Cooking Gas Explosions As Cause Of Burns Among Patients Admitted To A Regional Burn Centre In Nigeria.

Burn injury has become a major source of mortality and morbidity in countries with low socioeconomic status. World energy consumption is mainly based on fossil fuels. This source of energy, if not properly handled, can be a source of major accident to lives and properties. The aim of this study is to highlight cases and the outcome of management of burns from cooking gas explosions in Lagos, Nigeria. The study involved all patients who sustained burns following cooking gas explosion within the study period. The parameters considered included demography, spread, anatomical locations and presence of inhalational injury, and outcome of management. A total of 347 patients were treated for burns during the study period, and 49 had burns from cooking gas explosion. Male to female ratio was 1.04:1. Patients between the ages of 21-40 years were the most affected. Extremities were involved in nearly all the patients. The presence of inhalational injury and larger burn surface area were found to be poor prognostic indices. Mortalities occurred within the first two weeks of injury. Cooking gas is becoming increasingly popular in Nigeria. Prevalence of burns from gas explosion is also on the increase. People are however not aware of its safe handling. More public enlightenment is required.

Les brûlures représentent une cause de morbidité et de mortalité considérables dans les pays à IDH faible. L'énergie consommée dans le monde est principalement d'origine fossile et son mésugeage est la cause d'accidents aux conséquences humaines et matérielles graves. Cette étude s'est penchée les caractéristiques et l'évolution de 49 patients (sur 347) hospitalisés dans le CTB de Lagos après explosion de réchaud à gaz. Nous avons relevé la démographie des patients, la surface et la localisation des brûlures, l'existence éventuelle d'une inhalation de fumées et le devenir. Le sex-ratio M/F était de 1,04/1, la tranche d'âge 21-40 ans était la plus fréquemment touchée. Les extrémités de presque tous les patients étaient brûlées. L'augmentation de la surface brûlée et la présence d'une inhalation de fumées étaient des facteurs de mauvais pronostic. En cas de décès, la mort survenait dans la première quinzaine. L'augmentation de la prévalence des brûlures lors d'une explosion de réchaud à gaz est parallèle à l'augmentation de leur utilisation, ce qui montre que des campagnes d'information sont nécessaires.

The socioeconomic impact of burns in Lagos, Nigeria: a one-year prospective study.

A one-year prospective study of burn patients presenting to the National Orthopaedic Hospital, Igbobi, Lagos from June 1, 2007 to May 31, 2008 was conducted to evaluate the socioeconomic impact of burn injuries sustained by the patients. A proforma reflecting the various data of interest was the main instrument of the study. The data was subjected to simple statistical analysis. A total of 52 patients with a mean age of 25 ± 17.1 years were studied. There were 27 males and 25 females giving a M:F ratio of 1.1:1. Man-hours were lost by 88.5% of the patients, 55.8% of whom were income earners. About 74% of the patients had returned to work or school at the conclusion of the study. The most common opportunity cost of treatment was a relative stopping work or school. Half of the patients were unsatisfied with their appearance and 26.9% desired cosmetic surgery. Social interactions were normal in 74.5% of the patients and none reported a poor quality of life. The study showed a significant socioeconomic burden from burns. It highlighted the importance of the informal sociocultural support system and the need for formal, well-structured social support systems.

Une étude prospective concernant les patients brûlés se présentant à l'hôpital orthopédique national Igobi de Lagos entre le 1er juin 2007 et le 31 mai 2008 a été conduite afin d'évaluer l'impact socio-économique de leur blessure. Une feuille de recueil des données à étudier a été utilisée, les variables étant ensuite analysées. Cinquante deux patients de 25 ± 17,1 ans ont été inclus. Il y avait 27 hommes et 25 femmes soit un sex-ratio de 1,1:1. Un arrêt de travail a été nécessaire pour 88,5 % des patients dont 55,8 % étaient soutien de famille. A peu près les 3/4 des patients avaient repris le travail ou l'école à la fin de l'étude, cet arrêt d'activité représentant l'essentiel des coûts indirects. La moitié des patients souffraient de leur apparence et 26,9 % désiraient une prise en charge de chirurgie plastique. La vie sociale était normale pour 74,5 % des patients, aucun d'eux ne se plaignait d'une mauvaise qualité de vie. L'étude a montré un impact socio-économique significatif des brûlures. Elle a permis de souligner l'importance du rôle de soutien du système socio-culturel informel et donc la nécessité d'en développer un officiel.

Progress in burns research: a review of advances in burn pathophysiology.

Severe burns trigger a wide range of responses in the victim. Initial vascular changes are followed by hypermetabolic, inflammatory and immunologic changes. The prolonged hypermetabolic response is associated with an elevated resting rate of energy consumption, tissue wasting and altered substrate kinetics. There is increased blood glucose though insulin levels are above normal. The cortisol level is raised and, together with catecholamine, drives the metabolic response. The immune system is typically weakened. There is elevation in blood levels of a wide range of cytokines from activated cells. These agents drive a prolonged inflammatory response which can lead to tissue damage and multiple organ failure. Dynamic fluid resuscitation regimens have cut down mortality from shock in the early post-burn period. However, unbalanced activity of pro- and anti-inflammatory cytokines can leave patients in an immuno-suppressed state that affects outcomes. So far, many treatments, such as propranolol, a cardio-protector, and anabolic agents, such as oxandrolone and growth hormone, have been tried with mixed results. This review focuses on research that elucidated burn pathophysiology. Some clinical areas in which treatment centred on correcting altered physiology were also included. We have highlighted both the challenges and significant findings. Finally, this paper draws attention to the gaps between progress in basic research and clinical application and suggests areas where further research and funding could be focused.

Les brûlures graves déclenchent un large éventail de réponses chez la victime. Après des modifications vasculaires initiales, on assiste a des changements hyper métaboliques, inflammatoires et immunologiques. La réponse hyper métabolique prolongée est associée à un taux élevé de consommation d'énergie au repos, d'élimination des déchets tissulaires et de la cinétique de substances altérées. Il y a une augmentation de glucose dans le sang même si les taux d'insuline sont supérieurs à la normale. Le niveau de cortisol est élevé ainsi que celui des catécholamines, et ils induisent la réponse métabolique. Le système immunitaire est généralement affaibli. Il y a aussi une élévation du taux d'un grand nombre de cytokines. Ces agents causent une réponse inflammatoire prolongée qui peut conduire à des lésions tissulaires et à une défaillance multi viscérale. Des nouveaux plans de réanimation liquidienne ont réduit la mortalité causée par le choc dans la période initiale après la brûlure. Cependant, l'activité déséquilibrée des cytokines pro- et anti-inflammatoires peut laisser les patients dans un état d'immunosuppression qui influe sur les résultats. Jusqu'à présent, de nombreux traitements, tel que le propranolol, un cardio-protecteur, et des agents anabolisants, tels que l'oxandrolone et l'hormone de croissance, ont été essayés avec des résultats mitigés. Cette revue se concentre sur la recherche qui a éclairci la physiopathologie des brûlures. Certains domaines cliniques centrés sur la correction des troubles physiologiques ont également été inclus. Au total,nous avons mis en évidence les défis et les résultats significatifs. Avec cet article, nous attirons l'attention sur les lacunes qui persistent entre les progrès de la recherche et son application. En plus, nous suggérons des domaines où la recherche et le financement pourraient être prioritaires.

Ambulance services of lagos state, Nigeria: a six-year (2001-2006) audit.

BACKGROUND: Emergency medical care is designed to overcome the factors most commonly implicated in preventable mortality, such as delays in seeking care, access to health facility, and the provision of adequate care at the facility. The developed world has recognized the importance of organized emergency medical services and has well established systems. The Lagos State Government established the first emergency medical system in Nigeria in 2001. OBJECTIVE: This was to review the activities of the Lagos State Emergency Ambulance Services (LASAMBUS) within the stated period with the hope that our findings can be used to audit the system and make recommendations for further improvement. SUBJECTS, MATERIALS AND METHODS: We reviewed the records of the State Ministry of Health for the data on the activities of LASAMBUS from 2001-2006. The number and types of emergencies that were seen and managed with the associated morbidity and mortality were reviewed. The constraints that were encountered by the LASAMBUS staff were also studied. The data that was obtained was entered into a proforma designed for the study. Analysis of the data was done using the Microsoft Excel software. RESULTS: A total of 32,774 cases comprising 21,977(67.1%) males,10,797(32.9%) females and a male to female (M:F) ratio of 2.04:1, were seen during the study period. Trauma was responsible for 29,500 (90%) of the cases. No mortality was recorded during the transfer of the cases. The records of mortality for the LASAMBUS-transferred cases were not available. CONCLUSION/RECOMMENDATIONS: Trauma cases formed the majority of the cases that were seen with road traffic accident constituting a large proportion of these. Health education focusing on improving driving etiquette of Drivers and injury prevention should intensified. More equipped emergency centres should be established to reduce victims transit and injuryintervention time. Record keeping and documentations should be improved for better assessment of the activities.

The protective role of ascorbic acid in burn-induced testicular damage in rats.

OBJECTIVE: To investigate the ability of ascorbic acid to protect the testes from damage in severe burns. DESIGN: Experimental study. SETTING: University of Lagos Medical School, Department of Anatomy. ANIMALS: 28 adult male Wistar rats (250-300 g). INTERVENTION: Third degree burn was induced on 40% body surface area of rats and they were given ascorbic acid at 4 mg/kg over 8 weeks. MAIN OUTCOME MEASURED: Weight of reproductive organs and epididymal sperm parameters were measured. Oxidative status was assayed and a semi-quantitative assessment of histologic changes was also carried out. RESULTS: Burn caused severe seminiferous tubular damage, especially germ cell loss (p<0.05). This was matched by significant reduction in sperm density and morphology (p<0.05). Burn also increased oxidative stress, with elevated malondialdehyde (MDA) levels (p<0.01) and changes in catalase and superoxide dismutase enzyme levels. Ascorbic acid prevented the changes in all sperm parameters. It normalized MDA levels (p<0.01) and attenuated changes in the levels of catalase and superoxide dismutase. Ascorbic acid treatment also significantly reduced histologic damage to seminiferous tubules. CONCLUSION: This study shows that severe thermal injury causes significant testicular damage and impairs spermatogenesis. It also shows that ascorbic acid protects the testis from such damage and therefore has the potential to be a useful adjunct therapy during treatment of young males with severe burns.

Delayed diagnosis of intersex state: surgical outcome of cases seen and review of current concepts.

BACKGROUND: Sexual ambiguity is said to occur when the gender of the baby cannot be determined at birth. The gender of an individual is in question because the genitals do not appear clearly as that of male or female. It is traumatizing to the family. It also causes confusion and problems in determining the sex, in which a child would be reared. The abnormality is relatively uncommon. Disorders of sexual differentiation can arise from abnormalities in chromosomes, gonadal development or hormonal production or activity. The orderly development process may also be affected by various environmental factors. Some of these factors may ultimately lead to the development of ambiguous external genitalia. CASE PRESENTATIONS AND MANAGEMENT: Three of such patients with ambiguous genitalia are presented, in which the initial diagnosis proved to be incorrect. The various investigations that were carried out and surgical management are discussed. CONCLUSION: Arguments which led to the ultimate choice of the sex of a child ranged from strict medical, to psychosocial and even cultural considerations. Expert examination shortly after birth would allow an early and definite decision, avoiding more serious problems with sexual ambiguity in later life.

Characteristics of paediatric burns seen at a tertiary centre in a low income country: a five year (2004-2008) study.

BACKGROUND: Children are the most risk prone in cases of burns. The previous epidemiologic study of paediatric burns in Lagos-Nigeria was carried four decades ago. A new study becomes necessary in view of the increasing incidences of petroleum related fire disasters in Nigeria. PATIENTS AND METHODS: : Children up to the age of 14 years admitted for major burns at the Lagos State University Teaching Hospital (LASUTH), Ikeja-Lagos, Nigeria between January 1, 2004 and December 31, 2008 were studied. Information about the demographics, mechanism/circumstances of burns, associated injuries, surface extent (TBSA) and depth, modes of management and outcome, length of admission, and post mortem findings in cases of death were collected. RESULTS: : A total of 298 children with major burns were seen; 198 were males and 100 females. The ages ranged from 1 day to 14 years with mean of 4.56 ± 3.95 years. Forty percent of the cases occurred among the toddlers and 25.5% in the 2-5 years age group. Fire was the leading cause of burns, occurring in 198 (66.4%) cases. The TBSA ranged from 1% to 100% with mean of 29.67 ± 21.98. The mortality rate was 29.9%. Autopsy showed asphyxia as the primary cause of death in 14 (48.27%) cases, multiple organ dysfunctions in 27.59% and septicaemia in 13.79%. CONCLUSION: This study identifies the main causes of paediatric burns and the major factors responsible for morbidity and mortality at the present time in a low income country. The level of awareness about burns prevention among the populace and health care facilities should be improved.

Burns and fire disasters from leaking petroleum pipes in Lagos, Nigeria: an 8-year experience.

INTRODUCTION: Petroleum products are mostly inflammable and require strict regulations for safe handling. This study characterises the epidemiology of people who sustained burns from leaking petroleum pipes in Lagos, Nigeria. Risk factors for the leaks were determined and proposals for preventive measures made. MATERIALS AND METHODS: Records of burn patients treated in our hospital from June 1999 to September 2004 were studied and victims of petroleum pipeline fires treated from October 2004 to May 2007 interviewed. RESULTS: Nine incidents of pipeline fire disasters occurred during the study period. A total of 646 victims sustained 100% burns and died at the disaster sites. Deliberate pipeline damage caused explosions in 55.6% of the cases and spontaneous ruptures in 44.4%. Forty-eight patients were admitted to our hospital for major burns from pipeline explosions. Their ages ranged from 15 to 50 years with a mean of 25.36 ± 5.62 years. The total body surface area (TBSA) involved in burns ranged from 31% to 100% with a mean of 75.71 ± 18.60. Over 40% of the patients had burns beyond 80% TBSA. Mortality rate was 67.3%. Poverty, irregular supply and high prices of petroleum products were responsible for the deliberate pipeline damage and lack of maintenance and surveillance for the spontaneous ruptures. CONCLUSION: The incidents of fire disasters from broken petroleum pipelines increased over the study period with considerable mortality. Programmes to reduce poverty, regular product supply, pipeline maintenance and surveillance may reduce the occurrence of the disasters.

The direct hospitalization cost of care for acute burns in Lagos, Nigeria: a one-year prospective study.

Objective. We conducted a prospective study to identify the direct hospitalization cost of managing major acute burns in Lagos, Nigeria, and to determine the factors that influence the cost. Method. All consecutive and consenting patients seen and managed for major burns at the National Orthopaedic Hospital, Igbobi, Lagos, between 1 June 2007 and 31 May 2008 were recruited for the study. A special form designed for the study was used to collect the necessary data. Results. Fifty-two patients were seen during the study period (27 males and 25 females). The ages ranged from 2 months to 69 yr with a mean of 25.4 ± 17.1 yr. The length of hospital stay ranged from 0.3-12 months (mean, 3.2 ± 3.1 months). The average daily cost of treating a patient was ₦ (naira) 8,855 (₦1000 = €4.44) and the average overall cost was ₦209,303.70, with the costs of wound dressings, hospital admission, and surgery constituting respectively 29.5%, 25.7%, and 19.1% of the total amount spent. Conclusion. The length of hospital stay was prolonged in many patients and management methods should be reviewed to reduce this. The cost of managing burns is prohibitive for an average Nigerian. Efforts should be intensified to prevent burn injury and a Special Health Insurance policy should be established to finance burns management.

Severe idiosyncratic drug reactions with epidermal necrolysis: A 5-year study.

INTRODUCTION: Idiosyncratic drug reactions (IDRs) are unexpected responses to a drug. The spectrums of severe cutaneous reactions include Stevens-Johnson Syndrome (SJS), SJS/Lyell Syndrome and Toxic Epidermal Necrolysis (TEN). The conditions are associated with high mortality. This study was designed to determine the causal agents, patterns of presentations, review the management and make recommendations to reduce the incidence and mortality of this class of drug reactions. MATERIALS AND METHODS: A retrospective study was made of patients seen with IDR in the Lagos State University Teaching Hospital, LASUTH, between January, 2004 and December, 2008. They were cases admitted with bullous skin eruptions with associated systemic symptoms. RESULTS: Sixty-seven patients were seen, with 45 (67.2%) satisfying the inclusion criteria. Fifteen males and 30 females were involved, giving a male to female (M:F) ratio of 1:2. Their ages ranged from 7 to 79 years (mean, 40.02 ± 17.89 years). Peak incidences occurred among the 20-24 and 30-34 year age groups. The causal agents were antibiotics (48.89%), sulphonamides (24.44%), herbal preparations (17.78%) and artemisinin drugs (8.89%). CONCLUSIONS: The age groups with the peak incidence are the most likely to indulge more in drug abuse in environments with poor drug control. Diagnosis of SJS, SJS/TEN and TEN were missed in many patients at first contact due to the progressive nature of the conditions. Patients needed reviews at regular intervals when IDR was suspected. Health education to prevent drug abuse is important and herbal preparations should be scientifically studied to determine the efficacy and side-effects.

Burn severity and post-burn infertility in men.

Burn wounds are a common cause of much morbidity and misery, especially in low- and medium-income countries. A number of studies show that severe burns cause infertility from poor sperm production. The pathways leading to such infertility are not well understood, and it is not known how the severity of injury affects this post-burn infertility (PBI). We evaluated the relationship between sperm parameters and indices of burn severity, such as burn surface area and depth in 19 adults. Total sperm counts ranged from 0 to 160 million/ml, with a mean of 19.58+/-7.52 million/ml. About 60% of the subjects had total counts of 20 million/ml or less, falling into the clinically oligospermic range. We found only a weak correlation between infertility and both burn depth and burn surface area. There was, however, a fairly strong positive correlation between infertility and length of time between injury and participation in the study. The correlation coefficient was 0.560. Our findings suggest that PBI is progressive and not predicted by TBSA. Any measures to control it should be started early and be applied to burn patients across a wide range of clinical severity.

Testicular Biopsies of Azoospermic Men at The Lagos State University Teaching Hospital

Objectives: This study was conducted to evaluate the histological findings from testicular biopsies in azoospermic men seen at the Lagos State University Teaching Hospital; Ikeja - Lagos; Nigeria. Patients and Methods: A retrospective study of testicular biopsies of azoospermic men who presented to our institution from 2005 to 2006 was performed. The patient's age; type of infertility and histopathological diagnosis were evaluted. All biopsies were preserved in 10formaldehyde solution. Results: Of the 51 azoospermic men (mean age 30 years; range 25 - 46 years) 25 (49.0) had primary infertility; 11 (21.6) had secondary infertility and 15 (29.0) were not specified. Five (9.8) patients had normal spermatogenesis. Abnormal histological parameters occurred in 46 (90.2) patients: testicular atrophy in 30 (58.8); maturation arrest in 14 (27.5) and hypospermatogenesis in 2 (3.9) patients. Conclusion: The presence of normal spermatogenesis in azoospermic men; which would suggest an obstructive lesion; is not common in our practice; in contrast to previous studies from our country. This may indicate a changing pattern in the aetiology of male infertility in our environment. Identification of the possible causes of testicular damage resulting in non-obstructive azoospermia in our environment may help to prevent male infertility

Day case cleft lip surgery in Lagos, Nigeria.

BACKGROUND: The correction of cleft lip deformity has included overnight admission and postoperative ward admission from 5 to 7 days. In developing countries, increasing cost of treatment and medical insurance and shortage of bed space have led to a reduction in the length of hospitalization or its elimination for some cases of surgery. OBJECTIVE: To assess the feasibility and complications associated with day case cleft lip surgery in our center. METHODS: A prospective study of patients undergoing day case cleft lip repair at three hospitals from 1995 to 2005. RESULTS: A total of 43 patients were seen. Twenty seven (63.8%) were treated as day case, and 16 (37.2%) were operated as inpatients. The mean age for patients treated as day case was 1.32 +/- 1.45 years. Fifteen (55.6%) of these patients had severe associated nasal deformities, six (22.2%) had moderate nasal deformity, and four (14.83%) had mild nasal deformity. The only complication was a nasovestibular fistula that occurred in one of the day case patients. From 27 patients operated on as day cases, eight calls were received. Two (7.4%) mothers called to report febrile illness in their children on the first postoperative day. Two mothers (7.4%) reported excessive crying. The most frequent reason for postoperative consultation was obstruction of the modified nasal retainer, which occurred in four patients (14.8%). CONCLUSION: Day case surgery for cleft lip can be said to be safe, with a 2.3% rate of complications in selected patients. Day case surgery was a cheaper alternative to admission.

The surgical repair of macrostomia.

BACKGROUND: Many surgical techniques have been described for the repair of macrostomia. However, most were designed for the repair of unilateral macrostomia. Most reports of repairs involved small numbers of patients. This has not allowed for evaluation of complications and comparison of various techniques. OBJECTIVE: This study describes a modification of an older technique designed for unilateral macrostomia. Details of the operative technique used for the repair are described, along with the principles underlying the various steps. MATERIALS AND METHODS: This study involves 13 patients operated for macrostomia using the same surgical technique. The patients were seen at a recent screening and mass surgery exercise for patients with orofacial and craniofacial deformities. RESULTS: Eleven patients had bilateral macrostomia; two had unilateral macrostomia. No anesthetic or surgical complications occurred in any of the patients. All patients tolerated the procedure well. Oral continence and acceptable facial symmetry were restored in all patients, with minimal scarring.

Severe idiosyncratic drug reaction (Lyells syndrome) after ingesting dihydroartemisinin.

Lyells syndrome also called Toxic epidermal necrolysis is the extreme form of idiosyncratic drug reaction that is called Steven Johnsons Syndrome: The condition results in an extensive loss of the skin with mucous membrane involvement. Lyells syndrome has been induced by many agents. The commonest agent in the literature being sulphonamides. However, in our search of the medical literature there was no report of dihydroarthemisinin as a cause of Lyells syndrome. We report three patients seen at two tertiary health institutions with Lyells syndrome after treatment for malaria with dihydroarthemisinin. This resulted from administration of dihydroarthemisinin with chloroquine in two patients and dihydroarthemisinin with Amodiaquine in one patient. The first patient was a seven year old child who developed 90% cutaneous involvement and died from hemorrhagic shock. The second was a 28 old female that developed a 76% body surface involvement and died from septicemia. The third patient was a pregnant 37 year old woman that developed 52% body involvement and died from septic shock. In these patients the earliest symptoms were not recognized and there was considerable delay before referral. In view of the recent WHO recommendation ofArthemisinin Combination Treatment (ACT) for malaria, we expect more cases of Steven Johnson Syndrome and Lyells syndrome from ACT treatment. The aim of this report is to raise the awareness of clinicians to this potentially fatal complication.

A Comparative Study of the Wound Healing Properties of Moist Exposed Burn Ointment (MEBO) and Silver Sulphadiazine.

Burns expose the deeper tissues of the skin or body to invasive microbes. Topical preparations for treating burn wounds, to be useful, should ideally have antibiotic power and promote healing. Silver compounds have been the mainstay of topical burn treatment for decades. However, most chemical substances retard wound healing. Several natural agents such as honey and moist exposed burn ointment (MEBO) are believed to protect wounds from infection and promote healing without causing any of the adverse effects of purified chemicals. In this study, we compared the wound healing properties of MEBO, a herbal preparation of Chinese origin, with silver sulphadiazine (SSD), a long-standing conventional burn dressing. Ten adult Sprague Dawley rats were divided into two groups. They were housed in separate cages and received partial-thickness burn wounds on their dorsal skin. They were then treated with MEBO and SSD. The wounds were inspected daily until day 8, when all the animals were sacrificed, perfused with normal saline, and had their wounds excised and prepared for histology. It was found that animals in both groups were well preserved. No clinical infections occurred. Wound healing was at an advanced stage by day 8 in all the animals. Clinical and histological examination showed that the two agents gave the animals comparable protection and healing possibilities. It is concluded that MEBO is a suitable and efficacious alternative to conventional silver-based topical therapies for treating partial-thickness burn wounds.

Mass Burns Disaster in Abule-egba, Lagos, Nigeria from a Petroleum Pipeline Explosion Fire.

The aim of this paper is to review the basic principles of triage in mass burns disasters and discuss the experience of the Lagos State University Teaching Hospital (LASUTH), Ikeja, Nigeria, in the December 2006 disaster at Abule-Egba, Lagos, Nigeria. It is hoped that the experience gained will help in the planning for and management of similar disasters in the developing countries with limited facilities. Burn injury has been described as the severest form of trauma and its management is very challenging as it is often accompanied by numerous pathophysiological changes. Successful management requires expert management by well-trained personnel in equipped and dedicated centres. In mass disasters the total number of victims may exceed the capability of the facility and its staff and a system for sorting out the patients and caring for those that will benefit from the facilities available needs to be developed. Other patients will either be sent to other medical facilities for further treatment or discharged after initial care for future follow-up. Documented experiences in the management of mass burns disasters from petroleum pipeline explosions from developing countries are rare. However, petroleum pipeline explosions, especially in the Lagos area of Nigeria, are relatively common. These cases have been associated with a variety of factors. The resulting morbidity and mortality have been high. LASUTH has a dedicated burns centre, which has received and managed many burn patients. Triage is the medical process of screening patients according to their need of treatment and the resources available. The aims and objectives of triage are discussed, its various levels described, and the final goals elaborated. All the burn victims involved in the 2006 disaster were studied, together with the triage carried out at different levels and the consequent sorting of the patients. Standard burns management was carried out. A total of 385 patients sustained burns of various degrees from the fire resulting from the explosion. On site, emergency department (ED) and intra-hospital triage were carried out. Ninety patients were brought to the LASUTH ED. Of these, 51 patients (56.67%) received first-aid treatment and were either discharged for out-patient follow-up or referred to secondary health care facilities. Twenty-eight (31.11%) out of the remaining 39 patients with burns in more than 70% total body surface area (TBSA) were categorized as unsalvageable and 11 (12.22%) with less than 70% TBSA as salvageable. All the patients in the unsalvageable group died (i.e. 100% mortality), while one patient died in the salvageable group (mortality rate, 9.09%). The mortality rate for the ruptured petroleum product pipeline incident was 84.16%; the fatality rate for all patients seen at LASUTH was 32.22%. The need for caution in the handling of petroleum products is discussed and the effectiveness of the triage system used is highlighted. In conclusion, burns from flammable petroleum products can be very dangerous and proper triage should therefore be carried out, with salvageable patients being managed by experts in dedicated burns centres.

Sperm quality changes in survivors of severe burns.

Severe thermal injury occurs frequently, especially in the low-income countries of the world, where they account for a substantial mortality and a wide range of devastating morbidity. Almost all systems of the body are affected, including the cardiovascular, immune, and reproductive systems. A number of studies have shown that people with severe burns may develop impaired spermatogenesis and testicular damage. However, if we consider the many systems that are negatively affected by burns, the effects on the reproductive system are among the least investigated and are therefore poorly understood. We delineated sperm quality changes in 20 men recovering from severe burn injury. They submitted semen at monthly intervals for analysis over a fourmonth period. Our results show that these subjects had significantly lower total sperm counts than normal for their age range. Sperm counts were 20 million/ml or less in half of the study population with a mean of 26.58 ± 7.52 m/ml. Progressive motility was even more severely affected; the score was less than 20% in more than half of the patients, with a mean of 27.74 ± 7.64. Though abnormal sperm rates were within the normal range, in many of the patients 80% of abnormal cells had swollen, oblong and round heads. Cells with tail anomalies made up the rest. Our findings suggest that severe burns cause significant reduction of sperm density and motility. They also cause specific head abnormalities in the cells produced. Such sperm is now known to have very poor fertilization potential.

Limb deformities: the Lagos, Nigeria experience

Background: Individuals with various forms and degrees of limb deformities are common on the streets of Lagos; Nigeria. State-sponsored screening and surgical correction of the deformities were carried out in Lagos between June 2004 and May 2006. A report on the pattern of limb deformities is presented. Methods: This was a prospective study of all the patients that were seen and treated during the various screening programmes and operating sessions. Data was stored electronically and analysed using Microsoft Excel software. Results: A total number of 1;321 patients were screened; and 344 satisfied the inclusion criteria for enrolment. They were aged between 9 months and 64 years but only 20were aged 5-years and below. Females constituted 58.2and males 41.8. A total of 513 limbs were surgically corrected. The most frequent deformity and disease entity were bilateral genu varum (45.1) and Blounts disease (48.7); respectively. Proximal tibial wedge corrective osteotomy was the most frequent surgical procedure performed. Most beneficiaries presented late and were discharged within 48-hours of hospital admission. Conclusions: Improved public awareness about the availability of hospital based resources to solve the problem of limb deformity is advocated

Fatal domestic accident from a 1.5 volt dry-cell battery explosion as seen in lagos state university teaching hospital, ikeja, lagos, Nigeria.

OBJECTIVE: To illustrate the danger of wrong disposal of used dry-cell batteries in Lagos, Nigeria. METHOD: Information was extracted from the case notes of a patient who died following the explosion of a 1.5 volt dry-cell battery. No post-mortem was performed because the death certificate was inadvertently issued and the body was buried hurriedly according to Islamic rites. RESULTS: A 53% burn involving the face, upper arm, trunk, and thigh was found on examination, in addition to inhalation injuries. CONCLUSION: Dry-cell batteries are highly explosive when heated. There is a need to educate the populace about their explosive nature and to keep batteries away from children.