Intensive care admissions and outcome at the University of Calabar Teaching Hospital, Nigeria

An intensive care unit (ICU) is for critically ill patients who are likely to benefit from the expertise care provided. The outcome is dependent on the available human and material resources. The University of Calabar Teaching Hospital is a 410-bed hospital. It has a 3-bed general ICU consisting of 2 adult and 1 pediatric beds. A retrospective analysis of all ICU admissions as well as the mortality rate during a 12-month period that spans April 2009 and March 2010 was done. The data were collected from the ICU admissions and nurses' report books. The data extracted were the patients ages, stratified to pediatric (0-18 years) and adult (>18 years); the source of admission, primary diagnosis, the duration of admission, and the patients who were ventilated were also noted. The outcome in terms of mortality was examined in relation to parameters stated above. Eighty-five patients were admitted during the 1-year period, with a bed occupancy rate of 23%. There were 11 (12.9%) pediatric patients and 74 (87.1%) adult patients. Sources of admissions were 64 (75.3%) patients from the operating room, 8 (9.4%) from the inpatient wards, and 13 (15.3%) from the accident and emergency department. Among the adult patients, there were 23 (31%) patients with trauma. There were 45 (61%) surgical patients and 6 (8%) medical patients. Sixteen (19%) patients were mechanically ventilated. The overall mortality was 28 (32.9%). Sixty-four percent of the mortality occurred during the first 24 hours of admission. A mortality rate of 83.3% was recorded among medical patients and 62.5% in those referred from the wards. In mechanically ventilated patients, the mortality rate was 62.5%. Ventilator malfunction, power failure, and oxygen exhaustion led to the unfavorable outcome in patients who were ventilated. In pediatric patients, the mortality rate was 45.5%. Early identification and referral of critically ill patients from the wards, availability of ventilator with battery backup, and maintenance of functioning equipment would reduce the high mortality rate recorded in the study.     

High voltage versus low voltage electrical stimulation. Force of induced muscle contraction and perceived discomfort in healthy subjects

High voltage pulsed galvanic stimulation (HVPGS) and low voltage neuromuscular stimulation (LVNMS) techniques were compared for peak torque of an induced isometric contraction, perceived discomfort, and subjective preference of treatment. The high voltage current used a 40-microseconds monophasic waveform, and the low voltage current used a 300-microseconds biphasic waveform. Both currents used a pulse rate of 50 pps. Both HVPGS and LVNMS were administered to one muscle group, either knee extensors or plantar flexors, of 24 healthy subjects. An isokinetic dynamometer was used to assess peak torque. The perceived discomfort experienced with each type of electrical stimulation was quantified by the use of a visual analog scale. For all dependent measures, data first were analyzed for the whole treatment group and then analyzed for each subgroup. Correlated t tests for the whole group and the plantar flexor muscle subgroup demonstrated that HVPGS produced a significantly greater average peak force of muscle contraction than LVNMS and HVPGS was perceived to be significantly less uncomfortable than LVNMS. No significant differences were found between treatments in the knee extensor muscle subgroup for these dependent variables. Chi-square analysis revealed a subject preference for HVPGS in the whole group and in both subgroups. This study indicates that HVPGS can produce a stronger, less uncomfortable, induced isometric muscle contraction than LVNMS.     

Determination of tissue viability in experimental electrical injuries

Electrical burns or ischemia (induced by vascular ligation) were produced in the legs of 15 anesthetized dogs to study evolution of tissue changes compared with impedance alterations. After the application of 1-ampere currents at 60 Hz, animals were monitored from 1 to 4 days. Muscle impendance was measured with frequency sweeping to determine tissue destruction. Nuclear magnetic resonance spectroscopy (phosphorus 31) was used to assess metabolic activity, and results were compared to impedance measurements. In burned limbs, 70% reduction in muscle impedance was seen, which corresponds to decreased metabolic activity (absent organic phosphates) and suggests necrosis. Visually viable tissue had impedance decreases of 25% and levels of organic phosphates slightly lower than normal. Relaxation frequencies in dogs with severe burns exceeded 80 kHz; in viable tissue, 30 to 40 kHz (normal: 30 kHz). In ischemic muscle, organic phosphates decreased rapidly (1 to 2 hours); impedance changes evolved more slowly (1 day), but they ultimately reached the same degree of severity. Measurement of impedance may be a valuable adjunct in the evaluation of electrical burns, since significant changes strongly suggest nonviability.     

On-the-Job Nutrition Teaching in the Hospital

Development and implementation of the Biocommunications Network in the Memphis region have relied on sharing of resources among hospital libraries. Implied in this system is the recognition that all health care professionals have a right of access to health sciences libraries.     

The evaluation and management of electrical injuries

It is essential for the critical care physician to understand the ramifications of electrical injuries, as these patients are frequently seen in the ICU. Being able to anticipate possible complications may be ultimately life-preserving. A collaborative effort between the surgeon, critical care physician, and ICU staff ensures premium care for this injured patient. Educational efforts for the public regarding precautions in the avoidance of electrical and lightning injuries will help prevent many of these accidents.     

Bacterial pathogens associated with secondary peritonitis in Lagos University Teaching Hospital (LUTH)

Secondary peritonitis is a common and serious form of intra-abdominal infection, often associated with high morbidity and mortality. The overall patient outcome has not markedly improved in spite of advances in patient management. There is therefore need to study the pattern of bacterial pathogens associated with secondary peritonitis in Lagos University Teaching Hospital (LUTH) and the antibiotic susceptibility pattern as that would help in formulation of empiric antibiotic policy on peritonitis and improve the outcome/prognosis of the patients. A prospective study of 35 patients with suspected peritonitis at LUTH between February, 2002 and June 2003 was done. Peritoneal fluids of these patients were collected intra-operatively under aseptic conditions. The specimens were subjected to aerobic and anaerobic studies. Twenty-seven isolates were identified aerobically with Escherichia coli being the most predominant organism 11 (31.4%) followed by Staphylococcus aureus 6 (17.1%) then Klebsiella spp 4 (11.4%). Anaerobic culture showed Prevotella species as the most predominant 14 (40%) followed by Bacteroides fragilis group 8 (22.9%). Overall, Prevotella species were the most predominant organisms isolated in LUTH patients with secondary peritonitis.