Competency-based Learning: The effectiveness of targeted resident education and clinical auditing feedback on completed death certificate accuracy rates

Background: Death certification is an integral part of physician practice, yet common errors are being encountered from this vital source of health information. Most medical training programs lack formal curricula for this important skill. Accurate information from DC will help in improve our mortality data which can be use public health purposesObjectives: This study evaluated the effect of a multifaceted educational intervention on accuracy of completing death certification in a tertiary-based paediatric residency programMethod: A pre-post intervention and control cohort study over 12- month period to assess the effect of our multifaceted intervention accuracy rate of completed DC was conducted. The intervention consisted of a 3-part program (distribution of educational material, presentation by a skilled instructor, skills workshop, and clinical mortality/auditing feedback sessions). Primary outcome was the difference in scores preand post-intervention and also the rate of accuracy on the MAHI death certificate scoring system.Results: The mean score before the intervention was 6.8±2.7 and 7.1±2.3 in both the intervention and control cohorts respectively. The mean score after the intervention was 16.3±2.5 and 7.3±2.8 in both the intervention and control cohorts respectively indicating an increase in scores. The mean difference in pre- and post-tutorial scores was significant (t=20.39, p=0.0001).Conclusions: We found that using a multifaceted educational intervention to train junior physicians on how to correctly complete a DC was effective in a residency-based pediatric programKeywords: Death certificate, medical education, multifaceted training, heath information, Nigeria

Pelvimetry of kuri and bunaji cows in Maiduguri metropolitan slaughterhouse, northern Nigeria

The study was conducted on 58 indigenous cattle consisting of 33 Kuri and 25 Bunaji cows slaughtered at the Maiduguri Metropolitan Slaughter house. The internal and external pelvic dimensions in the two breeds were  obtained immediately post slaughter before the animals were dressed.  The Mean ± SEM for pelvic area were found to be 120.83 cm ± 3.6 and 110.1 cm ± 3.4 for Kuri (K) and Bunaji (WF) respectively. The mean ± SEM for various body measurements were 80.98 cm ± 0.5 and 74.0 cm ± 0.8  for heart girth; 149.9 cm ± 1.1 and 138 cm ± 0.7 for height at withers;  129.3 cm ± 1.04 and 117.96 ± 1.4 for height at pin bone; 141.3 cm ± 0.54 and 131.7 cm ± 1.05 for height at hook bone; 46.2 cm ± 0.42 and 42.3 cm ± 0.51 for rump length; 43.6 cm ± 0.45 and 40.8 cm ± 0.74 for rump width; 10.7 cm ± 0.2 and 9.5 cm ± 0.16 bisilliac distance and 11.85 cm ± 0.02 and 11.12 cm ± 0.18 sacropubis distance for Kuri and Bunaji respectively. There was a significant correlation (P<0.05) between pelvic area and sacropubis, bisilliac, height at pin bone and height at withers in both breeds. The pelvic area was significantly (P<0.05) correlated with height at hook bone in Kuri cows but, there was no correlation with heart girth. The Bunaji showed a significant correlation of the pelvic area with the heart girth while, there was no correlation with the height at hook bone. A significant difference (P<0.05) was observed in the dimensions of the traitsbetween the breeds except in the heart girth and rump width. The study indicated that the parameters measured above may be used as good indicators of cows with large pelvic area in both breeds

Presentation, complications and management outcome of community acquired pneumonia in hospitalized children in Maiduguri, Nigeria

Background: Pneumonia remains a leading cause of U-5 morbidity and mortality in developing countries like Nigeria. This study was conducted to determine the clinical presentation, complications and factors contributing to mortality in the hospitalized children with community acquired pneumonia (CAP) in Maiduguri, Nigeria.Methods: Children younger than 14 years admitted into the EmergencyPaediatric Unit of the University of Maiduguri Teaching Hospital(UMTH), Maiduguri, in 2011 with the diagnosis of community acquiredpneumonia were followed up until discharge or death. Chest radiographswere read by radiologists.Results: Eighty nine children aged two months to 14 years were studied. The commonest clinical features were fever, cough, tachypnoea and dyspnoea. Radiographic evidence of pneumonia was found in 84 (94.4%) of cases. Dehydration and congestive cardiac failure (CCF) were the commonest complications encountered. Eight (9.0%) children died, seven of whom had complications of pneumonia. The rate of occurrence of complications, radiographic pattern of pneumonia and outcome of treatment did not significantly differ statistically in the different age groups; p = 0.135, 0.622 and 0.167 respectively.Conclusion: While dehydration and CCF were found to be commonestcomplications, mortality was commoner among the male infants hospitalized for pneumonia

Corruption in Nigeria: A call for an aggressive legal solution

Corruption has been an issue which has equally become an obstacle to the achievement of a better, efficient and effective economic development and virile democracy globally. Corruption is not exclusively economic phenomenon but manifest in every facet of our life, in political, the processes and other sectors like industries, banks, government establishments/institutions, law enforcement and judicial system, legislative  assemblies, that is to say in both private and public sectors etc.1 This article will  proffer aggressive legal solution as a panacea to this hydra-headed cankerworm

OPTIMIZATION OF NICKEL (II) AND CHROMIUM (III) REMOVAL FROM CONTAMINATED WATER USING SORGHUM BICOLOR

A central composite design (CCD) under the response surface methodology (RSM)was used to study the effect of three adsorption variables (pH, initial concentration, and adsorbent dosage) in order to determine the optimum process conditions for the adsorptions of Ni (II) and Cr (III) onto sulphuric acid modified sorghum bicolor activated carbon (SBAC).This study yielded removal efficiency of 98.89 % for Ni (II) and 94.27 % for Cr (III) ion under optimal conditions of pH (8), initial metal ion concentration (25 mg/L), adsorbent dosage (10 mg) and pH (7), initial metal ion concentration (5 mg/L), dosage (15 mg);respectively. Statistical analysis of variance results showed a good correlation existed between the experimental and predicted data with R2 values of 0.99 for Ni and 0.98 for Cr. The equilibrium data for Ni (II) adsorption was best described using Freundlich model while Langmuir model best fit Cr (III) adsorption. The mechanism of adsorption for both Ni and Cr adsorptions on SBAC followed Pseudo second order kinetic model.  http://dx.doi.org/10.4314/njt.v36i3.4

Aberrant axillarybreast carcinoma: a case report andliterature review

Ectopic breast tissue (EBT) develops along the mammary line owing to incomplete embryologic regression of the mammary ridges. This includes supernumerary breasts and aberrant breast tissue, in which malignancy is rarely reported. The commonest site of ectopic breasts is at the axilla, and the subcutaneous axillary mass may pose a diagnostic challenge to theclinician. Case Report: We report the case of a 31 year old multiparous Nigerian woman who presented with a painless left axillary mass of two months' duration. The anatomical breasts were grossly and radiologically normal. A diagnosis of aberrant breast carcinoma in her left axilla was confirmed by tissue biopsy. She had wide local excision and left axillary dissection, followed by one course of cytotoxic chemotherapybeforeshe began radiotherapy. Conclusion: Malignancy of aberrant breast tissue is a rare entity. A high index of suspicion and a low threshold for biopsy of subcutaneous lesions in the periphery of the breast allows for early intervention and a better prognosis. Triple assessment with clinical, radiological and pathological assessment of lesions in the axilla or along the embryonic milk line can not be over-emphasized

Co-morbidities in children hospitalized for community acquired pneumonia in Maiduguri, Nigeria

Background: Pneumonia is one of the commonest causes of morbidity and mortality in children, especially in developing countries. These children are also at risk of other morbidities, thus, increasing the morbidity and mortality.Objective: This study was conducted to examine the prevalence and pattern of co-morbidities in children admitted for community acquired pneumonia (CAP) in Maiduguri.Methodology: All children admitted into the Emergency Paediatric Unit (EPU) of the University of Maiduguri Teaching Hospital (UMTH), Maiduguri, in 2011, with CAP were prospectively followed until discharge or death. The children were evaluated for co-morbidities clinically and by examination of appropriate specimen where necessary.Result: A total of 115 children aged one month to 14 years were admitted for CAP during the study period. While majority of the children studied were underfive; 107 (93%), 65(56.5%) were males, 101 (87.8%) had one or multiple co morbidities, with about half of them 58 (50.4%) afflicted by malaria. Pre admission medication was commoner for orthodox than traditional medication. No significant difference in mortality outcome was however noticed between children with co-morbidity and those without comorbidity, p > 0.05.Conclusion: The occurrence of comorbid conditions among children hospitalized for CAP in Maiduguri is common; however, the presence of co-morbidity did not significantly affect the mortality outcome of their management. It is recommended that the presence of comorbidity be actively looked for in children hospitalized for pneumonia, so as to effect holistic treatment, and improve the outcome of management.Keywords: Pneumonia, Children. Co-morbidity, Maiduguri, Mortality outcom

Post-neonatal tetanus in University of Maiduguri Teaching Hospital, North-eastern Nigeria

Background: Tetanus is a public health problem in Nigeria. This study examines the demographic and clinical profile of postneonatal tetanus (PNT) seen in University of Maiduguri Teaching Hospital (UMTH), North- eastern Nigeria.Methods: This is a hospital-based prospective study of PNT. All childrenbeyond the neonatal period to 14 years of age admitted into the Paediatrics unit of UMTH, Maiduguri from June 2009 to July2011 with the diagnosis of PNT were studied.Results: A total of 39 cases of PNT were admitted over the period underreview. The male: female ratio was 2.3:1.0. Their ages at presentationranged between 16 months and 14 years, with mean +SD of 6.9+3.87 years. Over 90 percent of the children were either not immunizedagainst tetanus or their immunization status was unknown and onlytwo of the children were fully immunized. No booster immunizationwas received by any of the eligible children. The portal of entry of the infection was injury to the lower limbs and otogenic route in 53.9% and 33.3% respectively. Majority of patients were of low socioeconomicstatus. The duration of hospital stay ranged between 1-50 days with mean + SD (18.68+ 11.51).The mortality rate was (7)18 %.Conclusion: Tetanus still remains a major cause of childhood morbidityand mortality in Nigeria. Severe disease and the first one week of admission are the main variables identified to influence outcome.Therefore, there is need to strengthen routine immunization and booster doses of tetanus toxoid (TT) should be mandatory at primary and secondary school entry. Close monitoring of patients with severe tetanus during the critical period is imperative for successful management

Modified collection methods and quality of semen in Nigerian local turkeys (Meleagris gallopavo)

Semen collection in birds was initially achieved either via post-mortem drainage of the vas deferens or by cloacal retrieval after natural mating. Current techniques do not exclude stress and risk of injury during restraint or milking, especially in domestic turkeys. The present study was designed to develop more convenient methods of semen collection in turkeys. It involved five (n = 5) matured turkey toms weighing approximately 12 – 15 kg and two (n = 2) turkey hens. In the improved collection method, toms were stimulated by exposing them to hens, covered using a locally constructed wooden box. They were allowed to mount until there was evidence of ejaculatory response, demonstrated by increased abdominal pressure and cloacal contraction. After mounting, the tail feathers were lifted, and a collection vial was placed immediately below the cloaca to collect the ejaculates. In the modified abdominal massage, the turkey toms were restrained on sterna recumbency while the ejaculatory response was initiated by gently massaging the soft part of the abdomen and backward massage of the tail feathers. This is continued by rubbing either side of the cloaca till erection is achieved and semen is milked into a collection vial by gently squeezing the cloaca. Collections were made twice a week for four weeks using each method independently. The mean semen volume in the improved collection method was significantly (p < 0.05) higher than the modified abdominal massage. There was no significant (p > 0.05) difference in motility, abnormalities and concentration between both methods. The results from this study suggest that both collection methods were satisfactory for practical use and may offset some challenges associated with the most widely used abdominal massage technique of semen collection in turkeys

Morphometric Study of the Skull of the Greater Cane Rat (Thryonomys swinderianus, Temmnick)

This study was designed to investigate some morphometric characteristics of the skull of the Greater cane rat (GCR) involving 30 morphometric parameters. A total of 10 adult GCR were used for this study comprising of both sexes (5 males and 5 females). Student t-test was used to analyze the values obtained and to determine differences between the sexes. Morphological features were found in the zygomatic bone which occurred as a large and thick bone on both ends. From 30 parameters analyzed, 12 were statistically significant (p≤ 0.05) between both sexes, confirming the presence of sexual dimorphism in the skull of this rodent. This study provided baseline research data on the typology of the skull of the GCR.KEYWORDS: Greater cane rat, morphometry, skull, sexual dimorphism, craniometry