria is put at 1.6 per100,000 population. (2) Most studies conducted on various aspects of limb amputation in Nigeria came from tertiary and specialist orthopaedic centres, results of which may or may not necessarily represent the nationalpattern in view of the wide variation in sociocultural and demographic indices of the six geopolitical zones of the country. To document and share our experience in amputation surgery over a ten – year period in a secondary healthcare facility in sub- Saharan Africa. A retrospective study of 117 patients that underwent amputation in the facility between January 1998 and December 2007. Trauma remains the commonest indication for amputation in our environment. Only very few of the amputees were known to have been fitted with prostheses. Efforts should be made for proper and adequate treatment of limb injuries to avoid loss of limb. Traditional bone setters and the general public need to be enlightened about the harmful effects of inappropriate application of splints. Also improvement in facilities available in our hospitals especially in area of vascular surgery will go a long way in salvaging some limbs

Osteogenesis Imperfecta: Report of Two Consecutive Cases in a Monogamous Family from South-West, Nigeria

Osteogenesis imperfecta is a heritable disorder of connective tissue, affecting both bone and soft tissue. It is characterized by multiple fractures, bone deformities, short stature, ligament laxity, bluish sclera, among others. We present a monogamous family with two affected consecutive siblings, aged 5 and 3 years respectively, and a third sibling, three days old, who is unaffected

Buruli Ulcer: A Case Report from South-West, Nigeria Nigerian Hospital

We present a case report of a 15 year-old girl with Buruli ulcer which was confirmed during assessment/advocacy visit to a secondary Health facility in south-west, Nigeria by Global Buruli Ulcer Initiative, a WHO initiative. This case underscores the need for more education of health care providers working in the endemic areas of Nigeria. Collaboration among all players in the health care delivery system for the prevention, control, and early treatment of Buruli ulcer in order to prevent permanent disability is emphasized.Key words: Buruli ulcer, Mycobacterium ulcerans, South-western Nigeria, Abeokuta, Neglected tropical diseas

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)