Awareness of Venous Thromboembolism among Doctors in a Nigerian Tertiary Centre

Background: Venous thromboembolic (VTE) is a preventable leading cause of morbidity and mortality worldwide and is a cause of sudden death. Awareness of VTE among doctors will reduce the incidence of unexpected deaths in hospitalised patients.Objective: To assess doctors' awareness of venous thromboembolism in our centre.Design: Cross sectional questionnaire based study.Setting: University of Port Harcourt Teaching Hospital; Nigeria.Subjects: One hundred and twenty four doctors attending a hospital grand-rounds session were recruited. Results: The response rate was 82.7% (124 of 150 questionnaires). Almost half (n=57; 46%) correctly identified VTE; but two (1.6%) did not know what VTE was and 27 (21.8%) stated it to be normal haemostasis. Commonly identified risk factors included: increased body mass index 113 (91.1%); diabetes mellitus 105 (84.7%); pregnancy 105 (84.7%); age 104 (83.9%); and immobility 104 (83.9%). Although clinical features were identified; VTE was acknowledged to be asymptomatic by 62 (50%) responders. About 68 (54.8%) did not know of a VTE risk stratification model and only one (0.8%) had used a model in practice. Responders commonly prescribed anticoagulants for prophylaxis. Although most had come across VTE in practice; 15 (12.1%) had not seen a case of VTE.Conclusion: The knowledge of VTE was average. There was a gap between knowledge and practice for this preventable disorder. Patients in our centre were not routinely risk stratified for VTE. Updating of medical knowledge is encouraged

Surgical Inpatient Mortality in a Nigerian Tertiary Hospital

Background: There is paucity of literatures on audit of mortality in the surgical units of tertiary hospitals in the country. This has made the spectrum of mortality not to been known in some of the centers and therefore; there is a great disparity and dearth in apportioning health care services appropriately. Aim: The determination of the pattern of mortality in a surgical unit helps in planning; provision of quality surgical care and prioritizing of limited resources in developing countries. Methods: This is a retrospective study of all patients who died during admission into surgical wards of our hospital between 2007 and 2012. Data on demography and events leading to death were collected and analyzed from all surgical wards; the emergency unit; surgical outpatients; and theater records. Results: A total of 527 deaths occurred among the 8230 patients admitted during the 6-year period giving a mortality rate of 6.4%. Three hundred and forty-five (65.5%) were male; while 282 (34.5%) were females. The mortality rates in units were as follows: Burn and plastic (23.1%); general surgery (5.5%); neurosurgery (7.9%); urology (6.0%); orthopedics (3.8%); pediatric surgery (3.4%); and cardiothoracic surgery (11.9%). The yearly mortality rate were as follows; respectively: 2007 (7.1%); 2008 (6.0%); 2009 (4.5%); 2010 (6.5%); 2011 (7.2%); and 2012 (7.5%). About 84.6% of the patients died within 1 month on admission. The leading causes of mortality were trauma (41.8%) and cancer (32.4%). Most of the deaths (64.9%) occurred between 20- and 70-year-old. Conclusion: Trauma and cancer constitute a great deal of health burden in our region. Strong legislation and screenings with timely interventions are required

Urological Malignancies in Port Harcourt; Nigeria: a 14-Year Review

Background: Urological malignancies are complex; covering the urinary system in both sexes and the genital system of males. They are common in this setting and posing a lot of problems to the patients. In most cases; the disease terminates in the death of the patient. Aim: To study the pattern and frequency of urological malignancies. Methods: All the urological tissues histologically diagnosed as malignant at the University of Port Harcourt Teaching Hospital; Port Harcourt; Nigeria between 1990 and 2003 were retrospectively studied. Variables such as the age and sex of the patients; anatomical site of the cancer; laterality of the tumours; clinical presentation and the histological types were obtained from the theatre operation register; patient's case notes; histology request forms; reports and autopsy reports. Results: There were 270 histologically confirmed urological malignancies during the period under review. This accounted for 11.3of the total malignancies and affected all ages of both sexes with a male to female ratio of 9.8:1 . The 70 years and above age group were most affected [103(38.1)] and carcinoma of the prostate was the most frequent [189(70.0)]. Adenocarcinoma of the prostate gland was the leading histological variant [187(64.0)] and urinary outflow obstruction was the most common clinical presentation [62(23.0)]. Conclusion: Urological malignancies are fairly common in this environment and carcinoma of the prostate gland is dominating

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