Early Experience of Laparoscopic Surgery in a Teaching Hospital in Rural Nigeria.

INTRODUCTION/BACKGROUND: Laparoscopic surgery is still at its budding phase in low resource countries. The reasons for this include poor financing of the health sector and lack of trained personnel. The aim of this article is to highlight our initial experiences, our challenges in setting up laparoscopic surgery in a private tertiary hospital in rural southwestern Nigeria, and to share our efforts towards alleviating these challenges. METHODOLOGY: A retrospective analysis of all patient who had laparoscopic surgery between January 2019 and December 2020 at the Surgery Department of Babcock University Teaching Hospital, Ilisan, Ogun State was carried out. Their sociodemographic, preoperative and intraoperative data along with postoperative records were subjected to descriptive analysis. RESULTS: During the period, 19 patients had laparoscopic procedures: 12(63.2%) males and 7 (36.8%) females with age ranging from 4 to 63years. The most common indication for laparoscopic surgery was appendicitis, representing 84.2% of the procedures. Most of the procedures were done on emergency basis (63.1%) while 36.9% were elective procedures. All the procedures were therapeutic though in 21.1% we started with diagnostic intent but intra-operatively we proceed to therapeutic procedure following confirmation of the diagnosis. The duration of the procedures ranged from 40 minutes to 107 minutes with a mean duration of 74.8±19 minutes. No intra or post operative complications were recorded in this cohort of patients. The mean duration of hospital stay was 2 days. CONCLUSION: Laparoscopic surgery is safe and feasible in low resource setting. We recommend that centers embarking on laparoscopic surgeries should start with diagnostic procedures and gradually incorporate therapeutic procedures as they improve in proficiency.

INTRODUCTION/CONTEXTE: La chirurgie laparoscopique en est encore à sa phase naissante dans les pays à faibles ressources. Les raisons en sont le faible financement du secteur de la santé et le manque de personnel qualifié. Le but de cet article est de mettre en lumière nos premières expériences, nos défis dans la mise en place de la chirurgie laparoscopique réalisée dans un hôpital tertiaire privé rural du sud-ouest du Nigeria, et de partager nos efforts pour atténuer ces défis. MÉTHODOLOGIE: Une analyse rétrospective de tous les patients ayant subi une chirurgie laparoscopique entre janvier 2019 et décembre 2020 au service de chirurgie de l'hôpital universitaire de Babcock, à Ilisan, dans l'État d'Ogun, a été réalisée. Leurs données sociodémographiques, préopératoires et peropératoires ainsi que les dossiers postopératoires ont fait l'objet d'une analyse descriptive. RÉSULTATS: Au cours de la période, 19 patients ont subi des interventions laparoscopiques : 12 hommes (63,2 %) et 7 femmes (36,8 %) âgés de 4 ans à 63 ans. L'indication la plus fréquente de la chirurgie laparoscopique était l'appendicite, représentant 84,2 % des interventions. La plupart des procédures ont été effectuées en urgence (63,1 %) tandis que 36,9 % étaient des procédures électives. La plupart des procédures étaient thérapeutiques (78,9 %) tandis que les autres (21,1 %) étaient à la fois diagnostiques et thérapeutiques. Pour ce groupe de patients, nous avons commencé par une laparoscopie diagnostique et, en peropératoire, une procédure thérapeutique a été effectuée après confirmation du diagnostic. La durée des procédures variait de 40 minutes à 107 minutes avec une durée moyenne de 74,8 ± 19 minutes. Aucune complication per ou post opératoire n'a été enregistrée dans cette cohorte de patients. La durée moyenne d'hospitalisation était de 2 jours. CONCLUSION: La chirurgie laparoscopique est sûre et faisable dans les milieux à faibles ressources. Nous recommandons que les centres qui se lancent dans des chirurgies laparoscopiques commencent par des procédures de diagnostic et intègrent progressivement des procédures thérapeutiques au fur et à mesure de leur amélioration. Mot-clé: Laparoscopie, Expérience, Rural, Hôpital.

The minimal invasive surfactant therapy: experience from a low resource setting.

OBJECTIVE: To evaluate all cases managed with the Minimal Invasive Surfactant Therapy (MIST) and its effect on outcome. BACKGROUND: Respiratory distress syndrome (RDS), a major cause of morbidity and mortality in preterm new-borns is common in sub-Saharan Africa. Surfactant replacement therapy (SRT) is less practiced and the new MIST is just introduced in Asaba, Nigeria. METHODS: This descriptive survey recruited new-borns of consenting parents who provided for the surfactant and other commodities. Demographic characteristics were obtained. Intervention included MIST Surfactant, nasal bubble Continuous Positive Airway Pressure (n b-CPAP). Aminophylline or Caffeine, early breast milk feeding and Kangaroo mother care (KMC). Data were collected over a 1-year period and Standard statistical methods were used for data analysis. RESULTS: From 1 May 2019 to 30 April 2020, there were 1801 live births, preterm birth rate of 10.72% (193/1801) at the FMC, Asaba. Admissions to the Neonatal Unit (NNU) comprised a total of 731 newborn: 270 preterms. Of these preterm; 52(19.26%) were extreme preterms; 122 (16.15%) very preterm. Of these 731 total admissions there were 104 (14.23%). Their gestational ages (GA) ranged from 24 to 38 weeks and birthweights from 600 to 3400 g. A total of 51 Newborns received surfactant. Their GA ranged from 24 to 38 Weeks; birth weights 600 to 3400 g. These comprised 48 preterm and 3 terms. All 51 infants with RDS who received MIST surfactant included 48 preterms and 3 terms with perinatal Asphyxia and Meconium Aspiration Syndrome. The obstetric management of five mothers of early preterm included two doses of antenatal cortico-steroids prior to delivery. MIST was successful in 47 of 51 (92.2%) cases. Age range at administration was one to 48 h. Duration of n-bCPAP post surfactant: ranged 6 h to 96 h: 4 babies were weaned off CPAP within 24 h; 12 babies at <48 h, another 9 at <72 h; and 20 beyond 96 h. Five babies received a second dose of MIST after 48 h of the first dose. Twelve of 51 (23.5%) babies died; 4 at 48 h, 2 at 72 h, 3at 96 h and 3 beyond 7 days. Prior to the MIST, respiratory distress (RD) and severity rating as indicated by the Silverman Anderson Score (SA) scores in the survivors ranged from 6/10 to 8/10. CONCLUSIONS: The MIST, at FMC Asaba, improves outcome of the extreme preterm. Financial barriers remain a major constraint to its use.

Comparing Asthma Control Test with Global Initiative for Asthma Defined Control in Nigerian Adult Asthmatics: A Prospective Cross-sectional study.

BACKGROUND: Assessment of control is central to asthma management. The Asthma Control Test (ACT) and Global Initiative for Asthma (GINA) defined control are commonly used measures of asthma control. This study examined the agreement between the ACT and GINA defined control and determined the best cut-off point of ACT to predict GINA level of control. METHODS: It was a cross-sectional study of 82 consecutive [72% females, age 44 (IQR) 29-60 years] asthmatic patients in a tertiary teaching hospital. We compared ACT with GINA defined control using Cohen's kappa and receiver operating characteristics curve was computed to determine sensitivity and specificity. RESULTS: There was fair to moderate level of agreement between ACT and GINA defined control (kappa 0.34 to 0.46). To detect GINA-defined controlled asthma, the ACT cut-off point of =20 had a sensitivity of 81%, specificity of 74%, a positive predictive value of 52% and negative predictive value of 92%, with an area under the receiver operating characteristics curve(AUC) value of 0.82 [95% confidence interval (CI): 0.72-0.90]. ACT scores of = 19 predicted GINA-defined uncontrolled asthma with sensitivity of 87%, specificity of 51%, positive predictive value of 41%, negative predictive value of 91% with AUC values of 0.75 (95% CI: 0.75-0.84). CONCLUSION: In Nigerian asthmatics, ACT scores of =20 and =19 are useful for identifying patients with controlled and uncontrolled asthma respectively, as defined by GINA 2014 criteria. However, the former is more predictive than the latter.

Sub-Acute Toxicity Study of Ethylene Glycol Monomethyl Ether on the Antioxidant Defense System of the Testes and Epididymes of Wistar Rats.

Ethylene glycol monomethyl ether is a toxicant with wide industrial applications. This study is aimed atinvestigating its effect on the antioxidant system of the reproductive organs of male rats. Fifty male Wistar rats weredistributed into five groups. Group I received distilled water, Groups II-V received EGME at 100, 200, 300 and 400 mg/kgbody weight respectively. All administrations were done orally for fourteen days and the weight was monitored weekly. Onday fifteen, the animals were sacrificed and reproductive organs were collected and weighed. The testes and epididymeswere processed for the biochemical estimations, histopathology and spermatozoa analysis. The percentage body weightgained weekly and the relative weight of the testes reduced significantly (p < 0.05) in the treatment groups. The spermatozoaanalysis showed decreases in the treatment groups. In the testis and epididymis, various antioxidant parameters such assuperoxide dismutase and glutathione-S-transferase were affected. The histopathology results confirmed the biochemicalfindings. The study suggests that EGME exerts deleterious effects on the testes and epididymes by increasing the oxidativeload in rats.

Liver aminotransferases in under-five HIV-positive children on HAART.

BACKGROUND: Higher mortality rates were reported in developing countries during early months of HAART initiation than in developed countries. The study aimed at assessing the effect of Highly Active Antiretroviral Therapy (HAART) on liver function of under-fives. METHOD: Two hundred and thirty-eight under-fives children were enrolled from five hospitals in Southern Nigeria. Ethical permission and written consent were obtained. Group A involved 91 seropositive-children on HAART regimen while Group B1 involved 24 seronegative-infants who received nevirapine from birth till age 6-week. Group B2 (18) and B3 (48) involved seronegative-children who received co-trimoxazole and were 6-month and 18-month old respectively. Group C involved 11 seropositive-children who received co-trimoxazole only. Group D involved 46 seronegative-children who served as the control group. A 2ml blood sample was obtained from each participant during first phase of the study and was analysed for alanine aminotransferase (ALT) and aspartate aminotransferase (AST) using kits manufactured by Randox. Group A children returned for second and third phases of the study after 3-month and 6-month respectively. Data were analysed by using ANOVA. RESULTS: The results showed that ALT was highest in group A (12.8 ± 11.0 IU/L) suggesting hepatotoxicity while AST was highest in group B2 (35.4 ± 53.1 IU/L). Second phase, ALT and AST of group A were significantly reduced by 39.3% (p < 0.05), 29.9% (p < 0.05) respectively suggesting resolved hepatotoxicity. Third phase, ALT and AST were significantly reduced by .50.6% (p < 0.05) and 32.2% (p < 0.05) respectively suggesting resolved hepatotoxicity. CONCLUSION: Hepatotoxicity observed among HIV-infected children on HAART was resolved after 6-month of monitoring.

The influence of environmental sanitation on prevalence of malaria in a rural town in south-western Nigeria.

INTRODUCTION: The single most significant cause of morbidity and mortality in sub-Saharan Africa and other third world countries is the poor standard of environmental sanitation.This factor plays a major role in disease transmission especially for endemic diseases such as malaria. This study was therefore designed to assess the influence of environmental sanitation on prevalence of Malaria in a rural town in South-Western Nigeria. METHODS: This was an analytical cross-sectional study. A multi stage cluster sampling technique was used to select the participants into the study. One participant per each household was selected into the study. A semistructured questionnaire was used to collect relevant information. RESULT: A total of 300 households were recruited into the study. Only 14 [4.7%] were regularly involved in daily cleaning of the environment outside their houses and 286 [95.3%] were aware that dirty environment increases the risk of contracting malaria. Majority 178 [62.2%] believe that bushes around the house are major facilitators of malaria. 32 [11.2%] mentioned presence of stagnant water while 76 [26.6%] mentioned unclean drainage system. The prevalence of Malaria attack in the last 6 months among respondents was 192 (64.0 %). Regular cleaning of respondent's environment outside their houses was statistically significant associated with prevalence of Malaria in the households studied [OR = 1.88, CI = 2.61-54.13] while the knowledge of environmental impact on malaria [OR = 1.37, Cl = 0.92-2.05] and malaria transmission [OR = 0.70, CI = 0.43-1.12] were not statistically significandy associated with prevalence of malaria. CONCLUSION: The study concludes that regular cleaning of house surroundings was associated with prevalence of malaria infection in rural areas in Nigeria. Sustainable control and elimination of malaria cannot occur in isolation from other sector of the society most especially the environmental health and engineering services.

Ecological vulnerability: seasonal and spatial assessment of trace metals in soils and plants in the vicinity of a scrap metal recycling factory in Southwestern Nigeria.

The concentrations of selected heavy metals in the soil and vegetation in the immediate vicinity of a metal scrap recycling factory were determined in the dry and wet seasons using the Atomic Absorption Spectrophotometer. The results showed that the soil pH in all the sites indicated slight acidity (from 5.07 to 6.13), high soil organic matter content (from 2.08 to 5.60 %), and a well-drained soil of sandy loam textural composition. Soil heavy metal content in the dry season were 0.84-3.12 mg/kg for Pb, 0.26-0.46 mg/kg for Cd, 9.19-24.70 mg/kg for Zn, and 1.46-1.97 mg/kg for Cu. These values were higher than those in the wet season which ranged from 0.62-0.69 mg/kg for Pb, 0.67-0.78 mg/kg for Cd, 0.84-1.00 mg/kg for Zn, and 1.26-1.45 mg/kg for Cu. Except for cadmium in the dry season, the highest concentrations occurred in the northern side of the factory for all the elements in both seasons. An increase in the concentrations of the elements up to 350 m in most directions was also observed. There was no specific pattern in the level of the metals in the leaves of the plant used for the study. However, slightly elevated values were observed in the wet season (Pb 0.53 mg/kg, Cd 0.59 mg/kg, Cu 0.88 mg/kg) compared with the dry season values (Pb 0.50 mg/kg, Cd 0.57 mg/kg, Cu 0.83 mg/kg). This study showed that the elevated concentrations of these metals might be associated with the activities from the recycling plant, providing the basis for heavy metal pollution monitoring and control of this locality that is primarily used for agricultural purposes.

Bone malignancies in orthopaedic hospital Igbobi Lagos, Nigeria.

AIMS AND OBJECTIVES: To document the pattern of bone malignancies in a highly populated orthopaedic hospital in Lagos Nigeria; PATIENTS AND METHODS: A total of 21 cases of primary malignant bone tumours were studied. This comprised 12 cases of Osteosarcoma, 7 cases of Malignant Fibrous Histiocytoma (MFH) and 2 cases of Chondrosarcoma. Males (13) were affected more than females (8) giving a male to female ratio of 1.6 to 1. The age range was 7 to 45 years with a median age of 24 years. The diameter of the swelling ranged from 6 to 20 cm with a median of 12 cm. All patients had ablative surgery except for those with affectation of the ilium. Data was analysed using the Statistical Package for Social Sciences (SPSS 16). Enneking's classification was used to grade the tumour. The duration of symptoms of all the patients before presentation ranged from 3 weeks to 4 years with a mean of 7 months. The commonest site affected was around the knee (76.2%); distal femur had 42.9% and proximal tibia 33.3%. RESULTS: Osteosarcoma was the most common malignant bone tumour in this series and accounted for 57.1%. The peak incidence was found in the 2nd decade of life. The youngest patient was 7 years old and the oldest 43 years. The tumour was found primarily around the knee. 7 cases were in the distal part of the femur, 4 in the proximal part of the tibia and 1 case was found in the distal radius. Out of the 12 patients with osteosarcoma, 8 had paraosteal type (5 high grade, 3 intermediate grade), the remaining 4 had periosteal (all high grade) Malignant Fibrous Histiocytoma was found in 7 patients and accounted for 33.3%. The peak incidence was found in 3rd and 4th decades. 4 out of the 7 patients were high grade pleomorphic osteosarcoma, 2 were myxoid high grade dedifferentiated and one was low grade giant cell tumour type. Chondrosarcoma was found in 2 patients, accounting for 9.5%. both cases were in the ilium CONCLUSION: Primary malignant bone tumours occurred in children and young adult in this study. It is commoner among males and most of the patients presented late to the hospital. Osteosarcoma is the commonest followed by Malignant Fibrous Histiocytoma, both occurred commonly around the knee and chondrosarcoma on the ilium.

AN INVESTIGATION INTO THE ANTIMALARIAL EFFECT OF METHANOLIC EXTRACT OF PAULLINIA PINNATA LEAVES IN PLASMODIUM BERGHEI INFECTED MICE AND COURSE OF INFECTION.

AIM: The aim of this study was to investigate the antimalarial activity of methanolic leaves extract of Paullinia pinnata on chloroquine-sensitive Plasmodium berghei NK 65 infected mice. METHODOLOGY: The curative study was conducted in thirty-six Wistar albino mice of both sexes which were divided into six groups of six animals each. The animals were infected with P. berghei NK 65. Group I was the negative control and received the vehicle (10% DMSO). Group II received no treatment. Groups III and IV were the positive controls and received chloroquine (CQ) (10mg/kg) and artesunate (4 mg/kg)-amodiaquine (10mg/kg) combination (ACT) respectively. Groups V and VI received 100mg/kg and 200mg/kg doses of the extract respectively. Administration was done orally once for three or four days for the standard drugs or the extract/vehicle respectively. The percentage parasitaemia, packed cell volume (PCV), body weight and death was monitored on days 0, 1, 2, 3, 4 and 11 (7 day post administration). The study of the course of infection of P. berghei was monitored in eighteen Wistar albino mice of both sexes which were similarly grouped, infected and treated for 3 days. Group A received the vehicle (distilled water) only. Group B was treated with CQ (10 mg/kg) and Group C with ACT. The percentage parasitaemia and death was monitored from day 0 to day 30 (27 day post administration). RESULTS: In the curative study, the extract suppressed parasitaemia at both doses on day 4. The group treated with 200mg/kg dose showed a higher percentage chemosuppression though not significant. The course of infection study revealed that recrudescence occurred on day 8 in the CQ treated group which lasted until day 23 after which the recrudescence was lost without re-treatment. A similar result was observed in the ACT group. CONCLUSION: The methanolic leaves extract of Paullinia pinnata has weak anti-malarial property. Chloroquine-sensitive P. berghei NK65 loses credibility and needs to be revalidated biannually.

Acute and sub-acute toxicity studies of the methanol extract of the leaves of Paullinia pinnata (Linn.) in Wistar albino mice and rats.

BACKGROUND: The aim of this study was to investigate the toxicological effects of the leaves of Paullinia pinnata Linn.(PP) in rodents using Wistar albino mice and rats as experimental models. METHODOLOGY: Acute toxicity study of the methanol extract of PP was carried out in Wistar strain albino mice using varying doses of the extract at 100, 200, 400, 800, 1600, 3200, 6400, and 10,000 mg/kg body weight. These doses were administered orally to male Wistar albino mice with the exception of the control group and observed for morbidity and mortality after Day 1, Day 7 and Day 14. Sub-acute toxicity study was conducted in male Wistar albino rats with varying doses of 50, 100, 200, 400 and 800 mg/kg body weight. These doses were administered orally once daily at 24 hour intervals for 28 days and the vehicle (physiological saline and Tween 80 (70:30 v/v)) was administered to the control groups in the experiments. Biochemical analyses were carried out on the plasma while pathological changes in the kidneys, liver and lungs were examined histologically. RESULTS: In the acute toxicity study, the mice did not show any form of morbidity or mortality. For the sub acute toxicity study, plasma levels of alkaline phosphatase (ALP), aspartate aminotransferase (AST), total cholesterol and the triglycerides were significantly elevated (p < 0.05) at the 400 mg/kg body weight dosage. Elevated levels of plasma ALP were also observed at 800 mg/kg body weight. The histopathological study showed that the lungs exhibited dose -dependent lymphocytic infiltrations and the pattern of occurrence of lesions observed in the liver was at a frequency of one rat per group at the 400 and 800 mg/kg body weight doses. CONCLUSION: The methanol leaf extract of Paullinia pinnata (Linn.) is well tolerated when orally administered at a dose of 200 mg/kg body weight but toxic at higher doses.

Outcome analysis of surgical treatment of Blount disease in Nigeria.

OBJECTIVE: The objective was to evaluate the results of surgery of Blount diseases using the postoperative metaphyseal-diaphyseal angle (MDA) at 2-year follow-up. BACKGROUND: The goal of surgery in Blount disease is to restore the normal configuration of the articular surface of the proximal end of the tibia in proper relationship to the mechanical axis of the limb. Our hypothesis is that patients will demonstrate significant clinical improvements following surgery and predictive models can be developed. MATERIALS AND METHODS: All patients who had surgery for Blount disease from January 2002 till December 2007 at the National Orthopaedic Hospital Lagos Nigeria and follow-up for 2 years were included. Data extracted were gender, affected limb, Blount's type, age when deformity was noted, and age at presentation, preoperative femoral tibial angle (TFA), Langenskiold score, preoperative MDA, and postoperative MDA. Linear regression was used to assess the predictive effect of selected clinical and radiographic measures on post-MDA. The model was adjusted for confounders: age deformity noted, age at presentation, affected limb, Blount's type, and gender. Variables in the adjusted model achieving significance at P < 0.05 were included in a multiple regression analysis. RESULTS: Eighty-six knees in 57 patients were included. The mean preoperative and postoperative MDA at 2 years was 34.6° ± 8.9° and 10.6° ± 4.3°, respectively. Seventy-three knees (84.9%) have correction of ≤10° with recurrence in 13 (15.1%) knees at 2 years (P < 0.001). The postoperative MDA was graded into good outcome if ≤10°. There was a significant improvement between preoperative MDA and postoperative MDA (P < 0.001). The multilinear analysis demonstrated that the preoperative MDA was a significant predictor of the postoperative MDA. The postoperative MDA was predicted with a standard error of 0.92 with the following formula: post-MDA = 1.027 + 0.404 pre-MDA. CONCLUSION: The mean postoperative MDA of 84.9% of the knees operated at 2 years was 9.4° ± 3.1° with recurrence rate of 15.1%. Postoperative MDA is a good outcome measure for surgical treatment of Blount disease and surgical correction should aim at producing post MDA ≤10°.

Variation of total hyoscine content of cultivated Datura metel Linn.

A titrimetric method is described for rapid assay of hyoscine content of organs of locally cultivated Datura metel Linn. Raw materials required (approximately 1.5 gm) are much less than those required for conventional percolation processes. Using the procedure, the flowers have been shown to be richest in hyoscine, only minimal levels of alkaloids being detected in the fruits. Furthermore, the total alkaloid content of D. metel has been shown to peak in the hot dry season, and at its lowest during the rainy season in Ibadan.