A Prospective, Observational Cost Comparison of Laparoscopic and Open Appendicectomy in Three Tertiary Hospitals in Nigeria.

BACKGROUND: The clinical benefits of laparoscopic appendicectomy are well recognized over open appendicectomy. However, laparoscopic procedures are not frequently conducted in many low-and middle-income countries (LMICs) for several reasons, including perceived higher costs. The aim of this study was to assess the feasibility and cost of laparoscopic appendicectomy compared to open appendicectomy in Nigeria. METHODS: A multicenter, prospective, cohort study among patients undergoing appendicectomy was conducted at three tertiary hospitals in Nigeria. Data were collected from October 2020 to February 2022 and analyses compared the average healthcare costs at 30 days after surgery. Quantile regression was conducted to identify variables that had an impact on the costs, reported in Nigerian Naira (Naira) and US dollars ($), with standard deviations (SD). FINDINGS: This study included 105 patients, of which 39 had laparoscopic appendicectomy and 66 had open appendicectomy. The average healthcare cost of laparoscopic appendicectomy (147,562 Naira (SD: 97,130) or $355 (SD: 234)) was higher than open appendicectomy (113,556 Naira (SD: 88,559) or $273 (SD: 213)). The average time for return to work was shorter with laparoscopic than open appendicectomy (mean: 8 days vs. 14 days). At the average daily income of $5.06, laparoscopic appendicectomy was associated with 9778 Naira or $24 cost savings in return to work. Further, 5.1% of laparoscopic appendicectomy patients had surgical site infections compared to 22.7% for open appendicectomy. Regression analysis results showed that laparoscopic appendicectomy was associated with $14 higher costs than open appendicectomy, albeit non-significant (p = 0.53). INTERPRETATION: Despite selection bias in this real-world study, laparoscopic appendicectomy was associated with a slightly higher overall cost, a lower societal cost, a lower infection rate, and a faster return to work, compared to open appendicectomy. It is technically and financially feasible, and its provision in Nigeria should be expanded.

Transanal protrusion of intussusceptions in children.

BACKGROUND: The aim of the following study is to report our management experience and outcome of transanal protrusion of intussusceptions. PATIENTS AND METHODS: Retrospective analysis of all cases of intussusceptions protruding through the anal opening from January 2008 to June 2013. RESULTS: Of 62 cases of intussusceptions, transanal protrusion occurred in 10 patients (16% anal protrusion rate) with a male:female ratio of 2:3. They were aged 4-96 months (mean 22.6 ± 30.7, median 7.5 months). Six were infants while four were above 1 year. Duration of symptoms ranged from 2 to 14 days (mean 5.9 days ± 3.4) with only two patients presenting within 48 h. Clinical features included vomiting (100%), abdominal pains (100%), bloody mucoid stool (100%), abdominal distension (90%), and palpable left iliac fossa mass (70%). Three patients had preceding diarrhoea (30%) and two had preceding upper respiratory tract infection (20%). Duration of hospital stay ranged from 5 to 23 days (mean 12 days ± 5.6). Findings at surgery included seven ileocolic and two colocolic intussusceptions (one patient died before surgery). Operative procedures were right hemicolectomy (5), operative manual reduction (3), left hemicolectomy (1) giving a 67% bowel resection rate. One patient died giving a 10% mortality rate. CONCLUSION: Transanal protrusion occurred more in females and is associated with late presentation, older age, high bowel resection rate, and high mortality.

Toxicological study of the Anam River in Otuocha, Anambra State, Nigeria.

The authors studied the quality of water and soil samples from the Anam River in Nigeria. Using an atomic absorption spectrophotometer, they analyzed levels of lead, cadmium, copper, and nickel. They also analyzed sulfates, nitrates, biological oxygen demand, total hardness, total dissolved solids, pH values, electrical conductivity, chloride, and salinity. The ranges of detected metals were 0.002-0.005 mg/L for cadmium, 0.008-0.016 mg/L for lead, and 0.580-1.345 mg/L for copper. In the soil samples, the authors detected cadmium (0.07-3.45 ppm), copper (4.38-13.54 ppm), lead (0.59-7.34 ppm), and nickel (0.36-5.64 ppm). The mean values of the chemical parameters were 11.34 +/- 1.20 mg/L for total hardness, 4.43 +/- 1.54 mg/L for biological oxygen demand, 20.00 +/- 0.00 mg/L for total dissolved solids, and 0.22 +/- 0.05 mg/L for nitrates. Chloride, salinity, electrical conductivity, and pH values were 8.00 +/- 1.73 mg/L, 14.44 +/- 3.13 mg/L, 19.33 +/- 0.67 ps cm-L, and 7.09 +/- 0.05, respectively. The World Health Organization guidelines for the parameters in soil were exceeded.

Heavy metal hazards of sachet water in Nigeria.

The authors assessed sachet water samples sold in Eastern Nigeria. Using an atomic absorption spectrophotometer, they analyzed levels of lead, cadmium, copper, and nickel. They also analyzed other parameters, such as nitrates, sulfates, chlorides, salinity, total hardness, biological oxygen demand, total dissolved solids, and pH level. Lead levels ranged from 0.002 to 0.036 mg/L in the samples; 5 samples (12.2%) had lead levels above the maximum contaminant level (MCL; 0.015 mg/L). Lead was not detectable in 20 samples (48.8%). Cadmium levels ranged from 0.002 to 0.036 mg/L and exceeded the MCL of 0.005 mg/L in 8 samples (19.5%); it was not detectable in 23 samples (56.1%). Copper was not detected in 2 (0.05%) of the samples. Its range was between 0.018 and 1.401 mg/L. Two samples (0.05%) had copper levels above the MCL (1.30 mg/L). Nickel levels ranged from 0.003 to 0.050 mg/l. The biological oxygen demand of the samples ranged from 3.20 to 36.80 mg/L. Other parameters were normal. The authors found that some of the sachet waters contain heavy metals, and consumers may be exposed to hazards.