Background: A critical incident is any preventable mishap associated with the administration of anesthesia and which leads to or could have led to an undesirable patients' outcome. Patients' safety can be improved by learning from reported critical incidents and near misses. Materials and Methods: All perioperative critical incidents (excluding obstetrics) occurring over 5 months were voluntarily documented in a pro forma. Age of patient, urgency of surgery, grade of anesthetist, and patients' outcome was noted. Results: Seventy-three critical incidents were recorded in 42 patients (incidence 6.1% of 1188 procedures) with complete recovery in 88.1% (n = 37) and mortality in 11.9% (n = 5). The highest incidents occurred during elective procedures (71.4%), which were all supervised by consultants, and in patients aged 0–10 years (40.1%). Critical incident categories documented were cardiovascular (41.1%), respiratory (23.25%), vascular access (15.1%), airway/intubation (6.85%), equipment errors (6.85%), difficult/failed regional technique (4.11%), and others (2.74%). The monitors available were: pulse oximetry (100%), precordial stethoscope (90.5%), sphygmomanometer (90.5%), capnography (54.8%), electrocardiogram (31%), and temperature (14.3%). The most probable cause of critical incident was patient factor (38.7%) followed by human error (22.5%). Equipment error, pharmacological factor, and surgical factor accounted for 12.9%. Conclusion: Critical incidents can occur in the hands of the highly skilled and even in the presence of adequate monitoring. Protocols should be put in place to avoid errors. Critical incident reporting must be encouraged to improve patients' safety and reduce morbidity and mortality.

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Fourniers gangrene is a genital catastrophe with significant morbidity and mortality. We present a 57 year old patient with fournier's gangrene and perianal abscess. He had serial debridements with daily bedside dressing and secondary closure of the scrotal defect. Further evaluation during the course of treatment revealed diabetes mellitus. We conclude that aggressive multidisciplinary treatment will improve outcome and that the existence of fournier's gangrene coexisting perianal abscess could alert the clinician to the possibility of underlying diabetes mellitus - A common denominator.

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Background: Uterine rupture remains a major life-threatening obstetric disaster encountered in many developing countries and is associated with a high maternal and perinatal mortality and morbidity. Objectives: The objective of this study was to determine the incidence, associated risk factors, trend, clinical presentation, management as well as maternal and fetal outcome of uterine rupture at the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria. Materials and Methods: This was a retrospective study of patients with uterine rupture at the LUTH, Idi-Araba, Lagos, Nigeria, from June 1, 2005 to May 31, 2013. The case records of patients in this period were retrieved from the medical health records department. The relevant data of sociodemographic characteristics, clinical presentation, management as well as maternal and perinatal outcome were collated using a structured questionnaire. Results: Of the 13,138 deliveries during the study period, there were eighty cases of uterine rupture giving a hospital incidence of 6.1/1000 deliveries. Patients with parities of 1 (28.36%) and 2 (38.81%) were identified to be at higher risk of uterine rupture. Previous caesarean section (46.28%), obstructed labor (26.87%), and injudicious use of oxytocin (16.42%) were the common associated factors. Rupture along previous anterior scar was the most common site affected in 32.84%; repair with bilateral tubal ligation was the surgical procedure in most of the cases (47.76%). The case fatality rate for ruptured uterus was 11.94% for the mothers and the perinatal mortality rate of 791/1000 babies. Conclusion: Uterine rupture is a major cause of maternal and perinatal death in Lagos, Nigeria.

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Background: Children with neurodevelopmental disorders (CNDs) are a group requiring more attention as their care is often challenging, particularly for parents with primary caregiving roles in resource-restricted settings. This study had set out to investigate the burden and psychological distress among caregivers of children with neurodevelopmental delays. Materials and Methods: A total of 68 caregivers were recruited during the 2013 annual autism health program organized by the College of Medicine, University of Lagos in collaboration with Guaranty Trust Bank, Nigeria and Blazing Trails, USA. Of these caregivers, 60 respondents (caregivers and children) were included in the final analyses due to poorly completed questionnaires. The Zarit Caregivers Burden Scale (ZCBS) and General Health Questionnaire version 12 (GHQ-12) were administered to elicit caregivers' experience with respect to burden and psychological distress, respectively. Results: Of the 60 participants included in the final analyses, the majority constituted parents (96.3%) with mothers accounting for 71.7%; 28 (46.7%) participants were government workers and 3 (5%) were full-time housewives. The mean age of CNDs was 6.8 (±3.2) years, and 33 (55.0%) were males. Delivery by cesarian section was reported in 19 (31.8%). The common presenting complaints by caregivers were inability to walk (32.7%), repetitive behavior (25.5%), difficulty with verbal communication (10.9%), nonsocialization (9.1%), seizures (9.1%), and hyperactivity (3.6%). Problems were noticed at ≤ 1 year in 46.7% while they were noticed after 2 years in more than half the children, and a little above one-eighth (14%) had siblings with similar problems. On the ZCBS, nine (15.0%) caregivers reported a significant burden. In addition, 23 (38.3%) caregivers had psychological distress. Caregivers' burden was significantly related to the report of psychological distress in caregivers (P < 0.001) and there was a trend toward the presence of psychological distress in almost all caregivers with children experiencing seizures. Conclusions: The findings in this study underscore the need for counseling and psychosocial support for caregivers of CNDs. Further research on the emotional experience of caregivers is also warranted.

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Introduction: Worldwide, it has been estimated that violence against women is as serious a cause of death and incapacity among women of reproductive age as cancer, and a greater cause of ill health as traffic accidents and malaria combined. This study was therefore carried out to determine the prevalence and predictors of intimate partner violence among women of reproductive age group in Sagamu local government area (SLGA) of Ogun State, Nigeria. Settings: The study was conducted in SLGA Ogun State, which is located in the South Western part of Nigeria. A total of 500 women were interviewed in this study. One participant per each household was selected into the study. Methodology: This analytical cross-sectional study was conducted between April 22, and May 13, 2013. Multistage sampling technique was used to select the participants into the study. A semi-structured questionnaire was used to collect relevant information. Results: The overall rate of intimate partner violence in the last 12 months among respondents was 16.0% and was the most common (65.0%) among age 25–39 years (P = 0.003) and those with primary education (P = 0.001). About 12.3% of the respondents had an abnormal General Health Questionnaire (GHQ). Those who had abnormal GHQ were strongly statistically associated with intimate partner violence (P = 0.0001). Strain relationship (odds ratio [OR] =3.7, confidence interval [CI] =1.74–7.87), thinking that violence is acceptable (OR = 1.96, CI = 1.24–3.09) were predisposing factors for intimate partner violence while being mentally healthy (OR = 0.51, CI = 0.34–0.75) reduce the occurrence of violence by half after controlling for the effect of confounders. Conclusion: This study suggests that women education and healthy mental health is essential to the reduction of violence among intimate partners. Resolving it requires the provision of counseling services by educational and mental health sectors working together at the community, national and international levels.

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A case of discrete gingival enlargement as a long-term consequence of artificially created midline diastema by a dental quack in an otherwise healthy 33-year-old female was reported. The patient and her husband were bothered by the gingival enlargement and requested treatment. The patient was unconcerned about the associated discolored tooth. The lesion was diagnosed as fibrous epulis and was treated by surgical excision after which the patient was referred to the restorative dentist for endodontic treatment. To conclude, discrete gingival enlargement occurring as a long-term consequence of artificially created midline diastema by a dental quack should be considered as fibrous epulis until proven otherwise.

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Background: The Lagos State Regulation of Smoking Law was passed in February 2014 and stipulates the total restriction of tobacco smoking in listed public places. Workers in hospitality venues are at a high risk of exposure to second-hand smoke (SHS). Therefore, their awareness of the health risks, attitudes toward SHS and their reported levels of exposure may play a crucial role in developing an effective monitoring, implementation, and enforcement mechanism. Methods: We conducted a cross-sectional, descriptive study among workers in restaurants, bars, and nightclubs registered with the Lagos State Ministry of Tourism in the second quarter of the year 2014. We used a multistage sampling technique to select one respondent each from the 300 centers randomly selected to participate in the survey. Data were collected using a modified version of the World Health Organization Global tobacco surveillance system tools. Univariate and bivariate analysis were carried out. Exposure to SHS in the workplace and in other public places was treated as the outcome variable in the bivariate analysis. Results: Majority (75.3%) of the respondents were aged between 21 and 40 years with a mean age of 27.7 + 8.6 years. Many (66%) were waiters/waitresses and spent more than 8 h a day. Most (60.6%) of the venues were indoor only establishments, and 26.8% had no form of smoking restrictions. Majority of the respondents were exposed to SHS at work, and this was higher in bars and nightclubs. A bivariate analysis of results showed that workers were exposed to SHS at work irrespective of workplace smoking restrictions or respondents smoking status. Conclusion: Our study demonstrates that second-hand smoke exposure is very high (65% in smokers; 65.6% in nonsmokers) among workers in restaurants, bars, and nightclubs in Lagos State. We are therefore of the opinion that strict enforcement of law would ensure the protection of these workers.

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Background: The adrenal gland is not spared from the involvement by tuberculosis. One of the recognized causes of adrenal insufficiency (AI) is tuberculosis. AI, mostly at the subclinical level, is common in persons with pulmonary tuberculosis (PTB) infection, occurring in about 23% of patients. Coinfection with PTB and human immunodeficiency virus (HIV) may compromise adrenocortical function and produce significant adrenocortical insufficiency. Objective: To determine if coinfection with tuberculosis and HIV have a compound effect on adrenocortical function in persons with HIV and PTB coinfection. Materials and Methods: Persons with sputum-positive PTB, treatment naive, who met our inclusion criteria, were selected. All the recruited patients were screened for HIV and those positive for HIV infection had confirmatory test. A baseline blood samples for cortisol, fasting plasma glucose, full blood count, and electrolytes were collected between 8.00 h and 9.00 h immediately before administration of adrenocorticotropic hormone (ACTH). The persons received an intravenous bolus injection of 1 μg ACTH (Alliance Pharmaceuticals Ltd., Chippenham, Wiltshire SN15 2BB) and blood sample was drawn for cortisol level at 30 min. Results: Forty-four people with PTB infection and forty people with PTB and HIV coinfection met the inclusion criteria of the study. The adrenal response to 1 μg ACTH stimulation in participants with PTB and PTB and HIV coinfection showed that the mean basal cortisol level in the 2 groups was not statistically significant; however, 30-min post-ACTH stimulation cortisol level was 630.84 ± 372.17 and 980.36 ± 344.82 nmol/L (P < 0.001) and increment was 367.79 ± 334.87 and 740.77 ± 317.97 nmol/L (P < 0.001), respectively. Fourteen persons (31.8%) with PTB has subnormal adrenal response to ACTH stimulation while only 2 (5%) persons with PTB and HIV coinfection has subnormal response. Conclusion: AI, at subclinical level, was less frequent in those with PTB and HIV co-infection.

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Background: The use of complementary and alternative medicine (CAM) has increased tremendously in the past decades. Herbs in this study involved the use of plant products in their raw or cooked forms which have not been subjected to laboratory investigations for their safety and efficacy. Objective: To explore strategies to reduce barriers in reporting herbal use to the health-care provider among childbearing age women in two communities in Ogun state, Nigeria. Materials and Methods: A descriptive cross-sectional survey was used to explore strategies to reduce barriers in reporting herbal use to the health-care provider. The study population constitutes childbearing age women that attend two private hospitals and one comprehensive health center in two communities of Ogun state, Nigeria. Out of the 270 patients who were randomly sampled for the study, 250 agreed to participate (response rate: 92.6%). Results: The mean age of the participants was 29.3 years ± 5.5 and 77.6% were married. The majority (69%) had used herbal medicines in the last 6 months before seeking medical care, and 66% did not disclose the use of herbal medicines to health-care providers. Conclusion: Health-care professionals should routinely include herbal remedy category in the list of drug history when asking about the patient's drug. This will help identify herbal remedy use and assist to take precautions relating to safety. Patients and traditional birth attendants should be educated through community mobilization and educational programs about alternative medicines particularly herbal. The disclosure of CAM use and its adverse outcomes should be encouraged by health-care professionals.

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Background: Among treatment modalities, grafting of biomaterials/bone substitutes has been used with varying success to accomplish the reconstruction of the lost periodontal attachment apparatus. Biodegradable polymers, especially those belonging to the family of polylactic acid (PLA) and polyglycolic acid (PGA), are playing an increasingly important role in bone reconstructive procedures. The aim of this study was to evaluate the clinical outcome of reconstructive surgery in human deep intrabony defects with the use of fisiograft (polylactic and PGA copolymer) with open flap debridement (OFD) versus OFD alone in the treatment of periodontal intrabony defects. Materials and Methods: Thirty 2- or 3-walled intrabony defects were treated in 15 (ten male and five female) patients with a mean age of 50.4 years. All had completed nonsurgical treatment and a period of supportive periodontal therapy. The study used a split-mouth design where two intrabony defects were randomly chosen to receive fisiograft (polylactic and PGA copolymer) with OFD (Group 1) on 15 sites and remaining 15 sites were chosen only for OFD alone (Group 2). Statistical Analysis: Wilcoxon's signed-rank test as an alternative to paired t-test and Mann–Whitney U-test as an alternative to unpaired t-test were used for statistical analysis. Results: There was a decrease in probing pocket depth of 3.93 ± 0.08 mm for PGA/PLA with OFD and 3.14 ± 0.41 mm for OFD alone with a mean gain of relative clinical attachment level of 3.81 ± 0.30 and 2.46 ± 0.03 for PGA/PLA with OFD and OFD alone, respectively. Gingival margin position was 0.667 ± 0.51 mm and 3.626 mm for the PGA/PLA with OFD and OFD alone. The mean amount of defect fill for PGA/PLA with OFD and OFD alone was 1.80 ± 0.86 mm and 1.20 ± 0.94 mm, with a mean change in the level of alveolar crest after 6 months being 0.267 ± 0.46 and − 0.86 ± 0.74 for the two groups, respectively. The mean difference in percentage of original defect resolved when compared between the test and control groups 6 months postoperatively was found to be 31.85% which was statistically significant (P = 0.001). Conclusion: In the present study, fisiograft (polylactic and PGA copolymer) with OFD group showed better results than where OFD alone was used in the treatment of periodontal intrabony defects in terms of both clinical as well as radiographic assessment. Although Fisiograft^® has shown promising results on clinical and radiological evaluation in the present study, it would be inappropriate to draw definite conclusions regarding the nature of the defect fill.

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