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ABSTRACTS
Year : 2019  |  Volume : 25  |  Issue : 1  |  Page : 131-138  

Abstracts presented at the 74th conference and AGM of Nigeria Surgical Research Society


Date of Web Publication11-Mar-2019

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1117-6806.253793

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How to cite this article:
. Abstracts presented at the 74th conference and AGM of Nigeria Surgical Research Society. Niger J Surg 2019;25:131-8

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. Abstracts presented at the 74th conference and AGM of Nigeria Surgical Research Society. Niger J Surg [serial online] 2019 [cited 2019 Mar 21];25:131-8. Available from: http://www.nigerianjsurg.com/text.asp?2019/25/1/131/253793




  Abstracts in Order of Presentation Top



  Knowledge and Perception of Objective Structured Clinical Examination among Clinical Undergraduate Medical Students at Ahmadu Bello University, Zaria Top


Sholadoye TT, Tolani MA, Aminu MB, Maitama HY

Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

Study Background: Traditional clinical examination is perceived to be biased and to overcome this, objective structured clinical examination (OSCE) was introduced. A survey of students’ opinion is important to assess the strengths and weaknesses of the system so as to guide improvement. Aims: The aim is to assess the knowledge and perception of OSCE among clinical undergraduate medical students at Ahmadu Bello University, Zaria. Methodology: A cross-sectional study of students who had surgical OSCE from July to October 2018. Using a structured questionnaire, the knowledge, exposure, and future preference for OSCE were assessed using the 5-point Likert scale. Data were analyzed using SPSS Version 20. Results: A total of 134 students was reviewed; mean aged 24.1 ± 4.3 years with a male-to-female ratio of 2.5:1. The majority were in their first year of clinical experience (Phase I) and have had exposure to OSCE. Although 64.7% of them strongly agreed that OSCE is the standard mode of examination, only 75 (58.1%) students felt they have adequate knowledge to participate and 48 (36.1%) strongly believed that it was easier to pass. More than half of the students perceived the content of the OSCE is appropriate, wide-scoped, unbiased, and it brought out specific areas of weakness. Many students felt that there is a need for improvement in the simulation of life events, the guidelines clarity, and availability of chaperones; but most of the students felt that OSCE is superior to conventional clinical examination in terms of fairness, examination structure, examination coordination, examination ethics, communication skills, self-learning, and a better chance of passing. Examination related anxiety and fatigue were perceived to be more in clinical by 52.3% and 39.5% of the students, respectively. Nearly, all the students would like to do OSCE again. Conclusion: The medical students have better perception of OSCE over conventional clinical examination both in process and structure. They will prefer OSCE examinations for future surgical assessment.


  Cutaneous Squamous Cell Carcinoma of The Neck: A Case of Dramatic Response to Cytotoxic Chemotherapy or Spontaneous Regression? Top


Daniyan M, Dauda MM, Liman AA1, Nwabuoku SE, Maimuna A

Departments of Surgery and 1Pathology and Morbid Anatomy, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

Study Background: Squamous cell carcinoma (SCC) is the most common nonmelanoma skin cancer in Nigeria. The primary goal of treatment is the complete removal of tumor with maximal preservation of function and cosmesis. Systemic chemotherapy is frequently indicated in our subregion due to advanced disease at presentation. Cisplatin-based chemotherapy has been reported mainly in case reports and case series with varying response. Aim: The aim is to add to the existing body of literature on the treatment of advanced SCC in our environment and highlight the possibility of spontaneous regression. Methodology: We report a case report of a 55-year-old male farmer with histologically confirmed locally advanced moderately differentiated SCC (with good host response) of the neck. Results: Index patient presented with an ulcerated left neck mass of 4 months duration. No obstructive symptoms were found. Mass measured 16 cm × 12 cm, involving both anterior and posterior triangles, had multiple areas of ulceration having everted edges, attached to sternocleidomastoid muscle with areas of pulsatility. There was no evidence of distant metastasis. He had cisplatin and methotrexate combination with remarkable clinical partial response. Conclusion: Cutaneous SCC appears to respond well to cisplatin and methotrexate combination. However, spontaneous regression may partly be responsible.


  Hearing Threshold Determination in Adult Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome Patients on Antiretroviral Drugs Top


Chitumu D, Bakari A, Ahmed AO1, Salisu AD1, Shuaibu IY, Mohammed IB, Shofoluwe NA

Department of Surgery, Division of Otorhinolaryngology, Ahmadu Bello University Teaching Hospital, Zaria, 1Department of Otorhinolaryngology, Aminu Kano University Teaching Hospital, Kano, Nigeria

Background/Aim: Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is a global pandemic with a large burden in Sub-Saharan Africa. Hearing loss has been reported as part of the effects of the disease and increasingly as the side effects of the medications used. This study aims to determine hearing threshold changes among HIV/AIDS adults on antiretroviral therapy and the relationship between HIV/AIDS disease stage and the hearing threshold changes. Methodology: It was a longitudinal study that was carried out at the President’s Emergency Plan for AIDS Relief clinic of Ahmadu Bello University Teaching Hospital, Zaria. All patients aged 18 years and above who were about to commence antiretroviral medication were recruited and matched with controls. A pro forma was administered and clinical otoscopy was done to rule out other obvious causes of hearing loss. Blood was collected for CD4 count at first contact. Baseline pure-tone audiometry was carried out and was repeated at 3 months for participants. The data obtained were analyzed using the Statistical Package for the Social Sciences version 16 and results presented using tables and figures. Results: One hundred and five participants were recruited, 55 participants as study group and 50 controls matched for age and sex. Forty-five participants and 44 controls completed the study with an attrition rate of 18.2% and 12%, respectively. Among the study group, 52.7% were females and 47.3% were males with age range of 20–60 years (mean: 38.1 years) which were similar to that of controls. At recruitment, 16.4% of the study group and 10% of controls had hearing loss with sensorineural and conductive hearing loss being the most common, respectively. Majority, 63.5% of participants had Stage C HIV/AIDS disease at recruitment, but there was no statistically significant association between disease stage and development of hearing loss (P = 0.206). After 3 months exposure to antiretroviral medications, 46.7% of participants had hearing loss the most common being sensorineural hearing loss. Conclusion: Hearing loss is more prevalent in HIV/AIDS population on antiretroviral drugs though not statistically significant. No statistically significant association was found between disease stage and hearing impairment.


  Breast Cancer With Metastasis to The Parotid Gland in A Postmenopausal Nigerian Woman Top


Nwabuoku SE, Luwa PSA1, Daniyan M, Abur PP, Yusufu LMD, Adogu I2

Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Departments of 1Surgery and 2Pathology, Rasheed Shekoni Teaching Hospital, Dutse, Jigawa State, Nigeria

Background: Distant metastasis to the parotid gland is very rare but has been reported from primaries in the lungs, kidneys, and breasts. Between 1982 and 2018, the authors are aware of only 22 reported cases in the literature worldwide. Aim: The aim is to report a case of breast cancer with metastasis to the parotid gland and review the available literature on this matter. Methodology: We present the case below of a 65-year-old woman with breast cancer, metastasis to the contralateral parotid gland, and paraplegia. Results: A 62-year-old woman with a 3-year history of painless right breast lump and 5-month history of painless left facial lumps. Examination revealed a cachectic pale middle-aged woman with a 6 cm × 6 cm hard lump in the left parotid region and a 20 cm × 24 cm hard mass in the right breast fixed to the skin and pectoralis major muscle with an overlying 10 cm × 10 cm ulcer that had destroyed the right nipple-areolar complex and had everted edges, dirty, nodular floor, and hard base. She was counseled for chemotherapy but refused treatment and eventually discharged herself against medical advice. Conclusion: A parotid swelling in any patient with a malignancy should prompt the attending doctor to thoroughly assess the patient, preferably assuming it is a metastatic lesion until proven otherwise.


  Have Our Strictures Changed? Analysis of Current Etiology and Clinical Characteristics of Urethral Stricture Disease in Zaria, Nigeria Top


Nasir O, Ahmed M, Lawal AT, Maitama HY, Tolani MA, Abdulsalami K, Hamza BK, Sudi A, Awaisu M, Afolayan AA, Fidelis L, Yakubu A

Department of Surgery, Ahmadi Bello University Teaching Hospital, Zaria, Nigeria

Objectives: Urethral stricture is a common cause of lower urinary tract symptoms in the middle-aged and elderly men. Its presentation and management is closely linked with its etiology and this varies across geographical regions of the world as well as over time. We hereby review the etiology, characteristics, and presentation of men with urethral strictures in a tertiary hospital in Northern Nigeria over a year and compare it with previous studies in the region. Methodology: This study was a prospective study from January to December 2016; all patients with urethral strictures and who consented to the study were enrolled in the study. Data were collected using a structured questionnaire and analyzed using SPSS version 23. Results: The mean age was 44.1 years, with a range of 13–71 years. The age interval 30–39 years accounted for most of the patients 24 (28.6%). Most of the patients were traders 21 (25%). The armed forces constituted 13 (15%) of the patients, while students were the least of the study group 8 (9.5%). Forty-three percent of the patients had short-segment urethral strictures (<2 cm), while 57% had long-segment strictures (>2 cm). The bulbar urethra was the site of most strictures with a frequency of 65%. Strictures were found in penile and penobulbar urethra in 25% and 21%, respectively. Only 10% of patients studied had multiple strictures. The etiology was infection in majority of the patients with a frequency of 53.3%. Posttraumatic strictures occurred in 33.3%, while iatrogenic and catheter-induced strictures were seen in 7.1% and 6%, respectively. About 8.3% had recurrent strictures, 1.2% had previous dilations, and 2.4% had previous direct visual internal urethrotomy. About 88% had no previous intervention for the stricture before presentation. The complications from urethral strictures observed in the patients were acute urinary retention in 83.4%, urethra-cutaneous fistulae in 2.4%, and urosepsis in 1.2% of the patients. About 11% presented with no complication. Suprapubic cystostomy was found in 85.7% of the patients, urethral induration in 16.7%, and urethral discharge in 9.5%. The trends in etiology of urethral stricture disease in the region reported is: Ahmed et al. in Zaria (1990) Infection accounted for 66.50%, posttraumatic stricture 31.50%. Ntia et al. and Sokoto (2006), found infection as etiology in 44.70% and posttraumatic strictures in 47.40%. Ofoha et al. in Jos, however, found Infection in 53.30% and posttraumatic 40.30%. Conclusion: Although there is a gradual rise in posttraumatic and iatrogenic strictures in our environment, postinflammatory strictures still predominates. It is, however, infrequently accompanied by fistulae as seen decades ago. These strictures are mostly long segments single bulbar strictures


  Role of Prostate-Specific Antigen and Prostate-Specific Antigen Density in Predicting The Rate of Prostate Cancer Detection and Gleason’S Score Top


Tolani MA, Ahmed M, Lawal AT, Afolayan AO, Hamza BK, Fidelis L, Sudi A, Nasir O, Awaisu M, Bello A, Maitama HY

Department of Surgery, Division of Urology, Ahmadu Bello University/Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria

Background: The burden of prostate cancer in African men is high. The most common tool in evaluating these patients is prostate-specific antigen (PSA). However, the clinical relevance of elevated values has been questioned in blacks due to the relatively larger volume of prostate in this population and its unpredictable relationship with Gleason’s score in those with poorly differentiated tumor. The aim of this study was to determine the role of PSA and PSA density (PSAD) in predicting the detection and aggressiveness of prostate cancer. Methods: It was a prospective study conducted on patients with clinical suspicion of prostate cancer over a period of 1 year at ABUTH, Zaria. Information on the patient’s age, PSA, and PSAD were computed. Following anesthesia administration, transrectal ultrasound-guided sextant prostate biopsy was carried out and the histological outcome was obtained. Statistical analysis was done on SPSS version 20 with P < 0.05 considered to be significant. Results: One hundred and six patients were analyzed in the study. Their mean age was 66.7 ± 7.4 years, while median PSA and PSAD were 18.6 (4.0–102.1) ng/ml and 0.4 (0.02–3.2) ng/ml/g. Prostate cancer was detected in 26 (25.7%). PSA or PSAD had significant correlation with cancer detection (r = 0.436, P = 0.001; r = 0.296, 0.003, respectively) and were significant predictors of cancer detection (area under the receiver operating characteristic: 0.788 and 0.695, respectively). However, they were not predictors of a more aggressive malignancy. Conclusions: Tumor detection may be accurately predicted by PSA and PSAD. However, these parameters do not appear to have an independent role in predicting the aggressiveness of prostate cancer.


  A Randomized, Comparative Study Using Nefopam/Paracetamol and Pentazocine/Paracetamol in The Management of Postoperative Pain Following Abdominal Surgeries among Adult Patients Top


Daniyan M, Yusufu LMD, Ogboli-Nwasor EO1, Dauda MM, Abur PP

Departments of Surgery and 1Anaesthesia, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

Study Background: For decades, opioids have remained the mainstay of postoperative pain (POP) management. One major barrier to the optimum use of these agents by patients and health-care providers is that of side effects. Finding a replacement or at least reducing their use will be a major relief to health workers and patients alike. Aim: The aim is to compare two postoperative analgesic regimens (pentazocine/paracetamol vs. nefopam/paracetamol) in the management of POP following abdominal surgeries among adult patients. Methodology: This was a prospective study of patients admitted into the General Surgery Unit of Ahmadu Bello University Teaching Hospital, Zaria, for elective and emergency abdominal surgery between January 2016 and 2017. Patients were randomized into two groups: group A pentazocine and Group B nefopam. Pain severity was assessed following recovery from anesthesia and subsequently thereafter at 24 and 48 h postsurgery using the numeric pain rating scale. Side effects and patients’ satisfaction were assessed. Results: Ninety-two patients were studied. Mean age was 36 years with M:F ratio of 1.3:1. Incidence of POP was 100%; mild (26.1%), moderate (31.5%), and severe (42.4%). Moderate-to-severe pains were recorded among 34.7% and 43.5% of pentazocine and nefopam group, respectively, after 24 h. This was same (10.8%) for both groups after 48 h. Of the 41 (44.6%) patient who reported adverse effect, 28 (68.3%) occurred among patients in the pentazocine group. This observed difference was statistically significant (P = 0.005). Overall, 98% of patients expressed some degree of satisfaction with their pain management. Conclusion: The efficacy of nefopam hydrochloride in reducing pain severity was shown to be comparable with pentazocine, in addition to having a lower side effect profile.


  Gleason Group Grade Correlates Positively With Clinical Stage of Cancer Among Nigerian Men With Adenocarcinoma of The Prostate Gland Top


Murtala Abubakar, Almustapha Aliyu Liman, Sani Mohammed Shehu, Saad Aliyu Ahmed

Department of Pathology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

Background: The Gleason grading system was first introduced in 1966 and it has, over time, established itself as the most widely accepted system of grading adenocarcinoma of the prostate gland. This system has undergone several modifications the latest of which was the Gleason grade group system endorsed in 2014 by the International Society of Urological Pathologist (ISUP) consensus conference. The modified system is considered to correlate better with prognostic criteria of prostate cancer such as serum PSA concentration and clinical stage of cancer. Objective: The objective is to determine the association between the Gleason group grade (2014 ISUP modification of Gleason grading system) and the clinical stage among patients with prostate adenocarcinoma. Methods: This is a retrospective analytical study carried out in the Department of Pathology, Ahmadu Bello University, Zaria, Nigeria. Two hundred and eleven cases of histologically confirmed adenocarcinoma of the prostate were reviewed. All cases were graded using the Gleason group grade system. Clinical stages of the cancer were obtained from the patient’s case records in the Urology unit of the hospital for each of the cases. The Gleason group grade and the clinical stage were then examined for statistically significant association. Results: Gleason Grade Group 1 was the most common group among our patients (32.2%). The study also revealed a statistically significant relationship between the Gleason grade group system and the clinical stage of cancer. Conclusion: There is a statistically significant association between the Gleason group grade and the clinical stage of the tumor in patients with prostatic adenocarcinoma.


  Laryngeal Carcinoma in North Central Nigeria, University of Abuja Teaching Hospital Experience: A 19-Year Review Top


Quadri OR, Gbujie IO, Damtong FM, Folorunso DF, Shofoluwe NA, Nwankwo BE, Dahilo EA, Ibekwe TS, Nwaorgu OGB

ENT Department, Gombe State University, Gombe, Nigeria

Background: Laryngeal carcinoma is an important epithelial cancer of the head-and-neck region with a relatively low incidence. National incidence in Nigeria is unknown. The aim of the study was to determine the incidence, clinical profile, and management outcome of laryngeal carcinomas managed at the ENT-HN Surgery Department of UATH. Materials and Methods: It was a 19-year review of cases managed at the ENT-HN Surgery Department of University of Abuja Teaching Hospital, Gwagwalada, Abuja, from January 1999 to December 2017. Data from the clinic histology register and case notes of patients were collated and analyzed according to the aim of the study. Results: Out of the 123 cases of histologically confirmed head-and-neck cancers reviewed within the study period, laryngeal cancers were 21 (17.1%), but 20 cases had complete data for the study, with a male:female of 9:1 and a mean age of 54.3 years. The most common symptom was hoarseness (100%); others included dyspnea (80.0%), odynophagia (35.0%), cough (25.0%), and hemoptysis (15.0%). The mean duration of symptoms at presentation was 21.8 months. No etiological factor was identified in most of the patients, while there were 2 (10.0%) long-standing cigarette chain smokers. All the patients presented with late disease except two cases of carcinoma-in situ, while others were squamous cell carcinoma. Eight (40.0%) patients had total laryngectomy with a complication rate of 37.5%, while 9 (45.0%) were referred for radiotherapy. Conclusion: Late presentation and poverty (on the path of patients), cost of care, and untimely availability of radiotherapy are among the challenges of managing laryngeal cancers.


  Challenges of Cancer Management: Our Experience at Federal Teaching Hospital Gombe, Nigeria Top


Yahya AI, Ali A1, Ali-Gombe M2, Adamu DB2, Abdullahi YM3, Lawan AI3, Girei AI4, Yuguda S4, Quadri OR1, Kabilis L, Adigun AW

Department of Ear, Nose and Throat, Federal Teaching Hospital Gombe, Gombe State, Departments of 1Ear, Nose and Throat, 2Radiology, 3Histopathology and 4Haematology, College of Medical Sciences, Gombe State University/Federal Teaching Hospital Gombe, Gombe State, Nigeria

Background: The public health concerns of cancer are significantly increasing globally, especially in low- and middle-income countries such as Nigeria where the management of cancer patients is challenging. Purpose: The purpose is to highlight our experience at FTH Gombe regarding the challenges of managing cancer. Methods: The available records from Cancer registry and Multidisciplinary teams, as well as activities/policies of the tumor board of FTH Gombe were reviewed. Findings: The challenges facing cancer management include: (1) lack of awareness and knowledge of the burden of cancer as a disease; (2) late presentation, delay and/or misdiagnosis; (3) stigma and psychosocial problems; (4) lack of family or community support; (5) lack of comprehensive cancer care centers; (6) cost and adverse effects of treatment; (7) lack of survivorship care and rehabilitation; (8) limited cancer registries, research, and policies; and (9) lack of political will. The resolution of the tumor board of FTH Gombe is to treat all cancer cases as emergency. Formulated policies were built on multidisciplinary approach to care and aimed at providing optimal cancer care in our facility. Conclusion: These challenges, which may be overwhelming, can be adequately resolved with effective policies and efficient comprehensive cancer care centers, among others.


  Significant and Unexpected and Critical Findings in Surgical Pathology Practice in A University Hospital in Nigeria: A 5-Year Retrospective Survey Top


Liman AA, Kabir B, Abubakar M, Abdullahi S, Shehu SM

Department of Pathology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

Introduction: Critical values or findings are result(s) of laboratory tests representing a significantly pathophysiological state of the patient. The idea of critical values in clinical laboratory practice and its recent extension into anatomic/surgical pathology practice and its significance in terms of policy, documentation, and timely communication as a quality tool for improving patient safety and patient management outcome is gaining ground. Objective: A descriptive and prescriptive study to demonstrate the occurrence and distribution patterns of significant and unexpected diagnoses in surgical pathology practice in Ahmadu Bello University Teaching Hospital (ABUTH) and possibly raise awareness and make case for a new policy in our surgical pathology practice. Methodology: All the surgical pathology cases seen at the ABUTH over a 5-year period (January 2013– December 2017) were reviewed and cases that met up criteria as significant and unexpected diagnoses in surgical pathology. The data were analyzed. Results: The study found that 3.15% of the 14,696 cases reviewed fell in the categories outlined, and of these, in declining order, insufficient/absent biopsy material (43.63%), uterine contents without villi or trophoblasts (16.20%), and unexpected malignancies (14.04%) had the highest frequency ratios with the lowest ratio belonging to the category of leukocytoclastic vasculitis (0.22%). Conclusion: The prevalence as established here was comparatively high, hence the need for institutionalizing critical diagnoses guidelines in our surgical pathology practice as a patient safety initiative.


  Laboratory Correlation of Seminal Fluid Analysis and Peroxidase-Positive Leukocytospermia Among Partners of Infertile Women Attending Infertility Clinic in Zaria Top


Umar Hauwa S, Adebiyi GA, Ahmad SA1

Department of Obstetrics and Gynaecology and 1Pathology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

Background: Male factor accounts for 40%–50% of cases of infertility. Impairment in seminal parameters such as sperm motility, sperm concentration, capacity for fertilization, damage to sperm membrane, and DNA fragmentation have been attributed to leukocytospermia. However, the routine semen analysis method is not an accurate method for determining leukocytospermia, because it lacks the ability to differentiate the round cells into leukocytes and immature germ cells. Thus, the need to use the standard peroxidase-positive stain to study the effect of leukocytospermia on semen parameters. Aim: The aim is to determine the correlation of peroxidase-positive leukocytospermia with semen parameters using the peroxidase-positive test. Methods: A cross-sectional study where the semen samples of 136 male partners of women attending the infertility clinic and side laboratory of the Obstetrics and Gynaecology Department of the Ahmadu Bello University Teaching Hospital, Zaria, were tested for leukocytospermia. Data were analyzed using Minitab Software version 17. Results: The prevalence of leukocytospermia by the peroxidase method was 35%. Out of the 42 (31%) with significant round cells, 39 (83%) were found to be leukocytospermic and was statistically significant (P < 0.05). There was statistically significant reduction in the number of clients with normozoospermia in the leukocytospermic group compared to nonleukocytospermic group (χ2 = 7.87, P = 0.02). There was positive correlation with significant association between leukocytospermia and oligozoospermia (r = 0.22, P = 0.009) and asthenozoospermia (r = 0.22, P = 0.013). Conclusion: Peroxidase-positive leukocytospermia (leukocytes count ≥1 × 106) was significantly associated with abnormal semen parameter.


  Comparative Evaluation of Alvarado Score and its Modifications in The Preoperative Diagnosis of Acute Appendicitis at A Tertiary Center in Sokoto, Nigeria Top


Umar Muktar, Ibrahim Abubakar Umar, Usman Mohammed Bello1

Department of Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, 1Department of Surgery, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria

Background: Decision-making in patients suspected of having acute appendicitis has remained a diagnostic challenge worldwide despite the advances in imaging and appendiceal surgery. There have been efforts to improve the diagnosis of appendicitis using clinical scoring systems. We evaluated and compared the diagnostic accuracy and role of Alvarado score and two of its modification (Kalan and Al-Fallouji) in the preoperative diagnosis of acute appendicitis. Methods: This was a prospective study conducted at the Usmanu Danfodiyo University Teaching Hospital, Sokoto, of all adult patients operated for acute appendicitis from July 2014 to June 2017. The result was analyzed on computer using the Statistical Package for the Social Sciences Version 15. Results: One hundred and eleven patients were studied. About 66 (59.5%) patients were male and 45 (40.5%) were female. Male:female ratio of 1.5:1. The mean age of 23.89 ± 4.93 years. The Alvarado score sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 90.3%, 83.3%, 96.6%, 62.2%, and 89.2%, respectively, were similar to findings for Kalan score (90.3%, 83.3%, 96.6%, 62.5%, and 89.2%, respectively) and Al-Fallouji score (96.8%, 66.7%, 93.8%, 80%, and 91.9%, respectively). The receiver operating curve and area under the curve shows that Alvarado, Kalan, and Al-Fallouji are accurate scores in preoperative diagnosis of acute appendicitis with an area under the curve of 0.88, 0.86, and 0.85, respectively. Conclusion: kalan and Al-Fallouji scores have comparably good diagnostic accuracy as the Alvarado score among our patients. Any of these scores can be used as an adjunct in preoperative diagnosis of acute appendicitis.


  Operative Management and Outcome of Neglected Elbow Dislocations Top


Maitama MI, Lawal YZ, Ogirima MO, Dahiru IL, Ejagwulu FS, Magami IA, Audu SS

Department of Orthopaedic and Trauma Surgery, ABU, Zaria, Kaduna, Nigeria

Background: Patients with posterior elbow dislocation sometimes present to the hospital late due to initial nonorthodox patronage. As such, closed manipulative reduction is near impossible due to triceps and common forearm flexor tendons contracture, surrounded by articular cavitary fibrosis. Even after surgical reduction, elbow function may be suboptimal due to secondary arthritic changes, weakness of active elbow extension, juxta-articular myositis ossificans, pains, nerve injury, and instability. Aims and Objective: Functional outcome assessment of surgery for neglected posterior elbow dislocation using the Mayo Elbow Performance Score. Methodology: We present 12 patients who underwent open reduction and pinning for neglected posterior elbow dislocation over 5-year period from January 2013 to 2018. Intraoperatively, standard posterior approach was used, followed by ulna nerve identification, V-Y triceps elongation, olecranon and trochlear fossae clearance, tenotomy of common flexor tendons (optional), radial head excision (optional), joint reduction, and pinning. Results: At longest 5-year follow-up, patients demonstrated good-to-excellent Mayo Elbow Performance functional score. Conclusion: Open reduction and pinning is a viable method of treating neglected posterior elbow dislocation in our environment with satisfactory early-to-midterm results.


  Prognostic Factors Affecting Survival of Typhoid Intestinal Perforation in A Tertiary Center in Northeastern Nigeria Top


Umar Muktar, Abdulmalik Aisha

Department of Surgery, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria

Background: Typhoid intestinal perforation continues to pose a great public health challenge as the most dreaded complication of typhoid fever in the developing world. There are conflicting reports of the prognostic factors affecting survival. Aim: We studied the prognostic factors affecting mortality among patients presenting to a tertiary center in Northeastern Nigeria. Methods: This is a 3-year retrospective study of all patients admitted and managed with typhoid intestinal perforation at Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria, from September 1, 2014 to August 31, 2017. Results: Two hundred and seventy-one patients were studied. 157 (57.9%) patients were male and 114 (42.1%) were female, with a male-to-female ratio of 1.4:1. Age ranged from 3 months to 70 years with a mean of 13 ± 9 years. The peak age group was in the 6–10 years age group accounting for 35.4% of cases. 90 patients died giving a mortality rate of 33.2%. Female gender (P = 0.008), extremity of age (P = 0.01), delay of more than 72 h in presentation after perforation (P = 0.004), hypotension (P = 0.03), high American Society of Anesthesiologists score (P = 0.001), end-organ failure (P = 0.001), heavy fecal peritoneal contamination (P = 0.006), and multiple perforations (P = 0.003) were found to be independent indicators of high mortality. Conclusion: Typhoid perforation is still quite common in Northeastern Nigeria with unacceptably high mortality. Mortality is adversely affected by delay in presentation with subsequent sequel of prolonged fecal peritoneal contamination. This ugly narrative can be curbed by improvement of access to safe drinking water, vaccination, and public education on need for early presentation.


  Management of Complex Genital Fistulae: Experience in A Tertiary Sub-Saharan Hospital Top


Ngwobia P Agwu, Abdulwahab A, Ahmed, Sadiq MS, Hassan M, Oyibo EU, Mungadi IA

Urology and Nephrology Institute, Usmanu Danfodiyo University, Sokoto, Nigeria

Background: Genital fistula is a physically and psychosocially debilitating condition in which an abnormal connection exists between the genital tract and the urinary or intestinal tract. Complex urogenital fistulae are those larger than 2.5 cm, from failed previous repair, recurrent, associated with prior radiation or malignancy; involving the trigone, bladder neck, or those associated with poor tissue quality. Management is very challenging due to the cost and technical skill demand of the procedures. Objectives: We report our experience in the management of patients with complex genital fistulae and highlight the role of the reconstructive urologists in management. Methods: This was a retrospective review of female patients at the Usmanu Danfodiyo University Teaching Hospital, Sokoto, from 2006 to 2017 for complex urinary fistulae. Relevant information was extracted from patient case notes, and the data analyzed using the SPSS software. Results: There were 24 female patients mean age 28.9 ± 11.1 and a range of 13–55 years. Etiology of the fistulae was prolonged obstructed labor 10 (41.7%), cesarean hysterectomy 7 (29.2%), and cesarean section and abdominal hysterectomy 2 (8.4%), respectively. Other causes were from attempted repair of stress urinary incontinence, childhood measles, and as complication of female genital mutilation. The types of fistulae were vesicovaginal (VVF) 16 (66.7%) and ureterovaginal 3 (12.5%). Others were vesicocutaneous, urethrovaginal and rectovaginal (RVF) fistula involving the bladder neck. Prior attempt at fistula repair was done in 7 (29.2%) and the number of attempts ranged from 1 to 4. The failed repairs had been done at VVF center in 3, peripheral hospitals in 2 and in UDUTH, while in 1 patient, repair was attempted at both VVF center and UDUTH. Surgical procedures included direct closure in 9 (37.5%), closure and ureteroneocystostomy 7 (29.2%), ureteroneocystostomy only 3 (12.5%), closure and abdominal hysterectomy 2 (8.3%), closure and continent catheterizable neobladder 2 (8.3%) and 1 (4.2%) closure, abdominal hysterectomy and ureteroneocystostomy. Surgical approaches were vaginal 11 (45.8%), abdominal (37.5%), and combined abdominovaginal 5 (20.8%). Postoperative complications were noted in 2 (8.3%) and consisted of gynatresia and recurrent RVF. Seventeen (70.8%) patients achieved continence and failed repair in 4 (16.7%), while 3 (12.5%) had postrepair stress urine incontinence. Conclusion: Complex genital fistulae in our practice are mainly of obstetric origin and involve the bladder, vagina, ureters, and urethra. The reconstructive urologist in conjunction with the urogynecologists has a crucial role in order to ensure a favorable outcome.


  Assessment of Surgical Clerkship Program and Surgical Career Choice: A Preliminary Report of A Multicenter Study Top


Akpo EE, Ojo EO1,2, Ibrahim NA3, Eleweke ND4, Anele AA5, Ituen AM6, Ibrahim AA7

Department of Surgery, Delta State University, Abraka, 1Department of Surgery, University of Jos, Jos. Plateau State, 3Department of Surgery, Lagos State University, Ikeja. Lagos State, 4Department of Surgery, Abia State University, Aba, 2Department of Surgery, Benue State University, Makurdi, 5Department of Surgery, Imo State University, Orlu, 6Department of Surgery, University of Calabar, Calabar. Cross-Rivers State, 7Department of Surgery, University of Abuja, Gwagwalada. Nigeria

Background: With a greater need for surgeons in Nigeria and the declining proportion of students choosing surgery as a career, we sort to find out the major factor important in making this career decision. Methodology: This is an ongoing online prospective study of medical students who have undergone surgical clerkship program in the above institutions and were studied between October 1, 2018 and December 12, 2018. Analysis was done using Google analytics. Results: A total of 195 respondents age 21–47 years (mean = 25.61 ± 3.20 years) were studied. Males were 124 (63.60%), while females were 71 (36.40%). A total of 180 (92.30%) respondents like the course called surgery. Overall, only 63 (32.31%) respondents rated their training experience in surgery as “very good,” and only 67 (34.36%) rated their lecture series as very good. Majority (83, 42.56%) scored radiology posting experience as very good, while other subspecialty postings percentages scored “very good” were general surgery (68, 34.87%), anesthesia (40, 20.51%), ENT (33, 16.92%), orthopedics (57, 29.23%), plastics and burns (38, 19.49%), neurosurgery (16, 8.21%), cardiothoracic (23, 11.79%), ophthalmology (64, 32.82%), urology (52, 26.67%), and pediatric surgery (42, 21.54%). On the average, 163 (83.60%) like the surgical clerkship program design in their institution. Majority of the respondents prefer activities in the clinic (109, 55.90%), while majority do not like clinical meetings (165, 84.60%). Majority of the respondents (123, 63.08%) do not have the desire to study general surgery or its subspecialties. Most respondents indicate that their career choice is due to personal satisfaction (146, 74.87%). Majority of respondents think that cardiothoracic (109, 55.89%) and neurosurgery (98, 50.26%) need to be improved upon generally. A total of 45 (23.10%) respondents were not satisfied with their undergraduate surgical training experience. Overall, 46 (63.01%) respondents think that there was no quality opportunity for them to participate in direct patient care and 30 (41.10%) did not have any form of training in basic surgical skills acquisition. A total of 143 (73.33%) respondents suggest that their lecturers need to undertake a training course on how to teach and pass knowledge to upcoming students. Conclusion: Interest in the field of general surgery or its subspecialties is low even though the majority of respondents like the training program design in their centers. The lack of interest in choosing surgery as a career appears to be due to poor teaching methods. Trainers are thus encouraged to improve on their knowledge transfer skills.


  Rectal Prolapse in A Nigerian Adult Induced by A Vesical Hernia: A Case Report Top


Jatta FN, Ukwubile L, Daniyan M, Mai A

Department of Surgery, Ahmadu Bello UniversityTeaching Hospital, Zaria, Nigeria

Rectal prolapse occurs when the full thickness of the rectal wall protrudes through the anal canal. It has fascinated surgeons for many years and yet enjoys considerable controversy over optimal surgical approach. The mechanism, by which this benign disorder occurs, remains poorly understood. We report a case of rectal prolapse associated with a vesical hernia. A 60-year-old male bus driver was admitted as an emergency to our unit with a 6-h history of an irreducible, painful anal protrusion. This was said to follow a year’s history of recurrent protrusions following episodes of defecation. He sustained pelvic fracture following a road traffic accident which was managed traditionally, few years before his presentation. He was acutely ill on admission and found to have a huge, nonreducible, edematous rectal prolapse. There was deformity of the left femur otherwise his vital signs were stable. He was resuscitated and investigated and had perineal proctosigmoidectomy. He did well postoperatively and was discharged. He, however, complained of an increasing difficulty of micturition during his follow-up visits. He was reviewed generally and for his urinary symptoms, but no obvious cause was found except for an occasionally, reducible L groin bulge, thought to be a groin hernia that was said to be painful some of the time. At surgery, a vesical hernia was found and repaired. The patient thereafter became free of the urinary symptoms and had no recurrence of the prolapse 2 years after his surgeries.






 

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