Afrimedic Journal

An unusual and preventable complication of vascular injury following Supra-pubic catheter placement in a resource poor setting

Christian Agbo Agbo, Joseph Taruni Godwin , Onih Philip Nwafor — Mon, 20 Nov 2023 00:00:00 +0000

Background: Vascular injury though uncommon is a fatal complication of suprapubic catheter placement. This case report is novel in that it describes an iatrogenic injury to the vesical venous plexus caused by an inexperienced health personnel during suprapubic catheter insertion. Thus, the need to be mindful of such complication and the importance of training and retraining of health workers.

Case presentation: A.A, 45year old male presented following a referral from another facility with features consistent with clot retention and anaemia secondary to post-suprapubic cystostomy and BPE. He subsequently had blood transfusion and bladder exploration with intraoperative findings of clots at the retropubic space and venous bleedings from the vesical plexus. He had clot evacuation and hemostatsis of bleeding vessels by figure of 8 suturing technique with SPC catheter placement.

Conclusion: Vascular injury though less common is the most feared complication of SPC. Notable causes of intra-operative difficulties encountered include a small collapsed/contracted bladder, and surgical scarring of the lower abdominal wall. Younger and inexperienced Surgeons are advised to call for help when faced with intra-operative difficulties during the procedure.

Detection of npmA Gene in Enterobacteriaceae Isolated from Clinical Specimens

Mon, 20 Nov 2023 00:00:00 +0000

Background: Antimicrobial resistance has become of utmost concern to the global public health and the emergence of high-level aminoglycoside resistance has threatened the synergistic use of β-lactam and aminoglycoside antibiotics in the treatment of infections, especially those due to Gram-negative bacteria, thus resulting in increasing morbidity and mortality, as well as treatment cost. The aim of the study was to determine the presence of high-level aminoglycoside resistance npmA gene in Enterobacteriaceae isolates recovered from clinical specimens in a tertiary hospital.

Methods: A total of 419 non-duplicate bacteria isolated from clinical specimens were screened for Enterobacteriaceae using the Microbact 12A Gram negative bacilli semi-automated identification system. Antimicrobial susceptibility tests were performed on the Enterobacteriaceae isolates using commercially available gentamicin antibiotic discs. Gentamicin (120µg) was used for phenotypic confirmation of high-level aminoglycoside resistance. All the resistant isolates were examined for the presence of npmA gene using conventional polymerase chain reaction.

Results: Out of the 419 isolates 250 (60.1%) were confirmed Enterobacteriaceae, 30.4% (76/250) were resistant to 30µg of gentamicin, while 4% (10/250) of the Enterobacteriaceae isolated were resistant to 120µg gentamicin. However, the npmA gene was not detected in any of the high-level aminoglycoside resistant isolates.

Conclusion: Despite the phenotypic prevalence of high-level aminoglycoside resistance observed in the Enterobacteriaceae isolates, the npmA gene was not detected. The absence of the npmA gene therefore suggests that other factors may be responsible for the phenotypic high level aminoglycoside resistance recorded in this study.

Pulmonary Embolism Presenting With Repetitive Seizures: A Case Report

C U Ufoaroh, N E Ihediohanma, C P Ele, C H Enemuo , A E Anyabolu, P U Ele — Mon, 20 Nov 2023 00:00:00 +0000

Pulmonary embolism despite being a common occurrence continues to pose a diagnostic problem. This is mainly because of the wide array of symptoms and signs in its presentation. Interestingly, seizures with its numerous medical causes is an atypical but significant presenting symptom of pulmonary embolism.

We describe the case of a 31 yr old female who presented with symptoms of seizures and was subsequently diagnosed of pulmonary embolism.

Our emphasis is on the need for high index of suspicion for early diagnosis and prompt intervention.

The Awareness And Pattern Of Risk Factors For Infertility Among Infertile Women

Gabriel Dogbanya, Adebiyi G Adesiyun, Umma S Bawa , Nana H Madugu — Mon, 20 Nov 2023 00:00:00 +0000

BACKGROUND

Infertility is a major reproductive health challenge in developing countries and many risk factors have been identified. Awareness of these factors can be important in preventive management.

Aim: To determine the awareness of infertility risk factors in patients.

METHODS

The study involved 220 patients attending the infertility clinic of ABUTH. Using interviewer administered structured questionnaire, data was collected on socio-demographic, gynecological, obstetrics and other history.

RESULT

The mean age of respondents was 29.2±2.5 years. Primary and secondary infertility accounted 36.8% and 63.20% respectively. Coital exposure was ≤ 2 in 48.1% of the patients. 45% has menstrual irregularity and 59.5% had been treated for STI in the past. There is history of surgery in 25% and 71.5% were either overweight or obese and 3.2% had female genital mutilation. Of those with secondary infertility 33.6% were un-booked in their last pregnancy and the outcome was spontaneous miscarriage in 40.9%, induced miscarriage was 12.7% and stillbirth in 14.5%.On awareness of risk factors, 33.6%, had no knowledge of risk factors.

CONCLUSION

The study shows avoidable and preventable risk factors are still prevalent in our setting and there is a lack of sufficient awareness to drive preventive measures

Tolerace And Toxicity To Anthracycline Based Neoadjuvant Chemotherapy In Premenopausal Women With Breast Cancer

Chimezie Innocent Madubogwu — Mon, 20 Nov 2023 00:00:00 +0000

Background: Cytotoxic drugs play an important role in the management of breast cancer particularly in pre-menopausal patients and patients with triple negative breast cancer (TNBC).The adverse reactions to chemotherapeutic drugs are wide and varied. These adverse reactions to chemotherapy drugs could be haematologic and non-haematologic.

Objectives: The study aims to evaluate the toxicity and tolerance of cyclophosphamide, doxorubicin and 5-fluorouracil (CAF) combination on pre-menopausal women with breast cancer.

Materials and methods: A Doxorubicin containing regimen (CAF) consisting of cyclophosphamide 500 mg/m², Doxorubicin 50 mg/m², and 5-Fluorouracil 500 mg/m² all were given on day one. During the course of the cytotoxic drugs, all the side effects both haematological and non-haematological were recorded. The data collected were analyzed using the SPSS statistical software version 23.0. (Statistical Package for Social Sciences SPSS Inc.).

Results: Forty-nine patients were recruited with age range 24 to 54 (40.92±7.98) years. Out of 49 patients, 8(16.3%) developed anaemia, 2(4.1%) leucopenia and 3(6.1%) mild thrombocytopenia during neoadjuvant chemotherapy. The majority of the patients, 41 (83.7%), did not produce significant haematologic side effects. Out of a total of 49 patients, 47 (95.9%) developed atleast one non-haematologic side effect during neoadjuvant chemotherapy. The most common side effects were: vomiting, nausea and body weakness at the frequencies of 29 (59.2%), 28 (57.1%) and 24 (50.0%), respectively.

Conclusion: The study demonstrated that neoadjuvant CAF chemotherapy was very tolerable by our patients with only minimal haematological and non-haematological toxicities. The recorded toxicities were readily managed by simple measures without need for admission.