Overcrowding of accident & emergency units: is it a growing concern in Nigeria?

Background: The inability of the Nigeria’s Accident and Emergency Departments (AED) to meet current demands is growing among the public and health care professionals. The data supporting perceptions of insufficient capacity are limited. Therefore, this study was intended to determine the prevalence, causes, and effects of overcrowding AEDs in Nigeria.Materials and Methods: This was a cross sectional, descriptive study carried out among AED staff of 3 referral teaching hospitals in Nigeria, using a pre-tested and validated structured questionnaire.Results: The analysis of the 267 AED staff revealed 20-56years (36.40+5.1 mean) age range. One hundred and twenty eight (47.9%) were males, 139 (52.1%) females. Two hundred and fifty nine (97%) agreed that an AED should have a bed capacity of 21-30. Agreement to AED overcrowding in Nigeria was quite considerable. The frequency of AED overcrowding per week was 4-7 times. The average bed occupancy level was 3.25. Agreed common causes of prolonged AED admissions were to be a high volume of critically ill patients, Delayed transfer of patients to the wards, delay in theatre operation, delay in radiological investigations and exceptionally high proportion of patients requiring admission in AED. Also, long pre-review waiting time and haematological delays were more causes. The average waiting time for victims to be seen was 29.7minutes.Conclusion: There are many causes of AED overcrowding in this environment. However, improving AED bed management, better organized and diligent discharge planning, and reducing access block should be a priority to reduce AED overcrowdingKeywords: Overcrowding, accident, emergency surgery, Nigeri

Extremity trauma in midwestern Nigeria: an epidemiological study

Objectives: to determine the pattern of extremity injuries presenting in a major trauma centre in Midwestern Nigeria.Materials and Methods: This was a prospective study performed at the trauma unit of the University of Benin Teaching Hospital, involving individuals who sustained upper and lower extremity injuries between august 2008 and September 2009.Outcome measurements: patient demographics, mechanism of injury, severity of injuries (as evidenced by presence of fatalities), type of limb injury, associated injuries, immediate outcome.Results: Two hundred and twenty eight (228) patients presenting with extremity injuries were seen during the study period. The male to female ratio was about 3:1. Majority of the patients seen were between the ages of 20 and 40 years. Soft tissue injury was the commonest presentation (69.3%) with fractures and dislocations making up 42.1% and 17.1% respectively. Road traffic accidents were the commonest injuring mechanism (68%) with motor vehicular crashes responsible for 39.9% of all cases seen. The lower limbs were more likely to be injured than the upper limbs and less than 15% of cases seen had other associated injuries. In all cases with associated injuries, the central nervous system was the most commonly involved system, being present in 11.4% of all cases seen. There was a 5% mortality rate among this group of patients with discharges against medical advice responsible for 7% of all cases and 88% surviving their injuries.Conclusion: Extremity injuries continue to be a major cause of morbidity in our environment with road traffic accidents being the most common cause of injury. Although the mortality rate is relatively low, prompt treatment is necessary to mitigate long term morbidity in these patients.Keywords: extremity trauma, patterns, dislocations, fracture

Prevention of Breast Cancer in African women

No Abstract.African Journal of Reproductive Health Vol. 10 (1) 2006: pp. 7-

Fournier\'s gangrene secondary to prolonged use of Steroid- containing cream: a case report

A case of Fournier's gangrene in a patient that had used a steroid containing bleaching cream for five years is reported with a brief discussion on the possible mode of action of the cream. Other effects of the cream (striae, ‘bleaching') are also noted. We also present this case as a rare cause of Fournier's gangrene. Keywords: Fournier's gangrene, Bleaching cream, Steroid, Striae. Annals of Biomedical Science Vol. 1 (2) 2002: pp. 152-15

Perforation of the jejunum-an unusual mechanism

Background: Perforation of the jejunum following blunt abdominal trauma can be as a result of various mechanisms. Its diagnosis oftentimes is challenging. Aim: To report a rare case of blunt abdominal trauma with perforation of the jejunum due to a coffin and discuss the diagnosis and management of this condition. Setting: Department of Surgery, University of Benin Teaching Hospital, Benin City, Nigeria. Case Report: A 19-year-old female was an unrestrained passenger in a 14-seater bus conveying several passengers and an unrestrained coffin. The bus was involved in a roll-over vehicle crash during which the patient suffered a severe impact to the abdomen from the coffin with perforation of the jejunum. She had a trauma laparotomy with repair of the jejunum and had an uneventful recovery. Conclusion: This case illustrates the inherent risks involved in transporting caskets and corpses in a passenger vehicle. We recommend that these be conveyed in hearses with the appropriate restraints in place. Health education, legislation and enforcement on this issue are imperative in developing countries. Keywords: Casket, Blunt abdominal trauma, Jejunal perforation PHMJ Vol. 2 (2) 2008: pp. 174-17

Modifications hémorheologiques chez les cancéreuses

Several Studies have indicated the existence of thrombo-embolic complications in cancer patients and that this could be associated with changes in heamorheological parameters. Packed cell volume (PCV), heamoglobin (Hb), relative plasma viscosity (RPV) and plasma Fibrinogen concentration (PFC) were measured in 50 healthy control women, 50 age-matched women with breast cancer, and 10 women with histophathologically proven benign breast tumour. There were significant differences between the controls and breast cancer patients in all the parameters measured (p<0.05). However, patients with cancer have significantly higher RPV and PFC (p<0.001) respectively than controls. There was significant mean difference between pre and post mastectomy in fibrinogen concentration (p<0.05) and this was observed over the 5-week study period. Since increased fibrinogen may give rise to increase fibrin formation which has been asserted as an independent cardiovascular risk factor for thromb-oembolic complications, African patients with breast cancer may well be predisposed to thrombotic complications during illness. The rheological assessment may offer valuable benefit for the management and early diagnosis of breast cancer in African women.Beaucoup d&apos;études ont montré l&apos;existence des complications thrombe-embolique chez les cancéreuses et qu&apos;on peut lier ceci aux modifications dans les paramètres hémorheologiques. Le volume globulaire concentré (VGC), l&apos;hémoglobine (Hb), la viscosité du plasma relatif (VPR) et la concentration du fribinogène du plasma (CFP) ont été mesurés chez 50 femmes en bonne santé comme femmes témoin, 50 femmes cancéreuses qui ont été appariées selon l&apos;âge et 10 femmes qui souffraient de la tumeur du sein bénigne qui a été prouvée histopathologiquement. Il y avait des différences importantes entre les témoins et les patientes cancéreuses dans tous les paramètres mesurés (p < 0,05). Toutefois, les patientes cancéreuses ont une VPR considérablement plus élevé et la CFP (p < 0,001) respectivement que les témoins. Il y a une différence moyenne importante entre la pré et la post mastéctomie dans la concentration du fribinogène (p < 0,05) et ceci a été observé au cours des cinq semaines que l&apos;étude a duré. Puisque l&apos;augmentation du fibrinogène peut aboutir a l&apos;augmentation de la formation de la fibrine qui a été acceptée comme un facteur indépendant de risque cardiovasculaire pour des complications thrombe-emboliques. Les patientes cancéreuses africaines pourraient bien être prédisposées à des complications thrombotiques pendant la maladie. L&apos;évaluation rhéologique peut donner des avantages valables pour le traitement et le diagnostique anticipé du cancer du sein chez les femmes africaines