Background: The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was developed to standardize the reporting of thyroid nodule fine-needle aspiration cytology (FNAC) results. The adoption of TBSRTC is based on the implied risk of malignancy per category, but this has shown wide variation in different regions worldwide. Aim: The aim of this study is to determine the diagnostic accuracy of the Bethesda classification of thyroid nodules in a Kenyan hospital. Methods: A retrospective longitudinal study examined FNAC and histopathology data of thyroid gland nodules at a Kenyan hospital from 2010 to 2019; specimens from 347 patients were found. An analysis was performed to determine the diagnostic accuracy of the Bethesda classification in detecting malignancy among these patients. Results: The malignancy rate was 16.1%. The risk of malignancy as per the Bethesda category was as follows: non-diagnostic— 19.6%, benign—6%, atypia of undetermined significance—20%, follicular neoplasm—16.7%, suspicious for malignancy—80%, and malignant—85.7%. The diagnostic properties of FNAC defining “malignant” and “suspicious for malignancy” categories as malignant were as follows: sensitivity—64.7%, specificity—97.6%, and accuracy—92.7%. Conclusion: The Bethesda classification had high diagnostic accuracy, with the risk of malignancy consistent with the Bethesda findings. Classifying malignancy as “malignant” and “suspicious for malignancy” yielded the most favorable diagnostic properties for FNAC.

Abdominal tuberculosis (TB), an extrapulmonary manifestation of TB, can present with nonspecific symptoms that may resemble an acute surgical abdomen or abdominal malignancy. Peritoneal tuberculosis/TB peritonitis, typically manifests with abdominal pain, abdominal distension (possibly due to ascites), weight loss, and night sweats. We present two cases of peritoneal TB where patients exhibited abdominal distension and weight loss with features suggestive of intestinal obstruction or an abdominal malignancy. They were initially treated with standard anti-TB medication (RHZE regimen), but showed no improvement. However, after undergoing laparotomy and lavage, resulting in reduced focus of infection, they responded well to the 6-month course of anti-TB medication. The current management approach for abdominal TB recommends a 6-month regimen of anti-TB medication. Despite the lack of initial response to anti-TB medication, the substantial improvement observed when initiating anti-TB treatment after peritoneal lavage indicates its potential benefit in such patients. Further research is needed to explore this question.

Background: Erectile dysfunction (ED) is an adverse effect of chronic kidney disease (CKD) treatment that can reduce patients’ quality of life. Consequently, the purpose of this study is to assess the incidence and severity of ED in CKD patients who have undergone continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis. Methods: We performed a systematic search on several electronic reference databases (PubMed, ScienceDirect, Web of Science, and Cochrane). Inclusion criteria are articles published in English, full-text availability, and articles published between 2001 and 2023. The reviewed studies were observational studies. The studies analyzed either CAPD or hemodialysis. Results: A total of 15 studies were included. ED in patients with CKD who had undergone CAPD and hemodialysis varied, ranging from 51.84% to 80.5%and 56% to 89%, respectively. A pooled estimate showed that CKD patients who underwent hemodialysis had higher odds of developing ED (odds ratio [OR]=12.56; 95% confidence interval [CI]=6.37–24.77; p<0.001) compared with those who underwent CAPD (OR=8.02; 95%CI=1.64–39.15; p=0.01). Regarding the laboratory outcomes, no significant differences were found in creatinine serum (MD= −1.08; 95%CI= −3.21 to 1.06; p=0.32) and hemoglobin levels (MD= −0.38; 95%CI= −1.05 to 0.30; p=0.27) between CKD patients who underwent dialysis, either with or without ED. Conclusion: ED is prevalent among patients undergoing hemodialysis. In addition, hemodialyzed patients exhibited more severe levels of ED compared with CAPD patients. Therefore, we suggest CAPD for CKD patients with ED.

Introduction: The research output in surgical branches such as orthopedics and sports medicine (OSM) is meager from Africa, considering the population and the high burden of health-related problems. We conducted this study to analyze the trend of publications in OSM from African countries and compared it with other surgical specialities. Methods: We used the SCOPUS data from the Scimago Journal & Country Rank website, as it allows us to draw substantial journal metrics for research. Results: During the past three decades (between 1996 and 2022), Africa’s global contribution to all surgical specialities has increased. In OSM, this was only 0.65% in 1996 and had risen to 1.79% in 2022. The total publications in OSM were 8297 from 49 countries during this period. The number of publications has risen from 61 (in 1996) to 931 (in 2022), with the maximum surge seen during the past decade. South Africa, Egypt, and Tunisia are the leading African nations in OSM publications and have contributed 77% of the total publications from Africa in 2022. There were only three orthopedic and four other surgical specialities indexed journals listed in the SCImago, arising from Africa. Conclusions: There was an increased research output from Africa in OSM during 1996–2022, especially in the past decade. However, only three nations have contributed more than three-fourth of these publications. There is a scarcity of indexed journals in the surgical disciplines arising from Africa.

Bilateral spontaneous lumbar colocutaneous fistulae are rare. They are associated with high costs of care, morbidity, and mortality. We present the case of a 50- year-old male patient who presented with a 10-year history of two low-output spontaneous colocutaneous fistulae from both the left and right lower lumbar regions with no identifiable risk factors. He was managed operatively with segmental left colon resection and a temporary loop ileostomy with uneventful recovery after reversal of the ileostomy 2 months later. Whether the etiology of the fistulae is clinically apparent or not, the management should follow commonly known principles. This report highlights a case of bilateral lumbar region spontaneous colocutaneous fistulae of unknown cause that was managed operatively with satisfactory short-term outcomes.

Background: Digitization of healthcare data has led to widespread healthcare transformation. This has been enhanced by the availability of new technologies at lower costs. Video recording can improve the quality of care, provider skills, education, and patient follow-up. However, limitations such as the risk of litigation, patient privacy, and poor legal framework have curtailed adoption. Rural hospitals have older analog equipment due to limited financial resources. Objectives: This study aims to present an alternative low-cost option. Methods: We present an economical method of recording and digitizing endoscopic and laparoscopic procedures performed on analog video processing towers. We showcase a video of the step-by-step procedure that involves connecting a digital video home system (VHS) video recorder to an analog Olympus endoscopy machine (Model CV-100) and transferring media via a portable storage device to an electronic medical record database. Conclusion: Using simple home video recording devices provides a low-cost solution to creating digital records from analog video endoscopic machines. The technique, however, creates additional steps to the endoscopy process and the need for capacity building of the endoscopist. Patient consent forms should cover video creation. Medical centers should have a robust information management system to securely store and retrieve digitized video records.

Intermittent calf pain is also called claudication. It is common in patients with spinal canal stenosis or those with peripheral vascular occlusion disorders. It is rarely found in local muscle pathology. We herein report a case of a 50-year-old man who presented with left-sided calf pain on mild exertion. On evaluation, the systemic review was normal, with no spondylosis or vascular pathology, but with local fatty degeneration in the gastrocnemius, which was causing the calf pain. He was given analgesics and underwent physiotherapy and counseling, and his condition improved over 6 months.

No abstract.

The superior mesenteric vein (SMV) is one of the two tributaries to the portal vein, which is the main pre- hepatic drainage channel of the splanchnic circulation. Venous thrombosis in the SMV is one of the rare causes of splanchnic ischemic syndrome. Clinical presentation is often vague abdominal symptoms. It seldom presents with hematemesis, which may further confound diagnosis, thereby increasing the risk of poor outcomes. This case highlights an otherwise healthy 31-year-old woman, who presenting at a tertiary hospital in Nairobi with a 2-day history of epigastric pain and copious hematemesis. She had been treated for Helicobacter pylori gastritis 2 months prior. Common differentials were considered. However, with normal esophagogastroduodenoscopy findings and dark- colored fluid sequestered in the upper gastrointestinal tract, mesenteric venous congestion with associated small bowel ischemia was suspected. Three-phase abdominal computed tomography angiogram confirmed proximal superior mesenteric venous thrombosis extending into the portal vein confluence. Associated small bowel necrosis was suspected, and surgery involving resection and primary ileo-jejunal anastomosis was performed. Post-operative 2-week parenteral nutrition and anticoagulation were administered. The patient was discharged after 3 weeks of hospitalization and remains in excellent condition.

Peripheral venous cannulation is a common invasive procedure. Fracture of an intravenous cannula is rare and an under-reported complication of peripheral venous cannulation. Embolization of the intravenous fragment into the central venous system is potentially fatal. Urgent surgical retrieval, which is performed through a transverse or longitudinal incision, is the treatment of choice. We herein present the use of Z-plasty incision for the retrieval of a retained fractured peripheral intravenous cannula in a 61-year-old Nigerian man on hemodialysis for chronic kidney disease. The major benefits of this innovation are facilitation of access for exploration and prevention of joint contracture.