Body size and abnormal lipids among adult patients at the Baptist Medical centre, Ogbomoso, Nigeria.

BACKGROUND: In many developing countries overweight, obesity and obesity-related morbidity are becoming a problem of increasing importance. Obese individuals are more likely to have elevated total cholesterol, triglycerides, low density lipoprotein (LDL) cholesterol and decreased high density lipoprotein (HDL) cholesterol. OBJECTIVE: To determine the prevalence of obesity using the measure of body mass index (BMI) and abnormal lipid level and the association between obesity and abnormal lipid level among adults in Ogbomoso, Nigeria. METHODS: A cross-sectional descriptive study of 400 adults aged 18 years and above was carried out at the Baptist Medical Centre, Ogbomoso, Nigeria. Participants were administered a standardized questionnaire and had measurements of weight, height and blood lipids taken. RESULTS: Four hundred subjects were randomly selected (221 females and 179 males) with a mean age of 48.65 ± 16.56 years. The overall prevalence of obesity was 14.75% (8.9% for males and 19.5% for females p<0.05). The female subjects were significantly more sedentary than the males (50.8% for males, 62.4% for females, p<0.05). Most of the subjects who were obese (88.1%) preferred high calorie food. The overall prevalence of abnormal lipid levels was 28.5% (26.8% for males and 29.9% for females). The prevalence of abnormal lipid levels among the subjects who were obese was 40.7%. CONCLUSION: Obesity in this environment is particularly significant among females and is associated with abnormal lipid level.

Gram stain microbiological pattern of upper extremities suppuration at Baptist Medical Centre, Ogbomoso Nigeria: a fifteen month review.

Sixty-eight (68) patients with serious upper extremity suppurative infections, presenting within a period of fifteen (15) months, were prospectively studied clinically, Gram stain of aspirates/pus were performed, specimen cultured, planted, and where indicated glucose levels and haemoglobin genotype determined. Half of the patients had hand infections. Staphylococcus aureus was isolated from thirty-nine (39) patients. Gram Negative bacilli, including Salmonella were more isolated from patients with diabetes mellitus or Hgb SS or SC. The Gram stain results correlated with the culture result 90%. When Gram Positive cocci were demonstrated in the primary microscopic examination, cultures were not mandatory. When no organism was demonstrated on primary Gram stain or the patient was diabetic or a sickler, cultures of the specimens were done. The Gram stain, well performed, remains a useful, inexpensive, technologically appropriate laboratory test for abetting decision making in patients with upper extremity suppurative infections. Organisms encountered in this study included: Staphylococcus aureus, Streptococcus pyogenes, Salmonella typhi, Proteus mirabilis, Pseudomonas aeruginosa, and Coliforms.

Complications of fracture treatment by traditional bonesetters in southwest Nigeria.

BACKGROUND: Traditional bonesetters (TBS) practice widely in Nigeria. OBJECTIVE: Our aim was to evaluate the types of complications seen in patients previously treated by TBS and to assess factors that may predispose to the complications. METHODS: We carried out a prospective non-randomized controlled study in a general hospital in southwest Nigeria. All patients brought into the hospital over the 10-month study period with fractures who had been treated previously by a TBS and, as a control, all patients brought directly to and treated by us were studied. Each patient was assessed and prescribed the most appropriate treatment for their fracture: reduction, immobilization (operatively and otherwise) and physiotherapy. Malunion, non-union, delayed union, gangrene, stiffness of joints and loss of joint motion, Volkman's ischaemic contracture and tetanus were all investigated. RESULTS: Over half of the patients in the TBS subgroup had malunion, and a quarter had non-union. Only one out of the 36 (2.8%) had no complaints and was satisfied with the outcome of treatment of his fractures by the TBS. In the orthodox subgroup, there were seven complications as a result of treatment of a total of 49 bones (14%). Most of the complications involved the loss of joint motion. CONCLUSIONS: There were no statistically significant associations between the complications recorded and the ages of the patients, types of bone fractured or the duration of treatment in patients who were in the TBS subgroup. The introduction of a health insurance scheme in Nigeria may make it easier for individuals and families to be able to afford proper fracture treatment in hospitals.

Amputations in general practice.

A retrospective review was carried out, of cases of amputation, which were performed between 1985 and 1999 at the Baptist Medical Centre, Ogbomoso with the aims of documenting our experience and complications. The majority of the operations were performed by trainee family practitioners. There was a preponderance of males (M/F ratio of 1.89:1) and over half of the patients were between 21 and 50 years of age. Most of the patients were admitted for trauma and most of them underwent a two stage operation. Slightly less than half of the amputations performed were below knee amputation (BKA). Eleven patients died, 6 of whom were diabetics (55%). It is recommended that medical practitioners be aggressive with wound care, especially in diabetics and that special attention be paid to the foot hygiene of these patients in order to prevent limb loss.

Prospective randomized comparison of two preoperative skin preparation techniques in a developing world country.

Povidone-iodine (PI) is a scarce and expensive item for some hospitals in developing countries. This prospective, randomized study was performed at Baptist Medical Centre (BMCO) in Ogbomoso, Nigeria to determine if the use of PI for preoperative skin preparation would result in a lower postoperative wound infection rate and to identify other factors influencing the infection rate. Two hundred patients undergoing inguinal hernia repair were randomized to receive skin preparation with either: (1) locally available, inexpensive market soap and methylated spirit or (2) imported PI. The two groups were equally stratified. The overall postoperative wound infection rate was 5.5%, and there was no significant difference between the groups (5.1% vs. 5.9%). Factors that did not affect the infection rate included gender, age, type of anesthesia, type or duration of the operative procedure, and number of breaks in optimal technique. There were eight abscesses and three cases of cellulitis without suppuration diagnosed an average of 10 days postoperatively. Staphylococcus was the only bacterium identified on Gram stain or culture. The expense of procuring PI is not justified at BMCO. Available funds may better be used for preoperative antibiotics or for improvement in hospital infrastructure, which should result in fewer breaks in optimal operating room technique.

Incidence of umbilical hernia in African children: redefinition of "normal" and reevaluation of indications for repair.

This study was undertaken to assess the degree of ubiquity of umbilical hernias (UHs) in Nigerians and to determine if a laissez faire approach to the presence of UHs is justified. A prospective evaluation was conducted of the umbilical area of 4052 Nigerians living in the vicinity of the Baptist Medical Centre (BMCO) in Ogbomoso, Nigeria. The diameter of the fascial defect was measured with the subject supine and the protrusion of the umbilical skin with the subject erect. Subjects were divided into three groups: group 1 (1 month to 18 years old); group 2 (older than 18 years); and group 3 (pregnant women in an antenatal clinic). "Outies" (defined as any protrusion of the umbilical tip past the periumbilical skin) were present in 92% of group 1, 49% of group 2, and 90% of group 3 subjects. UHs (defined as protrusion of at least 5 mm and diameter of at least 10 mm) were present in 23% of group 1, 8% of group 2, and 15% of group 3 subjects. Spontaneous closure of UHs seems to occur until age 14. A retrospective analysis identified 11 patients undergoing emergency operations for UH-related problems during the past 15 years. With a low incidence and 0% mortality rate associated with management of these emergencies, a policy of prophylactic repair is not justified at BMCO. Because most of the children we examined had outies, repair for cosmetic reasons is rarely requested. The only logical indication for repair of UHs at BMCO is incarceration, and this rarely occurs.

Gastric outlet obstruction in Ogbomoso, Nigeria.

Forty-three patients were operated upon for gastric outlet obstruction over an eight year period. Six (14%) of these patients bad malignant gastric outlet obstruction. Three groups of procedures were used: truncal vagotomy and drainage (TV-D) in 32 patients, highly selective vagotomy and drainage (HSV-I)) in 8 patients, and gastric resection with or without vagotomy in 3 patients. Post-operatively, it took an average of 6.6 days for patients to recommence oral intake (6.2 days for patients who underwent truncal vagotomy and 8.5 days for those who underwent highly selective vagotomy). There were no deaths; immediate post-operative morbidity included gastric atony in 21% and wound infection in 7% of the patients. Long-term complications include postvagotomy diarrhea in one patient and dumping in two patients. One patient had a recurrence of gastric outlet obstruction necessitating re-operation.

Operative management of thyroid abnormalities in a general medical practice hospital in sub-Saharan Africa.

This is a retrospective analysis of 82 patients undergoing thyroid operations in a general medical practice hospital in sub-Saharan Africa. All patients complained of neck swelling, and in 75% of patients this was the only symptom. Indications for operation included cosmesis in 74%, suspected malignancy in 13%, hyperthyroidism in 7% and pressure symptoms in 5%. Operative complications included recurrent laryngeal nerve injury in two (2.4%), wound haematoma in two (2.4%), wound infection in three (3.6%) and hypoparathyroidism in one (1.2%). There were no deaths and no instances of thyroid storm. Thyromegaly can be operatively managed in a hospital such as ours with a relatively low morbidity rate using conservative gland extirpation techniques. This conservative approach may result in under treatment for thyroid malignancies but should result in a lower incidence of recurrent nerve damage and hypoparathyroidism in the majority of people who undergo thyroidectomy solely for cosmetic indications.

Ketamine : A safe and effective anesthetic agent for children in the developing world.

Ketamine is used extensively in the developing world (DW) because of its effectiveness, availability, relatively low cost, and presumed safety. This report is a prospective, objective assessment of the efficacy and safety of ketamine when used as the sole anesthetic agent in a general medical practice hospital in the DW in children less than 16 years of age undergoing nonemergent operative procedures. Children undergoing laparotomy, thoracotomy, or craniotomy were excluded. Data analysis included serial arterial hemoglobin saturation (SpO2) and pulse rate, amount of ketamine utilized, adequacy of anesthesia, and perioperative complications. One hundred thirty-one children undergoing a total of 210 anesthetics were studied. The level of anesthesia was adequate in all cases. The SpO2 dropped below 90% in 40 (19%) children, below 85% in 25 (12%), and below 80% in 13 (6%). SpO2 drops occurred significantly (P = 0.004) more often after IM than after IV injection. All drops in SpO2 were abrupt without premonitory signs. Thirty-three (82.5%) of these 40 children responded readily to airway manipulation with a jaw thrust, and only 7 (3.3% of the total series) required face-mask O2. None required intubation or positive-pressure ventilation. Transient laryngospasm occurred in 1 child, but there were no other complications. In particular, there was no mortality, apnea, emesis, excessive salivation, or significant early or delayed emergence phenomena. Ketamine is quite effective when used as the sole anesthetic agent in DW children. It is relatively safe, but hypoxemia may go undetected unless technologically sophisticated monitoring equipment is available. Proper suction and ventilatory support equipment should be readily available prior to ketamine injection. The first step when hypoxemia is detected is simple airway manipulation, followed by oxygen administration by face mask if needed. Rarely will intubation be indicated. Ketamine is also a good drug for the management of pediatric emergency department procedures in the United States, but all children in these more developed centers should be monitored with a pulse oximeter, since a significant number of children have a precipitous drop in SpO2.

The outcome of suprapubic prostatectomy: a contemporary series in the developing world.

OBJECTIVES: To assess the appropriateness of the technique of suprapubic prostatectomy using a removable bladder neck partition suture for use in a developing world hospital and to provide contemporary open prostatectomy outcome data currently lacking in the world's literature. METHODS: From 1984 to 1994, 240 consecutive patients presenting to a developing world hospital with acute urinary retention underwent suprapubic prostatectomy using a removable bladder neck partition suture. The average length of time from bladder decompression until operation was 2.5 months. The outcome of these cases was retrospectively analyzed. RESULTS: The overall early complication rate was 19.6%. There were no deaths. The transfusion rate was 4.6%. Clot retention occurred in 6.7%, and 2.9% required return to the operating room for evaluation. For the second half of the series, the early complication rate decreased to 8.3%, the clot retention rate to 0.8%, and the transfusion rate to 1.7%. Other early and late complications were minimal. The length of delay from decompression until operation did not affect outcome. CONCLUSIONS: The technique of suprapubic prostatectomy using a removable bladder neck partition suture is appropriate for use in developing world hospitals because of its low morbidity and mortality rates. The outcome in this contemporary series of open prostatectomy cases compares favorably with the outcome from reported contemporary transurethral resection of the prostate (TURP) series. These data demonstrate that suprapubic prostatectomy is an acceptable option when the patient's anatomy or the state of local medical facilities precludes TURP.