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Pressure ulcers presentation and management at Kenyatta National Hospital and Spinal Injury Hospital
Get PDFObjective: To determine the presentation and management of patients with pressureulcers.Design: A prospective study.Setting: The Kenyatta National Hospital (KNH) and National Spinal Injury Hospital(NSIH).Subjects: One hundred and thirteen patients were evaluated. Ninety six patients fromKNH and seventeen from NSIH. Patients admitted at Kenyatta National Hospital andNational Spinal Injury Hospital with pressure ulcers during the study period.Results: Of the 113 patients, 77 (68.1%) were male and 36 (31.9%) were female. Meanage of the patients studied was 38.1 years while the range was between 12 and 74 years.Paraplegia was the main associated medical condition accounting for 35.4%, followedby HIV/AIDS with 27.4%. The most common anatomical site for pressure ulcerswas tronchanteric region with 43% of the ulcers. Pressure ulcers of grade III and IVaccounted for 66.4% of the ulcers. Two hourly turning was the most common methodof pressure dispersion used. Gauze dressing was the most common method used inwound care while 67.3% of the patients had their wounds cleaned with povidoneiodine.Fasciocutaneous flaps were the most common surgical procedure performed(81.7%) for closure of pressure ulcers. Overall, 59.3% of surgical procedures had beensuccessful at one month. This was, however, reduced to 48.1% at three months.Conclusion: Majority of patients with pressure ulcers were in a relatively youngage group with a mean age of 38 years. Most of the ulcers were located along bonyprominence points of the pelvic girdle and the proximal femur. Most of the ulcers inthis study were treated conservatively, with only a few ulcers subjected to surgicalinterventions. For the ulcers treated with surgical interventions the early outcome wasgood, however studies need to be done to determine long term outcomes
Re-usable low density polyethylene arm glove for puerperal intrauterine exploration
No full textObjective: To design a long arm glove that can be used within a puerperal uterus to prevent the health-care worker contracting HIV from an infected patient. The designed long arm glove should be cheap (affordable) and readily available in low resource centres and must have proven sterilityassurance and tensile strength to confer protection for the health worker.Design: Prospective study.Setting: Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria from 1st December 2006 to 31st May, 2007.Subjects: Fifty medical students of both sexes were selected randomly and the average length from the styloid process to the mid upper-arm of each was measured and the average length was later determined. This was to determine the length of the low density polyethylene long arm gloves tobe made from virgin polyethylene material. Consecutive cases of patients with retained placentae in the puerperium who were scheduled for manual removal of the placenta within the period.Results: Packs of low density polyethylene (LDPE ) long arm gloves were made from virgin polyethylene material. When subjected to bacteriological analysis, three out of four glove packs were contaminated with Staphylococcus, Bacillus and Klebsiella species of bacteria. Gamma irradiation ranging from 28.133 to 83.35 kiloGray of gamma-irradiation (kGy) sterilised all the gloves as postirradiation glove specimens showed no bacterial contamination. However, at doses up to 50 kGy gamma irradiation caused “strengthening” of the polyethylene gloves. While at doses greaterthan 50 kGy, gamma irradiation caused “embrittlement” of the material. Thus, 50 kGy of gamma irradiation was found to be an ideal dose to strengthen and to sterilise the glove for usage. The sterilized gloves were found to be effective when used in consecutive cases of retained placentain protecting the health care workers (HCW) from contamination by possibly HIV contaminated blood.Conclusion: There is a risk of contracting HIV for the health-care worker while carrying out a procedure within the puerperal uterus. The low density polyethylene arm glove was designed to prevent this in low resource centres as it would be affordable, available, with proven sterility assurance and mechanical properties to confer protection for the healthcare worker
Predictive factors for primary amputation in trauma patients in a Nigerian University Teaching Hospital
No full textBackground: The decision to attempt salvage or to amputate a severely injured limb is among the most difficult decision that the orthopaedist must face.Objective: To determine possible predictive factors that could become guides in taking decision for primary amputation as a first line treatment for trauma patients.Design: A prospective study of post-traumatic primary limb amputations.Setting: The Obafemi Awolowo University Teaching Hospital Ile-Ife, Nigeria from January, 2000 to December, 2004.Subjects: Sixty six trauma patients admitted through the Accident and Emergency Unit from January 2000 to December 2004.Results: Sixty six traumatised patient limbs were primarily amputated during the study period.The male: female ratio was 3.7:1 and means age was 28.6 years ±16.6(range: 4-7lyears). 80.3% of the patients were below forty years. All the patients had a single limb amputation. The mean MESS score was 9.4 ± 1.3 (range: 7.0-12.0). The main predictive factors in trauma at the emergency unit for primary amputation include age, sex , occupation, limb ischaemia, gangrene, severe open fracture, source or nature of injury, presence of shock, delay in hospital presentation, and MESS.Conclusion: Immediate amputation is often viewed by the patient and family as a result of the injury. Conversely, a delayed amputation may be viewed as a failure of treatment. Identified predictive factors for primary amputation will reduce trauma associated morbidity and mortality
METHYLDOPA VERSUS NO DRUG TREATMENT IN THE MANAGEMENT OF MILD PREECLAMPSIA
No full textObjectives: To evaluate the efficacy of methyldopa in the treatment of mild pre-eclampsia,to prevent its progress and to investigate its effect on the pregnancy outcomes.Designs: Randomised clinical trial.Setting: Wad Medani Hospital in the central Sudan.Subjects: Seventy primigravidae with single, alive baby of 28-36 weeks gestational agesuffering from true mild pre-eclampsia were enrolled. The patients were randomised in twogroups, treatment group who received methyldopa 750- 4000 mg/day (n=34) and a controlgroup who received no treatment (n=36). All the (treatment and control) patients were drugfollowed as in-patients till the delivery, seen with their babies on the days 7, 42 after thedelivery.Main outcomes measures: The outcomes examined were, rise of the diastolic blood pressureto 110 mm Hg or more, occurrence of imminent eclampsia or the eclampsia, if the maturitycould be achieved, occurrence of intrauterine growth retardation, abruptio placentae, modeof delivery, birth weight, placental weight, perinatal death, Apgar score and referral of thebabies to the pediatrician.Results: Three out of 34 (8.8%) of the treatment group had a rise in the diastolic bloodpressure of 110 mm Hg, 18/36(50%) of the control had a rise in the diastolic blood pressureof 110 mmHg (p <0.05). Three out of thirty four (8.8%) of the treatment group developedimminent eclampsia, while 10/36 (27.8) of the control group developed imminent eclampsia(p<0.05). The maturity was achieved in 82.3% and 88.8% of the treatment and the control,respectively (p > 0.05). There were ten (14.2%) perinatal deaths, four of them in thetreatment group, while six in the control (p > 0.05). There was no difference regarding birthweight, occurrence of intrauterine growth retardation, placental weight, mode of delivery,Apgar score, referral of the babies to the paediatrician. No patient developed eclampsia orabruptio placenta; there was no maternal death in both groups.Conclusion: Methyldopa can prevent the progress of the mild pre-eclampsia to severe preeclampsia,without affecting the maturity, birthweight or the neonatal outcomes
PRIMARY HEALTH CARE, SELECTIVE OR COMPREHENSIVE, WHICH WAY TO GO?
No full textABSTRACTObjective: To critically review the advantages and disadvantages of selective versuscomprehensive Primary Health Care(PHC) approaches as a strategy towards improvinghealth in the developing world.Data sources: Review of literature on PHC.Data selection: Relevant papers from western and developing world literature.Data extraction: Search of Pub-med, WHO/UNICEF reports, and relevant publications onPHC.Data synthesis: Examination of principles behind PHC and practical experiences in PHCin the developing world.Conclusions: Selective PHC programs have improved specific aspects of health, frequentlyat the expense of other health sectors, but fail to address an individual’s health in holisticmanner, or the health infrastructure of countries. Selective PHC programs tend to focusonly on a small subset of the community. Comprehensive PHC is expensive to implement,however addresses health of individuals more holistically, addresses both preventive andcurative health care, and promotes health infrastructure development and communityinvolvement, thereby providing more sustainable improvement of health in the wholecommunity
SUPERIOR MESENTERIC ARTERY SYNDROME: CASE REPORT
No full textSUMMARYSuperior Mesenteric Artery Syndrome (SMAS) is caused by trapping of the third partof the duodenum between Superior Mesenteric Artery (SMA) and aorta as result ofnarrowing of the angle between the two vessels due to acute loss of mesenteric fat whichis secondary to rapid weight loss. A fifteen year old caucasian female on a mountainclimbing expedition with an acute on chronic upper gastrointestinal obstruction ispresented. The diagnosis was confirmed with a barium meal and at surgery, a bypassprocedure performed to relieve the obstruction
ENTEROTOXIGENICITY AND DRUG SENSITIVITY OF STAPHYLOCOCCI FROM CHILDREN AGED FIVE YEARS AND BELOW WITH SPORADIC DIARRHOEA
No full textABSTRACTObjective: To investigate the incidence of enterotoxigenic strains of staphylococci inchildren aged five years and below suffering from sporadic diarrhoea and their antibioticsusceptibility pattern.Design: Collection of stool samples from children with sporadic diarrhoea and laboratorybased microbiological analysis.Setting: Microbiology Research Laboratory, Department of Veterinary Microbiology andParasitology, University of Ibadan, Ibadan, Nigeria.Results: Out of one thousand seven hundred and sixty one diarhoeic faecal specimenscollected, one hundred and seven strains of staphylococci were isolated as pure culture.Seventy two of these 107 staphylococci were coagulase positive S. aureus, 33 strainswere S. epidermidis and two strains were S. saprophyticus. Sixty one (84.7%) of 72 isolatesof S. aureus produced enterotoxins. Staphylococcal enterotoxins A was produced singlyby 37(60.7%) of the toxigenic strain, while 12(19.7%) produced enterotoxin D alone.Two strains produced both enterotoxins A and C, six strains produced both enterotoxinsA and D, one strain produced enterotoxins A, C and D while two strains producedenterotoxins A, B, and D. Most strains were resistant to pennicilin, with minimuminhibitory concentrations (MIC) within the range of 1-16m g/ml.Conclusion: Enterotoxigenic strains of S. aureus were recovered from children aged fiveyears and below suffering from sporadic diarhoea. The incidence rate was 3.5% of thesamples investigated. Results of their antibiogram revealed that chloramphenicol,gentamicin, cephalothin and clindamycin would be appropriate for treatment of suchdiarrhoea after the clinical value of the antibiotics in young children has been evaluated
LEIOMYOMA OF THE URINARY BLADDER: CASE REPORT
No full textA case of leiomyoma of urinary bladder, a rare benign tumour, is presented. The patientwas a 42 year old female who presented with dysuria and frequency of micturition.The radiological features, diagnosis and management are discussed and the literatureon this subject is briefly reviewed
FACTORS INFLUENCING THE USE OF EPISIOTOMY DURING VAGINAL DELIVERY IN SOUTH EASTERN NIGERIA
No full textBackground: Given considerable evidence that routine episiotomy increases maternal morbidity and without evidence to support maternal or neonatal benefit, has episiotomy use changed among health care providers? To date, very limited information exists relating to the past and current practice of episiotomy in many developing countries.Objective: To determine the prevalence of episiotomy at Aba in South Eastern Nigeria, examine factors influencing the performance of episiotomy and document complications associated with the procedure.Design: A hospital based retrospective study.Setting: The Abia State University Teaching Hospital (ABSUTH), Aba in South Eastern Nigeria, from January 2001 to December 2005.Subjects: Four thousand, one hundred and seventy two mothers who delivered vaginally within the study period.Results: There were 1877 episiotomies, for an episiotomy rate of 45%. Ninety per cent of the primigravid parturients had episiotomy. Women undergoing episiotomy were younger (mean age 24.7 years; range 16-37) than women without episiotomy (mean age 28.5 years, range 20-43). Whencontrolled for parity and maternal age, other risk factors were occipito-posterior position, vacuum extraction, forceps delivery, vaginal breech delivery, and a history of Caesarean section. Episiotomy use was also associated with major perineal lacerations and increased length of hospital stay.Conclusion: The episiotomy rate of 45 per 100 vaginal deliveries in this study is obviously higher than evidence-based recommendations for optimal patient care. A policy of systematic reduction in the incidence of episiotomy can be pursued in this hospital. Greater attention needs to be paidto selection of women to undergo episiotomy
IMPACT OF FEMALE GENITAL hlUTILATION ON MATERNAL AND NEONATAL OUTCOhiES DURING PARTURITION
No full textObjective: To evaluatc tire impact of female genita) n~utilation on parturition and to createawareness of iis implication on women and neonatal health.Design: A crosh-sectional study.Setting: Tikur Anbessa, St. Paul's a d Ghandhi Memorial hospitals between January andDecember 1997.Subjects: One thousal~d two hundred and twenty five mothers with and 256 without FGhlwho have had spontaneous, term, singleton and vcrtex vaginal delivrr~. Of these, 762(51.57, ) were prin~iyaraand 719 (48.5W uf them multipara. The parameters focussed uponincluded age, ethnicity, parity, type of circumcision, eyisiotomy. stages of labour, Apgarscores and related complications.K~suks: Thc study revealfd that 82.7 % of the subjects had one form of FGM. The mean agcsfur the circu~ncised and nnn-circumcised werc 25.935.9 and 21.8k4.5 years, respectively. Thefrequently perfurnled genital mutilation was typc I! (85.5 % ). The rnothcrs w hu required anepisiotomy incision for foetal and maternal indications among the circumcised accounted for43.070 whercas it was only 24.6% for the referent group. The mean duration of labour byconventional standi~rds is prolonged in primiparae and multiparae both in the circurnri~edand non-circumcised groups, tilough the second stage is delayed more so for the circumcisedcategory (pc0.05). Thc first and tenth minute mean Apgarscores seem to be more favourablefor the non-circun~cisrd 4p<0.05) but the perinatal mortality rates are quite similar. Morecomplications in terms of perincal tears., bleeding, incontinence and febrile iltnesscs arcregistered for the FGM.Conclusions: The study demonstrates the negative impact of FCM more on maternal thanneonatal outcomes during parturition