The Civilian Vascular Trauma in a Low‑Income Country: The Determinant Factors of Morbidity and Mortality

Background: Civilian vascular injury is relatively common in the West African subregion, but it is highly underreported. Aim/Objective: The aim of the study was to evaluate the patients managed for civilian vascular surgeries and to determine the factors causing morbidity and mortality in low‑income countries. Materials and Methods: This is a retrospective study spanning a period of 13 years (2007–2019) of civilian vascular injuries managed in a tertiary hospital in a low‑income country. We obtained data from our hospital record department. Data obtained and analyzed were demography, etiology, vessels affected, pattern of presentation, stratification, and treatment. Results: Within the envisaged period, 58 patients were affected in civilian vascular trauma with a mean of 4.5 cases per year. The male‑to‑female ratio was 0.9:0.1. The age range of patients affected was from 0–10 to 71–80, with the age group of 21–30 years being the most affected. Male was more affected (87.9%). Motor vehicle crashes were the most common etiology agent (42.0%). The femoral artery was the most commonly injured vessel (31.3%). In the pattern of presentation, bleeding with shock was dominant (49.8%). Lateral tarsorrhaphy accounted for the major vascular treatment interventions (30.2%). Conclusion: The outcome was very variable and depended on warm ischemic time, type and/or mechanism of injury, collateral blood supply at the site of injury, and comorbidity. Keywords: Amputation, civilian, injury, vascular, warm ischemic tim

Surgical Treatment of Valvular Heart Disease in Nigeria: A 6-Year Experience

Surgical treatment of valvular heart disease in Nigeria, the most populous country in sub-Saharan Africa, is adversely affected by socioeconomic factors such as poverty and ignorance. To evaluate our experience in this context, we identified all patients who underwent surgery for acquired or congenital valvular heart disease at our Nigerian center from February 2013 through January 2019. We collected data from their medical records, including patient age and sex, pathophysiologic causes and types of valvular disease, surgical treatment, and outcomes. Ninety-three patients (43 males [46.2%]; mean age, 38.9 ± 10.0 yr [range, 11–80 yr]) underwent surgical treatment of a total of 122 diseased valves, including 72 (59.0%) mitral, 26 (21.3%) aortic, 21 (17.2%) tricuspid, and 3 (2.5%) pulmonary. The most prevalent pathophysiologic cause of disease was rheumatic (87 valves [71.3%]), followed by functional (20 [16.4%]), congenital (8 [6.6%]), degenerative (5 [4.1%]), and endocarditic (2 [1.6%]). All 3 diseased pulmonary valves had annular defects associated with congenital disease. Surgical treatment included mechanical prosthetic replacement of 92 valves (75.4%), surgical repair of 29 (23.8%), and bioprosthetic replacement of 1 (0.8%). We conclude that, in Nigeria, valvular disease is mainly rheumatic, affects mostly younger to middle-aged individuals, and is usually treated with prosthetic replacement

Correlation between serum uric acid levels and outcomes of pre-eclampsia in Abakaliki, South-east, Nigeria

Background: Pre-eclampsia is a leading cause of fetomaternal and perinatal morbidity and mortality. The role of serum uric acid (SUA) in determining the complications of preeclampsia has been controversial. This study compared mean SUA levels between severe pre-eclamptics and normotensive women at term and ascertained its correlation with outcomes of preeclampsia; as well as determined if there is a threshold value of SUA level beyond which fetomaternal complications occur.Methods: A case-controlled study where 80 severe pre-eclamptics at term and 80 normotensive women matched for gestational age were recruited. Blood samples were collected from them for assay of SUA levels and they were followed till delivery. The fetomaternal outcomes and the corresponding SUA levels at diagnosis were documented and variables statistically analyzed. A receiver operating characteristic curve was used to determine the cut-off value of SUA beyond which adverse fetomateral complications are likely to occur in pre-eclampsia.Results: The mean SUA level in severe pre-eclamptics (0.283±0.09 mmol/l) was not significantly higher than that of normotensive women (0.263±0.09 mmol/l, p=0.13). There was a weak positive correlation between the SUA levels and fetomaternal outcomes [maternal (r=0.102, p=0.236) and fetal (r=0.096, p=0.226)]. The study was unable to identify the threshold SUA level at which adverse fetomaternal outcomes occur as the values of SUA were closely related.Conclusions: SUA levels of pre-eclamptics and normotensive women did not show significant difference and correlated weakly with fetomaternal outcomes and are therefore poor predictor of fetomaternal outcomes in pre-eclampsia

The AU free movement protocol: Challenges in its implementation

One of the major pillars of the African Union is the integration of peoples and the ability for them to move freely from one member country to another, with the right to reside and practise their trade or profession. This aspect of integration found full expression in the Protocol to the Treaty Establishing the African Economic Community Relating to the Free Movement of Persons, Right of Residence andRight of Establishment, adopted in 2018. Upon operationalization, it will remove obstacles to the movement of people, capital and resources in the region and give expression to aspiration 2 of the African Union Agenda 2063. However, significant challenges lie on the path of its implementation. This article doctrinally reviews the protocol, looking at its prospects for promoting African integration and development, anticipates some of the problems that the protocol will face. It concludes with recommendations for achieving its lofty but desirable ends

The Profile of Diaphragmatic Hernias in three tertiary hospitals in South-East Nigeria: A 13-Year Review

Background: The diaphragm is a fibro-muscular partition that separates the relatively low-pressure thoracic cavity from the relatively high-pressure abdominal cavity. This difference in pressure causes transmigration of abdominal contents into the thoracic cavity whenever there is a defect, often resulting in cardio-respiratory disturbances.Objective: To describe the profile of diaphragmatic hernias managed in three tertiary hospitals in, South-East Nigeria and compare same with global outcomes.Methodology: Retrospective study of patients with different types of diaphragmatic hernias managed in three centre over a 13-year period was done. Data on demography, types of hernias, mode of presentation, diagnostic methodology, treatment offered and prognosis including complications were obtained from Record Departments of each hospital.Results: There were a total of 44 patients with male to female ratio of 9:2. The ages ranged from 21 days to 840 months. The profile of the hernias was congenital (n=8, 18.2%), acquired traumatic (n= 30, 68.2%) and acquired non-traumatic (n=6, 13.6%). Among the congenital types-four (50%) were central, three (37.5%) were posterior while one (12.5%) was anterior. In the acquired traumatic types, left side was dominant. In the hiatal hernia (acquired non-traumatic), types 1 has the highest occurrence followed by type IV. Associated injuries in traumatic diaphragmatic hernias were the determinants of morbidity.Conclusion: Thoraco-abdominal hernias as described are not uncommon in our centre. Multidisciplinary approach and functional Intensive care unit (ICU) played significant role in the outcome of congenital diaphragmatic hernias. Keywords: Profile, Diaphragm, Hernias, Enug