Experience in the management of the mass casualty from the January 2010 Jos Crisis.

BACKGROUND: On the 17 of January 2010, a sectarian crisis broke out in Jos the capital of Plateau state, Nigeria. It created a mass casualty situation in the Jos University Teaching Hospital. We present the result of the hospital management of that mass casualty incident. OBJECTIVE: To share our experience in the management of the mass casualty situation arising from the sectarian crisis of Jos in January 2010. METHODOLOGY: We retrospectively reviewed the hospital records of patients who were treated in our hospital with injuries sustained in the Jos crisis of January 2010. RESULTS: A total of 168 patients presented over a four day period. There were 108 males (64.3%) and 60 females (35.7%). The mean age was 26 ± 16 years. Injury was caused by gunshots in 68 patients (40.5%), machete in 56 (33.3%), falls in 22 (13.1%) and burning in 21 (13.1%). The body parts injured were the upper limbs in 61(36.3%) patients, lower limbs 44 (26.2%) and scalp 43 (25.6%). Majority, 125 (74.4%) did not require formal operative care. Fourteen (8.3%) patients had complications out of which 10 (6.0%) were related to infections. There were 5 (3.1%) hospital mortalities and the mean duration of hospital stay was 4.2 days. The hospital operations returned to routine 24 hours after the last patient was brought in. As a result of changes made to our protocol, management proceeded smoothly and there was no stoppage of the hospital response at any point. CONCLUSION: This civil crisis involved mostly young males. Injuries were mainly lacerations from machete and gunshot injuries. Majority of the victims did not require formal surgical operations beyond initial care. Maintaining continuity in the positions of the Incident commander and the mass casualty commander ensure a smooth disaster response with fewer challenges.

IMPALEMENT HEAD INJURY WITH A SPEAR.

Impalement injuries to the craniofacial region are uncommon due to the fact that the face is a smaller target in relation to the rest of the body. We report a case of a 26-year old man who was attacked on the face with a spear. He was promptly evaluated and resuscitated; the blade of the spear was successfully extracted under general anaesthesia. He was discharged home after 2 weeks hospitalization; he has been followed up for three months with good outcome.

Otomycosis in Jos: Predisposing factors and Management.

BACKGROUND: Otomycosis is a challenging and frustrating common Otologic condition to both patients and managing clinician. This fungal infection most often involves the squamous epithelium of the external auditory canal and is; characterized by pruritus, occasional otalgia and hypoacusis. OBJECTIVES: To highlight the predisposing factors and management of Otomycosis in our center. STUDY DESIGN: Retrospective review of 35 patients with a clinical diagnosis of otomycosis treated from January 2012 to March 2013. SETTING: The study was carried out at the Jos University Teaching Hospital, in the outpatient clinic of the department of Ear Nose Throat & Head. PARTICIPANTS: Thirty-five patients diagnosed with otomycosis had their medical data analyzed for this study. INTERVENTION: Antifungal eardrop was used for dressing the ears. RESULT: 35 patients were seen within 15 months period (Jan. 2012- Mar. 2013). There were 11 males: 24 females given a gender ratio of 1:2.1. The commonest age group involved was 41-50(25.71%). There were 13, 10 and 6 cases of right, left and bilateral cases of Otomycosis m respectively. 16 cases were seen during the wet season and 19 cases during the dry season. In terms of occupation, house wives and civil servants constitute 28.60 and 17.15 % respectively. Diabetic mellitus was noted in1 (2.86%) patient. CONCLUSION: The predisposing conditions for Otomycosis are present in Jos environment and can usually be diagnosed by clinical examination. This study suggested that otomycosis found are predominantly unilateral, more common in older age group, in female mainly housewives, civil servants and Candida species is the most common causative organism implicated in causation of otomycosis and treated with clotimazole containing drugs. Discontinuation of antifungal agent is most appropriate in antibiotic induced otomycosis.

Traumatic Intracranial Aerocele With Progressive Blindness - A case report.

BACKGROUND: Traumatic intracranial aerocele, also known as pneumocephalus, is an uncommon condition that may be asymptomatic or may present with progressive neurological deficits and life threatening conditions that demand urgent decompressive craniotomy to reduce the acute rise in intracranial pressure and the sequelae. AIMS & OBJECTIVES: A high degree of suspicion and continuous neurological monitoring are essential for the early detection and the prompt neurosurgical intervention demanded for the achievement of a good outcome in patients following traumatic acute severe head injury with life threatening neurological complications. METHOD: Presentation of a young motorcyclist who was not wearing a crash helmet and was involved in a road traffic accident in which he sustained a compound cranio-facial injury with loss of consciousness and symptomatic intracranial aerocele. RESULTS: The case of a 28-year old motorcyclist without a helmet, following a road traffic accident, sustained compound skull fracture with CSF rhinorrhea, ventricular aerocele and progressive blindness who recovered his vision fully following bitemporal decompressive craniotomy. CONCLUSION: A high index of suspicion enabled early detection and prompt decompressive craniotomy that stemmed the progressive loss of vision in this patient with an uncommon but symptomatic intracranial aerocele and cranio-facial compound head injury.

Swab and aspiration specimen collection methods and antibiogram in chronic suppurative otitis media at Jos University Teaching Hospital: Which is superior?

BACKGROUND: Chronic suppurative otitis media is a very common otologic problem in our environment. Appropriate methods for obtaining sample specimens for specific bacteria isolation has generated a lot of controversy. The simplest method available in our environment is the traditional swab method which, however, has been condemned on the basis of introducing contaminants. The objectives of this study were to compare the bacterial yield and the antibiogram of two specimen collection methods: the traditional swab method and aspiration method. METHOD: This was a 3-month prospective study involving outpatients seen at both the emergency and outpatients' clinics of the Jos University Teaching Hospital in the period between May 2008 and July 2008. The biodata, duration of discharge and sites of samples were recorded in the study data form after obtaining consent from the patients or the parents of child. RESULTS: Eighty patients were studied comprising 40 each for aspiration and swab technique. This consists of 30 males (37.5%) and 50 females (62.5%) with a male to female ratio of 1:1.7. There were 24 (30%) children (14 males, 10 females). Six (4 males, 2 females) and 74 (26 males, 48 females) patients had bilateral and unilateral ear discharges, respectively. A total of 86 specimens were obtained in all, consisting of 42 left and 44 right ears. There were 68 bacteria isolates comprising Pseudomonas (30), Staphylococcus (18), Proteus (12), and (8) Klebsiella species. Two were incidental fungal isolates of (Candida species), (8) cultures grew contaminants and (10) specimens had no growth at all. Each of the swab and aspiration techniques had (44) specimens. CONCLUSIONS: Despite the controversy surrounding the sampling technique in literature, swab technique has been found to be as good as the aspiration technique in our study. The organisms isolated are the same as those obtained in other places. Contaminants found were few and occurred in equal amount in the same patients in the two methods.

Experience with rigid esophagoscopy in Jos, north-central Nigeria.

OBJECTIVE: Esophagoscopy which may be done for either a therapeutic or diagnostic reason has remained useful in the management of esophageal diseases. This study evaluates our experience with rigid esophagoscopy with special emphasis on esophageal foreign bodies in our unit. METHOD: This is a six-year (January 2000-December 2005) retrospective review of cases of rigid esophagoscopy in the Ear, Nose and Throat Unit of our center. RESULTS: Fifty-seven patients with ages ranging from 10 months 75 years were studied. There were 35 (61.4%) males and 22 (38.6%) females. Fifty-three of the patients (93%) had varying foreign bodies in the esophagus, 3 (5.2%) patients had carcinoma of the esophagus while 1 (1.8%) had pharyngeal pouch. The 0-10 year age group had the highest prevalence of esophageal foreign bodies (66.0%) with the middle third of the esophagus been the commonest site of impaction (58.5%). There was no fatality recorded. CONCLUSION: Rigid esophagoscopy is a relatively safe procedure in trained hands and ideal environment with the necessary facilities in place.

Cervical necrotizing fasciitis: case series and review of literature.

INTRODUCTION: Cervical necrotizing fasciitis is a fatal and rapid multi- bacteria infection causing extensive necrosis of the subcutaneous tissues and fascial planes with resultant skin gangrene and associated systemic manifestation. The aim of the present study is to report four cases of cervical necrotizing fascitis highlighting their source. METHOD: The case notes of the patients were retrieved and reviewed, literature search was done using Medline, journals available and various texts. RESULTS: Most often the cause of cervical necrotizing fascitis is of dental origin. The diagnosis depends mainly on clinical features and a high index of suspicion because the clinical features maybe innocuous at the early stage. CONCLUSION: Despite aggressive management with liberal wound debridement, intravenous antibiotics, and nutritional support, the mortality was still high due to late presentation.

An unusual oronasal foreign body: report of a case.

BACKGROUND: Foreign body removal in children is very common in the daily routine of an otolaryngologist but reports of oronasal foreign bodies and their management are rare. METHOD: The case note of a 5-year-old female child presenting with an oronasal foreign body following a domestic accident was retrieved and studied and followed up. RESULT: a 5-year-old female child with an oronasal foreign body which created an oronasal fistula that was closed with local palatal mucoperiosteal-lined flaps. The patient defaulted following treatment, a common practice by patients in our society. CONCLUSION: This report highlights the occurrence of this rare condition, its management and the need to put measures in place to prevent domestic accidents especially for those most at risk.

Day case adenotonsiletomy: experience of two private clinics in Nigeria.

BACKGROUND: adenoidectomy and tonsillectomy are among the common surgeries perform in children in otorhinoryngological practice. It was the aim of this study to evaluate the post operative mobility in patients undergoing day-case adenoidedtomy/tonsillectomy or adenotonsillectomy. METHODOLOGY: All pediatrics cases requiring adenoidectomy, tonsillectomy or both who presented at HANSA clinics Enugu (January 1990 to June 2004) and GENIKS specialist clinics Ibadan (January 2000 to June 2004) were counseled for day case surgery. The inclusion criteria were: Patients certified fit for surgery-ASA grade I or II for general anaesthesia and had no intercurrent CVS disease or bleeding diathesis among others. RESULTS: A total number of 144 patients requiring adenoidectomy Tonsillectomy or both were seen at the study centers with only sixty six (45.8%) meeting the inclusion criteria. Adenoidectomy constituted 47% of the surgeries with over 80 of the patient age less than 7 years reactionary haemorrhage was noted in 3 (4.5%) of the patient, the other complications were non-persistent vomiting 13 (19.7%), low grade fever 5 (7.6%) and pain at time of discharge 23 (34.8%). There were no fatalities. CONCLUSION: The complication rates were low. Day-case Adenoidectomy/tonsillectomy or adenotonsillectomy is safe and the presence or closeness of the family members contributed greatly to patients/post recovery as this as this had a soothing/calming effect on the patient/s.

Tinnitus and the prevalence of co-morbid psychological stress.

BACKGROUND: Tinnitus is a symptom of unknown pathophysiology with few therapeutic measures and may present with co-morbid psychological stresses necessitating psychiatric treatment. This study aims at determining the prevalence of depression and anxiety in tinnitus sufferers in our environment. METHOD: This is a one year (April 2006 March 2007) prospective study of out-patients presenting with tinnitus to our Ear, Nose and Throat clinic who were administered the Hospital Anxiety and Depression Scale (HADS) questionnaire until the sample size was reached. RESULTS: Questionnaires were administered to one hundred and four patients with tinnitus, 92 patients filled theirs correctly and these were analyzed. There were 42 (45.7%) males and 50 (54.3%) females (Table 1) with an age range of 20 to 78 years. Six hundred and eighty seven patients presented with various otologic ailments in the study period, of which 104 (15.1%) patients had tinnitus. The overall prevalence of depression was 17.4%, higher in females (9.8%) than males (7.6%). The overall prevalence of anxiety was 22.8% with males having a higher prevalence (11.9%) than females (10.9%). Three (3.2) patients had both depression and anxiety Eighty three (90.2%) patients were in the active and productive age group with 13 patients (prevalence of 14.1%) having depression and 20 patients (prevalence of 21.7%) with anxiety. CONCLUSION: We recommend the screening or assessment for psychological distress in tinnitus sufferers so that patients can be adequately treated.

Day case adenotonsiletomy: experience of two private clinics in Nigeria

Background: adenoidectomy and tonsillectomy are among the common surgeries perform in children in otorhinoryngological practice. It was the aim of this study to evaluate the post operative mobility in patients undergoing day-case adenoidedtomy/tonsillectomy or adenotonsillectomy. Methodology: All pediatrics cases requiring adenoidectomy; tonsillectomy or both who presented at HANSA clinics Enugu (January 1990 to June 2004) and GENIKS specialist clinics Ibadan (January 2000 to June 2004) were counseled for day case surgery. The inclusion criteria were: Patients certified fit for surgery- ASA grade I or II for general Anaesthesia and had no intercurrent CVS disease or bleeding diathesis among others. Results: A total number of 144 patients requiring adenoidectomy; Tonsillectomy or both were seen at the study centers with only sixty six (45.8) meeting the inclusion criteria. Adenoidectomy constituted 47of the surgeries with over 80 of the patient age less than 7 years reactionary haemorrhage was noted in 3 (4.5) of the patient. the other complications Were non-persistent vomiting 13 (19.7); low grade fever 5 (7.6) and pain at time of discharge 23 (34.8). There were no fatalities. Conclusion: The complication rates were low. Day-case Adenoidectomy/tonsillectomy or denotonsillectomy is safe and the presence or closeness of the family members contributed greatly to patients/ post recovery as this as this had a soothing/calming effect on the patient/s

An unusual rhino-pharyngeal foreign body.

BACKGROUND: Foreign bodies of the upper aerodigestive tract are commonly seen in the paediatric population; however adult patients with nasal foreign bodies in particular are much less common and when sharp foreign bodies are present there is a great risk of developing complications. STUDY DESIGN: This is a case report of a 20-year-old male magician with impacted rhino-pharyngeal foreign body. He intentionally inserted two long sewing needles into the right nasal cavity during a magical act. RESULTS: The impacted foreign bodies were located in his nose/pharynx and removal was achieved per orally under general anaesthesia. Only a minimal evidence of retropharyngeal abscess was noted despite the prolonged stay of the foreign bodies. CONCLUSION: This case highlights the fact that both a deliberate and an accidental foreign body in an adult nasal cavity can get impacted as well as the significance for its early removal.

Hypopharyngeal paraganglioma: a case report.

Paragangliomas are neuroendocrine neoplasms that primarily afflict patients during the fourth and fifth decades of life. The majority of extra-adrenal paragangliomas arise in the head and neck region, notably from the carotid and aortic bodies, jugular bulb and tympanic plexus. Although one-fifth of all parapharyngeal neoplasms are paragangliomas, primary hypopharyngeal paraganglioma is relatively uncommon, only one other case having previously been documented by Filippin et al. (1989). We report a second case of hypopharyngeal paraganglioma in an 18-year-old male as seen in our center.