Forensic psychiatry in Africa : prospects and challenges

Forensic Psychiatry has a history that dates back almost two thousand years, and has evolved into a recognised discipline with a robust background of scientific enquiry, mostly because mental health care has always had an important interface with the law. Nevertheless, even in the developed world there are differences between countries with respect to the extent forensic mental health services have developed. This has been exacerbated by the differences in legal systems, resources and priorities in each country. Consequently comparisons and cooperation between forensic psychiatrists internationally has been difficult. In Africa, which is the second largest and most populous continent and containing an immense diversity of languages, religious traditions, ethnic groups and sociopolitical systems forensic psychiatry has largely remained underdeveloped within the context of a pervasive neglect in the provision of mental health services. The situation is compounded by the dearth of information about forensic services on the continent. As described by an eminent African psychiatrist, "the practice of forensic psychiatry in Africa is shrouded in both mystery and confusion". In addition to the lack of appropriate facilities, most countries in Africa have, on average, one psychiatrist per one million inhabitants. Moreover many psychiatrists have migrated to developed countries, leaving a small number of mental health professionals burdened with large numbers of patients.http://www.journals.co.za/ej/ejour_medjda.htm

Flaccid penile length and stretch factor in the newborn

Objective: Little is known about the flaccid penile length in the newborn and the degree of stretch of the penis among investigators while measuring the stretched penile length. This study aimed to document the flaccid penile length and the stretch factor in the newborn.Methods: This cross-sectional study was carried out on 200 term male infants within the first 72 hours of life. The flaccid penile length and the stretched penile length were measured with a wooden spatula and the stretch factor was calculated.Results: The mean (±SD) flaccid and stretched penile length were 30.9 ± 3.8 mm and 38.9 ± 4.0 mm respectively. The mean stretch factor was 26.4 %. Both testes had the same mean volume of 1.6 ± 0.5 ml. There was a significant correlation between flaccid and stretched penile lengths (r = 0.775, p = 0.000). The flaccid penile length was a significant predictor of the stretched penile length.Conclusion: This study has been able to determine the stretch factor while measuring the flaccid and stretch penile lengths in Nigerian newborn infants. It is recommended that the flaccid penile length be measured along with the stretched penile length and determine the stretch factor in order to compare how much investigators stretch the penis during measurement. This will allow for detailed comparison of penile anthropometry across different ethnic groups and races. Keywords: flaccid penile length, newborn, stretch factor, stretched penile length

Randomized controlled trial of prophylactic intravenous calcium therapy for post–exchange blood transfusion hypocalcaemia in the newborn: A preliminary report

Background: Exchange Blood Transfusion (EBT) is a form of massive blood transfusion mostly used to treat severe hyperbilirubinaemia and  anaemia in the newborn period. Hypocalcaemia is a known complication of EBT hence the practice of prophylactic administration of intravenous calcium. Objective: To compare the prevalence of post-EBT hypocalcaemia among babies who received prophylactic intravenous calcium and babies who received a placebo. Materials and Methods: A randomized placebo-controlled trial among hospitalized babies who required EBT for hyperbilirubinaemia in a Nigerian tertiary facility was done. Following strict methods of randomization, some babies received prophylactic calcium (calcium group) while the others received sterile water (placebo group) during EBT. Serum calcium was measured pre- EBT and at six and 24 hours post- EBT. Results: All the 16 and 13 babies recruited into the calcium and placebo groups had double volume  EBT. Babies in both arms of the study were comparable in terms of age, body weight and EGA. The mean serum calcium levels pre- EBT and at six hours and 24 hours post-EBT were 8.1 ± 1.6mg/dl, 8.2 ± 1.1mg/dl and 8.4 ± 1.1mg/dl respectively for the calcium group and 8.6 ± 2.6mg/dl, 9.0 ± 1.6mg/dl and 9.1 ± 1.7mg/dl for the placebogroup. The prevalence of hypocalcaemia at six hours post-EBT was 37.5% and 15.4% in the calcium and placebo groups respectively. Conclusion: The study did not demonstrate a clear role of prophylactic intravenous calcium therapy during EBT in the prevention of hypocalcaemia. It may be safer to screen for hypocalcaemia and treat it appropriately. Keywords: Calcium, Exchange Blood Transfusion, Hyperbilirubinaemia, Hypocalcaemia, Prophylaxis