A 12-month prospective study of intra-abdominal hypertension and abdominal compartment syndrome incidence and outcomes at a tertiary hospital in Nigeria

Background: Peritoneal sepsis is a life-threatening emergency, more so in the low- and middle-income countries (LMICs) where immediate hospital presentation for much needed urgent surgical care is the exception rather than the norm. Continued research into the multifactorial aetiopathogenesis responsible for the high level of morbidity and mortality is necessary. We aimed to determine the incidence of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in patients presenting with generalized peritonitis in a tertiary hospital in Nigeria. Methods: We conducted a prospective study involving recruitment of consenting patients managed for generalized peritonitis over 12 months. Results: Fifty-seven consenting and appropriate patients were recruited over the course of the study and managed as per study protocol. The duration of symptoms ranged between 11 hours and 7 days. All patients had varying degrees of IAH and ACS at presentation with generalized peritonitis. A laparotomy with definitive surgery was done in 51 patients (89%), with 6 patients (11%) having only a bedside peritoneal drain inserted for decompression. Significant improvement of the respiratory rate (P < 0.001), oxygen saturation (P = 0.041), and urinary output (P = 0.021) only occurred after decompression by laparotomy or tube drainage. The consecutive mean ± standard deviation (SD) intra-abdominal pressures measured, respectively, at presentation, immediately postsurgery, then postoperatively at 6 h, 24 h, and 72 h reflected significant improvement at each point (respectively in cmH2O: 11.4 ± 6.03, 6.58 ± 5.58, 5.78 ± 3.29, 4.73 ± 2.86, 6.72 ± 5.18; P < 0.001). Conclusions: IAH and ACS are not uncommon in our setting, and ACS at presentation is a significant predictor of mortality in patients with peritoneal sepsis. Surgical decompression invariably leads to an improvement in all clinical variables investigated. Keywords: intra-abdominal hypertension; abdominal compartment syndrome; peritonitis; laparotomy; percutaneous catheter decompression; Nigeria

Demographic and epidemiological characteristics of HIV opportunistic infections among older adults in Nigeria

Background: In view of the maturing HIV epidemic in sub-Saharan Africa, better understanding of its epidemiology among older adults is necessary in order to design appropriate care and treatment programmes for them.Objectives: To describe the demographic and epidemiological characteristics of HIV opportunistic infections among newly enrolled patients aged 50 years and above in Ibadan, South-West Nigeria.Methods: Analysis of data extracted from electronic records of 17, 312 subjects enrolled for HIV/AIDS care and treatment between January 2006 and December 2014 at the ART clinic, University College Hospital, Ibadan.Results: Age of the patients ranged from 18 to 90 years with a mean of 36.4 years (SD= 10.3) with older adults constituting 12.0% (2075). Among older adults, about half (52.9%) were females. Majority (59.1%) were currently married while 25.9% were widowed. Prevalence of opportunistic infections was 46.6%. The commonest opportunistic infections (OIs) were: oral candidiasis (27.6%), chronic diarrhoea (23.5% and peripheral neuropathy (14.8%). Significant factors associated with opportunistic infections in older adults were: CD4 count less than 350 (OR=3.12, CI: 2.29-4.25) and hepatitis C virus co-infection (OR=2.17, CI: 1.14-4.13).Conclusion: There is need for prompt response to the peculiar challenges associated with the emerging shift in the epidemiology of HIV and associated infections in sub-Saharan Africa.Keywords: HIV/AIDS, older adults, epidemiological characteristics, opportunistic infections, Nigeri

Demographic and epidemiological characteristics of HIV opportunistic infections among older adults in Nigeria.

Background: In view of the maturing HIV epidemic in sub-Saharan Africa, better understanding of its epidemiology among older adults is necessary in order to design appropriate care and treatment programmes for them. Objectives: To describe the demographic and epidemiological characteristics of HIV opportunistic infections among newly enrolled patients aged 50 years and above in Ibadan, South-West Nigeria. Methods: Analysis of data extracted from electronic records of 17, 312 subjects enrolled for HIV/AIDS care and treatment between January 2006 and December 2014 at the ART clinic, University College Hospital, Ibadan. Results: Age of the patients ranged from 18 to 90 years with a mean of 36.4 years (SD= 10.3) with older adults constituting 12.0% (2075). Among older adults, about half (52.9%) were females. Majority (59.1%) were currently married while 25.9% were widowed. Prevalence of opportunistic infections was 46.6%. The commonest opportunistic infections (OIs) were: oral candidiasis (27.6%), chronic diarrhoea (23.5% and peripheral neuropathy (14.8%). Significant factors associated with opportunistic infections in older adults were: CD4 count less than 350 (OR=3.12, CI: 2.29-4.25) and hepatitis C virus co-infection (OR=2.17, CI: 1.14-4.13). Conclusion: There is need for prompt response to the peculiar challenges associated with the emerging shift in the epidemiology of HIV and associated infections in sub-Saharan Africa

Tumor necrosis factor-alpha and interleukin-1 alpha as predictors of survival in peritonitis: A pilot study

Context: Peritonitis induces an inflammatory response characterized by the elevation of various cytokine levels. Included in this cascade of cytokines are tumor necrosis factor-alpha (TNF-α) and interleukin-1 alpha (IL-1α). The outcome of patient care may be associated with the pattern of elaboration of these cytokines. Aim: The aim of this study was to describe the pattern of cytokine response (TNF-α and IL-1α) in the course of peritonitis and evaluate them as predictors of mortality in peritonitis. Setting and Design: This was a prospective study conducted in the Division of Gastrointestinal Surgery, University College Hospital, Ibadan. Methods: Consenting patients with clinical diagnosis of generalized peritonitis over a 6-month period (July to December 2015) were recruited. The serum samples of these patients were obtained at presentation, immediately after surgery, and 24 h and 48 h after surgery with a follow-up period of 30 days. Results: Twenty-six samples out of thirty could be analyzed. Serum TNF-α and IL-1α levels were both elevated at presentation in all patients. However, the patterns of change after intervention varied between the survivors and nonsurvivors. Conclusion: Peritonitis triggers a simultaneous increase in serum levels of TNFα and IL-1α. Lower serum level of TNF-α is associated with survival, while on the contrary, higher level of IL-1α is associated with survival

The Top 25 Laboratory Tests by Volume and Revenue in Five Different Countries

Objectives: To compare the most common diagnostic/laboratory tests across five different referral hospitals by volume and revenue. Methods: The authors obtained data on volumes and reimbursement rates for the most common 25 tests at the five hospitals with which they are affiliated and organized them to be as comparable as possible. Simple descriptive statistics were used to make cross-country comparisons. Results: There are strong similarities across all five hospitals in the top five tests by both volume and revenue. However, the top five by volume differ from the top five by revenue. Reimbursement rates also follow common patterns, being lowest for the most common biochemical test; intermediate for the most common hematology and microbiology tests, respectively; and highest for the most common pathology test. Conclusions: Most of the most common tests also appear in the new Essential Diagnostics List. This may inform plans for universal health coverage

WOMAN-ETAC Dataset

The WOMAN trial is an international clinical trial to study the effect of tranexamic acid on death, hysterectomy and other maternal outcomes, in women with PPH.14. The trial tested whether tranexamic acid, a blood clot stabiliser discovered in Japan in the 1950’s, could become an essential tool for fighting excessive bleeding soon after giving birth. This condition, known as postpartum haemorrhage, is the number one cause of maternal death around the world, particularly in low and middle income countries. Dataset contains baseline and follow-up measurements for: D-dimer concentration (mg/L), Maximum lysis (%), Haemoglobin concentration (g/L), International normalized ratio (INR), Prothrombin time (seconds), Activated partial thromboplastin time (seconds), Fibrinogen concentration (g/L), Clotting time (seconds), Amplitude (firmness) at 5 minutes (mm), Amplitude at 10 minutes (mm), Clot lysis at 30 and 60 minutes (%), and Maximum clot firmness (mm). THE DATASET CAN BE DOWNLOADED FROM THE FREEBIRD PLATFORM AT https://ctu-app.lshtm.ac.uk/freebird/