Prevention of prosthetic joint infection in total hip and knee arthroplasties: evidence based recommendations

Prosthetic joint infection is a dreaded complication of Total Joint Arthroplasty. Prevention, which is far more cost effective, should be of paramount importance to the arthroplasty surgeon. Proper patient selection and preparation as well as strict asepsis and antisepsis are the basic principles of prevention

Hepatoprotective role of Moringa oleifera ethanolic leaf extract on Liver functions (Biomarker) in cadmium chloride induced hepatotoxicity in Albino wistar rats

This study investigated the hepatoprotective role of ethanolic extract of Moringa oliefera (M.O) on liver function (Biomarkers) in cadmium chloride (CdCl2)-induced hepatotoxicity on the liver of albino Wistar rats. Sixty-six adult male albino wistar rats weighing between 130g – 180g were used. LD50 was determined for both CdCl2and MO using twenty-six (26) rats, while 40 rats were used for the experiment proper. The experimental rats were distributed into eight groups –A (control) and B, C, D, E, F, G and H, served as the treatment groups that received graded doses of CdCl2or MOor both simultaneously or at separate periods. The animals were then euthanized for sample collection and analysis using standard methods. The results showed significant increase (P<0.05) in the serum levels of Alanine aminotransferase (ALT) (430.50 ± 149.20), Aspartate aminotransferase (AST) (421.10 ± 8.34) and Alkaline Phosphatase (ALP) (515.60 ± 21.78) of animals in group B, but some protective effect of MO in the treatment groups with significant decreases in ALT, AST and ALP levels. The study therefore concludes that ethanolic extract of Moringa oleifera showed appreciable hepatoprotective values on liver functions (biomarkers) in CdCl2hepatotoxicity.Key words: Liver Functions, Cadmium, Moringa oleifera, Hepatoprotective, Hepatotoxici

Acute osteomyelitis in children in Ibadan, Nigeria. Is surgical decompression necessary?

A total of 17 Children with acute osteomyelitis presenting to division of orthopaedics and trauma surgery is presented. The male:female ratio is 1:1:3, mean age of 6.12 years. The median time of illness before presentation is 8 days. The Tibia bone is the most common site of infection (52.9%) while multifocal infection occurs in 35.3% of the patient. Staphylococcus aureus is the most common isolate (47.1%) while Salmonella typhi occurred in 23.5% of the patients, all with sickle cell disease. There was positive bone aspirate in all the patients while all patient had surgical intervention with sequential intravenous - oral antibiotic therapy with an excellent outcome in 94.1%. Surgical intervention appears to be essential to cure of acute osteomyelitis in addition to antibiotic use

Autogenous Corticocancellous Iliac Bone Graft in Reconstruction of Mandibular Defect: Point of Technique

Mandible resection and subsequent defect created lead to aesthetic and functional abnormalities. The surgical reconstruction of the defect is a major challenge in maxillofacial surgery. Lack of appropriate facilities and the high cost of newer modalities made the use of non-vascularized iliac bone graft in reconstruction of mandibular defect an attractive option in our environment. The technique of harvesting iliac crest graft is highlighted in this prospective study involving 37 iliac crest grafts for mandibular defect reconstruction between 1999 and 2006. Ameloblastoma was the most common indication for mandibular resection in 27 patients (73 percent), while 24 patients (64.9 percent) had hemimandibulectomy which is the most common type of mandibulectomy. A graft take rate of 91.1percent was achieved in this study. Graft site infection was the most complication with overall incidence of 27.0 percent. Most of the infections were superficial and responded to antibiotic use and local wound care. Donor site complications were few in the study. We recommend the use of autogenous iliac bone graft for reconstruction of mandibular bone defect in our environmen

Prevalence and Pattern of Back Pain among Pregnant Women Attending Ante-Natal Clinics in Selected Health Care Facilities

Back pain is (BP) is recognized as an important problem in pregnancy. The objectives of this study were to examine the prevalence and pattern of back pain (BP) in pregnancy. A survey of 2,187 pregnant women attending ante-natal clinics in selected Medical facilities in Ibadan and Ogbomoso, Nigeria was carried out using pre-tested close-ended questionnaire. Information on prevalence, pattern and characteristics of back pain in pregnancy were obtained. Data obtained was analyzed using both descriptive and inferential statistics of mean, standard deviation, and inferential statistics of independent t-tests and chi-square tests. One thousand and eight (52.5%) of the 1919 included subjects had back pain in pregnancy. The mean age of those with and without back pain was 26.8 ± 5.3 and 27.1 ± 5.4 years respectively. Mean number of pregnancy was higher in subjects with back pain than those without back pain. The pain site among the 1008 subjects with back pain was low back in 669 subjects (66.4%), posterior pelvic in 242 subjects (24.0%) and high back in 97 subjects (9.6%). Among the subjects with back pain, 315 (31.3%) and 53 (5.3%) were in their first and sixth pregnancies respectively. Postural modification relieved the back pain in about 50% of the subjects across the three back pain groups during pregnancy. It was concluded that back pain is a common and real complaint in pregnancy. It is therefore recommended that rather than dismiss it as trivial, back pain in pregnancy should be attended to as part of ante-natal care

Total anti-oxidant status and C-reactive protein values in Nigerians with symptomatic primary osteoarthritis of the knee joint – an initial report

Osteoarthritis is a degenerative as well as an inflammatory disorder of joints. The joint inflammation in this disease (as with inflammation in other organs of the body) leads to the production of acute phase proteins like C-reactive protein (CRP) along with the release of cytokines and neutrophils. The lysosomes released from the activated neutrophils result in the production of large amounts of free radicals which are harmful to the human body. Antioxidants on the other hand are substances that when present even in low concentrations avidly react with and annihilate free radicals before oxidative damage is inflicted on vital components of the cells. This case-control study was aimed at investigating the influence of age; body mass index, total antioxidant status (an indirect measure of total free radicals) and c-reactive protein (an acute phase reactant) on symptomatic osteoarthritis of the knee. Thirty five subjects with clinical and radiological features of osteoarthritis of the knee were recruited from the Orthopaedic clinic of the University College Hospital, Ibadan. Twenty healthy age-matched controls were recruited from the Surgical Outpatient Clinic of the same hospital. Informed consent, biodata and body mass indices were obtained after which venous blood samples were obtained from each subject. Total plasma antioxidant status (TAS) was estimated spectrophotometrically by the Koracevic method while the CRP concentration was measured using Humatex CRP kit® (Human GmbH, Germany). The mean ages of the test and control groups were 58.8±12.0 and 52.3±7.9 years respectively. Osteoarthritic patients demonstrated significantly higher (p <0.05) BMI (32.2±6.9 kg/m2) compared to controls (26.1±3.4 kg/m2). The mean TAS was significantly lower (p <0.05) in the test (1.09±0.38 mmol/l) compared to the controls (1.61±0.09 mmol/l). CRP was positive in 19 (54.3%) of the test subjects but negative in all the control. There was an inverse correlation between the BMI and TAS (p <0.05) as well as between age and TAS (p <0.05). This study shows that Nigerian patients with symptomatic osteoarthritis of the knee tend to be obese and have a lower total antioxidant status. Antioxidant supplementation of the diet as a means of minimizing the severity of osteoarthritis and other free radical-mediated diseases in older Nigerian adults is advocated

The Trend of Wound Microbial Characteristics in Open Fractures at the University College Hospital, Ibadan

Background: Infection remains a significant challenge in the management of open fractures, and microbial characteristic of open fractures will&nbsp; guide the use of antibiotics as an adjunct in their treatment. The aim was to ascertain the trend in microbial attributes in open fractures and sensitivity pattern especially with the advent of new antibiotics introduced into the hospital drug formulary. Materials and Methods: This study is a hospital-based prospective study of patients with open fractures presenting between January 2013 and December 2013 in the Accident and Emergency Department, of a tertiary hospital in Nigeria. Swabs of superficial and deep parts of the wound were taken aseptically at the presentation of the patient before wound debridement and commencement of antibiotics. Two other samples and biopsies were taken at the deeper parts of the wound on the 3rd and 7th day of admission. All samples were sent for microscopy, culture and sensitivity&nbsp; pattern to antibiotics. The result of culture and sensitivity pattern were determined and presented. Result: One hundred and thirty patients were recruited for the study, the sterile swab was taken from their wounds at presentation, but only 81 patients completed the study (i.e. had swabs taken for 3rd and 7th day). Men constituted 71.5% of the patients with a modal age of 35 years, and a mean age been 36.5 (± 15.8) years. Staphylococcus aureus and Clostridium perfringens were the most predominant aerobic, anaerobic organism cultured. The isolates were sensitive to ciprofloxacin, ceftriaxone, co-amoxiclav, gentamycin, cefotaxime and metronidazole.Conclusion: The microbial characteristics of the open fracture and antibiotic sensitivity pattern in the emergency department of Hospital were not different from the trend from a previous study in the same centre. The similarity of the superficial and deep culture isolates suggests possiblemigration of microbes from the surface to the deeper part of the wounds. Keywords: Open fracture. Microbial characteristics, Antibiotic Sensitivity Pattern. Ibadan, Nigeria

Multiple levels of delay in the management of musculoskeletal tumours in Nigeria

Introduction: Musculoskeletal tumours are comparatively rare tumours and rank in the top 10 of all tumours in both sexes at the Ibadan tumour registry. Early diagnosis and multimodality treatments have been shown to improve outcomes. In our environment, patients with these tumourstend to present late. The aim of the study was to characterise the causes and levels of delay in their management.&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; Patients and Methods: This was a five year (January 2006-December 2010) review of all orthopaedic patients with diagnosis of musculoskeletal tumour who had surgery at the University College Hospital, Ibadan. From the case notes of these patients, the following specific time frames were extracted: patient delay, doctor delay, referral interval, specialist delay, symptom interval and histopathology wait time.Results: Fifty-nine patients had biopsies/procedures for tumours over the 5 year study period. The biopsies were for giant cell tumours (24.1%), Osteogenic Sarcoma (10.3%) and Osteochondromas (10.3%). The Median Patient delay was 50 weeks (range 3-11 44weeks) while the MedianDoctor delay was 8 weeks (range 1 108 weeks). The Median Histology interval was 3 weeks (range 1 13 weeks). The Median Referral interval was 4.3 weeks (range 0-56), while the Mean Specialist delay was 12 weeks (range 1-108 weeks). The Median Symptom interval was 61 weeks (range 15-1200 weeks). Nine patients (28.1%) had visited alternative medical practitioners before presenting at the hospital. Eleven patients (34.4%) were lost to follow-up and 10 (31.3%) had documented improvement. Females were found to have a significantly longer symptom interval.Conclusion: Many patients with musculoskeletal tumours visit alternative medical practitioners. Significant professional delays still exists in the care of patients with musculoskeletal tumours. Incorporating bone setters into the healthcare system and educating primary care doctorswould help to reduce these delays