Preliminary experience in the management of tracheobronchial foreign bodies in Lagos, Nigeria

Aspiration of tracheobronchial foreign bodies commonly affects young children, is potentially life threatening and requires early intervention for extraction. Access to facilities and skill manpower for bronchoscopic extraction is however limited in Nigeria. The aim of this study is to describe the experience in our institution with bronchoscopic removal of tracheobronchial foreign bodies and highlight the challenges encountered. This is a retrospective study of all patients referred to the Lagos State University Teaching Hospital with a diagnosis of tracheobronchial foreign body within the period of February 2008 and February 2013. Data extracted from the medical records were age, sex, time interval between aspiration and presentation, location of tracheobronchial foreign body, bronchoscopic technique, complications and outcome. A total of 24 patients were referred and confirmed at bronchoscopy to have tracheobronchial foreign bodies. Mean age was 6.6 + 5 years. Male to female ratio was 1:1. Delayed presentation was common with 22 patients (91.7%) presenting more than 24 hours after aspiration. Aspirated material was inorganic in 17 patients (70.8%) and organic in 7 patients (29.2%). Location of tracheobronchial foreign bodies was right main bronchus in 16 patients (66.7%), left main bronchus in 6 patients (25%) and the trachea in 2 patients (8.3%). Challenges to speedy and safe removal of the foreign bodies were delayed presentation and a limited range of bronchoscopic equipment early in the series which caused prolonged procedures and increased complications. Two mortalities occurred early in the series; one from airway obstruction and the other from respiratory failure caused by tracheobronchial oedema. Extraction of tracheobronchial foreign bodies was faster, more complete and safer later in the series due to a wider range of bronchoscopy equipment which included both flexible and rigid videobronchoscopy with the use of optical forceps. This preliminary experience suggests that an adequate armamentarium of bronchoscopy equipment is required to increase the chances of complete extraction, speed up the procedure and reduce the risk of complications of Tracheobronchial Foreign Bodies in our environment. Delayed presentation increases the difficulty of the procedure so earlier referral of these patients would help reduce the risk involved in  their management.Key words: Bronchoscopy, Tracheobronchial Foreign Bodies, Lagos, Nigeri

The Nigerian Twin and Sibling Registry:An update

Here we provide an update of the 2013 report on the Nigerian Twin and Sibling Registry (NTSR). The major aim of the NTSR is to understand genetic and environmental influences and their interplay in psychological and mental health development in Nigerian children and adolescents. Africans have the highest twin birth rates among all human populations, and Nigeria is the most populous country in Africa. Due to its combination of large population and high twin birth rates, Nigeria has one of the largest twin populations in the world. In this article, we provide current updates on the NTSR samples recruited, recruitment procedures, zygosity assessment and findings emerging from the NTSR

The prevalence of psychological co-morbidity in people with vitiligo: a systematic review and meta-analysis

Background: Vitiligo is a chronic disorder causing skin depigmentation with global prevalence varying from 0.2 to 1.8%. UK guidelines recommend assessment of psychological state during clinical evaluation of vitiligo. However, the prevalence of psychological co-morbidity in people with vitiligo has not been described. Objectives: We aimed to establish the prevalence of psychological symptoms or disorders in people with vitiligo and describe the outcome measures used. Methods: We performed a comprehensive search of MEDLINE, Embase, CINAHL and PsychInfo to identify observational studies assessing the prevalence of psychological symptoms or disorders (December 2016). DerSimonian and Lard random-effects models were utilized to estimate the overall pooled prevalence. Results: We identified 29 studies with 2530 people with vitiligo. Most studies included a measure of either depression (n=25) or anxiety (n=13).The commonest tools were the Hospital Anxiety and Depression Scale and the Centre for Epidemiology Studies Depression Scale. Ten studies provided information on thirteen other psychological outcomes. Pooled prevalence using depression-specific and anxiety-specific questionnaires was 0.29 (95%CI 0.21, 0.38) and 0.33 (95%CI 0.18, 0.49) respectively. Prevalence was lower for clinically diagnosed depression (0.21; 95%CI 0.15, 0.28) and anxiety (0.15; 95%CI 0.06, 0.24). When non-specific tools were used the prevalence remained similar for depression (0.27; 95%CI 0.08, 0.46) but increased for anxiety (0.46; 95% CI 0.39, 0.52). High heterogeneity was observed. Conclusions: A range of psychological outcomes are common in people with vitiligo. The prevalence of anxiety was influenced by type of screening tool, suggesting validation of psychological outcome screening tools in the field of dermatology

Sex in the shadow of HIV:A systematic review of prevalence, risk factors, and interventions to reduce sexual risk-taking among HIVpositive adolescents and youth in sub-Saharan Africa

Background Evidence on sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa is urgently needed. This systematic review synthesizes the extant research on prevalence, factors associated with, and interventions to reduce sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa. Methods Studies were located through electronic databases, grey literature, reference harvesting, and contact with researchers. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Quantitative studies that reported on HIV-positive participants (10-24 year olds), included data on at least one of eight outcomes (early sexual debut, inconsistent condom use, older partner, transactional sex, multiple sexual partners, sex while intoxicated, sexually transmitted infections, and pregnancy), and were conducted in sub-Saharan Africa were included. Two authors piloted all processes, screened studies, extracted data independently, and resolved any discrepancies. Due to variance in reported rates and factors associated with sexual risk-taking, meta-analyses were not conducted. Results 610 potentially relevant titles/abstracts resulted in the full text review of 251 records. Forty-two records (n=35 studies) reported one or multiple sexual practices for 13,536 HIV-positive adolescents/youth from 13 sub-Saharan African countries. Seventeen cross-sectional studies reported on individual, relationship, family, structural, and HIV-related factors associated with sexual risk-taking. However, the majority of the findings were inconsistent across studies, and most studies scored Conclusions Sexual risk-taking among HIV-positive adolescents and youth is high, with inconclusive evidence on potential determinants. Few known studies test secondary HIV-prevention interventions for HIV-positive youth. Effective and feasible low-cost interventions to reduce risk are urgently needed for this group.</p

Severe idiosyncratic drug reactions with epidermal necrolysis: A 5-year study

Introduction: Idiosyncratic drug reactions (IDRs) are unexpected responses to a drug. The spectrums of severe cutaneous reactions include Stevens-Johnson Syndrome (SJS), SJS/Lyell Syndrome and Toxic Epidermal Necrolysis (TEN). The conditions are associated with high mortality. This study was designed to determine the causal agents, patterns of presentations, review the management and make recommendations to reduce the incidence and mortality of this class of drug reactions. Materials and Methods: A retrospective study was made of patients seen with IDR in the Lagos State University Teaching Hospital, LASUTH, between January, 2004 and December, 2008. They were cases admitted with bullous skin eruptions with associated systemic symptoms. Results: Sixty-seven patients were seen, with 45 (67.2%) satisfying the inclusion criteria. Fifteen males and 30 females were involved, giving a male to female (M:F) ratio of 1:2. Their ages ranged from 7 to 79 years (mean, 40.02 ± 17.89 years). Peak incidences occurred among the 20-24 and 30-34 year age groups. The causal agents were antibiotics (48.89%), sulphonamides (24.44%), herbal preparations (17.78%) and artemisinin drugs (8.89%). Conclusions: The age groups with the peak incidence are the most likely to indulge more in drug abuse in environments with poor drug control. Diagnosis of SJS, SJS/TEN and TEN were missed in many patients at first contact due to the progressive nature of the conditions. Patients needed reviews at regular intervals when IDR was suspected. Health education to prevent drug abuse is important and herbal preparations should be scientifically studied to determine the efficacy and side-effects

Prevalence, Spectrum and Determinants of Diabetes Mellitus Complications in Sagamu, South-West Nigeria

Background: Diabetes Mellitus is a chronic metabolic disease associated with numerous complications. The prevalence of diabetes mellitus is increasing in our locality and constitutes a major public health problem. The objective of this study was to determine the prevalence and associated determinants of diabetes complications.Materials and Methods: The study was a cross-sectional study conducted among diabetes patients attending the endocrinology clinic in Olabisi Onabanjo University Teaching Hospital. A sample size of 253 participants was recruited using the systematic random sampling technique. A well-structured questionnaire was developed for this study and was administered by trained research assistants. Information obtained was entered into SPSS version 24 and analysed.Results: Out of 253 respondents, one hundred and ninety (75.1%) had at least one diabetes complication. Co-morbidities were&nbsp; recognized among 104 (64.8%). All participants had HbA1c above the normal reference value of 6.5. Fasting blood glucose was within diabetes range among 154 (60.9%) patients. Neuropathy was the commonest (90, 36.0%). Age at diagnosis, duration of disease and presence of comorbidities were significantly associated with diabetes complications (P &lt;0.05). Conclusions:&nbsp; The prevalence of diabetes complication was high, the main complication was neuropathy. More than two-thirds had suboptimal glycaemic control. It is important to ensure appropriate measures to ensure tight glycaemic control to improve the quality of life. Keywords: Co-Morbidities, Complications, Diabetes mellitu

High Cadmium / Zinc Ratio In Cigarette Smokers: Potential Implications As A Biomarker Of Risk Of Prostate Cancer.

Tobacco smoke may be one of the most common sources of cadmium (Cd) in the general population, particularly in the rising population of smokers in developing countries. Although a relationship between both cigarette smoking and environmental Cd contamination with prostate cancer exist, the mechanisms are unclear. Most prospective cohort studies found a positive association between current smoking and a fatal cancer of the prostate. We investigated the interaction between zinc and cadmium and the potential risk of prostate cancer in smokers. Serum cadmium level was significantly (P<0.001) higher in smokers compared with non-smokers, the level in smokers was three-fold that in non-smokers. In contrast zinc was significantly (P<0.001) reduced in smokers compared with non-smokers. Unlike Zn, Cu was significantly (P<0.05) higher in smokers than in non-smokers. Iron (Fe) though higher in smokers was not significantly different. Zinc: cadmium ratio was very significantly (P<0.001) reduced, implying high cadmium: zinc ratio. This ratio was 4.5-fold the level in non-smokers. Total protein, albumin and total globulin levels were all significantly (P<0.001) reduced in smokers compared with non-smokers respectively. Potassium (K+) was significantly (P<0.05) higher in smokers than in non-smokers. Magnesium (Mg) was significantly (P<0.01) reduced in smokers compared to non-smokers. Altered Zn status culminating in high Cd:Zn ratio appears the central factor in smokers; leading to oxidative stress, DNA damage, mutation, impaired DNA repair, P53 expression, angiogenic effect of Cu and impaired vitamin A metabolism. These converge in the risk of the carcinogenic process, suggesting high Cd: Zn ratio as the critical determinant of the risk of prostate cancer in smokers and possibly a biomarker of susceptibility to this environmental disease

Hypertension: Predictors of Knowledge among Market Women in the Sub-Urban Town of Sagamu, South West Nigeria

Introduction:Hypertension is a major public health problem. Based on prevalence of hypertension in Nigeria, only 1/3 of Nigerians are aware that they are hypertensive and of this, only two-third is on treatment for the hypertension. This may be because of inadequate provision of proper education and counseling by health care providers on the risks associated with high blood pressure. This study was to assess the knowledge of hypertension and the determinants among market women in Sagamu, South West Nigeria. Materials and Methods:The study was a cross sectional study conducted among women in the four major markets in Sagamu. The participants were recruited using multistage technique, thereafter a pretested questionnaire was administered to obtained relevant information. Data obtained were entered and analyzed using IBM SPSS 21. Results:All the participants had heard of hypertension. Regarding overall knowledge scores, two hundred and fifty-two (60%) had good knowledge, 128(30%) fair/average knowledge while 40(10%) had poor knowledge. Two hundred and fourteen (51%) of the respondents had been diagnosed of hypertension. Those with normal weight, those who were overweight, those who had spent less than 10 years in the market (less time spent in a sedentary occupation) and those with co-morbidities were more likely to have good knowledge of hypertension. Those with informal/primary education, family history of hypertension and co-morbidities had a higher likelihood of reporting a previous diagnosis of hypertension. Conclusion and recommendation:This study revealed that women in Sagamu are aware of hypertension. About two-thirds of them have good knowledge of hypertension. Determinants of knowledge of hypertension include educational status, number of years spent in market business (sedentary occupation), BMI, family history of hypertension and presence of comorbidities. There remains a need for continued community education about hypertension. Keywords: Hypertension, Knowledge Predictors, South West Nigeri