Abdominal Pain in Adult Sickle Cell Disease Patients: A Nigerian Experience

Background: Abdominal pain is a relatively frequent occurrence in sickle cell disease. The aetiology of abdominal pain in sickle cell disease is often difficult to diagnose clinically. Despite the frequent occurrence, diagnostic dilemma, and the need for an accurate, early diagnosis, abdominal pain insickle cell disease has not been rigorously studied.Objective: We therefore sought to describe the different presentations and patterns of abdominal pain in persons with sickle cell disease.Methods: A prospective case series of 20 patients was done in which data was collected on demographic characteristics, hemoglobin electrophoresis patterns, a description of the abdominal pain including sites, severity, and type of pain, packed cell volume and the provisional and final diagnosis.Results: Haemoglobin S patients were 17 in number constituting eightyfive percent (85%) of our study population whilst the rest 3 were Hb S+C. Most patients (70%) had one site of abdominal pain. The pain was mainly colicky or tightening, moderate to severe in nature and, in some cases, associated with vomiting. We did not find any significant difference between the steady state PCV and the PCV during the acute abdominal pain episodes. The final diagnosis showed that only 38.8% of the patientshad vasoocclusive crises and the reliability index between the provisional diagnosis and the final diagnosis was 67%.Conclusion: Abdominal pain in sickle cell disease may present in different ways and it is important to recognize that the possible diagnoses are numerous. Not all cases are due to vasoocclusive crises. Early diagnosisand prompt treatment can be life saving.Keywords - Abdominal Pain, Sickle Cell Disease, Anaemi

The epidemiology of chronic pain in Libya: a cross-sectional telephone survey.

BACKGROUND: Chronic pain is a public health problem although there is a paucity of prevalence data from countries in the Middle East and North Africa. The aim of this study was to estimate the prevalence of chronic pain and neuropathic pain in a sample of the general adult population in Libya. METHODS: A cross-sectional telephone survey was conducted before the onset of the Libyan Civil War (February 2011) on a sample of self-declared Libyans who had a landline telephone and were at least 18 years of age. Random sampling of household telephone number dialling was undertaken in three major cities and interviews conducted using an Arabic version of the Structured Telephone Interviews Questionnaire on Chronic Pain previously used to collect data in Europe. In addition, an Arabic version of S-LANSS was used. 1212 individuals were interviewed (response rate = 95.1 %, mean age = 37.8 ± 13.9 years, female = 54.6 %). RESULTS: The prevalence of chronic pain ≥ 3 months was 19.6 % (95 % CI 14.6 % to 24.6 %) with a mean ± SD duration of pain of 6 · 5 ± 5 · 7 years and a higher prevalence for women. The prevalence of neuropathic pain in the respondents reporting chronic pain was 19 · 7 % (95 % CI 14 · 6-24 · 7), equivalent to 3 · 9 % (95 % CI 2 · 8 to 5 · 0 %) of the general adult population. Only, 71 (29 · 8 %) of respondents reported that their pain was being adequately controlled. CONCLUSIONS: The prevalence of chronic pain in the general adult population of Libya was approximately 20 % and comparable with Europe and North America. This suggests that chronic pain is a public health problem in Libya. Risk factors are being a woman, advanced age and unemployment. There is a need for improved health policies in Libya to ensure that patients with chronic pain receive effective management

Global Anesthesia Workforce Crisis: A Preliminary Survey Revealing Shortages Contributing to Undesirable Outcomes and Unsafe Practices

BACKGROUND. The burden of disease, disability, and mortality that could be averted by surgery is growing. However, few low and middle income countries (LMICs) have the infrastructure or capacity to provide surgical services to meet this growing need. Equally, few of these countries have been assessed for key infrastructural capacity including surgical and anesthesia providers, equipment, and supplies. These assessments are critical to revealing magnitude of the evolving surgical and anesthesia workforce crisis, related morbidity and mortality, and necessary steps to mitigate the impact of the crisis. METHODS. A pilot Internet-based survey was conducted to estimate per-capita anesthesia providers in LMICs. Information was obtained from e-mail respondents at national health care addresses, and from individuals working in-country on anesthesia-related projects. RESULTS. Workers from 6 of 98 countries responded to direct e-mail inquiries, and an additional five responses came from individuals who were working or had worked in-country at the time of the survey. The data collected revealed that the per-capita anesthesia provider ratio in the countries surveyed was often 100 times lower than in developed countries. CONCLUSIONS. This pilot study revealed that the number of anesthesia providers available per capita of population is markedly reduced in low and lower middle income countries compared to developed countries. As anesthesia providers are an integral part of the delivery of safe and effective surgical care, it is essential that more data is collected to fully understand the deficiencies in workforce and capacity in low and middle income countries

Anaesthesia and Sickle Cell Disease

A review of adult patients with Haemoglobinopathy who had anaesthesia and surgery at the University College Hospital, Ibadan over a three year period was carried out. The 53 patients constituted 1.2% of all surgical cases operated. Two thirds of the patients were ASA II with the rest being ASA III and ASA IV. The steady state PCV of all patients ranged from 22% to 31% with a mean of 26.4% and general anaesthesia was administered in 83% of the patients while the others had their operations under regional blocks. Peri-operative course was satisfactory in all but two patients (3.8%) who were admitted in the Intensive Care Unit for close observation because of excessive oozing from operation site. Adequate post-operative care including hydration, analgesia, warmth, and blood transfusion when appropriate, ensured minimal post operative morbidity. These observations emphasize the fact that surgical patients with sickle cell disease do have satisfactory outcome when meticulous attention is paid to details of their peri-operative care. Nigerian Quarterly Journal of Hospital Medicine Vol. 9, No. 1 (1999) pp. 21-2

Knowledege And Attitudes Of Terminally Ill Patents And Their Family To Pallative Care And Hospice Services In Nigeria

Background: A palliative care and Hospice service is a neglected aspect of medical discipline especially in a developing country like Nigeria. With the global increase in incidence of cancer and HIV/AIDS and 70% of them presenting late, coupled with limited resources, for effective symptom control, palliative care therefore remains the only option left to improve the quality of life of the patients. Objective: To asses the knowledge and attitudes of patients and their relations to palliative care and hospice services [PC&H] and to fashion out appropriate services for the patients. Materials and methods: A total of 130 participants were studied using a questionnaire which comprised of three parts: Socio-demographic variables, Information about Knowledge and Attitudes towards PC&H. Results: Sixty nine were patients, while 61 were family members. Ninety four [72.3%] had no knowledge of PC&H regardless of level of education and social status. 109 [84%] agreed that symptoms of the terminally ill patients should be treated to improve their quality of life and 75% of the participants agreed that this will be better done in a Hospice. 106 [83%] participants desire to have hospice established in every community, this again was regardless of tribe. Conclusion: There is a gross lack of knowledge about PC&H in our community as evidenced among the participants studied. However, there is a positive attitude towards PC&H suggesting a general acceptance, since there is presently no well established Hospice in Nigeria; we recommend that government and Non governmental organizations should assist in this area. A hospital based Hospice might be a starting point. Key words: Knowledge, Palliative care, Hospice. Nigerian Journal of Clinical Practice Vol 8(1) 2005: 19-2

Image-Guided Cervical Epidural Steroid Injections For Cervical Radicular Pain: Reports of Two Cases

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