Olayinka Oladiran Adegbehingbe

Motorcycle crash characteristics in Nigeria: implication for control.

Despite being the second most common cause of road traffic injuries (RTIs) in Nigeria, no study had examined the peculiarities of motorcycle crash site characteristics in Nigeria. We examined and interviewed 363 motorcycle RTI patients in three tertiary hospitals in southwest Nigeria. All the motorcycles are small with capacities between 80 and 125cm3. 68.9% of the patients sustained their injuries while working or going to work and 23.4% on their way to school. 176 (48.5%) of the crashes were with moving vehicles and in 83 (22.3%) cases, either the motorcycle or the other vehicle is moving against the traffic. 37.8% of all crashes occurred at junctions with no roundabout versus 5% at junctions with roundabout. Some risky practices of the patient included carrying more than 2 persons (15.02%), travelling without headlight at night (31.7%) and not wearing helmets (96.5%). This study showed that risky behavior among motorcycle riders, chaotic traffic and road design faults accounted for most of the motorcycle crashes. The implications for the prevention and control of motorcycle injuries were discussed.

Clinical effects of Garcinia kola in knee osteoarthritis.

ObjectivesOver the past years, there has been a growing number of knee osteoarthritis (KOA) patients who are not willing to comply with long-term non-steroidal anti-inflammatory drugs (NSAID) treatment and wish to use herbal anti- rheumatic medicine. This study assessed the clinical effects of Garcinia kola (GK) in KOA patients.Patients and methodsProspective randomized, placebo controlled, double blind, clinical trial approved by the institutional medical ethics review board and written informed consent obtained from each patient. All KOA patients presenting at the Obafemi Awolowo University Teaching Hospital complex were recruited into the study. The patients were grouped into four (A = Placebo, B = Naproxen, C = Garcinia kola, D = Celebrex). The drugs and placebo were given twice a day per oral route. Each dose consisted of 200 mg of G. kola, Naproxen (500 mg), Celebrex (200 mg) and Ascorbic acid (100 mg). The primary outcome measure over six weeks study period was the change in mean WOMAC pain visual analogue scales (VAS). Secondary outcome measures included the mean change in joint stiffness and physical function (mobility/walking).Results143 patients were recruited, 84 (58.7%, males – 24, females – 60) satisfied the selection criteria and completed the study. The effect of knee osteoarthritis bilateralism among the subjects was not significant on their outcome (p > 0.05). The change in the mean WOMAC pain VAS after six weeks of G. kola was significantly reduced compared to the placebo (p < 0.001). Multiple comparisons of the mean VAS pain change of G. kola group was not lowered significantly against the naproxen and celebrex groups (p > 0.05). The onset of G. kola symptomatic pain relief was faster than the placebo (p < 0.001). However, it was slower than the active comparators (p > 0.05). The duration of therapeutic effect of Garcinia kola was longer than the placebo (p > 0.001). G. kola period of effect was less than naproxen and celebrex (p < 0.001). G. kola subjects had improved mean change mobility/walking after six weeks better than the control group(p < 0.001). The mean change in mobility of the G. kola group when compared to the active comparators was not significantly better (p < 0.05). The mean change of knee joint stiffness (p < 0.001) and the change of mean WOMAC score (p < 0.001) were improved on Garcinia kola as compared to the placebo. The mid term outcome of eleven Garcinia kola subjects after cessation of use had a mean pain relief period of 17.27 +/- 5.15 days (range: 9–26 days). There was no significant cardiovascular, renal or drug induced adverse reaction to Garcinia kola.ConclusionGarcinia kola appeared to have clinically significant analgesic/anti-inflammatory effects in knee osteoarthritis patients. Garcinia kola is a potential osteoarthritis disease activity modifier with good mid term outcome. Further studies are required for standardization of dosages and to determine long-term effects.

Timing of antibiotic prophylaxis in tourniquet surgery.

It is customary to administer prophylactic antibiotics before exsanguination of the limb and inflation of a tourniquet in extremity surgery. To compare the clinical outcome in lower limb operations when prophylactic antibiotics were administered before versus after limb exsanguination and tourniquet inflation, we randomized patients to the administration of prophylactic antibiotics 5 minutes before exsanguination and inflation of the tourniquet (ABT) and administration of prophylactic antibiotics 1 minute after inflation of the tourniquet (AAT). A total of 106 patients completed the study, including 76 males (71.7%) and 30 females (28.3%). Of the 106 patients, 54 (50.9%) received antibiotics before tourniquet inflation (ABT) and 52 (49.1%) after tourniquet inflation (AAT). Most of the operations (71.7%) involved open reduction and internal fixation of fractures. In the ABT group, 8 wounds (14.8%) developed postoperative infection. In the AAT group, 2 (3.9%) developed wound infection (P = .031). The mean period to wound healing in the ABT group was 4.0 ± 2.3 weeks and was 3.0 ± 0.5 weeks in the AAT group (P = .002). Overall, 100% of the patients in the AAT group were satisfied compared with 85.2% in the ABT group. The difference was statistically significant (P = .005). The results of our study suggest that administration of prophylactic antibiotics before exsanguination and inflation of a lower extremity tourniquet does not give better results than administration of the antibiotic shortly after inflation of the tourniquet.

Efficacy of garcinia kola 0.5% aqueous eye drops in patients with primary open-angle glaucoma or ocular hypertension

Purpose: To evaluate the intraocular pressure (IOP) lowering efficacy of Garcinia kola 0.5% aqueous solution eye drops in patients with newly diagnosed primary open-angle glaucoma or ocular hypertension (POAG/OH). Materials and Methods: A randomized, double-masked, multicenter, active-controlled prospective study. Patients who met the inclusion criteria were randomly assigned in equal numbers to receive Timolol 0.5% eye drops as a control medication (A = Group 1 eyes) or Garcinia kola 0.5% eye drops as the study medication (B = Group 2 eyes). All drops were instilled at 6 am and 6 pm daily. Goldman applanation tonometry was performed at 9 am, 12 pm and 3 pm at baseline, week-6, week-12 and week-24 visits. Voluntary and actively elicited reports of adverse events were documented. The mean change in IOP over 24 weeks was the primary outcome measure. Both groups were compared for statistically significant differences at all visits. A P < 0.05 was considered statistically significant. Results: A total of 178 patients were randomly assigned to G. kola and Timolol groups. At baseline there were no differences in mean IOP between groups, based on age, sex, or diagnosis. At the end of the study period (24th week), the mean (± SD) reduction in IOP was 12.93 ± 2.3 mmHg (47.8% ± 0.8% reduction) in G. Kola group and 13.09 ± 2.8 mm Hg (48.2% ± 1.03% reduction) in the Timolol group (P > 0.05). Adverse events were mild in nature with no statistically significant differences between groups (P > 0.05). Conclusions: Garcinia kola ophthalmic solution significantly reduces IOP as compared to baseline. The IOP lowering effect of both treatments was equivalent.

Psychological reactions to amputation in a sample of Nigerian amputees

OBJECTIVE The study compares psychological symptoms between amputees and other orthopedic patients. METHOD Forty-two consecutive amputees were interviewed between 7 and 28 days after amputation, and an equal number of other orthopedic patients matched for age, sex, marital status, and occupation were used as controls. Each respondent completed a sociodemographic questionnaire, while clinical variables were obtained from the case notes. Respondents also completed the General Health Questionnaire, State Trait Anxiety Inventory, and the Zung Self-Rating Depression Inventory. RESULTS The mean age of amputees in this study was 42.33 years (S.D.=15.89 years), and the average weekly income is #3500.00 (

Vulnerability of motorcycle riders and co-riders to injuries in multi-occupant crashes

29.00). Anxiety and depressive symptoms were high among amputees (64.3% and 59.5%, respectively) compared to other orthopedic patients (14.3% and 12.0%, respectively). Correlation analysis showed that there was significant correlation between anxiety and age (negative), marital status, and level of education, while depressive symptoms significantly correlated significantly with age (negative) and marital status. CONCLUSION Psychological symptoms are high in this sample of amputees, indicating the importance of social and emotional support for these patients.

Ponseti method treatment of neglected idiopathic clubfoot: Preliminary results of a multi-center study in Nigeria

In developing countries, most motorcycles are ridden with more than one occupant. The objective of this study was to establish the relative vulnerability of riders and co-riders to injury and determine the injury risk factors in multi-occupant motorcycle crashes. Between January and December 2010, we collected crash and injury data from victims of multi-occupant motorcycle. It is a hospital-based study. The probability of sustaining injuries was similar for co-riders and riders, but co-riders were more likely to sustain severe injuries. Occupants of >2-occupant motorcycles were also more likely to be involved in risky behaviours like not wearing helmet and speeding than those on 2-occupant motorcycles. Occupants of motorcycles on which there were more than two occupants were at an increased risk of sustaining injuries compared with occupants of motorcycles with only two occupants (OR: 2.1, 95% CI: 1.1–4.3). Motorcycle co-riders were more vulnerable to severe injuries than riders. The significance of the study finding to prevention was discussed.

A prospective cohort study on comparison of early outcome of classical Ponseti and modified Ponseti post tenotomy in clubfoot management

AIM To evaluate the effectiveness of the Ponseti method for initial correction of neglected clubfoot cases in multiple centers throughout Nigeria. METHODS Patient charts were reviewed through the International Clubfoot Registry for 12 different Ponseti clubfoot treatment centers and 328 clubfeet (225 patients) met inclusion criteria. All patients were treated by the method described by Ponseti including manipulation and casting with percutaneous Achilles tenotomy as needed. RESULTS A painless plantigrade foot was obtained in 255 feet (78%) without the need for extensive soft tissue release and/or bony procedures. CONCLUSION We conclude that the Ponseti method is a safe, effective and low-cost treatment for initial correction of neglected idiopathic clubfoot presenting after walking age. Long-term follow-up will be required to assess outcomes.

Therapeutic decision in chronic osteomyelitis: sinus track culture versus intraoperative bone culture

Introduction Ponseti method has become the main treatment modality for the management of clubfoot producing good long-term results. However, variation in cast application post tenotomy has not been evaluated. Methods A prospective cohort study involving 40 patients with 67 clubfeet were randomized into two groups: 32 above knee cast (AKC) and 35 below knee cast (BKC) after percutaneous tenotomy. All had foot abduction brace after post tenotomy cast. The median age was 21 weeks (range: 1–104 weeks) and 1.9:1 male/female ratio. 27 (67.5%) patients had bilateral clubfoot and unilateral in 13 (32.5%). Patients were followed-up for 6 months with documentation of the Pirani Score and the cost of treatment. Results No significant difference between AKC and BKC mean Pirani score before treatment (p = 0.550) and after treatment (p = 0.702). However, mean Pirani score at 6 months was significantly different (p = 0.038). Overall mean number of casting was 6.4 in AKC group and 4.7 in BKC group (p = 0.003). There was recurrence in 2 feet before completion of treatment (6.3%) among AKC and none among BKC group. However, there was no recurrence at 6 months after treatment in both groups. The mean cost for AKC and BKC were ₦10,427.34 (52.33 US dollars) and ₦7021.54 (35.24 US dollars) respectively (p = 0.002). Conclusion Early results of below knee cast after tenotomy were comparable to the classical above knee cast after tenotomy in Ponseti treatment protocol for clubfoot. There was also reduction in cost of treatment in the modified Ponseti compared to the classical Ponseti. Long-term result will be desirable.