Awareness and attitudes towards total cardiovascular disease risk assessment in clinical practice among physicians in Southern Nigeria

Introduction: The disparity between the increasing burden of cardiovascular disease (CVD) and available resources to treat it in sub-Saharan Africa necessitates preventive strategies. Total CVD risk assessment is a cost-effective approach to guide primary preventive therapy. However, in order to utilise this approach there has to be an understanding about it among the end-users. The objective of this study was to determine the awareness, use, and attitudes regarding total CVD risk assessment in clinical practice among physicians in Port Harcourt, Nigeria.Methods: a cross-sectional survey of 150 physicians in government hospitals and private practices in Port Harcourt city. The characteristics of ‘users’ versus ‘non-users’ of CVD risk assessment were compared with the Chi-Square test of significance.Results: 106 physicians completed the questionnaires. 74 (69.8%) reported awareness of tools available to assess total CVD risk. Among those aware, 87.1% agreed that CVD risk assessment is useful, 81% agreed it improves patient care, 74.3% agreed it leads to better decisions about recommending preventive therapies and 60% agreed that it increased the likelihood that they would recommend risk-reducing therapies to high-risk patients. However, 62.9% of these physicians felt it was time-wasting to use and only 21 (28.4%) actually use CVD risk assessment regularly in practice. The most commonly reported barrier was unfamiliarity with how to use risk estimation tools (52.8%). Majority who use it do so to guide preventive therapy. Female sex and the use of an Internet-enabled smartphone were associated with increased odds of being a ‘user’ of risk estimation tools (odds ratios 4.8, CI 1.4-16.9; and 5.9, CI 1.7-20.0 respectively).Conclusion: Utilisation of risk assessments in clinical practice is low. A major barrier was nonfamiliarity with how to use the tools. Continuous medical education and wider use of smartphone technology may represent health system approaches to tackling this issue.Keywords: Risk assessment, cardiovascular disease, and primary preventio

Utilization of Soursop (Annona muricta) Flour for the Production of Chin-Chin

The present study was aimed at utilizing soursop flour for the production of chin-chin. Soursop (SS) was processed to flour. Chin-chin was prepared from blends of wheat and soursop flours using 90:10, 80:20, 70:30, 60:40, 50:50 of wheat flour to soursop flour (SSF), and 100% wheat flour as control. Proximate and sensory analysis of the chin-chin was determined using standard methods. The samples were also stored for 3 weeks and evaluated at weekly intervals for total bacterial and fungal counts. Proximate composition of the chin-chin revealed a significant (p<0.05) increase in ash (0.42-0.96%), fat (33.31-39.29%), crude protein (5.32-7.94% protein), crude fibre (0.95-1.12%), and moisture content (4.85-7.65%) with a decrease in carbohydrate content (55.14-42.94%) as substitution of soursop flour increased. Energy content decreased as substitution of soursop flour increased, but beyond 30%, level, the energy content was observed to increase significantly. Substitution of soursop flour with wheat flour at the level of 10% compared favorably with the control sample suggesting that acceptable chin-chin could be produced at SSF substitution of up to 10%. The samples presented adequate microbiological conditions after storage of 3 weeks with counts ranging from 5.20×103-7.00×104cfu/g and 4.00×104-6.00×104cfu/g, for total bacterial and fungal counts, respectively. The study therefore showed that soursop can be utilized for the development of chin-chin with improved nutritional value over 100% wheat flour thereby serving as a nutritious household food which will help address the problem of protein-energy malnutrition

Intervertebral disc herniation: prevalence and association with clinical diagnosis

Background: Low back pain is one of the common health problems encountered in life with intervertebral disc herniation being a common cause of its occurrence. Magnetic resonance imaging has emerged the gold standard for diagnosing a herniated disc.Aims and Objectives: To assess the frequency and pattern of occurrence of disc herniation as well as evaluate the association of disc herniation on magnetic resonance imaging with clinical symptoms.Method: A total of 120 adult patients who came for magnetic resonance imaging scan of the lumbosacral spine for a period of 1year in the department of Radiology University of Port-Harcourt Teaching Hospital. The end plates of 600 lumbar interspaces were graded for type, size and site of lumbar disc herniation.Results: The age distribution of patients was from 18-80 years; mean age was 51.

Prevalence of risk factors for chronic kidney disease among adults in a university community in southern Nigeria

Introduction: The rising prevalence of chronic kidney disease (CKD) remains a global public health challenge particularly in developing countries, including our local environment, where subjects with the disease present late and may already be in need of renal replacement therapy. Early detection of modifiable risk factors of CKD is a plausible strategy to reduce its prevalence and burden. The 2014 World Kidney Day (WKD) exercise provided a veritable opportunity to identify CKD risk factors among adult Nigerians for early intervention. Methods: Subjects were mobilized from the University community for the 2014 WKD exercise. The parameters assessed were demographics, Body mass index (BMI), blood pressures, proteinuria, glycosuria, serum creatinine and fasting plasma glucose. Glomerular Filtration Rate (GFR) was estimated using the Cockcroft-Gault equation. Data were analyzed using SPSS version 17.0. Results: A total of 259 volunteers were studied, mean age of 28.3±9.7years (16-66years). Males comprised 135(52.1%) while  124(47.9%) were females. The frequency of risk factors of CKD observed were obesity in 31(12.2%) subjects, proteinuria and glycosuria in 32(12.4%) and 7(2.7%) subjects respectively. Hypertension and hyperglycaemia were seen in 54(20.8%) and 11(4.3%) of subjects respectively. Five subjects (1.9%) had e-GFR < 60mls/min/1.73m2. Conclusion: Prevalence of CKD risk factors in this study population was high. There is need for continuous education, regular screening for early detection and early intervention by risk factor modification to prevent and/or reduce the growing burden of CKD and its sequelae in Nigeria

Effects of antibiotic resistance, drug target attainment, bacterial pathogenicity and virulence, and antibiotic access and affordability on outcomes in neonatal sepsis: an international microbiology and drug evaluation prospective substudy (BARNARDS)

Background Sepsis is a major contributor to neonatal mortality, particularly in low-income and middle-income countries (LMICs). WHO advocates ampicillin–gentamicin as first-line therapy for the management of neonatal sepsis. In the BARNARDS observational cohort study of neonatal sepsis and antimicrobial resistance in LMICs, common sepsis pathogens were characterised via whole genome sequencing (WGS) and antimicrobial resistance profiles. In this substudy of BARNARDS, we aimed to assess the use and efficacy of empirical antibiotic therapies commonly used in LMICs for neonatal sepsis. Methods In BARNARDS, consenting mother–neonates aged 0–60 days dyads were enrolled on delivery or neonatal presentation with suspected sepsis at 12 BARNARDS clinical sites in Bangladesh, Ethiopia, India, Pakistan, Nigeria, Rwanda, and South Africa. Stillborn babies were excluded from the study. Blood samples were collected from neonates presenting with clinical signs of sepsis, and WGS and minimum inhibitory concentrations for antibiotic treatment were determined for bacterial isolates from culture-confirmed sepsis. Neonatal outcome data were collected following enrolment until 60 days of life. Antibiotic usage and neonatal outcome data were assessed. Survival analyses were adjusted to take into account potential clinical confounding variables related to the birth and pathogen. Additionally, resistance profiles, pharmacokinetic–pharmacodynamic probability of target attainment, and frequency of resistance (ie, resistance defined by in-vitro growth of isolates when challenged by antibiotics) were assessed. Questionnaires on health structures and antibiotic costs evaluated accessibility and affordability. Findings Between Nov 12, 2015, and Feb 1, 2018, 36 285 neonates were enrolled into the main BARNARDS study, of whom 9874 had clinically diagnosed sepsis and 5749 had available antibiotic data. The four most commonly prescribed antibiotic combinations given to 4451 neonates (77·42%) of 5749 were ampicillin–gentamicin, ceftazidime–amikacin, piperacillin–tazobactam–amikacin, and amoxicillin clavulanate–amikacin. This dataset assessed 476 prescriptions for 442 neonates treated with one of these antibiotic combinations with WGS data (all BARNARDS countries were represented in this subset except India). Multiple pathogens were isolated, totalling 457 isolates. Reported mortality was lower for neonates treated with ceftazidime–amikacin than for neonates treated with ampicillin–gentamicin (hazard ratio [adjusted for clinical variables considered potential confounders to outcomes] 0·32, 95% CI 0·14–0·72; p=0·0060). Of 390 Gram-negative isolates, 379 (97·2%) were resistant to ampicillin and 274 (70·3%) were resistant to gentamicin. Susceptibility of Gram-negative isolates to at least one antibiotic in a treatment combination was noted in 111 (28·5%) to ampicillin–gentamicin; 286 (73·3%) to amoxicillin clavulanate–amikacin; 301 (77·2%) to ceftazidime–amikacin; and 312 (80·0%) to piperacillin–tazobactam–amikacin. A probability of target attainment of 80% or more was noted in 26 neonates (33·7% [SD 0·59]) of 78 with ampicillin–gentamicin; 15 (68·0% [3·84]) of 27 with amoxicillin clavulanate–amikacin; 93 (92·7% [0·24]) of 109 with ceftazidime–amikacin; and 70 (85·3% [0·47]) of 76 with piperacillin–tazobactam–amikacin. However, antibiotic and country effects could not be distinguished. Frequency of resistance was recorded most frequently with fosfomycin (in 78 isolates [68·4%] of 114), followed by colistin (55 isolates [57·3%] of 96), and gentamicin (62 isolates [53·0%] of 117). Sites in six of the seven countries (excluding South Africa) stated that the cost of antibiotics would influence treatment of neonatal sepsis

A simulation study of the lower limit of permeability for a commercially feasible gas well

Due to the character of the original source materials and the nature of batch digitization, quality control issues may be present in this document. Please report any quality issues you encounter to [email protected], referencing the URI of the item.Bibliography: leaf 44.Not availabl

The Occurrence of Vibrio species in the Gut of Sardinella madrensis in Port Harcourt, Nigeria

The occurrence of vibrio bacteria in the gut of “Songu”: Sardinella madrensis was investigated using enrichment procedures. Seventy percent (70%) of the total fish samples examined were positive for vibrios. The mean bacterial counts ranged between 2.68 x 102 to 1.30 x 104 cfu/g in all the fish samples. The weight of fish samples ranged between 25.0g and 30.9g and the bacterial counts increased with fish weight. Four major species were isolated, though in varying frequencies and they included Vibrio cholerae (2.7%), V. hollisae (5.4%), V. parahaemolyticus (10.8) and V. vulnificus (81.5%). The presence of these bacterial species in the fish samples might expose the consumers to a wide variety of disease conditions. Keywords: Vibrio flora, “Songu”: Sardinella madrensis, gut Journal of Medical Laboratory Science Vol. 13 (2) 2004: pp. 62-6

The aetiology of neonatal septicaemia in Port Harcourt, Nigeria

No Abstract. Mary Slessor Journal of Medicine Vol. 8 (1) 2008: pp. 27-3