Medical Mortality in the Accident and Emergency Unit of the University of Port Harcourt Teaching Hospital

Background:The quality of care in the emergency room is an indirect indicator of the standard of healthcare delivery in a given health institution. Mortality in the emergency room may result from various factors including incompetence of the attending junior physicians; delays in presentation and inadequate facilities. The aim of the study is to highlight the causes of mortality; age and sex distribution of the deaths and the duration of admission before death among medical cases in the accident and emergency unit of the University of Port Harcourt Teaching Hospital. Methods: A one year (January to December; 2005) clinical audit of all adult medical admissions in the accident and emergency department of the University of Port Harcourt Teaching Hospital (UPTH). Results: Of the 5304 admitted over the study period; 349 (6.8) patients died. Two hundred and thirty three (66.8) of these deaths were due to medical cases only.These medical deaths were made up of 126 males and 107 females giving a male to female ratio of 1.2:1. The presumed causes of deaths were stroke in 56(24.5); HIV/AIDS in 53 (22.7); sepsis in 20 (8.6); while 14 (6.0) died from meningitis. Ten patients (4.3) died from diabetic ketoacidosis; and hepatic encephalopathy and tetanus were responsible for 10(4.3) and 7 (3.0) deaths respectively. Conclusion: In the period studied; medical mortality was high in the accident and emergency room of UPTH. The major causes of deaths were cerebrovascular accidents and HIV/AIDS

Medical Mortality in the Accident and Emergency Unit of the University of Port Harcourt Teaching Hospital

Background:The quality of care in the emergency room is an indirect indicator of the standard of healthcare delivery in a given health institution. Mortality in the emergency room may result from various factors including incompetence of the attending junior physicians; delays in presentation and inadequate facilities. The aim of the study is to highlight the causes of mortality; age and sex distribution of the deaths and the duration of admission before death among medical cases in the accident and emergency unit of the University of Port Harcourt Teaching Hospital. Methods: A one year (January to December; 2005) clinical audit of all adult medical admissions in the accident and emergency department of the University of Port Harcourt Teaching Hospital (UPTH). Results: Of the 5304 admitted over the study period; 349 (6.8) patients died. Two hundred and thirty three (66.8) of these deaths were due to medical cases only.These medical deaths were made up of 126 males and 107 females giving a male to female ratio of 1.2:1. The presumed causes of deaths were stroke in 56(24.5); HIV/AIDS in 53 (22.7); sepsis in 20 (8.6); while 14 (6.0) died from meningitis. Ten patients (4.3) died from diabetic ketoacidosis; and hepatic encephalopathy and tetanus were responsible for 10(4.3) and 7 (3.0) deaths respectively. Conclusion: In the period studied; medical mortality was high in the accident and emergency room of UPTH. The major causes of deaths were cerebrovascular accidents and HIV/AIDS

Phaeochromocytoma and Reversible Myocardial Ischaemia in a 23-year Old Female

Background : Phaeochromocytoma is a rare neuroendocrine tumour with highly variable clinical presentation including serious and potentially lethal cardiovascular complications. Aim: to present a case of myocardial ischaemia in Phaeochromocytoma which was reversed after surgery. Setting: University of Port Harcourt Teaching Hospital (UPTH). Case report: A young female undergraduate aged 23 years presented with recurrent blackouts; paroxysmal hypertension which was resistant to several anti- hypertensive drugs and marked postural drop was referred from a private clinic to UPTH. Rest electrocardiogram (ECG) showed ischaemic changes and right axis deviation. Ultrasound scan and compu- terised tomographic (CT) scan showed a mass on the anteromedial portion of the left kidney with centrally located cystic areas. The 24-hour urine level of vanillyl mandelic acid (VMA) was normal. The tumour was excised by open surgery and histopathological findings confirmed Phaeochromocytoma. The ECG changes reversed after surgical excision. There was no recurrence or metastasis postoperatively after a long term follow up of 5 years. Her blood pressure remained normal postoperatively without taking antihyperten- sive medication. Conclusion: Phaeochromocytoma is a catecholamine secreting neuroendocrine tumour with a high cardiovascular morbidity and mortality. ECG features of myo-cardial ischaemia can be reversed by surgical intervention

Adult tetanus at the University of Port Harcourt Teaching Hospital: An analysis of 42 cases

Background: Adult tetanus is still common in Nigeria as in other developing countries where immunization programmes are poor. Recently; fee for service was introduced in tertiary medical institutions. Type of Study: Retrospective. Aim: To define the characteristics of cases of tetanus in adults admitted to the University of Port Harcourt Teaching Hospital (UPTH) from 1991 to 1995. Methods: Patients with features of tetanus were identified from ward records and the Medical Records Department. The case note were examined and analysed. The management was carried out in the general medical wards and consisted of anti-tetanus serum (ATS); crystalline penicillin; dextrose infusion; diazepam and metho carbarmol provided for by patients. Results: There were 42 patients: 26 males and 16 females. The ages ranged from 15 to 60 years (mean 29 years). The immunization history was poor. The commonest portal of entry was the lower limb (47.6). The predominant social groups were students and fishermen. There was delay in the treatment of some of the patients as a result of which 25 cases had complications such as tachycardia; pneumonia and hypertension. Nine patients had multiple complications. Twenty-one patients died on admission. Eighteen deaths occurred within the first week of admission. Conclusion: The high mortality may reflect treatment delays and lack of intensive care unit facilities. Adequate campaign for anti-tetanus immunization should be embarked upon especially for the high risk students and fishermen