Ia Adigun

Economic Burden of Drug Use in Patients with Acute Burns: Experience in a Developing Country

Background/Objective. Burn injury is a devastating injury. The economic drain on the patients purse is equally devastating. Few studies have examined the cost of managing burn patients particularly the drug component. Methods. The financial implication of drug use in the management of 69 consecutive patients admitted by the burn unit over a period of two years was retrospectively analysed. Results. Thirty-six (52.2%) patients were males and 33 (47.8%) females with a mean age of 17.9 years (SD = 18.4). The patients spent an average sum of

Clinicopathological study of neurofibromatosis type 1: an experience in Nigeria

91.21 to procure drugs; 84.3% of the costs were for antibiotics, 11.1% for analgesics, and 4.6% for others. Conclusion. Significant amount of money is spent on the procurement of drugs. Most of the money is spent on prescribed antibiotics. Measures that reduce antibiotics use in burn management might relief patients of the huge economic burden associated with its use.

Violence in the emergency department: a multicentre survey of nurses’ perceptions in Nigeria

Background  Neurofibromatosis type 1 (NF1) is the commonest single gene autosomal dominant disorder, and its diagnosis is usually composed of a set of clinical criteria. Histological examination of skin lesions is often neglected. This study was designed to evaluate the clinical and pathologic pattern of NF1 among Nigerians and to emphasize the place of histological examination.

Pattern of rhabdomyosarcoma in Nigerian children.

Background Emergency department (ED) violence is common and widespread. ED staff receive both verbal and physical abuse, with ED nurses bearing the brunt of this violence. The violence is becoming increasingly common and lethal and many institutions are still improperly prepared to deal with it. Methods A questionnaire based survey of the perception of violence among nurses working in six tertiary hospitals’ EDs across five states in Nigeria was conducted. Results 81 nurses were interviewed with a male to female ratio of 1:4. Most were right about the definition of violence. About 88.6% of respondents have witnessed ED violence while 65.0% had been direct victims before. Nurses followed by doctors were the usual victims. The acts were carried out mostly by visitors to the ED. Men were usually responsible for the violence, which usually occurred in the evenings. Weapons were not commonly utilised: only 15.8% of the nurses had been threatened with a weapon over a 1-year period. The main perceived reasons for violence were overcrowded emergency rooms, long waiting time and inadequate system of security. All the institutions were lacking in basic strategies for prevention. While most of the nurses were not satisfied with the EDs that were considered not safe, few would wish for redeployment to other departments/units. Conclusions There is a need to make the EDs safer for all users. This can be achieved by a deliberate management policy of ‘zero’ tolerance to workplace violence, effective reporting systems, adequate security and staff training on prevention of violence.

Clinico-pathological patterns of squamous cell carcinoma in Nigeria

BACKGROUND Soft-tissue sarcomas are uncommon tumors that are infrequently seen in most surgical practices. They represent 6.5% of all cancers in children < 15 years of age and are the fifth leading cause of cancer death in that age group. This study was conducted to show the prevalence and pattern of distribution of rhabdomyosarcoma among children in a black African population. METHODS We retrospectively reviewed 232 cases of soft-tissue sarcomas that were managed for a period of 22 years (1985-2006). Materials were obtained from the clinical records, operation notes and histopathology reports of the patients. The records of patients with rhabdomyosarcoma were analyzed in details. RESULTS The result showed the age peak incidence for the total soft-tissue sarcomas occurring between the third and sixth decades of life. Rhabdomyosarcoma constitutes 9.5% of the total number of patients managed, and 54.5% of these patients are age < 20 years. CONCLUSION We conclude that parents must be educated about the need to look out for any mass on their children that persists for > 4 weeks so as to reduce the delayed and advanced stage of presentation.

Fulminant necrotizing fasciitis following the use of herbal concoction: a case report

Squamous cell carcinoma (SCC) is the second most common form of skin cancer and frequently arises in the sun-exposed skin of middle-aged and elderly individuals. We retrospectively reviewed 443 patients managed for SCC (cutaneous and non-cutaneous) in our hospital from January 1979 to December 2002. The age distribution showed peak incidence between fourth and sixth decades of life. The duration of symptoms ranged from 6 months to 552 months (standard deviation [SD] = 54.29), while the head and neck region was the most common site of cutaneous SCC. SCC is not rare in our environment. Patients with skin lesions are advised to present early to their physician for early diagnosis and appropriate treatment.

Soft tissue sarcoma of the thigh: Need for angiography in the developing countries

IntroductionNecrotizing fasciitis is a rare and life-threatening rapidly progressive soft tissue infection. A fulminant case could involve muscle and bone. Necrotizing fasciitis after corticosteroid therapy and intramuscular injection of non-steroidal anti-inflammatory drugs has been reported. We present a case of fulminant necrotizing fasciitis occurring in a patient who used a herbal concoction to treat a chronic leg ulcer.Case presentationA 20-year-old Ibo woman from Nigeria presented with a three-year history of recurrent chronic ulcer of the right leg. She started applying a herbal concoction to dress the wound two weeks prior to presentation. This resulted in rapidly progressive soft tissue necrosis that spread from the soft tissue to the bone, despite aggressive emergency debridement. As a result she underwent above-knee amputation.ConclusionThe herbal concoction used is toxic, and can initiate and exacerbate necrotizing fasciitis. Its use for wound dressing should be discouraged.

Management dilemma of a recurrent huge fibrosarcoma in a 25-year-old African: a case report

BACKGROUND Soft tissue sarcomas (STS) are relatively rare tumors that are seldom seen in many surgical practices. In the developing countries, most patients present lately to the tertiary center either because of poverty, ignorance, or poor management by the primary health workers that first come into contact with these patients. METHODS We bring you five patients with large STS thighs that were managed by unity between the years 2005 and 2007. RESULTS Three of these patients are deceased, and one of the two surviving patients has amputation below the knee. The two surviving patients lost view after 3 months. CONCLUSION Although angiography has been relegated to the background by the advent of modern techniques such as tomography imaging by computer (CT) and imaging by magnetic mirroring (IRM), in the developing countries angiography remains important as one pri-opiratoire of surgical guide in the thigh STS.

The Naso-labial and lateral forehead flaps as a single stage: A case report and review of literature

IntroductionSoft tissue sarcomas are rare tumours that are infrequently seen in most surgical practices. They can occur in any anatomic region of the body. The size of a soft tissue sarcoma is an important prognostic variable and so affects the quality of tumour resection.Case presentationA 25-year-old Nigerian African presented with recurrent huge fibrosarcoma measuring about 55 × 40 × 10 cm at his posterior trunk. The patients clinical condition was poor; the tumour seemed unresectable and the patient looked inoperable. He had an extensive excision of the tumour but could not afford adjuvant therapies. He was discharged home against medical advice but may succumb to metastases.ConclusionSarcomas in black people can present as extremely large masses; the dilemma in management is not only limited to the delay in presentation but also the poor socio-economic status of the patients and the frequent non-availability of supporting services. Treatment grants or subsidies from government may go a long way to ensuring that patients receive appropriate care.

Ulnar Hemimelia with Oilgodactyly: Report of Two Cases

We present here the case of a patient with a major traumatic nasal loses who had a near-total nasal reconstruction as a single-stage procedure. A 35 year-old civil servant who was involved in a road traffic injury about two years before presentation. He sustained extensive and multiple facial injuries with complete loss of nasal cover and lining. Reconstruction was performed by using superiorly based, bilateral, nasolabial flaps to line the floor and the nasal septum, and a paramedian forehead flap for skin cover. The patient did well postoperatively and was discharged home on the 7th postoperative day. If the principles concerning cover, support, and lining are adhered to, excellent functional and aesthetic results can be achieved as we have obtained in our patient.