A total of 69 patients were evaluated with 71 limbs affected; there were two patients who had bilateral above-knee amputations (AKA). There were 52 males and 17 females with a male-to-female ratio of 3:1. The age range was 10 months to 80 years, with a peak age range of 20-29 years (Figure 1).
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PATIENTS AND METHODS
This was a retrospective study of amputations done at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria, from June 1, 1998 to May 31, 2003. Case notes of all patients who had major limb amputations within the study period were examined. The following variables were extracted: patient’s age, sex, occupation, limb affected, indication for amputation, degree of trauma and Wagner’s classification of diabetic foot (Generic Amaryl reating patients with type 2 diabetes who cannot control blood sugar levels). All amputations distal to the wrist and the ankle were excluded.
INTRODUCTION
The indications for limb amputations are generally considered as the three Ds: dead limb, deadly limb and a damn nuisance of a limb. The most common indications for limb amputation vary from study to study: trauma, complications of diabetes mellitus and peripheral vascular disease.
There is a growing aggressive policy of revascularization in the developed world with various procedures being advocated in an attempt at revascular-izing an ischemic limb even in poor candidates. Medicolegal issues sometimes influence decisionmaking as to whether to salvage or amputate a limb. The decision to perform limb salvage or primary amputation is thus a crucial one for the surgeon to make, and it is imperative that the surgeon makes a good initial decision.
The April 2003 guidelines for HIV testing from the CDC advocated routine offering of HIV tests in both inpatient and outpatient settings in order to increase the number of patients who are aware of their serostatus. The implementation of this recommendation in the primary care setting is difficult. It is cumbersome, especially in a time-restricted encounter, for a primary care provider to bring up a sensitive or embarrassing topic that could potentially lead to a prolonged discussion simply to screen for the “traditional” risk factors associated with HIV infection.
One-hundred-one patients participated in the study (Table 1). The mean age of the participants was 33 years. Eighty percent of the sample was female, of which nearly 40% were married. Most respondents self-identified their race/ethnicity as black, Hispanic or white. Sixteen percent self-identified as American Indian/Alaskan Native, Asian and Pacific Islander, Cape Verdian, or mixed race/ethnicity. Due to sample size restrictions, we combined all of the latter groups into one category: “other” (Table 1).
An anonymous, self-administered cross-sectional survey of primary care outpatients was conducted from April until August 2002 at a group of community health centers affiliated with Providence Ambulatory Community Health Centers, Inc. (PACHC) located in Providence, Rl.
INTRODUCTION
The Centers for Disease Control and others estimate that up to one million people in the United States are HIV infected. Approximately one-third of those infected are unaware of their HIV status. Heterosexual transmission is increasing, especially among young men and women without traditional risk factors, such as substance abuse or same-sex relationships. The outpatient primary care setting represents an ideal place to identify those who are HIV infected by offering routine testing for HIV. This setting could easily provide earlier identification of HIV infection and immediate linkage to healthcare of those infected.