Determinants of Mortality in Chest Trauma Patients

Background: Chest trauma is an important trauma globally accounting for about 10% of trauma admission and 25‑50% of trauma death. Different types and severity of chest trauma in different subsets of patients with varying associated injuries result in differing outcomes measured with mortality. Early mitigation of poor prognostic factors could result in improved outcome, therefore the need to know such factors or determinants of mortality in chest trauma patients.Patients and Methods: Retrospective and prospective analysis of demographic details, socio‑economic, clinical details, modified early warning signs (MEWS) score on presentation, investigation findings, treatment and outcome of chest trauma patients who presented to our cardiothoracic surgery unit was undertaken. Data were collected and were analyzed using WINPEPI Stone Mountain, Georgia: USD Inc; 1995 statistical software. Results: A total 149 patients with thoracic trauma were studied over a 5 year period constituting 40% of the unit workload. There were 121 males and 28 females (81.2% vs. 18.8%; m: f = 4:1) with age range from 7 to 76 years (mean: 37.42 ± 12.86 years) and about 55% aged 45 years or below and more blunt trauma than penetrating trauma (65.1% vs. 34.9%), but no statistical significance amongst the groups on outcome analysis. Sub‑grouping of the 149 patients according to their on‑admission MEWS score shows that 141 patients had scores of 9 and less and all survived while the remaining eight had scores >9 but all died. As independent variables, age, sex and type of chest injury did not prove to be correlated with mortality with P values of 0.468, 1.000 and 1.000 respectively. However presence of associated extra thoracic organ injury, high on‑admission MEWS score >9, delayed presentation with injury to presentation interval longer than 24 h, and severe chest injury as characterized by bilateral chest involvement correlated positively with mortality with P values of 0.0003, 0.0001, 0.0293 and 0.0236 respectively. Conclusion: Associated extra thoracic organ injury, high on‑admission MEWS score >9, late presentation beyond 24 h post trauma and severe chest injury with bilateral chest involvement were found to be determinants of mortality in chest trauma.Keywords: Chest trauma, determinants, mortalit

Isolated Dextrocardia coexisting with Skeletal Anomalies and Mild Cardiac Anomalies

Background: There are various types of dextrocardia presentation, with some more common than others. This case is reported because of the unusual association of dextrocardia with atrial septal aneurysm and  skeletal anomalies.Methods: The case records of a 2 day old male who presented at the University of Nigeria teaching hospital, Enugu for care and a review of the literature of the subject was utilized.Results: A case of a 2 day old male baby with isolated dextrocardia is presented. The initial diagnosis was made by chest radiograph and confirmed by echocardiography. There were no associated severe cardiac anomalies.Conclusion: This case is reported as isolated dextrocardia coexisting with skeletal anomalies and mild cardiac anomalies. Extensive skeletal and cardiac evaluation is advised for subjects with dextrocardia, in order to identify all associated anomalies.Keywords: Isolated dextrocardia; skeletal anomalies; coexisting atrial septal aneurysm

Medical students' preference for choice of clinical specialties: A multicentre survey in Nigeria

Background: The important goal of undergraduate medical training is to train doctors who would undergo further training to become specialists in various fields of clinical medicine. The admission into the specialty training programame depends largely on the pool of undergraduate medical students who have passed qualifications exams and are willing to choose and undergo training in a given clinical specialty. There are many factors considered by medical students when they make up their minds to choose a clinical specialty. This study seeks to determine the medical student preference for the clinical specialty and the factors that they consider in making such choice.Methods: This is a cross-sectional questionnaire based multicentre study in 3 accredited medical training institutions in Nigeria. Final year medical students who were willing to participate in the study filled out the questionnaires for fifteen minutes.  Information on their age, gender, specialty of preference and reason for choosing a particular clinical specialty were sought.Results: A total of 187 final year students took part in the study. Most of the students where in 21 – 30 year age range. Obstetrics and Gynaecology (24.9%), Surgery (18.9%), Internal medicine (14.1%) and Paediatics (8.1%), where the top clinical specialties preferred by the respondents. The less preferred specialties where Pathology  (2.7%), radiology (1.1%) ophthalmology (4.3%), ENT (0%). Personal liking  (51.9%), society perception (13.0%), financial reward (8.1%); where the most considered reasons for the choice of specialty.Conclusion:Medical students prefer to choose core-clinical specialty based on personal liking, financial reward and society perception.Keyword: Medical Students' Preference; Clinical Specialties; Nigeri

Pattern of Cardiothoracic Surgical Diseases in a New Cardiothoracic Surgery Unit in Nigeria

Background: Cardiothoracic surgical pathologies are available in all  geographical regions of the world. Human and material resources are necessary for prompt diagnosis and proper treatment of these cases.Methodology: Retrospective analysis of cardiothoracic surgical cases in the first five years of our new cardiothoracic surgery unit was done.Results: A total of 714 cases were seen during the study period with age range one month to 76 years with mean age of 37.12±11,24 and male  female ratio of 2:1. The yearly admissions from 2007 to 2011 were 14%, 17%, 21%, 21% and 26% respectively. Cardiovascular diseases occurred in 22.30%, with 6% of children suffering from congenital heart defect and 6% of men suffering from acquired vascular disease. Surgical complications of pleuropulmonary tuberculosis occurred in 21.4% while thoracic trauma occurred in upto 21% of the patients. Aerodigestive tract foreign bodies were encountered in 10.1% of cases and Pyogenic diseases occurred in 8.68%. Oesophageal lesions were diagnosed in 6.4% of the patients, pulmonary tumours including primary and secondary tumours were found in 4.3% while nontraumatic chest wall pathologies which included chest wall tumours, congenital deformities and chronic osteomyelities accounted for 3.2%. Mediastinal pathologies occurred in 0.98% and in the remaining 1.5% rare diseases were diagnosed such as third degree heart block,  pulmonary embolism and thoracic endometriosis syndrome.Conclusion: This study shows that cardiothoracic surgical pathologies are common in our centre with predominance of thoracic pathologies, and  therefore need to prioritize and ensure manpower development for  treatment of all kinds of thoracic pathologies

Challenges of vascular access in a new dialysis centre - Uyo experience

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Outcome of tube thoracostomy in paediatric non-traumatic pleural fluid collections

Objective: Management of pleural fluid collection not due to trauma  increases workload of the paediatric thoracic surgeons, while delay or inappropriate treatment worsens the prognosis of the disease. This study aimed at assessing the outcome of therapeutic tube thoracostomy in non-traumatic paediatric pleural fluid collections and identifying factors responsible for treatment failure with tube thoracostomy.Design: Prospective analysis of socio-demographic characteristics, clinicalfeatures, clinical diagnosis, radiological diagnosis, and bacteriological diagnosis including bacteria cultured with sensitivity pattern, also treatment offered including tube thoracostomy with duration of tube thoracostomy and length of hospitalisation, indication for additional  surgical procedure with type, and outcome of treatment of 30 paediatric patients with  non-traumatic pleural fluid collection.Results: Thirty paediatric patients with various causes of non-traumatic pleural fluid collection in 34 pleural spaces were analysed. Their ages ranged between six months and 16 years (mean= 6.5 years) and M:F ratio of 2:1. Pleural effusion and empyema thoracis accounted for 46% and 40% with staphylococcus aureus and streptococcus pneumoniae cultured in 10% each and a high negative culture rate of 46%, which was higher with age. The parents of 40% of the patients belonged to social class 3. Success rate of tube thoracostomy was 86% in unilateral cases, 50% in bilateral cases and 81% in all cases. Alternative treatment with  thoracotomy and decortications gave a success rate of 100%.Conclusion: Thoracotomy with decortication is superior to tube   thoracostomy in paediatric non-traumatic pleural fl uid collection andshould be chosen as the primary treatment option when there is bilateral disease, chronicity, loculated effusion, thickened pleural membranes or trapped lung.Keywords: Tube thoracostomy, Pleural fluid collections, Paediatri

Challenges of Lung Cancer Management in a Developing Country

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Tricuspid Atresia with Normal Axis on ECG Palliated With A Central Shunt; A Case Report

Background: Tricuspid Atresia is the 3rd commonest cyanotic congenital Heart disease .It is characterized by lack of communication between the right atrium and right ventricle. The treatment often requires a palliative systemic to pulmonary shunt before definite surgery. The use of a central shunt via a median sternotomy is suggested here as an alternative to other traditional shunts via a thoracotomy. Method:The management of a 3 month old boy who presented with dyspnoea, fever, cough and cyanosis is presented here as obtained from Clinical records. Result: Following resuscitation, a central shunt (Ascending Aorta to main Pulmonary Artery) was constructed and the patient did well despite a turbulent post -operative period. Conclusion: The management of tricuspid atresia likes other cyanotic heart disease is daunting but palliative treatment is possible in our environment and definitive treatment where possible affords a fairly satisfactory prognosis. Keywords: Tricuspid Atresia, Normal Axis, Central Shunt, Prognosis and Treatment.Nigerian Journal of Medicine Vol. 17 (4) 2008: pp. 462-46

Knowledge and practice of prophylaxis of deep venous thrombosis: A survey among Nigerian surgeons

Background: Venous thromboembolism is a potentially dangerous condition that can lead to preventable morbidity and mortality among surgical patients.Objectives: We aimed to determine the knowledge and practice of surgeons practising in Tertiary Hospitals in Nigeria about prophylaxis of deep vein thrombosis (DVT).Materials and Methods: Eight Tertiary Institutions were selected from institutions in the geopolitical regions of the country by simple random sampling using balloting method. A semi‑structured questionnaire was administered, and the response was obtained from 105 out of 254 surgeons.Results: The mean knowledge score was 5.81 ± 1.67, and only 33.3% have good knowledge about DVT prophylaxis. No statistical difference was observed between the different groups of surgeons. The mean practice score was 5.19 ± 1.8 and only 20% of surgeons have a good practice of DVT prophylaxis. The majority (90.5%) have encountered DVT whereas 83.5% have encountered pulmonary embolism in their practice. Most commonly encountered risk factors include prolonged immobility, advanced age, and pelvic surgery. Only 13.3% have used Well’s score in the clinical evaluation of their patients. The prophylactic modality adopted varies, but most surgeons (77%) utilized both the pharmacological and mechanical methods. Low molecular weight heparin is the commonly used chemoprophylactic agent while a combination of early ambulation and limb physiotherapy is the most commonly preferred mechanical method of thromboprophylaxis.Conclusion: There is a deficiency in the knowledge and practice of DVT prophylaxis among surgeons in Nigeria. There is a need to improve both the knowledge and practice by introducing institutional guidelines or protocol for DVT prophylaxis for surgical patients.Key words: Deep vein thrombosis prophylaxis, knowledge, practice, surgeons, surgical patient