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Arterial injuries in civilian practice in Lagos, Nigeria
MO Thomas, SO Giwa, TO Adekoya-Cole
Nigerian Journal of Clinical Practice , 2005,
Abstract: Objective: This is a retrospective study of patients managed at the Lagos University Teaching Hospital for peripheral arterial injuries from January 1995 to April 2003. The aim was to study the pattern of peripheral arterial injuries in Lagos, Nigeria and to look at the outcome of management and see what improvements could be made in future. Method: Data was collated from case notes of patients, operation register in theatre and admission and discharge books from the surgical wards and the data bank of consultants involved in patients' management. Result: Forty-one patients, 37 males and 4 females, were treated within the study period (M:F ratio of 9:1). Twenty three patients (56.1%) suffered gunshot injuries during armed robbery attacks while 9 patients (22.0%) had stab injuries in civilian violence. Twenty-one patients (3 with gunshot injuries and 18 non gunshot penetrating injuries) were managed by direct suturing of vessels. Eight patients had prosthetic graft interposition while 2 patients had reversed saphenous vein grafts. Two patients had the superficial branches of their radial arteries tied up at the wrist. Conclusion: Gun shot injuries from armed robbery attack was the commonest cause of peripheral arterial injuries in this environment during the period of study.
Epidemiology of gunshot injuries in Kano, Nigeria
AZ Mohammed, ST Edino, O Ochicha, AB Umar
Nigerian Journal of Surgical Research , 2005,
Abstract: Background: The incidence of civilian gunshot injuries has been reported to be on the increase globally. This study was undertaken to determine the epidemiology of gunshot injuries in Kano, Northern Nigeria. Patients and Methods: A retrospective analysis of patients with gunshot injuries seen at five major government hospitals in Kano metropolis over a four year period (1999-2002). Results: There were 224 cases, with males out-numbering females by a ratio of 27:1. Eighty -one point three percent of patients were aged between 20 and 44 years. The most commonly injured body regions were the lower limbs (31.6%), chest (15.6%), upper limbs (9.4%) and head (9.0%). A fatal outcome was recorded in 12.5% of cases. Most injuries occurred among traders, students, farmers and security agents, and armed robbery attacks and civil conflicts were the aetiological factors in majority of cases. Conclusion: Gunshot injuries are a major cause of morbidity among adult men in Kano. Addressing the root causes of violence such as poverty, unemployment, and substance abuse will reduce the incidence of gunshot injuries in our society.
Spectrum of musculo-skeletal disorders in sickle cell disease in Lagos, Nigeria
Rufai A Balogun, Dike C Obalum, Suleiman O Giwa, Thomas O Adekoya-Cole, Chidiebere N Ogo, George O Enweluzo
Journal of Orthopaedic Surgery and Research , 2010, DOI: 10.1186/1749-799x-5-2
Abstract: In a prospective study of 318 consecutive patients with genotype-confirmed SCA at the Lagos University Teaching Hospital (LUTH), the musculo-skeletal pathologies, anatomic sites, grade of disease, age at presentation and management outcome were recorded over a one-year period. Data obtained were analyzed using Epi-Info software version 6.0. Data are presented as frequencies (%) and mean values (SD) as appropriate.The HbSS genotype occurred in 296 (93.0%), while 22 (7.0%) were HbSC. 100 (31.4%) patients with average presenting haemoglobin concentration of 8.2 g/100 ml in the study group, presented with 131 musculo-skeletal pathologies in 118 anatomic sites. Osteomyelitis 31 (31%) and septic arthritis 19 (19%) were most commonly observed in children less than 10 years. Skin ulcers and avascular necrosis (AVN) occurred predominantly in the older age groups, with frequencies of 13 (13.0%) and 26 (26.0%) respectively. 20 (71.5%) of diagnosed cases of AVN presented with radiological grade 4 disease. The lower limbs were involved in 84 (71.1%) of sites affected. Lesions involving the spine were rare 11 (0.9%). Multiple presentations occurred in 89 (28.0%) of patients; 62 (69.7%) of which were children below 10 years.Musculo-skeletal complications are common features of sickle cell anaemia seen in 31.4%. Infectious aetiologies predominate with long bones and joints of lower limbs more commonly affected by osteomyelitis and septic arthritis. Healthcare providers managing SCA should be aware of the potential morbidity and mortality of these conditions to ensure early diagnosis and adequate management.Sickle cell disease (SCD) is a group of inherited haemoglobinopathies occurring mainly in Negroid populations in and out of Africa, characterized by a predominance of haemoglobin S (HbS) in the erythrocytes [1]. It was first recognized by James B. Herrick [2] in 1910 when he described abnormal sickle-shaped cells in an anaemic patient of Negroid extraction. Pauling et al [3] disc
Pattern of civilian gunshot injuries in Irrua, Nigeria
JE Onuminya, E Ohwowhiagbese
South African Journal of Surgery , 2005,
Abstract: This retrospective review of 76 patients with gunshot wounds was undertaken to evaluate the pattern and outcome of civilian gunshot injuries in our region. The extremities were the most commonly affected site (51.5% of all gunshot wounds). Gunshot injuries were most common among young males in the third decade of life, and armed robbery was the cause of gunshot trauma in 69.7% of cases. Time from injury to arrival at hospital was less than 6 hours in 64.4% of cases. Wound exploration and debridement were the mode of treatment in the majority of cases. Hypovolaemia resulting from acute haemorrhage accounted for 52.9% of complications. The mortality rate was 5.3%. It is pertinent to observe that inefficient firearm control is a major factor contributing to civilian gunshot injuries in our region. In addition, high rates of unemployment and poverty in our society may be contributing to the increasing incidence of youth restiveness, armed robbery and associated gunshot injuries. Strong government legislation is required to provide adequate security for the teeming civilian population. The national government should embark on a poverty eradication strategy and engage the youth in gainful employment to reduce the incidence of youth restiveness, armed robbery and firearm-related violence. South African Journal of Surgery Vol. 43 (4) 2005: pp. 170-172
A civilian perspective on ballistic trauma and gunshot injuries
Philipp Lichte, Reiner Oberbeck, Marcel Binneb?sel, Rene Wildenauer, Hans-Christoph Pape, Philipp Kobbe
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2010, DOI: 10.1186/1757-7241-18-35
Abstract: A search of the National Library of Medicine and the National Institutes of Health MEDLINE database was performed using PubMed.Craniocerebral gunshot injuries are often lethal, especially after suicide attempts. The treatment of non space consuming haematomas and the indications for invasive pressure measurement are controversial. Civilian gunshot injuries to the torso mostly intend to kill; however for those patients who do not die at the scene and are hemodynamically stable, insertion of a chest tube is usually the only required procedure for the majority of penetrating chest injuries. In penetrating abdominal injuries there is a trend towards non-operative care, provided that the patient is hemodynamically stable. Spinal gunshots can also often be treated without operation. Gunshot injuries of the extremities are rarely life-threatening but can be associated with severe morbidity.With the exception of craniocerebral, bowel, articular, or severe soft tissue injury, the use of antibiotics is controversial and may depend on the surgeon's preference.The treatment strategy for patients with gunshot injuries to the torso mostly depends on the hemodynamic status of the patient. Whereas hemodynamically unstable patients require immediate operative measures like thoracotomy or laparotomy, hemodynamically stable patients might be treated with minor surgical procedures (e.g. chest tube) or even conservatively.In contrast to a stagnating incidence of civilian gunshot wounds in the United States, gunshot violence shows different trends in European countries. Firearm associated crime was increasing up to 30% in the UK between 1998 and 2002 [1]. In the same period firearm associated crime in Germany was markedly decreasing. In 2007 in Germany only 4558 criminal acts with the use of firearms were registered [2]. Additionally, in high income countries a significant number of gunshot wounds are related to suicide attempts [3]. As seen in the United States, gunshot violence has bes
FACTORS EFFECTING MORTALITY IN PATIENTS WITH GUNSHOT INJURIES
Sava? Eri?,Murat Orak,Beh?et Al,Cahfer Gülo?lu
Marmara Medical Journal , 2009,
Abstract: Objective: We planned this study in order to determine the factors affecting mortality in patients with gunshot injuries in more than one organ.Methods: We retrospectively reviewed the hospital records of 714 patients admitted to the Emergency Department of Dicle University, between January 2000 and December 2004. The factors that we considered would affect mortality such as age, sex, attempts suicide, long barreled gun injuries, pellet injuries, contact/near contact shot, delayed admission time, presence of serious anemia and shock during admission, more than four entrance wounds, injury areas, serious cranial, thorax and abdominal injuries, vascular injuries in the extremity, administration of multiple transfusion, and trauma scores as GKS, RTS, PATI were analyzed.Results: As a result of unvaried statistical analyses, we determined that suicide attempts (p=0.001), presence of serious anemia (p=0.001) and shock (p=0.001) during admission, presence of serious cranial (p=0.001), thorax (p=0.001) and abdominal (p=0.001) injury, femoral artery injury (p=0.001), multiple blood transfusion (p=0.009), , GKS 0-7, GKS 8-12 (p=0.001) and low RTS (p=0.001)were significant factors affecting mortality.Conclusion: Multivariate analysis showed that serious anemia during admission, serious cranial injury, serious abdominal injury and low RTS were independently significant in predicting mortality (p<0.05).
Epidemiology of armed robbery related gunshot injuries in Maiduguri, Nigeria
AD Abbas, AA Bakari, AM Abba
Nigerian Journal of Clinical Practice , 2012,
Abstract: Background and Objectives: Gunshot Injuries used to be rare in Nigeria until the civil war of 1967–1970. Unfortunately, it has become very rampant recently. The objective of this paper is to look at the epidemiology of armed robbery related gunshot injuries as seen in the University of Maiduguri Teaching Hospital over a five year period. Materials and Methods: Data on patients that presented with gunshot injuries within the study period (January 2002 to December 2006) were collected and analyzed retrospectively. Results: We studied 129 patients with gunshot injuries that were managed during the study period. This comprises of 117 males and 12 females (M:F=9.8:1). Eighty four (65.1%) were young males between 20 and 40 years. One hundred and fifteen (89.2%) of the 129 victims were shot by armed robbers, the remaining 14 (10.8%) were shot under other circumstances not related to armed robbery. Analysis of the time of attack revealed 72% of victims were attacked at night. Over 80% of victims were shot along the highway. The anatomical sites of gunshot entry wound show the extremities having the highest of 46.1%. Ninety one (79.1%) victims were treated operatively while 16 (13.9%) were treated nonoperatively. Conclusion: Armed robbery is the motive behind most gunshot injuries in Nigeria. Most of these attacks are preventable if the government would support and motivate the security apparatus responsible. There is also need for the government to support the victims by shouldering their treatment and subsequent rehabilitation. Nigerian Journal of Clinical Practice Jan-Mar 2012 Vol 15 Issue 1
Epidemiology of golf related musculo-skeletal injuries  [cached]
Dhillon Mandeep,Singh Sanjay,Dhillon Himmat,Sandhu Jaspal
Indian Journal of Orthopaedics , 2006,
Abstract: Background : Golfing has become an increasingly popular sport enjoyed by both men and women. Although the game is not viewed as hazardous, golfers do sustain injuries connected with the game. However, golf injuries have received little attention in the literature and there is no study from Asia. Methods : A prospective study was undertaken to analyze the incidence, cause and type of injury among amateur golfers. Open ended questionnaires were sent to 1000 golfers; 240 responded (Av age 51 years, 200 males and 40 females). The respondents played an average of 2 rounds per week. Results : One hundered and ten (46%) responders had sustained one or more orthopaedic injuries. Both among men and women, the lower back was the most common site of injury followed by shoulder and dorsal spine. There was a difference in the injury pattern in skilled and relatively unskilled players. Lack of warm up, excessive practice and improper swing mechanics were the most common causes. Conclusion : Golf injuries perhaps could be prevented or reduced by proper technique, controlled practice routines, physical conditioning and pre-play stretching exercises. The most important factor in this playing population seems to be prevention.
Gunshot injuries: A Tanzanian experience in a Teaching hospital in the Lake Zone
PL Chalya, M Mchembe, JM Gilyoma, JB Mabula, ES Kanumba
East and Central African Journal of Surgery , 2011,
Abstract: Background: Gunshot injuries (GSIs) are a unique form of trauma that are on increase all over the world and contribute significantly to high morbidity and mortality. The aim of this study was to evaluate the incidence, injury characteristics and treatment outcome of GSI in our local setting and to suggest preventive strategies as well as treatment protocols. Methods: This was a combined retrospective and prospective study of GSI patients who were managed at Bugando Medical Centre from April 2006 to March 2010. Data were collected from patients’ records and operation theatre registers and analyzed using SPSS software version 11.5. Results: A total of 84 GSI patients were studied. Males outnumbered females by a ratio of 15.8:1. Their mean age was 29.82 ± 16.26 years. The modal age group was 21-30 years. The majority of GSIs (84.6%) were caused by armed robbery attacks and low-velocity injuries were the majority (61.9%). Most injuries were in the limbs (64.1%) and the majority of gunshot wounds were punctured wounds (56.5%) and lacerations (23.9%). Soft tissue injuries (100%) and fractures (45.7%) were the most common type of injuries sustained. The majority of patients (85.7%) were treated surgically. Wound exploration and debridement were the mode of treatment in the majority of cases. Wound infection (49.1%) and complications of fractures (21.1%) were the most common complications. The mean duration of hospital stay was 34.2 days (1 – 186 days). Mortality rate was 8.3%. Conclusion: Gunshot injuries are a major cause of morbidity and mortality among young adult males in our setting. Addressing the root causes of violence such as poverty, unemployment, and substance abuse will reduce the incidence of gunshot injuries in our environment.
Computed Tomography (CT) in civilian gunshot head injuries in Ibadan
MO Obajimi, MT Shokunbi, AA Malomo, AM Agunloye
West African Journal of Medicine , 2004,
Abstract: Background: There is data on civilian gunshot injuries in Nigerians. The purpose of the study is to describe the Computed Tomography findings of civilian gunshot injuries (GSI) to the head in Ibadan, Nigeria. Method: This is a retrospective study of Computed Tomography (CT) films and clinical records of 28 consecutive civilian gunshot injuries to the head from 1996 to 1999. Results: The gunshot injuries to the head were mostly armed robbery related. Though there was a steady annual increase of civilian gunshot injuries during the study period, a low CT Scan frequency (0.61%) was recorded. The following CT findings were present in all the patients; bullet fragments, intraparenchymal haemorrhage, vault fractures and soft tissue swelling. The resting position of the bullets showed a predilection for the parietal lobe (32.1%) and the most common fracture site was also the parietal bone (42.8%). Conclusion: CT findings simplified the management of civilian gunshot injuries to the head in the patients studied by demonstrating the exact pathology sequel to the injury. Despite important constraints, CT remains a cost effective means of managing GSI to the head. Key Words: Gunshot, Head injury, Computed Tomography Résumé II s'agit des donnees sur des civils atteints des blessures par balle au Nigéria. L'objet de cet étude est de décrire les résultats de la tomographie Calculée des civils atteints de blessures par balle dans la tête à Ibadan. Nigeria. Méthodes: C'est une étude rétrospective de la Tomographie Claculée (CT) cinema et dossiers cliniques de 28 civils consécutifs atteints des blessures par balle dans la tête de 1996 a 1999. Resultats: Les blessures par belle dans la tête étaient principalement liées au vol à main armée. Quoiqu'il ait une augumentation continue annuelle des cas des blessures par balle chez dez civils pendant la periode de cet étude, on a noté une frequence de 0, 61% de CT Scan tres bas. Les résultats de CT suivants ont été remarqués chez tous les patients:- morceau de balle, hémorragie intraparenchymal, fractures de saut et tuméfaction de tissu mou, lieu d'abri des balles a indiqué une prédilection pour le lobe pariétal (32, 1%) et le siege le plus concerné de la fracture également l'os pariétal (42, 8%). Conclusion: Les résultats à travers le CT ont simplifie la prise en charge des blessures par balle dans les têtes des civils chez des patients étudiés tout en donnant une demonstration pratique du fonctionnement de la pathologie exacte suite à la blessure. En dépit des restriction/constraints considerables, CT demeure un moyen rentable de la prise en charge de GSI dans la tête. West African Journal of Medicine Vol.23(1) 2004: 58-61
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