Stroke: Critical appraissal of intensive care management

Background: Stroke is a common medical condition in the medical units.Stroke patients are usually managed on the medical wards while some that needs organ support are admitted into the intensive care unit.However there is conflicting data on the benefits or otherwise of admitting stroke patients into the intensive care unit.This necessitated this study to know how much benefit is derived from admitting stroke patients into the intensive care unit.Aim and Objective: The study aims at the benefits of admitting stroke patients into the intensive care unit.The objective included studying the prognostic factors that determines the outcome of stroke patients admitted into the intensive care unit.Methodology: The case files of all patients admitted and managed in the intensive care unit of LAUTECH teaching hospital between 2002 and 2014 were retrieved and were analysed.The factors used in analyzing included the type of stroke,the age of the patients,the Glasgow Coma scale at admission,the need for intubation and mechanical ventilation as well as the percentage mortality in each subsets.Results: A total of 48 patients were admitted over the study period of which 19 were males and 29 were females.The percentage mortality in females was 78.95 while mortality in males was 62.5%.The higher the age the worse the prognosis, the higher the GCS the better the prognosis. Patients that were intubated and ventilated had percentage mortality of 68.8%.and better than non ventilated patients.The hemorrhagic strokes also carries worse prognosis.Conclusion: The admission of stroke patients to the intensive care unit should be individualized considering the above mentioned prognostic factors.However patients that are likely to benefit from intensive care unit should be admitted early for them to derive the maximum benefits.Keywords:Stroke,Intensive care unit,prognosis,benefit

Perception of Nurses about Palliative Care: Experience from South-West Nigeria

Background: Nurses play a major role all over the world in the palliative care team.Aim: The aim of this study was to investigate the knowledge and attitude of nurses toward palliative care in a tertiary level hospital in Nigeria. Subjects and Methods: Setting: This cross-sectional questionnaire-based study was carried out among nurses at a tertiary health care facility inAdo-Ekiti, South-West Nigeria. Design: A cross-sectional questionnaire-based study was carried out. The questionnaire sought information about the sociodemographic profile of respondents, their knowledge of definition and philosophy of palliative care among other things. Descriptive statistics was used to obtain the general characteristics of the study participants, while Chi-square was used to determine the association between categorical variables. A two-sided P < 0.05 was considered as significant.Results: A total of 100 questionnaires were returned with a female preponderance among the respondents with F: M ratio of 9:1. Regarding the definition of palliative care, 71.8% (48/66) of the respondents  understood palliative care to be about pain medicine, 55% (33/60) thought it to be geriatric medicine, while 90.2% (83/92) felt palliative care is about the active care of the dying. Exactly 80.5% (66/82) respondents agreedthat palliative care recognizes dying as a normal process while 84.1% (74/88) respondents were of the opinion that all dying patients would require palliative care. The use of morphine would improve the quality of life of patients according to 68.9% (42/61) of respondents.Conclusion: There are gaps in the knowledge of healthcare workers in the area of palliative care and this call for a review of the current nursing curriculum and practice guidelines in Nigeria.Keywords: End of life, Nursesf attitude, Pain management, Palliative car

Review of prostate cancer research in Nigeria

Prostate cancer (CaP) disparities in the black man calls for concerted research efforts. This review explores the trend and focus of CaP research activities in Nigeria, one of the ancestral nations for black men. It seeks to locate the place of the Nigerian research environment in the global progress on CaP disparities. Literature was reviewed mainly through a Pubmed search with the terms “prostate cancer”and “Nigeria”, as well as from internet and hard copies of journal pages

Agricultural Value Added, Food and Nutrition Security in West Africa: Realizing the SDG 2

This study examined how food security will be achieved in ECOWAS through agricultural value added. The study made use of panel data sourced from the World Bank World Development Indicators (WDI) and the Food and Agricultural Organisation (FAO) databases; it employed the fixed effects econometric technique. Results from the analysis showed that 1% increase in agricultural production, agriculture employment, agricultural valued added, political stability and absence of violence as well as access to electricity all things being equal, will bring about 14.2, 56.9, 1.9, 1.5 and 42.5% increase in food security. Thus, the study recommended that the governments of the West African countries should ensure that there is adequate security in the economies so as to encourage people to practice agriculture

An Estimate of the Incidence of Prostate Cancer in Africa: A Systematic Review and Meta-Analysis

Prostate cancer (PCa) is rated the second most common cancer and sixth leading cause of cancer deaths among men globally. Reports show that African men suffer disproportionately from PCa compared to men from other parts of the world. It is still quite difficult to accurately describe the burden of PCa in Africa due to poor cancer registration systems.We systematically reviewed the literature on prostate cancer in Africa and provided a continentwide incidence rate of PCa based on available data in the regio

Characterization of the Compressive Strength of Sandcrete Blocks in Ondo State, Nigeria

Research activities in different countries have shown that the compressive strengths of sandcrete blocks are always far below the recommended values in the codes. This work reports the compressive strengths and the statistical characteristics of sandcrete blocks collected from twenty five (25) different block industries in Ondo State, Nigeria. A total of seventy five (75) of 450 mm x 225 mm x 225 mm and seventy five (75) of 450 mm x 150 mm x 225 mm blocks were collected and tested. The results showed that the 450 mm x 150 mm x 225 mm sandcrete blocks in circulation as at May 23, 2005 had an average strength of 0.55 N/mm2 while those of 450 mm x 225 mm x 225 mm had an average compressive strength of 0.45 N/mm2 as at November 13, 2005. These values are very much lower than those stipulated by the relevant Codes and Standards. Although statistical analysis showed that the compressive strength of these blocks followed a normal distribution, the overall coefficient of variation stood at 0.54 for the 450 mm x 150 mm x 225 mm blocks and 0.71 for the 450 mm x 225 mm x 225 mm blocks. These values are high and they indicate very poor quality control in the production processes. On the basis of the noted poor quality control, recommendations appropriate for improving the strength and effectiveness of sandcrete blocks production in Nigeria are made. Keywords: Sandcrete Blocks, Compressive Strength, Mix Ratio Journal of Civil Engineering Research and Practice Vol. 5 (1) 2008: pp. 15-2

A review of stroke admissions at a tertiary hospital in rural Southwestern Nigeria

Background: Stroke is a common neurological disorder and is the third leading cause of death and a major cause of long-term disability. The disease is expected to increase in low- and middle-income countries like Nigeria. There is no information on stroke in rural Nigeria. Objectives: To review the clinical patterns, risk-factors, and outcome of stroke in a tertiary hospital in rural Nigeria and examine the rural-urban variation of stroke hospitalization in Nigeria. Materials and Methods: We carried out a retrospective study of patients who had a clinical diagnosis of stroke at the Federal Medical Centre, Ido-Ekiti, South-western Nigeria between November 2006 and October 2009. Results: A total of 101 patients who had stroke were admitted during this review period, accounting for 4.5% of medical admission and 1.3% of total hospital admission. Women accounted 52.5% of cases, with a male to female ratio of 1 : 1.1. Their mean age was 68 ± 12 years. Stroke occurrences increased with age, as almost half (49.5%) of the cases were aged ≥70 years and majority (84.2%) of them were in low socioeconomic class. The mean hospital stay for stroke treatment was 12 ± 9 days, Glasgow coma score on admission was 11 ± 4. Ischemic stroke was 64.4%; hemorrhagic stroke, 34.7%; and indeterminate, 1.0%. Hypertension (85.2%), diabetes mellitus (23.8%), and tobacco smoking (22.8%) were the common identifiable risk factors for stroke. Of all the patients, 69% had ≥2 risk factors for stroke. Thirty-day case fatality was 23.8%; it increases with age and was higher among men than women (29.2 vs 18.9%) and in patients with diagnosis of hemorrhagic stroke (34.3 vs 18.5%). The numbers of identifiable risk factors of stroke has no effect on the 30-day case fatality. When compared with stroke in urban areas of Nigeria, we found no differences in frequency of hospitalization (1.3 vs 0.9 - 4%) and the major risk factor (hypertension). Hemorrhagic stroke was more common in urban than in the rural community (45.2 - 51 vs 34.7%) and the 30-day case fatality was lower in the rural community (23.8 vs 37.6 - 41.2%). Conclusion: Stroke is also a common neurological condition in rural Nigeria, in view of the fact that almost 70% of the patients had ≥2 risk factors of stroke. We recommend that, sustainable, community-friendly intervention programmes are incorporated into the health care system for the early prevention, recognition, and modification of the risk factors in persons prone to the disease.DOI: 10.4103/1596-3519.8206

Crystalloid Preload Plus Crystalloid Coload for Management of Hypotension During Subarachnoid Block for Emergency Caesarean Section

Background: Maternal hypotension following spinal anaesthesia remains a persistent major clinical burden. Several physical methods, fluid loading, dose adjustments, addition of opioids or vasopressors have been tried alone or in combinations but with controversial findings.Purpose: To determine whether crystalloid coloading will enhance control of maternal hypotension  provided by crystalloid preloading during spinal anaesthesia.Patients and Methods: Women in preload group (PL, n=25) received 15ml/kg normal saline within 15 minutes before induction of spinal anaesthesia, then had  maintenance infusion of 20ml/kg normal saline for the next one hour. Those in coload group (CL, n=25) received 15ml/kg normal saline within 15 minutes following  induction of spinal anaesthesia, then had maintenance infusion of 20ml/kg normal saline for the next one hour. The parturients in combined preloadcoload group (BL) received 15ml/kg normal saline within 15 minutes before spinal anaesthesia and 15ml/kg normal saline within 15 minutes following induction of spinal anesthesia,   then had maintenance infusion of 5ml/kg normal saline over one hour. Maternal hypotension, total rescue fluid, neonatal outcome and ephedrine used were  documented.Results: Incidence of hypotension was significantly higher among patients in preload group 15(60%) and coload group 18(75%) compared to combined group 4  (16.7%) (p=0.0001). The mean dose of ephedrine administered following hypotension was significantly higher in coload group (15.2 ± 3.2 mg) and preload group (12.3 ± 1.4 mg) compared to combined group (3.1 ± 0.9 mg) (P=0.0001). Neonatal outcome was similar in the three groups.Conclusion: Combined crystalloid preload-coload is a better prophylactic method of managing spinal-induced hypotension than crystalloid preload or coload alone in women undergoing caesarean section under subarachnoid block.Keywords: caesarean section, hypotension, preload, preload-coload, spinal anaesthesia

Scheffe’s polynomial optimisation of laterite concrete incorporating periwinkle shells and coir

This is the author accepted manuscriptRecent emphases on minimising the carbon footprint of concrete have focused on the use of non-conventional materials for the production of low-cost concrete. Such materials include laterite, periwinkle shells and coir which have been reported as suitable for use as fine and coarse aggregate replacements in specified proportions. However, the use of two or more unconventional materials in a concrete mix would require significant experimental effort that is time- and resource-consuming and usually performed by trial and error to determine the optimum mix design. A popular optimisation technique used for concrete mix design is Scheffe’s second-degree polynomial modelling. However, the application of a more accurate Scheffe’s third-degree polynomial optimisation technique in designing cementitious composites incorporating unconventional aggregates is rare. This study, therefore, presents the use of Scheffe’s third-degree model to determine the optimum proportions of coir, laterite and periwinkle shell aggregates in a concrete mix in order to obtain the best mechanical properties of the hardened concrete. The constituents of the concrete were optimised for seven components of water, cement, fine-aggregate, laterite soil, coarse aggregate, periwinkle shell and coir on an N(7, 3) Sheffe’s factor space. The optimal mix ratio for compressive and flexural strengths of 11.33 and 1.20 MPa, respectively, was 0.5149, 1.044, 3.009, 0.126, 3.934, 0.054, and 0.0046 for pseudo-components X_i:{∀ i=1,2,3,4,5,6,7}. The coefficients of determination (R^2) were 98.74% and 98.53% for the compressive and flexural response models, respectively, while the p-values obtained for the response coefficient fit parameters β_i, β_ij, β_ijk for (i=1,2,3,4,5,6,7) were 96.77% and 91.49% for the compressive and flexural strength models, respectively. The optimised Low-Performance Concrete (LPC) is about 4% cheaper than LPC made from conventional aggregates and is adequate for patio slabs, pedestrian footpaths, kerbs, and floorings in residential buildings. The use of Sheffe’s third-degree model eliminates the significant experimental efforts needed in the design of concrete mixes incorporating unconventional aggregates

In vitro and in vivo toxicity assessment of biologically synthesized silver nanoparticles from Elaeodendron croceum:

The cytotoxic properties of nanoparticles have attracted a great deal of attention in the field of nanoscience and nanotechnology due to their small size and ability to penetrate cellular membranes