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Background: The outcome of neonatal surgery depends on safe anaesthesia, competent surgery and good nursing care. The University of Uyo Teaching Hospital, Uyo, Nigeria, established in February 2008, has specialist anaesthetic and surgical manpower. The aim of the study was to determine the outcome and contributing factors to mortality in neonatal surgical emergencies at this new tertiary health institution. Method: It was a retrospective descriptive study of neonates that underwent emergency surgery at the University of Uyo Teaching Hospital between June 2008 and May 2011. Data was obtained from the anaesthetic register, ward admission and discharged register, nurses report books and patient case files. Results: Forty-five neonates were operated upon during the three year period. There were 28 males and 17 females with a male to female ratio of 1.7:1. Forty-four (97.8%) of the neonates were referred to the University of Uyo Teaching Hospital. The mean age and body weight at presentation were 47.5 ± 44.4 hours and 2.65 ± 0.61 kg respectively. The mean interval between admission and surgical intervention was 4.9 ± 6.2 days. Malformations of the gut (40%) and anterior abdominal wall (26.7%) were the major pathologies. The overall mortality following surgery was 62.2%. Case fatality rates ranged from 0% for Hirschprung’s disease to 100% for tracheoesophageal fistula. The immediate causes of death among these neonates were peritonitis from gangrenous gut, hypovolaemia and repeat surgery. Contributing factors to mortality were delivery in unorthodox health facilities, delay in presentation as well as surgical intervention and inefficient postoperative monitoring. Conclusion: Emergency neonatal surgeries at the UUTH are associated with unacceptable high mortality. Reduction in such mortality would require campaign for early presentation, a lot more timely surgical interventions and upgrading of monitoring facili- ties to help in improving perioperative monitoring and care.

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 commonest mechanism. The use of a local antibiotic delivery system improved cure rates from 57.7% to 77.8%). Conclusion: Multiple surgical interventions increase the socioeconomic costs of treating this condition and have a direct impact on the economies of individuals especially in the developing world. Surgical interventions should aim at achieving maximum impact w...

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 + 0.56 secs versus 2.03 + 0.41 secs). Although not statistically significant, there were four cases (12.8%) of superficial wound infection in the drain group and 1 case (3.2%) in the no-drain group. Conclusion

BACKGROUND:Rising trend in Non-Communicable Diseases (NCDs) in developing countries often result in sudden death, which are largely preventable through effective cardiopulmonary resuscitation (CPR). Most communities in Sub-Saharan Africa, however, lack access to CPR services, due to a deficiency in requirements for the establishment of such services. These requirements can be grouped into a triad of awareness, infrastructure and capacity building.AIM:This study was aimed at assessing the perceived need and recommendations for improvement in CPR services in Cross River State.METHODS:Proportionate sampling was used to recruit healthcare workers in this cross-sectional study. Data was obtained using semi-structured open-ended questionnaire consisting of recommendations for improving CPR services. Responses were coded and grouped into three essential areas. Data were entered and analysed using SPSS version 20.0.RESULT:Two hundred and twenty-nine (229) questionnaires were completed; mean age of respondents was 42.1 ± 11.2 years. The commonest cadre of healthcare worker was nurses (135, 59.0%). One, two, and three areas of suggestions were made by 55.5%, 37.1%, and 7.4% of respondents, respectively. Suggestions included training of health care workers on CPR (111, 48.5%) and provision of resuscitation equipment (95, 41.5%). Sixty-five respondents (29.3%) recommended creating awareness and means of contact, while some respondents recommended capacity building (132, 57.6%) and resuscitation infrastructure set-up (149, 65.1%).CONCLUSION:Healthcare workers perceive an urgent need for the establishment of CPR services in our health facilities and communities. There is need to address the triad of awareness, infrastructure and capacity building for the establishment of CPR services peculiar to Sub-Saharan Africa.