Use of External Fixator in Achieving Early Osseous Fusion in Boyd’s Amputation of the Ankle – A Review of Two Cases

Boyd amputation refers to amputation at the level of the ankle with preservation of the calcaneus and heel pad with consequent fixation of the calcaneus to the tibia. This allows for complete weight bearing and provides stabilization of the heel pad. It is a technically more difficult procedure to perform than the Syme amputation which is a more popular procedure done in ankle disarticulations. The aim of this report is to document our experience with the use of external fixators to achieve osseous union in the management of diabetic foot gangrene. Two cases of diabetic foot gangrene were managed successfully by Boyd’s amputation using external fixators to achieve compression, osseous integration and union. This procedure will be quite useful in developing countries where prosthesis utilization is poor and expensive as obtains in higher level amputations.Key words: Calcaneus, Disarticulation, Diabetic foot, Gangren

Respiratory Diphtheria in Two Children Presenting to A Tertiary Hospital in South–East Nigeria

Respiratory diphtheria is an acute and infectious disease that can progress to cardiac and neurological complications ultimately resulting in increased morbidity and mortality in affected individuals. Diagnosis was made in line with the WHO clinical case definition for Diphtheria. This is a report of two probable cases of complicated respiratory diphtheria presenting within 3 weeks of each other to the Paediatrics Department of Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi, Anambra state, South-East Nigeria. The first patient was a 5-year-old female who presented on referral with a history of fever, throat pain, noisy breathing and facial fullness, in whom bull neck appearance and membrane in the throat was observed. She was tachycardic, in respiratory distress, had elevated jugular venous pulse (JVP), soft tender liver and a greyish membrane in the throat. She was managed as a case of Diphtheric Carditis and discharged after 17 days on admission in stable condition. The second patient was also a 5-year-old, male, who presented with a history of fever, difficulty in swallowing, change of voice (progressing from hoarseness to whispers), cough and staggering gait. Onset of the illness was associated with membrane in the throat, bull neck and stridor. Examination revealed cranial nerve deficits, aphonia, hypotonia and staggering gait. CSF analysis was within normal. He was managed as a case of Diphtheric Neuropathy and was discharged home in stable condition after 16 days on admission. C. diphtheria IGG done 2 weeks post discharge was 0.19 IU/ml. The cases suggest that respiratory diphtheria still occurs in children in our environment. A high index of suspicion is needed to diagnose and properly nurse these children back to health. Keywords: Corynbacterium diphtheriae, Paediatric Pulmonolog

Tibio-fibular synostosis - a viable option in the management of segmental tibial loss: case report

Segmental tibia loss resulting in gap non-union presents a major challenge to the orthopaedic surgeon, especially when associated with infection, old or active osteomyelitis, and multiple previous surgeries. This is made rather worse in the presence of extensive skin and soft tissue scarring. Several options of treatment have been proposed with the most recent advance being the Ilizarov technique. However, in the face of extensive skin and soft tissue scarring especially in the anterior and antero-medial portions of the leg, bone transport becomes almost impossible and resort to other methods of treatment become handy.We report a case of segmental tibial loss in a26-year-old man who presented to the outpatient clinic with a two-year history of gap non-union of the right tibia (8cm) following a road traffic accident. This was complicated by a chronic ulcer seating on scar tissue with extensive skin and soft tissue scarification and muscle atrophy. He was successfully managed by proximal tibio-fibular synostosis with radiological evidence of distal tibio-fibular synostosis. Limb length and alignment were fully restored.Keywords: Antibiotics, bone graft, gap non-union, Kirschner wire, segmenta

Pattern of Presentation of Primary Bone Tumors in Nnewi, South-East Nigeria

Background: Primary bone tumors are rare and there is paucity of information on the pattern of its presentation in our environment. There is less thought given to it by the patients and sometimes medical personnel, leading to late presentation, late diagnosis and subsequent adverse sequelae. Objective: The aim of this study was to determine the pattern of presentation of primary bone tumors in Nnewi South Eastern Nigeria Methodology: This was a retrospective hospital based study. Records of patients with histological confirmed primary bone tumors seen between January 2012 and December 2016 were reviewed. Patient’s bio-data, symptoms, time of presentation to hospital, anatomical sites involved and tumor histological types were obtained and analyzed. Results: Thirty one (31) patients were studied. There were more males than females (1.1:1). The mean age of the patients was 38.8± 1.2 years with a range of 4-73 years. The most common malignant bone tumor seen was Osteosarcoma. Pain was the most common symptom and the interval between onset of symptom and presentation was 36.9 months with a range of 2-168 months. The distal femur is the most commonly involved anatomical site. Conclusion: Primary bone tumors are not very common, but more patients with malignant tumors were seen in our environment. Most patients presented with pain and swelling. Medical personnel are advised to have a high index of suspicion when evaluating patients with these symptoms.Key words: Primary bone tumors, Epidemiology, Bone lesions, Histologic types, Nnewi

Exercise Induced Bronchospasm and associated factors in primary school children: a cross-sectional study

Abstract Background Exercise Induced Bronchospasm(EIB) is not equivalent to asthma. As many as 20%of school aged children are estimated to have EIB. In Nigeria, there is still a dearth of information on EIB as a clinical entity. This study determined the presence of EIB(using pre and post-exercise percentage difference in peak expiratory flow rate(PEFR) and associated factors such as age, gender, social class and nutritional status in primary school children in Nnewi, Anambra state, South-East Nigeria. The study also grouped those with EIB into those with asthma(EIBA) and those without asthma(EIBWA). Methods This was a community based cross-sectional study involving 6–12 year olds. The PEFR was taken at rest and after a 6 min free running test on the school play-ground using a Peak Flow Meter. A diagnosis of EIB was made if there was a decline of ≥ 10%. Those who had EIB were grouped further based on the degree of decline in post-exercise PEFR (a decline ≥ 10% < 25% → Mild EIB, ≥ 25% < 50% → Moderate EIB and ≥ 50% → Severe EIB) and then categorized as those with EIBWA/EIBA. Results EIB in the various minutes post-exercise was as follows: 19.2%(1stmin), 20.9%(5thmin), 18.7%(10thmin), 10%(20thmin), 0.7%(30thmin). Mild EIB accounted for the greater proportion in all minutes post-exercise and none of the pupils had severe EIB. Using values obtained in the 5thmin post-exercise for further analysis, EIBWA/EIBA = 84.1%/15.9% respectively. Mean difference in the post-exercise PEFR of EIB/no EIB and EIBWA/EIBA was -48.45(t = -7.69, p =  < 0.001) and 44.46(t = 3.77, p = 0.01) respectively. Age and gender had a significant association to the presence of EIB and 58% of the pupils with EIB were of high social class. The BMI for age and gender z-scores of all study subjects as well as those with EIB was -0.34 ± 1.21, -0.09 ± 1.09 respectively. Other features of allergy(history of allergic rhinitis: OR–5.832, p = 0.001; physical findings suggestive of allergic dermatitis: OR–2.740, p = 0.003)were present in pupils diagnosed with EIB. Conclusion EIB has a high prevalence in primary school children in Nnewi and the greater proportion of those with EIB had EIBWA. EIB therefore needs to be recognized as a clinical entity and stratified properly based on the presence or absence of asthma. This will help the proper management and prognostication

Compendium of Oral Pathologies in Children Presenting to A Tertiary Hospital in Nigeria

Background: Oral diseases are one of the most common non-communicable diseases. They are also the most neglected particularly in children.Objective: To determine the pattern and trend of oral diseases among children who presented in the dental clinic of a Nigerian Tertiary hospital over 58 months.Methodology: A retrospective study that assessed for oral diseases among children using the dental health records.Results: 1104 cases presented at the dental clinic, comprising 546 males and 558 females with a ratio of 1:1.02. The mean age of the subjects was 10.6 years ± 4.2 with an age range of 1 month to 17 years. Close to ninety-eight percent of cases reviewed were symptomatic. Across all age groups, dental caries and its sequalae was observed in 62.2% of cases and this was independent of age group and year of presentation (p&lt;0.0001).Conclusion: An increasing trend of oral diseases was observed annually with the leading diagnosis been dental caries and its sequalae

Paediatric HIV test in a south-eastern tertiary centre: does provider initiated testing and counseling increase the uptake rate?

Background: Provider Initiated Testing and Counseling (PITC) encourage early detection of Human Immunodeficiency Virus (HIV) infection and prompt treatment once diagnosis is confirmed. It was primarily designed to augment the universal screening of clients at presentation to a health facility. Sustaining PITC in health facilities appears to be facing numerous challenges with reduction of testing ratesObjectives: The study was carried out to determine the rate of uptake of HIV testing prior to and during PITC era, and to assess the influence of PITC on HIV testing rate in children at the service points of the hospitalMethodology: Data were extracted from clinical records of all children (aged below 18 years) who presented in our centre Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi, Nigeria from March 2005 to December 2010 (era of voluntary counseling and testing); and from January 2010 to March 2015 (era of PITC) using questionnaires. Analysis was done with SPSS version 20.Results: Out of a total of 76,825 children who presented to the hospital from March 2005 to March 2015, seven thousand five hundred and three children (9.8%) were tested for HIV. The highest uptake of HIV testing was 18.7% recorded in 2011, with subsequent decline until 2015 (11.8%). There was significant association between year of testing and result of tests (P=0.001)Conclusion: Provider initiated testing improved the uptake of HIV testing in our centre when compared to voluntary testing, but this was not sustained.Keywords: Voluntary Counseling and testing, HIV screenin , Infectious diseases, Communicable disease

Knowledge and Compliance with Standard Precaution Among Healthcare Workers in A South-East Nigerian Tertiary Hospital

Background: Adherence to standard precautions (SP) is critical to reducing the burden of nosocomial infections. Objective: We assessed the knowledge and practice of SP among healthcare workers (HCWs). Methodology: A cross-sectional study was conducted among HCWs in Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi Anambra State, Nigeria using self-administered questionnaire and key informant interview. Results: Mean age and employment duration of subjects were 33.4±11.9 and 6.0 ± 6.7 years, respectively. Majority of the 341 HCWs had heard about SP (82.1%) and agreed that it should be applied to all patient care (78.0%). Only 45.7% of them correctly cited ≥2 components of SP. Two-third of participants reported that SP was poorly practiced in their unit mainly due to inadequate supply of materials (63.1%), inadequate staff training/retraining (62.2%), inadequate support by management (51.4%) and unavailable standard operating procedures (SOPs) on SP (37.8%). Compliance with SP and specifically, personal protective equipment (PPE) use were 65.1% and 76.2%, respectively. Profession (p=0.023), awareness about SP (p&lt;0.001), SOP display in prominent places (p&lt;0.001) and regular supply of running water (p&lt;0.001) were significantly associated with SP compliance. Key informant interview revealed lack of written SP policies or its communication to HCWs, lack of training/retraining of HCWs and lack of materials required for SP practice. Conclusion: Knowledge of basic concept and practice of SP was not satisfactory among HCWs. Major barriers to SP were lack of materials, training and active support by hospital management. Awareness, SOP display in prominent places and regular supply of running water positively influenced SP compliance. Having written policies and communicating such to all HCWs, consistent supply of necessary materials, intensified training, and regular supervision are recommended Keywords: Universal precautions, Nosocomial infections, Tertiary hospitals, Health Personnel, Nigeri

Longitudinal Ambient PM<inf>2.5</inf> Measurement at Fifteen Locations in Eight Sub-Saharan African Countries Using Low-Cost Sensors

Peer reviewed: TrueFunder: Medical Research Council Doctoral Training Program scholarshipFunder: Aldama FoundationFunder: NIHR Global Health Research Unit on Lung Health and TB in Africa at LSTM— “IMPALA”Funder: National Institute for Health Research (NIHR) using UK aid from the UK Government to support global health researchAir pollution is a major global public health issue causing considerable morbidity and mortality. Measuring levels of air pollutants and facilitating access to the data has been identified as a pathway to raise awareness and initiate dialogue between relevant stakeholders. Low-and middle-income countries (LMICs) urgently need simple, low-cost approaches to generate such data, especially in settings with no or unreliable data. We established a network of easy-to-use low-cost air quality sensors (PurpleAir-II-SD) to monitor fine particulate matter (PM2.5) concentrations at 15 sites, in 11 cities across eight sub-Saharan Africa (sSA) countries between February 2020 and January 2021. Annual PM2.5 concentrations, seasonal and temporal variability were determined. Time trends were modelled using harmonic regression. Annual PM2.5 concentrations ranged between 10 and 116 µg/m3 across study sites, exceeding the current WHO annual mean guideline level of 5 µg/m3. The largest degree of seasonal variation was seen in Nigeria, where seven sites showed higher PM2.5 levels during the dry than during the wet season. Other countries with less pronounced dry/wet season variations were Benin (20 µg/m3 versus 5 µg/m3), Uganda (50 µg/m3 versus 45 µg/m3), Sukuta (Gambia) (20 µg/m3 versus 15 µg/m3) and Kenya (30 µg/m3 versus 25 µg/m3). Diurnal variation was observed across all sites, with two daily PM2.5 peaks at about 06:00 and 18:00 local time. We identified high levels of air pollution in the 11 African cities included in this study. This calls for effective control measures to protect the health of African urban populations. The PM2.5 peaks around ‘rush hour’ suggest traffic-related emissions should be a particular area for attention.</jats:p