Relationship between age and location of the apex beat among apparently healthy Nigerian children

Background: Normal location of apex beat varies with age in children. Location of apex beat is an integral part of routine cardiovascular system examination in clinical practice. However, there is paucity of literature on apex beat location in Nigerian children. Objective: The aim of this study was to locate apex beat position in apparently healthy Nigerian children from birth to ten years, and to relate the location with age. Subjects and Methods: This was a cross sectional study carried out in Sagamu, Nigeria. A sample size of two hundred and thirty-seven was calculated from a previous study. Hence two hundred and thirty-seven apparently healthy Nigerian children who satisfied the inclusion criteria were enrolled for the study. Apex beat location in the intercostal space was determined and distance of apex beat from the midline, midclavicular line and nipple lines were measured. The measured distances were related to age using linear regression and Pearson correlation. Results: The mean distance of apex beat from the midline from birth to 10 years ranged from 2.3cm to 6.4cm. The distance of apex beat from the midline increased progressively with age. In children up to the age of three years, the apex beat was in the 4th left intercostals space. In 91.7%, 51.3% and 14.3% of children aged four, five and six years respectively, the apex beat was present in the 4th left intercostal space. Above six years, it was located in the 5th left intercostals space. Conclusion: The location of the apex beat from the midline was strongly related with age Thus, the distance of apex beat from the midline can be predicted from age in months.Keywords:  Apex beat, Children, Mid-clavicular line, Nigeria, Nipple lin

Relationship between anthropometric parameters and the location of apex beat in children

Background: Childhood growth is characterized by changes in anthropometric parameters. The location of the apex beat may besimilarly influenced by growth.Objectives: The objective of this study was to determine any relationshipbetween the location of the apex beat and anthropometric parameters.Subjects and Methods: This crosssectional survey was carried out inSagamu, Nigeria. Apparently healthy children were randomly selected for the study. Apex beat location in the intercostal space was determined and distance from the midline was recorded. Weight and length/height were also recorded while Body Mass Index (BMI) and Body Surface Area (BSA) were calculated.Results: A total of 237 children aged 12 hours to 10 years were surveyed.The mean distance of the apex beat from the midline from birth to 10 years ranged from 2.3cm to 6.4cm. The mean distance of apex beat from the midline increased progressively with weight, height, chest circumference and BSA but not with BMI. Strong correlations were observed betweendistance of apex beat from the midline and weight (r = 0.850, p .0.001); height (r = 0.867, p .0.001); chest circumference (r = 0.833, p . 0.001); BSA (r = 0.862, p . 0.001) but not with Body Mass Index (r = 0.019, p = 0.774).Conclusion: The location of the apex beat in children was stronglyinfluenced by growth as suggested by anthropometric parameters.Key words: Anthropometry, apex beat, children, mid-clavicular line,nipple lin

Congenital Ichthyosis in a Nigerian preterm neonate: A case report and review of the literature

Congenital ichthyoses are relatively uncommon skin disorder s wi th worldwide occurrence. The ichthyoses are heterogenous disorders of keratinisation characterised by scaling of the skin of varying severity. This report describes a case of congenital ichthyosis in a preterm, male Hausa infant which happened to be the first case managed at the OOUTH, Sagamu. The infant was managed using stringent thermoregulation, optimal hydration, use of topical emollient and antibiotics. Although, the skin disorder resolved within fifteen days of treatment, the infant thereafter developed inguinoscrotal hernia and hydrocephalus necessitating surgical consult. The case is reported to highlight the good outcome of the cutaneous disorder following conservative management in a low-resource setting.Keywords: Collodion baby, Congenital ichthyosis , hydrocephalus, newborn, Sagam

Profile of clinically-diagnosed dementias in a neuropsychiatric practice in Abeokuta, South-Western Nigeria

Objective: Many subjects with dementia present primarily to neuropsychiatric practices because of behavioural and psychological symptoms (BPSD). This study reviewed the profile of clinically-diagnosed dementias and BPSD seen in a pioneer neuropsychiatric practice in Abeokuta, southwestern Nigeria over a ten year period (January1998 – December 2007). Methods: A review of hospital records of all patients with diagnoses of dementia or dementing illness using the ICD-10 criteria as well as specific diagnostic criteria for different dementia phenotypes. Associated BPSD, co-morbidities and treatments were also reviewed. Results: Out of a total of 240,294 patients seen over the study period, 108 subjects met clinical diagnostic criteria for probable dementia giving a hospital frequency of 45 per 100,000. Alzheimer’s disease (AD) and Vascular dementia (VaD) were the predominant phenotypes seen in 62 (57.4%) and 18 (16.7%) subjects respectively. Others include mixed dementia (4 cases), frontotemporal dementia (4 cases), Lewy body dementia (3 cases), alcohol-related dementia (3 cases), PD dementia (1 case) and unclassifiable (13 cases). Apathy, night time behaviour, aberrant motor behaviour, agitation and irritability were the most common BPSD features, while hypertension was the most common co-morbidity. Neuroleptics, anticholinergics and anti-hypertensives were most commonly prescribed. Anticholinesterase inhibitors were sparingly used. Conclusion: Probable AD was the most prevalent dementia phenotype seen in this practice. Increased awareness of dementia and better utilization of specific treatments are needed among psychiatrists and primary care practitioners in Nigeria.Keywords: Dementia phenotypes; BPSD; Neuropsychiatric practice; Nigeria; Afric

National neonatal resuscitation training program in Nigeria (2008-2012): A preliminary report

Background: Routine institutional training of doctors and nurses on newborn resuscitation have commenced, to improve the quality of resuscitation available to high-risk babies, in Nigeria, as a means of reducing newborn deaths in the country. Perinatal asphyxia contributes to 26% of newborn deaths in Nigeria. Perinatal asphyxia results when babies have difficulty establishing spontaneous respiration after birth.Materials and Methods: Between 2008 and 2012, doctors and nurses drawn from all the geo.political zones were trained using the Neonatal  Resuscitation Training (NRT) manual of the American Heart Association and the American Academy of Pediatrics. Questionnaire.based, cross.sectional surveys of doctor and nurse trainees from the six geo.political zones in Nigeria were conducted eight months after the primary training, to evaluate the post.training  neonatal resuscitation activities.Results: Over the period of study, 357 doctors and 370 nurse/midwives were primarily trained in NRT. The overall ratio of step down training was 1:22 with 1:18 for doctors and 1:26 for nurses. In 2008, the delivery attendance rates were 11 per doctor and 9 per nurse/midwife. These rates increased to 30 per doctor and 47 per nurse in 2012. Between 88 and 94% of the doctors and between 72 and 93% of the nurses successfully used bag and mask to help babies breathe in the post.training period. The nurses used bag and mask for infant resuscitation more frequently,   compared to doctors, with the rate fluctuating between two.to.one and four.to.one. Over the years, 87 to 94% of the doctors and 92 to 97% of the nurses/midwives trained other birth attendants.Conclusion: The NRT in Nigeria is well.subscribed and the frequency of secondary training is good.Key words: Birth asphyxia, birth attendants, delivery room care, neonatal resuscitation training, perinatal mortalit

Constraints to exclusive breastfeeding practice among breastfeeding mothers in Southwest Nigeria: implications for scaling up

<p>Abstract</p> <p>Background</p> <p>The practice of exclusive breastfeeding is still low despite the associated benefits. Improving the uptake and appropriating the benefits will require an understanding of breastfeeding as an embodied experience within a social context. This study investigates breastfeeding practices and experiences of nursing mothers and the roles of grandmothers, as well as the work-related constraints affecting nurses in providing quality support for breastfeeding mothers in Southwest Nigeria.</p> <p>Methods</p> <p>Using a concurrent mixed method approach, a structured questionnaire was administered to 200 breastfeeding mothers. In-depth interviews were also held with breastfeeding mothers (11), nurses (10) and a focus group discussion session with grandmothers.</p> <p>Results</p> <p>Breastfeeding was perceived as essential to baby's health. It strengthens the physical and spiritual bond between mothers and their children. Exclusive breastfeeding was considered essential but demanding. Only a small proportion (19%) of the nursing mothers practiced exclusive breastfeeding. The survey showed the major constraints to exclusive breastfeeding to be: the perception that babies continued to be hungry after breastfeeding (29%); maternal health problems (26%); fear of babies becoming addicted to breast milk (26%); pressure from mother-in-law (25%); pains in the breast (25%); and the need to return to work (24%). In addition, the qualitative findings showed that significant others played dual roles with consequences on breastfeeding practices. The desire to practice exclusive breastfeeding was often compromised shortly after child delivery. Poor feeding, inadequate support from husband and conflicting positions from the significant others were dominant constraints. The nurses decried the effects of their workload on providing quality supports for nursing mothers.</p> <p>Conclusion</p> <p>Breastfeeding mothers are faced with multiple challenges as they strive to practice exclusive breastfeeding. Thus, scaling up of exclusive breastfeeding among mothers requires concerted efforts at the macro, meso and micro levels of the Nigerian society.</p

Psychiatric, Psychological and “Witchcraft” Defences to Murder in the Nigerian Legal Context

Background: Expert psychiatric testimony may be relevant in certaininstances of homicide especially murder. However, the exposure of mostpsychiatric trainees may be inadequate in relation to the range of psychological defences available to an offender accused of homicide. Aim: To describe the psychiatric and psychological defences to murder available within the Nigerian legal context as well as review cases of witchcraft defence within the same jurisdiction. Method: Review of extant laws in relation to murder using the Criminal Code, the Penal Code and the Criminal Procedure Act where applicable. Cited cases were presented from standard Law Reports. Results: The criminal defences in Nigerian courts which possess psychological and psychiatric modulation notably include the Insanity Plea, &#8220;Witchcraft&#8221; defence, and the defence of intoxication. Self-defence, Defence of Provocation, and &#8220;Doli Incapax&#8221; also demonstrate indirect psychological or psychiatric underpinnings. The &#8220;Witchcraft&#8221; defence appears to be the most tenuous and least justifiable of the pleas highlighted. Conclusion: A fairly wide range of psychological and psychiatricdefences are proffered in Nigerian courts in the defence of criminal acts, including murder. Some require expert testimony where insanity and related issues are raised. Thus, mental health experts practicing in Nigerian jurisdictions have both an educative role and a moral responsibility to provide evidence-based testimony during courtproceedings.Key words: expert testimony, psychiatric, psychological, defence, insanity

Human immunodeficiency virus genetic variation that can escape cytotoxic T cell recognition.

In a longitudinal study of HIV seropositive patients, there were fluctuations in the specificity of cytotoxic T cells for the virus. This was matched by variability in proviral gag DNA epitope sequences in the lymphocytes of these patients. Some of these viral variants are not recognized by autologous T cells. Accumulation of such mutations in T-cell antigenic targets would provide a mechanism for immune escape