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  Access statistics : Table of Contents
   2017| April-June  | Volume 26 | Issue 2  
    Online since February 13, 2020

 
 
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CASE REPORTS
Emergency inevitable caesarean myomectomy, challenge to obstetrician/ gynaecologist: A case report
S Eli, DG B Kalio, DS Abam, K Onumbu, DK O Pepple, HA A Ugboma
April-June 2017, 26(2):185-187
DOI:10.4103/1115-2613.278294  
BACKGROUND: Caesarean myomectomy is not routinely done by Obstetricians/Gynaecologists due to associated complications and increased risk of maternal morbidity/mortality.The incidence of fibroid in pregnancy varies from 1.6% to 10.7% globally. AIM: To present an uncommon management modality. +0 CASE REPORT: Mrs BD is a 34-year-old unbooked G1 Para 0+0 at 3 weeks' gestation who presented on selfreferral from a maternity with complaints of increasing abdominal pain and breathlessness of 1day duration. Examination at presentation revealed fundal height of 44cm, intra-abdominal mass consistent with huge uterine fibroid extending from the fundus to the lower segment, oblique-lying foetus with normal heart tones. Obstetric ultrasound done on admission were in keeping with above clinical findings with uterine fibroid measuring 22cm by 20cm. She was billed for elective caesarean section but went into labour which necessitated an emergency caesarean section with delivery of a live male baby, birth weight 3.2kg and myomectomy for uterine fibroid at the lower uterine.The estimated blood los was 800mls,She had a unit of blood intra-operatively. Her post-operative period was uneventful. She was counselled on the extent of the surgery including her future fertility and family planning.She was discharged home on her 7th post-operative day in satisfactory clinical condition. CONCLUSION: Caesarean myomectomy may be a hazardous surgical procedure to the attending Obstetrician/Gynaecologist. However,adequate pre-operative preparation,the skill and speed of the surgeon may help improve maternal /perinatal outcome.
[ABSTRACT]   Full text not available  [PDF]
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ORIGINAL ARTICLES
Awareness and utilisation of postnatal care services among antenatal clinic attendees at ahmadu bello university teaching hospital Zaria
John Kingsley C. Nwajagu, Nkeiruka Ameh, Adekunle O Oguntayo
April-June 2017, 26(2):112-116
DOI:10.4103/1115-2613.278282  
BACKGROUND: Postnatal period is the period from one hour to six weeks after the birth of an infant. It is a critical period for the woman,her new born and her family on a physiological,emotional and social level especially because 50-70% of all maternal deaths occur during this period. AIM: To identify the determinants of women's utilization of postnatal clinic services (PNCs). METHODS: A descriptive study on 188 eligible antenatal clinic attendees at the Obstetrics and Gynaecology Department of Ahmadu Bello University Teaching Hospital (ABUTH) Shika-Zaria from October to December 2013.Structured questionnaires were used for the study.Approval was obtained from the Ethical committee of the ABUTH, Shika-Zaria.TheSPSS version 16 was used for data analysis and the results was subjected to descriptive analysis. RESULTS: The majority were Hausas. 39.9% had tertiary school education. Majority of them (42%) were multiparous women, 77.7% were aware of the postnatal services they should receive. Previous antenatal clinic (ANC) attendance was 95.1% and 74.4% attended PNC. Educational level affected PNC utilisation, tertiary education (60%),secondary (28%) and primary (5%).Employed respondents had more PNC attendance (84%) than the unemployed (25%). CONCLUSION:The study shows that awareness, education, employment and antenatal clinic attendance are the promoting factors to utilisation of PNC services and the hindering factors to utilisation of PNCs include lack of awareness,distance and lack of transportation,poverty or lack of money.
[ABSTRACT]   Full text not available  [PDF]
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Digital habits and use of the internet as source of sexual and reproductive health information among undergraduates in northern Nigeria
Z Iliyasu, AY Mohammed, AU Gajida, AM Jibo, MH Aliyu
April-June 2017, 26(2):138-145
DOI:10.4103/1115-2613.278286  
BACKGROUND: Surfing the internet and networking via social media have evolved at a startling pace. OBJECTIVES: To determine internet and social media habits and identify predictors of their use as sexual and reproductive health resource among Bayero University students. STUDY DESIGN: A cross section of 385 students was interviewed using pre-tested anonymous structured selfcompleted questionnaires. RESULTS: Nearly all students 98.4% (n=377) had accessed the internet and most 96.3% (n=363) had visited social media sites.Face book 57.3% (n=208),Twitter 22.3% (n=81) and Blackberry Messenger 8.8% (n=32) were the most popular among students.Of those with internet access, 51.2%, 46.2%, 39.2% and 38.5% mainly searched for information on HIV/AIDS, STI, sexual activities and menstrual problems respectively. There was more than twofold likelihood of accessing online sexual information among female students compared to males, adjusted Odds ratio (aOR=2.52); 95% Confidence Interval (95%CI= 2.41-4.86). Similarly, ever-married students had more than twice the chance relative to single students (aOR=2.2, 95%CI=1.17-4.28). Furthermore, younger students (<20 years) were twice more likely to have used online resources compared to their older colleagues (=30 years) (aOR=2.12,95%CI=1.32-4.17). CONCLUSION: Undergraduate students are increasingly turning to the internet for sexual and reproductive health information.This presents an opportunity for programming.
[ABSTRACT]   Full text not available  [PDF]
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CASE REPORTS
Posterior perforation of gastric ulcer: A rare surgical emergency
MO Afolayan, TO Olajide, OS Balogun
April-June 2017, 26(2):178-180
DOI:10.4103/1115-2613.278292  
BACKGROUND: Gastric ulcer perforation is a rare surgical emergency.Posterior gastric ulcer is even rarer and usually has a delayed presentation with attendant greater morbidity and mortality. AIM: To report a case of posterior perforation of gastric ulcer and review the literature. CASE REPORT: A 65yr old driver was seen in the hospital with a 4- day history of epigastric pain which became generalized. Examination revealed a patient in shock with a board-like rigidity of the abdomen. Chest x-ray confirmed pneumoperitoneum. He had an exploratory laparotomy. Findings at surgery include moderate peritoneal fluid collection and 1.5cm diameter perforation on the posterior gastric wall which was closed primarily with an omental patch. Biopsy of the ulcer edge was negative for malignancy. He was discharged 10 days after surgery. CONCLUSION:To the best of our knowledge,perforation of a posterior gastric ulcer is an unusual encounter in surgery.A high index of suspicion is needed to prevent high mortality.
[ABSTRACT]   Full text not available  [PDF]
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Bilateral gluteal abscesses and myofibrosis complicating intramuscular pentazocine abuse: A case report
NO C Onyemaechi, AE Arunsi, P Ojobo, AG Obiefuna, S Ugwu, Olibe Alexander
April-June 2017, 26(2):181-184
DOI:10.4103/1115-2613.278293  
BACKGROUND: There is paucity of reports on the musculoskeletal complications of pentazocine abuse in Nigeria.The aim was to report a case of bilateral gluteal abscesses and myofibrosis as a consequence of parenteral pentazocine abuse. CASE SUMMARY: We report a case of a 39 year old housewife who presented with bilateral gluteal pyomyositis and myofibrosis following intramuscular pentazocine abuse.The patient had received parental pentazocine for pain relief for about 3 weeks seven years ago.She gradually developed dependence on this drug and received increasing doses of this drug by self injection on both buttocks. She subsequently developed bilateral gluteal abscesses and myofibrosis that was treated by surgical drainage,debridement,wound dressing and antibiotics. CONCLUSION: Pentazocine abuse should be considered a differential diagnosis in cases of multiple gluteal abscesses.Clinicians should be cautious in the use of pentazocine as routine painkillers.
[ABSTRACT]   Full text not available  [PDF]
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ORIGINAL ARTICLES
Does clerkship experience influence interest in internal medicine career?
Ekenze Oluchi Stella, Ekenze Sebastian Okwuchukwu, Onyebueze John Ugochukwu
April-June 2017, 26(2):132-137
DOI:10.4103/1115-2613.278285  
BACKGROUND: The career intention of undergraduate medical students may be influenced by the clerkship experience in the various specialties. AIM: This study was undertaken to assess the medical student's perception of the internal medicine clerkship and determine its influence in the choice of internal medicine as a career. METHODS: The study involved a cross-sectional survey of 2009 and 2010 graduating medical class of University of Nigeria using self-administered questionnaires.The clerkship evaluation was assessed using a 3-point Likert scale (1> poor and 3 excellent). RESULTS: The response rate was 70.3% (275/391).Sixty -five (23.6%) rated their medicine clerkship as excellent (mean rating 2.04).Aspects of the clerkship experience that contributed to the overall poor rating include quality of opportunity to participate in direct patient care, ability to manage problems in a general medicine setting, accessibility to consultants and feedback on performance during the postings.Experience in learning basic physical examination skills and overall quality of consultant teaching was considered excellent by 42.3% and 30.8% of the participants respectively. Twenty–six (9.5%) of the participants indicated interest in internal medicine while 96(35%), 43(15.6%) and 34(12.4%) chose surgery, paediatrics and obstetrics and gynecology respectively. Factors that swayed the choice of medicine were personal inclination (57.7%), clerkship experience (30.8%), diligence of faculty (7.7%),and lifestyle (3.8%). CONCLUSION: Clerkship experience may not be the main factor influencing choice of internal medicine. However, a review of clerkship in internal medicine may improve experience and enhance choice of internal medicine as a specialty among medical students.
[ABSTRACT]   Full text not available  [PDF]
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Depression in pregnancy and the puerperium in a tertiary health facility in Nigeria. A neglected area of practice
Mkpe Abbey, Terhemen Kasso
April-June 2017, 26(2):146-155
DOI:10.4103/1115-2613.278287  
BACKGROUND: Depression is common in pregnancy in high-income-countries but rarely spoken about in Nigerian Tertiary Obstetric Centres. OBJECTIVES: This study was conducted to ascertain the prevalence and risk factors for major depression in pregnancy and puerperium at the University of Port Harcourt Teaching Hospital and determine awareness of it among obstetricians. METHODS: This was a cross-sectional study.Two hundred and five women from the obstetric and paediatric wards and clinics were interviewed in two stages.In the first stage,data on their socio-demographic characteristics, obstetric and medical history was collected while in the second, which followed immediately after the first, the MINI international neuropsychiatric questionnaire was used to collect data which was analysed on SPSS-19 software. RESULTS: The prevalence of major depression in pregnancy and the puerperium was 9.76% but there was variation in the antenatal and postnatal periods of 9.57% and 16.98% respectively. The factors that were independently associated with major depression in pregnancy were domestic violence (P=0.008), single mothers (P=0.038) and past episode of major depression (P= 0.001). CONCLUSION: Irrespective of the high prevalence of major depression in the pregnant population at the UPTH, obstetric practitioners are not aware of it.There is therefore the need for continuous medical and health education in mental health problem in pregnancy.
[ABSTRACT]   Full text not available  [PDF]
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Aetiology and pattern of bone and joint infection presenting at a regional orthopaedic hospital
UE Anyaehie, OA Lasebikan, II Orikpe, KC Eze, TO Ikpegbu
April-June 2017, 26(2):128-131
DOI:10.4103/1115-2613.278284  
BACKGROUND: Bone and joint infection is one condition that can either be rewarding,or a night mare to the surgeon.This work reports the auses and pattern of presentation of bone and joint infections in our sub region. METHOD: A retrospective review of 73 cases of non granulomatous bone infection seen over two years fromJanuary 2012 to December 2013 was done. Patients' biodata,complaint,time to presentation in the hospital and if any intervention by the traditional bone setters, limbs involved, primary cause, diagnosis, organism cultured and retroviral status were obtained from the folders.Results:Commonest age group involved was in the second decade with 21.9%. Male to female ratio is 2.2:1. Chronic osteomyelitis was the commonest infection with 46.6% (34 patients) followed by septic arthritis with 26%.The lower limb was more involved than the upper limb with a ratio of 5.6: 1.A significant number of patients 59 (80.8%) presented more than two weeks after onset of symptoms while 27 patients (36.9%) visited the traditional bone setters for treatment before presenting to the hospital. Staphylococcus aureus was the commonest organism isolated. CONCLUSION: Chronic osteomyelitis is the commonest bone and joint infections in our environment mainly from trauma and closely followed by improperly treated haematogenous acute osteomyelitis.Acute osteomyelitis is a rare occurrence as late presentation and patronage of traditional bone setters is rife.
[ABSTRACT]   Full text not available  [PDF]
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Predictors of sickness absence and job satisfaction among staff of a coastal hospital in Calabar, Nigeria
IB Okokon, UE Asibong, PE Adat, CM Okeke
April-June 2017, 26(2):117-127
DOI:10.4103/1115-2613.278283  
BACKGROUND: Sickness absence can predict job satisfaction in many systems; whereas job satisfaction drives active participation in decision-making processes and is a bed-rock for effective patient care among healthcare workers. AIM: The objectives of this study were to determine the predictors of sickness absence and job satisfaction and their relationship among staff of a hospital in Calabar,Nigeria. METHODOLOGY: This was a cross-sectional analytic hospital-based study involving 324 healthcare workers of the University of Calabar Teaching Hospital.The study used a semi-structured pre-tested interviewer administered questionnaire, developed and standardized by the researchers. Data generated was analyzed using the Statistical Package for Social Sciences for windows version 18, descriptive and regression statistics, with the p-value set at 0.05. RESULT: Thirty-five (10.8%) of the respondents were physicians, 42(13.0%) nurses, while non-clinician health workers constituted 55.9%.Their average age was 37.05±8.84 years with a slight preponderance of female over male (1.4:1). There were statistically significant associations between duration of sickness absence and job satisfaction (p=0.002). Following logistic regression, occupation was found as an independent predictor of job satisfaction. Participants who were non-clinician health workers, {Odds Ratio3.3;95% Confidence interval 1.505- 7.261} were significantly more likely to have job satisfaction compared with the clinicians. CONCLUSION: The study found a high level of dis-satisfaction with the job using specific parameters in the work setting for assessment.The institution of a safety unit in the Hospital,adjustment of work schedules together with the supply of ergonomic-oriented work equipment to check discomfort at work are recommended.
[ABSTRACT]   Full text not available  [PDF]
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REVIEW ARTICLES
Monopolar transurethral resection of the prostate for benign prostatic hyperplasia: What are the outcomes and complications in our patients?
IC Akpayak, SI Shuaibu, VE Onowa, LE Nabasu, ZZ Galam
April-June 2017, 26(2):173-177
DOI:10.4103/1115-2613.278291  
BACKGROUND: Transurethral resection of the prostate (TURP) is the current gold standard for the operative management of symptomatic Benign prostatic hyperplasia (BPH) and has excellent long term efficacy. Currently there is a gradual shift towards bipolar TURP and Holmium enucleation of the prostate (HoLEP) due to fear of complications, particularly transurethral resection (TUR) syndrome associated with monopolar TURP. However, bipolar generator and high powered holmium laser resectoscpe remain very expensive and make the bipolar TURP/HoLEP out of reach for majority of our patients.This study seeks to review our experience with monopolar TURP with a view to appraising its outcomes and complications seen in our patients. PATIENTS AND METHODS: Records of 42 patients, who underwent monopolar TURP for BPH between October, 2013 and September, 2016 were reviewed retrospectively.The data of patients who had undergone monopolar TURP,following standardized technique,were retrieved and subjected to statistical analysis. RESULTS: The mean age of the 42 patients was 67.07±9.38 (range 51 – 86).Those in the age range 60-69 years had most of the procedure.The mean prostate volume was 70±23.74 (ml);the mean prostate specific antigen (PSA) was 5.32±5.4ng/ml. All the patients had spinal anaesthesia.The mean intraoperative time was 71.05±19.07 (mins), awhile the mean hospital stay for the patients was 61.14±27.13 (hrs).The mean volume of 5% dextrose-water used for irrigation at surgery was 30L.Most of the patients,33(78.6%) had their catheters removed at 3-5 postoperative days. Only, 9(21.4%) had catheter for more than 5 days.The mean weight of resected prostatic chips was 29±9.2g. Intraoperatively, 1(2.4%) patient had bleeding that needed blood transfusion, 6(14.3%) had capsular perforations while none of our patients had TUR syndrome. Postoperatively, 3(7.2%) patients had clot retention while 2(4.8%) had UTI and 32(76%) had retrograde ejaculation. All patients except 1(2.4%) had satisfactory voiding at removal of catheter and subsequent follow up visits. CONCLUSION: Improved antibiotics, perioperative care and instrumentation have greatly improved the morbidity of modern monopolar TURP and make it still useful for our patients.
[ABSTRACT]   Full text not available  [PDF]
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Stability of candida albicans over long and short term storage in a resource-limited setting
Mark O Okolo, Esther Kim, Henrietta S Tiri, Gyaran Z Umar, Esther A Envuladu, Linda Y Tiri, Erochukwu Nwodo, Kenneth I Onyedibe, Edmund B Banwat, Daniel Z Egah
April-June 2017, 26(2):163-166
DOI:10.4103/1115-2613.278289  
BACKGROUND: Candida albicans are widely isolated fungal yeast agents from clinical samples. Several storage methods for fungi have evolved overtime and they are not without setbacks. Preservation method is critical for research,training and teaching.In resource–poor setting,the method to employ must be cheap and easy to maintain with minimal risk of contamination as well as degeneration of the organisms.We thus,set out to study the stability of Candida albicans over long and short term storage in a resource-limited setting. METHODS: One hundred Candida albicans strains isolated from patients with vulvovaginal candidiasis and oral candidiasis were preserved in triplicates using sterile distilled water,Chromagar plate,mineral oil overlay and brain heart infusion broth plus 10% glycerol at -20OC.Recovery rates were determined at six months,12 months and 18 months by sub-culturing onto sabouraud dextrose agar. RESULT: The recovery rate of C. albicans was 100% for all the preservation methods used during the six months storage,mineral oil overlay and brain heart infusion broth plus 10% glycerol for the 12months storage,and only the brain heart infusion broth plus 10% glycerol during the 18months storage. CONCLUSION: Candida albicans can be preserved over long period of time in resource- limited setting where power supply is erratic using brain heart infusion broth plus 10% glycerol at -20OC and mineral oil overlay technique whereas for short term preservation, sterile distilled water and taped culture plates technique can be used. Preservation of Candida albicans isolates in resource- limited setting over short or long term period is possible and affordable depending on the technique employed.
[ABSTRACT]   Full text not available  [PDF]
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ORIGINAL ARTICLES
Factors affecting compliance to treatment among children with epilepsy attending at a paediatric neurology clinic of a tertiary hospital in Enugu
JN Eze, EN Aguwa, CB Eke, R Ibekwe, AE Aronu, NC Ojinnaka
April-June 2017, 26(2):104-111
DOI:10.4103/1115-2613.278281  
BACKGROUND: This study aimed to determine the factors affecting compliance to treatment among children with epilepsy in Enugu,Nigeria. METHODS: Children with diagnosis of epilepsy were consecutively recruited.Their 6 months retrospective and 1 month prospective data were collected; and analyzed using SPSS version 20.0 (p < 0.05). RESULTS: Fifty six children with epilepsy (mean age= 9.7 ± 4.1 years) were studied. Generalized tonic clonic epilepsy was noted in 41.1% (23/56) of them.Thirty six (64.3%) complied strictly with the treatment regimen. Polytherapy, high cost of drugs, multiple drug dosages and drug related side effects affected compliance. Majority (79.4%, 27/34) of patients on monotherapy and a few (27.2%, 6/22) on poly-therapy had good seizure control (p<0.001). CONCLUSION: Poor drug compliance is a major constraint to adequate seizure control in children with epilepsy in our setting.Addressing the problem of poor compliance will enable them to achieve optimal seizure control.
[ABSTRACT]   Full text not available  [PDF]
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REVIEW ARTICLES
Validation of mangled extremity severity score in assessing the need for extremity amputation
BA Okechukwu, OI Akinmokun, GO Enweluzo, SO Giwa
April-June 2017, 26(2):156-162
DOI:10.4103/1115-2613.278288  
INTRODUCTION: The decision to either salvage or amputate a mangled extremity poses great challenge to a surgeon.Different scoring systems were therefore developed to aid orthopaedic surgeons in this decision,eitherto contemplate amputation or proceed to salvage a mangled extremity. Of these scoring systems, the mangled extremity severity score (MESS) is mostly used.However,the high predictive accuracy reported by its developers has not been replicated by other authors. This study was carried out to validate the use of this scoring system in Nigeria and by extension, Africa. PATIENTS MATERIALS AND METHOD: The study was a hospital based prospective descriptive one which studied all patients with mangled extremities that were admitted into the Accident and Emergency room of the Lagos University Teaching Hospital (LUTH), Idi- Araba, from April 2014 to March 2015. Injured patients with mangled extremities were resuscitated and relevant investigations conducted. The MESS was calculated at presentation in the emergency room by two senior doctors in orthopaedic and trauma units (not lower than senior registrar cadres) independently and an average score calculated, rounded up to the nearest positive integer and documented.Type of treatment offered was based on the experience of the managing consultants. Patients' progresses were monitored and functional outcomes documented. All data generated during the study were analysed using Statistical Package for the Social Sciences (SPSS inc. Chicago, Illinois. version 21.0.Year of release - 2012). RESULTS: Twenty-nine mangled extremities in 27 patients were studied.The male: female ratio was 3.5:1.Age of patients ranged between 21-70 years with a mean age of 39.9 ±12.3years. Nineteen (65.5%) extremities were salvaged while 10(34.5%) were primarily amputated. Average MESS of all mangled limbs reviewed was 8.1+ 2.6 with scores that ranged from 3 to 13. The mean MESS for limb salvage was 7.0 +2.2while that for primary amputation was 10.1+2.0(P value- 0.01).MESS in this study had a sensitivity of 90%,specificity of 47.4%,positive predictive value mof 47.4%, negative predictive value of 90%.AUROC in this study was 0.853.The cost of treatment, number of surgeries, and duration of hospital stay were higher in those with Salvaged limbs.The functional outcome for salvaged upper and lower extremities were better than for those whose limbs were amputated.Level of satisfaction was better in the limbs salvaged group than for those who had ablative surgery with statistical significance (P value- .000). CONCLUSION: This study validated the clinical utility of MESS in predicting the need for amputation in patients with mangled extremity injuries but it had a low predictive accuracy for extremities that would eventually enter the limb salvage pathway.Therefore,when contemplating limb salvage for a patient with mangled extremity,in addition to the result of the MESS score,the surgeons experience cannot be overemphasized.
[ABSTRACT]   Full text not available  [PDF]
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Open heart surgery: Management of nonsurgical bleeding in the peri-operative period; 31/2-years institutional experience
IA Nwafor, MN Nwafor, JC Eze, N Ezemba, JM Chinawa, OC Nzewi, CI Ngene
April-June 2017, 26(2):167-172
DOI:10.4103/1115-2613.278290  
BACKGROUND: Excessive perioperative bleeding remains a major complication following open heart surgery, resulting in increased morbidity and mortality of some patients in our institution. A study of the principal causes of excessive nonsurgical haemostatic perioperative bleeding,clinical evaluation,treatment and preventive strategies is justified. OBJECTIVE/AIM: To identify the causes of bleeding in patients with haemorrhage that did not require reexploration and assess the impact on the patient outcomes from different causes of nonsurgical bleeding perioperatively. MATERIALS AND METHOD: For a period of 31/2 years (March 2013 – February 2016), the National Cardiothoracic Center of Excellence,UNTH,Ituku/Ozalla,Enugu,Nigeria, partnered with different foreign cardiac missions (USA,UK and India) for the performance of open heart surgery.The case files of the patients managed in the envisaged period were retrieved and analyzed using SPSS, version 2.0(Chicago). The data analyzed were patients' demographics, the total number of open heart surgery cases, the number that had perioperative nonsurgical bleeding,clinical detection strategies,treatment and preventive modalities as well as the outcome. RESULTS: During the period,a total number of 78 cases of open heart surgery (OHS) were done.There were 43 males and 35 females, with a ratio of approximately 1.3:1.The youngest age was 5 months and the oldest was 74 years, with a mean of 11.1 +/-SD 0.05. Out of these 78 cases, a total of 7 patients had perioperative nonsurgical bleeding, giving a percentage of 9%.3 patients were noticed intraoperatively in the operating room (OR) while 4 were noticed postoperatively in the intensive care unit (ICU). Treatment included the use of tranexemic acid or aprotinin, fresh frozen plasma (FFP) or fresh whole blood, platelet concentrate and additional doses of protamine, when incomplete reversal of heparin was the cause. CONCLUSION: Detection of the cause(s) of nonsurgical bleeding without thromboelastography or platelet function analyzer can be quite challenging in our environment.Applying appropriate pharmacologic agents among other interventions can reduce allogenic blood requirements with their attendant complications.
[ABSTRACT]   Full text not available  [PDF]
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