The Pattern of Admissions into the MedicalWards of the University of Nigeria Teaching Hospital, Enugu

Objective: To study the pattern of medical admissions at the University of Nigeria Teaching Hospital (UNTH), Enugu, with a view to determining the disease trend and providing a comparative analysis with the previous study conducted in the same centre in the preceding five-year period. Method: A review of admissions into the medical wards of the UNTH, Enugu, over the five year period between December, 1998 and November, 2003, was done using the register of admissions and discharges; as well as a review of the case file where necessary. Results: The patients admitted during the period numbered 7399, with age range of 15 to 102 years. There were 4324 (58.4%) males and 3075 (41.6%) females, with a male to female ratio of 1.4:1. Disorders of the cardiovascular system accounted for 1389 (18.8%) of the admissions, and those of the central nervous system 1178 (15.9%) while HIV-related disorders accounted for 501 (6.7%) respectively. Non-communicable diseases accounted for 4493 (60.3%) of the cases while communicable diseases accounted for 2906 (39.3%). There were more admissions in the wet season (April to September), with 56.8%, while the month of December cumulatively recorded the least admission rate. The mean hospital stay was 15.5 (±15.4) days. Conclusion: The study shows an increasing trend in medical admissions at the UNTH, Enugu, with noncommunicable diseases and male gender preponderance, while 53% of those affected are in the 30 60 years range. Serious efforts at revamping the health sector services and facilities, and particularly, national and local strategies to combat non-communicable diseases, are emphasized. Keywords: Pattern, medical admissions, teaching hospital, Enugu. Nigerian Journal of Clinical Practice Vol. 11 (3) 2008: pp. 185-19

Medical practice in the face of economic meltdown: Peculiar challenges in Nigeria and other developing countries

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Medical causes of death in a teaching hospital in South‑Eastern Nigeria: A 16 year review

Background: Most developing regions of the world are undergoing gradual epidemiological transition resulting in high burden of both communicable and noncommunicable diseases. This affects the pattern of death in this region.Objective: The objective of this study is to determine the causes of death in the medical wards of the University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, South‑East Nigeria from 1995 to 2010.Materials and Methods: Data were collected retrospectively from January 1995 to December 2010.Statistical Analysis Used: Statistical Package for Social Sciences (SPSS Inc. Chicago, IL, USA) version 17.0 was used. Simple descriptive statistics were done. Student’s t‑test was used to compare means of continuous variables, while Chi‑square test was used to test significance of differences between two proportions.Results: The mortality rate was 22.8% (6250/27,514) admissions. The male to female ratio was 1.7:1. Infections (20.2%) were the most common cause of death. However, chronic kidney disease was the single most common disease entity causing death (12.3%). Other important causes of death in order of prevalence were cerebrovascular accident (10.5%), acquired immune deficiency syndrome and tuberculosis either alone or as co‑infection (10.3%), heart failure (8.8%), chronic liver disease (7.0%), septicemia (6.5%), respiratory failure (5.3%), diabetes mellitus (4.6%), cardiac arrhythmias (2.9%), and primary liver cell carcinoma (2.7%). There were few deaths from tetanus, malaria, typhoid fever, and coronary artery disease.Conclusion: Mortality is high in our medical wards and reflects the emerging trend of mixed disease spectrum comprising communicable and noncommunicable diseases.Keywords: Chronic kidney disease, infections, medical wards, mortality, Nigeri

Haematological assessment of occupational exposure to lead handlers in Enugu Urban, Enugu State, Nigeria

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Pattern of cancer deaths in the medical wards of a teaching hospital in South East Nigeria

Background: Cancers are emerging public health problems in developing countries like Nigeria. The epidemiological shift and aging population make cancers a challenge.Objective: We set out to describe the pattern of death due to cancer in our medical ward. The hospital is one of the premier hospitals covering the South East zone of Nigeria.Materials and Methods: We retrospectively reviewed the case notes and death certificates of all who died of cancer in our adult medical wards for 16 years (January 1995 to December 2010).Statistical Analysis Used: Statistical Package for Social Sciences (SPSS Inc. Chicago, IL) version 17.0 was used.Results: Twenty seven thousand, five hundred and fourteen patients were admitted into the medical wards. Six thousand, two hundred and fifty died. Out of the 6250 deaths, cancers accounted for 7.6%. Male to Female ratio was 2.4:1. The mean age at death was 43.7 ± 17.4 years. The mean age at death in both sexes was similar (42.9 ± 17.5 for men and 45.7 ± 17.0 years for women), P = 0.109. Primary liver cell carcinoma was the most common cause of death among men (40.8%), while cancer of hematopoietic organ was the most common in women (48.7%). The overall fatality rate was 1.7% (477/27 514) of medical admissions. Younger and middle age groups were most commonly affected in both sexes. Conclusion: Since the most productive age groups were affected, governments in developing countries should as a matter of urgency put in place adequate cancer preventive and curative services.Keywords: Cancer, mortality, medical wards, South East NigeriaNigerian Journal of Clinical Practice • Oct-Dec 2013 • Vol 16 • Issue

Prothrombin time, activated partial thromboplastin time and other haematological parameters among non-diabetic hypertensive patients

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COMPARATIVE EFFECTIVENESS STUDY OF COMBINED ANTIHYPERTENSIVES FOR NIGERIAN PATIENTS

Objective: The objective of the study was to compare the clinical and economic effectiveness of four combination antihypertensives recommended for Nigerians. Methods: An open, randomized, controlled, and longitudinal double-blind trial of four groups of antihypertensives combinations: Telmisartan/ chlorthalidone/amlodipine (TCA), TC, CA, and TA was conducted among hypertensive patients. The participants were recruited from three hospitals in Enugu, and randomly assigned to the study groups. The primary outcome for this study was blood pressure (BP) control, based on Joint National Committee-8 and cost per BP control. The secondary outcomes were cost per quality adjusted life years (QALY) and patients’ self-reported health status. Descriptive and inferential statistics were used for statistical analysis. Results: Of the 110 patients enrolled in the study, more than half were women (55.5%). The mean age of patients was 54.93±12.38. The enrollees had hypertension for over 9 years (9.17±8.40). About 77% of the patients completed the study in all the groups except for TA (66.7%). There was no difference in BP in all the groups at baseline and at end-of-study (p>0.050). However, the probability of BP control was highest in TCA group (0.37±0.01), followed by TC group (0.23±0.02). The TA group showed the most favorable cost per QALY, then CA, TC, and TCA in that order. The group with the most favorable cost per BP control was TCA (70.92±0.04), then TA (94.16±0.05). Conclusion: The triple combination therapy of TCA had the best cost per BP control in the management of hypertensive patients. It demonstrated the highest probability of BP control

Intra‑cardiac masses in adults: A review of echocardiogram records at two echocardiographic laboratories in Enugu, South‑East Nigeria

Background: Transthoracic echocardiography (TTE) is an excellent initial diagnostic technique used to evaluate and diagnose cardiac masses, even though transoesophageal echocardiography (TEE) provides superior image resolution and better visualization of cardiac masses, especially in patients with suboptimal transthoracic echocardiographic studies. TTE is the clinical procedure of choice for identification of left ventricular thrombi. TTE has greater than 90% sensitivity and greater than 85% specificity for detection of left ventricular thrombi and is probably superior to the sensitivity and specificity of TEE, especially for apical thrombi.Aims: The study aimed to identify the common types of cardiac masses and their commonest locations in the heart.Materials and Methods: We did a retrospective review of our echocardiogram reports from May 2003 to July 2012 to identify the frequency of intra‑cardiac masses in adults, as well as the gender distribution and commonest location of these masses.Results: There were 2,814 echo examinations in adults over this period, comprising 1,661 males (59.1%) and 1,153 females (40.9%). Intra‑cardiac masses were found in 20 of these patients representing 0.7% of the study population. Thrombi were the commonest masses noted in our study, and there were more masses in the atria than in the ventricles. The left heart chambers also had more masses than the right heart chambers. There was no sex difference in the frequency of cardiac masses.Conclusion: Intra‑cardiac masses are rare, and transthoracic echocardiography is still valuable in the diagnosis and initial characterization of cardiac masses.Keywords: Adults, echocardiography, intra‑cardiac masses, NigeriaNigerian Journal of Clinical Practice • Oct-Dec 2013 • Vol 16 • Issue

Reversal of neuroinflammation in novel GS model mice by single i.c.v. administration of CHO-derived rhCTSA precursor protein

Galactosialidosis (GS) is a lysosomal cathepsin A (CTSA) deficiency. It associates with a simultaneous decrease of neuraminidase 1 (NEU1) activity and sialylglycan storage. Central nervous system (CNS) symptoms reduce the quality of life of juvenile/adult-type GS patients, but there is no effective therapy. Here, we established a novel GS model mouse carrying homozygotic Ctsa IVS6+1g→a mutation causing partial exon 6 skipping with concomitant deficiency of Ctsa/Neu1. The GS mice developed juvenile/adult GS-like symptoms, such as gargoyle-like face, edema, proctoprosia due to sialylglycan accumulation, and neurovisceral inflammation, including activated microglia/macrophage appearance and increase of inflammatory chemokines. We produced human CTSA precursor proteins (proCTSA), a homodimer carrying terminal mannose 6-phosphate (M6P)-type N-glycans. The CHO-derived proCTSA was taken up by GS patient-derived fibroblasts via M6P receptors and delivered to lysosomes. Catalytically active mature CTSA showed a shorter half-life due to intralysosomal proteolytic degradation. Following single i.c.v. administration, proCTSA was widely distributed, restored the Neu1 activity, and reduced the sialylglycans accumulated in brain regions. Moreover, proCTSA suppressed neuroinflammation associated with reduction of activated microglia/macrophage and up-regulated Mip1α. The results show therapeutic effects of intracerebrospinal enzyme replacement utilizing CHO-derived proCTSA and suggest suppression of CNS symptoms

Health workforce and governance: the crisis in Nigeria

Background In Nigeria, several challenges have been reported within the health sector, especially in training, funding, employment, and deployment of the health workforce. We aimed to review recent health workforce crises in the Nigerian health sector to identify key underlying causes and provide recommendations toward preventing and/or managing potential future crises in Nigeria. Methods We conducted a scoping literature search of PubMed to identify studies on health workforce and health governance in Nigeria. A critical analysis, with extended commentary, on recent health workforce crises (2010–2016) and the health system in Nigeria was conducted. Results The Nigerian health system is relatively weak, and there is yet a coordinated response across the country. A number of health workforce crises have been reported in recent times due to several months’ salaries owed, poor welfare, lack of appropriate health facilities and emerging factions among health workers. Poor administration and response across different levels of government have played contributory roles to further internal crises among health workers, with different factions engaged in protracted supremacy challenge. These crises have consequently prevented optimal healthcare delivery to the Nigerian population. Conclusions An encompassing stakeholders’ forum in the Nigerian health sector remain essential. The national health system needs a solid administrative policy foundation that allows coordination of priorities and partnerships in the health workforce and among various stakeholders. It is hoped that this paper may prompt relevant reforms in health workforce and governance in Nigeria toward better health service delivery in the country