Outcome of intensive care management of acute chest syndrome in a Nigerian Teaching Hospital: A preliminary report

Objectives: Acute chest syndrome (ACS) is a common complication of vaso-occlusive crisis in sickle cell disease patients. It causes respiratory failure which may require mechanical ventilation in the intensive care unit, but outcome of such intervention has been sparingly reported in our environment. This study highlights the intensive care management and outcomes of acute chest syndrome in our centre. Design: This was a retrospective descriptive study Setting: This study was carried out at the intensive care unit of a tertiary hospital in Nigeria Subjects or participants: These were 27 sickle cell disease patients with acute chest syndrome managed in our intensive care unit from January 2013 to December 2017. Methods: We reviewed the medical records of all the 27 sickle cell disease patients managed in our intensive care unit on account of acute chest syndrome in the last 5 years. Relevant information on supplemental oxygen administration, modes of ventilation, transfusion, length of stay in the ICU and mortality rate was also extracted.Main outcome measure: The main outcome measure was the number of patients who survived and discharged from the intensive care unit.Results: Nine (50%) out of the 18 patients with acute chest syndrome, complicated by severe respiratory insufficiency, ventilated mechanically survived. The median length of ICU stay was 6 (12) days.Conclusion: Mechanical ventilation of patients and adequate pain control can help reduce the mortality and enhance the quality of life of sickle cell disease patients with acute chest syndrome

Transforaminal epidural steroid injections for the treatment of lumbosacral radicular pain in a Nigeria tertiary hospital: observational study

Background: Lumbosacral radicular pain is a common cause of chronic low back pain. Despite published reports of effectiveness of transforaminal epidural steroid for lumbosacral radicular pain, it is underutilised in many tertiary hospitals in sub-Saharan Africa. This study assessed the clinical effects of transforaminal epidural steroid injections in patients with lumbosacral radicular pain at a major tertiary health facility in Nigeria.Methods: This is a prospective observational study carried out between March 2012 and February 2016. Under fluoroscopy, the epidural space was accessed through the neuroforamen using 22G spinal needles in 47 adult patients with lumbosacral radicular pain; and a mixture of 10 mg triamcinolone acetonide and 0.25% plain bupivacaine (2 mLs per level) was injected. Pain intensity and functional impairment were assessed with the Numeric Pain Rating Scale (NPRS) and the Oswestry Disability Index (ODI) scores respectively at three and six months.Results: The pain and ODI scores at baseline and at six months’ follow-up improved significantly; 8.49 ± 1.28 vs. 3.6 ± 1.5 (p = 0.002) and 45.1 ± 11.5 vs. 32.4 ± 11.5 (p = 0.001) respectively.Conclusion: Transforaminal epidural steroid injections provided significant pain relief and improved function in patients with lumbar radicular pain due to intervertebral disc herniations.Keywords: herniated intervertebral disc, lumbosacral radicular pain, Nigeria, pain relief, transforaminal epidural steroid injectio

Knowledge and attitudes of pregnant women towards anaesthetic techniques for caesarean delivery in a North Central Teaching Hospital

As caesarean deliveries increase globally, more women will be exposed to anaesthesia as part of the surgical procedures. Evaluation of the knowledge and attitudes of parturient will guide patient education and counselling and may improve overall satisfaction with caesarean delivery. This was a cross sectional study involving parturient aged 21-47 years scheduled for elective caesarean delivery at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. Sampling method was purposive, informed consent was obtained from all participants and data collection was through an interviewer-administered questionnaire. Data analysis was by SPSS version 20.0 and p<0.05 was significant. Awareness about anaesthetic techniques for caesarean delivery was 85(78%) but 31 (37%) were adequately informed about the techniques. The preferences of parturient for specific anaesthetic techniques favoured regional anaesthesia (spinal [68.3%], epidural [5%]), compared to general anaesthesia (18.3%). Educational level, previous anaesthetic experience, types of occupation, partner’s level of education among others had likelihood of improving the knowledge and choice of anaesthetic techniques for caesarean delivery among the respondents.  Conclusion from the study revealed that spinal anaesthesia was preferred for caesarean delivery similar to the global trend due to its perceived safety. Adequate information at antenatal clinic and involvement of anaesthestists may help to improve knowledge and acceptance of anaesthetic techniques by parturient.Keywords: Knowledge, Attitudes, Pregnant women, Anaesthetic techniques, Caesarean sectio