Open Access Original Research Article

Etiology and Management of Epistaxis in Makurdi, North-Central Nigeria: An Eight Year Descriptive Review

Amali Adekwu, Francis A. Ibiam, Barnabas A. Eke, Itodo C. Elachi, Gabriel A. Ajogwu, Michael E. Efu, Temple A. Otene

Asian Journal of Medicine and Health, Page 1-7
DOI: 10.9734/AJMAH/2017/35142

Background: Epistaxis or bleeding from the nose is a fairly common emergency presentation in otorhinolaryngological practice. The aim of this study is to describe the etiological profile and management outcome of epistaxis in Makurdi and compare our findings with those of other centers.

Methods: This is an eight year retrospective review of medical records of two tertiary health facilities of all patients with complaints of epistaxis managed at the Ear, Nose and Throat clinics; accident and emergency units; ward admissions and theatres of the Benue State University Teaching Hospital, and Federal Medical Centre, Makurdi between June 2009 and May 2017. Data retrieved included demographics, cause of epistaxis (comorbidities, medications), and site of bleeding, treatment protocol and complications.

Results: A total of 107 patients presented with epistaxis out of 11839 that were attended to at the hospitals during the period under review. There were 4281 cases with nasal pathologies within the same period. Of the 107 patients, there were 70 males and 37 females (M:F=1.9:1). Their ages ranged from 6 to 73 years with a mean of 22.5+-3.7 years. 43.5% of patients were in their 4th and 5th decades. Etiological factors included idiopathic (27.2%), hypertension/atherosclerosis (25.0%), and trauma (21.7%). Most of the cases were anterior in origin which constituted 64%. Ninety-two (86%) of the patients were successfully managed while recurrence occurred in 15(14%). Nasal packing was the commonest procedure done which accounted for 65.2%. Complications encountered included multiple blood transfusions (6.6%), intranasal adhesions (2.2%) and death (2.2%), with complication rate of 11%.

Conclusion: In Makurdi, epistaxis is a significant nasal presentation in the 4th and 5th decades of life. Idiopathic etiology, cardiovascular factors and trauma are the commonest causes. Anterior epistaxis is also common. Conservative method of treatment was effective in the control of epistaxis prior to treating the cause if known.

Open Access Original Research Article

Prognostic Value of Elevated Cardiac Troponin I Levels in Pre-dialysis Chronic Kidney Disease Patients without Cardiac Symptoms

Ehimen Phyllis Odum, Victor Chukwuma Wakwe, Hope Ilanye Bell-Gam, Richard Ishmael Oko-Jaja

Asian Journal of Medicine and Health, Page 1-8
DOI: 10.9734/AJMAH/2017/38087

Introductory Concepts: Elevation of cardiac troponin I may be a marker of increased risk of cardiovascular outcomes such as left ventricular hypertrophy, congestive heart failure, ischemic heart disease and reduced survival in asymptomatic CKD patients.

Aim: To measure serum cardiac troponin I concentration in pre-dialysis chronic kidney disease (CKD) patients who do not have any acute symptoms of cardiac disease and determine its relationship with cardiovascular risk factors.

Methodology: Cross-sectional study conducted from January 2014 to December 2015. Blood pressure, serum cardiac troponin I, HDL-cholesterol, total cholesterol, triglyceride, fasting plasma glucose, urine and serum albumin, urine and serum creatinine concentrations were measured in 83 diagnosed chronic kidney disease patients attending the renal clinic and 83 age- and sex-matched healthy control subjects. Body mass index (BMI), estimated glomerular filtration rate (eGFR), urinary albumin-creatinine ratio (UACR) and LDL-cholesterol were calculated. 

Results: CKD patients had higher cardiac troponin I, higher blood pressure, higher serum creatinine, higher UACR, higher triglyceride, lower serum albumin, lower HDL and lower eGFR than controls. Twenty-two (26.5%) patients, but no controls, had elevated cardiac troponin I.  Patients with high cardiac troponin I levels had a higher prevalence of diabetes mellitus and obesity but similar prevalence of other cardiovascular risk factors compared to patients with normal cardiac troponin I levels. Cardiac troponin I levels increased progressively with reduced renal function and the highest elevations were observed among patients in CKD stages 4 and 5.

Conclusion: Elevated cardiac troponin I was associated with higher prevalence of diabetes and obesity but reduced eGFR among pre-dialysis CKD patients. Further research is required to determine the effect of reduced GFR and uremia on the diagnostic and prognostic efficiency of cardiac troponins, particularly in end-stage renal disease patients.

Open Access Original Research Article

Analysis of Patients Who Died Following Hartmann’s Procedure

Ruth Wieland, Arkadiusz P. Wysocki, Therese Rey-Conde, Jennifer Allen, John B. North

Asian Journal of Medicine and Health, Page 1-7
DOI: 10.9734/AJMAH/2017/38057

Introduction: Hartmann’s procedure is typically performed for sigmoid colon obstruction or perforation. The primary aim of this study was to compare patients who died after a Hartmann’s procedure for obstruction and perforation. The secondary aim was to collate opinions of surgeon reviewers of any clinical events.

Methods: Patients who died in Queensland, Australia after a Hartmann’s procedure, between January 2009 and December 2014, were identified from the Queensland Audit of Surgical Mortality.

Results: 275 patients died; of those 56% underwent surgery for perforation, 20% for obstruction and 24% for other indications. Patients with perforation were of the same age as those with obstruction (p = 0.178) but those with perforation were more likely to be female (p = 0.059) and have a higher ASA class (p = 0.001). Patients with perforation underwent surgery one day earlier than those with obstruction (p = 0.066) but had the same postoperative length of stay as those with obstruction (p = 0.430). Surgeon reviewers identified between 1 and 7 clinical events per patient in 105 patients (38.2%).

Conclusion: Patients with perforation who died following a Hartmann’s procedure were of a higher ASA class but had a shorter time to theatre compared to patients with obstruction. Clinical events were identified in one third of patients.

Open Access Original Research Article

Comparison of the Effectiveness of Intravenous Promethazine and Intravenous Diazepam in the Treatment of Benign Paroxysmal Positional Vertigo in the Emergency Department

Maryam Massaeli, Farid Rahi, Masoud Shahabian

Asian Journal of Medicine and Health, Page 1-7
DOI: 10.9734/AJMAH/2017/38001

Objective: The aim of researches was comparing the effectiveness of promethazine with that of diazepam in the treatment of Benign Paroxysmal Positional Vertigo (BPPV) in the emergency department.

Methods: This clinical trial was conducted on 100 patients with BPPV who were presented in the emergency department of Besat Hospital, Tehran, IR Iran, March 2013- March 2014. Patients were selected based on convenience sampling method, matched according to their age, sex, clinical symptoms and features, and then randomly divided into two groups. 50 patients received promethazine and 50 patients received diazepam.

Results: Both drugs had comparable effects (P value ‹ 0.05). The clinically treatment of BBPV was seen in 76% of patients in the promethazine group and 82% of whom received diazepam. The median of the duration with a feel of heaviness in the head after the first injection was 37 minutes in the promethazine group and 33 minutes in the diazepam group. The time to discharge the patient in the promethazine group was 30 minutes longer than the diazepam group.

Conclusions: This study demonstrated no more effectiveness of study medications on each other in management of BPPV, but given the better performance of diazepam regarding the secondary outcomes compared to promethazine, it could be the preferred choice in patients with BPPV.

Open Access Short Research Article

Applying Two-Dimensional Quality Model for Identifying Critical Factors of Service Quality: A Case Study on Traditional Chinese Medicine Clinic in Taiwan

Chien-Chih Wang, Hsin-Hao Chen

Asian Journal of Medicine and Health, Page 1-7
DOI: 10.9734/AJMAH/2017/37403

Objective: Traditional Chinese Medicine clinics (TCM) are small, National Health Insurance and private clinics in Taiwan. Measuring patient satisfaction is very difficult due to limited resources. Therefore, helping these clinics to improve service quality and satisfaction of provided treatment is an important issue for improving performance in TCM.

Methods: This study involved administering a questionnaire to investigate the quality attributes of the TCM clinic and medical service quality to increase patient satisfaction. The Kano two-dimensional quality model questionnaire design for the TCM clinic included pre-treatment (structure), treatment period (process), and post-treatment (outcome). Subjects seeking treatment at a TCM in New Taipei City were sampled. Data was collected and analyzed.

Results: Patients pay attention to service quality. In this study, service quality was classified using attraction quality, one-dimensional quality, must-be quality, or indifferent quality. The 25 TCM clinic medical service quality factors have 2 medical service quality factors that the subjects classified as attractive.

Conclusion: Two attractive qualities were identified as care support issues that involved convenient transportation and waiting room amenities. If TCM clinics wish to attract more patients, these two factors of attractive quality require to be addressed by providing similar services and incorporating future improvement goals to address service quality.