Post-operative symptoms at home in children following day case surgery

No Abstract. Southern African Journal of Anaesthesia and Analgesia Vol. 12(3) 2006: 101-10

Perioperative adverse airway events in cleft lip and palate repair

Background: Airway-related problems account for the majority of anaesthetic morbidity in paediatric anaesthesia, but more so for cleft lip and palate repair. The aim of this study was to assess the frequency, pattern, management and outcome of adverse airway events during the perioperative period in cleft lip and palate patients. Method: This was a prospective cohort study conducted in a tertiary hospital in a suburban south-western Nigerian town. One hundred and sixteen patients who had cleft lip and palate repair over a five-year period were included. The demographic data, surgical diagnosis, congenital anomalies, procedures performed, medical problems, perioperative anaesthetic and surgical complications were studied. Results: Adverse airway events were observed in six patients (4.6%). These included postoperative chest infection (n=2), failed intubation (n=1), difficult intubation (n=1), post-extubation bronchospasm (n=1), and laryngeal oedema (n=1). All, except one, who developed complications were patients with combined cleft lip and palate. No mortality was recorded. Conclusion: Adverse perioperative airway events in cleft lip and palate surgery are common and are more likely to be associated with combined cleft lip and palate than with isolated lip or palate defects. These complications usually occur immediately following extubation or in the early postoperative period. The severity may necessitate intensive care unit admission and specialised care.South Afr J Anaesth Analg, 2011;17(6):370-37

Outcomes of Tunneled and Nontunneled Internal Jugular Catheters for Hemodialysis at Zenith Medical and Kidney Centre, Nigeria

Objectives: Tunneled and nontunneled jugular access routes are the most widely used routes for hemodialysis (HD) in developing countries.This study was a retrospective review of the utility, safety, and outcomes of both tunneled and nontunneled curved internal jugular catheteruse in patients with end‑stage renal disease (ESRD) in Zenith Medical and Kidney Centre, Abuja, Nigeria. Materials and Methods: This is a retrospective study of 100 ESRD patients on maintenance HD at the center between June 2019 and December 2019. All patients on maintenance dialysis with tunneled and nontunneled curved internal jugular catheter were observed for immediate and short‑term complications associated with the catheter. Results: Among the patients, 90 (90.0%) had tunneled dialysis catheters placement and dialyzed with it, while 10 (10%) patients had nontunneled dialysis catheters use. While 90 (90%) of the patients with the dialysis catheters developed no complications, ten (10%) patients had catheter‑related complications either during catheter insertion or while it was being used for dialysis. The most common in this study was reactionary hemorrhage which occurred in 5% of the patients evaluated. Ten (10%) of the patients with catheter placement required ultrasonic guidance. No death was recorded during catheter placement. Conclusion: Internal jugular tunneled and Non tunneled dialysis catheters (NTDCs) are safe with good outcomes among our ESRD patients. Keywords: Catheters, hemodialysis, Nigeria, outcome, tunneled and nontunneled dialysis catheters, Zenith Medica

Sulfoxide Synthase versus Cysteine Dioxygenase Reactivity in a Nonheme Iron Enzyme

The sulfoxide synthase EgtB represents a unique family of nonheme iron enzymes that catalyze the formation of a C-S bond between N-α-trimethyl histidine and γ-glutamyl cysteine, which is the key step in the biosynthesis of ergothioneine, an important amino acid related to aging. A controversy has arisen regarding its catalytic mechanism related to the function of the active-site Tyr377 residue. The biosynthesis of ergothioneine in EgtB shows structural similarities to cysteine dioxygenase which transfers two oxygen atoms to the thiolate group of cysteine. The question, therefore, is how do EgtB enzymes catalyze the C-S bond-formation reaction, while also preventing a dioxygenation of its cysteinate substrate? In this work we present a quantum mechanics/molecular mechanics study into the mechanism of sulfoxide synthase enzymes as compared to cysteine dioxygenase enzymes and present pathways for both reaction channels in EgtB. We show that EgtB contains a conserved tyrosine residue that reacts via proton-coupled electron transfer with the iron(III)-superoxo species and creates an iron(III)-hydroperoxo intermediate, thereby preventing the possible thiolate dioxygenation side reaction. The nucleophilic C-S bond-formation step happens subsequently concomitant to relay of the proton of the iron(II)-hydroperoxo back to Tyr377. This is the rate-determining step in the reaction cycle and is followed by hydrogen-atom transfer from the CE1-H group of trimethyl histidine substrate to iron(II)-superoxo. In the final step, a quick and almost barrierless sulfoxidation leads to the sulfoxide product complexes. The work highlights a unique machinery and active-site setup of the enzyme that drives the sulfoxide synthase reaction

Emergency non–obstetric abdominal surgery in pregnancy

Background: Despite recent advances in anaesthetic, perinatal and preoperative care, surgical intervention during pregnancy may still result in fetal loss from either spontaneous abortion (especially in the first trimester) or premature labor (especially in the third trimester). This study was aimed at determining the factors that affect fetal and maternal outcome following emergency non-obstetric abdominal surgery in pregnancy.Methods: We reviewed all cases of emergency non-obstetric abdominal surgery performed on pregnant women at Obafemi Awolowo University Teaching Hospital complex from January 1991 and December 2006. The socio-demographic characteristics, obstetric history, diagnosis and outcome of management were documented and analyzed.Results: A total of 46 pregnant patients presented with various conditions necessitating emergency non-obstetric abdominal surgery during the study period. Their ages ranged from 23 to 39 years with a mean age of 29.33 +/-4.904. Six (13%) of the patients presented during the first trimester, 32 (69.6%) patients during the second trimester and 8 (17.4%) were seen in the third trimester. Thirty-two (69.6%) patients presented with features of acute appendicitis out of 12 had ruptured appendicitis and 8 had appendicular abscess. Eight (17.4%) had intestinal obstruction, 5 (10.8%) had haemoperitonueum from abdominal injury and 1 (6.7%) had an ectopic foetus in bladder. Four (8.8%) mothers and 20(43.5%) babies died. Factors affecting maternal outcome included parity (P=0.010), duration of symptoms (P<0.0001) and delay in surgery (P<0.0001) while the factors affecting fetal outcome include maternal age (P<0.0001), booking status (P<0.0001), educational status (P<0.010), parity (P<0.040), gestational age (P=0.048) and delay in surgery (P=0.016).Conclusion: Complicated appendicitis is the most common indication for abdominal surgery in pregnancy in our center. High foetal loss seen in this study can be reduced by early presentation of the patients, early booking and high index of suspicion and prompt treatment by the attending surgeon

Status of Urinalysis in Nigeria: Way Forward

Urinalysis serves as a diagnostic procedure employed to assess the condition of a patient\u27s urinary system, encompassingthe examination of physical, chemical and microscopic attributes within a urine sample. In Nigeria, urinalysis stands asa frequently utilized diagnostic modality, widely accessible within health care facilities and is generally cost-effective.Nevertheless, despite its widespread availability, certain obstacles persist that hinder its effective utilization. Through thisreview, we aim to emphasize the significance of urinalysis in the diagnosis of kidney diseases within low-income nations,while also addressing the impediments that hinder its proper application. We also propose a range of requisite measuresfor enhancement

A high-valent non heme μ-oxo MnIV dimer generated from a thiolate-bound MnII complex and O2

International audienceThis study deals with the unprecedented reactivity of dinuclear non-heme MnII -thiolate complexes with O2 , which dependent on the protonation state of the initial MnII dimer selectively generates either a di-μ-oxo or μ-oxo-μ-hydroxo MnIV complex. Both dimers have been characterized by different techniques including single-crystal X-ray diffraction and mass spectrometry. Oxygenation reactions carried out with labeled 18 O2 unambiguously show that the oxygen atoms present in the MnIV dimers originate from O2 . Based on experimental observations and DFT calculations, evidence is provided that these MnIV species comproportionate with a MnII precursor to yield μ-oxo and/or μ-hydroxo MnIII dimers. Our work highlights the delicate balance of reaction conditions to control the synthesis of non-heme high-valent μ-oxo and μ-hydroxo Mn species from MnII precursors and O2

An iron-oxygen intermediate formed during the catalytic cycle of cysteine dioxygenase

Cysteine dioxygenase is a key enzyme in the breakdown of cysteine, but its mechanism remains controversial. A combination of spectroscopic and computational studies provides the first evidence of a short-lived intermediate in the catalytic cycle. The intermediate decays within 20 ms and has absorption maxima at 500 and 640 nm

Review of adult head injury admissions into the intensive care unit of a tertiary hospital in Nigeria

Background: Head injury is frequently associated with death and disability and imposes considerable demands on health services. Outcome after head injury is closely related to prompt management, including prevention of secondary brain injury and intensive care unit (ICU) management. This study aimed at determining the aetiological spectrum, injury characteristics, ICU admission patterns, and treatment outcomes of adult head-injured patients at a sub-Saharan tertiary hospital.Methods: A retrospective study on adult head-injured patients admitted to the ICU of a sub-Saharan tertiary hospital between July 2000 and June 2010.Results: A total of 198 head-injured adult patients were managed in the ICU during the study period. This included 128 males and 70 females with a male-to-female ratio of 1.8:1. The most common mode of injury was road traffic accident. All the patients admitted to ICU had either moderate or severe head injury, with 73.7% having severe head injury. About 26.3% of the patients had associated cervical spine injuries and 50% had various musculoskeletal and soft tissue injuries. Cranial computed tomography findings included brain contusions and intracranial haematomas. Mean duration of ICU stay was 18 days (range 24 hours-42 days), with 89.9% discharged out of ICU care. The overall mortality was 10.1%, although only 36.9% had satisfactory outcomes, as determined by the Glasgow Outcome Scale. Outcome had statistically significant (P < 0.05) relationship with severity of head injury and surgical intervention.Conclusions: Head injury management in the ICU requires an approach to ensure prevention of secondary brain injury; appropriate and early neuroimaging to diagnose lesions that would benefit from timely surgical intervention; as well as management of fluid, electrolyte and haematological derangements.Keywords: head injury; admissions; IC