Causal conditions for major limb amputation at a specialist hospital in north central Nigeria

Background: Amputation is said to be a mutilating surgical procedure with causes varying within and between countries. Even though most causes of amputation result from potentially preventable conditions, it is one of the most commonly performed procedures. The aim of this study is to elucidate the of causes of major limb amputation at NKST Rehabilitation Hospital, Mkar , Benue State so as to proffer preventive measures.Methodology: Case records of patients who had major limb amputation between January 2007 and December 2011 at NKST Rehabilitation Hospital, Mkar, were retrieved from the Medical Records Department and analyzed for age at time of amputation, gender, indication for amputation, and early complications following surgery.Results: A total of 198 major limb amputations in 198 patients were audited. There were 139(70.2%) males and 59(29.8%) females with an age range of 2-85 years. The causes of major limb amputation included trauma (n=122, 61.6%), diabetic foot disease (n=36, 18.2%), musculoskeletal tumours (n=26, 13.1%) and peripheral vascular disease (unrelated to diabetes) (n=10, 5.1%). Traditional bone setters' gangrene was the predominant cause (n=65, 53.3%) of traumatic amputation. Surgical site infection was the leading early complication(n=63, 31.8%).Conclusion: Trauma and diabetic foot disease were the leading causes of major limb amputation from the study. Regulating traditional bone setters' practices, enforcing road safety regulations and adequate diabetic foot care practices are recommended.Keywords: Major limb amputation, Indications, TraumaJos Journal of Medicine, Volume 7 No.

Differential susceptibility of Onchocerca volvulus microfilaria to ivermectin in two areas of contrasting history of mass drug administration in Cameroon: relevance of microscopy and molecular techniques for the monitoring of skin microfilarial repopulation within six months of direct observed treatment

Background Ivermectin is an excellent microfilaricide against Onchocerca volvulus. However, in some regions, long term use of ivermectin has resulted in sub-optimal responses to the treatment. More data to properly document the phenomenon in various contexts of ivermectin mass drug administration (IVM-MDA) is needed. Also, there is a need to accurately monitor a possible repopulation of skin by microfilariae following treatment. Skin snip microscopy is known to have a low sensitivity in individuals with light infections, which can be the case following treatment. This study was designed with two complementary objectives: (i) to assess the susceptibility of O. volvulus microfilariae to ivermectin in two areas undergoing IVM-MDA for different lengths of time, and (ii) to document the repopulation of skin by the O. volvulus microfilariae following treatment, using 3 independent diagnostic techniques. Method Identified microfilaridermic individuals were treated with ivermectin and re-examined after 1, 3, and 6 months using microscopy, actin real-time PCR (actin-qPCR) and O-150 LAMP assays. Susceptibility to ivermectin and trends in detecting reappearance of skin microfilariae were determined using three techniques. Microscopy was used as an imperfect gold standard to determine the performance of actin-qPCR and LAMP. Results In Bafia with over 20 years of IVM-MDA, 11/51 (21.6%) direct observe treated microfilaridemic participants were still positive for skin microfilariae after 1 month. In Melong, with 10 years of IVM-MDA, 2/29 (6.9%) treated participants were still positive. The microfilarial density reduction per skin biopsy within one month following treatment was significantly lower in participants from Bafia. In both study sites, the molecular techniques detected higher proportions of infected individuals than microscopy at all monitoring time points. LAMP demonstrated the highest levels of sensitivity and real-time PCR was found to have the highest specificity. Conclusion Patterns in skin mirofilariae clearance and repopulation were established. O. volvulus worms from Bafia with higher number of annual MDA displayed a lower clearance and higher repopulation rate after treatment with ivermectin. Molecular assays displayed higher sensitivity in monitoring O. volvulus microfilaridemia within six months following treatment

Correction to: Differential susceptibility of Onchocerca volvulus microfilaria to ivermectin in two areas of contrasting history of mass drug administration in Cameroon: relevance of microscopy and molecular techniques for the monitoring of skin microfilarial repopulation within six months of direct observed treatment

After publication of the original article [1], the authors identified an error in the author name of Manuel Ritter. The given name and family name were erroneously transposed. The original article has been corrected. (BMC Infectious Diseases, (2020), 20, 1, (726), 10.1186/s12879-020-05444-2

Using Postcolonial Perspectives to Consider Rehabilitation with Children with Disabilities: The Bamenda-Toronto Dialogue

This work is published and distributed by The Critical Institute.This article discusses tensions in children’s rehabilitation that came to light through a series of ‘postcolonial dialogues’ amongst Canadian and Cameroonian participants. We defined ‘tensions’ as conflicts, contrasting ways of seeing things, and/or taken-for-granted ideas that shape issues related to rehabilitation for children with disabilities. These tensions were identified, articulated, and deconstructed through an iterative, multi-phase dialogue among eight individuals who identify as people with disabilities, rehabilitation providers, and/or rehabilitation researchers in Cameroon and Canada. The tensions discussed in this article problematize conceptualizations of disability and of client-centred care, the role of pain as a reinforcement tool in rehabilitation, and assumptions about poverty and religion in the context of rehabilitation practice. We present this synthesis to achieve several aims: (1) to provide multiple ways for rehabilitation providers and others to better understand these particular substantive issues; (2) to model the use of a critical lens as an approach for thinking about rehabilitation that promotes reflective and deliberate practice and that can be applied across contexts; and, (3) to promote dialogue about postcolonial and other critical perspectives on rehabilitation with children and with other groups