Minimally Invasive Surgery in Port Harcourt, Nigeria: Progress So Far.

Background The global practice of minimally invasive surgery (MIS) has progressed from basic to advanced procedures. Consequent to this, almost all surgical procedures can be performed through a minimally invasive technique. This study aims to audit the practice of MIS in healthcare facilities within a city in a developing country in Africa. Methods This is a multicenter, multispecialty, retrospective descriptive study of minimally invasive diagnostic and therapeutic surgeries performed in private and public health care facilities in Port Harcourt, Rivers State, Nigeria, conducted for a duration of 10 years, from January 2010 to December 2019. A proforma was distributed for completion to identified surgeons from the included study centers. Data on MIS, including types of procedures, time trends, frequency, category of surgery, and cost, were collated. Statistical analysis was performed using IBM Statistical Package for the Social Sciences (IBM SPSS version 20.0, New York, USA). Results There were 5845 minimally invasive procedures performed during the study period, out of which only 92 (1.57%) were carried out in government-owned hospitals. Of these, 2570 were gynecologic (44.0%), 1873 were urologic (32.0%), 1300 were general surgeries (22.2%), 142 were pediatric surgeries (2.4%), and 3 (0.05%) were thoracic minimally invasive procedures performed within the 10-year period. The cost of procedures ranged from <$200 USD to >$2000 USD. The hospital stays ranged from <1 day to a maximum of 13 days. Conclusion The practice of MIS has made significant progress but has been primarily driven by the private sector. Subsidizing the cost of MIS procedures in government-owned hospitals is likely to improve patronage and improve the skills of surgeons.

COVID-19 and obstetric practice: A critical review of the Nigerian situation.

OBJECTIVE: To review what is known about COVID-19 and highlight gaps in the context of Nigerian obstetric practice. Research data on COVID-19 are understandably sparse in Africa. Nigeria, like most African countries, is battling a disease she is poorly equipped to fight. METHODS: The current available literature on COVID-19 was reviewed in relation to obstetric practice in the Nigerian context, gaps were identified, and recommendations were made to improve the handling of the COVID-19 pandemic in Nigerian obstetric practice. RESULTS: In and out of hospital, both the obstetrician and the obstetric patient are constantly being put at risk of exposure to the coronavirus because testing and preventive measures are either ineffective or non-existent. CONCLUSION: The pandemic has exposed the gross inadequacies in Nigeria's healthcare system and is therefore a wake-up call to the need for a complete overhaul of infrastructure and services. The government will do well to increase the budget allocation for health from the current paltry 4.14% to the recommended 15% of the total budget. The Nigerian obstetrician stands a high risk of exposure due to inadequate preventive measures, and testing and diagnostic challenges.

Abnormal cervical cytology among HIV-positive women in Nigeria.

OBJECTIVE: To determine the prevalence of abnormal cervical smears and high-grade lesions among HIV-positive and HIV-negative women, and to assess the relationship between severity of disease and CD4 count. METHODS: In a prospective cross-sectional comparative study, 250 HIV-positive and 250 HIV-negative women attending the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria, were enrolled between January and March 2012. Cervical smear samples were collected from participants, examined, and reported via the Bethesda system. Data management and analysis was done with SPSS. Differences between the 2 study groups were determined by χ2 test and Student t test. RESULTS: The prevalence of abnormal cervical smears was significantly higher among HIV-positive women (34.4%) than among HIV-negative women (20.2%) (P<0.01). The proportion of high-grade lesions was significantly higher among HIV-positive women (23.5%) than among HIV-negative women (8.2%) (P=0.025). HIV-positive women with a CD4 count below 500 cells/mm3 had significantly more abnormal cervical smears (28.3%) compared with those with a CD4 count of 500 cells/mm3 or more (6.1%) (P=0.04). CONCLUSION: HIV-positive women were found to be at significantly greater risk of developing abnormal cervical cytology and high-grade lesions compared with HIV-negative women.

Pregnancy outcome after cerclage for cervical incompetence at the University of Port Harcourt Teaching Hospital, Port Harcourt.

Cervical incompetence is often associated with mid trimester pregnancy losses and preterm labour. cervical cerclage to prevent miscarriage and preterm labour is practiced world wide. The objective of this study was to document the feto-maternal outcome following cervical cerclage for cervical incompetence. The study reviewed all case files of pregnant women who had cervical cerclage for cervical incompetence between January 1, 2004 to December 31, 2008, at the University of Port Harcourt Teaching Hospital. The study found an incidence of 0.17% of cervical incompetence among the antenatal population. Following cervical cerclage, miscarriage rate was 9.4%. Preterm delivery occurred in 21.8% while term pregnancy occurred in 68.8% of the women. There is improvement in pregnancy outcome after cervical cerclage for cervical incompetence hence we recommend the insertion for true cases of cervical incompetence.