Pathology of firearm mortalities in the Niger Delta region of Nigeria: a study of 136 consecutive autopsies.

A prospective autopsy study of firearms-related death was carried out by the authors in the Niger Delta region of Nigeria. The purpose of the study was to evaluate the pattern, frequency, and anatomical sites of wounds, also the cause of death and the age and sex distribution of victims. The autopsies were performed after being served with the coroner's inquest forms. In all cases standard autopsy procedures were adopted and reports issued. A total of 136 consecutive firearm deaths were autopsied. There were 122 (89.7%) males and 14 (10.3%) females, giving a male to female ratio of 8.7:1. The highest number of deaths, 95 (69.8%), occurred in the age group of 10-39 years with a peak of 51 (37.5%) deaths at 20-29 years. In 112 (82.4%) cases death occurred from homicidal gunshot wounds. The commonest targets of gunshot wounds were the head, 58 (42.6%); multiple anatomical sites, 30 (22.1%); chest, 16 (11.8%); abdomen, 11 (8.1%) and neck, 10 (7.4%). Haemorrhagic shock was the cause of death in 131 (96.3%) cases. Significant causes of traumatic death in the Niger Delta region of Nigeria are gunshot wounds and associated complications. Stringent laws on illegal firearms handling should be passed and enforced by the government to reduce the frequency of such deaths.

Industrial accidental deaths in the Niger delta region of Nigeria: a study of 32 autopsies in Port Harcourt.

Accidents in the oil industry in the Niger delta region of Nigera raise concerns about safety measures and the management of industrial sites. A total of 32 autopsies were performed after coroners' inquest forms were served on the authors by the State, which serve as consent and request. Standard procedures were adopted in all the cases and the reports were appropriately issued. Death from industrial accidents accounted for 2.5% and 6.1% of total autopsies and accidental death autopsies respectively. The youngest victim was a 19 year old male while the oldest was a 55 year old male. The age group 30-39 years was the most vulnerable. There was a male dominance; (male:female ratio = 9.7:1). The commonest accidents in their order of frequency were: falling from a height, explosion/fire, motor vehicle accidents and falling objects. Multiple injuries, head and neck trauma and drowning were the commonest cause of death at autopsy. Accidental deaths were commoner in the small-scale industries (81%) than in the large-scale industries (19%). This is the first time such a study has been carried out locally. The proportion of accidental deaths in the small scale industries relative to that of the large ones may be attributed to the poor enforcement of safety measures in the smaller industries

Pattern and management approach of diabetic foot disease in a developing country.

BACKGROUND: Diabetes mellitus is a common endocrine illness in our environment. Diabetic foot gangrene is its commonest surgical complication and is a health burden in Niger Delta region of Nigeria. The aim of the study was to highlight the demography, bacterial incidence, time frame to development of diabetic foot, reaction to ablative surgery and the use of San Antonio wound classification system forthe treatment decision. METHODS: We retrospectively reviewed 46 diabetic feet in 41 diabetics over a 5 year period, January 1999 to December 2003, using the San Antonio classification system. The case notes of all patients seen in the University of Port Harcourt Teaching Hospital were included in the study. RESULTS: There were 32 males and 9 females with a male female ratio of 3.6:1. The age range was 34 to 90 years with a mean of 56 +/- 12 years. The mean duration between diagnoses of diabetes mellitus and development of foot disease was 13 +/- 5 years. Twenty four patients (59.5%) with stages A or B irrespective of the grade had a chance of limb salvage using appropriate antibiotic, serial wound debridement, regular dressing and skin grafting where necessary. Of the 24, 3 absconded, 5 died and 16 healed and were discharged. The remaining 17 patients (40.5%) were stages C and D and were offered ablative surgery irrespective of the grade. Nine discharged against medical advice, 5 died and 3 were discharged in good condition. CONCLUSION: This is a disease of the older population. Delay in accepting ablative surgery affects prognosis. Outcome in management of diabetic foot disease can be improved by education, early presentation, funding for establishment of specialized diabetic foot clinics and early decisive definitive management.

Traumatic death from rival gang violence in Rivers State, Nigeria.

A prospective autopsy study in Rivers State, Nigeria, was undertaken to evaluate the patterns of death as a result of rival gang clashes and to highlight the menace of rival gang violence. Between 1 January 1999 and 31 December 2003 medico-legally autopsied bodies in Rivers State, where death was the result of gang violence, were studied after being served with the coroner's form. In all cases, standard autopsy procedures were adopted and reports were issued. A total of 58 bodies were autopsied for the study. Three (5.2%) were females and 55 (94.8%) were males, giving a female to male ratio of 1:18.3. The age group of 10-29 years recorded the highest frequency of death (65.6%) with a peak in the age group 20-29 years (39.7%). Gang violence and politically motivated mob action were the most common precipitating factors (60.3% and 20.7% respectively). Firearms (41.4%) was the most common method applied for the killing. Death was more common in the rural areas of Rivers State. Gang clashes, volatile political rallies, illegal drug peddling and illegal oil bunkering should be banned and stringent laws be passed. Such laws should also cover gun handling and should be enforced.

Soft tissue sarcomas in the Niger Delta Region of Nigeria (a referral hospital's study).

BACKGROUND: Soft tissue sarcomas are rare tumours in this environment. Recently, an upsurge in frequency was noticed that called for attention. The aim of this study is to study soft tissue sarcomas based on age, sex of patients, tumour sites and histologic types. METHODOLOGY: A 14 year retrospective study in University of Port Harcourt Teaching Hospital (UPTH) Port Harcourt. Histological slides previously processed and stained with hematoxylin and eosin stains (H & E) were reviewed and re-evaluated. Special stains were also used for proper diagnosis of some tumours. The tumours were classified based on World Health Organization (WHO) classification of soft tissue tumours. RESULTS: Only 66 soft tissue sarcomas were used for this study which accounted for 2.8% of the total malignancies diagnosed during the period under review. The youngest was a 3 year old girl while the eldest was a 76 year old female. A total of 38 and 28 tumours were diagnosed in males and females respectively, giving a sex ratio of 1.4:1. Rhabdomyosarcoma was most frequent (39.4%) while the least was leiomyosarcoma (1.5%). These tumours are more frequent in the under 20 years (22.7%) and least in 70 years and above (7.6%). The lower limb was most affected (36.4%) while the least was the retroperitoneum (6.1%). The commonest predilection sites vary with different classes of these group malignancies. CONCLUSION: Soft tissue malignancies are globally uncommon but they constituted an integral part of malignant tumours causing serious morbidity and mortality in this environment. The recent upsurge noticed necessitated the need for regional studies in Nigeria in order to come up with a national epidemiologic data of these malignancies.