Brucellosis as an Emerging Threat in Developing Economies:Lessons from Nigeria

Nigeria is the most populous country in Africa, has a large proportion of the world's poor livestock keepers, and is a hotspot for neglected zoonoses. A review of the 127 accessible publications on brucellosis in Nigeria reveals only scant and fragmented evidence on its spatial and temporal distribution in different epidemiological contexts. The few bacteriological studies conducted demonstrate the existence of Brucella abortus in cattle and sheep, but evidence for B. melitensis in small ruminants is dated and unclear. The bulk of the evidence consists of seroprevalence studies, but test standardization and validation are not always adequately described, and misinterpretations exist with regard to sensitivity and/or specificity and ability to identify the infecting Brucella species. Despite this, early studies suggest that although brucellosis was endemic in extensive nomadic systems, seroprevalence was low, and brucellosis was not perceived as a real burden; recent studies, however, may reflect a changing trend. Concerning human brucellosis, no studies have identified the Brucella species and most reports provide only serological evidence of contact with Brucella in the classical risk groups; some suggest brucellosis misdiagnoses as malaria or other febrile conditions. The investigation of a severe outbreak that occurred in the late 1970s describes the emergence of animal and human disease caused by the settling of previously nomadic populations during the Sahelian drought. There appears to be an increasing risk of re-emergence of brucellosis in sub-Saharan Africa, as a result of the co-existence of pastoralist movements and the increase of intensive management resulting from growing urbanization and food demand. Highly contagious zoonoses like brucellosis pose a threat with far-reaching social and political consequences

Incidence of Postoperative Residual Paralysis in a Nigerian Teaching Hospital

Background: Postoperative residual paralysis (PORP) is a known risk factor after general anesthesia (GA) for critical respiratory events and increased postoperative morbidity. PORP is defined as a train‑of‑four ratio (TOFR) of <0.9 using acceleromyography (AMG). TOFR <0.9 has been associated with increased risk of aspiration, obstruction of the upper airway and an impaired hypoxic ventilatory response. Aim: The aim of this study was to determine the incidence of PORP, associated factors related with its occurrence and critical respiratory events in the postanesthesia recovery room (PAR) at our institution. Methodology: Forty‑one adult patients were scheduled for elective surgeries requiring GA with the use of at least 1 dose of a nondepolarizing neuromuscular blocking drug (NMBD). An independent anesthetist quantitatively measured TOFR of recruited patients postoperatively in the recovery room using the TOF-watch SX acceleromyograph (Organon Teknika) 5 min after arrival. Results: The incidence of PORP was 75.6% (n = 31), with severe PORP (TOFR <0.7) seen in 41.5% (n = 17) of patients. Median time to full recovery in the PAR was 33 min (range 5–164 min). There was no statistical difference in the incidence of PORP related to the choice of NMBD (P = 0.186) or duration of surgery (P = 0.175). No respiratory complications or events were observed in patients with residual blockade. Conclusion: The incidence of PORP is quite high and undetected in our environment. Quantitative monitoring for residual paralysis is advocated as part of routine monitoring with the use of NMBDs for improved patient safety.Keywords: Incidence, neuromuscular blockade, Nigeria, postoperative, residualparalysi

Posterior spinal decompression, stabilization and arthrodesis in Nigerian adults: Profile and outcome

Background: The availability of intraoperative fluoroscopy and improved access to varieties of spinal titanium implants has revived posterior spinal stabilization techniques with their distinct advantages. Our aim is to describe the profile of various spine pathologies requiring subaxial posterior spinal decompression, stabilization (using titanium implants), and arthrodesis, and to determine the rate of postoperative complications and factors affecting outcome. Materials and Methods: This is a prospective single institution study of consecutive adult patients seen during the study period. Data collected included the patients’ demographics, radiological findings, indication for surgery, surgical procedure, operation time, intraoperative blood loss, and postoperative complications. Results: There were 26 patients (15 males and 11 females). Their ages ranged between 24 and 78 years (median = 42 years). The most common indications for surgery were spinal trauma and degenerative spine disease (24 patients). The region that was most commonly stabilized was the lumbar- 12 cases (46.2%). No patients experienced neural or vascular injury as a result of screw position; likewise no patient had screw loosening. There was a case each of superficial surgical site infection and transient cerebrospinal fluid leak but no case of implant failure was encountered. The outcome was significantly associated with the etiology (0.030) of the indication for surgery and preoperative power grade (0.000). Conclusion: Spinal trauma and degenerative spine disease are the two most common indications for posterior spinal decompression, stabilization and fusion in our center. It is associated with acceptable postoperative complication rate when done under fluoroscopic guidance. Outcome is related more to the preoperative neurological deficit and etiology of the indication for surgical stabilization.Keywords: Expansive laminoplasty, lateral mass screw, pedicle screwsNigerian Medical Journal | Vol. 53 | Issue 1 | January-March | 201

Pattern Of Refractive Errors At Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria

Objective: The objective of this paper is to determine the prevalence and pattern of cases of refractive error reported at the eye clinic of the Obafemi Awolowo University Teaching Hospital, Ile-Ife (OAUTH). Methodology: All consecutive new patients seen at the eye clinic of the OAU Teaching Hospital, Ile-Ife, between October 1997 and September 1998 were examined. Those patients who complained of difficulty in seeing near or far objects, whose vision improved with the pinhole or those who had difficulty doing close work like reading or threading needles were refracted by the author. Results: Out of the 1,550 new patients seen within the period of study, eight- hundred and sixty eight (54.9%) had refractive errors. Refractive errors were twice as common among the females than the males in this study. Myopia was the commonest spherical error (22.7%). The highest degree was -12.0DS. Presbyopia was present in 31.8% of the patients. The youngest age of presentation for presbyopia was 36 years. Astigmatism occurred in 55.8% of the patients seen. Most of the patients (68.3%) had myopic astigmatism. One of the two patients who had anisometropia had developed amblyopia in the more hypermetropic eye. Conclusion: Since refractive errors were found to be very common in this study increased health education and provision of adequate, affordable and modern facilities for correction of refractive errors are highly recommended. Nigerian Journal of Ophthalmology Vol. 11(2) 2003: 76-7

Cerebral Abscess in a 7yr old with uncorrected tetralogy of Fallot: Anaesthetic management

Patients with uncorrected Tetralogy of Fallot (TOF) tend to be poor candidates for anaesthesia but with a goodunderstanding of the pathophysiology of the disease and an individualized anaesthetic plan, they can undergo surgicalinterventions safely. We report a case of a 7 year old boy with uncorrected TOF with features of raised intracranialpressure (ICP) due to a cerebral abscess who successfully underwent an emergency craniotomy with drainage at ourinstitution.Keywords: Tetralogy of Fallot, cerebral abscess, anaesthesia, cyanotic, heart diseas

One lung ventilation using double‑lumen tubes: Initial experience from Lagos, Nigeria

Background: One lung ventilation (OLV) is a technique routinely used in thoracic anesthesia to facilitate thoracic surgery. Double‑lumen tubes (DLT) remain the most popular and reliable choice for one lung ventilation especially in adult patients though use in Nigeria is limited. This study aimed to describe the experience in our institution with the use of double‑lumen tubes for one lung ventilation.Materials and Methods: This was a retrospective cross‑sectional study conducted on all patients who had double‑lumen tube intubations for one lung ventilation between March 2008 and Feb 2013.Results: A total of 55 patients (27 males and 28 females, with a mean age of 39.6 ± 15.7 years) had left double‑lumen tube intubations during the period. There were 30 left‑sided (54.5%) and 25 right‑sided (45.5%) surgical procedures performed. Tube position was verified by flexible bronchoscopy in 50 patients (91.9%) and by chest auscultation in 5 patients (9.1%) with satisfactory collapse in all but one of the procedures. The major surgical indications for one lung ventilation were Video‑assisted Thoracic Surgery (VATS) in 22 patients (40%) and Heller’s cardiomyotomy in 17 (30.9%). There were no mortalities and all patients had a complete recovery with no sequelae attributable to double‑lumen tube use or one lung ventilation.Conclusions: One lung ventilation is an integral component of modern anesthetic practice. It can be safely practiced in Nigeria with appropriate equipment and expertise. The use of DLT for OLV to enhance thoracic anesthetic practice should be encouraged in other Nigerian institutions.Key words: Anesthesia, double‑lumen tubes, Nigeria, one lung ventilation, thoraci

Video‑assisted thoracic surgery in a Nigerian teaching hospital: Experience and challenges

Background: Video‑assisted thoracic surgery (VATS) is well established. Its application in Nigeria has however been limited and not been reported. The aim of this study was to describe our institutional experience and challenges with VATS.Materials and Methods: This was a retrospective cross‑sectional study of all patients that underwent VATS in our institution between March 2008 and June 2013. Data were extracted from a prospectively maintained database.Results: Two hundred and sixty‑one patients were assessed as potential VATS cases. VATS was initiated in 26 patients, but completed in 25 patients (9.6%) as there was one case of conversion of a planned VATS bullectomy due to the failure of one lung ventilation. There were 12 males and 13 females. Mean age was 40.7 ± 13.9 years. The indication was interstitial lung disease in 9 patients (36%), malignant pleural effusion in 6 patients (24%), spontaneous pneumothorax in 5 patients (20%), indeterminate pulmonary nodule in 2 patients (8%), pleural endometriosis in 2 patients (8%) and bronchogenic cyst in one patient (4%). Procedures performed were lung biopsy in 13 patients (52%), pleural biopsy and pleurodesis in 6 patients (24%), bullectomy and pleurodesis in 5 patients (20%) and excision of bronchogenic cyst in one patient (4%). Mean hospital stay was 4 ± 0.7 days. There were no complications and no mortalities.Conclusion: VATS is being performed in our institution with successful outcomes. The use of VATS in Nigeria is encouraged. The relatively high cost of VATS is, however, a major limitation to more widespread use.Key words: Nigeria, video‑assisted thoracic surgery, experienc