Safety of daycare hernia repair in Jos, Nigeria

Objective: To evaluate the safety of day surgery for inguinal hernia.Design: A randomised prospective study of patients presenting for elective inguinal hernia repair.Setting: Jos University Teaching, Jos, Nigeria.Subjects: One hundred and twenty one patients who completed a six-week follow up period.Interventions: Sixty one patients had elective hernia repair as daycares while 60 patients were treated as inpatients. Forty six herniotomies and seventy five herniorrhaphies were performed under local or general anaesthesia.Main outcome measures: Early post-operative complications, including wound complications were evaluated.Results: Early post-operative complications occurred in two of the 61 daycares and 15 of 60 inpatients (p=0.002). There were twelve and ten wound complications in daycares and inpatients respectively (p = 0.668). There was no mortality.Conclusion: Outpatient elective inguinal hernia repair in carefully selected patients is relatively safe in our environment

Modified Alvarado Scoring System as a diagnostic tool for Acute Appendicitis at Bugando Medical Centre, Mwanza, Tanzania

<p>Abstract</p> <p>Background</p> <p>Decision-making in patients with acute appendicitis poses a diagnostic challenge worldwide, despite much advancement in abdominal surgery. The Modified Alvarado Scoring System (MASS) has been reported to be a cheap and quick diagnostic tool in patients with acute appendicitis. However, differences in diagnostic accuracy have been observed if the scores were applied to various populations and clinical settings. The purpose of this study was to evaluate the diagnostic value of Modified Alvarado Scoring System in patients with acute appendicitis in our setting.</p> <p>Methods</p> <p>A cross-sectional study involving all patients suspected to have acute appendicitis at Bugando Medical Centre over a six-month period between November 2008 and April 2009 was conducted. All patients who met the inclusion criteria were consecutively enrolled in the study. They were evaluated on admission using the MASS to determine whether they had acute appendicitis or not. All patients underwent appendicectomy according to the hospital protocol. The decision to operate was the prerogative of the surgeon or surgical resident based on overall clinical judgment and not the MASS. The diagnosis was confirmed by histopathological examination. Data was collected using a pre-tested coded questionnaire and analyzed using SPSS statistical computer software.</p> <p>Results</p> <p>A total number of 127 patients were studied. Their ages ranged from eight to 76 years (mean 29.64 ± 12.97). There were 37 (29.1%) males and 90 (70.9%) females (M: F = 1:2.4). All patients in this study underwent appendicectomy. The perforation rate was 9.4%. Histopathological examination confirmed appendicitis in 85 patients (66.9%) and the remaining 42 patients had normal appendix giving a negative appendicectomy rate of 33.1% (26.8% for males and 38.3% for females). The sensitivity and specificity of MASS in this study were 94.1% (males 95.8% and females 88.3%) and 90.4% (males 92.9% and females 89.7%) respectively. The Positive Predictive Value and Negative Predictive Value were 95.2% (males 95.5% and females 90.6%) and 88.4% (males 89.3% and females 80.1%) respectively. The accuracy of MASS was 92.9% (males 91.5% and females 87.6%).</p> <p>Conclusion</p> <p>The study shows that use of MASS in patients suspected to have acute appendicitis provides a high degree of diagnostic accuracy and can be employed at Bugando Medical Centre to improve the diagnostic accuracy of acute appendicitis and subsequently reduces negative appendicectomy and complication rates. However, additional investigations may be required to confirm the diagnosis in case of atypical presentation.</p

Structural and spectroscopic characterisation of a heme peroxidase from sorghum

A cationic class III peroxidase from Sorghum bicolor was purified to homogeneity. The enzyme contains a high-spin heme, as evidenced by UV-visible spectroscopy and EPR. Steady state oxidation of guaiacol was demonstrated and the enzyme was shown to have higher activity in the presence of calcium ions. A Fe(III)/Fe(II) reduction potential of -266 mV vs NHE was determined. Stopped-flow experiments with H2O2 showed formation of a typical peroxidase Compound I species, which converts to Compound II in the presence of calcium. A crystal structure of the enzyme is reported, the first for a sorghum peroxidase. The structure reveals an active site that is analogous to those for other class I heme peroxidase, and a substrate binding site (assigned as arising from binding of indole-3-acetic acid) at the γ-heme edge. Metal binding sites are observed in the structure on the distal (assigned as a Na(+) ion) and proximal (assigned as a Ca(2+)) sides of the heme, which is consistent with the Ca(2+)-dependence of the steady state and pre-steady state kinetics. It is probably the case that the structural integrity (and, thus, the catalytic activity) of the sorghum enzyme is dependent on metal ion incorporation at these positions

Does the Wagner's Law Hold for Nigeria? : 1950-2008

Wagner’s Law suggests that as the economic activity of a country increases, so does its government expenditure. This paper examines the validity of Wagner’s law in Nigeria for the time period 1950-2008. For investigating the existence of a long run and causal relationship between government expenditure and national income, three of the most advanced econometric methods, the Johansen maximum likelihood cointegration method, error correction modeling and the Granger causality test have been applied to Musgrave (1969) version of the functional interpretations of the law. All the results of the empirical estimations point to the fact that Wagner’s Law is supported for Nigerian economy during the period under review. Policy wise, this contribution suggests that Government of Nigeria cut back on public capital spending because of lack of transparency in the procurement of capital projects which has left such expenditures unproductive. Government should see the urgent need to provide environment conducive for private sector active participation in economic activities and implement with all sincerity the on-going Public Private Partnership Programme (PPPP). These will ensure increased efficiency in the allocation of resources and tend to reduction in government size. The results further imply that development plans of Nigeria must incorporate such fiscal policy measures that would guarantee commensurate growth in government revenue to accommodate the expected growth in government size.Keywords: Wagner’s law; causality; government size; growth

The Impact of Exchange Rate Variations on Trade Balance: Evidence from Nigeria, 1970-2005

This study examines the empirical relationship between the real exchange rate and aggregate trade balance of Nigeria. Conventional wisdom states that a nominal devaluation of exchange rate improves the trade balance. This conjecture is founded on the Bickerdike-Robinson-Metzler (BRM) and Marshall- Lerner (ML) conditions. Empirically, the evidence for Nigeria has been inconsistent in either rejecting or supporting BRM or ML conditions. This study tests the ML conditions to see if it is satisfied for Nigeria. It uses the a regression model formulation which include income and real exchange rate, so that absorption approach to balance of payments is also investigated. The econometric procedures used to assess the impact of exchange rate variations on the aggregate trade balance are: Unit root tests (ADF and PP), Johansen an Juselius approach to estimation of multivariate cointegration system and ordinary least square (OLS). The results suggest no co integration for the trade balance model. The results further show that depreciation/devaluation improves trade balance and that Marshall-Learn (ML) condition holds for Nigeria. This is an indication that in Nigeria, exchange rate management may be regarded as a relevant tool for balance of trade adjustment.Keywords: Nigeria, Exchange Rate, ML Condition, Trade Balance and OLS

Estimating Aggregate Import-Demand Function In Nigeria: A Co-Integration Approach

This paper investigates the behaviour of Nigeria's aggregate imports between the periods 1980-2005. In the empirical analysis of the aggregate import demand function for Nigeria, cointegration and Error Correction modeling approaches have been used. Our econometric estimates suggest that real GDP largely explains the import demand function. This is significant for policy makers as it indicates the ineffectiveness of using exchange rate policy option in influencing import demand in Nigeria. Keywords: Import; GDP; trade liberalization; cointegrationJORIND Vol. 6 (1) 2008: pp. 18-1

Insulin initiation in Type 2 diabetes mellitus outpatients – data from the multicentre evaluation of type 2 diabetes mellitus outpatients on insulin therapy in Nigeria (METOIN study)

People living with type 2 diabetes mellitus (T2DM) have relative insulin deficiency and, therefore, have options to insulin therapy. To be on insulin alone or in combination with other therapies in type 2 DM outpatients is a choice made personalized for each patient. Published literature on the insulin initiation patterns among T2DM outpatients in Nigeria is scanty. The objective of this study, therefore, is to bridge this gap in knowledge. This was a prospective cross sectional study conducted in five tertiary health facilities in Nigeria in which consenting type 2 DM outpatients on insulin therapy alone or in combination with other therapies and who meet the inclusion criteria for the study were recruited. Relevant data relating to insulin use initiation by the patients were analyzed using Statistical Package for Social Sciences (SPSS) version 23.0 software. A total of 268 outpatients living with type 2 DM on insulin therapy, made up of 116 (43.3%) male and 152 (56.7%) females participated in the study. Only 55 (20.5%) of the patients started insulin at onset of diagnosis of T2DM while 46 (17.2%) of the patients started insulin therapy after 5 years of living with T2DM. The duration of living with DM before insulin initiation and the patient's highest level of education were not statistically significant. Insulin initiation was delayed several months to years after diagnosis of T2DM by predominantly endocrinologists in tertiary health facilities but it was initiated in 19 (7.1%) of the T2DM outpatients by primary care physicians (GPs) in peripheral hospitals. It is recommended that diabetes education be intensified for T2DM patients to appreciate the key role of insulin therapy in diabetes care. Keywords: insulin initiation, type 2 diabetes mellitus outpatients, Nigeria

Comparative economic analysis of seed yam production techniques in Nigeria

No Abstract.Nigeria Agricultural Journal Vol. 38 2007: pp. 92-9