Care Hospital In Nigeria Research Articles

Prevalence and antibiotic susceptibility pattern of Uro-pathogens isolated from urine in a tertiary care hospital in Nigeria

Prevalence and antibiotic susceptibility pattern of Uro-pathogens isolated from urine in a tertiary care hospital in Nigeria

Antibiotic Susceptibility Pattern of Extended Spectrum Beta-Lactamase (ESBLs) Producing Enterobacteriacaea Isolated from Urine in a North-Eastern Tertiary Care Hospital in Nigeria.

This study was done to evaluate the frequency of extended spectrum Beta-lactamase (ESBLs) producing uropathogens and their susceptibility pattern isolated from urine in Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH) Bauchi. A total of 373 urine samples from out-patients and hospitalized patients were studied. Samples were inoculated on Cystine Lactose Electolyte-deficient (CLED) agar, Blood agar and MacConckey agar. 165 isolates were obtained which were further identified by standard Microbiological methods. Antimicrobial Susceptibility pattern was studied by Kirby-Bauer’s disc diffusion method. Among the 165 uropathogens isolated from patients with UTI, the commonest isolate was E. coli (29.1%) followed by Klebsiella pneumonae (15.8%) with the least Citrobacter spp. 1(0.6%). The overall prevalence of UTI of this study is 44.0%. Extended spectrum beta lactamase (ESBL) was noted in 100 (77.0%). Among the ESβLs producers detected, E. coli recorded the highest occurrence rate of 46 (46.0%) followed by K. pneumoniae with 22(22.0%). Others were, K.oxytoca 15(15.0%), P. aeruginosa 4(4.0%). However, there was no evidence of ESβL production observed in the clinical isolates of P. vulgaris and Citrobacter spp. Multidrug resistance was found to be significantly (P<0.05) more in ESBL producing isolates (77.0%) than Non-ESBL producers (23.0%. Monitoring of ESBL production and antimicrobial susceptibility testing are necessary to avoid treatment failure in patients with UTI.

The Trend of Cholecystectomies After the Introduction of Laparoscopic Surgery in a District Hospital in Abuja, North Central Nigeria.

Background Laparoscopic cholecystectomy is not readily available in secondary care hospitals in Nigeria, even though it is now the gold standard for the treatment of cholelithiasis and other gallbladder diseases worldwide. Thus, many hospitals in Nigeria still offer open cholecystectomies. This retrospective study investigated the trend of cholecystectomies performed in the general surgery unit of a district hospital in Abuja before and after the commencement of laparoscopic surgery services in 2016. Methodology This retrospective study was conducted in Asokoro District Hospital, Abuja, Nigeria The records of all patients who underwent a cholecystectomy from January 2000 to December 2019 were retrieved and analyzed for the number, types, and rate of cholecystectomies performed per year. All open cholecystectomies were performed via a right subcostal incision, whereas all laparoscopic cholecystectomies were performed via the standard four-port incisions approach. Results A total of 96 patients underwent cholecystectomies from January 2000 to December 2019. In total, 50 (52.08%) open cholecystectomies were performed in 20 years with a yearly average of 2.5, and 46 (47.92%) laparoscopic cholecystectomies were performed in four years with a yearly average of 11.5. The trend of open cholecystectomies in four years dropped from three (30%) in 2016 to one (5.26%) in 2019, whereas laparoscopic cholecystectomies increased from seven (70%)to 18 (94.74%) within the same period. Conclusions There is a drop in the trend of open cholecystectomies and an increase in both laparoscopic and total cholecystectomies in our hospital. We recommend adequate capacity and subsidized laparoscopic cholecystectomy for secondary healthcare facilities in Nigeria.

Amsler Grid Versus 10-2 Test in Primary Open Angle Glaucoma.

Glaucoma is the leading cause of global irreversible blindness. The goal of management in glaucoma lies in its early detection and treatment to prevent further optic neuropathy. Available equipment for early glaucoma detection is not cost-effective or readily available in resource-scarce settings such as Nigeria. Thus, there is a need for a simple cost-effective tool to detect glaucomatous central visual field (CVF) defects in all the stages of glaucoma within the community in resource scarce-settings. The aim of this article is to determine the validity of the Amsler grid in detecting central glaucomatous visual field defects in primary open angle glaucoma (POAG). This was a cross-sectional study of follow-up glaucoma patients at a secondary eye care hospital in Nigeria. All patients had detailed ophthalmic examination in addition to 24-2 and 10-2 CVF tests and Amsler grid test. POAG was classified using the Hodapp-Parrish-Anderson criteria into mild, moderate, and severe on 24-2 CVF. The diagnostic validity of the Amsler grid was calculated using the 10-2 CVF as a reference standard. Regression analyses were performed between the Amsler grid scotoma area and 10-2 CVF parameters [mean deviation (MD), scotoma extent (SE), and scotoma mean depth (SMD)]. A total of 150 eyes of 150 patients were enrolled. The sensitivity, specificity, and positive predictive value and negative predictive value of the Amsler grid compared with the 10-2 CVF was 49.5%, 95.9%, 96.2%, and 47.9%, respectively, with an area under curve of 0.7. Sensitivity increased with increasing severity (P < 0.001) from 20.0%, 31.0%, and 76.6% in mild, moderate, and severe POAG, respectively. The Amsler grid scotoma area had the strongest relationship with the 10-2 MD, followed by 10-2 SE and 10-2 SMD with a quadratic R2 of 0.579, 0.370, and 0.307, respectively. The Amsler grid has a low sensitivity in mild-to-moderate POAG. However, it may serve as an adjunctive tool in resource-scarce settings for detection of severe POAG in the community by primary eye care providers.

Antibiotic utilization and resistance patterns in a secondary care hospital in Nigeria

Antibiotic utilization and resistance patterns in a secondary care hospital in Nigeria

Doctors' and Nurses' Knowledge and Perceived Barriers Regarding Acute Oxygen Therapy in a Tertiary Care Hospital in Nigeria.

Oxygen may cause serious consequences when administered wrongly. This study aimed to assess doctors' and nurses' knowledge of acute oxygen therapy and perceived delivery barriers. We conducted a cross sectional study among 202 healthcare providers (134 doctors and 68 nurses) in a Nigerian hospital. The validated Acute Oxygen Therapy Questionnaire (AOTQ), which consisted of 21 knowledge assessment questions, was self administered by participants. Provider's knowledge was classified as good if the score was≥80% and poor if < 60%. Overall, 26.7% (37.3% doctors and 5.9% nurses) had good knowledge of acute oxygen therapy (AOT), 35.9% were aware, and 19.3% used the AOT guidelines. The commonest source of knowledge on oxygen therapy was medical /nursing school (75.2%). The participants' mean knowledge score was 14.75 ± 2.83(possible score of 0-21). Doctors in postgraduate (PG) training obtained the highest score (15.96±2.48) among the participants (F=12.45, df=4, p<0.001). Most doctors (62%) and 23.5% of nurses considered oxygen as a drug. More doctors (52.2%) than nurses (14.7%) believed that a doctor's order was mandatory before oxygen administration, contrary to guidelines recommendations. Most nurses did not know that breathlessness does not always signify hypoxemia and that asymptomatic anemia was not an indication for oxygen. Concerning oxygen prescription, 39.7% of nurses and 64.2% of doctors knew that it should be prescribed to achieve a target saturation range rather than a fixed dose. In acute oxygen delivery in COPD, doctors and nurses exhibited poor knowledge of the appropriate device and flow rate. The reported barriers to oxygen delivery were: a shortage of oxygen supply, inadequate delivery devices, power outages and out of pocket costs. A significant proportion of doctors and nurses had poor knowledge of acute oxygen therapy, poor awareness and infrequently used AOT guidelines, and reported pertinent delivery barriers that warrant educational and administrative interventions.

Implementation and evaluation of obstetric early warning systems in tertiary care hospitals in Nigeria.

Obstetric Early Warning Systems (EWS) use combined clinical observations to predict increased risk of deterioration and alert health workers to institute actions likely to improve outcomes. The objective of this study was to explore the experience of health workers about the implementation of an obstetric EWS and assess its effectiveness as an alternative clinical monitoring method compared to standard practice. This mixed-method study included obstetric admissions (n = 2400) to inpatient wards between 01/08/2018 and 31/03/2019 at three Nigerian tertiary hospitals (1 intervention and two control). Outcomes assessed were the efficiency of monitoring and recording vital signs using the patient monitoring index and speed of post-EWS trigger specialist review. These were evaluated through a review of case notes before and four months after EWS was introduced. Qualitative data was collected to explore healthcare workers' views on EWS' acceptability and usability. EWS was correctly used in 51% (n = 307) of the women in the intervention site. Of these women, 58.6% (n = 180) were predicted to have an increased risk of deterioration, and 38.9% (n = 70) were reviewed within 1 hour. There was a significant improvement in the frequency of vital signs recording in the intervention site: observed/expected frequency improved to 0.91 from 0.57, p<0.005, but not in the control sites. Health workers reported that the EWS helped them cope with work demands while making it easier to detect and manage deteriorating patients. Nurses and doctors reported that the EWS was easy to use and that scores consistently correlated with the clinical picture of patients. Identified challenges included rotation of clinical staff, low staffing numbers and reduced availability of monitoring equipment. The implementation of EWS improved the frequency of patient monitoring, but a larger study will be required to explore the effect on health outcomes. The EWS is a feasible and acceptable tool in low-resource settings with implementation modifications. Trial registration: ISRCTN, ISRCTN15568048. Registration date; 9/09/2020- Retrospectively registered, http://www.isrctn.com/ISRCTN15568048.

Donor Blood Procurement, Safety, and Clinical Utilization: A Study of Blood Transfusion Services in a Tertiary Care Hospital in Nigeria.

Background Donated blood is an essential component of the management of many diseases, and hospital-based blood banks in Nigeria are saddled with the responsibility of provision of safe blood and coordination of its appropriate utilization for patient care. Objective This study reviewed the extent to which the hospital blood transfusion service ensures adequate safe blood supply and utilization. Materials/Methods. This was a retrospective study of 2 years record of the blood bank service of Alex Ekwueme Federal University Teaching. Methods of donor blood procurement, transfusion transmissible infection status, the pattern of blood, and blood component usage across the hospital's clinical departments were evaluated. Statistical analysis was conducted using IBM SPSS, and data were presented as percentages. Fisher's tests were used to test significance, and p value <0.05 is significant. Results The highest proportion of donors was male family replacement donors aged 26–35 years (3634 (39.68%)) while total voluntary donors were 315 (2.65%). Hepatitis B had the highest seroprevalence 267 (2.22%) among blood-borne diseases screened. National Blood Transfusion Service (NBTS) supplied only 3 (0.03%) of total blood units used. The accident and emergency department had the highest proportion of persons who utilized whole blood; 4568 (99.96%). Conclusion The hospital blood bank relies heavily on family replacement donors with little or no assistance from the National Blood Transfusion Service. Family replacement donors have the highest risk of TTIs, and hepatitis B infection has the highest prevalence. The high cost of blood component therapy increases the need for whole blood.

An Appraisal of Poisoning Patterns among Adolescent Patients Admitted into Tertiary Care Hospitals in Nigeria

Background: Poisoning is a common medico-social problem globally that results in significant morbidity and mortality. The extent of the problem differs among age groups, social-economic classes, and country to country. However, there is a dearth of information on the pattern of poisoning in adolescents in Nigeria. Objective: The study aims to assess the poisoning pattern among adolescent patients admitted into Tertiary Care Hospitals in Nigeria. Methods: In this study, a critical, constructive analysis of relevant literature on the subject areas of poisoning cases in tertiary care hospitals in Nigeria was carried out. Published cases between the periods of 2000 and 2019 were analysed. Results: The study showed that 24 patients made up of 13 females and 11 males were involved in poisoning cases during the studied period (2000–2019). About 85% of the patients were aged 10–15 years, while 12.5% were aged 16–30 years. Most of the poisoning cases (83%) occurred at home. Accidental cases were 29.16%, while 70.8% of the cases were intentional. Among the 17 intentional cases, 28.6% were ingested for the hallucinating effect and 17.6%) were suicidal cases. The agents used for poisoning included organophosphates, plant extracts, alcohol, drugs, food, kerosene and herbal mixture, among others. Some reasons for poisoning or suicidal intent observed in the study include peer influence, edgy relationships in the family system, disagreement with parents, failure in examination, and clashes with the boyfriend. Conclusion: There is a need for the government to establish poisoning control centres in each region of the country for proper profiling of the poisoning epidemic. Furthermore, parents and guardians are strongly advised to closely observe their teenage children and educate them about the dangers of any poisoning. Also, schools should provide friendly and accommodating environments to minimize and possibly eliminate suicidal intentions in youths and adolescents.

The out-of-pocket cost of breast cancer care at a public tertiary care hospital in Nigeria: an exploratory analysis.

Introductionin Nigeria, the incidence of breast cancer has increased by over 80% in the last four decades. This study quantifies the out-of-pocket (OOP) cost of breast cancer management and the associated rate of catastrophic healthcare expenditure (CHE) at a public tertiary care facility in Ile-Ife, Nigeria.Methodspatients treated between December 2017 - August 2018 were identified from a prospective breast cancer database. A questionnaire was developed to capture the total cost of care, including direct and indirect expenses. Three commonly used thresholds for a CHE were used in this analysis. The cost of radiotherapy and targeted therapy were captured separately.Resultsdata was collected from 22 eligible patients. Sixty-eight percent had no form of health insurance. The mean cost of diagnosis and treatment was $2,049 (SD $1,854). At a threshold of 10% and 25% of annual income, 95% and 86% of households experienced a CHE. Based on a household´s capacity-to-pay, 90% experienced a CHE. The mean cost of radiotherapy was $462 (SD $223) and the mean cost of trastuzumab was $6,568 (SD $2,766). Cost precluded surgery in 14% of patients with resectable disease. As a result of accessing treatment, 72% of households had to borrow money and 9% of households interrupted a child´s education.Conclusionthe out-of-pocket cost of breast cancer care in Nigeria is significant. This results in a CHE for 68-95% of households, which has significant health and economic sequelae. Greater financial protection is essential as the burden of breast cancer increases in Nigeria.

Older adults' exposure to anticholinergic medications: Implications for pharmaceutical care for Nigerian older adults.

Introduction:Anticholinergic medications which are commonly prescribed to older adults can produce more pronounced adverse effects compared to the younger population.Objectives:To investigate the prevalence of polypharmacy, describe the prescription patterns of anticholinergic medications, determine the prevalence of exposure to high-risk anticholinergic cognitive burden (ACB) medications, and identify the potential predictors of exposure to high-risk ACB medications in older adults in a Nigerian secondary hospital.Methods:This cross-sectional study that included older adults prescribed at least one anticholinergic medication was conducted at a secondary care hospital in Nigeria. The study data were initially summarized using descriptive statistics, whereas multivariable logistic regression analysis was used to identify the potential predictors of exposure to high-risk ACB medications. In this study, the cumulative ACB scores were dichotomized into low risk (score 1–2) and high risk (score ⩾ 3). A p value less than 0.05 was considered to be statistically significant.Results:A total of 256 older adults were included in this study; 113 (44.1%) had polypharmacy, whereas 26.6% (188/256) were exposed to high-risk ACB medications. Of a total of 391 anticholinergic medications used by the population, furosemide (36.57%) was the most commonly prescribed. The adjusted multivariable logistic regression analysis indicated that patients who had acute diseases were 2.5 times (adjusted odds ratio (AOR) = 2.49, 95% confidence interval (CI): 1.40–4.45) more likely to be exposed to high-risk ACB medications than those with chronic diseases.Conclusion:The study demonstrates a high prevalence of polypharmacy and exposure to high-risk ACB medications suggesting the need for pharmaceutical care in this high-risk population. Older adults’ exposure to high-risk ACB medications was significantly associated with prescriptions for acute diseases.

Incarcerated and strangulated inguinal hernias in children: A 10-year retrospective analysis

Abstract Background: In pediatric inguinal hernia, the most feared complication is incarceration, which can lead to catastrophic consequences if not resolved expeditiously. Aims: This study assessed the usefulness of manual reduction of complicated inguinal hernia in children. Settings and Design: This study was designed to study the age at presentation, gestation age at birth, duration of symptoms, success rate of manual reduction of incarcerated inguinal hernia, subsequent treatment, operative findings, and outcome of strangulated cases in pediatric patients. Materials and Methods: This is a retrospective study involving 56 children under 15 years of age with a diagnosis of complicated inguinal hernia managed between January 2009 and December 2018 at a tertiary care hospital in Nigeria. Demographic characteristics, clinical presentations, management, and outcome were retrieved. Data were analyzed using SPSS software version 22 (IBM Corp., NY, USA). The results were presented as frequencies and percentages. Categorical variables were analyzed using Chi-square test. P &lt; 0.05 was deemed statistically significant. Results: The age of patients ranged between 8 days and 14 years, with a median of 2 months; 79% were infants. Males outnumbered females by a ratio of 27:1, and the rate of incarceration was 5.0%. Majority (89.3%) had no previous hospital visits. Those who had successful manual reduction was 80%. Time of presentation was a statistically significant factor for successful reduction, P &lt; 0.05. One patient experienced en masse reduction, and there was no mortality. Conclusion: Majority of those with incarcerated inguinal hernias were infants, and manual reduction was associated with early presentation.

Utilization study of antidiabetes medicines at a tertiary care hospital in Nigeria

ObjectivesTo describe antidiabetes medicines prescribing and utilization patterns and to demonstrate gender, and age specific differences in the antidiabetes medicines consumption in the National Health Insurance Scheme (NHIS). MethodsOne hundred and fifteen out-patients prescriptions that contained at least one antidiabetes medicine issued to different NHIS patients that attended the health facility in 2013 were used for this study. WHO drug prescribing indicators was used to evaluate the medicines prescribing patterns, while WHO Anatomical Therapeutic Chemical/Defined Daily Dose methodology was used to describe the antidiabetes medicines consumption patterns. ResultsThe average number of all medicines prescribed per encounter was 5.9 ± 2.0. The percentage of medicines prescribed by generic names and antidiabetes medicines from NHIS essential medicine list were 53.2% and 49.0% respectively. Metformin alone and combinations were most predominantly prescribed, higher proportion of prescriptions comprised multi antidiabetes medicine regime (77.4%) than monotherapy (22.6%). Metformin alone, glibenclamide, and glimepiride made it to Drug utilization 90% segment with an index of adherence to the reference clinical guidelines of 83.6%. Metformin was the most consumed antidiabetes medicine and was equally consumed by both women and men (15.8 vs 15.9 DDD/1000 Patients/Day, p > 0.05). Compared to other age groups, patients aged 40–59 years consumed significantly higher metformin, glibenclamide, and glimepiride than other age groups (p < 0.05). ConclusionThis study shows a tendency for irrational prescribing, metformin was the most prescribed and consumed antidiabetes medicine. No substantial gender difference was observed, but higher consumption of antidiabetes medicines was noted in patients aged 40–59 years than other age groups.

Perinatal HIV Infection and Exposure and Their Association With Dental Caries in Nigerian Children.

Although HIV infection is associated with well-known oral pathologies, there remains a dearth of comparative studies aimed at determining the association between HIV infection/exposure and early childhood caries. This is a cross-sectional study using a convenience sample of 3 groups of children receiving care at a tertiary care hospital in Nigeria. The groups include HIV infected (HI), HIV exposed but uninfected and HIV-unexposed and -uninfected children 6 through 72 months of age. Medical records were reviewed, and caregivers were interviewed for sociodemographic, maternal and birth factors as well as early feeding and dietary information. Oral examinations were performed by trained dentist examiners. Of 335 children enrolled, 33 (9.9%) presented with caries. In an adjusted analysis, compared with HIV-unexposed and -uninfected children, HI children had significantly greater odds of having caries (odds ratio = 2.58; 95% confidence interval: 1.04-6.40; P = 0.04), but there was no statistically significant difference in HIV exposed but uninfected children (odds ratio = 2.01; 95% confidence interval: 0.56-7.23; P = 0.28). Factors significantly associated with higher caries prevalence include low CD4 counts and percentage, older age, longer duration of breastfeeding and spontaneous membrane rupture during delivery. Caries was more prevalent in HI children. These findings support the need to target HI children for oral health prevention and treatment services particularly in Nigeria and other developing countries.

Carotid Intima-Media Thickness in Patients with Diabetes Mellitus Attending Tertiary Care Hospital in Nigeria

Objective: Carotid intima-media thickness is a significant and independent predictor of coronary artery disease in patients with diabetes. The aim of our study was to determine carotid intima-media thickness in Nigerians with diabetes.Methods: This was an observational cross-sectional study involving consecutively presenting patients with type 2 diabetes mellitus and healthy age-matched adults. Anthropometric variables were measured, and blood samples collected for fasting blood sugar, cholesterol, and HbA1c. Carotid intima-media thickness was measured using a 2-D scanner. Association of carotid intima-media thickness with other variable was assessed using correlation and multivariable linear regression models.Results: One hundred and fifty two subjects (87 diabetics and 65 healthy adults) were studied. Carotid intimamedia thickness was significantly higher among diabetics. Seventy nine (90.8%) and seventy two (82.8%) patients with diabetes had carotid intima-media thickness greater than 0.9 mm and 1.0 mm respectively. Carotid intimamedia thickness was higher in patients with higher HbA1c, fasting blood sugar, body mass index, total cholesterol and LDL cholesterol, and significantly correlated with HbA1c, age, fasting blood sugar, systolic blood pressure, total cholesterol, LDL-c and HDL-c. Age, HbA1c and duration of hypertension predicted increased carotid intima-media thickness.Conclusion: The prevalence of increased carotid intima-media thickness is extremely high among Nigerians with diabetes, and this significantly correlated with other risk factors for cardiovascular diseases. Assessment of carotid intima-media thickness should be routinely included in evaluation of subjects with diabetes, and assessment of total cardiovascular risk.

Profile of Secondary Glaucoma in A Semi Urban Tertiary Health Care Hospital In Nigeria

Introduction: Glaucoma is the second-most-frequent cause of blindness in the world. Most primary glaucomas are managed by early diagnosis and treatment however secondary glaucomas differ from primary by the fact that, if the primary pathology is treated properly and the possibility of secondary glaucoma is kept in mind, glaucomatous damage can be easily prevented. This study is aimed at determining the prevalence and pattern of secondary glaucoma, the knowledge of which will help in reducing the glaucoma blindness. Methods: A retrospective review of medical records of all consecutive newly diagnosed glaucoma patients attending the eye clinic of Ekiti state university teaching hospital,(Eksuth) Ado Ekiti, from January 2011 to December 2012 were selected for the study. Each patient had a complete ophthalmic evaluation, including relevant history, visual acuity testing, slit-lamp examination, applanation tonometry, gonioscopy with a 4mirror goniolens and standard automated perimetry. Data collected was collated and analyzed using SPSS version 16 (SPSS, Inc, Chicago, USA). Frequencies and means were generated to observe patterns of variable distribution among the patients. Result: A total of 5655 new patients attended the eye clinic during the study period, 1660(29.4%) were diagnosed with glaucoma out of which primary glaucoma were 1561(94.0%) while secondary were 99(6.0%). The spectrum of secondary glaucoma were post traumatic glaucoma 25(25.2%), lens related glaucoma 16(16.2%), steroid induced glaucoma 14(14.2%), neovascular glaucoma 12(12.1%), uveitic glaucoma 10(10.1%), pseudoexfoliation glaucoma 10(10.1%), pigmentary glaucoma 6(6.1%), aphakic glaucoma 6(6.1%). Conclusion: Post traumatic secondary glaucoma has the highest frequency of occurrence and as with others, requires prompt diagnosis and treatment which may help significantly in preventing resultant visual impairment and blindness.

Comparative analysis of morbidity and mortality due to ectopic pregnancy at a tertiary care hospital in Nigeria over two study periods

Comparative analysis of morbidity and mortality due to ectopic pregnancy at a tertiary care hospital in Nigeria over two study periods

A study on prevalence of discharge against medical advice in a tertiary care hospital in Nigeria

Background: The length of hospital stay for every neonate admitted for care is more often than not at the mercy of the parents/caregivers. Aims: To determine the pattern of request for discharge against medical advice of neonates. Methodology: A 5-year cross-sectional study at the Special Care Baby Unit (SCBU) of Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria. All babies that were discharged against medical advice (DAMA) between January, 2008 and December, 2012 were recruited. Both baby/maternal information and the indications for the discharge were documented. Statistical analysis was done using SPSS version 20.0 Results: Admission to SCBU for the period was found to be 2,426 (20.2%). Forty two (1.7%) babies were DAMA; males 17 (40.5%), females 25 (59.5%); M: F; 0.7:1.5. Twenty seven (64%) delivered in UDUTH, 15 (36%) outside the facility. Birth weights ranged from 1.0 – 4.8kg with mean SD of 3.03 ± 0.8. 36 (85.7%) were spontaneous vertex deliveries, and term babies accounted for 78.6%. Babies delivered vaginally had more DAMA. Birth asphyxia was the commonest diagnosis. The mean duration of hospital stay was 8.2 ± 5.4 days. Nineteen babies (45.2%) were DAMA in the first 8 days of admission, majority of these were from the low and middle income groups. Four neonates (9.5%) were re-admitted. The commonest reason for DAMA was financed (45.2%) and father was the main signatory to the DAMA (92.9%). Conclusions: Discharge against medical advice remains a paediatric problem in the study area despite adequate counselling.

HIV and HBsAg Seropositivity Amongst Patients Presenting for Ocular Surgery at a Tertiary Eye Care Hospital in Nigeria

Background:The prevalence of HIV/AIDS and HBsAg sero-positivity is very high in sub-Saharan African. There is a risk of horizontal transmission of these diseases amongst ophthalmic patients.Aim:To determine the proportion patients for eye surgery who are HIV/AIDS and HBsAg sero-positive at the National Eye Centre, Kaduna, Nigeria.Methods:Patients selected for eye surgery during a surgical camp at the National Eye Centre, Kaduna were counseled for Voluntary Counseling and Testing (VCT) and HBsAg to determine their viral status.Results:A total of 650 patients who were selected were screened. The distributions of the indications for selection were as follows: cataract 483 (74.3%); glaucoma 44 (6.8%) and pterygium 123 (18.9%). Two patients (0.2%) were found to be HIV seropositive while 11 (1.5%) were HbsAg positive.Conclusion:Pre-operative screening of all patients going for ophthalmic surgery for HIV and HbsAg may be desirable in our environment.

Clinical profile and outcomes of adult patients with hyperglycemic emergencies managed at a tertiary care hospital in Nigeria.

Background:To document the clinical profile and treatment outcomes of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) managed in a tertiary care hospital.Materials and Methods:This was a retrospective review of hospital records of patients with DKA and HHS admitted to a tertiary care hospital over a 24-month period. Data on demographics, precipitating factors, clinical features, serum electrolytes, duration of hospital admission, and mortality were extracted.Results:Eighty-four patients were included in the study. Fifty (59.5%) were females. Ten (11.9%) persons had type 1 diabetes mellitus (T1DM) and 74 (88.1%) had type 2 diabetes mellitus (T2DM). There were 35 cases of DKA and 49 cases of HHS. Nine patients with T1DM presented in DKA and one in HHS. Forty-eight (55.2%) subjects were previously not diagnosed of diabetes mellitus (DM). The mean±SEM age, casual blood glucose, calculated serum osmolality, and duration of hospital stay of the study subjects were 50.59±1.63 years, 517.98±11.69 mg/dL, 313.59±1.62 mOsmol/L, and 18.85±1.78 days, respectively. Patients with T2DM were significantly older than those with T1DM (54.32±1.34 vs. 23.40±1.38 years, P<0.001).The precipitating factors were poor drug compliance 23 (27.4%), malaria 12 (14.3), urinary tract infection 10 (11.9%), lobar pneumonia 4 (4.8%), and unidentifiable in 29 (34.5%). Common electrolyte derangements were hyponatremia, 31 (36.9%) and hypokalemia 21 (25%). Mortality rate was 3.6%.Conclusion:DKA is common in patients with T2DM.Over 50% of the patients presenting with DKA or HHS have no previous diagnosis of DM. Non-compliance, malaria, and infections are important precipitants. Mortality rate is low.