NEBULIZED MAGNESIUM VERSUS KETAMINE FOR PREVENTION OF POST-OPERATIVE SORE THROAT IN PATIENTS FOR GENERAL ANAESTHESIA.

BACKGROUND: Sore throat is a common post-operative complaint which can cause significant distress and morbidity. We tested and compared the efficacy of nebulized Magnesium and Ketamine on the incidence and severity of sore throat within the first 24 hours after general anaesthesia. OBJECTIVE: To compare the incidence and severity of post-operative sore throat at 2, 4, 8, 12 and 24 hours after extubation following pre-induction administration of nebulized Magnesium and Ketamine. METHODOS: In this randomized controlled trial, 99 adult ASA I and II patients between the ages of 16 - 65 years were administered nebulized Ketamine 50 mg, Magnesium Sulphate 250 mg or saline for ten minutes prior to induction of general anaesthesia and orotracheal intubation. Incidence and severity of post-operative sore throat were assessed at 2, 4, 8, 12 and 24 hours post extubation. RESULTS: The incidence of sore throat at 4, 8, 12 and 24 hours post tracheal extubation were significantly lower in the Magnesium (18.2%, 12.1%, 0, 0; p = 0.009, 0.006, ≤0.0001, 0.003) and Ketamine group (24.2%, 12.1%, 6.1%, 0; p = 0.041, 0.006, 0.001, 0.003) compared with the saline group (48.5%, 42.4%, 39.4%, 24.2%). Patients also had significantly less severe sore throat at 4 and 8 hours post extubation in both Magnesium and Ketamine groups (p = 0.0 11, 0.041). CONCLUSION: Pre-induction nebulization of Ketamine or Magnesium can decrease the incidence and severity of sore throat in the first 24 hours after anaesthesia.

Estimation of fetal weight: a comparison of clinical and sonographic methods.

Fetal weight estimation is important in the management of labour and delivery. This study aimed to compare the accuracy of the clinical and ultrasound methods of fetal weight estimation. This was a prospective study involving 110 term cephalic singleton pregnancies delivered within 24 hours of clinical fetal weight estimation using Johnson's and Dare's formulae and ultrasound estimation at a Tertiary hospital in Abakaliki, Nigeria. The data were analysed with Stata 11 software. The sonographic estimation within 10% of the actual birth weight (ABW) of 68.2% was significantly greater than the accuracy of Johnson's (23.6%), Dare's (26.4%), and the combined clinical formulae (27.1%). The clinical methods overestimated the fetal weight. Both methods showed a positive correlation with the ABW. In conclusion, the sonographic method had a better accuracy than the clinical methods. However, fetal weight overestimation by clinical methods warrants their usefulness in resource-poor settings such that the clinical determination of a normal weight foetus will exclude fear of complications from macrosomia. Impact statement What is already known on this subject? An accurate estimation of fetal weight is important in the management of labour and delivery. However, there is limited evidence that any of the available methods of fetal weight estimation is more accurate than the others. What do the results of this study add? This study showed that the clinical methods using Johnson's and Dare's formulae had a significantly higher mean percentage and absolute mean percentage error compared to the sonographic estimation of fetal weight. The sonographic estimation within 10% of actual birth weight (ABW) of 68.2% was significantly greater than that of Johnson's and Dare's formulae with 23.6% and 26.4%, respectively. All of the methods showed a positive correlation with the ABW. What are the implications of these findings for clinical practice and/or further research? This implies that the sonographic method has a better accuracy than the clinical methods in estimating the fetal weight. However, the overestimation of fetal weight by the clinical methods warrants their usefulness in resource-poor settings such that the clinical determination of a normal weight foetus will exclude the fear of complications from macrosomia.

MEDICATION HISTORY DOCUMENTATION IN REFERRAL LETTERS OF CHILDREN PRESENTING AT THE EMERGENCY UNIT OF A TEACHING HOSPITAL IN LAGOS, NIGERIA.

BACKGROUND: Medical literature has demonstrated that referral hospitals often receive inadequate information about the care and medications their patients received from referring hospitals. OBJECTIVE: This study aimed to assess the completeness of referral letters, especially the medication history, for patient presenting at the children emergency room of a teaching hospital in Lagos, Nigeria. METHOD: A pro forma form was developed to obtain from the referral letters the demographic information of children referred to the emergency room of the Lagos University Teaching Hospital (LUTH), Idiaraba, over a period of three months. The nature of the referring centre, tentative diagnoses made at the referring centre, duration of illness prior to referral, vital signs and physical examination findings, investigation results, and treatment given were also extracted from the letters. In addition, we extracted from the letters the name, dosage, frequency and duration of use of medicines administered at the referring centres. Parents were also interviewed about the details of medicines used prior to presentation of their child at the referring centres. RESULTS: Among those referred with a letter, 100 patients met the inclusion criteria and constituted those evaluated in this study. Most of the patients were referred from general hospitals (31%), another tertiary hospital (29%), and private hospitals/clinics (24%). Gender (30%) and tentative diagnoses (12%) were omitted in the referral letters. However, information about the weight (82%), vital signs (57%), physical examination findings (44%), treatment given (92%), and medication history (71%) were much more omitted in the referral letters. CONCLUSION: Medication history as well as many other data points is infrequently reported in referral letters to a tertiary care hospital in Lagos, Nigeria. Standard referral guidelines may be useful to improve documentation of medication history.

Nocturnal Enuresis among Nigerian Children and its Association with Sleep, Behavior and School Performance.

OBJECTIVE: To study the association of nocturnal enuresis with sleep, behavior and school performance. METHODS: Hospital-based, cross-sectional descriptive study of 216 children (?6-year-old) using structured questionnaire and behavioral tools. SETTING: Two hospitals at Lucknow in Northern India. RESULTS: Prevalence of enuresis was 37.0%. Nocturnal enuresis was significantly associated with abnormal behaviour (P=0.049) and poor sleep hygiene (P%0.05). School performance was not associated with enuresis. CONCLUSION: Children with nocturnal enuresis were at an increased risk of behavioral problems and poor sleep hygiene.

Ultrasound estimation of foetal gestational age by transcerebellar diameter in healthy pregnant nigerian women.

BACKGROUND: Ultrasonography has application in advanced obstetric practice through relatively detailed assessment of foetal anatomy and accurate assessment of gestational age (GA), especially during the first half of pregnancy. Foetal trans-cerebellar diameter (TCD) is an emerging parameter for gestational age determination among Africans. AIM: This study was carried out to establish baseline data for TCD at various corresponding gestational ages in Nigerian women, and evaluate the correlation between these two parameters. MATERIALS AND METHODS: Four hundred and fifty healthy singleton pregnant women, referred for antenatal scans were prospectively studied, following informed consent. Main inclusion criterion was certain last menstrual dates. A SONOACE χ6 ultrasound scanner, with a curvilinear probe and 3.5 MHz transducer, was used to measure the TCD. Data analysis was done and statistical significance set at p ≤ 0.05. RESULTS: TCD of the foetuses studied ranged from 11.9 mm (at 13 weeks) to 59.3mm (at 41 weeks) with a mean value 34.2 ± 14.1mm.There was significant correlation between TCD and menstrual gestational age (r =0.984; p=0.000). TCD has a predictive accuracy of 96.9% with a standard error of ± 10 days. CONCLUSION: A normogram of foetal TCD throughout gestation is established for Nigerian Africans.

PREDICTIVE ACCURACY OF TRANSCEREBELLAR DIAMETER IN COMPARISON WITH OTHER FOETAL BIOMETRIC PARAMETERS FOR GESTATIONAL AGE ESTIMATION AMONG PREGNANT NIGERIAN WOMEN.

OBJECTIVE: To compare the predictive accuracy of foetal trans-cerebellar diameter (TCD) with those of other biometric parameters in the estimation of gestational age (GA). DESIGN: A cross-sectional study. SETTING: The University of Benin Teaching Hospital, Nigeria. SUBJECTS: Four hundred and fifty healthy singleton pregnant women, between 14-42 weeks gestation. MAIN OUTCOME MEASURES: Trans-cerebellar diameter (TCD), biparietal diameter (BPD), femur length (FL), abdominal circumference (AC) values across the gestational age range studied. Correlation and predictive values of TCD compared to those of other biometric parameters. RESULTS: The range of values for TCD was 11.9 - 59.7mm (mean = 34.2 ± 14.1mm). TCD correlated more significantly with menstrual age compared with other biometric parameters (r = 0.984, p = 0.000). TCD had a higher predictive accuracy of 96.9% ± 12 days), BPD (93.8% ± 14.1 days). AC (92.7% ± 15.3 days). CONCLUSION: TCD has a stronger predictive accuracy for gestational age compared to other routinely used foetal biometric parameters among Nigerian Africans.

Isolation of pathogenic bacteria from hospital staff apparel in Nigeria.

A survey of bacteria contamination of hospital staff apparel in use in Anambra State, Nigeria, was carried out to determine the extent of contamination by clinically important bacteria. Of a total of 125 swab samples of hospital staff apparel, 72 (58%) showed bacterial contamination including 32 (70%) of 46 samples from hand gloves, 28 of 45 (62%) samples from protective gowns, and 12 of 34 (35%) samples from face-shields. The potentially pathogenic bacteria isolated were Salmonella spp, Proteus vulgaris, Shigella dysenteriae, Pseudomonas aeruginosa and Staphylococcus aureus. The isolation of clinically important bacteria from the apparel suggests the need for improved infection control measures.

Diagnosis and Management of Chancroid in Nigeria.

There is a broad group of venereal disease that is referred to as the "Tropical Venereal Disease". They are so-called because they are most frequently seen in the tropical and sub-tropical areas of the world. Among them are conditions like chancroid, lymphogranuloma venereum (LGV or climatic bubo) and granuloma inguinale (chronic venereal sores). Chancroid is variously called "soft sore" or "soft chancre" because it bleeds easily and "ulcus moile".1 It is an acute infection and auto-innoculable disease. The extent of chancroid genital ulceration in Nigeria is greater in the Northern partly due to permissive sexual practices especially for men.