Clinical characteristics and outcome of patients with upper gastrointestinal bleeding at the emergency department of a tertiary hospital in Nigeria

Background: Upper gastrointestinal bleeding is a potentially life threatening condition with multiple causes. There is scarcity of health data depicting the clinical characteristics of the condition in African countries. This study was designed to describe the demographic, clinical characteristics and outcome of the patients who presented to our Emergency Department.Methods: The records of cohort of all patients admitted with upper gastrointestinal tract bleeding from 1 January 2011 to 31 December 2012 were retrospectively reviewed from admission to discharge or death.Results: There were 169 patients with median age of 44.0 years (range 13-89); 25 (15.0%) of them were known peptic ulcer disease patients. Most (69.2%) of the patients were males. The most common presenting symptom was haematemesis (34.9%) followed by melaena (16.6%). There was a history of NSAIDs use in 16.8% and alcohol ingestion in 12%. Upper Gastrointestinal Endoscopy was performed in 6.8% cases. Twenty-three (13.6%) patients died. There was association between mortality and diastolic blood pressure; more deaths (1/7; 14.3%) occurred in those with diastolic blood pressure > 90mmHg compared with <90mmHg (5/70; 7.1%) (P = 0.002). There were more deaths among patients who did not receive blood transfusion (4/40; 10.0%) compared with those who had blood transfusion (2/37; 5.4%) (P=0.008).Conclusions: The common presentations were haematemesis and melaena, mainly in middle aged men with mortality in one out of seven patients. The high mortality may be due to co-morbidities and poor support services.Keywords: Upper gastrointestinal bleeding, Emergency department, Characteristics, Outcom

Orthopaedic anaesthesia for upper extremity procedures in a Nigerian hospital

BackgroundGeneral anaesthesia and regional anaesthesia have been used successfully for upper extremity orthopaedic procedures. Despite the advantages of regional anaesthesia, there is low utilisation in Nigeria. In this study, weassessed the types of anaesthesia employed for upper extremity surgeries in our centre.MethodsAfter obtaining approval from the institutional ethics committee, all the patients who had upper extremity surgeries from 1 January 2011 to 31 December 2012 were included in this review. Both prospective and retrospective data were gathered. The choice of anaesthesia was at the discretion of the attending anaesthetist.ResultsA total of 226 patients with a male-to-female ratio of 1.6:1 and median age of 35.0 (range 2 – 89) years, had orthopaedic upper extremity procedures during the study period. Sixty-three cases (27.9%) had general anaesthesia, 5 (2.2%) combined regional and general anaesthesia while 158 (69.9%) had regional blocks. The regional blocks comprised 145 (89%) different approaches to the brachial plexus and 18 (11%) local anaesthetic infiltrations. The arm was the site mostly operated upon; while supraclavicular and axillary brachial plexus blocks were performed in equal amounts. In 14 (6.2%) patients, brachial plexus blocks were performed with spinal anaesthesia because of concomitant iliac crest bone grafts. While the duration of surgery did not differ significantly, regional anaesthesia provided a significantly longer duration of anaesthesia than general anaesthesia (251 ± 70.8 min versus 141.3 ± 65.5 min; p = 0.0000001).ConclusionThere is a high use of regional anaesthesia for upper extremity orthopaedic surgeries in our centre, which is a positive development in a resource limited setting

Cardiac arrest during anesthesia at a University Hospital in Nigeria

Background: We assessed the incidence and outcomes of cardiac arrest during anesthesia in the operating room at our university hospital. A previous study on intraoperative cardiac arrests covered a period from 1994-1998 and since then; anesthetic personnel, equipment, and workload have increased remarkably.Materials and Methods: After obtaining institutional ethics approval, we retrospectively reviewed patients’ hospital records such as anesthetic charts and register and ICU admission charts between 1st July 2005 and 30th June 2010. The cardiac arrests encountered during anesthesia was identified from anesthetic charts and followed‑up in the intensive care unit (ICU) for the first 24 h postoperatively. We consider that cardiac arrest occurred in any patient under anesthesia with asystole or ventricular fibrillation requiring cardiac compression or electrical defibrillation. We define recovery as an alive and non‑comatose patient 24‑h after the cardiac arrest.Results: During the study period, a total of 12,143 surgeries were done; the median age of all the patients was 30 years (range: 1 day-119 years). A total of 31 cardiac arrests identified (frequency 25.5:10,000; 95% confidence interval (CI) 17.7‑35.8) out of which 17 were nonfatal. Mortality related to anesthesia was 11.5:10,000 (95% CI 6.5‑18.9). The median age of patients with cardiac arrests was 39 years (range: 2 months–78 years). Overall, 80.7% cardiac arrests occurred in the American Society of Anesthesiologists’ (ASA) physical status 3-5. Cardiothoracic and neurosurgical operations accounted for 54.8% of the total cardiac arrests. The known risk factors identified among those who had cardiac arrest were, ASA physical status 3-5 (80.7%), procedures performed out‑of‑work hours (60%), and manually ventilating patients during general anesthesia (39%).Conclusion: Cardiac arrest during anesthesia is higher in poor risk patients (ASA 3-5) who are manually ventilated under general anesthesia and operated during out‑of‑work hours.Key words: Anesthesia, cardiac arrest, fatal, nonfatal, outcom

Vulvo-vaginal candidosis in a cohort of hormonal contraceptive users in Ibadan, Nigeria

Introduction: Most women who acquire HIV and other sexually transmitted infections (STIs) are in their child bearing years and are current or potential users of contraceptive methods. The study was undertaken to provide information on the association between the hormonal contraceptive methods and vulvo vaginal candidiasis among women attending Family Planning clinics, University College Hospital, Ibadan, Nigeria.Methods: It was a cross-sectional study in a population of women using hormonal contraceptive methods attending Family Planning clinics. Detailed medical history, endocervical and high vaginal swabs were collected from the women to establish diagnosis after clinical examination and informed consent. Aliquots of sera from venous blood samples of the women were tested for antibodies to HIV-1/2. Data was analysed using SPSS for windows’ version 17.0.Results: There were 116 women using hormonal contraceptive methods who participated in the study with mean age of 28.70 years (SD = 6.72, range = 19 –54). The mean age of sexual debut of the women was 19.2 years (SD = 2.96). The prevalence of vulvo-vaginal candidosis was 23.3%. Other associated sexually transmitted infections were bacterial vaginosis (24.1%), HIV (12.1%), trichomoniasis (10.3%), chlamydia cervicitis (7.8%), syphilis (5.2%), genital warts (6.0%) and gonorrhoea (2.6%).Younger age of sexual debut influenced the decision of selecting various forms of hormonal contraceptives especially the emergence of oral contraceptive forms (P = 0.043). Majority of the women on hormonal contraceptives had multiple sexual partners. Vulvovaginal candidosis is strongly associated with vaginal discharge and pruritus in women utilizing hormonal contraceptive methods (P = 0.001, 4.2 (1.0–13.2).Conclusions: Women seeking contraception to prevent unintended pregnancy are as much in need of education about prevention of STIs. The study found that younger age, numbers sexual partners, and use of hormonal contraceptives could increase the risk of acquiring vulvovaginal candidosis. Candidose vulvo-vaginale dans une cohorte d'utilisateurs contraceptifs hormonaux a Ibadan, NigeriaIntroduction: La plupart des femmes qui contractent le VIH et d'autres infections sexuellement transmissibles (IST) sont en âge de procréer et sont des utilisatrices actuelles ou potentielles de méthodes contraceptives. L'étude a été entreprise pour fournir des informations sur l'association entre les méthodes contraceptives hormonales et la candidose vulvo vagin chez les femmes fréquentant les cliniques de planification familiale, University College Hospital, Ibadan, Nigeria.Méthodes: Il s'agissait d'une étude transversale menée auprès d'une population de femmes utilisant des méthodes contraceptives hormonales dans des cliniques de planification familiale. Des antécédents médicaux détaillés, des prélèvements endocervicaux et des prélèvements vaginaux élevés ont été effectués auprès des femmes pour établir un diagnostic après un examen clinique et un consentement éclairé. Des aliquotes de sérums d'échantillons de sang veineux des femmes ont été testées pour rechercher des anticorps anti-VIH-1/2. Les données ont été analysées à l'aide de SPSS pour la version 17.0 des veuves.Résultats: 116 femmes utilisant des méthodes contraceptives hormonales ont participé à l'étude avec un âge moyen de 28,70 ans (ET = 6,72, intervalle = 19-54). L'âge moyen des débuts sexuels des femmes était de 19,2 ans (ET = 2,96). La prévalence de la candidose vulvo-vaginale était de 23,3%. Les autres infections sexuellement transmissibles étaient la vaginose bactérienne (24,1%), le VIH (12,1%), la trichomonase (10,3%), la chlamydia cervicite (7,8%), la syphilis (5,2%), les verrues génitales et la gonorrhée. . L'âge plus jeune des débuts sexuels a influencé la décision de choisir différentes formes de contraceptifs hormonaux, en particulier l'émergence de formes contraceptives orales (p = 0,043). La majorité des femmes sur les contraceptifs hormonaux avaient plusieurs partenaires sexuels. La candidose vulvovaginale est fortement associée aux pertes vaginales et au prurit chez les femmes utilisant des méthodes contraceptives hormonales (p = 0,001, 4,2 (1,0-13,2).Conclusions: Les femmes qui recherchent une contraception pour prévenir les grossesses non désirées ont autant besoin d'éducation sur la prévention des IST. L'étude a révélé que le plus jeune âge, le nombre de partenaires sexuels et l'utilisation de contraceptifs hormonaux pourraient augmenter le risque d'acquisition de la candidose vulvo-vaginale

Representativeness of suspected measles cases reported in a southern district of Nigeria

AbstractObjectiveTo compare the characteristics of suspected measles cases at the health facilities and to determine the representativeness of the data.MethodsWe visited 25 hospitals in the Aniocha Local Government Area (LGA) of Delta State, Nigeria, from which information on reportable diseases was collected. In particular, the suspected measles cases in their registries between January 1, 2007, and June 30, 2008, were reviewed. We compared the characteristics, including age, sex, location, and month of reporting, of the suspected cases with the LGA surveillance records.ResultsIn the LGA records, 10% cases involved individuals older than 14 years, compared with 20% in the same age group in the health facility records. Based on geographic location, 53% of the measles cases among the hospital records came from a single location, in contrast to only 30% of the cases among the LGA records. An analysis considering time revealed that 30% of the cases in the LGA records occurred in August 2007, whereas 20% of hospital cases were reported in February and May 2008 combined.ConclusionsThe two record types differed considerably in all of the characteristics used in this comparison

Analgesia in patients with or without single-shot lamina thoracic paravertebral block following breast cancer surgery in a Nigerian hospital

Background: In this pilot study, we evaluated the postoperative analgesic effect of the new lamina thoracic paravertebral block using a single-shot technique for major breast cancer surgery.Methods: A retrospective observational design was used to compare data involving 16 consecutive ASA 1 and 2 female patients who had unilateral modified radical mastectomy with axillary clearance under general anaesthesia with paravertebral block and 15 others without block between 13/03/2014 to 12/05/2015. We compared the time to the first request for analgesic, total analgesic (opioid and non-opioid) consumption (in mg) and postoperative pain scores over 72 h between the two groups.Results: One patient was excluded from the cohort due to block failure. The median time to first request for analgesic was 43 h (25.2-73.0 h) in the block group versus 2 h (1.0-2.5 h), p=0001. The pain scores was significantly lower at all measurement points among the block patients compared with the no-block group until 24 h postoperatively. No patient in the block group required analgesic within 24 h after surgery. The total consumption of pentazocine was nil (block group) vs. 154.0±74.2 (range 90-300) mg, p=0.0000001.Conclusions: Single-shot lamina paravertebral block provided prolonged postoperative analgesia and reduced opioid and non-opioid consumption

Brachial Plexus Blocks for Upper Extremity Surgeries in a Nigerian Hospital

Background: Different techniques of brachial plexus blocks are in use to provide surgical anaesthesia from the shoulder to the fingertips. However, they are perceived as time-consuming and unreliable as the sole anaesthetic for surgical procedures. Until recently (July 2008), only general anaesthesia was employed in our centre even for hand surgeries.Objective: To evaluate the use and outcome of brachial plexus blocks for upper extremity surgeries.Design: A retrospective review of patients’ records and prospective observation of patients with upper extremity surgeries.Setting: The University College Hospital, Ibadan, situated in Southwestern Nigeria with over 875 beds.Subjects: Patients who had surgeries of the shoulder, humerus, elbow, forearm, wrist and hand were studied.Results: In 2006 and 2007, only general anaesthetic accounted for the 220 upper extremity surgeries. However, in 2008, 2009 and 2010, brachial plexus blocks accounted for 6.9, 27.9 and 48.6% respectively. From a success rate of 60.0% in the first year of practicing brachial plexus anaesthesia using 40% paraesthesia technique, the second and third years were 78.9 and 96.5% respectively due to better localisation techniques (nerve stimulation alone or in combination with echo-guidance).Conclusion: Our study shows an increasing successful use of brachial plexus block techniques for upper extremity procedures

Epidemiology of road traffic crashes among long distance drivers in Ibadan, Nigeria

Background: Road Traffic Crashes (RTCs) are major causes of morbidity and mortality in Nigeria. Few studies in Ibadan have focused on the distribution and determinants of RTC among long distance drivers.Objective: To describe the distribution of crashes by place, times of occurrence, characteristics of persons involved and identify associated factors.Methods: A cross-sectional study was carried out among consenting long distance drivers within selected parks in Ibadan.Results: Respondents (592) were males, with median age of 42.0 years (range 22.0-73.0 years). Secondary education was the highest level of education attained by 38.0%. About 34.0% reported current use of alcohol. The life-time prevalence of crashes was 35.3% (95% CI= 31.5-39.2%) and 15.9% (95% CI=13.1-19.0%) reported having had at least one episode of crash in the last one year preceding the study. The crash occurred mainly on narrow roads [32/94 (34.0%,)] and bad portions of tarred roads [35/94 (37.2%,)] with peak of occurrence on Saturdays 18/94 (19.1%,). Significantly higher proportions of drivers aged ≤39years (23.4%) versus >39years (11.7%), those with no education (29.9%) versus the educated (13.8%) and those who reported alcohol use (21.9%) versus non users (12.8%) were involved in crashes in the year preceding the study. Significant predictor of the last episode of crashes in the last one year were age (OR=2.2, 95% CI=1.4-3.5), education (OR=2.7, 95% CI=1.5-4.6) and alcohol use (OR=1.8, 95% CI=1.2-3.0).Conclusion: Road traffic crashes occurred commonly on bad roads, in the afternoon and during weekends, among young and uneducated long-distance drivers studied. Reconstruction of bad roads and implementation of road safety education programmes aimed at discouraging the use of alcohol and targeting the identified groups at risk are recommended.Keywords: Road traffic crashes, long distance drivers, mortalit

Assessment of Emergency Obstetric Care Services in Ibadan- Ibarapa Health Zone, Oyo State, Nigeria

Nigeria’s high maternal mortality has been attributed to poor utilization of obstetric care services to handle complications of pregnancy and childbirth. But how available are standard emergency obstetric care services? This facility based cross sectional study assessed the availability and accessibility of emergency obstetric care services in Oyo State, Nigeria. Using a multi-stage sampling technique, 61 primary and 10 secondary health care facilities were selected. Data was collected using a structured questionnaire from the heads of the maternity units. Spatial mapping of the facilities was also produced. Results showed availability of comprehensive emergency obstetric care (CEmOC) facilities (0-3.9/500,000 population) was adequate, however a gross lack of basic emergency obstetric care (BEmOC) facilities (0-5.4/500,000 population) was observed, where available, they were clustered in the urban settlements. Prompt action needs to be taken to upgrade basic emergency obstetric care facilities accessible to the larger rural population dwellers to improve maternal health indices. Keywords: Maternal Mortality, Comprehensive, Basic, Emergency obstetric car

A community-based intervention for improving utilization of medical services by rape survivors in refugee camps in Zambia

Background: Rape is the most common form of violence in conflict and refugee situations but because of the associated stigma few cases are reported. This study assessed the outcome of an intervention targeted at women groups on the utilization of medical services by rape survivors in refugee camps in Zambia.Methods: A prospective quasi-experimental community-based intervention study was carried out in two refugee camps allocated into intervention and comparison areas. The intervention was participatory education sessions for women groups. Data was collected using the clinic records and the main outcome was the number of rape survivors who utilized and completed medical services provided at the camp clinics. Univariate, bivariate and multivariate analyses were carried out with level of significance set at 5%.Results: The proportion of the rape survivors who accessed medical care within 72 hours increased significantly from 41.2% to 84.8% in the intervention area but from 31.1% to 38.9% in the comparison area, (p=0.005). Those who completed their medical treatment and the follow-up visits increased significantly from 42.8% to 94.8% in intervention area but reduced from 38.5% to 21.4% in the comparison area, (p=0.002). Being resident in the intervention area predicted the utilization of medical services, [OR: 3.15; 95%CI: 1.955-5.681], p=0.002.Conclusion: Community-based intervention using participatory women’s group discussion had a significant impact on increasing the utilization of medical services by rape survivors and should be considered for scaling up as a key intervention for increasing utilization of medical services for rape survivors especially in refugee situations.Keywords: Rape survivors, Participatory group discussion, Medical services, Zambi