Myasthenia Gravis with Toxic Goiter: Challenges with Management in a Low-Resource Setting in Africa; Review of Literature and Case Report.

ABSTRACT: Myasthenia gravis (MG) is an antibody-mediated autoimmune disease with the cardinal feature being exertional voluntary skeletal muscle weakness and fatigability. It can be an isolated finding or in association with other autoimmune conditions such as Hashimoto's thyroiditis, Graves' disease, systemic lupus erythematosus (SLE), or rheumatoid arthritis. Thymectomy is recommended for most patients with MG whose symptoms begin before the age of 60 years. Patients with thymoma or thymic hyperplasia do respond to thymectomy compared to those without thymoma or enlarged thymus. Those with enlarged goiter would benefit from thyroidectomy. The management of these patients requires a multidisciplinary approach as performed in a low-resource setting. We are reporting the case of a 24-year-old who presented with MG with toxic goiter and had good control on medication. A computed tomography scan of the chest showed a superior mediastinal mass and a soft tissue scan of the neck was done which showed a diffusely enlarged thyroid gland. She subsequently had thymectomy and subtotal thyroidectomy with a satisfactory outcome. We highlight this case to show that MG with thymoma and goiter could coexist. Reports of such findings are infrequently reported in our environment.

High-Impact Medical Education in Basic Life Support: A Comparative Study of Doctors and Medical Students in a Tertiary Hospital.

INTRODUCTION: Although very crucial in medicine, mastery of cardiopulmonary resuscitation remains poor in many low and-medium income countries (LMICs) due mainly to the lack of readily accessible training facilities and expertise. SUBJECTS AND METHODS: The current study was aimed at evaluating the knowledge of Basic Life Support (BLS) among senior-level medical students and doctors in Nigeria, as well as to evaluate the value of a video teaching method in improving the knowledge base of BLS. It was a two-cohort prospective study carried out over a duration of one month. Each group of participants had an initial assessment of their knowledge of Basic Life Support using a questionnaire. Thereafter, the 45-minute CHEMPIONS-BLS video was projected. On completion of the video session, the same questionnaire was again administered to each group of participants. This was followed by a practical, hands-on workshop at the skills laboratory. Data was collected using the questionnaires and comparisons were made between the pre and post-test responses. RESULTS: Seventy-five medical students and 41 doctors were enrolled into this study. Overall, their knowledge of BLS and their exposure to previous BLS training were poor, but there was a significant improvement in the mean scores, and the overall performance after viewing the video just one time; t = 27.30, p = .000 and χ² = 116.01; p = .000 respectively. CONCLUSION: This study reveals poor knowledge and exposure to basic life support training among both medical students and practicing doctors. It further reveals the value of a novel training method in improving BLS knowledge.

INTRODUCTION: Bien que cruciale en médecine, la maîtrise de la réanimation cardio-pulmonaire reste faible dans de nombreux pays à revenu faible et moyen (PRFM), principalement en raison du manque d'infrastructures de formation et d'expertise facilement accessibles. SUJETS ET MÉTHODES: La présente étude visait à évaluer les connaissances en matière de réanimation cardio-pulmonaire de base (Basic Life Support - BLS) parmi les étudiants en médecine et les médecins au Nigeria, ainsi qu'à évaluer la valeur d'une méthode d'enseignement par vidéo pour améliorer la base de connaissances en BLS. Il s'agissait d'une étude prospective à deux cohortes menée sur une durée d'un mois. Chaque groupe de participants a fait l'objet d'une évaluation initiale de ses connaissances en matière de réanimation cardio-pulmonaire à l'aide d'un questionnaire. Ensuite, la vidéo CHEMPIONS-BLS de 45 minutes a été projetée. À l'issue de la séance vidéo, le même questionnaire a été administré à chaque groupe de participants. Cette séance a été suivie d'un atelier pratique au laboratoire de compétences. Les données ont été collectées à l'aide des questionnaires et des comparaisons ont été faites entre les réponses avant et après le test. RÉSULTATS: Soixante-quinze étudiants en médecine et 41 médecins ont participé à cette étude. Dans l'ensemble, leur connaissance du BLS et leur exposition à une formation BLS antérieure étaient faibles, mais il y a eu une amélioration significative des scores moyens et de la performance globale après avoir visionné la vidéo une seule fois ; t = 27,30, p = .000 et χ² = 116,01 ; p = .000 respectivement. CONCLUSION: Cette étude révèle que les étudiants en médecine et les médecins en exercice ont une connaissance et une exposition insuffisantes à la formation aux soins de base en réanimation. Elle révèle également l'intérêt d'une nouvelle méthode de formation pour améliorer les connaissances en matière de BLS. Mots clés: Soins de base en réanimation (BLS), Réanimation cardiopulmonaire (RCP), Éducation médicale, Arrêt cardiaque extrahospitalier (OHCA), Formation post-COVID, Formation médicale continue (FMC), Hôpital universitaire spécialisé d'Irrua (ISTH), Le Nigeria.

Management of a huge intrathoracic goitre in a rural specialist hospital in Nigeria-Case report and review of literature.

Retrosternal goiter is expectedly a common presentation in rural African communities due to long periods of neglect. The treatment of choice is surgical - commonly via a trans-cervical incision. A few require an extra-cervical surgical approach and multidisciplinary management as reported in this case performed in a rural specialist hospital in Nigeria.

Buccal mucosal graft urethroplasty for proximal bulbar urethral stricture: A revisit of the surgical technique and analysis of eleven consecutive cases.

BACKGROUND: Urethral stricture disease is prevalent, and many surgical techniques have been developed to treat it. Currently, urethroplasty for bulbar strictures implies ventral or dorsal stricturotomy and a buccal mucosa graft (BMG) patch. OBJECTIVE: To describe the surgical approach of the ventral patch BMG urethroplasty for proximal bulbar urethral stricture and to analyze 11 consecutive cases for whom the technique was used. PATIENTS AND METHODS: The diagnosis of urethral stricture was confirmed with a combined retrograde urethrography and micturating cystourethrography. A single team exposed the urethra, harvested, and planted the BMG in the lithotomy position under general anesthesia. The oral preoperative preparation was done with oraldene (hexetidine) mouth wash three times daily beginning from the 2nd preoperative day. The buccal mucosa was harvested from the left inner cheek in all the patients. The donor site was left unclosed but packed with wet gauze. Data related to age, preoperative adverse conditions, stricture length, urine culture result, perineal/oral wound complications, postoperative residual urine volume, and duration of hospital stay were recorded. RESULTS: Eleven patients with proximal bulbar urethral stricture had BMG urethroplasty from August 2013 to October 2015. Stricture length ranged from 2 to 5 cm. In six (54%) of the men, the stricture resulted from urethritis thereby constituting the most common etiology of urethral stricture in this study. The preoperative adverse conditions were age above 70 in three, diabetes mellitus in two, severe dental caries in one, and recurrent stricture in two. All of them were able to resume reasonable oral intake 72 h postoperatively. One (9.2%) had perineal wound infection, while two (18.2%) still had mild pain at donor site 4 weeks postoperatively. Ten (90.9%) of the 11 patients had <30 ml residual urine volume at 2 months of follow-up. CONCLUSION: Urethritis is still a common cause of urethral stricture in this rural community. Ventral onlay buccal mucosal graft urethroplasty for proximal bulbar urethral stricture is safe, even in certain adverse preoperative conditions. Buccal mucosa from the cheek is however now preferred.

Comparative study of the haemodynamic effects of propofol and thiopentone in modified electroconvulsive therapy in Nigerians.

BACKGROUND: Electroconvulsive therapy provokes abrupt changes in systemic haemodynamics. We compared the effects of propofol and thiopentone on haemodynamic responses of patients scheduled for ECT between September 2008 and March 2009 in two Nigerian tertiary hospitals. METHODS: In a prospective, randomized study, 40 patients scheduled for ECT were allocated into 2 groups of 20 each. Anaesthesia was induced with either 1mg/kg propofol (PG) or 5 mg/kg thiopentone (TG) and 0.5mg/kg suxamethonium prior to ECT. Heart rate (HR), blood pressure- systolic (SBP), mean arterial (MAP) and diastolic (DBP) were taken before ECT and at 1 and 5 minutes postictal. The means of the increases in haemodynamic parameters were compared. RESULTS: There were significant increases in mean HR in both groups at 1 and 5 min and the increases were comparable between the 2 groups (p = 0.784). The increases in SBP were not significant in both groups and were comparable (p = 0.988). The increases in mean DBP were not significant in both groups but it was significantly greater in TG (p = 0.012). Increase in MAP was significantly greater in the TG at 1 min (p = 0.028). CONCLUSION: Propofol at 1 mg/kg and thiopentone at 5 mg/kg used for modified ECT in this study resulted in significant increases in heart rates. However, a significant increase in mean arterial pressure with thiopentone and a significantly greater increase in diastolic blood pressure when the two agents are compared confer some superiority on propofol over thiopentone in attenuating haemodynamic responses to ECT.