MEDICAL OUTREACH AND IMPROVED ACCESS TO SPECIALIST SERVICES FOR THE RURAL COMMUNITY OF BAUCHI STATE, NIGERIA: THE REQUIREMENTS FOR SUSTAINABILITY.

Introduction: The West African College of Physicians (Nigeria) conducted its Annual General and Scientific Meeting (AGSM) in Bauchi State, Nigeria on 11th-15th of July, 2023. The theme of the AGM is HEALTH-RELATED SDGs IN NIGERIA: THE PROGRESS SO FAR. The sub- themes included challenges of health care in the face of Disaster and the menace of brain drain on health care manpower and medical education. Part of the activities for the AGSM was a medical outreach conducted at Durum community of Bauchi LGA, Bauchi State on Saturday, 8th July, 2023 between 8:00AM to 5:00PM at Durum primary school premises. Objectives: We examined the role of specialist medical outreach in supporting primary health care services and overcoming the barriers to health care faced by the rural dwellers and also examined issues affecting sustainability. Methods: Durum community was chosen from the list of 3 rural communities submitted to the Local Organizing Committee (LOC). A community entry was conducted to the relevant stakeholders. A descriptive cross-sectional design was used for the study. A semi-structured data form was used to collect information from 1062 participants. The activities included health talk and consultations on common health problems in the community as well as referral services. Relevant screenings tests for HBV, HCV, DM, Kidney diseases (Urinalysis), HIV and Tuberculosis were conducted. Medications for common diseases affecting the community were prescribed by the Doctors and dispensed during the outreach. The data were analyzed using SPSS version 26 at 5% significance level and 95% confidence interval. Results: A total of 1,062 filled forms were retrieved. The results show that majority of the participants are females 615(58%) while 447(42%) are males. Half of the respondents are illiterate 526(50%) and only 1%(11) attended tertiary institution. Majority are unemployed 646(61%) and only 1%(13) are civil servants. The commonest existing chronic medical conditions among the participants are hypertension 43(4%) and diabetes 15(1%). The commonest presenting complaints of the respondents are fever 404(38%), headache 170(16%), cough 53(%), dizziness 53(5%), skin rashes 43 (4%), abdominal pain 159 (15%), diarrhoea 53(5%) and vaginal discharge 127(12%). Regarding medical check-up, 481(45%) of the respondents have never ever had a medical check-up. 44(4%) had a check-up in the last preceding month, 41(4%) had check-up in the last preceding week, 40(4%) had check up in the last 6 months, while 34(3%) had check-up in the last one year. 84(42%) and 81(41%) among those tested had positive results for hepatitis B and C respectively and were counseled and referred. None tested positive for Tuberculosis and 1(1%) tested positive for HIV among those screened. 301(80%) among those tested had positive results for malaria and were counseled and offered treatment. The commonest health problems in the community were malaria (41%), enteric fever (26%), PUD/Dyspepsia (19%), UTI (9%) and skin diseases (5%). Conclusions: The study found out that half of the participants are illiterate and unemployed. The commonest health problems in the community were malaria, enteric fever, PUD/Dyspepsia, UTI, skin diseases, Hepatitis B & C. Thus, we recommend that the Primary Health Care Centre in the community should continue to provide the basic health services to the community. The Drug Revolving Fund (DRF) of the facility should be upgraded with relevant drugs and medical consumables at an affordable cost and a Doctor should be posted to the centre on temporary basis. These require the support of Ward Development Committee, Department of Primary Health Care of Bauchi Local Government Area, Bauchi State Primary Health Care Development Agency and the Bauchi State Ministry of Health. In addition, the State Government should improve the allowances for the health care personnel working in the rural areas and support the community in educational enrollment and poverty alleviation as well as collaborating with health institutions like the WACP in providing quality services to the State.

Atypical Presentation of Mammary Analogue Secretory Carcinoma of the Lip.

Mammary analogue secretory carcinoma (MASC) of the salivary gland is a rare tumor that was first described by Skalova et al in 2010, and since then, only a few hundred cases have been reported in the literature. Prior to Skalova's report, MASC was histologically misclassified as acinic cell carcinoma (ACC), pleomorphic adenoma, mucoepidermoid carcinoma, or adenocarcinoma, not otherwise specified. Mammary analogue secretory carcinoma has a low incidence rate overall, accounting for less than 0.3% of all salivary gland tumors. Histopathologic and cytogenic analysis of MASC is identical to secretory carcinoma of the breast, leading to the proposed name by Skalova. The purpose of this case presentation is to describe an atypical presentation of MASC, to compare this case with the classic description of MASC, and to contrast the various features of MASC to ACC in order to improve the accuracy of future diagnoses and help guide treatment.

Key principles in running a successful business in facial plastics.

The ultimate goal for most facial plastic surgeons is to develop a successful practice. For those currently owning a practice and those planning on developing a practice, the skills and training necessary to establish and manage a facial plastic practice are not taught in medical school, residency, or most fellowships. The goal of this article is to underline the key principles of running a successful business. This article does not replace an MBA, but it allows you to be aware of potential challenges that all businesses encounter.

Posterior conjunctival plication to correct secondary ptosis after eyelid retraction repair in Graves disease.

PURPOSE: To describe the results of posterior conjunctival plication for the treatment of secondary eyelid ptosis after eyelid retraction repair in Graves disease. METHODS: Case series. All patients were evaluated preoperatively by routine eye examination and eyelid measurements including Margin Reflex Distance 1 and levator function. Two eyes of 2 patients who presented with ptosis following eyelid retraction repair were corrected with posterior conjunctival plication. RESULTS: Posterior conjunctival plication for secondary ptosis following eyelid retraction repair was successful in 2 eyelids of 2 patients with Graves disease. Follow up period ranged from 6-10 months over which no sign of recurrent ptosis was observed. CONCLUSIONS: Posterior conjunctival plication is an effective surgical technique for the correction of secondary ptosis following eyelid retraction repair in patients with Graves disease.

The effects of alar batten grafts on nasal airway obstruction and nasal steroid use in patients with nasal valve collapse and nasal allergic symptoms: a prospective study.

IMPORTANCE: Clinical management of nasal airway obstruction (NAO) in patients with and without nasal allergic symptoms and nasal valve collapse (NVC). OBJECTIVE: To examine the impact that autologous alar batten grafts have on patients with NAO owing to NVC and their affect on nasal steroid use and allergic symptoms. DESIGN: A prospective study. SETTING: Indiana University Medical Center, Indianapolis. PARTICIPANTS: Patients with NAO due to NVC with or without symptoms of nasal allergic symptoms. INTERVENTIONS: All of the patients had placement of autologous batten grafts during the study period. STUDY SELECTION: Prospective study of patients with dynamic NVC undergoing alar batten graft treatment. DATA EXTRACTION: Nasal Obstruction Symptom Evaluation survey preoperatively and postoperatively, prospective outpatient questionnaire to determine use of nasal steroids and presence of nasal allergic symptoms preoperatively and postoperatively. RESULTS: A total of 126 patients underwent surgical intervention for the treatment of NAO due to NVC. All of these patients were using nasal steroid sprays, and 78 patients (62%) also reported nasal allergic symptoms at their initial presentation. At 6-month and 1-year postoperative evaluations, 118 (94%) and 122 (97%), respectively, reported significant improvement of their NAO, regardless if they had presented with or without allergic nasal symptoms. Sixty-two of the 78 patients (79%) who initially presented with NAO owing to NVC and nasal allergic symptoms preoperatively reported significant improvement in their NAO and nasal allergic symptoms postoperatively. Eight of 126 (6%) restarted their use of nasal steroids postoperatively. All 8 of these patients reported nasal allergic symptoms preoperatively. No patients in the nonallergic group continued the use of nasal steroids postoperatively. There was no increase in nasal steroid use at the 12-month follow-up visit. CONCLUSIONS AND RELEVANCE: Nasal airway obstruction due to NVC in patients can be surgically treated with autologous alar batten grafts. In addition, the use of alar batten grafts may improve NAO in patients with nasal allergic symptoms and reduces their use of nasal steroids. These results support the idea of potential surgical repair of the nasal valve to treat patients with NAO due to nasal allergic symptoms and NVC. LEVEL OF EVIDENCE: 4.

Use of fracture size and soft tissue herniation on computed tomography to predict diplopia in isolated orbital floor fractures.

PURPOSE: To determine the role of fracture size and soft tissue herniation as measured by computed tomography in predicting the development of persistent diplopia in patients with isolated orbital floor fractures. METHODS: A retrospective chart review identified patients presenting between March 2009 and 2012 with isolated orbital floor fractures. Computed tomographic scans were assessed for transverse fracture size and absence or presence of soft tissue herniation and rectus involvement. Presence of diplopia at 6-10 days, decision for surgical repair, and presence of diplopia were recorded. RESULTS: Fifty-six patients fulfilled inclusion criteria. Eighteen of 56 patients (32%) had preoperative diplopia. In Type A fractures, 0/9 (0%) small, 1/8 (12.5%) medium, and 2/14 (14%) large fractures had diplopia. For Type B fractures, 3/4 (75%) small, 9/13 (69%) medium, and 4/8 (50%) large fractures had diplopia. Type B fractures were significantly more likely to cause diplopia than Type A fractures in the small (p = 0.003) and medium (p = 0.007) size groups but not in the large groups (p = 0.07). CONCLUSION: Transverse fracture size and presence of soft tissue herniation on CT imaging can predict development of persistent diplopia in isolated orbital floor fractures. Small and medium sized fractures with soft tissue herniation are more likely to cause diplopia than large sized fractures. We recommend early repair or closer observation of small and medium sized orbital floor fractures with soft tissue herniation due to the high risk of diplopia.

Dry eye symptoms and chemosis following blepharoplasty: a 10-year retrospective review of 892 cases in a single-surgeon series.

OBJECTIVES: To determine the incidence of and risk factors associated with dry eye symptoms (DES) and chemosis following upper or lower blepharoplasty. To examine the outcomes among long-term blepharoplasty data to better understand the incidence of and risk factors associated with dry eye symptoms (DES) and chemosis, to evaluate the known risk factors for DES in the general population, and to analyze intraoperative procedures (such as forehead-lift, midface-lift, canthopexy, and canthoplasty) to determine their effects on DES and chemosis. METHODS: A retrospective medical record review was performed among all the cases of upper or lower blepharoplasty performed by the senior author during a 10-year period (January 1999 through December 2009). A self-reported dry eye questionnaire was used to collect baseline and follow-up data. Patients with incomplete medical records, multiple (>1) revision procedures, less than 3 weeks of postoperative follow-up data, or a history of Sjögren syndrome, severe thyroid eye disease, histoplasmosis ocular infection, periocular trauma causing eyelid malposition, or radiotherapy for nasopharyngeal cancer were excluded from the study. Binary logistic regression analyses were performed to analyze the relationship between 13 preoperative and anatomical variables and DES or chemosis. χ2 Tests were performed to analyze the relationship between intraoperative risk factors and DES or chemosis. RESULTS: In total, 892 cases met the study inclusion criteria. Dry eye symptoms and chemosis following blepharoplasty were reported in 26.5% and 26.3% of patients, respectively. The incidences of DES and chemosis were significantly higher in patients who underwent concurrent upper and lower blepharoplasty (P < .001) and in patients who underwent skin-muscle flap blepharoplasty (P = .001). Hormone therapy use and preoperative scleral show were associated with DES after blepharoplasty (P < .05). Male sex, preoperative eyelid laxity, and preoperative DES were associated with an increased incidence of chemosis following blepharoplasty (P < .05). Intraoperative canthopexy significantly increased the risk for developing chemosis (P = .009), and postoperative lagophthalmos significantly increased the risk for DES following blepharoplasty (P < .001). CONCLUSIONS: Dry eye symptoms and chemosis are common following blepharoplasty, and the risk for developing these conditions may increase with intraoperative canthopexy, postoperative temporary lagophthalmos, concurrent upper and lower blepharoplasty, and transcutaneous approaches violating the orbicularis oculi muscle. Patients with a preoperative history of DES, eyelid laxity, scleral show, or hormone therapy use may be at greater risk for developing dry eyes or chemosis following surgery.

The interarytenoid spatial relationship: accuracy and interrater reliability for determining sidedness in cases of unilateral adductor paresis.

BACKGROUND/OBJECTIVE: When adductor vocal fold paresis manifests without obvious motion impairment, identifying the paretic side can be challenging. Although increased vocal fold waveform amplitude ("floppiness") on videostroboscopy may be helpful, it has been shown to have low interrater reliability. We have found that the interarytenoid spatial relationship (IASR) can often accurately be used to predict the sidedness of electromyography (EMG)-determined unilateral adductor (thyroarytenoid/lateral cricoarytenoid [TA/LCA]) paresis. The goal of this study was to determine if a series of otolaryngology residents could learn to assess the IASR on videostroboscopy and use the IASR to identify the side of EMG-documented adductor paresis with high accuracy and interrater reliability. STUDY DESIGN: Otolaryngology resident population surveys. METHODS: Ten residents were given videostroboscopy images on abduction/adduction from 10 consecutive patients with EMG-documented unilateral TA/LCA paresis and asked to identify the paretic side in a pretest. The IASR was then conceptually introduced to the otolaryngology residents in a brief presentation. Posttesting was then performed and used to assess EMG-based accuracy and interrater reliability. RESULTS: Before the IASR presentation, otolaryngology residents accurately identified the paretic side in 63% (95% confidence interval [CI]: 56-70%) of cases. In the posttest session, the residents accurately identified the paretic side in 93% (95% CI: 87-99%) of cases, and interrater reliability was 0.873. CONCLUSIONS: The IASR may be useful in determining sidedness in cases of unilateral TA/LCA paresis. Further studies are needed to determine the sensitivity and specificity of the IASR for determining sidedness of unilateral TA/LCA paresis with intact mobility.

Nasal batten grafts: are patients satisfied?

OBJECTIVES: To learn how nasal batten grafts affect patients' assessment of their nasal airway patency and to determine the extent to which patients believe batten grafts altered their appearance. METHODS: A prospective survey study of 18 patients in a tertiary veterans hospital who had nasal airway obstruction (NAO) due to nasal valve collapse was completed. Patients had placement of bilateral polyethylene batten grafts during a 36-month study period. The Nasal Obstruction Symptom Evaluation (NOSE) validated survey was used to measure a patient's subjective postoperative change in nasal airway obstruction. In addition, the patients were asked to rate the extent their appearance had changed. RESULTS: All patients presented with complaints of NAO due to nasal valve collapse either in isolation or in combination with another anatomical source of obstruction. The nasal valve collapse was identified by clinical examination. All patients had preoperative photographs. Most patients had a trial with an intranasal stent before opting for surgical implantation of the batten grafts. The results of the NOSE survey demonstrate significant improvement in nasal obstruction. Patients also reported only a minimal change in appearance. There was 1 patient with implant extrusions and only a few implants were removed. CONCLUSIONS: Nasal airway obstruction due to nasal valve collapse can be effectively treated with polyethylene batten grafts. The implants are well tolerated, and patients report a significant improvement in NAO. There is little risk of implant extrusion, exposure, or intolerance. In addition, patients did not note a significant change to their appearance.

The alar-spanning suture: a useful tool in rhinoplasty to refine the nasal tip.

The alar-spanning suture is a surgical technique used by an experienced rhinoplastic surgeon to address certain nasal tip deformities. Wide nasal tip deformities with strong, convex lower lateral cartilages are best indicated for treatment with this technique. The alar-spanning suture can improve lateral crural position and eliminate dead space by refining and narrowing the supratip, often without requiring extensive dissection or additional strut grafting. We use operative photographs and an intraoperative video to demonstrate the alar-spanning suture technique, which is a useful addition to the armamentarium of any rhinoplastic surgeon.

Long-term analysis of surgical correction of the senile upper lip.

OBJECTIVE: A quantitative comparison of immediate and long-term results of surgical correction of the senile upper lip using lip advancement and lip lift. METHODS: Retrospective review of 30 patients who underwent senile upper lip repair, including lip advancement or lip lift. Digital image analysis was used to standardize each patient's preoperative and postoperative photographs for accurate, objective comparison. RESULTS: Lip lift and lip advancement achieve significant improvement in the appearance of the senile upper lip (P < .001). This improvement is sustained during many years (mean, 5 y; P < .001). Using repeated measures analysis of variance, no significant difference was found in the operative group compared with the control group when examining age-related change. CONCLUSION: Lip advancement and lip lift can restore the senile upper lip to a more youthful and natural appearance with sustained long-term benefits.

Optimization of autologous muscle stem cell survival in the denervated hemilarynx.

OBJECTIVE: Current treatments for vocal fold paralysis are suboptimal in that they fail to restore dynamic function. Autologous muscle stem cell (MSC) therapy is a promising potential therapy for vocal fold paralysis in that it can attenuate denervation-induced muscle atrophy and provide a vehicle for delivery of neurotrophic factors, thereby potentially selectively guiding reinnervation. The goal of this project was to characterize optimal conditions for injected autologous MSC survival in the thyroarytenoid (TA) muscle following recurrent laryngeal nerve (RLN) injury by local administration of adjuvant factors. STUDY DESIGN: Animal experiment. METHODS: Unilateral RLN transection and sternocleidomastoid muscle (approximately 1 g) biopsies were performed in 20 male Wistar rats. One month later, 10 autologous MSCs labeled via retroviral-enhanced green fluorescent protein (EGFP) transduction were injected into the denervated hemilarynx of each animal with one of four adjuvant therapies: cardiotoxin [(CTX) 10 M], insulin-like growth factor-1 [(IGF- 1) 100 microg/mL], ciliary neurotrophic factor [(CNTF) 50 microg/mL], or saline. Animals were euthanized 1 month later and larynges harvested, sectioned, and analyzed for MSC survival. RESULTS: All specimens demonstrate extensive MSC survival, with fusion of the MSCs with the denervated myofibers. Based on mean fluorescent intensity of the laryngeal specimens, IGF-1 and CNTF had the greatest positive influence on MSC survival. Myofiber diameters demonstrated myofiber atrophy to be inversely related to MSC survival, with the least atrophy in the groups having the greatest MSC survival. CONCLUSIONS: Autologous MSC therapy may be a future treatment for vocal fold paralysis. These findings support a model whereby MSCs genetically engineered to secrete CNTF and/or IGF-1 may not only promote neural regeneration, but also enhance MSC survival in an autocrine fashion.