Weekend versus weekday hospital deaths: Analysis of in‑patient data in a Nigerian tertiary healthcare center

Aim: This study aims at comparing weekday deaths to weekend deaths of in‑patients of a tertiary hospital in Nigeria.Materials and Methods: This is a 10‑year retrospective survey conducted at the Nnamdi Azikiwe University Teaching Hospital in which the death records of the hospital were accessed from the various wards and health records department to extract relevant data pertaining to the time of hospital death. Tests of statistical significance were done using Chi‑square test at 95% confidence intervals.Results: A total of 3934 deaths were recorded during the period of study. The ages ranged from a few hours to 94 years with a mean age of 38.5 years. The male to female ratio was 1.2:1. An average of 547 weekend deaths and 568 weekday deaths were recorded, giving a ratio of 0.96:1. A ratio of weekend to weekday death rate of 0.99:1 and 0.93:1 for the males and females, respectively was noted. The labor ward, followed by the intensive care unit (ICU) had the highest weekend to weekday death ratio of 1.72:1 (P = 0.0461) and 1.41:1 (P = 0.1440), respectively. Weekend deaths were less in the other wards, with the gynaecological ward having the least ratio of 0.63:1 (P = 0.7360).Conclusion: The rate of hospital deaths was generally found not to vary significantly over the weekends and weekdays in the hospital except for the labor ward which had significantly higher weekend to weekday death rates of 1.72:1. There is therefore need for confidential enquiry into the causes of hospital deaths, especially in the labor ward, in order to identify and prevent avoidable deaths.Keywords: Hospital deaths, in‑patients, weekend deathsNigerian Journal of Clinical Practice • Oct-Dec 2013 • Vol 16 • Issue

Inevitable Caesarean Myomectomy

The standard teaching is to avoid caesarean myomectomy as much as possible for the fear of the attendant severe haemorrhage. Classical caesarean section in spite of its risk of uterine rupture in subsequentpregnancies had been prescribed in its place.We report a case of a 32 year old nullipara who had an inevitable removal of a huge intramural fibroid in order to assess the baby. A high dose oxytocin infusion, and skillful surgeryensured minimal intra operative and post operative blood loss.Keywords: caesarean myomectomy, inevitable, fibroid

Serum urea and uric acid concentration in pregnant women in sub-urban commercial community in Africa

Serum uric acid and urea levels were determined in 27 pregnant and 17 non-pregnant blackAfrican women. Uric acid levels for the pregnant women were significantly raised, and the relationship between uric acidelevation and gestational proteinuric hypertensionwas discussed. In conclusion, we recommend that uric acid estimation should be included during routine antenatal clinics in normal pregnancy. That the use of uric acid levels should be encouraged for the diagnosis and management of gestational proteinuric hypertension in African pregnant women. The above recommendation will help to reduce prenatalmorbidity andmortality inAfrican pregnantwomen

Cervical Cancer Screening by Female Workers in South East Nigeria

Cervical cancer is one of the commonest female cancers especially in developing countries. Efforts towards its prevention worldwide have focused on screening women at risk of disease using Pap smears and treating pre-cancerous lesions. A good knowledge and understanding of the level of practice of cervical cancer screening among female workers in south east Nigeria will help in creating population-specific healthcare programs and interventions aimed at improving women’s health. OBJECTIVES: To determine the perception and practice of cervical cancer screening among female workers in south east Nigeria as well as ascertain the influence of age, educational status and marital status on the practice of cervical cancer screening among this group. METHOD: A cross-sectional descriptive study carried out among female workers in Nnewi who were selected using multi-stage approach between December 2007 and January 2008. Tests of statistical significance were done using chi square test at 95% confidence interval. RESULTS A total of 172 females responded. The mean age was 29.7 ± 8.8 years and the ages ranged from 15 to 65 years. One hundred and twenty-three respondents (71.5%) knew about cervical cancer screening. Only 12 (9.8%) of the respondents who were aware of Pap smear had done the test, of which 9 (75.0%) had disease detected. There was no statistically significant association between educational level, age andmarital status respectively and the practice of cervical cancer screening. CONCLUSION: There is avery lowlevel of practice of cervical cancer screening in this group. Educational level, age and marital status were found not to affect the practice of cervical cancer screening. Key Words: Cervical cancer, workers, practice, Nigeri

Data from: Children with type 1 diabetes who experienced a honeymoon phase had significantly lower LDL cholesterol 5 years after diagnosis

Manuscript abstract: Importance: Landmark studies showed that partial clinical remission in new-onset type 1 diabetes is associated with reduced prevalence of long-term complications, but early clinical indicators of this favorable outcome are poorly characterized. Aim: To determine if there were any differences in lipid parameters, especially LDL-cholesterol, between remitters and non-remitters 4 to 5 years after the diagnosis of type 1 diabetes after controlling for hemoglobin A1c, body mass index, and pubertal status. Subjects and Methods: A longitudinal retrospective cohort study of 123 subjects of mean age 11.9 ± 2.9 years, [male 11.7 ± 2.9 years, (n=55); female 12.0 ± 2.9 years, (n=68), p=0.60] with type 1 diabetes of 4-5 years duration. Anthropometric and biochemical data were collected at the 4th or 5th year after diagnosis in line with the American Diabetes Association recommendation to initiate screening for complications in children either at the beginning of puberty or 4-5 years after diagnosis. Puberty was defined by Tanner stages II-V. Partial clinical remission was defined by the gold-standard insulin-dose adjusted hemoglobin A1c (IDAA1c) of ≤9. Results: There were 44 (35.8%) remitters (age 13.0 ± 2.5y; male 52.3%). Both the total cholesterol and LDL-cholesterol were significantly lower in remitters compared to non-remitters: LDL-C: 78.8 ± 28.7 mg/dL vs. 91.6 ± 26.5 mg/dL, p=0.023; and total cholesterol: 151.5 ± 32.6 mg/dL vs. 167.0 ± 29.6 mg/dL, p=0.015. Other lipid fractions were similar between the groups. There were no differences between the groups for glycemic control, body mass index z score, thyroid function, celiac disease occurrence, or vitamin D status. Though a greater number of remitters were in puberty compared to non-remitters (86.4% vs. 60.8%, p=0.006), LDL-C concentration was similar in prepubertal remitters vs. non-remitters (p=0.93), but was significantly lower in remitters in puberty compared to non-remitters in puberty (p=0.018) after adjusting for age and duration of diabetes. Conclusions: Children with type 1 diabetes who underwent a honeymoon phase had significantly lower LDL cholesterol 5 years after diagnosis regardless of their age, glycemic control, adiposity, or pubertal status. This early divergence in lipidemia may explain the dichotomy in the prevalence of long-term complication in type 1 diabetes between remitters and non-remitters. It also offers a pathway for targeted lipid monitoring in type 1 diabetes, by establishing non-remission as a non-modifiable risk factor for vascular complication in type 1 diabetes

Children with type 1 diabetes who experienced a honeymoon phase had significantly lower LDL cholesterol 5 years after diagnosis

IMPORTANCE: Landmark studies showed that partial clinical remission in new-onset type 1 diabetes is associated with reduced prevalence of long-term complications, but early clinical indicators of this favorable outcome are poorly characterized. AIM: To determine if there were any differences in lipid parameters, especially LDL-cholesterol, between remitters and non-remitters 4 to 5 years after the diagnosis of type 1 diabetes after controlling for hemoglobin A1c, body mass index, and pubertal status. SUBJECTS AND METHODS: A longitudinal retrospective cohort study of 123 subjects of mean age 11.9 +/- 2.9 years, [male 11.7 +/- 2.9 years, (n = 55); female 12.0 +/- 2.9 years, (n = 68), p = 0.60] with type 1 diabetes of 4-5 years duration. Anthropometric and biochemical data were collected at the 4th or 5th year after diagnosis in line with the American Diabetes Association recommendation to initiate screening for complications in children either at the beginning of puberty or 4-5 years after diagnosis. Puberty was defined by Tanner stages II-V. Partial clinical remission was defined by the gold-standard insulin-dose adjusted hemoglobin A1c (IDAA1c) of \u3c /=9. RESULTS: There were 44 (35.8%) remitters (age 13.0 +/- 2.5y; male 52.3%). Both the total cholesterol and LDL-cholesterol were significantly lower in remitters compared to non-remitters: LDL-C: 78.8 +/- 28.7 mg/dL vs. 91.6 +/- 26.5 mg/dL, p = 0.023; and total cholesterol: 151.5 +/- 32.6 mg/dL vs. 167.0 +/- 29.6 mg/dL, p = 0.015. Other lipid fractions were similar between the groups. There were no differences between the groups for glycemic control, body mass index z score, thyroid function, celiac disease occurrence, or vitamin D status. A greater number of remitters were in puberty compared to non-remitters (86.4% vs. 60.8%, p = 0.006). LDL-C concentration was similar in prepubertal remitters vs. non-remitters (p = 0.93), but was significantly lower in remitters in puberty compared to non-remitters in puberty (p = 0.018) after adjusting for age and duration of diabetes. CONCLUSIONS: Children with type 1 diabetes who underwent a honeymoon phase had significantly lower LDL cholesterol 5 years after diagnosis. This early divergence in lipidemia may explain the dichotomy in the prevalence of long-term complication in type 1 diabetes between remitters and non-remitters. It also offers a pathway for targeted lipid monitoring in type 1 diabetes, by establishing non-remission as a non-modifiable risk factor for vascular complication in type 1 diabetes

Refractive ocular conditions and reasons for spectacles renewal in a resource-limited economy

<p>Abstract</p> <p>Background</p> <p>Although a leading cause of visual impairment and a treatable cause of blindness globally, the pattern of refractive errors in many populations is unknown. This study determined the pattern of refractive ocular conditions, reasons for spectacles renewal and the effect of correction on refractive errors in a resource-limited community.</p> <p>Methods</p> <p>A retrospective review of case records of 1,413 consecutive patients seen in a private optometry practice, Nigeria between January 2006 and July 2007.</p> <p>Results</p> <p>A total number of 1,216 (86.1%) patients comprising of (486, 40%) males and (730, 60%) females with a mean age of 41.02 years SD 14.19 were analyzed. The age distribution peaked at peri-adolescent and the middle age years. The main ocular complaints were spectacles loss and discomfort (412, 33.9%), blurred near vision (399, 32.8%) and asthenopia (255, 20.9%). The mean duration of ocular symptoms before consultation was 2.05 years SD 1.92. The most common refractive errors include presbyopia (431, 35.3%), hyperopic astigmatism (240, 19.7%) and presbyopia with hyperopia (276, 22.7%). Only (59, 4.9%) had myopia. Following correction, there were reductions in magnitudes of the blind (VA<3/60) and visually impaired (VA<6/18-3/60) patients by (18, 58.1%) and (89, 81.7%) respectively. The main reasons for renewal of spectacles were broken lenses/frame/scratched lenses/lenses' falling off (47, 63.4%).</p> <p>Conclusions</p> <p>Adequate correction of refractive errors reduces visual impairment and avoidable blindness and to achieve optimal control of refractive errors in the community, services should be targeted at individuals in the peri-adolescent and the middle age years.</p

Strategies for Fostering Creativity Among Business Education Graduates in Nigeria

This study was designed to find out the strategies for fostering creativity among business education graduates in Nigeria. The instrument that was used to collect the data for this study was a questionnaire. The study sample comprised all the 71 Business Education lecturers in the universities and colleges of Education in Edo and Delta states in the South-South geo-political zone of Nigeria. Mean, standard deviation and t-test were the statistical tools used for the analysis of data. The findings of the study reveal that the respondents agreed that the 20 creativity skill-items are needed by business education graduates. Furthermore, the study also show a no significant difference between the mean rating of opinion of male and female business educators on the strategies for fostering creativity among business education graduates in Nigeria. Finally, some recommendations that are likely to enable both the pre-service and in-service business education graduates acquire relevant creativity skills designed to make them useful to themselves and the society at large have been proffered.Keywords: Strategies, Creativity, Business Education Programme, Graduate Employment

Attitude of women towards private and public hospitals for obstetric care in South-East Nigeria: Implications for maternal mortality reduction

Background: The privately owned hospitals play key roles in healthcare delivery in Nigeria.Objective: To determine the attitude of women towards private and public hospitals in accessing obstetric care in Nnewi, South-East Nigeria and evaluate its implications for maternal mortality reduction efforts in the country.Methodology: A cross sectional survey of 400 market women using semi-structured questionnaires and focus group discussions.Results: Majority of the women (72.1%) attended antenatal clinic in their last pregnancy in private hospitals while only 17.8% of them received antenatal care in government hospitals. Twenty-five (6.3%) of the women had antenatal care in maternity homes, and most of the respondents (72.8%) had their last deliveries in private hospitals. Equal numbers of them (36.4% each), delivered at the private specialist hospitals and private general practice hospitals, respectively. Only sixty-two (15.6%) of the respondents delivered in the government hospitals, while 37(9.3%) delivered in the maternity homes. Majority (79.4%) would prefer to deliver in the private hospitals in their next confinement while 14.1% would prefer government hospitals. The major reasons for choosing a particular hospital over the others included the friendly attitude of the health workers (33.9%), availability of attending staff at all times (27.4%) and proximity of the facility to their homes (14.6%).Conclusion: Most women in Nnewi prefer to have antenatal care and delivery in private hospitals rather than in public hospitals. Thus, private hospitals should be included in maternal mortality reduction efforts in this part of the country so as to achieve the desired results