Profile and outcome of medical emergencies in a tertiary health institution in Port Harcourt, Nigeria

Medical emergencies are a daily occurrence in medical practice. The profile and outcome medical emergencies are a reflection of the prevailing pattern of disease and the responsiveness of the healthcare system. This study seeks to evaluate the pattern and outcome of medical emergencies presenting to the university of Port Harcourt teaching hospital (UPTH); Port Harcourt.METHODS: A retrospective study of medical records of the accident and emergency unit of UPTH was assessed over a twelve month period (June 2008 May 2009).RESULTS: A total of 7246 patients presented to the emergency room; with 1256 (17.3) medical emergencies. Infectious diseases accounted for 274 (21.8) of emergencies while non-communicable diseases in the cardiovascular 195 (15.5); renal 105 (8.4); neurological 224 (17.8); endocrine 163(13.0) and gastrointestinal/ hepatobiliary 163(13.0) systems were the other prevalent emergencies. The crude mortality rate was 127 deaths (10.2). The major contributors to mortality were HIV/AIDS related infectious diseases (22.4); hypertension related heart disease (18.4) and stroke (15.7). Other contributors to mortality were renal failure (8.8); diabetic emergencies (8.8); chronic liver disease (12.8) and haematological malignancies (9.6).CONCLUSION: The spectrum of medical emergencies and the pattern of mortality indicate a mixed disease burden of infective and non-communicable diseases; with cardiovascular and cerebrovascular diseases and HIV/AIDS related infectious as the most significant contributors. There is need for action to improve on the responsiveness of our healthcare systems to cope with this trend of disease pattern in our emergency rooms and reduce mortality from medical emergencies

Recent Change of locality as Risk Factor for Malaria Fever among New Residents of Ahoada East Local Government Area in Southern Nigeria

Relocation which is a well-known determinant of malaria in non-immune travelers to malarious areas; has also been found to be a risk factor for malaria among semi-immune persons who change locality within endemic regions. Further research evidence suggests that the higher transmission intensity at the travel location is an underlying factor which may indicate exposure to new variants of P falciparum for which specific immunity is lacking. This study was conducted to determine if recent change of locality increased the risk of malaria fever among semi-immune National Youth Service Corps members serving in a district in southern Nigeria.Method: Ninety six corps members who had just been posted to Ahoada-East LGA in southern Nigeria and 83 others that had been in service for six months; were followed up for malaria fever in a prospective cohort design over a 3 month period from September 2010 to December 2010. Active surveillance was used to obtain reports of fever among the cohort; followed by medical examination at designated local health facilities.Results: No significant differences in age and use of protection against malaria were found between the study groups. The incidence proportion of malaria for the recently relocated group (34) was significantly higher than that of the resident group (15.7). Recent change of locality was more associated with malaria fever (RR 2.19; 95 CI 1.243.88; AR 54.4).Conclusion: The recent change of locality within an endemic region; which serves as an indicator of exposure to new variants of P falciparum; for which specific immunity is lacking; is a significant risk factor for malaria fever. Protection against malaria is recommended for semi-immune individuals moving to new locations with significant risk of malaria transmission

Evaluation of Peak Expiratory Flow rates (PEFR) of Workers in a Cerment Factory in Port Harcout South-South; Nigeria

Occupational lung diseases (OLD) remain one of the most common workplace health challenges since the industrial revolution. One of the risks for OLD is the exposure to cement dust which is associated with varying degrees of respiratory symptoms and reduction in lung function. This study aimed to measure the peak expiratory flow rates (PEFR) of workers in a cement manufacturing company in Port Harcourt and estimate the determinants of the measured rates.Method: In this descriptive cross-sectional study; 105 workers of a cement company who presented for the annual fitness to work exercise were sampled and had their peak expiratory flow rates measured using a spirometer. Data were also collected using structured interviewer-administered questionnaires and a walk through survey carried out to examine workplace situation. The results were analyzed using descriptive and inferential statistics.Results: The study showed that 13.3 of the workers had abnormal (i.e low) PEFR. The lowest mean PEFR of 327.5L/min was found among workers who had worked for 21 23 years and worked mainly at the production and bagging area. Most of the workers (81.9) made effective use of some form of personal protective equipment (PPE).Conclusion: Reduction in the PEFR implied that prolonged exposure to cement dust may result in decreased lung function and by extension pulmonary disease. The high percentage of normal PEFR found among the workers; irrespective of their duration of work; could be attributed to the effective use of the PPE

Occupational and environmental lead exposure in Port Harcourt, Nigeria: analysis of its association with renal function indices

Background: In spite of the high risk of lead exposure in Nigeria, there is a paucity of data on the occupational and environmental burden of lead exposure and its impact on human health especially its nephrotoxic effects. This study aims to assess the degree of occupational and environmental lead exposure in Port Harcourt Nigeria and the relationship between lead exposure and indices of renal function. Methods: A cross sectional comparative study of 190 adult subjects with occupational lead exposure and 80 matched controls. Blood lead was used as the biomarker of lead exposure. Serum urea, creatinine, uric acid, urine albumin and glomerular filtration rate were the renal function indices measured. Results: Occupationally lead exposed subjects had higher mean blood lead 50.37±24.58 ug/dl, than controls 41.40±26.85 ug/dl (p= 0.008). The mean values of serum urea, creatinine and uric acid were significantly higher in study subjects compared to controls 3.06±0.81 mmol/L vs. 2.7±0.84 mmol/L (p = 0.002), 87.2±14.30 umol/L vs. 80.68±14.70 umol/L (p = 0.001) and 271.93±71.18 umol/L vs. 231.1±62.70 umol/L (p = 0.000) respectively. Creatinine clearance was significantly lower in subjects compared to controls 98.86±21.26 ml/min/1.72m2 vs.108.18±25.16 ml/mi /1.72m2 (p = 0.002). Blood lead correlated positively only with blood urea [r = .031, r2 = .017, p = .031] and negatively [r = -.144, r2 = .021, p = .018] with serum phosphate. Conclusion: The level of environmental and occupational lead exposure in Port Harcourt, Nigeria is high, with occupational lead exposure increasing the risk of lead toxicity and renal function impairment

Acute pulmonary embolism: A review

Background: Pulmonary embolism (PE) is a common clinical disorder which is associated with high morbidity and mortality if untreated. Due to the high morbidity and mortality associated with undiagnosed and poorly treated PE; there is a need for protocols based on risk factor assessment to facilitate early diagnosis of PE and protocols to ensure early and adequate treatment. The aim of this review is to highlight the risk factors associated with PE and discuss the modalities for optimal management of PE. Method: Literature was reviewed using available medical journals; Science direct; Medline and Embase databases. Key words employed were: pulmonary embolism; deep venous thrombosis (DVT); venous thromboembolism (VTE) and thrombophilia. Information was also sourced from the British Thoracic Society and The National Heart; Lung and Blood Institute websites. Results: Studies have shown that hypercoagulability state; stasis and local trauma to the vessel wall predisposes to PE. These studies further underscored that heparin is the cornerstone of therapy hence optimal diagnostic approach should be observed to avoid unnecessary anticoagulant therapy considering the fact that it carries a risk for bleeding. Conclusion: This review was able to highlight the risk factors and management of pulmonary embolism. Patients with one or more predisposing factors and having high index of suspicion based on clinical assessment should be managed according to an agreed hospital protocol

Acute Pulmonary Embolism: A Review

Background: Pulmonary embolism (PE) is a common clinical disorder which is associated with high morbidity and mortality if untreated. Due to the high morbidity and mortality associated with undiagnosed and poorly treated PE; there is a need for protocols based on risk factor assessment to facilitate early diagnosis of PE and protocols to ensure early and adequate treatment. The aim of this review is to highlight the risk factors associated with PE and discuss the modalities for optimal management of PE. Method: Literature was reviewed using available medical journals; Science direct; Medline and Embase databases. Key words employed were: pulmonary embolism; deep venous thrombosis (DVT); venous thromboembolism (VTE) and thrombophilia. Information was also sourced from the British Thoracic Society and The National Heart; Lung and Blood Institute websites. Results: Studies have shown that hypercoagulability state; stasis and local trauma to the vessel wall predisposes to PE. These studies further underscored that heparin is the cornerstone of therapy hence optimal diagnostic approach should be observed to avoid unnecessary anticoagulant therapy considering the fact that it carries a risk for bleeding. Conclusion: This review was able to highlight the risk factors and management of pulmonary embolism. Patients with one or more predisposing factors and having high index of suspicion based on clinical assessment should be managed according to an agreed hospital protocol

Acute Pulmonary Embolism: A Review

Background: Pulmonary embolism (PE) is a common clinical disorder which is associated with high morbidity and mortality if untreated. Due to the high morbidity and mortality associated with undiagnosed and poorly treated PE; there is a need for protocols based on risk factor assessment to facilitate early diagnosis of PE and protocols to ensure early and adequate treatment. The aim of this review is to highlight the risk factors associated with PE and discuss the modalities for optimal management of PE. Method: Literature was reviewed using available medical journals; Science direct; Medline and Embase databases. Key words employed were: pulmonary embolism; deep venous thrombosis (DVT); venous thromboembolism (VTE) and thrombophilia. Information was also sourced from the British Thoracic Society and The National Heart; Lung and Blood Institute websites. Results: Studies have shown that hypercoagulability state; stasis and local trauma to the vessel wall predisposes to PE. These studies further underscored that heparin is the cornerstone of therapy hence optimal diagnostic approach should be observed to avoid unnecessary anticoagulant therapy considering the fact that it carries a risk for bleeding. Conclusion: This review was able to highlight the risk factors and management of pulmonary embolism. Patients with one or more predisposing factors and having high index of suspicion based on clinical assessment should be managed according to an agreed hospital protocol

Echocardiography in the University of Port Harcourt Teaching Hospital: April 2000 to March 2003

Background: Echocardiography is a cheap and non-invasive technique for the investigation of cardiac diseases with reliable levels of accuracy. Echocardiography services commenced in the Cardiac unit of the University of Port Harcourt Teaching Hospital (UPTH) in April 2000. There is a need to establish an accurate pattern of cardiac diseases seen in the centre based on echocardiography assessment. The aim of the study was to review the pattern of cardiac diseases diagnosed by echocardiography in the cardiology unit of the University of Port Harcourt Teaching hospital. Method: A prospective descriptive study of patients referred to the cardiology unit of UPTH for echocardiography for a variety of cardiac complain was done. Subjects had two dimensional and M-mode echocardiography assessment using a Siemens Sonoline SL 1 machine with a 3.5 MHz sector probe. Results: One hundred and forty one subjects aged between 16-84 years with a mean age of 44.2 ± 11.5 years had echocardiography assessment over the three year period. Eighty two (58.2%) of the subjects were males while 59(41.8%) were females. Fourty eight (34.0%) of subjects had hypertensive heart disease, 28(19.9%) had Cardiomyopathies, 13(9.2%) had rheumatic heart disease. Pericardial disease, congenital heart disease and cor pulmonale was found in 6(4.3%), 2(1.4%) and 1(0.7%) respectively. Fourty three (30.5%) of subjects had normal findings on echocardiography. Conclusion: Hypertensive heart disease was found to be the most prevalent cardiac condition followed by the cardiomyopathies and rheumatic heart disease in that order. This trend is very similar to what obtains in sub Saharan Africa as documented by similar studies

Lipid profile of healthy adult nigerians in Port Hacourt, Nigeria

Background: Hyperlipidaemia is a major cardiovascular risk factor for coronary artery disease, atherosclerosis, hypertension and stroke. It is thought that serum cholesterol levels are low in Nigerians as shown by results of a population survey done over twenty years ago. In addition the last national non communicable disease survey recorded a low prevalence of Hyperlipidaemia (4.0%) in Nigeria. With increasing urbanisation and socioeconomic improvement, changing population dynamics is expected to influence disease pattern and noncomminucable diseases are expected to rise. Thus there is a need to screen healthy adults for their lipid pattern in Port Harcourt a city with high population dynamics where such studies have not been previously reported. Method: A prospective descriptive population survey was carried out among healthy adults residing in Port Harcourt. A total of ninety two adults were screened after obtaining informed consent. Weight, height, blood pressure, fasting blood sugar and fasting lipid profile were measured. Results were analysed using simple statistical methods. Results: A total of ninety two subjects were recruited into the study. Fourty seven (51.1%) of the subjects were males while fourty five (48.9%) were females. The age range of subjects was 24-59 years with mean of 38.84 ± 8.36 years. The mean BMI was 28.76 ± 5.91 Kg/m2. There was no significant statistical difference between the mean BMI for males and females. The mean fasting blood sugar, mean total cholesterol and mean LDL cholesterol were 4.45 ± 0.89 mmol/L, 4.76 ± 1.06 mmol/L and 3.65 ± 0.89 mmol/L. The mean total triglyceride was 1.02 ± 0.30 mmol/L while the mean HDL was 0.90 ± 0.25 mmol/L. There was an increase in total cholesterol with increasing age and an increase in total cholesterol and LDL cholesterol with increasing social class. Subjects with total cholesterol above 6.5mmol/L constituted 31.52 % of study subjects. Subjects with BMI between 25-29 Kg/m2 made up 43.48% of subjects while 33.69% of subjects had BMI above 30Kg/m2. Conclusion: A high mean total and LDL cholesterol values were observed among healthy adults in Port Harcourt. The prevalence of obesity was also found to be high. There is a need for public health action to address these findings especially as high serum cholesterol levels have a direct correlation with coronary artery disease. Further large scale urban survey of non communicable diseases in the country is therefore necessary at this time