Archive 2011 - No 1

A D SALISU

Correspondence to: DR A D SALISU Department of Otorhinolaryngology. Aminu Kano Teaching Hospital, Kano. E Mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Background: Endoscopic extraction of impacted sharp and or irregularly shaped esophageal foreign bodies is associated with higher complication rates and frequent failed extraction attempts especially in resource limited settings. Objectives: To review the management outcome of endoscopic extraction in a resource-limited endoscopy unit with a view to identifying factors in patient management requiring attention to improve patient care. Materials and method: This is a retrospective study of patients who presented with impacted esophageal foreign body to a tertiary health institution over a five year period (2001-2005) at a time when the rigid endoscopy unit was inadequately equipped.Case notes were retrieved and studied. Results: Sixteen (16) cases of sharp or irregularly shaped esophageal foreign bodies (SIFB) were studied, with dentures 7cases (43.8%) been most common. Age ranged from 10 months to55 years with a mean of 21.8 years. While 15 cases (93.8%)presented within 12 hours of the incident to the initial health facility, the mean duration of impaction at presentation to our centre was 2.8days. In 15 cases (93.8%), pre-operative plain radiographs revealed accurately the site of impaction. In 12 cases(75%), the SIFB was impacted at the cricopharyngeal area.Fifteen (93.8%) SIFB were endoscopically extracted successfully by consultant otorhinolaryngologist. Mucosal abrasion was the most common complication. No case of esophageal perforation or mortality was recorded. Average hospital stay was 3 days. Conclusion: Success at endoscopic extraction of SIFB can be achieved if the operator is experienced even in the face of inadequate equipment. Factors contributing to successful outcome include pre-operative radiological localization and cervical esophageal arrest of the foreign bodies. Delayed presentation due to referrals arising from paucity of endoscopy centres is common. While training and re-training of endoscopist is emphasized, it is recommended that health institutions in developing countries strive to acquire basic rigid endoscopy equipment.

CHIJIOKE A, MAKUSIDI AM
Correspondence to: Dr. Adindu Chijioke Baboko Post Office, P.O. Box 13945, Ilorin, Nigeria Phone: 234 (+8056507210) E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Background: Mortality rates in acute kidney injury (AKI) are still very high despite enormous research and technological advances in its management. It varies between 40-50% in hospitalized patients and 70-90% in cases admitted into intensive care units. Management of severe AKI is capital intensive and majority of Nigerians with the disease die prematurely because they can hardly afford cost of renal replacement therapy (RRT). Reasons for the persistent poor survival may vary from one region to another, even in the same environment. Objective: To review clinical features and factors contributing topoor outcome of patients with AKI in Ilorin, Kwara State.Subjects and Method: Retrospective appraisal of acute kidney injury at University of Ilorin Teaching Hospital, Ilorin, Nigeria (Jan.1989- Dec. 2009.) All patients that met stage 3 RIFLE criteria forAKI and presented primarily or referred to our renal care centre were studied. RIFLE is the acronym for staging AKI which means Risk of renal dysfunction, Injury to the kidneys, Failure of renal function persisting for 24hours, Loss of renal function persisting formore than 1 month and End stage kidney disease (loss of function for more than 3 months). A total of 113(52males and 61 females) outof 1,275 renal patients that had AKI (8.86%) were reviewed. Results: Unusual weakness, oliguria, altered sensorium, vomiting and hiccups were major presenting features. About 80.5% of the patients were less than 40 years of age with male and female meanages of 27.29 + 7.77 and 29.15+ 6.98 years respectively. The aetiological factors were septicaemia, severe gastroenteritis, acute glomerulonephritis, drug induced, ante/post partum haemorrhage and obstructive uropathy. Overall mortality rate was 47.6%. Sixtythree patients were managed conservatively with 62% mortality while 33 and 9 patients had haemodialysis and peritoneal dialysiswith mortality rates of 15% and 67% respectively. Conclusion: Aetiological factors were largely preventable and treatable conditions. The main contributory factors to highmortality rate were ignorance, late presentation, delayed intervention therapy, bleeding diathesis, severe infections, financial constraints and high cost of dialysis. Haemodialysis appear to be abetter modality of treatment than peritoneal dialysis for severe AKI in our environment.

GARBA NA, MUHAMMAD Z

Correspondence to: DR. MUHAMMAD ZAKARI Department of Obstetrics and Gynaecology, Bayero University/Aminu Kano Teaching Hospital, Kano E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Background: With the development of antibiotic therapy and modern blood-banking techniques, caesarean section has evolved into one of the safest and most commonly performed major operative procedures.Objective: To determine the caesarean section rate, its morbidity and mortality in Aminu Kano Teaching Hospital, Kano. Study Design: A two-year descriptive study from 1st January2006 to 31st December 2007, in Aminu Kano Teaching Hospital,Kano. All patients that were delivered by caesarean section were included.Results: There were 6,355 deliveries from 1st January 2006 to 31stDecember 2007, out of which 1,005 were by caesarean section,giving a caesarean section rate of 15.8%. Nine hundred and thirty eight (938) case notes were retrieved, out of which emergency caesarean sections were performed in 812 (86.6%) and elective caesarean sections in 126 (13.4%). Of the 938 patients, 434(46.3%) were booked at Aminu Kano Teaching Hospital, Kano,314 (33.5%) were booked elsewhere and 190 (20.2%) were unbooked.The commonest indication was cephalo-pelvic disproportion/obstructed labour in 27.7% of the patients, then previous caesarean sections in 18.6%, hypertensive disorders in14.8% and ante partum haemorrhage in 11.1% of the patients.Three hundred and six (33.6%) of the patients had at least one complication. The common complications were postpartum anaemia (21.3%), prolonged hospital stay (9.4%) and postpartum haemorrhage (4.5%). The caesarean section related mortality rate was 1.1% or 1066/100,000; 80% of which occurred in unbooked patients, 60% occurred in patients with eclampsia, 20% inpatients with obstructed labour and the other 20% in patients with ante partum haemorrhage. Conclusion: Morbidity and mortality from caesarean section isstill high, due to the high number of unbooked patients and late referrals. Efforts should be made to educate our women about the importance of antenatal booking and early presentation in labour.Early referrals should be encouraged through continuing education programme for Doctors in private and government hospitals.

M HALILU, UU MODIBBO, H HAZIEL
Correspondence to: MAL. HALILU MUSA Department of Food Science & Technology Federal University of Technology, Yola, Adamawa State, Nigeria. E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Background : Water is a very essential constituent of life, and the availability of good quality water is an indispensable feature for preventing diseases and improving quality life. Objective: The study was conducted to ascertain the wholesomeness in terms of presence and concentration of heavy metals in sachet water sold in Gombe metropolis. Methodology: A total of 20 brands of sachet water were randomly selected from 25 brands sold in Gombe. These were obtained from water vendors in the markets and motor parks in Gombe town. Physico-chemical analysis was conducted on the collected water samples, and data analysed using SPSS 13. Results: The heavy metal concentration in sachet water studied revealed that, all samples were within World health organisation (WHO) standard. Iron concentration ranged from (0.00-0.29mg/l), Zinc and chromium ranged from 0.001-1.40 and 0.00-0.04mg/l respectively. Similarly concentration for lead, copper and magnesium were 0.00-0.04mg/l, 0.00-0.05mg/l and 2.00-3.40mg/l respectively. However, manganese and chloride concentration ranges from 0.00-0.06mg/l and 11.5-16.32mg/l. the colour, taste, odour and alkalinity were all within the standards of WHO. Conclusion: The physico-chemical parameters analyzed and the heavy metals concentration in the sachet water sampled in Gombe had values within the acceptable limits as prescribed by WHO standards for quality of drinking water. The study provides guidance to help water processors in collaboration with public health authorities to identify those chemicals that are likely to be present in water sold which may present potential public health risk on a long term exposure.

MA TALLE, BN OKEAHIALAM, B BAKKI, CO ANJORIN, MM BABA, BW GONI, H YUSUF
Correspondence to: Dr Mohammed Abdullahi Talle, Division of Cardiovascular Medicine, Department of Medicine, College of Medical Sciences, University of Maiduguri, PMB 1069, Maiduguri. Nigeria. E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Background: With the increasing prevalence of hypertension, an increase in burden of diseases due to hypertensive changes in left ventricular (LV) geometry is eminent. Assessment of LV geometric pattern identifies hypertensive patients with increased risk of cardiovascular mortality and morbidity. Methods: This was a cross-sectional study in which LV geometric patterns were evaluated in treatment naïve adult hypertensive patients. Blood pressure (BP) and anthropometric parameters were determined using standard protocols. Echocardiographic LV indices were obtained using American Society of Echocardiography (ASE) guidelines. Spot urine sample was collected for determination of urine albumin-creatinine ratio(ACR). Data was analyzed using SPSS Version 16 for windows and a p value of =0.05 considered significant. Results: One hundred and thirty six patients (made of 66 males and 70 females) with a mean of 44.82 (10.51) years were studied.Abnormal LV geometry was observed in 80.88%. Concentric remodeling was seen in 44.12%. Concentric left ventricular hypertrophy (LVH) was present in 24.26% while 12.50% had eccentric LVH, giving an overall prevalence of 36.77% for LVH.LVH is commoner among the obese and those with stage II hypertension. Ejection fraction (EF) and fractional shortening(FS) were significantly lower in eccentric hypertrophy but did not differ in other geometric patterns. Systolic blood pressure, pulse rate and ACR independently predicts LVH. Conclusions: There is a high prevalence of abnormal LV geometry and LVH in newly presenting untreated hypertensive patients. Eccentric hypertrophy is associated with lower systolic function compared to other geometric patterns.