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BACKGROUND: The cytokine tumour necrosis factor (TNF)-α is a well-studied potent candidate mediator that is systemically involved in a variety of inflammatory diseases. Several single nucleotide polymorphisms (SNPs) of the TNF-α gene have been studied with regard the pathogenesis of acne vulgaris, but the results have been inconclusive. AIM: This case-control study investigated the association of the TNF -308 G>A and -238 G>A SNPs with acne vulgaris in a high-risk Pakistani population. METHODS: In total, 160 healthy controls and 140 patients with acne were enrolled in this study. Polymorphisms were determined by PCR and restriction fragment length polymorphism analysis. RESULTS: Our data showed that the TNF -308 G>A and TNF -238 G>A SNPs were present at a significantly higher rate in cases than in controls (P < 0.01 and P < 0.02; respectively). There was a significant difference between the G and A alleles from patients with acne and controls for -308 G>A (OR = 1.5, 95% CI = 1.07-2.19, P < 0.02) and -238 G>A (OR=1.6, 95% CI = 1.06-2.44, P = 0.02) genotype. Moreover, the severity of acne was significantly associated with TNF genotype (TNF -308 G>A: χ² = 34.6, P < 0.001; TNF -238 G>AL χ² = 12.9, P < 0.01). CONCLUSION: Our data suggest that the TNF -308 G>A and TNF -238 G>A SNPs may contribute to the pathogenesis of acne in the study population. Furthermore, patients with severe acne showed an increased frequency of mutant TNF genotypes at -308 and -238 compared with patients with less severe acne.

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Chemical burns represent a major challenge for reconstructive surgeons. They are caused by exposure to acids, alkalis or other corrosive substances which result in various degrees of injury. This report highlights the challenges faced in managing such patients in a Nigerian teaching hospital. The medical records of seven patients (four females and three males) treated for chemical burns injury from January 2001 to December 2010 were retrospectively reviewed. All patients were younger than 30, with a mean age of 23.3. Most of them (85.7%) had sustained full thickness burns ranging from 8% to 33% of their body surface area. All cases were result of assaults. The male to female ratio was 1:1.3, and the average duration of hospital stay was 7.5 months. The face was affected in all patients. Patients presented with multiple deformities, like ectropion of eyelids, keratopathies, blindness, nasal deformities, microstomia, loss or deformities of the pinna, mentosternal contractures, and severe scarring of the face. Twenty-nine surgical procedures were performed, which included nasal and lip reconstruction, ectropion release, commissuroplasty, contracture release, and wound resurfacing. Management of chemical burns, especially in a developing country lacking specialised burn centres with appropriate facilities, is challenging. Prevention through public awareness campaigns, legislation for control of corrosive substances, and severe punishment for perpetrators of assaults using these substances will go a long way in reducing the incidence of chemical burns.

Les brûlures chimiques représentent un défi majeur pour les chirurgiens de reconstruction. Les brûlures chimiques sont causées par l'exposition aux acides, aux alcalis ou à d'autres substances corrosives qui aboutissent à des degrés divers de lésion. Les Auteurs mettent en évidence les difficultés rencontrées dans la gestion de ces patients dans un hôpital universitaire nigérian. Les dossiers médicaux des sept patients (quatre femmes et trois hommes) traités pour des brûlures chimiques dans la période janvier 2001/décembre 2010 ont été revus rétrospectivement. Tous les patients avaient moins de 30 ans (âge moyen, 23,3 ans). La plupart d'entre eux (85,7%) avaient subi des brûlures au troisième degré allant de 8% à 33% de leur surface corporelle. Dans tous les cas il s'agissait d'agressions. Le ratio homme-femme était de 1:1,3, et la durée moyenne d'hospitalisation était de 7,5 mois. Le visage a été la partie du corps la plus gravement atteinte chez tous les patients, qui présentaient des malformations multiples, comme ectropion des paupières, kératopathies, cécité, malformations nasales, microstomie, perte ou malformations du pavillon, contractures mentosternales, graves cicatrices au visage. Vingt-neuf procédures chirurgicales ont été réalisées, qui comprenaient la reconstruction nasale et des lèvres, la libération de l'ectropion, la commissuroplastie, la libération des contractures, et le resurfaçage de la plaie. La gestion des brûlures chimiques, en particulier dans un pays en développement qui ne possède aucun centre spécialisé de brûlures doué d'installations appropriées, est un défi. Pour réduire la fréquence des brûlures chimiques, il faut intensifier la prévention par des campagnes de sensibilisation du public, par la législation pour le contrôle des substances corrosives, et par de graves sanctions pour les auteurs d'agressions qui utilisent ces substances.

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High-tension electrical burns are a rare but devastating form of injury. The objective of this case report is to bring to the fore the severity of this rare form of injury and highlight the benefits of active surgical management of such a condition. We report the cases of two patients who were managed for high-tension electrical burns and highlight the main features of their presentation and management. Both patients needed urgent resuscitation and subsequent multiple amputations and disarticulations to save their lives. In high-tension electrical burns early resuscitation and wound exploration coupled with decisive action on the need for amputation would reduce the morbidity and mortality often associated with the ensuing overwhelming sepsis.

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Objective: Epilepsy; a common clinical disorder usually presents with generalized tonic clonic seizures resulting in a fall and loss of consciousness. Seizures occurring near a burning agent may lead to a fall onto the burning agent and result in severe burns. A prospective study of all patients who sustained burns during an epilepsy seizure presenting to Federal Medical Center Azare; Bauchi State; Nigeria between January 2003 and June 2005 was conducted. Methods: The age; sex; place of incidence; site and extent of injury; cause of burns and treatment outcome were analyzed. Results: A total of 79 patients presented with burns during the study period; nine (11) were as a result of an epileptic seizure. The nine patients comprised of 6 adults and 3 children. Majority were mothers and their children. The place of accident was the home in 7 patients while 2 occurred on the farm. Seven were flame burns and two scalds. Conclusion: This study highlights that epilepsy is an important cause of severe burns in our environment. Women at home and children dependent on them are more at risk hence the need for public enlightenment

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An extremely rare case of asymmetrical bilateral oblique facial cleft presumably secondary to amniotic bands is presented. The cleft on the right side of the patient commenced from the lower lip through the maxillary region of the face to the temporal area and was described as a lower oro-temporal cleft to differentiate it from the previously reported type commencing from the upper lip.

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Encephalocele is a common congenital problem in the practice of Neurosurgery worldwide, with varying sizes of the underlying skull defects. This study was carried out to determine the size of the problem; to assess whether the skull defects are being under-managed or not; and also to determine those patients that will benefit from cranioplasty. The case notes of the patients with encephalocele managed over a 5 year period were reviewed and the relevant data obtained. Seventy-six percent of the patients had occipital encephalocele. The average diameter of the skull defect was 1.8 cm. Only 2 (9.5%) of the patients had cranioplasty. Cosmesis was acceptable to all the patients. No recurrence was noted in the series studied. We therefore concluded that the skull defects are not being under-managed, however large anteriorly based lesions with wide skull defects (i.e >2.5 cm) will require cranioplasty.

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