Influence of Adhesive Incise Drape Use on Surgical Site Infection Rates in Contaminated and Dirty Abdominal Operations.

BACKGROUND: Surgical Site Infection (SSI) remains the most common cause of Healthcare-Associated Infections (HCAIs). In particular, contaminated and dirty abdominal wounds are attended by a high rate of SSI which in turn is associated with a huge burden on patients, caregivers and the entire health care system. OBJECTIVE: To compare SSI rates following the use of iodine-impregnated adhesive incise drapes (Ioban) with routine conventional drapes in contaminated and dirty abdominal surgical wounds in a Nigerian tertiary hospital. METHODOLOGY: Consecutive, consenting adult patients who underwent laparotomy for cases classified as contaminated and dirty were prospectively enrolled in the study. Patients in the investigation arm had in addition to conventional drapes, iodine-impregnated adhesive incise drapes (Ioban) applied on the skin of the abdomen through which incisions were made, while patients in the control arm only had routine conventional drapes applied. All patients were followed up to 30 days after the operation. Surgical site infection rates were compared between the two groups. RESULTS: Sixty-two consecutive patients were enrolled into this study, of which 55 completed the 30-day follow-up. The mean ages of patients in the two groups were 37.96 ± 19.59 years and 36.74 ± 16.93 years (p=0.81). Males were 36 (65.5%) and females were 19 (34.5%). Overall, 30 (54.5%) patients had surgical site infection (SSI) in this study. Thirteen (46.4%) patients had SSI in iodine iodine-impregnated adhesive incise drape group while 17 (63%) patients had SSI in the conventional drape group, a difference that was not statistically significant (p=0.22). The most commonly isolated organism from infected wounds was Klebsiella species. CONCLUSION: The use of iodine-impregnated surgical incise drapes was associated with a lower, though non-statistically significant SSI rates compared to the use of conventional drapes. This marginal benefit will require a larger population study to examine its potential cost-effectiveness in our setting.

CONTEXTE: L'infection du site chirurgical (ISC) reste la cause la plus courante des infections associées aux soins de santé (IASC). En particulier, les plaies abdominales contaminées et sales sont associées à un taux élevé d'ISC, ce qui entraîne une charge importante pour les patients, les soignants et l'ensemble du système de santé. OBJECTIF: Comparer les taux d'ISC après l'utilisation de draps incisifs adhésifs imprégnés d'iode (Ioban) avec des draps conventionnels habituels dans les plaies chirurgicales abdominales contaminées et sales dans un hôpital tertiaire nigérian. MÉTHODOLOGIE: Des patients adultes consécutifs et consentants qui ont subi une laparotomie pour des cas classés comme contaminés et sales ont été inscrits de manière prospective dans l'étude. Les patients dans le groupe d'investigation avaient, en plus des draps conventionnels, des draps incisifs adhésifs imprégnés d'iode (Ioban) appliqués sur la peau de l'abdomen à travers laquelle les incisions ont été faites, tandis que les patients dans le groupe témoin n'avaient que des draps conventionnels habituels appliqués. Tous les patients ont été suivis pendant 30 jours après l'opération. Les taux d'infection du site chirurgical ont été comparés entre les deux groupes. RÉSULTATS: Soixante-deux patients consécutifs ont été inscrits dans cette étude, dont 55 ont terminé le suivi de 30 jours. L'âge moyen des patients dans les deux groupes était de 37,96 ± 19,59 ans et 36,74 ± 16,93 ans (p=0,81). Les hommes étaient au nombre de 36 (65,5%) et les femmes de 19 (34,5%). Globalement, 30 (54,5%) patients ont présenté une infection du site chirurgical (ISC) dans cette étude. Treize (46,4%) patients ont présenté une ISC dans le groupe avec draps incisifs adhésifs imprégnés d'iode, tandis que 17 (63%) patients ont présenté une ISC dans le groupe avec draps conventionnels, une différence qui n'était pas statistiquement significative (p=0,22). L'organisme le plus fréquemment isolé dans les plaies infectées était l'espèce Klebsiella. CONCLUSION: L'utilisation de draps incisifs chirurgicaux imprégnés d'iode était associée à des taux d'ISC plus bas, bien que non statistiquement significatifs, par rapport à l'utilisation de draps conventionnels. Cet avantage marginal nécessitera une étude avec une population plus importante pour examiner son potentiel de rentabilité dans notre contexte. MOTS-CLÉS: Plaies contaminées et sales, Drap incisif adhésif, Infection du site chirurgical (ISC).

Effect of Perioperative Tranexamic Acid on Blood Loss following Open Simple Prostatectomy: A Prospective Review in Nigerian Men.

BACKGROUND: Haemorrhage is a common complication following open simple prostatectomy and patients may sometimes require a blood transfusion. Tranexamic acid has been shown to reduce blood loss following transurethral resection of the prostate and open radical prostatectomy. This study evaluated the effect of perioperative intravenous administration of tranexamic acid on blood loss and blood transfusion rates in patients who had OSP for benign prostatic enlargement. METHODOLOGY: This was a comparative study of patients with documented prostate glands 60g and above scheduled for OSP. Initial hematocrit was done a day before surgery. The patients were randomized into a tranexamic acid group, which received perioperative intravenous tranexamic acid and the no-TXA group which received placebo (0.9% saline). All patients had open simple retropubic prostatectomy. Final post-operative hematocrit was assessed 72 hours after surgery, and blood loss was calculated using the modified Gross formula (actual blood loss = estimated blood volume x change in hematocrit / mean hematocrit). The transfusion rate was documented. RESULTS: Fifty-six patients participated in this study and were randomized into a tranexamic acid group and no-tranexamic acid group. The mean age of patients in the tranexamic acid group was 66.07 ±7.08 years and was comparable to the no- tranexamic acid group which was 66.50 ± 8.80 years (P = 0.842). The median total blood loss was lower in the tranexamic acid group (502mls, IQR 613) compared to the no-tranexamic acid group (801mls, IQR 1069). The difference in the median blood loss between the two groups was 299mls (U 275, P 0.055). The rate of blood transfusion was lower in the tranexamic acid group (6 patients, 21%) compared to the no tranexamic acid group (11 patients, 39%), (P = 0.146). There was no difference in complication rates between the two groups. CONCLUSION: The use of tranexamic acid in patients undergoing open simple prostatectomy showed a trend towards reduced intraoperative blood loss and less need no tranexamic for blood transfusion. This is of clinical significance, especially in elderly patients with low cardiovascular reserve.

CONTEXTE: L'hémorragie est une complication courante après une prostatectomie simple ouverte et les patients doivent parfois recevoir une transfusion sanguine. Il a été démontré que l'acide tranexamique réduit la perte de sang après une résection transurétrale de la prostate et une prostatectomie radicale ouverte. Cette étude a évalué l'effet de l'administration intraveineuse périopératoire d'acide tranexamique sur les pertes sanguines et les taux de transfusion sanguine chez des patients ayant subi une PSO pour hypertrophie bénigne de la prostate. MÉTHODOLOGIE: Il s'agissait d'une étude comparative de patients dont la prostate de 60 g et plus était documentée et qui devaient subir une PSO. L'hématocrite de base a été effectué un jour avant la chirurgie. Les patients ont été répartis aléatoirement dans le groupe acide tranexamique, qui a reçu de l'acide tranexamique periopératoire par voie intraveineuse, et dans le groupe sans TXA, qui a reçu un placebo. Tous les patients ont subi une prostatectomie rétropubienne simple ouverte. L'hématocrite postopératoire a été évalué, et la perte de sang calculée à l'aide de la formule de Gross modifiée. Le taux de transfusion a été documenté. RÉSULTATS: Cinquante-six patients ont participé à cette étude et ont été randomisés entre le groupe avec acide tranexamique et le groupe sans acide tranexamique. L'âge moyen des patients du groupe acide tranexamique était de 66,07 ±7,08 ans et était comparable à celui du groupe sans acide tranexamique qui était de 66,50 ± 8,80 ans (P =0,842). La perte sanguine totale médiane était plus faible dans le groupe avec acide tranexamique (502 ml, IQR 613) que dans le groupe sans acide tranexamique (801 ml, IQR 1069). La différence de la perte de sang médiane entre les deux groupes était de 299 ml (U 275, P 0,055). Le taux de transfusion sanguine était inférieur dans le groupe acide tranexamique (6 patients, 21%) par rapport au groupe sans acide tranexamique (11 patients, 39%), (P =0,146). Il n'y avait pas de différence dans les taux de complication entre les deux groupes. CONCLUSION: L'utilisation de l'acide tranexamique chez les patients subissant une prostatectomie simple ouverte a montré une tendance à la réduction de la perte de sang peropératoire et un besoin moindre de transfusion sanguine. Mots clés: Hypertrophie bénigne de la prostate, Prostatectomie simple ouverte, Hémorragie, Acide tranexamique.

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.

Addressing Unmet Surgical Needs in an Underserved Nigerian Community: Report of a 'Town and Gown' Initiative.

BACKGROUND: Access to quality and timely care prevents unnecessary deaths and morbidity from potentially curable surgical diseases. This study describes the magnitude of unmet surgical needs in a Nigerian community and describes the experiences garnered during a surgical outreach organized by a tertiary institution in an underserved community. METHODS: This is a descriptive study highlighting details of a surgical outreach to a community in south-Western part of Nigeria. The project was based on a collaboration between a University Teaching Hospital (gown) and the community (town). Details of the patients' demographic and disease characteristics as well as barriers to seeking medical care were obtained. The operational workflow, treatment offered, and outcomes are highlighted. Results are presented as descriptive statistics. RESULTS: Over a two-day period, 83 out of 3,056 patients who were screened had surgically treatable conditions (2.7%), predominantly hernias (37, 46.6%), goitres (13, 15.7%) and soft tissue swellings (9, 10.8%). The majority were adults (56, 67.5%) while 27 (32.5%) were in the paediatric age group. The mean duration of symptoms was 8.64 months ± 9.5 months. About half of the patients (46.9%) had never visited a medical facility on account of their index illnesses. Lack of funds was cited by many patients as the main reason for having not presented at a hospital. Sixty-three surgical operations were performed with no peri-operative adverse events. CONCLUSION: Lack of financial access was the major barrier to surgical care in the sampled community. Moving from 'gown to town' helped address a significant proportion of the unmet needs over a relatively short period. Tertiary hospitals can provide surgical oversight to communities within their jurisdiction using this approach.

CONTEXTE: L'accès à des soins de qualité et en temps opportun permet d'éiter les décès et la morbidité inutiles dus à des maladies chirurgicales potentiellement curables. Cette étude décrit l'ampleur des besoins chirurgicaux non satisfaits dans une communauté nigériane et décrit les expériences recueillies au cours d'une action chirurgicale organisée par une institution tertiaire dans une communauté mal desservie. MÉTHODES: Il s'agit d'une étude descriptive mettant en évidence les détails d'une action chirurgicale dans une communauté du sud-ouest du Nigeria. Le projet était basé sur une collaboration entre un hôpital universitaire (ville) et la communauté (ville). Les détails des caractéristiques démographiques et pathologiques des patients ainsi que les obstacles à la recherche de soins médicaux ont été obtenus. Le déroulement des opérations, le traitement proposé et les résultats sont mis en évidence. Les résultats sont présentés sous forme de statistiques descriptives. RÉSULTATS: Sur une période de deux jours, 83 des 3056 patients examinés présentaient des affections pouvant être traitées chirurgicalement (2,7 %), principalement des hernies (37, 46,6 %), des goitres (13, 15,7 %) et des tuméfactions des tissus mous (9, 10,8 %). La majorité des patients étaient des adultes (56, 67,5 %), tandis que 27 (32,5 %) appartenaient au groupe d'âge pédiatrique. La durée moyenne des symptômes était de 8,64 mois ±9,5 mois. Environ la moitié des patients (46,9 %) ne s'étaient jamais rendus dans un établissement médical en raison de leurs maladies index. Le manque de moyens financiers a été cité par de nombreux patients comme la principale raison pour laquelle ils ne s'étaient pas présentés à l'hôpital. Soixante-trois opérations chirurgicales ont été réalisées sans aucun événement indésirable périopératoire. CONCLUSION: Le manque d'accès financier était le principal obstacle aux soins chirurgicaux dans la communauté échantillonnée. Le passage de la ville à l'hôpital a permis de répondre à une proportion importante des besoins non satisfaits sur une période relativement courte. Les hôpitaux tertiaires peuvent fournir une supervision chirurgicale aux communautés de leur juridiction en utilisant cette approche. Mots clés: Chirurgie, Besoins non satisfaits, Nigeria, Communauté mal desservie.

Breast Cancer Stage at Diagnosis in a Nigerian Hospital: Trend over a Decade.

BACKGROUND: Breast cancer outcomes are poor in Nigeria, partly due to late-stage diagnosis. To assess the impact of past and present interventions, a review of an institutional data base was performed to determine the trend with respect to stage at diagnosis over a decade. METHODS: A retrospective analysis of an institutional data base was performed over a decade. The review period was divided into segments (2013-2015, 2016-2018 and 2019-2022). The latter period (2019-2022), corresponds to a time of more intense community interventions aimed at promoting early diagnosis and treatment around the locality of the teaching hospital. The stage at diagnosis within these periods were compared. The relationship between stage and sociodemographic variables (age, religion, marital status, menopausal status, and level of education) was assessed. RESULTS: There were 910 patients, 144 within the first period (2013-2015), 318 in the second (2016-2018) and 454 in the third period (2019-2022). The majority presented with stage 3 disease (73.8%). There was a significant decline in the proportion of metastatic cases and a concomitant increase in early cases in the latter part of the review. The proportion of metastatic cases reduced from 23.6% (2013-2015), to 15.7% (2016-2018) and 9.3% (2019-2022) (p=0.001). Level of education was significantly associated with stage (p=0.001). CONCLUSION: This study shows a trend towards downstaging of breast cancer in our locality. This trend corresponds to the period of more intense community interventions, justifying the need to further interrogate the direct impact of each of the interventions. This will provide a firm basis for sustaining or improving on current efforts to achieve more robust gains.

CONTEXTE: Les résultats du cancer du sein sont médiocres au Nigeria, en partie en raison d'un diagnostic tardif. Pour évaluer l'impact des interventions passées et actuelles, une revue d'une base de données institutionnelle a été réalisée pour déterminer la tendance en ce qui concerne le stade au moment du diagnostic sur une décennie. MÉTHODES: Une analyse rétrospective d'une base de données institutionnelle a été effectuée sur une décennie. La période de revue a été divisée en segments (2013-2015, 2016-2018 et 2019-2022). La dernière période (2019-2022) correspond à une période d'interventions communautaires plus intensives visant à promouvoir un diagnostic précoce et un traitement autour de la localité de l'hôpital universitaire. Les stades au moment du diagnostic au cours de ces périodes ont été comparés. La relation entre le stade et les variables sociodémographiques (âge, religion, état matrimonial, statut ménopausique et niveau d'éducation) a été évaluée. RÉSULTATS: Il y avait 910 patients, 144 dans la première période (2013-2015), 318 dans la deuxième (2016-2018) et 454 dans la troisième période (2019-2022). La majorité présentait une maladie de stade 3 (73,8 %). On a observé une diminution significative de la proportion de cas métastatiques et une augmentation concomitante des cas précoces dans la dernière partie de la revue. La proportion de cas métastatiques est passée de 23,6 % (2013-2015) à 15,7 % (2016- 2018) et 9,3 % (2019-2022) (p=0,001). Le niveau d'éducation était significativement associé au stade (p=0,001). CONCLUSION: Cette étude montre une tendance à la réduction du stade du cancer du sein dans notre localité. Cette tendance correspond à la période d'interventions communautaires plus intenses, justifiant la nécessité d'interroger davantage l'impact direct de chacune des interventions. Cela fournira une base solide pour soutenir ou améliorer les efforts actuels afin d'obtenir des gains plus robustes. Mots-clés: Sein, Cancer, Stade, Nigéria.

Relationship between Glycaemic Control and Oral Immunologic Proteins.

BACKGROUND: Attaining a good glycaemic control is usually the target for therapy in diabetic patients as this is expected to prevent both acute and chronic complications. Oral infections are however very common among diabetic patients despite the presence of many immunologic proteins in the saliva. This study was designed to determine the impact of glycaemic control on levels of these proteins in diabetic patients. METHODS: Salivary lysozyme, histatins, immunoglobulin A and immunoglobulin G were measured in diabetic patients. The levels of these immunologic proteins were compared between patients whose HbA1c were less than 7% and those whose values were greater than or equal to 7%. RESULTS: A total of 95 participants were recruited for this study with 37 (38.9%) of them having a median HbA1c of 6.3% (IQR 5.3- 6.6) and the remaining 58 (61.1%) having a median HbA 1c of 9.1% (IQR 8.1-10.5). There was no significant difference in salivary lysozyme (31.24 vs 33.77 ng/ml; p = 0.69), histatins (9.65 vs 9.17 ng/ml; p = 0.27), IgA (12.79 vs 12.19 µg/ml; p = 0.16) and IgG (31.29 vs 32.49 µg/ml; p = 0.85) between the group with good and those with poor glycaemic control. CONCLUSION: This study showed that glycaemic control does not impact the levels of salivary immunologic proteins in diabetic patients, so quality attention should be given to oral care to avoid the development of oral complications.

CONTEXTE: L'obtention d'un bon contrôle glycémique est généralement l'objectif du traitement des patients diabétiques, car il est censé prévenir les complications aiguës et chroniques. Les infections buccales sont cependant très fréquentes chez les patients diabétiques malgré la présence de nombreuses protéines immunologiques dans la salive. Cette étude a été conçue pour déterminer l'impact du contrôle glycémique sur les niveaux de ces protéines chez les patients diabétiques. MÉTHODES: Le lysozyme, les histatines, l'immunoglobuline A et l'immunoglobuline G salivaires ont été mesurés chez les patients diabétiques. Les niveaux de ces protéines immunologiques ont été comparés entre les patients dont le HbA1c était inférieur à 7 % et ceux dont les valeurs étaient supérieures ou égales à 7 %. RÉSULTATS: Au total, 95 participants ont été recrutés pour cette étude, 37 (38,9 %) d'entre eux ayant une HbA1c médiane de 6,3 % (IQR 5,3- 6,6) et les 58 autres (61,1 %) ayant une HbA1c médiane de 9,1 % (IQR 8,1- 10,5). Il n'y avait pas de différence significative dans le lysozyme salivaire (31,24 vs 33,77 ng/ml ; p= 0,69), les histatines(9,65 vs 9,17 ng/ml ; p= 0,27), les IgA (12,79 vs 12,19 ?g/ml ; p= 0,16) et les IgG (31,29 vs 32,49 ?g/ml ; p= 0,85) entre le groupe avec un bon et celui avec un mauvais contrôle glycémique. CONCLUSION: Cette étude a montré que le contrôle glycémique n'a pas d'impact sur les niveaux de protéines immunologiques salivaires chez les patients diabétiques, une attention de qualité devrait donc être accordée aux soins bucco-dentaires pour éviter le développement de complications orales. Mots clés: Diabète, Contrôle glycémique, Protéines salivaires, Cavité orale, Protéines immunologiques.

Unveiling research training gaps in oncology: Evaluating a research capacity-building effort among Nigerian physicians.

Background: Cancers are a disease of growing public health importance in Africa, but cancer research capacity in the region is underdeveloped. The quest to foster and promote locally conceptualized and conducted oncology research in Africa have informed the African Research Group for Oncology's (ARGO) research capacity-building efforts in Nigeria. Aim: To evaluate the effectiveness of oncology research capacity-building initiatives among Nigerian senior trainees and junior faculty physicians. Subjects and Methods: Panel study design was employed to study Nigerian senior trainees and junior faculty physicians who participated in two research capacity-building symposia. Data were collected pre-and immediate post-symposia, and 3-month post-first symposium. Changes in knowledge were assessed using the Chi-square test and confidence levels using the Wilcoxon signed rank test. A P value of <0.05 was considered statistically significant. Results: : In the first symposium, the participants' pass rate in the knowledge-based questions improved from 9.8% to 46.7% to 81.5% at the baseline, immediate post-symposium, and 3-month post-symposium, respectively (P < 0.001). Likewise, the participants' confidence level in carrying out certain research-related activities increased after the second symposium (P < 0.001). Conclusion: The study concludes that building capacity for oncology research in low- and middle-income countries is possible with focused symposia and educational programs.

Nigerian resident doctors' work schedule: A national study.

Background and Aim: The deleterious effects of Resident Doctors' (RDs') long duty hours are well documented. Driven by concerns over the physician's well-being and patient safety, the RDs' duty hours in many developed countries have been capped. However, in Nigeria and many African countries, there are no official regulations on work hours of RDs. This study evaluated the work schedule of Nigerian RDs and its impact on their wellbeing and patient safety. Subjects and Methods: A national survey of 1105 Nigerian RDs from all specialties in 59 training institutions was conducted. With an electronic questionnaire designed using Google Forms, data on the work activities of RDs were obtained and analyzed using the IBM SPSS software version 24. The associations were compared using Chi-squared test with the level of significance set at < 0.05. Results: The mean weekly duty hours (h) of the RDs was 106.5 ± 50.4. Surgical residents worked significantly longer hours than non-surgical residents (122.7 ± 34.2 h vs 100.0 ± 43.9 h; P < 0.001). The modal on-call frequency was two weekday on-calls per week (474, 42.9%) and two weekend on-calls per month (495, 44.8%), with the majority of RDs working continuously for up to 24 hours during weekday on-calls (854, 77.3%) and 48-72 hours during weekend on-calls (568, 51.4%), sleeping for an average of only four hours during these on-calls. The majority of RDs had post-call clinical responsibilities (975, 88.2%) and desired official regulation of duty hours (1,031, 93.3%). Conclusion: The duty hours of Nigerian RDs are currently long and unregulated. There is an urgent need to regulate them for patient and physician safety.

Effectiveness of Triclosan Coated Suture for Subcutaneous Wound Closure in Preventing Surgical Site Infection following Mesh Repair of Inguinal Hernia: A Pilot Study.

BACKGROUND: The role of prophylactic antibiotics in mesh repair of inguinal hernia is controversial and often based on institutional policies. Surgical site infection rate from earlier studies in Nigeria justifies the continued use of prophylactic antibiotics during hernia repair. With increased use of antibiotics comes the challenge of antibiotic resistance and toxicity. The use of antimicrobial coated suture may help avoid these challenges but its efficacy needs to be tested. OBJECTIVE: To compare Triclosan coated suture with intravenous antibiotics for the repair of inguinal hernia with mesh. METHODS: Patients with uncomplicated inguinal hernia undergoing mesh repair were randomized to either have intravenous antibiotics administered for prophylaxis or to have wound closure with Triclosan coated Vicryl 2/0 suture. Post operatively, wound infection rates were compared between the two groups. Follow up was for 1 year. RESULTS: We studied 49 patients with 59 hernias with a mean age of 53 years. Hernias were solitary in 75% of cases, the majority of which were right sided, while 25% were bilateral. There were 25 patients with 32 hernias in the Intravenous antibiotic group (Group A) and 24 patients with 27 hernias in the Triclosan suture group (Group B). Wound grades were similar between the two groups with one patient in the Triclosan group confirmed to have wound infection (4.2%) and none in the Intravenous antibiotics group (p=0.27). Wound infection was of the superficial type which resolved with wound care within 1 month. CONCLUSION: Triclosan coated suture may be safely used as an alternative to intravenous antibiotics for the mesh repair of inguinal hernia. Further studies are required to validate this finding.

RÉSUMÉ: Le rôle des antibiotiques prophylactiques dans la réparation par maille de la hernie inguinale est controversé et souvent basé sur les politiques institutionnelles. Le taux d'infection du site opératoire d'études antérieures au Nigeria justifie l'utilisation continue d'antibiotiques prophylactiques pendant la réparation d'une hernie. L'utilisation accrue des antibiotiques pose le défi de la résistance et de la toxicité aux antibiotiques. L'utilisation d'une suture enduite d'un antimicrobien peut aider à éviter ces défis, mais son efficacité doit être testée. OBJECTIF: Comparer la suture enduite de triclosan avec des antibiotiques intraveineux pour la réparation de la hernie inguinale avec un filet. MÉTHODES: Les patients présentant une hernie inguinale non compliquée subissant une réparation par filet ont été randomisés pour recevoir soit des antibiotiques par voie intraveineuse à titre prophylactique, soit une fermeture de la plaie avec une suture Vicryl 2/0 revêtue de triclosan. Après l'opération, les taux d'infection des plaies ont été comparés entre les deux groupes. Le suivi a duré 1 an. RÉSULTATS: Nous avons étudié 49 patients avec 59 hernies avec un âge moyen de 53 ans. Les hernies étaient solitaires dans 75 % des cas, majoritairement du côté droit, tandis que 25 % étaient bilatérales. Il y avait 25 patients avec 32 hernies dans le groupe antibiotique intraveineux (groupe A) et 24 patients avec 27 hernies dans le groupe suture au triclosan (groupe B). Les grades des plaies étaient similaires entre les deux groupes avec un patient dans le groupe Triclosan confirmé pour avoir une infection de la plaie (4,2%) et aucun dans le groupe antibiotiques intraveineux (p=0,27). L'infection de la plaie était de type superficiel qui s'est résolue avec le soin de la plaie en 1 mois. CONCLUSION: La suture enduite de triclosan peut être utilisée en toute sécurité comme alternative aux antibiotiques intraveineux pour la réparation par maille de la hernie inguinale. D'autres études sont nécessaires pour valider ce résultat. MOTS CLÉS: Hernie au triclosan, infection.

Comparative study of collagen and elastin content of abdominal wall fascia in inguinal hernia and non-hernia patients in an African population.

PURPOSE: Altered composition of collagen and elastin in abdominal fascia has been linked with the pathogenesis of hernias. This has not been studied amongst Africans who have hernia presentations which vary significantly from Caucasian cohorts. The aim of this study was to determine, and compare, the collagen and elastin contents of the transversalis fascia and rectus sheath of inguinal hernia patients with non-hernia controls. METHODS: Twenty-five patients with solitary, primary, uncomplicated inguinal hernia and twenty-five non-hernia controls were evaluated. Biopsies of the transversalis fascia and anterior rectus sheath were stained with Masson Trichrome and Verhöeff van-Gieson to isolate collagen and elastin respectively, which were quantified using the ImageJ/Fiji® image analysis software. RESULTS: Inguinal hernia patients were aged 19-85 years with a mean age of 45.2 years, mean body mass index (BMI) of 23.3 kg/m2 and mean duration of hernia of 42.5 months. Lateral hernias with no hernia defect or posterior wall defect [PL0] were the predominant clinical type. There were significantly lower collagen and higher elastin content in the transversalis fascia and rectus sheath of inguinal hernia patients [P < 0.001]. Regression analysis identified smoking and long duration of hernias as independent predictors of low collagen levels in this study CONCLUSION: Inguinal hernia patients in the study population demonstrated depleted collagen in the connective tissue of the inguinal canal. This might justify the routine use of prosthetic mesh for the reinforcement of the posterior wall during hernia repair.

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.

Daytime Versus Night-Time Emergency Abdominal Operations: Perspective from a Low-Middle-Income Country.

BACKGROUND: Emergency abdominal operations carry significant risk of mortality and morbidity. The time of the day when such operations are performed has been suggested as a predictor of outcome. A retrospective comparison of outcomes of daytime and night-time emergency abdominal operations was conducted. METHODS: Clinical data of patients who had abdominal operations over a five-year period were obtained. Operations were classified as 'daytime' (group A) if performed between 8.00 am and 7.59 pm or 'night time' if performed between 8.00 pm and 7.59 am (group B). Post-operative outcomes were compared. RESULTS: A total of 267 emergency abdominal operations were analysed: 161 (60.3%) were performed in the daytime while 106 (39.7%) were performed at night. The case mix in both groups was similar with appendectomies, bowel resections and closure of bowel perforations accounting for the majority. Baseline characteristics and intra-operative parameters were similar except that 'daytime' operations had more consultant participation (p = 0.01). Mortality rates (13.7% in group A and 12.3% in group B, p = 0.2), re-operation rates (9.3% in group A and 10.4% in group B, p = 0.7) and duration of hospital stay (group A-11.1 days, group B-12.4 days p = 0.4) were similar. ASA status, re-operation and admission into the intensive care unit were identified as predictors of mortality. CONCLUSION: Timing of emergency abdominal operations did not influence outcomes. In resource-limited settings where access to the operating room is competitive, delaying operations till daytime may be counterproductive. Patients' clinical condition still remains the most important parameter guiding time of operation.

Comparing Lichtenstein with darning for inguinal hernia repair in an African population.

PURPOSE: Being a relatively new entrant into our practice, mesh repair has not been compared with previously existing tissue-based techniques in our setting. This study is set out to compare darning with Lichtenstein technique of inguinal hernia repair in terms of frequency of post-operative complications, recovery and cost. METHOD: Patients with uncomplicated, primary inguinal hernia were randomized to have their hernias repaired either by the Lichtenstein or darning technique. Details of their socio-demographic, hernia characteristics and intra-operative findings were recorded. Postoperatively patients were assessed for pain, wound site complications and recurrence. Both direct and indirect costs were calculated. Mean duration of follow-up was 7.5 months. RESULT: Sixty-seven patients were studied. Thirty-three had Lichtenstein repair while 34 had darning repair. Lichtenstein repair was associated with less post-operative pain, less analgesic requirement, and shorter time of return to work activities, these were all statistically significant (p < 0.05). Frequency of post-operative complications was comparable in both groups with wound haematoma and scrotal oedema being the commonest. There was no recurrence in any of the groups. Total cost was comparable between the two groups. CONCLUSION: Lichtenstein is superior to darning in terms of post-operative recovery while both techniques are comparable in terms of frequency of early post-operative complications and total cost.

Early Experience with Stapled Gastrointestinal Anastomoses in a Nigerian Hospital.

BACKGROUND: Hand-sewn gastrointestinal anastomoses has been the traditional approach to gastrointestinal anastomosis in Nigeria while stapled anastomoses are infrequently performed in few centers. OBJECTIVES: To describe the outcome of our initial experience with stapled gastrointestinal anastomoses in a semi-urban patient population. PATIENTS AND METHODS: Consecutive patients who had stapled gastrointestinal anastomoses between January 2011 and June 2014 in a Nigerian tertiary hospital were prospectively evaluated. Indications for operation, procedures performed and anastomoses constructed and postoperative outcome of each patient were documented. RESULTS: Nineteen patients including seven males and 12 females had stapled anastomoses within the period. Their ages ranged between 41 and 68 (mean 52.5) years. Six (31.6%) Roux-en-Y gastrojejunostomies, 6 (31.6%) ileo-colic, 3 (15.8%) ileo-ileal, 2 (10.5%) colo-colic, and 2 (10.5%) colo-anal anastomoses were performed. Indications include antral gastric cancer in 4 (21.1%), right colon cancer 4 (21.1%), ileal perforations in 3 (15.8%) while 2 (10.5%) each had left colon cancer, common bile duct obstruction, rectal cancer and ruptured appendix. Mean duration of operation was 108 ± 46 min and mean duration of postoperative stay was 5 ± 2.6 days. No intraoperative complications were recorded and no anastomotic leakage occurred. At a median follow-up of 5 months no staple related stricture had occurred. CONCLUSIONS: Stapled gastrointestinal anastomoses are associated with a good outcome in our center. We propose a prospective, large-population randomized comparison of the technique with hand-sewn anastomoses.

Pattern and outcome of traumatic gastro- intestinal injuries in ile-ife.

AIMS AND OBJECTIVES: Trauma continues to assume a prominent role in the cause of disease in the developing world with increased westernization. This study highlights the pattern, management and outcome of gastrointestinal injuries following abdominal trauma in our hospital. PATIENTS AND METHODS: A descriptive retrospective study of all patients who had laparotomy following abdominal trauma at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife between January 2008 and April 2013. RESULTS: A total of 120 patients had laparotomy following abdominal trauma. Forty- five patients comprising 41 males and 4 females whose ages ranged between 14 and 65 years had gastrointestinal injuries. Majority (68.9%) were in the third and fourth decades with penetrating injury occurring in 55.6% .Causes of injury included gunshots (44.4%), road traffic accidents (37.8%), stabs (8.9%), falls (6.7%) and impalement (2.2%). The small intestine was the commonest site of injury (57.8 %) irrespective of the mechanism. Gut perforations accounted for 71.1% of all injuries. Two-thirds of patients had other associated injuries with retroperitoneal trauma being the commonest associated intra-abdominal injury. Majority (44.4%) had bowel resection and anastomosis with surgical site infection recorded in 35.6%. Overall mortality was 6.7% and this was significantly associated with pre-operative blood transfusion (p<0.05). CONCLUSION: Gut perforations from gunshot especially of the small intestine are the commonest gastro-intestinal injury in our setting. Pre-operative blood transfusion, perhaps indicating severity of injury, implies poor prognosis.

Incidental finding of complete situs inversus in a polytraumatized adult.

BACKGROUND: Situs inversus is a rare abnormality typically posing a diagnostic dilemma during routine evaluation of acute abdominal emergencies such as in acute appendicitis and cholecystitis. It is rare to detect such in the setting of trauma. OBJECTIVE: To report an incidental finding of complete situs inversus in a poly-traumatized adult. METHODS: The clinical records of the patient including preoperative evaluation, intra-operative findings and postoperative care were reviewed. RESULT: A 53 year old man presented with difficulty breathing, left sided chest pain, generalized abdominal pain and distension 18 hours after a vehicular road traffic accident. Examination revealed features of left sided haemothorax, absent heart sounds, generalized peritonitis and limb injuries. Plain chest radiograph confirmed left haemothorax with dextrocardia. He had a left closed thoracostomy tube drainage and exploratory laparotomy which revealed complete situs inversus of intra-abdominal organs alongside a jejunal perforation which was repaired. Postoperative recovery was uneventful. CONCLUSION: Complete situs inversus is uncommon and may not be anticipated in evaluation of trauma patients. Preoperative clinical and radiological evaluation may however be helpful in making a pre-operative diagnosis and further management.

Torsion of wandering spleen, an unusual cause of acute abdomen; a report of two cases.

BACKGROUND: Wandering spleen is an uncommon entity that is rarely considered in the evaluation of patients with acute abdominal conditions. OBJECTIVE: To report two cases of wandering spleen presenting with acute abdominal pain. METHODS: The clinical records of the patients including preoperative evaluation, intra-operative findings and postoperative care were reviewed RESULT: A 6 year old boy presented with right lumbar pain which worsened over a 36 hour period with findings of a tender right lumbar mass. Abdominal ultrasound showed a mass with echogenicity consistent with that of the spleen with no blood flow and an empty splenic bed. The pre-operative diagnosis was torsion of a wandering spleen. The second case was that of a 42 year old woman who presented with severe colicky lower abdominal pain which worsened over three days with a background history of progressively increasing lower abdominal mass which was tender and about 26 week gestational size at presentation. The initial diagnosis was torsion of an ovarian cyst. Abdomino-pelvic Ultrasound scan showed a heterogeneously hypo-echoic mass overlying the uterus and the left ovary with no blood flow. The presence of wandering spleen with torsion of the vascular pedicle was confirmed at laparotomy in both instances. Splenectomy was performed in both cases with good recovery. CONCLUSION: Torsion of a wandering spleen poses a diagnostic challenge. A high level of suspicion is required to make a diagnosis and institute appropriate treatment.