Endocrine-related diseases in the emergency unit of a Tertiary Health Care Center in Lagos: A study of the admission and mortality patterns

Introduction:

Non-communicable diseases are emerging as an important component of the burden of diseases in developing countries. Knowledge on admission and mortality patterns of endocrine-related diseases will give insight into the magnitude of these conditions and provide effective tools for planning, delivery, and evaluation of health-care needs relating to endocrinology.

Materials and Methods:

We retrieved medical records of patients that visited the emergency unit of the Lagos University Teaching hospital, over a period of 1 year (March 2011 to February 2012) from the hospital admissions and death registers. Information obtained included: Age, gender, diagnosis at admission and death, co-morbidities. Diagnoses were classified as endocrine-related and non-endocrine related diseases. Records with incomplete data were excluded from the study.

Results:

A total of 1703 adult medical cases were seen; of these, 174 were endocrine-related, accounting for 10.2% of the total emergency room admission in the hospital. The most common cause of endocrine-related admission was hyperglycaemic crises, 75 (43.1%) of cases; followed by diabetes mellitus foot syndrome, 33 (19.0%); hypoglycaemia 23 (13.2%) and diabetes mellitus related co-morbidities 33 (19.0%). There were 39 endocrine-related deaths recorded. The result revealed that 46.1% of the total mortality was related to hyperglycaemic emergencies. Most of the mortalities were sepsis-related (35.8%), with hyperglycaemic crises worst affected (71.42%). However, the case fatalities were highest in subjects with thyrotoxic crisis and hypoglycaemic coma.

Conclusion:

Diabetic complications were the leading causes of endocrine-related admissions and mortality in this health facility. The co-morbidity of sepsis and hyperglycaemia may worsen mortality in patients who present with hyperglycaemic crises. Hence, evidence of infection should be sought early in such patients and appropriate therapy instituted.     

Early result of hemiarthroplasty in elderly patients with fracture neck of femur

Background:

Fractured neck of femur is a frequent and severe injury in elderly patients with consequent high morbidity and mortality. Hemiarthroplasty is an established treatment modality for displaced intracapsular femoral neck fractures in elderly patients above 60 years. This study analysed the early functional outcome and complications of Austin Moore endoprosthesis in elderly patients above 60 years with fractured neck of femur.

Materials and Methods:

Retrospective data were obtained over a 5 year period from January 2007 to December 2012. Thirty-five elderly patients of 60 years and above with displaced intracapsular fracture neck of femur treated with hemiarthroplasty using Austin Moore endoprosthesis were included. Data were analysed using SPSS version 21.

Results:

A total of 35 patients were involved. The age-range was 60-90 years with mean age of 69.7 ± 7 years. The predominant mechanism of injury was trivial falls in 18 (66.7%) patients. The commonest complication was pressure sore in 2 (5.7%) patients, followed by surgical site infection in 1 (2.9%) patient and periprosthetic fracture in 1 (2.9%) patients. Early post-operative mortality was 2.9%. Post-operative hip functional status according to Postel and Merle d Aubigne revealed that majority (66.6%) of patients had satisfactory hip function.

Conclusion:

Functional outcome of Austin Moore in elderly patients above 60 years with fracture neck of femur was satisfactory in most of the cases with minimal morbidity. Careful patient selection for hemiarthroplasty is vital and may decrease the incidence of complications and ameliorate the outcomes in the treatment of intracapsular femoral neck fractures.     

A histopathological study of prostate lesions in Lagos,Nigeria: A private practice experience

Introduction:

Prostatic carcinoma (CaP) is globally the second most frequently diagnosed cancer and the sixth leading cause of cancer death in males. The aim of this study is to determine the pattern of histopathological types of prostatic lesions seen in a private laboratory in Lagos, Nigeria.

Materials and Methods:

Histopathological reports of all prostate specimens, which were received and processed by histopathology section of a private laboratory in Lagos, Nigeria, from August 2009 to December 2013 were reviewed.

Results:

A total of 304 prostatic tissue specimens were received and processed during the period under review. The youngest patient was 32 years old while the oldest patient was 99 years old with a mean of 67.8 years ± 9.5. The most common diagnosis was benign prostatic hyperplasia (BPH) (62.8%), distantly followed by CaP (29.3%), inadequate samples (6.6%), prostatic intraepithelial neoplasia (1%), and metastasis to the prostate (0.3%). The peak incidence was age group of 60-69 years, closely followed by 70-79 years accounting for 38.2% and 36.2%, respectively. Moderately differentiated CaP (Gleason scores [GSs] 5-7) accounted for 58.1% of the cases while GS 7 was the most common individual score and was seen in 32.3% of the CaP cases.

Conclusion:

In this private practice, BPH is the most common prostate lesion. CaP is relatively high and most of the cases have a high GS that portends high mortality in our population. Efforts should be made to increase awareness so as to reduce the mortality.     

The Little India riot: experience of an emergency department in Singapore

INTRODUCTION

Singapore experienced its second riot in 40 years on 8 December 2013, in the area known as Little India. A retrospective review of 36 casualties treated at the emergency department was conducted to evaluate injury patterns.

METHODS

Characteristics including the rate of arrival, injury severity, type and location, and disposition of the casualties were analysed.

RESULTS

The injuries were predominantly mild (97.2%), with the most common injuries involving the head (50.0%) and limbs (38.9%). 97.2% of the casualties were managed as outpatient cases.

CONCLUSION

The majority of the injuries in this incident were mild and could be managed as outpatient cases. Important lessons were learnt from the incident about the utilisation of manpower and safety of staff in the emergency department.     

Anogenital warts in Northern Nigeria: A ten-year Review

Background:

Anogenital warts are a common cause of morbidity affecting mainly the productive age group of the economy. Paucity of data in Nigeria necessitated this study.

Materials and Methods:

The pathology records of anogenital warts diagnosed in the Department of Pathology, Ahmadu Bello University Zaria between 1^st January 2000 and 31^st December 2009 were reviewed.

Results:

A total of 68 warts were diagnosed within the study period with anogenital warts constituting 39.7%. Majority of cases (62%) were in the 20-39 years age group (range: 5–50 years) and vulva was the most common site affected.

Conclusion:

Genital warts are common in our environment, biopsy of suspicious lesions is recommended for diagnostic yield.     

Rupture of the gravid uterus in a tertiary health facility in the Niger delta region of Nigeria: A 5-year review

Background:

Ruptured uterus is a major life-threatening condition encountered mostly in developing countries and is an index of failure of obstetric care at a point in time in a woman''s reproductive career. With worsening economic condition, increasing caesarean section rates, and patients’ aversion for operative delivery this condition would still remain a major obstetric matter for discussion.

Objective:

To identify the incidence, sociodemographic variables, clinical characteristics, causes, and outcome of ruptured uterus at the University of Port Harcourt Teaching Hospital.

Materials and Methods:

A 5-year retrospective study of cases of ruptured uterus at the University of Port Harcourt Teaching Hospital was carried out. The case notes of 40 patients with uterine rupture during the period 2003-2007 were analyzed. Data collected included sociodemographic characteristics, etiologic factors, clinical presentation, and outcome. Data were analyzed using Microsoft Excel version 2007 and SPSS 14.0 computer software.

Results:

The incidence of rupture of the gravid uterus was 1:258 deliveries. In patients with rupture of the gravid uterus, 65% (26) of patients were unbooked; 37.5% (15) were aged between 25 and 29 years. A total of 42.5% (17) of patients had secondary education and 21 (52.5%) were housewives. Rupture of a previous scar was the commonest etiologic factor accounting for 32.5% (11). The commonest presentation was abdominal pain in 92.5% of cases. Perinatal mortality and maternal mortality were 80% and 17.5% respectively.

Conclusion:

Rupture of the gravid uterus still remains a major cause of maternal mortality. Injudicious use of oxytocics should be discouraged in peripheral health facilities and reinforcement of the need for hospital based deliveries in patients with previous caesarean sections should also be intensified to improve outcome.     

Values of the Wells and Revised Geneva Scores Combined with D-dimer in Diagnosing Elderly Pulmonary Embolism Patients

Background:

Pulmonary embolism (PE) can be difficult to diagnose in elderly patients because of the coexistent diseases and the combination of drugs that they have taken. We aimed to compare the clinical diagnostic values of the Wells score, the revised Geneva score and each of them combined with D-dimer for suspected PE in elderly patients.

Methods:

Three hundred and thirty-six patients who were admitted for suspected PE were enrolled retrospectively and divided into two groups based on age (≥65 or <65 years old). The Wells and revised Geneva scores were applied to evaluate the clinical probability of PE, and the positive predictive values of both scores were calculated using computed tomography pulmonary arteriography as a gold standard; overall accuracy was evaluated by the area under the curve (AUC) of receiver operator characteristic curve; the negative predictive values of D-dimer, the Wells score combined with D-dimer, and the revised Geneva score combined with D-dimer were calculated.

Results:

Ninety-six cases (28.6%) were definitely diagnosed as PE among 336 cases, among them 56 cases (58.3%) were ≥65 years old. The positive predictive values of Wells and revised Geneva scores were 65.8% and 32.4%, respectively (P < 0.05) in the elderly patients; the AUC for the Wells score and the revised Geneva score in elderly was 0.682 (95% confidence interval [CI]: 0.612–0.746) and 0.655 (95% CI: 0.584–0.722), respectively (P = 0.389). The negative predictive values of D-dimer, the Wells score combined with D-dimer, and the revised Geneva score combined with D-dimer were 93.7%, 100%, and 100% in the elderly, respectively.

Conclusions:

The diagnostic value of the Wells score was higher than the revised Geneva score for the elderly cases with suspected PE. The combination of either the Wells score or the revised Geneva score with a normal D-dimer concentration is a safe strategy to rule out PE.     

Profile of benign breast diseases in western Saudi Arabia: An 8-year histopathological review of 603 cases

Objectives:

To describe the histopathological patterns of benign breast diseases (BBD) among Saudi patients.

Methods:

This is a retrospective review of BBD reports of Saudi patients of both genders and all age groups seen between January 2006 and December 2013 at King Fahad Hospital, Madinah, Kingdom of Saudi Arabia.

Results:

Out of the total 1005 breast biopsies, 603 cases (60%) were BBD. The female to male ratio was 30.7:1. The overall mean age for BBD was 27.5 years, with an age range of 14-80 years. The most common lesion was fibroadenoma (FA) accounting for 44.3% of cases (mean age: 23.5 years), followed by 23.4% fibrocystic change (FCC) (mean age: 37.1 years). Both lesions had a peak occurrence in the third decade. Inflammatory lesions constituted 13.9% of cases. Most common were granulomatous mastitis (3.5%), chronic mastitis (3.3%), and acute mastitis with abscess (3.1%). Other major lesions encountered were fibroadenomatoid hyperplasia (3.1%), intraductal papilloma (2.8%), and benign phylloides tumor (2.6%). All benign diagnoses in male patients were gynecomastia and most patients (68.4%) were under 40 years.

Conclusion:

In this study, BBD constituted 60% of breast lumps, and were mostly FA and FCC. The BBD peaked at the 20-29 year age range.Breast diseases are a significant component of the routine workload and experience of a histopathologist, due to the increasing awareness regarding breast cancer (BC). Breast cancer is the most common cancer among women with an estimated 1.67 million new cancer cases diagnosed in 2012 as reported by GLOBOCAN,1 as well as in the Kingdom of Saudi Arabia (KSA), according to the 2012 Saudi Tumor Registry report.2 Reviewing the recent medical literature of the last decade on BBD,3-6 a number of articles reporting the spectrum of BBD on hospital-based retrospective studies in the histopathology laboratories were found. However, there is only one BBD publication from KSA during the last decade, which is from the Eastern region of KSA. There is a lack of publications on BBD from the Western region recently. Therefore, our study was carried out to observe any changes in the disease patterns of BC. The aim of the present study has been describe the histopathological patterns of BBD among Saudi patients in Madinah, KSA.     

Knowledge of heart disease risk factors among workers in a Nigerian University: A call for concern

Introduction:

Cardiovascular disease is the commonest cause of mortality worldwide. Many risk factors predate the development of cardiovascular diseases. Adequate knowledge of risk factors for cardiovascular diseases is the first step towards effective preventive strategies to combat the cardiovascular diseases burden in any population. This study aims to determine the knowledge of workers in a Nigerian University on risk factors for cardiovascular diseases.

Materials and Methods:

A cross-sectional survey of 206 academic and non-academic staff of Ladoke Akintola University of Technology, Ogbomoso, Nigeria using the Heart Disease Fact Questionnaire (HDFQ). Demographic data were taken. The lipid profile and random blood sugar were taken. Statistical analysis was done using SPSS 17.0.

Results:

The mean age of the study participants was 45.3 ± 7.9 years. There were 96 males (46.6%). The mean HDFQ score was 48.6%. Only 41 (19.9%) of participants were assessed to have good knowledge of heart disease risk factors. Majority, 101 (49.0%) had poor knowledge while 64 (31.2%) had fair knowledge of heart disease risk factors. There was no significant difference between prevalence of CV risk factors between those with good or fair or low level of knowledge. Most participants did not have a good level of knowledge about risk factors, prevention, treatment and association with diabetes as it relates to heart diseases.

Conclusion:

Knowledge of heart disease risk factors is low among University workers in Nigeria. Effective education on heart disease risk factors and appropriate preventive strategies are indeed important to reduce cardiovascular disease burden in Nigerian University communities.     

Synopsis of non-communicable diseases in children admitted to the paediatric ward of the university of Nigeria teaching hospital (UNTH) Enugu,Nigeria: A ten year review

Background:

Non-communicable diseases are increasing worldwide due to rapidly changing lifestyles and socio-economic status. It is contributing significantly to the global burden of diseases.

Objective:

To determine the pattern of non-communicable diseases in children admitted into the Paediatrics ward in a tertiary health centre in Enugu.

Materials and Methods:

A review of admissions into the Paediatrics ward of the University of Nigeria Teaching Hospital Enugu, between January 1999 and December 2008 was done using the registry of admission and discharge.

Results:

The age range of patients admitted during the period was 2 months to 18 years (mean 5.27 ± 5.42 years). There were 1173 (59.6%) males and 796 (40.4%) females. Disorders of the haematological system accounted for 514 (23.3%) of the non-communicable diseases among the admissions, malignancies accounted for 424 (19.2%) among the admissions, whereas the renal, central nervous, and cardiovascular systems were involved in 282 (12.8%), 274 (12.4%), and 241 (10.9%) patients, respectively. There were 274 (12.4%) deaths and 1667 (75.5%) discharges while 38 (1.7%) were discharged against medical advice. Data on 221(10.2%) of the patients were reported missing. Malignancies contributed to 75 (27.3%) of the deaths, haematological disorders accounted for 44 (16%) whereas renal disorders and nutritional disorders contributed to 43 (15.7%) and 41 (15%) of the deaths, respectively.

Conclusion:

Non-communicable diseases affect children in our environment and contribute to morbidity and mortality in children. Strategies to prevent these diseases should be encouraged in order to avert the challenges of double burden of the diseases in children.     

Tuberculosis trends over a five-year period at a tertiary care university-affiliated hospital in Singapore

INTRODUCTION

Tuberculosis (TB), a potentially fatal infectious disease, poses significant health problems. The objective of this study was to analyse trends among newly diagnosed TB patients seen at the Singapore General Hospital (SGH).

METHODS

This study was a retrospective case record review of notified TB patients at SGH between 2006 and 2010 (inclusive).

RESULTS

A total of 1,979 cases of TB were notified over the five years. The number increased from 368 in 2006 to 407 in 2010 (p = 0.51), in tandem with the increasing number of patients seen at the hospital and the rising population in Singapore. Singaporean residents accounted for 82.8% of the cases, while non-Singaporean residents and non-residents made up the remainder. The year-to-year percentage of non-Singaporean residents and non-residents notified remained stable throughout the five years (p = 0.783). The number of male Singaporean residents (70.7%) notified was more than twice that of female Singaporean residents (29.3%). The majority of patients infected with TB (31.9%) were elderly patients aged > 65 years. Although testing for the human immunodeficiency virus increased from 43.8% (2006) to 64.2% (2010), the number detected with coinfection remained stable (14 and 12 patients in 2006 and 2010, respectively). Mortality rates also remained stable at 12.0%.

CONCLUSION

We cannot afford complacency, as there was no downward trend in the number of notified TB cases at SGH from 2006 to 2010. As the elderly contribute significantly to the TB burden, increased efforts are required to manage this vulnerable population.     

Awareness Status of Chronic Disabling Neurological Diseases among Elderly Veterans

Background:

The awareness, treatment and prevention of chronic diseases are generally poor among the elderly population of China, whereas the prevention and control of chronic diseases in elderly veteran communities have been ongoing for more than 30 years. Therefore, investigating the awareness status of chronic disabling neurological diseases (CDND) and common chronic diseases (CCD) among elderly veterans may provide references for related programs among the elderly in the general population.

Methods:

A cross-sectional survey was conducted among veterans ≥60 years old in veteran communities in Beijing. The awareness of preventive strategies against dementia, Alzheimer''s disease (AD), Parkinson''s disease (PD), sleep disorders, cerebrovascular disease (CVD) and CCD such as hypertension, and the approaches used to access this information, including media, word of mouth (verbal communication among the elderly) and health care professionals, were investigated via face-to-face interviews.

Results:

The awareness rates for CCD and CVD were approximately 100%, but that for AD was the lowest at <10%. The awareness rates for sleep disorders, PD and dementia, were 51.0–89.4%. Media was the most commonly selected mode of communication by which veterans acquired knowledge about CCD and CVD. Media was used by approximately 80% of veterans. Both health care professionals and word of mouth were used by approximately 50% of veterans. With respect to the source of information about CDND excluding AD, the rates of the use of health care professionals, word of mouth and media were 10.6–28.2%, 56.5–76.5%, and approximately 50%, respectively.

Conclusions:

The awareness of CDND among elderly veterans was significantly lower than that of CCD. More information about CDND should be disseminated by health care professionals. Appropriate guidance will promote the rapid and extensive dissemination of information about the prevention of CDND by media and word-of-mouth peer education.     

Echocardiographic pattern of acquired heart diseases in Nigeria

Background:

Acquired heart diseases (AHDs) are present from childhood to old age, and the frequency of pathology differs according to age and the geographical region of the patients. The aim of this study was to document the echocardiographic patterns of AHDs in our setting.

Materials and Methods:

Retrospective analysis of echocardiographic diagnosis of AHD was done for age, sex, and echocardiographic pattern.

Results:

There were 190 diagnoses in the 163 patients with 27 patients having a double diagnosis, consisting of 88 (54%) males and 75 (46%) females. The mean age was 50.4 years (age range 9-85 years). Ten types of acquired heart pathologies were identified and they included hypertensive heart disease in 49.47%, rheumatic heart disease in 26.32%, cardiomyopathy in 11.05%, endomyocardial fibrosis in 4.74%, and pericarditis in 3.68%. Others were cor pulmonale, pulmonary hypertension, intracardiac thrombi, left atrial myxoma and degenerative heart disease which accounted for the remaining 4.74%.

Conclusion:

This study identifies 10 types of AHDs among the study population. The huge impact of hypertensive heart disease and rheumatic heart disease is a big indicator pointing to the existence of a sub-optimal level of healthcare in the country.     

Cemented hemiarthroplasty in traumatic displaced femoral neck fractures and deep vein thrombosis: is there really a link?

INTRODUCTION

Traumatic displaced femoral neck fractures in the elderly can be treated with cemented or uncemented hemiarthroplasty with good outcomes. Earlier studies reported a higher incidence of deep vein thrombosis (DVT) associated with cemented prostheses in elective total hip or knee arthroplasty. In addition, the hypercoagulable state after a traumatic femoral neck fracture and possible thrombogenic properties of bone cement could put these patients at greater risk for thromboembolism. We aimed to compare the incidence of DVT and progression to pulmonary embolism (PE) or mortality in cemented and uncemented hemiarthroplasty.

METHODS

The data of 271 patients treated with cemented or uncemented hemiarthroplasty after a traumatic displaced femoral neck fracture was retrospectively analysed for the incidence of DVT. The level of thrombosis, progression to PE and mortality were compared.

RESULTS

There were 133 (49.1%) patients with cemented hemiarthroplasty, while 138 (50.9%) had uncemented hemiarthroplasty. The patients had an average age of 76.6 (range 53–99) years and 11 (4.1%) patients had DVT. There were no significant differences in development of DVT, level of thrombosis, PE and mortality regardless of whether a cemented or an uncemented prosthesis was used.

CONCLUSION

Cemented hemiarthroplasty is not associated with higher risks of DVT, PE or mortality in patients with traumatic displaced femoral neck fracture. Cemented prostheses can be safely used for this group of patients.     

Audit of an urban paediatric emergency department visits

Background:

This study aimed to highlight the health seeking behavior of children in an Emergency Department (ED).

Materials and Methods:

Retrospective files review of ED was done for the month of July, 2008. Data about the children ≤12 years of age was gathered.

Results:

In one month period a total 21000 patients visited our ED, out of them 6120 (29%) were children. Males, Saudis and children of (1-6 years) were more frequent, i.e., 3540 (57.8%), 5760 (94.1%) and 3180 (52%), respectively. Majority of patients visited in shift “2”, i.e., 15:30 hours to 23:30 hours. Among the patients “diseases of respiratory system” were found more frequent 4170 (68.1%) and main diagnosis was “acute upper respiratory tract infection” 3300 (53.9%). Non-urgent cases were 2020 (33%) while 244 (4%) were admitted.

Conclusion:

Young children as well as non-urgent cases were predominant. Evening shift was the busiest one.     

Infections During Induction Therapy of Protocol CCLG-2008 in Childhood Acute Lymphoblastic Leukemia: A Single-center Experience with 256 Cases in China

Background:

Infections remain a major cause of therapy-associated morbidity and mortality in children with acute lymphoblastic leukemia (ALL).

Methods:

We retrospectively analyzed the medical charts of 256 children treated for ALL under the CCLG-2008 protocol in Beijing Children''s Hospital.

Results:

There were 65 infectious complications in 50 patients during vincristine, daunorubicin, L-asparaginase and dexamethasone induction therapy, including microbiologically documented infections (n = 12; 18.5%), clinically documented infections (n = 23; 35.3%) and fever of unknown origin (n = 30; 46.2%). Neutropenia was present in 83.1% of the infectious episodes. In all, most infections occurred around the 15^th day of induction treatment (n = 28), and no patients died of infection-associated complications.

Conclusions:

The infections in this study was independent of treatment response, minimal residual diseases at the end of induction therapy, gender, immunophenotype, infection at first visit, risk stratification at diagnosis, unfavorable karyotypes at diagnosis and morphologic type. The infection rate of CCLG-2008 induction therapy is low, and the outcome of patients is favorable.     

Prevalence and Risk Factors of Atrial Fibrillation in Chinese Elderly: Results from the Chinese Longitudinal Healthy Longevity Survey

Background:

Prevalence of atrial fibrillation (AF) is increasing as the world ages. AF is associated with higher risk of mortality and disease, including stroke, hypertension, heart failure, and dementia. Prevalence of AF differs with each population studied, and research on non-Western populations and the oldest old is scarce.

Methods:

We used data from the 2012 wave of the Chinese Longitudinal Healthy Longevity Survey, a community-based study in eight longevity areas in China, to estimate AF prevalence in an elderly Chinese population (n = 1418, mean age = 85.6 years) and to identify risk factors. We determined the presence of AF in our participants using single-lead electrocardiograms. The weighted prevalence of AF was estimated in subjects stratified according to age groups (65–74, 75–84, 85–94, 95 years and above) and gender. We used logistic regressions to determine the potential risk factors of AF.

Results:

The overall prevalence of AF was 3.5%; 2.4% of men and 4.5% of women had AF (P < 0.05). AF was associated with weight extremes of being underweight or overweight/obese. Finally, advanced age (85–94 years), history of stroke or heart disease, low high-density lipoprotein levels, low triglyceride levels, and lack of regular physical activity were associated with AF.

Conclusions:

In urban elderly, AF prevalence increased with age (P < 0.05), and in rural elderly, women had higher AF prevalence (P < 0.05). Further exploration of population-specific risk factors is needed to address the AF epidemic.