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Umar Muktar

Usmanu Dan Fodiyo University, Sokoto-Nigeria, Surgery, Faculty Member

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SUNY: Stony Brook University

SYED MUHAMMAD ALI

Hamad Medical Corporation

Universidad de Buenos Aires

Ghadeer Al-shaikh

King Saud University

Rita Niciporuka

Riga Stradins University

Dr. Chowdhury Iqbal Mahmud

Bangabandhu Sheikh Mujib Medical University

Şerafettin OKUTAN

Bitlis Eren University

Uludag University

vincenzo borrelli

Istituto Clinico Humanitas

Predrag Andrejevic

University of Malta

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Papers by Umar Muktar

Comparative study of alvarado score and its modifications in the preoperative diagnosis of acute appendicitis at a tertiary center in Sokoto, Nigeria

Nigerian Journal of Surgery, 2020

Background: Decision-making in patients suspected of having acute appendicitis has remained a dia... more Background: Decision-making in patients suspected of having acute appendicitis has remained a diagnostic challenge worldwide despite the advances in imaging and appendiceal surgery. There have been efforts to improve the diagnosis of appendicitis using clinical scoring systems. Aim: We evaluated and compared the diagnostic accuracy and role of Alvarado score (AS) and two of its modification (Kalan and Al-Fallouji) in the preoperative diagnosis of acute appendicitis. Materials and Methods: This was a prospective study conducted at the Usmanu Danfodiyo University Teaching Hospital, Sokoto, of all adult patients operated for acute appendicitis from July 2014 to June 2017. The results were analyzed on computer using Statistical Package for the Social Science version 15.Results: One hundred and eleven patients were studied. Sixty-six (59.5%) patients were males and 45 (40.5%) were females. The male-to-female ratio was 1.5:1. The mean age was 23.89 ± 4.93 years. The AS sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 90.3%, 83.3%, 96.6%, 62.2%, and 89.2%, respectively, were similar to the findings of Kalan score (90.3%, 83.3%, 96.6%, 62.5%, and 89.2%, respectively) and Al-Fallouji score (96.8%, 66.7%, 93.8%, 80%, and 91.9%, respectively). The receiver operating curve and area under the curve show that Alvarado, Kalan, and Al-Fallouji are accurate scores in the preoperative diagnosis of acute appendicitis with an area under the curve of 0.88, 0.86, and 0.85, respectively. Conclusion: Kalan and Al-Fallouji scores have comparably good diagnostic accuracy as the AS among our patients. Any of these scores can be used as an adjunct in the preoperative diagnosis of acute appendicitis.

Disseminated Gonococcal Infection Caused by a Multidrug-Resistant Pathogen Presenting with Hemorrhagic Manifestation: A Case Report

Journal of Laboratory Physicians

The incidence of disseminated gonococcal infection (DGI) is rising in some parts of the world, bu... more The incidence of disseminated gonococcal infection (DGI) is rising in some parts of the world, but there is paucity of data on its true incidence from sub-Saharan Africa. DGI has varied manifestations in different population group. We report a case of a 30-year-old sexually active woman presenting with hemorrhagic symptoms 2 weeks after a surgery on account of diagnosis of uterine fibroid made at a peripheral hospital. A multidrug-resistant Neisseria gonorrhoeae was isolated from the wound on her surgical site and blood sample. She was managed with intravenous meropenem, pressure dressing, and blood products, with the patient making a full recovery after a week. This case is presented because it is a rare one. Moreover, there is the need to revive the awareness of clinicians on the existence of multidrug-resistant gonococcus in our environment. We herein report a case of DGI from Nigeria.

Lipoma of the transverse colon: Review of literature and a case report in a young Nigerian female

Nigerian Journal of Medicine

Colonic lipomas are rare benign tumour of the gastrointestinal tract(GIT); however, they remain t... more Colonic lipomas are rare benign tumour of the gastrointestinal tract(GIT); however, they remain the commonest nonepithelial(mesenchymal) benign neoplasm of the GIT tract. The majority remains asymptomatic. They can mimic malignant tumours of the GI tract. We present a review of literature and our experience with the management of a case of this rare tumour. A 35year old woman presented to us with an upper abdominal pain of six weeks,vomiting and passage of bloody mucoid stool of four weeks. A huge palpable mass in the epigastric region. Contrast-enhanced Computed tomography revealed a well-defined, 18cm, fatty tissue mass in the transverse colon. She had a right hemicolectomy. Histology confirmed the diagnosis revealing a submucous lipoma. One year follow up, she remained symptom-free with no evidence of recurrence. This study raises the awareness of this rare tumour as a cause of GIT symptoms and highlights the challenges in differentiating it from the more common malignancy of the colon.

Global economic burden of unmet surgical need for appendicitis

British Journal of Surgery

Background There is a substantial gap in provision of adequate surgical care in many low- and mid... more Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality wa...

Global variation in anastomosis and end colostomy formation following left‐sided colorectal resection

BJS Open, 2019

Background: End colostomy rates following colorectal resection vary across institutions in high-i... more Background: End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods: This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle-and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results: In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6⋅9 per cent) from low-HDI, 254 (15⋅5 per cent) from middle-HDI and 1268 (77⋅6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57⋅5, 40⋅9 and 35⋅4 per cent; P < 0⋅001) and subsequent use of end colostomy (52⋅2, 24⋅8 and 18⋅9 per cent; P < 0⋅001) in low-compared with middle-and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3⋅20, 95 per cent c.i. 1⋅35 to 7⋅57; P = 0⋅008) after risk adjustment for malignant disease (OR 2⋅34, 1⋅65 to 3⋅32; P < 0⋅001), emergency surgery (OR 4⋅08, 2⋅73 to 6⋅10; P < 0⋅001), time to operation at least 48 h (OR 1⋅99, 1⋅28 to 3⋅09; P = 0⋅002) and disease perforation (OR 4⋅00, 2⋅81 to 5⋅69; P < 0⋅001). Conclusion: Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone. * Members of the GlobalSurg Collaborative are collaborators in this study and are listed in Appendix S1 (supporting information)

Prolapsed ileocolic intussusception in an adult : A bizarre presentation leading to delayed diagnosis in a low resource setting.

by Umar Muktar and stephen yusuf

Research Journal of Health Sciences, 2021

Background:Intussusception is the telescoping of one part of the intestine into the lumen of the ... more Background:Intussusception is the telescoping of one part of the intestine into the lumen of the adjoining
part, which occurs more in the ileocaecal part of the intestine. It is the most common cause of intestinal
obstruction in children younger than 3years of age. Occurrence is rare in adult, with prolapsed
intussusceptions even rarer and occuring more in association with an underlying predisposing intestinal
abnormality.
Case Report: A 19year old boy presented with 6months history of recurrent non-specific, occasionally
dull aching abdominal pain, progressive weight loss and a 4hour history of anal protrusion. He had
presented multiple times to a peripheral hospital where the definitive diagnosis was missed. He was
evaluated for ileocolic intussusception and he had exploratory laparotomy and right hemi colectomy
done.
Conclusion: Intussusceptions are rare outside childhood, however there should be a high index of
suspicion of intussusception in adult with nonspecific abdominal symptoms who has not responded to
conventional conservative therapy.

Use of Telemedicine for Postdischarge Assessment of the Surgical Wound International Cohort Study, and Systematic Review With Meta-analysis

Annals of Surgery , 2023

Objective: This study aimed to determine whether remote wound reviews using telemedicine can be s... more Objective: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardized assessment tools are needed. Background: Surgical site infection (SSI) is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery. Methods: The primary outcome of this study was SSI reported up to 30 days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analyzed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30 days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596). Results: The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs 11.1%, P < 0.001), which persisted after risk adjustment in a mixed-effects model (adjusted odds ratio: 0.73, 95% confidence interval: 0.63-0.84, P < 0.001). This association was consistent across sensitivity and subgroup analyses, including a propensityscore matched model. In 9 eligible nonrandomized studies identified, a pooled mean of 64% of patients underwent telemedicine follow-up. Upon meta-analysis, the SSI rate reported was lower with telemedicine (odds ratio: 0.67, 0.47-0.94) than in-person (reference) follow-up (I 2 = 0.45, P = 0.12), although there a high risk of bias in included studies. Conclusions: Use of telemedicine to assess the surgical wound postdischarge is feasible, but risks underreporting of SSI. Standardized tools for remote assessment of SSI must be evaluated and adopted as telemedicine is upscaled globally.

KNOWLEDGE AND PRACTICE OF BREAST SELF-EXAMINATION FOR EARLY DETECTION OF BREAST CANCER AMONG WOMEN ATTENDING ANTENATAL CLINIC AT USMANU DANFODIYO UNIVERSITY TEACHING HOSPITAL SOKOTO

American Journal of Public Health and Epidemiology, 2024

Background: Breast cancer is currently the most common cancer worldwide. Poor outcomes of breast ... more Background: Breast cancer is currently the most common cancer worldwide. Poor outcomes of breast cancer management in Africa are linked to late presentation. Early diagnosis based on breast self-examination and awareness has been advocated. Objective: To develop guidelines for Breast self-examination (BSE) in Nigeria, there is a need for current Knowledge and practice of breast selfexamination. This study aims to provide foundational literature in our setting. Methodology: This cross-sectional study assessed knowledge and determined the practice of self-breast Examination of women attending the antenatal Clinic of Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto from January to March 2023. Results: A total of 602 pregnant women participated in the study. The mean age of the respondents was 22±4 years. Most (70.4%) participants had heard about breast cancer. The older age groups were more likely to have heard of BSE. There was a significant relationship between awareness of BSE and level of education (p-0.002), but no significant relationship was found between marital status and awareness of BSE. Most (66.0%) believed that BSE would make them worry about breast cancer. The percentage of positive attitudes increased as a woman is getting older (p-0.0001). A total of 142 participants (23.6%) had ever practiced BSE. Conclusion: This study showed that knowledge of BSE was good, but attitude and practice were unacceptably poor. Age, marital status, education level, and family history of BC were important determinants.

CLINICAL PROFILE AND SURGICAL MANAGEMENT OF COLORECTAL CANCER IN A TERTIARY CENTER IN NORTHWEST NIGERIA: A 10-YEAR DESCRIPTIVE STUDY

International Research Journal of Medical and Pharmaceutical Sciences, 2024

Background: Colorectal cancer (CRC) is a common surgical problem globally, with an increasing inc... more Background: Colorectal cancer (CRC) is a common surgical problem globally, with an increasing incidence and worse outcomes in Low-and medium-income countries, where the magnitude remains under-reported. Objective: To describe the presentation of colorectal cancer in a tertiary hospital in Northwest Nigeria and highlight the challenges of surgical management. Methods: The study period was 10 years, January 2012 to December 2021, for all patients presenting with histologic diagnosis of colon or rectal cancer presenting through the surgical outpatient clinics, emergency departments, or seen through non-surgical wards of Usmanu Danfodiyo University Teaching Hospital Sokoto, Nigeria during the study period. Results: There was a total of 221 patients with histologically confirmed colon and rectal cancers over the study period. The male-to-female ratio was 1.1:1, age range was 14-80 years, and a peak age group of 30-40years. 195 patients (88.24%) were 50 years or less, early-onset CRC. There was a rise in the yearly hospital-based incidence of presentation in CRC for 12 patients in 2012 to 32 patients in 2019. Majority, 140 patients (63.35%), presented in emergency, and delay in presentation was a common feature, with over 60% of patients presenting for the first time 6 months after onset of symptoms. The rectum was the most affected site, accounting for 66.06% of patients (n=146). A third of patients did not receive surgical intervention due to advanced inoperable disease, financial constraints, or refusal of colostomy. Majority of the patients presented with advanced stage. 55% of patients (n=121) presented with Dukes' stage C. 10% of patients (n=22) had metastatic disease. Conclusion: Colorectal Cancer incidence is increasing in our environment. Early-onset disease at an advanced stage is the common presentation. With the challenges of surgical care, poor outcomes have been maintained in our patients.

EXPERIENCE AND OUTCOME OF SURGICAL OPTIONS OF MANAGEMENT OF FISSURE IN ANO AT A TERTIARY HOSPITAL IN SOKOTO, NORTH-WEST NIGERIA, 2024

Background: A typical and common source of perianal pain is the anal fissure contributing to 10-1... more Background: A typical and common source of perianal pain is the anal fissure contributing to 10-15% of all proctological consultation worldwide. Different surgical procedures have been used for treatment for patients with Chronic fissure in ano with varying reported outcomes. We aimed to study the outcome of different surgical procedures in a single tertiary hospital. Materials and Method: A Five-year retrospective study of all patients operated for fissure in ano at Usmanu Danfodiyo University Teaching Hospital from January 2018 to December 2022 was conducted. Sociodemographic, clinical and operative data was retrieved from the case notes of the patients and collected in a profoma. The data was entered and analysed with SPSS version 25. Results: A total of 32 patients were operated during the period under review. Age ranged between 20-37years (mean age 27years), Male: Female ratio of 3:1. 29(90.6%) had a posteriorly located lesion. 20 had Fissurectomy (62.5%), 8 had Open Partial Lateral Internal Sphinctorotomy (PLIS) (25%), 4 patients had Closed PLIS (12.5%). Postoperatively, those who had Fissurectomy spent an average of 3days on admission after surgery while those that had PLIS spent an average of 24hours. After a follow up of 6months 4(20%) of patients who had fissurectomy had recurrence of pain while none had recurrence among those that had PLIS (p=0.0001) Conclusion: In our experience PLIS has a more superior short-term outcome with faster recovery in comparison to fissurectomy amongst patients with Symptomatic Fissure in ano.

DIAGNOSTIC VALUE OF SERUM BILIRUBIN IN PREDICTING COMPLICATION IN ACUTE APPENDICITIS; A PROSPECTIVE STUDY AT ABUBAKAR TAFAWA BALEWA UNIVERSITY TEACHING HOSPITAL BAUCHI, NIGERIA

Global Journal of Medical and Health Science Volume 11, Number 4; October-December,2024; , 2024

Background: Appendicitis is a common surgical emergency. Despite the increasing use of advanced i... more Background: Appendicitis is a common surgical emergency. Despite the increasing use of advanced imaging techniques, the rates of misdiagnosis of appendicitis (15%) and appendiceal rupture remain unchanged. The significance of hyperbilirubinemia as a predictive factor of acute appendicitis has continued to gain attention in recent studies; however, its value in the diagnosis of perforated/gangrenous appendicitis has not been studied in our practice. We studied the diagnostic value of serum bilirubin in predicting complications of acute appendicitis. Methods: This prospective study was conducted at the Surgery Department of Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH) Bauchi, Nigeria over a duration of three calendar years from January 2020 to December 2022. Results: A total of 396 patients who met the predefined inclusion criteria were included in the analysis. The mean age of 24 ± 10 years, and the maleto-female ratio was 1.4:1. The majority of patients (63.7%) had nonperforated appendicitis. Notably, among the patients with a normal appendix, the percentage of female patients (69.44%) was significantly higher. 107 (29.72%) exhibited hyperbilirubinemia, and among the patients diagnosed with perforated appendicitis, 62 (86.11%) had hyperbilirubinemia. Significantly more patients with appendiceal perforation had hyperbilirubinemia than those with acute perforated appendicitis (86.11% vs. 17.36%, p < 0.001). Bilirubin demonstrated a higher specificity (97.29%) in detecting acute appendicitis, but it has a low sensitivity. A comparative analysis of serum bilirubin levels to discriminate between acute appendicitis and perforated/gangrenous appendicitis demonstrated sensitivity and specificity of 86.11% and 82.63%. A statistical analysis indicated that patients with perforated/gangrenous appendicitis were 4.96 times more likely to have hyperbilirubinemia than those with acute appendicitis. Conclusions- There is a significant difference in bilirubin levels between the patients diagnosed with acute appendicitis and those diagnosed with perforated appendicitis. Bilirubin is a valuable armamentarium for the diagnosis of perforation or gangrene.

Retained gauze in the abdomen following prior laparotomy

Nigerian Journal of Basic and Clinical Sciences, 2021

Retained gauze in the abdomen (Gossypiboma) is a serious complication of abdominal surgery that o... more Retained gauze in the abdomen (Gossypiboma) is a serious complication of abdominal surgery that often leads to medicolegal lawsuits. The most important risk factor is a failure of gauze count before and after laparotomy. Other related factors in order of occurrence include abdominal, gynaecologic, urologic and vascular procedures. We herein present a case of retained gauze following prior laparotomy.

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

The Lancet. Infectious diseases, Jan 13, 2018

Surgical site infection (SSI) is one of the most common infections associated with health care, b... more Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with e...

Solid pseudopapillary neoplasm of the pancreas in Sub-Saharan Africa: A case report and review of literature

Indian Journal of Case Reports, Dec 31, 2018

Solid pseudopapillary neoplasm of the pancreas is a rare indolent malignant tumor mostly found in... more Solid pseudopapillary neoplasm of the pancreas is a rare indolent malignant tumor mostly found in young women in the second and third decades of life. Only about 3000 cases have been reported in English literature, with none in the West African region. Here, we report to the best of our knowledge, the first histologically confirmed case of solid pseudopapillary neoplasm of the pancreas in West Africa. A 29-year-old woman with a slow-growing left upper abdominal mass of 10 months. Abdominal ultrasound and computed tomography scans revealed a cystic-solid mass arising from the tail of the pancreas. She underwent surgical excision of the mass, with post-operative histopathology findings in keeping with solid pseudopapillary neoplasm of the pancreas. This case report highlights the importance of improved abdominal imaging, histopathology and the need for increased awareness as a differential diagnosis of an intra-abdominal tumor, especially in young women.

Experience on the surgical management of biliary stones in Sokoto, North West Nigeria

International Journal of Advances in Medicine

Background: Cholelithiasis are relatively rare in Nigeria and Africa at large. However, recently ... more Background: Cholelithiasis are relatively rare in Nigeria and Africa at large. However, recently the incidence has been reported to be on the rise. We present a ten-year review of our experience in managing gallstones to highlight the recent trends in our practice.Methods: This is a 10-year retrospective study on patients who were managed for gall bladder disease in the Usmanu Danfodiyo university teaching hospital Sokoto from August 2011 to July 2021. The biographic data, clinical features, radiologic, operative findings, histologic findings and outcome of treatment were analyzed with IBM SPSS 25.Results: There were 82 patients over the period of the study comprising of 18 (22%) males and 64 females (78%). Their ages range was 17 to 60 years with a mean of 37.59 years ±11.02. All patients had right upper quadrant pain as the main complaint with 24 patients (29.3%) having associated epigastric pain and 14 patients (17.1%) presented with jaundice. Preoperative ultrasound (USS) diagno...

Correlation of Alvarado Score and Intra-operative Findings in patients presenting to a tertiary Center in Northwestern Nigeria

BACKGROUND: Acute appendicitis is the most common abdominal emergency in both the developed and d... more BACKGROUND: Acute appendicitis is the most common abdominal emergency in both the developed and developing countries. This common surgical disease continues to remain a diagnostic problem. This study aims to evaluate the accuracy of the Alvarado score (AS) in the pre-operative diagnosis of acute appendicitis in our setting. METHODS: A prospective study conducted in Usmanu Danfodiyo University Teaching Hospital Sokoto over a three year period from July 2014 to June 2017. All consecutive patients operated during the study period with an initial clinical diagnosis of acute appendicitis were enrolled into the study. Alvarado scores were correlated with intra operative grades of appendicitis and histopathological findings. Sensitivity, specificity and accuracy of Alvarado Scores were calculated. RESULTS: One hundred and eleven patients were studied with a Male: Female (M:F) of 1.5:1 and mean age of 23.89±4.93years. Patients presenting within first 24hours had a perforation rate of 15% as...

Abstracts presented at the 74th conference and AGM of Nigeria Surgical Research Society

Nigerian Journal of Surgery, 2019

Solid Pseudopapillary Neoplasm of the Pancreas in a 12-Year-Old Female: Case Report and Review of the Literature

European Journal of Pediatric Surgery, 2006

We aimed to review clinical and histologic findings of solid-pseudopapillary neoplasm (SPN) in ch... more We aimed to review clinical and histologic findings of solid-pseudopapillary neoplasm (SPN) in children and determine the predictive factor of the malignancy. Method: The records of 45 patients (9 males, 36 females) who underwent surgery for SPN in the Asan Medical Center from 1992 to 2012 were retrospectively analyzed. We analyzed the factors between histologic benign group (n = 36) and malignant group (n = 9). Results: The mean age of children was 14.9 ± 3.15 years (range 9-20 years). Mean size of the tumor was 6.36 ± 3.61 cm, and most common site in the pancreas was the tail (n = 23). Three patients had distant metastasis at initial diagnosis. The sites were the liver (n = 2) and the omentum (n = 1). All patients underwent complete resection, and the median follow up period was 34 months. Recurrence (n = 4) was more common in the malignant group (p b 0.05). We calculated the proportion of solid component by manual volumetry with a CT scan. The median value was 41.5% in benign group and 88.4% in malignant group. On comparative analysis, the proportion of solid component was found to have significant association with malignancy (p b 0.05). Conclusion: Histologic malignant SPN has high risk of recurrence. We should consider more radical resection when finding a predominantly solid tumor in a CT scan.

Comparative study of alvarado score and its modifications in the preoperative diagnosis of acute appendicitis at a tertiary center in Sokoto, Nigeria

Nigerian Journal of Surgery, 2020

Background: Decision-making in patients suspected of having acute appendicitis has remained a dia... more Background: Decision-making in patients suspected of having acute appendicitis has remained a diagnostic challenge worldwide despite the advances in imaging and appendiceal surgery. There have been efforts to improve the diagnosis of appendicitis using clinical scoring systems. Aim: We evaluated and compared the diagnostic accuracy and role of Alvarado score (AS) and two of its modification (Kalan and Al-Fallouji) in the preoperative diagnosis of acute appendicitis. Materials and Methods: This was a prospective study conducted at the Usmanu Danfodiyo University Teaching Hospital, Sokoto, of all adult patients operated for acute appendicitis from July 2014 to June 2017. The results were analyzed on computer using Statistical Package for the Social Science version 15.Results: One hundred and eleven patients were studied. Sixty-six (59.5%) patients were males and 45 (40.5%) were females. The male-to-female ratio was 1.5:1. The mean age was 23.89 ± 4.93 years. The AS sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 90.3%, 83.3%, 96.6%, 62.2%, and 89.2%, respectively, were similar to the findings of Kalan score (90.3%, 83.3%, 96.6%, 62.5%, and 89.2%, respectively) and Al-Fallouji score (96.8%, 66.7%, 93.8%, 80%, and 91.9%, respectively). The receiver operating curve and area under the curve show that Alvarado, Kalan, and Al-Fallouji are accurate scores in the preoperative diagnosis of acute appendicitis with an area under the curve of 0.88, 0.86, and 0.85, respectively. Conclusion: Kalan and Al-Fallouji scores have comparably good diagnostic accuracy as the AS among our patients. Any of these scores can be used as an adjunct in the preoperative diagnosis of acute appendicitis.

Disseminated Gonococcal Infection Caused by a Multidrug-Resistant Pathogen Presenting with Hemorrhagic Manifestation: A Case Report

Journal of Laboratory Physicians

The incidence of disseminated gonococcal infection (DGI) is rising in some parts of the world, bu... more The incidence of disseminated gonococcal infection (DGI) is rising in some parts of the world, but there is paucity of data on its true incidence from sub-Saharan Africa. DGI has varied manifestations in different population group. We report a case of a 30-year-old sexually active woman presenting with hemorrhagic symptoms 2 weeks after a surgery on account of diagnosis of uterine fibroid made at a peripheral hospital. A multidrug-resistant Neisseria gonorrhoeae was isolated from the wound on her surgical site and blood sample. She was managed with intravenous meropenem, pressure dressing, and blood products, with the patient making a full recovery after a week. This case is presented because it is a rare one. Moreover, there is the need to revive the awareness of clinicians on the existence of multidrug-resistant gonococcus in our environment. We herein report a case of DGI from Nigeria.

Lipoma of the transverse colon: Review of literature and a case report in a young Nigerian female

Nigerian Journal of Medicine

Colonic lipomas are rare benign tumour of the gastrointestinal tract(GIT); however, they remain t... more Colonic lipomas are rare benign tumour of the gastrointestinal tract(GIT); however, they remain the commonest nonepithelial(mesenchymal) benign neoplasm of the GIT tract. The majority remains asymptomatic. They can mimic malignant tumours of the GI tract. We present a review of literature and our experience with the management of a case of this rare tumour. A 35year old woman presented to us with an upper abdominal pain of six weeks,vomiting and passage of bloody mucoid stool of four weeks. A huge palpable mass in the epigastric region. Contrast-enhanced Computed tomography revealed a well-defined, 18cm, fatty tissue mass in the transverse colon. She had a right hemicolectomy. Histology confirmed the diagnosis revealing a submucous lipoma. One year follow up, she remained symptom-free with no evidence of recurrence. This study raises the awareness of this rare tumour as a cause of GIT symptoms and highlights the challenges in differentiating it from the more common malignancy of the colon.

Global economic burden of unmet surgical need for appendicitis

British Journal of Surgery

Background There is a substantial gap in provision of adequate surgical care in many low- and mid... more Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality wa...

Global variation in anastomosis and end colostomy formation following left‐sided colorectal resection

BJS Open, 2019

Background: End colostomy rates following colorectal resection vary across institutions in high-i... more Background: End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods: This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle-and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results: In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6⋅9 per cent) from low-HDI, 254 (15⋅5 per cent) from middle-HDI and 1268 (77⋅6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57⋅5, 40⋅9 and 35⋅4 per cent; P < 0⋅001) and subsequent use of end colostomy (52⋅2, 24⋅8 and 18⋅9 per cent; P < 0⋅001) in low-compared with middle-and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3⋅20, 95 per cent c.i. 1⋅35 to 7⋅57; P = 0⋅008) after risk adjustment for malignant disease (OR 2⋅34, 1⋅65 to 3⋅32; P < 0⋅001), emergency surgery (OR 4⋅08, 2⋅73 to 6⋅10; P < 0⋅001), time to operation at least 48 h (OR 1⋅99, 1⋅28 to 3⋅09; P = 0⋅002) and disease perforation (OR 4⋅00, 2⋅81 to 5⋅69; P < 0⋅001). Conclusion: Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone. * Members of the GlobalSurg Collaborative are collaborators in this study and are listed in Appendix S1 (supporting information)

Prolapsed ileocolic intussusception in an adult : A bizarre presentation leading to delayed diagnosis in a low resource setting.

by Umar Muktar and stephen yusuf

Research Journal of Health Sciences, 2021

Background:Intussusception is the telescoping of one part of the intestine into the lumen of the ... more Background:Intussusception is the telescoping of one part of the intestine into the lumen of the adjoining
part, which occurs more in the ileocaecal part of the intestine. It is the most common cause of intestinal
obstruction in children younger than 3years of age. Occurrence is rare in adult, with prolapsed
intussusceptions even rarer and occuring more in association with an underlying predisposing intestinal
abnormality.
Case Report: A 19year old boy presented with 6months history of recurrent non-specific, occasionally
dull aching abdominal pain, progressive weight loss and a 4hour history of anal protrusion. He had
presented multiple times to a peripheral hospital where the definitive diagnosis was missed. He was
evaluated for ileocolic intussusception and he had exploratory laparotomy and right hemi colectomy
done.
Conclusion: Intussusceptions are rare outside childhood, however there should be a high index of
suspicion of intussusception in adult with nonspecific abdominal symptoms who has not responded to
conventional conservative therapy.

Use of Telemedicine for Postdischarge Assessment of the Surgical Wound International Cohort Study, and Systematic Review With Meta-analysis

Annals of Surgery , 2023

Objective: This study aimed to determine whether remote wound reviews using telemedicine can be s... more Objective: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardized assessment tools are needed. Background: Surgical site infection (SSI) is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery. Methods: The primary outcome of this study was SSI reported up to 30 days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analyzed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30 days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596). Results: The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs 11.1%, P < 0.001), which persisted after risk adjustment in a mixed-effects model (adjusted odds ratio: 0.73, 95% confidence interval: 0.63-0.84, P < 0.001). This association was consistent across sensitivity and subgroup analyses, including a propensityscore matched model. In 9 eligible nonrandomized studies identified, a pooled mean of 64% of patients underwent telemedicine follow-up. Upon meta-analysis, the SSI rate reported was lower with telemedicine (odds ratio: 0.67, 0.47-0.94) than in-person (reference) follow-up (I 2 = 0.45, P = 0.12), although there a high risk of bias in included studies. Conclusions: Use of telemedicine to assess the surgical wound postdischarge is feasible, but risks underreporting of SSI. Standardized tools for remote assessment of SSI must be evaluated and adopted as telemedicine is upscaled globally.

KNOWLEDGE AND PRACTICE OF BREAST SELF-EXAMINATION FOR EARLY DETECTION OF BREAST CANCER AMONG WOMEN ATTENDING ANTENATAL CLINIC AT USMANU DANFODIYO UNIVERSITY TEACHING HOSPITAL SOKOTO

American Journal of Public Health and Epidemiology, 2024

Background: Breast cancer is currently the most common cancer worldwide. Poor outcomes of breast ... more Background: Breast cancer is currently the most common cancer worldwide. Poor outcomes of breast cancer management in Africa are linked to late presentation. Early diagnosis based on breast self-examination and awareness has been advocated. Objective: To develop guidelines for Breast self-examination (BSE) in Nigeria, there is a need for current Knowledge and practice of breast selfexamination. This study aims to provide foundational literature in our setting. Methodology: This cross-sectional study assessed knowledge and determined the practice of self-breast Examination of women attending the antenatal Clinic of Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto from January to March 2023. Results: A total of 602 pregnant women participated in the study. The mean age of the respondents was 22±4 years. Most (70.4%) participants had heard about breast cancer. The older age groups were more likely to have heard of BSE. There was a significant relationship between awareness of BSE and level of education (p-0.002), but no significant relationship was found between marital status and awareness of BSE. Most (66.0%) believed that BSE would make them worry about breast cancer. The percentage of positive attitudes increased as a woman is getting older (p-0.0001). A total of 142 participants (23.6%) had ever practiced BSE. Conclusion: This study showed that knowledge of BSE was good, but attitude and practice were unacceptably poor. Age, marital status, education level, and family history of BC were important determinants.

CLINICAL PROFILE AND SURGICAL MANAGEMENT OF COLORECTAL CANCER IN A TERTIARY CENTER IN NORTHWEST NIGERIA: A 10-YEAR DESCRIPTIVE STUDY

International Research Journal of Medical and Pharmaceutical Sciences, 2024

Background: Colorectal cancer (CRC) is a common surgical problem globally, with an increasing inc... more Background: Colorectal cancer (CRC) is a common surgical problem globally, with an increasing incidence and worse outcomes in Low-and medium-income countries, where the magnitude remains under-reported. Objective: To describe the presentation of colorectal cancer in a tertiary hospital in Northwest Nigeria and highlight the challenges of surgical management. Methods: The study period was 10 years, January 2012 to December 2021, for all patients presenting with histologic diagnosis of colon or rectal cancer presenting through the surgical outpatient clinics, emergency departments, or seen through non-surgical wards of Usmanu Danfodiyo University Teaching Hospital Sokoto, Nigeria during the study period. Results: There was a total of 221 patients with histologically confirmed colon and rectal cancers over the study period. The male-to-female ratio was 1.1:1, age range was 14-80 years, and a peak age group of 30-40years. 195 patients (88.24%) were 50 years or less, early-onset CRC. There was a rise in the yearly hospital-based incidence of presentation in CRC for 12 patients in 2012 to 32 patients in 2019. Majority, 140 patients (63.35%), presented in emergency, and delay in presentation was a common feature, with over 60% of patients presenting for the first time 6 months after onset of symptoms. The rectum was the most affected site, accounting for 66.06% of patients (n=146). A third of patients did not receive surgical intervention due to advanced inoperable disease, financial constraints, or refusal of colostomy. Majority of the patients presented with advanced stage. 55% of patients (n=121) presented with Dukes' stage C. 10% of patients (n=22) had metastatic disease. Conclusion: Colorectal Cancer incidence is increasing in our environment. Early-onset disease at an advanced stage is the common presentation. With the challenges of surgical care, poor outcomes have been maintained in our patients.

EXPERIENCE AND OUTCOME OF SURGICAL OPTIONS OF MANAGEMENT OF FISSURE IN ANO AT A TERTIARY HOSPITAL IN SOKOTO, NORTH-WEST NIGERIA, 2024

Background: A typical and common source of perianal pain is the anal fissure contributing to 10-1... more Background: A typical and common source of perianal pain is the anal fissure contributing to 10-15% of all proctological consultation worldwide. Different surgical procedures have been used for treatment for patients with Chronic fissure in ano with varying reported outcomes. We aimed to study the outcome of different surgical procedures in a single tertiary hospital. Materials and Method: A Five-year retrospective study of all patients operated for fissure in ano at Usmanu Danfodiyo University Teaching Hospital from January 2018 to December 2022 was conducted. Sociodemographic, clinical and operative data was retrieved from the case notes of the patients and collected in a profoma. The data was entered and analysed with SPSS version 25. Results: A total of 32 patients were operated during the period under review. Age ranged between 20-37years (mean age 27years), Male: Female ratio of 3:1. 29(90.6%) had a posteriorly located lesion. 20 had Fissurectomy (62.5%), 8 had Open Partial Lateral Internal Sphinctorotomy (PLIS) (25%), 4 patients had Closed PLIS (12.5%). Postoperatively, those who had Fissurectomy spent an average of 3days on admission after surgery while those that had PLIS spent an average of 24hours. After a follow up of 6months 4(20%) of patients who had fissurectomy had recurrence of pain while none had recurrence among those that had PLIS (p=0.0001) Conclusion: In our experience PLIS has a more superior short-term outcome with faster recovery in comparison to fissurectomy amongst patients with Symptomatic Fissure in ano.

DIAGNOSTIC VALUE OF SERUM BILIRUBIN IN PREDICTING COMPLICATION IN ACUTE APPENDICITIS; A PROSPECTIVE STUDY AT ABUBAKAR TAFAWA BALEWA UNIVERSITY TEACHING HOSPITAL BAUCHI, NIGERIA

Global Journal of Medical and Health Science Volume 11, Number 4; October-December,2024; , 2024

Background: Appendicitis is a common surgical emergency. Despite the increasing use of advanced i... more Background: Appendicitis is a common surgical emergency. Despite the increasing use of advanced imaging techniques, the rates of misdiagnosis of appendicitis (15%) and appendiceal rupture remain unchanged. The significance of hyperbilirubinemia as a predictive factor of acute appendicitis has continued to gain attention in recent studies; however, its value in the diagnosis of perforated/gangrenous appendicitis has not been studied in our practice. We studied the diagnostic value of serum bilirubin in predicting complications of acute appendicitis. Methods: This prospective study was conducted at the Surgery Department of Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH) Bauchi, Nigeria over a duration of three calendar years from January 2020 to December 2022. Results: A total of 396 patients who met the predefined inclusion criteria were included in the analysis. The mean age of 24 ± 10 years, and the maleto-female ratio was 1.4:1. The majority of patients (63.7%) had nonperforated appendicitis. Notably, among the patients with a normal appendix, the percentage of female patients (69.44%) was significantly higher. 107 (29.72%) exhibited hyperbilirubinemia, and among the patients diagnosed with perforated appendicitis, 62 (86.11%) had hyperbilirubinemia. Significantly more patients with appendiceal perforation had hyperbilirubinemia than those with acute perforated appendicitis (86.11% vs. 17.36%, p < 0.001). Bilirubin demonstrated a higher specificity (97.29%) in detecting acute appendicitis, but it has a low sensitivity. A comparative analysis of serum bilirubin levels to discriminate between acute appendicitis and perforated/gangrenous appendicitis demonstrated sensitivity and specificity of 86.11% and 82.63%. A statistical analysis indicated that patients with perforated/gangrenous appendicitis were 4.96 times more likely to have hyperbilirubinemia than those with acute appendicitis. Conclusions- There is a significant difference in bilirubin levels between the patients diagnosed with acute appendicitis and those diagnosed with perforated appendicitis. Bilirubin is a valuable armamentarium for the diagnosis of perforation or gangrene.

Retained gauze in the abdomen following prior laparotomy

Nigerian Journal of Basic and Clinical Sciences, 2021

Retained gauze in the abdomen (Gossypiboma) is a serious complication of abdominal surgery that o... more Retained gauze in the abdomen (Gossypiboma) is a serious complication of abdominal surgery that often leads to medicolegal lawsuits. The most important risk factor is a failure of gauze count before and after laparotomy. Other related factors in order of occurrence include abdominal, gynaecologic, urologic and vascular procedures. We herein present a case of retained gauze following prior laparotomy.

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

The Lancet. Infectious diseases, Jan 13, 2018

Surgical site infection (SSI) is one of the most common infections associated with health care, b... more Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with e...

Solid pseudopapillary neoplasm of the pancreas in Sub-Saharan Africa: A case report and review of literature

Indian Journal of Case Reports, Dec 31, 2018

Solid pseudopapillary neoplasm of the pancreas is a rare indolent malignant tumor mostly found in... more Solid pseudopapillary neoplasm of the pancreas is a rare indolent malignant tumor mostly found in young women in the second and third decades of life. Only about 3000 cases have been reported in English literature, with none in the West African region. Here, we report to the best of our knowledge, the first histologically confirmed case of solid pseudopapillary neoplasm of the pancreas in West Africa. A 29-year-old woman with a slow-growing left upper abdominal mass of 10 months. Abdominal ultrasound and computed tomography scans revealed a cystic-solid mass arising from the tail of the pancreas. She underwent surgical excision of the mass, with post-operative histopathology findings in keeping with solid pseudopapillary neoplasm of the pancreas. This case report highlights the importance of improved abdominal imaging, histopathology and the need for increased awareness as a differential diagnosis of an intra-abdominal tumor, especially in young women.

Experience on the surgical management of biliary stones in Sokoto, North West Nigeria

International Journal of Advances in Medicine

Background: Cholelithiasis are relatively rare in Nigeria and Africa at large. However, recently ... more Background: Cholelithiasis are relatively rare in Nigeria and Africa at large. However, recently the incidence has been reported to be on the rise. We present a ten-year review of our experience in managing gallstones to highlight the recent trends in our practice.Methods: This is a 10-year retrospective study on patients who were managed for gall bladder disease in the Usmanu Danfodiyo university teaching hospital Sokoto from August 2011 to July 2021. The biographic data, clinical features, radiologic, operative findings, histologic findings and outcome of treatment were analyzed with IBM SPSS 25.Results: There were 82 patients over the period of the study comprising of 18 (22%) males and 64 females (78%). Their ages range was 17 to 60 years with a mean of 37.59 years ±11.02. All patients had right upper quadrant pain as the main complaint with 24 patients (29.3%) having associated epigastric pain and 14 patients (17.1%) presented with jaundice. Preoperative ultrasound (USS) diagno...

Correlation of Alvarado Score and Intra-operative Findings in patients presenting to a tertiary Center in Northwestern Nigeria

BACKGROUND: Acute appendicitis is the most common abdominal emergency in both the developed and d... more BACKGROUND: Acute appendicitis is the most common abdominal emergency in both the developed and developing countries. This common surgical disease continues to remain a diagnostic problem. This study aims to evaluate the accuracy of the Alvarado score (AS) in the pre-operative diagnosis of acute appendicitis in our setting. METHODS: A prospective study conducted in Usmanu Danfodiyo University Teaching Hospital Sokoto over a three year period from July 2014 to June 2017. All consecutive patients operated during the study period with an initial clinical diagnosis of acute appendicitis were enrolled into the study. Alvarado scores were correlated with intra operative grades of appendicitis and histopathological findings. Sensitivity, specificity and accuracy of Alvarado Scores were calculated. RESULTS: One hundred and eleven patients were studied with a Male: Female (M:F) of 1.5:1 and mean age of 23.89±4.93years. Patients presenting within first 24hours had a perforation rate of 15% as...

Abstracts presented at the 74th conference and AGM of Nigeria Surgical Research Society

Nigerian Journal of Surgery, 2019

Solid Pseudopapillary Neoplasm of the Pancreas in a 12-Year-Old Female: Case Report and Review of the Literature

European Journal of Pediatric Surgery, 2006

We aimed to review clinical and histologic findings of solid-pseudopapillary neoplasm (SPN) in ch... more We aimed to review clinical and histologic findings of solid-pseudopapillary neoplasm (SPN) in children and determine the predictive factor of the malignancy. Method: The records of 45 patients (9 males, 36 females) who underwent surgery for SPN in the Asan Medical Center from 1992 to 2012 were retrospectively analyzed. We analyzed the factors between histologic benign group (n = 36) and malignant group (n = 9). Results: The mean age of children was 14.9 ± 3.15 years (range 9-20 years). Mean size of the tumor was 6.36 ± 3.61 cm, and most common site in the pancreas was the tail (n = 23). Three patients had distant metastasis at initial diagnosis. The sites were the liver (n = 2) and the omentum (n = 1). All patients underwent complete resection, and the median follow up period was 34 months. Recurrence (n = 4) was more common in the malignant group (p b 0.05). We calculated the proportion of solid component by manual volumetry with a CT scan. The median value was 41.5% in benign group and 88.4% in malignant group. On comparative analysis, the proportion of solid component was found to have significant association with malignancy (p b 0.05). Conclusion: Histologic malignant SPN has high risk of recurrence. We should consider more radical resection when finding a predominantly solid tumor in a CT scan.