Retroperitoneal paraganglioma in a young patient presenting with hypertensive crisis and transient loss of sight; a rare case report and literature review.

INTRODUCTION: Catecholamine secreting tumors are a rare type of neuroendocrine tumors whose embryological origin is neural crest cells. 80 % to 90 % arise from the chromaffin cells of adrenal medulla while 10 % to 20 % arise from sympathetic and parasympathetic ganglia. Paragangliomas can be symptomatic due to excess catecholamine secretion or can be asymptomatic. Definitive treatment of paragangliomas is surgical resection. CASE: A 16 yr old male who presented with right iliac fossa pain and hypertension associated with headache and transient loss of sight. Contrasted CT scan of the abdomen revealed a para-aortic retroperitoneal mass, 24 h urine Normetanephrines were significantly elevated. Pre-operative patient preparation included administration of alpha blockers then later beta blockers with adequate hydration. Intra operative blood pressure elevation during tumor manipulation managed with intravenous beta blockers. Post operatively patient required no inotropic support or anti hypertensives. Histopathology revealed features suggestive of a paraganglioma and immunohistochemistry s100 (+) Chromogranin A (+). DISCUSSION: Functional paragangliomas are manifested by symptoms that result from catecholamine hypersecretion. Biochemical confirmation and functional localization of the tumors is recommended. Definitive management is surgical resection with a pre requisite of adequate patient preparation which includes blood pressure control and volume replacement. CONCLUSION: Tumor localisation and adequate patient preparation with alpha blockers and adequate hydration is an important prerequisite to surgical resection.

Living with a hernia: A qualitative study of patient experience of abdominal wall hernias in Ndola, Zambia.

Despite hernias being one of the most common surgical problems in low and middle income countries, very little is known about the impact that having a hernia has on the quality of life of patients in these settings. We performed a pilot study to understand how living with a hernia impacts on the quality of life. Twelve semistructured interviews were performed. A number of themes were identified. These demonstrated the significant impact on physical health, ability to work, psychological health and social relationships. Further work is required to better understand the patient perspective and ensure that hernia operations improve quality of life in these settings.

Understanding surgical education needs in Zambian residency programs from a Resident's perspective.

INTRODUCTION: Approximately 100 surgeons in Zambia serve a population of 16 million, a severe shortage in basic surgical care. Surgical education in Zambia and other low-middle income countries has not been well characterized. The aim of this study was to evaluate surgical training resources from a resident perspective. METHODS: 6 of 8 COSECSA-accredited major medical centers were included. We developed a Surgical Education Capacity Tool to evaluate hospital characteristics including infrastructure, education, and research. The questionnaire was completed by administrators and trainees. RESULTS: 18 of 45 trainees were surveyed. Caseloads and faculty-to-trainee ratio varied by location. No sites had surgical skills, simulation, or research labs. Most had medical libraries, lecture halls, and internet. Outpatient clinics, bedside teaching, M&M conferences, and senior supervision were widely available. Despite some exposure, research mentorship, basic science, and grant application guidance were critically limited. CONCLUSIONS: Lack of access to proper infrastructure, research, and personnel all impact surgical training and education. The Surgical Education Capacity Tool offers insights into areas of potential improvement, and is applicable to other LMICs.

A multimodal infection control and patient safety intervention to reduce surgical site infections in Africa: a multicentre, before-after, cohort study.

BACKGROUND: Surgical site infections (SSIs) are the most frequent health-care-associated infections in developing countries. Specific prevention measures are highly effective, but are often poorly implemented. We aimed to establish the effect of a multimodal intervention on SSIs in Africa. METHODS: We did a before-after cohort study, between July 1, 2013, and Dec 31, 2015, at five African hospitals. The multimodal intervention consisted of the implementation or strengthening of multiple SSI prevention measures, combined with an adaptive approach aimed at the improvement of teamwork and the safety climate. The primary outcome was the first occurrence of SSI, and the secondary outcome was death within 30 days post surgery. Data on adherence to SSI prevention measures were prospectively collected. The intervention effect on SSI risk and death within 30 days post surgery was assessed in a mixed-effects logistic regression model, after adjustment for key confounders. FINDINGS: Four hospitals completed the baseline and follow-up; three provided suitable (ie, sufficient number and quality) data for the sustainability period. 4322 operations were followed up (1604 at baseline, 1827 at follow-up, and 891 in the sustainability period). SSI cumulative incidence significantly decreased post intervention, from 8·0% (95% CI 6·8-9·5; n=129) to 3·8% (3·0-4·8; n=70; p<0·0001), and this decrease persisted in the sustainability period (3·9%, 2·8-5·4; n=35). A substantial improvement in compliance with prevention measures was consistently observed in the follow-up and sustainability periods. The likelihood of SSI during follow-up was significantly lower than pre-intervention (odds ratio [OR] 0·40, 95% CI 0·29-0·54; p<0·0001), but the likelihood of death was not significantly reduced (0·72, 0·42-1·24; p=0·2360). INTERPRETATION: Implementation of our intervention is feasible in African hospitals. Improvement was observed across all perioperative prevention practices. A significant effect on the overall SSI risk was observed, but with some heterogeneity between sites. Further large-scale experimental studies are needed to confirm these results and to improve the sustainability and long-term effect of such complex programmes. FUNDING: US Agency for Healthcare Research and Quality, WHO.

Surgical registrars' perceptions of surgical training and capacity in Zambia: Results from three COSECSA affiliated training hospitals.

BACKGROUND: Surgery is a vital component of a comprehensive health system, but there are often personnel limitations in resource constrained areas. Zambia provides post graduate surgical training through two systems to help address this shortage. However, no studies have analyzed surgical trainees' perceptions of these programs. METHODS: Surgical registrars at COSECSA affiliated hospitals in Zambia were surveyed about their programs. Responses were analyzed to identify key strengths and challenges across several categories including: operative training, clinical training, educational experiences, and career plans. RESULTS: Registrars report having significant independence and receiving broad and high quality operative training. They note specific challenges including limitations in specialty training, resources, and infrastructure. CONCLUSIONS: Zambian training programs have the potential to increase number of surgeons in Zambia by a significant amount in the coming years. These programs have many strengths but also face challenges in their goal to expand surgical access in the country.

Nutritional risk and associated factors of adult in-patients at a teaching hospital in the Copperbelt province in Zambia; a hospital-based cross-sectional study.

BACKGROUND: Nutritional risk and undernutrition are common problems among medical and surgical patients. In hospital, malnutrition is frequently under-diagnosed and untreated thereby contributing to morbidity and mortality. The purpose of this study was to determine the prevalence of nutritional risk among adult inpatients at a teaching hospital in Zambia. In addition, the study sought to establish factors associated with nutritional risk. METHODS: A hospital-based cross-sectional study comprising of 186 consecutive in-patients aged 18-64 years admitted in medical and surgical wards was conducted at a teaching hospital. Out of one hundred and ninety eight (198) patients eligible to participate, complete data were collected from 186, representing a response rate of 93.9%. The Malnutrition Universal Screening Tool was used to collect data over a period of six months. Evaluated patients were dichotomized into no risk and nutritional risk. Binary logistic regression was performed to identify variables associated with nutritional risk. RESULTS: The mean age of adult in-patients was 40.72 ± 14.4 years. Majority of the patients were male (61.8%), while 38.2% were female. Results indicate that 59.7% of hospitalized patients were at nutritional risk. Vomiting, weakness, appetite decrease, dysphagia and weight loss were significantly associated (p = 0.019, p = 0.008, p < 0.001, p = 0.007, and p < 0.001 respectively) with nutritional risk. However, weight loss and appetite decrease were the most significant factors associated with nutritional risk (OR = 50.16, 95% CI = 5.75-36.70, p < 0.001 and OR = 28.06, 95% CI =1.49-8.12, p = < 0.001 respectively). CONCLUSION: Findings of our study suggest that close to 60% of adult inpatients at the teaching hospital were at nutritional risk. Nutritional risk is an issue of major concern at the teaching hospital and is associated with a number of variables. Identification of nutritional risk using Malnutrition Universal Screening Tool among adult inpatients is feasible in resource-poor settings like ours.