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Immigration Official, UCH Trade Blame Over Surgery

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A Nigerian Immigration officer, Aliu Lawal is at loggerheads with some doctors at the University College Hospital, Ibadan, Oyo State, over the alleged shoddy treatment of his fractured left leg.

But the hospital absolved the doctors who attended to Lawal of any wrongdoing, claiming that the poor outcome was due to the patient’s non-compliance with the treatment protocol.

Sunday PUNCH learnt that Lawal was involved in a car accident in Lokoja, Kogi State, on July 10, 2017 and was first attended to at the Federal Medical Centre, Lokoja, before he was transferred to the UCH two days later.

At the UCH, he was scheduled to be attended to by a consultant surgeon, one Dr Ifesanya, for the correction of “femur and tibia fractures” he sustained during the crash.

The officer said he didn’t meet with the consultant and instead, a team of resident doctors operated on him and allegedly improperly placed an implant on his femur which failed even before he was discharged from the hospital.

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He said the alleged poor treatment worsened his condition and had since caused him harrowing pains.

In a letter to the chairman, Medical Advisory Committee of the UCH, dated September 24, 2020, Lawal, through a rights group, Veteran Organisation for Human Rights, detailed how he was treated at the hospital.

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The letter was titled, “A passionate appeal for immediate attention and redress to the honourable minister of health, the honourable speaker of the Federal House of Representatives, the CMD, UCH, the chairman, Medical Advisory Committee, UCH, the chairman Servicom, UCH, on a case of serious threat to life, inhuman treatment, masochism, clavicle damage and improper placement of an implant on the femur fracture of Mr Lawal Aliu Abolaji, leading to angulations of the left femur and persistent excruciating pain perpetrated by Dr Okunlola and others, of the Orthopedic Unit of the UCH.”

The petition stated that in the absence of Ifesanya, the femur implant was carried out without the consultant’s supervision, noting that Lawal sustained a clavicular fracture in the process.

It read, “This mistake led to angulations and shortening of the leg by 2-3 centimeters. Subsequently, all the doctors he has been meeting kept posting him and giving him flimsy excuses, as a result of this grave and life-threatening mistake, he was bedridden for more than a year. Fortunately, Mr Lawal came across a female doctor in October 2018 who told him the surgery has to be performed again.”

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Lawal was said to have been referred to one Dr Oladiran, who promised to repair the damaged clavicle and booked him for a surgery in April 2019. As a result of an alleged delay on the part of doctors, the surgery was cancelled and postponed till May that year.

Oladiran reportedly insisted that Lawal should write an undertaking that he (Lawal) chose to undergo clavicle operation before another femur surgery.

“On the day of the clavicle surgery, a woman among the officials of the theatre, who felt Lawal has been dehumanised and maltreated asked him about the time the accident occurred and he told her 2017.

“She asked further why the operation wasn’t done before now. He replied that the doctors kept telling him that they didn’t do clavicle surgery in UCH, giving an impression that it could be done elsewhere,” the letter added.

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Two months after the clavicle surgery, Lawal reportedly met Oladiran for the femur correction but the latter allegedly declined, claiming that the femur would become shorter.

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The doctor was said to have referred Lawal to another consultant, one Dr Okunola, who, upon examining the x-rays, reportedly remarked that K-nail implant ought to have been used for the femur and insisted that it would be operated in order to straighten the bent bone.

The petition further read in part, “Dr Okunola insisted on a method that ordinarily should be used for a 4cm shortening. When Mr Lawal noticed it was a double standard decision, he met one doctor to help him plead with Dr Okunola but he refused. He himself pleaded with him before he eventually paid the sum of N200,000 to the account given to him.

“The surgery however made the femur to remain bent as the method used for 4cm shortness was used for Lawal’s 2.5-3 cm shortness. At the physiotherapy unit, UCH, One Mrs. Orogbemi took the measurement to 2.7cm and it was documented. Another measurement was taken at High Rise Orthopedic, was 3cm.

“After the surgery (on November 4, 2019), when Mr Lawal sighted the x-ray, he was shocked because instead of correcting angulations at the fracture site, Dr Okunola fractured another place on the femur bone. Up till now, Mr Lawal is still living in excruciating pain for more than three years now which has become a life-threatening situation.”

The human rights group led by Sikirullahi Abayomi, urged the medical advisory committee to investigate the matter thoroughly and ensure that justice prevailed.

But the UCH, in its response dated October 13, 2020 and signed by one Niyi Ajayi for the Director of Administration and Chief Medical Director, said it could not establish any treatment errors after conducting an extensive enquiry.

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The hospital said in the course of Lawal’s treatment, the primary consultant, Ifesanya, went on a study leave; hence Oladiran, the next consultant in the unit, took over the treatment.

It claimed that Lawal was admitted to the facility with diagnosis of multiple injuries which included c-spine injury, blunt chest injury, mandibular fracture, clavicular fracture and fractures of left femur and right tibia and was co-managed by Orthopaedics and Trauma, Cardiothoracic, Neurosurgical and Oral and Maxillofacial surgical teams.

It further said Lawal was operated upon by an orthopaedics and trauma team on July 17, 2017 by competent senior registrars under the supervision of their respective consultants, describing it as the standard practice “as the procedure is within the competency of the operating surgeons.”

The hospital stated, “The implant failed shortly after surgery because the patient failed to adhere to treatment protocol of not bearing weight on the fracture fixation and this led to angulation of the fracture, improper union and shortening of the limb. The clavicular fracture was not operated on initially as it is managed mostly non-operatively in UCH, Ibadan and this is because evidence based practice revealed that there is no significant difference in functional outcome between clavicular fracture managed with and without surgery.

“Mr Lawal’s symptomatic non-united fracture of clavicle was operated only after a duly signed informed consent by him as there are attendant complication risks of non-union and other surgical and anaesthetic complications. After the fixation of the clavicular fracture on May 24, 2019, Mr Lawal demanded re-operation on the femur as the fracture was not fully united and there was associated deformity and shortening.

“Further operation with conventional treatment with either plate and screws or intramedullary nail will lead to further shortening of the limb and there is also the possibility of non-union of the fracture.”

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The hospital said Lawal was consequently referred to Okunola for an alternative fracture fixation with circular external fixators that would best address the challenges of non-union, deformity and shortening of the limb simultaneously through a surgery.

It claimed that Lawal, being a paramilitary officer opted for the procedure to have his lower limb equalised, adding that the details of the surgery were explained to him.

“This includes the steps involved in the surgery, the estimated cost of surgery, the duration of treatment (between seven and nine months) during which he would have the external fixator on, the fact that the circular external fixator to be used had to be sourced from outside the hospital because it is not available within.

“He has to be highly motivated and cooperative throughout the course of treatment. Following the detailed counselling, Mr Lawal consented to have the surgery done for his benefit and promised to cooperate with the managing team,” the hospital’s response further read.

After the operation, the UCH said Lawal was trained in daily adjustments of the external fixator to gradually correct the deformity, achieve fracture union and leg equalisation and was discharged home “to ambulate on partial weight bearing with crutches to aid treatment.”

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It said, “However, throughout the time he was on an external fixator, he did not comply with the treatment protocol. He did not follow daily adjustments of the external fixator strictly and did not ambulate with crutches regularly. He moved about in a wheelchair most of the time and complained of unbearable pain despite adequate analgesic, persuasion and encouragement.

“He mounted a lot of pressure for the removal of the circular external fixator before the appropriate time despite a lot of persuasion and entreaty. Though the length of the limb was equal to the other side, the fracture and the new bone had not fully consolidated when the external fixator was removed at his request.”

The hospital claimed that due to the premature removal of the external fixator that supported the limb, the new bone responsible for the leg length equalisation collapsed under Lawal’s weight, leading to further deformity of the whole femur and associated shortening.

It added, “Despite the failure of treatment because of poor compliance to treatment protocol, another option of care was discussed with the patient with the use of free intramedullary nails donated by an international organisation for indigent patients to achieve deformity correction and improve the leg length inequality.

“In view of the findings made during the investigation, the management therefore believes that appropriate surgical procedures and adequate care was given to Mr Lawal since he became a patient of the hospital in July 2017 and there was no procedure carried out on him that resulted in a threat to his life.”

However, Lawal, who also wrote to the Medical and Dental Practitioners, faulted the UCH’s findings, saying that he was not invited during the investigation.

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Responding to his complaint, the Secretary of the Investigative Panel of the Medical and Dental Practitioners, Dr E.D Abdu, furnished Lawal with responses of Okunola and Oladiran, dated July 14, 2021 and promised that “further communication would be conveyed to you in due course.”

Oladiran, in a letter he deposed to and addressed to the panel, said he couldn’t reply to Lawal’s complaint because he was unable to access the patient’s record and documents in the custody of the hospital due to the ongoing strike by the Nigerian Union of Allied Health Professionals of the hospital at the time.

He added, “The medical records and other related matters of the complainant are germane to my defence and as soon as the association calls off its industrial action, I will prepare my reply to the complainant’s petition and forward the same to your panel accordingly.”

Okunola also gave the same reason and promised to respond to the request of the investigating panel as soon as the NUAHP called off its strike.

When our correspondent contacted Abdu on Thursday on the phone to know if the doctors had eventually sent in their responses to the panel, he said, “We don’t talk to the press on investigations. So the person (complainant) should call and we will tell them whatever they want to know.”

PUNCH.

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Don Confirms ‘Zobo’ As Antihypertensive Therapy

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The Deputy Vice Chancellor, University of Nigeria Enugu Campus, UNEC, Prof. Daniel Nwachukwu, after research findings and clinical trials in both animals and human, has confirmed that Hibiscus Sabdariffa, popularly called ‘zobo’ drinks, has all the curative potentials as an antihypertensive therapy.

Nwachukwu, who is a Professor of Cardiovascular Physiology in the university, stated that the antihypertensive effectiveness of the Hibiscus Sabdariffa (zobo) was comparable to those of known antihypertensive drugs that are popular in the retail pharmacies, adding that zobo’s availability, cheapness and absence of side effects make it attractive as an alternative therapeutic agent in mind to moderate hypertensive subjects.

He however cautioned that care should be applied to avoid abuse in the consumption of Hibiscus Sabdariffa (zobo), adding that the therapy could interfere with some anti-malaria drugs while its high dose was also reported to have toxic effects on the liver and kidney.

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Nwachukwu’s discoveries were contained his 201st Inaugural Lecture of the University of Nigeria with the topic “The Marriage Between the Cardiovascular System and Hibiscus Sabariffa: Let no One Put Asunder,” delivered at the moot court hall, Law faculty of the University of Nigeria, Enugu campus.

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The DVC warned that Hibiscus Sabariffa consumption is not recommended for persons with low blood pressure because of its well established hypotensive action, advising that during combined therapy with antihypertensive drugs, the blood pressure, BP, must be carefully monitored.

He recommended that industrialists and investors should support large scale production of Hibiscus Sabariffa beverage and its distribution to rural communities in Nigeria, particularly since the raw materials (Hibiscus Sabariffa calyx and water) are cheap and readily available.

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According to Nwachukwu, “This lecture is intended to draw the public attention to our research efforts and unveiling the antihypertensive ability of Hibiscus Sabariffa which is called zobo in our common parlance. What we used for our studies was the same concentration as the locally produced zobo, and we found out that it exerted significant antihypertensive ability, in some cases even higher than the antihypertensive drugs and also did combination therapy with other antihypertensive drugs.

“What is significant is that this zobo is within us, it’s very cheap and it does not have any side effects compared to other antihypertensive agents. The raw material is just to buy zobo, prepare it under hygienic conditions, boil water and put it, sieve it and drink. It may have a sour taste but we do not encourage people to add things like pineapple or sugar in order to make it sweet, because once you do that, you are diluting or reducing its antihypertensive effectiveness.

“We have demonstrated it, both in animal studies and in humans. We are the first to do clinical trials, using mild to moderate antihypertensive Nigerians and we found it very useful. Some of the results show that one can actually use it and we equally saw that you can use it to prevent even diabetes from occurring because it reduces the rise in glucose level.”

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Vice Chancellor of the University, Professor Charles Igwe while summarizing the lecture said that the lecture was in three dimensions; one on health grounds, another in academics and the third an economic value.

“Its economic in the sense that we can also begin to use what God has given us to make money. Maybe because God gave us everything in abundance in this country, we don’t recognize the simplest things God gave us in our environment. Therefore, what we are saying is that we should begin to, at all these pure water productions and incorporate zobo production so as to make money out of it.

“The university has made its contribution through our laboratories and it’s now left for the business community and the industries to come and buy into it and start widening it and make it very economic,” Igwe suggested.
Vanguard

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Glaucoma: What You Need To Know

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By Silver Yeibake 

Hi, did you know that Tuesday 12th March, 2024 is world Glaucoma day?Kindly avail yourself of this opportunity to learn about this important health issue as presented below:

Glaucoma is a dangerous eye disorder that damages the optic nerve, causing visual impairment or permanent blindness if not treated.
The optic nerve transmits visual information from the eye to the brain. Damage to this nerve might cause gradual visual loss that is not immediately obvious.

Worldwide, this disease affects 67 million people and contributes 6.7 million of blindness in this population. Glaucoma is the leading cause of blindness in the world.
The total number of cases is expected to increase to 111 million by 2040. Males are slightly more affected than females.

One of the basic causes of glaucoma is an increase in intraocular pressure (pressure within the eyeball), which can eventually damage the optic nerve (the nerve that makes seeing possible). This increase in pressure could be caused by an accumulation of aqueous humor, the fluid that nourishes the eye.

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FROM THE AUTHOR: Food Poisoning: What You Need To Know

There are several forms of glaucoma, including open-angle glaucoma, angle-closure glaucoma, normal-tension glaucoma, and secondary glaucoma, each with unique characteristics and treatment choices.

Some of the risk factors for glaucoma include sustained elevation of intraocular pressure, family history of glaucoma, race (African, Asian), short-sightedness, long-sightedness, age over 50, previous eye injury or surgery, hypertension, diabetes mellitus, migraines, and prolonged steroid therapy.

Glaucoma symptoms may not appear until the problem has advanced sufficiently, therefore regular eye checks are essential for early detection. Blurred vision, eye pain, nausea, and light halos are some of the most frequent glaucoma symptoms. However, these symptoms might be mild or readily misinterpreted as other eye problems, emphasizing the significance of regular eye examinations.

Glaucoma treatment tries to reduce intraocular pressure and protect the optic nerve from further damage. This can be accomplished using a variety of approaches, including prescription eye drops, oral medicines, laser therapy, and surgical procedures. Treatment options are determined on the kind and severity of glaucoma, as well as personal characteristics such as overall health and medical history.

To summarize, glaucoma is a serious eye disorder that requires timely diagnosis and treatment to prevent irreversible vision loss. Regular eye examinations, early detection, and commitment to treatment plans are critical for protecting vision and eye health in glaucoma patients.
Thank you.

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Dr. Yeibake, Weriwoyingipre Silver, a
Senior Registrar, Faculty Of Pediatrics, West Africa College of Physician (WACP), writes from Yenagoa, Bayelsa State.

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Cough: What You Need To Know

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By Silver Yeibake

The cough reflex is a protective mechanism that helps to clear the airways of mucus, irritants, or foreign particles. When our airway is irritated, it sends a signal to the brain, which then triggers the muscles in our chest and abdomen to quickly expel air, clearing or removing the irritant. This reflex acts as a crucial defense mechanism for the respiratory system. “Cough is not a disease process.”

Kindly note the beautifully coordinated steps involved in the action we know as cough:

1. Irritatant detection: The first step in the cough reflex is the detection of an irritant in the airways, such as dust, smoke, or mucus by special protein complexes called irritants receptors (for convenience) which convert the sensation into an electrical impulse.

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2. Signal Transmission: The receptors in the airway send the signals along nerves to the brain, specifically to a part called *”the cough center”* located in the medulla oblongata, a part of the brainstem.

3. Signal Processing: The brain processes these signals and responds by sending nerve impulses back to the muscles involved in the coughing process.

4. Muscle Contraction: The diaphragm, abdominal muscles, and muscles in the chest wall contract, increasing the pressure in the chest and forcing air out of the lungs at a high speed, making the sound that is characteristic of cough.

5. Expelling Irritant: The forceful release of air clears the airway, expelling/removing the irritant and helping to protect the respiratory system.

The above steps are designed to occur repeatedly until the irritant is removed from the airways or respiratory system or drugs are given to suppress this important protective function.

Although taking cough medication for relief as first aid is usual, it is best to identify and address the cause as soon as possible. Seek medical attention if 2 to 3 days of therapy do not give improvement or the symptom worsened rapidly.

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Dr. Yeibake, Weriwoyingipre Silver, a
Senior Registrar, Faculty Of Pediatrics, West Africa College of Physician (WACP), writes from Yenagoa, Bayelsa State.

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