Management of open achilles tendon injury: Primary repair and early mobilization

Background: Achilles tendon injuries have progressive increase worldwide in the last few decades. This is attributable to increase in both competitive and recreational sports. In most of the literature written on Achilles tendon injuries there were rarely any information about open Achilles tendon lacerations. In fact, Achilles tendon injuries were erroneous equated to Achilles tendon ruptures and subsequently the management.Objective: To show that primary repair of open Achilles tendon lacerations (or incisions) and early postoperative mobilization in carefully selected patients may give excellent results.Methods: This was a prospective study that took place at the Plastic Surgery Unit of Irrua Specialist Teaching Hospital, Edo State, Nigeria over a period of 5 years. There were 52 cases of open Achilles tendon injuries that presented but only 12 of them, with lacerations or incisions, had primary repair and early postoperative mobilization. The study was between February 2010 and January 2015. The exclusion criteria included: (i) Achilles tendon injuries like avulsions and crush injuries; (ii) Patients that presented later than six hours of injury; (iii) Patients who had other system injuries or co-morbidity. The following data were collected which include biodata, side involved, the aetiology and complications and then analyzed.Results: There were 12 cases that fit into this study. There were 5 males (41.7%) and 7 females (58.3%) with male: female ratio of about 2.5:1. The average age was 37.6 years (range 6-60 years). Forty one point seven percent of them were within the paediatric age group of 0-15 years while the rest were adults. The most common aetiology was motorbike spoke. Nine (75%) of the injuries were on the left side. Two patients had infection which resolved with oral antibiotics.Conclusion: Literature on open Achilles tendon injuries are sparse, however it is an important subset of Achilles tendon injuries. Primary repair and early post-operative mobilization in open uncomplicated Achilles tendon lacerations or incisions gives excellent results.Key words: Open, Achilles tendon, Lacerations, Primary repair, Complication

Adolescent and adult cleft lip and palate, in Ile-Ife, Nigeria

Introduction: Congenital cleft lip and palate (CLP) defects usually present in childhood, especially in places with available and affordable care. In Nigeria, their incidence is low but late presentation in Adult life have been reported. This article aims at reviewing adolescent and adult CLP patients in our center, with the advent of free and available care, and to documentthe patterns and management outcomes of these patients as an addition to existing literature on the subject of adult CLP. Materials and Methods: A retrospective review of adolescent and adult CLP patients managed from May 2006 to April 2010. Demographic data as well as clinical information were retrieved from the hospital records and include the type of cleft deformity, surgical intervention prior to presentation, the type of surgery performed and postoperative outcomes. Some pertinent clinical photos were also reviewed. Results: Adolescent and adults constituted 24% of the 137 patients, their age ranged from 13 to 76 years, with a mean, median and modal age of 28, 22 and 20 years respectively. Unilateral cleft of primary palate was commonest with female preponderance. Most never had surgery, others desired revision surgery or secondary procedures. Theoutcomes were satisfactory in the 37 procedures performed on 33 patients.Conclusion: A relatively high ratio of adolescent and adult clefts is observed. Most of them have never had surgical intervention. Some had failed surgical intervention prior to presentation. Satisfactory outcomes were achieved despite late intervention but failed initial intervention was associated with poorer outcomes

Epidermiology of Hand Injuries Seen at Two Teaching Hospitals in Sothern Nigeria

No Abstract

The use of chicken egg shell as an alternative source of calcium in the diet of cockerel chickens.

The study was conducted to determine the effect of replacing oyster shell fraction in the diet of growing-finishing cockerel chickens partially or wholly with eggshell. A total of one hundred and twenty (120) 8 weeks old Harco cockerel chicken of mean weight 515.78 ± 3. 8g were used for the feeding trial that lasted for ten weeks. The birds were allotted to four dietary treatments in which oyster shell fraction of the diet was replaced at 0% (T1), 50% (T2), 75% (T3), and 100% (T4). Each treatment was replicated 3 times with 10 birds per replicate in a completely randomized design. The diets were formulated to contain about 16% crude protein and energy of about 2600 kcal/kgME. Variables measured were feed intake, weight gain. Feed efficiency, dressing percentage and cost /weight gain were calculated. The results showed that the mean feed intake and weight gain were not significantly (P>0.05) affected by varying levels of eggshell in the diet. The efficiency of feed utilization was relatively similar (P>0.05) in all the treatments. Dressing percentage and organs weight were relatively similar in all the treatments (P>0.05). The total feed cost and cost per weight gain reduced as the level of oyster shell in the diet increased. The highest cost per weight gain of N145.35 was recorded in T1 while the lowest cost per weight gain of N133.89 was recorded in cockerel fed diet containing 100% eggshell as replacement for oyster shell fraction of the diet. It could be concluded that eggshell could replace oyster shell up to 100% in the diet of growing finishing cockerels at reduced cost.Keywords: Cockerel chicken, egg shell, feed utilization, oyster shell, replacement

The spatio-temporal epidemic dynamics of COVID-19 outbreak in Africa.

Corona virus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first detected in the city of Wuhan, China in December 2019. Although, the disease appeared in Africa later than other regions, it has now spread to virtually all countries on the continent. We provide early spatio-temporal dynamics of COVID-19 within the first 62 days of the disease's appearance on the African continent. We used a two-parameter hurdle Poisson model to simultaneously analyse the zero counts and the frequency of occurrence. We investigate the effects of important healthcare capacities including hospital beds and number of medical doctors in different countries. The results show that cases of the pandemic vary geographically across Africa with notably high incidence in neighbouring countries particularly in West and North Africa. The burden of the disease (per 100 000) mostly impacted Djibouti, Tunisia, Morocco and Algeria. Temporally, during the first 4 weeks, the burden was highest in Senegal, Egypt and Mauritania, but by mid-April it shifted to Somalia, Chad, Guinea, Tanzania, Gabon, Sudan and Zimbabwe. Currently, Namibia, Angola, South Sudan, Burundi and Uganda have the least burden. These findings could be useful in guiding epidemiological interventions and the allocation of scarce resources based on heterogeneity of the disease patterns

Azithromycin-induced Hiccups

Background: Hiccups are not only known symptoms of some diseases but have been found to be induced by some drugs. In this report, we present a very rare case of azithromycin induced hiccups seen in a young male adult.Methods: The case records of a 34 year old male who was admitted and successfully managed for sepsis but placed on azithromycin as the only medication at the time of discharge was reviewed.Results: T he patient presented again at the hospital within twelve (12) hours of discharge with a history of severe hiccups which improved significantly with administered chlorpromazine.H e was sent home the following day while still on azithromycin.T he patient stopped all the medications at home after the second dose of azithromycin due to persistent drowsiness and decided to take the last dose of azithromycin two days later after realizing that the drowsiness was chlorpromazine induced.H e developed another severe episode of hiccups which was successively retreated with oral chlorpromazine.Conclusion: The patient developed hiccups within 12 hours while he was taking only azithromycin on two (2) different occasions. We then concluded that azithromycin was the probable cause of the hiccups.Keywords: hiccups, azithromycin, drug-induced,ad verse drug reactio

Abdominal Wall Hernias as seen in LAUTECH Teaching Hospital, Osogbo, Osun State, Nigeria

A prospective survey of Abdominal Wall Hernia patients was done in LAUTECH Teaching Hospital, Osogbo, from November 2000 to February 2002. The objective is to determine the pattern, management and outcome in a 101 patients with 110 hernias. Males accounted for 88.1% of the patients with mean age of 51.1 ± 11.7 years and 48.5% were farmers. Benign prostatic hyperplasia coexisted with hernia in 19.8% of patients. Inguinal/inguino-scrotal was the commonest (88.1%), while femoral hernia was rare (2.7%). Hernia occurred on the right side in 49% and bilateral in 10.9%. Consultants operated on 66(65.3%) patients, while residents under supervision operated on 35(34.7%) patients 65.2% of the patients were above 50 years. Day case surgery in our series was 75.3%; Elective surgery was in 76(75.2%) patients; while emergency cases was in 25(24.8%) patients. Local, spinal and general anaesthesia were used in 54(53.5%), 27(26.7%), 20(19.8%) patients, respectively. 19.8% had benign prostatic hyperplasia with hernia, while 5% had simultaneous prostatectomy and herniorrhaphy, 11.5% had gangrenous intestine that needed resection and reanastamosis. Commonest post operative complication was wound infection 14.9%, others were scrotal oedema, wound sinus, hypertrophic scars occurred in 3(3%), 2(2%), 3(3%) patients, respectively; with mortality in 1 patient (1%) in an elderly man who had strangulated intestinal obstruction. Key Words: Abdominal wall hernias, Coexisting prostatic hypertrophy. Sahel Med. J. Vol.6(2) 2003: 44-4