Schistosomiasis prevention option: toxicological evaluation of Vernonia amygdalina on the tissues of Bulinus truncatus at different pH conditions.

Research into, and the use of plant products in the control of vectors of pathogens is being revived and seriously considered as an alternative or complete replacement for the classical synthetic agents. The study was designed to investigate toxicological assessment of the aqueous leaf extract of Vernonia amygdalina on mortality and tissue level damages of the freshwater snail Bulinus truncatus at different pH levels. The effects of the extract on total protein concentration and activities of acetylcholinesterase, acid phosphatase and alkaline phosphatase in the tissues of the snail were assayed using standard methods. Compared to the control (snail group not treated with the extract of V. amygdalina), there were significant (p < 0.05) reductions in the total protein concentrations and acetylcholinesterase activity in the snails' tissues of the treated groups (0.20 mg/L, 0.40 mg/L and 1.00 mg/L) at all the pH conditions (3.5, 7.0 and 10.5). The reverse of this trend followed in the case of acid and alkaline phosphatases' activities. The study provides a substantial possibility of exploiting local indigenous plant resources such as V. amygdalina for control of freshwater snails and monitor water pollution. The study also raised a possibility of the locals living around freshwater bodies prone to trematode borne diseases to reflexively control freshwater snail population by just squeeze-washing their V. amygdalina around the river banks.

Management of malignant pleural effusion (MPE) in a Tertiary Hospital in a low-income-country: challenges and prospects

Background: In the West African sub-region, significant morbidity and mortality are known to affect patients with malignant pleural effusion (MPE) but are highly under reported unlike USA, Europe or South Africa. Aim/Objective: To review cases of MPE in our tertiary hospital in the last 13 years with a view to determining the challenges and prospects. Materials and Method: This is a retrospective study spanning over a decade from January, 2007 to December, 2019. Malignant pleural effusion from various neoplasms constitutes the commonest thoracic malignancy in our tertiary hospital. After 13 years of management of such patients, we reviewed the datafrom the hospital record's department. The data obtained were demography, aetiology, total number of pleural fluid specimens for cytology and pleural biopsies submitted for histology, pleurodesis and other treatment modalities. Result: 211 patients with MPE were admitted and managed during the period under review. Of these numbers, 135(64.0%) were confirmed cytologically positive (MPE). 76(36.0%) tested falsely negative and were initially regarded as paramalignant, later confirmed MPE. The age affected was from 7 to 81 years with a mean of 44 years. Of 211 patients with MPE, 94 were males while 117 were females, with a male to female ratio of 4:5. Aetiologically, metastatic breast cancer was the highest followed by advance lung cancer. Conclusion: Submission of insufficient samples resulted in false negative cytology. Review of recurrent pleural effusion and exophytic tumour at the sites of CTTD resulted in late diagnosis of MPE. Additionally, prolonged hospital stay awaiting CTTD and cytology results are among the challenges

Blood pressure values in healthy term newborns at a tertiary health facility in Enugu, Nigeria.

BACKGROUND: Blood pressure (BP) is a reflection of hemodynamic variables. It is an important vital sign and indicator of clinical stability. Accurate measurement of this physiological signal is essential for the optimal management of the ill infant. An increase in the awareness of hypertension among neonates has resulted to increased ability to diagnose neonates with the disease. OBJECTIVES: This study aimed to determine BP values in apparently healthy term newborns in the first 48 h of life and evaluate the factors affecting BP at birth. METHODS: Three hundred and ten healthy appropriate for gestational age term newborns were consecutively recruited. BP measurements were determined using the oscillometric technique with the neonate supine after an appropriate size cuff was applied on the right arm. The monitor (Dinamap 8100) is switched on while the cuff inflation and deflation is automatically done by the instrument with subsequent display of the BP values on the screen. BP measurements were taken at age 0-24 h and 25-48 h. Their weight was measured with infant's weighing scale, and data analyzed with SPSS version 15. RESULTS: The mean systolic BP (SBP), diastolic and mean arterial BP at 0-24 h were 63.3 ± 5.5 mmHg, 36.8 ± 5.3 mmHg and 46.4 ± 5.2 mmHg respectively. There was a positive correlation between birth weight and SBP at birth. No significant correlation was found between BP and gender, mode of delivery or maternal age. CONCLUSION: This study provides current normative BP values that can be used in neonatal Intensive Care Unit.

GIANT PSEUDOANEURYSM OF A SPLANCHNIC ARTERY; A Case Report.

A true aneurysm is defined as an enlargement of an artery resulting in a diameter more than 1.5 times the anatomic size. It can be fusiform when it covers the entire perimeter of the vessel, or saccular when it bulges on one side of the artery. The pseudoaneurysm is a pulsating encapsulated haematoma in communication with the lumen of the ruptured vessel,which affects the the intima and the media and which is stopped from developing by the adventitia and the surrounding connective tissue. Geographically, aneurysm can be broadly divided into intracranial and extracranial types.While the neurosurgeon manages the intracranial types, the vascular surgeon manages the extracranial types. Vascular surgeons also do divide the extracranial types into central (abdominal-aorto-iliac, thoracic including ascending, transverse aortic arch and descending), peripheral (extremities) and visceral (splanchnic arteries). Splanchnic artery aneurysm includes the coeliac, superior mesenteric, inferior mesenteric arteries including their branches. Of all intra-abdominal aneurysms, only around 5% are due to the splanchnic arteries,which could be either true or pseudo. The prevalence has been estimated at 0.1-0.2%.

The profile of chest injuries in a southeastern Nigeria teaching hospital, a 10-year experience.

BACKGROUND: Globally, major chest injuries have both high morbidity and mortality. A detailed study of chest injuries in south-eastern Nigeria is here presented. AIMS: To determine the incidence, the predisposing factors, the pattern of presentation and the outcome of management of chest injuries. MATERIALS AND METHODS: This is a retrospective study spanning a period of 10 years (2002-2011). The medical records of all patients with documented chest injuries that presented to our hospital within the period under review, were retrieved and analysed, by simple arithmetic percentages. RESULT: A total of 402 patients (average of 40/year) with the age ranges in the spectrum of 0-10 and 81-90 years, with a mean of 2.2 were found. Gender-wise, 301 males (74.9%) and 101 females (25.1%) were affected. The aetiological or the predisposing factors were blunt chest injuries (61.2%) and penetrating chest injuries (38.8%). In the pattern of presentation, haemothorax (20.9%), haemopneumothorax (16.2%), pneumothorax (17.4%) including simple, open and tension types as well as multiple ribs fractures (7.7%) constituted the majority. In the management strategies, conservative methods were mainly used. The outcome ranged from very good to fair. CONCLUSION: The management of chest injuries in our sub-region like any other developing countries is very much challenging. Concerted efforts are needed to overcome the burden it imposes.

Right colon interposition in corrosive esophageal long segment stricture: our local experience.

BACKGROUND: Aim of our study is to highlight technical details in pedicled right colon interposition locally in cases of long segment corrosive esophageal stricture. Lesion results from cicatrization of burns wound inflicted by chemicals. Restoration of swallowing is of paramount importance. MATERIALS AND METHODS: It was a retrospective study involving adult and adolescent patients who had surgery because of corrosive esophageal stricture between January 2001 and December 2010. Hospital records were reviewed for age, sex, radiological findings, detail of anesthesia, operative procedure, and follow up. The steps which included mobilization of colon with intact marginal blood supply, safeguarding the middle colic artery that forms the pedicle, and doing three anastomoses that were leak proof were ascertained. RESULT: There were 12 males (70.5%) and six females (29.4%) and age ranged from 14 to 45 years. Caustic soda caused the problem among 10 (58.8%) patients while liquid acid battery was involved in three (17.6%) patients. The rest were distributed equally between native concoction and unknown substance. All were done under general anesthesia and mean duration of the procedure was 306.8 ± 54.6 min with an average intra operative blood loss of 823.1 ± 428.5 m. Sixteen (94.1%) had successful pedicle isolation and 15 (82.3%) patients had neither dysphagia nor reflux at follow-up. CONCLUSION: Securing a pedicled right colon based on middle colic artery was a critical step. This surgical technique should be used to restore swallowing among patients with long segment esophageal stricture.

Pattern and clinical profile of children with complex cardiac anomaly at University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria.

BACKGROUND: Complex congenital cardiac abnormalities are rare among children and contribute to mortality and morbidity. The prevalence and pattern of presentation vary from place to place. MATERIALS AND METHODS: The objective of this study was to determine the clinical profile and pattern of presentation of complex congenital cardiac malformations among children attending a tertiary hospital in Enugu State. A cross-sectional retrospective study in which a review of the records of children who attended the children outpatient clinic of University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu State over a 5-year period (January 2007-June 2012) was undertaken. RESULTS: Thirty one thousand seven hundred and ninety-five (31,795) children attended the outpatient clinic of the hospital over the study period, of these, 65 had cardiac diseases, from which 16 were found to have congenital complex cardiac abnormalities of various types, giving a prevalence of 0.05%. Complex abnormalities seen in these children are Tricuspid atresia with various associations, cor triatriatum, single ventricle, and large ASD (atrio-septal defect) with complete AVCD, cor triatriatum sinistrum with cardiomyopathy, DORV (double outlet right ventricle) with left sided aorta, hypoplastic tricuspid valve with a PDA (patent ductus artriosus), TOF (tetralogy of fallot), prolapse of aortic valve, and pulmonary regurgitation. One of these complex cardiac anomalies presented with Turner's syndrome and another with VACTERAL association. CONCLUSIONS: The results of this study show that 0.05% of children who presented at cardiology clinic of a teaching hospital in Enugu State had congenital complex cardiac abnormalities and that the commonest forms seen were those with cor triatriatum and TOF.

Pattern and Clinical Profile of Children with Complex Cardiac Anomaly at University of Nigeria Teaching Hospital; Ituku-Ozalla; Enugu State; Nigeria

Background: Complex congenital cardiac abnormalities are rare among children and contribute to mortality and morbidity. The prevalence and pattern of presentation vary from lace to place.Materials and Methods: The objective of this study was to determine the clinical profile and pattern of presentation of complex congenital cardiac malformations among children attending a tertiary hospital in Enugu State. A cross-sectional retrospective study in which a review of the records of children who attended the children outpatient clinic of University of Nigeria Teaching Hospital (UNTH); Ituku-Ozalla; Enugu State over a 5-year period (January 2007-June 2012) was undertaken. Results: Thirty one thousand seven hundred and ninety-five (31;795) children attended the outpatient clinic of the hospital over the study period; of these; 65 had cardiac diseases; from which 16 were found to have congenital complex cardiac abnormalities of various types; giving a prevalence of 0.05. Complex abnormalities seen in these children are Tricuspid atresia with various associations; cor triatriatum; single ventricle; and large ASD (atrio-septal defect) with complete AVCD; cor triatriatum sinistrum with cardiomyopathy; DORV (double outlet right ventricle) with left sided aorta; hypoplastic tricuspid valve with a PDA (patent ductus artriosus); TOF (tetralogy of fallot); prolapse of aortic valve; and pulmonary regurgitation. One of these complex cardiac anomalies presented with Turner's syndrome and another with VACTERAL association. Conclusions:The results of this study show that 0.05 of children who presented at cardiology clinic of a teaching hospital in Enugu State had congenital complex cardiac abnormalities and that the commonest forms seen were those with cor triatriatum and TOF

Occupational risk factors associated with lymphoid malignancies in Benin City, Nigeria.

AIM: This study is designed to identify the associated occupations most at risk of developing lymphoid malignancies. PATIENTS AND METHODS: The medical records of all lymphoid malignancy cases seen in University of Benin Teaching Hospital between July 2001 and June 2010 were retrieved from medical record library. The patient's bio-data, occupational, social and past medical history and pathologic subtypes were extracted. RESULTS: A total of 252 patients records with diagnosis of lymphoid malignancies were reviewed in this study. Farmers (20.6%) and students (38.9%) form the majority of the cases seen and both showed statistically significant association with risk of LM (p<0.0001) CONCLUSION: This study revealed that agricultural workers and students in Benin City are at higher risk of developing lymphoid malignancies. Although previous studies have implicated agricultural exposure, the same cannot be said about students. It is therefore recommended that a follow up study should be conducted to ascertain the possible environmental, nutritional, social/lifestyle stressors that put students in Benin City at higher risk of lymphoid malignancies.

The challenges facing the management of arterial aneurysm in UNTH, Enugu.

BACKGROUND: The management of arterial aneurysm either central or peripheral has undergone evolution over the past decades. We encounter both true and pseudo aneurysm on regular basis with its complications: OBJECTIVE: To assess the challenges of managing arterial aneurysm at UNTH, Enugu in view of the health complications of the condition. METHOD: Medical records of all patients with documented arterial aneurysm over a 5-year period (2007-2011) were reviewed. Data collected and documented included patients' demographics, type of vessels involved, investigative tools used in confirming the diagnosis, type of treatment, outcome and length of hospital stay. RESULT: Atotal of 37 patients were managed for arterial aneurysm during the period under review. These consisted of 24 males (64.9%) and 13 females (35.2%). Age range was 11-78 years with a mean of 2.4 years. Central aneurysms involved ascending, arch and descending aorta as well as abdominal aorta. Peripheral ones affected femoral, axillary, brachial, and popliteal artery. The central aneurysms with the exception of abdominal aortic aneurysms were managed conservatively. Those that failed conservative management were referred to centres with expertise and facilities for on pump surgery. The peripheral ones in addition to abdominal aortic aneurysms were managed operatively with good outcome. The challenges identified in the management included non-availability of on pump expertise and prosthesis, late presentation of patients, under utilisation of CT and or MRI, poor compliance to antihypertensive drugs and poor follow up. CONCLUSION: Intervention in arterial aneurysms is the gold standard but not yet easily available and affordable at this centre. The challenges that have been identified are real and need to be addressed in order to deliver optimal care to patients within our domain. Efforts are underway in tackiling them.

Awareness of information, expectations and experiences among women for obstetric sonography in a south east Nigeria population.

BACKGROUND: The role of obstetric sonography in the development of diagnostic ultrasound technology has remained invaluable in obstetric and gynaecological investigation. OBJECTIVES: This work investigated the awareness of information, expectations and experiences of pregnant women coming for obstetric sonography. METHODS: One hundred and ten (110) pregnant women in Anambra State of Nigeria were prospectively studied during prenatal ultrasound scan. RESULTS: The mean age of the studied population was 30.5 +/- 14.5 years. Majority (85%) of the subjects were already aware of obstetric ultrasound scan. Most of the subjects were between the ages of 26-35. 73% got their information from antenatal centre. Over 20% were interested in the lies and presentation of their foetus. During the scan, about 69% subjects interested with the sonographers, and more than half of the population (51%) saw their babies. CONCLUSION: The role of prenatal a-sonography in obstetric care should be promoted by creating awareness campaign in antenatal centres, and initiating mother/sonographers interaction are necessary.

Audit of cardiothoracic diseases seen at the National Cardiothoracic Centre Enugu Nigeria.

BACKGROUND: The University of Nigeria Teaching Hospital, Enugu was designated the national centre of Excellence for Cardiothoracic diseases, because of the availability of skilled manpower. This study was therefore undertaken to see the pattern of cardiothoracic diseases managed in the surgical unit of the centre and to see if the objectives of its establishment are being achieved. METHOD: A retrospective analysis of in-patient admission records managed surgically or conservatively between 2000 and 2004 was made. RESULTS: A total of 704 cases were identified; 469 (55.6%) men, 121 (17.2%) women and 114 (16.2%) children. Majority, 163 (23.25%) were between the age range of 20-29 years. Enugu, the State where the hospital is domicile had the highest admission rate of 318 patients (45.15%) while the 19 Northern States had a total of 67 patients (9.51%). Chest wall disorder constituted the majority of cases (28.69%) of which chest trauma from road traffic accident was the majority 49.6%. Most patients were hospitalised for an average of 2-4 weeks (56%). CONCLUSION: The study revealed a low admission rate with a declining trend over the years and a skewed distribution of their origin. It also identifies militating factors and draws the attention of the relevant authorities to take necessary actions to stem this trend.

Traumatic diaphragmatic rupture through the central tendon with herniation of the stomach and coils of small bowel into the pericardial cavity.

UNLABELLED: Traumatic diaphragmatic rupture through the central tendon with herniation of the stomach and coils of small bowel into the pericardial cavity. METHOD: Case note of a patient managed for traumatic diaphragmatic rupture through the central tendon with herniation of the stomach and coils of small bowel into the pericardial cavity was used with a review of relevant literature. SUMMARY: A 49-year old civil engineer who presented with 2-year history of easy fatigability and palpitations as well as a 6-month history of hypertension and was initially managed as a case dilated cardiomyopathy to rule out incipient CCF secondary to hypertension, was evaluated and found to have chronic diaphragmatic hernia through the central tendon with evisceration of the stomach and coils of the small bowel into the pericardial cavity. Though there was history of motor vehicle crash preceding the development of the symptoms, but the long history of effort dyspnoea and palpitations added to enlarged cardiac silhouette on posterior anterior chest x-ray, a diagnostic challenge was posed which was resolved by thoracoabdominal CT scan. Patient had left sided posteriorlateral thoracotomy via 7h intercostal space followed with reduction of thq stomach and coils of small bowel after careful adhesiolysis and repair of the defect in double layers. CONCLUSION: High index of suspicion is very important in the diagnosis of diaphragmatic central tendon injury considering the rarity of the injury and diagnostic challenges it poses in chronic form. However, where the facilities are available, CT scan and 2-D echo will most of the time clinch the diagnosis; also is upper gastrointestinal series.

A study of extracranial aneurysms at UNTH in Enugu, Nigeria.

BACKGROUND: Previous studies on aneurysms in Nigeria have either been case reports or studies of peripheral aneurysms. No study has comprehensively evaluated all aspects of this disease as an entity among Nigerians. The need therefore arises to re-evaluate this lesion so as to make deductions on incidence, sex ratio, aetiology and management. STUDY DESIGN: This is a retrospective descriptive study of arterial aneurysms at the University of Nigeria Teaching Hospital (UNTH), Enugu. Those treated between January 1993 and December 2002 were included for the study. Data were obtained from medical records for all patients admitted with aneurysms over the study period. RESULTS: Atotal of 26 patients were admitted during the period, but 24 case notes were analysed. The age range was 10-75 years with male: female ratio of 1.4:1. Traumatic pseudo aneurysms accounted for 16 cases (67.0%) while true aneurysms comprised the remaining. Of all the aneurysms, femoral artery with most of the pseudo aneurysms had 8 out of 24 (33.0%). This is followed by the infra-renal abdominal aorta (5/24, 21.0%) and other sites (11/24, 46.0%). Diagnoses were made clinically in most cases and by abdominal ultrasonography in abdominal aortic aneurysms. Twenty-one patients had surgical intervention with 9.5% operative mortality. CONCLUSION: The incidence of aneurysm is low in our locality (2.6/year) based on the rate of diagnosis. Abdominal aorta harbours most of the true aneurysms with diameter ranging from 8.0-15.0 cm without rupture. Untreated, all will eventually rupture with catastrophic consequences. Treatment involved excision with graft interposition. This is not only expensive but the graft is often not readily available. As a solution, grafts should be stocked with drug revolving fund.

A Study of Extracranial Aneurysms at UNTH in Enugu; Nigeria

Previous studies on aneurysms in Nigeria have either been case reports or studies of peripheral aneurysms. No study has comprehensively evaluated all aspects of this disease as an entity among Nigerians. The need therefore arises to re-evaluate this lesion so as to make deductions on incidence; sex ratio; aetiology and management. This is a retrospective descriptive study of arterial aneurysms at the University of Nigeria Teaching Hospital (UNTH); Enugu. Those treated between January 1993 and December 2002 were included for the study. Datawere obtained frommedical records for all patients admittedwith aneurysms over the study period. Atotal of 26 patientswere admitted during the period; but 24 case noteswere analysed. The age rangewas 10-75 yearswithmale: female ratio of 1.4:1. Traumatic pseudo aneurysms accounted for 16 cases (67.0)while true aneurysms comprised the remaining.Of all the aneurysms; femoral artery with most of the pseudo aneurysms had 8 out of 24 (33.0).This is followed by the infra-renal abdominal aorta (5/24; 21.0) and other sites (11/24; 46.0). Diagnoses were made clinically in most cases and by abdominal ultrasonography in abdominal aortic aneurysms. Twenty-one patients had surgical interventionwith 9.5operativemortality. The incidence of aneurysm is low in our locality (2.6/year) based on the rate of diagnosis.Abdominal aorta harbours most of the true aneurysms with diameter ranging from 8.0-15.0cm without rupture. Untreated; all will eventually rupture with catastrophic consequences. Treatment involved excision with graft interposition. This is not only expensive but the graft is often not readily available. As a solution; grafts should be stocked with drug revolving fund

Percutaneous needle pleural biopsies in pleural effusion of uncertain aetiology in a Nigerian teaching hospital.

Clinical observation shows that most of the patients with pleural effusion of undetermined aetiology in a Nigerian teaching hospital receive antiTB drug trials. This observation prompted the authors to evaluate the role of percutaneous needle pleural biopsy as a diagnostic tool in effusions of uncertain aetiology. Thirty-seven patients with pleural effusion of uncertain aetiology were investigated by percutaneous pleural biopsies using Abrams pleural biopsy needle over an 18-month period. In 34, the aetiology was established giving a sensitivity of 92%. Non-specific pleurisy/empyema remains the commonest cause of effusion (41%), followed closely by malignancies (29.4%) and TB pleurisy (22%), respectively. Percutaneous needle pleural biopsies establish diagnosis of malignancy in 91% of the cases with 72% of the malignancies originating from the lung. There is a significant association between malignancy and pleural effusion of uncertain aetiology in patients above 40 years of age (P = 0.022). The empirical use of antiTB drugs in the absence of investigative results suggestive of the diagnoses should be discouraged. Instead concerted effort should be made to establish the cause of such effusion.

Pregnancy after heart valve replacement--case report.

There is an increased risk of thromboembolism, anticoagulant-related haemorrhage, foetal-wastage, and congestive cardiac failure in pregnant women with mechanical heart valves. Pregnancy in such patients is a high risk venture. In order to have a good outcome, the care of such patients must necessarily be multidisciplinary and in a well-equipped centre with adequate support services. One such patient who had mechanical mitral valve replacement in 1986 and was on warfarin anticoagulant presented in April 2003 with a first trimester pregnancy. She was in stable haemodynamic state and went through pregnancy without event. Delivery was by an elective caesarian section at 38 weeks gestation. The care of this patient during pregnancy, delivery, and puerperium is the basis of this report.