PROMETHAZINE-INDUCED THROMBOPHLEBITIS IN A NIGERIAN MAN: A CASE REPORT.

Introduction: Promethazine is a phenothiazine derivative that possesses antihistamine, anti-dopaminergic and anticholinergic properties. It is commonly used to treat motion sickness, allergic conditions, nausea and vomiting, in addition to its use as a sedative. Promethazine has vesicant properties and is highly caustic to the intima of blood vessels and surrounding tissues. Intravenous administration may result in thrombophlebitis, unintentional intra-arterial administration, perivascular extravasation and tissue necrosis. To the best of our knowledge there is no previous published report of promethazine-induced thrombophlebitis from sub- Saharan Africa. Case Report: A 29-year-old Nigerian male was admitted at our hospital on account of malaria with acute gastroenteritis. Due to persistent vomiting, he was administered 25 mg of promethazine injection via a size 22G intravenous cannula which was inserted the previous day on the anteromedial aspect of his right forearm and maintained with continuous intravenous crystalloid infusion. Upon administration of promethazine, he experienced intense burning and erythema. The cannula was removed immediately, another cannula was inserted on the contralateral arm, and promethazine was replaced with ondansetron. Subsequently, he developed a tender, subcutaneous cord-like swelling extending from the middle-third of the anteromedial aspect of his right forearm, corresponding with the site of previous venous cannulation. Ultrasonography revealed a hypoechoic, non-compressible basilic vein, with no flow on colour Doppler interrogation, in keeping with superficial thrombophlebitis. He was treated with a topical anti-inflammatory agent, and the pain and redness subsided after four weeks. Conclusion: The preferred parenteral route of administration of promethazine is deep intramuscular injection. Recommendations to prevent promethazine-induced thrombophlebitis include: use of large and patent veins, use of lower doses, drug dilution and slow administration, use of alternative therapies, and patient education. Promethazine-induced tissue injury is under-reported in this part of the world. Creating awareness through this case report would help reduce the morbidity following promethazine administration.

Computed Tomographic Imaging Appraisal of Traumatic Brain Injury in a Tertiary Hospital in South-South Nigeria: A 6-Year Review.

BACKGROUND: Computed tomography (CT) remains the gold standard in imaging evaluations of traumatic brain injury (TBI). TBI on its own has become a major concern in developing countries with its untoward effects. OBJECTIVES: The objective was to appraise the craniocerebral computed tomograms of patients who had TBIs. MATERIALS AND METHODS: A retrospective study of patients who underwent craniocerebral CT on account of head injury in the University of Uyo Teaching Hospital, Uyo, Nigeria, from November 13, 2013 to May 31, 2019 was done. The duration was regardless of the disjointed periods of service interruption. Patients' demographic and CT features were evaluated with application of simple analysis of data. RESULTS: Two hundred and thirty-two patients were evaluated with minimum and maximum ages of 6 months and 78 years, respectively. Males were predominant with a ratio of 2.74: 1. Most affected age ranges were 30-39 years (23.27%) and 20-29 (22.84%). Normal brain CT was seen in 44 patients (18.97%). The most frequent lesion in patients with abnormal CT was intracranial hemorrhages (n = 188, 81.03%). Here, extra-axial hemorrhages (n = 100, 53.19%) supersede intracerebral hemorrhages (n = 88, 46.81%). Half of the intracerebral hemorrhages were multiple. Calvarial fractures were seen in 34.48% (n = 80) of patients. The most common localization was the facial bones (n = 24, 30.00%), whereas the least site was the occipital bone (n = 4, 5.00%). Fifteen percent of the patients had multiple fractures which also included base of the skull. CONCLUSION: TBIs commonly occur among young active males. The most frequent lesion is intracranial hemorrhages with extra-axial bias.

Magnetic resonance imaging in chronic headache: our experiences and perspectives.

BACKGROUND: Headache is a common symptomatology necessitating hospital consultations. Despite the prohibitive cost to patients in Nigeria, Magnetic resonance imaging (MRI) has become an evaluating tool for headache. OBJECTIVES: To determine the yield of cranial MRI and frequency of significant intracranial lesions among patients with chronic headache. METHODS: A three-year retrospective analysis of cranial MR images and records of patients referred to Medicaid Diagnostic Centre in Abuja, Nigeria on account of chronic headache was done. Data was analyzed using SAS software version 9.3. RESULTS: 150 patients aged 9 to 73 years (mean= 39.5 years) with chronic headache were studied. There were 54 males and 96 females with a ratio of 1:1.8. 48% and 52% had normal and abnormal MRI findings respectively. Although the number with abnormal MRI was higher than those with normal exams, this difference was not significant (p=0.624). The commonest neoplastic and non-neoplastic abnormalities were pituitary macroadenoma (4%) and sinusitis (21.3%) respectively. CONCLUSION: In our study, MRI had a low diagnostic yield in patients with chronic headache. Therefore, it is expedient that physicians stratify patients with chronic headache based on red flag signs to determine the need for cranial MRI in view of financial burden.

Impact of physical exercises on immune function, bone mineral density, and quality of life in people living with HIV/AIDS: a systematic review with meta-analysis.

BACKGROUND: Compromised immune function, associated with human immune deficiency virus(HIV) infection, is improved by antiretroviral therapy(ART) which also decreases bone mineral density(BMD), and possibly the quality of life(QoL). However, physical(aerobic/resistance) exercises, were reported to induce reverse effects in uninfected individuals and were appraised in the literature for evidence of similar benefits in people living with HIV/AIDS(PLWHA). The main study objective was to evaluate the impact of physical (aerobic and resistance) exercises on CD4+ count, BMD and QoL in PLWHA. METHODS: A systematic review was conducted using the Cochrane Collaboration protocol. Searching databases, up to June 2017, only randomized control trials investigating the effects of either aerobic, resistance or a combination of both exercise types with a control/other intervention(s) for a period of at least 4 weeks among adults living with HIV, were included. Two independent reviewers determined the eligibility of the studies. Data were extracted and risk of bias(ROB) was assessed with the Cochrane Collaboration ROB tool. Meta-analyses were conducted using random effect models using the Review Manager(RevMan) computer software. RESULTS: Nineteen studies met inclusion criteria(n = 491 participants at study completion) comprising male and female with age range 22-66 years. Two meta-analyses across 13 sub-group comparisons were performed. However, there were no RCTs on the impact of physical exercises on BMD in PLWHA. The result showed no significant change in CD4+ count unlike a significant effect of 5.04 point(95%CI:-8.49,-3.74,p = 0.00001) for role activity limitation due to physical health(QoL sub-domain). Overall, the GRADE evidence for this review was of moderate quality. CONCLUSIONS: There was evidence that engaging in moderate intensity aerobic exercises (55-85% Maximum heart rate-MHR), for 30-60 min, two to five times/week for 6-24 weeks significantly improves role activity limitation due to physical health problems, otherwise physical(aerobic or/and resistance) exercises have no significant effects on CD4+ count and other domains of QoL. Also, there is lack of evidence on the impact of exercises on BMD in PLWHA due to the paucity of RCTs. The moderate grade evidence for this review suggests that further research may likely have an important impact on our confidence in the estimate of effects and may change the estimate.

Utility of first trimester obstetric ultrasonography before 13 weeks of gestation: a retrospective study.

INTRODUCTION: First trimester pregnancy is defined as twelve weeks after the last menstrual period. Ultrasonography has revolutionized validation and management of first trimester pregnancies. The aim was to analyze ultrasonographic findings of first trimester pregnancies in University of Uyo teaching hospital (UUTH), Uyo, Nigeria. METHODS: The departmental ultrasonographic records of pregnant women who were referred to Radiology department of UUTH, Uyo, Nigeria. For ultrasound scans were retrospectively reviewed. The period under consideration was from 8th January 2013 to 8th February, 2016. Demographic data and ultrasonographic parameters of first trimester pregnancies like gestational sacs were recorded. Data were statistically analyzed using SPSS Chicago 13. Exclusion criterion included incomplete data and acyesis despite positive ßhCG test. RESULTS: 26.4% (n-645) of the 2438 pregnant women who underwent obstetric ultrasonography had first trimester ultrasonography during the studied period. The peak frequency was seen in the 20-29 age range with 52.2% (n-337) and followed by 30-39 age range with 41.7% (n-269). The commonest first trimester ultrasound findings was viable pregnancy with 42.5% (n-274), followed by incomplete miscarriage with 34.3% (n-221). The least finding was trophoblastic pregnancies 0.3% (n-2). The earliest age at which normal viable pregnancy was diagnosed in this study was 5weeks 5days from the last menstrual period. Only 2.19% (n-6) of the normal viable pregnancies were multiple pregnancies and they were all twins. The highest number of referrals to Radiology Department for first trimester ultrasonography was from accident and emergency unit with 34.42% (n-222) while antenatal clinic referral was only 16.12% (n-104). CONCLUSION: The commonest first trimester's obstetric ultrasonographic findings in Uyo, Nigeria are viable pregnancies and are predominantly single gestation. The earliest age of ultasonographic pregnancy detection in Uyo is 5week 5days and peak maternal age is second and third decades.