Background: The Plastibell technique is the most frequently used device due to its perceived “ease of use” by all categories of practitioners including nonqualified people like barbers and technicians. Nonetheless, Plastibell technique for circumcision is not without its problems. We aim to describe a simple and objective technique of choosing an appropriate Plastibell size for Plastibell circumcision. Technique and Methods: The circumference of the glans penis (C) is measured at the level of the glanular ridge. The diameter of the glans corresponding to the Plastibell size is determined using the formula πD = C. The glans diameter (D) equals 0.32C. This technique was used to choose Plastibell size for 25 consecutive infants in a pilot study. Results: The median age of the infants was 21 days. The median circumference of the glans was 4.1 cm, and the median size of the Plastibell used was 1.3. The median time taken by the device to fall off spontaneously after circumcision was 4 days. There was no complication recorded. Conclusions: This objective method of choosing the appropriate Plastibell size is easy and safe. It has the potential to reduce the complications of Plastibell circumcision.

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Context: Different techniques are used for periodontal therapy, viz. scaling and root planing, subgingival curettage, gingivectomy, and full- or split-thickness flap procedures with or without osseous recontouring. Most of the said periodontal surgeries are invasive and associated with pain and secondary discomfort, thus leading to a quest for newer techniques such as laser-assisted closed pocket debridement techniques for periodontal therapy. The present study was designed to compare the efficacy of closed pocket debridement with diode laser and periodontal open flap debridement as assessed by clinical and microbiological parameters. Materials and Methods: Twenty patients in an age range of 20–54 years and with pocket depth of ≥5 mm and ≤7 mm were included in the study. The plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL), and colony forming units (CFUs) of the periodontal pathogens namely Porphyromonas gingivalis, Fusobacterium nucleatum, Aggregatibacter actinomycetemcomitans, and streptococci were compared in patients undergoing closed pocket debridement with diode laser (Group I) against open flap debridement (Group II) at baseline and after 3 months of the procedure. Results: There was a statistically significant difference between the PD reduction in Group I and Group II (P = 0.02), with Group II showing greater reduction in PD. Furthermore, the mean value of CFUs after 3 months of the procedures in Group I was significantly less as compared to Group II. Conclusion: The laser-treated group (Group I) was found to be better in terms of decrease in clinical PD as compared to Group II. The bactericidal effect of the diode laser was, also, clearly evident by a greater reduction of CFUs of periodontal pathogens in Group I as compared to Group II.

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Background: Cancers in children are increasing all over the globe, however, the outcome in LMICs is still quite poor due to a myriad of factors. Aim: This review focused on pattern of admissions in a pediatric oncology unit in Lagos, Nigeria and the determinants of outcome. Settings and Design: This was a retrospective descriptive study at the Lagos University Teaching Hospital from January 2015 to July 2017. Common treatment protocols like UKALL, NWTSG etc are adapted for use in the unit. Data Analysis: This was done using SPSS version 22. Results: A total of 178 children were seen at the oncology unit with a slight male preponderance of 1.4:1. The most common malignancy seen was acute lymphoblastic leukemia (20.8%) while retinoblastoma was the commonest solid tumor (19.6%). Mortality rate observed in the period under review was 45% and a large number of patients (22%) abandoned treatment. Conclusion: The management of childhood cancers is still a big challenge in resource constrained settings and a robust health insurance policy will improve outcomes.

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Background: Intrauterine contraceptive devices (IUCDs) are the most frequently used method of reversible female contraception worldwide, but their utilization varies considerably in different countries. Objectives: The objective of this study is to determine the pattern of use of IUCD, sources of referral, its associated complications and reasons for its discontinuation over a 10-year period. Materials and Methods: This was a retrospective study of all the women who sought contraceptive services at the Family Planning Clinic of the Lagos University Teaching Hospital over a 10-year period (January 1, 2006, to December 31, 2015). The case notes of these women were retrieved and relevant data extracted. Descriptive statistics were computed for the data, and results were presented in simple tables and charts. Results: A total of 1726 women accessed contraceptive services during the period under review with 521 (30.2%) choosing IUCD as their preferred method. A majority of the clients were aged between 30 and 34 years (34.5%) and multiparous (92.3%). The largest proportion of the studied clients (71.9%) had up to the tertiary level of education with the majority of the referrals coming from nurses (39.5%) and doctors (20.0%). The most common undesirable effect reported by the clients was abnormal vaginal discharge (40.8%) while 40.7% of the women discontinued the use of the IUCD prematurely. The most common reason for discontinuing the use of IUCD was the occurrence of an undesirable effect (44.8%). Conclusions: Our study revealed a modest decline in the uptake of IUCD among contraceptive users in Lagos. Health-care providers still appear to be the best source of information and referral as they play a crucial role in influencing women's acceptability of these services.

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Background: Intestinal stomas are frequently constructed as part of abdominal surgeries in our center especially for colorectal cancer (CRC). There has been no previous documentation of the experience at our tertiary center. Objective: The objective of this study is to document the indications, types, and complications of intestinal stomas in our center to make necessary recommendations. Patients and Methods: This was a retrospective descriptive study of all patients who had intestinal stomas constructed during a 4-year period. The demographic data of patients, the information on indications, types, and complications of intestinal stomas were obtained from theatre records, and case notes. Data were analyzed using SPSS version 23. Results: A total of 85 intestinal stomas were constructed during the study period. Forty-four (51.8%) were males and 41 (48.2%) females with a male-female ratio of 1.07 to 1. The common indications were large bowel obstruction due to CRC (21.2%), anastomotic dehiscence (15.3%), and rectal/sigmoid injuries (12.7%). The intestinal stomas constructed in patients included defunctioning stomas (61.2%), decompression stomas (31.8%), permanent end colostomy following abdominoperineal resection of rectum for cancer (3.5%), and palliative sigmoid colostomy (3.5%) in patients with anal cancer. Sigmoid loop was the commonest stoma, constructed in 26 patients (30.6%). The common complications were peristoma skin excoriation (53.5%), retraction (11.6%) pouch leakage (9.3%), and prolapse (9.3%). Conclusion: Malignant intestinal obstruction due to CRC was the most common indication for stoma construction at our institution. Consequently, massive health education campaign to ensure early presentation of CRC is needed to reduce the need for stoma creation.

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This is a case of situs inversus totalis (SIT) in a 22-year-old woman who presented at our facility for routine medical examination of fitness. There were no cardiac or other symptoms to suggest the existence of the anomaly in her before this consultation. Chest radiography, abdominal ultrasonography, and computerized tomography of the abdomen (abdominal computed tomography) were done. This case is presented to illustrate the imaging features of SIT and highlight its implications for clinical and radiological practice. This case also adds to the growing body of literature on the existence of this anomaly in our environment.

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Background: Long-lasting insecticides nets (LLINs) are a key prevention tool that has been found to reduce uncomplicated malaria by 51% and decrease all-cause mortality by 18% in children. LLINs have been shown to be effective in reducing childhood morbidity and mortality by reducing mosquito bites while sleeping. This is a comparative cross-sectional study designed to determine and compare the ownership and utilization of LLINs among caregivers of children under 5 years in a rural and an urban area of Ogun State. Materials and Methods: A community-based comparative cross-sectional study on 575 caregivers of children under 5 years living in the urban and rural area of Ogun State was done using a multistage cluster sampling technique to recruit respondents. A pretested semi-structured interviewer-administered questionnaire was used to collect information on LLINs ownership and use. Analysis and statistical calculation were done using SPSS version 20.0. Relationships between categorical variables were tested using Chi-square test with P = 0.05. Logistic regression model was used to describe predictors of LLIN ownership and utilization among the respondents. Results: The study shows that 80% of caregivers of under-five living in the rural area compared with 63.5% living in the urban area owned LLINs (P < 0.001). Percentage of children under-five who slept under LLINs the night prior the study was 50.2% in the urban versus 52.4% in the rural households (P = 0.252). Stagnant water and dirty surroundings were identified as mode of transmission of malaria among 32.6% urban versus 44.8% rural respondents and 44.2% urban versus 29.7% rural respondents respectively (P = 0.005). Children were identified as one of the most vulnerable groups for malaria infection by 44.6% urban versus 33.8% rural respondents (P = 0.008). The LLINs was hanged on the bed by 81.2% urban versus 64.4% rural respondents (P = 0.018). The predictors of ownership of LLINs were as follows: urban residence (OR 0.34 [95% confidence interval [CI] 0.22–0.53]), caregiver with higher education (OR 4.85 [95% CI 1.42–16.55]), and the predictors of utilization of LLINs were as follows: level of education of the caregiver (OR 2.87 [95% CI 1.11–7.41]), possession of LLINs at immunization (OR 2.92 [95% CI 2.02–4.22]). Conclusion: Free distribution of LLINs may not necessarily lead to use. Behavior change interventions that address the community level perceptions that positively position LLINs as an effective prevention tool to prevent malaria should be strengthened among the caregivers of children under-five generally and most especially in the urban areas of Ogun State.

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Aim: The aim of this study is to analyze the surgically managed maxillary sinus tumors presenting in General Hospital, Lagos, Nigeria. Methods: Review of cases seen at the General Hospital, Lagos, in 10 years. Data were obtained from the patients' case notes. The biodata investigations done, diagnosis and treatment were recorded. Results: A total of 16 patients were treated with maxillary sinus tumors. There were nine males and seven females. Ages range from 6 to 72 years with the mean age of 44.3 years. There are 10 benign tumors and six malignant tumors in the study. The most common tumor is squamous cell carcinoma of the maxillary antrum represent 25% of maxillary tumors seen in this study. Conclusion: Maxillary sinus tumors represent a common group of neoplasm in the oral cavity. It poses a diagnostic and therapeutic difficulty to clinician due to the late presentation and proximity to vital structures such as the eyes and base of the skull. Maxillectomy with preservation of floor of the orbit is a safe procedure even for malignant lesions not involving the orbit.

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Context: Neurosurgical patients following surgery or trauma are often monitored in an intensive care setting for a period of time. Studies with a comprehensive and predictive model of factors contributing to Intensive Care Unit (ICU) outcome following neurosurgical admissions are few in our environment. Aims: The aim of the study was to document the pattern of neurosurgical ICU admissions and predictors of outcome in our center for improved resource allocation and overall reduction in a poor outcome. Settings and Design: A retrospective study was conducted on adult patients admitted to ICU in 2015 with neurosurgical diagnosis. Subjects and Methods: Patient demographics, admission characteristics, details of neurosurgical diagnosis, ICU interventions, and outcome were obtained from the ICU record. Statistical Analysis Used: Data were analyzed with SPSS version 20. Results: Of 286 patients admitted in the study year, 95 (33.2%) followed neurosurgical indications. Twelve patients below 16 years were excluded leaving 83 adults in the review. Admissions following traumatic brain injury and intracranial tumor surgery each accounted for 35%. Although poorer outcome was observed in the traumatic brain injury, traumatic myelopathy, and clot evacuation groups, the difference was not statistically significant (P 0.34). Forty-two (50.6%) and 28 (34%) patients had ventilatory and vasopressor therapy, respectively. Only Modified Early Warning Score (MEWS) on admission predicted poor outcome (P = 0.04, β =1.63). Conclusions: Traumatic brain injury and intracranial tumor surgery were the main neurosurgical indications for ICU admission. A higher MEWS and lower Glasgow Coma Score on admission were observed among nonsurvivors, but only MEWS on admission predicted poor outcome.

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Background and Objectives: Avulsion of the distal biceps tendon insertion from the radial tuberosity is rare. It is an opportunity for a double-incision surgical technique for repairing a complete tear of the distal biceps tendon. The aim of this study is to evaluate the double-incision technique with regard to full functional restoration, complication rate, and safety. Materials and Methods: A retrospective review of consecutive complete biceps tendon repair was performed at one institution over a 6-year period. Thirty-two patients met the inclusion criteria and 28 were available for follow-up which included subjective assessment, physical examination, and strength testing. The mean age of patients was 40 ± 28 years (ranging from 25 to 71 years). Modified two-incision surgical approach (Boyd and Anderson) was performed for all the patients. Functional outcome after repairs was measured by physical examination, range of motion measurements using a goniometer and radiographic follow-up, as well as isokinetic tests and Disability of the Arm, Shoulder, and Hand scores. Furthermore, the average patient satisfaction rating on a Likert scale associated with complications was documented. Results: There were no statistically significant differences in regard to flexion strength or endurance and supination strength or endurance between the injured and uninjured arm in each patient. The overall incidence of complications was 7.2%. The average patient satisfaction rating was 9.6. Conclusion: The modified Boyd–Anderson two-incision produced adequate and full functional restoration of strength with a low complication rate. This technique is safe to perform by a surgeon.

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