The efficacy and toleration of celecoxib (Celebrex) in the treatment of osteoarthritis in Nigeria: a multicentre study.

BACKGROUND: Non-selective, non-steroidal anti-inflammatory drugs (NSAIDs) are effective in terms of pain relief and improving function in osteoarthritis. The advent of cyclooxygenase-2 (Cox-2) specific inhibitor, celecoxib, in the treatment of osteoarthritis has shown similar efficacy in relieving pain in osteoarthritis with low incidence of GI (Gastrointestinal) symptoms. OBJECTIVE: To determine the efficacy and toleration of celecoxib in treatment of osteoarthritis in Nigerian population. METHODS: Eighty patients were recruited from six tertiary health institutions scattered over Nigeria. A fixed dose of 200 mg celecoxib was administered daily with patient seen on the second and six weeks after commencement of study. Efficacy of the drug and safety were assessed during the study. RESULTS: The patients had a mean age of 57.8 years with a standard deviation of 13.3 year. The mean weight was 74.7 +/- 14.9kg while the female sex constituted the majority (73.8%) of the patients. Using the physician global assessment of osteoarthritis instrument, 36.3% of the patients were rated as having poor arthritis score at baseline. This value reduced to 2.6% at second visit and 0.00% at end of the study respectively. There was no significant difference between the vital signs, haematological indices, renal and hepatic function at baseline and the final visit. There was no case of serious adverse effect. CONCLUSION: The study showed statistically significant improvements in the symptoms of osteoarthristis following the administration of Celecoxib 200mg daily for six weeks.

A prospective evaluation of Medizip in Nigeria.

In a one year period between April, 1997 and March 1998 we have carried out a randomized controlled prospective study to evaluate the outcome of Medizip Surgical Zipper technique in closing 50 surgical wounds in Nigeria. There were similar sex, age and wound distribution between the Medizip study group and the conventional (needle and thread) control group. The cosmetic outcome of scar was rated as good or bad. It was good if the emerging scar was a thin linear (< or = 2 mm wide) scar, and bad if the scar was a broad flat (> 2 mm wide) or a heap-up (hypertrophic or keloidal) scar. The cosmetic outcome of scar was good in 45 (90%) of the Medizip study group as compared with 22 (44%) of the conventional control group. The observed difference between the two groups was statistically significant (P < 0.05). We observed superficial wound infection in one (2%) of the Medizip study group as compared with 10 (20%) of the conventional control group. The results of our study clearly demonstrated that the use of Medizip surgical Zipper would be a superior technique of closing surgical wounds in terms of the cosmetic outcome of scars and associated problems.

Major amputations in Nigeria: a plea to educate traditional bone setters.

A study was made of 100 major amputations performed on 96 patients in two regional hospitals in a 10-year period in Nigeria. The objective of the study was to evaluate the outcome of major amputations in Nigeria. The median age of patients was 30 years with male to female ratio 3:1. Ninety of the 100 major amputations involved the lower limbs with the above-the-knee/elbow-the-knee ratio of 0.5. Trauma was the leading indication for 70 amputations, of these 60 were iatrogenic resulting from mismanaged fractures by the traditional bone setters. The non-traumatic indications were: diabetic limb gangrene (20); bone malignancies (9); and vascular insufficiency (1). Provisional amputation was offered in 60 cases, of these 10 had reamputation. There were eight (8.5%) mortalities. The functional outcome for this group was discouraging. Only 25 amputees affording successful prosthetic fitting and social rehabilitation. Major amputation in Nigeria foreshadows a dismal existence and emphasizes the need for health policies which are effective in controlling the risk factors.

Traditional bone setter's gangrene.

Traditional bone setter's gangrene (TBSG) is the term we use to describe the sequelae sometimes seen after treatment with native fracture splints. Twenty five consecutive complications were recorded in 25 patients aged between 5-50 years with a median age of 10 years. The major complication of the native fracture splint treatment was distal limb gangrene necessitating proximal amputations in 15 cases.

Comparative double blind study of the efficacy and safety of tenoxicam vs. piroxicam in osteoarthritis of knee and hip joints.

The efficacy and safety of tenoxicam was compared to that of piroxicam in 48 Nigerian patients with Osteoarthritis of the knee or hips. Of these 31 females and 11 males, with a mean age of 52.5 +/- 11.0 years, were evaluated for comparable efficacy and tolerability. On fulfilling the selection criteria each patient was treated with either tenoxicam 20 mg or piroxicam 20 mg daily for six weeks. Efficacy was evaluated in terms of presence of pain (at rest, with mobility and after one day of normal activity), functional status and physicians global assessment of therapeutic efficacy. Tolerability was evaluated by incidence of adverse events whilst safety was evaluated by measurement of haematological and biochemical profile pre and post therapy. Thirty seven patients had been on previous medication before being switched over to trial drug. There was a dose change in three patients in the piroxicam group due to inefficacy. Also there was loss of efficacy during maintenance in one patient in the piroxicam group. Clinical efficacy was judged excellent or good in 82.3% of patients with tenoxicam and 76.0% with piroxicam. Tolerability was excellent or good in 88.2% of patients with tenoxicam and 60.0% with piroxicam. The incidence of adverse event was 15.8% with tenoxicam and 21.7% with piroxicam. Overall, when judged on various evaluation parameters, tenoxicam 20 mg/day appears to be more effective and better tolerated than piroxicam 20 mg/day, though these differences were not statistically significant.