Learning Style Preference: Impact on Academic Performance of Preclinical Medical Students, a Nigerian Survey

Background: Understanding the differences in learning styles among medical students and their impact on the learning processes may enhance better learning and knowledge acquisition that is necessary for improving learning outcomes. This study aimed at the determination of the learning style preferences of the University of Nigeria preclinical medical students and the impact they have on their academic performance. Materials and Methods: The study involved 158 third-year medical students (102 males and 56 females). Each student completed the VARK questionnaire (Version 7) comprising 16 questions that identified four different learning style preferences, namely V – visual, A – aural, R – read–write, and K – kinesthetic. The academic performance of the students was obtained from the results of their second MBBS professional examination. Analysis of data was done using Statistical Package for the Social sciences (SPSS) version 21; the percentages and charts of distribution for each VARK component were determined. The presence/absence of significant interactions between academic performance and learning style preferences was determined using Chi-square test. Results: The results showed that 30.4% of the students were unimodal (V-2.5%, A-7%, R-17.1% and K-3.8%), while 69.6% were multimodal in learning. With respect to gender, the males (70.6%) and females (67.9%) preferred multimodal learning, and both genders showed similar patterns in their preferences (read–write, followed by aural, kinesthetic, and visual). Visual learners exhibited the highest scores among unimodal learners, followed by kinesthetic, aural, and read–write learners, although the mean performance of multimodal learners (65%) was higher than those of unimodal learners (54%) (P < 0.001). Conclusion: A blend of V‑A‑R‑K instructional techniques would benefit most students. Students who are strongly unimodal in learning need to be specifically targeted with their unique learning style. Keywords: Anatomy, Nigeria, learning style. academic performance, preclinical students, V-A-R-

Epidemiology of lumbar disc herniations in adults with low back pain in Enugu, Nigeria

Background: Lumbar intervertebral disc herniation is used to describe a spectrum of anatomical abnormalities involving disc extension beyond the interspace. It follows a tear in the annulus fibrosus of the intervertebral disc. It is one of the most common causes of low back pain among adults. The study aims to assess the epidemiological pattern of lumbar disc herniations among adults with low back pain in Enugu urban.Methods: The study was a prospective study at National Orthopedic Hospital Enugu and Annunciation Specialist Hospital Enugu. Following ethical approval and written informed consent, patients who met the inclusion criteria were consecutively recruited. The MRI scans of the participants were viewed using DICOM® (Digital Imaging and Communications in Medicine) software on laptop computer. The data included the patients’ demographics, functional disability index for back pain, weight, height, the anatomical level(s) and site(s) of the herniated disc among other parameters.Results: A total of 81 subjects who met the inclusion criteria were included and analyzed using SPSS version 20.0. The mean age of the subjects is 52.99±13.13 years. The most common affected age group is 51-60 years (27.2%). Majority of the subjects (68; 84%) had multiple level herniations which usually includes L4 level(74; 91.4%).Conclusions: That multilevel lumbar disc herniation is far more common than single level herniation with a prevalence of 84% among adults with low back pain in Enugu urban. That, there is statistically significant association of lumbar disc herniation and increasing age

Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012

OBJECTIVE: To provide an update to the "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock," last published in 2008. DESIGN: A consensus committee of 68 international experts representing 30 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict of interest policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independent of any industry funding. A stand-alone meeting was held for all subgroup heads, co- and vice-chairs, and selected individuals. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. METHODS: The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence from high (A) to very low (D) and to determine the strength of recommendations as strong (1) or weak (2). The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. Recommendations were classified into three groups: (1) those directly targeting severe sepsis; (2) those targeting general care of the critically ill patient and considered high priority in severe sepsis; and (3) pediatric considerations. RESULTS: Key recommendations and suggestions, listed by category, include: early quantitative resuscitation of the septic patient during the first 6 h after recognition (1C); blood cultures before antibiotic therapy (1C); imaging studies performed promptly to confirm a potential source of infection (UG); administration of broad-spectrum antimicrobials therapy within 1 h of the recognition of septic shock (1B) and severe sepsis without septic shock (1C) as the goal of therapy; reassessment of antimicrobial therapy daily for de-escalation, when appropriate (1B); infection source control with attention to the balance of risks and benefits of the chosen method within 12 h of diagnosis (1C); initial fluid resuscitation with crystalloid (1B) and consideration of the addition of albumin in patients who continue to require substantial amounts of crystalloid to maintain adequate mean arterial pressure (2C) and the avoidance of hetastarch formulations (1B); initial fluid challenge in patients with sepsis-induced tissue hypoperfusion and suspicion of hypovolemia to achieve a minimum of 30 mL/kg of crystalloids (more rapid administration and greater amounts of fluid may be needed in some patients (1C); fluid challenge technique continued as long as hemodynamic improvement is based on either dynamic or static variables (UG); norepinephrine as the first-choice vasopressor to maintain mean arterial pressure ≥65 mmHg (1B); epinephrine when an additional agent is needed to maintain adequate blood pressure (2B); vasopressin (0.03 U/min) can be added to norepinephrine to either raise mean arterial pressure to target or to decrease norepinephrine dose but should not be used as the initial vasopressor (UG); dopamine is not recommended except in highly selected circumstances (2C); dobutamine infusion administered or added to vasopressor in the presence of (a) myocardial dysfunction as suggested by elevated cardiac filling pressures and low cardiac output, or (b) ongoing signs of hypoperfusion despite achieving adequate intravascular volume and adequate mean arterial pressure (1C); avoiding use of intravenous hydrocortisone in adult septic shock patients if adequate fluid resuscitation and vasopressor therapy are able to restore hemodynamic stability (2C); hemoglobin target of 7-9 g/dL in the absence of tissue hypoperfusion, ischemic coronary artery disease, or acute hemorrhage (1B); low tidal volume (1A) and limitation of inspiratory plateau pressure (1B) for acute respiratory distress syndrome (ARDS); application of at least a minimal amount of positive end-expiratory pressure (PEEP) in ARDS (1B); higher rather than lower level of PEEP for patients with sepsis-induced moderate or severe ARDS (2C); recruitment maneuvers in sepsis patients with severe refractory hypoxemia due to ARDS (2C); prone positioning in sepsis-induced ARDS patients with a PaO (2)/FiO (2) ratio of ≤100 mm Hg in facilities that have experience with such practices (2C); head-of-bed elevation in mechanically ventilated patients unless contraindicated (1B); a conservative fluid strategy for patients with established ARDS who do not have evidence of tissue hypoperfusion (1C); protocols for weaning and sedation (1A); minimizing use of either intermittent bolus sedation or continuous infusion sedation targeting specific titration endpoints (1B); avoidance of neuromuscular blockers if possible in the septic patient without ARDS (1C); a short course of neuromuscular blocker (no longer than 48 h) for patients with early ARDS and a PaO (2)/FI O (2) 180 mg/dL, targeting an upper blood glucose ≤180 mg/dL (1A); equivalency of continuous veno-venous hemofiltration or intermittent hemodialysis (2B); prophylaxis for deep vein thrombosis (1B); use of stress ulcer prophylaxis to prevent upper gastrointestinal bleeding in patients with bleeding risk factors (1B); oral or enteral (if necessary) feedings, as tolerated, rather than either complete fasting or provision of only intravenous glucose within the first 48 h after a diagnosis of severe sepsis/septic shock (2C); and addressing goals of care, including treatment plans and end-of-life planning (as appropriate) (1B), as early as feasible, but within 72 h of intensive care unit admission (2C). Recommendations specific to pediatric severe sepsis include: therapy with face mask oxygen, high flow nasal cannula oxygen, or nasopharyngeal continuous PEEP in the presence of respiratory distress and hypoxemia (2C), use of physical examination therapeutic endpoints such as capillary refill (2C); for septic shock associated with hypovolemia, the use of crystalloids or albumin to deliver a bolus of 20 mL/kg of crystalloids (or albumin equivalent) over 5-10 min (2C); more common use of inotropes and vasodilators for low cardiac output septic shock associated with elevated systemic vascular resistance (2C); and use of hydrocortisone only in children with suspected or proven "absolute"' adrenal insufficiency (2C). CONCLUSIONS: Strong agreement existed among a large cohort of international experts regarding many level 1 recommendations for the best care of patients with severe sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for this important group of critically ill patients

Invitro Anticoccidial Effect of Fractions of Chromolaena Odorata Extract on Sporulating Eimeria Tenalla Oocysts

Coccidiosis is an important cause of digestive system disorders in birds, especially the poultry. The aim of this study was to evaluate the in-vitro anticoccidial effects of the different fractions of Chromolaena odorata extracts on sporulated Eimeria tenella oocysts. Sporulation inhibition bioassay was used to evaluate the activity of crude methanol fraction of Chromolaena odorata extracts; n-hexane, ethyl acetate, and methanol fractions of Chromolaena odorata on sporulation of Eimeria tenella, which was used to cause coccidiosis. in the birds following oral inoculation of experimental broiler birds with oocysts. Post-mortem examination of dead birds showed lesions consistent with Eimeria tenella. The fractions of the Chromolaena odorata were examined for the oocysticidal activities. Amprolium an anticoccidial drug was used as control. The fractions were used in 4 doses: 0 mg/ml; 0.1 mg/ml; 0.2 mg/ml and 0.4 mg/ml. The control drug was used in corresponding doses. The highest oocysticidal activity of tested plant extracts and fractions was recorded. The n-hexane fraction of Chromolaena odorata gave the highest oocysticidal activity. This oocysticidal activity was noticed at lower concentrations but activity was found to be dose-dependent. The highest oocysticidal activity for the n-hexane fraction of Chromolaena odorata was at 65.67±2.08%. Amprolium showed no oocysticidal activity at all concentrations. However, other fractions of the Chromolaena odorata showed different levels of oocysticidal activities. The methanol fractions were secondary to the n-hexane while the ethyl acetate was the least.  In conclusion, this study provides the basis for using Chromolaena odorata, especially the n-hexane fraction as preventive agents against coccidiosis and suggests their use as a feed additive in the control of coccidiosis. &nbsp

Protective Effects of Aqueous Extract of Allium Sativum (Garlic) On the Histomorphology and Biochemical Parameters of Lead -Induced Cerebellar Injury on the Adult Male Wistar Rats

The study was aimed at evaluating the effects of an aqueous extract of Allium sativum on the biochemical parameters and histo-architecture of lead-induced cerebella damage in male Wistar rats. Sixteen male rats were procured for the study. They were divided into 4 groups, with 4 rats in each group. Group 1 (Control group) received only food and water, those in group 2 were given lead at the dosage of 120 mg/kg body weight. Group 3 received lead at the dosage of 120 mg/kg body weight and the extract at 300 mg/kg body weight while those in group 4 were given lead at the dosage of 120 mg/kg and 500 mg/kg body weight of the extract. The extracts were administered orally for 21 days. Blood samples were collected for biochemical evaluation. The rats were sacrificed, and their cerebella were harvested for histo-morphological studies. The levels of Superoxide dismutase (22.49 ± 1.21) and Malondialdehyde (1.17 ± 0.092) were normal in group 1. There was significant derangement in their levels in group 2, Superoxide dismutase (9.83 ± 0.93) and Malondialdehyde (11.42 ± 1.82). In groups 3 and 4, the levels of Superoxide dismutase increased towards the levels of the control group (12.81 ± 1.13, 16.06 ± 0.29), while those of Malondialdehyde also decreased towards the levels of the control group (6.49 ± 0.57, 3.12 ± 0.36).  The histo-architecture of the cerebella in group 1, appeared normal, those in group 2 showed traumatic encephalopathy of the granular cell layer. In groups 3 and 4, there was mild tissue traumatic encephalopathy. The extract of A. sativum showed a significant protective effect on the biochemical parameters and histo-architecture of lead-induced cerebella damage in adult male Wistar rats