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   2011| July-September  | Volume 18 | Issue 3  
    Online since November 25, 2015

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The Challenges and Solutions of Laparoscopic Surgical practice in the developing Countries
OO Afuwape, OO Akute
July-September 2011, 18(3):197-199
Laparoscopic surgery has become the preferred standard in developed countries. New procedures in laparoscopic surgery are continually being developed. Despite these innovations Nigeria and many other African are yet to fully embrace this surgical approach. Few therapeutic laparoscopic surgery procedures are performed annually in Nigerian teaching hospitals. Appropriate personnel and the initial high cost of acquiring state of the art equipments are some of the challenges in laparoscopic surgery in developing countries. A few centres have developed ways of solving these challenges. We discuss the envisaged problems with laparoscopic surgery in Nigeria and some other African countries and suggest solutions to these problems.
[ABSTRACT]   Full text not available  [PDF]
  1,019 144 -
Management of Mass Casualty: A Review
A. R. K. Adesunkanmi, AO Lawal
July-September 2011, 18(3):210-216
Aims and objectives: The aim of this article is to discuss the management of mass casualty and sensitise authorities at various levels and trauma surgeons the need for awareness and training in the management of mass casualty. Materials and methods: Thorough Medline and bibliography search and available local literatures relevant to the management of mass casualty was reviewed. The available articles were reviewed in order to decipher the management pattern in various forms and degree of disasters resulting in mass casualty. Results: Little attention was paid to mass casualty management in civilian population until mid nineties, even, in developed countries. Knowledge in this area has expanded in the last 10 years due to terrorist attacks in the United State America. In developing countries, nothing is known to be on the ground in form of planning for appropriate response to mass casualty. Conclusion: Mass casualty usually associated with straining of existing facilities, and with high morbidity and mortality. Pre-incident and adequate training is necessary to reduce morbidity and mortality from major incident which occurrence is often not predictable.
[ABSTRACT]   Full text not available  [PDF]
  1,021 120 -
An Audit of Mandibular defect Reconstruction Methods in a Nigerian Tertiary Hospital
JT Arotiba, OS Obimakinde, SO Ogunlade, AO Fasola, VN Okoje, VI Akinmoladun, PT Sotunmbi, EA Obiechina
July-September 2011, 18(3):172-176
Aims and Objectives : To audit methods of mandibular defect reconstruction used in our institution. Materials and methods : A retrospective study of mandibular bone reconstruction at the University College Hospital Ibadan between January 2001 and December 2007. Relevant records were retrieved from patients' case notes and operation register. Comparative analysis of various methods of reconstruction was done by assessing treatment outcomes such as restoration of continuity and stability, graft infection, extrusion and fractures. Results: Only 65 of the 82 patients that had mandibular continuity defect during the study period had reconstruction. Ameloblastoma accounted for 67% [n=55] of pathologies that required mandibular resection. Methods of reconstruction included non vascularised iliac bone anchored with either stainless steel wire (NVIBw) [n=38] or titanium plate (NVIBp) [n=9], titanium reconstruction plate [n=4] Steinman pin [n=12], rib graft [1] and acrylic plate temporisation [n=1]. The findings showed that titanium plate and NVIBp had the least complications in terms of infection, graft extrusion, fracture and wound dehiscence. NVIBw and Steinman pin had the highest infection rates. Conclusion : We recommend the use of NVIBp and titanium reconstruction plate as they have the least complication rate. We also advocate future prospective study.
[ABSTRACT]   Full text not available  [PDF]
  979 143 -
Comparison of Maternal and Neonatal Outcomes following Caesarean section in Second Versus First stage of Labour in a Tertiary Hospital in Nigeria
KA Rabiu, AA Adewunmi, OI Akinola, AE Eti, AO Tayo
July-September 2011, 18(3):165-171
Aims and Objectives: To compare maternal and neonatal outcomes between caesarean section performed in the first and second stages of labour at the maternity unit of the Lagos State University Teaching Hospital, Lagos, Nigeria. Materials and methods : Patients hospital records from 1st January 2008 to 31st December 2009 were examined. Data were extracted using a structured proforma. Information on demographics, intrapartum and intraoperative characteristics as well as selected maternal and neonatal outcomes were obtained. Comparative analysis was done using the student t test for continuous variables and the chi- square with Yates correction or the Fisher exact test for categorical variables. Results: Of the 347 caesarean deliveries available for analysis, 245 (70.6%) were performed in the first stage while 102 (29.4%) were performed in the second stage of labour. Women who had caesarean deliveries performed in the second stage were more likely to be referred rather than institutional patients (p< 0.001), to have longer operative time, higher blood loss, more cases of intraoperative trauma, primary post partum haemorrhage, blood transfusion, re-look laparotomy, hysterectomy, post op pyrexia, wound infection and longer hospital stay (all with p value <0.05). Infants born to women who had caesarean section in the second stage of labour, had higher incidence of birth asphyxia, admission to neonatal intensive care unit, sepsis, seizure, need for ventilation and neonatal death (all with p value <0.05). Conclusion: Caesarean section in the second stage of labour is associated with significantly increased maternal and neonatal morbidity as well as increased neonatal mortality.
[ABSTRACT]   Full text not available  [PDF]
  1,003 112 -
Open Heart Surgery: Preliminary Report of Blood Transfusion Practice and Haematological Changes. Experience from a Nigerian Tertiary Teaching Hospital
AO Dosunmu, AA Akinbami, OO Oshinaike, A Adediran, TA Adeyemo, AS Akanmu
July-September 2011, 18(3):177-181
Aims and Objectives: The study aimed at reviewing the utilisation of blood / blood products and haematological profile changes, with a view to developing a hospital transfusion guideline in open heart surgery in Nigeria. Materials and Methods: The surgeries were performed at the intensive care unit theatre of Lagos State University Teaching Hospital. Eligibility for surgery was determined by the Cardiologist and the cardiovascular Surgeon based on clinical presentation, electro- and echocardiography assessments among other tests. Fourteen open-heart surgeries were conducted. Blood products demand for different procedures and several peri-operative laboratory parameters such as full blood count, and coagulation profile were determined. Results: The greatest demand for blood products was found in valvular surgery and atrial septal defect (ASD) where a mean of four units of red cell concentrate, fresh frozen plasma and cryoprecipitate were transfused. Other surgeries such as, patent ductus arteriosus, Tetralogy of Fallot did not require much transfusion of blood products. Overall, the pre-operative and post-operative haematocrit, white cell count, platelet count, and international normalized ratio (INR) mean were 37% /25%,4.9 X 10 9/L / 11.4 X 10 9/L, 182 X 10 9/L/ 97 X 10 9/L, and 1.15/ 2.2 respectively. Conclusion: It appears that transfusion requirement in most open heart surgeries aside from valvular surgery and atrial septal defect (ASD) repair, is minimal. Patients for valvular heart surgeries and ASD repair should be evaluated for possible autologous blood transfusion.
[ABSTRACT]   Full text not available  [PDF]
  1,000 93 -
The Effect of Palm Wine on Lipid Peroxidation and Antioxidant status of Rural dwellers in South West Nigeria
PS Ogunro, PO Ologunagba
July-September 2011, 18(3):186-190
Aims and Objectives: To evaluate the levels/activities of antioxidants and lipid peroxidation in the blood of subjects that consumed palm wine on regular bases. Subjects and Methods: Sixty-four male volunteers between the ages of 30-70years were recruited for the study. The subjects were those that visited palm wine vendor outlet on regular basis at least for a minimum duration of 5 years, with daily intake of 80-160 gm of palm wine at a sitting for a minimum of 3 to 4 days per week. Plasma activities of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma-glutamyltransferase (γ-GT); plasma concentration of total antioxidant status (TAS), Malonyldialdehyde ((MDA), selenium (Se) and erythrocyte glutathione peroxidase (GSH-Px) activity were determined. Results: The plasma activity of γ-GT and marker of lipid peroxidation (MDA) were significantly increased in subjects compared to the controls p<0.01. However, the erythrocyte scavenging antioxidant activity of GSH-Px and plasma Se for the subjects were significantly reduced compared to the controls p<0.05. Positive correlation was observed between MDA/ level of palm wine consumption (r= + 0.471, p<0.01), AST/ level of palm wine consumption (r= + 0.263, p<0.05) and γ- GT/level of palm wine consumption (r= + 0.518, p< 0.001) for the subjects. However, a negative correlation was obtained between GSH-Px/level of palm wine consumption (r= - 0.364, p<0.05) and selenium/ level of palm wine consumption (r=- 0.375, p<0.05) for the subjects. Conclusion: Reduced plasma Se and erythrocytes GSH-Px activity with increased plasma MDA in this study revealed that palm wine consumption may deplete the body's antioxidants against free radical attacks and render the body in a state of oxidative stress.
[ABSTRACT]   Full text not available  [PDF]
  977 106 -
Subarachnoid Bupivacaine and Pethidine for Caesarean Section: Assessment of Quality of Perioperative Analgesia and Side Effects
CO Imarengiaye, FD Asudo, DD Akpoduado, II Akhideno, CE Omoifo, AT Ogunsakin
July-September 2011, 18(3):200-204
Aims and Objectives : This study determined the quality of perioperative analgesia and side effect profile of spinal bupivacaine plus pethidine for caesarean section. Patients and Methods: Patients were randomised to receive 2.0mL of bupivacaine + pethidine 7.5mg or 2.0mL bupivacaine + saline of equal volume. Spinal anaesthesia was instituted at L2/3, L3/4 or L4/5 using a 25G pencil point spinal needle. Heart rate, blood pressure and oxygen saturation were monitored. Timelines such as time of injection of study medication, skin incision, delivery time, termination of surgery and time to first request for analgesia as well as complications were noted. Demographic characteristics were also recorded. Results: 50 patients were studied in 2 groups and the demographic characteristics were similar. Addition of pethidine resulted in block height greater than T6 and longer duration of analgesia (256.9 ΁ 112.2 min.) compared with the saline group (160.5 ΁ 65.0 min; p = 0.0005). Maternal hypotension occurred more in the pethidine group (10/25 vs 2/25; p = 0.01). Peritoneal irritation and inadequate anaesthesia were more frequent in the saline group. Nausea and vomiting and drowsiness were mild and occurred only in the pethidine group. In the Post Anaesthetic Care Unit (PACU), more patients reported pain in the saline group (p = 0.002). Conclusion: Bupivacaine with pethidine 7.5mg resulted in better quality of anaesthesia, longer postoperative analgesia with acceptable side effect profile. This will be of value in the management of post-caesarean section pain particularly in the resource poor setting.
[ABSTRACT]   Full text not available  [PDF]
  951 121 -
Porocephalosis due to encysted Armillifer nymph presenting as an Acute Abdominal Emergency: Case Report and Review of Literature
PO Ibinaiye, MM Dauda, KL Damisa
July-September 2011, 18(3):217-219
A rare case of porocephalosis infection presenting with an acute abdominal emergency in a 60 year old Nigerian is presented. The characteristic radiologic appearance of Armillifer nymph is described, and clinical findings which may be caused by this parasite are reviewed. A brief review of the epidemiology of porocephalosis is also included.
[ABSTRACT]   Full text not available  [PDF]
  974 97 -
Examination Malpractice in our Medical Schools: Prevalence and Import on Tomorrow's Doctors
A. O. A. Aderounmu, PB Olaitan, IK Kolawole, MD Dairo, KS Oluwadiya, LI Okeke, AA Salako
July-September 2011, 18(3):191-196
Aims and objectives . The objective of this paper is to estimate the prevalence of examination malpractice among medical students; its import on medical education and future doctors. Materials and methods: Structured questionaires were administered to consenting medical students of participating four medical colleges in Nigeria. Data was collated and analysed using SPSS version 11. Results: Three hundred and eighty two students responded. There were 210 males and 172 females (M: F-1.2:1); age range 19-45 years, mean 24.86±SD. Majority 304(79.6%) were in the 5th and final years. At secondary and tertiary levels, 67(18.1%) and 79(22.2%) were respectively involved in cheating. Mode of cheating included seeking examination materials, 10(2.6%); copying answers between examination rooms, 18(4.8%); copying assignments, 290(77.7%) and copying laboratory results 206(56.6%). Clinical examinations not performed were described as "normal" by 206(56.6%). Motivation for cheating included previous failures and escape punishment in 6(3.3%) and 31(10.4%) respectively. While 46(12.8%) tried to induce lecturers to change grades, 97(25.8%) would not inform the authority if they suspected that examination leaked. Conclusion: Examination malpractice in High schools and Tertiary institutions also includes the medical students. Educating pupils from the elementary schools on effects of cheating, inclusion of this practice in the medical curriculum as part of Medical Ethics and Institutional culture of Integrity among doctors are recommended. Stiffer punishment for offenders would reduce the practice among the students.
[ABSTRACT]   Full text not available  [PDF]
  931 103 -
Short Hospital Stay after Appendicectomy
A. R. K. Adesunkanmi, TA Badmus, U Onakpoya
July-September 2011, 18(3):182-185
Aims and objectives: To determine the applicability of short hospital stay after appendicectomy in rural and semi-urban Nigerian community. Patients and methods : A 30-month prospective study on patients with uncomplicated acute appendicitis was carried out age ranged from 5-70years, mean of 28.7years, there was almost even sex distribution between male and female. All the patients presented with clinical evidences of acute appendicitis. Results: The operative findings were inflamed and oedematous appendix in about %, minimal exudates drained in only about 25% of the patients. Postoperative wound complications occurred in 1.3-5% of patients. All the postoperative complications were successfully managed in the outpatient clinic. 71.8% were discharged on the 2nd postoperative day, 20.5% on 3rd postoperative day, 4 (5%) on 4th postoperative day and 1(1.3%) each on 5th and 7th day. There was postoperative pain tolerance and late mobilisation in those who stayed for 3-4 days; moderately severe wound infection was responsible for those who stayed for 5th- 7th day. Conclusion: Short hospital stay after appendicectomy was possible in majority of patients with uncomplicated acute appendicitis. Minimal postoperative fluid therapy and antibiotic administration was adequate in well-selected cases.
[ABSTRACT]   Full text not available  [PDF]
  925 101 -