Ten-year mortality review in a pioneer psychiatric hospital in West Africa

Objective: To determine the mortality among admitted patients in the study centre, a pioneer psychiatric facility in the West African sub-region. Design: A detailed retrospective study of the records of all deaths among the inpatients during the ten-year period of January, 1991 to December, 2000. Setting: Psychiatric Hospital Yaba, Lagos, Nigeria; established in 1907 with present bed status of 535 and patronage from Lagos and it's environ, including the neighbouring Benin Republic. Subjects: Ninety six patients that died while on admission in the centre during the study period. Results: A total of 96 patients died over the ten-year period, giving an annual rate of 9.6. The age range was 14-87 years, and mean of 44.4 (SD ±16.8) years. The male: female ratio was 1:1.6. Schizophrenia (26%) and major depression (25%) constituted the main psychiatric diagnoses at the time of admission among the cohort. The commonest cause of death included infections/infestations, most especially malaria and septicaemia (44% of the cohort). Conclusion: It is concluded that the major psychotic disorders, schizophrenia and depression continue to constitute the highest psychopathologies diagnosed psychiatric mortality study. Finally, infections/infestations still continue to play leading role as major causes of death in the West African sub-region. East African Medical Journal Vol.80(7) 2003: 379-38

Quality of primary care physicians’ communication of diabetes self-management during medical encounters with persons with diabetes mellitus in a resource-poor country

Background: Most of the Nigerian studies on the determinants of diabetes self-management have focused on patient-related factors. There is no previous local study that examined the quality of diabetes self- management education provided by primary care physicians to people with diabetes mellitus.Methods: A descriptive cross-sectional study was conducted among 105 primary care physicians during a workshop. The quality of diabetes self-management education provided by the physicians was assessed using a self-designed scale of 39 Likert questions derived from American  Association of Diabetes Educators seven domains of diabetes self-management. Cronbach’s reliability coefficient of each domain/subscale was ≥ 0.7. The data was analysed using the independent sample t-test and one-way ANOVA.Results: Over half of the physicians provided ‘inadequate quality’ diabetes self-management education in all the domains. Physicians had the highest mean score in the ‘taking medication’ domain (4.35 ± 0.59). The mean scores in the ‘problemsolving domain’ (3.63 ± 0.74) and the ‘being active domain’ (3.57 ± 0.71) were low. The quality of diabetes self-managementeducation provided by the physicians was not associated with any of the physician characteristics.Conclusion: The quality of physicians’ communication of diabetes self-management was suboptimal in this study. The majority of the adequately communicated diabetes self-management behaviours were risk factors reduction related and disease-centred. Thus, training of primary care physicians on diabetes self-management education is recommended because of the key role these physicians play in diabetes management in resource-poor countries.Keywords: diabetes self-management, patient–physician communication, primary care physicians, resource-poor countries, Nigeri

Kola nut from Cola nitida vent. Schott administered to pregnant rats induces histological alterations in pups’ cerebellum

Kola nut (from Cola nitida) is popular in Nigeria and West Africa and is commonly consumed by pregnant women during the first trimester to alleviate morning sickness and dizziness. There is, however, a dearth of information on its effects on the developing brain. This study, therefore, investigated the potential effects of kola nut on the structure of the developing neonatal and juvenile cerebellum in the rat. Pregnant Wistar rats were administered water (as control) or crude (aqueous) kola nut extract at 400, 600, and 800 mg/kg body weight orally, from pregnancy to day 21 after birth. On postnatal days 1, 7, 14, 21 and 28, the pups were weighed, anaesthetised, sacrificed and perfused with neutral buffered formalin. Their brains were dissected out, weighed and the cerebellum preserved in 10% buffered formalin. Paraffin sections of the cerebellum were stained with haematoxylin and eosin for cerebellar cytoarchitecture, cresyl violet stain for Purkinje cell count, Glial Fibrillary Acidic Protein (GFAP) immunohistochemistry (IHC) for estimation of gliosis, and B-cell lymphoma 2 (Bcl-2) IHC for apoptosis induction. The kola nut-treated rats exhibited initial reduction in body and brain weights, persistent external granular layer, increased molecular layer thickness, and loss of Bergmann glia. Their Purkinje cells showed reduction in density, loss of dendrites and multiple layering, and their white matter showed neurodegeneration (spongiosis) and GFAP and Bcl-2 over-expression, with evidence of reactive astrogliosis. This study, therefore, demonstrates that kola nut, administered repeatedly at certain doses to pregnant dams, could disrupt normal postnatal cerebellar development in their pups. The findings suggest potential deleterious effects of excessive kola nut consumption on human brain and thus warrant further studies to understand the wider implications for human brain development

Evaluation of the safety of C-spine clearance by paramedics: design and methodology

<p>Abstract</p> <p>Background</p> <p>Canadian Emergency Medical Services annually transport 1.3 million patients with potential neck injuries to local emergency departments. Less than 1% of those patients have a c-spine fracture and even less (0.5%) have a spinal cord injury. Most injuries occur before the arrival of paramedics, not during transport to the hospital, yet most patients are transported in ambulances immobilized. They stay fully immobilized until a bed is available, or until physician assessment and/or X-rays are complete. The prolonged immobilization is often unnecessary and adds to the burden of already overtaxed emergency medical services systems and crowded emergency departments.</p> <p>Methods/Design</p> <p>The goal of this study is to evaluate the safety and potential impact of an active strategy that allows paramedics to assess very low-risk trauma patients using a validated clinical decision rule, the Canadian C-Spine Rule, in order to determine the need for immobilization during transport to the emergency department.</p> <p>This cohort study will be conducted in Ottawa, Canada with one emergency medical service. Paramedics with this service participated in an earlier validation study of the Canadian C-Spine Rule. Three thousand consecutive, alert, stable adult trauma patients with a potential c-spine injury will be enrolled in the study and evaluated using the Canadian C-Spine Rule to determine the need for immobilization. The outcomes that will be assessed include measures of safety (numbers of missed fractures and serious adverse outcomes), measures of clinical impact (proportion of patients transported without immobilization, key time intervals) and performance of the Rule.</p> <p>Discussion</p> <p>Approximately 40% of all very low-risk trauma patients could be transported safely, without c-spine immobilization, if paramedics were empowered to make clinical decisions using the Canadian C-Spine Rule. This safety study is an essential step before allowing all paramedics across Canada to selectively immobilize trauma victims before transport. Once safety and potential impact are established, we intend to implement a multi-centre study to study actual impact.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov <a href="http://www.clinicaltrials.gov/ct2/show/NCT01188447">NCT01188447</a></p

Diabetes-Related-Distress and its Relationship with Glycaemic Control Among Type 2 Diabetes Mellitus Patients Attending a Specialty Clinic in Lagos, Nigeria

Background: Diabetes Mellitus (DM) is a chronic metabolic disease with various complications throughout its course. The presence of emotional burden in diabetes disease, which is referred to as diabetes-related distress (DRD) is common among such patients and may affect their response to treatment. Objectives: To assess the relationship of diabetes-related distress and glycaemic control among patients with Type 2 Diabetes mellitus. Methods: This hospital-based cross-sectional study was conducted at the Family Medicine Department of LASUTH, Ikeja, Lagos. A total of 317 patients with Type 2 Diabetes mellitus were systematically recruited. The data were collected over a four-month period. Important clinical information including clinical characteristics and diabetes-related distress using the diabetes distress scale (DDS-17) was collected. Glycosylated haemoglobin (HbA1c) was also assessed. Results: The degrees of DRD were as follows: 54.9% (None/little), 40.1% (moderate) and 5.0% (severe). The mean HbA1c estimate for all participants was 7.83±1.8%. Among the 317 study participants, 67.2% had poor glycaemic control while 32.8% had good glycaemic control. There was a statistically significant association between DRD and glycaemic control (p< 0.001). Likewise, the various domains of DRD had statistically significant associations with glycaemic control with the exception of physician-related domain. Participants with better glycaemic control reported lower levels of DRD than participants with poorer glycaemic control. Conclusion: There is a high level of diabetes-related distress patients with diabetes mellitus. Good glycaemic control is important in improving or preventing DRD. Therefore, T2DM patients should be screened for DRD during their treatment

Intrascrotal anomalies related to testicular torsion in nigerians: an anatomical studyLes anomalies intra scrotales associées à la torsion testiculaire chez les Nigériens - une étude anatomique

Objective: The abnormalities that predispose to torsion are often bilateral. They include horizontally lying testis, bell-clapper deformity (BCD), long mesorchium, well-developed spiral cremasteric muscle and ectopic testis. The pattern and incidence of intrascrotal anomalies that predispose to testicular anomalies in Nigerians have not been studied. Our objective was to define and document this. Material and Methods: The scrotal sacs of fifty cadaver scrotums and inguinal canals from patients aged between 35 and 57 years (mean age: 42 years) were examined. The parameters studied were the location (scrotal or canalicular), alignment (horizontal, vertical), mesorchium (height and width), cremasteric muscle development (well or poorly developed) and parietal tunica vaginalis investment of the testis (normal, intermediate or BCD). Results: Forty-nine testes had descended to the scrotal position; all were anchored by the ligamentum testis. The canalicular position was noted to be present in one cadaver. Forty-eight testes lay vertically. 16% of the testes had BCD, while intermediate tunica investment was noted in 12%. The most common type of epididymal and testicular relationship was Type I (84%). The mesorchium was normal in all specimens examined. Conclusion: The most common anomaly in our study was that of tunica investment, and this is usually bilateral. The need for bilateral orchiopexy in cases of testicular torsion is further strengthened since the anatomic anomalies are usually bilateral. Résumé Objectif: Les caractères anormaux qui prédisposent à la torsion testiculaire sont souvent bilatéraux. Ils incluent des testicules ascenseurs horizontalement, difformité du bell-clapper (BCD), un long mesorchium, un muscle cremasterien en spirale bien développé et testicules ectopiques. Le type et la fréquence d'anomalies intra scrotales qui prédisposent aux anomalies testiculaires chez les Nigériens n'ont pas été étudiés. Notre objectif était de définir et documenter ceci. Matière et méthodes: Les scrotums et les canaux inguinaux de cadavres de patients d'âge entre 35 et 57 années (âge moyen: 42 années) étaient examinés. Les paramètres étudiés étaient l'emplacement (scrotal ou canaliculaire), l'alignement (horizontal, vertical), le mesorchium (hauteur et largeur), le développement du muscle cremasterien (bien ou peu développé) et le développement de la tunica vaginalis pariétal des testicules (normal, intermédiaire ou BCD). Résultats: Quarante-neuf testicules étaient descendus en place dans le scrotum; tous ont été ancrés par les ligaments testiculaires. Le siège canalaire était présent chez un cadavre. Quarante-huit testicules sont disposés verticalement. 16% des testicules avaient un BCD, cependant le développement intermédiaire de la tunica vaginalis a été noté chez 12%. Le type le plus commun de rapport entre l'épididyme et le testicule était le Type I (84%). Le mesorchium était normal dans tous les spécimens examinés.Conclusion: L'anomalie la plus commune de notre étude était le développement intermédiaire de la tunica vaginalis, et c'est bilatéral habituellement. L'orchidopexie bilatérale dans les cas de torsion testiculaire est nécessaire parce que les anomalies anatomiques sont bilatérales habituellement. African Journal of Urology Vol. 12(1) 2006: 24-2

Anesthetic and surgical predictors of treatment outcome in re-do craniotomy

Introduction: Craniotomy is a neurosurgical operation done to remove brain tumor, repair vascular lesion, and relieve intracranial pressure. Complications can arise which may necessitate re-do craniotomy. The study is planned to find out the relationship between variables such as age, American Society of Anaesthesiologist (ASA), Glasgow coma score (GCS), frequency of re-do craniotomy, and surgical outcome of re-do craniotomy. Materials and Methods: This is a retrospective study of all the patients who had re-do craniotomy over a 4-year period. The data that were collected included age, sex, ASA classification, indication for re-do craniotomy, GCS, frequency of re-do craniotomy, postoperative complications, and outcome. Results: Twenty-five patients had indication for re-do craniotomy within the study period. Forty percent were male and 60% were female, and their mean age was 38.56 ± 17.38 years. The indications for re-do craniotomy were removal of residual tumor, evacuation of clot, and cerebrospinal fluid leakage. Seventy-six percent had good outcome, while 24% had poor outcome. Outcome was good for patients who had re-do craniotomy done once, while poor outcome was for patients with second and third craniotomies. Ninety percent of patients with ASA 2 had good outcome, while 9.1% had poor outcome; but 64.3% had good outcome with ASA 3, while 37.7% had poor outcome with a P-value of 0.18. Seventy-five percent had poor outcome in patients with GCS of less than 9, while 25% had good outcome; but 14.3% had poor outcome in patients with GCS above 9, while 85.7% had good outcome with a P-value of 0.031. Conclusions: Increasing frequency of re-do craniotomy and lower GCS were major factors affecting outcome in re-do craniotomy in our center. The outcome of these patients is valuable in the management of other patients with re-do craniotomy in future

Conservative Management Of Third Trimester Cervical Spinal Cord Injury Using Gardner-Wells\' Tongs Traction

Spinal cord injury, though an important cause of morbidity appears to be uncommon in pregnant women or perhaps, has not been accurately documented among them. Superimposed on the many impairments resulting from spinal cord injury is the presence of the foetus in the womb, which in itself normally brings about intense physiological alterations in the patient. Despite the complexities, neither the pregnancy nor the spinal cord injury needs jeopardize the optimal care of the other as long as the standard protocols are followed. In the past 10 years, the University college Hospital, Ibadan, Nigeria treated approximately 900 spinal cord injury patients, and only 3 of these were pregnant-an incidence of 0.30 per 90 patients per year, or 0.33%. We report here, the conservative management of one of these pregnant patients using the Gardner-Wells\' tongs traction, resulting in normal parturition and full neurological recovery. Key Words: Spinal cord injury, Third trimester pregnancy, Gardner-Wells\' tongs traction Nigerian Journal of Clinical Practice Vol 8(1) 2005: 46-5

Severe Neurological Involvement In Tuberous Sclerosis: A Report Of Two Cases And A Review Of The African Literature

Tuberous sclerosis (TS) is a genetic disorder characterised by the triad of cutaneous lesions, epilepsy and mental retardation. TS is known to have a wide clinical spectrum, with some affected individuals having only the cutaneous manifestations, normal IQ and no seizures, while others are severely affected having intractable seizures and profound mental retardation. A report of two Nigerian children with TS managed at the University College Hospital, Ibadan, Nigeria is presented. Both had severe neurological manifestations of the disease and a sub clinical affectation was found in a first degree relative in one of them. African Journal of Neurological Sciences Vol. 26 (2) 2007: pp. 102-10