Maternal mortality in a Transitional Hospital in Enugu, South East Nigeria

Nigeria has one of the highest maternal mortality ratios in the world. The study was to determine the trend of maternal mortality ratio in the hospital as it transits from a General through a Specialist to a Teaching hospital. It was a retrospective review of maternal deaths at Enugu State University Teaching Hospital Parklane, over its 5 year transition period (January 2004 to December 2008). There were 7146 live births and 60 maternal deaths giving an overall maternal mortality ratio (MMR) of 840/100,000 livebirths. The MMR rose from 411 to 1137/100 000 live births as a specialist hospital, with a decline to 625/100 000 as a Teaching hospital. Pre-eclampsia/eclampsia was the leading cause (29.63%) of maternal death. MMR was highest as a Specialist hospital due to limited manpower and inadequate facilities to properly manage the rising number of referred obstetric emergencies. Adequate preparations should be made before upgrading a hospital, to enable it cope with the challenges of managing referred obstetric emergencies (Afr J Reprod Health 2009; 13[4]:67-72)

An assessment of orofacial clefts in Tanzania

<p>Abstract</p> <p>Background</p> <p>Clefts of the lip (CL), the palate (CP), or both (CLP) are the most common orofacial congenital malformations found among live births, accounting for 65% of all head and neck anomalies. The frequency and pattern of orofacial clefts in different parts of the world and among different human groups varies widely. Generally, populations of Asian or Native American origin have the highest prevalence, while Caucasian populations show intermediate prevalence and African populations the lowest. To date, little is known regarding the epidemiology and pattern of orofacial clefts in Tanzania.</p> <p>Methods</p> <p>A retrospective descriptive study was conducted at Bugando Medical Centre to identify all children with orofacial clefts that attended or were treated during a period of five years. Cleft lip and/or palate records were obtained from patient files in the Hospital's Departments of Surgery, Paediatrics and medical records. Age at presentation, sex, region of origin, type and laterality of the cleft were recorded. In addition, presence of associated congenital anomalies or syndromes was recorded.</p> <p>Results</p> <p>A total of 240 orofacial cleft cases were seen during this period. Isolated cleft lip was the most common cleft type followed closely by cleft lip and palate (CLP). This is a departure from the pattern of clefting reported for Caucasian and Asian populations, where CLP or isolated cleft palate is the most common type. The distribution of clefts by side showed a statistically significant preponderance of the left side (43.7%) (χ²= 92.4, p < 0.001), followed by the right (28.8%) and bilateral sides (18.3%). Patients with isolated cleft palate presented at very early age (mean age 1.00 years, SE 0.56). Associated congenital anomalies were observed in 2.8% of all patients with orofacial clefts, and included neural tube defects, Talipes and persistent ductus arteriosus.</p> <p>Conclusions</p> <p>Unilateral orofacial clefts were significantly more common than bilateral clefts; with the left side being the most common affected side. Most of the other findings did not show marked differences with orofacial cleft distributions in other African populations.</p

Cleft Surgery Service at National Orthopaedic Hospital Enugu: Impact of free treatment programme

INTRODUCTION: Previous reports on free surgeries have tended to focus on the numbers of patients treated. Little has been documented on the impact on training hence this report. Such grants should positively impact training, patient outcome and volume of patients.METHODS: A retrospective review of all cleft surgeries carried out two years before and after the commencement of free surgical treatment at the hospital (from November 2004 to October 2008) was undertaken. The demographics were studied for both primary and revisional surgeries. The primary surgeons were also noted. Excluded from the study are procedures to remove sutures. Simple arithmetic analysis was used.RESULTS: Seventy-three cleft procedures had been carried out before, while 168 procedures were carried out after October 2006. Eight patients aged over 15 years had lip repairs before while 42 patients over 15 years had lip repair after commencement. Fourteen procedures were carried out by three trainee surgeons before; while 29 procedures were carried out by nine trainees after October 2006. In 2005 an average of four procedures a month were undertaken; this increased by 2008 to eight.CONCLUSION: Free treatment positively impacts patient turnout and training, and are encouraged to improve the quality of healthcare in the country.KEYWORDS: cleft care, free treatment, training Nigeri

Extensive calvarial exposure and full thickness sequestration following electrical burn injury presenting after one year: case report.

Background: Calvarial osteomyelitis is an uncommon complication of burn injury due to electricity.Patient: A case of electrical injury that progressed from full thickness scalp loss to calvarial osteomyelitis and sequestration of outer and inner tables seen after one year of calvarial exposure is presented.Result: The patient had calvarial sequestrectomy which exposed a four-centimetre diameter inner table defect, and a 13 cm diameter full thickness scalp and outer table defect. A single stage closure with Orticochea flaps and split skin grafts was achieved. There was an uneventful post operation course.Conclusion: Late presentation in electrical burn injury of the scalp complicated by calvarial loss has been managed without intracranial complications.Key words: electrical burns, calvarial exposure, sequestrectomy, late presentatio

Blood Pressure Correlates in Orthopeadic and Plastic Patients at a Regional Orthopaedic Hospital in Nigeria

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Aesthetic surgery indications at the National Orthopaedic Hospital, Enugu

Background: Aesthetic surgery is not well developed in Nigeria. It forms a small part of plastic surgery service at the National Orthopaedic Hospital Enugu. Few reports of the scope of aesthetic surgery are available from the sub region. We report our experience of aesthetic surgery in our centre, a Nigerian sub regional apex hospital specializing in plastic, orthopaedic and trauma surgery, and make pertinent recommendations.Patients and methods: Retrospective analysis records of consecutive patients attended to between January 2000 andDecember 2005.Results: Elective plastic surgical procedures performed were 3,759, of which 68 (1.81%) were for aesthetic indications.Fifteen of the clients (22.06%) were male and 53 (77.94%) female. Fifty procedures (73.53%) were performed on the face, nine on the limbs, six on the trunk, two on the skull and one on the neck.Fifty four of these (79.41%) were scar revisions, six mammoplasties, and three were otoplasties, two cranioplasties, and one lip augmentation, one abdominoplasty and one rhinoplasty. Forty nine were carried out by consultants and nineteen by senior residents; seventeen of those procedures being scar revision. Specialized instruments such as lasers and cannulae for liposuction or liposculpture were not available.Conclusion: Aesthetic surgery is still underdeveloped in our practice

Antimicrobial spectrum of honey for aerobic organisms as seen at the National Orthopaedic Hospital, Enugu

Background: Honey is an ancient topical wound dressing that has evoked international interest. The widespread use of honey on wounds is being encouraged but differences in its antimicrobial spectrum exist.There are few local laboratory studies available to guide clinicians in this environment, hence this study.Materials and methods: A sample of commercially prepared honey from the tropical bee species was obtained and used in this prospective study. The initial medium was a 1-in-3 dilution of pure honey-agarmixture. Against this was smeared isolates from aerobic cultures of wounds in the microbiology laboratory of the National Orthopaedic Hospital, and incubated at 370 C for 72 hours. Seventy-five samples are presentedin this on going study, of which 67 are consecutive samples. The rest are specific isolates of pathogenic organisms grown from patients’ wounds and cultured against the honey sample and incubated for 24hours.Eight such samples were further incubated up to 72 hours and checked. A crude flammability test for purity was applied to the honey sample before use.Results: Honey was found to inhibit the growth of common gram positive and negative organisms including multi-resistant Staphylococcus aureus. When the pure cultures were treated with honey for 72 hours and thenstreaked on agar plates, no aerobic organism grew thereafter, including those that had previously grown on the 1-in-3 honey-agar mixture.Conclusion: Routine laboratory honey antimicrobial spectrum provided by use of honey-agar mixture is recommended as a guide to its clinical use.Key words: honey, antimicrobial sensitivity, laboratory test

Cleft lip repair with subcuticular closure at National Orthopaedic Hospital, Enugu: Is there any advantage?

Background: Skin closure in unilateral cheiloplasty with non absorbable sutures is commonly practiced, resulting in longer hospitalisation and another anaesthetic session for suture removal in children; increasing costs and risks. Subcuticular suturing obviates crosshatching and may also result in a finer scar, an advantage in patients with oily pigmented skins. Subcuticular closure became routine in the hospital in 2004. This five year study was undertaken to verify if subcuticular closure in unilateral cleft lip surgery reduced the burden of care.Patients and methods: Consecutive patients with unilateral cleft lip repaired at the National Orthopaedic Hospital, Enugu from January 2004 to December 2008 were studied retrospectively. There were 33 patients with subcuticular sutures and 84 with skin sutures. The follow up was a month to four years.Result: Patients with skin suture had 124 surgical sessions and a mean of 7.11 days after surgery before discharge; and those with subcuticular sutures spent a mean of 2.43 days after surgery before discharge. Complications were similar in both groups. Subcuticular closure was associated with reduced hospitalisation time and anaesthetic sessions; reduced risks, costs, and burden of care.Conclusion: The technique of subcuticular suturing may be considered as a viable alternative to non absorbable skin sutures

Traumatic radial artery aneurysm at National Orthopaedic Hospital, Enugu

Background: Traumatic radial artery pseudo aneurysms are rare and infrequently present to the plastic surgeon. At National Orthopaedic, Enugu, between January 2003 and June 2012 repair of aneurysms constituted 0.04% of all elective surgical procedures carried out by plastic surgeons. Repair by excision and vein conduit is well established but not many reports in children abound. Our aim is to share our experience, review the literature, and propose treatment options. Methods: Theatre records, photographs and case notes of patients that presented with traumatic radial artery aneurysm between 2003 and 2012 were retrieved and examined. Results: Three patients presented with radial artery pseudo-aneurysms within the period. All the three patients had excision of the aneurysms and reversed cephalic vein interposition graft. The outcomes were satisfactory.Keywords: radial artery aneurysm, vein graftNigerian Journal of Plastic Surgery Vol. 9, No 2, September 201

Letter to the Editor: Burn Disaster Acute Care Management in a Nigerian Hospital: Any change 10 years after?

This study is derived from retrospective data from the management of a fire disaster involving nine students managed in the institution following a fire disaster at the female students' hostel.The average length of stay was 19 days. The total cost was $47.74 per day per patient.KEY WORDS: Burn care costs, injury, Nigeri