Pattern of indications for tracheostomy in a tertiary hospital in South Western Nigeria.

Introduction: Tracheostomy is a life-saving procedure; the benefits and frequency of procedures being performed have led to frequent reviews of indication in many regions of the world. The aim is to establish the indications, diagnosis and complications of tracheostomy performed in the past 10 years in a tertiary hospital in Lagos. Methods: This is a 10-year retrospective study of all patients who had tracheostomies for various indications from 2010 to 2019. Patient medical records were analysed for demographic profile, diagnosis, indication, elective or emergency tracheostomy, surgeon's rank, technique of decannulation and type of complications. All the variables in the data were imputed and analyzed using the IBM Statistical Package for the Social Sciences version 27. Continuous variables were presented as mean and standard deviation, whereas categorical variables were presented as frequency and percentage. Results: Four hundred and eighty-six tracheostomies were carried out during the period under review, and 440 patients had complete data retrieved. The age group of 0-9 years constituted the most common age for tracheostomy (18%). The most common indication for tracheostomy was for relief of upper airway obstruction in 53.4%. Neoplasms (40%) and trauma (30.7%) constituted primary diagnosis requiring tracheostomies. Amongst the paediatric age group with upper airway obstruction, infections (31.8%) and foreign body inhalation (24.3%) constituted the most common primary diagnosis. Stoma infection and peristomal granulation tissue were the most common early complication (21.8%) and late complication (43.4%), respectively. Conclusion: Relief of upper airway obstruction from neoplasm remains the most common indication for tracheostomy, and peristomal granulation infection was the most common complication.

Quality of Life and Life after Amputation among Amputees in Lagos, Nigeria.

Background: Amputation is a life-changing surgical procedure that can cause significant disruptions in the quality of life of an individual. Objectives: This study aimed to evaluate the quality of life of patients with limb amputations in Lagos. Materials and Methods: This was a cross-sectional study carried out among amputees recruited from two tertiary institutions and roadsides in Lagos state. A structured interviewer-administered questionnaire was used to collect data on demography, medical history, and postamputation health status. Also, a short form (SF-12V2) health questionnaire was used to assess their quality of life. Results: Two hundred and fifty-four (254) subjects with extremity amputation, aged 18-75 years with a mean age of 47.82 ± 11.53 years were studied. The male-to-female ratio was 1.4:1. The commonest age group of the amputees was 45-60 years (52%). The commonest indication for amputation was diabetic gangrene (126 [49.6%]) and trauma (90 [35.4%]). Postamputation, 98 (38%) were employed, and 117 (75%) of those unemployed resorted to begging as a means of livelihood. While 57 (22.4%) used prostheses frequently, 68 (26%) did not want prostheses as they supposed that it negatively affected their begging business. Female amputees have a statistically significantly better quality of life than males in the physical (r = 0.03) and mental components (r = 0.04). Conclusions: A proper rehabilitation program, the use of prostheses, and adequate employment opportunities would improve the quality of life of amputees.

Audiologic Screening of People with Down Syndrome in Special Schools in Surulere Lagos, Nigeria.

Background: Down syndrome (DS) is associated with a high incidence of ear pathologies and hearing loss. There is a paucity of information on the audiology of people with DS particularly those in special schools in Nigeria. This study aimed to compare pneumatic otoscopy with tympanometry for middle ear screening and pure tone audiometry (PTA) with distortion product otoacoustic emission (DPOAE) for hearing screening in the different age groups of people with people DS. Methodology: People with DS in two special schools for people with intellectual disability in Surulere, Lagos state were selected based on the schools' record and their phenotype. Otoscopy, pneumatic otoscopy, tympanometry, screening PTA and screening DPOAE were performed on the subjects. Results: 52 subjects aged 6 to 36years and an M: F ratio of 1.5:1 were studied. 82.7% of subjects had wax impaction. The prevalence of otitis media with effusion (OME) by pneumatic otoscopy was 57.8% and 40.2% by tympanometry and the same number of subjects performed both tests successfully. Screening PTA and DPOAE were successfully performed on 32.7% and 94.2% of the subjects respectively. Fail rate of 29.4% by PTA and 65.3% by DPOAE were recorded. Conclusion: Regular ear check-up in people with DS is essential for the detection and treatment of ear wax, OME and hearing impairment which is highly prevalent in them. Pneumatic otoscopy is recommended for the detection of OME in all the age groups. Screening PTA and OAE are recommended for adults and children and non-cooperative adults hearing screening respectively.

Correlation of Nasal Endoscopy and Computed Tomography Scan Findings in Adult Patients With Chronic Rhinosinusitis.

Background: The diagnosis of chronic rhinosinusitis (CRS) is usually based on appropriate clinical features. However, confirmation is based on the evidence of features of inflammation on nasal endoscopy and/or computed tomography (CT) scan of the paranasal sinuses. Though CT scan is the gold standard, studies have found nasal endoscopy equally helpful and sometimes complementary to CT scan in the diagnosis of CRS. Aims and Objectives: The aim of this study is to assess and correlate the findings on nasal endoscopy and CT scan of adult patients with CRS. Materials and Methods: Consecutive adult patients clinically diagnosed with CRS were enrolled. Those who did both nasal endoscopy and CT scan of the paranasal sinuses within 3 months' interval were studied. The findings were correlated. Results: The commonest symptoms were rhinorrhea and nasal obstruction seen in 95% and 92.5% of the patients. Purulent discharge in the middle meatus was the commonest finding on nasal endoscopy seen in 56.7% of the patients. There was pathology of at least one paranasal sinus in 71.7% of the patients on CT scan. Maxillary sinus was most commonly affected. Obstruction of the osteomeatal complex was present in 51.7% of the patients. The sensitivity, specificity, positive, and negative predictive values of nasal endoscopy were 73.3%, 85.3%, 92.7%, and 55.8%, respectively. Conclusion: The presence of cream-coloured discharge in the middle meatus on nasal endoscopy is a good predictive index in the diagnosis of CRS, whereas sinus intraluminal lesions are better elucidated by CT scan.

Infantile supratentorial subdural empyema managed by percutaneous aspiration: an outcome study in a Nigerian city.

Subdural empyema (SDE), a common neurosurgical emergency in the developing countries, accounts for 15%-20% of localised paediatric intracranial infections. In regions where modern diagnostic tools are scarce and inaccessible, detection of SDE may be delayed with subsequent poor outcome. Percutaneous subdural aspiration in patients with open anterior fontanel may be the only surgical option in resource-poor regions of the world. This review focuses on the management outcome, including neurological outcome of these children. Clinical charts of children with SDE and treated by percutaneous subdural tap between February 2006 and August 2014 were reviewed. Demographic, clinical, radiological, bacteriological parameters and outcome data were analysed. Forty-five children with a mean age of 10.6 ± 6.2 months (range: 2-17 months) and followed up for a median duration of 16.4 months were included. The most frequent clinical features were enlarged head circumference, fever, focal neurologic deficits and altered level of consciousness. Diagnosis of SDE was confirmed using trans-fontanel ultrasound scan in 32 (71.1%) children, computerised tomography in 12 (26.7%) children and magnetic resonance imaging in one (2.2%) child. SDE was unilateral in 73.3% and bilateral in 26.7%. In 23 (51.1%) children with a positive culture, Staphylococcus aureus (n = 10), anaerobes (n = 7), Escherishia coli and Haemophilus influenza (n = 6 each) were the most common organisms. Forty-three children (95.6%) survived, 36 of which had good Glasgow outcome score. Seven children still had moderate deficits at 3 months. Treatment of SDE in young children with patent fontanel using percutaneous subdural tap has good therapeutic and neurological outcome.

Impact of emotional distress on caregivers burden among Nigerian children with Obstructive Adenotonsillar hypertrophy.

BACKGROUND: Despite the significance of the role of caregivers among children with Obstructive Adenotonsillar hypertrophy (OAT), their caregiving experience and emotional well-being are given poor attention in research, policy and service design. This study represents a novel effort sought to investigate the burden experienced by caregivers of children with OAT and the impact of emotional distress on their caregiving burden. METHODOLOGY: A total of one hundred consecutive caregivers of children with OAT were interviewed with designed socio-demographic questionnaire. This was subsequently followed by administration of General Health Questionnaire-12 (GHQ-12) to ascertain emotional distress using cut-off score ≥ 3 and Zarit Caregivers Burden of care scale was used to characterize the pattern of burden experienced by these caregivers. RESULTS: In this study, the mean ages of children with OAT and their caregivers were 36.7(± 21.8) months and 34.4(± 5.4) years, respectively. The affected children were mainly males (68%), while their caregivers were predominantly females (84%). Fifty-seven percent of children with OAT were schooling but 13% of them had academic delay. Majority of the caregivers (66%) had a tertiary level of education. Of the total participants, up to 43% reported various degrees of burden of care, with majority (34%) of them reporting mild to moderate burden of care. In the same vein, 48% were emotionally distressed. Following regression analyses, emotional distress was independently associated with burden of care among participants (Odds ratio [OR]=0.108; 95% Confidence Interval [95% CI]=0.043-0.272; p < 0.001). CONCLUSION: Caregivers of children with OAT reported the experience of various degrees of burden, and worse among caregivers with emotional distress. Overall, the level of distress and burden observed in this study were many-fold what has been reported among caregivers of other populations of children. The results of this study support the proposal of proactive measures to address the psychosocial needs of caregivers as integral to the care of children with OAT. Further research on the well-being of caregivers is also justified.