Mortality Pattern in Surgical Wards of a University Teaching Hospital in Southwest Nigeria: A Review

Background

There are many reports from different parts of the world addressing different aspects of surgical mortality. There are few reports from our country, however, and most of them have dealt with mortality in the emergency room. The aim of this study was to determine the prevalence of mortality associated with surgical care and the trends in prevalence of surgical mortality. We used our results as benchmarks to identify areas of improvement.

Methods

The records of all patients who died during admission for surgical care in Olabisi Onabanjo Teaching Hospital Sagamu between January 2006 and December 2010 were studied retrospectively. Relevant data were extracted, including demographics, surgical diagnosis, co-morbid conditions, length of hospital stay, surgical procedure performed, outcome of treatment, and date of death. Results were analyzed with Statistical Package for Social Sciences version 15.

Results

The total admission in the surgical wards for 2005–2010 was 5,444, with a total of 2,217 surgical operations carried out during the same period. There were 277 (5.09 %) deaths (165 male and 112 female patients). Of 277 deaths, only 170 case notes (61 %) were available for review. Primary causes of death were classified as cancer (50 deaths, 29.4 %), trauma (66, 38.8 %), infection/inflammatory (16, 9.4 %), and other (38, 22.4 %). Surgical operations were performed in 60 (35.3 %) of the patients who died. No surgery was done in 110 (64.7 %) of those who died.

Conclusions

The pattern of surgical mortality is not directly related to surgical procedures as most of the deaths occurred in the nonoperative care group. Trauma-associated deaths topped the list.     

Suicide risk among adults with epilepsy in Kaduna,Nigeria

Objective

There is paucity of information on epilepsy and suicide in Nigeria. The objective of this study therefore was to assess the prevalence and determinants of suicide risk among adults with epilepsy (AWE) in Kaduna, Nigeria.

Method

We administered the suicidality module of the Mini International Neuropsychiatric Interview, the three-item Oslo Social Support Scale and the Hospital Anxiety and Depression Scale to 170 consecutive AWE attending the outpatient clinic of Federal Neuropsychiatric Hospital, Kaduna, between January and June 2011 to determine the prevalence of suicide risk, the level of social support and the psychological symptoms, respectively. We also recorded the sociodemographic and clinical characteristics of the subjects.

Results

There are 99 males and 71 females. The subject’s mean age was 28.7±12.1 years. The prevalence of suicide risk was 20.0%. Short seizure-free periods (χ²= 4.658, P= .031), previous suicide attempts (χ²= 12.216, P< .001), anxiety symptoms (χ²= 5.075, P= .024) and depressive symptoms (χ²= 5.093, P= .016) were significantly associated with suicidal tendencies. However, after a logistic regression analysis, none of the above variables predicted suicide risk.

Conclusion

Suicide risk is common among AWE. Poor seizure control, previous suicidal attempts and emotional distress are associated factors.     

Seasonal ataxia: A case report of a disappearing disease

Introduction

Seasonal ataxia is a clinical syndrome of acute cerebellar ataxia which follows ingestion of roasted larvae of Anaphe venata Butler, an alternative protein source consumed in western Nigeria. It was first reported in the 1950s in western Nigeria when it caused a wave of epidemics. This is the first case report of this condition in the literature since 1993.

Case report

We present the case of a 35 year old woman from western Nigeria who was admitted in October 2012 with acute onset of gait instability and bilateral hand tremors, preceded by several episodes of vomiting. She had ingested a meal containing roasted larvae of the African silkworm, 2 hours before the onset of vomiting.

Conclusion

Seasonal ataxia is an important differential diagnosis of acute cerebellar ataxia among the indigenous ethnic population of western Nigeria.It is non-fatal and treatable, with complete resolution of symptoms usually following thiamine therapy.     

Pharmacodynamic and efficacy profile of TGN 255, a novel direct thrombin inhibitor, in canine cardiopulmonary bypass and simulated mitral valve repair

Heparin-induced thrombocytopenia can be a life-threatening sequel to conventional use of unfractionated heparin in cardiopulmonary bypass (CPB). This study evaluated the pharmacokinetic/pharmacodynamic (PK/PD) and efficacy profile of a novel direct thrombin inhibitor, TGN 255, during cardiac surgery in dogs. Point-of-care coagulation monitoring was also compared against the plasma concentrations of TRI 50c, the active metabolite of TGN 255. The study was conducted in three phases using 10 animals: phase 1 was a dose-ranging study in conscious animals (n = 6), phase 2 was a similar but terminal dose-ranging study in dogs undergoing CPB (n = 6), and phase 3 was with animals undergoing simulated mitral valve repair (terminal) using optimal TGN 255 dose regimens derived from phases I and II (n = 4). During the study, PD markers and drug plasma levels were determined. In addition, determinations of hematologic markers and blood loss were undertaken. Phase 1 studies showed that a high-dose regimen of a 5-mg/kg bolus and infusion of 20 mg/kg/h elevated PD markers in conscious animals, at which time there were no measured effects on platelet or red blood cell counts, and the mean plasma concentration of TRI 50C was 20.6 microg/mL. In the phase 2 CPB dose-ranging study, this dosing regimen significantly elevated all the PD markers and produced hemorrhagic and paradoxical thrombogenic effects. In the phase 3 surgical study, a lower TGN 255 dose regimen of a 2.5-mg/kg bolus plus 10 mg/kg/h produced anticoagulation, elevated PD markers, and produced minimal post-operative blood loss in the animals. Plasma levels of TRI 50C trended well with the conventional point-of-care coagulation monitoring. TGN 255 provided effective anticoagulation in a canine CPB procedure, enabling successful completion with minimal blood loss. These findings support further evaluation of TGN 255 as an anticoagulant for CPB.     

Essential thrombocythaemia associated with priapism: a case report

A case of priapism complicating essential thrombocythaemia in a 45-year old Nigerian gardener is described. His platelet counts ranged from 1.2-1.6 x 10(12)/L, haematocrit from 0.25-0.33 L/L and leucocytes from 23.4-30.6 x 10(9)/L. There was a splenomegaly of 5cm. He had bilateral cavernostomy but is yet to regain penile erection 3(1)-2 months after surgery.     

Acyl-enzymes as thrombolytic agents in a rabbit model of venous thrombosis

A derivative of human lys-plasmin in which the active site has been reversibly acylated (BRL 26920; p-anisoyl human lys-plasmin) has been examined as a fibrinolytic agent in a previously described rabbit model of venous thrombosis and shown to be significantly more active and less fibrinogenolytic than free plasmin. A p-anisoylated derivative of a streptokinase (SK)-activated plasmin preparation was significantly less fibrinogenolytic in vivo than the non-acylated enzyme. Acylation increased the fibrinolytic activity of preparations of SK-plasmin activator complexes. BRL 26921, the active site anisoylated derivative of the primary 2-chain SK-plasminogen complex was the most potent fibrinolytic agent studied. SK-Val442-plasminogen complexes, free or acylated, were biologically inactive in this model and confirm the essential nature of fibrin binding processes for effective thrombolysis in vivo.     

Comparison of the hypotensive effects of streptokinase-(human) plasmin activator complex and BRL 26921 (p-anisoylated streptokinase-plasminogen activator complex) in the dog after high dose, bolus administration

In view of current interest in the possibility of rapid, high-dose administration of thrombolytic agents by the intravenous route in patients with coronary thrombosis (AMI), a study of this technique was carried out in the dog. Streptokinase-(human) plasmin activator complex (SK-Pm) and BRL 26921 (p-anisoylated streptokinase-(human) plasminogen activator complex) were each given at equivalent doses (28,500 IU/kg and 800 micrograms/kg respectively) to groups of beagle dogs by rapid injection over 10 sec and their effects on blood pressure, plasmin formation and kallikrein production were compared over the next 3h. SK-Pm produced, within 1-3 min, a pronounced hypotensive effect that was kinetically related to a rapid and steep rise in systemic plasmin and kallikrein concentrations. BRL 26921 had no hypotensive effect, the rise in plasmin production was slower and the rate and extent of kallikrein formation was significantly less than in the SK-Pm group.