Outcome of transurethral resection of the prostate (TURP) using 5% dextrose water as irrigant.

Background: TURP remains the gold standard for simple prostatectomy presently. Different fluids have been used for irrigation while performing monopolar TURP. The choice of irrigation fluid depends on a lot of factors. Aim: We sought to find out if the outcome of monopolar TURP using 5% dextrose water in our setting compares with findings in other studies using different fluids as irrigation fluid in monopolar TURP. Materials and Methods: This was a prospective study of 220 patients who had monopolar TURP using 5% dextrose water as irrigation fluid from 2015 to 2020. Results: The study was completed by 220 patients. The mean age was 66.25 yrs. The mean weight of prostate was 53.2 g, and mean resected weight was 30.10 g using a mean irrigation volume of 45.35 liters, 5% dextrose water over a mean resection time of 66.08 mins. The mean changes in International Prostate Symptom Score/quality of life score (IPSS/QOLS) were statistically significant. Early complications recorded were postoperative hematuria with clot retention (1.4%), urinary tract infection (UTI) (13.2%), and secondary hemorrhage (10%). TURP syndrome was not recorded. Late complications seen within 2 years follow-up were transient urinary incontinence (6.4%), urethral stricture (4.1%), and bladder neck contracture (2.3%). There was no repeat TURP for residual adenoma within this period. Conclusion: TURP using 5% dextrose water has comparable outcomes to other irrigation fluids for monopolar TURP. It is a good alternative to any other irrigation fluid.

Prevalence and Distribution of Postvoid Residual Urine Volume in a Hospital-Based Sample of Men with Symptomatic Benign Prostatic Hyperplasia.

BACKGROUND: Benign prostatic hyperplasia (BPH) is a known cause of bladder outlet obstruction (BOO) in aging men. Patients present with lower urinary tract symptoms (LUTS), elevated postvoid residual urine (PVR), and reduced peak flow rate of urine. Although urodynamic study is the gold standard for diagnosing and quantifying BOO, it is invasive and as such urologists in their routine practice frequently rely on less invasive methods like PVR estimation to objectively assess BOO. AIM: To study the prevalence and distribution of PVR in a hospital-based population of men with symptomatic BPH. MATERIALS AND METHODS: Patients aged 40 years and above were enrolled for the study. History was taken from each of the 170 participants recruited, and physical examination was done including digital rectal examination. Every one of them completed the International Prostate Symptom Score (IPSS) questionnaire and also had ultrasonography assessment of PVR. Relevant laboratory investigations (PSA, renal function test, full blood count, urinalysis, and urine culture) and uroflowmetry to determine the peak flow rate of urine (Qmax) were done. RESULTS: A total of 170 subjects who met the inclusion criteria were enrolled for this study. The mean age of the subjects was 63.70 ± 9.92 years with a range of 42-88 years. The subjects had a mean PSA of 2.68 ± 0.91 ng/ml and a mean prostate volume of 70.8 ± 39.5 ml. The prevalence of significant PVR was 57.06%. The distribution of PVR was skewed with values ranging from 4.0 ml to 382.9 ml, a median value of 60.5 ml (interquartile range, IQR, =25.0-100.76), and a mean value of 77.70 ± 69.30 ml. An IPSS range of 8 to 23 with a mean value of 13.64 ± 4.14 and a median value of 13 (interquartile range = 10.0-16.0) was observed. The Qmax range was from 5 ml/s to 50 ml/s with a mean value of 20.25 ± 9.70 ml/s, and a median value of 18.0 ml/s (interquartile range = 14.0-24.0). CONCLUSION: This study showed that the prevalence of significant PVR volume among men with symptomatic BPH in our environment is high. There was also a high variation in the distribution of PVR among the subjects. Therefore, it is essential to create more public awareness especially among men in their fourth decade of life and above to visit a urologist whenever they have BPH symptoms so as to avoid impairment in quality of life and renal function associated with neglected significant PVR.

Comparison of pregnancy outcomes of triangular 3-bites and mcdonald techniques of cervical cerclage in women with cervical insufficiency: A pilot study.

Background: Cervical cerclage is the procedure of choice for preventing preterm birth due to cervical insufficiency. Despite the simplicity of the McDonald's method of cerclage application, it is still technically difficult to take four bites around the cervix before knotting. There is a need to develop a simpler method of cervical cerclage application with similar or improved pregnancy outcomes. Aim: This is to compare the ease/duration of application and pregnancy outcomes of the new triangular three-bite cervical cerclage technique and McDonald's technique in women with cervical insufficiency. Patients and Methods: This is a pilot study with 20 participants that met the inclusion criteria. They were randomly grouped into triangular three-bite method (n = 10) and McDonald's method (n = 10). The pregnancy outcomes were compared between the groups with the Chi-square test and student's t-test. A P value of <.05 was set as level of significance. Results: The sociodemographic characteristics of the two groups were similar. There was no statistically significant difference between the two groups regarding the pregnancy outcome (spontaneous miscarriage P = 1.00, preterm delivery P = 0.61, and neonatal birthweight P = 0.96). However, the duration of cerclage application (5.98 ± 1.79 minutes vs. 14.25 ± 7.5 minutes; P <.002) and estimated blood loss (29 ± 9.94 mls vs. 48.5 ± 25.82 mls; P = .04) were significantly lower in the triangular three-bite arm than in the McDonald's arm. Conclusion: The new triangular three-bite technique has similar pregnancy outcomes with the conventional McDonald's technique and has shown a lower duration of procedure and blood loss. Since this is a pilot study, a well-structured randomized control trial to compare the two methods is recommended.

Retention and motivation of health workers in remote and rural areas in Cross River State, Nigeria: a discrete choice experiment.

BACKGROUND: Cross River State is making investments geared towards ensuring equitable distribution and improved retention of its frontline health workforce in remote and rural areas. This informed the conduct of a discrete choice experiment to determine the motivating factors supporting the retention of healthcare workers. METHODS: Study participants were 198 final year students of nursing, midwifery and community health and frontline health workers. Eight focus group discussions and 38 key informant interviews were conducted to obtain information about the dimensions of the work conditions that are important to frontline health workers when choosing to take up posting or stay in their rural work locations. RESULTS: Health workers are 2.7 times more likely to take up a rural posting or continue to stay in their present rural duty posts if they receive a salary increment. They are also four times more likely to take a rural job posting if a basic housing or a housing allowance is provided. CONCLUSION: Improving working conditions of frontline health workers in terms of adequate staff strength, good skills mix and equipment, etc., as well as improving opportunities for career advancement will support retention in rural health posts.

Postoperative analgesic effect of intrathecal dexmedetomidine on bupivacaine subarachnoid block for open reduction and internal fixation of femoral fractures.

BACKGROUND: One of the drawbacks of subarachnoid block is the short duration of analgesia particularly when adjuvants are not added to local anesthetics agent used. However, dexmedetomidine an α2-adrenergic agent has been found to possess analgesic effect. AIMS: This study seeks to determine the analgesic efficacy of intrathecal 7.5 µg of dexmedetomidine and its side effects when used for open reduction and internal fixation (ORIF) of femoral fractures. METHODOLOGY: It is a prospective randomized, double-blinded study that was carried out in a Nnamdi Azikiwe University Teaching Hospital, Nnewi in Nigeria. Seventy American Society of Anesthesiologists I or II patients were randomized into two groups of 35 each to receive 3 ml of 0.5% hyperbaric bupivacaine combined with either 7.5 µg of dexmedetomidine in 0.3 ml of normal saline (Group D) or 0.3 ml of normal saline alone (Group S). Patient's outcome measures noted (time to first request of analgesia, proportion of patients with pain score <4 postoperatively using numerical rating scale [NRS], and total analgesic consumed in 24 h.). RESULTS: The patients in Group D had a longer time to first request of analgesia, larger proportion of patients with pain score <4 using NRS in the 2nd h postoperatively and lower amount of total analgesic consumed compared to those in Group S. These differences between the two groups were all statistically significant. Furthermore, there was no difference in the incidences of side effects between the two groups (P > 0.05). However, the patient satisfaction was better in Group D. CONCLUSION: The addition of 7.5 µg of dexmedetomidine to bupivacaine for subarachnoid block in the management of femoral fractures using ORIF provided better anesthetic profile, particularly prolonged duration of postoperative analgesia without significant side effects.

Health-related quality of life in people with chronic diseases managed in a low-resource setting - A study from South East Nigeria.

BACKGROUND: Assessment of health-related quality of life (HRQOL) in resource-limited settings is critical to evaluate and improve the burden of morbidity and mortality associated with chronic medical disorders. There is a dearth of data on HRQOL among patients suffering from chronic medical disorders in Nigeria. This study assessed the HRQOL of participants with diabetes mellitus (DM), human immunodeficiency virus (HIV) infection, and cancer in a hospital setting with limited resources and highlighted associated factors. METHODS: The WHOQOL-BREF instrument was used to study a cross section of the participants at the University of Nigeria Teaching Hospital, Enugu. Data were analyzed using Statistical Package for Social Sciences (SPSS). RESULTS: The distribution of the 613 study population was diabetes mellitus 120, HIV 389, and various cancers 104. Majority (67.9%) earned less than $1 per day and only 7.5% had any form of health insurance. The HIV group had higher QoL scores. Younger age, higher educational status, being employed, and having a care giver were positively associated with higher QoL. Patients with no comorbidities (76.6%) had an overall higher QoL score. CONCLUSION: Majority of the patients living with chronic medical diseases in Enugu, Nigeria were poor, vulnerable, and without access to health insurance. People living HIV generally had better quality life than those with other health conditions. There is a huge unmet need for people living with chronic medical conditions in Nigeria, which require strategies to counteract.

Knowledge and perception of plastic surgery among tertiary education students in Enugu, South-East Nigeria.

BACKGROUND: Knowledge, perception, and acceptance of plastic surgery among any population are influenced by channel of presentation. A good understanding of the public awareness will define the way plastic surgery services will be provided. AIM: To assess the knowledge, awareness of availability, and acceptance of plastic surgery practice in Enugu, South East Nigeria. MATERIALS AND METHODS: A questionnaire-based prospective study. RESULTS: The electronic media is the most common medium of awareness. Less than half the sample knew about the existence of plastic surgeons in Enugu even though a large proportion was aware of the existence of plastic surgery as a specialty. The concentration of plastic surgeons in a center is directly related to awareness of plastic surgery services in that facility. The most common esthetic procedure done by a plastic surgeon in Enugu is tattoo removal and scar refashioning. Orthopedic surgeons are thought to be key players in the management of burn patients as much as the plastic surgeons due to the "SIGNPOST EFFECT." CONCLUSION: The level of awareness is high in the sampled population with associated increase in acceptance of its practice and willing utilization. All public hospitals should be encouraged to employ the services of plastic surgeons. Appropriate branding of specialized hospitals where plastic surgery service is available will advance the practice significantly.

Evolving pattern of spinal anaesthesia in stable eclamptic patients undergoing caesarean section at University of Benin Teaching Hospital, Benin, Nigeria.

BACKGROUND: Eclampsia is still associated with high maternal and perinatal and perinatal morbidity and mortality, especially in resource poor countries with limited access to perinatal and critical care facilities. The ideal method of anaesthesia for caesarean section in eclamptics is not generally agreed upon. METHODS: Review of the patients' case notes as well as records of the institution's Labour Ward Theatre, Intensive Care Unit and Postnatal Ward was carried out between January 2011 and December 2012. Patients' clinical and demographic data, anaesthetic management methods, maternal and perinatal outcome measures were evaluated and analysed. RESULTS: Ninety-nine cases of eclampsia were reviewed, of which 87 had Caesarean section. After excluding five patients who had intercurrent medical ailments, 82 patients were finally analyzed. Of these, 65 (79.3%) had spinal anaesthesia while 17 (20.7%) had general anaesthesia. Out of the 19 (23.2%) who were transferred to the intensive care unit, 12 (70.6%) had general anaesthesia while 7 (10.8%) had spinal anaesthesia. Of the 17 patients who had general anaesthesia, 10 (58.8%) were ventilated post operatively versus only 2 (3.1%) in spinal anaesthesia. Nine of the 17 general anaesthesia patients (52.9%) versus only 1 of 65 spinal anaesthesia (1.5%) died in ICU. Apgar was two fold better in the spinal anaesthesia group at 5 minutes.There was a higher risk ratio for stillbirths in the general anaesthesia patients. CONCLUSION: maternal and perinatal survival and well being are better in eclamptics who had spinal anaesthesia for caesarean section compared to those who had general anaesthesia.

Improved Dosimetry with Daily Online Adaptive Radiotherapy for Cervical Cancer: Waltzing the Pear.

AIMS: Standard of care radiotherapy for locally advanced cervical cancer includes large margins to ensure the uterocervix remains within the treatment fields over the course of treatment. Daily online cone-beam adaptive radiotherapy corrects for interfractional changes by adjusting the plan to match the target position during each treatment session, thus allowing for significantly reduced clinical target volume (CTV) to planning target volume (PTV) margins. We hypothesise that reduced margins from daily online adaptive radiotherapy will reduce organ at risk dose without compromising target coverage. MATERIALS AND METHODS: Ten patients with cervical cancer (stage IIB-IIIC2) were treated with definitive chemoradiation using daily online cone-beam adaptive radiotherapy in 25-27 fractions. Initial and all adapted treatment plans were generated with CTV to PTV margins versus standard of care image-guided radiotherapy (IGRT) plans as follows: cervix/uterus/gross tumour volume (0.5 versus 1.5 cm), parametria/vagina (0.5 versus 1.0 cm) and nodal chains and gross nodes (0.5 versus 0.5 cm). IGRT plans were created and copied to synthetic computed tomography scans and contours generated from each daily adapted fraction. The dosimetry of each clinically treated online adapted fraction was compared with emulated IGRT plans. Statistical significance was defined as P < 0.05. RESULTS: Daily online cone-beam adaptive radiotherapy significantly improves bowel bag dosimetry compared with IGRT, with a reduction in V40 by an average of 91.3 cm3 [V40 (-6.2%) and V45 (-6.1%)]. The daily adapted plans showed significant improvements in bladder and rectum [V40 (-25.2% and -36.0%) and V30 (-9.7% and -17.1%), respectively]. Additionally, bone marrow had a significantly reduced dose [V10 (-2.7%) and V20 (-3.3%)]. Daily online cone-beam adaptive radiotherapy improved uterocervix CTV coverage and reduced hotspots compared with IGRT [D95% (+1.6%) and Dmax (-0.9%)]. CONCLUSIONS: Reduced CTV to PTV margins achievable with daily online adaptive radiotherapy improves organ at risk dosimetry and target coverage when compared with standard of care IGRT for locally advanced cervical cancer. The clinical impact of improved dosimetry is currently undergoing investigation.

MICROBACTERIAL PROFILE OF SURGICAL SITE INFECTION AND THEIR PATTERN OF SENSITIVITY IN TERTIARY HOSPITAL IN NORTH CENTRAL HOSPITAL, NIGERIA.

Background: Surgical site infections (SSI) remain a problem in surgical practice despite the improvement in advanced technology and the use of antibiotics. Also, there is also a growing menace of antibiotic resistance which poses a great challenge in treating SSI. The study aimed to find out the most common bacterial pathogens responsible for surgical site infection and their antibiotic sensitivity profile. Material and Methods: It was a descriptive study carried out in Federal Medical Centre, Bida. 500 surgical procedures were carried out and samples were obtained from 73 patients that showed clinical evidence of SSI for culture and susceptibility test. Samples were collected from each patient using a swab stick. Bacteriological culture examination and identification were done following standard microbiological techniques. Susceptibility testing was performed by Kirby-Bauer technique according to Clinical and Laboratory Standards institute 26th edition. Data were analysed using SPSS 26. Results: Out of the 73 samples taken, 83 isolates were obtained while five samples yielded no growth. Gram-negative bacteria (GNB) were predominant in 73(88.1%) with the dominant being E. Coli species (38.6%). From the strains that were isolated, there were 9(10.8%) Staph aureus was the only Gram-positive organism. Concerning antibiotic susceptibility, the results demonstrated remarkably high multidrug resistance. However, the meropenems and amikacin demonstrated good activities against all gram-negative isolates. The resistance pattern of enterobacteriaceae to tested antibiotics were to ciprofloxacin (90.2%) levofloxacin (82.2%) augmentin (88.5%) ceftriaxone (85.2%) ceftazidime (80.3%), gentamicin (80.3%) meropenems (14.8%) amikacin (16.4%.). Conclusion: The study demonstrated a high alarming rate of multidrug resistance following SSI and this should call for concerns and surveillance among surgeons.

Optimal sites for agricultural and forest residues energy conversion plant using geographic information system.

The Federal Government of Nigeria (FGN) has committed to net-zero emission development pathways to respond to the Paris Agreement adopted in 2015. However, the country is in dire need of energy to support its developmental ambitions. Therefore, it is necessary to consider green energy technologies to support both socioeconomic development and to meet the FGN's emission reduction target. In view of this, the current work presents the optimal sites for bioenergy plants in a state in Nigeria using Geographic Information System (GIS). Key findings suggest that 62.03 PJ/yr and 4.12 PJ/yr of energy could be derived from crop residues and forest residues, respectively, to support the state's bioenergy development. The crop residues considered include plantain (stem), oil palm (shell and fibre), maize (stalks) and cassava (peel and stalks). Six criteria were used in selecting the optimal sites, and include biomass residue distribution, settlement, road accessibility, nearness to waterline, slope and aspect. These criteria were incorporated into the ArcGIS platform through the weighted overlay tool. Strategically, the analysis presents seven sites for biomass plants to sustainably meet part of the energy needs. The efforts of the current work which supports not less than three SDGs-SDG 7 (Clean and Affordable Energy), SDG 12 (Responsible Consumption and Production) and SDG 13 (Climate Action), will assist policymakers in Nigeria to make appropriate policies within the climate change space.

A GIS based flood vulnerability modelling of Anambra State using an integrated IVFRN-DEMATEL-ANP model.

Flooding is a major environmental problem facing Anambra State of Nigeria, which also threatens food security in the state. To address this issue, continual flood vulnerability mapping exploring more efficient methods is needed to facilitate flood risk management in the state. The advantages of employing spatial information technologies such as Remote Sensing (RS) and Geographic Information System (GIS) in flood vulnerability mapping has been widely documented; the limitations of employing GIS alone in effective vulnerability analysis have also been documented by researchers. To overcome these limitations, this study adopted the use of GIS and the integration of Interval Value Fuzzy Rough Number (IVFRN), Decision Making Trial and Evaluation Laboratory (DEMATEL), and Analytical Network Process (ANP) method in vulnerability assessment of flood hazard. The result of the study shows that the state is very vulnerable to flood with 73% of the total area of the state lying between Very High and Medium vulnerable zones. The most vulnerable Local Government Area (LGA) in the State is Anambra West with 95% of the total area of the LGA lying between Very High and Medium vulnerable zones. Furthermore, the obtained values of R ˜ - D ˜ show that Rainfall Intensity factor is the major cause of flood in the study area with the highest positive value of 1.55 and Soil factor is the major effect with the highest negative value of -0.93. The IVFRN-DEMATEL-ANP assessment model was validated using AUC-ROC method; an AUC value of 0.946 was obtained, this indicates that the model has excellent prediction accuracy. This study was able to establish the feasibility of integrating the IVFRN, DEMATEL and ANP methods in flood vulnerability assessment. It is recommended that the provision of adequate drainage systems should be prioritized to areas of high flood vulnerability index; to help mitigate flood hazards in the State. Also, strategic planning of infrastructures and emergency routes for moving people and key assets from vulnerable areas especially during the rainy season should be geospatial-based and systematic.

A survey of common pathogens in wound in patients at the University of Port Harcourt Teaching Hospital (U.P.T.H), Port Harcourt.

During a 30-month period, January 1996 to June 1998, a total of 2458 wound swab samples were collected, cultured and identified. In descending order of frequency, the organisms isolated include: Staphylococcus aureus (31.60%), Escherichia coli (25.97%), Pseudomonas aeruginosa (21.21%), Klebsiella species (10.82%), Proteus species (8.23%), non-haemolytic streptococci (1.29%), Beta-haemolytic streptococcus (0.43%) and Candida albicans (0.43%). The variation in frequency of the isolates according to sex, age and ward is reported. The antibiotic sensitivity pattern of these isolates is also presented.