West African journal of medicine
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Comparative Study
Pain assessment in Nigerians--Visual Analogue Scale and Verbal Rating Scale compared.
The usefulness of 2 methods of pain assessment was determined in a cohort of Nigerians who had pain as a symptom and were receiving physiotherapy for various indications. The English and Yoruba versions of two Pain Rating Scales, the Visual Analogue Scale (VAS) and Verbal Rating Scale (VRS) with 1 to 4 or 1 to 5 intensity scales (VRS-4 or VRS-5) were employed for the assessment of pain in 100 patients. The mean pain score on the 4-point VRS scale was 2.49 +/- 0.72, for the 5-point VRS 2.1 +/- 1.18 and for the VAS 4.93 +/- 2.5. Correlation analysis for corresponding groups of patients showed a significant positive relationship between the VAS and VRS-4 (r = 0.68 P < 0.001) VAS and VRS-5 (r = 0.64 P < 0.001) indicating that both VAS and VRS constitute useful tools for pain assessment in Nigerian patients.
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In order to determine the pattern of intra-operative cardiac arrests in a developing country, we reviewed 40 consecutives cases of cardiac arrests at the Jos University Teaching Hospital between January 1993 and December 1997. During this period 15,060 minor cases and 9800 medium/major surgical procedures were performed and an arrest rate of 1:15,060 for minor cases and 1:251 for medium/major cases were obtained. The age ranged between one day and 65 years with a mean of 29.8 years and a male/female ratio of 1:1.3 as there were 18 males and 22 females. ⋯ There was no arrest with spinal anaesthesia. The predisposing factors for a patient to arrest on the operating table in our environment include emergency major surgery, poor risk patients with ASA 111 and above, surgery performed outside work hours, under general anaesthesia administered by nurse anaesthetists or junior anaesthetic residents. The success rate at resuscitation is highest with patients with ASA 1 & 11, operations performed during work hours and by senior surgeons and anaesthetists.
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A combined retrospective and prospective study of Gunshot Injuries (GSI) that presented to the National Orthopaedic Hospital, Igbobi (NOHL) between 1991 and 1995 was undertaken with the aim of determining the characteristics of these injuries in Lagos, Nigeria. 232 patients with 281 gunshot wounds and 212 gunshot fractures were seen during this period. 68.9% of patients in the study were in the age group 21-40 years with a mean age at presentation of 32.46 +/- 11.21 years. The male to female ratio was 9:1. 87 (37.5%) presented within 6 hours of injury. Armed robbery dominated the events surrounding the shootings with high velocity weapon (HVW) accounting for 47% of the cases. ⋯ Wound infection was the commonest complication (25%) with amputation being performed in 5.6% of cases. This study does not confirm the belief that high velocity weapon causes greater morbidity than low velocity weapon. Even though the average duration of hospitalisation was 33.5 +/- 23.4 days, we advise that for our present state of development gunshot fractures should not be primarily treated with internal fixation.
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Traumatic, injuries arising from high velocity means of mobility, increased industrialization, frequent ethnic and religious classes and terrorist activities by way of bomb blasts, etc., often result in sudden unexpected mass casualty presenting to a given secondary or tertiary health institution. The successful management of such situation involves multidimensional and multidisciplinary approach anchored on awareness, preplanning and alertness. In response to the challenge, the orthopaedic and trauma unit of Jos University Teaching Hospital worked out the "Jos Protocol" which embodies the principle and strategy for mass casualty management and response to field distress call to the hospital within the practical limitations of our infrastructure. ⋯ The difficulties encountered during the management and recommendation for improved immediate mass casualty management are discussed. Further, we believe that it has become necessary for every secondary and tertiary health institution to work out a mass casualty management protocol adapted to its peculiar working circumstances. A case is made for the establishment of regional disaster committees.
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Three hundred and five patients with falls over a period of 4 years were reviewed with the aim to determine the pattern, severity and outcome of childhood injuries from falls in our environment. The results showed that falls accounted for 25% of all childhood injuries. There were more male than female in ratio 2:1. ⋯ Hospital stay ranges from 1-45 days with mean of 3.8 days. The hospital stay correlated very well with the Injury Severity Score. Wound Infection occurred in only 1.4% of the patients with mortality in 2 patients (0.6%) with Injury Severity Score of 17 and 26 respectively.