Changing Epidemiology and Outcome of Pediatric Thermal Burn Injury in South Western Nigeria

The pediatric age group has been noted to be particularly vulnerable to burn injuries. Burn is the fifth most common cause of childhood injuries. Nigeria has a very young population with a median age of 18.1 years. Scald is the most common form of burn injuries in this age group globally; however, previous reports from our institution found flame to be the most common form of burn in pediatric age. The most recent report from 13 years ago still maintained flame as the most common cause of pediatric burn injury. This study was carried out to determine the changes in epidemiology and outcome of pediatric thermal burn injury. This was a retrospective study carried out between January 2013 and December 2022. Data were analyzed using the statistical package for social sciences software version 23. The significance was set at a P-value of .05. Two hundred and sixty-five children presented with thermal burn with a male-to-female ratio of 1.3:1. 63.4% occurred in children 0-5 years. Scald (59.6%) was the most common cause of injury. Most flame injuries in females were due to liquified petroleum gas cookstove explosion, while petrol explosion was the most common cause in males (P ≤ .001). There is a yearly increase in burn depth (P = .009). Most inhalation injuries occurred in those aged 11-16 years (P = .006). Mortality rate was 10.2%, with total body surface area burned (P ≤ .001), burn depth (P ≤ .001), and inhalation injury (P ≤ .001) associated with increasing mortality. Scald is now the most common cause of thermal burn in our institution, with a remarkable reduction in mortality rate.

Current Trend in the Epidemiology of Thermal Burn Injury at a Tertiary Hospital in South Western Nigeria

Worldwide, thermal burn is the leading etiological type of burn injury accounting for 86% of burn injuries requiring admissions. Flame, Scald, and contact burn are the leading causes of thermal burn. Changes in the sociodemographic characteristics of societies have led to alterations in the epidemiology of burn. An understanding of such changes in the epidemiology of burn is essential in formulating and executing adequate burn prevention programs. We sought to establish the current trend in the etiology, gender distribution, age, occurrence of inhalation injury, burn surface area, burn depth, and mortality rate of thermal burns at Ibadan. This was a retrospective study carried out between January 2013 and December 2022. Thermal burns constitute 92% of burn injuries. The male-to-female ratio was 1.4:1. There were 265 (45%) patients in the pediatric age group and 323 adults (55% of the patients). The proportion of flame, scald, and contact burns were 378 (58%), 203 (32%), and 14 (2%), respectively. Flame burns resulting from liquified petroleum gas (LPG) explosion show a rising trend, with a decline in flame burns from kerosene (P < .001). One hundred and ninety (32%) patients had inhalation injury. The overall mortality was 19% (N = 114). Kerosene flame, 38% (17 of 45 patients), and LPG, 32% (41 of 130 patients), were the most lethal causes of flame injuries (P < .043). The study shows the increasing contribution of LPG to the etiology of thermal burn injuries. Burn prevention programs should target safe use of LPG stoves and cylinders.

Differences in burn wound size estimation between points of referral and the burn unit: experience at a major burn center in southwestern Nigeria

BACKGROUND

Accurate burn wound size estimation is important for resuscitation and subsequent management. It is also important for the development of referral guidelines in Nigeria.

OBJECTIVE

To establish whether a significant discrepancy exists in burn size estimation between referral centers and burn units.

METHODS

A retrospective review of burn patients managed at the burn unit of a premier tertiary hospital in Ibadan, southwestern Nigeria, between January 1, 2016, and October 31, 2019 was conducted. Patients' demographic and other characteristics, inclusive of TBSA estimation from point of referral and the burn unit, were retrieved and analyzed.

RESULTS

A total of 96 burn injury records were found for the study period, with a male-to-female ratio of 1.3:1. Thirty-five records (36.5%) included no burn size estimation by the referring physician. There was a statistically significant difference in TBSA estimation between referring physicians and burn unit physicians (P = .015). Burn wounds were more likely to be overestimated than underestimated (P = .016). Overestimation is more likely with minor burns and in pediatric patients. Underestimation was more likely in adults.

CONCLUSION

There is a significant difference in burn size estimation between burn unit physicians and referring physicians. This finding underscores the need for continuous education on burn estimation to aid proper referral and management.

Cosmetic surgery procedures accessed by Nigerian women at a single private cosmetic surgery practice: A retrospective review

Background

Little is known about the cosmetic surgery procedures sought by Nigerian women. Aim: We sought to report the proportion of cosmetic surgery procedures accessed by Nigerian women and determine any associations between the demographics and cosmetic procedures accessed.

Patients and Methods

A retrospective review was conducted between January 2020 and July 2021 of all cosmetic surgery procedures at a single private cosmetic surgery practice. Data were analyzed using means, Mann-Whitney U-test, chi square test, and Fisher's exact test as appropriate. The statistical significance was set at P ≤ 0.05.

Results

Of the 392 consultations for cosmetic procedures, 245 (62.5%) patients accessed cosmetic surgery. Most were women (239 (97.6%)) and single (178 (72.7%)). The median age of the patients at surgery was 29.0 years (IQR 26-33), the median weight was 78.8 kg (IQR 71.4-88.8), and the median body mass index (BMI) was 28.1 (IQR 25.7-32.3). Liposuction was the procedure accessed by nearly all the patients (224 (91.4%)). Next to this was bilateral buttock augmentation (199 (81.2%)). Other cosmetic procedures such as tummy tuck, facial cosmetic surgery, umbilicoplasty, and labiaplasty each constituted less than three percent of the patients. The abdomen (224 (91.4%)), back (219 (89.4%)), and arms (79 (32.2%)) were the most common regions of the body sought for liposuction, while the calves (2 (0.8%)) were the least. Liposuction of the arms was associated with the BMI (p < 0.003).

Conclusion

Liposuction and bilateral buttock augmentation are the most common cosmetic surgery procedures accessed by this cohort of Nigerian women.

Trends of cleft surgeries and predictors of late primary surgery among children with cleft lip and palate at the University College Hospital, Nigeria: A retrospective cohort study

BACKGROUND

Cleft of the lip and palate is the most common craniofacial birth defect with a worldwide incidence of one in 700 live births. Early surgical repairs are aimed at improving appearance, speech, hearing, psychosocial development and avoiding impediments to social integration. Many interventions including the Smile Train partner model have been introduced to identify and perform prompt surgical procedures for the affected babies. However, little is known about the trends of the incidence and surgical procedures performed at our hospital. Nothing is also known about the relationship between the clinical characteristics of the patients and the timing of primary repairs.

OBJECTIVE

To determine the trends in cleft surgeries, patterns of cleft surgeries and identify factors related to late primary repair at the University College Hospital, UCH, Ibadan, Nigeria.

METHODS

A retrospective cohort study and trends analysis of babies managed for cleft lip and palate from January 2007 to January 2019 at the UCH, Ibadan was conducted. The demographic and clinical characteristics were extracted from the Smile Train enabled cleft database of the hospital. The annual trends in rate of cleft surgeries (number of cleft surgeries per 100,000 live births) was represented graphically. Chi square test, Student's t-test and Mann Whitney U were utilised to assess the association between categorical and continuous variables and delay in cleft surgery (≥12 months for lip repair, ≥18months for palatal repair). Kaplan-Meier graphs with log-rank test was used to examine the association between sociodemographic variables and the outcome (late surgery). Univariable and multivariable Cox proportional hazard regression was conducted to obtain the hazard or predictors of delayed cleft lip surgery. Stata version 17 (Statacorp, USA) statistical software was utilised for analysis.

RESULTS

There were 314 cleft surgeries performed over the thirteen-year period of study. The male to female ratio was 1.2:1. The mean age of the patients was 58.08 ± 99.65 months. The median age and weight of the patients were 11 (IQR:5-65) months and 8 (IQR: 5.5-16) kg respectively. Over half (n = 184, 58.6%) of the cleft surgeries were for primary repairs of the lip and a third (n = 94, 29.9%) were surgeries for primary repairs of the palate. Millard's rotation advancement flap was the commonest lip repair technique with Fishers repair introduced within two years into the end of the study. Bardachs two flap palatoplasty has replaced Von Langenbeck palatoplasty as the commonest method of palatal repair. The prevalence of late primary cleft lip repair was about a third of the patients having primary cleft lip surgery while the prevalence of late palatal repair was more than two thirds of those who received primary palatoplasty. Compared with children who had bilateral cleft lip, children with unilateral cleft lip had a significantly increased risk of late primary repair (Adj HR: 22.4, 955 CI: 2.59-193.70, P-value = 0.005).

CONCLUSION

There has been a change from Von Langenbeck palatoplasty to Bardachs two-flap palatoplasty. Intra-velar veloplasty and Fisher's method of lip repair were introduced in later years. There was a higher risk of late primary repair in children with unilateral cleft lip.

Steri-stripTM versus subcuticular skin closure of paediatric groin wounds: A randomised study

BACKGROUND

A technique that offers the best chance of an optimal result is most appropriate to be employed for wound closure.

AIMS

We set out to compare the cosmetic outcome, and wound complication rates associated with clean paediatric groin wounds closed using Steri-Strip™ or subcuticular suturing.

SETTINGS AND DESIGN

A prospective randomised study.

SUBJECTS AND METHODS

Children of African descent with unilateral and bilateral clean groin wounds were randomised into subcuticular suture skin closure and Steri-Strip™ groups and followed up postoperatively. Cosmetic assessment and outcome were scored based on parents' satisfaction using the visual analogue scale (VAS) and a single Plastic Surgeon assessed pictures of the scars using the Hollander Wound Evaluation Scale (HWES). Statistical analysis was used SPSS version 18.

RESULTS

Seventy-five wounds were assessed, (n = 35, Steri-Strips™) and (n = 40, suturing). Closure with Steri-Strips resulted in scars with comparable cosmesis as those with subcuticular suturing. Wound complications were also similar. There was no statistically significant difference between mean VAS scores on the 5^th day (P = 0.320), 2^nd week (P = 0.080), 4^th week (P = 0.070) and 8^th week (P = 0.080). The HWES scores were also comparable at those times.

CONCLUSIONS

We conclude that skin closure of clean paediatric groin wounds with SteriStrips™ gives comparative cosmetic outcomes with subcuticular suturing.

Pattern of congenital hand anomalies at a tertiary plastic surgery service in South-Western Nigeria: A 10-year, cross-sectional retrospective review

Context

Although congenital hand anomalies are among the more common musculoskeletal anomalies worldwide, we do not know its prevalence in our practice.

Aims

The aim of the study was to determine the pattern of congenital hand anomalies presenting to our tertiary plastic surgery outpatient service in South-Western Nigeria.

Materials and Methods

This is a cross-sectional retrospective analysis of outpatient cases of congenital hand anomalies presenting over a 10-year period. Descriptive and inferential statistics were performed using frequencies, Student's t-test and Chi-square as appropriate. The data were analysed using IBM SPSS Statistics 23.0. The statistical significance value was set at P < 0.05.

Results

One hundred and twenty-two cases were identified. The highest number of cases was seen in the year 2012, 23 patients (19.3%). There was a male preponderance of 66 patients (55.1%). Thirty-two patients (26.2%) presented as neonates and 36 (29.5%) as infants. Bilateral anomalies were seen in 67 patients (54.9%). The most common anomaly was failure of differentiation, 88 patients (72.1%) followed by duplication, 26 patients (21.3%). Syndactyly with 43 patients (35.2%) was the most common anomaly under failure of differentiation. No significant associations were found between the type of anomaly and gender or laterality.

Conclusions

Syndactyly was the most common congenital hand anomaly in this study. There was a preponderance of bilateral involvement in both syndactyly and polydactyly.

Parental views on plastic surgery for Down syndrome: an African perspective

Introduction

Plastic surgery for Down syndrome has not been embraced in sub-Saharan Africa. This study sought to determine the attitudes of some parents from sub-Saharan Africa to plastic surgery for their Down syndrome child.

Methods

Consenting parents completed a questionnaire survey instrument that obtained demographic characteristics and contained a likert scale on attitudes to plastic surgery. Internal consistency of the scale was determined with Chronbach's alpha and Pearsons chi square analysis was used to analyze relationships between demographic variables and attitudes scores. Values less than 0.05 were considered statistically significant.

Results

Most (61.9%) of the 42 consenting mothers were above 35 years of age. The most disturbing of the Down syndrome characteristics were the protruding tongue, 18(42.9%), slanting palpebral fissures, 14(33.3%) and the flattened nasal bridge 14(33.3%). Although the mothers had low awareness of plastic surgery most of them had favourable attitudes towards it. A reliability analysis of the mother's attitudes on the likert scale showed good internal consistency. Chronbachs alpha 0.87.

Conclusion

The parents in this study have favourable attitudes towards plastic surgery for Down syndrome. The prominent tongue was the most disturbing feature.

Demographic characteristics and prognostic indicators of childhood burn in a developing country

Children constitute a significant proportion of burn victims in most studies from the developing countries. While there has been a progressive improvement in the outcome from childhood burn in many developed nations, the morbidity and mortality remains high in many low and middle income countries. The aim of our study is to evaluate the demographic characteristics and prognostic indicators of childhood burn in a major referral teaching hospital in a developing country. A review of the records of 638 patients with acute burns managed over a 10-year period from January 2001 to December 2010 at the University College Hospital, Ibadan Nigeria was done. The clinical and epidemiological data were retrieved from computerized data base using the ISBI proforma. Information obtained includes Biodata, Etiology, location, TBSA, presence of Inhalation injury and the treatment outcome. Data of patients aged 16 years and below were analyzed using the SPSS version 16. The main outcome measure was the patient's survival. 289 children representing 45.3% of the total number of burn patients were managed over the period. The M:F ratio was 1.1:1. The median age of the cohort was 4.0 years while the median TBSA was 21.0%. Non-intentional causes were responsible for 89.6% cases. Most of the injuries (88.6%) occurred at home. Eighty-three patients had inhalation injury out of which 57 (68.7%) deaths were recorded. The overall mortality rate in the cohort was 39.5% with an LA50 of burn size of 45%. The TBSA was also found to be a determinant of outcome. Majority of childhood burns are from preventable causes with attendant dismal mortality figures. Effective burn prevention strategies and improved quality of care remain pivotal in reducing childhood burn morbidity and mortality in the developing countries.

Partial characterization of a fibroblast-stimulating factor produced by cloned murine T lymphocytes

T cells may regulate tissue fibrosis through the elaboration of soluble factors that stimulate fibroblast growth. The authors previously identified a factor produced by cloned Schistosoma mansoni antigen-specific T cells which served as a competence factor for murine fibroblasts. In the present report, they further characterize this fibroblast-stimulating factor (FsF) and differentiate it from a number of other T-cell-derived lymphokine activities. Crude supernatants from concanavalin-activated cloned T cells were fractionated by gel filtration, ion exchange, or reversed-phase high-pressure liquid chromatography. FsF has an apparent molecular weight of 17,000 and could be differentiated from colony-stimulating factor (CSF), interleukin-3 (IL-3), and interferon (IFN) on the basis of chromatographic characteristics. Highly purified or recombinant IL-2, IL-3, CSF, and IFN had no significant effect on fibroblast proliferation. Furthermore, a monoclonal anti-B-cell-stimulating factor-1 antibody only partially blocked the fibroblast proliferation induced by T-cell supernatants.

In vitro and in vivo evidence that autoimmune reactivity to collagen develops spontaneously in Schistosoma mansoni-infected mice

Egg-induced granuloma formation in murine schistosomiasis mansoni results from vigorous anti-parasite reaction by activated T cells, macrophages, eosinophils, and fibroblasts. The present study suggests that strain-specific, autoimmune T-cell reactivity directed against host matrix proteins might also contribute to granulomatous hypersensitivity. T cells from infected C57B1/6, but not from CBA or BALB/c mice, proliferative in vitro in response to denatured collagen. T cells from uninfected mice, previously immunized with soluble egg antigen (SEA), did not respond in vitro to collagen. Spleen cells from acutely infected mice, but not chronically infected or uninfected animals, formed granulomas around collagen-coupled polyacrylamide beads in vitro. This response was blocked by anti-collagen antibodies that had no inhibitory effect on in vitro granuloma formation around SEA-coupled beads. In related in vivo studies, granuloma formation was quantitated after iv injection of SEA-, collagen-, or uncoated beads into normal or infected recipients. The mean diameter of lung granulomas induced by collagen-coupled beads in infected mice was significantly greater than the diameter of granulomas around either collagen beads in uninfected mice or uncoated beads in infected mice. these observations indicate that anti-collagen responses develop spontaneously in Schistosoma-infected mice and suggest that such reactivity might play a secondary role in granuloma formation and the pathogenesis of hepatic fibrosis.

In vitro granuloma formation using defined antigenic nidi

The in vitro granuloma model provides an excellent tool to study granulomatous hypersensitivity. In our studies of granuloma formation in schistosomiasis, we have demonstrated the utility of the model with respect to analysis of human PBL responses, cloned T cells, purified antigens of the parasite, and regulatory mechanisms. We have also presented data which demonstrate the applicability of this model to other antigenic systems. While the suggestion that this model may be suitable for the study of sarcoidosis may be premature, we would propose that the system may be adapted to screen potentially causative antigens. Furthermore, with the identification of the critical antigen(s), the in vitro granuloma model will facilitate studies at the clinical level.

Production of a fibroblast-stimulating factor by Schistosoma mansoni antigen-reactive T cell clones

Fibrosis in schistosomiasis is the terminal event of a complex pathophysiologic cascade involving interactions between fibroblasts and both host and parasite products. In the present study, the effect of lymphokines produced by cloned Schistosoma mansoni antigen-reactive T cells on the proliferation of murine fibroblasts was investigated. These T cells previously have been shown to proliferate, produce lymphokines, mediate delayed-type hypersensitivity responses, and generate in vitro granulomas in response to soluble egg antigen (SEA). T cells, co-cultured with irradiated antigen-presenting cells and pulsed with SEA, produced levels of fibroblast-stimulating factor (FSF) comparable to equivalent numbers of dispersed hepatic granuloma cells isolated from infected mice. Supernatants of cloned T cells pulsed with Con A (in the absence of macrophages) contained no detectable interleukin 1 activity, but did stimulate fibroblast activation and growth. T cell FSF activity was trypsin-sensitive, was stable at 56 degrees C but not to boiling, and was retained by Con A Sepharose. Activity was associated with HPLC fractions corresponding to an m.w. of 10,000 to 40,000. Neither recombinant interferon-gamma nor affinity-purified interleukin 2 was capable of stimulating fibroblast proliferation. In functional studies, the degree of fibroblast proliferation was related to the length of exposure to the factor. In addition, quiescent fibroblasts were maximally stimulated by T cell FSF only if a second co-factor such as insulin or epidermal growth factor was present. The synergism between T cell FSF and known progression factors suggests that FSF-T may provide a competence signal to fibroblasts. The present results suggest that a direct molecular link may exist between T cells and fibroblasts in schistosomiasis.

Production of a fibroblast-stimulating factor by Schistosoma mansoni antigen-reactive T cell clones

Fibrosis in schistosomiasis is the terminal event of a complex pathophysiologic cascade involving interactions between fibroblasts and both host and parasite products. In the present study, the effect of lymphokines produced by cloned Schistosoma mansoni antigen-reactive T cells on the proliferation of murine fibroblasts was investigated. These T cells previously have been shown to proliferate, produce lymphokines, mediate delayed-type hypersensitivity responses, and generate in vitro granulomas in response to soluble egg antigen (SEA). T cells, co-cultured with irradiated antigen-presenting cells and pulsed with SEA, produced levels of fibroblast-stimulating factor (FSF) comparable to equivalent numbers of dispersed hepatic granuloma cells isolated from infected mice. Supernatants of cloned T cells pulsed with Con A (in the absence of macrophages) contained no detectable interleukin 1 activity, but did stimulate fibroblast activation and growth. T cell FSF activity was trypsin-sensitive, was stable at 56 degrees C but not to boiling, and was retained by Con A Sepharose. Activity was associated with HPLC fractions corresponding to an m.w. of 10,000 to 40,000. Neither recombinant interferon-gamma nor affinity-purified interleukin 2 was capable of stimulating fibroblast proliferation. In functional studies, the degree of fibroblast proliferation was related to the length of exposure to the factor. In addition, quiescent fibroblasts were maximally stimulated by T cell FSF only if a second co-factor such as insulin or epidermal growth factor was present. The synergism between T cell FSF and known progression factors suggests that FSF-T may provide a competence signal to fibroblasts. The present results suggest that a direct molecular link may exist between T cells and fibroblasts in schistosomiasis.

Golgi apparatus and acid phosphatase in mammary gland and kidney cells under the influence of diethylstilbestrol (DES)

It is commonly accepted that hormonal disturbances in experimental animals produce pathological changes in several organs namely in mammary glands and kidney. Taking into consideration the close relationship between acid phosphatase and Golgi apparatus, the present study was undertaken, to study the relationship in kidney and mammary gland cells under the influence of DES. The observation indicate, that acid phosphatase and Golgi apparatus were localized in the cytoplasm of mammary gland and kidney cells. It has also been found a parallel change in the activity of acid phosphatase and the degree of development of Golgi apparatus after DES administration.

Schistosoma haematobium infection in the white mouse--histopathological and histochemical studies

Mice were infected with 1000 Schistosoma haematobium cercariae (Egyptian strain). Histopathological and histochemical studies were performed on the different organs, during the first four weeks after infection and on the fourth week after oviposition. Pathological changes during early prepatency matched with those in S. mansoni infection. Eggs were laid in aggregates in the colon and liver. They initiated the development of typical granulomatous lesions. Abundant bilharzial pigment and areas of sclerosis were present in both liver and spleen. The heart, kidneys and urinary bladder were pathologically free. Disturbed succinic dehydrogenase and acid phosphatase enzyme levels were detected which point to a derangement in the functions of the cell organelles.

Indirect immunoperoxidase tests in the diagnosis of schistosomiasis

An enzymatic technique, immunoperoxidase histochemistry, was applied in the diagnosis of human schistosomiasis. Sera of patients with S. haematobium, S. mansoni and mixed infection, together with control sera, were studied. The test proved easily applicable and gave reliable results particularly with S. mansoni and double infection. The depth of the colour reaction, was then compared with ELISA readings, but there was no relation in the results of the individual cases.

Granuloma size in the liver of mice with Schistosoma haematobium infection and Schistosoma mansoni challenge

Swiss albino mice have been infected with S. haematobium and challenged with S. mansoni. S. haematobium infection in the mouse runs a course more or less parallel to that of S. mansoni infection. Granuloma has reached a maximal size at 135 days post infection and has regressed thereafter. Suppression of S. mansoni granuloma was observed in mice previously infected with S. haematobium. This manifests the presence of cross immunization.