Communal Conflict- Related Ocular Trauma

[Nig J Clinical Practice Vol.5(1) 2002: 1-4]Purpose: To determine the cause, morbidity and visual outcome of ocular injuries sustained during the Ife/Modakeke communal conflict which occurred between A9ugust 1997 and December 1998. Method: We conducted a retrospective study of all patients with eye injuries resulting from the conflict, treated at Obafemi Awolowo University Teaching, Hospital, Ile-Ife and 2 private eye clinics in Ile-Ife and Modakeke. Results: Fifty-five eyes of 54 patients were injured. The mean age was 32 years with a male preponderance of 96.3%. Forty-two eyes (76.4%) were injured by gunfire through direct impact, backfire or stray bullet. Thirty-one eyes (56.4%) sustained closed-globe injuries while 24 (43.6%) had open-globe injuries. Thirty-five eyes (63.6%) were blind, out of which 9 eyes (16.4%) required primary enucleation. Conclusion: Civilian conflict with the use of firearms is associated with severe ocular morbidity. Maintenance of peace is essential. KEYWORDS: Conflict, ocular trauma, gunshot injury, blindness [Nig J Clinical Practice Vol.5(1) 2002: 1-4

Typhoid Intestinal Perforations in a Tropical Tertiary Health Facility: A Prospective Study.

Background: Despite decades of improvement in patient care globally, typhoid intestinal perforation remains a frequently fatal illness in the developing world. This study aimed at determining the factors that influenced the outcome of surgical management of typhoid intestinal perforation in Sagamu, South-West Nigeria. Methods: Twenty-three consecutive adult cases managed between January 2006 and December 2008 at the surgical department of Olabisi Onabanjo University Teaching Hospital Sagamu were studied prospectively. Patients received parental ciprofloxacin or ceftriaxone in addition to metronidazole. They all had laparotomy after adequate resuscitation. Patients in American Society of Anesthesiologists (ASA) class VE were operated upon under local anaesthesia, intravenous ketamine and diazepam. Results: There were 13 males and 10 females with a male to female sex ratio of 1.3:1. The ages ranged from 19 to 51 years. Seventeen (73.9%) patients were aged between 20 and 34years.Two patients, one each from ASA grades IVE and VE, died on 1st and 2nd postoperative days respectively. The mortality of 8.7% was significantly associated with ASA class (P= 0.040). ASA class was strongly associated with severity of peritonitis (P=0.021). Complications occurred in 11 (47.8%) patients. Ten (43.5%) developed wound infection and one (4.3%) an entercutaenous fecal fistula. Wound infection was significantly associated with method of closure of perforation (P=0.034), and number of perforations (P=0.007). Conclusion: This study has shown that ASA class is a significant predictor of mortality in patients treated for typhoid intestinal perforation in our centre. We recommend that patients in ASA classes IV and V should have post-operative intensive care to reduce the risk of death

Facial plexiform neurofibroma: a surgical challenge

Introduction: Plexiform neurofibroma occurring in the Head and Neck region can be disfiguring, causing cosmetic embarrassment to the affected patients. Surgical management is the mainstay of therapy. This is however a challenging undertaking because of the vascularity and the risk of primary haemorrhage, infiltration of facial soft tissues against the need to preserve functions and maintain aesthesis.Subjects and methods: We present case reports of four patients managed in our institution over the pasttwo years with a discussion on some practical points of management.Results: All the four patients had surgical excision and refashioning. Post–operative results of surgical excision alone are satisfactory.Conclusion: Plexiform neurofibromatosis is a benign tumour of nerve sheath amenable to surgical intervention when attended by meticulous details in well prepared patients.KEYWORDS: Plexiform neurofibromatosis; facial, surgical excisio

Indications and Outcomes of Medical Intensive Care Admissions in a Nigerian Tertiary Hospital

Background: The demand for intensive care is rising in many developing countries with specialties requiring specialized intensive care services. Medical conditions constitute a substantial proportion of demands for intensive care. Objectives: To determine the patients’ characteristics and outcomes of medical indications for intensive care unit (ICU) admissions in a Nigerian tertiary hospital. Methods: A retrospective descriptive study was conducted at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Southwest Nigeria. The data of all patients aged 16 years and above managed from 2010 to 2019 were extracted from the general ICU admissions book. The age, sex, indication for admission, need for mechanical ventilation, length of stay in the ICU and outcome of care were retrieved for analysis. Results: There were 255 patients with medical conditions, constituting 12.6% of all (3,213) ICU admissions during the study period. The male-to-female ratio was 1.3:1.0 and the age range was 16 to 89 years. The most common indication for admission was neurological illnesses (56.7%). Stroke accounted for 40.4% of all medical ICU admissions. The mean length of ICU stay was 4.9±5.95 days. A larger proportion of patients (75.0%) who had mechanical ventilation died compared to 25.0% who survived (p = 0.001). Conclusion: Neurological disorders, especially stroke, were the most common indications for ICU admission. Many medical conditions had high mortality rates and outcomes were notably poor for mechanically ventilated patients

Decision-to-Delivery Interval and Obstetric Outcomes of Emergency Caesarean Sections in a Nigerian Teaching Hospital

Background: Prolonged Decision-to-Delivery interval (DDI) is associated with adverse maternal-foetal outcomes following emergency Caesarean section (EmCS). Objectives: To determine the DDI, predictive factors, and the foeto-maternal outcomes of patients that had EmCS in a Nigerian Teaching Hospital. Methods: A descriptive study of all EmCS performed at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria, from 1st June 2020 to 31st May 2021, was conducted. Relevant data were extracted from the documentations of doctors, nurses and anaesthetists using a designed proforma. The data obtained were analysed using the IBM SPSS Statistics for Windows, version 25. Results: The median (IQR) DDI was 297 (175-434) minutes. Only one patient was delivered within the recommended DDI of 30 minutes. The most common cause of prolonged DDI was delay in procuring materials for CS by patients’ relatives(s)/caregiver(s) (264, 85.2%). Repeat CS (AOR = 4.923, 95% CI 1.09-22.36; p = 0.039), prolonged decision-to-operating room time (AOR = 8.22, 95% CI 1.87-8.66; p 150 minutes was significantly associated with maternal morbidity (p = 0.001), stillbirth (p = 0.008) and early neonatal death (p = 0.049). Conclusion: The recommended DDI of 30 minutes for CS is challenging in the setting studied. To improve foeto-maternal outcomes, efforts to reduce the DDI should be pursued vigorously, using the recommended 30 minutes as a benchmark