Myasthenia Gravis with Toxic Goiter: Challenges with Management in a Low-Resource Setting in Africa; Review of Literature and Case Report.

ABSTRACT: Myasthenia gravis (MG) is an antibody-mediated autoimmune disease with the cardinal feature being exertional voluntary skeletal muscle weakness and fatigability. It can be an isolated finding or in association with other autoimmune conditions such as Hashimoto's thyroiditis, Graves' disease, systemic lupus erythematosus (SLE), or rheumatoid arthritis. Thymectomy is recommended for most patients with MG whose symptoms begin before the age of 60 years. Patients with thymoma or thymic hyperplasia do respond to thymectomy compared to those without thymoma or enlarged thymus. Those with enlarged goiter would benefit from thyroidectomy. The management of these patients requires a multidisciplinary approach as performed in a low-resource setting. We are reporting the case of a 24-year-old who presented with MG with toxic goiter and had good control on medication. A computed tomography scan of the chest showed a superior mediastinal mass and a soft tissue scan of the neck was done which showed a diffusely enlarged thyroid gland. She subsequently had thymectomy and subtotal thyroidectomy with a satisfactory outcome. We highlight this case to show that MG with thymoma and goiter could coexist. Reports of such findings are infrequently reported in our environment.

Predictors of Surgical Site Infection in Contaminated Abdominal Surgical Wounds: Our Experience in Irrua Specialist Teaching Hospital.

BACKGROUND: Secondary peritonitis is a common emergency surgical condition with varying aetiologies managed by surgeons all over the world. One important morbidity associated with it is postoperative surgical site infection (SSI). A better prevention strategy can be instituted if this complication in patients can be correctly predicted. The study aimed to identify factors in patients with peritonitis that have a significant bearing on the development of postoperative SSI. METHOD: A total of fifty patients operated on for peritonitis in a period of one year were studied. Factors including age, gender, comorbidities, presenting symptoms, time of presentation, time of intervention, intraoperative findings, duration of surgery, and postoperative SSI were noted. Chi-square, Fisher's exact test and Student's t-test were used to test for association where appropriate and a p-value of < 0.05 was considered statistically significant. RESULTS: Peritonitis was most commonly due to a ruptured appendix (46%) followed by perforated peptic ulcer disease (42%). The incidence of SSI was 44%. For the patients that developed SSI, the lowest rate was observed in cases of ruptured appendix (39.1%) and the highest in perforated gastric ulcer (64.3%) which was closely followed by perforated duodenal ulcer (57.1%). The association between the time of presentation and the occurrence of SSI was statistically significant (p = 0.028). CONCLUSION: The SSI rate (44%) from peritonitis in our centre was quite high and the time of presentation played a crucial role. Prevention strategies focusing on predictors of SSI is necessary to reduce the rate of SSI in our setting.

CONTEXTE: La péritonite secondaire est une affection chirurgicale d'urgence fréquente avec diverses étiologies gérées par des chirurgiens du monde entier. Une morbidité importante associée à cela est l'infection postopératoire du site chirurgical (SSI). Une meilleure stratégie de prévention peut être mise en place si cette complication chez les patients peut être correctement prédite. L'étude visait à identifier les facteurs chez les patients atteints de péritonite qui ont une incidence significative sur le développement d'une SSI postopératoire. MÉTHODE: Au total, cinquante patients opérés pour une péritonite sur une période d'un an ont été étudiés. Des facteurs tels que l'âge, le sexe, les comorbidités, les symptômes de présentation, le moment de la présentation, le moment de l'intervention, les constatations peropératoires, la durée de la chirurgie et la SSI postopératoire ont été notés. Le test du chi carré, le test exact de Fisher et le test t de Student ont été utilisés pour tester les associations lorsque cela était approprié et une valeur de p < 0,05 était considérée comme statistiquement significative. RÉSULTATS: La péritonite était le plus souvent due à une appendicite rompue (46 %), suivie de près par une perforation de l'ulcère gastrique (42 %). L'incidence de la SSI était de 44 %. Pour les patients qui ont développé une SSI, le taux le plus bas a été observé dans les cas d'appendicite rompue (39,1%) et le plus élevé dans l'ulcère gastrique perforé (64,3 %), suivi de près par l'ulcère duodénal perforé (57,1 %). L'association entre le moment de la présentation et l'occurrence de la SSI était statistiquement significative (p = 0,028). CONCLUSION: Le taux de SSI (44 %) provenant de la péritonite dans notre centre était assez élevé et le moment de la présentation jouait un rôle crucial.Des stratégies de prévention axées sur les prédicteurs de la SSI sont nécessaires pour réduire le taux de SSI dans notre contexte. Mots-clés: Péritonite, Infection du site opératoire, Prédicteurs de la SSI, Moment de la présentation.

Management of a huge intrathoracic goitre in a rural specialist hospital in Nigeria-Case report and review of literature.

Retrosternal goiter is expectedly a common presentation in rural African communities due to long periods of neglect. The treatment of choice is surgical - commonly via a trans-cervical incision. A few require an extra-cervical surgical approach and multidisciplinary management as reported in this case performed in a rural specialist hospital in Nigeria.