Orthopaedic anaesthesia for upper extremity procedures in a Nigerian hospital

BackgroundGeneral anaesthesia and regional anaesthesia have been used successfully for upper extremity orthopaedic procedures. Despite the advantages of regional anaesthesia, there is low utilisation in Nigeria. In this study, weassessed the types of anaesthesia employed for upper extremity surgeries in our centre.MethodsAfter obtaining approval from the institutional ethics committee, all the patients who had upper extremity surgeries from 1 January 2011 to 31 December 2012 were included in this review. Both prospective and retrospective data were gathered. The choice of anaesthesia was at the discretion of the attending anaesthetist.ResultsA total of 226 patients with a male-to-female ratio of 1.6:1 and median age of 35.0 (range 2 – 89) years, had orthopaedic upper extremity procedures during the study period. Sixty-three cases (27.9%) had general anaesthesia, 5 (2.2%) combined regional and general anaesthesia while 158 (69.9%) had regional blocks. The regional blocks comprised 145 (89%) different approaches to the brachial plexus and 18 (11%) local anaesthetic infiltrations. The arm was the site mostly operated upon; while supraclavicular and axillary brachial plexus blocks were performed in equal amounts. In 14 (6.2%) patients, brachial plexus blocks were performed with spinal anaesthesia because of concomitant iliac crest bone grafts. While the duration of surgery did not differ significantly, regional anaesthesia provided a significantly longer duration of anaesthesia than general anaesthesia (251 ± 70.8 min versus 141.3 ± 65.5 min; p = 0.0000001).ConclusionThere is a high use of regional anaesthesia for upper extremity orthopaedic surgeries in our centre, which is a positive development in a resource limited setting

The Incidence of Intestinal Obstructive Diseases in Selected Veterinary Clinics and Hospitals in South Western Nigeria

Intestinal obstructive diseases are medical and surgical emergencies which require precise diagnosis and rapid surgical intervention. They are characterized by severe hypovolemia and septic shock secondary to devitalization of the intestinal wall. The consequent surgical complicationssuch as ileus, adhesions and short bowel syndrome with resultant death of the patients also pose management challenges to the clinician.This study investigated the incidence of intestinal obstructive diseases in some animals presented at selected Veterinary Hospitals and Clinics in southwestern Nigeria between 1998 and 2008. Records of surgical cases were grouped into 11 categories and further grouping of intestinal obstructive conditions in small and large animals were presented using descriptive statistics. th Intestinal obstructive conditions ranked 8 among the 11 categorized surgical conditions, and 7.0 % of the surgicalcases which were presented between 1998 and 2008. Most of the intestinal conditions such as intussusception, volvulus and torsion were strangulating obstructive conditions and occurred more in small than large animals. Hernia ranked highest among the surgical conditions, followed byintussusception, volvulus and rectal prolapse in that order. The intestinal conditions were more prevalent in post mortem records and in small animals than in large animals. The findings in this study showed that intestinal surgical conditions are not uncommon in Veterinary hospital andclinics in the study area. It further showed that the management of intestinal surgical conditions is still a major challenge in some Veterinary hospital and clinics in Nigeria

Evaluation of the Outcome of Femoral Plate) steosynthesis in a Teaching Hospital in a Developing Country

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Tooth loss: Are the patients prepared?

Background and Aim: Tooth loss is associated with esthetic, functional, psychological, and social impacts on the life of individuals. This study was designed to find out how Nigerians feel about losing their teeth and what effects, if any, this has on their lives. Most of the problems presented to the dentist as difficult denture tolerance could be as a result of the emotional effects of tooth loss rather than problems from the denture itself.Materials and Methods: The study was carried using a self-administered questionnaire to consenting adult patients undergoing tooth extraction at the Oral and Maxillofacial Clinic, University College Hospital, Ibadan, Nigeria. The data collected were analyzed using SPSS, version 15.5.Results: A total of 90 respondents completed the questionnaires; 35 (27.6%) were males while 55 (43.3%) were females. The respondents were aged 0–70 years. Immediate acceptance of tooth loss was noted in 88 (69.3%) cases, but 6 (47%) accepted the loss only after 1 year, while 8 (6.3%) of the cases found it difficult to accept losing their teeth and incidentally, all of them were 30 years and above. Only 52 (40.9%) of the patients were prepared for the emotional effect of losing their teeth. A feeling of relief immediately following tooth extraction was expressed by 75 (43.9%) cases and of these 32 (47.8%) were females. The emotional effects following teeth loss were sadness 22 (12.9%) cases, depression in 11 (6.4%), feeling of losing body part in 24 (14%), feeling of aging in 4 (2.3%), while 13 (7.6%) respondents felt unconcerned.Conclusion: We observed that emotional effects of tooth loss are also experienced among our patients with a range of emotions quite similar to those observed by previous authors from the developed world. The significant number of patients that failed to come to terms with their tooth loss indicates that the effect of tooth loss on self-esteem and selfimage is not short lived as it has been assumed

Physical Functionality and Self-Rated Health Status of Adult Patients with Knee Osteoarthritis Presenting in a Primary Care Clinic

Background: Knee osteoarthritis is a chronic medical condition of public health importance in Nigeria which causes disability and impacts daily activities in the sufferers. This study aimed to describe the physical functionality and self-rated health status of adult patients with clinical knee osteoarthritis presenting at the Family Medicine Department, University College Hospital, Ibadan, Nigeria.Method: This was a cross-sectional study of 400 respondents. Knee osteoarthritis was diagnosed clinically using the criteria of the American College of Rheumatology. Morbidities, self-rated health status and physical functionality of the respondents were also assessed.Results: Knee osteoarthritis was diagnosed in 46(11.5%) respondents. Respondents with knee osteoarthritis significantly rated their health worse than those without knee osteoarthritis (p <0.0001). Experience of pain, stiffness and performance of daily activities were significantly worse among respondents with knee osteoarthritis. Those who had knee osteoarthritis had significantly higher waist (p <0.0001), hip (p <0.0001) and knee circumferences (p <0.0001) respectively. Logistic regression analysis showed increasing age (OR=1.103; 95% CI=1.022 – 1.191), self-rated health worse than six months ago (OR=12.562; 95% CI=1.178–125.243), experience of stiffness after waking up in the morning (OR=12.758; 95% CI=3.572–45.569), stiffness after sitting/lying down/resting (OR=21.517; 95% CI=2.213–209.220) and waist circumference (OR=1.225;95% CI=1.017–1.477) to be the most significantly associated with knee osteoarthritis.Conclusion: Knee osteoarthritis significantly impairs the health and daily activities of adult patients in Ibadan, Nigeria. Healthcare workers need to screen adult patients routinely at first-contact to detect knee osteoarthritis clinically early and manage appropriately.Keywords: Family practice clinic, functionality, health status, knee osteoarthritis, Nigeri

Brachial Plexus Blocks for Upper Extremity Surgeries in a Nigerian Hospital

Background: Different techniques of brachial plexus blocks are in use to provide surgical anaesthesia from the shoulder to the fingertips. However, they are perceived as time-consuming and unreliable as the sole anaesthetic for surgical procedures. Until recently (July 2008), only general anaesthesia was employed in our centre even for hand surgeries.Objective: To evaluate the use and outcome of brachial plexus blocks for upper extremity surgeries.Design: A retrospective review of patients’ records and prospective observation of patients with upper extremity surgeries.Setting: The University College Hospital, Ibadan, situated in Southwestern Nigeria with over 875 beds.Subjects: Patients who had surgeries of the shoulder, humerus, elbow, forearm, wrist and hand were studied.Results: In 2006 and 2007, only general anaesthetic accounted for the 220 upper extremity surgeries. However, in 2008, 2009 and 2010, brachial plexus blocks accounted for 6.9, 27.9 and 48.6% respectively. From a success rate of 60.0% in the first year of practicing brachial plexus anaesthesia using 40% paraesthesia technique, the second and third years were 78.9 and 96.5% respectively due to better localisation techniques (nerve stimulation alone or in combination with echo-guidance).Conclusion: Our study shows an increasing successful use of brachial plexus block techniques for upper extremity procedures

Outcome of Femoral Plate Osteosynthesis in a Teaching Hospital in a Developing Country

Background: Fractures of the femur are a common presentation of  traumatic injuries and are usually associated with other injuries. The need for surgical fixation is undisputed although operative options are varied, and often the choice is based on fracture pattern, available facilitiesand the surgeon's preference. This decision should be determined by the predicted functional outcome rather than by the type of implant to be used. The main objective of this study was to evaluate the results of treatment of femoral shaft fractures using plate osteosynthesis in our centre.Method: This was a retrospective study done by reviewing the medical records of patients presenting with femoral shaft fractures between 2005 and 2012.Results: A total of two hundred and four patients underwent plate  osteosynthesis of femoral shaft fractures within the period under  consideration. One hundred and seventy (83.3%) patients achieved clinical and radiological union after an average of 5months. There were 12 (5.9%) nonunions, 10 (4.9%) infected implants and 4 (2%) broken implants.Conclusion: Plate osteosynthesis is vital in the management of femoral fractures especially in developing countries where the cost of care is entirely borne by the patients and relations. Careful patient selection and meticulous post-operative follow-up care are essential for a favourableoutcome.Key words: Femoral, Plate, Osteosynthesis,Outcome,Developing, Countr

Results of Lateral Condylar Blade Plate Fixation of Supracondylar Fractures of the Femur in an African Tertiary Hospital in Nigeria

Background: The concerns about operative stabilization of supracondylar femoral fractures are complications, especially hardware infection and disturbance of normal knee function. We reviewed the results of operative fixation of supracondylar femoral fractures using the lateral condylar blade plate device in our centre.Methods: All patients operatively treated using a lateral condylar blade plate device within a 13-year period were reviewed.Results: There were thirty two fractures. Mean age was 47.3±21.5 years. There were 22 AO type 33-A, 4 type 33-B and 6 type 33-C fractures.Traffic crashes accounted for 15 cases (46.9%). Six were open (Gustilo type IIIa). Surgery was delayed for an average of 21.3 days. Length of hospitalization was 69.7±43.5 days. Follow up averaged 23.6 weeks and average time to fracture union was 17.8±1.0 weeks. All fractures unitedduring follow up with an excellent outcome in 22 (68.8%), good in 5 cases (15.6%), moderate in 4 (12.5%) and a poor outcome in one patient using the Schatzker and Lambert criteria. Complications included knee stiffness (15.6%), bone infection (9.4%) and loosening of an implant. The infections subsided after removal of the hardware.Conclusions: Treatment of supracondylar femoral fractures with the lateral condylar plate usually promises good results. However, high energy injuries are often prone to complications.Keywords: Supracondylar femur, fracture, operative treatment, injuries, Nigeria

An assessment report on an immunization clinic located in a tertiary institution in Ibadan

Objectives: The aims of the assessment report were to appraise immunization system components and review vaccination coverage between January 2007 and December 2011 at the University College Hospital (UCH) immunization clinic.Methods: The immunization clinic has an annual target population of 997 (for children < one year of age) and 1246 (for pregnant women), which were used in this assessment. The data collection method used included; Key informant - interview, administration of a semi-structured  questionnaire, records review and observations during immunization sessions.Results: The UCH immunization clinic mainly offers fixed sessions and only provides outreach services when there is a need, such as during outbreaks. However, there are no records of vaccinepreventable diseases being  monitored. The coverage rate for nearly all of the vaccines was greater than 100% of the estimated target population for the hospital. Except for the coverage rate of Bacille Calmette Guerin (BCG) vaccine, which peaked in 2011, other vaccines’ coverage peaked in 2009, after which therewas a decline. The highest dropout rate was recorded in 2007, while the rates between 2009 and 2010 were <10%, but the BCG and measles drop out rates were >10% for the 5-year period. For the adult immunizations, yellow fever recorded the highest coverage rate, while the lowest rate was recorded for tetanus toxoid dose 5 (TT5). The vaccines that were most often in short supply included Diphtheria-pertusis-tetanus, Hepatitis B,yellow fever, oral polio, and cerebrospinal meningitis vaccines. Although good-quality supplies, equipment and consumables were observed, there was no inventory of these items. There were evident interpersonal communication and community mobilization as well as capacity building for staff.Conclusion: The assessment showed there was progress in the provision and administration of immunization based on available resources. There is, however, the need to improve documentation of clinic activities

Epidemiology of injuries presenting to the national hospital in Kampala, Uganda: implications for research and policy

BackgroundDespite the growing burden of injuries in LMICs, there are still limited primary epidemiologic data to guide health policy and health system development. Understanding the epidemiology of injury in developing countries can help identify risk factors for injury and target interventions for prevention and treatment to decrease disability and mortality.AimTo estimate the epidemiology of the injury seen in patients presenting to the government hospital in Kampala, the capital city of Uganda.MethodsA secondary analysis of a prospectively collected database collected by the Injury Control Centre-Uganda at the Mulago National Referral Hospital, Kampala, Uganda, 2004-2005.ResultsFrom 1 August 2004 to 12 August 2005, a total of 3,750 injury-related visits were recorded; a final sample of 3,481 records were analyzed. The majority of patients (62%) were treated in the casualty department and then discharged; 38% were admitted. Road traffic injuries (RTIs) were the most common causes of injury for all age groups in this sample, except for those under 5 years old, and accounted for 49% of total injuries. RTIs were also the most common cause of mortality in trauma patients. Within traffic injuries, more passengers (44%) and pedestrians (30%) were injured than drivers (27%). Other causes of trauma included blunt/penetrating injuries (25% of injuries) and falls (10%). Less than 5% of all patients arriving to the emergency department for injuries arrived by ambulance.ConclusionsRoad traffic injuries are by far the largest cause of both morbidity and mortality in Kampala. They are the most common cause of injury for all ages, except those younger than 5, and school-aged children comprise a large proportion of victims from these incidents. The integration of injury control programs with ongoing health initiatives is an urgent priority for health and development