Penetrating head trauma following gunshot in a nonneurosurgical trauma centre: a case report

With the dearth of trained neurosurgeons in sub-Saharan Africa and increasing civilian violence, penetrating head trauma occasionally present to other clinicians for management. The National Orthopaedic Hospital, Enugu is a non-neurologic trauma centre having the south-east, south-south geopolitical zones, and parts of Benue and Kogi states as the catchments area. A retrospective report from the case note of a patient with infratentorial brain injury from a gunshot is presented. He was treated conservatively and had a satisfactory outcome. The follow up is for four years. Adequate resuscitation and monitoring is crucial in successfully managing head injuries

A Prospective Analysis of Surgeons’ Experience and Incidence of Oronasal Fistula: Focus on von Langenbeck Palatoplasty and Intravelar Veloplasty

Context: The extrinsic causes of unintentional fistula are those pertaining to surgical technique and operative strategy. It has been reported and asserted by researchers that the surgeon performing the repair is the strongest predictor of fistula formation. Not much is known about this association in our sub-region.Aim: To determine the relationship between surgeons’ experience and oronasal fistula.Setting and Design: One year prospective non-blinded study.Materials and Method: All consecutive patients with cleft palate that presented to the study institutions within the period and met inclusion criteria were studied. Surgeons were grouped into two; experienced and less experienced. Palatoplasty was by either von Langenbeck repair or intravelar veloplasty. Patients were monitored postoperatively for fistulae.Statistical analysis used: Chi-square and Mann – Whitney U tests were used. P-values ˂0.05 were considered significant.Results: Forty-six patients were studied. Eight surgeons performed surgical procedures, three experienced and five less experienced palatal surgeons. With Intravelar veloplasty, fistula rate was 23.08% for experienced surgeons and 42.85% for less experienced surgeons. While for the von Langenbeck repair, fistulae rates were 37.50% and 70.00% for the experienced and less experienced surgeons respectively. However, these were not statistically significant. Conclusion: Though found not to be statistically significant, the surgeon’s experience predicted occurrence of fistula. Experienced surgeons had lower fistula rate with each procedure. Keywords: Surgeons’ experience, Oronasal fistula, von Langenbeck, intravelar veloplasty.

Orthodontic needs of patients with cleft lip and palate in Enugu, five years post repair

Background: Orthodontists play an integral role in the management of cleft lip and palate anomaly. This study looks at the frequency of  anomalies amenable to orthodontics in patients who have had surgery and the effect of early or late surgical intervention.Methodology: Patients aged 0-5 years with cleft of the lip and/or palate who were operated on by the plastic surgeon at the Good  Shepherd Specialist Hospital, Enugu between 1st July 2011 and 30th June 2014, were recalled after a minimum of five years post-surgery and examined to determine the absence or presence of dental anomalies, amenable to orthodontic treatment, which have arisen since surgical repair. Descriptive statistics and t-test were used for data analysis and significance was at 0.05.Results: Thirty-one children were operated upon in the period under review. Seventeen had timely (three months or less) lip repair. Seven had timely palate repair (18 months or less). Thirteen patients were successfully recalled, 12 had cleft lip repair while one had cleft palate repair. Repair was timely in 10 (83.3%) of the 12 that had lip repair with a mean frequency of four dental anomalies, while the two (16.7%) that had late repair had a mean frequency of five dental anomalies and this was not statistically significant (P value=0.711). The only isolated cleft palate patient successfully recalled had a late repair. All 13 patients had at least four dental anomalies amenable to orthodontics. Hypoplastic maxilla were the most commonly occurring (eight patients, 61.54%) dental anomaly amenable to orthodontic treatment. None of the patients had a clinically visible supernumerary tooth. Out of 13 patients reviewed, sis were males with a mean frequency of four dental anomalies while seven were females, also with a mean frequency of four dental anomalies. This was not  significant (P-value=0.553).Conclusion: There is need for the long term Orthodontic follow up of cleft lip and palate patients. The orthodontic management of dental anomaly should, therefore, be central in the planning and treatment of patients with cleft lip and palate

Outcomes of cleft palate surgeries at the National Orthopaedic Hospital, Enugu, Nigeria: November 2008 – November 2013

Background: Despite an increase in the number of palatoplasty procedures at the National Orthopaedic Hospital Enugu (NOHE) sequel to a partnership with Smile Train, no reports on subsequent outcomes have been published. We investigated the speech outcomes and rates of fistula formation, the relationship between introduction of solids and incidence of post-operative oronasal fistulae and the benefits of post-operative honey licks. Objective: To determine the outcome of palatal repairs performed at our center in relation to the timing and nature of post-operative feeds. Method: This was a cohort study of patients who had palatoplasty over a five-year period and were subsequently followed up for a maximum period of 9 years. The patient’s present condition, timing of first feeds, onset of solid feeds, honey licks, frequency of wound dehiscence, fistula formation, and speech outcomes were assessed. The evaluation for a fistula was made from two weeks after the surgery by a senior resident in plastic surgery. Analysis was done using SPSS version 21.0 and p value set at <0.05. Results: A total of 115 surgeries: 90 primary cleft palate repairs, 6 combined cleft lip and palate surgeries and 19 secondary cleft palate repairs were done. Male to female ratio was 1:1.3. Age range of patients was 6 weeks to 36 years. Timing of introduction of solid meals significantly affected incidence of repair breakdown; and 58% had normal to near-normal speech. Conclusions: Licking honey was associated with fewer wound breakdowns. Early return to solid feeds is associated with a higher incidence of wound breakdown following palate repair

Mortalité maternelle vue à travers un hôpital transitoire à Enugu, Sud-est du Nigéria

Nigeria has one of the highest maternal mortality ratios in the world. The study was to determine the trend of maternal mortality ratio in the hospital as it transits from a General through a Specialist to a Teaching hospital. It was a retrospective review of maternal deaths at Enugu State University Teaching Hospital Parklane, over its 5 year transition period (January 2004 to December 2008). There were 7146 live births and 60 maternal deaths giving an overall maternal mortality ratio (MMR) of 840/100,000 livebirths. The MMR rose from 411 to 1137/100 000 live births as a specialist hospital, with a decline to 625/100 000 as a Teaching hospital. Pre-eclampsia/eclampsia was the leading cause (29.63%) of maternal death. MMR was highest as a Specialist hospital due to limited manpower and inadequate facilities to properly manage the rising number of referred obstetric emergencies. Adequate preparations should be made before upgrading a hospital, to enable it cope with the challenges of managing referred obstetric emergencies (Afr J Reprod Health 2009; 13[4]:67-72).Le Nigéria a une de plus grandes proportions de la mortalité maternelle du monde. L’étude avait pour but de déterminer la tendance de la proportion de la mortalité maternelle dans l’hôpital dans sa transition d’un Hôpital Général en passant par l’Hôpital spécialisé à un Centre Hospitalier Universitaire. Il s’agissait d’une analyse rétrospective des décès maternels au Centre Hospitalier Universitaire à Enugu à travers sa période de 5ans de transition (janvier 2004 – décembre 2008). Il y avait 7146 naissances vivantes et 60 décès maternels, ce qui donne dans l’ensemble une proportion de la mortalité maternelle (PMM) de 840/100,000 naissances vivantes. La PMM a augmenté de 411 a 1137/100.000 naissances vivantes dans l’hôpital spécialisé avec une baisse jusqu'à 625/100,000 dans un Centre Hospitalier Universitaire. La pré-éclampse/éclampsie était la cause principale (29,63%) du décès maternel. La PMM était plus élevée dans l’hôpital spécialisé à cause d’une main-d’œuvre limitée et du manque de facilités qui ne permettent pas de bien prendre en charge le nombre montant de cas obstétriques d’urgence qui sont orientés vers ces hôpitaux spécialisés. Il faut prendre des dispositifs adéquats avant d’améliorer un hôpital, afin de lui permettre de se débrouiller avec les défis de la prise en charge des urgences obstétriques qui sont adressées d’un autre hôpital (Afr J Reprod Health 2009; 13[4]:67-72)

Patterns of gestational weight gain and its association with birthweight in Nigeria

Background: Despite the increasing global importance of gestational weight gain (GWG) and its impact on birthweight, little is known about the patterns of GWG in African populations.Objectives: To determine the pattern of GWG and its association with birthweight in Nigeria.Methods: It was a longitudinal study of 200 pregnant women receiving antenatal care at two tertiary hospitals in Enugu, south eastern Nigeria. The women were consecutively recruited at <14 weeks gestation and their body mass indexes recorded upon recruitment. Thereafter, weight measurements were taken at each visit until 38–39 weeks.Results: Mean total GWG was 10.7 ± 3.4 kg, while mean birthweight was 3.3 ± 0.6 kg. GWG in second trimester had positive correlation with birthweight (r = 0.164, P = 0.02). Obese women gained above the recommended limits by the "institute of medicine" while underweight women gained below the limits. Excessive total GWG was associated with higher risk of macrosomia [8/21 (38.1%) vs. 7/179; RR: 9.74; 95% CI: 3.9–24.2; P < 0.001] while inadequate total GWG was associated with higher risk of low birth weight [7/72 (9.7%) vs. 3/128 (2.3%; RR: 4.15; 95% CI: 1.1–15.4; P = 0.03]. Maternal age of <35 years, high social class, nulliparity, and regular antenatal care were associated with normal GWG while maternal age <35 years and regular antenatal care were associated with normal birthweight (P < 0.05).Conclusions: Women should be counseled on the factors that influence GWG and birthweight. Interventions to assist women achieve appropriate GWG may need to include components related to improved dietary intake for the underweight and increased physical activity for the obese.Keywords: birthweight, body mass index, pregnancy, Nigeria, weight gai

Genetic studies in the nigerian population implicate an MSX1 mutation in complex oral facial clefting disorders

BACKGROUND: Orofacial clefts are the most common malformations of the head and neck with a World-wide prevalence of 1/700 births. They are commonly divided into CL(P) and CP based on anatomical, genetic and embryological findings. A Nigerian craniofacial anomalies study “NigeriaCRAN” was set up in 2006 to investigate the role of gene-environment interaction in the etiology of orofacial clefts in Nigeria. SUBJECTS AND METHODS: DNA isolated from saliva from the Nigerian probands was used for genotype association studies and direct sequencing on the cleft candidate genes: MSX1, IRF6, FOXE1, FGFR1, FGFR2, BMP4, MAFB, ABCA4, PAX7 and VAX1, and the chromosome 8q region. RESULTS: A missense mutation A34G in MSX1 was observed in nine cases and four hap map controls. No other apparent etiologic variations were identified. A deviation from HWE was observed in the cases (p= 0.00002). There was a significant difference between the affected side for unilateral CL (p=0.03) and, between bilateral clefts and clefts on either side (p=0.02). A significant gender difference was also observed for CP (p=0.008). CONCLUSIONS: The replication of a mutation previously implicated in other populations suggests a role for the MSX1 A34G variant in the etiology of CL(P)