Pentazocine pain relief in adult patients with acute abdominal ain: A prospective randomized clinical trial

Background: Reported studies in the African population, on early pain relief in patients with acute abdominal pain are few. The objective of the study was to evaluate the effect of pentazocine (PZ) on pain relief, diagnostic accuracy and treatment decisions in patients with acute abdominal pain.Methods: This was a prospective randomized clinical trial undertaken at the emergency department, Federal Medical Centre, Abeokuta. Seventy adult patients with acute abdominal pain were randomized to receive equal volumes intravenously, normal saline, (control group) or pentazocine 30mg (PZ group). Pain was measured with a standard 0 – 100mm Visual analogue scale (VAS). Pain score, diagnosis and treatment decision were recorded before and 60minutes after the injection. A VAS score change > 12mm was considered as clinically significant. Outcome measures were the differences in these parameters between the two study arms.Results: Twenty patients in the PZ group and 9 patients in the control group had a VAS score drop >12mm. This difference is statistically significant. (X2= 6.56: p <0.02). In two patients pentazocine interfered with correct diagnosis and treatment. The initial decision to operate was deferred.Conclusion: Pentazocine provided analgesia in patients with acute abdominal pain. Its administration caused delay in correct diagnosis and treatment in some patients

Autoamputation of the Breast in Invasive Ductal Carcinoma: A Case Report

Autoamputation is the spontaneous detachment from the body and elimination of an appendage or abnormal growth. Autoamputation of an organ due to malignancy has been reported in various organs, although its aetiopathogenesis has not been fully explained. Autoamputation of the breast is associated with late presentation and slow desmoplastic reaction in breast cancer. The patient was a 43- year- old Nigerian woman who presented with a one-year history of left breast mass diagnosed as triple negative invasive ductal carcinoma. She defaulted from hospital care but represented after autoamputation of the left breast. The case is reported to showcase the variations in the clinical course of breast cancers

Knowledge, Attitude and Practice of Breast Self Examination in Female Health Workers in Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria

Background: Breast cancer is the leading cause of cancer mortality in women worldwide. This study was designed to assess the knowledge, attitude and practice of breast self examination (BSE) among female health workers in Sagamu. Methods: Questionnaire was used to obtain information such as demographic characteristics, knowledge of breast cancer, attitudes towards BSE and questions relating to practices of BSE from female health workers. Statistical analysis was carried out using descriptive statistics and Chi Square method. Results: The medical doctors had more knowledge about breast cancer than the nurses and laboratory scientists. The medical doctors (81.8%), laboratory scientists (56.5%) and the nurses (41.4%) knew the correct timing and frequency for performance of BSE. The monthly practice of BSE was very low among the nurses (30%), while only 68.2% of the doctors and 78.3% of laboratory scientist admitted carrying out BSE monthly. The doctors (68.2%), nurses (35.7%) and laboratory scientist (30.4%) started BSE below the age of 19 years. Conclusion: The results indicate that the nurses had poor attitude towards BSE and this affected their practice of BSE though they had knowledge. The finding that some of the female health workers did not practice BSE, suggests that there is a need for continuing education programs to change attitude and behaviour towards BSE

An audit of Cancer in the Surgical Wards of a Tertiary Healthcare facility in a resource-limited setting

Background: In Africa, cancer is an emerging public health concern. In Sub-Saharan Africa, data on cancer epidemiology and survival which are necessary for the planning of treatment and control of cancers are scarce. Methods: A retrospective study of all patients who were admitted to the surgical wards in a Nigerian tertiary facility between January 2012 and December 2016 was done. The retrieved data included demographic features, presenting symptoms, mode of presentation, duration of illness, diagnosis, stage of disease, treatment modalities, treatment intention, compliance with treatment, survival, and current status. Result: The 279 patients studied comprised 81 (29.0%) males and 198 (71.0%) females. Cancer of the female breast was the leading malignancy occurring in 59% (165/279) patients; this was followed by colon cancer in19% (54/279) and prostate cancer in 10% (29/279). The commonest cancer among the females was breast cancer while prostate cancer was the commonest among the males. The stage of the disease was classified as early in 14.7% (41/279), locally advanced in 61.6% (172/279) and metastatic in 23.7% (66/279). Treatment goal was palliative for 57% (159/279) of the patients, curative in 26%while 13.6% (38/279) of the patients received no anti-cancer treatment. Ninety-six patients (34.5%) refused treatment or defaulted from treatment after the commencement of therapy. Although 53 (19%) patients died within the first month of admission, the overall mean duration of survival was 12.71 ± 13.0 months (range of 1- 84 months). Conclusion: Late presentation of patients, high treatment default rate, inappropriate management plan and overall poor survival were identified as daunting issues in cancer management in a resource-limited setting

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance.

Investment in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing in Africa over the past year has led to a major increase in the number of sequences that have been generated and used to track the pandemic on the continent, a number that now exceeds 100,000 genomes. Our results show an increase in the number of African countries that are able to sequence domestically and highlight that local sequencing enables faster turnaround times and more-regular routine surveillance. Despite limitations of low testing proportions, findings from this genomic surveillance study underscore the heterogeneous nature of the pandemic and illuminate the distinct dispersal dynamics of variants of concern-particularly Alpha, Beta, Delta, and Omicron-on the continent. Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve while the continent faces many emerging and reemerging infectious disease threats. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Outcome of Laparascopic Surgical Procedures in a Developing Country

Laparoscopic surgery has become the gold standard for some abdominal surgical conditions. The aim of the study is to demonstrate the feasibility of Laparoscopic surgical procedures in Queen Elizabeth II Hospital Maseru Lesotho. 26 adult patients had laparoscopic procedures under general anaesthesia using standard port entry with CO2 pneumoperitoneum. 10 patients (38.4%) had appendectomy, 9 patients (34.6%) had Cholecystectomy, 5 patients (19.2%) had diagnostic laparoscopy, 1 patient (3.8%) had right Orchidectomy, and 1 patient (3.8%) had Cholecystojejunostomy. Range of duration of surgery was 35minutes to186minutes with a mean of 69.5minutes.The duration of hospital stay was 1 to 21 days with mean of 3.9 days. One Cholecystectomy out of nine was converted to open procedure. One patient had diathermy bowel perforation during appendectomy. It is concluded that Laparoscopic procedures are feasible in developing countries provided the required equipments and expertise are available. The present results are not different from that obtained in the developed world. Key words: Laparoscopy, operation, developing country. Nigerian Medical Practitioner Vol.47(4) 2005: 51-5

Experience with Lichtenstein Hernioplasty in Sagamu

Background: Newer methods have evolved to address the major drawback of the traditional methods of hernia repair. These emphasize the use of prosthetic materials to strengthen the posterior wall of the inguinal canal without tension. Although Lichtenstein hernioplasty, like other newer methods, is associated with low recurrence rates, it is not commonly used in our clinical setting. Objective: To review the outcome of Lichtenstein hernioplasty using polypropylene mesh in a resource-poor setting. Methods: The hospital records of patients who had Lichtenstein hernioplasty between the year 2004 and 2013 in a six-bed private surgical clinic and who were followed up over a two- to ten-year period, were studied. Demographic data, clinical features, operative findings and outcome measures like post-operative complications and recurrence rates, were recorded. Results: There were 62 patients (with 69 hernias) of which 2 were females with the age range of 12-84years. 50 hernias (72.5%) were of the inguinoscrotal type, 39 patients (63.0%) had right inguinal hernias, 5 (7.2%) hernias were obstructed and 8 (11.2%) hernias were recurrent. Six (9.7%) had emergency surgery, 46 (74.2%) had surgery under local infiltrations and 15 (24.2%) had spinal anaesthesia. Scrotal oedema (4.3%), haematoma (1.4%), and hydrocoele (1.4%) were the early complications recorded. One recurrence of hernia occurred in a patient who had repair of twice recurrent hernia. The mean duration of follow-up in years was 5 (S.D 2.5) years. Conclusion: Lichtenstein repair of inguinal hernia was a safe and effective procedure in the private clinical setting

Acute appendicitis in Olabisi Onabanjo University Teaching Hospital Sagamu, a three year review

Background: Olabisi Onabanjo University Teaching Hospital is located in Sagamu, a suburban town with a population of 50,000 (1992 census). The hospital is a tertiary care facility in competition with a large number of private hospitals with different levels of competence. Objective: The objective of the study is to review the outcome of the surgical management of acute appendicitis in our hospital. Method: A retrospective study of subjects who had appendectomy for the clinical diagnosis of acute appendicitis between January 2002 and December 2004 was done. Result: 113 subjects consisting of 52 females (46%), and 61 males (54%) were studied. The mean age was 24.1 years, 71 subjects (62.9%) were in the 10-30 years range. 57.5% of the subjects were students and 71 subjects (62.8) resided in urban area. All the subjects, had generalized in 23.9%). The mean duration of symptoms was 3.53days with standard deviation of 3.69days. Only 3 subjects presented on the day of onset of symptoms. Only 15 subjects (13.3%) had surgery on the day of admission. 69subjects (61.1%) had uncomplicated inflamed appendix at surgery and 2subjects (1.8%) had clinically normal appendix. The mean duration of hospital stay was 10.6days with standard deviation of 7.4. The commonest postoperative complication was pyrexia in 16 subjects (14.2%), followed by wound infection in 12 subjects (10.6%). One subject died (0.9%). Conclusion: The outcome reflects the late presentation and delay in surgical treatment. Keywords: acute appendicitis, late presentation, hospital delay, outcome Nigerian Journal of Clinical Practice Vol. 9(1) 2006: 52-6

Pattern of Presentation and Management of Typhoid Intestinal Perforation in Sagamu, South-West Nigeria: a 15 year Study

Background: Mortality from typhoid intestinal perforation remains high in the West African sub-region. The aim of this retrospective analysis was to assess the presentation pattern, mode of therapy and outcome of cases diagnosed and treated as typhoid intestinal perforation at Olabisi Onabanjo University Teaching Hospital, Sagamu, between January 1990 and December 2004. Methods: Complete records of 105 adult patients were studied. Results: The male to female ratio was 2:1. The mean age was 27years. Prior to arrival in our hospital, all the patients were on various combinations of antibiotics. Twenty-seven (26%) patients had been hospitalized elsewhere during the current illness. Chloramphenicol was the drug of first choice in the first ten years (phase 1). It was replaced with ciprofloxacin in the subsequent five years (phase 2). Blood culture was positive for salmonella organisms in 5(4%) patients. Resistance to chloramphenicol was found in three (60%) out of these five positive cultures. All patients had laparotomy after resuscitation. There were 112 perforations, mostly in the ileum and jejunum. Perforations were single in one hundred and one patients and multiple in four patients. Single perforations were treated by two-layered closure, multiple perforations by primary resection and anastomosis. Fifty-five (52.4%) patients developed complications. Fourteen (13.3%) patients died. There was a slight drop in mortality (8.8 %) in phase 2. Deaths were due to septicaemia in 8(57%) patients. Conclusion: The pattern of presentation and outcome of management of typhoid intestinal perforation are similar to what is observed in other centres in our local environment. However the drop in mortality rate in the last 5 years of the study and the finding of strains of salmonella typhi resistant to chloramphenicol require further evaluation. Keywords: typhoid intestinal perforation, ciprofloxacin, chloramphenicol, operative management.Nigerian Journal of Medicine Vol. 17 (4) 2008: pp. 387-39