Annals of Clinical Sciences

Outcomes and complications of head and neck microvascular reconstruction in a resource limiting setting.

Tuoyo Okoturo — Wed, 27 Sep 2023 00:00:00 +0000

Background

This is a study on the complications and outcomes of head and neck microvascular reconstruction in a resource limiting centre. The aim is to evaluate the impact of the events in this limiting environment on the outcome of free tissue transfer for head and neck reconstruction and how this can be prevented to help improve outcomes.

Methodology

This was a retrospective cohort of cases seen over a 4- year period (2019-2022). All the patients that underwent free tissue transfer for head and neck ablative defects were included. The high-risk cases were evaluated using age > 60 years, Charlson comorbidity index and American Society of Anaesthesiologist (ASA) physical status evaluation scores as predicted variables. Outcomes and postoperative complications were also evaluated, and predictor variables analysed against complications.

Result

Twenty-three cases underwent free tissue transfer for specific head and neck defects over the study period. Their median age was 53 years and male to female ratio was 2:1. Fifty-six percent of the tumours were benign, 52% of flaps were fibular free flaps, while 44% were radial forearm free flaps. Twenty-six percent of the flaps failed while 74% survived. Thirty-nine percent of the flaps experienced complications while an 8% mortality occurred. High-risk cases with comorbidities showed no association to complications or outcomes.

Conclusion

This study suggests that the circumstance of a limited resource healthcare system impacts negatively on free tissue transfer outcome more than associated comorbidities, provided patients are properly selected.

KNOWLEDGE, ATTITUDE AND CONTROL PRACTICES OF SICKLE CELL DISEASE AMONG ADULTS IN RURAL COMMUNITIES IN UDU LGA, DELTA STATE, NIGERIA

James Erusiafe, N. S. Awunor — Wed, 27 Sep 2023 00:00:00 +0000

Background: Sickle cell disease (SCD) is an inherited abnormality of the red blood cell characterised by chronic haemolytic anaemia with numerous clinical consequences. It is important for the family, communities, and institutions to have good knowledge of the condition in order to make informed decisions about their reproductive lives, choice of partner, and related health issues. The study therefore seeks to determine the level of awareness, knowledge, attitude, and control practices of sickle cell disease among the residents of selected communities in Udu Local Government Area.

Methodology: A cross-sectional study was carried out among 400 participants selected using a pretested, self-administered structured questionnaire and analysed using SPSS software, version 25. Ethical approval was obtained from Research and Ethics Committee, Delta State University Teaching Hospital.

Results: The majority of the participants (85%) were aware of sickle cell disease with the main source of awareness being health care workers (37%), followed by the media (20%). However, 97% had a poor knowledge of the disease. In the study, age (p=0.001), marital status, (p=0.014) and level of education (p=0.003) were significantly associated with knowledge of SCD. The majority, 87.8%, had negative attitudes towards people living with SCD. Regarding control practices, 61.8% of the respondents had undergone a genotype test. Most individuals who were Christians, married, and had attained a tertiary level of education had been screened for sickle cell status, and there was a statistically significant association between religion (p<0.001), marital status (p=0.018), level of education (p<0.001) and screening to determine sickle cell status.

Conclusion: Comprehensive knowledge about SCD was found to be low despite high level of awareness among respondents. If SCD control strategies must yield significant results, there is a need to improve knowledge about SCD, especially among rural communities in Nigeria.

The TRIDAX PROCUMBENS LEAF AMELIORATES ALTERED CORPORA CAVERNOSA ACTIVITY IN DIABETIC WISTAR RATS VIA NITRIC OXIDE, K-ATP, AND RECEPTOR-OPERATED CALCIUM CHANNELS

Mon, 31 Jul 2023 00:00:00 +0000

Background: Tridax procumbens leaf is known for its antidiabetic potential, but its effect on diabetes-induced erectile tissue dysfunction is unclear. This study investigates Tridax procumbens ethanol leaf (TPL) treatment in streptozotocin-induced diabetic male Wistar rats.

Methods: Thirty adult male Wistar rats were grouped as follows: 1) non-diabetic rats treated with normal saline (control), 2) non-diabetic rats treated with TPL (100 mg/kg), 3) diabetic non-treated rats, 4) diabetic rats treated with TPL (100 mg/kg), and 5) diabetic rats treated with glibenclamide (5 mg/kg). Fasting blood glucose, C-reactive protein, and testosterone levels were measured. Cavernosa contractile responses were assessed using various stimuli with the Ugo Basile data capsule acquisition system.

Results: TPL treatment significantly reduced fasting blood sugar in diabetic rats. Serum C-reactive protein was notably elevated in diabetic non-treated rats compared to diabetic + TPL co-treated rats. Serum testosterone levels were significantly reduced in the diabetic non-treated group but were higher in the control and diabetic + TPL co-treated groups. Cavernosa tissue relaxation responses to acetylcholine were significantly enhanced in diabetic + TPL co-treated rats, indicating improved NO-mediated relaxation. Calcium ion influx-mediated contraction of cavernosa tissue was significantly inhibited in both the diabetic + TPL co-treated and non-diabetic TPL-treated groups compared to diabetic non-treated rats, suggesting modulation of impaired cavernosa activity.

Conclusion: TPL treatment in streptozotocin-induced diabetic rats enhanced cavernosa activity by improving NO, guanylyl cyclase, and ATP-sensitive potassium channels while inhibiting receptor-operated calcium channels. TPL's anti-inflammatory, antioxidant, and androgenic properties contribute to this modulation of cavernosa activity in diabetes.

A COMPARISON OF A 3D-PRINTED HIGH VOLUME EVACUATION TIP WITH TWO INTRAORAL EVACUATOR TIPS FOR PERFORMANCE DURING DENTAL PROCEDURES: A BENCHTOP PROCEDURE

Tolulase, Olugbenga, Adeola, Adenike, Samson — Mon, 31 Jul 2023 00:00:00 +0000

ABSTRACT

Background: The pandemic of coronavirus disease has allowed dental experts to reconsider how they manage infections while administering treatments. Established protocols advise the use of high-capacity suction devices for procedures that create aerosols in dental practise. Lately, the spread of COVID-19 has become a significant worry in dental offices, primarily because procedures generate contaminated aerosols and tiny saliva droplets, leading to possible transmission.

Methodology: This study compared the performance of three suction tips of different sizes and shapes in a bench top experiment. The suction performance and breadth of suction of a prototype 3D printed high volume evacuator tip, a saliva ejector and a standard high volume evacuator tip were compared using timed water test, salt, and talc powder tests.

Results: Using analysis of variance and Turkey’s post hoc tests, both the prototype and standard high volume evacuator tips exhibited a significant increase in water flow rate (P < 0.001) compared with that of the saliva ejector. However, the results showed no statistically significant difference in water flow rate between the prototype and the standard high volume evacuator tips (P = 0.362). In addition, a statistically significant difference was observed in the width of suction of salt and talc powder, the prototype tip had the widest breadth of suction while the saliva ejector had the narrowest breadth (P < 0.001).

Conclusions: Within the study limitation, the study results showed that the prototype high volume evacuator tip performed better than the conventional HVE in suction breadth, but both are similar in flow rate performance. Hence, utilising the prototype tip for isolation during dental procedures could potentially decrease the risk of exposure to pathogens in the oral cavity.

POST CARDIOEMBOLIC STROKE AFTER KIDNEY TRANSPLANTATION: A RARE COMPLICATION AND LOCAL MULTI-DISCIPLINARY MANAGEMENT EXPERIENCE

Mon, 31 Jul 2023 00:00:00 +0000

Kidney transplant (KT) remains the definitive renal replacement therapy in patients with end-stage renal disease. Studies have shown that cardiovascular complications are the commonest reasons for increased morbidity and mortality. Cardioembolic stroke in KT patients accounts for about 8%. Other less related central nervous system complications include the use of immunosuppressive agents, post-transplant lymphoproliferative disease (PTLD), and viral infections (CMV). In this index case, we present the experience of our teaching hospital, where a 37-year-old woman developed a rare cause of stroke a year after KT. The cardioembolic stroke was confirmed by echocardiography, MRI brain, haematology and serology tests. The patient was managed by multi-disciplinary specialists with fair clinical responses.