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Introduction: Body stalk anomaly (BSA) is a rare and severe congenital malformation in which the exact pathophysiology is still unknown. The possible causes of body stalk anomaly include early amnion rupture with direct mechanical pressure and amniotic bands, vascular disruption of the early embryo, or an abnormality in the germinal disk. Case presentation: We report a case of sonologically delayed diagnosis of BSA which was confirmed post-delivery following histopathological examination and we reviewed relevant literature regarding this phenomenon. Sonographic features of the foetus included a wide anterior abdominal wall defect (omphalocele) with protrusion of the liver into the amniotic cavity. The umbilical arteries show normal calibre, flow, velocimetry, and spectral waveform. Conclusion: Body stalk anomaly is accepted as a fatal anomaly, so it is important to differentiate it from other anterior abdominal wall defects prenatally and this could guide the management options.
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Introduction: Less than three decades ago, depression was seen as a predominantly adult disorder as children were considered too developmentally immature to experience depressive disorders, and adolescent low mood was considered as part of 'normal' teenage mood swings. Major depressive disorder in children and adolescents is a serious psychiatric illness especially in paediatric surgical patients. This may be due to their altered metabolic rate and heighten metabolic response to trauma which has significant implications for the psychological development of the child, yet it remains under-recognized and undertreated. The well-being of the care givers is also not left out as the care givers are inundated with the task of sourcing and providing finance for hospital care., in addition to the stress of providing care for the patient. This may result in loss of man hour, sleeplessness, and physical exhaustion associated with caring for these ill children which can ultimately significantly increase the risk of them having depressive episode. The aim of this commentary is to highlight the fact that paediatric surgical patients are not exempt to having a major depressive disorder and the care givers should also be evaluated during hospital admission of their wards. Methodology: This is a commentary on depressive disorders among Nigerian paediatric surgical patients. Related publications on children and adolescents presenting to hospital were searched using the domain - Depression in Nigerian adolescent, Paediatric surgery patients on PubMed, Google Scholar, and MEDLINE to appraise this review. Conclusion: Mood disorders, especially depression in children and adolescents have been studied increasingly over the last two decades and surgical conditions worsen the outlook, culminating in increased knowledge about the presentation, and treatment. Despite this, it is still often missed or misdiagnosed because it sometimes presents with uncharacteristic symptoms. Prevalence of depressiion among paediatric surgical patient were found to be between 46-82% in this review among Nigerian patients.
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Background: Paediatric day case surgery refers to planned procedures on patients on a non-resident basis but requires some facilities and time for recovery before discharge home on the day of surgery. This study was conducted to audit paediatric day case surgery practice at our centre, and to determine the outcome of day case surgeries. Patients and Methods: This is a retrospective study of cases seen over a period of 12 years, 2010 to 2022. These patients' data were assessed from their case notes and information obtained for each of the patients included age, gender, diagnosis, type of operation, type of anesthesia and post operative complications. The data were analyzed using SPSS version 22.0 for windows. Results: A total of 1,211 patients were recruited, with a M: F; 6: 1. The age of patients ranged from one week to 15 years with a median age of two years. A higher proportion of case load involved infants and toddlers compared to the other paediatric age groups. In this review, the largest volume of cases was seen in the last five years with the peak in 2018 (202). The right groin for an isolated diagnosis was operated in 381 (59 %) patients compared to the left 265 (41 %). The mean duration of surgery time was 40 minutes. Most of the patients had General Anesthesia (GA) with endotracheal tube, face mask, and laryngeal mask airway (LMA) using isoflurane, halothane and propofol at different times as anesthetic agents. There were no re admissions or mortality, however two of our patients had recurrence necessitating a re-do surgery. Conclusion: Groin hernias are the most common day cases in children in our facility. Day case paediatric surgery is safe, and outcome is generally good, when well managed.
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Background: Bibliometric appraisal of a research publication outfit of this nature serves as a tool to evaluate the direction of research activities of Annals of Ibadan Postgraduate Medicine Journal as it pertains to article publication between 2003 and 2023, and to determine the research impacts on the body of knowledge. The essence of this review is to determine the quantum volume of research output, nature of publication, regional distribution, and citations. Methodology: Information was transcribed on the cataloguing cards for the generation of data bank. Subject analysis was carried out using Medical Subject Headings of 2023 edition. Excel spreadsheet was used to analyze the data. Univariate analysis was done and presented in frequency and proportions. Descriptive statistics were presented in charts, line graphs, and tables. Results: Five hundred and fifty-two research articles were submitted during this period (2003 - 2023) while 21 out of this are still in the peer review cycle and has been carried forward to year 2024. Of the 531 reviewed, 441 was published with a manuscript acceptance rate of 83%. The highest number of articles, 45 (8.2%) was published in 2023, followed by 2021 with 39 articles (7.1%) and the least published year was 2003 with eight. AIPM has contributed significantly to the body of knowledge with a total of 441 research output over this period, out of which we had 309 publications between 2008 - 2021 with 2,869 citations. Oyo State recorded the maximum number of publications in terms of geographical distribution with most of the authorship from Ibadan. Conclusion: AIPM has contributed significantly to the body of knowledge with a total of 441 research output, and manuscript acceptance rate of 83%. Also, a 2,869 citations were recorded over a 13-year period. There was a gradual increase in research output during the period.
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Background: Congenital Hernia of umbilical cord (CHUC) is a rare presentation. The failure of return of intestinal loops following physiological herniation has been postulated as the embryological basis of this condition. This is usually mistakenly termed as omphalocele minor. We aim to highlight this rare finding, the clinical features, diagnostic dilemma, and management of CHUC. Case Presentation: He is a 4-day old male with obstructed CHUC. He had an oedematous umbilical stump, with circumferential normal abdominal wall skin folds in the form of a collar wrapping round the proximal aspect of the protrusion. The umbilical defect measured about 4 cm in diameter. Subsequently, surgical reduction and repair of defect was done, with resolution of symptoms. Conclusion: CHUC though a rare entity and easily missed, accurate diagnosis and management offer good prognosis. Also, recognition will prevent iatrogenic bowel injury from careless clamping of the cord with associated morbidity and mortality. It also helps to prevent mis categorization and prevent unwarranted anxiety with misdiagnosis.
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Background: The housemanship period is a peculiar time in a doctor's career, and some have described it as a "Nuisance year" during which the junior doctor assumes many roles at the same time - as a doctor of his patients, a student of his trainers (Resident doctors and Consultants) and a teacher of medical students. He is also at the same time undergoing training and research to practice as a professional in an increasingly competitive society-https://youtu.be/SaaQmMHy_qI. Nigerian perspective: A typical House officer is seen neatly dressed with black circles around the eyes depicting tiredness, ward coat pockets stuffed with enough materials to start up a new ward; ranging from continuation sheets, syringes, water for injection, capillary tubes, hand gloves, investigation forms, commonly used drugs, cannula, tourniquet et cetera, smart shoes and feet ready to move on large doses of caffeine, and with carbonated drinks at arm's reach for a quick glucose rush for the day.He or she is faced with institutional problems, staff and workplace disharmony ranging from lack of adequate residential apartment for interns, early daily resumption and retires much later than the team to effectively carry out the work plan among acute shortage of staff. Majority of interns also try to adapt to the internship workings because they are new to the system, and some health workers typically try to take advantage of them which sometimes interfere with their work and the intern struggles to give the patients his best. Despite all these, the house officer interacts with the patient and relatives more often than the rest of the team. He builds the trust, respect, and confidence the patient has for the team as he represents not only himself but also the team. Conclusion: As once said by Sir William Osler - the great physician whose name is still being invoked in modern day medicine - that "his time was ripe for him, and he was ripe for his time". Trainees must always make themselves "ripe for their time", and the relevant authorities must also make time "ripe for trainees". The ideal scenario will then be a nexus of an ideal trainee and an ideal work environment.
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Introduction: The internship period is a peculiar time in a doctor's career, and some have described it as a "nuisance year" during which the junior doctor assumes many roles at the same time. Junior doctors especially house officers are faced with many unique challenges; this is even more pronounced in poor resource settings like Nigeria. This study aimed to unravel and improve understanding of the challenges faced by medical and dental interns in Nigeria. Methodology: A nine-member House officers Research and Statistics Committee (HRSC) was immediately set up to include three senior colleagues - Senior Registrars and Registrar. To carry out her responsibility efficiently the committee created the House Officers Research Collaboration Network (HRCN), a 103- member team comprising medical and dental interns from across Nigeria under a collaborative - Medical INternship Training in Nigeria (MINTING) study. Results: Out of a total of the 103 House Officers Research Collaboration Network, 80 of them participated in this survey giving a 78% response rate. Ten of the intern Collaborators had additional qualification and seven of them had BSc as an initial degree. About 66 % of the Collaborators have never authored any publication. Of the 27 that have published an article; three collaborators are said to have published 15, 13, 16 articles respectively. Male collaborators where more likely to have published at least one article in the past. Thirty one of the 80 Collaborators have never been in a research collaborative group prior to this MINTING collaborative. Conclusion: This commentary is set out to describe in detail Nigerian House Officers initiative in terms of the structure, functions, operational modalities, and to investigate the demographics of the HRCN collaborators which showed that over two third of collaborators have never authored any publication and about a third of them have never been involved in collaborative research. We also believe the findings will serve as policy guide and benchmark in training the critical medical health force.
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Introduction: Myiasis is the infestation of tissues of humans and other living vertebrates with the larva of flies, and it can affect any part of the body. Cutaneous myiasis is the commonest form of presentation. Furuncular myiasis which is a sub-type of cutaneous myiasis typifies the presentation in this index patient. It is commonly caused by Cordylobia anthropophaga in Sub-Saharan African countries including Nigeria. It commonly occurs among rural dwellers, as well as people of low socio-economic and poor educational status. Case presentation: We present a case of balanitis from distal penile myiasis in a 3 year 8-month-old male child of a health worker in a tertiary hospital in Nigeria. Conclusion: It is believed that with adequate knowledge, measures such as good hygiene and proper drying and ironing of underwear are helpful.
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Background: The surgical condition termed hydrocoele of the canal of Nuck is one of the rarest clinical entities in the female group. It occurs due to the failure of obliteration of the derivative of the peritoneum, the processus vaginalis. It usually presents with painless inguinal swellings and is sometimes associated with features of intestinal obstruction if there is hernia coexisting with it that has become obstructed. Abdominopelvic ultrasonography and magnetic resonance imaging provide the basis for diagnosis, where these imaging modalities are available. However, a definite diagnosis may only be made during surgery. Definitive treatment includes groin exploration and excision of the cyst with high ligation of the neck of the sac up to the peritoneal pouch, along with repair of the inguinal hernia, if present. Case Presentation: We present a rare case of a 34-year-old woman who presented with clinical features of a left inguinolabial swelling post-surgery, and diagnosed as left recurrent irreducible inguinal hernia. Intraoperatively, a cystic swelling with serous collection was observed. She had hydrocoelectomy and repair of the left groin surgical wound. Conclusion: Hydrocoele of the canal of Nuck may be misdiagnosed as inguinal hernia because of its rarity, lack of adequate knowledge regarding the entity and paucity of literature on the subject matter. This report is to furthermore increase our level of awareness of this condition especially after a previous groin surgery.
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Background: A large proportion of patients with preoperative enterocolitis still have enterocolitis persisting even after surgery while others resolve thereafter. Some researchers have studied Calprotectin, C-reactive protein (CRP), Blood and Plasma viscosity as markers of inflammation, hence, the choice of their use. The aim of the study is to determine the sensitivity and reliability of Calprotectin, C-reactive protein (CRP), Blood and Plasma viscosity as biochemical predictors of enterocolitis in children with colorectal anomaly post-surgery at University College Hospital Ibadan. Patients and Methods: This is an observational analytic study of 32 patients with either Hirschsprung's disease or Anorectal malformation carried out over a year period. The demographic data of the patients, clinical condition and the preoperative and postoperative readings of the biochemical analytes were recorded in a chart. Statistical analysis were carried out using SPSS version 23 and test for statistical association done. Results: The incidence of Hirschsprung associated enterocolitis is 12.5% and for Ano rectal malformation 6.3 %. Gender difference was not statistically significant even with the observed clinical difference. Plasma viscosity and blood viscosity correlate positively with each order. C-reactive Protein and Calprotectin did not predict enterocolitis in this study and the Sensitivity of blood viscosity at T1 and T2 is as low as 66% with a Positive Predictive Value of 25 %. Conclusion: The incidence of Enterocolitis associated with Hirschsprung's disease and Anorectal malformation is 19 %. Calprotectin and C-reactive protein did not predict enterocolitis in this patients. The outcome of care was satisfactory in over 90 % of the patients.
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Intussusception is the most common, non-congenital, cause of intestinal obstruction in infants. There are various patterns of intussusception seen in children with the most common being ileo-colic variety. Compound intussusception in which intussusception involves more than one non-adjacent segment is a rare finding in the literature and it can be associated with worse morbidity than typically occurs, especially in a region where delayed presentation is a major contributor to morbidity and mortality in the treatment of intestinal obstruction. We report the first documented case of double compound intussusception in an African child and reviewed relevant literature.
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BACKGROUND: Obstructed inguinal hernia in children is associated with high morbidity in developing countries due to delay in accessing care. Attempts made to reduce waiting time to herniotomy are not backed by a predictive model of disease occurrence and modeling obstructed inguinal hernia implies knowledge of factors associated with this complication. AIM & OBJECTIVES: To determine the relationship between socio-demographic variables and obstructed inguinal hernia in children. DESIGN: Case controlled. SETTING: Paediatric surgery unit of a tertiary hospital. MATERIALS AND METHODS: The study was prospective - all children presenting with obstructed inguinal hernia at University College Hospital, Ibadan, Nigeria between May 2009 and April 2014 were studied. For each case, two children with non-obstructed inguinal hernia were recruited consecutively as controls. Their demographics, clinical features, management and outcomes were obtained including the socio-demographic attributes of the parents. The data obtained were computed using SPSS; the p-value for significance was set at < 0.05. RESULTS: A total of 81 consecutive patients (27 with obstructed inguinal hernia and 54 with non-obstructed inguinal hernia) were studied; they were aged between 2 weeks and 13 years with a mean of 25.9 ± 3.8 months. There were no differences between cases and controls based on gender, parents' religion, tribe, social status and side affected (p > 0.05). The mean age at presentation was 13.7 ± 5.6 months in the obstructed inguinal hernia vs. 32.0 ± 4.8 months in the non-obstructed inguinal hernia groups (p = 0.016). The duration of groin swelling before presentation was not significantly different (30.0 ± 7.7 vs. 28.3 ± 6.4 months, p = 0.893). Infants were three times more likely than older children to develop obstruction (OR = 3.33, CI: 1.20, 9.09, p = 0.020). CONCLUSION: The age at presentation is the significant socio-demographic variable in this study that could predict obstruction in healthy children with inguinal hernia delivered at term.
