Awareness and attitudes towards total cardiovascular disease risk assessment in clinical practice among physicians in Southern Nigeria

Introduction: The disparity between the increasing burden of cardiovascular disease (CVD) and available resources to treat it in sub-Saharan Africa necessitates preventive strategies. Total CVD risk assessment is a cost-effective approach to guide primary preventive therapy. However, in order to utilise this approach there has to be an understanding about it among the end-users. The objective of this study was to determine the awareness, use, and attitudes regarding total CVD risk assessment in clinical practice among physicians in Port Harcourt, Nigeria.Methods: a cross-sectional survey of 150 physicians in government hospitals and private practices in Port Harcourt city. The characteristics of ‘users’ versus ‘non-users’ of CVD risk assessment were compared with the Chi-Square test of significance.Results: 106 physicians completed the questionnaires. 74 (69.8%) reported awareness of tools available to assess total CVD risk. Among those aware, 87.1% agreed that CVD risk assessment is useful, 81% agreed it improves patient care, 74.3% agreed it leads to better decisions about recommending preventive therapies and 60% agreed that it increased the likelihood that they would recommend risk-reducing therapies to high-risk patients. However, 62.9% of these physicians felt it was time-wasting to use and only 21 (28.4%) actually use CVD risk assessment regularly in practice. The most commonly reported barrier was unfamiliarity with how to use risk estimation tools (52.8%). Majority who use it do so to guide preventive therapy. Female sex and the use of an Internet-enabled smartphone were associated with increased odds of being a ‘user’ of risk estimation tools (odds ratios 4.8, CI 1.4-16.9; and 5.9, CI 1.7-20.0 respectively).Conclusion: Utilisation of risk assessments in clinical practice is low. A major barrier was nonfamiliarity with how to use the tools. Continuous medical education and wider use of smartphone technology may represent health system approaches to tackling this issue.Keywords: Risk assessment, cardiovascular disease, and primary preventio

Effects of antibiotic resistance, drug target attainment, bacterial pathogenicity and virulence, and antibiotic access and affordability on outcomes in neonatal sepsis: an international microbiology and drug evaluation prospective substudy (BARNARDS)

Background Sepsis is a major contributor to neonatal mortality, particularly in low-income and middle-income countries (LMICs). WHO advocates ampicillin–gentamicin as first-line therapy for the management of neonatal sepsis. In the BARNARDS observational cohort study of neonatal sepsis and antimicrobial resistance in LMICs, common sepsis pathogens were characterised via whole genome sequencing (WGS) and antimicrobial resistance profiles. In this substudy of BARNARDS, we aimed to assess the use and efficacy of empirical antibiotic therapies commonly used in LMICs for neonatal sepsis. Methods In BARNARDS, consenting mother–neonates aged 0–60 days dyads were enrolled on delivery or neonatal presentation with suspected sepsis at 12 BARNARDS clinical sites in Bangladesh, Ethiopia, India, Pakistan, Nigeria, Rwanda, and South Africa. Stillborn babies were excluded from the study. Blood samples were collected from neonates presenting with clinical signs of sepsis, and WGS and minimum inhibitory concentrations for antibiotic treatment were determined for bacterial isolates from culture-confirmed sepsis. Neonatal outcome data were collected following enrolment until 60 days of life. Antibiotic usage and neonatal outcome data were assessed. Survival analyses were adjusted to take into account potential clinical confounding variables related to the birth and pathogen. Additionally, resistance profiles, pharmacokinetic–pharmacodynamic probability of target attainment, and frequency of resistance (ie, resistance defined by in-vitro growth of isolates when challenged by antibiotics) were assessed. Questionnaires on health structures and antibiotic costs evaluated accessibility and affordability. Findings Between Nov 12, 2015, and Feb 1, 2018, 36 285 neonates were enrolled into the main BARNARDS study, of whom 9874 had clinically diagnosed sepsis and 5749 had available antibiotic data. The four most commonly prescribed antibiotic combinations given to 4451 neonates (77·42%) of 5749 were ampicillin–gentamicin, ceftazidime–amikacin, piperacillin–tazobactam–amikacin, and amoxicillin clavulanate–amikacin. This dataset assessed 476 prescriptions for 442 neonates treated with one of these antibiotic combinations with WGS data (all BARNARDS countries were represented in this subset except India). Multiple pathogens were isolated, totalling 457 isolates. Reported mortality was lower for neonates treated with ceftazidime–amikacin than for neonates treated with ampicillin–gentamicin (hazard ratio [adjusted for clinical variables considered potential confounders to outcomes] 0·32, 95% CI 0·14–0·72; p=0·0060). Of 390 Gram-negative isolates, 379 (97·2%) were resistant to ampicillin and 274 (70·3%) were resistant to gentamicin. Susceptibility of Gram-negative isolates to at least one antibiotic in a treatment combination was noted in 111 (28·5%) to ampicillin–gentamicin; 286 (73·3%) to amoxicillin clavulanate–amikacin; 301 (77·2%) to ceftazidime–amikacin; and 312 (80·0%) to piperacillin–tazobactam–amikacin. A probability of target attainment of 80% or more was noted in 26 neonates (33·7% [SD 0·59]) of 78 with ampicillin–gentamicin; 15 (68·0% [3·84]) of 27 with amoxicillin clavulanate–amikacin; 93 (92·7% [0·24]) of 109 with ceftazidime–amikacin; and 70 (85·3% [0·47]) of 76 with piperacillin–tazobactam–amikacin. However, antibiotic and country effects could not be distinguished. Frequency of resistance was recorded most frequently with fosfomycin (in 78 isolates [68·4%] of 114), followed by colistin (55 isolates [57·3%] of 96), and gentamicin (62 isolates [53·0%] of 117). Sites in six of the seven countries (excluding South Africa) stated that the cost of antibiotics would influence treatment of neonatal sepsis

The Occurrence of Vibrio species in the Gut of Sardinella madrensis in Port Harcourt, Nigeria

The occurrence of vibrio bacteria in the gut of “Songu”: Sardinella madrensis was investigated using enrichment procedures. Seventy percent (70%) of the total fish samples examined were positive for vibrios. The mean bacterial counts ranged between 2.68 x 102 to 1.30 x 104 cfu/g in all the fish samples. The weight of fish samples ranged between 25.0g and 30.9g and the bacterial counts increased with fish weight. Four major species were isolated, though in varying frequencies and they included Vibrio cholerae (2.7%), V. hollisae (5.4%), V. parahaemolyticus (10.8) and V. vulnificus (81.5%). The presence of these bacterial species in the fish samples might expose the consumers to a wide variety of disease conditions. Keywords: Vibrio flora, “Songu”: Sardinella madrensis, gut Journal of Medical Laboratory Science Vol. 13 (2) 2004: pp. 62-6

Assessment of Complementary Feeding Practices and Nutritional Status of Children (0-24 months) in Akuku Toru Local Government Area of Rivers State, Nigeria

This study was carried out to assess complementary feeding practices of under-five children in Akuku Toru Local Government Area of Rivers State. A cross-sectional descriptive survey research was adopted for the study. The population for the study consisted of nursing mothers with children (0-24 months) attending their normal health services in seven (7) major primary health care centres in Akuku Toru Local Government Area, Rivers State. A sample size of 210 nursing mothers was selected for the study. The instrument used for data collection was a self-structured questionnaire titled “Assessment of Complementary Feeding Practices of Children Questionnaire”. The questionnaire was validated by three validates. Data generated using the research instrument was analyzed using frequency, percentages and mean. The findings obtained showed that most nursing mothers initiate complementary feeding at early age and their reasons often times are pressure from their family members who do not understand the benefits of adequate breast milk and pressure from employers to resume work. Majority of the sampled nursing mothers in the study area prefer cereal/grain, fruits, vegetables, yoghurt and custard over other complementary foods used in nursing a child. Majority of the respondent agreed that the nutritional status of infants introduced to complementary foods at their early stage of development is usually underweight, stunting and wasting. It was also established that inappropriate complementary feeding practices adopted by nursing mothers in the study areas has significant effect on the nutritional status of their infants. Therefore, the study recommends that there is need for promotion of women’s health and nutrition as a strategy that will benefit child nutritional status. Interventional programmes should target poorer household and mothers with lower educational level to improve complementary feeding practices of mothers. Developmental programmes should focus on empowering women in rural communities by improving of household income through creation of employment and access to credit facilities that will enable women engage in sustainable means of livelihood

Effects of Gasoline on Blood Cells and Liver Functions of Albino Rats (Rattus rattus)

The acute toxicological effects of gasoline on blood cells, and liver functions of albino rats were investigated. The rats were intraperitoneally injected with gasoline at different dose levels and were observed within 24 hours for signs and symptoms of toxicity. From the pilot study, 35.0g/kg was obtained as the minimum dose of gasoline that caused 100% death (LD100). Furthermore, LD50 study gave 12.30g/kg as the dose of gasoline that caused 50% death in rats (median lethal dose). The symptoms observed included occurrence of pallor, sedation, respiratory distress, coma and death and they were dose-dependent. Death rate increased with increase in the concentration of gasoline. The results of the hematological parameters obtained showed decrease in the mean + SEM values with increase in doses of gasoline injection. The biochemical parameters obtained showed an increase in the ALT and AST levels from 0.00 to 35.0g/kg and a corresponding increase in the ALP level from 0.00 to 35.0g/kg, indicating a case of hepatotoxicity. Direct and total bilirubin were also increased with increase in the doses of gasoline. The results, of this study showed that exposure to gasoline is potentially toxic and the degree of toxicity may be influenced by the dose or concentration to which persons are exposed. Keywords: Albino Rat, Gasoline, Histopathology Journal of Medical Laboratory Science Vol. 13 (2) 2004: pp. 24-2

Changes in Immunohaematological Characteristics of Human Immunodeficiency

Highly active anti-retroviral therapy (HAART) has changed the mode of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) care in the developed countries, but its benefits and effects have not been well elucidated in Nigeria. In this case-control study, we have investigated the immediate effects of HAART with stavudine, lamivudine and nevirapine on the haematological and immunological parameters of 70 antiretroviral naïve, HIV-positive subjects during the first 8 weeks of therapy. Thirty HIV-positive antiretroviral naïve individuals not yet on HAART were included as controls. At baseline, treated subjects and controls did not differ significantly in their haematological and immunological parameters. After 8 weeks of HAART, the differences in mean haemoglobin (t = 5.77,

Kidney Transplant in a 26-Year-Old Nigerian Patient with Sickle Cell Nephropathy

Sickle cell nephropathy (SCN) is a common complication of sickle cell disease (SCD). It has variable presentation, ranging from hyposthenuria to end-stage renal disease (ESRD). Management of ESRD in SCD patients is froth with multiple challenges which has potential to impact negatively the outcome of the patient. Kidney transplant is the preferred renal replacement therapy in these patients. The objective of this case study is to report kidney transplant in a Nigerian young man with sickle cell nephropathy and to highlight the outcome and the challenges to kidney transplant in this patient. The index case is a 26-years-old sickle cell disease patient with ESRD complicated with cardiovascular, pulmonary, immunological, and infective challenges. These conditions were controlled, and the patient had a successful live-related kidney transplant. Kidney transplant is a viable option for sickle cell disease patients with ESRD

Case Report Kidney Transplant in a 26-Year-Old Nigerian Patient with Sickle Cell Nephropathy

Sickle cell nephropathy (SCN) is a common complication of sickle cell disease (SCD). It has variable presentation, ranging from hyposthenuria to end-stage renal disease (ESRD). Management of ESRD in SCD patients is froth with multiple challenges which has potential to impact negatively the outcome of the patient. Kidney transplant is the preferred renal replacement therapy in these patients. The objective of this case study is to report kidney transplant in a Nigerian young man with sickle cell nephropathy and to highlight the outcome and the challenges to kidney transplant in this patient. The index case is a 26-years-old sickle cell disease patient with ESRD complicated with cardiovascular, pulmonary, immunological, and infective challenges. These conditions were controlled, and the patient had a successful live-related kidney transplant. Kidney transplant is a viable option for sickle cell disease patients with ESRD