Reliability of bedside blood glucose estimating methods in detecting hypoglycaemia in the children’s emergency room

Background: Hypoglycaemia occurs in many disease states common in the tropics. Facilities and skilled manpower required for laboratory blood glucose measurement are not always available in health facilities in developing countries. Objective: The study was carried out to determine the validity of bedside methods of blood glucose measurement in detecting hypoglycaemia.Methods: Blood glucose was determined by two bedside methods (Accuchek Active® and Betachek Visual®) in 430 patients aged between one month and 10years and simultaneously sent for laboratory spectrophotometric analysis at a wavelength of 500nm using the hexose kinase method. Hypoglycaemia was defined as plasma glucose < 2.5mmol/L.Results: The prevalence of hypoglycaemia was 5.6%.There was a higher correlation (r =0.84, p< 0.05) between Accuchek Active® results and laboratory values than was obtained with Betachek Visual ® (r = 0.48, p=0.000).In detection of hypoglycaemia, both bedside glucose monitors were found to have a high specificity and high predictive values of a negative test (99.8% and 98.5% for Accuchek Active® and 89.4% and 97.8% for Betachek Visual® respectively) with moderate sensitivity (75.0% and 66.7% respectively). However, the Accuchek Active® monitor has a much higher predictive value of a positive test (94.1%) compared to the Betachek Visual® (27.1%).Conclusion: The bedside glucose monitors are valid bedside tools for detecting or ruling out hypoglycemia.Keywords: hypoglycaemia, children, bedside investigation, glucose estimation, blood glucose

Determination of the growth rate and volume of lipid produced by Lipomyces species isolated from shear butter leaf (Vitellaria paradoxa)

A Lipomyces strains was isolated from shear butter leaf (Vitellaria paradoxa) by placing the leaf sample in 10 ml of sterile distilled water containing 0.002 g of potassium dihydrogen phosphate and incubatedfor 3 days at 28oC. A drop of this was subsequently streaked nitrogen free medium. For determination of growth rate and volume of lipid produced, 24 h culture of the Lipomyces species isolated was washed into each of the following medium: yeast extract both (YE), nitrogen free broth (NF), maize broth free of salts (MF), maize broth with salts (MB), sorghum broth with salts (SB) and sorghum broth free of salts (SF). These were incubated for 7 days at 28oC on a shaker, and the lipid produced was extracted by using diethyl ether. The Lipomyces species was found to be able to grow and produce lipid more efficiently in yeast extract broth than in other medium used. The organism produced 25 ml of lipid per 8 g of glucose in yeast extract broth

Comparison of Rapid Diagnostic Tests and Microscopy for Malaria

Presumptive treatment of malaria results in significant overuse of antimalarials. This study compared the diagnostic accuracy of Histidine Rich Protein II and plasmodium lactate dehydrogenase (pLDH)-based Rapid Kits( RDTs)and using expert microscopy as the gold standard for the detection of falciparum and non-falciparum in 200 individuals suffering from fever episodes over a period 8months in a malaria-endemic area in Osogbo, Osun State. 99(44.5%) of these patients were microscopically parasitaemic with three Plasmodium species identified expect P.ovale. 25 (12.5%) of the study population had temperature < 37.50C at the time of presentation in the clinic among which 16 (64% ) were parasitaemic. Furthermore, 148 (74%) of the study population had fever episode of which 65(44%) were positive for malaria. The sensitivity and specificity of pLDH (Pf) were 84.7% and  78.3% respectively and HRP-2 were 72.7% and 90.9% respectively. Both had high detection (94.7%) at parasite density ≥ 10,000 parasite/`l of blood. Microscopy still remains the ‘Gold Standard’ since both are not 95% sensitive and cannot determine parasites quantification.Keywords: Plasmodium, Microscopy, Rapid Kits, Osogbo, Nigeria, LAUTECH Le traitement présomptif de paludisme résulte de l’usage abusif considérable des antipaludiques. Cette étude a pour but de comparer l’efficacité de diagnostic de l'histidine RichProtein II et de test de diagnostic rapide (TDR) à base de kits plasmodium lactate déshydrogénase (pLDH) et en utilisant la microscopie experte comme «gold standard» pour la détection de P. falciparum et non-falciparum chez 200 personnes souffrant d'épisodes de fièvre sur une période de huit mois dans une région où le paludisme est endémique dans Osogbo, l'Etat d'Osun. 99 (44,5%) de ces patients étaient parasitémiques à la microscopie à trois espèces de Plasmodiumidentifiées différentes de P. ovaleattendu. 25 (12,5%) de la population étudiée avait une température <37,5°C au moment de leur arrivée à la clinique parmi lesquels, 16 (64%) étaient parasitémiques. En outre, 148 (74%) de la population d’étude avait un épisode de fièvre dont 65 (44%) étaient positifs pour le paludisme. La sensibilité et la spécificité de pLDH (Pf) étaient respectivement de 84,7% et 78,3% et celles de HRP-2 étaient respectivement de 72,7% et 90,9%. Tous les deux tests avaient une bonne détection (94,7%) à densité parasitaire ≥ 10000 parasite/ul de sang. La microscopie reste le «Gold Standard» puisque les deux autres tests ne sont pas sensibles à 95% et ne peut pas déterminer la quantité parasitaire.Mots clés: Plasmodium, microscopie, kits de test rapide, Osogbo, Nigeria, LAUTECHArticle in English

Biological studies on albino rats fed with Sorghum bicolorstarch hydrolyzed with &#8733-amylase from Rhizopus sp.

Partially purified amylase was extracted from the culture medium of Rhizopus sp. grown in potato dextrose broth for 48 h at room temperature by precipitation with 96.9% ethanol. The enzyme was usedto hydrolyze sorghum starch. The hydrolyzed product was afterwards formulated into rat feed, which was fed to albino rats for a period of thirty days. The average daily body weight of the albino rats fed with hydrolyzed formulated feed on the 30th day of the experiment was 131 g while the values recorded for the groups fed with unhydrolyzed and commercial feed were 120 and 97.4 grams respectively. Thehematological analysis revealed that the packed cell volume (PCV), Hemoglobin (Hb), red blood cells (RBC), mean cell hemoglobin concentration (MCHC) of the group fed with hydrolyzed formulated feed of 51.8%, 16.9 g/dl, 8.7 x 105 ƒÊl-1 and 32.7%, respectively, were higher than the experimental animals fed with commercial feed with values of 44.2%, 14.4 g/dl, 7.7 x 10

Relationship between admission serum C-reactive protein and short term outcome following acute ischaemic stroke at a tertiary health institution in Nigeria

Background: There is evidence of an association between mediators of inflammation, particularly C-reactive protein (CRP), and outcome of acute ischaemic stroke. This provides a potential opportunity for interventions aimed at improving outcome. There is sparse data exploring the role of inflammatory markers such as CRP and stroke outcome in Africans. The study objective was to determine the association between admission serum CRP levels and short-term outcome in the Nigerian patient presenting with acute ischaemic stroke.Materials and Methods: Consecutive patients hospitalized for first-ever acute ischaemic stroke at the Lagos University Teaching Hospital, Lagos, Nigeria, were prospectively enrolled between October 2007 and June 2008. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS). Serum CRP was determined on samples obtained within 7 days of stroke onset. All stroke patients were followed up till day 30 post-stroke. Outcome measures were 30 day Glasgow outcome scale score and functional impairment on the modified Rankin Scale (mRS). An age- and gender-matched healthy control group had serum CRP determined at inclusion. Elevated CRP was defined as any level above the cutoff (mean +2 x standard deviation of CRP level of controls).Results: Eighty patients with acute ischaemic stroke (47 men and 33 women) and 40 controls (27 male and 13 female) (P = 0.47) were studied. Mean age in cases was 59.1 ± 15.0 years. Mean CRP was significantly higher in stroke cases than controls (17.7 ± 14.4 mg/L versus 1.1 ± 1.7 mg/L respectively) (P < 0.00001). The frequency of elevated CRP (>4.5 mg/L) was 76.3% in stroke (N = 61) and 5% (N = 2) in controls (P < 0.0001). The case fatality rate in stroke with elevated CRP (32.8%) was significantly higher than stroke with normal admission CRP (0%; P= 0.015). The association of higher admission CRP with fatality () was statistically significant (P < 0.0001). Amongst survivors, mean CRP levels were markedly higher in the patients with unfavorable motor outcome (moderate/severe disability; n = 22; 21.5 ± 11.1) compared to those with favorable outcome (mild disability; n = 38; 6.5 ± 6.2) (P < 0.00001). In multivariate regression analysis, only high NIHSS score (P = 0.004) and admission CRP (P = 0.008) were independently associated with case fatality.Conclusions: Elevated admission CRP and high NIHSS score are independent predictors of short-term case fatality and adverse functional outcome following acute ischaemic stroke in Nigerians.Key words: C-reactive protein, ischaemic stroke, outcom

Congenital Toxoplasmosis: A Review of its Pathology, Immune Response and Current Treatment Options.

Toxoplasmosis, caused by the protozoan parasite Toxoplasma gondii, is one of the most common parasites of man and other warm-blooded animals. Humans are infected through contaminated food, water, and blood transfusion, organ transplantation or from mother to foetus through the placenta. Severe congenital infections occur as a result of primary T. gondii infection in early pregnancy. Transmission of T.gondii to the foetus can result in serious health problems, including mental retardation, seizures, blindness and death. Frequency of foetal infection is higher when maternal infection occurs later in pregnancy and sequelae are more severe when maternal infections occur early in the first trimester of pregnancy. The ability of the parasite to survive intracellularly largely depends on the blocking of different proapoptotic signaling cascades of the host cells. During pregnancy, however, alterations in the incidence of apoptosis are associated with abnormal placental morphology and function. Both cellular and humoral immune responses control T.gondii infection. Toxoplasma is asymptomatic, infected women can only be detected by serological testing. In many instances, congenital toxoplasmosis can be prevented by educating pregnant women and women of childbearing age about the route of transmission. The need for screening suspected cases of T. gondii will help reduce transmission to the foetus. Keywords: Toxoplasmosis, Congenital toxoplasmosis, Toxoplasmosis and immunosuppression. Toxoplasma gondii

From decentralization to commonization of HIV healthcare resources: Keys to reduction in health disparity and equitable distribution of health services in Nigeria

Access to quality care is essential for improved health outcomes. Decentralization improves access to healthcare services at lower levels of care, but it does not dismantle structural, funding and programming restrictions to access, resulting in inequity and inequality in population health. Unlike decentralization, Commonization Model of care reduces health inequalities and inequity, dismantles structural, funding and other program related obstacles to population health. Excellence and Friends Management Care Center (EFMC) using Commonization Model (CM), fully integrated HIV services into core health services in 121 supported facilities.This initiative improved access to care, treatment, support services, reduced stigmatization/discrimination, and improved uptake of HTC. We call on governments to adequately finance CM for health systems restructuring towards better health outcomes

Industrial Action by Healthcare Workers in Nigeria in 2013 - 2015: An Inquiry into Causes, Consequences and Control. A Cross-sectional Descriptive Study.

© 2016 Oleribe et al.Background: Nigeria has suffered from several healthcare workers strikes in the past 36 months, involving all categories of health workers. Frequent healthcare workers strikes result in the closure of public healthcare institutions preventing Nigerians access to quality health services. The purpose of this study was to identify the root cause(s) of strikes by healthcare workers, their effects on the health system and possible solutions to prevent, or at least reduce, industrial action. Methods: A cross-sectional descriptive survey was used to execute this study between February and March 2015. A self-administered questionnaire with both closed- and open-ended questions was used for this study. Data were analysed using EpiData™ and SPSS 21. Simple frequencies and chi-square analysis were carried out. Results: A total of 150 healthcare workers participated in the study. Sixty-two (41.3 %) participants were males, 86 (57.3 %) married, 90 (60.0 %) Christians and 119 (79.3 %) graduates, and about half of the participants earn less than N129 000.00 (US$ 737.00) per month. Less than half of the participants (43.6 %) supported industrial actions. Poor healthcare leadership and management were cited as the most common (92 %), as well as the most important (43.3 %), cause of healthcare worker strikes in Nigeria. Other causes cited were a demand for higher salaries and wages (82 %), infrastructural issues (63.3 %) and inter-personal issues (61.3 %). Only 2.0 % rated current healthcare management as excellent, while 24.0 % rated it as very good. Several strategies were cited towards improving healthcare management. Conclusions: The findings of this study differ from previous studies that identified demand for increased salaries and wages as the most common cause of healthcare workers strikes in Nigeria. Identified causes of these continued strikes, especially inadequate healthcare leadership/management, must be tackled in order to eliminate industrial action by healthcare workers. Training doctors in health management and leadership towards building skilled physician leaders is a strategy that is long overdue in Nigeria