Septic Arthritis: A Need to Strengthen the Referral Chain in a Developing Economy

ABSTRACT Aim: This retrospective analysis documents the features and factors that potentially affect outcomes in septic arthritis in the Cross River Basin area of south-south Nigeria. Patients and Methods: A retrospective analysis of 43 patients who presented with septic arthritis in 45 joints between September 2007 and August 2010. All patients with pain, fever, joint swelling and non-weight bearing/refusal to move the limb and had a joint aspiration productive of a turbid and/or purulent aspirate were included in the analysis. Patients whose joint aspiration produced frank blood or a clear exudate were excluded. Results: There were 24 males and 19 females (M:F = 1.3:1). Forty patients were children while three were adults. Thirty-three patients were urban dwellers, 8 were semi-urban dwellers and 2 were rural dwellers. Twenty-five children were first seen by a Paediatrician. Only 5 patients were first seen by an Orthopaedic surgeon. Definitive treatment was conservative in 28 children and arthrotomy/washout in 12 children and 3 adults. Staphylococcus aureus was the commonest isolated pathogen in both age groups. Conclusion: Injudicious interventions in musculoskeletal conditions consist not only of traditional bone setting and other unorthodox practices, but also sub-optimal orthodox medical practices. Healthcare outcomes in Africa are a function of the skewed distribution of the healthcare workforce and a weak referral chain. The near absence of follow-up culture underscores the need for education on injudicious antibiotic therapy to be directed at patients and physicians. Judicious interventions in musculoskeletal sepsis at first contact and a strengthening of the referral chain are important

Atomic absorption spectrophotometric microdetermination of total mercury in undigested biological samples

Journal of Analytical Toxicology123132-135JATO

Atomic absorption spectrophotometric determination of mercury in undigested biological samples

Industrial Health263173-178INHE

Basal and squamous cell carcinomata on the same patients: report of two cases in Aibinos

Background: Skin cancer is the most common cancer among the lightly pigmented individuals in Europe, North America and Australia. It occurs infrequently in darkly pigmented individuals because they have more melanin. Melanin and albinism are a known risk factors for skin cancers in Africans. Those already treated for skin cancer run a risk of developing another skin cancer. Method: Two case reports of albinos who developed basal cell carcinoma (BCC) and squamous cell carcinomata (SCC) later are presented. The two female albinos aged 61 and 21years had BCC and SCC involving the left arm and the dorsum of the left hand in case1 and involving the face and the medial side of the right elbow in case 2. Both patients had numerous actinic keratoses that indicated chronic exposure to sunlight. Results: The outcome was good for the BCC\'s as the wounds healed post excision. There was no evidence of recurrence when the patients represented with SCC at 12 and 18 months respectively. Conclusion: Albinos run a risk of developing both BCC and SCC with chronic exposure to sunlight. Health education strategies on the need for early institution of preventive measures and follow up are emphasised as they run a risk of developing another cancer. Keywords: Albinos, Basal cell carcinoma, Squamous cell carcinoma, Same individualsPort Harcourt Medical Journal Vol. 3 (1) 2008: pp. 111-11

Budd Chiari Syndrome: an unexpected diagnosis in a gastroenterology practice in Calabar, Nigeria

Background: Vascular disorders of the liver are relatively rare in clinical practice. Budd Chiari syndrome (BCS) is a potentially life-threatening condition. It describes a group of disorders characterized by hepatic venous outflow obstruction at any level from the small hepatic veins up to the junction of the inferior vena cava and the right atrium. The prevalence of Budd Chiari Syndrome is greatly influenced by geographical differences. There is a dearth of data in Nigeria regarding this condition.Case report: We report the case of a thirty seven year-old woman presenting with an eight year history of recurrent abdominal swelling, jaundice and progressive weight loss. The patient was promptly screened for viral hepatitis B and C, which were both negative. The laboratory work-up revealed mild hepatic dysfunction and an abdominal ultrasound scan showed mild hepatomegaly and ascites. Abdominal Computed Tomography (CT) scan findings were consistent with Budd Chiari Syndrome, based on the findings of an extensive thrombus, involving the common iliac and hepatic veins, in addition, the inferior vena cava (IVC) and right atrium.Conclusion: This case report highlights the importance of the knowledge of Budd Chiari Syndrome and the diagnostic approach. This condition should be considered whenever investigating the aetiology of chronic or acute liver disease in Gastroenterology practice in Nigeria.Keywords: Budd Chiari Syndrome, Thrombosis, Hepatic Venous Outflow Obstruction, Ascite

Motorcycle Road Traffic Injuries in Southern Nigeria: The Small Motorcycle as a Prevention Strategy

Background: The commonest mode of public transportation in Uyo is by motorcycle. There are two sizes of motorcycle in common use - the big one (Qlink or Skygo model, made in China) and the small one (C90, made in China). The study was carried out to determine if there is a lower risk of RTI severe enough to be brought to the hospital, attributable to using a small motorcycle. Methods: Motorcycle RTI victims admitted at the Accident and Emergency department of the University of Uyo Teaching Hospital (UUTH), were reviewed prospectively over a 15 month period. Three community visual surveys of the proportion of small to large motorcycles were also conducted. Results: A total of 131 RTI victims were reviewed over 15 months. The visual surveys of motorcycles in Uyo revealed that the mean proportion of small to large is 38 to 62, a ratio of 1:1.6. Eighty-three (63.3%) of the 131 RTI′s involved motorcycles. 74 of these occurred in large motorcycles. There was a statistically significant relationship between motorcycle size and occurrence of an RTI severe enough to be brought to hospital. Conclusion: There is a lower risk of RTI severe enough to be brought to hospital, from using a small motorcycle