Agnathia-synotia-microstomia (otocephaly): a case report in an African woman

A journal article on a "defective pregnancy" in an African woman.Pharyngeal arches appear in the 4th and 5th weeks of development of the human embryo. The Is1 pharyngeal arch develops into the incus and malleus, premaxilla, maxilla, zygomatic bone; part of the temporal bone, the mandible and it contributes to the formation of bones of the middle ear. The musculature of the 1st pharyngeal arch includes muscles of mastication, anterior belly of the digastric mylohyoid, tensor tympani and tensor palatini.1 The second pharyngeal arch gives rise to the stapes, styloid process of the temporal bone, stylohyoid ligament, the lesser horn and upper part of the body of the hyoid bone. The stapedius muscle, stylohyoid, posterior belly of the digastric, auricular and muscles of facial expressional all derive from the 2nd pharyngeal arch. Otocephaly has been classified as a defect of blastogenesis, with structural defects primarily involving the first and second branchial arch derivatives. It may also result in dysmorphogenesis of other midline craniofacial field structures, such as the forebrain and axial body structures

A national survey of oxytocin use during caesarean section in Zimbabwe

Background: Post-partum haemorrhage is the leading cause of mortality for labouring women in Zimbabwe. Current literature supports the use of low dose oxytocin to prevent bleeding during Caesarean section. Internationally, clinical practice has been slow to change and the use of potentially harmful, higher than recommended dose is common.Objective: To describe the current clinical practice in Zimbabwe.Design: A self-administered questionnaire survey. Descriptive statistics were used to report the study results.Setting: In 2013 a national survey was conducted on the use of oxytocin by different types of clinicians, who provide either anaesthesia or surgery for Caesarean section.Results: Of a total of 221 (61%) questionnaires returned, 170 (80%) were completed fully. Only 23% of respondents would give an intravenous dose of 5.0 IU or less of oxytocin for elective Caesarean section. The majority of clinicians (77%) would administer more than 5.0 IU of oxytocin at elective. A significant number of nurse anaesthetists 16/59 (27%), and a non-negligible number of specialist anaesthetists 3/48 (6%) would even give 20 IU of oxytocin in elective cases rising to 30% and 13% respectively for emergency cases. In case of persistent bleeding due to uterine atony, oxytocin was more likely to be repeated (45%), rather than using misoprostol (25%) or ergometrine (19%).Conclusion: Most clinicians in Zimbabwe use oxytocin doses well above current internationally recommended. This illustrates the urgent need for updated national guidelines for the prevention of post-partum haemorrhage during Caesarean section

Open heart surgery: the Zimbabwean experience

No Abstrac

Agnathia-Synotia-Microstomia (Otocephaly): A case report in an African woman

No Abstrac

Peer-assisted teaching at the University of Zimbabwe, College of Health Sciences: A prospective observational study

Objectives: We describe the effects of peer-assisted learning, focusing on the practical proficiency of the trainees to perform one particular regional anaesthesia technique. We also describe the effect the peer assisted learning had on patient service provision. Design: This was a prospective observational study of the23 students in the department at the time. It was conducted at the two teaching hospitals Parirenyatwa and Harare Central Hospitals in 3 stages. Stage 1 Initial assessment of the trainees and audit of theatre registers, stage 2 the setup and implementation of the module and stage 3 reassessment after the setup and implementation. The Data was analysed using a Students t test, Chi square test and descriptive statistics used to report. Setting: Special Referral Hospital. Subjects: Medical students in the department of Anaesthesia and Critical Care Medicine. Main Outcome Measures: Performance of the Supraclavicular Brachial Plexus Block. Results: There was a statistically significant increase in the number of trainees who had performed a supraclavicular brachial plexus block from 2 (8.7%) to 15 (65.3%), [p=0.001]. The number of blocks performed increased from 0-47.6% [p=0.000] and 1.7%-20.8% [p=0.0005] at Parirenyatwa and Harare Central Hospitals respectively. Twenty two of the 23 students thought the module beneficial. Conclusion: Introduction of a peer assisted learning module improved learning of fellow trainees and ensured more had acquired the skill. This resulted in more patients in whom the technique was indicated receiving the beneficial service. Thus peer assisted teaching functioned as a good adjunct to traditional methods

A Review of Massive Blood Transfusion and its Associated Syndromes in Zimbabwe

Background and objectives: Massive blood transfusion is defined as transfusion approximating or exceeding a patient's total blood volume (5-6 litres in adults) within 24-hours. This procedure is used to manage severely anaemic and bleeding patients. Negative outcomes associatedwith acidosis, hypothermia and coagulopathy may result. The study was carried out to review the management of massive transfusion in Zimbabwe.Materials and methods: A 4-year retrospective clinical laboratory-based study was carried out on patients who had massive blood transfusionat a Zimbabwean hospital, from January 2014 to December 2017. Data was collected from patients’ hospital records after permission from thehospital director.Results: Of the 180 patient records, 145 (80.6%) were from female and 35 (19.4%) from male patients. Massive blood transfusion was done mostly on obstetric patients. Full blood count was the most commonly requested laboratory test, with 155 (86%) requests. Some of the patients had severe anaemia. Routine coagulation tests were significantly abnormal. All patients received packed red cells during the first 24 hours, followed by fresh frozen plasma (57.8%). Platelets, cryoprecipitate and whole blood were infrequently transfused (22%, 3% and 2% respectively). The mortality rate was 25.6% within 24 hours after transfusion. Transfusion of packed red cells alone was significantly associated with mortality (p<0.001) which increased significantly with the use of high numbers of packed red cell units.Conclusion: Massive blood transfusion is associated with a high mortality rate in Zimbabwe. Transfusion of packed red blood cells alone resulted in highest mortality. There was an insufficient use of laboratory tests to monitor massive blood transfusion. This potentially can be addressed by establishing a national massive transfusion protocol for Zimbabwe. French Title: Une revue de la transfusion sanguine massive et de ses syndromes associés au Zimbabwe Contexte et objectifs: La transfusion sanguine massive est définie comme une transfusion se rapprochant ou dépassant le volume sanguin total d'un patient (5-6 litres chez l'adulte) dans les 24 heures. Cette procédure est utilisée pour gérer les patients gravement anémiques et hémorragiques. Des résultats négatifs associés à l'acidose, l'hypothermie et la coagulopathie peuvent en résulter. L'étude a été réalisée pourexaminer la gestion de la transfusion massive au Zimbabwe.Matériel et méthodes: Une étude rétrospective clinique en laboratoire de 4 ans a été menée sur des patients ayant subi une transfusion sanguine massive dans un hôpital du Zimbabwe, de Janvier 2014 à Décembre 2017. Les données ont été collectées à partir des dossiers des patients de l'hôpital après autorisation du Directeur de l'hôpital.Résultats: Sur les 180 dossiers de patients, 145 (80,6%) provenaient de femmes et 35 (19,4%) de patients de sexe masculin. Une transfusion  sanguine massive a été effectuée principalement sur des patientes obstétricales. L'hémogramme complet était le test de laboratoire le plus  demandé, avec 155 (86%) demandes. Certains patients souffraient d'anémie sévère. Les tests de coagulation de routine étaient significativement  anormaux. Tous les patients ont reçu des concentrés de globules rouges au cours des 24 premières heures, suivis de plasma frais congelé (57,8%). Les plaquettes, le cryoprécipité et le sang total ont été rarement transfusés (22%, 3% et 2% respectivement). Le taux de mortalité était de 25,6%  dans les 24 heures suivant la transfusion. La transfusion de concentrés de globules rouges seule était significativement associée à la mortalité (p<0,001) qui augmentait significativement avec l'utilisation d'un nombre élevé d'unités.Conclusion: La transfusion sanguine massive est associée à un taux de mortalité élevé au Zimbabwe. La transfusion de concentrés de globules rouges seule a entraîné la mortalité la plus élevée. Les tests de laboratoire étaient insuffisants pour surveiller les transfusions sanguines massives. Cela peut potentiellement être résolu en établissant un protocole national de transfusion massive pour le Zimbabw

Comparison of haemodynamic effects of a bolus of five units of oxytocin versus a bolus of ten units of oxytocin on parturients undergoing caesarean section at Parirenyatwa and Harare hospitals, Zimbabwe

Objectives: This study was done to compare the haemodynamic effects of an intravenous bolus of 5 IU oxytocin versus a bolus of 10 IU.Study Design: A prospective randomised clinical trial.Setting: The study was conducted at Harare Central Hospital Maternity Unit and Mbuya Nehanda Maternity hospitalStudy Subjects: The study was conducted in 86 ASA 1 and 2 parturients undergoing spinal anaesthesia for elective and emergency caesarean sectionMethods: The 86 patients were randomized to receive either five IU or ten IU of oxytocin post-delivery. Noninvasive monitoring of Heart rate, Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Mean Arterial Pressure (MAP) was done. Blood loss was also measured.Results: There was a statistically significant greater increase in mean Heart rate in patients who received 10 IU than in those who received 5 IU of oxytocin (p=0.028). There was a larger decrease in Mean Arterial Pressure, Diastolic blood pressure and Systolic blood pressure in patients who received 10 IU of oxytocin than in patients who received 5 IU of oxytocin (p<0.0001). There was no difference in blood loss between the two groups.Conclusions: During caesarean section, a bolus of 5 IU oxytocin results in less haemodynamic change than a bolus of 10 IU of oxytocin with no difference in the blood loss

Metabolic effects of Carbon Dioxide (CO2) insufflation during laparoscopic surgery: changes in pH, arterial partial Pressure of Carbon Dioxide (PaCo2) and End Tidal Carbon Dioxide (EtCO2)

Background: Acid base alterations occur during laparoscopy with carbon dioxide insufflation. The purpose of this study was to investigate the effects of low tidal volume ventilation on acid base status during pneumoperitonium.Materials and Methods: 30 patients undergoing laparoscopic surgery under General Anaesthesia were ventilated with tidal volume of 6 ml/kg and respiratory rate of 12 breaths/minute. Arterial blood gas analysis was done before, during and after C02 pneumoperitoneum. Arterial haemoglobin oxygen saturation by pulse oximetry (SPO2) and EtC02 were monitored continuously throughout the laparoscopy. Respiratory adjustments were done for EtCO2 levels above 60mmHg or SPO2 below 92% or adverse haemodynamic changes.Results: low tidal volume ventilation during pneumoperitoneum resulted in a significant elevation in PaCO2 (p<0.001) and a fall of pH (p <0.001), ion bicarbonate (HCO3-) (p = 0.011), and base excess (ABE) (p <0.001). A correlation was found between the EtCO2 and PaCO2 during pneumoperitoneum. Oxygenation was well maintained during pneumoperitoneum. No ventilatory adjustments were instituted on any of the patients as they maintained EtCO2 below 60mmHg throughout pneumoperitoneum.Conclusion: Ventilation with low tidal volume during pneumoperitoneum causes a mixed respiratory and metabolic acidosis. EtCO2 is still a good non-invasive monitor for estimation of PaCO2 during low tidal volume ventilation during pneumoperitoneum

Severe malaria in Parirenyatwa Hospital, Harare Intensive Care Unit: a case record review of 16 cases

Background: Zimbabwe has reported a decrease in malaria admissions and mortality rates by 64% and 71% respectively between 2003 and 2012, suggesting the country is on track to achieve a decrease in admission rates by 50-75% and mortality rates by >75% by 2015. The aim of this study is to review the Intensive Care Unit (ICU) outcomes of the malaria patients admitted into Parirenyatwa Group of Hospitals (PGHs) adult  ICU and to determine whether the Multiple Organ Dysfunction Score can be applied to a small set of patients with severe malaria in our unit.Materials and Methods: A retrospective case record review of patients admitted in ICU with a diagnosis of malaria at PGH general adult ICU. Demographic data, clinical data, laboratory data and data on interventions in ICU were collected. Multiple Organ Dysfunction Score (MODS), Malaria Prediction Score (MPS) and Malaria Score for Adults (MSA) were applied for all patients.Results: Sixteen (16) malaria patients were included in the study and all were adults with an age range of 18-68 and 10 (62.5%) were female. Parasitaemia on admission was quantified in 8/16 (50%) patients were 2 patients had parasitaemia greater than 5% and 6 had parasitaemia less than 5%. The complications included unarousable coma 12 (75%), persistent seizures 6 (37.5%), circulation collapse 3 (18.8%), Moderate to severe ARDS 4 (25%), renal impairment 7 (44%), severe metabolic acidosis 8 (50%), severe anaemia 8 (50%), severe thrombocytopaenia 4 (25%), hyperbilirubinaemia 9 (56%) and hypoglycaemia 2 (12.5%). The case fatality rate was 50%. Death was associated with a shorter duration of ICU stay and higher MODS scores.Conclusion: Although antimalarial therapies are the mainstay of malaria treatment, ICU admission and interventions remain pivotal in reducing morbidity and mortality in severe malaria. The MODS score is a good predictor of mortality in a small number of malaria patients; however specific scores should be studied