Risk assessment of tuberculosis laboratories and biosafety practices among laboratory health workers in two selected states in Nigeria

Background: Occupational tuberculosis among mycobacteriology laboratory workers has received insufficient attention especially in countries with high burden of tuberculosis despite the associated greater risk than the general population. The aim of the study was to conduct a risk assessment of tuberculosis (TB) laboratories and biosafety Practices among laboratory health workers.Method: A descriptive study conducted among the laboratory health workers involved primarily in the diagnosis of tuberculosis (TB) in two selected states in Nigeria. A semi-structured questionnaire based on tuberculosis laboratory procedure risk assessment was self-administered by consenting laboratory workers. Data obtained were based on the degree of exposure, viability of bacilli, aerosol generation, laboratory configuration, typology and fitness of the staff to work in the TB laboratory. Risk assessment of tuberculosis (TB)laboratories and biosafety practices was determined by these sets of questions and categorized into low, middle and high risk.Results: Fifty-eight (58) of the 64 laboratory health workers participated in the study. Their average age was 38.8±7.6 years and male to female ratio of 1 to 1.4 and 82.7% had worked in the TB laboratory for  less than 10 years. The calculated risk for occupational TB was low 55(94.8%) and moderate 3(5.2%) without any of the respondents having high risk. With regards to laboratory practices, majority of the respondents (91.4%) did not reuse slides for smear staining, 81.0% admitted that the laboratories were well-ventilated and75% regarded their laboratories safe to work. However, preemployment screening for TB, HIV, diabetes mellitus, and kidney disease was done in 3(5.2%), 7(12.1%), 2(3.4%) and 1(1.7%) respectively.Conclusion: The result of this study shows that the risk of laboratory health workers exposure to tuberculosis (TB) and potential hazard is low, however moreattention be given to infection control policies and pre-employment screening for TB.Keywords: Occupational tuberculosis, Laboratory, Practice, Risk, Nigeri

A comparative study of the incidence and severity of sore throat after insertion of the laryngeal mask airway and endotracheal tube

BackgroundPostoperative sore throat is a common and unpleasant complication following airway insertion during general anaesthesia.ObjectiveWe compared the incidence and severity of sore throat following passage of two airway devices.MethodsFollowing ethical committee approval, patients were randomly allocated by blind balloting into one of two groups; Group ETT (n=45) had endotracheal tube insertion and group cLMA (n=45) had classic laryngeal mask airway insertion. Induction of anaesthesia was achieved with propofol 2.5 mg/kg and fentanyl 1.5μg/kg., followed by pancuronium 0.1mg/kg, after test ventilation. Introduction of airway device was done 3 minutes after administration of muscle relaxant. The incidence of dryness of the throat, hoarseness of voice, cough and severity of sore throat was accessed using visual analogue scale, on the 1st and 2nd postoperative days.ResultsThe incidence of sore throat was comparable between the two groups on both 1st and 2nd postoperative days, (p =0.371, p =0.668) respectively. On 1st postoperative day, incidence of cough and hoarseness were significantly more in the ETT group than in the LMA group, (p =0.001, p =0.026) respectively. While on 2nd postoperative day, the incidence of cough and hoarseness were comparable, (p =0.147, p =0.571) respectively.ConclusionThe incidence of sore throat following the use of the classic laryngeal mask airway and endotracheal tube were similar. However, on 1st postoperative day, the development of cough and hoarseness of the voice was significantly more following endotracheal tube insertion

The outcome of anaesthesia related cardiac arrest in a

Background: Anaesthesia related cardiac arrest is undesirable, and different attempts have been made to reduce the mortality associated with it through continuous specialist training, and provision of state of art equipment, combined with rigorous research. Patients and methods: We determined the outcome of all cardiac arrests that occurred within 24 h of a surgical procedure and anaesthesia from January 2013 to May 2014. Results: There were nine anaesthesia related cardiac arrest in 4229 cases, (incidence of 21.28 per 10,000), with a mortality of 7/4229; (16.55 per 10,000). There were 60 perioperative cardiac arrests (incidence of 141.88 per 10,000), with a mortality of 55/4229 (130.05 per 10,000). There was return of spontaneous circulation in 34 (56.67%) cases, among them only 7 (20.59%) survived to hospital discharge. The independent determinant of perioperative mortality was the duration of cardiac arrest ⩾ 5 min (RR 10.50, 95% CI 2.721–40.519, p < 0.001), cardiac arrest in the absence of a witness (RR 9.56, 95% CI 2.486–36.752, p < 0.001), nonstandard time of cardiac arrest (RR 3.2, 95% CI 1.792–5.714, p < 0.001), ASA physical status ⩾ III (RR 2.017, 95% CI 1.190–3.417, p = 0.017), and emergency surger (RR 2.17, 95% CI 1.151–4.049, p = 0.011). Conclusion: Anaesthesia related cardiac arrest and mortality were linked to cardiovascular depression from halothane overdose in our institution. The burden can be reduced by improving on establishing standard monitoring in the perioperative period, and a team approach to patients care

Complications and outcomes following central neuraxial anesthesia in a sub-Saharan Tertiary Hospital: The legal implication

Background: Complications following central neuraxial anesthesia have led to litigations and claims in developed nations, however, the incidence of litigation is low in our environment. Anesthetist practicing in Nigeria need to be aware that such complications are not uncommon. Aim and objective: To determine central neuraxial anesthesia related complications and the legal implications. Method: This was a prospective observational study conducted in 821 patients scheduled for surgery under central neuraxial anesthesia from February 2012 to January 2013. The choice of anesthesia depended on the indication and the duration of surgery. Results: The observed complications of central neuraxial anesthesia, which may result in litigation included inadvertent high block (22.4%), paresthesia during needle placement (6.2%), inadequate block (3%), failed block (1.2%), and postdural puncture headache (1.15%). Others were seizure (0.1%), meningism (0.1%), persistent pain in the lower limb for 48 hours (0.1%), back pain (0.7%) and cardiac arrest (0.49%); three of the four cardiac arrest died. There was, however, no report of litigation or claim in this study. Conclusion: We have demonstrated that complications, which may result in litigation and claim following central neuraxial anesthesia is not a rare occurrence in our institution. However, there was no record of litigation or claim in our review. Anesthetist in Nigeria need to be aware of the legal implication of such complications. When performing blocks, well recognized complications should be discussed before obtaining consent. If any untoward effect occurs, a detailed note of the findings and treatment should be documented for future reference

Prevalence and clinical characteristics of headaches among undergraduate students in three tertiary institutions in Ilorin, Nigeria

Objective: Headache is a common chronic neurologic disorder with huge economic and psychosocial impact. In comparison with other neurological disorders, there is limited data on primary headache, especially from sub‑Saharan Africa. This study was done to fill in the gap and provide recent information on headache among Nigerian undergraduate students.Methodology: Quota sampling was used to select students from three tertiary educational institutions within Ilorin, the capital of Kwara state. Two‑stage self‑administered questionnaires developed from the guideline of the International Society of Headache were used to harvest information.Results: A total of 1500 students participated in the study. The mean age of the students was 20.9 ± 3.1 years, with male:female ratio of 1.6:1. A total of 356 students have frequent headache within previous 1 year, given the headache frequency of 23.7%. Fifty‑three students (3.5%) had headaches on almost daily basis, 84 (5.6%) had ≥4 attacks/week, 145 (9.7%) had ≤2–3 attacks/month, and 123 (8.2%) had 1–3 attacks every 3 months. Close to 75% indicated that it limits their daily activity frequently. One hundred and eighty‑seven (12.5%) students fulfilled the criteria for tension‑type headache, 36 (2.4%) for migraine headache, and 133 (8.9%) had nonclassified headaches. The most frequent headache‑associated symptoms are photophia – 100 students (6.7%), phonophobia – 159 students (10.6%), while 62 students (4.1%) had nausea and vomiting. None of the students had seen a physician for proper headache diagnosis. Majority (90.2%) used none prescription over-the-counter analgesia (acetaminophen) for symptomatic treatment of their aches.Conclusion: Headache is a common complaint among Nigerian undergraduate students and it limits the daily activity of majority of the sufferers. Students need proper education regarding treatment to alleviate their suffering and forestall complication, especially those associated with analgesic overuse.Keywords: Headache, migraine, prevalence, tension‑type headache, undergraduate

How safe is sedated upper gastrointestinal endoscopy in a sub-Saharan teaching hospital?

Background: Upper gastrointestinal endoscopy may induce autonomic reactions, with transient changes in haemodynamics and oxygen saturation. We audited the changes in cardiovascular parameters and oxygen saturation during sedated endoscopy.Patients and Methods: A prospective observational study of 110 consecutive patients scheduled for upper gastrointestinal endoscopy under conscious sedation. The sedative agent, duration of endoscopy, heart rate (HR), systolic blood pressure (SBP), and oxygen saturation (SPO2) were recorded, while the rate pressure product (RPP) was computed. The patient's preoperative anxiety, pain score and discomfort score during the procedure was recorded on a modified visual analogue scale (VAS) rated from 1-10.Results: Atotal of 110 patients were studied: 69(62.7%) received IV midazolam, and 41(37.3%) had IV pentazocine. The mean HR and RPP increased significantly at all times during the study period from presedation values, p &lt;0.0001. However, the mean HR, SBP and RPP were comparable between midazolam and pentazocine groups. The maximum HR, SBP, RPP in the midazolam group was 155 bpm, 189 mmHg, and 23.35 mmHg/bpm respectively compared to the pentazocine group with 151 bpm, 174mmHg, and 24.71 mmHg/bpm respectively, p &lt;0.05.Oxygen desaturation (SPO2 ≤ 94%w)as noted in 15 patients (13.6%); midazolam (8.2%) versus pentazocine (5.5%), p =0.82. The lowest SPO2 in midazolam group was 92% versus 93% in pentazocine group. The post endoscopy ECG changes included sinus tachycardia in (12), ST segment elevation (5) and T wave inversion (8) in all patients. The number of patients with pain (VAS &gt;7) during endoscopy was comparable: midazolam (26) versus pentazocine (20), p = 0.25.Conclusion: Sedationwith either midazolam or pentazocine during endoscopy had similar effects on cardiovascular parameters and oxygen saturation. However, severe pain with VAS &gt;7 was not uncommon.Keywords: Upper gastrointestinal Endoscopy, midazolam, pentazocine, cardiorespiratory changes, Pain, anxiety score, discomfort scor

Does Electroconvulsive therapy aggravate the rise in potassium and creatine kinase following suxamethonium administration?

Background: Potassium and creatine kinase levels increase after the administration of suxamethonium. This rise may be exaggerated by the combination of suxamethonium fasciculation and the modified tonic/clonic convulsion induced by electroconvulsive therapy. This study compared the magnitude of increase in potassium and creatine kinase levels after electroconvulsive therapy and surgery using suxamethonium.Methods: A total of 40 patients were studied; electroconvulsive therapy (ECT), n=20 and surgery (Control), n=20. Intravenous sodium thiopentone (5mg/kg) and suxamethonium (1.5mg/kg) were administered. The changes in potassium and creatine kinase levels were assessed at presuxamethonium, 1 and 3 minutes after fasciculation in Control group and ECTinduced seizure activity in the ECT group. Our hypothesis was that a significant increase occurs in the mean potassium and creatine kinase levels after suxamethonium administration during electroconvulsive therapy.Results: Both groups exhibited a rise in potassium concentration after administration of suxamethonium. The mean increase was significantly higher in the ECT group than in the Control group; at 1 minute; ECT (0.71 ±SEM 0.24) versus control (0.28 ±SEM 0.19) mmol/L, p =0.003, and at 3 minutes; ECT (0.35 ±SEM 0.23) versus control (0.20 ±SEM 0.15), p =0.044. The mean increase in the creatine kinase concentration was significantly higher in the ECT group (34.11 ±SEM 10.76) than in the Control group (19.71 ±SEM 6.32) IU/L, p = 0.023, at 3 minutes.Conclusion: The creatine and potassium concentrations following suxamethonium administration were significantly higher in the electroconvulsive therapy group than in the control group.Keywords: ECT, surgery, creatine kinase, potassiu

Antiseizure effects of ketogenic diet on seizures induced with pentylenetetrazole, 4-aminopyridine and strychnine in wistar rats

The ketogenic diet (KD) is a cheap and effective alternative therapy for most  epilepsy. There are paucity of experimental data in Nigeria on the usefulness of KD in epilepsy models. This is likely to be responsible for the poor clinical acceptability of the diet in the country. This study therefore aimed at providing experimental data on usefulness of KD on seizure models. The study used 64 Wistar rats that were divided into two dietary groups [normal diet (ND) and ketogenic diet (KD)]. Animal in each group were fed for 35days. Medium chain triglyceride ketogenic diet (MCT-KD) was used and it consisted of 15% carbohydrate in normal rat chow long with 5ml sunflower oil (25% (v/w). The normal diet was the usual rat chow. Seizures were induced with one of Pentelyntetrazole (PTZ), 4-Aminopyridine (AP) and Strychnine (STR). Fasting glucose, ketosis level and serum chemistry were determined and seizure parameters recorded. Serum ketosis was significantly higher in MCT-KD-fed rats (12.7 ±2.6) than ND-fed (5.17±0.86) rats [p=0.003]. Fasting blood glucose was higher in ND-fed rats (5.3±0.9mMol/l) than in MCT-KD fed rats  (5.1±0.5mMol/l) with p=0.9. Seizure latency was significantly prolonged in ND-fed compared with MCT-KD fed rats after PTZ-induced seizures (61±9sec vs  570±34sec) and AP-induced seizures (49±11sec vs 483±41sec) p&lt;0.05. The difference after Str-induced seizure (51±7 vs 62±8 sec) was not significant (p&gt;0.05). The differences in seizure duration between ND-fed and MCT-KD fed rats with PTZ (4296±77sec vs 366±46sec) and with AP (5238±102sec vs  480±67sec) were significant (p&lt;0.05), but not with STR (3841±94sec vs 3510±89sec) [p&gt;0.05] respectively. The mean serum Na+ was significantly higher in MCT-KD fed (141.7±2.1mMol/l) than ND-fed rats (137±2.3mMol/l) with p&lt;0.05. There was no significant difference in mean values of other serum electrolytes between the MCT-KD fed and ND-fed animals. MCT-KD caused increase resistance to PTZ-and AP-induced seizures, but has no effect on STR-induced seizures. This antiseizure property is probably mediated through GABAergic receptors (PTZ effect) and blockade of membrane bound KATP channels (AP effect) with some  enhancement by serum ketosis.Keywords: Ketogenic diet, Antiseizure, Pentylenetetrazole, Amino-Pyridine, Strychnin

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran