Relapse episodes of schizophrenia in patients treated with antipsychotic medications in Maiduguri: causes and interventions

Relapse in schizophrenia can present with some difficulties in some settings. An understanding of factors that influence relapse episode in individuals can provide vital information to set priorities or design more effective preventive measures and institute appropriate interventions. Objectives: The objectives were to identify factors that cause relapses among patients in the region and to quantify the extent of relapse. Method: One hundred and thirty-four patients with schizophrenia, which comprise 72 males and 62 females with reported symptoms recurrence after first episode of the illness that lead to rehospitalisation, were studied. Demographic data were retrieved from the patients' case notes. The causes and duration of re-occurrence as well as the interventions taken to prevent further episode were investigated. Results: Patients who experienced first relapse episode within one month during home care were 6.7% while 11.2% of the patients reported first relapse within 2-5 months. Patients who similarly experienced first relapse within 6 months to 1 year,1-2 years, 2-5 years, 5-10 years and those above 10 years were 20.9%, 16.4%, 24.6%, 15.7% and 4.5% respectively. Sixty-six (49.3%) patients who experienced first relapse also had second relapse while 12 (9.0%) further experienced third relapse. Several patients' related factors such as financial problems (14.9%), perceived wellness (7.5%), forgetfulness (10.5%) and breast feeding (3.0%) were identified as the cause of relapse in some patients. Lifestyle related factors like substance abuse and medication related factors such as adverse effects accounted for 17.9% and 14.2% respectively. Disease-related factors such as poor insights (6.0%) and co-morbid depression (1.5%) were other identified causes. Many patients (22.4%) linked their relapse episodes to several insurgency-related problems. Relapse due to medication non-adherence accounted for 66.4% patients. The major interventions to prevent further episodes of schizophrenia were rehabilitation (29.9%), education and counselling (26.9%), change in drug formulation (25.4%), dosage adjustment (11.9%) and change of drug (6.0%). Conclusion: Several patients, medications, diseases and lifestyles' related factors were responsible for relapse of schizophrenia but patients' related factors such as non-adherence, substance abuse and treatment related factors particularly medication side effects were the most common causes. This study underscores the need to continually monitor drug therapy, identify factors that may cause relapse in individual and educate patients or their caregivers in order t

An Automatic Safety Control for Immersion Water Heater

The heating of liquids, especially water, is carried out in the homes and industries for various reasons. The domestic water heater has become a near- ubiquitous appliance in the Nigerian homes. An important source of concern with this appliance is the frequent possibility of outbreak of fire due to negligence on the part of the user. This paper describes an immersion water heater that is free from such hazards. The safety condition is achieved by incorporating a device, which automatically switches off power from the heating element when the water level drops below a certain mark

Assessing the impacts of various street-level characteristics on the burden of urban burglary in Kaduna, Nigeria

Evidence suggests that crimes committed in urban environments are geographically concentrated across a range of scales, and that the variation in rates of crime within an urban space is significantly dependent on the physical environment as well as the situation in which the crime takes place. However, these assertions are typically drawn from environmental criminological studies that have focussed on Euro-American cities and western intellectual perspectives. We seek to move beyond these by focussing on a second-tier city in sub-Saharan Africa (Kaduna, Nigeria), a context for which very little literature exists. This paper therefore examines the association between a range of street characteristics and the risk of residential burglary in Kaduna for the first time. It describes a methodology for conducting a household crime victimisation survey in Nigeria, and then aggregating the information to a street-level to perform a population-based ecological study. It integrates street network analysis and statistical modelling techniques in order to provide novel estimates for factors that may increase the risk of burglary such as street accessibility metrics (e.g. connectivity, betweenness and closeness centrality), segment length, socioeconomic status and business activities. Finally, the article provides a discussion on the plausibility and implication of findings within the sub-Saharan African context

RSM optimization and yield prediction for biodiesel produced from alkali-catalytic transesterification of pawpaw seed extract: thermodynamics, kinetics, and Multiple Linear Regression analysis

Optimization of alkali transesterification of pawpaw seed extract to biodiesel using NaOH catalyst was carried out to analyze kinetics, thermodynamic parameters, and optimum conditions. Response Surface Methodology (RSM) and Multiple Linear Regression (MLR) algorithms were used to confirm the optimum yield results. GC chromatography and X-ray diffraction (XRD) were used to determine the fatty acid profile and characteristics of the pawpaw seed oil (PSO). The maximum biodiesel yield of 80% was obtained at optimum temperature, catalyst weight, and methanol to oil ratio of 60 °C, 1.0 wt%, and 3:1 via the RSM. Kinetics shows that the effect of NaOH on the overall reaction rate was feasible at 30 min while MLR predictions exercised outside the design matrix confirmed that increasing catalyst weights and temperature increases biodiesel yield within the optimum conditions. The finding obtained from the MLR was consistent with the experimentally determined percentage yield practicable based on the experimentally determined value conducted to verify the predicted output. The predicted output indicated a ± 0.025 standard deviation from the result practicable. Some key fuel properties derived from PSO satisfied ASTM (D6751) specifications and complied with EN141215 standards. The XRD patterns and GC/MC characterization confirm PSO is a good source for biodiesel production

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

HELICOBACTER PYLORI SEROLOGY AND EVALUATION OF GASTRODUODENAL DISEASE IN NIGERIANS WITH DYSPEPSIA

Helicobacter pylori (H. pylori) has been strongly associated with various gastroduodenal diseases worldwide with only a few studies emanating from developing countries. The objectives of this study were to determine the prevalence of serum Immunoglobulin G (IgG) and underlying gastroduodenal pathology in Nigerian patients with dyspepsia and ascertain the usefulness of H. pylori IgG screening in decreasing endoscopic workload in dyspeptics in Nigeria. Fifty-five patients with dyspepsia and 55 age and sex-matched apparently normal control were screened for H. pylori IgG using ImmunocombRII kits. Each of the 55 patients was also examined endoscopically with biopsies taken appropriately. Serology was positive in 94.5% and 92.7% of dyspeptic patients and controls respectively. Gastroduodenal inflammation was the commonest endoscopic finding, 43 (78.18%). Other findings were malignant gastric tumour 6(10.9%), reflux oesophagitis 3 (5.45%), gastric ulcer 2 (3.64%), and duodenal ulcer in 1 (1.82%). Chronic gastritis was the main histopathologic finding in the dyspeptic patients. It is concluded that serum H. pylori IgG cannot be used as a screening procedure to reduce endoscopic workload in Nigerian patients with dyspepsia. Key Words: dyspepsia; Helicobacter pylori serology; gastroduodenal disease African Journal Of Clinical And Experimental Microbiology Jan 2004 Vol.5 No.1 131-13