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Summary Background Indiscriminate antimicrobial use is one of the greatest contributors to antimicrobial resistance. A low level of asepsis in hospitals and inadequate laboratory support have been adduced as reasons for indiscriminate use of antimicrobials among surgical patients. At present, there are no guidelines for presumptive antibiotic use in Nigeria and sub-Saharan Africa. Aim Surgical inpatients at the study hospital were surveyed to determine the level of antimicrobial use and degree of compliance with prescription quality indicators. Methods A cross-sectional survey was conducted among all surgical inpatients in May 2019 using a standardized tool developed by the University of Antwerp to assess the point prevalence of antimicrobials. Inpatients who were admitted from 08:00 h on the day of the survey were included. Data on patients' demographics, indication for antimicrobial use, reason for antimicrobial use, stop/review date, adherence to guidelines and laboratory use were collected. The prevalence of antimicrobial use in the surgical department was estimated. Results Eighty-two inpatients were included in the survey. Of these, 97.6% were receiving at least one antimicrobial agent. Only 5.4% of the prescriptions were targeted, and 37.6% of prescriptions were for empirical treatment of infections. Approximately half (50.7%) of the patients were receiving presumptive antibiotics, and 6% were receiving prophylactic antibiotics. In total, 58.7% of prescriptions were administered parenterally, and 98.2% of patients had documentation of a stop/review date. Metronidazole ( P =32.3%, T=29.2%), ceftriaxone ( P =28.4%, T=19.8%) and ciprofloxacin ( P =14.2%, T=14.6%) were the most common antimicrobials used. Conclusions There is a high rate of antimicrobial use among surgical inpatients, and the rate of indiscriminate antimicrobial prescribing among these patients needs to be reduced. This can be achieved by developing antimicrobial guidelines for presumptive antimicrobial therapy.

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Background Gunshot wounds of the external genitalia are rare. Rarer still are civilian self-inflicted gunshot wounds of the external genitalia. The protocol for the management of gunshot wounds of the penis especially with respect to urethral injuries is not fully established. Case presentation We present a 27-year-old male undergraduate student, who accidentally shot himself in the penis. He sustained American Association for the Surgery of Trauma (AAST) grades IV to V injuries to the penis, scrotum and left testes. He was managed in a multistage, multi-disciplinary fashion including staged buccal mucosal graft repair of 4 cm proximal penile urethral defect with satisfactory cosmetic and functional outcome. Conclusions Excellent functional and cosmetic results may be obtained after severe penetrating trauma to the external genitalia even in low resource centres in the hands of non-reconstructive urologists. Buccal mucosal graft is a viable option for two stage reconstruction of the urethra.

Breast necrotizing fasciitis is a rare condition that has a tendency to rapidly progress with untoward morbidity and potential mortality. Its rarity often results to misdiagnosis and the fulminant course of the disease. We wish to present a case managed with nipple areola conservation following early intervention. We report a 28-year-old woman managed for unilateral right breast necrotizing fasciitis following stillbirth and resultant breast congestion in a background hypoalbuminemia. Early intervention ensured nipple-areola salvage. Wound was covered with split-thickness skin grafting. Early aggressive intervention in necrotizing fasciitis of the breast in a post-stillbirth lady with congestion contributed to preservation of nipple areola complex with eventual satisfactory management using split-thickness skin grafting.

Introduction chronic leg ulcers cause a prolonged hospital stay with devastating effects on the patients. Several modifiable factors are taken care of to reduce the duration of stay. A further measure to hasten wound bed preparation pre-grafting and to hasten graft healing post-grafting is with negative pressure dressing. Methods sixty-two patients were placed in two groups of 31 cases each. The wound beds were prepared with negative pressure apparatus locally adapted with suction machine for group A and with conventional gauze dressing using 5% povidone iodine soaks for group B. Grafted wound was also dressed similarly for the respective groups. Grafts were inspected on the 5 th post-operative day and were determined with planimeter grid. Grafts were monitored until completely healed and patients were discharged. Satisfaction and length of stay were determined at discharge. Results the mean hospital stay pre-grafting and post-grafting were 12.2 (±8.64) days and 13.6 (±2.03) days respectively for the negative pressure dressing and 28.8 (±30.9) days and 21.8 (±21.97) days respectively for the traditional dressing group. These differences with p values of 0.038 for the pre-grafting stay and 0.006 for the post-grafting stay were statistically significant. The patients managed with negative pressure dressing also recorded greater satisfaction with the process and the outcome. Conclusion negative pressure dressing contributes significantly to reducing the length of hospital stay in chronic leg ulcers both in wound bed preparation and in graft healing resulting to better patient satisfaction than in patients treated with conventional gauze dressing and 5% povidone iodine soaks.

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