Integrative phytochemical, ligand structure based drug design nephroprotective potential of Annona muricata flower-petals.

This study was aimed at investigating the ability of extract of Annona muricata (AM) flower-petals in ameliorating the toxic effects of acetaminophen on the kidneys of albino rats. The biochemical results showed a marked increase in AM 200 mg (32.84 ± 0.14) and AM 400 mg (32.64 ± 0.78). Increase levels of total protein in AM 200 mg (77.00 ± 5.65) displays nephroprotective potential of the flower extract. Reduction of renal activities of serum urea in AM 400 mg group (6.41 ± 0.22) indicates its protective potency against acetaminophen induced kidney damage. Increased activities of SOD levels at 200 mg (4.97 ± 0.05) and CAT levels at 200 mg (23.39 ± 1.13). This study showed that A. muricata has good prospects of being a nephroprotective drug candidate.

Surgical Treatment of Valvular Heart Disease in Nigeria: A 6-Year Experience.

Surgical treatment of valvular heart disease in Nigeria, the most populous country in sub-Saharan Africa, is adversely affected by socioeconomic factors such as poverty and ignorance. To evaluate our experience in this context, we identified all patients who underwent surgery for acquired or congenital valvular heart disease at our Nigerian center from February 2013 through January 2019. We collected data from their medical records, including patient age and sex, pathophysiologic causes and types of valvular disease, surgical treatment, and outcomes. Ninety-three patients (43 males [46.2%]; mean age, 38.9 ± 10.0 yr [range, 11-80 yr]) underwent surgical treatment of a total of 122 diseased valves, including 72 (59.0%) mitral, 26 (21.3%) aortic, 21 (17.2%) tricuspid, and 3 (2.5%) pulmonary. The most prevalent pathophysiologic cause of disease was rheumatic (87 valves [71.3%]), followed by functional (20 [16.4%]), congenital (8 [6.6%]), degenerative (5 [4.1%]), and endocarditic (2 [1.6%]). All 3 diseased pulmonary valves had annular defects associated with congenital disease. Surgical treatment included mechanical prosthetic replacement of 92 valves (75.4%), surgical repair of 29 (23.8%), and bioprosthetic replacement of 1 (0.8%). We conclude that, in Nigeria, valvular disease is mainly rheumatic, affects mostly younger to middle-aged individuals, and is usually treated with prosthetic replacement.

Post-operative fever (POF) after cardiac surgery in a low- and middle-income-country: 7-year institutional experience.

BACKGROUND: Post-operative fever (POF) after cardiac surgery in a developing country is of great concern because of the associated morbidity and mortality. In our country, we experience this complication more because of a high rate of malaria infestations, gastroenteritis, and malnutrition. We also experience a low yield of positive diagnostic tests when POF develops; this is partly due to expense and the prioritisation of other essential items in our poorly equipped cardiac ICU. AIMS/OBJECTIVE: To assess the causes of POF after cardiac surgery and determine its impact on the outcome on patients. MATERIALS AND METHODS: International Cardiac Surgery Mission teams visited our centre for 7 years (2013-2019). During this period, a significant number of cardiac surgeries were performed. A retrospective study of patients with POF was performed with data from our hospital's database, and included standard demographics; types of surgery performed, and management protocols being used in the peri-operative care. RESULTS: A total of 242 patients were treated during the study period and underwent 266 surgeries. Of these, 151 (56.8%) and 115 (43.2%) were adult and paediatric cases respectively. Ages ranged between 0 and 90 years; 34 (14.1%) had POF. When we evaluated the clinical and associated laboratory findings, pyrexia (temp >38.0 °C) and elevated white blood cell count with differential neutrophilia were present in 10 patients (29.4%). The time of onset and duration of POF were between <24 and >144 hours. In the invasive procedure related to POF, sternotomy infections were present in seven patients (18.4%). Malaria infestations and breach in sterility protocol were predominant. CONCLUSION: The management of POF in the cardiac ICU was complicated by the requirement of co-operation from a larger number of specialties than is usually required in advanced centres with special expertise in malaria confirmation. We, therefore, introduced structured clinical, laboratory, and appropriate interventions to treat POF more aggressively. We found that more careful attention to peri-operative details to ensure strict observation of sterility protocol with anti-malaria prophylaxis led to improvements in our centre's outcomes.

Establishing a sustainable open heart surgery programme in Nigeria, a low-income country: which is the best model?

BACKGROUND: In any country, the development of open heart surgery programme parallels stable political climate, economic growth, good leadership, and prudent fiscal management. This is lacking in a country like Nigeria without a functional cardiac hospital. OBJECTIVE: To review and compare the various models being adopted towards establishing a sustainable open heart surgery programme in Nigeria. MATERIALS AND METHODS: For ethnic and cultural reasons, Nigeria is divided into six geopolitical regions. Each region has one or more Federal Teaching Hospitals including medical centres. The hospitals have trained cardiothoracic surgeons and cardiologists as well as other auxiliary staff. After attainment of democratic rule in 1999, individual hospitals have devised various models to establish sustainable open heart surgery programme. The number of hospitals in each region, the models devised, and the limitations including the outcome were studied and analysed. RESULTS: Each geopolitical zone has about three to four centres, either public or private, trying to establish the programme. There are six different models. Each centre has been trying the different models since the year 2000. The oldest of the model is cardiac mission and the newest is employment of highly skilled retired expatriate consultant cardiac surgeon to help develop the local team. Inadequate funds, lack of governmental support, and brain drain syndrome have largely affected the programme.

Surgical management of CHD in the adult population: the role of humanitarian cardiac surgery mission in Nigeria.

BACKGROUND: The clinical effects of CHD can occur during the neonatal period, childhood, adolescent, and even adulthood. Some CHD in the adult population have indications for surgical management. OBJECTIVE: The objective of this study was to review the role of humanitarian cardiac surgery missions in the surgical management of CHD in the adult population in a developing country.Materials and methodOver a 5.5-year period - June, 2003, February, 2013-October, 2017 - five different humanitarian cardiac surgery teams visited National Cardiothoracic Center of Excellence, Nigeria. During the period, they operated on adults with CHD. A retrospective study of the patients treated was performed using data obtained from our Hospital Information Technology Department. The demography of the patients, types of CHD, operative modalities, as well as the outcome was analysed using Microsoft Excel. The results were presented in arithmetic of percentages using tables. RESULTS: During the period, a total of 18 CHD patients were treated.

Utilisation of blood and blood products during open heart surgery in a low-income country: our local experience in 3 years.

BACKGROUND: In Nigeria, access to open heart surgery (OHS) is adversely affected by insufficient blood and blood products, including the challenges because of the lack of patient-focused blood management strategies owing to the absent requisite point-of-care tests in the operating theatre (OR)/ICU. In addition, the limited availability of altruistic blood donors including the detection of transfusion transmitted infections more commonly among non-altruistic blood donors is another burden affecting the management of excessive bleeding during and after open heart surgery in our country. OBJECTIVE: The objective of this study was to review our local experience in the use of blood and blood products during open heart surgery and compare the same with the literature.Materials and methodsIn a period of 3 years (March, 2013-February, 2016), we performed a retrospective review of those who had open heart surgery in our institution. The data were obtained from our hospital health information technology department. The data comprised demography, types of operative procedures and units of blood and blood products transfused per procedure, including the details regarding the usage of the cell saver, as well as those who had severe bleeding requiring excessive blood transfusion. RESULTS: During the study period, 102 patients had open heart surgery, an average of 34 cases in a year. Among them, there were 75 (73.53%) males and 37 (36.27%) females, giving a ratio of 2:1. The ages of the patients were from 0.6 (7/12) to 74 years. Mitral valve procedure was the most common (n=22, 21.6%) surgery type. Transfusion requirements averaged 1.9 units of fresh frozen plasma, 0.36 units of platelet concentrate, and 1.68 units of packed cells per procedure. The least common surgical procedure was common atrium repair (n=1, 0.01%). CONCLUSION: Open heart procedure is a very complex procedure requiring cardiopulmonary bypass with associated severe perioperative bleeding. The attendant blood loss and haemostatic challenges are combated by intricate and selective transfusions of allogeneic blood and or blood products.

Management of complex CHD at the National Cardiothoracic Center of Excellence, University of Nigeria Teaching Hospital, Enugu: the role of foreign cardiac missions in 3.5 years.

BACKGROUND: CHD is defined as structural defect(s) in the heart and proximal blood vessels present at birth. The National Cardiothoracic Center of Excellence, University of Nigeria Teaching Hospital (UNTH), Enugu, through the aid of visiting Cardiac Missions has managed a significant number of patients within the last 3.5 years. Aim/Objective The objective of this study was to review surgical options and outcome of complex CHD among patients attending UNTH, Enugu, Enugu. Materials and Method During the period of 3.5 years (March, 2013 to June, 2016), a total of 20 cases of complex CHD were managed by cardiac missions that visited UNTH, Enugu. Their case notes and operating register were retrieved, reviewed, and analysed using SPSS version 19 (Chicago). RESULTS: There were eight females and 12 males, with a ratio of 2:5. The age range was from 5 months to 34 years with a mean of 1.7. Among all, five patients died giving a mortality rate of 25%. The operative procedures ranged from palliative shunts to complete repair. The outcome was relatively good. CONCLUSION: Complex CHD are present in our environment. Their surgical management in our centre is being made possible by periodic visits of foreign cardiac missions.

Atrial septal defects: Pattern, clinical profile, surgical techniques and outcome at Innova heart hospital: A 4-year review.

BACKGROUND: Atrial septal defect (ASD) is a congenital heart defect that leads to shunting of blood between left and right atria. It may be asymptomatic and sometimes may present with heart failure. Surgical repair is definitive, but currently non-surgical procedure is used to close the defect. MATERIALS AND METHODS: It is a retrospective study of patients who underwent transcatheter closure of ASD at Innova Heart Hospital, Hyderabad, India. Echocardiography was repeated at intervals of 24 hours, then at 1, 3 and 6 months after the procedure to assess complications. The morphological characteristics of the ASD, including its diameter, location, shape and the width of surrounding septal margins, were also evaluated. RESULTS: From April 2007 to June 2011, 69 consecutive children (29 males, 40 females) with a median age of 9.0 years (range = 3.2-19 years) registered with diagnosis of ASD. The median weight was 31.5 kg (range = 7.5-39.0 kg). Five patients (7.2%) were young children aged 3-5 years. Forty-four (63.8%) of these children presented with symptoms of heart failure, whereas 47 (68.1%) of the cases repaired with device were large-sized ASD. The most common interventional procedures done were Searcare Heart(®) and Amplatzer(®) technique with a highest success rate obtained in 2010. CONCLUSIONS: ASD is a common congenital heart disease with a high success rate for those who undergo intervention.

Colon interposition graft for corrosive esophageal stricture: midterm functional outcome.

BACKGROUND: Corrosive esophageal stricture is a major cause of morbidity among Nigerians. In most cases, this follows accidental or parasuicidal ingestion of caustic sodium hydroxide solution (NaOH) often used in the local production of soaps. Various treatment modalities have been advocated for the treatment of esophageal stricture. In this study, we review the results of our adopted technique in the past 10 years for pedicled colonic interposition. METHODS: This is a retrospective study of 21 patients who underwent substernal isoperistaltic pedicled colonic interposition graft for management of corrosive esophageal stricture. The right colon was pulled up into the neck in all the patients without resecting the strictured esophagus. RESULTS: Long segment strictures and multiple strictures were the main indications for the procedure. The mean duration of the procedure was 339.6 ± 71.1 min. The average intraoperative blood loss was 673.1 ± 398.1 mL. There were two (9.5 %) hospital mortalities. Graft infarction (9.5 %), cervical fistulae (19.0 %), and reflux neo-esophagitis (14.3 %) were the main non-fatal complications. In the mid-term, dysphagia was completely relieved in a little over 84 % (16/19) of patients, while one patient (4.8 %) still experienced reflux neo-esophagitis requiring treatment. There was no case of gross regurgitation or nocturnal aspiration in the mid-term. CONCLUSIONS: Although the use of pedicled colonic interposition graft offers a good mid-term functional outcome with relief of dysphagia, early postoperative morbidity is high. Graft infarction is the single most important factor for poor functional outcome and every effort must be made to prevent its occurrence.

Synopsis of congenital cardiac disease among children attending University of Nigeria Teaching Hospital Ituku Ozalla, Enugu.

BACKGROUND: The objective of this study was to determine the pattern of congenital cardiac disease among children attending UNTH, Enugu, Nigeria. The nature of these abnormalities and the outcome were also considered. The exact etiology is unknown but genetic and environmental factors tend to be implicated. The difference in the pattern obtained worldwide and few studies in Nigeria could be due to genetic, environmental, socioeconomic, or ethnic origin. METHODS: A retrospective analysis of discharged cases in which a review of the cases of all children attending children outpatient clinics including cardiology clinic of the University of Nigeria Teaching Hospital (UNTH), Enugu over a five year period (January 2007-June 2012) was undertaken. All the children presenting with cardiac anomalies were included in the study and the cases were investigated using ECG, X-ray and echocardiography studies. RESULTS: A total of 31,795 children attended the children outpatient clinics of the hospital over the study period. Of these, seventy one (71) had cardiac diseases. The overall prevalence of cardiac disease is 0.22%. The commonest symptoms were breathlessness, failure to thrive and cyanosis. Almost all types of congenital detects were represented, the commonest being isolated ventricular septal detect (VSD), followed by tetralogy of Fallot. One of these cardiac anomalies presented with Downs's syndrome and another with VACTERAL association. CONCLUSIONS: The results of this study show that 0.22% per cent of children who attended UNTH in Enugu State had congenital cardiac abnormalities and the commonest forms seen were those with VSD.

Challenges of lung cancer management in a developing country.

BACKGROUND: The investigation of pulmonary neoplasm in Nigeria is hampered by lack of investigative tools and religio-cultural beliefs that detest autopsy. However, recent publications seem to suggest an increasing incidence of this lesion in Nigeria. MATERIALS AND METHODS: A 30-month prospective study of all cases of lung cancer seen at a tertiary health institution in Nigeria was done to document the incidence and challenges of management in the region. RESULTS: Fifty one new cases of primary carcinoma of the lung were identified during the study period. The age ranged from 30-81 years, mean 56.6 +/- 21.6 years and male:female ratio of 2.4:1. The age-standardized incidence rate was 7.9 per 100.000 with a peak in the 60-69 year age group. In 42% of the males there was cigarette smoking history. Adenocarcinoma of the lung was the predominant histologic subtype, and treatment was largely palliative. CONCLUSION: The incidence of lung cancer in South East Nigeria is on the increase even in the absence of state-of-the-art diagnostic modalities. The high prevalence of cigarette smoking amongst the males is a call for the intensification of the preventive measures against tobacco use.

Obstructed inguinal hernia: role of technical aid program.

AIM: The purpose of the study was to determine the influence of the presence of a surgeon on the outcome of obstructed inguinal hernia at Mongomo, in Equatorial Guinea. METHODOLOGY: A prospective study of patients with obstructed inguinal hernia seen between June 1997 and May 1999 was carried out. During the same period, all uncomplicated hernias seen at the surgical outpatient clinic were noted. RESULT: Fifteen patients presented with obstructed inguinal hernia, while 138 were uncomplicated. All the 15 patients were males, and one of them died. Death resulted from lack of treatment as he presented on our arrival on a technical aid program from Nigeria. The others (N = 14) were operated upon, and eight of them had resection of the intestine because of gangrene. The duration of obstruction was more than two days among those that had bowel resection. COMMENT: Inguinal hernia is a treatable surgical condition. When done electively, the cost and the risk of treatment are very low. Operative treatment can only be offered to patients with inguinal hernia by a surgeon in the community. CONCLUSION: The study has demonstrated that the presence of a surgeon in a community changes the outcome of obstructed inguinal hernia. Sponsorship of medical aid programs should be encouraged.