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Salawu ON, Ibraheem GH, Babalola OM, Kadir DM, Ahmed BA, Agaja SB, Olawepo A, Nasir AA. Clinical outcomes after open locked intramedullary nailing of closed femoral shaft fractures for adult patients in a Nigerian Hospital. Niger J Clin Pract 2018; 20:1316-1321. [PMID: 29192638 DOI: 10.4103/njcp.njcp_294_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Femoral shaft fractures are common injuries in adults. Closed locked intramedullary nailing is the recommended treatment for femoral shaft fractures due to its high union rate. OBJECTIVE The objective of this study is to determine the outcome of management of closed femoral shaft fractures in adult patients, using open locked intramedullary nailing. PATIENTS AND METHODS This is a prospective study which was carried out on all adult patients aged 16 years and above who presented within 2 weeks of sustaining closed femoral shaft fractures to the accident and emergency unit of a University Teaching Hospital in Nigeria from January 2013 to December 2013. Pathological fractures were excluded from the study. The procedure was carried out using standard techniques, and each patient was followed up for a minimum of 1 year. RESULTS Forty-three patients were recruited into the study. They had a mean age of 36.9 ± 11.7 years, with a male to female ratio of 2.9:1. The most common cause of closed femoral shaft fractures was road traffic crashes (95.3%), with motorcycle-related injuries found to be the highest type (56.1%). The rate of union in the study was 95.3%. The average time to radiological union was 14.0 ± 1.2 weeks while the mean time to painless full weight bearing was 14.2 ± 1.2 weeks. Among the complications encountered were broken nails (4.7%), infection, loosening of the distal screw, and limb length discrepancy (2.3% each). Using Thoresen's criteria, excellent results were obtained in 93% and poor results in 4.7% of patients. CONCLUSION Open locked intramedullary nailing gives excellent clinical outcomes with high union and low complication rates in the management of closed femoral shaft fractures in adult patients.
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Affiliation(s)
- O N Salawu
- Department of Surgery, Federal Medical Centre, Birnin Kebbi, Nigeria
| | - G H Ibraheem
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - O M Babalola
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - D M Kadir
- Department of Surgery, General Hospital, Ilorin, Nigeria
| | - B A Ahmed
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - S B Agaja
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - A Olawepo
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - A A Nasir
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria
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Hussain K, Ijaz M, Durrani AZ, Anjum AA, Nasir AA, Farooqi SH, Aqib AI, Ahmad AS. Bacterial count and predisposing factors of Clostridium perfringens (targeting CPA gene) infection along with antimicrobial sensitivity in diarrheic sheep in Pakistan. Trop Biomed 2018; 35:434-441. [PMID: 33601817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Clostridium perfringens (C. perfringens) is a normal inhabitant in the gut of animals. It may proliferate rapidly in favorable conditions and produces lethal toxins. These toxins may cause lethal effects in the intestines and systemically it may cause enterotoxaemia. In disease conditions, the presence of C. perfringens CFU/g in fecal sample can be of diagnostic value. This study aims to determine the bacterial counts and predisposing factors of C. perfringens (targeting CPA gene) infection in addition to an in-vitro antimicrobial trial in entero-toxemic sheep in Pakistan. A total of 192 diarrheic sheep irrespective of age, gender and breed were selected and the CFU/g was determined from the fecal samples. The study showed that 34.9% of the samples had elevated level of bacterial count compared to the normal (104-107 CFU/g). Out of the total, 7.8% of the samples had subnormal bacterial count (CFU/g), while, 57.3% of the samples showed bacterial counts in the normal ranges. The confirmation of selectively isolated C. perfringens was done by amplification of 324bp CPA gene fragment using polymerase chain reaction (PCR). The in-vitro antimicrobial sensitivity trials showed that penicillin, ciprofloxacin and ceftriaxone are 100% efficacious against C. perfringens, while, bacitracin, ampicillin and amoxicillin were found to be least effective. The key determinants in this study which support the in-vivo growths of C. perfringens were; carbohydrate rich diet and overcrowding with the odds ratios (OR) of 5.44 and 2.26, respectively. This study concludes that C. perfringens is highly prevalent in sheep population of Pakistan. The incidence of enterotoxaemia can be minimized by controlling the factors which enhance its in-vivo growth. The diseased animal associated with elevated C. perfringens levels can be effectively cured using any one of the penicillin, ciprofloxacin and ceftriaxone.
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Affiliation(s)
- K Hussain
- Department of Clinical Medicine and Surgery, University of Veterinary and Animal Sciences, Lahore
| | - M Ijaz
- Department of Clinical Medicine and Surgery, University of Veterinary and Animal Sciences, Lahore
| | - A Z Durrani
- Department of Clinical Medicine and Surgery, University of Veterinary and Animal Sciences, Lahore
| | - A A Anjum
- Department of Microbiology, University of Veterinary and Animal Sciences, Lahore
| | - A A Nasir
- Veterinary Research Institute, Lahore
| | - S H Farooqi
- Department of Clinical Medicine and Surgery, University of Veterinary and Animal Sciences, Lahore
| | - A I Aqib
- Department of Clinical Medicine and Surgery, University of Veterinary and Animal Sciences, Lahore
| | - A S Ahmad
- Department of Parasitology, University of Veterinary and Animal Sciences, Lahore
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Oyedepo OO, Nasir AA, Abdur-Rahman LO, Kolawole IK, Bolaji BO, Ige OA. EFFICACY AND SAFETY OF ORAL KETAMINE PREMEDICATION IN CHILDREN UNDERGOING DAY CASE SURGERY. J West Afr Coll Surg 2016; 6:1-15. [PMID: 28344934 PMCID: PMC5342622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Oral premedication for paediatric age group is an uncommon practice amongst anaesthetists in Nigeria. Both parents and the child suffer some form of emotional or psychological distress. AIM To determine the efficacy and safety of oral formulated ketamine for premedication in children scheduled for ambulatory surgeries. METHODS Seventy three children aged 1 - 6 years with American Society of Anesthesiologists (ASA) physical status I-II were prospectively studied. They were assigned randomly to receive either 5 mg/kg (Group A), 10 mg/kg (Group B), or no ketamine (Group C).The children were observed for acceptance of premedication, sedation and anxiolysis at 10, 20 and 30 minutes after drug administration. Behavior/response of each child at the time of separation from parents, intravenous access, and acceptance of facemask for induction, postanaesthetic arousal state and complications were also recorded. RESULTS There were 73 children in this study with a mean age of 37.4±18.0 months. The groups were comparable in age. The studied agent was tolerated by both groups that received premedication with no significant difference (P 0.73). Adequate sedation and anxiolysis were observed in groups A and B, (52%, 84%) and (68%, 88%) respectively. However, more children in group B (82.6%) had satisfactory behaviour at separation from parents and a better acceptance of anaesthetic face mask (64%) at induction than those in groups A and C (33.3%, 21.7%, respectively). No side effect was recorded in either of the premedication groups or the control group. CONCLUSION Oral ketamine is acceptable and safe premedication for children. It provided good sedation, relieved anxiety and had no side effect in the children at the studied doses.
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Affiliation(s)
- O O Oyedepo
- Department of Anaesthesia, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - A A Nasir
- Department of Surgery, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - L O Abdur-Rahman
- Department of Surgery, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - I K Kolawole
- Department of Anaesthesia, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - B O Bolaji
- Department of Anaesthesia, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
| | - O A Ige
- Department of Anaesthesia, College of Health Sciences, University of Ilorin, Ilorin, Nigeria
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Nasir AA, Mishra SK, Ahmadi A, Murali V, Kori VB, Kori VB, Sabnis RB, Desai MR. ROLE OF MICROPERC IN MINIMAL INVASIVE EXTRACTION OF Renal STONES IN CHILDREN. J West Afr Coll Surg 2014; 4:54-73. [PMID: 26457266 PMCID: PMC4553235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Microperc using all-seeing needle is associated with reduced tract-related morbidity. AIM & OBJECTIVES The purpose of this study was to examine the effectiveness and safety of microperc in children. PATIENTS & METHODS From July 2010 to August 2014, a total of 17 children with renal stones underwent microperc at Muljibhai Patel Urological Hospital, Nadiad, India. Renal access was achieved through 4.85-Fr (16 gauge) all-seeing needle (PolyDiagnost, Pfaffenhofen, Germany). and fragmentation with 200 µm holmium:YAG laser fiber. The patient's demographic data, clinical features, operating time, hemoglobin drop, stone clearance, complications (Clavien-Dindo), and length of hospital stay were prospectively studied. RESULTS A total of 17 patients with a median age of 9 years were studied. The stone size ranged from 5.3mm to 24.9mm. The median operative time was 40 minutes. The median decrease in haemoglobin was 1.2 mg/dl. The stone-free rate at first postoperative day and at the first month after the procedure were 82.4% and 88.2% respectively. The mean hospital stay was 56.4 hours. None of the patients required blood transfusion. An overall success rate of 94.1% was achieved at median follow-up of 4 months. Comparing small size stones (< 1cm) and moderate size stone (1-3cm); the immediate clearance rates were 100% and 75% respectively (p=0.331). There was no statistically significant difference in the operating time (40 vs 43mins; p=0.592), haemoglobin drop (0.85 vs 1.25 g/dl; p=0.595) and the length of hospital stay. One patient in each group had conversion to miniperc to remove residual stone fragment. There was one minor intra-operative pelvic perforation (Clavien II). There were two postoperative complications in patients with moderate stone; one of the patients had right lower lobar pneumonia and the other had colic pain and both cases were managed conservatively (Clavien I). CONCLUSION This study has demonstrated that microperc is a safe and effective procedure in the extraction of small to medium size renal stones in children.
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Affiliation(s)
- A A Nasir
- Department of Surgery, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - S K Mishra
- Department of Surgery, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - A Ahmadi
- Department of Surgery, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - V Murali
- Department of Surgery, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - V B Kori
- Department of Surgery, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - V B Kori
- Department of Surgery, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - R B Sabnis
- Department of Surgery, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - M R Desai
- Department of Surgery, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
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Abdur-Rahman LO, Baba S, Bamigbola KT, Olaoye I, Oyinloye AO, Nasir AA, Adeniran JO. Outcome of management of complicated extragonadal teratoma in a resource poor setting. Afr J Paediatr Surg 2013; 10:323-6. [PMID: 24469482 DOI: 10.4103/0189-6725.125432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Extragonadal teratomas (EXGTs) are ubiquitous in the human body; hence, they have varied presentation. In underdeveloped areas presentation and management are affected by socio-economic, cultural and health facilities factors. The aim of this study was to review the outcome of management of complicated EXGT in a tertiary health centre. MATERIALS AND METHODS A review data of paediatric patients with EXGT was done between January 1999 and December 2012. Variables reviewed were bio-data, mode of presentation and site of tumour, comorbidity, treatments and outcome. The data was analysed with Statistical Package for Social Sciences (SPSS (R)) version 16.0. RESULTS There were 21 complicated EXGT (77.8%) among 27 children, age ranges from 4 days to 16 years (median = 2 years). Male:Female ratio of 1:2. The complications per region of the body at presentation were cervical 4 (66.7%), mediastinal 2 (100%), abdominal 3 (75%) and sacrococcygeal 12 (75%). The complications were respiratory distress 6, intestinal obstruction 5, faecal incontinence 2, bladder outlet obstruction 3, malignant transformation 5, ruptured sacrococcygeal teratoma 2, ulcerated tumour 2, anaemia 3 and malnutrition 3. There were 5 (23.8%) progressive disease post-excision outside our facility. Excision biopsy was successful in 19 (85%) patients two of which had neoadjuvant cytotoxic therapy. Overall mortality was 5 (23.8%) (septicaemia, anaemia, respiratory distress, renal failure) and post-excision mortality was 11.8% (endotracheal tube blockage and progressive disease). CONCLUSION Delay presentation (due to local belief, ignorance and poverty) malnutrition, sepsis, malignant transformation characterised presentation of children in this study and the lack of paediatric intensive care unit facility and intensivists compromised survival of children with EXGT.
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Affiliation(s)
- L O Abdur-Rahman
- Department of Surgery, Division of Paediatric Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Nigeria
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Abstract
BACKGROUND The practice and pattern of male infants circumcised is influenced by culture, religion and socio-economic classification. The debate about the benefits and risks of circumcision has made a hospital-based practice the most acceptable. OBJECTIVE The objective of this study is to evaluate the ages, indications, co-morbidity, types and methods of circumcision, usage and mode of anaesthesia and outcome of male circumcision at a tertiary health centre in Nigeria. MATERIALS AND METHODS A retrospective review of male circumcision in a paediatric surgery unit was done from January 2002 to December 2007. The data was analysed using SPSS software version 15. RESULTS There were 438 boys with age ranged between 6 days and 10 years (median 28 days, mean 53.6 days standard deviation 74.2). Neonatal circumcision (<29 days) was 201 (46%) and 318 (72.6%) of the children were circumcised by the 3 rd month of live. Religion or tradition were the major indicators in 384 (87.7%) patients while phimosis 38 (8.7%), paraphimosis 4 (1%), redundant post circumcision skin 10 (2.3%) and defective prepuce in 2 (0.5%) were other indications. Plastibel™ (PD) was used in 214 (48.9%), classical circumcision 194 (44.2%), guillotine technique (GT) and Gomco™ 10 (2.3%) cases each while 10 (2.3%) had a refashioning/re-excision post previous circumcision. There was an increase in use of PD, drop in the use of GT; and increase in the number of circumcision done over the years. Only 39.7% had anaesthesia administered and complication rate was 6.7%. CONCLUSION Neonatal circumcision was highest in the hospital-based circumcision practice, which allowed the expected ideals in the use of devices in a tertiary health centre. However, the low rate of anaesthetic use is unacceptable.
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Affiliation(s)
- L O Abdur-Rahman
- Department of Surgery, Paediatric Surgery Unit, University of Ilorin; University of Ilorin Teaching Hospital, Ilorin, Nigeria
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Ofoegbu CKP, Afolabi OA, Nasir AA, Abdur-Rahman LO, Solagberu BA. Acute neck injuries in Ilorin. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040590w.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ibraheem GH, Ofoegbu CKP, Nasir AA, Solagberu BA. Economic burden of various injuries in a low income community. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040590w.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Agere IA, Nasir AA, Yakub S, Abdur-Rahman OL, Ofoegbu CKP, Solagberu AB. Violent injury in Ilorin. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040590j.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Nasir AA, Niyonkuru F, Nottidge TE, Adeleye AO, Ali S, Ameh EA, Bekele A, Bonet I, Derbew M, Ekenze SO, Oluwadare E, Jani PG, Labib M, Mezue WC, Mijumbi C, Zimmerman K, Baird R, Carsen S, Dreyer JS, Fairfull Smith RJ, Ferri-de-Barros F, Friedman J, Gill R, Gray A, Howe K, Bhoj I, Poenaru D, Rosen B, Yusuf AS, Abdur-Rahman LO, Ahmed BA, Panikar D, Abraham MK, Petroze RT, Groen RS, Ntaganda E, Kushner AL, Calland JF, Kyamanywa P, Ekrikpo U, Ifesanya AO, Nnabuko RE, Mazhar SB, Kotisso B, Shiferaw S, Ngonzi J, Dorman K, Byrne N, Satterthwaite L, Pittini R, Tajirian T, Kneebone R, Bello F, Desalegn D, Henok F, Dubrowsk A, Ugwumba FO, Obi UM, Ikem IC, Oginni LM, Howard A, Onyiah E, Iloabachie IC, Ohaegbulam SC, Kaggwa S, Tindimwebwa J, Mabweijano J, Lipnick M, Dubowitz G, Goetz L, Jayaraman S, Kwizera A, Ozgediz D, Matagane J, Bishop T, Guerrero A, Ganey M, Poenaru D, Park S, Simon D, Zirkle LG, Feibel RJ, Hannay JAF, Lane RHS, Cameron BH, Rambaran M, Gibson J, Howard A, Costas A, Meara JG, St-Albin M, Dyer G, Devi PR, Henshaw C, Wright J, Leah J, Spitzer RF, Caloia D, Omenge E, Chemwolo B, Zhou G, July J, Totimeh T, Mahmud R, Bernstein M, Ostrow B, Lowe J, Lawton C, Kozody LL, Coutts P, Nesbeth H, Revoredo A, Kirton R, Sibbald G, Dodge J, Giede C, Jimenez W, Cibulska P, Sinesat S, Bernardini M, McAlpine J, Finlayson S, Miller D, Elkanah O, Itsura P, Elit L. Bethune Round Table 2012: 12th Annual Conference: Filling the GapImpact of international collaboration on surgical services in a Nigerian tertiary centreSurgeons OverSeas Assessment of Surgical Needs (SOSAS) Rwanda: a useful rural health experience for medical studentsPreinternship Nigerian medical graduates lack basic musculoskeletal competencyDecompressive craniectomy: a low-cost surgical technique from a developing countryEfficacy of surgical management with manual vacuum aspiration versus medical management with misoprostol for evacuation of Lrst trimester miscarriages: a randomized trial in PakistanGaps in workforce for surgical care of children in Nigeria: increasing capacity through international partnershipsAnalyses of the gap between surgical resident and faculty surgeons concerning operating theatre teaching: report from Addis Ababa University, EthiopiaIntroduction of structured operative obstetric course at Mbarara Regional Referral Hospital with resultant reduction in maternal mortalityA training cascade for Ethiopian surgical and obstetrical care: an interprofessional, educational, leadership and skills training programUndergraduate surgery clerkship and the choice of surgery as a career: perspective from a developing countryIntramedullary nail versus external Lxation in management of open tibia fractures: experience in a developing countryThe College of Surgeons of East, Central and Southern Africa (COSECSA) Llling the gap; increasing the number of surgeonsClinical officer surgical training in Africa: COST-AfricaSecondary neuronal injuries following cervical spine trauma: audit of 68 consecutive patients admitted to neurosurgical services in Enugu, NigeriaCapacity building and workforce expansion in surgery, anesthesia and perioperative care: the GPAS model in UgandaKnowledge retention surveys: identifying the effectiveness of a road safety education program in Dar es Salaam, TanzaniaA tale of 2 fellowships: a comparative analysis of Canadian and East-African pediatric surgical trainingOutcomes of closed diaphyseal femur fractures treated with the SIGN nailManaging surgical emergencies: delivering a new course for the College of Surgeons of East Central and Southern AfricaAn evaluation of the exam for the University of Guyana Diploma in SurgeryPriority setting for health resource allocation in Brazil: a scoping literature reviewForeign aid effects on orthopedic capacity at the Hospital Saint Nicholas, HaitiReTHINK aid: international maternal health collaborationsEffect of electronic medical record implementation on patient and staff satisfaction, and chart completeness in a resource-limited antenatal clinic in KenyaImplementation of awake craniotomy in the developing world: data from China, Indonesia and AfricaRegionalization of diabetes care In Guyana, South AmericaQuantifying the burden of pediatric surgical disease due to delayed access to careImplementation of oncology surgery in Western Kenya. Can J Surg 2012. [DOI: 10.1503/cjs.016812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Abstract
BACKGROUND Abnormalities of rotation and fixation of the intestines are of intense interest to the pediatric surgeon, as they are frequently associated with volvulus which has catastrophic consequences when diagnosis is delayed or not even considered. This study evaluates the outcomes of surgical management of intestinal malrotation (IM) in children. MATERIALS AND METHODS The medical records of all patients with symptomatic malrotation, who underwent surgery between January 2000 and September 2009, were reviewed. Patients' characteristics, management, complications, and survival were evaluated. RESULTS Nine patients (eight boys and a girl) underwent surgery for malrotation at a median age of 15 days. Eight presented with acute symptoms and one with chronic symptoms. All the patients had symptoms of intermittent or complete upper intestinal obstruction, and malrotation was documented by an upper gastrointestinal contrast study in two of them. Volvulus was found at the time of surgery in seven patients, five of whom were neonates. One patient also had associated mesentery cyst. Seven patients were treated by Ladd's operation. One patient with massive bowel gangrene due to volvulus had right hemicolectomy. There was one perioperative death from anastomostic leak. Median length of stay was 9 days. Postoperative bowel obstruction was seen in two patients (one died), resulting in an overall mortality of 22.2%. CONCLUSIONS Bowel gangrene from volvulus contributes to mortality, and small bowel adhesive intestinal obstruction is a cause of morbidity and mortality following surgery for IM. Neonates with bilious vomiting should raise the suspicion of malrotation until proven otherwise and given prompt intervention. There is a need for high index of suspicion in babies with bilious vomiting especially when recurrent to prevent devastating complications when present.
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Affiliation(s)
- A A Nasir
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria.
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Abdur-Rahman LO, Kolawole IK, Adeniran JO, Nasir AA, Taiwo JO, Odi T. Pediatric day case surgery: experience from a tertiary health institution in Nigeria. Ann Afr Med 2010; 8:163-7. [PMID: 19884692 DOI: 10.4103/1596-3519.57238] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The general observation that children achieve better convalescence in the home environment supports the need for adoption of day case surgery, which is gaining considerable acceptance in developing countries. Pediatric surgical service is in great demand in developing countries, and in-patient beds and surgical supplies are insufficient. METHOD A prospective collection of data on all pediatric day surgeries (PDSs) by the pediatric surgical unit University of Ilorin Teaching Hospital (UITH, Ilorin, was done. Parents had pre-operative outpatient briefing and postoperative interviews on the second and ninth days for consultation regarding post-operative complications and events at home. Study period was between April 2005 and September 2007 (2(1/2) years). RESULTS Of the 660 elective cases, 449 (68.02%) children were recruited as day cases. The male-to-female ratio was 14.3:1. Age ranged between 20 days and 15 years with a mean of 37.6 months and standard deviation (SD) of 34.4 months. Congenital hernias/ hydroceles were the highest indications (71.2%), followed by lump/ masses (12.9%), undescended testes (8.7%), umbilical hernias (4.8%) and thyroglossal duct cyst (2.5%). In 98.9% of cases, the parents resided within 20 km radius of the hospital, and 91.5% of them could reach the hospital within 1 hour. Fathers and mothers of 80.1% and 77.1% of children, respectively, had above-primary education. More than half of the fathers (55%) were civil servants, while 30% were self-employed. The mothers were civil servants in 37.3% of cases, and 34% were self-employed. The average number of outpatient clinic visits before surgery was 2-3 visits (41.2%) with mean interval to surgery of 4-5 weeks (60.3%). Logistics (investigations and availability of operation list) and patient's fitness for surgery were statistically significant delay factors (P= 0.001). CONCLUSION Parents reported 14 children to be irritable at home due to pain, while the others reported satisfactory day case experience. No unplanned admission or mortality was recorded, and only 3 (0.8%) parents would not recommend day case surgery to other people. CONCLUSION Pediatric day case surgery is feasible for well-selected and monitored cases in our environment. Term neonates with informed parents are suitable for pediatric day case surgery. There is a need for a day case center to reduce waiting list at UITH.
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Affiliation(s)
- L O Abdur-Rahman
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria.
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Abstract
BACKGROUND Although bowel resections are commonly done for congenital malformations in children in developed countries, they usually follow neglected and preventable acquired diseases of the intestine in developing countries. OBJECTIVES To determine the indications and outcome of bowel resections in children of a developing country in a university teaching hospital. MATERIALS AND METHODS Data of the patients operated (from birth to 15 years) was retrospectively collected over eight years (January 1999 to December 2006). The biodata of children included the following: Indications for operation, type of operations, duration of admission, and outcome of treatment including complications. Patients with Hirschsprung's disease were excluded from the study because bowel resection forms part of their definitive surgical management. RESULTS There were 70 patients (38 boys and 32 girls). The age ranged between four hours to 15 years (median, five months). There were 16 (22.9%) neonates, 26 (37.1%) infants, and 28 (40%) grown children. The indications were congenital anomalies in the 16 neonates. Also, 23 (88.5%) infants had intussusception, 2 (7.7%) had midgut vovulusm and 1 (3.8%) had congenital small intestine band. Among the grown children, typhoid ileal perforation (TIP) was seen in 14 (50.0%), intussusception in 5 (17.9%), and other causes in nine patients. Overall, intussusception was the most common indication for bowel resection, followed by TIP. A total of 24 patients developed 33 complications. Complications included wound infection in 47.8% and anastomotic leak in 42.8%. The duration of admission ranged between 4-35 days (median, 15 days). The overall mortality was 17.1% -; which was highest among neonates (56.3%), followed by the infants (26.9% -). CONCLUSION Bowel resections are mainly done for intussusception and complications of TIP at our centre. Late presentation, preexisting malnutrition, and nonavailability of parenteral nutrition contributed to unacceptable morbidity and mortality.
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Affiliation(s)
- L O Abdur-Rahman
- Department of Surgery, Paediatric Surgery Unit, University of Ilorin Teaching Hospital, Ilorin, Nigeria.
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Nasir AA, Adeniran JO, Abdur-Rahman LO, Abdulkadir AY, Inikori AK, Taiwo JO. Pyogenic liver abscess in children: is ruptured appendix still relevant as cause? Case report. Niger Postgrad Med J 2009; 16:176-178. [PMID: 19606202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Pyogenic liver abscess [PLA] is a rare and life-threatening disease in children. Appendicitis was the leading source of PLA in the pre-antibiotic era, but it essentially has been eliminated in recent times. Most patients with persistent fever after exploratory laparatomy for perforated appendicitis are often found to have residual abdominal collection. We report a 12-year old girl with PLA after laparotomy for perforated appendix. She developed persistent fever and respiratory distress post operatively. Physicians had an impression of pneumonia but abdominal ultrasound showed cystic mass with mobile internal echoes within the right lobe of the liver suggesting an abscess. Patient was successfully managed by percutaneous drainage under ultrasound guidance. Culture of the pus yielded no growth. She was discharged after 7 weeks of hospital stay. Aetiology, evaluation and treatment modalities were reviewed.
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Affiliation(s)
- A A Nasir
- Department of Surgery, University of Ilorin Teaching Hospital, Nigeria.
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Nasir AA, Adeniran JO, Abdur-Rahman LO, Odi TO, Omotayo JA. Typhoid intestinal disease: 32 perforations in 1 patient. Niger Postgrad Med J 2008; 15:55-57. [PMID: 18408786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Typhoid intestinal perforation is a common complication of typhoid fever in our environment. The occurrence of multiple intestinal perforations that involves both small and large bowel is increasingly being seen in our practice. We report a case of 32 intestinal perforations in a child. This is the highest number of perforations seen in any 1 patient in our search of the English literature. This article details our approach to management of this type of patient.
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Affiliation(s)
- A A Nasir
- Paediatric Surgery Unit University of Ilorin Teaching Hospital Ilorin, Kwara State, Nigeria.
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Solagberu BA, Ofoegbu CKP, Nasir AA, Ogundipe OK, Adekanye AO, Abdur-Rahman LO. Motorcycle injuries in a developing country and the vulnerability of riders, passengers, and pedestrians. Inj Prev 2007; 12:266-8. [PMID: 16887951 PMCID: PMC2586788 DOI: 10.1136/ip.2005.011221] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
At a Nigerian university hospital, none of the motorcyclists who presented over a 12 month period had been wearing a helmet, and of the eight patients who died, seven had head injuries. Of the five collision types described, the rate of motorcycle-other vehicle collisions was highest at 40.6%, while the motorcycle-pedestrian rate was 23.4%. Measures to prevent these collisions might reduce overall crashes by 64%; in addition, helmet law should be enforced.
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Affiliation(s)
- B A Solagberu
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria.
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Adeniran JO, Abdur-Rahman LO, Nasir AA. Hirschsprung's disease: 8 years experience in a Nigerian teaching hospital. J Indian Assoc Pediatr Surg 2007. [DOI: 10.4103/0971-9261.33210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Adeniran JO, Abdur-Rahman L, Nasir AA. Mesenteric Cysts Presenting with Acute Intestinal Obstruction: A Case Report. Sahel Med J 2004. [DOI: 10.4314/smj2.v7i1.12865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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