Communal Conflict- Related Ocular Trauma

[Nig J Clinical Practice Vol.5(1) 2002: 1-4]Purpose: To determine the cause, morbidity and visual outcome of ocular injuries sustained during the Ife/Modakeke communal conflict which occurred between A9ugust 1997 and December 1998. Method: We conducted a retrospective study of all patients with eye injuries resulting from the conflict, treated at Obafemi Awolowo University Teaching, Hospital, Ile-Ife and 2 private eye clinics in Ile-Ife and Modakeke. Results: Fifty-five eyes of 54 patients were injured. The mean age was 32 years with a male preponderance of 96.3%. Forty-two eyes (76.4%) were injured by gunfire through direct impact, backfire or stray bullet. Thirty-one eyes (56.4%) sustained closed-globe injuries while 24 (43.6%) had open-globe injuries. Thirty-five eyes (63.6%) were blind, out of which 9 eyes (16.4%) required primary enucleation. Conclusion: Civilian conflict with the use of firearms is associated with severe ocular morbidity. Maintenance of peace is essential. KEYWORDS: Conflict, ocular trauma, gunshot injury, blindness [Nig J Clinical Practice Vol.5(1) 2002: 1-4

Typhoid Intestinal Perforations in a Tropical Tertiary Health Facility: A Prospective Study.

Background: Despite decades of improvement in patient care globally, typhoid intestinal perforation remains a frequently fatal illness in the developing world. This study aimed at determining the factors that influenced the outcome of surgical management typhoid intestinal perforation in Sagamu, South-West Nigeria. Methods: Twenty-three consecutive adult cases managed between January 2006 and December 2008 at the surgical department of Olabisi Onabanjo University Teaching Hospital Sagamu were studied prospectively. Patients received parental ciprofloxacin or ceftriaxone in addition to metronidazole. They all had laparotomy after adequate resuscitation. Patients in American Society of Anesthesiologists (ASA) class VE were operated upon under local anaesthesia, intravenous ketamine and diazepam. Results: There were 13 males and 10 females with a male to female sex ratio of 1.3:1. The ages ranged from 19 to 51 years. Seventeen (73.9%) patients were aged between 20 and 34 years. Two patients, one each from ASA grades IVE and VE, died on 1st and 2nd postoperative days respectively. The mortality of 8.7% was significantly associated with ASA class (P= 0.040). ASA class was strongly associated with severity of peritonitis (P=0.021). Complications occurred in 11 (47.8%) patients. Ten (43.5%) developed wound infection and one (4.3%) an entercutaenous fecal fistula. Wound infection was significantly associated with method of closure of perforation (P=0.034), and number of perforations (P=0.007). Conclusion: This study has shown that ASA class is a significant predictor of mortality in patients treated for typhoid intestinal perforation in our centre. We recommend that patients in ASA classes IV and V should have post-operative intensive care to reduce the risk of death

Is there a need for extra-length spinal needles for obstetric spinal anaesthesia in obese parturients? A multi-centre study

Background: Neuraxial blocks are often the preferred anaesthetic techniques in obese mothers for caesarean section because of  increased risk of difficult intubation in them. However, these techniques may be challenging possibly because of poor landmark of spinal space and poor selection of spinal needles in them. Objective: To investigate if there is need for extra-length spinal needles in obese parturients during caesarean section. Design: A prospective observational study Setting: Four University Teaching Hospitals in South-Western Nigeria. Subjects: Parturients scheduled for caesarean section under spinal anaesthesia Results: The mean age, weight, body mass index and skin to subarachnoid space depth (SSD) were 31.49 ± 5.12 years, 75.21 ± 14.14 kg, 27.68 ± 5.45 kg/m2 and 6.08 ± 0.98 cm respectively. Of the 485 parturients, 156 (32.2%) were obese. Majority of the obese patients were greater than 30 years of age when compared with those that were under 30 years and this was statistically significant (p= 0.007). Only one obese parturient needed an extra-length spinal needle for skin to sub-arachnoid space depth (SSD) of 10 cm. There was a more positive linear correlation between depth of spinal needle and weight (0.455) than BMI (0.229) Conclusion: Although about one-third of parturients in our study were obese, only one required an extra-length spinal needle. Extra-length spinal needle is rarely needed in our populatio