An analysis of postdural puncture headache in obstetric patients: A study from Kano, Nigeria

Background: One of the complications of spinal anesthesia is postdural puncture headache. Many risk factors have been identified which when addressed could reduce the incidence.Objectives: This was a prospective study that analyzed the incidence, onset and severity of postdural puncture headache among pregnant women who had cesarean section under a subarachnoid block in Aminu Kano Teaching Hospital, Kano, Nigeria.Patients and Methods: Spinal anesthesia was performed on 146 patients using size 25‑ or 26‑gauge Quincke, Whitacre, or Sprotte needles. Patients were followed up to determine the incidence, onset, and severity of post spinal headache. The data were analyzed using Statistical Package for Social Sciences (SPSS) version 18.0 (SPSS Inc., SPSS Statistics for Windows, Chicago, IL, USA). Demographic variables were presented using tables while summary was done using means, standard deviation, and percentages. Test of association was done using Fisher’s Exact test. A P value < 0.05 was considered statistically significant.Results: The overall incidence of postdural puncture headache was 15.8% with all cases presenting within the first 24 hours. Most patients rated their headache as mild to moderate on a 10‑cm visual analogue scale.Conclusion: Traumatic Quincke spinal needle is associated with high incidence of postdural puncture headache and therefore we recommend the use of atraumatic pencil tip needle especially in obstetric anesthesia.Key words: Cesarean section; postdural puncture headache; spinal anesthesia

Metallic foreign body in esophagus: Are multiple radiographs necessary?

No Abstract

Otology practice in a Nigerian tertiary health institution: A 10-year review

Background: The practice of otology in developing countries has remained unsatisfactory. The aim of this study is to describe the practice in a tertiary health institution with a view to articulate strategies for improvement.Materials and Method: This a retrospective study of patients with otology problems, who attended Ear, Nose and Throat clinic of Aminu Kano Teaching Hospital, Kano, over a 10-year period (1997–2007). Case notes were retrieved and studied.Results: Otologic conditions accounted for 56.3% of the 8070 clinic visits. The most frequent condition seen was chronic otitis media (25.4%). Sensorineural hearing loss (mostly preventable) accounted for 16%. Other cases included wax impaction (7.5%) and foreign body in ear (7.3%). Modern diagnostic and operative equipment were lacking. Operative surgery was offered to 4% of cases of chronic suppurative otitis media and 72% of patients needing hearing aid could not afford one. There was no middle ear reconstructive or inner ear operation in the 10-year period.Conclusion: A significant number of patients are in need of otology services. These services are inadequate presently. Concerted effort should be geared toward strengthening preventive ear health, training and re-training, procurement of relevant diagnostic and operative equipment

Pattern and outcome of surgical management of nasolachrymal duct obstruction in children: A five year review

Objective: To determine the pattern of naso.lachrymal duct obstruction (NLDO) and outcome of dacryocystorhinostomy (DCR) in children in Aminu Kano Teaching Hospital Kano, over a 5.year period.Patients and Methods: The clinic and theater registers were used to retrieve the records of all patients below the age of 15 years who presented with NLDO. The information obtained included age, sex, duration, and types of clinical signs at presentation cause of obstruction and outcome of DCR. Successful outcome is defined as patent naso.lachrymal duct 1 year after surgery. All the patients had external DCR with stent inserted into the lachrymal sac and anchored to the columella and left in situ for 6 weeks. Fortnightly for three visits then at 2 months intervals. At each visit, the patient had lachrymal punctal cannulation and irrigation with normal saline to ensure free drainage.Results: There were 17 patients, 9 males and 8 females (M: F = 1.1: 1). Two patients (11.8%) had bilateral disease and 15 (88.2%) were unilateral. The patientsf ages ranged between 2 and 10 years. The commonest presenting features were tearing and discharge. In 14 patients (82%) tearing started from birth though patients presented much later. Congenital NLDO occurred in 82%, and in the remaining 18%, obstruction was caused by depressed nasal fracture. Fifteen patients (88%) had successful outcome of DCR at 1.year follow.up. The commonest  complication noted was stent extrusion before 6 weeks in 17.6% of cases.Conclusion: NLDO was mostly of congenital origin and was characterized by delayed presentation. Patients have good outcome with external DCR.Keywords: Children, dacryocystorhinostomy, naso lachrymal duct,  obstructio

Acute retropharyngeal abscess in children: the Kano experince

Background: Infection within the retropharyngeal space could progress on to an abscess formation. Retropharyngeal abscess can be a life- threatening emergency, with potential for airway obstruction. Aim: This review was aimed at highlighting the features and management of the patients. Methods: This was a retrospective study of all children admitted with diagnosis of acute retropharyngeal abscess over seven- year period (January 1998 to December 2004). The case notes of the patients were reviewed and information extracted were age, sex, duration and nature of symptoms, bacteriological findings, surgical procedures, complications and duration of hospitalization. Results: There were thirty-two patients. Eighteen (56.2%) were males and 14(43.8%) females. The median age was 65 months. Twenty-five (78.1%) were below 5 years of age. The major complaints were fever (93.5%), respiratory distress (90.6%), cough (87.5%), and neck pain/swelling (81.2%.). Hyperextension of the neck was evident in 18(56.3%) and bulging of the posterior pharyngeal wall in 20(62.5%). All the patients had surgical drainage of the abscess. Twenty-nine (90.6%) had intra-oral, drainage while 3(9.4%) had the abscess drained by external (cervical) incision. The mean duration of hospital admission was 10.4 days. Conclusion: The treatment of retropharyngeal abscess should be prompt empirical usage of broad spectrum antibiotics and timely surgical drainage. Keywords: children, retropharyngeal abscess, incision and drainage, Kano Nigerian Journal of Otorhinolaryngology Vol. 3(1) 2006: 21-2

Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.

BACKGROUND: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. METHODS: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. FINDINGS: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2-2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3-0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2-18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46-13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99-17·34]) or anaesthesia complications (11·47 (1·20-109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7-5·0). INTERPRETATION: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. FUNDING: Medical Research Council of South Africa.Medical Research Council of South Africa