In vivo tumor-targeted dual-modal fluorescence/CT imaging using a nanoprobe co-loaded with an aggregation-induced emission dye and gold nanoparticles.

As an intensely studied computed tomography (CT) contrast agent, gold nanoparticle has been suggested to be combined with fluorescence imaging modality to offset the low sensitivity of CT. However, the strong quenching of gold nanoparticle on fluorescent dyes requires complicated design and shielding to overcome. Herein, we report a unique nanoprobe (M-NPAPF-Au) co-loading an aggregation-induced emission (AIE) red dye and gold nanoparticles into DSPE-PEG(2000) micelles for dual-modal fluorescence/CT imaging. The nanoprobe was prepared based on a facile method of "one-pot ultrasonic emulsification". Surprisingly, in the micelles system, fluorescence dye (NPAPF) efficiently overcame the strong fluorescence quenching of shielding-free gold nanoparticles and retained the crucial AIE feature. In vivo studies demonstrated the nanoprobe had superior tumor-targeting ability, excellent fluorescence and CT imaging effects. The totality of present studies clearly indicates the significant potential application of M-NPAPF-Au as a dual-modal non-invasive fluorescence/X-ray CT nanoprobe for in vivo tumor-targeted imaging and diagnosis.

Post operative nausea and vomiting in adult Nigerians.

BACKGROUND: This is a prospective study to determine the pattern of postoperative nausea and vomiting in a Nigerian adult population. METHOD: 348 consecutive patients were assessed prospectively for the incidence and risk factors of postoperative nausea and vomiting over a 6-month period. The exclusion criteria included inability to give consent, nausea or vomiting during the period 24 hours before surgery, raised intracranial pressure and patients who received an anti-emetic in the period 48 hours before surgery. RESULT: Patient's age ranged between 18 and 90 years. There were 213 females (61.2%) and 135 males (38.8%). The incidence of postoperative nausea was 32.2% and vomiting was 20.1%. The major risk factors identified were female gender, body mass index, general anaesthesia-inhalational technique, Ketamine induction, pancuronium, pain and movement of patients from the recovery room to surgical wards (p < 0.05). CONCLUSION: Nausea and vomiting was identified as a common postoperative complication with multifactoral aetiology. It is recommended that high risk patients should receive prophylactic antiemetics. Regional techniques should also be considered in such patients.

An audit of surgical admissions to the intensive care unit of the Lagos University Teaching Hospital (1997 - 2002).

OBJECTIVE: To review the pattern of adult surgical admissions into the Intensive Care Unit (ICU) of Lagos University Teaching Hospital (LUTH). METHODS: A six-year retrospective review of data of patients above 12 years old admitted to the ICU of LUTH was performed. RESULTS: 290 patients representing 82.6% of the total ICU admissions (351) during the study period were evaluated. 251 (86.6% ) were surgical and 39 (13.4% ) non-surgical. The overall mortality was 40.3% (Surgical - 37.8% , Medical 62.9% ). Emergency admissions accounted for 221 (76.2% ) while electives were 69(33.8% ). The Mean hospital stay (MHS) was 4.8 +/- 0.4 days (Surgical: Medical - 3.9 +/- 0.2:10.1 +/- 2.5). The highest admissions were as a result of trauma (32.1% ) and obstetric complications (9.7% ). Cardiorespiratory monitoring (57.2% ) and respiratory distress (34.1% ) were the main indications for admission. Emergency admission and artificial ventilation contributed significantly to the observed mortality (p < 0.0001) CONCLUSION: At LUTH, trauma and obstetric complications constituted the major causes for ICU adult surgical admissions.

Acute airway obstruction in the puerperium secondary to massive thyroid enlargement.

Pregnancy is known to be thyrogenic and may exacerbate features of thyroid disease. We report the case of a patient whose pregnancy was complicated by respiratory symptoms following remarkable increase in size of a pre-existing goitre. She declined surgery during the pregnancy and it was rescheduled for after the puerperium. A week postpartum she developed acute airway obstruction which necessitated urgent thyroidectomy and management of tracheomalacia with a tracheostomy postoperatively. The effect of pregnancy on the course of her disease and the anaesthetic challenges in the face of limited airway equipment are highlighted.

Comparison of suxamethonium and priming with atracurium for rapid sequence orotracheal intubation in a Nigerian adult population.

OBJECTIVE: To compare suxamethonium with atracurium using the priming principle, for rapid sequence orotracheal intubation assessing onset time, time to successful laryngoscopy and intubation and quality of intubating conditions. PATIENTS AND METHODS: A prospective double-blind, randomised study was performed in 90 ASA physical status I and II patients aged between 18 and 64 years undergoing elective surgery requiring endotracheal intubation between October 2002 and June 2003 in a university teaching hospital . All patients were premedicated with 5-10mg oral diazepam and randomly assigned to one of two groups to receive either suxamethonium as a bolus dose (group A) or atracurium (priming with 0.05 mg/kg followed by 0.55 mg/kg after induction of anaesthesia) (group B). In both groups, the trachea was intubated when there was maximal muscle relaxation, determined clinically by jaw muscle relaxation. Muscle paralysis using a PNS, quality of intubating conditions, and occurrence of muscle weakness due to the priming dose of atracurium, time to laryngoscopy and onset time were all noted. RESULTS: Onset time was 87.1 +/- 25.60s and 135.8 +/- 46.23s in groups A and B respectively (P < 0.05). Group A had a laryngoscopy time of 73.6 +/- 25.22s compared to 107.7 +/- 41.32s in group B (P < 0.05). Intubating conditions were significantly better in group A compared to group B (P < 0.05). The frequency of muscle weakness from the priming dose of atracurium was 6.6%. CONCLUSION: Atracurium, using the priming principle, is an option in our environment for modified rapid sequence induction when suxamethonium is contraindicated.

Knowledge and perception of obstetric analgesia among prospective parturients at the Lagos University Teaching Hospital.

BACKGROUND: Natural labour is painful. Such pain has little value and is potentially harmful to the parturient and foetus. OBJECTIVE: To assess knowledge, perceptions and acceptance of obstetric analgesia among prospective parturients. The effect of age, educational status and parity on the above variables was evaluated. DESIGN AND SETTING: Prospective cross-sectional study between October 2002 and April 2003 at the Lagos University Teaching Hospital (LUTH). PATIENTS AND METHODS: Patients attending ante-natal clinics voluntarily responded to a structured questionnaire which enquired patient's age, educational status and parity; knowledge, perceptions and acceptance of obstetric analgesia. The association between the variables was determined with the Pearson's Chi square test. RESULT: Four hundred and fifty patients of varying educational levels were studied. Only 175 (38.9%) knew of obstetric analgesia. There was a significant association between educational status and knowledge of obstetric analgesia (p = 0.000). Two hundred and ninety four patients (65.3%) would accept analgesia during labour of which 179 (60.9%) would leave the choice to the doctor to give them the "best available". There was no association between age, educational status and parity with acceptance (p > 0.05). Reasons for rejection included labour being a 'natural process' in 15.1%, faith in divine intervention 6.0% and concerns about side effects 3.1%. CONCLUSION: This study has revealed a dearth of knowledge and gross misconception about obstetric analgesia. With proper education, many patients will accept some form of analgesia during labour. There is an urgent need to commence standard obstetric analgesia services in our tertiary hospitals.