Comparison of the duration and quality of epidural analgesia between plain bupivacaine alone and plain bupivacaine with tramadol in lower limb orthopaedic surgeries

Background: This study was aimed at comparing the duration and quality of epidural analgesia between plain bupivacaine alone with plain bupivacaine and tramadol in lower limb orthopaedic surgeries. Method: This was a prospective randomized double blinded control study involving 74 ASA I and II patients scheduled for elective lower limb orthopaedic surgeries. Group A (n=37) received 19mls of 0.5% epidural plain bupivacaine with 1 ml of water for injection, while group B received 19mls of 0.5% epidural plain bupivacaine with 1ml (50mg) of preservative freetramadol. The duration of analgesia was from the time of epidural block to the time of rescue analgesia. While, the quality of block was measured with Visual Analogue Scale (VAS) and Bromage scale. Results: Thestudy ages were between 16-60years,consisting of 22(60%) male and 15(40%) female in group A, while in group B 20 (54%) were male and 17(46%) female. It showed the mean duration of analgesia were 189.05±21.92min and 254.19±32.78min in group A and B respectively with p <0.01.The intra-operative VAS scores between the two groups did not show any significant difference between study groups (P> 0.05).The differences of grades of motor block and maximum sensory block height were not statistically significant (P=0.26) among the study groups. Conclusion: The addition of 50mg (1ml) of tramadol to plain bupivacaine epidurally prolonged the duration of analgesia and improved the quality of analgesia when compared to the use of bupivacaine alone

Comparative evaluation of carotid intima media thickness in paediatric type 1 diabetic children and healthy children in Ibadan and Lagos, Nigeria

Patients with type 1 diabetes are at greater risk of cardiovascular disease and atherosclerosis. Carotid in-tima­media thickness (CIMT) measured by ultrasound is a marker of atherosclerosis and can predict future cardiovascular events.The aim of this study was to measure the CIMT in paediatric type 1 diabetes patients in Ibadan and Lagos and compare results with the CIMT of non-diabetic healthy control children. Carotid ultrasound was performed and CIMT measured in 70 subjects (35 diabetic patients and 35 non-diabetic controls matched for age and sex). Mean age was 12.8±3.2 years. A slightly higher, but non-significant mean CIMT was seen in diabetic cases: mean values in type 1 diabetes patients were 0.475±0.068 and 0.476±0.069 (right and left respectively) while in controls, mean values were 0.467±0.064 and 0.468±0.054 (p=0.618 and 0.575 respectively). The CIMT in both groups correlated positively with age and body mass index (BMI). Significantly higher mean CIMT values were seen in males with type 1 diabetes on both sides. However, there was no significant correlation between CIMT and duration of illness, insulin dosage, or blood pressure. CIMT is a safe and convenient measurement, which may be helpful in predicting an increased risk of future cardiovascular disease in children with type 1 diabetes

Factors Contributing to Non-Compliance with the Standard Antenatal Visits among Women in Nyaruguru District; Southern Province; Rwanda

Background: Non-compliance with at least four standard antenatal care (ANC) visits is a critical public health problem. In Rwanda; the proportion of pregnant women who follow the four ANC remains relatively low (43.9%) although it has relatively increased.Objectives: To assess the level of knowledge of selected pregnant women on the importance of using the ANC service; to determine the proportion of pregnant women attending the four ANC and to identify factors limiting the women to the four standards ANC compliance.Design: A descriptive; cross-sectional; quantitative study.Setting: Nyaruguru District.Subject: All women on term and those with child aged one year. They were randomly selected from each village until the sample size of the study (n = 367) was attained.Results: About 13.4% of pregnant women made at least four ANC visits. The low ANC attendance was significantly associated with the long walking distance from home to the health centre (p=0.05); insufficient knowledge on the importance of the use of the ANC service (p=0.01). Conclusion: There is a need to strengthen education and awareness on the importance of ANC in that community in order to reduce maternal and infant mortality in Nyaruguru District

Acute Sigmoid Volvulus in a West African Population

BACKGROUND: Acute sigmoid volvulus is one of the commonest causes of benign large bowel obstruction. Its incidence varies considerably from one geographic area to another. OBJECTIVE: To review the management of acute sigmoid volvulus in a relatively high prevalence area. METHODS: All adult patients with acute sigmoid volvulus seen at the Royal Victoria Teaching Hospital (RVTH) Banjul; between September 2000 and January 2005 were studied. Information obtained for analysis from the records included age; sex; clinical features; test results; and outcomes. RESULTS: A total of 48 patients; 45 (93.8) males and three (6.3) females; with a male: female ratio of 14.3:1; age range of 19 to 78 years and mean age of 45.8 +17.6 years; underwent treatment for acute sigmoid volvulus. Twenty-one (43.8) of the patients were aged 40 to 59 years. Two (4.2) had rectal tube detortion followed by elective sigmoidectomy and primary anastomosis on the same admission; while 24 (50) had emergency laparotomy at which bowel decompression; onestage resection and primary anastomosis without on-table lavage was done. The rest of the patients; 22 (45.8) had gangrenous sigmoid colons at laparotomy and consequently had Hartmann's procedure done. Fourteen patients (29.1) developed wound infection and five (10.4) had prolonged ileus that was managed conservatively. There was no anastomotic leak. The mean hospital stay was 11.1 days. There were five deaths giving a mortality rate of 10.4. CONCLUSION: Acute sigmoid volvulus in the Gambia is almost exclusively a male disease. Sigmoid colectomy and primary anastomosis can be carried out safely in those with viable colon without on-table colonic lavage

Experience with Acute Perforated Duodenal Ulcer in a West African Population

Background: The advent of proton pump inhibitors and helicobacter pylori eradication in the management of chronic peptic ulcer disease has reduced the operative treatment of this condition to its complications. Perforated duodenal ulcer remains a major life threatening complication of chronic peptic ulcer disease. This retrospective study reviews our experience at the Royal Victoria Teaching Hospital . Methods: All patients with clinical diagnosis of perforated duodenal ulcer seen in this hospital between June 2003 and October 2005 were included in this study. Data extracted from their hospital records were analyzed for age; sex; duration of symptoms; previous history of peptic ulcer disease; use of NSAIDS; main presenting features; investigations; resuscitative measures; time of surgery; operative findings; and type of surgery offered; complications and mortality. After resuscitation; laparotomy followed by simple closure or definitive ulcer surgery and helicobacter pylori eradication therapy was given to all the patients. Duration of follow up ranged 8 to 12 months with endoscopy in some patients. Results: There were 41 patients with intraoperative diagnosis of acute perforated duodenal ulcer seen over the study period; comprising 34 males (82.9) and 7 females (17.1); a male female ratio of 4.8:1; age range of 18-77 years and a mean age of 45.49+/-14.46 years. Previous history of peptic ulcer disease was found in 32 (78.6) of the patient and the main presenting features were sudden onset of severe abdominal pain in 95.1of cases and fever in 65.8. Features of frank peritonitis were demonstrable in all the patients and 11(26.8) presented in shock. Plain chest x-rays demonstrated gas under the diaphragm in 21(65.6) of the patients. After adequate resuscitation; all the patients underwent laparotomy where the abdomen was explored; the diagnosis of perforated duodenal ulcer was confirmed and 29(70.7) had simple closure of the perforation with omentum (after Graham). The average time between presentation and surgery was 9 hours (range 6-11hours). The mean size of perforation was 10.5mm (range 5- 15mm). Definitive peptic ulcer surgery was done in 12 (29.3) patients. 8 had truncal vagotomy and pyloroplasty. The major complications included wound infection in 14 (34.1); postoperative fever in 16 (39.0) and prolonged ileus in 15 (36.6) There were 7 deaths; mortality rate of 17.1and the causes of death included severe electrolyte imbalance in 1 and gram negative septicaemia and shock in 6. The average duration of hospital stay was 10 days (range 8 36). Conclusion: Perforated duodenal ulcer is a major complication of chronic peptic ulcer disease. Simple omental patch by open method and helicobacter pylori eradication therapy is sufficient to prevent reperforation

Effects of Cassia occidentalis Aqueous Leaf Extract on Biochemical Markers of Tissue Damage in Rats

Purpose: Among the Hausas of Northern Nigeria; it is claimed by local (traditional) healers that the infusion of C. occidentalis leaves is used as a cure for hepatitis. This study was designed to evaluate the possible negative effects of the aqueous extract of this herb on serum total proteins; albumin; bilirubin; alanine amino transferase (ALT); aspartate amino transferase (AST) and alkaline phosphatase (ALP); as part of a larger study undertaken by these authors to ascertain the hepatoprotective potential of the plant extract. Methods: Fresh leaves of C. occidentalis were extracted with water and screened for phytochemical components. The extract was used for the treatment of 18 albino rats. Serum from these animals was used for the determination of the test parameters. Results: The extract showed hypoproteinaemic effect. ALT; AST and ALP levels were significantly elevated (P 0.05). Conclusion: Hypoproteinaemic effects; and increase in ALT; AST and ALP are indications that the crude extract of C. occidentalis leaves may be slightly toxic as a concoction for liver ailments