DSpace Collection: Dissertations in Surgery

MAJOR SKELETAL COMPLICATIONS OF SICKLE-CELL DISEASE IN IBADAN, NIGERIA, WITH SPECIAL REFERENCE TO BACTERIAL INFECTIONS

1986-06-01T00:00:00Z

Title: MAJOR SKELETAL COMPLICATIONS OF SICKLE-CELL DISEASE IN IBADAN, NIGERIA, WITH SPECIAL REFERENCE TO BACTERIAL INFECTIONS Authors: EBONG, W. W. Abstract: The landmark contributions to the recognition and understanding of sickle-cell disease at the clinical, cellular and molecular levels are reviewed. The variable natural history of the disease with environmental and socio-economic factors is noted, and the devastating clinical course of the disease in West Africa stressed. The literature on the skeletal manifestations of sickle-cell disease is reviewed, with special emphasis on contributions from Africa. The general clinical syndrome of sickle-cell disease in 207 Nigerian patients studied, is presented. The general clinical features of sickle-cell disease are similar to previous accounts from West Africa, but differ from reports from non-malarial countries in the incidence of florid infective complications and the frequency of severe anaemia. Details are presented of 266 major skeletal complications encountered in the 207 Nigerian sicklers; Fyogenic osteomyelitis was present in 129 patients septic arthritis in 31, avascular necrosis of the femoral head in 75, pathological fracture in 26 and miscellaneous complications in 5 patients. Infection comprised 70% of the 266 skeletal complications in this series. Acute osteomyelitis is a commoner and more florid disease among sicklers in Nigeria than in non-malarial countries. Salmonella comprised 50% of the positive cultures; and 80% of Salmonella acute osteomyelitis was multifocal. A combination of chloramphenicol and cloxacillin was found to be the best guess antibiotic in acute osteomyelitis in Ibadan. The incidence of progression from acute to chronic osteomyelitis was higher when pus was evacuated by open drainage than by needle aspiration. Chronic osteomyelitis was commoner and more difficult to treat than in non-malarial countries. Sinographic findings in 14 patients with chronic discharging osteomyelitis of 18 Iong bones are described. This investigation contributed to the choice of definitive treatment and the type of operative procedure in 13 (72%) of the 18 long bones. Operative treatment of chronic osteomyelitis was safe, and the results were comparable with those in patients without haemoglobinopathy, but conservative treatment yielded poor results. Septic arthritis was commoner and more florid than in sicklers in non-malarial countries. Its pattern was similar to that described in patients without haemoglo-binopathy, apart from the high incidence of multifocal joint infection in HbSS, the marked preponderance of gram-negative infection, and the high complication rate. The pattern of avascular necrosis o the femoral head was similar to recent reports from non-malarial countries. The early results of rotation upper femoral osteotomy in young children with Perthes-like necrosis appeared encouraging; but conservative treatment yielded poor results. Pathological fracture complicating osteomyelitis was commoner than in non-malarial countries. It was similar in pattern to fracture complicating bone infarcts in West Africa, except for a preponderance in male HbSS patients under 10 years of age, with left-sided, whole-diaphysial, gram-negative osteomyelitis. These findings are discussed and contrasted with the patterns of major skeletal complications in sicklers elsewhere. It is concluded that pyogenic skeletal infections are commoner and more florid here than in non-malarial countries. They significantly impair the quality of life, and are a major cause of crippling of many surviving sickle-cell patients in Nigeria. Description: A Thesis submitted for the Degree of Master of Surgery of the University of Ibadan, Department of Surgery, University Ibadan, Nigeria.

AUDIT OF PROTOCOL SUBMISSIONS TO THE UNIVERSITY OF IBADAN/UNIVERSITY COLLEGE HOSPITAL HEALTH RESEARCH ETHICS COMMITTEE (2002-2007)

2010-03-01T00:00:00Z

Title: AUDIT OF PROTOCOL SUBMISSIONS TO THE UNIVERSITY OF IBADAN/UNIVERSITY COLLEGE HOSPITAL HEALTH RESEARCH ETHICS COMMITTEE (2002-2007) Authors: EYELADE, O. R. Abstract: The University of lbadan/University College Hospital Health Research Ethics Committee (UI/UCH HREC) was established in 2002 to review and approve all research proposals submitted by staff and students of the two institutions. Research proposals submitted are reviewed according to international guidelines and the Nigerian National Health Research Ethics Code (NHREC). Since inception, there had been one audit of protocols submitted to the committee. The objectives of the current review are to determine the types of protocols submitted, the duration for review and reasons for revision and amendment. This retrospective review of all proposals submitted to the UI/UCH HREC during a 6-year period (2002 -2007) was performed using a 25 item questionnaire. The questionnaire contained information on month and year of submission, status of principal investigator, type of funding, scope, location and nature of research. Other questions include the study design, sample size, study participants, the number of revision required before approval, reasons for revision and the time interval between submission and approval. Categorical data were presented as proportions and using frequency distribution. Student t-test was used to compare the mean time from submission of protocols to approval for protocol granted exempt approval and protocol requiring review. The results showed that the committee received a total of 752 protocols between 2002 and 2007, out of which 728 (97%) could be retrieved for this audit. Of the 728 protocols audited, 56 (0.08%) were still under consideration while decision has been reached on 656 (90%) protocols. Six hundred and eighteen protocols were while 38 protocols were not approved. Clinical researches on hospital patient based in single tertiary health institution constituted the bulk of the protocol received accounting for 44.9% of the entire protocols. The principal investigators were mainly postgraduate students (67.1%) while academic staff constituted 21.3%. Thirty-three (5.3%) of the protocols were gained exempt approval, 464 (75.1%) required only minor modifications after first review. 118 (19.1%) protocols required a second review while 3 (0.5%) required a third review. Of the 566 protocols requiring review, the main reasons for revision in 50% (283/566) was inadequate information on the informed consent form. Other reasons for revision include, use of inappropriate methodology and statistics, scientific justification, simple size calculation, inclusion criteria, inadequate information on treatment of patient. The average time from submission to approval is approximately 21 weeks (95% CI: 20 - 23 weeks); it took a shorter time for protocols granted exempt approval (6 weeks. 95%CI: 4 - 8 weeks) and internationally sponsored protocols (n = 64, mean: 16weeks. 95%Cl: 12 - 20 weeks). The period of time between submission of research proposal and approval is significantly affected by the need for review, number of revision and sponsoring agent (p<0.05). In conclusion, majority of the proposals reviewed by the UI/UCH HREC were submitted by postgraduate and undergraduate students (78.7%.). Providing a worksheet for reviewer to hasten the process of review and increasing the number of trained reviewers and expertise available for consultation are recommended to improve the review process. Description: A Dissertation in the Department of Surgery, submitted to the Faculty of Clinical Sciences, College of Medicine, in partial fulfillment of the requirements for the award of Degree of Master of Science in Bioethics, University of Ibadan, Ibadan, Nigeria,.