Background. Hepatitis B virus (HBV) infection is a well recognised occupational health hazard preventable by vaccination. Objectives. To determine the knowledge of operating room personnel (ORP) in Nigeria about the Hepatitis B vaccine, their perception of Hepatitis B vaccination and vaccination status against HBV. Methods. Four university hospitals were selected by simple random sampling. A structured questionnaire was administered to 228 ORP after obtaining consent. Result. Only 26.8% of ORP were vaccinated against HBV. The primary reason for not being vaccinated or for defaulting from vaccination was lack of time. Differences in age, sex, duration of practice and respondent's institution between vaccinated and unvaccinated ORP were not significant (P > 0.05). The majority (86.8%) had the awareness of the existence of Hepatitis B vaccine. 83.8% of respondents believed that the vaccine should be given to the ORP as part of work place safety measures. The majority were aware of the modes of transmission of HBV infection. 78.9% of respondents believed that Hepatitis B vaccine is safe and 81.1% would recommend it to another staff. Conclusion. Despite a good knowledge about HBV infection and vaccine, most of ORP are still not vaccinated. Hepatitis B vaccination should be a prerequisite for working in the theatre, hence putting surgical patients at reduced risk.

BackgroundWe report two cases of innocuous dentoalveolar infections which rapidly progressed to deep neck abscesses complicated by descending mediastinitis in a resource-constrained rural mission hospital in the Cameroon.Case presentationThe clinical presentations of a 35-year-old man and a 32-year-old woman both of Fulani origin in the Northern region of Cameroon were similar with submandibular fluctuant and tender swelling and differential warmth to palpation. The patients had tachycardia, high grade pyrexia, and normal blood pressure. Further physical and neurological examinations were unremarkable. An ultrasound scan of the neck swellings showed submandibular turbid collections. Plain chest radiographs confirmed empyema thoraces. Our patients had serial drainage of the neck abscesses as well as closed thoracostomy tube drainage which were connected to pleurovac and suctioning machines, with significant amount of pus drainage. Both patients were admitted to our intensive care unit for close monitoring. The first patient continued to make satisfactory clinical progress and was discharged by the fourth week of admission. The patient who had human immunodeficiency viral infection died on the fifth postoperative day.ConclusionsThe possibility of lethal complications and the associated morbidity and mortality portray this clinical entity as an important public health concern. Clinicians taking care of patients with dentoalveolar and oropharyngeal infections need to be sensitized to these potentially fatal complications. Alternatively, strategies to improve oral health and reduce the incidence of dental caries, the main cause of dental abscess, would maximize use of resources; especially in resources-constrained centers like ours in Banso Baptist Hospital.

BackgroundSudden cardiac arrest following spinal anesthesia is relatively uncommon and a matter of grave concern for any anesthesiologist as well as clinicians in general. There have been, however, several reports of such cases in the literature. Careful patient selection, appropriate dosing of the local anesthetic, volume loading, close monitoring, and prompt intervention at the first sign of cardiovascular instability should improve outcomes. The rarity of occurrence and clinical curiosity of this entity suggest reporting of this unusual and possibly avoidable clinical event.Case presentationWe report the occurrence of unanticipated delayed cardiac arrest following spinal anesthesia in a 25-year-old Cameroonian man. Incidentally, the index patient was successfully resuscitated with timely and appropriate cardiopulmonary resuscitative measures. He went ahead to have emergency open appendectomy with good post-operative outcome and recovery.ConclusionsThe management of such cardiac arrest under spinal anesthesia is very challenging in resource- limited settings such as ours. Anesthetists and clinicians need to be well informed of this grave complication. A good understanding of the physiologic changes caused by spinal anesthesia and its complications, adequate patient selection, respecting the contraindications of the procedure, adequate monitoring, and constant vigilance are of paramount importance to the eventual outcome.

BACKGROUND: Hand hygiene practice entails hand washing, which is simple, cost-effective, and one of the first lines of defense in ceasing the spread of the current pandemic. This narrative review of published studies is conducted to highlight factors impacting hand hygiene practice and identify evidence-based strategies for improvement in sub-Saharan Africa. METHODS: The literature search strategy covered printed and online sources, including manual library search (PubMed), Embase, Medline, and Cochrane Library. For papers written in English and published in the last ten years. A systematic analysis of available data was subsequently performed based on the review questions. RESULTS: An estimated 134 articles were found online, and thirty-two articles utilized in the final analysis. Overall, hand hygiene betides with low compliance rates in developing countries. The calculated compliance rate was 20.49%. The challenges identified were the poverty of awareness and scientific knowledge concerning hand hygiene, infrastructural deficit including lack of access to clean and potable water, soap, hand rub gel, misconceptions regarding hand hygiene practice, etc. CONCLUSION: Healthcare-associated infections draw increasing attention from all and sundry due to the growing recognition that most of these are preventable. Free evidence-based practice suggests that strict adherence to hand hygiene reduces the risk of cross-transmission of infections and especially in the COVID-19 pandemic era. The challenges identified in this review are consistent with the findings of studies conducted elsewhere. With “Clean Care is Safer Care” as a prime list of the World Health Organization’s global initiative on patient safety programs; therefore, it is high time for developing countries to formulate the much-needed policies for implementing basic infection prevention practices in our healthcare settings.

Background: Perforated peptic ulcer disease is a common cause of emergency surgical admission with potential risk of grave complications. Management is often by surgical closure. The age-long controversy had been whether omentoplasty or omental patch is necessary or not? This study therefore brings to the fore the patterns of presentation and methods of management of perforated peptic ulcer as well as the outcome, in a resource-constrained mission hospital, Northwestern Cameroon. Methods:Retrospective cross-sectional study of patients with perforated peptic ulcer disease seen at St Elizabeth Catholic General Hospital, Shisong, Northwestern Cameroon over a three-year period from January 2016 to December 2018. Patients' records were reviewed for socio-demographics, probable risk factors, duration of disease, type of surgery and complications. Data obtained was analyzed using SPSS 22.0.Result: Eighty-eight patients were analyzed. The mean age was (number; n= 38 years ± SD 12.4 years). There were (n=64; 72.7%) males out of which (n=58; 65.9%) survived and (n=24; 27.3%) females out of which (n=20; 22.7%) survived and this difference was statistically insignificant (p>0.05). The Male: Female ratio was 3.0: 1. Mean age of survivors was 37.4 years and 43.7 years in those who expired. Farmers constituted the single largest group (n=38; 43.18%) followed by artisans (n=14; 15.70%), NSAIDs abuse (n=44), previous peptic ulcer disease (n=52) and no prior dyspeptic symptoms (n=36) constituted 50%, 60% and 40% respectively of cases. The age range was between 16 years and 74 years (The duration of symptoms before presentation ranged from 1 to 7 days; Fifty-two (n=52; 59%) patients had perforated duodenal ulcer while thirty-six (n=36; 41%) patients had perforated gastric ulcer. The preferred method of repair was simple closure of the edges with omental reinforcement in (n=58; 65.9%) patients. The classical Graham's omentoplasty in (n=20; 23%), and simple closure mainly in (n=10; 11.6%); we had three (n=3; 3.4%) failed repair and ten (n=10; 11.4%) mortalities. The presence of shock and sepsis is the single most important predictor of morbidity and mortality. Conclusion:Surgery for perforated peptic ulcer still is a subject of debate despite more than an era of published expertise. Our patients present very late and, in most cases, following abuse of local herbal preparation and Non-steroidal anti-inflammatory drugs. The presence of shock and sepsis is the single most important predictor of morbidity and mortality. Credence is being laid on the pragmatic surgical intervention with modified Graham's omentoplasty in addition to broad spectrum antibiotics and H. pylori eradication therapy is still highly beneficial in common practice. Health education to improve early health seeking habit is mandatory.