Major limb amputations at a teaching hospital in the sub-Saharan Africa: Any change in trend?

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Outcome of Femoral Plate Osteosynthesis in a Teaching Hospital in a Developing Country

Background: Fractures of the femur are a common presentation of  traumatic injuries and are usually associated with other injuries. The need for surgical fixation is undisputed although operative options are varied, and often the choice is based on fracture pattern, available facilitiesand the surgeon's preference. This decision should be determined by the predicted functional outcome rather than by the type of implant to be used. The main objective of this study was to evaluate the results of treatment of femoral shaft fractures using plate osteosynthesis in our centre.Method: This was a retrospective study done by reviewing the medical records of patients presenting with femoral shaft fractures between 2005 and 2012.Results: A total of two hundred and four patients underwent plate  osteosynthesis of femoral shaft fractures within the period under  consideration. One hundred and seventy (83.3%) patients achieved clinical and radiological union after an average of 5months. There were 12 (5.9%) nonunions, 10 (4.9%) infected implants and 4 (2%) broken implants.Conclusion: Plate osteosynthesis is vital in the management of femoral fractures especially in developing countries where the cost of care is entirely borne by the patients and relations. Careful patient selection and meticulous post-operative follow-up care are essential for a favourableoutcome.Key words: Femoral, Plate, Osteosynthesis,Outcome,Developing, Countr

Results of Operative Fixation of Fractures of the Ankle at a Tertiary Hospital in a Developing Country

Background: Operative fixation of ankle fractures is becoming popular in developing countries. The concern however is the outcome of care. The objective was to evaluate the results of open reduction and internal fixation (ORIF) of fractures of the ankle in our hospital.Methods: All cases ORIF of fractures of the ankle at the University College Hospital (UCH), Ibadan between March 2010 and December 2012 were recruited into the study. The indications for surgery, techniques of fixation, time interval between injury and presentation as well as outcome  measures like time to union, complications and functional outcomes were evaluated.Results: Seventy patients who had ORIF of ankle fractures were studied. Twenty-one (30%) were open fractures while forty-nine (70%) were closed. Sixty (85.7%) patients presented within the first week of injury, 4 (5.7%) after 4 weeks, 4 (5.7%) after 6 weeks and 2 (2.9%) after 52 weeks. Time to union averaged 12.6±4.1weeks. Complications included wound infection 14.3%, wound dehiscence with exposed implants 2.9%, malunion 8.6% and non union 5.7%. Good to excellent functional outcomes were achieved in 77.1% of the patients.Conclusion: ORIF is a viable option in the treatment of ankle fractures

Seatbelt use and risk of major injuries sustained by vehicle occupants during motor-vehicle crashes: A systematic review and meta-analysis of cohort studies

BackgroundIn 2004, a World Health Report on road safety called for enforcement of measures such as seatbelt use, effective at minimizing morbidity and mortality caused by road traffic accidents. However, injuries caused by seatbelt use have also been described. Over a decade after publication of the World Health Report on road safety, this study sought to investigate the relationship between seatbelt use and major injuries in belted compared to unbelted passengers.MethodsCohort studies published in English language from 2005 to 2018 were retrieved from seven databases. Critical appraisal of studies was carried out using the Scottish Intercollegiate Guidelines Network (SIGN) checklist. Pooled risk of major injuries was assessed using the random effects meta-analytic model. Heterogeneity was quantified using I-squared and Tau-squared statistics. Funnel plots and Egger's test were used to investigate publication bias. This review is registered in PROSPERO (CRD42015020309).ResultsEleven studies, all carried out in developed countries were included. Overall, the risk of any major injury was significantly lower in belted passengers compared to unbelted passengers (RR 0.47; 95%CI, 0.29 to 0.80; I-2=99.7; P=0.000). When analysed by crash types, belt use significantly reduced the risk of any injury (RR 0.35; 95%CI, 0.24 to 0.52). Seatbelt use reduces the risk of facial injuries (RR=0.56, 95% CI=0.37 to 0.84), abdominal injuries (RR=0.87; 95% CI=0.78 to 0.98) and, spinal injuries (RR=0.56, 95% CI=0.37 to 0.84). However, we found no statistically significant difference in risk of head injuries (RR=0.49; 95% CI=0.22 to 1.08), neck injuries (RR=0.69: 95%CI 0.07 to 6.44), thoracic injuries (RR 0.96, 95%CI, 0.74 to 1.24), upper limb injuries (RR=1.05, 95%CI 0.83 to 1.34) and lower limb injuries (RR=0.77, 95%CI 0.58 to 1.04) between belted and non-belted passengers.ConclusionIn sum, the risk of most major road traffic injuries is lower in seatbelt users. Findings were inconclusive regarding seatbelt use and susceptibility to thoracic, head and neck injuries during road traffic accidents. Awareness should be raised about the dangers of inadequate seatbelt use. Future research should aim to assess the effects of seatbelt use on major injuries by crash type

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

Entrepreneurship Development: A People Change Approach To Self Actualization And Sustainability

This research presents an educational, training, and development approach that is focused on the need for change in the behaviour of the entrepreneurial stream, and the society in general, to attain true self-actualization and sustainability. The paper considers self actualization and sustainability as essentially entrepreneurial behaviour. A model that specifies the appropriate approaches for entrepreneurial education, training and development is presented. The emphases are, on individual, immediate environment, and the larger society in shaping the entrepreneurial personality. The paper reports a field study where four hypotheses were tested on education, training and development of entrepreneurs in Nigeria. The results showed strong support for the effect of education, training and Development on the entrepreneur\'s emergence, the behaviour of entrepreneurs was perceived to be negatively affected by lack of training and Development, and finally, the entrepreneurs perceived positive relationship between training and development, and entrepreneur\'s performance. The selected sample of entrepreneurs were asked to list areas of training and development needs in order to improve them on their various vocations and trades. The paper notes that the lessons from this research is that, education, training and development could be used as a vehicle for people change approach to self actualization and sustainability for the Nigerian nation, because they can be used to produce change in the behaviour of entrepreneurs. Conclusions and recommendations on the approach were highlighted. Keywords: Development; Entrepreneurs; Change; Self actualization Sustainability JORIND Vol. 5 (2) 2007: pp. 11-1