Less severe retinopathy of prematurity induced by surfactant replacement therapy

To assess the effect of surfactant replacement therapy (SRT) on the prevalence and severity of retinopathy of prematurity (ROP), we compared data from 160 SRT-treated preterm infants with data from 230 historic controls. The prevalence of ROP was 30.6% in the treatment group and 23.4% in the control group. Severe ROP (stages 3-4) was seen in 6.1% of the infants with ROP in the treatment group and 20.3% of the ROP patients in the control group. Surfactant therapy had no influence on the prevalence of ROP (odds ratio 1.4, 95% confidence interval 0.797-2.459, p = 0.242). However, SRT was associated with a decreased risk for severe ROP, compared to mild ROP (odds ratio 0.226, 95% confidence interval 0.056-0.905, p = 0.036). These data suggest that SRT is associated with a decreased risk for severe ROP.     

Twin births in the university of Portharcourt teaching hospital Portharcourt: a 6 year review

Objective:To provide information on twin births and associated factors in Port barcourt South South Nigeria.Methods:Data on twin deliveries from 1st January 2003 to 31st December 2008 were collected and analysed.This included the maternal age and parity,gestation age,Apqar scores,sex and birth weight of twins.Results:A total of 11042 deliveries occurred over the study period with 333 being twins giving a twin rate of 1∶33.Male twins constituted 48% of twin births with male to female ratio of 1∶1.08.The mean age and parity of mothers were 29.6 years and 2.5 respectively.Presentation of the cephalic/cephalic for the first and second twins was the most common(63.4%).Severe birth asphyxia(first minute Apgar score 1-3)occurred in 3.9% of twins.Male-male twin pair occurred in 28.5% of twins,male-female in 39% while female-female occurred in 32.5%.The Caesarian section rate was 48%.Conclusion:The twining rate in this study is high.In this locality,there is a need for early ultrasound scanning of pregnant women particularly those of parities 1 to 3 and those aged 25-34 years in whom highest rates of twinning occurred to detect twinning when present and refer them to sufficiently equipped centres for adequate antenatal and perinatal care.     

Neonatal mortality in a tertiary hospital in Southern Nigeria

Objective: With improved and sustained efforts in the prevention and management of pneumonia, diarrhea and vaccine preventable diseases, neonatal mortality is increasingly becoming a major contributor to childhood mortality particularly in developing countries. Evaluation of neonatal mortality pattern is an essential step in the effort to curb its incidence. We therefore, set out to determine the neonatal mortality pattern and its associated factors in a tertiary hospital in southern Nigeria. Methods: This is a retrospective study of neonatal mortality in a tertiary hospital from August 2004 to July 2007(a 3 year period). Data obtained include total live births, neonatal deaths, relevant information on pregnancy, labour and delivery, neonatal morbidity and duration of life. Results: There were a total of 3,051 live births and 44 neonatal deaths with a neonatal mortality rate of 14.4/1000 live births. Early neonatal mortality constituted 81.8%of over all neonatal mortality with the major causes being prematurity 40% severe birth asphyxia 29.5%and neonatal sepsis 18.3%. Low birth weight babies (<2500 grams) constituted 55.5% of total neonatal mortality. Conclusion: Early neonatal mortality constitutes an overwhelming proportion of neonatal mortality in Southern Nigeria. This can be significantly curtailed by reducing the incidence and death from prematurity, severe birth asphyxia and neonatal sepsis.     

Negotiated dying: a grounded theory of how nurses shape withdrawal of treatment in hospital critical care units

Background

The process of withdrawal of treatment in critical care environments has created ethical and moral dilemmas in relation to end of life care in the UK and elsewhere. Common within this discourse is the differing demands made on health professionals as they strive to provide care for the dying patient and family members. Despite reports that withdrawal of treatment is a source of tension between those nurses and doctors involved in the process, the role of the nurse in facilitating withdrawal of treatment has received relatively little attention.

Objectives

To illustrate how differing dying trajectories impact on decision-making underpinning withdrawal of treatment processes, and what nurses do to shape withdrawal of treatment.

Design

Qualitative methods of enquiry using clinical vignettes and applying Charmaz's grounded theory method.

Methods and settings

Single audio-recorded qualitative interviews with thirteen critical care nurses from four intensive care specialities: cardiac; general; neurological and renal were carried out. Interviews were facilitated by an end-of-life vignette developed with clinical collaborators.

Findings

Across critical care areas four key dying trajectories were identified. These trajectories were shaped by contested boundaries associated with delayed or stalled decision-making around how withdrawal of treatment should proceed. Nurses provided end of life care (including collaborative and action-oriented skills) to shape the dying trajectory of patients so as to satisfy the wishes of the patient and family, and their own professional aims.

Conclusions

Differing views as to when withdrawal of treatment should commence and how it should be operationalised appeared to be underpinned by the requirements of the role that health professionals fulfil, with doctors focusing on making withdrawal of treatment decisions, and nurse's being tasked with operationalising the processes that constitute it. Multidisciplinary teams need a ‘shared’ understanding of each other's roles, responsibilities, aims, and motivations when planning and implementing the dying trajectory of withdrawal of treatment.     

Evaluation of utilization of antenatal services by mothers of babies with severe birth asphyxia

Objective:To evaluate the utilization of antenatal services by mothers of babies delivered with severe birth asphyxia at the University of Port Harcourt Teaching Hospital(UPTH) Port Harcourt,Nigeria.Methods: A case control study of the utilization of antenatal services by 97 mothers of newborns with severe birth asphyxia delivered at UPTH from 1st February to 31st October 2009 compared with mothers of newborns with normal Apgar scores was done.Relevant pregnancy,birth,family and social history was obtained by personal interviews and referral to case notes.Results: Significantly more of the mothers of babies with normal Apgar score booked early(4 months or less) and had up to 8 or more antenatal visits prior to delivery than mothers of asphyxiated babies 86(88.6%) vs 68(70.2%),P=0.002;93(95.7%) vs 68(70.2%),P=0.001 respectively.Significantly more subjects 56(57.7%) than the controls 45(46.4%) were primiparous,P= 0.04.Also,significantly more subjects 19(19.5%) suffered delay prior to intervention in labour than the controls 5(5.1%),P=0.004.Conclusion: Primiparity,delayed booking,inadequate antenatal visits and late intervention in labour have been identified as significant contributors to severe birth asphyxia.     

Public awareness of testicular cancer and testicular self-examination in academic environments: a lost opportunity

BACKGROUND:

Although testicular cancer is the most common cancer among 18- to 50-year-old males, healthcare providers seldom teach testicular self-examination techniques to clients, thus potentially missing opportunities for early detection. This form of cancer is easily diagnosable by testicular self-examination and is 96% curable if detected early. Periodic self-examination must be performed for early detection. Knowledge deficits and sociocultural norms contribute to low levels of health-related knowledge in most patients, resulting in undue delays before seeking medical advice.

OBJECTIVE:

Our aim is to assess the level of awareness of testicular cancer and the prevalence of the practice of testicular self-examination in academic environments to enable appropriate interventions.

METHOD:

A cross-sectional survey was administered to 750 consecutive males aged 18–50 years in three tertiary institutions in Port Harcourt from October 2008 to April 2009.

RESULT:

Knowledge or awareness of testicular cancer was poor. Almost all of the respondents were unaware that testicular lumps may be signs of cancer. A lump was typically construed as a benign carbuncle or something that could resolve spontaneously. The main factor contributing to respondents'' lack of knowledge of testicular cancer was that few reported that they were “ever taught about testicular self-examination.”

CONCLUSION:

Young adult men are unaware of their risk for testicular cancer, which is the most common neoplasm in this age group. Healthcare providers are not informing them of this risk, nor are they teaching them the simple early detection technique of self-examination of the testes.     

Genital chlamydia trachomatis infection among female undergraduate students of University of Port Harcourt,Nigeria

Background:

Genital Chlamydia trachomatis infection is a common bacterial sexually transmitted infection worldwide. There is little information about this infection in Nigeria. This study determined the prevalence of genital Chlamydia trachomatis infection among female undergraduates of University of Port Harcourt and identify the various associated risk factors.

Materials and Methods:

A cross-sectional prospective study of 354 female students was done. Their socio-demographic characteristics and pattern of sexual behaviour was noted followed by collection of endocervical swab which was analysed with a Chlamydia Rapid Test Device. Data management was done by SPSS version 17.0 statistical package.

Result:

The prevalence of genital Chlamydia trachomatis infection was 30.2%. First coital exposure at14 years or less had the highest prevalence of the disease. Multiple sexual partners, tribe and inconsistent use of condom were significantly related with Chlamydia trachomatis infection.

Conclusion:

Genital Chlamydia trachomatis is prevalent among female undergraduates of the University of Port Harcourt.     

The breaking of an intrathecally-placed epidural catheter during extraction

IMPLICATIONS: Misplacement of an epidural catheter into the subarachnoid space is a recognized complication. However, breakage of an intrathecal epidural catheter during removal presents a dilemma. Appropriate imaging, a neurosurgical consultation, and aggressive surgical exploration and extraction of the retained piece are warranted, even in the asymptomatic patient.