Efficacy of prophylactic use of intraoperative vancomycin powder in preventing surgical site infection in neurological surgeries in Irrua, Nigeria: A randomized controlled study.

PURPOSE: The objective was to determine the efficacy of intraoperative vancomycin powder in preventing SSIs in neurological surgeries. METHODS: A prospective randomized controlled study of patients who had clean cranial and non-implant spine surgeries at the Irrua Specialist Teaching Hospital, Irrua, Nigeria from February 1, 2021 to January 31, 2022. Patients were randomized into two groups. Group A patients had prophylactic intraoperative vancomycin powder applied to the surgical bed before wound closure while group B patients did not. Patients in both groups were followed up for 30 days post-operatively for evidence of SSI. The occurrence of SSIs was determined using clinical and laboratory parameters. Baseline characteristics, operative details, rates of wound infection, and microbiological data for each case were recorded. Data was analyzed using Statistical Package for Scientific Solution (SPSS) version 23 software. RESULTS: Forty-two patients were randomized into 2 groups of 21 patients each. The age range of the patients was 20 to 80 years. The majority of the patients were males (32 out of 42). The mean age of patients in group A was 48.05 ± 17.03 years, while group B had a mean age of 45.95 ± 19.14 years. The mean Body Mass Index of patients in groups A and B were 23.92 ± 5.21 and 23.21 ± 3.99 respectively. Seven out of 21 patients (33.3 %) in the control group ( group B) had superficial SSIs while no patient in the experimental group had SSI, p-value < 0.05. The organisms cultured were Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus. CONCLUSION: Intraoperative vancomycin powder was effective in reducing the rate of SSIs following neurological surgeries and without adverse drug reactions.

Results of open wound technique in the treatment of post-sequestrectomy dead space.

BACKGROUND AND METHOD: Severe chronic osteomyelitis with variable outcomes is still common among children in developing nations. There has been no consensus on the optimal method of treatment. We therefore prospectively evaluated the rates of wound healing and recurrence following open wound treatment of post-sequestrectomy dead spaces in 30 patients with haematogenous chronic osteomyelitis of the tibial shaft at the King Orthopaedic Clinic, Ekpoma, Edo State, Nigeria, between January 2001 and December 2005. Thirty similar patients whose post-sequestrectomy dead spaces were treated by closed wound technique formed the control group. Both groups were subjected to standard methods of perioperative management. Saucerisation, sequestrectomy and curettage were the cornerstones of surgical therapy. The wounds were primarily either left open (study group) or closed (control group). The rates of wound healing and recurrence were used to assess the outcome of treatment. The chi-square test was used for statistical analysis. RESULTS: The median age was 13 years, with a range of 6 - 60 years. Staphylococcus aureus was the organism most commonly associated with chronic osteomyelitis. Rates of wound healing and recurrence in the study group were significantly better than in the control group (p<0.05), even though it took a relatively longer period to achieve healing with the open method of treatment. The follow-up period ranged from 1 to 5 years, with a median of 2 years. CONCLUSION: We observed that the results of the open method of treating post-sequestrectomy dead spaces were good, and we advocate its use in resource-poor settings.

Results of Open Wound Technique in the Treatment of Post-Sequestrectomy Dead Space

BACKGROUND AND METHOD. Severe chronic osteomyelitis with variable outcomes is still common among children in developing nations. There has been no consensus on the optimal method of treatment. We therefore prospectively evaluated the rates of wound healing and recurrence following open wound treatment of post-sequestrectomy dead spaces in 30 patients with haematogenous chronic osteomyelitis of the tibial shaft at the King Orthopaedic Clinic; Ekpoma; Edo State; Nigeria; between January 2001 and December 2005. Thirty similar patients whose post-sequestrectomy dead spaces were treated by closed wound technique formed the control group. Both groups were subjected to standard methods of perioperative management. Saucerisation; sequestrectomy and curettage were the cornerstones of surgical therapy. The wounds were primarily either left open (study group) or closed (control group). The rates of wound healing and recurrence were used to assess the outcome of treatment. The chi-squaretest was used for statistical analysis. RESULT. The median age was 13 years; with a range of 6 - 60 years. Staphylococcus aureus was the organism most commonly associated with chronic osteomyelitis. Rates of wound healing and recurrence in the study group were significantly better than in the control group (p0.05); eventhough it took a relatively longer period to achieve healing with the open method of treatment. The follow-up period ranged from 1 to 5 years; with a median of 2 years.CONCLUSION. We observed that the results of the open method of treating post-sequestrectomy dead spaces were good; and we advocate its use in resource-poor settings

A prospective evaluation of the diagnostic value of sinus specimen cultures in chronic osteomyelitis.

We prospectively compared organisms isolated from sinus and bone marrow specimens in 25 patients with chronic osteomyelitis at the King Orthopaedic Clinic, Ekpoma, Edo State, Nigeria between January 2001 and December 2003. Sinus and bone marrow specimens were taken from each patient at the time of surgery and sent for aerobic cultures. The mean age was 12 years, with a range of 6-40 years. Staphylococcus aureus was the commonest organism associated with chronic osteomyelitis. Organisms isolated from the sinus specimens were similar to those obtained from the bone marrow specimens. Sinus specimen culture is a good guide to selection of antibiotics in the preoperative treatment of chronic osteomyelitis.

Pattern of civilian gunshot injuries in Irrua; Nigeria : trauma

This retrospective review of 76 patients with gunshot wounds was undertaken to evaluate the pattern and outcome of civilian gunshot injuries in our region. The extremities were the most commonly affected site (51.5of all gunshot wounds). Gunshot injuries were most common among young males in the third decade of life; and armed robbery was the cause of gunshot trauma in 69.7of cases. Time from injury to arrival at hospital was less than 6 hours in 64.4of cases. Wound exploration and debridement were the mode of treatment in the majority of cases. Hypovolaemia resulting from acute haemorrhage accounted for 52.9of complications. The mortality rate was 5.3. It is pertinent to observe that inefficient firearm control is a major factor contributing to civilian gunshot injuries in our region. In addition; high rates of unemployment and poverty in our society may be contributing to the increasing incidence of youth restiveness; armed robbery and associated gunshot injuries. Strong government legislation is required to provide adequate security for the teeming civilian population. The national government should embark on a poverty eradication strategy and engage the youth in gainful employment to reduce the incidence of youth restiveness; armed robbery and firearm-related violence

Pattern of civilian gunshot injuries in Irrua, Nigeria.

This retrospective review of 76 patients with gunshot wounds was undertaken to evaluate the pattern and outcome of civilian gunshot injuries in our region. The extremities were the most commonly affected site (51.5% of all gunshot wounds). Gunshot injuries were most common among young males in the third decade of life, and armed robbery was the cause of gunshot trauma in 69.7% of cases. Time from injury to arrival at hospital was less than 6 hours in 64.4% of cases. Wound exploration and debridement were the mode of treatment in the majority of cases. Hypovolaemia resulting from acute haemorrhage accounted for 52.9% of complications. The mortality rate was 5.3%. It is pertinent to observe that inefficient firearm control is a major factor contributing to civilian gunshot injuries in our region. In addition, high rates of unemployment and poverty in our society may be contributing to the increasing incidence of youth restiveness, armed robbery and associated gunshot injuries. Strong government legislation is required to provide adequate security for the teeming civilian population. The national government should embark on a poverty eradication strategy and engage the youth in gainful employment to reduce the incidence of youth restiveness, armed robbery and firearm-related violence.

The role of the traditional bonesetter in primary fracture care in Nigeria.

BACKGROUND: In view of the growing interest in the management of fracture worldwide, the traditional bonesetter (TBS) practice in Nigeria was documented. OBJECTIVE: To highlight the role of the TBS in primary fracture care in Nigeria. SETTING: Rural. STUDY DESIGN: Over a 5-year period a qualitative study of the TBS settings and knowledge, diagnostic techniques and principles of fracture treatment in four TBS centres in Nigeria was carried out by active participation, on the spot assessment, interactive dialogues and oral interviews. RESULTS: It was found that TBS services are well preserved as a family practice, and training is by apprenticeship. Records are kept by oral tradition. There is no prescribed fee and the patronage is high. Fracture diagnosis is based on physical assessment and experience. The TBS relies solely on the conservative method of fracture treatment, and all fractures are reduced by the closed method and stabilised with an external traditional splint and a protracted period of immobilisation. The outcome of TBS treatment is good for closed fractures of the shaft of the humerus, ulna, radius and tibia, but poor for peri-articular and open fractures. Non-union, malunion, traumatic osteomyelitis and limb gangrene were the common major complications of TBS treatment. CONCLUSION: Despite criticisms and antagonism from orthodox medical practitioners TBS practice is well patronised by Nigerians. In order to guarantee safety and efficiency of the TBS practice in primary fracture care service delivery in Nigeria, there is therefore a need both to educate the community and to train the TBS.

A prospective evaluation of Medizip in Nigeria.

In a one year period between April, 1997 and March 1998 we have carried out a randomized controlled prospective study to evaluate the outcome of Medizip Surgical Zipper technique in closing 50 surgical wounds in Nigeria. There were similar sex, age and wound distribution between the Medizip study group and the conventional (needle and thread) control group. The cosmetic outcome of scar was rated as good or bad. It was good if the emerging scar was a thin linear (< or = 2 mm wide) scar, and bad if the scar was a broad flat (> 2 mm wide) or a heap-up (hypertrophic or keloidal) scar. The cosmetic outcome of scar was good in 45 (90%) of the Medizip study group as compared with 22 (44%) of the conventional control group. The observed difference between the two groups was statistically significant (P < 0.05). We observed superficial wound infection in one (2%) of the Medizip study group as compared with 10 (20%) of the conventional control group. The results of our study clearly demonstrated that the use of Medizip surgical Zipper would be a superior technique of closing surgical wounds in terms of the cosmetic outcome of scars and associated problems.

Major amputations in Nigeria: a plea to educate traditional bone setters.

A study was made of 100 major amputations performed on 96 patients in two regional hospitals in a 10-year period in Nigeria. The objective of the study was to evaluate the outcome of major amputations in Nigeria. The median age of patients was 30 years with male to female ratio 3:1. Ninety of the 100 major amputations involved the lower limbs with the above-the-knee/elbow-the-knee ratio of 0.5. Trauma was the leading indication for 70 amputations, of these 60 were iatrogenic resulting from mismanaged fractures by the traditional bone setters. The non-traumatic indications were: diabetic limb gangrene (20); bone malignancies (9); and vascular insufficiency (1). Provisional amputation was offered in 60 cases, of these 10 had reamputation. There were eight (8.5%) mortalities. The functional outcome for this group was discouraging. Only 25 amputees affording successful prosthetic fitting and social rehabilitation. Major amputation in Nigeria foreshadows a dismal existence and emphasizes the need for health policies which are effective in controlling the risk factors.

Traditional bone setter's gangrene.

Traditional bone setter's gangrene (TBSG) is the term we use to describe the sequelae sometimes seen after treatment with native fracture splints. Twenty five consecutive complications were recorded in 25 patients aged between 5-50 years with a median age of 10 years. The major complication of the native fracture splint treatment was distal limb gangrene necessitating proximal amputations in 15 cases.

Active prophylactic management of respiratory obstruction after standard thyroidectomy for giant goitre in the middle belt region of Nigeria.

Respiratory obstruction is a lethal complication of thyroidectomy for giant goitre. Prophylactic tracheal splintage by retaining the endotracheal tube in situ for 24 h post-operatively and its meticulous management in the intensive care unit (ICU) is a safe and rewarding practice. Over a 7-year period, 33 patients, all women who had standard thyroidectomy for giant goitre were managed accordingly. There was no incidence of post-operative respiratory distress, nor mortality in the series. The average duration of stay in ICU was 2 days for all patients and the average hospital stay was 6 days for 27 of the 33 patients (81.8%). We suggest that judicious post-thyroidectomy management of giant goitre patients in ICU with endotracheal tube in situ for 24 h improves their survival chances.

Dyspepsias among the highlanders of Nigeria: an epidemiological survey.

An epidemiological survey of the dyspepsias in a Nigerian Community drawn from five different local government areas, is described. Analysis of the data obtained from 1,151 respondents (684 males and 467 females) showed that 45.0% of this population had complaints of dyspepsia within the immediate six months period preceeding this study. The relevance of the independent variables as age, sex, marital status, family size, place of abode, number of meals per day, type of staple food consumed, self-medication and presence of melaena stool to the prevalence of dyspepsia was statistically analysed using the Chi-square test method. The family size (P < 0.05), occupational scatter (P < 0.001), type of staple food consumed (P < 0.05), presence of melaena stool (P < 0.01) and indulgence in self-medication (P < 0.001) were found to be the most significant variables. Since the vast majority of subjects with complaints of dyspepsia are to be encountered by general practitioners at the Primary Health Care level, it is hoped that the findings will go a long way towards evolving a more meaningful management strategy for this subset of subjects.

Diabetic Foot Gangrene

Over a 5-year period; 1987 to 1991; 108 patients with foot gangrene were treated at the National Orthopaedic; Enugu. Out of these; 30 were diabetics; 12 of them being diagnosed on admission. Diabetic control; wound care and amputation constituted the treatment regimen. Amputations were peformed in 66.7of the cases. Patients ignorant of their diabetic status before admission had the worst prognosis. There was 33 percent mortality. This can be bettered with health education; including better awareness among doctors in peripheral hospitals