Childhood colostomies: patterns, indications and outcomes in a Nigerian University Teaching Hospital.

Background: Most childhood colostomies are done for decompression or diversion in gastrointestinal tract congenital anomalies. Colostomy may be sited in the transverse or sigmoid colon as loop or defunctioning (divided) colostomies. Current pattern seems towards construction of more sigmoid and defunctioning colostomies. Aims: To evaluate the patterns, indications and outcomes of childhood colostomies. Patients and Methods: Retrospective chart review of all colostomies performed in children below 15 years from September 2010 to August 2020. Results: There were 104 colostomies (55males; 49females; 65 sigmoid; 39 transverse colostomies; 3 loop; 101 defunctioning colostomies. Anorecatal Malformation (ARM)was indication in 32 males and 41 females; age range 2 days to 13 years. Hirschsprung's Disease (HD) was indication in 18 males and 4 females; age range 6 weeks to 15 years.In HD there were three loop colostomies (3/22) in transverse colon and 19 defunctioning colostomies (8 sigmoid, 11 transverse) while in ARM all 73 were defunctioning colostomies(P=0.01)In HD there were 14/22 transverse colostomies and 8/22 sigmoid colostomies while ARM had 24/73 transverse and 49/73 sigmoid colostomies (P =0.013)In HD 91% colostomies were done beyond infancy while in ARM 93% were before one year(P<0.0001). Mortalities were noted in 1.9% patients. Conclusion: Commonest indication for colostomy is ARM. There are more defunctioning than loop colostomies, and more sigmoid than transverse colostomies. of most colostomies in ARM were during infancy while mostly beyond infancy in HD.

Effects of rational emotive psychotherapy consort on business education students' perception about image of technical vocational education and training in South-East Nigeria.

BACKGROUND: We determined the effects of rational-emotive psychotherapy on the perception of Business Education Students about TVET Image. Negative perception about TVET by youths, parents and the society has made TVET programs unattractive, uninteresting, less productive and by extension created an unhealthy organizational climate. Improving participants' perception will assist them to mitigate the effect of irrational beliefs, emotional distress, strengthening their psychosocial wellbeing and occupational health. METHOD: This study adopted a pre-test-post-test control group design. Data were collected from 568 participants comprising 104, 137, and 333 from nine federal, state and private owned universities in South-East Nigeria. RESULTS: The result showed that rational-emotive psychotherapy significantly improved the emotional distress, perceptions of TVET image and positively addressed the organizational climate among participants in the intervention group compared to the participants in the waitlist group. The result also revealed that occupational risk management practices of the participants in the intervention group improved significantly more than those in the waitlist group. From the result, we conclude that TVET institutions can apply the REBT model as an intervention program for improving the perceptions of stakeholders about TVET image in order to increase students' interest, boost their self-confidence, self-esteem, and zeal for TVET practices. CONCLUSION: It was concluded that the REBT-oriented therapy helped to improve the emotional distress, irrational beliefs, and poor perception of the Business Education students who perceived TVET programs as an inferior and low-esteemed profession.

Congenital obstructive bowel anomalies presenting after neonatal age.

Background: Delayed presentation might affect the ultimate management of children with congenital bowel obstructive bowel anomalies (CBA). We evaluated the profile, challenges of treatment and outcome of CBA presenting after neonatal age. Methods: We did a retrospective analysis of data of children with CBA presenting after neonatal age from January 2013 to November 2017. We used the Statistical Package for Social Sciences (SPSS) for data entry and analysis. Results: There were 57 cases in total comprising of Hirschsprung's disease (HD; 37 cases), anorectal malformation (ARM; 15 cases), and duodeno-jejunal web (5 cases), with median age of 9 months (IQR 4 months - 2 years) on presentation. Overall, 52 (91.2%) patients had one or more complications on presentation. Definitive procedure did not differ from established operations, but only 9 (15.8%) had primary procedures and 48 (84.2%) cases required multi-stage treatment. After an average follow up period of 19.5 months (range: 1-45 months), 18 (31.6%) cases developed procedure-related complications and 3 (5.3%) had residual bowel dysfunction, but there was no mortality. The morbidity was limited to cases with HD and ARM. Conclusion: In our setting, HD is the commonest bowel anomaly that presents after the neonatal age. The delayed presentation may predispose to complications and preclude single-stage treatment in some cases. Training of healthcare providers to improve recognition and early referral of these anomalies may lead to early diagnosis and minimize morbidity.

Chronic bowel obstruction from colonic stenosis in early infancy-A report of two cases.

Bowel obstruction in early infancy may result from a variety of congenital anomalies involving parts of the small and large bowel. However, in infancy, chronic bowel obstructions from congenital or acquired stenosis of the colon are rare and can cause diagnostic quandary. We present two cases of an eleven-week old male and a nine-week old male with massive abdominal distension and features of chronic bowel obstruction dating from neonatal period. In the first case investigations were inconclusive and laparotomy revealed isolated stenosis of the ascending colon. In the second case colonic stenosis was suspected preoperatively and a barium enema done showed multiple colonic stenosis confirming our working diagnosis. The diagnostic dilemmas encountered in managing the first patient are discussed to highlight the need for high index of suspicion of this condition in infants with chronic constipation. The way experience in managing the first case influenced diagnosis of the second case is also highlighted.

Continuing barriers to care of Wilms tumor in a low-income country.

BACKGROUND/OBJECTIVE: This study evaluates the outcome of Wilms tumor (WT) following introduction of multidisciplinary team management and patient treatment stratification by tumor histology in two referral centers in southeastern Nigeria. METHODS: We analyzed histologically confirmed WT cases managed from January 2008 to June 2017. RESULTS: There were 45 patients, peak age incidence of 2 to 5 years who presented after mean symptom duration of 4.9 months (range, 1-12 months), with mean tumor weight of 1040 g (range, 350-4200 g). Overall, 14 (31.1%) had unfavorable histology of WT. A total of 22 (48.9%) patients received preoperative chemotherapy, 43 (95.6%) received postoperative chemotherapy based on stage of disease and histopathology, but none received adequate radiotherapy. Of these, 19 (44.2%) patients complied with chemotherapy regimen, 15 (33.3%) were lost to follow-up and 12 (26.7%) cases relapsed. With 30 cases available for evaluation and mean follow-up duration of 23 months (range, 6-80 months), the overall 5-year survival is 53.3% (16 cases). Survival in children who complied with postoperative chemotherapy was 73.7%, and abandonment-sensitive survival was 35.6%. Persisting challenges were late presentation, poor compliance to treatment, and lack of radiotherapy treatment. CONCLUSION: Multidisciplinary team management and chemotherapy based on tumor histology might have resulted in slight improvement of outcome since our last report. However, to ensure survival that may approach global benchmarks, there is need for public health measures to improve time to diagnosis, and improvement of facilities and healthcare funding to ensure compliance to all phases of standard therapy.