Background:Acquired heart diseases (AHDs) are present from childhood to old age, and the frequency of pathology differs according to age and the geographical region of the patients. The aim of this study was to document the echocardiographic patterns of AHDs in our setting.Materials and Methods:Retrospective analysis of echocardiographic diagnosis of AHD was done for age, sex, and echocardiographic pattern.Results:There were 190 diagnoses in the 163 patients with 27 patients having a double diagnosis, consisting of 88 (54%) males and 75 (46%) females. The mean age was 50.4 years (age range 9-85 years). Ten types of acquired heart pathologies were identified and they included hypertensive heart disease in 49.47%, rheumatic heart disease in 26.32%, cardiomyopathy in 11.05%, endomyocardial fibrosis in 4.74%, and pericarditis in 3.68%. Others were cor pulmonale, pulmonary hypertension, intracardiac thrombi, left atrial myxoma and degenerative heart disease which accounted for the remaining 4.74%.Conclusion:This study identifies 10 types of AHDs among the study population. The huge impact of hypertensive heart disease and rheumatic heart disease is a big indicator pointing to the existence of a sub-optimal level of healthcare in the country.
Background: Pleural drainage is a life-saving procedure that is commonly performed to evacuate pleural collection of air or liquid from traumatic or non-traumatic causes. The pleural tube drain is commonly connected to underwater seal bottle thereby limiting the movement of the patients with attendant risks of immobilisation. There are reports of pleural drainages utilising small bore pleural drains attached to drainage bag and asserted to be as effective as large bore thoracic catheter connected to underwater seal bottle. In addition to the reported effectiveness of small bore ambulatory pleural drainage, the risks of prolonged immobilisation are mitigated, and there is saving of costs. Literature search has not revealed any comparison of the two pleural drainage systems in Nigeria, hence this index study. Objective: To compare the pleural drainage characteristics of small bore pleural drains attached to drainage bag with those of large bore thoracic catheters connected to underwater seal bottle in the management pneumothorax and haemothorax. Results: Among patients with pneumothorax, 66.7% of conventional group and 100% of small bore group regained normal respiratory rate before removal o pleural drain, although at 30 days post drainage check all n the two groups were normal. Using oxygen saturation (SpO2), conventional drainage system was initially better (66.7% vs 25% p<0.0001), later inferior (83.3% vs 100%), and finally same at follow-up (100% vs 100%). Lung re-expansion was also initially better in the conventional drainage group at 30 minutes following commencement of pleural drainage than in the small bore pleural drain group (66.7% vs 50.0%), but afterward became complete in all patients in the two groups before removal of pleural drain and at 30 days follow up. Duration of pleural drainage and length of hospitalisation were shorter in more patients in the small bore group than in the large bore group (p=0.571). In the patients with haemothorax, there was no statistically significant difference in any outcome measure among the groups. Conclusion: The use of small bore pleural drains was as equally effective as the use of large bore chest tubes in the management of pneumothorax and haemothorax.
Background: The use of conventional chest tube and underwater seal bottle (CCT) for pleural drainage (PD) makes the treatment expensive, immediately un-affordable by more than 80% of the patients in Nigeria, and also immobilizes the patients with the attendant risks. To curtail the above mentioned problems, some researchers have reported the use of one-way valve and drainage bag for PD. Objective: To evaluate and compare PD using urobag versus CCT Methodology: Prospective randomized study of adult patients with pleural effusion who had PD with CCT and urobag respectively. Results: Before PD and at 30 minutes into the drainage, no patient in the two groups had normal respiratory rate (RR), but by 30 minutes before removal of the pleural drain, 80.5% in the CCT group and 69.2% in the urobag group had achieved normal RR. And by the 30 days follow up assessment, 100% in both groups maintained normal RR (p=0.459). The equivalent figures evaluating the patients for peripheral arterial oxygen saturation showed subnormal saturation in all patients in the two groups at 30 minutes before PD, normal saturation in 22% of patients in CCT group versus zero percent in the urobag group at 30 minutes after commencement of PD (p<0.0001). At 30 minutes before removal of pleural drain saturation was normal in 97.6% of the CCT and 84.6% of the urobag group. By 30 days follow up, saturation became normal in 97.6% of CCT group versus 100% of urobag group. Lung expansion assessed with chest radiographs at 30 minutes before pleural drainage showed that no patient in the two groups had fully expanded lung. However at 30 minutes after pleural drainage 46.3% in the CCT group versus 53.8% in the urobag group had complete lung expansion. These figures rose to 97.6% and 100% respectively at 30 minutes before removal of pleural drain and at 30 days follow-up (p=0.823). Duration of drainage of pleural effusion was less than 7 days in 92.7% of patients on CCT and in 92.3% of the urobag group. Length of hospital stay analysis showed that length of stay was shorter than 10 days in 97.6% and 100% of the CCT and urobag groups respectively. Complications attributable to the drainage systems were negligible. Conclusion: Pleural drainage with urobag and CCT all result in acceptable outcome of drainage.
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