Assessment of handgrip strength in healthy african subjects: Establishing age and gender stratified reference values.

Background: The handgrip strength assesses hand function in traumatic and non-traumatic upper extremity conditions. It is also a surrogate marker for other systemic diseases unrelated to the upper limb. Various reference values have been established in different world regions, with few studies in our population. Aim: To determine the average handgrip strength by gender and age categories among healthy subjects in Nigeria. Materials and Methods: It was a cross-sectional study assessing handgrip strength by age category (ten-year bin width), gender, and handedness in 210 healthy persons aged 10 to 79 in Nigeria. Its relationship with age, height, weight, mid-arm circumference, triceps skinfold thickness, and mid-arm muscle area was evaluated using multiple linear regression. Results: The mean handgrip strength in the dominant and non-dominant hands was 31.09 kg and 28.45 kg, respectively, P < 0.001. Males have higher values than females in all age categories. The grip strength peaked in the 30-39-year age group in both genders and declined afterward. Age exhibited a nonlinear pattern but had an overall negative relationship, while height was positively related to grip strength in both genders. In contrast, mid-arm circumference and mid-arm muscle area predicted handgrip strength only in males. Triceps skinfold thickness was excluded from the model because of multicollinearity with the mid-arm muscle area, while weight did not predict grip strength in either gender. Conclusion: The handgrip strength in this study is less than that in western literature. Hence, test interpretation should reference the values from this study.

Decreasing incidence of cutaneous chemical burns in a resource limited burn centre: is this a positive effect of modernization?

BACKGROUND: Burns present a devastating injury to patients. Burns caused by chemical agents, present a worse scenario. In a resource limited country like Nigeria, readily available sources of these corrosive agents are mainly from lead-acid battery vendors and to some extent local small scale soap manufacturers who use caustic soda. We hypothesized that with the reduction in small scale soap manufacturing and increasing trend towards modernization in the use of dry cell batteries, chemical burns may be on the decline, and we sought to investigate this. METHODS: The records of all acute burn patients seen at the Burns and Plastic Department of the National Orthopaedic Hospital Enugu Nigeria between January 2011 and December 2014 were retrospectively reviewed. The results were compared to similar studies carried out at the same centre. A questionnaire was administered to corrosive chemical (sulphuric and caustic soda) vendors to assess the trends in product sales and use in recent times. RESULTS: A total of 624 acute burn cases were treated during the period; among which, 12 cases (1.9%) were chemical burns. When compared with previous studies at the centre, Chemical burn cases were  recorded as the lowest rate. The median age of patients was 24 years. There were eight males and four females. Interpersonal assault was the commonest mechanism of injury with sulphuric acid suspected to be the commonest agent in 83.3% of the cases, while 16.7% of the cases were from accidental use of caustic soda. The head and neck as well as the upper limbs were the most affected (30%). Twenty-six questionnaires to lead-acid vendors were analyzed and revealed that all respondents noticed a marked downward trend in the sale of either sulphuric acid or caustic soda, and they attributed this to the ready availability of imported alternatives to locally manufactured soap or wet lead-acid batteries. Ease of use, durability and convenience of the dry cell batteries were cited as principal reasons. CONCLUSION: There appears to be a downward trend in the prevalence of chemical burns in our study compared to previous studies in the centre which may be due to reduced availability and access of corrosive chemicals to the general public. Further prospective multicentre studies to confirm this are recommended.

DONOR SITE MORBIDITY FOLLOWING HARVEST OF SPLIT-THICKNESS SKIN GRAFTS IN SOUTH EASTERN NIGERIA.

BACKGROUND: Split-thickness skin grafting is a very common procedure. Few documentation of its complications exist in the literatures especially in our sub-region where excessive scarring is a major issue. OBJECTIVE: The objective of the study was to document the common complications observed at the donor site for split thickness skin grafts. METHODS: This is a prospective study carried out at the National Orthopaedic Hospital, Enugu, Nigeria over a six month period. All patients with wounds requiring split-thickness skin grafts, who gave consent, were recruited. An observer administered questionnaire was opened for each patient. Any donor site complication was noted on inspection and documented. Analysis of the results was done using SPSS with frequencies, mean and test of significance. RESULTS: A total of 120 patients were recruited for the study. Males accounted for 59.2% of the patients while females made up 40.8%. Donor site complications noted were pain which was exaggerated after 24 hours, itching, infection, dyschromia, hypo-pigmentation, hyper-pigmentation, and hypertrophic scars. At 1 month post-operative period, dyschromia was the commonest complication (39.2%), followed by itching (22.5%), hypo-pigmentation (19.2%), infection (17.5%), and exaggerated pain (1.7%). However, by 3 months, hyper-pigmentation was most common (55.4%), followed by dyschromia (37.5%), hypertrophic scar (3.6%) and itching (3.6%). Whereas by 6 months most patients had hyper-pigmentation (96.0%) while 4.0% had hypertrophic scars. The exaggerated pain was treated successfully with analgesics and was no longer present in any patient after the first month. While infection was also treated successfully following wound swab culture and sensitivity, appropriate antibiotic therapy and local wound care. Pigmentation changes were in keeping with previous studies as hyper-pigmentation was an invariable event following healing of a partial thickness wound. CONCLUSION: Donor site morbidity can be a big problem especially with regard to infection which increases duration of admission and therefore cost of management.

Burn Injuries in Enugu, Nigeria - Aetiology and Prevention. A Six-year Retrospective Review (January 2000 - December 2005).

Background.Burn injuries frequently occur in our homes and workplaces and during travels. They are a common presentation at the National Orthopaedic Hospital, Enugu, Nigeria, which is a regional centre for burns care and for plastic surgery, orthopaedic surgery, and trauma patients. Most burn injuries are preventable, and campaigns to arouse greater awareness are necessary to reduce the number of occurrences. Objectives.The objectives of this study are to highlight the causes of burn injuries and to characterize age and sex incidences, as also the severity of burn injuries. It is hoped that formidable preventive measures will be suggested to aid public enlightenment campaigns in fighting the scourge of burn injuries. Materials and method. A retrospective review of patient's folders from Jan. 2000 to Dec. 2005 showed that 414 cases of burn-injured patients were treated at the emergency unit of the National Orthopaedic Hospital, Enugu. Results. Flame burns accounted for 48.3% of burn injuries followed by scalds with 40.6%; chemical burns accounted for 6.3%, while electrical and friction burns accounted for 4.6% and 1.0% respectively. Males made up 60.4% of the cases and females 39.6% (ratio, 1.5:1). The age group most commonly affected was that of children aged between 0 and 10 yr, accounting for 37.2% of cases, followed by the 21-30 yr age group with 22.7%. Altogether, 95.0% of the patients were aged less than 50 yr. With regard to flame burns, 51.5% were due to petrol flames (premium motor spirit), while 33.0% were due to kerosene. Cooking gas explosions accounted for 7.5% of the cases and diesel (automotive gas oil) 1.0%. Of the scalds, hot water accounted for 89.3% and hot oil 7.7%. As to chemical burns, 84.6% were due to acids, with alkalis, corrosive creams, and others making up the rest. With regard to electrical injury, current passage accounted for 63.2% of cases and flash burns for 36.8%.

Cleft lip and palate repair: the experience from two West African sub-regional centres.

Compliance with primary surgical treatment in people with cleft lip and palate is a well-known problem, especially in developing countries fraught with poverty and ignorance. Different protocols of treatment exist. In this paper, we retrospectively review a cohort from two centres, with a discussion on the outcome and its implications. The records of all patients with cleft lip and palate seen in the National Orthopaedic Hospital, Enugu, Nigeria, from January 1993 to December 1999, were sought, and all available case notes reviewed retrospectively. This included new cases seen in the period, and also cases operated during this period. Follow up took place until January 2005, when the data were collated. The records of all such patients seen at Ladoke Akintola University Teaching Hospital Osogbo, Nigeria, from September 2004 to June 2006 were also collated and analysed. During this period, 102 patients were seen (93 at Enugu and nine at Osogbo). Fifteen had isolated cleft palate, 42 had isolated cleft lip and 45 had combined cleft lip and palate. Presentation time ranged from 1 day to 43 years. The palate was not repaired in 20 people after lip repair; two patients with cleft lip and palate completely defaulted; and only one person with isolated cleft palate failed to undergo surgery in this period. Two patients in Osogbo absconded. The West African sub-region has a high drop out rate after lip repair.

Marjolin's Ulcers on the Thigh two Years after Burn.

An 18-yr-old female patient presented to our unit two years after she had sustained a flame burn, with a three-month history of a right thigh scar ulcer. The ulcer had rapidly progressed with involvement of the sciatic nerve and infiltration of the right femur. Biopsy of the ulcer revealed squamous cell carcinoma. The patient however died shortly after admission from an overwhelming sepsis. The rarity of early onset of Marjolin's ulcer and the rapidity of fatality in this case constitute the reasons for presenting this report.

Groin flap for coverage of upper extremity defects in Enugu, Nigeria.

BACKGROUND: Extensive tissue loss of the hand has remained a big challenge to the Plastic and Reconstructive Surgeon. The objective of this study is to review the use of pedicle groin flap for coverage of distal forearm and hand defects in our centre, and to find out problems of using the flap and make suggestions for improvement. METHOD: This is a retrospective study done using case records of patients treated with pedicle groin flaps for upper extremity defects at the National Orthopaedic Hospital Enugu from January 1999 to December 2004 (six year period). Information on biodata, clinical presentation, treatment, complications and outcome was extracted and analyzed using descriptive statistics. RESULTS: Thirteen (13) patient's case files met the inclusion criteria and were analyzed. There were seven (7) males and six (6) females with mean age ranges between 9 years and 42 years. Four (4) had distal forearm and nine (9) hand wound coverage's. Flap survival was very good to excellent in all cases and the outcome quite satisfactory. CONCLUSION: Use of pedicle groin flap for coverage of defects of the hand and distal forearm remains a very valuable treatment option in our environment.

Preliminary reports of autologous blood transfusion in a plastic surgery unit.

We commenced autologous blood transfusion at the plastic surgery unit of the National Orthopaedic Hospital, Enugu, Nigeria in January 2001. Forty-three patients who have so far had autologous blood transfusion up to June 2004 are reviewed. Autologous blood was found to be cheaper than homologous blood with no untoward reactions. We conclude that autologous blood is safe, cheap and should be considered in elective surgical cases.

Pattern of severe electrical injuries in a Nigerian regional burn centre.

BACKGROUND: Electrical injuries, though uncommon usually have devastating consequences. They are largely preventable. The objectives of the study were to highlight the pattern of severe electrical injuries seen in our environment, the management problems faced here compared with other studies and proffer suggestions for improvement and prevention. METHODS: A 10-year retrospective study of case files of patients seen with electrical injuries in our centre was carried out from January 1995 to December 2004. Case notes were retrieved and data collated from them were analysed by descriptive statistics. RESULTS: Twenty four (24) case files met the inclusion criteria and were analysed. Electrical burns constituted 2.8% of total burn admissions. Patients' ages ranged from 15 months to 42 years. Male: Female ratio was 4.8:1. Seven (29%) had high voltage injuries, mostly work-related. Sixteen (67%) had low voltage injuries while one (4%) had a lightening injury. Fourteen (58%) presented or were referred more than 24 hours post injury. Fifteen (63%) had a form of surgical treatment with wound debridement (33%) skin grafting (38%) and amputations (29%) being the commonest ones. The mortality was 12.5% with septicaemia as the leading cause of death. CONCLUSION: Late presentation of patients to specialised centres, inadequate management at the primary centres of treatment, poverty and inadequate facilities even at the specialised centres were the main problems encountered. We recommend re-education of the populace including medical practitioners, enforcement of safety rules in the home and workplaces and upgrading of our health facilities to decrease the menace of severe electrical injuries.

Dog bite of the face in an adult Nigerian--a case report.

BACKGROUND: Dog bite of the face is uncommon in adults. This is, in fact very rare in our environment and presentation of this single case to our centre led to our desire to discuss both the presentation and management of the patient in this paper. METHODS: An adult female Nigerian who had dog bite to her face involving both lips and the commisure is presented. The folder of the patient and the operation note were the sources of the information. RESULTS: She had minimal debridement of the wound with Abbe-Estlander flap cover of the wound. The dog was also placed under surveillance for a period of 2 weeks. The wound healed perfectly with no complication. The involved dog remained healthy 2 weeks after the injury. CONCLUSION: Dog bite of the face, though uncommon, can present in an adult. Sometimes the challenges of reconstruction of such defect could be great. Wound management with minimal debridement and closure gives good results on the face.

Attitude of nurses in a burn unit to hiv/aids burn patients.

The human immunodeficiency virus (HIV) and the acquired immunodeficiency syndrome (AIDS) have constituted a major challenge and concern worldwide. This is especially true among health workers who have to take care of such patients. This paper is aimed at studying the attitude to HIV/AID burn patients of nurses working in a burn unit. The work was carried out at the burns unit of the National Orthopaedics Hospital in Enugu, Nigeria. In a cross-sectional descriptive study, 125 questionnaires were distributed among nurses working in the burn unit. All the 120 nurses who responded were aware of HIV/AIDS: 80.8% of them believed that the prevalence was high, 93.3% that they could be infected while taking care of the patients, 91.5% that all burn patients should be screened for HIV, and 41.4% that their knowledge of the patients' HIV status would affect their professional duty to them; 31.1% would not want to dress the wounds of known HIV/AIDS burn patients. We conclude that there is a need to educate nurses and indeed all health care workers on adherence to universal precaution rather than routine screening for HIV of all burn patients as knowledge of the patients' HIV status may lead to discrimination against them.