A Comparison of Chlorhexidine-Alcohol and Povidone-Iodine-Alcohol on the Incidence of Surgical Site Infection.

BACKGROUND: Surgical site infection (SSI) persists as a global challenge, accounting for 20%-25% of all healthcare-associated infections. The SSI rate has been reported to range from 2.5% to 41.9%. Skin preparation with acceptable antiseptic preparations has a high recommendation from the Centers for Disease Control as an SSI preventive measure. AIM: The aim was to compare the efficacy of 10% povidone-iodine in 70% isopropyl alcohol with 2% chlorhexidine in 70% isopropyl alcohol in preventing SSI. METHOD: This prospective randomized study included patients who were followed up for 30 days looking for SSI. Swabs were taken from wounds that developed SSI. A culture of all swabs was done. RESULT: One hundred and fifty-three patients were recruited into the study. Overall, eight (5.23%) of the 153 patients developed SSI. The SSI rate in clean wounds was 2.6%, while the SSI rate in clean-contaminated wounds was 7.9%. No statistically significant difference was found (p=0.141) between the two groups.

Immunohistochemical Profiling of HER-2/neu, Steroid Hormone Receptors and KI-67 Biomarkers in A Cohort of Nigerian Women with Breast Cancer.

Background: Progressive improvement in the accuracy of profiling of hormone receptors in breast cancer provides the basis for targeted endocrine therapy, a major pillar of multimodal breast cancer treatment. However, the disparity in findings from comparatively smaller sample-sized studies in West Africa has led to somewhat conflicting conclusions and recommendations. Objectives: This study investigates the immunohistochemical (IHC) profile of breast cancer specimens for estrogen receptor (ER), progesterone receptor (PR), human epidermal receptor-2 (HER2)/neu, and Ki-67 in a tertiary hospital in Ibadan, Nigeria over 12 years. Materials and Methods: We reviewed 998 IHC reports, documented clinicopathologic parameters, computed patterns of biomarkers, and stratified them based on the American Society of Clinical Oncology/College of American Pathologists recommendations. Descriptive analysis including frequency, mean, and median were generated from the data extracted. Results: Out of the 998 cases, 975 (97.7%) were females and 23 (2.3%) were males. The mean age was 48.84 ± 11.99 years. Open biopsies were the most common types of specimens (320, 41.6%): lumpectomy and incisional biopsy of ulcerated, fungating or unresectable tumours. In those cases, 246 (32.0%) were samples of breast-conserving or ablative surgical extirpation (mastectomy/wide local excision/quadrantectomy), and 203 (26.4%) were obtained by core needle biopsies. Invasive ductal carcinoma was the most common histopathological type (673, 94.5%). The majority of graded tumours were intermediate grade (444, 53.5%). Four hundred and sixty-nine (48.4%) were ER positive, 414 (42.8%) were PR positive, and 180 (19.4%) were HER2/neu positive. Three hundred and thirty-four (34.0%) were triple-negative. Eighty-nine cases had Ki-67 staining done, and of these 61 (68.5%) had positive nuclear staining. Conclusion: Steroid hormone receptors and HER-2/neu proportions in our cohort are likely to be more representative than the widely varied figures hitherto reported in the sub-region. We advocate routine IHC analysis of breast cancer samples as a guide to personalized endocrine therapy.

Characterization of Typhoid Intestinal Perforation in Africa: Results From the Severe Typhoid Fever Surveillance in Africa Program.

Background: Typhoid intestinal perforation (TIP) remains the most serious complication of typhoid fever. In many countries, the diagnosis of TIP relies on intraoperative identification, as blood culture and pathology capacity remain limited. As a result, many cases of TIP may not be reported as typhoid. This study demonstrates the burden of TIP in sites in Burkina Faso, Democratic Republic of Congo (DRC), Ethiopia, Ghana, Madagascar, and Nigeria. Methods: Patients with clinical suspicion of nontraumatic intestinal perforation were enrolled and demographic details, clinical findings, surgical records, blood cultures, tissue biopsies, and peritoneal fluid were collected. Participants were then classified as having confirmed TIP, probable TIP, possible TIP, or clinical intestinal perforation based on surgical descriptions and cultures. Results: A total of 608 participants were investigated for nontraumatic intestinal perforation; 214 (35%) participants had surgically-confirmed TIP and 33 participants (5%) had culture-confirmed typhoid. The overall proportion of blood or surgical site Salmonella enterica subspecies enterica serovar Typhi positivity in surgically verified TIP cases was 10.3%. TIP was high in children aged 5-14 years in DRC, Ghana, and Nigeria. We provide evidence for correlation between monthly case counts of S. Typhi and the occurrence of intestinal perforation. Conclusions: Low S. Typhi culture positivity rates, as well as a lack of blood and tissue culture capability in many regions where typhoid remains endemic, significantly underestimate the true burden of typhoid fever. The occurrence of TIP may indicate underlying typhoid burden, particularly in countries with limited culture capability.

Effectiveness of postoperative analgesia in the management of acute pain in day-case surgeries.

Background: Surgery is the most common source of acute pain. Aim: To determine the intensity of acute pain following day case surgery and evaluate the effectiveness of the prescribed analgesics. Methods: A descriptive observational study carried out at the main operating and the Urology Outpatient theatre suites of the University College Hospital, Ibadan. Seventy consecutive adult patients presenting for day case surgeries between July and September 2013 were recruited. The procedures were stratified as follows: peripheral, groin/perineal, urologic/endoscopy or orthopedic/plastic surgeries. The prescribed postoperative oral analgesics were paracetamol alone or in combination with diclofenac, tramadol or both. Postoperative pain intensity was assessed on arrival in the recovery room and at 6, 12, 24, 48, & 72 hours using the Verbal Intensity Pain Scale (VIPS). The pain scores were presented as mean±SD at different time intervals for each stratified surgical procedures and analgesics using tables and frequency bar charts. A mean pain score of less than 2 for each category of surgical procedures or analgesics group was considered as satisfactory pain control and thus effective analgesia. Result: The overall prevalence of moderate to worst possible pain after surgery in this study was 54.3% on arrival in the recovery room. The mean pain score was greater than 2 at 6 hours postoperative in all surgical categories except in patients who had peripheral surgeries irrespective of single or combination analgesic therapy. Conclusion: A high proportion of patients arrived in the recovery room with a high pain score; measures to improve intraoperative analgesia should be employed.

RésuméContexte: La chirurgie est la source la plus fréquente de douleur aiguë. But: Déterminer l'intensité de la douleur aiguë après un cas de chirurgie de jour et évaluer l'efficacité des analgésiques prescrits. Méthodes: Une étude observationnelle descriptive réalisée à la salle principale d'opération et les suites de théâtre ambulatoire d'Urologie au Collège Hospitalier Universitaire, Ibadan. Soixante-dix patients adultes consécutifs se présentant pour des cas de chirurgies de jour entre juillet et septembre 2013 ont été recrutés. Les procédures ont été stratifiées comme suit: chirurgie périphérique, aine / périnéale, urologique / endoscopie ou chirurgie orthopédique / plastique. Les analgésiques oraux postopératoires prescrits étaient le paracétamol seul ou en combinaison avec le diclofénac, le tramadol ou les deux. L'intensité de la douleur postopératoire a été évaluée à l'arrivée dans la salle de récupération et à 6, 12, 24, 48 et 72 heures en utilisant l'échelle d'intensité verbale de l'intensité (VIPS). Les scores de douleur ont été présentés sous forme de moyenne ± écart-type à différents intervalles de temps pour chaque procédure chirurgicale stratifiée et analgésiques en utilisant des tableaux et des graphiques à barres de fréquence. Un score de douleur moyen inférieur à 2 pour chaque catégorie de procédures chirurgicales ou de groupe analgésique a été considéré comme un contrôle satisfaisant de la douleur et donc une analgésie efficace. Résultat: La prévalence globale de la douleur modérée à la pire possible après la chirurgie dans cette étude était de 54,3% à l'arrivée dans la salle de récupération. Le score moyen de la douleur était supérieur à 2 à 6 heures postopératoires dans toutes les catégories chirurgicales, sauf chez les patients ayant subi une intervention chirurgicale périphérique, quel que soit le traitement antalgique simple ou combiné. Conclusion: Une proportion élevée de patients est arrivée dans la salle de récupération avec un score de douleur élevé; des mesures visant à améliorer l'analgésie peropératoire devraient être utilisées.

Single-shot lamina thoracic paravertebral block with ketofol for modified radical mastectomy.

We describe the use of single-shot lamina thoracic paravertebral block (TPVB) with sedation for a 56-year-old female patient who had modified radical mastectomy with axillary clearance. Two years ago, she suffered vocal cord palsy post thyroidectomy, which was managed with tracheostomy. The tracheostomy tube was removed 8 months later, leaving the patient with persistent hoarseness of voice and left vocal cord palsy. She declined general anesthesia and consented for TPVB. The surgery lasted 95 minutes and was successfully completed with TPVB. Her vital signs were stable during the operation. She had low pain scores, minimal opioid use, early alimentation, and no postoperative nausea and vomiting and was discharged early. We present the anesthetic management of this case in our setting, where TPVB under ultrasound guidance and modern drug-delivery systems for sedation are unavailable.

Diathermy versus Scalpel Incision in a Heterogeneous Cohort of General Surgery Patients in a Nigerian Teaching Hospital.

BACKGROUND: The anecdotal fear of using cautery for surgical incisions is still common in surgical practice despite recent evidences. The aim of this study is to compare the results of electrocautery and the scalpel in skin incisions. MATERIALS AND METHODS: This is a prospective randomized double blind study conducted in the Department of Surgery, of a teaching hospital in Ibadan. Patients were randomized to have either scalpel or electrocautery incisions. The duration used in making the skin incision; the incisional blood loss and the ensuing length and depth of the wound were noted. Postoperative pain; duration of wound healing and the occurrence of surgical site infection were also noted. RESULTS: There were 197 patients consisting of the scalpel group (n = 98) and the electrocautery group (n = 99). The ages ranged from 16 to 73 years. The demography, case distribution and body mass index were similar in both groups. The mode of presentation was predominantly elective. The incision time was shorter in the electrocautery group (P < 0.001). The blood loss was less with the diathermy compared to the scalpel (6.53 ± 3.84 ml vs. 18.16 ± 7.36 ml, P < 0.001). The cumulative numerical rating scale score for pain was 12.65 (standard deviation [SD] 8.06) and 17.12 (SD 9.49) in the diathermy and scalpel groups respectively (P < 0.001). There was no statistically significant difference in wound infection and wound closure (epithelialization time) (P = 0.206). CONCLUSION: The use of electrocautery in making skin incision is associated with reduced incision time, incisional blood loss, and postoperative pain.

A review of the current profile of gastric cancer presentation in the university college hospital Ibadan, a tertiary health care institution in the tropics.

INTRODUCTION: Gastric cancer is the fourth commonest malignancy and the second leading cause of cancer-related death. Although gastric carcinoma is less common throughout Africa than in Europe, there are considerable variations in its incidence and pattern. It accounts for about 5% of cancer-related death. It is characterized with significant morbidity and mortality mainly because of late presentation in developing and poor countries. Previous studies on gastric cancer in Ibadan and other West African centres demonstrated the preponderance of distal (pyloric antrum) gastric lesions when compared to proximal (cardia, fundus) lesions. Nevertheless, recent studies in developed nations show that distal gastric lesions are on the decline while there is an increase in the proportion of proximal gastric lesions. OBJECTIVE: The objective of this study is to review the pattern of presentation of patients with gastric carcinoma managed in our surgical division over a 5-year period and to determine changes in the trend in our environment. METHODOLOGY: A retrospective study of all patients with gastric carcinoma between November 2004 and October 2009 was carried out. Simple descriptive analysis was used to characterize the patients' demographic parameters, symptomatology, clinical and investigative findings along with treatment and outcome modalities. RESULTS: There were 49 cases managed by the division over the period under review. The male to female ratio was 1.45:1 with a mean age of 56 years at presentation. Duration of symptom was less than 5 months (20 weeks) in 47.9% of the patients. Dysphagia was present in 12.2% while 52.6% had a history of suspected peptic ulcer disease. There was electrolyte derangement in 31.7% of the patients while 52.6% had anaemia at presentation. Proximal tumours of the gastro-oesophageal region, cardia and the body constituted 51% of the cases; 51.4% of the patients were blood group O as opposed to 28.6% and 20%, respectively, with blood A and B. Thirty-six patients (73.5%) had a histological diagnosis of adenocarcinoma, five patients (10%) had signet ring variant of adenocarcinoma carcinoma, while three patients (6.1%) were each had gastrointestinal stromal tumours or lymphomas. DISCUSSION: Our review shows a peak age in the sixth and seventh decades at presentation. There is a significant increase in the proportion of proximal gastric lesions and a predominance of blood group O. Gastrointestinal stromal tumour and lymphoma should be considered as differential diagnosis. Patients still present late with advanced diseases, and curative treatment is often impossible.