The level of knowledge of the advanced trauma life support protocol among nonspecialist doctors involved in trauma care in Enugu metropolis

Background: Trauma is one of the leading causes of mortality in developing countries. Nonspecialist doctors are the first caregivers to attend to trauma patients. Most nonspecialist doctors in Nigeria lack extra training in trauma care including the ATLS training for doctors.Objectives: To determine the knowledge of the ATLS protocol among nonspecialist doctors involved in trauma care in Enugu, Nigeria.Materials and Methods: We prepared and shared out questionnaires to the respondents, and later analyzed the information received using the SPSS 15.Results: 65 out of 110 respondents (59.1%) filled and returned their questionnaires. 59 (90.8%) were males and 6 (9.2%) females. Their ages ranged from 29 to 47 years (35.6 ± 3.85 years) and they had been practicing for 1-16 years (mean 4.40 ± 3.540 years). 5 (7.7%) were medical officers while 60 (92.3%) were residents at various stages of training in different Surgical subspecialties. 41 or 63.1% rated their knowledge of the ATLS protocol as satisfactory. 22 (33.8%) demonstrated a satisfactory knowledge of ATLS. The three respondents (4.8%) who had undertaken a formal training in ATLS demonstrated excellent knowledge of ATLS. All believed that training in the protocol would be beneficial in their career.Conclusion: There is a poor knowledge of ATLS among nonspecialist doctors involved in trauma care in Enugu, Nigeria. ATLS training should be adopted by the hospitals involved in the training of doctors and should become a condition to employ surgery residents.Key words: Knowledge, non-specialist, traum

Application of electrical resistivity survey for groundwater investigation in a basement rock region: A case study of Akobo - Ibadan, Nigeria

A geo-resistivity exploration has been carried out for groundwater within the Akobo catchment of the ancient city of Ibadan. The area lies within the basement rock terrain of South Western Nigeria and bounded by  longitudes 3o 51′ – 3o 53′E and latitudes 7o 22′ – 7o 24′N. The exploration was done using SYSCAL KID meter while a total of 10 VES with an average of 46m station interval were completed in 3 profiles by means of Schlumberger configuration with total current electrode spread of 160m. The results revealed that the area is underlain by four geo-electric layers. The top lateritic soil has resistivity values ranging from 28.1 to 481.8 Ωm and thickness of 0.8 to 5.7m. The second layer has sand/clay intercalation with resistivity values varying between 47.7 and 192.5 Ωm and thickness varying between 2.8 and 19.4 m. The weathered/fractured basement has resistivity values from 106.2 to 846.8 Ωm with thickness of 13.2 to 24.9m while the partly weathered/fresh basement layer has resistivities rangingfrom 130 to 856.4 Ωm. The distribution of resistivities in the area shows that the weathered basement has a relatively low resistivity (< 200 Ωm) values in the north-eastern and north-western axis coupled with high thickness values (> 20 m) which suggests the presence of an aquiferous zone. Therefore, this portion of the study area could be highly hydro-geologically promising and maybe recommended for siting groundwater tube.Key words: Geo-resistivity, groundwater, basement rock, borehole and Ibada

Computer Simulation of the Impact of Cigarette Smoking On Humans

In this edition, emphasis has been laid on computer simulation of the impact of cigarette smoking on the population between now and the next 50 years, if no government intervention is exercised to control the behaviour of smokers. The statistical indices derived from the previous article (WAJIAR Volume 4) in the series were plugged in as input to the simulation model. The software simulation followed a statistical model. The simulation software was developed using the internationally accepted Software Engineering Methodology – the Structured System Analysis and Design Methodology (SSADM), coding by OOP and packaging by Prototyping methodologies. The simulation is intended to be predictive and to enable policy makers see the impact and dangers of cigarette smoking between now and the next 50 years if current abuse is not controlled, that is, the number of smokers likely to contact liver, brain and related diseases and who are most likely to die from these diseases. The summary of the result shows that in the next fifty years, a total of 2379591 people will likely suffer liver diseases, 2379818 people will likely suffer lung diseases, 2380297 people will likely suffer hepatitis and 2379689 will also likely suffer Brain Damage. Generally, a total of 9519395 people will likely suffer these four diseases caused by cigarette smoking and most importantly, the total number of deaths is expected to be 1903880. This result suggests that the negative impact of cigarette smoking is significant and demands immediate government intervention to avoid further population decimation. Keywords: Simulation, Software, Model, Population, Design

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Surgical Limb Amputation: A Five-Year Experience At Hilltop Orthopedic Hospital Enugu, Nigeria

BACKGROUND: Limb amputation is one of the oldest and commonest surgical procedures known to man. It is performed by the orthopedic, general, vascular and trauma surgeons. At Hilltop Orthopedic Hospital, Enugu, limb amputation is found prevalent, yet most times it is objectionable to the patient. METHOD: A prospective study was decided and carried out on all limb amputations over a five-year period, between January 1998 and December 2002. AIM The aim was to analyzed the indications for the amputations and the outcome to see it they really justifiable. RESULTS: 44 amputations were done in 44 patients in the age range of 9 to 83 years with the peak age incidence in the 4th decade. Trauma was commonly found in our sub region as the commonest indication for amputation in 52% of cases. However, it was found out that mismanaged trauma constituted the greater majority of cases due to trauma making up 34%, while trauma per se made up the remainder 18%. All the cases of mismanaged trauma were by the traditional bonesetters. Ignorance was found to be the reason for this mismanagement. Ways of eliminating this ignorance are suggested. There was a mortality of 15%, which is on the high side but within the general range quoted for amputation for trauma in civilian practice. Most of the survivors, 35 out of 37 (95%) were able to lead a reasonable degree of independent life. CONCLUSION: Traditional bone setting is a problem area in our culture. Legislation might be necessary to stem the tide of these avoidable problems. KEY WORDS: Amputation, Indication, traditional bone setting Nigerian Journal of Orthopaedics and Trauma Vol.3(2) 2004: 139-14

Cervical Spine Injury: A ten‑year multicenter analysis of evolution of care and risk factors for poor outcome in southeast Nigeria

Study Design: Retrospective study.Objective: To describe the evolution of care and risk factors for poor outcome in patients with cervical spine injury (CSI) treated at three centers in southeast Nigeria.Setting: Nigeria, southeast.Materials and Methods: A 10‑year retrospective multicenter analysis of patients with CSI, managed at three centers in southeast Nigeria, from January 2003 to December 2012.Results: Two hundred and seven patients (55%) had CSI out of 377 spinal injury cases in the three study centers, but 195 cases had complete records and were studied. There were 148 males and 47 females. The age range was 3-74 years with a mean of 32.6 (±1.9) years 95% CI. Most injuries (149 cases) resulted from motor vehicular accidents (MVA). The C5 spinal level was involved in 75 (38%) cases One hundred and seventeen patients (60%) presented with American Spinal Injury Association A (ASIA A) injury. CSI care evolved from the application of a Minerva jacket or cervical traction only to cervical traction and spinal fusion resulting in a reduction in hospital stay (F = 52.5, DF (2, 3) P &lt; 0.05). When compared to 51 patients with incomplete injuries, who improved in neurologic al status at discharge, only three patients with ASIA grade A experienced some improvement. The mortality rate from our series is 16% (32 patients). Those who died were more likely to have a complete injury (25 patients) or a high cervical injury (X2 = 61.2, P &lt; 0.05) among other factors.Conclusion: The cervical spine is the most commonly injured spinal segment in southeastNigeria. Although treatment evolution has resulted in reduction of hospital stay, the associated mortality risk still remains high.Key words: Cervical spine injury, pattern, southeast Nigeria, treatment outcom

Prevalence of selected fall variables and relationship among them in a Nigerian stroke population

Objectives- This study investigated the relationships among the three fall indices of fall incidence (FI), fall risk (FR) and fear of falling (FOF)among stroke survivors in a Nigerian population.Design: Ex-post facto study with co-relational designMethods-This correlation study involved 26 stroke survivors (17 males, 9 females) recruited through consecutive non-probability samplingtechnique from two South-Eastern Nigeria teaching hospitals. The Modified Falls Efficacy Scale (MFES), Berg Balance Scale (BBS) and oralinterview were respectively used to assess fear, risk and incidence of falls of participants.Results- FOF prevalence in the studied population was 81% while actual fall prevalence was 19.2% within the 6months period preceding datacollection. Risk of falling was also present in about 70% of participants. FOF and FR both significantly correlated (

Impact of overweight and obesity on the musculoskeletal system using lumbosacral angles

Ndubuisi OC Onyemaechi,1,2 Godson E Anyanwu,3 Emmanuel N Obikili,3 Okechukwu Onwuasoigwe,1,2 Okechukwu E Nwankwo1,2 1Department of Surgery, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria; 2University of Nigeria Teaching Hospital, Enugu, Nigeria; 3Department of Anatomy, College of Medicine, University of Nigeria, Enugu, Nigeria Background: Overweight and obesity have been identified as independent risk factors for musculoskeletal disorders. However, the association between obesity and low back pain remains controversial. Little is known about the effects of overweight and obesity on the angles of the lumbosacral spine. The objective of this study was to evaluate the effects of body mass index (BMI) and waist&ndash;hip ratio (WHR) on lumbosacral angles. Methods: The effects of BMI and WHR on the lumbar lordosis angle (LLA), lumbosacral angle (LSA), sacral inclination angle (&deg;&deg;), and lumbosacral disc angle (LSDA) of 174 overweight and obese subjects (test group) and 126 underweight and normal-weight subjects (control group) were analyzed. Results: The test group had a significantly higher mean LSA, LLA, sacral inclination angle (SIA), and LSDA (P=0.001). A significant correlation was noted between BMI and LSA (P=0.001), LLA (P=0.001), SIA (P=0.001), and LSDA (P=0.03). There was also a positive relationship between WHR and LSA (P=0.012), LLA (P=0.009), SIA (P=0.02), and LSDA (P=0.01). Conclusion: There was an increase in lumbosacral angles in individuals with raised BMI and WHR. This may result in biomechanical changes in the lumbosacral spine, which increase the incidence of low back pain. Keywords: body mass index, waist&ndash;hip ratio, lumbosacral angle