₦airaland Forum

Well done!!

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Ishilove:
I'm fine, good sir. It's been quite a while we saw you in these unhallowed parts

Google is my friend, quite alright but we are taking a break from each other, so break it down for us

Hmmm difficult to break it down but will give it a try.

The lady went for the surgery due to heavy bleeding and pain.. That suggests a good sized fibroid or several fibroids which in itself is a risk factor for heavy bleeding..

The initial BP suggest a lady who was yet to recover from the heavy bleeding encountered in theatre. I'd presume she might have been given some pressors- to counteract low BP due to hypoperfusion. Pressors paradoxically affect kidney function unfortunately.

This would suggest a lot of bleeding occurred in theatre. A few centres at the time might consider taking the uterus out - which means no more children , at this point......... but concerns that the lady and her family would be irate at this turn of events- might have affected surgical consensus at the time.

Early onset jaundice--yellow eyes-- is uncommon with DIC that early - - DIC which is basically the loss of an inherent ability to form clots and stop bleeding as a result.
This brings the opinion of a possible blood transfusion reaction - - QA has to be on point here. Or a drug/ gas which affects the liver..

It'd appear that there were quite a number of unfortunate events. The lack of clotting factors may have accelerated the deterioration.. Despite the whole blood transfusion.

To some of the comments made earlier..
As much as overseas advice is useful, people should be careful about utilising advice from people who have restricted real-time contextual analysis.

It's not uncommon here to close a patient and do a hematological work up before a return back to theatre as there's so much surgery can do. Waiting for those few hours alongside abdominal packing with clotting factor replacement, hoping her body catches up and fights whilst in ICU has proven very useful.

Imho, imaging was needed at Premier as she was rather unstable to move elsewhere... In the early hours post surgery.

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Jman06:
Let's stop making excuses for a bad system and work towards righting the wrongs we have ignored for ages!

Many pharmacists in the country are very much ready to practice clinical pharmacy but are being restricted by the bad system. Aside the approval of the Pharm.D program by NUC which aims to produce more clinically inclined pharmacists, some of these pharmacists have gone further to go through the West African College of Pharmacy at their own expense to acquire all the training they need to practice clinical pharmacy but rather than recognize and put them into use for the patient's gain, our hospital managers (most of whom are physicians) have continued to sideline them at the detriment of the healthcare-consuming populace. So, some of these pharmacists now practice pharmaceutical care in their private pharmacies.

The government should make no mistake of being tight fisted when it comes to remunerating healthcare workers because health is wealth since only a healthy person can work and contribute to the nation's GDP.

Your comments are noted

I think in the private hospitals.. The governance framework is non existent and therefore leads to some concern or anxiety..
This may be corrected by having the large ward rounds of yesteryears or having a pharmaceutical ward round before the major ward round.

The bottom line is the need for detailed real-time communication and of course funding. In a privately run exercise, funding rather Governance may be the primary obstacle.

Regarding your comments about Government, your comments say it all...

But I'd mention that if the safety and protection of its citizens from bandits, herdsmen and terrorist attacks alongside equipping its army or airforce is below par, not entirely sure if the health needs of its population sits high on their list of priorities.


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Jman06:
When some of us advocate for overhaul of our healthcare system, especially her management, it is because we care for a better and healthy nation. A system that we can be proud to bequeath to our unborn generations.

It is not like we can not join the bad system and make good money from it, but doing that will be akin to destroying the world rather than building it.

Anybody who had been following my posts on this forum will agree that I have been a great advocate of a revamped healthcare system in Nigeria. But some people may think that we are chasing clout or trying to monopolize the system. That is not the case!


Let's fix our health sector now!

Laudable your intentions...

But it's about the money and setting standards without any partisanship..

This can be by PPI in designated regions with a robust Governance framework system that is not open to abuse by politicians and the like.

The HMO setting needs revamping so the bundles of care / tarriffs are regularly revised and updated from trends identified through yearly audits and to some extent Pareto charts..

When these few centres become visual centres of excellence with a good financial outlay - no deficit- by default people talk with their feet and that leads a drive towards excellence.

Going through ministries or government parastatals delays, dilutes and deranges the initial objectives. Not with the perennial lack of investment.


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therealMcCain:
I will advise you go for a second opinion.

Appendicitis is not something you play with especially if it ruptures.

Unlikely to be sub-acute or grumbling appendicitis given his completely resolved symptoms and lack of a mass on scan.

A repeat scan +/- inflammatory markers should suffice, methinks.

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joyandfaith:
If internal bleeding is due to dic, moving him to theatre without arresting dic would be wrong.
I am suspecting dic, a complication of myomectomy that may be precipitated by intra or postoperative blood transfusion.
An haematologist should have reviewed the blood film before and after surgery and INR should have been monitored.
Abd USS should have been done when she complained about abdominal pain. Though ct scan is ideal.

Agree with your entry..

Taking her to theatre would result in death within minutes of anaesthetic.... Similar to performing euthanasia

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[quote author=DECLAN2015 post=101522347][/quote]I agree to your surmise..

It's quite upsetting, very traumatic to lose a loved one particularly one deemed to be of relative good health in such a dramatic way.

But people have to recognise that there are risks to every surgery. Just because A or B had the same surgery with no problems, does not mean that the surgery is easy with no problems.

There are many factors that interplay - - some obvious and others not so obvious.

In developed climes, we have near-misses not because of negligent practices but on account of likelihood, if the patient had a relatively rare condition or response to an intervention that makes what should have been an easy case, an intricately difficult one.


I'm not in any way deflecting scrutiny into malpractice but people should have at the backs of their minds that some unfortunate situations will occur despite best practice.

Doctors are not gods regardless of their charisma or carriage..but only tools
"They care but God heals"


For a tool to be effective, it must be used for the right work, at the right time and in the right enabling environment, that's where the inconsistencies in the Naija ecosystem become obstructive.


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bunto:
Well said doc.

But why didn't the hospital and the attending physicians carry the family along?
Respect!!!...until we start to respect each other's feeling.
"Do unto others as you want them to do unto you" ...
Clean, neat principle. Age long too!

To the above, I agree.

However, the clinical picture may not be very clear as things were evolving..

I can sit from the comfort of my home, look at things clearly given the time lines described by the husband or family and brainstorm about possible factors that led to her death.

When in that situation, its difficult to get that clarity of thought particularly in cases like these with no robust support health system with quick turnaround service, in place - - blood transfusions lab identifying antibodies - ABO incompatibility , presence of possible blood disorders such as vWF, hemophilias, blood products such as FFP, Cryo etc,.. Onsite imaging such as CT Scan.


DIC has a 20-50% mortality rate... Despite available resources..
It's a condition you best presume and identify early on with focused treatment rather than wait for full manifestation.. By then you've missed the boat.

Waiting for lab blood results after an hour to 90 minutes is frankly imho, playing catch up..
That sort of intensity of care "might" be possible in an ICU, not on a general ward.





Comfort to the family and loved ones, I pray.


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Ishilove:
This lingo is too technical for laymen like us

Hello ma'am..
Howdy..hope the Sunday is going along well

For the lingo.. ermmm.. Google is your friend

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Jman06:
Incorporating pharmaceutical care helps! Before drugs are administered to patients, a clinical pharmacist should see the patient. They're in a better position to take those histories and brainstorm with the doctor to determine appropriate drugs for the patient's condition. Their jobs shouldn't just be to dispense drugs! Many lives would be saved if we start allowing pharmacists play pharmaceutical care roles in the wards like is done in the developed nations!

You alluded to allergies as though allergic reactions are the only drug therapy problems we have. There are many DTPs and some can lead to patient's death!

Your submissions are recognised but not practicable in an environment such as Naija where basic core staff such as medics and nurses are in few numbers. That's why education is limited to these core clinical staff with regards to allergy history - taking and also minimising drug errors.

Yes in developed climates where abundant resources aid good undergraduate education (clinical pharmacokinetics alongside physiology) all through to practice as a clinical pharmacist.. and maintenance in the postgrad realm through regular specific CPD support...

But in Naija, where 1 person doubles up as the quasi-physician, nursing assistant, lab scientist and pharmacy technician,....... I don't see that role developing quickly in an equitable, consistent manner and also the macro-economics alongside patient's preference will not enable sufficient forward-planning to cement the vision.

A quick survey amongst most Naija pharmacists may also identify a lack of engagement in that direction. It's more work to their ever-growing burden with little money to show for it.


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R. I. P to the deceased and I pray comfort attends to the family and loved ones..

Going through the timelines, I wonder about the possibility of a severe blood transfusion reaction - which is a silent killer due to poor lab practices - given the jaundice, which only made the evolving acute DIC fatal. The other thing to consider may be the generous vasopressor use intra-operatively given the low BP. This might contribute to the AKI alongside anaesthetic gases impact on her liver.

Myomectomies are generally very bloody operations - not unusual to have a blood loss of 1-3litres depending on number and position of fibroids - so having a possible bleeding disorder such as vWF - currently underdiagnosed as not checked in routine blood tests- complicates the picture, and raises the likelihood of developing DIC.

DIC can be quite difficult to treat once the boat has left the shores.. Given the lack of FFP/ factor 7 or Cryo in Naija.


Overall, if the above were to be present, a return to theatre may not have helped.. It might only have sped up her demise - - something the surgeons might have been thinking - hence their reluctance, despite contrary overseas opinion.


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Jman06:
The problem is that Nigeria is yet to start practicing pharmaceutical care the way it should be. Our doctors just assume that the few months they learnt pharmacology in school is enough to know all. Your dad obviously reacted to the injection he was administered. Thank God oxygen was available to help calm things down.

Like in the case of this Omolara, I can bet anything to the fact that she reacted to whatever stuff that was administered to her during that initial hospital visit. We have had many similar cases in the past. A friend of mine died in that manner in an Enugu hospital. Someone who went to the hospital by himself and then immediately he was injected whatever, his condition worsened. BP dropped drastically and the next thing was death! A painful incidence it was!

This is no complicated pharmaceutical care but just taking a basic allergy history and having at hand.. Phenergan injections / hydrocortisone injection / adrenaline with oxygen - - - contents of an emergency crash trolley.


Taking a careful medical history - conditions that run in patients and their families help

You often find that patients don't have a full knowledge of their own history or don't remember in some cases.

That's why wearing dog tags for those with allergies-- antibiotics, latex, even paracetamol - - is very good. Also those with diabetes, renal or liver failure.


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Rebound here ?

Just asking....


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NOT drugs

This is a hoe business..
Look at her page..
Needs to sell markeet to help pay for the fake hair, lashes, clothes and overall lifestyle.

SM kerbwalk!!



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zolajpower:
Did the late queen had the crown prince and current king out of wedlock ?
Because from the currents kings age (46) he was born in 1974 and his mother( the late queen ) got married in 1977.
I just want to know if something is missing . Or his the current king an adopted son before the queen got married ?

Well spotted

Seems the same happened with Queens Buthle (2yr delay) and Zola (9 year delay) .... Looking at the family tree


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Hahahah


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kingxsamz:
Osheey, detective Fashola.

You thought you were being smart when you made that circle?
Can't you see the photos were taken at both sides of the bridge?
And both sides has a house at each end. One of the houses is farther than the other. Look before exposing your ignorance, detective Fash.

The banksides look different though.... Just saying.

Posting a panoramic view will stop the bickering


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R. I. P to the young lady and other victims
Comfort to all their families, I pray

Focus should be to itemise details as found on that murder scene or compound so families of missing persons can get closure.



Its clear that this man wasn't working alone as noted from testimonies from neighbours who recounted a scene of a naked girl running out of the compound late one night.. After driving in with a group of men

The theory of being a psychopath here does not wash--- the M.O is quite varied - - for armchair pundits.

This is someone possibly with psychopathic tendencies but largely killing for a living--profit not for pleasure!! He had his entire family and girlfriend in on the deal, an unusual norm for psychopaths.


The chances of getting justice in Nigeria is slim, much less so when there are powerful people behind the perpetrator..
You could start to sniff them in the case,... some possibly here on NL.

In addition, he has more grave sites.. Possibly one or 2 in Abuja as well.

I can only call on the Church he belonged to, to be the "light to the world" here: and push for a complete investigation


Rest in peace, I pray!

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Crackwipes all over



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iammo:



A tiny minute fraction of what she's about to get...

Since Bill Gates doesn't know how to flex money like a real baller, his ex would show him how to paint the town red in style

Bill Gates is worth $130 billion USD, about ₦50 trillion Naira.... Bill Gates can afford to spend ₦50 million daily for the next 989300 days or 2710 years without going broke

Meanwhile Bill Gates is still busy wearing some cheap cloths and buying $10 burgers and chips at a cheap fast food joint donating his money to charity of countries that don't even appreciate him, while his ex is living the life Lavida Loca



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Still my guy anyday

There's something quite titillating about being abstemious even though powerful


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YorubaLord:
Waterfall bawo? Dis one wey look like canal outlet...

Waterfall or watershed


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Arewa1stSon:
I am beginning to love Buhari!!

Like i said...

We must ask,take our fair share of every govt employment at whatever cost: No people has ever prospered when their resources, oppurtunities and chances are blocked and dominated by others. Our constant preachment of peace must stop: justice and and equity must be our new slagon.

The problem is believing in the propaganda of enemies which saps our resourcefulness and infuse our senses with feelings of backwardness that really do not exist, or are caused by false perception. The greatest defeat one can suffer is to see oneself as projected by one's enemies

As the Easterners intensify drums of hate and aggression we draw back to give peace, that is never forthcoming, a chance.

Try asking for propotionate representation in all government employment in all institutions and at all levels,they will cry out about mediocrity supplanting merit as if those half literates southerners dominating the place are Einstein incanates. Or they will blackmail you with Islamization.
Try treating their traders in our markets as they treat ours and they will cry xenophobia...

Well, their era of dominance and false propaganda is coming to an end with the coming of age of young northerners who could no longer accept marginalization because of blackmail or threat.

The new Generation of Northern youth have seen how Easterners cowered when asked to leave the North two years ago. Their cries for secession are empty ruse.
We will be better off without them and they will definitely be worse off will have nothing on returning back home.

It's good our leaders are now gradually waking up including Buhari!!

Emotional blackmail isn't going to work on us any longer!!

Rather jaundiced view!!


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Congratulations to the couple

Litmus:
If government could track down online instigators, arrest and prosecutes some of you, Nigeria will go a long way in solving some of these insecurity problems. For insistence, Social media played and plays a massive role in demoralising the Nigeria military fighting men and women.

Haba...
Oga... Let the government put such energies in eradicating BH or ISWAP, we go talk say dey do well...

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Burna's no. 1 fan

Sweet mother!!!

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kayjay69:
Some of you may think Buhari asking for AFRICOM to relocate to Nigeria is about fighting terrorism in Nigeria, it is not.

Buhari has one mission and one mission alone, to consolidate power for his kinsmen, the Fulani.

Buhari cannot say with a straight face that he or persons around him were not involved in sponsoring or at the very least encouraging the growth and the actions of Boko Haram and the Fulani killer herdsmen.

Buhari and/or persons around him were instrumental to the influx of these foreign terrorist herdsmen who he promised land in exchange for guaranteeing they would unleash chaos if he did not win the 2015 presidential election.

Buhari is on record as being sympathetic toward Boko Haram, calling previous government intervention against them, an attack on the North.

Buhari is an ethnic and religious bigot, these are not debatable, these are facts that cannot be refuted!!!

The US are not remotely interested in propping up his government, Nigeria is of no strategic use to the USA. The US state department had long predicted that we were a failed state and would sooner break up.
I am certain the Americans, as well as their European collaborators, would love nothing more than to see us tear each other to pieces.

Succinct


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^^^^^^^^

Inuwa Yahaya........ .not Yahaya Bello

YB is still collecting his packaged "doctorate" from the University operating from a 1 room office in downtown London!!



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I hope this young man jumps back to greater heights...
Ignore KimK-W and fly

The Kardashian curse consumes not!!


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Doraty1:
“Don’t remove him. You’ll regret,” Mr Gumi warned.



https://gazettengr.com/we-need-more-pantamis-in-power-sheikh-gumi/?utm_source=ReviveOldPost&utm_medium=social&utm_campaign=ReviveOldPost

Yet killing codedly by giving radio orders...


Gumi should go control his BH homies, Bandit cousins, Muric agitators and Cattle rustler out-laws before meddling in national affairs.

Clean up your house first...
Then maybe you can help



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saphiere:
Study has shown that most males in Ameriacan prisons are blacks. A black man is synonymous with violence, fraud, rape, murder, etc.

Synonymous is a rather harsh generalisation.. Like saying 70-90% of black men commit the above..
That's not true



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Interesting


If true, who are we to expect better from the subjects??



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Kestolove:
one babymama gone, May we die not as a babymama but as a legally married woman.

Who she born for..


Comfort to her family, RIP to the lady.


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