Computed Tomography in the Evaluation of Recurrent Unprovoked Seizure Disorders at the University of Port Harcourt Teaching Hospital (UPTH), Nigeria.

AIMS AND OBJECTIVES: To evaluate the efficacy of cranial Computed Tomography (CT) Scan in detecting intracranial structural diseases related to recurrent unprovoked seizure disorder. PATIENTS AND METHODS: This was a retrospective analysis of the findings in 120 patients who had cranial CT scan for recurrent unprovoked seizure disorders in the Department of Radiology of University of Port Harcourt Teaching Hospital from August 2010 to September 2012. RESULTS: Of the 1,240 cranial CT scans performed during the period under review, only 120 (9.7%) cases had recurrent unprovoked seizure as indication for the procedure and were therefore included in the study. The patients were 71 (59.2%) males and 49 (40.8%) females. The ages of patients ranged from 1 month to 90 years. The mean age was 29.7+21.8 years. The highest prevalence of seizure disorder (25.8%) occurred in the less than ten year age group. The commonest lesions found were cerebral tumours 11 (9.2%), cerebral infarction 11 (9.2%) and cerebral atrophy 7 (5.8%). Cranial CT Scans were normal in 76 (63.3%) patients with recurrent unprovoked seizure disorders. The most frequent seizure type was generalized tonic clonic (76.7%). CONCLUSION: The use of Cranial CT Scan as a diagnostic tool led to the detection of intracranial lesions in 36.7% of patients with recurrent unprovoked seizure disorders. The detection of intracranial lesions in these patients would facilitate early and appropriate intervention.

Analgesic nephropathy as a cause of end-stage renal disease in a 55 year-old Nigerian.

Analgesic nephropathy is a subtle but significant cause of chronic renal failure. There is paucity of data on analgesic nephropathy in Nigeria. This case presentation is to highlight the need to have high index of suspicion in patients at risk of developing analgesic nephropathy. In March 2009 a 55-year-old businessman was referred to the renal unit on account of azotemia by the hematologist who had hitherto managed the patient as a case of refractory anemia. The patient had osteoarthritis for over 10 years and was managed with several analgesic drugs over the same period. He was found to have features suggestive of analgesic nephropathy and had end-stage renal disease. He was commenced on appropriate therapy, and he had a live related kidney transplant six months later. Analgesic nephropathy is preventable and morbidity/mortality can be remarkably reduced with appropriate and prompt intervention.

Stroke in young Nigerian adults.

Stroke in adults under the age of 45 results in a greater loss of potential years of life than for other adults. This premature loss of life is associated with a high social and economic burden. Few data are available regarding stroke among young Nigerian adults in the Niger Delta Basin. This study sought to determine the incidence, risk factors, stroke subtypes and case fatality of stroke among young Nigerian adults. The medical records of all 18- to 45-year-old patients admitted with stroke in the medical wards of the University of Port Harcourt Teaching Hospital (UPTH) from January 2003 to December 2008 were retrospectively reviewed. Of the 611 patients admitted with stroke, 54 (8.8%) were aged 18-45 years. There were 26 males and 28 females. Hypertension was responsible for 42 (77.8%) stroke cases. Other important risk factors were excessive alcohol intake (27.8%), heart disease (13%), diabetes mellitus (11.1%), cigarette smoking (11.1%) and HIV infection (7.4%). The total case fatality was 29.6% with intracerebral hemorrhage (ICH) having higher case fatality of 69.2% than cerebral infarction (CI) with a case fatality of 16.7%. Among the young Nigerian adults who presented with stroke, 53.7% survived. The authors conclude from the above information that the incidence of stroke in young patients at UPTH is low. Hypertension is the most important risk factor of stroke; however, other less common but important risk factors in the young adults are cigarette smoking, diabetes mellitus and HIV. Efforts should be made to reduce the impact of stroke in this age group by focusing on these risk factors, which are either preventable or modifiable.

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.

Community acquired pneumonia in Port Harcourt Rivers State of Nigeria.

BACKGROUND: Community acquired pneumonia (CAP) is a major cause of death world wide. Knowledge of the likely pathogens and their sensitivity/resistance pattern can help in the choice of antibiotic therapy and improve outcome. OBJECTIVE: To identify the seasonal variation; age and sex distribution; bacteriology; antimicrobial sensitivity pattern of isolates; haematological data; radiology and clinicaloutcome of community-acquired pneumonia (CAP) in adult patients admitted to hospital in Port Harcourt, Nigeria. DESIGN: Prospective study. SETTING: University of Port Harcourt Teaching Hospital, and Braithwaite Memorial Hospital, Port Harcourt, Rivers State. PATIENTS: Adults admitted to the hospitals with CAP between 1 May 2002, and 30 April 2003. INTERVENTIONS: A diagnostic strategy using regular collection of sputum samples for gram stain, bacteriological culture and chest radiography were done. Blood cultures were done in severe cases. Antibiotic sensitivity testing was done on the positive cultures. RESULTS: During a 12 month period, 54 patients aged 16 to 82 years (mean 38.1 years) were evaluated. A total of 944 medical admissions were seen during the same period. This gives a prevalence rate of 5.7%. Twenty six classes of bacteria were isolated from the sputum of 23 patients (yield, 42.6%). Streptococcus pneumoniae, the most common pathogen, was isolated in nine cases (34.6%), followed by Klebsiella pneumoniae which was present in eight (30.8%). Other isolates included, Escherichia coli, four cases (15.4%), Pseudomonas aeruginosa, three cases (11.5%), and Staphylococcus aureus, two cases (7.7%). The commonest radiological pattern was lobar consolidation (49.9%) with no Distinct pattern associated with any conventional bacterial pathogen. The isolates showed good sensitivity to the newer and more expensive antibiotics (quinolines and cephalosporines) with marked resistance to the older and cheaper ones. However, clinical responses to benzyl penicillin and gentamycin were found to be good. Out of 54 patients evaluated, four (7.4%) died. CONCLUSION: Streptococcus pneumoniae and Klebsiella were common aetiological organisms of CAP in Port Harcourt. Treatment of CAP with benzyl penicillin remains an appropriate first line choice in this environment while the more expensive quinolines and cephalosporines can be used as backups.

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

A 14-year-old Nigerian female with idiopathic intracranial hypertension (Pseudotumor cerebri or benign intracranial hypertension).

A 14-year-old secondary school girl presented with acute onset severe generalized headache associated with vomiting and diplopia. These followed an initial fever, which responded to chloroquine. She had been on peflacine for a left knee septic arthritis until onset of her symptoms. The main findings on physical examination were mild obesity, left abducent nerve palsy, bilateral papilledema and evidence of resolving arthritis of her left knee. The results of her investigations, including a brain CT scan were within normal limits. A diagnosis of IIH was made. She responded satisfactorily to oral acetazolamide with complete resolution of her symptoms and signs within 12 days of hospitalization and 2 weeks of follow-up.

Pattern of rheumatic heart disease in adults in Maiduguri--north east Nigeria.

The pattern of rheumatic heart disease in 84 adolescent and adult patients seen over a 9 year period (1982-1990) at the University of Maiduguri Teaching Hospital (UMTH) is presented. Over 70% were in second and third decades of life. Pure mitral incompetence and mixed mitral valve disease were the commonest valvular lesions. This pattern appears similar to those in other developing countries. Congestive cardiac failure was the commonest complication. Declining economic fortunes of the developing countries, over crowding, malnutrition and inadequate medical facilities may further perpetuate the condition. Early recognition and the management of rheumatic carditis and early valvular lesions will reduce the morbidity and mortality.

Urinary schistosomiasis in Maiduguri, north east Nigeria.

From January to December 1983, 12,207 specimens of urine were examined for ova of Schistosoma haematobium and 753 (6.17%) were positive. From this group, 44 adult patients were investigated for urinary tract abnormalities. Haematuria was the commonest presenting symptom (81.8%) followed by lower abdominal pain (77.3%) and dysuria (68.2%). Urinalysis revealed proteinuria in 55.5%, leucocyturia in 90.9% and microhaematuria in 88.6% of patients. Twenty-four hour protein excretion ranged from 230 mg to 2.2 g (mean 960 mg). Serum creatinine was raised in one patient (2.2 mg dl-1), Urological abnormalities included calcification of the bladder in 36.4%, ureteric strictures and dilatations in 65.9%, hydronephrosis in 9.1%, squamous cell carcinoma of the bladder in 4.5%, vesicle calculus in 2.3%, and multiple granulomatas in the bladder in 2.3% of the patients. The results of the study suggest that a sizeable population of this area is at risk of developing urological complications and consequently chronic renal insufficiency.