Audit of Preoperative Fasting for Elective General Surgeries in the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.

BACKGROUND: Despite overwhelming evidence in favour of a relaxed fasting protocol, the traditional practice of keeping patients nil per oral from midnight before the day of surgery for all elective operations still appears to hold sway in many practices. METHODS: A prospective study to evaluate the pattern of preoperative fasting among patients undergoing elective general surgical operations in the Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, was conducted between June and December 2020. Data obtained was analysed using the IBM SPSS Statistics for Windows, version 24, and presented as descriptive statistics in the form of frequencies and percentages. RESULTS: The mean prescribed fasting duration was 11.2 ± 2.4 hours. The mean actual fasting duration of 17.6 ± 13.1 hours was significantly longer than the mean prescribed fasting duration (p= <0.001). Eighty-nine percent of patients fasted for >12 hours before their surgical operations. Bowel surgeries had the longest actual fasting duration of 34.9 ± 27.5 hours, while ventral hernia repairs and superficial mass excisions had the shortest duration of 13.5 ± 0.7 hours. Surgeries performed after noon had the longest actual fasting duration compared to those performed before noon (21.5 ± 18.7 hours vs. 15.6 ± 8.6 hours). Ninety percent of respondents reported hunger score of>4 while fasting. CONCLUSION: Preoperative fasting duration in our surgical unit remains long and conventional. The potential implications of this practice on patients' physiological status and surgical outcomes are strong enough to motivate a change.

CONTEXTE: Malgré les preuves accablantes en faveur d'un protocole de jeûne assoupli, la pratique traditionnelle consistant à maintenir les patients à jeun par voie orale à partir de minuit avant le jour de l'intervention chirurgicale pour toutes les opérations non urgentes semble toujours avoir cours dans de nombreux cabinets. MÉTHODES: Une étude prospective visant à évaluer le modèle de jeûne préopératoire chez les patients subissant des opérations chirurgicales générales non urgentes dans le département de chirurgie, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, a été menée entre juin et décembre 2020. Les données obtenues ont été analysées à l'aide du logiciel IBM SPSS Statistics for Windows, version 24, et présentées sous forme de statistiques descriptives sous forme de fréquences et de pourcentages. RÉSULTATS: La durée moyenne de jeûne prescrite était de 11,2 ± 2,4 heures. La durée moyenne du jeûne effectif de 17,6 ± 13,1 heures était significativement plus longue que la durée moyenne du jeûne prescrit (p= <0,001). Quatre-vingt-neuf pour cent des patients sont restés à jeun pendant plus de 12 heures avant leur intervention chirurgicale. Les opérations de l'intestin ont eu la durée de jeûne réelle la plus longue, soit 34,9 ± 27,5 heures, tandis que les réparations de hernies ventrales et les excisions de masses superficielles ont eu la durée la plus courte, soit 13,5 ± 0,7 heures. Les interventions chirurgicales réalisées après midi ont eu la durée de jeûne réelle la plus longue par rapport à celles réalisées avant midi (21,5 ± 18,7 heures contre 15,6 ± 8,6 heures). Quatre-vingt-dix pour cent des personnes interrogées ont signalé une sensation de faim >4 pendant le jeûne. CONCLUSION: La durée du jeûne préopératoire dans notre unité chirurgicale reste longue et conventionnelle. Les implications potentielles de cette pratique sur l'état physiologique des patients et les résultats chirurgicaux sont suffisamment fortes pour motiver un changement. Mots-clés: American Society of Anaesthesiologists (ASA), Score de faim, Nil Per Oral (NPO), Jeûne de nuit, Jeûne prolongé, Protocole de jeûne traditionnel.

Awareness and Knowledge of Breast Cancer and Breast Examination amongst Undergraduate Students. Mixed Method Approach.

INTRODUCTION: Breast cancer is the most common cause of cancer death amongst women, and the stage at presentation has been found to be an important prognostic index. The study aims to assess breast cancer awareness, including breast cancer education and knowledge of breast self-examination, among undergraduate students with the hope of improving their knowledge of breast cancer. METHODS: The study used the mixed method approach, to evaluate during breast cancer awareness month. All consenting participants completed a pre-test questionnaire before a breast health seminar, after which the post-test questionnaire was filled out. Consenting participants also had clinical breast examinations performed on them. The data were analyzed using IBM SPSS version 24. RESULTS: One hundred and thirteen participants filled out the pre-test questionnaire while 127 participants filled out the post-test. There was a significant change following the seminar. About 87.9% of respondents knew about breast cancer but had poor knowledge of the predisposing factors (11.3%). Most participants (94.3%) knew about self-breast examination (SBE), however, only 46% examined themselves in the past with only 21% aware of the correct timing for SBE. Clinical breast exams were conducted on 80 participants, six (7.5%) breast lumps were found and two had excision biopsies with histopathology diagnosis of fibroadenoma. CONCLUSION: Breast education is important, as knowledge about breast cancer is still low, even among undergraduate students. Continuous breast education should be encouraged.

INTRODUCTION: Le cancer du sein est la cause la plus fréquente de décès par cancer chez les femmes, et le stade de la maladie au moment de la présentation s'est avéré être un indice pronostique important. L'étude vise à évaluer la sensibilisation au cancer du sein, y compris l'éducation au cancer du sein et la connaissance de l'auto-examen des seins, chez les étudiantes de premier cycle, dans l'espoir d'améliorer leurs connaissances sur le cancer du sein. MÉTHODES: L'étude a utilisé une méthode mixte pour évaluer la sensibilisation au cancer du sein pendant le mois de la sensibilisation au cancer du sein. Toutes les participantes consentantes ont rempli un questionnaire de pré-test avant un séminaire sur la santé des seins, après quoi le questionnaire de post-test a été rempli. Les participantes consentantes ont également subi un examen clinique des seins. Les données ont été analysées à l'aide de la version 24 d'IBM SPSS. RÉSULTATS: Cent treize participantes ont rempli le questionnaire du pré-test et 127 celui du post-test. Des changements significatifs ont été observés à la suite du séminaire. Environ 87,9 % des personnes interrogées connaissaient le cancer du sein, mais avaient une faible connaissance des facteurs prédisposants (11,3 %). La plupart des participantes (94,3 %) connaissaient l'auto-examen des seins, mais seulement 46 % d'entre elles s'étaient déjà examinées et 21 % connaissaient le bon moment pour le faire. Des examens cliniques des seins ont été effectués sur 80 participantes, six (7,5 %) masses mammaires ont été trouvées et deux ont subi des biopsies d'excision avec un diagnostic histopathologique de fibroadénome. CONCLUSION: L'éducation mammaire est importante, car les connaissances sur le cancer du sein sont encore faibles, même chez les étudiantes de premier cycle. Il convient d'encourager la formation continue sur le cancer du sein. Mots-clés: Auto-examen des seins, Cancer du sein, Étudiantes de premier cycle, Méthode mixte.

From the Breast to the Finger - A Case Report of Acrometastasis.

BACKGROUND: Acrometastasis is an unusual presentation that is associated with a poor prognosis. SUMMARY OF CASE: We report a case of an advanced breast cancer in a Nigerian woman, with clinical, radiological and histopathological features of lung, brain, and distal phalanx metastases. We report this case to highlight the need to have a high index of suspicion for acrometastasis as well as to emphasize the effect and challenges of managing metastatic breast cancer in a low-income country. CONCLUSION: Breast cancer metastasis to the bones of the hand is a rare condition and associated with poor prognosis.

CONTEXTE: L'acrométastase est une présentation inhabituelle associée à un pronostic défavorable. RÉSUMÉ DU CAS: Nous rapportons le cas d'un cancer du sein avancé chez une femme nigériane, présentant des caractéristiques cliniques, radiologiques et histopathologiques de métastases pulmonaires, cérébrales et de la phalange distale. Nous rapportons ce cas pour souligner la nécessité d'avoir un haut degré de suspicion pour l'acrométastase ainsi que pour souligner les effets et les défis de la prise en charge du cancer du sein métastatique dans un pays à faible revenu. CONCLUSION: La métastase du cancer du sein aux os de la main est une condition rare et associée à un pronostic défavorable. MOTS-CLÉS: Cancer du sein, Métastase, Acrométastase.

Use of commercial mesh for hernia repair in a low resource setting: experience after 500 cases.

BACKGROUND: The use of mesh has revolutionized the management of hernias in many parts of the world. There is, however, limited experience on its use in sub-Saharan Africa. This study describes a single hospital experience after 500 cases of mesh hernia repairs in a sub-Saharan African country. METHODS: We reviewed the records of the first 500 cases of abdominal wall hernia operations performed using commercial mesh since year 2007. Socio-demographic characteristics, hernia type, method of repair and outcome data were analyzed and presented as descriptive statistics. RESULTS: The first 500 cases of mesh hernia repairs were performed between 2007 and 2017 during which a total of 1,175 hernia operations were carried out, mesh repair accounting for 42.5% of the total. There was a progressive rise in the uptake of mesh repairs over time, with mesh repairs overtaking tissue based repairs in the last few years of the review. Inguinal hernia was by far the commonest indication for mesh use (80.4%), followed by incisional hernia (9%). Polypropylene mesh was the most common type of mesh used in about 96.2% of cases. Overall, there were seven recurrences (1.4%) at a mean follow-up period of 15.3 months (1-108 months) CONCLUSION: In spite of resource limitations, the use of mesh for hernia repairs continues to rise and has overtaken tissue-based repairs in a sub-Saharan African setting. Results show good outcomes justifying continued use.

Feasibility study for a randomized clinical trial of bupivacaine, lidocaine with adrenaline, or placebo wound infiltration to reduce postoperative pain after laparoscopic cholecystectomy.

Background: Short-term pain relief can be achieved by local anaesthetic infiltration of port sites at the end of laparoscopic surgery. This study aimed to assess feasibility of performing an RCT to evaluate short-term postoperative analgesia after laparoscopic surgery in Nigeria using two local anaesthetics for port-site infiltration versus saline placebo. Methods: This was a placebo-controlled, patient- and outcome assessor-blinded, external feasibility RCT. Patients undergoing elective laparoscopic cholecystectomy for symptomatic ultrasound-proven gallstones were randomized into three groups: lidocaine with adrenaline (epinephrine), bupivacaine or saline control. The feasibility of recruitment, compliance with randomized treatment allocation, and completion of pain and nausea outcome measures were evaluated. Pain was assessed at 2, 6, 12 and 24 h after surgery using a 0-10-point numerical rating scale (NRS) and a four-point verbal rating scale. Nausea was assessed using NRS at the same time points. Clinical outcomes were assessed only in patients who received the correct randomized treatment allocation. Results: Of 79 patients screened for eligibility, 69 were consented and randomized (23 per group). Overall, compliance with randomized treatment allocation was achieved in 64 patients (93 per cent). All pain and nausea assessments were completed in these 64 patients. On the NRS, most patients had moderate to severe pain at 2 h (39 of 64, 61 per cent), which gradually reduced. Only six patients (9 per cent) had moderate to severe pain at 24 h. Conclusion: Recruitment, compliance with the randomized allocation, and completion of pain outcome measures were satisfactory. This study demonstrates the feasibility of conducting a surgical RCT in a resource-limited setting. Registration number: ISRCTN 17667918 (https://www.isrctn.com).