An Audit of Basic Practical Skills Acquisition of Final Year Medical Students in a Nigerian Medical School

Background/Objective: Young medical graduates undertaking their housemanship are naturally expected to demonstrate reasonable competence in basic practical skills. Failure to do this may not only be a source of anxiety to the doctor but also potentially dangerous to the patient. The objective was to assess the level of exposure of final year medical students of a Nigerian medical school to basic practical skills. Materials and Methods: This is a descriptive cross-sectional study. Structured questionnaires were distributed to a set (all) of 86 final year medical students of the University of Port Harcourt immediately after their last lecture in their final posting in medicine and surgery. The questionnaires listed some selected basic practical skills (e.g. phlebotomy; male urethral catheter insertion; etc.) that house officers are expected to be competent in. The students were asked to anonymously fill them and return same before leaving the lecture hall. Results: Of the 86 students; 84 completed and returned the questionnaires; giving a 97.7response rate. No student had performed an arterial puncture for an arterial blood sample. Seventy-six students (90.5) had not inserted a naso-gastric tube. Only 14 (16.7) students had successfully inserted more than 10 intravenous canulae. A significant number; 38 (45.2); had never inserted a urinary catheter (for male patients) nor had any experience with bag/mask skills. Majority; 59 (70.2) had had some experience with intravenous antibiotics administration. Forty-one (48.7) students had had 6 or more successful attempts at venous blood sampling. Conclusion: The exposure level of final year medical students to basic practical skills was low

Acute Abdominal Conditions in People with Sickle Cell Disease: A 10-year Experience in Port Harcourt; Nigeria

Background: Abdominal crises (vaso-occlusive) are not infrequent in patients with sickle cell anemia. They usually present as acute abdomen. These patients none the less present with other causes of acute abdomen like others without hemoglobinopathy. Six cases of surgical acute abdomen in sickle cell disease patients treated in the University of Port Harcourt Teaching Hospital (UPTH) are presented. Materials and Methods: Six sickle cell anaemia patients presenting with acute abdominal conditions from 1999 to 2008 (inclusive) in the University of Port Harcourt Teaching Hospital were studied retrospectively (two patients) and prospectively (four patients). After initial resuscitation; appropriate surgical procedures; namely; appendicectomy (2); cholecystectomy (1); open drainage of splenic abscess (1); and release of adhesive band (1) were performed. Results: Six cases were treated (female/male ratio 2:1). Four patients were in the 11-20 year age group. Two patients had appendicectomy and two presented with acute cholecystitis/cholelithiasis; one of whom had open cholecystectomy. One young girl had drainage of splenic abscess and a 42-year-old male had division of obstructive adhesive band at laparotomy. There were two complications; namely; postoperative haemorrhage (in cholecystectomy patient) and acute chest syndrome (in one appendicectomy patient). These were successfully managed with blood transfusion and antibiotic/oxygen therapy; respectively. There was no mortality. Conclusion: Sickle cell anaemia patients are not exempt from acute abdominal conditions requiring surgery. A high index of suspicion coupled with repeated clinical examination is needed for early diagnosis and appropriate treatment

Colorectal carcinoma in Port Harcourt

Background: Colorectal carcinoma, the commonest malignant tumour of the gastrointestinal tract, is rather uncommon in Nigeria, occurring often at a relatively early age. Aim: To report experience with colorectal carcinoma in the University of Port Harcourt Teaching Hospital (UPTH). Methodology: Patients treated for colorectal cancer at the UPTH over a 19- year period (1987-2006) and had complete information, were studied. Data were collected from patients/' case notes, ward registers, theatre records and histopathology reports. The data were analyzed with respect to age, gender, clinical features and investigations. Other indices studied were treatment, postoperative complications, duration of hospital stay and outcome/mortality. Results: The records of 36 cases were available for study. Male to female ratio was 2:1. The 41-60 year age range recorded the highest number of cases (52.8%). Weight loss, change in bowel habit, rectal bleeding, and abdominal/rectal mass constituted the main symptoms. Diagnosis was made from clinical examination, double contrast barium enema and proctosigmoidoscopy/biopsy. The rectum and caecum/ascending colon were commonly affected. The appropriate surgical treatment was duly performed. Some patients had postoperative adjuvant treatment using 5-fluorouracil only. Postoperative complications included surgical site infection, persistent perineal discharge, perineal pain, and obstruction of colostomy, hepatic encephalopathy and obstructive uropathy. The average duration of hospital stay was 12 days and follow-up assessment ranged from 3 months to 14 years. The postoperative mortality at three years was high. Conclusion: Colorectal carcinoma is relatively uncommon in our environment. The younger age groups tend to be more affected. Late presentation resulted in poor survival in spite of surgical treatment and adjuvant therapy

Local anaesthesia for appendicectomy: one surgeon's experience

Background: Appendicectomy can be performed under general; regional and local anaesthesia but the anaesthetic risks are least with the later. Where it is appropriate to perform a procedure under local anaesthesia therefore; this method should be readily utilized. This report aims to share one surgeon's experience with local anaesthesia for appendicectomy. Method: A prospective study was carried out at the Mile One Hospital; a private clinic in Port Harcourt; Nigeria. Patients with acute appendicitis admitted for appendicectomy between July 1999 and December 2002 were assessed and recruited into the study based on criteria such as weight less than 70 kg and option for local anaesthesia. Lignocaine (0.5) in a dose of 3-4mg/kg body weight was infiltrated in the line of incision (Lanz) superficially and then into deeper planes. Those who would not tolerate lignocaine alone were sedated with 10mg of diazepam and 30mg of pentazocine. Patients who still would not tolerate the procedure were converted to general anaesthesia with ketamine. The appendix was removed with the stump unburied. Results: Out of 78 patients with acute appendicitis 35 (44.85) were considered suitable for local anaesthesia. Only 31 eventually tolerated the procedure; 7 of these patients requiring sedation. General anaesthesia was resorted to in 4 patients who failed to tolerate local anaesthesia with sedation. Five patients (16.13) developed surgical site infections; 10 (32.26) had nausea intra-operatively while 7 (22.58) had subcutaneous emphysema in the immediate postoperative period. The mean operative time was 39minutes. There was no mortality

Ileosigmoid Knotting : A Report of Two Cases

Background: Ileosigmoid knotting (ISK) is a rare cause of acute intestinal obstruction with high morbidity and mortality. The diagnosis is rarely made preoperatively because of its infrequency and the variations in presentation.Aim: To report two cases managed by the author; which will hopefully increase awareness of this condition.Case Reports: The first was a 51-year-old man who presented with a sudden onset of colicky lower abdominal pain; which later became generalized. His pulse rate was 100 beats/minute while his blood pressure was 80/60 mmHg.There was mild abdominal distension with absent bowel sounds. The second was a 50-year-old man with a sudden onset of generalized colicky abdominal pain; abdominal distension and vomiting. His pulse rate was 120 beats/minute and the blood pressure 80/50 mmHg. His bowel sounds were markedly reduced. They were resuscitated accordingly. In both patients; exploratory laparotomy revealed a copious amount of sero-sanguinous fluid in the peritoneal cavity with ileosigmoid knotting; and extensive gangrene involving the distal ileum and the sigmoid colon. In the first patient; the caecum was involved in the knot and therefore also gangrenous. Each of them had a sigmoid colectomy with a right hemicocetomy. The first patient died of adult respiratory distress syndrome while the other had an uneventful recovery. In the patient who died; surgery was done on the third day of onset of symptoms.Conclusion: A high index of suspicion; aggressive resuscitation; and prompt surgical intervention are indispensable for a successful outcome

Gunshot injuries in the Niger Delta region of Nigeria

Background: Violent trauma especially by gunshot injuries appears to be on the increase worldwide. There is inadequate data from many centres in Nigeria to support this observation. Aim: To determine the pattern of gunshot injuries in the University of Port Harcourt Teaching Hospital (UPTH). Methods: This was a prospective study covering a period of three years (January 2002-December 2004). A standard proforma was used to record all cases of gunshot injuries reporting to the UPTH. Details sought were age, gender, occupation, gun type, anatomic region of the body involved and treatment given. Other information recorded were time of injury, duration of hospital stay, injury time before presentation, assailant and outcome. Information was obtained directly from victims, relations, the police or those accompanying the victim. Where surgical operations were done or patients were admitted to the wards, relevant information or findings were then retrieved from theatre and ward records. Results: There were 135 patients (120 males and 15 females) between the ages of 1½ -67 years. Students and civil servants constituted the largest number. Seventy-one injuries were due to high velocity missiles while 64 were low velocity. Armed robbery and attacks by "unknown assailants" were the commonest modes of attack with 47 and 41 victims respectively. The lower limbs, abdomen and chest were the most frequent anatomic regions involved recording 38, 28 and 27 cases respectively. There were 9 cases in which multiple anatomic sites were affected. The majority of patients (56) presented within 12-18 hours after injury; only 9 cases presented within 6 hours. Twenty-nine patients underwent laparotomy while 14 had thoracostomies. Forty-nine patients were treated and discharged. Minor surgery (like wound debridement) was the commonest treatment in 43 patients. All cases of fracture among these were subsequently referred to the trauma unit for appropriate treatment. Thirty patients died giving a mortality rate of 22.2%. Conclusion: Gunshot injuries constitute a major cause of violent trauma in the Niger Delta Region of Nigeria with a high and disturbing level of morbidity and mortality