Latex glove conduit as improvised blood vessel model for microvascular anastomosis training.

BACKGROUND: In the growing need of microvascular surgery in modern-day plastic surgery, financial burden on surgeon or institution can discourage acquisition of skill particularly in the initial phase of laboratory simulation. This article describes the construction of a cheap, easy-to-make blood vessel model. MATERIALS AND METHOD: The model was made using infusion giving set, latex glove, scissors, tape measure and Swan glue CD 308. A cut sheet from the latex glove was rolled twice over two glue-painted segment of the infusion giving set stent. The stents were gently pulled out, turning the sheet into a conduit. The blood vessel model was then allowed to dry. DISCUSSION: The use of latex glove for initial training in microvascular anastomosis has been for long. Previously described productions into a conduit are cumbersome. This model is easy to construct and is useful in an office or dry laboratory setting. CONCLUSION: The latex glove blood vessel model described in this article is a useful material in the training of budding microsurgeons. Residents in our institution have reported a very good learning experience with its use.

STATE DISTRIBUTION OF NEW PATIENTS PRESENTING WITH CLEFT LIP AND PALATE TO THE UNIVERSITY COLLEGE HOSPITAL: A PILOT STUDY.

BACKGROUND: The UCH/Smile Train partnership, which offers free cleft surgeries to patients provides succor. OBJECTIVE: The objective of the study was to determine the state distribution of new patients presenting with cleft lip and palate, to The UCH. METHODS: A retrospective review of all new cleft patients presenting to The UCH between January 2012 and June 2015. The data obtained were their local government area of residence, age of the patients, gender of the patients and the type of cleft. Descriptive statistics was used to analyze the distribution of patients seen while Chi square test was used to analyze the influence of gender and laterality on the type of cleft. RESULTS: Sixty-seven eligible patients were seen within the study period. Majority (83.6%) of patients seen were from 14 of the 33 Local Government Areas (LGA's) in Oyo state. Patients were seen from LGA's in proximity to UCH. A few (16.4%) of the patients came from outside the state. Iwajowa, the LGA with the least number of patients (1.8%) was furthest from UCH. Left sided clefts were significantly more than bilateral or right-sided clefts (p=0.001). Most of the patients from Oluyole LGA had CP while no patient with CP was seen from Lagelu and Akinyele LGA's. CONCLUSION: There is the need to intensify cleft awareness programs. Further studies into the health habits, cultural beliefs and genetic profile of communities may explain some regional distribution of cleft types seen.

Management of split skin graft donor site in the West African sub region: survey of plastic surgeons' practice.

Split skin graft (SSG) is one of the most commonly performed operations on any Plastic Surgery service. Rate of donor site healing is affected by various factors including the type of dressing applied. The aim of this study was to survey the practice of plastic surgeons in the sub region with respect to management of SSG donor site and see how it conforms to international standards. Structured questionnaires on various aspects of the harvest and management of SSG donor sites were administered to plastic surgeons during the 53rd annual conference of the West African College of Surgeons (WACS) at Lome, Togo in March 2013. The data were analyzed using descriptive statistics. There were 47 respondents out of 55 plastic surgeons from four West African countries, which represented 85.4% of registered participants at the plastic surgery section of the conference. All the respondents performed SSG regularly, and the thigh was the most commonly used donor site. Different types of paraffin gauze remained the most commonly used primary donor site dressing. Only 17% of the respondents apply a topical local anaesthetic agent on the donor site. The choice of SSG donor site dressing in the sub region was driven mainly by availability. Concerted efforts must be made to access newer wound care products for optimum management of this commonly performed operation.

Les greffes de peau mince font partie des opérations les plus fréquemment réalisées dans tout service de chirurgie plastique. La qualité de cicatrisation du site donneur dépend de plusieurs facteurs, dont le type de pansement utilisé. Le but de cette étude est d'enquêter sur la pratique des chirurgiens plasticiens en Afrique de l'Ouest, vis-à-vis de la gestion du site donneur de peau mince et de vérifier si elle est en accord avec les standards internationaux. Des questionnaires structurés sur les différents aspects du prélèvement cutané de peau mince ont été remis aux chirurgiens plasticiens pendant la 53e Conférence annuelle des chirurgiens du Collège des Chirurgiens de l'Afrique de l'Ouest(WACS) à Lomé, Togo en Mars 2013. Les données ont été analysées à l'aide de statistiques descriptives. Ont été recueillies 47 réponses sur 55 chirurgiens plastiques de 4 régions de l'Afrique de l'Ouest, soit 85 8,4 % des participants inscrits à la section chirurgie plastique de la Conférence. Toutes les réponses émanaient de chirurgiens pratiquant des greffes de peau mince de façon régulière et la cuisse était la zone la plus communément utilisée. Différents types de pansements à la paraffine étaient le plus souvent utilisés en première intention. Seulement 17 % des réponses signalaient l'utilisation d'un topique anesthésiant local sur le site donneur. Le choix de pansement du site donneur dépendait principalement de sa disponibilité. Des efforts concertés doivent être faits pour avoir accès aux nouveaux produits cicatrisants, afin d'obtenir une meilleure prise en charge de ce type d'intervention couramment pratiquée.

NORMAL VALUES OF KEY PINCH STRENGTH IN A HEALTHY NIGERIAN POPULATION.

BACKGROUND: With the severity of machine hand injuries in our environment, the need to determine the normal values for key pinch strength with which to compare restorative surgeries was justified. METHOD: A cross sectional survey of participants who had no previous hand injuries limiting hand function. Data obtained included age, gender, body mass index, hand dominance and hand span. The Baseline Hydraulic Pinch Gauge was used to obtain key pinch strength. The influence of the above variables on measured pinch strength was analyzed using independent sample t-tests and Pearson's correlation. RESULTS: Of the 242 recruited participants, age range between 20 and 80 years, 163(67.4%) were male and 79 (32.6%) were female. Males had higher pinch strength (right-8.3±2.7kg, left-7.6±2.5kg) than females (right-6.3±1.5kg, left- 5.8±1.5kg). Pinch strength varied with age peaking in the fifth decade in males and females. Interestingly, the left handed dominant female had higher right pinch strength than her right handed counterpart (p<0.009). Height, and hand span correlated with pinch strength in females. CONCLUSION: Normal values for key pinch strength in this Nigerian population are lower than that of Caucasians.

Demographic characteristics and prognostic indicators of childhood burn in a developing country.

Children constitute a significant proportion of burn victims in most studies from the developing countries. While there has been a progressive improvement in the outcome from childhood burn in many developed nations, the morbidity and mortality remains high in many low and middle income countries. The aim of our study is to evaluate the demographic characteristics and prognostic indicators of childhood burn in a major referral teaching hospital in a developing country. A review of the records of 638 patients with acute burns managed over a 10-year period from January 2001 to December 2010 at the University College Hospital, Ibadan Nigeria was done. The clinical and epidemiological data were retrieved from computerized data base using the ISBI proforma. Information obtained includes Biodata, Etiology, location, TBSA, presence of Inhalation injury and the treatment outcome. Data of patients aged 16 years and below were analyzed using the SPSS version 16. The main outcome measure was the patient's survival. 289 children representing 45.3% of the total number of burn patients were managed over the period. The M:F ratio was 1.1:1. The median age of the cohort was 4.0 years while the median TBSA was 21.0%. Non-intentional causes were responsible for 89.6% cases. Most of the injuries (88.6%) occurred at home. Eighty-three patients had inhalation injury out of which 57 (68.7%) deaths were recorded. The overall mortality rate in the cohort was 39.5% with an LA50 of burn size of 45%. The TBSA was also found to be a determinant of outcome. Majority of childhood burns are from preventable causes with attendant dismal mortality figures. Effective burn prevention strategies and improved quality of care remain pivotal in reducing childhood burn morbidity and mortality in the developing countries.

Awareness and attitude of doctors and nurses at a teaching hospital to skin donation and banking.

INTRODUCTION: This study sought to determine the awareness and attitude of doctors and nurses in a teaching hospital to skin donation and banking, and to identify needs for personnel educational programmes. METHODS: A cross sectional survey on doctors and nurses was carried out using a 44-item questionnaire that included a Likert scale on attitudes. Predictors of favourable attitudes were determined. RESULTS: Eighty (49.7%) doctors and 81 (50.3%) nurses participated in the study. Many participants, 126 (78.3%), knew that skin could be donated, but only 96 (59.6%) participants were aware of skin banking. The main source of information was during professional training (17.4%). Only 41 (25.5%) participants were willing to donate skin after death. Body disfigurement was the major reason (20.5%) against skin donation. Participants who were doctors, were aware of skin banking, and who were previous blood donors had higher attitudes scores (p<0.001, p=0.004, p=0.007 respectively). Being a doctor and having heard of skin banking were predictors of favourable attitudes to skin donation and banking. CONCLUSION: Knowledge transfer during health professional training on the usefulness of banked skin in patients with major burns may lead to improved attitude of health professionals and acceptance of this modality of burn management.

Evidence for a dissociation in the control of sparteine, debrisoquine and metoprolol metabolism in Nigerians.

The 0-8 hour urinary distributions of the metabolic ratios of sparteine (100 mg), debrisoquine (10 mg) and metoprolol (100 mg) were measured in 165 healthy, unrelated, black Nigerian medical students. There was a weak correlation (rs = 0.51, p < 0.001; n = 82) between the metoprolol/alpha-hydroxymetoprolol (M/HM) and the sparteine/total (2- + 5-) dehydrosparteine (S/DHS) ratios. No significant correlations were found between the debrisoquine/4-hydroxydebrisoquine (D/HD) and M/HM ratios (rs = 0.16, n = 33) and between the D/HD and S/DHS ratios (rs = 0.31, n = 38). Both visual inspection and kernel density analysis of the data suggested the presence of two phenotypic groups for sparteine oxidation, with 4% of the population studied being putative poor metabolizers. In contrast biomodality was not apparent in the distribution of the log10M/HM and log10D/HD ratios. These findings provide evidence for a dissociation in the control of metoprolol, sparteine and debrisoquine oxidation in Nigerians and highlight the difficulties in the interpretation of data from pharmacogenetic studies in different ethnic groups.

Stereoselective metabolism of metoprolol in Caucasians and Nigerians--relationship to debrisoquine oxidation phenotype.

The relationship between debrisoquine oxidation phenotype and the stereoselective metabolism of metoprolol was investigated in populations of British Caucasians (n = 139) and Nigerian subjects (n = 117). The 0-8 h urinary S/R-metoprolol (S/R-M) ratio was related to the ability to metabolise metoprolol and debrisoquine in both ethnic groups. The median S/R-M ratio was significantly higher in Caucasians (1.27) than in Nigerians (1.10). In the Caucasian population poor metabolisers of debrisoquine had significantly lower S/R-M ratio (median = 0.84) than extensive metabolisers (median = 1.28). Bimodality in the frequency distribution of the S/R-M ratio was not apparent in either ethnic group.

Clinical experience with nadolol in Nigerian patients with essential hypertension.

Response to Nadolol (Corgard) tablets has been studied in newly diagnosed Nigerian patients with essential hypertension attending the hypertension clinic of the University College Hospital, Ibadan. 21 out of 26 recruited patients completed the study. The mean age was 47.3 +/- 9.5 SD years. The mean supine systolic blood pressure post placebo was 177.6 +/- 13.3 SD mm Hg, while the diastolic blood pressure was 101.7 +/- 11.7 SD mm Hg. After 8 weeks, the mean readings were 126.2 +/- 11.2 SD mm Hg supine systolic and 81 +/- 8.9SD mm Hg supine diastolic. In the erect position, the corresponding mean readings post placebo and at 8 weeks 168.8 +/- 21.9 SD mm Hg and 125.2 +/- 15.4 SD mm Hg systolic, and 107.4 +/- 12.2 SD mm Hg and 86 +/- 8 SD mm Hg diastolic respectively. There was a significant difference (P less than .001) between the mean readings post placebo and at 8 weeks in both systolic and diastolic blood pressures in the supine and erect positions). The mean supine pulse rate per minute post placebo was 80 +/- 7, and at 8 weeks 70 +/- 3. There was a significant difference (P less than .001) between the two pulse rates. 2 of the 26 patients were taken off the trial at 4 weeks because of poor response, but were included in the determination of effectiveness, toleration and side effects. Nadolol was found highly effective in 15 patients (65.2%) moderately effective in 6 patients (26%) and ineffective in 2 patients (8.6%). Side effects were not a problem in this study and toleration was excellent in most cases.

Plasma levels of digitalis-like substance in Nigerians with essential hypertension.

A plasma Na+-K+ ATPase inhibitor, which is estimated by a technique in which it competes with ouabain for binding on red cells, was measured in three groups of individuals: (a) normotensive subjects without a family history of hypertension, (b) normotensive subjects with a family history of hypertension, (c) untreated essential hypertensive subjects. The mean value of the inhibitor in group (b) subjects was significantly higher than the mean value in group (a). The mean value in group (c) subjects was also significantly higher than in group (a) subjects. However, the means of the values in groups (b) and (c) were not significantly different. There was a significant positive correlation between the levels of the inhibitor and the urinary Na+ excretion in all subjects. However, there was no correlation between the inhibitor levels and mean arterial pressure. The relevance of these results to the pathophysiology of hypertension in the black African subject is discussed.

Prolonged prednisolone therapy in adult nephrotic syndrome: a preliminary study.

Twenty-five adult Nigerian patients suffering from the nephrotic syndrome with normocomplementaemic mesangiocapillary glomerulonephritis were studied. Twelve of these were treated with prednisolone at a dose of 1.5 mg/kg body weight/day, with maximum dose of 90 mg/day initially for 2 weeks. Thereafter, a quarter of the daily dose was given on alternate days for a period varying from 6 to 12 months. The 13 others were similarly followed up on a dietary and diuretic regime alone. Oedema disappeared completely in all the steroid group except one, whilst it persisted in five of the controls. Proteinuria persisted in all the controls but remitted in five of the test patients. Renal function deteriorated with rising plasma creatinine in five of the controls, in contrast with one of the test patients. The beneficial effect of prednisolone observed here calls for further long-term studies.

Clinical pharmacokinetics of digoxin in Nigerians.

The pharmacokinetics of digoxin have been studied in eight healthy volunteers, 23 congestive cardiac failure and 10 chronic renal failure patients. The mean serum digoxin concentrations in the volunteers and the congestive cardiac failure patients were significantly different (P less than 0.001) from those in the chronic renal failure patients. The mean half-life of digoxin in the healthy volunteers (37.2 h +/- 8.6 s.d.) was comparable to the widely accepted 40 h for digoxin half-life in normal individuals. Half-life was significantly prolonged in renal failure patients. There was a good inverse correlation, in the three groups, between serum creatinine and creatinine clearance, but the expected close correlation between the renal clearance of digoxin and serum creatinine was not demonstrated, probably because this was an oral study. There was no statistically significant difference in the age and weight in all three groups. There was also no significant difference in all parameters, measured and derived, between the volunteers and the congestive cardiac failure patients. However, when the volunteers and/or the congestive cardiac failure patients were compared with the renal failure patients, there was a significant difference in all parameters except age and weight. Thus, in the absence of renal impairment and hypokalaemia, standard dosages of digoxin can be used in congestive cardiac failure patients, provided symptoms and signs of toxicity are constantly monitored. Therapeutic drug monitoring of digoxin is desirable in view of its low toxicity: therapeutic ratio, and its kinetics should be studied in detail in each community to establish correct dosages to prevent and manage digoxin toxicity.

Metoprolol and debrisoquin metabolism in Nigerians: lack of evidence for polymorphic oxidation.

The role of genetic polymorphism in the oxidative metabolism of metoprolol and debrisoquin was investigated in a population of 138 unrelated Nigerians. The debrisoquin/4-hydroxydebrisoquin 0-8 hour urinary ratio (D/HD) correlated significantly with the metoprolol/alpha-hydroxymetoprolol 0-8 hour urinary ratio (M/HM) (rs = 0.54; P less than 0.001), the metoprolol/H117-04 [4-(2-hydroxy-3-isopropylaminopropoxy)-phenylacetic acid] 0-8 hour urinary ratio (M/H117-04) (rs = 0.42; P less than 0.001), and the plasma metoprolol concentration at 3 hours (rs = 0.48; P less than 0.01). Both the median D/HD and M/HM ratios were significantly higher in this population than in a previously studied population of white British subjects. According to criteria established in studies of white populations, only one subject, later identified as an Indian, would be classified unequivocally as a poor metabolizer of both metoprolol and debrisoquin. All the other subjects were black Africans. Bimodality in the frequency distribution of both the log10 M/HM and D/HD ratios was not apparent. The poor hydroxylation trait may, therefore, be present at a lower frequency than in whites, absent altogether, or obscured by other factors. In ethnic studies of drug metabolism each racial group should be examined separately for evidence of polymorphic metabolism and antimodes should not be extrapolated from one population to another.

Plasma renin activity and plasma aldosterone concentrations in untreated Nigerians with essential hypertension.

On the basis of existing information we set out to test an hypothesis that 'the blood volume and more specifically total body sodium and sodium disposition in the body play a more important role in blood-pressure regulation and the pathophysiology of hypertension than other regulatory mechanisms in the indigenous African'. To achieve our objective, ninety-eight newly diagnosed unmedicated hypertensives with adequate renal function were admitted to the study. Fifty-one (52%) of the subjects were males while forty-seven (48%) were females. Their ages ranged between 21 and 70 years. All grades of the disease were adequately represented with thirty (31%) being mild, fifty (51%) moderate and eighteen (18.4%) in severe phase of the disease. Blood-pressure measurements and blood samples were obtained in the supine position in all the patients after adequate preparation. Plasma renin activity (PRA) and plasma aldosterone concentrations were measured by specific radioimmunoassays. Contrary to what obtains elsewhere, seventy-six (77%) of our patients were of the low renin status, twelve (12%) of whom had undetectable levels by our assay system. Eighteen (18.4%) had PRA levels in the medium range and five (5.1%) in the high range. In a cohort, forty-two (43%) of our ninety-eight patients, we estimated plasma aldosterone levels. The results obtained showed that the plasma aldosterone concentrations were significantly higher in hypertensives than in our normal controls (P less than 0.01). There was lack of correlation between PRA or plasma aldosterone when compared to mean arterial pressure or serum Na+. These results are discussed in relation to the management of hypertension in our environment.

Pharmacokinetics of chloroquine in renal insufficiency.

The pharmacokinetics of chloroquine and its desethyl metabolite were studied in six patients with chronic renal failure and compared with a control group of twelve patients with normal renal function. Chloroquine was given as a single oral dose of 600 mg and blood levels monitored for 144 h. Plasma chloroquine concentrations were determined using an HPLC method. The plasma half-life of chloroquine was significantly higher in renal patients than in controls. This finding suggests that extra caution should be exercised when prescribing chloroquine for prolonged use in patients with renal insufficiency.

Role of hepatitis Bs antigen in chronic glomerulonephritides in Nigerians.

Using enzyme-linked immunosorbent assay technique (Boehring Institute Laboratory), eighty-one adult patients were studied for hepatitis Bs antigenaemia. Nine of the patients had asymptomatic persistent proteinuria, thirty-nine, nephrotic syndrome, and thirty-three had profuse proteinuria, azotoaemia and hypertension. The histopathology obtained in forty showed twenty-two with MCGN, four with focal glomerulosclerosis, three with proliferative glomerulonephritis, one with minimal change glomerulonephritis and ten with end-stage kidney disease. None of the patients had apparent clinical evidence of liver disease nor a past history of jaundice. One hundred and eighty apparently normal adults served as controls; 33.3% of the patients had positive hepatitis Bs antigenaemia, in contrast to 6% (P less than 0.001) in the normal controls. Hepatitis Bs antigenaemia was more prevalent in the groups with nephrotic syndrome and persistent asymptomatic proteinuria than in the group with advanced renal failure. Hepatitis Bs antigenaemia was detected in all histopathologic forms but was most prevalent in the MCGN (P less than 0.001) which is also the more commonly encountered lesion. The implications of these findings are discussed.

Peak expiratory flow rate in normal Nigerian children.

Peak expiratory flow rate was estimated in 569 school children in Ibadan to determine normal values in Nigerians. Two hundred and seventy-six boys and 293 girls, aged 6-18 without antecedent history of respiratory disease, from different socio-economic backgrounds were selected. The peak expiratory flow rate (PFR) was estimated using the Wright peak flowmeter. The results indicated that the mean values of Nigerian children were lower than those of Caucasians of the same height, sex and age. The possible reasons for this are discussed. The PFR values were found to correlate highly (P less than 0.01) with age, weight and height, and also with FVC and FEV1. In this study, PFR correlated more closely with weight than height, contrary to the results observed in Caucasian children. Since there is a positive correlation between PFR and FVC or FEV1, PFR can therefore be used in assessment of respiratory function in clinical practice, particularly in younger children, who cannot adequately cooperate when the spirometer is used for lung-function studies.

Serum immunoglobulins and complement in nephrotic syndrome.

Serum concentrations of IgG, IgM and complement components C3 and C4 were estimated in thirty-one adult Nigerian patients with nephrotic syndrome; twenty-eight of whom had 'active' disease, while three were in remission. Eleven normal adults served as controls. The mean serum IgG was significantly lower, while the mean serum IgM was higher in the patients with active disease than in the controls. Similarly mean serum C3 and C4 levels were statistically significantly higher (P less than 0.05) in active disease than in normal controls. These findings in Nigerian patients are similar to those observed in Caucasians, and further support the role of a fundamental immunological defect in the pathogenesis of the nephrotic syndrome.

Serum metformin levels in Nigerians with non-insulin-dependent diabetes mellitus.

'Steady state' serum concentrations of metformin have been measured in sixteen Nigerians with non-insulin-dependent diabetes mellitus. There was a thirty-eight-fold variation in the serum levels (50-1886 ng/ml). The mean serum level of metformin was 512 +/- 485.2 ng/ml. This compared favourably with the mean levels (382.3 +/- 76.9 ng/ml) obtained in a similar study in Italians. The observed levels however fell far short of those expected in patients on 1-5 g metformin daily. The role of poor bioavailability vis-à-vis poor patient compliance deserves further detailed pharmacokinetic study.