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Risk Factors for Lower Extremity Amputation among Diabetic Patients with Diabetic Foot Gangrene in ATBUTH, Bauchi

Open Journal of Orthopedics 2024年第9期14卷 391-403页

作者： stephen yusuf Shaphat Shuaibu Ibrahim Abubakar Musa yusuf Aliyu Salihu Friday Titus Nyako Ngwan David Wujika Department of Orthoepaedics and Trauma Abubakar Tafawa Balewa University Teaching Hospital Bauchi Nigeria Radiology Department Abubakar Tafawa Balewa University Teaching Hospital Bauchi Nigeria Department of Orthopedic and Trauma Surgery University of Maiduguri Maiduguri Nigeria Department of Surgery Modibbo-Adama University Teaching Hospital Yola Nigeria

Background: Diabetic mellitus was described as an evolving global epidemic of the twenty-first century, due to the exponential rise in the number of people with the condition. Lower extremity amputation is one of the common complications of diabetes. With increase in the number of people with diabetes there will also be increase in the number of diabetics going for lower extremity amputation, increasing both the financial as well as psychologic burden of treatment. Methodology: A prospective cross-sectional study of all diabetic patients going for lower extremity amputation will be done. All the patients with advanced diabetic foot syndrome needing lower extremity amputation are enrolled (Wagener stage IV and V), both through the clinic and emergency center. Informed consent is obtained from the patient after which data are collected using a structured questionnaire. All the investigation results of the patients were also documented. Data collected are analyzed using the SPSS version 29. Chi-square and student t-test were used to measure significant relationship between the variables at 95% confident interval. Results: Within the period of study, which extends from 1st January 2022 to 1st of January 2024, a total of 171 patients were recruited. All diabetic patients with diabetic foot Wagener grade IV and V who presented to the clinic or emergency department were enrolled in the study. We found a significant relationship between gender, previous procedure on the affected limb or amputation of the contralateral limb, knowledge of foot care among diabetics and risk of amputation. There was, however, no statistically significant relationship between. There is no statistically significance relationship between the level of education, occupation, presence of co-morbidity with the risk of amputation among diabetic patients with foot syndrome. Conclusion: Previous lower limb procedure/amputation, male gender, paucity of knowledge on foot care, prolonged duration of the dis

关键词： Diabetes Mellitus Lower Limb Amputation Risk Factors Rehabilitation

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Clinical Versus Doppler Based Assessment in Determining Amputation Level in Diabetic Foot Gangrene;A Prospective Cross-Sectional Study at Atbuth, Bauchi

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Open Journal of Orthopedics 2024年第8期14卷 366-373页

作者： Shaphat Shuaibu Ibrahim stephen yusuf Abubakar Musa Shirama Yakubu Bababa yusuf Aliyu Salihu Makama Baje Salihu Bukar Shehu Department of Orthoepaedics and Trauma Abubakar Tafawa-Balewa University Teaching Hospital Bauchi Nigeria Department of Radiology Abubakar Tafawa-Balewa University Teaching Hospital Bauchi Nigeria Department of Surgery Abubakar Tafawa-Balewa University Teaching Hospital Bauchi Nigeria

Background: Amputation is defined as the surgical removal of a limb or part of a limb through the bone. If the amputation is done above or below the knee, they are termed major while minor amputations involve the partial removal of foot including forefoot resections, ray amputation of the digits or parts of the digits. Significant number of patients with diabetic foot ulcers end with amputations. In the past the amputation level was decided by clinical assessment alone, such as physical examination using color, temperature, peripheral pulses and wound bleeding during surgical procedure. The use of Doppler ultrasound to measure arterial blood pressure at the proposed amputation site has been advocated as a predictor of amputation success. An optimal choice of the level of amputation can reduce amputation complications. Methodology: A Prospective comparative randomized cross-sectional study carried out between 1st January 2022 and 1st January 2024 in ATBUTH, Bauchi amongst patients with diabetic foot Wagener stage IV and V scheduled for amputation. Outcome measures of wound break down, flap necrosis and re-amputation were assessed amongst the clinical based level assessment group and the doppler based level assessment group. Results: A total of 171 patients were recruited into the study. Males 103 and 68 are females, giving a male to female ratio of 1.5:1. mean age 47 years. There were 84 patients in the clinical based level assessment group and 87 patients in the doppler based level assessment. Conclusion: Diabetes mellitus foot disease is a significant risk factor for non-traumatic lower limb amputation and doppler level assessment is superior to clinical level in determining amputation level among diabetic patients scheduled for amputation. P-value 0.003.

关键词： Diabetics Amputation Foot Gangrene Doppler Clinical

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Small Cell Prostate Cancer;Center Review of Two Cases and Testimony of a Rare and Aggressive Disease

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Case Reports in Clinical Medicine 2024年第9期13卷 410-417页

作者： Makama Baje Salihu Haruna Liman stephen yusuf Dauda Suleiman Shaphat Shuaibu Ibrahim yusuf Aliyu Salihu Isa Sajo Mienda Department of Urology ATBUTH Bauchi Bauchi State Nigeria Department of Orthopaedics ATBUTH Bauchi Bauchi State Nigeria Department of Histopathology ATBUTH Bauchi Bauchi State Nigeria Department of Radiology ATBUTH Bauchi Bauchi State Nigeria

Small cell cancers were initially described in the lungs and later found to occur in a wide range of organs of the body, constituted a disease entity that is characterized by an aggrieve path/course and a huge disease related mortality. They are also called neuroendocrine tumors with peculiar histologic and biologic disease entity. Here we present two cases of small cell cancer of the prostate seen and managed in our facility with focus on their presentation, disease progression and outcome. The first patient was a 72-year-old retired military officer who presented with a progressively painful scrotal swelling of 3-month duration, and scrotal ulceration with contact bleeding of a month duration associated with a foul-smelling discharge. There was also history of progressive weight lost, loss of appetite and constipation. Patient was pale and lethargic on examination with a foul smelling exophytic scrotal mass. Serum PSA was 4 ng/l (within normal limit). Wedge biopsy and trucut prostate biopsy revealed small cell cancer of the prostate. Patient was resuscitated and prepared for chemoradiation, had a single dose of chemotherapy and died before the second dose. Second patient was a 63-year-old farmer who presented with lower urinary tract symptoms, progressive weight loss and constipation of two months duration, a known hypertensive and diabetic who has been regular on his medication. He was lethargic on examination, pale and unable to stand without support. Trucut prostate biopsy shows small cell cancer of the prostate. He was also resuscitated and being prepared for chemoradiation but died before commencement of treatment.

关键词： Small Cell Prostate Cancer Mortality Chemoradiation

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Fournier’s Gangrene: A Review of Fournier’s Gangrene Severity Index (FGSI) and Other Predictors of Mortality

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Open Journal of Urology 2024年第7期14卷 391-399页

作者： Makama Baje Salihu Haruna Liman stephen yusuf Aminu Umar Abraham Tunde Oladimeji Aremu Abdulrazak Urology Unit Department of Surgery Abubakar Tafawa Balewa University Teaching Hospital Bauchi Nigeria

Background: Fournier gangrene is an acute and rapidly progressive necrotizing fasciitis of the scrotum, perianal and perineal region of the body. It is a polymicrobial infection having an interplay of both anaerobic and aerobic orgasms in a soup of microbial disaster. Fournier’s gangrene was also initially thought to be an idiopathic condition but a lot of risk factors have been associated now with this condition, both systemic risk factors and local. Systemic risk factors include diabetes mellitus, HIV/AIDS, cancers, chronic liver disease, chronic steroid use etc. The local risk factors include perineal injuries, watering can perineum, perianal abscess, chronic perineal itching etc. Purpose: The swiftly flourishing bacteria orgasms cause a similar disruptive event in the body of the patients both clinically and biochemically and these can be used to create a predictive score or index for patients in order to assess the disease severity and guide in the management and prognostication of this condition. Materials and Method: Urology ward record books, clinic record books and operating theater records were used to identify patients managed for Fournier gangrene in ATBUTH Bauchi. A retrospective study of the medical files of all the patients managed from January 2011 to January 2024 was done. Folders were retrieved and the medical records were reviewed. Results: Of the 50 patients reviewed, Male to female ratio is 24:1. The mean age is 56 years (2 weeks to 97 years). Mortality rate was 34%. There is a significant difference between delayed presentation/initial use of unorthodox treatment with mortality (p = 0.002). Of the 17 patients that died, 15 had FGSI > 9 and of the 33 patients that survived 29 had FGSI 9 is 88.2% while the mortality rate for those with FGSI Conclusion: knowledge of the predictors of its mortality is necessary in other to help stratify patients and ensure the best response by the caregivers. FGSI, delayed presentation/initial patronage of unorthod

关键词： Fournier’s Gangrene FGSI Risk Factors Mortality

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Evaluation of Some Treatment Options Inlate and Neglected Hip Fractures Using the Modified Harris Hip Score

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Open Journal of Orthopedics 2024年第6期14卷 259-269页

作者： Shaphat Shuaibu Ibrahim Abubakar Musa Olaoluwa Moses Shodipo Emuan Timothy Zailani Buhari stephen yusuf Mienda Isa Department of Orthopaedics Abubakar Tafawa-Balewa University Teaching Hospital (ATBUTH) Bauchi Nigeria Orthopaedic Unit Department of Surgery FMC Bida Nigeria

Background: The choice of the appropriate operative intervention in patients with late and neglected hip fracture continuous to be a huge dilemma for orthopedic surgeons. Purpose: To evaluate the satisfaction or otherwise of some treatment options using the modified Harris-hip score (HHS) in resource poor setting. Materials and Methods: A retrospective cross-sectional study conducted at ATBUTH, Bauchi. Data of 60 patients over the age of 18 years with hip fractures (femoral neck, intertrochanteric and sub trochanteric fractures) who had operative intervention between 1st September 2019 and 31st August 2020 with cannulated screws, Proximal femur lock compression plate (PFLCP), cementlessor cemented bipolar hemiarthroplasty (BHA). Results: The mean age of studied patients was 65.7 ± 16.1 years, with age ranging from 19 - 101 years. M:F ratio was 1.2:1 across all age groups and 1:1.4 amongst those >60 years. 51 patients (85%) presented > 1 week after injury with 24 patients (40%) sustaining hip fractures from low energy trivial indoor fall and 28 patients (46.7%) mostly younger sustaining fractures from high energy motor vehicular accident (MVA). The prevalence rate for femoral neck, intertrochanteric and subtrochanteric fractures were 32 (53.3%), 17 (28.3%) and 11 (18.3%) respectively. From the data retrieved, 21patients (35.0%), 17 patients (28.3%), 20 patients (33.3%) and 2 patients (3.3%) had PFLCP, cemented BHA, cementless BHA and cannulated screw fixation respectively. Most (66.7%) of those who had PFLCP achieved satisfactory radiologic union and there was also 94.1% and 85% satisfactory outcome rate amongst the patients with cemented BHA and cementless BHA respectively. Irrespective of the operative intervention method at 1 year follow-up, there was a statistically significant improvement in post-operative HHS (P value 0.02), with 83.4% having good to excellent results. Conclusion: There is highrate of late and neglected hip fracture in our environment. Satisfac

关键词： Hip Fracture Late and Neglected BHA PFLCP Cannulatedscrew Outcome Measures HHS

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Fournier’s Gangrene: 13-Year Experience in a Tertiary Center, North Eastern Nigeria

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Open Journal of Urology 2024年第7期14卷 407-414页

作者： Makama Baje Salihu Haruna Liman stephen yusuf Aminu Umar Oladimeji Abraham Tunde Ayodele Olufikayo Oshagbemi Amur Ibrahim Urology Unit Department of Surgery Abubakar Tafawa Balewa University Teaching Hospital Bauchi Nigeria

Background: Fournier’s gangrene is a fulminant infection of the genitourinary tract characterized by progressive necrosis of the skin and subcutaneous tissue of the external genitalia. Initially mainly seen involving the scrotum of elderly men with different moods of occurrence each unpleasantly lethal. With varying types of presentation only one thing has remained constant;the poor prognosis of this condition. Purpose/Aim: Thus, it’s important to study the trends of the presentation of this condition laying emphasis on the challenges in the management of these patients;both the negative and positive prognostic factors. Materials and Methods: Urology ward record books, clinic record books and operating theater records were used to identify patients managed for Fournier gangrene in ATBUTH Bauchi. A retrospective study of the medical files of all the patients managed from January 2011 to January 2024 was done. Data was analyzed using SPSS version 29. Results: Data from 47 patients seen during the period of study were carefully collected and analyzed. The age range is 2 weeks to 97 years. There were two neonates, one at 2nd week of life and the other at 3rd week. Mortality rate is 36%. The average time duration before presentation for patients that died was two weeks, a minimum of 9 days prior to presentation and a maximum of 21 days, about 10 of which came in septic shock and the remaining presented with fever and very extensive necrotizing fasciitis of the perineum. All the patients that died had diabetes mellitus as a comorbidity except the neonate. All the patients that survived were much younger, all were below 60 years of age (2 weeks - 53 years). Conclusion: Here, we share our experience managing patients with Fournier’s gangrene in our facility in the past 13-year period from January 2011 to January 2024. .

关键词： Fournier’s Gangrene Prognosis Elderly Presentation Treatment

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Drug Use and Abuse among Orthopedic Ward Patients—A Revolving Cycle of Menace in Atbuth, Bauchi

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Journal of Biosciences and Medicines 2024年第9期12卷 13-20页

作者： yusuf stephen Shaphat Shuaibu Ibrahim Timothy Emuan Buhari Abdullahi Zailani Bukar Shehu Aminu Umar Shirama Yakubu Bababa Ibrahim Babangida Hussaini Blessing Eneh Vincent Department of Orthoepaedics and Trauma Abubakar Tafawa Balewa University Teaching Hospital Bauchi Nigeria Department of Radiology Abubakar Tafawa Balewa University Teaching Hospital Bauchi Nigeria Department of Nursing Abubakar Tafawa Balewa University Teaching Hospital Bauchi Nigeria

Background: The use of drugs for purposes other than those for which they are meant to be used or in excess amounts. Psychoactive drugs are some of the drugs more commonly abused, also, antibiotics and other medications too can be misused. Drug abuse and misuse can lead to serious social, medical and emotional harm to the patients, and antibiotic resistance that makes treatment harder are also likely complications. Method: Patients in both male and female wards of the Orthoepaedics Department of ATBUTH, Bauchi were interviewed using a structured questionnaire and their responses were recorded and data were analyzed using the SPSS version 29. Results: A total of 112 patients were interviewed, 76 males and 36 females. Thirty-two (28.6%) patients had taken various kinds of unprescribed medications while on admission: 9 patients had taken unprescribed tramadol, 4 patients had taken codeine, 6 Ampiclox, 5 flagyl and about 8 patients had taken different kinds of traditional medications while on admission. Among the 32 patients, 23 (72%) are aged less than 30 years, 5 (16%) are aged between 30 and 50 years and 4 (12%) are aged above 50 years. Sixteen (50%) had such medications brought to them by relatives or friends, 10 (30%) were given by other patients on admission, 5 (15%) brought or bought the drugs by themselves while 1 (5%) were given by a non-clinical staff of the hospital. Conclusion: Drug misuse and abuse is a very serious, deleterious practice with destructive consequences in its wake, such consequences as drug dependency with all its antecedent effects, antibiotic resistance and difficulties in controlling/managing infections are but a few. So, it’s very important to both educate patients about these terrible practices and cope with the spread of them in our wards and hospitals.

关键词： Drug Abuse Misuse Dependency Resistance

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