Impact of short-term Educational Interventions on Asthma Knowledge and metered-dose Inhaler Techniques among post basic nursing students in Ilorin, Nigeria- Result of a pilot study

Background: Nurses’ knowledge of asthma and inhaler device technique could positively or negatively affect the outcome of asthma treatment. There exists paucity of data on asthma knowledge and inhaler techniques in Nigeria.Objective: Our study aimed at evaluating the level of knowledge of asthma and inhaler techniques among post basic nursing students in Ilorin, Nigeria.Methods: This was a pre-post intervention design study carried out among 40 post basic nursing students from September to October 2011. A pretest was conducted which involved self- administration of asthma knowledge questionnaire and demonstration of inhaler device techniques using the pressurized metered dose inhaler (pMDI). The pre-test was followed immediately by educational interventions (lecture, physical and video demonstrations), and after one month by a post test.Results: Forty out of 44 nurses completed the study giving a response rate of 91%. The median years after basic nursing training was 4 (range 1-21 years). Majority (70.0%) have not had a recent training on how to use inhalers. The total mean percentage score of asthma knowledge increased significantly from 75.9 %( pre intervention) to 86.5% (post intervention). For the demonstration of pMDI, none (0%) of the respondents had percent demonstration score of 100% pre intervention and post intervention 25.0% had a demonstration score of 100%.Conclusion: The knowledge of asthma was satisfactory while the demonstration of inhaler techniques was very poor pre intervention, both of which significantly improved after educational intervention. Additional studies need to be performed in larger, mixed populations of healthcare professional to confirm these findings.Keywords: Asthma, inhaler techniques, nursing students, Nigeria

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

Pediatric ophthalmic indications for examination under anesthesia in Ilorin, Nigeria

Objective: To determine the ophthalmic indications and challenges for pediatric ocular examination under anesthesia (EUA).Methods: The surgical register and patients’ records of children who underwent EUA between 1990 and 2007 were examined to document patients’ bio data, diagnoses and details of procedures and anesthesia.Results: Thirty-nine children underwent EUA during the 18-year period. The indications included congenital glaucoma (20 cases, 21.3%) and congenital cataract (5 cases, 12.8%). There were two cases each (5.1%) of microphthalmia, megalocornea, and squint. A case each of other indications constituted the remaining 10.3%.Conclusion: The commonest ophthalmic indication for EUA among children is congenital glaucoma. Most of the children (36, 92.3%) had inhalational anesthesia administered by anesthetists at great cost to their parents. Werecommend the use of ketamine anesthesia administered by nonanesthetist with some training in anesthetic resuscitation procedure, for short pediatric procedure such as EUA in resource-challenged settings

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

Serial pathologic fractures of five long bones on four separate occasions in a patient with primary hyperparathyroidism, challenges of management in a developing country: a case report

Multiple pathologic fractures secondary to parathyroid adenoma is rarely recognized and reported in the tropics. Inadequate evaluation causes worsened disability and increased psychological stress. We present a 27-year-old Nigerian male student with recurrent unexplained pathological fractures of the long bones. Primary Hyperparathyroidism was later diagnosed and he benefited from a unilateral parathyroidectomy. Primary hyperparathyroidism secondary to parathyroid adenoma is difficult to diagnose and needs a high index of suspicion. Surgery and good  postoperative biochemical control of serum calcium produce satisfying outcomesKey words: Pathologic fractures, parathyroid adenoma, Primary Hyperparathyroidism, serum calcium, surger

Potentials of leaves of Aspilia africana (Compositae) in wound care: an experimental evaluation

<p>Abstract</p> <p>Background</p> <p>The potentials of the leaves of the haemorrhage plant, <it>Aspilia africana </it>C. D Adams (Compositae) in wound care was evaluated using experimental models. <it>A. africana</it>, which is widespread in Africa, is used in traditional medicine to stop bleeding from wounds, clean the surfaces of sores, in the treatment of rheumatic pains, bee and scorpion stings and for removal of opacities and foreign bodies from the eyes. The present study was undertaken to evaluate the potentials for use of leaves of this plant in wound care.</p> <p>Methods</p> <p>The effect of the methanol extract (ME) and the hexane (HF) and methanol (MF) fractions (obtained by cold maceration and graded solvent extraction respectively) on bleeding/clotting time of fresh experimentally-induced wounds in rats, coagulation time of whole rat blood, growth of microbial wound contaminants and rate of healing of experimentally-induced wounds in rats were studied as well as the acute toxicity and lethality (LD₅₀) of the methanol extract and phytochemical analysis of the extract and fractions.</p> <p>Results</p> <p>The extract and fractions significantly (<it>P </it>< 0.05) reduced bleeding/clotting time in rats and decreased coagulation time of whole rat blood in order of magnitude of effect: MF>ME>HF. Also, the extract and fractions caused varying degrees of inhibition of the growth of clinical isolates of <it>Pseudomonas fluorescens </it>and <it>Staphylococcus aureus</it>, as well as typed strains of <it>Ps. aeruginosa </it>(ATCC 10145) and <it>Staph. aureus </it>(ATCC 12600), and reduced epithelialisation period of wounds experimentally-induced in rats. Acute toxicity and lethality (LD₅₀) test in mice established an i.p LD₅₀of 894 mg/kg for the methanol extract (ME). Phytochemical analysis revealed the presence of alkaloids, saponins, tannins, flavonoids, resins, sterols, terpenoids and carbohydrates.</p> <p>Conclusion</p> <p>The leaves of <it>A. africana </it>possess constituents capable of arresting wound bleeding, inhibiting the growth of microbial wound contaminants and accelerating wound healing which suggest good potentials for use in wound care.</p

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Difficult airway management in a patient with giant malignant goitre scheduled for thyroidectomy - case report

No Abstract. Nigerian Medical Practitioner Vol. 47(5) 2005: 77-8

Airway Management Dilemma in a Patient with Maxillofacial Injury

A 35year old male presented at the Accident and Emergency room of our hospital with partial upper airway obstruction, dysphonea and inability to lie supine following multiple facial injuries from assault. Clinical examination revealed a young man with avulsed floor of the mouth, comminuted fracture of the mandible, ragged laceration of the lower lip and the tongue. The patient could not assume the supine position as any such attempt resulted in immediate airway compromise. He had tracheostomy and repair of the laceration under general anaesthesia. Anaesthesia was induced with intravenous ketamine with the patient in the left lateral position whiletraction on the tongue using a Magill’s forceps ensured patency of the airway. A classical laryngeal mask airway was subsequently inserted to manage the airway to enable a surgical airway and repair. The patient was dischargedhome in a satisfactory condition, six weeks after surgery

Anaesthesia manpower and services in private hospitals in Ilorin, Nigeria: a preliminary survey

Background: While in the developed world, the specialty of anaesthesia is well advanced, in the developing world, patients have little access to anaesthetic services. Objectives: The objective of this study was to carry out a survey to determine the type of personnel providing anaesthetic service among others. Methodology: A preliminary questionnaire survey of anaesthetic manpower and services was carried out in 30 privately-owned hospitals in Ilorin, Nigeria between March and April 2009. Results: The results showed that 20 (66.7%) hospitals had anaesthetic personnel coverage on part-time basis while 10 (33.3%) hospitals did not have. Eleven (36.7%) hospitals had anaesthetic machines while 19 (63.3%) did not have. Fourteen (46.7%) hospitals performed intra-abdominal surgeries with endotracheal general anesthesia being the commonest technique . Twenty (66.7%) hospitals performed caesarean sections with ketamine as the sole anaesthetia being the commonest technique. Conclusion: General anaesthesia was the technique in 50% of the intra-abdominal operations in this study ,while ketamine as a sole anaesthetic was the commonest technique in caesarean surgeries. Though ketamine has a wide safety profile, its use as a sole anaesthetic for intra-abdominal and caesarean surgeries may not be without its problems. KEY WORDS: anaesthesia manpower, anaesthetic techniques, private hospitals, Ilorin, Nigeria