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Background: In developing countries where resources are scarce and health care financing is essentially by out-of-pocket payment, a surgical expedition is often a huge economic relief. Children are a category of the vulnerable group that can benefit from such exercises. However, an anaesthesia technique that is economical in both human and material resources should be explored, Objective: To describe the outcome of regional anaesthesia techniques during a surgical expedition for paediatric patients. Methods: Children aged 6 months to 16 years, who had been previously screened for free surgery in different surgical specialities, were recruited for the study. Results: Fifty-six (56) children were screened but only 35 were recruited for the surgical expedition. There were nineteen (19) males and sixteen (16) females with a male to female ratio of 1.5:1. Surgical procedures covered surgical specialities such as orthopaedics, plastic and general paediatric surgery. All the patients had one form of regional technique and/or peripheral nerve blocks. There were no intra-operative or post-operative anaesthetic complications up to a period of 30-days while on follow-up care. Conclusion: Regional anaesthesia is safe and a cheap choice of anaesthesia in children during surgical expeditions.

Ano-rectal malformations comprise a wide spectrum of diseases, which can affect males and females, and involve the distal anus and rectum as well as the urinary and genital tracts. The incidence, type or variety of malformations varies from one region or geographical location to another. Ano-rectal anomalies tend to be associated with other congenital anomalies. The aim of this study is to determine the incidence, presentation and types of ano-rectal malformations and their treatment outcome. It is a prospective observational study from March 2012 to February 2019. Information obtained from cases of ano-rectal anomalies who presented to our health institution during the study period was entered into a proforma. Relevant clinical information was obtained and documented in a structured proforma. A total of 60 patients were seen during the study period. Males were 35 (58.3%) while females were 25 (41.7%). Age at presentation ranged from 2 hours -15 years. High anomalies were seen in 34 (56.7%), low anomalies 18 (30%) and intermediate 8 (13.3%). Associated congenital anomalies were seen in 12 (20%) patients. 28 patients had the traditional three-stage procedure of initial colostomy, PSARP and colostomy closure while 13 patients had double staged procedure of initial colostomy and definitive surgery with colostomy closure at the same time. Fifteen (15) patients had single staged procedure (PSARP) without an initial colostomy. Three (3) patients are awaiting colostomy closure after definitive surgery. Post-Operative complications were seen in 16 patients. A mortality of 10 (16.7%) was observed.

Malrotation occurs in approximately 1 in 500 live births. However, the true incidence of malrotation is unknown since many asymptomatic patients fail to present. Approximately 90% of patients with malrotation are diagnosed within the 1st year of life. Eighty per cent of them are diagnosed within the 1st month of life. Nevertheless, there are recent reports of manifestations later in life both as emergency conditions and more chronic gastrointestinal symptoms. The relationship between malrotation and horseshoe kidney has not been fully understood, but few case reports have highlighted their occurrence in the same patient. The mode of presentation of this case and its association with a horseshoe kidney is the reason for this report. This was a case of malrotation associated with horseshoe kidney. He had exploratory laparotomy and Ladd's procedure. Malrotation is associated with horseshoe kidney which presented as gastric outlet obstruction. He responded well to treatment after Ladd's procedure.

Background: Incidence of symptomatic prostatic diseases increases with age. Nocturia disturbs sleep. We set out to determine the quality of sleep and severity of lower urinary tract symptoms (LUTS) and bother score in patients with benign prostatic hyperplasia (BPH) and carcinoma of the prostate (CAP). Methods: A cross-sectional study of new patients seen in the urology outpatient clinic with bladder outlet obstruction (BOO) from either BPH or CAP over a period of 18 months. Patients were interviewed using Pittsburgh Sleep Quality Index (PSQI) and International prostate symptoms score (IPSS) questionnaires. Data obtained were analyzed using SPSS version 23. Results:168 patients were interviewed. CAP patients were older than their BPH counterparts. About 45% of the patients had poor sleep quality. CAP patients (52.9%) were more of poor sleepers compared with BPH patients (40.0%). CAP patients (46.3%) had more severe IPSS than BPH patients (33.3%). Both CAP (70.6%) and BPH (76.0%) patients reported high bother score. Conclusion: CAP and BPH patients have high bother score, affirming need for early treatment. CAP patients had more severe lower urinary tract symptoms and poorer sleep quality than BPH patients. Keywords: IPSS, Sleep quality, LUTS, Bother score

Background: Most patients with cancer in the low-income environment present late, when the chances of cure are remote. Palliative care which includes surgery is needed to improve quality of life and minimize suffering and emotional disturbances associated with end of life. Methodology: Retrospective study of palliative surgery cases over five years. Data extracted included demographic features, diagnosis, procedure carried out, clinical status at 30 days postoperative, and survival. Results: 1,581 patients were operated over the study period. 227 patients were operated for malignancies; of these 91 patients (40%) had palliative procedures. The diagnoses in palliative surgery cases: prostate cancer 50 patients (54.9%), breast cancer 14.3%, stomach cancer 9.9%, and others. Indications for surgery were: urinary bladder outlet obstruction 46.1%, pleural effusion 14.3 %, obstructive jaundice 13.2%, and others. Bilateral total orchidectomy was performed in 50.5%, tube thoracostomy in 14.3%, laparotomy and biopsy in 11%. Thirteen patients (14.3%) died postoperatively; 57 patients (62.6%) were alive and well at 30 days after surgery. Survival period was

IntroductionThe novel Coronavirus disease has had significant impact on healthcare globally. Knowledge of this virus is evolving, definitive care is not yet known, and mortality is increasing. We assessed its initial impact on paediatric surgical practice in Nigeria, creating a benchmark for recommendations and future reference.MethodsSurvey of 120 paediatric surgeons from 50 centres to assess socio-demographics and specific domains of impact of COVID-19 on their services and training in Nigeria. Seventy four surgeons adequately responded. Responses have been analysed. Duplicate submissions for centres were excluded by combining and averaging the responses from centres with multiple respondents.ResultsForty-six (92%) centres had suspended elective surgeries. All centres continued emergency surgeries but volume reduced in March by 31%. Eleven (22%) centres reported 13 suspended elective cases presenting as emergencies in March, accounting for 3% of total emergency surgeries. Nine (18%) centres adopted new modalities for managing selected surgical conditions: non-operative reduction of intussusception in 1(2%), antibiotic management of uncomplicated acute appendicitis in 5(10%), more conservative management of trauma and replacement of laparoscopic appendectomy with open surgery in 3(6%) respectively. Low perception of adequacy of Personal Protective Equipment (PPE) was reported in 35(70%) centres. Forty (80%) centres did not offer telemedicine for patients follow up. Twenty-nine (58%) centres had suspended academic training. Perception of safety to operate was low in 37(50%) respondents, indifferent in 24% and high in 26%.ConclusionMajority of paediatric surgical centres reported cessation of elective surgeries whilst continuing emergencies. There is however an acute decline in the volume of emergency surgeries. Adequate PPE need to be provided and preparations towards handling backlog of elective surgeries once the pandemic recedes. Further study is planned to more conclusively understand the full impact of this pandemic on children’s surgery.What is already known and what this study addsAnecdotal evidence suggests that elective surgeries in children have been suspended due to COVID-19 pandemic.Our study shows that most centres have suspended elective surgeries. All centres continued emergency surgeries but the volume reduced by 31% in March 2020. Moreover, 3% of the emergency surgeries were some of the suspended elective cases presenting as emergencies. Almost 20% of centres have newly adopted non-operative modalities for managing selected emergency surgical conditions.This data shows an urgent need for consensus guidelines for emergency services and protocols for handling backlog of elective surgeries in children once the pandemic recedes. Outcome of the modifications in treatment may be subject to future research.

Hydronephrosis is enlargement of renal collecting system including renal calyces with or without ureters. It is the most common prenatal anomaly and accounts for about 30–50% prenatal ultrasonography anomalies. Urinary tract dilation occurs in 1/100 pregnancies (1%) and causes significant uropathy in 1/500 (0.2%) cases. Antenatal hydronephrosis means dilation of the fetal renal collecting system that could be detected on prenatal ultrasonography and the prevalence is between 0.5% and 4%. Outcome depends on the underlying etiology. The index case was prenatally discovered at a gestational age of 6 months and postnatal assessment revealed a Grade V hydronephrosis with the absence of excretion or function on the right side.

Background The incidence rate of breast cancer (BC) in the high income countries (HIC) is higher than in low income countries (LIC) and middle income countries (MIC), but the overall mortality rate is much less than in LIC and MIC. Most cases of BC in HIC present early as a result of established screening programs which detects the disease at curable stage. In most LIC and MIC like Nigeria, most cases of BC present late coupled with dearth of personnel, equipment and drugs required with resultant effect of poor survival and high mortality rate associated with BC. Overwhelming studies have identified late presentation as a major cause of poor outcome of BC management in our country; however there are few studies about why the BC patients present late.

In recent times, there has been an increase in the rate of pollution of our environment and this is evident as shown in rapid climate change, ozone layer depletion, toxic pollution, depletion of non renewable resources, acidification and eutrofication of our soils and water. With all these environmental challenges, there is still increase in population and more mouths to feed. If these effects are not controlled or reduced, it means that before long, there will be an increase in the extinction of species, scarcity of fresh water and possibly more extreme weather conditions and loss of agricultural production and biodiversity, As a foremost research institute, we have goals and mandates to meet with regards to roots and tuber crops and achieving these set goals and mandates will promote sustainable agricultural development in our country. On the other hand, these mandates can only be achieved by our human workforce if they work under a safe and protected environment. Therefore, it is very important that we make sure that our work does not in any way affect our employees or add to the jeopardy of the environment because it is the workforce that will see to it that our mandates are achieved under sustainable development. In a country like Nigeria, it is naturally believed that Health, Safety and Environment is only synonymous with the oil and gas sector, big construction companies, engineering and manufacturing firms. As a research institute in the Agricultural sector, we carry out research work that involves our employees working in different laboratories where the work with different types of chemicals and organisms that are hazardous to health, we have field operations in the farms where our employees work with hand held tools and are exposed to different harsh weather conditions, engineering sector, wielding units as well as kitchen departments and other various units.

Background: In low-Human Development Index countries, population-based screening programs for breast cancer are virtually nonexistent, but there are occasional screening programs organized by nongovernmental organizations in these countries. This study aims to describe the clinical and histopathological characteristics and the prevalence of breast diseases detected by clinical breast examination (CBE) in a cohort of women who participated in a community-based breast screening program. Methodology: This is a retrospective cross-sectional study of women who were referred for assessment in our Breast Clinic following CBE during a breast cancer screening program. Palpable lesions were subjected to biopsy and histopathological examinations. Results: Of the 2450 women screened, 102 had breast biopsy. Twenty-one were malignant (20.6%) and 79 were benign (77.5%). The mean age for benign breast disease was 32 ± 14 years, whereas that for women with malignant breast lesions was 57 ± 11 years (P

A 24-day old female Nigerian neonate presented with protracted vomiting, fever and dehydration but without palpable abdominal tumour or visible gastric peristalsis. There was no derangement of serum electrolytes. The initial working diagnosis was Late-Onset Sepsis but abdominal ultrasonography showed features consistent with the diagnosis of IHPS. This case report highlights the atypical presentation of this surgical condition and the need to investigate cases of protracted vomiting in the newborn with at least, ultrasonography to minimize complications and reduce the risk of mortality in a resource-poor setting.Pan African Medical Journal 2016; 24

Background: The management of dirty abdominal wounds has remained a challenge to surgeons because of the associated complications. Objective: This study was undertaken to determine the outcome of primary closure of dirty abdominal wounds in children. Design: A retrospective study (between 1st January, 2006 and 5th May, 2009) on the outcome of the primary closure of dirty abdominal wounds in children. Setting: Paediatric Surgery Division, Department of Surgery, Olabisi Onabanjo University Teaching Hospital, Sagamu. Materials and Methods: Cases of dirty abdominal wounds managed during the study period were retrieved from the medical records. Information regarding the age, sex, diagnosis, treatment, type of abdominal wound closure, duration of stay in hospital, complications arising from the abdominal wounds, and outcome was obtained and documented. Results: A total of 120 cases of dirty abdominal wound were managed during the study period. However, 90 case notes were retrieved and further evaluated for the proposed study. The age range of the patients studied was 2 months to 14 years. Males were 48 (53.3%), while females were 42 (46.7%). All the cases were acute abdominal emergencies. Differential diagnosis of dirty abdominal wounds managed during the study period are ruptured appendicitis/appendiceal abscess 30 (33.3%), intussusception 19 (21.1%), strangulated inguinoscrotal hernia 16 (17.8%), typhoid ileal perforation 14 (15.6%), and abdominal injuries 11 (12.2%). Healing without complications was seen in 70 (77.8%) patients, while complications occurred in 20 (22.2%) patients. The complications that occurred were wound infections 17 (68%), wound dehiscence 3 (12%), incisional hernia 3 (12%), enterocutaneous fistula 2 (8%), and duration of hospitalization 7-55 days and mortality of 4 (4.4%) was recorded.