TENS for surgical stabilisation of acetabular fracture in the skeletally immature: A novel technique.

BACKGROUND: Acetabular fractures in childhood are rare and the literature is scarce to describe a standard protocol in surgical management of these injuries. As the patient is still growing, it warrants a detailed assessment with a sound surgical plan if operative intervention is deemed necessary to prevent late complications. Throughout literature, most fixation rely on using pins, screws, plates or combination of the three which require large surgical exposure and risk of secondary physeal injury, hence we come up with a method of using the Titanium Elastic Nail System (TENS) to overcome this issue. We describe a novel technique in managing acetabular fractures in this group of patients using the TENS. METHOD: An 8 year old girl with a diagnosis of right anterior column posterior hemitransverse acetabular fracture was fixed with 3 TENS for supra-acetabular, anterior column and posterior column fragments. Surgery was performed in a minimally invasive manner. No drilling was performed during the surgery and implant insertion is done manually. RESULTS: Advantages of this procedure include minimally invasive surgery with smaller wounds, minimal intraoperative bleeding and theoretically reduces the risk of premature fusion of the triradiate cartilage. Patient is allowed early rehabilitation with this method. CONCLUSION: This novel method provides an alternative to traditional usage of wires, pins, plates and screws as is described in most literature. However, it requires the surgeon to appreciate that the safe corridors for the implant are much narrower than adults. We recommend this technique for fractures that are deemed suitable for intramedullary fixation and further research in the future will be needed.

Effect of hemoglobin polymorphism on performance traits in indigenous chicken genotypes in Nigeria.

The effect of hemoglobin polymorphism on performance traits in Nigerian indigenous chicken types was investigated in this research. The chickens were obtained through the pure mating of the sire and dam of each population of frizzle feathered, normal feathered, and naked neck chickens to produce F1 offsprings. One hundred fifty-five chicks (37 frizzle, 79 normal, and 39 naked neck) were measured for body weight (g), breast girth (cm), and tibia length (cm). At 20 weeks, 5 mL of blood was collected from the wing vein of each chicken into heparinized tubes and labeled according to its tag number for electrophoresis. The electrophoresis procedures outlined by RIKEN BRC (2006) was used. 0.6 µl of undiluted blood constituent was taken. The prepared buffer (Tris 10.91 g, EDTA 0.60 g, boric acid 3.10 g) at pH 8.5 was used for the gel preparation. The cellulose acetate membrane was used as a supporting medium. The electrophoresis was carried out at a voltage of 150 V for about 50 min at a temperature of 4 °C. The migration of the genotype was from cathode (-) to anode (+). Each bird was scored as either fast (AA), midway (AB), or slow (BB) according to the mobility on the cellulose acetate paper for hemoglobin. Data were analyzed using statistical analysis system (SAS 2002), and significant means were separated using Tukey's Honestly Significant Difference. Hardy Weinberg's equation was used to calculate genotypic and allelic frequencies and tested using chi-square (χ2). Hemoglobin had three polymorphic forms viz AA, AB, and BB. The genotypic frequencies of hemoglobin (HbAA, HbAB, and HbBB) were 49, 56, and 50, respectively, while the allelic frequencies were 0.50 for both HbA and HbB. The effect of the polymorphic forms on body weight (g), breast girth (cm), and tibia length (cm) showed that the AA had significantly higher (P < 0.05) body weight (g) than AB and BB (1296.43 g, 1029.59 g, and 884.46 g, respectively). The AA was also higher (P < 0.05) than the AB and BB for breast girth (cm) and tibia length (cm). Heterozygotes adapted and survived better than the homozygotes. The effect of the polymorphic forms of hemoglobin on body weight (g), breast girth (cm), and tibia length (cm) showed that it could be used for body weight selection.

Street dust heavy metal pollution implication on human health in Nicosia, North Cyprus.

The consequence of carcinogenic and non-carcinogenic health risks of the heavy metal concentrations in street dust of North Cyprus is yet to be reported. This study is aimed at investigating the concentration of six different heavy metals' concentration explicitly: As, Cu, Zn, Ni, Cr, and Pb, along leading highways in Nicosia. The result obtained was analyzed using an X-ray fluorescent machine. Multivariate and statistical methods were applied for the data analysis using xlstat MS-excel; furthermore, index of geo-accumulation (Igeo) and human health risk assessment using exposure pathways as defined by United State Environmental Protection Agency (USEPA) pollution mode were also used for level assessment and health risk implications. The average (M ± SD) concentrations of the metals in the dust are as follows: As (17.48 ± 1.53 mg/kg), Cu (51.86 ± 8.60 mg/kg), Cr (321.14 ± 8.20 mg/kg), Pb (35.62 ± 8.54 mg/kg), Ni (64.79 ± 8.72 mg/kg), and Zn (136.13 ± 30.85 mg/kg). Variation coefficient, Vc, and principle component analysis (PCA) suggested that As, Cr, Ni, and Pb have same source of pollution emission from both natural and anthropogenic activities, Zn from traffic emission while Cu from natural source. However, the result was compared with other nearby towns bordering North Cyprus; all the metal shows similar pattern of pollution with the exception of Cr which is 5 and 11 times higher than street dust of Amman (Jordan) and Tokat (Turkey), respectively. Additionally, Igeo result has the following decreasing order: Zn > Cr > Pb > Ni > Cu > As and also revealed that the As, Cu, and Ni have originated from natural source. Cr has mix source: one from traffic and the other one from atmospheric deposition. Also, Pb is emitted from industrial pollution, whereas 80% of Zn are from traffic-related emissions. The non-carcinogenic health risk (hazard quotient (HQ) and hazard index (HI)) follows the order Cr > As>Ni > Pb > Zn > Cu for children and adults. It is found that the HI of As, Cu, Ni, Pb, and Zn is less one; hence, the street dust does not exhibit non-carcinogenic health risk. But that of Cr content is greater than one, with HI values of Cr 1.44E+02 and 1.55E+01 for children and adults, respectively. The result for carcinogenic health risk (total cancer risk (TCR)) has the following order: Pb (1.42E-05) > Cr (4.81E-09) > (Ni 1.35E-09) > As (1.96E-10). With all the values less than threshed hole limit of TCR ≥ 10-4, street dust does not possess carcinogenic health risk for the entire values of six heavy metals considered in this work.

Clinicopathological and molecular significance of Sumolyation marker (ubiquitin conjugating enzyme 9 (UBC9)) expression in breast cancer of black women.

The majority of breast cancers (BC) in Nigerian women are triple negative and show breast cancer-associated gene 1 (BRCA1) deficiency as well as the basal like phenotype, with a high mortality rate. In contrast to the well-defined predictive factors for the hormonal therapy, there is a paucity of information on the BRCA1 deficiency breast tumor biology, particularly among African women. BRCA1 Sumoylation (UBC9) has been speculated to be involved in the ER transcription activity, BRCA1 deficiency and triple negative BC. We therefore hypothesized that UBC9, a SUMOylation marker, may have contributed to the aggressive nature of BRCA1 tumor phenotype observed in Nigerian women. This study investigated the immunoprofiles of UBC9 in tissue microarray (TMA) of 199 Nigerian women and correlated their protein expression with clinical outcome, pathological responses and the expression of other biomarkers to demonstrate the functional significance in Nigerian women. The protein expression of UBC9, as compared with other biomarkers, showed an inverse correlation with steroid hormones (ER, progesterone (PgR)), BRCA1, p27, p21 and MDM4, and a positive correlation with triple negative, basal cytokeratins (CK14 and CK5/6), epidermal growth factor receptor (EGFR), basal-like breast cancer phenotype, p53, phosphoinositide-3-kinases (PI3KCA), placental cadherin, (P-cadherin) and BRCA1 regulators (metastasis tumor antigen-1 (MTA1). Survival analysis showed that those tumors positive for UBC9 expression had a significantly poorer breast cancer-specific survival (BCSS) as compared with those showing negative expression. UBC9 remained an independent predictor of outcome for BCSS. This study demonstrates that UBC9 appears to play an important role in the tumor biology of Nigerian women. Therefore, a novel UBC9 targeted therapy in black women with BC could enhance a better patient outcome.

Diabetic foot lesions as seen in Nigerian teaching hospital: pattern and a simple classification.

BACKGROUND: Diabetic foot syndrome is a complication of diabetes mellitus that has serious socioeconomic implications for the individual, family and the society as a whole. When there are ulcers, the condition becomes limb threatening. Early detection of the risk factors and appropriate management of the ulcers reduces the incidence of amputations, morbidity and mortality. OBJECTIVE: To find the pattern of diabetic foot laesions (DFL) as seen at the orthopaedic clinic of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria over a five-year period and to present a classification of DFL. MATERIALS AND METHODS: From June 2006 to June 2011 diabetics who had complaints arising from their feet were referred to the orthopaedic clinic at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. At presentation each patient was examined and investigated. Each foot was examined thoroughly and all the laesions were documented and graded according to Wagner's classification. Out come of management of the cases of DFL was also recorded. All the data collected was analysed. RESULTS: Two groups (A and B) of patients were identified. In group (A) were patients in whom there was good renal function, no septicaemia, mean value of fasting blood glucose most often was < or = 14 mmol/l. In this group only the feet were threatened. There was a second group (B) in whom there was septicaemia, mean value of fasting blood glucose most often was < or = 15 mmol/l, and impaired renal function (ketone bodies were identified in urine, high serum levels of urea and creatine). Most of these patients had gangrene of the whole foot. In some of the patients infections extended into the gastrosnemius muscle. In diabetic foot laesions grades 0-3, no part of the foot was amputated. In diabetic foot laesions grade 4, infections were controlled and part of the foot had to be amputated. In diabetic foot laesions grade 5, infections were controlled with difficulty and there were systemic symptoms. Amputation of the whole foot was always indicated in this group of patients. The level of amputation most often was far above the ankle joint, either below or above knee. CONCLUSION: Outcome of treatment revealed three groups of feet. There were salvageable, difficult to salvage and unsalvageable feet. These three outcomes of treatment of diabetic foot lesions formed the basis of a new grading system: gradel (salvageable), grade 2 (difficult to salvage) and grade 3 (unsalvageable). The condition of the patient determines the urgency, extent of intervention and length of stay in the hospital.

Molecular characteristics and prognostic features of breast cancer in Nigerian compared with UK women.

Although breast cancer (BC) incidence is lower in African-American women compared with White-American, in African countries such as Nigeria, BC is a common disease. Nigerian women have a higher risk for early-onset, with a high mortality rate from BC, prompting speculation that risk factors could be genetic and the molecular portrait of these tumours are different to those of western women. In this study, 308 BC samples from Nigerian women with complete clinical history and tumour characteristics were included and compared with a large series of BC from the UK as a control group. Immunoprofile of these tumours was characterised using a panel of 11 biomarkers of known relevance to BC. The immunoprofile and patients' outcome were compared with tumour grade-matched UK control group. Nigerian women presenting with BC were more frequently premenopausal, and their tumours were characterised by large primary tumour size, high tumour grade, advanced lymph node stage, and a higher rate of vascular invasion compared with UK women. In the grade-matched groups, Nigerian BC showed over representation of triple-negative and basal phenotypes and BRCA1 deficiency BC compared with UK women, but no difference was found regarding HER2 expression between the two series. Nigerian women showed significantly poorer outcome after development of BC compared with UK women. This study demonstrates that there are possible genetic and molecular differences between an indigenous Black population and a UK-based series. The basal-like, triple negative and BRCA1 dysfunction groups of tumours identified in this study may have implications in the development of screening programs and therapies for African patients and families that are likely to have a BRCA1 dysfunction, basal like and triple negative.

Histological study of smoke extract of Tobacco nicotiana on the heart, liver, lungs, kidney, and testes of male Sprague-Dawley rats.

BACKGROUND: Some of the effects of tobacco on man's health are well documented in many scientific reports. Whenever tobacco is used either in smoked or chewed form, nicotine is absorbed by the lungs and oral cavity and is spontaneously moved into the bloodstream where it is circulated throughout the body system. MATERIALS AND METHODS: Ten male Sprague-Dawley rats were used for this investigation. The animals were randomly assigned into two groups, A and B, of five animals each. The animals in group B (treatment group) were exposed to smoke from a completely burnt 0.74 g leaf extract of Tobacco nicotiana, wrapped in 0.5 g of sterilized cotton wool for 5 minutes three times daily (7 am, 10 am, and 1 pm). The animals in group A (control group) were exposed to smoke from completely burnt 1.24 g of sterilized cotton wool with the same parameters as observed with the treatment groups. The duration of exposure was 5 days. Three hours after the last exposure, all the animals were killed by cervical dislocation. The heart, liver, lungs, kidney, and testes were carefully excised, blotted dry, and fixed in formol saline for histological analysis using Hematoxylin and Eosin stain. RESULTS: Using the light microscope, it was observed that the histoarchitectural profiles of the studied organs in the sections obtained from the control animals were well preserved. Histopathological observations of the heart, liver, lungs, kidney, and testes in the treated animals showed a varying pattern of histological alterations, and distortions such as mild edema and occasional destruction of myocardial fibers, degeneration of the hepatocytes, reduction in the population of the germ cells, enlargement of the alveoli, alveolar hemorrhage, shrinkage of the glomerulus and glomerular hemorrhage were observed in the sections of the organs of the study of the animals in the treatment group when compared with the control group, hence showing that the smoke extract of Tobacco nicotiana has adverse and compromising effects on the heart, liver, lungs, kidney, and testes of male Sprague-Dawley rats. CONCLUSION: From these observations, it can be inferred that the exposure of male Sprague-Dawley rats to the smoke extract of Tobacco nicotiana may be associated with structural damage of some vital organs.

The use of drains in thyroid surgery.

OBJECTIVE: To evaluate the necessity and benefits of the use of drains and their limitations in thyroidectomy and assess their relationship with cost of surgery and hospital stay. METHODS: We conducted a prospective randomised study on 67 patients divided into two groups. A consisted of 35 patients with drain and B, 32 patients without drain between January 2005 and June 2007. All had subtotal thyroidectomy and the technique and method of closure were the same. No anticoagulant was used and the clotting profiles were within normal range in the two groups. RESULTS: The sixty seven patients recruited for the study were made up of 60 females (89.6%) and 7 males (10.4%). The mean age for group A was 50.14 +/- 10.7 years, group B was 51.97 +/- 9.5 years. The P value for the mean ages of the two groups is 0.464 (p=0.05,t=3.98).There was no blood transfusion. Three patients developed features of respiratory obstruction (respiratory distress and stridor) -the first 2, one from each group was as a result of laryngeal oedema from trauma of difficult intubation. The third was from group B, as a result of hemorrhage and haematoma collection (she was one of the controlled thyrotoxic patients). Two patients (5.7%) developed wound infections in group A, which increased morbidity, hospital bill and prolonged hospital stay as compared to group B. The highest volume of drainage of 35ml was from a woman with a big goiter (120g). Average drainage was 17.7 +/- 6.9ml. CONCLUSION: The use of drains is not necessary in all cases of thyroidectomy but for cases with large cavity post extraction and copious oozing in vascular glands. Some of the limitations to the use of drains are infections, this can prolong hospital stay and thereby increase hospital bill.

Multiple embolisations in rheumatic heart disease: a case report.

BACKGROUND: Though systemic thromboembolism is not an infrequent complication of rheumatic valvular disease, multiple embolic phenomena are rare. OBJECTIVE: To present a patient with rheumatic heart disease associated with multiple embolic complications. CASE REPORT: A 44-year-old lady with rheumatic valvular disease and atrial fibrillation defaulted anticoagulant medication, and subsequently presented with acute chest pain, acute left ventricular failure, focal neurological deficit and gangrenous lower limb extremities. Electrocardiography showed atrial fibrillation and an old anteroseptal myocardial infarction. Echocardiography showed multiple valvular lesions and multiple thrombi in the left atrium. Computed tomogram scan demonstrated a large infarct involving the region supplied by the right middle cerebral artery. Bilateral above knee amputation was performed. Recovery from neurological deficit was complete. She had, during a 4-year follow-up and anticoagulation remained free of new clinically evident embolic complications. Serial echocardiography however showed that the atrial clots had persisted and presumably fibrosed. CONCLUSION: Multiple systemic thromboembolisms are serious complication of atrial fibrillation of valvular aetiology, and their prevention requires continuous anticoagulation.

General and regional anaesthesia for thyroidectomy in rural/semi-urban Nigerian centres.

OBJECTIVE: To evaluate the feasibility and benefits of regional anaesthesia (RA) for thyroidectomy in rural/semi-urban centres. DESIGN: A prospective study. SETTINGS: Missionary Hospital Saki, Nigeria and Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. SUBJECTS: One hundred and seventy five patients with goitre. RESULTS: The average time for the anaesthetists to put patients to sleep was 4.06 +/- 1.02 minutes, while it took 17.8 +/- 2.9 minutes to give the regional block. Post operative laryngeal complications in RA group were very minimal, while in general anaesthesia (GA) group, there were significant complications in 32 (36%) patients laryngeal oedema 15 (17%), erosions in 10 (11%) and ulcer in seven (8%). Cost of surgery in GA was thrice as much as in RA group. Thirty one (35%) with GA had steam inhalation for sore throat. It was possible to converse (laryngeal nerve monitoring) with the patient during operation but not possible with GA group. There was early discharge of patients in RA group. CONCLUSION: Regional/local anaesthesia is feasible for some cases of thyroidectomy with a lot of advantages and specifically allows surgeons to converse with the patients during operation-direct laryngeal and other nerve monitoring. Despite advancement in cuff design a lot of lesions still occur from endotracheal intubations.

Emergency partial thyroidectomy under cervical block to relieve severe acute airway obstruction from thyroid cancer.

A 75 year old male, Nigerian, retired civil servant presented to the Surgical Endocrine Unit of the Olabisi University Teaching Hospital, Sagamu, Nigeria with features of severe acute airway obstruction from advanced thyroid cancer. He was immediately worked up for an emergency partial thyroidectomy within an hour of arrival in the hospital under superficial bilateral cervical blockage using 2% xylocaine with aderanalin (30 mls) 1:100,000 with mild sedation, using 10 mg pentazocine and 5 mg diazepam as other forms of anaesthesia were not feasible because of his worsening respiratory distress. Findings at operation were a very haemorrhagic, friable thyroid gland with all the lobes matted together. He had isthmusectomy with bilateral partial lobectomy to relieve pressure on the trachea. Respiration improved in the immediate post-operative period as reflected by the values of arterial blood gases. He was maintained on respiration and intranasal oxygen therapy in Intensive Care Unit (ICU) for 2 days. He had an uneventful recovery and was discharged 2 weeks after surgery. He had radiotherapy and was followed up in the clinic for a year.

Surgical complications from local herbal practitioners: report of five cases.

Over a 12-month period, five patients (out of a total of 72) with serious complications resulting from use of herbs by traditional healers were seen at the surgical unit of Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. The age range was one and a half to five years with a mean age of 23.4 +/- SD years and a male to female ratio of 3:2. All the cases were misdiagnosed and mismanaged and ended up with various complications. Such as penile amputations, digital necrosis, upper and lower limb gangrene as well a severe sepsis among others. Ignorance, cultural beliefs and attitudes, delusion, poverty and inaccessibility to orthodox medical practice were some of the factors responsible for the patronage of traditional healers.

Rectal carcinoma in a nine-year-old Nigerian male child: case report.

Carcinoma of the colon and rectum are rare in children and under the age of 40 years. A case of coro-rectal carcinoma in a nine-year-old Nigerian male child is reported. Family history was significant in the patient, it revealed that his father died three years earlier because of chronic diarrhoea and mucoid stool with associated on and off constipation and one of his elder brothers died eight years ago of colonic cancer at the age of twenty years. Exploratory laparotomy was done for the patient which revealed fixed rectosigmoid tumour with metastases to the liver, omentum and small intestine and ascites was also found. Hartmann's procedure with sigmoid colostomy was performed and the tumour was resected. Histological report of the biopsy specimen was consistent with poorly differentiated adeno-carcinoma. To the best of our knowledge, the youngest patient recorded in the literature is seven years old, which is younger than our patient, but this is still the youngest in our records.

A review of diagnosis and modes of presentation of tropical idiopathic lower limb gangrene.

BACKGROUND: Tropical idiopathic lower limb gangrene (TILLG) is also known as Symmetrical gangrene in the African, Idiopathic gangrene in the African and Idiopathic peripheral gangrene of the tropics. The aetiopathogenesis of this clinical entity is a mystery. OBJECTIVE: To review methods of diagnosing tropical idiopathic lower limb gangrene (TILLG) and highlight its clinical variants. METHOD: All Literature on idiopathic gangrene of the extremities was searched from libraries, colleagues and internet but only literature on TILLG (in Africans) from 1947 to date was scrutinised. Each case was studied to find out the basis of diagnosis. RESULT: TILLG is not fully understood and not easy to recognise. Two sets of criteria are known to be helpful in establishing diagnosis. These criteria can be classified as major and minor criteria. Major criteria are those clinical data that can establish the diagnosis of TILLG. No devices are required to identify them. Minor criteria are pathological changes that are consistent with TILLG. Devices are required to identify them. Three pathomorphological types of TILLG were described in literature and are classified as types A, B and C. CONCLUSIONS: This review is supposed to sensitise the clinician and make diagnosis easier. This will also encourage more researches. As more information becomes available, aetiopathogenesis of TILLG will be clearer and more clinical variants of the disease may be reported. This additional information will help in the prevention of gangrene, reducing the socioeconomic problems arising from amputation.

Ruptured false iliac artery aneurysm--a case report from Nigeria.

A 23 year old male Nigerian presented to the Nephrology unit of the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria with features of chronic renal failure secondary to chronic glomerulonephritis. He was referred to the surgical department of the hospital on account of severe torrential uncontrollable bleeding from an infected cannulation site. He was maintained on regular hemodialysis but developed femoral triangle sepsis at the cannulation site and aneurysm of the external iliac artery. The aneurysm later ruptured with severe jet exsanguinations bleeding. Exploration revealed a-4 cm rent in the external iliac artery that was sutured with 6/0 prolene, interrupted, using clamp and suture technique. Perfusion was satisfactory in the immediate post-operative period. The patient was transfused with 11 pints of blood within 12 hours and had an uneventful post-operative period.

Case Report: Acute Limb Ischaemia and Gangrene associated with Peripartum Cardiomyopathy.

UNLABELLED: Thromboembolic complications are frequent in patients with peripartum cardiomyopathy (PPCM). Peripheral artery occlusions are however rare. This case report describes a 30-year-old grand multiparous woman with PPCM complicated by acute lower limb ischaemia and gangrene. This followed left intraventricular thrombi despite maintenance of sinus rhythm. We suspect that the thrombosis is caused by the hypercoagulable state of peripartum period, ventricular dilatation and hypokinesis. The impacts of economic and sociocultural factors in the management of this rare complication of PPCM in a resource depleted nation are highlighted. KEYWORDS: peripartum cardiomyopathy, limb ischaemia.

Thermal injuries in under-4-year-old children: the Lesotho experience.

The Queen Elizabeth II Hospital is the apex of the health care services in the Kingdom of Lesotho but has no designated burns unit. A review of patients managed during a 5-year period was done to document our experience so as to show what can be achieved even without a standard burns unit. We reviewed the clinical course of children who were admitted for care of acute thermal injuries during a 5-year period, May 1997 to April, 2002 inclusive. All were treated in the children surgical ward in accordance with a protocol of care emphasizing urgent care of shock, accurate fluid therapy, open wound care and early enteral feeding. Ninety-eight children (51 males and 47 females) aged 4 months to 43 months (mean 21.66 +/- 11.30 months) were admitted on account of acute thermal injuries during the study period. The injuries included scalding (46%) involving predominantly the upper part of the body and full thickness burns (87%). Skin grafting was needed in 82% of the patients. The common complications were infection, fluid imbalance, respiratory problems, and contracture deformities. The mean duration of hospital stay was 40 +/- 4.43 days and the case fatality rate was 9%. The case fatality rate in this series is considered high and could be improved if there were a well staffed specialized burns unit.

Basic trauma life support: knowledge of medical students.

BACKGROUND: The first hour of management (golden hour) of any trauma patient might be the determining factor if he/she will survive. The first contact most patients have in an emergency room is with a young medical graduate. The knowledge of basic trauma life support (BTLS) by all doctors therefore becomes important. AIMS AND OBJECTIVES: This study set out to assess how much knowledge medical students had about BTLS in their final year compared with their knowledge at the beginning of clinical postings. METHOD: A cross-sectional study of fourth and sixth (final) year medical students to evaluate their knowledge of BTLS using a test of 30 questions under examination conditions. One hundred and twenty-three fourth year students were given a test after a lecture on the care of injured patients. The same test was administered on 41 sixth year students without prior lecture on day of test, having had a similar lecture 2 years before. Data analysis was performed using the SPSS 11.0 for Windows statistical software and EPI INFO version 6.04. RESULT: Mean scores were 25.8 +/- SD1.91 for the 4th year students and 21.0 +/- SD2.93 for the 6th year students. There was a statistically significant difference between scores of the 4th year and the 6th year (P < 0.000001). CONCLUSION: Knowledge was imparted in the 4th year but was forgotten by the 6th year. It is essential that courses in BTLS be given periodically to all medical graduates and all personnel involved in care of the traumatised patient.