Tolerance and acceptance for unsedated diagnostic upper gastrointestinal endoscopy in Kaduna, North-West Nigeria.

Background: Upper gastrointestinal endoscopy (UGIE) using pharyngeal anesthesia, with or without sedation to improve tolerance and acceptance, is now standard practice but the unsedated examination is easier to perform, costs less and is associated with fewer complications. It is, therefore, attractive in resource-limited settings like sub-Saharan Africa but studies about tolerance and acceptance of unsedated UGIE there are limited. Objective: The objective of this study was to report the tolerance and acceptance of unsedated UGIE in a tertiary institution in Kaduna, Nigeria. Methods: Consecutive patients referred for diagnostic UGIE were requested to report the overall level of discomfort for the procedure on verbal and visual analogue scales and to indicate whether they would accept the procedure in the future. Their pulse rate, oxygen saturation and blood pressure were monitored. Results: Of 306 patients (mean age: 45.5 years, 39.2% <40 years, 57.5% of females), 51.3% reported no or mild discomfort and only 5.6% reported severe and intolerable discomfort. Overall, 232 (75.8%) tolerated the procedure well and 229 (79.5%) accepted to have the same procedure in the future. Patients <40 years and those with secondary/post-secondary education were significantly less likely to tolerate the procedure well than older patients (81.1% vs. 87.9%, P = 0.006) and those with lower education (72.7% vs. 86.2%, P = 0.032), respectively. 79.5% accepted to have the procedure in the future, with males significantly more so than females (86.9% vs. 74.4%, P = 0.019). Conclusion: Most patients undergoing unsedated diagnostic UGIE in Kaduna, Nigeria, tolerated the procedure well and accepted to have the same procedure in the future.

Endoscopy for upper gastrointestinal bleeding in a tertiary hospital in Kaduna, North-West Nigeria: Experience and findings.

Background: Upper gastrointestinal bleeding (UGIB) is a common medical emergency and upper gastrointestinal endoscopy (UGIE) makes diagnosis and treatment possible; performing this procedure within 24 h of bleeding is considered the standard of care for managing this condition. Access to upper endoscopy improves the prognosis of the disease. Methods: We present our experience and findings of performing UGIE in patients referred for UGIB to a new endoscopy unit in a tertiary center in North-West Nigeria. The age, gender, reasons for referral, interval between endoscopy, and last known episode of bleeding and endoscopic findings were obtained from endoscopy records. Results: We performed UGIE in 204 patients for UGIB over a 7-year period: Mean age 45.5 years (range 10-88 years), 61.8% male, 54.8% <50 years. Most patients (81.3%) had endoscopy seven or more days after the last known episode of bleeding and none had endoscopy within 24 h. Esophageal and gastric varices were found in almost 30% of patients while peptic ulcer disease was found in 23%. Portal hypertensive gastropathy was found in 12.7% of patients all of whom also had esophageal or gastric varices. Gastric mucosal erosions (7.4%) and gastric malignancy (6.4%) were other notable findings. No significant abnormalities were detected in 11.8% of patients. Conclusion: Bleeding from esophageal/gastric varices and peptic ulcer disease were the most common finding in our patients. There was delay in performing endoscopy and improving access and training for endoscopy will go a long way in addressing some of the challenges we identified.

Résumé L'hémorragie gastro-intestinale haute (UGIB) est une urgence médicale courante et l'endoscopie gastro-intestinale haute (UGIE) rend diagnostic et traitement possibles; la réalisation de cette procédure dans les 24 heures suivant le saignement est considérée comme la norme de soins pour la prise en charge de cette condition. L'accès à l'endoscopie haute améliore le pronostic de la maladie. Méthodes : Nous présentons notre expérience et nos résultats de réalisation UGIE chez les patients référés pour UGIB à une nouvelle unité d'endoscopie dans un centre tertiaire du nord-ouest du Nigeria. Âge, sexe, raisons de l'orientation, l'intervalle entre l'endoscopie et le dernier épisode hémorragique connu et les résultats endoscopiques ont été obtenus à partir des dossiers d'endoscopie. Résultats : Nous réalisé CELU chez 204 patients pour UGIB sur une période de 7 ans : âge moyen 45,5 ans (extrêmes 10­88 ans), 61,8 % hommes, 54,8 % < 50 ans. Suite les patients (81,3 %) ont eu une endoscopie sept jours ou plus après le dernier épisode hémorragique connu et aucun n'a eu d'endoscopie dans les 24 heures. Oesophagien et des varices gastriques ont été trouvées chez près de 30% des patients tandis qu'un ulcère peptique a été trouvé chez 23%. La gastropathie hypertensive portale était trouvé chez 12,7% des patients qui avaient tous aussi des varices oesophagiennes ou gastriques. Érosions de la muqueuse gastrique (7,4 %) et malignité gastrique (6,4 %) étaient d'autres découvertes notables. Aucune anomalie significative n'a été détectée chez 11,8 % des patients. Conclusion : Saignement de l'œsophage/gastrique les varices et les ulcères peptiques étaient les signes les plus fréquents chez nos patients. Il y a eu un retard dans la réalisation de l'endoscopie et l'amélioration L'accès à l'endoscopie et la formation contribueront grandement à relever certains des défis que nous avons identifiés. Mots-clés: Endoscopie, hémorragie non variqueuse, saignement gastro-intestinal supérieur, endoscopie gastro-intestinale supérieure, hémorragie variqueuse.

A rare concurrence: bee venom associated acute tubular necrosis and acute interstitial nephritis.

Acute kidney injury (AKI) is generally associated with increased morbidity and mortality and is even more devastating in patients with comorbidities. Although AKI due to multiple bee stings is well established in the literature, it is still a rare entity with complex pathophysiologic mechanisms. The most commonly reported histological findings in AKI due to bee stings is acute tubular necrosis (ATN), with a few studies attributing it to acute interstitial nephritis (AIN), whereas the concurrence of both ATN and AIN is rarely reported. We hereby present a 50-year-old known Type 2 diabetes mellitus patient with a prior normal renal function, who developed AKI following multiple stings from >1000 bees. He had a kidney biopsy on account of non-recovery of his kidney function despite being on intermittent hemodialysis that showed combined features of ATN and AIN. He subsequently had a full recovery of his renal function following appropriate management.