Weekend Versus Weekday Hospital Deaths: Analysis of In-Patient Data in a Nigerian Tertiary Healthcare Center

Aim: This study aims at comparing weekday deaths to weekend deaths of in-patients of a tertiary hospital in Nigeria. Materials and Methods: This is a 10-year retrospective survey conducted at the Nnamdi Azikiwe University Teaching Hospital in which the death records of the hospital were accessed from the various wards and health records department to extract relevant data pertaining to the time of hospital death. Tests of statistical significance were done using Chi-square test at 95 confidence intervals.Results: A total of 3934 deaths were recorded during the period of study. The ages ranged from a few hours to 94 years with a mean age of 38.5 years. The male to female ratio was 1.2:1. An average of 547 weekend deaths and 568 weekday deaths were recorded; giving a ratio of 0.96:1. A ratio of weekend to weekday death rate of 0.99:1 and 0.93:1 for the males and females; respectively was noted. The labor ward; followed by the intensive care unit (ICU) had the highest weekend to weekday death ratio of 1.72:1 (P = 0.0461) and 1.41:1 (P = 0.1440); respectively. Weekend deaths were less in the other wards; with the gynaecological ward having the least ratio of 0.63:1 (P = 0.7360). Conclusion: The rate of hospital deaths was generally found not to vary significantly over the weekends and weekdays in the hospital except for the labor ward which had significantly higher weekend to weekday death rates of 1.72:1. There is therefore need for confidential enquiry into the causes of hospital deaths; especially in the labor ward; in order to identify and prevent avoidable deaths

Infant Feeding Tube as Urinary Tract Stent

Background: The infant feeding tube is a cheap and readily available device with many uses in the urinary tract. Many types of stents are available in the market but among other factors; cost and affordability limit their use in developing countries and remote areas. Aim: To document experience with infant feeding tubes as stents in the urinary tract. Methods: Data from the hospital records of patients who required stents at the University of Port Harcourt Teaching Hospital; Port Harcourt; Nigeria were obtained from their case notes from May 2003 to May 2006. Information extracted from these case notes included: age and sex of patient; indications for stenting; stent-related complications and outcome of surgery. The data were analysed using Microsoft Excel Software. Results: Thirty-three patients who required stents within the period were included in the study. In nineteen patients (57.6) feeding tubes were used as urethral stents while in 14 (42.4) as ureteric stents. Operations requiring stents include: dismembered pyeloplasty 9.1 (3); ureteric re-implantation 24.3 (8); ureterolithotomy 9.1 (3); and urethroplasty 57.6 (19). The stents were left in situ for 2-3 weeks depending on the indication. Ureteric stents were left for 3 weeks while urethral stents were usually left for 2 weeks. However; where a significant complication was noted; the stent was removed. Complications noted in 4 patients (12.1) which were probably stent-related include: bladder spasm; infection and wound dehiscence. Conclusion: Infant feeding tubes can be used as suitable urinary tract stents where expensive stents are not available

Infant feeding tube as urinary tract stent

Background: The infant feeding tube is a cheap and readily available device with many uses in the urinary tract. Many types of stents are available in the market but among other factors; cost and affordability limit their use in developing countries and remote areas.Aim: To document experience with infant feeding tubes as stents in the urinary tract.Methods: Data from the hospital records of patients who required stents at the University of Port Harcourt Teaching Hospital; Port Harcourt; Nigeria were obtained from their case notes from May 2003 to May 2006. Information extracted from these case notes included: age and sex of patient; indications for stenting; stent-related complications and outcome of surgery. The data were analysed using Microsoft Excel Software.Results: Thirty-three patients who required stents within the period were included in the study. In nineteen patients (57.6) feeding tubes were used as urethral stents while in 14 (42.4) as ureteric stents. Operations requiring stents include: dismembered pyeloplasty 9.1(3); ureteric re-implantation 24.3(8); ureterolithotomy 9.1(3); and urethroplasty 57.6(19). The stents were left in situ for 2-3 weeks depending on the indication. Ureteric stents were left for 3 weeks while urethral stents were usually left for 2 weeks. However; where a significant complication was noted; the stent was removed. Complications noted in 4 patients (12.1) which were probably stent-related include: bladder spasm; infection and wound dehiscence. Conclusion: Infant feeding tubes can be used as suitable urinary tract stents where expensive stents are not available

Obstructive uropathy in childhood : a Review

Background: Obstructive uropathy is any affection of the urinary tract characterized by impairment of urine flow through the tract and which; if left untreated; will cause progressive renal damage.Aim: To present an update on obstructive uropathy in children with emphasis on the situation in Nigeria.Methods: Contemporary information on the management of obstructive uropathy was obtained by searching the Medline and adding information from the authors' experience.Results: Obstructive uropathy causes renal impairment in all age groups. The causes in children may be congenital or acquired. The congenital causes include pelvi-ureteric junction obstructions; posterior urethral valves (PUV); urethral atresia; phimosis and meatal stenosis. Associated anomalies include imperforate anus and ver tebral malformations. Acquired causes include calculi; post-traumatic and post-inflammatory strictures and meatal stenosis. Some specific manifestationsare prune-belly syndrome; hydronephrosis and renal failure. Diagnostic investigations include ultrasonog raphy; intravenous urog raphy; cystography and renography. Recent technological advances have impacted on the treatment of the different lesions. These include in utero vesico- amniotic shunt and endoscopic valve ablation for PUV and minimally invasive techniques for urolithiasis. Nephrectomy may be indicated in a unilateral damaged kidney. Not all lesions require treatment. Criteria to select patients for treatment require definition. Occasionally treatment fails because of pretreatment irreversible renal damage. The resulting end-stage renal failure is an indication for renal transplantation.Conclusion: Obstructive uropathy is an important cause of renal impairment. Contemporary advances in the management are yet to become available in developing countries. Compromise treatment options therefore prevail. Adequate treatment is essential to prevent end-stage renal failure