Urinary calcium: a promising predictive biomarker for early recognition of environmental lead exposure in children

Background: In the continuous search for accessible, reliable and sensitive biomarkers for early detection of environmental lead exposure, authors determined the interaction between blood lead level (BLL), the conventional marker of lead exposure, and the indices of calcium and bone metabolism in children.Methods: This cross-sectional study involved 309 apparently healthy children from eight public primary schools in Ibadan, Nigeria who were classified as Elevated BLL (EBLL) and control based on standard cut-off for childhood BLL. BLL, serum Ca (tCa), phosphate, magnesium (Mg), 25-hydroxy-Vitamin D, alkaline phosphatase (ALP), urinary calcium (uCa) and urinary deoxypyridinoline (uDPD) were determined using AAS, HPLC and ELISA as appropriate. Bone-specific ALP (B-ALP) and ionized calcium (iCa) were calculated using standard formulae. Data analyses involved Student’s t-test, Pearson correlation and multivariate regression analysis. p0.05). BLL had significant positive correlation with uCa (r=0.176, p=0.002) (p0.05). BLL could be accounted for by uCa by applying the equation, BLL=0.329+0.324uCa.Conclusions: Urinary calcium could be a promising predictive biomarker for early recognition of significant environmental lead exposure in children

Efficacy of Cognitive Rehabilitation Therapy on Poststroke Depression among Survivors of First Stroke Attack in Ibadan, Nigeria

Background and Purpose. Poststroke depression (PSD) is a common complication after stroke. There is no adequate treatment for PSD. This study examined efficacy of cognitive rehabilitation therapy (CRT) in the treatment of PSD among stroke survivors. Methods. An experimental design, 30 participants with poststroke depression were randomly assigned into 3 groups of cognitive rehabilitation therapy (CRT), psychoeducation (PE), and the control group (CG). CRT consisted of nine sessions with three-phased sessions focusing on activity stimulation, negative thoughts, and people contacts, PE consisted of nine sessions focusing on knowledge on stroke and poststroke depression, and the CG group was on the waiting list. The BDI scale was used for assessing PSD at posttest. Results. There was a significant difference in the efficacy of CRT, PE, and the CG on PSD, with CRT–CG mean difference of −9.4 ± 3.11 and PE–CG 1.0 ± 3.83. Furthermore, stress was not a confounding variable on the efficacy of CRT. The type of therapy significantly influenced PSD at posttest, with the CRT having greater mean reduction to CG (−11.1 ± 3.1) than PE to the CG (3.0 ± 3.8). Conclusions. Cognitive rehabilitation therapy significantly reduced poststroke depression. Hence, it should be integrated as an adjunct treatment of poststroke depression

Spectrum of Echocardiography Abnormalities among 168 Consecutive Referrals to an Urban Private Hospital in South-Western Nigeria

Trans-thoracic echocardiography (TTE) is an important non-invasive cardiac examination that provides structural and functional information. It is useful in the diagnosis of cardiac diseases and often guides the management and follow-up of patients with cardiovascular diseases (CVD). The study aimed to present an audit of the echocardiograms performed in an urban private hospital over a two-year period in order to define the pattern of cardiac diseases in our center. Echocardiogram reports of 168 consecutive patients performed between May 2011 and April 2013 at an organized private sector hospital in Lagos, south-west Nigeria were reviewed. Studies were performed with a Toshiba Nemio XG ultrasound machine. The data obtained were analyzed for mean age, sex, clinical indications, and echocardiographic diagnosis in the study subjects. A total of 168 echocardiography reports were examined, comprising of 92 males (54.8%) and 76 females (45.2%). The age range of the subjects was 10-76 years (mean 42.5 ± 12.1 years). The commonest indication for echocardiography was systemic hypertension and hypertension related causes (38.1%), followed by abnormal resting electrocardiogram (14.9%). Routine annual medical screening was the next most common indication, representing 13.1% of the indications for echocardiography. The other indications are as presented in Table 1 . The echocardiogram was normal in 64.3% of the subjects. The commonest abnormality detected was hypertensive heart disease (HHD); accounting for 9.6% of the subjects studied. Isolated atrial enlargement (left, right, or bi-atrial) was the next most common abnormality accounting for 6% of the echocardiographic diagnosis. Pulmonary hypertension was the next most common diagnosis accounting for 4.8% of our findings. The other echocardiographic diagnoses are as listed in Table 2 . Hypertension represents the commonest indication for echocardiography. Normal echocardiogram was the commonest echocardiographic finding while HHD was the commonest echocardiographic abnormality. The prevalence of ischemic heart disease by echocardiography was 2.4%. There was no case of rheumatic heart disease (RHD). The prevalence of hypertrophic cardiomyopathy (HCM) was 1.2%. Ease of access to echocardiography may influence the findings in an echocardiographic audit and policy makers should incorporate appropriateness criteria into their guidelines for reimbursement

Seasonality in TB notification in Nigera: Reality or myth?

Background: Seasonal fluctuations in tuberculosis (TB) notifications have been identified and reported in a number of countries. Nigeria remains one of the 22TB high-burden countries (HBCs) in the world, and the notification of TB cases in the country over the years has shown a definite pattern that suggests seasonal variation. Previous studies conducted in India, Japan, Mongolia, the Netherlands, Russia, Spain, the United Kingdom and the United States have evaluated the seasonality of TB notification. However, in Nigeria, there has been no systematic study to establish that this pattern is not just a myth. This study seeks to establish the seasonal variations suggested by the trend pattern of TB case notification (all forms of TB) in Nigeria over the past ten years. Method: The yearly TB notification data in Nigeria from 2004 to 2013 was examined for seasonal fluctuations by plotting the quarterly notification figures for the years under review. A rapid trend analysis was done based on the amplitude of the fluctuating curves. Standardization was done by zones. Results: The trend analysis showed a spike in the first quarter of the year for the ten-year period studied (with the exception of 2005 and 2011). This quarter is generally characterized by the dusty, dry harmattan wind in most parts of the country, particularly the northern region. The curves generally plummeted in the third quarter and remained in that neighborhood for the rest of the year. The differences in case notification between the first and last quarter for the ten-year period ranged from 347 to 4230 cases notified. The result of this trend analysis when standardized by zones for the six zones of the country was similar to the overall result for the country. Conclusion: According to the results of this study, there is evidence to suggest that there are seasonal variations in notification of TB cases across the four quarters of the year. This has significant implications for TB control strategies. Further investigation of the reasons for seasonal variations may help to identify risk factors. Also, planning and forecast of TB commodities to order cannot be based on experience from the preceding quarters, but must rather be based on reports from the same quarter in the previous year. Allocation of resources may also have to be intensified during the peak periods in order to adequately control the disease at these periods. Footnotes: Further investigation is required to unmask the reasons for the seasonal variations in TB notification in Nigeria

Perceptions of community members on tuberculosis and its effect on health-seeking behavior in Nigeria☆

Background: Tuberculosis (TB) remains a major health challenge in the sub-Saharan African countries; Nigeria being one of the most affected countries. A number of interventions have been employed to reduce the scourge of the disease; however, the burden of the disease remains of public health dimensions. This study seeks to provide insight into the factors that may be affecting access to TB services by exploring the perception of the TB disease among the general population and how this affects health-seeking behavior. The specific perceptions addressed in this study are the causes of TB and whether there is a cure for TB. Methods: Qualitative methodology using in-depth interviews and focus group discussions (FGDs) were employed. This was done as part of a knowledge, attitude and practice survey. The survey was conducted in six States, namely: Akwa Ibom, Ebonyi, Gombe, Katsina, Benue and Ondo States. Results: Community key informants and FGD participants identified financial capability, knowledge about orthodox medicine, fear of stigmatization and the influence of religious leaders as factors that determine the choice of treatment. Across the six States, the general thought is that people first consult the chemist, then traditional healers/faith-based healers before visiting the hospital because it is cheaper. It was found that persons who believe that the disease is caused by germs usually seek health care in the formal health settings, while those who believe that TB is caused by supernatural forces, such as ancestral curses and witchcraft, usually seek help at the herbalists/traditional/unorthodox health settings. Also, people who believe that TB can be cured are more likely to seek medical care. Conclusion: Specific information on TB, such as the fact that TB is curable and caused by a germ, if well disseminated at the population level to the point where the information is understood and accepted to be true, is able to change the health-seeking behavior of the population such that the population seek care for TB at the formal health clinics

Successful Medical Management of a Left Ventricular Thrombus and Aneurysm following Failed Thrombolysis in Myocardial Infarction

We report the case of a patient with an extensive anterior myocardial infarction complicated by left ventricular systolic dysfunction, left ventricular apical thrombus and an apical left ventricular aneurysm following failed thrombolysis. We obtained serial two-dimensional echocardiograms at short intervals in the acute phase and also during the months of recovery and follow up. The patient was successfully and exclusively medically managed

Volume Measurements in Aortic Root Assessment Using Two-Dimensional Echocardiography

Background Aortic dilatation is associated with the presence of aortic diseases. Current guidelines for assessing the aortic root (AoR) depend on linear measurements acquired by two-dimensional (2D) echocardiography. We considered that real-time three-dimensional echocardiography, which correlates better with AoR volume obtained by computed tomography, is widely unavailable, and therefore, there is a need to determine the AoR volume using 2D echocardiography. Methods Fifty-one consecutive apparently healthy volunteers were recruited and subsequently divided into three age groups. Specified planes of acquisition and previously defined landmarks were identified, and phases of the cardiac cycle that allowed for measurement standardization were used. Volume was determined by the modified Simpson's method. Results Although the average diastolic and systolic volume measurements of the AoR dimensions were not significantly different across the three age groups in the study population, a highly significant difference was observed in the volume measurements between male and female normotensive persons, P < 0.01 in each case. AoR volume measurements were five times in the diseased compared with the normotensive individuals; however, linear measurements were only 1.5 times in size of the normal individuals. Both point and interval estimates of the volume measurements of AoR in adult normotensives in three age groups were presented as baseline information. Conclusions We hereby present a novel way to determine the AoR volume using 2D echocardiography and the normal reference range with respect to age and gender. We also established the relevance of our measurement by comparing the normal population with two isolated diseased aortas

Assessing the acceptability of village health workers' roles in improving maternal health care in Gombe State, Nigeria a qualitative exploration from women beneficiaries.

IntroductionMaternal, and under-five mortality rates in Gombe State are disproportionately high. The Society for Family Health (a Non-Governmental Organization) in collaboration with Gombe State Primary Health Care Development Agency implemented the Village Health Worker (VHW) Program in Gombe to address the low uptakes of maternal neonatal and child health (MNCH) services and reduced the impact of healthcare worker insufficiency. VHWs are lay indigenous women trained to educate and encourage women to use MNCH services, provide simple community-based maternal and new-born care through home visits, and facilitate facility linkage. We assessed the acceptability of VHW services among women beneficiaries of the Program.MethodsQualitative data were obtained through six focus group discussions with 58 women beneficiaries of the VHW program who delivered within the last 12 months preceding study period (October-November 2018). Themes explored were roles and acceptability of VHWs, and the influence of VHWs on the uptake of MNCH services. We analyzed data with NVivo 12, using Grounded Theory.ResultsParticipants' mean age was 25.1 (± 5.3) years old. Most participants 39 (67%), had been in contact with a VHW for at least 10 months. VHWs visited pregnant women at home and registered them for antenatal care, provided them basic maternal healthcare, health education, and facilitated facility linkage. Participants generally accepted the VHW Program because it was community-based, VHWs were indigenous community members, delivered clear messages, and influenced husbands and mothers-in-law to support women's' use of MNCH services. VHWs' interventions were perceived to have improved health literacy and the uptake of MNCH services. Participants generally admired the VHW occupation and recommended VHW program scale-up, and for VHWs to be offered basic obstetric training and employment by health facilities or the government.ConclusionThe general acceptance and positive views of VHWs from beneficiaries of the program demonstrates the feasibility of the program to improve the uptake of MNCH services

Orofacial cancers: pattern and management in Ibadan, Nigeria

Background: Orofacial cancers remain a significant health burden globally, especially in the developing countries where the incidence is higher and appears to be increasing. This study aims to document the pattern, management and survivorship of patients with orofacial cancers as seen at a tertiary healthcare facilityin Nigeria.Materials and Methods: This is a retrospective study of patients who presented at our centre with orofacial cancers in the period between January 2010 and December. Patients' demographics, location of lesion, histopathological diagnosis, treatment given and follow-up events were extracted from the records. Patient with insufficient data for analysis were excluded. Data was analysed using IBM SPSS version 21.Results: 21,090 patients were seen during the study period and 228 of the 1,029 biopsies done were malignant. The study included 213 patients (121 males and 92 females. mean age 48.2 years) with orofacial cancers. The commonest sites were the jaws (48.8%), palate (13.1%) and the tongue (7.5%).Carcinomas constituted 71.8% and were the commonest malignancies. All patients presented in stages III (34.6%) or IV (65.4%). 39.4% of patients  had no treatment instituted and surgery alone (21.9%) was the commonest treatment provided. The mean interval between treatment and recurrence was 3.0 months while mean expiration period was 13.5 months.Conclusion: Treatment conferred a higher probability of survival. Patients treated with surgery (and radiotherapy/chemotherapy) survived better than those treated non-aggressively. In general, about a third (30.8%) of orofacial cancer patients were alive at 5 years post presentation and about 50% of these survivors were living with the disease.Keywords: Orofacial cancer; outcome; survival; Nigeri