Chronic cutaneous ulcers are commonplace in the developing world, especially in rural areas with poor living conditions and often result from the trauma of road-traffic injuries. Chronic cutaneous ulcers may also be due to vascular insufficiency, neuropathy, nodular leprosy, pressure, diabetes, or hemoglobinopathies, or they may be tropical ulcers. If poorly managed, these lesions may undergo malignant transformation. We evaluated the clinical histories and treatment outcomes of patients seen at the University of Calabar Teaching Hospital, between January 2000 and December 2004, who had histologic diagnosis of Marjolin's ulcer, in an attempt to identify risk factors for this problem. The six patients were men, age 30-70 years (mean, 42 years). Trauma was the leading cause of injury leading to ulceration: road-traffic accidents (four patients, 66.7%), fall (one patient, 16.7%), and flame burn (one patient, 16.7%). Most injuries involved the limbs: lower (four patients, 66.7%) and upper (one patient, 16.7%). The histologic diagnosis in all the cases were squamous cell carcinoma and mean latency period from injury to diagnosis of malignancy was 18.5 years. All the patients had been admitted because of poor results from topical treatment. Three patients (50%) were managed with wide excision and skin grafting with the lesions healed. Ignorance as well as economic and sociocultural factors were the underlying issues. Education concerning the risks associated with chronic wounds and the need for prompt and proper surgical management are recommended.

Background: The emergency department (E.D) of any hospital is an important entry point of critically ill patients. The initial management of these patients is often challenging, and for valuable lives to be saved, the in fracture and manpower should be up to date. Objective: To analyze the epidemiology of death in our Emergency Department within 72hours after admission, the death rate, and to establish any contributory factors. Method: Demographic data, time of arrival at the ED ,physical finding, the Glasgow coma scale(GCS),the injury severity score(ISS),the diagnosis, investigations done, treatment offered ,the time of death and the autopsy report, were entered into a Proforma. These data was analyzed using EPI-Info statistical programme version 3.4.3 of 2007. Results: Four thousand and eleven (4,011) patients were seen in the E.D during the period. A total of three hundred and fifty five (355) mortalities were recorded. Their ages ranged from 4-87years, with an average of 34.5years.The male: female ratio was 2.1:1. The overall mortality in the hospital during the period was 859: the E.D mortality figure representing 41.3%. Fifteen patients were brought in dead. The 355 deaths fell into two categories: trauma and non-trauma. One hundred and forty-seven (41.4%) persons died from trauma; road traffic accidents (RTAs) accounting for 118 (80.3%). Two hundred and eight (58.6%) persons died from nontrauma related causes, with chronic cardiovascular disorders been the most frequent cause of death 52 [25.0]. Majority of the mortalities were between 26-50 years age range. 86.2% of the mortalities presented late, greater than 6hours after the incidence. Within the 72 hours period, only 129(36.3%) were able to do the requested tests. Out of the 355 deaths, only 4[1.1%] were autopsied. An in-hospital 72hours death rate of 8.6 was recorded. Conclusion: Road traffic accidents and cardiovascular disorders are the common causes of emergency death in UCTH.A recorded death rate of 8.6% is high, suspected contributory factors include systemic deficiencies such as the lack of a trauma system, prehospital care; late presentation, the role of chemist operators, traditional healers, and delayed referral systems.

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Background: Penetrating abdominal trauma (PAT) typically involves the violation of the abdominal cavity by a gunshot wound (GSW) or stab wound. Recently several studies have favored a more conservative approach as opposed to mandatory exploratory laparotomy. Methods: Patients admitted in the University of Calabar Teaching Hospital (UCTH), Calabar, with PAT from January 2008 to December 2010 were prospectively studied based on a questionnaire. The total number of patients with PAT was compared with total number of emergencies, traumatic injuries and abdominal trauma seen during the same period. Results: A total of 48 patients presented with abdominal trauma: PAT 29 (60%) and blunt abdominal trauma (BAT) 19 (40%). The ages of the patients (28 male, 1 female) ranged from 3 -62 years (mean 28.1 years). Gunshot wound (GSW) 11 (38%) patients, stab wound 8 (27.6%) patients and machete cut 4 (13.8%) patients ranked first, second and third respectively as causes of PAT. The commonest organ injury was perforation of the small intestine. Four (13.8%) patients were managed conservatively while 25 (86.2%) patients had laparotomy. The duration of admission ranged from 2 -19 days (mean 10.5 days). Morbidity [surgical site infection (SSI)] and mortality were recorded in 2 (6.9%) and 3 (10.3%) patients respectively. Conclusion: Key areas that require attention have been highlighted. Revamping the ailing economy and gainful employment for youths are paramount areas that require prompt, dedicated and sustained intervention for reduction in violent crimes.

Ignorance and sociocultural factors were underlying issues in delaying treatment. Education highlighting the risk associated with chronic wounds and albinism, and the need for prevention, prompt treatment and proper surgical management, would improve prognosis with a reduction in the healthcare cost of this problem.