Peer-Review Abstracts

PEER-REVIEWED ABSTRACTS OF SCIENTIFIC PAPER PRESENTATION AT THE 54th ANNUAL CONFERENCE OF THE WEST AFRICAN COLLEGE OF SURGEONS AT KUMASI, GHANA 24TH – 28TH FEBRUARY, 2014. RESUMES ÉVALUÉS PAR LES PAIRS DE LA RECHERCHE SCIENTIFIQUE PAPIER PRÉSENTE À LA 54E CONFÉRENCE ANNUELLE DU COLLEGE DES CHIRURGIENS DE L' AFRIQUE DE L'OUEST, KUMASI, GHANA 24 - 28 FÉVRIER 2014. A NEW METHOD FOR SURGICAL RISK STRATIFICATION BASED ON PRE-OPERATIVE RISK FACTORS IN PAEDIATRIC SPINAL DEFORMITY SURGERY. Oheneba Boachie-Adjei, Mitsuru Yagi, Cristina SacramentoDominguez, Harry Akoto, Bettye Wright, Irene Wulff, Jennifer Ayamga

and risk factors for major peri-operative complications in regions with limited resources (West Africa) are unknown. Methods: A retrospective analysis of a prospectively collected single-center database of 427 consecutive pediatric and adult patients with complex spinal deformities due to various etiologies who underwent instrumented spine surgery was performed. Radiographic and demographic data were reviewed at pre-op and immediate post-op time points. Results: The average age was 15.0 yrs (1-47 yrs). The etiology was idiopathic scoliosis (n=201), congenital deformity (n=103), infectious/TB kyphosis (n=89), neuromuscular scoliosis (n=30), and other (n=4). 86 pts had a three-column osteotomy. Major complications were seen in 85 cases (20%) and consisted of a neurologic deficit [(n=26/6.1%), transient (n=19/4.4%) and permanent (n=7/1.6%)], wound infection (n=17/4%), implant related (n=18/4.3%), progressive deformity (n=13/3%), and death (n=6/1.4%). Univariate predictors of both post op complication and neurologic deficit indicated 3 column osteotomies and curves exceeding 100 degrees as independent risk factors. Conclusion: Post-op complications were seen in 20% of surgically treated patients with complex spine deformities at a SRS GOP site in West Africa. In underserved regions severe untreated spine deformities are often encountered and will challenge the resources of even first world institutions and experienced surgeons. The results of this study should be a guide for surgeons in their pre-operative planning and surgical management of severe spine deformities, especially in global outreach sites where resources are limited.

Background: Corrective spine surgery for complex deformity is technically demanding and carries a substantial risk. The purpose of this study is to review the postoperative complications in pediatric patients undergoing spine surgery and to establish a pre-operative classification that stratifies surgical risk and case difficulty. Methods: 145 consecutive paediatric spine deformity patients, with various etiologies, who underwent instrumented spinal fusion, were reviewed. A classification was established based on the curve magnitude, etiology, ASA grade, number of levels fused, the pre-op neurologic status, BMI and type of osteotomies. Multiple and Logistic regression analysis (MRA and LRA) were applied to indicate risk factor(S) for complications. We hypothesized that higher the risk score levels will be associated with high complication rates. Results: 5 patients were classified Level 1, 19 were level 2, 25 were level 3, 58 were level 4 and 39 in level 5. Intra-operative neuromonitoring change was observed in 46 cases. Major complication was seen in 45 cases and consisted of implant related (n=13), deep wound infection (n=8), neuro deficit (n=7), death (n=2), and others (n=9). Multiple regression analysis indicated the significant correlation between the risk score (FOCOS level) and %EBL/TBV, time of surgery, and complication ratio. No independent risk factor for complications was observed. Conclusion: The newly established surgical risk stratification based on patient specific clinical and radiographic factors reliably predicts perioperative outcomes and can guide surgeons in their preoperative planning and surgical management of severe spine deformity in order to achieve optimal results.

GLOBAL HEALTH AND THE CHALLENGES OF BUILDING AN ORTHOPEDIC CENTRE OF EXCELLENCE IN WEST AFRICA Oheneba Boachie-Adjei, Cristina Sacramento-Dominguez, Harry Akoto, Bettye Wright, Irene Wulff, Jennifer Ayamga

INCIDENCE AND THE RISK FACTORS FOR MAJOR SURGICAL COMPLICATIONS IN PATIENTS WITH COMPLEX SPINE DEFORMITY- A REPORT FROM THE SCOLIOSIS RESEARCH SOCIETY GLOBAL OUTREACH SITE (SRS-GOP) IN GHANA, WEST AFRICA. Oheneba Boachie-Adjei, Mitsuru Yagi, Cristina SacramentoDominguez, Harry Akoto, Bettye Wright, Irene Wulff, Jennifer Ayamga

Background: Musculoskeletal conditions cause pain, physical disability and loss of personal and economic independence and affect millions of people of all ages in all cultures and in all countries. The prevention and treatment of musculoskeletal conditions and injuries should be among the leading major health concerns in the minds, actions and funding priorities of international health agencies, governments, non-governmental organizations, medical and research communities, funders, media and the general public.

Background: Surgical treatment for complex spine deformities is challenging. A multidisciplinary approach is often required in managing these patients peri-operatively and the incidence

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Methods: The foundation of orthopedic and complex spine (FOCOS) was established with the Vision to establish a sustainable Infrastructure to deliver state of the Art Orthopedic Care and Education in West Africa and our mission is to provide optimum orthopedic care, to improve the quality of life and expand capacity West Africa. Results: FOCOS has partnered with Philanthropic organizations, Medical device companies, Hospital institutions and benefactors to fund the operations, programs and services at the hospital. To date the 50-bed state of the art orthopedic facility has about 200 employees has had 26,957 outpatient visits and performed 1,100 major orthopedic surgeries with $100million in health care cost savings. The Challenges have included inadequate funding, infrastructure, technical expertise, reliable utilities and the daunting challenges of managing complex and neglected orthopedic diseases. Conclusion: Despite challenges, FOCOS orthopedic hospital in Accra, Ghana is a collaboration of programs and services of international volunteers, local professionals and authorities working together to circumvent the problem with brain drain in West Africa.

fond Déformation vertébrale, la scoliose est une m a n i fe s t a t i o n o r t h o p é d i q u e p r é d o m i n a n t e d e neurofibromatose. Les patients peuvent présenter des douleurs et ou myélopathie débilitante. Échec de la gestion des déformations est assez fréquent en raison de la nature dystrophique des os . Neurofibromatose comme une cause de la maladie de la colonne vertébrale liées est bien établi dans la littérature mondiale. La documentation dans la littérature médicale africaine pauvres lésions de la colonne vertébrale en particulier cervicale . La présentation de ces patients a généralement tendance à être en retard dans notre sousrégion et les résultats ont également tendance à être pauvres. méthodologie Nous présentons trois patients qui présentaient des lésions de la colonne vertébrale secondaires à la neurofibromatose qui ont été gérés de façon très agressive. Ces patients ont été traités au cours des 12 derniers mois dans deux institutions. Les trois patients présentaient des déficits neurologiques. Tous les 3 patients ont été traités avec des procédures complexes de la colonne vertébrale, suivie par la physiothérapie agressive. Leurs scores Asie avant et après la chirurgie a été enregistré. Forme SRS 22 a été administré. résultatsTous les patients ont eu une amélioration significative du score ASIA. Les deux patients qui avaient des déficits moteurs complets ont été ambulant avec des appareils fonctionnels dans les 2 mois suivant la chirurgie. Un patient qui avait des déficits moteurs incomplets été Ambulating indépendamment dans les 3 mois suivant la chirurgie. Spine déformation a été traitée avec des procédures complexes d'instrumentation ayant un bon rétablissement de l' alignement de la colonne vertébrale. C o n c l u s i o n . Tr o u b l e s n e u r o l o g i q u e s d u s à l a neurofibromatose a un très bon résultat et doit être géré par excision chirurgicale agressive et chirurgie reconstructive de la colonne vertébrale déformation.

SURGICAL MANAGEMENT OF SPINAL LESIONS IN NEUROFIBROMATOSIS Harry Akoto, Oheneba Boachie-Adjei, Arthur sackeyfio, Rufia Mahmud Background: Vertebral deformity, scoliosis is a predominant orthopedic manifestation of Neurofibromatosis. Patients may present with debilitating pain and or myelopathy. Failure of management of the deformities is quite common due to the dystrophic nature of the bones. Neurofibromatosis as a cause of spine related disease is well established in the world literature. The documentation in the African medical literature is poor especially cervical spine lesions. The presentation of these patients generally tends to be late in our sub region and the outcomes also tend to be poor. Methods: We present three patients who presented with spinal lesions secondary to neurofibromatosis who were managed very aggressively. These patients were managed over the past 12 months in two institutions. All three patients presented with neurological deficits. All 3 patients were managed with complex spine procedures followed by aggressive physiotherapy. Their ASIA scores before and after surgery was recorded. SRS form 22 was administered. Results: All patients had significant improvement in ASIA score. Both patients who had complete motor deficits were ambulating with assistive devices within 2 months of surgery. One patient who had incomplete motor deficits was ambulating independently within 3 months of surgery. Spine deformity was addressed with complex instrumentation procedures with good restoration of the spine alignment. Conclusion: Neurological impairment due to neurofibromatosis has a very good outcome and must be managed with aggressive surgical excision and spine reconstructive surgery.

PYGOMELIA AT TREICHVILLE (ABIDJAN) TEACHING HOSPITAL: ABOUT TWO NEW CASES Moulot M, Agbara K S, Yebouet E, Kouame Agnes, Bankole S R INTRODUCTION: Pygomelia is a rare malformation (1/100000), which defined itself by the presence of one or more supernumerary members in the pelvic region. We report two new cases of which one operated successfully in Abidjan. CASES: The 1st case was characterized by the presence of two additional lower limbs sitting in hypogastric position and a 3rd vestigial épigastric upper limb associated with visceral deformations. The surgical treatment was successfully realized. The clinical examination of the 2nd case objectified the third lower limb at the level of the left buttock with a rudimentary pelvis, a sacrococcygeal tératoma and a genital duplication. The newborn child died during the investigations. CONCLUSION: The nosological limits of pygomelia are still badly specified because it gets closer to duplications of the lower limb and dipygus KEY WORDS: Pygomelia, Dipygus, Caudal duplication

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LA PYGOMELIE AU CHU DE TREICHVILLE (ABIDJAN) A PROPOS DE DEUX NOUVEAUX CAS. Moulot M., Agbara K S., Yebouet E ,Kouame Agnes, Bankole S R.

Methods: All patients admitted to KATH with a fracture of the femur, or Arbeitsgemeinschaft fu¨r Osteosynthesefragen (AO) class 31, 32, 33, were entered into a locally designed, electronic femur fracture database. Patients' characteristics and data quality were assessed by using descriptive statistics. Orthopedic trauma research barriers and opportunities were identified from key informants at the research site and supporting site. Results: Ninety-six femur fracture patients were enrolled into the registry over a 5-week period. The majority of patients resided in the Ashanti region surrounding the hospital (78 %). Most participants were involved in a road traffic crash (58 %) and physiologically stable with a Cape Triage Score of yellow upon admission (84 %). AO class 32 femur fractures represented the majority of femur fractures (78 %). Median times from injury to admission, admission to surgery, and surgery to discharge were 0, 5, and 10 days, respectively. Data quality analysis showed that data collected at admission had higher rates of completion in the database relative to data collected at various follow-up time points. Conclusions:Data and data quality analyses highlighted characteristics of femur fracture patients presenting to KATH as well as the technological, administrative support, and hospital systems-based challenges of longitudinal data collection in LMICs.

Introduction: La pygomélie est une malformation rare (1/100000) qui se définit par l'implantation d'un ou de plusieurs membres inférieurs dans la région pelvienne. Nous rapportons ici deux nouveaux cas dont un opéré avec succès à Abidjan. CAS: Le 1er cas était caractérisé par la présence de deux membres inférieurs supplémentaires siégeant en position hypogastrique et un 3e membre supérieur vestigial épigastrique associé à des malformations viscérales. Le traitement chirurgical a été réalisé avec succès. L'examen clinique du 2e cas objectivait un troisième membre inférieur au niveau de la fesse gauche avec un bassin rudimentaire, un tératome sacrococcygien et une duplication génitale. Le nouveau-né est décédé pendant les investigations. Conclusion: Les limites nosologiques de la pygomélie sont encore mal précisées car elle se rapproche des duplications du membre inférieur et des dipygies. MOTS CLES: Pygomélie, Dipygie, duplication caudale AVULSION FRACTURE OF THE TIBIAL TUBEROSITY: THE DOUALA EXPERIENCE. Fokam P G, Taku C M, Farikou I, Fogang M Hopital General, Douala. Correspondence:[email protected]

A PROSPECTIVE COHORT STUDY OF THE ADOPTION OF TITANIUM ELASTIC INTRAMEFULLARY NAILS FOR THE TREATMENT OF FEMUR FRACTURES IN KUMASI 1 Holland T, 1Karsel S P, 2Baidoo P K, 2Yeboah D, 1Coughlin R, 2 Konadu P, 2Kumah-Ametepey R

Background: Avulsion fracture of the tibial tuberosity is an uncommon injury occurring typically in adolescents usually during sports. It has been classified by Watson- Jones and modified by Ogden into types I II and III depending on the severity. Treatment is mainly surgical. Complications may include genu recurvatum and extension lag. Methods: We reviewed 15 patients with this injury managed in Hopital General Douala and Polyclinic Bonanjo for a three-year period. Results: There were 14 adolescents between the ages of 1317yrs and an exceptionally 1 adult of 43years old. We had 14 males and 1 female. A majority were type II (60%) and were treated by open reduction and internal fixation with screws with or without tension band wiring. The results were excellent with complete union of fracture site and full range of motion after 6 months of follow-up. There was only 1 reported case of extension lag of 10 degree. Conclusion: There has been a steady but slight increase in the incidence of this injury. Diagnosis is straightforward, treatment is typical and patients generally do well. KEY WORDS: Avulsion fractures, Tibial tuberosity, Adolescent

Institution: 1Dept. of Orthopedic Surgery, University of California, San fransisco, USA; 2Komfo Anokye Teaching Hospital, Kumasi, Ghana BACKGROUND: Titanium elastic nails have been shown to be effective in the treatment of transverse and short oblique femur fractures in children. No studies have compared outcomes Of titanium elastic nails versus skin traction for paediatric femur fractures. At KATH, prior to 2010, all paediatric femur fractures were treated with skin traction until union. This study was designed to compare the early results and cost of elastic titanium nails versus skin traction and determine health related quality of life (HRQOL) outcomes of children treated with titanium elastic nails. Methods: A Prospective observational study of 83 pediatric patient's age 3---14 years presenting With closed femur fractures KATH from January to December 2010. Implant costs were borne by the patient's family. Those that did not purchase implants were treated with skin traction until union, and this comprised the control group. Patient and injury demographics, initial radiographs, postoperative radiographic outcomes, length of stay, and total costs were compared between groups. The child's HRQOL at 6 months was assessed using the pediatric quality of life inventory (PedsQL). Results: There was significantly better radiographic alignment in the 45 children treated with elastic nails. Average post

THE IMPLEMENTATION OF PILOT FEMUR FRACTURE REGISTRY AT KOMFO ANOKYE TEACHING HOSPITAL : AN ANALYSIS OF THE DATA QUALITY AND BARRIERS TO COLLABORATIVE CAPACITY BUILDING Daniel B. Sonshine, Jesse Shantz, Raphael Kumah-Ametepey, R. Richard Coughlin, Richard A. Gosselin Background: Trauma registries are essential for injury surveillance and recognition of the burden of musculoskeletal injury in low- and middle-income countries (LMICs). The purpose of this study was to pilot a femur fracture registry at Komfo Anokye Teaching Hospital (KATH) to assess data quality and determine the barriers to research partnering in LMICs.

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treatment length of stay was 30.8 days in the traction group versus 15.6 days in the elastic nails group (p = 0.001). Cost of hospitalization was significantly lower in the elastic nails group. The mean HRQOL remained significantly lower in total score and in all three subscales (physical health, psychosocial health, and emotional functioning) than the general population mean at 6 month follow up. Conclusion: The adoption of elastic titanium nail in the management of paediatric femoral shaft fractures has better results, shorter hospital stay and lower cost of hospitalization.

Results: 12 (57.1%) were males, while 9 (42.9%) were females. Age range is between 15 to 82 years, average of 40.1years. 11 (52.3%) patients had displaced fracture neck of femur. 7 (28.6%) patients had femoral head avascular necrosis out of which 4 (19.1%) have sickle cell disease. 2(9.5%) patients had neglected posterior hip dislocation, and 1(4.8%) had neglected anterior hip dislocation. 19 (90.5%) patients had the procedure with bipolar endoprosthesis and 2 (9.5%) patients with Austin moore. Bone cement was used in 4 patients (19.1%), the rest (80.9%) were non cemented. 3 (14.3%) elderly women with fracture neck of femur died and 5 (23.8%) patients were lost to follow up. 1 patient had conversion to girdlestone on account of pain. In 12 patients (57.1%) result was satisfactory in terms of ambulation, absence of pain and good quality of life. Conclusion: Hemiarthroplasty is an established method of treatment for indicated hip joint pathology. In our center displaced fracture neck of femur among elderly is the frequent indication of this procedure with good functional outcome. OBJECTIF: Identifier les indications communes pour Hémi dans notre centre et d'évaluer le résultat fonctionnel. Méthode: Il s'agit d'une étude prospective réalisée sur 21 patients consécutifs atteints de diverses pathologies de la hanche qui avait Hemiarthroplasy sur une période de 4 ans , (Décembre 2009 - Décembre 2013) . RÉSULTAT: 12 (57,1% ) étaient des hommes , tandis que 9 ( 42,9 % ) étaient des femmes . Tranche d'âge se situe entre 15 à 82 ans, moyenne de 40,1 années . 11 ( 52,3 %) patients avaient déplacées fracture du col du fémur . 7 ( 28,6 % ) des patients avaient la tête fémorale nécrose avasculaire dont 4 ( 19,1% ) ont la drépanocytose . 2 (9,5%) patients avaient négligé hip luxation postérieure , et 1 ( 4,8% ) avaient négligé luxation antérieure de la hanche . 19 ( 90,5 %) patients avaient la procédure avec 2 (9,5%) patients avec Austin moore endoprothèse bipolaire et . Le ciment osseux a été utilisé chez 4 patients (19,1%) , le reste ( 80,9 %) ont été non cimentées . 3 ( 14,3% ) des femmes âgées avec fracture du col du fémur sont morts et cinq (23,8%) patients ont été perdus de vue . 1 patient avait conversion à girdlestone à cause de la douleur . Chez 12 patients ( 57,1% ) résultat était satisfaisant en termes de déambulation , l'absence de douleur et de bonne qualité de vie . CONCLUSION. Hémi est une méthode établie de traitement de la pathologie indiqué articulation de la hanche . Dans notre centre de cou de fracture déplacée du fémur chez les personnes âgées est l'indication fréquente de cette procédure avec un bon résultat fonctionnel.

PROCESS IMPROVEMENT: A VALUABLE TOOL FOR HEALTH SYSREMS STRENGTHENING 1 Elliott I, 1Caldwell A, 2Konadu P, 2Awariyah D, 2Ativor V 1 Dept. of Orthopedic Surgery, University of California, San fransisco, USA; 2Komfo Anokye Teaching Hospital, Kumasi, Ghana Background: The burden of orthopaedic trauma at the Komfo Anokye Teaching Hospital in Kumasi, Ghana is significant. Compounding this burden are barriers to getting patients in and through the operating theatre. These barriers are a contributor to infection rates for open fractures by limiting the ability to conduct serial irrigation and debridement as well as delayed primary closures. In collaboration with the Institute for Global Orthopaedics and traumatology a process improvement approach, typically used in manufacturing and business, was applied to map out the operating theatre capacity and patient flow to better identify areas of improvement and impact intervention to improve infection rates for open fractures through academic partnerships. Methods: The process mapping techniques used followed the framework and principles outlined in “Workflow Modeling: Tools for Process Improvement and Application Development, 2nd Edition” by Alec Sharp and Patrick McDermott. The steps include defining the scope of the operating theatre, identify key personnel and conduct interviews over a 3--week period to develop a process map. The process map was validated by shadowing all key personnel and operating theatre daily workflow and presented to key stakeholders. Results: A map of the theatre was produced starting with the “decision to operate” and ending with the patient being transported to the wards after surgery. This map identified in a visual way the complexity of workflow necessary to get a patient in and thru the operating theatre. Key areas for streamlining and improving communication were outlined and presented to key stakeholders. The framework used for recommendations suggested seven opportunities that are possible without any additional funds, personnel or resources. Conclusion: The process map and methodology used is dynamic and if embraced can serve as a practical and simple tool to advocate and facilitate change in the system.

EFFECT OF ANTEGRADE AND RETROGRADE APPROACHES TO INTERLOCKING NAIL FIXATION OF FEMORAL DIAPHYSEAL FRACTURES ON IPSILATERAL HIP AND KNEE JOINT MOTION. Toluse A M, Ikem I C, Akinyoola A L, Oluwadare E, Asuquo J E Department of Orthopaedic Surgery and Trauma, Obafemi Awolowo University Teaching Hospitals' Complex, Ile- Ife, Nigeria.

HEMIARTHROPLASTY FOR HIP JOINT PATHOLOGY. THE A.B.U.T.H ZARIA EXPERIENCE M I Maitama, Y Z Lawal, K E Amaefule, M O Ogirima, F S Ejagwulu, I L Dahiru Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.

Background: The objective of this study was to evaluate the early impact of antegrade and retrograde interlocking nail fixation of femoral diaphyseal fractures on the ipsilateral hip and knee joint range of motion. Methods: A prospective evaluation was performed of 62 consecutive limbs with femoral diaphyseal fractures that had interlocking nail fixation through the antegrade or retrograde approach. All participants had post-operative physiotherapy. Follow-up was for 9 months.

Background: To identify the common indications for Hemiarthroplasty in our center and evaluate the functional outcome. Methods: This is a prospective study carried out on 21 consecutive patients with various hip joint pathology who had hemiarthroplasy over a period of 4 years, (December 2009 December 2013).

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Results: The mean hip flexion angle at 9 months was 137.50 in the antegrade group and 133.80 in the retrograde group (p = 0.150). Trendelenburg test was negative in both groups and there was no knee extension lag at 9 months. While the mean knee flexion angle at 9 months was 119.90 in the retrograde group and 134.50 in the antegrade group (p = 0.023). All patients had achieved radiologic and clinical fracture union by twentyfour weeks post-operatively. Conclusion: There was no significant effect of antegrade or retrograde approach on the range of motion of the hip joint. However, knee motion improved more quickly in the group that had antegrade nailing. KEY WORDS: interlocking nail, femoral diaphyseal fractures, joint motion

Methods: We prospectively evaluated all patients who presented with testicular pain to our surgical emergency department over a 24-month period using a questionnaire, which included 6 clinical, and 9 physical examination parameters. Bedside urinalysis was done using dipsticks and all patients had scrotal exploration done.A cross tab and multivariate analysis on SPSS and a significance level of P < 0.05 was performed to identify individual history and physical exam findings that correlated the most with a diagnosis of testicular torsion. RESULTS: Forty-one patients were included in this study.The age range was 9 – 65 years with a modal age of 14 years and mean age of 24.2 years. Twenty eight (68.3%) were students who are minors under parental care thus seeking healthcare is dependent on their care givers. 17 (60.7%) of these parents/care givers had tertiary education which significantly influenced the prompt presentation at an adequate healthcare facility (P= 0.03) was significantly predictive of torsion.Thirty one (75.6%) had no UTI (P= 0.012), 25 (61%) had a high riding testes (P= 0.000), 19 (46.34%) had a negative Prehn's test (P=0.000) and 13 (31.7%) had palpable cord knot (P=0.000) and were all significantly predictive of torsion so was severity of pain (P=0.012). All 13 patients who had palpable cord knot had various degrees of cord twists seen at surgery. Gastrointestinal symptoms (P= 0.127), scrotal erythema (P=0.687), fever (P=0.084), duration of pain (P=0.348), age (P=0.54), tender testes (P=0.209), tender epididymis (0.084), presence of urinary symptoms (P=0.145) and sexual activity (P=0.410) were not significantly predictive of torsion. Eighteen subjects (44%) had testicular torsion confirmed at surgery. 10 (24.4%) had a non-viable affected testes and had Orchidectomy done and Orchidopexy of the unaffected testes. CONCLUSION: Clinical signs (severe testicular pain with an abnormal orientation, negative Prehn's test and palpable cord knot with a simple bedside urinalysis can be safely used to diagnose testicular torsion.

EFFET DE ANTEROGRADE ET RETROGRADE DES APPROCHES A EMBOITEMENT ONGLES FIXATION DES FRACTURES DIAPHYSAIRES FEMORALES SUR LA HANCHE ET DU GENOU IPSILATERAL REQUETE CONJOINTE . Résumé Objectif: L'objectif de cette étude était d'évaluer l'impact précoce des antérograde et rétrograde de verrouillage fixation de clou de fractures diaphysaires fémorales sur la hanche et du genou ipsilatéral gamme de mouvement des articulations. Méthodes: Une évaluation prospective a été réalisée sur 62 membres consécutifs avec des fractures diaphysaires fémorales qui avait verrouillage clou fixation par l'approche antérograde ou rétrograde. Tous les participants ont eu la physiothérapie post-opératoire . Le suivi a été de 9 mois. Résultats: L'angle de flexion de la hanche moyenne à 9 mois était 137.50 dans le groupe antérograde et 133.80 dans le groupe rétrograde (p = 0,150) . Test de Trendelenburg était négative dans les deux groupes et il y avait pas de décalage de l'extension du genou à 9 mois . Alors que l'angle moyen de la flexion du genou à 9 mois était dans le groupe 119,90 et 134,50 rétrograde dans le groupe antérograde (p = 0,023) . Tous les patients avaient atteint radiologique et de l'union de fracture clinique par 24 semaines après l'opération. Conclusion: Il n'y avait pas d'effet significatif de antérograde ou rétrograde approche sur la plage de mouvement de l'articulation de la hanche. Cependant, le mouvement du genou amélioré plus rapidement dans le groupe qui avait clouage antérograde . Mots clés: verrouillage ongles , fractures diaphysaires fémorales , requête conjointe

UNE EVALUATION PROSPECTIVE DES PREDICTEURS CLINIQUES DE TORSION TESTICULAIRE Introduction: Torsion testiculaire est une urgence urologique . Les patients peuvent présenter tôt à cause de la douleur, mais sont généralement mal diagnostiquée. Son diagnostic est essentiellement clinique et ne peut pas exiger des enquêtes en raison de contraintes de temps. Cette étude visait à étudier la relation entre les symptômes et les signes physiques chez les patients souffrant de douleurs dans les testicules et d'identifier ceux qui sont le plus prédictif de torsion testiculaire.

A PROSPECTIVE EVALUATION OF THE CLINICAL PREDICTORS OF TESTICULAR TORSION Abolarinwa A A, Omisanjo O A, Badmus A M, Ikuerowo S O CORRESPONDENCE: Dr. Abolarinwa Abimbola The Urology Division, Department of Surgery, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria. Email: [email protected]

Méthodes: Nous évalué prospectivement tous les patients qui présentaient des douleurs testiculaires à notre service d'urgence chirurgicale sur une période de 24 mois à l'aide d'un questionnaire qui comprenait 6 clinique et 9 paramètres de l'examen physique .Chevet analyse d'urine a été fait en utilisant des bandelettes réactives et tous les patients avaient exploration scrotale fait .nUn tableau croisé et une analyse multivariée sur SPSS et un niveau de signification de p 12 ans ont été inclus dans la présente analyse afin de déterminer la période et le point prévalence de l'hématurie et la rétention urinaire. Résultats: De 3645 répondants totaux , 1054 ( 28,9 % ) étaient des hommes > 12 ans inclus dans l'analyse . Période et le point

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3

Résultats: La question clé qui se pose est la norme minimale à atteindre dans le traitement du cancer de la prostate en Afrique de l'Ouest . Le consensus et lignes directrices couvriront les groupes dépistage , diagnostic , mise en scène , de traitement , d'éducation et de soutien aux patients , les réseaux de spécialistes multidisciplinaires , de la vérification , de la recherche , registre du cancer et de l'éducation de l'urologue . Conclusion: La directive précisera les normes acceptables pour atteindre ou aspiré dans le traitement du cancer de la prostate en Afrique de l'Ouest. Il permettra d'identifier les domaines prioritaires pour l'audit, la recherche, l'éducation et le développement .

Department of Obstetrics & Gynecology, Enugu state University Teaching hospital, Parklane Enugu State, Nigeria Correspondence: Euzebus C Ezugwu, [email protected]

Abstract Introduction: Although the maternal mortality ratio in the sub-region is unacceptably high, some of the causes of these deaths are largely preventable. Objective: To assess the impact of the adoption of evidence based guidelines on maternal mortality reduction at Enugu State University Teaching Hospital, Nigeria. Materials and Methods: A retrospective review of all maternal deaths between 1st January, 2005 and 31st December, 2010 was carried out. Evidence based management guidelines for eclampsia and post-partum hemorrhage were adopted. These intervention strategies were carried out from 1st January, 2008-31st December, 2010 and the result compared with that before the interventions (2005-2007). Main outcome measures: Maternal mortality ratio (MMR) and case fatality rates. Results: There were 9150 live births and 59 maternal deaths during the study period, giving an MMR of 645/100 000 live births. Pregnant women who had no antenatal care had almost 10 times higher MMR.There was 43.5% reduction in the MMR with the interventions (488 vs. 864/100 000 live births P = 0.039, odds ratio = 1.77). There was also significant reduction in case fatality rate for both eclampsia (15.8% vs. 2.7%; P = 0.024, odds ratio = 5.84 and Post partum hemorrhage (PPH) (13.6% vs. 2.5% P value = 0.023, odds ratio = 5.5. Obstetric hemorrhage was the most common cause of death (23.73%), followed by eclampsia. Conclusion: Administration of evidence based intervention is possible in low resource settings and could contribute to a significant reduction in the maternal deaths.

OVERACTIVE BLADDER: ETIOLOGY SYMPTOMATOLOGY AND RESPONSE TO TREATMENT (JANUARY 2010 – JULY 2013) ODOEMENE C. A. Federal Teaching Hospital Abakaliki (FETHA), Ebonyi – State, Nigeria. Email: [email protected] Objective: Overactive bladder is a hydra-headed monster, agonizing the patient and distracting the Urologist. It is characterized by the syndrome of unstoppable urgency, urinary frequency, nocturia with or without urge urinary incontinence. We set out to find out the etiology, Symptomatology, and response to treatment in two tertiary health institutions viz; FETHA Ebonyi State and Niger Foundation Hospital and Diagnostic Centre, Enugu. Methods: The study is entirely prospective involving 382 patients who had the syndrome seen in the two hospitals during the study period. Detailed history taking, thorough physical and neurological examination, laboratory investigations and various imaging studies were done when indicated. Tolterodine was the main anticholinegic used to treat the syndrome while the underlying the pathology was treated accordingly. Results: 382 patients, 363 (95%) males and 19 (5%) females where involved. Age range was between 37yrs and 103yrs with a mean of 73.4yrs. 313 (82%) patients had prostatic disease, while 99 (26%) patients had diabetes mellitus. Both urge urinary incontinence and fecal incontinence were observed simultaneously in 133 (35%) patients during the episode of involuntary painful bladder contraction. In 271 (71%) patients, the response to treatment with anticholinegic and treating the underlying pathology was excellent. Conclusion: Noted in this study was a common association of overactive bladder amongst patients with obstructive prostatic disease. Recognition of this syndrome should be prompt and adequate appropriate treatment instituted to prevent or ameliorate the depressive and miserable impact on the quality of life of these patients. KEY WORDS: Overactive bladder, Urge urinary incontinence, fecal incontinence and Tolterodine.

REDUIRE LA MORTALITE MATERNELLE DANS UN CADRE BAS DES RESSOURCES AU NIGERIA Résumé Introduction: Bien que le taux de mortalité maternelle est la sous-région est beaucoup trop élevé , certains des causes de ces décès sont en grande partie évitables . Objectif: évaluer l'impact de l'adoption de lignes directrices fondées sur des preuves sur la réduction de la mortalité maternelle à l'hôpital universitaire de l'Etat d'Enugu , au Nigeria . Matériel et méthodes : Une étude rétrospective de tous les décès maternels entre le 1er Janvier 2005 et le 31st Décembre 2010, a été réalisée. Directives de gestion fondée sur les preuves pour l'éclampsie et hémorragie post-partum ont été adoptées . Ces stratégie d'interventions ont été réalisées à partir du 1er Janvier 2008-Les 31st Décembre 2010 et le résultat par rapport à celle d'avant les interventions (20052007). Principaux critères de jugement : Taux de mortalité maternelle (TMM) et taux de létalité . Résultats: Il ya eu 9150 naissances vivantes et 59 décès maternels au cours de la période de l'étude , ce qui donne un TMM de 645/100 000 naissances vivantes . Les femmes

REDUCING MATERNAL DEATHS IN A LOW RESOURCE SETTING IN NIGERIA Ezugwu Euzebus C1, Agu Polycarp U1, Nwoke Miriam O2, Ezugwu Frank O.3 1

Department of Obstetrics & Gynecology, University of Nigeria Teaching Hospital, Ittuku-Ozalla, Enugu State, Nigeria 2 Department of Anesthesia, University of Nigeria Teaching Hospital, Ittuku-Ozalla Enugu State, Nigeria.

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enceintes qui n'avaient pas de soins prénatals ont près de 10 fois plus élevés MMR.There était la réduction de 43,5 % du TMM aux interventions (488 vs 864/100 000 naissances vivantes P = 0,039, odds ratio = 1,77 ) . Il y avait également une réduction signifi cative du taux de létalité pour les éclampsie ( 15,8 % vs 2,7 %, p = 0,024 , odds ratio = 5,84 et post partum (HPP ) ( 13,6% vs 2,5 % de la valeur P = 0,023 , odds ratio = 5.5 . hémorragie obstétricale était la cause la plus fréquente de décès ( 23,73 %), le suivi de l' éclampsie . Conclusion: intervention administration de la preuve fondée est possible dans les milieux à faibles ressources et pourrait contribuer à une réduction significative des décès maternels.

détermination des causes de décès et les facteurs contributifs évitables . MDSR s'appuie sur l'examen de la mortalité maternelle (MDR), les tendances et les causes de la mortalité maternelle au niveau installation communauté et Méthodologie:Une enquête confidentielle de tous les décès maternels déclarés dans les installations Schéma service des sages-femmes (SMS) et les communautés d'accueil dans les trois zones du Nord du Nigeria à partir du 1er Juillet 2011 au 31 D é c e m b re 2 0 1 1 , e n u t i l i s a nt d e s o u t i l s M D R . Résultats:Le taux de mortalité maternelle globale (ROR) était de 181 /100 000 naissances vivantes . Sur les 141 décès maternels confirmés, 53,6 % étaient unbooked et 38,2 % étaient grandes multipares. La plupart de ces femmes étaient mariés (99,3 %) , musulmans ( 95,3 %) , sans éducation formelle ( 82,5 % ) et étaient femmes au foyer à temps plein (95,0 %) . Complications obstétricales directes ont représenté 80,9 % des décès d'hémorragie obstétricale et comptabilité éclampsie pour 2/3rd de ces décès. Le taux de natalité était encore 18/1000 les livraisons totale . Cinquante pour cent des livraisons ont été effectuées par des accoucheuses qualifiées. Décès post-partum (70%), les livraisons à domicile (55,4 %) , les décès des établissements de santé ( 51,8 %) et facteurs liés au patient ( 87,2 %) ont été les principaux facteurs sous-jacents . Conclusion: Les facteurs évitables de décès maternels dans le nord du Nigeria étaient les suivants: facteurs faible statut socio-économique , livraison à domicile , des patients et de la communauté . Une contraception efficace , la détection des signes de danger , la livraison de l'hôpital et invite soins obstétricaux d'urgence de qualité sont les principales interventions pour réduire la mortalité maternelle dans le nord du Nigeria . Mots-clés: maternelle réponse Surveilance mort , le nord du Nigéria .

MATERNAL DEATH SURVEILANCE RESPONSE IN NORTHERN NIGERIA OCHEJELE S1, ABDULLAHI M J2, OKOLI U2, ALOBO G1. Correspondence Author:[email protected] 1 Federal Medical Centre Makurdi, Nigeria. 2. National Primary Health Care Development Agency Abuja, Nigeria. Background: Maternal death surveillance response (MDSR) means taking action to reduce avoidable maternal mortality by improving quality of care based on the identification, notification, quantification, and determination of causes of death and their avoidable contributing factors. MDSR builds on maternal death review (MDR), trends and causes of maternal death at the community- and facility-level. Methods: A confidential enquiry of all reported Maternal deaths at the Midwives Service Scheme facilities (MSS) and the host communities in the three Northern zones of Nigeria from 1st July, 2011 to 31st December, 2011 using MDR tools was carried out. Results: The overall Maternal Mortality Ratio (MMR) was 181/100,000 live births. Out of the 141 confirmed maternal deaths, 53.6% were unbooked and 38.2% were grand multiparous women. Most of these women were married (99.3%), Muslims (95.3%), with no formal education (82.5%) and were full time house wives (95.0%). Direct obstetric complications accounted for 80.9% of the deaths with Obstetric haemorrhage and Eclampsia accounting for 2/3rd of these deaths. The still birth rate was 18/1000 total deliveries. Fifty percent of the deliveries were conducted by Skilled Birth Attendants. Postpartum deaths (70%), Home deliveries (55.4%), Health facility deaths (51.8%) and Patient factors (87.2%) were the main underlying factors. Conclusion: The avoidable factors for maternal deaths in Northern Nigeria were: Low socioeconomic status, home delivery, patient and community factors. Effective contraception, detection of danger signs, hospital delivery and prompt quality Emergency obstetric care are the key interventions to reduce maternal mortality in Northern Nigeria. Keywords: Maternal Death Surveillance Response, Northern Nigeria.

EXPERIENCE WITH FACILITY BASED MATERNAL DEATH REVIEW IN NORTHERN NIGERIA Hauwa Mohammed Jan J Hoffman , Health Partners International, UK. Background: Facility-based Maternal Death Reviews (MDRs) were introduced in 75 Emergency Obstetric and Newborn Care (EmONC) facilities in three Northern Nigeria states in 2008.The is to evaluate effectiveness of the MDR system and give recommendations based on the findings. Methodology: Combination of quantitative and qualitative research methods, including review of MDR forms and HMIS data on maternal deaths (MDs) and interviews with members of the MDR committees. Results: MDRs were initially conducted in 33 hospitals, but the process came to a halt after some time and had to be revitalised in 2012. Reasons for this were transfer of key members of MDR teams, lack of regular supervision and shortage of staff. 12% of 768 identified MDs were recorded on MDR forms and 6.7% had actually been reviewed. Actions undertaken based on MDRs: organizing on-the-job training, establishment of emergency cupboards in labour ward, redistribution of staff, voluntary blood donation campaigns and health education in the community and strengthening of the referral system. Achievements include: better management of patients, mobilization of resources, and recruitment of staff and establishment of revolving emergency drugs funds. Challenges were: fear of blame by the health workers,

MORTALITE MATERNELLE SURVEILANCE RÉPONSE DANS LE NORD NIGERIA Objectif: Réponse de surveillance de la mortalité maternelle ( MDSR ) signifie prendre des mesures pour réduire la mortalité maternelle évitable en améliorant la qualité des soins basée sur l'identification , la notification , la quantification et la

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shortage of staff, and transfer of key members of the MDR team, inadequate supervision and poor record keeping. Conclusion: MDR requires teamwork, commitment and champions in health facilities to spearhead the process. MDR needs to be institutionalized in Ministry of Health, which provides policy guidance and supportive supervision.

Methods: Households of deceased persons were purposively selected and verbal autopsy questionnaires administered to their relatives. Thedeceased relatives were thus interviewed to recall the signs and symptoms suffered by the deceased prior to death. These were later interpreted based on expert or data-derived algorithms to establish most probable cause of death. The outcome of the questionnaire survey was then matched with information of cause of maternal death retrieved from the district hospital records. Results: Haemorrhage emerged as the major cause of maternal deaths in the Offinso district, with the 30 – 35 year age bracket constituting the most vulnerable group. Specific cause of death could be estimated at 61.76% reliability. Conclusions: In many rural areas of developing countries death records are not adequately captured as many deaths especially in remote communities occur outside health facilities. Verbal autopsy technique for assigning cause of death can be usefully applied to fill this gap. Such knowledge of pattern of death in such a community is important to policymakers, public health officials and medical personnel in order to set health budgetary priorities and design appropriate policies for intervention.

EXPERIENCE AVEC DES INSTALLATIONS BASE MATERNELLE REVUE DE MORT DANS LE NORD NIGERIA Introduction: Sur les décès maternels en fonction des installations ( MDR ) ont été introduits dans 75 obstétricaux d'urgence et néonatals ( SONU ) installations dans trois Etats du nord du Nigeria en 2008 . Objectifs: Évaluer l'efficacité - du système MDR et donner des recommandations fondées sur les résultats . Méthodologie - Combinaison de méthodes de recherche quantitatives et qualitatives, y compris l'examen des formes MDR et les données de SIMD sur les décès maternels (MDS) et des entretiens avec les membres des comités MDR. Résultats - MDR ont d'abord été menées dans 33 hôpitaux, mais le processus s'est interrompu après un certain temps et a dû être revitalisé en 2012. Les raisons de ce transfert étaient des membres clés des équipes MDR le manque de supervision régulière et la pénurie de personnel. 12 % des 768 médecins identifiés ont été enregistrés sur les formes multirésistantes et 6,7 % avaient effectivement été examinés. Les actions entreprises sur la base MDR: organisation de la formation en cours d'emploi , la création d'armoires d'urgence en salle de travail , la redistribution du personnel , des campagnes de don de sang volontaires , éducation à la santé dans la communauté et le renforcement du système de référence . Les réalisations comprennent: une meilleure gestion des patients, la mobilisation des ressources , le recrutement du personnel et la création de fonds renouvelables de médicaments d'urgence . Défis sont : la peur du blâme par les travailleurs de la santé , la pénurie de personnel , le transfert des membres clés de l'équipe MDR , une supervision inadéquate et mauvaise tenue des dossiers . Conclusion - MDR nécessite un travail d'équipe, l'engagement et les champions dans les établissements de santé pour guider le processus . MDR doit être institutionnalisée au sein du ministère de la Santé , qui donne des orientations et la supervision formative .

RÉSUMÉ EVALUATION DU ROLE DE L'AUTOPSIE VERBALE COMME UN OUTIL DE VERIFICATION DANS LA DEFINITION DE LA MORTALITE MATERNELLE DANS LE DISTRICT OFFINSO DU GHANA Cette étude visait à évaluer le rôle de l'autopsie verbale comme un outil de vérification dans la définition de la mortalité maternelle pour la période 2006-2011 dans le district Offinso du Ghana . Les ménages de personnes décédées ont été choisis à dessein et questionnaires d'autopsie verbale administrés à leurs parents. Parents ont ainsi été interrogés Thedeceased de rappeler les signes et les symptômes subis par le défunt avant son décès. Ceux-ci sont interprétées plus tard sur la base de l'expert ou des algorithmes de données dérivées pour établir la cause la plus probable de death.The résultats de l'enquête par questionnaire a ensuite été comparé avec les données de la cause de décès maternel extraites des dossiers de l'hôpital de district . Hémorragie apparue comme la principale cause de mortalité maternelle dans le quartier Offinso , avec le 30 - support 35 ans l'année constituant le groupe le plus vulnérable . Cause précise du décès peut être estimé à 61,76 % de fiabilité. Dans de nombreuses zones rurales des pays en développement les actes de décès ne sont pas suffisamment pris en compte le plus grand nombre de décès en particulier dans les collectivités éloignées se produisent en dehors des établissements de santé. Technique d'autopsie verbale pour attribuer la cause du décès peut être utilement appliquée à combler cette lacune. Cette connaissance de motif de la mort dans une telle communauté est important pour les décideurs, les responsables de la santé publique et le personnel médical afin d' établir les priorités de la santé budgétaire et élaborer des politiques appropriées d'intervention .

ASSESSMENT OF THE ROLE OF VERBAL AUTOPSY AS AN AUDIT TOOL IN DEFINING MATERNAL MORTALITY IN THE OFFINSO DISTRICT OF GHANA. Opare-AddoH.S1; SapporC.A 2 1. Department of Obstetrics and Gynaecology KomfoAnokye Teaching Hospital Kumasi, Ghana 2. St. Patrick Catholic Hospital Offinso -Kumasi, Ghana Background: This study sought to assess the role of verbal autopsy as an audit tool in defining maternal mortality for the period 2006-2011 in the Offinso District of Ghana.

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through collaboration amongst various departments and effective coordination of activities.

DECISION TO DELIVERY INTERVAL FOR EMERGENCY CAESAREAN SECTION AT UNIVERSITY OF NIGERIA TEACHING HOSPITAL IN ENUGU (UNTH), SOUTH EAST NIGERIA Euzebus Chinonye Ezugwu, Chukwuemeka A Lyoke, Emmanuel OnyebuchiUgwu, EmekaIfeanyiIIoghalu, Tochukwu C Okeke

Résumé Introduction: Retard dans la conduite de la césarienne (C / S ) dans des conditions d'obstétrique d'urgence a été associée à une mauvaise maternelle et la santé périnatale . Objectif: déterminer la prestation de décision de l'intervalle fœtus (DDI ) en cas d'urgence C / S et les facteurs responsables des retards dans la mise en oeuvre d'urgence C / S lorsque cela est indiqué , afin de proposer des solutions . Méthodes: Une étude observationnelle prospective de 12 mois tous consécutive urgence C / S à UNTH , Enugu à partir du 1er Janvier 2012 au 31 Décembre 2012. L'utilisation d'un questionnaire préformé , des mesures d'information et de résultats pertinents ont été recueillies. Les données ont été analysées à l'aide de statistiques à la fois descriptives et déductives à intervalle de confiance de 95 % en utilisant Epi info version du logiciel statistique . P valeur inférieure à 0,5 a été considérée comme statistiquement significative. résultat :Un total de 351 cas d'urgence C / S et 987 livraisons ont été effectuées au cours de la période d'étude soit un taux de 35,56 % C / S d'urgence . L'âge moyen des femmes était de 30,28 ± 4,9 années, la parité moyenne de 1,82 ± 1,58 . À propos de 23,9 % ( 84 ) présenté en urgence unbooked . Environ 74 % ( 260 ) de la C / S ont été fait sous anesthésie rachidienne , 22,79 % ( 80 ) sous anesthésie générale et épidurale 3,13% ( 11 ) . Les chirurgies ont été réalisées principalement par les officiers supérieurs ( 95,16 %) et 4,84% par des consultants ( 4,84% ) .L'intervalle décision d'incision moyenne était de 231 ± 280.77mins ( gamme de 60 à 1080 ) minutes . L' DDI moyen était de 299,97 ± 178,94 ( gamme de 90 à 1100 ) minutes . Retard anesthésie était la raison la plus courante pour le retard ( 56,3 % ) , suivie par un retard dans l'acquisition de médicaments essentiels ( 43,7 %) et la sécurisation du sang pour la chirurgie ( 33 . % % ) . La plus fréquente indication C / S était une absence de progrès / dystocie (42% ) , la souffrance fœtale (28% ) et l'éclampsie et l'éclampsie sévère avant ( 19 % ) . conclusion: La DDI pour urgence C / S dans l'institution est élevé et peut affecter négativement le résultat maternelle et périnatale. Ce délai peut être évité grâce à une coordination efficace des activités et la collaboration entre les différents départements

Department of Obstetrics &Gynaecology, University of Nigeria Teaching Hospital, Ituku-Ozalla PMB 01129, Enugu State, Nigeria, E-mail:[email protected] Introduction: Delay in conducting caesarean section in emergency obstetric condition has been associated with poor maternal and perinatal outcome. Objective: To determine the decision to delivery interval for emergency caesarean section and the factors responsible for delays in carrying out emergency caesarean section when indicated in order to proffer solutions. Methods: A 12 months prospective observational study of all consecutive emergency caesarean sections at University of Nigeria teaching hospital Enugu from 1st January 2012 to 31st December 2013. Cases of IUFD were excluded from the study. All participants were followed up from the point of decision until discharge by a trained doctor. Using a preformed questionnaire relevant information and outcome measures were gathered. Data were analyzed using both descriptive and inferential statistics at 95% confidence interval using Epi info statistical software version. P value less than 0.5 was considered statistically significance. Result: A total of 351 emergency caesarean out of sections were performed out of the 987 deliveries during the study period giving an emergency C/S rate of 35.56%. The mean age of the women was 30.28±4.9 (range 15 and 47) years, mean parity 1.82±1.58 ( range 0- 8). About 76.1% (267) received antenatal care in the institution while 23.9% (84) presented as unbooked emergencies. All the participants had some level of education. About 74% (260) of the cases were done under spinal anaesthesia, 22.79% (80) under General anaesthesia and epidural 3.13% (11). The Surgeries were done mainly by Senior registrars (95.16%) and very few by the consultants (4.84%). The mean decision to incision interval was 280.77mins ± 231 (range 60-1080) minutes while the decision -delivery of the fetus interval was 299.97± 178.94 (range 90- 1100) minutes. The mean duration of surgery was 91.57± 30.4 (range 60 and 1440) minutes. Anaesthetic delay was the commonest reason for the delay, followed by delay in procuring essential drugs and securing blood for surgery. The commonest indication for caesarean section was suspected fetal distress, failure to progress/ obstructed labour and severe pre eclampsia and eclampsia. Conclusion: The decision delivery interval for emergency caesarean section in the institution was long and may negatively affect the maternal and perinatal outcome following caesarean section in the institution. Such delay can be avoided

SEVERE MORBIDITIES ASSOCIATED WITH INDUCED ABORTIONS IN KOMFO ANOKYE TEACHING HOSPITAL, KUMASI, GHANA Damalie FJMK1, Dassah ET1, Morhe ESK1,2, Nakua EK2, TagborHK2, Opare-Addo HS1,2 1 Komfo Anokye Teaching Hospital,Kumasi, Ghana 2

School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana Correspondence to: Francis JMK Damalie, Email: [email protected]

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pas un revenu régulier pour soutenir une famille ( p = 0,001 ) . L'âge gestationnel au cours de laquelle la grossesse a été interrompue était indépendamment associée à une morbidité sévère (RR ajusté 1,96 , IC 95% , 1.22-3.15 ) . Bien morbidités sévères semblent plus fréquents chez les utilisateurs de misoprostol, la différence n'était pas statistiquement significative après ajustement pour les facteurs confondants. Conclusion: La planification familiale et les soins complets d'avortement permise par la loi doit être madeeasily accessibles à la population, en particulier les adolescents de l'école .

Background: Misoprostol has become a popular over the counter self-administered abortifacient in Ghana. This study aimed to compare the sociodemographic characteristics and clinical complications associated with induced abortions among misoprostol users and non-users admitted to KomfoAnokye Teaching Hospital (KATH), Kumasi. Methods: This was a retrospective cohort study conducted at the gynaecological ward of KATH, over a four-month period using a structured pre-tested questionnaire. Data were analysed using χ2, Fisher's exact and student t-tests. Poisson regression models with a log-link function were fitted to examine the factors associated with severe morbidity using crude and adjusted relative risks (RRs) with 95% confidence intervals (CIs). P < 0.05 was considered statistically significant. Results: Overall, 126 misoprostol users and 126 misoprostol non-users were recruited into the study. About 71% of the clients had self-induced abortions. Misoprostol users were more likely to be younger (p15years presenting to the Radiology Department of Komfo Anokye Teaching Hospital (KATH) for abdominal ultrasound between 2009 and 2012. Patient demographics, presenting complaint, weight and height were recorded. The gallbladder was assessed by ultrasound for presence of gallstones. Cholelithiasis was defined as presence of gallstones or absence of gallbladder. Data were expressed as descriptive and inferential statistics. Results: There were 2824 participants. Fifty-five percent were females. Mean age was 47±18 years. Mean body mass index (BMI) was 24.0±5.5. Mean parity among females was 3±3. 141 participants had gallstones present and 25 had undergone cholecystectomy, giving a prevalence of cholelithiasis of 5.9 (95%C.I: 5.0,6.8). Prevalence among males and females were 4.7 and 6.8 respectively. Prevalence increased steadily from 2.8 among patients 0.05). CONCLUSIONS: Prevalence of cholelithiasis among patients undergoing ultrasonography in KATH was 5.9. Age, sex, BMI, family history and parity influenced the prevalence. TITRE : PREVALENCE DE LA LITHIASE BILIAIRE CHEZ LES PERSONS AYANT UNE ECHOGRAPHIE ABDOMINALE A KOMFO ANOKYE TEACHING HOSPITAL(KATH) KUMASI, GHANA 1,2 Adam Gyedu, 2Kwadwo Adae-Aboagye, 3Augustina Badu-Peprah 1

l'École des sciences médicales, Université Kwame Nkrumah de Sciences et technologies de Kumasi, Ghana; 2 départementde chirurgie, KATH, Kumasi, Ghana; 3 départementde radiologie, KATH, Kumasi, Ghana CORRESPONDANT: [email protected]

INTRODUCTION: Un nombre croissant de patients ayant subi une cholécystectomie au Ghana a été signalée. Toutefois, la prévalence de calculs biliaires parmi le Ghanéens reste inconnue. Nous visons à déterminer la prévalence des calculs biliaires parmi la population de Kumasi. METHODES: Nous avons effectué une étude transversale des patients >15 ans présentant au département de radiologie de KATH pour échographie abdominale entre 2009 et 2012. Les données démographiques des patients, leur plainte, le poids et la taille ont été enregistrées. La vésicule biliaire a été évaluée

par échographie par la présence de calculs biliaires. La lithiase biliaire a été définie comme la présence de calculs biliaires ou absence de vésicule biliaire. Les données ont été exprimées comme descriptif et inférence statistique. RESULTATS: Il y a eu 2824 participants. Cinquante-cinq pour cent étaient des femmes. Âge moyen était de 47 ± 18 ans. L'indice de masse corporelle (IMC) était 24.0± 5,5. La Parité moyenne chez les femmes était 3 ± 3. 141 Participants avaient des calculs biliaires et 25 avaient subi une cholécystectomie, donnant une prévalence de lithiase biliaire de 5,9 (95 %C. I : 5.0, 6 .8). La prévalence chez les hommes et les femmes ont était de 4,7 et 6,8 respectivement. La prévalence a augmenté régulièrement de 2,8 parmi les patients 5 (OU=1.71 ;p>0.05 ). CONCLUSIONS: La prévalence des lithiases biliaires chez les patients subissant une échographie à KATH était de 5,9. Âge, sexe, IMC, antécédents familiaux et la parité influencent la prévalence.

CHARACTERISTICS OF PATIENTS WITH PRIMARY LIVER CANCER AT KOMFO ANOKYE TEACHING HOSPITAL, GHANA 1,2 Gyedu A, 3Shrauner WR, 4Kingham TP 1

School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; 2Directorateof Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana, 3 Weill Cornell Medical College, New York, USA, 4Division of Hepatopancreatobiliary Surgery, Dept. of Surgery, Memorial Sloan-Kettering Hospital, New York, USA Correspondence: [email protected] Background: Little is known about the epidemiology of primary liver cancer (HCC) in Ghana. This study aimed to describe the characteristics of HCC patients at the Komfo Anokye Teaching Hospital (KATH) and to determine their treatment options per the Barcelona Clinic Liver Cancer (BCLC) staging system. Methods: We conducted a retrospective review of patients managed as HCC at KATH between January 2007 and May 2013. Patients' demographics, investigations, management and outcome were extracted. BCLC staging system was applied to determine their treatment option. Therapeutic options were calculated for low, intermediate, and high INR values as 98.1% of these were missing. Results: 44.3% of charts were available for review(206/465). Average patient age was 44years. 64.1% of patients presented with ascites; 21.8% with hepatic encephalopathy. 52% were HBV positive. All patients received supportive treatment, save four receiving chemotherapy. None underwent surgery, tumor ablation or transarterial chemoembolization (TACE). Majority of patients with available charts(76.2%) were

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discharged alive. However half of the 465 patient cohort died in hospital. Sufficient information for BCLC staging was available in 118 patients. Depending on the predicted INR,