Oche MO, Ezenwoko AZ, Abulazeez U, Bello AM, Garba H, Shuaibu S

Background: Hypertension, also known as high blood pressure, which is a condition in which there is sustained elevation in the systemic arterial blood pressure. It is a major risk factor for chronic kidney disease, heart disease, stroke, and retinopathy and a major cause of mortality and morbidity globally. This study aimed to examine the prevalence, knowledge and risk factors of hypertension among traders in Sokoto Metropolis, Sokoto State, Nigeria. Methods: The study design is cross sectional comprising of 335 consented, adult traders plying their trade in Sokoto metropolis. Using a semi- structured questionnaire, participants were interviewed and data generated were analysed using IBM SPSS version 23.0 Armonk, NY: IBM Corp. for analysis. Results: The overall prevalence of hypertension was 23.6%; 83.3% were males while 13.7% were females. Hypertension was more prevalent among traders of 30-39 years (21.3%). Two hundred and ninety- eight respondents (89%) had good knowledge of hypertension and risk factors for hypertension observed included excess salt intake 190 (56.7%), smoking cigarettes 101 (30.1%) and alcohol consumption 55 (16.4%). Conclusion: Almost one quarter of the respondents had hypertension despite most of them having good knowledge of the illness. The increase in cases of hypertension across board underscores the need for concerted efforts aimed at mitigating the risk factors through creating awareness using the platform of market associations and other community-based organisations.

Key words: Hypertension, prevalence, knowledge, risk factors, traders

Kabir A, Usman M, Adamu IA, Bukar AZ, Chiroma EM, Abe MA

Background:  Cancers of the female genital tract are quite common worldwide and constitute a public health problem. They continue to exert a heavy toll on female population even though majority are preventable with currently effective preventive measures. We provide an update on the pattern of gynaecological malignancies and determine the changing trends of these cancers reported in our tertiary health institution. Methods: This is a retrospective, descriptive study of all histologically-diagnosed cases of female genital tract malignancies at the University of Maiduguri Teaching Hospital (UMTH), over a period of 10 years (2015- 2024). Records of diagnosed cases of gynaecological malignancies were retrieved from the Histopathology request forms and Cancer Registry. Demographic data, presenting complaints, tumour sites and histopathologic types were extracted. The results were analyzed using descriptive statistics. Results: The total number of cancers diagnosed during the period of study was 2809, out of which 1667 cases were from the female population, while 530 were cancers of female genital tract. Therefore, gynaecological malignancies constituted 18.9% of overall cancer cases and 31.7% of all female cancers. The age range for the female genital tract cancers was from 9 years to 85 years. The peak age group of occurrence of the malignancies was 41 – 50 years, while the lowest age group was 1 - 10 years; the mean age was 48.8 (+ 8.6). Cervical cancer was the most common malignancy of female genital tract accounting for 63.8 % of cases. Other gynaecological malignancies analyzed included cancers of uterine corpus (n=98; 18.5%), ovary (n=74; 14.0%), and vulvovaginal (n=20; 3.8%). The four most common presenting complaints were abnormal vaginal bleeding, abnormal vaginal discharge, lower abdominal pain and abdominal swelling. Conclusion: This study shows that cancers of the female genital tract represent a significant proportion of malignancies in the female population, especially those in their prime reproductive age. Cervical cancer is still the leading gynaecological malignancy despite being a preventable cancer. Therefore, concerted efforts are needed to reduce the burden of these malignancies. 

Keywords: Female genital tract, Cancers, Pattern, Frequency, Maiduguri, Nigeria

Osazee K, Ogwah CE

Background:  Preterm delivery is the birth of the foetus before 37 completed weeks of gestation. It can occur following spontaneous preterm labour or iatrogenic preterm delivery. Prematurity is a significant cause of perinatal morbidity and mortality with attendant enormous psychological and financial burdens on the patient, her family, the health system and society. Objectives: to review the prevalence of preterm delivery and the pattern of presentation in spontaneous preterm labour. Methods: It is a five-year descriptive retrospective study of parturients presenting with spontaneous preterm labour and preterm premature rupture of membranes who progressed to preterm delivery at the University of Benin Teaching Hospital, Benin City, South-South, Nigeria. The delivery register for the period was reviewed. Results: A Total of 1,391 (13.82%) of the total deliveries (10,087) occurred in the preterm period. Spontaneous preterm labour or preterm premature rupture of membranes accounted for 60.84% of the total preterm deliveries. Spontaneous preterm labour was more common among the unbooked and nulliparous women. The mean age at presentation was 31.5 years, and the mean gestational age at presentation was 31.7 weeks. At least one risk factor was found in about 85.5% of parturients who presented with spontaneous preterm labour. The most common risk factor identified was preterm premature rupture of membranes, followed by maternal infections and infestations. Other factors found among the parturients include multiple gestation, previous preterm delivery, antepartum haemorrhage, hypertensive diseases in pregnancy, uterine fibroid, cervical incompetence and polyhydramnios. Conclusion: Specific strategies to control modifiable risk factors will help reduce the burden of preterm delivery. 

Keywords: Preterm Delivery, Preterm Labour, Preterm Premature Rupture of Membranes

Mohammed A, Salahu D, Abdurrahman A, Adesope S, Atiku M, Ibrahim N, Ahmed AF, Abubakar Y

Background: Caudal block is often utilized for postoperative pain following paediatric surgical procedures including day-case herniotomy. It is, however, limited by the short duration of action of the one-shot caudal bupivacaine commonly utilized, thus necessitating the inclusion of an effective adjuvant for a prolonged action. Objective: This study compared the total duration of analgesia between caudal block with bupivacaine combined with dexmedetomidine and bupivacaine alone in paediatric day case inguinal herniotomy. Methods: Eighty male children between the age of 3 and 8 years scheduled for day case inguinal herniotomy were enlisted into this double-blind, prospective, randomised-controlled study. The children were randomised into Bupivacaine mixed with dexmedetomidine (BD) Group and Bupivacaine mixed with normal saline (B) Group. All patients had caudal block, after induction of anaesthesia, patients in B Group received 0.5ml/kg of 0.25% plain bupivacaine made up to 20ml with normal saline, while those in BD Group received 0.5ml/kg of 0.25% plain bupivacaine mixed with 1µg/kg of dexmedetomidine made up to 20ml with normal saline. Surgery commenced 15 minutes later and anaesthesia was maintained with halothane. Time to first analgesia request (at pain scores of above 4) and total analgesia consumption were documented. Results: The demographic characteristics of the groups were comparable. The time to first analgesic (TFA) request was 10.37 ± 0.97 hr in BD group and 4.62 ± 0.88 hr in B group (p<0.001). Five patients in B group received rescue fentanyl and none in BD group in the PACU. The mean total Paracetamol consumption was 9.41 ± 4.13 ml in BD group compared to 16.47 ± 4.72 ml in B group (p < 0.001). Conclusion: Dexmedetomidine (1µg/kg) in combination with caudal bupivacaine 0.25% prolongs the duration of analgesia and resulted in a reduction in analgesia consumption in day-case paediatric inguinal herniotomy. 

Keywords: Dexmedetomidine, bupivacaine, caudal block.

Sulaiman AT, Adewunmi OL, Nganjiwa US, Gali BM, Naaya HU

Background: Acute appendicitis is a common cause of acute abdominal emergencies. Tzanakis scoring system is a combination of clinical evaluation, ultrasonography and laboratory findings, used in the diagnosis of acute appendicitis. Objective: was to evaluate the probabilistic prediction of Tzanakis scoring system in the preoperative diagnosis of acute appendicitis and compare its accuracy with histopathological examination (HPE). Methods: A prospective observational study designed to analyze these patients who presented with clinical suspicion of acute appendicitis, admitted to accident and emergency unit of University of Maiduguri Teaching Hospital (UMTH) during the study period. After complete clinical examination, radiological and laboratory investigations Tzanakis score was calculated, and patients underwent appendectomy irrespective of the Tzanakis score and HPE results were analyzed. Results: Out of the 115 appendectomies performed during the study period, 110 were eligible for the study based on the inclusion criteria. The sensitivity and specificity of Tzanakis score was 70.8% and 71.4% respectively. The overall diagnostic accuracy was 70.9% with positive predictive value of 94.4% and negative predictive value of 26.3%. The negative appendectomy rate was 5.6%. Conclusions: Tzanakis scoring system is an effective diagnostic tool in the establishment of diagnosis of acute appendicitis, but the limitation is that the score involves the use of ultrasonography which is observer dependent and subsequently makes the score vary from one location to another. 

Keywords: Acute appendicitis, Sensitivity, Specificity, Tzanakis scoring system, Negative appendectomy

Ibrahim BA, Bukar MA, Wala SI, Farouk AG, Pius S, Talle MA

Keywords: Congenital heart disease, rheumatic heart disease, paediatric cardiology, global health, sub-Saharan Africa, health services research, health equity. 

Hassan AA, Mubi BM, Adamu AA, Dungus MM, Amali AO, Musa AH

Background: Adrenal dysfunction is common in human immunodefıciency virus (HIV) infection, but diagnosis is diffıcult due to the overlap of symptoms with advanced HIV disease. This study assessed the clinical and laboratory features of adrenal insuffıciency (AI) in newly diagnosed, treatment naive HIV patients in Maiduguri, Nigeria. Methods: This cross-sectional study enrolled 138 stable HIV-infected adults and 132 apparently healthy adults as controls. Adrenal function was evaluated using the 1-µg low-dose short synacthen test, with serum cortisol measured at baseline and at 30 and 60 minutes. Fasting plasma glucose, full blood count, erythrocyte sedimentation rate (ESR) and serum electrolytes were also measured. Using a locally derived reference cut-off from the apparently healthy controls in this study, AI was defıned as a peak cortisol of <504 nmol/L at 30 or 60 minutes and a cortisol increment of <124 nmol/L. Results: Weight loss (57.4%) and weakness (47.3%) were the most frequent symptoms among the HIV patients, with no signifıcant difference between patients with AI and those with normal adrenal function. Compared with healthy controls, HIV patients had signifıcantly lower fasting plasma glucose, serum sodium, bicarbonate, haemoglobin, body weight, and body mass index, while serum chloride and erythrocyte sedimentation rate were higher. However, no signifıcant differences in anthropometric or laboratory parameters were observed between HIV patients with and without AI. Conclusion: The lack of distinction in classical clinical features and common laboratory parameters between HIV patients with and without AI underscores the diffıculty in clinical differentiation. These fındings emphasized the critical need for biochemical confırmation of AI in HIV patients using diagnostic tests like the low-dose short synacthen test.

Keywords: Adrenal insufficiency, Human immunodefıciency virus, ACTH stimulation test, Weight loss, Weakness, Nigeria

Ekienabor OG, Eki-Udoko FE, Alimati AO

Background: Helicobacter pylori is the most common human bacterial infection, affecting approximately 50% of the world's population. Infection is typically acquired in childhood and persists into adulthood without treatment. H. pylori infection is associated with gastritis, peptic ulcer disease and gastric malignancies. Few studies have been conducted in resource-limited settings on H. pylori infection (HPI) in apparently healthy under-fives, where the burden of the infection is highest. Method: This cross-sectional-analytical-study was conducted at UBTH, Benin City, Nigeria, from November 2023 to May 2024. The study aimed to determine the prevalence and nutritional status of H. pylori in apparently healthy children aged 1-59 months using the monoclonal stool antigen test (SAT). Result: A total of 252 apparently-healthy-children were recruited for the study. Nutritional status was determined using weight-for-age, weight-for-height, length/height-for-age, and BMI for age z-scores based on the 2006 WHO growth standards. The DiaSpot® H. pylori Antigen Rapid Test Cassette was used to test for the presence of H. pylori antigens in stool samples. The prevalence of HPI was 26.6%. H. pylori infection was significantly associated with over-nutrition with a higher than normal BAZ score being an independent predictor of H. pylori positivity. Conclusion: the high prevalence of HPI in apparently healthy children suggests that screening for the infection may be beneficial. Early identification and follow-up for those who test positive could prevent the development of long-term complications. The study highlights the need for further research into the relationship between over-nutrition and HPI in children.

Keywords: Helicobacter pylori, Nutritional status, Apparently healthy children, Tertiary hospital

Ibrahim HA, Nkama IP, Yakubu YM, Mustapha MG, Garba MA

Keywords: Measles, immunoglobulin G, protective antibodies, vaccination, under-5 children. 

Mbaya KM, Kwari AI, Kura ZM, Sabo MJ, Abdullahi SA, Ibrahim AG, Tahir C, Ishaku GA, Habib AM, Watila N 

Background: Burn injuries remain a major cause of morbidity and mortality, particularly in low- and middle-income countries where preventive measures and access to specialized care are limited. Objective: To evaluate the pattern of burn injuries and management outcomes at the University of Maiduguri Teaching Hospital, focusing on causes, severity, treatment modalities, and outcome determinants. Methods: This retrospective study reviewed cases of burn patients managed at the Burns Centre of the University of Maiduguri Teaching Hospital, Northeastern Nigeria, from January 2022 to December 2025. Data was obtained from patient records and analyzed using SPSS version 25. Management included resuscitation, wound debridement, and supportive care, with selected cases undergoing early excision and skin grafting. Wound care involved open or closed dressing techniques, supported by antibiotics, nutritional therapy, physiotherapy, and microbiological assessment. Results: A total of 373 patients were studied, with males accounting for 57.1%. Children aged 1-10 years constituted 73.5% of cases. Scald injuries were most common, followed by flame burns, with predominantly second-degree or mixed-depth injuries. Mean total body surface area (TBSA) involved was higher among non-survivors (38.49 ± 18.64%) than survivors (13.87 ± 9.14%). Inhalation injury and flame burns were significant predictors of mortality (p < 0.001). Most patients (70%) healed with conservative management, while 21% required split-thickness skin grafting. Conclusion: Burn injuries predominantly affect children. Injury severity, especially TBSA and inhalation injury, strongly influenced outcomes. Early presentation, and access to specialized care are essential to reduce morbidity and mortality associated with burns.

Keywords: Burn injury, total body surface area (TBSA), internally displaced persons (IDP), Burn outcomes

Osazee K, Anyanwu CE, Anya CJ, Eruwha ME

Background: The introduction of intracytoplasmic sperm injection (ICSI) has brought hope to cases of severe male factor infertility. Despite widely reported success rates with ICSI, studies have shown that poor semen quality is associated with a reduced blastocyst formation rate, which may impair embryogenesis and lead to implantation failure. Methods: This was a cohort study of all couples undergoing ICSI at our Centre from 1 January 2024 to 31 December 2025. Couples were classified into three groups based on the WHO 2010 semen criteria. Group 1 (Grade 1 semen; normal parameters); group 2 (Grade 2 semen; mild OAT syndrome) with sperm concentration < 20×10^6/ml, motility < 50%, and morphology < 30% normal forms; and group 3 (Grade 3 semen; severe OAT syndrome) with sperm concentration < 1×10^6/ml, motility < 25%, and morphology < 10%. Oocyte retrieval was performed after standard ovarian stimulation using a short protocol. ICSI was used to inseminate the retrieved oocytes, and fertilization was confirmed 16-20 hours post-ICSI by the presence of pronuclei. Embryo cleavage was assessed 42-49 hours post-ICSI and graded based on shape, size, and degree of fragmentation. Embryo transfers were performed on days 3 to 5. Data are presented as mean + standard error of the mean (SEM). Comparisons among the groups were performed using ANOVA for numerical parameters and the chi-square test for categorical variables. Data analysis was conducted using SPSS 11, with significance set at p<0.05. Results: A total of 65 couples were enrolled. Grade 1 semen accounted for 3.6% of samples, while the majority (96.4%) were grade 2, with no grade 3 cases. Although grade 1 semen exhibited a higher mean number of fertilized oocytes (71.0) than grade 2 semen (67.3), this difference was not statistically significant (p=0.794). There was no significant difference in the mean cleavage rate between the semen groups; however, grade 1 had a higher mean cleavage rate (75%) than grade 2 (46.2%). Grade 1 semen demonstrated a higher mean blastocyst formation rate (75.0%) than grade 2 (47.4%). Conclusion: The use of ICSI for male infertility is associated with high fertilization rates but lower cleavage and blastocyst rates. This may affect embryo quality, potentially leading to implantation failure. Therefore, we recommend that infertile males undergo thorough investigation and receive appropriate treatment to improve sperm quality before IVF.   

Keywords: Intracytoplasmic Sperm Injection (ICSI), Embryo, Sperm quality, Fertilization

Dekah IP, Popoola AM, Yakubu YH, Idris ME

Background: Misoprostol-induced shivering is a common and distressing adverse effect among women undergoing caesarean section under spinal anaesthesia. Although both tramadol and nefopam have been used for shivering prevention, evidence comparing their effectiveness in obstetric patients receiving misoprostol remains limited. Methods: This randomized double-blind controlled trial enrolled 100 parturients undergoing elective caesarean section under spinal anaesthesia. Participants were randomly assigned to receive either intravenous tramadol 1 mg/kg (Group T, n=50) or intravenous nefopam 0.15 mg/kg (Group N, n=50) following administration of misoprostol. The primary outcome was the incidence of shivering. Secondary outcomes included shivering severity, time to onset of shivering, haemodynamic parameters, adverse effects, and rescue therapy requirements. Results: Baseline demographic and perioperative characteristics were comparable between groups. Shivering occurred in 20 patients (40%) in the tramadol group and 10 patients (20%) in the nefopam group (p=0.028). Moderate-to-severe shivering was significantly less frequent among patients receiving nefopam (p=0.041). The mean time to onset of shivering was significantly longer in the nefopam group (26.4 ± 6.1 minutes) than in the tramadol group (18.6 ± 5.2 minutes; p<0.001). Nausea occurred more frequently with tramadol (28% vs 12%; p=0.041), whereas tachycardia was more common with nefopam (24% vs 6%; p=0.012). Rescue therapy was required less frequently in the nefopam group (4% vs 16%; p=0.046). Conclusion: Intravenous nefopam was more effective than tramadol in preventing misoprostol-induced shivering during caesarean section under spinal anaesthesia. Nefopam reduced shivering incidence and severity, delayed symptom onset, and decreased rescue therapy requirements while maintaining acceptable haemodynamic stability.

Keywords: Nefopam, Tramadol, Misoprostol, Shivering, Caesarean section. 

Halilu AD, Dalhatu AMC, Musami UB, Yakubu AI, Abubakar RM, Sunkani MK, Muhammad BM, Ezenwagu-Onedi CA, Elechi HA, Watila WA

Background: Psychiatric morbidity, particularly anxiety and depressive disorders, is common among caregivers of children living with chronic illnesses such as sickle cell disease (SCD). Early identification of psychological distress in caregivers is essential to improve overall caregiving outcomes and psychosocial functioning. The Hospital Anxiety and Depression Scale (HADS) is a widely used screening instrument for anxiety and depression; however, validation against structured diagnostic tools within Nigerian populations remains limited. Objective: This study aimed to assess the psychometric properties of the Hospital Anxiety and Depression Scale-Anxiety (HADS-A) and Hospital Anxiety and Depression Scale-Depression (HADS-D) against the anxiety and depressive modules of the Composite International Diagnostic Interview (CIDI) among caregivers of children living with SCD. Methods: A hospital-based cross-sectional validation study was conducted among 193 informal caregivers of children with SCD attending the paediatric sickle cell clinic at State Specialist Hospital Maiduguri, Nigeria. Participants were recruited using systematic random sampling. Data collection tools included a sociodemographic questionnaire, HADS-A, HADS-D, and the anxiety and depression modules of the CIDI. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 25. Descriptive statistics summarized participant characteristics. Reliability was assessed using Cronbach's alpha. Validity was evaluated through sensitivity, specificity, predictive values, contingency analyses, and receiver operating characteristic (ROC) curves. Results: The prevalence of anxiety and depression using CIDI was 59.1% and 62.5%, respectively, while HADS identified anxiety in 63.2% and depression in 66.9% of participants. Internal consistency was satisfactory for HADS (Cronbach's alpha = 0.852), CIDI depression (0.981), and CIDI anxiety (0.891). HADS-A demonstrated optimal diagnostic performance at a cut-off score of ≥8 with sensitivity of 91%, specificity of 96%, positive predictive value of 97%, and area under the curve (AUC) of 0.982. HADS-D showed optimal performance at a cut-off score of ≥9 with sensitivity of 93%, specificity of 97%, positive predictive value of 94%, and AUC of 0.915. Conclusion: The findings indicate that HADS-A and HADS-D demonstrate strong psychometric properties when compared with CIDI diagnostic modules among caregivers of children with SCD. HADS-A at a cut-off score of ≥8 and HADS-D at a cut-off score of ≥9 may be useful screening thresholds for identifying anxiety and depressive disorders in this population. 

Keywords: Anxiety, Depression, Caregivers, Sickle Cell Disease, Hospital Anxiety and Depression Scale, Composite International Diagnostic Interview 

Muhammad AS, Lawal AM, Ibrahim HI 

Keywords: pelvic organ prolapse, young, primipara, Manchester repair. 

Monguno HFK, Damina DI, Yusuf HM, Jelani NI, Ibrahim BA

Background: Venous thromboembolism (VTE) is uncommon in the general paediatric population but is associated with significant morbidity. Although central venous catheters, malignancy, and trauma are well-established risk factors, hypoalbuminaemia is increasingly recognised as a potential prothrombotic condition that is often overlooked. Case Summary: We report the case of an 8-year-old girl who presented with a three-month history of recurrent fever, progressive generalised oedema, and recent weight loss. Her clinical condition initially manifested as anasarca and later progressed to painful localised swelling of the left lower limb. Doppler ultrasonography demonstrated an extensive thrombus extending from the internal iliac vein to the posterior tibial veins. A comprehensive diagnostic evaluation excluded common causes of paediatric thrombosis including nephrotic syndrome, malignancy, inherited thrombophilia, and infection. The only significant abnormality was profound hypoalbuminaemia (2.2 g/dL; reference: 3.5–5.0 g/dL). The patient was treated with low-molecular-weight heparin (LMWH) bridged to warfarin, in addition to nutritional rehabilitation. She showed progressive clinical improvement with complete clinical resolution by discharge. Conclusion: This case highlights the importance of considering hypoalbuminaemia as a potential provoking factor for paediatric VTE when common causes have been excluded. It underscores the possible pathophysiological link between low albumin levels and hypercoagulability. 

Keywords: Deep vein thrombosis, hypoalbuminaemia, venous thromboembolism, anticoagulation.

Nganjiwa US, Sulaiman AT, Tizhe L, Gali BM, Tarfa H, Nganjiwa HU

Background: Amyand's hernia (AH) is the presence of a vermiform appendix (inflamed or not inflamed) in the inguinal hernia sac. It is a rare condition, commonly seen in males, and very difficult to clinically diagnose preoperatively. Clinically, it may be asymptomatic or present with complications of either the hernia, the appendix or both. Imaging may be a valuable tool, and management depends on the patient's presentation. We report a case of type II AH in a 28-year-old male who presented with a right irreducible indirect inguinal hernia, with an operative finding of an inflamed appendix in the sac. The patient had both an appendectomy and an open right herniorrhaphy. We discussed the rarity of AH, the difficulty in pre-operative diagnosis, a literature review on sensitization, and various treatment options available. 

Keywords: Amyand's Hernia, Vermiform Appendix, Appendectomy, Herniorrhaphy, Rare

Dathini H, John E, Inna A K, Kever R T, Haba H, Lola N, Joseph-Shehu EM

Background: Ventilator-associated pneumonia (VAP) is the most common hospital-acquired pneumonia that develops within days of patient intubation in the critical care unit. Evidence has demonstrated that implementing the VAP care bundle is effective in preventing this condition. Objective: This review aims to determine intensive care nurses' knowledge, compliance, and barriers to implementing Ventilator-Associated Pneumonia (VAP) care bundles. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guided this systematic review. Three online databases (PubMed, Web of Science, and EMBASE) were searched for relevant articles, alongside a grey literature search. A total of 11 articles meeting the inclusion criteria were included in the study. Articles providing adequate information for meta-analysis were analyzed using Comprehensive Meta-Analysis software version three. Result: The study results revealed that intensive care nurses' knowledge of the VAP care bundle was 0.516 or 51.6% (CI: 0.357-0.671), indicating an average knowledge level. Regarding nurses' compliance with the VAP bundle, a statistically significant (p-value 0.022) high compliance level of 66.7% or 0.667 (CI: 0.525-0.784) was observed. Identified barriers to implementing the VAP bundle included inadequate knowledge, insufficient equipment, and absence of protocols or guidelines for VAP care bundle implementation. Conclusion: The study therefore concludes that intensive care nurses require training on VAP care bundle implementation. Furthermore, hospital managers should ensure adequate availability of equipment and guidelines to support effective practice. 

Keywords: Ventilator-associated Pneumonia; Knowledge; Compliance; Barriers; Intensive care nurses

Suleiman IE, Tsauni IJ, Garzali IU

Background: Retained foreign bodies after abdominal surgery, termed gossypiboma. The clinical presentation varies from asymptomatic cases to severe complications such as obstruction, abscess, or fistula formation. Case Summary: A 27-year-old Para 3+0, presented with one year history of lower abdominal pain, colicky, intermittent, mainly affecting the left lower quadrant. There was associated history of alternating constipation with diarrhea, tenesmus, and progressive weight loss. She also reported foul smelling vaginal discharge and fever. She had undergone caesarean section for ruptured uterus two weeks prior to symptom onset. On examination, she was cachectic and weak but afebrile. Vaginal and rectal examinations revealed a fistula at the posterior fornix and a mass located anteriorly respectively. Abdominopelvic CT scan revealed thickening of the rectal wall and dilated bowel loops. Examination under anesthesia, revealed sponge like material, which was extracted per anus and identified as an abdominal mop. Our case highlights the diagnostic challenge of gossypiboma and its potential to mimic malignancy. It highlights the importance of maintaining a high index of suspicion of gossypiboma in patient with abdominal symptoms especially if patients had abdominal surgery in the past. 

Keywords: Gossypiboma, abdominal pain, vaginal discharge