Pattern and outcome of admissions as seen in the paediatric emergency ward of the Niger Delta University Teaching Hospital Bayelsa State, Nigeria

Objective: To describe the pattern and outcome of childhood illnesses seen in a paediatric emergency ward of a tertiary centre in the Niger Delta region of Nigeria.Methods: Admission records of all children seen in the Children’s Emergency Ward (CHEW) between the 1st of January 2008 and 31st ofDecember 2011 were retrospectively reviewed and analysed.Results: A total of 1756 children were admitted into the emergency ward over a four year period (1st January 2008 to 31st December 2011). The age range was one month to 18 years with a mean of 36.6 months. There was a male preponderance with a male to female ratio of 1.4:1. Majority, 1386 (78.9%) of the patients were below the age of five years. The meanduration of stay was 2.2 days. The major causes of admission were malaria, 562 (32.0%), diarrhoeal disease 389 (22.2%), respiratory tract infections 162 (9.2%) and anaemic heart failure 112(6.4%). Peak admissions period and mortality were in the months of January, May and December. There were 799 transfers, 710 discharges, 94 discharges against medical advice and 20 referrals. Over the period, 133 children diedgiving a mortality rate of 7.6%. Major causes of mortality wereanaemic heart failure 32(24.1%), malaria 26 (19.6%), septicaemia 17(12.8%) and diarrhoeal disease 15 (11.3%).Conclusions: Infections are the major cause of morbidity and mortalityin the study environment with the under-fives being the most vulnerable.Key words: children, under-fives, emergency room, admissions, morbidity, mortalit

Exploring potential climate-related entrepreneurship opportunities and challenges for rural Nigerian women

Entrepreneurship is a tool for facilitating rural economic development, which is becoming increasingly needed to respond to the growing impacts of accelerating climate change on rural women’s livelihoods in less developed countries creating constraints on sustainable development. This study examines the awareness of and impacts of climatic changes as perceived by women in South West Nigeria in diverse vegetation zones. It elicits the challenges facing women and which constrain their entrepreneurial activities. It therefore identifies potential adaptation strategies and opportunities, including drawing on a review of wider developments in at international development level, such as technological, institutional and infrastructural innovations. The study employed explorative, mixed approaches, including quantitative and qualitative methods. Five hundred and ninety-five questionnaires were administered to selected respondents through multi-stage sampling technique, while Focused Group Discussions (FGDs) were used to solicit qualitative data from two hundred and forty women. Quantitative data were analysed with SPSS for descriptive and analysis of variance, and Atlas ti. was used to thematically analyse qualitative data. Findings showed that women have high levels of awareness of changes in their climate. Analysis of variance revealed that most of the women involved in crop farming in the vegetation zones showed better understanding than women in other livelihood. They strongly agreed (with mean of approximately 5) that climate change had greatly affected soil fertility, caused less predictable, and prolonged the dry season. Over 90% of the women perceived significant impacts of these changes on their livelihood activities. Overall, there were no clear divergences in women’s attitudes towards innovation and entrepreneurship between the vegetation zones and a relatively high expectation of government support. Wider review of current practice and innovations highlights a wide range of new opportunities for building women’s adaptive capacity which could directly or indirectly catalyse increased entrepreneurship amongst women. Furthermore, the involvement of local authorities and community-based organisations, as well as diverse public and private actors, in the development of adaptation strategies is crucial to achieving this

Social tipping points and Earth systems dynamics

Recently, Early Warning Signals (EWS) have been developed to predict tipping points in Earth Systems. This discussion highlights the potential to apply EWS to human social and economic systems, which may also undergo similar critical transitions. Social tipping points are particularly difficult to predict, however, and the current formulation of EWS, based on a physical system analogy, may be insufficient. As an alternative set of EWS for social systems, we join with other authors encouraging a focus on heterogeneity, connectivity through social networks and individual thresholds to change

Data-driven malaria prevalence prediction in large densely populated urban holoendemic sub-Saharan West Africa

Over 200 million malaria cases globally lead to half-million deaths annually. The development of malaria prevalence prediction systems to support malaria care pathways has been hindered by lack of data, a tendency towards universal "monolithic" models (one-size-fits-all-regions) and a focus on long lead time predictions. Current systems do not provide short-term local predictions at an accuracy suitable for deployment in clinical practice. Here we show a data-driven approach that reliably produces one-month-ahead prevalence prediction within a densely populated all-year-round malaria metropolis of over 3.5 million inhabitants situated in Nigeria which has one of the largest global burdens of P. falciparum malaria. We estimate one-month-ahead prevalence in a unique 22-years prospective regional dataset of > 9 × 10^{4} participants attending our healthcare services. Our system agrees with both magnitude and direction of the prediction on validation data achieving MAE ≤ 6 × 10^{-2}, MSE ≤ 7 × 10^{-3}, PCC (median 0.63, IQR 0.3) and with more than 80% of estimates within a (+ 0.1 to - 0.05) error-tolerance range which is clinically relevant for decision-support in our holoendemic setting. Our data-driven approach could facilitate healthcare systems to harness their own data to support local malaria care pathways

Metastatic breast carcinoma in the mandible presenting as a periodontal abscess: a case report

<p>Abstract</p> <p>Introduction</p> <p>Tumors can metastasize to the oral cavity and affect the jaws, soft tissue and salivary glands. Oral cavity metastases are considered rare and represent approximately 1% of all oral malignancies. Because of their rarity and atypical clinical and radiographic appearance, metastatic lesions are considered a diagnostic challenge. The purpose of this report is to present a rare case of a metastatic breast carcinoma mimicking a periodontal abscess in the mandible.</p> <p>Case presentation</p> <p>A 55-year-old Caucasian woman was referred to our clinic for evaluation of bisphosphonate-induced jaw osteonecrosis. She had undergone modified radical mastectomy with axillary lymph node dissection for invasive ductal carcinoma of the left breast. Her clinical examination showed diffuse swelling and a periodontal pocket of 6 mm exhibiting suppuration in the posterior right mandible. Moreover, paresthesia of the lower right lip and chin was noted. There were no significant radiographic findings other than alveolar bone loss due to her periodontal disease. Although the lesion resembled a periodontal abscess, metastatic carcinoma of the breast was suspected on the basis of the patient's medical history. The area was biopsied, and histological analysis confirmed the final diagnosis of metastatic breast carcinoma.</p> <p>Conclusion</p> <p>The general dentist or dental specialist should maintain a high level of suspicion while evaluating patients with a history of cancer. Paresthesias of the lower lip and the chin should be considered ominous signs of metastatic disease. This case highlights the importance of the value of a detailed medical history and thorough clinical examination for the early detection of metastatic tumors in the oral cavity.</p

Estimation of airway obstruction using oximeter plethysmograph waveform data

BACKGROUND: Validated measures to assess the severity of airway obstruction in patients with obstructive airway disease are limited. Changes in the pulse oximeter plethysmograph waveform represent fluctuations in arterial flow. Analysis of these fluctuations might be useful clinically if they represent physiologic perturbations resulting from airway obstruction. We tested the hypothesis that the severity of airway obstruction could be estimated using plethysmograph waveform data. METHODS: Using a closed airway circuit with adjustable inspiratory and expiratory pressure relief valves, airway obstruction was induced in a prospective convenience sample of 31 healthy adult subjects. Maximal change in airway pressure at the mouthpiece was used as a surrogate measure of the degree of obstruction applied. Plethysmograph waveform data and mouthpiece airway pressure were acquired for 60 seconds at increasing levels of inspiratory and expiratory obstruction. At each level of applied obstruction, mean values for maximal change in waveform area under the curve and height as well as maximal change in mouth pressure were calculated for sequential 7.5 second intervals. Correlations of these waveform variables with mouth pressure values were then performed to determine if the magnitude of changes in these variables indicates the severity of airway obstruction. RESULTS: There were significant relationships between maximal change in area under the curve (P < .0001) or height (P < 0.0001) and mouth pressure. CONCLUSION: The findings suggest that mathematic interpretation of plethysmograph waveform data may estimate the severity of airway obstruction and be of clinical utility in objective assessment of patients with obstructive airway diseases

The Endogenous Th17 Response in NO<inf>2</inf>-Promoted Allergic Airway Disease Is Dispensable for Airway Hyperresponsiveness and Distinct from Th17 Adoptive Transfer

Severe, glucocorticoid-resistant asthma comprises 5-7% of patients with asthma. IL-17 is a biomarker of severe asthma, and the adoptive transfer of Th17 cells in mice is sufficient to induce glucocorticoid-resistant allergic airway disease. Nitrogen dioxide (NO2) is an environmental toxin that correlates with asthma severity, exacerbation, and risk of adverse outcomes. Mice that are allergically sensitized to the antigen ovalbumin by exposure to NO2 exhibit a mixed Th2/Th17 adaptive immune response and eosinophil and neutrophil recruitment to the airway following antigen challenge, a phenotype reminiscent of severe clinical asthma. Because IL-1 receptor (IL-1R) signaling is critical in the generation of the Th17 response in vivo, we hypothesized that the IL-1R/Th17 axis contributes to pulmonary inflammation and airway hyperresponsiveness (AHR) in NO2-promoted allergic airway disease and manifests in glucocorticoid-resistant cytokine production. IL-17A neutralization at the time of antigen challenge or genetic deficiency in IL-1R resulted in decreased neutrophil recruitment to the airway following antigen challenge but did not protect against the development of AHR. Instead, IL-1R-/- mice developed exacerbated AHR compared to WT mice. Lung cells from NO2-allergically inflamed mice that were treated in vitro with dexamethasone (Dex) during antigen restimulation exhibited reduced Th17 cytokine production, whereas Th17 cytokine production by lung cells from recipient mice of in vitro Th17-polarized OTII T-cells was resistant to Dex. These results demonstrate that the IL-1R/Th17 axis does not contribute to AHR development in NO2-promoted allergic airway disease, that Th17 adoptive transfer does not necessarily reflect an endogenously-generated Th17 response, and that functions of Th17 responses are contingent on the experimental conditions in which they are generated. © 2013 Martin et al

Serum testosterone levels of HbSS (sickle cell disease) male subjects in Lagos, Nigeria

<p>Abstract</p> <p>Background</p> <p>Infertility is a major problem in sickle cell disease patients, especially in males. In addition to low serum testosterone, other abnormalities involving the accessory sex organs, such as the seminal vesicles and the prostate gland, as well as marked decrease in ejaculate volume may be observed in male HbSS patients. Hence, the need to study the role of sex hormones as a cause of infertility in male HbSS patients.</p> <p>Methods</p> <p>An unmatched case-control study was performed using seventy-five consenting subjects from Lagos University Teaching Hospital. These included 47 patients with haemoglobin phenotype SS from the Sickle cell clinic and 28 volunteered medical students and members of staff with haemoglobin phenotype AA. Demographic data were obtained using a self-administered questionnaire. A total of 5 mls of blood was collected from each subject between 9.00 am & 11.am, and assayed for serum testosterone concentration.</p> <p>Results</p> <p>The concentrations of serum testosterone in HbSS patients ranged from 0.2 to 4.3 ng/ml with a mean of 1.28 ± 0.72 ng/ml whilst the values in HbAA controls ranged from 1.2 to 6.9 ng/ml with a mean of 2.63 ± 1.04 ng/ml. Seven (25.0%) of the 28 controls had serum testosterone concentration lower than the quoted reference (normal) range whereas 44 (93.6%) of the 47 HbSS subjects had serum testosterone concentration lower than the reference range.</p> <p>Conclusion</p> <p>Overall, subjects with HbSS have significantly lower mean serum testosterone than HbAA controls.</p