Nigerian Journal of Postgraduate Medicine

Septic abortion at a university teaching hospital in South West Nigeria.

O.E Jagun, O Ayoola-Sotubo, O Ogunlaja, K.S Oritogun, A.O Olatunji

Background: Abortion is a common cause of maternal mortality and this usually follows severe haemorrhage or sepsis. Septic abortion is sequelae of unsafe abortion and this usually occurs when it is done in a clandestine manner which may be due to lack of legalization of abortion. The study is to determine the pattern of septic abortion managed in the hospital. METHOD: This is a retrospective study of consecutive cases of septic abortion that were admitted into the gynaecological ward between 1998 and 2007 in the hospital. The diagnosis of sepsis was based on clinical and laboratory findings. RESULTS: Thirty-four cases of septic abortion that warranted admissions were seen during the study period and this represented 1.64% of all gynaecology ward admissions. The age range of the patients was between 15-41years with a mean of 24.53years and nulliparous patients represented 47.1%. Fifty eight percent of the abortions were done by quacks while 9.7% was done by medical doctors. The abortion was induced in 91.2% of the cases and only 20.6% of the patients had not had a previous abortion. The abortion was by dilatation and curettage in 61.8% of the cases. The gestational age at abortion ranged between 5 and 26 weeks with majority at 6-10weeks (47.1%) with a mode of 8weeks. Apart from the sepsis, 61.8% of the patients had other complications like anaemia and peritonitis. Definitive management was by conservative measures in 79.4 % with antibiotics and evacuation. The mean interval between abortion and presentation at OOUTH was 9.9days. There was only one case of mortality in the series giving a case fatality rate as 2.94%. Conclusion There is a need for training and retraining of health workers on methods of evacuation of the uterus and early detection of complications. Since it is a problem that is more common among nulliparous young adults, more effort need to be made to reach out to the young adult through incorporation of family life education.

Prediction of LVH from average of R wave amplitude in leads I and V5 among adult Nigerians with hypertension

O Ogunlade

Left ventricular hypertrophy (LVH) is an independent risk factor for cardiovascular events. Many methods are used to assess it but the reference standard is echocardiography. However, this facility is available only in a few hospital centres. A set of criteria based on voltage threshold as assessed by electrocardiogram, a more readily available and portable tool had been developed. This study evaluates the ability of one of the ECG criteria to predict left ventricular hypertrophy. Aim: The aim of this study was to determine the sensitivity, specificity, accuracy, positive and negative predictive values of average of R wave amplitude in leads I and V5 in predicting LVH Methodology: This is a cross-sectional descriptive study of adult hypertensive subjects. Participants were assessed for LVH using the average of R wave amplitude in lead I and V5 =18mm. Echocardiogram was used to determine their left ventricular mass index and a value greater than 125g/m2 was used as the cut off point for LVH. The sensitivity, specificity, accuracy, positive and negative predictive values were determined for the ECG criterion. Result: Ninety subjects (45 males, 45 females) participated in the study. The prevalence of LVH by echocardiogram and the ECG criterion were 32.2% and 27.8% respectively. The sensitivity, specificity, accuracy, positive and negative predictive values for the ECG criterion were 41.9%, 79.7%, 66.7%, 52.0% and 72.3% respectively. Conclusion: The average of R wave amplitude in leads I and V5 can reliably predict LVH among hypertensive subjects. Key words: Sensitivity, Specificity, ECG criterion, LVH, hypertension

Clinicopathological review of hepatocellular carcinoma in black Africans

MC Kew

Hepatocellular carcinoma occurs commonly in the Black population of sub-Saharan Africa. The tumour runs a particularly fulminant course and is a major cause of deaths from cancer in the sub-continent. In most Black African patients, hepatocellular carcinoma presents clinically with typical symptoms and physical findings. However, in a significant number of the patients the tumour presents in a variety of unusual ways, some of which are the result of complications of the tumour, such as biliary obstruction as a result of invasion of the biliary tree, a Budd Chiari- like presentation with growth of the tumour into the hepatic veins, inferior vena caval obstruction resulting from growth of the tumour into the inferior vena cava, or acute haemoperitoneum secondary to tumour rupture. Others are the result of paraneoplastic manifestations of the tumour, such as hypoglycaemia, polycythaemia, or hypercalcaemia.

Save lives, make hospital safe in emergencies: framework for disaster preparedness in hospitals in Nigeria

K.S Oluwadiya, O.O Olusola

All over the world, it is becoming obvious that there is a need to make hospitals safe at times of disasters and emergencies, when the need for their services become even more urgently needed. This is one of the reasons why the World Health Organization chose “Save lives, make hospital safe in emergencies” as the theme of the 2009 World Health Day. The WHO intends that stakeholders become aware of the important role hospitals play in disasters and emergencies. This article is an extension of that purpose in that it is designed to give a synopsis of the current thinking regarding safe hospitals, and how the knowledge can be adapted to fit the Nigerian situation.

Severe iron deficiency anaemia in a 37-year-old with HBSC disease: a case report and review of literature.

R.A Bolarinwa, A.A Oyekunle, L Salawu, N.O Akinola, D.D Ogbaro

Background: Iron deficiency anaemia (IDA) is not a recognised complication of sickle cell disease; it is uncommon in an adult patients. However, it could occur in children with the disease on the background of a significant nutritional deficiency. Method: Clinical note of the patient was retrieved for relevant information. The date of first contact with health facility, and subsequent follow-up clinical status was noted. The steady state blood counts, the clinical and laboratory findings at presentation of severe IDA was reviewed. Result: The patient runs a mild disease and was haemoglobin SC. The severe IDA was precipitated by ascaris lumbricoides infestation. This necessitated packed cell transfusion for the first time ever in this patient. Conclusion: There should be a high index of suspicion for worm infestations in previously untransfused SCD patients presenting with severe anaemia. The role of iron-deficient state in sickle cell disease amelioration needs further evaluation. Key words: sickle cell disease, iron deficiency, worm infestation.

Case Report: Strongyloides stercoralis coinfection in a Nigerian with HIV.

A.A Oyekunle, R.A.A Bolarinwa, O.A Aboderin, L Salawu, N.O Akinola, A Olotu

Background: Strongyloides stercoralis is an important cause of morbidity and mortality in many areas of the world where human contact with fecalcontaminated soil or water is common. The nematode is endemic in tropical and subtropical regions, including southwestern Nigeria. Strongyloides infections in the immunocompetent are often asymptomatic or associated with few clinical features, particularly during initial migration through the body. However, persons with defective cellular immunity are at risk of severe, clinically significant disease (mainly involving the gastrointestinal and respiratory systems). Patient, Methods and Results: A human immunodeficiency virus (HIV)-infected Nigerian trader with candidiasis and trichomoniasis, while being screened for antiretroviral therapy, was found to also have S. stercoralis infection. She was treated with oral mebendazole. We report the first documented case of Strongyloides infection in an HIV-infected Nigerian. Conclusion: S. stercoralis infection is much easier to prevent than treat, and so we strongly advocate routine screening of all HIV patients for intestinal opportunistic pathogens and prompt therapy. Keywords: Human immunodeficiency virus (HIV), Strongyloides stercoralis, Nigeria.