Idowu Olusegun Fadeyibi

Characteristics of paediatric burns seen at a tertiary centre in a low income country: A five year (2004–2008) study

BACKGROUND Children are the most risk prone in cases of burns. The previous epidemiologic study of paediatric burns in Lagos-Nigeria was carried four decades ago. A new study becomes necessary in view of the increasing incidences of petroleum related fire disasters in Nigeria. PATIENTS AND METHODS : Children up to the age of 14 years admitted for major burns at the Lagos State University Teaching Hospital (LASUTH), Ikeja-Lagos, Nigeria between January 1, 2004 and December 31, 2008 were studied. Information about the demographics, mechanism/circumstances of burns, associated injuries, surface extent (TBSA) and depth, modes of management and outcome, length of admission, and post mortem findings in cases of death were collected. RESULTS : A total of 298 children with major burns were seen; 198 were males and 100 females. The ages ranged from 1 day to 14 years with mean of 4.56 ± 3.95 years. Forty percent of the cases occurred among the toddlers and 25.5% in the 2-5 years age group. Fire was the leading cause of burns, occurring in 198 (66.4%) cases. The TBSA ranged from 1% to 100% with mean of 29.67 ± 21.98. The mortality rate was 29.9%. Autopsy showed asphyxia as the primary cause of death in 14 (48.27%) cases, multiple organ dysfunctions in 27.59% and septicaemia in 13.79%. CONCLUSION This study identifies the main causes of paediatric burns and the major factors responsible for morbidity and mortality at the present time in a low income country. The level of awareness about burns prevention among the populace and health care facilities should be improved.

Psychosocial effects of cleft lip and palate on Nigerians: the Ikeja-Lagos experience.

Abstract We studied 116 patients who presented with cleft lip and palate (CLP) and were seen during a state-wide screening exercise for people with orofacial deformities in Ikeja-Lagos, Nigeria between May 2006 and July 2007. Detailed histories were taken and physical examinations made. The following psychometric instruments: General Health Questionnaire 28 (GHQ28), State-Trait Anxiety Inventory Y1 (STAI-Y1), STAI-Y2, and Self rating Depression Scale (SDS) were given on the respondents by a clinical psychologist. The respondents comprised 57 men and 59 women with a male:female ratio of 1:1.04. There were 42 (36%) adults and 74 (64%) children. Fifty-four (47%) patients had cleft lip (CL), 27 (23%) had cleft lip and palate (CLP), and 35 (30%) had cleft palate alone. Forty-five (39%) of the respondents were parents and guardians who responded to the presence of the deformity on behalf of children who were less than 6 years old, and assessed the reactions of those who were aged 6–12 years old. Older patients replied directly to the psychometric instruments. The outcome of the assessment of the Mental Health Profile of the participants showed high incidence of anxiety, depression, and impairment of general wellbeing. The effects were most pronounced in the 6–12 year age group. We recommend that the psychosocial impacts of CLP on the patients, parents, and relations should be managed together with the reconstructive procedures.

Burns and fire disasters from leaking petroleum pipes in Lagos, Nigeria: an 8-year experience.

INTRODUCTION Petroleum products are mostly inflammable and require strict regulations for safe handling. This study characterises the epidemiology of people who sustained burns from leaking petroleum pipes in Lagos, Nigeria. Risk factors for the leaks were determined and proposals for preventive measures made. MATERIALS AND METHODS Records of burn patients treated in our hospital from June 1999 to September 2004 were studied and victims of petroleum pipeline fires treated from October 2004 to May 2007 interviewed. RESULTS Nine incidents of pipeline fire disasters occurred during the study period. A total of 646 victims sustained 100% burns and died at the disaster sites. Deliberate pipeline damage caused explosions in 55.6% of the cases and spontaneous ruptures in 44.4%. Forty-eight patients were admitted to our hospital for major burns from pipeline explosions. Their ages ranged from 15 to 50 years with a mean of 25.36 ± 5.62 years. The total body surface area (TBSA) involved in burns ranged from 31% to 100% with a mean of 75.71 ± 18.60. Over 40% of the patients had burns beyond 80% TBSA. Mortality rate was 67.3%. Poverty, irregular supply and high prices of petroleum products were responsible for the deliberate pipeline damage and lack of maintenance and surveillance for the spontaneous ruptures. CONCLUSION The incidents of fire disasters from broken petroleum pipelines increased over the study period with considerable mortality. Programmes to reduce poverty, regular product supply, pipeline maintenance and surveillance may reduce the occurrence of the disasters.

Practice of first aid in burn related injuries in a developing country

INTRODUCTION First aid with cool running water reduces the severity of burn. Low level of knowledge of first aid in burns was shown in previous studies with few patients receiving first aid by water lavage. A study investigating the use of water lavage as first aid in patients presenting to hospital with burn in Lagos, Nigeria was carried out. METHODS Patients admitted to a University Teaching Hospital for treatment of burns were recruited for this prospective study. Data detailing demographics, scene and aetiology of burns, material used for first aid, who administered first aid, level of education and relationship of first-aider with patients, length of hospital stay, complications and outcome of treatment were collected and statistical analysis performed. RESULTS 168 patients; 73 (43.4%) children and 95 (56.6%) adults were seen. Burns were sustained at home in 95 (74.2%) cases and outside in 33 (25.8%). Water lavage was used in 49 (29.2%) cases, raw eggs in 21 (12.5%), pap in 16 (9.5%) and other materials in 48.8%. 40 (23.8%) patients had not received any form of first aid at presentation. Patients that received no water first aid had higher complication rate (35.3% versus 18.4%) compared with those that had water first aid. CONCLUSION AND RECOMMENDATIONS The use of water first aid in burns was shown to reduce complication rate in this study. People should be educated on the efficacy of water first aid in pre-hospital care of burns.

Bacteriology of infected burn wounds in the burn wards of a teaching hospital in Southwest Nigeria

BACKGROUND Burns are characterized by the loss of varying proportions of the protective layers of the skin, depression of immune responses, and increased wound susceptibility to infection. Wound infection is a major cause of morbidity and mortality in burn cases. This study characterizes those factors that predispose burn wounds to infection and the bacteriology of the microorganisms in our environment. PATIENTS AND METHODS Prospective study of burns patients that were admitted and treated at the Lagos State University Teaching Hospital (LASUTH), Ikeja-Lagos, Nigeria between January 1 and May 31, 2010 was carried out. Information about the demographics, aetiology/mechanism of burns, interval between the time of injury and admission, microbial studies, and antibiotic therapy were collected and analyzed. RESULTS A total of 74 patients consisting of 43 males and 31 females were seen. The ages range between one week and 95 ± 22.42 years. Wound infections were confirmed in 28 patients (infection rate of 37.84 per 100 patients). Delayed presentation at LASUTH and length of hospital stay were significantly related to the development of wound infection. Pseudomonas aeruginosa and Proteus mirabilis were the most common infective organisms occurring in 53.6 and 10.7 percentages respectively. The isolated organisms were resistant to the beta-lactam antibiotics and mostly sensitive to carbapenem and aztreonam preparations. CONCLUSION Factors predisposing to invasive wound infections in our environment were highlighted and suggestions made on methods that could reduce the infections and thus reduce morbidity and mortality in burns.

Differential diagnosis and management of giant fibroadenoma: Comparing excision with reduction mammoplasty incision and excision with inframammary incision

Abstract Giant fibroadenoma (GFA) may present with breast asymmetry and can be excised with an inframammary incision (IFI) or reduction mammoplasty incision (RMI). This study investigated the clinical presentation and compared excision with the IFI and RMI. All patients with benign breast tumours greater than 5 cm underwent core needle biopsy and a histopathological diagnosis. All confirmed GFA had their clinical details documented and randomised into two groups for excision with an IFI or RMI. Twenty-two patients were studied. The age range was 12–46 years, mean 21.18 ± 2.22 years. The patients were divided into two groups: a juvenile group (n = 16) (73%) aged 12–18 years, mean age 14.06 ± 0.42 years, and a perimenopausal group (n = 5) aged 28–46 years. The juvenile group showed cyclic increases in breast size monthly with menstruation while the perimenopausal showed an initial slow growth of 6–24 months followed by a rapid growth. Fifteen patients (68%) had excision biopsy with IMI and seven patients with RMI. Seven of the patients treated with IFI had minimal preoperative asymmetry and satisfactory aesthetic outcome. Among the patients with severe preoperative asymmetry treated with IFI (n = 8) and RMI (n = 7), those treated with IFI had persistent postoperative skin redundancy and asymmetry, which was not found in those treated with RMI. In conclusion, for patients with significant asymmetry, excision with the IFI was associated with persistent asymmetry while excision with RMI was associated with restoration of symmetry.

Burn severity and post-burn infertility in men

Burn wounds are a common cause of much morbidity and misery, especially in low- and medium-income countries. A number of studies show that severe burns cause infertility from poor sperm production. The pathways leading to such infertility are not well understood, and it is not known how the severity of injury affects this post-burn infertility (PBI). We evaluated the relationship between sperm parameters and indices of burn severity, such as burn surface area and depth in 19 adults. Total sperm counts ranged from 0 to 160 million/ml, with a mean of 19.58+/-7.52 million/ml. About 60% of the subjects had total counts of 20 million/ml or less, falling into the clinically oligospermic range. We found only a weak correlation between infertility and both burn depth and burn surface area. There was, however, a fairly strong positive correlation between infertility and length of time between injury and participation in the study. The correlation coefficient was 0.560. Our findings suggest that PBI is progressive and not predicted by TBSA. Any measures to control it should be started early and be applied to burn patients across a wide range of clinical severity.

Mammograms and breast arterial calcifications: looking beyond breast cancer: a preliminary report

BackgroundTo find out the prevalence, clinical and biochemical correlates of Breast Artery Calcification (BAC) in the Nigerian women.FindingsThis is a cross sectional study involving 54 consecutive adult female subjects sent to the Radiology Department of the Lagos State University Teaching Hospital (LASUTH), Ikeja-Lagos, Nigeria for screening and diagnostic mammography. The study was carried out for a period of five months.The prevalence of BAC was 20%. Ageing was found to be related to BAC. Cardiovascular risk factors including diabetes mellitus (DM), hypertension, obesity, alcohol ingestion, use of oral contraceptives and hormone replacement therapy, were not significantly related to the presence of BAC in this study.ConclusionThis study showed that though the presence of BAC in a mammogram is related to age, it may not predict or serve as a significant marker for cardiovascular diseases (CVD) in women in our environment.

Day Case Cleft Lip Surgery in Lagos, Nigeria

Background: The correction of cleft lip deformity has included overnight admission and postoperative ward admission from 5 to 7 days. In developing countries, increasing cost of treatment and medical insurance and shortage of bed space have led to a reduction in the length of hospitalization or its elimination for some cases of surgery. Objective: To assess the feasibility and complications associated with day case cleft lip surgery in our center. Methods: A prospective study of patients undergoing day case cleft lip repair at three hospitals from 1995 to 2005. Results: A total of 43 patients were seen. Twenty seven (63.8%) were treated as day case, and 16 (37.2%) were operated as inpatients. The mean age for patients treated as day case was 1.32 ± 1.45 years. Fifteen (55.6%) of these patients had severe associated nasal deformities, six (22.2%) had moderate nasal deformity, and four (14.83%) had mild nasal deformity. The only complication was a nasovestibular fistula that occurred in one of the day case patients. From 27 patients operated on as day cases, eight calls were received. Two (7.4%) mothers called to report febrile illness in their children on the first postoperative day. Two mothers (7.4%) reported excessive crying. The most frequent reason for postoperative consultation was obstruction of the modified nasal retainer, which occurred in four patients (14.8%). Conclusion: Day case surgery for cleft lip can be said to be safe, with a 2.3% rate of complications in selected patients. Day case surgery was a cheaper alternative to admission.

Pudendal thigh flap in the treatment of acquired gynatresia from caustic pessaries

To evaluate the use of vaginoplasty with the pudendal thigh flap in patients with gynatresia caused by herbal pessaries in a multidisciplinary context.