Background: Complex defects in the distal third of the leg are often difficult problems for the reconstructive surgeon. Objective: This study aims to identify the early outcomes of reconstruction for complex defects of the distal leg. It explores basic demographics and presentation challenges associated with these defects. It further highlights various methods of reconstruction, complications, and outcomes. Materials and Methods: Between 2008 and 2013, all patients with lower leg and ankle defects that had definitive flap cover were prospectively studied. Age, sex, duration of defect, cause of defect, comorbidity, size of defects, and the reasons for delay in intervention were obtained for each patient. The type of flap used, complications, duration of hospital stay, early outcome, and ambulation status at 6 months were noted. Results: Twenty five patients were studied during the period with a male to female ratio of 3:2. Sixty eight percent (17) of the defects were trauma related. The inability to pay for treatment was the commonest cause of intervention delay. The mean size of the defects was 31 cm². Diabetes and peripheral vascular disease were the commonest comorbidities. Perforator-based fasciocutaneous flaps were the most commonly used (48%;12), while muscle flaps (24%;6) and adipofascial turnover flaps (20%;5) were less utilized. Two patients died and one underwent a below-knee amputation. Late infection persisted in 16%(4) of the patients seen. Conclusion: Trauma-related defects predominated in this study, and financial issues delayed definitive intervention in many cases. Inspite of this, successful coverage was obtained in 84% of the patients. There was, however, a trend toward increasing infection and mortality among older patients.

Critically ill patients have poor physiological reserves, and are at increased risk of cardiopulmonary complications such as hypoxia, hypotension, arrhythmias and cardiac arrest when undergoing airway management. This study audited airway management in critically ill patients. Patients Method: A Prospective observational study in 120 critically ill adult patients who required endotracheal intubation over a one year period. Induction was with IV midazolam (0.15mg/kg), and suxamethonium (1.5mg/kg). Data collected included immediate complications (complications during intubation), and early complications (complications on days one to seven of tube insertion). Results: The median age was 32 years, males constituted 68 (56.6%) and female 52 (43.4%). One hundred and fifty-eight intubation attempts were recorded, one attempt to success in 93 (77.5%), and 2 attempts in 22 (18.33%). Difficult intubation occurred in 17 (10.49%), of whom 5 subjects had more than 3 intubation attempts, and 2 had surgical tracheostomy performed. The intubation aids used included stylet in 86.67%, bougie (3.33%), and laryngeal mask airway (1.67%). There was a significant association between the number of attempts at intubation, and trauma, bleeding, oesophageal intubation, aspiration or cardiac arrest, P<0.05. Tubal blockade occurred in 65 (36.31%) subjects after a median duration of 38.5 hours. Conclusion: This study elicited the need to review the airway management of critically ill patients in our institution, provide different airway and intubating devices during difficult intubation, and ensure appropriate training in airway skills.

Background: The retention of primitive reflexes (PRs) is considered to be one of the primary impairments associated with cerebral palsy (CP). However, little is known about the pattern of retention of PRs across the different classes of CP. Objectives: This study was undertaken to evaluate, identify, and describe selected PRs in children diagnosed with CP and to determine their association with motor development. Materials and Methods: This study was a cross-sectional analytical survey conducted in the physiotherapy departments of four conveniently selected public hospitals in Lagos metropolis. Thirty-one children diagnosed with CP aged between 18-84 months were recruited. A PR profile consisting of 15 PRs were evaluated. The World Health Organization (WHO) windows of achievement for six key motor milestones were employed to explore their motor development. Results: The placing reflex presented the highest pattern of persistence (12.96%) across all the classes of CP. Children with spastic CP had the highest mean sum of retained PRs (6.24 ± 2.36). There was no significant association between the sum of retained PRs and motor development (P > 0.05). In addition, there were characteristic patterns of responses for specific PRs. Conclusion: The pattern of retained PRs varies for the different classes of CP. There is no significant association between the retention of PRs and motor development for children with CP. There is a need for further, in-depth study of these reflexes, individually, to better understand how they influence the motor development of children with CP.

Aims and Objectives: The aim of this study is to determine the plasma levels of interleukin-6 (IL-6), tumor necrosis factor alpha (TNFα) and C-reactive protein (CRP) in adult Nigerians with the metabolic syndrome and to determine the relationship between components of the metabolic syndrome and CRP in adult Nigerians. Materials and Methods: This was a cross-sectional analytical study of 50 adult men and women with metabolic syndrome and 50 age- and sex-matched men and women without metabolic syndrome. Metabolic syndrome was defined based on the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) criteria. Written informed consent was obtained from the participants. Blood pressure and anthropometric measurements were taken and venous blood was collected after an overnight fast. The Ethics Committee of the Lagos University Teaching Hospital, Lagos, Lagos State, Nigeria approved the study protocol. Comparisons of the continuous variables and the categorical variables were done using the Student's t-test and Chi-square test, respectively. Regression analysis was used to determine the associations between the variables. Statistical significance was set at P < 0.05. Results: The study subjects differed in some clinical and laboratory parameters such as diastolic blood pressure (P = 0.048), waist circumference (P = 0.002), body mass index (BMI) (P = 0.012), waist/hip ratio (P = 0.023), high-density lipoprotein (HDL) (P = 0.012), and insulin resistance (P = 0.042). There was a statistically significant increase in the inflammatory marker, CRP (P = 0.019), cytokines, IL-6 (P = 0.040), and TNFα (P = 0.031) between the subjects with and without metabolic syndrome. There was also a positive significant association between CRP, waist circumference, and insulin resistance and a negative significant association between CRP and HDL in metabolic syndrome (P < 0.05). Conclusion: This study reports increased plasma levels of the inflammatory cytokines, IL-6, TNFα and in the inflammatory marker and CRP in metabolic syndrome. Understanding the role of inflammation in the metabolic syndrome may provide novel strategies for the management of metabolic syndrome and related disorders.

Background and Objective: The Emergency Department is of significance and is the vital entry points of patients into the healthcare facility of the hospital all around the world. This study aims to assess the knowledge, attitude and practices of emergency personnel at two tertiary hospitals in Lagos as regards emergency management and preparedness. Aims: This study aims to assess the knowledge, attitude, and practices of emergency personnel at two tertiary hospitals in Lagos with regard to emergency management and preparedness. Settings and Design: This was a descriptive, cross-sectional study. Materials and Methods: A convenient recruitment was made of eligible and consenting individuals at both hospitals until the required sample size was reached. Statistical Analysis Used: The data obtained were analyzed using Epi Info statistical software version 3.5.1. Results: The majority (93.2%) of the participants were clinicians. It was discovered that less than half or 98 (47.8%) of the participants had good knowledge of emergency preparedness and planning, 76 (37.1%) had a fair knowledge, while 31 (15.1%) had poor knowledge. The respondents' attitude toward emergency preparedness was generally positive, as most of them, that is, 191 (93.2%) believed that they needed to know about emergency planning. Only a minority, that is, 72 (35.1%) of the respondents knew that emergency drills are done in their respective hospitals. Conclusions: There was an overall deficiency in the respondents' knowledge of emergency preparedness. Their attitude was good and acceptable, but their practices in terms of the frequency of emergency drills and the frequency of regularly updating the emergency plans were grossly inadequate.

Introduction: Recent procurement of new endoscopies and accessories led to the reactivation of diagnostic and therapeutic colonoscopy services at our center. A preliminary audit is deemed necessary after a 2-year period of open access colonoscopy. Objective: To assess the pattern of indications, diagnostic yield, and selected key performance indicators in the practice of colonoscopy at our tertiary hospital. Patients and Methods: The endoscopy reports of all patients that underwent colonoscopy from January 2012 to April 2014 were reviewed. The demographic data, indications, and endoscopic findings were recorded. Information on cecal intubation, colonoscopy withdrawal time, polyp detection, adverse events, and bowel preparation quality were also extracted and analyzed. Results: Colonoscopy was performed in 149 patients. They were 81 males and 68 females, aged between 18 and 101 years with a mean of 46.9 ± 22.7 years. 126 (84.5%) patients had a colonoscopy for symptomatic conditions while 5 (4%) were for screening. Bowel preparation was assessed to be excellent in 81 (54.4%), adequate in 42 (28.2%), and inadequate in 26 (17.4%) patients, respectively. The cecal intubation rate (CIR) was 80.2%, polyp detection rate 7.4%, average colonoscopy withdrawal time was 6 min 53 s, overall diagnostic yield 55.9% and there were no adverse events. Tumors were seen in 19 patients (10.1%); 13 were located in the rectum, three in the sigmoid and three in the descending colon. Conclusion: The audit revealed that our CIR could be improved by a more effective bowel preparation, increased expertise, and procedure volume of endoscopists. Tumors of the colorectum were detected in 10.1% of patients.

Background: Lagos University Teaching Hospital (LUTH) is one of the foremost teaching institutions in Nigeria. It is a recognized training institution for residency training in Nigeria. However, a thorough evaluation of the procedures being undertaken by the orthopaedic teams in this centre and the impact on the type of training being passed on to the resident doctors in training is the focus of this paper. Objectives: To determine the pattern of procedures performed by the orthopaedic units of the Department of Surgery, LUTH with a view to import the findings in re-organizing its structure based on service requirement, manpower allocation and to make recommendation. Methods: We retrospectively reviewed data including age, sex, procedures and leading surgeons retrieved from all our operating theatres over a period from 1^st January 2010 to 31^st December 2011. The data retrieved was analyzed. Results: A total 741 procedures were performed over the 2 year period. More male patients (58.5%) had procedures performed on them than the female patients. The mean age of patients treated was 37.2±15.5 years. Trauma related procedures accounted for 68.8% of the total procedures. Open reduction and internal fixation surgical operations were the most common trauma related procedure while ablative surgical operations following Diabetic Mellitus foot syndrome were the most common non-trauma related procedure performed. Conclusion: Trauma related surgery remains the most common procedures in our teaching hospital. Efforts should be made to increase the number of elective operations like Arthroplasties, Arthroscopic operations and Spinal axis correction operations being performed.

Congenital maxillomandibular fusion is a very rare condition with few cases reported worldwide. This paper reports a rare case of bony maxillomandibular fusion of the jaws, with synechiae of buccal mucosa and the gingivae in an adult patient. Separation of the fusion was done under general anesthesia. Isolated cleft of the hard palate was discovered during surgery. This report adds more information to literature, by reporting an adult with syngnathia and isolated cleft of the hard palate.