Immuno-Haematological Characteristics Of Nigerian Sickle Cell Disease Patients In Asymptomatic Steady State

Aim: The aim of this study is to investigate some immuno-haematological characteristics of Nigerian sickle cell disease (SCD) patients in asymptomatic steady state. Material and Methods: Thirty asymptomatic SCD patients and 30 apparently healthy age- and sex-matched non-sickle cell dis-ease individuals were investigated. The packed cell volume, white blood cells and differentials, and platelet counts were done on automated blood cells counter, while the ESR was determined by Westergren′s technique. C3 activator, C1-INH, IgA, IgG and IgM were estimated by the single radial immuno-diffusion method. Results: The SCD patients had elevated ESR and a significantly higher total leukocyte count compared to the controls (t= 5.22, p= 0.000). A positive correlation was found between ESR and C3 activator (r= +0.449, p= 0.047), and between ESR and serum IgM levels (r= +0.531, p= 0.016). Serum levels of IgA and C3 activator were significantly higher in SCD subjects (IgA: t= 2.47, p= 0.019; C3 activator: t= 2.79, p= 0.009), while the levels of C1-INH and 1gM, though higher in SCD subjects, were not significant. Conclusions: It could be concluded from this study that immune dysfunction are evident in Nigerian SCD patients

Pelvic fractures management in a teaching hospital in Nigeria

BACKGROUND: Significant external forces are required to fracture a normal pelvis. The forces usually result from rapid deceleration or crushing injuries. Associated injuries are common as the energy is delivered to multiple anatomical sites. AIMS/OBJECTIVE: The aim of this study was to highlight the pattern of presentation of pelvic injuries, causes, types of the pelvic fracture and outcome of the treatment of these injuries in a teaching hospital in a developing country. SETTING: Department of Orthopaedic Surgery and Traumatology, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria. DESIGN: A seven-year retrospective study was done from January 1995 to December 2001. RESULTS: The mean age of the patients at presentation was 35.0+14.8 (SD) with 42 males and 11 females. The mean injury severity score was 20.1. Motor vehicular accident remains the most common cause of pelvic fractures in 37(69.8%) patients, fall from height in 8(15.1%) patients, collapsed walls of dilapidated building in 4(7.6%) patients, motor vehicle pedestrian accident and motorbike pedestrian accidents in 2(3.8%) patients each. The type of pelvic fracture was classified according to Tile. Types A, B, and C were found in 24(45.3%), 17(32.1%), and 12(22.6%) patients respectively. In three patients, the fractures were open. Directly associated injury was diagnosed in 9 patients, these were mainly urogenital system, 2 had bladder injuries, 4 had urethral injuries and 3 had vagina laceration. All the patients were managed without recourse to open operative reduction. The outcome was adjudged excellent, good, fair and poor in 18(34%), 20(37.4%), 9(17%), and 6(11.3%) patients respectively. CONCLUSION: It was concluded that most types of pelvic fractures could be managed with satisfactory results in this environment using the facilities available. KEY WORDS: Pelvis fracture, motor vehicle accidents, falls. Nigerian Journal of Orthopaedics and Trauma Vol.3(1) 2004: 10-1

Blood transfusion practices in Orthopaedic and Trauma Department in a tertiary health institution in Nigeria: a two year retrospective review

Aim: The aim of this study is to review blood and blood products use in the Orthopaedics and Trauma department of Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife. Subjects and methods: Records of patients seen at the Orthopaedic and Trauma Unit of the OAUTHC, Ile-Ife, between July 2004 and June 2006, were retrospectively studied. Clinical and laboratory parameters extracted from their case files included age, gender, diagnosis, blood group, indication for transfusion and number of units received, and complications, if any. Results: A total of 85 patients were managed during the study period. Their ages ranged between 1.5 and 94 years with a median of 30 years. There were 52 males and 33 females with a M: F ratio of 1.6:1. All the patients had allogeneic whole or packed red cells. No patient received autologous blood, and none received platelet concentrate, fresh frozen plasma or any other blood products. Forty-eight of the eighty-five patients (56.5%) were blood group O Rhesus D positive. Major indications for blood transfusion included traumatic fractures (39/85 or 45.9%), osteomyelitis (13/85 or 15.3%), gangrene (11/85 or 12.9%), malunion and non-union (13/85 or 15.3%). The highest numbers of transfusion were seen in multiply injured patients, extremity gangrene, gunshot injuries and sarcomas. Mild febrile and allergic blood transfusion reactions were encountered in 6 (7.1%) of our patients. Conclusion: Fractures and its complications were the most common indications for blood transfusion in orthopaedics and trauma patients in our hospital. Keywords: Blood transfusion, Indications, Orthopaedics, Trauma.Nigerian Journal of Orthopaedics and Trauma Vol. 6 (2) 2007: pp. 55-5

Extended-spectrum Beta-lactamase Orthopedic Wound Infections in Nigeria

Background: Extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacteria are emerging and impacting significantly on the management of patients and hospital costs. Besides, they are not being routinely sought after in diagnostic laboratories thus contributing to treatment failure. Materials and Methods: Bacterial isolates from wounds of 45 patients were identified using commercial identification kits and antibiotic susceptibility was evaluated by the Bauer-Kirby method. Screening and phenotypic confirmation of ESBL production were done as prescribed by the Clinical and Laboratory Standards Institute. The conjugation experiment was performed by the mating assay in broth between the ESBL producers and E. coli ATCC 25922 as the recipient. Results: Out of 102 Gram-negative bacteria isolated, 36 were positive for ESBL mainly of the Enterobacteriaceae family (33) and the rest were oxidase-positive bacilli (3). The predominant bacteria were Klebsiella spp. and E. coli. Others were Serratia rubidae, Citrobacter freundii, Morganella morgannii, Proteus spp., Providencia stuartii, and Enterobacter spp. There was a significant association between treatment with third-generation cephalosporins (3GCs) and isolation of ESBLs ( p=0.0020 ). The ESBL producers were multiply resistant and moderately sensitive to colistin. The conjugation experiment showed that the ESBL gene was transferred horizontally and tetracycline, cotrimoxazole, nitrofurantoin, gentamicin, and aztreonam resistance genes were co-transferred. No mortality was recorded but the mean length of stay in the hospital was 82 days. Conclusion: The development and spread of ESBL among Gram-negative bacteria and possible horizontal transfer calls for concern, especially in view of treatment failure, high treatment cost, and consequent discomfort to patients

Opracowanie i wstępne badania nad przyjaznym kulturowo narzędziem do oszacowania bólu u dzieci − Skala Bólu wg Wizerunków Płaczących Twarzy (Crying Faces Pain Scale)

Having a universal tool for assessing pain in children is hamstrung by cultural sensitivity. This study aimed to develop and validate a culturally-friendly pain assessment tool (i.e. Crying Faces Pain Scale (CFPS)) among Nigerian Children. This study employed criterion-standard design. The study was in three phases, namely: (1) development of CFPS, (2) cross-validity and (3) validation of the CFPS. 70 children (39 (55.7%) males and 31 (44.3%) females) within the age range of 4-13 years who had post-surgical pain, orthopaedic pain, stomach pain or headache were involved in the validation phase. Psychometric properties and preferences for the CFPS compared with the Wong-Baker FACES Pain Rating Scale (FACES) were examined. Descriptive and inferential statistics were used to analyze the data. Alpha level was set at p<0.05. The median score of the CFPS was 4.60 compared to FACES median score of 4.49. There was weak correlation between FACES and CFPS (r=0.325; p=0.006). Preference score as a culturally friendly tool for CFPS and FACES was 6.07±1.23 and 3.67±1.09 respectively, based on a modified 0-10 numerical pain scale. Conclusions: The crying faces pain scale has fair psychometric properties for assessing pain in children. However, CFPS was preferred to FACES as a culturally friendly tool for assessing pain among Nigerian children. Implications: The CFPS is more culturally friendly and so might be better suited as a pain scale in Africa. However, due to its fair psychometric properties, further studies may be needed to improve upon this scale.Podstawy i cele: Posiadanie uniwersalnego narzędzia do oceny bólu u dzieci jest utrudnione przez wrażliwość kulturową. Badanie to miało na celu opracowanie i walidację przyjaznego kulturowo narzędzia do oceny bólu u dzieci tj. Skali Bólu wg Wizerunków Płaczących Twarzy (Crying Faces Pain Scale, CFPS) wśród nigeryjskich dzieci. Metody: W badaniu tym zastosowano standard wzorcowy. Badanie odbyło się w 3 fazach, mianowicie: 1) opracowanie CFPS, 2) walidacja krzyżowa oraz 3) walidacja CFPS. W fazie walidacji wzięło udział 70 dzieci, (39 (55.7%) chłopców i 31 (44.3%) dziewcząt) w przedziale wiekowym 4-13 lat, cierpiących na ból pooperacyjny, ból ortopedyczny, ból brzucha czy ból głowy. Zbadano właściwości psychometryczne i preferencje dla CFPS, w porównaniu z Graficzną Skalą Oceny Bólu Wonga-Bakera (FACES, Wong-Baker Faces Pain Rating Scale). Do analizy danych wykorzystano statystyki opisowe i inferencyjne. Poziom Alpha ustawiono na p<0.05. Wyniki: Średni wynik dla CFPS wyniósł 4,60, w porównaniu do średniego wyniku FACES wynoszącego 4,49. Wystąpiła słaba korelacja pomiędzy FACES a CFPS (r=0,325; p=0,.006). Preferowany wynik dla kulturowo przyjaznego narzędzia dla CFPS i FACES wyniósł odpowiednio 6,07 ±1,23 i 3,67 ±1,09, na podstawie zmodyfikowanej liczbowej skali bólu 0-10. Wnioski: Skala CFPS ma wystarczające właściwości psychometryczne do szacowania bólu u dzieci. Jednak preferowano bardziej CFPS niż FACES, jako bardziej przyjazne kulturowo narzędzie do oceny bólu wśród dzieci w Nigerii. Implikacje: CFPS jest bardziej przyjazny kulturowo i dlatego mógłby być bardziej odpowiedni, jako skala bólu w Afryce. Jednak, ze względu na swoje właściwości psychometryczne, potrzebne będą dalsze badania w celu poprawy tej skali