The Intensive Care Unit of the University Teaching Hospital, Ilorin, Nigeria: a ten year review (1991 - 2001)

A retrospective study was conducted on all patients admitted to the Intensive Care Unit (ICU) of the University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria, over a 10 - year period (October 1991 - Sept. 2001). This period marks the first decade of the establishment of our ICU. The purpose of this study is to describe the pattern of admission of patients into the ICU, highlighting the variety of cases, indications for admission, outcome and causes of death, and the problems of medical and administrative management of the unit. No similar study has previously been carried out in this institution. A total of 295 patients, consisting of 185 males (62.7%) and 110 females (37.3%) were admitted to the ICU during the study period. The commonest indication for ICU admission was for postoperative high care (54.9%), with postlaparotomy patients accounting for 59.9% of these cases. Medical indications for admission accounted for 21.3%, with respiratory failure and asthma being the commonest and each accounting for 11.5%. One hundred and ten patients (37.3%) died during their ICU admission, giving an ICU survival rate of 62.7%. Late presentation of cases and inadequate staffing and equipment were important factors which may have contributed to mortality in these patients. Improved funding, training of additional staff and acquisition of advanced monitoring and life support equipment would improve the efficiency of our intensive care unit and patient survival. South African Psychiatry Review Vol. 11(4) 2005: 146-15

Anaesthesia management for thyroidectomy in a non-euthyroid patient following cardiac failure

A 24-year-old male thyrotoxic student of a tertiary institution had thyroidectomy in the presence of a persistently elevated thyroxine (T4) and tri-iodothyronine (T3) levels. He was initially managed for hypertension at a private hospital before he was referred to our hospital for expert management. He had symptoms of thyrotoxicosis three years before presentation at our hospital. Physical examination revealed bilateral anterior neck masses and a diagnosis of toxic goitre was made. The serum T3 and T4 were elevated. Chest X-Ray, electrocardiogram and echocardiography showed abnormal findings. He was commenced on antithyroid drugs. Surgery was postponed several times due to persistently elevated thyroid hormones. However, he developed cardiac failure after six months on medical treatment and was treated with digoxin and frusemide. He had thyroidectomy under general anesthesia after his cardiovascular status was optimized in order to prevent further deterioration of his cardiac function. The anesthetic management is presented and discussed

Theoretical investigation of the performance of some environment-friendly refrigerants in a sub-cooling heat exchanger refrigeration system

As a result of global concerns over the depletion of the earth’s protective stratospheric ozone layer by the atmospheric release of chloroflurocarbons (CFCs) and hydrochlorofluoro-carbons (HCFCs) refrigerants, their production has been restricted and they are no longer choices fornew equipment. This paper presents theoretical investigation of the performance of some environment-friendly refrigerants in a sub-cooling heat exchanger refrigeration system. Five promising environment-friendly refrigerants (R23, R32, R134a, R143a and R152a) were selected frommethane and ethane derivatives and they were investigated theoretically. Sub-cooling heat exchanger was used to evaluate the impact of selected refrigerants on the exchanger effectiveness, system capacity and coefficient of performance (COP). The results obtained showed excellentperformance of R152a and R134a, and fair performance of R143a when compared with R12 in vapour compression refrigeration system. The results also showed that using R23 and R32 in the refrigeration system will be detrimental to the system performance

Predictors of maternal mortality among critically ill obstetric patients

Aim: Evaluation of the predictors of maternal mortality among critically ill obstetric patients managed at the intensive care unit (ICU).Methods: A case control study to evaluate the predictors of maternal mortality among critically ill obstetric patients managed at the intensive care unit (ICU) of the University of Ilorin Teaching Hospital, Ilorin, Nigeria from 1st January 2010 to 30th June 2013. Participants were critically ill obstetric patients who were admitted and managed at the ICU during the study period. Subjects were those who died while controls were age and parity matched survivors. Statistical analysis was with SPSS-20 to determine chi square, Cox-regression and odds ratio; p value < 0.05 was significant.Results: The mean age of subjects and controls were 28.92 ± 5.09 versus 29.44 ± 5.74 (p = 0.736), the level of education was higher among controls (p = 0.048) while more subjects were of low social class (p = 0.321), did not have antenatal care (p = 0.131) and had partners with lower level of education (p = 0.156) compared to controls. The two leading indications for admission among subjects and controls were massive postpartum haemorrhage and severe preeclampsia or eclampsia. The mean duration of admission was higher among controls (3.32 ± 2.46 versus 3.00 ± 2.58; p = 0.656) while the mean cost of ICU care was higher among the subjects (p = 0.472). The statistical significant predictors of maternal deaths were the patient’s level of education, Glasgow Coma Scale (GCS) score, oxygen saturation, multiple organ failure at ICU admission and the need for mechanical ventilation or inotrophic drugs after admission.Conclusion: The clinical state at ICU admission of the critically ill obstetric patients is the major outcome determinant. Therefore, early recognition of the need for ICU care, adequate pre-ICU admission supportive care and prompt transfer will improve the outcome

Prevalence of Trichomonas vaginalis Infection among Pregnant Women in Abeokuta, Nigeria

Trichomoniasis caused by Trichomonas vaginalis has emerged as one of the most common sexually transmitted infections. The infection may lead to an important complication in pregnancy, as it has been related with prematurity and low birth weight. The aim of this study was to determine the prevalence of T. vaginalis among Nigerian women attending ante natal clinic at the State Hospital, Abeokuta. A cross-sectional descriptive study was conducted among two hundred (200) pregnant women attending ante-natal at Ogun State Hospital, Abeokuta. High vaginal swabs (HVS) and urine samples were collected from consenting pregnant women and examined for the presence of T. vaginalis under the microscope. Out of 200 women, a total of 40 (20%) were found to be infected with T. vaginalis. The women between the age group 20-30 had the highest prevalence of 21.3% while age group >20 years had the lowest of 12.5% but the difference was not statistically significant. Women in second trimester had the highest prevalence of 25% while those of first trimester were the lowest with 18%. Results obtained from comparing HVS and urine microscopy in this study showed that HVS had a prevalence of 40% compared to urine microscopy (5.5%) and the difference in their detection was statistically significant p=0.0041. These results may be useful for health authorities, especially for ante-natal care and protection against STDs. The higher recovery rate obtained by using HVS microscopy confirms its advantage over urine microscopy

Dose related effects of oral clonidine pre-medication on bupivacaine spinal anaesthesia

Introduction: The duration of action of sub-arachnoid block is short, and one of the ways to overcome this is the use of oral clonidine. Methods: 108 patients of ASA I and II, aged 18 to 65 years undergoing lower abdominal surgeries under spinal anaesthesia were randomized into three groups.. Control group A (n=36) no oral clonidine pre-medication, Group B (n=36) and group C (n=36) received 100 \u3bcg and 200 \u3bcg of oral clonidine pre-medication respectively, 1hr before spinal anaesthesia. Haemodynamic parameters were recorded. Sensory block, degree of motor blockage, and sedation were assessed. Results: Clonidine prolonged the mean duration of motor block by 189.98\ub126.93 min (100\u3bcg) and 191.89\ub128.13 min (200\u3bcg) compared to 117.92\ub125.13 min in the control group p<0.05. The mean duration of analgesia was 188.19\ub135 min (100\u3bcg) and194\ub124.58 min (200\u3bcg) in the clonidine groups compared to 115.89\ub126.66 min in control group p<0.05. All the patients were awake in the control group while 71.43% and 100% were drowsy in groups B and C respectively. Conclusion: Oral clonidine produces better clinical effects on the onset and duration of Bupivacaine spinal anaesthesia

Intranasal Endoscopic Repair of Bilateral Choanal Atresia in a Male Newborn with Crouzon's Syndrome

No Abstract

Prolonged upper airway obstruction in an eclamptic patient – challenges of management

No Abstrac

Outcome of Intensive Care management of neurosurgical patients before and after the commencement of neurosurgical service in a resource poor centre: A Nigerian perspective

Background: Outcome of intensive care management of neurosurgical patients depends not only on the standard and effectiveness of the treatment obtained but also on the available technical and human resource. We aimed at evaluating the impact of a new neurosurgeon-led team on the outcome of neurosurgical patients managed in our multipurpose resource scarce ICU. Patients and Methods: Demographics, neurological data, length of stay (LOS) and mortality rates (MR) of patients admitted 5 years before (n=22) and five years after (n=159) the commencement of the neurosurgical service were collated and analysed. Outcome was retrospectively compared between the two periods. Results: Neurosurgical patients (n=181) constituted 24.6% of 735 admissions into the ICU during the ten-year period. The commonest indications for admission were head injury (157, 86.6%), spinal cord injury (9, 5%) and postbrain tumour excision (13, 8.2%). From the first to the second period, the overall MR declined from 77.3% to 47.2%, while MR in head and spinal cord injured patients dropped from 83.3% to 49.6% and 50% to 40% respectively. Among the head injured, outcome was significantly influenced by post-resuscitation GCS (