Assessing Patients’ Perception of Health Care Service Quality Offered by COHSASA-Accredited Hospitals in Nigeria

Service quality in health care institutions is an emerging phenomenon, and many hospitals are concerned about providing quality service to their patients based on information obtained by the patient’s perceptions of service quality. First, we aimed to determine patients’ perception of service quality offered at Council for Health Service Accreditation of Southern Africa (COHSASA)–accredited private hospitals in Nigeria. And that included reexamining the dimensionality of SERVQUAL (the test tool) based on our sample data. Second, we aimed to find out whether there are any existing gaps between patients’ expectation and perception of the service quality. Third, this research is an attempt to test the perceived quality effects on patients’ satisfaction and repurchase intentions toward health services. Quantitative research was conducted via self-administered questionnaires to patients who attended a randomly selected COHSASA-accredited private hospital in Nigeria and analyze their data using a variety of quantitative procedures including structural equation modeling, factor analyses, and paired-samples t tests. A systematic sampling method was used, and a total of 228 questionnaires were used for the final analyses. SERVQUAL was found to be a three-factor variate comprising the following: tangibility, reliability, and sensitivity. Our results concluded that perceived quality was significantly lower than expected quality despite being accompanied with positive levels of satisfaction and repurchase intentions. Finally, patient’s satisfaction was found to fully transmit the indirect effects of two of the three factors, quality sensitivity and reliability, onto repurchase intentions, whereas tangibility does not exert indirect significant influences over repurchase intentions via patient satisfaction

What Clinical and Laboratory Parameters Distinguish Between Acute and Chronic Renal Failure?

Introduction: In developing countries, a large number of patients presenting acutely in renal failure are indeed cases of advanced chronic renal failure. In this study, we compared clinical and laboratory parameters between patients with acute renal failure (ARF) and chronic renal failure (CRF), to identify discriminatory features. Patients and methods: The Renal Unit of Obafemi Awolowo University Teaching Hospitals Complex is a major referral center for renal disease in Nigeria. 20 patients with ARF and 22 patients with CRF (who had not had dialysis intervention) were recruited for the study at presentation. They had full evaluation including demography, history of duration of symptoms, blood pressure, volume of urine, and laboratory parameters: serum creatinine, urea, potassium, and packed cell volume (PCV). These parameters were compared using Mann Whitney U test for nonparametric data to determine statistical significance. Results: There were no significant differences between the two groups regarding their (i) ages (ii) serum creatinine and (iii) PCV. In contrast, statistically significant differences were obtained for (i) the mean duration of symptoms, which was longer in CRF patients, (ii) the mean 24 hour urine volume, which was larger in CRF patients, (iii) the mean systolic and diastolic blood pressures, both being significantly higher in CRF patients, (iv) and the mean serum urea level, which was higher in ARF patients. Conclusion: It is concluded that the duration of symptoms, quantity of urine, blood pressure, and serum urea levels are distinguishing parameters between ARF and CRF, while serum creatinine and PCV are not. Key words: Acute Renal Failure, Chronic Renal Failure, Laboratory Parameter

Comparison of changes in serum prostate specific antigen in prostate cancer patients treated either with flutamide or stilboestrol monotherapy

Prostate cancer is a disease of males. Though commoner in the elderly, cases are beginning to be reported in the younger population. It is thecommonest cancer diagnosed in males. Risk factors include ageing, genetic/familial factors, racial predilection, increased fat diet, and hormonal imbalance. It is a slow-growing tumour but can be associated with severe morbidity. The commonest histologic type is adenocarcinoma (>95%). When detected early, cure may be possible. Prostate-specific antigen (PSA) is the major serum marker used to monitor progress of the disease and its' response to therapy. Several treatment modalities have been used in the management of prostate cancer. This includes watchful waiting, prostatectomy, radiotherapy, hormone therapy, and chemotherapy. These treatment options are not without devastating and sometimes life-threatening adverse effects; hence the choice of therapy depends on patient's age, stage of disease, other co-morbidities, and even patient's choice.Aims and Objectives: This study aimed at establishing the variation in PSA among patients with advanced CaP treated either with Flutamideor Stilboestrol monotherapy in UCTH, Calabar. This helped in choosing an agent with better patient compliance, better therapeutic effect, minimal side-effects, and cost-effectiveness.Method: All newly diagnosed prostate cancer patients in the Division of Urology, Department of Surgery, UCTH, Calabar that met certain inclusion criteria were treated either with Flutamide or Stilboestrol monotherapy over a period of one year. Patients enrolled into the study were shared into two equal groups based on certain considerations. Response to therapy was monitored by conducting a three-monthly PSA check and results from the groups compared.Results: Fifty patients were enrolled into the study. The mean age was 70.12±8.93, and age range was 51-93 years. The peak age range was 61-70 years constituting 40.0% of total number of patients. The decline in serum PSA caused by flutamide and stilboestrol during each quarter of the year was 8.0%, 12.0%, 12.0%, 4.0% and 28.0%, 4.0%, 28.0%, 4.0% respectively. Overall flutamide caused a 36.0% reduction and stilboestrol 64.0% reduction in serum PSA over the period. In all, stilboestrol caused a greater decline in serum PSA compared to flutamide, and this became statistically significant at 9 months (p=0.044) and one year (p=0.048) of therapy.Conclusion: Patients who are on androgen deprivation therapy for CaP have their serum PSA reduced by either flutamide or stilboestrol monotherapy. However, over time, the PSA is more rapidly reduced by stilboestrol monotherapy compared to flutamide monotherapy. Keywords: Prostate Cancer, Flutamide, Stilboestrol, PSA

The direct cause of amplified wettability:Roughness or surface chemistry?

Higher contact angles or amplified wettability observed on surfaces of rough solid materials are typically expressed as a function of a physical dimension (roughness factor). Herein, we present a simple experimental approach that demonstrates that roughness may only magnify the inherent surface chemistry that seems to have direct influence on surface wettability. We investigate gradual change in surface chemistry (hydrophobisation) of rough and smooth glass surfaces, from a very low concentration (10−7 M) of dichlorodimethylsilane, DCDMS through various intermediate hydrophilic/hydrophobic states to when the surfaces are maximally hydrophobised with DCDMS at 0.1 M. The wettability of the modified glasses was studied by water contact angle measurements using drop shape analysis system (DSA). The data obtained indicate a deviation from Wenzel model, with the functionalized rough glass surfaces showing higher reactivity towards DCDMS when compared to the smooth glass surfaces, indicating that the two surfaces are not chemically identical. Our study reveals that just like transforming a solid material to powder, a well-divided glass (rough) surface may not only exhibit a greater surface area than the smooth counterpart as rightly predicted by the Wenzel model, but seems to be bloated with functional groups (–OH or –CH3 ) that can amplify surface interaction when such functional species dominate the solid surface.</p

Postoperative Throat Complications after Tracheal Intubation

Background: A prospective study was carried out to determine the incidence of sore throat after endotracheal intubation and the associated causative factors. Methods: Two hundred patients aged 18-77 years who had surgery over sixteen months were studied. Sizes 7mm - 8.0mm internal diameter (I.D) portex endotracheal tubes with cuff were used for females while sizes 8.5mm - 9.0mm I.D were used for males. A standardized form was used to collect patients' details, types of surgery, technique of airway maintenance and number of attempts at intubation. The use of nasogastric tubes, throat pack, duration of intubation and status of the anaesthetists were also noted. The presence of sore throat and other throat complications were determined within 24 - 36 hours after surgery. Results: One hundred twenty six (63%) patients experienced throat complications. The incidence of sore throat was similar in both males and females. There was no statistically significant difference P=1.0000, odd ratio = 1.035, 95% CI: 0.5064 - 2.115. There was no statistical difference between the group whose tubes were lubricated and the one without tube lubrication. P = 0.5296, odds ratio - 1.255; 95% CI: 0.6702 - 2.351. There was statistically significant difference between the incidence of throat complications in throat related surgery and non- throat related surgery. P=0.0001., odds ratio-9.771, 95% CI: 3.065-31.148. Multiple attempts at intubation did not contribute to the development of sore throat. Duration of intubation greater than 60 minutes contributed to a higher incidence of throat complications and it was considered statistically significant. Conclusion: Routine endotracheal intubation can result in trauma and pathological changes, which could lead to postoperative throat symptoms. There is need to further evaluate if the use of smaller sized endotracheal tubes could reduce the incidence of throat complicationsFond: Une \ue9tude \ue9ventuelle a \ue9t\ue9 effectu\ue9e pour d\ue9terminer l'incidence de l'angine apr\ue8s l'intubation endotrach\ue9ale et les facteurs causatifs associ\ue9s. M\ue9thodes: Deux cents malades \ue2g\ue9s de 18-77 ans qui ont eu la chirurgie pendant une p\ue9riode de seize mois ont \ue9t\ue9 \ue9tudi\ue9s. Des tailles des tubes endotrach\ue9aux de portex du diam\ue8tre interne (D.I) de 7mm \u96 8,0mm avec la manchette ont \ue9t\ue9 utilis\ue9s pour des femelles tandis que des tailles D.I de 8,5mm - de 9,0mm ont \ue9t\ue9 employ\ue9es pour des m\ue2les. Une forme normalis\ue9e a \ue9t\ue9 employ\ue9e pour rassembler les d\ue9tails de malades, les types de chirurgie, la technique de l'entretien de voie a\ue9rienne et le nombre de tentatives d'intubation. L'utilisation des tubes gastriques, l'enveloppement de pharynx, la dur\ue9e de l'intubation et le statut des anesth\ue9sies ont \ue9t\ue9 \ue9galement not\ue9s. La pr\ue9sence de l'angine et d'autres complications pharyng\ue9es ont \ue9t\ue9 d\ue9termin\ue9es dans un d\ue9lai de 24 - 36 heures apr\ue8s chirurgie. R\ue9sultats: 126 (63%) malades ont eu des complications pharyng\ue9es. L'incidence de l'angine \ue9tait semblable dans des m\ue2les et des femelles. Il n'y avait aucune diff\ue9rence statistiquement significative P=1,0000, rapport des cotes = 1,035, 95% CI : 0,5064 \u96 2,115. Il n'y avait aucune diff\ue9rence statistique entre le groupe dont les tubes ont \ue9t\ue9 lubrifi\ue9s et celui sans lubrification de tube. P = 0,5296, rapport des cotes \u96 1,255 ;95% CI : 0,6702 - 2.351. Il y avait de diff\ue9rence statistiquement significative entre l'incidence des complications de pharynx dans les chirurgie pharyng\ue9es et non-pharyng\ue9es. P=0.0001., rapport des cotes \u969,771,95%CI : 3,065-31,148. Les tentatives multiples d'intubation n'ont pas contribu\ue9 au d\ue9veloppement de l'angine. La dur\ue9e d'intubation pus grande que 60minutes a contribu\ue9 \ue0 une incidence plus \ue9lev\ue9e des complications pharyng\ue9es et on l'a consid\ue9r\ue9 statistiquement significatif. Conclusion: L'intubation endotrach\ue9ale courante peut avoir comme cons\ue9quence le trauma et les changements pathologiques, qui pourraient mener aux sympt\uf4mes pharyng\ue9s postop\ue9ratoires. Il y a le besoin d'\ue9valuer de plus si l'utilisation de plus petits tubes endotrach\ue9aux pourrait r\ue9duire l'incidence des complications pharyng\ue9es

U94 alters FN1 and ANGPTL4 gene expression and inhibits tumorigenesis of prostate cancer cell line PC3

BACKGROUND: Insensitivity of advanced-stage prostate cancer to androgen ablation therapy is a serious problem in clinical practice because it is associated with aggressive progression and poor prognosis. Targeted therapeutic drug discovery efforts are thwarted by lack of adequate knowledge of gene(s) associated with prostate tumorigenesis. Therefore there is the need for studies to provide leads to targeted intervention measures. Here we propose that stable expression of U94, a tumor suppressor gene encoded by human herpesvirus 6A (HHV-6A), could alter gene expression and thereby inhibit the tumorigenicity of PC3 cell line. Microarray gene expression profiling on U94 recombinant PC3 cell line could reveal genes that would elucidate prostate cancer biology, and hopefully identify potential therapeutic targets. RESULTS: We have shown that stable expression of U94 gene in PC3 cell line inhibited its focus formation in culture, and tumorigenesis in nude mice. Moreover gene expression profiling revealed dramatic upregulation of FN 1 (fibronectin, 91 ± 16-fold), and profound downregulation of ANGPTL 4 (angiopoietin-like-4, 20 ± 4-fold) in U94 recombinant PC3 cell line. Quantitative real-time polymerase chain reaction (QRT-PCR) analysis showed that the pattern of expression of FN 1 and ANGPTL 4 mRNA were consistent with the microarray data. Based on previous reports, the findings in this study implicate upregulation of FN 1 and downregulation of ANGPTL 4 in the anti tumor activity of U94. Genes with cancer inhibitory activities that were also upregulated include SERPINE 2 (serine/cysteine protease inhibitor 2, 7 ± 1-fold increase) and ADAMTS 1 (a disintegrin-like and metalloprotease with thrombospondin type 1 motif, 7 ± 2-fold increase). Additionally, SPUVE 23 (serine protease 23) that is pro-tumorigenic was significantly downregulated (10 ± 1-fold). CONCLUSION: The dramatic upregulation of FN 1 and downregulation of ANGPTL 4 genes in PC3 cell line stably expressing U94 implicate up-regulation of FN 1 and downregulation of ANGPTL 4 in anti tumor activity of U94. Further studies are necessary to determine functional roles of differentially expressed genes in U94 recombinant PC3 cell line, and hopefully provide leads to potential therapeutic targets in prostate cancer

Dataset on physical properties of raw and roasted cashew nuts

Cashew nut is one of the topmost edible crops in the world. However, one of the challenges of this crop is processing. Designing an equipment for the processing of cashew nut requires the knowledge of its physical properties data. The dataset in this article contained the physical properties of raw and roasted cashew nuts. The physical properties include length, width, thickness, geometric mean diameter, spheric- ity, true density, bulk density, porosity and mass of cashew nut. Two experiments were performed. In one experiment, raw cashew nut was roasted in groundnut oil. In the sec- ond experiment, raw cashew nut was roasted in palm-kernel oil. The physical properties of the nuts were measured be- fore and after roasting in hot oil. The data were subjected to a paired sample t-test analysis to determine the level of sig- nificant difference. The data of the cashew nut graded with machine and sorted with hand manually were compared. The data provided in this article will be useful in designing vari- ous types of equipment for grading, separating and cleaning cashew nut. It will also be useful in the design of storage structures and processing machines

Prostate cancer disparities in Black men of African descent: a comparative literature review of prostate cancer burden among Black men in the United States, Caribbean, United Kingdom, and West Africa

<p>Abstract</p> <p>Background</p> <p>African American men have the highest prostate cancer morbidity and mortality rates than any other racial or ethnic group in the US. Although the overall incidence of and mortality from prostate cancer has been declining in White men since 1991, the decline in African American men lags behind White men. Of particular concern is the growing literature on the disproportionate burden of prostate cancer among other Black men of West African ancestry in the Caribbean Islands, United Kingdom and West Africa. This higher incidence of prostate cancer observed in populations of African descent may be attributed to the fact that these populations share ancestral genetic factors. To better understand the burden of prostate cancer among men of West African Ancestry, we conducted a review of the literature on prostate cancer incidence, prevalence, and mortality in the countries connected by the Transatlantic Slave Trade.</p> <p>Results</p> <p>Several published studies indicate high prostate cancer burden in Nigeria and Ghana. There was no published literature for the countries Benin, Gambia and Senegal that met our review criteria. Prostate cancer morbidity and/or mortality data from the Caribbean Islands and the United Kingdom also provided comparable or worse prostate cancer burden to that of US Blacks.</p> <p>Conclusion</p> <p>The growing literature on the disproportionate burden of prostate cancer among other Black men of West African ancestry follows the path of the Transatlantic Slave Trade. To better understand and address the global prostate cancer disparities seen in Black men of West African ancestry, future studies should explore the genetic and environmental risk factors for prostate cancer among this group.</p

The relationship between red blood cell distribution width and blood pressure in patients with type 2 diabetes mellitus in Lagos, Nigeria.

Background: High red blood cell distribution width (RDW) is related to impairment of erythropoiesis, reflecting chronic inflammation and increased levels of oxidative stress, both of which are telltale signs of type 2 diabetics. The aim of this study was to evaluate the relationship between the RDW and fasting blood sugar/blood pressure, and compare the results from diabetics with nondiabetic controls. Methods: This was an unmatched case-control study involving 200 participants consisting of 100 diabetics and 100 nondiabetic controls. Blood (4.5 mL) was collected from all of the diabetics and nondiabetic controls, and placed into EDTA anticoagulant tubes. A full blood count was performed using the Sysmex KX-21N, a three-part auto analyzer able to run 19 parameters per sample, including RDW. Blood pressure was measured during sample collection and in a sitting position. Results: The mean fasting blood sugar level was 95.20±30.10 mg/dL in the controls, and 147.85±72.54 mg/dL in the diabetics. The mean blood pressures for diabetics was 138/90 mmHg and for non-diabetics 120/80 mmHg. The mean RDW-SD (RDW standard deviation) was 46.44±4.64 fl in the controls, and 46.84±3.18 in the diabetics. The mean RDW-CV (RDW coefficient of variation) was 14.74%±1.94% in controls, and 14.80±0.71 for diabetics. No statistically significant correlation was found between the RDW-SD and fasting blood sugar/blood pressure in the diabetics. A statistically significant positive correlation was found between the RDW-CV and blood pressure in the diabetics. Conclusion: A positive correlation between the RDW-CV and blood pressure was established in the diabetics in this study