ABSTRACT
Congenital arteriovenous fistula is an extremely rare vascular malformation. Its symptomatology is variable and depends on its size as well as its location. We report the case of a 12-year-old girl with no known medical or surgical history, who was referred for an ultrasound examination at the Abidjan Heart Institute. Doppler ultrasound of the upper limb revealed a high-flow brachio-brachial arteriovenous fistula. The patient was subsequently transferred to the vascular surgery department for management.

ABSTRACT
Introduction: The paper discusses the challenges in providing care for children from underserved rural areas, for complex surgical conditions. It highlights the need to empower selected secondary hospitals to handle paediatric cases that represent a significant burden of surgical admissions, such as Pediatric Colorectal Diseases (PCRD), and risk inappropriate treatment when seen at a peripheral health facility level, as financial or transportation difficulties constrain access to a specialist hub. Materials and Methods: The study examines the capacity acquired by a secondary health facility to provide surgical care for Anorectal Malformations (ARM) and Hirschsprung's Diseases (HSCR) in terms of diagnostic accuracy, appropriate management, reduced complications, and favourable outcomes. The hospital serves a large catchment area with approximately 10 million people, including 45% who are under the age of 15. Results: Among 966 paediatric surgical admissions during the study period, ninety-four were referred for colorectal disease (ARM and HSCR). The document details the types of surgeries performed, complications encountered, and outcomes achieved. Posterior Sagittal Anorectoplasty (PSARP) was performed in 28 out of 42 ARM cases observed (66%) at a mean age of three years, and four were scheduled for treatment in a short time. Forty-six out of 48 HSCR cases could be treated with a favourable outcome by abdominoperineal pull-through or posterior rectal sphincterotomy. Conclusion: Extending specialist surgical coverage for children through selected secondary facilities with upgraded local capacities can significantly improve the management of Pediatric Colorectal Diseases in underserved areas, making appropriate staged treatments and close postoperative follow-up more accessible.

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Background: Fractures of the tibia that involve both the proximal and distal segments presents with specific biomechanical issues. While plating remains the treatment of choice for fractures of the distal tibia, this case illustrates the application of intramedullary (IM) nailing as the definitive treatment for an axially stable comminuted distal tibial fracture associated with a tibial shaft fracture. Case presentation: The patient presented with pain on the right leg after sustaining injury by MTA as a passenger, Preoperative imaging revealed a stable comminuted tibia fracture with an associated oblique tibial shaft fracture and fibular fracture. Conclusion: The case illustrates that IM nailing alone, without supplemental fixation, is appropriate for treating axially stable, multilevel tibial fractures which possess inherent stability. It highlights the need for careful preoperative evaluation of the fracture pattern and challenges the use of blocking screws or fibular fixation in selected cases.

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Introduction: Bladder cancer is the fourth most common cancer in men accounting for 6.6% of all cancer cases in the world. In women, it is the ninth most common cancer accounting for 2.4% of all cancer cases. In our country the prevalence of bladder also seems to be increasing due to increasing number of aging people, increased exposure to carcinogens but unfortunately till today, there is no available data on prevalence of bladder cancer in our country. Aim of the Study: The aim of the study is to assess age-wise distribution of patients with urinary bladder carcinoma. Methods: This cross sectional study on 819 patients of carcinoma of urinary bladder was done in 10 different hospitals in Dhaka city. This study was carried out from January 2007 to December 2009. All specimen of bladder tissue that was sent for histopathological examination were included in the study. All specimen of bladder tissue that was sent for histopathological examination that reveals other diagnosis than cancer were excluded from the study. Results: A total of 1088 patients included in the study, out of which 819(75.3%) patients having carcinoma at 95% Confidence Interval (Cl) (72.7% to 77.8%) and rest 269(24.7%) others (Benign tumour, Tubercular cystitis, Chronic cystitis) at 95% Cl (22.2%-27.3%). According to histopathological report it was observed that 792(96.7%) transitional cell carcinoma (TCC) at 95% CL (95.5% to 97.9%), 10(1.2%) squamous cell carcinoma (SCC) at 95% Cl (0.5% to 2.0%), 13(1.6%) Adenocarcinoma at 95% Cl (0.7 to 2.4%) and 4(0.5%) Mixed type (Embryonal rhabdomyoscarcoma, Scarcomatoid Ca) at 95% Cl (0 to 1.0%). In traditional cell carcinoma (TCC) it was observed that nearly one third (31.7%) of the patients belonged to 61-70 years. In squamous cell carcinoma (SCC), most (40.0%) of the patients belonged to 41-50 years. Adenocarcinoma more frequent in 41-70 years age group and mixed type was found 2(50.0%) in 51-60 years age group and 2(50.0%) in 81-90 years age groups.

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Major burn injuries are an important cause of morbidity and mortality worldwide. Reports of improved outcome in developed countries may not reflect the situation in developing nations despite efforts at improving burn care. We aimed at evaluating yearly trends in burn injury outcome. The study was a retrospective study of patients who presented with burn injuries from 2011 - 2021. Information obtained included biographic data, injury characteristics, trends and determinants of outcome. Data was analyzed using SPSS version 29. A total of 866 patients were recorded with yearly average of 78.72. Incidence and severity of injury increased over the years. Some more current practices were yet to be adopted at the center. Most common complications were sepsis and renal failure. Trends of outcome measures were not consistent. Average maximum TBSA salvaged was 62.32 ±12.13 (41- 81), mean mortality rate was 15.16 ± 10.00 (0 - 36.23), mean LA50 was 55.25 ± 19.05 (37.36 - 95.91) while average mean TBSA in those that died was 68.37 ±10.71 (50 – 88). Age, gender, dressing agents, TBSA, inhalation and depth of injury had variable but significant effects on outcome. Adopting more current practices will improve outcome but requires funds and support.

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Background: Chronic exposure to biofuel smoke from biomass fuels like wood and charcoal poses major respiratory health risks, especially in low- and middle-income countries. Commercial food vendors in Maiduguri, Northeast Nigeria, often use these fuels for cooking, but their respiratory health effects are under-researched. Objective: This study examined the association between exposure to biofuel pollutants (PM2.5, CO, CO2, NO2, VOCs) and respiratory symptoms and lung function among commercial food vendors compared to controls without biomass smoke exposure. Methods: A cross-sectional comparative study enrolled 195 adult food vendors and 195 matched controls. Air pollutants were measured during peak cooking hours using portable sensors at vendor workplaces and control sites. Respiratory symptoms were assessed using the Modified Medical Research Council questionnaire; ventilatory function was measured by spirometry (PEF, FEV1, FVC, FEV1/FVC). Logistic regression and correlation analyses assessed pollutant effects. Results: Vendors were exposed to significantly higher median levels of PM2.5 (162 vs. 14 µg/m³), CO (36 vs. 2 ppm), CO2 (836 vs. 580 ppm), and VOCs (908 vs. 139 ppb) compared to controls (p < 0.001); NO2 levels were similar. PM2.5 exposure was significantly linked to increased odds of dyspnoea (OR=1.018; p=0.002). CO exposure correlated with cough (OR=1.043; p=0.051) and phlegm (OR=1.056; p=0.034). Lung function measures (PEF, FEV1, FVC) correlated positively with PM2.5 but negatively with CO2. Oxygen saturation did not differ between groups. Conclusions: Commercial food vendors in Maiduguri experience high biofuel pollutant exposure associated with increased respiratory symptoms and altered lung function, underscoring the urgent need for interventions to reduce occupational exposure.

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Background: Biomass fuel combustion, a common practice among commercial food vendors in Nigeria, generates harmful air pollutants that may increase respiratory symptoms. This study assesses the prevalence of respiratory symptoms among food vendors exposed to biomass fuels in Maiduguri, Northeast Nigeria, compared to unexposed controls. Methods: A community-based cross-sectional study with a comparative design was conducted among 195 food vendors using biomass fuels and 195 age-, sex-, and height-matched controls in Maiduguri. Respiratory symptoms were assessed using the Modified Medical Research Council (MRC) Questionnaire. Data were collected and symptom prevalence was compared using chi-square tests, with significance set at p < 0.05. Results: Vendors exhibited significantly higher prevalence of dyspnea (54.4% vs. 14.9%, p < 0.001), cough (18.5% vs. 9.7%, p = 0.013), and phlegm (13.8% vs. 6.2%, p = 0.011) compared to controls. Other symptoms, including wheeze (5.1% vs. 3.1%, p = 0.305), nasal congestion (8.7% vs. 6.7%, p = 0.458), runny nose (11.8% vs. 8.2%, p = 0.234), itchy nose (5.1% vs. 4.6%, p = 0.354), and sneezing (7.7% vs. 4.1%, p = 0.192), were more frequent among vendors but not statistically significant. Conclusion: Food vendors exposed to biomass fuels in Maiduguri experience a significantly higher prevalence of respiratory symptoms, particularly dyspnea, cough, and phlegm, compared to controls.