Etiology and Clinical Evaluation of Patients with Bronchiectasis in a Tertiary Hospital in Nigeria.

BACKGROUND: Bronchiectasis is often considered an orphan disease in developed societies. This may not be the case with low-income countries. Currently there is a paucity of data on the pattern and presentation of this condition in Nigeria. OBJECTIVE: This study was undertaken to determine the frequency and pattern of presentation of bronchiectasis in a tertiary healthcare facility in Uyo, South-South, Nigeria. METHODS: We carried out a three-year prospective study of adult patients aged between 15-85 years diagnosed with bronchiectasis in the University of Uyo Teaching Hospital in Uyo, Nigeria between 2016 and 2019. RESULTS: Eighty-two patients were identified from the clinic register. Out of these, 76 were recruited into the study; made up of 44(57.9%) males and 32 (42.1%) females. The average age of the patients was 49.7 ± 14.1 years. Sixteen (21.1%) of the patients were HIV positive. Forty-four (57.9%) patients had previously been treated for pulmonary tuberculosis. Majority of the patients; 72 (94.7%) had chronic productive cough. Sixty-four (84.2%) had at least one episode of exacerbation within the last 12 months while 36(47.4%) had a severe exacerbation requiring hospitalisation. Hospitalisation was associated with several factors with the strongest contributor being the presence of respiratory distress on physical examination (OR 15.4 p= 0.002). CONCLUSION: Bronchiectasis is not an uncommon disease amongst our patients. A previous history of pulmonary tuberculosis is the commonest associated predisposing medical condition. There is a high rate of exacerbation among these patients with respiratory distress as the strongest predictor of hospitalisation.

CONTEXTE: La bronchectasie est souvent considérée comme une maladie orpheline dans les sociétés développées.Ce n'est peut-être pas le cas dans pays à faible revenu. Actuellement, il y a une pénurie de données sur les caractéristiques et la présentation de cette maladie au Nigeria. OBJECTIF: Cette étude a été entreprise pour déterminer la fréquence et le mode de présentation de la bronchectasie dans un établissement de soins tertiaires à Uyo, dans le sud-sud du Nigeria. MÉTHODES: Nous avons mené une étude prospective sur trois ans auprès de patients adultes âgés de 15 à 85 ans chez qui on a diagnostiqué une bronchectasie dans l'hôpital universitaire d'Uyo, à Uyo, entre 2016 et 2019. Uyo, au Nigeria, entre 2016 et 2019. RÉSULTATS: Quatre-vingt-deux patients ont été identifiés à partir du registre de la clinique registre. Parmi ceux-ci, 76 ont été recrutés dans l'étude ; composés de 44 (57,9 %) hommes et 32 (42,1 %) femmes. L'âge moyen des patients était de 49,7 ± 14,1 ans. Seize (21,1 %) des patients étaient séropositifs. Quarante-quatre (57,9 %) patients avaient déjà été traités pour une tuberculose pulmonaire.La majorité des patients ; 72 (94,7%) avaient une toux productive chronique. Soixante-quatre (84,2 %) ont eu au moins un épisode d'exacerbation au cours des 12 derniers mois, tandis que 36 (47,4 %) ont eu une exacerbation sévère nécessitant une hospitalisation. L'hospitalisation était associée à plusieurs facteurs, le facteur le plus important étant la présence d'une présence d'une détresse respiratoire à l'examen physique (OR 15.4 p= 0.002). CONCLUSION: La bronchectasie n'est pas une maladie rare parmi nos patients. Un antécédent de tuberculose pulmonaire est l'état médical prédisposant le plus fréquent.ll existe un taux élevé d'exacerbation chez ces patients, la détresse respiratoire étant le facteur prédictif le plus fort d'hospitalisation. MOTS CLÉS: Étiologie, Caractéristiques cliniques, Bronchiectasie, Exacerbation, Hospitalisation.

Review of cardiovascular involvements in COVID-19

Background: A spectrum of cardiovascular pathologies occurs in patients with COVID-19 and increases the risk of mortality. Risk of mortality is also heightened in cardiovascular disease patients who contact COVID-19. Methodology: Online search for the keywords in PubMed, Medline, Embase, Google scholar was done. Relevant research articles yielded from the searches were reviewed. Results: the searches yielded a total of 172 results, out of which 111 were reviewed. Cardiac involvement was found in 70.6% COVID-19 patients: tachycardia (19%), electrocardiography abnormalities (22%), echocardiography abnormalities (57%), elevated myocardial enzymes (53%), and acute cardiac injury (9%). Eight percent of patients with acute cardiac injury were aged >60 years; 87.5% of them had ≥2 underlying comorbidities (hypertension, diabetes mellitus, cardiovascular diseases, chronic obstructive pulmonary disease, and chronic kidney disease). Novel coronavirus pneumonia was much more severe in the patients with acute cardiac injury than in patients with non-definite acute cardiac injury (P<0.001). Multivariate analyses showed that C-reactive protein (CRP) levels, old age, novel coronavirus pneumonia severity, and underlying comorbidities were the risk factors for cardiac abnormalities in patients with COVID-19. Conclusion: Besides its prominent expression at the level of the respiratory apparatus, COVID-19 is also characterized by a substantial degree of cardiovascular involvement, both in terms of deterioration of pre-existing conditions, and as the effect of inflammation-facilitated acute events. They include ischemic and inflammatory heart disease, ventricular arrhythmias, conduction disturbances, thrombotic events at the level of the lungs, systemic activation of the coagulation cascade and disseminated intravascular coagulation.

Pattern of chest injuries and treatment outcome in a nigerian teaching hospital

Chest injuries are a common type of injuries associated with significant morbidity and mortality. Its occurrence in all parts of the world with high impact on the productive age groups makes it important research area. To evaluate the pattern of chest injury with outcome of treatment in our centre. Retrospective review of patients' data and clinical information from January 2014 to December 2016 in the Surgical Out Patient Department of University of Uyo Teaching Hospital, Uyo, Nigeria. Over the three year period, 442 patients with diagnoses of chest injuries were included with age range 2years to 78years (mean=38.7years) and male: female ratio of 3.5:1. Students, civil servants and motorcyclists/tricyclists operators and drivers were commonly affected (27.6%, 25.1%, 26.9% and 9.3%). Blunt chest injury was commoner than penetrating chest injury (69.7% vs 30.1%); while motor vehicular accident accounted for the majority of chest injury (55.% %) followed by assault (23.1%). Rib fracture was the commonest type of injury (85.5%) followed by haemothorax 29.3%, haemopeumothorax 25.6% and pneumothorax 9.5%. Associated injuries included fracture of upper and lower limb (3.4%), abdominal injury (3.4%) and head injury (2.8%). Majority (89.1%) of the patients were managed either conservatively or with tube thoracostomy with good outcome (96.4%) and mortality rate of 1.1%. Many clinical entities of chest injuries were treated with a low mortality figure of 1.1%

Knowledge and practice of prophylaxis of deep venous thrombosis: A survey among Nigerian surgeons.

BACKGROUND: Venous thromboembolism is a potentially dangerous condition that can lead to preventable morbidity and mortality among surgical patients. OBJECTIVES: We aimed to determine the knowledge and practice of surgeons practising in Tertiary Hospitals in Nigeria about prophylaxis of deep vein thrombosis (DVT). MATERIALS AND METHODS: Eight Tertiary Institutions were selected from institutions in the geopolitical regions of the country by simple random sampling using balloting method. A semi-structured questionnaire was administered, and the response was obtained from 105 out of 254 surgeons. RESULTS: The mean knowledge score was 5.81 ± 1.67, and only 33.3% have good knowledge about DVT prophylaxis. No statistical difference was observed between the different groups of surgeons. The mean practice score was 5.19 ± 1.8 and only 20% of surgeons have a good practice of DVT prophylaxis. The majority (90.5%) have encountered DVT whereas 83.5% have encountered pulmonary embolism in their practice. Most commonly encountered risk factors include prolonged immobility, advanced age, and pelvic surgery. Only 13.3% have used Well's score in the clinical evaluation of their patients. The prophylactic modality adopted varies, but most surgeons (77%) utilized both the pharmacological and mechanical methods. Low molecular weight heparin is the commonly used chemoprophylactic agent while a combination of early ambulation and limb physiotherapy is the most commonly preferred mechanical method of thromboprophylaxis. CONCLUSION: There is a deficiency in the knowledge and practice of DVT prophylaxis among surgeons in Nigeria. There is a need to improve both the knowledge and practice by introducing institutional guidelines or protocol for DVT prophylaxis for surgical patients.

Pattern of cardiothoracic surgical diseases in a new cardiothoracic surgery unit in Nigeria.

BACKGROUND: Cardiothoracic surgical pathologies are available in all geographical regions of the world. Human and material resources are necessary for prompt diagnosis and proper treatment of these cases. METHODOLOGY: Retrospective analysis of cardiothoracic surgical cases in the first five years of our new cardiothoracic surgery unit was done. RESULTS: A total of 714 cases were seen during the study period with age range one month to 76 years with mean age of 37.12 +/- 11.24 and male female ratio of 2:1. The yearly admissions from 2007 to 2011 were 14%, 17%, 21%, 21% and 26% respectively. Cardiovascular diseases occurred in 22.30%, with 6% of children suffering from congenital heart defect and 6% of men suffering from acquired vascular disease. Surgical complications of pleuropulmonary tuberculosis occurred in 21.4% while thoracic trauma occurred in upto 21% of the patients. Aerodigestive tract foreign bodies were encountered in 10.1% of cases and Pyogenic diseases occurred in 8.68%. Oesophageal lesions were diagnosed in 6.4% of the patients, pulmonary tumours including primary and secondary tumours were found in 4.3% while nontraumatic chest wall pathologies which included chest wall tumours, congenital deformities and chronic osteomyelities accounted for 3.2%. Mediastinal pathologies occurred in 0.98% and in the remaining 1.5% rare diseases were diagnosed such as third degree heart block, pulmonary embolism and thoracic endometriosis syndrome. CONCLUSION: This study shows that cardiothoracic surgical pathologies are common in our centre with predominance of thoracic pathologies, and therefore need to prioritize and ensure manpower development for treatment of all kinds of thoracic pathologies.

Malignant transformation in von recklinghausen disease in a rural farmer presenting as huge metastatic soft tissue chest wall tumour: a case report.

INTRODUCTION: Although von Recklinghausen disease is relatively common at an incidence of 1 in 4000 live births, malignant transformation in a neurofibromatosis is quite rare estimated at about 5% therefore the importance of life-long follow up of all patients von Recklinghausen disease. CASE PRESENTATION: This is a case report of a 45-year old Nigerian-Ibibio male farmer who presented with six months history of rapid growth in one of the numerous skin nodules which had been present since his teenage age. The clinical diagnosis of malignant change in von Recklinghausen's disease was confirmed by histopathologic examination of an incisional biopsy specimen. Radiological investigations also showed the metastatic status of the disease. The patient could not afford the cytotoxic chemotherapeutic agents prescribed. He therefore left the hospital and failed to return when a free-treatment voucher was ready for treatment in the following two days. He is assumed dead at home. CONCLUSION: Lifelong follow up for von Recklinghausen disease is emphasized to enable early detection of malignant change and also expansion of the national health insurance scheme to benefit the unemployed citizens.

Morbidity and mortality of caustic ingestion in rural children: experience in a new cardiothoracic surgery unit in Nigeria.

Background. Inspite of the fact that accidental caustic ingestion is an entirely easily preventable problem, it has however persisted in rural Nigerian communities because the commonly implicated agent which is caustic soda (sodium hydroxide, NaOH) is sold in open markets without restrictive legislations. This study aims to identify the perpetuating factors of paediatric caustic ingestion and recommend preventive measures. Method. Retrospective analysis of clinical records of our paediatric patients who presented following caustic ingestion between November 2006 and November 2010 was made for demography, socioeconomic status of parent(s), caustic substance ingested with amount (where known), circumstance of ingestion, means of oesophageal evaluation, treatment and outcome. Results. There were 16 paediatric cases of caustic ingestion during the study period with age ranging from 1 to 18 years with mode in the 1-3 years group and male : female ratio 4.3 : 1. In 100% of the cases, the caustic ingestion was accidental, while caustic soda was the agent in 93.7%, and 87.5% of the parents were into local soap and detergent production. In all patients, the oesophagus was evaluated with late barium swallow/meal and oesophagoscopy before treatment. Conclusion. Caustic ingestion among rural children in Nigeria can be prevented.

Use of the General Health Questionnaire as a screening tool for geriatric patients in Calabar, Nigeria.

BACKGROUND: Old age is inevitably associated with general biological and physical decline.Mental health issues are among the most prevalent health problems of the elderly and constitute an important source of distress for patients and caregivers. Primary care providers frequently fail to diagnose these problems, and, even when they do, management may not be optimal. This study aimed to determine the proportion of geriatric mental health morbidity detected by Family Physicians and compare this with General Health Questionnaire detection in the recognition ofmorbidity in this cohort. METHOD: This was a cross-sectional descriptive survey involving 107 elderly respondents, conveniently recruited for the study from the Family Medicine Geriatric Clinic of the University of Calabar Teaching Hospital, Calabar. Respondents were grouped into 'cases' and 'non-cases' using a cut-offscore of'3' with the General Health Questionnaire as the main comparative detection instrument. Family Physicians' abilities to identify mental health morbidity were then compared with the General Health Questionnaire ratings. Socio-demographic correlates and identification rates were determined by statistical tests of associations. RESULTS: The General Health Questionnaire identified 48.6% 'cases' while the Family Physicians identified 9.4% among the attendees. Statistically significant differences in socio-demographic characteristics of respondents were found for marital status (chi2 = 21.84; p< 0.009), level of education (chi2 = 42.58; p<0.005) and sex chi2 = (6.98; p<0.008). CONCLUSION: This study concludes that using the General Health Questionnaire and paying attention to geriatrics' socio-demographic parameters can improve the detection of mental health morbidities in the elderlyby Family Physicians.

Recognition of mental health problems by primary care physicians in a tertiary care hospital in Nigeria.

AIMS AND OBJECTIVES: This study sought to determine the difference in detection of attendees with mental health problems visiting the General Out-patient clinic of a tertiary institution; the General Health Questionnaires (GHQ-12) were compared with those identified by the physicians. PATIENTS AND METHODS: Three hundred and twenty two (322) subjects aged 18 years and above, attending the clinic for the first time, were recruited for the study by a systematic random sampling method. Using a cut off score of '3' on the 12-item General Health Questionnaire (GHQ-12), 'Cases' and 'Non-cases' generated were compared with those identified by the doctors. Identification rates for both groups were calculated and the coefficients determined using a two-by-two contingency table. RESULTS: The GHQ-12 identified 46.6% 'cases' while the General Out-patient Clinic (GOPC) doctors identified 6.8% with a diagnostic sensitivity of 8% and a specificity of 94% CONCLUSION: Despite the high proportion of mental health problems in the GOPC of the hospital, the detection rate by the clinic doctors was low. There is a need for the use of an easy tool like the GHQ-12 for screening and identification of attendees with mental health problems especially in a busy clinic setting.

Tricuspid atresia with normal axis on ECG palliated with a central shunt; a case report.

BACKGROUND: Tricuspid Atresia is the 3rd commonest cyanotic congenital Heart disease. It is characterized by lack of communication between the right atrium and right ventricle. The treatment often requires a palliative systemic to pulmonary shunt before definite surgery. The use of a central shunt via a median sternotomy is suggested here as an alternative to other traditional shunts via a thoracotomy. METHOD: The management of a 3-month-old boy who presented with dyspnoea, fever, cough and cyanosis is presented here as obtained from Clinical records. RESULT: Following resuscitation, a central shunt (Ascending Aorta to main Pulmonary Artery) was constructed and the patient did well despite a turbulent post-operative period. CONCLUSION: The management of tricuspid atresia likes other cyanotic heart disease is daunting but palliative treatment is possible in our environment and definitive treatment where possible affords a fairly satisfactory prognosis.

Cardiac pacemaker treatment of heart block in Enugu a 5-year review.

BACKGROUND: Symptomatic heart block is a treatable cardiac cause of death which occurs globally. In Nigeria it is increasingly diagnosed and treated with permanent artificial cardiac pacemaker insertion and pulse generator implantation, sometimes after a period of misdiagnosis and inappropriate treatment. METHODS: Twenty-three patients who were diagnosed with symptomatic heart block and surgically treated with permanent artificial cardiac pacemaker in National Cardiothoracic Centre, Enugu, between April 2001 and March 2006 had their case notes retrospectively reviewed and information entered into a proforma. This was analyzed. Patients diagnosed with symptomatic heart block but not treated with artificial cardiac pacemaker insertion were excluded from the study. There were eight such patients who could not afford the cost of surgical treatment during the period under review. RESULTS: The mean age of the patients was 70 years and the commonest presentation was shortness of breath (100%). Hypertensive heart disease was present in 65% of the patients and a history of chronic chloroquine usage was positive in 73% of the patients. Predominant pretreatment pulse rate was in the range of 30-40 per minute (43%) while 21% of the patients had pulse rate below 30 per minute. These categories of patients commonly had Stoke-Adams syndrome. Sixty-seven per cent of the patients had predominantly systolic hypertension on admission and 16% had hypotension. Third degree heart block was present in 65% of the patients and 89% of all patients needed pre-pacing haemodynamic stabilization with positive inotropic/chronotropic drug(s). Treatment consisted of permanent endocardial pacing in 65% and epicardial pacing in 35% of the patients with equally good response in symptoms, haemodynamic parameters and electrocardiographic features. CONCLUSION: Permanent artificial cardiac pacing is, the reliable treatment of symptomatic heart block and should be included in the National Health Insurance Scheme list.

Cardiac Pacemaker Treatment of in Enugu a 5-Year. Review

Background: Symptomatic heart block is a treatable cardiac cause of death which occurs globally. In Nigeria it is increasingly diagnosed and treated with permanent artificial cardiac pacemaker insertion and pulse generator implantation; sometimes after a period of misdiagnosis and inappropriate treatment. Methods: Twenty-three patients who were diagnosed with symptomatic heart block and surgically treated with permanent artificial cardiac pacemaker in National Cardiothoracic Centre; Enugu; between April 2001 and March 2006 had their case notes retrospectively reviewed and information entered into a proforma. This was analyzed. Patients diagnosed with symptomatic heart block but not treated with artificial cardiac pacemaker insertion were excluded from the study. There were eight such patients who could not afford the cost of surgical treatment during the period under review. Results: The mean age of the patients was 70 years and the commonest presentation was shortness of breath (100). Hypertensive heart disease was present in 65of the patients and a history of chronic chloroquine usage was positive in 73of the patients. Predominant pre-treatment pulse rate was in the range of 30-40 per minute (43) while 21of the patients had pulse rate below 30 per minute. These categories of patients commonly had Stoke-Adams syndrome. Sixty-seven per cent of the patients had predominantly systolic hypertension on admission and 16had hypotension. Third degree heart block was present in 65of the patients and 89of all patients needed pre-pacing haemodynamic stabilization with positive inotropic / chronotropic drug(s). Treatment consisted of permanent endocardial pacing in 65and epicardial pacing in 35of the patients with equally good response in symptoms; haemodynamic parameters and electrocardiographic features. Conclusion: Permanent artificial cardiac pacing is the reliable treatment of symptomatic heart block and should be included in the National Health Insurance Scheme list