Morbidity and mortality amongst infants of diabetic mothers admitted into a special care baby unit in Port Harcourt, Nigeria

<p>Abstract</p> <p>Background</p> <p>Infants born to diabetic women have certain distinctive characteristics, including large size and high morbidity risks. The neonatal mortality rate is over five times that of infants of non diabetic mothers and is higher at all gestational ages and birth weight for gestational age (GA) categories.</p> <p>The study aimed to determine morbidity and mortality pattern amongst infants of diabetic mothers (IDMS) admitted into the Special Care Baby Unit of University of Port Harcourt Teaching Hospital.</p> <p>Methods</p> <p>This was a study of prevalence of morbidity and mortality among IDMs carried out prospectively over a two year period. All IDMs (pregestational and gestational) admitted into the Unit within the period were recruited into the study.</p> <p>Data on delivery mode, GA, birth weight, other associated morbidities, investigation results, treatment, duration of hospital stay and outcome were collated and compared with those of infants of non diabetic mothers matched for GA and birth weight admitted within the same period. Maternal data were reviewed retrospectively. Data were analyzed using SPSS 16.0.</p> <p>Results</p> <p>Sixty percent of the IDMs were born to mothers with gestational diabetes, while 40% were born to mothers with pregestational DM. 38 (74.3%) were born by Caesarian section (CS), of which 20 (52.6%) were by emergency CS. There was no significant difference in emergency CS rates, when compared with controls, but non-IDMs were more likely to be delivered vaginally. The mean GA of IDMs was 37.84 weeks ± 1.88. 29 (61.7%) of them were macrosomic. The commonest morbidities were Hypoglycemia (significantly higher in IDMs than non-IDMs) and hyperbilirubinaemia in 30 (63.8%) and 26 (57.4%) respectively.</p> <p>There was no difference in morbidity pattern between infants of pre- gestational and gestational diabetic mothers. Mortality rate was not significantly higher in IDMs</p> <p>Conclusions</p> <p>The incidence of macrosomia in IDMs was high but high rates of emergency CS was not peculiar to them. Hypoglycaemia and hyperbilirubinaemia were the commonest morbidities in IDMs.</p> <p>Referring women with unstable metabolic control to specialized centers improves pre- and post- natal outcomes. Maternal-Infant centers for management of diabetes in pregnancy are advocated on a national scale to reduce associated morbidity and mortality</p

Gender variations in specialties among medical doctors working in public healthcare institutions in Bayelsa State, Nigeria

Background: Gender variations exist in the choice of specialties among doctors globally. This variation is of public health importance as it affects the distribution of doctors in public health institutions and patient care. In Bayelsa, Nigeria,no such study had been undertaken.This study aimed to examine gender variations in specialties among medical doctors working in public healthcare institutions in Bayelsa State.Methods: Cross-sectional study design was adopted for this study. Information about doctors working in public healthcare institutions in Bayelsa were collected via data extraction from the register of doctors at Niger Delta University Teaching Hospital (NDUTH) and at Hospital Management Board (HMB) of State Ministry of Health, and with self-completed questionnaires from doctors at Federal Medical Centre (FMC). In this paper, statistical analyses were restricted to data from FMC (n=91) and NDUTH (n=100) because they have multiple specialties. All available data were analyzed by gender and data analyses were carried out using SPSS statistical software.Results: Out of the191 doctors included in the analysis, 135(70.7%) were males. The median age was 32 years for male doctors and 29 years for female doctors.The top three specialty choices for males were obstetrics and gynaecology (14.8%),internal medicine (11.1%) and surgery (8.9%). For female doctors,pediatrics was the topmost specialty (25%) followed by obstetrics and gynaecology (10.7%) and internal medicine (8.9%). There were no female doctors in 14 specialties. Female doctors had higher proportions of house officers compared to males (45.5% versus 32.3% respectively). Conversely, male doctors had higher proportions of consultants/specialists than females (24.1% versus 9.1% respectively).Conclusion: Specialty distribution of doctors in Bayelsa is gendered and some specialties appear not to attract female doctors. These findings call for further studies to investigate the factors responsible for this gender variation, and to identify and address any barriers.Keywords: Gender variation,Specialties,Doctors,Public healthcare,Health workforc

Characteristics of medical doctors working in public healthcare institutions in a southern Nigerian state

Objective: This study assessed the characteristics of medical doctors working in public healthcare institutions and examined differences in some of the characteristics by geographical (urban versus rural) location.Methods: A cross-sectional study of doctors working in public healthcare institutions using data obtained from 3 centres in Bayelsa, Nigeria.Results: Three-quarters (75.4%) of the 280 medical doctors were males. Most of the doctors (68.6%) were working at tertiary healthcare level, 16.1% at primary and 15.4% at secondary healthcare levels. In terms of their professional positions, there were more medical officers (34.5%) relative to the other cadres while 17.2% were consultants. When their places of practice were dichotomised into rural and urban settings, 88.2% were practising in urban settings. A higher proportion of the 69 female doctors were practising in urban settings compared to rural settings (26.7% versus 9.1% respectively, P=0.027). There was a statistically significant relationship between residency status and place of practice (P=0.001). Specialists  (i.e. doctors who have completed residency training) were more likely to practice in urban (19.2%) than in rural settings (3.3%).Conclusion: Only a quarter of doctors in this study were females. There seemed to be more doctors at tertiary level of care and in urban areas. These findings suggest that there may be a shortage of female doctors, and that there may be unmet personnel needs at primary and secondary healthcare levels and in rural areas.Keywords: Health services, Human resources for heath, Health workforce, Geographical Distribution, Medical Doctor

SCREENING OF CRUDE EXTRACTS OF TWELVE MEDICINAL PLANTS AND “WONDER-CURE” CONCOCTION USED IN NIGERIA UNORTHODOX MEDICINE FOR ACTIVITY AGAINST MYCOBACTERIUM TUBERCULOSIS ISOLATED FROM TUBERCULOSIS PATIENTS SPUTUM

The antimicrobial activity of extracts of twelve Nigerian medicinal plant species and a “wonder cure” concoction [Epa –Ijebu]; used in traditional medicine for the treatment of tuberculosis and cough were screened for activity against Mycobacterium tuberculosis isolated from tuberculosis patient sputum and the control strains of M. tuberculosis (H37RV). Both ethanolic and aqueous solution of the extract of Allium ascalonicum, Terminalia glaucescens, Allium cepa and Securidaca longepedunculata (ethanolic extract only) at 0.05g/ml as well as aqueous solution of “wonder cure” concoction at same concentration inhibited the growth of M. tuberculosis. However at lower concentration of 0.2 µg/ml (critical proportion level of the control drug (isoniazide), M. tuberculosis was resistant to both aqueous and ethanolic extracts of the plants as well as the aqueous solution of the wonder-cure concoction. The phytochemical analysis of the plant extract and the Epa-Ijebu showed the presence of bioactive compounds: tannin, flavonoid, alkaloids, phlobatannin, anthocyanin, reducing sugar, saponin and anthraquinone. Our results offer a scientific basis for the traditional use of aqueous and ethanolic extracts of Allium ascalonicum, Terminalia glaucescens, Allium cepa, Securidaca longepeducunlata (ethanolic extract only) and aqueous solution of the “wonder cure” concoction at higher concentration against M. tuberculosis. However local herbs such as Nicotiana tabacum, Allium sativum, Aframomum melegueta, Aprus precatorius, Xylopia aethiopica, Tetrapleura tetraptera, Crinium jagus, and Garcinia kola were ineffective

Possible Impact of Co-infections of Tuberculosis and Malaria on the CD4+ Cell Counts of HIV Patients in Nigeria

Background: This study focused on evaluating the possible impact of co-infections of tuberculosis and malaria on the CD4+ cell counts in HIV infected subjects. Methods: This is a cross sectional study. The subjects were drawn from three hospitals and a blood bank in LagosState. After due consent, blood samples were obtained from 69 subjects with single infections (HIV, TB, and Malaria), 34 subjects with multiple infections (HIV/Malaria, HIV/TB, Malaria/TB, HIV/TB/Malaria) and 24 blood donors (controls). The CD4+ cell counts of all the 127 blood samples were estimated using a FACS count. Results: Data obtained were analysed and a comparison of the results showed that the median CD4+ counts in all groups of subjects with HIV infections (whether single or co-infection) were similar and significantly lower than the median counts for the healthy control group as well as groups without HIV infection (malaria, TB and malaria/TB). Conclusion: Overall data further confirmed the progressive depletion of CD4+ cells in HIV infection while co-infections with TB and malaria did not have any impact on the CD4+ cells of HIV infected subjects. A larger prospective study is needed.Fond: Cette \ue9tude a \ue9t\ue9 consacr\ue9e \ue1 l'\ue9valuation de l'impact possible de co-infections de tuberculose et le paludisme sur les comptes de cellule CD4+ des sujets infect\ue9s du VIH. M\ue9thode: Ceci est une \ue9tude transversale. Les sujets ont \ue9t\ue9 choisis de trois diff\ue9rents h\uf4pitaux et une banque du sang dans l'Etat de Lagos. Apr\ue8s le consentement n\ue9cessaire, les \ue9chantillons de sang ont \ue9t\ue9 obtenus de 69 sujets avec les mono-infections (VIH, TB, et le Paludisme), 34 sujets avec les infections multiples (le VIH/PALUDISME, LE VIH/TB, LE Paludisme/TB, VIH/TB/le Paludisme) et 24 donneurs de sang (les contr\uf4les). les comptes de cellule CD4+ de tous les 127 \ue9chantillons de sang ont \ue9t\ue9 estim\ue9s utilisant une compte FACS. R\ue9sultats: les donn\ue9es obtenues ont \ue9t\ue9 analys\ue9es et une comparaison des r\ue9sultats a d\ue9montr\ue9 que le m\ue9dian des comptes CD4+ dans tous les groupes de sujets avec les infections de VIH (soit mono ou co-infection) \ue9taient similaires et significativement plus bas que les comptes m\ue9dianes pour le groupe de contr\uf4le sain de m\ueame que les groupes sans l'infection de VIH (le paludisme, TB et le paludisme/TB). Conclusion: les donn\ue9es g\ue9n\ue9rales ont confirm\ue9 le plus l'\ue9puisement progressif des cellules CD4+ dans l'infection de VIH pendant que les co-infections avec TB et le paludisme n'ont pas eu aucun impact sur les cellules CD4+ des sujets infect\ue9s de VIH. Une plus profonde \ue9tude sera n\ue9cessaire

Experimental evaluation in wireless communications

This editorial sums up relevant topics on the assessment of wireless communication systems covered by the especial issue entitled "Experimental Evaluation in Wireless Communications". The topics include practical aspects on the implementation of distributed asynchronous non-linear kernel methods over wireless sensor networks; localization methods based on the exploitation of radio-frequency identification (RFID) wireless sensors and cellular networks or on sparsity approximations; channel sounding and assessment of broadband orthogonal frequency-division multiplexing (OFDM)-based wireless systems in high-speed vehicular communications; coexistence analysis of femtocell-based and outdoor-to-indoor systems; techniques for peak-to-average power ratio (PAPR) reduction; new solutions for baseband and radio frequency (RF) hardware impairments in full-duplex wireless systems; and, finally, suitability of interference alignment for broadband indoor wireless communications

Bacteriocinogenicity and production of pyocins from Pseudomonas species isolated in Lagos, Nigeria

A total of 52 strains of Pseudomonas identified as P. aeruginosa (27), P. putida (9), P. fluorescens (13) and P. stutzeri (3) were isolated from Nigerian patients with burns, wound and skin infections, UTI, diarrhoea and eye infections. 81.5, 55.6, 76.9 and 33.3% of these species produced pyocins at a range of 410 -670 g/ml. High yields of pyocins at 35 -37 o C, which declined sharply at temperatures above 37 o C were obtained from all the producing strains. The strains also displayed significant pyocin expression (P &lt; 0.05) under UV irradiation. Pyocins from a total of 25 producing strains; P. aeruginosa (14/27), P. putida (4/9), P. fluorescens (7/13) were inhibitory to the growth of P. putida indicator strain with four strains: PA02, PA20, PP03 and PF01 producing inhibition zone diameter &gt;3 mm. These pyocins also displayed growth inhibitory activity against some Nigerian isolates of Gram-positive and Gram-negative bacteria when undiluted and at 1:2 -1:16 dilutions. The susceptible organisms include Bacillus cereus, Listeria monocytogenes, Klebsiella spp., Staphylococcus aureus, S. epidermidis, Proteus spp. and Vibrio parahaemolyticus. The results of this study have provided evidence for broadspectrum antibacterial activity of pyocins elicited by Pseudomonas species from Nigeria

In-vitro Assessment of Brands of Ampicillin Sold in Nigerian Markets

Objective: To determine the efficacy of ampicillin sold in Nigerian markets on bacterial pathogens and to ascertain their usefulness in the control of bacterial infections.Method: Five brands of ampicillin; Reichlin, Amcillin, Amikap, Neslin and Rajampi were tested for susceptibility using disc diffusion and broth dilution methods. Assay using Minimal Inhibitary Concentration (MIC) and Minimal bactericidal Concentration (MBC) were by two-fold dilution method.Concentrations 250&mu;g/ml and 100 &mu;g/ml served as stock.Results: Susceptibility were, Staphylococcus aureus (50%), Enterococcus faecalis(90%),E.coli (0%), Ps.aeruginosa (0%) and S.typhi (100%) . MIC (3-63)&mu;g/ml and MBC (8-125)&mu;g/ml were the range for all brands against S.aureus and E.faecalis, while Neslin and Rajampi were between (8-31)&mu;g/ml for Salmonella typhi. The MIC critical values were (4-63) &mu;g/ml at (30 to 40%) occurrence.Conclusion: This study has shown that ampicillin can be useful in the treatment of infections involving gram-positive organisms, in contrast to the illusion that it has no place in therapy, although S.aureusexpressed resistance to Neslin and Rajampi. Ps.aeruginosa and E.coli were 100% resistant therefore not useful for treatment of infections involving them. .The study provides the basis for continous monitoring of shelved antibiotics which may turn out to be useful, cost effective and indirectly conserve the tenacity of newer antibiotics

POSSIBLE IMPACT OF CO-INFECTIONS OF TUBERCULOSIS AND MALARIA ON THE CD4+ CELL COUNTS OF HIV PATIENTS IN NIGERIA

Background: This study focused on evaluating the possible impact of co-infections of tuberculosis and malaria on the CD4+ cell counts in HIV infected subjects. Methods: This is a cross sectional study. The subjects were drawn from three hospitals and a blood bank in LagosState. After due consent, blood samples were obtained from 69 subjects with single infections (HIV, TB, and Malaria), 34 subjects with multiple infections (HIV/Malaria, HIV/TB, Malaria/TB, HIV/TB/Malaria) and 24 blood donors (controls). The CD4+ cell counts of all the 127 blood samples were estimated using a FACS count. Results: Data obtained were analysed and a comparison of the results showed that the median CD4+ counts in all groups of subjects with HIV infections (whether single or co-infection) were similar and significantly lower than the median counts for the healthy control group as well as groups without HIV infection (malaria, TB and malaria/TB). Conclusion: Overall data further confirmed the progressive depletion of CD4+ cells in HIV infection while co-infections with TB and malaria did not have any impact on the CD4+ cells of HIV infected subjects. A larger prospective study is needed