Anaesthetic challenges in emergency peripartum hysterectomy in West Africa: a Nigerian perspective

Background: To determine the foeto-maternal outcome and the anaesthetic challenges in emergency peripartum hysterectomy at the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria. Method: A retrospective study was carried out on parturients that had had emergency peripartum hysterectomy at UNTH in Nigeria, from July 1998 to June 2006. Data collected included demographics, anaesthetic and obstetric records, foeto-maternal outcomes and the need for critical care management. Results: There were a total of 6 798 deliveries and 6 485 live births, with 16 emergency peripartum hysterectomies. The incidence of emergency peripartum hysterectomy was 0.23% of all deliveries (2.3/1 000 deliveries). The causes of emergency hysterectomies were ruptured uterus (11 patients or 69%), placenta accreta/morbidly adherent placenta (4 patients or 25%) and uncontrollable postpartum haemorrhage following vaginal delivery (1 patient or 6%). Eight patients had subtotal hysterectomy, while eight had total abdominal hysterectomy (TAH). All the patients received general anaesthesia and blood transfusion. There were two postoperative admissions to the intensive care unit (ICU) and two procedure-related deaths due to hypovolaemic shock. There were nine stillbirths but no documented neonatal deaths. Conclusion: Emergency peripartum hysterectomies challenge the anaesthetist and the obstetrician who have to maintain haemodynamic stability in patients who may have lost volumes of blood, in a setting where blood and colloid availability is often limited. The maternal mortality was higher than that of most of the studies reviewed.Keywords: anaesthesia; peripartum hysterectomy; West Africa; Nigeri

Malaria diagnosis and treatment amongst health workers in University of Nigeria Teaching Hospital Enugu, Nigeria

Background: Confirmation of malaria and appropriate treatment are keys to malaria control.Objective: To determine the practice of malaria diagnosis and treatment in a Nigerian tertiary hospital.Materials and Methods: Retrospective review of patients’ records at the Children’s Clinic in UNTH.Results: Out of 6,684 children seen within the one year reviewed period, children diagnosed with malaria were 35.8 percent. Males were 60 percent and females were 40 percent. Children under five years were 72.6 percent of the total. Folders successfully traced were 1012; in 92 percent investigations for malaria were requested while 32 percent had differential diagnosis. Out of the 931 malaria investigations requested, 30percent did the tests and positive results were 94.9 percent. Presumptive treatment was 98 percent. Majority (83.3%) received ACTs.Conclusion: The practice of presumptive treatment was high and few cases had a differential diagnosis. Training of health workers on the need to confirm malaria cases is required.Key words: Children, diagnosis, malaria, Nigeria, treatmen

Management of pituitary adenoma with mass effect in pregnancy: a case report

A middle aged primigravida was managed at the University of Nigeria Teaching Hospital, Enugu, Nigeria for a pituitary macroadenoma. She was admitted at 33 weeks gestational age following a history of blurred vision and generalized headache, worse on bending down. After neurological consultation and investigations, a diagnosis of pituitary macroadenoma with mass effect was entertained. A plan for neurosurgery after delivery was made and the patient put on bromocriptine to reduce tumour size. Premature labour at 35 weeks resulted in caesarean delivery of a live baby. She was managed in the intensive care unit for three days where oral bromocriptine was resumed before she was transferred to the postnatal ward. Within ten hours of the transfer, she developed accelerated hypertension with encephalopathy and had a cardiac arrest shortly afterwards. This rare case highlights both the possible role of bromocriptine as a cause of postpartum hypertension and the possible development of a sudden catastrophic intramoural infarction or hemorrhage (pituitary apoplexy) in a patient with a macroadenoma

Diagnosis of malaria parasitemia in children using a rapid diagnostic test

Aim: This cross-sectional study was conducted to evaluate the diagnostic performance of a new rapid immunochromatographic test named “Paracheck pf” in the diagnosis of malaria in Nigerian children.Materials and Methods: A total of 380 Nigerian children aged between 6 and 59 months who presented at the University of Nigeria Teaching Hospital (UNTH) Enugu with fever and no obvious focus of any other infection were consecutively recruited. Malaria parasitemia was determined using simple microscopy and “Paracheck pf”.Results: “Paracheck pf” has the following diagnostic performance characteristics: Sensitivity of 82%, specificity of 91.5%, negative predictive value of 91.5%, positive predictive value of 82%, a strong positive correlation between parasite density and test sensitivity, and a detection limit of 397 parasites/ml.Conclusions: The test is, therefore, recommended for the use in Nigerian children aged between 6 and 59 months in Enugu for the diagnosis of malaria, but negative results should be cautiously interpreted in infants because symptomatic malaria may occur in these children at parasite densities as low as 100/ml

Prevalence of hematological abnormalities and malnutrition in HIV-infected under five children in Enugu

Background: Hematological abnormalities such as anemia, neutropenia, and thrombocytopenia occur in children infected by the human  immunodeficiency virus (HIV). These abnormalities are due to myelosuppression caused by the HIV and contribute to the morbidity and mortality of HIV.infected children. Malnutrition is prominent in HIV-infectedchildren due to associated conditions such as oropharyngeal candidiasis, diarrhea, and cytokine production which resultin poor intake, nutrient loss, and increased metabolic rate, respectively.Objectives: To determine the prevalence of hematological abnormalities (using the World Health Organization (WHO) case definitions) and malnutrition in HIV-infected children receiving care at the University of Nigeria Teaching Hospital, Enugu.Materials and Methods: The hematological and anthropometric indices of HIV.infected children between 18 and 59 months were assessed. Their hemoglobin level, neutrophil, and platelet counts were the hematological profiles evaluated using the WHO case definitions in HIV clinical staging. The weight-for-height z-score index was used to assess the nutritional status of subjects using the WHO reference ranges. The t-test, Chi-square, and Pearson correlation coefficient were used for statistical analysis.Results: There were 67 HIV positive children: 34 males and 33 females, aged 18-59 months. The mean hematological levels of subjects were hemoglobin (Hb) 10.4 ± 1.2 g/dl, neutrophil count 3,031 ± 1,039 cells/mm3, platelets count 294 ± 78 ~ 109/L. Two children (3.0%) had anemia (hemoglobin < 8 gm/dl) and were severely immunosuppressed,on highly active antiretroviral therapy treatment and had advanced HIV disease (clinical stage 3). Children who were malnourished were 15 (22.4%).Conclusion: Hematological abnormalities and malnutrition occur in HIV positive children.Key words: Haematological, malnutrition, anaemia, childre

Protective role of Phyllantus niruri extract on serum lipid profiles and oxidative stress in hepatocytes of diabetic rats

Diabetes mellitus has been associated with lipid abnormalities and oxidative stress. Some phytochemical properties have been shown to possess antioxidant activities, improving the effects of oxidative stress on diabetes. This present investigations confirmed that untreated diabetic rats were associated with lipid abnormalities as indicated by high levels of total- and LDL-cholesterol, triacylglycerols and low levels of HDL-cholesterol and phospholipids, compared to non-diabetic rats(control). The aqueous extract of Phyllanthus niruri significantly normalized the serum lipids levels. The study also showed that untreated diabetic rats were subjected to oxidative stress as indicated by significantly abnormal activities of their scavenging enzymes (superoxide dismutase and catalase and significantly low levels of non-enzymic antioxidants (vitamin C, vitamin E and reduced glutathione) in liver and plasma when compared with controls and in the extent of lipid peroxidation (increased malondialdehyde levels) in plasma and liver cells. The aqueous extract of P. niruri possessedantioxidant activities as shown by increased activities of enzymic and non-enzymic antioxidants and decrease in malondialdehyde levels

Urinary tract infection in febrile under five children in Enugu, South Eastern Nigeria

Background: Fever is a common symptom of urinary tract infection (UTI) in children less than 5 years of age. Little attention is however paid to UTI as a cause of fever in this age group.Objective: The objective of the following study is to determine the  prevalence of UTI in febrile children less than 5 years of age and relate it to demographic and clinical characteristics.Materials and Methods: Urine specimen of febrile children aged 1.59 months obtained by suprapubic or midstream methods were analyzed using standard laboratory methods of microscopy, culture and sensitivity.Results: A total of 200 children were enrolled; nearly 56% (112/200) were males. The mean age of the subjects was 31.14 } 17.96 months. The prevalence of UTI was 11% and was significantly higher in females than in males (P = 0.049). Children below 12 months of age had a higher rate of UTI than those 12 months and above (P = 0.028). The common clinical features were vomiting, abdominal pain, diarrhea, urinary frequency and urgency but none had a significant association with UTI.Conclusion: UTI is common in febrile under.fives especially among females and infants. No association was apparent between the occurrence of UTI and clinical parameters.Key words: Fever, under.five children, urinary tract infectio

Changing Pattern of Bacteriuria among Asymptomatic Secondary School Adolescents within Enugu South East Nigeria

Background: Urinary tract infection is one of the infections that could lead to chronic kidney disease. Most of the offending isolates are usually Gram-negative bacteria such as Escherichia coli. Adolescent age groups are a special group of individuals who indulge in some risk behavior that could predispose them to urinary tract infections with possible mixed flora.Aim: The aim was to determine the burden of Gram.positive significant bacteriuria among adolescents in Enugu.Subjects and Methods: A survey of 628 adolescents attending secondaryschools in Enugu was studied. Information on sociodemographic profile was obtained using a self-administered questionnaire. Clean-catch urine sample was collected using a sterile boric acid bottle, and this was cultured in both anaerobic and aerobic media. Significant isolates were Gram-stained in order to determine their characteristics. Data were analyzed using SPSS version 15.0.(Chicago Illinois USA). Results: There were 324 females and 304 males. Significant bacteria growth was identified in 61 samples giving a prevalence rate of 9.7% (61/628). Gram-positive bacteria were isolated in 77.1% (47/61) of samples, while Gram-negativebacteria were isolated in 22.9% (14/61) of samples. Staphylococcus saprophyticus was the most common Gram-positive organism isolated this consists 38.3% (18/47) while E. coli was the most common Gram.negative bacteria isolated comprising 64.2% (9/14). Other Gram-positive bacteria isolated were Staphylococcus auerus, Staphylococcus epididimis. All isolated bacteria were more common in females 44/61 (72.1%) than males 17/61 (27.9%).Conclusion: Gram-positive bacteriuria is prevalent among secondary school adolescents, and S. saprophyticus is the most common Gram-positive organism implicated. Further studies should be undertaken to determine the risk factors and possible sensitivity pattern among the age group.Keywords: Adolescents, Bacteriuria, Urinary tract infectio

Oxidative stress and non-enzymic antioxidant status in hypertensive patients in Nigeria

Oxidative stress and non-enzymic antioxidant status in plasma of hypertensive patients in Nigeria were investigated. One hundred and fifty hypertensive patients (82 males and 68 females) age range 55 – 75 years visiting Federal Medical Centre, Owerri were selected for the study. Controls were 120 apparently healthy subjects (66 males and 54 females) age range 55 -75 years. Patients with complication such as renal diseases, viral and bacterial infections were excluded from the study. In The hypertensive patients presented significantly higher mean values of plasma total cholesterol, LDL-cholesterol and triacylglycerolsand reduced HDL-cholesterol and phospholipids (p < 0.05). The result of plasma lipid peroxide was significantly higher in hypertensive patients (p < 0.05). Also the levels of non-enzymic antioxidantssuch as Vitamin C, vitamin E and reduced glutathione in plasma were significantly depleted in the hypertensive patients (p < 0.05). This study shows that hypertension is associated with increasedoxidative stress and depleted non-enzymic antioxidant status even in developing countries like Nigeria

Bacteriology of urinary tract infection and antimicrobial sensitivities in under-five children in Enugu

Background: Urinary tract infection (UTI) is one of the serious bacterial infections in febrile young children, which may cause chronic morbidities. Studies from different parts of Nigeria have shown varying pattern in itsbacteriology and antibiotic sensitivities. Antimicrobial resistance rate among uropathogens is an increasing problem limiting therapeutic options, and underscores the need to determine local bacteriological pattern that will guide empiric antibiotic choices.Objectives: To identify the bacterial pathogens responsible for UTI in febrile under-five children in Enugu as well as their antibiotic sensitivity patterns.Methods: A cross-sectional descriptive hospital based study of eligible febrile children aged one to 59 months. Urine samples were collected using mid-stream and suprapubic aspiration methods. Standard laboratory  procedures were used to culture the urine specimens, identify the bacterialpathogens as well as their antibiotic sensitivity patterns. Descriptive statistics were used to analyse the outcome.Results: Significant bacteriuria occurred in 22 (11%) of the 200 samples. Escherichia coli isolates were the most common organisms in 7(31.8%) of the 22 positive samples. Others were Staphylococcus aureus, Klebsiella spp and Streptococcus faecalis isolated in 5 (22.7%), 3(13.6%), and 3(13.6%)of the positive samples respectively. Most of the isolates were sensitive to ofloxacin (90.9%), ciprofloxacin (81.8%), nitrofurantoin (77.3%) and ceftriaxone (72.7%). High levels of resistance to ampicillin, cotrimoxazole,amoxicillin, nalidixic acid and clavulanate-potentiated amoxicillin were observed.Conclusion: Escherichia coli is the most common cause of UTI in febrile under-five children studied. Ciprofloxacin and ceftriaxone showed better sensitivities are advocated for the empiric treatment of febrile UTI in Enugu.Key words: UTI, under-fives, bacterial pathogens, antibiotic sensitivitie