Paediatric Acute Appendicitis: A Comparison of Diagnostic Accuracy of Three Pre-operative Diagnostic Modalities.

Introduction: The diagnosis of acute appendicitis (AA) is usually clear cut but sometimes there is atypical presentation of this condition in children. There is a need to determine and compare the diagnostic accuracy of these three pre-operative diagnostic modalities: Paediatric Appendicitis Score (PAS), abdominal ultrasonographic scan (USS) findings, and serum C-reactive proteins (CRPs). The objective of this study was to determine the diagnostic accuracy of the three diagnostic modalities and to compare each diagnostic test result with the histopathological results of the appendix specimens. Materials and Methods: This was a prospective cross-sectional study that involved children aged 4-15 years with suspected AA who presented at the emergency paediatric unit of a tertiary health care hospital in North Central, Nigeria. The PAS, quantitative serum CRP, and abdominal USS were performed for all eligible patients. Results: A total of 43 patients were included in this study. Forty appendicectomy specimens (93%) were histologically confirmed to be AA and three appendicectomy specimens (7%) were normal appendix. The diagnostic accuracy values of PAS, abdominal USS, and CRP were 95.3%, 93.0%, and 90.7%, respectively. Conclusion: This study demonstrated that PAS, abdominal USS, and serum CRP provided useful diagnostic accuracy for AA in children.

Pediatric Groin Surgeries: A Comparison of Analgesic Effects of Caudal Block and Inguinal Field Block Using Plain Bupivacaine.

Introduction: There is a paucity of studies in the West African sub-region which have compared both the intraoperative and postoperative analgesic effects of caudal block and inguinal field block using plain bupivacaine in groin surgeries in children. The study aimed to compare the duration of analgesia and complications of caudal block and inguinal field block in pediatric groin surgeries. Patients and Methods: This was a prospective, double-blind randomized study conducted at a tertiary health institution in North Central, Nigeria, over a period of 6 months. A total of 74 children scheduled for day case groin surgeries for inguinal hernia, hydrocoele and palpable undescended testis were recruited into the study. The effectiveness of the analgesic effect was assessed by measuring serum cortisol levels before surgery (i.e. baseline at 8am), 5minutes after caudal block or inguinal field block, and 1-hour after surgery. Post-operative pain was determined using FLACC score (Face, Legs, Activity, Crying and Consolability) every 15 minutes till 6 hours after surgery when the patients were discharged home and the caregivers measured the patients' pain scores using the FLACC score every 1 hour to a maximum duration of 10 hours after surgery. Data obtained from the study was entered into the study proforma and analysed using IBM SPSS version 21.0. The P value was considered statistically significant at <0.05. Results: A total of 74 patients were recruited for this study, with 68 males (91.9%) and 6 females (8.1%). The children's age range was 6 months to 7 years, with a mean age of 3.35 ± 1.90 years. The mean basal serum cortisol levels of the caudal block group and inguinal block group were 11.15 ± 5.38 µg/dL and 10.79 ± 4.92µg/d respectively (p-value = 0.767). Five minutes after caudal block, the mean serum cortisol level was 10.50 ± 5.39µg/dL while inguinal field block was 10.63 ± 4.68µg/dL (p-value = 0.288). The mean serum cortisol level obtained one hour after each procedure was 9.34 ± 4.05 µg/dL for the caudal block group and 10.00 ± 3.56 µg/dL in the inguinal field block group with p-value = 0.275.Using the FLACC score, the mean duration of analgesia in caudal block group was 372.00 ± 71.55 minutes and was inguinal field block group was 387.43 ± 62.65 minutes with a p-value = 0.116. There was no anaesthetic technique related complications that was recorded in both caudal block group and inguinal group during the study period. Conclusion: This study demonstrated that caudal block and inguinal field block using plain bupivacaine provided comparable duration of analgesia in paediatric groin surgeries. Therefore, caudal block or inguinal field block using plain bupivacaine should be recommended for both intraoperative and postoperative analgesia in elective paediatric groin surgeries.

Host, vehicular and environmental factors responsible for road traffic crashes in a Nigerian city: identifiable issues for road traffic injury control.

INTRODUCTION: Road traffic injury (RTI) has assumed major public health importance world-wide and the burden is heavier on the health-care infrastructure of countries in Sub-Saharan Africa. In Nigeria, RTI is the leading cause of trauma related morbidity and mortality. While there are some published epidemiological reports on RTI in the region, studies on the mechanism of causation of road traffic crashes (RTC) are not available. METHODS: Over a 9-month period, we prospectively captured the 571 victims of RTC presenting to a single tertiary health care center in Nigeria. Data collected include demographic data, Mechanism of causation of RTC, Injuries sustained and outcomes. RESULTS: Over three-quarters of the victims are young people and half were either traders (27.5%) or students (20%). Pedestrians, motorcycle riders and open truck occupants (people sitting at the rear loading compartment of trucks) often had fatal injuries. Analysis of collision patterns showed that lone crashes were the most frequent though car-to-motorcycle crashes caused a quarter of the deaths. Host factors (over-speeding driver, driver misjudgment, sleeping driver etc.) were responsible for four-fifths of the crashes while vehicular and environmental factors accounted for the remaining. On binary regression analysis, head injured victims had higher odds of dying than the non-head injured (Odds ratio = 6.5). CONCLUSION: This paper elucidates the mechanisms of causation of and types of injuries sustained following RTC in Nigeria and thus provide opportunities for prevention and control of this unacceptable situation.

Community-based study of circumcision practices in Nigeria

Background: Circumcision practice around the world has various implications and has generated a lot of debate about the pros and cons of the practice. Nigeria is one of the countries where male and female circumcision practice still occurs however, there has been claim of reduction in female genital cutting. Congregational or 'group' circumcision prevails in some communities as a means of upholding traditions and commemoration of festive period. Objective: To determine the pattern of circumcision practice and identify factors affecting the practice in Ilorin community. Materials and Methods: The study was a descriptive, cross sectional study conducted among parents of under-5 children of both the sexes using pre-tested, semi-structured questionnaires, which were administered to the respondents by trained research assistants over a six-week period. Clinical examination of genital area in index child of each respondent was done by a pediatric surgeon, who was the principal investigator. Results: Three hundred and ninety three (93%) respondents completed the questionnaire and the same number of index children's external genitalia was examined by the pediatric surgeon. The mean age of respondents was 33.2±9.3 years, and the main source of family income was private enterprises and civil services. The circumcision status of fathers was 100%, mothers, 65.6%, and overall female-child circumcision rate was 46.7%. Though, most of the index children were delivered at health centers (72.3%), the circumcisions were performed at almost equal frequencies by traditional circumcisionists (39.8%) and doctors (39.2%), with more than half of the circumcision being done outside the hospital. The mean age at circumcision was 22 ±0.69 months, with 73.9% of girls as against 91.7% boys being circumcised by the age of five years. Family choice was the main determinant of the age at circumcision and the circumcisionist. Female circumcision was done by traditional circumcisionist, nurses, and doctors in 1 in 4, 1 in 5, and 1 in 10 cases of circumcision, respectively. Traditional open (classical) circumcision technique was mostly used (40.4%), followed by Plastibel TM (ring type) (32.6%), and 'group' circumcision was practiced among 41.2% of respondents. Post-circumcision complications were seen in 116 (33.7%) of circumcised children examined. Conclusion: Circumcision practice in Ilorin is still higher among the traditional circumcisionists, despite of high hospital delivery. Female circumcision and 'group' circumcision were also being practiced, using mainly the traditional open circumcision technique. The high rate of circumcision complications indicate the need for proper enlightenment and retraining of health care providers and traditional circumcisionists on the safe methods available. The government should involve the religion and opinion leaders in the community to assist in the prevention of negative and harmful traditional practices including female circumcision

Nonfluoroscopic pressure colostography in the evaluation of genitourinary fistula of anorectal malformations: experience in a resource-poor environment.

BACKGROUND: Radiological imaging is paramount for defining the genitourinary fistulae commonly associated with anorectal malformations prior to definitive surgery. The imaging options are resource-limited in many parts of the world. Nonfluoroscopic pressure colostography after colostomy is a cheap method for the evaluation of anorectal malformations. OBJECTIVE: To describe our experience with nonfluoroscopic pressure colostography in the evaluation of anorectal malformations in boys. MATERIALS AND METHODS: The study included 12 boys with anorectal malformation who had colostomy and nonfluoroscopic pressure-augmented colostography with water-soluble contrast medium between January 2006 and December 2007. RESULTS: Patient ages ranged from 2 days to 1 year. The types of genitourinary fistula were rectovesical (7.7%) and rectourethral (92.3%). Oblique radiographs were of diagnostic value in all patients. The types of anorectal malformations were high, intermediate and low in 75%, 8.3% and 16.7%, respectively. Short-segment urethral constriction was a common feature of rectourethral fistula (75%, n=9). CONCLUSION: Our experience has shown that genitourinary fistulae associated with anorectal malformations can be demonstrated reliably by nonfluoroscopic pressure colostography with two oblique radiographs, providing an option in resource-poor settings where fluoroscopic equipment is scarce.