Use of exchange blood transfusion in the management of severe COVID-19 infection in pregnancy: experience from Lagos, Nigeria.

Coronavirus disease 2019 (COVID-19) presents with symptoms that may be mild or severe. The individual with the severe form of the disease usually presents with a constellation of respiratory symptoms typical of acute respiratory distress syndrome. In this report, we present our experience of the successful management of an oxygen-dependent pregnant woman with severe COVID-19 infection who had 2 sessions of partial exchange blood transfusion. We discussed the principles that informed this intervention and the need to adopt this novel approach in the care of severe COVID-19 infection.

Use of exchange blood transfusion in the management of severe COVID-19 infection in pregnancy: experience from Lagos, Nigeria

Coronavirus disease 2019 (COVID-19) presents with symptoms that may be mild or severe. The individual with the severe form of the disease usually presents with a constellation of respiratory symptoms typical of acute respiratory distress syndrome. In this report, we present our experience of the successful management of an oxygen-dependent pregnant woman with severe COVID-19 infection who had 2 sessions of partial exchange blood transfusion. We discussed the principles that informed this intervention and the need to adopt this novel approach in the care of severe COVID-19 infection.

Transabdominal repair of vesicovaginal fistulae: A 10-year tertiary care hospital experience in Nigeria.

BACKGROUND: Vesicovaginal fistula (VVF) is still a major cause for concern in many developing countries. Arguments continue as to the best approach for repair. This study aimed to present our experience with transabdominal VVF repair. SUBJECTS AND METHODS: This was a 10-year retrospective review of transabdominal VVF repair. Important data extracted from the case notes included patients' demography, aetiology, previous repair, operative findings, procedures and treatment outcome. Data were analysed using SPSS version 21. Bivariate analysis of factors affecting treatment outcome was carried out with the level of significance set at P < 0.05. RESULTS: Fifty-three VVF repairs were carried out in 51 patients. Mean age was 29.8 ± 15.4 years. Forty-five (84.9%) had previous repairs. The aetiologies of VVFs were prolonged obstructed labour in 41 (80.4%) and post-operative in 10 (19.6%). Forty-one repairs were through a transperitoneal transvesical approach whereas 12 had an extraperitoneal transvesical approach. The fistulae diameter ranged from 0.3 to 2.8 cm with an average of 1.64 cm. Six had ureteric re-implantation; (bilateral in two patients). Repair was successful in 47 (88.7%) cases, which translated to the overall success rate of 92.1% in the 51 patients treated. Success rate was higher (95.6%) for the subset of patients who had previous transvaginal repairs. Catheter blockage in the post-operative period was a significant factor that had effect on outcome (P < 0.015). CONCLUSION: Transabdominal repair recorded an excellent result in patients who had previously failed transvaginal repairs and may be considered as the first option in these patients.

Combined intrarectal lidocaine gel and periprostatic nerve block: A 'balanced' anaesthesia for transrectal ultrasound-guided prostate biopsy?

BACKGROUND AND AIM: Periprostatic nerve block (PNB) which appears to be the gold standard for pain relief during transrectal ultrasound-guided prostate (TrusP) biopsy has been proven to be lacking in providing satisfactory anaesthesia during transrectal ultrasound (Trus) probe insertion into the anorectum necessitating the addition of another technique to produce a 'balanced' anaesthesia. The aim of this study was to determine whether combined intrarectal lidocaine gel and periprostatic nerve block (cGPNB) will provide adequate anaesthesia at all stages of TrusP compared with caudal block (CB). PATIENTS AND METHODS: Data were prospectively collected from patients with indications for TrusP who were randomly assigned to either cGPNB (Group A) or CB (Group B). Comparative analysis of the numerical rating pain score (NRS) between two groups was done after administration of anaesthesia, Trus probe insertion, biopsy needle puncture of the prostate and 1 h after biopsy. RESULTS: There were 56 patients in Group A and 53 in Group B. There was no significant difference in NRS grouping between the two arms of the study after administration of anaesthesia (P = 0.93), biopsy needle puncture of the prostate (P = 0.28) and 1 h after the procedure (P = 0.39). There was no statistically significant difference in the number of patients with no/mild pain between the two arms of the study during probe insertion (P = 0.65). None of the patients in both arms of the study had severe pain. Across Group A and B, 35 (62.5%) versus 40 (75.5%), 20 (35.7%) versus 11 (20.8%) and 1 (1.8%) versus 2 (3.8%) adjudged the procedure as very tolerable, fairly tolerable and intolerable respectively (P = 0.20). All the patients in Group A versus 49 (92.5%) in Group B will choose the same anaesthesia for subsequent biopsies (P = 0.11). CONCLUSIONS: cGPNB provides balanced anaesthesia at all stages of TrusP with excellent patient tolerability.

Does a wrist tourniquet improve the quality of Biers block for surgeries in the hand?

This study aims to determine the effect of a wrist tourniquet on Biers Block quality for short hand procedures. 40 patients were randomized into 2 groups. One had the intravenous lignocaine injected with a wrist rubber tourniquet in situ, While the control group had none during injection. The onset of block, sensation, motor activity, need for additional analgesia and duration of surgeries were recorded for each group and analysed statistically. 27 males and 13 females were recruited. Mean onset for the tourniquet group was 4.3minutes and 9.0 minutes for the control (p< ˂0.0000005), Visual analog Pain Scores were 0.2 for Tourniquet and 1.8 for control (p< 0.0003) at 15 minutes. Sensory and motor block scores were significantly higher at 15 minutes following anaesthetic agent administration in the tourniquet group compared to the control(p<0.05). At 30 minutes there was no statistically significant difference in the scores. There was also no difference in the need for additional analgesia in either group. It appears that the use of a wrist tourniquet shortens the onset of Biers block for hand surgeries. However, it does not improve overall block quality after 30 minutes of administration but allowed a smaller dosage to be used with fewer side effects

Neonatal burns in Lagos, South-Western Nigeria: Epidemiology and outcome of management.

BACKGROUND: Burns in the neonate are rare and result mostly from iatrogenic sources in developed countries. The socioeconomic settings of developing countries are different from those in the developed countries. A review of the epidemiology and management of burns in the neonates in Lagos, Nigeria is presented. METHODS: The case notes of burns in patients less than 29 days-old from 2004 to 2008 in 4 tertiary health institutions in Lagos were retrieved from the Medical Records Department; necessary data were extracted and analyzed. RESULTS: There were 21 neonates with burns within the study period. The incidence of neonatal burns ranged between 0.5 and 2.5%/year. The mean age was 16.38 ± 1.84 days and the mean BSA of 26.00 ± 5.53%. The etiology of burns was thermal in 19(90.5%) and chemical in 2(9.5%). Hypokalemia was common at early stages of their treatment. Burns were sustained at home in 90.5% of the cases. The mortality rate was 43.5%. Inhalation and thermal injuries were associated with most of the deaths. CONCLUSION: Domestic incidents from flames are the commonest causes of neonatal burns in the study environment. These are associated with prolonged morbidity and high mortality rate. Health education, highlighting methods of prevention should be undertaken in the community. Well equipped burn centers should be established to treat burns in all age groups.