West African Journal of Medicine

A Survey on Selection and Administration of Perioperative Antibiotics by Anaesthetists

OT Alagbe-Briggs, BOI Onajin Obembe — Fri, 06 Feb 2015 00:00:00 +0000

Background: Perioperative antibiotic administration for prophylaxis of surgical site infections can increase the anaesthetists workload. However, timely administration is essential to reduce risks and improve patient outcome.
Objective: This survey evaluates anaesthetists’ opinion concerning perioperative antibiotic therapy and training.
Methodology: Structured questionnaires relating to the study objective were administered to a cross-section of anaesthetists present at a national conference. The 16 question survey focused on the grade of anaesthetists, practice centre, opinion about perioperative antibiotic therapy and anaesthetists´ training regarding use. Data was analysed and presented as percentages of total responses.
Results: A total of 82 questionnaires were administered with 66 respondents (response rate- 81.0%); which included consultants 16(24.2%), residents 39(59.1%) and nurses 9(13.6%). Most 58(87.9%) were practicing in teaching hospitals and 62(93.9%) agreed that the surgeon was responsible for preoperative antibiotic selection. The anaesthetist 30(45.5%) and surgeon 26(39.4%) were responsible for preoperative administration, but the anaesthetist assumes responsibility following preoperative omissions 43(65.2%). Confirmation of administration preincision was by anaesthetist 31(47.0%) and surgeon 29(43.9%), but repeat administration during prolonged surgery was by former 38(57.6%). Training of anaesthetists in the selection 46(69.7%) and administration 36 (antibiotics was inadequate; and deemed necessary by50(75.8%) and 55(83.3%) respondents respectively.
Conclusion: Antibiotic selection though exclusively by the surgeon, higher responsibility is placed on the anaesthetist for preoperative administration, confirmation before incision and intraoperative re-dosing during prolonged surgery. Knowledge in selection and administration of antibiotics is inadequate and should be incorporated during the training.

Keywords: Perioperative antibiotics, Anaesthetist, Selection, Administration, Training.

An Evaluation of Usefulness of Prostate Specific Antigen and Digital Rectal Examination in the Diagnosis of Prostate Cancer in an Unscreened Population: Experience in a Nigerian Teaching Hospital

RW Ojewola, KH Tijani, EA Jeje, MA Ogunjimi, CC Anunobi, AO Adesanya — Fri, 06 Feb 2015 00:00:00 +0000

Objective: To evaluate the usefulness of prostate specific antigen (PSA) and digital rectal examination (DRE) in the diagnosis of cancer of the prostate (CaP) amongst unscreened patients.
Patients, Materials ans Methods: A prospective study168 unscreened men who were referred for evaluation for CaP. They all had a 10-core extended transrectal prostatic needle biopsy using size 16 Tru Cut needle for either an elevated serum total PSA of >4ng/ml or abnormal DRE findings or both. Overall cancer detection rate was determined and detection rates were determined separately for patients with elevated PSA with normal DRE, abnormal DRE with normal PSA and those with both indications. The performances of each indication were determined separately and in combination in terms of their sensitivity, specificity, predictive values and accuracy. The results were compared amongst patients with different indications for biopsy.
Results: The overall cancer detection rate was 44.0%. Detection rates in patients with elevated PSA with normal DRE and abnormal DRE with normal PSA were 30.0% and 17.4% respectively. There was statistically significant increased detection of 61.2% amongst patients with both indications. The overall sensitivities of PSA, DRE and combination of both were 94.6%, 75.7% and 70.3% respectively while the specificities were 20.2%, 44.7% and 64.9% respectively. The accuracies of PSA, DRE and combination of both indications were 53%, 58% and 67.3% respectively while the PPVs were 48.3%, 51.9% and 61.2% respectively. Mean Gleason score was 6.82 while the overall complication rate was 23.2%
Conclusion: Neither PSA nor DRE is sensitive, specific, predictive or accurate enough on its own to be an ideal screening or diagnostic test for CaP. Therefore, optimal evaluation of patients with suspected CaP is best achieved with both even in unscreened populations.

Keywords: Prostate cancer, detection rate, sensitivity, specificity, predictive values, accuracy.

Financial Hardship in Settling Medical Bills among Households in a Semi-Urban Community in Northwest Nigeria

MN Sambo, SH Idris, SS Bashir, JB Muhammad — Fri, 06 Feb 2015 00:00:00 +0000

Background: An equitable health care system that responds to the needs of its people is important to break the cycle of poverty and ill-health. However, rising health care cost, and the preponderance of user fees to finance health care have often limited access to needed health services.
Study Design: A cross-sectional descriptive study design was employed, using a pretested, semi-structured, intervieweradministered questionnaire.
Results: The study was carried out among 188 respondents. Majority (88.2%) of the respondents were within the agegroup 20-49 years, about two-thirds 63.8% were married and about half (42.8%) had family size between 5 and 9. The study revealed that about a quarter (26.1%) experienced hardship in settling their medical bills. While one-third (31.1%) had to sell their assets, about half (45.2%) had to secure loan while 16.6% had to resort to begging because of hardship encountered in settling the medical bills. Furthermore, of those who sold theirs asset; 46.2% sold their farmlands, 38.5% sold a piece of land, while 16.3% sold their vehicles.
Conclusion: This study has revealed that inhabitants of Samaru community experience hardship in settling their medical bills. Consequently, innovative strategies like deferment of payment and fee exemption, enrolling into community-based health insurance schemes as well as voluntary contributory health insurance schemes etc need to be considered, in order to alleviate the hardship in settling the medical bills.

Keywords: Financial, hardship, settling, medical bills.

Frequency and Risk Factors of Contrast-Induced Nephropathy after Contrast Procedures in a Nigerian Tertiary Centre

O Okoye, L Ojogwu, E Unuigbe, E Oviasu — Fri, 06 Feb 2015 00:00:00 +0000

Contrast-induced nephropathy (CIN) is a significant yet underestimated problem in clinical practice. The increasing use of contrast media in diagnostic and interventional procedures over the last 30years has resulted in CIN becoming the third leading cause of hospital-acquired acute renal failure (ARF) in developed countries. Despite this, there is still a paucity of data on the incidence of CIN following intravenous contrast media especially in developing countries.
The goals of this study were to determine the frequency and risk factors of CIN amongst patients receiving intravenous contrast in a tertiary health institution.
This is a hospital-based prospective observational study. One hundred and eighty (180) consenting patients were recruited consecutively over a 6-month period. Venous blood and urine were collected for haematocrit, serum urea, electrolytes and creatinine estimation and urinalysis, before contrast exposure and up to 72 hours post-exposure.
The frequency of CIN was 35.9% and one patient required haemodialysis. Baseline renal insufficiency, anaemia and age >55 years were significant risk factors for CIN and predictive of CIN in univariate but not multivariate analysis.

Keywords: Contrast-induced Nephropathy, risk factors, frequency, contrast media.

Illness Concept among People with Epilepsy and their Caregivers and Preferred Treatment Methods in a Suburban Community in Southeast Nigeria

PO Nwani, EO Arinzechi, AL Asomugha, KO Enwereji, MC Nwosu, AO Ogunniyi — Fri, 06 Feb 2015 00:00:00 +0000

Background: Epilepsy, one of the world’s most prevalent chronic diseases is still regarded as a supernatural disease in many parts of the world. These superstitious and cultural beliefs tend to influence treatment seeking behavior of people living with epilepsy (PWE) and their caregivers.
Study design: People living with epilepsy in a semi-urban community in Southeast Nigeria were identified in a two phase door-to-door cross-sectional descriptive study. Those identified and their caregivers were further interviewed to determine their concepts of the disease, their treatment (actual and preferred) and what informed treatment.
Results: We found 29 cases of active epilepsy, 16 (55.2%) males and 13 (44.8%) females. Witchcraft was held as a major cause of epilepsy in the community accounting for 36.2% (n=17) of the responses. The three major treatment modalities used were spiritual (healing churches), traditional (herbal medicines) and orthodox treatment with antiepileptic drugs. Spiritual treatment was the preferred treatment modality, though most (89.7%) have used traditional (herbal medicine) treatment at one point in the course of the disease. Beliefs on epilepsy and information on the disease obtained mostly from non-medical sources informed treatment.
Conclusion: The epileptic population studied preferred spiritual treatment though use of traditional treatment was also common. Treatment seeking behavior was greatly influenced by their beliefs and information on the disease obtained mainly from non-medical sources.

Keywords: Active epilepsy, Witchcraft, Spiritual treatment, Traditional treatment.

In the Eyes of the Beholder: Assessment by Clients on Healthcare Delivery in a Large Teaching Hospital in Ghana

AE Yawson, AJ Hesse Afua, PK Amoo, AC Reindorf, HNA Seneadza, AN Baddoo — Fri, 06 Feb 2015 00:00:00 +0000

Background: Improving quality of health care delivery is a primary goal of all health care institutions. Health care systems face challenges in providing quality health care to the citizenry due to rising health care cost and clients demanding higher standards of care.
Objectives: The study aimed at finding out clients’ perceptions of the quality of health care delivery at the tertiary care level in Ghana, using the Central Outpatient Department (COPD) of the largest teaching hospital in Ghana as a case study.
Study design: Overall 665 clients were selected through systematic random sampling procedure over a four-week period, between September and October 2010. Clients were interviewed after a visit to the COPD of thehospital during the survey period using a structured questionnaire.Two focus group discussions were held for clients during the period.
Results: Majority of clients (56%) were females and most (84%) were clients coming for review. During the focus group discussion, clients’considered one hour as the mean maximum time they would like to waitwhile seeking medical help,however, more than half of clients (51.9%)waitedfor over an hour (after registration) to see a doctor. About 86% had their condition explained to them and 87% were physically examined. In all, 83% of clients were satisfied, and 6% very satisfied with care given at the COPD. Clientshowever, considered poor attitude of some health workers, long waiting times,late starting times of clinic, uncomfortable physical environment and inadequate staff as being detrimental to the effective delivery of quality healthcare.
Conclusion: Overall quality of health care as measured by the indicators used were generally perceived to be high except with client waiting time for services, lack of directional signs in the hospital and an uncomfortable waiting area at the COPD. There were concerns about attitude of some staff and late starting times of outpatient clinics. These when addressed would further improve quality.

Keywords: Client satisfaction, quality of care, waiting time, tertiary health care, Ghana.

Inflammatory Bowel Disease in Accra: WhatNewTrends?

TNA Archampong, KN Nkrumah — Fri, 06 Feb 2015 00:00:00 +0000

Background: Inflammatory bowel disease (IBD) has been more common in Western Europe and North America. Initially IBD had been thought to be low in incidence among Sub- Saharan Africans. However, it is now being increasingly recognised in patients of African descent.
Objective: A comparative assessment of the patterns of IBD in Accra from 1997 to 2011.
Methods: This study used a retrospective design to access clinical details of follow-up patients attending the Gastroenterology Unit of the Korle-Bu Teaching Hospital, Accra between February, 1997 and May, 2011. It was a comparative seven-year review of clinical presentations of IBD between April, 2004 – August, 2011 (t2) and February, 1997 – March, 2004 (t1) for changing patterns of disease in tertiary care.
Results: Twenty-eight (28) new IBD patients were seen in the Gastroenterology Clinic, KBTH with IBD during 2004 – 2011 (t2) in comparison to 17 patients over1997 – 2004 (t1). Presentations of severe diarrhoea were 70.4% and 55.6% in (t1) and (t2) respectively. Eighty-two percent (82%) of patients with IBD in (t2) had a severely inflamed colon on the index colonoscopy. Most patients (70–80%) responded to medical therapy (steroids, sulfasalazine) with no colon resections for steroid-refractory colitis.
Conclusion: Although relatively uncommon, IBD recorded a 65% rise in incidence over the study periods with a male preponderance. Most patients with IBD were presenting late with severe clinical and endoscopic features of disease yet medically responsive. Non-specific (indeterminate) colitis gained prominence in (t2).

Keywords: Inflammatory, bowel, trends, Accra, Ghana, Africans, non-specific colitis.

Pathology and the Surgical Management of Goitre in an Endemic Area Initiating Supplementary Iodine Nutrition

JCB Dakubo, SB Naaeder, Y Tettey, RK Gyasi — Fri, 06 Feb 2015 00:00:00 +0000

Goitre in the West African sub-region is caused by iodine deficiency and goitrogens in the diet. Supplementary iodine nutrition on a mass scale was started in Ghana in 1996. In areas where iodine deficiency have been corrected the histological pattern of goitre changes and this influences surgical decision making. Data on the histological types of goitre in our institution is lacking.
Objective: To define the histopathological types of goitre in this initial period of iodine supplementation and relate this to the types of thyroid surgeries that were performed.
Methods: It was a prospective study of consecutive patients who underwent thyroidectomy from January 2003-December 2007. Descriptive statistics was employed in analyzing the data
Results: Five hundred and twenty eight cases were studied made up of 470 (89%) females and 58 (11%) males with mean age of 41.98yrs, SD ±12.90yrs. The excised mean thyroid tissue weight was 161.4g, SD ±116.3yrs. Hyperplastic goitres were 373 (70.7%), toxic goitre 70 (13.3%), adenoma 37 (7.0%), carcinoma 25 (4.7%) and thyroiditis 23 (4.4%). Papillary carcinoma accounted for 56% (14) cancers. Subtotal thyroidectomy was performed in 278 (52.7%) of patients, near total thyroidectomy 107 (20.3%), lobectomy 98 (18.6%), total thyroidectomy 24 (4.5%), excision or completion thyroidectomy 20 (3.8%) and de-bulking 1 patient. Overall, complications occurred in 32 patients (6.1%) and were made up mostly of haemorrhage in 10 (1.9%), Hypocalcaemia 10 (1.9%), unilateralRecurrent Laryngeal Nerve(RLN) injury 3 (0.57%), Tracheal collapse 3 (.57%) and Bilateral RLN injury 2 (0.4%).
Conclusion: The introduction of iodine supplementationon a mass scale in Ghana is yet to have its fullest impact on thyroid diseases. Goitres are still large and cause pressure effects. Toxic, inflammatory and malignant goitres are gaining prominence, and surgery for malignant goitre was oncologically inadequate.Near total thyroidectomy is recommended as the minimum surgery to avert the need for completion thyroidectomies in view of the lack of preoperative pathological diagnosis of thyroid lesions.

Key words: Goitre, iodine deficiency, iodated salt, Endemic goitre, Thyroidectomy.

Prevention of Dental Caries: Knowledge, Practice and Opinion of Paediatricians in Lagos

OO Olatosi, EO Sote, OJ Akinsola, FA Oredugba, AS Adenaike — Fri, 06 Feb 2015 00:00:00 +0000

Background: Dental caries is the most prevalent oral disease in children and this is preventable. Paediatricians are the first professionals whom children visit and are in good position to begin the process of prevention of dental caries if they recognize and encourage good preventive habits.
Objective: To determine the knowledge, practice and opinion of pediatricians in prevention of dental caries.
Materials and Methods: A cross sectional survey was undertaken among pediatricians in Lagos. Questionnaires were administered to pediatricians practicing in Teaching hospitals, general and private hospitals in Lagos. The questionnaire assessed their personal details, knowledge about caries, practice guidelines and opinion towards its prevention.
Results: Less than one-third (27.7%) of the pediatricians knew that bacteria causing caries can be transmitted from mother to child. Only about one-third (30.8 %) of the paediatricians examine children’s teeth for dental caries. Majority (87.7%) were of the opinion that paediatricians have a role in promoting oral health. A total of 59% of the paediatricians had moderate knowledge, while (71%) of them had poor practice and their opinion for prevention of dental caries was positive in more than two-thirds of them (71%).
Conclusion: We concluded that most paediatricians in Lagos had moderate knowledge, poor practice and lacked proper awareness about prevention of dental caries.
Recommendation: We recommend that preventive dentistry topics in oral health promotion and prevention of dental caries be part of their postgraduate curriculum, continued dental health education programme for paediatricians, referral of related cases to paediatric dentists and oral health related topics be published in paediatric medical journals.

Keywords: Dental Caries, Paediatricians, Lagos.

QT Dispersion in Hypertensive Nigerians with and without Left Ventricular Hypertrophy

OK Ale, JNA Ajuluchukwu, DA Oke, AC Mbakwem — Fri, 06 Feb 2015 00:00:00 +0000

Background: Increased QT dispersion (QTd) has been implicated as a marker of arrhythmogenesis and cardiac death. Paucity of literature on QTd in Nigeria necessitated an inquiry into QTd in adult hypertensive population. This study sought to: (i) compare the QTd values of adult hypertensive subjects with age and sex matched normotensivesubjects and (ii)examine the relationship between QTd and left ventricular hypertrophy (LVH).
Study Design: One hundred and fifty-one hypertensive patients and 101 age and sex-matched controls were recruited into this study. A resting 12- lead ECG was obtained from all subjects for determination of QTd and ECG LVH using Sokolow Lyon (SL) and Araoye’s codes. Echocardiographic LVH was determined for 60 hypertensive subjects and 60 age/sex matched controls.
Results: Hypertensive subjects had higher mean QTd than the controls (65.6 ± 28.1ms vs 38.7 ± 11.3 ms, p< 0.0001). QTd of hypertensives with ECG LVH was significantly higher than those without ECG LVH (Araoye: 71.5 ± 22.0ms vs 62.2 ±24.1ms, p = 0.02, SL; 72.0 ±24.4ms vs 61.6±23.1ms p = 0.009). Similarly the QTd of hypertensives with echocardiographic LVH (72.6 ± 21.3ms) was higher than those without (60.1 ± 22.2ms) but did not achieve statistical significance (p = 0.085).
Conclusion: Hypertension with or without ECG LVH is associated with significantly increased QTd. Echocardiographic LVH is associated with a non significant increase in QTd in hypertensive subjects.

Keywords: QT dispersion left ventricular hypertrophy, Nigerians, hypertensives.

Ultrasound Evaluation of Intima-Media Thickness of Carotid Arteries in Adults with Primary Hypertension at Ibadan, Nigeria

EO Umeh, AM Agunloye, AJ Adekanmi, AO Adeyinka — Fri, 06 Feb 2015 00:00:00 +0000

Background: Ultrasound measured Carotid Intima-Media Thickness (CIMT) is a simple and inexpensive tool for assessing the cumulative effects of hypertension on the carotid arterial walls. It is also an independent predictor of future myocardial infarctionand stroke risk.
Objectives: This study compared ultrasound measured CIMT in hypertensive adults with non-smoking normotensive controls. It also documented variations in CIMT with subjects’ age and sex.
Methodology: Hypertensives (120) of both sexes aged 18years and above were recruited from the Hypertension Clinic at University College Hospital (UCH) Ibadan. Normotensive controls (120) were also recruited from the general public. The CIMT was measured on B- mode ultrasound using the technique of ‘Multiple Carotid Sites Measurement’
Results: Mean CIMT values were 0.756mm ± 0.130 and 0.751mm ± 0.129 for the hypertensive group and 0.638mm ± 0.088 and 0.670mm ± 0.107 for the control group on the left and right sides respectively (P=0.000). Higher CIMT values were noted among male hypertensive subjects (P=0.030). CIMT values also showed positive correlation with subjects’ age.
Conclusion: There was a significant difference in CIMT for hypertensives when compared with normotensives in the study area. CIMT also varies with subjects’ age and sex.

Keywords: Ultrasound,carotid, intima-media thickness, hypertension

Case Report: Calciphylaxis Causing Digital, Gangrene in End Stage Renal Disease

AA Sanusi, FA Arogundade, AIA Udo, MO Hassan, O Oyewole, T Kolawole, A Akinsola — Fri, 06 Feb 2015 00:00:00 +0000

Calcific uraemic arteriolopathy (CUA), a potentially lifethreatening vasculopathy of the skin and subcutaneous tissues is rarely associated with advanced chronic kidney disease (CKD) particularly in patients on haemodialysis. It is more frequently reported in whites than in blacks and commonly accompanies hyperphosphataemia, elevated calcium-phosphate product and marked secondary hyperparathyroidism. We report a rare case of CUA that complicated end stage renal disease secondary to obstructive uropathy in a 68 year old Nigerian. The risk factors for CUA, diagnosis, management and our peculiar limitations were reviewed and discussed.

Keywords: Calciphylaxis, calcium, phosphare, ESRD, gangrene, blacks.

Case Report: Twin Reversed Arterial Perfusion Sequence in a Triplet Natural Pregnancy: Case Report from Korle Bu Teaching Hospital, Accra, Ghana and a Review of the Literature

EV Badoe, A Darko, BH Atuguba — Fri, 06 Feb 2015 00:00:00 +0000

Background: Twin reversed arterial perfusion sequence is probably the most severe malformation found in humans. It is also called acardia , acardiac twinning or acardius acephalus and is a very rare condition that occurs in monozygotic twins and rarely in triplet pregnancy. It has not been described in the West African Medical literature. A case was recorded in a twin delivery at the labour ward four years ago in the same hospital but the underlying diagnosis was not made.
Objective:To describe a rare case of twin reversed arterial perfusion sequence occurring in a triplet pregnancy and review the current literature.
Methods: A case was evaluated at the delivery ward, Department of Obstetrics and the Neonatal unit of the Korle Bu Teaching Hospital upon information from the obstetric team that a monster had been born from a triplet set. Full documentation was done.
Results: The case documented was a twin reversed arterial perfusion sequence in a triplet pregnancy.
Conclusion: This rare condition has been well characterized and Obstetricians and Paediatricians should now be able to make an accurate diagnosis.

Keywords: Twin reversed arterial perfusion (TRAP) sequence, Acardiac acephalus.

Case Report: Rare Intracardiac Aneurysms seen in Jos, Nigeria: A Report of two Cases

BN Okeahialam, TS Anya, C Chundusu, G Isiguzo — Fri, 06 Feb 2015 00:00:00 +0000

Background: Some congenital heart diseases are compatible with early life presenting their peculiar challenges in adulthood. Some of them are particularly rare, and are misdiagnosed in the absence of modern imaging facilities. Intracardiac aneurysms fall into this group.
Objective: The clinical presentation of the cases up to point of sudden death were documented and echocardiography done.
Results: Two such cases which were never encountered in over 20 years of echocardiography in our unit are reported. One was a ruptured sinus of Valsalva aneurysm dissecting the interventricular septum and the other ventricular septal defect aneurysm involving the tricuspid valve.
Conclusion: Some congenital heart diseases present late. Increased availability of echocardiography and skilled personnel should lead to early diagnosis preventing fatality that follows late diagnosis as occurred here.

Keywords: Aneurysm, Rare, Congenital, Heart, Sudden death