vol19no2

AtwoliL,¹ErhaborGE,²GbakimaAA,³HaileamlakA,⁴NtumbaJ-M K,⁵KigeraJ,⁶Laybourn-Langton L,⁷Mash B,⁸Mohia J.⁹MulaudziFM,¹⁰Ofori-AdjeiD,¹¹OkonofuaF,¹²RashidianA,¹³El-Adawy M,¹⁴SidibéS,¹⁵Snouber A,¹⁶TumwineJ,¹⁷YassienMS,¹⁸YongaP,¹⁹ZakhamaL,²⁰ZielinskiC.²¹

1. Editor-in-Chief,East African Medical Journal.

2. Editor-in-Chief,West African Journal of Medicine.

3. Editor-in-Chief,Sierra Leone Journal of Biomedical Research.

4. Editor-in-Chief,Ethiopian Journal of Health Sciences.

5. Chief Editor,Annales Africaines de Medecine.

6. Editor-in-Chief,Annals of AfricanSurgery.

7. University of Exeter.

8. Editor-in-Chief,African Journal of Primary Health Care & Family Medicine.

9. London School of Medicine and Tropical Hygiene.

10. Editor-in-Chief,Curationis.

11. Editor-in-Chief,Ghana Medical Journal.

12. Editor-in-Chief,AfricanJournal of Reproductive Health.

13. Executive Editor,Eastern Mediterranean Health Journal.

14. Director of Health Promotion,Eastern Mediterranean Health Journal.

15. Director of Publication,Mali Médical.

16. Managing Editor,Journal de la Faculté de Médecined’Oran.

17. Editor-in-Chief,African Health Sciences.

18. Editor-in-Chief,Evidence-Based Nursing Research.

19. ManagingEditor,East African Medical Journal.

20. Editor-in-Chief,La Tunisie Médicale.

21. University of Winchester.

Mikhail A, Salahu D, Atiku M, Adesope S,Abdurrahman A, Abdullahi MM

Background:Endotracheal intubation usually aided by the muscle relaxant suxamethonium can elicit responses and changes which are hazardous in some patients including children; suxamethonium is also contraindicated in some patients. Fentanyl, a short-acting opioid maybe a suitable alternative with varying results.

Objective: This study compares the changes associated with the facilitation of endotracheal intubation with either the commonly used suxamethonium or fentanyl.

Methods: Eighty two American Society of Anaesthesiologist (ASA) physical status classification I and II patients aged between 3 and 12 years scheduled for surgeries requiring general anaesthesia with endotracheal intubation received either 3 μg/kg fentanyl (group F) or 1.5 mg/kg suxamethonium (group S)following induction of anaesthesia with propofol. Haemodynamic parameters: pulse rate (PR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were assessed post-intubation at 1, 3, 5 and 10 minutes respectively. The incidence of side effects and post-intubation upper airway events were also observed.

Results:Patients in group S experienced a significant increase in HR when compared to baseline values (p=0.0001). The SBP and DBP were significantly lower than baseline values in patients in group F (p<0.023). MAP increased in group S and declined in group F at all study timings. However, the post-intubation MAP was significantly lower than the baseline only at the 5th minute (p=0.026). There were no records of postoperative upper airway injuries, hypotension, bradycardia, desaturation, masseter spasm and malignant hyperthermia in the two study groups.

Conclusion: Propofol-Fentanyl produced more stable parameters compared to propofol-suxamethonium. No significant difference in terms of side effects between Propofol-Fentanyl and propofol-suxamethonium.

Key words: Fentanyl, Suxamethonium, Propofol, Facilitation, Endotracheal intubation

Background: Laparoscopic surgical services are well established in most hospitals in developed countries but not in developing countries like Nigeria. Moreover, the scope of healthcare financing like the health insurance scheme in Nigeria has not expanded to accommodate laparoscopy. Basic surgeries like appendicectomy, cholecystectomy and advanced surgery like hemicolectomy form common surgical procedures now performed via laparoscopy in Nigeria. Objective: To share our experiences with laparoscopic general surgical operations performed in a private hospital in Abuja, Nigeria.

Methods: Retrospective study of 119 patients who had laparoscopic general surgeries over 5 years period at a private hospital in Abuja, Nigeria, from January 2017 to December 2021. The variables analysed were patients’ demographic data, diagnosis, type and duration of operations and outcome.

Results: One hundred and nineteen patients had laparoscopic surgery over the period. Of these, majority were females 71 [59.7%] and males 48 [40.3%] giving M:F of 1:1.5. The age range of patients was 12 to 81 years and the mean age was 43.4 years ± 14.0. A higher proportion of the patients [58%, n=69], were aged 40 years and above. The commonest procedures done were laparoscopic cholecystectomies [49.6%, n=59], followed by appendicectomies [21.0%, n=25]. Seven [5.9%] patients had laparoscopic adhesiolysis and drainage of liver cysts each, laparoscopic fundoplication 5 [4.2%] and left hemicolectomy 3 [2.5%]. The commonest postoperative complication was surgical port site infection 4 [3.4%].

Conclusion: The scope of laparoscopic general surgeries provided in a private hospital in Abuja, Nigeria is broad and safe. The outcomes are comparable to those from other centres in the region.

Keywords: General surgery, laparoscopy, Private Hospital, Abuja

Oyediji FJ,Mpyet CD

Background: With multiple medical specialities and subspecialties, the choice of a lifelong speciality can be a daunting task. Most medical students commence undergraduate training without complete knowledge of all the medical specialities available. Considering that various factors affect the choice of a speciality, practice
location and productivity, this study sought to assess ophthalmologists’ job satisfaction, remuneration and scope of practice.

Methods: A semi-structured, pre-tested self-administered questionnaire was distributed to 140 consenting Ophthalmologists and ophthalmic Residents that attended the 2016 Annual Scientific Conference of Ophthalmological Society of Nigeria. Information obtained included participants’ socio-demographic data, practice environment, remuneration, job satisfaction, and areas participants felt required a change in their ophthalmic practice. Responses were analysed using IBM Statistical Package for the Social Sciences 16.0 (IBM Corp., Armonk, NY, USA).

Results: One hundred and five (75%) of the 140 questionnaires were filled and returned. The median age of participants was 35 years (range: 21-70 years) and 54.3% were females. Most Nigerian ophthalmologists practice in urban area. Consultants do more research spending an average of 6.44 hours per week on research. Most respondents (70, 66.7%) felt fairly compensated for their work with government-employed earning significantly less (₦4.2million/annum) than their private sector counterparts (₦6.3 million/annum). Most respondents (99[94.3%]) reported high levels of job satisfaction and 69(65.7%) were fairly productive.

Conclusion: Despite the discrepancies in remuneration in private versus public sector ophthalmologists and trainees, most survey participants feel satisfied with their current level of remuneration and productivity.

Keywords: Practice, Remuneration, Work satisfaction, Nigeria, Ophthalmologists, Ophthalmology residents

YahyaH.

Background: Skin diseases are common in African patients with HIV infection. They are often the first clinical manifestations of immune deficiency and their frequency increases as impaired immunity worsens and decreases as immunity improves with antiretroviral drugs (ARV). Objective: To report the relative incidence and clinical presentation of HIV-related skin disease over 20 years when diagnosis and treatment availability varied.

Methods: Records of patients with HIV-related skin disease attending a dermatology clinic in Kaduna, Nigeria from 2001 to 2021 were reviewed.

Results: HIV-related skin disease was diagnosed in 525/29,278 (1.8%) patients with 610 episodes of skin disease: Mean age 36.2 years (range:4 – 68 years), 60% age < 40, males 55%. Almost 72% of patients were seen between 2001 and 2010 and only 9.3% were seen after 2015. Patients seen between 2001 and 2010 were significantly less likely to know their HIV status (19.9% vs. 80.1%, P = 0.000) and be receiving ARV (21.5%, vs. 51.4%, P = 0.000) than those seen between 2011 and 2021. The most common skin conditions were: pruritic papular eruption 33%, herpes zoster 19.7%, Kaposi sarcoma 11%, atopiform dermatitis 8.9%, and seborrheic dermatitis 3.8%. Plane warts, adverse drug reactions, folliculitis, furunculosis, genital herpes simplex, psoriasis, dermatophyte infection, and molluscum contagiosum were also seen. Almost 60% of patients a had CD4 count < 200 cells/ml at presentation.

Conclusion: We noted a marked change in the frequency and pattern of disease between 2001-2010 and 2011-2021 likely due to the increased availability of care and treatment over the period.

Keywords: HIV, Skin disease, Relative incidence, Kaduna-Nigeria, sub-Saharan Africa

BadukuTS, YusufA,ThompsonM.

Background: Stroke is a leading cause of morbidity and mortality worldwide, most of which occur in low and middle-income countries. Neuroimaging is the cornerstone for guiding its management, and computed tomography (CT) is an established tool for its diagnosis.

Objective: The purpose of this study was to examine recent CT brain findings among stroke patients in a rural-based, private teaching hospital in south-west Nigeria, and to compare them with previous findings within Africa.

Methods: This is a retrospective study conducted for thirty months in the Radiology Department of Babcock University Teaching Hospital, Ilisan- Remo, Nigeria. Brain CT images and reports performed between 1st November 2019 and 30th April 2022 were retrieved, processed and analyzed.

Results: The patients were 199 males (62.6%) and 119 females (37.4%), with a mean age of 61.7 years. The highest frequency wasbetween the ages of 70 and 74 years. The most frequent presenting complaint was the inability to move (21.5%). Infarcts constituted the majority of lesions while the most frequent CT findings were left-sided hemispheric infarcts (13.7%).

Conclusion: The result of the study showedamalepreponderanceintheincidenceofcerebrovascularaccidents(CVA).Thereisalsoa preponderance of ischaemic over haemorrhagic CVA. Left-sided hemispheric lesions are more frequent.

Keywords: Cerebrovascular accident, Computed Tomography, Babcock University Teaching hospital, South-
West Nigeria

Usman B, Mohammed B, Daibu U,Bukar A A, Zarami A B

IbrahimBA,AkuhwaRT,AdamuAI, IbrahimHU,AliyuI

Background:Congenital melanocytic nevi are common and vary in size. Some can be quite extensive but are usually benign. However,a giant congenital nevus is rare and has the potential for malignant transformation. Giant nevus could occur in any part of the body; though it is most common on the trunk, it rarely covers over three-quarters of the skin. It is known to be associated withother congenital malformations such as spina bifida and foot deformity. Very few cases of bulky perineal naevocytoma associated with giant congenital melanocytic naevi have been reported in the literature.

Case summary:We report a case of a 2 day old female neonate with a giant melanocytic nevus that covers about 85% of the whole body associated with a bulky perineal naevocytoma arising within the lesion.

Conclusion: Such extensive lesion is at high risk of malignant transformation and has a major psychosocial impact on the caregivers.

Keywords: perineal naevocytoma, congenital, melanocytic, nevus, neonate.