Comparison of Chlorhexidine - Alcohol and Providone Iodine Skin Preparation Skin Preparation Solutions in Orthopaedic and Trauma Surgery at An African Tertiary Hospital

No Abstract

Normal values of key pinch strength in a healthy Nigerian population

Background: With the severity of machine hand injuries in our environment, the need to determine the normal values for key pinch strength with which to compare restorative surgeries was justified.Methods: A cross sectional survey of participants who had no previous hand injuries limiting hand function. Data obtained included age, gender, body mass index, hand dominance and hand span. The Baseline Hydraulic Pinch Gauge was used to obtain key pinch strength. The influence of the above variables on measured pinch strength was analyzed using independent sample t-tests and Pearson’s correlation.Results: Of the 242 recruited participants, age range between 20 and 80 years, 163(67.4%) were male and 79 (32.6%) were female. Males had higher pinch strength (right-8.3±2.7kg, left-7.6±2.5kg) than females (right-6.3±1.5kg, left-5.8±1.5kg). Pinch strength varied with age peaking in the fifth decade in males and females. Interestingly, the left handed dominant female had higher right pinch strength than her right handed counterpart (p<0.009). Height, and hand span correlated with pinch strength in females.Conclusion: Normal values for key pinch strength in this Nigerian population are lower than that of Caucasians.Keywords: Key pinch, Nigerians, Normal value

Surgical site infection in critically ill patients with secondary and tertiary peritonitis: epidemiology, microbiology and influence in outcomes

BACKGROUND: Surgical site infection (SSI) remains a significant problem in the postoperative period that can negatively affect clinical outcomes. Microbiology findings are typically similar to other nosocomial infections, with differences dependent on microbiology selection due to antibiotic pressure or the resident flora. However, this is poorly understood in the critical care setting. We therefore aimed to assess the incidence, epidemiology and microbiology of SSI and its association with outcomes in patients with severe peritonitis in the intensive care unit (ICU). METHODS: We prospectively studied 305 consecutive patients admitted to our surgical ICU from 2010 to 2014 with a diagnosis of secondary or tertiary peritonitis. We collected the following data: SSI diagnosis, demographics, Acute Physiology and Chronic Health Evaluation (APACHE) II score, Simplified Acute Physiology Score (SAPS) II score, type of surgery, microbiology, antibiotic treatment and outcomes. Microbiological sampling was done by means of swabs. RESULTS: We identified 269 episodes of SSI in 162 patients (53.1 %) aged 64.4 ± 14.3 years, of which 200 episodes occurred in men (64.6 %). The mean APACHE II and SAPS II scores were 19.7 ± 7.8 and 36.5 ± 16.1 respectively. The mean ICU and hospital stays were 19.8 ± 24.8 and 21.7 ± 30 days respectively. Pseudomonas spp. (n = 52, 19.3 %), Escherichia coli (n = 55, 20.4 %) and Candida spp. (n = 46, 17.1 %) were the most frequently isolated microorganisms, but gram-positive cocci (n = 80, 29.7 %) were also frequent. Microorganisms isolated from SSIs were associated with a higher incidence of antibiotic resistance (64.9 %) in ICU patients, but not with higher in-hospital mortality. However, patients who suffered from SSI had longer ICU admissions (odds ratio = 1.024, 95 % confidence interval 1.010–1.039, P = 0.001). CONCLUSIONS: The incidence of SSI in secondary or tertiary peritonitis requiring ICU admission is very high. Physicians may consider antibiotic-resistant pathogens, gram-positive cocci and fungi when choosing empiric antibiotic treatment for SSI, although more studies are needed to confirm our results due to the inherent limitations of the microbiological sampling with swabs performed in our research. The presence of SSI may be associated with prolonged ICU stays, but without any influence on overall mortality

Global injury morbidity and mortality from 1990 to 2017 : results from the Global Burden of Disease Study 2017

Correction:Background Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. Methods We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). Findings In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). Interpretation Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.Peer reviewe

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Surgical wound infection: A general overview

No Abstract.Annals of Ibadan Postgraduate Medicine Vol. 3 (2) 2005: pp. 26-3

Rising up to the challenge in Plastic Surgery in Nigeria

Introduction: The environment for the practice of Plastic Surgery in Nigeria has become increasingly challenging. This has motivated the thoughts that have been put together in this lecture which was delivered in honour of the first indigenous plastic surgeon in Nigeria.Method and Results: Several issues that bother on challenges and how they have been coped with from mentorship through wound and keloid management, to setting up a free tissue transfer unit at Ibadan were discussed.Conclusion: Although myriads of problems which include inadequate infrastructure and funding of tertiary health care abound in our society, plastic surgeons are challenged to rise up to the challenge of ensuring global best practices

Nasal measurements among major ethnic groups in Nigeria

Background: Parameters in anthropometry, including height, weight, length, thickness and widths of various part of the body vary amongst races and even among ethnic group of the same race. This study of nose dimensions in normal adult Nigerians, was carried out at University College Hospital, Ibadan. Nigeria between January and March 2001. Objective: To provide baseline measurements of nose dimensions and standard nostril type for major ethnic groups in Nigeria. Methods: The subjects were 300 adult Nigerians selected by convenience sampling method, composed of 169 (56.3%) males and 131 (43.7%) females. Two hundred and seventeen (72.3%) were Yorubas, 43 (14.3%) Ibos, 13(4.3%) Hausa/Fulanis and 27(8.9%) were other tribes. Nostril type was assigned according to the inclination of the medial longitudinal axis of the nostril following Topinard system. Other measurement includes length of the nose and 5 soft tissue nose measurements. Results: The mean length of the nose found in the study was 46.6(4.9) mm, mean width 44.4(5.0)mm and the most common nostril type was Nostril type VI(57%) A significant tribe difference in the length of the nose, width of the nose and nasal tip protrusion was observed. Hausa/Fulanis having mean length of nose 49.7(9.0) mm, Yorubas had 46.2(4.9) mm. (

Reconstruction of a complex anterior abdominal wall defect with autologous tissues – a case report

Background: The anterior abdominal wall is an important complex composite structure that poses a challenge to the reconstructive surgeon. Defects produced from infection, herniation, tumour extirpation or trauma, are often encountered. Different techniques of reconstruction have been described using autologous tissues and prosthetic materials with varying results, availability and cost implications. The use of totally autologous tissues presents a readily available reconstructive option that has been shown to be associated with a satisfactory outcome and low morbidity. In this report, we describe the use of autologous tissues for the reconstruction of a major abdominal wall defect. Method: This communication describes our experience of the use of purely autologous tissues for a full thickness anterior abdominal wall defect, presented as a case report. Result: The initial result that was obtained confirms that this is a useful technique with a satisfactory outcome with minimal morbidity. Conclusion: Utilizing purely autologous tissues, avoids most of the complications of the other techniques, is readily available, relatively cost-effective (especially advantageous in the developing country) and is less technically demanding.Keywords: Abdominal wall tumour, Fascia lata, Omentum, Skin graf

Family Planning Behaviour of Male Civil Servants in Ibadan, South Western Nigeria

Men play critical roles in women's ability to seek health care and Reproductive Health programmes are likely to be more effective when men are involved in some way. The study was designed to assess the family planning (FP) behaviour of male civil servants in Ibadan, and determine their roles in their spouses' FP practices. This was a descriptive, cross-sectional survey carried out among 403 currently married male civil servants working in 8 selected ministries in Oyo State Secretariat, Ibadan, Nigeria. The mean age of the respondents' in this study was 44 ±9.74. Two hundred and twenty two (55.1%) desired to have 1 – 4 children in their lives while 117 (29.0%) desired 5-8 children. Though most of all the respondents, 292 (72.5%) opined that decisions on family planning practice should be jointly reached by the couple and many, 202 (50.1%) remind their wives to use contraceptive, only 91 (22.6%) attended family planning clinics with their wives. The results showed that though many of the male civil servants in Ibadan desired small sized family and actually encouraged their wives to use their contraceptives, most were not willing to attend FP clinic with their spouses. FP clinics and services should be made more men-friendly and strategies to reach out to men should be devised.  Key words: Family planning behaviour, clinic attendance, Male civil servant