Dicephalus parapagus conjoined twins discordant for anencephaly: a case report

INTRODUCTION: Cases of conjoined twins occur so rarely that it is important to learn as much as possible from each case. CASE PRESENTATION: We present a case of 9-hour-old, female, Nigerian dicephalus parapagus conjoined twins discordant for anencephaly diagnosed only after the birth of the twins. The anencephalic twin was stillborn while the normal one died within 9 hours of birth from cardiopulmonary failure. CONCLUSION: Many congenital defects of interest can now be detected before birth. A severe lesion such as that found in our index case, which is incompatible with postnatal life, requires counselling. If detected early enough during a properly monitored antenatal care, it may indicate termination of pregnancy

Syndromic anorectal malformation associated with Holt–Oram syndrome, microcephaly, and bilateral corneal opacity: a case report

BACKGROUND: The occurrence of an anorectal malformation with Holt–Oram syndrome, microcephaly, and bilateral corneal opacity is rare and to the best of our knowledge has not previously been reported in the literature. Hence, there is a need to document our experience in this case and learn as much as possible from it. CASE PRESENTATION: We present the case of a Nigerian female neonate with a postnatal diagnosis of syndromic anorectal malformation associated with Holt–Oram syndrome, microcephaly, and bilateral corneal opacity. The infant had successful staged correction of her anorectal malformation but developed a metastatic Wilms’ tumor and died before other corrective procedures could be instituted. CONCLUSIONS: An anorectal malformation is here reported to occur with Holt–Oram syndrome, an association that has not been reported previously. To enhance the prognosis and quality of life of children with syndromic anorectal malformation, prenatal ultrasound monitoring of high-risk pregnancies and expertise in prenatal detection of congenital anomalies are invaluable in antenatal care

An Analysis of the Extent of Implementation of Environmental Cost Management and Its Impact on Output of Oil and Gas Companies in Nigeria, (2001-2010)

This study was set out to critically analyzed the extent of implementation of environmental cost management and its impact on output of oil and gas companies in Nigeria from 2001 to 2010. The paper was aim at ascertaining the extent to which implantation of environment cost management has impacted on the oil and gas industries in Nigeria. Using multiple regression analytical technique," data from the central bank of Nigeria (CBN) and Environmental Impact Assessment Agency were obtained. Findings revealed that there exist a significant relationship between the parameters that influence environmental cost management and output of oil and gas produced in Nigeria. Also, it was discovered that there are no established standards in Nigeria guiding environmental cost management in the oil and gas industries in Nigeria. Again there is a lacuna in external reporting of environmental cost data in Nigeria. It was concluded that the extent of environmental cost management in the oil and gas industries is at  its rudimentary stage. It was however recommended inter alia that; there should be improvement in external reporting of environmental cost data in the oil and gas industries in Nigeria. And the adoption  of the United Nations Environmental cost Management Accounting (ECMA) guidelines which will enhance the formulation of a Generally Accepted Accounting Principles (GAAP) in Nigeria, which will evolve environmental cost management accounting practice. This will facilitate the global campaign for environmentally enhanced society.   Keywords: Social contract, Eco-efficiency, Environmental quality cost, Environment pollution prevention costs,                          Environmental internal failure costs, Environmental external failure costs, Environmental detection cost

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05-1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4-7 days or ≥ 8 days of 1.25 (1.04-1.48), p = 0.015 and 1.31 (1.11-1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care

Utilization of banked blood in pediatric surgical procedures in Calabar, Nigeria

Background: Performing major surgery in a child demands that blood is cross-matched and saved to be transfused as indicated. Because the cost of cross-matching and donation of blood can be enormous and may equal or surpass the cost of surgery in our setting, it is pertinent to evaluate its utilization. The aim of this study was to determine how banked blood meant for pediatric surgical procedures was utilized with the hope of streamlining our blood requisition policy. This may be useful to pediatric and other surgeons involved in the operative care of children in similar settings. Materials and Methods: This was a prospective study of all children who had ELECTIVE or EMERGENCY surgical procedures between January 2009 and June 2010. The age, sex, nature of surgery, blood loss, banked units of blood and amount transfused were collected and analyzed. Results: Eighty two patients had 81 units of blood banked for them. Forty - eight and half units (59.9%) of the banked blood were for the emergency group but only 18 units (22.2%) were actually transfused at the end (P = 0.044) leading to inadequate use of the product. Conclusion: Banking large quantities of blood but utilizing only little is tantamount to inadequate use and delays surgical intervention. Indirectly, it increases cost of surgery. There is need to rationalize our blood ordering habits without causing harm to patients

Outcome of primary closure of abdominal wounds following typhoid perforation in children in Ile-Ife, Nigeria

<b>Background:</b> Abdominal wounds following surgery for typhoid perforation are classified as dirty, with an infection rate of over 40&#x0025;. To date, the optimal method for closure of these wounds remains controversial. Delayed primary closure which was conventionally recommended as standard practice, is now considered to be of no value in preventing surgical site infection (SSI). This study evaluates the outcome of primary closure of this class of wounds in children in Ile-Ife, Nigeria, and advocates a multidisciplinary wound management protocol. <b> Patients and Methods:</b> This is a retrospective study of children aged &lt; 1-15 years who had had surgery for typhoid perforation in a teaching hospital in south western Nigeria, over a period of ten years. <b> Results:</b> Thirty-two patients, 18 males and 14 females, in the ratio of 1.3:1 were managed for typhoid perforation during the ten year period. All 32 patients had primary closure of their abdominal wounds. There was primary wound healing in six (18.8&#x0025;) patients, while 19 (59.4&#x0025;) patients had surgical site infections. Wound dehiscence, intraabdominal abscess, and faecal fistulas were the other complications documented in the study.<b> Conclusion:</b> Abdominal wounds of typhoid perforation, though classified as being dirty, can be closed primarily with good healing outcomes. A multidisciplinary approach to wound management will reduce the incidence of wound sepsis and its associated morbidity and costs

Epidemiology of external birth defects in neonates in South western Nigeria

<b>Background:</b> There is paucity of information on the prevalence of birth defects in Nigeria, particularly in our setting. This study determined the epidemiology of external congenital anomalies in Southwest Nigerian children. <b> Patients and Methods:</b> This was a stratified, randomized study of neonates presenting with external birth defects in Ife-Ijesha in Southwestern Nigeria, from August 2003 to July 2004. The neonates were screened for obvious congenital malformations by thorough physical examination. <b> Results:</b> A total of 624 neonates were screened, 43 (6.9&#x0025;) of whom had external birth defects (prevalence: 3.7 &#x00B1; 0.8&#x0025; SD). There was a slight male preponderance (M: F= 1.4: 0.9). The overall prevalence rates of external congenital and major anomalies in Ife-Ijesa are 6.9 and 3.7&#x0025; respectively. A higher prevalence for major malformations, 6.3&#x0025;, was also found within the minority ethnic groups in these communities compared to the native majority. Musculoskeletal abnormalities are the most common anomaly, followed by those of abnormal external genitalia and head defects. <b> Conclusion:</b> Major malformations are more common amongst the minority settlers in this study, and musculoskeletal abnormalities were the most prevalent

Day case inguinal hernia surgery in Nigerian children: Prospective study

Background: There has been an increase in day case surgery for children worldwide, but there have been few reports of the practice (most of them being retrospective) by many of the surgical sub-specialties in the sub-region. The aim of this study was to document our experience with day case inguinal hernia surgery in a developing economy. Materials and Methods: This was a prospective study of uncomplicated inguinal hernias treated as day case at OAUTHC between April 2004 and December 2004. Data were collected and analysed. Results: Eighty-eight patients were recruited into the study and none defaulted. There were 88 patients, (M:F = 16.6:1). A majority (n = 54) of the hernias occurred on the right side, while just a few (n = 18) occurred on the left. There were 5 cases of wound infections giving an infection rate of 4.8&#x0025;. In all, the morbidity following day case inguinal hernia surgery was slight and no patient required readmission into the hospital. Conclusion: Day case inguinal hernia surgery in children is safe and well accepted by patients and parents alike. Health institutions in which children with inguinal hernias still queue for long periods for space on the operation list need to adopt day case surgery for inguinal hernia in order to forestall the risk of their obstruction