An assessment of referral letters to a specialist diabetes outpatient service in Ibadan

Background: Diabetes is a complex, chronic illness which requires continuous medical care. Requests for specialist consultation is a regular occurrence, and the referral process is most commonly initiated by a referral letter. The ability to effectively formulate an appropriate management plan for a patient at the time of specialist consultation largely depends on the quality of clinical information provided in the referral letter.Aim: The aim of the study was to assess the information provided in referral letters to the specialist diabetes clinic in a tertiary hospital in Nigeria.Methods: This was a cross-sectional study conducted between August and December 2017. All referral letters presented to the diabetes clinic on selected clinic days were evaluated using a data extraction tool designed by the investigators.Results: The majority of referral letters provided information on patient identifiers. However, the provision of clinical information deemed vital for effective patient triage and good quality review in the specialist diabetes clinic was generally unsatisfactory. Less than a quarter of the referral letters provided information on key parameters such as physical examination findings, patients medication and glycated hemoglobin (HbA1c) level. Short term measures of glycemic control, blood pressure status, serum creatinine and serum lipid profiles were reported in just 51.3%, 35%, 6.7% and 2.5% of referral letters respectively.Conclusion: We have observed that referral letters to our specialist diabetes clinic often do not contain adequate information considered essential for a good quality consultation. Identifying the root causes of the inadequacies observed and the institution of intervention measures to address the problems identified could help improve the delivery of specialist review services for patients with diabetes. Interventions such as the use of standardized formats for referral letters, provision of referral guidelines and physician education programmes might help improve the quality of information provided at the time of referral.Keywords: Assessment, Referral Letters, Diabetes, Specialis

Therapeutic Efficacy of Cervical Traction in the Management of Cervical Radiculopathy: A Control Trial

Background: Severe pain and disability from cervical disorder is second to that of low back pain in musculoskeletal practice. Methods: Forty eight patients who met the inclusion criteria were placed into experimental (n=24) and control (n=24) group randomly. Participants in both groups received massage, cryotherapy and active exercises. Cervical traction was administered to experimental group for 15 minutes, thrice per week for four weeks while the other group served as control. Verbal rating scale (VRS) and Neck Disability Pain Index (NDI) were used as outcome measures. Data were analyzed using descriptive, dependent –t-test and independent-t-test. Results: There was a significant improvement in the pretreatment and post treatment pain intensity (t=10.75, p< 0.001) and neck functional disability (t=2.42, p=0.03) of participants in experimental group. There was a significant difference (t=-3.98, p=0.006) in the post treatment pain intensity between the cervical traction and control group. Conclusion: It could be concluded that application of continuous cervical traction can significantly reduce pain intensity of patients with cervical  radiculopathy.Key words: Cervical traction, cryotherapy, neck disability index, and verbal rating scale

Nodular Lymphocyte-Predominant Hodgkin Lymphoma in Progressive Transformation of Germinal Centers

Nodular lymphocyte-predominant Hodgkin lymphoma is an uncommon variant of Hodgkin lymphoma. Progressive transformation of germinal centers has been associated with and can develop prior to, concurrent with, or after the diagnosis of nodular lymphocyte-predominant Hodgkin lymphoma. We present a patient with a history of progressive transformation of germinal centers of the right parotid who presented 4 years later with ipsilateral parotid mass and cervical adenopathy. Knowledge of her previous diagnosis raised our concern for lymphoma, influenced our surgical management, and spared the patient additional surgery with risk of facial nerve injury inherent in revision parotidectomy

Determinants of Contraceptive Options among Postpartum Women Attending Selected Health Care Facilities in Nigeria: A Cross-Sectional Study

Introduction: Differences in availability and choices of contraceptive methods among postpartum women have been found to influence their quality of life as the fertility rate is very high, and the contraceptive usage rate persistently remains low in Nigeria. Objectives: This study assessed the determinants of contraceptive options among postpartum women in Nigeria. Methods: Two Local Governments were randomly selected from the four Local Governments. Within these two local governments, five health facilities were selected. A multistage sampling technique was used to select the 240 respondents, while a structured questionnaire was used to collect data. Results: Findings from the study indicated that 81.7% of the respondents have planned to have their current baby, and about 65.4% of the women have resumed sexual activities since delivery. Of those who have resumed sexual activities, the majority, 91.1% did so 6 weeks after delivery. Some form of contraceptive usage was prominent among 59.2% of the respondents, as the most common contraceptive method used was withdrawal (24.8%). Contraceptive prevalence was slightly lower for urban respondents than rural respondents, although the relationship was not significant. Also, there was a statistically significant relationship between the current use of contraceptives and resumption of sexual activities since delivery (p = .001), resumption of menstruation (p = .001), and information received about postpartum family planning (p = 0.013). Conclusion: Findings from this study emphasize the urgent need for enhanced accessibility and availability of contraceptive methods, with a parallel emphasis on targeted interventions and effective communication strategies to promote contraceptive uptake and family planning. Addressing these determinants is vital in improving postpartum women's overall quality of life in the study area

Effect of Moringa oleifera flower fortification on the nutritional quality and sensory properties of weaning food

Moringa oleifera is a nutrient rich plant that has the potential to combat malnutrition problems in Africa. This study aims to investigate the effect of fortification using Moringa oleifera flower powder on the sensory and proximate attributes of fermented yellow maize and millet blend (Ogi). The formulation was grouped into seven blends in ratio 100:0:0, 70:30:0, 70:25:5, 70:20:10, 70:15:15, 70:10:20, 70:5:25 for maize, millet and Moringa oleifera flower powder (MOFP) respectively. Moringa oleifera flower was air-dried for 5days, milled and sieved to obtained fine powder. The fine powder was mixed thoroughly with fermented maize and millet, wet milled and sieved. The proximate composition of fermented yellow maize and millet (Ogi) fortified with Moringa oleifera flower powder showed an increase in crude protein, crude fibre, ash and fat with increase in the levels of Moringa oleifera flower powder and decrease in carbohydrate and moisture content. Moisture, protein, fibre, fat, ash and carbohydrate contents varied in the range 7.92-9.74%, 10.46_16.06%, 2.31-4.13%, 2.90-4.07%, 1.23-1.93% and 66.45-73.25% respectively. Sensory evaluation shows that blend 6 (20% MOFP) compared favourably with the control. Also, nutritional analysis shows that blend 6 is favourable as weaning food. Therefore, blend 6 formulation can be used as alternative to the weaning foods to improve the nutritional status of children and help to curb protein malnutrition

MICELLIZATION OF QUARTERNARY BASED CATIONIC SURFACTANTS IN TRIETHANOLAMINE-WATER MEDIA: A CONDUCTOMETRY STUDY

The effect of polar organic solvent, triethanolamine (TEA) on the micellization of a mixture of dodecyltrimethylammonium bromide (DETABr) and hexadecyltrimethylammonium bromide (HATABr) has been studied by conductance measurements at temperature range of 298.1 to 313.1K in steps of 5.1K. The values of the critical micelle concentration (CMC*) and the extent of counter-ion binding were obtained by fittings of the specific conductivity-concentration curve to the integrated form of the Boltzmann-Sigmoid equations. The values of CMC* was found to decrease with increase in the percentage composition of TEA. The degree of counter-ion binding of the mixed micelles (β) was determined from the ratio of the slopes corresponding to the post (A2) and pre-mixed micellar regions (A1). The thermodynamic quantities ( and ) was evaluated with the aid of the equilibrium model of mixed micelle formation. The negative deviation of the CMC* from the ideal system, the spontaneity, and the increased degree of randomness of the system were discussed on the basis of hydrophobic-solvophobic interactions of the monomers at elevated temperature

Isolation, characterization and immunochemical studies on fibrous proteins from cowry shell (Cypraea moneta, Linnaeus)

Background: Biomaterials are non-drug substances used to treat, enhance or replace functions of body tissues or organs. Natural sources of biomaterials have recently become the focus of several research activities. Cowry shell constitutes one of the most promising natural sources of biomaterials because of its chemical stability, biodegradability and biocompatibility in the body. However, its applications may be limited due to immunogenic and toxic responses that may occur following implantation, hence this study.Materials and Methods: Crude fibrous protein extracted with citrate buffer from pulverised cowry shells (Cypraea moneta (L)), was resolved into two components (CSP1 and CSP2) by gel filtration. Immunological studies were performed with antisera obtained from rabbits by double immunodiffusion and immunoelectrophoresis techniques. Mice treated with the proteins were observed for signs of toxicity and their liver, kidney, lungs and spleen were processed histologically.Results: The native molecular weight of CSP1 and CSP2 determined by gel filtration were 91kDa and 33kDa respectively. CSP1 and CSP2 displayed single bands on SDS-PAGE with subunit molecular weight values of 19kDa and 19.5kDa respectively. Antisera obtained from rabbits immunised with the crude citrate buffer extracts precipitated the antigen in double immunodiffusion tests. Histopathological examinations revealed a dose-dependent damaging effect of the shell proteins on liver, kidney, lung and spleen tissues of the treated mice.Conclusion: This study showed that cowry shells contain fibrous proteins which are immunogenic and toxic in mice at relatively high concentrations, causing visible organ damage without concurrent physical manifestations.Keywords: cowry shell protein, purification, immune activation, toxicit

Willingness of in‑patients to Uptake the Vital Contributor Social Health Insurance Program in a Teaching Hospital, Southwest Nigeria

Background: The introduction of the Vital Contributor Social Health Insurance (SHI) Program in Nigeria was to scale up access to healthinsurance and achieve universal health coverage. However, many Nigerian in‑patients still pay out‑of‑pocket for health services. This study aimedto determine Nigerian in‑patients’ willingness to pay for the Vital Contributor SHI Program. Methodology: Across‑sectional analytical study conducted among 133 adult in‑patients and care‑givers of pediatric in‑patients of a tertiary health facility in southwestern Nigeria, not under a health insurance cover, and recruited through a simple random sampling technique. Data were  collected using an interviewer‑administered questionnaire. Willingness to Pay was assessed using the double contingent valuation by the Bidding method. Descriptive and inferential statistical analysis was performed using the IBM SPSS version 20 with inference made at P > 0.05. Results: Findings showed a low awareness (42.1%) of the National Health Insurance Scheme (NHIS), and much lower awareness of the Vital Contributor Insurance Scheme, (27.1%). A high proportion of the respondents (67.7%) were willing to participate in the scheme, whereas 67.3% of those not willing to participate gave insufficient funds as the reason. The median maximum amount of premium respondents were willing to pay annually was ₦15,000 ($38) and ₦5000 ($12.8) interquartile range. Respondents in the working population (P = 0.032), with some form of education (P = 0.002), having difficulty with paying their medical bills (P = 0.044), who were aware of the Vital Contributor Scheme (P = 0.001) and were  knowledgeable about the NHIS benefits (P = 0.026) were significantly more willing to uptake the Vital Contributor SHI Scheme. Conclusion: Although awareness of the Vital Contributor SHI Scheme is low, the proportion of respondents willing to partake in it is satisfying.  Increased targeted awareness campaigns should improve uptake. Health management organizations should take the lead in the awareness creation process. Keywords: Health insurance, vital contributor social health insurance scheme, voluntary contribution, willingness to pay     &nbsp