Retrobulbar versus subconjunctival anesthesia for cataract surgery

Objectives: To compare the effectiveness, in terms of pain relief and akinesia of retrobulbar and subconjunctival an aesthesia during cataract surgery and also to compare the degree of postoperative ptosis associated with each technique.Materials and Methods: Consecutive adult patients undergoing cataract surgery between March and June 2008 at the Guinness Eye Center Onitsha, were randomized into retrobulbar and subconjunctival an aesthesia by simple random sampling. Patients’ subjective perception of pain was graded into none, mild, moderate and severe; eyeball movement during surgery was graded into none, slight, moderate excessive. Two weeks after surgery, the palpebral fissure width was measured with the metre rule to determine the degree of post-operative ptosis.Results: Of the 90 patients studied, 55 (61.1%) patients had subconjunctival an aesthesia while 35(38.9%) had retrobulbar injection. In the retrobulbar injection group 25 (71.4%) patients had none or mild pains compared to 44 (80.0%) in the subconjunctival injection group; while 10 (28.6%) patients in the retrobulbar group experienced moderate to severe pains, 11 (20%) patients in the subconjunctival group had moderate pains and none experienced severe pains. But the difference in the degree of pain perception between the 2 groups is not statistically significant (χ2 = 0.01; df – 1; P>0.05). In the retrobulbar injection group, there was none or slight movement of the globe in 30 (85.7%) patients compared to 49 (89.1%) patients in the subconjunctival group. While 5 (14.3%) patients in the retrobulbar injection group had moderate globe movement, no patient in this group had excessive movement. In the subconjunctival injection group, 5 (9.1%) patients had moderate movement and 1 (1.8%) patient had excessive eyeball movement. The difference in the movement of the eyeball between the retrobulbar and the subconjunctival injections group was not significant (χ2 = 0.004; df – 1; P>0.05). In the retrobulbar injection group, the palpebral fissure width was within ≥10mm in 18 (51.0%) patients compared with 29 (53.0%) patients in the subconjunctival group. This difference was not statistically significant (χ2 = 0.0006; df – 1; P>0.05).Conclusions: Both retrobulbar and subconjunctival an aesthetic techniques are effective and safe for cataract surgery although the pain experience may be slightly more for patients being operated upon under retrobulbar anaesthesia

Weekend versus weekday hospital deaths: Analysis of in‑patient data in a Nigerian tertiary healthcare center

Aim: This study aims at comparing weekday deaths to weekend deaths of in‑patients of a tertiary hospital in Nigeria.Materials and Methods: This is a 10‑year retrospective survey conducted at the Nnamdi Azikiwe University Teaching Hospital in which the death records of the hospital were accessed from the various wards and health records department to extract relevant data pertaining to the time of hospital death. Tests of statistical significance were done using Chi‑square test at 95% confidence intervals.Results: A total of 3934 deaths were recorded during the period of study. The ages ranged from a few hours to 94 years with a mean age of 38.5 years. The male to female ratio was 1.2:1. An average of 547 weekend deaths and 568 weekday deaths were recorded, giving a ratio of 0.96:1. A ratio of weekend to weekday death rate of 0.99:1 and 0.93:1 for the males and females, respectively was noted. The labor ward, followed by the intensive care unit (ICU) had the highest weekend to weekday death ratio of 1.72:1 (P = 0.0461) and 1.41:1 (P = 0.1440), respectively. Weekend deaths were less in the other wards, with the gynaecological ward having the least ratio of 0.63:1 (P = 0.7360).Conclusion: The rate of hospital deaths was generally found not to vary significantly over the weekends and weekdays in the hospital except for the labor ward which had significantly higher weekend to weekday death rates of 1.72:1. There is therefore need for confidential enquiry into the causes of hospital deaths, especially in the labor ward, in order to identify and prevent avoidable deaths.Keywords: Hospital deaths, in‑patients, weekend deathsNigerian Journal of Clinical Practice • Oct-Dec 2013 • Vol 16 • Issue

Effects of Phoenix dactylifera Tree Fruit Extract on Cadmium Induced Renal Damage in Adult Wistar Rats

The objective of the study is to investigate the ameliorative potential of date palm tree (Phoenix dactylifera) fruit on cadmium induced kidneydamage in adult Wistar Rat using standard technique. Thirty (30) adult Wistar rats were divided into six groups of five rats per group.  Group A (control); Group B (0.1ml/kg body weight of cadmium); Group C (200mg/kg body weight of Phoenix dactylifera); Group D (600mg/kg body weight of Phaoenix dactylifera); Group E (0.1ml/kg body weight of cadmium and 200mg/kg body weight of Phoenix dactylifera); Group F (0.1ml/kg body weight of cadmium and 600mg/kg body weight of Phoenix dactylifera). Treatments were administered once daily for 30 days. After day 30, biochemical and histopathological studies were conducted to appraise oxidative stress and renal toxicity. Serum levels of creatinine, urea, catalase (CAT) and superoxide dismutase (SOD) were quantified. Animals treated alone with cadmium (Group B), showed significant (P < 0.05) increase in serum urea, serum creatinine and CAT, SOD levels statistically. Treatment of rats with Phoenix dactyliferaalongside cadmium (Group E and F) showed significant (P < 0.05) improvement in renal function and restoration of biochemical parameters mentioned earlier. Histopathological findings confirm these conservations. Therefore, the administration of aqueous extract of Phoenix dactylifera has protective effect on cadmium-induced renal toxicity and oxidative stress in wistar rats which can be attributed to Phoenix dactylifera antioxidant activity

Towards Effective Implementation of in-Loco Parentis in Nigeria Tertiary Institutions

In Ioco parentis or literally "in the place of the parent" is a legal doctrine that, historically, charged individuals caring for minors (including schools and camps) with the same rights, duties, and obligations possessed by the child's parents — most commonly in the area of discipline or conduct. Is doctrine in loco parentis still a valid principle for engaging the active relationship between tertiary institutions and parents of colleges and university students in the twenty first century? What are the historical antecedents to the current status of care and responsibility of university administrators for students under their watch? Is it worth while to wait for law suits before putting in place measures that safe guard students while in the care of the university? This article examines the doctrine of in loco parentis, (in place of the parents) in its historical context in the United States in comparison with the local Nigerian experience. Eleven recommendations emerge on how best to implement the doctrine in light of legal battles brought against institutions by parents who lose their children to death or sustain serious injuries while under the care of the institution. Keywords. In loco parentis, university discipline, parental responsibilit

Thermodynamic optimization tools for power tracking in a multistage concentrated solar power Rankine plant

Abstract: The object of the study is to present a method of thermodynamic optimization of power generating plants, in a mode that consolidates and simplifies the analysis of data on heat-work interaction of the plant components. The optimization scheme identifies the technical and process parameters that can improve the thermodynamic performance of the plant with respect to an objective variable, and further, the required thermodynamic measures necessary to improve the operating condition of the plant. Simple but effective tools are used to evaluate the optimal and suboptimal power generating capacities vis-à-vis the fundamental variables—namely, the thermodynamic quantity ratio (TQR) and the power-energy quantity ratio (PQR)—without routing optimization procedures. Beyond the optimal value of the objective variable, the power generation capacity of the plant is affected. The determination of the optimal value of the objective variable can also be approached by computerization; for fixed prescriptions of the boiler, superheater, and turbine parameters, variables such as boiler pressure and temperature can be optimally selected. DOI: 10.1061/(ASCE)EY.1943-7897.0000367. © 2016 American Society of Civil Engineers

Funding Youth Entrepreneurship in SMEs: A Panacea for Youth Unemployment in Niger-Delta , Nigeria

The objective of this study was to identify profitable and viable small and medium-sized enterprises (SMEs), which could form a basis for a youth economic empowerment programme in the crisis-torn Niger  Delta Region. Data analysed formed a basis for identifying profitable enterprises, and preparing financial proposals. The proposals can be used to source funds, which would enable youth to either work with  the identified SMEs or expand existing ones

Complications following nasotracheal intubation using cuffed polyvinyl chloride tube: a prospective cross sectional study

Background: To examine the complications following nasotracheal intubation by documenting the nasal traumas observed with the use of untreated cuffed polyvinyl chloride tube in unprepared nostrils.Methods: Patients who had maxillofacial surgeries under general anesthesia, muscle relaxation and nasotracheal intubation were included in the study. Nasotracheal intubation was carried out after induction of anesthesia was effected with intravenous propofol and suxamethonium by an Anesthetist using well lubricated cuffed polyvinyl chloride tube. Sizes 6.0, 6.5 and 7.0mm were inserted in females while sizes 7.0 and 7.5mm were inserted in males. Occasionally, the natural curve of the tube guides it through the cords without the aid of Magill forceps. Anterior rhinoscopy was performed by otolaryngologist 24 hours after surgery. Results were subjected to statistical analysis.Results: Sixty four patients were included in the study. They were between the ages of 21 and 63 years (mean 33.2 ± 14.1 years); they were 39 males and 25 females. The most frequently used nasotracheal tube (NT) was size 7.0mm internal diameter. Epistaxis was noticed in 52 (81.2%) patients. There were no statistically significant differences in the incidence of epistaxis observed in males and females, and also between right and left nostrils. A total of 46.8% of nasal trauma were inferior turbinate trauma involving the inferior medial aspect.Conclusion: The use of untreated cuffed polyvinyl chloride tube for nasotracheal intubation in unprepared nostrils is associated with a high incidence of epistaxis and nasal trauma.Keywords: nasotracheal intubation, epistaxis, nasal traum

HYPOGLYCAEMIA AS A CONSEQUENCE OF PRE-OPERATIVE FASTING: MYTH OR REALITY?

Background: The fatal risk of pulmonary aspiration of gastric contents during anaesthesia had since been recognized and consequently preoperative fasting guideline is usually prescribed to prevent this. Concern about development of hypoglycaemia during prolonged fasting has often been expressed, especially in children. AIM: This study is intended to determine the fasting blood glucose in preoperative patients of different age groups who were fasted for varying duration of time, and determine whether indeed hypoglycaemia occurs during inadvertently prolonged fasting which we often encounter in our practice setting. Methodology: A prospective cohort study of fasting blood glucose (FBG) of patients presenting for elective surgery in the principal investigator's operating rooms at the National Orthopaedic Hospital, Enugu, Nigeria was carried out. Blood glucose meter was used for estimation of glucose in capillary whole blood of the patients and the obtained data were analysed using SPSS version 16.0 statistical software. Comparison of mean values was done using the Chi-square test with statistical significance put at P < 0.05.  Results: Out of one hundred and thirty three patients studied with mean age of 30.2 ± 19.60 years (range: 1-72 years), and mean duration of fasting 12.73 ± 2.01 hours, (range: 8-16 hours), the mean fasting blood glucose was found to be 91.49 ± 13.36mg/dl (range: 58 - 124mg/dl). No relationship was found between age and FBG (Pearson's correlation coefficient, r = 0.025). Likewise duration of fasting did not relate with FBG (Pearson's correlation coefficient, r = 0.088). One patient (0.8%) had hypoglycaemia, with blood glucose of 58mg/dl. Conclusion: Hypoglycaemia as a consequence of pre-operative fasting is rare, even in non-infants fasted for considerably long hours. Neither patient's age, gender, nor duration of fasting had any significant influence on the fasting blood glucose of the patients. Keywords: Hypoglycaemia; Pre-operative fasting; Whole blood; Plasma

HYPOGLYCAEMIA AS A CONSEQUENCE OF PRE-OPERATIVE FASTING: MYTH OR REALITY?

Background: The fatal risk of pulmonary aspiration of gastric contents during anaesthesia had since been recognized and consequently preoperative fasting guideline is usually prescribed to prevent this. Concern about development of hypoglycaemia during prolonged fasting has often been expressed, especially in children. AIM: This study is intended to determine the fasting blood glucose in preoperative patients of different age groups who were fasted for varying duration of time, and determine whether indeed hypoglycaemia occurs during inadvertently prolonged fasting which we often encounter in our practice setting. Methodology: A prospective cohort study of fasting blood glucose (FBG) of patients presenting for elective surgery in the principal investigator\u27s operating rooms at the National Orthopaedic Hospital, Enugu, Nigeria was carried out. Blood glucose meter was used for estimation of glucose in capillary whole blood of the patients and the obtained data were analysed using SPSS version 16.0 statistical software. Comparison of mean values was done using the Chi-square test with statistical significance put at P < 0.05.  Results: Out of one hundred and thirty three patients studied with mean age of 30.2 ± 19.60 years (range: 1-72 years), and mean duration of fasting 12.73 ± 2.01 hours, (range: 8-16 hours), the mean fasting blood glucose was found to be 91.49 ± 13.36mg/dl (range: 58 - 124mg/dl). No relationship was found between age and FBG (Pearson\u27s correlation coefficient, r = 0.025). Likewise duration of fasting did not relate with FBG (Pearson\u27s correlation coefficient, r = 0.088). One patient (0.8%) had hypoglycaemia, with blood glucose of 58mg/dl. Conclusion: Hypoglycaemia as a consequence of pre-operative fasting is rare, even in non-infants fasted for considerably long hours. Neither patient\u27s age, gender, nor duration of fasting had any significant influence on the fasting blood glucose of the patients. Keywords: Hypoglycaemia; Pre-operative fasting; Whole blood; Plasma

Sources and Functionality of Rural Water Supply in Communities from three Senatorial Zones of Imo State, Nigeria

Sustainability of domestic water access in communities is essential for good health, society’s dignity and progress. This study investigated the sources and functionality of rural water supply in nine communities of three local government area (LGA) in three senatorial zones of Imo State, Nigeria using structured questionnaires. The questionnaires were administered on 100 women in each community. Data obtained were analysed using multivariate analysis of variance (MANOVA) to reveal the frequency of using the various sources of rural water supply, and Wilcoxon’s test for matched pairs to reveal the functionality status of the most frequently used water source. The findings indicate the importance of borehole water facilities in these rural communities and the necessity for intervention programs to strengthen their functionality in tandem with the State’s aspirations in achieving sustainable development goals