A 5-year review of research ethics applications in a tertiary health and educational institution in Nigeria.

Background: African contribution to global research output is said to be low. Poor funding and poor skills in grant writing have been suggested as important factors for this situation. Objectives: Applications for research ethics clearance in a hospital were reviewed to have an overview of the planned studies and the proportion of them that attracted national and international funding. Methods: A review of all applications for ethical clearance received by the institutional review board of a university teaching hospital at Ile-Ife, Nigeria, from 2016 to 2020. They were analysed according to study nature, scope, purpose, and sponsorship using descriptive statistics presented as frequency tables and charts. Results: A total of 878 applications were reviewed. There were 803 (91.5%) applications for local, 45 (5.1%) for national multicentre, and 30 (3.4%) for international multicentre studies. Applications for medical fellowship were 352 (40.0%) while 208 (23.8%) were from academic staff for non-degree research. There were 610 (69.5%) applications for self-sponsored studies. Only 18 (2.0%) and 26 (3.0%) received sponsorship from national and international donor agencies, respectively. Conclusions: Local studies formed the bulk of the submissions for ethics clearance. National and international donor funding of research is abysmally low in this Nigerian tertiary institution studied.

Anesthetic challenges in oro-facial cleft repair in Ile-Ife, Nigeria.

BACKGROUND AND METHODS: A retrospective review of all patients with oro-facial lip defects operated at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria over an 18 month period was undertaken with a view to determine: the pattern of presentation; associated clinical problems and congenital anomalies; perioperative complications; anaesthetic techniques used and outcomes; and the determinants of outcome. RESULTS: Of the 80 patients treated, 74 were managed under general anaesthesia but the case records of only 60 (81%) of these patients were available for review. The ages ranged between 3 months and 59 years. The male to female ratio was 1:1. Eighty percent of all cases studied were cleft lip (CL) +/- cleft palate (CP). Of these, 65% were left sided CL, 23% were right sided while 12% were bilateral. All patients had ASA score 1 or 2 at the time of surgery. Halothane in O2 induction was employed in 60% of the patients while 40% had IV induction. Intubation was facilitated with muscle relaxant in 63.3% of these patients. Naso-tracheal intubation was performed in 82% of all cleft palate repairs. Preoperative complications were encountered in 18% of the patients. Associated congenital anomalies were noted in 5% of the cases. One case each of difficult intubation and failed intubation were encountered. Intra-operative dysrrhythmia was noted in 5% of cases; no life-threatening complication was encountered peri-operatively. CONCLUSIONS: There is a dramatic increase in the number of patients presenting for care due to improved awareness of the population. Peri-operative attention to detail is essential in handling the challenges posed by the condition.

A 10-year retrospective review of perioperative mortality in pediatric general surgery at Ile-Ife Hospital, Nigeria.

BACKGROUND/PURPOSE: The analysis of perioperative mortality as well as surgery- and anesthesia-related death in pediatric patients may serve as a potential tool to improve outcome. The aim of this study is to report the 24-h and 30-day overall, and surgery and anesthesia-related, mortality in a tertiary hospital. METHODS: This is a retrospective review of perioperative mortality in children ≤15years at a general pediatric surgery unit. All pediatric general surgery cases operated under general anesthesia between January 2007 and December 2016 were included in the study and data analyzed. RESULTS: A total of 4108 surgical procedures were performed in 4040 patients. The age was 1day to 15years with a median age of 2years. The all cause 24-h mortality was 34 per 10,000 procedures and the all cause 30-day mortality was 156 per 10,000 procedures. Septicemia was the most common cause of death. The determinants of mortality were neonatal age group (Adjusted Odd Ratio (AOR)=0.033, 95% CI=0.015-0.070, p=0.001), emergency surgery (AOR=90.91, 95% CI=27.78-333.33, p=0.001), higher ASA status (AOR=0.014, 95% CI=0.005-0.041, p=0.001) and multiple operative procedures (AOR=38.46, 95% CI=10.64-142.85, p=0.001). CONCLUSIONS: Neonatal age group, children with poorer ASA status, emergency and multiple surgeries were predictors of perioperative mortality. LEVEL OF EVIDENCE: Retrospective study.

Early experience with open heart surgery in a pioneer private hospital in West Africa: the Biket medical centre experience.

INTRODUCTION: More than forty years after the first open heart surgery in Nigeria, all open heart surgeries were carried out in government-owned hospitals before the introduction of such surgeries in 2013 at Biket Medical Centre, a privately owned hospital in Osogbo, South-western Nigeria. The aim of this paper is to review our initial experience with open heart surgery in this private hospital. METHODS: All patients who underwent open heart surgery between August 2013 and January 2014 were included in this prospective study. The medical records of the patients were examined and data on age, sex, diagnosis, type of surgery, cardiopulmonary bypass details, complications and length of hospital stay were extracted and the data was analysed using SPSS version 16. RESULTS: Eighteen patients comprising of 12 males and 6 females with ages ranging between 8 months and 52 years (mean= of 15.7 +/- 15 years) were studied. Pericardial patch closure of isolated ventricular septal defect was done in 7 patients (38.9%) while total correction of isolated tetralogy of Fallot was carried out in 5 patients (27.8%). Two patients had mitral valve repair for rheumatic mitral regurgitation. Sixty day mortality was 0%. CONCLUSION: Safe conduct of open heart surgery in the private hospital setting is feasible in Nigeria. It may be our only guarantee of hitch free and sustainable cardiac surgery.

Perioperative blood glucose in a paediatric daycase facility: effects of fasting and maintenance fluid.

BACKGROUND: Many Children are daily exposed to prolonged preoperative fasting time. The choice of intraoperative maintenance fluid continues to be an issue of controversy. This study assesses the duration of preoperative fast among children undergoing ambulatory surgery and the appropriateness of the maintenance solutions used. PATIENTS AND METHODS: Seventy-eight children undergoing ambulatory surgery were prospectively randomised to receive lactated Ringer's (LR) solution or 4.3% dextrose in 0.18% saline (DS) as maintenance fluid. The duration of preoperative fast was noted and the blood glucose measured at induction, but before infusion of any intravenous fluid, and subsequently every 30 min. Data were analysed with Statistical Packages for the Social Sciences 16.0 (SPSS incorporated, Chicago Ill, USA). P < 0.05 was considered as significant. RESULTS: The age range was 3 months to 15 years (mean = 4.9 ± 3.6 years); mean weight was 16.3 ± 7.8 kg. The mean duration of fasting was 13.4 ± 3.5 h (range = 4-18.5 h), but no child was hypoglycaemic throughout the study. The mean blood glucose in the LR group rose steadily from 5.18 ± 0.98 mmol/L post-induction to a peak value of 7.40 mmol/L at 120 min. In the DS group, the mean blood glucose level increased from the post-induction value of 5.56 ± 0.86 mmol/L to 12.7 ± 3.98 mmol/L at 120 min. CONCLUSION: Most children undergoing ambulatory surgery at our facility are still exposed to prolonged fasting time. Glucose containing fluid often administered as maintenance fluid to treat the presumed hypoglycaemia causes worsening hyperglycaemia, which may be harmful.

Sublingual epidermoid cyst in a neonate.

Epidermoid cysts (EC) in the head and neck region could be considered a rare condition representing only 6.9% of all ECs occurring in the body. They occur rarely in children and neonates. We present a case of sublingual EC in a Nigerian neonate.