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Background: Haemorrhage is a common complication following open simple prostatectomy and patients may sometimes require a blood transfusion. Tranexamic acid has been shown to reduce blood loss following transurethral resection of the prostate and open radical prostatectomy. This study evaluated the effect of perioperative intravenous administration of tranexamic acid on blood loss and blood transfusion rates in patients who had OSP for benign prostatic enlargement., Methodology: This was a comparative study of patients with documented prostate glands 60g and above scheduled for OSP. Initial hematocrit was done a day before surgery. The patients were randomized into a tranexamic acid group, which received perioperative intravenous tranexamic acid and the no-TXA group which received placebo (0.9% saline). All patients had open simple retropubic prostatectomy. Final post-operative hematocrit was assessed 72 hours after surgery, and blood loss was calculated using the modified Gross formula (actual blood loss = estimated blood volume x change in hematocrit / mean hematocrit). The transfusion rate was documented., Results: Fifty-six patients participated in this study and were randomized into a tranexamic acid group and no-tranexamic acid group. The mean age of patients in the tranexamic acid group was 66.07 ±7.08 years and was comparable to the no- tranexamic acid group which was 66.50 ± 8.80 years (P = 0.842). The median total blood loss was lower in the tranexamic acid group (502mls, IQR 613) compared to the no-tranexamic acid group (801mls, IQR 1069). The difference in the median blood loss between the two groups was 299mls (U 275, P 0.055). The rate of blood transfusion was lower in the tranexamic acid group (6 patients, 21%) compared to the no tranexamic acid group (11 patients, 39%), (P = 0.146). There was no difference in complication rates between the two groups., Conclusion: The use of tranexamic acid in patients undergoing open simple prostatectomy showed a trend towards reduced intraoperative blood loss and less need no tranexamic for blood transfusion. This is of clinical significance, especially in elderly patients with low cardiovascular reserve., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2023 by West African Journal of Medicine.)

Background: Advances in surgical techniques have significantly improved the safety of thyroidectomy. Quality of life issues, such as voice changes, however continue to be important considerations. This study evaluated the prevalence and determinants of voice changes following thyroidectomies for non-malignant goiters in a Nigerian Hospital., Methodology: Consecutive adults who had thyroidectomy for non-malignant goiters were evaluated. Preoperatively, each participant had laryngoscopy and voice assessment using the Voice Handicap Index-10. At surgery, the intubation difficulty score, size of endotracheal tubes, and duration of operation were recorded. Laryngoscopy and VHI-10 assessments were repeated 1 week, 1 month, and 3 months after surgery. Pre and postoperative assessments were compared., Result: Fifty-four patients completed the study. Subtotal thyroidectomy was the commonest operation performed in 17 patients (31.48%), with 14 (25.93%) having total thyroidectomy. Baseline median VHI-10 score was 6.5(IQR-10). Five patients had abnormal preoperative laryngoscopy findings (benign vocal cord lesions). Postoperatively, seven patients had endoscopic evidence of vocal cord paralysis, six were unilateral while one was bilateral. Ten patients (18.5%) had early voice changes. Median VHI-10 score at one week was significantly higher than baseline (10 vs. 6.5, p = 0.01). At 3 months, VHI-10 reverted back to baseline in five of the ten patients while five patients (9.3%) had persistent voice changes. Abnormal endoscopic findings predicted the occurrence of early postoperative voice changes., Conclusion: Thyroidectomy for non-malignant goiters is associated with transient voice changes, many of which revert to normal over time. Abnormal endoscopic findings predict its occurrence., (© 2022. The Author(s) under exclusive licence to Société Internationale de Chirurgie.)

Background: Globally, COVID-19-related psychological distress is seriously eroding health care workers' mental health and well-being, especially in low-income countries like Nigeria. The use of mobile health (mHealth) interventions is now increasingly recognized as an innovative approach that may improve mental health and well-being. This project aims to develop an mHealth psychological intervention (mPsyI) to reduce COVID-19-related psychological distress among health care workers in Nigeria., Objective: Our objective is to present a study protocol to determine the level of COVID-19-related psychological distress among health care workers in Nigeria; explore health care workers' experience of COVID-19-related psychological distress; develop and pilot test mPsyI to reduce this distress; and assess the feasibility of this intervention (such as usability, engagement, and satisfaction)., Methods: A mixed (quantitative and qualitative) methods approach is used in which health care workers will be recruited from 2 tertiary health care facilities in southwest Nigeria. The study is divided into 4 phases based on the study objectives. Phase 1 involves a quantitative survey to assess the type and levels of psychosocial distress. Phase 2 collects qualitative data on psychosocial distress among health care workers. Phase 3 involves development of the mHealth-based psychological intervention, and phase 4 is a mixed methods study to assess the feasibility and acceptability of the intervention., Results: This study was funded in November 2020 by the Global Effort on COVID-19 Health Research, and collection of preliminary baseline data started in July 2021., Conclusions: This is the first study to report the development of an mHealth-based intervention to reduce COVID-19-related psychological distress among health care workers in Nigeria. Using a mixed methods design in this study can potentially facilitate the adaptation of an evidence-based treatment method that is culturally sensitive and cost-effective for the management of COVID-19-related psychological distress among health care workers in Nigeria., International Registered Report Identifier (irrid): DERR1-10.2196/36174., (©Adesanmi Akinsulore, Olutayo Aloba, Olakunle Oginni, Ibidunni Oloniniyi, Olanrewaju Ibigbami, Champion Tobi Seun-Fadipe, Tolulope Opakunle, Afolabi Muyiwa Owojuyigbe, Olushola Olibamoyo, Boladale Mapayi, Victor Ogbonnaya Okorie, Abiodun Olugbenga Adewuya. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 16.11.2022.)

Background: Coronavirus Disease 2019 (COVID-19) is anemerging disease with a global spread that has affected millions of lives. In Nigeria, the third wave of the outbreak is being experienced with many patients requiring hospitalization. Being a novel disease, we characterized the clinical profile and outcomes of patients admitted into our isolation centre., Methods: A case series of 65 COVID-19 patients admitted at theIsolation Centre of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, from June 2020 to March 2021 is presented. Information on demographic characteristics, medical history, symptoms, treatment and outcomes was obtained. Data were analysed using SPSS version 25., Results: Most (47; 72.3%) patients were less than 65 years old and 39 (60.0%) were males. The commonest symptoms were cough (42; 64.6%), breathlessness (41; 63.1%), fever (40; 61.5%), muscle aches (40; 61.5%), and anosmia (16; 24.6%). Hypertension (41; 63.1%) and diabetes (18; 27.7%) were the most predominant comorbidities. Forty-three patients (66.2%) had supplemental oxygen therapy. The majority (44; 70%) of patients were admitted for 10 days or less and 58 (89.3%) patients were discharged home. However, 6 deaths (9.2%) were recorded among patients with advanced comorbidities and severe sepsis with all deaths occuring within 5 days of admission., Conclusion: There was a male predominance among patients admitted at the Isolation Centre and all mortalities occurred within five days of admission. Early detection, prompt management of cases with hypoxaemia and optimal treatment of comorbidities are recommended for good outcomes in COVID-19 patients., Competing Interests: The Authors declare that no competing interest exists., (Copyright © 2022 by West African Journal of Medicine.)

Background: Open-heart surgery started at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) Ile-Ife, Nigeria, 5 years ago through partnership with foreign partners. This paper reviewed the difficulties facing the development of paediatric cardiac anaesthesia, the pattern, and the outcome of cases managed., Methods: A review of the infrastructure, equipment, manpower and operational setup for open-heart surgery at OAUTHC was done. A retrospective study of all patients that were operated on from April 2016 to March 2021 was performed. Extracted data were analysed with Statistical Packages for the Social Scientists using descriptive statistics., Results: A total of 102 patients had open-heart surgeries during the period under review by the various teams in a shared facility of the hospital's main theatre. Challenges with manpower, infrastructure, and supplies were major limitations to service delivery. Most of the patients (75.5%) were aged < 5 years. The commonest procedures performed were ventricular septal defect closure (31.4%), total correction of tetralogy of Fallot (26.5%), and atrial septal defect closure (9.8%). Fast-tracked anaesthesia was used always except where it was contraindicated. Most (76.7%) of the cases were extubated within 24 hours after surgery; the mean (SD) duration of ventilation in the ICU was 0.99 (1.2) days and the average length of ICU stay was 3 days. The overall mortality rate was 20.6%., Conclusion: Numerous challenges confront the provision of sustainable paediatric cardiac anaesthesia services in resource-constrained settings like ours. Much can be achieved with appropriate investment in material and manpower, and partnership with experienced teams., Competing Interests: The Authors declare that no competing interest exists., (Copyright © 2022 by West African Journal of Medicine.)

Background: This study aimed at evaluating the endoscopic management and clinical outcomes in patients with obstructive jaundice undergoing Endoscopic Retrograde Cholangiopancreatography (ERCP) within a newly established apprenticeship teaching model at an academic centre in a resource-limited setting., Materials and Methods: We employed an apprenticeship-style model of ERCP training with graded responsibility, multidisciplinary group feedback and short-interval repetition. We collected sociodemographic and clinicopathologic data on consecutive patients who underwent ERCP from March 2018 to February 2020., Results: A total of 177 patients were referred, of which 146 patients had an ERCP performed for obstructive jaundice and 31 excluded during the study period. The median age was 55 years, age range from 8 to 83 years. The most common referral diagnosis was pancreatic head cancer 56/146 (38.1%), followed by choledocholithiasis 29/146 (19.7%), cholangiocarcinoma 22/146 (15.0%) and gall bladder cancer 11/146 (7.5%). In all, 102 patients had a malignant indication for ERCP. The cannulation rate was 92%. The most common site for malignant biliary obstruction was proximal bile stricture in 31/102 (30.4%), followed by distal bile strictures in 30/102 (28.4%), periampullary cancer 20/102 (19.6%) and mid bile duct stricture in 9/102 (8.8%). The common benign obstructive etiology includes choledocholithiasis in 33/44 (75%) and mid duct obstruction from post-cholecystectomy bile duct injury in 3/44 (2.9%) while 2/44 (2.0%) patients had choledochal cyst. Overall complications were post-ERCP pancreatitis (8/146 patients), cholangitis (3/146 patients), stent migration and post-sphincterotomy bleeding (one patient each). Peri-procedural mortality was 5/146 (3.4%)., Conclusion: ERCP is an effective and safe method of treatment of patients with benign and malignant biliary obstruction. The low morbidity and mortality and its immediate therapeutic benefits, together with the short duration of hospitalization, indicate that this procedure is an important asset in the management of such patients., Competing Interests: None

Background: Pain is a public health problem requiring serious attention. One major barrier to the provision of quality pain treatment in many countries is lack of training for healthcare workers. The aim of this study was to evaluate the impact of pain education on the knowledge and attitude of healthcare workers, and opioid utilization in a university teaching hospital., Methods: Pain management workshops were conducted for healthcare workers over a 12-month period. The modified "Knowledge and Attitudes Survey Regarding Pain" questionnaire was administered to participants pre- and post- training for each of the workshops. The total mark by each participant was entered into the Statistical Package for Social Sciences (SPSS) software version 16 software for windows (SPSS Inc., Chicago, Illinois, USA) for comparison of means for pre- and post-test. Changes in opioid utilization were evaluated., Results: The pre-test and post-test questionnaires were filled by 715 and 700 participants respectively. The mean post-test score was significantly higher than the pre-test score (68% versus 49% respectively, p = 0.00001). The doctors scored significantly higher than the other groups (p < 0.0001) in the pre-test. The mean post-test scores were significantly higher than the corresponding mean pre-test scores for the various groups (p < 0.0001). Sustained increase (up to 60.4%) in total morphine utilization was observed during the training., Conclusion: There is a wide knowledge gap requiring regular training and re-training to achieve improved pain management and opioid utilization among healthcare workers. Inclusion of robust pain curricula in medical training programs will significantly improve pain management.

Background: Short-term pain relief can be achieved by local anaesthetic infiltration of port sites at the end of laparoscopic surgery. This study aimed to assess feasibility of performing an RCT to evaluate short-term postoperative analgesia after laparoscopic surgery in Nigeria using two local anaesthetics for port-site infiltration versus saline placebo., Methods: This was a placebo-controlled, patient- and outcome assessor-blinded, external feasibility RCT. Patients undergoing elective laparoscopic cholecystectomy for symptomatic ultrasound-proven gallstones were randomized into three groups: lidocaine with adrenaline (epinephrine), bupivacaine or saline control. The feasibility of recruitment, compliance with randomized treatment allocation, and completion of pain and nausea outcome measures were evaluated. Pain was assessed at 2, 6, 12 and 24 h after surgery using a 0-10-point numerical rating scale (NRS) and a four-point verbal rating scale. Nausea was assessed using NRS at the same time points. Clinical outcomes were assessed only in patients who received the correct randomized treatment allocation., Results: Of 79 patients screened for eligibility, 69 were consented and randomized (23 per group). Overall, compliance with randomized treatment allocation was achieved in 64 patients (93 per cent). All pain and nausea assessments were completed in these 64 patients. On the NRS, most patients had moderate to severe pain at 2 h (39 of 64, 61 per cent), which gradually reduced. Only six patients (9 per cent) had moderate to severe pain at 24 h., Conclusion: Recruitment, compliance with the randomized allocation, and completion of pain outcome measures were satisfactory. This study demonstrates the feasibility of conducting a surgical RCT in a resource-limited setting. Registration number: ISRCTN 17667918 (https://www.isrctn.com).

Background: Magnetic resonance imaging (MRI) in paediatric patients requires them to be calm during the procedure to avoid motion artefacts in the acquired images. Sedation and/or anaesthesia is a way to achieve this. We evaluated all paediatric MRI sedations since installation of an MRI device in our hospital., Material/methods: We retrospectively reviewed 69 paediatric MRI sedations performed over a 5-year period using records of patients' biodata, MRI date, indication, findings and scan time, sources of referral, body region scanned, type, dose, related adverse events and route of administration of sedatives as well as image quality., Results: The median age and weight of the patients were 24 months {range of 0.3 months (10 days) to 132 months (11 years)} and 11.5 kg (range of 2.6 kg to 42 kg), respectively. Males constituted 50.7% of the patients. Most participants (94.2%) were in-patients of the hospital, mainly (60.0%) referred from the paediatric unit, with slightly over one third (36.2%) of the studies performed in 2015. The commonest indication and scanned body region were macrocephaly (18.8%) and the brain (76.8%), respectively. Hydrocephalus (17.4%) was the commonest MRI finding. Sedation was planned in 66 (95.7%) patients and was successful in 68 (98.6%). Midazolam and the IV route were the commonest sedative agent and route of administration, respectively. Image quality determined by age was fair to good in 68 (98.6%) patients with only 1 patient requiring re-scanning due to motion blur. No adverse events with sedation were recorded., Conclusions: Midazolam via the IV route with or without oral route is the drug of choice for MRI sedation in children in our institution with a success rate of about 99%.

Objectives: To examine the practices related paediatric adenotonsillectomy in our setting especially in relation to blood request and transfusion, routine investigations, post-operative analgesic practice and complications., Methods: We reviewed the record of paediatric patients who had adenotonsillectomy in our facility over a 5-year period to obtain relevant information to our study., Results: There were 33 males and 19 females with mean age of 3.27 ± 2.76 years. Sinus tachycardia was found in 11(21.2 %) of the subjects and T wave anomaly in 1(1.9%) of the subject. Thirty-five (67.3%) patient had adenotonsillectomy, 13(25.0 %) adenoidectomy only and 4(7.7%) tonsillectomy only. Majority of the patients (24, 46.2%) were classified as ASA physical status I. Pre-operative blood request rate was high (49, 94.3%) though the transfusion rate was 1.9 % (1 patient). Acetaminophen combined with other analgesics was used for post-operative analgesia for most of the patients. There was significant weight gain post-operatively among patient., Conclusions: Cold steel adenotonsillectomy is safe and effective in our environment. We believe that there is no justification for routine pre-operative blood request as a preconditions for surgery. We also like to suggest that post-operative pain management be streamlined taking into consideration the available analgesics in our setting.

Background: It has been generally observed that children achieve better convalescence in the home environment especially if discharged same day after surgery. This is probably due to the fact that children generally tend to feel more at ease in the home environment than in the hospital setting. Only few tertiary health institutions provide routine day-case surgery for paediatric neurosurgical patients in our sub-region., Objective: To review the pattern and practice of paediatric neurosurgical day-cases at our hospital., Patients and Methods: A prospective study of all paediatric day-case neurosurgeries carried out between June 2011 and June 2014., Results: A total of 53 patients (34 males and 19 females) with age ranging from 2 days to 14 years were seen. Majority of the patients (77.4%) presented with congenital lesions, and the most common procedure carried out was spina bifida repair (32%) followed by ventriculoperitoneal shunt insertion (26.4%) for hydrocephalus. Sixty-eight percentage belonged to the American Society of Anesthesiologists physical status class 2, whereas the rest (32%) belonged to class 1. General anaesthesia was employed in 83% of cases. Parenteral paracetamol was used for intra-operative analgesia for most of the patients. Two patients had post-operative nausea and vomiting and were successfully managed. There was no case of emergency re-operation, unplanned admission, cancellation or mortality., Conclusion: Paediatric day-case neurosurgery is feasible in our environment. With careful patient selection and adequate pre-operative preparation, good outcome can be achieved.

Background: The unimodal approach of using pentazocine as post-cesarean section pain relief is inadequate, hence the need for a safer, easily available and more effective multimodal approach., Aim: To evaluate the effectiveness of rectal diclofenac combined with intramuscular pentazocine for postoperative pain following cesarean section., Methods: In this double blind clinical trial, 130 pregnant women scheduled for cesarean section under spinal anesthesia were randomly assigned to two groups. Group A received 100mg diclofenac suppository and group B received placebo suppository immediately following surgery, 12 and 24h later. Both groups also received intramuscular pentazocine 30mg immediately following surgery and 6 hourly postoperatively in the first 24 h. Postoperative pain was assessed by visual analogue scale at end of surgery and 2, 12 and 24 h after surgery. Patient satisfaction scores were also assessed., Results: One hundred and sixteen patients completed the study. Combining diclofenac and pentazocine had statistically significant reduction in pain intensity at 2, 12, and 24 hours postoperatively compared to pentazocine alone (p <0.05). No significant side effects were noted in both groups. The combined group also had significantly better patient satisfaction scores., Conclusion: The addition of diclofenac suppository to intramuscular pentazocine provides better pain relief after cesarean section and increased patient satisfaction.

Aims and Objectives: We set out to determine the safety and efficacy of the use of three sedative regimens, namely propofol alone, propofol with benzodiazepine and/or opioids and benzodiazepine with opioids in Nigerian patients undergoing diagnostic colonoscopy at a Nigerian tertiary hospital., Patients and Methods: A total of 120 patients undergoing outpatient colonoscopy were assigned prospectively to one of the three treatment regimens. Patients in Group A (n = 40) received propofol alone (PRO), Group B (n = 40) received propofol with midazolam and/or fentanyl and Group C (n = 40) received opioids and midazolam (fentanyl and midazolam - conscious sedation). Study outcome measures include the level of sedation, length of the procedure, sedation/recovery time, patient satisfaction and adverse events., Results: Patients receiving PRO alone received higher doses of PRO compared with PRO and additives (P = 0.043). The overall procedure and sedation duration were similar in both PRO containing groups but statistically significantly shorter than the conscious sedation group (P < 0.0001, P < 0.006). The recovery time was statistically shorter in the PRO additives group compared to the other two groups (P < 0.0001). While the drop in blood pressure was similar in all the groups (P = 0.227), the occurrence of hypoxaemia was higher in the PRO containing groups (P < 0.0001). Overall physicians and patients pain assessment scores were statistically different in the three groups (both P < 0.0001)., Conclusion: Our data suggest that PRO sedation is safe when used for outpatient diagnostic colonoscopy in low-resource settings with better patients and physician satisfaction. The synergistic sedative effect of midazolam and/or opioids combined with PRO help reducing the dose of PRO used with better recovery.

Background: Anxiety is an unpleasant emotional experience that involves feelings of tension, apprehension, nervousness and high autonomic activity. Few studies have been conducted in Nigeria on anxiety levels among patient undergoing surgical operation. The aim of this study is to assess preoperative and postoperative anxiety level of patients and identify factors that may influence patient's preoperative anxiety level., Methods: Fifty one adult patients scheduled for elective surgery in a tertiary public hospital in Nigeria were assessed a day before and after their surgery using a questionnaire with socio-demographic and clinical details. Anxiety was assessed with the state portion of the State-Trait Anxiety Inventory (STAI) and different factors responsible for their anxiety were selected from a list. Statistical analysis was done using SPSS version 17., Result: Twenty-six patients (51.0%) had significant preoperative anxiety while 8 (15.7%) had significant postoperative anxiety. The patients preoperative mean anxiety score of STAI (42.72 ± 9.84) was statistically significantly higher than their postoperative mean anxiety score (37.73 ± 8.44; p = .001). In 10 items of STAI, there were significant differences between the preoperative and postoperative mean STAI scores. Fear of complications and result of operation were the most common factors responsible for preoperative anxiety while few patients were anxious about nil per mouth, getting stuck with needle and harm from doctor/nurse mistake., Conclusion: The prevalence of preoperative anxiety is high in Nigerian surgical patients. Psychological preparation and provision of correct information that addresses identified factors may help in reducing preoperative anxiety.

Background: Situs inversus is a rare abnormality typically posing a diagnostic dilemma during routine evaluation of acute abdominal emergencies such as in acute appendicitis and cholecystitis. It is rare to detect such in the setting of trauma., Objective: To report an incidental finding of complete situs inversus in a poly-traumatized adult., Methods: The clinical records of the patient including preoperative evaluation, intra-operative findings and postoperative care were reviewed., Result: A 53 year old man presented with difficulty breathing, left sided chest pain, generalized abdominal pain and distension 18 hours after a vehicular road traffic accident. Examination revealed features of left sided haemothorax, absent heart sounds, generalized peritonitis and limb injuries. Plain chest radiograph confirmed left haemothorax with dextrocardia. He had a left closed thoracostomy tube drainage and exploratory laparotomy which revealed complete situs inversus of intra-abdominal organs alongside a jejunal perforation which was repaired. Postoperative recovery was uneventful., Conclusion: Complete situs inversus is uncommon and may not be anticipated in evaluation of trauma patients. Preoperative clinical and radiological evaluation may however be helpful in making a pre-operative diagnosis and further management.