Simple tandem repeat (TTTA)(n )polymorphism in CYP19 (aromatase) gene and breast cancer risk in Nigerian women

BACKGROUND: Breast cancer is the most common cancer and the leading cause of cancer related deaths in women worldwide. The incidence of the disease is increasing globally and this increase is occurring at a faster rate in population groups that hirtherto enjoyed low incidence. This study was designed to evaluate the role of a simple tandem repeat polymorphism (STRP) in the aromatase (CYP19) gene in breast cancer susceptibility in Nigerian women, a population of indigenous sub-Saharan African ancestry. METHODS: A case-control study recruiting 250 women with breast cancer and 250 women without the disease from four University Teaching Hospitals in Southern Nigeria was carried out between September 2002 and April 2004. Participants were recruited from the surgical outpatient clinics and surgical wards of the Nigerian institutions. A polymerase chain reaction (PCR)-based assay was employed for genotyping and product sizes were detected with an ABI 3730 DNA Analyzer. RESULTS: Conditional logistic regression analysis revealed that harboring the putative high risk genotypes conferred a 29% increased risk of breast cancer when all women in the study were considered (Odds ratio [OR] = 1.29, 95% confidence interval [CI] 0.83–2.00), although this association was not statistically significant. Subgroup analysis based on menopausal status showed similar results among premenopausal women (OR = 1.35, 95% CI 0.76–2.41 and postmenopausal women (OR = 1.27, 95% CI 0.64–2.49). The data also demonstrated marked differences in the distribution of (TTTA)(n )repeats in Nigerian women compared with other populations. CONCLUSION: This study has shown that harboring 10 or more repeats of the microsatellite (TTTA)(n )repeats of the CYY19 gene is associated with a modest increased risk of breast cancer in Nigerian women

Reshaping maternal services in Nigeria: any need for spiritual care?

BACKGROUND:High maternal and perinatal mortalities occur from deliveries conducted in prayer houses in Nigeria. Although some regulatory efforts have been deployed to tackle this problem, less attention has been placed on the possible motivation for seeking prayer house intervention which could be hinged on the spiritual belief of patients about pregnancy and childbirth. This study therefore seeks to determine the perception of booked antenatal patients on spiritual care during pregnancy and their desire for such within hospital setting.METHOD:A total of 397 antenatal attendees from two tertiary health institutions in southwest Nigeria were sampled. A pretested questionnaire was used to obtain information on socio-demographic features of respondents, perception of spiritual care during pregnancy and childbirth; and how they desire that their spiritual needs are addressed. Responses were subsequently collated and analyzed.RESULTS:Most of the women, 301 (75.8%), believe there is a need for spiritual help during pregnancy and childbirth. About half (48.5%) were currently seeking for help in prayer/mission houses while another 8.6% still intended to. Overwhelmingly, 281 (70.8%) felt it was needful for health professionals to consider their spiritual needs. Most respondents, 257 (64.7%), desired that their clergy is allowed to pray with them while in labour and sees such collaboration as incentive that will improve hospital patronage. There was association between high family income and desire for collaboration of healthcare providers with one's clergy (OR 1.82; CI 1.03-3.21; p?=?0.04).CONCLUSION:Our women desire spiritual care during pregnancy and childbirth. Its incorporation into maternal health services will improve hospital delivery rates

Maintainability through recruitment in manpower system of changing size

No Abstract

Cervical Spine Injury: A ten‑year multicenter analysis of evolution of care and risk factors for poor outcome in southeast Nigeria

Study Design: Retrospective study.Objective: To describe the evolution of care and risk factors for poor outcome in patients with cervical spine injury (CSI) treated at three centers in southeast Nigeria.Setting: Nigeria, southeast.Materials and Methods: A 10‑year retrospective multicenter analysis of patients with CSI, managed at three centers in southeast Nigeria, from January 2003 to December 2012.Results: Two hundred and seven patients (55%) had CSI out of 377 spinal injury cases in the three study centers, but 195 cases had complete records and were studied. There were 148 males and 47 females. The age range was 3-74 years with a mean of 32.6 (±1.9) years 95% CI. Most injuries (149 cases) resulted from motor vehicular accidents (MVA). The C5 spinal level was involved in 75 (38%) cases One hundred and seventeen patients (60%) presented with American Spinal Injury Association A (ASIA A) injury. CSI care evolved from the application of a Minerva jacket or cervical traction only to cervical traction and spinal fusion resulting in a reduction in hospital stay (F = 52.5, DF (2, 3) P < 0.05). When compared to 51 patients with incomplete injuries, who improved in neurologic al status at discharge, only three patients with ASIA grade A experienced some improvement. The mortality rate from our series is 16% (32 patients). Those who died were more likely to have a complete injury (25 patients) or a high cervical injury (X2 = 61.2, P < 0.05) among other factors.Conclusion: The cervical spine is the most commonly injured spinal segment in southeastNigeria. Although treatment evolution has resulted in reduction of hospital stay, the associated mortality risk still remains high.Key words: Cervical spine injury, pattern, southeast Nigeria, treatment outcom

Intensive Care Unit Admissions in Federal Medical Centre Umuahia South East Nigeria

Background: The Federal Medical Centre Umuahia(FMCU) is a tertiary referral centre in Abia state, southeast Nigeria serving a catchment area made of Abia state and environs . An intensive care unit(ICU) was established in the hospital in December 2009 to improve healthcare delivery to critically ill patients. Objective: To determine the admission patterns and report the initial experience in the intensive care of patients in the FMCU. Methods: This is a retrospective study of the patients admitted into the ICU of FMCU from December 2009 to March 2011.Data retrieved from the patients ICU records included demographics, indication for admission, length of stay in ICU, and outcome of stay. The cost of ICU care was extracted from the financial records of the patient following discharge or demise. Data acquisition and analysis was performed using the statistical package for social sciences(SPSS) version 15. Results: A total of 87 patients were studied consisting of 59 males and 28 females. The ages ranged from 2days to 87years with a mean age of 41±2.34 years. There were 11 patients within the pediatric age range(12.6%). Post-operative surgical patients(51) accounted for the majority of the admissions (58.6%).There were also 21 non-operated trauma cases(24.1%), 7 medical cases (8.1%), 8 obstetrics and gynecological cases(9.2%). Post-operative admissions were mainly emergencies --39 cases(76.5%) cases while 12(23.5%) were elective. Most post-operative ICU admissions followed abdominal surgery -31 cases(58.8%) while neurological trauma accounted for most non-operated trauma 17cases (81%).The cost of stay per patient ranged from N2745.65 to N238123.4 ($82.23 to$1536.28) with an average cost per day of N19506.75($125.85). The cost per day for mortality cases was N28598.74($184.51) . The modal length of ICU stay was 2days with a mean of 3.63±0.34days and a range of one to sixteen days. About 68.4% of the patients spent =3days(38.3% of total ICU days),while 31.6% spent >3days(61.7% of total ICU days).Of the 87 patients,57 (65.5%)were discharged from ICU to the wards,28(32.2%) died in ICU while 2(2.3%) were referred to bigger centers. Twelve mortalities(42.8%) were among the emergency postoperative patients and 10(35.8%) non-operated trauma patients(80% of which are neurological trauma). Conclusion: From our study, most ICU admissions come from the operating theatre. The mortality is high and is comparable to other studies in Africa. The cost of stay is very high when compared with annual per capita income in Nigeria of $1190. Keywords: Intensive care unit, admissions, outcom

Do consumers' preferences for improved provision of malaria treatment services differ by their socio-economic status and geographic location? A study in southeast Nigeria.

BACKGROUND: Improvement of utilization of malaria treatment services will depend on provision of treatment services that different population groups of consumers prefer and would want to use. Treatment of malaria in Nigeria is still problematic and this contributes to worsening burden of the disease in the country. Therefore this study explores the socio-economic and geographic differences in consumers' preferences for improved treatment of malaria in Southeast Nigeria and how the results can be used to improve the deployment of malaria treatment services. METHODS: This study was undertaken in Anambra state, Southeast Nigeria in three rural and three urban areas. A total of 2,250 randomly selected householders were interviewed using a pre tested interviewer administered questionnaire. Preferences were elicited using both a rating scale and ranking of different treatment provision sources by the respondents. A socio-economic status (SES) index was used to examine for SES differences, whilst urban-rural comparison was used to examine for geographic differences, in preferences. RESULTS: The most preferred source of provision of malaria treatment services was public hospitals (30.5%), training of mothers (19%) and treatment in Primary healthcare centres (18.1%). Traditional healers (4.8%) and patent medicine dealers (4.2%) were the least preferred strategies for improving malaria treatment. Some of the preferences differed by SES and by a lesser extent, the geographic location of the respondents. CONCLUSION: Preferences for provision of improved malaria treatment services were influenced by SES and by geographic location. There should be re-invigoration of public facilities for appropriate diagnosis and treatment of malaria, in addition to improving the financial and geographic accessibility of such facilities. Training of mothers should be encouraged but home management will not work if the quality of services of patent medicine dealers and pharmacy shops where drugs for home management are purchased are not improved. Therefore, there is the need for a holistic improvement of malaria treatment services

Validation of Siriraj Stroke Score in southeast Nigeria

Innocent Ijezie Chukwuonye,1 Kenneth Arinze Ohagwu,2 Enoch Ogbonnaya Uche,3,4 Abali Chuku,5 Rowland Ihezuo Nwanke,2 Christopher Chukwuemeka Ohagwu,6 Ignatius U Ezeani,7 Collins Ogbonna Nwabuko,8 Martin Anazodo Nnoli,9 Efosa Oviasu,4,10 Okechukwu Samuel Ogah4,11 1Division of Nephrology, 2Division of Neurology, Department of Internal Medicine, Federal Medical Centre, Umuahia, Nigeria; 3Division of Neurosurgery, Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria; 4Federal Medical Centre, Umuahia, Nigeria; 5Department of Ophthalmology, Federal Medical Centre, Umuahia, Nigeria; 6Department of Radiography, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria; 7Division of Endocrinology, Department of Internal Medicine, Federal Medical Centre, Umuahia, Nigeria; 8Department of Hematology, Federal Medical Centre, Umuahia, Nigeria; 9Department of Anatomical Pathology, University of Calabar, Calabar, Nigeria; 10Division of Nephrology, Department of Internal Medicine, University of Benin Teaching Hospital, Benin City, Nigeria; 11Division of Cardiology, University College Hospital Ibadan, Ibadan, Nigeria Abstract: The aim of the study is to validate the use of Siriraj Stroke Score (SSS) in the diagnosis of acute hemorrhagic and acute ischemic stroke in southeast Nigeria. This was a prospective study on validity of SSS in the diagnosis of stroke types in southeast Nigeria. Subjects diagnosed with stroke for whom brain computerized tomography (CT) scan was performed on admission were recruited during the study period. SSS was calculated for each subject, and the SSS diagnosis was compared with brain CT scan-based diagnosis. A total of 2,307 patients were admitted in the hospital medical wards during the study period, of whom 360 (15.6%) were stroke patients and of these, 113 (31.4%) adult subjects met the inclusion criteria. The mean age of the subjects was 66.5±2.6 years. The mean interval between ictus and presentation was 2.5±0.4 days. Ischemic stroke was confirmed by CT in 74 subjects; however, SSS predicted 60 (81.1%) of these subjects correctly (P<0.05). Hemorrhagic stroke was confirmed by CT in 39 subjects, and SSS predicted 36 (92.3%) of them correctly (P<0.05). In acute ischemic stroke, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of SSS were 92%, 94%, 97%, 86%, and 93%, respectively, while in patients with hemorrhagic stroke, the corresponding percentages were 94%, 92%, 86%, 97%, and 93%, respectively. SSS is not reliable enough to clinically differentiate stroke types in southeast Nigeria to warrant interventions like thrombolysis in acute ischemic stroke. Keywords: stroke, Siriraj Stroke Score (SSS), hemorrhagic stroke, acute ischemic stroke, CT sca

Anaemia in pregnancy: associations with parity, abortions and child spacing in primary healthcare clinic attendees in Trinidad and Tobago

Objective: To determine the prevalence of anaemia in antenatal clinic attendees; to investigate the effects of parity, age, gravidity, previous abortions, child spacing and other factors on the prevalence of anaemia in pregnancy. Methods: This was a retrospective and cross-sectional study. Antenatal records of 2287 pregnant women attending 40 public healthcare centres from January 2000 to December 2005 in Trinidad and Tobago were used. Data pertaining to the investigated variables were recorded. The national prevalence of anaemia was calculated and chi-square tests, odds ratios and logistic regression were used to assess the relationship between anaemia and each variable. Results: The prevalence of anaemia was 15.3% (95% CI 13.4%, 16.6%). No significant difference in the prevalence of anaemia was found among the different clinics or counties. At the first haemoglobin reading, age was inversely related to the presence of anaemia, whereas gestational age at first visit was directly related. At the final haemoglobin reading, parity, gravidity, and previous spontaneous abortions were directly related to the prevalence of anaemia, while the number of visits was inversely related. Age was inversely associated to the severity of anaemia while gravidity was directly related. Conclusion: The prevalence of anaemia decreased by 18.7% from 1967. Despite this positive indication, women under 24 years and those commencing antenatal care after the first trimester are still at a higher risk for developing anaemia. Early commencement of antenatal care and close monitoring of the risk groups identified should be strongly advocated