Evaluation of Myocardial Injury Using Serum Cardiac Troponin-I in Asphyxiated Neonates at Enugu State University Teaching Hospital, Enugu, South-East Nigeria.

BACKGROUND: The burden of perinatal asphyxia remains high in our environment and when asphyxia is severe, vital organs are affected, with resultant multiorgan hypoxic-iscahemic injury to the heart, the brain, adrenals and other organs. STUDY AIM: To evaluate for myocardial injury in asphyxiated term neonates with hypoxic ischaemic encephalopathy using serum cardiac troponin-I (cTnI). METHODS: The study was a hospital-based descriptive cross-sectional study involving sixty term asphyxiated neonates and sixty gestational age-and sex-matched controls. The subjects were term neonates with five-minute Apgar score ≤ 6 and HIE while the controls were healthy term neonates with five-minute Apgar score > 6. Five-minute Apgar score was utilized to classify asphyxia into mild, moderate and severe asphyxia. The degree of encephalopathy was determined by modified Sarnat and Sarnat criteria. The serum cTnI was measured in subjects and controls at 12-24 hours of life using Enzyme-linked immunosorbent assay technique. The serum bilirubin levels were also measured in participants to exclude hyperbilirubinemia. RESULTS: The median serum cTnI levels was significantly higher in the subjects (0.56ng/mL; 0.25-0.94ng/mL) than in the controls (0.50ng/mL; 0.00-0.67ng/mL), respectively; p=0.001. Similarly, the median serum cTnI level in HIE stage II (0.56ng/mL; 0.38-0.72ng/mL) or III (0.56ng/ml; 0.50-0.94ng/mL) was also significantly higher than the median value in HIE stage I (0.38ng/mL;0.25-0.72ng/mL) or in controls (0.50ng/mL; 0.00-0.67ng/mL); p<0.001. There was significant positive correlation between serum cTnI levels and severity of HIE in asphyxiated neonates (rs = 0.505, p < 0.001). CONCLUSION: serum cTnI levels were elevated in severely asphyxiated neonates with HIE. The concentration of serum cTnI demonstrated significant positive correlation with HIE severity. Hence, the presence of HIE in asphyxiated neonates should prompt an evaluation for myocardial injury using serum cTnI. Any derangement noted should warrant instituting cardiovascular support in order to improve outcome and reduce asphyxia-related mortality.

Epidemiology of injuries seen in a nigerian tertiary hospital.

BACKGROUND: The study aimed to describe the pattern of injuries among patients presenting at a tertiary care hospital in Enugu southeast Nigeria. PATIENTS AND METHODS: A retrospective review of records of all injured patients seen in our hospital over a 12-month period was done. RESULTS: A total of 789 patients had complete medical records and were included in the study. Road traffic accident (RTA) was the most common cause of injury. Lacerations/abrasions, fractures, and traumatic brain injury (TBI) were the most frequently seen injuries. The injury severity score (ISS) of the patients ranged from 1 to 50 with a mean score of 8.9 ± 3.5. RTAs were responsible for 90.8% of patients with ISS >15. Patients with ISS >15 contributed to 64.1% of all deaths. The mortality rate was 4.5%. Most deaths resulted from RTA and were associated with TBI (P = 0.001). CONCLUSION: Lacerations and fractures were the most common injuries. RTA was the leading cause of injury. TBI was the most common cause of injury-related death.

Skull traction for cervical spinal injury in Enugu: A 5-year retrospective multicenter analysis of the clinical outcomes of patients treated with two common devices.

BACKGROUND: Treatment of cervical spine injury is the most challenging of all the injuries of the spine, and there is yet no agreement on the best method of care. OBJECTIVE: We studied the complications and outcome of two skull traction devices used to treat cases of cervical spine injury in three centers in Enugu, South East Nigeria. PATIENTS AND METHODS: A retrospective analysis of patients with cervical spine injury managed with skull traction as the definitive treatment using either Crutchfield or Gardner-Wells tongs over a 5-year period (April 2008-March 2013). The traction was applied for 6 weeks, and the patient was subsequently mobilized with either hard cervical collar or Minerva jacket for another 6 weeks. RESULTS: One hundred and five patients with complete records out of 127 cervical spinal injured patients treated were studied. Forty-one had the American Spinal Injury Association (ASIA) Grade A whereas 64 had incomplete cord injury of ASIA Grades B-E. Forty-eight had Crutchfield traction whereas 57 had Gardner-Wells traction. At the end of treatment, no patient improved among those with ASIA Grades A and B. All the 12 cases of mortality were recorded as well among ASIA A (n = 9) and B (n = 3) Grades. Over 50% of ASIA Grades C and D patients improved to Grade E. The complication profile varied significantly between the traction subgroups with those treated using Crutchfield tongs experiencing more events (χ2 = 6.5, df = 1, P< 0.05). However, there was no significant statistical difference in the Association Impairment Scale (AIS) outcome (P = 0.55) as well as mortality rates (χ2 = 0.97, DF = 1, P> 0.05) between those treated with Crutchfield and Gardner-Well traction. CONCLUSION: Crutch field tong traction may be associated with more complications when compared with Gardner-Wells traction. However, from our study, the final American Spinal Injury AIS outcome, as well as the overall mortality rates associated with the two traction techniques, did not vary significantly.

Cervical spine injury: a ten-year multicenter analysis of evolution of care and risk factors for poor outcome in southeast Nigeria.

STUDY DESIGN: Retrospective study. OBJECTIVE: To describe the evolution of care and risk factors for poor outcome in patients with cervical spine injury (CSI) treated at three centers in southeast Nigeria. SETTING: Nigeria, southeast. MATERIALS AND METHODS: A 10-year retrospective multicenter analysis of patients with CSI, managed at three centers in southeast Nigeria, from January 2003 to December 2012. RESULTS: Two hundred and seven patients (55%) had CSI out of 377 spinal injury cases in the three study centers, but 195 cases had complete records and were studied. There were 148 males and 47 females. The age range was 3-74 years with a mean of 32.6 (± 1.9) years 95% CI. Most injuries (149 cases) resulted from motor vehicular accidents (MVA). The C5 spinal level was involved in 75 (38%) cases One hundred and seventeen patients (60%) presented with American Spinal Injury Association A (ASIA A) injury. CSI care evolved from the application of a Minerva jacket or cervical traction only to cervical traction and spinal fusion resulting in a reduction in hospital stay (F = 52.5, DF (2, 3) P < 0.05). When compared to 51 patients with incomplete injuries, who improved in neurologic al status at discharge, only three patients with ASIA grade A experienced some improvement. The mortality rate from our series is 16% (32 patients). Those who died were more likely to have a complete injury (25 patients) or a high cervical injury (X² = 61.2, P < 0.05) among other factors. CONCLUSION: The cervical spine is the most commonly injured spinal segment in southeast Nigeria. Although treatment evolution has resulted in reduction of hospital stay, the associated mortality risk still remains high.

Cervical Spine Injury: A Ten-Year Multicenter Analysis of Evolution of Care and Risk Factors for Poor Outcome in Southeast Nigeria

Study Design: Retrospective study. Objective: To describe the evolution of care and risk factors for poor outcome in patients with cervical spine injury (CSI) treated at three centers in southeast Nigeria. Setting: Nigeria; southeast. Materials and Methods: A 10-year retrospective multicenter analysis of patients with CSI; managed at three centers in southeast Nigeria; from January 2003 to December 2012. Results: Two hundred and seven patients (55) had CSI out of 377 spinal injury cases in the three study centers; but 195 cases had complete records and were studied. There were 148 males and 47 females. The age range was 3-74 years with a mean of 32.6 (?1.9) years 95) cases One hundred and seventeen patients (60 CI. Most injuries (149 cases) resulted from motor vehicular accidents (MVA). The C5 spinal level was involved in 75 (38) presented with American Spinal Injury Association A (ASIA A) injury. CSI care evolved from the application of a Minerva jacket or cervical traction only to cervical traction and spinal fusion resulting in a reduction in hospital stay (F = 52.5; DF (2; 3) P 0.05). When compared to 51 patients with incomplete injuries; who improved in neurologic al status at discharge; only three patients with ASIA grade A experienced some improvement. The mortality rate from our series is 16 (32 patients). Those who died were more likely to have a complete injury (25 patients) or a high cervical injury (X 2

A virtual source model of a kilo-voltage radiotherapy device.

The purpose of this work is to develop a virtual source model (VSM) for the 50 kV INTRABEAM® device for Monte Carlo (MC) dose calculation. The geometry of the device was modelled in Geant4. A phase space file (PSF) was computed by simulating the interactions of monoenergetic primary electrons with the target. The PSF was approximated by computing the energy spectrum of the photons in the PSF. The variation of photon intensity, mean direction cosine and standard deviation along the axis of the source was thereafter computed. The isotropy of the source was used to approximate the properties of the source on the transverse plane. These functional approximations thereafter defined the VSM of the device. A sub-source was used to account for two kinds of photons, which were suppressed by the PSF approximation method. The intensity (relative to the main source) and emission directions of the sub-source required optimization. Optimization was achieved by the iterative adjustment of either or both parameters following MC simulation with the VSM and comparison of the calculated results to experimental data. The optimized source model was validated by comparing the calculated dose to water under several experimental setups, with reference data from the manufacturer, independent dosimetric check, and to literature results. The calculated photon energy spectra at other operating potentials (30 and 40 kV) of the device were also compared to literature data. The calculated energy spectra at all operating voltages are consistent with literature reports. The optimized sub-source has a relative intensity of 5% and an emission direction that is favoured along the axis of the source. The calculated depth dose curve for the bare probe agreed with the reference data, and the isodose lines are similar to published experimental results. Validation of the source model under a more complex experimental setup by film dosimetry agreed to within 2%/1 mm (98% pixel pass rate) of the values calculated with the VSM. We derived a VSM of the 50 kVp INTRABEAM source from a PSF. The dose predicted by the model agreed with reports in literature, reference data from the device manufacturer, and with an independent validation check. The algorithm could be used for treatment planning.

Epidemiological and treatment profiles of spinal cord injury in southeast Nigeria.

STUDY DESIGN: Retrospective study. OBJECTIVE: To evaluate the epidemiology and treatment outcome of spinal cord injuries (SCIs) at three tertiary care centres within southeast Nigeria. SETTING: Southeast Nigeria. METHODS: Causes, seasonal variation, transportation to hospital, severity of injury, treatment and outcome of patients with SCIs treated by the authors at three study locations from September 2009 to August 2012 were studied. RESULTS: Eighty-five patients with SCI had been admitted during that period to the three hospitals and were qualified for the study. The age range was 2-75 years with a mean of 36.13 years. The 31-45 years age group is the most frequently affected. Altogether, 69 male and 16 female individuals were involved. Motor vehicle accident (MVA) (47, 55.3%) was the most frequent cause of injury. Falls from palm trees (3.5%) were markedly reduced from what they were inferred to be (40.2%) from a similar study in our area in 1988. Injury peaks were observed during major festivities. Only three patients (0.035%) were transported to care centres with an ambulance. Forty patients were classified as being affected by ASIA grade A injury, whereas 45 patients had various ASIA grades of incomplete injury. Sixty-eight patients were managed conservatively; 23 of them improved from their grades, 35 remained the same, 1 worsened, while 9 died. Of 17 patients treated operatively, 9 improved, 5 remained the same, 2 worsened and 1 died. CONCLUSION: Currently, SCIs reported in the three main hospitals located in southeast Nigeria are caused mainly by MVAs. SCI affects mainly male individuals and peak frequencies are observed during festivities.

The level of knowledge of the advanced trauma life support protocol among nonspecialist doctors involved in trauma care in Enugu metropolis.

BACKGROUND: Trauma is one of the leading causes of mortality in developing countries. Nonspecialist doctors are the first caregivers to attend to trauma patients. Most nonspecialist doctors in Nigeria lack extra training in trauma care including the ATLS training for doctors. OBJECTIVES: To determine the knowledge of the ATLS protocol among nonspecialist doctors involved in trauma care in Enugu, Nigeria. MATERIALS AND METHODS: We prepared and shared out questionnaires to the respondents, and later analyzed the information received using the SPSS 15. RESULTS: 65 out of 110 respondents (59.1%) filled and returned their questionnaires. 59 (90.8%) were males and 6 (9.2%) females. Their ages ranged from 29 to 47 years (35.6 ± 3.85 years) and they had been practicing for 1-16 years (mean 4.40 ± 3.540 years). 5 (7.7%) were medical officers while 60 (92.3%) were residents at various stages of training in different Surgical subspecialties. 41 or 63.1% rated their knowledge of the ATLS protocol as satisfactory. 22 (33.8%) demonstrated a satisfactory knowledge of ATLS. The three respondents (4.8%) who had undertaken a formal training in ATLS demonstrated excellent knowledge of ATLS. All believed that training in the protocol would be beneficial in their career. CONCLUSION: There is a poor knowledge of ATLS among nonspecialist doctors involved in trauma care in Enugu, Nigeria. ATLS training should be adopted by the hospitals involved in the training of doctors and should become a condition to employ surgery residents.

Limb gangrene following treatment of limb injury by traditional bone setter (Tbs): a report of 15 consecutive cases.

UNLABELLED: This study is done to evaluate cases of limb gangrene resulting from treatment of limb injury by traditional bonesetter. METHOD: This is a prospective study in which patients with limb gangrene are evaluated as each presents. Data extracted for evaluation include history of having been to a traditional bonesetter, the original injury, type of treatment given by the traditional healer, progression of condition while on treatment and reason for not coming to orthodox orthopaedic centre ab initio for treatment. RESULTS: 15 cases were seen during the 5-year of study spanning June 1997 to May 2002. Upper limbs were involved in 4 cases while 11 involved the lower limbs. The original injuries were 3 cases of soft tissue injury to the joints, 7 closed fractures and 5 open fractures of type I and II. There was associated sepsis and toxemia in all except one. All the cases were treated by amputation. There were 4 deaths. CONCLUSION: Limb gangrene was not a justifiable end-result of treatment in all the cases judging by the nature of the original injury. Reasons for this end result were adduced. The need to avert unnecessary limb loss from mismanagement of limb injury by education of public in general and enlightenment of the traditional bonesetters of the harmful procedures in their practice is highlighted.

Outcome of a 12-week programme for management of the spinal cord injured with participation of patient's relations at Hilltop Orthopaedic Hospital, Enugu, Nigeria.

STUDY DESIGN: Description of 12-week programme of treatment. OBJECTIVES: In Enugu, Nigeria, not all spinal injured (SCI) can be treated in teaching and orthopaedic hospitals. The 12-week programme was developed with the aim of getting such patients back into society as useful and independent as possible, using the patients relations to complement the deficiency in personnel. SETTING: Enugu, Nigeria. METHODS: Staged weekly programmes of assessment and treatment were mapped out to end at the twelfth week. Spinal injured patients of less than 2 weeks duration were entered into these programmes as they presented. Outcome was assessed at the end of the twelfth week. The study lasted for 6 years (January 1996 to December 2000). RESULTS: Seventy-four patients were admitted into the study. Nine patients had incomplete cord injury of Frankel C while 65 had clinically complete injury of Frankel A on admission. Eight of the nine incomplete injuries improved to Frankel D and walked home within the 12-week programme. In the clinically complete group, eight died. Out of the 57 remaining, six recovered to Frankel D and walked home, while the remaining 51 who did not recover, 49 were conversant with wheelchair use within the 12-week programme. CONCLUSION: It is concluded that adoption of this programme would allow the spinal cord injured to get expert treatment within a reasonable time in less ideal hospital settings where man-power and skilled members of the spinal cord injury treatment team are lacking.

Osteosarcoma seen at the National Orthopaedic Hospital; Enugu - A retrospective review of 20 cases

A case study of 20 primary osteosarcoma seen at National Orthopaedic Hospital; Enugu for a period of ten years (June 1; 1978 to June 1; 1988) was done. The tumor was found to be the commonest bone tumor constituting 40of the malignant bone tumors seen at the hospital. Ninety per cent of the tumors occurred in the long bones; with 60occurring in the region of the knee. 15occurred in the upper limb while 85in the lower limb. Greater percentage of patients seen were lost to follow-up after one year and only six deaths were recorded. Treatment mostly was ablative surgery and adjuvant chemo-therapy

Fractures of the femur - a report of two hundred consecutive cases

Femoral fracture is quite a disabling injury and one of the most difficult to treat. Developing countries like ours have their own logistic problems that might affect the ultimate results. Ignorance and poverty have resulted in late presentations with resultant complications. Large series of femoral fractures treated over a ten year period at National Orthopaedic Hospital; Enugu has been reviewed. Of the two hundred cases seen 48.5was due to Road Traffic Accidents which mainly occurred during period of festivities. 41.5of the patients had already been to the traditional bone setters