Community-based Management of Micronutrient deficiency in Malnourished Children in Ghana

The relationship between undernutrition and ill health is complex. It is complicated by growth retardation, impaired mental development, and significant morbidity from malaria, diarrhoeal diseases, pneumonia etc. and mortality. Several micronutrients are required for adequate growth and development especially in young children. They also account for three of the four most important forms of malnutrition worldwide. This review attempts to evaluate the community-based management of malnutrition in developing countries while comparing it to the in-patient management of malnourished children. Parameters evaluated include cost, coverage, choice, nosocomial infection acquisition and effect on productivity. The community-based management of severe malnutrition has many benefits that should be harnessed by healthcare givers so as to reduce the burden of malnutrition in low resource settings.DOI: http://dx.doi.org/10.3329/bjms.v13i4.20552Bangladesh Journal of Medical Science Vol.13(4) 2014 p.383-387

Bone malignancies in orthopaedic hospital Igbobi Lagos, Nigeria

AIMS AND OBJECTIVES

To document the pattern of bone malignancies in a highly populated orthopaedic hospital in Lagos Nigeria;

PATIENTS AND METHODS

A total of 21 cases of primary malignant bone tumours were studied. This comprised 12 cases of Osteosarcoma, 7 cases of Malignant Fibrous Histiocytoma (MFH) and 2 cases of Chondrosarcoma. Males (13) were affected more than females (8) giving a male to female ratio of 1.6 to 1. The age range was 7 to 45 years with a median age of 24 years. The diameter of the swelling ranged from 6 to 20 cm with a median of 12 cm. All patients had ablative surgery except for those with affectation of the ilium. Data was analysed using the Statistical Package for Social Sciences (SPSS 16). Enneking's classification was used to grade the tumour. The duration of symptoms of all the patients before presentation ranged from 3 weeks to 4 years with a mean of 7 months. The commonest site affected was around the knee (76.2%); distal femur had 42.9% and proximal tibia 33.3%.

RESULTS

Osteosarcoma was the most common malignant bone tumour in this series and accounted for 57.1%. The peak incidence was found in the 2nd decade of life. The youngest patient was 7 years old and the oldest 43 years. The tumour was found primarily around the knee. 7 cases were in the distal part of the femur, 4 in the proximal part of the tibia and 1 case was found in the distal radius. Out of the 12 patients with osteosarcoma, 8 had paraosteal type (5 high grade, 3 intermediate grade), the remaining 4 had periosteal (all high grade) Malignant Fibrous Histiocytoma was found in 7 patients and accounted for 33.3%. The peak incidence was found in 3rd and 4th decades. 4 out of the 7 patients were high grade pleomorphic osteosarcoma, 2 were myxoid high grade dedifferentiated and one was low grade giant cell tumour type. Chondrosarcoma was found in 2 patients, accounting for 9.5%. both cases were in the ilium

CONCLUSION

Primary malignant bone tumours occurred in children and young adult in this study. It is commoner among males and most of the patients presented late to the hospital. Osteosarcoma is the commonest followed by Malignant Fibrous Histiocytoma, both occurred commonly around the knee and chondrosarcoma on the ilium.

Prehospital transport of spinal cord-injured patients in Nigeria

BACKGROUND

Well-organised and efficient prehospital transport is associated with an improved outcome in trauma patients. In Nigeria there is a paucity of information on prehospital transport of spinal cord-injured patients and its relation to mortality.

OBJECTIVE

To determine whether prehospital transportation is a predictor of mortality in spinal cord-injured patients in Nigeria.

DESIGN

Prospective cohort study.

METHODS

Prehospital transport-related conditions, injury-to-arrival intervals and persons who brought spinal cord-injured patients to the casualty departments at the University of Abuja Teaching Hospital, Gwagwalada, and the National Orthopaedic Hospital, Lagos, were noted. Data were analysed using descriptive statistics, the chi-square test and multiple logistic regressions.

MAIN OUTCOME MEASURES

Mortality within 6 weeks of admission. Results. During the review period, 168 patients with spinal cord injury presented to the casualty departments. Most presented 24 hours or more after the injury (67.9%) and were brought to casualty by their relatives (58.3%). Saloon cars were the most common mode of transportation (54.2%), most patients (55.4%) lying on their back during transfer. The majority of the patients (75%) had been taken to at least one other hospital before arriving at our casualty departments. The mortality rate was 16.7%. Multivariate analysis after adjusting for age, gender and means of transportation revealed that age (odds ratio (OR) 63.41, 95% confidence interval (CI) 9.24 - 43.53), a crouched position during transfer (OR 23.52, 95% CI 7.26 - 74.53), presentation after 24 hours (OR 5.48, 95% CI 3.20 - 16.42) and multiple hospital presentations (OR 7.94, 95% CI 1.89 - 33.43) were associated with death within 6 weeks of admission.

CONCLUSION

Well-organised and efficient prehospital transport would reduce mortality in spinal cord-injured patients. Providing information on prehospital transport would also reduce mortality.

Prehospital transport of patients with spinal cord injury in Nigeria

BACKGROUND

A well-organized and efficient prehospital transport is associated with improved outcome in trauma patients. In Nigeria, there is paucity of information on prehospital transport of patients with spinal cord injury (SCI) and its relation to mortality.

OBJECTIVE

To determine if prehospital transportation is a predictor of mortality in patients with SCI in Nigeria.

DESIGN

Prospective cohort study

METHODS

Prehospital transport related conditions, injury arrival intervals and persons that brought patients with SCI to the casualty were noted. Data analyzed using descriptive statistics, the chi-square test and multiple logistic regressions.

MAIN OUTCOME MEASURES

Mortality within 6 weeks on admission

RESULTS

168 patients with SCI presented in the casualty during this review period. Majority (67.9%) presented after 24 hrs of the injury. Majority (58.3%) were conveyed into the casualty by their relatives. Salon car (54.2%) was the most common mode of transportation where majority (55.4%) laid on their back during the transfer. Majority (75%) of the patients had multiple hospital presentation before reporting in our casualty. The mortality observed was 16.7%. Multivariate analysis after adjusting for age, gender, and means of transportation revealed that age (OR= 63.41, 95% CI= 9.24-43.53), crouched position during transfer (OR= 23.52, 95% CI= 7.26-74.53), presentation after 24 hrs (OR=5.48, 95% CI=3.20-16.42) and multiple hospital presentation (OR= 7.94, 95% CI= 1.89-33.43) were associated with mortality within 6 weeks of admission.

CONCLUSION

A well-organized and efficient prehospital transport would reduce mortality in spinal cord injured patients. Public enlightenment campaign on factors that could reduce road traffic injury would help reduce mortality.

Klippel-Feil syndrome: a case report

OBJECTIVE

To report the clinical presentation and peculiarity of management of Klippel-Feil syndrome (KFS) at the University of Abuja Teaching Hospital, Gwagwalada.

BACKGROUND

KFS is a rare pathology that has not been previously reported on in Nigeria.

METHODS

Case review was employed to report this pathology.

RESULT

This case is a 10 year old boy with KFS presenting with cosmetic blemish and scoliosis. Surgical treatment of the cosmesis was offered but patient defaulted because of fund due to their low income.

CONCLUSION

KFS is an uncommon pathology in the male. The management is essentially conservative but surgery is an option if there was cervical spine instability, scoliosis and cosmetic blemish.