Spectrum and outcome of acute abdomen in surgery department of a mission hospital

Background: Acute abdomen usually refers to a sudden onset severe abdominal pain that requires urgent attention. It is a medical emergency in many cases and significant number requires immediate surgical intervention. Objective: To evaluate the epidemiology, aetiological pattern and treatment of acute abdomen managed operatively in a mission hospital. Methodology: This is a three-year retrospective study spanning from January 2014 to December 2016. All the patients that had surgical operation for a preliminary diagnosis of acute abdomen within the study period were recruited into the study. Patient's demographics including: age, sex, diagnosis, intra-operative findings, operative procedures, complications and outcome were recorded. Results: A total of 177 surgeries were done for acute abdomen out of 1,908 surgical operations amounting to 9.28% of the total surgeries done during the study period. Patients' age ranged from 4-85 years with a mean of 33.98±17.57 years; and a male to female ratio of 1.08:1. A total of 83(46.9%) of the patients had appendicitis related diagnosis, 16(9.0%) of the cases resulted from trauma, 25(14.1%) had intestinal obstruction from post-operative bands, 28(15.8%) had intestinal obstruction from colonic tumours and 17(9.6%) had perforated peptic ulcer disease. A total of 12 patients had complications following surgery giving a complication rate of 6.8%. Five patients died giving a mortality rate of 2.8%. Conclusion: Acute appendicitis and its complications still remained the most common acute abdomen. Mortality rate from acute abdomen is low at 2.8%

Analysis of 5 Years of Morbidity and Mortality Conferences in a Metropolitan South African Trauma Service

BACKGROUND:Since 2008 the Pietermaritzburg Metropolitan Trauma Service (PMTS) has run a structured; self-reporting; metropolitan morbidity and mortality conference (MMC). In 2012 a hybrid electronic medical registry (HEMR) was introduced to capture routine data and to generate reports on morbidity and mortality. This paper reviews our experience in setting up a metropolitan MMC and compares the quality of the reported morbidity data from the pre- and post-HEMR era. METHODS:We compared data from the MMC before and after the introduction of the HEMR to audit the impact of these meetings on the reporting and analysis of surgical morbidity and mortality in our service RESULTS:During the 4-year period from 2008 to 2011; a total of 208 MMCs were held. A total of 10 682 patients were admitted by the PMTS during that period; of whom 87% were males; and the mean age was 26 years. Penetrating trauma accounted for 40.9% (4 344/10 628) of the total workload. A total of 432 (4.1%) morbidities were identified. Of these; 36.6% (158) were related to human error; 32% (138/432) were related to surgical pathologies and the remaining 31.9% (136/432) were related to systemic diseases. There was an exponential increase in the reporting of morbidity each year. The total in-hospital mortality was 3% (358/10 682). Following the introduction of the HEMR; from 2012 to 2014; 6 217 patients were admitted. A total of 1 314 (21.1%) adverse events and 315 (5.1%) deaths were recorded by the HEMR. The adverse events were divided into 875 'pathology-related' morbidities and 439 'error-related' morbidities.CONCLUSIONS:The development of the MMC led to increased reporting of morbidity and mortality. The introduction of the HEMR resulted in a dramatic improvement in the capturing of morbidity and mortality data; suggesting that a paper-based self-reporting system tends to underestimate morbidity. Over one-third of all morbidities were related to human error. Common morbidities have been identified

Placenta Praevia at Usmanu Danfodiyo University Teaching Hospital; Sokoto: a 5-year review

Background : Placenta praevia is one of the most acute life-threatening obstetric emergencies. Its prompt management has been advocated to prevent associated morbidity and mortality. This study determines the incidence; risk factors; presentation; and maternal/fetal morbidity and mortality associated with placenta praevia in Usmanu Danfodiyo University Teaching Hospital; Sokoto. Materials and Methods : In this retrospective study; case notes of patients' that had placenta praevia from January 1; 2003 to December 31; 2007 were retrieved. Relevant data were extracted and analyzed using the Epi-info Version 3.5.1 statistical package. Results : The incidence of placenta praevia was 0.84. Grand multiparous women (50.0) were more affected than multiparous women (42.7). Majority (46.9) presented with vaginal bleeding after 28 weeks of gestation. The Major type of placenta paevia (77.1) occurred more than the Minor variety (22.9). The most common risk factor was previous abortion (18.75) while anemia (7.3) was the most common complication. Most (83.3) were delivered by Caesarean section. There was one (1.0) maternal mortality and 12 (12.5) perinatal deaths. Conclusions : Placenta praevia has a low incidence in the study population; is mainly of the Major type with identifiable risk factors and occur mainly in the 21-30 years age group and multiparous women. The major modes of presentations are vaginal bleeding and threatened abortion. Though maternal mortality is low perinatal mortality is high

Hypertension in a Rural Community in Rivers State; Niger Delta Region of Nigeria: Prevalence and Risk Factors

Background: Hypertension, a known independent and major risk factor for cardiovascular disease which was initially considered to be rare in sub Saharan Africa (SSA), is now a serious endemic threat and an important public health issue. Different studies in SSA have reported higher prevalence of hypertension in urban compared to rural areas. However more recent studies from the rural areas show an increasing pattern in hypertension prevalence. This may be attributed to the rapid 'westernization' of lifestyle in the rural Africa. Only few rural surveys have been conducted in the Nigeria oil-rich Niger Delta region necessitating this study with the aim of determining the hypertension prevalence and risk factors.Methods: This was a rural community-based cross-sectional study involving 500 adults. A questionnaire administered by face-to-face interview was used to assess socio-demographic characteristics of the subjects. Medical history such as prior knowledge of blood pressure status and family history of hypertension were all elicited by the questionnaire. Height and weight measurement were done and body mass indices (BMI) calculated as weight in kilogram divided by the square of height in meters.Results: There were 156 males and 344 females with male to female ratio of 1:2.3. The overall mean age was 41.32±17.0. The mean age for males was 42.84±17.8 and that for females was 40.62±16.6. The prevalence of hypertension in this rural community was 20.2 %. The overall mean systolic blood pressure was 1 2 0.4 6 ± 21.59mmHg (M a l e s123.57±20.41mmHg; females 119.05±22.36 mmHg; p= 0.04) and the mean diastolic blood pressure was 73.86±12.63mmHg (Males 75.52±13.03mmHg; females 73.25±12.3 mmHg; p=0.502). The prevalence was found to be higher in males than females though not statistically significant (Males 20.5%; Females 20.1%; X 0.651; p = 0.72). There was a progressive increase of hypertension prevalence with age. (X for trend = 69.434; p < 0.001). Pearson and Spearman' rho correlation analysis revealed that age, marital status, occupation, educational status and BMI correlated with hypertension in the study subjects while logistic regression analysis showed that BMI and age were the only positive predictors of hypertension in this study .Conclusion: Hypertension and its risk factors, which were initially rare in the rural sub Saharan Africa, is now on the increase in addition to high burden of communicable diseases in this region. The increasingly high 'westernization of lifestyle' may be part of the explanation for this. Hence there is need for an organized and deliberate health campaign and regular screening with adequate management in order to both reduce the incidence of hypertension and to prevent hypertension associated morbidity and mortal

Pattern and Clinical Profile of Children with Complex Cardiac Anomaly at University of Nigeria Teaching Hospital; Ituku-Ozalla; Enugu State; Nigeria

Background: Complex congenital cardiac abnormalities are rare among children and contribute to mortality and morbidity. The prevalence and pattern of presentation vary from lace to place.Materials and Methods: The objective of this study was to determine the clinical profile and pattern of presentation of complex congenital cardiac malformations among children attending a tertiary hospital in Enugu State. A cross-sectional retrospective study in which a review of the records of children who attended the children outpatient clinic of University of Nigeria Teaching Hospital (UNTH); Ituku-Ozalla; Enugu State over a 5-year period (January 2007-June 2012) was undertaken. Results: Thirty one thousand seven hundred and ninety-five (31;795) children attended the outpatient clinic of the hospital over the study period; of these; 65 had cardiac diseases; from which 16 were found to have congenital complex cardiac abnormalities of various types; giving a prevalence of 0.05. Complex abnormalities seen in these children are Tricuspid atresia with various associations; cor triatriatum; single ventricle; and large ASD (atrio-septal defect) with complete AVCD; cor triatriatum sinistrum with cardiomyopathy; DORV (double outlet right ventricle) with left sided aorta; hypoplastic tricuspid valve with a PDA (patent ductus artriosus); TOF (tetralogy of fallot); prolapse of aortic valve; and pulmonary regurgitation. One of these complex cardiac anomalies presented with Turner's syndrome and another with VACTERAL association. Conclusions:The results of this study show that 0.05 of children who presented at cardiology clinic of a teaching hospital in Enugu State had congenital complex cardiac abnormalities and that the commonest forms seen were those with cor triatriatum and TOF

Motor Traffic Injuries (MTIs) in Sub-Saharan Africa (SSA)

"Introduction: Motor traffic injuries are recognized as a major public health problem in developing countries. MTIs continue to cause morbidity; mortality and disability in Sub Saharan Africa (SSA). Objectives: To describe the magnitude of MTI's in SSA and to find the magnitude of morbidity and mortality caused by MTI's. Methodology: The World Health Organization (WHO); PUBMED and EMBASE database were used to identify documents and articles on MTIs in SSA and its effects. The literature review was supplemented by document review and interviews with a key informant in one region of Tanzania to determine the magnitude of morbidity and mortality associated with MTIs in Tanzania. Results: The mortality rate due to MTIs in Lower and Middle Income Countries(LMIC's) including SSA is about 20 per 100;000 population while in High Income Countries(HIC's) is about 10.3 per 100;000 population. MTI's also represent the ninth leading cause of Disability Adjusted Life Years (DALY's) lost and it is forecasted by WHO to be the third leading cause of DALY's lost by 2020. Total number of reported accidents in Kilimanjaro region in 2008 was 906 while in 2009 it was 1;125 accounting for an increase of 24. The total mortality reported in 2008 was 147 and 202 in 2009 with an increase of 37. The total morbidity was 622 in 2008 and 933 in 2009 accounting for a 50increase. Discussion: The high mortality rate in SSA of about 20 per 100;000 populations is contributed mainly by human factors with the major being reckless driving and negligence of drivers; pedestrians and passengers. Morbidity and mortality due to MTI's is increasing gradually over time as seen from the Kilimanjaro documents. The burden of MTI morbidity and mortality is predicted to rise by 80in SSA and fall by 30in HIC's by 2020. Conclusion et recommendations: MTI is still a public health problem in LMIC's. Measures to improve human factors in causing MTA are urgently required in order to reverse the trend. I hereby conclude with the motto by the National Road Safety Council of Tanzania which says ""Road safety is NO ACCIDENT"" and that ""Road safety is for sharing""."

Microbiological Evaluation and Antimicrobial Treatment of Complicated Intra-Abdominal Infections

Intra-abdominal infection is a major cause of morbidity and mortality. The principles of management of intra-abdominal infections include adequate surgical procedures; as well as antimicrobial therapy. This review provides insights into the microbiology of complicated intra-abdominal infections and offers an approach to the microbiological evaluation; as well as antimicrobial treatment strategies; in the South African context. Local antibiotic guidelines for the management of intra-abdominal infections are urgently required to optimise clinical outcomes; while limiting the emergence of resistance; toxicity and the selection of pathogenic organisms

Antihypertensive Treatment in the Elderly

Hypertension is a major risk factor for cardiovascular disease; but it is also very prevalent in the community. These two factors combined prompted the World Health Organization (WHO) to report that high blood pressure is the first cause of death worldwide.1 The prevalence of hypertension has been estimated to be approximately one in four; and this increases with age to such an extent that almost two-thirds of people over the age of 60 years have hypertension.2

Risk Factors and Bacterial Profile of Suspected Neonatal Septicaemia at a Teaching Hospital in Kano; Northwestern; Nigeria

Neonatal septicaemia is a common cause of morbidity and mortality in developing countries and a major health concern. The aim of this study is to evaluate the bacterial profile; antibiotics susceptibility pattern and associated risk factors of suspected septicaemia in neonates in this locality. Five hundred and forty seven consecutive blood samples from neonates admitted in the special baby care unit (SCBU); Aminu Kano Teaching Hospital (AKTH); Kano between January 2007 and December 2008 were cultured aerobically and anaerobically in the Microbiology Department; Aminu Kano Teaching Hospital by standard bacteriological methods. Antibiotic susceptibility pattern was done by disc diffusion methods. One hundred and fifty two (27.8) positive blood cultures were obtained from the present study. The most frequently isolated organism was Staphylococcus aureus (25.0) followed by Klebsiella pneumoniae (21.1) and Escherichia coli (15.0). Gentamicin; ofloxacin; ceftriaxone and amoxycillin/clavulanate showed higher percentage antibiotic sensitivity pattern while chloramphenicol; cotrimoxazole and ampicillin showed very low percentage antibiotic sensitivity pattern against the various bacterial isolates. The present study showed that Staphylococcus aureus is the leading isolate in neonatal septicaemia in Kano. Gentamicin and Ceftriaxone are recommended as first line drugs in the management of neonatal septicaemia in our locality

Perceived Susceptibility of Cervical Cancer Screening among Women Attending Mahalapye District Hospital; Botswana

Cervical cancer is a significant cause of morbidity and mortality in Botswana. Papanicolaou (Pap) cervical cytology screening has helped to reduce cervical cancer rates dramatically through early detection of premalignant lesions in countries with screening programmes that have been well implemented. The objectives of this cross-sectional study were to describe the women's perceived susceptibility to cervical cancer and the association between socio-demographic characteristics. A total of 300 participants were selected by convenience sampling techniques. Participants' mean age was 37 years (SD=11). Results indicated that cervical cancer screening rates were 39. Most of those that had ever been screened for cervical cancer (64); had been screened in the previous three years. Most of the participants (75) were aware of their perceived susceptibility to cervical cancer. There was a significant association between perceived susceptibility and screening for cervical cancer (c2=20.86; p 0.001). Among those with low perceived susceptibility to cervical cancer; 31 had screened for cervical cancer as compared to 59 screening rates among those with high perceived susceptibility to cervical cancer. Those with high perceived susceptibility were 3.2 times more likely to screen for cervical cancer (OR

Morbidity and Mortality Patterns of Nigerian Petroleum Oil Refining and Distribution Industry

Aimed at unraveling the nature and extent of health effects and impacts of occupational exposures in the Nigerian petroleum refining and distribution industry; this study probed the morbidity and mortality partterns of this industry using oral interviews; questionnaires responses and secondary data from the industry. Results revealed that workers of this industry suffer from wide range of disease conditions involving virtually all body organs/systems; manifesting with varied symptoms that often brought them to the industry-based plant clinic. Questionnaire responses by the staff showed that Bad eye sight (16.3); sexually transmitted diseases (8.9); hypertension (8.8); musculo-skeletal health effects including chronic and intermittent back/low back pain (8.6); neck and shoulder pain (2.7) and chest pain (2.0)); sleeping/relaxing difficulty (8.0); recurring headache (6.4); reduced hearing/noise-induced hearing loss (NIHL) (6.4); erectile dysfunction (weak erection)(5.3); breathing difficulty (3.9); Road transport accident (3.1); Peptic Ulcer disease (PUD)(3); Diabetes mellitus(2); prostate enlargement (0.5); Tonsil enlargement (0.1); pulmonary disease (0.1) and renal disease (0.1) were some of the symptoms/diseases or complaints by the staff. Documentations at the plant clinic however; revealed that malaria/functional disorders (33.3); respiratory disorders (13.5); Musculo-skeletal/ Rheumatic diseases (14.0); High blood pressure (10.9); gastrointestinal disorders (9.1) and Diabetes mellitus (4.1) were among the leading clinical conditions responsible for higher clinical attendance at the plant clinic. Genito-Urinary disorder (3.3); Eye/Visual Disorder (2.7); ear; nose and throat Problems (1.9); Occupational dermatitis (0.3) and Non-Occupational Skin Disorders (2.3) are among the reckonable entries that made the list of ailments suffered by the staff. Mortality statistics showed that a total of 79 deaths occurred within the period under review. Retroviral disease (21) topped the list of cause of death; followed by road/water transport accidents (16.5) and cardiac related diseases (13.9). Virtually all body organ/system-related pathologies including those of the lungs (5.1); endocrines (presence of diabetes mellitus (3.9); kidneys (3.8); liver (2.5); blood (leukaemia 2.5); and CNS (1.3) contributed to the cause of death. These results indicate that oil and gas work environment predisposes to sundry health effects that might hasten staff death. This calls for a comprehensive review of the contents of the occupational health services as to guarantee total health protection for the workers of this critical sector of the Nigerian economy

A 6-Month Review of Medical Admissions in a Nigerian Teaching Hospital

Purpose: To provide an overview of morbidity and mortality in the medical wards of a teaching hospital and to generate discussions among staff members with a view to improving patient outcomes and data handling. Methods: A retrospective survey of admissions and mortalities in the medical wards of the University of Benin Teaching Hospital was undertaken from 1st January to 30th June 2006; using ward Record and Change books; and copies of death certificates. Morbidity data were assessed for two medical wards and mortalities for all medical admissions within the period under review were evaluated. Results: Health information was managed entirely manually. Data sources were quite often inaccessible or mutilated; and the utility of available data was limited by incomplete and incorrect documentation. No clinical coding of morbidities or mortalities was available. Human immunodeficiency virus (HIV) infection and its complications accounted for significantly more female than male admissions (26.1and 16.2respectively; p=0.005); and for more female than male deaths (34.6and 29.6respectively; p 0.0001). Most deaths occurred between midnight and the start of the working day; with a second peak during prime working hours. Conclusions: Less than optimal health information management was apparent in the health facility studied. Mortality among the patients was highest in HIV-infected patients than other diseases. Capacity building and appropriate infrastructural development is required to improve the management of vitally important health information

Reduced Thyrotropin in Euthyroid Goitrous Patients Suggesting Subclinical Hyperthyroidism

B a c k g r o u n d : Subclinical hypertyhroidism; a biochemical finding of low serum thyrotropin (TSH) with the serum levels of thyroxine (T4 ) and triiodothyronine (T3) within the reference range; could easily be ignored by clinicians; as it; usually; does not manifest with any thyroid specific symptoms. It is of two types : endogenous and exogenous. However; patients with the findings of low TSH; normal T4 and T3 develop some abnormalities in the cardiovascular system; such as atrial fibrillation; increasein left ventricular mass and diastolic dysfunction. It is believed that treatment intervention may reduce or halt the progression of the cardiac abnormalities. The main objective of the study was to determine how frequent subclinical hyperthyroidism was occurs and to serve as a reminder to the existence of the disorder. Methods : It was a hospital-based study carried out at the Jos University Teaching Hospital (JUTH). Consecutive clinically euthyroid goitre patients attending the outpatient department of JUTH; were studied for various parameters including TSH; T4 and T3. The serum concentrations of T4 and T3 were determined by enzyme-linked immunosorbent assay (ELISA) technique. The serum TSH concentration was estimated using a 2nd generation ELISA technique. Results : 98 patients participated in the study. Nine patients had non-specific symptoms not referable to the thyroid and found to have high levels of thyroid hormone concentration with depressed TSH and were excluded from further analysis; while 7 had subclinical hyperthyroidism giving a prevalence rate of 7.9among these clinical euthyroid goitre patients. The subjects with this condition were mainly above 60 years of age and mainly had long-standing goitre. Conclusion: Endogenous subclinical hyperthyroidism was present in 7.9of these clinically euthyroid goitre patients mainly 60 years and above; with long - standing goitre. This high prevalence rate calls for high index of suspicion as this condition is associated with morbidities that can raise mortality

The management of Complex Pancreatic Injuries

Major injuries of the pancreas are uncommon; but may result in considerable morbidity and mortality because of the magnitude of associated vascular and duodenal injuries or underestimation of the extent of the pancreatic injury. Prognosis is influenced by the cause and complexity of the pancreatic injury; the amount of blood lost; duration of shock; speed of resuscitation and quality and nature of surgical intervention. Early mortality usually results from uncontrolled or massive bleeding due to associated vascular and adjacent organ injuries. Late mortality is a consequence of infection or multiple organ failure. Neglect of major pancreatic duct injury may lead to life-threatening complications including pseudocysts; fistulas; pancreatitis; sepsis and secondary haemorrhage. Careful operative assessment to determine the extent of gland damage and the likelihood of duct injury is usually sufficient to allow planning of further management. This strategy provides a simple approach to the management of pancreatic injuries regardless of the cause. Four situations are defined by the extent and site of injury: (i) minor lacerations; stabs or gunshot wounds of the superior or inferior border of the body or tail of the pancreas (i.e. remote from the main pancreatic duct); without visible duct involvement; are best managed by external drainage; (ii) major lacerations or gunshot or stab wounds in the body or tail with visible duct involvement or transection of more than half the width of the pancreas are treated by distal pancreatectomy; (iii) stab wounds; gunshot wounds and contusions of the head of the pancreas without devitalisation of pancreatic tissue are managed by external drainage; provided that any associated duodenal injury is amenable to simple repair; and (iv) non-reconstructable injuries with disruption of the ampullary-biliary-pancreatic union or major devitalising injuries of the pancreatic head and duodenum in stable patients are best treated by pancreatoduodenectomy. Internal drainage or complex defunctioning procedures are not useful in the emergency management of pancreatic injuries; and can be avoided without increasing morbidity. Unstable patients may require initial damage control before later definitive surgery. Successful treatment of complex injuries of the head of the pancreas depends largely on initial correct assessment and appropriate treatment. The management of these severe proximal pancreatic injuries remains one of the most difficult challenges in abdominal trauma surgery; and optimal results are most likely to be obtained by an experienced multidisciplinary team