Sani Usman Alhassan

Organ transplantation: legal, ethical and islamic perspective in Nigeria.

Organ transplantation dates back to the ancient times and since then it has become one of the important developments in modern medicine; saving the lives, as well as improving the quality of life of many patients. As the demand for organ transplantation far exceeds the organ availability, the transplant program is often saddled with complex legal and ethical issues. This review article highlights the legal and ethical issues that might arise regarding organ transplantation and appraises the existing legal frame work governing organ transplantation in Nigeria. Information on legal, cultural, religious and medical ethical issues regarding organ transplantation in Nigeria was obtained by searching the PubMed and Google Scholar, conference proceedings, seminar paper presentations, law library and other related publications were collated and analyzed. In decision making for organ transplantation, the bioethical principles like autonomy, beneficence and justice must be employed. It was believed by Catholic theologians that to mutilate one living person to benefit another violates the principle of Totality. Among Muslim scholars and researchers, there are those who throw legal support as to its permissibility while the other group sees it as illegal. Organ/tissues transplantation is considered a medical intervention that touches on the fundamental rights of the donor or the recipient. Where there is an unlawful infringement of the right of such persons in any way may be regarded as against Section 34 of the 1999 Nigerian Constitution dealing with right to dignity of the human person. Worldwide, the researchers and government bodies have agreed on informed consent for organ/tissue donation and for recipient should be obtained without coercion before embarking on such medical treatment Worldwide organ transplantation has become the best medical treatment for patients with end stage organ failure. However, there is no law/legislation backing organ/tissues transplantation in Nigeria. The government should take measures to combat transplantation tourism and the problem of national and international trafficking in human tissues and organs, ethics commission and National Transplant registry should be established in order to monitor and regulate the programme in the country.

Outcome and complications of permanent hemodialysis vascular access in Nigerians: A single centre experience

BACKGROUND It is widely accepted that autogenous arteriovenous fistula (AVF) carries less morbidity and mortality compared to all other forms of vascular accesses in maintenance hemodialysis patients. There is paucity of data on vascular access from sub-Saharan Africa. The aim of this study was to assess the outcome and complications of permanent vascular access in our center. MATERIALS AND METHODS The study is a prospective, hospital-based, longitudinal study. All consecutive patients on maintenance hemodialysis in Aminu Kano Teaching Hospital who were referred to the surgical unit of for creation of permanent hemodialysis vascular access were included in the study. The patients clinical and demographic data were documented. Data about vascular access types, outcomes, and complications were obtained over a 1-year period from the time of vascular access creation. RESULTS One hundred and seventy four patients were operated upon between January 2008 and December 2010 with a mean age of 46.4 years (range 18-76 years) and a male to female ratio of 1.5:1. Brescio--Cimino fistula was performed in 110 (63.2%) patients, brachiocephalic (Kauffmann) fistula in 51(29.3%), and synthetic graft in 1 (0.6%) patients respectively. Ten patients (5.7%) had brachio-brachial transposition arteriovenous fistula and 2 patients (1.1%) had transposition graft using harvested long saphenous vein. One-year patency rate was 63.2%. Complications encountered include AVF failure in 47(27.3%), steal syndrome in 2(1.1%), distal venous insufficiency in 2(1.1%), and false aneurysm in 6(3.5%) patients. CONCLUSION The outcome of permanent vascular access is favorable in our patient population with a one-year patency rate of 63.2%. The first choice of vascular access in our maintenance dialysis population should be AVF.

Transurethral prostatectomy in human immunodeficiency virus-infected patients, morbidity and surgical risks in a developing economy

Human immunodeficiency virus (HIV) infection is increasing world-wide and highly active antiretroviral treatment (HAAT) is allowing afflicted individuals to live near normal life span and acquire surgical diseases of the aged as in the unaffected population. This pose occupational hazards to operating surgeons especially in tropical Africa where the seroprevalence is so high that seroconversion in the medical staff contaminated with the virus is estimated to be as much as 15 times (per annum) more than what obtains in developed. A 63-year old man was admitted to our Hospital with urethral catheter in situ and having failed medical therapy, he opted for transurethral prostatectomy (TURP) which was done without any post-operative complication. He was known to be afflicted with human immunodeficiency virus and on treatment for 3 years. He also had a large but reducible inguinoscrotal hernia for 4 years attributed to lower urinary tract obstruction. He had a Lichtenstein repair of right inguinoscrotal hernia which was complicated by small hematoma that was evacuated. The risk of transmission and surgical morbidity during transurethral prostatectomy could be minimized by adequate universal precaution, pre-testing of all consented patients and wise selection of patients that would benefit from such surgical therapy.

Catheterization Related Complications Among Adults Male Patients with Urinary Retention in a Teaching Hospital

Urethral catheterization is a common procedure in urologic practice. It is most commonly employed in relieving urinary retention. Various complications are associated with urethral catheterization and these depend on availability of expertise and strict observation of asepsis during the procedure. This study aimed at establishing the types and prevalence of complications associated with urethral catheterization among patients with urinary retention. It was a prospective study on 110 patients who presented in urinary retention and who were catheterize to relieve the retention. On presentation the patients were catheterize and urine was immediately taken for microscopy, culture and sensitivity. Patients with established UTI were excluded from subsequent investigation of catheter related UTI. Other complications of catheterization were also looked for and recorded. The patients age ranged from 17 to 100 years, with a mean age of 56±19.3 SD years. Up to 74.5% of the patients in this study did not develop any of the complications. The most common complication was introduction of UTI in 17.3%. This was followed by haematuria in 5.5% of the patients. Three patients (2.7%) had their urethra injured and none had post obstructive diuresis. Catheterization related urinary tract infection is common despite observing asepsis in relieving urinary retention but other complications are not common.

Giant Hydronephrosis Containing Eighteen Liters of Fluid in a Child: A Case Report

Giant hydronephrosis is defined as the accumulation of more than 1L of fluid in the collecting system of the kidney. We present a case of giant hydronephrosis containing 18 L of fluid in a 13 -year-old girlresulting from neglected PUJ obstruction. She had a single stage nephrectomy and did very well post -op.