Normal Limits of Electrocardiogram and Cut-Off Values for Left Ventricular Hypertrophy in Young Adult Nigerians

This study assessed healthy young adults to determine the normal limits for electrocardiographic variables and cut-off values for left ventricular hypertrophy. It was a cross sectional descriptive study in which the participants were evaluated clinically by standard 12-lead resting electrocardiogram (ECG) at 25mm/s during quiet respiration. The heart rate, P wave duration, axis and amplitude, PR and QT intervals, QRS duration, axis and amplitude and T wave axis were assessed. Three hundred and twenty four (324) volunteers comprising of 175 males and 149 females aged 20 to 30 years (mean, 23.01±2.88years) participated in the study. The normal limits for heart rate, P wave duration, amplitude and axis in lead II, QRS duration and axis, T wave axis, PR interval, QT interval and QTc respectively were; 61-93beats per  minute,0.08-0.12s,1.00-2.00mm,22.00-79.000,78.00-106.00ms,15.50-81.000, 24.25-69.000,0.12-0.19s, 0.32-0.40s and 0.36-0.44s. The cut-off values for Sokolow-Lyon, Cornell and Araoye criteria for assessment of left ventricular hypertrophy (LVH) were higher than those previously in use in  medical practice. Gender difference exists in some cut-off values for LVH. This study defined the normal limits for electrocardiographic variables for young adult Nigerians. Racial factor should be taken into consideration in interpretation of ECG.Keywords: Normal limits, Electrocardiogram, Cut-off values, Left ventricular hypertrophy, Young Adult

Knowledge Levels of Extension Agents and their Perceived Impact of Climate Change on Extension Service Provision in Ghana

This study examined the knowledge levels of extension agents and their perceived impact of climate change on extension service provision in Ghana. Specifically, it examined awareness levels of agents on the causes, effects and methods for mitigating climate change. It also determined their perceived impact of climate on extension service delivery. A structured questionnaire was used to elicit information from a sample size of 192 respondents from 10 regions in Ghana who were randomly selected. The data were analyzed using frequency, percentages, mean, and standard deviation. Data was further analysed qualitatively by content analysis given the prevalent use of Likert type scale analyses. The findings showed that majority of the respondents were males within the age range of 40 to 49 years, married with above 15years work experience in extension service provision. They possessed high awareness of the concept - climate change, and need for farmers to be exposed to new technology. The study concluded that extension workers have to be abreast of innovations in agriculture and there is a need for incorporation of meteorological information in extension messages to farmers. It was recommended that extension agents should embrace a more innovative and participatory approaches of providing services

Autoamputation of the Breast in Invasive Ductal Carcinoma: A Case Report

Autoamputation is the spontaneous detachment from the body and elimination of an appendage or abnormal growth. Autoamputation of an organ due to malignancy has been reported in various organs, although its aetiopathogenesis has not been fully explained. Autoamputation of the breast is associated with late presentation and slow desmoplastic reaction in breast cancer. The patient was a 43- year- old Nigerian woman who presented with a one-year history of left breast mass diagnosed as triple negative invasive ductal carcinoma. She defaulted from hospital care but represented after autoamputation of the left breast. The case is reported to showcase the variations in the clinical course of breast cancers

Mandibular defect reconstruction with nonvascularized iliac crest bone graft

Context: Reconstruction of mandibular defect is a challenge to the head and neck surgeon because of associated functional and esthetic problems. Our experience with the use of nonvascularized iliac crest bone graft is hereby reported.Aim: The aim was to report our experience with the use of nonvascularized iliac crest bone for mandibular defect reconstruction at University College Hospital, Ibadan. Nigeria.Settings and Design: A retrospective descriptive study was performed.Materials and Methods: Cases of mandibular reconstruction with iliac crest bone graft between January 2001 and December 2007 were included in this study. Grafts were secured with either a stainless steel wire or a titanium plate.Preoperative diagnosis, postoperative follow-up records including investigations, diagnosis of graft infection and subsequent treatment modalities were extracted from the available records.Statistical analysis used: Descriptive variables were analyzed with SPSS version 14.Results: A total of 47 patients had mandibular defect reconstruction with nonvascularized iliac crest block bone during the study period. Thirty-eight patients had graft secured with transosseous wire [NVIBw] while 9 had a titanium plate [NVIBp]. The male:female ratio was 26:21 while the mean age of the patients was 24.6±4.25 years. Ten patients (21.3%) developed persistent graft infection during the postoperative period. All cases of infection occurred in patients who had transosseous wiring and analysis showed that 60% of the infected grafts revealed mixed microbial isolates containing klebsiela spp, pseudomonas aeurogenosa, and e coli. Six (60%) of the infected grafts were removed as a result of unabated infection while 4 (40%) were successfully treated by exploration and pus drainage.Conclusions: Nonvascularized iliac crest bone graft provides an affordable and less technical choice for mandibular reconstruction with minimal complications in a resource-limited economy

Prevalence and Predictors of Tuberculosis Coinfection among HIV-Seropositive Patients Attending the Aminu Kano Teaching Hospital, Northern Nigeria

Background: The HIV/AIDS epidemic has been accompanied by a severe epidemic of tuberculosis (TB), although the prevalence of coinfection is largely unknown, especially in developing countries, including Nigeria. The aim of this study was to determine the prevalence and predictors of TB coinfection among HIV-seropositive Nigerians. Methods: The case files of HIV/AIDS patients attending Aminu Kano Teaching Hospital, Nigeria from January to December 2006 were reviewed. Results: A total of 1320 HIV/AIDS patients had complete records and were reviewed, among which 138 (10.5%) were coinfected with TB (95% CI, 8.9% to 12.2%). Pulmonary TB was diagnosed in 103 (74.6%) patients, among whom only 18 (17.5%) were sputum-positive. Fifty (36.2%) coinfected patients had some type of extrapulmonary TB (EPTB); 15 had both pulmonary TB and EPTB. Among the 35 patients with EPTB only, 20 (57.1%) had abdominal TB, 5 (14.3%) had TB adenitis, 5 (14.3%) had spinal TB, 3 (8.6%) were being monitored for tuberculous meningitis, and 1 (2.9%) each had renal TB and tuberculous adrenalitis. The highest prevalence of TB, 13.7% (n = 28), was seen among patients aged 41–50 years. TB coinfection was significantly associated with marital status, WHO clinical stage, and CD4 count. Marital status (OR, 2.1; 95% CI, 1.28–3.59; P = 0.04), WHO clinical stage at presentation (4.81; 1.42–8.34; P = 0.001), and baseline CD4 count (2.71; 1.51–6.21; P = 0.02) remained significant predictors after adjustment for confounding. Conclusions: The moderately high prevalence of TB among HIV-seropositive patients underscores the urgent need for strategies that lead to rapid identification and treatment of coinfection with active or latent TB

The burden of open fractures of the tibia in a developing economy

Background and purpose of study: Open fractures are difficult to treat particularly because of the risk of infective complications. The rudimentary emergency rescue services in a developing country like ours with attendant delays in presentation of patients amongst other factors would suggest a dismal outcome for open tibial fractures in Nigeria.Patients and methods: Ninety two patients with 98 open tibial fractures who presented to the University College Hospital(UCH), Ibadan over a 12-month period were reviewed. The aetiology and severity of these fractures were explored as well as thetreatment outcomes.Result: The mean age was 33.3 years (peak 21-40 years) with men being 2.4 times at risk. Eighty three percent were from roadtraffic injuries; pedestrian crashes led other traffic injuries with 32% of cases. A quarter of the patients presented after 8 hours of injury. Three quarters of the fractures occurred in the shaft. Gustilo type IIIb injuries was the commonest (36.7%). The methods of treatment included plaster cast (71.5%), external fixation (15.7%), plating and primary amputation (5.7% each), and  intramedullary nailing (1.4%). Average time to union was 26.2 ± 12.7 weeks. Forty six late complications occurred in 32 fractures (there were 6 cases of chronic osteomyelitis).Conclusion: The incidence and severity of open fractures in our environment calls for urgent steps geared towards reducing theincidence of road crashes. The provision of standard, prompt and affordable emergency as well as definitive health care facilitiesfor the victims should be a priority

Skeletal birth injuries: presentation, management and outcome at the University College Hospital, Ibadan

No Abstract. Nigerian Journal of Paediatrics Vol. 32(1) 2005: 12-1

"By slapping their laps, the patient will know that you truly care for her": A qualitative study on social norms and acceptability of the mistreatment of women during childbirth in Abuja, Nigeria

Background Many women experience mistreatment during childbirth in health facilities across the world. However, limited evidence exists on how social norms and attitudes of both women and providers influence mistreatment during childbirth. Contextually-specific evidence is needed to understand how normative factors affect how women are treated. This paper explores the acceptability of four scenarios of mistreatment during childbirth. Methods Two facilities were identified in Abuja, Nigeria. Qualitative methods (in-depth interviews (IDIs) and focus group discussions (FGDs)) were used with a purposive sample of women, midwives, doctors and administrators. Participants were presented with four scenarios of mistreatment during childbirth: slapping, verbal abuse, refusing to help the woman and physical restraint. Thematic analysis was used to synthesize findings, which were interpreted within the study context and an existing typology of mistreatment during childbirth. Results Eighty-four IDIs and 4 FGDs are included in this analysis. Participants reported witnessing and experiencing mistreatment during childbirth, including slapping, physical restraint to a delivery bed, shouting, intimidation, and threats of physical abuse or poor health outcomes. Some women and providers considered each of the four scenarios as mistreatment. Others viewed these scenarios as appropriate and acceptable measures to gain compliance from the woman and ensure a good outcome for the baby. Women and providers blamed a woman's “disobedience” and “uncooperativeness” during labor for her experience of mistreatment. Conclusions Blaming women for mistreatment parallels the intimate partner violence literature, demonstrating how traditional practices and low status of women potentiate gender inequality. These findings can be used to facilitate dialogue in Nigeria by engaging stakeholders to discuss how to challenge these norms and hold providers accountable for their actions. Until women and their families are able to freely condemn poor quality care in facilities and providers are held accountable for their actions, there will be little incentive to foster change

Mistreatment of women during childbirth in Abuja, Nigeria: a qualitative study on perceptions and experiences of women and healthcare providers

BACKGROUND: Global efforts have increased facility-based childbirth, but substantial barriers remain in some settings. In Nigeria, women report that poor provider attitudes influence their use of maternal health services. Evidence also suggests that women in Nigeria may experience mistreatment during childbirth; however, there is limited understanding of how and why mistreatment this occurs. This study uses qualitative methods to explore women and providers' experiences and perceptions of mistreatment during childbirth in two health facilities and catchment areas in Abuja, Nigeria. METHODS: In-depth interviews (IDIs) and focus group discussions (FGDs) were used with a purposive sample of women of reproductive age, midwives, doctors and facility administrators. Instruments were semi-structured discussion guides. Participants were asked about their experiences and perceptions of, and perceived factors influencing mistreatment during childbirth. Thematic analysis was used to synthesize findings into meaningful sub-themes, narrative text and illustrative quotations, which were interpreted within the context of this study and an existing typology of mistreatment during childbirth. RESULTS: Women and providers reported experiencing or witnessing physical abuse including slapping, physical restraint to a delivery bed, and detainment in the hospital and verbal abuse, such as shouting and threatening women with physical abuse. Women sometimes overcame tremendous barriers to reach a hospital, only to give birth on the floor, unattended by a provider. Participants identified three main factors contributing to mistreatment: poor provider attitudes, women's behavior, and health systems constraints. CONCLUSIONS: Moving forward, findings from this study must be communicated to key stakeholders at the study facilities. Measurement tools to assess how often mistreatment occurs and in what manner must be developed for monitoring and evaluation. Any intervention to prevent mistreatment will need to be multifaceted, and implementers should consider lessons learned from related interventions, such as increasing audit and feedback including from women, promoting labor companionship and encouraging stress-coping training for providers