Effect of Perioperative Tranexamic Acid on Blood Loss following Open Simple Prostatectomy: A Prospective Review in Nigerian Men.

BACKGROUND: Haemorrhage is a common complication following open simple prostatectomy and patients may sometimes require a blood transfusion. Tranexamic acid has been shown to reduce blood loss following transurethral resection of the prostate and open radical prostatectomy. This study evaluated the effect of perioperative intravenous administration of tranexamic acid on blood loss and blood transfusion rates in patients who had OSP for benign prostatic enlargement. METHODOLOGY: This was a comparative study of patients with documented prostate glands 60g and above scheduled for OSP. Initial hematocrit was done a day before surgery. The patients were randomized into a tranexamic acid group, which received perioperative intravenous tranexamic acid and the no-TXA group which received placebo (0.9% saline). All patients had open simple retropubic prostatectomy. Final post-operative hematocrit was assessed 72 hours after surgery, and blood loss was calculated using the modified Gross formula (actual blood loss = estimated blood volume x change in hematocrit / mean hematocrit). The transfusion rate was documented. RESULTS: Fifty-six patients participated in this study and were randomized into a tranexamic acid group and no-tranexamic acid group. The mean age of patients in the tranexamic acid group was 66.07 ±7.08 years and was comparable to the no- tranexamic acid group which was 66.50 ± 8.80 years (P = 0.842). The median total blood loss was lower in the tranexamic acid group (502mls, IQR 613) compared to the no-tranexamic acid group (801mls, IQR 1069). The difference in the median blood loss between the two groups was 299mls (U 275, P 0.055). The rate of blood transfusion was lower in the tranexamic acid group (6 patients, 21%) compared to the no tranexamic acid group (11 patients, 39%), (P = 0.146). There was no difference in complication rates between the two groups. CONCLUSION: The use of tranexamic acid in patients undergoing open simple prostatectomy showed a trend towards reduced intraoperative blood loss and less need no tranexamic for blood transfusion. This is of clinical significance, especially in elderly patients with low cardiovascular reserve.

CONTEXTE: L'hémorragie est une complication courante après une prostatectomie simple ouverte et les patients doivent parfois recevoir une transfusion sanguine. Il a été démontré que l'acide tranexamique réduit la perte de sang après une résection transurétrale de la prostate et une prostatectomie radicale ouverte. Cette étude a évalué l'effet de l'administration intraveineuse périopératoire d'acide tranexamique sur les pertes sanguines et les taux de transfusion sanguine chez des patients ayant subi une PSO pour hypertrophie bénigne de la prostate. MÉTHODOLOGIE: Il s'agissait d'une étude comparative de patients dont la prostate de 60 g et plus était documentée et qui devaient subir une PSO. L'hématocrite de base a été effectué un jour avant la chirurgie. Les patients ont été répartis aléatoirement dans le groupe acide tranexamique, qui a reçu de l'acide tranexamique periopératoire par voie intraveineuse, et dans le groupe sans TXA, qui a reçu un placebo. Tous les patients ont subi une prostatectomie rétropubienne simple ouverte. L'hématocrite postopératoire a été évalué, et la perte de sang calculée à l'aide de la formule de Gross modifiée. Le taux de transfusion a été documenté. RÉSULTATS: Cinquante-six patients ont participé à cette étude et ont été randomisés entre le groupe avec acide tranexamique et le groupe sans acide tranexamique. L'âge moyen des patients du groupe acide tranexamique était de 66,07 ±7,08 ans et était comparable à celui du groupe sans acide tranexamique qui était de 66,50 ± 8,80 ans (P =0,842). La perte sanguine totale médiane était plus faible dans le groupe avec acide tranexamique (502 ml, IQR 613) que dans le groupe sans acide tranexamique (801 ml, IQR 1069). La différence de la perte de sang médiane entre les deux groupes était de 299 ml (U 275, P 0,055). Le taux de transfusion sanguine était inférieur dans le groupe acide tranexamique (6 patients, 21%) par rapport au groupe sans acide tranexamique (11 patients, 39%), (P =0,146). Il n'y avait pas de différence dans les taux de complication entre les deux groupes. CONCLUSION: L'utilisation de l'acide tranexamique chez les patients subissant une prostatectomie simple ouverte a montré une tendance à la réduction de la perte de sang peropératoire et un besoin moindre de transfusion sanguine. Mots clés: Hypertrophie bénigne de la prostate, Prostatectomie simple ouverte, Hémorragie, Acide tranexamique.

Clinical Profile and Outcome of COVID-19 Cases Admitted at a Tertiary Health Facility In South-West Nigeria.

BACKGROUND: Coronavirus Disease 2019 (COVID-19) is anemerging disease with a global spread that has affected millions of lives. In Nigeria, the third wave of the outbreak is being experienced with many patients requiring hospitalization. Being a novel disease, we characterized the clinical profile and outcomes of patients admitted into our isolation centre. METHODS: A case series of 65 COVID-19 patients admitted at theIsolation Centre of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, from June 2020 to March 2021 is presented. Information on demographic characteristics, medical history, symptoms, treatment and outcomes was obtained. Data were analysed using SPSS version 25. RESULTS: Most (47; 72.3%) patients were less than 65 years old and 39 (60.0%) were males. The commonest symptoms were cough (42; 64.6%), breathlessness (41; 63.1%), fever (40; 61.5%), muscle aches (40; 61.5%), and anosmia (16; 24.6%). Hypertension (41; 63.1%) and diabetes (18; 27.7%) were the most predominant comorbidities. Forty-three patients (66.2%) had supplemental oxygen therapy. The majority (44; 70%) of patients were admitted for 10 days or less and 58 (89.3%) patients were discharged home. However, 6 deaths (9.2%) were recorded among patients with advanced comorbidities and severe sepsis with all deaths occuring within 5 days of admission. CONCLUSION: There was a male predominance among patients admitted at the Isolation Centre and all mortalities occurred within five days of admission. Early detection, prompt management of cases with hypoxaemia and optimal treatment of comorbidities are recommended for good outcomes in COVID-19 patients.

CONTEXTE: La maladie de la coronavirus 2019 (COVID-19) est une maladie émergente dont la propagation mondiale a affecté des millions de vies. Au Nigéria, la troisième vague de l'épidémie est en train de se produire avec de nombreux patients nécessitant une hospitalisation. S'agissant d'une nouvelle maladie, nous avons caractérisé le profil clinique et les résultats des patients admis dans notre centre d'isolement. MÉTHODES: Une série de cas de 65 patients atteints de COVID-19 au Centre d'isolement de l'Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, de juin 2020 à mars 2021 est présentée. Des informations sur les caractéristiques démographiques, les antécédents médicaux, symptômes, le traitement et les résultats ont été obtenus. Les données ont été à l'aide de SPSS version 25. RÉSULTATS: La plupart des patients (47 ; 72,3 %) étaient âgés de moins de 65 ans et 39 (60,0 %) étaient des hommes. Les symptômes les plus fréquents étaient la toux (42 ; 64,6%), l'essoufflement (41 ; 63,1%), la fièvre (40 ; 61,5%), les douleurs musculaires (40; 61,5%) et l'anosmie (16 ; 24,6 %). L'hypertension artérielle (41; 63,1%) et le diabète (18 ; 27,7%) étaient les comorbidités les plus prédominantes. Quarante-trois patients (66,2 %) avaient une oxygénothérapie complémentaire. La majorité (44 ; 70%) des patients ont été admis pour 10 jours ou moins et 58 (89,3%) ont été renvoyés chez eux. Cependant, 6 décès (9,2 %) ont été enregistrés parmi les patients présentant des comorbidités avancées et une septicémie grave, tous les décès étant survenus dans les 5 jours suivant l'admission. CONCLUSION: Il y avait une prédominance masculine parmi les patients admis au centre d'isolement et tous les décès sont survenus dans les cinq jours cinq jours après l'admission. La détection précoce, la prise en charge rapide des cas l'hypoxémie et le traitement optimal des comorbidités sont recommandées recommandés pour obtenir de bons résultats chez les patients atteints de COVID-19. Mots clés: COVID-19, Profil clinique, Résultat, Gestion des cas, Centre d'isolement.

Paediatric Cardiac Anaesthesia at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria: The Hurdles, Struggles, and Successes.

BACKGROUND: Open-heart surgery started at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) Ile-Ife, Nigeria, 5 years ago through partnership with foreign partners. This paper reviewed the difficulties facing the development of paediatric cardiac anaesthesia, the pattern, and the outcome of cases managed. METHODS: A review of the infrastructure, equipment, manpower and operational setup for open-heart surgery at OAUTHC was done. A retrospective study of all patients that were operated on from April 2016 to March 2021 was performed. Extracted data were analysed with Statistical Packages for the Social Scientists using descriptive statistics. RESULTS: A total of 102 patients had open-heart surgeries during the period under review by the various teams in a shared facility of the hospital's main theatre. Challenges with manpower, infrastructure, and supplies were major limitations to service delivery. Most of the patients (75.5%) were aged < 5 years. The commonest procedures performed were ventricular septal defect closure (31.4%), total correction of tetralogy of Fallot (26.5%), and atrial septal defect closure (9.8%). Fast-tracked anaesthesia was used always except where it was contraindicated. Most (76.7%) of the cases were extubated within 24 hours after surgery; the mean (SD) duration of ventilation in the ICU was 0.99 (1.2) days and the average length of ICU stay was 3 days. The overall mortality rate was 20.6%. CONCLUSION: Numerous challenges confront the provision of sustainable paediatric cardiac anaesthesia services in resource-constrained settings like ours. Much can be achieved with appropriate investment in material and manpower, and partnership with experienced teams.

CONTEXTE: La chirurgie à cœur ouvert a commencé au complexe hospitalier universitaire Obafemi Awolowo (OAUTHC) Ile-Ife, au Nigeria, il y a 5 ans grâce à un partenariat avec des partenaires étrangers. Cet article a passé en revue les difficultés rencontrées dans le développement de l'anesthésie cardiaque pédiatrique, le schéma et l'issue des cas pris en charge. MÉTHODES: Un examen de l'infrastructure, de l'équipement, de la main-d'œuvre et de la configuration opérationnelle pour la chirurgie à cœur ouvert à l'OAUTHC a été effectué. Une étude rétrospective de tous les patients opérés d'avril 2016 à mars 2021 a été réalisée. Les données extraites ont été analysées avec des progiciels statistiques pour les spécialistes des sciences sociales à l'aide de statistiques descriptives. RÉSULTATS: Au total, 102 patients ont été opérés à cœur ouvert au cours de la période étudiée par les différentes équipes dans une salle commune du bloc opératoire principal de l'hôpital. Les défis liés à la main-d'œuvre, à l'infrastructure et aux fournitures constituaient des obstacles majeurs à la prestation de services. La plupart des patients (75.5%) étaient âgés de < 5 ans. Les gestes les plus fréquemment pratiqués étaient la fermeture de la communication interventriculaire (31.4%), la correction totale de la tétralogie de Fallot (26.5 %) et la fermeture de la communication interauriculaire (9.8%). L'anesthésie accélérée a toujours été utilisée sauf en cas de contre-indication. La plupart (76.7%) des cas ont été extubés dans les 24 heures suivant la chirurgie ; la durée moyenne (ET) de la ventilation en USI était de 0.99 (1.2) jours et la durée moyenne de séjour en USI était de 3 jours. Le taux de mortalité global était de 20.6%. CONCLUSION: De nombreux défis font face à la prestation de services durables d'anesthésie cardiaque pédiatrique dans des contextes aux ressources limitées comme le nôtre. Beaucoup peut être réalisé avec un investissement approprié en matériel et en main-d'œuvre, et un partenariat avec des équipes expérimentées. MOTS-CLÉS: Pédiatrie, Anesthésie, Chirurgie Cardiaque, Nigéria, Pays en Développement.

Impact of Pain Management Workshop on the Knowledge and Attitude of Healthcare Workers and Opioid Utilization in a Nigerian Teaching Hospital.

BACKGROUND: Pain is a public health problem requiring serious attention. One major barrier to the provision of quality pain treatment in many countries is lack of training for healthcare workers. The aim of this study was to evaluate the impact of pain education on the knowledge and attitude of healthcare workers, and opioid utilization in a university teaching hospital. METHODS: Pain management workshops were conducted for healthcare workers over a 12-month period. The modified "Knowledge and Attitudes Survey Regarding Pain" questionnaire was administered to participants pre- and post- training for each of the workshops. The total mark by each participant was entered into the Statistical Package for Social Sciences (SPSS) software version 16 software for windows (SPSS Inc., Chicago, Illinois, USA) for comparison of means for pre- and post-test. Changes in opioid utilization were evaluated. RESULTS: The pre-test and post-test questionnaires were filled by 715 and 700 participants respectively. The mean post-test score was significantly higher than the pre-test score (68% versus 49% respectively, p = 0.00001). The doctors scored significantly higher than the other groups (p < 0.0001) in the pre-test. The mean post-test scores were significantly higher than the corresponding mean pre-test scores for the various groups (p < 0.0001). Sustained increase (up to 60.4%) in total morphine utilization was observed during the training. CONCLUSION: There is a wide knowledge gap requiring regular training and re-training to achieve improved pain management and opioid utilization among healthcare workers. Inclusion of robust pain curricula in medical training programs will significantly improve pain management.

Feasibility study for a randomized clinical trial of bupivacaine, lidocaine with adrenaline, or placebo wound infiltration to reduce postoperative pain after laparoscopic cholecystectomy.

Background: Short-term pain relief can be achieved by local anaesthetic infiltration of port sites at the end of laparoscopic surgery. This study aimed to assess feasibility of performing an RCT to evaluate short-term postoperative analgesia after laparoscopic surgery in Nigeria using two local anaesthetics for port-site infiltration versus saline placebo. Methods: This was a placebo-controlled, patient- and outcome assessor-blinded, external feasibility RCT. Patients undergoing elective laparoscopic cholecystectomy for symptomatic ultrasound-proven gallstones were randomized into three groups: lidocaine with adrenaline (epinephrine), bupivacaine or saline control. The feasibility of recruitment, compliance with randomized treatment allocation, and completion of pain and nausea outcome measures were evaluated. Pain was assessed at 2, 6, 12 and 24 h after surgery using a 0-10-point numerical rating scale (NRS) and a four-point verbal rating scale. Nausea was assessed using NRS at the same time points. Clinical outcomes were assessed only in patients who received the correct randomized treatment allocation. Results: Of 79 patients screened for eligibility, 69 were consented and randomized (23 per group). Overall, compliance with randomized treatment allocation was achieved in 64 patients (93 per cent). All pain and nausea assessments were completed in these 64 patients. On the NRS, most patients had moderate to severe pain at 2 h (39 of 64, 61 per cent), which gradually reduced. Only six patients (9 per cent) had moderate to severe pain at 24 h. Conclusion: Recruitment, compliance with the randomized allocation, and completion of pain outcome measures were satisfactory. This study demonstrates the feasibility of conducting a surgical RCT in a resource-limited setting. Registration number: ISRCTN 17667918 (https://www.isrctn.com).

Impact of basic life support training on the knowledge of basic life support in a group of Nigerian Dental Students.

UNLABELLED: Aim and Objetive: The burden of cardiac arrest remains enormous globally. Early recognition and prompt and effective cardiopulmonary resuscitation are crucial to successful outcome following a cardiac arrest. This study assessed the impact of basic life support (BLS) training on the knowledge of a group of dental students. MATERIALS AND METHODS: Sixty-eight dental students participated in this interventional study. Using convenience sampling, pre- and post-BLS training assessment were conducted with a questionnaire. RESULTS: The mean score (standard deviation) for pretest was 4.7 (±1.47) with a range of 2-8 out a total of 10, while the mean posttest score was 8.04 ± 1.47 with a range of 3-10. The differences were statistically significant (P < 0.01). There was a marked improvement in the knowledge of the respondents with 88.2% of them having a posttest score of ≥7. CONCLUSION: The results of this study suggest that the group of dental students' knowledge of BLS was very poor prior to the BLS training. The study also showed that the BLS training had a positive influence on the BLS knowledge of the participants.

Incidental finding of complete situs inversus in a polytraumatized adult.

BACKGROUND: Situs inversus is a rare abnormality typically posing a diagnostic dilemma during routine evaluation of acute abdominal emergencies such as in acute appendicitis and cholecystitis. It is rare to detect such in the setting of trauma. OBJECTIVE: To report an incidental finding of complete situs inversus in a poly-traumatized adult. METHODS: The clinical records of the patient including preoperative evaluation, intra-operative findings and postoperative care were reviewed. RESULT: A 53 year old man presented with difficulty breathing, left sided chest pain, generalized abdominal pain and distension 18 hours after a vehicular road traffic accident. Examination revealed features of left sided haemothorax, absent heart sounds, generalized peritonitis and limb injuries. Plain chest radiograph confirmed left haemothorax with dextrocardia. He had a left closed thoracostomy tube drainage and exploratory laparotomy which revealed complete situs inversus of intra-abdominal organs alongside a jejunal perforation which was repaired. Postoperative recovery was uneventful. CONCLUSION: Complete situs inversus is uncommon and may not be anticipated in evaluation of trauma patients. Preoperative clinical and radiological evaluation may however be helpful in making a pre-operative diagnosis and further management.