A Review of the Patterns of Admission and Outcome of Postcaesarian Section Patients in the Intensive Care Unit of a Tertiary Hospital in Nigeria

Despite the increased utilization of invasive monitoring and mechanical ventilation in the care of the obstetric patient, a dedicated intensive care unit (ICU) for this group of patients is almost lacking in the developing world. Critical care for the obstetric patient has been recognized as a useful tool in the reduction of maternal morbidity and mortality. We sought to review the clinical characteristics and outcome of all post-Caesarean section(C/S) patients admitted into a multi-disciplinary ICU over a 10 year period. Parameters evaluated were indications for C/S, duration of stay, mechanical ventilation and ICU outcome. 114 post-C/S patients were admitted into the ICU during the study period, constituting 9.8% of all admission into the ICU. Emergency C/S constituted 92.2% of all C/Ss and eclampsia represented the commonest indication of C/S requiring care in the ICU. Mortality rate was 23.2% and non post-C/S patients were twice more likely to die in the ICU. Majority of these patients had a short ICU stay, 1-2 days and 19.3% required mechanical ventilation. Obstetric critical care is evolving and increasing proportion of obstetric patients utilized ICU care in our environment. A dedicated ICU for the obstetric patients will afford more of this special group intensive care with improved maternal health

Blood transfusion in critically ill patients in an Intensive Care Unit of a Tertiary Hospital in Nigeria

Objective: To evaluate the use of whole blood and blood products in our ICU to determine patterns and outcome after transfusion.Design: A retrospective, case-control study.Setting: The Intensive care unit (ICU) of the University of Benin Teaching Hospital, a seven-bed open unit for the management of surgical, medical and paediatric patients.Subjects: Patients who received blood transfusion in the ICU. Every patient who received blood transfusion was matched for a similar case without blood transfusion. Patients’ socio-demographic characteristics, number of units of blood transfused, length of stay and outcomes were determined.Result: Approximately 30% of all patients admitted during the study period were transfused with blood. Majority of these patients (83.2%) had one to three units of blood. Obstetrics and neuro-surgical patients had more blood transfused than others. Whole blood constituted >85% of blood transfused while packed cells and fresh frozen plasma constituted 11.8% and 2.8% respectively. Blood transfusion did not have any significant impact on patients’ length of stay and mortality. The number of units of blood transfused appears to be associated with poor outcome (P=0.006).Conclusion: Obstetric and neuro-surgical patients utilised blood and blood products in the ICU more than any other patients. The number of units of blood transfused was more predictive of mortality than the blood  transfusion per se. A judicious use of blood and blood products, giving patients what they need and the development of transfusion guideline in the ICU is expedient

The Need for Family Meeting in the Management of Patients Admitted into the Intensive Care Unit: Experience from a Teaching Hospital in Nigeria

Objective: To evaluate the knowledge of family members of patients admitted into the Intensive Care Unit (ICU) in terms of their patients’ clinical state, reasons for admission and progress of treatment.Design: Prospective, cross-sectional study.Setting: General Intensive Care Unit of the University of Benin Teaching Hospital, Benin City, Edo State, Nigeria.Subjects: Twenty-five family members of patients admitted into the ICU were recruited. The data collected included socio-demographic characteristics, level of education, awareness of the indications for ICU admission, expectations of outcome and level of satisfaction with family meeting.Results: Fifty- six percent of family members claimed to be aware of the indication for admission into the ICU while 44% claimed ignorance. Only 24% of thefamily members who claimed to be aware were correct about the indication for admission. Among the participants, 36% were well informed about the prognosis of their patients’ clinical condition. All the relatives interviewed were satisfied with the family meeting held with them.Conclusion: Majority of family members of critically ill patients were neither carried along in the management of their patients nor were they informed of likely outcome. A timely, well-planned and regular family meeting is therefore advocated in the management of critically ill patients

Investigating veterinary management choices for canine heartworm disease (Dirofilaria immitis) in northern Mississippi

Canine heartworm disease affects nearly 45% of dogs in endemic regions of the United States (Atkins, 2005). There are concerns that the chronic use of macrocyclic lactone (ML) preventives to kill adult heartworms (“soft-” or “slow-kill”) may have contributed to the development of ML resistance. My study of this problem had three objectives: (a) to determine the frequency of “slow-kill” treatment in heartworm-positive patients and compare them to practitioner estimates; (b) to survey practitioner opinions on the factors influencing heartworm disease management; and (c) to analyze the heartworm prevention history of heartworm-positive patients in order to understand the causes of heartworm infection in this region. The study group consisted of dogs determined to be heartworm-positive when presented to a mixed-animal practice in northern Mississippi. Client records were scrutinized for heartworm preventive purchase history. Veterinarians in the four-doctor practice completed a questionnaire concerning their beliefs and practices in regard to heartworm treatment. 75% of heartworm-positive patients received “slow-kill” treatment, more than 20% greater than that estimated by the practitioners. 12.5% of patients received adulticidal treatment, equivalent to those that received no treatment. Injectable moxidectin was the most common ML preventive used in “slow-kill” treatment. Client financial concerns were cited as the primary reason for choosing “slow-kill” treatment. The results of this study show that practitioner estimates of “slow-kill” prevalence within their clinics may be suspect in their accuracy. Despite the recommendations of the American Heartworm Society, clients and veterinarians prefer the “slow-kill” method of heartworm treatment. However, trends in patient heartworm preventive history show that poor client compliance remains the predominant reason for heartworm infection. Thus, consistent use of existing, effective heartworm preventives should be the primary goal in reducing prevalence of heartworm infection, regardless of the recognized threat of resistance. Further study is needed on the risks and efficacy of “slow-kill” treatment and the effects of different ML preventives for the treatment of heartworm infection

The effects of dexamethasone and metoclopramide on early and late postoperative nausea and vomiting in women undergoing myomectomy under spinal anaesthesia

Background: Post.operative nausea and vomiting (PONV); early or late, has detrimental effects on surgical patients such as surgical wound disruption, esophageal tear and delayed discharge from the post  anesthetic care unit. This study evaluated the effects of  dexamethasone.metoclopramide (DM) in the prevention of early and late PONV in women undergoing myomectomy under subarachnoid block.Materials and Methods: Following approval from the Research and Ethics Committee of the Hospital, informed consent was obtained from each prospective patient. Patients were randomly allocated to either the DM group, metoclopramide only (MO) group or dexamethasones only (DO) group using the computer.generated random numbers in sealed envelopes. Immediately after the induction of spinal anesthesia, the DM group received intravenous (i.v.) dexamethasone 8 mg and  metoclopramide 10 mg, the MO group received metoclopramide 10 mg i.v and the DO group received dexamethasone 8 mg i.v. The incidence of early and late PONV formed the primary outcome.Results: A total of 90 patients, with aged range between 21.64 years were studied. Dexamethasone alone group had the highest incidence of 40% for early but no for late PONV (P = 0.003) Metoclopramide alone group had an incidence of 29.97% for early PONV and 26.6% for late PONV. There was reduced incidence of both early and late PONV in the DM group, but of lesser magnitude than DO or MO respectively.Conclusion: Dexamethasone protects against the incidence of late PONV with a minimal effect on early PONV. The combination of dexamethasone and metoclopramide had comparable effect on both and of better  magnitude than metoclopramide alone.Key words: Antiemetic, myomectomy, spinal anaesthesi

Blood use in sub‐Saharan Africa: a systematic review of current data

Background: Data on the use of blood products in sub-Saharan Africa (SSA) are scarce. A systematic review of published data on blood utilization according to diagnosis in SSA was performed. Study design and methods: Studies published from January 2000 to June 2018 were searched in PubMed, Embase and African Index Medicus. Data were extracted and synthesized. The proportion of blood products used for different diagnostic categories is presented. Results: 37 studies representing 159,746 transfusions to 96,690 patients from 14 countries in SSA were included. Data from six of 37 studies were pooled to determine blood product use according to diagnosis. The primary diagnostic categories were pediatric malaria (20%), sickle cell anemia [SCA] (18%), obstetric hemorrhage (16%), and other causes of bleeding (16%). About 8%, 6% and 2% of products were used for other infections, cancer treatment, and surgery respectively. Overall, 58.5% of the products transfused were red blood cells, 31.7 % whole blood, 7.2% fresh frozen plasma, and 2.6% as platelets. Estimated blood product use per population in SSA was 5.3 transfusions per 1000 people, compared with 52 and 34 per thousand for Australia and United States respectively. Conclusion: This study provides a systematic attempt to quantify blood utilization for SSA. Blood products in SSA are used primarily for pediatric malaria, SCA, obstetric hemorrhage and other causes of bleeding. Studies such as this represent an important early step towards improving hemovigilance in SSA

Investigating management choices for canine heartworm disease in northern Mississippi

Abstract Background There are concerns that the chronic use of macrocyclic lactone preventives to kill adult heartworms (“soft-” or “slow-kill”) may have contributed to the development of macrocyclic lactone resistance. This prospective analysis was designed to expand our understanding of currently employed treatment decisions, protocols utilized in a “slow-kill” methodology, and trends in heartworm prevention in a region with concerns about macrocyclic lactone resistance. We tested the hypothesis that practitioners underestimate the actual percentage of heartworm-positive dogs treated with “slow-kill” therapy. Owners’ financial concerns and veterinarians’ efforts at meeting client preferences are the primary reasons for employment of “soft-kill” treatment. Methods A prospective analysis of dogs determined to be heartworm-positive when presented to a mixed-animal practice in northern Mississippi was conducted for the second quarter of 2016. Client records were scrutinized for heartworm preventive purchase history. Veterinarians in the four-doctor practice completed a questionnaire regarding their beliefs and practices of heartworm treatment. Results Forty of 321 canine patients tested heartworm-positive with a commercial antigen test kit. Of these, two were considered to be due to possible product failure. The majority (75.0%) of patients received a “slow-kill” method, a percentage greater than that estimated by the practitioners. Patients were equally likely to have received adulticidal treatment as they were to receive no treatment (12.5%). Injectable moxidectin was the most common preventive used in “slow-kill” treatment (80.65%). Client financial concerns were cited as the primary reason for choosing “slow-kill” treatment (79.0%). Conclusions Despite American Heartworm Society recommendations, clients and veterinarians prefer the “slow-kill” method of heartworm treatment. Trends in patient heartworm preventive history show that poor client compliance remains the predominant explanation for heartworm infection. Thus, consistent use of existing, effective heartworm preventives should be the primary goal in reducing prevalence of heartworm infection, regardless of the recognized threat of resistance. It is also noteworthy that practitioner estimates may be suspect in their accuracy. Further study is needed on the risks and efficacy of “slow-kill” treatment and the effects of different ML preventives for this off-label use

Ascaris Lumbricoides (Round Worm) in the Upper Airway of an Intubated Patient in the Intensive Care Unit: A Case Report (NMP)

Infestation of the airway with Ascaris lumbricoides is very rare in the intubated patient. Migration of the worm from its natural habitat in the gastrointestitnal tract (GIT) through the oesophagus to the tracheal is possible. Serious airway obstruction occurs when the adult worm obstructs the bronchi or the vocal cords with attending sequaele. We hereby present a case of a 67 year old man with cerebrovascular accident (stroke) admitted and mechanically ventilated in the Intensive Care Unit. However, four days later, a 15cm long adult ascaris lumbricoides was found coming out of the oropharynx beside the cuffed endotrachael tube. We also highlight and discuss various clinical situations where ascaris lumbricoides has inhabited the airway documented in the literature

Prolonged Stay in the Intensive Care Unit: a Report of 2 Cases

Prolonged stay in the Intensive Care Unit (ICU) is described as at least a 14- day stay in the ICU. It is associated with increased cost of care, increased resource utilization and impact on patients' morbidity and mortality. We present a report of two cases of prolonged stay in the ICU (32 and 39 days respectively) with emphasis on the course of illness and intervention. The role of serial arterial blood gas analysis, early tracheostomy and the presence of a dedicated consultant in the unit in the eventual outcome were highlighted