Respiratory effects of propofol-ketamine and propofl-fentanyl combinations for total intravenous anaesthesia

propofol combined with other intravenous analgesic agents has been used as the sole anaesthetic agent to provide hypnosis and analgesia for various minor and major surgeries. However, because it lacks analgesic property, propofol in large doses causes respiratory depression. Combination of propofol with other analgesic agents reduces the dose of propofol necessary for procedural sedation. Objectives: This study evaluated the respiratory effects of two drug combinations: propofol-ketamine and propofol-fentanyl used as the sole anaesthetic agents. Method: one hundred and eight adults aged 18 to 50 years of either gender with ASA physical status I & II, randomly grouped into K and F, comprising of 54 patients each. Group K received propofol-ketamine while group F received propofol-fentanyl for induction and maintenance of anaesthesia. Respiratory Rate (RR) and Oxygen saturation (SpO were recorded before and one 2) minutes after induction of anaesthesia and thereafter every five minutes till the end of procedure and at recovery till the patient is fully recovered. Results: Demographic and clinical characteristics such as age, sex, weight, duration of surgery, types of surgical procedures and volumes of drugs used were comparable between the two groups. Fall in respiratory rate was greater in propofol-fentanyl group compared to propofol-ketamine group during maintenance and early postoperative period (p<0.05). Conclusion: Both propofol-ketamine and propofolfentanyl combinations produced safe and effective anaesthesia. Propofol-ketamine results in a more stable respiratory profile

Evaluation of nutrient composition of some cereals and legumes crops residues as compost materials

The use of compost for horticultural crops production in Nigeria is beginning to gain some attention, since it has been reported to improve plant growth and yield. Some cereals and legumes crops residues with potentials of being used as compost materials such as Sorghum Stovers, Rice Straws, Maize Stovers, Millet Stovers, Groundnut Haulms, Cowpea Stems and Cotton Stalks grown at the Kano University of Science and Technology Research farm were selected and analyzed for nutrient content. Data obtained were subjected to analysis of variance (ANOVA) using F-test. Results obtained indicated that Nitrogen (0.98gkg-1) and Phosphorous (0.31kg-1) were highly significant (p<0.05) in rice straws compared to other residues of cereals. Also Groundnut haulms was found to be highest in N(1.10kg-1) and P(0.0597) than other legumes residues. Other essential nutrients like calcium, magnesium and potassium were also determined. Generally, crop residues and their ashes are valuable materials that can be used in making compost fertilizer as they contain high amount of nutrients. However, intensive cultivation and crop residues removal tend to break the natural cycle and prevent the return of nutrient taken up by the crop to the soil.Keywords: Ashes, crop residues, compost and nutrients

Anaesthesia for Ophthalmic Procedures in a Teaching Hospital

Objectives: To study the pattern of anaesthesia for ophthalmic procedures in order to improve the scheduling of cases in the ophthalmic operating room. Methods: The surgical register of the operating room from August 01, 1999 to July 31, 2004 was examined, to document the types of procedure, timing of surgery (elective or emergency), methods of anaesthesia, and involvement of anaesthesia personnel. Results: A total of 970 patients (506 males, 464 females) had ophthalmic surgery in the five-year period under review. General anaesthesia was employed for 119 (12.3%) patients and regional anaesthesia for 851 (87.7%). 400 patients had their procedures on ambulatory basis (LA = 397, GA = 3). Local blocks were the favoured technique for both the outpatient and inpatient settings. Cataract extraction, repair of corneal/scleral/conjunctival/lid lacerations, excision biopsy, trabeculectomy and evisceration were the leading indications. General anaesthesia was the more commonly employed anaesthetic technique in younger patients and for emergency ophthalmic procedures. The general anaesthesia was administered by the registrar and senior registrar grades of anaesthetists. Conclusion: The study shows that the use of general anaesthesia appeared largely restricted to paediatric patients and emergency situations. However, evolving techniques – like sub-tenon block, total intravenous anaesthesia (TIVA), monitored anaesthesia care – should be encouraged. Keywords: ophthalmic anaesthesia, paediatric anaesthesia, regional blocks, outcomeNigerian Journal of Ophthalmology Vol. 16 (1) 2008: pp. 1-

Comparison of the duration and quality of epidural analgesia between plain bupivacaine alone and plain bupivacaine with tramadol in lower limb orthopaedic surgeries.

This study was aimed at comparing the duration and quality of epidural analgesia between plain bupivacaine alone with plain bupivacaine and tramadol in lower limb orthopaedic surgeries. Method: This was a prospective randomized double blinded control study involving 74 ASA I and II patients scheduled for elective lower limb orthopaedic surgeries. Group A (n=37) received 19mls of 0.5% epidural plain bupivacaine with 1 ml of water for injection, while group B received 19mls of 0.5% epidural plain bupivacaine with 1ml (50mg) of preservative freetramadol. The duration of analgesia was from the time of epidural block to the time of rescue analgesia. While, the quality of block was measured with Visual Analogue Scale (VAS) and Bromage scale. Results: Thestudy ages were between 16-60years,consisting of 22(60%) male and 15(40%) female in group A, while in group B 20 (54%) were male and 17(46%) female. It showed the mean duration of analgesia were 189.05±21.92min and 254.19±32.78min in group A and B respectively with p <0.01.The intra-operative VAS scores between the two groups did not show any significant difference between study groups (P> 0.05).The differences of grades of motor block and maximum sensory block height were not statistically significant (P=0.26) among the study groups. Conclusion: The addition of 50mg (1ml) of tramadol to plain bupivacaine epidurally prolonged the duration of analgesia and improved the quality of analgesia when compared to the use of bupivacaine alone

Lichen sclerosis: a rare cause of urethral stricture in blacks, managed by buccal mucosal graft urethroplasty

Penile Lichen Sclerosus is a chronic progressive inflammatory disease of the foreskin. Balanitis Xerotica Obliterans is a traditional terminology used to refer to Lichen Sclerosus affecting the foreskin and glans penis. Involvement of the urethra by Lichen Sclerosus is quite uncommon in our region butcan result in urethral stricture. Method: We reported a case of urethral stricture secondary to Lichen Sclerosus, which was managed by Buccal Mucosal Graft Urethroplasty with a satisfactoryoutcome. Conclusion: High index of suspicion helps in diagnosing this case allowing the best treatment option to be instituted. Early circumcision is one of the preventive measures

Detection of African swine fever virus (ASFV) antibodies in pigs in Taraba state north east Nigeria

A serological study was conducted between 2011 and 2013 to detect the presence of antibodies to African swine fever virus (ASFV) in Pigs in Taraba State, north eastern Nigeria. Sixty (60) pig farms were studied. Questionnaires (N=885) consisting of sections related to the farmer and the animal were distributed and blood samples taken to analyze for the African swine fever virus antibodies. All the 60 questionnaires were answered by the farmers, while 885 were retrieved for the individual pig studied. Of the 60 famers, only 13 (21.7%) were aware of the disease while 47 (78.3%) were ignorant (P<0.05). Out of the 885 pigs examined, none (0%) was infected nor showed any clinical signs of the infection. However, 117 (13.2%) out of the 885 sera samples analyzed for the three year period were positive for ASFV antibodies. The results obtained in 2013 (22.5%) was significantly higher (P<0.05) those in 2011 (12.9%) and 2012 (4.0%). Although male pigs recorded higher sero-prevalence (13.7%) than the females (12.9%), this was no statistically significant (P>0.05). The highest sero-prevalence (16.3%) was  recorded in the Northern zone in 2011, followed by 10.0% and 5.0% in Southern and Central zones  respectively. In the year 2012, no ASFV antibody was detected from the 100 and 99 pigs examined from Central and Northern zones respectively. However, the Central zone recorded a sero-prevalence of  12.0%. In 2013, the sero-prevalence in Southern (29.0%) and Central zones (24.0%) is significantly higher (P<0.05) than in the Northern zone. The sero-prevalence obtained may pose a great risk in the study area, it is therefore recommended that adequate veterinary services, proper sanitary measures and monitoring of pig movement be instituted to avert an outbreaks.Keywords: African swine fever virus, Antibodies, ELISA, Pigs, Taraba State, North eastern Nigeri

The role of anaesthetist in the management of patients due to insurgency in the North-eastern Nigeria.

The roles played by the team of Anaesthetists in the management of patients due to insurgency are enormous and very vital in the survival of the patients and indeed in the reduction of the possible morbidities and mortalities due to injuries from the insurgency. Objective: This study is aimed at giving an overview of the role of Anaesthetist in important areas of patient's management due to insurgency and to suggest ways of improvement. Method: This is a prospective study of 1,339 patients managed for various injuries sustained due to insurgency in the University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria, for the period of five years (January, 2010 and December, 2014). Results: One thousand three and thirty nine (1,339) patients who were injured directly due to the insurgency were included in the study during the period under review. Their ages ranged from 1 month to 80 years with the mean age of 38.6±18.3 years. Most of the injuries occurred among the age group 18 - 35 years. Patients were resuscitated, had anaesthesia for surgeries and also had intensive care management. Conclusion: The roles played by the Anaesthetist are so vital in the survival of the patients due to insurgency. However, there is a need for an increase in the number of Anaesthesia manpower and for the training and re-training of these Anaesthetists in the management of mass casualties

Maternal deaths in Sagamu in the new millennium: a facility-based retrospective analysis

BACKGROUND: Health institutions need to contribute their quota towards the achievement of the Millennium Development Goal (MDG) with respect to maternal health. In order to do so, current data on maternal mortality is essential for careproviders and policy makers to appreciate the burden of the problem and understand how best to distribute resources. This study presents the magnitude and distribution of causes of maternal deaths at the beginning of the 21st century in a Nigerian referral hospital and derives recommendations to reduce its frequency. METHODS: A retrospective descriptive analysis of all cases of maternal deaths at Olabisi Onabanjo University Teaching Hospital, Sagamu, Southwest Nigeria between 1 January 2000 to 30 June 2005. RESULTS: There were 75 maternal deaths, 2509 live births and 2728 deliveries during the study period. Sixty-three (84.0%) of the deaths were direct maternal deaths while 12 (16.0%) were indirect maternal deaths. Major causes of deaths were hypertensive disorders in pregnancy (28.0%), haemorrhage (21.3%) and sepsis (20.0%). Overall, eclampsia was the leading cause of deaths singly accounting for 24.0% of all maternal deaths. Abortion and HIV-related mortality accounted for 1.3% and 4.0% of maternal deaths, respectively. The maternal mortality ratio of 2989.2 per 100,000 live births was significantly higher than that reported for 1988–1997 in the same institution. Up to 67/794 (8.4%) patients referred from other facilities died compared to 8/1934 (0.4%) booked patients (OR: 22.1; 95% CI: 10.2–50.1). Maternal death was more likely to follow operative deliveries than non-operative deliveries (27/545 vs 22/2161; OR: 5.07; 95% CI: 2.77–9.31). CONCLUSION: At the middle of the first decade of the new millennium, a large number of pregnant women receiving care in this centre continue to die from preventable causes of maternal death. Adoption of evidence-based protocol for the management of eclampsia and improvement in the quality of obstetric care for unbooked emergencies would go a long way to significantly reduce the frequency of maternal deaths in this institution

Natural multi-occurrence of mycotoxins in rice from Niger State, Nigeria

Twenty-one rice samples from field (ten), store (six) and market (five) from the traditional rice-growing areas of Niger State, Nigeria were analysed for aflatoxins (AFs), ochratoxin A (OTA), zearalenone (ZEA), deoxynivalenol (DON), fumonisin B1 (FB1) and B2 (FB2), and patulin (PAT) by thin-layer chromatography (TLC) and high-performance liquid chromatography (HPLC) respectively. T-2 toxin was determined using TLC only. AFs were detected in all samples, at total AF concentrations of 28–372 μg/kg. OTA was found in 66.7% of the samples, also at high concentrations (134–341 μg/kg) that have to be considered as critical levels in aspects of nephrotoxicity. ZEA (53.4%), DON (23.8), FB1 (14.3%) and FB2 (4.8%) were also found in rice, although at relatively low levels. T-2 toxin was qualitatively detected by TLC in only one sample. Co-contamination with AFs, OTA, and ZEA was very common, and up to five mycotoxins were detected in a single sample. The high AF and OTA levels as found in rice in this study are regarded as unsafe, and multi-occurrences of mycotoxins in the rice samples with possible additive or synergistic toxic effects in consumers raise concern with respect to public health

Serological assessment of gastric mucosal atrophy in gastric cancer

<p>Abstract</p> <p>Background</p> <p>Non-invasive tools for gastric cancer screening and diagnosis are lacking. Serological testing with the detection of pepsinogen 1 (PG1), pepsinogen 2 (PG2) and gastrin 17 (G17) offers the possibility to detect preneoplastic gastric mucosal conditions. Aim of this study was to assess the performance of these serological tests in the presence of gastric neoplasia.</p> <p>Methods</p> <p>Histological and serological samples of 118 patients with gastric cancer have been assessed for tumor specific characteristics (Laurén type, localisation), degree of mucosal abnormalities (intestinal metaplasia, atrophy) and serological parameters (PG1, PG2, PG1/2-ratio, G17, <it>H. pylori </it>IgG, CagA status). Association of the general factors to the different serological values have been statistically analyzed.</p> <p>Results</p> <p>Patients with intestinal type gastric cancer had lower PG1 levels and a lower PG1/2-ratio compared to those with diffuse type cancer (<it>p </it>= 0.003). The serum levels of PG2 itself and G17 were not significantly altered. <it>H. pylori </it>infection in general had no influence on the levels of PG1, PG2 and G17 in the serum of gastric cancer patients. There was a trend towards lower PG1 levels in case of positive CagA-status (<it>p </it>= 0.058). The degree of both intestinal metaplasia and atrophy correlated inversely with serum levels for PG1 and the PG1/2-ratio (p < 0.01). Laurén-specific analysis revealed that this is only true for intestinal type tumors. Univariate ANOVA revealed atrophy and CagA-status as the only independent factors for low PG1 and a low PG1/2-ratio.</p> <p>Conclusions</p> <p>Glandular atrophy and a positive CagA status are determinant factors for decreased pepsinogen 1 levels in the serum of patients with gastric cancer. The serological assessment of gastric atrophy by analysis of serum pepsinogen is only adequate for patients with intestinal type cancer.</p