BackgroundThere has been limited success in establishing Open Heart Surgery programmes in Nigeria despite the high prevalence of structural heart disease and the large number of Nigerian patients that travel abroad for Open Heart Surgery. The challenges and constraints to the development of Open Heart Surgery in Nigeria need to be identified and overcome. The aim of this study is to review the experience with Open Heart Surgery at the Lagos State University Teaching Hospital and highlight the challenges encountered in developing this programme.MethodsThis is a retrospective study of patients that underwent Open Heart Surgery in our institution. The source of data was a prospectively maintained database. Extracted data included patient demographics, indication for surgery, euroscore, cardiopulmonary bypass time, cross clamp time, complications and patient outcome.Results51 Open Heart Surgery procedures were done between August 2004 and December 2011. There were 21 males and 30 females. Mean age was 29 ± 15.6 years. The mean euroscore was 3.8 ± 2.1. The procedures done were Mitral Valve Replacement in 15 patients (29.4%), Atrial Septal Defect Repair in 14 patients (27.5%), Ventricular Septal Defect Repair in 8 patients (15.7%), Aortic Valve Replacement in 5 patients (9.8%), excision of Left Atrial Myxoma in 2 patients (3.9%), Coronary Artery Bypass Grafting in 2 patients (3.9%), Bidirectional Glenn Shunts in 2 patients (3.9%), Tetralogy of Fallot repair in 2 patients (3.9%) and Mitral Valve Repair in 1 patient (2%). There were 9 mortalities (17.6%) in this series. Challenges encountered included the low volume of cases done, an unstable working environment, limited number of trained staff, difficulty in obtaining laboratory support, limited financial support and difficulty in moving away from the Cardiac Mission Model.ConclusionsThe Open Heart Surgery program in our institution is still being developed but the identified challenges need to be overcome if this program is to be sustained. Similar challenges will need to be overcome by other cardiac stakeholders if other OHS programs are to be developed and sustained in Nigeria.

Background There are well‐documented racial and ethnic disparities in treatment and perioperative outcomes for patients with adolescent idiopathic scoliosis. Aims We hypothesize that the implementation of a coordinated care pathway for pediatric patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis may be associated with a reduction in racial and ethnic disparities in perioperative outcomes. Methods This is a retrospective pre‐ and post‐test cohort study of patients who underwent posterior spinal fusion for adolescent idiopathic scoliosis at our institution between July 1, 2013 and August 5, 2019. We implemented a coordinated care pathway in March 2015. Patient demographics included age, race, ethnicity, weight, gender, insurance status, ASA class, time between the date surgery was ordered and the date surgery occurred, degree of scoliosis, and the number of spinal levels fused. The primary outcome was length of stay. The secondary outcomes included transfusion rates, pain scores, and postoperative complications. Multivariable regression models compared outcome medians across race/ethnicity. Disparities were defined as the difference in adjusted outcomes by race/ethnicity. Results Four hundred twenty‐four patients underwent posterior spinal fusion for adolescent idiopathic scoliosis at our institution (116 prepathway and 308 postpathway). The median length of stay of Black patients was 1.0 day (95% CI: 0.4, 1.5; p = .006) longer than White patients prepathway. Prepathway patients who self‐identified as Other had a 1.2 (95% CI: 0.5, 1.9; p = .004) higher median average pain score on postoperative day 1 compared with White patients. On postoperative day 2, patients who identified as Other had 2.0 (95% CI: 0.8, 3.2; p = .005) higher pain score compared with White patients prepathway. Postpathway, there were no significant differences in outcomes by race/ethnicity. Conclusions Our study supports the hypothesis that use of a coordinated care pathway is associated with a reduction in racial and ethnic disparities in length of stay and pain scores in pediatric patients undergoing posterior spinal fusion.

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Objectives: Buruli Ulcer Disease (BUD) caused by Mycobacterium ulcerans is a severe neglected tropical disease of the skin, which has been reported in over 33 countries globally including Nigeria where the disease was first reported in 1967 and later in 1975. Since these reports, there has been no research on BU in the southwest Nigeria. In this study we assessed the presence of BUD in five states of the southwest Nigeria.Method: This was a community-based, cross-sectional study where BU awareness sessions preceded active search for suspected cases. Questionnaires were administered for participants' demography. Swab and fine needle aspirate specimens from suspected BU lesions were subjected to IS2404-based Nested PCR and Real time (qPCR) techniques to confirm BUD.Results: A total of 256 samples were collected and analyzed between April, 2016 and December, 2018. 157 (61.3%) samples were positive to IS2404 of M. ulcerans. Children below 15 years of age and adults constituted 42 cases (26.8%) and 115 cases (73.2%), respectively. Index BU cases were confirmed in Ekiti 4 (2.5%), Lagos 11 (7.3%), Ondo 16 (10.6%), Osun 61 (38.9%) and the remaining 64 (40.4%) were found in Ogun State. Ogun and Osun States accounted for 79.3% of all confirmed BU cases in this study.Conclusions: Conclusion: BU cases, for the first time, were confirmed in five states of SW Nigeria with two of them (Ogun and Osun States) indicating endemic situation, hence the need for those states to be kept under surveillance as potential BU flash points. On a larger scale, a robust BU awareness program nationwide should be embarked upon by the government and other stakeholders.