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Extremity gangrene is a fairly common pathology, which complicates systemic vascular and endocrine diseases. Most often, it is encountered in diseases like uncontrolled Diabetes Mellitus, presenting as diabetic foot gangrene, severe peripheral arteriosclerosis with gangrene of the extremity complicating severe uncontrolled systemic hypertension and meningococcal septicaemia with peripheral gangrene. It also occurs in some cases of snake bite as well as frost bite (in regions with extreme cold weather conditions). Some of them present as monolateral extremity gangrene. see more However, others present as bilateral symmetrical peripheral gangrene (SPG) characterized by bilateral extremity ischaemia resulting in gangrene in which there is no major vascular occlusive disease. There is disseminated intravascular coagulation with the gangrene being considered as a cutaneous marker and some of the patients that survive ultimately require amputation of the affected limb(s) in the severe cases. The mild cases end up losing some of the digits or just exfoliation of the dead cutaneous layer. The effects are generally more severe in the lower limbs than in upper limbs. Notable among these are some of those complicating meningococcal sepsis resulting from peripheral intravascular coagulation. We present here, five patients who presented with varying degrees of peripheral gangrene during an epidemic of meningitis and the treatments that were carried out depending on the severity of their cases.BACKGROUND Laparoscopic surgery is a relatively new and expanding field of surgical therapy in Ondo state. This is a multi-centre study cataloguing the work of the authors in Ondo State, Nigeria. AIM To determine the indications, operative findings, and interventions at Laparoscopy in our resource challenged settings. PATIENTS AND METHODS Medical records of all patients who had laparoscopic procedure at the Federal Medical Centre, Owo, Ondo State Specialist hospital, Okitipupa, University of Medical Sciences Teaching Hospital, Ondo, George and Martins Medical Centre, Ore and Mishmael Hospitals and Clinics, Akure from December, 2009 to December, 2018 were reviewed. Data on patient's age, gender, indications for surgery, duration of hospital stay, outcome of surgery were analyzed. Challenges and adaptations were also noted. RESULTS One hundred and eighty-one (181) laparoscopic procedures were done, but only 152 had complete records for review. The median age was 35.5 years (mean = 33.7±11.4years; age range of 8 month -72 years). There were more males 88(57.9%) than females, 64(42.1%). Laparoscopy was purely diagnostic (n=28,18.4%), therapeutic (n=118, 77.6%) or both (n=6, 3.9%). Cholecystectomy (n=76, 50%) and appendicectomy (n=37, 24.3%) were the two most common procedures done. In the paediatric patients, patent processus vaginalis (hernia), cryptorchidism and indeterminate sex (gender) were common indication. Challenges encountered were power failure (n=3, 2%), equipment failure (n=4, 2.6%) and difficult dissection (n=4, 2.6%). The mean duration of surgery was 96.96(±25) minutes (diagnostic), 150 (±57.6) minutes (therapeutic); while the mean duration of hospital stay was one day (diagnostic) and 2.3(±1.7) days for therapeutic interventions. CONCLUSION Laparoscopic service is achievable with adequate motivation, males appear to benefit more in our setting, and the service transcends all aged groups.Hysteroscopy involves the visualization of the endometrial cavity with the aid of a hysteroscope (Telescope) inserted through the cervix. Hysteroscopy can be performed in an office setting and minor pathologies managed. A distension medium is necessary for proper visualization. These media include gaseous media such as carbon dioxide, used for diagnostic hysteroscopy, and liquid based media such as normal saline and 1.5% glycine, used for both diagnostic and operative hysteroscopy. Complications following hysteroscopy are few. A hysteroscope should become part of the armamentarium of every gynaecologist.BACKGROUND Proximal femoral surgeries involving femoral head replacement are common procedures worldwide. In these patients, the femoral heads are replaced with femoral head prosthetic implants. Pre-operative planning to determine the likely size of the prosthetic implant is important. Estimation from radiographs is the commonest method being used but this is fraught with problems. This study, therefore, developed an alternative method that can be used to estimate the femoral head size prior to hemiarthroplasty. MATERIALS AND METHODS This was a prospective descriptive study that involved measurements of parts of femoral bone. Forty-eight adult femoral bones were measured. Measurements taken were the femoral head size (FH), the femoral bone maximum length (ML), the trochanteric length of the femur (TL), and the distal femoral breadth (DFB) of the femur. All measurements obtained were recorded and were analyzed using STATA version 13 (StataCorp, Texas, USA). RESULTS The maximum length of the femora ranged from 42.1 cm to 51.5 cm. The trochanteric length ranged from 39 cm to 48.3 cm. The distal femoral breadth ranged from 53.8 mm to 92.3 mm. The femoral head size ranged from 39 mm to 55 mm with a mean value of 46.6 ± 2.9 mm. An equation was generated using the trochanteric length. Femoral head size = 16 + 0.7(trochanteric length in centimeter) ± 5 mm. This will provide a range of possible femoral head prostheses that should be made available for the surgery. CONCLUSION This study generated an alternate method to be used during the pre-operative planning of a femoral head replacement surgery. It provides the possible range of prosthetic implants sizes to be made available for such surgeries. The trochanteric length can be easily measured. The method described will be of great benefit in middle and low income countries where prosthetic implants are not usually stocked within the hospital.BACKGROUND AND OBJECTIVES The purpose is to update the consensus statements on management of prostate cancer in West Africa. In 2010, "Prostate Cancer Guidelines for diagnosis and treatment in West Africa" was first published. Since then, there have been several developments in diagnosis and management of prostate cancer. These need to be incorporated to produce a 2019 update. The aspiration is that it will serve as a benchmark for the basic standard of care for patients with prostate cancer in West Africa or even as a working document for the development of guidelines for treatment of prostate cancer by urological associations, other professional societies, institutions or government. METHODS A search of the literature was performed to identify recent studies. Those of relevance to West Africa, were extracted for evaluation to enable update of the recommendations. RESULTS There are three themes (screening/diagnosis, clinical pathology, treatment) with 20 guideline topics covering screening, diagnosis, staging, grading, classification and management. New evidence in screening, definition of normal prostate-specific antigen, and use of pre-biopsy magnetic resonance imaging, have been incorporated. CONCLUSION This update will serve as a benchmark to assist clinicians in achieving best practice in the management of prostate cancer. It should also serve as a trigger for audits and research towards improving access to effective diagnosis and treatment of prostate cancer in West Africa.BACKGROUND Epidemiological studies have linked morbidity and mortality of individuals to exposure to atmospheric gaseous and particulate matter especially fine particles (PM2.5) and coarse particles (PM10).The process of garri (cassava crisps) production (frying with firewood) is associated with production of gaseous and particulate matter which contribute to ambient particulate matter air pollution. The objective of this study was to determine the impact of air quality indices on the prevalence of respiratory symptoms among the garri processing workers in Ogbomoso. METHODOLOGY A comparative cross-sectional study was carried out among 351 garri processing workers in Ogbomoso as subjects and 351 residents of Ogbomoso metropolis as controls that were age, sex and height-matched. A semi-structured questionnaire was used to obtain sociodemographic profiles and respiratory symptoms of participants and document physical examination findings. Particulate matter counter was used for air quality sampling. RESULTS The mean age of subjects was 41.7 ± 14.9 years and that of controls was 41.6 ± 14.7 years (p =0.960). The two groups were also matched for socioeconomic status, sex and height. Prevalence of respiratory symptoms was higher at 48.4% among the garri workers than the control group which was 29.1% (p less then 0.001). Cough was the predominant symptom with a prevalence of 29.3% and 10.5% among the subjects and controls respectively. The mean count of PM1.0 in garri processing locations was significantly higher than that recorded in Ogbomoso metropolis; 73.77±42.08 vs 15.04±6.66mg/m3 (p less then 0.0001). CONCLUSION Garri processing work is associated with significant increase in ambient air pollution and increased prevalence of respiratory symptoms among the workforce compared to the control population. Effective preventive strategies including education and provision of safety masks may reduce the occupational hazards associated with garri processing factory workers in Nigeria.BACKGROUND Medical doctors are prone to stress and utilize a variety of coping strategies. This study aims to measure the level of perceived stress and its relationship with coping strategies among doctors working in a tertiary hospital in Ile-Ife, Nigeria. METHODS A cross-sectional, descriptive study using a self-administered questionnaire containing Perceived Stress Scale (PSS) and Brief COPE Scale to assess perceived stress and coping strategies among different cadres of doctors. Out of the 217 questionnaires distributed, 185 completed copies were analysed. RESULTS Most of the respondents were less than 35 years (mean = 33.6 ±6.21) and the rate of perceived stress was 43.2%. The mean scores of Perceived Stress Scale and Brief COPE were 23.08 (±6.58) and 59.46 (±12.05). Socio-demographic factors significantly associated with perceived stress were age less than 35 years, being single, working in the hospital and years of practice less than 5 years and being house-officer or registrar (p less then .001). Respondent that were not stressed reported significant higher mean scores in active coping and positive reframing but lower mean scores in humor (p less then .05). Also, they reported significant lower mean scores in maladaptive coping and its subscales (p less then .003). Perceived stress had a significant negative correlation with active coping (p=.017) and positive correlation with maladaptive coping and all its subscales (p less then .006). Only age of respondents significantly predicted perceived stress among respondents (p = .003). CONCLUSION There is high level of stress among a sample of Nigerian doctors. Hence, there is a need for stress management program among them.BACKGROUND An effective health information system (his) generates information to enable decision makers make evidence-based decisions on health policy and allocate scarce resources. Health care workers at all levels within the health system need the knowledge and the right attitude towards hmis recognizing that they are the keys to recording accurate and reliable data. STUDY DESIGN A quasi-experimental study design was used, which consisted of baseline, intervention and end line components. RESULTS The study was carried out among a study and a control group, each consisting of 76 phc workers. The mean age was 34.6 + 8.3 years for the study group and 33.7 + 8.4 years for the control group. The baseline level of good knowledge in the study group increased from 13.2% to 48.7% at end line. The increase was statistically significant (p-value less then 0.001). In the control group the level of good knowledge increased from 6.6% to 9.7%. The increase was not statistically significant (p-value 0.714). Prior to the intervention, 52.
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