Central laboratory and point-of-care cardiac marker testing capacity of tertiary hospitals in Nigeria - a multicenter study.

Background: Cardiovascular diseases are major contributors to morbidity and mortality. It is generally recognized that cardiac markers are of particular benefit in the evaluation of patients with suspected Acute Coronary Syndrome (ACS). Tertiary hospitals, mainly teaching hospitals, are expected to be optimally equipped to offer these services. The study therefore aimed at determining the central laboratory and point-of-care cardiac marker testing capacity of tertiary hospitals in Nigeria. Method: A cross-sectional survey was carried out in government-owned tertiary hospitals in Nigeria. Data were collected using semi-structured self-administered questionnaires, and analyzed using Stata version 13 (Stata Corp., USA). Results: A total of 34 hospitals participated in the study. The mean (SD) age of respondents was 43.68 (5.2) years. A total of 19 (55.88%) hospitals were found to have a functional cardiac marker testing facility, either in the form of point-of-care, central laboratory testing or both. Of those without a facility, lack of funds to procure equipment was the major reason given. In hospitals with a testing facility, most testing devices were located in the Central laboratory. Conclusion: Cardiac marker testing capacity of tertiary hospitals in Nigeria, both in the form of point-of-care and central laboratory testing, was found to be barely adequate. Improvement is needed in this area for better diagnosis and evaluation of patients who need the tests.

Perioperative mortality in children in a tertiary teaching hospital in Nigeria: a prospective study.

Background: Perioperative mortality is one of the tools that can help to assess the adequacy of healthcare delivery in a nation. This audit was conducted to determine the 24-hour, 7-day and 30-day perioperative mortality rates and the predictors of mortality in a pediatric surgical cohort. Methods: This was a prospective study of children whose ages ranged from a few hours to 15 years and who were operated on between May 2019 and April 2020. The primary outcome was to determine the incidence of in-hospital perioperative mortality. Results: A total of 530 procedures were done in 502 children. Their ages ranged from a few hours to 15 years with a median of 36 months. The 24-hour, 7-day and 30-day mortality rates were 113.2 per 10 000 procedures [95% confidence interval (CI) =40 to 210], 207.6 per 10 000 procedures (95% CI=110 to 320) and 320.8 per 10 000 procedures (95% CI=190 to 470), respectively. Congenital anomalies complicated by postoperative sepsis contributed to death in the majority of cases. The predictors of mortality were neonatal age group [adjusted odds ratio (AOR)=19.92, 95% CI=2.32 to 170.37, p=0.006], higher American Society of Anesthesiologists Physical Status III and above (AOR=21.6, 95% CI=3.05 to 152.91, p=0.002), emergency surgery (AOR=17.1, 95% CI=5.21 to 60.27, p=0.001), congenital anomalies (AOR=12.7, 95% CI=3.37 to 47.52, p=0.001), and multiple surgical procedures (AOR=9.7, 95% CI=2.79 to 33.54, p=0.001). Conclusion: Perioperative mortality remains high in our institution.

Early experience with permanent pacemaker implantation at a tertiary hospital in Nigeria.

INTRODUCTION: artificial pacemakers generate electrical impulses and regulate the heart´s conduction system. They are often used to treat individuals with bradycardia. Permanent pacemaker implantation is a lifesaving procedure especially in patients with symptomatic bradyarrhythmias. The objectives was to evaluate the clinical attributes and outcomes of permanent pacemaker implantation in Ile-ife, Nigeria. METHODS: we retrospectively reviewed medical records of 22 patients who had pacemaker implantation from January 2015 to December 2019. Patient´s demographics, clinical presentation, diagnosis, comorbidities, type of device, complications and long-term follow up were studied. RESULTS: sixteen males (72.7%) and 6 females (27.3%) were recruited into the study with ages ranging between 54 and 84 years and a mean of 70.3 +8.7 years. The commonest symptom was easy fatigability (45.5%) followed by syncope (31.8%). The main indication for permanent pacemaker implantation was complete heart block (86.4%). Seventeen (77.3%) patients had hypertension as the comorbidity present at diagnosis. Single chamber (VVIR) pacemaker was implanted in 13(59.1%) patients while dual chamber (DDDR) was implanted in 9(40.9%) patients. Hematoma, pneumothorax and acute lead dislodgement were the complications observed in 3 patients. There was no statistical significance between the type of device implanted and the occurrence of complications, p-value 0. 186. There was no mortality and 15 patients (68.2%) are currently attending regular 6 monthly follow-up. CONCLUSION: complete heart block is the most common indication for permanent pacemaker implantation and the procedure is safe with minimal complications and satisfactory outcomes.

Comparison between flutter valve drainage bag and underwater seal device for the management of non-massive malignant and paramalignant pleural effusions.

INTRODUCTION: The aim of this study is to compare the use of flutter valve drainage bag system as an alternative to conventional underwater seal drainage bottle in the management of non-massive malignant/paramalignant pleural effusion. METHODS: Forty-one patients with non-massive malignant and paramalignant pleural effusions were randomized into two groups. Group A (21patients) had their chest tubes connected to an underwater seal drainage bottle, while group B (20 patients) had their chest tubes connected to a flutter bag drainage device. Data obtained was analyzed with SPSS statistical package (version 16.0). RESULTS: Breast cancer was the malignancy present at diagnosis in 24(58%) patients. Complication rates were similar, 9.5% in the underwater seal group and 10 % in the flutter bag drainage group. The mean duration to full mobilization was 35.0±20.0 hours in the flutter bag group and 52.7±18.5 hours in the underwater seal group, p-value 0.007. The mean length of hospital was 7.9±2.2 days in the flutter bag group and 9.8±2.7 days in the underwater seal group. This was statistically significant, p-value of 0.019. There was no difference in the effectiveness of drainage between both groups, complete lung re-expansion was observed in 16(80%) of the flutter bag group and 18(85.7%) of the underwater seal drainage group, p-value 0.70. CONCLUSION: The flutter valve drainage bag is an effective and safe alternative to the standard underwater seal drainage bottle in the management of non-massive malignant and paramalignant pleural effusion.

Perception of problem based learning versus conventional teaching methods by clinical medical students in Nigeria.

INTRODUCTION: Problem-based learning (PBL) method which was introduced about 50 years ago in Canada is beginning to gain acceptance over conventional teaching method (CTM) worldwide in medical education but still remains unpopular in Nigeria. This study aims to determine the perception of clinical medical students to the use of both learning methods in pathology courses. METHODS: A cross-sectional quantitative survey was conducted in four Nigerian universities drawn from four regions of the country. Data were collected using pretested semi-structured self-administered questionnaires. RESULTS: The study included 310 respondents, 182(58.7%) males and 128(41.3%) females. Of all the participants, 257(82.9%) had heard of PBL prior to the study and 260(83.9%) thought it suitable for teaching and learning Pathology. Majority of participants, 221(71.3%) preferred a combination of both PBL and CTM while 238(76.8%) thought PBL suitable for all medical students. Some identified factors capable of enhancing adaptation of PBL into medical curriculum include conducive quiet spaces for learning and availability of computers with internet facilities for students' use. CONCLUSION: Participants demonstrated high level of awareness of PBL and thought it suitable for all medical students. Availability of computers and up-to-date libraries with internet and audio-visual facilities could enhance adaptation of PBL into medical curriculum in Nigeria.