Management of complex CHD at the National Cardiothoracic Center of Excellence, University of Nigeria Teaching Hospital, Enugu: the role of foreign cardiac missions in 3.5 years

2017 ◽  
Vol 27 (6) ◽  
pp. 1174-1179
Author(s):  
Ikechukwu A. Nwafor ◽  
Josephat M. Chinawa ◽  
Daberechi K. Adiele ◽  
Ijeoma O. Arodiwe ◽  
Ndubueze Ezemba ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Surgical Management ◽  
Teaching Hospital ◽  
Structural Defect ◽  
Center Of Excellence ◽  
Number Of Patients ◽  
Nigeria Teaching Hospital ◽  
Surgical Options ◽  
Age Range

AbstractBackgroundCHD is defined as structural defect(s) in the heart and proximal blood vessels present at birth. The National Cardiothoracic Center of Excellence, University of Nigeria Teaching Hospital (UNTH), Enugu, through the aid of visiting Cardiac Missions has managed a significant number of patients within the last 3.5 years.Aim/ObjectiveThe objective of this study was to review surgical options and outcome of complex CHD among patients attending UNTH, Enugu, Enugu.Materials and MethodDuring the period of 3.5 years (March, 2013 to June, 2016), a total of 20 cases of complex CHD were managed by cardiac missions that visited UNTH, Enugu. Their case notes and operating register were retrieved, reviewed, and analysed using SPSS version 19 (Chicago).ResultsThere were eight females and 12 males, with a ratio of 2:5. The age range was from 5 months to 34 years with a mean of 1.7. Among all, five patients died giving a mortality rate of 25%. The operative procedures ranged from palliative shunts to complete repair. The outcome was relatively good.ConclusionComplex CHD are present in our environment. Their surgical management in our centre is being made possible by periodic visits of foreign cardiac missions.

Role of aggressive surgical debulking in older adults with gastrointestinal neuroendocrine tumors.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 377-377
Author(s):  
Zeljka Jutric ◽  
Aaron G Lewis ◽  
Mustafa Raoof ◽  
Philip HG Ituarte ◽  
Gagandeep Singh ◽  
...  
Keyword(s):  
Older Adults ◽  
Liver Metastases ◽  
Surgical Management ◽  
Neuroendocrine Tumors ◽  
Patient Discharge ◽  
California Cancer Registry ◽  
Significant Survival ◽  
Number Of Patients ◽  
Surgical Debulking

377 Background: Carcinoid and neuroendocrine tumors are often diagnosed in older adults. However, limited evidence currently exist regarding the role of aggressive surgical debulking of primary gastrointestinal-neuroendocrine tumors (low to medium grade-pancreas, small bowel, colorectal) (GI-NETs) in older adultsage > 70 years. Methods: Patients age 70 years or older with a diagnosis of GI-NETs were identified using the California Cancer Registry between the years 2000 to2012. Linkage to patient discharge records provided information including resection of primary site (RPS), resection of liver metastases (LR), and liver directed therapy (LDT). Treatment group effects on overall survival (OS) were compared by Cox proportional hazard models. Results: A total of 2,039 patients were identified. Among the 1,661 patients without metastases, 74% (n = 1,234) received RPS and demonstrated improved survival (HR 0.50, p < 0.001) compared to those without RPS. Of the 378 number of patients with liver metastases, LDT alone (n = 23) was not significantly associated with survival (HR 0.65, p = 0.082). Reduced risk was similar for RPS alone (n = 149; HR 0.44, p < 0.001) when paired with LDT (n = 17, HR 0.45, p = 0.007). RPS with LR, either with or without LDT, indicated the greatest impact in survival risk (n = 25; HR 0.14, p < 0.001). Conclusions: Surgical management of the primary tumor and liver metastases in older adults age > 70 years with GI-NETs demonstrated a significant survival benefit.Aggressive surgical debulking should be considered among older adultsage > 70 years. Future studies among older adults with GI-NETs are warranted to better identify patients most likely to benefit from aggressive surgical management.

scholarly journals The Role of CorrugateDrain In Decreasing Postoperative Complication Of Penile Fracture Surgery

2017 ◽  
Vol 26 (2) ◽  
pp. 220-232
Author(s):  
Salam Abd El-Ameer Almosawi ◽  
Ahmed Turki Obaid
Keyword(s):  
Teaching Hospital ◽  
Age Distribution ◽  
Cross Sectional Study ◽  
Penile Fracture ◽  
Cross Sectional ◽  
Penile Pain ◽  
Male Patients ◽  
Age Range ◽  
Fracture Surgery

Objective:tostudy the role of corrugate drain (which is used by some urosurgeons) followed surgical correction of fractured penis in decreasing post operative complications such as penile swelling, pain and curvature. Patient and method:comparative cross sectional study was carried out at the urological department of Al-Hilla teaching hospital from March 2008 to April 2011. Twenty male patients (age between 21-40 years) admitted to the urological department in Al-Hila teaching hospital suffering from penile fracture from March 2008 to April 2011 were included in this study. Immediate surgical repair done to all those patients ,corrugate drain put post operatively for 10 patients while the remaining 10 patients without drains. All patients are fallowed for at least 3 months regarding postoperative penile swelling, deformity, pain and sexual function. Result:regarding age distribution of patients suffering from fracture penis, from twenty patients included in this study 11 patients their agerange from (20-30)years, 7 patients their age group range from (31-45)years and only 2 patients their age range from (46-60)years. Fifteen patients are married and only 5 patients are unmarried. No one develop postoperative penile swelling in patients with corrugate drain and only one patient develops swelling in patients without corrugate drain. Regarding postoperative pain, in patients surgically corrected with drain, 6 patients develop pain and only 2 patients surgically corrected without drain develops pain. Conclusion:No beneficial effect of corrugate drain in decreasing postoperative penile swelling or curvature and on the other hand it increase post operative penile pain.

scholarly journals Prevalence and Pattern of Diabetic Ketoacidosis among Children an Enugu, Southeast Nigeria: a 10 Year Retrospective Study

2021 ◽  
Vol 3 (1) ◽  
pp. 36-43
Author(s):  
Ikenna Kingsley Ndu ◽  
Ugo Nnenna Chikani ◽  
Benedict Onyeka Edelu ◽  
Obinna Chukwuebuka Nduagubam ◽  
Adaobi Ijeoma Bisi-Onyemaechi ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Mortality Rate ◽  
Diabetic Ketoacidosis ◽  
Teaching Hospital ◽  
University Teaching ◽  
State University ◽  
Emergency Rooms ◽  
Tertiary Institutions ◽  
Nigeria Teaching Hospital ◽  
Enugu State

Diabetic ketoacidosis (DKA) is the most severe complication in pediatric cases of type 1 diabetes and also the leading cause of death in these children. There is a broad geographic variation in the frequency of DKA at the onset of diabetes. This study sought to determine DKA's prevalence and pattern in Enugu and review the treatment and outcome over ten years. This retrospective study conduct in the Children Emergency Rooms (CHER) of the two tertiary institutions in Enugu State, southeast Nigeria: Enugu State University Teaching Hospital (ESUTH) and the University of Nigeria Teaching Hospital (UNTH). The biochemical criteria for the diagnosis of diabetic ketoacidosis (DKA) base on the presence of hyperglycemia (blood glucose > 11 mmol/L), acidosis (serum bicarbonate < 15 mmol/L), and ketonuria (urine ketone ?1+). A total of 16,488 children were admitted during the ten years, of which 21 children presented with DKA, representing a prevalence of 0.13%. Six (28.6%) of the patients were newly diagnosed diabetics, while fifteen (71.4%) known diabetics, of which 9 (60%) were presenting with DKA for the first time. A total of two patients died, giving a mortality rate of 9.5%. The rest treated and discharged. The total hospitalization duration ranged from 1–31 days, with a mean duration of 13.3 ± 7.5 days. This study has revealed some of the challenges with the management of children with DKA and the unacceptably high mortality rate.

scholarly journals Surgical management of camptocormia in Parkinson’s disease: systematic review and meta-analysis

2019 ◽  
Vol 131 (2) ◽  
pp. 368-375 ◽  
Author(s):  
Andrew K. Chan ◽  
Alvin Y. Chan ◽  
Darryl Lau ◽  
Beata Durcanova ◽  
Catherine A. Miller ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Surgical Management ◽  
Sagittal Plane ◽  
Case Reports ◽  
Meta Analysis ◽  
Management Strategies ◽  
Number Of Patients ◽  
Spinal Deformity Surgery ◽  
Surgical Options

OBJECTIVECamptocormia is a potentially debilitating condition in the progression of Parkinson’s disease (PD). It is described as an abnormal forward flexion while standing that resolves when lying supine. Although the condition is relatively common, the underlying pathophysiology and optimal treatment strategy are unclear. In this study, the authors systematically reviewed the current surgical management strategies for camptocormia.METHODSPubMed was queried for primary studies involving surgical intervention for camptocormia in PD patients. Studies were excluded if they described nonsurgical interventions, provided only descriptive data, or were case reports. Secondarily, data from studies describing deep brain stimulation (DBS) to the subthalamic nuclei were extracted for potential meta-analysis. Variables showing correlation to improvement in sagittal plane bending angle (i.e., the vertical angle caused by excessive kyphosis) were subjected to formal meta-analysis.RESULTSThe query resulted in 9 studies detailing treatment of camptocormia: 1 study described repetitive trans-spinal magnetic stimulation (rTSMS), 7 studies described DBS, and 1 study described deformity surgery. Five studies were included for meta-analysis. The total number of patients was 66. The percentage of patients with over 50% decrease in sagittal plane imbalance with DBS was 36.4%. A duration of camptocormia of 2 years or less was predictive of better outcomes (OR 4.15).CONCLUSIONSSurgical options include transient, external spinal stimulation; DBS targeting the subthalamic nuclei; and spinal deformity surgery. Benefit from DBS stimulation was inconsistent. Spine surgery corrected spinal imbalance but was associated with a high complication rate.

scholarly journals Role of Laparoscopy in Management of Nonpalpable Undescended Testis in Children

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
E F Ibrahim ◽  
S M Abdelameguid ◽  
A S Hussein ◽  
I A A Abdelhai
Keyword(s):  
Teaching Hospital ◽  
Undescended Testis ◽  
Convincing Evidence ◽  
University Teaching ◽  
Preoperative Imaging ◽  
Testicular Descent ◽  
Number Of Patients ◽  
Wide Range ◽  
Impalpable Testis

Abstract Background Normal testicular descent relies on a complex interplay of numerous factors. Any deviation from the normal process can result in an undescended testis (UDT). UDT is a common abnormality that carries fertility and malignancy implications. Aim of the Work The aim of this study is Evaluation of the role of laparoscopy in diagnosis and management of clinically impalpable testis. Patients and Methods Nineteen male patients were included in this study with twenty two non-palpable testes. All these patients were subjected to diagnostic laparoscopy & the subsequent decision was then based on the laparoscopic finding. There was no age limit for the procedure. The procedure was carried in Ain Shams University teaching hospital and El-mataria teaching hospital. Results The study included nineteen patients with twenty two non-palpable testes. Age at presentation was averaging 18.5 ± 12.5 months. Our study may present convincing evidence that laparoscopy has significant advantage over imaging procedures. Preoperative imaging proved inaccurate in determining testicular position in 10 of the 22 testes (45.5%) this is in agreement with many studies which reported that ultrasonography helped to identify only 45% of non palpable testis. Conclusion This study tried to assess roughly the effectiveness of laparoscopy as a diagnostic tool and treatment of non-palpable undescended testis. This study dealt with a very small number of patients and this issue still needs more researches to study all the benefits and disadvantage and shall need further study on a wide range of patients.

scholarly journals Association between Emergency Department Overcrowding and Mortality at a Teaching Hospital in Saudi Arabia

2020 ◽  
Vol 13 (1) ◽  
pp. 756-762
Author(s):  
Fatimah Yahyia Khubrani ◽  
Mona Faisal Al-Qahtani
Keyword(s):  
Saudi Arabia ◽  
Mortality Rate ◽  
Teaching Hospital ◽  
Public Awareness ◽  
Patient Capacity ◽  
Number Of Patients ◽  
Ed Overcrowding ◽  
Healthcare Crisis ◽  
Professional Assistance ◽  
Occupancy Rates

Introduction: Emergency Departments (ED) are highly important in hospital settings because they offer 24-hour professional assistance to patients in need of healthcare. However, ED overcrowding has started to become a global healthcare crisis, such that the patient capacity of EDs is no longer sufficient to meet patient demand. Aim: Thus, this study aimed to determine the relationship between ED overcrowding and the mortality rate of patients to draw the attention of decision makers in Saudi Arabia toward this issue, with the hope of ultimately attaining a solution to this problem. Methods: Using patients’ electronic health records that were stored in the Quadra Med system in 2018, we calculated the occupancy rates of the ED of a target teaching hospital at different quarters and associated those figures with the mortality rates for the same quarters. Results: Our results showed that there was no significant association between mortality rate and crowding status in the ED. Nonetheless, we recommend increasing public awareness and bed capacity at EDs in Saudi Arabia because overcrowded EDs can lead to adverse patient outcomes. Conclusion: The present study showed that the highest percentage (38%) of deaths that occurred during the overcrowded period were mostly of patients between 30 and 44 years of age, while patients between 60 and 74 years of age accounted for 36% of deaths. The current study also assessed patient triaging, revealing that the highest number of patients was associated with level four (62.7% of the total patients in the overcrowded ED) and level five (33.1% in the overcrowded ED) triaging. We also discovered higher levels of admission in the critical care unit during the ED overcrowding period compared with other periods.

Social and Temporal Comparisons as Moderators of Psychological Resources Associations With Wellbeing

2016 ◽  
Vol 37 (2) ◽  
pp. 96-104 ◽  
Author(s):  
Hasida Ben-Zur
Keyword(s):  
Life Satisfaction ◽  
Positive Affect ◽  
Subjective Wellbeing ◽  
Social Comparisons ◽  
Self Esteem ◽  
Psychological Resources ◽  
Low Levels ◽  
Age Range ◽  
General Wellbeing

Abstract. The current study investigated the associations of psychological resources, social comparisons, and temporal comparisons with general wellbeing. The sample included 142 community participants (47.9% men; age range 23–83 years), who compared themselves with others, and with their younger selves, on eight dimensions (e.g., physical health, resilience). They also completed questionnaires assessing psychological resources of mastery and self-esteem, and three components of subjective wellbeing: life satisfaction and negative and positive affect. The main results showed that high levels of psychological resources contributed to wellbeing, with self-enhancing social and temporal comparisons moderating the effects of resources on certain wellbeing components. Specifically, under low levels of mastery or self-esteem self-enhancing social or temporal comparisons were related to either higher life satisfaction or positive affect. The results highlight the role of resources and comparisons in promoting people’s wellbeing, and suggest that self-enhancing comparisons function as cognitive coping mechanisms when psychological resources are low.

Treatment of ebola and other infectious diseases: melatonin “goes viral”

2020 ◽  
Vol 3 (1) ◽  
pp. 43-57 ◽  
Author(s):  
Russel J Reiter ◽  
Qiang Ma ◽  
Ramaswamy Sharma
Keyword(s):  
Mortality Rate ◽  
Infectious Diseases ◽  
Hemorrhagic Shock ◽  
Safety Profile ◽  
Ebola Virus ◽  
Viral Infections ◽  
Virus Disease ◽  
Attractive Potential ◽  
Potential Treatment

This review summarizes published reports on the utility of melatonin as a treatment for virus-mediated diseases. Of special note are the data related to the role of melatonin in influencing Ebola virus disease. This infection and deadly condition has no effective treatment and the published works documenting the ability of melatonin to attenuate the severity of viral infections generally and Ebola infection specifically are considered. The capacity of melatonin to prevent one of the major complications of an Ebola infection, i.e., the hemorrhagic shock syndrome, which often contributes to the high mortality rate, is noteworthy. Considering the high safety profile of melatonin, the fact that it is easily produced, inexpensive and can be self-administered makes it an attractive potential treatment for Ebola virus pathology.  

The Use of Posterior Pericardiotomy Technique to Prevent Postoperative Pericardial Effusion in Cardiac Surgery

2012 ◽  
Vol 15 (2) ◽  
pp. 84 ◽  
Author(s):  
Canturk Cakalagaoglu ◽  
Cengiz Koksal ◽  
Ayse Baysal ◽  
Gokhan Alici ◽  
Birol Ozkan ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Pericardial Tamponade ◽  
Anxiety Level ◽  
Control Group ◽  
Echocardiographic Study ◽  
Number Of Patients ◽  
Hospital Stays

<p><b>Aim:</b> The goal was to determine the effectiveness of the posterior pericardiotomy technique in preventing the development of early and late pericardial effusions (PEs) and to determine the role of anxiety level for the detection of late pericardial tamponade (PT).</p><p><b>Materials and Methods:</b> We divided 100 patients randomly into 2 groups, the posterior pericardiotomy group (n = 50) and the control group (n = 50). All patients undergoing coronary artery bypass grafting surgery (CABG), valvular heart surgery, or combined valvular and CABG surgeries were included. The posterior pericardiotomy technique was performed in the first group of 50 patients. Evaluations completed preoperatively, postoperatively on day 1, before discharge, and on postoperative days 5 and 30 included electrocardiographic study, chest radiography, echocardiographic study, and evaluation of the patient's anxiety level. Postoperative causes of morbidity and durations of intensive care unit and hospital stays were recorded.</p><p><b>Results:</b> The 2 groups were not significantly different with respect to demographic and operative data (<i>P</i> > .05). Echocardiography evaluations revealed no significant differences between the groups preoperatively; however, before discharge the control group had a significantly higher number of patients with moderate, large, and very large PEs compared with the pericardiotomy group (<i>P</i> < .01). There were 6 cases of late PT in the control group, whereas there were none in the pericardiotomy group (<i>P</i> < .05). Before discharge and on postoperative day 15, the patients in the pericardiotomy group showed significant improvement in anxiety levels (<i>P</i> = .03 and .004, respectively). No differences in postoperative complications were observed between the 2 groups.</p><p><b>Conclusion:</b> Pericardiotomy is a simple, safe, and effective method for reducing the incidence of PE and late PT after cardiac surgery. It also has the potential to provide a better quality of life.</p>

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