Medical causes of death in a teaching hospital in South‑Eastern Nigeria: A 16 year review

Background: Most developing regions of the world are undergoing gradual epidemiological transition resulting in high burden of both communicable and noncommunicable diseases. This affects the pattern of death in this region.Objective: The objective of this study is to determine the causes of death in the medical wards of the University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, South‑East Nigeria from 1995 to 2010.Materials and Methods: Data were collected retrospectively from January 1995 to December 2010.Statistical Analysis Used: Statistical Package for Social Sciences (SPSS Inc. Chicago, IL, USA) version 17.0 was used. Simple descriptive statistics were done. Student’s t‑test was used to compare means of continuous variables, while Chi‑square test was used to test significance of differences between two proportions.Results: The mortality rate was 22.8% (6250/27,514) admissions. The male to female ratio was 1.7:1. Infections (20.2%) were the most common cause of death. However, chronic kidney disease was the single most common disease entity causing death (12.3%). Other important causes of death in order of prevalence were cerebrovascular accident (10.5%), acquired immune deficiency syndrome and tuberculosis either alone or as co‑infection (10.3%), heart failure (8.8%), chronic liver disease (7.0%), septicemia (6.5%), respiratory failure (5.3%), diabetes mellitus (4.6%), cardiac arrhythmias (2.9%), and primary liver cell carcinoma (2.7%). There were few deaths from tetanus, malaria, typhoid fever, and coronary artery disease.Conclusion: Mortality is high in our medical wards and reflects the emerging trend of mixed disease spectrum comprising communicable and noncommunicable diseases.Keywords: Chronic kidney disease, infections, medical wards, mortality, Nigeri

Novel colorimetric assay of mefenamic acid using 4-amino-3,5-dinitrobenzoic acid (ADBA)

Purpose: To develop a novel colorimetric assay method for mefenamic acid capsules. Method: The new method (aromatic ring derivatization technique) is based on a diazo coupling reaction using diazotized 4-amino-3,5-dinitrobenzoic acid (ADBA) as a chromogenic derivatizing reagent. Result: Optimization studies showed that the coupling reaction is very fast and completed in less than 1 minute. A 1:1 drug to reagent stoichiometric ratio was obtained for the azo dye formed. The azo adduct formed exhibits bathochromic shift with absorption maximum (lmax) at 490 nm, which was selected as the analytical wavelength. Lower limit of quantitation of mefenamic acid was 1 mg/ml. The assays were linear over the concentration range of 1 - 6 mg/ml and reproducible. This new method has been successfully applied in the assay of mefenamic acid capsules with accuracy similar to the official (B.P) titrimetric method of assay (p>0.05) and has the advantages of speed, high sensitivity, lower limit of detection and can be automated. Conclusion: The method developed could find application in in-process quality control of mefenamic acid capsules. Keywords: Mefenamic acid assay, 4-amino-3,5-dinitrobenzoic acid, colorimetry, diazotization Trop J Pharm Res, June 2002; 1(1): 15-2

Age, Weight and Height at Menarche Among School Girls in Zaria

Context: Age at menarche has been trending downwards in most communities and this period often coincides with the onset of coitus and the first pregnancy, especially in Northern NigeriaObjectives: The aim of the study was to determine the current age at menarche of schoolgirls in Zaria and ascertain the biosocial and other factors that may be influencing it.Materials and Methods: Girls from selected schools in Zaria were interviewed, using a structured questionnaire, to ascertain their age at menarche and obtain other socio-demographic information. Their weighta and heights were also measured. The results were analyzed with a computer statistical package and tabulatedResults: Out of the 3,130 girls in the eight schools selected, 148 of them attained menarche in the preceeding three months and they constituted the study group. The age of menarche ranged from 132 to 206 months (11.0 to 17.17 years). The mean menarcheal age ranged from 162.1 months for girls in Social Class I to 178.5 months for those in Class V.Conclusion: Earlier onset of menarche in Nigerian school girls reinforces the need for appropriate family life and sexuality education to minimize the risk of reproductive health problems in these adolescents.Key Words: Menarche, Anthropometric Measurements, Adolescenc

Pattern of cancer deaths in the medical wards of a teaching hospital in South East Nigeria

Background: Cancers are emerging public health problems in developing countries like Nigeria. The epidemiological shift and aging population make cancers a challenge.Objective: We set out to describe the pattern of death due to cancer in our medical ward. The hospital is one of the premier hospitals covering the South East zone of Nigeria.Materials and Methods: We retrospectively reviewed the case notes and death certificates of all who died of cancer in our adult medical wards for 16 years (January 1995 to December 2010).Statistical Analysis Used: Statistical Package for Social Sciences (SPSS Inc. Chicago, IL) version 17.0 was used.Results: Twenty seven thousand, five hundred and fourteen patients were admitted into the medical wards. Six thousand, two hundred and fifty died. Out of the 6250 deaths, cancers accounted for 7.6%. Male to Female ratio was 2.4:1. The mean age at death was 43.7 ± 17.4 years. The mean age at death in both sexes was similar (42.9 ± 17.5 for men and 45.7 ± 17.0 years for women), P = 0.109. Primary liver cell carcinoma was the most common cause of death among men (40.8%), while cancer of hematopoietic organ was the most common in women (48.7%). The overall fatality rate was 1.7% (477/27 514) of medical admissions. Younger and middle age groups were most commonly affected in both sexes. Conclusion: Since the most productive age groups were affected, governments in developing countries should as a matter of urgency put in place adequate cancer preventive and curative services.Keywords: Cancer, mortality, medical wards, South East NigeriaNigerian Journal of Clinical Practice • Oct-Dec 2013 • Vol 16 • Issue

Surgical wound infection

Objective. To review the risk factors for surgical would infection; the use of prophylactic antibiotics in the prevention of wound infection; and the benefits of wound surveillance programmes to reduce the rate of surgical wound infection. Data sources. Medline literature search and review of published work on surgical wound infection, and the references cited in them. Study selection. Critical studies containing supporting evidence were selected. Data extraction. Data were extracted independently by multiple observers. Data synthesis. Factors that effect the susceptibility of a wound to infection include a pre-existing illness, the duration of the operative procedure, wound contamination, three or more diagnoses at the time of discharge, and abdominal operations. Antibiotic prophylaxis can decrease postoperative morbidity, shorten hospital stay, and reduce overall costs attributable to infection; the choice of antibiotic depends on the would class. Wound surveillance can also decrease wound infection rates. Conclusion. Surgical wound infections are common and consume a considerable portion of health care finances. A reduction in the infection rate to a minimal level, however, can be achieved by the judicious use of antibiotic prophylaxis and the use of an organised system of wound surveillance and reporting.published_or_final_versio

A step into the world of Pakistanis: oral health education for Pakistani adults in Hong Kong

Includes bibliographical references (p. 32).Questionnaire in English and Urdu.published_or_final_versio

A simulation study of the effects of alcohol on driving performance in a Chinese population

Driving under the influence of alcohol (DUIA) is a significant factor contributing to road traffic crashes, injuries, and fatalities. Although the effects of alcohol on driving performance are widely acknowledged, studies of the effects of alcohol impairment on driving performance and particularly on the control system of Chinese adults are rare. This study attempts to evaluate the effects of alcohol on the driving performance of Chinese adults using a driving simulator.Method: A double-blind experimental study was conducted to evaluate the effects of alcohol impairment on the driving performance of 52 Chinese participants using a driving simulator. A series of simulated driving tests covering two driving modules, including emergency braking (EB) and following braking (FB), at 50. km/h and 80. km/h were performed. Linear mixed models were established to evaluate driving performance in terms of braking reaction time (BRT), the standard deviation of lateral position (SD-LANE), and the standard deviation of speed (SD-SPEED).Results: Driving performance in terms of BRT and SD-LANE was highly correlated with the level of alcohol consumption, with a one-unit increase in breath alcohol concentration (BrAC) degrading BRT and SD-LANE by 0.3% and 0.2%, respectively. Frequent drinkers generally reacted faster in their BRT than less-frequent drinkers and non-drinkers by 10.2% and 30.6%, respectively. Moreover, alcohol impairment had varying effects on certain aspects of the human control system, and automatic action was less likely to be affected than voluntary action from a psychological viewpoint.Conclusion: The findings should be useful for planning and developing effective measures to combat drink driving in Chinese communities.Department of Civil and Environmental Engineerin

Transactivation of EGFR by LPS induces COX-2 expression in enterocytes

Necrotizing enterocolitis (NEC) is the leading cause of gastrointestinal morbidity and mortality in preterm infants. NEC is characterized by an exaggerated inflammatory response to bacterial flora leading to bowel necrosis. Bacterial lipopolysaccharide (LPS) mediates inflammation through TLR4 activation and is a key molecule in the pathogenesis of NEC. However, LPS also induces cyclooxygenase-2 (COX-2), which promotes intestinal barrier restitution through stimulation of intestinal cell survival, proliferation, and migration. Epidermal growth factor receptor (EGFR) activation prevents experimental NEC and may play a critical role in LPS-stimulated COX-2 production. We hypothesized that EGFR is required for LPS induction of COX-2 expression. Our data show that inhibiting EGFR kinase activity blocks LPS-induced COX-2 expression in small intestinal epithelial cells. LPS induction of COX-2 requires Src-family kinase signaling while LPS transactivation of EGFR requires matrix metalloprotease (MMP) activity. EGFR tyrosine kinase inhibitors block LPS stimulation of mitogen-activated protein kinase ERK, suggesting an important role of the MAPK/ERK pathway in EGFR-mediated COX-2 expression. LPS stimulates proliferation of IEC-6 cells, but this stimulation is inhibited with either the EGFR kinase inhibitor AG1478, or the selective COX-2 inhibitor Celecoxib. Taken together, these data show that EGFR plays an important role in LPS-induction of COX-2 expression in enterocytes, which may be one mechanism for EGF in inhibition of NEC

In Vivo Comparative Evaluation of Effects of Artemeter-Lumefantrine, Sulphadoxine-Pyrimetamine and Halofantrine on G6PD Activities, Haemoglobin Concentration and Malaria Parasite Clearance Rate in Malaria Infected Adults

Background: The use of antimalaria combination therapy especially regimens containing an artemisin-based compound has been recommended as a good first-line treatment for malaria by WHO. However, limited reports exist on the effects of the ACT and other antimalarial drugs on some vital biological parameters such as G6PD activity and haemoglobin concentration. In this study, we investigated the effects of Artemeter-Lumefantrine, sulphadoxine-pyrimetamine combination therapies and Halofantrine monotherapy on G6PD activity, Haemoglobin level and parasite clearance rate in malaria-infected adults treated with the drugs in Enugu, Nigeria. Methodology: Forty malaria-infected adults aged between 20 and 30 years were used. The subjects were divided into four groups (A, B, C and D). The groups A, B and C were given Artemeter-Lumefantrine, sulphadoxine-pyrimetamine and halofantrine respectively, while group D was a control group (malaria-positive control). Blood samples of the subjects were collected through venepuncture at baseline (Day 0) and after treatment on Day 4, for comparative analysis of G6PD activity, haemoglobin concentration and parasite clearance for each group. Results: The result of this study showed that sulphadoxine-pyrimetamine significantly (p<0.05) lowered haemoglobin concentration as compared with Halofantrine, Artemeter-lumefantrine and control. The haemoglobin concentration of the last three groups did not show any significant difference (p>0.05) between each other. The G6PD activity of the group treated with sulphadoxine-pyrimetamine was significantly (p<0.05) higher as compared with that treated with Artemeter-lumefantrine but non-significant (p>0.05) as compared with halofantrine and control. Parasite clearance rate was significantly (p<0.05) highest with the Halofantrine group (76%, p< 0.05) while Sulphadoxine-pyrimetamine had the lowest (52%) parasite clearance. Conclusion: This study therefore indicated that antimalaria drugs as well as malaria parasite could cause a reduction in haemoglobin concentration with sulphadoxine-pyrimetamine causing significant (p<0.05) increase in G-6-PD activity. Keywords: Antimalarials, Artemether-Lumefantrine, G6PD, sulphadoxine-pyrimetamine, Parasite clearance, Halofantrine, Haemoglobin concentratio