Hepatobiliary Findings in Nigerian Children with Sickle Cell Anaemia.

INTRODUCTION: Hepatobiliary abnormalities occur commonly in sickle cell anaemia and these have been extensively reported in the adult patients. However, complications have been sparsely reported in children especially in the sub-Saharan African continent. This study aimed to highlight the hepatobiliary complications in this group of children using clinical examination, laboratory testing and abdominal ultrasonography. The challenges in a resource limited country are also highlighted. SUBJECTS, MATERIALS AND METHODS: One hundred and thirty- four (134) children aged 1-18years with sickle cell anaemia in steady state were recruited into this crossectional study. Clinical history and physical examination obtained were documented. Relevant basic haematologic and biochemical indices (Full blood count, liver enzymes and viral markers for hepatitis B and C) and abdominal ultrasonographic parameters were documented for all the children. The relationship between the complications and possible risk factors (age, frequency of crisis and blood transfusions) were also documented. RESULT: Fifty-three (39.6%) of the children had hepatobiliary abnormalities. Chronic hepatitis B infection was the most prevalent complication (14.9%) seen followed by cholelithiasis (12.7%) and Hepatitis C infection (4.5%). Other complications identified were cholecystitis (3.0%), biliary sludge (1.5%), liver cirrhosis (0.7%). Age was significantly associated with viral hepatitis (p=0.003) and cholelithiasis (p=0.0007) and the conditions were more prevalent in the older age group. The hepatobilary complications were also more prevalent in the males. Frequent blood transfusions was significantly related to viral hepatitis (p=0.03). The use of hydroxyurea was not significantly related to any of the complications. CONCLUSION: Hepatobiliary abnormalities are prevalent in children with sickle cell anaemia. Clinical screening and the use of ultrasonography would aid early diagnosis and appropriate therapeutic intervention in this group of children.

INTRODUCTION: Les anomalies hépatobiliaires sont fréquentes dans la drépanocytose et ont été largement rapportées chez les patients adultes. Cependant, les complications ont été peu rapportées chez les enfants, en particulier sur le continent africain sub-saharien. Cette étude visait à mettre en évidence les complications hépatobiliaires dans ce groupe d'enfants en utilisant l'examen clinique, les tests de laboratoire et l'échographie abdominale. Les défis à relever dans un pays aux ressources limitées sont également soulignés. SUJETS, MATÉRIEL ET MÉTHODES: Cent trente-quatre (134) enfants âgés de 1 à 18 ans atteints de drépanocytose à l'état stable ont été recrutés dans cette étude transversale. L'histoire clinique et l'examen physique obtenus ont été documentés. Les indices hématologiques et biochimiques de base pertinents (numération globulaire, enzymes hépatiques et marqueurs viraux pour l'hépatite B et C) et les paramètres échographiques abdominaux ont été documentés pour tous les enfants. La relation entre les complications et les éventuels facteurs de risque (âge, fréquence des crises et des transfusions sanguines) a également été documentée. RÉSULTAT: Cinquante-trois (39,6 %) des enfants présentaient des anomalies hépatobiliaires. L'infection chronique par l'hépatite B était la complication la plus fréquente (14,9 %), suivie par la cholélithiase (12,7 %) et l'infection par l'hépatite C (4,5 %). Les autres complications identifiées étaient la cholécystite (3,0 %), les boues biliaires (1,5 %) et la cirrhose du foie (0,7 %). L'âge était significativement associé à l'hépatite virale (p=0,003) et à la cholélithiase (p=0,0007) et ces affections étaient plus fréquentes dans le groupe d'âge le plus élevé. Les complications hépatobiliaires étaient également plus fréquentes chez les hommes. Les transfusions sanguines fréquentes étaient significativement liées à l'hépatite virale (p=0,03). L'utilisation de l'hydroxyurée n'était pas significativement liée à aucune des complications. CONCLUSION: Les anomalies hépatobiliaires sont prévalentes chez lesenfants atteints de drépanocytose. Le dépistage clinique et l'utilisation de l'échographie permettraient un diagnostic précoce et une intervention thérapeutique appropriée chez ce groupe d'enfants. MOTS CLÉS: Hépatobiliaire, complications, enfants, drépanocytose, Nigeria.

Expanding access to surgical care toward universal health coverage: Leveraging sustainable financing strategies for Sub-Saharan Africa.

The National Surgical Obstetric and Anaesthesia Plan is an invaluable country resource with the capacity to promote increased access to safe and affordable surgical and anaesthesia care if implemented. Although cost of implementation is only a fraction of Health Sector Strategic Plan cost in the countries with costed plans, it is important that the funding of the plans is based on sustainable financing strategies. This will ensure appropriate and timely implementation and sustainability of the plan itself. The aim of this review was to discuss and make recommendations on innovative and sustainable strategies for financing national surgical plans in sub-Saharan Africa.

Scholarly Activities Participation among Surgical Resident Doctors in Nigeria.

BACKGROUND: Scholarly activity in various forms are academic deeds such as researches and research outputs in articles, oral presentations, publications and theses which are disseminated and peer- reviewed. OBJECTIVES: This study aims to assess the level of participation of residents in scholarly activities including their attendance of national and international conferences during residency training. METHODS: This was a descriptive cross-sectional study of 81 resident doctors in General and Orthopaedic surgery, who attended the revision courses organized by their Faculties. Self-administered structured questionnaires were used to collect data. Data obtained was analyzed using SPSS version 21.0. RESULTS: The mean age of the respondents was 34.1 ± 4.5 years, and age ranged from 26 years to 48 years. The male: female ratio was 12.5:1. The average number of years of respondents in residency programme was 3.9 ± 1.8 years. 80.3% of the residents had participated in research since commencement of their residency. Only 18.5% of the resident doctors had any publications in a peer-reviewed journal. While 51.9% of residents had attended local and national conferences since the beginning of their training, only 17.3% had had oral and/or poster presentations at local conferences. No resident involved in this study had oral or poster presentation done at any of the international conferences attended, despite an attendance rate of 12.3%. CONCLUSION: Resident doctors should be encouraged to participate in researches and to publish their works. They should also be encouraged to present their works at conferences.

H-type tracheo-oesophageal fistula: a diagnostic challenge in a resource-poor country. A case report.

H-type fistula is a rare form of congenital tracheo-oesophageal fistula accounting for 4% of all cases of Tracheo-oesophageal fistula. The typical picture is that of recurrent chest infection due to both missed and delayed diagnosis as well as cyanosis and choking during feeds. In resource poor countries this problem is further exaggerated by ignorance, poverty and lack of access to basic investigative modalities. This is the case of [abstract incomplete].