Challenges of Residency Training and Early Career Doctors in Nigeria Phase II: Update on Objectives, Design, and Rationale of Study

Background: Early career doctors (ECDs) are a dynamic and highly mobile group of medical and dental practitioners who form a significant proportion of the health workforce in Nigeria. The challenges of residency training and ECDs in Nigeria CHARTING Phase I study explored limited challenges affecting ECDs under the broad themes of demography, workplace issues, and psychosocial issues. The CHARTING II was expanded to provide wider insight into the challenges of ECDs in Nigeria. Objective: This protocol aims to provide clear objectives including description of objectives, design, and rationale for the conduct of the proposed CHARTING II study which seeks to explore other components under the various themes of demographic, workplace, psychosocial issues affecting the ECDs in Nigeria, and which were not explored under CHARTING I.   Methodology: This shall be a mixed study design that will combine qualitative and quantitative methods, to investigate 27 subthemes among 2000 ECDs spread across 31 centers, accredited by the Nigerian Association of Resident Doctors. Participants shall be selected using the multistage sampling method. The primary data will be generated using structured proforma and validated questionnaires,while administrative sources would serve as a source of secondary data. Data will be entered and analyzed using appropriate statisticalsoftware. Conclusion: CHARTING II study would provide more robust data and insight into the problems encountered by ECDs in Nigeria. This would in turn build a platform for institutional engagement and advocacy in order to drive relevant policies to mitigate these challenges. Keywords: Early career doctors, Nigeria, residency, resident doctors, trainin

The Effect of Histamine on the Rat Oestrous Cycle

Intracerebroventricular (icv) administration of histamine (80-120mg) to adult Wistar rats was found to induce irregular cycles and, at times, persistent oestrous cycle when administered at different stages of the cycle. Cimetidine (50 mg/kg), a H2-receptor antagonist, administered intraperitoneally (ip) produced a transient change in the cycle, which returned to normal rhythm after a day or two. Triprolidine (50 mg/kg; ip), a H1-receptor antagonist, showed no changes in the oestrous rhythm while chlorpheniramine (50 mg/kg; ip), another H1-receptor antagonist, produced a non-significant degree of changes in the cycle. Drugs were administered at proestrus (P) oestrus (E), metoestrus (M) and dioestrus (D) of the cycle. Older rats exhibited more cycling irregularities than the younger ones when they were injected with histamine. These results suggest that histamine could play a role in reproduction as higher levels of histamine may be liable to cause adverse changes or damage to the clock mechanism (suprachiasmatic nucleus) controlling the gonadotrophin secretion and thus affect the reproductive functions. Key Words: Effect of histamine, oestrous cycle, rat. Résumé L'administration intracerebroventriculaire(ICV) de l'histamine(80-120mg)chez les “wistar rats” s'est avérée induire des cycle irreguliers et par moment des cycle œstru persistant quand administré à different stades du cycle. La cimetidine(50mg/kg),un recepteur-H2 antagoniste administre par voie intrapéritoneal(ip)générait un changement transitoire dans le cycle qui retournait a son rythme normal un ou deux jours après. La Tripolidine(50mg/kg,ip) un recepteur H1 antagonist ne montrait aucun changement dans le cycle œstral alors que le chlorpheniramine(50mg/kg,ip) un autre recepteur H1 Antagonist produisait un degrée de changement non significatif dans le cycle. Les médicaments ont été administrés à des périodes proœstral œstral, metaœstral et diœstral du cycle. Les souris les plus agées exhibère plus d'irrégularité dans leur cycle que les jeunes quand elles étaient injecter a l'histamine. Ces resultants sugèrent que l'histamine peut jouer un rôle dans la reproduction puisque des dose élevées peuvent causer des changement adverses.ou des degats au mechanisme de l'horloge interne(suprachiasmatique) qui contrôle la sécretion des gonadotrophines. Et ce sur la reproduction. Mot clés: effet histaminique, cycle œstrus, souris West Afr. J. Pharmacol. Drug Res. Vol.19 (1&2) 2003: 47-5

Pre-clinical and preliminary dose-finding and safety studies to identify candidate antivenoms for treatment of envenoming by saw-scaled or carpet vipers (Echis ocellatus) in northern Nigeria

The aim of this study was to identify candidate antivenoms with specific activity against the venom of the saw-scaled or carpet viper (Echis ocellatus) in northern Nigeria, where bites by this species cause great morbidity and mortality but where effective antivenoms have become scarce and unaffordable. Selected antivenoms were destined to be compared by randomised controlled clinical trials (RCTs). Standard pre-clinical neutralisation assays were carried out in rodents. We included two licensed antivenoms of established clinical efficacy and 6 candidate antivenoms. Although 6 of the tested antivenoms showed promising efficacy, all but 3 were excluded from further study because of inadequate pre-clinical efficacy or because they were unavailable or unaffordable for the anticipated RCTs. Median effective doses (ED 50) of the remaining three candidate antivenoms suggested that the following doses might neutralise the maximum observed venom yield of 24.8mg (dry weight) of venom milked from captive E. ocellatus: 10ml of MicroPharm " EchiTAb G" (ET-G) antivenom; 30ml of Instituto Clodomiro Picado " EchiTAb-Plus-ICP" (ET-Plus) antivenom; 50ml of VacSera, Cairo " EgyVac" antivenom. A preliminary clinical dose-finding and safety study of these three antivenoms was carried out in 24 patients with incoagulable blood after E. ocellatus bites who were not severely envenomed. A 3+3 dose escalation design was employed. Initial doses of 10ml ET-G and 30ml ET-Plus restored blood coagulability in groups of 6 patients with early mild reactions (pruritus only) in not more than one third of them. EgyVac antivenom did not fulfil efficacy or safety criteria in 12 patients. On the basis of these results, ET-G and ET-Plus were selected for comparison in a RCT. © 2009 Elsevier Ltd

Pre-clinical and preliminary dose-finding and safety studies to identify candidate antivenoms for treatment of envenoming by saw-scaled or carpet vipers (Echis ocellatus) in northern Nigeria.

The aim of this study was to identify candidate antivenoms with specific activity against the venom of the saw-scaled or carpet viper (Echis ocellatus) in northern Nigeria, where bites by this species cause great morbidity and mortality but where effective antivenoms have become scarce and unaffordable. Selected antivenoms were destined to be compared by randomised controlled clinical trials (RCTs). Standard pre-clinical neutralisation assays were carried out in rodents. We included two licensed antivenoms of established clinical efficacy and 6 candidate antivenoms. Although 6 of the tested antivenoms showed promising efficacy, all but 3 were excluded from further study because of inadequate pre-clinical efficacy or because they were unavailable or unaffordable for the anticipated RCTs. Median effective doses (ED(50)) of the remaining three candidate antivenoms suggested that the following doses might neutralise the maximum observed venom yield of 24.8 mg (dry weight) of venom milked from captive E. ocellatus: 10 ml of MicroPharm "EchiTAb G" (ET-G) antivenom; 30 ml of Instituto Clodomiro Picado "EchiTAb-Plus-ICP" (ET-Plus) antivenom; 50 ml of VacSera, Cairo "EgyVac" antivenom. A preliminary clinical dose-finding and safety study of these three antivenoms was carried out in 24 patients with incoagulable blood after E. ocellatus bites who were not severely envenomed. A 3+3 dose escalation design was employed. Initial doses of 10 ml ET-G and 30 ml ET-Plus restored blood coagulability in groups of 6 patients with early mild reactions (pruritus only) in not more than one third of them. EgyVac antivenom did not fulfil efficacy or safety criteria in 12 patients. On the basis of these results, ET-G and ET-Plus were selected for comparison in a RCT