Term quadruplet pregnancy: a case report

Higher order multiple pregnancies are rare and often associated with complications. Term delivery is uncommon. This is a report of a 22 years old G3 p2 + 0 (1 alive) teacher who had quadruplet pregnancy following ovulation induction is presented. She had elective caesarean section at term with the delivery of two live male and two live female infants with birth weights ranging between 1750gram and 2850grams. Term delivery in quadruplet pregnancy is possible as demonstrated in this case, and has the advantage of improved perinatal outcome. Bed rest early detection and management of antenatal complications, and planned elective delivery are probably the keys to a successful outcome

Molecular reductions in glucokinase activity increase counter-regulatory responses to hypoglycemia in mice and humans with diabetes.

OBJECTIVE: Appropriate glucose levels are essential for survival; thus, the detection and correction of low blood glucose is of paramount importance. Hypoglycemia prompts an integrated response involving reduction in insulin release and secretion of key counter-regulatory hormones glucagon and epinephrine that together promote endogenous glucose production to restore normoglycemia. However, specifically how this response is orchestrated remains to be fully clarified. The low affinity hexokinase glucokinase is found in glucose-sensing cells involved in glucose homeostasis including pancreatic β-cells and in certain brain areas. Here, we aimed to examine the role of glucokinase in triggering counter-regulatory hormonal responses to hypoglycemia, hypothesizing that reduced glucokinase activity would lead to increased and/or earlier triggering of responses. METHODS: Hyperinsulinemic glucose clamps were performed to examine counter-regulatory responses to controlled hypoglycemic challenges created in humans with monogenic diabetes resulting from heterozygous glucokinase mutations (GCK-MODY). To examine the relative importance of glucokinase in different sensing areas, we then examined responses to clamped hypoglycemia in mice with molecularly defined disruption of whole body and/or brain glucokinase. RESULTS: GCK-MODY patients displayed increased and earlier glucagon responses during hypoglycemia compared with a group of glycemia-matched patients with type 2 diabetes. Consistent with this, glucagon responses to hypoglycemia were also increased in I366F mice with mutated glucokinase and in streptozotocin-treated β-cell ablated diabetic I366F mice. Glucagon responses were normal in conditional brain glucokinase-knockout mice, suggesting that glucagon release during hypoglycemia is controlled by glucokinase-mediated glucose sensing outside the brain but not in β-cells. For epinephrine, we found increased responses in GCK-MODY patients, in β-cell ablated diabetic I366F mice and in conditional (nestin lineage) brain glucokinase-knockout mice, supporting a role for brain glucokinase in triggering epinephrine release. CONCLUSIONS: Our data suggest that glucokinase in brain and other non β-cell peripheral hypoglycemia sensors is important in glucose homeostasis, allowing the body to detect and respond to a falling blood glucose.Yousef Jameel Fund Sir Jukes Thorn Trust Elmore Fund Chang Gung University College of Medicin

A Comparison of Client Perception of the Quality of Child Welfare Service at the Lagos University Teaching Hospital and a Primary Health Centre in Mushin LGA, Lagos State

The objective of this study was to compare client perception of the quality of child welfare service at Lagos University Teaching Hospital (LUTH) and Palm Avenue health centre in Mushin LGA. A descriptive cross sectional study was carried out in March 2004. Study instrument was an interviewer–administered questionnaire. Exit interviews were conducted at Community Health Outpatient Clinic, (CHOP) LUTH and at the Palm Avenue Primary School Health Care Centre over a 3-week period. Data was analyzed with EPI-INFO. A total of 100 respondents and 99 respondents were interviewed at CHOP and Palm Avenue Health Centres respectively. The mean age at CHOP was 30.2yrs while it was 29.1yrs at Palm Avenue. The mean waiting time to see the primary care giver at CHOP was 92.4 mins. compared to 55.9mins at Palm Avenue Health Centre. Overall, majority of clients (above 80%) were satisfied with service at both centers, through the proportion was higher at Palm Avenue. Age of respondents was significantly associated with client satisfaction with the staff attitude.; the older respondents were more satisfied than the younger ones. Majority of clients were satisfied with services at the health centre. However, there is a need for client flow analysis and a plan of action to reduce the time spent at these clinics to further improve client satisfaction with health services. Keywords: client, perception of child welfare service.NQJHM Vol. 15 (4) 2005: pp. 150-15

Assessment of the Quality of Packaged Water on Sale in Onitsha Metropolis

Background: In recent years, sale of packaged water has been on the increase in most urban cities in Nigeria. In order to safe guard public health, it is essential that the available packaged water is of the highest quality. Objective: To assess the physical, chemical and bacteriological quality of packaged water on sale in Onitsha metropolis Methodology: Two samples each of 60 brands of packaged water were randomly obtained from six different commercial locations within two LGAs in Onitsha metropolis. The samples were analysed for colour, odour, turbidity, pH, fluoride and coliform count. Membrane filtration technique was used for coliform count. Results: Forty five (75%) of samples were of high aesthetic value. All samples recorded fluoride levels within recommended WHO range of 0.5- 1.5 mg/dl. . Majority (70% ) of all samples of water were found to have coliform count of 10 or more per 100ml. 34% of samples were faecally contaminated with Klebsiella and E.coli being the major organisms.. Packaged water that was registered by NAFDAC had a higher bacteriological quality compared to unregistered ones.( Odds'ratio 6.05 CI : 1.37-36.4, p< 0.01.) Conclusion: Majority of the packaged water on sale in Onitsha metropolis were bacteriologically unsafe though most were of acceptable physical quality. There is a need for continuous monitoring of packaged water products by NAFDAC which should ensure strict enforcement of regulations to promote availability of potable packaged water. Keywords: Assessment, Quality, Packaged Water NQJHM Vol. 16 (2) 2006: pp. 56-5

Factors Determining Correct Case Management of Acute Respiratory Infections in Children by Primary Health care in Ibadan

Background: Inappropriate case management of Acute Respiratory Infections (ARIs) is one of the factors responsible for the high ARI mortality in developing countries. Identification of factors which influence ARI case management by health workers is key for interventions to improve Quality of case management. Objective: To identify factors which determine correct case management of Acute Respiratory Infections (ARIs) in children by primary health care workers in Ibadan. Design: A descriptive cross sectional study was carried out from June to December 1999 in Ibadan South East LGA and Lagelu LGA. Study materials included observation checklists, validation checklist, and health worker interview questionnaires. Results: Twenty-five health workers and 20 health workers were observed managing 390 children and 386 children in Ibadan South East and Lagelu LGA respectively. More than half of Pneumonia cases were correctly treated in the two LGAs (62.3% and 66.1% respectively). Sex and category of health workers was significantly associated with correct treatment of mild ARI with female workers and Nursing staff doing better (Odds ratio 4.57, 95% CI 2.15, 9.95 and 4.61, 95% CI 2.57, 8.31 respectively). Health workers who had been trained performed better in the management of Pneumonia though it was not statistically significant. Conclusions: There is a need for targeted research to identify the relative contribution of the myriad of factors influencing health worker performance in specific localities in order to improve the quality of care in child health programmes. Keywords: Factors, Case Management, ARI, Health workers.NQJHM Vol. 16 (1) 2005: pp. 14-1

Quality of life of family caregivers of children with orofacial clefts in Nigeria:A mixed-method study

BACKGROUND: Orofacial clefts (OFCs) are common birth defects that may impose a large burden on the health and psychosocioeconomic well-being of affected individuals and families. The current study aims to identify qualitative factors that affect the quality of life (QOL) of family caregivers of children with OFCs. METHODS: A mixed method study in which family caregivers of OFCs children were consecutively recruited from cleft clinics over a 3-month period. Quantitative data was analyzed using SPSS version 17 and FGD by framework analysis. RESULTS: A total of 107 caregivers participated in the entire study and 24 caregivers participated in the focus group discussions. About 50% of the children had cleft lip and palate (CLP), 28% with cleft lips only (CL) and 23.4% with cleft palate only (CP). Poor access to specific information and lack of empathy of professionals affected the quality of life and delivery of family centered care. CONCLUSIONS: To improve the quality of life of family caregivers, individual focused counseling sessions should be organized for caregivers soon after birth. This will provide an opportunity to discuss laid out plans for supportive care. It will also as an avenue to address arising social issues by health professionals and counselors

CASE REPORT - Term quadruplet pregnancy: a case report

Higher order multiple pregnancies are rare and often associated with complications. Term delivery is uncommon. This is a report of a 22 years old G3 p2 + 0 (1 alive) teacher who had quadruplet pregnancy following ovulation induction is presented. She had elective caesarean section at term with the delivery of two live male and two live female infants with birth weights ranging between 1750gram and 2850grams. Term delivery in quadruplet pregnancy is possible as demonstrated in this case, and has the advantage of improved perinatal outcome. Bed rest early detection and management of antenatal complications, and planned elective delivery are probably the keys to a successful outcome

Awareness of workers on Hazards Exposure and Safety Measure in an Aluminum industry in Ojo L.G.A. of Lagos State

A study of workers in an Aluminium industry located in Ojo Local Government Area of Lagos State, was carried out to determine the level of awareness to hazards and the use of preventive and protective measures put in place to control these hazards. Questionnaires were administered to all the staff of the company available during the period of data collection. Of the 150 questionnaires distributed, 120 were returned giving a response rate of 80%. The mean age of the respondents was 32.19 ± 9.3 years while the median age was 30 years. Majority (50%) of the respondents were in the age grouping 25 – 34 years. There was no significant statistical association between age, educational level and hazard awareness in the studied population. Males were more likely to regularly use protective devices compared to females, 4.6.5% and 23.5% respectively. Workers who had tertiary education were less likely to regularly use personnel protective equipment compared to those with secondary education, 32.1% and 50% respectively. The study makes recommendations to further improve knowledge and awareness of hazards in the work place towards safely control measures. Keywords: Knowledge, Hazards, Workers, Aluminum industryNQJHM Vol. 14 (3&4) 2004: pp. 220-22