Lower limb amputations at a Nigerian private tertiary hospital.

BACKGROUND: Lower Limb amputation remains one of the commonest surgical procedures. The incidence is on the rise in Nigeria due mainly to increasing motorcycle accidents and increased prevalence of uncontrolled diabetes complicated by neuropathy, vasculopathy and diabetic foot gangrene. OBJECTIVE: To determine the pattern and outcome of lower limb amputations in a private tertiary setting. METHODS: This was a 10-year retrospective review of lower limb amputations done at Havana Specialist Hospital (HSH), a multi-specialist private hospital in Lagos, Nigeria. Utilizing theatre and ward records, case notes of patients that had lower limb amputations in the hospital between 1997 and 2006 were studied. RESULTS: A total of 68 lower limb amputations performed on 64 patients were studied. All were closed amputations. Ages 2 to 76 years were affected with a mean of 36.0 +/- 16.2 years and peak age in the 21-30 year group. There were 44 (68.8%) males and 20 (31.2%) females, showing a male to female ratio of 2:2.1. Trauma was the most common indication accounting for 42 (61.8%). Motorcycle related accidents were implicated in 26 (61.9%) of the trauma related cases followed by 8 (19.0%) pedestrians involved in road traffic accidents, while 30 (71.4%) of the patients with trauma had visited traditional bone setters before presenting at the hospital. Below knee amputation was done in 51 (75.0%) of cases and stump wound infection was found in 18 (26.5%). Three (4.7%) patients died. Fifty-five (77.9%) amputation stumps healed by primary intention. Postoperative hospital stay ranged from 21 to 72 days. CONCLUSION: Most lower limb amputations were done on young adult males and were mostly due to trauma, predominantly from motorcycle accidents. Majority of the stumps healed by primary intention. Mortality was highest in diabetic related amputations.

The effects of birth interval on the birthweights of consecutive, same-sex term siblings.

OBJECTIVE: To investigate the effect of birth interval on the relationship between the birthweights of successive siblings. METHODS: The records of women who had delivered two consecutive, same-sex, live, singletons babies (1983 through 1997) in a private hospital were analysed. The intervals between the birth dates of the siblings were calculated. The first of the siblings was coded Set A and the second, Set B. The ratios of the birthweights (Set B/Set A) were calculated. Comparison of findings was made between various ranges of birth interval. RESULTS: The birth interval band 24-29 months was associated with the highest mean birthweight for Set B babies and the highest birthweight ratio (p=0.016). Set A babies weighing less than 3000 g were most likely to be outweighed by their Set B siblings (p=0.000001). CONCLUSION: Birth intervals of 24 to 29 months and small size of Set A babies were associated with most significant advantages in birthweight for Set B siblings.

Uterine incision closure at caesarean section: a randomised comparative study of intraperitoneal closure and closure after temporary exteriorisation.

BACKGROUND: The safety of the technique of uterine exteriorization at caesarean section though popular among obstetricians, remains controversial. OBJECTIVE: To evaluate the influence of exteriorization of uterus during uterine repair on caesarean morbidity. METHODS: A randomized comparative study of 136 women undergoing primary caesarean delivery at Havana Specialist Hospital Lagos Nigeria. Data on operation time, estimated blood loss, postoperative morbidities were collected and analysed with comparison between the two groups using chi square, Fischer's exact test and t-test as appropriate. RESULTS: The mean operative time, estimated blood loss, transfusion rate and postoperative anemia rate were significantly less in the exteriorized group than the intraperitoneal group (p = 0.000, 0.009,0.048 0.038 and 0.028 respectively), but not in other outcome measures. CONCLUSION: With shorter operative time, less blood loss and similar morbidity profile exteriorization of uterus during caesarean section seems to be preferred except where it is not possible because of adhesions and surgeons inexperience.

Emergency peripartum hysterectomy in a Nigerian hospital: a 20-year review.

Postpartum haemorrhage is a major cause of maternal morbidity and mortality and occasionally severe enough to warrant hysterectomy to prevent maternal death. Hysterectomy often is fraught with danger and regular audit is necessary to assist in the reduction of these dangers. A 20-year audit of all emergency peripartum hysterectomies, performed at Havana Specialist hospital Lagos, Nigeria, is reported. Of the 6599 deliveries and peripartum referrals seen during the period, 22 had an emergency hysterectomy as a result of severe postpartum haemorrhage (0.33%). The aetiological factors associated with the postpartum haemorrhage included uterine atony (45.5%), placenta praevia (27.3%), pathologically adherent placenta (18.2%) and ruptured uterus (9.1%). The majority of the procedures were subtotal hysterectomy (81.8%) and the mean operative time was significantly shorter than for total hysterectomy (P<0.05). The postoperative complications included postoperative anaemia (28.6%), febrile morbidity (36.9%), wound infection (19.0%) and urinary tract infection (9.5%), together with three maternal deaths. In conclusion, emergency peripartum hysterectomy, although life-saving, is associated with severe morbidity and mortality and subtotal hysterectomy is usually the operation of choice.

Vaginal misoprostol induction of labour: a Nigerian hospital experience.

We reviewed our experience with vaginal misoprostol induction of labour in 339 consecutive women with a live fetus and intact fetal membrane using 100 mcg 12-hourly until labour was established. The labours were monitored using the WHO partograph protocol. Two hundred and sixty-five women had a successful induction while 74 had an emergency caesarean section because of cephalopelvic disproportion (63.5%), fetal distress (14.9%), prolonged labour (12.2%), antepartum haemorrhage (6.8%) and other indications (2.8%). The induction delivery interval among the women who had successful induction ranged from 3 hours 42 minutes to 26 hours 15 minutes with a mean of 9 hours 23 minutes (SD 2 hours 41 minutes). Most (73.6%) of these patients delivered within 12 hours of starting induction, the majority (95.3%) requiring only 100 mcg to go into established labour. Complications recorded in this series include fetal distress in 32 (9.4%), postpartum haemorrhage in 23 (6.8%), hyperstimulation in six (1.8%), uterine rupture in one (0.3%), birth asphyxia in eight (2.5%), admission in neonatal intensive care ward in five (1.5%), neonatal death in one (0.3%) and maternal death in one (0.3%) patient. In conclusion, misoprostol was found not only to be efficacious but relatively safe in comparison to other methods of induction in use in our hospital.

Prevalence and pattern of domestic violence against pregnant Nigerian women.

Five hundred and twenty-two pregnant Nigerians attending the antenatal clinic in two private hospitals in Lagos between January and June 2003 were interviewed using a structured questionnaire about their experiences of domestic violence. One hundred and four women declined to participate; a response rate of 80.1% was obtained. Analysis of the completed questionnaire by 418 respondents showed that 197 (47.1%) women reported a history of abuse. Of the 197 women who reported abuse, 23 (11.7%) experienced abuse for the first time during the current pregnancy, 97 (49.2%) experienced abuse prior to and during the current pregnancy and in the remaining 77 (39.1%) abuse predate the current pregnancy. A total of 120 (28.7%) women experienced some form of abuse during current pregnancy. Although all social and ethnic groups were involved, no association could be established between prevalence and pattern of abuse and sociodemographic characteristics. Verbal abuse was the most common type of abuse reported (52.3%), followed by economic deprivation (30%), physical abuse (25%), threat of violence (10.8%) and forced sex in 14.2%. The perpetrators of the abuse were husband and boyfriend (78.7%), in-laws (31.5%) and other relations (6.1%). The majority of abused women (99.0%) were not ready to report the abuse to the police. In conclusion, domestic violence is common in our environment and health-care providers should be alert to the clues in order to protect the women from further abuse.

Semen characteristics of the guinea fowl Numida meleagris meleagris.

Eighteen adult exotic Golden Sovereign guinea fowl (Numida meleagris meleagris) males identified by leg bands and housed individually in cages were ejaculated two times a week at 4- and 3-d intervals (Mondays and Thursdays) for 6 wk. Semen was obtained manually by gently massaging the dorso-lateral lumbo-sacral region. Semen collection and evaluation were done between 1400 and 1800 h each day of test. Mean semen volume was 0.032+/-0.001 ml, sperm motility was 37.1+/-0.1% and sperm concentration/ml was 2.62+/-0.01x10(9). Percentage live sperm averaged 91.6+/-0.1, while the mean percentage morphologically normal spermatozoa was 76.9+/-0.5. Primary and secondary sperm abnormalities were 11.9+/-0.2% and 11.3+/-0.2%, respectively. Birds differed significantly in all ejaculate characteristics studied except percent secondary abnormalities, indicating that considerable variation exists for improvement of these semen traits. There were significant bird x collection interval (P<0.05) and birdxweek (P<0.01) interactions for sperm concentration/ml and bird x week interaction for sperm motility (P<0.05). The results generally are within acceptable levels and show that the semen is suitable for use in artificial insemination.

Chemotherapy in the control of urinary schistosomiasis in Nigeria.

Praziquantel (Biltricide, Bayer AG), which has been found to be very effective in the treatment of schistosomiasis, was evaluated to formulate the minimal cost-effective dose in selective chemotherapy of 135 school children aged 6-15 years. Side effects were minimal. The drug had no effect on the heavy load of intestinal helminths found in 78.1% of the subjects. However, it cleared the urinary schistosomiasis in all but 0.9% of the subjects at the dosages used and after 18 months only 0.59% of the entire school population had new infections. The targetted chemotherapy reduced the prevalence rate from 16.0% to 0.59%. The lowest dose of 1 X 20 mg/kg body weight was able to clear the light infections of 52 subjects. This has a great economic advantage because the drug is expensive and most of the infections in Nigeria are light to moderate.

Ijanikin: a study of environmental health in a rural Nigerian community.

Ijanikin is a typical Yoruba village in the rain forest belt area of Southern Nigeria. The childhood years in this community are fraught with the danger of numerous communicable diseases, compounded by inadequate supply of good quality foods to meet normal requirements and allow a margin of safety for the stress of infections. Overcrowding and poor ventilation in the houses are important factors in the spread of communicable diseases, while poor sanitation and deficient personal hygiene account for the heavy burden of intestinal parasitoses. Improvement in the health of this and other similar rural communities would require the provision of clean water supply, installation of essential sanitary facilities, provision of adequate food supply, and a well-planned and carefully executed health education programme.

Effects of buffers on ruminal rate of passage and degradation of soybean meal in steers.

Eight rumen-fistulated steers were randomly assigned to medium- and high-concentrate diets supplemented with 0, .75, 2.5 and 5% of either sodium bicarbonate or an artificial saliva salts mixture. Each animal was fed for 21 d at 75 g dry matter/kg body weight . 75. Rates of soybean meal (SBM) degradation were predicted by adjusting digestion rates in nylon bags with respective passage rates of chromium-mordanted SBM particles. Measures of rumen fermentation were made during the incubation period. Liquid dilution rate was determined with 51Cr-EDTA. The high-concentrate diet produced higher (P less than .05) liquid dilution rates than the medium-concentrate diet, but there were no differences in response to the two buffers (P greater than .05). The liquid dilution rates averaged across diets for 0, .75, 2.5 and 5% levels of buffer were 6.2, 6.3, 8.5 and 8.7%/h (SE = .03) and passage rates for SBM were 5.2, 5.2, 6.5 and 6.7%/h (SE = .025). The 2.5 and 5% levels of buffer increased the rate of disappearance of SBM from the nylon bags and buffers fed at these levels also increased rumen pH and NH3-N concentration. Rumen pH was correlated with N disappearance from the nylon bag (r = .903, P less than .05). Buffer levels did not affect degradation rates of SBM.

Effect of sodium bicarbonate on rate of passage and degradation of soybean meal in postpartum dairy cows.

Effects of sodium bicarbonate on rate of passage and disappearance of soybean meal from the rumen were determined in a change-over experiment with eight cows. Experimental diets containing 50 or 60% roughage were fed over five 21-day periods with four cows per diet. Sodium bicarbonate at 1.0 and 2.5% (diet dry matter) were changed over in periods 2 and 4, whereas periods 1, 3, and 5 served as control. Rate of passage of soybean meal was measured with chromium-mordanted soybean meal and rate of disappearance by nylon bag technique. Effects of diet were similar for all responses. Response to the two percents of buffer was similar for dry matter intake, milk yield, milk fat, and protein. Percent buffer fed was associated positively with ruminal pH and with disappearance of nitrogen from nylon bags. The 0, 1, and 2.5% of buffer resulted in turnover rates of mordanted soybean meal of 8.22, 9.80, and 10.52%/h, but degradation of protein remained relatively constant at 36.0, 38.4, and 38.2%. The influence of rate of passage on ruminal degradability is discussed.

Pancreatic ascites.

A case of pancreatic ascites in an African is presented. It is a rare condition which is rapidly fatal. The diagnosis can be established if the clinician is aware of this condition; the significant finding is a grossly elevated ascitic fluid amylase.

Studies on the etiology and symptomatology of root and storage rot disease of cocoyam in Nigeria.

The losses caused by root and storage rot of cocoyam in Nigeria are estimated as 40 to 45%. Field symptoms of the disease include inhibited growth, leaf chlorosis followed by necrosis and shrivelling of affected parts, and finally premature death of the aerial portions of the plant. A large proportion of the roots are destroyed. Poor production of cormels and reduced corm size are other field symptoms of the disease, differing according to the type of causal agent. Botryodiplodia theobromae, Fusarium solani, F. moniliforme, and Sclerotium rolfsii were isolated from diseased corms, occurring single or in mixed infection. All isolated fungi proved pathogenous on Xantbosoma spec. as well as on Colocasia spec., with Colocasia exhibiting greater damages. Three types of rot are suggested for classification of cocoyam rot in Nigeria: black rot, Fusarium rot, Sclerotium rot.

Amoebic abscess in the cirrhotic liver.

Though amoebic liver abscess and liver cirrhosis occur very commonly in hospital practice in the tropics, they have not to the knowledge of the present authors hitherto been reported to occur simultaneously in the same patient. The patient described here, who had clear-cut clinical and histological features of chronic liver cirrhosis with portal hypertension and ascites, presented somewhat acutely with liver pain and an amoebic liver abscess that contained 'chocolate sauce' on needle aspiration. The amoebic abscess, although, no doubt, superimposed on chronic irreversible cirrhosis, rapidly regressed on metronidazole therapy. The infrequency with which liver abscess and liver cirrhosis coexist cannot be satisfactorily explained. It is probable, however, that extensive scarring in the liver may prevent entamoeba histolytica from thriving.