State University Teaching Hospital Aba Research Articles

Evaluation of Some Hematological Parameters in Patients with Diabetes Mellitus Attending Abia State University Teaching Hospital Aba Based on Socio-Demographic Characteristics

The evaluation of lipid profile and some hematological parameters in diabetic patients attending Abia State Teaching Hospital Aba, was carried out. Venous blood samples were collected from 150 participants who gave consent. This comprises 100 diabetic patients as test and 50 healthy subjects as control. The plasma glucose and hemoglobin levels were determined using spectrophotometric methods. Data from this study were analyzed using statistical package for the social sciences (SPSS). Result shows that, platelet (395.44±72.11x109/l), prothrombin time (13.63±0.95secs) levels were higher in study population compared with control (176.18±25.26x109/l, 11.85±0.63secs, respectively) (p<0.05 in each case). The hemoglobin (124.83±15.01g/l) was lower in diabetic patients compared with control (131.66±10.45g/l) (p<0.05). From the findings, management of conditions related to cardiovascular disease, artherosclerotic disease, anemia and stress in diabetics may benefit patients if some hematological parameters are included as part of their routine laboratory investigations. Keywords: hematological parameters, coagulation, platelets, cardiovascular disease, diabetes mellitus

Pattern of Complications Following Prostrate Biopsies: A Five Year Review in Abia State University Teaching Hospital Aba, South Eastern Nigeria

Prostate Cancer is the most common cancer among Nigeria men. Prostrate Biopsy remains the single most important investigation for establishment of prostate cancer diagnosis. Even though simple to perform and basically an outpatient procedure, often times, complications occur, some of which may be mild and self-limiting, while others may require hospitalization and other severe measures to deal with. The aim of this study is to analyze the rate and types of complications following biopsies done at Abia State University Teaching Hospital, Aba. Between January 2016 and December 2020 involving 198 men, 198 biopsies were done, out of which complications occurred in 55 cases (27.78%). Hemorrhage was the commonest cause with 28 cases (14.18%) followed closely by perianal pain with 11 cases (5.58%). Other complications seen included: vasovagal attack with 5 cases (2.28%), acute urinary retention with 4 cases (2.028%), lower urinary tract symptoms (luts) with 4 cases (2.028%) and sepsis with 3 cases (1.518%). Hemorrhagic complications were the most common complications found in Abia State University Teaching Hospital Aba.

Review of the Pattern of Prostate Cancer Aggressiveness Using the Gleason Scoring System among Men Attending Abia State University Teaching Hospital Aba, South Eastern, Nigeria

Prostate cancer is the most common cancer among African – American men and the second most common cause of death in the western world. It is the most common cancer among Nigerian men with increasing incidence, morbidity and mortality. The morbidity and mortality depend on the tumor aggressiveness. The three most important prognostic parameters for this disease include Tumor pathologic stage Tumor histologic differentiation (gleason score) Level of prostate specific antigen (PSA) These factors are needed in stratifying patients into risk groups. The gleason grading system , both in needle biopsy and radical prostatectomy specimens remains one of the most significant factors in the clinical decision making process. Key Challenges of the biopsy based determination of prostate cancer aggressiveness include Tumor heterogeneity Biopsy sampling error and variations in biopsy interpretations The resulting uncertainty in risk assessment leads to significant over treatment with associated cost and morbidity.

A 5 Year Review of Prostate Biopsies Taken from Men Attending Abia State University Teaching Hospital Aba, South Eastern Nigeria

Prostate cancer is the most common cancer among African-American men. It is the second most common cause of cancer death in the Western world. Prostate cancer is rarely diagnosed before the age of 50 years, but the incidence and mortality from the disease increases exponentially thereafter. This increased incidence has been attributed mainly to the introduction of screening techniques, especially (the estimation of serum prostate-specific antigen) PSA. There is a great variation in the geographic epidemiology of the disease, and environmental factors appear to be significant contributors to this difference. However, African-American men have higher incidence and mortality than white men. Within the African continent prostate cancer ranks in the top 10 and usually the top 5 for male cancers. Male relatives of prostate cancer patients have an increased risk of developing the disease. Heredity, however, appears to play a prominent role having a small percentage of prostate cancer cases (mostly early-onset disease) with the majority of patients falling in the category of sporadic cancer. Occupation and lifestyle is significant, especially when there is association between high dietary intake of animal fat. Heavy metal exposure (cadmium in particular) plays a role. The most consistent factor is hormone concentration and metabolism. Testosterone levels have been shown to be higher in African-American men than white men.

Glomerular Filtration Rate Decline and increased Serum Creatinine Concentration in Abia State University Teaching Hospital Aba

Glomerular filtration Rate (GFR) is essentially the most reliable index of kidney function in health. A decrease in GFR is a pointer to decline in Kidney function and persistent or progressive GFR decline is a specific diagnostic criterion for chronic kidney disease (CKD). In defining CKD, we consider GFR of less than 60ml/min/1.73m 2 for three months or more. Markers of Kidney function test assess the normal function of kidneys. These markers may be biochemical or even radioactive. They assist in measuring GFR, as well as the concentrating and diluting property (tubular function) of kidneys. One of such biochemical markers is Serum Creatinine. An increase or decrease in the serum level of these biomarkers can be of help in determining the efficiency of kidney function. Endogenously produced creatinine is an accepted biomarker of kidney function. It is produced from the metabolism of skeletal muscle creatine. It is released into the plasma in a stable rate in normal subjects, and freely filtered at the glomerulus. However, creatinine is secreted into the urine in the proximal tubule which can occasionally overestimate GFR by 10- 20 %.A number of GFR estimating equations have been developed to overcome some of the limitations of estimating GFR from serum creatinine. The CG equation (Cockcroft Gault) was developed in 1973 and is used widely. A new equation Modification of diet in renal disease (MDRD) study equation was developed in 1999 and has since been validated in a number of populations. The MDRD equation was used in estimating GFR in this study.

Pattern of Diabetic Eye Diseases in a Tertiary Health Facility, South East Nigeria

Diabetes mellitus (DM) is characterized by chronic hyperglycaemia; the latter predisposes persons living with diabetes to certain diseases of the eyes such as diabetic retinopathy, diabetic macular oedema, cataract, glaucoma etc, each of which may progress to visual loss and blindness. The burden and pattern of diabetic eye diseases among persons living with diabetes in the commercial city of Aba, Nigeria is not known. This study, therefore, set out to determine this. This was a 6-year retrospective study in which all diabetic patients referred to or presenting at the Ophthalmology clinic of Abia State University Teaching Hospital (ABSUTH) Aba, Nigeria between January 2013 and December 2018 were included. The patients were examined by ophthalmologists and optometrists. Visual acuity, refraction, tonometry, slit-lamp examination of the anterior segment and fundus examination were carried out on each patient. Data was analyzed using SPSS version 20.0 and p<0.05 was considered statistically significant. Participants in the study were 56 (44.4%) males and 70 (55.6%) females. Diabetic ocular complications occurred in 2.4% of the total Ophthalmology clinic visits in ABSUTH, Aba. The commonest diabetic eye disease was cataract which was present in 50% of the participants, No diabetic patient presented with blindness and the commonest co morbid disease in the participants was systemic hypertension. Ocular complications of DM constitute a significant burden to the Ophthalmology clinic visits in the commercial city of Aba and the commonest of these complications is cataract.

Pattern of Diabetic Eye Diseases in a Tertiary Health Facility, South East Nigeria

Diabetes mellitus (DM) is characterized by chronic hyperglycaemia; the latter predisposes persons living with diabetes to certain diseases of the eyes such as diabetic retinopathy, diabetic macular oedema, cataract, glaucoma etc, each of which may progress to visual loss and blindness. The burden and pattern of diabetic eye diseases among persons living with diabetes in the commercial city of Aba, Nigeria is not known. This study, therefore, set out to determine this. This was a 6-year retrospective study in which all diabetic patients referred to or presenting at the Ophthalmology clinic of Abia State University Teaching Hospital (ABSUTH) Aba, Nigeria between January 2013 and December 2018 were included. The patients were examined by ophthalmologists and optometrists. Visual acuity, refraction, tonometry, slit-lamp examination of the anterior segment and fundus examination were carried out on each patient. Data was analyzed using SPSS version 20.0 and p<0.05 was considered statistically significant. Participants in the study were 56 (44.4%) males and 70 (55.6%) females. Diabetic ocular complications occurred in 2.4% of the total Ophthalmology clinic visits in ABSUTH, Aba. The commonest diabetic eye disease was cataract which was present in 50% of the participants, No diabetic patient presented with blindness and the commonest co morbid disease in the participants was systemic hypertension. Ocular complications of DM constitute a significant burden to the Ophthalmology clinic visits in the commercial city of Aba and the commonest of these complications is cataract.

Pattern of Diabetic Eye Diseases in a Tertiary Health Facility, South East Nigeria

Diabetes mellitus (DM) is characterized by chronic hyperglycaemia; the latter predisposes persons living with diabetes to certain diseases of the eyes such as diabetic retinopathy, diabetic macular oedema, cataract, glaucoma etc, each of which may progress to visual loss and blindness. The burden and pattern of diabetic eye diseases among persons living with diabetes in the commercial city of Aba, Nigeria is not known. This study, therefore, set out to determine this. This was a 6-year retrospective study in which all diabetic patients referred to or presenting at the Ophthalmology clinic of Abia State University Teaching Hospital (ABSUTH) Aba, Nigeria between January 2013 and December 2018 were included. The patients were examined by ophthalmologists and optometrists. Visual acuity, refraction, tonometry, slit-lamp examination of the anterior segment and fundus examination were carried out on each patient. Data was analyzed using SPSS version 20.0 and p<0.05 was considered statistically significant. Participants in the study were 56 (44.4%) males and 70 (55.6%) females. Diabetic ocular complications occurred in 2.4% of the total Ophthalmology clinic visits in ABSUTH, Aba. The commonest diabetic eye disease was cataract which was present in 50% of the participants, No diabetic patient presented with blindness and the commonest co morbid disease in the participants was systemic hypertension. Ocular complications of DM constitute a significant burden to the Ophthalmology clinic visits in the commercial city of Aba and the commonest of these complications is cataract.

Pattern of Diabetic Eye Diseases in a Tertiary Health Facility, South East Nigeria

Diabetes mellitus (DM) is characterized by chronic hyperglycaemia; the latter predisposes persons living with diabetes to certain diseases of the eyes such as diabetic retinopathy, diabetic macular oedema, cataract, glaucoma etc, each of which may progress to visual loss and blindness. The burden and pattern of diabetic eye diseases among persons living with diabetes in the commercial city of Aba, Nigeria is not known. This study, therefore, set out to determine this. This was a 6-year retrospective study in which all diabetic patients referred to or presenting at the Ophthalmology clinic of Abia State University Teaching Hospital (ABSUTH) Aba, Nigeria between January 2013 and December 2018 were included. The patients were examined by ophthalmologists and optometrists. Visual acuity, refraction, tonometry, slit-lamp examination of the anterior segment and fundus examination were carried out on each patient. Data was analyzed using SPSS version 20.0 and p<0.05 was considered statistically significant. Participants in the study were 56 (44.4%) males and 70 (55.6%) females. Diabetic ocular complications occurred in 2.4% of the total Ophthalmology clinic visits in ABSUTH, Aba. The commonest diabetic eye disease was cataract which was present in 50% of the participants, No diabetic patient presented with blindness and the commonest co morbid disease in the participants was systemic hypertension. Ocular complications of DM constitute a significant burden to the Ophthalmology clinic visits in the commercial city of Aba and the commonest of these complications is cataract.

Pattern of Diabetic Eye Diseases in a Tertiary Health Facility, South East Nigeria

Diabetes mellitus (DM) is characterized by chronic hyperglycaemia; the latter predisposes persons living with diabetes to certain diseases of the eyes such as diabetic retinopathy, diabetic macular oedema, cataract, glaucoma etc, each of which may progress to visual loss and blindness. The burden and pattern of diabetic eye diseases among persons living with diabetes in the commercial city of Aba, Nigeria is not known. This study, therefore, set out to determine this. This was a 6-year retrospective study in which all diabetic patients referred to or presenting at the Ophthalmology clinic of Abia State University Teaching Hospital (ABSUTH) Aba, Nigeria between January 2013 and December 2018 were included. The patients were examined by ophthalmologists and optometrists. Visual acuity, refraction, tonometry, slit-lamp examination of the anterior segment and fundus examination were carried out on each patient. Data was analyzed using SPSS version 20.0 and p<0.05 was considered statistically significant. Participants in the study were 56 (44.4%) males and 70 (55.6%) females. Diabetic ocular complications occurred in 2.4% of the total Ophthalmology clinic visits in ABSUTH, Aba. The commonest diabetic eye disease was cataract which was present in 50% of the participants, No diabetic patient presented with blindness and the commonest co morbid disease in the participants was systemic hypertension. Ocular complications of DM constitute a significant burden to the Ophthalmology clinic visits in the commercial city of Aba and the commonest of these complications is cataract.

Complicated appendicitis in Children in Aba, Nigeria

Introduction: Acute appendicitis is one of the most common abdominal emergencies globally. Etiologyremains poorly understood with few advances over the past decades. Obtaining a confident pre-operativediagnosis remains a challenge, as appendicitis must be entertained in any patient presenting with an acuteabdomen. A clinical classification is used to stratify management based on simple (non-perforated) andcomplex (gangrenous or perforated) inflammation, although many patients remain with an equivocaldiagnosis, which remains one of the most challenging dilemmas. The aim of the study is to evaluate themanagement and outcome of complicated appendicitis at the Abia State University Teaching HospitalAba Nigeria. Methodology: A prospective analysis of all children treated for appendicitis at the AbiaState University Teaching Hospital Aba between 2016 and December 2018. Proforma was opened fordemographic data, clinical presentation, diagnosis, treatment, complication and outcome. Results: A totalof 100 children aged between 2 and 15 (mean 8.7 ± 2.8) years, comprising 60males and 40 females withmale/female ratio 3:2 had appendectomy which accounted for 8% of total pediatric operations and 40% ofpediatric abdominal operations. Only 40 (40%) children presented during the first episode of symptomsand in clinically stable state while 60 (60%) were referred after wrong diagnosis and treatment by generalpractitioners which resulted in different complications ranging from appendix abscess 10 (10%), appendixmass 15 (15%), perforated appendix 30 (30%), gangrenous appendix 5 (5%) . These influenced postoperative outcome with wound infection recorded in 20 (20%), wound break down 10 (10%), septicemia15 (15%), pelvic abscess 5 (5%) and death 1 (1%). These were not recorded among those who presentedearly who also had significantly lower duration of hospitalization and cost of treatment. Conclusion: Latereferral due to paucity of knowledge, long referral chain and low index of suspicion was rampant whichsignificantly increased associated morbidities and mortality among children managed with appendicitisKeywords: Appendicitis, children, complicated

Body Mass Index and Breast Cancer Risks Among Igbo Women in Imo and Abia States, Nigeria: A Case Control Study

Background: The association between body mass index (BMI) and breast cancer risk has been well recognized. The purpose of this study was to determine the association of BMI with breast cancer risks among women of Igbo origin in Imo and Abia states in South Eastern Nigeria.
 Methods: The study was conducted at three different locations: Abia State University Teaching Hospital Aba, Abia State; Federal Medical Centre, Owerri, Imo State; and the Maranatha Specialist Mission Hospital, Aba, Abia State. This was a prospective hospital-based case control study. Data were collected on socio-demographic characteristics and anthropometric measures using a structured questionnaire. Collected data were imported to SPSS version 23 for analysis. In all, 681 patients participated in the study of which 347 were cases and 334 were controls. The T-test was used to assess statistical differences of height, weight, and BMI in the studied groups. Logistic regressions were used to calculate the multivariate odds ratio (OR) using 95% confidence interval (CI) with significant level set at p>0.05.
 Results: Higher BMI is associated with increased risk of breast cancer. There was a significant statistical difference between the height of cases and controls in both pre-and post-menopausal women. The mean value of height was 161.14± 7.1cm among cases compared to controls which was 161.39 cm (p<0.05). The mean weight among cases was 66.34 ± 11.8kg compared to controls at 65.45 ± 9.2kg (p<0.05); the mean BMI was 25.6± 4.8kg/m2 among cases compared to controls 25.1± 4.6 kg/m2 (p<0.05).
 Conclusion and Implications For Translation: Primary prevention measures are important to modestly curtail the increasing burden of obesity and high BMI. By controlling the weight, through physical activities, changes in diet and modestly alcohol intake will reduce the risk of breast cancer.
 Key words: • Breast Cancer • Imo State • Abia State • South East Nigeria • Body Mass Index • Nigeria
 
 © 2019 Oyamienlen et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Childhood Typhoid Intestinal Perforation in Aba, Nigeria

Typhoid intestinal perforation is still prevalent in many low and middle income countries. This may be due to lack of potable water, poor refuse disposal and health education. This study is to evaluate the outcome of management of typhoid intestinal perforation in children at the Abia State University Teaching Hospital Aba Nigeria. This is a prospective study of children who were managed for typhoid intestinal perforation at the Paediatric Surgery unit, department of Surgery of the Abia State University Teaching Hospital Aba Nigeria from November 2016 to September 2018. Proforma was opened for demography, clinical features, investigation, site of perforation, type of surgery, complications and outcome. Data collected were analysed using SPSS computer software version 17 for proportions and percentages. Results: Sixty patients were seen over the sixteen months study period. Forty males and twenty females with a male to female ratio {2:1}. Their ages ranged from 3 years to 15 years with a mean age of 8.9 years. Fever, abdominal pain, vomiting and abdominal distension were the commonest clinical features in over 50% of patients. Doubled layer closure and resection and anastomosis of ileal segment were done in equal number of patients [20 patients each]. Surgical site infection was the most common complications in 50 [83.3%] of patients. Five patients died giving a mortality rate of 8.3%. Typhoid intestinal perforation is still a persistent scourge in low income countries. Morbidity is still high despite low mortality in this series. Early presentation, good nutrition and public health education will improve outcome.

Influence of Employees' Job Satisfaction and Performance on Health Care Delivery in Abia State University Teaching Hospital, Nigeria

Employee’s job satisfaction for high performance in the workplace has been of great concern since the beginning of industrial revolution. Satisfaction is believed to be fundamental to individual and organizational performance. To this end, in recent time, especially in a developing country like Nigeria, there has been increasing concern over the adverse implications of the failure to adequately satisfy all levels of employees in any work organization. It is on this context that this study looked at the employees job satisfaction and performance and its effect on health care provision, with reference to Abia State University Teaching Hospital Aba, Nigeria. The general objectives of this study is to examine the extent which employee job satisfaction and performance among health workers in Abia State University Teaching Hospital Aba, affect health care delivery in the institution. This study adopted a survey research design using structured questionnaire for qualitative data and in-depth interview for qualitative information. From the findings, it was concluded that despite the findings that majority of the workers were not satisfied in relation to the satisfaction indicators such as prompt payment of salaries, on the job training, objective promotion, payment of allowances, etc; the workers delivered their duties diligently. Finally, it was recommended that the hospital management should ensure regular and adequate staff training and development programmes with a view to improving staff skills, knowledge, attitude, ability, competence, and above all, satisfaction of the staff for optimum performance.

Management of Undescended Testis in Children in Aba Nigeria

Introduction: The anomalies of descent of the testes are common problem in newborn male infants. An absence of the testis in the scrotal sac is defined as cryptorchidism. Ectopic testis occurs when it migrates from its usual path of descent to lie in an unusual location. it affects 2–5% of the infants at birth and 1–2% of them at 3 months of age, the incidence is even higher in preterm infants, reported at 30%. Methodology: This was a prospective cross-sectional study of all male children above 3 months of age with undescended testes who were managed by the Paediatric Surgery Unit of the Abia State University Teaching Hospital Aba from January 2016 to December 2018. Results: Thirty children aged ≤ 15 years with 40 undescended testes managed in 3 years The age at surgery was fourteen months to 15 years (median six years); five (17%) had correction before two years, 10 (33%) before five years and 15 (50%) at age ≥ 5 years. Thirty (75%) testes were palpable and ten (25%) non-palpable. Evaluation was mainly clinical. Ultrasonography was performed for six non-palpable testes but was not helpful. Laparoscopy was not used in any patient. The condition was unilateral in twenty (67%) and bilateral in ten (33%). Forty per cent of the testes were in the inguinal canal, 25% at the external ring, and 15% each at the internal ring and abdomen respectively. Six (20%) testes were macroscopically atrophic (canalicular three, abdominal two, internal ring one). Orchidopexy was performed for 34 undescended testes and orchidectomy forsix testes. Groin and scrotal haematoma developed following one orchidopexy. Following orchidopexy, two (6%) testes retracted necessitating repeat surgery. Conclusion: There is a need to educate parents, traditional birth attendants, midwives and doctors in our sub-region to ensure earlier presentation and treatment.

Challenges in the Management and Outcome of Posterior Urethral Valve in Aba, Nigeria

Posterior urethral valves are the commonest cause of bladder outlet obstruction in boys. The incidence varies from 1 in 5000 to 25,000 live birth worldwide. The incidence in lower and middle- income countries is unknown due to paucity of data. . The aim of this study was to review the presentation, management and outcome of posterior urethral valve at the Abia State University Teaching Hospital Aba, Nigeria. Patients and Methods: Fifteen boys with posterior urethral valve seen at the Abia State University Teaching Hospital Aba from January 2016 to June 2018 were included in the study. Data collected includes demographic data, clinical features, and duration of symptoms, serum biochemistry, radiological diagnosis, surgical management and outcome. Results: The patient age ranged from 2 weeks to 2 years, Median age of 6 months. 7(46.6%) of the patients were neonates. The commonest symptoms were voiding dysfunction, distended bladder and anaemia. Duration of symptoms was 2weeks in 6 (40%) patients, 4 weeks in 4(27) patients and 8weeks in 5(33%) patients. 2(13%) patients had grade 2 vesicoureteric reflux on expressive cystourethrogram. All the patients had foley catheter avulsion of posterior urethral valve. There was no case of frank haemorrhage but haematuria was noticed which resolved spontaneously. Fourteen (93.3%) out of 15 patients reported consistent good urinary stream without evidence of renal deterioration. A patient (6.6%) had persistent straining at micturition requiring a repeat Foley catheter balloon avulsion. All mothers were satisfied with the outcome of treatment due to good post- operative urinary stream. There was complete resolution of the vesicoureteric reflux at 6 months post valve ablation expressive cystourethrogram. The post -operative urinary stream, serum electrolyte, and urea and cretinine status remained normal during follow up period of 6 months. Conclusion: Posterior urethral valve is a common cause of bladder outlet obstruction in boys, high index of suspicion will lead to early diagnosis, late presentation still persist due to poor knowledge of health care workers in our environment.

Awareness and Practice of Pap Smear among Female Hospital Workers in Abia State University Teaching Hospital Aba South East Nigeria

Awareness and Practice of Pap Smear among Female Hospital Workers in Abia State University Teaching Hospital Aba South East Nigeria

The Use of Prophylactic Antibiotics in Day Case Herniotomy at Abia State University Teaching Hospital, Aba, Nigeria

Background: There has been tremendous improvement in the knowledge of prophylactic antibiotics use in surgery. There are controversies on the use of prophylactic antibiotics clean surgical cases. This study aims to determine if there is need to use prophylactic cefuroxime in day case herniotomy at the Abia State University Teaching Hospital Aba. Objective: To determine if there is need for prophylactic antibiotics in paediatric day case herniotomy and to compare the rate of surgical site infection in patients that receive preoperative cefuroxime to patients that did not receive it. Method: This was a hospital based prospective study carried out between April 2017 and April 2018 during which 126 herniotomy were performed as day cases at the Abia State University Teaching Hospital Aba. The patients were randomly placed into two groups: 63 patients in group A that received prophylactic cefuroxime at induction of anaesthesia and 63 patients in group B that did not receive cefuroxime. The two groups were compared to determine the factors that influenced development of surgical site infection. Results: There were 115(91.3%) males and 11(9.7%} females. Their ages ranged from 1-14 years with a median of 2 years. The average duration of the operative procedure was 34.8 minutes (34.3 minutes in group A and 35.4 minutes in group B). After a follow up of 3 weeks, a total of 8 patients developed surgical site infection (3 patients in group A; 5 patients in group B) (p=0.358). The duration of operation (p= 0.549) and mode of transport (p=0.605) did not affect rate of surgical site infection. Conclusion: Development of surgical site infection after day case herniotomy in our hospital is not affected by the use of prophylactic antibiotics and duration of operation. The study confirms that day case herniotomy can be undertaken without prophylactic antibiotics.

Challenges and Outcome of Neonatal Surgery at the Abia State University Teaching Hospital Aba Nigeria

Background: Neonatal surgery is still a challenge in developing country due to lack of appropriate equipment, inadequate work force and lack of political will by hospital management. However, there has been significant improvement in outcome over the last century. Objective: This study evaluates neonatal surgery in commercial city of Aba South East Nigeria with emphasis on challenges and management outcome. Methods: Prospective analysis of sixty neonates who had operative treatment at Abia State University Teaching Hospital Aba from October 2016 to July 2018. Proforma was opened for sex, weight, prenatal care, age at presentation, duration of symptoms prior to presentation, surgical pathology, treatment offered, associated congenital anomaly, evidence of prenatal diagnosis, complications and outcome. Results: There were 40 males and 20 females, male to female ratio of 2:1. The mean weight of the neonates was 2.5kg (range1.1-4.3kg). The average age at operation was 3 days (1-15days), the mean duration of symptoms before presentation was 3.5days. The major indication for operation was anorectal malformation 32 patients {53.3%} anterior abdominal wall defect 8 patients {13.3%}, Intestinal atresia 8 patients {13.3%}, intestinal perforation 8 patients {13.3%}, obstructed hernia 4 patient {6.6%}/There was associated congenital abnormality in 5 patients {8.3%} and prenatal diagnoses was made in 10 cases {16.6%}. During a mean follow up of 3months {1week to 9months, procedure related complications in 16 patients {26.6%} and 8patients died {mortality of 13.3%}. Conclusion: Surgical care of the neonate with a wide range of pathologies is still major challenge in our setting. Good political will, capacity building in form of manpower development and procurement of appropriate equipment will enhance the outcome.

Refractory Oedema of Nephrotic Syndrome in a Resource Poor Setting: A Case Presentation

Background: Oedema, a constant feature of childhood nephrotic syndrome can be severe, enough to cause respiratory embarrassment. It can also be refractory to diuretic monotherapy. In such cases, combination of salt poor albumin (SPA) infusion and diuretics has remained the best treatment option. However, the cost of SPA has made it practically unavailable in resource-poor settings. It becomes a therapeutic dilemma when nephrotic syndrome patients of financially-constrained caregivers present with refractory anasarca in a resource-poor settings. Case review: We present a seven-year-old boy with relapsed steroid sensitive nephrotic syndrome who presented to Abia State University Teaching Hospital Aba, in respiratory distress with anasarca and a weight of 58 kilograms. SPA could not be accessed due to financial constraints. A decision to use fresh whole blood in the place of SPA, in combination with frusemide, achieved a lifesaving diuresis and regression of the anasarca. Conclusion: Whole blood is a good alternative for the treatment of refractory oedema in children with nephrotic syndrome in resource poor settings.