Paediatric day-case surgery at NAUTH, Nnewi, Nigeria

Day-care surgery is strongly advocated in well-selected paediatric cases when the complications are within acceptable limits because it is very cost effective.     

Morbidity and mortality following induced abortion in Nnewi,Nigeria

We present a study of the maternal morbidity and mortality among 76 patients treated at the Nnamdi Azikiwe University Teaching Hospital, Nnewi for complications of induced abortion from January 1996 to December 2000. The total number of maternal admissions over this period was 5750, and illegal induced abortion was responsible for 1.3% of the admissions, with a mortality rate of 5.3% (n = 4) for induced abortion. This accounted for 21.1% of the total maternal deaths (n = 19) for the period. The mean age of the women was 20.6 years (range 15-34 years), 94.7% (n = 72) were unmarried, 93.5% (n = 71) were nulliparous and 76.5% (n = 58) were unemployed, 67.1% (n = 51) had had a mid-trimester termination at > 13 weeks gestational age. It is significant that 55.3% of the patients were teenagers and 45.1% of the mid-trimester abortions occurred in this group. Genital sepsis, haemorrhage, pelvic infection with peritonitis and abscess formation, uterine perforation, and gut injury were the major complications encountered. This study demonstrates that induced abortion is still a major cause of maternal mortality in Nigeria. Integrated family health education, planned parenthood and contraceptive education, a mass literacy campaign and improvement of the existing national health services are recommended in order to ameliorate the problems of illegally induced abortion in Nigeria.     

Use of prophylactic antibiotics in a paediatric day-case surgery at NAUTH, Nnewi, Nigeria: a randomized double-blinded study

This was a randomized double-blinded study to assess the need for prophylactic antibiotics in paediatric day-case surgery, as well as the cost implication. Group A received preoperative intravenous ampiclox and vitamin B complex in doses appropriate for weight and age, while group B received only vitamin B complex as a placebo. The study was completed by 138 (95.2%) patients in group A, and by 140 (97.2%) patients in group B. Wound infection was seen in seven (5%) patients in group A and six (4.3%) patients in group B. The average cost of hernia repair in group A was US 43 dollars and US 31.1 dollars in group B.     

Food poisoning outbreak in Ibadan, Nigeria, due to a new phage type of Salmonella typhimurium

An outbreak of food poisoning in Ibadan, Nigeria, claimed about 20 lives. A new phage type U282 of Salmonella typhimurium, the causative organism, was isolated from a sandwich filling, which yielded 4 X 10(9) viable organisms/g. The sandwiches were prepared in Lagos and kept without refrigeration until consumption next day. There is need for stricter control in the tropical developing countries of private catering agencies which imitate those of the advanced industrial countries.     

Advances in the non-drug, non-surgical, non-device management of chronic heart failure

There have been many articles, reviews and editorials about the recent advances in pharmaceutical and device management of chronic heart failure in this and other journals over the last few years. What has been less praised are the significant advances we have made in understanding the best management of heart failure using other non-drug, non-surgical, non-device approaches. Approaches as diverse as nutrition, education, exercise, physiotherapy, psychotherapy and therapies for sleep-disordered breathing have shown considerable promise in improving the lot of our chronic heart failure (CHF) patients. Chronic heart failure is a common condition with a poor prognosis. It generates many debilitating symptoms for the sufferer. Non-pharmacologic treatment modalities play an important role alongside effective modern pharmaceutical, surgical and device therapies in relieving symptoms and improving prognosis. These treatments include those lifestyle measures that reduce the risk of underlying diseases such as coronary artery disease, diabetes, and hypertension lifestyle interventions of benefit in established CHF. Recent advances are reviewed including specialist nursing care, multi-disciplinary heart failure clinics, exercise rehabilitation, the treatment of sleep-disordered breathing, depression, obesity and cachexia. The day of the multi-disciplinary patient-centred CHF clinic has arrived and all sufferers deserve experienced management using all these approaches.     

心房颤动——命名、分类和非药物治疗

~~心房颤动——命名、分类和非药物治疗@陈新!100037北京$中国医学卫生院中国协和医科大学心血管病研究所阜外心血管病医院心律失常诊治中心 @陈柯萍!100037北京$中国医学卫生院中国协和医科大学心血管病研究所阜外心血管病医院心律失常诊治中心 @张澍!100037北京$中国医学卫生院中国协和医科大学心血管病研究所阜外心血管病医院心律失常诊治中心~~     

The non-drug treatment of hypertension in the diabetic patient

A wide range of non-pharmacological manoeuvres have been tried for the control of BP but the majority of studies have not examined diabetic patients. Alteration of individual dietary components is difficult to achieve and results difficult to interpret. A high fibre, low fat, moderate salt restricted diet is as efficacious as drug therapy in some hypertensive diabetic patients. Similar diets have been recommended for all diabetic patients by the British Diabetic Association and the European Association for the Study of Diabetes. This diet has the added advantage of improving glycaemic control and plasma lipid profiles. The benefits of behavioral modifications are variable, with some being better than placebo. Although there is no evidence for a hypertensive effect of smoking, it should be strongly discouraged in diabetic patients because of the added cardiovascular risk it places upon them. Studies of dietary control of BP indicate that a response should be observed after three months of treatment. If blood pressure remains elevated after this time the patient should be treated with pharmacological agents. Hyperinsulinaemia may be important in the pathogenesis of Type II diabetes, coronary artery disease and essential hypertension. Dietary manoeuvres which reduce plasma insulin levels may prove to be of benefit in all of these conditions, but as yet data are not available to support this hypothesis.     

慢性心衰的诊断、药物及非药物治疗进展

心力衰竭是各种心脏结构或功能性疾病导致心室充盈及（或）射血能力受损而引起的一组综合征,是多数心血管疾病的最终转归,也是导致患者死亡的主要原因,在一般人群中的患病率为1％～2％,＜65岁者为1％,（65～79）岁者＞5％,80岁以上者达10％～20％,心功能Ⅲ级和Ⅳ级的患者年死亡率高达50％[1].美国Framingham研究[2]表明,冠心病、高血压、糖尿病是引起心衰的主要原因.Cowie等[3]的调查也得出类似结果.经济不发达国家的病因构成与以上明显不同.     

Chloroquine-resistant malaria in Jos, Nigeria

A 16-year-old Nigerian boy who had lived all his life in a malaria endemic region presented with continuing fever after what would ordinarily be accepted as adequate treatment for malaria. He went on to develop cerebral malaria, recovering only after administration of quinine.     

Sigmoid volvulus in Kaduna,Nigeria

Worldwide regional variations exist in the incidence of sigmoid volvulus. This article describes the experience with sigmoid volvulus at the Ahmadu Bello University Teaching Hospital in Kaduna, Nigeria. Sixty of 121 patients who had large-bowel obstruction over a 15-year period had sigmoid volvulus. Fifty-seven (95 percent) had gangrenous bowel. The mortality rate was 16.7 percent. The clinical presentation and the treatment modalities offered are discussed.     

Gynaecologic mortality in Enugu, Nigeria

A retrospective review of 79 deaths in 2033 gynaecologic admissions at a referral centre showed that the leading causes of mortality were cervical cancer, choriocarcinoma, septic abortion and ovarian cancer, in that order. The results suggest a need for an organized cancer programme to limit morbidity and mortality from malignant disease of the female genital tract.     

Enterocutaneous fistulas in Enugu,Nigeria

Forty-four patients with enterocutaneous fistulas treated at the University of Nigeria Teaching Hospital (UNTH) Enugu in five years (1977–81) are reviewed. Most fistulas resulted from complications of surgery (29 per cent) and appendicitis (55 per cent). The commonest locations were in the cecum (48 per cent), ileum (30 per cent), and colon (20 per cent). The outstanding complication was sepsis. Spontaneous closure occurred in 15 patients (34 per cent). Twenty-two patients were treated surgically. There was a high mortality of 18 per cent from septic complications and malnutrition.     

Rectal polyps in Zaria,Nigeria

Conclusion Thus, we conclude that true adenomatous polyps are uncommon in northern Nigeria, and appear in patients more than 20 years old (fig. 7). The commonest type of rectal polyp is the juvenile polyp. Next in importance is the schistosomal polyp, which is seen at an earlier age here than in Egypt. These two histologic types together account for three quarters of all the rectal polyps, and appear mostly before the age of 20 years. While the schistosomal polyp in Zaria looks a little different histologically from that seen in Egypt, neither seems to have a malignant potential. There appears to be no relationship between these polyps and colorectal carcinoma, which is relatively uncommon in this region.     

Neonatal septicaemia in Calabar, Nigeria

A three-year survey of neonatal septicaemia (363 bacteriologically proven cases) in the University of Calabar Teaching Hospital, Calabar, has demonstrated that the dominant blood isolate was Staphylococcus aureus (53%) followed by unclassified Coliforms (20%), an unexpected Chromobacterium violaceum (5%). The incidence of neonatal septicaemia was 54.9 per 1000 live births for inborn infants. The predominant organisms were largely susceptible to gentamicin, ceftriazone and cefuroxime with a mortality rate of 19% with most (60.9%) of the fatalities being due to Gram-negative organisms.     

Dracunculiasis in Igbon, Oyo State, Nigeria

Studies conducted between 1978 and 1979 to determine the prevalence and site of guinea-worm transmission in Igbon, Nigeria, showed that in less than 5 years of the introduction of dracunculiasis into this community, the infection rate had reached over 75% among the economically active group. Multiple infections were rampant and the frequency of occurrence of severe incapacitation was correspondingly high as reflected by prolonged and excessive absenteeism from schools, inability to engage in farming, trading and domestic work. The peak of transmission occurred in November which coincided with the retreat of rain and the abundance of Thermocyclops nigerianus in the two adjacent ponds where active transmission occurred. While ignorance was primarily responsible for annual transmission, secondary infection resulting from unsanitary methods of local treatment, seemed to be the major cause of prolonged and severe incapacitation.