COVID-19 and Pregnancy: A Prospective Descriptive Study from a Tertiary Hospital in Nigeria.

BACKGROUND: It is known that pregnant women are more susceptible to viral infectious diseases, with an attendant risk of adverse foetal and maternal outcomes. The objective of this descriptive study is to evaluate the epidemiologic and clinical pattern, as well as the obstetric and COVID-19 outcome among pregnant women seen at a tertiary hospital in Southern, Nigeria. METHODS: This was a descriptive prospective study of all pregnant women seen and diagnosed with COVID-19 based on positive RT-PCR for SARS-COV-2, at the University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria from March 2020 to August 2020. RESULTS: Seven (5.2%) pregnant patients were diagnosed with COVID-19 out of 134 patients. The common presenting symptoms were fever 4(57.1%), Productive cough 3 (42.9%), shortness of breath 3 (42.9%), myalgia 3 (42.9%), rhinorrhoea 3 (42.9%), and anosmia 3 (42.9%). The majority (85.7%) of patients were in the second and third trimesters at diagnosis. All deliveries occurred at term, with a mean gestational age of 38±0.82 weeks. Four patients (57.1%) had caesarean section (CS) deliveries for obstetric indications. No adverse outcomes were recorded for mothers and babies with birth weight ranging from 2.5 to 3.5 Kg. No case fatality was recorded. CONCLUSION: In this study, pregnant women with COVID-19 did not have adverse maternal and foetal outcome. The pattern of symptoms and the presence of severe disease also did not differ from what is observed in the general non-pregnant population. The impact of COVID-19 on pregnancy is less severe when compared to other high consequence viral infectious diseases.

CONTEXTE: On sait que les femmes enceintes sont plus sensibles aux maladies infectieuses virales, avec un risque concomitant d'issues fœtales et maternelles indésirables. L'objectif de cette étude descriptive est d'évaluer le schéma épidémiologique et clinique, ainsi que les résultats obstétricaux et COVID-19 chez les femmes enceintes vues dans un hôpital tertiaire du sud du Nigeria. MÉTHODES: Il s'agissait d'une étude prospective descriptive de toutes les femmes enceintes vues et diagnostiquées avec COVID-19 sur la base d'une RT-PCR positive pour le SRAS-COV-2, à l'hôpital universitaire de Port Harcourt, Port Harcourt, Rivers State, Nigeria à partir de mars 2020 à août 2020. RÉSULTATS: Sept (5,2%) patientes enceintes ont reçu un diagnostic de COVID-19 sur 134 patientes. Les symptômes de présentation courants étaient la fièvre 4 (57,1 %), la toux productive 3 (42,9 %), l'essoufflement 3 (42,9 %), la myalgie 3 (42,9 %), la rhinorrhée 3 (42,9 %) et l'anosmie 3 (42,9%) . La majorité (85,7%) des patients étaient dans les deuxième et troisième trimestres au moment du diagnostic. Tous les accouchements ont eu lieu à terme, avec un âge gestationnel moyen de 38 ± 0,82 semaines. Quatre patientes (57,1 %) ont eu des accouchements par césarienne (CS) pour des indications obstétricales. Aucun résultat indésirable n'a été enregistré pour les mères et les bébés dont le poids à la naissance était compris entre 2,5 et 3,5 kg. Aucun cas de décès n'a été enregistré. CONCLUSION: Dans cette étude, les femmes enceintes atteintes de COVID-19 n'ont pas eu d'issue maternelle et fœtale défavorable. Le schéma des symptômes et la présence d'une maladie grave ne différaient pas non plus de ce qui est observé dans la population générale non enceinte. L'impact de COVID-19 sur la grossesse est moins grave par rapport à d'autres maladies infectieuses virales à conséquences élevées. MOTS-CLÉS: COVID-19, SARS-CoV-2, Grossesse, Obstétrique, Nigéria.

Perioperative factors impacting intensive care outcomes following Whipple procedure: A retrospective study.

BACKGROUND AND AIMS: Whipple procedure is associated with perhaps the most perioperative morbidity and mortality amongst surgical procedures. Current data regarding their ICU profile and outcomes are lacking. Thus, in the present study, we aimed to determine perioperative factors affecting patient-centred outcomes following the Whipple procedure. METHODS: In a cohort of patients undergoing pylorus-sparing pancreaticoduodenectomies, we strove to determine perioperative variables that may impact outcomes. Unfavourable outcomes (composite of mortality, prolonged ICU stay of more than 14 days or ICU readmission) of patients who underwent the procedure were recorded and logistic regressions analysis of significant variables conducted. RESULTS: Around 68 patients recruited over a 20-month period which included 57 males (83.8%); mean age was 53.4(±11.2) with mean acute physiology and chronic health evaluation (APACHE) II score12.5 (±6.1). Nineteen patients remained intubated at the end of procedures (27.9%). Median ICU stay was 2 days (IQR 2-3). Unfavourable ICU outcomes were 14 in number (20.6%) and 2 (2.9%) hospital deaths occurred. Pulmonary complications occurred in 12 patients (17.7%) and non-pulmonary complications occurred in 41 patients (60.3%). In a multiple logistic regression analysis, the APACHE score 1.34 (1.09-1.64) and pulmonary complications 17.3 (2.1-145) were variables that were identified as predictors of unfavourable outcomes. CONCLUSION: The APACHE II score may reliably predict adverse outcomes following Whipple procedure. Although non-pulmonary complications are common, pulmonary complications in these patients adversely impact patient outcomes.

Comparative effects of single shot low dose spinal bupivacaine only and bupivacaine with fentanyl on labour outcome.

BACKGROUND: Childbirth has been recognised as the most painful experience known to women. This study aimed at studying the efficacy and safety of the single shot spinal analgesia for pain relief in labour. MATERIALS AND METHODS: One hundred and twelve parturients in labour were randomized into two groups of 55 paturients each. Group B received 2.5 mg of spinal plain bupivacaine only while Group BF had 2.5 mg plain bupivacaine with 25 gg of fentanyl. Onset of sensory block, time to achieve maximum sensory block, duration of sensory and motor block and the level of block were recorded. The need for oxytocin augmentation, instrumental delivery, neonatal Apgar scores and umbilical artery blood pH were recorded. RESULTS: The numeric rating pain scores for groups B and BF were significantly reduced from a mean prespinal score of 8.17 +/- 0.96 cm and 8.30 +/- 0.23 cm respectively to a mean post-spinal pain score of 0.23 +/- 0.45 cm and 0.09 +/- 0.47 cm respectively, p = 0.000. The mean duration of analgesia in Group B was 61.60 +/- 6.47 mins while it was 128.98 +/- 21.61 mins in Group BF, p = 0.000. CONCLUSION: The study showed that low dose spinal bupivacaine either alone or in combination with fentanyl is safe for labour analgesia, but the combination f bupivacaine with fentanyl provided much more prolonged pain relief

An Audit of Anaesthetic Record Charts in the Orthopaedic Theatre of a Nigerian Teaching Hospital

Objective: The anaesthetic record is an essential part of a patient's record; providing useful information for the management of the patient. It is of medico-legal importance and can be used for quality assurance and researchpurposes. An analysis of anaesthetic record charts from a satellite operating theatre of the University of Port-Harcourt Teaching Hospital (UPTH) was undertaken to determine their legibility; correctness and completeness. Method: A retrospective analysis of the anaesthetic record charts from March 2003 to February 2004 of the orthopaedic theatre of the UPTH was undertaken. Results : A total of 232 anaesthetic record charts were analyzed. All entries were manually-written. Of these; 141 (60.9) were filled by anaesthetic registrars; the rest were filled by senior registrars 85 (36.5) and consultants 6 (2.6). One hundred and twenty-one charts (52.2) were legible; completely and correctly filled; but 47.8were incompletely filled; and 47.7had at least an illegible parameter. Conclusion: It is concluded from this analysis that the standard of anaesthetic record-keeping needs to be improved and consideration given to the use of computer-generated records which will eliminate the problems of illegible records