Ulcerative Colitis Prone to Delayed Diagnosis in a Nigerian Population: Case Series

Inflammatory bowel disease is an emerging disease burden in the developing world. In Nigeria there is a persisting perception among physicians that it is a very rare disease, and publications on it are sparse. Early manifestations of ulcerative colitis (UC) are therefore likely to be missed at many health institutions. This publication aims to contribute to the growing literature on UC among Nigerians. We present 3 cases of UC that were diagnosed at very late stages. It took a range of 2–7 years for the diagnosis to be made from onset of symptoms. UC was confirmed in the first patient after bowel resection for massive gastrointestinal haemorrhage. The other two had colonoscopy and biopsy for confirmation. An increased awareness about UC is necessary in Nigerian population, because the condition may be commoner than hitherto thought. Provision of colonoscopy services to a wider population will assist in early discovery of this disease.Keywords: Delayed diagnosis, Nigeria, Ulcerative coliti

Gender marginalization and the strive for emancipation in Nigerian drama: Julie Okoh's Edewede and Barclays Ayakoroma's dance on his grave as paradigms

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Sideswipes Injuries of Upper Limbs: A Case Series Report and Review of Literature

BACKGROUND: Sideswipe injuries are consequent to object striking an elbow on the window edge of a moving vehicle. It often results in severe soft tissue and bony injuries or partial amputation of the upper limb.Functional outcome in most patients is poor. The aim is to highlight the occurrence and functional outcome of these injuries.METHOD: In our series we report three cases which presented to us in succession within four weeks.RESULTS: Two of the patients were passengers of commercial buses while one patient is the driver of a private car. Two were males. All were protruding their arm from the open vehicle window at the time of impact.All presented within five hours of injury. All sustained open fracture-dislocations. All were managed with external fixation and soft tissue cover. They all had poor outcome as evidenced by joint stiffness.CONCLUSION: The functional outcome of such injuries is usually poor especially if the dominant limb is involved. Therefore the need for prevention cannot be overemphasized. Simple measures like ensuring that no part of the limb is sticking outside a moving vehicle, winding up glass up to mid window level etc will greatly reduce the occurrence of these injuries

Intent at Day Case Laparoscopic Cholecystectomy in Owerri, Nigeria: Initial Experiences

Background and Objective: Laparoscopic cholecystectomy has been the default operation for cholelithiasis at Federal Medical Centre, Owerri for the past 2 years and the outcomes have been good. The duration of post operative stay has been decreasing. We therefore initiated a preliminary 2.year prospective study in May 2010 to determine the feasibility of carrying out day case laparoscopic cholecystectomy in our hospital.Materials and Methods: Patients undergoing laparoscopic cholecystectomy were included in the study if they satisfied the following criteria: Age < 65 years, body mass index < 35 kg/m2, American Society of Anaesthesiologyphysical status class I and II, patient residence within 20 km radius of the hospital, patient acceptance of the procedure and absence of previous complicated upper abdominal surgery.Results: Twelve patients (10 females, 2 males) were worked up with the intent of achieving same.day discharge of the patients. Five of the patients (41.7%) were discharged on the day of operation. The reasons for overnight stay included inadequate pain control, insertion of drain and patient wishes. There was no conversion to open surgery, no major complications and no case of readmission to the hospital.Conclusions: Day case laparoscopic cholecystectomy in our environment could be safely promoted but will dependon improved facilities and patient enlightenment.  Keywords: Day case, laparoscopic cholecystectomy, cholelithiasi

DEVELOPMENT OF QUALITY INDICATORS FOR PHARMACEUTICAL CARE PERFORMANCE ASSESSMENT IN NIGERIAN COMMUNITY PHARMACIES: A DELPHI PANEL

Objective: This study aimed to develop quality indicators for assessing pharmaceutical care performance in the Nigerian community pharmacies. Methods: We searched for existing quality indicators through an extensive literature review. The identified quality indicators consisted of thirty-four items in 10 core components. The Delphi method was used to arrive at a consensus on quality indicators for assessing pharmaceutical care performance in the Nigerian community pharmacies by surveying a panel of experts. There were 3 rounds of the Delphi panel conducted by consulting a panel of 10 experts in pharmaceutical care practice. A mean score>3.5, median>3.5, an absolute value between the median and mode<1.00 was used to establish consensus on the quality indicators for assessing pharmaceutical care performance in the Nigerian community pharmacies. Results: Ten studies met the inclusion criteria. A list of 33 quality indicators comprising of 10 core components emerged from the extensive literature review. They included quality management, documentation of care, communication with the patient, management of clinical risk in pharmacy, compounding, dispensing and patient care, follow-up of pharmacotherapy counselling, drug inventory and stocking, training of pharmaceutical staff. At the end of the round three votings, 24 statements of the quality indicator reached consensus in nine core components: quality management (5), continuity of care (1), communication with patients (3), clinical risk management (5), dispensing (1), follow-up of pharmacotherapy (3), counselling (1), logistics (3), training of pharmacy staff (2). Conclusion: This study developed a set of 24 quality indicators for assessing pharmaceutical care performance in community pharmacies in Nigeria

Isolated gallbladder perforation following blunt abdominal trauma: A missed diagnosis

This is a case of a 21-year-old man who presented with history of abdominal pain following blunt abdominal trauma. Although the initial ultrasound scan showed mild free peritoneal fluid, the patient was managed conservatively as a probable case of splenic injury and was discharged in satisfactory condition after 6 days of admission. He presented again 7 days later with recurring epigastric pain and had exploratory laparotomy on the presumptive diagnosis of peritonitis, probably due to peptic ulcer perforation. Intraoperatively, he was then discovered to have an isolated gallbladder perforation. This is a rare condition in which the diagnosis is often delayed or missed as was the case in our patient. To the best of our knowledge, this is the first reported case of isolated gallbladder perforation in Nigeria, and it behooves the clinician to be aware of the likelihood of this condition in patients with blunt abdominal injury.Key words: Abdominal trauma, blunt, gallbladder, perforatio

Prune belly syndrome: Early management outcome of nine consecutive cases

Background: Prune belly syndrome (PBS) is a rare congenital malformation of unclear etiology. The disease progress and outcome in developing countries are not clear as most reports are isolated case reports.Materials and Methods: A review of 9 patients managed for PBS in 5 years.Results: There were 7 males and 2 females, aged 30 min.11 days (median = 5 days) at the time of presentation (a child presented as neonate, defaulted from follow.up and represented at 10 years of life). Their weights on admission were 2.5.4.2 kg (median = 3 kg). Maternal age range was 26.37 years (median = 32 years), with five mothers being above 30 years. Seven mothers had febrile illness in the first trimester and took antimalarial drugs or antibiotics. Intestinal malrotation was the most  common associated anomaly. The degree of the anterior abdominal wall and the urinary tract morphology varies from patient to patient. Urinary tract anomalies were initially managed conservatively. Two infants however later had cutaneous ureterostomy due to worsening renal function and recalcitrant urinary tract infection (UTI). Four infants had abdominoplasty at the 2nd week, 6th week, 3rd year and 10th year of life. Seven orchiopexies were done. Four were done by Fowler.Stephenfs method while the rest were via the inguinal route. Of the former, 3 testicles have normal volume 6 months after, whereas one atrophied. Post abdominoplasty, there was a significant reduction in the frequency of respiratory tract infection (RTI), UTI and post void urine volume in three infants. In addition, there was improved peer interaction and academic performance in the 10.year.old child. One infant died of pulmonary hypoplasia and two others from worsening urosepsis and progressive renal failure.Conclusion: PBS presents with a spectrum of features. Initial conservative management of the urinary tract was beneficial. Abdominoplasty and orchiopexy have both physiological and improved quality of life benefits. Early Parental education helped in reducing defaults from follow.up.Key words: Abdominoplasty, congenital, Nigeria, prune belly syndrome, undescended testi

Prevalence and Susceptibility Patterns of Clinical Isolates of Escherichia coli to Various Antimicrobials in A Clinical Microbiology Laboratory in South-South Nigeria

The purpose of this study is to determine the prevalence of Escherichia coli as an aetiologic agent in bacterial infections and its antimicrobial susceptibility patterns to ciprofloxacin, ofloxacin, norfloxacin, perfloxacin, gentamycin and cotrimoxazole as a guide for empiric therapy. A retrospective study was carried out using a clinical microbiology laboratory in Nigeria. Data retrieved include number of E. coli isolates, sources of the isolates and their antimicrobial susceptibility to various fluoroquinolones, gentamycin and cotrimoxazole between 2005 and 2009. Statistical analysis was carried out using SPSS version 14, Chicago IL. Out of a total of 906 bacterial isolates, E. coli accounted for 23 % (211) of the isolates. Thirty-eight percent (38.39 %) was isolated from urine samples, 27.96 % from high vaginal swab samples, 24.17 % from stool samples, 0.95% from urethra swabs, 1.9% from wound swabs and 6.6% from semen samples. There was poor level of susceptibility to norfloxacin (2.2%) and cotrimoxazole (23.7%), susceptibility to ofloxacin, ciprofloxacin and pefloxacin were 51.1%, 54.7% and 52.5% respectively, that of gentamycin was 51.8%. The trends across the years showed a significant increase in susceptibility to ciprofloxacin, pefloxacin and ofloxacin in 2007 after which it started reducing, while norfloxacin’s susceptibility was low across the five years with maximum susceptibility at 9.1% in 2006. There was an increase in susceptibility to gentamycin as the susceptibility levels of the  fluoroquinolones were reducing. There should be continuous surveillance of antimicrobial susceptibility patterns and empiric treatment with fluoroquinolones discouraged, especially for non urinary tract infections.KEYWORDS: Antimicrobial susceptibility, Nigeria, Escherichia coli, fluoroquinolones, gentamyci

Communicating social and development issues through Theatre for Development (TFD): A study of Eziokwu- Bu -Ndu Project

Among many communication tools available, Theatre for Development (TfD) is a powerful medium for communication because of its performative, festive, communal, realistic and concrete nature. It is a good medium of communicating messages to local communities for the actors are often from the local community and the villagers do not have to travel to see the performances for it is performed in their locality. Many Social and Development issues facing various communities require public investment to address them. This investment will only arise if the general community is supportive and community support is only likely if the issues are widely acknowledged and  understood. Some believe that Social and Development issues have to be solved by government alone, they do not seem to understand their share of responsibility in solving the problems. TfD is known to be alive to the social and development realities of its time. It is a kind of performance where the economic, social, religious and political issues of the society are outlined, evaluated and judged. Practitioners  are usually vanguards of social and developmental change in their respective capacities and they keep watchful eyes and attentive ears to the happenings in their various communities. The aim of this paper is to investigate the potentials of TfD in facilitating Social and  Development change. The objective of this study is to propagate the use of Theatre for development in achieving social and development change. It examines TfD as a tool for communication that enables people contribute towards the development of their community. The  paper analyses the role of TfD in communicating social and development issues. Data for the study is collected using the qualitative  research method approach. Focus group discussion, oral interview and the participant observation approach are employed for data collection. The study investigates the TFD workshop carried out by the researcher in Nibo community, Awka South Local Government Area of Anambra State, titled Eziokwu Bu- Ndu and concludes that TfD can be used in communicating Social and Developmental issues. It therefore, recommends that TfD should be used in communicating social and developmental change and suggests that its funding should be by prominent members of the community and government

Technology Manufacturing Leaders’ Innovation Strategies to Improve Users’ Choice Capabilities in a Fast-Changing Markets

Some leaders of technology manufacturing organizations lack strategies to educate their users on how to make the optimal cloud technology selection decisions for their organizations during rapidly evolving innovation, resulting in significant risk of wrong choices and loss of customer loyalty. Grounded in resource-based view theory, the purpose of this qualitative single case study was to explore strategies technology manufacturing leaders use to educate users on how to make optimal cloud technology selection decisions for their organizations. The participants were six executive-level leaders of the strategic sales division of a multinational technology organization based in the western United States who focus on educating their customers, partners, and users of cloud technology products. Study data were collected through semistructured interviews, a review of company websites, and organizational documents. Using an adapted version of Yin’s approach for thematic analysis, three themes emerged: (a) strategic customer intelligence, (b) credible agnostic cloud education, and (c) socially responsible involvement in the cloud industry ecosystem. The key recommendation to the leadership is to expand agnostic cloud education to include adaptive training tailored to evolving user needs and reposition the cloud education unit as a strategic business unit with significant autonomy to compete effectively in the new cloud curricula product line. The implication for positive social change is the potential to enrich employee careers, boost organizations’ sustainable innovation performance and capabilities to contribute more value to the business ecosystem and improve the quality of life in the community