African journal of medicine and medical sciences
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Traumatic injuries affecting bones of the hand and forearm often require peripheral nerve blocks for analgesia and surgical intervention. The successful use of subclavian perivascular block as a sole anaesthetic for orthopaedic surgery has not been reported in our environment. We report the use of this technique for open reduction and internal fixation of a left midshaft humeral fracture. ⋯ Complete sensorimotor block was achieved within 15 minutes and surgery lasted 55 minutes without complications. This technique obviated the use of general anaesthesia with its risks. The surgeon and the patient were satisfied with the quality of the anaesthesia.
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This prospective study was carried out at the Children Outpatient Clinic of the University College Hospital (UCH), Ibadan, Nigeria. The study aims to determine the convergent validity of the Oucher, Observer Pain Scale, Visual Analogue Scale (VAS) and the Numeric Rating Scale (NRS) among Nigerian children. Children aged between 6 months and 12 years who required venepuncture or phlebotomy for various investigative procedures were recruited. ⋯ The median pain score during the procedure were 4 (Observer Pain Scale), 5 (Oucher) and 4 (VAS and NRS). The average measure intra-class correlation coefficient (ICC) showed that the Oucher, the VAS and the NRS pain scales are reliable pain measuring tools with an ICC of 0.63-0.69 at baseline and 0.72 - 0.73 during the procedure. The VAS, NRS and Oucher pain scales are valid pain tools that can be used to assess pain in Nigerian children.
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This study presents a pioneer experience with laparoscopic operations in a General Surgical unit of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. Consecutive patients who had laparoscopic operations from April through December 2008 were prospectively studied. Following clinical diagnosis, initial diagnostic laparoscopy was undertaken in all patients, followed by therapeutic open or laparoscopic procedures. ⋯ Operative time ranged from 55-105 minutes with marked reduction in operation time as confidence and experience grew. No intraoperative complication was observed but one patient had superficial port site infection postoperatively. We conclude that with good patient selection and some improvisation, laparoscopic general surgical operations are feasible with acceptable outcome even in a poor resource setting.
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The diagnosis of cancer can devastate the physical, emotional, and socio-economic life of an individual. Caring for most cancer patients presents serious ethical challenges to physicians and other health workers. Inclusion of cancer patients in research could be no less challenging. ⋯ However, where these are in place, the need for recourse to philosophical approach, especially virtue ethics in analyzing and resolving ethical concerns in clinical practice cannot be overemphasized. This paper highlights the burden of cancer in Nigeria and the ethical challenges of clinical management of cancer patients, using a case study. The role of clinical ethics and health research ethics committees as well as the justification for virtue ethics above principlism in handling ethical issues in cancer management and research in Nigeria were highlighted.
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Cancer is a worldwide public health problem causing increasing morbidity and mortality, particularly in the developing world. Underlying trends are changing the pattern of cancer and this is also being influenced by the HIV/AIDS pandemic, particularly in Sub-Saharan Africa. Even though the pattern of cancer varies across Africa, there are identifiable trends. ⋯ Training of health care workers to diagnose cancer and treat it effectively within limited budgets is needed. Research to develop these new treatments and others, particularly from natural products is urgently needed and this can be done safely within established health research ethics regulatory frameworks. Several opportunities for collaborative research and training include an update of the epidemiology of cancers in African females; the relationship between HIV and other carcinogenic viruses; biological factors making cancers in Africa more lethal; cheaper vaccines that will be more available and easier to store and hence can be included in the immunization programme in African countries and development of vaccines like the HPV against other uncommon serotypes of the virus.