Infection risk in Gustilo and Anderson type III tibia and fibular fractures treated with external fixation in a tertiary hospital of a developing country

Background: Open fractures of the tibia and fibula present with multiple management challenges of wound care, bone stabilization, potential risk of infection and its control. Attempt to resolve this problem, stabilization of the fracture with external fixators was introduced. However, this procedure predisposes infection too. This was an overview of the disposition of infection in the course of managing type III fractures in our center.Methods: This was a retrospective study of disposition of infection in Gustilo and Anderson type III open fractures of the tibia and fibula treated with external fixation device over ten years in Jos university teaching hospital. Data extracted from patients records and operation notes included age, sex, nature of open fracture with respect to Gustilo and Anderson classification in theater. Wound culture reports extracted early and weeks after commencement of treatment. The findings were analyzed using Epi info statistical software version 3.5.3.Results: A total of 74 patients, 63 (85.1%) males and 11 (14.9%) females (M:F=5.7:1) with mean age of 37.97±13.57 years. The mean duration of injury-presentation time was 13.48±38.73 days, 41 (55.4%). Patients that present with clinical infection were 40 (54.1%) among which staphylococcus aureus was isolated in 21 (28.3%). While treatment was on, the flora became altered. Motor cycles were responsible for 25 (33.7%), gunshots 20 (27%), motor vehicle injuries 19 (25.6%) while pedestrians accounted for 9 (12.2%).Conclusions: Type III fractures sustained from high energy risk of infections due to late presentation in our setting. Bacterial isolates tend to alter in course of hospitalization

Evaluation of antimicrobial Activities of isolated compounds from the leaf of the white specie of Sesamum Indicum from Benue State, Nigeria

The isolated compounds from the petroleum spirit, chloroform and methanol crude leaf extracts of the white specie of the leaf of the Sesamum Indicum used by traditional medicinal practitioners for the management of infecticious diseases were investigated for in vitro antimicrobial activity against some organisms. The various extracts afforded compounds which had significant antimicrobial activities. The antimicrobial screening showed that all the pure isolates from the different solvent extracts were active against the organisms, Staphylococcus aureus , Streptococcus pyogenes , Salmonella typhi , Candida albicans , Candida krusei , and Candida tropicalis at various MIC\u2019s and (MBC/MFC)\u2019s. The pure isolates from methanol and ethyl acetate fractions were all inactive against Bacillus cereus , Corynebacterium ulcerans , and Escherichia coli . Only the pure isolates from petroleum spirit and chloroform fractions showed activity against Bacillus cereus, Corynebacterium ulcerans, and Escherichia coli at an MIC of 0.5mg/ml and MCB/MFC of 1mg/ml. Chromatographic techniques such as analytical TLC, Purification by dry vacuum liquid chromatography (DVLC) and Preparative TLC were used

Evaluation of in vitro antimycobacterial activity of Nigerian plants used for treatment of respiratory diseases

The global threat of tuberculosis (TB) demands for search for alternative antimycobacterial drugs. Some Nigerian medicinal plants used in the treatment of TB and other respiratory diseases wereevaluated for activity against a clinical isolate of Mycobacterium tuberculosis and a strain of Mycobacterium bovis (BCG). The crude methanolic extracts of eight plant species were screened foractivity against a clinical isolate of M. tuberculosis using broth microdilution method. Four out of the eight plant extracts exhibited inhibitory activities against M. tuberculosis at 78 and 1250 µg/mL. Thecrude extracts of Entada africana, Hymenocardia acida, Sterculia setigera and Stereospermum kunthianum did not inhibit significantly even at high concentration of 1250 ìg/mL. The hexane fractionsobtained after fractionation were the most active fractions for all the plants tested against BCG, having Anogeissus leiocarpus and Terminalia avicennioides exhibiting the highest activity at 312 and 200µg/mL, respectively. Fractions Ta5 and Al4 obtained on further purification exhibited most significant activity (MIC of 4.7 and 7.8 g/mL, respectively). From the results of phytochemical analysis, terpenes and triterpenoid saponins are the most prominent compounds in these fractions and several reports earlier indicated that these metabolites are potential antimycobacterial agents. This class of metabolites presents interesting area for further investigation with special attention on the Combretaceae family from Nigeria flora

ANTIMYCOBACTERIAL ACTIVITY OF SOME MEDICINAL PLANTS IN NIGER STATE, NIGERIA

Ten Nigerian medicinal plants Abrus precatorius, Annona senegalensis, Anogeissus leiocarpus, Crateva adansonii, Detarium microcarpum, Faba spp, Neocarya macrophylla, Ocimum gratissimum, Securidaca longpenduculata and Terminalia avicennioides used by traditional medicine practitioners for the management of infectious and chronic diseases such as tuberculosis and whooping cough were investigated for in vitro antimycobacterial activity against attenuated strains of Mycobacterium bovis (BCG). Hexane and methanol extracts of the plant materials were obtained by maceration. The antimycobacterial activity was determined by the broth microdilution method. The hexane extracts of Anogeissus leiocarpus and Terminalia avicennioides showed strong inhibitory activity at 312µg/ml. Eight of the ten plant extracts showed moderate inhibitory activity in either hexane or methanol extract at 1250µg/ml. While the hexane and methanol extracts of Detarium microcarpum and Neocarya macrophylla did not exhibit any significant activity. These observed activities could be associated with secondary metabolites in these plants. This study demonstrates the efficacy of Nigerian medicinal plants as potential agents in the management of the tuberculosis disease

Megaprostheses in Orthopaedic Practice-indications, Prospects and Challenges

Introduction: In the case of primary malignant tumors, extensive metastatic disease, major trauma or end-stage revision arthroplasty, the  orthopaedic surgeon often has to deal with the need to reconstruct large skeletal defects, or replace bone of low quality. In recent past as part of our therapeutic armamentaria, this was frequently impossible. Methods: This was a prospective descriptive study of consecutive patient who presented to the Daisyland orthopaedic hospital Jos since 2016 and  had joint replacement using Mega prostheses. Results: Seven patients had Arthroplasty using Megaprosthesis of which all of them where females. Their mean age was 70.7(±9.8) years, the mean  hospital stay was 5.7(±1.2) days and they were all discharged home on full weight bearing

Experience in the management of the mass casualty from the January 2010 Jos Crisis

Background: On the 17 of January 2010, a sectarian crisis broke out in Jos the capital of Plateau state, Nigeria. It created a mass casualty situation in the Jos University Teaching Hospital. We present the result of the hospital management of that mass casualty incident.Objective: To share our experience in the management of the mass casualty situation arising from the sectarian crisis of Jos in January 2010.Methodology: We retrospectively reviewed the hospital records of patients who were treated in our hospital with injuries sustained in the Jos crisis of January 2010.Results: A total of 168 patients presented over a four day period. There were 108 males (64.3%) and 60 females (35.7%). The mean age was 26 ± 16 years. Injury was caused by gunshots in 68 patients (40.5%), machete in 56 (33.3%), falls in 22 (13.1%) and burning in 21 (13.1%). The body parts injured were the upper limbs in 61(36.3%) patients, lower limbs 44 (26.2%) and scalp 43 (25.6%). Majority, 125 (74.4%) did not require formal operative care. Fourteen (8.3%) patients had complications out of which 10 (6.0%) were related to infections. There were 5 (3.1%) hospital mortalities and the mean duration of hospital stay was 4.2 days. The hospital operations returned to routine 24 hours after the last patient was brought in. As a result of changes made to our protocol, management proceeded smoothly and there was no stoppage of the hospital response at any point.Conclusion: This civil crisis involved mostly young males. Injuries were mainly lacerations from machete and gunshot injuries. Majority of the victims did not require formal surgical operations beyond initial care. Maintaining continuity in the positions of the Incident commander and the mass casualty commander ensure a smooth disaster response with fewer challenges.Keywords: Conflict, disaster, hospital response, mass casualty, traum

Comparison of the irrigation of open fractures of the lower limbs with normal saline versus tap water in patients presenting to accident and emergency of Jos University Teaching Hospital (Juth), Jos, Nigeria

Infection is a major contributing factor to the morbidity and mortality associated with traumatic wounds. Tap water has been used for centuries as wound cleanser while normal saline is regarded as the most appropriate and preferred cleansing solution. The objective of the study was to determine the outcome of irrigation of open fractures of the lower limbs with normal saline versus tap water in  patients with open fractures. A randomized prospective study was done to compare the infection rate and bacteriology of open fractures of the lower limbs when irrigated with normal saline versus tap water amongst 107 patients in normal saline group and 102 patients in the tap water group was carried out in Department of Orthopedics and Trauma, Jos University Teaching Hospital, Jos using simple random sample method. The mean age for normal saline group was 37.2±1.4 years and 39.4±1.4 years for the tap water group. The male to female ratio was 3.1:1 in the normal saline group and 3.5:1 in tap water group. Ninety-five (45.5%) of the 209 patients had  their wounds infected, 50 (46.7%) from normal saline group and 45 (44.1%) from tap water group. No statistically significant difference in infection rate in the two groups (P=0.705). No statistically significant difference in distribution of bacterial isolates from the wounds of both groups (P=0.886). It can be deduced that tap water is an effective alternative to normal saline for irrigation of open fractures.&nbsp

Glove Punctures in Orthopedics and Trauma Surgery: Frequency and Nature of Occurrence

Background: Glove punctures are a common occurrence in surgical practice and especially in orthopedic practice. Intact gloves protect members of the operating team from transmission of blood borne infections. Glove punctures however expose the members of the operating team to body fluids and increase the risk of these infections. With the prevalence of conditions such as HIV, Hepatitis B and C, this study aims at determining the rate of and factors that determine glove perforations.Methodology: Gloves were collected from consecutive orthopedic procedures, and were tested using the standardized water leak test The gloves were assessed for leaks and a control group of unused gloves from the same pack was tested similarly after each procedure.Results: A glove perforation rate of 7.7% (119/1548) was found with operative perforation rate of 48.2%. The surgeons' glove was the most frequently perforated 19.3% (85/440). The Index finger and thumb were the most commonly perforated digits 70.8% and 15.6% of perforations respectively. The outer glove had a higher rate compared to inner glove 80.7% to 19.3% respectively. Surgeries lasting more than 90minutes were associated with more perforations (70.4%).Conclusion: The use of double gloving techniques is advocated and a change of outer gloves for prolonged procedures is encouraged as this will reduce the risk of exposure.Key Words: Glove, Punctures, Orthopedics, surgery

IN VITRO ANTIMYCOBACTERIAL ACTIVITY OF TWO MEDICINAL PLANTS IDENTIFIED FROM NIGER STATE, NIGERIA

The global threat of tuberculosis demands for search for alternative antimycobacterial drugs [1]. The crude methanolic extracts of eight Nigerian medicinal plant species used in the treatment of TB and other respiratory diseases were evaluated for activity against a clinical isolate of Mycobacterium tuberculosis and attenuated Mycobacterium bovis (BCG) using broth microdilution method. The plant parts used were obtained as described by the users from a forest near Baddegi, Niger State, Nigeria. Voucher specimens were deposited in the Herbarium at the Department of Biological Sciences, Ahmadu Bello University (ABU), Zaria, Nigeria and National Institute for Pharmaceutical Research and Development (NIPRD), Abuja, Nigeria. Two hundred grams (200g) of each dried plant material was powdered and extracted by maceration with methanol for 72h at room temperature (3 x 250mL). All the crude extracts were filtered and evaporated in vacuo (350C). Each extract was then partitioned with n-hexane-MeOH (3 x 250mL, 1: 1) to give n -hexane and MeOH solubles as well as all the partitioned extracts for each plant were combined; concentrated and dried in vacuo. Both hexane and methanol extracts of each plant species were tested for antimycobacterial activity. Four out of the eight plant extracts exhibited inhibitory activities against Mycobacterium tuberculosis at 78 and 1250μg/mL [2]. The hexane fractions obtained after fractionation were the most active fractions for all the plants tested against BCG, having Anogeissus leiocarpus and Terminalia avicennioides exhibiting the highest activity at 312 and 200μg/mL respectively. Fractions Ta5 and Al4 obtained on further purification exhibited most significant activity (MIC 4.7μg/mL, 7.8μg/mL) respectively. From the results of phytochemical analysis, terpenes and triterpenoid saponins are the most prominent compounds in these fractions and several reports earlier indicated that these metabolites are potential antimycobacterial agents [1]. This class of metabolites presents interesting area for further investigation with special attention on the Combretaceae family from Nigeria flora. References: [1] Copp, BR: The Review of Natural Products with antimycobacterial activity. Nat. Prod. Rep., 20(6): 535-557. (2003). [2] Mann, A., Amupitan, J. O., Oyewale, A.O., Okogun, J. I., Ibrahim, K., Oladosu, P., Lawson, L., Olajide, I., and Nnamdi, A.: Evaluation of in vitro antimycobacterial activity of Nigerian plants used for treatment of respiratory diseases, Afri. J. Biotech., 7 (11): 1630-1636 (2008

The Mass Casualty from the Jos Crisis of 2008: The Pains and Gains of Lessons from the Past

Background: Following the mass casualty of September 2001, we experienced challenges due to the prolonged nature of the crisis and disaster response. We subsequently made changes to our response protocol which were soon tested in the mass casualty resulting from the violence ofNovember 2008 in our city. We present here the management of the mass casualty situation that resulted from that crisis.Patients and methods: A retrospective analysis of the management of the patients who presented following thecrisis. Data was collected from the Emergency Room, theoperating room records and the crisis register. Informationgathered included patient demographics, cause of injury, mechanism, body part affected, treatment, morbidity and mortality. Data was analyzed using Epi Info statisticalsoftware using simple percentages.Results: One hundred and three patients presented over 2 days. There were 101 males (98.1%) and 2 females (1.9%) patients. The ages ranged from 11-65 (+ SD 10.23) years. Injury was caused by gunshots in 71 (68.9%) patients and machetes in 23 (22.3%) patients. The most frequently affected body parts were the lower limbs in 36 (35.0%) patients, upper limbs in 29 (28.2%) patients, chest in 18 (17.5%) patients and abdomen in 14 (13.6%) patients.Nineteen (18.4%) patients required formal surgicalprocedures, mainly exploratory laparotomy, 10 (9.7%).Complications were seen in 14 (13.6%) patients, 11 (10.7%) of these were infection related. There were 3 (2.9%) hospital mortalities. All had severe head injuries.Conclusion: Majority of the injuries were due to gunshots and only one fifth required urgent life saving interventions. From previous experience, effective and continuous IncidentCommand and Mass Casualty Commander positions , andactivation of unit specific protocols within the hospitalensured a hitch free hospital response and enabled the hospital to return to routine activities within 24hours