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See the tallest building in Anambra state and the wealthy owner.
The tallest building in Anambra state is owned by Doctor Godwin Maduka AKA the lion of Africa. He is from Umuchukwu in Orumba south local government area of Anambra state and was born in the year 1959. He has five children with his wife, Stella Maduka.
He is a doctor and owner of Las Vegas Pain Institute and Medical Centre which is located in the United states of America. The tallest building is located in his home town in Anambra state, it is a 15 story building which has modern day facilities. It is considered to be one of the biggest medical research facilities in the whole of Africa. His building helps in providing materials for researchers and helps students in their clinical training. The building is indeed marvelous and is inspiring many indigenous people.
This article is not meant to make you have anal sex or to deter you from it, rather it's purpose is to feed you a little more facts about it.
From the author's note on this article, a first hand account of the realities of anal sex.
Anal sex is always painful the first few times; as the passive partner, you are inevitably tense, nervous, and anxious. Yet, in the gay male community, this becomes all a part of the initiation ceremony; a rite into manhood usually performed by an older and more experienced male.
Blood typically accompanies this practice; heightening the pseudo-occultist experience of blood-brotherhood; also, hence the extremely high rates of continuing HIV infections among gay males. As one physician explained: “Physiologically, the anus is not designed for penetration by any hard object. As a protective reflex action, the anal sphincter tightens ordinarily if stimulated. Any attempt at penile insertion can be distressing, even if done slowly and gradually.
The lining [mucus membrane] of the rectum is very thin, tears easily, does not heal fast and therefore is vulnerable to infections. Also, the tears can enlarge to a fissure or a crack. These are painful and slow to heal. There is also a possibility that a fistula could open up, allowing feces to re-route into the abdominal cavity. This can cause serious surgical complications.
One may lose control over the anal sphincter causing continuous involuntary leakage of fecal matter. There is also the increased risk of hemorrhoids, which are quite uncomfortable. Rectal prolapse—wherein the walls of the rectum protrude through the anus and hence become visible outside the body—is another surgical emergency that is seen resulting out of anal intercourse.”
The very real incidence of anal trauma in gay men recently compelled several public and professional medical organizations, including the New York City Department of Health and Mental Hygiene, the Department of HIV Medicine in London (UK) and The American Society of Colon Rectal Surgeons, to call for further studies and to issue directives warning members and other healthcare researchers and professionals: in New York City, the rampant rise of unprotected anal sex among the cities’ gay male population; the incidence of patients suffering injury from an aggressive form of anal intercourse combined with drug use at one UK hospital; and the curious rise in Proctitis among American gay men.
In the pre-HIV era, the various gastrointestinal and rectal maladies in male homosexuals seen by physicians and proctologists were collectively referred to as “gay bowel syndrome.” I experienced this first hand, as the constant ritual of anal cleansing, douching, enemas, and penetration, caused the already naturally dry and thin-skinned rectum to become perpetually red, irritated, and swollen.
Diarrhea was a relentless affliction; some rather active gay men who otherwise were beautifully muscular and apparently healthy-looking took to wearing diapers - especially during intense work-outs or weight-lifting scissions at the gym, as the increased pressure often caused abnormal leakage. Visits to a San Francisco proctologist were frequent, and his waiting room, crowded with other gay men, sometimes turned into a place to meet and talk as there was always someone I knew - also there waiting to see the doctor.
Though, not everyone with this secret problem was single and adventurous; one such friend - a sincere guy who had been in a monogamous relationship for a couple of years, was continuously left with painful anal fissures. After I left the lifestyle, and went back home, my smaller town doctor still knew of my past - as soon as he saw the ravages of what had been my backside. By then, my hemorrhoids were protruding severely - and thus began a few years of one painful surgery after another. During that time, I was constantly walking about with suppositories, frequently with embarrassing stains soaking through my pants, my underwear had to be continually bleached to remove blood stains, and I stunk from fecal matter seeping out. It was a little foreshadowing of purgatory – and, I kept saying to myself: “It hadn’t been worth it.”
In the 1990s, there was pressure from the gay political power brokers for medical journals and doctors to abandon the term gay bowel syndrome altogether; a rather insignificant occurrence, yet, it does reveal an underling ambition among those who wanted to see a more normalized public perception of gay male sex; and, as one attorney argued, in front of the Supreme Court, there was once “an incorrect understanding that gay couples were fundamentally different than straight couples.” Only, they are “fundamentally different;” as heterosexual sex in marriage does not result in a higher rate of injury and disease.
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- Stones within the urinary tract
- Sites (CUUP)
i. UreteroVesicular junction (Where Ureter meets the bladder)
- Most common site
- Cup like extensions within the kidneys
- Cavity where urine collects before it flows through the pelvis, Ureter and into the bladder
iii. UreteroPelvic junction (UPJ)
- When the Pelvis meets the Ureter
- The Pelvis is wider than the ureter and drains the Kidneys into the ureter
iv. Intersection of Ureter and Iliac vessels (Near Pelvic brim)
*Pyridoxine deficiency may lead to hyperoxalaturia
Risk Factors of Nephrolithiasis (DULL HIM)
- Low fluid intake (Most common)
- Fam History
- Illnesses causing stones
- Loop diuretics and other medications
- Male gender (3x Female)
- UTIs (Urease-producing bacteria)
- Dietary (Low ca2+ and High Oxalate intake)
Mneimonic: DULL HIM
Illnesses causing kidney Stones
- Causes Uric acid stones
- Due to hyperuriceamia
ii. Crohn's disease
- Ileal dysfnx = Oxalate hyperabsorption
- Diarrhea also promotes the formation of Calcium-fatty acids salts = less ca2+ to bind oxalate in the intestinal lumen
- hypocitraturia and hypomagnesuria (they form soluble complex with calcium in the urine, increaes act of macromolecules eg Tamm-Horsfall protein, that inhibit ca oxalate aggregatn. citrate also helps bone formation)
iv. Type 1 RTA (Distal) - Renal Tubular Acidosis
Medications causing Kidney stones
i. Loop diuretics
Types of Kidney stones (SUCK)
1. Kalcium stones (Calcium)
2. Uric Acids
3. Struvite stones (AMP)
Calcium Kidney stones
- most common (85%)
- Calcium Oxalate > Calcium Phosphate
- Bipyramidal (Envelope shaped) or Biconcave ovals
- Radiodense (Seen on Radiograph)
- Secondary to
- Treat with
i. Thiazide diuretics
iii. Low-Sodium diet
Causes of Hypercalciuria
- Inc Intestinal absorption of Calcium
- Dec Renal calcium absorption
- Inc Renal excretion of calcium
- Inc Bone resorption
- Primary Hyperparathyroidism
- Vitamin D excess
Causes of HyperOxaluria (Mostly Malabsorption)
- Severe Steatorrhea
- Small bowel disease
- Pyridoxine def (Vit B6 def)
Uric Acid Kidney stones
- Second most common
- Caused by persistently Acidic urine (<5.5)
- They form Flat square plates crystals
- These crystals escape x-rays detection
- Associated with
iii. Chemotherapy (Leukemia/Lymphomas)
i. Flat square plates
ii. Radiolucent images (CT scan, Ultra Sound, IntraVenous Pyelogram)
i. Alkalinization of urine
- URIC Acid stones
U = US can dx
R = Romboid (Flat square plates)/Rosettes shape
I = IVP can dx
C = CT scan can dx
- Acid = Acidic urine promotes URIC acid stones
Struvite Kidney stones (Ammonium Magnesium Phosphate stones)
- Also called Staghorn stones
- Radiodense crystals are formed (Rectangular Prisms)
- Common in pts with recurrent UTIs (due to urease +ve bacteria)
- Precipitates in Alkaline urine (Urea splitting bacteria convert urea to ammonia - Alkaline)
- Ammonia combines with Magnesium or Phosphate = Struvite stones
- may involve entire renal collecting system
Urea Splitting bacteria causing UTI (SPEK)
A SPEK in the UT = Staghorn/Struvite stone
- A SPEK in the UT is StruvitAL
- least common (1%)
- Genetic predisposition = Cystinuria (Autosomal Recessive)
- Hexagon-shaped crystals (Sixtine - Six sizes)
- Can also staghorn
- Sodium Cyanide Nitroprusside test +VE
- Urine is acidic
- poorly visualized
- Cystine is poorly soluble
- PCT Cystine reabsorbing transporter losses fnx
- PCT defect causes poor reabsorption of COLA
- Treat with Low sodium, Chelating agents, Alkalinization of urine
Course of Kidney stones (StONE)
- Patient may pass out stone < half of a 1cm
- Stone > 1cm gets stuck
- Recurrence is common (within 10 yrs)
Classic Presentation of Nephrolithiasis
- Sudden onset of Colicky flank pain radiating to groin
- Urinalysis = Hematuria
- Renal colic (due ureteral obstruction and spasm (Sudden, becomes severe, cant sit still, occus in waves or paroxysms, begins in flank and radiates anteriorly)
- Nausea/Vomiting (Due to severe pain)
- Hematuria (>90% of cases)
Laboratory diagnosis of Nephrolithiasis
- If kidney is associated pain + Hematuria + Pyuria = Stone with Concomitant infection
- Microscopic or Gross hematuria
- Assoc UTI (Pyuria/Bacteriuria - SPEK)
- Examine Sediment for Crystals
* Envelope/ Dumbbell/ Wedge shape = Calcium
* Romboid/Rosettes shape = Uric acid
* Cysine - Hexagonal shape = Cystine
* Coffin lid shape = Struvite
* Decreased PH (Acidic Urine) = Cystine or Uric acid stone
* Increased pH (Basic Urine) = Calcium phospahte or Struvite
- If suspect infectn
- Renal fnx (Cr)
- Ca, Urate, Oxalate, Citrate levels
- Renal fnx (BUN and Cr)
- Ca, Urate, Oxalate, Citrate levels
Associated pain + Hematuria + Pyuria = Stone with Concomitant infection
Plain Radiograph (KUB,ie of the Kidney, Ureter and Bladder)
- initial imaging
- Acidic Urine - Cystine and Uric stones not seen on plain imaging
Spiral CT without contrast
- Gold standard for all stones
IntraVenous Pyelogram (IVP)
- defines degree and extent of obstruction
- helps in deciding need for procedural therapy
- Not needed for dx of stones
Renal US (UltraSound)
- detects hydronephrosis or hydroureter
- false -ve in early
- low visual yield
- choice for pts who can’t receive radiation (Pregnancy)
Stone (Attempt to recover stone passed)
- Helpful in achieving
i. Analysis of the stone and determination of the cause
ii. Choice of treatment
iv. Reporting history
Treatment of Nephrolithiasis
2. Specific (Pain and Obstruction)
- Tries to help the patient pass the stone with less pain, also treats underlying.
- IV Morphine, Parenteral NSAIDS (Ketorolac)
ii. Vigorous fluid hydration
iii. Antibiotics if UTI
iv. Consider Indications for admission
Indications for Hospitalization.
1. Pain refractory to Oral medications
2. Anuria (Most likey in a patient with a Single kidney)
3. Colic + UTI
4. Large stONE (>1cm)
- Based on Pain Severity
1. Mild-Moderate severity
- High Fluid intake
- Oral analgesia
- wait for stone to pass (Urine strainer)
2. Severe pain
- IV fluids
- KUB/IVP to find site
- If stone doesnt pass after 3 days = Urologist consult
Severe pain measure
- IV fluids + Narcotics
- KUB and IVP
- Urology consult if > 3days
If Obstruction + Persistent pain (refractory to Narcotics)
- Surgery (Breaks the calculus for spontaneous passage)
- Extracorporeal shock wave lithotripsy (Most common, > 5mm, < 2cm stones) - ESWL
- Percutaneous nephrolithotomy (If Lithotripsy fails, best for >2cm stones) - PCNL
Shock Wave Lithotripsy (SWL) is the most common treatment for kidney stones in the U.S. Shock wavesfrom outside the body are targeted at a kidney stone causing the stone to fragment. The stones are broken into tiny pieces.
Percutaneous nephrolithotomy is a minimally-invasive procedure to remove stones from the kidney by a small puncture wound through the skin. It is most suitable to remove stones of more than 2 cm in size and which are present near the pelvic region. It is usually done under general anesthesia or spinal anesthesia.
Prevention of Kidney stones
i. Dietary measures
- High fluid inake
- Limit animal protein (esp in hyperuricosuria)
- Limit calcium intake (esp in calcium stone
ii. Pharm measures to prevent Stones
* Thiazide diuretics
- Reduce urinary calcium (esp in Hypercalciuria)
- Allopurinol (Prevents recurrent uric acid stones)
One would ask or any Nabco Trainee would ask about his fate upon completing the three years Contract training. It is for this reason that Nabco Trainees officially petitioned the office of the president through their associations.ï»¿
Even though Nabco Trainees never heard what they wanted in the NPP manifesto but many personalities have assured Nabco Trainees to be rest assured that after their three years contract, they would be transitioned to permanency in their respective organisation.
The communication Team lead of Nabtag has assured Nabco trainees of permanency in a statement released on the gram. Read the statement below;
"Following the inauguration of the NPP manifesto (dubbed: Leadership of Service) for the next term in office, held on the 22nd day of August 2020, in the Central Region, the executives of NABTAG have come across several reactions from section of NABCO beneficiaries expressing their disappointment for not hearing H.E the president, Nana Addo Dankwa, and his able Vice, Dr. Mahamudu Bawumia, address the prospect of the soon-to-end three-year NABCO contract in their introductory speech.
NABTAG wishes to urge NABCO beneficiaries not to be discouraged, because the actual policies and programs spelt out in the manifesto document were not holistically touched on. The speech delivered by the president and his vice featured few excerpts from the detailed projects outlined in the manifesto.
NABCO is one of the special initiatives established by the Akufo Addo-led NPP administration under job creation of direct supervision by the office of the president. The absence of NABCO in the their introductory address does not automatically map out to non-existent considerations for permanent employment after the expiration of the current three-year work and learn scheme.
The NABCO initiative was not envisaged in the 2016 manifesto document of the NPP, but, today, we have 100,000 graduate youth securing their future through the scheme. The manifesto specifies, in general, broader policy objectives to direct the administration of government, out of which the actual implementation plan emerges along the way.
The prospect of NABCO beneficiaries regarding permanent employment may have not been "facially" mentioned, but that does not abrogate the immediate direct connection to the bigger policy for job creation which was stated in the manifesto. For emphasis, page 180 of the manifesto, details the reinforcements of all government programs to create Jobs for the youth.
Note: ".......we believe we need to accelerate the participation of young Ghanaians in the economy through entrepreneurship and industry. We intend to do this by reinforcing all the existing programmes we have implemented to create jobs and support young entrepreneurs, while mainstreaming their participation in new initiatives."
In addition, NABTAG'S letter of petition on behalf of trainees has also been recieved by the presidency through the Ashanti Regional Minister. This will enforce, amongst other avenues, the leadership consideration for permanent employment.
Furthermore, the engagement term of NABCO has not yet elapsed, thus, let us focus on executing our respective duties in our places of work as Nation Builders in anticipation of a favorable prospect from the leadership of the NPP government.
Do not be discouraged; the Akufo Addo-led NPP administration will not let its guard down on securing the future of the youth through job creation.
Caution: 1. Desist from taking clues on permanent employment from bloggers. The main source of authentic information must be the National Secretariat of NABCO, not blogging websites
2. Since we are at the climax period of campaign for all political parties ahead of the general elections in December, delusions are all over, especially, from the opposition. We have a lot of people parading themselves as NABCO trainees on the various platforms engaging the genuine ones in belittling the NABCO scheme. Let us be mindful of such individuals blinded by partisan politics to face issues with genuine conscience. Guess what, it wouldn't be ideal to pay attention to such persons whose presidential candidate finds OKADA business better than NABCO.
National Communication Team Lead (NABTAG)
Cc: Dennis Katakyie,
National President (NABTAG)".
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Surgery rotations at the EFTSH, Banjul, The Gambia was really interesting and impactful. Everyone was friendly and patient, a prerequisite for a successful rotation.
A Brief Opinion based on my experience.
The rotations were standard when you want to compare to similar rotations in countries like Nigeria, The Caribbean’s, etcetera (I was able to do some comparison with some friends in these countries).
The Consultants are really kind and understanding, they would try to teach you as much as you need to know.
It is very important that you study before you start your surgery rotations because your superiors (Consultants, Registrars, Medical officers and House officers) would expect that you already know a lot from Basic sciences and previous rotations.
They are going to ask you a lot of questions, don’t run away. Be bold, give answers to questions you know, attempt the ones who have an idea of and politely excuse yourself for those you have no knowledge.
Some of the consultants took note of their students, they noticed how much questions you answer during the rounds, they also notice your punctuality and probably many other salient characters I can’t point at now. That way they have a mental picture before the examination. The point is, you may earn your marks even before the examination day, so study before your rounds at least.
Clerking of patients, cannot be over emphasized. Practice clerking as often as possible, say at least one patient per day. You can clerk/follow up your patients for better understanding of the cases, this would boost your confidence for the long case examination.
Time management is really important in clerking, if you know the local languages (Wollof, Mandika, Fula etcetera) you are in luck.
Surgery rotation's most common/High yield topics.
I have compiled a list of the most popular/high yield topics that was encountered during our rotations, most would be tested during ward rounds, out patients and surgical procedures and others would be tested during the examination.
The list below may not be complete, but if you are able to cover most, I will bet on you for the student surgery examination whether it be in The Gambia, West Africa or The Caribbean’s (These I have knowledge of).
I will prepare notes on most of these topics and place the links here. Guide yourself with these topics and always check back to see if I have updated the links to my notes here. These notes would be of great help to you, especially in forming the base for your studies.
This list is in no particular order. You may read/order according to most common cases during your rotations (Ward rounds, surgeries and outpatients) as most questions asked during ward rounds are based on the cases on ground.
1. Pre-operative (Before surgery/operation) and Post-operative (after surgery/operation) management
2. General Physical Exam
4. Wound classification
5. Process of wound healing
6. Factors affecting wound healing
9. Classification of Diabetic foot
11. Description of Ulcers
12. Types of Amputations
13. Indications for Amputation
14. Complications of Amputation
16. Anatomy of the foot
17. Deep Venous Thrombosis (DVT)
18. Pulmonary Embolism and Virchows triad
19. Intestinal Obstruction
20. Complications of Intestinal Obstruction and their Treatment
22. Classification of pneumothorax
23. Curvesoirs sign
25. GI bleeding
26. Hernia (Really high yield)
27. Urine output
28. Hirschprung disease
29. Peptic Ulcer Disease – types and complications
32. Gastric Outlet Obstruction (Inability of Gastric content to go beyond proximal duodenum)
33. Upper Motor Neurons and Lower Motor Neuron lesions (for the neurosurgeon)
34. Factors that impair/prevents Wound healing
35. Surgical site infection
36. Charcot Triad and Reynolds Pentad
37. Necrotizing fasciitis (Deep Spreading infection affecting the fascia planes)
38. Acute Abdomen
39. Gangrene (A type of Necrosis of body tissue. Types: Dry, Wet, Gas, Founier)
40. Septic foot
41. Spinal Injury (Motor deficits, Abnormal/Decreased sensations)
43. Colon cancer
44. Transfusions (Whole blood, PRBCs, FFP, Cryoprecipitate, Platenlets)
46. The Diaphragm (Supply and anatomic relations)
Viva Examination focus
1. Resuscitation equipment
2. X-Ray (Chest, Head)
3. CT scan
6. Fluids & Crystalloids (Composition & Uses)
7. NG tube
8. Endotracheal tube
9. Surgical Instruments
Short case Examination focus
1. Neck swelling
2. Hernia/Groin mass
3. Breast mass
4. Hirschsprung disease
I will suggest you pay attention to these topics for neurology.
I remember the neurosurgeon liked these topics. He even openly said he would not forgive anyone who fails to answer questions on the Glasgow Coma Scale.
1. American Spinal Injury Association (ASIA) classification of spinal injury
3. Types of spinal cord injury
4. History and Physical Examination of the Neurologic system
5. Glasgow Coma Scale (GCS)
7. Spina bifida and anencephaly
This list covers only Surgery 1 rotations.