Private Specialist Hospital Research Articles

Successful Removal of Forty- Two Number Fibroid Masses during Caesarean Section in A Primigravid Woman in a Private Facility in a Low Resource Area: A Case Report

Uterine fibroid is the most common pelvic tumour in women of reproductive age. It has an incidence of 0.05 – 5%. Its prevalence peaks between 30 – 39 years. It is seven times (7x) more common among blacks than Caucasians [1]. Here, we present a 30-year-old primigarvid woman who had caesarean myomectomy in which 42 number of variously sized fibroid masses were enucleated in a private specialist hospital. This case report suggests that caesarean myomectomy does not appear to increase the risk of immediate or short term post-partum morbidity. It also shows that it is feasible to remove all the visible and palpable fibroid nodules during caesarean myomectomy with relative safety.

Delayed presentation of giant uterine fibroids in a Nigerian private specialist health facility

Giant uterine fibroids (leiomyoma or myomas) which are fibroid masses greater than 11.4 kg are very rare. Although benign in nature, it may present with symptoms that impact negatively on the quality of life and health of the patient and impose greater management challenges. We present two cases of giant uterine fibroids that were successfully managed in a private specialist hospital without complications. Case 1 was a 38-year-old nulliparous Nigerian woman who presented with giant uterine fibroids (11.6 kg) who initially had delay of surgery due to fear that after surgery she may lose her “womb” or not be able to conceive after the operation. Later, she had successful open abdominal myomectomy, with the use of Foley catheters as improvise equipment for tourniquet and abdominal drain. Anti-adhesion agent was not used. Case 2 was a 47-year-old nulliparous Nigerian teacher with giant fibroids (13.2 kg) who also initially had delayed surgery due to fear that fibroid surgery is a major operation that it may get complicated and she may die. Also, she was afraid that she may not have her womb in her next world if she gets reincarnated. She had total abdominal hysterectomy and bilateral salpingo-oophorectomy without complications. For both cases, pre-surgery leiomyosarcoma assessment with computed tomography scan or magnetic resonance imaging and anti-adhesion agent were not used due to very unaffordable high costs. These reports of giant uterine fibroids (leiomyoma or myomas) are very rare gynecological entity, and management can be successful despite overwhelming challenges in low-income countries. Cheaper, affordable and available alternatives (improvises) can be resorted to for tackling its challenges in low-income settings.

Experience with Hysteroscopy in a Private Specialist Hospital in Nigeria.

Background:Hysteroscopy is a standard method for the evaluation and treatment of various gynecological disorders. Its availability and accessibility are limited in our setting owing to resource constraints. Nevertheless, the utilization is on the increase mostly in private health institutions in Nigeria and as an adjunct in infertility management.Objectives:The objective is to document the experience and outcome of hysteroscopy surgeries at a private specialist-assisted reproduction and endoscopy unit.Materials and Methods:A retrospective review of all hysteroscopic procedures conducted at the unit was undertaken. Relevant sociodemographic and clinical information were extracted for analysis. In addition, outcomes of the procedure and outcome for those who eventually had in vitro fertilization (IVF) treatment were documented for analysis.Results:A total of 106 patients had hysteroscopy over the study period. The age of patients ranged from 24 to 55 years. The most common indication for hysteroscopy was uterine synechiae (50%) others were preparatory for IVF (30.2%), uterine fibroid/polyp (10.4%), and abnormal uterine bleeding (9.4%), respectively. The major findings at hysteroscopy were intrauterine adhesions 68.9%. Therapeutic adhesiolysis was done using the scissors in most cases (83%) while two patients (1.9%) had adhesiolysis and resection of uterine polyp. A complication of noncardiogenic pulmonary edema was recorded from fluid overload. Overall most had return to normal menses (65.1%). Thirty-nine (38.8%) women had IVF treatment after hysteroscopy of which outcome was successful in 16 (41%) women.Conclusion:The utilization of hysteroscopic surgeries in management of endometrial pathologies is increasing. It offers a safe and effective treatment and is a useful adjunct for improving IVF outcome especially for those with repeated failed treatment.

Sociodemographic Factors and its Impact on Health Related Quality of Life (HRQoL) among Adult Asthma Patients in a Private Specialist Hospital in Malaysia

: Objectives: The present study aimed to explore the factors associated to asthma and HRQoL of patients. Asthma and Chronic obstructive pulmonary diseases implicate severe restrictions on physical, social and emotional aspects of the patients’ life. Health-related quality of life (HRQoL) is a patient derived measurement that defines the functional effects of illness and treatment, as perceived by the patient. Methodology: A descriptive cross-sectional study comprised of 100 asthma patients sampled in the outpatient department of KPJ Seremban Specialist Hospital. Mini-Asthma Quality of Life Questionnaire (Mini-AQLQ) with two sections was used as instrument in this study. The first section comprises six (6) Sociodemographic questions and the second section comprises fifteen (15) questions of HRQoL covering four main domains such as emotional, activity, symptoms and environmental. Results: The sociodemographic factor that correlated positively with HRQoL in all domains of the AQLQ was the higher education level of patients. Factors that negatively influenced the entire AQLQ domain were the older age of the patients and lower occupation status. The most affected domain of AQLQ due to asthma is the emotional domain and the least affected domain is the activity domain. Conclusion: This study represents that age decreased the HRQoL of patients and concluded that higher education level contributes to better HRQoL scores and implies that higher education plays a pivotal role in HRQoL and we believe that it can be improve by reinforcing Health education.Key words: Bronchial Asthma, Health related quality of life, Sociodemographic factors, Symptoms domain, Activity domain, Emotional domain, Environmental domain.

Correlation of Ultrasonographic Estimation of Fetal Weight with Actual Birth Weight as Seen in a Private Specialist Hospital in South East Nigeria

Background Ultrasound estimation of fetal weight at term provides vital information for the skilled birth attendants to make decisions on the possible best route of delivery of the fetus. This is more pertinent in a setting where women book late for antenatal care. Aim and Objectives The study evaluated the accuracy of estimation of fetal weight with ultrasound machine at term. Methods This was a cross sectional study conducted at a private specialist hospital in Nigeria. A coded questionnaire was used to retrieve relevant information which included the last menstrual period, gestational age, parity, and birth weight. Other information obtained includes Ultrasound-delivery interval, maternal weight, and route of delivery. The ultrasound was used to estimate the fetal weight. The actual birth weight was determined using a digital baby weighing scale. The data were inputted into Microsoft excel and analyzed using STATA version 14. Statistical significance was considered at p-values less than 0.05. Measures of accuracy evaluated in the statistical analysis included mean error, mean absolute error, mean percentage error, and mean absolute percentage error. Pearson correlation was done between the estimated ultrasound fetal weight and the actual birth weight. The proportion of estimates within ±10% of actual birth weight was also determined. ResultA total of 170 pregnant women participated in the study. The mean maternal age was 30.77 years ± 5.54. The mean birth weight was 3.47 kg ± 0.47, while the mean estimated ultrasound weight was 3.43 kg ± 0.8. There was positive correlation between the ultrasound estimated weight and the actual birth weight. The mean ultrasound scan to delivery interval was 0.8 days (with range of 0–2 days). The study recorded a mean error of estimation of 41.17 grams and mean absolute error of 258.22 grams. The mean percentage error was 0.65%, while the mean absolute error of estimation was 7.56%. About 72.54% of the estimated weights were within 10% of the actual birth weight. Conclusion The ultrasound estimated fetal weight correlated with the actual birth weight. Ultrasound estimation of fetal weight should be done when indicated to aid the clinician in making decisions concerning routes of delivery.

Influence of induced abortion on tubal findings in hysterosalpingography among women with infertility in Calabar, Nigeria

Background/Aim: Induced abortion is a major cause of infertility in our environment, with postabortal complications commonly occurring, especially when done by untrained medical personnel, and in unsafe environments. Imaging plays a very important role in the assessment of tubal factors as a possible cause of infertility; hence, the choice of hysterosalpingography (HSG) as a vital initial tool in the diagnostic evaluation of these patients. The aim of the study was to determine the relationship between induced abortions and HSG tubal findings in the management of females with infertility. Materials and Methods: This was a cross-sectional descriptive study of 87 HSG's of women being managed for infertility in a private specialist hospital over 2 years from November 2015 to October 2017. Results: The overall mean age of the respondents was 34.09 ± 4.82 years. Most of the respondents were between 30 and 39 years (60.9%) of age, 70 (80.5%) respondents were nulliparous, and 71 (81.6%) had a previous history of induced abortion. Tubal findings were found to be normal in over a third of the respondents (35.6%). The most common abnormal findings were tubal blockage and hydrosalpinx (50.6%). The abnormal tubal findings were significantly associated with a history of more than one induced abortion and nulliparity (P < 0.05). Hydrosalpinx (86.4%) was commonly linked with a previous history of induced abortion, although the difference was not statistically significant (P ≥ 0.05). Conclusions: The study demonstrated that abnormal tubal findings in HSG are more common among women with a history of induced abortion; however, the prevalence of tubal damage had mild correlation with the number of induced abortions.

Day of Surgery Cancellation in Urology at a Public Tertiary Hospital and a Private Specialist Hospital

Background: There is a high variability in the reasons for cancellation of elective urological surgery cases. Case cancellation rate is expected to be high in the Public Health System with perceived inefficiencies compared to private facilities in the same developing economy. Aims and Objectives: This comparative analysis was to determine the case cancellation rate and the reasons for cancellation of elective urological surgeries in a public tertiary hospital and a private specialist hospital in Accra. This is intended to form a basis for interventions aimed at reducing the case cancellation rate. Methods: This was a retrospective analysis of prospectively collected data on Day of Surgery cancelled elective urological cases from September 2014 to October 2015 at the urology unit of the Korle-Bu Teaching Hospital (KBTH), a public Tertiary Hospital and the Trust Specialist Hospital (TSH), a privately managed hospital in Accra. The reasons for case cancellation were categorized into structural factors, patient factors and process factors. Results: There was no significant difference between the case cancellation rate for elective urological cases at KBTH and the TSH which were 20.8% and 17.1% respectively (p = 0.317). For KBTH, the reasons for cancellation of elective urological cases were due to structural factors in 11/117 (9.4%), patient factors in 15/117 (12.8%) and process factors in 91/117 (77.8%) which was due mainly to surgery running late. At the TSH, the reasons were due to structural factors in 1/29 (3.4%), patient factors in 27/29 (93.1%) mainly due to patient not turning up and process factors in 1/29 (3.4%). Conclusion: The case cancellation rate of elective urological surgeries in both the Public Tertiary Hospital and the Private Specialist Hospital were high with no significant difference between the two. However, in the Public Tertiary Hospital, process factors predominated as the cause of these cancellations while patient factors were the predominant cause in the privately managed facility. Exposure of theater managers in public facilities to management practices in privately run facilities should be encouraged to help improve the efficiency of the public facilities.

Hospital treatment delays due to prayer ministries: A report of three tumor cases in a private specialist hospital, Southeast Nigeria

Prayer ministries that profess miracles through prayers and vigils to heal sick persons abound in our clime. In many cases, this causes so much delay before the search for appropriate medical solutions. Often, the worsening conditions of enlarging tumor masses, pain, anemia, and weight loss may be the compelling reasons for surgical consultations. By this time, a varying number of them may not respond positively to treatment because of the late presentations. This report aims to draw attention to the problems caused by these religious groups whose modus operandi are the use of prayers and miracles to solve all medical conditions and inadvertently cause delays in accessing proper medical treatment by the patients, thus resulting in more complications.

Cost Burden of Post Stroke Condition in Nigeria: A Pilot Study

Aim:Estimation of cost burden of a disease condition is a very important part of health care policy making worldwide. Till now, such documents are lacking especially on non-communicable diseases in the health policy making process in Nigeria. This article therefore attempts to report the results of a prospective cross-sectional study on the cost burden of a cerebrovascular accident condition (stroke) in Nigeria. It estimates the direct health care cost for a minimum period of 12weeks and maximum of 36weeks for post stroke hemiplegia.Study Design/Setting:It was a collaborative cross-sectional study amongst centers situated in urban and sub-urban environments in Southern Nigeria. It involved a hospital of an Oil and Gas Company in Port Harcourt, Nigeria, two Government tertiary hospitals in Port Harcourt and Benin-City, all in South-South Nigeria, the industrial hub of the country. A Private Specialist hospital in Lagos, South-West Nigeria, the corporate hub of the country was also included.Method:Patients diagnosed and admitted for management for cerebrovascular accident (stroke) in the above named health facilities formed the subjects of this study. Medical records (case files) of two hundred and forty (240) stroke patients managed within the last six years (2005- 2011) were randomly selected from the medical record departments of the study centers. Files of the patients who were admitted during acute care period (without discharge against medical advice) and were followed on out-patient basis without default within the study period were purposively utilized. The files were then assessed for the various investigations and treatment interventions of acute and long term care and the costs thereof. Ethical approval to access patients’ case files was sought and granted by the Research Ethics Committee of the different study centers.Results:The results revealed that it requires an average of N95,100: 00 ($600) and N767,900: 00 ($4860)in a government and a private hospital, respectively to access care within the first 36weeks of post stroke affectation in Nigeria.Conclusion:The outcome of this study suggests that managing stroke constitutes a huge direct cost burden unaffordable by an average Nigerian stroke sufferer. The implication is that lack of means for rehabilitative care may result in disability adjusted life years which further compounds burdens in terms of indirect cost on the sufferers’ and care givers’ productivity. It is therefore recommended that awareness of this disorder is created by policy makers and implementers where it does not exist and increased where it does with health promotion and preventive measures.

Clinical pattern and management outcome of uterine fibroids seen in a private specialist hospital in southeast Nigeria.

BackgroundUterine fibroid is the commonest tumour affecting women of reproductive age in our locality. Owing to the significant role played by privatehealth facilities in healthcare delivery in the developing countries, most of these cases will be handled at the private facilities. Therefore aconstant review of pattern of presentation and treatment outcome in these hospitals is necessary to improve on the efficiency of the diagnosis andtreatment of this common condition.Objective: To ascertain the pattern of clinical presentation, findings at surgery and treatment outcome of cases of uterine fibroids managed byabdominal myomectomy in Private Specialist Hospital in Southeast Nigeria, over a 5-year period.Setting: Grace Specialist hospital Onitsha, South East of Nigeria.Materials and methods: This prospective descriptive study was carried out between 1st January 2003 and 31st December 2007. Patients whowere booked for myomectomy on account of uterine fibroids were recruited for the study. The diagnosis of uterine fibroids was made bothclinically and use of ultrasound. Biodata, clinical presentation, findings at surgery, complications following surgery and duration of hospital staywere recorded. The data was analyzed with the epi info statistical package, version 2006.Result: The mean age of the patients was 32.9±6.5 years. Majority of the patients were nulliparous (7.0%). The commonest presenting symptomwas menorrhagia (44.40%) and majority (54.2%) of the women had medium sized fibroids (uterine size 12-16weeks).The total number of fibroid nodules ranged from 1-148(mean= 11) with weight varying between 25g to 3850g. Most (68.1%) of the patients had a combination ofintramural, subserous, submucous fibroids and intraligamentary fibroids. The transverse abdominal incision was used in majority (51.4%) of thepatients. The estimated mean blood loss was 500±150mls, with a mean drop in haemoglobin concentration of 1.4 +0.6g/dl. 22.20% of thepatients received blood transfusion intraoperatively. Postoperative complications were encountered in 11.80% of patients and constitute mainly of febrile morbidity (5.6%) and wound infection (2.8%). The mean hospital stay was 9.1=3.6 days. No mortality was recorded.Conclusion: Most of the women managed for uterine fibroids were nulliparous and presented mainly with menorrhagia and multiple fibroidsnodules. Myomectomy as a form of treatment is safe but may be attended by a high level of blood transfusion. Efforts should be made to reduceintraoperative blood loss by the use of tourniquet and the gonadotrophin releasing hormone analogues.

Seroprevalence of hiv infection among antenatal women at a private specialist hospital in Onitsha, Anambra state, southeast, Nigeria.

Objective : The objective of this study was to determine the seroprevalence of HIV I I df = 5; p = 0.000044), and parity distribution and HIV seropositivity (X2 = 17.42; df = 5; p = 0.007763) Conclusion : The seroprevalence of HIV among the anatenatal women was high. The test is highly acceptable to the women. Therefore it is very feasible to establish routine antenatal HIV screening in private hospitals which will also serve as a channel of recruiting women into PMTCT of HIV/AIDS.

Musculoskeletal injuries: A private specialist hospital perspective

Trauma remains one of the leading causes of death globally. It also leads to short and long term morbidity as well as enormous economic loss, especially for a developing economy such as Nigeria. To describe the pattern and outcome of musculoskeletal injuries. This is a 5-year retrospective study of musculoskeletal injuries seen in Havana Specialist Hospital, Lagos, Nigeria. A private hospital servicing mainly families of the upper and middle economic class. One thousand, one hundred and twenty-one cases were studied. Males accounted for 730 (65.1%). Ages 3 weeks to 78 years were affected with a mean of 34 years and peak incidence in the 21-30 years group. Road traffic accident caused 959(85.5%) of the injuries, followed by falls 76 (6.8%) and gunshots 52 (4.6%). Four hundred and eighty-three (50.4%) of the RTA were motorcycle related. Lower limbs alone were affected in 228 patients (20.3%), upper limbs in 74 (6.6%), head and neck in 41 (3.7%). Two hundred and fifty-eight patients (23.0%) had two hundred and sixty-six fractures. Five hundred and eight patients (45.3%) had multiple injuries. Twenty-five patients (2.2%) died. Musculoskeletal injuries are mostly caused by road traffic accidents and affects mainly young adult males. Motorcycle related incidents constitute majority of road traffic accidents.