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Septic Arthritis: A Need to Strengthen the Referral Chain in a Developing Economy  [PDF]
Ikpeme A. Ikpeme, Ngim E. Ngim, Anthonia A. Ikpeme, Afiong O. Oku
Open Journal of Orthopedics (OJO) , 2013, DOI: 10.4236/ojo.2013.32022

Aim: This retrospective analysis documents the features and factors that potentially affect outcomes in septic arthritis in the Cross River Basin area of south-south Nigeria. Patients and Methods: A retrospective analysis of 43 patients who presented with septic arthritis in 45 joints between September 2007 and August 2010. All patients with pain, fever, joint swelling and non-weight bearing/refusal to move the limb and had a joint aspiration productive of a turbid and/or purulent aspirate were included in the analysis. Patients whose joint aspiration produced frank blood or a clear exudate were excluded. Results: There were 24 males and 19 females (M:F = 1.3:1). Forty patients were children while three were adults. Thirty-three patients were urban dwellers, 8 were semi-urban dwellers and 2 were rural dwellers. Twenty-five children were first seen by a Paediatrician. Only 5 patients were first seen by an Orthopaedic surgeon. Definitive treatment was conservative in 28 children and arthrotomy/washout in 12 children and 3 adults. Staphylococcus aureus was the commonest isolated pathogen in both age groups. Conclusion: Injudicious interventions in musculoskeletal conditions consist not only of traditional bone setting and other unorthodox practices, but also sub-optimal orthodox medical practices. Healthcare outcomes in Africa are a function of the skewed distribution of the healthcare workforce and a weak referral chain. The near absence of follow-up culture underscores the need for education on injudicious antibiotic therapy to be directed at patients and physicians. Judicious interventions in musculoskeletal sepsis at first contact and a strengthening of the referral chain are important.

NonOperative Management of Blunt Solid Abdominal Organ Injury in Calabar, Nigeria  [PDF]
Asuquo Maurice, Bassey Okon, Etiuma Anietimfon, Ngim Ogbu, Ugare Gabriel, Anthonia Ikpeme
International Journal of Clinical Medicine (IJCM) , 2010, DOI: 10.4236/ijcm.2010.11006
Abstract: Background: Over the past several years, nonoperative management has been increasingly recommended for the care of selected blunt abdominal trauma patients with solid organ injuries. Objective: To evaluate the pattern and outcome of blunt abdominal trauma using haemodynamic stability and ultrasonography in the selection of patients for nonoperative management in a facility without computed tomogram. Methods: Patients admitted with blunt abdominal trauma between February 2005 and January 2010 were prospectively studied. Haemodynamic stability and sonography formed the basis for selecting patients for nonoperative management. Results: In total, 58 patients suffered blunt abdominal trauma and 19(33%) patients were successfully managed nonoperatively suffered blunt solid abdominal organ injuries. Road traffic accidents inflicted 17(89%) patients while 2(11%) patients sustained sports injury (football). The spleen was the commonest solid organ injured 12(60%), while the liver and kidney were injured in 6(30%) and 2(10%) respectively. Associated injuries were fractured left femur recorded in 3(16%) patients and fractured rib in a patient (5%). Conclusion: Nonoperative treatment is a safe and effective method in the management of haemodynamically stable patient with blunt solid abdominal organ injury. This translated to a reduction in hospital stay, absence of the risk of blood transfusion as well as attendant morbidity and mortality associated with laparotomy. Establishment of trauma system, provision of diagnostic and monitoring facilities, good roads, and education on road safety is recommended for improved outcome.
Blunt Abdominal Trauma in a Teaching Hospital, Calabar, Nigeria  [PDF]
Maurice Asuquo, Victor Nwagbara, Mark Umoh, Gabriel Ugare, Cyril Agbor, Emmanuel Japhet, Anthonia Ikpeme
International Journal of Clinical Medicine (IJCM) , 2012, DOI: 10.4236/ijcm.2012.37124

Background: Road traffic injury remains a major source of blunt abdominal trauma (BAT). Road traffic injury and other forms of trauma have become a major health problem throughout the world especially in low and middle-income countries. In a previous study (2005-2007), abdominal trauma constituted 79 (4.8%) of trauma cases; BAT, 40 (53%) and penetrating abdominal trauma (PAT), 39 (47%). Effective policies on road safety should be developed based on local research and not on adapted models. We present this study to highlight the possible effect of legislation on the ban of the use of motorcycles on blunt abdominal trauma. Methods: Patients that presented to the University of Calabar Teaching Hospital, Calabar with BAT from 2008-2010 were prospectively studied based on a questionnaire following the legislation prohibiting the use of motorcycles. Results: A total of 12,083 patients presented during the study period, trauma patients totaled 4942 (41%), of this, 48 (1%) suffered abdominal trauma: BAT 19 (40%), penetrating abdominal trauma (PAT) 29 (60%). The age range of the patients was from 5 to 48 years (mean 26.6 years) with a M:F = 5.3:1. Road traffic accident (RTA) 17 (90%) [Motorvehicle 7 (37%), motorcycles 10 (53%)] was the commonest cause of trauma. The spleen was the commonest injured organ 14 (74%). Conclusion: Road traffic injury constitutes a public health challenge and the hallmark is prevention. Legislation prohibiting the use of motorcycles may have been responsible for the reduction in BAT.

Non-Governmental Organizations (NGOs), Conflict and Peace Building in Nigeria  [PDF]
Anthonia O. Uzuegbunam
Open Journal of Philosophy (OJPP) , 2013, DOI: 10.4236/ojpp.2013.31A034

Despite some efforts by the government, corporate bodies, civil society, national universities commission etc to reduce situations of conflict in Nigeria, peace is still elusive to her and consequently to sustainable development. This paper thus aims at an in-dept description of NGOs, conflict and peace building and proffering a way forward to reduce conflict situations through NGOs. Content analysis, was adopted, using the secondary sources of collecting data from books, journals and articles. NGOs are an aspect of civil society, without government representation, embarking in conflict reduction, welfare scheme, empowerment and employment. Among the recommendations are: government recognition and support of NGOs; NGOs increased and effective performance and government/NGOs partnership in peace and conflict issues.

Women in Domestic Violence in Nigeria: Gender Perspectives  [PDF]
Anthonia O. Uzuegbunam
Open Journal of Philosophy (OJPP) , 2013, DOI: 10.4236/ojpp.2013.31A031

Theoretically, violence is a human rights issue, and human rights are fundamental to values of dignity, equality, non-discrimination and non-interference, and these cut across gender, social, cultural, political, class, religious and geographical issues. Human beings, properties and resources are in millions daily destroyed. Children are abused. Women remain injured and humiliated, so much so that men’s status seemed to be changing. Hence, this study embarked on examining Women in Domestic Violence inNigeriausing gender perspectives. Among the findings is that in many parts ofNigeria, women and girls are subjected to physical, sexual and psychological abuse that cuts across lines of income, class, religion and culture. Recommendations made include the following: adoption of concerted or integrated approach to decision making and implementation.

Organizational Climate as a Predictor Of Employee Job Satisfaction: Evidence from Covenant University
Anthonia Adenike
Business Intelligence Journal , 2011,
Abstract: The study aim to explore organizational climate as a predictor of employee job satisfaction of academic staff from a private Nigerian University. The study of the antecedents of job satisfaction is important because of the role it plays in job satisfaction of employees which in turn affects organizational productivity. Data were collected from three hundred and eighty-four academic staff of the university with the aid of questionnaire out of which a total of two hundred and ninety-three questionnaires were returned fully and appropriately filled. Three hypotheses were tested and the results of the finding showed a significant positive relationship between these two variables. Thus, the study then paves way into other research opportunities in the field to stretch the depth of knowledge into public universities- i.e. the federal and state universities. It also serves as eye opener to conduct the research into other zones in Nigeria to see whether their organizational climate in relation to job satisfaction of the academics in those places will differ from what we have in the south-west Nigeria. Therefore, apart from confirming a theoretical proposition, the findings of this study are likely to have significant practical value.
Cost Accounting Skills Needs of Small Business Operators  [PDF]
Anthonia Uju Umeji, Chiaka Augusta Obi
American Journal of Industrial and Business Management (AJIBM) , 2014, DOI: 10.4236/ajibm.2014.45032

The major purpose of the study was to determine the record-keeping, inventory control and price determination skills needs of small business operators in Anambra State. Three research questions and two null hypotheses were used to attain this purpose. A descriptive survey research design was adopted in the study which involved 280 registered small business operators in the state. Due to the manageable size of the population, all the 280 registered small business operators were surveyed. Therefore there was no sampling. Data were collected with the help of three research assistants using structured Cost Accounting Skills Needs (CASNs) questionnaire with 43-item statements. The questionnaire was divided into four sections (A - D). Section A was used to obtain the personal data of the respondents. Sections B, C and D carried a bipolar scale of perceived importance and expressed possession to obtain the respondents’ ratings of the skills (record-keeping, inventory control and price determination skills). The instrument was validated by three experts. Cronbach Alpha reliability technique was used to determine the internal consistency of the instrument. Reliability coefficient of 0.78, 0.83 and 0.75 were obtained for record-keeping, inventory control and price determination skills respectively. Data from 269 copies returned were used for data analysis. Analysis was done using mean and correlated t-test at 0.05 level of significance to answer the research questions while analysis of variance was used to test the two null hypotheses. The study found that record-keeping, inventory control and price determination skills were perceived to be very important by the operators, but the levels of possession were still below expectation. Based on these findings, the study recommended that a training programme be mounted for small business operators in the state on record-keeping and inventory control skills needed for business operation.

Comparison of the Outcome of Treatment of Chronic Osteomyelitis by Surgical Debridement with and without Local Antibiotic Delivery System: Experience from a Nigerian Teaching Hospital  [PDF]
Ikpeme A. Ikpeme, Enembe O. Oku, Ngim E. Ngim, Iniabasi U. Ilori, Innocent E. Abang
International Journal of Clinical Medicine (IJCM) , 2013, DOI: 10.4236/ijcm.2013.47055
Abstract: Background: Chronic osteomyelitis is still common in the developing world and presents a continuing therapeutic challenge. Antibiotics cannot penetrate the dense fibrotic scar tissue that surrounds infected and avascular bone which perpetuates the infection. Surgical debridement/sequestrectomy is the cornerstone to treatment and aims to create a viable, vascularized base which promotes healing. Surgical debridement necessarily creates a dead space which must be dealt with to prevent re-infection. Local antibiotic delivery systems serve the dual purpose of obliterating dead space and creating a sterile local environment with high bactericidal concentrations. Aim: To determine the outcomes in patients with chronic osteomyelitis who received debridement/sequestrectomy alone, and those who received the procedure combined with a local antibiotic delivery system in the University of Calabar Teaching Hospital. Patients and Methods: A prospective descriptive analysis of patients managed surgically for chronic osteomyelitis from July 2007 to December, 2012. Patients’ biodata, aetiology, organisms, treatment options and outcomes were analysed. Results: Forty-four patients presented with the condition and accepted surgery. Male:Female ratio was 2.1:1, and mean age was 27.27 ± 17.48 years. The tibia was the most commonly affected bone (45.5%), Staphylococcus aureus was the commonest organism (56.8% of sinus cultures; 73% of marrow/sequestral cultures) and previous acute haematogenous osteomyelitis was the
Long Bone Non-Unions and Malunions: Risk Factors and Treatment Outcomes in Calabar, Southern Nigeria  [PDF]
Ikpeme A. Ikpeme, Nkese E. Mkpanam, Innocent E. Abang, Ngim E. Ngim, Anthony M. Udosen
Open Journal of Orthopedics (OJO) , 2013, DOI: 10.4236/ojo.2013.36047
Abstract: Background: Diaphyseal non-unions and malunions constitute significant morbidities in fracture care. Fracture treatment modalities seek to restore anatomic orientation and functional rehabilitation as soon as possible after a fracture incident. Malunions and non unions present a treatment challenge with the need for prolonged hospitalization, multiple surgical interventions and economic burden. In the developing world, traditional bonesetting practices are popular and these often result in a host of preventable complications. The added socioeconomic costs of treating these complications present a considerable strain on the resources of these already fragile economies and households. Aim: To document the risk factors, treatment options and outcomes for diaphyseal non-unions and malunions in our environment. Patients and Methods: Fifty-two consecutive patients comprising 37 non-unions and 15 malunions who presented in the orthopaedic unit of a tertiary hospital in Southern Nigeria were evaluated. Information sought included biodata, location of pathology, type of incident fracture, local risk factors including traditional bonesetting; treatment options and final outcomes. Information obtained was analyzed using SPSS version 20 (IBM, New York). Results are presented in simple frequency tables. Results: There were 34 males and 18 females (M:F = 1.9:1) with a mean age of 38.76 ± 14.55 years. There were 37 non-unions and 15 malunions. The femur was the commonest site of pathology in 21 (40.4%) cases, and among the non-unions, the atrophic variety was the commonest type (n = 26; 70.3%). The mean fracture-to-surgery interval was 11.35 ± 7.95 months and traditional bonesetting was the commonest risk factor (n = 36; 69.2%). Plate and screw Osteosynthesis with bonegraft augmentation was the commonest treatment modality and the overall union rate was 94%. Conclusion: Traditional bonesetting plays a major role in the health seeking behaviour of many African societies. The complications are varied and add to the overall socioeconomic
Prophylactic Wound Drainage in Orthopaedics: A Comparative Evaluation of Closed Suction Drainage versus No-Drainage in a Nigerian Teaching Hospital  [PDF]
Ikpeme A. Ikpeme, Ngim E. Ngim, Iniabasi U. Ilori, Enembe Oku, Anthony M. Udosen
Surgical Science (SS) , 2013, DOI: 10.4236/ss.2013.45054

Background: Surgical wound drainage is practiced routinely by many orthopaedic surgeons despite studies that challenge the practice. Among proponents, the advantages of drainage include prevention of haematoma and/or seroma formation which potentially reduces the chances for infection, prevention of wound swelling, prevention of compartment syndrome and improvement of the local wound environment. Opponents argue that prophylactic wound drainage confers no significant advantages, increases the risk of infection and the need for blood transfusion with the attendant risks of this therapy. Aim: To ascertain if prophylactic drainage of clean orthopaedic wounds confer any significant advantages by evaluating wound and systemic factors in two treatment groups. Patients and Methods: A prospective analysis of 62 patients was undergoing clean orthopaedic procedures. The patients were randomly assigned to a “No drain” (study) group and a “drain” (control) group. Each group had 31 patients. Surgeons were blinded to the randomization process and the evaluation of clinical outcomes. The parameters assessed included pain, superficial wound infection, the need for post-operative transfusion, wound leakage, dressing changes and the surgery-discharge interval. Data was analysed using SPSS statistics version 20 (IBM Corp., New York). Results: There were no significant differences in the demographic data. Femoral fractures were the commonest indication for surgery (43.55%), and plate and screw osteosynthesis was the commonest procedure (48.4% in the drain group and 67.7% in the no-drain group). There was a significantly higher need for post-operative transfusion in the drain group (22.6% against 0%) as well as a significantly prolonged capillary refill time (2.39

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