Intensive care unit admissions in the Jos University Teaching Hospital.

OBJECTIVE: To determine the pattern of admissions to the intensive care unit (ICU) of the Jos University Teaching Hospital (JUTH), a tertiary level referral hospital. METHOD: This is a retrospective study of the record of patients admitted between January 1994 and December 2002 to the ICU of the Jos University Teaching Hospital. The information obtained from the admission/discharge record as well as the patients' case notes included demographic data, working diagnosis, type of treatment, length of stay (LOS) in the ICU and outcome. RESULT: A total of 738 patients were admitted over this period and comprised 403 males (54.6%) and 335 females (45.6%) giving a male: female ratio of 1.2:1. The age ranged from one day to 98 years with a mean of 28.3 +/- 19.8 years. Postoperative surgical patients accounted for 48.2% of all admissions, while 15.2% were medical cases. Other indications for admissions included polytrauma (9.5%), Obstetrics and Gynaecological complications (16.1%) and burns (11%). The length of stay (LOS) in the unit ranged from 1 to 56 days, with a mean of 4.5 +/- 5.1 days. A total of 241 patients died while on admission giving an overall mortality of 42.8%. Postoperative surgical admissions accounted for 38.6% of deaths followed by burn and polytraumatised patients with 23.2% and 11.6% respectively. The lowest mortality of 8.7% was in the obstetrics and gynaecology patients. CONCLUSION: The pattern of admission into the unit and the outcome of treatment has not significantly changed after 1-2 decade of an initial report. There is need to increase the number and quality of equipment to cope with the increasing need for ICU care, as well as draw up a policy on the type of cases to be managed in order to improve the out come of care.

HIV and hepatitis B seroprevalence in trauma patients in North Central Nigeria.

BACKGROUND: With the high prevalence rate of HIV and Hepatitis B virus infections in sub-Saharan Africa, infected surgical patients, especially those with fresh open wounds, pose significant danger of occupationally-acquired infections to health workers. METHOD: A two-year double blind study aimed at determining the seroprevalence rates of HIV and Hepatitis B virus infections among trauma patients with fresh open wounds in North Central Nigeria. RESULTS: There were 134 patients with fresh open wounds in this study; their ages ranged between 17-80 years with a mean of 30.9 +/-9.6 years and the male:female ratio was 5:1. All the patients were tested for both HIV and Hepatitis B virus infections. Six(4.5%) patients were positive for HIV-1 while 95(70.9%) patients were positive for Hepatitis B. In all, 3(2.2%) male and 3(2.2%) female patients tested positive for HIV-1 while 77(57.4%) males and 18(13.4%) females tested positive for Hepatitis B; 5(3.7%) patients tested positive for both HIV and Hepatitis B. Though every social class was represented, HIV infection rate was higher in Social Class V than in Social Class 1 but the class incidence rate for Hepatitis B was about the same ranging between 1.2 and 1.6 for both the upper and lower classes. The significance of this study was that the incidence of Hepatitis B virus infection in trauma patients was remarkably higher than the incidence of HIV infection. The implication is that emphasis on control of exposure of health care workers to blood borne infections in the workplace should be as strong for Hepatitis B virus infection as it is for HIV. CONCLUSION: The main finding of this study was the determination of the seroprevalence of HIV and Hepatitis B virus infections in trauma patients with open wounds which underpinned the dangers they pose to health care workers.

Intra-operative cardiac arrest--a tropical experience.

In order to determine the pattern of intra-operative cardiac arrests in a developing country, we reviewed 40 consecutives cases of cardiac arrests at the Jos University Teaching Hospital between January 1993 and December 1997. During this period 15,060 minor cases and 9800 medium/major surgical procedures were performed and an arrest rate of 1:15,060 for minor cases and 1:251 for medium/major cases were obtained. The age ranged between one day and 65 years with a mean of 29.8 years and a male/female ratio of 1:1.3 as there were 18 males and 22 females. Twenty-five (62.5%) arrests occurred outside work hours while fifteen (37.5%) cases arrested during work hours. The surgical procedures with high arrest rates in this study were: emergency laparotomy 8 (20%), emergency caesarian sections 7 (17.5%), thoracotomy 6(15%), emergency craniotomy 5(12.5%), emergency hysterectomy 4(10%) and therapeutic bronchoscopy for foreign bodies in the airway 4(10%). The arrests occurred in 30(75%) emergency procedures as opposed to 10(25%) elective cases. Only in 3 out of the 18, 318 day case procedures did the patients arrest. One patient arrested during local infiltration of lignocaine while the other 39(97.5%) arrested under general anaesthesia. There was no arrest with spinal anaesthesia. The predisposing factors for a patient to arrest on the operating table in our environment include emergency major surgery, poor risk patients with ASA 111 and above, surgery performed outside work hours, under general anaesthesia administered by nurse anaesthetists or junior anaesthetic residents. The success rate at resuscitation is highest with patients with ASA 1 & 11, operations performed during work hours and by senior surgeons and anaesthetists.

The effect of lacidipine on patients with mild to moderate hypertension and the effect of a combination of lacidipine and hydrochlorothiazide in the treatment of hypertension uncontrolled after four weeks of lacidipine treatment: an open study.

In the treatment of hypertension, some patients may go off control while still on the drugs. This occurs especially with sympathetic inhibitors and vasodilators. Lacidipine, a new calcium antagonist acts principally by vasodilatation. After a wash out period, patients with mild to moderate hypertension received 4 mg of Lacidipine for two weeks. After evaluation at two weeks, those uncontrolled received 6 mg of Lacidipine, while those controlled continued with 4 mg of Lacidipine for another two weeks. By the next evaluation, while patients continued whatever doses they were on, any one who had gone off control had 25 mg of Hydrochlorothiazide added. They were evaluated finally after another two weeks. It was found in this study that 91.3% (21/23) were controlled by the end with only Lacidipine either in 4 mg or 6 mg doses. Another 8.7% (2/23) initially controlled on Lacidipine went off control while still on the drug, and were eventually controlled by adding Hydrochlorothiazide. Some transient side effects not warranting discontinuation were encountered. It is concluded that Lacidipine is effective as monotherapy in mildly to moderately hypertensive Nigerian Africans; with good tolerance and safety profile. Where transient control is encountered, addition of a diuretic could be beneficial.