Day-care Plastic Surgery in Nigeria: Coping With Limited Resources

Background: The main problems facing acute surgical services in most countries are shortages of resources and finance, and long waiting lists. The concept of day-care surgery has been well established since the early nineties. Since then, enthusiasts have also indicated that day-care surgery represents a safe, cost-effective and efficient practice. Methods: A 3-year retrospective analysis of all day-care plastic surgical cases undertaken in the unit from January 2001 to December 2003 at the Usmanu Danfodiyo University Teaching Hospital, Sokoto. Folders of such patients were obtained from the hospital's medical records department. The information obtained was analyzed for demographic data, surgical problems, type of anaesthesia and postoperative complications. Results: A total of 148 procedures were carried out in 137 patients. This represented 37.2% of all procedures done and 36.5% of all patients treated within the same period in the unit. The ages ranged between 2 weeks and 58 years (mean = 23.1 years). There were 66 males and 71 females, giving a male: female ratio of 1:1.1. The most frequently performed procedure was lipomectomy (11.7%), followed by biopsy of skin tumours (10.9%), incision of tongue tie (10.2%), excision of breast lump (9.5%), reconstruction of facial structures (8.8%), ganglionectomy (8.0%) and others. The anaesthesia used was loco-regional with lignocaine in 92(67.2%) patients, intravenous ketamine in 41(29.9%) patients and inhalation anaesthetics in the remaining 4 (2 .9%). postoperative complications were observed in 13 (9. 5%) patients, the commonest of which was wound infection (8. 0%), followed by bleeding (5.1%), pain (5.1%) and haematoma (2. 9%). Readmission rate was 3.6%, mainly due to bleeding and delayed recovery from anaesthesia. Neither significant wound disruption nor mortality was recorded. Conclusions: Good preoperative patient selection and preparation are essential prerequisites for day-care plastic surgery especially in resource-limited environments like ours. It is safe and cost-effective.Fond: Les probl\ue8mes principaux qui charact\ue9risent les services chirurgicaux aigus dans la plupart des pays sont des manques de ressources et de finance, et \ue9galement de longues listes d'attente. Le concept de chirurgie d'assistance sociale a \ue9t\ue9 bien \ue9tabli depuis le d\ue9but des ann\ue9es quatre-vingt-dix. Depuis, les fervents ont indiqu\ue9 aussi que cette chirurgie d'assistance sociale repr\ue9sente une pratique s\ufbre, rentable et efficace. M\ue9thode: Une analyse r\ue9trospective de 3 ann\ue9es de tous les cas chirurgicaux, en plastique et d'assistance sociale entrepris pendant la p\ue9riode du 2001 janvier au 2003 d\ue9cembre \ue1 l'h\uf4pital d'enseignement de l'Universit\ue9 d' Usmanu Danfodiyo, Sokoto. Les dossiers de tels malades ont \ue9t\ue9 obtenus du d\ue9partement de rapports m\ue9dical de l'h\uf4pital. L'information obtenue a \ue9t\ue9 analys\ue9e pour les donn\ue9es d\ue9mographiques, les probl\ue8mes chirurgicaux, le type d'anesth\ue9sie et de complications postop\ue9ratoires. R\ue9sultats : Un total de 148 proc\ue9dures a \ue9t\ue9 ex\ue9cut\ue9 dans 137 malades. Ceci a repr\ue9sent\ue9 37,2% de toutes proc\ue9dures faites et 36,5% de tous malades trait\ue9s dans la p\ue9riode pareille dans l'unit\ue9. Les \ue2ges se sont \ue9tendus entre 2 semaines et 58 ann\ue9es (moyen= 23,1 ann\ue9es). Il y avait 66 m\ue2les et 71 femelles, donnant une proportion de m\ue2le : femelle de 1:1,1. La proc\ue9dure le plus fr\ue9quemment ex\ue9cut\ue9e \ue9tait la lipomectomie (11,7%), suivi par la biopsie de tumeurs de peau (10,9%), l'incision de match nul de langue (10,2%), l'excision de tas de sein (9,5%), la reconstruction de structures du visage (8,8%), la ganglionectomie (8,0 %) et les autres. L'anesth\ue9sie utilis\ue9e \ue9tait loco-r\ue9gional avec xylocaine dans 92(67,2 %) malades, ketamine intraveineux dans 41(29,9 %) malades et l'anesth\ue9siologie inhalationale dans les 4 (2,9%) restants. les complications postop\ue9ratoires ont \ue9t\ue9 observ\ue9es dans 13 (9,5%) malades, dont le plus commun \ue9tait l'infection de blessure (8,0%), suivi par le saignement (5,1%), la douleur (5,1 %) et l'haematome (2,9%). Le taux de r\ue9admission \ue9tait 3,6%, principalement en raison du saignement et le r\ue9tablissement retard\ue9 de l'anesth\ue9sie. Ni l'interruption de blessure significative ni la mortalit\ue9 a \ue9t\ue9 enregistr\ue9e. Conclusion: La bonne s\ue9lection pr\ue9op\ue9ratoire des malades et la pr\ue9paration sont des conditions pr\ue9alables essentielles pour la chirurgie esth\ue9tique d'assistance sociale surtout dans les environnements de manque de ressources comme le n\uf4tre. C'est s\ufbr et rentable

Palatal avulsion injury by a foreign body in a child

A 6-year-old girl who claimed to have fallen while playing with metal rod that resulted in palatal avulsion injuries was presented. Neither of the parents was around when the incidence happened. She was brought to the hospital because of pain, bleeding from the mouth, drooling of saliva mixed with blood and inability to feed or phonate appropriately. Examinations of the oral cavity revealed a triangular area of avulsion in the posterior aspect of the hard palate extending to the soft palate. She had examination under anaesthesia and wound repaired with 3-0 vicryl interrupted sutures after thorough wound debridement. She did well and was discharged from the clinic

Towards a digital policing in developing nations : the Nigerian context

Technology-assisted living is a growing trend in most developing nations, particularly for young-aged demographic countries, as it presents a platform for personal development and knowledge management. However, this societyscaping trend has also introduced the myriad opportunity for the formation of complex crime, which is often beyond the (immediate) capability of the policing entity in developing nations. To address this lingering and futuristic problem, particularly in Nigeria, this study developed a context-based digital policing framework for the enhancement of the Nigerian Police. This Nigerian-context framework presents the viability and relevance of the digital policing mechanism in addressing challenges ravaging society. Furthermore, it also presents a modality for improving and enhancing the policing apparatus of the Nigerian society, as a model for other developing nations. The knowledge from the Nigerian-context of digital policing has both research and societal implications. In terms of research, it opens the community of security researchers into the contextual characteristics of digital policing as well as the probable research direction required to implement digital policing in developing nations. With respect to society, knowledge provides a substratum for the integration of the community-policing model.https://www.ijitee.orgpm2020Computer Scienc

Compartment syndrome of the extremity: Matters arising

Background: Compartment syndrome (CS) is a limb-threatening and a life-threatening condition that occurs when pressure within a musculofascial compartment exceeds tissue perfusion pressure. Morbidity and mortality from CS stem from delay in diagnosis and treatment. Aim: To highlight the various clinical and experimental aspects of CS, in order to increase the awareness of clinicians and reduce unnecessary morbidity and mortality resulting from this condition. Methods: A review composed through Medline Internet search, literature search and contributions from our individual and collective experiences over the years, as well as shared experiences from colleagues. Results: The compartments of the lower leg, foot and the volar forearm are particularly prone to developing CS. Many aetiological factors have been implicated, but the diagnosis is based on clinical, manometric, radiological and laboratory parameters. Although medical treatment may suffice in early cases, surgical decompression should be performed appropriately where necessary. Tendon transfers and stabilization may be indicated as late treatment. Conclusion: CS constitutes a threat to both limb and life. Prompt recognition of this condition is necessary in order to institute the appropriate management schedule

Cystic lymphangioma in an unusual site: The misdiagnosed scrotal mass

Background : Cystic lymphangioma (CL) is a congenital lymphatic malformation that is a rare cause of extratesticular scrotal masses in children, frequently misdiagnosed preoperatively. Complete excision is curative, but recurrence may result following incomplete excision. Aim: This case is presented to alert the medical fraternity on the possibility of CL in a rare site as the scrotum, and to consider same in the differential amongst commoner causes of scrotal masses in children and adults. Methods : A case report, Results : We report a case of cystic lymphangioma of the scrotum in a 7-year-old boy, which had been previously diagnosed as an epididymal cyst. Scrotal ultrasonography and operative findings were consistent with cystic lymphangioma, which was confirmed by histological examination of the excised specimen. The mass was completely excised and the child is free of recurrence at 3 years of follow-up. Conclusion : Scrotal masses may result from unusual causes like cystic lymphangioma, which must be taken into account in the differential diagnosis in such cases. High-resolution ultrasonography, followed by Computerized Tomography (CT) or Magnetic Resonance Imaging (MRI), are useful tools in diagnosis

Day-care plastic surgery in Nigeria: coping with limited resources

Background: The main problems facing acute surgical services in most countries are shortages of resources and finance, and long waiting lists. The concept of day-care surgery has been well established since the early nineties. Since then, enthusiasts have also indicated that day-care surgery represents a safe, cost-effective and efficient practice. Methods: A 3-year retrospective analysis of all day-care plastic surgical cases undertaken in the unit from January 2001 to December 2003 at the Usmanu Danfodiyo University Teaching Hospital, Sokoto. Folders of such patients were obtained from the hospital's medical records department. The information obtained was analyzed for demographic data, surgical problems, type of anaesthesia and postoperative complications. Results: A total of 148 procedures were carried out in 137 patients. This represented 37.2% of all procedures done and 36.5% of all patients treated within the same period in the unit. The ages ranged between 2 weeks and 58 years (mean = 23.1 years). There were 66 males and 71 females, giving a male: female ratio of 1:1.1. The most frequently performed procedure was lipomectomy (11.7%), followed by biopsy of skin tumours (10.9%), incision of tongue tie (10.2%), excision of breast lump (9.5%), reconstruction of facial structures (8.8%), ganglionectomy (8.0%) and others. The anaesthesia used was loco-regional with lignocaine in 92(67.2%) patients, intravenous ketamine in 41(29.9%) patients and inhalation anaesthetics in the remaining 4 (2 .9%). postoperative complications were observed in 13 (9. 5%) patients, the commonest of which was wound infection (8. 0%), followed by bleeding (5.1%), pain (5.1%) and haematoma (2. 9%). Readmission rate was 3.6%, mainly due to bleeding and delayed recovery from anaesthesia. Neither significant wound disruption nor mortality was recorded. Conclusions: Good preoperative patient selection and preparation are essential prerequisites for day-care plastic surgery especially in resource-limited environments like ours. It is safe and cost-effective

Relationship Between Epistaxis And Hypertension: A Study Of Patients Seen In The Emergency Units Of Two Tertiary Health Institutions In Nigeria

Both epistaxis and hypertension are common in the general population. This study aimed at determining the prevalence of hypertension among epistaxics, and the relationship between epistaxis and hypertension. Retrospective analysis of 62 adults comprising 31 each of males and females with a mean age of 41.4 ± 16.6 years (range: 18-90 years) that presented in the emergency units of two tertiary health institutions seen over 11 years was done.Main outcome measure was the prevalence of hypertension amongst epistaxics. Seventy-six age and sex-matched patients with bleeding from sites other than the nostrils with no record of epistaxiswere selected by simple random sampling as controls. Peak prevalence of epistaxis occurred during the months of January and March. Compared to the controls, the epistaxics had significantly higher blood pressures: (146.1 ± 40.7 mmHg versus 123.2 ± 16.3 mmHg systolic, P =0.001), and (91.3 ± 24.8 mmHg versus 78.2 ± 12.8 mmHg diastolic, P=0.001), and higher proportions of patientswith previous history of hypertension (32.3% versus 7.9%;

Extensive necrotising fasciitis in a 4-day-old neonate: a successful outcome from modern dressings, intensive care and early surgical intervention

Necrotising fasciitis (NF) is a fulminant and life-threatening soft tissue infection, which leads to vascular thrombosis and cutaneous ischemia. We present our experience with extensive necrotising fasciitis in a 4-day-old neonate and stress the importance of early diagnosis, modern dressings including negative pressure therapy, prompt surgical debridement and intensive care to improve the survival and cosmetic outcome of children with NF

Pubertal breast development in primary school girls in Sokoto, North-western Nigeria

Background. There is wide variation in normal pubertal timing among various populations. Objectives. To determine the mean age of pubertal stages of breast development and menarche, and the influence of nutrition and ethnicity on pubertal onset in primary school girls in Sokoto, North-Western Nigeria. Methods. A cross-sectional study using a multistage random sampling design was conducted on 994 primary school girls in grades 3 - 6. Weight and height measurements and Tanner breast staging were done. Body mass index (BMI) was calculated, and a BMI-for-age percentile was used to categorise nutritional status. There were four major ethnic groups. P≤0.05 was taken as showing statistical significance. Results. The participants’ mean age was 10.23 years (standard deviation (SD) 1.70, range 6 - 15 years). Of the 994 girls, 628 (63.2%) were pre-pubertal, and 366 (36.8%) were pubertal. Of the latter, 158 (15.9%) were in breast stage 2, while 112 (11.3%), 70 (7.0%) and 26 (2.6%) were in breast stages 3, 4 and 5, respectively. The mean ages (SD; range) of pubertal onset and menarche were 10.50 (1.33; 8 - 13), and 12.67 (1.65; 11 - 15), years, respectively. The overnourished (overweight/obese) and Igbo ethnic group girls had early-normal pubertal onset (p=0.006 and p=0.001, respectively). Conclusion. The mean ages of Tanner breast stages 1 - 5 and menarcheal age of girls in Sokoto, North-Western Nigeria, were within the age ranges reported worldwide. Pubertal onset was influenced by nutrition